Padervinskienė, Lina

Šio vadovėlio tikslas - pateikti šiuolaikinį požiūrį į politraumą (sin. dauginė trauma) patyrusio paciento radiologinę diagnostiką ir skirtas visiems radiologams ir kitų specialybių gydytojams, kurie klinikinėje praktikoje susiduria su politraumą patyrusiais pacientais. Visame pasaulyje garsiai kalbama apie poreikį politraumą patyrusius pacientus tirti ir gydyti vadovaujantis standartizuotais protokolais, nes esant kritinėms būklėms pirmosios valandos turi ypač didelę reikšmę tolesniam paciento tyrimui, gydymui ir išgyvenamumui. Todėl geros praktikos traumos komandos turi vadovautis principu, kad politraumą patyręs pacientas reikiamu metu atsidurtų reikiamoje vietoje reikalingam tyrimui ir gydymui gauti.

Background: Chronic obstructive pulmonary disease (COPD) is associated with right ventricular (RV) dysfunction and subclinical myocardial injury. The effects of dual bronchodilation on RV function and cardiac injury biomarkers remain limited. Objectives: To evaluate 12-week changes in pulmonary function, RV function, and serum troponin-I in newly-diagnosed COPD patients receiving tiotropium/olodaterol as routine clinical care and to assess differences in RV function and troponin-I between COPD and non-COPD controls with comparable cardiovascular diseases (CVDs). Design: Prospective real-world observational study. Methods: Treatment-naïve patients with moderate-to-severe COPD were assessed at baseline and after 12 weeks of treatment. Evaluations included spirometry, plethysmography, two-dimensional and speckle-tracking transthoracic echocardiography, cardiac magnetic resonance imaging (MRI), and troponin-I. Baseline RV measurements and troponin-I were compared between COPD (n = 47) and controls (n = 23). Results: COPD patients had lower RV fractional area change and RV free-wall strain (FWS) than controls (p < 0.001 and p = 0.018, respectively). Troponin-I was above the limit of detection in 93.6% of COPD and in 56.5% of controls (p < 0.001). COPD treatment increased forced expiratory volume in 1 second (FEV1) and forced vital capacity while reducing residual volume-to-total lung capacity (TLC) and functional residual capacity (FRC)-to-TLC (p < 0.05). RV global longitudinal strain (GLS) improved from 21.7 ± 2.6% to 23.0 ± 2.8%, and RV-FWS from 24.2 ± 3.3% to 26.1 ± 3.6% (both p < 0.05) in echocardiography (n = 29). ΔRV-GLS correlated positively with ΔFEV1 and inversely with ΔFRC/TLC (p < 0.05). In the moderate COPD subgroup, RV-GLS in MRI changed from 22.6 ± 6.1% to 25.5 ± 7.5% (p = 0.037), and troponin-I decreased from 1.23 pg/mL (IQR 1.03–1.56) to 1.09 pg/mL (IQR 0.95–1.20; p = 0.049). Conclusion: COPD affects RV function and troponin-I regardless of concomitant CVDs. Initiation of dual bronchodilation is associated with beneficial effects on RV strain and troponin-I in patients with COPD. Because of the small sample size, these findings should be interpreted cautiously and confirmed in larger studies.

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.

Background and Objectives: Lung cancer and pulmonary metastases are major causes of cancer-related mortality. Surgery is a standard curative approach, but many patients are ineligible due to age, comorbidities, or treatment preference. This study aimed to evaluate the safety, effectiveness, and quality-of-life outcomes of thermal ablation versus surgery and stereotactic body radiotherapy (SBRT) for malignant lung lesions. Materials and Methods: A prospective, non-randomized study was conducted on 68 patients with primary or metastatic lung tumours treated by surgery (n = 19), SBRT (n = 29), or thermal ablation (n = 20). The key outcomes included recurrence rates and patterns, disease-free and overall survival, complications, hospitalization, and health-related quality of life (HRQoL). Results: Surgery demonstrated the lowest total and regional recurrence rates (21.1% and 10.5%, respectively), significantly lower than SBRT (57.1% and 42.9%, respectively; p < 0.05). Additionally, surgery led to the longest disease-free survival but was associated with the highest complication rate (78.9%) and the greatest HRQoL decline. SBRT had fewer complications (17.2%) and moderate HRQoL outcomes. Thermal ablation showed no significant differences in recurrence (45.0% of total recurrence) or survival compared to surgery or SBRT, with a moderate complication rate (45.0%) and the most favorable HRQoL outcomes. Major complications were rare and comparable across all groups. Conclusions: Thermal ablation demonstrated comparable disease control and quality-of-life outcomes to SBRT, with lower complication rates. While surgery remains superior in local disease control, its invasiveness and impact on quality of life underscore the importance of minimally invasive treatments in multidisciplinary management of malignant lung lesions.

Radiology is a medical specialty that is becoming increasingly significant due to technological progress, particularly the development of artificial intelligence (AI). However, students’ and doctors’ perceptions of this field are influenced by various factors that can shape their professional choices. This study set out to understand how students, residents, and radiologists themselves view radiology as a specialty and to determine what role AI plays in their decision-making process. The study was conducted over three months, from October 2023 to January 2024, with a total of 182 respondents participating. These included 98 medical students, 33 radiology residents, and 51 practicing radiologists. Data were collected through an anonymous questionnaire tailored to each group. The responses were analyzed using statistical methods to identify patterns and significant associations. The findings revealed that students most valued flexibility in work schedules and the possibility of remote work or employment abroad. However, 70.4% stated that they did not see radiology as their future profession. Residents highlighted subspecialization opportunities and the growing impact of AI on reducing diagnostic errors. Practicing radiologists placed emphasis on salary prospects, compatibility with personal preferences, and limited direct patient contact. Although AI is seen positively across all groups, students were the least likely to consider its development as a decisive factor when choosing radiology. In contrast, residents and doctors increasingly recognized AI’s potential to support diagnostic processes and reduce human error. The results suggest that medical schools and residency programs should place greater emphasis on radiology’s technological advancements and practical applications to better align students’ perceptions with the reality of the specialty. More practical exposure to radiology and its integration with AI could enhance its appeal to future healthcare professionals.

Introduction Pulmonary hypertension (PH) is a rare, progressive disease that leads to right ventricular dysfunction and high mortality. Recent studies highlight the prognostic value of cardiac magnetic resonance imaging (CMRI)- derived functional and deformation parameters, which may improve risk stratification and long-term survival in patients with PH. Objectives:

1. To evaluate the five-year survival of patients with precapillary PH, treated at the Pulmonary Hypertension Centre, Hospital of LSMU Kauno Klinikos.
2. To identify the prognostic value of baseline right and left ventricular (RV and LV) geometry, function, and deformation indices, determined by CMRI, for five-year survival in patients with precapillary PH. Materials and methods: A retrospective study was conducted by analysing 55 patients with precapillary PH treated at The Pulmonary Hypertension Centre, Hospital of LSMU Kauno Klinikos. Clinical features at the time of diagnosis, levels of serum NT-proBNP concentration, 6-minute walking test results, and both ventricles’ functional and deformation parameters determined by CMRI were assessed. Data were analysed using the IBM SPSS Statistics 29.0 software, and differences were considered statistically significant at p < 0.05. Results: The five-year survival rate was 46.75%. Non-survivors had increased levels of serum NT-proBNP (1089.0 [239.0–2541.5] vs 2064.5 [1375.3–5473.5] ng/ml, p = 0.014), decreased LV global longitudinal strain (GLS) (-18.4 [-24.9–(-15.3)] vs -15.3 [-19.4–(-10.2)] %, p = 0.042), reduced RV ejection fraction (EF) (45.0 [34.5–54.0] vs 34.0 [24.3–40.8] %, p = 0.005), increased RV end-systolic volume index (ESVi) (44.0 [25.5– 66.5] vs. 62.0 [48.0–88.0], ml/m2 , p = 0.007), and lower RV free wall longitudinal strain (FWLS) (-20.5 [-27.4– (-15.8)] vs -13.9 [-18.1–(-11.0)] %, p = 0.004), when compared to survivors at the time of diagnosis. Threshold values associated with increased five-year mortality risk included NT-proBNP level of ≥ 534.5 ng/l, LV GLS ≥ -12.75%, RV EF ≤ 43.5%, RV FWLS ≥ -17.7%, and RV ESVi of ≥ 45.5 ml/m2 . Conclusions: Reduced longitudinal strain in both ventricles and lower right ventricular ejection fraction, as determined by CMRI, are associated with a higher risk of mortality within five years following the precapillary PH diagnosis.

Introduction. There is a growing interest in right ventricle (RV) function and RV–pulmonary artery (PA) coupling in patients with pulmonary hypertension (PH). While studies have shown correlation between TAPSE/PASP and pulmonary vascular resistance (PVR) in precapillary PH patients, the prognostic value of RV–PA coupling, as well as possible additional echocardiographic parameters representing RV function and coupling or uncoupling, remains underexplored. Objectives. The objective of this study was to assess the prognostic value of 2D echocardiographic parameters focusing on the right heart. We aimed to determine the predictive value of RV function and RV– PA coupling at baseline for one- and three-year survival in patients with precapillary PH. Materials and Methods. In this retrospective study 55 patients diagnosed with precapillary PH (groups 1 and 4) were included. The median age at the time of diagnosis was 57.5 years. Among them, 16 were male (29.1 %), and the remaining 70.9% were female. The median of mean pulmonary arterial pressure (mPAP) was 43 mmHg, pulmonary capillary wedge pressure 10.0 [6.0-11.0] mmHg. Specific treatment for PH did not differ between the survivor and non-survivor groups. Baseline 2D echocardiographic parameters were analyzed. Statistical analysis was performed to identify predictive parameters. Results. One-year survival was 78.2%, three-year survival was 50.9%. Survival rates did not differ between gender groups. In one-year survival analysis, a tendency towards lower RV fractional area change (FAC) in the non-survivor group was observed; however, the difference was not statistically significant (29.3 [24.2-34.3] % vs. 22.8 [21.0-30.9] %, p=0.087). A similar trend was observed for RV free wall longitudinal strain (FWLS), as baseline values were lower in the one-year non-survivor group compared to the survivor group (-12.9 [-10.2- (-18.2)] % vs. -10.9 [-9.28-(-12.3)] %, p=0.051). At three-year follow-up, several parameters demonstrated significant differences between the analysed groups. Tricuspid annular plane systolic excursion (TAPSE) was higher in the survivor group (17.0 [16.0–19.0] mm) compared to the non-survivor group (15.0 [12.8–17.0] mm), p=0.019. TAPSE/pulmonary artery systolic pressure(PASP) ratio was also higher among survivors (0.23 [0.15-0.37] mm/mmHg) versus non-survivors (0.16 [0.13-0.21] mm/mmHg), p=0.031. In addition, the S’/ PASP ratio was higher in the survivor group (0.12 [0.089-0.21] vs 0.10 [0.070-0.13], p=0.046). Conclusions. Right ventricle FWLS and FAC at baseline could have a predictive value in association with one-year mortality; however, stronger evidential support is still needed. RV-PA uncoupling (TAPSE/ PASP, S’/PASP) as well as reduced RV longitudinal function (TAPSE, S’) at baseline indicate an unfavorable three-year prognosis.

Introduction Radiology is an important part of the healthcare system, enabling the diagnosis of a wide range of diseases (1). The rapid application of artificial intelligence (AI) in radiology may become a tool that will influence the radiology specialty in daily practice (2). Observing the increasing use of AI in the specialty of radiology, we conducted a study to investigate the impact of AI on the attitudes of medical students, radiology residents and radiologists about the future prospects of AI in the specialty of radiology. Aim To investigate the attitudes of medical students, radiology residents and radiology physicians towards the impact of AI on the future of radiology. Methods Data were collected in a prospective study using an original questionnaire. Data analysis was performed using the IBM SPSS Satistics 29.0 statistical package. Statistically significant difference is considered when p ≤ 0.05. Results The analysis included 182 respondents, including 98 students, 33 radiology residents and 51 radiologists. There were 122 women and 60 men. The study found a statistically significant association (p=0.016) between students' gender and attitudes towards the influence of AI on choices in radiology. Women were more likely to deny (84.9%) the influence of AI development on their choice of specialty than men (15.1%), who admitted that AI has a greater influence on their choice of radiology specialty. We also found a statistically significant (p=0.05) correlation between the perceived impact of AI development in radiology on students' future specialty choice. In the question about the impact of AI on the future of the radiology specialty, one of the most frequent choices made by radiology residents was that AI will facilitate the work of radiologists (91.2%). Other options, such as AI will reduce the likelihood of errors in radiology and AI will change the way radiologists work, were also chosen by 76.5% and 41.2% of radiology residents respectively. When comparing the answers of radiology residents and radiologists, the option that AI will facilitate the work of radiologists was chosen by 20.6% less by radiologists. As a multiple-choice option, this option was chosen by 70.6% of radiologists. Also, a lower proportion of radiologists (68.6%) compared to residents (76.5%) indicated that AI will reduce the likelihood of errors, and almost half of radiologists (49%) believe that AI will change the way radiologists work in future. Conclusions Overall, it can be stated that the integration of AI in radiology has a significant impact on all groups of respondents in the study. The responses of the group of medical students showed that the integration of AI in radiology will have an important impact on the future choice of radiology specialty. Respondent groups of residents and physicians who have already chosen radiology stressed that the integration of AI in radiology will facilitate clinical work and reduce the likelihood of errors.

Introduction Cardiotoxicity remains a significant concern as breast cancer treatments continue to improve [1]. Cardiac magnetic resonance (CMR) offers additional measurements, including multiparametric tissue characteristics and deformation, which can show subtle changes in myocardial function [2]. Recent evidence indicates that the changes in the left atrium (LA) may also be one of the early subclinical signs of cardiotoxicity [3]. Aim This study aimed to evaluate early morphometric and functional changes of LA in patients undergoing potentially cardiotoxic anthracycline treatment for breast cancer and compare them to LV functional parameters. Methods Fifty-five women undergoing breast cancer treatment with anthracyclines were included in the study. CMR was performed before starting cardiotoxic therapy and three and six months after the initiation of treatment. The CMR images were analyzed using dedicated postprocessing software (Medis Suite MR, The Netherlands). Using the longaxis cine images, LA volume (LAV), LA area (LAA), LA emptying fraction (LAEF) (normal range 46–78% [4]) and LA strain (LAS), as well as LV global longitudinal strain (LVGLS), were calculated. LV ejection fraction (LVEF) was estimated using stack of short-axis CMR images. LA volume and area were indexed to body surface area. Statistical analysis was performed using the IBM SPSS 29.0 package. Results The mean age of the participants was 54 ± 10 years. The statistical analysis of LV function indicated a statistically significant decrease in LVEF over 6 months from 66,79 ± 5,30 % at baseline to 62,91 ± 5,79 % at the 6-month followup (p = 0,001), but remaining in normal range (higher than 55%). The change in LVGLS did not reach statistical significance (p = 0,297). The analysis revealed that the change in LAA (22,64 ± 4,17 cm2 vs. 21.95 ± 4,89 cm2 vs. 22,77 ± 4,77 cm2, p = 0,690) and LAAi (12,13 ± 2,01 cm2 /m2 vs. 12,03 ± 2,57 cm2 /m2 vs. 12,26 ± 2,19 cm2 /m2 ; p = 0,873) during 6 months period was not significant, nor were the changes in LAV (74,43 ± 19,22 ml vs. 70,58 ± 22,84 ml vs. 73,05 ± 23,71 ml; p = 0,453) and LAVi (40,25 ± 8,90 ml/m2 vs. 38,91 ± 11,34 ml/m2 vs. 39,21 ± 11,58 ml/m2 ; p = 0,431). The LAEF showed a statistically significant decrease between the baseline and 6-month followup (57,48 ± 9,70 % to 54,45 ± 8,17 %, p = 0,028). The LAS value had also decreased from 35,95 ± 12,01 at baseline to 30,26 ± 8,21 at the 6-month follow-up (p = 0,003), with the most significant changes occurring between the 3- month follow-up (35,41 ± 8,92) and the 6 month follow up (p = 0,002). Moreover, a moderate positive correlation was observed between LAV and LVGLS (r = 0,338, p < 0,001) and between LAV and LVEF (r = 0,338, p < 0,001), indicating a relevant link in LA volumetric and LV functional measurements. Conclusions LA functional measures decreased early, suggesting they could be one of the first markers of decreasing heart function and require further investigation.