Diagnostic and interventional radiology最新文献

Purpose: Patients with advanced non-small cell lung cancer (NSCLC) have varying responses to immunotherapy, but there are no reliable, accepted biomarkers to accurately predict its therapeutic efficacy. The present study aimed to construct individualized models through automatic machine learning (autoML) to predict the efficacy of immunotherapy in patients with inoperable advanced NSCLC.

Methods: A total of 63 eligible participants were included and randomized into training and validation groups. Radiomics features were extracted from the volumes of interest of the tumor circled in the preprocessed computed tomography (CT) images. Golden feature, clinical, radiomics, and fusion models were generated using a combination of various algorithms through autoML. The models were evaluated using a multi-class receiver operating characteristic curve.

Results: In total, 1,219 radiomics features were extracted from regions of interest. The ensemble algorithm demonstrated superior performance in model construction. In the training cohort, the fusion model exhibited the highest accuracy at 0.84, with an area under the curve (AUC) of 0.89-0.98. In the validation cohort, the radiomics model had the highest accuracy at 0.89, with an AUC of 0.98-1.00; its prediction performance in the partial response subgroup outperformed that in both the clinical and radiomics models. Patients with low rad scores achieved improved progression-free survival (PFS); (median PFS 16.2 vs. 13.4, P = 0.009).

Conclusion: autoML accurately and robustly predicted the short-term outcomes of patients with inoperable NSCLC treated with immune checkpoint inhibitor immunotherapy by constructing CT-based radiomics models, confirming it as a powerful tool to assist in the individualized management of patients with advanced NSCLC.

Clinical significance: This article highlights that autoML promotes the accuracy and efficiency of feature selection and model construction. The radiomics model generated by autoML predicted the efficacy of immunotherapy in patients with advanced NSCLC effectively. This may provide a rapid and non-invasive method for making personalized clinical decisions.

Radiography is a field of medicine inherently intertwined with technology. The dependency on technology is very high for obtaining images in ultrasound (US), computed tomography (CT), and magnetic resonance imaging (MRI). Although the reduction in radiation dose is not applicable in US and MRI, advancements in technology have made it possible in CT, with ongoing studies aimed at further optimization. The resolution and diagnostic quality of images obtained through advancements in each modality are steadily improving. Additionally, technological progress has significantly shortened acquisition times for CT and MRI. The use of artificial intelligence (AI), which is becoming increasingly widespread worldwide, has also been incorporated into radiography. This technology can produce more accurate and reproducible results in US examinations. Machine learning offers great potential for improving image quality, creating more distinct and useful images, and even developing new US imaging modalities. Furthermore, AI technologies are increasingly prevalent in CT and MRI for image evaluation, image generation, and enhanced image quality.

Purpose: To describe the short-term follow-up results of the recently introduced iCover balloon-expandable covered stents for iliac artery lesions.

Methods: All consecutive patients treated with iCover balloon-expandable covered stents between March 2022 and August 2023 were retrospectively reviewed. The primary endpoint was target lesion revascularization (TLR) at 6 months. Secondary endpoints included major adverse events, freedom from TLR throughout the follow-up period, primary and secondary patency, and clinical and technical success.

Results: In the study population of 40 adult patients (87.5% men, mean age: 63.5 ± 11 years), the mean follow-up period was 6.2 ± 2.8 months. A total of 98 stents of various sizes were implanted. The technical success rate was 100%. Freedom from TLR was 95.8% [95%, confidence interval (CI): 95%- 96.6%], the primary patency rate was 91.7% (95%, CI: 89.8%-93.6%), and the secondary patency rate was 95.8% (95%, CI: 95%-96.6%) at 6 months. The all-cause mortality rate was 5%.

Conclusion: These real-world data demonstrate a high technical and clinical success rate, a high 6-month primary patency rate, and a low requirement for TLR. These are promising indicators for the safety and efficacy of iCover stents.

Clinical significance: Balloon-expandable covered stents are frequently used in iliac artery atherosclerotic disease. This study shows that the short-term follow-up results of the new iCover stent are satisfactory, indicating its safety and efficacy.

Purpose: The study aimed to assess the feasibility and image quality of dual-source photon-counting detector computed tomography (PCD-CT) in evaluating small-sized coronary artery stents with respect to different acquisition modes in a phantom model.

Methods: Utilizing a phantom setup mimicking the average patient's water-equivalent diameter, we examined six distinct coronary stents inflated in a silicon tube, with stent sizes ranging from 2.0 to 3.5 mm, applying four different CT acquisition modes of a dual-source PCD-CT scanner: "high-pitch," "sequential," "spiral" (each with collimation of 144 × 0.4 mm and full spectral information), and "ultra-high-resolution (UHR)" (collimation of 120 × 0.2 mm and no spectral information). Image quality and diagnostic confidence were assessed using subjective measures, including a 4-point visual grading scale (4 = excellent; 1 = non-diagnostic) utilized by two independent radiologists, and objective measures, including the full width at half maximum (FWHM).

Results: A total of 24 scans were acquired, and all were included in the analysis. Among all CT acquisition modes, the highest image quality was obtained for the UHR mode [median score: 4 (interquartile range (IQR): 3.67-4.00)] (P = 0.0015, with 37.5% rated as "excellent"), followed by the sequential mode [median score: 3.5 (IQR: 2.84-4.00)], P = 0.0326 and the spiral mode [median score: 3.0 (IQR: 2.53-3.47), P > 0.05]. The lowest image quality was observed for the high-pitch mode [median score: 2 (IQR: 1- 3), P = 0.028]. Similarly, diagnostic confidence for evaluating stent patency was highest for UHR and lowest for high-pitch (P < 0.001, respectively). Measurement of stent dimensions was accurate for all acquisition modes, with the UHR mode showing highest robustness (FWHM for sequential: 0.926 ± 0.061 vs. high-pitch: 0.990 ± 0.083 vs. spiral: 0.962 ± 0.085 vs. UHR: 0.941 ± 0.036, P = non-significant, respectively).

Conclusion: Assessing small-sized coronary stents using PCD-CT technology is feasible. The UHR mode offers superior image quality and diagnostic confidence, while all modes show consistent and accurate measurements.

Clinical significance: These findings highlight the potential of PCD-CT technology, particularly the UHR mode, to enhance non-invasive coronary stent evaluation. Confirmatory research is necessary to influence the guidelines, which recommend cardiac CT only for stents of 3 mm or larger.

Purpose: This study aims to define the computed tomography (CT) criteria that distinguish extra-gastrointestinal stromal tumors (eGISTs) from intra-abdominal fibromatosis (IAF).

Methods: Retrospective analysis was conducted on CT images obtained from 31 pathologically confirmed cases, including 17 cases of eGISTs and 14 of IAF. Various parameters [e.g., lesion location, contour characteristics, border delineation, enhancement patterns, presence of intralesional necrosis, vessels, air, fat, and hemorrhage, the long diameter (LD), LD/short diameter (SD) ratio, and volume (LD × SD × height diameter)] were meticulously evaluated. In addition, the degree of enhancement during arterial and portal venous phases and the lesion-to-aorta CT attenuation ratio during both phases were quantified. Statistical analysis was performed using Fisher's exact test, the Student's t-test, and the receiver operating characteristic curve to identify significant CT criteria. Sensitivity and specificity assessments were conducted for single and combined CT criteria.

Results: Significant differentiators between eGISTs and IAF include non-mesenteric localization, irregular contour, well-defined borders, heterogeneous enhancement, presence of intralesional necrosis and vessels, and absence of intralesional fat, with LD exceeding 9.6 cm, an LD/SD ratio >1.22, and volume surpassing 603.3 cm³ (P < 0.05). A combination of seven or more of these criteria yielded a specificity of 100%.

Conclusion: Ten distinct CT criteria have been identified to distinguish eGISTs from IAF, notably encompassing non-mesenteric localization, irregular contour, well-defined borders, heterogeneous enhancement, presence of intralesional necrosis and vessels, absence of intralesional fat, LD >9.6 cm, an LD/SD ratio >1.22, and volume surpassing 603.3 cm³.

Clinical significance: The current findings establish CT criteria to distinguish eGISTs from IAF in a clinical setting.

Purpose: The present study aims to (1) assess the technical success and limb salvage rates of endovascular therapy in patients with critical limb-threatening ischemia (CLTI) and infra-popliteal Trans-Atlantic Inter-Society Consensus (TASC) C/D lesions according to the updated 2015 TASC II classification and (2) to present our institutional experience.

Methods: A single-center retrospective study was conducted on patients with TASC C/D CLTI who underwent endovascular treatment between 2012 and 2017. The follow-up protocol consisted of Doppler ultrasound conduction every 3 months for the first year unless patients showed symptoms of CLTI. Patients with at least 1 year of follow-up data were included in the study, and if applicable their 3-year results were evaluated in terms of primary patency, absence of amputation, amputation-free survival, and overall survival.

Results: A total of 248 patients and 287 limbs (238 TASC D lesions and 49 TASC C lesions) were treated via infra-popliteal percutaneous transluminal angioplasty. The overall technical success was 87%, the primary patency rate was 41.5% in the first year, and the freedom from amputation rates were 80.8% in 1 year and 67.7% in 3 years.

Conclusion: In patients with infra-popliteal arterial occlusive diseases, endovascular treatment methods demonstrate a high rate of technical success and favorable outcomes in limb preservation.

Purpose: To investigate the value of dual-energy computed tomography (DECT) in predicting lymphovascular invasion (LVI) and the accuracy of preoperative T-staging of rectal cancer (RC).

Methods: Forty-nine patients with RC who had not received radiotherapy were enrolled to undergo a DECT scan. All patients underwent surgical tumor resection within 3-5 days after the DECT scan. Preoperative T-staging of RC based on images was performed by experienced radiologists. The normalized iodine concentrations (NIC) of the tumor and the perirectal adipose tissue (PAT) from the arterial phase (AP) and venous phase (VP) were measured using DECT. The tumor LVI and T-staging confirmed by pathology were used as the gold standard for grouping (group A, LVI-; group B, LVI+; group C, T1-2; and group D, T3-4a). The NIC values between two groups were compared using the Mann-Whitney U test, with P < 0.05 indicating a statistically significant difference. The accuracy of NIC in predicting LVI and distinguishing T1-2 RC from T3-4a RC were determined via receiver operating characteristic curve analysis, and the optimal cut-off of NIC was determined using the area under the curve.

Results: The tumor NIC values were significantly higher in the LV+ group than in the LVI- group in the VP (0.728 ± 0.031 vs. 0.669 ± 0.034, P < 0.001). The NIC values of PAT were significantly higher in the T3-4a group than in the T1-2 group in both the AP (4.034 ± 0.991 vs. 3.115 ± 0.581, P < 0.05) and the VP (5.481 ± 1.054 vs. 3.450 ± 0.980, P < 0.001). The accuracy of using NIC values to distinguish between the LVI+ group and the LVI- group and to diagnose the T3-4a group were 85.7% and 89.8%, respectively. However, there was no statistically significant difference between the NIC value in the LVI+ group and in the LVI- group in the AP. There was also no statistical difference in the tumor NIC value between the T1-2 group and the T3-4a group.

Conclusion: The tumor and PAT NIC are valuable indicators in RC that can preoperatively predict LVI and improve the accuracy of preoperative RC T-staging.

Clinical significance: The use of DECT improves the T-staging and LVI prediction of RC, which is helpful in guiding the clinical selection of appropriate treatment modalities and improving prognostic outcomes.

Purpose: To evaluate the efficacy of staged full-length balloon-assisted maturation (BAM) for the maturation of arteriovenous fistulas (AVFs) on entire segmental veins, including stenosis, causing primary AVF failure.

Methods: This study included patients who underwent AVF surgery using an autogenous vein between February 2020 and June 2021 and received staged angioplasty with a full-length balloon catheter. To minimize balloon overlap and the risk of barotrauma to the immature vein, serial-staged upsizing balloon angioplasty with a long balloon catheter covering the entire vein segment was employed approximately 2 weeks apart.

Results: Twenty-three patients (mean age, 69.50 years; mean follow-up, 620.62 days) with average diameters of the radial artery and cephalic vein at 2.14 ± 0.5 mm and 2.43 ± 0.5 mm, respectively, were enrolled. In the first procedure, the average AVF diameter and flow were 4.03 ± 0.57 mm and 438.08 ± 220.95 mL/min, respectively, with juxta-anastomotic stenosis (JAS) present in 61.5% of cases. After staged full-length BAM, the average fistula diameter and flow improved to 5.95 ± 0.86 mm and 717.52 ± 305.95 mL/min, respectively. Maturation was achieved in 87% of the cases. No hematomas or ruptures occurred around the arterialized veins. Despite successful maturation and cannulation, 65.2% of the patients required additional percutaneous transluminal angioplasty (PTA) during the follow-up period. The necessity for PTA was determined by the presence of JAS prior to the first staged full-length BAM, with an odds ratio of 11.74 (95% confidence interval: 1.31-104.96, P = 0.03).

Conclusion: Staged full-length BAM can be safely used in patients with small veins requiring further maturation. Most patients achieved successful cannulation following maturation without post-procedural complications.

Clinical significance: Staged full-length BAM is a safe and effective method for enhancing maturation in patients with underdeveloped small veins.