Academic Radiology最新文献

Rationale and objectives: Intra-procedural patient motion is common in clinical MRI and degrades image quality. We evaluated whether certain clinical characteristics and patient sociodemographic factors are associated with patient motion during MRI.

Materials and methods: We retrospectively reviewed consecutive MRI reports from 2022 at two U.S. urban health systems (university and safety net). Exams were acquired using standardized protocols and reported by a single academic radiology group. Motion was defined by any mention of "motion" in the report body or impression. Clinical and sociodemographic characteristics were extracted from the electronic health record. Multivariable logistic regression assessed associations between patient characteristics and motion, adjusting for care setting.

Results: Among 68,517 MRIs, emergency and inpatient studies had higher odds (OR) [95%CI] of motion compared with outpatient exams (emergency OR 2.55; [2.38,2.74]; inpatient OR 3.26; [3.06,3.48]). After adjustment, older age remained associated with motion, (≥85 years OR 1.91; [1.64,2.23], vs. 19-34 years). Male gender had higher odds than female (OR 1.14; [1.08,1.20]). Black race had higher odds than White (OR 1.18; [1.10,1.27]). Increasing obesity was associated with greater odds (class II OR 1.11; [1.01,1.22]; class III OR 1.48; [1.34,1.64]). Ethnicity, preferred language, and health system were not significantly associated with motion.

Conclusion: Motion on MRI disproportionately affects elderly patients, men, individuals with obesity, and Black patients, independent of care setting. Accounting for motion-risk factors into scheduling, pre-scan counseling, and positioning protocols may reduce motion-limited studies. Addressing these patterns through workflow design is important for promoting equitable, high-quality MRI across diverse patient populations.

Rationale and objectives: To compare the efficacy of automatic breast ultrasound (ABUS) with handheld ultrasound (HHUS) as second-look US techniques in the identification of lesions that are detected on breast MRI, and to determine factors that affect lesion detection on second-look US examinations.

Material and methods: This single-center prospective study included 54 patients with 66 MRI-detected breast lesions referred for MRI-guided biopsy. All patients underwent second-look evaluation with both HHUS and ABUS. Histopathology or imaging follow-up served as the reference standard.US-guided biopsy or preoperative surgical localization was performed for lesions detected by US; while the rest of the patients underwent MRI-guided biopsy or localization procedures. Patients who refused to undergo MRI-guided procedures were followed-up with MRI for at least 2 year. ABUS and HHUS examinations were performed by different radiologists and evaluated based on BI-RADS lexicon.

Results: Out of the 66 lesions detected on MRI examinations, 30 (45.5%) were benign, 16 (24.2%) were high-risk lesions, and 20 (30.3%) were malignant. HHUS demonstrated 56/66 (84.9%), while ABUS demonstrated 46/66 (69.7%) of them; and the difference was statistically significant (p=0.010). Two out of 13 (15.4%) lesions detected only by HHUS, and 2/3 (66.7%) lesions detected only by ABUS were malignant. None of the 7 lesions (10.6%), that could not be detected by either method, were malignant. There was no statistically significant difference between the number of lesions detected on HHUS and ABUS in terms of lesion size, depth, lesion type (mass/non-mass), lesion localization, parenchymal density, kinetic features or morphological findings (p>0.05). Sensitivity was similar for HHUS and ABUS (90% for both). However, the positive predictive value (PPV) was higher for ABUS (39.1%) than for HHUS (32.1%) (notably due to a higher proportion of malignant lesions among ABUS-only detected findings).

Conclusion: HHUS was superior to ABUS in detecting lesions in second-look US evaluation. However, cancer detection rates were similar, resulting in a higher positive predictive value for ABUS. Our results show that the two methods are complementary to each other and have the potential to increase lesion detection rate when used together in clinics where both methods are available.

Rationale and objectives: To evaluate the diagnostic performance of preoperative computed tomography (CT) and magnetic resonance imaging (MRI)-based radiomics models in detecting liver metastases in patients with colorectal cancer (CRC).

Materials and methods: Following PRISMA 2020 guidelines, we systematically searched major databases up to July 2025. Study selection, data extraction, and quality assessment (Radiomics Quality Score and QUADAS-2) were performed independently. Separate bivariate random-effects meta-analyses were conducted for prognostic (metachronous) and diagnostic (synchronous) predictions.

Results: Twenty studies (3765 patients) were included in the systematic review. Twenty studies were included in the systematic review. Of these, 18 studies were included in the quantitative meta-analysis. For predicting metachronous metastases (13 studies), the pooled AUC was 0.83 (95% CI: 0.73-0.90), although significant publication bias suggested that this estimate may be optimistically inflated. For the detection of synchronous metastases (five studies), the pooled AUC was 0.85 (95% CI: 0.76-0.91). Heterogeneity was moderate to substantial. However, significant publication bias was detected for prognostic models (Deeks' test, P < 0.001), suggesting that these pooled estimates may be optimistically inflated.

Conclusion: Radiomics has the potential to predict metachronous and detect synchronous liver metastases in CRC. However, methodological weaknesses (mean Radiomics Quality Score ∼48%), geographic bias, and publication bias limit this evidence. Multinational validation is required before clinical application of the findings.

Rationale and objectives: Inflammation plays a crucial role in the pathophysiology of intracranial aneurysms (IAs). Our previous research demonstrated that blood inflammatory indices can serve as predictors of aneurysmal wall enhancement (AWE), which signifies the presence of inflammation within the aneurysmal wall and functions as an imaging biomarker for IA instability. Here, we aimed to further examine the relationship between blood inflammatory indices, AWE, and long-term clinical outcomes in patients with intracranial fusiform aneurysms (IFAs).

Materials and methods: We reviewed patients with IFAs who underwent high-resolution magnetic resonance imaging and blood laboratory tests, as recorded in our maintained database. Initially, a cross-sectional study was conducted to identify potential blood inflammatory indices that could predict the average value of aneurysmal wall enhancement in three dimensions (3D-AWE_avg). Subsequently, a follow-up study was performed to further elucidate the potential predictors associated with overall poor outcomes (CAO) in the same cohort.

Results: A total of 92 patients were included in the cross-sectional study. Both the systemic inflammation response index (SIRI), the systemic immune-inflammation index (SII), and the neutrophil-to-lymphocyte ratio (NLR) were associated with 3D-AWE_avg in univariate analysis; however, only SIRI was found to independently predict 3D-AWE_avg (P = 1.1 × 10^-5). In the follow-up study, 64 patients were included, with a mean follow-up period of 29.27 months. SIRI (13.725 [2.467-76.349], P = .003) and 3D-AWE_avg (5.387 [1.320-21.988], P = .019) were identified as the predictors of CAO in patients with IFAs. Furthermore, patients with a high SIRI value (≥0.725 × 10⁹/L, log-rank = 0.002) or a 3D-AWE_avg ≥ 0.604 (log-rank = 3 × 10^-5) had significantly higher risk of CAO.

Conclusion: SIRI predicts both aneurysmal wall enhancement and long-term adverse outcomes in patients with IFAs, supporting its potential role as a novel biomarker for risk stratification and clinical decision-making in this population.

Rationale and objectives: This study aims to compare the breast magnetic resonance imaging (MRI) features and clinicopathological characteristics of invasive breast cancer patients with different enhancement patterns, and to investigate the relationship between enhancement patterns and lymphovascular invasion (LVI).

Materials and methods: This retrospective study consecutively enrolled 1185 female patients with invasive breast cancer who underwent dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) at our institution. Propensity score matching (PSM) was employed to match patients between mass enhancement (ME) group and non-mass enhancement (NME) group. With the occurrence of LVI as the clinical endpoint, covariates with a standardized mean difference (SMD) greater than 0.1 and the enhancement patterns were incorporated into a Firth's bias-reduced logistic regression analysis to further evaluate the relationship between enhancement patterns and LVI.

Results: Compared to the ME group, lesions in the NME group demonstrated significantly higher rates of axillary lymph node positivity and LVI (both P<0.001). After PSM, differences in ADC values and the distribution of the triple-negative subtype persisted between the two groups. Firth regression analysis identified NME as a risk factor for LVI (P<0.001). Compared to the Luminal A subtype, the Luminal B (P<0.001), HER2-positive (P<0.001), and triple-negative (P=0.001) subtypes were all associated with a significantly increased risk of LVI. ADC value did not demonstrate a significant association with LVI (P=0.537).

Conclusion: NME was identified as a significant independent risk factor for LVI. Compared to the Luminal A subtype, the Luminal B, HER2-positive, and triple-negative subtypes were all associated with a significantly increased risk of LVI. The ADC value did not demonstrate a significant association with LVI.

RATIONALE AND OBJECTIVES: To evaluate the diagnostic and prognostic utility of the Node Reporting and Data System (Node-RADS) using preoperative MRI.

Methods: This was a retrospective, single-center cohort study of 126 consecutive patients with newly diagnosed rectal adenocarcinoma who underwent preoperative pelvic MRI and curative-intent surgery between 2017 and 2023. Regional nodes were graded using Node-RADS. Standard MRI descriptors (T stage, tumor length, and tumor location) and high-risk features-including MRI-detected extramural venous invasion (mrEMVI) and circumferential resection margin (CRM) involvement-were recorded. Serum tumor markers (CEA and CA19-9) obtained proximate to imaging were assessed. Associations with oncologic outcomes (RFS and OS) were examined using multivariable models adjusted for clinicopathologic covariates; nomogram model performance was quantified by discrimination, calibration, and decision-curve analysis. SHapley Additive exPlanations (SHAP) was used to quantify variable contributions and enhance model interpretability.

Results: In the assessment of regional lymph node status, Node-RADS achieved an AUC of 0.861. When a Node-RADS score ≥4 was used as the positivity threshold, the diagnostic accuracy reached 0.841. During a median follow-up of 56.2 months, the Kaplan-Meier estimated 3-year RFS and OS were 85.0% and 88.2%, and the corresponding 5-year RFS and OS were 82.0% and 78.6%, respectively. Multivariable analysis revealed that Node-RADS, age, and CA19-9 were independent predictors of OS, whereas Node-RADS, clinical EMVI, and CA19-9 were independent predictors of RFS. Based on these factors, nomograms for OS and RFS prediction were developed. For OS prediction, the 3-year and 5-year AUCs were 0.825 and 0.831, respectively, with a C-index of 0.821 being observed. For RFS prediction, the 3-year and 5-year AUCs were 0.741 and 0.786, respectively, with a C-index of 0.726 being observed. SHAP analysis ranked Node-RADS as the primary contributor to RFS predictions (mean |ϕ|=0.6) and the secondary contributor to OS predictions (mean |ϕ|=0.4).

Conclusion: Preoperative MRI-based Node-RADS has diagnostic and prognostic utility and may serve as a standardized imaging biomarker for preoperative risk stratification, supporting individualized treatment and surveillance.

Purpose: Leveraging hypergraph theory and spatio-temporal graph convolutional network (ST-GCN), this study uses multimodal MRI to elucidate thalamus-mediated high-order network dyscoordination of motor impairment in Parkinson's disease (PD).

Materials and methods: 64 PD patients and 64 age- and sex-matched healthy controls (HC) underwent resting-state functional MRI (rs-fMRI) and T1-weighted anatomical imaging (T1WI). Functional hypergraphs were constructed using dynamic thresholds on Pearson correlations; structural hypergraphs were generated from gray matter volume (GMV) via k-nearest neighbors (KNN). ST-GCN was employed to fuse the multimodal hypergraph features, and discriminative features were identified via stratified five-fold cross-validation. Group differences and clinical correlations were assessed using t-tests/Mann-Whitney U and Spearman's correlation (P<0.05), respectively.

Results: Compared to HC, eight key brain regions exhibited abnormalities in PD: left precentral gyrus (PreCG.L), left middle frontal gyrus (MFG.L), right superior occipital gyrus (SOG.R), left thalamus (THA.L), left hippocampus (HIP.L), right caudate nucleus (CAU.R), right supplementary motor area (SMA.R), and right paracentral lobule (PCL.R). Three significant hyperedges were identified: left putamen-left thalamus-right supplementary motor area (PUT.L-THA.L-SMA.R), right globus pallidus-right thalamus-right cerebellar Crus II (PAL.R-THA.R-Crus II.R), and left thalamus-left hippocampus-right angular gyrus (THA.L-HIP.L-ANG.R). Hyperedge strengths revealed a modest increase in PUT.L-THA.L-SMA.R, a significant increase in THA.L-HIP.L-ANG.R (P<0.05), and a reduction in PAL.R-THA.R-Crus II.R. These hyperedges were all positively correlated with UPDRS-III scores (P<0.05).

Conclusion: Multimodal hypergraph analysis reveals high-order network dysregulation of motor impairment in PD, involving the cerebellum, limbic system, and cortical-basal ganglia circuits, mediated by the thalamus. Furthermore, hyperedges may serve as potential biomarkers for motor dysfunction.

Rationale and objectives: This study aimed to develop a nomogram integrating extracellular volume fraction (ECV), dual-energy CT (DECT) quantitative parameters, and morphological features to predict perineural invasion (PNI) and recurrence-free survival (RFS) in gastric cancer (GC).

Materials and methods: We retrospectively collected GC patients' data from two centers. Two radiologists independently assessed ECV, DECT quantitative parameters, and morphological features. Multivariate logistic regression analyses were performed to identify independent risk factors for PNI and construct a predictive nomogram. The nomogram's predictive performance was evaluated using calibration curves, receiver operating characteristic (ROC) curves, and decision curve analysis (DCA). Multivariate Cox regression analyses were conducted to determine independent prognostic factors for RFS. Kaplan-Meier survival curves were generated to compare RFS between nomogram predicted PNI-positive and PNI-negative groups.

Results: A total of 268 patients were included in the analysis, with 166 in the training cohort and 102 in the validation cohort. ECV, NICdelay, and ctEMVI were identified as independent risk factors for PNI. The nomogram demonstrated good predictive performance for PNI, with area under the ROC curve (AUC) of 0.822 and 0.810 in the training and validation cohorts. Calibration curves indicated good agreement between predicted and observed PNI, and DCA demonstrated clinical utility. Nomogram-predicted PNI was an independent prognostic factor for RFS, with the predicted PNI-positive group exhibiting significantly lower RFS rate than the predicted PNI-negative group.

Conclusion: A nomogram integrating ECV, DECT quantitative parameters, and morphological features could effectively predict PNI in GC and provide significant prognostic value for postoperative RFS.

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