Abdominal Radiology最新文献

Purpose

Early-stage cirrhosis frequently presents without symptoms, making timely identification of high-risk patients challenging. We aimed to develop a deep learning-based triple-modal fusion liver cirrhosis network (TMF-LCNet) for the prediction of adverse outcomes, offering a promising tool to enhance early risk assessment and improve clinical management strategies.

Methods

This retrospective study included 243 patients with early-stage cirrhosis across two centers. Adverse outcomes were defined as the development of severe complications like ascites, hepatic encephalopathy and variceal bleeding. TMF-LCNet was developed by integrating three types of data: non-contrast abdominal CT images, radiomic features extracted from liver and spleen, and clinical text detailing laboratory parameters and adipose tissue composition measurements. TMF-LCNet was compared with conventional methods on the same dataset, and single-modality versions of TMF-LCNet were tested to determine the impact of each data type. Model effectiveness was measured using the area under the receiver operating characteristics curve (AUC) for discrimination, calibration curves for model fit, and decision curve analysis (DCA) for clinical utility.

Results

TMF-LCNet demonstrated superior predictive performance compared to conventional image-based, radiomics-based, and multimodal methods, achieving an AUC of 0.797 in the training cohort (n = 184) and 0.747 in the external test cohort (n = 59). Only TMF-LCNet exhibited robust model calibration in both cohorts. Of the three data types, the imaging modality contributed the most, as the image-only version of TMF-LCNet achieved performance closest to the complete version (AUC = 0.723 and 0.716, respectively; p > 0.05). This was followed by the text modality, with radiomics contributing the least, a pattern consistent with the clinical utility trends observed in DCA.

Conclusion

TMF-LCNet represents an accurate and robust tool for predicting adverse outcomes in early-stage cirrhosis by integrating multiple data types. It holds potential for early identification of high-risk patients, guiding timely interventions, and ultimately improving patient prognosis.

Purpose

To assess the accuracy of conventional MRI with T1- and T2-weighted sequences in detecting lymphatic nodal spread (N1) in intermediate- and high-risk prostate cancer (PCa) patients via morphological criteria alone, extended pelvic lymph node dissection (ePLND) was used as the reference standard.

Methods

This prospective observational study included patients between 2009 and 2016 with intermediate- and high-risk PCa according to the D’Amico criteria and an estimated risk of N1 > 20% on the basis of the Briganti nomogram. All patients underwent MRI prior to ePLND. Interobserver analysis was conducted across three centers.

Results

Ninety-nine men, mean age 67 (5.7 SD), 93% high-risk PCa patients and 39.4% with N1 disease, according to ePLND, were evaluated. The pooled sensitivity of MRI for detecting N1 was 24.6% (95% CI: 16.3–35.1), whereas the pooled specificity was 95% (95% CI: 85.3–98.8). Interobserver agreement was moderate (Fleiss’ κ = 0.56). All readers failed to identify patients with high-volume N1, and the identification of those with a high number of N1 events was inconsistent across readers. The strengths of this study include the high number of N1 cases, with a median of 17 (6–40) harvested lymph nodes per participant. Limitations include the time interval between MRI and ePLND (median of 44 days) and the lack of standardized lymph node evaluation criteria, reflecting real-world clinical practice.

Conclusion

MRI using only T1W and T2W sequences has demonstrated limited effectiveness in lymph node staging for intermediate- and high-risk prostate cancer, even in high-volume metastatic disease. Additionally, interobserver analysis shows only moderate agreement.

Objective

The aim of this study was to evaluate the capability of histogram analysis of weighted and quantitative MRI images to improve preoperative endometrial cancer (EC) risk stratification by providing information about the histological properties of the tumours.

Methods

In this prospective study, 94 patients with biopsy verified endometrial carcinoma underwent a preoperative MRI examination performed according to the European Society of Urogenital Radiology (ESUR) guidelines with addition of synthetic MRI, dynamic contrast enhancement and diffusion weighted imaging (DWI) with high b-values. Quantitative relaxation maps, perfusion maps and diffusion kurtosis imaging (DKI) maps were generated from the additional sequences. Tumours were segmented on three adjacent slices and histogram properties were compared between tumours with low and high histological risk.

Results

Significant differences were found between tumours with low and high histological risk in the histogram properties for the DKI derived apparent diffusion maps (D_app): mean (p = 0.048), median (p = 0.025), skewness (p < 0.001) and kurtosis (p = 0.003). No significant differences between the groups were observed in histogram properties of quantitative relaxation maps, acquired by synthetic MRI.

Conclusion

Histogram analysis of DKI shows better potential to discriminate between EC histological risk groups and histologically determined endometrioid tumour grades than regular DWI, relaxation maps from synthetic MR, perfusion maps and T1 or T2 weighted images.

MRCP is essential for noninvasive evaluation of the biliary and pancreatic ductal systems in children but can suffer from suboptimal image quality due to inconsistent protocols and technical factors. We performed a quality improvement project focused on enhancing the image quality of 3D MRCP at a tertiary children’s hospital. The project identified key contributors to poor image quality, including the inconsistent use of respiratory-triggered techniques and the absence of standardized protocols across multiple MRI units. Interventions were implemented, including updating protocols, technologist education, and improving communication between radiologists and technologists. We set a goal of achieving 90% of MRCP exams with acceptable image quality by September 2024. Our efforts increased the success rate from 68 to 77%. Although the target was not fully reached by the end of the set project timeline, the effort highlights the importance of multidisciplinary collaboration, continuous education, and ongoing auditing in driving improvements in imaging quality.

Purpose

To assess the homogeneity of pancreatic iron deposition in non-transfusion dependent thalassemia (NTDT).

Methods

The segments (head, body, and tail) R2* of the pancreas were measured separately in 119 cases that underwent pancreatic magnetic resonance imaging multi-echo gradient sequences of NTDT and analyzed the consistency.

Results

The median R2* values for pancreas: head = 26.7 1/s, body = 26.5 1/s, tail = 24.9 1/s, and the analysis showed no significant differences in pancreatic segments R2* value (P = 0.204). There were no significant difference in pancreatic segments R2* values within the subgroup of sex, heart iron degree, liver iron degree and pancreatic iron degree (all P > 0.05). There is a moderate correlation between the standard deviation and the coefficient of variation of R2* values for each segment of the pancreas and the mean value of the pancreas (r = 0.683, P < 0.001; r = 0.411, P < 0.001), R2* values were no different among pancreatic segments in the extremely severe iron overload group (with three times R2* the pancreatic Oiron overload threshold).

Conclusion

There were no significant differences in pancreatic iron deposition among the segments in NTDT, and R2* values for single-segment could be selected to assess the overall iron deposition of the pancreas.

Graphical abstract

Purpose

To evaluate the utility and complications of urethrosonography (US) in the preoperative assessment of urethral stricture compared to traditional diagnostic methods and its impact on therapeutic decision-making.

Methods

A prospective observational study was conducted on male patients diagnosed with urethral stricture who were candidates for surgical treatment. Preoperative assessment included flexible urethrocystoscopy, voiding cystourethrography (VCUG), and US. Demographic and epidemiological data were recorded and analyzed. Sensitivity and specificity were calculated. Agreement between diagnostic techniques was assessed using the Cohen’s Kappa coefficient. The impact of findings on surgical decision-making was evaluated, and potential complications associated with each technique were documented.

Results

Thirty-three male patients with a mean age of 59.5 years, diagnosed with urethral stricture who were candidates for surgical treatment, were evaluated. No statistically significant differences were found in the location or severity of the stricture among the different techniques, with good concordance with intraoperative findings. US demonstrated higher sensitivity (60% vs. 44.2%) and specificity (87.8% vs. 84.9%) compared to VCUG in assessing the length of the stricture, and was also more accurate than urethrocystoscopy in determining the degree of spongiofibrosis (77.02% vs. 69.11% for sensitivity, and 81.9% vs. 74.5% for specificity). The choice of preoperative technique influenced the selection of the surgical approach.

Conclusions

Urethrosonography is more sensitive and specific than traditional techniques in determining the length of the stricture, with similar concordance with intraoperative findings. It may serve as an alternative to conventional diagnostic tests in the preoperative evaluation of urethral stricture, offering several advantages such as the absence of radiation, lower complication rates, and its non-invasive nature.

Background and purpose

Cervical cancer is the fourth most common cancer and the fourth leading cause of cancer death among women worldwide. Appropriate treatment can reduce mortality rate and improve prognosis, where the choice of appropriate treatment option is closely related to the preoperative staging. In this study, we compared full protocol MRI (including contrast-enhanced images) and modified protocol (including only T2-weighted sequence and DWI + ADC map images) in preoperative cervical cancer staging based on the 2018 Federation of Gynecology and Obstetrics (FIGO) classification system.

Material and methods

In this retrospective cross-sectional study, pelvic MRIs of 128 patients with cervical cancer were evaluated. For all patients, staging was performed by two independent radiologists according to the 2018 FIGO Staging Classification, first based on modified protocol and then based on full protocol MRI. Inter-modality agreement was evaluated by Cohen’s kappa, intraclass correlation coefficient (ICC), and concordance correlation coefficient (CCC).

Results

There was very good agreement between the modified and full protocols in preoperative staging of cervical cancer (weighted kappa: 0.967) with a low number of discrepancies. There was also a high level of agreement between two modalities in the determination of parametrium, pelvic side wall, bladder, intestine, uterine, and lymph node involvements, as well as hydronephrosis and vascular encasement. Tumors at stage I had significantly higher ADC values compared to higher-stage tumors (p-value: 0.003).

Conclusion

Based on our study, modified MRI (including T2WI and DWI images) had substantial agreement with full protocol MRI in preoperative cervical cancer staging, suggesting its potential as a reliable contrast-free alternative for clinical practice.

Purpose

To evaluate the safety and efficacy of radiological interventions for iatrogenic hemobilia.

Materials and methods

This retrospective study included 53 patients (mean age: 44.9 years; 32 males, 21 females) who presented with hemorrhagic complications following hepatobiliary interventions (surgical, endoscopic, or radiological) and underwent percutaneous or endovascular embolization between January 2015 and May 2023. The patients were categorized into two groups: Group 1 included patients with a history of surgery, and Group 2 included patients with a history of non-surgical interventions. The clinical-data, imaging-findings, and details of embolization techniques were collected. Technical success and clinical success were assessed along with complications, recurrence, and mortality, and any predictive parameters for these outcomes. Statistical analysis was performed using chi-square and t-tests, with significance set at p ≤ 0.05.

Results

The overall technical success of embolization was 100% and clinical success was 98.1%. There were 17 patients in group 1 and 36 patients in group 2 with a significantly higher incidence of gastrointestinal bleeding (64.7% vs. 19.4%, p = 0.007) and pseudoaneurysms (88.2% vs. 50%, p = 0.013) in group 1. Clinical success was 94.1% in group 1 and 100% in group 2 (p = 0.321). One patient in group 1 had recurrence after a week, which was successfully managed with direct percutaneous n-butyl cyanoacrylate glue embolization. There were no major procedure-related complications. The overall mortality-rate was 13.2% (7/53), with all deaths attributed to the underlying disease. Shock at presentation (p = 0.001) was the sole predictor of mortality on multivariate-analysis (Odds-Ratio = 25.8, Confidence-Interval = 2.2–298.0). No significant difference was observed in recurrence or mortality rates between both the groups.

Conclusion

Radiological interventions are effective and safe for managing iatrogenic hemobilia, with high technical and clinical success rates. Shock on presentation is an independent predictor of mortality, emphasizing the need for urgent and definitive hemostatic control with radiological interventions in such patients.

Biliary tract neoplasms include a diverse set of benign and malignant entities that share both clinical presentations and imaging features. Radiologists need to understand the diagnostic features of these neoplasms to recognize them at initial diagnosis, and we must also provide key information to our surgical and oncology colleagues to facilitate proper management. This work reviews the most important intrahepatic and extrahepatic biliary neoplasms with an emphasis on radiological findings and differentiating features. This work also reviews normal anatomy and key variants of the biliary tree, arterial supply, and venous drainage that impact treatment planning for these entities. Assessment of tumor extent, involvement of critical anatomy, and differential diagnoses are also discussed. This work will support readers in their understanding of biliary tract neoplasms and in the delivery of actionable radiology reports as part of an integrated multidisciplinary care team.

Endometriosis is a common condition primarily impacting women of childbearing age. Despite increasing awareness that endometriosis can be diagnosed non-invasively with the correct imaging techniques, there exists a significant delay in diagnosis, to the tune of 5–10 years. This gap can be narrowed by understanding that this is a disease that lends itself to pattern recognition, and learning to recognize the characteristic patterns on any imaging study will allow earlier diagnosis and prevent long-term complications that can occur with progressive, untreated endometriosis. The disease is often multifocal and thus can present with a wide array of nonspecific symptoms. When clinical findings do not suggest endometriosis, patients often undergo non-targeted imaging, such as chest, abdominal, or pelvic computed tomography (CT); Magnetic Resonance imaging (MRI) studies optimized for neurologic or musculoskeletal indications; or ultrasound (US) exams performed for palpable masses or nonspecific abdominal pain. Familiarity with endometriosis’s characteristic patterns across organ systems and how it can masquerade as other diseases helps radiologists broaden their differential to include endometriosis, even on studies not originally aimed at its detection. This review article will describe those imaging findings of endometriosis affecting various organ systems that mimic other pathologies and will enable the reader to pause and question whether endometriosis should be included in the differential.

Graphical abstract