Acta radiologica open最新文献

Background: As CT pulmonary angiography (CTPA) is not performed in routine contrast-enhanced CT, it is important to improve the accuracy of embolism detection from the portal-venous phase images that are generally obtained.

Purpose: To assess the diagnostic performance of virtual monochromatic images (VMIs) obtained from portal phase dual-energy CT (PP-DECT) by qualitative and quantitative evaluation of contrast-to-noise ratio (CNR) and signal-to-noise ratio (SNR) compared with those of CTPA.

Material and methods: Included were 45 oncology patients who had been diagnosed with pulmonary embolism based on CTPA. Two radiologists evaluated conventional PP-DECT images and VMIs created from PP-DECT at 40, 55, 70, and 85 keV with the window width and level fixed at 400/70. The energy with the highest diagnostic accuracy was determined, and the image was re-evaluated under conditions where the window could be freely set. Quantitative evaluation was based on CNR and SNR.

Results: Under the condition of fixed window width and level, the energy with the highest accuracy was 55 keV for both radiologists. When the window was set freely in the 55 keV image, accuracy rates were 96.0% and 96.3%; and were 98.5% and 98.1% when limited to the main pulmonary artery or lobar level. CNR and SNR were highest at 40 keV, and were similar to those of CTPA.

Conclusion: Compared to original PP-DECT images, 55 keV images created from PP-DECT appear more useful for detecting pulmonary embolism.

Background: Drug-coated balloons (DCB) are used for vascular access interventional therapy (VAIVT). However, few studies on patients with repeated short-term restenosis after VAIVT using a standard balloon (SB) have been reported, and the effect of DCB use on patency in these patients remains unclear.

Purpose: This study aimed to evaluate the efficacy of DCB in patients with repeated short-term restenosis after VAIVT with SB.

Materials and methods: This was a single-center retrospective study. We enrolled 50 consecutive patients who suffered two consecutive restenosis episodes within 6 months after VAIVT with SB. In the third session, patients were treated with DCB or SB. Target lesion revascularization (TLR) was evaluated for 1 year after the third session, with the primary endpoint being the TLR-free rate at 6 months after VAIVT.

Results: At the third procedure, 24 patients were treated with DCB (DCB group), whereas 26 were treated with SB (SB group). The TLR-free rates at 6 months and 1-year were significantly higher in the DCB group than in the SB group (79.2% vs 26.9%, p < .001; and 41.7% vs 7.7%, p = .005). In the DCB group, a significant correlation was observed between the TLR duration from VAIVT with DCB and the prerestenosis duration before DCB treatment.

Conclusions: Among patients with repeated short-term restenosis after VAIVT, DCB use significantly improved short-term patency compared with that after SB use. DCB may help extend the period between sessions, which are repeated in the short term, to an acceptable length.

Background: Internal mammary lymph node (IM) metastasis significantly affects prognosis. However, reports using imaging techniques have been limited. Diffusion-weighted imaging with background suppression and maximum intensity projection (DWIBS-MIP) is a sophisticated imaging method that emphasizes key signal areas such as tumors or lymph nodes in three-dimensional, providing a quick and comprehensive view immediately. Therefore, DWIBS-MIP can become a screening method for IM metastasis.

Purpose: To investigates the usefulness of DWIBS-MIP for screening IM metastasis in patients undergoing preoperative breast MRI.

Material and methods: Breast cancer patients with suspected IM metastasis from January 2017 to June 2024 were assessed. We evaluated the visibility and the size of IM metastasis, the long axis, short axis, and short-to-long axis (S/L) ratio of the biopsied lymph nodes at DWIBS-MIP. Patient's age, maximum diameter and hormonal status of primary cancer, breast cancer stage, the presence of axillary lymph node (Ax) metastasis, the location of the primary lesion were evaluated.

Results: This study included 31 patients with IM metastasis and eight without IM metastasis. DWIBS-MIP exhibited a predictive value of 79.5% for screening IM metastasis. Between two groups, morphological characteristics of IM lymph nodes, including the long axis, short axis, and S/L ratio, demonstrated no significant differences. A higher proportion of Ax metastasis was possible in cases with IM metastasis. Other clinical data did not indicate significant differences.

Conclusions: DWIBS-MIP provides an easy and effective assessment method for screening IM metastasis. The study indicates incorporating DWIBS-MIP into routine clinical practice can improve IM detection accuracy.

Background: Pericoronary adipose tissue density (PCAT) is a parameter that quantifies inflammation and atherosclerosis around the coronary arteries.

Purpose: To investigate the correlation between PCAT and plaque features, stenosis degrees in coronary arteries (LAD, RCA, Cx) with stenotic vulnerable plaques.

Material and methods: A Retrospective study including 103 patients (64M, 39F) who underwent coronary computed tomography was retrospectively examined at a single center. PCAT and high-risk plaques were measured independently and compared to stenosis and coronary artery type. Adipose tissue attenuation, ranging from -180 to -25 HU, was measured along the plaque's length and in a 0.5-1 mm region around the perilesional coronary arteries.

Results: The PCAT values increases with the degree of stenosis in the LAD, Cx, and RCA (r = 0.9161, p < .001; r = 0.9717, p < .001; r = 0.9315, p < .001, respectively). PCAT values demonstrate a positive pattern when plaque length increases in all coronary arteries (r = -0.6316, p < .001; r = -0.8825, p < .001; r = -0.7529, p < .001; LAD, Cx, RCA). PCAT values differed significantly based on plaque type in all coronary arteries. Calcified plaques showed statistically significant differences compared to both soft and mixed plaques (p < .05). Patients with positive remodeling had PCAT values of -69.43 (±8.76) HU, while cases without positive remodeling had PCAT values of -84.54 (±7.65) HU, indicating a significant difference (p < .05).

Conclusion: The combined evaluation of plaque features, stenosis degree, and PCAT provides a more accurate prediction of possible acute coronary syndrome cases than analyzing stenosis degree alone.

Cardiac amyloidosis is an infiltrative cardiomyopathy caused by the deposition of abnormally folded proteins within the myocardium. Several amyloid subtypes have been documented, with diagnosis supported by abnormal serum plasma electrophoresis, multimodality imaging, and endomyocardial biopsy. Herein, we describe the atypical MRI findings of vascular-variant cardiac amyloid supported by histopathological diagnosis. Knowledge of the vascular-variant cardiac amyloid, in which amyloid deposits in the myocardial vasculature rather than the interstitium, will enable clinicians to proceed down appropriate diagnostic and treatment pathways.

Background: Pediatric patients are particularly vulnerable to the stochastic effects of ionizing radiation. Despite these risks, CT remains diagnostically essential in pediatric care. Diagnostic reference levels (DRLs) have been recommended as a radiation dose optimization tool to address these concerns. Purpose: This study aims to survey pediatric CT practices at different facilities in Australia, Canada, and Norway and to suggest local DRLs (LDRLs) at each facility as a baseline for future surveys. Materials and methods: Radiation dose indices, imaging, and demographic data were collected retrospectively at each facility using PACS for unenhanced CT head, contrast-enhanced chest, and contrast-enhanced abdomen-pelvis examinations in patients from 0 to 15 years of age. The LDRL values were determined for CT dose indices and size-specific dose estimate (SSDE) values. The Kruskal-Wallis test assessed the equality of populations across countries for all dosimetric quantities. Ordinary least squares regression was employed to express SSDE as a linear function of patient weight. Results: The LDRLs for Australian, Canadian, and Norwegian facilities were determined and examined for each age group. Canadian and Norwegian LDRL data were most similar, with Australian values being comparatively lower for all categories except for 11-15-year-old abdomen-pelvis examinations. The SSDE and patient weight were significantly positively correlated for each examination/country combination. Conclusion: The proposed local reference levels can provide local baselines for dose optimization and continuous dose assessment.

Background: There have been no previous studies comparing the effectiveness of echo-planar imaging (EPI)-diffusion-weighted imaging (DWI) and turbo spin echo (TSE)-DWI for female pelvic imaging on 1.5T and 3.0T magnetic resonance imaging (MRI) systems.

Purpose: This retrospective study compared EPI-DWI and TSE-DWI of the female pelvis at 1.5T and 3.0T MRI to evaluate image quality, geometric distortion, and apparent diffusion coefficient (ADC) values for optimal clinical diagnosis.

Materials and methods: Thirty-nine patients at 1.5T and 71 patients at 3.0T underwent both TSE- and EPI-DWI with b-values of 0 and 1000 s/mm². Spatial resolution was matched between systems and sequences. Geometric distortion, contrast ((uterine myometrium signal intensity (SI) - gluteal muscle SI)/(uterine myometrium SI + gluteal muscles SI)), and ADC values of the uterine myometrium and lesions were compared. Qualitative assessment included ghosting artifacts, image contrast, and overall image quality.

Results: There was no significant difference in patient demographics between 1.5T and 3.0T groups. TSE-DWI demonstrated significantly less distortion than EPI-DWI at both field strengths (p < .05). Contrast was higher with TSE-DWI than EPI-DWI at 3.0T (p < .05) and was greater at 3.0T than 1.5T. ADC values of malignancies differed significantly from the uterus and benign lesions across all sequences and field strengths (p < .05). TSE-DWI showed higher ghosting artifact scores than EPI-DWI at 3.0T (p = .019), but no other significant differences in qualitative evaluation were noted.

Conclusion: TSE-DWI provided superior contrast with reduced distortion compared to EPI-DWI in the female pelvis at both field strengths, with TSE-DWI demonstrating greater effectiveness at 3.0T.

Primary aortoenteric fistula is a rare entity with high mortality. Depending on the location of the fistula, primary aortoenteric fistulas may lead to upper or lower gastrointestinal hemorrhages. The majority of primary aortoenteric fistulas are associated with atherosclerosis or aneurysms of the aorta, without any previous aortic procedure. Local inflammation, compression, or erosion may lead to rupture of the aneurysm. Owing to difficulties in immediate and correct diagnosis, effective treatment of primary aortoenteric fistulas is often delayed, leading to almost 100% mortality in untreated patients. Here, we report a case of a repetitive mass of lower gastrointestinal hemorrhage due to a primary internal iliac arterial-sigmoid colon fistula. Finally, the patient was managed successfully through endovascular coil embolization.

Background: COVID-19 patients may have residual pulmonary alterations after the acute disease, with fibrotic-like alterations. Since metalloproteinases (MMP) and their regulators may be involved in inflammation and abnormal repair processing, we aimed to investigate the correlations between MMP-9, a tissue inhibitor of metalloproteinases (TIMP-1) and chest CT abnormalities in acute phase and mid-term follow-up.

Methods: COVID-19 patients with plasma analyses and CT scans performed at acute onset and 3 months after discharge (T post) were evaluated. MMP-9, TIMP-1, and MMP-9/TIMP-1 ratio were analyzed. CT extents of COVID-19 pneumonia and fibrotic-like alterations were visually scored (score range 0-25). Spearman rank correlation analysis (p-value <.05) was computed between acute and mid-term plasma analyses and CT scores.

Results: 39 patients were enrolled. At hospital admission, MMP-9, TIMP-1, and MMP-9/TIMP-1 had a median of 240.5 ng/mL, 258.8 ng/mL, and 0.9. The median CT global and fibrotic-like scores were 9 and 6. At T post, MMP-9 and TIMP-1 were not statistically different (p-value <.05). There was a reduction of CT global score (p-value = .00007). A significant correlation was found between MMP-9 and CT global score at hospital admission (ρ = 0.456, p-value = .003) and between MMP-9/TIMP-1 ratio and CT global score at hospital admission (ρ = 0.406, p-value = .009). No other significant correlations were found between plasma enzymes and CT alterations, both in acute and mid-term follow-up.

Conclusion: MMP-9 plasma levels and MMP-9/TIMP-1 ratio correlate with lung involvement during the acute phase. None of the levels of MMP-9, TIMP-1, and MMP-9/TIMP-1 ratio may be adopted as predictors of residual pulmonary alterations in mid-term follow-up.

Background: Hip dysplasia (HD) is a prevalent cause of non-traumatic hip pain, which may result in osteoarthritis. Radiological measurements of HD exhibit variability based on reader and imaging modality, why it is important to know the agreement between different measurement methods.

Purpose: To estimate agreement between measurements of lateral center edge angle (LCEA) and acetabular inclination angle (AIA) made, respectively, on Computed Tomography (CT) scans by humans and radiographs analyzed by an algorithm. To estimate impact of pelvic rotation on agreement between CT and radiographic measurements.

Material and methods: CT measurements were retrospectively extracted from 172 radiology reports. Radiographs were analyzed using an algorithm. Bland-Altman analysis assessed agreement between CT and radiographic measurements. Regression analyses estimated impact of pelvic rotation on inter-modality agreement.

Results: Mean measured bias (95% confidence interval [CI]) between CT and radiographs for LCEA of right/left hip was 5.53° (95% CI: 4.81 to 6.24) and 5.13 (95% CI: 4.43 to 5.83), respectively. Corresponding values for right/left AIA were 1.08 (95% CI: 0.49 to 1.67) and -0.03 (95% CI: -0.60 to 0.05). Pelvic rotation affected right LCEA and AIA measurements, with a change in obturator foramen index of, respectively, 0.35 and 0.6 resulting in approximately 2° change in values.

Conclusion: There was a significant difference in agreement of 5° between CT and radiographs for the LCEA bilaterally. The difference for the AIA was between 0 and 1°, probably of little clinical significance. Pelvic rotation slightly affected bias of the right LCEA, suggesting minimal clinical impact of a slightly rotated pelvis.