Acta radiologica最新文献

Background: Rapid and accurate measurement of computed tomography (CT) image noise, signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR) is a clinical challenge.

Purpose: To explore the feasibility of intelligent measurement of chest CT image noise, SNR, and CNR.

Material and methods: A total of 300 chest CT scans were included in the study, which was divided into research dataset, internal test dataset, and external test dataset. Based on the research dataset, automatically segment and measure the average CT values and standard deviation (SD) of CT values for background air and lung field under different thresholds to obtain noise, SNR, and CNR results. Using the results of manual measurements as the reference standard, we determine the optimal threshold with the highest consistency. Using internal and external test datasets, validate the consistency of automated measurements of noise, SNR, and CNR at the optimal CT threshold with reference standards.

Results: With background air set at -900 HU and lung field at -800 HU as thresholds, the automated measurements of noise, SNR, and CNR demonstrate the highest consistency with the reference standards. At the optimal threshold, the noise, SNR, and CNR measured automatically on both the internal (intraclass correlation coefficient [ICC] = 0.85-0.96) and external (ICC = 0.75-0.85) test datasets exhibit high consistency with their respective reference standards.

Conclusion: The method we explored can intelligently measure the noise, SNR, and CNR of chest CT images, exhibits high consistency with radiologists, and offers a novel tool for image quality evaluation and analysis.

Background: Acute pulmonary embolism (PE) is a disease with a serious prognosis and a high probability of death in the emergency department.

Purpose: To investigate the prediction of PE-related mortality and intensive care admission (ICU) of Qanadli (Qscore), Bova, and simplified Pulmonary Embolism Severity Index (sPESI) scores.

Material and methods: This retrospective observational study consisted of all patients diagnosed with acute PE who were imaged under computed tomography pulmonary angiography (CTPA) for a total of 5 years between 1 June 2018 and 1 June 2023. The prediction of radiological and clinical scores for mortality and ICU admission was examined.

Results: A total of 95 patients were analyzed. Patients who died and those who were admitted to the ICU had a significantly higher frequency of being found to have a high-risk (≥1) sPESI score (P = 0.04 and P = 0.016, respectively). For mortality, the sPESI score was found to be significant; the sensitivity and specificity were observed as 54% and 66% (area under the curve [AUC]=0.670, 95% confidence interval [CI]=0.527-0.814; P = 0.020). For ICU admission, the sensitivity and specificity of the Qscore, sPESI, and Bova scores were 35%, 77%, and 58%, and 78%, 65%, and 84% respectively (AUC=0.626, 95% CI=0.511-0.740, P = 0.031; AUC=0.769, 95% CI=0.674-0.865, P < 0.001; and AUC=0.767, 95% CI=0.671-0.862, P < 0.001, respectively).

Conclusion: It was found that the sPESI score was effective at predicting mortality in patients with acute PE. Qscore, sPESI, and Bova scores have been shown to be useful in predicting ICU admission.

Background: The reliability and diagnostic accuracy of commonly used diagnostic imaging modalities in the classification of lumbosacral transitional vertebrae (LSTV) are poorly known, and comparative studies are scarce.

Purpose: To compare the diagnostic performance of conventional radiography (CR), computed tomography (CT), and magnetic resonance imaging (MRI) in classifying LSTVs.

Material and methods: In this retrospective cross-sectional study, a total of 852 patients undergoing lumbar imaging studies using all three modalities were initially assessed for the presence of LSTV using CT scans. In total, 100 patients with LSTV anatomy were identified. Four readers performed blinded and independent evaluations of these 100 patients on each modality, and an experienced fellowship-trained radiologist performed a gold standard read using all three modalities. Inter-reader reliability metrics were analyzed in comparison to the gold standard. Statistical software R (4.2.1) was used for the analyses.

Results: We found superior diagnostic efficacy for CT: the sensitivity, specificity, accuracy, and balanced accuracy were 76%, 93%, 77%, and 84%, respectively. For MRI, the metrics were 54%, 88%, 56%, and 68%, and for CR 32%, 85%, 42%, and 59%, respectively. Inter-reader reliability was found to be good for CT (κ = 0.63-0.71) and fair for both CR (κ = 0.16-0.32) and MRI (κ = 0.24-0.56).

Conclusion: CT had the highest diagnostic performance in all measured metrics with good inter-reader reliability. MRI and CR showed fairly poor sensitivity and accuracy, and thus consideration should be used when classifying LSTVs with these two modalities.

Background: Radiofrequency ablation (RFA) of subphrenic hepatocellular carcinomas (HCCs) using ultrasound (US) guidance presents a challenge.

Purpose: To evaluate local tumor progression (LTP) and overall survival (OS) after RFA of right posterior subphrenic HCCs, and to identify the risk factors for LTP and OS after RFA.

Material and methods: We screened patients who underwent US-guided RFA for a single HCC <3 cm in the right posterior subphrenic area. Cumulative rates of LTP and OS were compared between multiple- and single-electrode treatments and artificial pleural effusion versus no-effusion groups using Kaplan-Meier curves and the log-rank test. The risk factors for LTP and OS were assessed.

Results: A total of 36 patients were included. The cumulative 5-year and 10-year LTP rates were 32.9% and 39.6%, respectively, and the corresponding OS rates were 72.2% and 48.7%, respectively. The multiple-electrode group had significantly lower cumulative LTP rates compared to the single-electrode group (P < 0.001). The group receiving artificial pleural effusion showed a trend towards lower LTP rates than the no-effusion group (P = 0.076). The albumin-bilirubin (ALBI) grade was the only risk factor for LTP (hazard ratio [HR] = 4.17, 95% confidence interval [CI] = 1.26-14.55; P = 0.020). A lower albumin level was a risk factor for mortality (HR = 0.24, 95% CI = 0.07-0.79; P = 0.020).

Conclusion: US-guided RFA with multiple electrodes and artificial pleural effusion tends to be linked with lower LTP rates. The ALBI grade and serum albumin level are risk factors for LTP and OS, respectively.

Background: This study utilized quantitative susceptibility mapping (QSM) to evaluate magnetic susceptibility of brain nuclei in Parkinson's disease (PD).

Purpose: To explore iron deposition patterns in PD and ascertain if these patterns can distinguish between motor subtypes.

Material and methods: This study enrolled 30 healthy controls and 34 patients with PD categorized mainly into postural instability and gait disorder (PIGD) (n = 12) and tremor dominance (TD) (n = 16). A total of 18 regions of interest were delineated, and a comprehensive classification of nuclei was conducted, including the differentiation of globus pallidus (GP) into its external (GPe) and internal (GPi) segments. All participants underwent brain magnetic resonance imaging.

Results: Notable differences in magnetic susceptibility were identified in bilateral substantia nigra pars reticulate (SNr) and substantia nigra pars compacta (SNc) between PD and HC. Significant differences in QSM values of bilateral GPe, SNr, and SNc-R were found between TD and PIGD. The susceptibility values of bilateral putamen (PUT) were positively correlated with MDS-UPDRSIII score and Hoehn-Yahr scale in PD. QSM values of bilateral PUT and SNc-L showed associations with MDS-UPDRSIII score in TD. QSM values showed associations with MDS-UPDRSIII in bilateral PUT and Hoehn-Yahr scale in PUT-L and TH-L in PIGD.

Conclusion: Pathologic iron deposition exhibits variability across nuclei of PD, with age also influencing this distribution. SN may be meaningful in identifying different subtypes of PD, such as differentiating PD from HC in the future.

Background: Individually tailored contrast medium (CM) may improve vascular image quality in chest computed tomography (CT).

Purpose: To evaluate vascular attenuation in chest CT by comparing CM dose calculations using lean body mass (LBM) and body surface area (BSA) with a fixed-dose protocol.

Material and methods: Patients referred for contrast-enhanced chest CT were categorized as either normal, muscular, or overweight. Patients were accordingly randomized into three CM dosing protocols: fixed-dose group (n = 87), LBM group (n = 92), and BSA group (n = 93).

Results: Of the patients, 94% in the fixed-dose group, 99% in the LBM group, and 98% in the BSA group achieved optimal vascular attenuation. In the overweight category, lower attenuation was demonstrated in the fixed-dose group compared to the LBM group (P = 0.032) and the BSA group (P = 0.010). In the fixed-dose group, vascular attenuation showed a negative correlation with total body weight for all body composition categories. In the LBM group, a positive correlation was observed between attenuation and total body weight in the muscular category (P = 0.041), while a negative correlation was noted for the overweight category in the BSA group (P = 0.049).

Conclusion: Fixed-dose CM protocol exhibited larger variations in vascular attenuation between patients of various body weights and body compositions compared to tailored CM doses based on LBM and BSA.

Background: The association of Mini-Mental State Examination (MMSE) with microstructure of individual regions across the entire brain remains unexplored.

Purpose: To investigate the relationship between cognitive function and the microstructure of each brain region in the gray matter using diffusion kurtosis imaging (DKI) in older adults with mild cognitive impairment (MCI), which is the transitional stage before the onset of dementia.

Material and methods: DKI and MMSE were obtained for 34 older adults with MCI and 16 cognitively normal (CN) individuals aged 65-85 years. The DKI parameters were measured from 31 distinct regions of interest in the gray matter. A multiple regression analysis was used to examine the association between DKI parameters and MMSE scores; subsequently, interactions between the DKI parameters and the groups (MCI and CN) were examined.

Results: The mean (±SD) MMSE score for the MCI group was 27.67 ± 1.90. Significant positive correlations were observed between MMSE score and mean kurtosis (MK) in the superior frontal, middle frontal, inferior frontal, precentral, postcentral, angular, middle temporal, and inferior occipital gyri, and superior parietal lobe for the MCI group. In addition, the interaction term of the MK in the middle frontal, precentral, postcentral, and angular gyri, and the groups was statistically significant.

Conclusion: Older adults with MCI may exhibit histological damage in certain regions of the brain, such as the middle frontal and angular gyri, as observed in this study. The findings could provide insights into understanding the pathophysiology of cognitive decline in this population group.

Background: Intravoxel incoherent motion diffusion-weighted imaging (IVIM-DWI), which indicates biological tissue attributes, may be applied to accurately assess breast tumors.

Purpose: To analyze the IVIM parameters of different molecular prognostic factors and subtypes to find out whether there are any connections.

Material and methods: A total of 181 patients enrolled in this retrospective study had preoperative magnetic resonance imaging (MRI) examinations, and pathologies were verified as breast cancers. Regions of interest were placed at all slices of the parameter maps (D, tissue diffusivity; ADC, apparent diffusion coefficient; f, perfusion fraction; and D*, pseudo-diffusivity maps) of IVIM and generated parameter values to be used for comparative analysis among molecular prognostic factors and subtypes.

Results: D and ADC were greater in estrogen receptor (ER)-negative, human epidermal growth factor receptor 2 (HER2)-positive, and Ki67-low expression groups (all P values < 0.05). The progesterone receptor (PR)-negative group had a higher D value (P < 0.05). f was larger in the lymph node metastasis-negative group and the PR-positive group (P = 0.012 and 0.046, respectively). Among breast cancer subtypes, D and ADC were different between the HER2-overexpression and the Luminal B (HER2-negative) subtypes (P = 0.019 and 0.028, respectively). The difference in D between the luminal and non-luminal subtypes was statistically significant (P = 0.008). The triple-negative subtype significantly differs from the other subtypes in D* and f (P = 0.012 and 0.016, respectively).

Conclusion: IVIM-related metrics exhibited relationships with breast cancer molecular prognosis factors and subtypes.

Background: The depth of myometrial invasion determines whether International Federation of Gynecology and Obstetrics stage I endometrioid endometrial carcinoma (EEC) patients undergo lymph node dissection. However, subjective evaluation results relying on magnetic resonance imaging (MRI) are not always satisfactory.

Purpose: To develop a nomogram based on whole-volume tumor MRI histogram parameters to preoperatively predict deep myometrial invasion (DMI) in patients with stage I EEC.

Material and methods: This retrospective analysis included 131 EEC patients and a training/validation cohort of 92/39 patients at a 7:3 ratio. The histogram parameters were obtained from multiple sequences (ADC mapping and T2-weighted imaging) within volumes of interest. Univariate analysis, least absolute shrinkage and selection operator (LASSO) regression, and multivariate logistic regression were used for feature selection. The performance of clinical model, histogram model, and histogram nomogram was evaluated by calculating the area under the receiver operating characteristic curve (AUC).

Results: Age and two morphological features (maximum anteroposterior tumor diameter on sagittal T2-weighted images [APsag] and the tumor area ratio [TAR]) were selected to construct the clinical model. Five histogram parameters were selected for the creation of the histogram model. The nomogram, which combines the histogram parameters, age, APsag, and TAR, achieved the highest AUCs in both the training and validation cohorts (nomogram vs. histogram vs. clinical model: 0.973 vs. 0.871 vs. 0.934 [training] and 0.972 vs. 0.870 vs. 0.928 [validation]).

Conclusion: The MR histogram nomogram can help predict the DMI of patients with stage I EEC preoperatively, assisting physicians in the development of personalized treatment strategies.

Background: Percutaneous ultrasound-guided thrombin injection has become the gold standard treatment for pseudoaneurysms caused by cardiac catheterization. However, failure can occur in up to 25% of the procedures and little is known about its causes.

Purpose: To study the efficacy and safety of the technique and to determine possible risk factors responsible for the unsuccess.

Material and methods: A cohort study was carried out based on data from medical records collected between December 2012 and June 2020 of 110 patients with the diagnosis of pseudoaneurysm, femoral or radial, secondary to cardiac catheterization. Clinical data, pseudoaneurysm morphological parameters, and technical factors related to catheterization were reviewed.

Results: Primary and global technical success rates were 85.5% and 100%, respectively. Age, neck, and anteroposterior diameter variables were predictors of primary failure on multivariate analysis. The odds ratio (OR) for age was 0.960 (95% confidence interval [CI]=0.927-0.995; P = 0.025), for anteroposterior diameter, OR was 2.023 (95% CI=1.144-3.578; P = 0.015), and for neck diameter, it was 4.625 (95% CI=1.023-20.904; P = 0.047). The receiver operating characteristic (ROC) curve was performed for the multivariate analysis model and the three predictors of failure. The area under the curve for the multivariate analysis model was 0.695, for age it was 0.675, for anteroposterior diameter it was 0.679, and for neck diameter it was 0.676. No complications were observed.

Conclusions: Percutaneous ultrasound-guided thrombin injection is safe and effective for the treatment of pseudoaneurysms after cardiac catheterization. Largest anteroposterior diameter, largest neck diameter, and a younger age were independent predictors of primary failure with the technique.