World journal of radiology最新文献

Endoscopic retrograde cholangiopancreatography (ERCP) is a cornerstone procedure for the diagnosis and management of pancreatic and hepatobiliary diseases. Although its diagnostic role has been increasingly supplanted by noninvasive imaging modalities such as magnetic resonance imaging (MRI) and magnetic resonance cholangiopancreatography, the therapeutic applications of ERCP have continued to expand. ERCP is widely used and has a generally favorable safety profile. However, it is important to recognize expected post-procedural imaging findings and serious complications that can arise. The increasing complexity of therapeutic interventions and the growing volume of procedures have led to a higher incidence of complications that often present with overlapping clinical and laboratory features, underscoring the critical role of imaging in differential diagnosis. This review focused on the typical normal ERCP findings and the imaging characteristics of common complications, including pancreatitis, bleeding, ERCP-related infections, perforations, and stent-related complications. Computed tomography (CT) is particularly valuable in timely recognition, management, and surgical decision-making for these complications. Furthermore, MRI offers a radiation-free alternative for managing complications in selected patients. Therefore, radiological modalities, particularly CT and MRI, are critical tools for the rapid diagnosis, management, and surgical decision-making processes for post-ERCP complications.

Background: Endometrial peristalsis (EmP) has been considered as a new indicator for evaluating endometrial receptivity and is associated with embryo implantation rate and successful pregnancy rate. However, EmP remains understudied, inconsistently measured, and poorly understood. New methods are needed urgently for better clinical practice.

Aim: To explore the value of EmP analysis (EmPA) technique in detecting and analyzing EmP features automatically and quantitatively.

Methods: One hundred and forty-five patients without abnormal findings on conventional transvaginal ultrasound were included in this study. A mid sagittal plane of uterus was recorded for 2 minutes in each patient and EmP features were analyzed using EmPA technique. EmP features in 50 patients were also analyzed by naked eyes analysis and the results of two methods were compared.

Results: EmPA was unsuccessful in 9 patients (9/145, 6.21%) due to the interference of respiratory or intestinal movement and was successful in 136 patients (136/145, 93.79%), of whom 21 patients showed no EmP and 115 patients underwent EmPA and obtained quantitative results. The results of EmPA technique and naked eyes analysis about EmP intensity and transfer time had no significant consistence. Menstrual cycle, uterine position and history of induced abortion affected the quantitative results of EmPA.

Conclusion: EmPA technique provides noninvasive, quantitative and accurate detection and analysis of EmP in normal population and can evaluate EmP changes associated with menstrual cycle, uterine position and history of induced abortion.

Male breast disorders, though less prevalent, present unique diagnostic challenges that differ significantly from their female counterparts. While benign entities such as gynecomastia are predominant, the risk of underlying malignancy, often diagnosed at an advanced stage, highlights the need for a systematic, image-guided assessment. Ultrasound and mammography are the first-line complementary tools, with magnetic resonance imaging reserved for problem-solving. This review outlines the anatomical, pathological, and radiological nuances of the male breast, describing crucial red flag signs, sonographic pitfalls, and mammographic mimics that aid in distinguishing benign entities from sinister pathologies such as invasive ductal carcinoma. Given the increasing visibility of transgender individuals, this review also addresses imaging considerations and screening recommendations tailored to this population. By integrating clinical insights with radiologic imaging, this review offers a comprehensive approach to both common and not-so-common male breast lesions, with an emphasis on an algorithmic stepwise diagnostic approach.

Thyroid nodules are common, with a prevalence of approximately 70% on thyroid ultrasonography; approximately 5% of these nodules are malignant. Distinguishing malignant and benign thyroid nodules is critical for clinical management. Clinicians can judiciously select patients for fine-needle aspiration, understand the cytology results and subsequent follow-up, and determine surveillance strategies for non-operated nodules. The challenge in selecting thyroid nodules for fine-needle aspiration is to avoid the diagnosis of small, clinically insignificant cancers without missing more severe diseases. The molecular characteristics of thyroid nodules are critical for their diagnosis and treatment. However, identifying these characteristics is costly and challenging because of unexpected technical difficulties. An imaging association model based on molecular features will bridge the essential link between molecular characteristics and the computed tomography radiomics, then improve diagnostic efficiency, reducing invasive examinations.

Background: Endometrial cancer (EC) is the most common gynecological malignancy in high-income countries, with incidence rates rising globally. Early and accurate diagnosis is essential for improving outcomes. Transvaginal ultrasound (TVUS) remains a cost-effective first-line tool, and emerging techniques such as three-dimensional (3D) ultrasound (US), contrast-enhanced US (CEUS), elastography, and artificial intelligence (AI)-enhanced imaging may further improve diagnostic performance.

Aim: To systematically review recent advances in US-based imaging techniques for the diagnosis and staging of EC, and to compare their performance with magnetic resonance imaging (MRI).

Methods: A systematic search of PubMed, Scopus, Web of Science, and Google Scholar was performed to identify studies published between January 2010 and March 2025. Eligible studies evaluated TVUS, 3D-US, CEUS, elastography, or AI-enhanced US in EC diagnosis and staging. Methodological quality was assessed using the QUADAS-2 tool. Sensitivity, specificity, and area under the curve (AUC) were extracted where available, with narrative synthesis due to heterogeneity.

Results: Forty-one studies met the inclusion criteria. TVUS demonstrated high sensitivity (76%-96%) but moderate specificity (61%-86%), while MRI achieved higher specificity (84%-95%) and superior staging accuracy. 3D-US yielded accuracy comparable to MRI in selected early-stage cases. CEUS and elastography enhanced tissue characterization, and AI-enhanced US achieved pooled AUCs up to 0.91 for risk prediction and lesion segmentation. Variability in performance was noted across modalities due to patient demographics, equipment differences, and operator experience.

Conclusion: TVUS remains a highly sensitive initial screening tool, with MRI preferred for definitive staging. 3D-US, CEUS, elastography, and AI-enhanced techniques show promise as complementary or alternative approaches, particularly in low-resource settings. Standardization, multicenter validation, and integration of multi-modal imaging are needed to optimize diagnostic pathways for EC.

Cardiac arrest is associated with high rates of mortality and significant long-term neurological disability in survivors. Timely and accurate assessment following successful resuscitation is critical for optimizing outcomes. Imaging plays a central role in this evaluation process, providing crucial insights into the etiology of arrest, the extent of cerebral and cardiac injury, and guiding both acute management and long-term prognostication. A structured, multimodal imaging approach utilizing tools such as computed tomography, magnetic resonance imaging, echocardiography, and angiography is increasingly recognized as essential in the post-cardiac arrest setting. This review aims to consolidate current evidence related to the use of various imaging modalities across neurological, cardiac and systemic contexts. Particular emphasis is placed on the prognostic value and optimal timing of neuroimaging, the detection of potentially reversible causes of arrest, such as coronary occlusion or pulmonary embolism, and the emerging role of whole-body imaging in evaluating patients with non-traumatic out-of-hospital cardiac arrest.

Background: Primary ciliary dyskinesia (PCD) is a rare condition characterised by dysmotile, immotile, or absent cilia. As a result of the impairment in respiratory mucociliary clearance, patients with PCD typically develop neonatal respiratory distress, nasal congestion, otitis media and recurrent respiratory infections leading to bronchiectasis and structural lung changes. These changes have been shown by chest computed tomography (CT) to develop in infancy and early childhood. Recent development and refinement of radiation-reducing CT techniques have allowed significant radiation dose reductions, with chest CT doses now in the range of chest radiography (CR).

Aim: To evaluate the efficacy of ultra-low dose CT (ULDCT) chest in identifying pulmonary changes within a PCD paediatric patient cohort.

Methods: Paediatric patients with PCD who presented for routine clinical outpatient follow-up within the study period, were eligible for inclusion in the study. ULDCT and CR were performed on these patients and the results compared. Comparison metrics included radiation dose, subjective and objective image quality and disease severity.

Results: Six paediatric patients (mean age 9 years) underwent clinically indicated ULDCT chest examinations and CR for surveillance of their PCD. The mean effective dose was 0.08 ± 0.02 mSv, a dose that approximates that of a frontal and lateral chest radiograph. The average Brody II score across the entire cohort was 12.92, with excellent inter-rater reliability and intra-class correlation coefficient (ICC) of 0.98. The average Chrispin-Norman score on CR was 1 with excellent inter-rater reliability and ICC of 0.92.

Conclusion: ULDCT demonstrates superior diagnostic capabilities, minimal radiation dose penalty, and high interobserver reliability in comparison to CR. Thus, we advocate for ULDCT to be the preferred modality for surveillance imaging in paediatric PCD.

Background: Anoxic brain injury is a potentially lethal condition characterized by cerebral hypoperfusion and irreversible neuronal injury. Arterial spin-labeling (ASL) perfusion and diffusion-weighted imaging (DWI) magnetic resonance imaging (MRI) have been proposed as tools to detect cerebral ischemic changes and may aid in the assessment of anoxic injury.

Aim: To explore the relationship between regional ASL perfusion patterns and clinical outcomes following cardiac arrest.

Methods: We performed a retrospective review to identify patients with clinical suspicion of anoxic brain injury who underwent MRI within 15 days of cardiac arrest. Receiver operator characteristic (ROC) analysis and univariate logistic regression were used to evaluate associations between ASL perfusion scores, DWI signal intensity, and the following clinical features: (1) Myoclonus status epilepticus (MSE) within 24 hours; (2) Absent extensor or motor reflexes (EMR) at day 3 post-arrest; and (3) Absent brainstem reflexes (BSR) within 15 days.

Results: Twenty-eight patients met inclusion criteria. Increased ASL signal in the left occipital lobe was significantly associated with MSE (P = 0.038), while a trend was observed between right frontal ASL signal and EMR (P = 0.078). ROC analysis showed that ASL scores ≥ 7 were associated with higher odds of absent BSR (OR 2.14, P = 0.53), though this did not reach statistical significance. DWI signal intensity did not show significant associations with clinical outcomes. The overall discriminatory performance of ASL for predicting outcomes was limited (AUC ≈ 0.52).

Conclusion: This exploratory study suggests that regional ASL hyperperfusion, particularly in the left occipital and right frontal lobes, may be associated with adverse clinical signs following cardiac arrest. However, most findings did not reach statistical significance, and the study was underpowered to detect small-to-moderate effects. These preliminary results should be interpreted with caution and considered hypothesis-generating. Larger, prospective studies are warranted to clarify the prognostic value of ASL perfusion imaging in anoxic brain injury.

Background: Lymph node metastasis (LNM) is a key prognostic factor in pancreatic cancer (PC). Accurate preoperative prediction of LNM remains challenging. Radiomics offers a noninvasive method to extract quantitative imaging features that may aid in predicting LNM.

Aim: To investigate the potential value of a computed tomography (CT)-based radiomics model in prediction of LNM in PC.

Methods: A retrospective analysis was performed on 168 pathologically confirmed PC patients who underwent contrast-enhanced-CT. Among them, 107 cases had no LNM, while 61 cases had confirmed LNM. These patients were randomly divided into a training cohort (n = 135) and a validation cohort (n = 33). A total of 792 radiomics features were extracted, comprising 396 features from the arterial phase and another 396 from the portal venous phase. The Minimum Redundancy Maximum Relevance and Least Absolute Shrinkage and Selection Operator methods were used for feature selection and Radiomics model construction. The receiver operating characteristic curve was employed to assess the diagnostic potential of the model, and DeLong test was used to compare the area under the curve (AUC) values of the model.

Results: Six radiomics features from the arterial phase and nine from the portal venous phase were selected. The Radscore model demonstrated strong predictive performance for LNM in both the training and test cohorts, with AUC values ranging from 0.86 to 0.94, sensitivity between 66.7% and 91.7%, specificity from 71.4% to 100.0%, accuracy between 78.8% and 91.1%, PPV ranging from 64.7% to 100.0%, and negative predictive value between 84.0% and 93.8%. No significant differences in AUC values were observed between the arterial and portal venous phases in either the training or test set.

Conclusion: The preoperative CT-based radiomics model exhibited robust predictive capability for identifying LNM in PC.