World journal of radiology最新文献

Diverticulitis is an infection of the diverticular sacs protruding from the intestinal wall. It typically presents as elevated inflammatory markers and left lower quadrant abdominal pain. Although clinical symptoms and biomarkers are essential for diagnosis, imaging methods, particularly computed tomography (CT), are critical due to the inability to perform endoscopic procedures in the acute phase because of the risk of perforation. Various classification systems that include imaging findings have been developed. The most recent and widely accepted system is the Sartelli classification, which is endorsed by the World Society of Emergency Surgery. This classification describes stages of diverticulitis ranging from edematous bowel wall thickening and phlegmon in the adjacent mesentery to microperforation, localized or distant abscess formation, and generalized peritonitis with free fluid and air. Imaging findings are also pivotal in diagnosing and managing complications such as abscesses, pylephlebitis, fistulas, and gastrointestinal bleeding. Moreover, imaging can differentiate diverticulitis from infectious colitis, epiploic appendagitis, ischemic colitis, colorectal carcinoma, and inflammatory bowel disease. This review focuses on the radiological findings of diverticulitis. We specifically discuss CT imaging and emphasize its clinical manifestations, significant complications, and differential diagnosis.

Background: Photon-counting detector (PCD) CT represents a transformative advancement in radiological imaging, offering superior spatial resolution, enhanced contrast-to-noise ratio, and reduced radiation dose compared with the conventional energy-integrating detector CT.

Aim: To evaluate PCD CT in oncologic imaging, focusing on its role in tumor detection, staging, and treatment response assessment.

Methods: We performed a systematic PubMed search from January 1, 2017 to December 31, 2024, using the keywords "photon-counting CT", "cancer", and "tumor" to identify studies on its use in oncologic imaging. We included experimental studies on humans or human phantoms and excluded reviews, commentaries, editorials, non-English, animal, and non-experimental studies. Study selection followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Out of 175 initial studies, 39 met the inclusion criteria after screening and full-text review. Data extraction focused on study type, country of origin, and oncologic applications of photon-counting CT. No formal risk of bias assessment was performed, and the review was not registered in PROSPERO as it did not include a meta-analysis.

Results: Key findings highlighted the advantages of PCD CT in imaging renal masses, adrenal adenomas, ovarian cancer, breast cancer, prostate cancer, pancreatic tumors, hepatocellular carcinoma, metastases, multiple myeloma, and lung cancer. Additionally, PCD CT has demonstrated improved lesion characterization and enhanced diagnostic accuracy in oncology. Despite its promising capabilities challenges related to data processing, storage, and accessibility remain.

Conclusion: As PCD CT technology evolves, its integration into routine oncologic imaging has the potential to significantly enhance cancer diagnosis and patient management.

Chronic otitis media (COM) is a long-standing inflammatory condition affecting the middle ear and mastoid cavity, often resulting in progressive structural damage and functional deficits. Radiological imaging is fundamental in diagnosing the disease, assessing its severity, and identifying possible complications. The literature indicates that the prevalence rates of extracranial and intracranial complications range from 0.69% to 5%, while the mortality rate for intracranial complications is 26%. While magnetic resonance imaging is particularly useful in distinguishing soft tissue abnormalities and detecting intracranial extensions like meningitis, brain abscess, and sigmoid sinus thrombosis, high-resolution computed tomography remains the preferred modality for evaluating bony erosion, cholesteatoma, and mastoid involvement. Key complications such as ossicular chain destruction, facial nerve damage, and labyrinthine fistulae can be precisely identified using advanced imaging modalities, allowing for timely and effective surgical intervention. This minireview underscores the essential role of radiology in both diagnosing and managing COM, highlighting critical imaging findings that facilitate early detection and inform treatment decisions. A collaborative approach among radiologists, otolaryngologists, and infectious disease specialists is crucial for improving clinical outcomes in affected patients.

Background: Ultrasound (US) can be a valuable tool for assessing arthritis associated with inflammatory bowel disease (IBD), especially in cases of psoriatic disease. The clinical case reviewed in this article addresses an exploratory finding that evaluates the effects of immunobiological treatments on dactylitis and IBD with the use of US techniques.

Case summary: A 40-year-old Caucasian woman with psoriatic arthritis (PsA) and ulcerative colitis (UC) reported experiencing finger pain, knee arthritis, and bloody diarrhea. She showed a high Disease Activity index for PsA score and a severe Mayo score. She began treatment with adalimumab. Over the course of six months, the 18 MHz US procedure was performed on her joints and a 3.5 MHz US on her intestines. The joint US indicated dactylitis and swelling in her finger joints, while the intestinal US revealed 6.6 mm swelling in the sigmoid colon, increased abdominal fat, and high Doppler signal. Her fecal calprotectin level was 5984 mg/kg, and a colonoscopy showed that UC extended to the hepatic flexure, along with mild narrowing of the transverse colon. After six months treatment, all parameters showed improvement, including a remission of the Mayo score, better colonoscopy results, and Limberg score of 0.

Conclusion: More research is needed to find out the importance of using US in patients with PsA and UC as this could improve treatment strategies.

Lung cancer, particularly non-small cell lung cancer (NSCLC), remains a leading cause of cancer-related death globally, and a significant number of patients develop brain metastasis (BM) as the disease progresses. The presence of BM, which affects up to 60% of patients with NSCLC, is correlated with an unfavorable prognosis and markedly decreased quality of life. Standard treatment options for BMs, such as whole-brain radiation therapy and surgery, have displayed limited efficacy in controlling disease progression, and they can cause significant neurocognitive side effects. Stereotactic radiotherapy (SRT), including stereotactic radiosurgery, fractionated SRT, and stereotactic body radiotherapy, represents an advanced and precise approach for treating BM that minimizes damage to surrounding healthy tissues. This review highlights recent advances in the application of SRT for treating BM of NSCLC, focusing on its underlying biological principles and mechanisms of action as well as the quality standards necessary for effective SRT implementation. The ability of SRT to deliver substantial radiation doses in a precisely targeted manner has resulted in better local tumor management, fewer side effects, and increased patient survival rates. Future research is crucial to improve SRT procedures and successfully incorporate them into multimodal therapy plans for patients with NSCLC and BM.

Background: Esophageal cancer (EC) is one of the most prevalent malignant gastrointestinal tumors; accurate prediction of EC staging has high significance before treatment.

Aim: To explore a rational radiomic approach for predicting preoperative staging of EC based on magnetic resonance imaging (MRI).

Methods: This retrospective study included 210 patients with pathologically confirmed EC, randomly divided into a primary cohort (n = 147) and a validation cohort (n = 63) in a ratio of 7:3. All patients underwent a preoperative MRI scan from the neck to the abdomen. High-throughput and quantitative radiomics features were extracted from T2-weighted imaging (T2WI) and gadolinium contrast-enhanced T1-weighted imaging (T1WI)-Gd images. Radiomics signatures were selected using minimal redundancy maximal relevance and the least absolute shrinkage and selection operator. Then a logistic regression model was built to predict the EC stages. The diagnostic performance of the radiomics model for discriminating between stages I-II and III-IV was evaluated using the area under the curve (AUC), sensitivity (SEN), and specificity (SPE).

Results: A total of 214 radiomics features were extracted. Following feature dimension reduction, the T1WI and T2WI sequences were retained, and 14 features from the T1WI sequence and 3 features from the T2WI sequence were selected to construct radiomics signatures. The radiomics signature combining T2WI with T1WI-Gd demonstrated superior discrimination of stages in the validation cohort (AUC: 0.851; SEN: 0.697; SPE: 0.793), which outperformed single-sequence models (AUC: 0.779, 0.844; SEN: 0.667, 0.636; SPE: 0.8, 0.8).

Conclusion: MRI-based radiomics signatures could identify EC stages before treatment, which could serve as a noninvasive and quantitative approach aiding personalized treatment planning.

Background: Signet ring cell carcinoma originating from the appendix is extremely rare, and the lack of specific clinical symptoms and imaging features makes preoperative diagnosis particularly challenging.

Case summary: We report a case of a 49-year-old woman who presented with irregular vaginal bleeding lasting more than five months. Computed tomography (CT) and magnetic resonance imaging (MRI) revealed an enlarged appendix with a thickened wall and progressive enhancement after contrast administration. The uterine myometrium and cervix were markedly thickened, with heterogeneous density and signal intensity, along with progressive enhancement. The uterine serosal surface remained intact. Preoperative MRI suggested diffuse uterine adenomyosis; however, postoperative histopathology confirmed Signet ring cell carcinoma originating from the appendix with implantation involving the entire uterus.

Conclusion: Imaging showed appendiceal wall thickening and marked thickening of the uterine myometrium, with lesions demonstrating progressive enhancement after contrast administration. These findings should raise suspicion for the implantation of Signet ring cell carcinoma originating from the appendix and involving the uterus. Signet ring cell carcinoma originating from the appendix is relatively rare, and its imaging features are seldom reported, making preoperative diagnosis extremely challenging. This study retrospectively analyzes a case of Signet ring cell carcinoma originating from the appendix with implantation involving the entire uterus. The imaging characteristics of the appendix and the uterus were evaluated using CT and MRI to enhance awareness of this disease.

Liver transplantation is the primary therapeutic choice for end-stage liver disease. Currently, biliary complications are among the main factors affecting the survival rate and quality of life of liver transplant recipients. Nevertheless, the clinical manifestations of biliary complications following liver transplantation are often non-specific, making early diagnosis and timely treatment crucial for improving patient outcomes. Ultrasound is the preferred imaging method following liver transplantation. Importantly, contrast-enhanced ultrasound, with the administration of contrast agents, can improve the resolution of biliary images and enable real-time, dynamic visualization of microcirculation perfusion in the biliary system and surrounding tissues. The present article describes the normal ultrasonic features of the biliary system following liver transplantation and briefly reviews the progress in the ultrasonic diagnosis of common biliary complications, including anastomotic biliary strictures, non-anastomotic biliary strictures, biliary leakage, biloma, and bile sludge/bile stone.

Placenta abnormalities, which are collectively termed as placenta accreta spectrum (PAS), are increasing globally in the female population due to the large number of cesarean sections performed worldwide. PAS represents a rare but life-threatening occurrence that can lead to an increased risk of postpartum hemorrhage due to the abnormal infiltration of the chorionic villi in the uterine wall up to the adjacent structures. Performing a prophylactic occlusion of the iliac arteries for a brief amount of time using balloon-occlusion endovascular catheters in patients with PAS can help control unwanted blood losses during cesarean delivery or postpartum demolition surgery. The aim of this narrative minireview was to provide an overview of the aspects about prophylactic occlusion with endovascular balloons in patients with PAS and to analyze current evidence on this topic. In particular, this minireview included an overview of indications, patient selection, type of materials and devices used, technical advice and suggestions, clinical outcomes, and complications to give every interventional radiologist as well as every gynecologist and midwife all the information that is needed to address this particular condition in a safe and prompt manner.

Background: Coronary computed tomography angiography (CCTA) is essential for diagnosing coronary artery disease as it provides detailed images of the heart's blood vessels to identify blockages or abnormalities. Traditionally, determining the computed tomography (CT) scanning range has relied on manual methods due to limited automation in this area.

Aim: To develop and evaluate a novel deep learning approach to automate the determination of CCTA scan ranges using anteroposterior scout images.

Methods: A retrospective analysis was conducted on chest CT data from 1388 patients at the Radiology Department of the First Affiliated Hospital of a university-affiliated hospital, collected between February 27 and March 27, 2024. A deep learning model was trained on anteroposterior scout images with annotations based on CCTA standards. The dataset was split into training (672 cases), validation (167 cases), and test (167 cases) sets to ensure robust model evaluation.

Results: The study demonstrated exceptional performance on the test set, achieving a mean average precision (mAP50) of 0.995 and mAP50-95 of 0.994 for determining CCTA scan ranges.

Conclusion: This study demonstrates that: (1) Anteroposterior scout images can effectively estimate CCTA scan ranges; and (2) Estimates can be dynamically adjusted to meet the needs of various medical institutions.