Journal of the Belgian Society of Radiology最新文献

Teaching point: Malakoplakia is a rare but clinically significant condition in immunocompromised patients and in these patients to be included in the differential diagnosis to distinguish this pseudotumoral process in a renal graft from malignant entities such as renal cell carcinoma and post-transplant lymphoproliferative disease (PTLD).

Objectives: This study aimed to examine the association between MRI radiomics features of malignant breast masses and their histopathological, molecular characteristics, and response to neoadjuvant treatments. Materials and methods: A retrospective cohort of 70 breast cancer patients was analyzed. Texture analysis was performed on preoperative MRI scans, extracting features such as entropy, contrast, and homogeneity. These features were analyzed against histopathological and clinical targets (e.g., lymph node metastasis) and molecular profiles. Statistical analyses and machine learning algorithms, including logistic regression and support vector machines, were employed to evaluate the predictive power of MRI texture features for molecular subtypes and the association of radiomics markers with neoadjuvant treatments. Results: The findings revealed significant associations between MRI texture features and the histopathological and molecular characteristics of breast tumors. Certain texture parameters correlated with aggressive phenotypes and poor chemotherapy response. Despite the limited dataset, machine learning models performed well in classifying tumors and predicting outcomes, highlighting the potential of MRI texture analysis in clinical decision‑making. Conclusion: MRI texture analysis emerges as a non‑invasive tool for personalized breast cancer management. The significant associations between MRI texture features and critical tumor characteristics suggest that these features could serve as biomarkers for predicting tumor behavior and treatment efficacy. Further large‑scale research is needed to integrate MRI texture analysis into clinical practice and improve patient outcomes.

Teaching point: The clues to the correct diagnosis of muscle sarcoidosis on MRI are the typical 'dark star' sign in the axial plane and the 'three‑stripe' sign in the longitudinal plane.

Teaching point: In young adults with neurological symptoms after neck trauma, consider vertebral artery dissection. High‑resolution magnetic resonance angiography is superior to CT angiography for diagnosis if the false lumen is thrombosed.

Teaching point: Palatal myoepithelioma has almost pathognomonic progressive heterogeneous delayed enhancement on contrast CT, and a dedicated software application contributes to the surgical planning through hyper‑realistic rendering (HRR) 3D delineation of tumor extent/spatial relationships with critical adjacent structures.

Pituitary adenoma, a common benign tumor that can invade the clivus or appear ectopically, poses diagnostic challenges. Intravascular lymphoma is extremely rare and frequently underdiagnosed. A case is presented of coexisting pituitary adenoma and clival intravascular large B‑cell lymphoma, highlighting the differential diagnosis of clival infiltrative lesions. Teaching point: Clival lesions present a wide diagnostic spectrum; when imaging findings are atypical, histopathology remains essential for definitive diagnosis and appropriate treatment.

Teaching point: Perihepatic splenosis should be considered in patients with a history of splenectomy presenting with a subdiaphragmatic mass that enhances similar to splenic tissue, to avoid unnecessary biopsy or surgery.

Objectives: To evaluate the impact of patient-specific contrast volume adjustments on preoperative aortic computed tomography angiography (CTA) image quality after adjusting and reducing the total, injected contrast volume based on patients' body surface area (BSA) and heart rate (HR) and after adapting the CT-scanner's kilovoltage (kV). Methods: Prospective study included 80 surgery-naive patients. Three study groups were included: Group 1 (n = 56 patients): the injected contrast dose, calculated from BSA and HR, was reduced by 50%; Group 2 (n = 11 patients): the injected contrast dose, calculated from BSA and HR, was reduced by 50%, and an additional volume reduction was based on the kV values; Group 3 (n = 13 patients): the injected contrast dose, calculated from BSA and HR, was reduced by 50% and additionally diluted to 80% contrast and 20% saline. Image quality was evaluated by quantitative analysis (Hounsfield units) and qualitative analysis (five-point visual score). Results: The mean injected contrast dose was 46.1 ml, 28.3 ml, and 35.0 ml in Groups 1, 2, and 3, respectively, with a significant difference between Group 1 vs Group 2 (P < 0.001) and between Group 1 vs Group 3 (P < 0.001). A linear relationship between the Hounsfield units and the given contrast dose for all study groups was observed. The mean image quality score for Group 1 was 4.34/5. The mean image quality score for Group 2 was 2.8/5 and for Group 3 was 3.5/5. Conclusions: Significant contrast dose reduction, based on HR and BSA, in preoperative aortic CTA is associated with acceptable diagnostic quality.

A high cumulative radiation dose (3394 mGy.cm, 51 mSv) delivered by two acquisitions on the abdomen and pelvis and corresponding to more than 10 times the local median dose for this examination was retrospectively detected thanks to the Dose Archiving and Communicating System (DACS). Retrospective analysis of the examination showed that the cause of this high dose was an off-centering of the patient-the table being in a too high position-disabling a correct diagnosis of an umbilical herniation that was visible on a repeated acquisition. Interestingly, the CTDIvol of the second acquisition was 40% lower than that of the first acquisition, a well-known effect of off-centering on automatic exposure control systems.

Teaching point: T2 Dixon imaging is valuable in assessing soft tissue lesions. Water-only images highlight fluid or edema, while fat-only images identify macroscopic fat and help delineate fat-devoid regions, which often indicate suspicious areas-or confirm their absence in benign lesions.