Academic Radiology最新文献

Rationale and objectives: To assess the predictive value of MRI-based radiomics of periprostatic fat (PPF) and tumor lesions for predicting Gleason score (GS) upgrading from biopsy to radical prostatectomy (RP) in prostate cancer (PCa).

Methods: A total of 314 patients with pathologically confirmed prostate cancer (PCa) after radical prostatectomy (RP) were included in the study. The patients were randomly assigned to the training cohort (n = 157) and the validating cohort (n = 157) in a 1:1 ratio. All had pre-surgery MRI followed by transrectal ultrasound-guided prostate biopsy. Radiological features were extracted from T2-weighted imaging (T2WI) and apparent diffusion coefficient (ADC) sequences for PPF and tumors. Univariate and multivariate logistic regression identified independent clinical risk factors, and a combined model was established by integrating radiomic features of PPF and PCa. Model performance was assessed using receiver operating characteristic (ROC) curves, calibration, and decision curve analysis.

Results: The combined model, incorporating radiomic features of PPF, PCa, and clinical data, predicted GS upgrading from biopsy to RP excellently (AUC=0.925, 95%CI0.872-0.979) in the training cohort. The Hosmer-Lemeshow test confirmed model fit (χ² = 9.316, P = 0.316). The nomogram was validated in the validating cohort; it showed good accuracy (AUC= 0.937, 95% CI, 0.891-0.983) and was well calibrated (χ² = 12.871, P = 0.116). Decision curve analysis indicated good clinical utility of the radiomic nomogram.

Conclusion: The combined model incorporating PPF, PCa, and clinical data showed excellent performance in predicting GS upgrading from biopsy to RP in PCa patients. This offers a novel and reliable noninvasive tool for GS upgrading risk stratification.

Rationale and objectives: Neuropsychiatric systemic lupus erythematosus (NPSLE) is one of the most severe complications of systemic lupus erythematosus (SLE), and its early biomarkers and immune mechanisms remain unclear. This study utilizes Resting-State functional magnetic resonance imaging (rs-fMRI) to explore early neuroimaging biomarkers and potential immune mechanisms of brain injury in SLE, with a particular focus on anti-ribosomal P protein antibody (ARPA).

Materials and methods: A total of 47 SLE patients and 33 healthy controls (HCs) underwent rs-fMRI. Amplitude of low-frequency fluctuations (ALFF) and degree centrality (DC) values were compared between SLE and HC groups, and between ARPA-positive and ARPA-negative SLE patients. Correlation analyses were conducted to evaluate relationships between neuroimaging indicators and clinical indicators, including immunoglobulins and antiphospholipid antibodies. Conventional MRI findings, including white matter hyperintensities (WMHs), were also assessed.

Results: SLE patients exhibited significant ALFF and DC alterations in regions associated with cognitive and sensory functions, including the inferior frontal and occipital regions. Notably, ARPA-positive SLE patients showed increased ALFF and DC values in areas related to cognitive and emotional regulation. Additionally, ACA-IgM and IgG correlate with brain injury in ARPA-positive patients. WMHs were more prevalent in ARPA-positive patients, with age and IgG levels identified as predictive markers for WMHs.

Conclusion: The combined use of ALFF and DC can effectively identify early biomarkers of brain injury in SLE patients. ARPA may synergize with other immune factors to combine to impair some brain functions, offering new insights into the immune-mediated mechanisms of SLE-related brain injury and potential targets for therapeutic interventions.

Objective: This study aims to assess the current trends in remote and flexible work models in radiology, evaluate their perceived impact on radiologists' well-being, and explore the importance of these options in shaping employment decisions.

Methods: A voluntary, anonymous survey was sent to 981 members of the Association of Academic Radiologists (AAR) in April 2024. Descriptive statistics were used to analyze demographics and trends in remote and flexible work participation. Statistical tests, including chi-square and Fisher's exact test, were employed to assess differences in perceptions based on gender and career stage. Responses from openended questions were analyzed to identify common themes and solutions related to remote and flexible work.

Results: A total of 205 respondents answered the survey resulting in a response rate of 20.9%. 91.8% of respondents reported that their institution offered remote work options, with 73% participating in remote work. The top benefits included improved work-life balance, flexibility, and reduced commute time. Hybrid work models were preferred by 79% of respondents, and 89% of those participating in remote work reported increased well-being. Flexible scheduling was offered to 46.4% of respondents, with 91% reporting an increase in well-being from these options. Remote and flexible work options were viewed as important in employment decisions by 68-70% of respondents. Gender and career stage: Significant differences emerged in the perceived benefits of remote and flexible work, with female radiologists and early- to mid-career radiologists reporting greater benefits related to work-life balance and caregiving responsibilities.

Conclusion: Remote and flexible work models in radiology are increasingly available and positively impact radiologists' well-being and job satisfaction. The study highlights the importance of these options, especially for early-career and female radiologists. Addressing the challenges of remote work can further optimize these work models, promoting retention, diversity, and workforce sustainability in radiology.

Rationale and objectives: To improve the diagnostic recognition of papillary renal neoplasm with reverse polarity (PRNRP) through comprehensive analysis of computed tomography (CT) and magnetic resonance imaging (MRI) findings.

Materials and methods: A retrospective multi-center study was conducted on patients with pathologically confirmed PRNRPs from 2019 to 2024, encompassing six institutions. Clinical and pathological data were meticulously documented. Preoperative CT (n=23) and MRI (n=9) features were independently evaluated in consensus by two genitourinary radiologists, focusing on tumor location, morphologic features, attenuation, signal intensity, and enhancement patterns. Postoperative outcomes were assessed through medical record review or telephone follow-up.

Results: The study cohort comprised 26 patients (mean age 62±12 years, 13 men) with 26 well-defined PRNRPs (mean diameter 2.2±1.0 cm) were included. 15 cases (58%) were situated in the right kidney, 18(69%) were exophytic, and 23(88%) were quasi-spherical. A pseudocapsule was identified in eight cases (89%) on MRI. All cases demonstrated iso- or slight hyperattenuation (43.1±13.6 HU) on non-contrast CT, hypointensity on T2-weighted imaging (T2WI), and mild diffusion restriction on diffusion-weighted imaging (DWI). All cases exhibited mild or moderate enhancement in the corticomedullary phase, followed by progressive enhancement in the nephrographic and excretory phases. Concomitant renal cysts were found in 17 cases (65%). All cases showed no evidence of recurrence or metastasis.

Conclusion: PRNRP typically presents as a small hypovascular renal mass, and characterized by a pseudocapsule, iso- or slight hyperattenuation on non-contrast CT, heterogeneous T2WI hypointensity, and mild diffusion restriction on DWI.

Rationale and objectives: Central arterial blood pressure (CBP) is considered a more valuable prognostic marker of major cardiovascular diseases than peripheral blood pressure. Non-invasive evaluation of central aortic pressure by Doppler echocardiography is a hopeful tool, avoiding many complications of invasive catheter strategy and diminishing time and costs.

Methods: A total of 118 patients were referred for elective cardiac catheterization at the Cardiovascular Medicine Department, Mansoura University. Standard transthoracic echocardiography was simultaneously performed during invasive measurement of the central aortic pressure in the cardiac catheterization lab.

Results: A significant correlation existed between invasive systolic, diastolic, and mean aortic pressure and aortic deceleration time, with P-values of 0.0003, 0.0002, and 0.0002, respectively. A significant correlation was also found between invasive systolic, diastolic, and mean aortic pressure and aortic Velocity Time Integral (VTI), with P-values of 0.006, 0.0004, and 0.0004, respectively. A significant and more reliable equation existed to calculate mean or diastolic central blood pressure by transthoracic aortic deceleration time values.

Conclusion: Central aortic pressure can be measured non-invasively using Doppler echocardiographic parameters: Left ventricular Mass (LVM), aortic deceleration time, and velocity time integral during routine echocardiography examination using rational equations. This represents a promising technique for further research.

Rationale and objectives: Comprehensive data on the use of ventilation-perfusion single-photo emission computed tomography/computed tomography (V/Q SPECT/CT), an established diagnostic tool for chronic thromboembolic pulmonary hypertension, in identifying pulmonary hypertension secondary to fibrinous mediastinitis (PH-FM) is scarce. This study aimed to assess its diagnostic efficacy for PH-FM.

Materials and methods: Patients with PH due to pulmonary artery stenosis were assessed using V/Q SPECT/CT, computed tomography pulmonary angiography (CTPA), and digital subtraction pulmonary angiography (PAG). Abnormal mediastinal or hilar features identified by V/Q SPECT/CT, correlating with perfusion defects, were used to diagnose PH-FM. Final clinical diagnosis is recognized as the gold standard for this study. Diagnostic accuracy was compared using receiver operating characteristic (ROC) analysis and Cohen's kappa coefficient to evaluate agreement among the imaging methods.

Results: Among the patients included, 21 had PH-FM, and 76 had PH associated with non-FM. V/Q SPECT/CT showed higher sensitivity (90%), specificity (95%), and accuracy (94%) for detecting PH-FM compared to CTPA (sensitivity 86%, specificity 92%, accuracy 91%) and PAG (sensitivity 62%, specificity 87%, accuracy 81%). The areas under the ROC curve for V/Q SPECT/CT, CTPA, and PAG were 0.93, 0.89, and 0.74, respectively. V/Q SPECT/CT achieved better agreement with the gold standard than CTPA or PAG (κ=0.82, κ=0.69 and κ=0.49, respectively).

Conclusion: V/Q SPECT/CT demonstrates superior diagnostic efficacy and accuracy compared to CTPA and PAG in diagnosing PH-FM.

Clinical relevance statement: Compared to computed tomography pulmonary angiography and digital subtraction pulmonary angiography, ventilation-perfusion single-photo emission computed tomography/computed tomography demonstrates superior diagnostic efficiency for pulmonary hypertension secondary to fibrinous mediastinitis, leading to improved early detection and accuracy, thus optimizing diagnostic pathways.

Key points:

Rationale and objectives: The purpose of this study is to conduct a meta-analysis to evaluate the diagnostic performance of current radiomics models for diagnosing osteoporosis, as well as to assess the methodology and reporting quality of these radiomics studies.

Methods: According to PRISMA guidelines, four databases including MEDLINE, Web of Science, Embase and the Cochrane Library were searched systematically to select relevant studies published before July 18, 2024. The articles that used radiomics models for diagnosing osteoporosis were considered eligible. The Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) tool and radiomics quality score (RQS) were used to assess the quality of included studies. The pooled diagnostic odds ratio (DOR), sensitivity, specificity, area under the summary receiver operator characteristic curve (AUC) were calculated to estimated diagnostic efficiency of pooled model.

Results: A total of 25 studies were included, of which 24 provided usable data that were utilized for the meta-analysis, including 1553 patients with osteoporosis and 2200 patients without osteoporosis. The mean RQS score of included studies was 11.48 ± 4.92, with an adherence rate of 31.89%. The pooled DOR, sensitivity and specificity for model to diagnose osteoporosis were 81.72 (95% CI: 51.08 - 130.73), 0.90 (95% CI: 0.87-0.93) and 0.90 (95% CI: 0.87-0.93), respectively. The AUC was 0.96, indicating a high diagnostic capability. Subgroup analysis revealed that the use of different imaging modalities to construct radiomics models might be one source of heterogeneity. Radiomics models built using CT images and deep learning algorithms demonstrated higher diagnostic accuracy for osteoporosis.

Conclusion: Radiomics models for the diagnosis of osteoporosis have high diagnostic efficacy. In the future, radiomics models for diagnosing osteoporosis will be an efficient instrument to assist clinical doctors in screening osteoporosis patients. However, relevant guidelines should be followed strictly to improve the quality of radiomics studies.

Rationale and objectives: The study aimed to evaluate demographic and radiological characteristics of breast incidentalomas found on 18-fluorodeoxyglucose Positron Emission Tomography-Computed Tomography (¹⁸F-FDG PET-CT) performed for extramammary indications.

Materials and methods: A total of 12633 ¹⁸F-FDG PET-CT scans performed between January 1, 2018 and January 1, 2024, were retrospectively reviewed. Breast incidentalomas that had undergone breast imaging, tissue diagnosis, or at least 2-year radiological follow-up were included. Demographic data and lesion size were recorded. Maximum and average standardized uptake values (SUV_max-SUV_avg) and SUV corrected for lean body mass (SUL) were calculated using region of interest (ROI).

Results: The inclusion criteria were met in 101 lesions (81 benign and 20 malignant). The most common benign lesion was fibroadenoma (n = 21), followed by stable lesions during follow-up (n = 18) and benign breast parenchyma (n = 11). The most common malignant lesion was invasive ductal carcinoma (n = 11). The diagnostic characteristics of SUV_max≥ 3, SUL_max≥ 2, SUV_avg≥ 0.735, SUL_avg≥ 0.48, and BI-RADS≥ 4 were 75%, 70%, 75%, 70% and 100% for sensitivity, 69%, 69%, 62%, 62% and 67% for specificity, and 69.3%, 68.3%, 62.4%, 61.4% and 73.3% for accuracy, respectively. The highest negative predictive values (NPV) were obtained with BI-RADS and SUV_max (100% and 92%, respectively). No significant difference in malignancy rate was observed for the lesion size and age of the patients (p > 0.05).

Conclusion: There is a risk of detecting malignancy in incidental lesions showing ¹⁸F-FDG uptake. Radiological workup must be done, but SUV_max, with a high NPV value, can be used in conjunction with BI-RADS assessment for appropriate patient selection and effective management of resources.