Filipe Barros Alves

Purpose To evaluate the Apparent Diffusion Coefficient (ADC) values of the primary tumor and lymph nodes in endometrial cancer, correlating them with pathological results, to determine their predictive accuracy for lymph node metastases. Methods A retrospective observational study was conducted on patients with endometrial carcinoma who underwent preoperative MRI staging, surgical treatment and postoperative pathological analysis in our institution from 2014 to 2022. The analyzed variables included were, among others: the mean, minimum and maximum ADC values of the primary tumor and lymph node(s); the variation of the mean, minimum and maximum ADC values between the lymph node(s) and the tumor; the short axis of the lymph node(s); and the pathological evaluation of the lymph node(s) - metastatic vs. non-metastatic involvement. A multivariable analysis was performed using R (version 4.2.2), with metastatic involvement of the lymph node(s) as the outcome. The inter-rater reliability for the ADC values’ measurements was assessed using intraclass correlation coefficient (ICC). Results The study’s cohort included 74 patients, comprising a total of 233 lymph nodes. A mean ADC value variation ≤ 0.13 between the lymph nodes and the primary tumor and a lymph node short axis ≥ 9 mm were significantly associated with lymph node metastases, with odds ratios of 10.91 (p < 0.001) and 18.13 (p < 0.001), respectively. ICC values for ADC measurements ranged from 0.81 to 0.96, indicating good inter-rater reliability. Conclusion Along with the lymph node short axis, the mean ADC value variation has potential to predict lymph node metastases in patients with endometrial cancer. Graphical abstract

This study aimed (a) to evaluate the spatiotemporal gait variables of total knee arthroplasty (TKA) before (pre-) and after the procedure (post-), and (b) to investigate the influence of the surgical side on these variables. Twenty-one volunteers (13 females and 8 males) participated, undergoing assessments pre-surgery and nine to 12 months post-surgery. Clinical tests indicated significant reductions in knee pain and improvements in active and passive extension post-surgery. TKA resulted in decreased pain, extension deficits, and functional assessments, with lower scores on the WOMAC questionnaire. A gait analysis showed post-surgery improvements in gait speed (5.8%), cycle time (−4.8%), step time (4.4%), double limb support time (−11.1%), step (4.4%) and stride (6.3%) lengths, and step (5.1%) and stride (5.0%) cadences. Comparisons between surgical side and limb dominance indicated significant differences in gait speed, stance, swing and step times, double limb support time, step and stride lengths, and step cadence. The non-dominant limb demonstrated greater improvements across most parameters compared to the dominant limb. These findings emphasize the importance of considering the limb dominance of patients with knee osteoarthritis when evaluating post-TKA function. These conclusions can be helpful for personalized rehabilitation programs, allowing tailored interventions for individuals undergoing knee surgery.

Early diagnosis of lung cancer via computed tomography can significantly reduce the morbidity and mortality rates associated with the pathology. However, search lung nodules is a high complexity task, which affects the success of screening programs. Whilst computer aided detection systems can be used as second observers, they may bias radiologists and introduce significant time overheads. With this in mind, this study assesses the potential of using gaze information for integrating automatic detection systems in the clinical practice. For that purpose, 4 radiologists were asked to annotate 20 scans from a public dataset while being monitored by an eye tracker device and an automatic lung nodule detection system was developed. Our results show that radiologists follow a similar search routine and tend to have lower fixation periods in regions where finding errors occur. The overall detection sensitivity of the specialists was 0.67±0.07, whereas the system achieved 0.69. Combining the annotations of one radiologist with the automatic system significantly improves the detection performance to similar levels of two annotators. Likewise, combining the findings of radiologist with the detection algorithm only for low fixation regions still significantly improves the detection sensitivity without increasing the number of false positives. The combination of the automatic system with the gaze information allows to mitigate possible errors of the radiologist without some of the issues usually associated with automatic detection systems.