World journal of radiology最新文献

Low-dose radiation therapy has emerged as a promising modality for cancer treatment because of its ability to stimulate antitumor immune responses while minimizing damage to healthy tissues. However, the significant heterogeneity in immune responses among patients complicates its clinical application, hindering outcome prediction and treatment personalization. Artificial intelligence (AI) offers a transformative solution by integrating multidimensional data such as immunomics, radiomics, and clinical features to decode complex immune patterns and predict individual therapeutic outcomes. This editorial explored the potential of AI to address immune response heterogeneity in low-dose radiation therapy and proposed an AI-driven framework for precision immunotherapy. While promising, challenges, including data standardization, model interpretability, and clinical validation, must be overcome to ensure successful integration into oncological practice.

Ultra-high dose rate flash radiotherapy (FLASH-RT) has attracted wide attention in the field of radiotherapy in recent years. For FLASH-RT, radiation is delivered at a very high dose rate [usually thousands of times compared with conventional radiotherapy (CONV-RT)] in an extremely short time. This novel irradiation technique shows a protective effect on normal tissues, also known as the flash effect. At the same time, FLASH-RT is comparable to CONV-RT in terms of tumor-killing efficacy. As basic research dedicates to uncover the mechanisms by which FLASH-RT reduces radiation-induced normal tissue damage, clinical trials of FLASH-RT have been gradually conducted worldwide. This article systematically reviews the evidence of the feasibility and safety of FLASH-RT in clinical practice and offers insights into the future translation of this technology in clinic.

This study highlights the significance of considering pituitary neuroendocrine tumor volume when determining the appropriate line of therapy for patients with acromegaly. The findings suggest that, although tumor volume may assist in predicting the need for more aggressive treatment strategies, it is not a reliable indicator of disease persistence following surgical intervention. Further research is warranted to investigate additional factors influencing acromegaly treatment outcomes to enhance patient care.

Leesmidt et al present a comprehensive analysis of abdominal vascular flow in children using four-dimensional (4D) flow magnetic resonance imaging (MRI), aim to establish normal hemodynamic values for the abdominal visceral organs and to assess the feasibility of 4D flow MRI (4D-f-MRI) in this population. The researchers performed 4D-f-MRI on 9 pediatric patients with a history or suspicion of bowel pathology. Flow velocities were measured in the abdominal aorta and superior and inferior mesenteric arteries. The quality of the 4D-f-MRI images was evaluated, and the agreement between the measured flow velocities and those obtained from Duplex ultrasound was established. However, due to the specific limitations of this work, future studies should address the issues of small sample size and the specific age group design.

Background: Traumatic hemothorax is a common complication of chest trauma; however, the timeline for its resolution, even with chest tube thoracostomy, remains unclear.

Aim: To determine the time to resolution of the hemothorax to ensure safe discharge based on chest radiography (CXR) findings.

Methods: A retrospective observational study was conducted at Hamad General Hospital, Qatar, from June 2014 to October 2019, including all patients with hemothorax diagnosed via computed tomography (CT) following chest trauma. Based on the initial imaging study, the hemothorax was divided into right, left, and bilateral.

Results: The study included 422 patients. Of the total, 57.82% (n = 244/422) resolved their hemothorax within three days of admission. Among these, 44 patients required chest tube insertion (CTI) and 200 were cleared without it. Between days 3 and 7, an additional 16.83% (n = 71 /422) of cases were resolved, of which 28 required chest tubes. By days 8 to 14, another 11.37% (n = 48/422) were cleared, with 15 patients requiring chest tubes. After 14 days, 13.98% (n = 59/422) of patients still had hemothorax, 14 of whom required CTI.

Conclusion: This study showed that a subset of patients continued to experience retained hemothorax despite early tube thoracostomy. Patients with a larger hemothorax, particularly on the left side, showed prolonged resolution times. Regular imaging such as CXR or CT is recommended for up to 14 days post-intervention. After this period, outpatient follow-up is generally safe, although some patients may still have a persistent hemothorax beyond two weeks.

Background: Radiotherapy (RT) is a cornerstone of cancer treatment. Compared with conventional high-dose radiation, low-dose radiation (LDR) causes less damage to normal tissues while potentially modulating immune responses and inhibiting tumor growth. LDR stimulates both innate and adaptive immunity, enhancing the activity of natural killer cells, dendritic cells, and T cells. However, the mechanisms underlying the effects of LDR on the immune system remain unclear.

Aim: To explore the history, research hotspots, and emerging trends in immune response to LDR literature over the past two decades.

Methods: Publications on immune responses to LDR were retrieved from the Web of Science Core Collection. Bibliometric tools, including CiteSpace and HistCite, were used to identify historical features, active topics, and emerging trends in this field.

Results: Analysis of 1244 publications over the past two decades revealed a significant surge in research on immune responses to LDR, particularly in the last decade. Key journals such as INR J Radiat Biol, Cancers, and Radiat Res published pivotal studies. Citation networks identified key studies by authors like Twyman-Saint Victor C (2015) and Vanpouille-Box C (2017). Keyword analysis revealed hotspots such as ipilimumab, stereotactic body RT, and targeted therapy, possibly identifying future research directions. Temporal variations in keyword clusters and alluvial flow maps illustrate the evolution of research themes over time.

Conclusion: This bibliometric analysis provides valuable insights into the evolution of studies on responses to LDR, highlights research trends, and identifies emerging areas for further investigation.

Background: Tumor deposits (TDs) are an independent predictor of poor prognosis in colorectal cancer (CRC) patients. Enhanced follow-up and treatment monitoring for TD+ patients may improve survival rates and quality of life. However, the detection of TDs relies primarily on postoperative pathological examination, which may have a low detection rate due to sampling limitations.

Aim: To evaluate the spectral computed tomography (CT) parameters of primary tumors and the largest regional lymph nodes (LNs), to determine their value in predicting TDs in CRC.

Methods: A retrospective analysis was conducted which included 121 patients with CRC whose complete spectral CT data were available. Patients were divided into the TDs+ group and the TDs- group on the basis of their pathological results. Spectral CT parameters of the primary CRC lesion and the largest regional LNs were measured, including the normalized iodine concentration (NIC) in both the arterial and venous phases, and the LN-to-primary tumor ratio was calculated. Statistical methods were used to evaluate the diagnostic efficacy of each spectral parameter.

Results: Among the 121 CRC patients, 33 (27.2%) were confirmed to be TDs+. The risk of TDs positivity was greater in patients with positive LN metastasis, higher N stage and elevated carcinoembryonic antigen and cancer antigen 19-9 levels. The NIC (LNs in both the arterial and venous phases), NIC (primary tumors in the venous phase), and the LN-to-primary tumor ratio in both the arterial and venous phases were associated with TDs (P < 0.05). In multivariate logistic regression analysis, the arterial phase LN-to-primary tumor ratio was identified as an independent predictor of TDs, demonstrating the highest diagnostic performance (area under the curve: 0.812, sensitivity: 0.879, specificity: 0.648, cutoff value: 1.145).

Conclusion: The spectral CT parameters of the primary colorectal tumor and the largest regional LNs, especially the LN-to-primary tumor ratio, have significant clinical value in predicting TDs in CRC.

Background: Acromegaly is caused by a pituitary neuroendocrine tumor (PitNET) with excessive production of growth hormone (GH), leading to multisystem complications. Previous studies have identified predictors of disease persistence following surgery and poor response to medical treatment, including tumor size, vertical and horizontal extensions of the adenoma, hyperintensity in T2-weighted magnetic resonance imaging, granulation density, and pre- and postoperative GH and insulin-like growth factor 1 (IGF-1) levels.

Aim: To evaluate PitNET volume as a complementary prognostic factor in patients with acromegaly.

Methods: This is a retrospective descriptive study with an analytical component evaluating the correlation between the volumetric analysis of GH-producing PitNETs, IGF-1 levels before and after surgery, disease control during follow-up, and the line of therapy required for disease control in a cohort of patients treated at two centers: Endocrinology Department of the Central Military Hospital and Centros Médicos Colsanitas, Bogotá, Colombia.

Results: A total of 77 patients with acromegaly (42 men, 35 women) were included in this study. The mean age at diagnosis was 42 years (SD: 12), with a mean disease duration of 9.9 years (SD: 7.2). The mean pituitary tumor volume was 4358 mm³ (SD: 6291, interquartile range [IQR]: 13602). Patients with controlled acromegaly had a mean PitNET volume of 3202 mm³ (SD: 4845, 95%CI: 621-5784) compared to 5513 mm³ (SD: 7447, 95%CI: 1545-9482) in the uncontrolled group (P = 0.15). A PitNET volume exceeding 3697 mm³ was associated with a higher likelihood of requiring third or fourth-line therapy (50% vs 36%; P = 0.03).

Conclusion: PitNET volume was associated with the need for higher-line therapy to manage acromegaly but did not correlate with long-term disease control or with pre- or postsurgical IGF-1 levels. Nevertheless, a trend towards an inverse relationship between tumor volume and future disease control was observed. While macroadenoma classification remains crucial, among patients with macroadenomas, those with a volume exceeding 3697 mm³ could have worse prognosis.

Background: Currently, only tumors classified as LR-5 are considered definitive hepatocellular carcinoma (HCC), and no further pathologic confirmation is required to initiate therapy. Previous studies have shown that the sensitivity of LR-5 is modest, and lesions enhanced by gadoxetic acid (Gd-EOB-DTPA) may exhibit lower sensitivity than those enhanced by Gd-DTPA.

Aim: To identify malignant ancillary features (AFs) that can independently and significantly predict HCC in Liver Imaging Reporting and Data System version 2018, and to develop modified LR-5 criteria to improve diagnostic performance on Gd-EOB-DTPA - enhanced magnetic resonance imaging.

Methods: Imaging data from patients with HCC risk factors who underwent abdominal Gd-EOB-DTPA - enhanced magnetic resonance imaging were collected. Univariate and multivariate logistic regression analyses were performed to determine AFs that could independently and significantly predict HCC. The modified LR-5 criteria involved reclassifying LR-4/LR-3 lesions based on major features combined with independently significant AFs for HCC, or by substituting threshold growth with significant AFs. McNemar's test was used to compare the diagnostic performance of the modified LR-5 criteria.

Results: A total of 244 lesions from 216 patients were included. Transitional phase hypointensity, mild - moderate T2 hyperintensity, and fat in mass (more than adjacent liver) were identified as significant independent predictors of HCC. Using the modified LR-5 criteria (e.g., LR-5-M1: LR-4 + transitional phase hypointensity; LR-5-M4: LR-5 by transitional phase hypointensity instead of threshold growth; LR-5-M5: LR-5 by mild - moderate T2 hyperintensity instead of threshold growth; LR-5-M8: LR-3/LR-4 + any two features of transitional phase hypointensity/mild - moderate T2 hyperintensity/fat in mass), sensitivities were significantly increased (88.5%-89.1%) compared to the standard LR-5 (60.6%; all P values < 0.05), while specificities (84.8%-89.9%) remained largely unchanged (93.7%; all P values > 0.05). The LR-5-M8 criterion achieved the highest sensitivity.

Conclusion: Mild - moderate T2 hyperintensity, transitional phase hypointensity, and fat in mass are independent and significant predictors of HCC malignant AFs. The modified LR-5 criteria can improve sensitivity without significantly reducing specificity.

In this editorial, a commentary on the article by Chang et al has been provided, the course of treatment of anorectal fistulas, especially complex and recurring ones, require accurate diagnostic procedures for determining ideal surgical procedures. Conventional ways of imaging sometimes fall short, offering insufficient insights in aggravated instances. In this editorial, a novel application of hydrogen peroxide-enhanced magnetic resonance imaging (HP-MRI) that promises significant improvements in the imaging of anorectal fistula. Study is based on a retrospective investigation of 60 patients, contrasts the new HP-MRI with conventional diagnostic techniques such as physical examination, trans-perineal ultrasonography and poor spatial resolution MRI. The findings demonstrate HP-MRI's incredible diagnostic performance, with sensitivity and specificity rates of 96.08% and 90.91%, respectively, and unparalleled interobserver agreement (Kappa values ranging from 0.80 to 0.89). It has been a significant advancement for assessment of anorectal fistulas providing a better roadmap for surgical planning, lowering recurrence rates as well as reduced personal and financial burden on patients by reducing the need for repeated treatment and extended hospital stays. The remaining funds can be utilized for treatment of other medical need. Ultimately HP-MRI provides us a healthier & more efficient society by improvising patients well-being & optimized healthcare infrastructure.