Acta radiologica最新文献

Background: The fatty infiltration and atrophy in the muscle after a rotator cuff (RC) tear are important in surgical decision-making and are linked to poor clinical outcomes after rotator cuff repair. An accurate and reliable quantitative method should be developed to assess the entire RC muscles.

Purpose: To develop a fully automated approach based on a deep neural network to segment RC muscles from clinical magnetic resonance imaging (MRI) scans.

Material and methods: In total, 94 shoulder MRI scans (mean age = 62.3 years) were utilized for the training and internal validation datasets, while an additional 20 MRI scans (mean age = 62.6 years) were collected from another institution for external validation. An orthopedic surgeon and a radiologist manually segmented muscles and bones as reference masks. Segmentation performance was evaluated using the Dice score, sensitivities, precision, and percent difference in muscle volume (%). In addition, the segmentation performance was assessed based on sex, age, and the presence of a RC tendon tear.

Results: The average Dice score, sensitivities, precision, and percentage difference in muscle volume of the developed algorithm were 0.920, 0.933, 0.912, and 4.58%, respectively, in external validation. There was no difference in the prediction of shoulder muscles, with the exception of teres minor, where significant prediction errors were observed (0.831, 0.854, 0.835, and 10.88%, respectively). The segmentation performance of the algorithm was generally unaffected by age, sex, and the presence of RC tears.

Conclusion: We developed a fully automated deep neural network for RC muscle and bone segmentation with excellent performance from clinical MRI scans.

Background: The optimal primary debulking surgery outcome of serous ovarian carcinoma (SOC) is greatly affected by primary ovarian neoplasm or metastatic lesion close to the rectum.

Purpose: To study the risk factors affecting postoperative residual primary ovarian neoplasm or metastatic lesion close to the rectum of SOC.

Material and methods: The clinical and MRI data of 164 patients with SOC eligible from institution A (training and test groups) and 36 patients with SOC eligible from institution B (external validation group) were collected and retrospectively analyzed. The clinical data included age, serum carbohydrate antigen 125 (CA-125), human epididymis protein 4, and neutrophil-to-lymphocyte ratio (NLR). Magnetic resonance imaging (MRI) data included ovarian mass distribution, maximum diameter of ovarian mass, ovarian mass features, degree of rectal invasion of the primary ovarian neoplasm or metastatic lesion, and amount of ascites. A model was established using multivariate logistic regression.

Results: By univariate and multivariate logistic regressions, CA-125 (P = 0.024, odds ratio [OR] = 3.798, 95% confidence interval [CI] = 1.24-13.32), NLR (P = 0.037, OR = 3.543, 95% CI = 1.13-12.72), and degree of rectal invasion of the primary ovarian neoplasm or metastatic lesion (P < 0.001, OR = 37.723, 95% CI = 7.46-266.88) were screened as independent predictors. The area under the curve values of the model in the training, test, and external validation groups were 0.860, 0.764, and 0.778, respectively.

Conclusion: The clinical-radiological model based on T1-weighted dual-echo MRI can be used non-invasively to predict postoperative residual ovarian neoplasm or metastasis close to SOC in the rectum.

Pseudolesions in bone and muscle are encountered mostly incidentally in routine imaging studies, especially due to the recent advancements on many different imaging modalities. These lesions can be categorized into the following categories: normal variants; congenital; iatrogenic; degenerative; and postoperative. In this review, we discuss the many different radiological characteristics of musculoskeletal pseudolesions that appear on imaging, which can prevent non-essential additional studies.

Background: Football (soccer) is the world's most popular team sport.

Purpose: To comprehensively examine the brain in football (soccer) players, with the use of magnetic resonance imaging (MRI) techniques.

Material and methods: The study involved 65 football players and 62 controls. The MR examinations were performed using MR 1.5-T system (Optima MR 360; GE Medical Systems). The examinations were carried out in the 3D Bravo, CUBE, FSEpropeller, and diffusion-weighted imaging (DWI) sequences. The 1HMRS signal was obtained from the volume of interest in the frontal and occipital lobes on both sides.

Results: The present study, based on structural MRI, shows some changes in the brains of the group of football players. The findings show asymmetry of the ventricular system in four football players, arachnoid cysts in the parieto-occipital region, and pineal cysts. NAA/Cr concentration in the right frontal lobe was lower in the football players than in the controls, and the Glx/Cr concentration in the right occipital lobe was higher. The apparent diffusion coefficient value is lower in football players in the occipital lobes.

Conclusion: Playing football can cause measurable changes in the brain, known to occur in patients diagnosed with traumatic brain injury. The present findings fill the gap in the literature by contributing evidence showing that playing football may lead to changes in the brain, without clinical symptoms of concussion.

Background: The diagnostic impact of deep learning computed tomography (CT) reconstruction on intracranial aneurysm (IA) remains unclear.

Purpose: To quantify the image quality and diagnostic confidence on IA in craniocervical CT angiography (CTA) reconstructed with DEep Learning Trained Algorithm (DELTA) compared to the routine hybrid iterative reconstruction (HIR).

Material and methods: A total of 60 patients who underwent craniocervical CTA and were diagnosed with IA were retrospectively enrolled. Images were reconstructed with DELTA and HIR, where the image quality was first compared in noise, signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR). Next, two radiologists independently graded the noise appearance, arterial sharpness, small vessel visibility, conspicuity of calcifications that may present in arteries, and overall image quality, each with a 5-point Likert scale. The diagnostic confidence on IAs of various sizes was also graded.

Results: Significantly lower noise and higher SNR and CNR were found on DELTA than on HIR images (all P < 0.05). All five subjective metrics were scored higher by both readers on the DELTA images (all P < 0.05), with good to excellent inter-observer agreement (κ = 0.77-0.93). DELTA images were rated with higher diagnostic confidence on IAs compared to HIR (P < 0.001), particularly for those with size ≤3 mm, which were scored 4.5 ± 0.6 versus 3.4 ± 0.8 and 4.4 ± 0.7 versus 3.5 ± 0.8 by two readers, respectively.

Conclusion: The DELTA shows potential for improving the image quality and the associated confidence in diagnosing IA that may be worth consideration for routine craniocervical CTA applications.

Background: Streak artifacts induced by irregular arm positioning have been an issue in diagnosing the abdomen.

Purpose: To illustrate the risk of misdiagnosis in abdominal computed tomography (CT) of patients with irregular arm positioning through a case-by-case evaluation and to test if it can be solved by the artificial intelligence iterative reconstruction (AIIR) algorithm.

Material and methods: By reviewing 5220 cases of chest and thoracoabdominal CT, 64 patients with irregular arm positioning were enrolled, whose image data were reconstructed using AIIR in addition to routine hybrid iterative reconstruction (HIR). Lesion detection for livers, spleens, kidneys, gallbladders, and pancreas on AIIR images, performed by two radiologists, was compared with those on HIR images. Discrepancies arising from AIIR images included both cases with additional abnormalities and those with corrections made on previous detections. For cases with discrepancies, artifact scores for organs where discrepancies were found, and contrast-to-noise ratios (CNRs) of cysts with discrepancies were compared between two image sets.

Results: Additional abnormalities were detected for 15 cases: additional liver cirrhosis (n=2); additional gallbladder stone (n=1); additional cholecystitis (n=1), additional spleen nodule (n=1); additional kidney cysts (n=8); additional liver cysts (3); and additional spleen cyst (n=1). A spleen contusion was corrected for one case. All involved artifact scores were improved on AIIR images. CNRs of involved liver, kidney, and spleen cysts were improved by up to 539.7%, 538.5%, and 245.5%, respectively.

Conclusion: Irregular arm positioning may induce a variety of misdiagnoses in abdominal CT, which is almost totally avoidable by the AIIR algorithm.

Background: There are no guidelines in the literature for the use of a computed tomography (CT) protocol in the initial phase of acute pancreatitis (AP).

Purpose: To evaluate the contribution of single portal venous phase CT compared to triple-phase CT protocol, performed in the initial phase of AP for severity assessment.

Material and methods: In this retrospective study, a total of 175 patients with acute pancreatitis who underwent initial triple-phase CT protocol (non-contrast, arterial phase, and portal venous phase) between D3 and D7 after the onset of symptoms were included. Analysis of AP severity and complications was independently assessed by two readers using three validated CT severity scores (CTSI, mCTSI, EPIC). All scores were applied to the triple-phase CT protocol and compared to the single portal venous phase. Inter-observer analyses were also performed.

Results: No significant difference whatever the severity score was observed after analysis of the single portal venous phase compared with the triple-phase CT protocol (interstitial edematous pancreatitis: CTSI: 2 vs. 2, mCTSI: 2 vs. 2, EPIC: 1 vs. 1; necrotizing pancreatitis: CTSI: 6 vs. 6, mCTSI: 8 vs. 8, EPIC: 5 vs. 5). Inter-observer agreement was excellent (ICC = 0.96-0.99), whatever the severity score.

Conclusion: A triple-phase CT protocol performed at the initial phase of AP was no better than a single portal venous for assessing the severity of complications and could lead to a 63% reduction in irradiation.

Background: Studies report that Lisfranc injury is more common than thought. Several imaging methods for assessing the stability of Lisfranc injury have been described but many are impossible to standardize and not accurate enough.

Purpose: To present a three-dimensional (3D) method for analyzing the changes in the joint space width of the midfoot joint and the joints of the medial part of the Lisfranc complex in healthy individuals.

Material and methods: Non-weightbearing and weightbearing cone-beam computed tomography (CBCT) images of 11 healthy feet were acquired and analyzed with 3D software. The mean range of joint space width changes of each joint was computed from the changes in individual image pairs.

Results: 3D analysis software was used to analyze the medial part of the Lisfranc complex. In this sample of healthy feet, the changes in the joint spaces in the medial part of Lisfranc complex, calculated with 3D analysis software, was less than 0.6 mm. The distance between bones increased or decreased, depending on which part of the joint surface the measurements were taken.

Conclusion: In this study, we present a 3D analysis method to evaluate midfoot joint space width changes. Our analysis revealed that in healthy feet there are only minimal changes in the joint space width between weightbearing and non-weightbearing indicating minimal movement of the midtarsal joints. The 3D analysis of weightbearing CBCT data provides a promising tool for analyzing the small midfoot joints in a variety of conditions.

Background: The goals of neuroimaging in idiopathic intracranial hypertension (IIH) are the exclusion of mimickers and effective management of disease. In recent studies, several imaging markers have been identified as potential predictors of IIH.

Purpose: To investigate the predictive roles of novel radiological markers as the Meckel's cave area, alongside classical radiologic markers in identifying IIH such as the empty sella.

Material and methods: The patients were classified according to cerebrospinal fluid (CSF) opening pressure as the IIH group and control group. The observational, case-control study included 22 patients with IIH and 22 controls. Groups were compared for presence of empty sella, Meckel's cave area, fat area of posterior neck, fat thickness of scalp, presence of transverse sinus stenosis, and ophthalmic markers, such as increase of optic nerve (ON) sheath diameter.

Results: In the IHH group, higher occurrences of increased ON sheath diameter, ON tortuosity, flattening of the scleral surface, and transverse sinus stenosis were observed (P < 0.001, P < 0.001, P = 0.046, and P = 0.021, respectively). Meckel's cave area and fat area of posterior neck were similar in both groups (P = 0.444 and P = 0.794).

Conclusion: Ophthalmic markers and transverse sinus stenosis could be utilized as radiologic features supporting early and precise diagnosis of IIH. However, enlargement of Meckel's cave area and measurements of fatty area of posterior neck are not helpful for diagnosis of IIH.

Background: Dual-layer spectral-detector computed tomography (DLCT) may have the potential to evaluate gastric wall thickening.

Purpose: To evaluate the efficacy of DLCT quantitative parameters in differentiating between benign and malignant thickening of the gastric wall.

Material and methods: A total of 58 patients with "gastric wall thickening" who underwent multi-phase abdominal enhanced DLCT scans were included in this study. Of these patients, 33 were malignant and 25 were benign. Parameters such as iodine concentration (IC), effective atomic number (Zeff), and attenuation of the lesions were measured during the arterial phase (AP) and venous phase (VP). Binary logistic regression was employed to calculate the combined prediction probabilities. The accuracy of the DLCT parameters was assessed using receiver operating characteristic (ROC) curves.

Results: The values of IC, nIC, Zeff, normalized Zeff, and attenuation in the AP and VP were significantly higher (all P < 0.05) in the malignant group compared to the benign group. The ROC curves revealed that the IC, Zeff, and attenuation in the VP exhibited high diagnostic performance, with area under the ROC curve (AUC) values of 0.864, 0.862, and 0.840, respectively. The new combination of these three factors and gastric wall thickness had an AUC of 0.884, and the sensitivity and specificity were determined to be 81.8% and 92.0%, respectively.

Conclusion: Spectral CT parameters, particularly the combination of gastric wall thickness, attenuation, IC, and Zeff in VP, have value in distinguishing between benign and malignant gastric wall thickening.