Diagnostic and interventional radiology最新文献

Purpose: To develop and validate a radiomics nomogram based on early ultrasound (US) imaging for predicting pathologic complete response (pCR) in patients with triple-negative breast cancer (TNBC) receiving neoadjuvant chemotherapy (NAC).

Methods: This retrospective study included 328 patients with TNBC treated between September 2019 and January 2024, divided into a training cohort (n = 230) and a validation cohort (n = 98). Clinicopathologic data, US features before NAC, tumor volume reduction (TVR) after two cycles of NAC, and radiomics features were collected. Multiple logistic regression was applied to identify the potential predictors of pCR. The efficacy of the nomogram was evaluated through the receiver operating characteristic, calibration, and decision curve analyses. The study was approved by the ethics committee on February 28, 2024, with approval number 2023-SR-799, and the requirement for informed consent was waived.

Results: Twelve features were selected to construct the radiomics signature (RS). The nomogram, incorporating tumor histologic grade, TVR, and RS, yielded an area under the curve of 0.856 [95% confidence interval (CI), 0.807-0.905] in the training cohort and 0.836 (95% CI, 0.749-0.923) in the validation cohort, outperforming both the clinico-ultrasonic and RS models. The calibration and decision curves confirmed the nomogram's excellent calibration and clinical utility.

Conclusion: The nomogram, which includes US characteristics, clinical variables, and radiomics features, exhibited satisfactory performance in predicting NAC efficacy in patients with TNBC.

Clinical significance: The US-based radiomics nomogram, incorporating histologic grade, TVR, and RS, shows preliminary clinical application potential for predicting NAC efficacy in patients with TNBC.

Purpose: Local thermal ablation is considered a standard treatment for small kidney masses. However, few studies have investigated the efficacy and safety of thermal ablation for cystic kidney masses.

Methods: The MEDLINE library, Cochrane, and SCOPUS databases were screened for studies investigating the efficacy of thermal ablation for cystic renal masses, comprising studies between 1995 and February 2024. In total, seven studies were deemed suitable and included in the present analysis.

Results: The studies included a total of 113 participants with 134 cystic renal masses. The sample sizes ranged from 5 to 38 participants. There were 76 men (67.2%) and 37 women (32.8%), with a mean age of 64.7 years (range: 50 to 75.4 years). Overall, 55 cystic masses were classified as Bosniak III (41%) and 79 as Bosniak IV (59%). Technical success of local thermal ablation was reported in 133 cystic masses (99.2%). The pooled meta-analytic technical success rate was 100% [95% confidence interval (CI): 96%-100%, I² = 0.0%]. Complications were reported in 9 cases (6.7%). According to the Society of Interventional Radiology classification system, there were 3 major complications (2.6%) and 6 minor complications (5.3%). The pooled meta-analytic complication rate was 10% (95% CI: 5%-20%, I² = 40%). No tumor recurrence was reported during follow-up.

Conclusion: Local thermal ablation can be considered a highly effective and safe procedure for cystic kidney masses. Most studies were performed using radiofrequency ablation, underscoring the need for further studies on alternative ablation techniques such as microwave ablation and cryoablation.

Clinical significance: Local thermal ablation is an effective and safe procedure for treating cystic kidney masses.

Purpose: Diffusion-weighted imaging (DWI) using single-shot echo-planar imaging (ss-EPI) is prone to artifacts, geometric distortion, and T2* blurring. Readout-segmented echo-planar imaging (rs-EPI) may improve image quality in the DWI of cervical cancer (CC). This study aimed to compare the image quality between rs-EPI and ss-EPI DWI in CC and to evaluate whether the apparent diffusion coefficient (ADC) values of ss-EPI (ssADC) and rs-EPI (rsADC) can differentiate the status of lymphovascular space invasion (LVSI) and lymph node metastasis (LNM).

Methods: This prospective study included 69 patients with CC who underwent ss-EPI and rs-EPI DWI before surgery. Qualitative reader scores, signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), and ADC values derived from ss-EPI and rs-EPI were compared. The differences in ADC values were analyzed in patients who were (a) LNM-positive (LNM+, n = 17) and LNM-negative (LNM-, n = 52); (b) LVSI-positive (LVSI+, n = 33) and LVSI-negative (LVSI-, n = 36).

Results: The rs-EPIs of CC had higher subjective image quality scores and a lower SNR than ss-EPI (all P < 0.001); no significant differences existed between rs-EPI and ss-EPI for either CNR or ADC (CNR, P = 0.313; ADC, P = 0.949; P > 0.05 for all). The rsADC and ssADC of the LNM+ group were substantially lower than those of the LNM- group (rsADC, P = 0.000; ssADC, P = 0.000; P < 0.001 for all); the areas under the receiver operating characteristic curve were 0.855 and 0.851, respectively. However, there were no differences in ADC values between the LVSI+ and LVSI- groups (rsADC, P = 0.271; ssADC, P = 0.200; P > 0.05 for all).

Conclusion: Over a similar scan time, rs-EPI improves the qualitative image quality of DWI significantly more than ss-EPI and has good diagnostic accuracy for LNM status in CC. However, neither could predict the LVSI status.

Clinical significance: Readout-segmented EPI improves the qualitative image quality of DWI and has good diagnostic accuracy for LNM status in CC, compared with conventional ss-EPI. It is more inclined to qualitative analysis of CC foci and provides a better scheme when choosing the DWI sequence scanning strategy for CC.

Purpose: This study aimed to assess the optimal balloon diameter for intravascular ultrasound (IVUS)-guided balloon angioplasty in calcified below-the-knee (BTK) tibial artery lesions.

Methods: Between February 2024 and April 2024, a retrospective review was conducted on 17 patients with Rutherford category 4-6 severely calcified tibial arteries with >70% stenosis, treated with IVUS-guided balloon angioplasty. Sequentially, 3 mm and then 3.5 mm diameter balloons were inflated. The minimum lumen diameter and area were measured before and after the procedure in the proximal, mid, and distal segments of the tibial arteries. One- and three-month follow-ups were conducted using Doppler ultrasound.

Results: Significant increases in lumen diameter (P < 0.001 for all) and lumen area (P < 0.001, P = 0.003, P = 0.002, respectively) were observed in the proximal, mid, and distal segments of the BTK arteries following IVUS-guided 3.5 mm balloon angioplasty. Ultra-low iodinated contrast media was used [median 2 mL (range, 1-4 mL)]. Lumen area increase ratios were similar among the proximal, mid, and distal segments (P = 0.905). No target vessel revascularization, major amputation, or mortality was observed during follow-up. Wound healing was seen in 62.5% of the cases with foot ulcers.

Conclusion: In the treatment of calcified BTK tibial arteries, a gradual balloon diameter increase up to 3.5 mm in IVUS-guided balloon angioplasty is safe and effective.

Clinical significance: Gradual balloon diameter increase up to 3.5 mm under IVUS guidance in calcified BTK lesions demonstrates significant potential. It enables ultra-low contrast usage, provides low complication rates, and achieves high patency and limb salvage, along with satisfactory wound healing in the short term.

Clival and paraclival pathologies encompass a broad spectrum of benign and malignant lesions, necessitating accurate imaging for precise diagnosis and management. Magnetic resonance imaging and computed tomography are pivotal in evaluating these lesions, facilitating differentiation, and guiding therapeutic decisions. This study reviews the imaging characteristics, differential diagnoses, and clinical significance of clival and paraclival pathologies.

Purpose: To evaluate and compare the in-plane and novel biplane imaging techniques in ultrasound-guided biopsies (USBx). USBx are effective for obtaining tissue samples in suspected malignancy or infection. The in-plane technique is the gold standard, offering continuous needle visualization. The biplane technique enables simultaneous in-plane and out-of-plane visualization, potentially improving biopsy outcomes. A study was conducted using gel phantoms to simulate USBx, with the goal of determining whether one technique offers distinct advantages over the other.

Methods: A total of 30 participants (mean age: 30 ± 7 years; 20 men) were recruited, primarily consisting of physicians in training with varying levels of experience. Each participant performed biopsies on gel phantoms using both the in-plane and biplane techniques in a randomized order after watching a standardized tutorial video. Procedure-related parameters were analyzed, and post-intervention questionnaires, including the NASA task load index (NASA-TLX), were collected to assess cognitive workload and personal preferences.

Results: All participants achieved successful biopsies with both techniques. The first-puncture success rate was significantly higher with the biplane technique (83% vs. 63%; P = 0.01). The biplane technique required significantly fewer biopsy attempts than the in-plane approach (37 vs. 43; P = 0.03). Although the biplane technique had a longer "mean time to first successful biopsy" (120 seconds vs. 72 seconds), this difference was not statistically significant (P = 0.09), likely due to high variability. No significant differences were found in safety-related parameters, including the number of skin punctures, needle retractions, percentage of time the needle tip was visible, and the number of biopsy attempts without needle tip visualization. The NASA-TLX indicated higher mental demand with the biplane technique (P = 0.013), but other dimensions showed no significant differences. Overall, 83% of participants, including 88% of more experienced operators, preferred the biplane technique, citing enhanced visualization and perceived safety.

Conclusion: In this study, the biplane technique in USBx was substantially superior in terms of total biopsy attempts and first-puncture success rate compared with the in-plane approach. It may offer safety and efficiency advantages, particularly for less-experienced operators. Further studies with larger sample sizes and experienced operators, especially in clinical settings, are needed to determine clear superiority.

Clinical significance: These findings suggest that biplane imaging may be especially beneficial for training less-experienced operators and in cases with elevated complication risk.

Purpose: Our study aimed to obtain clinical indication-based typical dose values and size-specific dose estimates (SSDEs) for multiphasic abdominopelvic computed tomography (CT) examinations and to review our data with published diagnostic reference levels (DRLs).

Methods: In this retrospective study, multiphasic liver, kidney, pancreas, and mesenteric ischemia protocol CT scans performed at our center between January 2018 and December 2021 were analyzed. The clinical indications were hepatocellular carcinoma, renal cell carcinoma, pancreas adenocarcinoma, and mesenteric ischemia. The computed tomography dose index volume (CTDI_vol) and dose-length product (DLP) values were recorded, and the SSDE and effective dose (ED) values were calculated. The water-equivalent diameter (Dw) value required for the SSDE calculation was measured using the automated calculation of the Dw program.

Results: The total number of patients was 514, with 86 patients excluded from this study. The dose values were calculated for 426 patients (183 female and 243 male; 111 liver, 120 kidney, 85 pancreas, and 110 mesenteric). The median values for the CTDI_vol, DLP, SSDE, and ED were 6.86 mGy, 683.02 mGy. cm, 8.75 mGy, and 10.45 mSv for the liver CT; 8.37 mGy, 908.37 mGy.cm, 10.37 mGy, and 13.89 mSv for the kidney CT; 7.82 mGy, 517.98 mGy.cm, 10.01 mGy, and 7.92 mSv for the pancreas CT; and 9.48 mGy, 983.68 mGy.cm, 12.78 mGy, and 13.86 mSv for the mesenteric CT, respectively. All dose values were lower than the published DRLs.

Conclusion: The literature reveals large differences in the multiphasic abdominopelvic CT protocols, especially in the number of phases and scan length. This situation makes comparing dose values difficult. Dose studies revealing the protocol parameters in detail are needed so that institutions can compare and optimize their own protocols. Additionally, users should periodically check the dose values in their own institutions.

Purpose: This study aims to detect common bile duct (CBD) dilatation using deep learning methods from artificial intelligence algorithms.

Methods: To create a convolutional neural network (CNN) model, 77 magnetic resonance cholangiopancreatography (MRCP) images without CBD dilatation and 70 MRCP images with CBD dilatation were used. The system was developed using coronal maximum intensity projection reformatted 3D-MRCP images. The ResNet50, DenseNet121, and visual geometry group models were selected for training, and detailed training was performed on each model.

Results: In the study, the DenseNet121 model showed the best performance, with a 97% accuracy rate. The ResNet50 model ranked second, with a 96% accuracy rate.

Conclusion: CBD dilatation was detected with high performance using the DenseNet CNN model. Once validated in multicenter studies with larger datasets, this method may help in diagnosis and treatment decision-making.

Clinical significance: Deep learning algorithms can aid clinicians and radiologists in the diagnostic process once technical, ethical, and financial limitations are addressed. Fast and accurate diagnosis is crucial for accelerating treatment, reducing complications, and shortening hospital stays.