Acta radiologica最新文献

BackgroundTo study the effects of direct oral anticoagulant (DOAC) treatment in patients with acute pulmonary embolism (PE), it is important to analyze iodine density perfusion maps by dual-layer spectral detector computed tomography (DLCT).PurposeTo investigate whether the total lung iodine value (TLIV) obtained from CT pulmonary angiography (CTPA) using DLCT provides valuable insights for assessing treatment response in acute PE.Material and MethodsWe conducted a retrospective study enrolling individuals receiving DOAC therapy for acute PE. Using DLCT, lung CT imaging before contrast was performed, followed by two contrast phases (when the region of interest in the pulmonary artery exceeded 150 HU [pulmonary arterial phase (PAP)] and 60 s after the start of contrast administration). Changes in TLIV and TLIV/LV were assessed from pre-treatment to post-DOAC treatment in both greater clot resolution group (group 1) and lesser clot resolution group (group 2). In addition, a comparison of the iodine level ratio between PAP and 60 s (60s/PAP ratio) for TLIV and TLIV/LV before and after treatment was performed between the two groups.ResultsIn total, 24 patients with acute PE were analyzed using DLCT before and after DOAC therapy. The TLIV (60s/PAP ratio; median 1.34, interquartile range [IQR]=1.18-1.72) of group 1 (n = 16) was significantly higher (P = 0.002) than the TLIV (60s/PAP ratio; median = 0.91, IQR = 0.79-0.99) of group 2 (n = 8).ConclusionMeasuring the iodine maps of all lungs showed promise as the level of lung perfusion after DOAC treatment appeared to reflect the treatment effect in acute PE.

BackgroundTreatment response assessment can be challenging in bone-metastasizing breast cancer. Whole-body magnetic resonance imaging (WB-MRI) is superior to contrast-enhanced computed tomography (CE-CT) for detecting progressive disease (PD) in bone-only metastatic breast cancer; however, the ability to detect PD in mixed visceral- and bone-metastasizing breast cancer remains to be assessed in prospective studies.PurposeTo prospectively compare WB-MRI and CE-CT for detecting PD in mixed visceral- and bone-metastasizing breast cancer and determine if WB-MRI could detect PD earlier than CE-CT.Material and MethodsA total of 43 women with mixed visceral- and bone-metastasizing breast cancer were prospectively followed with WB-MRI and CE-CT from the initiation of new chemotherapy. Kaplan-Meier analysis of time to progression was performed for both WB-MRI and CE-CT, and the time difference between the two was compared using a one-sample t-test. The ability to detect PD earliest was compared using McNemar's test.ResultsOf the 43 patients enrolled, 21 completed the study. Treatment was changed due to PD in 18 patients and due to side effects in three patients. Median time until change of treatment was 8 months (range=4-21 months). WB-MRI correctly detected PD in 16/18 patients compared to 13/18 for CE-CT. A total of 73 pairs of examinations were analyzed, of which WB-MRI detected PD earliest in 7/18 patients compared to 1/18 for CE-CT (P = 0.035).. There were no statistically significant differences in time to progression between WB-MRI and CE-CT (P = 0.41).ConclusionWB-MRI can detect PD in women with mixed visceral- and bone-metastasizing breast cancer earlier than CE-CT.

BackgroundOptimizing operational protocols in medical imaging is essential to ensure the quality of radiological diagnoses. However, a quantitative method for evaluating the image quality of actual patients and detectability of lesions within these clinical images has not yet been established.PurposeTo quantitatively assess the difficulty in detecting nodules on chest radiographs using a pixel value (PV)-based receiver operating characteristic (ROC) analysis approach.Material and MethodsA chest radiograph database from the Japanese Society of Radiological Technology-containing lung nodule images classified into five levels of detection difficulty-was used for analysis. Multiple regions of interest (ROIs) were defined to encompass both nodules and surrounding anatomical structures. The mean PV and standard deviation values were calculated for each region. Assuming normal PV distributions for both nodules and backgrounds, the PV-based area under the ROC curve (AUC) was computed using a theoretical formula. The method's validity was verified by analyzing correlations with the subtlety classification, which reflects detection difficulty.ResultsAnalysis of 154 nodule images demonstrated a strong correlation with nodule subtlety (r = 0.998), and with observer-derived AUC values (r = 0.955), confirming the effectiveness of the proposed metric.ConclusionThe proposed method enables quantitative evaluation of lesion detectability in clinical images. This novel index may offer valuable clinical feedback for optimizing imaging conditions and can serve as a practical tool for training in diagnostic radiology.

BackgroundPreoperative identification of normal-sized lymph node metastases (LNM) remains clinically significant yet challenging in cervical cancer.PurposeTo investigate the value of super-resolution T2WI-derived intratumoral and peritumoral radiomics for normal-sized LNM prediction in cervical cancer.Material and MethodsA total of 257 patients from three sites of our hospital were divided into a development cohort (site 1, n = 97), a validation cohort (site 1, n = 42), and two internal test cohorts (site 2, n = 62; site 3, n = 56). Super-resolution reconstruction based on generative adversarial network was applied to all images. The volume of interest delineation encompassed primary tumor boundaries with outward expansions (1-5 mm increments) in super-resolution T2-weighted (T2W) imaging. Radiomics features were independently extracted from intratumoral and five peritumoral regions. The clinical, radiomics and combined models were built using multilayer perceptron. Model performance was evaluated through receiver operating characteristic (ROC) analysis and decision curve analysis (DCA).ResultsThe IntraPeri3 mm radiomics model achieved superior discriminative performance compared to other radiomics models. The combined model integrated clinical variables (tumor size and squamous cell carcinoma antigen), intratumoral and peritumoral 3 mm radiomics features yielded optimal performance (AUC = 0.838 in the development cohort, 0.808 in the validation cohort, and 0.769 and 0.766 in the internal test cohorts). DCA confirmed the combined model's enhanced clinical utility across probability thresholds.ConclusionSuper-resolution T2W-based radiomics aids in predicting normal-sized LNM in cervical cancer, especially the combined model incorporating clinical information, intratumoral and peritumoral 3 mm radiomics features demonstrates optimal diagnostic performance.

BackgroundHepatic artery infusion chemotherapy (HAIC) combined with tyrosine kinase inhibitors (TKIs) shows promise for treating advanced hepatocellular carcinoma (HCC).PurposeTo compare the efficacy and safety of HAIC versus transarterial chemoembolization (TACE), each combined with TKIs, in patients with advanced HCC.Material and MethodsThis retrospective study analyzed 86 patients with unresectable HCC, predominantly Barcelona Clinic Liver Cancer (BCLC) stage B/C and with well-preserved liver function, treated at a tertiary medical center between January 2019 and December 2022. Patients were assigned to either the HAIC + TKI group (n = 40) or the TACE + TKI group (n = 46) based on multidisciplinary team recommendations, considering tumor burden, vascular invasion, and patient preference. Overall survival (OS) was evaluated using Kaplan-Meier analysis, and treatment-related adverse events (AEs) were recorded.ResultsThe median OS was 13.7 months in the HAIC group and 8.3 months in the TACE group (hazard ratio = 0.5489, 95% confidence interval = 0.3557-0.8472; P = 0.00661). The most frequent grade 3/4 AEs were elevated ALT (15.0% vs. 39.1%), elevated AST (17.5% vs. 34.8%), and abdominal pain (25.0% vs. 28.3%), with only ALT showing significant between-group difference. All AEs were manageable, with no treatment-related deaths.ConclusionIn a cohort of patients with unresectable HCC, primarily BCLC stage B/C, and preserved liver function, HAIC combined with TKIs offers superior survival and tumor control compared to TACE + TKIs in unresectable HCC, with acceptable safety. Prospective multicenter trials are needed to validate these findings and further optimize treatment strategies.

BackgroundHepatic cystic echinococcosis (CE) is a major health concern, particularly in endemic regions. The modified catheterization technique (MoCaT) offers an effective option for the percutaneous treatment of hepatic CE.PurposeTo evaluate the effectiveness of MoCaT in the percutaneous treatment of all types of hepatic CE in 183 patients.Material and MethodsData from 183 patients who underwent percutaneous treatment using the MoCaT between February 2010 and April 2024 were retrospectively analyzed. Demographic data, cyst types, initial and final cyst volumes, complications, lengths of hospitalization, catheterization, and follow-up periods were documented for each patient.ResultsThis study included 183 patients with 211 hepatic hydatid cysts who were treated percutaneously with MoCaT. Among the 211 cysts, 20 (9.5%) were CE1, 37 (18%) were CE2, 23 (11%) were CE3a, 98 (46%) were CE3b, 16 (7.6%) were CE4, and 2 (0.9%) were CE5. In total, 15 (7%) patients presented with infected cyst cavities. No mortality was seen. A total of 29 (14%) major complications were observed. Recurrence was observed in 6 (3.85%) patients, and residual daughter vesicles remained in 1 (0.64%) patient. The mean follow-up period was 48.35 ± 36.42 months (range = 3-133 months). Mean volume reduction was 92.69%.ConclusionThe MoCaT is an effective, minimally invasive method with low morbidity and recurrence rates. In addition to its reported success in treating CE2 and CE3b cysts, we report that the MoCaT is also safe, reliable, and effective for the treatment of all types of hepatic CE.

BackgroundHigh-resolution magnetic resonance imaging (MRI) is a feasible method for identifying and measuring luminal thrombosis in the occluded middle cerebral artery (MCA) of stroke patients.PurposeTo evaluate the relationship between thrombus length in the middle cerebral artery (MCA) and clinical prognosis in stroke patients using high-resolution MRI (T1-weighted [T1W]-CUBE).Material and MethodsIn this retrospective study, patients with MCA thrombi were identified via high-resolution MRI. Thrombus length was measured using T1W-CUBE sequences, and clinical prognosis was assessed using modified Rankin scale (mRS) scores at a 3-month follow-up. Patients were categorized into good or poor prognosis groups based on mRS scores. Statistical analyses compared thrombus length and diameter between groups. Restricted cubic spline (RCS) analyses were performed to examine the relationship between thrombus length, diameter, and mRS scores. Multiple logistic regression was used to explore the association between thrombus length and prognosis.ResultsThe mean thrombus length was significantly longer in the poor prognosis group compared to the good prognosis group (25.69 ± 8.78 mm vs. 15.11 ± 6.91 mm; P <0.001). Thrombus diameter did not significantly differ between the groups (P = 0.961). RCS showed a monotonically increasing relationship between thrombus length and log OR of mRS. Multiple logistic regression indicated that each additional millimeter of thrombus length increased the risk of poor prognosis by 1.22 times (odds ratio = 1.22, 95% confidence interval = 1.11-1.40; P <0.05).ConclusionMCA thrombus length is a significant predictor of prognosis in stroke patients, with longer thrombi associated with worse clinical outcomes.

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.

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.