European Journal of Radiology最新文献_第7页

Pancreatic imaging with ultra-high-resolution photon-counting computed tomography: Preliminary assessment of image quality 超高分辨率光子计数计算机断层扫描胰腺成像：图像质量的初步评估

IF 3.3 3区医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

European Journal of Radiology

Pub Date : 2025-12-01 DOI: 10.1016/j.ejrad.2025.112596

Ruikun Huang , Yanzhao Yang , Meng Gao , Zhihan Xu , Haipeng Dong , Fuhua Yan , Weimin Chai

Objectives

To evaluate the advantage of combining ultra-high-resolution (UHR) mode with virtual monoenergetic image (VMI) reconstruction in photon-counting CT (PCCT) to assess pancreatic ductal adenocarcinoma (PDAC) and peripancreatic vasculature.

Methods

From September 2024 to April 2025, participants with suspected PDAC were prospectively enrolled and underwent pancreatic multiphase contrast-enhanced CT in UHR scanning mode. Six image series were reconstructed: (a) 0.2-mm slice thickness, threshold three-dimensional images; (b) 1-mm slice thickness, VMIs at 70 keV; and (c–f) 0.4-mm slice thickness, VMIs at 40, 45, 50, and 55 keV. For quantitative analysis, signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were measured in tumors and peripancreatic vessels. For qualitative analysis, two blinded observers evaluated image quality for tumors, peripancreatic vessels, and fine pancreatic anatomy using 5-point Likert-type scales.

Results

Seventy-four participants (39 male; mean age, 65.7 ± 10.7 years) with histologically confirmed PDAC were included. The CNR and SNR for tumors and peripancreatic vessels declined with increasing monoenergetic levels during pancreatic parenchymal and portal venous phases (PVP), peaking at 40 keV (all P < 0.001, except for SNR_lesion). Image noise was lowest in 1-mm–70-keV series (all P < 0.001). Qualitative assessment favored 1-mm–70-keV, 0.4-mm–45-keV, and 0.4-mm–50-keV images for overall image quality across phases (all P < 0.05), except between 1-mm–70–keV and 0.4-mm–55-keV images during PVP. For fine anatomical details, 0.4-mm–45-keV and 0.4-mm–50-keV images received higher ratings relative to other series.

Conclusion

In PCCT, combining 0.4-mm slice thickness with low-keV VMI reconstruction (particularly at 45 keV) provides better image quality for preoperative evaluation of PDAC.

目的评价光子计数CT （PCCT）超高分辨率（UHR）模式与虚拟单能量图像（VMI）重建相结合在胰腺导管腺癌（PDAC）及胰周血管评估中的优势。方法于2024年9月至2025年4月，前瞻性纳入疑似PDAC患者，在UHR扫描模式下行胰腺多期对比增强CT检查。重构6个图像序列：(a) 0.2 mm切片厚度、阈值三维图像；(b) 1 mm切片厚度，vmi为70 keV；（c-f） 0.4 mm切片厚度，vmi在40、45、50和55 keV。为了定量分析，我们测量了肿瘤和胰腺周围血管的信噪比（SNR）和对比噪声比（CNR）。为了进行定性分析，两名盲法观察人员使用李克特5分量表评估肿瘤、胰周血管和精细胰腺解剖的图像质量。结果纳入74例经组织学证实的PDAC患者（男性39例，平均年龄65.7±10.7岁）。在胰腺实质期和门静脉期（PVP），肿瘤和胰腺周围血管的CNR和SNR随着单能水平的升高而下降，峰值为40 keV（除snr病变外，P均为0.001）。图像噪声在1 mm - 70 kev系列中最低（均P <； 0.001）。在PVP期间，除了1 mm - 70- kev和0.4 mm - 55- kev之间的图像外，定性评估更倾向于1 mm - 70- kev， 0.4 mm - 45- kev和0.4 mm - 50- kev图像在各个阶段的整体图像质量（均P <； 0.05）。对于精细的解剖细节，相对于其他系列，0.4 mm - 45- kev和0.4 mm - 50- kev图像的评分更高。结论在PCCT中，结合0.4 mm切片厚度与低keV VMI重建（特别是在45 keV下）可以为PDAC术前评估提供更好的图像质量。

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引用次数: 0

Clinical efficacy of the novel heat-balance technique in ultrasound-guided percutaneous microwave ablation for uterine fibroids: A retrospective study 新型热平衡技术在超声引导下经皮微波子宫肌瘤消融中的临床疗效回顾性研究。

IF 3.3 3区医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

European Journal of Radiology

Pub Date : 2025-12-01 DOI: 10.1016/j.ejrad.2025.112594

Xixi Sun , Yuke Zhao , Jie Chen , Zeyang Dong , Mengyao Zhao , Yan Liu , Bin Huang

Objective

To evaluate the clinical efficacy of the novel Heat-Balance Technique (HB type) in Ultrasound-Guided Percutaneous Microwave Ablation for Uterine Fibroids (PMWA).

Methods

According to the inclusion and exclusion criteria, 40 patients who underwent PMWA between June 2022 and June 2024 were selected. These patients were divided into two groups based on the specific surgical technique: one using the conventional technique and the other using a novel PMWA (HB-type). Relevant clinical data of the patients were retrospectively analyzed, and all patients were followed up postoperatively to assess the clinical efficacy of the two groups.

Results

All cases achieved effective ablation. Among them, 15 cases (93.75 %) in the HB-type group and 14 cases (87.5 %) in the conventional ablation group achieved marked efficacy, with no significant statistical difference between the two groups. Both modalities significantly improved patients’ clinical symptoms (p < 0.001). The HB-type group showed significantly shorter surgical duration (8 [6–12] min vs. 25 [20–30] min; p < 0.001) and fewer antenna placements (1 [1,2] vs. 5 [3,5]; p < 0.001) than the conventional group.

Conclusions

The HB-type technique in PMWA achieves comparable ablation effects and clinical efficacy to conventional ablation methods for uterine fibroids, while offering distinct advantages: shortened surgical duration, reduced number of antenna placements, and lowered the complication rates.

目的：评价新型热平衡技术（HB型）在超声引导下经皮微波子宫肌瘤消融（PMWA）中的临床疗效。方法：根据纳入和排除标准，选择2022年6月至2024年6月期间行PMWA的患者40例。这些患者根据具体的手术技术分为两组：一组使用传统技术，另一组使用新型PMWA （hb型）。回顾性分析患者的相关临床资料，并对所有患者进行术后随访，评价两组患者的临床疗效。结果：所有病例均获得有效消融。其中hb型组15例（93.75 %）、常规消融组14例（87.5 %）疗效显著，两组间差异无统计学意义。结论：PMWA中hb型技术对子宫肌瘤的消融效果和临床疗效与传统的子宫肌瘤消融方法相当，同时具有明显的优势：缩短手术时间，减少天线放置次数，降低并发症发生率。

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引用次数: 0

Application of three ablative margin assessment techniques for hepatocellular carcinoma in clinical practice: a comparative study 三种肝细胞癌消融切缘评估技术在临床中的应用比较研究。

IF 3.3 3区医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

European Journal of Radiology

Pub Date : 2025-12-01 DOI: 10.1016/j.ejrad.2025.112597

Haiyu Kang , Qiqi Liu , Shuang Liang , Huahui Liu , Wenguang Zhu , Liping Luo , Shanshan Wu , Sainan Guan , Ying Liu , Ronghua Yan , Erjiao Xu

Objectives

To compare the effect of the intra-operative ultrasound fusion imaging (FI), tumor ghost technique, and pre- and post-operative FI technique for assessing the ablative margin (AM) of patients with hepatocellular carcinoma (HCC) undergoing microwave ablation (MWA).

Materials and methods

This single-center retrospective cohort study collected clinical and imaging data from patients with HCC who underwent MWA between April 2020 and April 2024. The success rates of three techniques were recorded. The factors affecting technical success of tumor ghost technique were analyzed. Operation time and observer consistency for both tumor ghost and pre- and post-operative FI were compared.

Results

135 patients (median age, 63 years, interquartile ranges, 52–68 years; 115 men) were enrolled. The technique efficacy rate was 98.5 %, the incidence of local tumor progression (LTP) was 3.7 %, and the early recurrence rate was 32.6 %. The success rates of intra-operative ultrasound FI and pre- and post-operative FI were 96.0 % and 82.7 %, respectively, which were significantly higher than 32.2 % of tumor ghost technique (p < 0.001). Subgroup analysis of tumor ghost technique showed that adjacent to high-risk locations and post-operative imaging modality were significant factors affecting technical success. Tumor ghost technique had a shorter operation time than pre- and post-operative FI technique (32 s vs. 2.6 min, p < 0.001), with Cohen's kappa coefficients of 0.782 (95 %CI: 0.372–1.000) and 0.514 (95 %CI: 0.275–0.753), respectively (p < 0.001).

Conclusions

The intra-operative FI is preferred when feasible; pre- and post-operative FI serves as a reliable alternative; tumor ghost technique functions as a rapid adjunctive method. Each of the three methods has its own characteristics, and the appropriate one can be selected for evaluation based on the patient’s condition.

目的：比较术中超声融合成像（FI）、肿瘤虚影技术和术前、术后超声融合成像（FI）对肝细胞癌（HCC）微波消融（MWA）患者消融边缘（AM）的评估效果。材料和方法：这项单中心回顾性队列研究收集了2020年4月至2024年4月期间接受MWA治疗的HCC患者的临床和影像学数据。记录了三种方法的成功率。分析了影响肿瘤幽灵技术技术成功的因素。比较手术时间和观察一致性对肿瘤影和术前、术后FI的影响。结果：纳入135例患者（中位年龄63岁，四分位数范围52-68岁，男性115例）。技术有效率98.5%，局部肿瘤进展（LTP）发生率3.7%，早期复发率32.6%。术中超声FI和术前、术后FI的成功率分别为96.0%和82.7%，明显高于肿瘤虚影技术的32.2% (p)。结论：术中超声FI是可行的首选，术前、术后超声FI是一种可靠的替代方法，肿瘤虚影技术是一种快速的辅助方法。三种方法各有特点，可根据患者情况选择合适的方法进行评估。

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引用次数: 0

Personalized adrenal gland volume reference ranges and development of a fully automated deep learning screening tool 个性化肾上腺体积参考范围和全自动深度学习筛选工具的开发

IF 3.3 3区医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

European Journal of Radiology

Pub Date : 2025-11-29 DOI: 10.1016/j.ejrad.2025.112591

Yi Li , Yingnan Zhao , Caihong li , Liu Liu , Hang Shen , Ying Jing , Xiaofang Zhao , Huali Tang , Ting Luo , Yun Mao

Objective

This study aims to develop a low-dose CT-based, fully automated deep learning tool for screening adrenal gland volume abnormalities and establishing personalized reference ranges to assist in diagnosing adrenal diseases.

Methods

This study included subjects (≥18 years) who underwent low-dose non-contrast chest CT during routine health check-ups, and three datasets were extracted based on specific criteria: healthy reference, hypertension/diabetes validation, and adrenal abnormality validation. Randomly sampled from these datasets 400 low-dose chest CT images were used to train the nnU-Net-based deep learning model, and 550 images were used for validation. Multivariable regression and restricted cubic splines (RCS) assessed the effects of factors like age, sex, body surface area, and blood markers on adrenal volume. A quantile regression model was used to create individualized reference ranges. A GMM-based anomaly detection system was developed for abnormal volume screening, tested on datasets for hypertension, diabetes, and adrenal hyperplasia.

Results

Among the 18,538 adults, 7,907 (42.65 %) were healthy. Adrenal volume ranges ere 3.24 cm³ (2.49–4.06) on the right and 4.51 cm³ (3.72–5.39) on the left. Adrenal volume correlated with age, sex, blood pressure, and glucose (p < 0.05). The parameter-adjusted reference ranges were defined as: Lower limit = –2.739 + 0.016 × Age + 0.431 × Sex + 0.032 × Waist circumference (WC) + 0.874 × Body surface area (BSA) + 0.007 × Diastolic blood pressure (DBP) + 0.081 × Triglycerides (TG) – 0.445 × High-density lipoprotein cholesterol (HDL) + 0.306 × Fasting plasma glucose (FPG);Upper limit = − 3.549 + 0.031 × Age + 0.339 × Sex + 0.030 × Waist + 2.721 × BSA + 0.020 × DBP + 0.004 × TG − 1.244 × HDL + 0.447 × FPG.The segmentation model achieved a Dice Similarity Coefficient of 0.926 and an ICC of 0.954(95 % CI: 0.946–0.961).In validation sets for diabetes and hypertension (n = 3,266), the screening detected 62.31 % abnormal cases, while in adrenal hyperplasia (n = 240), the rate was 77.09 %.

Conclusion

This study developed individualized adrenal gland volume reference ranges and a low-dose CT–based deep learning tool for automated measurement. The screening tool shows potential to assist in identifying adrenal abnormalities and may provide a methodological basis for future clinical evaluation and application.

目的开发一种基于低剂量ct的全自动深度学习工具，用于筛查肾上腺体积异常并建立个性化参考范围，以辅助肾上腺疾病的诊断。方法本研究纳入在常规健康检查期间接受低剂量非对比胸部CT检查的受试者（≥18岁），并根据特定标准提取三个数据集：健康对照、高血压/糖尿病验证和肾上腺异常验证。从这些数据集中随机抽取400张低剂量胸部CT图像用于训练基于nnu - net的深度学习模型，并使用550张图像进行验证。多变量回归和限制性三次样条（RCS）评估了年龄、性别、体表面积和血液标记物等因素对肾上腺容量的影响。分位数回归模型用于创建个性化参考范围。我们开发了一种基于gmm的异常检测系统，用于异常体积筛查，并在高血压、糖尿病和肾上腺增生的数据集上进行了测试。结果18538名成人中，7907人（42.65%）健康。肾上腺容积范围右侧为3.24 cm3(2.49 ~ 4.06)，左侧为4.51 cm3（3.72 ~ 5.39）。肾上腺容量与年龄、性别、血压、血糖相关（p < 0.05）。参数调整后的参考范围定义为：下限= - 2.739 + 0.016 ×年龄+ 0.431 ×性别+ 0.032 ×腰围(WC) + 0.874 ×体表面积(BSA) + 0.007 ×舒张压(DBP) + 0.081 ×甘油三酯(TG) - 0.445 ×高密度脂蛋白胆固醇(HDL) + 0.306 ×空腹血糖（FPG）；上限=−3.549 + 0.031 + 0.339××年龄性别+ 0.030×腰+ 2.721×BSA + 0.020×1.244 + 0.004×类似TG−0.447××HDL +台塑。该分割模型的Dice Similarity Coefficient为0.926，ICC为0.954（95% CI: 0.946 ~ 0.961）。在糖尿病和高血压（n = 3266）验证集中，筛查检出率为62.31%，而在肾上腺增生（n = 240）中，筛查检出率为77.09%。本研究建立了个体化肾上腺体积参考范围和基于低剂量ct的深度学习自动化测量工具。该筛查工具显示出帮助识别肾上腺异常的潜力，并可能为未来的临床评估和应用提供方法学基础。

{"title":"Personalized adrenal gland volume reference ranges and development of a fully automated deep learning screening tool","authors":"Yi Li , Yingnan Zhao , Caihong li , Liu Liu , Hang Shen , Ying Jing , Xiaofang Zhao , Huali Tang , Ting Luo , Yun Mao","doi":"10.1016/j.ejrad.2025.112591","DOIUrl":"10.1016/j.ejrad.2025.112591","url":null,"abstract":"<div><h3>Objective</h3><div>This study aims to develop a low-dose CT-based, fully automated deep learning tool for screening adrenal gland volume abnormalities and establishing personalized reference ranges to assist in diagnosing adrenal diseases.</div></div><div><h3>Methods</h3><div>This study included subjects (≥18 years) who underwent low-dose non-contrast chest CT during routine health check-ups, and three datasets were extracted based on specific criteria: healthy reference, hypertension/diabetes validation, and adrenal abnormality validation. Randomly sampled from these datasets 400 low-dose chest CT images were used to train the nnU-Net-based deep learning model, and 550 images were used for validation. Multivariable regression and restricted cubic splines (RCS) assessed the effects of factors like age, sex, body surface area, and blood markers on adrenal volume. A quantile regression model was used to create individualized reference ranges. A GMM-based anomaly detection system was developed for abnormal volume screening, tested on datasets for hypertension, diabetes, and adrenal hyperplasia.</div></div><div><h3>Results</h3><div>Among the 18,538 adults, 7,907 (42.65 %) were healthy. Adrenal volume ranges ere 3.24 cm<sup>3</sup> (2.49–4.06) on the right and 4.51 cm<sup>3</sup> (3.72–5.39) on the left. Adrenal volume correlated with age, sex, blood pressure, and glucose (p < 0.05). The parameter-adjusted reference ranges were defined as: Lower limit = –2.739 + 0.016 × Age + 0.431 × Sex + 0.032 × Waist circumference (WC) + 0.874 × Body surface area (BSA) + 0.007 × Diastolic blood pressure (DBP) + 0.081 × Triglycerides (TG) – 0.445 × High-density lipoprotein cholesterol (HDL) + 0.306 × Fasting plasma glucose (FPG);Upper limit = − 3.549 + 0.031 × Age + 0.339 × Sex + 0.030 × Waist + 2.721 × BSA + 0.020 × DBP + 0.004 × TG − 1.244 × HDL + 0.447 × FPG.The segmentation model achieved a Dice Similarity Coefficient of 0.926 and an ICC of 0.954(95 % CI: 0.946–0.961).In validation sets for diabetes and hypertension (n = 3,266), the screening detected 62.31 % abnormal cases, while in adrenal hyperplasia (n = 240), the rate was 77.09 %.</div></div><div><h3>Conclusion</h3><div>This study developed individualized adrenal gland volume reference ranges and a low-dose CT–based deep learning tool for automated measurement. The screening tool shows potential to assist in identifying adrenal abnormalities and may provide a methodological basis for future clinical evaluation and application.</div></div>","PeriodicalId":12063,"journal":{"name":"European Journal of Radiology","volume":"195 ","pages":"Article 112591"},"PeriodicalIF":3.3,"publicationDate":"2025-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145691110","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Terminology inconsistencies in LLM-based studies: A caution for radiology 法学硕士基础研究中的术语不一致：对放射学的警告。

IF 3.3 3区医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

European Journal of Radiology

Pub Date : 2025-11-29 DOI: 10.1016/j.ejrad.2025.112590

Ali Salbas , Atilla Hikmet Cilengir

引用次数: 0

Consistent orientation of the knee in the CT scanner is key for accurate tibial component displacement detection 在CT扫描仪中，膝关节的方向一致是准确检测胫骨部件位移的关键。

IF 3.3 3区医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

European Journal of Radiology

Pub Date : 2025-11-29 DOI: 10.1016/j.ejrad.2025.112589

Maaike Annemiek ter Wee , Johannes Gijsbertus Gerardus Dobbe , Mario Maas , Leendert Blankevoort , Geert Johannes Streekstra

Background

CT-based load-induced displacement measurements can assist in diagnosing tibial component loosening following total knee arthroplasty (TKA).This involves acquiring two CT-scans of the knee under valgus and varus loads and measuring relative implant-to-tibia displacement through segmentation and registration. However, metal artefacts from the implant vary with its orientation in the CT scanner, affecting measurement accuracy. This study investigated how implant tilt angle and direction impact displacement measurement accuracy.

Methods

A phantom containing a TKA tibial component and a PVC-reference object was scanned at different tilt angles. A neutral scan was acquired with the implant stem aligned along the gantry’s central axis (z-axis). The phantom was rotated sidewards (from −40 to + 40° in 10° increments about the CT’s y-axis) and forwards/backwards (from −30° to 30° in 10° increments about the CT’s x-axis). Image analysis included segmentation and registration between CT scans with different tilts. Three metrics were used: 1) intensity similarity around the implant based on PVC-reference registration (unaffected by metal artefacts), 2) intensity similarity based on implant registration (affected by artefacts), and 3) relative displacement differences between registered implant and PVC-reference, quantified as mean target registration error (mTRE).

Results

Intensity similarity decreased with increasing implant tilt, especially when tilt angles crossed the central gantry axis. Implant registration increased intensity similarity but caused positioning errors over 0.5 mm (mTRE) for tilt differences larger than 20°.

Conclusions

Both implant tilt angle and direction influence metal artefact severity, but maintaining consistent alignment helps preserve segmentation quality and registration accuracy, and reliable displacement measurements.

背景：基于ct的负载诱发位移测量可以帮助诊断全膝关节置换术（TKA）后胫骨部件松动。这包括对外翻和内翻载荷下的膝关节进行两次ct扫描，并通过分割和配准测量植入物到胫骨的相对位移。然而，来自植入物的金属伪影在CT扫描仪中随其方向而变化，影响测量精度。研究种植体倾斜角度和方向对位移测量精度的影响。方法：以不同的倾斜角度扫描包含TKA胫骨假体和pvc参考物体的假体。中性扫描获得种植体干沿龙门的中心轴（z轴）对齐。幻影沿CT的y轴向两侧（以10°为单位从-40°旋转到+ 40°）和前后（以10°为单位从-30°旋转到30°）旋转。图像分析包括不同倾斜CT扫描之间的分割和配准。使用三个指标：1)基于pvc -参考配准的种植体周围强度相似性（不受金属假物影响），2)基于种植体配准的强度相似性（受假物影响），以及3)注册的种植体与pvc -参考的相对位移差异，量化为平均目标配准误差（mTRE）。结果：强度相似度随着种植体倾斜度的增加而降低，尤其是当倾斜度与中央龙门轴相交时。种植体配准增加了强度相似性，但当倾斜度差异大于20°时，定位误差超过0.5 mm （mTRE）。结论：种植体倾斜角度和方向都会影响金属假体的严重程度，但保持一致的对准有助于保持分割质量和配准精度，以及可靠的位移测量。

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引用次数: 0

Improving foundation doctors’ knowledge and compliance with the radiology legislation: A quality improvement project 提高基础医生的知识和遵守放射学法规：一个质量改进项目。

IF 3.3 3区医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

European Journal of Radiology

Pub Date : 2025-11-29 DOI: 10.1016/j.ejrad.2025.112588

Haider Merchant , Taona Nyamapfene , Lorna Sweetman , Glenda Shaw , Katja Adie

Rationale and objectives

Ionising Radiation (Medical Exposure) Regulations (IR(ME)R) exist to safeguard patients against unnecessary radiation exposure and enhance their involvement in decision-making. However, evidence suggests that resident doctors lack awareness of IR(ME)R. We conducted a quality improvement project to improve Foundation Doctors’ (FDs’) knowledge and compliance with IR(ME)R.

Materials and methods

FDs at a hospital were surveyed (cycle-one). The survey assessed self-reported understanding of IR(ME)R and confidence in using iRefer, knowledge of common radiation doses and lifetime cancer-risk, and the number of risk–benefit discussions held with patients prior to imaging requests. Following a one-hour lecture, post-session surveys were administered afterwards (cycle-two), and after six-months (cycle-three).

Results

Thirty-one FDs completed cycle-one, 28 completed cycle-two and 16 completed cycle-three. Knowledge and understanding of IR(ME)R improved significantly from cycle-one (1.0, IQR = 1.0) to cycle-two (3.0, IQR = 1.0) and cycle-three (3.0, IQR = 2.0; p < 0.01). Confidence using iRefer increased significantly post-session (1.0 [IQR = 1.0] to 3.0 [IQR = 1.0]; p < 0.01), but not after six-months (2.0 [IQR = 2.2]; p = 0.24). Knowledge of radiation doses rose significantly post-session (38.7 % to 61.6 %; p < 0.01), but not after six-months (46.6 %, p = 0.15). There were no significant improvements in knowledge of cancer-risk (71 % to 72.6 % to 74.3 %, p > 0.5). Risk–benefit discussions significantly increased from 2 (IQR = 6.25) to 7.5 (IQR = 8.25) by cycle-three (p = 0.029).

Conclusion

By evaluating long-term outcomes and increasing risk–benefit discussions with patients, this study builds on previous research. It demonstrates that dedicated teaching improves knowledge and compliance with IR(ME)R, supporting the integration of IR(ME)R education into the foundation curriculum. Longitudinal interventions may reduce outcome attrition. Larger, multicentred studies measuring objective behavioural or patient outcomes are recommended.

理由和目标：电离辐射（医疗照射）条例（IR(ME)R）的存在是为了保护患者免受不必要的辐射照射，并加强他们对决策的参与。然而，有证据表明住院医师缺乏对IR(ME)R的认识。我们开展了一项质量改进项目，以提高基础医生的知识和对IR(ME)R的遵守程度。材料与方法：对某医院的fd进行调查（第1周期）。该调查评估了自我报告的对IR(ME)R的理解和使用ireference的信心，对常见辐射剂量和终身癌症风险的了解，以及在成像请求之前与患者进行的风险-收益讨论的次数。在一个小时的讲座之后，在之后（第二周期）和六个月后（第三周期）进行了课后调查。结果：完成第1周期31例，完成第2周期28例，完成第3周期16例。从第一阶段（1.0,IQR = 1.0）到第二阶段（3.0,IQR = 1.0）和第三阶段（3.0,IQR = 2.0; p 0.5），对IR(ME)R的认识和理解显著提高。在第三个周期（p = 0.029），风险-收益讨论从2 （IQR = 6.25）显著增加到7.5 （IQR = 8.25）。结论：通过评估长期结果和增加与患者的风险-收益讨论，本研究建立在先前研究的基础上。研究表明，专门的教学提高了对IR(ME)R的认识和遵守，支持将IR(ME)R教育融入基础课程。纵向干预可以减少结果损耗。建议进行更大规模、多中心的研究，测量客观行为或患者结果。

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引用次数: 0

Time-dependent diffusion MRI derived microstructure parameters to predict differentiation degree and Ki-67 expression in rectal cancer 时间依赖扩散MRI衍生微观结构参数预测直肠癌的分化程度和Ki-67表达。

IF 3.3 3区医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

European Journal of Radiology

Pub Date : 2025-11-29 DOI: 10.1016/j.ejrad.2025.112522

Fulin Lu , Kuide Li , Ran Wu , Xiaoli Chen , Yisha Liu , Bin Luo , Meining Chen , Hang Li

Objective

To investigate the utility values of time-dependent diffusion MRI (td-dMRI) in predicting differentiation degree and Ki-67 expression in rectal cancer.

Methods

Seventy-three resectable rectal cancer patients who underwent td-dMRI examination were consecutively enrolled. Intracellular volume fraction (ICVF), cell diameter, extracellular diffusivity (Dex), cellularity, apparent diffusion coefficient (ADC) values at different diffusion times, relative ADC value, and ADC ratio were investigated. Intraclass correlation coefficients and Bland-Altman plots were used to determine repeatability. Mann-Whitney U test, logistic regression analysis, receiver operating characteristic (ROC), and the Delong’s test were used for parameter differences evaluation, independent risk factor identifying, diagnostic ability assessing, and the area under the ROC curve (AUC) comparations for differentiation degree and Ki-67 expressions, respectively.

Results

The cellularity, ADC_PGSE, and ADC_40HZ in the low differentiation degree group were significantly higher than moderate to high differentiation degree group (all P < 0.05). While, ICVF was significantly lower in low differentiation group. Tumor length, ICVF, cellularity, ADC_PGSE and ADC_40HZ were independent risk factors for low differentiation degree. The combined model achieved the highest diagnostic performance, with an AUC of 0.831 (95 %CI: 0.73, 0.93) for differentiation. For Ki-67 expression, ICVF in the high Ki-67 expression group was lower than that of low Ki-67 expression group (P = 0.001). MR-reported lymph node stage, extramural vascular invasion (EMVI), and ICVF were independent clinical risk factors for predicting high Ki-67 expression. The diagnostic ability of combined indicators reached an AUC of 0.820 (95 %CI: 0.71, 0.93) surpassed the individual of ICVF (AUC = 0.750, 95 %CI: 0.62, 0.88, P < 0.01).

Conclusion

Td-dMRI-derived microstructural parameters may provide an alternative form of non-invasive imaging marker of differentiation degree and Ki-67 expression in rectal cancer and provide valuable information for treatment decisions.

目的：探讨时间依赖扩散MRI （td-dMRI）在预测直肠癌分化程度和Ki-67表达中的应用价值。方法：连续入选73例行td-dMRI检查的可切除直肠癌患者。测定细胞内体积分数（ICVF）、细胞直径、细胞外扩散率（Dex）、细胞度、不同扩散时间下表观扩散系数（ADC）值、相对ADC值和ADC比。用类内相关系数和Bland-Altman图确定重复性。分别采用Mann-Whitney U检验、logistic回归分析、受试者工作特征（ROC）和Delong’s检验进行参数差异评价、独立危险因素识别、诊断能力评估、分化程度和Ki-67表达的ROC曲线下面积（AUC）比较。结果：低分化程度组细胞结构、ADCPGSE、ADC40HZ均显著高于中高分化程度组（P PGSE、ADC40HZ均为低分化程度的独立危险因素）。联合模型达到了最高的诊断性能，鉴别的AUC为0.831 （95% CI: 0.73, 0.93）。对于Ki-67表达，Ki-67高表达组ICVF低于Ki-67低表达组（P = 0.001）。mr报告的淋巴结分期、外血管浸润（EMVI）和ICVF是预测Ki-67高表达的独立临床危险因素。综合指标的诊断能力达到0.820 (95% CI: 0.71, 0.93)，超过ICVF个体（AUC = 0.750, 95% CI: 0.62, 0.88， P）。结论：td - dmri衍生的显微结构参数可作为直肠癌分化程度和Ki-67表达的一种非侵入性影像标志物，为治疗决策提供有价值的信息。

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引用次数: 0

Cardiac magnetic resonance imaging in atrioventricular discordance and congenitally corrected transposition (CCTGA) 房室不协调和先天性矫正转位（CCTGA）的心脏磁共振成像。

IF 3.3 3区医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

European Journal of Radiology

Pub Date : 2025-11-27 DOI: 10.1016/j.ejrad.2025.112548

Melonie Johns , Michael Rigby , Raad Mohiaddin , Cemil Izgi , Dudley J. Pennell , Inga Voges , Sylvia Krupickova

Patients with congenitally corrected transposition of the great arteries (CCTGA) have a heterogenous anatomy due to the altered ventricular topology and associated malformations, leading to a diverse range of management options. Crucially the dichotomous decision of whether to continue with the right ventricle as the systemic ventricle or to perform complex inflow and outflow re-routing surgery, restoring the left ventricle to its role as the systemic ventricle will determine the patient’s future care.

Using the protocol of a tertiary cardiac surgery centre we describe how cardiac MRI provides a uniquely accurate combination of anatomical and functional data about the complex native cardiac and extra-cardiac anatomy prior to operation. MRI provides a non-invasive and non-ionising modality without the limitations of echocardiography ‘acoustic windows’. We describe how to assess CCTGA from infancy to adulthood including the patency of the venous baffle pathways, re-routed outflow pathway and residual lesions/complications in post-operative patients. MRI also allows the study of tissue characterisation in our aging congenital heart disease population and is well-established in the lifelong surveillance and assessment of the systemic right ventricle across the world.

先天性纠正性大动脉转位（CCTGA）患者由于心室拓扑结构改变和相关畸形而具有异质性解剖结构，导致多种治疗选择。至关重要的是，是否继续将右心室作为全身心室或进行复杂的流入和流出重新路径手术，恢复左心室作为全身心室的作用，将决定患者未来的护理。使用三级心脏手术中心的方案，我们描述了心脏MRI如何在手术前提供复杂的原生心脏和心脏外解剖结构的独特准确的解剖和功能数据组合。MRI提供了一种非侵入性和非电离的方式，没有超声心动图“声窗”的限制。我们描述了如何评估从婴儿期到成年期的CCTGA，包括静脉挡板通路的通畅，重新定向的流出通道和术后患者的残留病变/并发症。MRI还允许对老化的先天性心脏病人群的组织特征进行研究，并在全球范围内对系统性右心室进行终身监测和评估。

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引用次数: 0

Imaging biomarkers are key to recognizing fatal breast cancers arising in the major ducts 成像生物标志物是识别主要导管中发生的致死性乳腺癌的关键

IF 3.3 3区医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

European Journal of Radiology

Pub Date : 2025-11-26 DOI: 10.1016/j.ejrad.2025.112564

László Tabár , Peter B. Dean , Tony Hsiu-Hsi Chen , Wendy Yi-Ying Wu , Robert A. Smith , Chen-Yang Hsu , Amy Ming-Fang Yen

<div><h3>Background</h3><div>The significant decrease in breast cancer deaths achieved by organized mammography screening programs and treatment of breast cancer at an early phase is a remarkable achievement in clinical cancer research. A remaining challenge is to recognize the breast cancers we are still failing to manage effectively, even when women attend screening regularly and receive modern therapeutic regimens. Many of these fatal tumours originate in the major lactiferous ducts through the carcinogenic process of neoductgenesis with the formation of invasive neoducts. The proposed name for these malignancies is ductal adenocarcinoma of the breast (DAB). Using imaging biomarkers correlated with large format histopathology, we sought to identify the DAB subgroups with the highest fatality.</div></div><div><h3>Method</h3><div>All histologically proven breast cancer cases (n = 3587) in women of all ages, diagnosed in our Institution from January 2008-June 2022 and followed up through 2023, were prospectively classified into their apparent site of tumour origin using imaging biomarkers mammographic tumour features. These have been correlated with large format histopathology and long-term, patient outcome. Breast cancers originating from the major lactiferous ducts (DAB) formed a subgroup of 570 consecutive cases, which were further subdivided according to their imaging biomarkers. The frequency of occurrence of the combined necrosis producing cases, the combined fluid producing cases and the non-calcified architectural distortion type DAB cases were compared with the death rate within each of these combined subgroups.</div></div><div><h3>Results</h3><div>Patients with the necrosis-producing DAB subtypes had a significantly elevated, 4.33-fold risk of breast cancer-specific death (95% CI: 1.73–10.84) compared with the fluid-producing DAB subtypes. Patients with the non-calcified architectural distortion DAB subtype had a non-significant 2.51-fold higher risk (95 % CI: 0.87–7.23 compared with the fluid-producing DAB subtypes. The majority of breast cancer deaths, 51/67 (76 %), were in the 317 women having fragmented casting type calcifications on the mammogram. Biopsied axillary node and distant metastases of some fatal cases revealed structures closely resembling neoducts.</div></div><div><h3>Conclusions</h3><div>Perception and recognition of the imaging biomarkers of the DAB subgroups are necessary first steps in controlling these malignancies, since these biomarkers indicate the site of tumour origin and have documented prognostic value. Reliable imaging-histopathologic correlation of these extensive, diffusely invasive malignancies calls for the use of a large section histopathology technique. The duct-like structures of each DAB subgroup are newly formed invasive neoducts produced by the carcinogenic process of neoductgenesis; they are not pre-existing ducts and can metastasize to the lymph nodes and to distant organs. These observations ch

有组织的乳房x线摄影筛查项目和早期乳腺癌治疗显著降低了乳腺癌死亡率，这是临床癌症研究的一项显著成就。仍然存在的挑战是认识到我们仍然未能有效管理的乳腺癌，即使妇女定期参加筛查并接受现代治疗方案。许多这些致命的肿瘤起源于主要的乳管，通过肿瘤发生的致癌过程与侵入性乳管的形成。建议将这些恶性肿瘤命名为乳腺导管腺癌（DAB）。利用与大幅面组织病理学相关的成像生物标志物，我们试图确定死亡率最高的DAB亚组。方法2008年1月至2022年6月在我院诊断并随访至2023年的所有年龄女性组织学证实的乳腺癌病例（n = 3587），使用影像学生物标志物乳房x线摄影肿瘤特征前瞻性地分类为肿瘤的明显起源部位。这些与大格式组织病理学和长期患者预后相关。起源于大乳管（DAB）的乳腺癌形成了570例连续病例的亚组，根据其成像生物标志物进一步细分。比较合并坏死病例、合并积液病例和非钙化建筑变形型DAB病例的发生频率及各合并亚组的死亡率。结果与产生液体的DAB亚型相比，产生坏死的DAB亚型患者的乳腺癌特异性死亡风险显著升高，为4.33倍（95% CI: 1.73-10.84）。与产生液体的DAB亚型相比，非钙化结构扭曲DAB亚型患者的风险增加了2.51倍（95% CI: 0.87-7.23）。大多数乳腺癌死亡，51/67(76%)，发生在317名在乳房x光检查中出现碎片状铸造型钙化的妇女中。腋窝淋巴结活检和一些死亡病例的远端转移显示了类似导管的结构。结论对DAB亚群的成像生物标志物的感知和识别是控制这些恶性肿瘤的必要的第一步，因为这些生物标志物表明了肿瘤的起源部位，并具有文献记载的预后价值。这些广泛的、弥漫性侵袭性恶性肿瘤的可靠的影像-组织病理学相关性要求使用大切片组织病理学技术。各DAB亚群的导管样结构为新生导管致癌过程中产生的新形成的侵入性新导管；它们不是预先存在的导管，可以转移到淋巴结和远处器官。这些观察结果对将导管原位癌（DCIS）一词用于这些DAB病例提出了挑战。除非医学界认识到新生细胞发生是一种侵入性的，而不是原位致癌过程，否则我们不太可能显著降低其高致死率。

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引用次数: 0