Current Medical Imaging Reviews最新文献

Purpose: The objective of this study was to evaluate the feasibility of weight-based tube voltage and iodine delivery rate (IDR) for coronary artery CT angiography (CCTA).

Methods: A total of 193 patients (mean age: 58 ± 12 years) with suspected coronary heart disease indicated for CCTA between May and October 2022 were prospectively enrolled. The subjects were divided into five groups according to body weight: < 60 kg, 60 - 69 kg, 70 - 79 kg, 80 - 89 kg, and ≥ 90 kg. The tube voltage and IDR settings of each group were as follows: 70 kVp/0.8 gI/s, 80 kVp/1.0 gI/s, 80 kVp/1.1 gI/s, 100 kVp/1.5 gI/s, and 100 kVp/1.5 gI/s, respectively. Objective image quality data included the CT value and standard deviation (noise) of the aortic root (AR), the proximal left anterior descending branch (LAD), and the distal right coronary artery (RCA), as well as the signal-to-noise ratio and contrast-to-noise ratio of the LAD and RCA. Subjective image quality assessment was performed based on the 18-segment model. Contrast and radiation doses, as well as effective dose (ED), were recorded. All continuous variables were compared using either the one-way ANOVA or the Kruskal-Wallis rank sum test.

Results: No significant differences were observed in all objective and subjective parameters of image quality between the groups (P > 0.05). However, significant differences in contrast and radiation doses were observed (P < 0.05). The contrast doses across the weight groups were 27 mL, 35 mL, 38 mL, 53 mL, and 53 mL, respectively, while the ED were 1.567 (1.30, 2.197) mSv, 1.53 (1.373, 1.78) mSv, 2.113 (1.963, 2.256) mSv, 4.22 (3.771, 4.483) mSv, and 4.786 (4.339, 5.536) mSv, respectively.

Conclusion: Weight-based tube voltage and IDR yielded consistently high image quality, and allowed for further reduction in contrast and radiation exposure during CCTA for coronary artery diseases.

Introduction: Diffuse-type tenosynovial giant cell tumor (D-TGCT) originates from synovial cells in tendon sheaths and bursae and rarely presents as a calcaneal mass.

Case report: A 44-year-old female presented with left heel pain that had persisted for over a year and had worsened over the past six months. A mass was found on the Lateral radiograph of the calcaneus, which was diagnosed as an aneurysmal bone cyst. Non-contrast computed tomography (CT) and magnetic resonance imaging (MRI)diagnosed a benign tumor. Based on light microscopy, special stains, and immunohistochemistry, a final diagnosis of diffuse tenosynovial giant cell tumor (D-TGCT) was rendered.

Results: D-TGCT is a slow-growing, infiltrative tumor that can form single or multiple masses outside the joint, and can also involve adjacent jointsmainly affects weight-bearing joints such as the knee, hip, and ankle. However, D-TGCT presents as a calcaneal mass, which poses a diagnostic challenge for all radiologists.

Conclusion: A calcaneal mass exhibiting well-defined borders, focal cortical destruction, a sclerotic rim, and T2WI hypointensity, the possibility of D-TGCT should be considered.

Background: Interstitial lung abnormalities (ILA) are associated with further disease progression, increased mortality risk, and decline in lung function in the elderly, which deserves enough attention.

Objective: The objective of this study was to quantify the extent of interstitial lung abnormalities (ILA) in a non-smoking asymptomatic urban cohort in China using low-dose CT (LDCT) and to analyze the age-related pathological changes.

Methods: We retrospectively analyzed clinical data and chest LDCT images from a cohort of 733 subjects who were categorized into 3 groups: 18-39, 40-59, and ≥60 years old according to age. Furthermore, we selected 40 cases of wax-embedded lung tissue blocks archived after pulmonary bullectomy and the same age groups were categorized. Four representative CT signs of ILA, including interlobular septal thickening (ILST), intralobular interstitial thickening (ILIT), ground-glass opacity (GGO), and reticular shadow (RS), were semi-quantified based on the percentage of the affected area. The scores and distribution of four CT signs of ILA were compared between different sex and age groups. The age-related pathological changes were analyzed.

Results: The ILA findings were found predominantly in the lower lobes and the subpleural region. The semi-quantitative scores of four CT signs in all subjects under 40 were 0. However, in subjects over 40 years old, the scores gradually increased with age, although most of them remained low. The size of the alveoli increased, the number of alveoli decreased, the alveolar septum became thinner, and the number of ATII cells increased with age. A statistically significant difference was observed among the different age groups (χ2=50.624, P=0.033; χ2=80.000, P=0.043; χ2=33.833, P=0.000; χ2=13.525, P=0.031). The macrophage population and the percentage of collagen fibers in the alveolar septum increased, while the percentage of elastic fibers decreased with age. There was no significant difference among the different age groups (χ2=19.817, P=0.506; χ2=52.419, P=0. 682; χ2=54.868, P=0.518).

Conclusion: When the four CT signs mentioned above are in the upper central area, and the score has a medium or high score, it is crucial to determine the underlying pathological causes. ILA may be the result of chronic lung injury.

Background: Acute inflammation induced by COVID-19 may lead to atherosclerotic plaque development or complicate existing plaque. In this study, we aimed to determine the atherogenic effect of COVID-19 pneumonia, confirmed by thoracic computed tomography, on coronary and carotid arteries in patients who recovered from the disease.

Methods: Our study included patients who were diagnosed with COVID-19 in our hospital at least 1 year ago, recovered, and then underwent coronary CT angiography with suspected coronary artery disease. The aim was to evaluate the burden of atherosclerotic plaque in the coronary arteries of these patients who underwent coronary CT angiography.

Results: Patients were assigned to 3 groups according to the results of the CT scan. Group 1 included patients in the control group with no history of COVID-19 (n=36), group 2 included those with mild to moderate pneumonia symptoms (n=43), and group 3 included those with severe pneumonia symptoms (n=29). The calcium scores were 23.25±36.8 in group 1, 27.65±33.4 in group 2, and 53.58±55.1 in group 3. The calcium score was found to be significantly higher in group 3 patients with severe pneumonia (group 1-2 p=0.885, group 1-3 p<0.05, group 2-3 p<0.05).

Conclusion: Although there is no conclusive evidence of a relationship between COVID-19 and atherosclerosis, our study suggests a possible relationship between them. Since this relationship was found especially in cases with severe disease in our study, we believe that the treatment should focus on preventing excessive inflammatory response, and such patients should be under control in terms of coronary artery disease.

Objective: Accurate prediction of recurrence risk after resction in patients with Hepatocellular Carcinoma (HCC) may help to individualize therapy strategies. This study aimed to develop machine learning models based on preoperative clinical factors and multiparameter Magnetic Resonance Imaging (MRI) characteristics to predict the 1-year recurrence after HCC resection.

Methods: Eighty-two patients with single HCC who underwent surgery were retrospectively analyzed. All patients underwent preoperative gadoxetic acidenhanced MRI examination. Preoperative clinical factors and MRI characteristics were collected for feature selection. Least Absolute Shrinkage and Selection Operator (LASSO) was applied to select the optimal features for predicting postoperative 1-year recurrence of HCC. Four machine learning algorithms, Multilayer Perception (MLP), random forest, support vector machine, and k-nearest neighbor, were used to construct the predictive models based on the selected features. A Receiver Operating Characteristic (ROC) curve was used to assess the performance of each model.

Results: Among the enrolled patients, 32 patients experienced recurrences within one year, while 50 did not. Tumor size, peritumoral hypointensity, decreasing ratio of liver parenchyma T1 value (ΔT1), and α-fetoprotein (AFP) levels were selected by using LASSO to develop the machine learning models. The area under the curve (AUC) of each model exceeded 0.72. Among the models, the MLP model showed the best performance with an AUC, accuracy, sensitivity, and specificity of 0.813, 0.742, 0.570, and 0.853, respectively.

Conclusion: Machine learning models can accurately predict postoperative 1-year recurrence in patients with HCC, which may help to provide individualized treatment.

Background: Fat-suppressed (FS) T2-weighed turbo spin-echo (TSE) sequence was used to detect the signal of the thymus and the characteristics of the thymus location, measure the two-dimensional diameter at specific levels, and analyze the association with gestational weeks.

Methods: This study involved 51 fetal specimens. Post-mortem MRI scanning was implemented with a 3.0-T MRI system. T2-weighted imaging (T2WI) features of the thymus in fetuses were quantitatively investigated with DICOM images. Statistical analysis was done with the Chi-Square test, oneway ANOVA, and Student's t-test.

Results: There was heterogeneity in the morphology of the fetal thymus. FS T2-weighted TSE sequence clearly exhibited the microstructure of the fetal thymus. The thymus extensively showed a lobulated appearance. The central signal is much higher than the peripheral signal in each lobule. In addition, FS-T2WI images can clearly show the interlobular septum, which is filled with fluid and presents a linear high signal. The signal intensity of fetal thymus increased with gestational weeks. The diameter measured in a particular plane was highly correlated with gestational week.

Conclusion: FS T2-weighted TSE sequence provides high-resolution images of the fetal thymus. The change in signal intensity, location, and two-dimensional diameter in a specific plane can be used as a research direction for the fetal thymus.

Background: The Glypican 3 (GPC3)-positive expression in Hepatocellular Carcinoma (HCC) is associated with a worse prognosis. Moreover, GPC3 has emerged as an immunotherapeutic target in advanced unresectable HCC systemic therapy. It is significant to diagnose GPC3-positive HCCs before therapy. Regarding imaging diagnosis of HCC, dynamic contrast-enhanced CT is more common than MRI in many regions.

Objective: The aim of this study was to construct and validate a radiomics model based on contrast-enhanced CT to predict the GPC3 expression in hepatocellular carcinoma.

Methods: This retrospective study included 141 (training cohort: n = 100; validation cohort: n = 41) pathologically confirmed HCC patients. Radiomics features were extracted from the Artery Phase (AP) images of contrast-enhanced CT. Logistic regression with the Least Absolute Shrinkage and Selection Operator (LASSO) regularization was used to select features to construct radiomics score (Rad-score). A final combined model, including the Rad-score of the selected features and clinical risk factors, was established. Receiver Operating Characteristic (ROC) curve analysis, Delong test, and Decision Curve Analysis (DCA) were used to assess the predictive performance of the clinical and radiomics models.

Results: 5 features were selected to construct the AP radiomics model of contrast-enhanced CT. The radiomics model of AP from contrast-enhanced CT was superior to the clinical model of AFP in training cohorts (P < 0.001), but not superior to the clinical model in validation cohorts (P = 0.151). The combined model (AUC = 0.867 vs. 0.895), including AP Rad-score and serum Alpha-Fetoprotein (AFP) levels, improved the predictive performance more than the AFP model (AUC = 0.651 vs. 0.718) in the training and validation cohorts. The combined model, with a higher decision curve indicating more net benefit, exhibited a better predictive performance than the AP radiomics model. DCA revealed that at a range threshold probability approximately above 60%, the combined model added more net benefit compared to the AP radiomics model of contrastenhanced CT.

Conclusion: A combined model including AP Rad-score and serum AFP levels based on contrast-enhanced CT could preoperatively predict GPC3-positive expression in HCC.

Introduction: The visualization and understanding of the details of the root configurations and root canal structure are essential prior to root canal treatment. This study aimed to identify key indicators of pronounced root divergence between the distobuccal and distolingual roots in mandibular first molars by highlighting common features observed in panoramic radiographs. These indicators can help predict the likelihood of encountering significant root divergence before initiating endodontic treatment.

Case presentation: We present three cases in which panoramic radiographs displayed imaging features characteristic of root resorption in the distal root of the mandibular first molars. However, subsequent periapical radiographs in case 1 and cone-beam computed tomography images in cases 2 and 3 revealed that the mandibular first molars were in normal condition, with pronounced root divergence but no evidence of root resorption.

Conclusion: Panoramic radiographs depicting mandibular molar roots with a resorptive and unclear appearance may indicate the presence of severe root divergence. In such cases, we strongly recommend additional cone-beam computed tomographic imaging to ensure precise diagnosis and facilitate optimal treatment planning for endodontic procedures.

Background: It is essential to determine whether bone marrow signal changes on magnetic resonance imaging (MRI) represent a physiological response or pathology; at present, the clinical significance of these signal changes is unclear. It is unknown whether a bone marrow biopsy is required when bone marrow signal changes are detected incidentally in individuals without suspected malignancy.

Objective: The primary purpose of this study was to determine whether incidentally detected bone marrow signal changes on MRI performed for various reasons (at the time of admission or during follow-up) are clinically significant.

Methods: We retrospectively evaluated the bone marrow biopsy clinical and laboratory findings of 42 patients with incidental bone marrow signal changes on MRI between September 2016 and January 2020. We also determined whether the patients were diagnosed with malignancy during admission or follow-up.

Results: Of the 42 patients, three (7%) were diagnosed with hematological malignancies during admission, while two were diagnosed with multiple myeloma and one with B-cell acute lymphoblastic leukemia. Of the 42 patients, 35 had a mean follow-up of 40.6 ± 5.3 months. One patient was diagnosed with monoclonal gammopathy of undetermined significance four months after their first admission.

Conclusions: In addition to MRI, detailed clinical and laboratory evaluations should be performed to inform the decision for bone marrow biopsy and exclude hematological malignancy. If there is any doubt, a bone marrow biopsy should be performed. Moreover, since bone marrow signal changes may be a preliminary finding, follow-up of these patients is essential.

Background: Pyogenic liver abscess (PLA) is a purulent disease caused by microbial contamination of liver parenchyma and includes amoebic liver abscess, fungal liver abscess, and the most common bacterial liver abscess.

Objective: Explore the efficacy of contrast-enhanced ultrasound (CEUS) via vessels and surgical drain guidance percutaneous catheter drainage (PCD) in the treatment of pyogenic liver abscesses (PLA).

Materials and methods: A total of 86 PLA patients who underwent PCD treatment in our hospital from May 2018 to February 2023 were retrospectively selected. Of them, 41 patients were treated under intravenous CEUS guidance (Control group), and 45 patients were treated under CEUS via vessels and surgical drain guidance (study group). Perioperative characteristics, treatment effectiveness, and incidence of complications were analyzed and compared between groups.

Results and discussion: The duration of surgery, drainage, white blood cell recovery, body temperature recovery, and hospitalization in the study group were longer than those in the control group (P<0.05). The total effective rate of the study group (95.56%) was higher than that of the control group (80.49%) (P<0.05). The incidence of complications in the study group (4.44%) was lower than that in the control group (19.51%) (P<0.05).

Conclusion: Compared with intravenous CEUS alone, treatment under CEUS via vessels and surgical drains-guided PCD was associated with shorter surgical time, faster recovery, better treatment effect, lower risk of complications, and ensured treatment safety in PLA patients.