Indian Journal of Radiology and Imaging最新文献

Introduction  Glioblastoma multiforme (GBM) is a highly malignant brain tumor with poor prognosis, despite maximal safe resection and chemoradiotherapy. Predicting survival outcomes is crucial for optimizing treatment strategies. While conventional magnetic resonance imaging (MRI) reveals tumor characteristics, advanced sequences like diffusion tensor imaging (DTI) and susceptibility-weighted imaging (SWI) may enhance prognostic accuracy. Materials and Methods  A retrospective study reviewed 45 newly diagnosed GBM patients treated with maximal safe resection, adjuvant radiotherapy, and temozolomide between 2016 and 2022. Preoperative MRI data, including conventional sequences, DTI, and SWI, were analyzed. Radiological parameters-tumor volume, edema:tumor volume ratio, necrosis, enhancement, fractional anisotropy (FA), and microhemorrhage-were assessed for survival prediction. Kaplan-Meier survival analysis and Cox regression evaluated their prognostic significance. Results  Among the 45 patients, the median follow-up was 58.3 weeks, with 30 deaths reported. Significant differences were observed in FA, edema:tumor volume ratio, necrosis, enhancement, and microhemorrhage between survivors and nonsurvivors. Higher edema:tumor volume ratio (cutoff ≥ 0.905, area under the curve [AUC] = 0.895) and higher FA (cutoff ≥ 0.655, AUC = 0.8) correlated with mortality and survival, respectively. Multivariate Cox regression identified edema:tumor volume ratio (hazard ratio [HR] = 7.4, p  < 0.05) and microhemorrhage > 25% (HR = 45.9, p  < 0.05) as independent predictors of mortality. Conclusion  Tumor-related edema and necrosis significantly influence mortality, with edema:tumor volume ratio emerging as a stronger predictor than individual tumor or edema volumes. FA values reflect tumor aggressiveness, correlating with survival. Incorporating advanced imaging parameters like DTI and SWI alongside conventional MRI enhances prognostic precision in GBM management.

Introduction: Incidentally detected small pulmonary nodules in patients with an underlying malignancy most often warrant sampling. Biopsy from such small pulmonary nodules (< 2 cm) is challenging. In this study, we aim to evaluate the accuracy of computed tomography (CT)-guided percutaneous core needle biopsy (CNB) of small pulmonary nodules.

Materials and methods: A total of 169 patients who had CT-guided percutaneous CNB for small pulmonary nodules (less than 2 cm) between January 2015 and December 2018 were the subjects of this retrospective, single-center investigation. We determined the success rate of CNB and the rate of a diagnostic biopsy. Calculations were made for a multivariate study of the risk variables for complications, such as pneumothorax and pulmonary hemorrhage.

Results: The success rate of lung biopsy, defined by obtaining a sample of pathologically reportable quality, was 92.9% (157/169). A malignancy was diagnosed in 60.4% of cases (102/169). Pneumothorax developed in 21.9% cases (37/169), with only 5.3% (9/169) patients requiring treatment (8 needle aspirations and 1 pigtail catheter drainage). Use of a thicker (18G) biopsy needle was the only statistically significant predictor of pneumothorax (odds ratio 2.61, 95% confidence interval 1.24-5.51, p  = 0.01). Perifocal hemorrhage was common (72.2%, 122/169) but clinically significant pulmonary lobar hemorrhage was seen only in 6.5% of the cases (11/169). One patient required intensive care unit admission due to desaturation from aspiration of blood.

Conclusion: CT-guided biopsy of small pulmonary nodules is safe and feasible with a good success rate.

Diabetic mastopathy (DMP) is a rare fibroinflammatory condition of the breast seen in patients with diabetes mellitus (DM), which mimics malignancy on imaging. We present eight cases of biopsy-proven DMP with typical (1/8 cases) and atypical (7/8 cases) imaging appearances and describe their histopathological features including duct dilatation/distortion, tight periductal cuffing by inflammatory infiltrates, type of inflammatory infiltrate, stromal fibrosis, epithelial fibroblasts, and grade of lobulitis (mild, moderate, and severe). Our case series depicts the varied atypical imaging findings in DMP and the indispensable role of histopathology in diagnosis. The postbiopsy diagnosis of DM in one of our patients highlights the possible role of histopathology in the detection of patients who may be prone to develop diabetes later. Our series also showed a lack of correlation between the radiopathological findings and clinical features such as duration or type of DM, treatment, and glycemic control status.

Background: Intracranial aneurysm rupture leading to subarachnoid hemorrhage (SAH) is associated with high morbidity and mortality. While conventional imaging modalities like computed tomography (CT) angiography and digital subtraction angiography (DSA) are commonly employed, they primarily visualize the lumen rather than the vessel wall itself. Recent advancements in magnetic resonance vessel wall imaging present an opportunity to explore the role of inflammation in aneurysm rupture, thus also potentially serving as a predictor for rupture risk.

Aims: This study aimed to assess vessel wall enhancement patterns in ruptured and unruptured intracranial aneurysms, correlating these patterns with aneurysm morphology and evaluate the relationship between the PHASES score and enhancement characteristics.

Materials and methods: Patients with confirmed intracranial aneurysms on CT angiography and/or DSA underwent plain and contrast-enhanced T1 SPACE (sampling perfection with application-optimized contrasts using different flip angle evolution) images to assess vessel wall enhancement, which was classified as absent, focal, or circumferential termed as grade 0, 1, and 2, respectively.

Results: Out of 60 patients included in the study, 60% presented with ruptured aneurysms. All ruptured aneurysms showed vessel wall enhancement, which was circumferential in 46.7% cases. In contrast, only 30% of unruptured aneurysms showed any form of enhancement, which was predominantly grade 1. Statistical analysis revealed a significant association between enhancement patterns and rupture status, with a p -value of < 0.001.

Conclusion: Vessel wall enhancement was observed in all ruptured aneurysms, thus suggesting a potential role of inflammation in the disruption of aneurysm wall integrity. It may thus also serve as a predictor of aneurysm rupture, enhancing clinical decision-making for patient management.

Renal vascular lesions are rare and often asymptomatic. They can be congenital or acquired. Congenital lesions include aneurysms, arteriovenous malformations (AVMs), and arteriovenous fistulas (AVFs). Acquired lesions are usually secondary to trauma or iatrogenic injury and include pseudoaneurysms, AVFs, and vessel transection. Management of renal vascular lesions depends on the location and type of the lesion. AVMs are managed by endovascular embolization of the nidus. It can be done by transarterial route when a single or a few arterial feeders are present. The transvenous route is preferred for complete obliteration of the nidus if multiple arterial feeders and a single collector vein are present. Liquid embolic agents are the preferred embolizing agents in AVMs. Congenital or acquired AVFs are managed by coil embolization. Superselective embolization using coils or n-butyl cyanoacrylate glue is the treatment of choice for aneurysms, pseudoaneurysms, and transections involving the segmental renal arteries. Aneurysms and pseudoaneurysms involving the main renal artery are treated by stent graft placement.

Purpose: This article evaluates the treatment response to chemoradiotherapy in locally advanced cervical squamous cell carcinoma using quantitative diffusion and perfusion magnetic resonance imaging (MRI) parameters and studies their role as response predictors.

Materials and methods: Patients diagnosed with locally advanced squamous cell carcinoma cervix (LASCC) and planned for concurrent chemoradiotherapy (CCRT) were included. Diffusion-weighted imaging (DWI) and perfusion MRI were performed both pre- and post-CCRT. Statistical analysis of quantitative DWI (apparent diffusion coefficient [ADC]) and perfusion MRI parameters (K _trans , K _ep , V _e , V _p , SI _max , SI _rel , and time-to-peak) was done to assess the tumor regression rate and compare them between the residual and nonresidual groups.

Results: All the MR perfusion parameters showed statistically significant results ( p  < 0.05) for the evaluation of the treatment response of LASCC to CCRT using the obtained cutoff values, except for Vp. The highest diagnostic performance was of pretreatment K _ep with a sensitivity of 100%, specificity of 80%, positive predictive value of 54.5%, negative predictive value of 100%, area under the curve of 0.833, and diagnostic accuracy of 74.2%. However, ADC values did not show any significant result for the evaluation of the treatment response of LASCC.

Conclusion: Quantitative MR perfusion parameters have a significant role in evaluating treatment response to CCRT in LASCC.

Image-guided percutaneous spinal biopsy is a minimally invasive procedure for histopathological confirmation and/or microbiological assessment of spinal lesions. When considering image-guided percutaneous spinal biopsy, both computed tomography (CT) and C-arm guidance have their advantages and specific applications. CT provides high-resolution cross-sectional images, allowing for precise localization of lesions and thus, effective for biopsy of spinal lesions in complex anatomical locations (e.g., cervical and upper dorsal spine). However, patients may receive higher doses of radiation than those with C-arm. C-arm guidance offers continuous imaging, which can enhance needle placement accuracy and is typically associated with lower radiation exposure than CT. However, C-arm provides less detailed images compared with CT, especially for certain lesions, and can be more challenging for accessing certain spinal areas, especially in the presence of anatomical variations. The choice between CT and C-arm guidance often depends on the specific clinical scenario, the location of the lesion, and the preferences of the clinician. For lesions that are easily accessible (lumbar, lower dorsal spine) and require real-time monitoring, C-arm may be preferred. For deeper or more complex lesions, CT guidance often provides better visualization and accuracy. Ultimately, the decision should be tailored to each patient's needs and the expertise of the clinician. This review article aims to compare the use of CT and C-arm guidance in percutaneous spinal biopsy, focusing on their technical aspects, diagnostic accuracy, and safety profiles.

Pancreaticoduodenectomy is the one of the most complex surgeries done for periampullary pathologies. Computed tomography is the imaging modality of choice in the postoperative period. The radiologist should have the knowledge regarding normal findings and complications that can be encountered postsurgery. This will help in quick decision making and timely management of these complex cases.

Background: Breast cancer is a major cause of mortality and morbidity in women. Hence, detecting suspicious microcalcifications on mammograms can be crucial for early diagnosis.

Aims: To determine the malignancy risk of suspicious microcalcifications detected on mammograms in terms of positive predictive value (PPV) based on morphology and distribution characteristics and correlate results with BI-RADS Atlas, fifth edition and world literature.

Materials and methods: This is a hospital-based observational study conducted at our institute over 15-month duration and included all symptomatic and asymptomatic females who underwent mammogram, detected with suspicious breast microcalcifications, followed by stereotactic or ultrasound-guided breast biopsy and histopathology.

Statistical analysis: The chi-square test was used to test the association of the outcome. A p  < 0.05 was considered to be statistically significant.

Results: Among 77 lesions, 56 were not associated with mass and 21 were associated with mass. Overall PPV for malignancy of suspicious microcalcifications not associated with mass was 37.5%, and PPV of these according to morphology descriptors was: amorphous 9.5%; coarse heterogeneous 45.4%; fine pleomorphic 50%, and fine linear/fine linear branching 100% ( p  < 0.001). Overall PPV when associated with mass was 71.4%. PPV of suspicious microcalcifications for distribution descriptors was: regional 0%, grouped 38.9%, linear 66.7%, and segmental 63.2%.

Conclusion: Results of our study correlated well with BI-RADS, fifth edition. Subcategorizing morphology and distribution descriptors provides accurate risk stratification, determines the need for image-guided biopsy, and guides further management strategies.