RADIOLOGIA最新文献

Diffuse idiopathic skeletal hyperostosis (DISH) is a multifactorial disease with a high prevalence and that is frequently detected incidentally in imaging tests. Most of its diagnostic criteria are focused on axial involvement and more specifically on the spine. However, peripheral involvement in DISH is less well known despite its non insignificant frequency. DISH can be associated with serious complications, the most severe being vertebral fractures in low energy trauma and dysphagia or airway obstruction in cervical involvement. Knowing how to identify the patterns of peripheral involvement of DISH and its complications helps in the radiological and clinical management of patients with this disease.

Purpose

Assess whether contrast-enhanced mammography (CEM) enables an evaluation of the residual size of breast tumours following neoadjuvant systemic therapy (NAST) in patients initially marked with magnetic seed.

Materials and methods

This single-centre prospective study was performed between March 2022 and April 2023 with patients with invasive breast carcinoma and lesional marking with magnetic seed. CEM was performed before and after NAST. The lesion size in CEM after NAST was compared to the pathological examination after surgery. Differences between sizes were evaluated and we determined the diagnostic capability indices.

Results

The breast lesions marked with magnetic seed were successfully localised in the preoperative stage for the 42 patients included in the study and selective surgical excision was also achieved in all cases. Tumour diameter after NAST was determined by comparing enhancement on combined CEM images from before and after NAST. The mean diameter was 13.6 mm while post-surgical pathological examination determined the mean diameter to be 12.9 mm. There were therefore no statistically significant differences between the measurements.

Conclusions

There is a positive correlation and similarity between CEM and pathological examination with regards to the detection of residual disease after NAST, with high specificity and positive predictive value.

Radiology departments have traditionally observed fasting protocols for patients undergoing radiological studies with intravenous contrast. However, there is no scientific evidence to support these protocols.

This practice has potentially harmful consequences, such as interruptions to long-term medication, dehydration, hypoglycaemia, test delays or anxiety, and has no benefits in terms of study interpretation or patient safety.

Numerous studies now suggest the need to review these protocols, as reflected in the updated policies of our specialty's main societies, such as the European Society of Urogenital Radiology (ESUR) and the American College of Radiology (ACR).

In this article, we review the available scientific evidence on this topic, and present our centre's experience of eliminating fasting prior to contrast-enhanced imaging studies.

Inflammatory mastitis of unknown etiology includes the entities periductal mastitis and idiopathic granulomatous mastitis. These relatively uncommon processes usually affect women of childbearing age. They usually present as a palpable mass that is painful on palpation. These lesions have an insidious clinical course and are difficult to diagnose. In some cases, they can resemble malignant disease, especially in some very developed cases where they can resemble inflammatory carcinoma. When considered all together in the appropriate clinical context, the magnetic resonance imaging signs enable us to approach a specific diagnosis. These entities share clinical and radiological characteristics with malignant processes, so biopsies are fundamental to rule out malignancy.

The aim of this work is to provide a diagnostic approach to the potential causes of optic neuropathy, focusing on the radiological findings associated with this pathology. Various etiologies have been identified, including inflammatory and demyelinating optic neuritis, developmental and hereditary diseases, neurodegenerative disorders, infectious conditions, post-traumatic causes, ischemic optic neuropathy (with anterior ischemic optic neuropathy being the most common form), and neoplastic etiologies. Optical coherence tomography and magnetic resonance imaging play a fundamental role in the diagnosis of optic neuropathy, allowing to distinguish patterns of optic nerve involvement. These studies are essential to locate and characterize the different pathologies, increasing the precision of the diagnosis in diseases presenting optic neuropathy as the main symptom. In conclusion, the findings obtained from magnetic resonance imaging are essential in the differential diagnosis of optic nerve diseases, aiding in the localization and characterization of various pathologies affecting either the optic pathway alone or multiple levels of the central nervous system and thereby increasing diagnostic accuracy.

Introduction and objectives

To compare the real time skin dosimeter values at lens between with the lens included in the scan range (orbitomeatal base line [OML]) or without the lens included in the scan range (superior orbitomeatal line [SOML]) at different tube voltages.

Materials and methods

We used three pediatric anthropomorphic phantoms with a 64 detector-row computed tomography (CT) scanner with the OML- or SOML-protocol at different tube voltages during the head CT. A real time skin dosimeter was inserted into the phantom center of the head, and surfaces of the lens. We compared the real time skin dosimeter values at lens between the OML- and SOML-protocol.

Results

There were no significant differences in the real time skin dosimeter values for the head in the scan area for each phantom at different tube voltages between the OML- and SOML-protocol (P > .05 for all phantom). Compared with the OML protocol, it is possible to reduce the real time skin dosimeter values at lens by approximately 80% by using the SOML protocol (P < .05) at all tube voltages. Compared with the OML protocol, it is possible to reduce the real time skin dosimeter values at mammary gland by approximately 20% by using the SOML protocol (P < .05) at all tube voltages.

Conclusions

During the pediatric head CT examination, SOML protocol was possible to reduce the real time skin dosimeter values at lens by approximately 80% compared with OML protocol at all tube voltages.

The examination for the Medical Intern Resident (MIR) is a multiple-choice test aimed at ranking candidates for specialized medical training positions in Spain. The objective of this study is to provide an objective analysis of this test in its 2022 edition as an evaluative tool for discrimination, with a particular focus on the field of radiology and nuclear medicine. The clinical cases associated with radiology images or nuclear medicine pose greater difficulty compared to the rest of the MIR exam questions. Out of the 14 questions related to radiological or nuclear medicine images, six of them exhibit high difficulty, and only 5 out of the 14 questions demonstrate good or excellent discriminatory capacity. While the MIR exam proves to be an excellent discriminatory tool in psychometric terms, the image-related questions show a significant potential for improvement. In order for the image-associated question to exhibit appropriate discrimination, it is essential to minimize irrelevant information, ensure that it complements the clinical information provided in the text without contradicting it, represent the characteristic imaging finding of the disease, utilize the appropriate imaging modality, maintain a moderate difficulty level for the questions, and ensure that the distractors are clearly false.

The European Union is taking the lead globally on the regulation of Artificial Intelligence (AI) and developing important legislation, namely the AI Act. The purpose of this article is to describe this regulation and examine three implications that will affect radiologists. In relation to the ‘risk approach’, AI applications in radiology will be classified as high risk, thus necessitating compliance with a series of requirements and obligations. Secondly, ‘effective radiologist supervision’ involves establishing supervision-automation levels, defining an appropriate degree of authority, and determining how AI recommendations will be documented in the radiological report. Finally, this article examines the different forms of ‘legal liability’ that radiologists may incur in the event of a diagnostic error made by combined radiologist-artificial intelligence.