Journal of Medical Imaging and Radiation Oncology最新文献

Introduction: While 2D mammography is the standard for breast cancer screening, its sensitivity is reduced in dense breasts, impacting early detection and extent assessment. This study, for the first time in New Zealand, evaluated the utility of supplementary multi-modality imaging (tomosynthesis, ultrasound and magnetic resonance imaging [MRI]) in a risk-stratified population.

Methods: A retrospective case study (May 2022-September 2023, New Zealand private clinic) analysed patients by Tyrer-Cuzick (TC) v8 lifetime risk and by Volpara density categories. All patients in the screening pathway (n = 2171) underwent 2D mammography and tomosynthesis. Those patients with high breast density received supplementary ultrasound, and those with TC8 Risk scores of ≥ 30% were offered abbreviated MRI. Symptomatic patients (n = 230) underwent standard diagnostic workup. Detection rates and extent of disease using multi-modality imaging were compared.

Results: Of the 2401 patients, 205 were high-risk criteria (≥ 30%) and 19 breast cancers (16 invasive, 3 DCIS only) were diagnosed. Tomosynthesis identified 38% (6/16) more invasive cancers than 2D mammography alone. Ultrasound and MRI detected an additional 27% (4/16) invasive cancers occult on other modalities, predominantly in those women with high density (Volpara 'D') breasts. Ultrasound and particularly MRI demonstrated superior accuracy in assessing disease extent, including identifying multi-focal and multi-centric disease that was not detected by 2D or tomosynthesis.

Conclusion: Supplementary imaging modalities, particularly MRI, significantly improve breast cancer detection and assessment of disease extent in high-risk women. These findings support a personalised screening approach integrating risk assessment and breast density to guide imaging modality selection.

Background: Increased breast density is associated with increased breast cancer risk, particularly interval-detected cancers. This study describes interval cancer detection rates by breast density notification status and timing of diagnosis (0-12 months vs. 13-24 months).

Methods: 401,254 screening records for 235,333 clients attending a population-based screening program in 2016-2019 were extracted from the BreastScreen Western Australia database. Crude and age-standardised interval cancer rates (ASR), aggregated over three-year periods, were calculated per 10,000 client-years and reported by breast density notification status, screening round, and timing of diagnoses.

Results: Overall, interval cancer rates were 2-6 times higher in clients notified they had dense breasts compared to those who were not flagged as having dense breasts. The 2016-2018 ASRs were higher in the first year (vs second year) for clients notified they had dense breasts (ASRs: 28.2 (95% CI: 12.9-66.0) vs 20.6 (95% CI: 13.2-55.8) per 10,000 client-years, respectively), particularly notified clients screening for the first time (ASRs: 32.7 (95% CI: 6.9-111.2) vs 18.2 (95% CI: 5.9-92.0), respectively). The corresponding rates for 2017-2019 showed a similar trend but of lesser magnitude (ASRs: 17.6 (95% CI: 12.9-34.2) vs 15.7 (95% CI: 11.0-35.5) for 0-12 vs 13-24 months, respectively), regardless of screening round.

Conclusion: Interval cancer rates were at least similar or higher in the first 12 months compared to 13-24 months post screening for clients notified they had dense breasts, contrary to national reports of interval cancer detection rates. The clinical implications are two-fold: performance metrics for screening programs that notify women of their breast density may need refinement, namely interval cancer rate targets within 0-12 months, and breast density notification could lead to earlier diagnoses of interval-detected breast cancers.

Introduction: Accurate staging is essential in anal cancer to guide therapy and prognostication. While MRI remains the modality of choice for local staging, its limitations in assessing nodal and distant metastases have prompted evaluation of FDG PET/CT as an adjunct. The American College of Radiology recommends FDG-PET/CT as a complementary modality for initial staging, particularly for nodal assessment.

Methods: A systematic search of PubMed, EMBASE, Web of Science and Scopus was conducted up to August 2025 following PRISMA guidelines (PROSPERO ID: CRD1149778). Studies included reported adult patients with biopsy-proven anal squamous cell carcinoma who underwent both MRI and FDG-PET/CT for initial staging. Primary outcomes included per-patient sensitivity/specificity for metastasis, changes in TNM staging and therapeutic outcomes, including management modification.

Results: Six studies (n = 246) met the inclusion criteria. Five studies reported on staging changes, where FDG-PET/CT altered staging in 22.5% (95% CI: 12.3-34.7) of patients, more commonly through upstaging than downstaging (16.2% [95% CI: 10.7-22.5] vs. 6.3% [95% CI: 1.5-14.2]). Upstaged patients were predominantly nodal (74.6% [95% CI: 63.2-83.1]). Previously occult metastases were identified with FDG PET/CT in 3% (95% CI: 1.1-6.9) of patients. Management changes occurred in 20.7% (95% CI: 14.9-27.4), predominantly through radiotherapy field expansion or dose modifications.

Conclusion: FDG-PET/CT following MRI provides incremental diagnostic and therapeutic value in anal cancer staging, through refining nodal and metastatic staging and influencing radiotherapy planning, supporting its routine integration to optimise staging accuracy and management decisions.

Trial registration: PROSPERO: CRD42023446290.

The uptake of stereotactic radiosurgery (SRS) for the treatment of brain metastases (BM) has been rapid. SRS differs from other forms of radiation therapy in that large radiation doses are typically delivered with small margins for error and high dose heterogeneity. Geometric accuracy relies on the integrity of the entire treatment chain including patient immobilisation, imaging, treatment equipment and verification. Given this requirement for high fidelity geometric and dosimetric accuracy, credentialing for SRS within clinical trials requires special considerations. This process is further complicated by the range of treatment equipment that may be used to deliver SRS. The Trans-Tasman Radiation Oncology Group (TROG) SRS Technical Working Group was established to develop technical guidelines for SRS to BM in clinical trials in Australia, New Zealand and any other countries contributing to TROG recruitment. The panel comprised experts from Radiation Oncology, Medical Physics, Radiation Therapy and the TROG Quality Assurance (QA) team. These guidelines were developed collaboratively to assist trial management committees to formulate SRS credentialing and QA requirements appropriate for the clinical questions addressed by their trial.

Introduction: CT guided microwave ablation (MWA) provides a suitable nonsurgical alternative for the treatment of hepatocellular carcinomas (HCC) in order to improve overall survival and local tumour progression. The purpose of this retrospective audit was to evaluate the overall efficacy of MWA and provide local data into the treatment's success, recurrence rates and overall survival.

Methods: A retrospective single centre audit of MWA for Hepatocellular Carcinomas (HCC) undertaken by interventional radiology at a large tertiary centre identified 90 eligible participants between January 2019 and 31st August 2024. Analysis among participants evaluated the overall technical success, procedural morbidity and mortality, and oncological outcomes including overall survival and local tumour progression through descriptive statistics.

Results: Of the 89 included participants (90 ablated HCCs), there was no reported immediate post-procedure residual disease with a peri-procedure morbidity of 5.6%, with all reported procedural complications minor. Median recurrence-free survival was 26.5 months (IQR 8.25-39.75 months) with a median time to local tumour progression of 12 months (IQR 8.5-48.1 months). The overall local tumour progression rate was 13.3%. The overall survival at one year was 88.89% (n = 63) and two years of 72.92% (n = 48). The median survival time was 35 months (95% CI 30-42 months).

Conclusion: MWA provides an effective and feasible nonsurgical treatment option for solitary HCCs with reported local tumour progression, overall survival, and technical success consistent with internationally published literature.

Introduction: The purpose of this study was to understand the clinical indications and utility of a barium swallow study in patients who have already been investigated with an upper gastrointestinal (UGI) endoscopy. It would be useful to determine the additional diagnostic information provided by a barium swallow study given endoscopy is considered the gold standard for examining the UGI tract.

Methods: This retrospective study examined all barium swallow studies performed at a single tertiary hospital and identified patients who had been investigated with an UGI endoscopy in the preceding 6 months. The radiology request forms, barium swallow reports, UGI endoscopy reports and clinic letters were reviewed to determine the most frequent clinical indications, quantify and characterise new findings on barium swallow and determine the proportion of patients with alteration in management.

Results: Between 1 January 2023 and 30 September 2023, 105 of 318 patients investigated with barium swallow studies had received a recent UGI endoscopy. Over half of the study requests were non-specific, aimed at identifying the cause of dysphagia. A total of 59 studies (56.2%) demonstrated findings that were not apparent on UGI endoscopy. The most common new finding was dysmotility (n = 53, 89.8%). Of the patients with new findings, 24 (40.7%) experienced no change in management, nine (15.2%) were offered lifestyle advice, seven (11.9%) were referred to speech and language therapy and seven (11.9%) were started on medication.

Conclusion: A barium swallow study is a helpful adjunct to UGI endoscopy, especially in the diagnosis of dysmotility.

Acute lymphoblastic leukaemia (ALL) is the most common paediatric malignancy and remains one of the most common causes of cancer-related death in children and adolescents. It is characterised by the proliferation of immature lymphoid cells capable of infiltrating bone marrow, blood and extramedullary sites. Five-year overall survival rates exceed 90% with current multidrug chemotherapeutic regimens. This manuscript reviews the abdominal imaging features of leukaemic infiltration in children with ALL at the time of initial diagnosis and following relapse.

Introduction: This retrospective single-institution study evaluated the safety, efficacy and durability of stereotactic radiosurgery (SRS) for trigeminal neuralgia (TN) and related facial pain syndromes-including TN1, TN2, multiple sclerosis (MS) associated-TN and atypical facial pain (AFP).

Methods: We included 192 patients treated with Gamma Knife SRS between 2015 and 2022 at Australia's only publicly funded GK centre. Outcomes included Barrow Neurological Institute (BNI) pain scores, time to response and relapse. Kaplan-Meier and Cox regression analyses were performed.

Results: Median follow-up was 5 years. Treatment response occurred in 88.5%, with a relapse rate of 30%. Faster response was seen with 85 Gy (p = 0.004) and prior SRS (p = 0.02). MS-related TN relapsed earlier than vascular, tumour, idiopathic or stroke-related causes (p = 0.027) and TN1/TN2/AFP (p < 0.0001). On multivariable analysis, prior balloon compression (HR 3.02, 95% CI 1.07-8.51, p = 0.036) and 85 Gy (HR 2.07, 95% CI 1.29-3.33, p = 0.003) were associated with faster response. Patients with vascular TN (HR 0.32, 95% CI 0.13-0.79, p = 0.013), tumour/stroke/idiopathic aetiology (HR 0.36, 95% CI 0.14-0.91, p = 0.031) had utilised prior medication only (HR 0.18, 95% CI 0.06-0.48, p = 0.001) and had undergone prior MVD alone (HR 0.11, 95% CI 0.03-0.5, p = 0.004) were less likely to relapse.

Conclusion: SRS remains a valuable option for refractory facial pain, including redo SRS in select patients.

Aim: To evaluate the incidence of pseudoprogression on ¹⁸F-FDG PET/CT scans in metastatic melanoma patients commencing immune checkpoint inhibitor therapy and to determine the average time to confirmed ¹⁸F-FDG PET/CT response in the pseudoprogression cohort identified.

Methods: Patients with metastatic melanoma who underwent baseline and follow-up ¹⁸F-FDG PET/CT scans after commencing immune checkpoint inhibitor therapy at Alfred Hospital (2012-2023) were retrospectively reviewed. Cases of pseudoprogression were identified by a keyword search of reports and confirmed on image review by a nuclear medicine physician. Data on timing of confirmed response, immune-related adverse events, and autoimmune history were also collected.

Results: 10/401 (2.49%) metastatic melanoma patients were confirmed as having pseudoprogression on PET/CT. 8/10 (80%) had new FDG-avid lesions and 2/10 (20%) had an increase in size and SUVmax of original disease. 8/10 (80%) of patients achieved complete metabolic remission on subsequent PET/CT scans with an average time to confirmed reduction of disease on PET/CT of 28.4 weeks. 4/10 (40%) received dual agent immunotherapy. 8/10 (80%) developed irAEs of varying types and severity. 2/10 (20%) had a history of pre-existing autoimmune disease. 9/10 (90%) of pseudoprogression patients are alive at last review.

Conclusion: Pseudoprogression on ¹⁸F-FDG PET/CT occurred in approximately 2.5% of metastatic melanoma patients commencing immunotherapy with an average time to subsequent confirmed response of ~6 months. This highlights the importance of not ceasing immunotherapy prematurely based on early ¹⁸F-FDG PET/CT findings.