World journal of radiology最新文献

With the rapid development of computed tomography (CT) technology, the widespread use of CT examinations in the evaluation of chest diseases in pediatrics has raised extensive concerns about radiation issues. This review first systematically summarizes the factors influencing radiation dose (detector, tube voltage, tube current-time product, field of view, and reconstruction algorithms) in pediatric chest computed tomography examinations. Methods to reduce radiation dose are also discussed, including the utilization of filters, automatic tube current modulation, automatic tube voltage selection, and organ dose modulation. Finally, the methods for individualized radiation dose calculation in pediatric chest CT examinations: effective dose, CT dosimetry software, Size-Specific Dose Estimate, and the Monte Carlo method are reviewed. Radiation exposure reduction is a multifaceted issue. This review aims to provide an optimal scanning scheme for pediatric chest CT from different perspectives.

Obstructed defecation syndrome (ODS) is a complex defecatory disorder associated with pelvic floor dysfunction. It affects approximately 50% of women over the age of 50 and significantly impacts their quality of life. The causes of ODS include structural abnormalities such as rectocele, enterocele, intussusception, and pelvic floor descent, as well as functional disorders like anismus. Accurate diagnosis is crucial for effective management due to the high risk of treatment failure associated with inaccurate findings. Various imaging modalities are used to assess pelvic floor disorders, including fluoroscopic defecography (FD), magnetic resonance defecography (MRD), pelvic floor ultrasound (PFUS), and echodefecography (EDF). FD is the most commonly performed test worldwide, offering high accuracy in diagnosing pelvic floor disorders. It provides dynamic visualization of defecation mechanics but involves radiation exposure. MRD offers excellent soft tissue detail and multiplanar imaging without radiation, making it particularly useful for multicompartment disorders; however, it is associated with high procedural costs and limited availability. Both PFUS and EDF are minimally invasive and avoid radiation exposure. PFUS shows promise as a valuable screening tool that could help minimize the need for advanced imaging if findings are normal. EDF is also promising but requires specialized training and remains less widely available. This review evaluates the accuracy, advantages, and limitations of various diagnostic modalities for pelvic floor disorders, aiming to guide optimal clinical decision-making.

This editorial critically evaluated Liu et al's recent retrospective analysis of 283 Chinese patients with resectable pancreatic ductal adenocarcinoma (PDAC) that validated a preoperative computed tomography-based risk scoring system originally developed in South Korea. The scoring system incorporated five parameters: (1) Tumor size; (2) Portal venous phase density; (3) Necrosis; (4) Peripancreatic infiltration; and (5) Suspected metastatic lymph nodes. While demonstrating satisfactory recurrence prediction capability without requiring complex technologies, thereby supporting clinical utility in Chinese populations, the study exhibited notable limitations. Most analyzed patients lacked neoadjuvant chemotherapy exposure, resulting in underrepresentation of low-risk subgroups. Additionally, the short follow-up duration potentially compromised long-term prognostic assessment. Contemporary advances in radiomics coupled with machine learning have enhanced multimodal data integration for PDAC management. However, clinical implementation continues to confront challenges including variability in imaging parameters, incomplete understanding of molecular underpinnings, and confounding treatment effects. Future investigations should prioritize developing multidimensional predictive frameworks that synergize radiographic, molecular, and clinical data. Prospective multicenter validation and artificial intelligence-powered real-time risk stratification systems represent essential steps to overcome current barriers in precision medicine translation, ultimately advancing personalized therapeutic strategies for PDAC.

Descriptive signs in radiology can aid in easier pattern recognition and quicker diagnosis. In spinal cord ischemia, paired anterior-horn T2-hyperintensities have traditionally been known as the "owl's eyes" or "snake eyes" sign. We discuss how these signs, while visually apt, convey no pathophysiologic context and propose renaming this finding the "snake bite sign". The image still evokes two punctate marks, yet the metaphor extends to a snake bite (two fang-like dots) rather than two bright foci (eyes) staring back at the viewer. Moreover, besides the sign metaphorically resembling a traumatic puncture of the two fangs, on the occasion of a venomous snake bite occurring elsewhere, additional neurological consequences may occur, paralleling the neurological deficits seen in anterior spinal artery infarction and several mimicking myelopathies, thus further highlighting the analogy. Such clinically driven terminology may facilitate teaching, enable diagnostic recall, and improve interdisciplinary communication.

Soft tissue sarcomas (STS) are rare malignant tumors originating from mesodermal tissues with a poor prognosis, accounting for approximately 1% of all malignancies and comprising around 50 distinct subtypes. Conventional imaging modalities, such as computed tomography (CT) and magnetic resonance imaging (MRI), primarily provide anatomical information, whereas ¹⁸F-fluorodeoxyglucose positron emission tomography/CT (¹⁸F-FDG PET/CT) integrates functional metabolic and anatomical imaging, serving as a critical complementary tool in the diagnosis and management of STS. This article reviews recent advances in the application of ¹⁸F-FDG PET/CT for STS. The advantages of ¹⁸F-FDG PET/CT in STS include: (1) Early detection of metabolic activity changes in tumors, particularly when morphological alterations are insignificant; (2) Effective differentiation between benign and malignant soft tissue tumors, as well as aiding in distinguishing high-grade from low-grade sarcomas; (3) Identification of occult metastatic lesions, improving staging accuracy, and facilitating restaging in cases of recurrence or metastasis; (4) Utilization of parameters such as maximum standardized uptake value and metabolic tumor volume to assist in tumor grading and prognostic evaluation; and (5) Monitoring treatment response to guide adjustments in personalized therapeutic strategies. However, ¹⁸F-FDG PET/CT has limitations in diagnosis of certain STS subtypes (e.g., myxoid liposarcoma), detection and biopsy of metastatic lymph nodes, necessitating integration with clinical evaluation and other imaging techniques. ¹⁸F-FDG PET/CT is poised to play an increasingly vital role in the precision diagnosis and treatment of STS.

Sudden cardiac death (SCD) is one of the most devastating sequelae of myocardial diseases and can be the initial symptom in younger athletes or middle-aged businesspeople. An implantable cardioverter defibrillator (ICD) prevents SCD and dramatically reduces the arrhythmic events in these patients; hence, the risk stratification for the SCD is important. In survivors of out-of-hospital cardiac arrest, identification of its etiologies is required to select the appropriate treatments following ICD installation. Cardiac magnetic resonance imaging (MRI) is useful for evaluating the morphology and function of the heart and for tissue characterization, MRI can therefore be used to stratify the risk of SCD associated with various myocardial diseases and leads to primary prevention using ICD. MRI can predict arrhythmic events, which suggest the progression of myocardial damage, following secondary prevention. In this review, we provide a clinical and MRI focused update and MRI protocol for the primary and secondary prevention of SCD. We summarize the contribution and limitations of cardiac MRI for prevention SCD using ICD implantation.

Caustic ingestion is a relatively rare but potentially catastrophic gastroenterological emergency. Upper gastrointestinal (GI) endoscopy is currently regarded as the gold standard modality not only to assess the depth and the extension of GI caustic injury, but also to guide the appropriate treatment. Intriguingly, contrast-enhanced computed tomography (CECT) has recently emerged as a promising non-invasive and more accurate alternative to endoscopy in this setting. However, to date, evidence concerning the role of CECT as an alternative or complementary diagnostic tool to endoscopy in caustic ingestion is still limited. The aim of our review was to summarize and discuss the current evidence concerning the role of CECT in the emergency diagnosis of caustic ingestion and its value in assessing injury severity among non-pediatric patients.

Background: Thyroid dysfunction during pregnancy is an important disease affecting the health of mothers and children. Two-dimensional (2D) shear wave elastography (SWE) is the newest ultrasonic elastography technology and its value in differentiating benign and malignant thyroid nodules has been widely recognized. However, the value of 2D SWE in evaluating and predicting thyroid function is unclear.

Aim: To explore prospectively the value of 2D SWE quantitative analysis for the evaluation of thyroid function in the first trimester.

Methods: We included outpatients of reproductive age in the Department of Gynecology in Shanghai Changning Maternity and Infant Health Hospital between March 2023 and March 2024 who had conventional ultrasound examination and 2D SWE of the thyroid. They also underwent transvaginal ultrasound examination to confirm early intrauterine pregnancy and serum thyroid stimulating hormone (TSH) level was measured. The patients were divided into pregnant with normal TSH, pregnant with abnormal TSH, and nonpregnant with normal TSH. Conventional ultrasound and 2D SWE results were compared among the three groups.

Results: A total of 108 patients were included in the study; 57 in the pregnant with normal TSH group, 18 in the pregnant with abnormal TSH group and 33 were in the nonpregnant with normal TSH group. Thyroid size, thyroid echotexture, 2D SWE quantitative parameters including mean elasticity in the region of interest and maximal elasticity in the region of interest showed no significant differences among the three groups (P > 0.05).

Conclusion: Conventional ultrasound and 2D SWE features could not reflect the level of serum TSH.

Background: Dual-phenotype hepatocellular carcinoma (HCC) is a relatively new subtype of HCC. Studies have shown that in the context of chronic hepatitis, liver cirrhosis, and other liver conditions, some intrahepatic cholangiocarcinomas (ICCs) exhibit an enhancement pattern similar to that of HCC. Both dual-phenotype HCC (DPHCC) and ICC can express biliary markers, making imaging and pathology differentiation difficult. Currently, radiomics is widely used in the differentiation, clinical staging, and prognosis assessment of various diseases. Radiomics can effectively differentiate DPHCC and ICC preoperatively.

Aim: To evaluate the value of radiomics in the differential diagnosis of DPHCC and ICC and to validate its clinical applicability.

Methods: In this retrospective study, the data of 53 DPHCC patients and 124 ICC patients were collected retrospectively and randomly divided into training and testing sets at a ratio of 7: 3. After delineation of regions of interest and feature extraction and selection, radiomics models were constructed. Receiver operating characteristic curve analysis was conducted to calculate the area under the curve (AUC) for each model. The AUC values of radiologists with and without assistance from the model were also assessed.

Results: In the training set, the AUC value of the radiomic model was the highest, and the combined model and the radiomic model had similar AUC (P > 0.05); the differences in the AUC values between the combined model and the clinical-sign model was statistically significant (P < 0.05). In the testing set, the AUC value of the combined model was the highest, and the differences in the AUC values between the combined model and the clinical-sign model was statistically significant (P < 0.05). With model assistance, the AUC values of Doctor D (10 years of experience in abdominal imaging diagnosis) and Doctor E (5 years of experience in abdominal imaging diagnosis) both increased.

Conclusion: Radiomics can differentiate DPHCC and ICC, and with assistance from the developed model, the accuracy of less experienced doctors in the differential diagnosis of these two diseases can be improved.

This pictorial review discusses the imaging approach to evaluate for proper placement or complications of pediatric gastrostomy tube (G-tube) placement and long-term use. G-tubes are crucial for long-term nutritional support in patients facing challenges with oral intake. The article depicts the role of imaging such as contrast radiography, fluoroscopy, ultrasound, and computed tomography scans for confirming G-tube position and evaluating complications, in addition to basic anatomical considerations and placement techniques. Complications discussed include malposition, intraperitoneal placement, buried bumper syndrome, and tube malfunction. Specific imaging techniques and checklists are provided to guide clinicians in assessing G-tube placement accurately. The latter half of the review is a comprehensive exploration of pearls and pitfalls of imaging when employed to detect complications to avoid false positives and negatives.