Clinical radiology最新文献

Aim: This study investigates the potential of positron emission tomography-computed tomography (PET-CT) as a reliable tool for the diagnosis of osteoporosis, using attenuation values as a marker for bone mineral density (BMD) assessment.

Materials and methods: We retrospectively identified 305 patients who underwent both PET-CT and dual-energy X-ray absorptiometry (DEXA) within a six-month interval at a tertiary healthcare centre. Attenuation values were measured from the first lumbar vertebra (L1) on noncontrast CT images acquired during PET-CT scans. These values were then compared with corresponding DEXA T-scores to determine their diagnostic performance. Statistical analyses, including one-way Analysis of Variance (ANOVA), Pearson correlation, and receiver operating characteristic (ROC) curve analysis were employed to assess the correlation between PET-CT attenuation values and DEXA-defined osteoporosis.

Results: The mean Hounsfield units (HU) differed significantly between groups classified by DEXA as osteoporosis, osteopenia, or normal BMD (P < 0.001). A strong correlation was found between HU and DEXA T-scores (Pearson coefficient = 0.65). Using logistic regression, we identified HU thresholds of 120 for 90% sensitivity and 98 for 90% specificity. The optimal balanced threshold was 109 HU, achieving both 80% sensitivity and specificity. The ROC curve for the model showed an area under the curve (AUC) of 0.88, indicating high diagnostic accuracy.

Conclusion: PET-CT can effectively screen for osteoporosis, offering a noninvasive, opportunistic diagnostic tool that requires no additional radiation exposure or resources. This study establishes 109 HU as the optimal threshold for diagnosing osteoporosis on PET-CT, providing a significant opportunity for early intervention and improved patient care.

Aim: To assess the safety of computed tomography-guided percutaneous cryoablation (PCA) in patients who had pre-procedural ureteral stenting, while they were treated for clinical T1 renal cell carcinoma (RCC) with complex location.

Materials and methods: This retrospective international multicenter cohort study included patients treated between January 2016 and February 2021 at two University Hospitals, X1 and X2. Patients aged more than 18 years with suspected RCC were included. All patients underwent pre-procedural ureteral stenting. The complications were recorded within 30 days and graded according to the Clavien-Dindo classification and the Society of Interventional Radiology classification of adverse events. Major complications were defined as complications ≥ grade 3 on the Clavien-Dindo classification.

Results: The cohort included 61 patients with a median age of 66 years (IQR 55-75 years). The median tumour size was 33 mm (IQR 24-38 mm), with a median R.E.N.A.L score of 8 (IQR 7-10). A complication rate of 36% (n=22) was recorded, and major complications occurred following 10% (n=6) of the procedures. A statistically significant association was found between using more than three cryoprobes and postoperative complications (OR, 4.19; 95% CI: 1.38-12.75; p=0.010). In addition, no associations were found between postoperative complications and prophylactic antibiotics, patient age, tumour complexity, tumour size, histological type, or whether the ice ball was touching the ureter.

Conclusion: This multicenter cohort study found a relatively high rate of postoperative complications in patients having a ureteral stent before PCA. However, no complications resulted in a chronic outflow obstruction. The number of high-complexity tumours could explain the high rate of complications.

Aim: To evaluate the correlation between semi-quantitative analyses and visual scores of pulmonary perfusion Single Photon Emission Computed Tomography (SPECT)/ Computed Tomography (CT) imaging and pulmonary function test parameters (PFTs) in patients with interstitial lung diseases (ILDs).

Materials and methods: This retrospective study included 35 patients with ILDs from China-Japan Friendship Hospital between January 2020 and December 2022. All patients underwent pulmonary perfusion SPECT/CT imaging and a pulmonary function test. Visual scores of pulmonary perfusion SPECT/CT images were determined using the Meyer method, and functional lung volumes of pulmonary perfusion were calculated using various cutoff values (5%-95% of the maximum pixel value). PFTs included forced expiratory volume in the first second (FEV1) and FEV1 as a percentage of the predicted value (FEV1%), forced vital capacity (FVC) and FVC as a percentage of the predicted value (FVC%), one-second rate (FEV1/FVC), pulmonary carbon monoxide dispersion (DLCO) and DLCO as a percentage of the predicted value (DLCO%). Pearson's correlation was calculated to compare visual scores and lung perfusion functional volumes with PFT indices.

Results: Visual scores correlated with FEV1, FEV1%, FVC% and DLCO%, with a significant correlation observed for FEV1% (r = 0.576, P < 0.001). When taking the maximal pixel value of bilateral lung fields or unilateral lung field as 100%, lung perfusion volumes were significantly correlated with FEV1, FEV1%, FVC and FVC% at a threshold of 15%-30% (r_s > 0.6, P < 0.001).

Conclusion: Pulmonary perfusion volumes within the threshold of 15%-30% in pulmonary perfusion SPECT/CT imaging reliably reflect lung function and outperform visual scores in patients with ILDs.

Aim: To evaluate and compare the diagnostic performance of diffusion-weighted imaging (DWI)-based virtual magnetic resonance (MR) elastography and serum fibrosis indexes for staging liver fibrosis in patients with chronic hepatitis B (CHB).

Materials and methods: This retrospective study included 145 patients with CHB. Virtual shear modulus (μ_Diff) was derived from DWI acquisition with b values of 200 and 1500/mm². Aspartate aminotransferase to platelet ratio index (APRI), fibrosis-4 index (FIB-4), S index, Fibro Q and gamma-glutamyl transpeptidase to platelet ratio (GPR) were calculated. The diagnostic efficacies of μ_Diff and serum indexes for staging liver fibrosis were compared.

Results: μ_Diff, APRI, FIB-4, S index, Fibro Q, and GPR increased as the hepatic fibrosis progressed (r=0.23-0.52, P<0.05). Areas under the curves (AUCs) of μ_Diff were 0.725, 0.817 and 0.764 for significant fibrosis, advanced fibrosis, and cirrhosis, respectively. μ_Diff had greater AUC over FIB-4 (0.686) and Fibro Q (0.638) for advanced fibrosis (P<0.05). The AUCs of combination of μ_Diff with APRI, FIB-4, S index, Fibro Q, and GPR individually were 0.779, 0.772, 0.763, 0.728, and 0.756 for significant fibrosis, 0.856, 0.842, 0.834, 0.831, and 0.834 for advanced fibrosis, 0.811, 0.818, 0.784, 0.835, and 0.788 for cirrhosis, respectively. The AUCs of the combinations were significantly higher than individual serum index for advanced fibrosis and cirrhosis (all P<0.05).

Conclusion: DWI-based virtual MR elastography could estimate liver fibrosis stages in patients with CHB, which outperformed FIB-4 and Fibro Q for advanced fibrosis. The combination of μ_Diff with each serum index appears superior to individual serum index for advanced fibrosis and cirrhosis.

Osseous and cartilaginous soft tissue tumours are a heterogenous group of neoplasms characterised by the presence of an osseous or cartilaginous component. Mineralisation of the osseous or cartilaginous component is a common finding amongst these lesions, presenting as calcification/ossification on radiological imaging. This pictorial review examines the key imaging findings and characteristics of osseous and cartilaginous soft tissue tumours with a focus on the distinguishing features which can help the radiologist to differentiate benign and malignant lesions. All examples provided are of histopathologically proven cases seen in our tertiary referral soft tissue sarcoma centre.

Aim: To assess the diagnostic accuracy and inter-reader agreement of a simulated abbreviated gadoxetate liver magnetic resonance imaging (MRI) protocol together with contrast-enhanced computed tomography (CE-CT) against a standard gadoxetate MRI for the detection of colorectal liver metastases at baseline.

Materials and methods: Three readers independently evaluated two sets of images per patient, recording number and location of metastases and benign lesions. Set 1 comprised T1w, T2w, DWI, multiphase CE-T1w, and hepatobiliary phase (HBP) images (standard). Set 2 included T2w, HBP, DWI (from Set 1) and CE-CT (simulated abbreviated). Diagnostic performance was compared using McNemar's test. The level of agreement between sets 1 and 2 was determined with Cohen kappa. For agreement in the number of benign lesions and metastases, we applied intraclass correlation coefficient (ICC).

Results: Seventy-five patients (245 metastases, 122 benign lesions) were evaluated. There was no significant difference in diagnostic accuracy between set 1 and 2 for each reader (mean P = 0.74). The total number of metastases and benign lesions showed high agreement between reading set 1 and 2 (κ = 0.81, 0.78). The total number of metastases showed substantial agreement between readers for set 1 and 2 (ICC = 0.99, 0.99). Good agreement was seen for metastatic segmental involvement (κ = 0.84-0.99).

Conclusion: At baseline, using a simulated abbreviated liver MRI together with CE-CT showed excellent agreement with standard MRI protocol for liver metastasis detection.

Aim: Compare the efficacy and procedural efficiency of central vascular plug-assisted portal vein embolization (PVE) with absolute ethanol compared to selective PVE.

Materials and methods: Between 2016 and 2023, patients who underwent ipsilateral percutaneous transhepatic PVE were included. Selective PVE involves serial cannulation and embolization of portal veins. Central vascular plug-assisted PVE involves deploying a vascular plug at the main portal vein with embolization. Recorded data includes patient demographics, disease diagnosis, volumetry, embolization procedure, biliary drainage, surgery, and measures of future liver remnant hypertrophy (relative hypertrophy, degree of hypertrophy, and kinetic growth rate).

Results: The cohort comprised of 30 patients (cohort mean age 64±9 years old, females n=14) of which 17 (57%) patients underwent central vascular plug-assisted PVE. Indications for PVE were predominately (87%, 26/30) due to bile duct cancer. Volumetric changes between central vascular plug-assisted PVE and selective PVE were not different between the two groups (DH 13%±5 vs 11%±4, p=0.21; and KGR 3%/week ± 2 vs 2%/week ± 2, p=0.27, respectively). Overall procedure times were shorter for central vascular plug-assisted PVE (45±20 minutes vs 112±34 minutes; p<0.001). Two adverse events occurred in selective PVE, while none in central vascular plug-assisted PVE. There was no difference in rates of surgery or no surgery for both methods (p=0.07).

Conclusion: Central vascular plug-assisted PVE with absolute ethanol effectively induced FLR hypertrophy, and significantly reduced procedure times due to faster embolization and simpler technique.

Aim: To develop a larynx preservation (LP) score model to predict laryngectomy-free survival (LFS) in advanced laryngeal squamous-cell carcinoma (LSCC) with morphological response to neoadjuvant chemotherapy (NAC).

Materials and methods: In this retrospective study, patients with advanced LSCC were included. All patients were classified into NAC response and non-response groups according RECIST. Arterial and venous phases of standardized iodine concentrations of dual-energy CT were measured in the response group, and the rate of iodine concentration change (ΔNIC%) was calculated by (NICpost-NICpre)/NICpre ×100%. Clinical outcomes between the two groups were analyzed using chi-square test. Univariable and multivariable cox regression analyses were performed to evaluate the independent predictors of LFS in the response group. A risk score was developed based on the hazard ratios from the multivariable analysis.

Results: A total of 146 patients were included. 86 patients achieved a response. T stage, N status, and ΔNAIC% were independent predictors of LFS for LSCC patients with NAC morphological response (all, p<0.001). Based on these factors, the established LP risk score model demonstrated an AUC of 0.877 for the 1-year LFS rate and 0.950 for the 2-year LFS rate. Patients with a score ≥6 had a worse LFS (p<0.001) and OS (p=0.001).

Conclusion: A prediction risk score incorporating T stage, N status, and ΔNAIC% shows good predictive effectiveness for LFS in advanced LSCC with morphological response to NAC. It can prevent high-risk patients in the NAC response group from undergoing salvage laryngectomy and improve patient prognosis.