European Radiology最新文献

Objectives: To compare the radiologic assessment of Hirschsprung disease (HD) based on contrast enema with automated image analysis using a deep neural network (DNN) for image recognition.

Materials and methods: A retrospective observational single-centre study was conducted at a tertiary care hospital, including paediatric patients who underwent contrast enema between January 2011 and December 2023, either for suspected HD or other clinical indications. A classifier based on a pretrained DNN (DenseNet121) was developed to detect HD in contrast enema images. DNN performance was assessed using balanced accuracy, sensitivity, and the area under the receiver-operating characteristic curve (AUC-ROC) and area under the precision-recall curve (AUC-PR) analyses. Rectal biopsy was the reference standard, with clinical follow-up in cases where a biopsy was not performed. The DNN classification performance was compared to historical expert radiologic assessment.

Results: A total of 278 contrast enemas were performed in 221 patients (64.8% male, 35.2% female), mean age of 4.14 years and a median of 2.65 years. DenseNet121 achieved 75.3% balanced accuracy, 58.5% sensitivity, and 92.1% specificity per individual image, improving to 82.8%, 72.7%, and 93.0%, respectively, at the contrast enema level. The model achieved a similar AUC-ROC compared to expert radiologists in their original reports (0.830 vs 0.804), and the interobserver agreement was moderate (Cohen´s kappa = 0.475).

Conclusion: The DNN model demonstrated higher specificity than radiologists in the interpretation of contrast enemas in patients with suspected HD. Moderate interobserver agreement underscores the model's potential value as a tool for diagnostic support and standardisation, particularly in settings where access to experienced specialists may be limited or in borderline cases.

Key points: Question Contrast enema is commonly used to evaluate suspected HD, but its diagnostic accuracy is variable and dependent on the radiologist's expertise. Findings A deep learning model outperformed radiologists in specificity (93.0% vs 79.1%), however, the difference was not statistically significant, and the interobserver agreement was moderate (Cohen´s kappa = 0.475). Clinical relevanceA DNN trained for automated analysis of contrast enema can identify patterns suggestive of HD with performance comparable to conventional radiological assessment, underscoring its value as a tool for diagnostic support in borderline cases or when access to experienced specialists may be limited.

Objectives: Iron is essential for oxygen transport and neuronal integrity, underscoring the importance of maintaining iron homeostasis for optimal brain function. This study aimed to elucidate the interplay among systemic iron status, brain iron levels, and cerebral blood flow (CBF), with a particular focus on their influence on cognitive performance.

Materials and methods: A total of 332 healthy women without a history of iron-related disorders were recruited and stratified into three groups based on serum iron concentrations: low-iron, reference, and high-iron groups. Brain iron content and CBF were assessed in the basal ganglia (BG) using quantitative susceptibility mapping and arterial spin labeling perfusion-weighted imaging, respectively. Cognitive performance was evaluated using attention-focused assessments.

Results: Although the low-iron group exhibited systemic iron deficiency, BG susceptibility values did not significantly differ from those of the reference group (p = 0.13). Path analysis revealed that lower blood iron levels were significantly associated with reduced BG susceptibility (p < 0.001), and that both lower blood iron (p < 0.001) and reduced susceptibility (p = 0.01) were associated with increased BG CBF. Decreased blood iron was associated with impaired attention performance, and a curvilinear relationship was observed between BG susceptibility and attention performance.

Conclusion: These findings indicate a dynamic interaction between systemic and brain iron homeostasis, which influences BG CBF and attention performance.

Key points: Question What are the associations among blood iron levels, brain iron content, cerebral blood flow (CBF), and attention performance in healthy women? Findings Reduced systemic and brain iron levels were significantly associated with elevated CBF. Variability in both iron levels was linked to alterations in attention performance. Clinical relevance The observed associations between systemic and brain iron status and cognitive performance highlight the importance of maintaining blood-brain iron homeostasis to prevent cognitive dysfunction, particularly in individuals with iron deficiency.

Objectives: Artificial intelligence (AI) has been applied in a number of breast screening settings with favourable results. While there are a limited number of studies exploring patient attitudes on the use of AI in breast screening, none to date have examined patient perceptions on the use of AI in the symptomatic setting.

Materials and methods: Following institutional approval, anonymous questionnaires were given to all patients attending the symptomatic breast clinic imaging department from 08/07/2024 to 04/10/2024. The questionnaire included questions on participant demographics and opinion questions on the use of AI in breast imaging. Multinomial logistic regression was performed to examine the associations between sociodemographic characteristics and patients' views about AI use in breast imaging.

Results: One thousand five hundred thirty-four participants completed the questionnaire. Most participants were aged 40-59 years(35.8%). Almost one-quarter had either a personal (n = 372) or family history of breast cancer (n = 367). 61.4% (n = 943) had some/strong interest in AI. 46.3% (n = 711) agreed the use of AI in healthcare was a good idea, and 43.9% (n = 673) were indifferent. 61% (n = 935) agreed to a radiologist and AI tool reading their mammogram, and 66.9% (n = 1026) disagreed with AI being the sole reader of their mammogram. Even if AI was shown to be more accurate, 66.1% of patients still prefer a radiologist to review their mammogram, and even if AI was shown to be more efficient, 75.4% prefer a radiologist.

Conclusion: Participants generally held favourable views towards the use of AI in healthcare. They welcome the use of AI as an adjunct for radiologists, but disagree with AI being the only reader of their mammogram.

Key points: Question Previous studies have explored patient attitudes on the use of AI in breast screening, but none to date have assessed this in the symptomatic setting. Findings The majority of participants welcome the use of AI as an adjunct for radiologists but disagree with AI being the sole reader of their mammogram. Clinical relevance This study highlights the importance of patient education to illustrate the benefits and limitations of AI in healthcare and how AI might work in the symptomatic breast setting.

Objectives: To compare clinical outcomes of transjugular intrahepatic portosystemic shunt (TIPS) in cirrhotic patients with a history of partial splenic embolization (PSE) vs splenectomy, focusing on shunt patency, overt hepatic encephalopathy (OHE), rebleeding, and survival.

Material and methods: This retrospective study included 240 cirrhotic patients undergoing TIPS (TIPS + PSE: n = 126; TIPS + splenectomy: n = 114). After propensity score matching, 88 patients per group were analyzed. The primary endpoint was shunt dysfunction; secondary endpoints included OHE, rebleeding, and survival.

Results: TIPS + PSE group had lower rates of shunt dysfunction (10.2% vs 30.7%, p < 0.001) and OHE (17.1% vs 39.8%, p < 0.001) than TIPS+splenectomy. No differences were found in rebleeding or survival (p > 0.05). Cox regression showed the treatment group (PSE vs splenectomy) as an independent predictor of shunt dysfunction (HR = 3.24, 95% CI: 1.56-6.91, p = 0.002) and OHE (HR = 1.96, 95% CI: 1.03-3.74, p = 0.042). Portal vein thrombosis was identified as an independent predictor of shunt dysfunction (HR = 2.47, 95% CI: 1.16-5.27, p = 0.019). Age (HR = 1.04, 95% CI: 1.00-1.08, p = 0.046) and Model for end-stage liver disease score (HR = 1.20, 95% CI: 1.02-1.41, p = 0.027) were independent predictors of mortality.

Conclusions: Among patients undergoing TIPS, those with prior PSE had a more favorable outcome regarding shunt dysfunction and OHE than those with prior splenectomy, with comparable rebleeding and survival. These findings support prioritizing PSE over splenectomy for patients who may later require TIPS.

Key points: Question The influence of prior splenic intervention on outcomes after TIPS in cirrhotic patients with portal hypertension remains uncertain, particularly regarding the comparative effects of PSE vs splenectomy. Finding Among patients undergoing TIPS, those with prior PSE had a more favorable outcome regarding shunt dysfunction and OHE than those with prior splenectomy, with comparable rebleeding and survival. Clinical relevance TIPS after PSE offers better outcomes in reducing shunt dysfunction and overt OHE in cirrhotic patients with portal hypertension, supporting prioritizing PSE over splenectomy for patients who may later require TIPS.

Objectives: Vacuum-assisted breast biopsy (VABB) and core needle biopsy (CNB) are percutaneous biopsy methods used for the assessment of suspicious breast lesions. This systematic review and meta-analysis focused on comparative diagnostic performance outcomes of lesions biopsied with VABB or CNB.

Materials and methods: Studies comparing VABB to CNB were searched in PubMed and Cochrane Library. Pooled risk ratios (RR) with 95% CI using random-effects models were calculated for atypical ductal hyperplasia (ADH) and ductal carcinoma in situ (DCIS) underestimation rates, repeat biopsy rate, concordance rate, calcification retrieval rate, and false-negative rate. Sensitivity analyses were performed using the leave-one-out approach. Risk of bias (RoB) was assessed using the quality assessment of diagnostic accuracy studies (QUADAS)-2 tool.

Results: Sixty studies were included from 937 records identified. ADH (RR: 0.63, 95% CI: 0.55-0.72, 22 studies) and DCIS (0.47, 0.39-0.58, 27 studies) underestimation was significantly lower with VABB compared to CNB. The repeat biopsy rate was significantly lower with VABB than with CNB (0.78, 0.69-0.88, 9 studies). VABB increased the likelihood that the surgical histology will match the biopsy (1.07, 1.04-1.11, 12 studies). The calcification retrieval rate was estimated to be significantly higher when using VABB (1.09, 1.04-1.14, 11 studies). Two-thirds of all studies had a low RoB.

Conclusion: VABB, as a first-line diagnostic procedure, is superior to CNB in terms of delivering a definitive diagnosis and reducing upgrade rates to malignancy, delivering a safe and efficient patient workflow.

Key points: QuestionWhat is the diagnostic performance of VABB vs CNB in assessing suspicious breast lesions, including those with and without calcifications? FindingsMeta-analysis results showed a significantly lower risk for DCIS underestimation, ADH underestimation, and repeat biopsies using any imaging-guided VABB compared to imaging-guided CNB. Clinical relevanceVABB, as a first-line diagnostic procedure, is superior to CNB in terms of delivering a definitive diagnosis and reducing upgrade rates to malignancy, delivering a safe and efficient patient workflow.

Objective: This systematic review and meta-analysis investigate the added value of contrast-enhanced breast MRI (CE-MRI) to rule out malignancy in patients with high-risk (B3) lesions diagnosed at image-guided biopsy.

Materials and methods: A systematic review and meta-analysis were performed using predefined criteria. Eligible English-language articles published until August 2024 focused on CE-MRI in high-risk lesions. Two reviewers extracted data on true positives (TP), false positives (FP), true negatives (TN), and false negatives (FN). Sensitivity, specificity, negative and positive likelihood ratios were calculated using a bivariate random-effects model. Fagan nomograms identified the maximum pretest probability at which post-test probabilities of a negative MRI matched the 2% malignancy threshold used for downgrading BI-RADS 4 to 3. I² statistics and meta-regression explored heterogeneity. p-values < 0.05 were considered significant.

Results: Seven studies comprising 479 patients with 493 high-risk lesions undergoing CE-MRI were included. The average breast cancer prevalence was 17% (88/493). Pooled sensitivity was 91.3% (95% CI: 82.8-95.8%) and pooled specificity was 68.8% (95% CI: 50.3-82.8%). Only 6/493 malignancies were missed by CE-MRI; all were small low-grade ductal carcinoma in situ (DCIS). Fagan nomograms indicated that CE-MRI could rule out malignancy in lesions with pretest probabilities up to 13.1%.

Conclusions: CE-MRI in assessing high-risk lesions may help identify patients who can safely avoid surgery, potentially reducing morbidity, anxiety, and healthcare resource use. Malignancy can be reliably ruled out in lesions with pretest probabilities ≤ 13.1%, although prospective studies are suggested for confirmation.

Key points: Question Can contrast-enhanced breast MRI help to rule out malignancy in patients with high-risk lesions at imaging-guided biopsy, thereby supporting more tailored decisions and potentially reducing unnecessary surgical excisions? Findings Contrast-enhanced breast MRI may reduce unnecessary surgical or vacuum excisions in high-risk (B3) lesions. Missed cancers were limited to small low-grade DCIS. Clinical relevance Contrast-enhanced breast MRI may support the identification of patients with high-risk lesions who could potentially avoid surgery. This non-invasive approach has the potential to reduce overtreatment, healthcare costs, and patient anxiety, while maintaining a high negative predictive value.

Objective: To determine which treatment parameters optimize focal therapy for intermediate-risk prostate cancer by balancing oncologic control with healthy tissue preservation, in a phase 2b multicenter trial of MRI-guided Focused Ultrasound (MRgFUS). Additionally, to assess the relationship of ablation volume relative to lesion volume with oncologic outcomes, urinary, and erectile function.

Materials and methods: In this retrospective interpretation of prospectively acquired data, the non-perfused volume (NPV) of prostate tissue encompassing the MRI-visible lesion volume defined the ablation-volume-to-lesion-volume ratio (ALVR). Oncologic efficacy was assessed as the absence of clinically significant (GGG ≥ 2) cancer in the treatment zone at 24-month biopsy. Associations between ALVR and outcomes were assessed using Student's t-tests. Baseline characteristics were compared using Kruskal-Wallis tests.

Results: Eighty-nine men (mean age, 63 years ± 7) had MRI-visible lesions with a volume of 0.47 mL (IQR: 0.20-0.95), with a surrounding NPV of 6.9 mL (IQR: 5.2-10.4). Men achieving oncologic efficacy had twice the ALVR compared to those with recurrence at the treatment site (17 vs 8, mean difference 8.8, 95% CI: 2.1, 16, p = 0.013). Increasing NPV relative to total prostate volume did not improve oncologic outcomes. Baseline characteristics did not significantly differ between men with and without GGG ≥ 2 at 24-month biopsy. ALVR did not differ in men with new erectile dysfunction (mean difference in ALVR: 2.1, 95% CI: -12, 16, p = 0.8) or urinary symptoms (mean difference in ALVR 4.0, 95% CI: -21, 29, p = 0.71).

Conclusions: In patients with intermediate-risk prostate cancer, higher ALVR was associated with superior 2-year oncologic outcomes without increased risk of urinary or erectile dysfunction.

Key points: Question What treatment parameters optimize focal therapy for prostate cancer by balancing healthy tissue preservation with favorable oncologic outcomes? Findings Patients without residual cancer at 24-month biopsy had twice the ALVR of those with recurrence, with no adverse impact on erectile or urinary function. Clinical relevance While fixed intra-prostatic margins (e.g., 5 mm or 10 mm) are commonly prescribed in focal therapy, this study highlights the importance of scaling the ALVR in the treatment plan to achieve sufficient oncologic coverage.