{"title":"Correction to epidemiological studies of CT scans and cancer risk: the state of the science.","authors":"","doi":"10.1259/bjr.20210471.c","DOIUrl":"https://doi.org/10.1259/bjr.20210471.c","url":null,"abstract":"","PeriodicalId":226783,"journal":{"name":"The British journal of radiology","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129074485","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Lu Zhang, Zhihan Xu, B. Jiang, Yaping Zhang, Lingyun Wang, Geertruida H deBock, R. Vliegenthart, Xueqian Xie
OBJECTIVES The purpose is to establish and validate a machine-learning-derived radiomics approach to determine the existence of atrial fibrillation (AF) by analyzing epicardial adipose tissue (EAT) in CT images. METHODS Patients with AF based on electrocardiographic tracing who underwent contrast-enhanced (n = 200) or non-enhanced (n = 300) chest CT scans were analyzed retrospectively. After EAT segmentation and radiomics feature extraction, the segmented EAT yielded 1,691 radiomics features. The most contributive features to AF were selected by the Boruta algorithm and machine-learning-based random forest algorithm, and combined to construct a radiomics signature (EAT-score). Multivariate logistic regression was used to build clinical factor and nested models. RESULTS In the test cohort of contrast-enhanced scanning (n = 60/200), the AUC of EAT-score for identifying patients with AF was 0.92 (95%CI:0.84-1.00), higher than 0.71 (0.58-0.85) of the clinical factor model (total cholesterol and body mass index) (DeLong's p = 0.01), and higher than 0.73 (0.61-0.86) of the EAT volume model (p = 0.01). In the test cohort of non-enhanced scanning (n = 100/300), the AUC of EAT-score was 0.85 (0.77-0.92), higher than that of the CT attenuation model (p < 0.001). The two nested models (EAT-score +volume and EAT-score +volume+clinical factors) for contrast-enhanced scan and one (EAT-score +CT attenuation) for non-enhanced scan showed similar AUCs with that of EAT-score (all p > 0.05). CONCLUSION EAT-score generated by machine-learning-based radiomics achieved high performance in identifying patients with AF. ADVANCES IN KNOWLEDGE A radiomics analysis based on machine learning allows for the identification of AF on the EAT in contrast-enhanced and non-enhanced chest CT.
{"title":"Machine-learning-based radiomics identifies atrial fibrillation on the epicardial fat in contrast-enhanced and non-enhanced chest CT.","authors":"Lu Zhang, Zhihan Xu, B. Jiang, Yaping Zhang, Lingyun Wang, Geertruida H deBock, R. Vliegenthart, Xueqian Xie","doi":"10.1259/bjr.20211274","DOIUrl":"https://doi.org/10.1259/bjr.20211274","url":null,"abstract":"OBJECTIVES\u0000The purpose is to establish and validate a machine-learning-derived radiomics approach to determine the existence of atrial fibrillation (AF) by analyzing epicardial adipose tissue (EAT) in CT images.\u0000\u0000\u0000METHODS\u0000Patients with AF based on electrocardiographic tracing who underwent contrast-enhanced (n = 200) or non-enhanced (n = 300) chest CT scans were analyzed retrospectively. After EAT segmentation and radiomics feature extraction, the segmented EAT yielded 1,691 radiomics features. The most contributive features to AF were selected by the Boruta algorithm and machine-learning-based random forest algorithm, and combined to construct a radiomics signature (EAT-score). Multivariate logistic regression was used to build clinical factor and nested models.\u0000\u0000\u0000RESULTS\u0000In the test cohort of contrast-enhanced scanning (n = 60/200), the AUC of EAT-score for identifying patients with AF was 0.92 (95%CI:0.84-1.00), higher than 0.71 (0.58-0.85) of the clinical factor model (total cholesterol and body mass index) (DeLong's p = 0.01), and higher than 0.73 (0.61-0.86) of the EAT volume model (p = 0.01). In the test cohort of non-enhanced scanning (n = 100/300), the AUC of EAT-score was 0.85 (0.77-0.92), higher than that of the CT attenuation model (p < 0.001). The two nested models (EAT-score +volume and EAT-score +volume+clinical factors) for contrast-enhanced scan and one (EAT-score +CT attenuation) for non-enhanced scan showed similar AUCs with that of EAT-score (all p > 0.05).\u0000\u0000\u0000CONCLUSION\u0000EAT-score generated by machine-learning-based radiomics achieved high performance in identifying patients with AF.\u0000\u0000\u0000ADVANCES IN KNOWLEDGE\u0000A radiomics analysis based on machine learning allows for the identification of AF on the EAT in contrast-enhanced and non-enhanced chest CT.","PeriodicalId":226783,"journal":{"name":"The British journal of radiology","volume":"36 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134300660","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
L. Jungblut, T. Sartoretti, Daniel Kronenberg, V. Mergen, A. Euler, B. Schmidt, H. Alkadhi, T. Frauenfelder, K. Martini
OBJECTIVES To evaluate the performance of virtual non-contrast images (VNC) compared to true non-contrast (TNC) images in photon-counting detector computed tomography (PCD-CT) for the evaluation of lung parenchyma and emphysema quantification. METHODS Sixty-five (mean age 73 years; 48 male) consecutive patients who underwent a three-phase (non-contrast, arterial and venous) chest/abdomen CT on a clinical first-generation, clinical dual-source PCD-CT were retrospectively included. Scans were performed in the multi energy (QuantumPlus) mode at 120kV with 70 ml intravenous contrast agent at an injection rate of 4 ml s-1. VNC were reconstructed from the arterial (VNCart) and venous phase (VNCven). TNC and VNC images of the lung were assessed quantitatively by calculating the global noise index (GNI) and qualitatively by two independent, blinded readers (overall image quality and emphysema assessment). Emphysema quantification was performed using a commercially available software tool at a threshold of -950 HU for all datasets. TNC images served as reference standard for emphysema quantification. Low attenuation values (LAV) were compared in a Bland-Altman plot. RESULTS GNI was similar in VNCart (103.0 ± 30.1) and VNCven (98.2 ± 22.2as compared to TNC (100.9 ± 19.0, p = 0.546 and p = 0.272, respectively). Subjective image quality (emphysema assessment and overall image quality) was highest for TNC (p = 0.001), followed by VNCven and VNCart. Both, VNCart and VNCven showed no significant difference in emphysema quantification as compared to TNC (p = 0.409 vs. p = 0.093; respectively). CONCLUSION Emphysema evaluation is feasible using virtual non-contrast images from PCD-CT. ADVANCES IN KNOWLEDGE Emphysema quantification is feasible and accurate using virtual non-contrast enhanced (VNC) images in Photon-counting detector CT. Based on these findings, additional TNC scans could be omitted in the future for emphysema quantification.
目的评价虚拟无对比图像(VNC)与真实无对比图像(TNC)在光子计数检测器计算机断层扫描(PCD-CT)中对肺实质和肺气肿定量评价的性能。方法65例(平均年龄73岁;回顾性纳入48例连续在临床第一代临床双源PCD-CT上进行三期(非造影剂，动脉和静脉)胸/腹CT的患者。在120kV的多能(QuantumPlus)模式下进行扫描，静脉注射造影剂70 ml，注射速度为4 ml s-1。分别从动脉期(VNCart)和静脉期(VNCven)重建VNC。通过计算全局噪声指数(GNI)对肺TNC和VNC图像进行定量评估，并通过两个独立的盲法阅读器(整体图像质量和肺气肿评估)对其进行定性评估。使用市售软件工具对所有数据集进行气肿定量，阈值为-950 HU。TNC图像作为肺气肿定量的参考标准。在Bland-Altman图中比较低衰减值(LAV)。结果VNCart的gni为103.0±30.1,VNCven的gni为98.2±22.2,TNC的gni为100.9±19.0,p = 0.546, p = 0.272。主观图像质量(肺气肿评估和整体图像质量)TNC最高(p = 0.001)，其次是VNCven和VNCart。与TNC相比，VNCart和VNCven在肺气肿量化方面均无显著差异(p = 0.409 vs。P = 0.093;分别)。结论利用PCD-CT的虚拟非对比图像评价肺气肿是可行的。在光子计数检测器CT上使用虚拟非对比增强(VNC)图像定量肺气肿是可行和准确的。基于这些发现，在未来的肺气肿量化中可以省去额外的TNC扫描。
{"title":"Performance of virtual non-contrast images generated on clinical Photon-Counting detector CT for emphysema quantification: Proof of concept.","authors":"L. Jungblut, T. Sartoretti, Daniel Kronenberg, V. Mergen, A. Euler, B. Schmidt, H. Alkadhi, T. Frauenfelder, K. Martini","doi":"10.1259/bjr.20211367","DOIUrl":"https://doi.org/10.1259/bjr.20211367","url":null,"abstract":"OBJECTIVES\u0000To evaluate the performance of virtual non-contrast images (VNC) compared to true non-contrast (TNC) images in photon-counting detector computed tomography (PCD-CT) for the evaluation of lung parenchyma and emphysema quantification.\u0000\u0000\u0000METHODS\u0000Sixty-five (mean age 73 years; 48 male) consecutive patients who underwent a three-phase (non-contrast, arterial and venous) chest/abdomen CT on a clinical first-generation, clinical dual-source PCD-CT were retrospectively included. Scans were performed in the multi energy (QuantumPlus) mode at 120kV with 70 ml intravenous contrast agent at an injection rate of 4 ml s-1. VNC were reconstructed from the arterial (VNCart) and venous phase (VNCven). TNC and VNC images of the lung were assessed quantitatively by calculating the global noise index (GNI) and qualitatively by two independent, blinded readers (overall image quality and emphysema assessment). Emphysema quantification was performed using a commercially available software tool at a threshold of -950 HU for all datasets. TNC images served as reference standard for emphysema quantification. Low attenuation values (LAV) were compared in a Bland-Altman plot.\u0000\u0000\u0000RESULTS\u0000GNI was similar in VNCart (103.0 ± 30.1) and VNCven (98.2 ± 22.2as compared to TNC (100.9 ± 19.0, p = 0.546 and p = 0.272, respectively). Subjective image quality (emphysema assessment and overall image quality) was highest for TNC (p = 0.001), followed by VNCven and VNCart. Both, VNCart and VNCven showed no significant difference in emphysema quantification as compared to TNC (p = 0.409 vs. p = 0.093; respectively).\u0000\u0000\u0000CONCLUSION\u0000Emphysema evaluation is feasible using virtual non-contrast images from PCD-CT.\u0000\u0000\u0000ADVANCES IN KNOWLEDGE\u0000Emphysema quantification is feasible and accurate using virtual non-contrast enhanced (VNC) images in Photon-counting detector CT. Based on these findings, additional TNC scans could be omitted in the future for emphysema quantification.","PeriodicalId":226783,"journal":{"name":"The British journal of radiology","volume":"25 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125953342","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A. Plumb, G. Rajeswaran, M. Abbasi, M. Abbasi, L. Masci, O. Warren, Jonathan Wilson
Inguinal hernias are the commonest type of hernia, and are frequently encountered by general, abdominal and musculoskeletal radiologists. Such hernias may cause discomfort or pain; but many other conditions may cause pain in a similar location, meaning it is not always straightforward to determine the underlying cause of a particular patient's symptoms. Although surgical fixation of hernia has high success rates with low recurrence, ongoing symptoms are common after apparently uncomplicated surgery. In particular, post-surgical chronic groin pain can be highly problematic in some patients. In this review, we highlight the relevant surgical and imaging anatomy, common modes of clinical presentation, contemporary surgical approaches to the repair of inguinal hernia, imaging techniques to diagnose such hernias in both unoperated and operated groins and mimics of hernia-related pain.
{"title":"Contemporary imaging of inguinal hernia and pain.","authors":"A. Plumb, G. Rajeswaran, M. Abbasi, M. Abbasi, L. Masci, O. Warren, Jonathan Wilson","doi":"10.1259/bjr.20220163","DOIUrl":"https://doi.org/10.1259/bjr.20220163","url":null,"abstract":"Inguinal hernias are the commonest type of hernia, and are frequently encountered by general, abdominal and musculoskeletal radiologists. Such hernias may cause discomfort or pain; but many other conditions may cause pain in a similar location, meaning it is not always straightforward to determine the underlying cause of a particular patient's symptoms. Although surgical fixation of hernia has high success rates with low recurrence, ongoing symptoms are common after apparently uncomplicated surgery. In particular, post-surgical chronic groin pain can be highly problematic in some patients. In this review, we highlight the relevant surgical and imaging anatomy, common modes of clinical presentation, contemporary surgical approaches to the repair of inguinal hernia, imaging techniques to diagnose such hernias in both unoperated and operated groins and mimics of hernia-related pain.","PeriodicalId":226783,"journal":{"name":"The British journal of radiology","volume":"11 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114155398","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
OBJECTIVE To analyse the frequency, demographics, primary disease, and cumulative effective dose of patients undergoing two or more 18F-FDGPET/CT examinations in a year. METHODS In a retrospective study performed at a tertiary care hospital, patients who underwent ≥2 18F-FDGPET/CT scans in a calendar year were identified for two consecutive years. The CT radiation dose was calculated using dose-length-product and sex-specific conversion factors. The primary malignancy of patients was retrieved from electronic medical records. RESULTS 10,714 18F-FDG PET/CT exams were performed for 6,831 unique patients in 2 years, yielding an average of 1.6 exams per patient. The maximum number of 18F-FDG PET/CT examinations any patient underwent in a single year was seven. 20.9% patients had ≥2 18F-FDG PET/CT exams in any single year. Thirty nine percent patients in the cohort were below 60 years age. The median dose for 18F-FDG PET/CT examination was 25.1 mSv and maximum value reaching 1.7 to 2.9 times the median value. Cumulative effective dose (CED) was ≥100 mSv in 12-13% of the patients. The cumulative dose for both years combined demonstrated the 25th percentile, 50th percentile and 75th percentile as well as the mean to be over 100 mSv, with the 25th percentile being 109 mSv. The dominant primary malignancies contributing to serial 18F-FDG PET/CTs in decreasing frequency were melanoma, non-Hodgkin's lymphoma (NHL), gastrointestinal cancer, breast cancer and Hodgkin's lymphoma. CONCLUSIONS A sizeable number of patients undergo ≥2 18F-FDG PET/CT exams with one out of every 8 patients receiving cumulative dose ≥100 mSv and that includes patients with long life expectancy. ADVANCES IN KNOWLEDGE The study found that 1 of 5 patients had ≥2 18F-FDG PET/CT exams in a calendar year, 1 of 4 patients in two years and 1 of 8 patients received cumulative dose ≥100 mSv. Top malignancies associated with serial imaging in decreasing order of frequency included melanoma, non-Hodgkin's lymphoma (NHL), gastrointestinal cancer, breast cancer and Hodgkin's lymphoma.
{"title":"Patients undergoing multiple 18F-FDG PET/CT exams: Assessment of frequency, dose, and disease classification.","authors":"Santoshi Indrakanti, Xinhua Li, M. Rehani","doi":"10.1259/bjr.20211225","DOIUrl":"https://doi.org/10.1259/bjr.20211225","url":null,"abstract":"OBJECTIVE\u0000To analyse the frequency, demographics, primary disease, and cumulative effective dose of patients undergoing two or more 18F-FDGPET/CT examinations in a year.\u0000\u0000\u0000METHODS\u0000In a retrospective study performed at a tertiary care hospital, patients who underwent ≥2 18F-FDGPET/CT scans in a calendar year were identified for two consecutive years. The CT radiation dose was calculated using dose-length-product and sex-specific conversion factors. The primary malignancy of patients was retrieved from electronic medical records.\u0000\u0000\u0000RESULTS\u000010,714 18F-FDG PET/CT exams were performed for 6,831 unique patients in 2 years, yielding an average of 1.6 exams per patient. The maximum number of 18F-FDG PET/CT examinations any patient underwent in a single year was seven. 20.9% patients had ≥2 18F-FDG PET/CT exams in any single year. Thirty nine percent patients in the cohort were below 60 years age. The median dose for 18F-FDG PET/CT examination was 25.1 mSv and maximum value reaching 1.7 to 2.9 times the median value. Cumulative effective dose (CED) was ≥100 mSv in 12-13% of the patients. The cumulative dose for both years combined demonstrated the 25th percentile, 50th percentile and 75th percentile as well as the mean to be over 100 mSv, with the 25th percentile being 109 mSv. The dominant primary malignancies contributing to serial 18F-FDG PET/CTs in decreasing frequency were melanoma, non-Hodgkin's lymphoma (NHL), gastrointestinal cancer, breast cancer and Hodgkin's lymphoma.\u0000\u0000\u0000CONCLUSIONS\u0000A sizeable number of patients undergo ≥2 18F-FDG PET/CT exams with one out of every 8 patients receiving cumulative dose ≥100 mSv and that includes patients with long life expectancy.\u0000\u0000\u0000ADVANCES IN KNOWLEDGE\u0000The study found that 1 of 5 patients had ≥2 18F-FDG PET/CT exams in a calendar year, 1 of 4 patients in two years and 1 of 8 patients received cumulative dose ≥100 mSv. Top malignancies associated with serial imaging in decreasing order of frequency included melanoma, non-Hodgkin's lymphoma (NHL), gastrointestinal cancer, breast cancer and Hodgkin's lymphoma.","PeriodicalId":226783,"journal":{"name":"The British journal of radiology","volume":"7 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121922507","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. Okada, Kenichiro Ihara, Keisuke Miyoshi, Sei Nakano, M. Tanabe, Y. Tokumitsu, Eijiro Harada, Kazuhiko Sakamoto, Hiroaki Nagano, Katsuyoshi Ito
OBJECTIVES Major liver resection is an effective treatment option for patients with liver malignancy. The future liver remnant (FLR) volume and complications after portal vein embolization (PVE) were compared between the ipsilateral right portal vein (PTPE) and trans-ileocolic (TIPE) approaches. METHODS A total of 42 patients (TIPE, n = 22; PTPE, n = 20) underwent right lobectomy after PVE. Computed tomography (CT) and hepatobiliary scintigraphy were repeated before and after PVE. The blood examination findings and the FLR values (FLRCT: calculated from CT, %FLRCT: FLRCT ratio, %FLRSPECT: FLR ratio using single-photon-emission CT, FLRCT/BS: FLRCT to body surface ratio) were compared between two approach sites. The complications and mortality were also analyzed after PVE and major right hepatectomy. RESULTS There were no significant differences in the patient characteristics, blood examination findings or FLR values between two groups. Adequate liver regeneration was observed without significant differences between PTPE and TIPE (increased ratio of FLRCT: 8.7% vs 19.2%, p = 0.15 [25-75 percentile: 17.1-60.4], %FLRCT: 11.2% vs 8.3%, p = 0.25 [6.3-13.3], %FLRSPECT: 15.4% vs 19.2%, p = 0.09 [16.0-22.4], FLRCT/BS: 33.6% vs 47.1%, p = 0.19 [17.2-60.4], respectively), but TIPE required a significantly longer procedure time than PTPE (181.4 min vs 108.7 min, p < 0.01 [103.3-193.5]). However, one patient was converted to TIPE due to bleeding during PTPE. After right lobectomy, portal vein stenosis or thrombosis was noted in 3 patients (two with TIPE [9.1%] and one with PTPE [5%]) and 3 TIPE patients died within 90 days (13.6%) after right hepatectomy. CONCLUSIONS FLR volume significantly increased after PVE, regardless of the approach sites; however, PTPE is a useful technique with a shorter procedure time.
目的:肝大切除是治疗肝恶性肿瘤的有效方法。比较同侧右门静脉栓塞(PTPE)和经回肠结肠栓塞(TIPE)两种入路门静脉栓塞(PVE)后肝脏残留(FLR)体积及并发症。方法共42例患者(TIPE, n = 22;PTPE, n = 20)在PVE后行右肺叶切除术。PVE前后分别行CT和肝胆造影检查。比较两个入路部位的血液检查结果和FLR值(FLRCT:由CT计算，%FLRCT: FLRCT比值，单光子发射CT %FLRCT: FLR比值，FLRCT/BS: FLRCT与体表比值)。分析了PVE和右肝大切除术后的并发症和死亡率。结果两组患者的特征、血液检查结果及FLR值均无显著差异。充分的肝再生在PTPE和TIPE之间没有显著差异(FLRCT的增加比例:8.7% vs 19.2%， p = 0.15[25-75百分位:17.1-60.4]，%FLRCT: 11.2% vs 8.3%， p = 0.25 [6.3-13.3]， %FLRSPECT: 15.4% vs 19.2%， p = 0.09 [16.0-22.4]， FLRCT/BS: 33.6% vs 47.1%， p = 0.19[17.2-60.4])，但TIPE比PTPE需要更长的手术时间(181.4分钟vs 108.7分钟，p < 0.01[103.3-193.5])。然而，有1例患者因PTPE期间出血而转为tpe。右肝切除术后，3例患者出现门静脉狭窄或血栓形成(TIPE 2例[9.1%]，PTPE 1例[5%])，3例TIPE患者在右肝切除术后90天内死亡(13.6%)。结论PVE后sflr体积显著增加，与入路部位无关;然而，PTPE是一种有用的技术，手术时间更短。
{"title":"Portal vein embolization via the ipsilateral percutaneous transhepatic approach versus laparotomic transileocecal approach: Complications, profile and changes in future liver remnant volume.","authors":"M. Okada, Kenichiro Ihara, Keisuke Miyoshi, Sei Nakano, M. Tanabe, Y. Tokumitsu, Eijiro Harada, Kazuhiko Sakamoto, Hiroaki Nagano, Katsuyoshi Ito","doi":"10.1259/bjr.20210854","DOIUrl":"https://doi.org/10.1259/bjr.20210854","url":null,"abstract":"OBJECTIVES\u0000Major liver resection is an effective treatment option for patients with liver malignancy. The future liver remnant (FLR) volume and complications after portal vein embolization (PVE) were compared between the ipsilateral right portal vein (PTPE) and trans-ileocolic (TIPE) approaches.\u0000\u0000\u0000METHODS\u0000A total of 42 patients (TIPE, n = 22; PTPE, n = 20) underwent right lobectomy after PVE. Computed tomography (CT) and hepatobiliary scintigraphy were repeated before and after PVE. The blood examination findings and the FLR values (FLRCT: calculated from CT, %FLRCT: FLRCT ratio, %FLRSPECT: FLR ratio using single-photon-emission CT, FLRCT/BS: FLRCT to body surface ratio) were compared between two approach sites. The complications and mortality were also analyzed after PVE and major right hepatectomy.\u0000\u0000\u0000RESULTS\u0000There were no significant differences in the patient characteristics, blood examination findings or FLR values between two groups. Adequate liver regeneration was observed without significant differences between PTPE and TIPE (increased ratio of FLRCT: 8.7% vs 19.2%, p = 0.15 [25-75 percentile: 17.1-60.4], %FLRCT: 11.2% vs 8.3%, p = 0.25 [6.3-13.3], %FLRSPECT: 15.4% vs 19.2%, p = 0.09 [16.0-22.4], FLRCT/BS: 33.6% vs 47.1%, p = 0.19 [17.2-60.4], respectively), but TIPE required a significantly longer procedure time than PTPE (181.4 min vs 108.7 min, p < 0.01 [103.3-193.5]). However, one patient was converted to TIPE due to bleeding during PTPE. After right lobectomy, portal vein stenosis or thrombosis was noted in 3 patients (two with TIPE [9.1%] and one with PTPE [5%]) and 3 TIPE patients died within 90 days (13.6%) after right hepatectomy.\u0000\u0000\u0000CONCLUSIONS\u0000FLR volume significantly increased after PVE, regardless of the approach sites; however, PTPE is a useful technique with a shorter procedure time.","PeriodicalId":226783,"journal":{"name":"The British journal of radiology","volume":"4 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133945201","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
OBJECTIVE To determine the differential diagnosis of bone lesions causing hip pain in children and the association between radiographic features of aggression and MRI appearances with final diagnosis. METHODS Retrospective review of children with hip pain referred to a specialist musculoskeletal oncology service between September 2018 and December 2020. Patient demographics, lesion location, the radiographic and MRI features, and the final diagnosis, which was made either by image-guided biopsy, surgical curettage or based on typical imaging features were recorded. Statistical analysis examined the association between the Lodwick-Madewell score (determined from available radiographs) and MRI findings with final diagnosis. RESULTS Fifty-nine patients were included, 40 males and 19 females with mean age 10.9 years, (range 3-16 years). Final diagnoses were based on histology in 24 (40.7%) cases and imaging in 35 (59.3%) cases. Eighteen lesions (30.5%) were classed as non-neoplastic, 31 (52.5%) as benign and 10 (16.9%) as malignant, of which four were primary bone sarcomas. There was a significant association between the Lodwick-Madewell score and final diagnosis (p < 0.001). On MRI, bone marrow oedema, presence of a focal lesion, bone expansion and the presence of an extraosseous mass were all significantly associated with final diagnostic classification. CONCLUSION The differential diagnosis of hip pain in children presenting to a bone tumour service is wide. Most cases are due to benign or non-neoplastic conditions, with only 10 out of 59 children having a malignant lesion. Radiography complemented by MRI plays a major role in differentiating non-neoplastic, benign neoplastic and malignant lesions and in determining the requirement for needle biopsy. ADVANCES IN KNOWLEDGE This is the first study to consider how imaging features relate to diagnosis in suspected paediatric hip tumours. Use of this information can help in determining which cases should undergo needle biopsy.
{"title":"Differential diagnosis of hip pain in children referred to a specialist bone tumour service.","authors":"A. Choraria, P. O'Donnell, A. Saifuddin","doi":"10.1259/bjr.20211397","DOIUrl":"https://doi.org/10.1259/bjr.20211397","url":null,"abstract":"OBJECTIVE\u0000To determine the differential diagnosis of bone lesions causing hip pain in children and the association between radiographic features of aggression and MRI appearances with final diagnosis.\u0000\u0000\u0000METHODS\u0000Retrospective review of children with hip pain referred to a specialist musculoskeletal oncology service between September 2018 and December 2020. Patient demographics, lesion location, the radiographic and MRI features, and the final diagnosis, which was made either by image-guided biopsy, surgical curettage or based on typical imaging features were recorded. Statistical analysis examined the association between the Lodwick-Madewell score (determined from available radiographs) and MRI findings with final diagnosis.\u0000\u0000\u0000RESULTS\u0000Fifty-nine patients were included, 40 males and 19 females with mean age 10.9 years, (range 3-16 years). Final diagnoses were based on histology in 24 (40.7%) cases and imaging in 35 (59.3%) cases. Eighteen lesions (30.5%) were classed as non-neoplastic, 31 (52.5%) as benign and 10 (16.9%) as malignant, of which four were primary bone sarcomas. There was a significant association between the Lodwick-Madewell score and final diagnosis (p < 0.001). On MRI, bone marrow oedema, presence of a focal lesion, bone expansion and the presence of an extraosseous mass were all significantly associated with final diagnostic classification.\u0000\u0000\u0000CONCLUSION\u0000The differential diagnosis of hip pain in children presenting to a bone tumour service is wide. Most cases are due to benign or non-neoplastic conditions, with only 10 out of 59 children having a malignant lesion. Radiography complemented by MRI plays a major role in differentiating non-neoplastic, benign neoplastic and malignant lesions and in determining the requirement for needle biopsy.\u0000\u0000\u0000ADVANCES IN KNOWLEDGE\u0000This is the first study to consider how imaging features relate to diagnosis in suspected paediatric hip tumours. Use of this information can help in determining which cases should undergo needle biopsy.","PeriodicalId":226783,"journal":{"name":"The British journal of radiology","volume":"6 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133921949","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
V. Pulappadi, S. Paul, S. Hari, E. Dhamija, S. Manchanda, K. Kataria, S. Mathur, K. Mani, A. Gogia, S. Deo
OBJECTIVE To evaluate the role of shear wave elastography (SWE) of suspicious axillary lymph nodes and its combination with B-mode USG in predicting nodal metastasis in breast cancer patients. METHODS Prospective observational study was performed from June 2018-August 2020 on breast cancer patients with suspicious axillary nodes on USG. B-mode features (cortical thickness, effacement of fatty hilum, non-hilar blood flow and round shape) and SWE parameters (Emax, Emin, Emean and ESD) of the node with the thickest cortex were evaluated. Diagnostic performances of USG, SWE and their combination were estimated using pathological status of the node on biopsy as the gold standard. RESULTS Of the 54 patients evaluated, optimal elasticity maps were obtained in 49 nodes of 49 patients (mean age, 46.3 ± 12.1 years; 48/49 (98%) females). On biopsy, 38 nodes (77.6%) had metastasis, while 11 (22.4%) had reactive hyperplasia. Emax, Emin, Emean and ESD of both cortex and hilum were significantly higher in metastatic than reactive nodes. Emax (cortex) ≥14.9 kPa had the best diagnostic performance (sensitivity, 73.7%; specificity, 81.8%). Cortical thickness ≥6.7 mm had the best diagnostic performance among B-mode features (sensitivity, 89.5%; specificity, 72.7%). Combining cortical thickness with effacement of fatty hilum and/or non-hilar blood flow yielded sensitivity of 89.5% and specificity of 90.9%. Addition of Emax (cortex) to cortical thickness and combination of ≥2 B-mode features increased their specificities to 90.9 and 100% respectively. CONCLUSIONS Metastatic axillary nodes are stiffer than reactive nodes on SWE in breast cancer patients. Emax (cortex) has the best diagnostic performance in differentiating between reactive hyperplasia and nodal metastasis. Combination of Emax (cortex) and cortical thickness increases the specificity for diagnosing metastasis, especially in nodes showing only cortical thickening. ADVANCES IN KNOWLEDGE Combination of SWE and B-mode USG is highly specific for differentiating metastasis from reactive hyperplasia in suspicious nodes of breast carcinoma patients, especially in nodes with only cortical thickening.
{"title":"Role of shear wave elastography as an adjunct to axillary ultrasonography in predicting nodal metastasis in breast cancer patients with suspicious nodes.","authors":"V. Pulappadi, S. Paul, S. Hari, E. Dhamija, S. Manchanda, K. Kataria, S. Mathur, K. Mani, A. Gogia, S. Deo","doi":"10.1259/bjr.20220055","DOIUrl":"https://doi.org/10.1259/bjr.20220055","url":null,"abstract":"OBJECTIVE\u0000To evaluate the role of shear wave elastography (SWE) of suspicious axillary lymph nodes and its combination with B-mode USG in predicting nodal metastasis in breast cancer patients.\u0000\u0000\u0000METHODS\u0000Prospective observational study was performed from June 2018-August 2020 on breast cancer patients with suspicious axillary nodes on USG. B-mode features (cortical thickness, effacement of fatty hilum, non-hilar blood flow and round shape) and SWE parameters (Emax, Emin, Emean and ESD) of the node with the thickest cortex were evaluated. Diagnostic performances of USG, SWE and their combination were estimated using pathological status of the node on biopsy as the gold standard.\u0000\u0000\u0000RESULTS\u0000Of the 54 patients evaluated, optimal elasticity maps were obtained in 49 nodes of 49 patients (mean age, 46.3 ± 12.1 years; 48/49 (98%) females). On biopsy, 38 nodes (77.6%) had metastasis, while 11 (22.4%) had reactive hyperplasia. Emax, Emin, Emean and ESD of both cortex and hilum were significantly higher in metastatic than reactive nodes. Emax (cortex) ≥14.9 kPa had the best diagnostic performance (sensitivity, 73.7%; specificity, 81.8%). Cortical thickness ≥6.7 mm had the best diagnostic performance among B-mode features (sensitivity, 89.5%; specificity, 72.7%). Combining cortical thickness with effacement of fatty hilum and/or non-hilar blood flow yielded sensitivity of 89.5% and specificity of 90.9%. Addition of Emax (cortex) to cortical thickness and combination of ≥2 B-mode features increased their specificities to 90.9 and 100% respectively.\u0000\u0000\u0000CONCLUSIONS\u0000Metastatic axillary nodes are stiffer than reactive nodes on SWE in breast cancer patients. Emax (cortex) has the best diagnostic performance in differentiating between reactive hyperplasia and nodal metastasis. Combination of Emax (cortex) and cortical thickness increases the specificity for diagnosing metastasis, especially in nodes showing only cortical thickening.\u0000\u0000\u0000ADVANCES IN KNOWLEDGE\u0000Combination of SWE and B-mode USG is highly specific for differentiating metastasis from reactive hyperplasia in suspicious nodes of breast carcinoma patients, especially in nodes with only cortical thickening.","PeriodicalId":226783,"journal":{"name":"The British journal of radiology","volume":"70 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130300934","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
E. Johnston, Jodie Basso, J. Winfield, J. Mccall, N. Khan, C. Messiou, D. Koh, N. Fotiadis
OBJECTIVES A commercially available CT guided robot offers enhanced abilities in planning, targeting, and confirming accurate needle placement. In this short communication, we describe our first UK experience of robotic Interventional Oncology procedures. METHODS We describe the device, discuss installation, operation, and report upon needle insertion success, accuracy (path deviation; PD and tip deviation; TD), number of adjustments, complications, and procedural success. RESULTS Nine patients (seven males), median age 66 years (range 43-79) were consented for biopsy or ablation between March and April 2021. Needle placement in biopsy was more accurate than ablation (1 vs 11 mm PD and 1 vs 20 mm TD) and required fewer adjustments (median 0 vs 5). No complications arose, and all procedures were successful (diagnostic material obtained or complete ablation at follow up). CONCLUSIONS Short procedure times and very high levels of accuracy were readily achieved with biopsy procedures, although tumour ablation was less accurate which likely reflects higher procedural complexity. ADVANCES IN KNOWLEDGE Achieving highly accurate robotic biopsy with is feasible within a very short time span. Further work is required to maximise the potential of robotic guidance in tumour ablation procedures, which is likely due to higher complexity giving a longer learning curve.
目的:一种商用CT引导机器人在规划、定位和确认准确的针头放置方面提供了增强的能力。在这个简短的交流中，我们描述了我们在英国的第一次机器人介入肿瘤手术的经验。方法对设备进行描述，讨论安装、操作，并报告针入成功率、准确性(路径偏差;PD和尖端偏差;TD)、调整次数、并发症和手术成功率。结果9例患者(7名男性)，中位年龄66岁(范围43-79)，同意在2021年3月至4月期间进行活检或消融。活检中的置针比消融更准确(1 vs 11 mm PD和1 vs 20 mm TD)，并且需要更少的调整(中位数0 vs 5)。没有出现并发症，所有手术都是成功的(在随访中获得诊断材料或完全消融)。结论:虽然肿瘤消融的准确性较低，这可能反映了较高的手术复杂性，但活检术的手术时间短，准确性高。在很短的时间内实现高精度的机器人活检是可行的。进一步的工作需要最大限度地发挥机器人在肿瘤消融过程中的指导潜力，这可能是由于更高的复杂性和更长的学习曲线。
{"title":"Starting CT guided robotic interventional oncology at a UK centre.","authors":"E. Johnston, Jodie Basso, J. Winfield, J. Mccall, N. Khan, C. Messiou, D. Koh, N. Fotiadis","doi":"10.1259/bjr.20220217","DOIUrl":"https://doi.org/10.1259/bjr.20220217","url":null,"abstract":"OBJECTIVES\u0000A commercially available CT guided robot offers enhanced abilities in planning, targeting, and confirming accurate needle placement. In this short communication, we describe our first UK experience of robotic Interventional Oncology procedures.\u0000\u0000\u0000METHODS\u0000We describe the device, discuss installation, operation, and report upon needle insertion success, accuracy (path deviation; PD and tip deviation; TD), number of adjustments, complications, and procedural success.\u0000\u0000\u0000RESULTS\u0000Nine patients (seven males), median age 66 years (range 43-79) were consented for biopsy or ablation between March and April 2021. Needle placement in biopsy was more accurate than ablation (1 vs 11 mm PD and 1 vs 20 mm TD) and required fewer adjustments (median 0 vs 5). No complications arose, and all procedures were successful (diagnostic material obtained or complete ablation at follow up).\u0000\u0000\u0000CONCLUSIONS\u0000Short procedure times and very high levels of accuracy were readily achieved with biopsy procedures, although tumour ablation was less accurate which likely reflects higher procedural complexity.\u0000\u0000\u0000ADVANCES IN KNOWLEDGE\u0000Achieving highly accurate robotic biopsy with is feasible within a very short time span. Further work is required to maximise the potential of robotic guidance in tumour ablation procedures, which is likely due to higher complexity giving a longer learning curve.","PeriodicalId":226783,"journal":{"name":"The British journal of radiology","volume":"187 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122595494","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
H. Meyer, Franz Benkert, Nikolaos Bailis, M. Lerche, A. Surov
OBJECTIVE Visceral adipose tissue (VAT) has been established as an important parameter of body composition. It can be assessed by imaging modalities like computed tomography (CT). The purpose of the present study was to analyse the prognostic role of VAT derived from thoracic CT in patients with acute pulmonary embolism (PE). METHODS The clinical database of our center was retrospectively screened for patients with acute PE between 2014 and 2017. Overall, 184 patients were included into the analysis. VAT was assessed on axial slices of the thoracic CT at the level of the first lumbar vertebra. Clinical scores, serological parameters, need for intubation, ICU admission and 30 days mortality were assessed. RESULTS Using the previously reported threshold of 100 cm² for visceral obesity definition 136 (73.9%) patients were considered as visceral obese. There was a moderate correlation between VAT and BMI (r = 0.56, p < 0.0001). There was also a moderate correlation between VAT and body height (r = 0.41, p =< 0.0001). Of all investigated clinical scores relating to acute PE, only the GENEVA score correlated weakly with VAT (r = 0.15, p = 0.04). There were significant correlations between VAT and creatinine (r = 0.38, p < 0.0001) and Glomerular filtration rate (r = -0.21, p = 0.005). No associations were identified for VAT and mortality or visceral obesity and mortality. CONCLUSION VAT was not associated with mortality in patients with acute pulmonary embolism. ADVANCES IN KNOWLEDGE Visceral obesity is frequent in patients with acute pulmonary embolism but it is not associated with mortality.
目的建立内脏脂肪组织(VAT)作为人体组成的重要参数。它可以通过计算机断层扫描(CT)等成像方式进行评估。本研究的目的是分析急性肺栓塞(PE)患者的胸部CT VAT的预后作用。方法回顾性筛选本中心2014 - 2017年急性PE患者临床数据库。总的来说，184名患者被纳入分析。在第一腰椎水平的胸部CT轴向片上评估VAT。评估临床评分、血清学参数、插管需求、ICU入院情况和30天死亡率。结果使用先前报道的100 cm²的内脏肥胖定义阈值，136例(73.9%)患者被认为是内脏肥胖。VAT与BMI有中度相关性(r = 0.56, p < 0.0001)。VAT与身高之间也存在中等相关性(r = 0.41, p =< 0.0001)。在所有与急性PE相关的临床评分中，只有GENEVA评分与VAT呈弱相关(r = 0.15, p = 0.04)。VAT与肌酐(r = 0.38, p < 0.0001)、肾小球滤过率(r = -0.21, p = 0.005)有显著相关性。没有发现VAT和死亡率或内脏肥胖和死亡率之间的关联。结论vat与急性肺栓塞患者的死亡率无相关性。内脏肥胖在急性肺栓塞患者中很常见，但与死亡率无关。
{"title":"Role of visceral fat areas defined by thoracic CT in acute pulmonary embolism.","authors":"H. Meyer, Franz Benkert, Nikolaos Bailis, M. Lerche, A. Surov","doi":"10.1259/bjr.20211267","DOIUrl":"https://doi.org/10.1259/bjr.20211267","url":null,"abstract":"OBJECTIVE\u0000Visceral adipose tissue (VAT) has been established as an important parameter of body composition. It can be assessed by imaging modalities like computed tomography (CT). The purpose of the present study was to analyse the prognostic role of VAT derived from thoracic CT in patients with acute pulmonary embolism (PE).\u0000\u0000\u0000METHODS\u0000The clinical database of our center was retrospectively screened for patients with acute PE between 2014 and 2017. Overall, 184 patients were included into the analysis. VAT was assessed on axial slices of the thoracic CT at the level of the first lumbar vertebra. Clinical scores, serological parameters, need for intubation, ICU admission and 30 days mortality were assessed.\u0000\u0000\u0000RESULTS\u0000Using the previously reported threshold of 100 cm² for visceral obesity definition 136 (73.9%) patients were considered as visceral obese. There was a moderate correlation between VAT and BMI (r = 0.56, p < 0.0001). There was also a moderate correlation between VAT and body height (r = 0.41, p =< 0.0001). Of all investigated clinical scores relating to acute PE, only the GENEVA score correlated weakly with VAT (r = 0.15, p = 0.04). There were significant correlations between VAT and creatinine (r = 0.38, p < 0.0001) and Glomerular filtration rate (r = -0.21, p = 0.005). No associations were identified for VAT and mortality or visceral obesity and mortality.\u0000\u0000\u0000CONCLUSION\u0000VAT was not associated with mortality in patients with acute pulmonary embolism.\u0000\u0000\u0000ADVANCES IN KNOWLEDGE\u0000Visceral obesity is frequent in patients with acute pulmonary embolism but it is not associated with mortality.","PeriodicalId":226783,"journal":{"name":"The British journal of radiology","volume":"9 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131915754","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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