Insights into Imaging最新文献

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.

Purpose: To investigate inter-and intra-observer agreement of Functional Liver Imaging Score (FLIS) in different populations, hepatobiliary phase (HBP), and radiologists, while analyzing the correlation between FLIS and liver function.

Methods: A single-center retrospective study analyzed 203 patients from 2017 to 2021. Inter-observer and intra-observer consistency was assessed by the Intraclass Correlation Coefficient (ICC) by means of Spearman correlation analysis, evaluating the correlation between FLIS and Child-Turcotte-Pugh (CTP) score, as well as the relevant laboratory data. The discriminatory efficacy of FLIS for different stages of CLD and CTP grades was assessed by the receiver operating characteristic curve.

Results: In all 203 patients, inter-observer ICC range was 0.885 to 0.954, and intra-observer ICC range was 0.946 to 0.985 among different radiologists. Inter-observer ICC range was 0.908 to 0.985, and intra-observer ICC range was 0.924 to 0.991 at different HBP time points. Inter-observer ICC range was 0.89 to 1, and intra-observer ICC range was 0.943 to 1 in different populations. The correlation coefficients between FLIS and albumin, total bilirubin, international normalized ratio, prothrombin time, and CTP scores were 0.617, -0.651, -0.706, -0.724, and -0.818. FLIS had good diagnostic efficacy in differentiating different stages of CLD and CTP grades; the area under the curve was 0.708, 0.752, 0.871, and 0.908.

Conclusions: FLIS had a good intra-observer and inter-observer agreement among different populations, HBP and radiologists. FLIS showed a good correlation with CTP grades and laboratory data. FLIS can be used as one of the imaging assessment tools to distinguish different stages of CLD and CTP grades.

Critical relevance statement: FLIS showed significant correlations with prothrombin time, international normalized ratio, serum albumin, total bilirubin, and CTP score, and distinguished different stages of CLD and CTP grades, which positioned it as a non-invasive imaging tool for liver function assessment.

Key points: High reliability: FLIS demonstrates excellent inter- and intra-observer agreement among different radiologists, hepatobiliary phase (10-25 min), and populations (healthy subjects, CLD, cirrhosis). Strong correlation with liver function: FLIS significantly correlates with liver function markers: albumin, total bilirubin, international normalized ratio, prothrombin time, and CTP scores. Diagnostic efficacy: differentiates CLD stages and CTP grades, highest accuracy for distinguishing advanced cirrhosis.

Clinical utility: FLIS serves as a robust and non-invasive imaging tool for assessing liver function and stratifying disease severity in CLD and cirrhosis.

Purpose: To assess the diagnostic value of CT and MRI in distinguishing nonunited avulsion fracture (NAF) of the lateral malleolus from os subfibulare (OSF).

Materials and methods: In this retrospective study, 114 subfibular ossicles (SFOs) in 108 patients were evaluated by CT and MRI for shape, margin, size, CT attenuation, spatial orientation, and anatomical relations. Surgical, arthroscopic, and follow-up findings served as reference standards. Logistic regression and receiver operating characteristic (ROC) analyses assessed diagnostic performance.

Results: NAFs were associated with higher incidences of lateral ankle pain (92.3% vs. 71.4%, p = 0.003) and instability (29.2% vs. 10.2%, p = 0.014) than OSF. CT showed that NAF had a more irregular shape, rougher margins, higher attenuation, and anteroposterior orientation compared to OSF (all p < 0.05). MRI revealed ligamentous attachment predominated in NAF (72.3%), while OSF mostly showed discontinuity or apposition (91.8%, p < 0.001). The combined CT model achieved an AUC of 0.782, accuracy of 74.3%, sensitivity of 91.9%, and specificity of 56.8%. MRI-based ligamentous attachment MRI strict criterion yielded an AUC 0.821, with a sensitivity of 72.3% and a specificity of 91.8%, while the MRI inclusive criterion was 0.752, 95.4% and 55.1%. Ossicle size correlated with symptom severity (p < 0.001).

Conclusion: MRI is highly effective for differentiating NAF from OSF by directly visualizing SFO-ligament attachments, while CT provides complementary morphological detail. The combined use of CT and MRI delivers robust diagnostic performance, supporting clinical decision-making in lateral malleolar lesions.

Critical relevance statement: CT and MRI can distinguish a nonunited avulsion fracture from os subfibulare. Especially, MRI can visually display the relationship between SFO and the lateral collateral ligament.

Key points: Distinguishing chronic lateral malleolus avulsion fractures from congenital accessory bones remains diagnostically challenging. MRI directly visualizing ligament attachment to the bone fragment best differentiates fractures from accessory bones. Combining MRI and CT findings provides comprehensive evidence for clinical management decisions.

Objectives: Artificial intelligence (AI) has gained increasing interest in supporting clinicians in patient selection, treatment planning, and prognostics. However, the current application of AI in the treatment of colorectal liver metastases (CRLM) is not clearly established and validated. This scoping review assesses the current impact of AI techniques on local therapeutic strategies for CRLM, exploring its benefits, challenges, and future directions.

Materials and methods: A comprehensive literature search in PubMed, EMBASE, Web of Science, and SCOPUS was conducted for patients with CRLM undergoing surgery or thermal ablation, along with descriptions of AI tools. Eligible studies were cohort studies or clinical trials. Data extraction focused on treatment strategies, AI techniques, clinical and radiomics parameters, and outcomes.

Results: Out of 1464 articles, thirteen met the inclusion criteria. Eight articles regarded thermal liver ablation, and five surgical resection for CRLM. Most studies used traditional machine learning methods, such as support vector machines and random forests, combined with radiomics for predictive model building. While most studies demonstrated high performance, they frequently involved small sample sizes, and machine learning techniques often lacked robustness.

Conclusions: AI shows promising results in improving local treatment strategies for CRLM, but further advancements are required for AI decision support tools. Future research should focus on large multicentre studies to validate AI-driven personalised colorectal liver metastases treatment strategies.

Critical relevance statement: This review evaluates the use of AI in colorectal liver metastases treatment for outcome prediction and treatment evaluation. Included studies used AI for segmentation and predictive modelling and were often limited by small sample-sized single-centre studies, necessitating multicentre studies.

Key points: The position of AI in local colorectal liver metastases treatments is not yet established. AI algorithms are mostly used for predictive model building and image registration. Studies often lack validity, limiting generalisability and implementation of AI support tools.

Objectives: Except for a few specific lesions, the analysis of the margins of focal bone lesions with MRI has been largely overlooked in the literature. We observed that some lesions exhibited concave margins, suggesting a non-aggressive nature. This study aimed to determine whether concave borders are more frequently present in certain types of focal lesions of the long bones on MRI, particularly in benign lesions.

Materials and methods: MRI examinations of 586 focal intraosseous lesions of the long bones were retrospectively reviewed. Each lesion margin was independently classified by two musculoskeletal radiologists as concave, non-concave, or cortical. The number of concave margins was analyzed according to the lesion type and its classification as tumoral (benign or malignant) or non-tumoral.

Results: The study group included 15 different types of lesions (75.1% tumors, 24.9% non-tumoral lesions). The number of concave margins per lesion varied significantly by lesion type (p < 0.001). Benign lesions and benign tumors had more concave margins than malignant lesions (p < 0.001). All osteonecrosis lesions, 44.8% of fibrous dysplasia lesions, 20.8% of abscesses, 14.8% of chondroblastomas, 12.5% of Langerhans cell histiocytosis lesions, and 2.9% of metastases showed at least two concave margins. No lesions in the other groups had more than one concave margin.

Conclusion: Our study revealed that several intraosseous lesions tend to exhibit concave margins. The presence of at least two smooth and regular inward-curved margins was most commonly found in benign lesions and benign tumors, such as fibrous dysplasia.

Critical relevance statement: This study shows that at least two smooth, inward-curved margins are more common in benign bone lesions and tumors and may help in recognizing fibrous dysplasia in non-fatty lesions.

Key points: Identifying concave margins may help in recognizing benign bone lesions and tumors. Concave margins are mainly observed in osteonecrosis and fibrous dysplasia. Concave margins suggest a non-aggressive nature of focal bone lesions.