Acta radiologica最新文献

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.

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.

BackgroundAccurate preoperative assessment of endometrial cancer (EC) is crucial in young women who may be eligible for fertility-preserving therapy, which is generally limited to patients with grade 1, endometrioid-type tumors without myometrial invasion (MI).PurposeTo evaluate the utility of quantitative parameters derived from intravoxel incoherent motion (IVIM) and diffusion kurtosis imaging (DKI) for improving the diagnostic performance of magnetic resonance imaging (MRI).Material and MethodsThis retrospective study included 107 patients diagnosed with EC (mean age = 59 years; age range = 25-89 years) who underwent preoperative MRI, including multiple b-value (0-2000 s/mm²) diffusion-weighted imaging, between January 2022 and March 2024. Quantitative parameters were extracted from the mono-exponential (ADC), IVIM (Di, D*, f), and DKI (Dk, K) models and compared across clinical and pathological features.ResultsADC, Di, and Dk values were significantly higher in patients without MI (P = 0.015, 0.035, and 0.005, respectively). Di and Dk were significantly higher (P = 0.003 and 0.016), and K was significantly lower (P = 0.013) in the G1 group. Patients eligible for fertility preservation had significantly higher ADC, Di, and Dk values (P = 0.002, 0.002, and 0.001) and significantly lower K values (P = 0.044). The overall diagnostic performance of these parameters was moderate (area under the curve < 0.70).ConclusionIVIM and DKI-derived metrics may enhance preoperative assessment of tumor grade and MI, supporting decisions regarding fertility-preserving treatment.

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.

BackgroundMeningiomas are the most common extra-axial tumors of the central nervous system, and accurate preoperative assessment of their histological grade is essential for effective treatment planning.PurposeTo investigate the relationship between the apparent diffusion coefficient (ADC) sequence, histopathological grade, and Ki-67 proliferation index for radiologically identifying meningiomas with poor prognosis.Material and MethodsThe study included 90 patients with histopathologically confirmed meningioma between March 2019 and February 2021. The Ki-67 proliferation index was assessed using an image analysis program. Retrospectively, ADC maps and diffusion-weighted imaging (DWI) were reviewed. An oval-shaped region of interest was placed over the lesion's solid component and the normal-appearing white matter in the opposite hemisphere. Each patient's ADC ratio (ADC meningioma/ADC normal-appearing white matter) was calculated. The relationship between ADC and Ki-67 proliferation index was investigated, and ADC values of benign and atypical meningiomas were compared. Independent sample t-test, Mann-Whitney U test, and receiver operating characteristic were used for statistical assessment.ResultsThe mean ADC value was 844.11 ± 123.55 mm²/s for low-grade and 743.75 ± 92.64 mm²/s for high-grade meningiomas. The mean ADC ratio was 1.11 ± 0.19 for low-grade and 1.00 ± 0.15 for high-grade meningiomas. Both ADC values and ADC ratio significantly distinguished histopathologic grades (P = 0.003, P = 0.030, respectively). No significant correlation was found between ADC values or ADC ratio and the Ki-67 proliferation index (r = -0.123, P = 0.248; r = 0.033, P = 0.755).ConclusionA statistically significant difference was found between ADC values and ADC ratio of low- and high-grade meningiomas. There was no correlation between either ADC values or ADC ratio and Ki-67 proliferation index.