Clinical radiology最新文献

Aim: The present study assessed the effectiveness and safety of stent placement for treating iliac vein compression syndrome (IVCS) with acute deep venous thrombosis (DVT).

Materials and methods: We conducted a retrospective study on 31 patients with IVCS companied with acute DVT who underwent percutaneous mechanical thrombectomy or catheter-directed thrombolysis and angioplasty combined with iliac vein stenting from January 2017 to January 2023. Follow-up was performed at 3, 6, and 12 months after the surgical procedure. At each visit, patients were evaluated by colour Doppler ultrasound or computed tomography venography to determine stent patency; additionally, visual analog scale (VAS), venous clinical severity score (VCSS), and five-level EuroQol-five dimensions (EQ-5D-5L) questionnaire were used to assess pain, severity, and symptoms associated with venous pathology and quality of life, respectively.

Results: The technical success rate of stent placement was 100 % in all patients. All patients completed follow-up at 3, 6, and 12 months after surgery. The primary patency rates were 96.8 % (95 % CI: 90.2-103.4 %) at 3, 6, and 12 months. The secondary patency rate was 96.8 % (95 % CI: 90.2-103.4 %) at 3 months and 100 % at 6, and 12 months. Only one patient experienced in-stent restenosis and underwent reintervention postoperation. All patients showed a significant improvement (P<0.05) in the scores of VAS, VCSS, and EQ-5D-5L.

Conclusion: Venous stent implantation was a safe and effective therapeutic approach for patients with IVCS combined with acute DVT.

Aim: To evaluate the diagnostic performance of nonenhanced magnetic resonance imaging (MRI) in grading glioma and correlating isocitrate dehydrogenase (IDH) mutation status.

Materials and methods: Patients with diagnoses confirmed by postoperative pathology were enrolled. Quantitative parameters, including the relative amide proton transfer-weighted (rAPTW), relative cerebral blood flow (CBF), and apparent diffusion coefficient (ADC) were applied to grade gliomas and correlate IDH mutation status. MRI parameters were compared with an independent-sample t-test. The diagnostic performance was assessed and compared with a receiver operating characteristic (ROC) curve and the area under the ROC curve (AUC).

Results: The rAPTW signal and rCBF values were significantly higher in high-grade gliomas (HGG) than in low-grade glioma (LGG), whereas ADC values were significantly lower in HGG than in LGG. Compared with 3D-pCASL imaging and diffusion-weighted imaging (DWI), 3D-APTW imaging had the best diagnostic performance in distinguishing LGG from HGG, with an AUC of 0.930, a sensitivity of 91.2% and a specificity of 87.5%. By adding 3D-APTW imaging to 3D-pCASL imaging, or DWI, the diagnostic performance of both sequences increased. Furthermore, APTW, rAPTW, CBF, and rCBF values in the IDH mutant-type (IDH-mut) group were significantly lower than those in the IDH wild-type (IDH-wt) group, ADC values were significantly higher in IDH-mut group than in IDH-wt group.

Conclusion: 3D-APTW imaging demonstrated better diagnostic performance than DWI or 3D-pCASL imaging in grading gliomas. Moreover, 3D-APTW imaging had added value in addition to both 3D-pCASL imaging and DWI in distinguishing LGG from HGG. 3D-APTW, 3D-pCASL, and DWI imaging could be used to discriminate between IDH-mut and IDH-wt group.

Aim: The aim of the study was to evaluate and compare contrast-to-noise ratios (CNRs) and signal-to-noise ratios (SNRs) of pre- and postcontrast T1 maps, T2 maps, early and late gadolinium images in terms of visual assessment of cardiac thrombus, to see if maps can replace contrast-enhanced images for detection of cardiac thrombus.

Materials and methods: T1, T2 maps, and postcontrast images of 22 patients with cardiac thrombus were retrospectively evaluated for SNR and CNR. SNR and CNR values of thrombus, blood pool, and myocardium measured at maps and contrast-enhanced images were compared with each other.

Results: The distinguishability of thrombus from blood pool and myocardium was better on early gadolinium images (EGE) and late gadolinium enhanced (LGE) images than T1 and T2 mapping. The mean CNRs calculated to be the highest on EGE, followed by LGE and then maps.

Conclusion: Native mapping sequences may have a potential in detecting cardiac thrombus, but contrast-enhanced images are superior. In future studies, the optimal mapping sequence for evaluation of thrombus in noncontrast images can be determined by using different modified Look-Locker inversion recovery schemes or other T1 and T2 mapping methods.

Precis: CNR values of EGE and LGE remained higher than mapping sequences.

Aim: To assess transmural remission in patients with Crohn's disease using low-dose small bowel computed tomography (CT) perfusion scans.

Materials and methods: Forty six patients were divided into active and remission phases based on Crohn's Disease Activity Index (CDAI) and C-reactive protein (CRP). Dual-source CT enterography with low-dose perfusion scans was conducted to generate perfusion parameter maps, including blood flow (BF), blood volume (BV), time to peak (TTP), mean transit time (MTT), and permeability of surface (PS). We compared differences in perfusion parameter values of intestinal walls, mesenteric fat, and lymph nodes between two groups. Receiver operating characteristic (ROC) curves were plotted, and area under the curve (AUC), sensitivity, specificity, and cutoff values were calculated.

Results: The BF, BV, TTP, MTT, and PS values of the intestinal wall were significantly higher in the active phase (P0.05). Additionally, lymph node BF and TTP displayed significant differences (P<0.01).

Conclusion: Dual-source CT enterography with low-dose perfusion scans enables quantitative assessment of Crohn's disease microcirculation in intestinal walls, mesenteric fat, and lymph nodes. These quantitative indicators provide strong diagnostic efficacy and offer insights into whether the disease is in transmural remission.

Aims: To describe the imaging features of patients presenting with soft tissue masses and a provisional diagnosis of soft tissue tumours, for whom biopsy confirmed the presence of necrotising granulomata consistent with tuberculoma.

Material and methods: A review of the histopathology database for patients who had a diagnosis of necrotising granulomata in nonspinal sites. Patients with bone and joint-based pathology were excluded. Patient age, sex, lesion location, and relevant history were recorded, as were the radiographic, magnetic resonance imaging (MRI), and US findings.

Results: Four males and three females were included, with a mean age of 45.7 years (range 20-71 years). Radiographs showed soft tissue calcification in two cases. On MRI, three lesions were mildly hyperintense on T1W TSE images, and a 'penumbra sign' was seen in six cases. T2W FSE and fat suppressed PDW FSE/STIR sequences demonstrated mixed fluid/solid signal intensity in all cases. All patients showed peri-lesional oedema, while postcontrast studies in two patients showed rim enhancement and heterogeneous enhancement, respectively. On US, one lesion appeared mainly solid, and six were predominantly fluid. US-guided needle biopsy established the diagnosis of necrotising granulomatous infection in all cases.

Conclusion: Soft tissue tuberculomas can present as soft tissue masses mimicking sarcomas. However, the presence of a 'penumbra sign' on T1W TSE sequences and peri-lesional oedema should raise the possibility of infection. Biopsy specimens should therefore be sent for both histopathology and microbiology culture and sensitivity.

Aim: To compare the image quality obtained using two accelerated high-resolution 3D fluid-attenuated inversion recovery (FLAIR) techniques for the brain-deep learning-reconstruction SPACE (DL-SPACE) and Wave-CAIPI FLAIR.

Materials and methods: A total of 123 participants who underwent DL-SPACE and Wave-CAIPI FLAIR brain imaging were retrospectively reviewed. In a qualitative analysis, two radiologists rated the quality of each image, including the overall image quality, artifacts, sharpness, fine-structure conspicuity, and lesion conspicuity based on Likert scales. In a quantitative analysis, the signal-to-noise ratio (SNR) for the normal-appearing white matter (NAWM) and lesion and the contrast-to-noise ratio (CNR) for a lesion were calculated and compared. Moreover, the volumes of white matter hyperintensities (WMHs) obtained with the two techniques were automatically quantified and compared.

Results: The DL-SPACE FLAIR technique demonstrated a significantly higher fine-structure conspicuity (P < 0.001), lower degree of artifacts (P < 0.001) and higher overall image quality (P = 0.001). The mean SNR values were significantly higher with the DL-SPACE FLAIR technique (NAWM, 43.95 vs. 31.6; lesion, 31.35 vs. 21.28; all, P < 0.001). Additionally, the mean CNR of the WMH was significantly higher with the DL-SPACE FLAIR technique (11.34 vs. 8.22; P < 0.001). The periventricular and deep WMH volumes were significantly larger with the DL-SPACE FLAIR technique (1.91 ± 4.69 vs. 1.54 ± 4.18; P < 0.001 and 0.26 ± 0.42 vs. 0.23 ± 0.38; P = 0.002, respectively).

Conclusion: The DL-SPACE FLAIR technique produced images with superior quality, SNR and CNR compared with the Wave-CAIPI FLAIR technique with the same acquisition time.

Aim: To provide a theoretical basis for the study of the pathogenesis of residual dizziness (RD) from the perspective of imaging.

Materials and methods: The general clinical data of the RD group and healthy control (HC) group were statistically analysed by two independent sample t tests, rank sum tests or chi-square tests. The imaging data of the two groups of people were preprocessed and statistically analysed by using the data processing and analysis for brain imaging (DPABI) software package.

Results: Compared with the HC group, the grey matter volume (GMV) in the left medial superior frontal gyrus, the left superior temporal gyrus, the right cerebellum crus1 area, and the right calcarine were significantly reduced in the RD group; the functional connectivity (FC) between the ventromedial prefrontal cortex (vmPFC) and the post insula in the RD group was enhanced; The FC between the vmPFC and the occipital lobe, between the temporal lobe and the inferior parietal lobe, between the mid insula and the mid insula, between the post cingulate gyrus and the post cingulate gyrus was weakened.

Conclusion: 1. The GMV of many brain areas processing vestibular information of RD patients is reduced, the FC between them is weakened, which may be an important cause of RD. 2. The FC between many brain areas dealing with emotional information in RD patients is abnormal, which may be the adaptive response of them caused by emotional factors.

Aim: To investigate the value of the LR-5, which is based on hepatobiliary phase (HBP) hypointensity, for small hepatocellular carcinoma (sHCC) using LI-RADS v2018 criteria.

Materials and methods: From January 2015 to December 2021 in institution 1, and from January 2019 to February 2022 in institution 2, 239 patients at high risk for hepatocellular carcinoma (HCC) underwent contrast-enhanced MRI. Two radiologists independently evaluated the imaging features and classified them according to LI-RADS v2018 criteria, calculating the diagnostic performance of LR-5 based on consensus data. LI-RADS-m1: HBP hypointensity was used as an additional major feature along with the LI-RADS v2018. LI-RADS-m2: HBP hypointensity replaced nonperipheral "washout" in the portal venous phase. The definition of LR-DN was nodules pathologically diagnosed as high-grade dysplastic nodules (HGDN) were recategorized as LR-DN. The diagnostic performance of LR-5 was recalculated. The diagnostic performance of the LR-5 was compared using McNemar's test.

Results: Using LI-RADS v2018, LI-RADS-m1, and LI-RADS-m2 criteria for LR-5, the sensitivities were 82.67%, 86.22%, and 88.44%, the specificities were 82.00%, 66.00%, and 54.00%, and the accuracies were 82.55%, 82.55%, and 82.18%, respectively. After the addition of the LR-DN, the sensitivities of LR-5 in the above diagnostic model remained unchanged, with accuracies of 84.36%, 87.27%, and 88.36% and specificities of 92.00%, 92.00%, and 88.00%, respectively.

Conclusions: HBP hypointensity may improve the sensitivity of LR-5. We attempted to propose the LR-DN, HBP hypointensity may be used as a complement to washout as an additional major feature without significantly decreasing specificity.

Aim: To enhance the understanding of COVID-19 regional lung damage pattern by analyzing the organ in subregions, beyond the typical lobe segmentation.

Materials and methods: This study used semiautomatic computed tomography (CT) imaging segmentation and quantification to investigate regional lung impairments in patients with COVID-19. Each lung was divided into 12 regions, and the anatomical impairments obtained from the CT image (emphysema, ground glass opacity, and collapsed tissue) were quantified. Then, the results for every region were correlated with clinical outcomes. This research encompassed 333 individuals, both COVID positive (n = 190) and COVID negative (n = 143), whose medical reports were checked for the need for ventilatory support and outcome (cure or deceased).

Results: Findings indicate a strong association between the extent of lung damage and COVID-19 diagnosis, the level of ventilatory assistance required, and patient survival rates. Notably, the medial posterior lung region exhibited increased opacities and collapse in COVID-positive patients (p < 0.05), particularly those requiring invasive ventilation or who succumbed to the illness.

Conclusion: The results expand the knowledge of COVID-19 regional impact beyond typical lobe segmentation and indicate that COVID-19 impairments in the lungs are localized. The most affected region identified was the medial posterior of both right and left lungs. Early detection of quantifiable lung damage can serve as a valuable prognostic tool, helping to pinpoint patients at heightened risk of severe complications or mortality.

Objective: To investigate the prevalence, patterns and influence factors for iodinated contrast media (ICM)-related adverse reaction (AR) in patients with a history of allergies.

Methods: Patients with a history of allergies who underwent contrast-enhanced CT between January 2014 and December 2020 were enrolled. ICM-related AR and patient information were retrospectively analyzed. χ² and Student t test were used to compare between different groups, and logistic regression analyses were adopted to investigate influence factors for AR.

Results: 325243 patients performed contrast-enhanced CT examinations. 713 cases with ICM allergy history and 27045 cases with non-ICM allergies history were included. The overall AR incidence was 0.66% (184/27758) and severe AR occurred in 0.05% (14 of 27758). 90.22% (166/184) of AR occurred within 20 minutes after injection. 2 severe AR occurred more than 30 minutes in patients with non-ICM allergies history. Compared with other ICMs, iodixanol was associated with higher incidence of AR in patients with ICM allergy history (10.71%; 12 of 112) and non-ICM allergies history (1.1%; 46 of 4172). Iohexol was associated with lower incidence of AR in patients with non-ICM allergies history (0.24%; 17 of 7134). Age ≥70 years (OR, 0.2; P<0.001) and hypertension (OR, 0.6; P=0.025) were protective factors for ICM-related AR in patients with non-ICM allergies history.

Conclusions: In patients with a history of allergies, most AR occurred within 20 minutes after injection. The AR incidence was associated with ICM generics. Age ≥70 years and hypertension were protective factors for ICM-related AR in patients with non-ICM allergies history.