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Dark-field radiography for the detection of bone microstructure changes in osteoporotic human lumbar spine specimens. 用于检测骨质疏松人体腰椎标本中骨微结构变化的暗视野射线照相术。
IF 3.7 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING Pub Date : 2024-11-04 DOI: 10.1186/s41747-024-00524-3
Jon F Rischewski, Florian T Gassert, Theresa Urban, Johannes Hammel, Alexander Kufner, Christian Braun, Maximilian Lochschmidt, Marcus R Makowski, Daniela Pfeiffer, Alexandra S Gersing, Franz Pfeiffer

Background: Dark-field radiography imaging exploits the wave character of x-rays to measure small-angle scattering on material interfaces, providing structural information with low radiation exposure. We explored the potential of dark-field imaging of bone microstructure to improve the assessment of bone strength in osteoporosis.

Methods: We prospectively examined 14 osteoporotic/osteopenic and 21 non-osteoporotic/osteopenic human cadaveric vertebrae (L2-L4) with a clinical dark-field radiography system, micro-computed tomography (CT), and spectral CT. Dark-field images were obtained in both vertical and horizontal sample positions. Bone microstructural parameters (trabecular number, Tb.N; trabecular thickness, Tb.Th; bone volume fraction, BV/TV; degree of anisotropy, DA) were measured using standard ex vivo micro-CT, while hydroxyapatite density was measured using spectral CT. Correlations were assessed using Spearman rank correlation coefficients.

Results: The measured dark-field signal was lower in osteoporotic/osteopenic vertebrae (vertical position, 0.23 ± 0.05 versus 0.29 ± 0.04, p < 0.001; horizontal position, 0.28 ± 0.06 versus 0.34 ± 0.04, p = 0.003). The dark-field signal from the vertical position correlated significantly with Tb.N (ρ = 0.46, p = 0.005), BV/TV (ρ = 0.45, p = 0.007), DA (ρ = -0.43, p = 0.010), and hydroxyapatite density (ρ = 0.53, p = 0.010). The calculated ratio of vertical/horizontal dark-field signal correlated significantly with Tb.N (ρ = 0.43, p = 0.011), BV/TV (ρ = 0.36, p = 0.032), DA (ρ = -0.51, p = 0.002), and hydroxyapatite density (ρ = 0.42, p = 0.049).

Conclusion: Dark-field radiography is a feasible modality for drawing conclusions on bone microarchitecture in human cadaveric vertebral bone.

Relevance statement: Gaining knowledge of the microarchitecture of bone contributes crucially to predicting bone strength in osteoporosis. This novel radiographic approach based on dark-field x-rays provides insights into bone microstructure at a lower radiation exposure than that of CT modalities.

Key points: Dark-field radiography can give information on bone microstructure with low radiation exposure. The dark-field signal correlated positively with bone microstructure parameters. Dark-field signal correlated negatively with the degree of anisotropy. Dark-field radiography helps to determine the directionality of trabecular loss.

背景:暗场射线成像利用 X 射线的波特性测量材料界面上的小角散射,以较低的辐射暴露提供结构信息。我们探讨了骨微结构暗视野成像在改善骨质疏松症患者骨强度评估方面的潜力:我们使用临床暗视野放射成像系统、微型计算机断层扫描(CT)和光谱 CT 对 14 个骨质疏松症/骨质疏松和 21 个非骨质疏松症/骨质疏松的人体尸体脊椎(L2-L4)进行了前瞻性检查。暗视野图像是在垂直和水平样本位置获得的。骨微结构参数(骨小梁数,Tb.N;骨小梁厚度,Tb.Th;骨体积分数,BV/TV;各向异性程度,DA)使用标准体外显微 CT 测量,羟基磷灰石密度使用光谱 CT 测量。相关性采用斯皮尔曼等级相关系数进行评估:结果:在骨质疏松症/骨质疏松的椎体中,测得的暗视野信号较低(垂直位置,0.23 ± 0.05 对 0.29 ± 0.04,P 结论:暗视野放射成像是一种可行的方法:暗场射线摄影是一种可行的模式,可用于对人体尸体椎骨的骨微观结构得出结论:了解骨的微观结构对预测骨质疏松症患者的骨强度至关重要。这种基于暗视野 X 射线的新型放射学方法可以深入了解骨的微观结构,而且辐射量低于 CT 模式:要点:暗视野X射线摄影能以较低的辐射量提供有关骨微观结构的信息。暗场信号与骨微观结构参数呈正相关。暗场信号与各向异性程度呈负相关。暗场射线照相术有助于确定骨小梁丢失的方向性。
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引用次数: 0
Probing clarity: AI-generated simplified breast imaging reports for enhanced patient comprehension powered by ChatGPT-4o. 探查清晰:由 ChatGPT-4o 支持的人工智能生成的简化乳腺成像报告可提高患者的理解能力。
IF 3.7 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING Pub Date : 2024-10-30 DOI: 10.1186/s41747-024-00526-1
Roberto Maroncelli, Veronica Rizzo, Marcella Pasculli, Federica Cicciarelli, Massimo Macera, Francesca Galati, Carlo Catalano, Federica Pediconi

Background: To assess the reliability and comprehensibility of breast radiology reports simplified by artificial intelligence using the large language model (LLM) ChatGPT-4o.

Methods: A radiologist with 20 years' experience selected 21 anonymized breast radiology reports, 7 mammography, 7 breast ultrasound, and 7 breast magnetic resonance imaging (MRI), categorized according to breast imaging reporting and data system (BI-RADS). These reports underwent simplification by prompting ChatGPT-4o with "Explain this medical report to a patient using simple language". Five breast radiologists assessed the quality of these simplified reports for factual accuracy, completeness, and potential harm with a 5-point Likert scale from 1 (strongly agree) to 5 (strongly disagree). Another breast radiologist evaluated the text comprehension of five non-healthcare personnel readers using a 5-point Likert scale from 1 (excellent) to 5 (poor). Descriptive statistics, Cronbach's α, and the Kruskal-Wallis test were used.

Results: Mammography, ultrasound, and MRI showed high factual accuracy (median 2) and completeness (median 2) across radiologists, with low potential harm scores (median 5); no significant group differences (p ≥ 0.780), and high internal consistency (α > 0.80) were observed. Non-healthcare readers showed high comprehension (median 2 for mammography and MRI and 1 for ultrasound); no significant group differences across modalities (p = 0.368), and high internal consistency (α > 0.85) were observed. BI-RADS 0, 1, and 2 reports were accurately explained, while BI-RADS 3-6 reports were challenging.

Conclusion: The model demonstrated reliability and clarity, offering promise for patients with diverse backgrounds. LLMs like ChatGPT-4o could simplify breast radiology reports, aid in communication, and enhance patient care.

Relevance statement: Simplified breast radiology reports generated by ChatGPT-4o show potential in enhancing communication with patients, improving comprehension across varying educational backgrounds, and contributing to patient-centered care in radiology practice.

Key points: AI simplifies complex breast imaging reports, enhancing patient understanding. Simplified reports from AI maintain accuracy, improving patient comprehension significantly. Implementing AI reports enhances patient engagement and communication in breast imaging.

背景:评估人工智能简化乳腺放射学报告的可靠性和可理解性:评估人工智能使用大型语言模型(LLM)ChatGPT-4o简化的乳腺放射学报告的可靠性和可理解性:一位有 20 年经验的放射科医生选择了 21 份匿名的乳腺放射学报告,其中 7 份是乳腺 X 线照相术,7 份是乳腺超声波检查,7 份是乳腺磁共振成像(MRI),并根据乳腺成像报告和数据系统(BI-RADS)进行了分类。在 ChatGPT-4o 中提示 "用简单的语言向患者解释这份医疗报告",从而简化了这些报告。五位乳腺放射科医生用 1 分(非常同意)到 5 分(非常不同意)的 5 点李克特量表评估了这些简化报告在事实准确性、完整性和潜在危害方面的质量。另一名乳腺放射科医生采用 1 分(优秀)到 5 分(较差)的 5 级李克特量表对五名非医护人员读者的文字理解能力进行了评估。使用了描述性统计、Cronbach's α 和 Kruskal-Wallis 检验:结果:不同放射科医生的乳腺 X 射线照相术、超声波检查和核磁共振成像显示出较高的事实准确性(中位数为 2)和完整性(中位数为 2),潜在危害得分较低(中位数为 5);没有观察到显著的组间差异(p ≥ 0.780)和较高的内部一致性(α > 0.80)。非医疗保健读者的理解能力较高(乳腺 X 射线照相术和核磁共振成像的中位数为 2,超声波为 1);不同模式之间无明显组间差异(p = 0.368),内部一致性较高(α > 0.85)。BI-RADS0、1和2报告得到了准确的解释,而BI-RADS3-6报告则具有挑战性:结论:该模型显示了可靠性和清晰度,为不同背景的患者提供了希望。像 ChatGPT-4o 这样的 LLM 可以简化乳腺放射学报告、帮助沟通并加强患者护理:由 ChatGPT-4o 生成的简化乳腺放射学报告在加强与患者的沟通、提高不同教育背景的患者的理解能力以及在放射学实践中促进以患者为中心的护理方面显示出潜力:人工智能简化了复杂的乳腺成像报告,提高了患者的理解能力。人工智能简化的报告保持了准确性,大大提高了患者的理解能力。实施人工智能报告可提高患者对乳腺成像的参与度和沟通能力。
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引用次数: 0
Deep learning-based segmentation of kidneys and renal cysts on T2-weighted MRI from patients with autosomal dominant polycystic kidney disease. 基于深度学习的常染色体显性多囊肾患者 T2 加权核磁共振成像上的肾脏和肾囊肿分割。
IF 3.7 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING Pub Date : 2024-10-30 DOI: 10.1186/s41747-024-00520-7
Rémi Sore, Pascal Cathier, Anna Sesilia Vlachomitrou, Jérôme Bailleux, Karine Arnaud, Laurent Juillard, Sandrine Lemoine, Olivier Rouvière

Background: Our aim was to train and test a deep learning-based algorithm for automatically segmenting kidneys and renal cysts in patients with autosomal dominant polycystic kidney disease (ADPKD).

Methods: We retrospectively selected all ADPKD patients who underwent renal MRI with coronal T2-weighted imaging at our institution from 2008 to 2022. The 20 most recent examinations constituted the test dataset, to mimic pseudoprospective enrolment. The remaining ones constituted the training dataset to which eight normal renal MRIs were added. Kidneys and cysts ground truth segmentations were performed on coronal T2-weighted images by a junior radiologist supervised by an experienced radiologist. Kidneys and cysts of the 20 test MRIs were segmented by the algorithm and three independent human raters. Segmentations were compared using overlap metrics. The total kidney volume (TKV), total cystic volume (TCV), and cystic index (TCV divided by TKV) were compared using Bland-Altman analysis.

Results: We included 164 ADPKD patients. Dice similarity coefficients ranged from 85.9% to 87.4% between the algorithms and the raters' segmentations and from 84.2% to 86.2% across raters' segmentations. For TCV assessment, the biases ± standard deviations (SD) were 3-19 ± 137-151 mL between the algorithm and the raters, and 22-45 ± 49-57 mL across raters. The algorithm underestimated TKV and TCV in two outliers with TCV > 2800 mL. For cystic index assessment, the biases ± SD were 2.5-6.9% ± 6.7-8.3% between the algorithm and the raters, and 2.1-9.4 ± 7.4-11.6% across raters.

Conclusion: The algorithm's performance fell within the range of inter-rater variability, but large TKV and TCV were underestimated.

Relevance statement: Accurate automated segmentation of the renal cysts will enable the large-scale evaluation of the prognostic value of TCV and cystic index in ADPKD patients. If these biomarkers are prognostic, then automated segmentation will facilitate their use in daily routine.

Key points: Cystic volume is an emerging biomarker in ADPKD. The algorithm's performance in segmenting kidneys and cysts fell within interrater variability. The segmentation of very large cysts, under-represented in the training dataset, needs improvement.

背景:我们的目的是训练和测试一种基于深度学习的算法,用于自动分割常染色体显性多囊肾(ADPKD)患者的肾脏和肾囊肿:我们回顾性地选择了2008年至2022年期间在我院接受冠状T2加权成像肾脏核磁共振检查的所有ADPKD患者。最近的 20 次检查构成测试数据集,以模拟伪回顾性登记。其余的构成训练数据集,并在此基础上添加 8 个正常的肾脏 MRI。一名初级放射科医生在一名经验丰富的放射科医生的指导下,对冠状 T2 加权图像上的肾脏和囊肿进行地面实况分割。20 张测试核磁共振成像的肾脏和囊肿由算法和三位独立的人类评分员进行分割。使用重叠度量对分割结果进行比较。使用Bland-Altman分析比较肾脏总体积(TKV)、囊肿总体积(TCV)和囊肿指数(TCV除以TKV):我们共纳入了 164 名 ADPKD 患者。算法与评分者分段之间的骰子相似系数从85.9%到87.4%不等,评分者分段之间的相似系数从84.2%到86.2%不等。在 TCV 评估中,算法与评分者之间的偏差(± 标准差,SD)为 3-19 ± 137-151 mL,不同评分者之间的偏差(± 标准差,SD)为 22-45 ± 49-57 mL。在 TCV > 2800 mL 的两个异常值中,算法低估了 TKV 和 TCV。在囊肿指数评估方面,算法与评分者之间的偏差(± SD)为 2.5-6.9% ± 6.7-8.3%,不同评分者之间的偏差(± SD)为 2.1-9.4 ± 7.4-11.6%:结论:该算法的性能在评分者之间的变异范围内,但大TKV和TCV被低估了:对肾囊肿进行准确的自动分割将有助于大规模评估 TCV 和囊肿指数在 ADPKD 患者中的预后价值。如果这些生物标志物具有预后价值,那么自动分割将有助于它们在日常工作中的应用:囊肿体积是ADPKD的一种新兴生物标志物。该算法在分割肾脏和囊肿方面的表现在评定者之间存在差异。超大囊肿在训练数据集中所占比例较低,因此需要改进对超大囊肿的分割。
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引用次数: 0
Amide proton transfer-weighted CEST MRI for radiotherapy target delineation of glioblastoma: a prospective pilot study. 用于胶质母细胞瘤放疗靶点划定的酰胺质子转移加权CEST磁共振成像:一项前瞻性试验研究。
IF 3.7 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING Pub Date : 2024-10-30 DOI: 10.1186/s41747-024-00523-4
Patrick L Y Tang, Alejandra Méndez Romero, Remi A Nout, Caroline van Rij, Cleo Slagter, Annemarie T Swaak-Kragten, Marion Smits, Esther A H Warnert

Background: Extensive glioblastoma infiltration justifies a 15-mm margin around the gross tumor volume (GTV) to define the radiotherapy clinical target volume (CTV). Amide proton transfer (APT)-weighted imaging could enable visualization of tumor infiltration, allowing more accurate GTV delineation. We quantified the impact of integrating APT-weighted imaging into GTV delineation of glioblastoma and compared two APT-weighted quantification methods-magnetization transfer ratio asymmetry (MTRasym) and Lorentzian difference (LD) analysis-for target delineation.

Methods: Nine glioblastoma patients underwent an extended imaging protocol prior to radiotherapy, yielding APT-weighted MTRasym and LD maps. From both maps, biological tumor volumes were generated (BTVMTRasym and BTVLD) and added to the conventional GTV to generate biological GTVs (GTVbio,MTRasym and GTVbio,LD). Wilcoxon signed-rank tests were performed for comparisons.

Results: The GTVbio,MTRasym and GTVbio,LD were significantly larger than the conventional GTV (p ≤ 0.022), with a median volume increase of 9.3% and 2.1%, respectively. The GTVbio,MTRasym and GTVbio,LD were significantly smaller than the CTV (p = 0.004), with a median volume reduction of 72.1% and 70.9%, respectively. There was no significant volume difference between the BTVMTRasym and BTVLD (p = 0.074). In three patients, BTVMTRasym delineation was affected by elevated signals at the brain periphery due to residual motion artifacts; this elevation was absent on the APT-weighted LD maps.

Conclusion: Larger biological GTVs compared to the conventional GTV highlight the potential of APT-weighted imaging for radiotherapy target delineation of glioblastoma. APT-weighted LD mapping may be advantageous for target delineation as it may be more robust against motion artifacts.

Relevance statement: The introduction of APT-weighted imaging may, ultimately, enhance visualization of tumor infiltration and eliminate the need for the substantial 15-mm safety margin for target delineation of glioblastoma. This could reduce the risk of radiation toxicity while still effectively irradiating the tumor.

Trial registration: NCT05970757 (ClinicalTrials.gov).

Key points: Integration of APT-weighted imaging into target delineation for radiotherapy is feasible. The integration of APT-weighted imaging yields larger GTVs in glioblastoma. APT-weighted LD mapping may be more robust against motion artifacts than APT-weighted MTRasym.

背景:胶质母细胞瘤的广泛浸润要求在肿瘤总体积(GTV)周围留出15毫米的余量,以确定放疗的临床靶体积(CTV)。酰胺质子转移(APT)加权成像可实现肿瘤浸润的可视化,从而更准确地划分 GTV。我们量化了将 APT 加权成像整合到胶质母细胞瘤 GTV 划分中的影响,并比较了两种 APT 加权量化方法--磁化传递比不对称(MTRasym)和洛伦兹差分(LD)分析--对目标划定的影响:九名胶质母细胞瘤患者在放疗前接受了扩展成像方案,获得了APT加权MTRasym和LD图。根据这两张图生成生物肿瘤体积(BTVMTRasym 和 BTVLD),并与常规 GTV 相加生成生物 GTV(GTVbio,MTRasym 和 GTVbio,LD)。比较结果采用 Wilcoxon 符号秩检验:GTVbio,MTRasym和GTVbio,LD明显大于常规GTV(P≤0.022),体积增加的中位数分别为9.3%和2.1%。GTVbio,MTRasym和GTVbio,LD明显小于CTV(p = 0.004),体积减少的中位数分别为72.1%和70.9%。BTVMTRasym 和 BTVLD 的体积差异不大(p = 0.074)。在三名患者中,BTVMTRasym的划定受到了残留运动伪影导致的大脑外围信号升高的影响;而在APT加权LD图上则没有这种升高:结论:与传统 GTV 相比,更大的生物 GTV 凸显了 APT 加权成像在胶质母细胞瘤放疗靶区划分方面的潜力。APT加权低密度成像在靶点划分方面可能更具优势,因为它对运动伪影的抵抗力更强:APT 加权成像的引入最终可能会增强肿瘤浸润的可视化,并使胶质母细胞瘤的靶区划分不再需要 15 毫米的安全裕度。这可以在有效照射肿瘤的同时降低辐射毒性风险:试验注册:NCT05970757(ClinicalTrials.gov):要点:将APT加权成像整合到放射治疗的靶区划分中是可行的。在胶质母细胞瘤中整合 APT 加权成像可获得更大的 GTV。与 APT 加权 MTRasym 相比,APT 加权 LD 映射对运动伪影的抗干扰能力更强。
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引用次数: 0
Transfer learning classification of suspicious lesions on breast ultrasound: is there room to avoid biopsies of benign lesions? 乳腺超声可疑病变的迁移学习分类:是否有避免良性病变活检的余地?
IF 3.7 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING Pub Date : 2024-10-28 DOI: 10.1186/s41747-024-00480-y
Paolo De Marco, Valerio Ricciardi, Marta Montesano, Enrico Cassano, Daniela Origgi

Background: Breast cancer (BC) is the most common malignancy in women and the second cause of cancer death. In recent years, there has been a strong development in artificial intelligence (AI) applications in medical imaging for several tasks. Our aim was to evaluate the potential of transfer learning with convolutional neural networks (CNNs) in discriminating suspicious breast lesions on ultrasound images.

Methods: Transfer learning performances of five different CNNs (Inception V3, Xception, Densenet121, VGG 16, and ResNet50) were evaluated on a public and on an institutional dataset (526 and 392 images, respectively), customizing the top layers for the specific task. Institutional images were contoured by an expert radiologist and processed to feed the CNNs for training and testing. Postimaging biopsies were used as a reference standard for classification. The area under the receiver operating curve (AUROC) was used to assess diagnostic performance.

Results: Networks performed very well on the public dataset (AUROC 0.938-0.996). The direct generalization to the institutional dataset resulted in lower performances (max AUROC 0.676); however, when tested on BI-RADS 3 and BI-RADS 5 only, results were improved (max AUROC 0.792). Good results were achieved on the institutional dataset (AUROC 0.759-0.818) and, when selecting a threshold of 2% for classification, a sensitivity of 0.983 was obtained for three of five CNNs, with the potential to spare biopsy in 15.3%-18.6% of patients.

Conclusion: In conclusion, transfer learning with CNNs may achieve high sensitivity and might be used as a support tool in managing suspicious breast lesions on ultrasound images.

Relevance statement: Transfer learning is a powerful technique to exploit the performances of well-trained CNNs for image classification. In a clinical scenario, it might be useful for the management of suspicious breast lesions on breast ultrasound, potentially sparing biopsy in a non-negligible number of patients.

Key points: Properly trained CNNs with transfer learning are highly effective in differentiating benign and malignant lesions on breast ultrasound. Setting clinical thresholds increased sensitivity. CNNs might be useful as support tools in managing suspicious lesions on breast ultrasound.

背景:乳腺癌(BC)是女性最常见的恶性肿瘤,也是第二大癌症死因。近年来,人工智能(AI)在医学影像领域的应用得到了蓬勃发展。我们的目的是评估卷积神经网络(CNN)的迁移学习在辨别超声图像上可疑乳腺病变方面的潜力:我们在公共数据集和机构数据集(分别为 526 张和 392 张图像)上评估了五种不同 CNN(Inception V3、Xception、Densenet 121、VGG 16 和 ResNet50)的迁移学习性能,并针对特定任务定制了顶层。机构图像由放射科专家绘制轮廓,并经过处理,为 CNN 的训练和测试提供素材。成像后的活组织切片被用作分类的参考标准。接受者操作曲线下面积(AUROC)用于评估诊断性能:网络在公共数据集上的表现非常好(AUROC 0.938-0.996)。直接推广到机构数据集的结果是性能较低(最大 AUROC 0.676);然而,仅在 BI-RADS 3 和 BI-RADS 5 上测试时,结果有所改善(最大 AUROC 0.792)。在机构数据集上取得了良好的结果(AUROC 0.759-0.818),当选择 2% 的分类阈值时,五个 CNN 中的三个灵敏度达到了 0.983,有可能使 15.3%-18.6% 的患者免于活检:总之,利用 CNN 进行迁移学习可获得较高的灵敏度,可作为一种辅助工具用于管理超声图像上的可疑乳腺病变:迁移学习是一种强大的技术,可利用训练有素的 CNN 的性能进行图像分类。在临床应用中,它可能有助于处理乳腺超声图像上的可疑乳腺病变,从而使相当数量的患者免于活检:要点:经过适当训练的具有迁移学习能力的 CNN 在区分乳腺超声良性和恶性病变方面非常有效。设置临床阈值可提高灵敏度。在管理乳腺超声可疑病变时,CNN 可能是有用的辅助工具。
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引用次数: 0
Ultrasound-guided cryoablation of early breast cancer: safety, technical efficacy, patients' satisfaction, and outcome prediction with MRI/CEM: a pilot case-control study. 超声引导下的早期乳腺癌冷冻消融:安全性、技术疗效、患者满意度以及磁共振成像/CEM的结果预测:一项试点病例对照研究。
IF 3.7 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING Pub Date : 2024-10-22 DOI: 10.1186/s41747-024-00515-4
Francesca Galati, Marcella Pasculli, Roberto Maroncelli, Veronica Rizzo, Giuliana Moffa, Bruna Cerbelli, Giulia d'Amati, Carlo Catalano, Federica Pediconi

Background: This pilot prospective study aimed to evaluate ultrasound-guided cryoablation of breast cancer (BC) by assessing: (i) technical efficacy as the presence of necrosis in surgical specimens and rate of complete tumor ablation; (ii) safety as incidence and severity of complications; and (iii) patients' satisfaction using a dedicated questionnaire. In addition, (iv) we tested the capability of magnetic resonance imaging (MRI) or contrast-enhanced mammography (CEM) to predict cryoablation efficacy.

Methods: From 07/2022 to 01/2023, we enrolled 20 patients with early-stage BC scheduled for breast surgery. Ten of them, with a cryo-feasible cancer location, were sent to cryoablation (cryo-group) and ten to routine surgical practice (control group). Both groups underwent surgery and were asked to answer a satisfaction questionnaire.

Results: Of eleven patients screened for cryoablation, only one refused to be treated at another hospital (acceptance rate 10/11, 91%). Surgery was quadrantectomy in 19 cases and mastectomy in 1. In the cryo-group, the procedure was completed and steatonecrosis was observed in 10/10 cases, with complete tumor ablation in nine of them. The post-procedural status was evaluated with MRI in five patients, with CEM in four patients, and with ultrasound in one patient who refused MRI and CEM. MRI or CEM correctly predicted complete cryoablation in eight patients and incomplete cryoablation in one patient. Patients in both groups did not have serious complications and responded positively to satisfaction questionnaires.

Conclusion: Ultrasound-guided cryoablation of early-stage BC is well accepted by patients, effective, and safe. MRI and CEM were able to predict the procedure's technical efficacy.

Trial registration: https://clinicaltrials.gov/study/NCT05727813 updated February 14, 2023.

Relevance statement: Our pilot study showed that ultrasound-guided cryoablation is a promising nonsurgical alternative for treating early-stage BC.

Key points: Ultrasound-guided cryoablation was effective and safe in early BC patients. The procedure was well-tolerated, with low morbidity and high patient satisfaction. MRI and CEM predicted cryoablation efficacy, in accordance with histopathologic findings. Cryoablation can be considered a potential alternative to surgery in selected patients.

研究背景这项试验性前瞻性研究旨在通过评估:(i) 技术疗效,即手术标本是否出现坏死和肿瘤完全消融率;(ii) 安全性,即并发症的发生率和严重程度;(iii) 使用专用问卷调查患者的满意度,对乳腺癌(BC)的超声引导下冷冻消融术进行评估。此外,(iv) 我们还测试了磁共振成像(MRI)或对比增强乳腺造影术(CEM)预测冷冻消融疗效的能力:方法:2022 年 7 月至 2023 年 1 月,我们招募了 20 名计划进行乳腺手术的早期 BC 患者。其中10名患者的癌变部位可进行冷冻消融(冷冻组),10名患者进行常规手术(对照组)。两组患者均接受了手术,并被要求回答满意度问卷:在接受冷冻消融术的 11 名患者中,只有一人拒绝在其他医院接受治疗(接受率为 10/11,91%)。在冷冻组中,10/10 的患者完成了手术并观察到了脂肪坏死,其中 9 例完全消融了肿瘤。对 5 例患者进行了核磁共振成像评估,对 4 例患者进行了 CEM 评估,对 1 例拒绝接受核磁共振成像和 CEM 的患者进行了超声波评估。核磁共振成像或 CEM 正确预测了 8 名患者的完全冷冻消融和 1 名患者的不完全冷冻消融。两组患者均未出现严重并发症,并对满意度调查问卷做出了积极回应:结论:超声引导下的早期 BC 冷冻消融术被患者广泛接受,有效且安全。核磁共振成像和CEM能够预测手术的技术疗效。试验注册:https://clinicaltrials.gov/study/NCT05727813,更新日期:2023年2月14日。相关声明:我们的试验研究表明,超声引导下冷冻消融术是治疗早期BC的一种很有前景的非手术疗法:要点:超声引导下冷冻消融术对早期BC患者有效且安全。手术耐受性良好,发病率低,患者满意度高。磁共振成像和CEM与组织病理学结果一致,可预测冷冻消融的疗效。冷冻消融术可被视为选定患者手术的潜在替代方案。
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引用次数: 0
Quantitative ultrasound assessment of fatty infiltration of the rotator cuff muscles using backscatter coefficient. 利用反向散射系数对肩袖肌肉的脂肪浸润进行定量超声评估。
IF 3.7 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING Pub Date : 2024-10-22 DOI: 10.1186/s41747-024-00522-5
Marco Toto-Brocchi, Yuanshan Wu, Saeed Jerban, Aiguo Han, Michael Andre, Sameer B Shah, Eric Y Chang

Background: To prospectively evaluate ultrasound backscatter coefficients (BSCs) of the supraspinatus and infraspinatus muscles and compare with Goutallier classification on magnetic resonance imaging (MRI).

Methods: Fifty-six participants had shoulder MRI exams and ultrasound exams of the supraspinatus and infraspinatus muscles. Goutallier MRI grades were determined and BSCs were measured. Group means were compared and the strength of relationships between the measures were determined. Using binarized Goutallier groups (0-2 versus 3-4), areas under the receiver operating characteristic curves (AUROCs) were calculated. The nearest integer cutoff value was determined using Youden's index.

Results: BSC values were significantly different among most Goutallier grades for the supraspinatus and infraspinatus muscles (both p < 0.001). Strong correlations were found between the BSC values and Goutallier grades for the supraspinatus (τb = 0.72, p < 0.001) and infraspinatus (τb = 0.79, p < 0.001) muscles. BSC showed excellent performance for classification of the binarized groups (0-2 versus 3-4) for both supraspinatus (AUROC = 0.98, p < 0.0001) and infraspinatus (AUROC = 0.98, p < 0.0001) muscles. Using a cutoff BSC value of -17 dB, sensitivity, specificity, and accuracy for severe fatty infiltration were 87.0%, 90.0%, and 87.5% for the supraspinatus muscle, and 93.6%, 87.5%, and 92.7% for the infraspinatus muscle.

Conclusion: BSC can be applied to the rotator cuff muscles for assessment of fatty infiltration. For both the supraspinatus and infraspinatus muscles, BSC values significantly increased with higher Goutallier grades and showed strong performance in distinguishing low versus high Goutallier grades.

Relevance statement: Fatty infiltration of the rotator cuff muscles can be quantified using BSC values, which are higher with increasing Goutallier grades.

Key points: Ultrasound BSC measurements are reliable for the quantification of muscle fatty infiltration. BCS values increased with higher Goutallier MRI grades. BCS values demonstrated high performance for distinguishing muscle fatty infiltration groups.

背景:前瞻性评估冈上肌和冈下肌的超声波反向散射系数(BSC),并与磁共振成像(MRI)上的Goutallier分类进行比较:方法:56 名参与者接受了肩部核磁共振成像检查和冈上肌与冈下肌超声波检查。确定 Goutallier MRI 分级并测量 BSC。对各组平均值进行比较,并确定测量值之间的关系强度。使用二值化的 Goutallier 组(0-2 与 3-4),计算接收者操作特征曲线下的面积 (AUROC)。使用尤登指数(Youden's index)确定最接近的整数截断值:结果:冈上肌和冈下肌的 BSC 值在大多数 Goutallier 等级之间存在明显差异(均为 p b = 0.72,p b = 0.79,p 结论:冈上肌和冈下肌的 BSC 值在大多数 Goutallier 等级之间存在明显差异(均为 p b = 0.72,p b = 0.79,p 结论):BSC 可用于肩袖肌肉脂肪浸润的评估。对于冈上肌和冈下肌,BSC 值随着 Goutallier 等级的升高而显著增加,并在区分低 Goutallier 等级和高 Goutallier 等级方面表现出色:肩袖肌肉的脂肪浸润可通过 BSC 值进行量化,随着 Goutallier 等级的增加,BSC 值也会增加:要点:超声 BSC 测量是量化肌肉脂肪浸润的可靠方法。BCS值随着Goutallier MRI分级的增加而增加。BCS值在区分肌肉脂肪浸润组别方面表现出很高的性能。
{"title":"Quantitative ultrasound assessment of fatty infiltration of the rotator cuff muscles using backscatter coefficient.","authors":"Marco Toto-Brocchi, Yuanshan Wu, Saeed Jerban, Aiguo Han, Michael Andre, Sameer B Shah, Eric Y Chang","doi":"10.1186/s41747-024-00522-5","DOIUrl":"10.1186/s41747-024-00522-5","url":null,"abstract":"<p><strong>Background: </strong>To prospectively evaluate ultrasound backscatter coefficients (BSCs) of the supraspinatus and infraspinatus muscles and compare with Goutallier classification on magnetic resonance imaging (MRI).</p><p><strong>Methods: </strong>Fifty-six participants had shoulder MRI exams and ultrasound exams of the supraspinatus and infraspinatus muscles. Goutallier MRI grades were determined and BSCs were measured. Group means were compared and the strength of relationships between the measures were determined. Using binarized Goutallier groups (0-2 versus 3-4), areas under the receiver operating characteristic curves (AUROCs) were calculated. The nearest integer cutoff value was determined using Youden's index.</p><p><strong>Results: </strong>BSC values were significantly different among most Goutallier grades for the supraspinatus and infraspinatus muscles (both p < 0.001). Strong correlations were found between the BSC values and Goutallier grades for the supraspinatus (τ<sub>b</sub> = 0.72, p < 0.001) and infraspinatus (τ<sub>b</sub> = 0.79, p < 0.001) muscles. BSC showed excellent performance for classification of the binarized groups (0-2 versus 3-4) for both supraspinatus (AUROC = 0.98, p < 0.0001) and infraspinatus (AUROC = 0.98, p < 0.0001) muscles. Using a cutoff BSC value of -17 dB, sensitivity, specificity, and accuracy for severe fatty infiltration were 87.0%, 90.0%, and 87.5% for the supraspinatus muscle, and 93.6%, 87.5%, and 92.7% for the infraspinatus muscle.</p><p><strong>Conclusion: </strong>BSC can be applied to the rotator cuff muscles for assessment of fatty infiltration. For both the supraspinatus and infraspinatus muscles, BSC values significantly increased with higher Goutallier grades and showed strong performance in distinguishing low versus high Goutallier grades.</p><p><strong>Relevance statement: </strong>Fatty infiltration of the rotator cuff muscles can be quantified using BSC values, which are higher with increasing Goutallier grades.</p><p><strong>Key points: </strong>Ultrasound BSC measurements are reliable for the quantification of muscle fatty infiltration. BCS values increased with higher Goutallier MRI grades. BCS values demonstrated high performance for distinguishing muscle fatty infiltration groups.</p>","PeriodicalId":36926,"journal":{"name":"European Radiology Experimental","volume":null,"pages":null},"PeriodicalIF":3.7,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11496476/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142476720","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Gadolinium-based coronary CT angiography on a clinical photon-counting-detector system: a dynamic circulating phantom study. 临床光子计数探测器系统上的钆基冠状动脉 CT 血管造影:动态循环模型研究。
IF 3.7 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING Pub Date : 2024-10-18 DOI: 10.1186/s41747-024-00501-w
Dmitrij Kravchenko, Chiara Gnasso, U Joseph Schoepf, Milan Vecsey-Nagy, Giuseppe Tremamunno, Jim O'Doherty, Andrew Zhang, Julian A Luetkens, Daniel Kuetting, Ulrike Attenberger, Bernhard Schmidt, Akos Varga-Szemes, Tilman Emrich

Background: Coronary computed tomography angiography (CCTA) offers non-invasive diagnostics of the coronary arteries. Vessel evaluation requires the administration of intravenous contrast. The purpose of this study was to evaluate the utility of gadolinium-based contrast agent (GBCA) as an alternative to iodinated contrast for CCTA on a first-generation clinical dual-source photon-counting-detector (PCD)-CT system.

Methods: A dynamic circulating phantom containing a three-dimensional-printed model of the thoracic aorta and the coronary arteries were used to evaluate injection protocols using gadopentetate dimeglumine at 50%, 100%, 150%, and 200% of the maximum approved clinical dose (0.3 mmol/kg). Virtual monoenergetic image (VMI) reconstructions ranging from 40 keV to 100 keV with 5 keV increments were generated on a PCD-CT. Contrast-to-noise ratio (CNR) was calculated from attenuations measured in the aorta and coronary arteries and noise measured in the background tissue. Attenuation of at least 350 HU was deemed as diagnostic.

Results: The highest coronary attenuation (441 ± 23 HU, mean ± standard deviation) and CNR (29.5 ± 1.5) was achieved at 40 keV and at the highest GBCA dose (200%). There was a systematic decline of attenuation and CNR with higher keV reconstructions and lower GBCA doses. Only reconstructions at 40 and 45 keV at 200% and 40 keV at 150% GBCA dose demonstrated sufficient attenuation above 350 HU.

Conclusion: Current PCD-CT protocols and settings are unsuitable for the use of GBCA for CCTA at clinically approved doses. Future advances to the PCD-CT system including a 4-threshold mode, as well as multi-material decomposition may add new opportunities for k-edge imaging of GBCA.

Relevance statement: Patients allergic to iodine-based contrast media and the future of multicontrast CT examinations would benefit greatly from alternative contrast media, but the utility of GBCA for coronary photon-counting-dector-CT angiography remains limited without further optimization of protocols and scanner settings.

Key points: GBCA-enhanced coronary PCD-CT angiography is not feasible at clinically approved doses. GBCAs have potential applications for the visualization of larger vessels, such as the aorta, on PCD-CT angiography. Higher GBCA doses and lower keV reconstructions achieved higher attenuation values and CNR.

背景:冠状动脉计算机断层扫描血管造影术(CCTA)可对冠状动脉进行无创诊断。血管评估需要静脉注射造影剂。本研究的目的是评估在第一代临床双源光子计数探测器(PCD)-CT 系统上使用钆基造影剂(GBCA)替代碘化造影剂进行 CCTA 的实用性:方法:使用一个包含胸主动脉和冠状动脉三维打印模型的动态循环模型来评估使用钆喷酸二葡胺的注射方案,注射剂量为批准的最大临床剂量(0.3 毫摩尔/千克)的 50%、100%、150% 和 200%。在 PCD-CT 上生成的虚拟单能量图像 (VMI) 重建范围从 40 keV 到 100 keV,增量为 5 keV。根据主动脉和冠状动脉测得的衰减和背景组织测得的噪声计算出对比-噪声比(CNR)。至少 350 HU 的衰减被视为具有诊断意义:结果:在 40 keV 和最高 GBCA 剂量(200%)下,冠状动脉衰减(441 ± 23 HU,平均值 ± 标准偏差)和 CNR(29.5 ± 1.5)最高。衰减和 CNR 随较高的 KeV 重建和较低的 GBCA 剂量而系统性下降。只有 GBCA 剂量为 200% 的 40 和 45 keV 重建以及 GBCA 剂量为 150% 的 40 keV 重建显示出 350 HU 以上的足够衰减:结论:目前的 PCD-CT 方案和设置不适合将 GBCA 用于临床认可剂量的 CCTA。PCD-CT 系统未来的进步包括 4 阈值模式和多材料分解,这可能会为 GBCA 的 k 边成像增加新的机会:对碘基造影剂过敏的患者以及未来的多对比 CT 检查将从替代造影剂中获益匪浅,但如果不进一步优化方案和扫描仪设置,GBCA 在冠状动脉光子计数矢量 CT 血管造影中的应用仍然有限:要点:GBCA 增强冠状动脉 PCD-CT 血管造影在临床认可的剂量下是不可行的。GBCA 有可能应用于 PCD-CT 血管造影对主动脉等较大血管的成像。较高的 GBCA 剂量和较低的 keV 重建可获得较高的衰减值和 CNR。
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引用次数: 0
Correction: Efficacy of compressed sensing and deep learning reconstruction for adult female pelvic MRI at 1.5 T. 更正:压缩传感和深度学习重建技术在 1.5 T 下用于成年女性盆腔磁共振成像的效果。
IF 3.7 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING Pub Date : 2024-10-16 DOI: 10.1186/s41747-024-00521-6
Takahiro Ueda, Kaori Yamamoto, Natsuka Yazawa, Ikki Tozawa, Masato Ikedo, Masao Yui, Hiroyuki Nagata, Masahiko Nomura, Yoshiyuki Ozawa, Yoshiharu Ohno
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引用次数: 0
Quantitative CT imaging and radiation-absorbed dose estimations of 166Ho microspheres: paving the way for clinical application. 166Ho 微球的定量 CT 成像和辐射吸收剂量估算:为临床应用铺平道路。
IF 3.7 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING Pub Date : 2024-10-14 DOI: 10.1186/s41747-024-00511-8
Chiron Morsink, Nienke Klaassen, Gerrit van de Maat, Milou Boswinkel, Alexandra Arranja, Robin Bruggink, Ilva van Houwelingen, Irene Schaafsma, Jan Willem Hesselink, Frank Nijsen, Bas van Nimwegen
<p><strong>Background: </strong>Microbrachytherapy enables high local tumor doses sparing surrounding tissues by intratumoral injection of radioactive holmium-166 microspheres (<sup>166</sup>Ho-MS). Magnetic resonance imaging (MRI) cannot properly detect high local Ho-MS concentrations and single-photon emission computed tomography has insufficient resolution. Computed tomography (CT) is quicker and cheaper with high resolution and previously enabled Ho quantification. We aimed to optimize Ho quantification on CT and to implement corresponding dosimetry.</p><p><strong>Methods: </strong>Two scanners were calibrated for Ho detection using phantoms and multiple settings. Quantification was evaluated in five phantoms and seven canine patients using subtraction and thresholding including influences of the target tissue, injected amounts, acquisition parameters, and quantification volumes. Radiation-absorbed dose estimation was implemented using a three-dimensional <sup>166</sup>Ho specific dose point kernel generated with Monte Carlo simulations.</p><p><strong>Results: </strong>CT calibration showed a near-perfect linear relation between radiodensity (HU) and Ho concentrations for all conditions, with differences between scanners. Ho detection during calibration was higher using lower tube voltages, soft-tissue kernels, and without a scanner detection limit. The most accurate Ho recovery in phantoms was 102 ± 11% using a threshold of mean tissue HU + (2 × standard deviation) and in patients 98 ± 31% using a 100 HU threshold. Thresholding allowed better recovery with less variation and dependency on the volume of interest compared to the subtraction of a single HU reference value. Corresponding doses and histograms were successfully generated.</p><p><strong>Conclusion: </strong>CT quantification and dosimetry of <sup>166</sup>Ho should be considered for further clinical application with on-site validation using radioactive measurements and intra-operative Ho-MS and dose visualizations.</p><p><strong>Relevance statement: </strong>Image-guided holmium-166 microbrachytherapy currently lacks reliable quantification and dosimetry on CT to ensure treatment safety and efficacy, while it is the only imaging modality capable of quantifying high in vivo holmium concentrations.</p><p><strong>Key points: </strong>Local injection of <sup>166</sup>Ho-MS enables high local tumor doses while sparing surrounding tissue. CT enables imaging-based quantification and radiation-absorbed dose estimation of concentrated Ho in vivo, essential for treatment safety and efficacy. Two different CT scanners and multiple acquisition and reconstruction parameters showed near-perfect linearity between radiodensity and Ho concentration. The most accurate Ho recoveries on CT were 102 ± 11% in five phantoms and 98 ± 31% in seven canine patients using thresholding methods. Dose estimations and volume histograms were successfully implemented for clinical application using a dose point kern
背景:微近距离放射治疗通过在瘤内注射放射性钬-166 微球(166Ho-MS),使局部肿瘤剂量高,周围组织不受影响。磁共振成像(MRI)无法正确检测局部高浓度的钬-166MS,单光子发射计算机断层扫描的分辨率也不够高。计算机断层扫描(CT)速度更快,成本更低,分辨率高,以前也能进行 Ho 定量。我们的目标是优化 CT 的 Ho 定量,并实施相应的剂量测定:方法:使用模型和多种设置对两台扫描仪进行了Ho检测校准。使用减法和阈值对五个模型和七名犬类患者进行了定量评估,包括靶组织、注射量、采集参数和定量体积的影响。辐射吸收剂量的估算是通过蒙特卡罗模拟生成的三维 166Ho 特定剂量点核来实现的:CT校准显示,在所有条件下,放射密度(HU)和Ho浓度之间的线性关系接近完美,但扫描仪之间存在差异。使用较低的管电压、软组织内核和无扫描仪检测限制时,校准过程中的 Ho 检测率较高。使用平均组织 HU + (2 × 标准偏差) 的阈值,模型中最准确的 Ho 恢复率为 102 ± 11%;使用 100 HU 的阈值,患者中最准确的 Ho 恢复率为 98 ± 31%。与减去单个 HU 参考值相比,阈值法能更好地恢复 HU 值,且变化较小,对相关容积的依赖性也较小。成功生成了相应的剂量和直方图:结论:166Ho 的 CT 定量和剂量测定应考虑进一步应用于临床,并使用放射性测量和术中 Ho-MS 及剂量可视化进行现场验证:目前,图像引导下的钬-166微近距离治疗缺乏可靠的CT量化和剂量测定,无法确保治疗的安全性和有效性,而CT是唯一能够量化体内高浓度钬的成像方式:要点:166Ho-MS 的局部注射可在局部肿瘤中产生高剂量,同时不损伤周围组织。CT可对体内高浓度钬进行成像量化和辐射吸收剂量估算,这对治疗的安全性和有效性至关重要。两种不同的 CT 扫描仪和多种采集与重建参数显示,放射密度与 Ho 浓度之间近乎完美的线性关系。使用阈值法,CT 上最准确的 Ho 恢复率在五个模型中为 102 ± 11%,在七名犬类患者中为 98 ± 31%。利用基于蒙特卡罗模拟的剂量点核,成功地将剂量估计和体积直方图应用于临床。
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European Radiology Experimental
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