Canadian Association of Radiologists Journal-Journal De L Association Canadienne Des Radiologistes最新文献

Dual-energy computed tomography has become a pivotal tool in abdominal imaging, particularly for pancreatic pathologies such as pancreatic ductal adenocarcinoma, trauma assessment, and acute pancreatitis. Its ability to provide enhanced contrast resolution, reduce artifacts, and optimize radiation dose makes it invaluable in both acute and non-acute clinical settings. This narrative review summarizes the technological advancements and clinical applications of dual-energy computed tomography in pancreatic imaging. A comprehensive review of 21 peer-reviewed studies published between 2013 and 2024 was conducted to evaluate the role of dual-energy computed tomography in all pancreatic imaging indications, including tumor detection, pancreatitis assessment, trauma evaluation, and radiation dose optimization. The analysis included retrospective and prospective studies retrieved from multiple databases, including PubMed, Scopus, and Google Scholar. The findings highlight the technology's capacity to improve diagnostic accuracy, reduce image artifacts, and lower radiation exposure through techniques such as virtual monoenergetic imaging and iodine quantification. Comparisons with conventional computed tomography focused on diagnostic performance metrics such as contrast-to-noise ratio, and signal-to-noise ratio. Additionally, this narrative review underscores the clinical relevance of dual-energy computed tomography in evaluating non-traumatic acute abdominal conditions, especially among elderly patients.

The Canadian Association of Radiologists (CAR) metabolic dysfunction-associated steatotic liver disease (MASLD) Working Group (WG) is a multidisciplinary working group composed of radiologists, hepatologists, and family physicians. In this 3-part series, we provide Delphi consensus-based guidance on clinical and imaging findings for patients with known or suspected MASLD (formerly termed nonalcoholic fatty liver disease or NAFLD). Part 1 focuses on the detection and grading of hepatic steatosis on imaging; Part 2 on risk stratification of patients with MASLD, including a patient pathway that applies blood-based and imaging-based investigations; and Part 3 on the implementation of practice recommendations for quality assurance using shear wave elastography (SWE) and magnetic resonance elastography (MRE) for disease staging. In the third part of these guidelines, the WG provides 18 recommendations for standardized implementation, remuneration, and quality assurance for SWE and MRE programs. Structured reporting templates for standardized SWE and MRE are provided. Introductory training presentations for technologists and radiologists are also provided. The goal of these guidelines is to enable standardized image-based screening and risk stratification of patients with MASLD across Canada.

Purpose: Accurate vessel measurement is essential in endovascular thrombectomy (EVT) for acute ischemic stroke. Discrepancies between computed tomography angiography (CTA) and digital subtraction angiography (DSA) may impact procedural planning and device selection. This study compares vessel diameter measurements from CTA and DSA in patients with middle cerebral artery (MCA) M1 occlusions.

Methods: In this single-center retrospective study, 90 consecutive patients who underwent EVT for MCA M1 occlusions between February 2020 and March 2024 were included. Vessel diameters were independently measured by 3 neuroradiologists using CTA and DSA (pre- and post-intervention). Statistical analysis included Wilcoxon signed-rank tests, intraclass correlation coefficient (ICC), and Bland-Altman analysis.

Results: CTA consistently overestimated vessel diameter compared to DSA. The mean M1 diameter was 2.29 ± 0.27 mm on CTA and 2.16 ± 0.30 mm on pre-EVT DSA (P < .001), with a median difference of 0.4 mm (IQR: 0.2-0.6 mm). In 70% of cases, CTA values exceeded DSA. Bland-Altman analysis confirmed a mean difference of +0.13 mm (limits of agreement: -0.25 to +0.51 mm). No significant change was observed between pre- and post-EVT DSA measurements (P = .103). Clot-side M1 segments were significantly smaller than contralateral measurements on CTA (P = .003). Inter-rater agreement was good (ICC = .785).

Conclusions: CTA overestimates MCA M1 diameter relative to DSA. While the discrepancy is modest, it may influence device selection in borderline cases. Awareness of this variability is important, and further research is warranted to explore its clinical implications.

Theranostic represents a transformative approach in precision medicine, integrating diagnostic imaging with targeted radiopharmaceutical therapy to enhance individualized disease management. Rooted in nuclear medicine, this approach uses molecular targeting agents labelled with diagnostic radioisotopes for imaging and therapeutic radioisotopes for treatment, ensuring a seamless transition from diagnosis to therapy. The field has evolved significantly in the last decade, with prostate-specific membrane antigen (PSMA)-targeted radioligand therapy transforming prostate cancer patient management and somatostatin receptor (SSTR)-targeted agents revolutionizing neuroendocrine tumour (NET) treatment. Considering its interdisciplinary nature, collaboration between nuclear medicine specialists, oncologists, radiologists, and other healthcare professionals is critical to refining clinical applications and improving patient outcomes. As prominent members of the theranostic team, radiologists play a pivotal role, from patient selection and imaging-based eligibility assessment to response evaluation and long-term monitoring. In this regard, advanced imaging modalities facilitate the precise evaluation of disease characteristics, guiding treatment decisions. Hence, as theranostics becomes increasingly integrated into patient management, radiologists face the need to be well-versed in both the technical aspects and clinical implications. In this review, we aimed to provide a primer for radiologists to gain a general insight into the theranostic field and its basic principles.

The Canadian Association of Radiologists (CAR) metabolic dysfunction-associated steatotic liver disease (MASLD) Working Group (WG) is a multidisciplinary working group composed of radiologists, hepatologists, and family physicians. In this 3-part series, we provide Delphi consensus-based guidance on clinical and imaging findings for patients with known or suspected MASLD (formerly termed nonalcoholic fatty liver disease or NAFLD). Part 1 focuses on the detection and grading of hepatic steatosis on imaging; Part 2 on risk-stratification of patients with MASLD, including a patient pathway using serological and imaging investigations; and Part 3 on the implementation of practice recommendations for quality assurance using shear wave elastography (SWE) and magnetic resonance elastography (MRE) programs. In Part 2 of these guidelines, the WG provides 14 recommendations for risk stratifying MASLD patients into low and high risk for advanced hepatic fibrosis (F ≥ 3) using a combination of serological and imaging investigations. Population screening and risk stratification of MASLD patients using a clinical and serological investigation (FIB-4) followed by imaging pathway is recommended. Clinical, technical, and grading recommendations for point shear wave elastography (pSWE), 2-dimensional SWE (2D-SWE), and MRE are discussed.