European Radiology最新文献

Objectives: This study investigated patients' acceptance of artificial intelligence (AI) for diagnosing prostate cancer (PCa) on MRI scans and the factors influencing their trust in AI diagnoses.

Materials and methods: A prospective, multicenter study was conducted between January and November 2023. Patients undergoing prostate MRI were surveyed about their opinions on hypothetical AI assessment of their MRI scans. The questionnaire included nine items: four on hypothetical scenarios of combinations between AI and the radiologist, two on trust in the diagnosis, and three on accountability for misdiagnosis. Relationships between the items and independent variables were assessed using multivariate analysis.

Results: A total of 212 PCa suspicious patients undergoing prostate MRI were included. The majority preferred AI involvement in their PCa diagnosis alongside a radiologist, with 91% agreeing with AI as the primary reader and 79% as the secondary reader. If AI has a high certainty diagnosis, 15% of the respondents would accept it as the sole decision-maker. Autonomous AI outperforming radiologists would be accepted by 52%. Higher educated persons tended to accept AI when it would outperform radiologists (p < 0.05). The respondents indicated that the hospital (76%), radiologist (70%), and program developer (55%) should be held accountable for misdiagnosis.

Conclusions: Patients favor AI involvement alongside radiologists in PCa diagnosis. Trust in AI diagnosis depends on the patient's education level and the AI performance, with autonomous AI acceptance by a small majority on the condition that AI outperforms a radiologist. Respondents held the hospital, radiologist, and program developers accountable for misdiagnosis in descending order of accountability.

Clinical relevance statement: Patients show a high level of acceptance for AI-assisted prostate cancer diagnosis on MRI, either alongside radiologists or fully autonomous, particularly if it demonstrates superior performance to radiologists alone.

Key points: Prostate cancer suspicious patients may accept autonomous AI based on performance. Patients prefer AI involvement alongside a radiologist in diagnosing prostate cancer. Patients indicate accountability for AI should be shared among multiple stakeholders.

Objectives: In patients with non-tuberculous mycobacterial pulmonary disease (NTM-PD), the response to treatment is evaluated based on microbiological, clinical, and radiological data. However, little is known about the dynamics of CT findings. The aim of this study was to evaluate CT changes in NTM-PD in order to define radiological criteria for treatment success.

Methods: Retrospective multicenter study (Hannover, Heidelberg, Gauting). Sixty patients with NTM-PD and at least two consecutive CT scans were included. Scoring for NTM-PD was performed by evaluating variables of bronchiectasis, mucus plugging, bronchiolitis, cavities, nodules, and consolidations on an ordinal scale from 0 to 3. Differences between baseline and follow-up were calculated, and patients with/without cultural conversion were compared using the Mann-Whitney U-test. For paired comparison of the two consecutive CT scans the Wilcoxon test was used.

Results: Comparing patients with and without culture conversion, there were significant differences in temporal changes of bronchiectasis (p < 0.001), cavities (p = 0.006), bronchiolitis (p < 0.001), consolidations (p = 0.004), and total score (p < 0.001). Nodules showed no significant differences between groups (p = 0.060). The Wilcoxon test showed significant differences between both CTs in patients with a microbiological cure for the total score (p < 0.001), cavities (p = 0.005), bronchiolitis (p < 0.001), and consolidations (p = 0.021) with a decrease after microbiological cure, whereas bronchiectasis (p = 0.102) and nodules (p = 0.18) stayed stable. In the case of persistently positive cultures, there was an increase in the total score (p = 0.010) which was attributable to progressive bronchiectasis (p < 0.001).

Conclusion: Cavities, consolidations, and bronchiolitis are useful to assess treatment response, whereas bronchiectasis and nodules may remain stable despite successful treatment.

Clinical relevance statement: Cavities, consolidations, and bronchiolitis can assess treatment response whereas bronchiectasis and nodules may remain stable despite successful treatment. In persistently positive cultures, bronchiectasis showed an increase over time indicating that NTM-PD is a progressive chronic disease.

Key points: Little is known about CT changes in nontuberculous mycobacteria pulmonary disease (NTM-PD) and criteria to evaluate treatment response. In the case of culture conversion, cavities and bronchiolitis decreased whereas bronchiectasis and nodules remained stable. Cavities and bronchiolitis can evaluate treatment response in NTM, but bronchiectasis and nodules may persist despite successful treatment.

Objective: To determine whether small, incidentally detected testicular lesions can be safely followed up, by assessing growth rate and volume threshold for benign vs. malignant lesions.

Methods: This retrospective observational study includes a consecutive series of 130 testicular incidentalomas < 1 cm and with negative tumour markers identified from October 2001 to November 2022, which were initially followed up with ultrasound. A total of 39 cases proceeded to surgery during the study period, either due to lesion growth (n = 28) or patient preference/recommendation by the referring urologist (n = 11). For the lesions that were growing, specific growth rate (SGR) and doubling time (DT) were calculated assuming an exponential growth pattern. In addition, the velocity of increase of the average diameter (∆D_av) and of the maximum diameter (∆D_max) were calculated.

Results: Of the 130 nodules that were initially followed up, six disappeared, eight were reduced in size, eighty-eight were stable, and twenty-eight increased in size. For operated nodules all 18 malignant tumours, 8/9 benign tumours, and 2/12 surgically proved non-neoplastic lesions were growing. The best cut-off values of the growth indicators to differentiate between malignant and non-malignant histology were 3.47 × 10^-3%volume/day, ≤ 179 days, > 10 × 10^-3mm/day, and > 5 × 10^-3mm/day for SGR, DT, ∆D_max, ∆D_av, respectively.

Conclusions: Malignant and non-malignant small incidentalomas can be effectively differentiated based on growing parameters, even though overlap exists. An increase of the maximum diameter of about 1 mm and 2 mm in three months and in six months, respectively, suggests malignancy.

Clinical relevance statement: Growing parameters allow an educated assessment of benign and malignant small testicular incidentalomas. Non-aggressive management is justified and safe when follow-up includes self-examination and tumour marker assessment to reduce the risk of interval tumour growth.

Key points: Small, non-palpable and asymptomatic testicular nodules < 1 cm are unexpectedly discovered during scrotal ultrasound. Growth indicators estimate the potential malignancy, even though overlap with non-malignant lesions exists. Non-growing incidentalomas can be safely followed up.

Objectives: Sigmoid volvulus (SV) is a common cause of bowel obstruction, especially in older patients. SV can be mesenteroaxial (M-SV) or organoaxial (O-SV). The purpose of this study was to assess if CT findings in SV are associated with clinical outcomes. including recurrence, choice of management, and mortality.

Materials and methods: This study includes patients with SV and a CT within 24 hours of presentation. CT features, including mesenteraoxial/organoaxial arrangement, direction of rotation, transition points, distension, whirl-sign, ischemia, and perforation were determined. Demographics, treatment, recurrence, and outcome data were recorded.

Results: One hundred and seventeen cases were diagnosed in 80 patients (54 male). The mean age was 70 years (± 17.1). M-SV and O-SV were equally prevalent (n = 39 vs. n = 41, respectively). M-SV was significantly more common with anticlockwise rotation in the axial plane (p = 0.028) and clockwise rotation in the coronal plane (p = 0.015). All patients with imaging features of ischemia underwent surgery (n = 6). There was no significant difference in outcome variables (30-day mortality, 30-day readmission, recurrence) between the O-SV and M-SV groups. The degree of bowel distension on initial presentation was a significant predictor of recurrence, with ≥ 9 cm vs < 9 cm associated with an increased odds of any recurrence (OR: 3.23; 95%CI: 1.39-7.92).

Conclusion: In SV, sigmoid distension of more than 9 cm at baseline CT was associated with an increased risk of recurrence. Imaging features of ischemia predicted surgical over endoscopic intervention. Organoaxial and mesenteroaxial SV had similar prevalence, but the type of volvulus was not associated with clinical outcomes or choice of management.

Clinical relevance statement: There is a risk of recurrent sigmoid volvulus with colonic distension greater than 9 cm. This work, comparing volvulus subtypes, shows that this finding at the initial presentation could expedite consideration for surgical management.

Key points: Reports of outcomes for different subtypes and rotational directions of volvuli have been contradictory. No difference in measured outcomes was found between subtypes; distension ≥ 9 cm predicted recurrence. CT features can aide management of sigmoid volvulus and can prompt surgical intervention.

Objectives: Li-Fraumeni syndrome (LFS) is a cancer syndrome associated with early-onset neoplasias. The use of whole-body magnetic resonance imaging (WBMRI) is recommended for regular cancer screening, however, evidence supporting the benefits in asymptomatic LFS patients is limited. This study aims to assess the clinical utility of WBMRI in germline TP53 mutation carriers at baseline and follow-up.

Materials and methods: We systematically searched PubMed, Cochrane, and Embase databases for studies evaluating WBMRI as an early detection method for tumor screening in patients with LFS. We pooled the prevalence of the included variables along with their corresponding 95% confidence intervals (CIs). Statistical analyses were performed using R software, version 4.3.1.

Results: From 1687 results, 11 comprising 703 patients (359 females (51%); with a median age of 32 years (IQR 1-74)) were included. An estimated detection rate of 31% (95% CI: 0.28, 0.34) for any suspicious lesions was found in asymptomatic TP53 carriers who underwent baseline WBMRI. A total of 277 lesions requiring clinical follow-up were identified in 215 patients. Cancer was confirmed in 46 lesions across 39 individuals. The estimated cancer diagnosis rate among suspicious lesions was 18% (95% CI: 0.13, 0.25). WBMRI detected 41 of the 46 cancers at an early-disease stage, with an overall detection rate of 6% (95% CI: 0.05, 0.08). The incidence rate was 2% per patient round of WBMRI (95% CI: 0.01, 0.04), including baseline and follow-up.

Conclusion: This meta-analysis provides evidence that surveillance with WBMRI is effective in detecting cancers in asymptomatic patients with LFS.

Clinical relevance statement: Our study demonstrates that whole-body MRI is an effective tool for early cancer detection in asymptomatic Li-Fraumeni Syndrome patients, highlighting its importance in surveillance protocols to improve diagnosis and treatment outcomes.

Key points: Current evidence for whole-body MRI screening of asymptomatic Li-Fraumeni Syndrome (LFS) patients remains scarce. Whole-body MRI identified 41 out of 46 cancers at an early stage, achieving an overall detection rate of 6%. Whole-body MRI surveillance is a valuable method for detecting cancers in asymptomatic LFS patients.

This ESR Essentials article intends to provide detailed, step-by-step, information on the role of imaging in the diagnosis, procedural management, and follow-up of patients with fluid collections. Evidence-based medicine recommendations for the positioning of percutaneous drainages and/or for diagnostic/therapeutic aspiration of fluid collections are provided. Although medical history, clinical symptoms, physical examination, and laboratory tests can raise suspicions regarding a collection, an imaging assessment is usually necessary for the diagnosis. Radiologists can easily identify fluid collections that are clinically suspected by using a wide range of imaging modalities, such as ultrasound, CT, MRI, and cone-beam CT. Consequently, these imaging methods (either alone or combined), can be used to aspirate the collection or for the placement of a drainage catheter. The choice of imaging technique to be used is influenced by the location of the collection, operator preference, size, and content of the collection. In addition, it is of utmost importance to underline the role of the interventional radiologist in the management and follow-up of patients with percutaneous drains, in collaboration with surgeons, clinicians, and diagnostic radiologists. KEY POINTS: Indications for percutaneous imaging-guided drainage are supported by clinical findings, laboratory tests, and pre-procedural imaging. Deciding between aspiration or drain insertion should follow patient assessment and fluid collection characterization. The interventional radiologist should be part of the entire patient care process including follow-up.

Objectives: To exploit the capability of super-resolution deep learning reconstruction (SR-DLR) to save radiation exposure from coronary CT angiography (CCTA) and assess its impact on image quality, coronary plaque quantification and characterization, and stenosis severity analysis.

Materials and methods: This prospective study included 50 patients who underwent low-dose (LD) and subsequent ultra-low-dose (ULD) CCTA scans. LD CCTA images were reconstructed with hybrid iterative reconstruction (HIR) and ULD CCTA images were reconstructed with HIR and SR-DLR. The objective parameters and subjective scores were compared. Coronary plaques were classified into three components: necrotic, fibrous or calcified content, with absolute volumes (mm³) recorded, and further characterized by percentage of calcified content. The four main coronary arteries were evaluated for the presence of stenosis. Moreover, 48 coronary segments in 9 patients were evaluated for the presence of significant stenosis, with invasive coronary angiography as a reference.

Results: Effective dose decreased by 60% from LD to ULD CCTA scans (2.01 ± 0.84 mSv vs. 0.80 ± 0.34 mSv, p < 0.001). ULD SR-DLR was non-inferior or even superior to LD HIR in terms of image quality and showed excellent agreements with LD HIR on the plaque volumes, characterization, and stenosis analysis (ICCs > 0.8). Moreover, there was no evidence of a difference in detecting significant coronary stenosis between the LD HIR and ULD SR-DLR (AUC: 0.90 vs. 0.89; p = 1.0).

Conclusions: SR-DLR led to significant radiation dose savings from CCTA while ensuring high image quality and excellent performance in coronary plaque and stenosis analysis.

Key points: Question How can radiation dose for coronary CT angiography be reduced without compromising image quality or affecting clinical decisions? Finding Super-resolution deep learning reconstruction (SR-DLR) algorithm allows for 60% dose reduction while ensuring high image quality and excellent performance in coronary plaque and stenosis analysis. Clinical relevance Dose optimization via SR-DLR has no detrimental effect on image quality, coronary plaque quantification and characterization, and stenosis severity analysis, which paves the way for its implementation in clinical practice.

Objectives: The interpretation of mammograms requires many years of training and experience. Currently, training in mammography, like the rest of diagnostic radiology, is through institutional libraries, books, and experience accumulated over time. We explore whether artificial Intelligence (AI)-generated images can help in simulation education and result in measurable improvement in performance of residents in training.

Methods: We developed a generative adversarial network (GAN) that was capable of generating mammography images with varying characteristics, such as size and density, and created a tool with which a user could control these characteristics. The tool allowed the user (a radiology resident) to realistically insert cancers within different regions of the mammogram. We then provided this tool to residents in training. Residents were randomized into a practice group and a non-practice group, and the difference in performance before and after practice with such a tool (in comparison to no intervention in the non-practice group) was assessed.

Results: Fifty residents participated in the study, 27 underwent simulation training, and 23 did not. There was a significant improvement in the sensitivity (7.43 percent, significant at p-value = 0.03), negative predictive value (5.05 percent, significant at p-value = 0.008) and accuracy (6.49 percent, significant at p-value = 0.01) among residents in the detection of cancer on mammograms after simulation training.

Conclusion: Our study shows the value of simulation training in diagnostic radiology and explores the potential of generative AI to enable such simulation training.

Clinical relevance statement: Using generative artificial intelligence, simulation training modules can be developed that can help residents in training by providing them with a visual impression of a variety of different cases.

Key points: Generative networks can produce diagnostic imaging with specific characteristics, potentially useful for training residents. Training with generating images improved residents' mammographic diagnostic abilities. Development of a game-like interface that exploits these networks can result in improvement in performance over a short training period.