Acta radiologica最新文献

Diffusion-weighted magnetic resonance imaging (DWI) analyzes water diffusion in tissues, indirectly reflecting cellular density and aiding tumor characterization. Our objective was to explore the utility of DWI in three topics: (i) differentiation of bone and soft tissue sarcomas with respect to tumor type/grade; (ii) correlation with chemotherapy response in Ewing's sarcoma and osteosarcoma; and (iii) differentiation of benign from malignant soft tissue and bone tumors. The aim of the review article was to assess the existing literature detailing the insight that can be provided by DWI when addressing bone and soft tissue tumors. A search was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines using Pubmed, Scopus, Embase, and CENTRAL databases from 1 January 2013 to 30 November 2023. Eligible studies were assessed for quality using the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) scoring system. In total, 22 studies met the inclusion criteria. DWI proved effective in select scenarios when distinguishing among bone and soft tissue sarcomas (sensitivity = 48%-89%, specificity = 75%-100%), correlating chemotherapy response with histopathology results (sensitivity = 25%-85%, specificity = 50%-100%), and differentiating between benign and malignant bone tumors (sensitivity = 54%-92%, specificity = 39%-92%) and soft tissue tumors (sensitivity = 68%-91%, specificity = 60%-81%). DWI is a valuable tool for the diagnosis and prognosis of bone and soft tissue sarcomas, treatment effect of primary bone tumors, and distinguishing benign from malignant bone/soft tissue tumors. Though promising, the technology has shown mixed results, warranting further research.

BackgroundThe necessity of thrombolytic therapy before percutaneous coronary intervention (PCI) in ST-segment elevation myocardial infarction (STEMI) patients remains controversial, requiring further evaluation of potential benefits.PurposeTo explore the efficacy of half-dose recombinant staphylokinase (r-SAK) intravenous bolus before PCI in STEMI patients.Material and MethodsPatients with STEMI were allocated to r-SAK or normal saline groups before PCI. Cardiac magnetic resonance (CMR) at 5 days after MI evaluated cardiac function, myocardial tissue characteristics, and strain. Segments were classified by late gadolinium enhancement (LGE) extent.ResultsA total of 64 STEMI patients were divided into the r-SAK group (n = 33) and NS group (n = 31). Patients in the r-SAK group had a significantly higher left ventricular ejection fraction and cardiac output index (P = 0.045 and 0.024). There was no significant difference between the two groups in mapping parameters, infarct size, area at risk, or the incidence of microvascular obstruction (MVO) and intramyocardial hemorrhage (IMH) (all P >0.05). Regardless of the extent of LGE in the segments, patients in the r-SAK group exhibited significantly better segmental longitudinal strain (all P <0.001). In addition, patients from the r-SAK group had a better segmental circumferential strain in LGE segments (P = 0.044).ConclusionFor STEMI patients expected to undergo PCI within 120 min of presentation, a single bolus of half-dose r-SAK administrated before PCI improved short-term cardiac function without increasing incidence of MVO or IMH.

BackgroundThe impact of deep learning (DL)-based computed tomography (CT) reconstruction on the visualization of distal and collateral arteries in diabetic lower extremity CT angiography (CTA) remains unclear.PurposeTo investigate the performance of a novel DL-based CT reconstruction algorithm, artificial intelligence iterative reconstruction (AIIR), in visualizing distal and collateral arteries on lower extremity CTA of diabetic patients, compared to the routine hybrid iterative reconstruction (HIR).Material and MethodsThis retrospective study included 59 diabetic patients who underwent clinically indicated lower extremity CTA. The images were reconstructed with both AIIR and HIR. Distal arterial visualization, collateral circulation depiction, and overall image quality were assessed and compared between two reconstruction methods.ResultsCompared with HIR, AIIR significantly improved the vessel visualization scores in the posterior tibial, dorsalis pedis, medial plantar, dorsal metatarsal, and dorsal digital arteries (all P <0.05). The scores for collateral circulation depiction were also higher with AIIR than those with HIR (all P <0.001). AIIR yielded significantly lower noise as well as higher signal-to-noise ratio and contrast-to-noise ratio compared with HIR (all P <0.001). The subjective score on overall image quality was significantly higher with AIIR than that with HIR (P <0.001).ConclusionCompared with HIR, AIIR provides improved visualization of distal and collateral arteries, as well as better overall image quality, in lower extremity CTA of diabetic patients.

BackgroundLower back magnetic resonance imaging (MRI) is a common imaging procedure; however, it often has low value in patients with uncomplicated back pain. Measures to reduce low-value procedures are necessary for a sustainable imaging service.PurposeTo evaluate the outcomes of the national intervention implemented in imaging centers by assessing referral quality and justification rate of lower back MRI in private imaging centers in Norway.Material and MethodsThis study used a before-after design to assess referrals retrospectively for justification and information quality to evaluate the intervention's effect. Four radiologists and four radiographers, all experienced in the field, assessed 360 referrals, half from before and half after the intervention. Descriptive, comparative, and Kappa statistics were used to analyze the data.ResultsThe rate of justified referrals increased from 60% to 65% when comparing before and after the implementation. The rate of unjustified referrals was reduced from 24% before to 19% after. The rate of referrals that lacked information was unchanged. Further, referral quality slightly increased after the intervention; still, 88% of the referrals were considered low quality. Radiologists were stricter in their assessment of referrals compared to radiographers. The interrater agreement was moderate in justification assessment and very good in referral quality assessment.ConclusionThe intervention slightly improved referral quality and justification rate. However, with a 20% unjustified rate after the intervention, further measures are needed to increase service quality and reduce wait times.

BackgroundCervical disc degeneration represents a significant healthcare challenge that necessitates precise diagnostic methodologies for optimal clinical management. Although conventional magnetic resonance imaging (MRI) remains the gold standard for disc assessment, the emergence of quantitative imaging techniques presents an opportunity to enhance diagnostic accuracy and facilitate objective evaluation of degenerative changes.PurposeTo investigate the feasibility and clinical value of the magnetic resonance image compilation (MAGiC) technique in evaluating cervical intervertebral disc degeneration.Material and MethodsA total of 200 patients (1000 cervical discs) underwent both conventional MRI and MAGiC scanning. Two experienced physicians performed Miyazaki grading on T2-weighted images. Quantitative measurements were taken from the anterior annulus fibrosus (AAF), posterior annulus fibrosus (PAF), and nucleus pulposus (NP) in MAGiC sequences.ResultsHigh consistency was observed in the region of interest (ROI) and Miyazaki grading (ICC > 0.8). T2 and R2 showed significant correlation with age and Miyazaki stage (P <0.001). Significant differences were found between classifications, except for quantitative parameters between grades Ⅰ and Ⅱ of the AAF and PAF regions, and T1 values between grades and PAF regions. NP parameters showed a statistical significance between adjacent Miyazaki grades. MAGiC parameters of NP demonstrated highest diagnostic efficiency for cervical disc degeneration.ConclusionMAGiC technique effectively quantifies cervical degenerative changes, with T2 and R2 values of NP showing highest effectiveness. This method provides accurate diagnostic information and may have clinical potential pending validation.

BackgroundMagnetic resonance enterography (MRE) can visualize Crohn's disease (CD) and its complications.PurposeTo determine the inter-observer agreement for the detection of ileocolonic CD.Material and MethodsThis post-hoc analysis included MRE scans from 48 patients selected from a prospective, blinded multicenter study of patients with suspected CD. Based on ileocolonoscopy in the main study, CD was diagnosed in 39 (81%) patients, with colonic involvement in 36 (69%). Two senior radiologists and two junior doctors undergoing specialist training, blinded to clinical data assessed the image quality, CD presence, and disease severity.ResultsThe inter-observer agreement for CD detection varied by location: terminal ileum (κ = 0.77, 95% confidence interval [CI] = 0.63-0.89), colon (κ = 0.59, 95% CI = 0.42-0.74), and ileocolon (κ = 0.65, 95% CI = 0.49-0.80). Agreement was higher among senior radiologists than juniors: terminal ileum (κ = 0.83 vs. 0.73; P = 0.60) and colon (κ = 0.73 vs. 0.41; P = 0.11), though differences were not statistically significant. The inter-observer agreement for disease severity was poor to moderate with intraclass correlation coefficients (ICCs) of 0.51 (95% CI = 0.35-0.67) for the MaRIA and 0.46 (95% CI = 0.29-0.62) for the simplified MaRIA. Senior radiologists showed higher consistency, with moderate to good agreement: ICC of 0.69 for the MaRIA, 0.70 for the simplified MaRIA, and 0.80 for bowel wall thickness.ConclusionIn early CD, MRE demonstrated moderate to substantial inter-observer agreement for ileocolonic evaluation. Limitations in colonic assessment likely reflect early disease detection rather than observer variability, highlighting the need for a complementary assessment.

BackgroundRadiological response of pancreatic ductal adenocarcinoma (PDAC) to neoadjuvant chemoradiation therapy (CRT) is challenging to assess.PurposeTo evaluate whether computed tomography (CT) and biological features can predict tumor regression grade (TRG), recurrence-free survival (RFS), and overall survival (OS) of patients who undergo surgery after CRT for PDAC.Material and MethodsThis retrospective study included 125 patients who underwent surgery after CRT for non-metastatic PDAC between January 2013 and March 2021. Two board-certified radiologists independently reviewed initial and post-CRT CT images and assessed the primary tumor extent and regional lymph node metastasis. Another board-certified radiologist quantitatively assessed the primary tumor on pre- and post-CRT diffusion-weighted and positron emission tomography images. Logistic regression and Cox regression analyses were performed to identify predictors of TRG 0/1, RFS, and OS.ResultsIn total, 44 (35.2%) patients had a TRG of 0/1. The normalized post-CRT carbohydrate antigen (CA) 19-9 level (<37 IU) (odds ratio [OR] = 3.69; P = 0.024) and adjacent organ invasion on post-CRT CT images (OR = 0.24; P = 0.042) were independent predictors of TRG 0/1. During follow-up (mean = 33.6 months), 68 (54.4%) patients experienced tumor recurrence and 65 (52.0%) died. The normalized post-CRT CA 19-9 level (<37 IU) (hazard ratio [HR] = 0.51; P = 0.028) was a significant predictor of RFS, and size change (%) after CRT (HR = 0.24; P = 0.044) was an independent predictor of OS.ConclusionThe normalized post-CRT CA 19-9 level and adjacent organ invasion on post-CRT CT images predicted TRG. The normalized post-CRT CA 19-9 level was associated with RFS, whereas size change was an independent predictor of OS.

BackgroundTranscatheter arterial embolization (TAE) is an established treatment of hemoptysis in patients with destroyed lung.PurposeTo identify the relevant risk factors for the recurrence of hemoptysis after TAE in patients with destroyed lung combined with hemoptysis.Material and MethodsA retrospective analysis was performed on 179 patients with destroyed lung and hemoptysis who underwent TAE between January 2014 and September 2023. Immediate and clinical success rates were assessed after TAE. Kaplan-Meier analysis estimated hemoptysis-free survival. The Cox regression model was used to identify factors associated with recurrence.ResultsAmong 179 patients (124 men, 55 women; mean age = 57.24 ± 12.30 years), immediate and clinical success rates were 92.2% and 89.5%, respectively. Freedom from hemoptysis at 24 h was achieved in 91.5% of patients. Cox regression analysis identified the average number of embolized vessels per damaged lobe as an independent predictor of recurrence (hazard ratio [HR] = 1.346, 95% confidence interval [CI] = 1.001-1.810; P <0.05). Patients with ≥4 embolized vessels per lobe had a significantly higher risk of recurrence than those with fewer vessels. Non-bronchial systemic arteries (NBSAs), particularly intercostal and subclavian artery branches, were key bleeding sources, with the ratio of NBSAs to bronchial arteries (BAs) embolized being approximately 1.38:1.ConclusionAlthough meticulous attention to NBSAs during TAE is essential, our study identifies the average number of embolized vessels per lobe as an independent predictor of recurrence. This indicates a disease state with high revascularization potential, necessitating long-term strategies that also address the underlying lung pathology.

BackgroundInterreader variability in ureteral stone size measurements affect the predicted probability of spontaneous stone passage (SSP), especially in proximal ureteral stones. Window settings have been shown to influence interreader variability.PurposeTo investigate interreader variability of ureteral stone size measurements in four different window settings.Material and MethodsPatients with a unilateral proximal ureteral stone ≥2.0 mm detected during emergency computed tomography (CT) were included in this single-center study. Five observers measured each stone in three dimensions in a soft-tissue window, bone window, and two half-value windows (based on the mean [half-value MEAN] or maximum attenuation of the stone [half-value MAX]). Limits of agreement of the mean (LOAM) for stone size in each window setting were assessed. Logistic regression curves were created for predicted probability of SSP.ResultsIn total, 124 patients (87 men, 37 women; mean age = 52 years; age range = 22-82 years) were retrospectively evaluated. LOAM: bone window (±1.6 mm, 95% confidence interval [CI]=1.24-4.90), soft-tissue window (±0.4 mm, 95% CI=0.37-0.82), half-value MEAN window (±0.3 mm, 95% CI=0.24-0.40), half-value MAX window (±0.2 mm, 95% CI=0.14-0.30). Prediction curves aligned and shifted to the left as mean stone size decreased in the half-value window settings.ConclusionThe bone window is unsatisfactory for ureteral stone size measurements. The interreader variability in soft-tissue and half-value windows is on a sub-mm magnitude, with no expected impact on clinical decision-making. The half-value MAX window had the smallest interreader variability and should be considered for reproducible and semiautomated ureteral stone size measurements.

BackgroundThe optimal endovascular treatment strategy for basilar artery trunk aneurysms (BATAs) remains a subject of ongoing debate.PurposeTo report the experience of management strategies for different types of BATA, with a focus on safety, efficacy, and mid-term outcomes.Material and MethodsA total of 33 consecutive BATAs (19 dissecting, 9 lateral saccular, 5 fusiform) were retrospectively analyzed. The treatment protocol consisted of overlapping stent-assisted coiling (SAC) for dissecting and ruptured cases, single SAC for lateral saccular aneurysms, and flow diverters (FDs) for most fusiform aneurysms; giant fusiform BATAs were treated with dual Leo-plus stents. The primary outcome measure was the 3-month clinical outcome.ResultsSAC was performed in 30 patients (8 single SAC; 22 overlapping SAC), and FD was used in 3 patients. Immediate occlusion was Raymond class 1 in 14/30 (46.7%), class 2 in 11/30 (36.7%), and class 3 in 5/30 (16.7%) among SAC-treated aneurysms; all FD-treated aneurysms (3/33) were OKM-B immediately. One patient died due to intraprocedural re-rupture of a dissecting aneurysm. Periprocedural ischemic complications occurred in 1 (3.0%) patient. A periprocedural hemorrhagic event occurred in 1/4 ruptured cases (overlapping SAC). One delayed ischemic stroke followed FD (mRS at 3 months = 4). At the 3-month follow-up, 30 patients (90.9%, 95% CI=75.1-97.3) achieved favorable outcomes. DSA follow-up (n = 27) demonstrated complete occlusion in 21 aneurysms (77.8%, 95% CI=59.2-89.4).ConclusionEndovascular treatment of BATAs is technically feasible and encouraging, characterized by high occlusion rates and acceptable morbidity rates. The use of overlapping SAC and judicious FD application may optimize treatment outcomes, especially for complex subtypes.