European Radiology最新文献

Objectives: To date, AI-supported programs for bone age (BA) determination for medical use in Europe have almost only been validated separately, according to Greulich and Pyle (G&P). Therefore, the current study aimed to compare the performance of three programs, namely BoneXpert, PANDA, and BoneView, on a single Central European population.

Materials and methods: For this retrospective study, hand radiographs of 306 children aged 1-18 years, stratified by gender and age, were included. A subgroup consisting of the age group accounting for 90% of examinations in clinical practice was formed. The G&P BA was estimated by three human experts-as ground truth-and three AI-supported programs. The mean absolute deviation, the root mean squared error (RMSE), and dropouts by the AI were calculated.

Results: The correlation between all programs and the ground truth was prominent (R² ≥ 0.98). In the total group, BoneXpert had a lower RMSE than BoneView and PANDA (0.62 vs. 0.65 and 0.75 years) with a dropout rate of 2.3%, 20.3% and 0%, respectively. In the subgroup, there was less difference in RMSE (0.66 vs. 0.68 and 0.65 years, max. 4% dropouts). The standard deviation between the AI readers was lower than that between the human readers (0.54 vs. 0.62 years, p < 0.01).

Conclusion: All three AI programs predict BA after G&P in the main age range with similar high reliability. Differences arise at the boundaries of childhood.

Key points: Question There is a lack of comparative, independent validation for artificial intelligence-based bone age estimation in children. Findings Three commercially available programs estimate bone age after Greulich and Pyle with similarly high reliability in a central European cohort. Clinical relevance The comparative study will help the reader choose a software for bone age estimation approved for the European market depending on the targeted age group and economic considerations.

Objective: To examine whether MRI with routine gadolinium-based contrast agent (GBCA) administration in the long-term surveillance of adult-type diffuse glioma identifies tumour progression earlier than T2-weighted (T2w) and/or T2w fluid-attenuated inversion recovery (FLAIR) MRI only.

Materials and methods: In this longitudinal retrospective multicentre cohort study patients with histopathologically confirmed adult-type diffuse glioma and at least two years survival after diagnosis in 2009-2010 were included. Progression was determined by the treating physician or during the multidisciplinary team meeting and defined as the moment a change in treatment or follow-up was required. The primary outcome was the proportion of patients that showed an increase of abnormalities on both contrast-enhanced T1-weighted (CET1w) and T2w/T2w-FLAIR at the time of progression. Chi-square testing was performed to analyse the relationship between the detection of progression on both scan sequences, with calculating the Phi coefficient to determine the degree of association.

Results: One hundred eight consecutive patients were included (58 male; 53 grade 2, 21 grade 3, 34 grade 4). Progression was present in 82 patients and was determined on both CET1w and T2w/T2w-FLAIR images in 59 patients (72.0%). In 20 patients (24.4%), progression was determined based solely on T2w/T2w-FLAIR abnormalities. Only three patients showed progression exclusively on CET1w (3.7%). There was a strong positive significant relationship between the detection of progression on both scan types (p < 0.001; Phi = 0.467).

Conclusion: An increase in CET1w abnormalities was generally accompanied by an increase in T2w/T2w-FLAIR abnormalities, raising the question of whether routine administration of GBCA is always necessary for long-term survivors of glioma.

Key points: Question Long-term survivors with glioma undergo many contrast-enhanced MRI scans, which involve a patient, financial, and environmental burden. Findings In almost all patients, an increase in T2w/T2w-FLAIR abnormalities was present at the time of tumour progression, mostly but not always accompanying contrast-enhancing findings. Clinical relevance T2w/T2-FLAIR MRI seems to detect glioma progression in long-term surviving patients similar to contrast-enhanced T1w MRI, raising the question of whether the routine administration of GBCA is necessary and justified in patients under long-term surveillance of glioma.

Objectives: To investigate the surgical impact of preoperative breast MRI in patients diagnosed with invasive lobular breast cancer (ILC) in a prospective observational study.

Methods: The prospective MIPA observational study database was queried for patients aged 18-80 with newly diagnosed unilateral ILC at needle biopsy referred for primary surgery. Patients who underwent preoperative MRI (MRI group) were matched (1:1) with those who did not (noMRI group) according to nine confounding covariates. Surgical outcomes were compared between the matched groups with nonparametric statistics after calculating odds ratios (ORs).

Results: A total of 547 women with unilateral needle biopsy-diagnosed ILC were identified (158 noMRI group, 389 MRI group). After patient matching, each group retained 103 patients, for a total of 206 matched patients. For the rate of women having a first-line mastectomy, there was no significant difference between the MRI group (21.4%, 22/103; p = 0.727; OR 1.20, 95% CI: 0.61-2.38) and the noMRI group (18.4%, 19/103). Conversely, the reoperation rate in the MRI group (1.9%, 2/103) was significantly lower (p = 0.007; OR of avoiding reoperation 7.29, 95% CI: 1.60-33.21) than in the noMRI group (12.6%, 13/103 patients). Overall mastectomy rates (first plus second-line) did not significantly differ between the MRI group (23.3%, 24/103; p = 0.867, OR 1.12, 95% CI: 0.58-2.16) and the noMRI group (21.4%, 22/103).

Conclusions: Women who had preoperative MRI after a needle biopsy diagnosis of ILC had a significant six-fold reduction in reoperations compared to those who did not have an MRI examination, with similar overall mastectomy rates.

Key points: Question No randomized controlled trials investigating the impact of preoperative MRI on surgical outcomes (mastectomy rates and reoperation) of needle-biopsy-diagnosed ILC have been conducted. Findings In a patient-matched analysis of 103 vs 103 women, preoperative MRI led to a greater than six-fold reduction of reoperations, without significant differences in first-line and overall mastectomy rates. Clinical relevance In the absence of randomized controlled trials, patient matching can be applied to mitigate confounding factors that drive the referral to preoperative MRI, showing that preoperative MRI has beneficial effects on surgical outcomes in patients with needle biopsy-diagnosed unilateral ILC.

Objectives: Multi-centre, multi-vendor validation of artificial intelligence (AI) software to detect clinically significant prostate cancer (PCa) using multiparametric magnetic resonance imaging (MRI) is lacking. We compared a new AI solution, validated on a separate dataset from different UK hospitals, to the original multidisciplinary team (MDT)-supported radiologist's interpretations.

Materials and methods: A Conformité Européenne (CE)-marked deep-learning (DL) computer-aided detection (CAD) medical device (Pi) was trained to detect Gleason Grade Group (GG) ≥ 2 cancer using retrospective data from the PROSTATEx dataset and five UK hospitals (793 patients). Our separate validation dataset was on six machines from two manufacturers across six sites (252 patients). Data included in the study were from MRI scans performed between August 2018 to October 2022. Patients with a negative MRI who did not undergo biopsy were assumed to be negative (90.4% had prostate-specific antigen density < 0.15 ng/mL²). ROC analysis was used to compare radiologists who used a 5-category suspicion score.

Results: GG ≥ 2 prevalence in the validation set was 31%. Evaluated per patient, Pi was non-inferior to radiologists (considering a 10% performance difference as acceptable), with an area under the curve (AUC) of 0.91 vs. 0.95. At the predetermined risk threshold of 3.5, the AI software's sensitivity was 95% and specificity 67%, while radiologists at Prostate Imaging-Reporting and Data Systems/Likert ≥ 3 identified GG ≥ 2 with a sensitivity of 99% and specificity of 73%. AI performed well per-site (AUC ≥ 0.83) at the patient-level independent of scanner age and field strength.

Conclusion: Real-world data testing suggests that Pi matches the performance of MDT-supported radiologists in GG ≥ 2 PCa detection and generalises to multiple sites, scanner vendors, and models.

Key points: QuestionThe performance of artificial intelligence-based medical tools for prostate MRI has yet to be evaluated on multi-centre, multi-vendor data to assess generalisability. FindingsA dedicated AI medical tool matches the performance of multidisciplinary team-supported radiologists in prostate cancer detection and generalises to multiple sites and scanners. Clinical relevanceThis software has the potential to support the MRI process for biopsy decision-making and target identification, but future prospective studies, where lesions identified by artificial intelligence are biopsied separately, are needed.

The urgency for climate action is recognized by international government and healthcare organizations, including the United Nations (UN) and World Health Organization (WHO). Climate change, biodiversity loss, and pollution negatively impact all life on earth. All populations are impacted but not equally; the most vulnerable are at the highest risk, an inequity further exacerbated by differences in access to healthcare globally. The delivery of healthcare exacerbates the planetary health crisis through greenhouse gas emissions, largely due to combustion of fossil fuels for medical equipment production and operation, creation of medical and non-medical waste, and contamination of water supplies. As representatives of radiology societies from across the globe who work closely with industry, and both governmental and non-governmental leaders in multiple capacities, we advocate together for urgent, impactful, and measurable changes to the way we deliver care by further engaging our members, policymakers, industry partners, and our patients. Simultaneous challenges, including global health disparities, resource allocation, and access to care, must inform these efforts. Climate literacy should be increasingly added to radiology training programs. More research is required to understand and measure the environmental impact of radiological services and inform mitigation, adaptation and monitoring efforts. Deeper collaboration with industry partners is necessary to support innovations in the supply chain, energy utilization, and circular economy. Many solutions have been proposed and are already available, but we must understand and address barriers to the implementation of current and future sustainable innovations. Finally, there is a compelling need to partner with patients, to ensure that trust in the excellence of clinical care is maintained during the transition to sustainable radiology. By fostering a culture of global cooperation and rapid sharing of solutions amongst the broader imaging community, we can transform radiological practice to mitigate its environmental impact, adapt and develop resilience to current and future climate and environmental threats, and simultaneously improve access to care. KEY POINTS: Question What actions can professional societies take to improve the environmental sustainability of radiology? Findings Better understanding of resource usage in radiology is needed; action is required to address regional and global disparities in access to care which stand to be exacerbated by climate change. Clinical relevance Radiological societies need to advocate for urgent, impactful, and measurable changes to mitigate the environmental impact of radiological practice. Research and education, as well as adaptation and resilience to current and future climate and environmental threats, must be prioritized while simultaneously improving access to care.

Objectives: To evaluate the diagnostic performance of the Avocado Sign, a novel contrast-enhancement-based MR imaging marker, for prognostication of mesorectal lymph node spread in rectal cancer.

Methods: This retrospective study included 106 patients with rectal cancer who underwent MRI examination. The Avocado Sign, defined as a hypointense core within an otherwise homogeneously hyperintense lymph node on contrast-enhanced T1-weighted images, was assessed. Of the cohort, 77 patients received neoadjuvant chemoradiotherapy followed by restaging MRI. Histopathological examination served as the reference standard. Diagnostic metrics were calculated and compared between subgroups using chi-square tests. Interobserver agreement was evaluated using Cohen's kappa.

Results: The Avocado Sign demonstrated high diagnostic accuracy for predicting lymph node involvement, with an overall sensitivity of 88.7%, specificity of 84.9%, PPV of 85.5%, NPV of 88.2%, and accuracy of 86.8%. The area under the ROC curve was 0.87. Subgroup analysis revealed excellent performance in both patients undergoing surgery alone (sensitivity 100%, specificity 83.3%) and those receiving neoadjuvant therapy (sensitivity 84.2%, specificity 85.4%). Interobserver agreement was almost perfect (κ = 0.92).

Conclusion: The Avocado Sign is a promising imaging predictor for mesorectal lymph node status in rectal cancer. Its straightforward application, high reproducibility, and remarkable diagnostic accuracy underline its potential to refine MRI staging. However, further validation in larger, prospective multicenter studies is warranted to confirm these findings and assess their impact on clinical decision-making.

Key points: Question Can the Avocado Sign on contrast-enhanced MRI improve mesorectal lymph node staging in rectal cancer independently of classical morphological criteria? Findings The Avocado Sign demonstrated high sensitivity (88.7%) and specificity (84.9%) as a standalone marker for predicting mesorectal lymph node involvement. Clinical relevance Incorporating contrast-enhanced sequences and the Avocado Sign into MRI protocols enhances nodal staging accuracy in rectal cancer, potentially informing treatment decisions. Further validation is required to confirm its effectiveness and compare it with existing criteria.