Citations

Abstract Objective Effective communication with humans and automated voice assistants (AVA) is essential for full participation in modern life. Because AVA relies on intelligible speech, individuals with speech impairments, such as those treated for oral cavity cancer (OCC), may face barriers when interacting with AVA. We assessed self‐reported communication difficulty in patients treated for OCC related to AVA and humans. Study Design Prospective cross‐sectional cohort study. Setting Out‐patient clinics in two tertiary care centers. Methods This study was conducted between July 2024 and March 2025 and included adults (≥18 years) diagnosed with and surgically treated for OCC (experimental group) and those without speech impairments (controls). Participants completed the Speech Communication Experience Survey (SCES), which assessed perceived intelligibility when communicating with familiar partners, strangers, and AVA; and, as reported elsewhere, the Speech Handicap Index (SHI). Results In total, 159 participants were included (69 OCC, 90 controls). OCC participants were more likely to report that familiar partners, strangers, and AVA “almost always” or “always” had difficulty understanding their speech ( P < .05). Free flap reconstruction and maxillectomy were associated with greater reported communication difficulty. AVA usage frequency and overall opinions toward AVA did not significantly differ between groups. Conclusion Patients treated for OCC report significantly greater difficulty being understood by both AVA and human listeners compared to controls. These perceptions may inform peri‐operative counseling and guide the development of more inclusive AVA technologies capable of accommodating diverse speakers. Level of Evidence : 3.

Abstract Background Conventional MRI cannot reliably distinguish radiation necrosis (RN) from recurrent metastasis after cranial radiotherapy, as both can show similar enhancement despite different biology. We tested whether these entities are mechanically non-equivalent in vivo and separable by MRE-derived viscoelastic metrics and perilesional interface-instability features. Methods In a prospective, histopathology-anchored cohort, 11 post-radiotherapy enhancing lesions were classified as RN (n=3) or recurrent/progressive tumor (n=8). MRE was acquired at 3.0 T with single-frequency 60-Hz excitation to derive storage modulus (G′), loss modulus (G″), and complex shear modulus magnitude (|G*|). Co-primary endpoints were median tumor G′ and |G*|, each tested one-sided (RN > tumor) with Holm correction across the two co-primary tests. Median tumor G″ was tested two-sided. A prespecified secondary 6-endpoint family (absolute and tumor/NAWM-normalized G′, G″, and |G*|) was analyzed with Benjamini–Hochberg FDR control. Exploratory instability mapping in a 0–6 mm peritumoral shell generated interface-topology metrics, including convexity. Results Absolute tumor-core medians were higher in RN than tumor for |G*| (1.79 vs 1.32 kPa; Cliff’s δ=0.67; q=0.10), G′ (1.62 vs 1.09 kPa; δ=0.50; q=0.14), and G″ (0.81 vs 0.46 kPa; δ=0.75; q=0.10). NAWM normalization improved separation: tumor/NAWM |G*| (2.26 vs 1.41; δ=0.92; q=0.04) and tumor/NAWM G″ (2.67 vs 0.87; δ=1.00; q=0.04) were FDR-significant. Convexity also differentiated RN from tumor (0.49 vs 0.36; δ=1.00; MWU p=0.01). Conclusions Tumor/NAWM G″, tumor/NAWM |G*|, convexity, and tumor G″ emerged as the strongest candidate features, indicating that RN is mechanically harder and more dissipative than recurrent metastasis. Signal strength was high (Cliff’s δ up to 1.00) but should be interpreted cautiously given sample size. Exploratory analyses further suggest that instability mapping captures biologically relevant interface behavior. These findings support a mechanics-based RN-versus-recurrence framework and justify prespecified, preregistered external validation.

Abstract Background Cardiomegaly is a clinically significant incidental finding on chest computed tomography (CT) associated with heart failure, arrhythmias, and sudden cardiac death. Qualitative radiologist assessment is variable, and automated AI tools may enable objective opportunistic cardiac volumetry. Purpose To evaluate whether AI-enabled total cardiac volume (TCVAI) derived from non-ECG-gated, non-contrast chest CT can identify cardiomegaly as defined by echocardiography. Materials and Methods This retrospective study included 307 consecutive patients (median age, 67 years; 56% male) who underwent non-contrast chest CT at a single center on 7 scanner types (4 vendors) and clinically indicated echocardiography within 31 days. A commercially available AI tool (AI-Rad Companion, Siemens Healthineers) automatically quantified TCVAI, indexed to body surface area (TCVAI/BSA). Echocardiography reports were reviewed for chamber dilation and left ventricular hypertrophy (LVH), collectively defined as cardiomegaly. Associations between TCVAI/BSA and echocardiographic findings were assessed using correlation, ordinal regression, and receiver operating characteristic (ROC). Interscan repeatability was evaluated in 248 patients with 544 repeat CT examinations. Prespecified sex-specific thresholds were tested in a temporally independent validation cohort of 50 patients. Results Median TCVAI was higher in patients with cardiomegaly than those without (1061.9 vs 798.4 mL; P &lt; .001). TCVAI/BSA was associated with chamber dilation and LVH severity on univariate analysis and remained associated in multivariable ordinal models, except for right ventricular dilation. Discriminatory performance was fair to good, with area under the curve (AUC) 0.81 (95% CI, 0.75-0.87) in men and 0.77 (95% CI, 0.69-0.85) in women. Interscan repeatability was excellent (intraclass correlation coefficient [ICC]: 0.93). In independent validation, performance ranged from sensitivity 89.3%/specificity 27.3% at a high-sensitivity threshold to sensitivity 28.6%/specificity 100% at a high-specificity threshold. Conclusion AI-derived cardiac volume from routine chest CT shows fair to good performance for identifying echocardiography-defined cardiomegaly with high measurement repeatability, supporting a potential role for automated cardiac volumetry as an objective, opportunistic biomarker.

Background: To compare oncologic and postoperative outcomes in patients with scalp squamous cell carcinoma with periosteal, but not gross calvarial, involvement, treated with margin-clearing excision including either calvarial burring or periosteal excision alone. Study Design: Retrospective cohort study. Setting: Single tertiary academic referral center. Methods: We retrospectively reviewed surgical cases from January 2001 to January 2025. Inclusion criteria: patients ≥18 years with biopsy-proven scalp squamous cell carcinoma involving the periosteum without cortical invasion on imaging. Management of the deep margin included either burring of the outer table or periosteal excision alone. Demographic, surgical, and oncologic outcomes were collected and analyzed descriptively. Results: Twenty patients met inclusion criteria. Median age was 70 (range 56-92), and 18 (86%) were male. Thirteen (65%) patients underwent calvarial burring, 7 (35%) underwent periosteal excision. Local recurrence occurred in 31% and 29% of the burring group and non-burring group. Disease-free survival at 2 years was 46% and 57% in the burring and non-burring group, respectively. Overall survival at 2 years was 77% and 86% in the burring and non-burring group. Three patients in the burring group had local recurrences with intracranial extension, 1 died of disease, 1 died with disease and concurrent meningitis, 1 is alive with disease recurrence currently on palliative treatment. There were 7 disease-related deaths. Conclusion: Burring did not confer a significant oncologic advantage compared to periosteal excision alone when there was no gross cortical invasion. Local recurrence in patients undergoing calvarial burring was associated with intracranial extension of disease.

ABSTRACT Purpose Active lesion expansion is clinically important because it can indicate disease progression and influence management and treatment planning. However, sequential imaging is often unavailable, and rapid growth can only be inferred from indirect findings such as active perilesional tissue injury. This study aimed to implement and test the feasibility of an MR elastography (MRE)‐based technique for assessing the expansile nature of mass lesions by detecting stiffness changes caused by mechanical strain manifestations in adjacent tissues. Methods A tissue strain mapping (TSM) algorithm was developed using spatial–temporal directional filtering to reveal the presence of perilesional latent strain that is not apparent in conventional MRE inversions. The technical feasibility was tested in tissue‐simulating phantoms containing a mass that was progressively expanded. Preliminary feasibility for clinical application was also demonstrated in representative in vivo examples. Resulting TSM maps were compared with conventional MRE stiffness maps. Results In the phantom experiments, TSM revealed the presence of local strain at the periphery of the expanding mass, with the effect increasing proportionally to the degree of expansion. Conventional MRE did not demonstrate comparable localized stiffening patterns. In vivo examples showed similar perilesional strain features that were not apparent on conventional MRE maps. Conclusion The feasibility of the proposed MRE‐based TSM technique was demonstrated in phantom and preliminary in vivo studies. These findings suggest that the technique is a promising tool for assessing the expansile nature of mass lesions and motivate further development of the TSM processing and exploration of potential clinical applications.

Background: Upfront resectable pancreatic ductal adenocarcinoma (PDAC) is defined by the NCCN as disease with ≤180° portomesenteric vein (PMV) abutment. However, the clinical significance of PMV abutment in this cohort remains unexplored, and we sought to investigate its impact. Methods: This multi-institutional study included patients who underwent pancreatoduodenectomy (PD) for upfront resectable PDAC from 2002 to 2023. Patients with PDAC with ≤180° PMV abutment were compared with those without. Overall survival (OS) was compared and stratified based on whether patients underwent upfront surgery or neoadjuvant therapy (NAT). Results: Among 1,446 patients included, 521 (36.0%) had PMV abutment. Median OS for patients with PMV abutment was 28.8 months compared with 31.2 months for those without ( P =.17). In a stratified analysis of patients who underwent upfront surgery, patients with PMV abutment had worse OS (19.2 vs 27.6 months; P <.05) and lower R0 resection rates (63.1% vs 87.2%; P <.05) compared with those without. However, in patients who underwent NAT, this difference in R0 resection rate was not observed (91.4% vs 94.0%, respectively; P =.27). Furthermore, there was no significant difference in median OS with NAT (42.5 vs 51.6 months, respectively; P =.48). Conclusions: In this largest cohort to date of patients with upfront resectable PDAC, PMV abutment was associated with worse OS compared with no PMV abutment when an upfront resection strategy was used. The use of NAT in patients with PMV abutment mitigated this survival difference with increased R0 resection rates. These findings suggest that patients with upfront resectable PDAC with PMV abutment benefit from a NAT approach for optimal survival outcomes, and that the current criteria guidelines need to be redefined.

Abstract Background Renal denervation (RDN) has emerged as a promising therapeutic adjunct for the management of hypertension, yet its efficacy in the long term, particularly in patients with hypertension and concurrent renal insufficiency, remains to be fully elucidated. This study was designed to evaluate the sustained impact of RDN on blood pressure control, renal function, and cardiovascular outcomes in hypertensive patients with pre-existing renal impairment over an extended follow-up period. Methods We conducted a single-center, single-arm, real-world retrospective study involving patients with hypertension and chronic kidney disease (CKD) stages 3-4 who underwent RDN at a hospital between 2011 and 2016. Comprehensive baseline data, including demographic information, comorbidities, and medication history, were meticulously recorded. Long-term follow-up assessments were performed at 1, 5, and 11.5 years post-RDN to monitor changes in office and home blood pressure, 24-hour ambulatory blood pressure results, renal function, and the incidence of cardiovascular events and mortality. Results A total of 20 participants completed the long-term follow-up, with a mean age of 51.7 ± 14.5 years (35% female), and a median follow-up duration of 11.5 years. At baseline, the cohort presented with an average office systolic blood pressure of 183.8 ± 18.6 mmHg and a diastolic blood pressure of 104.7 ± 17.0 mmHg. Following RDN, participants experienced a significant reduction in blood pressure, with an average decrease of -37.94/-20.38 mmHg (P &lt; 0.001) compared to baseline. Additionally, ambulatory systolic and diastolic blood pressures were reduced by 16.87 ± 9 mmHg (P &lt; 0.001) and 9.88 ± 4.05 mmHg (P &lt; 0.001) 11.5 years after the procedure, respectively. The study also revealed a substantial reduction in the need for antihypertensive medications (P &lt; 0.001) and a decrease in average heart rate (P = 0.046) following renal denervation. Assessments of renal function, as measured by estimated glomerular filtration rate and creatinine levels, were consistent with expected age-related decline. Importantly, no significant adverse events associated with RDN were observed in the long-term follow-up. Over the 11.5-year period, the cardiovascular mortality rate and overall mortality were 10% and 20%, respectively. Conclusion This long-term follow-up study demonstrates that RDN is a safe and effective intervention for managing hypertension in patients with renal impairment.