European Radiology最新文献

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.

Objectives: This study aimed to investigate the prognostic significance of stress dynamic myocardial CT perfusion imaging (CTP) and determine whether it has incremental advantages over coronary computed tomography angiography (CTA)-derived parameters.

Methods: This prospective multicenter study included patients with suspected coronary artery disease who had undergone coronary CTA and CTP and were followed for 6 years. The endpoint was time-to-first major adverse cardiovascular event (MACE). MACEs included all-cause mortality, cardiac death, nonfatal myocardial infarction, unstable angina, late revascularization, and heart failure or aggravated angina symptoms requiring hospitalization. The CTP-derived absolute myocardial blood flow (MBF), relative MBF ratio (r-MBF), and the CTA-derived fractional flow reserve (CT-FFR) and stenosis were analyzed. The independent predictors, time-to-event distributions and the incremental prognostic value of CTP over CTA-derived parameters were assessed.

Results: A total of 226 patients (66.7 ± 11.3 years, 37.6% women) were enrolled with a median follow-up time of 1233 days. Twenty-one patients (9.29%) experienced MACEs and ten patients (4.4%) experienced hard MACEs. The r-MBF was the only independent predictor for MACEs in both all patients (hazard ratio [HR]: 0.82 (0.69-0.97), p = 0.01) and patients available for CTA stenosis (%) and CT-FFR calculation (HR: 0.72 (0.57-0.91), p = 0.006). The incremental prognostic significance of r-MBF over CT-FFR was confirmed after combining with CTA-derived parameters (concordance index: 0.919 vs. 0.811; p < 0.01). Patients with r-MBF < 0.77 were more likely to experience MACEs and have a lower average survival time (1565 vs. 1790 days; p < 0.01) after stent implantation.

Conclusions: CTP-assessed r-MBF was independently correlated with MACEs and provided incremental prognostic significance.

Key points: Question The prognostic significance of CT perfusion (CTP) lacks sufficient support from clinical research. Findings In this Chinese population, CTP has the strongest prognostic significance, over CT-Fractional Flow Reserve (FFR) and CTA stenosis in predicting major adverse cardiovascular events (MACEs). Clinical relevance Relative myocardial blood flow ratio had the strongest prognostic value and incremental advantages in predicting MACEs beyond CT-FFR and coronary CTA stenosis quantification, as well as advantages in patients with stents, aiding in personalized diagnosis and treatment plans.

Objectives: To assess the correlation between the use of artificial intelligence (AI) software and burnout in the radiology departments of hospitals in China.

Methods: This study employed a cross-sectional research design. From February to July 2024, an online survey was conducted among radiologists and technicians at 68 public hospitals in China. The survey utilized general information questionnaires, the Maslach Burnout Inventory-Human Services Survey (MBI-HSS) scale, and a custom-designed AI usage questionnaire. This study analyzed the correlation between AI software usage and occupational burnout, and general information was included as a control variable in a multiple linear regression analysis.

Results: The analysis of survey data from 522 radiology staff revealed that 389 (74.5%) had used AI and that 252 (48.3%) had used it for more than 12 months. Only 133 (25.5%) had not yet adopted AI. Among the respondents, radiologists had a higher AI usage rate (82.0%) than technicians (only 59.9%). Furthermore, 344 (65.9%) of the respondents exhibited signs of burnout. The duration of AI software usage was significantly negatively correlated with overall burnout, yielding a Pearson correlation coefficient of -0.112 (p < 0.05). Multiple stepwise regression analysis revealed that salary satisfaction, night shifts, duration of AI usage, weekly working hours, having children, and professional rank were the main factors influencing occupational burnout (all p < 0.05).

Conclusion: AI has the potential to significantly help mitigate occupational burnout among radiology staff. This study reveals the key role that AI plays in assisting radiology staff in their work.

Key points: Questions Although we are aware that radiology staff burnout is intensifying, there is no quantitative research assessing whether artificial intelligence software can mitigate this occupational burnout. Findings The longer staff use deep learning-based artificial intelligence imaging software, the less severe their occupational burnout tends to be. This result is particularly evident among radiologists. Clinical relevance In China, radiologists and technicians experience high burnout rates. Even if there is an artificial intelligence usage controversy, encouraging the use of artificial intelligence software in radiology helps prevent and alleviate this occupational burnout.

Left-sided portal hypertension (LPH) refers to increased splenic venous pressure caused by splenic vein stenosis or occlusion. Pancreatitis is the leading cause of LPH. Typically, LPH remains asymptomatic, but it can lead to life-threatening hemorrhage from ruptured fundal varices in about 10% of patients. Further, it may be complicated by hypersplenism. Interventional radiology plays an essential role in LPH patients with failed endoscopic treatment. Variceal embolization is an effective salvage measure in bleeding gastric varices, but it carries a risk of recurrence and worsening of hypersplenism. Considering the pathophysiology, splenic vein recanalization (SVR) appears to be the best treatment; nevertheless, its lower technical success rate limits its utility only to a subgroup of LPH patients. Partial splenic embolization (PSE), a non-surgical alternative to splenectomy, reduces the splenic volume and venous outflow, thereby lowering variceal pressure. PSE is technically easier, which may explain its widespread use. Nonetheless, PSE can be complicated by life-threatening sepsis and portal vein thrombosis. Despite all attempts, some LPH patients eventually require a splenectomy. Importantly, the choice of therapy requires multidisciplinary discussion and is often influenced by availability, expertise, and clinical context. This article discusses various interventional strategies for managing LPH with the available evidence. KEY POINTS: Question Pressure within the main portal vein is normal in left-sided portal hypertension; thus, transjugular intrahepatic portosystemic shunt is ineffective. Findings Splenic vein stent placement can restore hepatopetal splenic blood flow and decompress splenic venous pressure. Clinical relevance Partial splenic embolization (PSE) is the most widely used interventional approach to manage left-sided portal hypertension-related complications.

Background: Fabry disease (FD) usually mimics hypertrophic cardiomyopathy (HCM). Decreased native T1 mapping and a unique late gadolinium enhancement (LGE) pattern by cardiac magnetic resonance (CMR) imaging are specific imaging markers for FD.

Purpose: Explore the performance of multiparametric CMR imaging in screening for FD in patients with a HCM phenotype.

Materials and methods: A prospective cohort of 602 patients with a HCM phenotype was assessed from April 2012 to December 2022. Participants underwent CMR imaging and genetic testing. FD diagnosis was according to genetic testing and enzyme-activity test of α-galactosidase A. Multiparameter CMR imaging included cardiac function, native T1 mapping, extracellular volume (ECV), T2 mapping, LGE, and myocardial strains. Diagnostic performance of CMR parameters in identifying FD from HCM was done by analysis of receiver operating characteristic (ROC) curves.

Results: FD prevalence was 1.8% (11 cases) in this cohort with HCM. Native T1 mapping was significantly lower in FD compared with HCM (FD vs. HCM: native T1 mapping: 1174.08 ± 60.60 vs. 1293.94 ± 55.86, p < 0.001). Ventricular function, mass, ventricular wall thickness, and strains did not show significant differences between the two groups. Binary logistic regression and analysis of ROC curves demonstrated myocardial native T1 mapping of the left ventricular basal slice had the best performance in screening for FD in patients with a HCM phenotype (cutoff: 1216 ms; AUC: 0.947; sensitivity: 91%; specificity: 90%).

Conclusion: Native T1 mapping is the best parameter for screening FD in a Chinese population with a HCM phenotype.

Key points: Question The prevalence of Fabry Disease (FD) in the study population is unknown and the efficacy of cardiac MRI (CMR) parameter screening for FD needs validating. Findings We report the prevalence of FD among a Chinese hypertrophic cardiomyopathy (HCM) cohort and found T1 mapping is the best CMR parameter for screening FD. Clinical relevance Native T1 mapping is the best CMR parameter for screening FD in the HCM cohort, providing an effective method for rapid screening of FD in clinic, which may help identify patients for early treatment of FD.