OBJECTIVE: Epilepsy surgery in the operculoinsular cortex is challenging due to the difficult delineation of the epileptogenic zone and the high risk of postoperative deficits. METHODS: Pre- and postsurgical data from 30 pediatric patients who underwent operculoinsular cortex surgery at the Motol Epilepsy Center Prague from 2010 to 2022 were analyzed. RESULTS: Focal cortical dysplasia (FCD; n = 15, 50%) was the predominant cause of epilepsy, followed by epilepsy-associated tumors (n = 5, 17%) and tuberous sclerosis complex (n = 2, 7%). In eight patients where FCD was the most likely etiology, the histology was negative. Seven patients (23%) displayed normal magnetic resonance imaging results. Seizures exhibited diverse semiology and propagation patterns (frontal, perisylvian, and temporal). The ictal and interictal electroencephalographic (EEG) findings were mostly extensive. Multimodal imaging and advanced postprocessing were frequently used. Stereo-EEG was used for localizing the epileptogenic zone and eloquent cortex in 23 patients (77%). Oblique electrodes were used as guides for better neurosurgeon orientation. The epileptogenic zone was in the dominant hemisphere in 16 patients. At the 2-year follow-up, 22 patients (73%) were completely seizure-free, and eight (27%) experienced a seizure frequency reduction of >50% (International League Against Epilepsy class 3 and 4). Fourteen patients (47%) underwent antiseizure medication tapering; treatment was completely withdrawn in two (7%). Nineteen patients (63%) remained seizure-free following the definitive outcome assessment (median = 6 years 5 months, range = 2 years to 13 years 5 months postsurgery). Six patients (20%) experienced corona radiata or basal ganglia ischemia; four (13%) improved to mild and one (3%) to moderate hemiparesis. Two patients (7%) operated on in the anterior insula along with frontotemporal resection experienced major complications: pontine ischemia and postoperative brain edema. SIGNIFICANCE: Epilepsy surgery in the operculoinsular cortex can lead to excellent patient outcomes. A comprehensive diagnostic approach is crucial for surgical success. Rehabilitation brings a great chance for significant recovery of postoperative deficits.

• MeSH
• dítě MeSH
• elektroencefalografie * MeSH
• epilepsie chirurgie   diagnostické zobrazování   MeSH
• kohortové studie MeSH
• kojenec MeSH
• lidé MeSH
• magnetická rezonanční tomografie MeSH
• malformace mozkové kůry chirurgie   komplikace   diagnostické zobrazování   MeSH
• mladiství MeSH
• mozková kůra diagnostické zobrazování   chirurgie   MeSH
• neurochirurgické výkony metody   MeSH
• předškolní dítě MeSH
• retrospektivní studie MeSH
• výsledek terapie MeSH
• Check Tag
• dítě MeSH
• kojenec MeSH
• lidé MeSH
• mladiství MeSH
• mužské pohlaví MeSH
• předškolní dítě MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

Objective: To report a case of mitochondrial retinopathy, highlighting its clinical and imaging findings, the importance of genetic confirmation, and the possible implications of heteroplasmy in this disease. Material and Methods: Case report of a mitochondrial retinopathy secondary to m.3243A>G mutation in the MT-TL1 gene. Results: A 32-year-old woman presented with bilateral vision loss, photophobia, and sensorineural hearing loss for more than 3 years. Best corrected visual acuity (BCVA) was 20/60 in the right eye (OD) and 20/25 in the left eye (OS). Fundus examination revealed multiple macular subretinal yellow-white deposits and central chorioretinal atrophy, without edema, hemorrhage, or subretinal fluid in the RE, and juxtafoveal atrophy with retinal pigment epithelium (RPE) metaplasia in the OS. Multimodal imaging raised suspicion of retinal dystrophy, and genetic testing confirmed a mitochondrial retinopathy secondary to the m.3243A>G mutation in the MT-TL1 gene. Conclusions: Bilateral and symmetric RPE atrophic changes in young individuals, especially when associated with systemic symptoms, should prompt a comprehensive evaluation, including multimodal imaging and genetic testing. Identifying causative mutations and understanding the dynamics of mitochondrial DNA in the pathogenesis of these diseases is crucial for improving diagnosis and suggesting potential therapeutic strategies, including gene therapy.

• MeSH
• dospělí MeSH
• heteroplazmie MeSH
• lidé MeSH
• mitochondriální DNA genetika   MeSH
• mitochondriální nemoci * diagnóza   genetika   MeSH
• mutace MeSH
• nemoci retiny * diagnóza   genetika   MeSH
• RNA transferová Leu genetika   MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• kazuistiky MeSH

Rhabdomyosarcoma is a highly malignant mesenchymal tumor growing out of the primitive mesenchyme, which is (usually) differentiated into predominantly striated skeletal muscle. It is the most common soft tissue sarcoma in childhood, with a predilection site that occurs in the head and neck area. Multimodal approaches in treatment include surgery, chemotherapy, and radiotherapy. We present a case of a 6-year- old girl with a history of nasal obstruction and mucus secretion more on the left side, with loss of smell and headache above the left eye. Through clinical examination, a pink tumor was detected in the left nasal cavity. CT and MRI were complemented and showed a tumor mass filling the entire nasopharynx, propagated into the left sphenoid cavity, to the clivus, and to the prevertebral space; the tumor mass completely obturated both choanae. The patient underwent endoscopic endonasal resection of the skull base tumor using CT navigation. Embryonal rhabdomyosarcoma has been confirmed. In the postoperative period, the patient underwent adjuvant oncology treatment, and control biopsies at 2 and 16 months after surgery were negative. The patient is now three years after surgery - clinically free of signs of tumor recurrence. Conclusion: Rhabdomyosarcoma, like other tumors in the skull base region, is a challenge for the surgeon due to the location in which complete resection of the tumor is sometimes very difficult or impossible. Meticulous preoperative analysis of imaging examinations, as well as intraoperative use of CT/MRI navigation, make this possible. Complete removal of the tumor increases the patient‘s chance for successful treatmet.

Rhabdomyosarkóm je vysoko malígny mezenchymálny nádor, ktorý vyrastá z primitívneho mezenchýmu, ktorý sa normálne diferencuje prevažne na priečne pruhované kostrové svalstvo. Ide o najčastejší mäkkotkanivový sarkóm v detskom veku s preferovaným výskytom v oblasti hlavy a krku. Multimodálny prístup v liečbe zahŕňa chirurgiu, chemoterapiu a rádioterapiu. Predstavujeme prípad 6-ročného dievčaťa s anamnézou nosovej obštrukcie a hlienovej sekrécie viac na ľavej strane, so stratou čuchu a bolesťou hlavy nad ľavým okom. Pri klinickom vyšetrení bol zistený ružový nádor v ľavej nosovej dutine. Doplnené boli CT a MR vyšetrenia, ktoré ukázali nádorovú masu vypĺňajúcu celý nosohltan, s expanziou do ľavej klinovej dutiny, ku klivu a do prevertebrálneho priestoru. Nádorová masa kompletne uzatvárala obe choány. Pacientka podstúpila endoskopickú endonazálnu resekciu nádoru v oblasti prednej bázy lebky s využitím CT navigácie. Bol potvrdený embryonálny rhabdomyosarkóm. V pooperačnom období pacientka podstúpila adjuvantnú onkologickú liečbu, kontrolné bio psie 2 a 16 mesiacov po operácii boli negatívne. Pacientka je momentálne 3 roky po operácii – klinicky bez známok recidívy nádoru. Záver: Rhabdomyosarkóm, podobne ako iné nádory v oblasti prednej bázy lebky, predstavuje výzvu pre chirurga vzhľadom na lokalizáciu, v ktorej je úplná resekcia nádoru niekedy veľmi náročná alebo nemožná. Dôkladná predoperačná analýza zobrazovacích vyšetrení ako aj intraoperačné využitie CT/MR navigácie to umožňujú. Kompletné odstránenie nádoru zvyšuje šancu pacienta na úspešnú liečbu.

• MeSH
• dítě MeSH
• embryonální rhabdomyosarkom * chirurgie   diagnostické zobrazování   diagnóza   farmakoterapie   MeSH
• endoskopie metody   MeSH
• lidé MeSH
• nádory hlavy a krku diagnostické zobrazování   diagnóza   klasifikace   MeSH
• nosní obstrukce etiologie   MeSH
• rhabdomyosarkom chirurgie   diagnostické zobrazování   diagnóza   farmakoterapie   MeSH
• zadní jáma lební * chirurgie   patologie   MeSH
• Check Tag
• dítě MeSH
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• kazuistiky MeSH

IMPORTANCE: High-resolution microultrasonography-guided biopsy is an alternative to MRI fusion-guided biopsy for prostate cancer diagnosis. OBJECTIVE: To compare microultrasonography-guided and MRI fusion-guided biopsy. DESIGN, SETTING, AND PARTICIPANTS: A multicenter, international, open-label, randomized, noninferiority trial of biopsy-naive men from 20 centers (8 countries) with clinical suspicion of prostate cancer (elevated prostate-specific antigen [PSA] and/or abnormal digital rectal examination findings) from December 2021 to September 2024. INTERVENTIONS: Participants were assigned to receive either microultrasonography-guided biopsy (n = 121), microultrasonography/MRI fusion-guided biopsy (microultrasonography/MRI; n = 226, in which microultrasonography biopsies were performed prior to unblinding the MRI), or MRI/conventional US fusion-guided biopsy (MRI/conventional ultrasonography; n = 331). All participants received synchronous systematic biopsy. MAIN OUTCOMES AND MEASURES: The primary outcome was the difference in detection of Gleason Grade Group 2 or higher cancers using microultrasonography plus systematic biopsy vs MRI/conventional ultrasonography plus systematic biopsy. The secondary outcome was the difference in detection of Gleason Grade Group 2 or higher cancers found using microultrasonography/MRI plus systematic biopsy vs MRI/conventional ultrasonography plus systematic biopsy. The noninferiority margin was set at 10%. RESULTS: A total of 802 men underwent randomization and 678 underwent biopsy. Median (IQR) age was 65 (59-70) years and prostate-specific antigen level was 6.9 (5.2-9.8) ng/mL; 83% self-identified as White. Gleason Grade Group 2 or higher cancer was detected in 57 participants (47.1%) in the microultrasonography group, in 141 (42.6%) in the MRI/conventional ultrasonography group, and in 106 (46.9%) in the microultrasonography/MRI group. Microultrasonography-guided biopsy was noninferior to MRI fusion-guided biopsy (difference, 3.52% [95% CI, -3.95% to 10.92%]; noninferiority P < .001). Combined biopsy with microultrasonography/MRI was also noninferior to MRI/conventional ultrasonography software-assisted MRI fusion biopsy using conventional ultrasonography devices (difference, 4.29% [95% CI, -4.06% to 12.63%]; noninferiority P < .001). The rate of Gleason Grade Group 2 or higher cancer diagnosed by targeted biopsy only was 38.0% in the microultrasonography group, 34.1% in the MRI/conventional ultrasonography group, and 40.3% in the microultrasonography/MRI group; these differences were not significant. CONCLUSIONS AND RELEVANCE: The use of microultrasonography-guided biopsy was noninferior to MRI/conventional ultrasonography fusion-guided biopsy for the detection of Gleason Grade Group 2 or higher prostate cancer in biopsy-naive men. Microultrasonography may provide an alternative to MRI for image-guided prostate biopsy. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT05220501.

• MeSH
• intervenční ultrasonografie * metody   MeSH
• lidé středního věku MeSH
• lidé MeSH
• magnetická rezonance intervenční * MeSH
• multimodální zobrazování metody   MeSH
• nádory prostaty * krev   diagnóza   patologie   MeSH
• palpační vyšetření konečníku MeSH
• prostata * patologie   diagnostické zobrazování   MeSH
• prostatický specifický antigen krev   MeSH
• senioři MeSH
• stupeň nádoru MeSH
• ultrazvukem navigovaná biopsie * metody   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• Publikační typ
• časopisecké články MeSH
• hodnocení ekvivalence MeSH
• klinické zkoušky, fáze III MeSH
• multicentrická studie MeSH
• srovnávací studie MeSH

Tato kazuistika zdůrazňuje význam multimodálního přístupu, personalizovaných léčebných intervencí a nepříznivou prognózu infarktu myokardu bez významného postižení koronárních tepen (myocardial infarction with non-obstructive coronary arteries, MINOCA) u mladého pacienta s antifosfolipidovým syndromem (antiphospholipid syndrome, APS). Na oddělení urgentního příjmu byl přivezen 39letý muž s diagnózou infarktu myokardu s elevacemi úseku ST (STEMI) ve třídě III Killipovy klasifikace. Angiografické vyšetření neprokázalo přítomnost obstrukčního postižení epikardu koronárních tepen, což si vyžádalo další vyšetření srdce magnetickou rezonancí (MR). Toto vyšetření odhalilo jizvy po infarktu myokardu na řadě míst na tepnách a těžkou dysfunkci levé komory. U pacienta došlo k rozvoji srdečního selhání se sníženou ejekční frakcí, a proto mu byl subkutánně implantován kardioverter-defibrilátor.

This case report highlights the importance of a multimodal approach, tailored therapeutic interven- tions, and the poor prognosis of myocardial infarction with non-obstructive coronary arteries (MINOCA) in a young patient with antiphospholipid syndrome (APS). A 39-year-old man was admitted with a diagnosis of a ST elevation myocardial infarction (STEMI), in Killip class III. Angiography showed absence of obstructive epicardial coronary artery disease prompting further evaluation with cardiac magnetic resonance imaging (MRI). It revealed infarction scars in multiple arterial territories and severe left ventricular dysfunction. The patient evolved with heart failure with reduced ejection fraction and a subcutaneous implantable cardioverter-defibrillator was implanted.

Anderson-Fabry disease (AFD) is a rare genetic disease with X-linked transmission characterized by a defect in the enzyme alpha-galactosidase A, which impairs glycosphingolipid metabolism and leads to an excessive storage of globotriaosylceramide (Gb3) within lysosomes. AFD involves renal, cardiac, vascular, and nervous systems and is mainly observed in male patients with onset in childhood, although cardiac manifestation is often shown in adults. AFD cardiomyopathy is caused by the accumulation of Gb3 within myocytes first showed by left ventricular hypertrophy and diastolic dysfunction, leading to restrictive cardiomyopathy and systolic heart failure with biventricular involvement. The diagnosis of AFD cardiomyopathy may be insidious in the first stages and requires accurate differential diagnosis with other cardiomyopathies with hypertrophic phenotype. However, it is fundamental to promptly initiate specific therapies that have shown promising results, particularly for early treatment. A careful integration between clinical evaluation, genetic tests, and cardiac imaging is required to diagnose AFD with cardiac involvement. Basic and advanced echocardiography, cardiac magnetic resonance, and nuclear imaging may offer pivotal information for early diagnosis (Graphical Abstract), and the management of these patients is often limited to centres with high expertise in the field. This clinical consensus statement, developed by experts from the European Society of Cardiology (ESC) Working Group on Myocardial and Pericardial Diseases and the European Association of Cardiovascular Imaging of the ESC, aims to provide practical advice for all clinicians regarding the use of multimodality imaging to simplify the diagnostic evaluation, prognostic stratification, and management of cardiac involvement in AFD.

• MeSH
• časná diagnóza MeSH
• diferenciální diagnóza MeSH
• dítě MeSH
• dospělí MeSH
• echokardiografie metody   normy   MeSH
• Fabryho nemoc * diagnostické zobrazování   terapie   MeSH
• konsensus MeSH
• lidé MeSH
• multimodální zobrazování * metody   normy   MeSH
• Check Tag
• dítě MeSH
• dospělí MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• konsensus - konference MeSH

PURPOSE: We aimed to find predictive tumour characteristics as detected by interim positron-emission tomography/magnetic resonance imaging (PET/MRI) in cervical cancer patients. We also investigated the type of interim response. Furthermore, we compared the investigated parameters with disease-free (DFS) and overall survival (OS) outcomes. METHODS: We evaluated 108 patients treated between August 2015 and January 2023 with external-beam radiotherapy (EBRT) and image-guided adaptive brachytherapy (IGABT) who had undergone pretreatment staging, subsequent mid-treatment evaluation after completed EBRT and definitive restaging 3 months after completing the whole treatment using PET/MRI. Patients were then divided into two groups based on the RECIST and PERCIST criteria: responders (achieving complete metabolic response, CMR) and non-responders (non-CMR). These two groups were compared using selected parameters obtained at pre-PET/MRI and mid-PET/MRI. The early response to treatment as evaluated by mid-PET/MRI was categorized into three types: interim complete metabolic response, interim nodal response and interim nodal persistence. RESULTS: Mid-TLG‐S (the sum of total lesion glycolysis for the primary tumour plus pelvic and para-aortic lymph nodes) parameter showed the best discriminatory ability for predicting non-CMR. The second factor with significant discriminatory ability was mid-MTV‐S (the sum of the metabolic tumour volume of the primary tumour plus pelvic and para-aortic lymph nodes). The strongest factor, mid-TLG‐S, showed a sensitivity of 40% and a specificity of 90% at a threshold value of 70. We found a statistically significant association of DFS and OS with the following parameters: number of chemotherapy cycles, early response type and CMR vs. non-CMR. CONCLUSION: We were able to identify thresholds for selected parameters that can be used to identify patients who are more likely to have worse DFS and OS. The type of early response during concurrent chemoradiotherapy (CCRT) was also significantly associated with DFS and OS. These aspects represent an important contribution to the possible stratification of patients for subsequent individualised adjuvant treatment.

• MeSH
• brachyterapie MeSH
• chemoradioterapie * metody   MeSH
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• magnetická rezonanční tomografie * MeSH
• multimodální zobrazování * MeSH
• nádory děložního čípku * terapie   diagnostické zobrazování   patologie   mortalita   MeSH
• pozitronová emisní tomografie * MeSH
• přežití bez známek nemoci MeSH
• radioterapie řízená obrazem MeSH
• senioři MeSH
• staging nádorů MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

OBJECTIVES: Annotating carious lesions on images is challenging. For artificial intelligence (AI) applications, the aggregation of heterogeneous multi-examiner annotations into one single annotation (e.g. via majority voting, MV) is usually needed. We assessed different aggregation strategies for multi-examiner annotations of primary proximal carious lesions on orthoradial radiographs and Near-Infrared Light Transillumination (NILT) images. METHODS: A total of 1007 proximal surfaces from 522 extracted posterior teeth were assessed by five dentists. Histological analysis provided the gold standard. Surfaces were classified as (1) sound, (2) enamel lesion or (3) dentin lesion. Four label aggregation strategies - MV, Weighted Majority Voting (WMV), Dawid-Skene (DS), and multi-annotator competence estimation (MACE) - were applied to unimodal (radiographs, NILT) and multimodal (combined) datasets. The area under the receiver operating characteristic curve (AUROC) was the primary outcome metric. RESULTS: According to the gold standard, 637 (63 %) surfaces were sound, 280 (28 %) showed carious lesions limited to the enamel, and 90 (9 %) showed lesions extending into the dentin. For radiographs, aggregation using MACE outperformed MV, WMV and DS significantly across all lesion depths (p < 0.002). For NILT, MACE significantly outperformed MV across all lesion depths (p < 0.001) and DS for enamel and dentin lesions (p ≤ 0.002). In the multimodal dataset, DS outperformed the other label aggregation strategies across all lesion depths significantly (p < 0.05). CONCLUSIONS: The commonly applied MV may be suboptimal. There is a need for informed application of specific aggregation strategies, depending on the dataset characteristics. CLINICAL SIGNIFICANCE: Most AI applications for dental image analysis are trained on a single annotation, usually resulting from aggregated multi-examiner annotations of each image. However, since these annotations are usually aggregated in an in vivo setting where no definitive ground truth is available, the choice of aggregation strategy plays a crucial role.

• MeSH
• dentin patologie   diagnostické zobrazování   MeSH
• lidé MeSH
• počítačové zpracování obrazu * metody   MeSH
• rentgendiagnostika zubní MeSH
• ROC křivka MeSH
• transiluminace MeSH
• umělá inteligence MeSH
• zubní kaz * diagnostické zobrazování   patologie   MeSH
• zubní sklovina diagnostické zobrazování   patologie   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

Early detection of malignant thyroid nodules is crucial for effective treatment, but traditional diagnostic methods face challenges such as variability in expert opinions and limited integration of advanced imaging techniques. This prospective cohort study investigates a novel multimodal approach, integrating traditional methods with advanced machine learning techniques. We studied 181 patients who underwent fine-needle aspiration (FNA) biopsy, each contributing one nodule, resulting in a total of 181 nodules for our analysis. Data collection included sex, age, and ultrasound imaging, which incorporated elastography. Features extracted from these images included Thyroid Imaging Reporting and Data System (TIRADS) scores, elastography parameters, and radiomic features. The pathological results based on the FNA biopsy, provided by the pathologists, served as our gold standard for nodule classification. Our methodology, termed ELTIRADS, combines these features with interpretable machine learning techniques. Performance evaluation showed that a Support Vector Machine (SVM) classifier using TIRADS, elastography data, and radiomic features achieved high accuracy (0.92), with sensitivity (0.89), specificity (0.94), precision (0.89), and F1 score (0.89). To enhance interpretability, we used hierarchical clustering, shapley additive explanations (SHAP), and partial dependence plots (PDP). This combined approach holds promise for enhancing the accuracy of thyroid nodule malignancy detection, thereby contributing to advancements in personalized and precision medicine in the field of thyroid cancer research.

• MeSH
• dospělí MeSH
• elastografie * metody   MeSH
• lidé středního věku MeSH
• lidé MeSH
• nádory štítné žlázy diagnostické zobrazování   klasifikace   patologie   diagnóza   MeSH
• prospektivní studie MeSH
• radiomika MeSH
• senioři MeSH
• štítná žláza diagnostické zobrazování   patologie   MeSH
• strojové učení * MeSH
• support vector machine MeSH
• tenkojehlová biopsie MeSH
• uzly štítné žlázy * diagnostické zobrazování   patologie   klasifikace   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

Structural, architectural, contractile, or electrophysiological alterations may occur in the left atrium (LA). The concept of LA cardiopathy is supported by accumulating scientific evidence demonstrating that LA remodelling has become a cornerstone diagnostic and prognostic marker. The structure and the function of the LA and left atrial appendage (LAA), which is an integral part of the LA, are key elements for a better understanding of multiple clinical conditions, most notably atrial fibrillation, cardioembolism, heart failure, and mitral valve diseases. Rational use of various imaging modalities is key to obtain the relevant clinical information. Accordingly, this clinical consensus document from the European Association of Cardiovascular Imaging, in collaboration with the European Heart Rhythm Association, provides comprehensive, up-to-date, and evidence-based guidance to cardiologists and cardiac imagers for the best practice of imaging LA and LAA for the diagnosis, management, and prognostication of the patients.

• MeSH
• echokardiografie metody   MeSH
• fibrilace síní diagnostické zobrazování   MeSH
• kardiologické zobrazovací techniky MeSH
• kardiologie MeSH
• konsensus * MeSH
• lidé MeSH
• multimodální zobrazování * metody   MeSH
• prognóza MeSH
• síňové ouško * diagnostické zobrazování   MeSH
• společnosti lékařské * MeSH
• srdeční síně * diagnostické zobrazování   MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• směrnice pro lékařskou praxi MeSH
• Geografické názvy
• Evropa MeSH