Radiology最新文献

Background Vertebrobasilar dissecting aneurysms (VBDAs) are important causes of stroke. Aneurysm wall enhancement at vessel wall (VW) MRI is a marker of inflammation. Previous studies have shown that statins may reduce inflammation in intracranial saccular aneurysms, but their effect on VBDAs remains unknown. Purpose To evaluate the effect of 6-month atorvastatin treatment on VBDA wall enhancement on VW MRI scans. Materials and Methods Participants with unruptured VBDAs were enrolled in this open-label, randomized controlled trial from July 2021 to January 2023 and randomized 1:1 to the daily 20 mg atorvastatin group or control group. VBDAs were imaged with VW MRI at baseline and at the 6-month follow-up. The primary end point was the change in aneurysm wall enhancement measured by the quantitative wall enhancement index (WEI) and three-dimensional wall enhancement volume rate (WEVR). The secondary outcomes were changes in aneurysm size or morphology and inflammation-related circulating biomarkers. All outcome analyses were performed using appropriate tests for categorical and continuous variables. Results A total of 40 participants were included (mean age, 52 years ± 11 [SD]; 34 men). In the statin group, both the WEI and WEVR of the aneurysm wall decreased at 6 months compared with those at baseline. The change in WEI was -0.3 in the statin group but 0.1 in the control group (P < .001). Similarly, the change in WEVR was -15.1% in the statin group but 5.3% in the control group (P < .001). Additionally, the circulating plasma levels of C-reactive protein, tumor necrosis factor α, interleukin-6, and interleukin-1β improved in the atorvastatin group compared with the control group (all P < .05). The atorvastatin group also showed slowed progression of intramural hematoma (304.0 mm³ vs 100.3 mm³; P = .006). No change in aneurysm size was detected in both groups. Conclusion Atorvastatin use decreased VBDA wall enhancement on VW MRI scans compared with the control group. ClinicalTrials.gov Identifier: NCT04943783 © RSNA, 2025 Supplemental material is available for this article. See also the editorial by Mohajer and Chernyak in this issue.

Prostate-specific membrane antigen (PSMA) PET is a powerful tool for prostate cancer staging and restaging, providing higher sensitivity and specificity than conventional imaging. The recognition of interpretive pitfalls led to the development of various scoring systems and frameworks, which in turn created challenges for consistent interpretation. The Prostate Cancer Molecular Imaging Standardized Evaluation (PROMISE) version 2 classification integrates the five-point PRIMARY score for assessing local disease, the molecular imaging TNM stage for disease extent, and the PSMA expression score to assess eligibility for PSMA-targeted radioligand therapy. The PSMA Reporting and Data System (PSMA-RADS) classifies PSMA PET/CT findings on the basis of the likelihood of presence of prostate cancer. For assessing therapy response, PSMA PET Progression (PPP) criteria focus on new lesions and clinical or biochemical progression, whereas Response Evaluation Criteria in PSMA PET/CT (RECIP 1.0) assess new lesions and changes in total PSMA-positive total tumor volume. The European Association of Nuclear Medicine (EANM) E-PSMA guideline and EANM-Society of Nuclear Medicine and Molecular Imaging procedure guidelines provide standardized reporting recommendations, incorporating elements from existing systems such as PROMISE, PSMA-RADS, and PPP. Nevertheless, such systems can be essential for optimizing prostate cancer management and facilitating communication among imaging professionals, clinicians, and patients. This article outlines these systems and discusses potential strengths and weaknesses.

Background Pulmonary function tests (PFTs) are the clinical standard for diagnosing chronic obstructive pulmonary disease (COPD) but face limitations in accessibility and complexity. Dynamic chest radiography (DCR) is an emerging technique that enables dynamic pulmonary function assessment with low radiation exposure, suggesting potential as an alternative to PFTs. However, its diagnostic validity remains unproven. Purpose To determine whether DCR is an efficacious alternative approach to PFTs for COPD screening. Materials and Methods This prospective single-center observational study enrolled participants with or without COPD from November 2022 to July 2024. Correlations between DCR parameters and PFT indexes were assessed using Pearson correlation. Receiver operating characteristic analysis was used to evaluate diagnostic performance. The least absolute shrinkage and selection operator (LASSO) and multivariable logistic regression were used to select features and build and train predictive models, which were tested on an internal test set. A nomogram was used to visualize COPD probability, calibrated using the Hosmer-Lemeshow test. Results This study included 553 participants (median age, 60 years [IQR, 53-67 years]; 355 men; 198 women; 191 with COPD, 362 controls). DCR parameters were positively correlated with PFT indexes in participants with COPD: The combined bilateral (right and left lungs) rate of change in projected lung area (ΔPLA) during deep breathing was correlated with forced expiratory volume in 1 second (FEV₁) percent predicted (r = 0.650; P < .001) and the ratio of FEV₁ to forced vital capacity (r = 0.638; P < .001). The diagnostic performance of bilateral ΔPLA during deep breathing was high in the internal test set (area under the receiver operating characteristic curve [AUC], 0.78 [95% CI: 0.72, 0.85]). Three DCR features were selected to construct the DCR model, which performed well in the internal test set (AUC, 0.82 [95% CI: 0.75, 0.89]). The combined model incorporating a DCR parameter and smoking status demonstrated high diagnostic performance (internal test set: AUC, 0.85 [95% CI: 0.78, 0.92]). Conclusion A DCR-based nomogram demonstrated robust diagnostic performance in identifying COPD, suggesting that DCR represents an efficacious alternative approach to standard PFTs for COPD screening. ClinicalTrials.gov Identifier: NCT06653413 © The Author(s) 2025. Published by the Radiological Society of North America under a CC BY 4.0 license. Supplemental material is available for this article. See also the editorial by Hatabu et al in this issue.

Background The clinical benefit of endovascular thrombectomy (EVT) for acute basilar artery occlusion (BAO) in patients with mild symptoms remains controversial. Purpose To evaluate the efficacy and safety of EVT versus intravenous thrombolysis (IVT) in patients with BAO with National Institutes of Health Stroke Scale (NIHSS) scores of 0-9 or 0-5. Materials and Methods In a multicenter retrospective study between January 2018 and January 2024, outcomes in patients with BAO with NIHSS scores of 0-9 or 0-5 who underwent EVT or IVT were compared using inverse probability weighting (IPW) methods. In a meta-analysis, studies (published until April 1, 2025) comparing EVT and medical management (ie, control treatment) in BAO were identified. Results The retrospective study included 200 patients (median age, 69 years [IQR, 60-76 years]; 137 men), and the meta-analysis included six studies encompassing 3014 patients. Among patients with NIHSS scores of 0-9, after IPW, EVT was associated with a higher likelihood of excellent functional outcome (modified Rankin Scale [mRS] score of 0-1) compared with IVT (adjusted odds ratio [OR], 2.02 [95% CI: 1.05, 3.86]; P = .04). In contrast, among patients with NIHSS scores of 0-5 (n = 52), EVT was associated with a lower likelihood of independent ambulation (mRS score of 0-3) than IVT (adjusted OR, 0.19 [95% CI: 0.05, 0.80]; P = .02). Meta-analysis indicated that in patients with NIHSS scores of 0-9, EVT was associated with a higher likelihood of excellent functional outcome compared with control treatment (adjusted OR, 2.15 [95% CI: 1.60, 2.91]; P < .001). However, among patients with NIHSS scores of 0-5, EVT was associated with a reduced likelihood of independent ambulation compared with control treatment (adjusted OR, 0.23 [95% CI: 0.09, 0.59]; P = .002). Conclusion Compared with IVT, EVT was associated with a higher likelihood of excellent functional outcome in patients with BAO with NIHSS scores of 0-9 but a lower likelihood of independent ambulation in patients with NIHSS scores of 0-5. © RSNA, 2025 Supplemental material is available for this article. See also the editorial by Kallmes and Rabinstein in this issue.

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.