Acta radiologica最新文献

BackgroundCardiac magnetic resonance (CMR) is challenging in patients implanted with metallic devices, such as pacemakers or defibrillators, given metallic susceptibility artifacts. The technique of T1-mapping investigates interstitial fibrosis. The most used method for myocardial T1-mapping is the modified Look-Locker Inversion recovery sequence (MOLLI) using balanced steady-state free precession (SSFP). However, SSFP is susceptible to off-resonance artifacts, leading to errors. Gradient echo (GRE) sequences are less prone to these artifacts.PurposeTo investigate whether T1-mapping using GRE was comparable to SSFP in this population.Material and MethodsPre/post-contrast T1-mapping was performed on 16 devices utilizing MOLLI with SSFP and GRE strategies at 1.5 T, as well as 10 non-device controls. The difference in mean T1 time by SSFP versus GRE (both pre- and post-contrast for each slice) for device patients was analyzed.ResultsNative T1 for the device cohort was 1053 ± 94 ms for SSFP and 969 ± 83 ms for GRE. GRE T1 measurements were shorter than SSFP measurements (difference over all slices for SSFP vs. GRE pre-/post-contrast were 74 ms and 27 ms). Mean λ for GRE (devices) was 0.520 ± 0.194 (p = 0.30). λ for SSFP (devices) was 0.536 ± 0.124 (P = 0.08). There was no difference in λ between SSFP versus GRE in device patients (P = 0.91). The percentage of segments identified as artifact on T1 maps for device patients was 24% and 45% for GRE and SSFP, respectively.ConclusionCompared to SSFP, T1 values using GRE were consistently shorter, while λ values remained equivalent. There was less visual artifact on GRE images, suggesting advantageous utility over SSFP in patients with cardiac devices.

BackgroundThe multiparametric magnetic resonance imaging (mpMRI)-based Prostate Imaging for Recurrence Reporting (PI-RR) system has been proposed to evaluate local recurrence in patients with prostate cancer (PCa) who have been treated with radiation therapy (RT) or radical prostatectomy (RP).PurposeTo evaluate the diagnostic performance and interreader agreement of the PI-RR system in the diagnosis of locally recurrent PCa remains.Material and MethodsA total of 110 patients who have biochemically recurrent PCa after RT (n = 35) or RP (n = 75) were included in this retrospective study. All patients underwent mpMRI, PSMA-PET/CT, and biopsy. Four radiologists with varying levels of expertise independently assessed the local recurrence of PCa using PI-RR. The reference standard was the biopsy pathology. The receiver operating characteristic (ROC) curve was used to evaluate the performance of PI-RR and PSMA-PET/CT, and areas under the ROC curve (AUC) were calculated. Interreader agreement across four readers was evaluated using the intraclass correlation coefficient (ICC).ResultsAmong 110 patients with biochemically recurrent PCa, 28 had local recurrence and 82 had no local recurrence. Using a cutoff of 4, the AUCs of PI-RR in the diagnosis of local recurrence were in the range of 0.61-0.84 in patients treated with RT and 0.71-0.89 in patients treated with RP. The ICC was 0.86 (95% confidence interval = 0.81-0.91).ConclusionPI-RR using a cutoff of 4 has a favorable diagnostic performance and interreader agreement, which might be alternatively used for detecting local recurrence in patients with biochemically recurrent PCa treated with RT or RP.

BackgroundSAPHO syndrome can involve the spine, along with vertebral fractures (VFs), and demonstrates osteoporosis and sarcopenia. However, the relationship between musculoskeletal factors with VFs in SAPHO patients is unclear.PurposeTo quantify bone and muscle loss in SAPHO syndrome and identify the factors associated with VFs.Material and MethodsThe study included 35 patients and 70 age- and sex-matched controls. The bone mineral density (BMD) of the lumbar spine (LS), femoral neck (FN), total hip (TH), the age- and sex-specific T- and Z-scores, and trabecular bone score (TBS) were evaluated using dual-energy X-ray absorptiometry (DXA). Cross-sectional muscle area (CSMA), skeletal muscle radio-attenuation (SMRA), skeletal muscle index (SMI), and skeletal muscle gauge (SMG) were assessed at the T8, T10, and T12 levels based on chest CT scans. The related factors of VFs were analyzed through univariable and multivariable analyses. The diagnostic accuracy of the related factors in VFs was based on receiver operator characteristic (ROC) curves.ResultsCompared to controls, LS-BMD, FN-BMD, TH-BMD, corresponding T- and Z-scores, and TBS were significantly reduced in women, whereas LS-BMD, T- and Z-scores were significantly increased in men. CSMA, SMI, and SMG at the T8, T10, and T12 levels were significantly reduced in women. LS-BMD and SMG-T12 were independently associated with VFs, and their combination showed the highest diagnostic efficacy for VFs.ConclusionFemale SAPHO patients exhibited notable bone and muscle loss, along with bone microstructure damage. LS-BMD and SMG-T12 hold the potential to offer valuable insights for the management of VFs risk in SAPHO patients.

BackgroundLacunar infarction accounts for almost 25% of ischemic strokes.PurposeTo evaluate the effectiveness of computed tomography perfusion (CTP) in identifying acute lacunar infarction (ALI) by comparing its performance with non-contrast CT (NCCT) and CT angiography (CTA), and to study the potential influence of various imaging characteristics on detection accuracy.Material and MethodsA total of 309 patients who underwent baseline CT and follow-up diffusion-weighted imaging due to lacunar symptoms were enrolled. The detection performance of NCCT, CTA, CTP, and various CTP-derived parametric maps for identifying ALI was calculated and compared. In addition, the study examined and compared the performance of CTP across different subgroups, categorized based on infarction location, infarction size, and degree of white matter hyperintensity.ResultsALI was identified in 184 patients. CTP demonstrated significantly higher sensitivity (44.6%) in detecting ALI compared to NCCT (8.2%) and CTA (12.0%) (both P < 0.001). Among the four CTP-derived parametric maps, sensitivity ranged from 2.2% (cerebral blood volume [CBV]) to 41.8% (mean transit time [MTT]). In subgroup analyses, CTP showed higher sensitivity for detecting cortical lesions (60.0%) compared to posterior lesions (41.0%) (P = 0.061) and subcortical lesions (39.8%) (P = 0.035). CTP showed slightly higher sensitivity in detecting ALI with a larger infarct size (>10.6 mm) and in cases with mild-to-moderate WMH. However, these differences were not statistically significant (>10.6 mm vs. ≤10.6 mm, 45.2% vs. 44.0%, P = 0.870; mild-to-moderate vs. severe WMH: 45.3% vs. 41.2%, P = 0.660).ConclusionIn this retrospective study, we found that CTP outperformed NCCT and CTA in detecting ALI. CTP demonstrated higher sensitivity for detecting ALI compared to posterior and subcortical lesions.

BackgroundThe morphology of radial sigmoid notch varies widely among individuals. It remains unclear whether variations in sigmoid notch morphology influence cartilage degeneration in this region. T1rho and T2 mapping, which are useful magnetic resonance imaging (MRI) methods to assess early cartilage degeneration, may help us evaluate the relationship between the morphology and cartilage degeneration of sigmoid notch.PurposeTo investigate the relationship between cartilage degeneration of radial sigmoid notch and its morphology.Material and MethodsWe investigated the dominant wrists of 40 healthy volunteers (mean age = 34.1 years) using 3-T MRI. We measured the inclination, depth, and width of the sigmoid notch on an axial multi-echo gradient-echo, and the ulnar head diameter on coronal T2-weighted images. T1rho and T2 values of the volar, central, and dorsal cartilages of the sigmoid notch were measured on coronal T1rho and T2 mapping. We evaluated the relationships of T1rho or T2 values of the three regions with age and morphological measurements using Pearson's correlation analysis and multiple linear regression analysis.ResultsThe T2 value of the dorsal sigmoid notch positively correlated with age and width of the sigmoid notch. Multiple linear regression analysis showed that older age and wider sigmoid notch significantly increased the dorsal T2 value.ConclusionA wider sigmoid notch and aging may induce cartilage degeneration in the dorsal sigmoid notch. This association can help future studies about distal radioulnar joint diseases.

BackgroundTesticular torsion (TT) is a scrotal emergency that needs urgent detection for successful treatment.PurposeTo investigate the diagnostic value of acute ultrasound and the possibility of more effective detection.Material and MethodsThis retrospective study included patients assessed with ultrasound for suspicion of TT between 2019 and 2023. Registration of parameters included symptoms, durations, ultrasound conclusions, and surgical outcome. Ultrasound assessment included inspection of the spermatic cord and testicular color Doppler signal. Sensitivity and specificity were presented with 95% confidence intervals (CIs) and symptoms with odds ratios (ORs).ResultsA total of 387 patients were included. Surgical exploration (SE) was carried out in 40 patients. TT was surgically confirmed in 23 patients. No missed cases of TT were detected. Spermatic cord rotation ≥180° showed a sensitivity of 100% (95% CI=86-100), specificity of 65% (95% CI=41-83), positive predictive value (PPV) of 79%, and negative predictive value (NPV) of 100%. Absent or reduced testicular color Doppler signal showed a sensitivity of 57% (95% CI=37-74), specificity of 77% (95% CI=53-90), PPV of 76%, and NPV of 57%. Sudden onset of pain (OR=9.44, 95% CI=2.10-42.35), earlier similar episodes (OR=6.71, 95% CI=2.27-19.89), and abdominal pain (OR=14.70, 95% CI=3.25-66.51) showed significant association with TT.ConclusionUltrasound, with focus on the spermatic cord, is reliable as a tool for the detection of TT. SE might be justified when cord rotation is ≥180°. These results can be used to develop and validate ultrasound guidelines for fast detection.

BackgroundAccurate differentiation between early and advanced Brucella spondylitis is crucial for effective treatment.PurposeTo develop a magnetic resonance imaging (MRI)-based radiomics nomogram model for distinguishing between early and advanced stages of Brucella spondylitis.Material and MethodsWe conducted a retrospective analysis of clinical and imaging data from 100 patients with early Brucella spondylitis and 100 patients with advanced Brucella spondylitis. Regions of interest were marked on sagittal T2-weighted fat-suppressed lumbar MRI scans. Radiomic features were extracted and used to build a radiomics model. The significance of these features was evaluated using the Shapley Additive Explanations (SHAP) method. Intravoxel incoherent motion (IVIM) quantitative parameters were also included as clinical features, with key parameters selected to create a clinical model. A nomogram model was developed by combining clinical and radiomic features. The performance of the three models was compared and validated using receiver operating characteristic curves, calibration curves, and decision curves.ResultsEight radiomic features were selected. The clinical feature's D-value showed significant differences between the training and test sets. The nomogram model integrating both clinical and radiomic features achieved an AUC of 0.998 in the training set and 0.992 in the test set, surpassing the performance of both the clinical and radiomic models alone. Calibration and decision curves confirmed the model's strong predictive performance.ConclusionThis study shows that the MRI-based radiomics nomogram model effectively differentiates between early and advanced Brucella spondylitis, offering clinicians a valuable tool for personalized treatment across different disease stages.

BackgroundAnterior cruciate ligament (ACL) reconstruction is a common surgical procedure; however, the anatomical features influencing graft maturation post-surgery remain partially understood.PurposeTo investigate whether knee-joint anatomical structure is associated with graft maturation 2 years after ACL reconstruction (ACLR).Material and MethodsData from 54 patients who underwent arthroscopic single bundle ACLR using hamstring tendons was analyzed after a 2-year follow-up in this retrospective study. The signal-to-noise quotient (SNQ) of the intra-articular graft was measured using magnetic resonance imaging. The median SNQ was used to divide patients into a high-signal group (group A) and a low-signal group (group B). Data on patient demographics, knee anatomy, and tunnel placement were collected.ResultsSignificant differences in the graft sagittal obliquity (45 vs. 52, P = 0.001), tibial tunnel placement (29.9 ± 2.15 vs. 34.71 ± 1.72, P = 0.028), lateral tibial posterior slope (LTPS) (12 vs. 8, P < 0.001) were observed between groups A and B after ACLR (t-test or Mann-Whitney U test, P < 0.05). Univariate analysis showed that graft sagittal obliquity (odds ratio, (OR) [95% (confidence interval, CI)]: 0.88 [0.78, 0.97]) and tibial tunnel placement (OR [95% CI]: 0.78 [0.60, 0.96]) were protective factors, whereas LTPS was a risk factor for ligamentization (OR [95% CI]: 1.63 [1.22, 2.38]). No significant difference was found in sex, injury-to-operation time, or location (P > 0.05).ConclusionAnatomic features and tibial tunnel placement may influence the ligamentization process of the ACL graft, aiding clinicians in the early prediction of healing outcomes after ACLR.

BackgroundComputed tomography (CT) scans account for 60% of the total radiation dose in medical imaging. Literature has shown that patient dose varies across CT scanners, diagnostic protocols, and technical parameters at each site, suggesting an opportunity for starting an optimization process through establishing diagnostic reference levels (DRLs).PurposeTo establish local DRLs (LDRLs) for six Norwegian private diagnostic institutes for frequently performed CT protocols.Material and MethodsDose data from 900 patients were collected from six diagnostic facilities. Data were recorded from non-contrast CT scans of the head and contrast-enhanced scans of the thorax and abdomen and pelvis from average-sized adult patients. An ANOVA test was performed to determine the variation in dose between scanners. LDRLs were determined by the 75th percentile of median values from dose indicators of CT scanners.ResultsThe difference between the means of the dose distribution from each scanner was statistically significant (P < 0,05) for all examinations. The LDRLs determined were lower, for both national and international DRLs.ConclusionObserved dose variations from the scanners indicate a need for protocol optimization for some institutes, while the LDRLs demonstrate a potential for establishing newer national diagnostic reference levels (NDRLs) in Norway.

BackgroundThe left piriform cortex and amygdala (PC&A) is an early target for deterioration due to aging and Alzheimer's disease (AD) in several neuropathological and magnetic resonance (MR) volumetric studies. We observed slight hyperintensity of the left PC&A in older adults and probable AD (pAD) patients on T2-weighted fluid-attenuated inversion recovery (T2W-FLAIR) images.PurposeTo quantitatively assess the validity of the left PC&A hyperintensity in older adults and pAD patients.Material and MethodsT2W-FLAIR images from three groups were retrospectively evaluated: (i) younger control (YC; n = 77): individuals aged 37.9 ± 8.4 years; (ii) older control (OC; n = 98): individuals aged 76.9 ± 5.3 years without cognitive impairment; and (iii) pAD (n = 35): individuals aged 80.5 ± 6.9 years with pAD. Signal intensity (SI) ratios of the left to right PC&A (L-PC&A/R-PC&A) were calculated for all groups. In the OC and pAD groups, SI ratios of the left PC&A to pons (L-PC&A/P) and the right PC&A to pons (R-PC&A/P) were calculated. The regions of interest were defined as large as possible on transaxial images in which the PC&As were most broadly depicted.ResultsThe mean L-PC&A/R-PC&A in the YC, OC, and pAD groups showed an increasing trend in that sequence (P < 0.001). The mean L-PC&A/P was higher in the pAD group than in the OC group (P < 0.001). However, the mean R-PC&A/P was not significantly different between the OC and pAD groups (P = 0.245).ConclusionThe SI of the left PC&A on T2W-FLAIR images significantly increased with age and in individuals with pAD, likely reflecting the deterioration of the left PC&A.