Clinical radiology最新文献

Aim: Superb microvascular imaging (SMI) is a new ultrasound tool that can detect small blood vessels while cancelling out artefacts. It may be useful in detecting the vascularity associated with malignant breast lesions. This study evaluated the reproducibility and diagnostic performance of SMI's Vascular Index (VI) in differentiating benign from malignant solid breast lesions.

Materials and methods: Solid breast lesions were prospectively assessed by two observers before core biopsy. Each lesion was given BIRADS score, and SMI VI was measured. The reproducibility and diagnostic performance of SMI VI were assessed by the intraclass correlation coefficient (ICC) and by the area under the receiver operating characteristics (AUROC) curve, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV).

Results: 121 lesions in 115 patients were assessed, of which 53 were malignant and 68 benign. The ICC for SMI VI readings was 0.72. The SMI VI AUROC was 0.61, the sensitivity was 90.4%, specificity of 31.9%, PPV of 50% and NPV of 81.5%. The BIRADS scores in all lesions had an AUROC of 0.78, sensitivity of 100%, specificity of 55.1%, PPV of 62.7%, and NPV of 100%.

Conclusion: This is the first study to assess the reproducibility and diagnostic performance of SMI VI in differentiating benign from malignant breast lesions in a European population. We have shown that SMI VI is poor at differentiating benign from malignant breast lesions, and therefore reproducibility is irrelevant in this context. Future studies may find other uses for SMI's depiction of lesion vascularity.

Aims: To develop a model predicting high-intensity focused ultrasound (HIFU) efficacy in adenomyosis treatment using enhanced T1WI and T2WI-FS radiomics combined with clinical imaging features.

Materials and methods: The study included 137 adenomyosis patients treated with HIFU from September 2021 to December 2023. Based on nonperfused volume ratio (NPVR), participants were divided into two groups: NPVR < 50% (n=77) and NPVR ≥ 50% (n=60). Patients were randomly split into training and test sets (7:3 ratio). Radiomics features were extracted from enhanced T1WI and T2WI-FS sequences, while clinical imaging features were selected using univariate analysis and binary logistic regression. Logistic regression models were built for radiomics, clinical imaging, and combined data. Model performance was assessed using ROC curves, Delong's test, and calibration curves.

Results: AUCs for the radiomics, clinical-imaging, and combined models in the training set were 0.831, 0.664, and 0.845, respectively, and 0.829, 0.597, and 0.831 in the test set. The combined model outperformed the clinical-imaging model (training p=0.001, test p=0.01) and the radiomics model (training p=0.012, test p=0.032). However, no significant difference was found between the combined and radiomics models (p>0.05). Calibration curves and decision curve analysis confirmed the combined model's accuracy and clinical applicability.

Conclusion: A model incorporating clinical-imaging features with T1WI and T2WI-FS radiomics effectively predicts HIFU success in adenomyosis treatment, offering valuable guidance for clinical decision-making.

Aim: Malignant biliary obstructive disease is commonly managed with percutaneous transhepatic biliary drainage (PTBD). Traditionally, outcomes are evaluated collectively despite substantial variability in the underlying aetiology and extent of disease. The purpose of this study was to investigate whether variability in survival could be explained by different underlying patient and disease factors.

Materials and methods: A single centre, retrospective study was performed looking at first-time malignant PTBD and respective survival outcomes between 2017- 2021. Survival censoring was taken as June 2022. Predictors included aetiology, age, preprocedural serum haemoglobin, and bilirubin. Subgroups were dichotomised with respect to median values. Kaplan-Meier survival analysis and the log rank test were used for univariate analysis and Cox proportional hazards regression for multivariate analysis.

Results: One hundred fifty-six patients were identified, including 62 pancreatic, 19 ampullary/duodenal, 55 hilar cholangiocarcinoma, and 20 non hepatobiliary cancers. Median overall survival for the entire cohort was 136 days. The underlying aetiology significantly impacted median survival with non-hepatobiliary obstruction faring the worst; 53 days, and was in stark contrast to cholangiocarcinoma (347 days, p < 0.001). On multivariate analysis, we found that in addition to aetiology, patients > 70 years, preprocedural haemoglobin (< 110) and bilirubin (> 232) were all independent prognosticators and had significantly worse survival (HR 1.2, 1.8, 1.6, and 1.4, respectively, all p < 0.05).

Conclusion: Age, underlying malignant aetiology, preprocedural haemoglobin, and bilirubin were identified as independent predictors of post-PTBD survival. Careful patient selection may therefore improve patient outcomes following PTBD.

Aim: To assess the diagnostic potential of a noncoronary-dedicated pre-TAVR CT angiography (CTA) conducted as a prospective ECG-gated scan without premedication and standard cardiac reconstructions in evaluating bystander coronary artery disease (CAD) against invasive coronary angiography (ICA) as the gold standard.

Materials and methods: This retrospective study included 232 patients who underwent both CTA and ICA as part of their pre-TAVR evaluation. Exclusion criteria included prior stent, pacemaker, coronary artery bypass, or valve surgery. Coronary arteries were analysed solely through thin-slice axial reconstructions, with observers blinded to ICA results. Stenosis was categorised as mild (< 50%), moderate (50%-69%), or severe (≥70%). Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy were calculated for 50% and 70% diameter stenosis (DS) thresholds.

Results: At the 50% DS threshold, CTA demonstrated 71% sensitivity, 74% specificity, 92% NPV, and 38% PPV. At the 70% DS threshold, results included 46% sensitivity, 91% specificity, 93% NPV, and 41% PPV. The highest vessel-specific NPV at 50% DS was for the left main (98%) and left anterior descending (LAD) (91%); at 70% DS, left main (LM) (98%) and left circumflex (LCX) (94%) showed the highest NPV. Image quality impacted NPV, with excellent or very good image quality linked to higher diagnostic performance.

Conclusion: Noncoronary-dedicated pre-TAVR CTA shows promise for ruling out significant CAD effectively and may act as a gatekeeper for ICA, aligning with typical coronary CT angiography (CCTA) outcomes.

Aim: This study aimed to identify the imaging feature of perinephric myxoid pseudotumor of fat (PMPF) in a large cohort.

Materials and methods: Institutional radiology and pathology databases were queried for PMPF for the period from January 2010 to December 2023. Of the 22 identified individuals, two were excluded due to nonavailability of computed tomography (CT) or magnetic resonance (MR) images and five due to lack of pathological confirmation. The study cohort comprised of 15 individuals (males = 10), with median age of 59 years (range: 26-87 years). Three abdominal radiologists in consensus reviewed all relevant CT, magnetic resonance imaging (MRI) and positron emission tomography (PET) images.

Results: Seventeen tumuors were analysed since two individuals had bilateral tumuors. The tumuors were at the renal hilum (n=7) or perinephric space (n=10). Two imaging patterns were seen: hazy ill-defined predominantly fatty mass (n=9) or a soft tissue mass (n=8) with variable fat content (0-90%). At presentation, the tumuors ranged in size from 1.5 to 16.5 cm (median: 6.2 cm). The perihilar tumuors encased central renal vessels without occlusion or thrombus. Ureteric encasement and mild hydronephrosis were seen in 11 and 4 tumuors, respectively. Most (9 of 13) of the affected native kidneys and all transplant kidneys (n=5) showed parenchymal poor contrast enhancement. Tumuors with greater than 12-month follow-up (n=11) showed a median growth of 15%.

Conclusion: PMPF may be considered in the diagnosis of tumuors with soft tissue and fat components situated at the renal hilum or perinephric space. The delayed contrast enhancement, relative lack of mass effect for size, and poor function of affected kidney are diagnostic features.

Aim: This study aimed to detail our experience of using SCOUT® radar reflector for lesion localisation in the breast and axilla.

Materials and methods: This is a prospective cohort study describing our clinical experience with the first 500 patients who received SCOUT® to localise lesions in the breast and axilla (from 23 July 2020 to 4 April 2022). Study measures include patient demographics, lesion location, diagnostic pathways (screening or symptomatic), imaging, and surgical and pathology outcomes.

Results: Of the 500 patients, most patients (n = 424; 84.8%) had a single device inserted. A total of 361 had SCOUT® inserted under ultrasound guidance, 128 under stereotactic guidance, and 11 under dual mammographic and ultrasonographic guidance. We successfully inserted SCOUT® in 33 patients for lymph node identification for potential targeted axillary dissection. The mean time between SCOUT® insertion and the planned surgical procedure was 40.6 days.

Conclusion: Our results suggest that SCOUT® is a promising preoperative localisation device for nonpalpable breast and axillary lesions. Its implementation has the potential to optimise the clinical workflow by eliminating the need for a separate localisation procedure using conventional localisation markers and streamlining the treatment pathway.

Aim: Evaluation of pericoronary adipose tissue changes induced by inflammation by non-invasive techniques is challenging.

Purpose: To find the association between pericoronary adipose tissue attenuation (FAI) changes and future acute coronary events in nonobstructive coronary artery disease.

Materials and methods: Ours was a single-centre, prospective observational study on patients with atypical chest pain who underwent coronary computed tomography angiography (CCTA). In patients with CADRADS 1 to 3 nonobstructive coronary artery disease (CAD), pericoronary FAI was measured around the proximal right coronary artery (RCA) and coronary artery segment with plaque using semi-automated postprocessing software. Patients were followed up for development of acute coronary events (ACE). Kaplan-Meier curves were used to see event-free survival rates.

Results: Of 120 patients with a mean follow-up period of 67 months, 21 patients developed acute coronary events. RCA-FAI and lesion FAI of patients with ACE were significantly higher as compared to patients without events. ROC curve analysis showed RCA-FAI as the best predictor of ACE at a cut-off point of > -77.3 Hounsfield unit (HU) (with an AUC of 0.915) with high sensitivity (95.24%), specificity (83.84%), and negative predictive value (98.80%). On multivariate analysis, RCA-FAI, diabetes mellitus, and stenosis ≥50% were independent risk factors of ACE with hazard ratios of 1.335 (1.173-1.518), 4.950 (1.716-14.278), and 7.446 (2.257-24.566), respectively.

Conclusion: RCA FAI can predict ACE in nonobstructive coronary artery disease patients. Detection of high RCA FAI of > -77.3 HU on CCTA can help to identify high-risk patients who need regular follow-up and early initiation of interventions.

Aim: To evaluate the impact of different b-value combinations on synthetic diffusion-weighted imaging (sDWI) and determine the sDWI with an optimal b-value combination for prostatic cancer (PCa) diagnosis.

Material and methods: A retrospective analysis of 68 patients with abnormal prostate-specific antigen (PSA) was conducted. The sDWI images with b value of 1500 s/mm² were separately reconstructed by the following five b-value combinations: b=0, 200s/mm² (sDWI_0-200); b=600, 800s/mm² (sDWI_600-800); b=0, 600s/mm² (sDWI_0-600); b=200, 800s/mm² sDWI_200-800); b=0, 800s/mm² (sDWI_0-800). Quantitative analysis was performed on the acquired DWI (aDWI) images with b=1500s/mm² (aDWI₁₅₀₀) and all sDWI images. These six image groups were scored in five aspects for image quality and further reviewed by two radiologists via six protocols: Protocol Ⅰ, T₂WI+sDWI_0-200; Protocol Ⅱ, T₂WI+sDWI_600-800; Protocol Ⅲ, T₂WI+sDWI_0-600; Protocol Ⅳ, T₂WI+sDWI_200-800; Protocol Ⅴ, T₂WI+sDWI_0-800; Protocol Ⅵ, T₂WI+aDWI₁₅₀₀. The corresponding diagnostic efficacies for PCa were evaluated using receiver operating characteristic (ROC) curves.

Results: Contrast ratio values of all sDWI images were higher than those of aDWI₁₅₀₀ images. Contrast-to-noise ratio values of sDWI_0-200 and sDWI_600-800 images were lower than those of the rest sDWI images. All subjective quality scores of sDWI_0-600, sDWI_200-800, and sDWI_0-800 were significantly higher than other groups except for background signal suppression. The area under the curve (AUC) of Protocol Ⅲ, Ⅳ, Ⅴ, and Ⅵ was significantly larger than those of other protocols.

Conclusion: Different b-value combinations impact the image quality and diagnostic accuracy of sDWI for PCa detection. The combination of b≤200s/mm² and b≥600s/mm² revealed to be optimal.

Clinical and interventional radiology services play a vital role in the provision of modern healthcare, but there is a widening gap between the capacity of the imaging workforce and increasing demand. In recent years there has been a programme of training expansion in England supported by tariff level funding from NHS England (Workforce Training and Education Directorate), enhancing long-term radiology workforce sustainability and bringing quality benefits for patients, departments, and trusts. Expansion is a multifaceted and challenging process in the current NHS climate, involving coordination of funding, capacity, and sustained educational quality. These challenges need to be overcome through collaborative working by NHS England, local NHS trusts, and the Royal College of Radiologists.

Aim: The study aim to use magnetic resonance imaging (MRI) radiomic features to predict high-risk cytogenetic abnormalities (HRCAs) to improve outcomes in patients with multiple myeloma (MM).

Materials and methods: One hundred ninety-five patients with MM from two centres undergoing MRI were retrospectively recruited. Patients from Institution I (71 and 88 HRCAs and non-HRCAs, respectively) identified by fluorescence in situ hybridisation were randomly divided into training (n = 111) and validation (n = 48) cohorts. Patients from Institution II served as the external test cohort (n = 36). Radiomics or combined models based on T1WI, T2WI, and FS-T2WI images and clinical factors were constructed using logistic regression and 10-fold cross-validation in the training cohort. Nomogram performance was evaluated and compared using C-index, bootstrapping, accuracy, sensitivity, specificity, positive predictive value, negative predictive value, and Akaike information criterion. C-indexes were used to select the most efficient radiomics predictive model. Optimal model performance was tested in an external cohort.

Results: FT₂+age, FT₂₊₁+age, and FT₂₊₂₊₁+age combined models were outstanding in differentiating the HRCAs of MM patients in single-, double-, and multi-sequence MRI images, respectively. The C-indexes of the training and validation cohorts corrected via the 1000 bootstrap method were 0.79 and 0.80, 0.83 and 0.84, and 0.88 and 0.84, respectively. In the external test cohort, the C-index of radiomics nomograms was 0.70, 0.76, and 0.77, respectively.

Conclusion: MRI radiomics can be used to predict HRCAs in MM patients, which will be helpful for clinical decision-making and prognosis evaluation before treatment.