Radiologia Medica最新文献

Purpose: This exploratory study aimed to investigate grey matter (GM) volume changes in patients with hip osteoarthritis undergoing hip joint arthroplasty using voxel-based morphometry (VBM), assessing pre- and postoperative differences and comparing findings with healthy controls (HC).

Material and methods: Twenty-one patients with unilateral hip osteoarthritis before and after hip prosthesis insertion (PT group) and 16 HC were studied. All participants were right-handed and free from neurological or psychiatric conditions. Structural T1-weighted MRI scans were acquired at 3 T before and after surgery in the PT group, with an average interval of 112 days, and in the HC group. VBM analyses were conducted using the Computational Anatomy Toolbox (CAT12). Preoperative GM volume differences between PT and HC groups, as well as changes in PT before and after surgery, were analysed using statistical parametric mapping with family-wise error (FWE) correction.

Results: Preoperative comparisons revealed a significant reduction in grey matter volume in the ipsilateral cerebellar Crus II in the PT group compared with HC (pFWE = 0.004). No significant GM volume differences were found between pre- and postoperative assessments in the PT group. Although all patients demonstrated marked clinical improvement at 1-month follow-up, MRI-clinical correlations could not be performed because clinical assessments and postoperative MRI were not acquired at the same time.

Conclusion: The findings provide preliminary evidence of cerebellar GM changes in patients requiring hip prostheses, suggesting central nervous system involvement in chronic hip pathology. Interpretation is constrained by the modest sample size and by variability in postoperative imaging intervals. The absence of significant postoperative changes highlights the need for further research to explore the timeline and extent of neuroplastic recovery. These results underscore the importance of considering central adaptations in the management of peripheral joint disorders.

Purpose: With the advent of CFTR modulators for cystic fibrosis (CF) like Trikafta®, robust, radiation-sparing imaging strategies are urgently needed for monitoring therapeutic effects in both adult and pediatric patients. We investigated whether low-dose and ultra-low-dose lung CT could serve as innovative tool for short-term monitoring of treatment response in adults and children, respectively.

Methods: A total of 30 CF patients (15 adults, 15 paediatric) initiated Trikafta® and underwent baseline CT and 12-18-month follow-up scans. Adults and children were imaged with low- and ultra-low-dose protocols, respectively. Disease severity and extent were quantified using Brody score through both qualitative and quantitative analysis. Pre- and post-treatment CT data were compared (paired t-tests), and results were correlated with spirometry and sweat chloride values.

Results: Remarkably, low and ultra-low-dose protocols maintained high diagnostic quality while reducing radiation exposure (effective dose 2.4 and 0.56 mSv respectively). The Brody score showed significant improvements across all patients, demonstrating substantial decreases in mucous plugging (73%) and bronchial thickening (51%). Each patient exhibited a drop in Brody score after therapy, paralleled by better lung function (r_s = - 0.71, p < 0.0001) and sweat test outcomes (r_s = 0.7, p < 0.0001).

Conclusions: Low- and ultra-low-dose lung CT protocols represent an important advancement in cystic fibrosis imaging, providing sufficient detail to evaluate disease status while substantially reducing cumulative radiation exposure. By enabling reliable short-term assessment of CFTR modulator efficacy through established disease scoring systems, these protocols fill a critical gap in the routine follow-up of patients who require frequent imaging.

Cerebral perfusion abnormalities often represent an early and dynamic marker in pediatric neurological emergencies, preceding structural changes detectable by conventional MRI. Arterial Spin Labeling (ASL), a noninvasive and contrast-free perfusion MRI technique, allows for quantitative assessment of cerebral blood flow and is gaining relevance in acute neuroimaging protocols. This review discusses the diagnostic and prognostic utility of ASL across a range of acute conditions including ischemic stroke, encephalopathies, and seizures. Technical principles, typical perfusion patterns, and clinical implications are outlined, highlighting ASL's potential to improve diagnostic confidence and optimize care in pediatric emergency neuroradiology.

Purpose: To compare MRI-based graft maturation and tibial tunnel behavior in all-inside anterior cruciate ligament (ACL) reconstruction using either a quadrupled semitendinosus (ST4) graft or a standard doubled semitendinosus-gracilis (DSTG) technique and to assess mid-term clinical outcomes.

Materials and methods: This is a single-center prospective comparative cohort with sequential, non-randomized allocation. Primary imaging endpoints were graft signal-to-noise quotient (SNQ, PD-FS) and tibial tunnel cross-sectional area (CSA) change; clinical endpoints included PROMs and laxity at ≥ 24 months. Reliability was assessed with two independent evaluators and reported using ICC (two-way random, absolute agreement) with 95% CIs.

Results: Forty patients (n = 20 per group) completed MRI at 12 months and clinical follow-up at 24 months. SNQ was similar between groups (ST4 1.94 [95% CI 1.28-2.60] vs DSTG 2.84 [1.93-3.75]; difference - 0.90 [- 1.99 to 0.19], P = 0.39). Tibial tunnel widening was lower with ST4 (45.5% [23.7-67.3]) versus DSTG (106.7% [78.3-135.1]); difference - 61.2% [- 95.8 to - 26.6]; P = .02. PROMs and laxity were comparable.

Conclusions: AI-ST4 and DSTG ACL reconstruction demonstrated similar graft maturation at 12 months, with less tibial tunnel widening after AI-ST4. At 24 months, clinical outcomes were equivalent between groups; although SNQ and tibial tunnel CSA demonstrated good reproducibility, these imaging differences were not demonstrably associated with functional superiority.

Aim of the study: To evaluate the diagnostic performance of the Clear Cell Likelihood Score (ccLS) in characterizing indeterminate small renal masses (SRMs) in patients undergoing percutaneous biopsy.

Materials and methods: Sixty consecutive patients who underwent MRI and percutaneous renal mass biopsy for SRMs at our institution between 2013 and 2023 were identified. Three radiologists retrospectively reviewed the MRI exams and assigned ccLS scores, blinded to the final histopathology. The diagnostic accuracy of ccLS for the diagnosis of clear cell renal cell carcinoma (ccRCC) and papillary RCC (pRCC) was evaluated, and interobserver agreement was assessed.

Results: A total of 60 SRMs in 60 patients were evaluated. At histopathologic analysis 28/60 (47%) were ccRCC, 15/60 (25%) pRCC, 11/60 (18%) oncocytomas, 4/60 (7%) chromophobe RCC and 2/60 (3%) were fat-poor angiomyolipomas. For ccRCC diagnosis, the AUC was 0.86 (95% CI: 0.77-0.95) for reader 1, 0.75 (95% CI: 0.63-0.87) for reader 2, and 0.88 (95% CI: 0.80-0.97) for reader 3, respectively. For pRCC diagnosis, AUC was 0.92 (95% CI: 0.85-0.99) for reader 1, 0.83 (95% CI: 0.73-0.93) for reader 2, and 0.88 (95% CI: 0.80-0.97) for reader 3, respectively. Interreader agreement was substantial for ccLS ≥ 3 (k = 0.60 [95% CI: 0.42-0.78], PA = 85% [95% CI: 78-93]) and ccLS ≥ 4 (k = 0.64 [95% CI: 0.49-0.80], PA = 82% [95% CI: 75-90]) scores.

Conclusions: ccLS score demonstrates good diagnostic accuracy and reproducibility for characterizing indeterminate SRMs in patients undergoing percutaneous biopsy.

Purpose: To assess the feasibility, safety, and accuracy of robotic needle placement for abdominal percutaneous interventions in a real-world, post-market setting.

Patients and methods: This prospective single-center study assessed a robotic guidance device for CT-guided needle placement during abdominal thermal ablation procedures. The primary endpoint was technical success, defined as successful robotic needle placement without technical failure (full manual insertion or two failed robotic attempts). Secondary endpoints included procedural safety, needle placement accuracy (3D deviation and manual adjustments categorized as minor [depth-only], moderate [lateral], and major [complete needle retrieval]), immediate ablation success, 2-month and 1-year local recurrence, and operator satisfaction (5-point Likert scale).

Results: Between April 2022 and January 2023, 54 patients (one duplicate inclusion excluded) were analyzed (30 men, 24 women); mean age 64.7 (± 12.9). Most had metastatic disease (74.1%). Target organs included mainly the liver (68.5%) and the kidney (24.1%). Mean lesion diameter was 24.7 mm (± 13.1), with 59.0% considered technically challenging. Ablation modalities included microwave (63.3%), cryoablation (35.0%), and radiofrequency (1.7%). A total of 108 needles were placed (mean 1.8/patient), yielding a technical success rate of 94.4%. The mean final 3D accuracy after adjustments when required was 2.5 mm (± 3.7). Immediate ablation success was achieved in 98.4% lesions (60/61), with a mean minimal margin of 5.6 mm (± 3.2). Local recurrence occurred in 8.3% of cases at 2 months and in 25.6% at 1 year. Operator satisfaction averaged 3.1/4.

Conclusion: Robotic guidance for CT-guided abdominal thermal ablation is feasible, safe, and provides high needle placement accuracy. Early oncologic outcomes appear comparable to conventional freehand techniques, supporting the integration of robotic systems into routine interventional radiology practice.

Whole-body magnetic resonance imaging (WB-MRI) is widely used in rheumatology to assess peripheral and axial joints and entheses throughout the body. Despite some limitations, it has potential in determining the overall inflammatory burden, tracking disease progression, and evaluating treatment response. It is used in the evaluation of idiopathic inflammatory myositis (IIM) or in the pediatric population where it is becoming the gold standard for the diagnosis and monitoring of conditions, such as juvenile idiopathic arthritis (JIA) and chronic recurrent multifocal osteomyelitis (CRMO). In addition to advancements in technology and the development of WB-MRI scoring systems, the integration of artificial intelligence (AI) may improve diagnostic accuracy by automating assessments and enabling early detection of subclinical inflammation. The aim of this review is to examine the current scientific evidence for the use of WB-MRI in rheumatology.

Purpose: Cortical lesions are specific for multiple sclerosis but remain challenging to detect using magnetic resonance imaging (MRI). While numerous MR sequences have been evaluated individually, their combined performance in clinical routine settings has not been validated histopathologically. This study aimed to determine the detection rate of histopathologically validated cortical lesions using combined assessment of multiple MRI sequences in postmortem in situ imaging.

Material and methods: Five MRI sequences [phase-sensitive inversion recovery (PSIR), double inversion recovery (DIR), fluid-attenuated inversion recovery (FLAIR), 3D-T₁, and proton density (PD)/T₂] were acquired at 3 T for 18 patients with multiple sclerosis using postmortem in situ whole-brain imaging. A total of 66 tissue samples were collected and stained for myelin to identify cortical lesions types I-IV. Cortical lesions were assessed prospectively on MRI (blinded to histopathology) and retrospectively (with histopathological knowledge) using combined sequence evaluation and consensus reading.

Results: Histopathological analysis revealed 115 cortical lesions in 16/18 patients (4 type I, 43 type II, 61 type III, 7 type IV). Prospective assessment using all MRI sequences combined detected 20/115 (17.4%) cortical lesions with 100% specificity. The combination of DIR and PSIR sequences showed a 43% relative increase in detection compared to conventional sequences. Retrospective assessment with histopathological knowledge increased detection to 46/115 (40.0%) lesions, with DIR and PSIR in  combination providing an 18% relative improvement.

Conclusion: Despite using advanced MRI sequences in a highly controlled postmortem setting, cortical lesion detection remains limited at 17.4%. The combination of DIR and PSIR sequences provides the most effective approach, significantly outperforming conventional sequences. These findings establish a reference benchmark for cortical lesion detection rates and highlight persistent limitations of current MRI technology for identifying cortical pathology in multiple sclerosis.

Purpose: This systematic review and meta-analysis aimed to investigate the diagnostic accuracy of dual-energy CT (DECT) in distinguishing intracerebral hemorrhage (ICH) from contrast staining after procedures and to assess the associated radiation dose in comparison with conventional CT.

Methods: A systematic search was conducted up to December 2024. Eligible studies included those applying DECT for cerebrovascular conditions with retrievable technical and diagnostic performance data. Pooled estimates of sensitivity, specificity, and radiation dose parameters were calculated using a random-effects model.

Results: A total of 68 studies, including 5530 patients, met the inclusion criteria. Among them, 34/68 (50%) focused on lesion detection, 18/68 (26%) on technical aspects, and 16/68 (24%) on prediction. A meta-analysis of 10 studies demonstrated a pooled sensitivity of 96.1% (95% CI 83.8%-99.1%) and specificity of 97.8% (95% CI 91.4%-99.5%) for differentiating ICH from contrast staining. Additionally, a radiation dose meta-analysis of 13 studies provided pooled estimates of computed tomography dose index volume (CTDIvol) at 28.83 mGy (95% CI 20.60-37.07 mGy) and dose-length product (DLP) at 517.66 mGy × cm (95% CI 400.19-635.13 mGy × cm), comparable to conventional single-energy CT.

Conclusion: DECT demonstrates excellent diagnostic accuracy in differentiating ICH from contrast staining, with radiation exposure comparable to conventional CT. The large variability in voltage and doses among different protocols reflects the relative immaturity of DECT and the need for multicentric harmonization and standardization. Given its high diagnostic accuracy and comparable radiation exposure to single-energy CT, where technically available, DECT should always be considered in the specific scenario of differentiating ICH from contrast staining.

Clinical relevance statement: DECT provides high diagnostic accuracy without increasing radiation exposure, enabling confident post-treatment differentiation between hemorrhage and contrast staining to guide timely therapeutic decisions.

Purpose: To investigate how the topographical distribution and CT/MRI/scintigraphy characteristics of osteoid osteoma (OO) differ between children and adults.

Materials and methods: Patients who underwent percutaneous thermal ablation of OO between May 2008 and April 2025 in a single center were retrospectively evaluated. A skeletal atlas of the distribution of OO was created for children and adults. Patient gender, topographical data (skeletal region, intraarticular status, classification relative to the cortex) and imaging features (size, surrounding sclerosis or periosteal reaction, central calcifications, presence of the vessel sign, bone marrow edema, MRI contrast uptake and bone tracer uptake) were compared between children and adults.

Results: 315 patients (median age, 21 years, IQR, 15-31; 203 men), including 104 children and 211 adults, were evaluated. There was a higher proportion of female patients in the pediatric group (43% vs. 32%, p = 0.045). Adults had a higher rate of intraarticular OO (67% vs 46%, p < 0.001), more spinal lesions (29% vs. 13%) and fewer lower extremity lesions (57% vs. 76%, p = 0.005). OO in adults were smaller (7.35 ± 2.64 mm vs. 8.44 ± 2.74 mm, p < 0.001) and were less frequently associated with perifocal sclerosis or periosteal reaction (67% vs. 86%, p < 0.001), bone marrow edema (88% vs. 100%, p = 0.04) and the vessel sign (39% vs. 66%, p < 0.001).

Conclusion: Osteoid osteoma in adults demonstrate less typical imaging features and occur in less typical locations compared to children. Awareness of these age-related differences is important when evaluating musculoskeletal pain and especially joint-related symptoms.