Polish Journal of Radiology最新文献

In recent years, lung ultrasound (LUS) has developed rapidly, and it is growing in popularity in various scenarios. It has become especially popular among clinicians. There are constant attempts to introduce it in new fields, with quite a strong resistance in the radiological community. In addition, knowledge regarding lung and LUS has been augmented by the recent COVID-19 pandemic. Unfortunately, this has led to many misconceptions. The aim of this review is to discuss lines, signs, and phenomena that can be seen in LUS in order to create a single, easily available compendium for radiologists and promote consistency in LUS nomenclature. Some simplified suggestions are presented.

Thermal ablation is a minimally invasive technology used to treat many types of tumors, including lung cancer. Specifically, lung ablation has been increasingly performed for unsurgical fit patients with both early-stage primi-tive lung cancer and pulmonary metastases. Image-guided available techniques include radiofrequency ablation, microwave ablation, cryoablation, laser ablation and irreversible electroporation. Aim of this review is to illustrate the major thermal ablation modalities, their indications and contraindications, complications, outcomes and notably the possible future challenges.

Purpose: Contrary to the self-limiting nature of reversible bone marrow lesions, irreversible bone marrow lesions require early surgical intervention to prevent further morbidity. Thus, early discrimination of irreversible pathology is necessitated. The purpose of this study is to evaluate the efficacy of radiomics and machine learning regarding this topic.

Material and methods: A database was scanned for patients who had undergone MRI of the hip for differential diagnosis of bone marrow lesions and had had follow-up images acquired within 8 weeks after the first imaging. Images that showed resolution of oedema were included in the reversible group. The remainders that showed progression into characteristic signs of osteonecrosis were included in the irreversible group. Radiomics was performed on the first MR images, calculating first- and second-order parameters. Support vector machine and random forest classifiers were performed using these parameters.

Results: Thirty-seven patients (seventeen osteonecrosis) were included. A total of 185 ROIs were segmented. Fortyseven parameters were accepted as classifiers with an area under the curve value ranging from 0.586 to 0.718. Support vector machine yielded a sensitivity of 91.3% and a specificity of 85.1%. Random forest classifier yielded a sensitivity of 84.8% and a specificity of 76.7%. Area under curves were 0.921 for support vector machine and 0.892 for random forest classifier.

Conclusions: Radiomics analysis could prove useful for discrimination of reversible and irreversible bone marrow lesions before the irreversible changes occur, which could prevent morbidities of osteonecrosis by guiding the decisionmaking process for management.

The purpose of this study is to show the actual recommendations for dose management and provide an overview of the available options for dose tracking and dose optimization. The legal institutions that supervise the radiological exposure of patients and their most important directives are presented. A literature review of existing diagnostic reference levels for computed tomography (CT), interventional radiology, radiography, paediatric radiography, mammography, and fluoroscopy in Europe and Poland was carried out. It has been shown that, in Poland, it is necessary to verify and determine the new diagnostic reference levels (DRLs) for each imaging modality because the existing ones are adapted from other countries and are not determined on the basis of data from Polish hospitals. They have not been updated for 11-17 years, although it is recommended to update them every 3-5 years. Many countries in Europe have already determined DRLs based on the analysis of their own dosage data (e.g. Austria and Germany). Analysing the existing DRLs for CT in Poland, it was noticed that they concern only a single anatomical region. It is necessary to determine the DRLs for multi-region CT (i.e. chest-abdomen-pelvis and neck-chest-abdomen-pelvis) examinations because these examinations account for about 60% of all oncological CT examinations-based on data collected from The Maria Sklodowska-Curie National Research Institute of Oncology in Warsaw.

Purpose: We aimed to provide diagnostic models based on different parameters of placental magnetic resonance imaging (MRI) to detect intrauterine growth restriction (IUGR), as well as the severity of placental insufficiency.

Material and methods: We included 44 foetuses with appropriate weight for gestational age (AGA) and 46 foetuses with documented IUGR, defined as the estimated foetal weight (EFW) below the 10^th centile. Using Doppler ultrasound, IUGR cases were divided into 2 groups: 1) IUGR with severity signs: EFW < 3^rd centile, or cerebroplacental ratio < 5^th centile, or abnormal umbilical/uterine artery pulsatility index; and 2) non-severe IUGR without any of this criterion. For all these participants, placental MRI was performed in the third gestational trimester, and its parameters were compared between AGA and IUGR, as well as between the severe and non-severe IUGR groups. Two diagnostic models consisting of significant predictors were developed, and their performance was investigated with accuracy metrics.

Results: The severity signs were detected in 25 (54.3%) IUGR cases. The diagnostic model for the differentiation of IUGR from AGA revealed an acceptable performance (area under the curve [AUC] of 0.749) and consisted of 2 variables: 1) the largest size of infarct ≥ 25 mm (odds ratio [OR] = 5.01, p = 0.001), and 2) thickness : volume ratio ≥ 0.043 (OR = 3.76, p = 0.027); while, the logistic regression model for detection of the severity signs was even better, with AUC = 0.862, and comprised of 2 predictors: 1) placental infarct percent ≥ 10% (OR = 26.73, p = 0.004), and 2) placental globular shape (OR = 5.40, p = 0.034).

Conclusions: Placental MRI parameters can differentiate IUGR from AGA, and more precisely, assess the severity of placental insufficiency in IUGR foetuses.

Purpose: The aim of the study was to analyse magnetic resonance imaging (MRI) of paediatric patients referred because of back pain.

Material and methods: The retrospective analysis included the medical records of 328 patients referred in 2020-2022 to the Department of Paediatric Radiology for spine examination. The criterion for inclusion in the analysed group was back pain as the dominant symptom. This symptom occurred in 20% (68 patients) of referrals for MRI examinations. The examination was performed with the 3T Magnetom Spectra.

Results: In 68 patients aged 2 to 17 years, with back pain as the first diagnosis, 53% (36 patients - 16 girls and 20 boys) showed abnormalities. The rest of the tests were assessed as normal. Among the patients with an abnormal MR image, the largest group were children with degenerative changes diagnosed: 10 children (28%) aged 13-17 years. In 9 patients (25%) aged 2-16 years the final diagnosis qualified the patients to the group of oncological diagnoses. Another group of 7 (19%) patients, aged 6-14 years, comprised children diagnosed with inflammation. The group of 5 patients, aged 3-17 years, presented symptoms most likely related to the trauma. One 7-year-old boy was diagnosed with large calcifications within the intervertebral disc.

Conclusions: Back pain, with accompanying neurological symptoms, should not be underestimated. Although in most clinical situations the MR image is normal, in the case of persistent symptoms and neurological abnormalities confirmed by the clinician, extending the diagnostics with MR imaging should be considered. This imaging can accelerate the correct diagnostic path or make a very precise diagnosis.

Although a long time has passed since its outbreak, there is currently no specific treatment for COVID-19, and it seems that the most appropriate strategy to combat this pandemic is to identify and isolate infected individuals. Various clinical diagnosis methods such as molecular techniques, serologic assays, and imaging techniques have been developed to identify suspected patients. Although reverse transcription-quantitative PCR (RT-qPCR) has emerged as a reference standard method for diagnosis of SARS-CoV-2, the high rate of false-negative results and limited supplies to meet current demand are the main shortcoming of this technique. Based on a comprehensive literature review, imaging techniques, particularly computed tomography (CT), show an acceptable level of sensitivity in the diagnosis and follow-up of COVID-19. Indeed, because lung infection or pneumonia is a common complication of COVID-19, the chest CT scan can be an alternative testing method in the early diagnosis and treatment assessment of the disease. In this review, we summarize all the currently available frontline diagnostic tools for the detection of SARS-CoV-2-infected individuals and highlight the value of chest CT scan in the diagnosis, prognosis, staging, management, and follow-up of infected patients.

Purpose: The aim of this study was to develop radiomics signature-based magnetic resonance imaging (MRI) to determine adrenal Cushing's syndrome (ACS) in adrenal incidentalomas (AI).

Material and methods: A total of 50 patients with AI were included in this study. The patients were grouped as nonfunctional adrenal incidentaloma (NFAI) and ACS. The lesions were segmented on unenhanced T1-weighted (T1W) in-phase (IP) and opposed-phase (OP) as well as on T2-weighted (T2-W) 3-Tesla MRIs. The LASSO regression model was used for the selection of potential predictors from 111 texture features for each sequence. The radiomics scores were compared between the groups.

Results: The median radiomics score in T1W-Op for the NFAI and ACS were -1.17 and -0.17, respectively (p < 0.001). Patients with ACS had significantly higher radiomics scores than NFAI patients in all phases (p < 0.001 for all). The AUCs for radiomics scores in T1W-Op, T1W-Ip, and T2W were 0.862 (95% CI: 0.742-0.983), 0.892 (95% CI: 0.774-0.999), and 0.994 (95% CI: 0.982-0.999), respectively.

Conclusion: The developed MRI-based radiomic scores can yield high AUCs for prediction of ACS.

Purpose: To determine the role of functional magnetic resonance imaging techniques (diffusion-weighted magnetic resonance imaging [DW-MRI] and dynamic contrast-enhanced magnetic resonance imaging [DCE-MRI]) in the differentiation of various salivary gland tumours.

Material and methods: In this prospective study, we evaluated 32 patients with salivary gland tumours using functional MRI. Diffusion parameters (mean apparent diffusion coefficient [ADC], normalized ADC and homogeneity index [HI]),semiquantitative DCE parameters (time signal intensity curves [TICs]) and quantitative DCE parameters (K_ep, K_trans and V_e) were analysed. Diagnostic efficiencies of all these parameters were determined to differentiate benign and malignant tumours as well as to characterize 3 major subgroups of salivary gland tumours, namely pleomorphic adenoma, Warthin tumour, and malignant tumours.

Results: Mean ADC, normalized ADC and HI were insignificant in differentiating benign and malignant tumours but were significant in differentiating pleomorphic adenomas, Warthin tumours, and malignant tumours. Mean ADC was the best parameter in predicting both pleomorphic adenomas and Warthin tumours (AUC: 0.95 and 0.89, respectively). Amongst DCE parameters, only TIC pattern could differentiate between benign and malignant tumours, with an accuracy of 93.75% (AUC: 0.94). The quantitative perfusion parameters aided greatly in characterizing pleomorphic adenomas, Warthin tumours and malignant tumours. For predicting pleomorphic adenomas, the accuracy of K_ep and K_trans was 96.77% (AUC: 0.98) and 93.55% (AUC: 0.95), respectively and for predicting Warthin tumours, the accuracy of both K_ep and K_trans was 96.77% (AUC: 0.97).

Conclusions: DCE parameters (particularly TIC, K_ep and K_trans) had higher accuracy in characterizing various tumour subgroups (pleomorphic adenomas, Warthin tumours, and malignant tumours) than DWI parameters. Hence, dynamic contrast-enhanced imaging adds immense value with only a minimum time penalty to the examination.

Background: Stroke related to cerebral venous thrombosis (CVT) is uncommon, with untoward lethal outcomes. Systemic anticoagulation is the treatment of choice. However, some patients can be resistant to this treatment. Endovascular management with thrombolysis and mechanical thrombectomy can be a viable option in such cases.

Material and methods: We retrospectively reviewed the endovascular management used for CVT in 8 patients who failed to respond to standard anticoagulation therapy between December 2017 and December 2022 in our institute. Clinical profile, imaging parameters, endovascular procedure details, and outcomes in terms of angiographic findings and clinical follow-up were analysed.

Results: In this period, a total of 8 patients underwent mechanical thrombectomy. The procedure was successful in all cases (8/8 = 100%), and 50% of them showed near total/complete recanalization; Perforation of the cortical veins was noted in 2 cases (~25%). Among the 8 patients, one died (1/8 = 12.5%) due to cardiac aetiology; the remaining 7 patients (87.5%) showed good clinical outcome with a modified Rankin Scale score 0 to 2.

Conclusion: Catheter-directed thrombolysis with mechanical thromboaspiration is a safe and effective treatment for cerebral venous sinus thrombosis not responding to anticoagulation.