Radiology最新文献

Arterial embolization is a rapidly growing therapy for joint pain, particularly in cases where conservative measures like nonsteroidal anti-inflammatory drugs and joint injections have failed. This article presents the technical aspects of embolization for knee osteoarthritis, frozen shoulder, and tennis elbow. The guide outlines patient selection criteria, procedural techniques, and postprocedural care. Several trials have produced results with high rates of clinical success and functional improvement. As embolization techniques evolve, procedural standardization will enhance treatment efficacy and minimize adverse events, potentially integrating embolization into broader treatment guidelines for joint pain.

Background Accurate assessment of residual viable hepatocellular carcinoma (HCC) after downstaging therapy is essential for optimizing clinical decision-making in patients with unresectable HCC. Purpose To evaluate the diagnostic performance of contrast-enhanced US (CEUS) in the detection of residual viable tumors in participants with HCC following lenvatinib and anti-programmed cell death protein-1 (PD-1) antibody therapy and to compare it with that of contrast-enhanced MRI (CEMRI). Materials and Methods From March 2024 to March 2025, this prospective study included participants with unresectable HCC who underwent CEUS and CEMRI following lenvatinib and anti-PD-1 antibody therapy, a form of downstaging therapy aimed at converting unresectable HCC to resectable status. Interobserver agreements between CEUS and CEMRI were assessed using the κ coefficient or intraclass correlation coefficients. Diagnostic performance was evaluated using reference standards, including histopathologic findings (38%), 4-8-month follow-up CEMRI (53%), and PET imaging results (9%). A noninferiority design was used to compare sensitivity, specificity, and area under the receiver operating characteristic curve (AUC). Results Sixty-seven participants (median age, 56 years [IQR, 50-66 years]; 57 male) with 95 HCC lesions were included. CEUS and CEMRI demonstrated good agreement in the detection of residual viable tumors (reader 1, κ = 0.78 [95% CI: 0.62, 0.90]; reader 2, κ = 0.73 [95% CI: 0.57, 0.87]). CEUS sensitivity and AUC were noninferior to those of CEMRI (P < .001 and P = .02, respectively), with differences of 5% (95% CI: -2, 12) and 0.01 (95% CI: -0.07, 0.09), respectively. Specificity decreased by 3% (95% CI: -18, 12) and failed noninferiority (P = .24). Subgroup analysis based on pathologic findings (21 viable and 15 nonviable tumors) showed that CEUS had similar sensitivity (difference, 9% [95% CI: 0, 24]; P = .24), specificity (difference, -7% [95% CI: -31, 17]; P = .75), and AUC (difference, 0.01 [95% CI: -0.13, 0.16]; P = .91) compared with that of CEMRI. Conclusion This preliminary study demonstrated that CEUS (consensus interpretation) achieved sensitivity and AUC noninferior to CEMRI (one reader) in the detection of residual viable HCC following lenvatinib and anti-PD-1 antibody therapy. Chinese Clinical Trial Registry no. ChiCTR2400094263 © RSNA, 2025 Supplemental material is available for this article.

Background Accurate recognition of nonmass lesions (NMLs) at breast US is essential for ensuring consistent diagnostic performance. Purpose To assess agreement in classifying lesions as masses or NMLs at US and to identify features that support confidence in NML identification. Materials and Methods This retrospective single-center study included patients who underwent US-guided biopsy of lesions from January to June 2021. Four breast radiologists participated in the study to assess interreader agreement in classifying lesions as either masses or NMLs. An additional radiologist reclassified NMLs that had conflicting interpretations, categorizing them as either definite NMLs or controversial NMLs. Features associated with definite NML judgments were evaluated by means of logistic regression analysis. Results Among 1067 lesions in 912 women (mean age, 53.4 years ± 12.1 [SD]), 11% (121 lesions) were classified as definite NMLs and 7% (80 lesions) as controversial NMLs. The agreement was moderate to substantial (κ = 0.534-0.638), with a concordance rate of 84%-91%. The odds of being classified as a definite NML were low for lesions smaller than 1 cm or subtle architectural distortion (odds ratio [OR], 0.269 [95% CI: 0.112, 0.647]; P = .003) and high for cases with echogenic foci associated with calcifications at mammography (OR, 2.679 [95% CI: 1.130, 6.354]; P = .03) and microcysts (OR, 3.578 [95% CI: 1.236, 10.360]; P = .02). The presence of corresponding findings at mammography (P = .27) or MRI (P > .99) was comparable between the definite and controversial NML groups. Conclusion Interreader agreement for classifying lesions at US as masses or NMLs was moderate to substantial, with high concordances rates. Smaller lesions or subtle architectural distortions were less likely to be consistently classified as NMLs, whereas lesions with echogenic foci associated with calcifications at mammography and microcysts were more likely to be consistently classified as NMLs. © RSNA, 2025 See also the editorial by Hooley in this issue.