Radiologia Medica最新文献

Purpose: In cancer therapy, tumor cell heterogeneity and dynamics influence gene sequencing and immunohistochemical staining. Importantly, patients treated with epidermal growth factor receptor (EGFR)-tyrosine kinase inhibitors (TKIs) have not demonstrated a favorable long-term prognosis. Therefore, this study proposes an integrated framework for artificial intelligence (IFAI) to explore new molecular detection methods.

Materials and methods: Our study integrated data from 506 non-small cell lung cancer (NSCLC) patients across three institutions in China and the USA. To fuse radiomics scores and deep network features from both tumors and surrounding tissues, we developed the IFAI with an attention-based DenseNet 121 as the backbone network. We also explored the synergy between IFAI and clinical factors (IFAI-C). Additionally, we gained further insights into the biological mechanisms of IFAI by analyzing patient RNA sequencing data.

Results: In independent test data, the IFAI-C demonstrated notable predictive performance, boasting an area under the curve of 0.912 for EGFR, 0.911 for exon 19 deletion (19Del), 0.905 for exon 21 mutation (L858R), 0.911 for T790M, and 0.904 for programmed cell death protein 1 (PD-1) or its ligand 1 (PD-L1). This capability is a crucial complement to traditional methods like gene sequencing and immunohistochemistry. Our analysis revealed that radiomics scores and deep network features in IFAI were significantly associated with EGFR genotypes, drug resistance mutations, and immune molecule expression. Furthermore, these features displayed robust connections with multiple genotypes associated with drug resistance and cancer progression mechanisms.

Conclusion: IFAI-C introduces a novel method with performance advantages, accompanied by biological analyses demonstrating the extraction of genotypic and immunomolecular information from both tumors and surrounding tissues. This discovery holds potential value in guiding therapeutic decisions for lung cancer.

Introduction: Skull base osteomyelitis (SBO) is a challenging diagnosis with a variety of nonspecific clinical manifestations and imaging findings. This study aims to determine the association between the type of SBO and the source and infection spread in patients with histopathology/culture-proven SBO.

Materials and methods: A retrospective analysis of 55 patients with suspected SBO was conducted. Twenty-two patients (40%) were excluded because either histology resulted in neoplasia without associated infection (2[9%]) or imaging findings were negative for SBO. An additional nine patients were excluded due to negative cultures and nonspecific inflammatory changes on histology without clinical signs of sepsis. A total of 24 patients met inclusion criteria with either a positive culture (13[54.1%] or histopathologic inflammation with signs of infection (11[45.9%]).

Results: Bacterial SBO was identified in 13 patients (54.1%) and fungal SBO in two patients (8.33%). Typical SBO (TSBO) was observed in 12 patients (50%). Twelve patients (50%) had typical SBO (TSBO), and the remaining 12 (50%) presented with central or atypical SBO (ASBO). The nasopharynx was identified as the primary source of infection in one-third of ASBO cases. In this group, the infection frequently extended to the masticator space (75%, p = 0.01) and carotid space (75%, p < 0.01), with internal carotid artery thrombosis seen in half of these patients (p = 0.06). Temporomandibular joint involvement was also observed (58.3%, p = 0.2). On MRI, peri-clival soft tissue enhancement (66%, p = 0.03) and sphenoid body bone marrow edema (50%, p = 0.08) were prominent findings in ASBO cases.

Conclusion: Central or atypical SBO accounted for half of the confirmed cases in this study and was frequently associated with extensive spread to adjacent deep neck spaces and vascular complications. Characteristic MRI findings such as peri-clival soft tissue enhancement and sphenoid body marrow edema may aid early recognition. Identifying the nasopharynx as a common infection source and recognizing these imaging patterns can support earlier diagnosis and tailored treatment strategies, potentially improving patient outcomes.

Purpose: To assess the accuracy and safety of CT-guided percutaneous core-needle biopsies of pancreatic lesions suspected to be malignant based on MRI or CT scans.

Materials and methods: This retrospective study analyzed CT-guided percutaneous biopsies of suspicious pancreatic lesions performed at our university hospital. Biopsy was performed using a 17G coaxial needle and an 18G core biopsy needle. Data on patient characteristics, lesions, procedures, and histologic results were recorded.

Results: A total of 90 patients (58.9% males, mean age 65 ± 12.2 years) underwent CT-guided percutaneous biopsies. The lesions had a mean size of 36.8 ± 12.2 mm and were predominantly located in the pancreatic head 61.1% (55/90). Technical success was achieved in all biopsies 100% (90/90). Most procedures 96.7% (87/90) were performed using direct access routes, while 3.3% (3/90) required indirect transhepatic or transgastric approaches. Among the biopsies, 65.6% (59/90) confirmed malignancy, with adenocarcinoma as the most common malignant subtype representing 55.6% (50/90) of all cases. The rate of non-malignant findings was 26.7% (24/90) including chronic pancreatitis at a rate of 5.6% (5/90) as well as pancreatic pseudocysts and pancreatic cystadenoma each at a rate of 2.2% (2/90), among others. A total of seven cases were identified as false negatives confirmed, but malignancy was later confirmed after re-biopsy or surgery. The initial diagnostic accuracy was 92.2% (83/90). The rate of major complications was 1.1% (1/90), and a total of two minor complications at a rate of 2.2% were observed.

Conclusion: This study shows that CT-guided pancreatic biopsy is a safe procedure with high diagnostic accuracy.

Purpose: We aimed to systematically review the studies that utilized deep learning (DL)-based networks to predict hematoma expansion (HE) in patients with intracerebral hemorrhage (ICH) using computed tomography (CT) images.

Methods: We carried out a comprehensive literature search across four major databases to identify relevant studies. To evaluate the quality of the included studies, we used both the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) and the METhodological RadiomICs Score (METRICS) checklists. We then calculated pooled diagnostic estimates and assessed heterogeneity using the I² statistic. To assess the sources of heterogeneity, effects of individual studies, and publication bias, we performed subgroup analysis, sensitivity analysis, and Deek's asymmetry test.

Results: Twenty-two studies were included in the qualitative synthesis, of which 11 and 6 were utilized for exclusive DL and combined DL meta-analyses, respectively. We found pooled sensitivity of 0.81 and 0.84, specificity of 0.79 and 0.91, positive diagnostic likelihood ratio (DLR) of 3.96 and 9.40, negative DLR of 0.23 and 0.18, diagnostic odds ratio of 16.97 and 53.51, and area under the curve of 0.87 and 0.89 for exclusive DL-based and combined DL-based models, respectively. Subgroup analysis revealed significant inter-group differences according to the segmentation technique and study quality.

Conclusion: DL-based networks showed strong potential in accurately identifying HE in ICH patients. These models may guide earlier targeted interventions such as intensive blood pressure control or administration of hemostatic drugs, potentially leading to improved patient outcomes.

Objectives: To develop a practical consensus for standardizing communication between rheumatologists and radiologists regarding magnetic resonance imaging (MRI) of the sacroiliac joints and spine in the diagnosis and management of axial spondyloarthritis (axSpA).

Methods: A task force comprising six rheumatologists and five musculoskeletal radiologists with expertise in axSpA imaging reviewed the Assessment of SpondyloArthritis International Society (ASAS) framework to draft initial recommendations and define project goals. A broader expert panel (21 rheumatologists, 19 radiologists) then participated in a voting process to refine and validate these recommendations. Final endorsement was sought from the steering committees of the Italian Society of Medical and Interventional Radiology (SIRM) and the Italian Society of Rheumatology (SIR) using a modified Delphi method.

Results: Thirty-one recommendations were validated, organized into eight domains. Domain 1 outlines five overarching principles. Domain 2 comprises recommendations on clinical features, symptoms, and risk factors. Additional domains address MRI technical parameters, including image quality and sequencing (Domain 3), and standardized reporting criteria. For the sacroiliac joints (Domains 4 and 5), five signs of inflammation and six of structural damage are defined. For the spine (Domains 6 and 7), five inflammatory and four structural features are specified. Domain 8 provides guidance on report conclusions. The recommendations were endorsed by SIRM/SIR with 88.5% approval.

Conclusion: This consensus offers structured guidance for MRI requesting and reporting in axSpA, fostering clear communication between radiologists and rheumatologists. The standardized approach aims to improve diagnostic accuracy and patient outcomes.

Purpose: To examine how reading grade levels affect stakeholder preferences based on a trade-off between accuracy and readability.

Material and methods: A retrospective study of 500 radiology reports from academic and community hospitals across five imaging modalities was conducted. Reports were transformed into 11 reading grade levels (7-17) using Gemini. Accuracy, readability, and preference were rated on a 5-point scale by radiologists, physicians, and laypersons. Errors (generalizations, omissions, hallucinations) and potential changes in patient management (PCPM) were identified. Ordinal logistic regression analyzed preference predictors, and weighted kappa measured interobserver reliability.

Results: Preferences varied across reading grade levels depending on stakeholder group, modality, and clinical setting. Overall, preferences peaked at grade 16, but declined at grade 17, particularly among laypersons. Lower reading grades improved readability but increased errors, while higher grades improved accuracy but reduced readability. In multivariable analysis, accuracy was the strongest predictor of preference for all groups (OR: 30.29, 33.05, and 2.16; p <0 .001), followed by readability (OR: 2.73, 1.70, 2.01; p <0.001).

Conclusion: Higher-grade levels were generally preferred due to better accuracy, with a range of 12-17. Further increasing grade levels reduced readability sharply, limiting preference. These findings highlight the limitations of unsupervised LLM transformations and suggest the need for hybrid approaches that maintain original reports while incorporating explanatory content to balance accuracy and readability.

Purpose: To evaluate the effectiveness of IL-17 and IL-23 inhibitors in psoriatic nail and enthesis involvement by ultrasonography with the use of high-frequency probes (HFUS). To correlate the obtained HFUS findings with disease activity of patients with psoriatic arthritis (PsA).

Material and methods: Consecutive early naïve patients with PsA underwent HFUS on nails and entheses before and after 24 weeks of treatment with IL-17 or IL-23 inhibitor. The Brown University Nail Enthesis Scale (BUNES), considering morphometry and Power Doppler (PD), and the Madrid Sonography Enthesitis Index (MASEI) score were used to evaluate these features. HFUS findings were correlated with the extension of the disease on skin by Psoriasis Area and Severity Index (PASI) and joints by Disease Activity Index for Psoriatic Arthritis (DAPSA).

Results: Twenty early naïve patients with PsA were treated for 24 weeks with an IL-17 or IL-23 inhibitor. A significant reduction of BUNES PD was observed considering the whole cohort of patients receiving these drugs (p = 0.044), whereas, despite a trend, no significant difference was reported comparing BUNES morphometry. The BUNES PD correlated with PASI (r = 0.466, p = 0.030) and with DAPSA (r = 0.444, p = 0.032), whereas BUNES morphometry did not. A significant reduction of MASEI was observed considering the whole assessed cohort of patients treated with these drugs (p = 0.045). The MASEI correlated with both PASI (r = 0.429, p = 0.037) and DAPSA (r = 0.499, p = 0.017).

Conclusions: This proof-of-concept study demonstrated that the assessment by HFUS may provide additional accurate information about the effectiveness of IL-17 and IL-23 inhibitors in psoriatic nail and enthesis involvement.