Acta radiologica最新文献

BackgroundMyocardial bridge (MB) may lead to myocardial ischemia. Non-contrast coronary magnetic resonance angiography (CMRA) offers a non-invasive, radiation-free alternative to computed tomography coronary angiography (CCTA); however, the performance of whole-heart versus volume-targeted CMRA for MB detection remains unclear.PurposeTo evaluate and compare the diagnostic efficacy of non-contrast whole-heart and volume-targeted CMRA using balanced SSFP sequences in MB detection.Material and MethodsThis prospective study enrolled 30 consecutive patients with suspected or confirmed MB. All patients underwent both whole-heart and volume-targeted CMRA. Image quality was scored on a 3-point scale. MB detection confidence was rated on a 5-point scale. Using CCTA as the reference standard, diagnostic performance was evaluated by biserial rank correlation (rb) and receiver operating characteristic (ROC) analysis with calculation of areas under the curve (AUCs). MB thickness and tunneled coronary segment length were additionally measured and compared between CMRA and CCTA.ResultsBoth CMRA techniques achieved a 97.04% diagnostic rate across coronary segments. Image quality scores (whole-heart=2.27-2.87; volume-targeted=2.37-2.93) showed no significant differences. At the patient level, strong correlations with CCTA were observed for whole-heart (rb = 0.66), volume-targeted (rb = 0.70), and combined CMRA (rb = 0.72) (all P <0.001). At the segment level, correlations remained strong for whole-heart (rb = 0.82), volume-targeted (rb = 0.70), and combined CMRA (rb = 0.82) (all P <0.001). ROC analysis showed comparable diagnostic performance among the three approaches at both LAD level (AUC=0.86, 0.89, 0.91; all P >0.05) and segment level (AUC=0.97, 0.89, 0.95; all P >0.05). No significant differences were observed between CMRA and CCTA in MB thickness or tunneled segment length for either whole-heart or volume-targeted CMRA (all P >0.05).ConclusionWhole-heart and volume-targeted CMRA provide high-quality, non-contrast coronary imaging for MB detection with diagnostic performance comparable to CCTA. The combined approach offers complementary advantages.

BackgroundLiver metastases occur in approximately 50% of patients with metastatic breast cancer (MBC). Currently, few patients with breast cancer liver metastases (BCLM) are considered for surgical intervention.PurposeTo estimate the proportion of BCLM patients potentially eligible for targeted liver intervention.Material and MethodsA total of 17,035 women were included (1991-1996) in the prospective Malmö Diet and Cancer Study. Diagnostic liver imaging (performed in 2003-2018) of women within the cohort later diagnosed with breast cancer (BC) was evaluated according to a predefined protocol. A multidisciplinary conference assessed BCLM resectability based on liver imaging and overall metastatic burden. Patients with non-skeletal, extrahepatic BC metastases were considered unresectable. Fisher's exact test and Kruskal-Wallis test were used for statistical comparisons.ResultsAmong 1242 women initially diagnosed with BC, 249 were further diagnosed with MBC of which 57 had liver metastases; of these, 48 had available and assessable images. Based on liver imaging and the overall metastatic burden, 10 (21%) patients had liver metastasis that were considered resectable. No statistically significant differences were found between resectable and unresectable groups in age at primary BC diagnosis, age at BCLM diagnosis, mode of BC detection, or primary BC tumor parameters.ConclusionApproximately one-fifth of BCLM patients in this cohort could potentially have been eligible for targeted intervention of liver metastases. These findings contribute to the limited evidence on BCLM resectability and may inform future treatment strategies.

BackgroundAccurate differentiation of clear cell renal cell carcinoma (ccRCC), the most aggressive subtype of renal masses, is crucial for guiding management decisions. Magnetic resonance imaging (MRI)-based Clear Cell Likelihood Score (ccLS) has recently emerged as a useful tool in this regard.PurposeTo evaluate the diagnostic performance and inter-observer reliability of the MRI-based ccLS in distinguishing ccRCC from other renal tumors that could not be clearly classified with conventional imaging.Material and MethodsThis single-center, retrospective study included 176 patients with renal masses who underwent preoperative dynamic contrast-enhanced MRI. Two radiologists independently reviewed the images, applying the ccLS scoring system based on T2 signal intensity, corticomedullary phase enhancement, and other imaging features as previously described. The histopathological results were used as the reference standard. The diagnostic performance of ccLS, with varying thresholds, was assessed, and inter-observer agreement was evaluated.ResultsThe study found that the ccLS system demonstrated high sensitivity (93.3%) but low specificity (47.9%) at a threshold of ≥3 and balanced accuracy (sensitivity = 81%, specificity = 70.4%) at a threshold of ≥4. Larger tumors (≥4 cm) showed superior diagnostic performance. MRI features such as T2 hyperintensity and corticomedullary hypervascularity were significantly more frequent in ccRCC compared to non-ccRCC (P <0.001). The inter-observer agreement for ccLS and key MRI features including T2 hyperintensity and corticomedullary hypervascularity were substantial (weighted kappa = 0.71-0.74).ConclusionAlthough highly reproducible, the current ccLS algorithm, should be used cautiously in distinguishing ccRCC from other renal masses that cannot be easily classified with conventional imaging.

BackgroundManagement strategies for small pneumothorax after computed tomography (CT)-guided lung biopsy may vary between institutions, and the approach to follow-up care can differ.PurposeTo evaluate the role of CT imaging performed 10 min after CT-guided lung biopsy in managing complicated small pneumothorax, particularly to assess its progression and guide subsequent treatment decisions.Material and MethodsA retrospective study was conducted on 86 cases of small pneumothorax identified immediately after CT-guided lung biopsy at our institution between January 2016 and December 2023. Small pneumothorax was defined as having insufficient space to insert a needle for aspiration. CT was performed 10 min after biopsy to assess pneumothorax progression, and cases were categorized into three groups: decreased, unchanged, or increased pneumothorax. Subsequent clinical courses and treatments were evaluated.ResultsAccording to CT performed 10 min after biopsy, pneumothorax decreased, unchanged, and increased in 37 (43.0%), 22 (25.6%), and 27 (31.4%) cases, respectively. Three cases (3.5%) with increased pneumothorax required manual aspiration at that time, which resolved within 3 days. In the 59 cases in which pneumothorax decreased or remained unchanged, 58 (98.3%) resolved spontaneously, while one case worsened after 4 days, requiring delayed aspiration.ConclusionCT performed 10 min following biopsy may be a valuable tool for predicting the course of small pneumothorax. In the absence of worsening, the likelihood of subsequent progression requiring treatment is minimal. Observation for 10 min and performing manual aspiration in cases with worsening pneumothorax may reduce the need for further treatment, contributing to improved patient management.

BackgroundPeople diagnosed with cystic fibrosis (pwCF) who have chronic rhinosinusitis undergo low-dose computed tomography (LDCT) scans of the paranasal sinuses as a crucial component of their disease management.PurposeTo assess and compare the intra-individual image quality and radiation dose between photon-counting CT (PCCT) and CT scanners utilizing an energy-integrating detector system (EID-CT) with LD protocols for pwCF.Material and MethodsIn this retrospective study, 23 pwCF who underwent LD paranasal sinuses PCCT and who had previously undergone LD paranasal sinuses EID-CT were included. An intra-individual comparison of image quality and radiation dose was carried out. Three blinded radiologists rated overall image quality, image sharpness, and image noise using a 5-point Likert scale. The study measured the dose length product, the volumetric CT dose index, the effective dose, and the signal to noise ratio (SNR).ResultsThe cohort comprised 23 individuals (6 women [26%], 17 men [74%]; mean age = 36.7 years). PCCT achieved superior evaluations for image quality in comparison to EID-CT (mean = 5 vs. 3; P <0.001). Furthermore, PCCT exhibited diminished image noise (mean = 4 vs. 3; P <0.001). The mean SNR of the paranasal sinuses demonstrated an increase in PCCT as opposed to EID-CT (P <0.001). PCCT demonstrated a reduction of approximately 36% in effective dose compared to EID-CT (mean = 0.09 vs. 0.15 mSv; P <0.001).ConclusionPCCT scans of the paranasal sinuses offer superior image quality and substantially reduce radiation dose compared to EID-CT scans in pwCF, offering a safer and more effective imaging alternative compared to EID-CT for managing cystic fibrosis.

BackgroundAlthough prior studies on peripheral arteriovenous malformations (AVMs) have addressed diagnosis and treatment, the prevalence and risk factors for cardiomegaly remain underexplored.PurposeTo assess the prevalence of cardiomegaly in peripheral AVMs, identify associated factors, and evaluate changes in cardiac size and function following endovascular treatment.Material and MethodsA retrospective review was conducted on 437 patients treated for peripheral AVMs between 2000 and 2022 at a single vascular anomalies center. AVM types were classified according to the Cho-Do angiographic classification. Cardiomegaly was defined as a cardiothoracic ratio (CTR) >0.5 on chest radiographs. Factors associated with cardiomegaly and post-treatment changes in CTR and cardiac function were analyzed.ResultsCardiomegaly was observed in 108/437 (24.7%) patients. Multivariate analysis identified type I/II (vs. III) (P = 0.002), lesion diameter >10 cm (P = 0.013), and bone involvement (P = 0.021) as significant risk factors. Abdominopelvic (P <0.001) and thoracic-neck AVMs (P = 0.018) had higher cardiomegaly prevalence than extremity AVMs. Among the 108 patients with cardiomegaly, 84 underwent follow-up chest radiographs. The median CTR reduction rate was 8.9% (interquartile range [IQR] 4.1-15.8), with a significant decrease (P <0.001). Higher angiographic devascularization was associated with greater CTR reductions (P = 0.013). Echocardiography was selectively performed in patients with suspected cardiac involvement. Among 27 patients with both pre- and post-treatment echocardiography, 44% showed functional improvement.ConclusionAVM type, extent, location, and bone involvement were significant factors influencing cardiomegaly risk. Endovascular treatment was effective in reducing cardiac enlargement and functional improvement was observed in a subset of patients.

BackgroundPatient-reported symptoms is considered a possible alternative to computed tomography (CT) for the evaluation of remaining ureteral stones at follow-up after a ureteral colic attack.PurposeTo investigate patient-reported symptoms at follow-up after a ureteral colic attack in patients with a remaining ureteral stone and to assess the association of symptoms with degree of urinary obstruction.Material and MethodsThis was a prospective study of 81 patients (68 men, 13 women; mean age = 59 years; age range = 23-88 years) referred for a follow-up CT after a ureteral colic attack with a remaining unilateral ureteral stone. A dynamic enhanced scan defined urinary obstruction. Stone size was the largest diameter of three multiplanar reformatations (axial, coronal, sagittal). Stone location was registered as proximal, mid-ureter or distal. Symptoms were registered in standardized questionnaires by the patient at the time of the follow-up.ResultsIn total, 43/81 (53%) patients reported symptoms. Obstruction of any degree was present in 16 (20%) patients. In 7 (100%) patients with moderate-severe obstruction reported discomfort attributed to the stone. In patients with mild obstruction, 5 (56%) reported discomfort; in patients with no obstruction, 31 (48%) reported discomfort.ConclusionAlmost half of the patients at follow-up reported no discomfort despite having a stone in the ureter. A significant association was found between a higher degree of obstruction and reported symptoms. Asymptomatic stones and silent partial obstruction could be missed based on reported symptoms. Imaging is still required to evaluate stone passage at follow-up after a ureteral colic attack.

BackgroundA fibrous actuator, composed of a nitinol-based coil memory alloy, functions as a flexible coil under normal conditions. It contracts and generates heat when activated with an electric current. This property makes it a promising candidate for use as an interventional thermal device.PurposeTo evaluate the thermal effects of a nitinol coil ablation device on liver tissue and the intrahepatic portal vein.Material and MethodsAn in vitro experiment using bovine resected liver was performed. Ten Japanese white rabbits were divided equally into two groups (0.6-W and 1.1-W) based on electric power settings. Ablation was performed in three liver regions for each rabbit. Ablated areas were measured using fat-suppressed T1-weighted imaging following gadolinium administration and histological examination with hematoxylin and eosin staining. For the intrahepatic portal vein ablation, nine rabbits were assigned to the ablation group and eight rabbits served as controls. Portography was conducted before and after the procedure.ResultsIn vitro, temperature increases at ablation site and at 5-, 10-, and 15-mm distances and ellipsoid-shaped ablated area were proportional to electric power. In the in vivo experiment, the 1.1-W group exhibited significantly greater ablation effects compared to the 0.6-W group, as measured by magnetic resonance imaging (50.6 vs. 22.7 mm²; P <0.001) and histopathology (38.9 vs. 21.7 mm²; P = 0.001). Nearly complete occlusion (>80% stenosis) was more frequently observed in the ablation group (72.2% vs. 22.2%; P = 0.007).ConclusionThe thermal ablation device utilizing a nitinol coil demonstrated effective liver ablation. Furthermore, it shows potential for customization in endovascular ablation applications.

BackgroundMYCN gene amplification is associated with poor prognosis in neuroblastoma (NB) patients; however, its detection relies on the invasive fluorescence in situ hybridization technique. Radiomics can non-invasively predict MYCN gene amplification by extracting high-dimensional features from medical images.PurposeTo systematically review and meta-analyze the performance of radiomics models in predicting MYCN gene amplification status in NB patients.Material and MethodsAs of 18 March 2025, a systematic search was performed for original literature on the prediction of MYCN amplification in NB patients using radiomics models in the following databases: PubMed, Embase, Web of Science, and Cochrane Library. The quality of the literature was assessed using the QUADAS-2 and Radiomics Quality Score (RQS) tools. The meta-analysis was performed using the random-effects model.ResultsThis research ultimately included nine articles (899 patients), from which data could be extracted for both radiomics-only models and combined models that integrate radiomic features with other predictors. The radiomics-only model demonstrated pooled sensitivity of 0.85 (95% confidence interval [CI] = 0.77-0.91) and specificity of 0.86 (95% CI = 0.79-0.90), while the combined model showed a sensitivity of 0.81 (95% CI = 0.75-0.87) and specificity of 0.92 (95% CI = 0.87-0.95). Summary receiver operating characteristic (SROC) curve yielded an area under ROC curve of 0.92 ± 0.02 for the radiomics-only model and 0.94 ± 0.02 for the combined model. No evidence of publication bias was found.ConclusionsRadiomics might be one promising approach for predicting MYCN gene amplification in patients with NB.

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.