World journal of radiology最新文献

Background: Accurate preoperative differentiation of benign and malignant thyroid nodules is critical for optimal patient management. However, conventional imaging modalities present inherent diagnostic limitations.

Aim: To develop a non-contrast computed tomography-based machine learning model integrating radiomics and clinical features for preoperative thyroid nodule classification.

Methods: This multicenter retrospective study enrolled 272 patients with thyroid nodules (376 thyroid lobes) from center A (May 2021-April 2024), using histopathological findings as the reference standard. The dataset was stratified into a training cohort (264 lobes) and an internal validation cohort (112 lobes). Additional prospective temporal (97 lobes, May-August 2024, center A) and external multicenter (81 lobes, center B) test cohorts were incorporated to enhance generalizability. Thyroid lobes were segmented along the isthmus midline, with segmentation reliability confirmed by an intraclass correlation coefficient (≥ 0.80). Radiomics feature extraction was performed using Pearson correlation analysis followed by least absolute shrinkage and selection operator regression with 10-fold cross-validation. Seven machine learning algorithms were systematically evaluated, with model performance quantified through the area under the receiver operating characteristic curve (AUC), Brier score, decision curve analysis, and DeLong test for comparison with radiologists interpretations. Model interpretability was elucidated using SHapley Additive exPlanations (SHAP).

Results: The extreme gradient boosting model demonstrated robust diagnostic performance across all datasets, achieving AUCs of 0.899 [95% confidence interval (CI): 0.845-0.932] in the training cohort, 0.803 (95%CI: 0.715-0.890) in internal validation, 0.855 (95%CI: 0.775-0.935) in temporal testing, and 0.802 (95%CI: 0.664-0.939) in external testing. These results were significantly superior to radiologists assessments (AUCs: 0.596, 0.529, 0.558, and 0.538, respectively; P < 0.001 by DeLong test). SHAP analysis identified radiomic score, age, tumor size stratification, calcification status, and cystic components as key predictive features. The model exhibited excellent calibration (Brier scores: 0.125-0.144) and provided significant clinical net benefit at decision thresholds exceeding 20%, as evidenced by decision curve analysis.

Conclusion: The non-contrast computed tomography-based radiomics-clinical fusion model enables robust preoperative thyroid nodule classification, with SHAP-driven interpretability enhancing its clinical applicability for personalized decision-making.

Background: Gastroenteropancreatic neuroendocrine tumors (GEP-NETs) frequently metastasize to the liver, with heterogeneity in tumor grade impacting patient prognosis and treatment. The Ki-67 index, a key prognostic marker, often varies between primary and metastatic sites; however, routine liver biopsy remains controversial. Although percutaneous computed tomography-guided core needle biopsy (PCT-CNB) is safe and effective for focal lesions, its role in detecting intertumor grading discrepancies and survival implications in GEP-NETs is underexplored. Conflicting survival associations with grade shifts have been reported in previous studies. We hypothesized that PCT-CNB could identify clinically significant grading heterogeneity in liver metastases, correlating with survival outcomes, thereby refining risk stratification and therapeutic strategies.

Aim: To investigate intertumor grading heterogeneity in GEP-NET liver metastases via PCT-CNB.

Methods: We retrospectively investigated 92 patients with liver metastases from GEP-NETs via PCT-CNB, 76 patient samples from the liver and primary sites, and 16 from the liver and secondary liver sites. Ki-67 immunohistochemistry was performed for tissue sampling, and grading classifications were determined. Intertumor grading classification heterogeneity and associated changes in patient survival outcomes were also evaluated.

Results: No procedure-related mortality was recorded during or after biopsy. In 37/92 patients (40.2%), the grading classifications changed: The grading increased from G1 to G2 in 13 patients, from G1 to G3 in 2, and from G2 to G3 in 14; the grading decreased from G2 to G1 in 5 patients, from G3 to G1 in 1, and from G3 to G2 in 2. Patients with G1 or G2 disease had better progression-free survival and overall survival (OS) outcomes than those with G3 disease did (P = 0.001 and P < 0.001, respectively). The 5-year and 10-year OS rates for stable G2 patients were 67.5% and 26.0%, respectively, decreasing to 46.4% and 23.2%, respectively, among G2 patients whose grade increased (P = 0.016).

Conclusion: The PCT-CNB of liver metastases from GEP-NETs differed in grade between the liver tumor and primary site/secondary liver metastases. Additionally, when grading increased from G2, the OS rate significantly decreased.

Background: Nonalcoholic fatty liver disease (NAFLD) is the most common chronic liver disease. The accuracy of noninvasive biomarkers for detecting hepatic steatosis is still limited.

Aim: To assess the diagnostic performance of noninvasive steatosis biomarkers in diagnosing NAFLD using magnetic resonance imaging proton density fat fraction (MRI-PDFF) as the gold standard.

Methods: A total of 131 suspected NAFLD patients (60% male, median age 36 years) undergoing MRI-PDFF were consecutively recruited from a tertiary hospital. Steatosis grades determined by MRI-PDFF were classified as none (< 5%), mild (5%-11%), moderate (11%-17%), and severe (≥ 17%). Six steatosis biomarkers were calculated according to clinical parameters and laboratory tests, including fatty liver index, hepatic steatosis index, ZJU index, Framingham steatosis index, triglycerides and glucose index, and visceral adiposity index. The accuracy of these biomarkers in detecting hepatic steatosis was evaluated using the area under the receiver operating characteristic curves (AUCs). The Youden index was used to determine the optimal cut-off for each biomarker. The linear trend analysis of each biomarker across the steatosis grades was conducted by Mantel-Haenszel χ ² test. Spearman's rank correlation assessed the relationship between steatosis biomarkers and MRI-PDFF.

Results: Steatosis grades based on MRI-PDFF prevalence were: None 27%, mild 40%, moderate 15% and severe 18%. Six steatosis biomarkers showed a linear trend across the steatosis grades and a significant positive correlation with MRI-PDFF. The six steatosis biomarkers demonstrated AUCs near 0.90 (range: 0.857-0.912, all P < 0.001) for diagnosing NAFLD by MRI-PDFF ≥ 5%. The optimal cut-offs showed sensitivity between 84.4%-91.7% and specificity between 71.4%-85.7%. The diagnostic performance of these biomarkers in detecting moderate-to-severe and severe steatosis was relatively weaker.

Conclusion: These noninvasive steatosis biomarkers accurately diagnosed NAFLD and correlated well with MRI-PDFF for detecting NAFLD, but they did not effectively detect moderate or severe steatosis.

This narrative review examines the use of imaging biomarkers for diagnosing and monitoring hydrocephalus from birth through childhood. Early detection and longitudinal follow-up are essential for guiding timely interventions and assessing treatment outcomes. Cranial ultrasound and magnetic resonance imaging (MRI) are the primary imaging modalities, providing critical insights into ventricular size, cerebrospinal fluid dynamics, and neurodevelopmental implications. Key parameters, including Evans' index, Levene's index, and the Cella Media index, as well as volumetric and diffusion-based MRI techniques, have been explored for their diagnostic and prognostic value. Advances in automated image analysis and artificial intelligence have further improved measurement precision and reproducibility. Despite these developments, challenges remain in standardizing imaging protocols and establishing normative reference values across different pediatric populations. This review highlights the strengths and limitations of current imaging approaches, emphasizing the need for consistent methodologies to enhance diagnostic accuracy and optimize patient management in hydrocephalus.

Primary sellar atypical teratoid/rhabdoid tumor (AT/RT) is the most aggressive sellar mass. Although rare, sellar AT/RT exhibits a very relentless clinical course and usually results in death within months to a few years after diagnosis. The best clinical evidence suggests that surgical debulking and timely adjuvant chemoradiation are most effective in prolonging survival. A preoperative radiological diagnosis of sellar AT/RT thus is crucial in informing patients and physicians about this devastating disease. This minireview summaries the imaging features of sellar AT/RT. magnetic resonance imaging features of sellar AT/RT and the much more common sellar mass, pituitary macroadenoma, are similar in most aspects: They are both isointense to brain gray matter on T1 and T2 imaging and enhance upon gadolinium administration. Suprasellar extension and cavernous sinus invasion are present in practically all cases of sellar AT/RT, but are also present in 50%-75% of pituitary macroadenomas, especially in large ones, suggesting that suprasellar extension and cavernous sinus invasion disproportionate to the tumor size may favor sellar AT/RT diagnosis. Since sellar AT/RT grows very rapidly and does not allow significant remodeling of perisellar structures, the imaging features of perisellar structures such as optic chiasm and cavernous sinus may be key for imaging diagnosis of sellar AT/RT although they have not been well described in sellar AT/RT. In limited cases of sellar AT/RT, optic chiasm degeneration and thinning, which are very common in pituitary macroadenoma, are not present, giving hope for using features of perisellar structures to diagnose sellar AT/RT by imaging.

Patent foramen ovale (PFO) is a common congenital heart disorder associated with stroke, decompression sickness and migraine. Combining synchronized contrast transcranial Doppler with contrast transthoracic echocardiography has important clinical significance and can improve the accuracy of detecting right-left shunts (RLSs) in patients with PFO. In this letter, regarding an original study presented by Yao et al, we present our insights and discuss how to better help clinicians evaluate changes in PFO-related RLS.

Background: Calciphylaxis, also called calcific uremic arteriolopathy, is characterized by microvascular calcification and occlusion, which is commonly seen in patients with end-stage renal disease (ESRD). Although several studies have demonstrated an association of calciphylaxis with ESRD, reports linking calciphylaxis to LT (LT) are scarce. This report presents a rare case of calciphylaxis in a patient who underwent LT, leading to microvascular occlusion and hyperbilirubinemia.

Case summary: A 34-year-old man presented with a 7-day history of jaundice and severe bilateral leg pain. The patient had undergone LT and was put on hemodialysis for one year due to calcineurin inhibitor-induced ESRD. Physical examination revealed jaundice, leathery skin changes, severe muscle pain in both legs, and penile induration. Laboratory tests identified elevated bilirubin levels, gamma-glutamyltransferase, and alkaline phosphatase, while alanine aminotransferase and aspartate aminotransferase concentrations were within normal limits. Computed tomography (CT) revealed extensive calcifications in the subcutaneous tissue. Three-dimensional CT reconstruction indicated significantly reduced blood flow in the hepatic artery, primarily in the small to medium-sized branches. Contrast-enhanced ultrasonography confirmed hepatic ischemia, with no enhancement seen in hepatic artery branches. Liver biopsy specimen revealed no signs of rejection. The patient decided to receive conservative treatment and succumbed to the illness after six months.

Conclusion: This case indicates that calciphylaxis should be suspected in patients who have undergone LT with ESRD presenting with hyperbilirubinemia and skin lesions.

Background: Obstructed defecation syndrome (ODS) is a subtype of constipation that is considered one of the major pelvic floor dysfunctions affecting the aging population, particularly women over 50 seeking medical care. The condition is characterized by the urge to defecate but an impaired ability to expel the fecal bolus. ODS is associated with various anorectal abnormalities, which are not always apparent during a standard physical examination, requiring specialized imaging techniques for proper diagnosis.

Aim: To study the distribution of causes of ODS in patients with chronic constipation by magnetic resonance defecography (MRD).

Methods: This observational study evaluated the causes of ODS in 57 patients with chronic constipation who presented to Bangabandhu Sheikh Mujib Medical University between July 2020 and June 2021. After obtaining institutional review board approval and informed consent, patients underwent history taking, physical exams, and relevant investigations. ODS was diagnosed using Rome III criteria, with colonoscopy ruling out organic causes. Standard MRD was performed in different phases, and images were analyzed by expert radiologists and reported in a standardized format.

Results: Pelvic floor descent and anorectal junction descent were the most frequent findings, each present in 94.7% of cases. Rectocele was observed in 78.9% of patients, while vaginal or uterine prolapse was seen in 59.4% of females. Less common abnormalities included paradoxical contraction (7%), and there were no cases of sigmoidocele. Functional measurements showed significant differences in pelvic floor dynamics between rest and defecation, particularly in the H-line, M-line, and descent of pelvic organs (P < 0.05).

Conclusion: Pelvic floor descent and anorectal descent were the most common findings in patients suffering from ODS, followed by rectocele. Younger females (< 30 years) were most affected.

Background: Indolent NK-cell lymphoproliferative disorder of the gastrointestinal tract (iNKLPD) is a rare and recently defined entity, recognized in the 2022 WHO classification of hematolymphoid tumors. iNKLPD typically exhibits a benign or slowly progressive clinical course, with disease localized to the gastrointestinal tract. Here, we present what we believe to be the first reported case of iNKLPD associated with protein-losing enteropathy (PLE), characterized by a poor response to chemotherapy and rapid clinical deterioration, culminating in death within a few months.

Case summary: We report the case of a 64-year-old man who presented with bilateral lower-extremity edema and fatigue. Laboratory tests revealed marked hypoalbuminemia, while other liver function parameters remained within normal limits. Renal and cardiac function assessments were unremarkable. Histopathological examination of endoscopic biopsies confirmed a diagnosis of iNKLPD of the gastrointestinal tract. The patient was treated with oral prednisone and cyclosporine, which led to temporary improvement in both symptoms and serum albumin levels. However, disease relapse occurred during corticosteroid tapering, accompanied by worsening hypoalbuminemia and refractory diarrhea. The patient died eight months after diagnosis, likely due to disease progression or severe treatment-related complications.

Conclusion: iNKLPD generally exhibits an indolent course; nonetheless, the prognosis may be poor if secondary PLE is involved.

Background: Chinese surgeons often rely on intraoperative exploration of the esophageal hiatus to determine the need for concurrent type I hiatal hernia (HH) repair during laparoscopic sleeve gastrectomy. However, no standardized criteria for the esophageal hiatus size or indications for exploration exist in China.

Aim: To investigate normal anatomical parameter ranges of the esophageal hiatus in patients with obesity.

Methods: A total of 158 patients, aged 20-49 years, was analyzed from January 2020 to June 2024. The patients were classified into the no reflux esophagitis (RE) no HH group (HHG), RE group, and type I HHG. The transverse and sagittal diameters and cross-sectional area of the esophageal hiatus were measured using multiplanar reconstruction of the computed tomography images.

Results: Body mass index was positively correlated with area and transverse and sagittal diameters of the esophageal hiatus (r = 0.72, 0.69, and 0.54, respectively; P < 0.01). In the no RE no HHG and RE group, the esophageal hiatus size in the subgroup with obesity was greater than that in the non-obesity subgroup (area: 326.15 ± 78 mm² vs 208.12 ± 64.44 mm², transverse diameters: 15.97 ± 2.06 mm vs 13.37 ± 1.99 mm, sagittal diameters: 15.7 ± 2.08 mm vs 11.73 ± 2.08 mm; P < 0.01). Patients with obesity showed no significant differences in esophageal hiatus size with or without RE or HH.

Conclusion: The esophageal hiatus size increased with body mass index and was larger in patients with obesity than in those without obesity.