Acta radiologica最新文献

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Society for the Study of Vascular Anomalies (ISSVA) classification, which distinguishes VMs from vascular tumors, outdated terminology persists.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.

BackgroundThe diagnostic performance of ultrasound (US) is heavily reliant on the operator's expertise. Advances in artificial intelligence (AI) have introduced deep learning (DL) tools that detect morphology beyond human perception, providing automated interpretations.PurposeTo evaluate Smart-Detect (S-Detect), a DL tool, for its potential to enhance diagnostic precision and standardize US assessments among radiologists with varying levels of experience.Material and MethodsThis prospective observational study was conducted between May and November 2024. US and S-Detect analyses were performed by a breast imaging fellow. Images were independently analyzed by five radiologists with varying experience in breast imaging (<1 year-15 years). Each radiologist assessed the images twice: without and with S-Detect. ROC analyses compared the diagnostic performance. True downgrades and upgrades were calculated to determine the biopsy reduction with AI assistance. Kappa statistics assessed radiologist agreement before and after incorporating S-Detect.ResultsThis study analyzed 230 breast masses from 216 patients. S-Detect demonstrated high specificity (92.7%), PPV (92.9%), NPV (87.9%), and accuracy (90.4%). It enhanced less experienced radiologists' performance, increasing the sensitivity (85% to 93.33%), specificity (54.5% to 73.64%), and accuracy (70.43% to 83.91%; P <0.001). AUC significantly increased for the less experienced radiologists (0.698 to 0.835 P <0.001), with no significant gains for the expert radiologist. It also reduced variability in assessment between radiologists with an increase in kappa agreement (0.459-0.696) and enabled significant downgrades, reducing unnecessary biopsies.ConclusionThe DL tool improves diagnostic accuracy, bridges the expertise gap, reduces reliance on invasive procedures, and enhances consistency in clinical decisions among radiologists.

BackgroundImproved intraoperative diagnostic imaging during fenestrated and branched endovascular aortic repair (f-bEVAR) may reveal unfavorable positioning of endograft components, endoleaks, and other procedural complications, enabling immediate corrective maneuvers. Consequently, improved intraoperative imaging could reduce the need for follow-up computed tomography (CT) examinations and reinterventions.PurposeTo assess the feasibility of performing intraoperative CT angiography (CTA) during f-bEVAR, and to compare intraoperative CTA findings with postoperative CTA.Material and MethodsIntraoperative catheter-CTA (cCTA) with intra-arterial administration of diluted contrast medium was performed in 31 patients undergoing f-bEVAR. Intraoperative cCTA findings were compared with postoperative CTA on day 1 in 28 patients. Discrepancies in findings between the two CTA, any adjunctive corrective maneuvers, time required for cCTA imaging, radiation dose exposure, and reintervention rates were recorded.ResultsIntraoperative cCTA was technically successful in all patients (100%). Immediate corrective maneuvers were performed in 2 (7%) patients based on cCTA findings. Discrepancies between intraoperative and postoperative CTA were observed in 4/28 (14%) patients, all related to early-phase endoleaks. No discrepancies were found regarding endograft positioning or procedural complications. Mean effective dose from intraoperative cCTA was 11.3 mSv (interquartile range = 8.0-12.8).ConclusionIntraoperative cCTA during f-bEVAR was feasible and achieved a high technical success rate. It provided reliable visualization of endograft architecture and intraprocedural complications, but cCTA did not identify the same number of early-phase endoleaks as postoperative CTA. While the routine use of intraoperative cCTA may offer limited patient benefit, it can be a useful adjunct in challenging cases.

BackgroundCone-beam computed tomography (CBCT) can offer advantages over multidetector CT in dose efficiency and economic costs, but musculoskeletal applications were limited in gantry-free systems.PurposeTo assess the utility of novel multi-scan-body CBCT for osseous imaging, compared to clinically implemented photon-counting-detector (PCCT) and energy-integrating-detector (EICT) CT.Material and MethodsAn anthropomorphic hand wrist phantom underwent gantry-based CBCT (low-dose, regular, enhanced, and best settings), PCCT, and EICT. Quantitative metrics included dose values, noise, and noise power spectrum (NPS). Three radiologists with varying experience levels (10, 6, and 1 years) assessed depiction of cortical and trabecular bone, articular surfaces, intraosseous ganglion cyst, and overall image quality using 5-point Likert scales.ResultsLow-dose and regular CBCT (0.37 and 0.67 mGy) showed the lowest dose values (CTDI_vol), followed by EICT, enhanced and best CBCT, and then PCCT (0.76, 1.08, and 1.61, and 3.56 mGy, respectively). Absolute noise was lowest for PCCT (15.1), followed by best (23.2), regular (25.1), and enhanced (27.4) CBCT. Highest noise was measured for low-dose CBCT (35.1) and EICT (30.1). CBCT showed overall irregular and relatively high NPS, compared to regular and high NPS of EID, whereas PCCT showed a cleaner texture with the lowest NPS. Qualitatively, CBCT (enhanced, best) generally achieved the best scores, while the other scans scored equally well. Average interreader agreement ranged from moderate to near-perfect (k = 0.53-0.87).ConclusionNovel multi-scan-body CBCT with variable image quality settings can provide detailed depiction of fine osseous structures, demonstrating comparable or lower doses compared to clinically implemented PCCT and EICT.