Acta radiologica最新文献

BackgroundIntracranial pressure is closely associated with pulsatile tinnitus (PT) caused by sigmoid sinus wall dehiscence (SSWD). Cerebrospinal fluid (CSF) plays a key role in regulating intracranial pressure; however, CSF alterations have not been reported in SSWD-PT patients.PurposeTo evaluate cardiac-driven CSF flow dynamics and volume changes in SSWD-PT patients with normal intracranial pressure.Material and MethodsSSWD-PT patients with normal intracranial pressure and age-, sex-, and handedness-matched healthy controls were prospectively enrolled and underwent MRI. Intracranial pressure was assessed using the index of transverse sinus stenosis and morphological changes. Cardiac-driven CSF flow dynamics were quantified by phase-contrast magnetic resonance imaging (MRI), and CSF volume was measured using ITK-SNAP segmentation software.ResultsThe study included 20 SSWD-PT patients and 35 controls. Compared with controls, the PT group showed a significant decrease in mean flux (MF) and a significant increase in regurgitant fraction (RF) (P = 0.043 and 0.008, respectively). No significant differences were observed in other parameters. The area under the curve (AUC), sensitivity, and specificity for MF and RF were 0.643, 100.0%, 31.4%, and 0.716, 50.0%, 88.6%, respectively. The combined diagnostic efficacy of MF and RF (AUC = 0.764) was higher than RF alone, though the difference was not significant (P = 0.390). The combined model and RF demonstrated significantly better diagnostic efficacy than MF (P = 0.025 and 0.045, respectively).ConclusionSSWD-PT patients exhibited altered cardiac-driven CSF flow dynamics, which may contribute to PT. The combination of MF and RF may serve as a complementary index for identifying the underlying etiology of SSWD-PT.

BackgroundComputed tomography with fistulography (CTF) using contrast material (CM) injected into a fistula is commonly used to visualize fistulous tracts (FT) in chronic osteomyelitis or chronic wounds. Typically, a CT scan is done twice: first without CM to identify sequestrum, followed by using CM to visualize the FT.PurposeTo develop a streamlined and effective CTF method that reduces patient radiation exposure and lowers examination costs.Material and MethodsThe method employs hydrogen peroxide (H₂O₂) as a contrast agent. When H₂O₂ enters the FT, it breaks down into water and oxygen, spreading under low pressure. Since gas has a significantly lower radiopacity than iodinated contrast agents, gas-filled fistulas appear black on the CT monitor, while CM, foreign bodies, and bones appear white. This technique has been used in over 200 patients for the lower and uppser extremities, pelvis, spine, and chest.ResultsThe images enabled a simultaneous investigation of the spatial relationship between the FT and sequestrum, irrespective of the body segment examined. Only a single scan was necessary. No complications or discomfort were reported by the patients.ConclusionThis method enhanced the topographic diagnosis of FT and the spatial positioning of sequestrum or foreign bodies, halving patient radiation exposure. It eliminates the need for expensive iodinated contrast agents and their associated complications, significantly reducing examination costs and time.

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.

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.

BackgroundIliocaval obstruction causes severe post-thrombotic syndrome (PTS) and impairs quality of life.PurposeTo evaluate endovascular treatment efficacy for symptomatic iliocaval obstruction in PTS.Material and MethodsA total of 17 patients underwent iliocaval venous reconstruction with stents between 2017 and 2022. All had bilateral iliac vein involvement; five presented with acute iliofemoral thrombosis and 12 with chronic iliocaval obstruction. All 17 patients had lower limb edema; nine patients reported lower limb pain (three acute iliofemoral thrombosis and six PTS) and four had active ulceration (all PTS). The technical results, adverse events, follow-up, and outcomes were documented.ResultsAll patients received successful iliocaval reconstruction with stents in a kissing configuration, with successful outcomes. Over a mean follow-up of 46.5 ± 16.7 months (final follow-up in April 2025), all four patients with baseline venous ulcers achieved complete healing, and no new or recurrent ulcerations were observed. Significant clinical improvement was observed, with mean Villalta scores reducing from 17.6 ± 5.1 at baseline to 3.9 ± 1.6 at 1 month postoperatively (P <0.001). At final follow-up, only two patients had symptom recurrence (mean Villalta score = 6.1 ± 4.7), with no significant change from the 1 month (P = 0.5). Reintervention for stent stenosis occurred in 35.3%. Primary patency rates were 82.4% (12 months), 70.6% (24 months), and 64.2% (36 months); secondary patency rates reached 94.1% (12 months), 94.1% (24 months), and 82.4% (36 months).ConclusionEndovascular interventions for iliocaval obstruction are safety and effectiveness, with excellent patency rates achieved.

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.

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.

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.

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.

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.