Radiologia Medica最新文献

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.

Background: Transarterial chemoembolization (TACE) is an effective treatment for patients with unresectable intrahepatic cholangiocarcinoma (iCCA), but tumor heterogeneity affects the efficacy of treatment. This study aimed to construct a Clinical-Radiomics (CR) model for predicting tumor response after the first TACE in patients with unresectable iCCA.

Methods: A total of 107 unresectable iCCA patients who received TACE as the first treatment with available contrast-enhanced MRI (CEMRI) were retrospectively enrolled. Patients were randomly assigned to the training (N = 75) and validation cohorts (N = 32) in a 7:3 ratio. Radiomics features were extracted from CEMRI (arterial, portal venous, and delayed phases) for tumor, peritumor 5 mm, and peritumor 10 mm, respectively, and then the features were selected by random forest before constructing the radiomics model. Radiomics model score and clinical variables were analyzed using univariate and multivariate logistic regression to construct the CR model. Kaplan-Meier method was utilized to assess OS.

Results: The radiomics model constructed based on the tumor plus peritumor 10 mm demonstrated the best performance. The CR model developed by combining with CA19.9 showed excellent performance in both the training (AUC = 0.941) and the validation cohorts (AUC = 0.903). Dividing groups based on the model predicted tumor responses, the Kaplan-Meier curves demonstrated a significant difference in OS between the two groups (P < 0.011). The main limitations of this study include the use of a single-center cohort, which lacks external validation, and the inherent characteristics of a retrospective design, leading to an unavoidable selection bias.

Conclusion: The model in this study demonstrated excellent performance in predicting tumor response after first TACE in patients with unresectable iCCA. The model could support clinicians to make more scientific guidance on the treatment of patients.

Aims: We search the literature on data regarding the role of whole-brain radiation therapy on neurocognitive functions, hearing, and alopecia, through the use of hippocampal-, scalp-, and cochlea-sparing radiotherapy (RT).

Methods: Prospective and retrospective studies with at least five patients were included in this analysis, following PRISMA recommendations.

Results: Eighteen works were selected for hippocampal sparing, published between 2015 and 2025 with 1736 patients. Neurocognitive functions were evaluated with a heterogeneous range of tests (mainly HVLT-R, TMT-A and TMT-B, Cowa test, and MME). For scalp-sparing RT, only three papers were selected, published between 2014 and 2015, for a total of 65 patients. There was an important heterogeneity in terms of scalp definitions, CTV prescriptions, used techniques and doses, and methods and scales adopted to evaluate the clinical efficacy of scalp-sparing RT. Regarding cochlea-sparing RT, no citation was selected. A meta-analysis could only be performed for the papers focusing on hippocampal-sparing procedures. Only nine papers meet the criteria, showing a high heterogeneity (chi-square = 229.96, df 8, p < 0.001, with the I2 index (96.52%) and the H2M index (27.75)). For this reason, we opted for random effect models DerSimonian Laird, maximum likelihood, and profile likelihood, which provided widely overlapping results. Although the data show an average protective effect of hippocampal avoidance on cognitive performance, the meta-analysis, based on the available studies, is unable to demonstrate its significance.

Conclusions: A high heterogeneity in terms of hippocampal-, cochlear-, and scalp-sparing RT was registered as well as different and difficult to compare data. Our findings indicate the need for further studies to explore this issue.

Objective: To explore the prognostic value of body compositions and radiomics in patients with resectable colon cancer, and to develop and validate a clinical-radiomics model for predicting the postoperative overall survival of patients with resectable colon cancer.

Methods: This study included 296 patients (43 months of median follow-up) with resectable colon cancer. Non-contrast CT images were used to quantify the body composition at the level of the third lumbar vertebra. Radiomics features were extracted from portal venous-phase CT scans. The recursive feature elimination and the least absolute shrinkage and selection operator regression were used for feature selection and construction of radiomic signatures. Univariate and multivariate Cox regression analysis were used to identify body composition. Combined with radiomics features, clinical-radiomics prediction model was constructed and plotted by nomogram, with performance metrics including the area under the receiver operating characteristic curve, calibration curves, decision curve analysis, and integrated discrimination improvement index.

Result: Low skeletal muscle density (HR = 0.398, 95%CI = 0.168-0.939, P = 0.035) and low visceral fat area (HR = 0.238, 95%CI = 0.108-0.524, P < 0.001) were significantly associated with poor OS. The integrated clinical-radiomics model achieved C-index of 0.802 and 0.786 in the training and test cohorts, with superior 3-year OS AUC values of 0.804 and 0.828. Furthermore, clinical-radiomics model has a significant improvement in performance compared with radiomics model (IDI: 23.2%, P < 0.001) and clinical model (IDI:5.2%, P = 0.008).

Conclusion: Nomogram combining body composition and tumor radiomics features can help predict the long-term prognosis of patients with resectable colon cancer and may serve as an effective tool to promote individualized treatment.

Purpose: This exploratory analysis aims to assess the clinical feasibility of transitioning breast cancer (BC) survivors from intensive follow-up to a long-term surveillance strategy based on double-reading mammography within a population-based screening model.

Material and methods: Women who underwent BC surgery in 2013 and were followed for 10 years at a tertiary cancer center in Italy were retrospectively included. Recurrence rates and time to relapse were analyzed using the Kruskal-Wallis test and Chi-square test. Available follow-up mammograms were independently reviewed by three experienced radiologists, blinded to clinical information, using a positive/negative binary scale. Pathology served as the reference standard. Sensitivity, positive predictive value (PPV), and inter-reader agreement (Cohen's and Fleiss' κ) were calculated. Simulated double reading was analyzed using McNemar's test. A p value < 0.05 was considered statistically significant.

Results: Among 505 women, 46 (9.1%) experienced BC recurrence: 19/271 (7.0%) in Luminal A, 6/84 (7.1%) in Luminal B, 3/28 (10.7%) in triple-negative (TN), 7/57 (12.3%) in HER2-positive (HER2 +) cancers, and 11/65 (16.9%) in ductal carcinoma in situ (DCIS), which showed the highest recurrence rate (p = 0.0024). Median time to relapse ranged from 4.7 years (TN) to 8.1 years (Luminal A), with no statistically significant difference among the subtypes (p = 0.190). Individual reader sensitivity ranged from 67.7 to 74.2%, increasing to 77.4-83.9% with double reading. PPVs ranged from 95.4 to 100% for single reading and from 96.0% to 96.2% for double reading. Differences in sensitivity and PPV between single and double reading were not statistically significant (p = 1.0). Five recurrences (16.1%) were mammographically occult and clinically detected. Inter-reader agreement was moderate to good (Cohen's κ = 0.38-0.69; Fleiss' κ = 0.57).

Conclusions: Double-reading mammography showed a higher detection rate of BC recurrences compared to single reading in this exploratory setting, suggesting its potential role as a long-term surveillance strategy for BC survivors. However, the occurrence of relapses outside the mammographic field of view warrants careful consideration.

Purpose: Serous cystadenomas (SCAs), solid pseudopapillary neoplasms (SPNs), neuroendocrine neoplasms (NENs), and mucinous cystic neoplasms (MCNs) are pancreatic tumors that frequently develop calcifications. Identifying the presence and pattern of calcifications on unenhanced CT scans can significantly aid radiologists in differential diagnosis.

Methods: Patients were included if they had a confirmed diagnosis through pathology or endoscopic ultrasound and MRI follow-up for at least one year. Exclusion criteria were the absence of CT imaging and multiple pancreatic lesions. Two radiologists independently reviewed unenhanced CT scans to assess lesion location, size, presence of calcifications, and calcification patterns, categorized as Type 1 (punctate), Type 2 (curvilinear/elongated), and Type 3 (coarse). Statistical analysis was performed using Fisher's test for categorical variables, Kruskal-Wallis and Mann-Whitney tests for numerical variables, and logistic regression models to assess the impact of calcification patterns on diagnosis. Sensitivity, specificity, accuracy, and AUC-ROC were calculated for predictive models.

Results: 311 patients (mean age 61 ± 14 years; 56.9% female) were included. Calcifications were present in 27.7% of cases. Calcified NENs and SPNs were more frequently in the body/tail (p = 0.003), and calcified NENs were larger than non-calcified ones (p < 0.001). Punctate calcifications were most common in NENs, while coarse calcifications predominated in SCAs, decreasing the likelihood of a NEN diagnosis and increasing the probability of SCA. The AUC-ROC values were 0.891 for NENs and 0.986 for SCAs.

Conclusions: Approximately 30% of pancreatic tumors exhibit calcifications. Punctate intratumoral calcifications are more indicative of NENs, whereas coarse calcifications strongly suggest SCAs, influencing the differential diagnosis.

Purpose: Creation and evaluation of a structured report (SR) for lumbar spine magnetic resonance imaging (MRI), with the implementation of a previously clinically validated grading system that differentiates lumbar stenosis based on the location and underlying causes, with particular attention to the often underestimated aspect of spinal epidural lipomatosis (SEL).

Material and methods: This prospective single-center study enrolled all the MRIs of the lumbar spine performed at our institution within one month. A (SR) was created using the RSNA's platform "RadReport.org" and submitted to radiologists of our center. Both free-text reports and SR were then evaluated by referring clinicians. The radiologists' intra- (after 2 months) and inter-operator agreement on the new grading system in a SR was assessed using Cohen's Kappa index. Subsequently, an evaluation survey was carried out among the 12 radiologists and 16 clinicians in our hospital, using a five-point Likert scale.

Results: In a period of 1 month, a total of 150 structured reports were generated (86 women, average age 58 ± 22 years). An almost perfect intra-operator (Kc = 0.955) and inter-operator (Kc = 0.838) agreement was detected. The survey showed almost complete satisfaction (89%) and perception of ease of use (83%) of the SR. The new grading system was preferred over the previous ones by 96% of clinicians and 81% of radiologists.

Conclusion: An MRI SR of the lumbar spine could be a valid and appreciated tool to improve communication between specialists, allowing a better multidisciplinary evaluation.

Various imaging modalities play key roles throughout the different stages of prostate cancer. Each imaging modality has different strengths and weaknesses and various scoring systems or frameworks are used to interpret their findings. Discordances between imaging modalities or interpretation frameworks, and even with clinicopathological findings are not uncommon. Discordances often lead to challenges in the decision-making process, especially with dynamically changing indications for newer imaging modalities. While more research is needed on harmonizing interpretations across different modalities, multidisciplinary team discussion is key to optimizing management of patients with prostate cancer when such discordances are present. In this comprehensive review, we take a deep dive in to these various discordances seen in clinical practice and explore their clinical implications.

Purpose: This study aimed to develop and validate a prognostic model for hepatocellular carcinoma (HCC) patients undergoing liver resection, using the functional liver imaging score (FLIS) derived from hepatobiliary-specific contrast-enhanced magnetic resonance imaging (MRI).

Material and methods: A total of 694 pathologically confirmed HCC patients who underwent hepatobiliary-specific MRI with either gadoxetic acid or gadobenate dimeglumine and subsequent liver resection were included. FLIS was calculated by assigning 0-2 points to three hepatobiliary-phase MRI features: hepatic enhancement, biliary excretion, and portal vein signal intensity. Multivariable Cox regression identified AFP level, tumor size, and extent of resection as independent predictors of overall survival (OS).

Results: FLIS ≤ 2, alpha-fetoprotein (AFP) > 400 ng/mL, tumor size > 5 cm, and major resection were identified as independent predictors of worse OS. A predictive model combining these factors demonstrated excellent prognostic performance, with Harrell's concordance indices of 0.91 in the training cohort and 0.96 internal validation cohort, and 0.94 in external validation cohort. The FLIS-based model significantly outperformed FLIS alone and conventional clinical models (p < 0.05). Kaplan-Meier survival analysis showed that low-risk patients had significantly better OS and recurrence-free survival (RFS) compared to high-risk patients across all cohorts (p < 0.05).

Conclusion: FLIS is a simple, non-invasive imaging biomarker for evaluating liver function and predicting outcomes in HCC patients. When integrated with key clinical variables, the FLIS-based model demonstrates excellent discrimination and calibration for OS and RFS, providing accurate postoperative prognostic stratification and showing great potential for guiding surveillance and improving long-term survival outcomes in future clinical applications.

Purpose: This study sought to investigate the presence of residual myocardial hyperemia on the recovery phase in patients undergoing stress CMR.

Material and methods: Fifty patients with clinical indication for stress CMR underwent quantitative perfusion imaging in resting conditions, after regadenoson-induced hyperemia (400 mcg, 5 mL), and 10 min after recovery with euphylline. Studies showing hypoperfusion due to ischemia and/or prior myocardial infarction were excluded. Global myocardial blood flow during rest (MBF_rest), stress (MBF_stress) and recovery (MBF_recovery) and MPR indices (MPR_stress/rest and MPR_{stress/recovery}) were calculated using automated pixel-wise quantitative myocardial perfusion mapping.

Results: A total of 30 patients (22 males, mean age of 62.7 ± 1 years) were included in the analysis. Global MBF_rest and MBF_stress were 0.83 ± 0.2 mL/g/min and 2.1 ± 0.6 mL/g/min, respectively. After recovery with euphylline, myocardial perfusion did not return to the resting values (MBF_recovery of 0.92 ± 0.3 mL/g/min) and statistically differed from MBF_rest (p < 0.01), suggesting residual myocardial hyperemia. This resulted in an abnormally low MPR_{stress/recovery} (2.43 ± 0.7) with respect to MPR_stress/rest (2.56 ± 0.7) (p = 0.03). A linear mixed-effects model accounting for repeated measures revealed statistically significant group differences over time in global MBF (mean difference 0.1, 95% CI 0.02-0.17, p = 0.01) and global MPR (mean difference -0.13, 95% CI -0.25 to -0.02, p = 0.02).

Conclusion: Despite the use of euphylline to counteract the vasodilator effect, MBF does not completely revert to resting values and MBF_recovery cannot be used as a substitute for MBF_rest when regadenoson is used. Consequently, a rest/stress protocol is advised for quantitative CMR perfusion to obtain accurate MBF and MPR parameters.