Reduction of olfactory and respiratory turbinates in the transition of whales from land to sea: the semiaquatic middle Eocene Aegyptocetus tarfa

Ethmoturbinates, nasoturbinates, and maxilloturbinates are well developed in the narial tract of land‐dwelling artiodactyls ancestral to whales, but these are greatly reduced or lost entirely in modern whales. Aegyptocetus tarfa is a semiaquatic protocetid from the middle Eocene of Egypt. Computed axial tomography scans of the skull show that A. tarfa retained all three sets of turbinates like a land mammal. It is intermediate between terrestrial artiodactyls and aquatic whales in reduction of the turbinates. Ethmoturbinates in A. tarfa have 26% of the surface area expected for an artiodactyl. These have an olfactory function and indicate that early whales retained a sense of smell in the transition from land to sea. Maxilloturbinates in A. tarfa have 6% of the surface area expected for an artiodactyl. These have a respiratory function and their markedly reduced size suggests that rapid inhalation and exhalation was already more important than warming and humidifying air, in contrast to extant land mammals. Finally, the maxilloturbinates of A. tarfa, although greatly reduced, still show some degree of similarity to those of artiodactyls, supporting the phylogenetic affinity of cetaceans and artiodactyls based on morphological and molecular evidence.The computed axial tomography scans of the skull of Aegyptocetus tarfa, a semiaquatic archaeoceti from the middle Eocene of Egypt, show that this whale retained all three sets of turbinates like a land mammal. Ethmoturbinates (olfactory function) in A. tarfa have 26% of the surface area expected for an artiodactyl, indicating that early whales retained a sense of smell in the transition from land to sea. Maxilloturbinates (respiratory function) in A. tarfa have 6% of the surface area expected for an artiodactyl, suggesting that rapid inhalation and exhalation was already more important than warming and humidifying air, in contrast to extant land mammals.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/152501/1/joa13088_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/152501/2/joa13088.pd

Comparative structural analysis of polyurethane and silicone catheters of totally implantable venous access devices by micro-computed tomography

Objectives: To investigate microstructural alterations of explanted long-term central venous catheters of totally implantable venous access devices, using micro-computed tomography. Methods: A total of 16 catheters (9 made of silicone and 7 made of polyurethane), all non-fractured, have been analyzed in this study. Eight catheters were implanted for an average duration of 994 days (min-max: 98-2731 days), while the remaining eight catheters (four for each material, forming the SIref and PUref control groups) were analyzed before implant and used as a reference. X-ray micro-computed tomography was used to reconstruct the three-dimensional geometry of selected segments of each catheter (ca. 10 cm per sample). Results: Morphometric analysis of the catheters revealed increases wall thickness and section area in the polyurethane group as compared with the reference central venous catheters of the same materials (wall thickness: 403 ± 12 μm in the polyurethane (PU) group vs 382 ± 4 μm in PUref, p = 0.014; wall cross-section area: 2.04 ± 0.09 mm2 in PU vs 1.91 ± 0.03 mm2 in PUref, p = 0.04), whereas implanted silicone catheters showed a larger luminal cross section as compared with their controls (lumen cross-section area = 0.851 ± 0.020 mm2 in silicone (SI) group vs 0.811 ± 0.007 mm2 in SIref, p = 0.007). All analyzed samples in this study presented some type of alteration in the catheter walls, namely, hyperdense spots (below 0.1 mm size), air gaps/bubbles and displacements of inner and outer axes causing heterogeneous wall thickness. The incidence of air gaps showed no difference with respect to both material type and duration of implant, whereas the SI group revealed more hyperdense spots as compared to all other groups. Conclusion: Morphological change and local structural alteration can occur in both silicone and polyurethane catheters. This evidence suggests the need for further studies connecting those morphological changes with modification of mechanical robustness, which ultimately can play a role for patient safety

A 13th-century cystic echinococcosis from the cemetery of the monastery of Badia Pozzeveri (Lucca, Italy)

Objective: To differentially diagnose a calcified formation recovered from a 13th century AD grave from the Tuscan monastery of Badia Pozzeveri, Lucca, Italy. Materials: A calcified formation from the thoraco-abdominal region of a skeleton buried in the monastery cemetery. Methods: Cone Beam Computed Tomography, Scanning Electron Microscope and Energy Dispersive X-Ray Spectroscopy. Results: A hollow, calcified ovoid formation was identified as typical of a hydatid cyst, permitting the diagnosis of cystic echinococcosis in a 35-45year-old female. Conclusions: The study reveals the circulation of the parasite Echinococcus granulosus in the region of Lucca in late medieval Tuscany. Significance: This finding is the fourth case of cystic echinococcosis from an archaeological context in Italy and provides insight into environmental conditions that appear to have affected members of a community, irrespective of social status. Limitations: Caution and the application of multiple analyses must be exercised in the differential diagnosis to discriminate among calcified formations. Suggestions for further research: Analysis of stable isotopes of the calcified formation, such as 15N and 13C, in order to compare them with isotopic values of the host individual and to further confirm the parasitic origin of the find

A first look into radiomics application in testicular imaging: A systematic review

The aim of this systematic review was to evaluate the state of the art of radiomics in testicular imaging by assessing the quality of radiomic workflow using the Radiomics Quality Score (RQS) and the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2). A systematic literature search was performed to find potentially relevant articles on the applications of radiomics in testicular imaging, and 6 final articles were extracted. The mean RQS was 11,33 ± 3,88 resulting in a percentage of 31,48% ± 10,78%. Regarding QUADAS-2 criteria, no relevant biases were found in the included papers in the patient selection, index test, reference standard criteria and flow-and-timing domain. In conclusion, despite the publication of promising studies, radiomic research on testicular imaging is in its very beginning and still hindered by methodological limitations, and the potential applications of radiomics for this field are still largely unexplored

Soft tissue tumor imaging in adults: European Society of Musculoskeletal Radiology-Guidelines 2023—overview, and primary local imaging: how and where?

Objectives: Early, accurate diagnosis is crucial for the prognosis of patients with soft tissue sarcomas. To this end, standardization of imaging algorithms, technical requirements, and reporting is therefore a prerequisite. Since the first European Society of Musculoskeletal Radiology (ESSR) consensus in 2015, technical achievements, further insights into specific entities, and the revised WHO-classification (2020) and AJCC staging system (2017) made an update necessary. The guidelines are intended to support radiologists in their decision-making and contribute to interdisciplinary tumor board discussions. Materials and methods: A validated Delphi method based on peer-reviewed literature was used to derive consensus among a panel of 46 specialized musculoskeletal radiologists from 12 European countries. Statements were scored online by level of agreement (0 to 10) during two iterative rounds. Either “group consensus,” “group agreement,” or “lack of agreement” was achieved. Results: Eight sections were defined that finally contained 145 statements with comments. Overall, group consensus was reached in 95.9%, and group agreement in 4.1%. This communication contains the first part consisting of the imaging algorithm for suspected soft tissue tumors, methods for local imaging, and the role of tumor centers. Conclusion: Ultrasound represents the initial triage imaging modality for accessible and small tumors. MRI is the modality of choice for the characterization and local staging of most soft tissue tumors. CT is indicated in special situations. In suspicious or likely malignant tumors, a specialist tumor center should be contacted for referral or teleradiologic second opinion. This should be done before performing a biopsy, without exception. Clinical relevance: The updated ESSR soft tissue tumor imaging guidelines aim to provide best practice expert consensus for standardized imaging, to support radiologists in their decision-making, and to improve examination comparability both in individual patients and in future studies on individualized strategies. Key Points: • Ultrasound remains the best initial triage imaging modality for accessible and small suspected soft tissue tumors. • MRI is the modality of choice for the characterization and local staging of soft tissue tumors in most cases; CT is indicated in special situations. Suspicious or likely malignant tumors should undergo biopsy. • In patients with large, indeterminate or suspicious tumors, a tumor reference center should be contacted for referral or teleradiologic second opinion; this must be done before a biopsy

Soft tissue tumor imaging in adults: whole-body staging in sarcoma, non-malignant entities requiring special algorithms, pitfalls and special imaging aspects. Guidelines 2024 from the European Society of Musculoskeletal Radiology (ESSR)

ObjectivesThe revised European Society of Musculoskeletal Radiology (ESSR) consensus guidelines on soft tissue tumor imaging represent an update of 2015 after technical advancements, further insights into specific entities, and revised World Health Organization (2020) and AJCC (2017) classifications. This second of three papers covers algorithms once histology is confirmed: (1) standardized whole-body staging, (2) special algorithms for non-malignant entities, and (3) multiplicity, genetic tumor syndromes, and pitfalls.Materials and methodsA validated Delphi method based on peer-reviewed literature was used to derive consensus among a panel of 46 specialized musculoskeletal radiologists from 12 European countries. Statements that had undergone interdisciplinary revision were scored online by the level of agreement (0 to 10) during two iterative rounds, that could result in 'group consensus', 'group agreement', or 'lack of agreement'.ResultsThe three sections contain 24 statements with comments. Group consensus was reached in 95.8% and group agreement in 4.2%. For whole-body staging, pulmonary MDCT should be performed in all high-grade sarcomas. Whole-body MRI is preferred for staging bone metastasis, with [18F]FDG-PET/CT as an alternative modality in PET-avid tumors. Patients with alveolar soft part sarcoma, clear cell sarcoma, and angiosarcoma should be screened for brain metastases. Special algorithms are recommended for entities such as rhabdomyosarcoma, extraskeletal Ewing sarcoma, myxoid liposarcoma, and neurofibromatosis type 1 associated malignant peripheral nerve sheath tumors. Satisfaction of search should be avoided in potential multiplicity.ConclusionStandardized whole-body staging includes pulmonary MDCT in all high-grade sarcomas; entity-dependent modifications and specific algorithms are recommended for sarcomas and non-malignant soft tissue tumors.Clinical relevance statementThese updated ESSR soft tissue tumor imaging guidelines aim to provide support in decision-making, helping to avoid common pitfalls, by providing general and entity-specific algorithms, techniques, and reporting recommendations for whole-body staging in sarcoma and non-malignant soft tissue tumors.Key Points..

Clinical indications for image-guided interventional procedures in the musculoskeletal system: a Delphi-based consensus paper from the European Society of Musculoskeletal Radiology (ESSR)-part VII, nerves of the lower limb.

Funder: Università degli Studi di MilanoOBJECTIVES: To perform a Delphi-based consensus on published evidence on image-guided interventional procedures for peripheral nerves of the lower limb (excluding Morton's neuroma) and provide clinical indications. METHODS: We report the results of a Delphi-based consensus of 53 experts from the European Society of Musculoskeletal Radiology who reviewed the published literature for evidence on image-guided interventional procedures offered around peripheral nerves in the lower limb (excluding Morton's neuroma) to derive their clinical indications. Experts drafted a list of statements and graded them according to the Oxford Centre for evidence-based medicine levels of evidence. Consensus was considered strong when > 95% of experts agreed with the statement or broad when > 80% but < 95% agreed. The results of the Delphi-based consensus were used to write the paper. RESULTS: Nine statements on image-guided interventional procedures for peripheral nerves of the lower limb have been drafted. All of them received strong consensus. Image-guided pudendal nerve block is safe, effective, and well tolerated with few complications. US-guided perisciatic injection of anesthetic provides good symptom relief in patients with piriformis syndrome; however, the addition of corticosteroids to local anesthetics still has an unclear role. US-guided lateral femoral cutaneous nerve block can be used to provide effective post-operative regional analgesia. CONCLUSION: Despite the promising results reported by published papers on image-guided interventional procedures for peripheral nerves of the lower limb, there is still a lack of evidence on the efficacy of most procedures. KEY POINTS: • Image-guided pudendal nerve block is safe, effective, and well tolerated with few complications. • US-guided perisciatic injection of anesthetic provides good symptom relief in patients with piriformis syndrome; however, the addition of corticosteroids to local anesthetics still has an unclear role. • US-guided lateral femoral cutaneous nerve block can be used to provide effective post-operative regional analgesia. The volume of local anesthetic affects the size of the blocked sensory area

Soft tissue tumor imaging in adults: European Society of Musculoskeletal Radiology-Guidelines 2023-overview, and primary local imaging: how and where?

OBJECTIVES: Early, accurate diagnosis is crucial for the prognosis of patients with soft tissue sarcomas. To this end, standardization of imaging algorithms, technical requirements, and reporting is therefore a prerequisite. Since the first European Society of Musculoskeletal Radiology (ESSR) consensus in 2015, technical achievements, further insights into specific entities, and the revised WHO-classification (2020) and AJCC staging system (2017) made an update necessary. The guidelines are intended to support radiologists in their decision-making and contribute to interdisciplinary tumor board discussions. MATERIALS AND METHODS: A validated Delphi method based on peer-reviewed literature was used to derive consensus among a panel of 46 specialized musculoskeletal radiologists from 12 European countries. Statements were scored online by level of agreement (0 to 10) during two iterative rounds. Either "group consensus," "group agreement," or "lack of agreement" was achieved. RESULTS: Eight sections were defined that finally contained 145 statements with comments. Overall, group consensus was reached in 95.9%, and group agreement in 4.1%. This communication contains the first part consisting of the imaging algorithm for suspected soft tissue tumors, methods for local imaging, and the role of tumor centers. CONCLUSION: Ultrasound represents the initial triage imaging modality for accessible and small tumors. MRI is the modality of choice for the characterization and local staging of most soft tissue tumors. CT is indicated in special situations. In suspicious or likely malignant tumors, a specialist tumor center should be contacted for referral or teleradiologic second opinion. This should be done before performing a biopsy, without exception. CLINICAL RELEVANCE: The updated ESSR soft tissue tumor imaging guidelines aim to provide best practice expert consensus for standardized imaging, to support radiologists in their decision-making, and to improve examination comparability both in individual patients and in future studies on individualized strategies. KEY POINTS: • Ultrasound remains the best initial triage imaging modality for accessible and small suspected soft tissue tumors. • MRI is the modality of choice for the characterization and local staging of soft tissue tumors in most cases; CT is indicated in special situations. Suspicious or likely malignant tumors should undergo biopsy. • In patients with large, indeterminate or suspicious tumors, a tumor reference center should be contacted for referral or teleradiologic second opinion; this must be done before a biopsy

The Added Value of Diffusion Weighted Imaging (DWI) in Magnetic Resonance Imaging (MRI) of Uterine Cervical Cancer

Purpose The aims of this study are to evaluate the behaviour of the metabolic and functional parameters in cervix uteri cancer, meant as DWI/ADC, to estimate the role of DWI and ADC values in diagnosis and follow-up of the cervix uteri cancer and to assess the possible additional contribution of DWI in this clinical setting. Materials and Methods From July 2012 to April 2017, we retrospectively selected 36 patients with clinical suspicion of cervix uteri cancer who underwent pelvic MRI for regional staging on 3.0T- MR scanner. We divided the population into 2 groups: group A composed of 17 patients (median age 48; range 29-81 years) who underwent first staging MRI and then went directly to surgical intervention, group (B) includes 19 patients (median age 50; range 36- 70 years) who underwent pelvic MRI before (staging MRI) and after neoadjuvant chemotherapy (NAChT). All the patients underwent 3.0T-MR scan with conventional pelvic study protocol with additional specific DWI sequences. ADC maps and specific lesions’ ADC (whole lesion and lowest ADC values) were obtained from the elaboration of the DW images. In both groups, the ADC values were compared with the histological grading; in addition in group B, ADC values before and after NAChT were analysed. Results In group A, 12 squamous cell carcinomas, 3 adenocarcinomas, 1 clear cell adenocarcinoma, and 1 negative for neoplasm (according to MRI report) were included. In group B, the following histological diagnosis were present: 9 squamous cell carcinomas, 3 adenocarcinomas and 1 neuroendocrine cancer; 6 patients did not undergo surgical intervention, so the confirm of malignancy was based on biopsy. First we analysed the performance of MRI, meant as best detection of the lesion, comparing DW and T2w images. Respectively in group A and B, the lesions were better depicted in DWI than in T2w images in 10 and 13 patients, while in 6 and 4 patients the two sequences were highly corresponding; in 1 and 2 patients the lesions were better depicted on T2w images. No significant correlation between ADC values and histological grading was found neither in group A nor in group B. In group A, the mean whole ADC and lowest ADC values was respectively 0.00088 s/mm2 and 0.00071 s/mm2. In group B, the mean baseline whole ADC and lowest ADC values was respectively 0.00086 s/mm2 and 0.00068 s/mm2. Regarding the post-ChT ADC value in group B, we obtained 0.00100 s/mm2 and 0.00084 s/mm2 respectively for whole ADC and lowest ADC mean values. In group B, the results show that there is no statistically significant difference between baseline and post-ChT whole ADC values but the p-value obtained (p=0.0583) is really close to the alpha level of 0.05 indicating a trend. The presence of statistically significant difference was found between baseline and post-ChT lowest ADC values (p=0,0370), but the non-parametric approach used is definitely less robust and more prone to the case for so small samples. Conclusions The addition of DWI to T2W sequences considerably improved the diagnostic ability of MRI. Our results support the inclusion of DWI in the MRI protocol for the detection, staging and follow-up of cervix uteri cancer. No correlation between ADC and histological grading was found. A statistically significant difference was found only between baseline and post-ChT lowest ADC values, while for whole ADC values it is suggested only a trend. Probably with a higher sample size a difference would be detected