Radiologia Medica最新文献

Purpose: White matter (WM) damage is a key pathophysiological process in amyotrophic lateral sclerosis (ALS). However, alterations in superficial WM (SWM) have not been systematically explored. This study aimed to assess SWM microstructural changes in early-stage ALS and their associations with cortical functional alterations and disease severity.

Methods: Forty-two early-stage ALS patients and 48 healthy controls were included. Disease severity was evaluated using the revised ALS Functional Rating Scale (ALSFRS-R). The SWM was identified by sampling voxels along the cortical surface, maintaining a fixed distance (2 mm) from the gray matter/WM interface and removing deep white matter regions. SWM microstructural impairments were evaluated via neurite orientation dispersion and density imaging. Functional disturbances in the cortical regions corresponding to impaired SWM were measured by assessing regional homogeneity (ReHo) that reflects local synchronization of neuronal activity.

Results: Patients showed a decreased neurite density index (NDI) in specific SWM regions, primarily including the bilateral precentral gyrus, supplementary motor area, paracentral lobule, and postcentral gyrus (family-wise error-corrected P < 0.05). Additionally, significant ReHo reductions were observed in cortical regions corresponding to compromised SWM. Both SWM NDI and cortical ReHo values significantly correlated with the ALSFRS-R score. Cortical ReHo alterations mediated the relationship between the SWM NDI value and the ALSFRS-R score (mediation effect = 0.103). SWM NDI assessments effectively identified ALS (area under the curve = 0.725-0.926).

Conclusion: Our findings highlight the SWM disruption as a crucial neurobiological substrate involved in early-stage ALS neuropathological mechanisms.

Purpose: To develop a deep learning model for predicting molecular subgroups of medulloblastoma (MB) using preoperative brain MRI.

Materials and methods: This study included a cohort of 350 patients with MB for model development. Preoperative multiparametric brain MRIs were acquired, and molecular classification data for tumor samples were analyzed. A dual-task deep learning model, composed of a 3D Swin Transformer backbone and a Transformer-based mask decoder, was developed for the prediction of MB molecular subgroups. The model was jointly optimized with a parallel task of tumor and cerebellum segmentation. Ablation analysis was conducted to verify the effectiveness of the dual-task model design. An independent test cohort of 126 patients with MB was established to validate the predictive performance of the dual-task model.

Results: Our dual-task deep learning model demonstrated superior performance for MB molecular subgroup prediction, achieving an AUC of 0.877, accuracy of 88.9%, sensitivity of 71.6%, and specificity of 91.9%. The performance remained robust across both adult and pediatric age populations, with AUCs of 0.915 and 0.871, respectively. Furthermore, our approach exhibited effective generalization to the independent test cohort, yielding an AUC of 0.853, accuracy of 89.7%, sensitivity of 73.5%, and specificity of 92.1%. Ablation analysis demonstrated a significant improvement in AUC of 0.169 (95% CI 0.097-0.244) when using the dual-task model design. In comparison with the radiomics-based model, our deep learning model achieved a higher AUC by 0.156 (95% CI 0.079-0.233).

Conclusion: Our proposed dual-task deep learning model enables automated and accurate prediction of MB molecular subgroups.

Purpose: This multicentric retrospective study aimed to evaluate the diagnostic outcomes, adherence to guideline-based recommendations, and sustainability implications of 280 initial chest CT scans performed without contrast. The scans were conducted at the Radiology Unit of the Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico of Milan and the Radiology Department of Treviglio-Caravaggio Hospital-ASST Bergamo Ovest. The study focused on optimizing patient selection and radiological recommendations to align with evidence-based guidelines.

Materials and methods: This retrospective study included 280 patients (mean age 61.68 years; 51.07% women, 48.93% men) who underwent their first chest CT scan without contrast. Diagnostic outcomes were analyzed across different clinical queries. Incidental findings and radiologists' recommendations were assessed for alignment with Fleischner Society and ACR guidelines. Deviations were categorized as unnecessary imaging suggestions or missed indications. Radiation exposure was quantified using the dose-length product (DLP).

Results: Diagnostic outcomes were positive in 54.64% of cases. Incidental findings occurred in 34.64% of cases, with guideline adherence at 81.43%. Deviations included unnecessary imaging in 14.29% and missed follow-up indications in 4.28% of cases. The median DLP was 237.5 mGy·cm (IQR 171.8-320.1).

Conclusion: This study highlights significant opportunities to refine patient selection and radiological recommendations through adherence to Fleischner Society and ACR guidelines. By integrating evidence-based practices into routine workflows, the findings advocate for reduced unnecessary imaging, enhanced diagnostic pathways, and sustainable healthcare practices in chest CT imaging.

Asthma is a heterogeneous disease characterized by respiratory involvement with wheezing, shortness of breath, dyspnea, and cough, along with systemic symptoms. The diagnosis of asthma predominantly relies on clinical history and bronchial hyperreactivity. However, due to its heterogeneity in manifestation, imaging can be a valuable option to support clinical examination. In fact, as stated by the latest guidelines, imaging examinations should not be routinely performed but should be tailored to the patient according to specific conditions or particular situations-such as exacerbation requiring advanced care, comorbidities, or severe asthma-that require further and more specific evaluation. The most common imaging findings in asthma are related to central and peripheral airway involvement, showing bronchial thickening and subsegmental bronchiectasis, along with additional radiographic features such as expiratory air trapping, inspiratory lung hyperinflation, and centrilobular micronodules. Despite having low specificity and sensitivity, chest X-ray is often the first examination performed due to its availability and usefulness in an emergency setting to identify complications as pneumothorax or superimposed infections. Among imaging techniques, HRCT remains the gold standard, allowing for the successful identification of both airway morphological changes (bronchial thickening) and parenchymal involvement related to asthma (centrilobular nodules and air trapping). Moreover, with the development of new techniques such as quantitative CT, more precise measurements of bronchial wall thickening can be done, establishing a potential correlation between HRCT imaging and data from pulmonary function tests. Despite being a promising and revolutionary technique, up to now MRI has played a marginal role in the evaluation of asthma, mainly restricted to assessing lung ventilation. However, recent studies are experimenting with MRI quantitative evaluation of bronchial wall dimensions with great results, which can be promising in the near future for new follow-up possibilities. The aim of this article is to analyze the state of the art of imaging techniques used in the field of asthma and to link advanced imaging findings with everyday clinical practice, offering insight into the future of precision medicine in asthma care.

Purpose: To assess the diagnostic concordance between contrast-enhanced mammography (CEM) and dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) in the preoperative staging of breast cancer (BCa) and to evaluate the clinical, operational, and economic implications of substituting CEM for MRI in concordant cases.

Methods: This retrospective single-center study included 280 patients who underwent both CEM and DCE-MRI within 15 days. Two experienced breast radiologists independently evaluated imaging concordance based on lesion detection, characterization, and clinical interpretability. A cost minimization analysis was performed assuming equivalent diagnostic performance in concordant cases. Direct procedural costs were derived from regional reimbursement rates (€215.20 for DCE-MRI; €74.00 for CEM). Operational efficiency was assessed using institutional time-motion data, and average radiologist reporting times were included to model overall organizational impact.

Results: Complete diagnostic concordance was observed in 190 cases (67.9%), while 78 (27.9%) showed that clinically relevant discordance and 12 (4.3%) were indeterminate. Substituting CEM for MRI in the concordant group yielded a projected total cost reduction of €26,828, representing a 44.9% decrease and €141.20 saved per patient. Procedural modeling indicated a net scanner time saving of 3,800 min (63 h and 20 min). CEM reporting required 15 min less per case on average, totaling 2,850 min (47 h and 30 min) in cumulative reading time saved.

Conclusion: CEM demonstrated substantial diagnostic concordance with MRI in a majority of cases, with significant benefits in cost reduction and workflow efficiency. Targeted CEM integration may support more sustainable, value-based breast imaging without compromising diagnostic quality.

Forensic radiology training significantly enhances the diagnostic accuracy of postmortem computed tomography (PMCT) in firearm-related deaths, reducing inter-reader variability and improving injury detection. This study examines the impact of forensic expertise on PMCT interpretation, evaluating whether specialized training supersedes clinical radiology experience (non-forensic). A retrospective observational analysis was conducted at the University of Palermo, examining 10 firearm fatalities (homicides or suicides) between 2021 and 2024. The sample included individuals aged 25 to 66, with injuries from both short- and long-barrel firearms. Four radiologists with varying forensic experience analyzed the PMCT scans: an experienced forensic radiologist, an experienced clinical radiologist without forensic training, a radiology resident with forensic training, and a radiology resident without forensic expertise. Findings were compared against autopsy results as the gold standard. A lesion-based analysis was carried out in performance metrics considering the total number of findings (n = 960) and the number of findings in each subgroup (ranging from 40 up to 230 lesions). Inter-rater agreement was assessed using Fleiss' kappa and Cohen's kappa, while diagnostic performance was evaluated with ROC curve analysis. Results showed significantly higher diagnostic accuracy among radiologists with forensic training, particularly in detecting entrance and exit wounds, as well as organ injuries. These findings underscore the critical role of forensic radiology training in enhancing PMCT reliability, particularly for firearm-related injuries. Standardized reporting protocols and structured training programs are crucial for strengthening medicolegal investigations, thereby ensuring accurate and reproducible forensic imaging assessments. Future research should explore advanced imaging techniques, including radiomics and AI-driven analysis, to optimize forensic radiology practices.

Purpose: This study aimed to assess the impact of photon-counting computed tomography (PCCT) virtual monoenergetic images (VMI) on quantitative and qualitative parameters in abdominal and pelvic vascular imaging for transcatheter aortic valve implantation (TAVI) planning.

Material and methods: A retrospective analysis of 125 patients undergoing dual-source PCCT scans before TAVI procedures was conducted. Reconstructions included polychromatic (T3D) images, leveraging multiple photon energy levels and VMI series spanning 40-100 keV in 15 keV increments. Quantitative parameters (signal-to-noise ratio [SNR] and contrast-to-noise ratio [CNR]) were evaluated. Qualitative assessments by three radiologists used clinically relevant five-point scales for overall image quality, TAVI access site suitability, and confidence in TAVI measurements.

Results: VMI reconstructions, particularly at 40 and 55 keV, demonstrated significantly higher SNR and CNR than T3D reconstructions (p < 0.001). T3D reconstructions had a mean noise of 12.61 ± 6.12, comparable to 100 keV VMI reconstructions (14.77 ± 8.23, p > 0.05). In qualitative evaluation, 55 keV VMI images scored highest in overall image quality and TAVI access site assessability, followed by 70 keV VMI reconstructions.

Conclusion: Low-keV PCCT VMI reconstructions provided superior quantitative and qualitative image quality for abdominal and pelvic vascular imaging in TAVI planning. Notably, 55 keV reconstructions showed an image quality reserve over T3D images, aiding confidence in TAVI-related measurements and enabling possible future reductions in contrast agent use, emphasizing the relevance of VMI techniques in optimizing TAVI imaging protocols.

Introduction: The management of residual or new ground-glass nodule (GGN)-like lung cancer after video-assisted thoracoscopic surgery (VATS) is challenging for patients who are not suitable for reoperation. This retrospective, large-sample, multicenter study aimed to evaluate the feasibility, safety, and preliminary efficacy of microwave ablation (MWA) for residual GGN-like lung cancer after VATS in early-stage lung cancer.

Methods: A total of 216 patients with 216 residual GGN-like lung cancers who underwent 235 procedures of CT-guided percutaneous MWA after VATS (R0) of stage I-IIA lung adenocarcinoma from July 2016 to December 2023 were included in the study. The primary endpoints were technical success, complications, and pulmonary function test (PFT) variations after the MWA procedure. The secondary endpoints were local progression-free survival (LPFS) and overall survival (OS).

Results: The rate of technical success was 100%. The major complications after MWA included pneumothorax (12.3%, 29/235), pleural effusion (5.5%, 13/235), pulmonary infection (2.6%, 6/235), hydropneumothorax (1.3%, 3/235), intrathoracic hemorrhage (0.4%, 1/235), and bronchopleural fistula (0.4%, 1/235). No MWA procedure-related death was observed. The PFT at 1-3 months after MWA was not significantly different from the baseline. The median follow-up duration was 58.5 months, and the 1-, 3- and 5-year OS rates were 100%, 99.1% and 96.3%, respectively. The median follow-up period after MWA was 33.8 months, and the 1-, 2- and 3-year LPFS rates were 100%, 97.7% and 96.3%, respectively.

Conclusions: CT-guided percutaneous MWA is a safe, effective, and potentially curative approach for patients with residual GGN-like lung cancer after VATS.

Background: Next-generation imaging (NGI) (68 Ga-prostate-specific membrane antigen (PSMA)-PET) represents a cornerstone in biochemical recurrent prostate cancer management. PSICHE is a multicentric prospective study, aimed to assess oncological outcomes of a predefined tailored imaging-guided treatment.

Methods:  Patients with biochemical recurrence (BCR) after surgery (prostate-specific antigen [PSA] > 0.2 ≤ 1 ng/mL) underwent staging with PSMA-PET. A predefined treatment algorithm was proposed to all patients: prostate bed salvage radiotherapy (SRT) in case of negative or positive PET within the prostate bed, stereotactic body radiotherapy (SBRT) if pelvic nodal recurrences or oligometastatic disease were detected, and androgen deprivation therapy (ADT) was proposed in widespread polymetastatic disease. Chi-square test was used to evaluate the relationship between baseline features and the rate of positive PSMA-PET/CT.

Results: One hundred and fifty-nine patients were enrolled. One hundred and seven patients had a PSMA negative/positive in the prostate bed; pelvic nodal disease or oligometastatic metastatic disease was detected in 39 and 10 patients, respectively. Three patients had a polymetastatic disease. Seventeen patients underwent observation because of prior postoperative radiotherapy (RT)/treatment refusal. Eighty-eight patients were treated with SRT, and SBRT was performed in 49 patients with pelvic or extrapelvic oligometastatic disease. Stratifying patients according to EAU criteria (low risk: PSA doubling time > 12 months and Gleason score < 8; high risk: PSA doubling time ≤ 12 months or Gleason score ≥ 8) after a median follow-up of 19 months in the overall population, median BRFS and MFS were not significantly different between the two risk subgroups (p = 0.58 and p = 0.21, respectively). Median metastasis-free and ADT-free survival were not reached.

Conclusions: A PSMA-targeted treatment strategy led to promising results, avoiding unnecessary toxicity from ADT or standard SRT administered in unselected patients. Analysis after longer follow-up is needed to clarify survival outcomes.

Background: The CCM-ITALUNG2 pilot was implemented to evaluate the feasibility of an organized lung cancer (LC) screening programme in five Italian centres.

Methods: The screening pathway included invitation, recruitment, referral to Smoking Cessation Services (SCSs), and use of the Lung-RADS score for low-dose CT reading. Dedicated screening operators followed up participants from recruitment through the clinical follow-up established by multidisciplinary teams. Eligibility criteria included age 55-75 years, ever-smokers with ≥ 25 pack-years; quit within the past 10 years. Baseline round results are presented.

Results: From November 2022 to May 2024, 1,144 of the 1,971 invited individuals (58.0%) were recruited following different strategies including in-person invitation by general practitioners (GPs; 356 subjects, 31.9%) or other healthcare personnel (18.1%), self-presentation (36.3%), and phone invitation using GPs' patient lists (13.7%). Among current smokers, 38.5% accepted referral to SCSs. Eighteen subjects (77.8% in stage I-II) were diagnosed with LC (prevalent LC rate 1.57%). The mean time to surgery was 147 days (standard deviation 73); the false-positive rate was 1.38% (15/1,085).

Conclusions: By utilizing different organizational models, the pilot was tailored to the specific characteristics of each centre. Phone invitations from GPs' patient lists, in-person invitations by GPs and other healthcare personnel, and self-presentation might enhance equity of access in comparison with self-referral only. Dedicated screening operators, the use of the Lung-RADS scoring system, and a structured clinical follow-up supported participants throughout the screening pathway. Delivering brief advice for smoking cessation during recruitment and offering SCS referral were feasible within the screening pathway.