Radiologia Medica最新文献

Radiomics represents the science of extracting and analyzing a multitude of quantitative features from medical imaging, revealing the quantitative potential of radiologic images. This scientific review aims to provide radiologists with a comprehensive understanding of radiomics, emphasizing its principles, applications, challenges, limits, and prospects. The limitations of standardization in current scientific production are analyzed, along with possible solutions proposed by some of the referenced papers. As the continuous evolution of medical imaging is ongoing, radiologists must be aware of new perspectives to play a central role in patient management.

Purpose: This multicenter prospective study aims to compare transradial access versus transfemoral access in conventional transarterial chemoembolization (c-TACE) procedures, focusing on operators radiations exposure, patients comfort, technical success and vascular access complications.

Materials and methods: Patients were affected by hepatocellularcarcinoma (HCC) in intermediate stage or previous stages unfit for ablation and/or surgery; they were randomized into two groups according to arterial access site (Group F: right femoral access in standard position; Group R: radial access with left arm abduced 90°). Overall fluoroscopy time was recorded. Eight thermoluminescence dosimeters were positioned immediately before each procedure to monitor radiation doses. Technical success was intended as complete HCC nodules lipiodolization at final plain cone-beam CT.

Results: Group F included 23 patients, while group R 19. Mean fluoroscopy time was lower in group F but difference was not statistically significant (p-value > 0.05). In terms of operators radiations exposure, no significant differences were found (p-value > 0.05). Technical success was obtained in 81.5% in group F and 84.8% in group R, without significant differences (p-value > 0.05). Patients discomfort was significantly (p-value < 0.05) higher in group F. Concerning minor complications, no statistical differences were appreciated (p-value > 0.05); no major complications occurred.

Conclusions: In this study, no statistical differences were observed in terms of operators radiations exposure, fluoroscopy time and technical success during c-TACE performed with left radial access compared to right femoral access; patients comfort was significantly better with radial access. These data should lead interventional radiologists to favor radial access in c-TACE interventions.

Background: Aim was to compare the efficacy of interventional radiotherapy (IRT) boost vs. external beam radiotherapy (EBRT) boost after chemoradiation (CCRT) in patients with anal cancer (AC).

Methods: The P.I.C.O. framework was: in patients with AC [P], is IRT boost [I] superior to EBRT boost [C] in terms of local control (LC), cancer specific survival (CSS), overall survival (OS), distant meta-static free Survival (DMFS), colostomy free survival (CFS) and toxicity [O]?

Results: 651 patients were analyzed. The median 5-year locoregional control rates was 87.8% in the IRT boost group versus 72.8% in the EBRT boost group. The 5-year cancer-specific survival rate was 91% in the IRT boost group versus 78% in the EBRT boost group. 5-years overall survival was 74.6% in IRT boost versus 67.7% in the EBRT boost. 5-years disease metastasis-free survival rate was 92.9% in IRT boost group vs. 85.6% for the EBRT boost group. Cancer-free survival rate was 76.8% in the IRT group vs. 63.1% in the EBRT boost group. Acute toxicity above grade 2 was less common in the IRT boost group while chronic toxicity was similar between both groups.

Conclusion: IRT boost after CCRT could lead to better outcomes than EBRT boost in treating AC.

Purpose: To develop and validate deep learning (DL) models using preoperative contrast-enhanced CT images for tumor auto-segmentation and microsatellite instability (MSI) prediction in colorectal cancer (CRC).

Materials and methods: Patients with CRC who underwent surgery or biopsy between January 2018 and April 2023 were retrospectively enrolled. Mismatch repair protein expression was determined via immunohistochemistry or fluorescence multiplex polymerase chain reaction-capillary electrophoresis. Manually delineated tumor contours using arterial and venous phase CT images by three abdominal radiologists are served as ground truth. Tumor auto-segmentation used nnU-Net. MSI prediction employed ViT or convolutional neural networks models, trained and validated with arterial and venous phase images (image model) or combined clinical-pathological factors (combined model). The segmentation model was evaluated using patch coverage ratio, Dice coefficient, recall, precision, and F1-score. The predictive models' efficacy was assessed using areas under the curves and decision curve analysis.

Results: Overall, 2180 patients (median age: 61 years ± 17 [SD]; 1285 males) were divided into training (n = 1159), validation (n = 289), and independent external test (n = 732) groups. High-level MSI status was present in 435 patients (20%). In the external test set, the segmentation model performed well in the arterial phase, with patch coverage ratio, Dice coefficient, recall, precision, and F1-score values of 0.87, 0.71, 0.72, 0.74, and 0.71, respectively. For MSI prediction, the combined models outperformed the clinical model (AUC = 0.83 and 0.82 vs 0.67, p < 0.001) and two image models (AUC = 0.75 and 0.77, p < 0.001). Decision curve analysis confirmed the higher net benefit of the combined model compared to the other models across probability thresholds ranging from 0.1 to 0.45.

Conclusion: DL enhances tumor segmentation efficiency and, when integrated with contrast-enhanced CT and clinicopathological factors, exhibits good diagnostic performance in predicting MSI in CRC.

Purpose: The aim of the study was to evaluate the concordance between computed tomography (CT)/magnetic resonance imaging (MRI) and histological examination in the evaluation of lymph nodal involvement (N+) and extranodal extension (ENE+) in patients with squamous cell cancer of the head-neck district (HNSCC). The second end point was to evaluate which of the imaging features was more sensitive and specific in establishing N+ and ENE+, and comparing the diagnostic accuracy between CT and MRI.

Material and methods: 58 patients with HNSCC undergoing surgical treatment with lymph node dissection at the Policlinico of Bari were enrolled in this retrospective study. The criteria used for identifying radiological N+ (rN+) included six characteristics; the presence of any two or more criteria out of these six was considered rN+. For each rN+, the radiological extranodal extension (rENE+) was evaluated analyzing three characteristics; rENE was considered positive if any one criterion was present.

Results: Of 167 lymph nodes, 45/167 (27%) had rN+, out of which 20/45 (44%) were rENE+. On pathological examination, 38/45 (84%) nodes were N+ and 11/20 (55%) were ENE+. The agreement between imaging and histology in the evaluation of N was (149/167) 89% with a good concordance (k = 0.7). The agreement between imaging and histology in the evaluation of ENE was (35/45) 78% with a moderate concordance (k = 0.5). Loss of fatty hilum was found to be the most sensitive (84%) imaging finding in N+ evaluation. Capsular irregularity with fat stranding had the highest sensitivity (82%) for the determination of ENE+. Comparing CT and MRI imaging in the evaluation of N+ and ENE+, we found no statistically significant differences (p-value of 0.3 for N+ and p-value of 0.3 for ENE +).

Conclusions: Imaging has good confidence in detecting rN+ but modest in assessing rENE+. Further research could improve the imaging specificity for the determination of rENE.

Purpose: To evaluate the correlation between ectopic adipose tissue and iron overload severity in patients with hemochromatosis.

Material and methods: A retrospective cohort of 52 patients who underwent liver iron concentration quantification from January 2015 to October 2023 using a 3.0T MRI scanner. R2* relaxation times and proton density fat fraction (PDFF) were assessed for the entire liver volume and a specific region of interest (ROI) placed in the right lobe. Total body fat (TF), subcutaneous fat (SCF), intermuscular fat (IMF), and visceral fat (VSF) percentages were calculated from a single axial slice at the level of the third lumbar vertebra. Additionally, ratios of IMF-to-VSF, IMF-to-SCF, and SCF-to-VSF were calculated. Standard iron laboratory parameters were collected at least one month prior to MRI. Pearson correlation coefficient was used for correlation analysis.

Results: The mean age of participants was 53.9 ± 19.6 years. IMF positively correlated with R2* values in the ROI (p = 0.005, r_s = 0.382) and entire liver (p = 0.016, r_s = 0.332). Conversely, VSF negatively correlated with R2* values from the ROI (p = < 0.001, r_s = - 0.488) and entire liver (p = < 0.001, r_s = - 0.459). Positive correlations were also found between IMF-to-VSF and R2* of the ROI (p = 0.003, r_s = 0.400) and whole liver (p = 0.008, r_s = 0.364). Ferritin levels positively correlated with R2* values calculated from ROI (p = 0.002, r_s = 0.417) and whole liver volume (p = 0.004, r_s = 0.397). A positive correlation was noted between PDFF of the entire liver and TF (p = 0.024, rs = 0.313).

Conclusion: The percentage of Intermuscular and visceral adipose tissues correlates with the severity of liver iron overload in hemochromatosis patients.

Background: Early and accurate identification of the metastatic tumor types of brain metastasis (BM) is essential for appropriate treatment and management.

Methods: A total of 450 patients were enrolled from two centers as a primary cohort who carry 764 BMs originated from non-small cell lung cancer (NSCLC, patient = 173, lesion = 187), small cell lung cancer (SCLC, patient = 84, lesion = 196), breast cancer (BC, patient = 119, lesion = 200), and gastrointestinal cancer (GIC, patient = 74, lesion = 181). A third center enrolled 28 patients who carry 67 BMs (NSCLC = 24, SCLC = 22, BC = 10, and GIC = 11) to form an external test cohort. All patients received contrast-enhanced T1-weighted (T1CE) and T2-weighted (T2W) MRI scans at 3.0 T before treatment. Radiomics features were calculated from BM and brain-to-tumor interface (BTI) region in the MRI image and screened using least absolute shrinkage and selection operator (LASSO) to construct the radiomics signature (RS). Volume of peritumor edema (VPE) was calculated and combined with RS to create a joint model. Performance of the models was assessed by receiver operating characteristic (ROC).

Results: The BTI-based RS showed better performance compared to BM-based RS. The combined models integrating BTI features and VPE can improve identification performance in AUCs in the training (LC/NLC vs. SCLC/NSCLC vs. BC/GIC, 0.803 vs. 0.949 vs. 0.918), internal validation (LC/NLC vs. SCLC/NSCLC vs. BC/GIC, 0.717 vs. 0.854 vs. 0.840), and external test (LC/NLC vs. SCLC/NSCLC vs. BC/GIC, 0.744 vs. 0.839 vs. 0.800) cohorts.

Conclusion: This study indicated that BTI-based radiomics features and VPE are associated with the metastatic tumor types of BM.

Verifying patients' position and internal anatomical changes are important steps in the radiotherapy of rectal cancer. Cone Beam Computed Tomography (CBCT) is an advanced imaging method that allows for the quantification of these modifications, ensuring the delivery of radiation dose to the tumor volume, while protecting surrounding organs at risk. The aim of this review is to discuss and analyze the benefits offered by this method of imaging on board the linear accelerator. In view of this, a systematic search of the scientific literature in the Medline/PubMed database was performed for publications over the last decade, with 20 articles found to be relevant for this study. To highlight the benefits of this imaging technique in rectal cancer, the frequency of CBCT use, identification of tumor volume and organs at risk on CBCT images, quantification of the movement of these organs and tumor volume, analysis of positioning errors as well as evaluation of dosimetric parameters were analyzed.

Objective: This study aimed to investigate the integration of dual-energy CT (DECT) into CT-guided bone biopsy procedures, comparing it with conventional CT techniques. The focus was on technical aspects, accuracy and radiation dose exposure.

Materials and methods: A total of 51 bone biopsies were conducted, with 36 using conventional CT and 15 utilizing DECT. Patient data, lesion characteristics and biopsy techniques were analyzed. Statistical analyses, including Fisher's exact test and independent samples t-test, were performed to compare accuracy and radiation doses between the two methods.

Results: DECT-guided biopsies demonstrated a significantly higher accuracy (93.33%) compared to conventional CT biopsies (86.11%). The radiation dose exposure for DECT was comparable to conventional CT. DECT's ability to differentiate tissues, especially in bone marrow edema detection, led to higher precision.

Conclusion: Integrating DECT into CT-guided bone biopsies enhances tissue differentiation and accuracy without significantly increasing radiation exposure. This advancement holds promise for improving musculoskeletal interventional radiology, leading to more precise diagnoses, informed treatment decisions and improved patient outcomes.