Acta radiologica最新文献

BackgroundEmbolization plays a significant role in interventional radiology and modern medicine, intersecting with several specialties. The technological advancement of embolic agents has contributed to successful outcomes in the treatment of a wide range of diseases.PurposeTo compare the histomorphological effects of Embosoft microspheres and Embosphere microspheres in uterine artery embolization (UAE) in sheep.Material and MethodsSuperselective and bilateral UAE was performed with Embosoft and Embosphere microspheres in 10 adult non-pregnant sheep. Embosoft microspheres with a diameter of 500-700 μm were compared with Embosphere microspheres of a similar diameter in two groups of five sheep each. One sheep was embolized only with non-ionic iodinated contrast solution and saline (SF0.9%). The evaluation was based on histopathological examination of the uterus, performed 7 days after embolization. Necrosis scores, the diameter of occluded arteries, and the number of particles were assessed. ANOVA test and Student's t-test were used to determine the differences between the study groups.ResultsThe mean volume of embolic agents was 18.35 mL in the Embosphere group and 19.1 mL in the Embosoft group, with no statistically significant difference (P = 0.62). No significant difference was observed between the corresponding sides in the two groups. In addition, there were no significant differences in the thickness of the surface epithelium (Embosphere 21.26 μm vs. 19.72 μm Embosoft; P = 0.56) and glandular area between the groups (Embosphere 12.20% vs. 17.77% Embosoft; P = 0.18).ConclusionEmbosoft micropheres were associated with a greater inflammatory response and a smaller area of degeneration compared to Embosphere microspheres.

BackgroundThis study examines the correlation between magnetic resonance imaging (MRI)-derived volume parameters, surgical outcomes, and renal function in adults undergoing ureteropelvic junction (UPJ) obstruction surgery. Understanding these relationships can improve surgical planning, patient selection, and postoperative prognosis.PurposeTo assess the correlation between anatomical parameters and surgical outcomes in adult patients with UPJ obstruction.Material and MethodsA prospective cross-sectional study was conducted on 60 patients with UPJ obstruction, selected via simple random sampling. The hydronephrosis volume (HV) to renal volume (RV) ratio was calculated using MR urography (MRU). Preoperative diethylene triamine pentaacetic acid (DTPA) differential renal function (DRF) and creatinine levels were also recorded. Patients requiring surgery were followed up after 6 months, measuring pelvis/RV ratio, creatinine, and DTPA DRF. Statistical analyses were performed to find correlations.ResultsOperated patients had a higher preoperative HV/RV ratio (AUC=0.914, 95% confidence interval [CI]=0.829-1.000; P <0.001) and higher DTPA DRF values (AUC=0.936, 95% CI=0.860-1.000; P <0.001). Patients with greater preoperative HV/RV ratios were less likely to achieve anatomical normalization. Significant correlations were found between HV/RV ratios with DTPA DRF and creatinine (P <0.05). DeLong's test showed no significant differences between HV/RV ratios and DTPA DRF in predicting surgical need.ConclusionQuantitative volumetric analysis using MRU can effectively predict the need for surgery and renal function deterioration in patients with UPJ obstruction. The HV/RV ratio plays a crucial role in guiding surgical decisions and predicting outcomes. This study emphasizes and tests the hypothesis that higher degree of hydronephrosis correlates with higher degree of deterioration of renal function and need for surgical intervention.

BackgroundHigher-resolution magnetic resonance imaging sequences are needed for the early detection of pancreatic cancer.PurposeTo compare the quality of our novel T2-weighted, high-contrast, thin-slice imaging sequence, with an improved spatial resolution and deep learning-based reconstruction (three-shot turbo spin-echo with deep learning-based reconstruction [3S-TSE-DLR]), for imaging the pancreas with imaging using three conventional sequences (half-Fourier acquisition single-shot turbo spin-echo [HASTE], fat-suppressed 3D T1-weighted [FS-3D-T1W] imaging, and magnetic resonance cholangiopancreatography [MRCP]).Material and MethodsPancreatic images of 50 healthy volunteers acquired with 3S-TSE-DLR, HASTE, FS-3D-T1W imaging, and MRCP were compared by two diagnostic radiologists. A 5-point scale was used for assessing motion artifacts, pancreatic margin sharpness, and the ability to identify the main pancreatic duct (MPD) on 3S-TSE-DLR, HASTE, and FS-3D-T1W imaging, respectively. The ability to identify MPD via MRCP was also evaluated.ResultsArtifact scores (the higher the score, the fewer the artifacts) were significantly higher for 3S-TSE-DLR than for HASTE, and significantly lower for 3S-TSE-DLR than for FS-3D-T1W imaging, for both radiologists. Sharpness scores were significantly higher for 3S-TSE-DLR than for HASTE and FS-3D-T1W imaging, for both radiologists. The rate of identification of MPD was significantly higher for 3S-TSE-DLR than for FS-3D-T1W imaging, for both radiologists, and significantly higher for 3S-TSE-DLR than for HASTE for one radiologist. The rate of identification of MPD was not significantly different between 3S-TSE-DLR and MRCP.Conclusion3S-TSE-DLR provides better image sharpness than conventional sequences, can identify MPD equally as well or better than HASTE, and shows identification performance comparable to that of MRCP.

BackgroundRadiofrequency ablation (RFA) is a first-line therapy for early-stage, single, small (≤3 cm) hepatocellular carcinoma (HCC) tumors; however, adequate control of subcapsular HCC by RFA remains challenging due to the higher risk of major complications and local tumor recurrence than non-subcapsular HCC.PurposeTo compare safety and efficacy of conventional transarterial chemoembolization (cTACE) and RFA as treatments for single, small (≤3 cm) HCC with a subcapsular location.Material and MethodsBetween 2008 and 2017, 717 treatment-naïve patients who underwent cTACE (n = 362) or RFA (n = 355) as a first-line treatment for single, small (≤3 cm), subcapsular HCC were enrolled. Propensity score analysis using inverse probability weighting (IPW) was applied to reduce the effect of potential confounding factors.ResultsThe median follow-up time was 87 months. After propensity score analysis using IPW, the 15-year overall survival rates in the cTACE and RFA groups were 47% and 45%, respectively (P = 0.89). The 15-year time to local tumor recurrence rates were 55% and 71%, respectively (P <0.001), and the 15-year time to recurrence rates were 29% and 30%, respectively (P = 0.18). The rates of major complication associated with cTACE and RFA after IPW were 1% and 4%, respectively (P = 0.01).ConclusioncTACE is a viable alternative to RFA for treating subcapsular HCCs measuring ≤3 cm, with a comparable overall survival rate and fewer major complications.

BackgroundIntensity-modulated radiotherapy targeting areas of active bone marrow effectively reduces hematological toxicity; consequently, it is important to determine whether the bone marrow is active.PurposeTo explore diffusion-weighted imaging (DWI) signal as a potential tool for assessing bone marrow function in middle-aged and elderly patients with rectal cancer.Material and MethodsA retrospective study investigated clinical and magnetic resonance imaging (MRI) data from middle-aged and elderly patients with rectal cancer. Pelvic bone marrow DWI signals (b = 800 s/mm²) were classified as high and iso-low signal groups. Factors influencing the DWI signal were analyzed individually in a multifactorial analysis. Subsequently, a comparison was made of the intravoxel incoherent motion (IVIM) parameters between the high and iso-low signal groups.ResultsThe study involved 73 patients, with 32 in the high-signal and 41 in the iso-low-signal groups. The multifactorial analysis showed that anemia (odds ratio [OR] = 5.264; P = 0.025) and proton density fat fraction (PDFF) (OR = 0.872; P <0.001) were independent factors influencing the DWI signal. In addition, the high-signal group demonstrated significantly lower values of the standard apparent diffusion coefficient (ADC) (median = 0.466 ×10^-3 mm²/s, interquartile range = 0.413-0.550 vs. 0.534 ×10^-3 mm²/s, interquartile range = 0.495-0.594; P <0.01) and the mean diffusion coefficient (D) (0.423 ± 0.065 vs. 0.482 ± 0.090, × 10^-3 mm²/s; P <0.01).ConclusionThe evaluation of pelvic bone marrow function through DWI signals is feasible in middle-aged and elderly patients with rectal cancer. A high DWI signal in the pelvic bone marrow correlates with post-anemic cellular proliferation, indicating active hematopoiesis.

BackgroundAutomatic exposure control (AEC) devices are necessary to reduce the radiation dose and enhance image quality in radiography. However, AEC devices are not being used in portable X-ray systems due to technical issues.PurposeTo evaluate the radiation dose and image quality of a new AEC for a wireless portable X-ray system compared to the standard fixed radiation dose of manual controls in chest radiography.Material and MethodsThis retrospective analysis evaluated the performance of a portable X-ray system equipped with software-based AEC on anteroposterior chest radiographs. A quantitative evaluation comparing the manual and AEC groups was conducted to ascertain the exposure index (EI) and dose-area product (DAP). We performed observer-based analysis of image quality for lowest exposure and average exposure images in the manual and AEC groups.ResultsOverall, 2093 examinations were conducted in 467 patients. AEC yielded a statistically significant reduction in the DAP (AEC: 1.64 dGycm²; manual: 1.99 dGycm²) and EI (AEC: 266; manual: 393) compared to manual control (P <0.001). Evaluation of the average and low exposure images revealed that the DAP and EI were consistently lower in the AEC group (P <0.01). Observer-based analysis of the lowest exposure images revealed that AEC yielded a statistically significant higher score compared to manual control (12.5 manual, 13.4 AEC; P <0.001).ConclusionAEC within a wireless portable X-ray system improves subjective image quality while reducing radiation exposure, as substantiated by quantitative and qualitative metrics.

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.

BackgroundMagnetic resonance imaging (MRI) scores have been validated for monitoring Crohn's disease (CD) but are not widely used in clinical practice.PurposeTo evaluate treatment response in patients with active CD using simple imaging markers compared to complex multifactorial scores.Material and MethodsThis was a post-hoc analysis of MRI-enterocolonographies performed in a prospective, blinded, multicenter study. Patients with endoscopically active CD completed ileocolonoscopy and MRI with intravenous contrast and diffusion-weighted sequences before and after medical treatment. Response was defined as ≥50% reduction of the Simple Endoscopic Score for Crohn's Disease. Changes in bowel wall thickness (BWT) and apparent diffusion coefficient (ADC) were compared to the magnetic resonance index of activity (MaRIA), simplified MaRIA, and Clermont score.ResultsA total of 42 patients entered the analysis, and endoscopic response was achieved in 19 (45.2%). All activity scores improved in patients with endoscopic response compared to non-responders (P <0.05). The relative reduction of BWT for the most severely affected bowel segment (area under the curve [AUC]=0.76, 95% confidence interval [CI]=0.61-0.91) trended towards a higher diagnostic accuracy compared to the global MaRIA score (AUC=0.63, 95% CI=0.45-0.81; P = 0.1). The per-segment response was more accurately evaluated with BWT compared to the segmental MaRIA score (AUC=0.82 and 0.67, respectively; P = 0.05). A 17% decrease in BWT resulted in an optimal sensitivity and specificity of 78.9% (95% CI=54.4-93.9) and 85.2% (95% CI=66.3-95.8), respectively.ConclusionBWT is not inferior to MaRIA when determining treatment response in CD. This measure is simple to perform and does not require intravenous contrast.

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.

BackgroundVoiding cystourethrography (VCUG) remains the best method to diagnose and to determine vesicoureteral reflux (VUR) grade.PurposeTo determine necessity and indications of VCUG and to investigate high-grade VUR predictors.Material and MethodsWe retrospectively reviewed data. The patients were sorted into three age groups: 0-12 months; 13-24 months; and above 24 months. Student t-test, Mann-Whitney U test, ANOVA, and Kruskal Wallis test were used to compare the means between groups. Pearson's correlation test was used for correlation analysis. Risk factors were determined by multivariate regression analysis.ResultsThe most common indication for VCUG was recurrent urinary tract infections (UTIs). VCUG revealed VUR in 96 (18.4%) patients, posterior urethral valve (PUV) in 13 (2.5%) patients, and bladder anomalies in 14 (2.6%) patients. Neither sex nor age was statistically significantly associated with presence or grades of VUR. Multivariate analysis showed that a history of recurrent UTI (P = 0.008), a presence of high-grade hydronephrosis (HN) on renal-bladder ultrasound (RBUS) (P = 0.001), and a presence of scarring on dimercaptosuccinic acid renal cortical scintigraphy (DMSA) (P < 0.001) were strongly associated with high-grade VUR. In addition, female sex, renal dysfunction, high-grade VUR, history of recurrent UTIs, and older age at diagnosis were identified as risk factors for renal scarring.ConclusionWe highlight that the most common indication for VCUG is recurrent UTIs, which is associated with higher renal damage and high-grade VUR. If a VCUG should be considered for children with recurrent UTIs, high-grade HN and renal scaring, which are the predictors of high-grade VUR.