Current Medical Imaging - Volume 20, Issue 1, 2024

Chronic liver disease (CLD) will affect the enhancement of hepatic parenchyma and portal vein on abdominal-enhanced MRI.

To investigate the difference in liver parenchyma and portal vein enhancement in patients with CLD of different liver function grades between Gd-EOB-DTPA and Gd-DPTA in the portal venous phase (PVP).

This retrospective study included 218 patients with CLD who had undergone abdominal enhanced MRI from January 2019 to June 2020. Patients with various degrees of liver dysfunction were identified with Child-Turcotte-Pugh and albumin-bilirubin grade. Two readers measured the precontrast and PVP signal intensities of liver parenchyma, portal vein, spleen, and psoas muscle. Relative liver enhancement, liver-to-spleen contrast index, portal vein image contrast, and portal vein-to-liver contrast were calculated.

The relative enhancement of liver parenchyma was significantly lower for the Gd-EOB-DTPA group in any degree of liver function than the Gd-DTPA group in the PVP. The Gd-EOB-DTPA group showed significantly lower portal vein-to-liver contrast in the overall study population, CTP class B, and ALBI grade 2 patients compared to the group of Gd-DTPA at PVP. No significant difference was noted in the portal vein image contrast between the two contrast agents, regardless of CTP and ALBI grading.

In CLD patients, Gd-EOB-DTPA yielded lower liver parenchymal enhancement and similar portal vein image contrast compared to Gd-DTPA in the PVP. Portal vein-to-liver contrast in the Gd-EOB-DTPA group was lower in the CTP class B and ALBI grade 2 subgroups compared to the Gd-DTPA group.

Lung cancer is a pervasive and persistent issue worldwide, with the highest morbidity and mortality among all cancers for many years. In the medical field, computer tomography (CT) images of the lungs are currently recognized as the best way to help doctors detect lung nodules and thus diagnose lung cancer. U-Net is a deep learning network with an encoder-decoder structure, which is extensively employed for medical image segmentation and has derived many improved versions. However, these advancements do not utilize various feature information from all scales, and there is still room for future enhancement.

In this study, we proposed a new model called Blend U-Net, which incorporates nested structures, redesigned long and short skip connections, and deep supervisions. The nested structures and the long and short skip connections combined characteristic information of different levels from feature maps in all scales, while the deep supervision learning hierarchical representations from all-scale concatenated feature maps. Additionally, we employed a mixed loss function to obtain more accurate results.

We evaluated the performance of the Blend U-Net against other architectures on the publicly available Lung Image Database Consortium and Image Database Resource Initiative (LIDC-IDRI) dataset. Moreover, the accuracy of the segmentation was verified by using the dice coefficient. Blend U-Net with a boost of 0.83 points produced the best outcome in a number of baselines.

Based on the results, our method achieves superior performance in terms of dice coefficient compared to other methods and demonstrates greater proficiency in segmenting lung nodules of varying sizes.

Portal vein size and hemodynamics can be altered in patients with portal hypertension. Elastography for liver stiffness has been proposed as a potential predictor of portal hypertension. However, the relationship between liver stiffness measured using point shear wave elastography (pSWE) and portal vein diameter and Doppler parameters remains unclear. Therefore, this observational study aimed to investigate the correlation between liver ultrasound pSWE and portal vein hemodynamics in healthy participants.

Twenty-five healthy men with no underlying medical conditions and who were not on regular medications were enrolled in the study. Liver stiffness, portal vein diameter, and Doppler parameters were measured using ultrasound EPIQ Elite with a curved-array transducer (C5-1 MHz) equipped with pSWE and Doppler imaging. Real-time pSWE measurements were taken from the liver. Portal vein diameter and Doppler parameters were measured in a longitudinal view of the extra-hepatic segment. Spearman correlation was used to assess the association between liver pSWE and portal vein diameter as well as Doppler parameters, with a significance level set at < 0.05.

There was no significant correlation between liver stiffness and portal vein diameter (p = 0.67) or Doppler parameters, including peak systolic velocity (p = 0.89), end-diastolic velocity (p = 0.65), and resistive index (p = 0.86).

Our findings suggest no direct correlation between liver stiffness measured using pSWE and portal vein hemodynamics in healthy adults. Further studies are warranted to investigate the relationship between liver pSWE and the hemodynamics of portal veins in patients with liver diseases.

Generalized distal radius die-punch fractures (GDP) can involve three columns. However, there is no three-column classification for GDP. The aim of this study was to introduce a three-column classification for GDP, and to investigate the application effect of the classification.

613 patients with GDP accrued from January 2013 to December 2021 were classified by column and fracture type based on imaging findings. First, the GDP was categorized into single-, double-, or three-column fractures. Second, the intermediate column fractures were divided into volar, dorsal, split, collapse, or mixed types; the radial column fractures were divided into metaphyseal, articular or mixed types; and the ulnar column fractures were divided into apical or basal types of the styloid process. The intra- and inter-observer consistency between the two assessors was analyzed with kappa statistics. 227 patients with less fracture displacement were treated conservatively, whereas 386 patients with increased fracture displacement were treated surgically, and the selection of surgical approaches and fracture reduction-fixation methods was guided by the classification. The differences in incidence, gender, age, treatment methods, and functional recovery were compared among the three categories, and the characteristics of different types were observed. The wrist joint function was evaluated according to the Sarmiento-modified Gartland-Werley method.

The intra- and the inter-observer kappa coefficients were obtained as ≥ 0.810. There were significant differences in the incidence (12.7%, 68.5%, and 18.8%, respectively) and age (39.8, 46.6, and 47.1 years, respectively) for single-, double- and three-column fractures (P<0.05). However, there was no significant difference in terms of gender among the three (P>0.05). The mixed, collapse, split, dorsal, and volar types accounted for 28.7%, 27.7%, 21.9%, 15.5%, and 4.5%, respectively. The metaphyseal, articular surface, and mixed types accounted for 35.9%, 33.1%, and 31.0%, respectively. The apical and base types were 81.7% and 18.3%, respectively. Among the cases of volar and dorsal types, the missed diagnosis rate of X-ray alone was 28.5%, but it was confirmed by subsequent CT. In the last follow-up of 12.2 months (range, 6 to 24 months), the excellent plus good rate was 82.7% and 82.6%, respectively, in total and among patients undergoing surgical treatment; the excellent plus good rate of the single column fractures was 96.2%, significantly higher than that of double- and three-column fractures (80.0% and 83.5%, respectively) (P<0.05). All patients with fair or poor wrist function had collapse or mixed-type intermediate column fractures.

Different categories/types of GDP have significant differences in terms of incidence, age, efficacy, and prognosis. Imaging classification by column and type of GDP better reflects the features and injury mechanism of the fractures with good consistency. Therefore, it has important reference value for the surgical modality and prognosis evaluation.

Currently, three-dimensional cephalometry measurements are mainly based on cone beam computed tomography (CBCT), which has limitations of ionizing radiation, lack of soft tissue information, and lack of standardization of median sagittal plane establishment.

This study investigated magnetic resonance imaging (MRI)-only based 3D cephalometry measurement based on the integrated and modular characteristics of the human head.

Double U-Net CycleGAN was used for CT image synthesis from MRI. This method enabled the synthesis of a CT-like image from MRI and measurements were made using 3D slicer registration and fusion.

A protocol for generating and optimizing MRI-based synthetic CT was described and found to meet the precision requirements of 3D head measurement using MRI midline positioning methods reported in neuroscience to establish the median sagittal plane. An MRI-only reference frame and coordinate system were established enabling an MRI-only cephalometric analysis protocol that combined the dual advantages of soft and hard tissue display. The protocol was devised using data from a single volunteer and validation data from a larger sample remains to be collected.

The reported method provided a new protocol for MRI-only cephalometric analysis of craniofacial growth and development, malformation occurrence, treatment planning, and outcomes.

Breast cancer, one of the most prevalent malignant tumors in females, usually occurs in the breast epithelial tissues.

The study aimed to explore the diagnostic value of contrast-enhanced ultrasound (CEUS) combined with shear wave elastography (SWE) in the diagnosis of benign and malignant breast masses in BI-RADS (Breast Imaging Reporting and Data System) 4.

Examination outcomes and clinical information of 83 patients with BI-RADS 4 breast masses were analyzed retrospectively. These included patients who received CEUS, SWE, and pathological examinations. The difference of CEUS in determining the classification of BI-RADS 4 breast masses was evaluated using histopathological outcomes of breast masses as a reference standard. The diagnostic value of CEUS, SWE, and CEUS combined with SWE in the diagnosis of benign and malignant breast masses in BI-RADS 4 was also explored.

Pathological biopsy results revealed 63 malignant masses and 20 benign masses among 83 BI-RADS 4 breast masses, with a 75.9% incidence of malignant masses. After the diagnosis of BI-RADS 4 breast masses with CEUS, SWE, and CEUS+SWE, the incidence of malignancy was 56.6%, 78.3%, and 73.5%, respectively. CEUS+SWE showed higher sensitivity (93.7% vs. 81% and 68.3%), specificity (90% vs. 30% and 80%), positive predictive value (96.7% vs. 78.5% and 91.5%), negative predictive value (81.8% vs. 33.3% and 44.4%), and diagnostic coincidence rate (92.8% vs. 68.7% and 71.1%) than SWE and CEUS alone in diagnosing pathological type of breast masses. Moreover, CEUS combined with SWE exhibited a larger area under the receiver operating characteristic (ROC) curve (0.918) than SWE (0.741, p = 0.028) and CEUS (0.555, p 0.001) alone in the diagnosis of BI-RADS 4 breast masses.

Overall, the diagnostic value of CEUS+SWE for the pathological type of BI-RADS is preferred over CEUS and SWE alone. CEUS+SWE showed higher values than CEUS and SWE alone in diagnosing BI-RADS 4 breast masses. Specifically, CEUS+SWE can correctly identify benign and malignant masses, reduce unnecessary trauma, and avoid misdiagnosis. In summary, CEUS combined with SWE can serve as an effective diagnostic method and avoid delaying the best treatment opportunity for some malignant lesions.

This paper presents a novel approach for detecting abnormality in coronary arteries using MRI data in RGB images. The study evaluates the test accuracy of the weak classifiers and the test accuracy and F1 score of the strong classifier.

The method involves separating the image into information planes, including R, G, and B color space, or bit-planes, and training a VGG-like convolutional neural network model on each plane separately, referred to as a “weak classifier.” The classification results of these planes are aggregated using a proposed soft voting method, forming a “strong classifier,” with the weights for the aggregation determined by the model's performance on the training set.

The results indicate that the strong classifier achieves a test accuracy and F1 score of around 68% to 74% on our private coronary artery dataset. Moreover, by aggregating the top three highest bit-plane levels in a grayscale image, the accuracy is slightly lower than that of the three color spaces but requires a significantly smaller CNN model of nearly 4M parameters.

The potential of bit-planes in reducing model storage costs is suggested. This approach holds promise for improving the detection of abnormalities in coronary arteries using MRI data.

To investigate the radiological characteristics of the PHNENs on CT and MRI and improve the understanding of the image manifestations and preoperative diagnosis of the disease.

Primary hepatic neuroendocrine neoplasms (PHNENs) are rare diseases, and most of the relevant studies are case reports. Characterized by no specific clinical symptoms, PHNENs not only have a low preoperative diagnosis rate with great difficulty in early diagnosis but are frequently misdiagnosed as primary hepatic cancer.

15 PHNEN patients were enrolled, with 10 cases in the G2 stage and 5 cases in the G3 stage.

The imaging and clinicopathological information of 15 patients pathologically diagnosed with PHNENs was retrospectively reviewed.

The average age of the patients enrolled was 46.14±18.24 years, and the average tumor size was 91.00±61.17 mm. 13 cases showed nodules or masses, 8 cases were located in the periphery of the liver, showing capsule depression and subcapsular effusion signs. CT enhanced scan showed heterogeneous and obvious enhancement in 9 arterial-phase cases, 2 cases in arterial and portal venous phases both saw mild enhancement; the enhancement degree of lesions in the G2 stage in the arterial phase was significantly higher than in the G3 stage. Gd-EOB-DTPA dynamic enhanced MRI was conducted on 3 cases, and scattered lesions with heterogeneous and slight hyperintensity were observed in the hepatobiliary-specific lesions. Image manifestations showed diffuse lesions in 2 cases, with heterogeneous enhancement in the arterial phase and decreased enhancement in the portal venous phase by the dynamic enhanced scan.

PHNENs were the imaging characteristics of PHNENs. The CT-enhanced scanning during the arterial phase may provide a certain reference for pathological grading (G2 and G3 grades). Gd-EOB-DTPA-enhanced MRI is helpful for PHNEN diagnosis.

This study aimed to characterize and assess the diagnostic value of prenatal magnetic resonance (MR) imaging in detecting fetal cerebellar hypoplasia/dysplasia and developmental malformations.

Reports of suspected intracranial abnormalities were retrospectively collected on ultrasound screening (US), and MR images of fetuses were reviewed at our institution over a 5-year period on picture archiving and communication system (PACS) servers. Two experienced radiologists recorded major abnormalities and coexisting abnormalities at the reading of the census. The results of the MRI were compared against the US in each case.

For prenatal MR imaging, we enlisted a total of 121 patients (mean gestational week, 24.5 ± 4.7 weeks). This included 28 cases with normal findings of MR imaging, 62 cases with findings of cerebellar hypoplasia or dysplasia, and the remaining 31 cases with other abnormities findings. Cerebral malformations cases included agenesis of the corpus callosum, cerebral hemorrhage, hydrocephalus, holoprosencephaly, ventriculomegaly, and brainstem/gyri malformation. Cerebellar abnormalities included vermis absence, cerebellar tonsil hernia, Dandy-Walker malformation, Blake’s pouch cysts, arachnoid cysts, and intracranial hemorrhage. Other systemic malformation cases included tethered cord syndromes (9 cases), cleft lip and palate (1 case), club foot (1 case), and cardiac malformation (1 case). In 12 cases (24.5%), compared to the US, MR imaging proved the value of confirming the diagnosis and/or even yielded more findings on abnormalities.

Prenatal MR imaging can better visualize systemic malformations coexisting with cerebellar abnormalities. MR imaging, a complementary means to the US, can aid in prenatal counseling and treatment selection for term delivery.

The aneurysmal bone cyst is a benign neoplasm that tends to form the appearance of a mass with a bony septum that forms cavities with blood inside. It is estimated to represent 1% of bone tumours and has an incidence of 0.14 per 100,000 people worldwide. Current publications have not shown a multidisciplinary approach that can benefit patients, mainly in the functionality and quality of the management approach.

Describe the multidisciplinary approach and the benefits of quality of life and functionality in this diagnosis.

A paediatric patient was diagnosed with an aneurysmal bone cyst located in the cervical spine, which initially manifested with muscle pain, enlargement of the posterior cervical region, and difficulty in performing arcs of movement. He was treated with multidisciplinary management with surgery, embolisation, radiation, and bisphosphonate support.

The purpose of approaching multidisciplinary management helped to improve the accompanying symptoms that prevented our patient from having an active and quality life. However, more successful cases have not been reported to establish the best therapeutic protocol.

MRI of patients with locally advanced rectal cancer (LARC) can predict the pathological complete response (pCR) to preoperative chemoradiation therapy (CRT). Our purpose was to use MRI results to evaluate the diagnostic value of combined changes in signal intensity (SI) and volume (V) of patients with LARC for predicting pCR to CRT.

This retrospective study on 100 patients with LARC analyzed clinical and imaging data that were collected from March, 2018, to March, 2020. Before and after CRT, T2-weighted (T2W), apparent diffusion coefficient (ADC), and contrast-enhanced T1-weighted (ceT1W) data were analyzed. Percent changes of V (%∆V) and relative SI ratio (%∆SIR) on different sequences were calculated. After CRT, patients had pathological confirmation as pCR or non-pCR. Data were analyzed using nonparametric tests and receiver operating characteristic (ROC) analysis.

There were 34 pCR and 66 non-pCR patients. Except for ADC-%∆SIR, the combined parameters and single parameters had a greater decrease in the pCR group. The combination of ADC-%∆V and T2W-%∆SIR had the greatest diagnostic value (AUC=0.85,cutoff=0.23%) and the combination of ADC-%∆V% and ∆SIR had the best accuracy (89%, cutoff=44.11%). Except for T2W-%∆V and T2W-%∆SIR, the different sequences had moderate differences in diagnostic performance. The diagnostic performance of combined parameters or single parameters on ADC and T2W was significantly better than those on ceT1W (p<0.01).

All sequences except ADC-%∆SIR provided reliable predictions of pCR, although ceT1W data had limited usefulness.

Modern medical imaging modalities used by clinicians have many applications in the diagnosis of complicated diseases. These imaging technologies reveal the internal anatomy and physiology of the body. The fundamental idea behind medical image fusion is to increase the image's global and local contrast, enhance the visual impact, and change its format so that it is better suited for computer processing or human viewing while preventing noise magnification and accomplishing excellent real-time performance.

The top goal is to combine data from various modal images (CT/MRI and MR-T1/MR-T2) into a solitary image that, to the greatest degree possible, retains the key characteristics (prominent features) of the source images.

The clinical accuracy of medical issues is compromised because innumerable classical fusion methods struggle to conserve all the prominent features of the original images. Furthermore, complex implementation, high computation time, and more memory requirements are key problems of transform domain methods. With the purpose of solving these problems, this research suggests a fusion framework for multimodal medical images that makes use of a multi-scale edge-preserving filter and visual saliency detection. The source images are decomposed using a two-scale edge-preserving filter into base and detail layers. Base layers are combined using the addition fusion rule, while detail layers are fused using weight maps constructed using the maximum symmetric surround saliency detection algorithm.

The resultant image constructed by the presumed method has improved objective evaluation metrics than other classical methods, as well as unhindered edge contour, more global contrast, and no ringing effect or artifacts.

The methodology offers a dominant and symbiotic arsenal of clinical symptomatic, therapeutic, and biomedical research competencies that have the prospective to considerably strengthen medical practice and biological understanding.

Castleman's disease is an extremely rare disease in the abdomen region characterized by benign lymphoepithelial proliferation.

We report a case of a 63-year-old female who presented with abdominal pain. Abdominal CT Angio and dynamic contrast-enhanced abdominal MRI revealed a mass lesion showing markedly contrast enhancement, no vascular invasion sign, and diffusion restriction lesion in the truncus coelicus bifurcation region. The mass was surgically resected completely. Pathological evaluation showed a hyaline-vascular type of Castleman’s disease.

Castleman's disease should be kept in mind in the differential diagnosis of an isolated intra-abdominal mass.

Hepatic artery aneurysms (HAAs) exhibit a notable risk of rupture, with both true aneurysms and pseudoaneurysms being exceptionally uncommon (incidence rate approximately 2 per 100,000). Symptoms include epigastric and right upper quadrant pain, jaundice, and potentially life-threatening bleeding upon rupture. This bleeding can extend into the portal vein, hepatic vein, biliary system, or abdominal cavity. While existing literature lacks reports of delayed post-therapeutic complications, this case report discusses a 27-year-old female who developed a pseudoaneurysm six months after bilateral biliary drain insertion, underscoring the potential for delayed complications.

The patient underwent gastric endoscopy revealing an extensive lower esophageal varix protruding into the proximal stomach, subsequently treated with banding. The stomach and duodenum were found to contain fresh blood and blood clots indicating acute bleeding.

An urgent CT scan identified active bleeding (extravasation) at segment V and blood accumulation at the confluence of the right and left biliary drains. This was followed by celiac and selective hepatic digital subtraction angiography (DSA).

This case study outlines the occurrence of a hepatic artery pseudoaneurysm six months after percutaneous insertion of bilateral biliary drains. The pseudoaneurysm manifested precisely at the confluence of the right and left drains. The reported delayed complication may have resulted from friction between the drains at the confluence or erosion of the adjacent artery by the drains. The insights gained from this case shed light on the causes and preventive measures for potential delayed complications associated with percutaneous biliary drain placement.

Ovarian cancer is a common gynecological malignant tumor in women. Most patients have reached the advanced stage when they visit the hospital. In order to diagnose ovarian cancer at an early stage, treat it at an early stage, and improve the survival rate of patients, this study has used the imaging computed tomography (CT) method to diagnose stage IA ovarian cancer.

The purpose of this work was to study CT features of stage IA ovarian cancer, and compare the borderline tumor and stage IC ovarian cancer at the same time so as to improve the CT diagnosis of early ovarian cancer.

We retrospectively collected clinical and CT data of patients with stage I ovarian cancer and borderline ovarian tumor admitted to Nantong Tumor Hospital from 2013 to 2021. Altogether, 23 cases of patients (borderline ovarian tumor, 9 cases; stage IA ovarian cancer, 5 cases; stage IC ovarian cancer, 9 cases) were involved. CT characteristics of these patients were analyzed in terms of the tumor diameter, cystic solid structure, solid component, septation, enhancement, peritoneal thickening, ascites, and abdominal lymph nodes.

CT features of stage IA ovarian cancer included large tumor size (average diameter: 15 cm), cystic solid structure (4/5; 80%), septation (4/5; 80%), and enhanced cystic wall, septum, or solid components of the tumor on contrast-enhanced CT (5/5; 100%), no peritoneal thickening (0/5; 0%), no ascites (0/5; 0%), and no abdominal lymph node enlargement (0/5; 0%). The tumor structure did not differ significantly between stage IA and IC ovarian cancers (p > 0.05), while intraperitoneal ascites did (χ² = 0.031; p < 0.05). Stage IA and borderline ovarian tumors did not differ significantly in ovarian tumor structure (p > 0.05).

CT features of stage IA ovarian cancer included large tumor size, cystic solid structure, septation, and enhanced cystic wall and solid parts in the tumors. No pelvic or abdominal metastasis was observed.

Lung ultrasound (LUS) is gaining recognition as an indispensable diagnostic tool in critical care.

The study aimed to characterize the global research landscape and trend of LUS with quantification and visualization approaches.

Documents related to LUS published between 2007 and 2023 were selected from the Web of Science Core Collection and identified. Visualization and statistical analysis were conducted with the VOSviewer 1.6.18, CiteSpace 5.7.R5, and Bibliometrix 4.1.0 Package, including analysis of the trend of global publications, prominent countries, active institutions, and funding agencies, key authors and journals, co-cited references, and keywords.

A total of 3010 publications, including 2434 articles and 576 reviews, were retrieved. The output of LUS-related research has increased steadily over the years, especially after 2018. Italy (n=756; 25.12%) has shown the highest output, being the country with the highest total citations (23423 times). The most influential author was Gargani Luna with 52 documents, who worked at the Consiglio Nazionale delle Ricerche. Chest and Intensive Care Medicine with high citations and impact factor scores were the most influential journals. Besides “lung ultrasonography”, the keywords developed included “coronavirus disease 2019 (COVID-19)”, “acute respiratory distress syndrome”, and “acute heart failure”.

Research output on LUS has increased steadily, especially after 2018. Italy and the United States are staying ahead in this field. Research collaboration still needs to be strengthened. This comprehensive analysis has presented the global research landscape and trends of LUS-related research, providing valuable information for researchers to pursue further exploration.

The fat attenuation index (FAI) of pericoronary adipose tissue is associated with coronary inflammatory reactions.

This study aimed to analyze the difference in the FAI ratio between pericoronary adipose tissue volume and aortic root epicardial adipose tissue volume (AO-EATV) using computed tomography (CT) in various plaques.

In total, 645 coronary artery CT angiogram images from 215 patients were collected. The types and number of coronary plaques were recorded, and the plaque volume and pericoronary FAI of each branch were compared between the groups. The ratio of the FAI in branches with or without plaques to the AO-EATV was determined and statistically analyzed between the groups.

No significant difference in the plaque volume among the left anterior descending (LAD), left circumflex (LCX), and right coronary artery (RCA) (P > 0.05) as well as in the FAI was observed among various plaque groups (P > 0.05). FAI[LAD]/AO-EATV was in the following order: noncalcified plaques (0.70 ± 0.06) < mixed plaques (0.72 ± 0.06) < calcified plaques (0.73 ± 0.08) < no plaques (0.74 ± 0.07); FAI[LCX]/AO-EATV was in the following order: noncalcified plaques (0.71 ± 0.06) < mixed plaques (0.72 ± 0.08) < calcified plaques (0.73 ± 0.09) < no plaques (0.74 ± 0.06); and FAI[RCA]/AO-EATV was in the following order: noncalcified plaques (0.71 ± 0.06) < mixed plaques (0.73 ± 0.07) < calcified plaques (0.74 ± 0.07) < no plaques (0.75 ± 0.09); the differences were statistically significant in each group (P = 0.041, 0.043, and 0.028, respectively).

Compared to simply comparing FAI, FAI/AO-EATV varied in the coronary arteries in various plaque groups. FAI/AO-EATV was lower in noncalcified or mixed plaques and was associated with coronary inflammatory reactions.

Klippel-Trenaunay syndrome (KTS) is a rare congenital disease that mainly involves blood vessels and is characterized by the presence of capillary malformations (port wine stains), varicose veins, soft tissue and/or bone hypertrophy.

We report a 28-year-old man who was diagnosed 20 years ago with Klippel-Trenaunay syndrome. Approximately 3 years ago, he found enlarged masses on both upper extremities and a new dark red mass that was pathologically diagnosed as cavernous haemangioma appeared on the right index finger.

KTS is a rare and potentially multisystem disease requiring multidisciplinary management for which imaging examination is an important auxiliary diagnostic method. Various complications may occur during its development, so regular follow-up is required to prevent serious accidents.

Meniscal tears are among the most common indications for knee arthroscopy. Artificial polyurethane scaffolds have demonstrated efficacy in reducing pain and promoting the growth of normal meniscal tissue, with high absorption rates facilitating full tissue regeneration.

This study aimed to evaluate the remodeling of polyurethane meniscal implants post-reconstruction using ultrasonography. This imaging technique not only assesses changes in implant properties, such as echogenicity, but also the shape changes during functional examination.

The assessment of meniscal extrusion, comparing size at rest and under weight-bearing, is an indirect parameter that provides insight into the physical properties of the remodeling implant, with greater extrusion indicating reduced stiffness and inferior physical properties of the meniscus. Ultrasonography has the valuable advantage of allowing for assessment of the blood supply to the meniscus through Power Doppler imaging.

The presence of vessels within the meniscal implants serves as evidence of ongoing remodeling. The study included 35 patients (13 female, 22 male; mean age 41.6 years, range 18-66) who underwent arthroscopic meniscal reconstruction with polyurethane implants, with an average time from surgery of 2.8 years (range 0.3-4.5 years). Results showed complete (29.7%), significant (45.9%), or moderate (16.2%) remodeling into natural meniscal tissue in 91.8% of the implants.

The mean values of extrusion in the supine position and during 90-degree flexion were significantly greater in the operated limb (2.603) compared to the contralateral limb (1.978; t(35) = 2.442; P < 0.05). No significant differences in extrusion were found between the limbs in a standing position, indicating favorable physical properties of the polyurethane meniscal implants. Further ultrasonography studies of meniscal scaffolds are deemed relevant.