Acta radiologica最新文献

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.

BackgroundThe fifth edition of the World Health Organization (WHO) CNS Tumors (CNS5) introduced a molecular framework for glioma classification, emphasizing the IDH gene and MGMT methylation status.PurposeTo evaluate the effectiveness of dynamic susceptibility contrast perfusion-weighted imaging (DSC-PWI), diffusion-weighted imaging (DWI), and multi-voxel magnetic resonance spectroscopy (MRS) in distinguishing histological glioblastomas (GBMhis) and molecular glioblastomas (GBMmol) from adult diffuse gliomas, while also differentiating oligodendrogliomas (ODGs) and assessing the impact of MGMT methylation.Material and MethodsWe conducted a retrospective analysis of 141 adult diffuse glioma patients. Imaging techniques included DSC-PWI, DWI, and MRS, analyzed for their ability to differentiate GBMhis, GBMmol, and ODGs from adult diffuse gliomas. Pathological and molecular data, including IDH, 1p19q, and MGMT status, were collected to correlate imaging findings with prognostic outcomes.ResultsDSC-PWI and DWI effectively distinguished GBMhis from diffuse gliomas. DWI-ADC was the only technique capable of identifying ODGs. Although MGMT methylation positively impacted prognosis, it was not directly reflected in imaging parameters. Significant differences in progression-free survival and overall survival were observed between groupings.ConclusionThis study suggests that DSC-PWI and DWI can help differentiate glioma types, while multi-voxel MRS shows limited sensitivity.

BackgroundGadobutrol is a macrocyclic gadolinium-based contrast agent (GBCA) with higher relaxivity than other GBCAs, suggesting the potential for dose reduction without compromising image quality.PurposeTo evaluate whether a 30% reduced dose of gadobutrol is as effective as the standard dose of gadoterate for lesion visualization and enhancement in diabetic foot osteomyelitis.MethodsThis study included 132 patients with preoperative contrast-enhanced foot MRIs prior to amputation surgery for diabetic foot osteomyelitis from November 2020 to January 2023. Sixty-six enhanced foot MRIs with reduced dose gadobutrol (0.07 mmol/kg) and 66 MRIs with standard dose gadoterate (0.1 mmol/kg) were reviewed by two radiologists. For the primary study objective, two parameters (lesion border visualization and subjective lesion enhancement) for qualitative lesion visualization were assessed between the two agents using a noninferiority analysis. In the quantitative assessment of lesion enhancement, lesion-to-background ratio and enhancement percentage were compared between the two agents.ResultsThe mean scores for lesion border delineation and the visual degree of contrast enhancement were nearly identical between the two groups. For both readers, the lower limit of the 95% confidence interval (CI) for the difference did not drop below -0.35, which is above the noninferiority margin. Regarding quantitative analysis, no significant differences were observed in the enhancement percentage and lesion-to-background ratio between the two agents (p > 0.5).ConclusionA 30% reduced dose of gadobutrol (0.07 mmol/kg) is as effective as the standard gadoterate dose (0.1 mmol/kg) for lesion visualization in contrast-enhanced MRI of diabetic foot osteomyelitis, with similar enhancement efficacy.

BackgroundContrast-enhanced mammography (CEM) is a promising and emerging digital mammography technique that improves diagnostic performance.PurposeTo quantitatively evaluate breast lesions on CEM and to investigate the effectiveness of CEM in differentiating benign lesions from malignancies. The secondary aim was to evaluate the effectiveness in lesion characterization of quantitative parameters derived from CEM, specifically relative signal density (RSD) and relative signal change (RSC).Material and MethodsA retrospective analysis was conducted of 170 lesions in 164 female patients who underwent CEM. Lesions were grouped as benign, non-infiltrating, and infiltrating cancer. RSD between lesion and background, including fatty and glandular tissue, was measured. RSCs between former (CC) and latter (MLO) images were calculated and contrast enhancement patterns were obtained. The association between CEM values and pathological results was analyzed.ResultsRelative signal differences on both CC and MLO CEM views showed higher relative signal density in infiltrating tumors than benign ones regardless of whether glandular tissue or fat tissue was used in proportion while different infiltrating malignant subgroups showed no statistical significance according to quantitative analysis (P < 0.001). No significant differences in contrast enhancement patterns (ascending, steady, and descending) were seen either between benign and malignant groups or among malignant subtypes.ConclusionCEM can be used to distinguish between benign and malignant breast lesions, regardless of fat or glandular tissue. However, no difference was observed between benign and malignant lesions according to the contrast-enhancement patterns. Therefore, contrast enhancement patterns in CEM and breast MRI may differ.

BackgroundVarious factors impact the prognosis of the patients with intracerebral hemorrhage (ICH).PurposeTo evaluate the initial magnetic resonance imaging (MRI) indicators of cerebral small vessel disease (CSVD) and evaluate the relationship between the MRI indicators and ICH prognosis.Material and MethodsClinical and imaging data were collected from individuals diagnosed with acute ICH who had undergone MRI within 48 h of symptom onset between October 2021 and March 2022. The 90-day modified Rankin Scale (mRS) scores were analyzed, focusing on identifying those patients with a mRS score ≥3 points, which was consistent with a poor prognosis.ResultsA total of 220 ICH patients were evaluated, with 81 (36.8%) having a poor prognosis at 90 days. The study identified encephalatrophy (P = 0.014, odds ratio [OR] = 2.431, 95% confidence interval [CI] = 1.242-3.768), grade 2 periventricular Fazekas scale (P = 0.021, OR = 2.389, 95% CI = 1.174-2.869), centrum semiovale perivascular space (P = 0.035, OR = 2.296, 95% CI = 1.110-3.798), age (P = 0.002, OR = 1.046, 95% CI = 1.017-1.077), female sex (P = 0.015, OR = 0.463, 95% CI = 0.250-0.859), and admission National Institutes of Health Stroke Scale score (P = 0.003, OR = 1.052, 95% CI = 1.022-1.084) as independent risk factors for poor prognosis of an ICH. The incorporation of MRI findings significantly enhanced the predictive accuracy of the poor prognosis model in comparison to a model lacking MRI findings (AUC = 0.833 vs. 0.815, net reclassification index = 0.186; P = 0.021, integrated discrimination improvement = 0.158; P = 0.016).ConclusionIdentification of initial MRI findings of CSVD, such as white matter hyperintensity, perivascular spaces, cerebral microbleeds, lacunar infarcts, brain atrophy, and leukodystrophy, has the potential to enhance prognostication of patients with ICHs.

BackgroundTotal body cone-beam computed tomography (CBCT) is recently developed for both weight-bearing and non-weight-bearing CT imaging of the spine. Before whole-spine weight-bearing CT is used in clinical practice, potential errors must be addressed, such as the need to stitch multiple volumes due to the field-of-view limitations of CBCT technology.PurposeTo determine the geometric error of fused CBCT images of the spine using automatic stitching software.Material and MethodsIn total, 144 CBCT scans were obtained using three human cadavers. The geometric stitching error was determined in terms of total translation and rotation between vertebrae Th12 and L5, which were positioned in separate image volumes, with a regular spiral CT scan as a reference. The effect of cadaver size, radiation dose, and volume overlap between adjacent CBCT images on the stitching error was determined using Spearman's rank correlation test.ResultsThe median total translation and rotation error were 1.88 mm (interquartile range [IQR] = 1.48-2.42 mm) and 0.54° (IQR = 0.35°-0.63°), respectively. A weak negative correlation between the different volumes of overlap and total translation (r = -0.396; P < 0.001) and rotation (r = -0.319; P < 0.001) was found, as well as a weak positive correlation between the cadaver size and total translation (r = 0.456; P < 0.001).ConclusionThe results of this cadaver study showed stitching errors in the order of 2 mm for translation and 0.5° for rotation in fused CBCT volumes of the spine. These findings function as a relevant step towards the clinical and quantitative application of whole-spine weight-bearing CT imaging.

BackgroundThe prognosis for hepatocellular carcinoma (HCC) is unfavorable, primarily attributable to the high incidence of recurrence.PurposeTo assess the prognostic value of multiparametric magnetic resonance imaging (mp-MRI) based on radiomic features for overall survival (OS) in patients with HCC.Material and MethodsPatients who underwent abdominal mp-MRI examination before hepatectomy in our hospital between January 2016 and December 2019 were retrospectively collected and divided into a training group and a verification group at a ratio of 7:3. The patients' images, clinical parameters, and semantic features were collected. A three-dimensional volume of interest was delineated and radiomics features were screened. Independent predictors of clinical imaging were screened and combined with radiomics features to construct a combinatorial model and draw a nomogram. The predictive efficacy of the model was evaluated.ResultsThe Harrell's C-index values were 0.737 and 0.711 for the clinical imaging model and 0.705 and 0.704 for the full sequence model in the training group and validation group, respectively. The combinatorial model had higher efficiency, and the C-index values in the training group and the validation group were 0.779 and 0.756, respectively. The survival curve showed that the low-risk group defined by the radiomics signature had significantly better OS than the high-risk group (3-year OS: 61.54% vs. 30.77%; P < 0.05).ConclusionThe combined model can predict the OS of patients with HCC non-invasively before surgical resection and can be used as a clinical tool to guide individualized treatment.