MF Radiologijos klinika (04.36)

Background/Objectives: Accurate assessment of pulmonary function is essential before planning radical lung cancer treatment. While spirometry reflects global lung function, perfusion imaging provides detailed information on regional perfusion patterns. This study aimed to characterize the pre-treatment profile of patients and compare the impact of surgical resection, radiotherapy, and thermal ablation on global pulmonary function and regional perfusion using SPECT/CT. Methods: In this prospective study of 68 patients, pre- and post-treatment assessments were conducted using lung perfusion SPECT/CT. While the entire cohort underwent imaging, longitudinal global pulmonary function (spirometry and gas diffusion) was analyzed for 45 patients who completed the three-month follow-up. Quantitative analysis included perfusion percentages and lung volumes, while a semi-quantitative scoring system evaluated the severity of perfusion defects. Results: In the overall cohort, the affected lung perfusion and volume significantly decreased (p = 0.002). Subgroup analysis revealed that the surgical resection group experienced significant reductions in perfusion (from 54.0% to 41.0%, p = 0.002) and volume (p < 0.001) of the affected lung, whereas no statistically significant changes were observed in the thermal ablation and radiotherapy groups (p > 0.05). Notably, 60.3% of patients presented with perfusion defects before treatment. Post-treatment spirometry parameters, particularly FEV1% (threshold 83.5%, AUC = 0.783), served as reliable predictors of persistent perfusion impairment. Conclusions: Radiotherapy and thermal ablation are lung-perfusion-sparing treatments compared to surgical resection. The high prevalence of pre-existing perfusion defects emphasizes the importance of incorporating lung perfusion SPECT/CT into routine pre-treatment evaluation to optimize treatment selection.

Magnetinio rezonanso tomografijos (toliau - MRT) atlikimas ir saugos principų taikymo metodinės rekomendacijos (toliau - Rekomendacijos) skirtos radiologijos technologams, gydytojams radiologams, kurie ambulatoriniams ir stacionaro pacientams atliks MRT tyrimus, gydytojams specialistams, bendrosios praktikos slaugytojams, siunčiantiems pacientus MRT tyrimui atlikti, rezidentams, studentams ir visiems darbuotojams, kurie, eidami savo pareigas, dalyvaus šio tyrimo atlikimo procese.

Background/Objectives LAS is common in adolescents, yet early management strategies differ. The traditional PRICE + NSAIDs protocol focuses on short-term symptom relief, whereas the PEACE and LOVE framework emphasizes education, early optimal loading, and progressive exercise. This study compared functional recovery between these two approaches.

The aponeurotic expansion of the supraspinatus tendon is a recognized but underappreciated anatomical structure of the shoulder. Its sonographic appearance may mimic or coexist with pathology of adjacent tendons, particularly the long head of the biceps tendon, creating diagnostic challenges. Although described in prior literature, many atypical variants remain insufficiently documented. This study aimed to characterize atypical sonographic manifestations of the aponeurotic expansion of the supraspinatus tendon and to propose new classifications based on its relationship with the supraspinatus tendon, its position within the rotator interval, and its association with the long head of the biceps tendon.

Introduction/Background: The aim of this retrospective study was to compare progression free survival (PFS) and overall survival (OS) in patients with advanced ovarian cancer (OC) treated at the single tertiary centre. Methodology: The patients treated for advanced OC (FIGO stages IIIA – IVB) during the period of 2020 – 2022 were included. Based on the radiological evaluation patients underwent primary cytoreductive surgery (PCS) or neoadjuvant chemotherapy followed by interval cytoreductive surgery (ICS). PFS and OS analysis was performed 24 months after completion of treatment. Results: Out of the 134 patients, 82 underwent PCS and 52 - ICS. There were no significant differences between the groups concerning the age (60.7 (SD 11.4) vs. 61.9 (SD 9.1), p=0.52) and ECOG status (ECOG of 0-1 in both groups was 91.5% and 92.5% (p=0.86), respectively). Complete (< 5mm residuals) cytoreduction was achieved in 45/82 (54.9%) PCS patients and 30/52 (57.7%) ICS patients (p=0.75). 90 (71.4%) recurrences and 43 (32.1%) deaths were registered. The patients in PCS group had significantly better median PFS (17 vs. 12 months) and mean OS (20 vs. 18 months) (HR 1.86 95% CI 1.02 to 3.39, p=0.04; HR 1.53 95% CI 1.01 to 2.32, p=0.047). The subgroup analysis showed significantly better PFS and OS in complete PCS subgroup (18 and 22 months, respectively), compared to the other three subgroups of incomplete PCS and complete and incomplete ICS (PFS HR 2.82 (95% CI 1.59 to 4.99 (p<0.001)), 2.06 (95% CI 1.14 to 3.71 (p=0.02)) and 3.31 (95% CI 1.74 to 6.31 (p<0.001); OS HR 3.56 (95% CI 1.38 to 9.18 (p=0.01)), 2.98 (95% CI 1.10 to 8.07 (p=0.03)) and 5.35 (95% CI 1.98 to 14.49 (p<0.001), respectively). Conclusion: Patients in PCS group showed significantly better PFS and OS compared to those in ICS group. The PCS patients with complete surgery had the best PFS and OS.

Background: Mycetoma is a chronic infectious disease caused by bacteria or fungi which typically affects the skin, deep tissues, and bones. This case involves bone mycetoma in an immunocompetent patient, marking the first known instance of actinomycetoma caused by Gordonia rubripertincta. Case Report: A 25-year-old male presented with severe pain and deformity in his left foot, symptoms that began five years prior after stepping on a wire. Initial surgery provided temporary relief, but symptoms worsened over time. Doxycycline treatment was ineffective. Skin biopsies were performed. The patient was diagnosed with actinomycetoma, with Gordonia rubripertincta identified in culture. Although initial improvement was observed with amoxicillin–clavulanate treatment, the condition later worsened, requiring long-term penicillin therapy and eventual surgical excision. Despite treatment, symptoms persisted, leading to a bone biopsy that showed no microorganism growth. A six-week course of ampicillin–sulbactam and ciprofloxacin, along with offloading, decreased pain and stabilized radiological findings. Conclusion: Gordonia infections mean there is no universally established treatment protocol. This case underscores the diagnostic and therapeutic challenges associated with mycetoma, particularly in non-tropical regions.

Background: Medical education increasingly emphasizes not only clinical knowledge but also communication, mentoring, and international collaboration. This abstract presents a reflective case based on an outreach presentation delivered by a fourth-year medical student at the Lithuanian University of Health Sciences (LSMU). Aim: The aim was to engage potential medical students in a dialogue about career paths, using radiology as a core example, while exploring the reflective growth such experiences offer. Methods: As part of the Erasmus+ exchange initiative in April 2024, the author conducted a 15-minute presentation in French for visiting German high school students. The talk, hosted by the Department of Radiology at LSMU, was independently prepared and included insights on radiology's diagnostic role, the flexible structure of clinical placements at LSMU, and the benefits of studying medicine in Lithuania. The session was interactive, including Q & A discussion. Results: The presentation encouraged both audience engagement and personal reflection. Students raised questions about the lifestyle and values of radiologists, prompting deeper consideration of the author's own motivations and long-term goals. The session fostered confidence and a sense of responsibility as a student representative. Furthermore, the experience highlighted the importance of autonomy in education and the role of mentorship in shaping medical identity. Conclusion(s): Early exposure to peer education and international outreach activities fosters the development of key professional qualities such as empathy, clarity in communication, and reflective thinking. Opportunities to explain complex topics to non-medical audiences can clarify one's own path and reinforce commitment to medicine. Such initiatives are beneficial for both prospective students and those presenting.

Background: Necrotizing fasciitis (NF) is a rapidly progressive infection of fascia and subcutaneous tissues. Early symptoms often mimic cellulitis, abscesses, or vascular disorders, complicating timely diagnosis. Radiological imaging (CT, MRI) is crucial for differentiating NF and guiding urgent surgical management. Aim: To highlight diagnostic challenges and differential diagnoses in NF of the thigh, emphasizing the role of imaging in early recognition and management. Methods: A literature search was conducted in PubMed, Scopus, and Google Scholar using "necrotizing fasciitis," "differential diagnosis," "radiology," "CT," and "MRI." Inclusion criteria were full-text articles in English published between 2020-2025, covering case reports, series, reviews, and original research. Articles not focusing on imaging-based differential diagnosis or older than five years were excluded. Findings were synthesized to summarize clinical and radiological features distinguishing NF from cellulitis, abscess, and vascular disorders. Additionally, a clinical case of NF diagnosed and managed at Kaunas Clinics is presented. Results: NF is frequently misdiagnosed as cellulitis, abscess, or vascular disease due to overlapping early signs such as pain, swelling, and erythema. Imaging is decisive: CT shows fascial thickening, subcutaneous gas, and fluid tracking, while MRI detects early soft tissue involvement. Laboratory tools like the LRINEC score aid risk assessment, though early values may be inconclusive. The presented case of a 76-year-old male with perforated sigmoid diverticulitis illustrates these challenges. Initial suspicion was femoral artery thrombosis, but CT revealed retroperitoneal gas spreading into the groin and thigh, confirming NF. Surgical exploration, sigmoid resection, repeated debridements, and supportive care led to survival, emphasizing early imaging and multidisciplinary management. Conclusion(s): NF often mimics common conditions, causing diagnostic delays. Early imaging, laboratory risk assessment, and prompt surgery are crucial. This case underscores the need for high clinical suspicion, including atypical presentations from rare intra-abdominal sources.

Biophysics-based, patient-specific modeling remains challenging for clinical translation, particularly for cerebrospinal fluid (CSF) flow where anatomical detail and computational cost are tightly coupled. We present a computational framework for steady net CSF redistribution in an MRI-derived cranial CSF domain reconstructed from T2-weighted imaging, including the ventricular system, cranial subarachnoid space, and periarterial pathways, to the extent resolvable by clinical MRI. Cranial CSF spaces were segmented in 3D Slicer and a steady Darcy formulation with prescribed CSF production/absorption was solved in COMSOL Multiphysics®. Geometrical and flow descriptors were quantified using region-based projection operations. We assessed discretization cost–accuracy trade-offs by comparing first- and second-order finite elements. First-order elements produced a 1.4% difference in transmantle pressure and a <10% difference in element-wise mass-weighted velocity metric for 90% of elements, while reducing computation time by 75% (20 to 5 min) and peak memory usage five-fold (150 to 30 GB). This proof-of-concept framework provides a computationally tractable baseline for studying steady net CSF pathway redistribution and sensitivity to boundary assumptions, and may support future patient-specific investigations in pathological conditions such as subarachnoid hemorrhage, hydrocephalus and brain tumors.

Background: Chronic low-grade inflammation has been strongly implicated in the pathogenesis of major depressive disorder (MDD) [1]. In particular, cytokines interleukin-6 (IL-6) and tumor necrosis factor α (TNF-α), have been associated with diagnosis of MDD and depressive symptoms in a subset of patients. Preclinical studies have demonstrated that administration of lipopolysaccharide (LPS), a pro-inflammatory component of gram-negative bacterial membranes, induces inflammation and depressive-like behaviours in animal models [2,3]. While these findings provide strong experimental support for an inflammatory component in depression, clinical data on circulating LPS levels in individuals with MDD remain limited. This study aimed to investigate whether plasma concentrations of LPS, IL-6, and TNF-α differ between patients with MDD and healthy controls. Methods: This cross-sectional study included patients with MDD and a control group of subjects without psychiatric history. MDD diagnoses were based on ICD-10 diagnostic criteria and verified by experienced psychiatrists. Participants with unstable medical comorbidities or current anti-inflammatory treatment were excluded. Each study participant completed a sociodemographic questionnaire. Fasting venous blood samples were assayed for plasma LPS, IL-6 and TNF- α using commercial ELISA kits. Descriptive statistics were used to summarize sociodemographic and clinical characteristics. Continuous variables were presented as medians with interquartile ranges (IQR), assessed by the Shapiro-Wilk test. Between-group comparisons for continuous variables were conducted using the Mann-Whitney U test, as data did not meet the assumptions of normality. The Z-score and p-value were reported for each comparison. Results: A total of 143 participants were included in the analysis – 97 subjects with MDD and 46 controls. Demographic and clinical characteristics were comparable between MDD groups and controls with respect to age (Z= –0.801, p=0.423), female proportion (Z= –0.807, p=0.931), and body mass index (BMI) (Z= –0.713, p=0.476). Smoking prevalence was significantly higher in MDD group (Z= –3.513, p<0.001). Somatic comorbidities did not differ between two groups (Z= –0.701, p=0.483). Blood plasma LPS levels were significantly elevated in all the participants with MDD (median: 148.0 pg/ml, IQR: 81.1–245.3) compared to controls (median: 95.6 pg/ml, IQR: 57.5–132.3), with a statistical result of Z = –3.525 and p<0.001. In contrast, IL-6 levels did not differ significantly between the groups (Z = –0.145, p = 0.884), with median values of 1.31 pg/ml (IQR: 0.55–3.20) for the MDD group and 1.25 pg/mL (IQR: 0.59–3.13) for the controls. TNF-α levels were mostly undetectable in both groups; however, a slight but statistically significant difference was noted (Z = –1.98, p = 0.048). Most participants in both the MDD and control groups had undetectable TNF-α levels, which may be attributed to the limited sensitivity of the immunoassay used. Conclusion: Elevated plasma LPS, but not IL-6 and TNF-α differentiates MDD patients from healthy controls. These findings support LPS as a potential biomarker and therapeutic target in MDD.