European Radiology最新文献

Background: Children with constitutional mismatch repair deficiency (CMMRD) syndrome have an increased risk of high-grade gliomas (HGG), and brain imaging abnormalities. This study analyzes brain imaging features in CMMRD syndrome children versus those with HGG without CMMRD.

Methods: Retrospective comparative analysis of brain imaging in 30 CMMRD children (20 boys, median age eight years, 22 with HGG), seven with Lynch syndrome (7 HGG), 39 with type 1 neurofibromatosis (NF1) (four with HGG) and 50 with HGG without MMR or NF1 pathogenic variant ("no-predisposition" patients).

Results: HGG in CMMRD and Lynch patients were predominantly hemispheric (versus midline) compared to NF1 and no-predisposition patients (91% and 86%, vs 25% and 54%, p = 0.004). CMMRD-associated tumors often had ill-defined boundaries (p = 0.008). All CMMRD patients exhibited at least one developmental venous anomaly (DVA), versus 14%, 10%, and 6% of Lynch, NF1, and no-predisposition patients (p < 0.0001). Multiple DVAs were observed in 83% of CMMRD patients, one NF1 patient (3%), and never in other groups (p < 0.0001). Cavernomas were discovered in 21% of CMMRD patients, never in other groups (p = 0.01). NF1-like focal areas of high T2-FLAIR signal intensity (FASI) were more prevalent in CMMRD patients than in Lynch or no-predisposition patients (50%, vs 20% and 0%, respectively, p < 0.0001). Subcortical and ill-limited FASI, possibly involving the cortex, were specific to CMMRD (p < 0.0001) and did not evolve in 93% of patients (13/14).

Conclusion: Diffuse hemispherically located HGG associated with multiple DVAs, cavernomas, and NF1-like or subcortical FASI strongly suggests CMMRD syndrome compared to children with HGG in other contexts.

Clinical relevance statement: The radiologic suggestion of CMMRD syndrome when confronted with HGGs in children may prompt genetic testing. This can influence therapeutic plans. Therefore, imaging features could potentially be incorporated into CMMRD testing recommendations.

Key points: Using imaging to detect CMMRD syndrome early may improve patient care. CMMRD features include: hemispheric HGG with multiple developmental venous anomalies and NF1-like or subcortical areas with high T2-FLAIR intensity. We propose novel imaging features to improve the identification of potential CMMRD patients.

Objectives: This study explored the clinical prognosis and lipidomics of hepatitis B virus steatohepatitic hepatocellular carcinoma (HBV-SHHCC) and aimed to identify a noninvasive and convenient method to diagnose this phenotype and guide treatment using MRI.

Methods: A total of 433 HBV-infected HCC patients were enrolled in this retrospective study. Survival data were analyzed using Cox regression analyses, and lipidomics was used to study HCC tissue composition. Logistic regression identified an independent predictor for HBV-SHHCC, and receiver-operating characteristic (ROC) analysis verified its discrimination.

Results: HBV-SHHCC patients had longer disease-free survival (DFS, p < 0.0001) and overall survival (OS) time (p = 0.00097). Compared with common HCC (cHCC), SHHCC was associated with significantly higher mean triacylglyceride (p = 0.010) and diacylglyceride contents (p = 0.002) in tumor tissues. Fat fraction (FF) was linearly correlated with lipid composition and fatty acid degradation (FAD) subtype, which could help in treatment options for HCC. The univariate and multivariate logistic regression indicated FF (p < 0.001) as an independent predictor for diagnosing this phenotype. ROC analysis confirmed excellent discrimination (area under the curve (AUC), 0.914; sensitivity, 92.3%; specificity, 78.7.0%). After using the optimal cutoff point, the DFS time of patients with SHHCC stratified by FF was significantly higher than that of patients with cHCC.

Conclusion: The biological behavior and prognosis of HBV-SHHCC were better than those of other types. FF is a valuable tool for the clinical diagnosis of SHHCC, prognosis prediction, and treatment guidance in patients with HCC.

Key points: Question Can the diagnosis of steatohepatitic hepatocellular carcinoma (SHHCC) be made noninvasively? Findings Fat fraction (FF) correlated with lipid composition and could be used to diagnose SHHCC with an AUC of 0.914, sensitivity of 92.3%, and specificity of 78.7%. Clinical relevance MRI-based FF could be used to diagnose HBV-related SHHCC, indicate prognosis, and guide the clinical treatment of patients with HCC.

Objectives: To evaluate the oncological efficacy and complications of cryoablation (CA) in treating lung metastases from colorectal cancer (CRC) at the lung periphery.

Materials and methods: The inclusion criteria for this bicenter retrospective study included patients with histologically confirmed CRC, with radiologically confirmed lung metastases at the periphery of the lung (distance of less than or equal to 2 cm from the costal, diaphragmatic, or cervical pleura) treated with CA between January 2017 and June 2022. Patients with intra-parenchymal metastases or metastases close to the mediastinal pleura and patients without follow-up were excluded.

Results: Seventy-three patients were included (median age: 69 years, range 47.0-83.0; 38 males, 52.0%) with 113 metastases and 89 procedures. Technical success was achieved in all procedures. During follow-up (median 22 months), on a per metastasis basis, local recurrence occurred for 8/113 (7%) of the metastases in 7 patients at a median time of 19 months; 7 had concomitant distant recurrence. Local progression-free survival rates were 95% at 1 year and 89% at 2, 3, and 4 years. Distant progression occurred in 41/73 (56.2%) patients, significantly associated with a history of liver metastasis and synchronous lung metastasis (p < 0.05). The median chemotherapy-free survival was 14 (IQR (5.0-21.5)) months. Complications were predominantly mild or moderate, with a low incidence of severe complications.

Conclusion: CA demonstrates high rate of local control and appears well-tolerated in the treatment of peripheral lung metastases from CRC. The procedure offers a viable therapeutic option, allowing patients a significant period without chemotherapy.

Key points: Question Despite its advantages over surgery, data on cryoablation of metastases from colorectal cancer at the periphery of the lung are lacking. Findings Cryoablation enabled very good local control, with local progression-free survival rates of 95% at 1 year and 89% at 2, 3, and 4 years. Clinical relevance Cryoablation is an effective treatment for local tumor control of lung metastases from colorectal cancer at the periphery of the lung. The treatment is well tolerated and can provide patients with substantial relief from chemotherapy.

Objective: To comprehensively examine the influence of auto-patient centering technologies on positioning accuracy, radiation dose, image quality, and time efficiency of computed tomography (CT) scans.

Materials and methods: A systematic search of peer-reviewed English publications was performed between January 2000 and November 2023 in PubMed, Embase, CINAHL, Scopus, and Web of Science. Two postgraduate students and an academic lecturer independently reviewed the articles to verify adherence to the inclusion criteria. The QUADAS-2 tool was employed to evaluate study quality. We derived summary estimates on positioning accuracy, radiation dose reduction, image quality, and time efficiency using proportion and meta-analysis methodologies.

Results: Nine studies were identified comparing automatic and manual CT positioning. Automatic positioning improved accuracy by reducing vertical offsets to 7 mm and 4 mm for thorax and abdominal CTs, compared to 19 mm and 18 mm with manual methods. Most studies showed significant reductions in radiation dose, ranging from 5.71 to 31%. Image quality results were mixed, automatic methods generally produced images with less noise, but differences were minimal. Time efficiency was better, with automatic positioning reducing preparation time from 0.48 min versus 0.67 min for manual positioning.

Conclusions: This review confirms that automatic patient-centering technologies enhance positioning accuracy and decrease preparation times in CT scans. While reductions in radiation doses and some improvements in image quality were observed, the evidence remains mixed. Findings support integrating these technologies into clinical practice to optimize patient care.

Key points: Question Does automatic patient centering in CT enhance positioning accuracy, reduce radiation exposure, and improve image quality? Findings Findings indicate that automatic centering can optimize image quality, reduce examination times and contribute to overall improvements in imaging efficiency. Clinical relevance Automatic patient centering in CT improves positioning accuracy, minimizes radiation exposure, enhances image quality, and accelerates imaging workflows, contributing to safer, more efficient imaging procedures that benefit patient care.

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.

Aim: Given that claudin 18.2 (CLDN18.2) is a cell surface protein specifically expressed by gastric cancer cells, anti-CLDN18.2 antibodies have demonstrated significant antitumor effects in patients with advanced gastric adenocarcinoma. The correlation of [¹⁸F]FDG PET/CT with CLDN18.2 expression remains unexplored. This study aimed to investigate whether CLDN18.2 expression was associated with [¹⁸F]FDG uptake and whether [¹⁸F]FDG PET/CT can be used to predict the CLDN18.2 status of gastric cancer.

Methods: A retrospective analysis of [¹⁸F]FDG PET/CT images from 163 patients diagnosed with metastatic gastric cancer was conducted, and the expression of CLDN18.2 was assessed immunohistochemically. SUV_max, metabolic tumor volume (MTV), and total lesion glycolysis (TLG) were calculated in 3D mode using vendor-provided software. The relationship between PET metabolic parameters and CLDN18.2 status was analyzed.

Results: CLDN18.2-negative tumors showed a higher median SUV_max of 13.2 (1.8-46.7) compared to CLDN18.2-positive tumors at 7.55 (2.3-34.8), with a significant difference (p < 0.001). The median TLG was significantly higher in CLDN18.2-negative tumors (231.6) than in CLDN18.2-positive ones (81.14), indicating greater metabolic activity (p = 0.001). Multivariate analysis suggested that SUV_max remained significantly correlated with the status of CLDN18.2 (p = 0.01). CLDN18.2 expression was predicted with an accuracy of 69.9% when the SUV_max value of 10.9 was used as a cutoff point for analysis.

Conclusion: Relatively reduced [¹⁸F]FDG uptake in metastatic gastric cancers correlates with positive CLDN18.2 expression compared to those with negative CLDN18.2 expression. [¹⁸F]FDG PET/CT may be useful for predicting the CLDN18.2 status of gastric cancer and thus aid in optimal treatment decisions.

Key points: Question The study resolves the clinical issue of determining the correlation between [¹⁸F]FDG PET/CT imaging and claudin 18.2 expression in metastatic gastric cancer. Findings Claudin 18.2-positive metastatic gastric cancers exhibit relatively lower [¹⁸F]FDG uptake than negative ones. The SUV_max of 10.9 moderately predicts claudin 18.2 expression. Clinical relevance [¹⁸F]FDG PET/CT imaging could be a noninvasive way to predict claudin 18.2 status in metastatic gastric cancer, helping to improve personalized treatment plans.

Objectives: This study aims to evaluate the prognostic implications of pretreatment [¹⁸F]FDG-PET metrics in esophageal cancer patients through a meta-analysis of the existing literature.

Methods: We carefully searched electronic databases, including PubMed and Embase, from inception to April 1, 2024, to identify studies describing the prognostic value of pretreatment PET metrics for advanced esophageal cancer. Clinical endpoints examined were overall survival (OS), recurrence-free survival (RFS)/disease-free survival (DFS), and progression-free survival (PFS). Hazard ratios (HRs) for PFS and OS were taken directly from the original reports.

Results: Forty-seven publications, including 5504 patients, were included in our analysis. OS and PFS were analyzed in 31 and nine studies, respectively, and DFS/RFS was analyzed in 16 studies. The comprehensive pooled analysis revealed significant associations between metabolic parameters derived from positron emission tomography (PET) imaging and clinical outcomes. Expressly, the pooled HR indicated that patients with higher SUVmax were significantly associated with poor PFS (HR: 1.06; 95% CI: 1.01-1.12, p = 0.011) and poor RFS/DFS (HR: 1.09; 95% CI: 1.02-1.18, p = 0.019). Patients with higher SUVmean were significantly associated with poorer OS (HR: 1.07; 95% CI: 1.01-1.14, p = 0.025). High MTV was significantly associated with inferior OS (HR: 1.02; 95% CI: 1.00-1.05, p = 0.049). High TLG was significantly associated with poorer RFS/DFS (HR: 2.02; 95% CI: 1.11-3.68, p = 0.022).

Conclusion: This study unveiled pretreatment FDG-derived parameters as valuable prognostic indicators in assessing esophageal cancer outcomes. Specifically, SUVmax is associated with PFS and RFS/DFS. SUVmean and MTV were correlated with OS, and TLG was only associated with RFS/DFS.

Key points: Question Inconsistent findings on the prognostic value of pretreatment [¹⁸F]FDG PET parameters in esophageal cancer require comprehensive analysis to clarify their role in outcome prediction. Findings Higher pretreatment [¹⁸F]FDG-PET metrics (SUVmax, SUVmean, MTV, TLG) are associated with poor survival outcomes, emphasizing their potential value in enhancing prognostic assessments for esophageal cancer. Clinical relevance This study highlights the prognostic significance of pretreatment [¹⁸F]FDG-PET metrics in esophageal cancer, providing valuable insights for patient outcome prediction and potentially guiding personalized treatment strategies.

Objectives: This study aimed to assess the early functional rehabilitation outcomes following percutaneous consolidation for pelvic ring tumor lesions.

Materials and methods: In this multicenter retrospective study, patients with pelvic bone tumor lesions, whether primitive or metastatic, underwent percutaneous consolidation (cementoplasty, screw fixation, or both). The primary outcome was postoperative weight-bearing ambulation. Secondary outcomes included hospitalization duration, procedural complications, and long-term consolidation. Inclusion criteria were patients treated for prophylactic consolidation or pathological fractures. Kaplan-Meier analysis was used for the primary outcome and hospital stay, with p-values < 0.05 indicating significance.

Results: A total of 143 consecutive procedures were performed in 138 patients (mean age, 65 years ± 13; 68 men) who underwent percutaneous screw fixation, cementoplasty, or both. Postoperative weight-bearing ambulation was achieved in 142/143 cases (99%). In total, 117/143 (82%) of these were in the first 24 h. 81/143 (57%) were discharged within 24 h (median, one day; Q3, one day; Q4, 112 days). 133/138 (96.5%) patients achieved long-term consolidation. The most common pattern was isolated acetabular involvement (N = 40; 28%). Of the 19 adverse events, 10 were asymptomatic. Three patients had delayed infections and one required screw removal.

Conclusion: Percutaneous consolidation effectively achieved postoperative weight-bearing ambulation and represents a safe and durable treatment option for patients with pelvic bone lesions.

Clinical trial registration: ClinicalTrials.gov: NCT06155890.

Key points: Question How can radiology continue to help improve care for patients with metastatic pelvic ring lesions? Findings 99% of patients achieved postoperative weight-bearing, with 82% doing so within 24 h. Clinical relevance Percutaneous consolidation enabled rapid functional rehabilitation of oncology patients, allowing short hospital stays with low complication rates, and demonstrating the expanding role of radiologists in diagnosis, risk assessment, and treatment planning, thereby enhancing patient care.