Radiologia Medica最新文献

The growing use of computed tomography (CT) in clinical practice has led to an increase in incidental pulmonary findings, with nodules being among the most commonly encountered. Managing these nodules remains a significant challenge in clinical radiology. In addition to nodules, interstitial lung abnormalities (ILAs) have emerged as a newly defined entity, necessitating recognition to prevent underestimation and misinterpretation, as well as to guide appropriate management. This review aims to examine the interpretation of incidental pulmonary nodules, providing clarity on their management and addressing gaps not covered by the 2017 Fleischner Society Guidelines. Additionally, we focus on recent updates related to ILA classification, as outlined by the Fleischner Society, and highlight key radiologic features critical for distinguishing ILAs from non-ILA alterations. Finally, we explore the potential future developments in the evaluation of ILAs, offering insights into how the radiologists' role in managing these abnormalities may evolve.

Purpose: Evaluate Late Iodine Enhancement (LIE) using the new Philips Spectral CT 7500 scanner without ECG-gating.

Material and methods: Fifty-one contrast-enhanced cardiac Computed Tomography (CT) scans with LIE phase (LIE-CT) acquired using the Philips Spectral CT 7500 scanner (8 cm, 256 reconstructed slices) were retrospectively reviewed. LIE-CT was acquired 6-7 min after the administration of contrast agent, using ultra-short scanning time without ECG-gating. LIE-CT technical and dosimetry data were compared with data from 17 cardiac CT scans acquired with Philips Brilliance iCT (4 cm, 128 reconstructed slices). On Spectral CT images, LIE was assessed using "Iodine no water" spectral maps and Extracellular Volume (ECV) quantification. CT findings were compared with the gold standard (Cardiac Magnetic Resonance, CMR) when available.

Results: Spectral CT images without ECG-gating exhibited high visual quality with minimal motion artifacts. Technical data significantly differed (p < .001) between Spectral CT and iCT: median scan time 0.69 s (interquartile range (IQR) 0.66-0.72) vs 8.02 s (IQR 7.32-8.49), median Table speed 433.2 mm/s vs 23.5 mm/s (IQR 21.8-26.5), median CTDIvol 7.2 mGy vs 29.6 mGy (IQR 27.8-33.3), median DLP 211 mGy*cm (IQR 199-222) vs 477.6 mGy*cm (IQR 430.9-551.7), current 812 mA vs 924 mA (IQR 924-925), voltage 100 kV (min 100-max 140) vs 80 kV. Interobserver reproducibility of ECV quantification on Spectral CT images was good in myocardium without LIE and excellent in LIE areas, with negligible bias between observers. Where available, LIE and ECV findings showed good concordance with CMR LGE and ECV.

Conclusion: Ultrafast non-ECG-gated cardiac Spectral CT provides high-quality images for evaluating LIE, 76% reduction of radiation dose, 50% increase in signal-to-noise ratio, and 91% reduction of acquisition time. ECV measurements demonstrate high interobserver reproducibility. Preliminary findings show good agreement with CMR; while based on a limited validation cohort with selective ECV use.

Purpose: To evaluate whether myocardial extracellular volume (ECV) could be estimated from whole-body CT examinations without electrocardiographic gating in cancer patients before and after the chemotherapy, with the goal to detect early-stage myocardial alterations heralding chemotherapy-induced cardiotoxicity.

Material and methods: Consecutive patients receiving chemotherapy with a high (High-risk group) or low (Low-risk group) risk of cardiotoxicity were retrospectively enrolled. Patients underwent a whole-body CT examination for cancer staging before (CT-I) and after the first chemotherapy cycle (CT-II). Precontrast, arterial phase, and late post-contrast CT-I and CT-II images were analysed using in-house software. Myocardial Attenuation-based estimation of ECV (ABE-ECV) maps were generated from the combined analysis of regions of interest in precontrast images and a pixel-wise analysis of late post-contrast images, whereas the increase of myocardial and blood densities in arterial phase from basal values were compared to calculate arterial myocardial λ (arterial increase of myocardial density/increase of blood density).

Results: The population included 89 patients (mean age 63 ± 14 years): 58 High-Risk and 31 Low-Risk. High-risk patients showed a significant increase of ABE-ECV of the interventricular septum, from 32% (31-35%) to 37% (35-39%) (p = 0.0002) and lateral wall, from 30% (27-31) to 32% (29-34) (p = 0.028). In contrast, Low-risk patients showed no significant variation of septal (p = 0.16) and LV lateral wall ABE-ECV (p = 0.93). Arterial myocardial λ at CT-II was reduced compared to CT-I in 31% of High-risk patients vs 10% of Low-risk patients (p = 0.036).

Conclusion: This preliminary study demonstrated that ECV can be estimated in ECG-ungated whole-body CT examinations for cancer staging in patients undergoing chemotherapy. Potentially cardiotoxic chemotherapy can be associated with alterations of ABE-ECV and arterial myocardial λ.

Purpose: To evaluate the clinical efficacy and safety of prostatic artery embolization (PAE) using glue (n-butyl cyanoacrylate, NBCA) in patients with benign prostatic hyperplasia (BPH) presenting with lower urinary tract symptoms (LUTS) due to obstruction or chronic urinary retention managed with an indwelling catheter (IUC).

Material and methods: A total of 101 patients (median age 79 years) were included, of whom 67 had LUTS and 34 had an IUC. All were treated with PAE with glue between 2021 and 2024. Clinical success was defined as either a ≥ 25% reduction in the International Prostate Symptom Score (IPSS) and a ≥ 3-point improvement in the quality of life (QoL) score or stable catheter removal.

Results: Technical success was achieved in 100% of cases, with bilateral embolization in 93% of patients. Among symptomatic patients, clinical success was observed in 92.5%, with a reduction in IPSS from 25.3 ± 8.1 to 15.3 ± 7.8 and in QoL from 4.5 ± 1.1 to 2.3 ± 1.4 at 36 months (p < 0.001). Mean prostate volume decreased by 37.6%. In patients with an IUC, 73.5% resumed spontaneous voiding within an average of 29 days. All complications (13.9%) were minor and managed conservatively.

Conclusion: Embolization with acrylic glue is a safe and effective minimally invasive alternative to surgery for BPH, with sustained long-term results. It is particularly suitable for elderly patients with comorbidities or those unfit for surgery presenting with LUTS or chronic urinary retention.

Purpose: To evaluate MRI changes in T2-weighted imaging (T2WI) signal intensity (T2SI) as a potential imaging marker for assessing response to radiotherapy (RT) in pediatric low-grade glioma (pLGG).

Materials and methods: This retrospective study analyzed imaging data of 56 pLGG patients (mean age, 12.4 ± 3.5 years; 33/56 [58.9%] male) treated with photon-based or proton-based RT within the SIOP-LGG 2004 study and registry. Tumor signal characteristics on T2WI were qualitatively and quantitatively assessed at baseline and up to 24 months post-RT. Tumor volumes were calculated, and correlations between ∆T2SI and volumetric changes were examined. Statistical tests included inferential tests, correlation analysis, and linear regression.

Results: At baseline, 87.5% tumors were rated as hyperintense, while none was rated hypointense. The mean ratio between T2SI of the tumors compared to the cerebral cortex was 1.70. A significant decrease in T2SI was observed over time with the strongest decrease at 24 months post-RT (- 18.7%; p = 0.002). ∆T2SI correlated significantly with tumor volume reduction (r = 0.46, p < 0.001) and response assessment (ρ = 0.51, p < 0.001). There was no significant influence of age, sex, tumor location, histology, or RT type on ∆T2SI. Cases of pseudoprogression cases exhibited stable T2SI despite transient increases in contrast enhancement or tumor volume.

Conclusion: A reduction in T2SI was consistently associated with tumor volume reduction, suggesting that a decrease in T2SI may serve as an additional imaging marker of a positive response to RT in pLGG patients.

Purpose: To evaluate the value of whole-lesion histogram analysis derived from mono-exponential, bi-exponential, and stretched-exponential DWI models in differentiating benign from malignant breast lesions and exploring molecular subtypes.

Material and methods: This retrospective study included 112 patients with 90 malignant lesions (17 Luminal A, 39 Luminal B, 18 HER2-positive, 10 triple-negative, and 6 undetermined) and 22 benign lesions, all examined with 1.5 T MRI. Histogram parameters-apparent diffusion coefficient (ADC), true diffusion (Dt), pseudo-diffusion (Dp), perfusion fraction (f), distributed diffusion coefficient (DDC), and heterogeneity index (alpha)-were analyzed using the Mann-Whitney U test, Kruskal-Wallis test, logistic regression, ROC analysis, the DeLong test, and the chi-square test.

Results: Histogram parameters from all models showed significant differences between benign and malignant lesions, with high diagnostic performance (AUC range: 0.898-0.938). However, combining the models did not significantly improve the AUC (p > 0.05). In molecular subtype analyses, DDC_75% differed significantly between Luminal A and triple-negative subtypes (p = 0.035); Dt_50%, Dt_75%, and DDC_75% distinguished Luminal B from triple-negative subtypes (p = 0.016, 0.021, and 0.041, respectively); and ADC_kurtosis and DDC_kurtosis showed significant differences between HER2-positive and triple-negative subtypes (p = 0.021 and 0.029, respectively). ROC analysis indicated variable diagnostic efficacy among parameters across molecular subtypes, and model combinations did not enhance AUC values.

Conclusion: Whole-lesion histogram analysis based on multi-model DWI shows potential for characterizing breast lesions. These exploratory findings, derived from an imbalanced single-center cohort, require further validation in larger prospective studies before clinical application.

Background: Artificial Intelligence (AI) in radiology has shown promise in detecting fractures on initial X-rays. However, the role of follow-up examinations in enhancing AI performance remains unexplored. This study evaluates the impact of including follow-up X-rays on the performance of neural networks in detecting pediatric wrist fractures.

Methods: Using the publicly available GRAZPEDWRI-DX dataset of 20,327 pediatric wrist X-rays, we created four training datasets: initial X-rays alone and combinations with follow-up X-rays (with and without casts). Two neural networks, EfficientNet (image classification) and YOLOv8 (object detection), were trained and evaluated using precision, recall, F1 score, and AP metrics. The dataset was divided into training, validation, and test sets, with 500 initial X-rays separated and reserved for testing.

Results: EfficientNet models showed no statistically significant improvements in classification performance with the inclusion of follow-up X-rays. In contrast, YOLOv8 demonstrated improved object detection metrics, particularly AP50 (p = 0.003) and F1 score (p = 0.009), when follow-up X-rays were included. The improvement was most evident when both cast and non-cast follow-ups were incorporated.

Conclusion: Adding follow-up X-rays did not enhance classification performance but improved fracture localization in object detection tasks. These findings suggest that including follow-up data shows no relevant improvement in the detection rate of fractures but can enhance AI applications for pediatric wrist fracture detection, particularly for object detection models.

The parapharyngeal space is a complex anatomical site in the head and neck which may harbour clinically occult pathology given its deep-seated location. The vast majority of parapharyngeal space lesions are of intermediate or hyperintense signal on T2W sequences. This review focuses on T2 hypointense parapharyngeal space lesions which are rare and may constitute a diagnostic dilemma. We present the differential diagnosis of these lesions, highlighting the pertinent radiological findings and identifying a histological correlation for the low T2 signal. A brief discussion of the physics principles accounting for these imaging features is also included. We propose a diagnostic algorithm to facilitate diagnosis and avoid unnecessary biopsy, whenever possible.

Purpose: This retrospective study aims to evaluate the habitat radiomics and deep learning models based on multi-sequence MRI in preoperatively predicting mismatch repair (MMR) status, and prognosis in colorectal liver metastasis (CRLM).

Material and methods: The total cohort (including 178 patients) was divided into a training cohort (93 patients), an internal validation cohort (40 patients), and an external validation cohort (45 patients). Axial T2WI, DWI (b = 800), and the BH Axial Dynamic Contrast-Enhanced (portal vein and delay phase) abdominal MRI were performed preoperatively for construction of classical radiomics model, habitat radiomics models, and deep learning model. Kaplan-Meier survival analysis was conducted to investigate prognostic stratification.

Results: Among 178 patients (including 126 males and 52 females), the prevalence of dMMR/MSI-H was 19.1% (34/178). The primary tumor grade and location were the independent clinical predictors of dMMR/MSI-H. The deep learning (DL) model outperformed the classical radiomics and habitat radiomics models in both internal (AUC = 0.817, 95% CI: 0.657 ~ 0.978) and external validation cohorts (AUC = 0.710, 95% CI: 0.519 ~ 0.900). The prognosis of the DL output-high and DL output-low subgroups exhibited significant differences (log-rank test, P = 0.011).

Conclusion: The habitat radiomics and deep learning models based on multi-sequence MRI can effectively predict the MMR status of CRLM. Meanwhile, the DL model demonstrates superior performance which may facilitate prognostic stratification of patients with CRLM, thereby assisting in individualized clinical treatment and prognosis prediction.

Objectives: To evaluate the feasibility of quantitative susceptibility mapping (QSM) and R2* mapping in assessing iron deposition in endometriotic ovarian cysts (EMO) and their potential implications for ovarian reserve.

Materials and methods: This prospective study included 28 patients (33 lesions) with histopathologically confirmed EMO who underwent preoperative MRI examinations, including R2* mapping and QSM. Cyst fluid iron concentration ([Fe]) was measured via inductively coupled plasma optical emission spectrometry. Serum anti-Müllerian hormone (AMH) levels were quantified as a marker of ovarian reserve. Pearson correlation and regression analyses were performed to assess associations among AMH, [Fe], R2*, and QSM values.

Results: In Group All Ages, AMH was negatively correlated with age (r = -0.74, p < 0.001) and [Fe] (r = -0.35, p = 0.048), while [Fe] showed moderate positive correlations with R2* (r = 0.55, p < 0.001) and QSM (r = 0.56, p < 0.001). In Group < 40 years, AMH exhibited moderate negative correlations with [Fe] (r = -0.45, p = 0.031), R2* (r = -0.48, p = 0.019), QSM (r = -0.49, p = 0.018). Multiple regression analyses confirmed that [Fe], R2*, QSM were significant predictors of AMH levels (p < 0.05). R2* and QSM were highly correlated (r = 0.72, p < 0.001), validating their consistency in assessing iron content.

Conclusion: R2* mapping and QSM reliably quantify iron deposition in EMO, with in vitro validation supporting their accuracy. Moreover, the potential link between iron deposition and ovarian reserve highlights the preliminary value of these methods in assessing ovarian function.