Acta radiologica open最新文献

Background: Although plain chest x-rays (CXRs) have become standard examinations in many countries, they vary greatly and are recognized as potentially inappropriate imaging procedures.

Purpose: To enhance the safety, quality, effectiveness, and efficiency of healthcare services, by providing knowledge of the temporal and geographical variations in the use of CXRs.

Materials and methods: Outpatient and inpatient data for CXRs was collected for Norway for the years 2013-2022. Data included patients' age and sex, NCRP code, examination name, modality, hospital/imaging centre, and whether they were in- or outpatients.

Results: On average 648,005 CXRs were performed per year in Norway. This amounts to 123 CXRs per 1000 persons per year (2022). 92% of the examinations were performed at public hospitals, and 39% were outpatient examinations. There was a 17% reduction in CXRs from 2013 to 2022. More male than female patients (54%) got a CXR, especially for the age years 60-79. Geographical variations with a factor of 3.7 and 4.7 were observed for inpatient and outpatient examinations, respectively. The differences between catchment areas decreased from 2013 to 2022.

Conclusions: This is the first study of the number of CXRs from a whole nation for as long as 10 years. It documents substantial geographical variations in number of examinations and a temporal reduction in the total number of examinations. Information of the temporal and geographical variations is crucial for addressing the issue of appropriate imaging and to increase the safety, quality, effectiveness, and efficiency of the healthcare services.

Erdheim-Chester disease (ECD) is a rare non-Langerhans cell histiocytosis. Mixed ECD-Langerhans cell histiocytosis (LCH) is uncommon, with fewer than 200 cases reported. Diagnosis is challenging and relies on clinical, radiological, and histopathological correlation. We present the case of a 61-year-old man with night sweats, weight loss, and recently diagnosed type 2 diabetes. Imaging revealed cystic lung lesions, perirenal infiltration, and circumferential aortic wall thickening. FDG PET-CT demonstrated multifocal hypermetabolism involving lymph nodes, perirenal soft tissues, and the aortic wall, but no bone involvement. These lesions were shown to progress on subsequent imaging. A lymph node and perirenal biopsies confirmed a mixed form of ECD-LCH with BRAFV600 E mutation and associated chronic myelomonocytic leukemia. The patient was started on targeted therapy with cobimetinib, a MEK inhibitor. Mixed ECD-LCH is a rare entity that typically demonstrates more frequent and widespread organ involvement, particularly affecting the lungs. Its clinical and radiological presentation can have features of both disorders, such as bone, lung, kidney, and vascular involvement. The diagnosis is challenging and requires biopsy with histopathology and genetic testing to be confirmed. Treatment is generally targeted therapy guided by the driver mutations that are identified. We present a rare case of mixed ECD-LCH with thoraco-abdominal and pulmonary involvement. Comprehensive diagnostic workup including histopathology and molecular profiling is crucial for accurate diagnosis and initiation of targeted therapy.

Metaplastic breast cancer (MBC) is a rare and heterogeneous malignancy characterized by the presence of both epithelial and mesenchymal elements. Among its variants, MBC with osteoclastic giant cells is extremely uncommon and presents diagnostic challenges because of its diverse histopathological and imaging features. We report the imaging features of a patient with pathologically proven MBC with osteoclastic giant cells as follows: a high-density mass with microcalcification was revealed on mammography; and a microlobulated, mixed cystic and solid mass with posterior acoustic enhancement was revealed on ultrasound. MRI revealed a round mass with circumscribed margins, rim enhancement and high T1-weighted signal intensity due to internal haemorrhage, heterogeneous T2-weighted high-signal intensity and initial fast enhancement and rapid washout kinetics that was classified as BI-RADS 5. Left mastectomy was performed, and the final diagnosis was consistent with that of MBC.

Background: Transjugular intrahepatic portosystemic shunt (TIPS) is effective for portal decompression, but its effect on splenic congestion is not proven. Platelet changes and spleen size following TIPS are controversially reported while the exact volume of the spleen has rarely been investigated.

Purpose: To analyze the effect of TIPS placement on portosystemic gradient (PSG), platelet count (PLT), and exact spleen volume (SV) using contrast-enhanced computed tomography (CT).

Methods: For study inclusion, successful TIPS placements in adult patients with liver cirrhosis and portal hypertension who received CT within 3 months prior and 12 months after TIPS-placement were reviewed (12/2013-09/2021). Exclusion criteria were additional liver/portal interventions, TIPS-dysfunction, progressive portal/liver vein occlusion and hepatic malperfusion or progressive portosystemic collaterals, and active bleeding on CT. Additionally, patients with splenic/hematological disorders, hemodialysis, and clinical apparent infections/multi-organ-failure/death were excluded. PSG and PLT were recorded. Exact SV were segmented on pre-/post-TIPS-CT. Data were compared before and after TIPS placement. Mean ± standard deviation and significance level (p) were given.

Results: Overall, data of 18 TIPS procedures were available for comparison. PSG reduction following TIPS placement was significant (pre: 18 ± 7 mmHg, post: 5 ± 2 mmHg; p < .001). SV tended to decrease (pre: 832 ± 412 cm³, post: 772 ± 345 cm³; p = .112) and PLT did not change (pre: 130 ± 64Tsd/µL, post: 116 ± 61Tsd/µL; p = .160).

Conclusion: When exact SV is assessed and confounders are excluded using CT, neither a significant SV reduction nor a PLT-increase are detected following TIPS. Patients without PLT increase and SV reduction after TIPS might benefit from additional interventions (e.g., splenic artery embolization).

Background: Bedside insertion of peripherally inserted central venous catheter (PICC) is still needed in the various clinical settings. For this procedure, the accuracy of predicting the PICC catheter length is important, however, only a few methods have been proposed so far.

Purpose: A new formula using pre-procedural chest X ray (pre-CXR) was validated for placing the PICC catheter tip precisely in the actual clinical setting.

Material and methods: The formula predicting the PICC catheter length was formed by the hybrids of the calculated expression in the thorax and the actual measurement of the outer arm. The predicted length in the thorax was based on the half ellipse formed by the three landmarks on the pre-CXR. Prospectively, this formula was applied in the 110 patients. The results were compared to those in the traditional anthropometrical measurements (TAM) in the 48 patients.

Results: The discrepancy of the catheter distance from the carina and the variance of the tip position were smaller by using the Formula than by the TAM (P = .00053 and P = .038). Comparing to the other patient's valuables, the Formula had the strongest correlation coefficient with the true PICC length (r = 0.787). Evaluation of validation success showed that the tip position was "optimal" in 79 cases (71.8%) and "suboptimal" in 26 cases (23.6%) in the clinical setting. There were no venous thromboses or catheter occlusions during the catheter placements.

Conclusion: This Formula could be acceptable in performing the bedside PICC placement in the real clinical settings.

Background: Signal-to-noise ratio (SNR) is a key metric for evaluating MRI image quality, but conventional measurement methods are time-consuming and operator-dependent. Deep learning offers potential for automating this process.

Purpose: To develop and validate a deep learning-based method for automatic SNR measurement from single MRI images.

Material and methods: A Pix2Pix framework with a U-Net++ generator and GAN-based discriminator was trained using axial brain MRI images (T1WI, T2WI, and FLAIR) from a 3T scanner. The model generated signal and noise maps from a single image, and SNR maps were computed by pixel-wise division. Whole-brain, white matter (WM), and cerebrospinal fluid (CSF) regions were automatically segmented for regional SNR measurement. The subtraction-map method served as the reference. Structural similarity index (SSIM), correlation coefficients, and Bland-Altman analyses were used to evaluate agreement.

Results: Across all sequences, the mean SSIM was 0.95 ± 0.02. SNR values showed strong correlations with the reference method (r > 0.86) and low relative errors (<7%) for whole-brain, WM, and CSF. Bland-Altman analysis demonstrated a small paired bias and narrow 95% limits of agreement across sequences.

Conclusion: The proposed deep learning method enables automatic, accurate, and observer-independent SNR quantification from single MR images, supporting clinical and research image quality evaluation.

Although a routine and generally safe procedure, central venous catheter insertion has inherent risks, which can be mitigated with the use of imaging studies. This case report describes the unrecognized intrathoracic placement of a central venous catheter in a 15-year-old female with a history of anorexia nervosa. A chest radiograph obtained immediately after the procedure appeared normal at the time, but retrospective review revealed a subtle right-sided pneumothorax. Subsequent computed tomography demonstrated that the catheter had perforated the right internal jugular vein and entered the thoracic cavity. The case highlights the limitations of relying solely on chest radiography for central venous catheter placement confirmation, the potential for missed subtle complications, and emphasizes the importance of clinical vigilance and additional imaging when catheter malposition is suspected.

Background: Right iliac fossa (RIF) pain is a frequent and challenging presenting complaint in emergency departments, encompassing a wide spectrum of acute and chronic conditions.

Purpose: To compare effectiveness of ultrasound versus initial clinical and lab tests for diagnosing acute appendicitis in patients with RIF pain, while also evaluating the impact of ultrasound operator experience as well as portable ultrasound system.

Materials and methods: This retrospective study included 525 patients (aged ≥15 years) presenting with acute RIF pain to three emergency departments in Thi-Qar Governorate, Iraq (January 2024-January 2025). Sensitivity, specificity, predictive values (PPV and NPV), and accuracy for diagnosing acute appendicitis were calculated. Multivariable logistic regression identified independent predictors of diagnostic accuracy for both modalities.

Results: Among 525 patients, appendicitis was the final diagnosis in 273 (52.00%). For diagnosing acute appendicitis, ultrasound demonstrated significantly higher sensitivity (89.7% vs 67.4%), specificity (67.1% vs 46.4%), and overall accuracy (78.9% vs 57.3%) compared to clinical-laboratory assessment. Independent predictors of higher ultrasound accuracy included US operator experience (Senior EM Physician vs. Resident: aOR 3.15, 95% CI: 1.80-5.52) and presence of rebound tenderness (aOR 2.40, 95% CI: 1.35-4.27). For clinical-laboratory assessment, ED physician experience (Senior vs. Resident: aOR 1.48, 95% CI: 1.15-2.41) was one of the independent predictors of higher accuracy.

Conclusion: Ultrasound significantly outperforms initial clinical-laboratory assessment in diagnosing acute appendicitis among patients with RIF pain in this setting. US operator experience is a key determinant of ultrasound accuracy. Our findings support the effective use of portable ultrasound systems in the emergency setting.

Background: Lumbar disc degeneration (LDD) is frequently evaluated using the Pfirrmann classification. While this composite grading system provides an overview of degeneration severity, it may oversimplify LDD by overlooking variability in individual disc components, reducing its effectiveness in longitudinal studies and constraining its applicability in artificial intelligence-based image analysis.

Purpose: To examine the 14-year progression of LDD using the Pfirrmann classification and its individual components, and to evaluate the potential of component-based analysis.

Material and methods: LDD was assessed using MRI in 19 males (95 discs) at ages 37 and 51 by two radiologists. Evaluations included Pfirrmann grading, quantitative nucleus pulposus (NP) signal intensity, and visual grading of NP inhomogeneity, annulus fibrosus (AF) border distinction, and disc height (DH). Analyses included longitudinal changes in LDD variables and correlations between Pfirrmann grading and disc components. To assess overall LDD, a summary score was calculated by summing individual disc grades.

Results: Pfirrmann grading correlated strongly with AF border distinction, moderately with NP signal intensity, and weakly with NP inhomogeneity and DH. Pfirrmann summary score (range 5-25) increased by 3 points over time. Variability was observed in the progression of individual disc component degeneration. While mean NP signal intensity significantly decreased, some discs exhibited increase.

Conclusion: This longitudinal study highlights complexity of LDD and variability in disc component changes. While Pfirrmann classification captures overall degeneration, its limitations in detecting subtle variations in disc components suggest a need for more detailed assessments to enhance diagnostic precision and support the development of automated analysis tools.

Dropped head syndrome, characterized by excessive flexion of the neck, frequently leads to significant impairment in quality of life. Among the various causes of this syndrome, some cases respond effectively to internal medicine. We report a case of a woman in her 70s who presented with dropped head syndrome and was finally diagnosed with hypothyroid myopathy limited to the extensor muscles of the neck. Cervical spine MRI at the initial examination indicated thyroid atrophy, increased subcutaneous fat, and a mild high signal in the right cervical extensor muscles on fat-suppressed T2-weighted images. Blood tests confirmed hypothyroidism. Treatment with levothyroxine improved the symptoms and normalized the blood test results. This case highlights the importance of careful evaluation of the thyroid gland and paravertebral muscles in cervical spine MRI. They can offer diagnostic clues for underlying the important causative role of thyroid disease in dropped head syndrome.