Frontiers in radiology最新文献

Percutaneous ablation therapies currently play a major role in the management of T1a and T1b renal cell carcinoma (RCC). These therapies include thermal ablative technologies like radiofrequency (RFA), microwave (MWA) and cryoablation, as well as emerging techniques like irreversible electroporation (IRE) and high-intensity focused ultrasound (HIFU). These therapies are safe and effective, with their low complication rate being mostly related to the minimal invasive character. To increase the outcomes and safety of ablation, particularly in the setting of larger tumors, adjunctive techniques may be useful. These include pre-ablation trans-arterial embolization (TAE) and thermal protective measures. TAE is an endovascular procedure consisting of vascular access, catheterization and embolization of renal vessels supplying target tumor, with different embolic materials available. The purpose of combining TAE and ablation is manifold: to reduce vascularization and improve local tumor control, to reduce complications (including the risk of bleeding), to enhance tumor visibility and localization, as well as to improve cost-efficiency of the procedure. Thermal protective strategies are important to minimize damage to adjacent structures, requiring accurate knowledge of anatomy and proper patient positioning. In RCC ablation, strategies are needed to protect the adjacent nerves, as well as the visceral and muscular organs. These include placement of thermocouples, hydro- or gas-dissection, balloon interposition, pyeloperfusion and skin protection maneuvers. The purpose of this review article is to discuss the updated role of ablation in RCC management, to describe the status of adjunctive techniques for RCC ablation; in addition it will offer a review of the literature on adjunctive techniques for RCC ablation. and report upon future directions.

Background: Bilateral extended pelvic lymph node dissection (ePLNR) is used in high-risk prostate cancer for assessing metastatic involvement and lymph node staging. Nevertheless, in patients with localized or locally advanced prostate cancer, loco-regional lymph nodes are not always metastatic. Based on this assumption, the aim of this study is to evaluate the potential of ePLND performed under fluorescence guidance after administration of the Indocyanine green (ICG)-Lipiodol mixture via embolization of the prostate arteries in order to identify metastatic lymph nodes, that are then confirmed by histopathology analysis.

Materials and methods: All participants underwent selective embolization of the prostatic arteries 24-48 h before the scheduled surgery. The embolization procedure involved the injection of 25 mg/ml ICG, distilled water, and Lipiodol adequately mixed. During ePLND, the "Firefly" mode integrated into the Da Vinci robotic system was used to assess fluorescence in loco-regional lymph nodes. The lymph nodes were harvested and sent for histopathological examination. Intraoperative fluorescence results, histopathological findings, and short-term postoperative complications were recorded and classified according to the Clavien-Dindo system. For statistical analysis, the Phi coefficient was used to assess the correlation between categorical variables.

Results: Ten patients diagnosed with high-risk or unfavorable intermediate-risk PCa were included. All patients underwent radical robot assisted prostatectomy with ePLND within 48 h of prostate embolization using ICG-Lipiodol. Intraoperative fluorescence results, final histopathological findings and postoperative complications were recorded. The lymph nodes with positive fluorescence, after being analyzed separately, were confirmed to be as metastatic upon dedicated histopathological examination, while non-fluorescent lymph nodes were found to be negative for metastatic involvement. The phi coefficient was calculated to establish the degree of correlation between detection of green fluorescence by Firefly system and the positivity of lymph nodes for metastatic invasion at the histopathological analysis. The concordance assessed by phi correlation coefficient was 0.76, with a sensitivity of 100% (95% confidence interval).

Conclusion: Although preliminary, the results of this study demonstrate the potential of fluorescence-guided ePLND after ICG-Lipiodol administration for improving the identification of metastatic lymph nodes during Robotic-assisted radical prostatectomy RARP. Further studies are required to validate our findings with a larger group of patients.

Acute aortic intramural hematoma (IMH) is a relatively uncommon but potentially life-threatening aortic disease that can occur primarily in hypertensive and atherosclerotic patients. The course of IMH varies widely, with the condition either regressing, remaining stable, or progressing until it leads to outward rupture or intimal layer disruption, eventually resulting in overt aortic dissection. Therefore, poor prognostic computed tomography (CT) features must be promptly recognized and reported by the radiologist. In emergency departments, readily accessible non-invasive CT angiography is crucial for achieving a rapid and accurate diagnosis essential for appropriate management. For Type A and B aortic dissection, surgery is typically recommended in Western countries for patients with Stanford Type A IMH and those experiencing irrepressible pain. For Stanford Type B IMH patients without complications or incessant pain, medical treatment is suggested but with imaging follow-up. In complicated Stanford Type B situations, thoracic endovascular aortic repair (TEVAR) is currently indicated. This review aims to present pathophysiology, CT diagnosis, and IMH fate and provide the reader CT image-based review of the CT diagnostic criteria, complications, and associated critical prognostic findings of this rather rare aortic disease.

Degenerative disc disease (DDD) is a common spinal condition characterized by the deterioration of intervertebral discs, leading to chronic back pain and reduced mobility. While magnetic resonance imaging (MRI) has long been the standard for late-stage DDD diagnosis, its limitations in early-stage detection prompt the exploration of advanced imaging methods. Positron emission tomography/computed tomography (PET/CT) using ¹⁸F- fluorodeoxyglucose (FDG) and ¹⁸F-sodium fluoride (NaF) has shown promise in identifying metabolic imbalances and age-related spinal degeneration, thereby complementing CT grading of the disease. The novel hybrid imaging modality PET/MRI provides new opportunities and are briefly discussed. The complex pathophysiology of DDD is dissected to highlight the role of genetic predisposition and lifestyle factors such as smoking and obesity. These etiological factors significantly impact the lumbosacral region, manifesting in chronic low back pain (LBP) and potential nerve compression. Traditional grading systems, like the Pfirrmann classification for MRI, are evaluated for their limitations in capturing the full spectrum of DDD. The potential to identify early disease processes and predict patient outcomes by the use of artificial intelligence (AI) is also briefly mentioned. Overall, the manuscript aims to spotlight advancements in imaging technologies for DDD, emphasizing their implications in refining both diagnosis and treatment strategies. The role of ongoing and future research is emphasized to validate these emerging techniques and overcome current limitations for more effective early detection and treatment.

Nowadays, the genetic and biomolecular profile of neoplasms-related with their biological behaviour-have become a key issue in oncology, as they influence many aspects of both diagnosis and treatment. In the neuro-oncology field, neuroradiological research has recently explored the potential of non-invasively predicting the molecular phenotype of primary brain neoplasms, particularly gliomas, based on magnetic resonance imaging (MRI), using both conventional and advanced imaging techniques. Among these, diffusion-weighted imaging (DWI), perfusion-weighted imaging (PWI), MR spectroscopy (MRS) and susceptibility-weighted imaging (SWI) and have been used to explore various aspects of glioma biology, including predicting treatment response and understanding treatment-related changes during follow-up imaging. Recently, intratumoral susceptibility signals (ITSSs)-visible on SWI-have been recognised as an important new imaging tool in the evaluation of brain gliomas, as they offer a fast and simple non-invasive window into their microenvironment. These intratumoral hypointensities reflect critical pathological features such as microhemorrhages, calcifications, necrosis and vascularization. Therefore, ITSSs can provide neuroradiologists with more biological information for glioma differential diagnosis, grading and subtype differentiation, providing significant clinical support in prognosis assessment, therapeutic management and treatment response evaluation. This review summarizes recent advances in ITSS applications in glioma assessment, emphasizing both its potential and limitations while referencing key studies in the field.

Aims: To follow disease progression in a rat model of Type 2 diabetes using multimodal MRI to assess changes in brain structure and function.

Material and methods: Female rats (n = 20) were fed a high fat/high fructose diet or lab chow starting at 90 days of age. Diet fed rats were given streptozotocin to compromise pancreatic beta cells, while chow fed controls received vehicle. At intervals of 3, 6, 9, and 12 months, rats were tested for changes in behavior and sensitivity to pain. Brain structure and function were assessed using voxel based morphometry, diffusion weighted imaging and functional connectivity.

Results: Diet fed rats presented with elevated plasma glucose levels as early as 3 months and a significant gain in weight by 6 months as compared to controls. There were no significant changes in cognitive or motor behavior over the yearlong study but there was a significant increase in sensitivity to peripheral pain in diet fed rats. There were region specific decreases in brain volume e.g., basal ganglia, thalamus and brainstem in diet fed rats. These same regions showed elevated measures of water diffusivity evidence of putative vasogenic edema. By 6 months, widespread hyperconnectivity was observed across multiple brain regions. By 12 months, only the cerebellum and hippocampus showed increased connectivity, while the hypothalamus showed decreased connectivity in diet fed rats.

Conclusions: Noninvasive multimodal MRI identified site specific changes in brain structure and function in a yearlong longitudinal study of Type 2 diabetes in rats. The identified diabetic-induced neuropathological sites may serve as biomarkers for evaluating the efficacy of novel therapeutics.

Introduction: Magnetic resonance-based electrical conductivity imaging offers a promising new contrast mechanism to enhance disease diagnosis. Conductivity tensor imaging (CTI) combines data from MR diffusion microstructure imaging to reconstruct electrodeless low-frequency conductivity images. However, different microstructure imaging methods rely on varying diffusion models and parameters, leading to divergent tissue conductivity estimates. This study investigates the variability in conductivity predictions across different microstructure models and evaluates their alignment with experimental observations.

Methods: We used publicly available diffusion databases from neurotypical adults to extract microstructure parameters for three diffusion-based brain models: Neurite Orientation Dispersion and Density Imaging (NODDI), Soma and Neurite Density Imaging (SANDI), and Spherical Mean technique (SMT) conductivity predictions were calculated for gray matter (GM) and white matter (WM) tissues using each model. Comparative analyses were performed to assess the range of predicted conductivities and the consistency between bilateral tissue conductivities for each method.

Results: Significant variability in conductivity estimates was observed across the three models. Each method predicted distinct conductivity values for GM and WM tissues, with notable differences in the range of conductivities observed for specific tissue examples. Despite the variability, many WM and GM tissues exhibited symmetric bilateral conductivities within each microstructure model. SMT yielded conductivity estimates closer to values reported in experimental studies, while none of the methods aligned with spectroscopic models of tissue conductivity.

Discussion and conclusion: Our findings highlight substantial discrepancies in tissue conductivity estimates generated by different diffusion models, underscoring the challenge of selecting an appropriate model for low-frequency electrical conductivity imaging. SMT demonstrated better alignment with experimental results. However other microstructure models may produce better tissue discrimination.

Background: Dark-field chest radiography allows the assessment of the structural integrity of the alveoli by exploiting the wave properties of x-rays.

Purpose: To compare the qualitative and quantitative features of dark-field chest radiography in patients with COVID-19 pneumonia with conventional CT imaging.

Materials and methods: In this prospective study conducted from May 2020 to December 2020, patients aged at least 18 years who underwent chest CT for clinically suspected COVID-19 infection were screened for participation. Inclusion criteria were a CO-RADS score ≥4, the ability to consent to the procedure and to stand upright without help. Participants were examined with a clinical dark-field chest radiography prototype. For comparison, a healthy control cohort of 40 subjects was evaluated. Using Spearman's correlation coefficient, correlation was tested between dark-field coefficient and CT-based COVID-19 index and visual total CT score as well as between the visual total dark-field score and the visual total CT score.

Results: A total of 98 participants [mean age 58 ± 14 (standard deviation) years; 59 men] were studied. The areas of signal intensity reduction observed in dark-field images showed a strong correlation with infiltrates identified on CT scans. The dark-field coefficient had a negative correlation with both the quantitative CT-based COVID-19 index (r = -.34, p = .001) and the overall CT score used for visual grading of COVID-19 severity (r = -.44, p < .001). The total visual dark-field score for the presence of COVID-19 was positively correlated to the total CT score for visual COVID-19 severity grading (r = .85, p < .001).

Conclusion: COVID-19 pneumonia-induced signal intensity losses in dark-field chest radiographs are consistent with CT-based findings, showing the technique's potential for COVID-19 assessment.

In neuro-oncology, MR imaging is crucial for obtaining detailed brain images to identify neoplasms, plan treatment, guide surgical intervention, and monitor the tumor's response. Recent AI advances in neuroimaging have promising applications in neuro-oncology, including guiding clinical decisions and improving patient management. However, the lack of clarity on how AI arrives at predictions has hindered its clinical translation. Explainable AI (XAI) methods aim to improve trustworthiness and informativeness, but their success depends on considering end-users' (clinicians') specific context and preferences. User-Centered Design (UCD) prioritizes user needs in an iterative design process, involving users throughout, providing an opportunity to design XAI systems tailored to clinical neuro-oncology. This review focuses on the intersection of MR imaging interpretation for neuro-oncology patient management, explainable AI for clinical decision support, and user-centered design. We provide a resource that organizes the necessary concepts, including design and evaluation, clinical translation, user experience and efficiency enhancement, and AI for improved clinical outcomes in neuro-oncology patient management. We discuss the importance of multi-disciplinary skills and user-centered design in creating successful neuro-oncology AI systems. We also discuss how explainable AI tools, embedded in a human-centered decision-making process and different from fully automated solutions, can potentially enhance clinician performance. Following UCD principles to build trust, minimize errors and bias, and create adaptable software has the promise of meeting the needs and expectations of healthcare professionals.