To evaluate the usefulness of radiomics features extracted from ultrasonographic images in diagnosing and predicting the severity of knee osteoarthritis (OA).
Methods
In this single-center, prospective, observational study, radiomics features were extracted from standing radiographs and ultrasonographic images of knees of patients aged 40–85 years with primary medial OA and without OA. Analysis was conducted using LIFEx software (version 7.2.n), ANOVA, and LASSO regression. The diagnostic accuracy of three different models, including a statistical model incorporating background factors and machine learning models, was evaluated.
Results
Among 491 limbs analyzed, 318 were OA and 173 were non-OA cases. The mean age was 72.7 (±8.7) and 62.6 (±11.3) years in the OA and non-OA groups, respectively. The OA group included 81 (25.5 %) men and 237 (74.5 %) women, whereas the non-OA group included 73 men (42.2 %) and 100 (57.8 %) women. A statistical model using the cutoff value of MORPHOLOGICAL_SurfaceToVolumeRatio (IBSI:2PR5) achieved a specificity of 0.98 and sensitivity of 0.47. Machine learning diagnostic models (Model 2) demonstrated areas under the curve (AUCs) of 0.88 (discriminant analysis) and 0.87 (logistic regression), with sensitivities of 0.80 and 0.81 and specificities of 0.82 and 0.80, respectively. For severity prediction, the statistical model using MORPHOLOGICAL_SurfaceToVolumeRatio (IBSI:2PR5) showed sensitivity and specificity values of 0.78 and 0.86, respectively, whereas machine learning models achieved an AUC of 0.92, sensitivity of 0.81, and specificity of 0.85 for severity prediction.
Conclusion
The use of radiomics features in diagnosing knee OA shows potential as a supportive tool for enhancing clinicians' decision-making.
{"title":"Ultrasound-based radiomics and machine learning for enhanced diagnosis of knee osteoarthritis: Evaluation of diagnostic accuracy, sensitivity, specificity, and predictive value","authors":"Takeharu Kiso , Yukinori Okada , Satoru Kawata , Kouta Shichiji , Eiichiro Okumura , Noritaka Hatsumi , Ryohei Matsuura , Masaki Kaminaga , Hikaru Kuwano , Erika Okumura","doi":"10.1016/j.ejro.2025.100649","DOIUrl":"10.1016/j.ejro.2025.100649","url":null,"abstract":"<div><h3>Purpose</h3><div>To evaluate the usefulness of radiomics features extracted from ultrasonographic images in diagnosing and predicting the severity of knee osteoarthritis (OA).</div></div><div><h3>Methods</h3><div>In this single-center, prospective, observational study, radiomics features were extracted from standing radiographs and ultrasonographic images of knees of patients aged 40–85 years with primary medial OA and without OA. Analysis was conducted using LIFEx software (version 7.2.n), ANOVA, and LASSO regression. The diagnostic accuracy of three different models, including a statistical model incorporating background factors and machine learning models, was evaluated.</div></div><div><h3>Results</h3><div>Among 491 limbs analyzed, 318 were OA and 173 were non-OA cases. The mean age was 72.7 (±8.7) and 62.6 (±11.3) years in the OA and non-OA groups, respectively. The OA group included 81 (25.5 %) men and 237 (74.5 %) women, whereas the non-OA group included 73 men (42.2 %) and 100 (57.8 %) women. A statistical model using the cutoff value of MORPHOLOGICAL_SurfaceToVolumeRatio (IBSI:2PR5) achieved a specificity of 0.98 and sensitivity of 0.47. Machine learning diagnostic models (Model 2) demonstrated areas under the curve (AUCs) of 0.88 (discriminant analysis) and 0.87 (logistic regression), with sensitivities of 0.80 and 0.81 and specificities of 0.82 and 0.80, respectively. For severity prediction, the statistical model using MORPHOLOGICAL_SurfaceToVolumeRatio (IBSI:2PR5) showed sensitivity and specificity values of 0.78 and 0.86, respectively, whereas machine learning models achieved an AUC of 0.92, sensitivity of 0.81, and specificity of 0.85 for severity prediction.</div></div><div><h3>Conclusion</h3><div>The use of radiomics features in diagnosing knee OA shows potential as a supportive tool for enhancing clinicians' decision-making.</div></div>","PeriodicalId":38076,"journal":{"name":"European Journal of Radiology Open","volume":"14 ","pages":"Article 100649"},"PeriodicalIF":1.8,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143746739","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}
Pub Date : 2025-04-01DOI: 10.1016/j.ejro.2025.100648
Jari-Pekka Vierula , Harri Merisaari , Jaakko Heikkinen , Tatu Happonen , Aapo Sirén , Jarno Velhonoja , Heikki Irjala , Tero Soukka , Kimmo Mattila , Mikko Nyman , Janne Nurminen , Jussi Hirvonen
Objectives
We assessed risk factors and developed a score to predict intensive care unit (ICU) admissions using MRI findings and clinical data in acute neck infections.
Methods
This retrospective study included patients with MRI-confirmed acute neck infection. Abscess diameters were measured on post-gadolinium T1-weighted Dixon MRI, and specific edema patterns, retropharyngeal (RPE) and mediastinal edema, were assessed on fat-suppressed T2-weighted Dixon MRI. A multivariate logistic regression model identified ICU admission predictors, with risk scores derived from regression coefficients. Model performance was evaluated using the area under the curve (AUC) from receiver operating characteristic analysis. Machine learning models (random forest, XGBoost, support vector machine, neural networks) were tested.
Results
The sample included 535 patients, of whom 373 (70 %) had an abscess, and 62 (12 %) required ICU treatment. Significant predictors for ICU admission were RPE, maximal abscess diameter (≥40 mm), and C-reactive protein (CRP) (≥172 mg/L). The risk score (0−7) (AUC=0.82, 95 % confidence interval [CI] 0.77–0.88) outperformed CRP (AUC=0.73, 95 % CI 0.66–0.80, p = 0.001), maximal abscess diameter (AUC=0.72, 95 % CI 0.64–0.80, p < 0.001), and RPE (AUC=0.71, 95 % CI 0.65–0.77, p < 0.001). The risk score at a cut-off > 3 yielded the following metrics: sensitivity 66 %, specificity 82 %, positive predictive value 33 %, negative predictive value 95 %, accuracy 80 %, and odds ratio 9.0. Discriminative performance was robust in internal (AUC=0.83) and hold-out (AUC=0.81) validations. ML models were not better than regression models.
Conclusions
A risk model incorporating RPE, abscess size, and CRP showed moderate accuracy and high negative predictive value for ICU admissions, supporting MRI’s role in acute neck infections.
{"title":"MRI-based risk factors for intensive care unit admissions in acute neck infections","authors":"Jari-Pekka Vierula , Harri Merisaari , Jaakko Heikkinen , Tatu Happonen , Aapo Sirén , Jarno Velhonoja , Heikki Irjala , Tero Soukka , Kimmo Mattila , Mikko Nyman , Janne Nurminen , Jussi Hirvonen","doi":"10.1016/j.ejro.2025.100648","DOIUrl":"10.1016/j.ejro.2025.100648","url":null,"abstract":"<div><h3>Objectives</h3><div>We assessed risk factors and developed a score to predict intensive care unit (ICU) admissions using MRI findings and clinical data in acute neck infections.</div></div><div><h3>Methods</h3><div>This retrospective study included patients with MRI-confirmed acute neck infection. Abscess diameters were measured on post-gadolinium T1-weighted Dixon MRI, and specific edema patterns, retropharyngeal (RPE) and mediastinal edema, were assessed on fat-suppressed T2-weighted Dixon MRI. A multivariate logistic regression model identified ICU admission predictors, with risk scores derived from regression coefficients. Model performance was evaluated using the area under the curve (AUC) from receiver operating characteristic analysis. Machine learning models (random forest, XGBoost, support vector machine, neural networks) were tested.</div></div><div><h3>Results</h3><div>The sample included 535 patients, of whom 373 (70 %) had an abscess, and 62 (12 %) required ICU treatment. Significant predictors for ICU admission were RPE, maximal abscess diameter (≥40 mm), and C-reactive protein (CRP) (≥172 mg/L). The risk score (0−7) (AUC=0.82, 95 % confidence interval [CI] 0.77–0.88) outperformed CRP (AUC=0.73, 95 % CI 0.66–0.80, p = 0.001), maximal abscess diameter (AUC=0.72, 95 % CI 0.64–0.80, p < 0.001), and RPE (AUC=0.71, 95 % CI 0.65–0.77, p < 0.001). The risk score at a cut-off > 3 yielded the following metrics: sensitivity 66 %, specificity 82 %, positive predictive value 33 %, negative predictive value 95 %, accuracy 80 %, and odds ratio 9.0. Discriminative performance was robust in internal (AUC=0.83) and hold-out (AUC=0.81) validations. ML models were not better than regression models.</div></div><div><h3>Conclusions</h3><div>A risk model incorporating RPE, abscess size, and CRP showed moderate accuracy and high negative predictive value for ICU admissions, supporting MRI’s role in acute neck infections.</div></div>","PeriodicalId":38076,"journal":{"name":"European Journal of Radiology Open","volume":"14 ","pages":"Article 100648"},"PeriodicalIF":1.8,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143746740","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}
Pub Date : 2025-03-27DOI: 10.1016/j.ejro.2025.100646
Ronald Booij , Pauline de Klerk , Erik Tesselaar , Mischa Woisetschläger , Anne Brandts , Mariëlle Olsthoorn , Jakob van Oldenrijk , Koen Bos , Jörg Schilcher , Edwin H.G. Oei
Purpose
To assess the image quality of the bone-implant interface of acetabular cup implants using photon-counting detector (PCD) CT with and without tin pre-filtration in a clinical setting.
Methods and materials
Twenty-four patients underwent PCD-CT imaging of their total hip replacement (THR). Twelve patients were scanned using 140 kVp and twelve patients using 140 kVp with tin pre-filtration (Sn140 kVp). All scans were acquired with a collimation of 120 × 0.2 mm. The acquired data was reconstructed with different slice thickness (0.2 mm – 0.6 mm) and kernel (Qr) strengths (56, 76, 89) with and without metal artifact reduction (iMAR). Two observers assessed the image quality of the bone-implant interface for the cup based on four image quality criteria. Bone contrast, contrast-to-noise ratio (CNR) of bone/fat and cortical sharpness was performed as quantitative measures.
Results
Image quality was rated highest for 0.2 mm slice thickness and Qr89 kernel across all four criteria for both the 140 kVp and Sn140 kVp by both observers, with a slight preference for the Sn140kVp over the 140 kVp. In all cases and for all image criteria the 0.2 mm/Qr89 was preferred above the Qr76 and Qr56/iMAR for both the 140 kVp and Sn140 kVp by both observers. Quantitative measurements confirmed significantly improved bone contrast as well as cortical sharpness using 0.2 mm/Qr89. Tin pre-filtration did not affect the CNR at 0.2 mm/Qr89 but tended to decrease cortical sharpness.
Conclusions
High resolution PCD-CT allows for in-vivo assessment of the bone-implant interface in patients with THR and is preferably acquired with tin pre-filtration.
{"title":"Assessment of bone-implant interface image quality for in-vivo acetabular cup implants using photon-counting detector CT: Impact of tin pre-filtration","authors":"Ronald Booij , Pauline de Klerk , Erik Tesselaar , Mischa Woisetschläger , Anne Brandts , Mariëlle Olsthoorn , Jakob van Oldenrijk , Koen Bos , Jörg Schilcher , Edwin H.G. Oei","doi":"10.1016/j.ejro.2025.100646","DOIUrl":"10.1016/j.ejro.2025.100646","url":null,"abstract":"<div><h3>Purpose</h3><div>To assess the image quality of the bone-implant interface of acetabular cup implants using photon-counting detector (PCD) CT with and without tin pre-filtration in a clinical setting.</div></div><div><h3>Methods and materials</h3><div>Twenty-four patients underwent PCD-CT imaging of their total hip replacement (THR). Twelve patients were scanned using 140 kVp and twelve patients using 140 kVp with tin pre-filtration (Sn140 kVp). All scans were acquired with a collimation of 120 × 0.2 mm. The acquired data was reconstructed with different slice thickness (0.2 mm – 0.6 mm) and kernel (Qr) strengths (56, 76, 89) with and without metal artifact reduction (iMAR). Two observers assessed the image quality of the bone-implant interface for the cup based on four image quality criteria. Bone contrast, contrast-to-noise ratio (CNR) of bone/fat and cortical sharpness was performed as quantitative measures.</div></div><div><h3>Results</h3><div>Image quality was rated highest for 0.2 mm slice thickness and Qr89 kernel across all four criteria for both the 140 kVp and Sn140 kVp by both observers, with a slight preference for the Sn140kVp over the 140 kVp. In all cases and for all image criteria the 0.2 mm/Qr89 was preferred above the Qr76 and Qr56/iMAR for both the 140 kVp and Sn140 kVp by both observers. Quantitative measurements confirmed significantly improved bone contrast as well as cortical sharpness using 0.2 mm/Qr89. Tin pre-filtration did not affect the CNR at 0.2 mm/Qr89 but tended to decrease cortical sharpness.</div></div><div><h3>Conclusions</h3><div>High resolution PCD-CT allows for in-vivo assessment of the bone-implant interface in patients with THR and is preferably acquired with tin pre-filtration.</div></div>","PeriodicalId":38076,"journal":{"name":"European Journal of Radiology Open","volume":"14 ","pages":"Article 100646"},"PeriodicalIF":1.8,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143705470","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}
Pub Date : 2025-03-25DOI: 10.1016/j.ejro.2025.100645
Elizabet Nikolova , Julia Weber , Giulia Zanetti , Jann Wieler , Thomas Frauenfelder , Andreas Boss , Magda Marcon
Purpose
To evaluate the diagnostic performance of an ABUS in an academic radiology department over the first three years after its implementation.
Methods
In this retrospective study women undergoing ABUS examination for screening and diagnostic purposes between October 2015–2018 were included in case of sufficient follow-up and established diagnosis. Women underwent ABUS + /- mammography in the same day. BI-RADS 1/ 2 cases with cancer diagnosis during follow-up and already visible in the previous exam were considered false negative (FN). BI-RADS 3/4 cases proved benign were considered false positive (FP). FP and number of additional targeted HHUS (addHHUS) were compared over the three years.
Results
1248 women (51.2 ± 11.2 years) were included: 956 (77.3 %) underwent ABUS+mammography; 283 (29.3 %) ABUS only. Mean follow-up ± SD was 53.5 ± 17.8 month. Thirty-three malignancies were present in the investigated exams. In 28/ 33 cases (84.8 %), lesions were classified BI-RADS 4 or 5 and one (3.6 %) lesion was only visible in ABUS. 3/33 malignancies (9 %) were classified BI-RADS 3. 2/33 (6 %) were visible in mammography and ABUS but not recognized and classified BI-RADS 2 (FN rate 6.1 %). Retrospectively, both cases had “retraction phenomenon sign” in the coronal images. BI-RADS 3 and BI-RADS 4 without a malignancy were attributed to 172 (13.8 %) and 14 (1.1 %) cases, respectively corresponding to a FP rate of 15.3 %. The number of FP as well as the number of addHHUS significantly reduced over the three years (both p < 0.001).
Conclusions
After the implementation of an ABUS FP cases and addHHUS reduce over the time.
{"title":"Implementation of an automated breast ultrasound system in an academic radiology department: Lesson learned in the first three years","authors":"Elizabet Nikolova , Julia Weber , Giulia Zanetti , Jann Wieler , Thomas Frauenfelder , Andreas Boss , Magda Marcon","doi":"10.1016/j.ejro.2025.100645","DOIUrl":"10.1016/j.ejro.2025.100645","url":null,"abstract":"<div><h3>Purpose</h3><div>To evaluate the diagnostic performance of an ABUS in an academic radiology department over the first three years after its implementation.</div></div><div><h3>Methods</h3><div>In this retrospective study women undergoing ABUS examination for screening and diagnostic purposes between October 2015–2018 were included in case of sufficient follow-up and established diagnosis. Women underwent ABUS + /- mammography in the same day. BI-RADS 1/ 2 cases with cancer diagnosis during follow-up and already visible in the previous exam were considered false negative (FN). BI-RADS 3/4 cases proved benign were considered false positive (FP). FP and number of additional targeted HHUS (addHHUS) were compared over the three years.</div></div><div><h3>Results</h3><div>1248 women (51.2 ± 11.2 years) were included: 956 (77.3 %) underwent ABUS+mammography; 283 (29.3 %) ABUS only. Mean follow-up ± SD was 53.5 ± 17.8 month. Thirty-three malignancies were present in the investigated exams. In 28/ 33 cases (84.8 %), lesions were classified BI-RADS 4 or 5 and one (3.6 %) lesion was only visible in ABUS. 3/33 malignancies (9 %) were classified BI-RADS 3. 2/33 (6 %) were visible in mammography and ABUS but not recognized and classified BI-RADS 2 (FN rate 6.1 %). Retrospectively, both cases had “retraction phenomenon sign” in the coronal images. BI-RADS 3 and BI-RADS 4 without a malignancy were attributed to 172 (13.8 %) and 14 (1.1 %) cases, respectively corresponding to a FP rate of 15.3 %. The number of FP as well as the number of addHHUS significantly reduced over the three years (both p < 0.001).</div></div><div><h3>Conclusions</h3><div>After the implementation of an ABUS FP cases and addHHUS reduce over the time.</div></div>","PeriodicalId":38076,"journal":{"name":"European Journal of Radiology Open","volume":"14 ","pages":"Article 100645"},"PeriodicalIF":1.8,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143687569","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}
Pub Date : 2025-03-24DOI: 10.1016/j.ejro.2025.100647
Jack Porrino , Eric Marten , Michael L. Richardson , Jay Moran , Colby Shreve , Hyojeong Lee , Andrew Haims
Objective
A ramp lesion describes injury at the junction of the posterior horn medial meniscus and posteromedial joint capsule occurring with anterior cruciate ligament deficiency. We sought to apply the consensus of the literature’s description of a ramp lesion on MRI (fluid signal interposed between the posterior medial meniscus and adjacent capsule) to a general population to determine how often this “abnormality” is present on routine MRI and help clarify its specificity.
Material and methods
100 consecutive MRI knee studies were retrospectively reviewed by 2 radiologists and in binary fashion characterized as either having features of a ramp lesion or normal appearance. If a ramp lesion was present, the lesion was subclassified according to the Thanaut et al. classification. Patient age, laterality, sex, clinical indication, and ancillary findings on MRI were recorded.
Results
Thirty-five of 100 (35 %) knees had MRI findings suggesting a ramp lesion with 31/35 (88.6 %) most consistent with a Thanaut et al. type 1. Only 7 of the 35 (20 %) with ramp lesion had ACL insufficiency. Age (p = 0.00044), right laterality (p = 0.019), and female sex (p = 0.029) were statistically associated with this lesion. There was no association with clinical history indicating recent trauma (p = 0.2399).
Conclusion
The appearance of the meniscocapsular junction of the posterior horn medial meniscus may be more varied than the literature discussing ramp lesions suggests. Most notably, fluid interposed between the posterior horn medial meniscus and adjacent posteromedial capsule is not uncommon in those undergoing knee MRI and appears to be nonspecific.
{"title":"Variability of the posteromedial meniscocapsular junction of the knee on MRI: Pitfall to imaging diagnosis of ramp lesions","authors":"Jack Porrino , Eric Marten , Michael L. Richardson , Jay Moran , Colby Shreve , Hyojeong Lee , Andrew Haims","doi":"10.1016/j.ejro.2025.100647","DOIUrl":"10.1016/j.ejro.2025.100647","url":null,"abstract":"<div><h3>Objective</h3><div>A ramp lesion describes injury at the junction of the posterior horn medial meniscus and posteromedial joint capsule occurring with anterior cruciate ligament deficiency. We sought to apply the consensus of the literature’s description of a ramp lesion on MRI (fluid signal interposed between the posterior medial meniscus and adjacent capsule) to a general population to determine how often this “abnormality” is present on routine MRI and help clarify its specificity.</div></div><div><h3>Material and methods</h3><div>100 consecutive MRI knee studies were retrospectively reviewed by 2 radiologists and in binary fashion characterized as either having features of a ramp lesion or normal appearance. If a ramp lesion was present, the lesion was subclassified according to the Thanaut et al. classification. Patient age, laterality, sex, clinical indication, and ancillary findings on MRI were recorded.</div></div><div><h3>Results</h3><div>Thirty-five of 100 (35 %) knees had MRI findings suggesting a ramp lesion with 31/35 (88.6 %) most consistent with a Thanaut et al. type 1. Only 7 of the 35 (20 %) with ramp lesion had ACL insufficiency. Age (p = 0.00044), right laterality (p = 0.019), and female sex (p = 0.029) were statistically associated with this lesion. There was no association with clinical history indicating recent trauma (p = 0.2399).</div></div><div><h3>Conclusion</h3><div>The appearance of the meniscocapsular junction of the posterior horn medial meniscus may be more varied than the literature discussing ramp lesions suggests. Most notably, fluid interposed between the posterior horn medial meniscus and adjacent posteromedial capsule is not uncommon in those undergoing knee MRI and appears to be nonspecific.</div></div>","PeriodicalId":38076,"journal":{"name":"European Journal of Radiology Open","volume":"14 ","pages":"Article 100647"},"PeriodicalIF":1.8,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143687567","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}
Pub Date : 2025-03-20DOI: 10.1016/j.ejro.2025.100644
Inácio Freitas , Carolina Soares-Aquino , Pedro Sá , Ana Catarina Silva , Damjana Ključevšek , Sílvia Costa Dias
Pediatric gonadal torsion is a critical surgical emergency requiring immediate diagnosis and intervention to preserve reproductive capabilities. This review addresses the diagnostic challenges, imaging patterns, and management strategies for both ovarian and testicular torsion, including a brief discussion on the emerging role of Contrast-Enhanced Ultrasound (CEUS), therefore filling a significant gap in the literature. We emphasize the need for a high index of suspicion due to often nonspecific clinical presentations, particularly in ovarian torsion. An accurate and swift diagnosis allows conservative surgical intervention to be offered, which is crucial to maximize gonadal salvage and minimize recurrence. While we highlight CEUS's potential benefits in enhancing diagnostic clarity without ionizing radiation, ultrasound and other modalities such as MRI and CT, have a paramount role in this setting. Future research comparing CEUS with MRI is essential to validate its diagnostic accuracy and effectiveness, potentially revolutionizing acute care diagnostics. Incorporating CEUS into diagnostic workflows, along with a deep understanding of the condition's epidemiology, pathophysiology, and clinical presentation, may probably significantly improve patient outcomes. We detail the characteristic imaging features, diagnostic pitfalls, and differential diagnoses essential for radiologists, with particular relevance for residents and those with limited pediatric radiology exposure. This review aims to bridge existing knowledge gaps and serve as a robust educational tool, facilitating better clinical decision-making and outcomes in pediatric gonadal torsion cases.
{"title":"Pediatric gonadal torsion in radiology: A comprehensive literature and pictorial review using surgically proven cases","authors":"Inácio Freitas , Carolina Soares-Aquino , Pedro Sá , Ana Catarina Silva , Damjana Ključevšek , Sílvia Costa Dias","doi":"10.1016/j.ejro.2025.100644","DOIUrl":"10.1016/j.ejro.2025.100644","url":null,"abstract":"<div><div>Pediatric gonadal torsion is a critical surgical emergency requiring immediate diagnosis and intervention to preserve reproductive capabilities. This review addresses the diagnostic challenges, imaging patterns, and management strategies for both ovarian and testicular torsion, including a brief discussion on the emerging role of Contrast-Enhanced Ultrasound (CEUS), therefore filling a significant gap in the literature. We emphasize the need for a high index of suspicion due to often nonspecific clinical presentations, particularly in ovarian torsion. An accurate and swift diagnosis allows conservative surgical intervention to be offered, which is crucial to maximize gonadal salvage and minimize recurrence. While we highlight CEUS's potential benefits in enhancing diagnostic clarity without ionizing radiation, ultrasound and other modalities such as MRI and CT, have a paramount role in this setting. Future research comparing CEUS with MRI is essential to validate its diagnostic accuracy and effectiveness, potentially revolutionizing acute care diagnostics. Incorporating CEUS into diagnostic workflows, along with a deep understanding of the condition's epidemiology, pathophysiology, and clinical presentation, may probably significantly improve patient outcomes. We detail the characteristic imaging features, diagnostic pitfalls, and differential diagnoses essential for radiologists, with particular relevance for residents and those with limited pediatric radiology exposure. This review aims to bridge existing knowledge gaps and serve as a robust educational tool, facilitating better clinical decision-making and outcomes in pediatric gonadal torsion cases.</div></div>","PeriodicalId":38076,"journal":{"name":"European Journal of Radiology Open","volume":"14 ","pages":"Article 100644"},"PeriodicalIF":1.8,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143687568","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}
Pub Date : 2025-03-15DOI: 10.1016/j.ejro.2025.100643
Da Guo , Liping Liu , Yu Jin
Objectives
This study aims to develop and validate a predictive nomogram for early recurrence in hepatocellular carcinoma (HCC), utilizing gadoxetic acid-enhanced MRI and intravoxel incoherent motion (IVIM) imaging to improve preoperative assessment and decision-making.
Materials and methods
From March 2018 and June 2022, a total of 245 patients with pathologically confirmed HCC, who underwent preoperative gadoxetic acid-enhanced MRI and IVIM, were retrospectively enrolled from two hospitals. These patients were divided into a training cohort (n = 160) and a validation cohort (n = 85). All patients were followed until death or the last follow-up date, with a minimum follow-up period of two years. Clinical indicators and pathologic information were compared between train cohort and validation cohort. Radiological features and diffusion parameters were compared between recurrence and non-recurrence groups using the chi-square test, Mann-Whitney U test and independent sample t test in training cohort. Univariate and multivariate analyses were performed to identify significant clinical-radiological variables associated with early recurrence in the training cohort. Based on these findings, a predictive nomogram integrating risk factors and diffusion parameters was developed. The predictive performance of the nomogram was evaluated in both the training and validation cohorts.
Results
No statistically significant difference in clinical and pathologic characteristics were observed between the training and validation cohorts. In training cohort, significant differences were identified between the recurrence and non-recurrence groups in tumor size, nodule-in-nodule architecture, mosaic architecture, non-smooth tumor margin, intratumor necrosis, satellite nodule, and peritumoral hypo-intensity in the hepatobiliary phase (HBP). The results of multivariate analysis identified tumor size (HR, 1.435; 95 % CI, 0.702–2.026; p < 0.05), mosaic architecture (HR, 0.790; 95 % CI, 0.421–1.480; p < 0.05), non-smooth tumor margin (HR, 1.775; 95 % CI, 0.941–3.273; p < 0.05), intratumor necrosis (HR, 1.414; 95 % CI, 0.807–2.476; p < 0.05), satellite nodule (HR, 0.648; 95 % CI, 0.352–1.191; p < 0.01), peritumoral hypo-intensity on HBP (HR, 2.786; 95 % CI, 1.141–6.802; p < 0.001) and D (HR, 0.658; 95 % CI,0.487–0.889; p < 0.01) were the independent risk factor for recurrence. The nomogram exhibited excellent predictive performance with C-index of 0.913 and 0.875 in the training cohort and validation cohort, respectively. Also, based on the nomogram score, the patients were classified according to risk factor and the Kaplan-Meier curve analysis also showed that the nomogram had a good predictive efficacy.
Conclusion
The nomogram, integrating radiological risk factors and diffusion parameters, offers a reliable tool for preoperative prediction of early
{"title":"Prediction early recurrence of hepatocellular carcinoma after hepatectomy using gadoxetic acid-enhanced MRI and IVIM","authors":"Da Guo , Liping Liu , Yu Jin","doi":"10.1016/j.ejro.2025.100643","DOIUrl":"10.1016/j.ejro.2025.100643","url":null,"abstract":"<div><h3>Objectives</h3><div>This study aims to develop and validate a predictive nomogram for early recurrence in hepatocellular carcinoma (HCC), utilizing gadoxetic acid-enhanced MRI and intravoxel incoherent motion (IVIM) imaging to improve preoperative assessment and decision-making.</div></div><div><h3>Materials and methods</h3><div>From March 2018 and June 2022, a total of 245 patients with pathologically confirmed HCC, who underwent preoperative gadoxetic acid-enhanced MRI and IVIM, were retrospectively enrolled from two hospitals. These patients were divided into a training cohort (n = 160) and a validation cohort (n = 85). All patients were followed until death or the last follow-up date, with a minimum follow-up period of two years. Clinical indicators and pathologic information were compared between train cohort and validation cohort. Radiological features and diffusion parameters were compared between recurrence and non-recurrence groups using the chi-square test, Mann-Whitney U test and independent sample t test in training cohort. Univariate and multivariate analyses were performed to identify significant clinical-radiological variables associated with early recurrence in the training cohort. Based on these findings, a predictive nomogram integrating risk factors and diffusion parameters was developed. The predictive performance of the nomogram was evaluated in both the training and validation cohorts.</div></div><div><h3>Results</h3><div>No statistically significant difference in clinical and pathologic characteristics were observed between the training and validation cohorts. In training cohort, significant differences were identified between the recurrence and non-recurrence groups in tumor size, nodule-in-nodule architecture, mosaic architecture, non-smooth tumor margin, intratumor necrosis, satellite nodule, and peritumoral hypo-intensity in the hepatobiliary phase (HBP). The results of multivariate analysis identified tumor size (HR, 1.435; 95 % CI, 0.702–2.026; p < 0.05), mosaic architecture (HR, 0.790; 95 % CI, 0.421–1.480; p < 0.05), non-smooth tumor margin (HR, 1.775; 95 % CI, 0.941–3.273; p < 0.05), intratumor necrosis (HR, 1.414; 95 % CI, 0.807–2.476; p < 0.05), satellite nodule (HR, 0.648; 95 % CI, 0.352–1.191; p < 0.01), peritumoral hypo-intensity on HBP (HR, 2.786; 95 % CI, 1.141–6.802; p < 0.001) and D (HR, 0.658; 95 % CI,0.487–0.889; p < 0.01) were the independent risk factor for recurrence. The nomogram exhibited excellent predictive performance with C-index of 0.913 and 0.875 in the training cohort and validation cohort, respectively. Also, based on the nomogram score, the patients were classified according to risk factor and the Kaplan-Meier curve analysis also showed that the nomogram had a good predictive efficacy.</div></div><div><h3>Conclusion</h3><div>The nomogram, integrating radiological risk factors and diffusion parameters, offers a reliable tool for preoperative prediction of early ","PeriodicalId":38076,"journal":{"name":"European Journal of Radiology Open","volume":"14 ","pages":"Article 100643"},"PeriodicalIF":1.8,"publicationDate":"2025-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143631869","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}
Pub Date : 2025-03-08DOI: 10.1016/j.ejro.2025.100641
Yue Jiang , Qiuju Hu , Yane Zhao , Dongsheng Jin , Guangming Lu , Tong Chen , Yong Yuan , Wenjing Liu
Background
Coronary magnetic resonance angiography (CMRA) is increasingly used in clinical practice, but lengthy scan times can be challenging for elderly patients. This study evaluates the impact of compressed sensing (CS) technology on image quality and diagnostic performance of 3 T CMRA in elderly patients, aiming to identify the optimal acceleration factor.
Methods
We prospectively enrolled elderly individuals who underwent coronary computed tomography angiography (CCTA) from June to November 2023 for non-contrast whole-heart CMRA with CS acceleration factors of 4, 6, or 8. Elderly volunteers rated their experiences with the optimal acceleration factor. Image quality and diagnostic performance were analyzed using a general linear model and the area under the receiver operating characteristic curves (AUC), with CCTA as the reference standard.
Results
Sixty-seven individuals (34 men, mean age 74.3 ± 7.2 years) were enrolled. Scan times significantly decreased from 578.6 ± 131.4 s to 366.1 ± 91.2 s and 261.1 ± 76.5 s for acceleration factors 4, 6, and 8, respectively. Subjective image quality scores, signal-to-noise ratio, and contrast-to-noise ratio were significantly better with CS4 and CS6 than with CS8. Diagnostic performance declined with increasing acceleration, with sensitivities of 92.2 %, 88.0 %, and 72.5 %, and specificities of 94.1 %, 92.6 %, and 85.3 % for CS4, CS6, and CS8, respectively. CS6 was determined to be the optimal acceleration factor. Volunteers reported that CS6 was more acceptable than CS4.
Conclusions
CMRA with CS6 provides rapid scanning while maintaining adequate diagnostic performance, making it a reliable alternative to CCTA for diagnosing coronary artery disease in elderly patients.
{"title":"3D non-contrast whole‑heart coronary MR angiography at 3 T with compressed sensing in elderly patients: Optimization of the acceleration factor","authors":"Yue Jiang , Qiuju Hu , Yane Zhao , Dongsheng Jin , Guangming Lu , Tong Chen , Yong Yuan , Wenjing Liu","doi":"10.1016/j.ejro.2025.100641","DOIUrl":"10.1016/j.ejro.2025.100641","url":null,"abstract":"<div><h3>Background</h3><div>Coronary magnetic resonance angiography (CMRA) is increasingly used in clinical practice, but lengthy scan times can be challenging for elderly patients. This study evaluates the impact of compressed sensing (CS) technology on image quality and diagnostic performance of 3 T CMRA in elderly patients, aiming to identify the optimal acceleration factor.</div></div><div><h3>Methods</h3><div>We prospectively enrolled elderly individuals who underwent coronary computed tomography angiography (CCTA) from June to November 2023 for non-contrast whole-heart CMRA with CS acceleration factors of 4, 6, or 8. Elderly volunteers rated their experiences with the optimal acceleration factor. Image quality and diagnostic performance were analyzed using a general linear model and the area under the receiver operating characteristic curves (AUC), with CCTA as the reference standard.</div></div><div><h3>Results</h3><div>Sixty-seven individuals (34 men, mean age 74.3 ± 7.2 years) were enrolled. Scan times significantly decreased from 578.6 ± 131.4 s to 366.1 ± 91.2 s and 261.1 ± 76.5 s for acceleration factors 4, 6, and 8, respectively. Subjective image quality scores, signal-to-noise ratio, and contrast-to-noise ratio were significantly better with CS4 and CS6 than with CS8. Diagnostic performance declined with increasing acceleration, with sensitivities of 92.2 %, 88.0 %, and 72.5 %, and specificities of 94.1 %, 92.6 %, and 85.3 % for CS4, CS6, and CS8, respectively. CS6 was determined to be the optimal acceleration factor. Volunteers reported that CS6 was more acceptable than CS4.</div></div><div><h3>Conclusions</h3><div>CMRA with CS6 provides rapid scanning while maintaining adequate diagnostic performance, making it a reliable alternative to CCTA for diagnosing coronary artery disease in elderly patients.</div></div>","PeriodicalId":38076,"journal":{"name":"European Journal of Radiology Open","volume":"14 ","pages":"Article 100641"},"PeriodicalIF":1.8,"publicationDate":"2025-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143578056","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}
Pub Date : 2025-03-07DOI: 10.1016/j.ejro.2025.100642
Carrie Wang , Purvish Trivedi , Esther Katende , Varun Awasthi , Riley Smith , Ryan Putney , Yahya Bondokji , Jong Y. Park , Jasreman Dhillon , Kosj Yamoah
Background
Traditional ultrasonography-based prostate biopsy uses a transrectal approach for systematic sampling of 12 cores. The magnetic resonance imaging (MRI) fusion biopsy uses a targeted approach, first identifying regions of interest (ROI) clinically suspicious for prostate cancer (PCa) through MRI, before performing a prostate biopsy aided by ultrasonography.
Methods
The single-center institutional retrospective cohort study used 442 men who were recommended for localized PCa management. Cohort A (n = 346) comprised patients who underwent MRI-guided TRUS biopsies, which included both standard 12-core TRUS biopsies and MRI-targeted biopsies performed simultaneously. Cohort B (n = 96) comprised patients who received only standard TRUS biopsy. The primary endpoint was Gleason reclassification, defined as the change in Gleason scores between standard TRUS and targeted region-of-interest (ROI) biopsies among cohort A. Secondary endpoint assessed the role of ROI biopsies in mitigating overtreatment by analyzing the probability of undergoing treatment and the duration of active surveillance (AS).
Results
Among men classified as no tumor on standard biopsy, 16.9 % showed Gleason disease on subsequent ROI biopsy. Additionally, ROI group also had a longer time to receive primary treatment (P = .017), as they were more likely to opt for AS (54 %). Lastly, median time spent on AS was longer for the ROI group compared with the non-ROI cohort (P = .002).
Conclusion
Adding multiparametric MRI (mpMRI) biopsy to standard TRUS biopsy may increase the detection of PCa. Additionally, mpMRI may allow patients to remain safely on AS, thereby reducing the need of prostate biopsies and improving cost-effectiveness.
{"title":"Role of region-of-interest magnetic resonance imaging fusion biopsy in mitigating overtreatment of localized prostate cancer – A retrospective cohort study","authors":"Carrie Wang , Purvish Trivedi , Esther Katende , Varun Awasthi , Riley Smith , Ryan Putney , Yahya Bondokji , Jong Y. Park , Jasreman Dhillon , Kosj Yamoah","doi":"10.1016/j.ejro.2025.100642","DOIUrl":"10.1016/j.ejro.2025.100642","url":null,"abstract":"<div><h3>Background</h3><div>Traditional ultrasonography-based prostate biopsy uses a transrectal approach for systematic sampling of 12 cores. The magnetic resonance imaging (MRI) fusion biopsy uses a targeted approach, first identifying regions of interest (ROI) clinically suspicious for prostate cancer (PCa) through MRI, before performing a prostate biopsy aided by ultrasonography.</div></div><div><h3>Methods</h3><div>The single-center institutional retrospective cohort study used 442 men who were recommended for localized PCa management. Cohort A (n = 346) comprised patients who underwent MRI-guided TRUS biopsies, which included both standard 12-core TRUS biopsies and MRI-targeted biopsies performed simultaneously. Cohort B (n = 96) comprised patients who received only standard TRUS biopsy. The primary endpoint was Gleason reclassification, defined as the change in Gleason scores between standard TRUS and targeted region-of-interest (ROI) biopsies among cohort A. Secondary endpoint assessed the role of ROI biopsies in mitigating overtreatment by analyzing the probability of undergoing treatment and the duration of active surveillance (AS).</div></div><div><h3>Results</h3><div>Among men classified as no tumor on standard biopsy, 16.9 % showed Gleason disease on subsequent ROI biopsy. Additionally, ROI group also had a longer time to receive primary treatment (<em>P</em> = .017), as they were more likely to opt for AS (54 %). Lastly, median time spent on AS was longer for the ROI group compared with the non-ROI cohort (<em>P</em> = .002).</div></div><div><h3>Conclusion</h3><div>Adding multiparametric MRI (mpMRI) biopsy to standard TRUS biopsy may increase the detection of PCa. Additionally, mpMRI may allow patients to remain safely on AS, thereby reducing the need of prostate biopsies and improving cost-effectiveness.</div></div>","PeriodicalId":38076,"journal":{"name":"European Journal of Radiology Open","volume":"14 ","pages":"Article 100642"},"PeriodicalIF":1.8,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143563569","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}
Pub Date : 2025-02-27DOI: 10.1016/j.ejro.2025.100640
Lijing Xin , Philippe Reymond , José Boto , Frederic Grouiller , Serge Vulliemoz , Francois Lazeyras , Maria Isabel Vargas
Background and purpose
This study aims to evaluate the neurochemical characteristics of pathological tissues by 1H magnetic resonance spectroscopy (MRS) in patient with pharmaco-resistant focal epilepsy at 7 T.
Methods
Thirteen patients with drug-resistant epilepsy and focal seizure successfully underwent MRS examinations at 7 T MRI scanners. 1H MR spectra were acquired from two voxels (lesion side and contralateral side) using the semi-adiabatic spin-echo full-intensity localized spectroscopy (sSPECIAL) sequence. Metabolite levels were quantified from LCModel and reported as to total creatine ratio.
Results
In comparison to the contralateral side, lesions in focal cortical dysplasia demonstrated significantly reduced macromolecule and N-acetyl aspartate, significantly increased total choline and glycine + myo-inositol, and a distinct reduction trend of glutamate.
Conclusions
We conclude that performing MRS at high magnetic field offered the potential to reveal metabolic alterations in epilepsy lesions that may help to further understand the underlying pathophysiology of the disease.
背景与目的本研究旨在通过1H磁共振波谱（MRS）评价7 T时耐药局灶性癫痫患者病理组织的神经化学特征。方法对13例耐药癫痫伴局灶性发作患者在7台 T MRI扫描机上进行MRS检查。利用半绝热自旋回波全强度局部化光谱（sSPECIAL）序列，获得了两个体素（病变侧和对侧）的1H磁共振光谱。从LCModel中量化代谢产物水平，并报告总肌酸比。结果局灶性皮质发育不良病变与对侧比较，大分子和n -乙酰天冬氨酸显著降低，总胆碱和甘氨酸+ 肌醇显著升高，谷氨酸有明显降低趋势。结论：在高磁场下进行MRS有可能揭示癫痫病变的代谢改变，这可能有助于进一步了解该病的潜在病理生理。
{"title":"Neurochemical characteristics of pathological tissues in epilepsy: A preliminary 1H MR spectroscopy study at 7 T","authors":"Lijing Xin , Philippe Reymond , José Boto , Frederic Grouiller , Serge Vulliemoz , Francois Lazeyras , Maria Isabel Vargas","doi":"10.1016/j.ejro.2025.100640","DOIUrl":"10.1016/j.ejro.2025.100640","url":null,"abstract":"<div><h3>Background and purpose</h3><div>This study aims to evaluate the neurochemical characteristics of pathological tissues by <sup>1</sup>H magnetic resonance spectroscopy (MRS) in patient with pharmaco-resistant focal epilepsy at 7 T.</div></div><div><h3>Methods</h3><div>Thirteen patients with drug-resistant epilepsy and focal seizure successfully underwent MRS examinations at 7 T MRI scanners. <sup>1</sup>H MR spectra were acquired from two voxels (lesion side and contralateral side) using the semi-adiabatic spin-echo full-intensity localized spectroscopy (sSPECIAL) sequence. Metabolite levels were quantified from LCModel and reported as to total creatine ratio.</div></div><div><h3>Results</h3><div>In comparison to the contralateral side, lesions in focal cortical dysplasia demonstrated significantly reduced macromolecule and N-acetyl aspartate, significantly increased total choline and glycine + myo-inositol, and a distinct reduction trend of glutamate.</div></div><div><h3>Conclusions</h3><div>We conclude that performing MRS at high magnetic field offered the potential to reveal metabolic alterations in epilepsy lesions that may help to further understand the underlying pathophysiology of the disease.</div></div>","PeriodicalId":38076,"journal":{"name":"European Journal of Radiology Open","volume":"14 ","pages":"Article 100640"},"PeriodicalIF":1.8,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143510250","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}
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