World journal of radiology最新文献

This letter to the editor critically appraises the study by Luo et al. While the study provides valuable insights into imaging-pathology correlations in pancreatic cancer, we identify several opportunities for enhancing its clinical relevance. Notably, the exclusion of magnetic resonance cholangiopancreatography and positron emission tomography/computed tomography imaging limits the study's diagnostic scope, as these modalities offer superior capabilities in differentiating benign from malignant lesions and assessing metabolic tumor activity. Additionally, the retrospective, cross-sectional design restricts the potential for dynamic insights into disease progression. We also highlight the untapped potential of radiomics-based analyses, which could significantly improve diagnostic accuracy and prognostic assessments. We recommend integrating these advanced imaging modalities, adopting longitudinal study designs, and leveraging radiomics approaches in future research to enhance the diagnostic frameworks in pancreatic cancer imaging.

In this editorial, we comment on the article by Lambert et al, published in the recent issue of the World Journal of Radiology. The focus of the editorial is to explore the advancements in whole-body magnetic resonance imaging (WB-MRI) technology, its current clinical applications, and the challenges that must be addressed to fully realize its potential in oncological imaging. WB-MRI has emerged as a pivotal tool in oncological imaging, offering comprehensive disease assessment without ionizing radiation. Its applications span the detection of bone metastases, evaluation of hematologic malignancies, and staging of a wide range of cancers, including lymphoma, prostate, and breast cancers. Advanced techniques such as diffusion-weighted imaging have enhanced its diagnostic performance by providing superior lesion-to-background contrast and quantitative metrics. Despite its diagnostic strengths, WB-MRI faces challenges in standardization, patient acceptance, and integration into clinical workflows. Variability in acquisition protocols, hardware differences, and patient-related factors, such as anxiety and motion artifacts, have limited widespread adoption. Emerging guidelines like MET-RADS-P and ONCO-RADS aim to address these issues by promoting standardized protocols tailored to specific clinical needs. This editorial explores the advancements in WB-MRI technology, its current clinical applications, and the barriers that must be overcome to maximize its utility. By addressing these challenges and embracing standardization, WB-MRI holds the potential to redefine the landscape of oncological imaging, aligning diagnostic precision with modern treatment goals of reducing long-term patient risk.

Background: Gastric adenocarcinoma with enteroblastic differentiation (GAED) is one of the common subtypes of alpha-foetoprotein (AFP)-producing gastric cancer. GAED frequently results in venous invasion and liver metastasis, the latter being particularly linked to a poor prognosis. So far, the evidence for liver metastases from AFP-producing gastric cancer is only focused on those from gastric hepatoid adenocarcinoma, owing to their imaging similarities with hepatocellular carcinoma. This case report describes the characteristic diagnostic imaging findings of liver metastasis from GAED.

Case summary: A 65-year-old man who had undergone a pyloric gastrectomy for GAED two years ago was found to have a liver tumor in the hepatic segment 7, accompanied by elevated serum AFP levels. Dynamic contrast-enhanced computed tomography revealed the tumor showing peripheral-dominant enhancement in the arterial phase with persistent central enhancement in the delayed phase. Gadolinium-ethoxybenzyl-diethylenetriamine penta-acetic acid-enhanced magnetic resonance imaging demonstrated a signal drop in the tumor periphery in chemical shift imaging, along with arterial enhancement. Additionally, rim-like hypointensity surrounding the tumor was observed in the hepatobiliary phase. Postresection examination confirmed the tumor to be a metastasis from GAED. Histopathological examination revealed severe invasion of the tumor into the portal vein and hepatic vein surrounding the tumor, which explained the imaging features.

Conclusion: The imaging features of blood flow alternations resulting from vascular invasion may be crucial to diagnosing liver metastases from GAED.

In response to an ageing global population, the primary hip and knee arthroplasty rate continues to increase. Although an effective treatment, up to 25% patients may require revision arthroplasty during their lifetime, commonly due to periprosthetic loosening. Revision procedures are associated with significantly increased healthcare costs; therefore, timely and accurate diagnostics are critical for clinicians and patients. Loosening, which may be septic or aseptic, remains a challenge and requires thorough clinical examination and multimodal imaging evaluation. Plain radiographs remain an essential diagnostic tool but advanced imaging modalities such as computed tomography, magnetic resonance imaging and nuclear medicine are playing an increasingly important role. This comprehensive review, through outlining the available radiological modalities, their respective strengths and weaknesses and the pertinent imaging findings, may help radiologists and orthopaedic surgeons make more informed decisions in the management of periprosthetic loosening.

Background: Liver cirrhosis patients can develop various complications including bacteremia as the intestinal flora is heterologous. In those with low immunity, trauma, or following surgery, etc., the body is susceptible to concurrent systemic or local infections. Under these circumstances, even minimally invasive treatment methods such as interventional therapy like transjugular intrahepatic portosystemic shunt (TIPS) for liver cirrhosis patients can also result in complications such as infections.

Case summary: A male patient with decompensated cirrhosis experienced multiple episodes of gastrointestinal bleeding and hypersplenism. He was admitted to hospital due to voluntary remedial TIPS. The patient developed a numerous intrahepatic liver abscess postoperatively. Following initial conservative treatment with intravenous antibiotics and parenteral nutrition, three months after TIPS, the liver abscess had disappeared on imaging examination. At the 6-month postoperative follow-up, outpatient re-examination showed that the patient had recovered and the liver abscess had resolved.

Conclusion: Attention should be paid to decreased blood cell counts, especially low leukocyte levels in patients with liver cirrhosis as the presence of intestinal microbiota dysregulation and portal pyemia can result in liver abscess and sepsis during invasive diagnostic and therapeutic procedures like TIPS. The addition of probiotics might reduce the risk in such patients.

Background: Three-phase dynamic computed tomography imaging is particularly useful in the liver region. However, dynamic imaging with contrast media has the disadvantage of increased radiation exposure due to multiple imaging sessions. We hypothesized that the contrast enhancement boost (CE-boost) technique could be used to enhance the contrast in equilibrium phase (EP) images and produce enhancement similar to that of portal vein phase (PVP) images, and if this is possible, EP imaging could play the same role as PVP imaging. We also speculated that this might allow the conversion of three-phase dynamic imaging to biphasic dynamic imaging, reducing patients' radiation exposure.

Aim: To determine if the CE-boost of EP, CE-boost (EP) is useful compared to a conventional image.

Methods: We retrospectively analyzed the cases of 52 patients who were diagnosed with liver cancer between January 2016 and October 2022 at our institution. From these computed tomography images, CE-boost images were generated from the EP and plane images. We compared the PVP, EP, and CE-boost (EP) for blood vessels and hepatic parenchyma based on the contrast-to-noise ratio (CNR), signal-to-noise ratio, and figure-of-merit (FOM). Visual assessments were also performed for vessel visualization, lesion conspicuity, and image noise.

Results: The CE-boost (EP) images showed significant superiority compared to the PVP images in the CNR, signal-to-noise ratio, and FOM except regarding the hepatic parenchyma. No significant differences were detected in CNR or FOM comparisons within the hepatic parenchyma (P = 0.62, 0.67). The comparison of the EP and CE-boost (EP) images consistently favored CE-boost (EP). Regarding the visual assessment, the CE-boost (EP) images were significantly superior to the PVP images in lesion conspicuity, and the PVP in image noise. The CE-boost (EP) images were significantly better than the EP images in the vessel visualization of segmental branches of the portal vein and lesion conspicuity, and the EP in image noise.

Conclusion: The image quality of CE-boost (EP) images was comparable or superior to that of conventional PVP and EP. CE-boost (EP) images might provide information comparable to the conventional PVP.

Angiomyolipomas (AMLs) represent the most common benign solid renal tumors. The frequency of their detection in the general population is increasing owing to advances in imaging technology. The objective of this review is to discuss computed tomography (CT) and magnetic resonance imaging findings for both typical and atypical renal AMLs, along with their associated complications. AMLs are typically defined as solid triphasic tumors composed of varying amounts of dysmorphic and tortuous blood vessels, smooth muscle components and adipose tissue. In an adult, a classical renal AML appears as a solid, heterogeneous renal cortical mass with macroscopic fat. However, up to 5% of AMLs contain minimal fat and cannot be reliably diagnosed by imaging. Fat-poor AMLs can appear as hyperattenuating masses on unenhanced CT and as hypointense masses on T2WI; other AMLs may be isodense or exhibit cystic components. Hemorrhage is the most common complication, and AMLs with hemorrhage can mimic other tumors, making their diagnosis challenging. Understanding the variable and heterogeneous nature of this neoplasm to correctly classify renal AMLs and to avoid misdiagnosis of other renal lesions is crucial.

Background: Four-dimensional (4D) flow magnetic resonance imaging (MRI) is used as a noninvasive modality for assessing hemodynamic information with neurovascular and body applications. The application of 4D flow MRI for assessment of bowel disease in children has not been previously described.

Aim: To determine feasibility of superior mesenteric venous and arterial flow quantitation in pediatric patients using 4D flow MRI.

Methods: Nine pediatric patients (7-14 years old, 5 male and 4 female) with history or suspicion of bowel pathology, who underwent magnetic resonance (MR) enterography with 4D flow MR protocol from November 2022 to October 2023. Field strength/sequence: 3T MRI using 4D flow MR protocol. Flow velocity and peak speed measurements were performed by two diagnostic radiologists placing the region of interest in perpendicular plane to blood flow on each cross section of superior mesenteric artery (SMA) and superior mesenteric vein (SMV) at three predetermined levels. Bland-Altman analysis, showed good agreement of flow velocity and peak speed measurements of SMV and SMA between two readers.

Results: Mean SMV flow velocity increased from proximal to mid to distal (0.14 L/minute, 0.17 L/minute, 0.22 L/minute respectively). Mean SMA flow velocity decreased from proximal to mid to distal (0.35 L/minute, 0.27 L/minute, 0.21 L/minute respectively). Observed agreement was good for flow velocity measurements of SMV (mean bias -0.01 L/minute and 95% limits of agreement, -0.09 to 0.08 L/minute) and SMA (mean bias -0.03 L/minute and 95% limits of agreement, -0.23 to 0.17 L/minute) between two readers. Good agreement for peak speed measurements of SMV (mean bias -1.2 cm/second and 95% limits of agreement, -9.4 to 7.0 cm/second) and SMA (mean bias -3.2 cm/second and 95% limits of agreement, -31.4 to 24.9 cm/second).

Conclusion: Flow quantitation using 4D Flow is feasible to provide hemodynamic information for SMV and SMA in children.

Background: Angiostrongylus cantonensis-induced acute parasitic infection is a rare food-borne disease in clinical practice. Lack of its specific laboratory markers and subsequent difficulty in detecting pathogens cause high misdiagnosis and missed diagnosis rates.

Case summary: A 20-year-old male developed persistent neck and back pain after consuming raw snail meat, followed by urinary retention and low fever. After admission, the patient was misdiagnosed as viral infection and Mycobacterium tuberculosis in central nervous system. After detection of Angiostrongylus cantonensis in blood and cerebrospinal fluid by metagenomics next generation sequencing, albendazole was administered with ceftriaxone and methylprednisolone treatment simultaneously. With effective antiparasitic treatment, the patient weaned from mechanical ventilation successfully and transferred out of intensive care unit for hyperbaric oxygen and rehabilitation treatment.

Conclusion: This case highlights the diagnostic challenges of Angiostrongylus cantonensis infection and the importance of advanced sequencing techniques in identifying rare pathogens.

Background: Autoimmune encephalitis (AE) is a rare and recently described neuroinflammatory disease associated with specific autoantibodies. Anti-leucine-rich glioma inactivated 1 (anti-LGI1) encephalitis is a rare but treatable type of AE discovered in recent years. Alzheimer's disease (AD) is a degenerative brain disease and the most common cause of dementia. AD may undergo a series of pathological physiological changes in brain tissue 20 years before the onset of typical symptoms. The stage of mild cognitive impairment (MCI) that occurs during this process, known as MCI due to AD, is the earliest stage with clinical symptoms. MCI is typically categorized into two subtypes: Amnestic MCI (aMCI) and non-aMCI.

Case summary: This report describes a patient with rapid cognitive impairment, diagnosed with anti-LGI1 antibody-mediated AE and aMCI, and treated at Peking University Shenzhen Hospital in March 2023. The patient was hospitalized with acute memory decline for more than 3 months. Both the cerebrospinal fluid and serum were positive for anti-LGI1 antibodies, biomarkers of AD coexisting in the patient's cerebrospinal fluid. Following combination treatment with immunoglobulin therapy and glucocorticoid, plus inhibition of acetylcholinesterase, the patient's cognitive function significantly improved. Throughout the 3-month follow-up period, a sustained improvement in cognitive function was observed. The results of serum anti-LGI1 antibody were negative.

Conclusion: This case has raised awareness of the possible interaction between AE and early AD (including MCI due to AD), and alerted clinicians to the possibility of concurrent rare and common diseases in patients presenting with cognitive impairment.