Acta radiologica最新文献

Background: Non-invasive approach other than conventional endoscopy could be effectively used for screening and monitoring esophageal variceal bleeding (EVB).

Purpose: To retrospectively investigate the role of four-dimensional (4D) flow magnetic resonance imaging (MRI) as an add-on tool to endoscopy for predicting EVB in cirrhotic patients with esophageal varices (EVs).

Material and methods: A cohort of 109 cirrhotic patients with EVs was divided into four groups: A = negative red color [RC] sign, no EVB, n = 60; B = negative RC sign, EVB, n = 13; C = positive RC sign, no EVB, n = 10; and D = positive RC sign, EVB, n = 26. All patients underwent laboratory assessments and 4D flow MRI using a 3-T scanner to analyze hemodynamic parameters within the main portal vein (PV), splenic vein, and superior mesenteric vein. Comparative analysis of 4D flow parameters among the groups was performed using the Mann-Whitney U-test, and diagnostic accuracy was assessed through the area under the receiver operator characteristic curve (AUC).

Results: In the main PV, all 4D flow parameters were significantly lower in patients with a positive RC sign compared to those with a negative RC sign (P < 0.05). Patients with EVB had lower parameters than those without EVB (P < 0.05). The AUC values predicting actual variceal bleeding was 0.762 for endoscopy alone and 0.770-0.787 for 4D flow MRI. Integrating the endoscopic classification with the 4D flow MRI significantly improved the AUC value to 0.871 (P < 0.05).

Conclusion: Four-dimensional flow MRI may be useful as an add-on tool to endoscopy for predicting actual bleeding in cirrhotic patients with EVs.

Background: The comparative diagnostic performance of ⁶⁸Gallium (Ga)-PSMA-11 PET/CT and ⁶⁸Ga-PSMA-11 PET/MRI in detecting bone metastases in prostate cancer (PCa) remains unclear.

Purpose: To systematically evaluate the early detection rate of biochemical recurrent (BCR) bone metastasis in PCa utilizing ⁶⁸Ga-PSMA-11 PET/CT and ⁶⁸Ga-PSMA-11 PET/MRI.

Material and methods: We searched PubMed, Embase, and Web of Science for relevant articles up to April 2023 and extracted studies that examined the positivity rate of both ⁶⁸Ga-PSMA-11 PET/CT and ⁶⁸Ga-PSMA-11 PET/MRI in the context of the BCR bone metastasis of PCa patients. Random-effects model was used to compare positivity rates for two imaging modalities. Heterogeneity among studies was assessed using the I² statistic. To evaluate the methodological quality of studies, we employed Quality Assessment of Diagnostic Performance Studies method. The study protocol was registered in PROSPERO (CRD42023454118).

Results: A total of 1670 publications were originally identified; 58 studies, encompassing a cohort of 8037 patients, met the inclusion criteria. Regarding the evaluation of BCR bone metastasis, results suggest no statistically significant difference in the utilization of ⁶⁸Ga-PSMA-11 PET/CT versus ⁶⁸Ga-PSMA-11 PET/MRI in 58 non-head-to-head studies (0.21, 95% CI=0.19-0.24 and 0.17, 95% CI=0.11-0.23; P = 0.19) and four head-to-head studies (0.16, 95% CI=0.08-0.27 and 0.16, 95% CI=0.08-0.27; P = 1.00). Meta-regression showed the study design of influenced the heterogeneity in the PET/MRI group (P < 0.01); but analysis of PET/CT did not identify the potential reason for heterogeneity.

Conclusion: There was no statistically significant difference in identifying BCR bone metastasis in PCa patients between ⁶⁸Ga-PSMA-11 PET/CT and ⁶⁸Ga-PSMA-11 PET/MRI.

Background: Computed tomography (CT) is the most common way to evaluate focal organizing pneumonia (FOP); however, sometimes it is difficult to differentiate FOP and peripheral lung carcinoma (PLC).

Purpose: To clarify the MRI manifestation of FOP and the value of MR in the differential diagnosis of FOP and PLC in comparison to CT.

Material and methods: Chest MR (3D T1WI, T2WI TSE, DWI) and CT images of 72 patients (50 men: mean age=64.7 years; 22 women: mean age=64.9 years; 36 FOPs and 36 PLCs) were retrospectively analyzed. Two experienced radiologists reviewed all CT and MR images and graded CT and MR findings completely independently. The apparent diffusion coefficient (ADC) value was measured by the two radiologists independently. Paired sample t-test and Fisher's exact test were used to compare the ADC values and MR features between the two groups. Finally, the ROC curve was used to evaluate the diagnostic efficiency of MR.

Results: The ADC value of FOP was larger than PLC (P < 0.05). Necrosis, abscess cavity, broad contact with the pleura, and focal pleural effusion were more common in FOP (P < 0.05). PLC patients showed more (P < 0.05) irregular margins, pleural indentation, and lymphadenopathy. ADC value can be used to differentiate FOP and PLC, and the cutoff value is 1048 × 10^-6mm²/s. The sensitivity, specificity, AUC and accuracy of diagnosis of CT, MR was (61.1%, 88.9%, 0.820, and 75%) vs (72.2%, 97.2%, 0.950, and 93.1%), respectively.

Conclusion: Compared with CT, MR can increase radiologists' confidence in the differential diagnosis of FOP and PLC.

Background: Early detection of changes in lumbar intervertebral disc degeneration (IVDD) has great clinical significance. T1rho and UTE-T2* relaxometry are capable of providing information about biochemical changes in IVDD. However, they have not been previously analyzed and compared directly in the same patients.

Purpose: To assess and compare the potential of T1rho and UTE-T2* in the diagnosis of early IVDD in vivo.

Material and methods: The UTE-T2* and T1rho values of 389 lumbar discs (L1/2-L5/S1) in 78 individuals were measured in three segmented disc regions. The lumbar intervertebral disc was graded using the 5-level Pfirrmann grading system and divided into three categories. Statistical analysis was performed on the regional differences of UTE-T2* and T1rho relaxometry and correlation with IVDD.

Results: Both UTE-T2* and T1rho values were negatively correlated with Pfirrmann grade (P < 0.001). They showed strong correlations with Pfirrmann grade in NP (r = -0.725 and -0.743, respectively; P < 0.001). Diagnostic accuracy of detecting early IVDD was better with T1rho than UTE-T2* value in AAF and NP, with areas under the curve (AUCs) of 0.834-0.934 (both P < 0.05). For advanced lumbar IVDD, UTE-T2* value showed significantly higher diagnostic accuracy than T1rho in all segments with AUCs in the range of 0.743-0.893 (P < 0.05).

Conclusion: UTE-T2* relaxometry provided another promising magnetic resonance imaging sequence for quantitatively evaluating lumbar IVDD, especially for detection of the advanced stage of IVDD. In addition, the T1rho value is superior to UTE-T2* in detecting early lumbar IVDD.

Background: Piriformis syndrome, an often-overlooked cause of sciatica, commonly presents as chronic gluteal pain and poses a diagnostic challenge, particularly in patients with axial spondyloarthritis (axSpA).

Purpose: To examine piriformis muscle abnormalities on sacroiliac magnetic resonance imaging (MRI) and their association with clinical outcomes in patients with axSpA.

Material and methods: This cross-sectional study included 100 axSpA patients (50 radiographic [r-axSpA], 50 non-radiographic [nr-axSpA]), classified by the 2009 ASAS Axial Spondyloarthritis criteria, who underwent MRI evaluations of the sacroiliac joints over a 6-month period. Piriformis evaluation included the measurement of muscle size, signal intensity, and the assessment of fatty infiltration. Sciatic neuritis was assessed by identifying enlarged sciatic nerves or increased signal intensity. Data collection included demographic details, disease activity, and functionality parameters. Statistical analysis was performed using appropriate methods, with P < 0.05 indicating significance.

Results: Piriformis syndrome findings were identified in 10% of patients, with a slightly higher incidence in r-axSpA patients (12%) compared to nr-axSpA patients (8%); however, this difference was not statistically significant (P = 0.739). Patients with these MRI findings had significantly higher disease activity, as indicated by the Ankylosing Spondylitis Disease Activity Score with C-reactive protein (3.5 vs. 2.82; P = 0.015), and greater functional impairment, measured by the Bath Ankylosing Spondylitis Functional Index (5.45 vs. 2.7; P = 0.041).

Conclusion: This study highlights the presence of MRI findings associated with piriformis syndrome among axSpA patients, which are linked to increased disease activity and reduced function. Recognizing piriformis syndrome as a co-morbidity may improve diagnosis and treatment, leading to better patient outcomes.

Background: Falcine sinuses can remain persistent after birth, but they can also become recanalized in cases where venous sinuses are invaded by meningiomas.

Purpose: To explore the incidence and imaging features of persistent falcine sinuses in healthy individuals and recanalized falcine sinuses in parasagittal meningioma (PSM) patients on magnetic resonance venography (MRV).

Material and methods: Radiologists evaluated imaging data of 168 healthy individuals and 168 PSM patients. The invasion extent of the superior sagittal sinus (SSS) in PSMs was confirmed by a neurosurgeon based on Sindou's criteria. We compared the incidence and imaging features of persistent and recanalized falcine sinuses.

Results: Among 168 health individuals (mean age = 46.2 ± 9.7 years), 5 (3.0%) persistent falcine sinuses were identified. Among 168 PSM patients (mean age = 53.0 ± 15.0 years), 14 (8.3%) recanalized falcine sinuses were found. Significant differences in SSS invasion extent and location were discovered between cases with and without recanalized falcine sinuses (P < 0.001 and P = 0.029). Recanalized falcine sinuses showed significant higher incidence and larger caliber than persistent ones (for incidence: 8.3% vs. 3.0%, P = 0.034; for caliber: 3.9 ± 1.2 vs. 2.5 ± 0.3 mm, P = 0.005). Under the cutoff of 3.1 mm in caliber with the area under the curve (AUC) of 0.929, we could differentiate between persistent and recanalized falcine sinuses.

Conclusion: Recanalized falcine sinuses in PSMs may form when meningiomas severely invade the posterior portion of the SSS, potentially offering a new perspective to assess sinus invasion. Differences between persistent and recanalized falcine sinuses may reflect different venous drainage status under normal and pathological conditions.

Background: In children and young adults, tumors in the chest and thoracic wall exhibit a wide variety of types, making it challenging to differentiate between benign and malignant cases before invasive histopathological examination.

Purpose: To evaluate the utility of apparent diffusion coefficient (ADC) for discriminating malignant thoracic masses in children and young adults.

Material and methods: This retrospective study included chest magnetic resonance imaging (MRI) scans in patients aged <30 years. Patients' age and sex, tumor location (mediastinum or thoracic wall), tumor size, MR characteristics including necrosis or hemorrhage, and ADC values were assessed.

Results: Malignant masses were found in older patients (mean age = 18.0 ± 8.1 vs. 10.6, ± 9.1 years; P = 0.008), had lower mean ADC values (0.765 ± 0.298 vs. 2.051 ± 0.855 × 10^-3 mm²/s; P < 0.001), and showed more internal hemorrhage (6/12 vs. 17/86; P = 0.031) compared to benign masses. Univariate and multivariate regression analyses also showed significant differences in age, tumor size, and ADC values. In the diagnostic performance analysis, age (area under the receiver operating characteristic curve [AUC] = 0.723, 95% confidence interval [CI] = 0.624-0.809; P = 0.004) and ADC mean value (AUC = 0.941, 95% CI = 0.874-0.978, P < 0.001) were significant. The optimal cutoff values were 13 years for age (sensitivity = 83.3%, specificity = 61.6%) and an ADC mean of 1.196 × 10^-3 mm²/s (sensitivity = 100%, specificity = 86.1%) for discriminating malignant from benign thoracic masses.

Conclusion: When evaluating thoracic masses in children and young adults, older age and lower ADC values help identify malignancy.

Background: Carotid artery stenting (CAS) is an interventional management in preventing ischemic stroke caused by carotid artery stenosis. After the treatment with CAS, in-stent restenosis caused by neointimal hyperplasia may develop.

Purpose: This study aims to obtain a better determination of neointimal hyperplasia using superb microvascular imaging (SMI), which provides a high-quality visualization of the endoluminal lesions, and to compare these results with B-mode and Doppler ultrasound (US).

Material and methods: A total of 106 patients who underwent CAS in our interventional radiology unit between 2018 and 2020 were retrospectively analyzed. In total, 44 patients whose procedure images and post-procedural follow-up Doppler US and SMI data could be accessed were included.

Results: There were nine patients who had in-stent restenosis. One patient had no velocity increase; however, on SMI the measurements showed in-stent restenosis both in area and diameter. The other eight patients had a stenosis degree in the range of 50%-79% on Doppler US. Five patients had in-stent restenosis, both in Doppler US and SMI, by area and diameter measurements. Two patients underwent digital subtraction angiography (DSA).

Conclusion: We suggest that using SMI with duplex sonography improves detecting neointimal hyperplasia and in-stent restenosis. With SMI, better visualization of the stent lumen may improve the patient selection for DSA.

Background: Bisphosphonate-associated stress fractures, atypical femur fractures (AFF), are a rare subgroup of femoral stress fractures. Their correct and early diagnosis is imperative for appropriate treatment.

Purpose: To investigate the sensitivity of written radiology reports to mention radiographic features of AFF, depending on the time period and academic level of the hospital.

Material and methods: We used 171 patients, aged 55 years or older, who sustained an AFF between 2008 and 2010 (early period) identified through the Swedish National Patient Register and radiographic review and 104 patients identified through the Swedish Fracture Register between 2015 and 2018 (late period). Plain radiographs were extracted from 72 radiology departments in Sweden and individually re-reviewed and classified based on the American Society for Bone and Mineral Research case definition for AFF. Radiology reports were viewed for mentioning AFF or stress/insufficiency features (true positives). The number of true positives was compared with the number of false positives for both periods using non-parametric statistics and using the gold standard as reference.

Results: We obtained 98 of the possible 171 reports with 7% of true positives for the early period and 77 of the possible 104 reports with 27% true positives for the late period (P < 0.001). The level of improvement over time was independent of the academic level of the hospital.

Conclusion: Despite improvements over time, written radiology reports seldom mention AFF features. Clinicians, specifically orthopedic surgeons, are encouraged to contribute to a correct and early diagnosis to tailor treatment, while awaiting improvements in radiology reports.

Background: Computed tomography (CT) is the gold standard imaging modality for the assessment of 3D bony morphology but incurs the cost of ionizing radiation exposure. High-resolution 3D magnetic resonance imaging (MRI) with CT-like bone contrast (CLBC) may provide an alternative to CT in allowing complete evaluation of both bony and soft tissue structures with a single MRI examination.

Purpose: To review the technical aspects of an optimized stack-of-stars 3D gradient recalled echo pulse sequence method (3D-Bone) in generating 3D MR images with CLBC, and to present a pictorial review of the utility of 3D-Bone in the clinical assessment of common musculoskeletal conditions.

Material and methods: 3D-Bone is a black-bone imaging technique for acquiring high-resolution 3D MR images with strong CLBC, achieved by first rendering as high a signal as possible from non-cortical bone tissues, and second by minimizing signal contrast between non-cortical bone tissues.

Results: 3D-Bone can be used in the clinical evaluation of bony morphology in common musculoskeletal conditions. Advantages include strong bone-soft tissue contrast, resistance to motion artefacts, simple hardware and software requirements, and straightforward image processing. Disadvantages include non-specificity for cortical bone, sensitivity to susceptibility artefacts, a lack of quantitative tissue measurements, as well as overall lower image resolution and bone-soft tissue contrast compared to CT.

Conclusion: The use of 3D MRI pulse sequences providing CLBC such as 3D-Bone could potentially offer complete clinical evaluation of bony morphology and soft tissues with a single MRI study for certain clinical indications, negating the need for ionizing radiation exposure from CT and reducing costs.