Acta radiologica最新文献

BackgroundThe Lake Louise Criteria (LLC) were updated in 2018 to improve accuracy in evaluating myocarditis. However, the diagnostic value of combining conventional magnetic resonance imaging (MRI) with contrast-enhanced whole-heart MRI (CE WH-MRI) in the diagnosis of acute myocarditis (AM) has not been determined.PurposeTo assess the diagnostic accuracy of the updated LLC and test the incremental value of CE WH-MRI in diagnosis of AM.Material and MethodsBetween March 2020 and November 2023, a total of 37 patients with clinically suspected AM were prospectively recruited for this study. The cardiac MR (CMR) protocol for myocarditis and controls included T2-STIR, breath-hold steady-state free precession, native T1, T2, CE WH-MRI, late gadolinium enhancement (LGE), and post-contrast T1 mapping.ResultsFor global native T1, the ideal cutoff value was 1308.5 ms (area under the curve [AUC]=0.879, sensitivity=82%, specificity=79%); for global T2, 43.2 ms (AUC=0.889, sensitivity=96%, specificity=75%), for ECV, 30.5% (AUC=0.946, sensitivity=97%, specificity=93%). The CE WH-MRI sequence detected 268 myocardial involvement (MI) segments, whereas 2D-LGE images identified 181 MI segments. Among 37 patients, 34 (91.9%) met the updated LLC definition for diagnosis, the AUC of updated LLC was 0.946.ConclusionThe updated LLC, as a recommended criterion for the diagnosis of AM, had better diagnostic accuracy compared with CMR mapping imaging. Moreover, this study highlighted the additional diagnostic value of CE WH-MRI in the identification of AM. Then, multiparametric CMR imaging can provide a satisfactory diagnostic value to enhance the accuracy of diagnosing AM.

BackgroundAssessment of subtle hip fractures on radiographs can be difficult, especially among less experienced emergency physicians, which may prolong the diagnosis and ultimately time to surgery. Clinical artificial intelligence (AI) decision support tools have shown great potential in assisting the detection of fractures on radiographs.PurposeTo investigate how a CE-marked AI fracture detection tool affects junior doctors' diagnostic accuracy in detecting hip fractures on radiographs.Material and MethodsEight junior doctors with affiliation to the Accident and Emergency (A&E) department read 246 hip radiographic examinations with and without AI support. The reference standard was determined by two musculoskeletal radiologists, to measure sensitivity and specificity for readers without and with support from the AI tool as well as the AI tool's standalone performance.ResultsMean sensitivity in detecting hip fractures increased significantly from 0.89 (95% confidence interval [CI] = 0.85-0.93) without AI support to 0.94 (95% CI = 0.92-0.97) (χ² = 9.27; P = 0.002) with AI support and the false-negative cases was thereby reduced by 49%. There was no significant change in mean specificity 0.90 (95% CI = 0.86-0.93) to 0.91 (95% CI = 0.88-0.94) (χ² = 0.34; P = 0.56). The AI standalone performance was 0.99 (95% CI = 0.99-1.00) and 0.73 (95% CI = 0.67-0.80) in sensitivity and specificity, respectively.ConclusionOut of eight junior doctors, seven detected more fractures with AI assistance than without. The applied performance gain for readers highlights the value of the product.

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.

BackgroundIn Sweden, approximately 1300 patients are diagnosed with renal cell carcinoma (RCC) every year. The use of a computed tomography (CT) scan of the thoracic cavity in the preoperative work up of kidney cancer has increased in Sweden, and current national guidelines recommend that all patients, regardless of tumor size, should be evaluated this wayPurposeTo investigate the need for the preoperative routine to include a CT scan of the thoracic cavity when investigating renal masses 4 cm or smaller.Material and MethodsBetween 2017 and 2022, 496 patients at a university hospital and a regional hospital received treatment with curative intent for T1a tumors. Patient data and pathological findings were registered from patient records.ResultsMedian follow-up was 38 months. A total of 260 patients were examined with a preoperative CT scan of the thoracic cavity without pathology: 46 had not been scanned, 118 had indeterminate lesions, and metastasis was suspected in two cases. During follow-up, six patients had local relapse and none was diagnosed with lung metastasis. In no case did the preoperative CT of the thoracic cavity contribute to an early discovery of lung metastases.ConclusionOur conclusion is that a chest CT scan is superfluous in the preoperative work-up. The cost, and the time to treatment, could be reduced by precluding the chest CT in the preoperative work up for small renal tumors.

BackgroundPeripheral zone (PZ) PI-RADS category 4 includes lesions with diverse pathological outcomes, leading to varying prostate cancer (PCa) detection rates between pure category 4 (pCategory-4) and upgraded category 4 (Category-3+1) PZ lesions, as well as different lesion sizes.PurposeTo compare PCa detection rates for pCategory-4 and Category-3+1, considering lesion size.Material and MethodsThis retrospective study included 293 participants with PI-RADS V2.1 category-4 PZ lesions, who underwent MRI-targeted biopsy between 2012 and 2021. Overall and clinically significant PCa (csPCa) detection rates for pCategory-4 and Category-3+1 lesions were compared using Pearson's chi-square (χ²) test. In addition, PCa detection rates were analyzed by lesion size (1-5 mm, 5-10 mm, 10-15 mm, and >15 mm) using Spearman's test. Logistic regression analysis included age, PSA, PSA density, lesion volume, and size/scale for PZ lesions.ResultscsPCa detection rates were 60.4% for pCategory-4 and 25.8% for Category-3+1, while overall PCa detection rates were 69.4% and 36.2%, respectively. pCategory-4 showed higher cancer detection rates than Category-3+1 (overall PCa: χ² = 22.34; P <0.0001, csPCa: χ² = 21.88; P <0.001). Larger lesions (>5 mm) were more likely to harbor PCa, with significant differences in detection rates observed for pCategory-4 and Category-3+1 (overall PCa: χ² = 20.05; P <0.001).ConclusionpCategory-4 lesions have significantly higher PCa detection rates compared to Category-3+1. Larger lesion size is associated with increased PCa detection in pCategory-4 lesions but not in Category-3+1.

BackgroundHepatic venous malformations (VMs) are adult-onset vascular anomalies that continue to be inaccurately labeled as "hepatic hemangiomas." Despite the widespread adoption of the International Society for the Study of Vascular Anomalies (ISSVA) classification, which distinguishes VMs from vascular tumors, outdated terminology persists. This misclassification may hinder diagnostic accuracy and limit the application of appropriate management strategies, including sclerotherapy.PurposeTo analyze the clinical, radiographic, and histopathologic characteristics of hepatic VMs in adults and assess the accuracy of the existing diagnoses.Material and MethodsThis is a retrospective review of a large tertiary referral center with a statewide catchment area, analyzing adult patients with pathology-proven hepatic VMs referred between January 2000 and July 2021. The original diagnosis and data on clinical, radiographic, pathological, and treatment methods of pathology-proven lesions were collected and analyzed.ResultsA total of 24 adult patients (13 women; mean age = 53.5 years) met the inclusion criteria. In 20 (83.3%) cases, imaging labeled the lesion as "hemangioma" before pathology confirmed the same diagnosis; in 4 (16.7%) cases, imaging initially suggested metastases, but pathology labeled them as "hemangioma." Most lesions were solitary (71%) and asymptomatic (67%). Symptomatic lesions had a larger mean diameter (9.3 cm) compared with the overall cohort (4.42 cm). Careful re-review of imaging and histopathology confirmed all lesions to be VMs.ConclusionHepatic VMs are frequently misdiagnosed as hemangiomas. Accurate classification is essential for improving clinical understanding, guiding treatment, and aligning terminology with current vascular anomaly standards.

BackgroundThe widespread use of high-resolution ultrasonography (US) imaging has led to an increased detection of thyroid nodules, which are common in the general population.PurposeTo evaluate the correlation between ultrasonographic and pathological findings of thyroid nodules undergoing US-guided fine-needle aspiration (FNA) and assess the contribution of US features to malignancy prediction.Material and MethodsA total of 573 patients (137 men, 436 women; age range = 20-88 years) who underwent US-guided FNA were included. Nodule characteristics were recorded using the British Thyroid Association (BTA) U classification, and cytological results were assessed according to the Bethesda system. Logistic regression analysis (LRA) was performed to determine the relationship between US features and malignancy.ResultsThe distribution of nodules in U2, U3, U4, and U5 categories was 212, 171, 84, and 36, respectively, with corresponding Bethesda (2-6) classifications of 287, 159, 18, 27, and 12. Malignancy rates (Bethesda 4-6) were 0%, 10%, 28.6%, and 44.5%, respectively. Hypoechogenicity (relative to muscle), internal vascularization, and microcalcifications were significantly associated with malignancy (P <0.05). LRA achieved an 85.5% accuracy in malignancy prediction.ConclusionUS features in the BTA U classification align with pathological findings. Hypoechoic solid nodules, central vascularization, and microcalcifications should raise suspicion for malignancy in the differential diagnosis of thyroid nodules. These study findings highlight the strong association between vascularity in the BTA classification and malignancy, suggesting its potential role in risk stratification.

BackgroundComputed tomography (CT) fluoroscopy provides high-resolution images and is widely used for safe and accurate procedures, but it exposes operators to high radiation doses.PurposeTo develop and evaluate a tunnel-shaped shielding system to reduce operator exposure to scattered radiation during CT fluoroscopy-guided procedures.Material and MethodsThe shield, designed based on scattered radiation distribution, consists of a semi-cylindrical leaded acrylic part and a bottom plate with a non-lead shielding board surrounding the patient. Radiation doses were measured with and without the shield using patient and operator phantoms. Dosimeters were placed at 10 locations on the operator phantom, including the eye lens, thyroid, chest, abdomen, pelvis, legs, patient-side armpit, and needle-holding hand. Percentage reductions in radiation exposure were calculated.ResultsThe tunnel-shaped shield significantly reduced radiation exposure, with dose reductions of 83%-100% at the eye lens, 88%-96% at the thyroid, 84%-95% at the upper chest, 84%-92% at the lower chest, 88%-94% at the abdomen, 91%-94% at the pelvis, 57%-68% at the upper leg, 44%-83% at the lower leg, 90%-94% at the patient-side armpit, and 73%-86% at the needle-holding hand. All reductions were statistically significant.ConclusionPhantom experiments demonstrated that the tunnel-shaped shielding system effectively reduces operator exposure to scattered radiation during CT fluoroscopy-guided procedures.

BackgroundContrast-enhancing magnetic resonance imaging is an expensive examination compared to contrast-enhanced spectral mammography (CESM) and cannot show microcalcifications.PurposeTo investigate the diagnostic performance of CESM for malignancy with microcalcifications alone and the relationship between tumor immunohistochemistry findings and tumor grade.Material and MethodsA total of 117 patients with suspected microcalcification at CESM were applied to our hospital between January 2022 and May 2024. Patients with accompanying mass and architectural distortion (n = 9) and the ones lacking pathology results (n = 11) were excluded. Patients with CESM and histopathological diagnosis (n = 97) were evaluated retrospectively. Mammography images were analyzed according to the American College of Radiology Breast Imaging-Reporting and Data System lexicon.ResultsIn our study, the diagnostic value of the presence of contrast enhancement in CESM was high in the evaluation of suspicious breast microcalcifications. Malignant pathology was detected in all of the microcalcifications with high-risk morphology. In addition, all of the microcalcifications that enhanced in solid and ground-glass form were invasive ductal carcinoma. However, no significant relationship was found between immunohistochemical parameters (ER, PR, CerB2, Ki-67 and grade) and enhancement in CESM. The highest enhancement rate among malignant subtypes was detected in the luminal B group.ConclusionCESM is useful to reduce the number of unnecessary benign biopsies with suspicious microcalcifications in the breast, and provides an important contribution to the radiologist's biopsy decision by simultaneously showing the morphological features of the microcalcification and the contrast enhancement information.

BackgroundIntraductal papillary mucinous neoplasms (IPMNs) of the pancreas are cystic lesions with varying malignant potential requiring long-term surveillance. However, optimal surveillance strategies remain debated.PurposeTo evaluate imaging and demographic characteristics of IPMN patients referred to our multidisciplinary team (MDT) conference over a 5-year period, and to determine the frequency and histopathological outcomes of surgical resections.Material and MethodsWe assessed a cohort of all patients referred to the weekly IPMN MDT conference between 1 January 2019 and 31 December 2023. Using electronic health records, we linked information from imaging records with clinical characteristics. Outcomes included imaging features, presence and development of worrisome features (WFs), and surgical interventions.ResultsDuring the study period, 1082 patients were eligible for inclusion in the study cohort. The majority were female (57.1%) and mean age at entry was 69.8 years. Branch duct IPMN was the most common subtype (95.3%). At baseline, WFs were present in 207 (19.1%) patients and an additional 47 (4.1%) patients developed WFs during follow-up. Rapid cyst growth was observed in 6.8% using the Fukuoka criteria and 10.3% using the updated Kyoto 2024 criteria. Surgical resection was performed in 62 (5.7%) patients, of whom 31 (2.9%) had malignant transformation or high-grade dysplasia.ConclusionMalignant transformation was uncommon among our IPMN patients. WFs and rapid cyst growth were not consistent predictors. These findings support more individualized and less intensive surveillance.