Razvan Tudor Tepordei

Background: Coronary artery disease remains the leading cause of morbidity and mortality worldwide. Increasing evidence has demonstrated that many acute coronary events originate not from severely obstructive lesions but from structurally unstable atherosclerotic plaques. Consequently, the identification of vulnerable plaques has become a major objective in contemporary cardiovascular imaging. Coronary computed tomography angiography (CCTA) has evolved from a modality primarily focused on luminal stenosis assessment into a comprehensive non-invasive technique capable of evaluating plaque morphology, composition, and overall coronary atherosclerotic burden. Results: Our review summarizes current evidence regarding the role of CCTA in the detection and characterization of vulnerable coronary plaques. Particular emphasis is placed on imaging biomarkers associated with plaque instability, including low-attenuation plaque, positive remodeling, spotty calcifications, and the napkin-ring sign, which have been consistently linked to an increased risk of adverse cardiovascular events. Advances in quantitative plaque analysis have further enhanced the ability of CCTA to assess plaque burden and monitor disease progression. Emerging technologies are rapidly expanding the capabilities of coronary CT imaging. Spectral CT techniques and photon-counting detector CT offer improved tissue characterization and enhanced visualization of plaque components. In parallel, artificial intelligence and machine learning algorithms are enabling automated plaque detection, segmentation, and risk prediction, facilitating more precise and reproducible analysis of large imaging datasets. Conclusions: Despite these advances, limitations remain, including restricted spatial resolution for microstructural plaque assessment and the limited ability of conventional CT to directly evaluate biological processes such as inflammation. Future developments integrating advanced CT technologies, artificial intelligence, and multimodality imaging are expected to further improve the non-invasive identification of vulnerable plaques and personalized cardiovascular risk stratification.

Background: Haller cells (HCs), infraorbital pneumatization of the anterior ethmoidal air cells, are anatomical variants frequently located adjacent to the maxillary sinus ostium. Their presence has been hypothesized to interfere with mucociliary drainage and contribute to the pathophysiology of chronic rhinosinusitis (CRS). Despite numerous imaging-based investigations, the etiological role of Haller cells in CRS remains uncertain. The aim of this meta-analysis is to highlight the association between HC and CRS using data derived from Computed Tomography (CT) and Cone-Beam Computed Tomography (CBCT) imaging. Materials and Methods: Following PRISMA guidelines and a registered protocol in the PROSPERO database, a systematic search across PubMed, EMBASE, and COCHRANE databases led to the inclusion of eight studies published between 2011 and 2024, comprising 2011 patients. The included studies employed multiplane reconstruction techniques and high-resolution imaging protocols. The majority of studies were retrospective, with only one adopting a prospective design. Results: The pooled odds ratio (OR) for the association between HC and CRS was 1.54 (95% Confidence Interval: 0.93–2.54; p = 0.09), suggesting a non-significant trend toward a positive correlation. Heterogeneity was substantial (I² = 87%, p < 0.01), due to differences in study design, populations, and diagnostic criteria, contributing to inconsistency in reported estimates across the studies. Moreover, Egger’s test showed no evidence of publication bias (intercept = 0.67, p = 0.895). Although three studies fulfilled all eleven evaluation criteria outlined by the JBI (Joanna Briggs Institute) checklist, the observed variability limits the interpretability of pooled outcomes. Conclusions: These findings suggest that, while HC may play a role in CRS pathogenesis, the current evidence does not support a statistically significant association. Future prospective research using standardized imaging and diagnostic criteria is essential to clarify the clinical impact of HC in sinonasal disease.

Current diagnostic assessments of lung disease rely primarily on medical imaging and global pulmonary function tests, which either provide static structural information or collapse complex regional behavior into global indices. As a result, important information about regional mechanical heterogeneity and early pathological changes may remain inaccessible. In this work, we introduce a conceptual diagnostic framework for the lung based on mechanical system identification and evaluate its feasibility using simulation-based analysis. Rather than directly imaging internal lung structure, the lung–thorax system is treated as an identifiable viscoelastic dynamical system whose internal mechanical properties can be inferred from its response to controlled external excitation. A multi-degree-of-freedom mechanical representation of the lung was developed to capture the dominant low-frequency behavior of the chest wall and major lung regions. Sensitivity and Fisher-information analysis confirmed the structural identifiability of regional stiffness parameters (FIM eigenvalues λ₁ = 1.75 × 10⁻⁹ and λ₂ = 8.91 × 10⁻¹⁰). Inverse fitting experiments accurately recovered simulated stiffness perturbations (e.g., k₀₁ = 240 → 239.5; k₀₂ = 154 → 159.5) from noisy frequency response data, while classification experiments achieved the complete separation of simulated pathological configurations in an idealized synthetic scenario, supporting theoretical discriminability rather than clinical performance claims. These findings demonstrate the theoretical feasibility of a diagnostic paradigm in which regional lung mechanical alterations can in principle be identified through mechanical system identification rather than direct imaging, thereby suggesting a complementary approach for a non-invasive assessment of regional lung mechanics from externally measured responses. By quantifying regional stiffness and mechanical heterogeneity, this framework may also support the personalization and monitoring of pulmonary rehabilitation strategies in chronic respiratory disease.

Background: Pulmonary fibrosis (PF) and post-infectious fibrotic lung disease are characterized by marked heterogeneity in radiologic patterns, physiologic impairment, and clinical presentation. Conventional analytic approaches often fail to capture non-linear and multimodal relationships between structural imaging findings and functional limitation. Integrating imaging-derived representations with clinical and functional data using artificial intelligence (AI) may provide a more comprehensive characterization of disease heterogeneity. Objectives: The objective of this study was to develop and evaluate a multimodal AI framework combining imaging-derived embeddings and structured clinical data to identify atypical clinical–radiologic profiles in patients with pulmonary fibrosis using unsupervised anomaly detection. Methods: A retrospective cohort of 41 patients with radiologically confirmed pulmonary fibrosis or post-infectious fibrotic lung disease was analyzed. Deep imaging embeddings were extracted from baseline thoracic CT examinations using a pretrained convolutional neural network and integrated with standardized clinical and functional variables. A multimodal variational autoencoder (VAE) was trained in an unsupervised manner to learn the distribution of typical patient profiles. Patient-specific anomaly scores were derived from reconstruction error plus latent regularization (β·KL divergence). Associations between anomaly scores, disease severity, and clinical markers were assessed using Spearman rank correlation. Results: Anomaly scores were right-skewed (median 26.91, IQR 22.87–32.11; range 19.75–46.18). Patients above the 85th percentile (anomaly score ≥ 33.85) comprised 7/41 (17.1%) of the cohort and occurred across all clinician-assigned severity categories (mild 3, moderate 1, severe 3). Anomaly scores overlapped substantially across severity groups, with similar medians (mild 26.47, moderate 28.55, severe 28.23). Correlations with conventional severity markers were weak and non-significant, including DLCO (% predicted; ρ = −0.25, p = 0.115) and FEV₁ (% predicted; ρ = −0.22, p = 0.165), a pattern consistent with anomaly scores reflecting multimodal deviation rather than severity alone, while acknowledging the exploratory nature of the analysis. Highly anomalous patients frequently exhibited discordant clinical–radiologic profiles, including preserved functional capacity despite marked imaging-derived deviation or disproportionate physiological impairment relative to imaging patterns. Conclusions: This proof-of-concept study demonstrates that multimodal VAE-based anomaly detection integrating imaging-derived embeddings with clinical data can quantify clinical–radiologic heterogeneity in pulmonary fibrosis beyond conventional severity stratification. Unsupervised anomaly detection provides a complementary framework for identifying atypical multimodal profiles and supporting individualized phenotyping and hypothesis generation in fibrotic lung disease. Given the modest cohort size, these findings should be interpreted as illustrative and hypothesis-generating rather than generalizable.

Introduction: Haller cells are anatomical variations in the ethmoid bone that can extend into the maxillary sinus and are often implicated in sinonasal pathologies. Their role in predisposing individuals to chronic rhinosinusitis (CRS) remains a subject of debate. This study aims to provide a comprehensive review of the association between Haller cells and CRS, focusing on their prevalence, diagnostic imaging, and clinical significance. Materials and Methods: A systematic review of the literature was conducted using databases such as PubMed, Scopus, and Web of Science. Studies published between 2000 and 2024 were included, analyzing the prevalence of Haller cells, their detection using imaging modalities (CT, MRI), and their correlation with CRS symptoms. Articles were evaluated for quality and relevance, and data were synthesized to highlight common findings and discrepancies. Results and Discussion: Haller cells were identified in approximately 10-45% of the population, with prevalence varying based on study design and imaging techniques. While not always symptomatic, larger or extensively pneumatized Haller cells were associated with obstruction of the infundibulum, impaired drainage of the maxillary sinus, and increased risk of CRS. Imaging, particularly CT, was critical in detecting these cells and assessing their anatomical impact. Surgical intervention, such as functional endoscopic sinus surgery (FESS), was reported to improve symptoms in cases where Haller cells contributed to CRS. However, the literature revealed inconsistencies regarding the direct causal relationship, emphasizing the need for individualized clinical evaluation. Conclusions: Haller cells may play a contributory role in the pathophysiology of CRS, particularly in cases with anatomical predisposition to sinus obstruction. Accurate imaging and assessment are essential for diagnosis and treatment planning. Future research should focus on prospective studies to better establish causality and optimize management strategies.

Neurodevelopment in children is an essential process. Its importance lies in the fact that the first stages of life are defined as critical for the formation of the brain and later cognitive, emotional and social skills. In this process, the intestinal microbiota is defined by its permanent bioactivity, continuously stimulating the interest in modern medical research. In agreement with the above, we set out to study how the interrelationship between the two entities impacts neurocognitive imbalances. We conducted a review of the most recent published data on the topic of interest. Centralized data attest to a strong correlation between gut dysbiosis and the development of neurological conditions in pediatrics (e.g., depression, autism spectrum disorders, attention deficit hyperactivity disorder, and Rett syndrome). The pathophysiology of intercurrents affects many ways, among which emphasizing the neuro-endocrine axis, immune or through the vagus nerve. We also note an apparent overlap of the main stages of neurodevelopment with those of microbiota maturation. In conclusion, we argue that interventions such as diet modification, supplementation with probiotics/prebiotics/symbiotics and fecal matter transplantation represent new research directions in the management of pediatric neurological conditions. Therefore, we believe that current efforts must focus on studying the possible benefits of manipulating the gut microbiota in preventing and ameliorating cognitive-behavioral damage and integrating them into the individualized management protocol of affected children.

Introduction: The atlas, or first cervical vertebra (C1), plays a crucial role in the craniovertebral junction. Unlike typical vertebrae, it lacks a vertebral body and is instead made up of two lateral masses connected by the anterior and posterior arches. Additionally, C1 is often associated with various congenital abnormalities, including defects in the posterior arch (PAD). The goal of our study is to characterize the defects of the C1 posterior arch, to identify the prevalence of this developmental anomaly in the population of north-eastern Romania and to objectivise the association with other C1 malformations. Materials and Methods: Our retrospective study encompassed 715 patients who underwent cranio-cerebral CT scans between May 2022 and August 2024. Two experienced radiologists reviewed the DICOM files. Results: In our cohort, we identified posterior arch defects (PADs) of the atlas in 1.95% of patients (14 out of 715). Our analysis revealed no significant differences related to sex, with the cases being equally distributed between seven women and seven men. The age group distribution was also similar, further supporting the notion that PADs are incidental findings. Although 4 out of 14 cases of PADs were associated with other malformations, statistical significance was not achieved. Conclusions: Posterior arch defects of the atlas are relatively common congenital malformations in the population of north-eastern Romania. The most frequent morphological form is median dehiscence, which aligns with Type A. These defects do not show a sex or age predominance, consistent with their classification as congenital malformations.

Odontogenic sinusitis (OS) is a form of maxillary sinus inflammation originating from dental pathologies, such as periapical lesions, periodontal disease, or complications following dental procedures. Accurate diagnosis is critical for effective treatment and prevention of chronic complications. Over the past decade, advancements in imaging modalities have revolutionized the diagnostic approach to OS, providing enhanced visualization of the maxillary sinus and its relationship with dental structures. This paper reviews modern imaging techniques, including panoramic radiography, cone-beam computed tomography (CBCT), multidetector computed tomography (MDCT), and magnetic resonance imaging (MRI), highlighting their respective roles, advantages, and limitations in the evaluation of OS. Among these, CBCT has emerged as the gold standard for its high resolution and three-dimensional visualization of the tooth-bone-sinus complex, offering unparalleled accuracy in identifying odontogenic causes of sinusitis. MDCT remains a valuable tool for broader evaluations, particularly in cases involving extensive sinonasal involvement. MRI, while limited in assessing bony structures, provides superior soft tissue contrast and is particularly useful in identifying mucosal inflammation or complications extending beyond the maxillary sinus. The paper emphasizes the importance of selecting the appropriate imaging modality based on clinical presentation and suspected pathology. By integrating advanced imaging techniques into the diagnostic process, clinicians can achieve more precise identification of odontogenic aetiologies, optimize treatment planning, and improve patient outcomes. Future research should focus on refining imaging protocols and exploring novel technologies to further enhance diagnostic accuracy and patient care.

Background: Articular damage is a marker of hereditary hemophilia, especially affecting the large joints of the upper and lower limbs. This retrospective study aimed to emphasize that hereditary coagulopathies, specifically hemophilia A and B, require a multidisciplinary approach due to their complex nature. The primary objectives of the paper are to determine the prevalence of hemophilic arthropathy among individuals with hemophilia in the northeastern region of Romania, identify the most frequently affected joints, and assess whether there is a correlation between the development of hemophilic arthropathy, the type of hemophilia, and the treatment received. The secondary objectives of the work are to identify a series of particularities regarding the occurrence of the comorbidities depending on the type of hemophilia and the treatment and severity of arthropathies. Materials and Methods: We conducted a retrospective study that included 36 adults with hemophilia A and B. The status of the osteoarticular system was evaluated using the modified Hemophilia Joint Health Score (mHJHS). Twelve joints were evaluated using the following parameters: swelling, duration of swelling, muscle atrophy, joint pain, crepitus on motion, flexion loss, and extension loss. Results and Discussions: The most severe damage was found in the joints of the knees, ankles, elbows, and wrists. In the knees, severe damage was noted significantly more frequently in the right knee (50% vs. 33.3%; p = 0.001). In the ankles, a higher frequency of mild damage to the left ankle was noted (44.4% vs. 27.8%; p = 0.002). The severe form of hemophilia was correlated with severe joint damage (p < 0.05). Comorbidities like cardiovascular disease, obesity, viral infection (HCV infection), and gastrointestinal disease were found in the hemophilia population of our study. All patients with HCV infection had severe joint damage, while 38.5% of patients without HCV infection had mild joint damage, and 30.8% had no joint damage (p = 0.001). In all patients with HCV virus infection, the treatment was short-term substitution (intermittent prophylaxis), while in 53.8% of patients without HCV virus infection, the treatment consisted of continuous prophylaxis (p = 0.001). Conclusions: It is currently essential to determine methods for comprehensive hemophilia care that involves multidisciplinary medical services necessary for the diagnosis, treatment, and management of the condition and its complications and comorbidities.

The limbic system is made up of a vast network of components such as the cingulate gyrus, the hippocampus and the parahippocampus or ismic formation. All these components make up the “Great Lobe Limbic”. Through its components, it makes numerous connections such as those with the septal area, the thalamus, the hypothalamus, the habenular nuclei or the mammary bodies. Our study aims to demonstrate the variability of the components of the limbic system through their morphometric evaluation on anatomical parts and, respectively on CT images. 13 adult brains without known neurological abnormalities, fixed in 10% formalin solution for a minimum of 10 weeks, and 22 CT craniocerebral datasets of patients without any organic cerebral dysfunctions were evaluated. To remove any bias, two teams of two investors each performed examinations. The anterior, superior and posterior diameters of the cingulate gyrus were measured, as well as the longitudinal and transverse diameters of the parahippocampal and isthmic gyri. In order to be able to compare the measurements made on the anatomical preparations with those provided by the CT images, we reported the diameters mentioned with the diameters of the corresponding hemisphere. All statistical analyses were conducted using Microsoft Excell 2016. Linear data were evaluated as mean +/- standard deviation. Comparisons between continuous variables were performed using the Student t-test. Statistical significance was set at a P-value 0.05. Statistical analyses demonstrated significant differences (p 0.01) between the two groups regarding FL/ACG, SL/SCG, OL/PCG and LCI/TCI. Only the LPG/TPG ratio was similar between the two cohorts. The limbic system has a great morphological and morphometrically variability. Our morphometric study proved precisely the variability that is found, both on anatomical parts and on CT images.