European Radiology最新文献

Objectives: We aimed to characterize the longitudinal evolution of perihematomal oligemia in acute intracerebral hemorrhage (ICH).

Materials and methods: A single center prospectively collected cohort of 150 patients with primary spontaneous ICH were imaged with computed tomography perfusion within 6 h from onset (T0), at 24 h (T1) and at 7 days (T7). Perihematomal cerebral blood flow (pCBF) was measured in the manually outlined perihematomal low-density area and categorized into ischemic (< 20 mL/100 g/min), oligemic (20-39.9 mL/100 g/min), normal (40-55 mL/100 g/min) and hyperemic (> 55 mL/100 g/min).

Results: pCBF values were ischemic in 20.7%, oligemic 47.3%, normal in 17.3%, and hyperemic in 14.7% of patients at T0. All patients with T0 ischemia remained ischemic at T7, normal and hyperemic patients at T0 maintained good perfusion values at T7, whereas 46.5% of oligemic patients at T0 developed delayed perihematomal ischemia. In patients with T0 perihematomal oligemia, the risk of conversion into delayed ischemia at T7 was higher in those with pCBF < 30 mL/100 g/min (p < 0.001). A total of 42.7% patients had perihematomal ischemia at T7 and this profile correlated with poor outcome, regardless of baseline perfusion status.

Conclusion: Our findings suggest that perihematomal oligemia may not represent a benign entity and indicate that delayed perihematomal ischemia is common and associated with unfavorable outcome.

Key points: Question The natural history and longitudinal evolution of perihematomal oligemia over time in patients with intracerebral hemorrhage (ICH) remains to be established. Findings Conversion of baseline perihematomal oligemia into ischemia occurs in 46.5% of oligemic ICH patients at 7 days, where a total of 42.7% patients were ischemic. Clinical relevance Evolution of perihematomal oligemia into ischemia during the transition from hyperacute to subacute phases is common. ICH patients with perihemorrhagic cerebral blood flow values < 30 mL/100 g/min are at high risk of ischemic progression, which in turn contributes to poor outcome.

Objectives: To characterize the radiological findings of desmoid-type fibromatosis (DF).

Methods: This two-institution retrospective study included 152 patients with pathologically confirmed DF who underwent computed tomography (CT), magnetic resonance imaging (MRI), or 18F-fluorodeoxyglucose-positron emission tomography (FDG-PET)/CT between January 2001 and February 2024. Two board-certified radiologists independently evaluated the CT, MRI, and FDG-PET/CT findings, and a third board-certified radiologist resolved discrepancies. Imaging was performed with and without contrast media: 70 patients underwent plain CT, 95 underwent contrast-enhanced (CE) CT, 115 patients underwent plain MRI examinations, 100 patients underwent CE-MRI, and 11 patients underwent FDG-PET/CT (most patients underwent several modalities).

Results: The median age of the patients was 40 years, with a female predominance (male, 39.5% vs female, 60.5%). Swelling or palpable mass was the most frequent symptom (78/152, 51.3%). Gross total resection of DF was performed in 57 patients, with a recurrence rate of 38.6% (22/57). Tumors were most frequently observed in the extra-abdominal region (79/152, 51.6%). Characteristic radiological features included intermediate intensity on T2-weighted imaging (112/113, 99.1%), intermediate-to-high intensity on T1-weighted imaging (109/111, 98.2%), substantial enhancement in the late phase on MRI (100/100, 100%), moderate to strong enhancement in the late phase on CT (18/20, 90%), and arterial penetration sign on CE-CT (25/96, 26.0%). The mean apparent diffusion coefficient (ADC) of DFs was 1.46 × 10^-3 mm²/s (range, 1.00-2.20).

Conclusion: This study highlights the unique imaging features of DF, including the arterial penetration sign and high mean ADC values, which can aid in differentiating DF from other soft tissue tumors. These findings may improve preoperative diagnostic accuracy and reduce the need for invasive procedures.

Key points: Question Imaging findings of DF are not well-documented in large-scale studies. Findings This study identifies unique imaging features of DF, such as the arterial penetration sign and high mean ADC values. Clinical relevance These distinctive imaging characteristics improve diagnostic accuracy for DF and lead to appropriate patient management, as DF requires distinct treatment strategies.

Objectives: To compare the performance and optimal combination of MRI descriptors used for the diagnosis of Ménière's disease (MD) between a real-IR sequence with "zero-point" endolymph (ZPE), and an optimised real-IR sequence with negative signal endolymph (NSE).

Materials and methods: This retrospective single-centre cross-sectional study evaluated delayed post-gadolinium ZPE and NSE real-IR MRI in consecutive patients with Ménièriform symptoms (8/2020-10/2023). Two observers assessed 14 MRI descriptors. "Definite MD" (2015 criteria) and "all MD" ears (wider clinical criteria) were compared to controls. Cohen's kappa and risk ratios (RR) were evaluated for each descriptor. Forward stepwise logistic regression established which combination of descriptors best predicted MD.

Results: The study included 132 patients (57 men; mean age 57.7 ± 13.6), with 87 "all MD" (56 "definite") and 39 control ears. The NSE sequence demonstrated increased perilymph SNR, and improved both diagnostic performance and reliability for 9/14 descriptors. However, ZPE demonstrated superior diagnostic performance for the best descriptor of "saccule absent, large as or confluent with the utricle" (RR 6.571, ZPE; 6.300, NSE) and that of "asymmetric perilymphatic enhancement" (RR 3.628, ZPE; 2.903, NSE). Both sequences combined these two descriptors in the optimal predictive model for "definite MD", with "grade 2 cochlear hydrops" also significant for NSE. ZPE and NSE descriptor combinations both correctly classified 95.8% of ears. The ZPE descriptor combination performed better for "all MD" (ZPE, AUC-ROC 0.914; NSE, AUC-ROC 0.893).

Conclusion: Parameter optimisation with NSE Real-IR influenced the optimal selection of MRI descriptors but did not improve their diagnostic performance in definite MD.

Key points: Question Delayed post-gadolinium ZPE (FLAIR) and NSE (REAL-IR) sequences are widely applied for diagnosing MD, but their relative benefits remain unclear. Findings Optimised NSE sequences improve perilymphatic depiction and influence the selection of the optimal MRI descriptors, but do not improve diagnostic performance. Clinical relevance Radiologists may continue to apply either ZPE or NSE sequences since they offer similar diagnostic abilities, but the choice of the sequence will influence which MRI features should be evaluated to support the diagnosis of MD.

Objectives: Women are under-represented in Radiology, both globally and in Ireland. An annual review of the medical workforce in Ireland for the year 2021-2022 revealed that although the overall gender breakdown of trainees is similar, with 56% female and 44% male trainees, certain specialities have disproportionate numbers of a given gender. Females only account for 38% of Irish Radiology trainees, one of the lowest of all the specialties. The cause for this disparity is likely multifactorial, but a lack of interest in applying for Radiology training by female doctors is a possible cause. The objectives of this study were to identify specific factors that attract or deter intern doctors from considering a career in Radiology and to identify underlying gender-specific differences.

Materials and methods: Anonymous online surveys were distributed to 50% of the intern population in Ireland between May and June 2022. The survey included questions on demographics, prior radiology exposure, and dedicated multiple-choice questions for those either considering or not considering radiology, which were subdivided into potentially influencing factors.

Results: Two-hundred-seven interns responded giving a response rate of 48.3%, which totalled almost 25% of the interns in Ireland. For those interns considering radiology, significantly more male interns (n = 24/67, 35.8%) are considering radiology compared with females (n = 26/139, 18.71%), (p  < 0.009). Significantly more females were deterred by the perception of radiology as a male-based speciality (p < 0.004).

Conclusion: Significantly fewer females are considering radiology, deterred by physics knowledge, use of technology, and, significantly, by the perception of radiology as a male-dominated speciality.

Clinical relevance statement: This survey highlights important reasons that female interns are deterred from radiology. It will help direct future medical training and doctor recruitment policies, with a view to addressing the ongoing gender disparity in the Irish radiology workforce.

Key points: Women are under-represented in the Irish and global Radiology workforce. Female interns are dissuaded from Radiology as a career by their perception of Radiology as male-dominated. This survey will shape medical training and doctor recruitment policies to improve gender diversity in radiology.

Objectives: We aimed to synthesise evidence from prospective studies of digital breast tomosynthesis (DBT) screening to assess its effectiveness compared to digital mammography (DM). Specifically, we examined whether DBT reduces interval cancer rates (ICRs) in population breast cancer screening.

Materials and methods: We performed a systematic review and meta-analysis of DBT screening studies (identified from January 2013 to March 2024). We included both RCTs and non-randomised prospective studies that used an independent comparison for our primary outcome ICRs. The risk of bias was assessed with QUADAS-2. We compared the ICR, cancer detection rate (CDR), and recall rate of DBT and DM screening using random effects meta-analysis models. Subgroup analyses estimated outcomes by study design. Sensitivity analyses estimated absolute effects from relative effects.

Results: Ten prospective studies (three RCTs, seven non-randomised) were eligible; all had a low risk of bias. There were 205,245 DBT-screened and 306,476 DM-screened participants with follow-up for interval cancer data. The pooled absolute ICR did not significantly differ between DBT and DM: -2.92 per 10,000 screens (95% CI: -6.39 to 0.54); however subsequent subgroup analysis indicated certain study designs may have biased this ICR estimate. Pooled ICR from studies that only sampled groups from the same time and region indicated DBT led to 5.50 less IC per 10,000 screens (95% CI: -9.47 to -1.54). Estimates from subgroup analysis that compared randomised and non-randomised trials did not significantly differ.

Conclusion: This meta-analysis provides suggestive evidence that DBT decreases ICR relative to DM screening; further evidence is needed to reduce uncertainty regarding ICR differences between DBT and DM.

Key points: Question Does DBT have long-term benefits over standard DM? Finding We find suggestive evidence in our primary analysis and stronger evidence in a follow-up analysis that DBT reduces interval cancers. Clinical relevance This meta-analysis provides the first indication that DBT may detect additional cancers that are clinically meaningful, based on suggestive evidence of a reduction in ICR. This finding does not preclude the simultaneous possibility of overdiagnosis.

Objectives: To develop a gadolinium-free MRI-based diagnosis prediction decision tree (DPDT) for adult-type diffuse gliomas and to assess the added value of gadolinium-based contrast agent (GBCA) enhanced images.

Materials and methods: This study included preoperative grade 2-4 adult-type diffuse gliomas (World Health Organization 2021) scanned between 2010 and 2021. The DPDT, incorporating eleven GBCA-free MRI features, was developed using 18% of the dataset based on consensus readings. Diagnosis predictions involved grade (grade 2 vs. grade 3/4) and molecular status (isocitrate dehydrogenase (IDH) and 1p/19q). GBCA-free diagnosis was predicted using DPDT, while GBCA-enhanced diagnosis included post-contrast images. The accuracy of these predictions was assessed by three raters with varying experience levels in neuroradiology using the test dataset. Agreement analyses were applied to evaluate the prediction performance/reproducibility.

Results: The test dataset included 303 patients (age (SD): 56.7 (14.2) years, female/male: 114/189, low-grade/high-grade: 54/249, IDH-mutant/wildtype: 82/221, 1p/19q-codeleted/intact: 34/269). Per-rater GBCA-free predictions achieved ≥ 0.85 (95%-CI: 0.80-0.88) accuracy for grade and ≥ 0.75 (95%-CI: 0.70-0.80) for molecular status, while GBCA-enhanced predictions reached ≥ 0.87 (95%-CI: 0.82-0.90) and ≥ 0.77 (95%-CI: 0.71-0.81), respectively. No accuracy difference was observed between GBCA-free and GBCA-enhanced predictions. Group inter-rater agreement was moderate for GBCA-free (0.56 (95%-CI: 0.46-0.66)) and substantial for GBCA-enhanced grade prediction (0.68 (95%-CI: 0.58-0.78), p = 0.008), while substantial for both GBCA-free (0.75 (95%-CI: 0.69-0.80) and GBCA-enhanced (0.77 (95%-CI: 0.71-0.82), p = 0.51) molecular status predictions.

Conclusion: The proposed GBCA-free diagnosis prediction decision tree performed well, with GBCA-enhanced images adding little to the preoperative diagnostic accuracy of adult-type diffuse gliomas.

Key points: Question Given health and environmental concerns, is there a gadolinium-free imaging protocol to preoperatively evaluate gliomas comparable to the gadolinium-enhanced standard practice? Findings The proposed gadolinium-free diagnosis prediction decision tree for adult-type diffuse gliomas performed well, and gadolinium-enhanced MRI demonstrated only limited improvement in diagnostic accuracy. Clinical relevance Even inexperienced raters effectively classified adult-type diffuse gliomas using the gadolinium-free diagnosis prediction decision tree, which, until further validation, can be used alongside gadolinium-enhanced images to respect standard practice, despite this study showing that gadolinium-enhanced images hardly improved diagnostic accuracy.

Objectives: This study aims to identify repeated previous shortcomings in medical imaging data collection, curation, and AI-based analysis during the early phase of respiratory pandemics. Based on the results, it seeks to highlight essential steps for improving future pandemic preparedness.

Materials and methods: We searched PubMed/MEDLINE, Scopus, and Cochrane Reviews for articles published from January 1, 2000, to December 31, 2021, using the terms "imaging" or "radiology" or "radiography" or "CT" or "x-ray" combined with "SARS," "MERS," "H1N1," or "COVID-19." WHO and CDC Databases were searched for case definitions.

Results: Over the last 20 years, the world faced several international health emergencies caused by respiratory diseases such as SARS, MERS, H1N1, and COVID-19. During the same period, major technological advances enabled the analysis of vast amounts of imaging data and the continual development of artificial intelligence algorithms to support radiological diagnosis and prognosis. Timely availability of data proved critical, but so far, data collection attempts were initialized only as individual responses to each outbreak, leading to long delays and hampering unified guidelines and data-driven technology to support the management of pandemic outbreaks. Our findings highlight the multifaceted role of imaging in the early stages of SARS, MERS, H1N1, and COVID-19, and outline possible actions for advancing future pandemic preparedness.

Conclusions: Advancing international cooperation and action on these topics is essential to create a functional, effective, and rapid counteraction system to future respiratory pandemics exploiting state of the art imaging and artificial intelligence.

Key points: Question What has been the role of radiological data for diagnosis and prognosis in early respiratory pandemics and what challenges were present? Findings International cooperation is essential to developing an effective rapid response system for future respiratory pandemics using advanced imaging and artificial intelligence. Clinical relevance Strengthening global collaboration and leveraging cutting-edge imaging and artificial intelligence are crucial for developing rapid and effective response systems. This approach is essential for improving patient outcomes and managing future respiratory pandemics more effectively.

Objectives: This study evaluates the advantages in diagnostic accuracy, confidence, and reading time of additional dual-energy CT-derived reconstructions for assessing acute bowel ischemia.

Methods and materials: This retrospective study includes 25 patients with surgically proven acute bowel ischemia and 25 gender- and age-matched controls who underwent biphasic abdominal dual-energy CT. Two fellowship-trained abdominal radiologists and two residents evaluated all cases with and without additional dual-energy CT-derived iodine maps and virtual non-contrast images. Diagnostic confidence was rated on a 10-point Likert scale. Reading time was recorded. The inter-reader agreement was assessed using Fleiss' kappa. Sensitivity and specificity were compared using McNemar's test, reader confidence, and reading times with the Wilcoxon signed-rank test.

Results: For conventional images alone, the inter-reader agreement was moderate (κ = 0.58), with a sensitivity of 77% (95% CI: 67.5-84.8%) and specificity of 90% (95% CI: 82.4-95.1%). Adding dual-energy CT images, inter-reader agreement increased to substantial (κ = 0.69), sensitivity increased significantly to 89% (95% CI: 81.2-94.4%, p = 0.02), while specificity increased non-significantly to 93% (95% CI: 86.1-97.1%, p = 0.51). Diagnostic confidence increased significantly from 8 (IQR: 6-8) to 9 (IQR: 8-9) (p < 0.01). Equivalent diagnostic accuracy and confidence increases were observed for fellowship-trained and resident radiologists. A non-significant increase in mean reading time per case from 196 s to 201 s was observed (p = 0.30).

Conclusion: Additional dual-energy CT reconstructions increase diagnostic accuracy and confidence without increasing reading time when evaluating suspected acute bowel ischemia. Both experienced and resident readers benefit from dual-energy CT images.

Key points: Question There are too few clinical studies assessing the diagnostic accuracy of dual-energy CT (DECT) to recommend its use for evaluating suspected acute bowel ischemia. Findings Adding DECT-derived iodine maps and virtual-non-contrast images increase reader sensitivity and confidence while maintaining high specificity when evaluating for acute mesenteric ischemia. Clinical relevance Dual-energy CT should be used to investigate suspected acute bowel ischemia. Both diagnostic accuracy and confidence can be increased independent of reader experience without significantly increasing reading time.