Acta radiologica最新文献

Background: AngioJet rheolytic thrombectomy is associated with a higher risk of acute kidney injury due to its potential for inducing mechanical harm and intravascular hemolysis. However, previous studies have focused on a single disease entity.

Purpose: To identify predictors associated with acute kidney injury after AngioJet rheolytic thrombectomy across a range of disease entities.

Material and methods: A total of 95 patients who underwent AngioJet rheolytic thrombectomy between October 2018 and April 2023 were retrospectively reviewed. In total, 11 patients were excluded due to the absence of a postprocedural serum creatinine test within 72 h; finally, 84 patients were included. Acute kidney injury was defined as a ≥1.5-fold increase or ≥0.3 mg/dL rise in serum creatinine within 72 h after the procedure. Univariate and multivariate analysis were performed to identify risk factors for acute kidney injury.

Results: Technical and clinical success were achieved in all patients (84/84, 100%). Of the 84 patients (40 men [47.6%], 44 women [52.4%]; mean age = 67.2 ± 15.9 years), 15 (17.8%) had developed acute kidney injury. Multivariate analysis showed concurrent malignancy (odds ratio [OR] = 42.231, 95% confidence interval [CI] = 2.332-764.693; P = 0.011) and AngioJet rheolytic thrombectomy in arterial system (OR = 24.109, 95% CI = 1.319-440.551; P = 0.032) as statistically significant predictors of acute kidney injury.

Conclusions: AngioJet rheolytic thrombectomy is a potential risk for acute kidney injury. Concurrent malignancy and AngioJet rheolytic thrombectomy in the arterial system are independent predictors of acute kidney injury.

Background: Giving contrast material before ¹H-magnetic resonance spectroscopy (MRS) could enhance the precision of locating the lesion of interest. However, evidence indicates that contrast material might influence the outcomes of MRS.

Purpose: To verify the effect of gadolinium-based contrast agent (GBCA) on MRS in normal white matter.

Material and methods: A total of 34 patients were referred for brain magnetic resonance imaging (MRI) with GBCAs, and they underwent single-volume MRS before and after administering contrast material. Those patients had the MRS voxel placed at the right frontal normal white matter, which remained consistent across all examinations. Measurements were taken for the integral concerning N-acetyl aspartate (NAA), choline (Cho), creatine (Cr and Cr2), and myo-inositol (Ins) in all examinations.

Results: NAA (P = 0.0313) and Cho (P = 0.0094) had a significant decrease in their integral after intravenous GBCA administration. No significant differences were found between the pre- and post-contrast MRS studies for Cr, Cr2, and Ins.

Conclusion: Intravenous GBCA can alter NAA and Cho integrals in normal white matter. Therefore, brain ¹H-MRS should precede intravenous GBCA administration to avoid the potential impact of contrast material on peak integrals.

Background: Radiomics and deep learning (DL) can individually and efficiently identify the pathological type of brain metastases (BMs).

Purpose: To investigate the feasibility of utilizing multi-parametric MRI-based deep transfer learning radiomics (DTLR) for the classification of lung adenocarcinoma (LUAD) and non-LUAD BMs.

Material and methods: A retrospective analysis was performed on 342 patients with 1389 BMs. These instances were randomly assigned to a training set of 273 (1179 BMs) and a testing set of 69 (210 BMs) in an 8:2 ratio. Eight machine learning algorithms were employed to construct the radiomics models. A DL model was developed using four pre-trained convolutional neural networks (CNNs). The DTLR model was formulated by integrating the optimal performing radiomics model and the DL model using a classification probability averaging approach. The area under the curve (AUC), calibration curve, and decision curve analysis (DCA) were utilized to assess the performance and clinical utility of the models.

Results: The AUC for the optimal radiomics and DL model in the testing set were 0.824 (95% confidence interval [CI]= 0.726-0.923) and 0.775 (95% CI=0.666-0.884), respectively. The DTLR model demonstrated superior discriminatory power, achieving an AUC of 0.880 (95% CI=0.803-0.957). In addition, the DTLR model exhibited good consistency between actual and predicted probabilities based on the calibration curve and DCA analysis, indicating its significant clinical value.

Conclusion: Our study's DTLR model demonstrated high diagnostic accuracy in distinguishing LUAD from non-LUAD BMs. This method shows potential for the non-invasive identification of the histological subtype of BMs.

Background: In this prospective study, we evaluated whether a sufficient number of glomeruli were achieved using the 8× magnification of smartphone cameras.

Purpose: To increase the percutaneous ultrasound-guided renal biopsy (PURB) diagnostic value with a method that has not been tried before and reduce the need for repetition of the procedure.

Material and methods: A total of 39 adult patients who underwent PURB were included in our study. After the PURB was applied to the patients, the biopsy specimen was placed on the previously prepared sterile gauze. At this stage, 8× magnification photos were taken of the biopsy samples using the smartphone camera. The glomeruli in the photograph were counted and recorded and compared with the number of glomeruli seen at the end of the histopathological examination.

Results: The mean number of glomeruli in the evaluated samples was counted as 6 ± 2.2 (range = 1-10) in the 8× magnification photograph. The mean number of glomeruli detected in the histopathological examination of these samples was 11 ± 5.7 (range = 2-30). A pathological glomeruli count of 10 was associated with more than five brown spots in the 8× magnification photograph (area under the curve = 0.977, P=0.0001).

Conclusion: To obtain more than 10 glomeruli in a PURB specimen, five or more brownish-red dots should be counted on the 8x magnification photograph. Using smartphones as an alternative tool for evaluating renal biopsy tissue adequacy can be practical and advantageous in terms of time and labor.

Background: Pelvic floor dysfunction (PVD), a prevalent clinical issue impacting quality of life, can be effectively assessed using magnetic resonance defecography (MRD) with the patient either supine or in the lateral decubitus position.

Purpose: To compare the measurement value and grading in dynamic MRD within the closed-magnet system of PFD patients performed in supine versus lateral decubitus position using the H line, M line, and organ prolapse (HMO) classification system.

Material and methods: During 2017-2019, 100 patients with PFD underwent MRD during defecation in both supine and lateral decubitus positions. MR images were measured and graded by two blinded radiologists. The mean value of each HMO parameter and grading severity were compared between supine and lateral positions. Image quality (IQ) between two positions was also evaluated. Paired t-test and Wilcoxon ranked test were performed for significant difference. P < 0.05 was considered statistically significant.

Results: For HMO measurement, M-line, levator plate angle (LPA), urethral hypermobility (UH), uterine prolapse, and peritoneocele had significantly higher mean values when measured in the lateral decubitus position than in the supine position. For grading, M-line, uterine prolapse, and peritoneocele also had more grading severity in the lateral decubitus than supine position with statistical significance (P = 0.002, 0.004, and 0.001, respectively). Only anterior rectocele had a mean value and grading severity in the supine more than the lateral position (P = 0.003 and P = 0.005). IQ in the supine was better than in the lateral decubitus position (P < 0.001).

Conclusion: MRD in lateral decubitus showed a more severe degree of PFD in most parameters based on the HMO grading system irrespective of inferior imaging quality.

Background: The Alberta Stroke Program Early Computed Tomography Score (ASPECTS) is a semi-quantitative tool for evaluating the extent and distribution of early ischemic changes.

Purpose: To assess the value of ASPECTS on non-contrast CT (NCCT), arterial-phase CT (APCT), or venous-phase CT (VPCT) in predicting the final infarct core (IC) on follow-up diffusion-weighted imaging (DWI) and the clinical outcomes of patients with acute ischemic stroke (AIS) after endovascular thrombectomy (EVT).

Material and methods: In total, 120 patients with AIS who underwent EVT in our center were retrospectively enrolled. Correlations between CT-ASPECTS and follow-up DWI-ASPECTS were analyzed using Spearman's rank correlation coefficient. Mean differences and limit of agreement (LoA) between CT-ASPECTS and follow-up DWI-ASPECTS were assessed using the Bland-Altman plots. Multivariate logistic regression and receiver operating characteristic curve analyses were used to identify independent factors and evaluate their performances in predicting the clinical outcomes.

Results: VPCT-ASPECTS exhibited the highest correlation with follow-up DWI-ASPECTS (r = 0.846, P < 0.001), followed by APCT-ASPECTS (r = 0.613, P < 0.001) and NCCT-ASPECTS (r = 0.557, P < 0.001). The mean difference between VPCT-ASPECTS and follow-up DWI-ASPECTS was 0.0 (limit of agreement = -2.1 to 2.1). National Institute of Health Stroke Scale (NIHSS) scores at admission (NIHSS_pre) (odds ratio [OR]=1.162, 95% confidence interval [CI]=1.063-1.270; P = 0.001) and VPCT-ASPECTS (OR=0.728, 95% CI=0.535-0.991; P = 0.044) were the independent factors associated with clinical outcomes. The combined model integrating NIHSS_pre and VPCT-ASPECTS exhibited an excellent performance in predicting good clinical outcomes (area under curve [AUC]=0.807; sensitivity=75.0%; specificity=72.3%).

Conclusion: VPCT-ASPECTS may be a promising imaging biomarker to predict the final IC and the clinical outcome of the patients with AIS after EVT.

Background: The etiology of medial-sided talar osteochondral lesions (OCLs) remains insufficiently understood.

Purpose: To identify anatomical risk factors contributing to the development of unilateral or bilateral OCL of the talus on the medial side, utilizing morphological parameters derived from magnetic resonance imaging (MRI).

Material and methods: In this retrospective study, 24 ankle MRI scans from 12 patients exhibiting bilateral OCLs of the talar dome on the medial side, 24 ankle MRIs from 24 patients with unilateral medial-sided OCLs, and 24 healthy controls matched for age, sex, and side within each group were analyzed. Six distinct MRI parameters were measured: the anterior opening angle of the talus (AOT); tibial axis-medial malleolus angle (TMM); plafond-malleolar angle (PMA); anterior talofibular ligament-posterior talofibular ligament (ATFL-PTFL) angle; the ratio of the distal tibial articular surface to the length of the trochlea tali arc (TAS/TAL); and the depth of the incisura fibularis (IncDep).

Results: The AOT, ATFL-PTFL angle, and TMM of individuals in both the bilateral and unilateral groups were significantly higher when compared to the healthy controls. In addition, TMM measurements in the unilateral group were significantly higher than in the bilateral group.

Conclusion: AOT and TMM appeared to be the primary predisposing factors in the development of both unilateral and bilateral OCLs. Furthermore, TMM shows a greater increase in unilateral OCL cases compared to bilateral OCL cases. The fact that TMM is not significantly high in known unilateral OCL cases can be a stimulus for investigating the other ankle for OCL.

Background: May-Thurner syndrome (MTS) is a continuous pathological change of the left common iliac vein intraluminal wall due to compression between the right common iliac artery and a lumbar vertebra, with clinical signs of compromised venous drainage of the left leg, which eventually leads to development of left-sided deep vein thrombosis (DVT).

Purpose: To analyze the correlation between iliac vessel geometry and probability of DVT in patients with MTS.

Material and methods: This study consists of two age-matched female groups: DVT (n = 21) and control (n = 28). Iliac vein geometry, including left common iliac vein (LCIV) diameter, percentage of stenosis, angle between LCIV and right common iliac vein (RCIV), tilt angle of each CIV with horizontal line, and crossing angle between right common iliac artery (RCIA) and LCIV, were measured on computed tomography venography (CTV) images. The probability of DVT development was assessed using logistic regression.

Results: Comparing the DVT and control groups, the mean LCIV diameter was 2.4 mm and 3.7 mm (P = 0.001), and mean LCIV stenosis was 77.7% and 68.3% (P = 0.001), respectively. After age-adjustment, the odds of left DVT in patients with MTS correlated with LCIV diameter (odds ratio [OR]=0.25, P < 0.001, 95% confidence interval [CI]=0.11-0.54), LCIV stenosis (%) (OR=1.12, P = 0.003, 95% CI=1.04-1.21), LCIV tilt angle (OR=0.95, P < 0.038, 95% CI=0.91-0.99), and angle between two CIVs (OR=1.04, P < 0.039, 95% CI=1.00-1.09).

Conclusion: LCIV diameter and percentage of stenosis, LCIV tilt angle, and CIV angle were independent risk factors for the development of DVT in patients with MTS.

Background: Lymphovascular space invasion (LVSI) is a strong and independent risk factor that increases the probability of endometrial carcinoma (EC) recurrence and reduces the survival rate of patients.

Purpose: To investigate the value of amide proton transfer weighted (APTw) and mDixon-Quant techniques in evaluating EC lymphovascular space invasion (LVSI).

Material and methods: Data of 50 EC patients (18 LVSI+ and 32 LVSI-) confirmed by surgery and pathology were retrospectively analyzed. Preoperative magnetic resonance imaging (MRI) scans included APTw and mDixon-Quant imaging. APT, transverse relaxation rate (R2*), and fat fraction (FF) plots were obtained by postprocessing. The APT, R2*, and FF values of the two groups of cases were measured by two observers.

Results: The agreement between the two observers was good. The mean APT, R2*, and FF values of LVSI+ EC were 2.947% ± 0.399%, 20.605 /s (range = 18.525-27.953), and 2.234% ± 1.047%, respectively, while the parameters of LVSI- EC were 2.628% ± 0.307%, 18.968 /s (range = 16.225-20.544), and 2.103% ± 1.070%, respectively. The APT and R2* values of LVSI+ EC were higher than those of LVSI- EC (P < 0.05). There was no significant difference in FF value between the two groups. The AUC values of APT, R2*, and APT + R2* for LVSI were 0.751, 0.713, and 0.781, respectively (all P > 0.05). APT value was moderately correlated with R2* value (r = 0.528, P < 0.001) and weakly correlated with FF value (r = 0.312, P = 0.027).

Conclusion: APTw and mDixon-Quant techniques could evaluate the LVSI status of EC, and their combined application could improve diagnostic efficiency.

Background: Meniscal ramp lesions are a special type of meniscal injury that affects the periphery of the posterior horn of the medial meniscus and/or its meniscocapsular attachments, strongly associated with anterior cruciate ligament (ACL) tears. Due to their location, these lesions can be missed arthroscopically so it is essential to diagnose them on preoperative magnetic resonance imaging (MRI).

Purpose: To evaluate the accuracy of MRI in detecting meniscal ramp lesions in patients with ACL tears using arthroscopy as the reference standard.

Material and methods: Two musculoskeletal radiologists, blinded to the surgical findings, retrospectively and independently evaluated 106 knee MRI scans for the presence of meniscal ramp lesions in non-consecutive patients who underwent arthroscopic ACL reconstruction between January 2019 and July 2022 by a single surgeon at one institution. Having arthroscopy as reference, the diagnostic sensitivity and specificity as well as the positive and negative predictive values (PPV/NPV) of the MRI scans were calculated. Cohen's kappa coefficient was used to test inter-observer reliability. A P value <0.05 was considered statistically significant.

Results: In the study group of 106 patients (72 men, 34 women; mean age = 33.84 ±13.12 years), 76 had an arthroscopy-confirmed meniscal ramp lesion, while 30 did not. The sensitivity and specificity of MRI for the detection of meniscal ramp lesion were 88% and 87%, respectively. The PPV and NPV were 94% and 74%, respectively. Inter-rater reliability was excellent (k = 0915).

Conclusion: This study demonstrates that MRI can accurately detect meniscal ramp lesions.