World journal of radiology最新文献

Background: Cardiac magnetic resonance (CMR) has been reported to identify myocardial damage inducing out-of-hospital cardiac arrest (OHCA). However, the usefulness of CMR may be affected by the medical institutions, patients' ages, and myocardial diseases.

Aim: To clarify the clinical usefulness and limitation of CMR for identifying myocardial damage in the survivors of OHCA in midtown.

Methods: Nineteen patients underwent CMR to detect myocardial damage related to OHCA in the midtown of a capital city. Cine, T1 and T2 mapping, T2-weighted, and late gadolinium enhancement (LGE) imaging were acquired using a 1.5 T scanner. We described the clinical characteristics of the survivors of OHCA and evaluated usefulness of CMR for identifying myocardial damage related to OHCA.

Results: Among 19 patients experiencing OHCA, 7 experienced it in trains or on railway platforms, 4 while practicing sports, and 4 during their daily work. Ten of the 19 survivors were diagnosed with coronary vasospasm (CVS), in whom CMR failed to depict its characteristic findings. CMR was useful for identifying myocardial damage associated with hypertrophic cardiomyopathy (HCM) or myocardial infarction (MI). LGE was related to serious ventricular arrhythmias after implantable cardioverter defibrillator (ICD) installation in 3 patients (CVS, 2; HCM, 1).

Conclusion: CMR is useful for identifying myocardial damage of HCM or MI inducing OHCA and predicting ventricular arrhythmias after ICD implantation but has limited capability for detecting myocardial damage of CVS.

Obstructed defecation syndrome (ODS) represents an important cause of constipation, primarily arising from dysfunctions within the pelvic floor. Characterized by an inability to complete defecation or effectively evacuate fecal material despite the urge to defecate, ODS results in a persistent sensation of incomplete evacuation and often requires excessive straining during defecation. Conventional clinical examinations fail to adequately assess the complex dynamic dysfunctions of the pelvic floor and anorectal region. Magnetic resonance defecography (MRD), a sophisticated form of dynamic pelvic floor imaging, provides a comprehensive, non-invasive means of visualizing and quantifying various anorectal and pelvic floor abnormalities. By allowing detailed assessment of structural and functional deficits during the defecation process, MRD plays a crucial role in the diagnostic workup of ODS, enabling colorectal surgeons to formulate more precise and individualized treatment strategies. This manuscript highlights the important anatomical and functional disorders of pelvic floor that are associated with ODS.

The article "Assessment of superior mesenteric vascular flow quantitation in children using four-dimensional flow magnetic resonance imaging" suggests to use of four-dimensional (4D) flow magnetic resonance imaging (MRI) which is also to measure the blood flow in the superior mesenteric vein (SMV) in pediatric patients over the traditional method. The study focuses on assessing the potential of SMV and superior mesenteric artery (SMA) flow quantification in children utilizing 4D flow MRI. It included 9 pediatric patients aged 18 years and below where 5 were male and 4 were female patients, on whom magnetic resonance enterorrhaphy (MRE) with 4D flow MRI protocol was used. Statistical analysis was performed using MedCalc. Measurements of SMV and SMA between two readers were calculated using Bland-Altman analysis. The results stated that six patients showed no MRE evidence of active inflammatory bowel disease, two patients showed unmarkable bowel appearance on MRI and one patient showed normal MRE without endoscopy performed at the same timeframe. The study utilized available 4D flow MRI sequences in this study aiming to show the feasibility of 4D flow quantitation of SMA and SMV flow in pediatric patients. The study also discovered good agreement for both peak velocity and peak speed measurements of SMA and SMV.

To address the sensitive and uncertain limitations of single-energy computed tomography (CT) calibration methods in computing proton stopping power ratio during treatment planning, different methods have been proposed using a dual energy CT approach. This paper reviews the most recent dual-energy CT approaches for computing proton stopping power ratio. These include image domain and projection domain methods. The advantages and uncertainties of these methods are analyzed based on existing studies. This paper highlights recent advances in dual energy CT, discussing their implementation, advantages, limitations, and potential for clinical adoption.

Background: Lower abdominal pain presents as a common complaint with diverse etiologies ranging from benign conditions to surgical emergencies. Computed tomography (CT) imaging has become instrumental in accurate diagnosis and management planning, though clinicians must carefully balance its benefits against radiation exposure concerns and resource allocation constraints.

Aim: To comprehensively evaluate the diagnostic accuracy, utility and clinical implications of CT in patients with acute lower abdominal pain, emphasizing rare anatomical variations, pregnancy-related issues, and practical limitations of other imaging modalities in emergency settings in Japan.

Methods: This retrospective review included 230 patients who underwent CT scans for acute lower abdominal pain at Juntendo University Shizuoka Hospital throughout 2014. CT findings were systematically correlated with the final clinical diagnoses. Cases with diagnostic uncertain underwent independent reviewed by two experienced radiologists. The CT protocols included portal venous-phase imaging with selective arterial-phase acquisition when clinically indicated.

Results: Idiopathic pain was the most common diagnosis (104 cases, 45.2%), followed by appendicitis (46 cases, 20.0%) and diverticulitis (27 cases, 11.7%). Right lower quadrant pain predominantly revealed appendicitis (20.2%), whereas left lower quadrant pain frequently indicated diverticulitis (12.1%). Nonspecific pain cases have diverse etiologies. Rare conditions included situs inversus (one case) and intestinal malrotation (one case). Pregnancy-related diagnoses included acute appendicitis and uterine fibroid degeneration.

Conclusion: CT significantly aids in the diagnosis of lower abdominal pain, especially given limited access to ultrasonography and MRI during emergency hours in Japan. Awareness of the anatomical variations and pregnancy-related constraints is crucial. Diagnosis-specific protocols for CT based on pain location can optimize clinical management and resource utilization.

Calvarial lesions are usually incidental and asymptomatic, rarely detected. However, these lesions can also present with pain, a palpable mass or a bone defect. Clinical information such as the patient's age and medical history are helpful in making the correct diagnosis. Calvarial lesions may occur due to congenital and anatomical variants, traumatic and iatrogenic, idiopathic, infectious and inflammatory, metabolic, benign and malignant neoplastic causes. Calvarial lesions may be solitary, multiple or diffuse, and may be lytic, sclerotic or mixed. Although most calvarial lesions are benign, radiologic imaging features can help to determine whether the lesion is benign or malignant. Methods that can guide treatment and are currently in use include plain radiography, ultrasonography, computed tomography, magnetic resonance imaging, angiographic studies, and nuclear scintigraphy studies such as 18F-fluorodeoxyglucose positron emission tomography and whole-body bone scintigraphy. Defects, lysis and sclerosis in the bone structure are assessed by plain radiography and computed tomography, and the soft tissue components of the lesions and their relationship to the surrounding soft tissue are assessed by magnetic resonance imaging. This article reviews the imaging findings of benign and malignant calvarial lesions and normal variants that may be confused with systemic diseases and pathologies affecting the calvarium.

Background: Acute kidney injury (AKI) is a frequent complication after liver transplantation (LT). How to realize the early diagnosis of AKI, perform active intervention, and reduce the mortality of post-LT patients is an urgent problem to be solved.

Aim: To investigate the accuracy of hepatorenal index (HRI) and renal resistive index (RRI) in monitoring of early AKI after LT.

Methods: This observational study included adult deceased-donor LT recipients at our center between February 2022 and February 2023 with no preoperative renal dysfunction. The HRI and RRI were recorded once per day in the postoperative period through to postoperative day (POD) 7. We followed up with the patients at 1 month after LT. The patients were divided into the AKI and non-AKI groups according to the Kidney Disease Improving Global Outcomes criteria.

Results: Of 121 patients were included in the study (mean age: 50.18 ± 8.88years; female: 17.36%). AKI developed in 53 patients (43.80%). The AKI and non-AKI groups were similar in terms of their baseline characteristics. An HRI of ≤ 1.12 on POD 1 detected AKI with a sensitivity of 62.30% and a specificity of 87.80% [area under the receiver operating characteristic curve (AUC) = 0.801, P < 0.01]. An RRI of ≥ 0.65 on POD 1 detected AKI with a sensitivity of 87.80% and a specificity of 67.60% (AUC = 0.825, P < 0.01). The HRI combined with the RRI was more effective at detecting AKI than either the HRI or RRI alone (AUC = 0.890, P < 0.01). The HRI increased as AKI resolved while the RRI decreased as AKI resolved.

Conclusion: The HRI and RRI are non-invasive bedside indices that can identify the occurrence and recovery of early AKI after LT.

Acromegaly, characterized by persistent hypersecretion of growth hormone (GH), is most often caused by a pituitary neuroendocrine tumor (PitNET), though, less often, ectopic GH or GH-releasing hormone secretion from various neoplasms outside the pituitary gland could cause it. Nearly 70% of somatotroph PitNETs are macroadenomas at diagnosis. Transsphenoidal surgery, the most effective treatment modality for acromegaly, could achieve remission in 73%. However, the remission rates could reach 87% if surgery is followed by medical therapy. Due to variable therapeutic responses to surgical and medical therapy, pre-treatment awareness regarding the best therapeutic modality based on clinical, biochemical, radiological, histopathological and genetic parameters would help in accurate pretreatment decision-making. Earlier studies have identified poor prognosis markers like tumor size, tumor invasion, T2-weighted hyperintensity, granulation, and pretreatment GH and/or insulin-like growth factor 1 levels. In a recent study, published by Alvarez et al identified that preoperative PitNET volume is a good predictor of control of acromegaly following surgical treatment and the likelihood of requiring more aggressive additional therapies after surgery. They found that PitNET volume exceeding 3697 mm³ was associated with poorer disease control in patients with somatotroph PitNETs.

Background: Back pain and sciatica are common complaints that often require imaging for accurate diagnosis and management. Conventional lumbar magnetic resonance imaging (MRI) protocols typically include sagittal and axial T1 and T2 sequences; however, these may miss certain pathologies. The addition of coronal short tau inversion recovery (STIR) sequences offers the potential to enhance the detection of both spinal and extra-spinal abnormalities, thereby improving clinical decision-making and patient outcomes.

Aim: To evaluate the impact of adding coronal STIR sequences to routine lumbar MRI in diagnosing back pain and sciatica.

Methods: We prospectively analyzed data from patients aged 6 and older presenting with back pain or sciatica who underwent lumbar spine MRI at our institution. The standardized MRI protocol utilized included sagittal and axial T1 and T2 sequences, complemented by a coronal STIR sequence. Data on structural abnormalities were collected, reviewed, and analyzed using counts, percentages, and Fisher's exact test for categorical variables.

Results: Our cohort comprised 274 patients (115 males, 159 females; mean age 44.91 years). Notably, 39 patients exhibited abnormalities across all sequences, while 72.63% showed normal findings on the coronal STIR sequence. Importantly, 30.29% of cases were diagnosed as normal without the coronal STIR, and 36 patients with normal T1 and T2 sequences presented abnormalities on the coronal STIR. The coronal STIR sequence successfully identified 26 spinal and 10 non-spinal pathologies, including 17 cases of sacroiliitis, with a significant association (P < 0.0001) between sacroiliitis diagnosis and abnormalities visible solely on this sequence.

Conclusion: Integrating coronal STIR into routine lumbar MRI enhances detection of hidden spinal and extra-spinal pathologies, improves patient management, and offers a cost-effective, practical upgrade with significant diagnostic and clinical value.

Pericoronary adipose tissue (PCAT) plays an important role in the pathogenesis and progression of cardiovascular diseases due to its bidirectional communication with the coronary artery wall. In recent years, PCAT parameters measured using coronary computed tomography have emerged as potential noninvasive imaging biomarkers for quantifying coronary artery inflammation, with significant clinical value in the early detection, disease progression assessment, treatment efficacy evaluation, and prognosis prediction of cardiovascular diseases. Furthermore, new technologies such as PCAT radiomics analysis have broadened its potential applications in evaluating coronary plaque vulnerability, predicting cardiovascular events, and improving risk stratification. This review discusses recent advances in PCAT research, focusing on its role in coronary artery disease risk identification and inflammation monitoring, and aims to offer imaging-based insights to support its future clinical use in cardiovascular disease management.