World journal of radiology最新文献

Tetralogy of Fallot (TOF) is a common cyanotic congenital heart disease. Imaging plays a pivotal role in the diagnosis and surgical planning of TOF. Trans-thoracic echocardiography, cardiac computed tomography, and magnetic resonance imaging are the commonly used non-invasive imaging modalities. Precise delineation of cardiac anatomy, pulmonary artery status, and associated anomalies is essential to guide the surgeon. Catheter angiography is used in specific situations for surgical planning and also to perform palliative procedures for cyanotic spells. Advances in imaging and surgical techniques have led to a better life expectancy. This has created a population of repaired TOF patients, in whom imaging plays a crucial role in both follow-up and the evaluation of complications. This article reviews the role of imaging modalities in TOF and repaired TOF, touching upon the basics of each modality, which are necessary for pre-operative diagnosis, surgical planning, and post-operative follow-up. The standard surgical strategies are also discussed, as relevant to post-operative imaging findings.

Background: The trigeminal nerve (TN) is frequently implicated in neurovascular conflicts, most commonly with the superior cerebellar artery (SCA), its predominant arterial counterpart in the cerebellopontine angle.

Aim: To examine the relationship between the SCA and TN utilizing high-resolution magnetic resonance imaging and evaluated whether particular anatomical configurations predispose to clinically significant contact.

Methods: Magnetic resonance imaging scans from 80 patients (160 sides) were retrospectively analyzed, excluding cases with pathological processes affecting the TN. Using multiplanar reconstruction, the TN root was identified and its spatial relationship with the SCA was evaluated.

Results: Eight distinct topographic patterns were identified. The SCA most commonly coursed superior (30.6%), lateral (18.8%), or superolateral (17.5%) to the TN. Medial configurations, although less frequent, were associated with the shortest artery-nerve distance (mean 1.85 ± 1.28 mm) and significantly higher contact rates (P < 0.001). Overall, SCA-TN contact was observed in 14.4% of sides, but only 20% of these patients reported ipsilateral facial numbness. Variations in SCA origin (basilar artery, posterior cerebral artery, or common origin) and duplication did not significantly influence the artery-nerve distance.

Conclusion: Although SCA-TN contact is relatively frequent, only particular medial and superior configurations seem to predispose individuals to symptomatic compression. These observations are consistent with cadaveric and surgical evidence highlighting the significance of root entry zone contact in trigeminal neuralgia. Vascular contact alone should not serve as a diagnostic criterion; instead, geometric configuration and related nerve alterations must also be incorporated into preoperative assessment.

Thermal ablation has become an established minimally invasive alternative to surgery for papillary thyroid carcinoma, particularly in low-risk patients seeking effective treatment with reduced morbidity. While clinical outcomes are favorable, wide variability in complication rates and patient-reported experiences persists across centers and operators, emphasizing the need for strategies that standardize safety and enhance quality of life. Cai et al now introduce thermal field management (TFM), a thoughtful approach that reframes thermal ablation from a purely technical procedure into a precision-guided, patient-centered intervention. By deliberately confining the ablation zone to protect surrounding tissues, TFM addresses complications such as voice change and pain, issues often overlooked in the pursuit of technical success. Their findings, showing reduced complications and improved patient comfort, highlight the value of integrating patient-reported outcomes into routine ablation practice. This places TFM within the broader trajectory of interventional oncology, where precision and patient-centeredness are becoming central goals. If validated in multicenter prospective studies, TFM could extend beyond thyroid cancer and inform the evolution of safer, standardized ablative therapies across multiple organ systems.

Background: Omental torsion (OT) is a rare cause of acute abdomen, it can be difficult to diagnose preoperatively and is frequently misdiagnosed. Computed tomography (CT) is the primary imaging modality for OT. It typically shows the swirl sign. contrast-enhanced CT can better visualize the central vascular structure of the mass, thus improving the diagnostic accuracy for OT. Surgical resection is the mainstay of treatment for OT. Laparoscopy allows direct visualization of the primary torsion site and comprehensive abdominal exploration, thereby decreasing misdiagnoses. It is a safe and reliable approach for OT treatment, which offers the advantages of minimal trauma, mild postoperative pain, and rapid recovery for stylistic precision.

Case summary: A 48-year-old man was admitted to our hospital due to lower right abdominal pain for the preceding 70 hours. Physical examination revealed lower right abdominal muscle strain, tenderness, and rebound pain, but no mass was palpable. Contrast-enhanced CT revealed a thickened, blurred omentum with swirling changes in the right abdomen. Laparoscopic exploration and omentectomy were performed in the emergency setting. The procedure revealed 50 mL of dark-red bloody ascites in the pelvis and twisting of the right omentum along its longitudinal axis, with a 10 cm × 8 cm purple-black necrosis at the distal end. Post-surgical pathology revealed omental hemorrhage, degeneration, and necrosis. The patient had an uneventful recovery and was discharged on the fourth postoperative day. During the subsequent nine-month follow-up, he remained asymptomatic.

Conclusion: OT is a rare disease that lacks specific clinical manifestations. Abdominal contrast-enhanced CT plays a crucial role in diagnosing OT, and laparoscopic surgery is a safe and effective diagnostic and therapeutic approach.

Non-traumatic headache is a common presentation in both emergency and outpatient settings, where timely identification of raised intracranial pressure (ICP) is crucial to prevent severe neurological complications. Conventional diagnostic methods such as computed tomography and lumbar puncture have important limitations, including invasiveness, delayed availability, and limited sensitivity in certain contexts. Point-of-care ultrasound measurement of the optic nerve sheath diameter (ONSD) has emerged as a rapid, non-invasive tool for detecting elevated ICP at the bedside. The technique is based on the anatomical continuity between the intracranial subarachnoid space and the optic nerve sheath, which expands in response to increased ICP. Evidence from multiple studies and meta-analyses indicates that ONSD measurements above 5.0-5.7 mm in adults strongly correlate with elevated ICP, showing pooled sensitivities and specificities approaching 90%. This modality enables immediate triage, guides urgency of neuroimaging, reduces unnecessary radiation exposure, and can be applied in outpatient and low-resource settings. Despite these advantages, ONSD assessment is subject to operator dependency, variability in threshold values, and reduced accuracy in patients with certain ocular or systemic conditions. Advances in artificial intelligence-assisted measurement, coupled with standardized training protocols, have the potential to improve reproducibility and broaden adoption. Overall, point-of-care ultrasound-based ONSD measurement represents a valuable adjunct in the early evaluation of patients with non-traumatic headache, facilitating faster diagnosis, better resource utilization, and improved patient outcomes.

Photon-counting computed tomography (PCCT) represents a transformative advancement in neuroimaging, offering superior spatial resolution, spectral imaging capabilities, reduced radiation dose, and enhanced contrast-to-noise ratios. This review explores the technical foundations of PCCT, its advantages over conventional CT, and its growing applications in neuroimaging. PCCT has shown promise in improving neurovascular imaging, detecting small vessels, and reducing artifacts near metallic implants. It also enhances the visualization of spontaneous intracranial hypotension and cerebrospinal fluid leaks and provides superior diagnostic accuracy in acute ischemic stroke imaging. However, current limitations, including protocol complexity, high data volume, and the absence of integrated artificial intelligence noise reduction algorithms, pose challenges to widespread adoption. Future research should address these limitations and refine PCCT's applications to unlock its full clinical potential.

Spinal cord injury and non-traumatic myelopathies are major causes of lifelong disability, yet conventional magnetic resonance imaging (MRI) can underestimate microstructural damage. Diffusion tensor imaging (DTI) and tractography map white-matter integrity by measuring fractional anisotropy (FA) and mean diffusivity (MD), but their adoption in spine imaging has been limited by long scan times and complex post-processing. Supsupin et al report a two-minute cervical DTI sequence integrated into routine MRI and applied to four representative pathologies - spinal cord contusion, metastatic compression, degenerative myelopathy, and multiple sclerosis - compared with five controls. Each lesion showed distinctive tractographic and quantitative patterns: For example, reduced FA with preserved MD in contusion and combined FA decrease and MD elevation in metastatic compression. These findings highlight the potential of tractography to improve diagnosis, guide surgical planning, and monitor treatment, while maintaining clinical feasibility. Remaining challenges include limited angular resolution, motion artifacts, and the need for multicenter validation and advanced reconstruction methods. This manuscript places the study in the context of current spinal diffusion imaging and outlines future directions toward routine, precision care.

Background: Shear wave elastography (SWE) is a non-invasive ultrasound-based technique used to assess tissue stiffness, which reflects underlying pathological changes. While SWE has been widely applied for liver fibrosis evaluation, its application to other abdominal organs, such as the spleen and pancreas, is gaining interest. However, normal stiffness values and inter-system agreement remain poorly defined.

Aim: To assess the feasibility and agreement of liver, spleen, and pancreas stiffness using three SWE methods.

Methods: This single-center observational study enrolled 50 healthy adult volunteers. Liver, spleen, and pancreas stiffness were assessed using three SWE methods: Point-SWE (p-QElaXto) and 2-Dimensional-SWE (2D-QElaXto) with Esaote MyLab 9, and 2D-SWE with SuperSonic Imagine. Feasibility, inter-operator reproducibility, and concordance among systems were evaluated. Stiffness was expressed as median kPa values, and technical reliability was assessed using the interquartile range/median ratio and stability index thresholds.

Results: Liver and spleen stiffness assessment was feasible in > 98% of patients, while pancreas stiffness was measurable in 84%-88% depending on the SWE technique. Mean liver stiffness ranged between 3.9-4.7 kPa across techniques, spleen stiffness ranged from 19.4-23.0 kPa, and pancreas stiffness from 5.2-7.6 kPa. Inter-operator agreement was excellent for liver (intraclass correlation coefficient > 0.90) and good to moderate for spleen and pancreas (intraclass correlation coefficient from 0.43 to 0.90). Bland-Altman analysis confirmed good correlation but also systematic differences among devices, especially in pancreas measurements.

Conclusion: This is the first study to establish normal liver, spleen, and pancreas stiffness using MyLab 9 SWE integrated methods as compared to SuperSonic Imagine, with acceptable inter-technique agreement. Liver and spleen values matched existing guidelines; pancreas SWE showed more variability and reduced reproducibility.

Background: The topography between the common carotid artery (CA), internal CA, and external CA (ECA) with the greater horn of the hyoid bone (GHHB) is of particular importance for anatomists, radiologists and neck surgeons.

Aim: To investigate these topographical relationships emphasizing anatomical classification, sexual dimorphism, and clinical significance.

Methods: A retrospective study was performed on 224 computed tomography angiographies from a cohort comprising 161 male and 63 female patients, with a mean age of 63.2 years. Multiplanar and three-dimensional reconstructions were executed utilizing Horos software. The spatial relationships between the CA and hyoid bone were categorized based on the 12-type classification system delineated by Manta et al in 2023. The data were subsequently stratified by sex and laterality.

Results: Type 0 (no arterial contact with the GHHB) was the most common configuration (46.9%), followed by type VI (ECA lateral to GHHB, 23.9%) and type VIII (internal CA and ECA lateral to GHHB, 13.2%). Bilateral symmetry was present in 54.02% of cases, mainly in males. Statistically significant sex-based differences were found (P = 0.012), while laterality was not significant (P = 0.779).

Conclusion: Carotid-hyoid topography displays significant anatomical variation with clinically essential patterns. Non-null variants, such as types VI and VIII, may increase the risk of dynamic carotid compression, especially in younger patients with cryptogenic cerebrovascular symptoms. Recognizing these variants during preoperative imaging is crucial to minimize surgical risk and inform patient care.

In the clinical diagnosis and treatment of liver tumors, the differential diagnosis between dual-phenotype hepatocellular carcinoma and intrahepatic cholangiocarcinoma has long been a challenging problem for clinicians. These two types of tumors not only exhibit overlapping pathological features but also have significantly different treatment strategies and prognoses. Misdiagnosis can directly affect patients' quality of life. Recently, a study published by Zhang et al has brought groundbreaking insights into this dilemma. Radiomics technology has demonstrated remarkable value in the differential diagnosis of these two diseases, opening up a new path for the precise diagnosis and treatment of liver tumors.