Current Medical Imaging Reviews最新文献

Introduction: Synchronous liver metastases (SLM) critically influence prognosis in rectal cancer, highlighting the need for accurate preoperative detection. This study aimed to compare the predictive performance of radiomic features extracted from T2-weighted imaging (T2WI) and diffusion-weighted imaging (DWI) MRI sequences and to develop machine learning-based predictive models for the early detection of SLM in rectal cancer patients.

Methods: This retrospective study included 160 rectal cancer patients confirmed by pathology at our institution between September 2018 and June 2023. After screening, 137 patients were enrolled, comprising 71 patients with SLM and 66 without SLM. Clinical characteristics such as age, gender, tumor (mrT) staging, lymph node (mrN) staging, tumor size, tumor distance from the anal verge, location, and circumferential range were analyzed, with mrT and mrN staging showing statistical significance (p < 0.012). Radiomic features were extracted from regions of interest (ROIs) on T2WI and DWI using Pyradiomics after manual segmentation in ITK-SNAP. A total of 3,452 radiomic features (1,726 each from T2WI and DWI) were extracted, of which 14 features (4 from T2WI and 10 from DWI) were selected using the LASSO. Predictive models were developed using three machine learning algorithms: Logistic Regression (LR), Support Vector Machine (SVM), and Random Forest (RF), with a five-fold cross-validation strategy.

Results: Among the machine learning algorithms, the RF consistently outperformed LR and SVM across all models. The Optimal model yielded the highest predictive performance, with RF achieving an AUC of 0.82 (95% CI: 0.66-0.93), an accuracy of 0.71, and an F1-score of 0.74. RF also showed superior performance in the Combined-Optimal model (AUC = 0.76, accuracy = 0.71). In contrast, models built using LR and SVM algorithms demonstrated moderate performance, with lower AUC values ranging from 0.68 to 0.70. Confusion matrix analysis confirmed RF's superior classification ability, accurately predicting SLM and non-SLM cases.

Discussion: The incorporation of radiomics and RF-based models conveys a promising, non-invasive approach for enhancing early detection and risk stratification of SLM, which could help with more reliable clinical decision-making and individualized treatment planning for patients with rectal cancer.

Conclusion: The optimal feature set-based predictive model demonstrated the highest accuracy for SLM detection, with the RF algorithm outperforming LR and SVM by consistently achieving the best AUC and balanced diagnostic performance.

Introduction: Transanal small bowel evisceration is an extremely rare and life-threatening surgical emergency that primarily occurs in debilitated elderly patients. Preoperative computed tomography (CT) can be useful for identifying the viability of eviscerated small bowel and other intra-abdominal pathologies.

Case presentation: In this study, we report the case of an 81-year-old woman who presented with sudden anal protrusion of small bowel loops. Computed tomography (CT) demonstrated a rectal wall defect, pneumoperitoneum, and herniation of the small bowel with features suggestive of strangulation. Emergency laparotomy revealed a firmly impacted ileal segment plugging a perforation at the rectosigmoid junction, likely due to increased intraabdominal pressure, necessitating small bowel resection and the Hartmann procedure. Early diagnosis and prompt surgical intervention led to a favorable postoperative course.

Conclusion: This case highlights the critical role of CT in identifying rectal perforation and intrarectal small bowel evisceration.

Introduction: This study aimed to systematically review the application of narrow band imaging (NBI) in the diagnosis, treatment, and follow-up of head and neck cancer.

Methods: Through literature review and generalization of our clinical experiences, this review thoroughly described the features, mechanisms, advantages, drawbacks, and prospects of NBI in the treatment of head and neck cancer.

Results: NBI is an emerging endoscopic technology that emits an ambient light at wavelengths of 415 nm (blue) and 540 nm (green) to clearly visualize the details on the mucosal surface. It presents potent efficiencies in the preoperative, intraoperative, and postoperative surveillance and diagnosis of head and neck cancer.

Conclusion: NBI is a front-edge imaging technology that allows early screening, precise treatment, and postoperative monitoring of head and neck cancer.

Background: Although airway size changes occur in patients with chronic asthma, HRCT has not yet been used to assess changes in the inner diameter of the airways.

Objective: This study aimed to evaluate the airway diameter in asthma recovery by using HRCT.

Methods: Thirty patients with asthma were recruited and underwent HRCT examination in acute exacerbation and stable phase, respectively. The inner diameter of the airway (Din) was measured from the bilateral main bronchi to all 18 segmental bronchi during acute exacerbation and the stable phase.

Results: The inner diameter of the airway reduced significantly in the acute exacerbation period compared to the stable period (P < 0.05). The mean Din reduction (%) in segmental bronchi was 12% and that in lobar bronchi was 6%. Among the 30 patients, the dorsal segmental bronchi of both lower lobes showed the highest incidence of stenosis during acute exacerbation compared to the stable phase (right: 18 cases; left: 16 cases), while the lingular bronchus exhibited the highest stenosis incidence among lobar bronchi (18 cases). Although the number of stenotic segmental and lobar bronchi demonstrated a positive correlation with disease severity across mild, moderate, and severe groups, no statistically significant differences were observed in intergroup comparisons (P>0.05).

Conclusion: CT images of bronchial stenosis showed obvious dilation after appropriate medication, and the inner diameter of the airway can be used as a practical and convenient index to evaluate the recovery of asthma.

Background: Non-invasive biomarkers of liver metabolism are essential for early detection of metabolic alterations. Choline plays a central role in hepatic function, yet its dietary intake and imaging correlates remain underexplored. This study evaluated the feasibility of proton Magnetic Resonance Spectroscopy (1H-MRS) at 3T for hepatic choline quantification and examined its correlation with dietary intake in young women, a population at risk of nutrient-sensitive liver conditions.

Methods: In this prospective cohort study, 88 healthy female radiology students (mean age: 21.4 ± 1.8 years) underwent single-voxel 1H-MRS of the liver using a 3T Siemens Magnetom Vida scanner. Spectra were acquired with a point-resolved spectroscopy (PRESS) sequence (TR = 2000 ms, TE = 40 ms, voxel size = 20 × 20 × 20 mm3), with automated shimming and unsuppressed water referencing. Spectral analysis was performed using LCModel (v6.3), applying quality thresholds (Signal-to-Noise Ratio (SNR) > 5, linewidth < 0.1 ppm, Cramér-Rao Lower Bound (CRLB) < 20%. Hepatic choline concentrations were expressed in Institutional Units (IU). Dietary intake was assessed using a validated Food Frequency Questionnaire (FFQ).

Results: High-quality spectra were consistently obtained (mean SNR: 12.6 ± 3.1; linewidth: 0.048 ± 0.012 ppm). Mean hepatic choline concentration was 4.63 ± 1.21 IU, while mean dietary intake was 29.1 ± 8.7 mg/day. A significant positive correlation was observed (r = 0.555, p < 0.001). Regression analysis confirmed dietary intake as a significant predictor (β = 0.56, R2 = 0.308, p < 0.001).

Conclusion: 1H-MRS at 3T is a feasible and reproducible technique for hepatic choline quantification. By measuring metabolites directly in the liver at their site of production, rather than in circulation, where concentrations may be altered, MRS provides physiologically relevant insights into nutrient-related hepatic metabolism. Its correlation with dietary intake highlights its potential as a translational imaging biomarker for early detection and risk stratification of nutrient-sensitive liver conditions.

Introduction: The biexponential model of Intravoxel Incoherent Motion (IVIM) has been applied to estimate renal damage. However, the role of the biexponential and stretched exponential models in assessing early renal damage in Chronic Kidney Disease (CKD) is unclear.

Methods: In this prospective study, 61 patients with CKD and 19 healthy volunteers underwent renal IVIM imaging. The monoexponential model yielded the Apparent Diffusion Coefficient (ADC); the biexponential model provided the true diffusion coefficient (ADCslow), pseudo-diffusion coefficient (ADCfast), and perfusion fraction (f); and the stretched-exponential model provided the Distributed Diffusion Coefficient (DDC) and diffusion heterogeneity index alpha (α). The estimated Glomerular Filtration Rate (eGFR) was calculated for all participants, and pathological scores were assessed in CKD patients. Correlations of ADC, ADCslow, ADCfast, f, DDC, and α with eGFR and pathological scores were analyzed. Receiver operating characteristic analysis compared the diagnostic performance of ADCslow, ADCfast, f, DDC, and α for grading renal pathological injury.

Results: ADCfast, f, and α showed high diagnostic accuracy in differentiating controls from CKD patients (AUC: 0.964, 0.974, and 0.981, respectively), as well as from CKD patients with high eGFR (AUC: 0.933, 0.952, and 0.966, respectively). Pathological scores were significantly higher in the low eGFR group than in the high eGFR group (P < 0.05). ADCfast, f, and α were negatively correlated with pathological scores (P < 0.05).

Discussion: Renal cortical ADCfast, f, and α are sensitive biomarkers of early renal injury in CKD even when eGFR is preserved. Moreover, the ADCfast and f values of the renal cortex were significantly correlated with tubulointerstitial damage. The primary limitations of this study are the single-center data and the limited scope of the region of interest. Further work is needed to recruit more participants, and those results will be verified by external centers.

Conclusion: Biexponential and stretched exponential model-derived parameters may be superior to monoexponential model-derived parameters for evaluating early renal damage in CKD.

The rapid advancement of computational technologies has significantly transformed medical diagnostics, particularly in the realm of neurological disorders. This review provides a comprehensive analysis of the current computational approaches employed for the diagnosis of five major neurological disorders: Alzheimer's disease, Parkinson's disease, Epilepsy, Huntington's disease, and Amyotrophic Lateral Sclerosis. By evaluating 140 peer-reviewed studies, we explored a diverse array of diagnostic methods, including machine learning algorithms, neuroimaging techniques, and electrophysiological signal analysis. Our review highlights the efficacy, accuracy, and limitations of these diagnostic methods, emphasizing their role in early detection and differential diagnosis. Furthermore, we discuss the integration of multimodal data and the potential of emerging technologies such as deep learning and artificial intelligence to enhance diagnostic practices. We also address the current challenges in clinical implementation and propose future research directions to improve diagnostic precision and patient outcomes. This review aims to serve as a valuable resource for researchers, clinicians, and stakeholders in the field of neurodiagnostics, fostering a deeper understanding of computational methodologies that shape the future of neurological disorder diagnosis.

Background: Acute Aortic Dissection (AD) is of great concern due to its high mortality rate. The probability of young patients without underlying diseases developing acute aortic dissection is relatively low. In extreme regions such as high-altitude areas, for patients presenting with atypical chest pain, it is necessary to not only consider life-threatening diseases such as aortic dissection and acute coronary syndrome, but also to rule out the interference of emphysema in the diagnosis. This case provides experience in the diagnosis, evacuation, and treatment of aortic dissection patients in high-altitude areas.

Case presentation: We present the case of a young man who experienced sudden neck pain at an altitude of 5200 m during defecation. The pain persisted and radiated to the back, but there were no typical symptoms of aortic dissection. However, on physical examination, the patient was found to have unequal blood pressure in both arms. After completing a CT scan, the diagnosis was confirmed as aortic dissection with subcutaneous emphysema. The patient was transferred to a hospital at a lower altitude to undergo an "aortic arch replacement under cardiopulmonary bypass." After follow-up, the patient had a good prognosis and was able to independently perform general daily activities.

Conclusion: The purpose of this case report is to raise awareness of the diagnostic interference caused by subcutaneous emphysema and to emphasize accurate diagnosis and timely intervention when encountering patients with atypical chest pain in high-altitude environments, which is expected to gain a therapeutic time window for the patient.

Background: Anterior Inferior Cerebellar Artery (AICA) aneurysms are rare, accounting for 0.1% to 0.5% of posterior circulation aneurysms. They often present with diverse morphologies and clinical symptoms, challenging diagnosis and management.

Case descriptions: We report three cases of AICA aneurysms with distinct clinical presentations and management strategies. Case 1: A 56-year-old male presented with chronic headache and left hemiparesis. MRI and 3D TOF MRA revealed a fusiform AICA aneurysm compressing the pons, treated with microsurgical clipping via anterior petrosectomy, resulting in a favorable outcome (mRS score of 0). Case 2: A 26-year-old female with a sudden-onset sentinel headache had a wide-neck saccular aneurysm of the right AICA confirmed by DSA. A posterior petrosectomy approach with clipping was performed, achieving complete aneurysm exclusion without complications (mRS score of 0). Case 3: A 21-year-old male with an incidentally detected saccular aneurysm underwent DSA and 3D angio-CT, confirming a wide-neck saccular aneurysm in the AICA territory. Microsurgical clipping via anterior petrosectomy was successful, with no residual lesion (mRS score of 0).

Conclusion: Microsurgical clipping remains a viable option for managing wide-neck and fusiform AICA aneurysms, particularly those unsuitable for endovascular techniques. Advanced imaging modalities and tailored cranial base approaches are crucial for optimizing outcomes. Further studies are needed to refine management strategies for these rare aneurysms.