Quantitative Imaging in Medicine and Surgery最新文献

Background: Despite the high prevalence of hysterectomy, the procedure is associated with a significant risk of subsequent pelvic floor dysfunction (PFD). This study aimed to evaluate pelvic floor alterations following hysterectomy and bilateral adnexectomy using real-time shear wave elastography (SWE) and pelvic floor ultrasonography.

Methods: This is a retrospective case-control study. A total of 133 patients who underwent hysterectomy and bilateral adnexectomy for benign or malignant pelvic conditions were included. Participants were categorized into three groups based on the time elapsed since surgery: less than 1 year (n=41), 1-3 years (n=45), and more than 3 years (n=47). Additionally, 45 healthy individuals without a history of hysterectomy or bilateral adnexectomy were enrolled as the control group. Pelvic floor ultrasonography was performed to assess parameters at rest and during the Valsalva maneuver. Real-time SWE was used to measure the elasticity of the anterior, middle, and posterior regions of the bilateral puborectalis (PR) muscle during rest, pelvic floor muscle contraction, and the Valsalva maneuver. Comparisons between two groups were conducted using independent t-tests, whereas multiple group comparisons were analyzed using analysis of variance (ANOVA). For intra-group comparisons, paired sample t-tests were used.

Results: Pelvic floor ultrasonography revealed that, compared to the control group, all postoperative groups exhibited a reduced urethral inclination angle at rest and an increased angle during the Valsalva maneuver (P<0.05). The levator hiatus area (LHA) was significantly larger during the Valsalva maneuver in all postoperative groups compared to the control group (P<0.05). Patients in the 1-3 years and more than 3 years post-surgery groups demonstrated reduced distance from the anterior urethrovesical junction to the reference line and posterior bladder wall distance during both rest and the Valsalva maneuver compared to the control group (P<0.05). Additionally, the more than 3 years post-surgery group indicated an increased bladder neck mobility during the Valsalva maneuver. Real-time SWE measurements showed that PR elasticity was highest during pelvic floor muscle contraction in the control group, followed by the Valsalva maneuver and rest. Among the postoperative groups, PR elasticity at rest was lower than it was in the control group (P<0.05), with further reductions observed during pelvic floor muscle contraction in the 1-3 years and more than 3 years post-surgery groups.

Conclusions: Real-time SWE and ultrasonography reveal that hysterectomy with bilateral adnexectomy leads to progressive, quantifiable declines in pelvic floor muscle elasticity and structural support. These findings provide objective biomarkers for postoperative assessment and potential targets for personalized rehabilitation.

Background: Hepatocellular carcinoma (HCC) and liver-dominant metastases remain major causes of cancer mortality, and yttrium-90 transarterial radioembolization (TARE) offers a vital treatment option for unresectable cases. Accurate dosimetry is critical for maximizing tumor control while minimizing lung toxicity, yet conventional planar scintigraphy may overestimate lung shunt and compromise therapeutic efficacy. This study evaluated the value of Q.Liver software in planning yttrium-90 TARE for liver cancer.

Methods: A total of 45 patients with liver cancer scheduled for treatment with yttrium-90 resin microspheres TARE were enrolled. Treatment planning was conducted via the partition model with two approaches for each case: the traditional method based on planar scintigraphy and the Q.Liver software based on single-photon emission computed tomography-computed tomography (SPECT/CT) imaging. Differences in liver and lung volume between the two methods were compared. Differences in lung shunt fraction (LSF) were analyzed in 43 patients, and yttrium-90-prescribed activity, liver-absorbed dose (D_Liver), and lung-absorbed dose (D_Lung) were compared between the two methods for the same patient. In the planar method, liver and lung volumes were obtained by enhanced CT, and LSF was obtained by planar scintigraphy; in the Q.Liver method, LSF, liver and lung volumes were obtained via SPECT/CT. The yttrium-90-prescribed activity, D_Liver, and D_Lung of each method were calculated.

Results: (I) The liver and lung volumes in the planar and Q.Liver methods were 1,809 and 1,820 mL (P=0.36), respectively, and 3,279 and 2,587 mL (P<0.05), respectively. (II) The LSF in the planar method was higher than that in the Q.Liver method (6.08% vs. 3.96%). (III) Yttrium-90-prescribed activity was higher in the planar method than in the Q.Liver method (2.02 vs. 1.82 GBq), The sum of D_Lung was 345.53 Gy in the planar method and 221.82 Gy in the Q.Liver method. (IV) With D_Lung being constant in the treatment planning system, the yttrium-90 prescribed activity, DTumor and D_Liver, were higher in the Q.Liver method than in the planar method. This led to changes in 44.19% (19/43) of the treatment plans.

Conclusions: SPECT/CT-based Q.Liver software was able to simplify yttrium-90 treatment. Planar scintigraphy overestimated LSF and D_Lung as compared to SPECT/CT imaging. If D_Lung remained constant, Q.Liver software increased DTumor and D_Liver, leading to changes in 44.19% of the treatment plans involving yttrium-90 resin microsphere TARE.

Background: S-detect is a deep learning (DL)-based ultrasound tool that automatically classifies breast nodules on grayscale images; however, its diagnostic specificity for Breast Imaging Reporting and Data System (BI-RADS 4) lesions is only 59.57%. Whether quantitative multimodal ultrasound (MUS) parameters can effectively enhance the performance of this tool remains unclear. This study therefore aimed to improve the diagnostic accuracy of S-detect in distinguishing benign from malignant breast nodules by integrating MUS parameters.

Methods: Clinical and ultrasound data of 231 female patients diagnosed with BI-RADS type 4 breast nodules from June 2019 to March 2024 were retrospectively included, and S-detect classification results based on grayscale ultrasound images were obtained. MUS parameters were extracted, including Adler blood flow grading, vascular resistance index (RI), calcification, elasticity score (ES), elastic strain ratio (SR), and vascularity index (VI), among others, and meaningful parameters were analyzed to optimize the diagnosis results of benign and malignant breast nodules classified by S-detect. Sensitivity (SE), specificity (SP), accuracy (ACC), receiver operating characteristic (ROC) curve, and area under the curve (AUC) were used to evaluate the performance of S-detect classification before and after optimization.

Results: Malignant nodules showed significantly higher SR [median 3.55 (2.39, 4.95) vs. 2.13 (1.47, 2.71), P<0.01] and VI [median 13.20 (6.80, 22.20) vs. 4.10 (0.00, 11.08); P<0.01], with optimal cut-offs of 3.08 and 5.15, respectively. Multivariate analysis identified the following independent predictors (all P<0.05): positive maximum oblique long-axis plane [odds ratio (OR) 5.54; 95% confidence interval (CI): 1.29-23.63], positive maximum oblique short-axis plane (OR 4.11; 95% CI: 1.02-16.62), micro-calcification (OR 12.03; 95% CI: 2.13-70.95), RI >0.70 (OR 5.31; 95% CI: 1.44-19.54), SR ≥3.08 (OR 1.58; 95% CI: 1.12-2.24), and VI ≥5.15 (OR 1.07; 95% CI: 1.02-1.12). The S-detect + MUS combined model achieved excellent diagnostic performance with SE 86.75%, SP 92.31%, and an AUC of 0.93. While maintaining high SE, the model significantly improved SP, especially for distinguishing BI-RADS 4a lesions.

Conclusions: Combining S-detect with multi-modal ultrasound parameters significantly improves the differential diagnosis accuracy of the four categories of lesions of BI-RADS, and provides a reliable basis for clinical decision-making. However, this study has the limitation of a single-center retrospective design, and future multi-center prospective studies are needed for further verification.

Background: Bone age (BA) assessment is crucial for evaluating pediatric growth, yet the standard radiographic method involves ionizing radiation. This study aimed to investigate the feasibility of a novel, quantitative ultrasound parameter-the epiphyseal ossification angle (OA)-as a non-invasive alternative for BA evaluation, and to examine its correlation with radiographically determined BA.

Methods: In this prospective study, 201 Chinese Han girls aged 5-14 years (mean age: 9.24±2.15 years) underwent both left wrist radiography and ultrasonography of the distal radius, distal ulna, and medial femoral condyle within a 1-week interval. The OA and the established ossification ratio (OR) were measured at each site. Composite indices-the total ossification angle (TOA, sum of OAs) and skeletal maturity score (SMS, sum of ORs)-were calculated. Radiographic BA was determined by the Tanner-Whitehouse 3 (TW3) method as the reference standard. Reproducibility was assessed using intraclass correlation coefficients (ICC), and correlations were analyzed with Pearson's method.

Results: Both OA and OR measurements demonstrated excellent intra- and inter-observer reproducibility, with ICCs ranging from 0.81 to 0.92 and 0.78 to 0.89, respectively (all P<0.001). OA at all individual sites showed significant negative correlations with TW3 BA (radius: r=-0.686; ulna: r=-0.650; femur: r=-0.721; all P<0.001). The composite TOA demonstrated a strong inverse correlation with BA (r=-0.808, P<0.001). Similarly, OR was positively correlated with BA at all sites (radius: r=0.807; ulna: r=0.632; femur: r=0.708; all P<0.001), with SMS showing the strongest positive correlation (r=0.813, P<0.001). A linear regression model based on TOA explained 65.3% of the variance in BA (R²=0.653, P<0.001).

Conclusions: The ultrasound-derived OA demonstrates a strong inverse correlation with radiographic BA. The composite TOA shows particular promise as a novel, non-invasive marker for pediatric BA assessment. These findings support the feasibility of the OA as a quantitative ultrasound parameter and warrant further investigation to develop and validate clinical prediction models.

Background: Difficult mask ventilation (DMV) poses significant perioperative challenges, particularly in oral and maxillofacial surgery. Maxillofacial computed tomography (CT) imaging may offer improved airway assessment. This study aimed to identify those preoperative midsagittal CT parameters associated with DMV in this high-risk patient population.

Methods: A retrospective cohort study was conducted that analyzed patients undergoing oral and maxillofacial surgery, with 21 anatomical parameters being measured on preoperative midsagittal CT scans. Multivariable logistic regression, adjusted for demographic characteristics, medical history, and traditional airway assessment parameters, was used to identify independent predictors of DMV. Subgroup analyses were performed for significant parameters.

Results: Among 449 participants included in the study, the incidence of DMV was 17.3%. Three CT parameters independently predicted DMV: anteroposterior diameter of the neck (dAP) [odds ratio (OR): 1.08; 95% confidence interval (CI): 1.03-1.13; P=0.003), uvula length (LU) (OR: 1.10; 95% CI: 1.03-1.18; P=0.008), and distance between the posterior nasal spine and the nasopharynx (Snp_Nph) (OR 0.92; 95% CI: 0.85-0.99; P=0.027). LU showed a stronger association with DMV in snoring patients (P for interaction=0.039) and Mallampati class I-II cases (P for interaction =0.038), while Snp_Nph showed a stronger association with DMV in patients with a body mass index (BMI) >24 kg/m² (P for interaction =0.050).

Conclusions: Neck morphology and uvular characteristics significantly influence DMV risk. Preoperative CT measurement of dAP, LU, and Snp_Nph may enhance DMV prediction, improving airway management in oral and maxillofacial surgery.

Background: Digital breast tomosynthesis (DBT)-guided biopsy has provided a direct method for the suspicious breast abnormalities detected by DBT. The aim of this study was to assess performance and outcomes of stereotactic (ST) and DBT-guided core needle biopsy (CNB).

Methods: All CNBs from August 2021 to July 2024 at our institution were retrospectively reviewed. The number of image exposures obtained, average glandular dose (AGD) per overall procedure, AGD per acquisition, procedure time and pathologic results of CNB, pathologic results of surgical excision when available, and different B categories of concordant or upgrade rate were recorded. Mann-Whitney U test or two independent-sample t-test were used to compare continuous variables and Chi-squared test or Fisher's exact test for categorical variables. If data were non-normal distributions, represented by median [1st quartile-3rd quartile (Q1-Q3)].

Results: A total of 134 lesions used DBT-guided CNB, and 100 used ST-guidance. The number of image exposures was lower for DBT-guided (1 [1-2] images) than for ST-guided (3 [3-3] images) CNB (P<0.001). The AGD overall procedure for ST-guided was 7.39 (6.23-8.09) vs. 2.09 (1.75-2.98) mGy for DBT (P<0.001). The AGD per acquisition was lower for DBT-guided than for ST-guided (1.89 [1.56-2.09] vs. 2.43 [2.10-2.72] mGy) CNB (P<0.001). In DBT-guided CNB, the procedure time was significantly reduced (571.0 [484.0-716.5] vs. 827.0 [712.5-968.5] s) (P<0.001). There were no significant differences between ST-guided and DBT-guided CNB in different B categories of the concordant or upgrade rate (all P>0.05).

Conclusions: Reduced procedure time and fewer image exposures were achieved with DBT-guided CNB, with overall less AGD, compared to ST-guided CNB.

Background: Accurate preoperative diagnosis of lymph node (LN) metastasis in papillary thyroid carcinoma (PTC) remains challenging. This study aimed to evaluate the diagnostic performance of Node Reporting and Data System (Node-RADS) magnetic resonance imaging (MRI) score for detecting LN metastasis in PTC and to investigate whether a novel diagnostic criterion incorporating Node-RADS with supplementary MRI features could improve diagnostic accuracy.

Methods: In this prospective study, 82 consecutive PTC patients with 156 histopathologically confirmed LNs were enrolled. Node-RADS and supplementary MRI features were evaluated by three radiologists independently. A new diagnostic criterion was further developed by combining Node-RADS and significant supplementary MRI features. Univariate and multivariate logistic regressions identified potential predictors of metastasis. Sensitivity, specificity, accuracy, and positive and negative predictive values were calculated. Receiver operating characteristic (ROC) curve analysis, with the area under the curve (AUC), was performed to evaluate diagnostic effectiveness.

Results: Node-RADS demonstrated the highest performance (sensitivity 80.7%; specificity 74.5%; AUC =0.776) in diagnosing LN metastasis in PTC when applying a Node-RADS ≥3 criterion, in comparison to Node-RADS ≥4 (sensitivity 51.4%; specificity 89.4%; AUC =0.704; P=0.034) and Node-RADS ≥5 (sensitivity 21.2%; specificity 95.7%; AUC =0.584; P<0.001). Node-RADS and T1 hyperintensity were independent predictors of metastasis on multivariate analysis. Node-RADS combined with T1 hyperintensity showed a better diagnostic performance (sensitivity 75.2%; specificity 87.2%; AUC =0.856) than Node-RADS alone.

Conclusions: The new MRI-based diagnostic criterion incorporating Node-RADS and T1 hyperintensity demonstrates improved performance for diagnosing LN metastasis in PTC compared to Node-RADS.