European Radiology最新文献

Background: Prolonged microvascular cerebral circulation time (mCCT) after endovascular thrombectomy (EVT) may reflect microvascular cerebral circulation impairment. The associations among mCCT, the development of malignant brain edema (MBE), and the functional outcome after successful recanalization (mTICI ≥ 2b) in large vessel occlusion stroke (LVOS) remain unclear.

Material and methods: We performed a retrospective analysis of 358 consecutive anterior circulation LVOS patients who achieved successful EVT. mCCT was measured intraprocedurally on DSA using syngo iFlow (Siemens Healthineers). MBE was assessed on follow-up imaging within 72 h. Functional outcome was modified Rankin Scale (mRS) score ≤ 2 at 90 days. Associations were tested using logistic regression and mediation analysis.

Results: MBE occurred in 42 patients (11.7%). Patients with MBE had significantly prolonged mCCT (median 4.7 s, IQR: 3.6-5.4) vs those without (3.4 s, IQR: 2.8-4.2; p < 0.001). Prolonged mCCT independently predicted MBE (aOR = 2.703; 95% CI: 1.833-3.985; p < 0.001) and unfavorable outcome (mRS > 2; aOR = 3.450; 95% CI: 2.402-4.954; p < 0.001). Adding mCCT to a model (collateral status, admission NIHSS, ASPECTS) significantly improved MBE prediction discrimination (AUC 0.915 vs 0.868; p = 0.015). Mediation analysis showed MBE did not significantly mediate the mCCT-functional outcome relationship (indirect effect coefficient = 0.001, p = 0.200; proportion mediated 7.6%).

Conclusions: Prolonged mCCT is a potential predictor of both MBE and unfavorable functional outcome after successful EVT for LVOS. While associated with increased MBE risk, mCCT's impact on prognosis appears largely independent of MBE. mCCT is a valuable intraprocedural biomarker for prognostication and guiding early post-EVT management.

Key points: Question How does prolonged mCCT after a successful EVT relate to MBE and functional outcomes? Findings Prolonged mCCT is a potential predictor of MBE and unfavorable functional outcomes. MBE does not significantly mediate mCCT's effect on outcomes. Clinical relevance Intraprocedural mCCT measurement identifies high-risk patients for early intervention (e.g., intensive monitoring, osmotherapy). It directly reflects microvascular injury, offering a novel biomarker for individualized post-EVT management.

Objectives: To quantify and compare the energy consumption of standard digital mammography (DM) and contrast-enhanced mammography (CEM), assess differences across manufacturers, and identify strategies to improve energy efficiency.

Materials and methods: This prospective study measured direct energy consumption from three mammography systems across two vendors in a tertiary breast care centre. In total, 193 examinations were analysed: 79 on Machine A, 92 on Machine B, and 22 CEM exams on Machine C. Minute-by-minute power monitoring provided net and gross energy per exam. A multivariable regression model adjusted for machine type, exam characteristics, and patient variables. Daily-level analyses evaluated baseload energy relative to workload, and annual energy use was estimated via Monte Carlo simulations.

Results: Machine B consumed more net energy per exam but achieved the lowest gross energy use due to minimal standby power. Machine A showed lower net but higher gross energy, primarily from greater idle consumption. Machine C had comparable net energy to A but higher gross energy per exam as a consequence of fewer daily exams. Machine type was the dominant determinant of energy use, while exam type, breast thickness, and density had no significant impact. Higher daily exam volumes improved energy efficiency across all systems, particularly for C. Annual energy estimates ranged from ~1660 to 2300 kWh per machine, with B consistently most efficient.

Conclusion: Mammography exhibits modest energy consumption, largely driven by standby operation rather than imaging activity. Vendor-specific differences exist, but DM and CEM show comparable net energy use.

Key points: Question Measure the energy use of standard digital and CEM, evaluate energy efficiency across vendors, and identify ways to reduce energy consumption. Findings Mammography uses relatively little energy, mostly during idle time; energy efficiency varies by manufacturer, and CEM does not increase net energy demand. Clinical relevance Optimizing scheduling appointments, powering down machines after hours, and considering vendor efficiency can significantly cut the environmental footprint of breast imaging without compromising patient care.

Objective: Blinded Independent Central Review (BICR) with double reads and adjudication is crucial in imaging-based clinical trials to ensure quality data. However, discrepancies in double reading can affect trial outcomes, particularly in assessing disease progression in phase 3 oncology studies using RECIST 1.1 criteria. This study examined discordance in the date of progressive disease (DoPD) across RECIST components: target lesion (TL), non-target lesion (nTL), new lesion (NL), exploring its impact on survival curves and whether discrepancies stem from timing differences or true/false PD detection.

Materials and methods: We retrospectively analyzed data from five clinical trials using BICR with double reads plus adjudication, involving 1932 lung cancer patients on immunotherapy or targeted therapy. RECIST components were examined to assess DoPD concordance, discrepancies, adjudicator acceptance, detection timing, and impact on survival curves.

Results: Readers showed a 39.3% discordance rate in DoPD assessments, with agreement on 17.3% of DoPD cases and 43.4% of non-PD cases. In 54.2% of concordant cases, multiple RECIST components contributed to PD. Discordance was primarily caused by NL (41.4%), sum of TL diameter increase (33.3%), nTL (11.8%), or multiple components (13.4%). In 49.2% of discrepant cases, PD was reported late, usually within one treatment cycle (79.8%). 62.5% of disputed PD cases were accepted by adjudication.

Conclusion: Different RECIST components vary in their likelihood of causing discordance and being accepted or refuted by adjudicators. NL detection is key for identifying progression but also the main source of disagreement. Using multiple RECIST components enhances the reliability of PD assessment.

Key points: Question How does discordance across RECIST components-especially new lesion detection-influence progression assessment timing and potentially alter survival outcomes in oncology clinical trials? Findings Reader disagreement on progression dates is common, driven mainly by new lesion detection; incorporating multiple RECIST components increases alignment and strengthens PD determination reliability. Clinical relevance Imaging endpoints guide cancer treatment decisions. RECIST 1.1 is the standard, inter-reader variability can undermine PFS accuracy. By evaluating RECIST component reliability, this work aims to improve trial precision, enabling faster, more confident decisions that ultimately benefit patients.

Involvement of the bone marrow by metastases from solid tumors or multiple myeloma (MM) is a critical challenge in oncologic imaging. Lesion detection and staging, as well as accurate assessment of treatment response, disease recurrence, and complications, are key to optimal patient management. This article provides recommendations for performing and interpreting bone marrow MRI in cancer patients. MRI should be the primary imaging modality for patients suspected of having skeletal bone metastases or MM, and should replace radiography, bone scintigraphy, and CT for these indications. Protocols must be tailored to the clinical context and to each specific cancer. Whole-body MRI (WB-MRI) is preferred for a comprehensive assessment, while axial skeleton MRI (AS-MRI) is a fast and reliable alternative for targeted or follow-up evaluations. We recommend standardized protocols that incorporate anatomical sequences (preferably fast spin echo T2 Dixon) and diffusion-weighted imaging (DWI). Quantitative biomarkers, e.g., apparent diffusion coefficient (ADC) and fat fraction (FF), should be implemented to improve diagnostic accuracy and evaluate treatment response. Radiologists must be familiar with the typical patterns of bone marrow replacement by cancer cells, response assessment principles, and common imaging pitfalls. Every medical imaging facility should offer optimal bone marrow MRI and implement these recommendations using available MRI systems and existing disease-oriented guidelines. This ESR Essentials illustrates when, how, and why to perform bone marrow MRI to improve diagnostic precision and oncologic care across a broad range of indications. KEY POINTS: Prefer MRI of the bone marrow over radiographs, bone scintigraphy, or CT for suspected bone metastases of solid cancers and for myeloma staging. Use MRI for diagnosis of bone involvement, disease staging, assessment of lesion response to treatment, detection of recurrence, and assessment of osseous complications. Tailor MRI protocol to cancer type following existing guidelines, targeting either the axial skeleton or the "whole body," and using a panel of sequences with fat-sensitive, fast spin echo T2 Dixon and diffusion-weighted sequences as the fundamental components.