Diagnostic and Interventional Radiology最新文献

PURPOSE We aimed to assess the performance of quantitative 3D shape analysis in the differential diagno- sis of pancreatic serous oligocystic adenoma (SOA) and mucinous cystic neoplasm (MCN). METHODS Four hundred thirty-two patients diagnosed with serous cystic neoplasms (SCNs) or MCNs were retrospectively reviewed from August 2014 to July 2019 and finally 87 patients with MCNs (n = 45) and SOAs (n = 42) were included. Clinical data and magnetic resonance morphologic fea- tures with 3D shape analysis of lesions (shape sphericity, compacity, and volume) were recorded and compared between MCNs and SOAs according to the pathology. Univariable and multivari- able regression analyses were used to identify independent impact factors for differentiating MCN from SOA. RESULTS The age of MCN patients was younger than SOAs (43.02 ± 10.83 years vs. 52.78 ± 12.31 years; OR = 0.275; 95% CI: 0.098-0.768; P = .014). MCN has a higher female/male ratio than SOA (43/2 vs. 27/15; OR = 40.418; 95% CI: 2.704-604.171; P = .007) and was more often located in the distal of pancreas (OR = 31.403; 95% CI: 2.985-330.342; P = .004). Shape_Sphericity derived from 3D shape analysis was a significant independent factor in the multivariable analysis and the value of MCN was closer to 1 than SOA (OR = 35.153; 95% CI: 5.301-237.585; P < .001). Area under the receiver operating characteristic curve (AUC) of Shape_Sphericity was 0.923 (optimal cutoff value was 0.964876). CONCLUSION Shape_Sphericity in combination with age, sex, and location could help to distinguish MCN from SOA.

PURPOSE This study aims to analyze the ability of quantitative dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) to distinguish between prostate cancer (PCa) and benign lesions in transition zone (TZ) and peripheral zone (PZ) using different methods for arterial input function (AIF) determination. Study endpoints are identification of a standard AIF method and optimal quantitative perfusion parameters for PCa detection. METHODS DCE image data of 50 consecutive patients with PCa who underwent multiparametric MRI were analyzed retrospectively with three different methods of AIF acquisition. First, a region of interest was manually defined in an artery (AIFm); second, an automated algorithm was used (AIFa); and third, a population-based AIF (AIFp) was applied. Values of quantitative parameters after Tofts (Ktrans, ve, and kep) in PCa, PZ, and TZ in the three different AIFs were analyzed. RESULTS Ktrans and kep were significantly higher in PCa than in benign tissue independent from the AIF method. Whereas in PZ, Ktrans and kep could differentiate PCa (P < .001), in TZ only kep using AIFpdemonstrated a significant difference (P = .039). The correlations of the perfusion parameters that resulted from AIFm and AIFa were higher than those that resulted from AIFp, and the absolute values of Ktrans, kep, and ve were significantly lower when using AIFp. The values of quantitative perfusion parameters for PCa were similar regardless of whether PCa was located in PZ or TZ. CONCLUSION Ktrans and kep were able to differentiate PCa from benign PZ independent of the AIF method. AIFaseems to be the most feasible method of AIF determination in clinical routine. For TZ, none of the quantitative perfusion parameters provided satisfying results.

PURPOSE We retrospectively evaluated the efficacy of percutaneous sclerotherapy using a 4 F catheter and 40 mL of 5% ethanolamine oleate (EO) for symptomatic large hepatic cysts. METHODS Twenty-four patients, including 10 with polycystic liver disease (PLD), were eligible. The mean long- and short-axis diameters of the cyst on computed tomography (CT) were 145.0 ± 35.5 mm (range, 72-216 mm) and 110.5 ± 21.4 mm (range, 63-150 mm), respectively. After aspiration of the fluid contents using a 4 F pigtail catheter, 40 mL of 5% EO was injected into the cyst for 30 min. Then, the catheter was withdrawn after EO removal. Symptomatic relief and complications were evaluated. The percentage reductions at the early (1-3 months later) and late (at the final follow-up) responses were evaluated using an estimated cyst volume calculated by using the following formula: volume = π/6 × long-axis diameter × (short-axis diameter)2 on the maximum cross-section image on CT. Spearman's rank correlation coefficient (ρ) was used to evaluate the correlation between the pretreatment estimated cyst volume and percentage reduction of early and late responses and between the percentage reduction of the late response and length of the follow-up period after sclerotherapy. RESULTS The symptoms disappeared in 23 patients and improved in 1 patient with PLD. The mean aspirated fluid volume was 1337.8 ± 845.4 mL (range, 140-3200 mL). In 1 patient, EO injection was postponed until the second procedure was performed 40 days later due to intraperitoneal leakage of contrast material. In another patient, the EO volume was reduced to 20 mL because of a small cyst size. The mean early and late percentage reductions of the treated cyst were 52.3% ± 23.8% and 87.5% ± 20.4% (mean follow-up period: 48.0 ± 42.4 months), respectively. The symptom recurred in 2 patients with PLD and 1 underwent additional sclerotherapy 14 months later due to re-enlargement of the treated cyst. Another patient underwent transarterial embolization 5 years and 4 months later for other enlarged cysts, although the treated cyst markedly shrank. There were significant negative correlations between the pretreatment estimated cyst volume and percentage reduction of early (P = .027, ρ = - 0.46) and late (P= .007, ρ = - 0.52) responses. However, there were no significant correlations between the percentage reduction and length of the follow-up period (P = .19, ρ = 0.31). Transient pain developed in 1 patient and low-grade fever in 3. CONCLUSION Sclerotherapy using a 4 F catheter and 40 mL of 5% EO is safe and effective for symptomatic large hepatic cysts.

PURPOSE The aim of this meta-analysis is to summarize the diagnostic accuracies of point shear wave elas- tography (pSWE) and two-dimensional (2D) SWE for esophageal varices (EV) and varices needing treatment (VNT). METHODS We conducted a systematic review and meta-analysis of diagnostic accuracy studies. We searched for studies reporting the EV and VNT diagnostic accuracy of pSWE and 2D SWE using PubMed Cen- tral, SCOPUS, MEDLINE, Embase, and Cochrane databases. STATA software"Midas"package was used for meta-analysis. RESULTS A total of 24 studies with 3867 patients were included in the review. Pooled score sensitivities of pSWE were 91% (95% CI, 80%-96%) for EV, and 94% (95% CI, 86%-97%) for VNT. Pooled score sensi- tivities of 2D SWE were 78% (95% CI, 69%-85%) for EV, and 79% (95% CI, 72%-85%) for VNT. Pooled score specificities of pSWE were 70% (95% CI, 60%-78%) for EV, and 59% (95% CI, 40%-75%) for VNT. Pooled score specificities of 2D SWE for EV were 79% (95% CI, 72%-85%) 72% (95% CI, 66%-77%) for VNT. We found significant heterogeneity for all the elastography-based measurements with the chi- square test results and an I2 statistic >75%. CONCLUSION Both pSWE and 2D SWE can diagnose EV and VNT with moderate diagnostic accuracy. Further large- scale setting-specific longitudinal studies are required to establish the best modality.

PURPOSE Inflammation is known to induce prostatic growth and lower urinary tract symptoms (LUTS) progression in patients with benign prostatic hyperplasia (BPH), but clinical indicators for intraprostatic inflammation other than biopsy have not yet been established. While 2-deoxy- 2-[18F]fluoro-D-glucose (FDG) positron emission tomography/computed tomography (PET/CT) is a useful tool for investigating inflammatory conditions, prostatic FDG uptake in patients with BPH has not been elucidated. Therefore, we evaluated the association between prostatic FDG uptake and LUTS. METHODS A total of 391 men in their 50s who underwent FDG PET/CT during health examinations were included. Mean and maximal prostatic standard uptake values (SUVs) on FDG PET/CT were measured. Prostatic volume, focal FDG uptake, and calcification were also evaluated. The International Prostate Symptom Score (IPSS) for LUTS was collected at baseline and follow- ups. The correlation between IPSS and other variables was analyzed. RESULTS The mean age of the study participants was 51.7 years, and the mean follow-up interval was 39.7 months. The average of the mean and maximal SUV for prostatic FDG uptake was 1.8 and 2.6, respectively. The prostate volume was 18.5 cm3. The mean IPSS was 4.82 at baseline and 5.46 at follow-ups. Neither the mean SUV nor the maximal SUV of prostatic FDG uptake was correlated with IPSS at baseline or follow-ups. Conversely, prostate volume was associated with baseline IPSS and follow-up IPSS. CONCLUSION Prostatic FDG uptake did not show a significant association with IPSS on FDG PET/CT as well as at follow-ups. FDG uptake may not reflect prostatic growth in nonmalignant cases.

PURPOSE We aimed to evaluate the relative contribution of susceptibility weighted imaging (SWI) in the detection of common bile-duct (CBD) stones in comparison to the conventional MRI protocol containing magnetic resonance cholangiopancreatography (MRCP), balanced turbo field echo (BTFE), and T2-weighted spin-echo imaging techniques. METHODS MRI data containing MRCP, BTFE, T2-weighted imaging, and abdominal SWI were independently evaluated by 2 sets of experienced radiologists in 44 patients with confirmed CBD stones. Endoscopic retrograde cholangiopancreatography, and endoscopic ultrasound where available, was used as the reference gold standard. Evaluation was performed for the visualization of CBD stones in each of the MRI techniques. Relative contribution of SWI was classified into one of four categories for each case: (1) no contribution to CBD stone visualization; (2) same as conventional techniques; (3) improved diagnostic confidence; and (4) critical for diagnosis. Stone size was also assessed. RESULTS Inter-rater agreement coefficient for CBD stone visualization was found to be "good" in MRCP (0.77), "very good" in SWI (0.94) and BTFE (0.84), and moderate in T2-weighted imaging (0.54). CBD stones were visualized with SWI in 86.4% and 82%, with MRCP in 70.5% and 70.5% cases, with BTFE in 73% and 61.4% cases, with T2-weighted imaging in 45.5% and 52.3% cases by reviewers 1 and 2, respectively. SWI did not contribute to CBD stone visualization in 2.3% (1/44); was the same as conventional techniques in 31.8% (14/44) cases; improved diagnostic confidence in 34.1%; and was critical for diagnosis in 20.5% cases. CONCLUSION SWI has the potential to serve as a strong adjunct to conventional MRI protocols used for CBD stone evaluation with very small scan-time penalty.

PURPOSE Paracentesis is commonly performed in interventional radiology practice, and large volume paracentesis (LVP) using wall suction can take up to an hour to complete, placing significant stress on room and resource time. As the number of LVP procedures performed by Interventional Radiologists continue to increase, this study was undertaken to analyze the impact of the RenovaRP® Paracentesis Management System (GI Supply) on procedure time and patient satisfaction. METHODS Between March 9, 2020 and May 29, 2020, procedural data and patient satisfaction was collected as part of a practice quality improvement project and retrospectively analyzed on 39 sequential paracenteses performed with wall suction prior to acquiring the RenovaRP® system and subsequently on 42 paracenteses performed with use of the device. RESULTS A substantially higher fluid flow rate was found using the RenovaRP® system compared to wall suction, 237.2 mL/min vs. 108.6 mL/min (P < .001). This resulted in a significant decrease in procedure room time from 53 min to 31 min (P < .001). There was associated improvement in the patient experience during paracentesis. CONCLUSION The RenovaRP® decreases procedure time for LVP with improvement in the patient experience during paracentesis.

PURPOSE We aimed to explore the effect of microwave ablation (MWA) protocols upon morphology and instant changes in intravoxel incoherent motion (IVIM) diffusion-weighted imaging (DWI) parameters on MWA zones in porcine livers. METHODS According to the empirical protocol for MWA in tumors less than 3 cm in our hospital, the power and application duration were assigned as five groups: A, 60 W × 5 min (n = 6); B, 80 W × 3 min (n = 7); C, 80 W × 5 min (n = 10); D, 100 W × 3 min (n = 10); E, 100 W × 5 min (n = 9). Spearman correlation between MWA protocols, morphological metrics, and instant post-ablation IVIM parameters was performed. RESULTS There was fair positive correlation between energy delivery and short axis (RSpearman = 0.426, P= .005) of the white zone. There was moderate-to-good positive correlation between wattage and short axis (RSpearman = 0.584, P < .001) of the white zone. For post-ablation IVIM parameters in the white zone, only wattage had moderate-to-good positive correlation with D value (RSpearman= 0.574, P < .001) or ADC value (RSpearman = 0.550, P < .001). No correlation between energy delivery, wattage, duration, and f value was observed (RSpearman = 0.185, P = .24; RSpearman= - 0.001, P = .99; RSpearman = 0.203, P = .20, respectively). CONCLUSION The increase in the short axis of the white zone is more likely to be affected by wattage than energy delivery. The instant post-ablation IVIM is feasible in monitoring the MWA zones since the f value in the white zones is not sensitive to changes in MWA protocols, which is promising in evaluating the instant effect of MWA.

PURPOSE The purpose of this paper was to distinguish solid pseudopapillary neoplasms (SPNs) and nonfunctional neuroendocrine tumors (nf-NETs) of pancreas using univariate analysis and clinical-CT logistic regression model. METHODS Twenty-eight patients with SPNs and 46 patients with nf-NETs underwent enhanced CT examinations. Clinical data (sex, age), categorical (location, cystic degeneration, calcification, hemorrhage, and enhancement pattern), and numeric CT features (lesion long diameter, long/ short diameter ratio, tumor attenuation values and tumor/pancreas attenuation ratios at unenhanced phase [UP], arterial phase [AP], and venous phase [VP]) were recorded. The logistic regression model was constructed by stepwise forward method of binary logistic regression after univariate analysis. The corresponding operating characteristic curve (ROC) and nomogram were delineated. The area under the curve (AUC), sensitivity, and specificity of ROC were calculated. RESULTS The SPNs were observed more often in relatively young (P < .001), female (P < .001) patients. After the univariate analysis, the categorical CT features of location (P = .048), hemorrhage (P = .003), and enhancement pattern (P = .004) and the numeric CT features of lesion long diameter (P = .005), tumor/pancreasUP (P = .002), tumorAP (P < .001), and tumor/pancreasAP (P < .001) had statistical significance. The AUC (95% CI), sensitivity, and specificity of a logistic regression model composed of age, tumor/pancreasUP, and tumor/pancreasAP were 0.933 (95% CI, 0.850-0.978), 84.78%, and 92.86%. CONCLUSION The SPNs often occurred in 20- to 40-year-old female patients, were located in the body or tail of pancreas, showed hemorrhagic degeneration, heterogeneous enhancement, and were relatively larger in size compared with nf-NETs. Tumor/pancreasUP, tumorAP, and tumor/pancreasAP values of SPNs were smaller than those of nf-NETs. The clinical-CT logistic regression model and nomogram consisting of age, tumor/pancreasUP, and tumor/pancreasAP parameters helped to differentiate SPNs from nf-NETs.