Acta radiologica最新文献

BackgroundDifferentiating small hepatic metastases from hemangiomas can be challenging on visual assessment.PurposeTo evaluate the diagnostic performance of magnetic resonance imaging (MRI) radiomics models based on T2-weighted (T2W) imaging in differentiating small hepatic metastases from hemangiomas.Material and MethodsThis retrospective study included patients with small (≤2 cm) hepatic metastases from colorectal cancer or hemangiomas who underwent liver MRI between August 2018 and January 2024. Datasets were divided into training, internal, and external validation sets based on MRI scanner type. Manual segmentation was performed on conventional T2W, heavily T2W, and fat-suppressed (FS)-T2W imaging. Random forest models were developed using 10-fold cross-validation on 10 selected radiomics features. AUCs were calculated to evaluate model performance. Before segmentation, each hepatic lesion in the validation sets was categorized into metastasis, hemangioma, or indeterminate lesion according to visual assessment on T2W imaging by two radiologists in consensus.ResultsA total of 285 patients (148 men; mean age=55.8 ± 12.5 years) were included: training (140 patients: 151 metastases, 155 hemangiomas), internal (86 patients: 87 metastases, 80 hemangiomas), and external (59 patients: 37 metastases, 69 hemangiomas) validation sets. AUCs for conventional/heavily/FS-T2W imaging were 0.976/0.972/0.946 (training), 0.979/0.991/0.989 (internal validation), and 0.969/0.976/0.809 (external validation), respectively. Among visually indeterminate lesions, 6/7 lesions in the internal validation set and 5/8 lesions in the external validation set were correctly classified using radiomics scores.ConclusionRadiomics models based on T2W imaging exhibit excellent performance in differentiating small hepatic metastases from hemangiomas and may contribute to the correct classification of visually indeterminate hepatic lesions.

BackgroundIdiopathic intracranial hypertension (IIH) in the pediatric population is a rare disease, and imaging is important in its diagnostic criteria.PurposeTo elucidate distinctive magnetic resonance imaging (MRI) findings of pediatric IIH and their correlation with clinical manifestations.Material and MethodsA total of 41 pediatric patients diagnosed with IIH and a control group consisting of 40 healthy children were retrospectively analyzed. Clinical parameters (body mass index, papilledema, cerebrospinal fluid [CSF] pressure), visual acuity, visual fields, and MRI findings were assessed. Statistical analysis was performed using SPSS 21.0 software.ResultsThe mean age was 12.4 ± 3.4 years, with 78% presenting with headaches and 24% with nausea and/or vomiting. MRI findings revealed optic nerve sheath dilatation (51.2%), posterior scleral flattening (43.9%), optic nerve tortuosity (19.5%), pituitary flattening (34.1%), and optic disc bulging (29.3%). Optic nerve sheath dilatation correlated with high CSF pressure. Scleral flattening correlated with elevated intracranial pressure, papilledema, and visual field defects. Optic disc bulging correlated with elevated papilledema and visual field defects also.ConclusionThis study highlights the diagnostic significance of optic nerve sheath dilatation and scleral flattening in pediatric IIH. Scleral flattening may be an important marker for optic nerve damage.

BackgroundSingle knee weightbearing (SKW) radiographs are considered more accurate for detecting minimal joint space width (mJSW) than double knee weightbearing (DKW) but have not been compared using a standardized method.PurposeTo compare medial and lateral tibiofemoral mJSW between SKW and DKW radiographs using manual and computerized measurements.Material and MethodsStandardized posteroanterior radiographs of both knees were obtained from 98 patients with knee pain (55 women; mean age = 64.5 years; age range = 41-81 years) using the DKW technique in semiflexion, followed by SKW. Medial and lateral mJSW, coronal translation, and tibial plateau alignment (intermargin distance) were measured manually. Intra- and inter-rater agreement was assessed using 100 knee radiographs. In addition, mJSW was measured using a fully automated computerized technique. Manual measurements were adjusted for magnification, while computerized measurements were not.ResultsInter- and intra-rater reliability of manual measurements was excellent. Both manual and computerized mJSW measurements showed a non-significant trend toward larger medial mJSW with DKW compared to SKW. Coronal translation did not differ between SKW and DKW. The intermargin distances were small, with no significant differences between SKW and DKW, indicating reproducible knee positioning. Computerized measurements consistently showed larger mJSW than manual measurements.ConclusionMedial and lateral mJSW did not differ significantly between SKW and DKW techniques using either manual or computerized measurements. However, a systematic difference was observed between manual and computerized mJSW measurements. The SKW technique did not offer any advantages over the DKW technique for assessing knee osteoarthritis.

BackgroundModern medical education demands refined methods, especially in radiology, where accuracy, speed, and clinical decision-making are critical.PurposeTo evaluate the impact of artificial intelligence (AI)-assisted and interdisciplinary educational interventions on residents' theoretical knowledge, confidence in professional skills, and practical clinical abilities. Assessments were conducted at Kirkpatrick Level 2 (Learning) for knowledge. Level 3 (Behavior) and Level 4 (Results) were not assessed in this study due to logistical constraints.Material and MethodsThe study was conducted between January and June 2024 at three medical centers in Shenzhen, China. A total of 240 residents were randomly assigned to three groups of 80 each: group 1 received standard training; group 2 participated in interdisciplinary seminars; and group 3 engaged in AI-assisted learning activities. The study included three stages: baseline assessment, core educational intervention, and final evaluation. Statistical analyses included Shapiro-Wilk and Kolmogorov-Smirnov tests for normality, followed by ANOVA and Tukey's post hoc tests for group comparisons.ResultsResidents in groups 2 and 3 demonstrated significant improvements across all measured domains. Group 3 (AI-assisted training) showed the greatest gains, with theoretical knowledge increasing by 21.5%, confidence in professional skills by 39.4%, and clinical skill performance by 27.1%. All between-group differences were statistically significant (P <0.01).ConclusionThe findings underscore the benefit of combining technology-driven exercises with collaborative, multispecialty learning to strengthen clinical competence. Future research should examine how such AI-based interventions influence long-term performance and how they can be adapted to different training environments.

BackgroundLymph node metastasis (LNM) greatly affects the prognosis and treatment of cervical squamous cell carcinoma (CSCC). Non-invasive imaging biomarkers that reflect tumor angiogenesis and vascular maturity may help predict LNM.PurposeTo determine whether the magnetic resonance imaging (MRI) quantitative parameters combined with microvascular characteristics predict the potential of LNM by reflecting angiogenesis or vascular maturation in CSCC.Material and MethodsThe clinicopathological characteristics, microvascular characteristics and MRI quantitative parameters of the LNM group (43 cases) and the non-LNM group (42 cases) were analyzed. The correlation between microvascular and MRI quantitative parameters and the ability of combined diagnosis of LNM were analyzed.ResultsThere were significant differences in the FIGO stage and the short diameter of the largest lymph node between patients with or without LNM. There was no significant difference in the apparent diffusion coefficient (ADC) value of the primary tumor between the LNM group and the non-LNM group (P >0.05). Spearman's correlation analysis showed that there was no correlation between ADC and MVD or microvessel pericyte coverage index (MPI) (all P >0.05). K^trans and K_ep were significantly higher, and MPI was significantly lower in patients with LNM. There were negative correlations between K^trans and MPI, and K_ep and MPI. Binary logistic regression analysis showed that a combined prediction model constructed by K^trans, K_ep, and MPI had the highest diagnostic efficacy.ConclusionK^trans and K_ep of CSCC can predict LNM by non-invasively reflecting the maturity of tumor vessels, and the combined K^trans, K_ep, and MPI have promising diagnostic efficiency for LNM.

BackgroundPancreatic cancer has poor outcomes, with vascular invasion being a critical factor in determining resectability and prognosis. Accurate assessment of vascular invasion remains challenging.PurposeTo investigate the predictors of vascular invasion and recurrence-free survival (RFS) in patients with pancreatic cancer undergoing surgery after chemotherapy using computed tomography (CT) and histopathological data, and to evaluate the diagnostic performance of CT-based vascular scoring system.Material and MethodsWe retrospectively analyzed 98 patients with pancreatic cancer showing vascular encasement on CT who underwent chemotherapy before surgery. Two reviewers evaluated baseline and preoperative CT to assess resectability. Clinicohistopathological factors were assessed. RFS was analyzed using the Kaplan-Meier method. The predictors were identified using Cox proportional hazards and logistic regression models. A 3-point scoring system quantified vascular involvement at baseline and preoperative CT, with total scores combining both time points.ResultsOf the 98 patients, 32 (32.7%) had pathologically confirmed vascular invasion. Change in tumor size (odds ratio [OR]=3.1; P = 0.022), T stage (OR=15.4; P = 0.038), and perineural invasion (OR=13.2; P = 0.028) predicted vascular invasion. Total vascular scores strongly correlated with vascular invasion (areas under the curve=0.924 and 0.803). Median RFS was 21 months, influenced by lymph node involvement at baseline and preoperative CT (hazard ratio [HR]=2.3; P = 0.009 and HR=2.6; P = 0.013, respectively), tumor differentiation (HR=3.3; P = 0.047), and elevated CA 19-9 (HR=2.8; P = 0.019).ConclusionChanges in tumor size on CT, T stage, and perineural invasion predict vascular invasion. In addition, a CT-based scoring systems can accurately predict vascular invasion after chemotherapy.

BackgroundDeep learning (DL)-based reconstruction may decrease the scan time of three-dimensional (3D) T1-weighted (T1W) imaging without compromising image quality. However, DL-based super-resolution reconstruction of volumetric interpolated breath-hold examination (DL-VIBE) has not previously been applied to intracranial contrast-enhancing lesions.PurposeTo investigate the diagnostic performance of DL-VIBE and compare it with conventional 3D T1 magnetization-prepared rapid-acquisition gradient echo (MPRAGE) for assessing intracranial enhancing lesions.Material and MethodsIn this study, 97 patients (35 men, 62 women; mean age = 59.2 ± 15.3 years) who underwent both contrast-enhanced 3D T1W imaging in the same imaging session (1 min 49 s vs. 5 min 32 s) between May and December 2023 were retrospectively included. Two neuroradiologists independently evaluated image quality, gray-white matter differentiation, lesion conspicuity, and artifacts using a 5-point Likert scale. Quantitative metrics included the number and maximum diameter of enhancing lesions, contrast:noise ratio (CNR) of lesion-to-normal parenchyma (CNR_{lesion/parenchyma}), and CNR of white:gray matter (CNR_WM/GM).ResultsAlthough DL-VIBE demonstrated lower overall image quality and gray-white matter differentiation, it showed significantly higher CNR_{lesion/parenchyma} and fewer motion and pulsation artifacts (P <0.001) than conventional MPRAGE. Furthermore, no significant differences were observed in the lesion conspicuity, number, or longest diameter of enhancing lesions between DL-VIBE and conventional MPRAGE (P >0.05).ConclusionDL-VIBE showed comparable diagnostic performance for intracranial enhancing lesions with reduced scan time compared to conventional MPRAGE, although it was limited by a lower image quality. Therefore, DL-VIBE represents a promising approach for the technical development of DL-based reconstruction in clinical practice.

BackgroundStandardized care pathway (SCP) for macrohematuria (patients aged ≥50 years) in Sweden includes four-phase computed tomography urography (CTU) before cystoscopy, but targeted SCP lead time for CTU (6 days)/treatment is fulfilled in <25% of patients.PurposeTo retrospectively analyze the incidence of CTU-diagnosed upper urinary tract (UUT), kidney and bladder tumors, calculi, radiation dose, and its implications for SCP.Material and MethodsA total of 4491 consecutive CTU reports on macrohematuria indication were reviewed, mainly during 2022 (86.6%) from nine radiology units: four regions, three university hospitals, and two private units. Tumor findings were verified via biopsy/cytology reports, CTU characteristics, and follow-up. Effective patient radiation doses were calculated.ResultsIn patients aged ≥50 years (n = 3915) the incidence of UUT/kidney/bladder tumors was 0.9%/1.0%/6.9%, respectively, and of calyceal, pelvic, ureteral, and bladder calculi was 13%, 2.0%, 2.7%, and 2.2%, respectively. Median effective dose was 12.9 mSv (range=10-22 mSv) in the six radiology units using four-phase CTU in 87%-100% of the examinations and 9-12 mSv in the three units using four-phase in 3%-53%.ConclusionThe limited incidence of UUT and kidney tumors diagnosed at CTU for macrohematuria necessitates a multidisciplinary discussion on how to improve SCP lead times for the vast majority with urothelial tumors, i.e. bladder tumors. Alternative diagnostic pathways such as cystoscopy and clinical risk evaluation before CTU should be contemplated. Additionally, there is a need to optimize radiation dose by reducing the number of CTU phases on one hand and without losing significant diagnostic accuracy on the other hand.

BackgroundMagnetic resonance imaging (MRI) is the gold standard for evaluating lumbar spinal stenosis (LSS); however, its high cost and potential overuse raise concerns. Although plain radiographs are more accessible and cost-effective, there is currently no established radiographic criterion for the diagnosis of LSS.PurposeTo investigate in 100 patients the effect of LSS on objective parameters reflected on radiographs and to adapt existing radiographic indices for the diagnosis of LSS.Material and MethodsBetween September 2017 and May 2018, a retrospective evaluation was performed on 100 patients who underwent lumbosacral MRI and lateral lumbosacral radiography for back and/or leg pain. LSS was confirmed in 50 patients, and various angles, measurements, and ratios were calculated on the radiographs of these patients.ResultsPelvic incidence (PI) was significantly higher in the LSS group (P = 0.029). Foraminal width (FW) and pedicle width (PW) were significantly lower at all levels in patients with spinal stenosis (P <0.001 and P <0.005). Sagittal vertebral body width (SBW):PW ratio was significantly higher at all levels in the LSS group (P <0.005). Receiver operating characteristic (ROC) analysis was performed for the parameters showing significant differences between the LSS and control groups. Cutoff values were calculated for each significant parameter and level, and among them, PW, FW, and SBW:PW showed relatively high sensitivity, specificity and accuracy.ConclusionPW, FW, and the SBW/PW ratio demonstrated high sensitivity and specificity in the diagnosis of LSS. These parameters may be useful for screening purposes; however, they are not sufficient on their own for clinical or surgical decision-making.

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.