Korean Journal of Radiology最新文献

Objective: This study aimed to evaluate the feasibility, safety, and oncologic outcomes of irreversible electroporation (IRE) using a clustered electrode in patients with locally advanced pancreatic cancer (LAPC).

Materials and methods: In this single-center prospective cohort study, 13 patients with LAPC (median age, 60 years; range, 48-78 years) underwent clustered electrode IRE between September 2022 and September 2024. Patient characteristics, procedural details, and clinical outcomes were recorded. Endpoints included technical success, procedure-related complications, overall survival (OS), and progression-free survival (PFS).

Results: Tumors were located in the pancreatic head in four patients (30.8%) and in the body/tail in nine (69.2%). The median tumor size was 2.4 cm (1.5-4.0 cm), and vascular invasion was present in all patients. Technical success was achieved in all patients. Intraoperative IRE was performed in 11 (84.6%) patients, and 2 (15.4%) patients underwent percutaneous IRE. Gastrointestinal bleeding events as major complications occurred in two patients (15.4%) and, both were successfully controlled by embolization. No 60-day mortality was observed. At a median follow-up of 24.5 months (range, 9.9-33.4 months) after IRE, median OS and PFS from IRE were 20.1 and 14.5 months, respectively.

Conclusion: IRE using clustered electrodes for LAPC appears to be a feasible therapeutic approach, offering reliable technical success and acceptable safety. Survival outcomes are encouraging; however, larger, controlled studies are required.

Objective: To systematically evaluate the long-term trajectory of pulmonary function test (PFT) and CT findings in COVID-19 survivors.

Materials and methods: A systematic literature search of PubMed and EMBASE was performed to identify studies published from January 2020 to June 2024 reporting PFT and/or chest CT outcomes at ≥6 months post-COVID-19, up to 36 months. The reference lists of relevant articles were also manually reviewed. Two investigators independently extracted study characteristics, patient demographics, and PFT and CT outcomes at prespecified follow-up intervals (6, 12, 24, and 36 months). Multivariate meta-analyses were conducted to evaluate temporal trends in lung function and radiological abnormalities. Sensitivity analyses, including stratification by disease severity and pooled analyses of studies with multiple follow-up time points, were performed to confirm the robustness of the findings.

Results: In total, 152 studies (n = 25,766; mean age, 56.7 ± 13.2 years; 14,999 men) were included: 133 reporting PFT outcomes and 80 reporting CT findings. Diffusion capacity (DLCO) impairment was the most common abnormality, showing gradual improvement from 42% at 6 months to 35% at 36 months (P = 0.008) with a corresponding increase in the % predicted DLCO. Similarly, the prevalence of forced vital capacity (FVC) impairment decreased over time, accompanied by an increase in the % predicted FVC. On chest CT, the proportion of patients with no relevant findings remained stable at 30%-40% (P = 0.14). The prevalence of ground-glass opacities (GGO) decreased from 32% at 6 months to 20% at 36 months (P = 0.01), while that of fibrosis persisted at 27%-47% without a significant change (P = 0.28). Subgroup analysis based on disease severity revealed similar temporal trends in both low-severity and high-severity cohorts.

Conclusion: DLCO, FVC, and GGO findings improved gradually up to 36 months post-COVID-19; however, over one-third of the patients continued to exhibit reduced DLCO. Fibrosis persists with limited evidence of resolution over a 3-year period, suggesting a stable but nonprogressive pattern.

Objective: To compare two breast cancer screening strategies, digital mammography (DM) plus radiologist-interpreted automated breast ultrasound (ABUS) and DM plus selective ABUS review, in which only examinations positive for DM or flagged by ABUS artificial intelligence-computer-aided diagnosis (AI-CAD) were reviewed by radiologists.

Materials and methods: This retrospective study included asymptomatic women who underwent DM and ABUS screening for breast cancer between March 2022 and March 2023. The radiologists' interpretations of DM and ABUS without AI assistance (DM + ABUS_radiologist) were collected from the clinical radiology reports. A selective DM plus ABUS reading strategy was simulated, in which only cases interpreted as positive in the radiologist's DM report or flagged by retrospectively applied ABUS AI-CAD were triaged for further evaluation through a full review by radiologists (DM + ABUS_AI-CAD). The cancer detection rate (CDR), sensitivity, specificity, and abnormal interpretation rate (AIR) were calculated and compared between DM + ABUS_radiologist and DM + ABUS_AI-CAD groups using the McNemar's test.

Results: Among 2,275 women (mean age, 56.1 ± 8.6 years), 12 cancers were diagnosed. The sensitivity, CDR and AIR for DM + ABUS_radiologist was 83.3% (10/12; 95% confidence interval [CI]: 51.6-97.9), 4.4 (10/2,275; 95% CI: 2.1-8.1) per 1,000 screening examinations and 16.7% (379/2,275; 95% CI: 15.1-18.3), respectively. DM + ABUS_AI-CAD triaged 84.0% (1,910/2,275) of the examinations as negative in both DM reports and retrospectively applied ABUS AI-CAD, requiring radiologist reassessment in only 16.0% (365/2,275). This approach reduced the AIR to 7.3% (167/2,275) and improved the specificity from 83.7% (1,894/2,263) to 93.1% (2,107/2,263) (all P < 0.001), while maintaining a CDR of 4.8 per 1,000 and a sensitivity of 91.7% (11/12) (all P > 0.999), compared to the DM + ABUS-radiologist.

Conclusion: An AI-CAD-assisted selective ABUS reading strategy reduces unnecessary recalls and improves specificity, which may help optimize reading priorities and reduce the reading workload while maintaining cancer detection performance.

The spleen is frequently referred to as the "silent and forgotten" organ of the abdomen by clinicians and radiologists, primarily because of the secondary nature of most splenic pathologies and their relative rarity compared with hepatic diseases. Nevertheless, the term splenomegaly frequently appears in radiological reports. Although it is often reported in the context of a known underlying cause, it is also commonly used as a purely descriptive term without reference to the underlying etiology. Although splenomegaly may occasionally be idiopathic, it commonly represents an underlying pathological condition. Therefore, radiologists are instrumental in accurately identifying splenomegaly, evaluating plausible differential diagnoses, and guiding appropriate clinical management and workups. Given the wide spectrum of etiologies and overlapping imaging features, a systematic approach is essential to enhance the diagnostic accuracy and clinical relevance. Here, we present a comprehensive literature review of splenomegaly from a radiological perspective, with causes categorized according to pathophysiological mechanisms.

Objective: To investigate whether breast tissue composition on preoperative automated breast ultrasound (ABUS) is associated with the accuracy of cancer multiplicity evaluation and postoperative recurrence-free survival (RFS) in patients with early-stage breast cancer.

Materials and methods: This retrospective analysis included women with early-stage breast cancer (clinical Tis, T1-2/N0) who underwent ABUS and digital mammography (DM) between October 2019 and April 2021. Tissue composition on ABUS was assessed using the Breast Imaging Reporting and Data System background echotexture (BE) (homogeneous-fat, homogeneous-fibroglandular, or heterogeneous). In a subgroup of patients with mammographically dense breasts, the glandular tissue component (GTC) on ABUS were further stratified into high (moderate or marked) or low (minimal or mild). Multivariable logistic and Cox regression analyses were used to identify factors associated with accurate cancer multiplicity categorization (unifocal, multifocal/multicentric, or bilateral) using ABUS + DM, and with RFS, respectively.

Results: Among 409 women (mean age ± standard deviation, 50.2 ± 8.7 years), ABUS combined with DM yielded accurate cancer multiplicity categorization in 368 patients (90.0%). Neither BE nor GTC on ABUS affected the accuracy of categorization when ABUS was combined with DM. Over a median postoperative follow-up of 3.5 years, 11 recurrences occurred. Heterogeneous BE on ABUS (hazard ratio [HR] 11.24 [95% confidence interval [CI]: 2.82-44.92]; P = 0.001), BRCA mutation (HR 15.94 [2.47-102.97]; P = 0.004), and pathologic index cancer size (HR per 1-cm increase 1.91 [1.13-3.23]; P = 0.02) was independently associated with RFS. In patients with dense breasts, heterogeneous BE (HR 14.17 [95% CI: 2.69-74.60]; P = 0.002) and high GTC (HR 10.32 [2.35-45.28]; P = 0.002) on ABUS, BRCA mutation (HR 24.34 [2.75-215.06]; P = 0.004), and pathologic cancer size (HR per 1-cm increase 2.62 [1.50-4.59]; P = 0.001) was independently associated with RFS.

Conclusion: In patients with early-stage breast cancer, heterogeneous BE and high GTC on preoperative ABUS, along with larger cancer size and BRCA mutation, was associated with worse RFS. However, BE and GTC did not affect cancer multiplicity evaluation when ABUS was used in combination with DM.