Diagnostic and interventional radiology最新文献

Purpose: Heterotopic ossification (HO) is an abnormal bone mass in soft tissue, often complicating spinal cord or brain injuries with paralysis. When ossification limits joint amplitudes and becomes symptomatic, surgical excision may be necessary, although it carries a high risk of hemorrhage. This study evaluates the role of preoperative arterial embolization on peri-operative bleeding.

Methods: A retrospective case-control study was conducted on patients undergoing hip HO resection between September 2019 and April 2024. Only anteromedial or circumferential HO were included. Data on blood loss, transfusion requirements, duration of surgery, and length of hospital stay were analyzed. Embolization was performed with microspheres 500-700 μm and/or coils. Statistical significance was determined using the Mann-Whitney U test (P < 0.05).

Results: A total of 18 resections of HO and 9 preoperative embolizations were performed. Embolization was technically successful in all cases, with an average of 1.2 embolized arteries per patient. Venous embolization was performed in three specific cases. The mean surgical time was 127 min. The estimated mean blood loss was 1.789 mL, with no significant reduction with embolization (P = 0.25). However, embolized patients had a significantly shorter hospital stay (6.2 vs. 8 days, P = 0.03). One complication (arterial thrombosis downstream of the puncture site) was reported and successfully treated.

Conclusion: Preoperative embolization may improve recovery by shortening hospital stay; however, its impact on surgical bleeding remains unclear. Further studies are needed to refine embolization strategies and evaluate long-term outcomes, including recurrence rates.

Clinical significance: Preoperative embolization is a promising adjunct to complex HO hip resections, with a favorable safety profile that justifies its consideration in multidisciplinary surgical planning.

Purpose: To compare the safety and diagnostic yield of two ultrasound (US)-guided percutaneous renal biopsy (PRB) approaches, lateral to medial and medial to lateral, which differ in access route, muscle groups traversed, and cortical targets.

Methods: This retrospective study included 490 patients (mean age: 38.2 ± 21.2 years; 267 men, 223 women) who underwent US-guided PRB between 2019 and 2024 and had abdominal computed tomography (CT)/magnetic resonance imaging (MRI) within 1 year. At the left kidney lower pole level (L3-L4), anterior-posterior thicknesses of the traversed muscle groups were measured on CT/MRI. Complications were classified according to the Society of Interventional Radiology guidelines. Diagnostic yield was categorized as optimal (≥ 12 glomeruli), suboptimal (≥ 3 glomeruli), and pathologist based (diagnostic according to final pathology assessment). Group comparisons were performed using the chi-square test, Fisher's exact test, and t-test.

Results: In 490 PRBs (237 lateral to medial, 253 medial to lateral), the medial-to-lateral approach, despite traversing thicker muscles (35.7 vs. 11.5 mm, P = 0.001), produced smaller hematomas (8.6 vs. 17.3 mm, P = 0.001) with similar complication rates (major: 3.6% vs. 3.4%, P = 0.913; minor: 36% vs. 33.8%, P = 0.608). Diagnostic adequacy was comparable, but optimal yield was higher with the medial-to-lateral route (85.0% vs. 73.0%, P = 0.001).

Conclusion: Both approaches demonstrated comparable safety. However, the medial-to-lateral route was associated with smaller hematomas and a higher proportion of optimal biopsies from the lateral cortex, but suboptimal and pathologist-based adequacy remained high in both techniques.

Clinical significance: When standard lower pole lateral cortex biopsy is not feasible due to cortical scarring, cysts, overlying skin lesions, or anatomic limitations-especially in patients for whom contralateral biopsy is not possible (e.g., solitary or ectopic pelvic kidney, severe unilateral hydronephrosis)-alternative cortical targets must be used. Understanding how different access routes and muscle pathways influence hemorrhage control and diagnostic yield helps operators choose the safest and most effective technique in these situations.

Desmoid tumors (DTs) are rare, locally aggressive soft tissue neoplasms with highly variable clinical behavior. Although benign, their infiltrative nature can lead to considerable morbidity. DTs present a major challenge due to their unpredictable behavior and potential for misdiagnosis. Recently, there has been a large shift in the treatment strategy for DTs, and the number of cases being followed up with imaging has increased. Cryoablation has emerged as a minimally invasive treatment option, yet post-procedural imaging features remain poorly characterized. This study illustrates the magnetic resonance imaging (MRI) evolution of DTs following percutaneous cryoablation, emphasizing key patterns across pre-treatment, intra-procedural, and follow-up studies. The available MRI follow-up ranged from 6 to 30 months. Through a pictorial approach, we aimed to provide radiologists with practical insights to avoid misinterpretation of expected post-treatment changes as recurrence and to improve clinical management.

Purpose: To evaluate whether deep learning reconstruction (DLR) can reduce the radiation dose in routine clinical computed tomography (CT) scans compared with iterative reconstruction (IR) while maintaining or improving image quality. The study assesses DLR's consistency and effectiveness across four distinct CT protocols-chest, head, chest-abdomen-pelvis (CAP) oncology, and lower limb CT angiography (CTA)-representing a wide range of clinical applications.

Methods: Our study is retrospective and monocentric. It involves a total population of 13,060 patients who underwent a CT scan using either a DLR algorithm (CT-DLR) or an IR algorithm (CT-IR) in one of four different CT acquisition protocols. Image quality was evaluated qualitatively and quantitatively by measuring standardized signal-to-noise ratio and contrast-to-noise ratio values. Assessment was performed on a subsample of 200 patients (25 per protocol per group).

Results: The overall reduction in radiation dose for the CT-DLR group compared with the CT-IR group was approximately 20%. By protocol, dose reductions were 22% for chest CT, 21% for CAP oncology, 20% for lower limb CTA, and 19% for head CT. The CT-DLR group exhibited superior subjective and objective image quality to the CT-IR group.

Conclusion: DLR algorithms allow for a significant reduction in radiation dose while achieving higher image quality compared with IR algorithms.

Clinical significance: This large-scale study confirms that DLR can significantly reduce the radiation dose in routine CT imaging while maintaining or enhancing diagnostic image quality. Its consistent performance across multiple protocols supports broader clinical adoption. Notably, the greatest dose reductions were observed in high-use protocols such as chest and CAP CT, underscoring DLR's potential to improve both individual patient care and long-term population-level radiation safety.

Purpose: Prostatitis is frequently observed in false-positive lesions scored as 5 in the Prostate Imaging Reporting and Data System (PI-RADS), necessitating improved diagnostic tools. This study investigated the potential of magnetic resonance imaging (MRI) texture analysis of apparent diffusion coefficient (ADC) sequences to enhance the differentiation of prostatitis from prostate cancer (PCa) in PI-RADS 5 lesions.

Methods: This retrospective study enrolled patients undergoing 3.0-T MRI with lesions scored as PI-RADS 5. Lesions were manually delineated on ADC maps, and texture features were extracted using FireVoxel. Clinical data and ADC texture parameters were collected. The diagnostic performance [area under the curve (AUC), sensitivity (SEN), specificity (SPE), positive predictive value (PPV), negative predictive value (NPV)] of the clinical data, ADC texture, and a combined model were calculated and compared using the DeLong test.

Results: The final cohort included 189 patients with 189 PI-RADS 5 lesions (164 PCa, 25 prostatitis). The combined model, incorporating clinical indicators (age, prostate-specific antigen density) and ADC texture parameters (signal coefficient of variation, ADC percentile), revealed the optimal diagnostic performance: SEN 98.7%, SPE 60.0%, PPV 97.9%, NPV 71.6%, and AUC 93.1%. Bootstrap resampling verified the robustness of the model. Decision curve analysis indicated an improved net benefit with the combined model for guiding biopsy decisions.

Conclusion: ADC imaging texture parameters are valuable for the differential diagnosis of prostatitis from lesions scored as PI-RADS 5. Their combination with clinical indicators substantially improves diagnostic performance, providing valuable information to facilitate surgical decision-making and potentially reduce unnecessary biopsies.

Clinical significance: This study addresses a critical limitation of the current PI-RADS system, which exhibits a notable rate of false positives in high-risk PI-RADS 5 lesions. By demonstrating the added value of quantitative ADC texture analysis in this specific diagnostic challenge, this research offers a practical and potentially translatable approach to reducing the number of unnecessary biopsies for PI-RADS 5 lesions.

Purpose: To evaluate the relationship between gas detected in solid organs, such as the aorta and heart, and hypostasis in the lung parenchyma on postmortem computed tomography (PMCT) in relation to the postmortem interval (PMI).

Methods: Between January 2021 and January 2025, 74 individuals (60 men, 14 women; 18-84 years; mean age, 41.8 ± 17.6 years) who underwent autopsy due to various forensic causes were retrospectively evaluated using PMCT images obtained prior to autopsy. The presence of gas in the heart, liver, kidneys, and aorta on postmortem thoracic and abdominal CT images was graded as follows: grade 0, absent; grade 1, ≤ 25%; grade 2, > 25% but < 50%; and grade 3, ≥ 50%. These findings were compared with the PMI. In addition, the presence of hypostasis and clotting in the lungs on thoracic PMCT was compared with the PMI.

Results: Intravascular gas was observed within the cardiac chambers in all but seven cases, and the amount of intracardiac gas increased in direct proportion to the PMI. The presence of clotting in the pulmonary arteries showed a statistically significant association with the PMI (P = 0.015). A strong positive correlation (r: 0.720) was identified between intravascular gas in the liver and that in the cardiac chambers. Furthermore, a statistically significant and strong positive correlation was found between pulmonary hypostasis and clotting in the pulmonary arteries (r: 0.892, P = 0.001). A strong correlation was also observed between pulmonary arterial clotting and the density differences between hypostatic and non-hypostatic regions of the lung parenchyma (r: 0.918).

Conclusion: On PMCT, decomposition-related gas can be detected in solid organs, particularly in the liver and heart, as early as within 48 hours postmortem, and its presence is associated with the PMI. A strong correlation exists between pulmonary arterial clotting or sedimentation and hypostasis in the lung parenchyma.

Clinical significance: PMCT can help determine the PMI, in addition to identifying forensic causes of death, and may contribute to routine forensic assessment.

Photon-counting detector computed tomography (PCD-CT) employs direct-conversion detectors that record the arrival and energy of individual photons, enabling high-resolution, multi-energy cardiovascular imaging. We searched MEDLINE, Embase, and Scopus from January 2021 through September 2025 and included 59 studies. Owing to heterogeneity in study designs, protocols, and endpoints, the findings were synthesized narratively across five domains (coronary, myocardial, structural/valvular, pulmonary-cardiopulmonary function, and aortic/visceral/peripheral arteries). In coronary imaging, a routine-practice cohort (n = 7.833) reported a per-patient specificity of 98% vs. 93%, lower invasive angiography of 9.9% vs. 13.1%, and a higher revascularization yield of 43.4% vs. 35.5% [PCD-CT vs. energy-integrating detector CT (EID-CT); ultra-high-resolution protocols achieved a vessel-level area under the curve (AUC) of up to 0.99. Low-dose CCTA was feasible at a CTDIvol of 1.72 mGy, and contrast-saving protocols supported diagnostic studies with a volume of 30 mL. Virtual non-contrast calcium scoring showed an intraclass correlation coefficient of 0.98 vs. true non-contrast. In myocardial tissue characterization, PCD-CT-derived extracellular volume differed from cardiovascular magnetic resonance by ≤2% in selected cohorts, with a kappa of up to 0.956 for late-enhancement agreement; segment-level inflammation classification reached an AUC of 0.95. For structural/valvular assessment, a comparative cohort reported an effective dose of 8.8 ± 4.5 vs. 15.3 ± 5.8 mSv, with visual image quality scores of 4.8 vs. 3.3, respectively, for PCD-CT vs. EID-CT. Lung-perfusion iodine maps for chronic thromboembolic pulmonary hypertension achieved an accuracy of 0.85-0.88 at approximately one-fifth of the dose of single-photon emission CT. For aortic/peripheral applications, thoracoabdominal protocols reported a dose of 4.2 ± 1.4 vs. 7.2 ± 2.2 mGy, with a higher signal-to-noise ratio/contrast-to-noise ratio (PCD-CT vs. EID-CT); infrapopliteal imaging used 60 versus 140 mL of contrast, respectively, with improved vessel sharpness for PCD-CT vs. EID-CT; diagnostic performance for peripheral stenosis reached a sensitivity of 91% and a specificity of 95%, respectively, when compared with digital subtraction angiography. Overall, the evidence-predominantly single center-indicates that PCD-CT may enable dose- and contrast-efficient cardiovascular imaging with strong diagnostic metrics, and confirmation in multicenter outcome and cost-effectiveness studies remains a priority.

Purpose: To date, no study provides definitive evidence for the pathogenesis of congenital absence of the vas deferens (CAVD). This study aims to evaluate the vas deferens (VD), particularly the intra-abdominal part and accompanying seminal vesicle (SV) pathologies, in search of an explanation for the pathogenesis of the disease using magnetic resonance imaging (MRI) in patients clinically diagnosed with CAVD.

Methods: MRI scans of patients admitted to our center with clinically diagnosed unilateral CAVD (CUAVD) or bilateral CAVD (CBAVD) in the infertility clinic were retrospectively evaluated. SV hypoplasia, SV agenesis, the distal part of the VD close to the ampulla, and the intra-abdominal part of the VD were investigated. Additionally, the association of CAVD and SV pathologies was assessed.

Results: Clinically and confirmed with scrotal sonography by evaluating the proximal part of the VD, 32 patients (62.7%) had CBAVD, and 19 patients (37.3) had CUAVD. In MRI, the intra-abdominal part of the VD was visible in 52.9% of all patients. The association between the intra-abdominal part of the VD and CAVD was statistically significant in the CBAVD patient group compared with the CUAVD group (Bonferroni-adjusted P value = 0,006). The intra-abdominal part of the VD dilatation is a new finding in CAVD and was not found in patients with CUAVD. Only 2 out of 51 patients (3.9%) had a standard SV.

Conclusion: In the assessment of CAVD and accompanying SV pathologies, detailed findings are obtained by MRI even in the evaluation of the intra-abdominal part of the VD. Preliminary findings in this study are consistent with the theory of acquired vasal agenesis in CBAVD.

Clinical significance: The detailed findings of an MRI may contribute to a better understanding of the disease.