Insights into Imaging最新文献

The ESR equity, diversity and inclusivity (EDI) subcommittee is a part of the Young ESR committee created in 2024. This statement paper is the first in our series regarding EDI and radiology. In this paper, we examine and discuss issues which have been studied and reported regarding the inequity of imaging services. Inequity is prevalent in radiology and imaging circles in Europe. The variations observed in women, ethnic, age, disabled, non-binary, and gender groups are examined, as well as the variations in radiology research and in artificial intelligence-related imaging. Radiology departments need to be aware of the existing variations in radiology services. They need to educate their personnel on the etiquette and interaction with diverse populations. There should be versatile equipment to serve patients with disabilities. Radiologists should be aware of the lack of evidence-based knowledge with regard to female and non-white populations. Regarding clinical AI, departments need to actively audit and check for possible biases in AI in clinical use. CRITICAL RELEVANCE STATEMENT: Understanding how EDI affects patient care is vital to providing equitable service to all patients. Radiologists should be aware of the lack of evidence-based knowledge regarding female and non-white populations, and be sensibly critical of guidelines which lack proper evidence. KEY POINTS: The workflow of the department should be organised so that all patients are served equitably. Radiologists need to be aware of the lack of evidence-based knowledge about female and non-white populations, and be critical of guidelines which lack proper evidence. Regarding AI, radiologists must actively audit and check for possible biases in AI in clinical use.

Contrast-enhanced mammography (CEM)-guided biopsy enables the tissue sampling of enhancing breast lesions that are not visible on conventional imaging. The technique combines dual-energy stereotactic acquisition with intravenous contrast administration, allowing accurate targeting of recombined-only lesions. It represents a practical alternative to MRI-guided biopsy, particularly in settings where MRI access is limited or contraindicated. This review examines current evidence, procedural experience, and challenges associated with CEM guidance. Early studies support its technical feasibility, although data remain scarce and heterogeneous regarding lesion selection, procedural experience, and outcome definitions. Broader implementation is challenged by equipment specifications, contrast administration practices, logistics, and reimbursement issues. As clinical adoption increases, structured patient triage pathways, standardised protocols, and prospective validation are essential. CEM-guided biopsy is a promising technique in breast imaging and has the potential to reduce reliance on MRI guidance. However, further research is required to define its role and ensure consistent performance across clinical settings. CRITICAL RELEVANCE STATEMENT: This review critically examines current evidence, technical feasibility, and implementation challenges of contrast-enhanced mammography-guided biopsy. It highlights potential advantages for clinical settings where MRI guidance is limited, while addressing existing limitations and areas that require further research. KEY POINTS: Contrast-enhanced mammography-guided biopsy is a dual-energy stereotactic procedure that enables the targeting of enhancing lesions that lack conventional imaging correlates. The modality is accurate and feasible, though its implementation is challenged by technical heterogeneity and the absence of standardised protocols. Broader clinical adoption requires structured diagnostic workflows, validated contrast administration strategies, and prospective multicentre evaluation.

Objective: To describe the frequency and types of incidental findings on prostate MRI in a screening setting.

Materials and methods: Prostate MRI reports from 2020 to 2024 for men aged 50-56 years were collected from three regional organised prostate cancer testing (OPT) programmes in Sweden. Incidental findings were categorised as suspicious for extra-prostatic malignancy, otherwise likely clinically relevant or of low or no clinical relevance that do not motivate contact with the screened man. Confidence intervals (CI) were calculated for proportions of scans with an incidental finding. Chi-square testing was used to test inter-regional differences of reported findings.

Results: At least one incidental finding was described in 119/1202 (9.9%) MRI reports. Ten reports described two incidental findings. Most (112/129, 87%) were categorised as of low or no clinical relevance, with inguinal hernia and colon diverticulosis being the most common. Proportions of these findings varied significantly (p = 0.005) between the regions: 47/355 (13%; 95% CI 10-17%), 47/539 (8.7%; 95% CI 6.5-11%) and 15/308 (5.8%; 95% CI 3.5-9.0%). Overall, 17/1202 (1.4%) of the reports described a suspected extra-prostatic malignancy or otherwise clearly clinically relevant incidental finding. Suspected extra-prostatic malignancy findings were four suspected tumours in the rectum, four suspected tumours in the bladder and two bone metastases with an unknown primary tumour.

Conclusion: Screening prostate MRI in men in their fifties yields few incidental findings of clear clinical importance. Reporting of incidental findings of low/no clinical relevance varies between centres. Consensus-based guidelines are needed to define which types of incidental findings should be reported and notified to the screened individuals.

Critical relevance statement: Screening prostate MRI detects few incidental findings of clear clinical relevance. Findings of low or no clinical relevance are variably reported, which calls for consensus-based guidelines on which types of incidental findings on screening prostate MRI should be reported.

Key points: No previous study has reported incidental findings on prostate MRI in a population-based screening setting. Screening prostate MRI detects few incidental findings of clear clinical relevance. Incidental findings of low or no clinical relevance are variably reported across centres. There is a need for consensus-based guidelines for which types of incidental findings on screening prostate MRI should be reported and notified to the screened individual.

Background: Normative adult body composition values from North American patients were recently provided, yet sex- and age-specific reference values for Europeans remain unexplored.

Materials and methods: This cross-sectional study was performed on adult trauma patients who underwent CT imaging that included the abdomen in the University Medical Center Utrecht, a level-1 trauma center, between January 2017 and December 2020. An artificial intelligence algorithm was used to automatically segment muscle and fat components on axial CT images at the level of the third lumbar vertebra. Measurements included areas and attenuation values for muscle and fat, including total muscle areas and "pure-muscle" sub-areas. Skeletal muscle indices were calculated by dividing skeletal muscle areas by the squared height of patients. Age- and sex-specific percentile curves for all parameters were generated.

Results: Of the 2383 adult trauma patients who underwent CT imaging that included the abdomen, 2286 were included. The median age was 53 years (IQR 32-69), and 67.2% were male. The mean BMI was 25.4 ± 4.4 kg/m². The total muscle index decreased with age starting around 60 years in males. In females, the total muscle index decreased with age when intramuscular fat was excluded from the analysis. Mean muscle attenuation of all included muscles showed substantial declines with age in both sexes. Visceral fat areas increased rapidly with age in both sexes, yet with higher values among males.

Conclusion: This study provides CT-derived populational body composition parameters established in Dutch adults, intended to be used as reference values in clinical practice.

Critical relevance statement: Obesity and sarcopenia are risk factors for various diseases and mortality. CT-based body composition assessment provides precise muscle and fat data, enabling personalized treatment plans and early identification of individual risks, ultimately improving patient outcomes and care management strategies.

Key points: European reference values of CT-derived muscle and fat parameters are not yet well established. This study provides Dutch reference curves and values of CT-derived body composition. CT-derived body composition assessment enables personalized risk assessment and treatment.

Background: Radiological assessment remains crucial for acute acalculous cholecystitis (AAC) diagnosis, however, there is debate regarding the optimal imaging pathway. In the clinical setting, the decision to intervene, and the chosen procedure, are greatly influenced by imaging findings, and there is a need for a clear evaluation of each imaging modality's proficiency for AAC detection and its prognostic utility.

Methods: We performed a survey of the literature on the radiological diagnosis of AAC. Prospective and retrospective studies were selected if they examined the diagnostic utility of the imaging modality using histology as the ground truth, and had a sample size of greater than ten patients.

Results: Seventeen relevant studies were identified, which analysed US, hepatobiliary iminodiacetic acid (HIDA) scan, CT or MRI. The US has a reported specificity of between 93% and 97%, however, the sensitivity varied widely from 20% to 100%. The specificity of HIDA was reported as between 78% and 100%, but again, the sensitivity varied, between 38% and 100%. The literature on CT and MRI is limited, and there is no clear benefit over US for AAC diagnosis, however, they may be valuable for ruling out other diagnoses, or for surgical planning.

Conclusion: While radiological assessment holds utility in the management of suspected AAC, further research is required to properly define its role. Future research should focus on well-designed prospective studies to establish the diagnostic performance of both individual and multimodal imaging strategies in AAC, as well as the standardisation of imaging criteria and protocols across institutions.

Critical relevance statement: Prompt radiological diagnosis of AAC can prevent complications and improve patient survival, however, radiological assessment still varies between institutions. Consequently, there is an urgent need for the diagnostic performance of imaging strategies to be established, and protocols across institutions to be standardised.

Key points: Radiological assessment is crucial for early diagnosis and prompt management of AAC. CT, MRI and HIDA scans demonstrate minimal benefit over US for diagnosis. Further research is required for evidence-based standardisation of imaging criteria and protocols.

Immunotherapy, particularly immune checkpoint inhibitors, plays a crucial role in the treatment of brain metastases in various primary cancers. Response assessment encompasses atypical patterns, including pseudoprogression, hyperprogression, or dissociated response, which present greater complexity than classical patterns defined by standardized response assessment criteria. Additionally, intracranial adverse events like hypophysitis or encephalitis may resemble tumor progression. Accurate evaluation and management of brain metastases during immunotherapy requires that radiologists are familiar with both classical and atypical response patterns, as well as potential intracranial adverse events. Brain MRI and advanced imaging techniques serve as essential tools for this purpose. CRITICAL RELEVANCE STATEMENT: Assessing brain metastases response to immunotherapy accurately is fundamental for therapeutic decision-making. Radiologists must recognize classical and atypical responses and adverse events associated with immunotherapy to ensure optimal patient management. KEY POINTS: Immunotherapy response assessment in brain metastases is complex due to atypical patterns including pseudoprogression, hyperprogression, and dissociated responses. Immunotherapy-induced intracranial adverse events, such as hypophysitis and encephalitis, must be accurately identified. Brain MRI, complemented by advanced imaging techniques (perfusion MRI, MRS, and amino acid PET), is crucial for distinguishing these complex scenarios.