Abdominal Radiology最新文献

Purpose

To explore the role of liver- and spleen-based Intravoxel Incoherent Motion Diffusion-weighted Imaging (IVIM) imaging in ruling out high-risk esophageal varices (HREVs) in patients with cirrhosis and compare it with other noninvasive tests (NITs).

Methods

Patients with liver cirrhosis who underwent paired Esophagogastroduod-enoscopy (EGD) and upper abdominal IVIM imaging between January 2015 and December 2021 were retrospectively enrolled. Logistic regression analyses were performed to determine the potential predictors of HREVs. The diagnostic performance was estimated with the area under the receiver operating characteristic curve (AUROC). We used the 95% sensitivity to determine the cutoff for ruling out HREVs and compared the spared EGD rate of IVIM imaging with that of NITs. A sensitivity analysis was carried out to assess the impact of the prevalence of HREVs on the negative predictive value (NPV) at given cutoff values.

Results

A total of 244 patients were included, and HREVs were found in 54.1% (132/244) of the patients. The parameters f_S, D*_S and D*_L independently predicted HREVs. Compared with NITs, f_S (AUROC: 0.90) performed significantly better (all p < 0.05), and D*_S (AUROC: 0.74) and D*_L (AUROC: 0.73) performed similarly. f_S (cutoff ≤ 16.1%) had the highest spared EGD rate (27.0%), with a missed HREVs rate of less than 5%, and showed excellent interobserver repeatability. The NPV of f_S remained above 90% as the prevalence of HREVs increased from 5 to 50%.

Conclusion

Splenic microcirculatory perfusion parameters (f_S and D*_S) are potential noninvasive markers for ruling out HREVs and avoiding unnecessary EGDs.

Esophageal cancer, particularly squamous cell carcinoma (SCC) and adenocarcinoma (EAC), is a major contributor to cancer-related mortality. The different histopathologic subtypes have different pathological origins, epidemiology and prognosis. TNM staging system allows to stratify the prognosis and determine the most appropriate treatment. Surgery remains the gold standard for treating early-stage esophageal cancer, including various procedures that can adapt to the singular cases helping to reduce morbidity. However, esophagectomy remains burdened by considerable postoperative complications, such as anastomotic leakage, pleural effusion, pneumonia, acute respiratory distress syndrome, stricture formation, chylothorax, delayed gastric emptying, hiatal herniation, and reflux esophagitis. Accurate radiologic evaluation plays a crucial role in detecting, characterizing, and staging esophageal cancer, directly influencing treatment strategies. Radiological imaging is pivotal in determining patient’s prognosis, both for the management of post-operative complications and for long-term follow-up. A thorough understanding of the imaging characteristics and underlying pathology is essential for improving diagnostic accuracy and guiding therapeutic decision-making.

Graphical abstract

Renal transplant is a life-saving treatment option for patients with end-stage renal disease. As with any intervention, transplantation is not without potential complications, which include disruption to arterial, venous and lymphatic structures in the region and can involve either native or transplanted anatomy. Management options range from open surgical intervention to endovascular procedures, the latter of which have become increasingly more prevalent due to their minimally invasive nature. Interventional Radiology has a diverse procedural skillset that can be utilized for successful management of post-transplant complications. Treatment modalities include, but are not limited to, embolization, thrombectomy and stent placement. The goal of this article is to explore common vascular and lymphatic complications that occur following renal transplant and review relevant minimally invasive management options. Positive treatment outcomes are essential to ensure graft, and in turn, patient survival.

Objective

To evaluate the feasibility of a standardized double low-dose CT (DLCT) protocol that simultaneously reduces both iodine contrast media (CM) dose and tube voltage, and to compare its image quality and diagnostic performance with a single low-dose CT (SLCT) protocol using fixed iodine dose and reduced tube voltage, representative of institutional low-radiation dose imaging practice in suspected acute appendicitis.

Methods

In this exploratory analysis of a prospective single-arm study, 49 participants aged 18–44 years presenting to the emergency department (ED) with suspected acute appendicitis underwent DLCT using automated kVp selection and a kVp- and weight-adjusted CM dosing protocol. This protocol targeted a 10% iodine dose reduction for every 10 kVp decrease from a reference standard of 0.521 g I/kg at 120 kVp. A historical control group of 53 patients with the same inclusion criteria, who had undergone SLCT using a fixed CM dose and low-kVp protocol (80–100 kVp) prior to study initiation, was retrospectively included. Quantitative (signal-to-noise ratio [SNR] and contrast-to-noise ratio [CNR]) and qualitative (subjective image quality and appendiceal visibility) assessments were compared. Diagnostic performance was evaluated using positive predictive value (PPV) for acute appendicitis and alternative diagnoses, based on surgical findings, clinical follow-up, or an Alvarado score ≥ 7.

Results

DLCT significantly reduced iodine dose (0.383 ± 0.049 g I/kg vs. 0.589 ± 0.085 g I/kg; P < 0.001) while maintaining comparable image noise and appendiceal visibility. Although SNR and CNR were lower in the DLCT group, diagnostic performance including PPVs for acute appendicitis (63.6% vs. 72.7%) and alternative diagnoses (100% vs. 86.7%) did not significantly differ between groups.

Conclusion

An iodine dose-reducing DLCT protocol tailored to tube voltage and body weight is feasible in the ED setting and offers substantial CM dose saving without compromising diagnostic performance for acute appendicitis or alternative diagnoses.

Objective

To determine the diagnostic performance of tumor capsule contact length (TCCL) and to determine its optimal cut-off on prostate MRI to predict extra-capsular extension (ECE) at histopathology of radical prostatectomy specimen in patients with prostate cancer.

Materials and methods

An electronic search of the PUBMED and EMBASE databases was performed until December 31, 2024 to identify studies analyzing TCCL as a predictor of ECE on prostate MRI. Pooled sensitivity and specificity of all studies were plotted in a hierarchical summary receiver operating characteristic plot and the risk of ECE was evaluated using bivariate random-effects meta-analysis. Meta-regression analysis for various TCCL cut-offs was performed.

Results

Twenty-three eligible studies were found. Reported sensitivity (between 47 − 94%) and specificity (between 46 − 88%) showed significant heterogeneity between studies, without evident threshold effect. Pooled sensitivity and specificity of TCCL for predicting ECE was 76.3% and 68.8% respectively with AUC of 0.787 for the summary ROC curve. Meta-regression analysis showed no significant difference in diagnostic performance according to various TCCL cutoffs, measurement methods, or ISUP grade distribution. Studies with 14 mm threshold had similar sensitivity (73%), but greater specificity (74% vs. 70%) and diagnostic odds ratio (8.3 vs. 6.5), when compared to 10 mm threshold.

Conclusion

TCCL on MRI has reasonable pooled sensitivity and specificity to predict ECE. While sensitivity remained moderately high for all TCCL thresholds, specificity at 14 mm (cutoff close to 15 mm suggested by PI-RADS v1.0) threshold was greater than that at 10 mm (cutoff suggested by PIRADS v2.1). This cutoff can be helpful in developing objective likelihood scores for ECE prediction on MRI.

Background

Magnetic Resonance Enterography (MRE) has emerged as a tool in diagnosing and monitoring Crohn’s disease. Despite its importance, no comprehensive bibliometric analysis has focused on MRE’s impact in this field. This study addresses this gap by analyzing the 100 most-cited articles related to MRE in Crohn’s disease, revealing key trends and influential research in the field.

Methods

Two independent researchers utilized Scopus to identify relevant articles using predefined keywords. The articles were ranked by citation count, and detailed bibliographic data was collected. Advanced statistical analyses were conducted to identify research trends and evaluate article influence using citation metrics.

Results

Our study analyzed trends from 1990 to 2024, revealing a peak in research activity between 2008 and 2018, with the most articles (n = 52) published in 5 years from 2010 to 2014. Citation activity mirrored the trends with 100 most cited articles between 2008 and 2016, peaking in 2011 at nearly 7000 citations with a sharp decline after 2016. No significant correlation (p = 0.40) was identified between citation count and journal impact factor. Our study identified the shift in past research trends from fluoroscopy to MRE and the saturation in research on MRE in recent years.

Conclusion

Our study highlights a shift from fluoroscopy toward advanced MR techniques for managing Crohn’s disease.

Advances in knowledge

Our study highlights a shift from fluoroscopy to MRE research in recent years. However, the plateau in MRE research underscores the need for innovative investigative approaches and novel research directions.

Graphical abstract

The prevalence of cancer continues to increase both in the United States and worldwide. Oncologic emergencies are potentially life-threatening conditions in cancer patients, and these may be directly or indirectly related to the underlying malignancy. Radiologists must be well-versed not only in cancer staging, but also in potential cancer related complications and emergencies to guide prompt appropriate management. Oncologic emergencies may occur due to direct local effects by the tumor or metastasis, associated systemic manifestations, or due to treatment related effects. These emergencies may sometimes be the first presentation of the underlying malignancy. The various gastrointestinal oncologic emergencies include airway-esophageal fistula, intestinal obstruction, intestinal ischemia, intestinal perforation, intussusception, inflammatory/infectious bowel changes, torsion, and tumor-related gastrointestinal bleeding. This review article aims to highlight the clinical and key imaging manifestations of oncologic emergencies along with implications for management, with a particular focus on the gastrointestinal system.

Objective

In nodule-negative primary aldosteronism (PA), quantitative CT findings in unilateral PA differed from those in bilateral PA. We attempted to identify PA by quantitative parameters of contrast-enhanced CT.

Methods

A retrospective search was performed for 81 patients with nodule-negative PA who underwent contrast-enhanced CT between January 2021 and November 2024 and adrenal vein sampling thereafter at XXXX. The test cohort and validation cohort were enrolled separately based on the PA type. The optimal cutoff value for identifying PA was analyzed and calculated in the test cohort, and its diagnostic performance was subsequently evaluated in the validation cohort.

Results

In the venous phase of the test cohort, the SD difference or ratio was significantly higher in unilateral-left PA than in bilateral PA [SD difference: 6.3 (4.4, 8.8) Hu vs. 2.5 (1.5, 4.4) Hu, P < 0.001; SD ratio: 1.2 (1.1, 1.3) vs. 1.1 (1.0, 1.1), P < 0.001]. At a cutoff value of 4.90 Hu, the sensitivity and specificity of the SD difference in predicting PA type were 0.733 and 0.957, respectively. The sensitivity and specificity of the SD ratio were 0.867 and 0.723 at a cutoff value of 1.130, respectively. In the validation cohort, the diagnostic performance of the SD difference in identifying PA type was similar to that of the SD ratio (0.801 vs. 0.917, P = 0.06).

Conclusion

Patients with nodule-negative PA can be further differentiated by bilateral adrenal heterogeneity on contrast-enhanced CT. The SD difference has similar predictive ability as the SD ratio.

Background and purpose

To appraise the inclusion of CEUS resection site evaluation in LI-RADS CEUS Nonradiation Treatment Response Assessment (TRA) v2024, currently applied for ablative therapy. We highlight the specific benefits afforded by CEUS in this effort.

Methods

Retrospective chart review was performed for 102 patients following surgical resection of HCC and ICC with post-operative CEUS at our center. Demographic data, surgical history, CT/MR findings, and resection site appearances on greyscale and CEUS were documented. The resection site where the tumor was originally positioned was designated as the treatment site and the resection margin as the perilesional tissue to establish equal assessment to TRA for ablative therapy. The morphology of the resection site was assigned one of three appearances, using novel descriptors: EDGE, VOID, or SURFACE DIVOT. Resection sites were evaluated for benign appearances, post-surgical changes, and tumor recurrence, and then categorized with a CEUS LI-RADS TRA score.

Results

102 patients had 120 resection sites following 115 operations for 94 HCC and 8 ICC. On CEUS, 59 (49%) were characterized as EDGE, 46 (38%) as VOID, and 15 (13%) as SURFACE DIVOT, n = 120. 23 (19%) of resection sites were LR-TR VIABLE for recurrence, 91 (76%) LR-TR NONVIABLE, and 6 (5%) EQUIVOCAL, n = 120. Benign post-surgical changes developed in 23 (19%) resection sites, n = 120. 63/115 surgeries (55%) had post-operative recurrence, 40 De Novo, 17 Perilesional, and 6 Intralesional.

Conclusion

Our conclusions are in two categories: the first assessing the success of CEUS in the assessment of post-surgical treatment sites following liver resections. CEUS can successfully distinguish between unique post-operative appearances such as benign tissue migration, resection VOIDs resembling an intrinsic mass, and true recurrence. CEUS is thus strongly recommended for secondary surveillance following HCC and ICC resection. The second conclusion evaluates the inclusion of resection sites into the CEUS LI-RADS TRA algorithm for ablative therapies. In this regard, we believe that our study was highly successful, improving the perspective of all our staff as to what is important in the assessment of the post-surgical liver on CEUS and the method whereby this information is communicated to our referring clinicians.

Graphical Abstract

Radical prostatectomy and radiation therapy, which are standard treatments for prostate cancer, are associated with various short- and long-term complications. Early post-prostatectomy complications include bleeding, vesicourethral anastomotic dehiscence, and anorectal injury, while late sequelae include urinary incontinence, anastomotic stenosis, urinary strictures and fistulas, osteomyelitis, and cancer recurrence. Radiation therapy can lead to bladder and bowel toxicity and, in rare cases, secondary malignancies. Imaging plays a crucial role in detecting and managing these complications. Multiphasic CT is preferred for detecting acute hemorrhage and urine leaks, while MRI is the modality of choice for evaluating urinary strictures, fistulas, and recurrent malignancies. Dynamic MR cystourethrography further enhances the assessment of urethral mobility and function, improves the detection of urinary fistula, and helps in surgical planning. MRI and PSMA PET imaging are key modalities for detecting post-treatment recurrence. As survival rates continue to improve for prostate cancer patients, the emphasis is shifting toward preserving quality of life and managing long-term treatment-related complications. In this review, we present a detailed overview of post-treatment surgical bed complications, emphasizing the role of various imaging modalities in the detection, characterization, and management of these complications.