Diagnostic and interventional radiology最新文献

Purpose: Despite the large number of patients requiring percutaneous cholecystostomy (PC) for acute cholecystitis (AC), no definitive results exist on the optimal imaging guidance modality, technique (Seldinger vs. trocar), or approach [transhepatic (TH) vs. transperitoneal]. This study evaluates the outcomes of ultrasound (US)-guided bedside PC using solely the TH approach and trocar technique in patients with AC.

Methods: A single-center retrospective study was conducted at a tertiary university hospital between 2018 and September 2023. The study included 81 patients with AC treated with US-guided bedside PC using the TH approach and trocar technique alone. Patients were diagnosed through clinical, laboratory, and radiological examinations, and an experienced interventional radiologist performed the procedures. Outcomes and complication rates were then evaluated.

Results: Technical and clinical success rates were 100% and 93%, respectively. No procedure-related complications occurred. Catheter dislodgement occurred in 4.9% (4/81). The catheter sizes used were 6 F (12.3%), 7 F (40.7%), 8 F (37%), and 10 F (9.9%). The median catheter dwell time was 42 days. Catheters were successfully removed in the majority of surviving patients following resolution of cholecystitis. At the end of the follow-up, 10 patients (12.3%) underwent elective cholecystectomy, and 12 patients (14.8%) died due to comorbidities with the catheter in place.

Conclusion: US-guided bedside PC using the TH approach and trocar technique is safe and effective for managing AC in high-risk patients. The study found no significant complications, highlighting the importance of thorough preprocedural evaluation and technique optimization. Further studies with larger, homogeneous patient groups are needed to compare outcomes across different PC techniques and approaches.

Clinical significance: Despite the growing adoption of PC in the management of AC, the definitive optimal access route and procedural technique remain unresolved. The current body of literature is limited by considerable heterogeneity across studies, including variability in technical approach, operator experience, patient coagulation profiles, and outcome definitions. This study exclusively employed bedside US-guided PC using the TH approach and trocar technique, and observed no procedure-related complications, including hemorrhage, bile leakage, infection, or abscess formation.

Photon-counting detector computed tomography (PCD-CT) is an emerging imaging technology that promises to overcome the limitations of conventional energy-integrating detector (EID)-CT, particularly in thoracic oncology. This narrative review summarizes technical advances and clinical applications of PCD-CT in the thorax with emphasis on spatial resolution, dose-image-quality balance, and intrinsic spectral imaging, and it outlines practical implications relevant to thoracic oncology. A literature review of PubMed through May 31, 2025, was conducted using combinations of "photon counting," "computed tomography," "thoracic oncology," and "artificial intelligence." We screened the retrieved records and included studies with direct relevance to lung and mediastinal tumors, image quality, radiation dose, spectral/iodine imaging, or artificial intelligence-based reconstruction; case reports, editorials, and animal-only or purely methodological reports were excluded. PCD-CT demonstrated superior spatial resolution compared with EID-CT, enabling clearer visualization of fine pulmonary structures, such as bronchioles and subsolid nodules; slice thicknesses of approximately 0.4 mm and ex vivo resolvable structures approaching 0.11 mm have been reported. Across intraindividual clinical comparisons, radiation-dose reductions of 16%-43% have been achieved while maintaining or improving diagnostic image quality. Intrinsic spectral imaging enables accurate iodine mapping and low-keV virtual monoenergetic images and has shown quantitative advantages versus dual-energy CT in phantoms and early clinical work. Artificial intelligence-based deep-learning reconstruction and super-resolution can complement detector capabilities to reduce noise and stabilize fine-structure depiction without increasing dose. Potential reductions in contrast volume are biologically plausible given improved low-keV contrast-to-noise ratio, although clinical dose-finding data remain limited, and routine K-edge imaging has not yet translated to clinical thoracic practice. In conclusion, PCD-CT provides higher spatial and spectral fidelity at lower or comparable doses, supporting earlier and more precise tumor detection and characterization; future work should prioritize outcome-oriented trials, protocol harmonization, and implementation studies aligned with "Green Radiology".

Purpose: To evaluate the feasibility of abbreviated liver magnetic resonance imaging (AMRI) with a second-shot arterial phase (SSAP) image for the viability of treated hepatocellular carcinoma (HCC) after non-radiation locoregional therapy (LRT).

Methods: We retrospectively enrolled patients with non-radiation LRT for HCC who underwent the modified gadoxetic acid-enhanced liver MRI protocol, which includes routine dynamic and SSAP imaging after the first and second injection of gadoxetic acid, respectively (6 mL and 4 mL, respectively), and an available reference standard for tumor viability in the treated HCC between March 2021 and February 2022. Two radiologists independently reviewed the full-protocol MRI (FP-MRI) and AMRI with SSAP. For the FP-MRI, observations were assigned using the Liver Imaging Reporting and Data System treatment response (LR-TR) algorithm v.2024. In the AMRI with SSAP, the observations were assigned using the abbreviated LR-TR category according to the arterial mass-like enhancement in SSAP. Ancillary features, such as diffusion restriction and T2-weighted mild-to-moderate hyperintensity, were also optionally used.

Results: Of the 95 patients (70 men and 25 women; mean age, 68.7 years), 42 (44.2%) had viable lesions and 53 (55.8%) had non-viable lesions. The scan time of the simulated AMRI was significantly shorter than the FP-MRI (7.6±0.49 and 23.6±0.50 min, respectively; p<0.001). For evaluating the viability of treated HCC, there were no significant differences in the sensitivity and specificity between the FP-MRI and AMRI with SSAP (sensitivity, 85.7% vs. 80.1%, P = 0.500; specificity, 96.2% vs. 96.2%, P = 1.000).

Conclusion: The abbreviated LR-TR score in AMRI with SSAP showed non-inferior diagnostic performance to FP-MRI in terms of evaluating the viability for the treated HCC, which may be helpful in clinical practice alongside a decreased scan time.

Clinical significance: Abbreviated liver MRI with SSAP may be helpful for evaluating the viability of treated HCC in practice, while also providing a decreased scan time.

Purpose: This study aimed to evaluate the effectiveness of artificial intelligence (AI) in diagnosing focal nodular hyperplasia (FNH) of the liver using magnetic resonance imaging (MRI) and compare its performance with that of radiologists.

Methods: In the first phase of the study, the MRIs of 60 patients (30 patients with FNH and 30 patients with no lesions or lesions other than FNH) were processed using a segmentation program and introduced to an AI model. After the learning process, the MRIs of 42 different patients that the AI model had no experience with were introduced to the system. In addition, a radiology resident and a radiology specialist evaluated patients with the same MR sequences. The sensitivity and specificity values were obtained from all three reviews.

Results: The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the AI model were found to be 0.769, 0.966, 0.909, and 0.903, respectively. The sensitivity and specificity values were higher than those of the radiology resident and lower than those of the radiology specialist. The results of the specialist versus the AI model revealed a good agreement level, with a kappa (κ) value of 0.777.

Conclusion: For the diagnosis of FNH, the sensitivity, specificity, PPV, and NPV of the AI device were higher than those of the radiology resident and lower than those of the radiology specialist. With additional studies focused on different specific lesions of the liver, AI models are expected to be able to diagnose each liver lesion with high accuracy in the future.

Clinical significance: AI is studied to provide assisted or automated interpretation of radiological images with an accurate and reproducible imaging diagnosis.

Purpose: Peripheral arterial disease (PAD) is increasingly prevalent, particularly among the aging population. Retrograde tibiopedal access (RTPA) has emerged as a useful endovascular treatment for PAD. However, there is limited research examining factors that influence the efficacy of RTPA. To investigate factors affecting the access, crossing, and recanalization success rates of RTPA for infrapopliteal PAD treatment.

Methods: A retrospective study was conducted on 720 patients who underwent endovascular treatment for PAD. Of these, 104 patients (mean age: 65.5 ± 16.2; 89 men) with 131 RTPA trials were included in the final evaluation. The disease and its duration, Rutherford score, smoking status, access site, and its occlusion status, access, crossing, and recanalization success were noted. Data were analyzed using Pearson's chi-square and Mann-Whitney U tests and multivariate logistic regression to evaluate the impact of various factors on success rates.

Results: The access success rate was 82.6%, the crossing success rate was 95.4%, and the recanalization success rate was 74%. Access success was significantly higher when the dorsal pedal artery (DPA) was the access artery compared with the posterior tibial artery (91.3% vs. 74.2%, P = 0.009). Access success was notably lower in patients with thromboangiitis obliterans compared with patients with diabetes mellitus (DM) and non-DM atherosclerosis (68.6% vs. 90.3% and 80.3%, P = 0.019). Recanalization success was higher when the puncture site was non-occluded (76.7% vs. 53.5%, P = 0.023).

Conclusion: The study suggests that RTPA is a generally effective and safe technique for infrapopliteal PAD treatment. The most favorable outcomes are observed in individuals with DM who have a non-occluded DPA at the puncture site. Recanalization success is only affected by the patency of the artery at the puncture site.

Clinical significance: These findings offer targeted guidance for clinicians and highlight areas requiring further investigation.

Purpose: This study aims to investigate the indications and therapeutic efficacy of flow-diverting stents (FDSs) in the management of extracranial carotid artery aneurysms (ECAAs) and dissections.

Methods: A retrospective analysis was conducted on 18 patients treated for ECAAs with an FDS between 2010 and 2024. Patient demographics, aneurysm characteristics, procedural details, and clinical and radiologic follow-up outcomes were extracted from medical records. Procedures were performed under general anesthesia using standard endovascular techniques. Patients received preoperative and postoperative antiplatelet therapy and were fully anticoagulated during the procedure. Follow- up assessments included digital subtraction angiography or computed tomography angiography at 6-12 months and clinical evaluations to monitor symptom resolution and complications.

Results: Eighteen patients, with an average age of 46.44 ± 17.54 years, underwent 19 endovascular interventions. Technical success was achieved in all cases. Single stent deployment was used in 15 aneurysms, and telescopic stent deployment in 7. Total occlusion of the aneurysm was achieved in 94.4% of cases. One patient required retreatment due to the separation of two overlapped telescopic stents. All patients were discharged within 2 days post-procedure, with symptomatic patients experiencing the complete resolution of symptoms. No complications or adverse events were reported during the follow-up period.

Conclusion: The endovascular treatment of ECAAs with FDSs appears to be a safe and effective alternative, achieving high technical success and positive clinical outcomes.

Clinical significance: The use of FDSs for treating ECAAs significantly improves patient outcomes with minimal complications.

Purpose: To quantitatively compare the diagnostic values of conventional diffusion-weighted imaging and diffusion kurtosis imaging (DKI) in differentiating clear cell renal cell carcinoma (ccRCC) and renal angiomyolipoma with minimal fat (RAMF).

Methods: Sixty-eight patients with ccRCC and 18 patients with RAMF were retrospectively studied. For DKI and apparent diffusion coefficient (ADC), respiratory-triggered echo-planar imaging sequences were acquired in the axial plane (three b-values: 0, 1000, 2000 s/mm²; one b-value: 2000 s/mm²). Mean diffusivity (MD), fractional anisotropy (FA), mean kurtosis (MK), kurtosis anisotropy (KA), radial kurtosis (RK), and ADC were evaluated. The diagnostic efficacy of various diffusion parameters in predicting ccRCC and RAMF was compared.

Results: The ADC and MD values of ccRCCs were higher than those of RAMFs (P < 0.05), whereas comparable FA, MK, and KA values were observed between ccRCCs and RAMFs (P > 0.05). Moreover, the RK values of RAMFs were higher than those of ccRCCs (P < 0.05). Receiver operating characteristic (ROC) curve analyses showed that MD values had the highest diagnostic efficacy in differentiating ccRCCs from RAMFs. In pairwise comparisons of ROC curves and diagnostic efficacy, DKI parameters demonstrated better diagnostic accuracy than ADC in differentiating between ccRCCs and RAMFs (P < 0.05).

Conclusion: DKI analysis demonstrates superior performance than ADC analysis in differentiating ccRCC and RAMF.

Clinical significance: DKI technology may serve as an additional non-invasive biomarker for the differential diagnosis of renal tumor types.

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.