British Journal of Radiology最新文献

Scrotal ultrasound imaging findings range from benign anatomical variants to surgical emergencies. Scrotal assessments can be daunting for clinicians who are unfamiliar with the typical anatomy and expected imaging characteristics of common pathologies. This pictorial review highlights key anatomical considerations and essential tips for scrotal ultrasound imaging. A practical approach to scrotal pathologies is discussed and supplemented with a plethora of ultrasound imaging examples. Particular emphasis is placed on describing the clinical presentation, imaging findings, and recommended management for: infectious/inflammatory conditions, vascular anomalies, sequelae of trauma, cystic lesions, and common testicular neoplasms.

Objective: This prospective study aimed to develop and validate integrated nomograms that combine preoperative radiomic features from dual-layer spectral detector CT (DLCT) with key postoperative pathological information for the prediction of programmed cell death ligand 1 (PD-L1) expression in invasive lung adenocarcinoma.

Methods: The study included 191 participants with invasive lung adenocarcinoma who underwent preoperative thoracic contrast-enhanced DLCT scans and PD-L1 expression testing. Radiomic features were extracted from various DLCT images. Least absolute shrinkage and selection operator was used to derive radscores for PD-L1 expression (tumor proportion score ≥ 1% was defined as PD-L1 positivity). Nomograms were developed by integrating radscores with clinicopathological characteristics through logistic regression analysis. Performance was assessed using receiver operator characteristic (ROC) curves, area under the curve (AUC), calibration curves, and decision curve analysis (DCA).

Results: Three sets of radiomic nomograms, based on iodine map (IM), virtual non-contrast (VNC), and conventional images (PCI), along with pathological stages (pTNM), were developed. The IM nomogram exhibited superior performance in both training (AUC = 0.791) and validation (AUC = 0.737) sets. Calibration and DCA confirmed the IM nomogram's consistency and clinical utility.

Conclusions: The IM nomogram demonstrated potential for individualized prediction of PD-L1 expression in invasive lung adenocarcinoma and identify the candidates who may benefit from immunotherapy.

Advances in knowledge: The nomogram based on Dual-layer spectral detector CT can predict the probability of PD-L1 expression in invasive lung adenocarcinoma and may help personalized immunotherapy decisions.

Women continue to be disproportionately affected by a large burden of disease including cardiovascular disease, cancer, gynecologic disorders, osteoporosis, and maternal health complications contributing to significant morbidity and mortality. Traditional diagnostic tools and risk models often fail to account for sex-specific factors, leading to underdiagnosis and delayed care. Artificial intelligence (AI) is rapidly emerging as a transformative tool in women's health, offering new methods for opportunistic screening, early detection, and risk prediction across multiple conditions. This review explores the application of AI in radiology imaging with a focus on diseases that only affect women, and those that affect both men and women, focusing on the outcomes for women and how AI is affecting their care. We describe different applications of AI and summarize types of bias affecting these applications, with recommendation on strategies to mitigate these disparities. Neglecting women's health has profound economic, societal, and global health consequences. We hope by highlighting some transformative AI applications for women's health, we can promote their adoption to accelerate care, while factoring in various pitfalls that risk leaving women behind in the ongoing AI transformation. Specifically, we recommend a sociotechnical approach to AI development and deployment for women's health-factoring in the impact of complex social systems that have allowed persistent disparities and underinvestment in women's health.

Objectives: To evaluate the ability of the maximum standardized uptake value (SUVmax) to predict the lymphovascular space invasion (LVSI) status in endometrial cancer (EC).

Method: PubMed/MEDLINE, Web of Science, Embase, and the Cochrane Library were systematically searched for all original studies evaluating the diagnostic efficacy of LVSI using PET/CT or PET/MR. Methodological quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2). A bivariate random effects model was used to acquire pooled sensitivity, specificity, heterogeneity, and the area under the summary receiver operating characteristic curve (AUROC). Meta-regression and sensitivity analysis were performed to identify sources of heterogeneity.

Results: A total of 6 studies (257 patients) were included. Most studies had a low risk of bias, and all studies had minimal applicability concerns. The summary AUROC values, pooled sensitivity and specificity of SUVmax in detecting LVSI in EC were 0.77, 62% and 83%, respectively. One study may have contributed to the unstable results of this study according to the sensitivity analysis.

Conclusion: Our study showed that SUVmax has moderate accuracy in noninvasively predicting LVSI in EC. More original studies with large samples are needed in the future to evaluate the role of SUVmax in differentiating LVSI.

Advances in knowledge: LVSI is closely related to the prognosis of EC, and it can only be obtained by surgical pathology. SUVmax has moderate diagnostic performance in preoperatively predicting LVSI in EC. Future studies with large samples are needed to confirm the clinical value of SUVmax in the preoperative prediction of LVSI.

Objectives: To assess CT-to-CT angiography (CT-CTA) times at primary stroke centres (PSCs) for patients eligible for mechanical thrombectomy (MT) in acute ischaemic stroke, and to identify causes of imaging delays.

Methods: This retrospective study analysed CT-CTA intervals in 200 consecutive patients referred from 18 PSCs in South-East England to a comprehensive stroke centre (CSC) (Jan 2022 - Mar 2023). Times were benchmarked (≤5 min = excellent, ≤10 min = adequate). Inclusion/exclusion following MT guidelines. Confounding variables were analysed using Welch's t-test and one-way ANOVA. A qualitative survey explored delay causes.

Results: The mean CT-CTA time at PSCs was 62 minutes (SD 21), versus 1 minute (SD 1) at the CSC (p < .00001, Hedges' g = 3). Only 9% of PSCs achieved excellent, and 36% adequate, CT-CTA times. No significant differences were found based on time of day, thrombolysis, or NIHSS. However, wide variation existed between PSCs. Survey findings cited technical (e.g., lack of CT perfusion, out-of-hours reporting), organisational (e.g., scanner access, lack of stroke specialists), and educational (e.g., unawareness or dismissal of guidelines) barriers.

Conclusions: CT-CTA delays at PSCs impede timely MT referrals. Improvements in training, infrastructure, and policy (e.g., revised SSNAP metrics) are needed for optimising stroke care pathways.

Advances in knowledge: This study is the first to systematically assess CT-CTA time adherence across PSCs and it reveals substantial delays and modifiable barriers. It provides actionable insights for optimising stroke imaging protocols, reinforcing the need for integrated workflows to enhance MT accessibility and outcomes.

Introduction: The standard of care for unresectable locally advanced non-small-cell lung cancer (LA-NSCLC) is chemoradiotherapy (CRT) followed by consolidation immunotherapy. We analysed clinical, biological, and dosimetric data to identify survival predictors and inform personalized treatment strategies.

Methods: We retrospectively reviewed LA-NSCLC patients treated between December 2015 and January 2023. Data were extracted from electronic medical records. Progression-free survival (PFS) and overall survival (OS) were calculated from diagnosis. Kaplan-Meier estimates and Cox proportional hazards models were used for survival analysis.

Results: We included 92 patients (median follow-up: 28.9 months); 66% were male, 60% former smokers, and the median age was 64. Stage IIIB (50%) and adenocarcinoma (60%) were most common. PD-L1 positivity was observed in 75%, and 27% had oncogenic drivers (KRAS: 24%, EGFR: 3%). Most (86%) received concurrent CRT, typically cisplatin-based (60%). Median durvalumab duration was 9.5 months. Median PFS and OS were 31.9 and 51.2 months, respectively. Recurrence was locoregional (15%) or metastatic (60% oligometastatic, 25% polymetastatic). PFS was longer in patients aged <66 years (45.4 vs. 16.0 months; p = 0.01), with pre-RT lymphocyte counts >1.80 G/L (45.4 vs. 27.7 months; p = 0.047), or PTV <450 cc (44.3 vs. 16.1 months; p = 0.01). On multivariate analysis, only PTV <450 cc remained significant (HR: 0.45; p = 0.04). No factor was associated with OS in multivariable analysis.

Conclusions: Smaller PTV was independently associated with longer PFS, supporting its value in personalized care for LA-NSCLC.

Advances in knowledge: PTV emerged as an independent prognostic factor for PFS, suggesting its utility in risk stratification and individualized treatment planning.

Objectives: To evaluate changes in PI-RADS ≥ 3 lesions on prostate MRI after prostate artery embolization (PAE) performed for lower urinary tract symptoms.

Methods: This retrospective single-center study included 18 consecutive patients, each presenting with 1 PI-RADS ≥ 3 prostatic images on pre-PAE MRI and who underwent follow-up MRI after PAE. We assessed changes in PI-RADS score, infarcted areas, and prostate volume.

Results: Before PAE, all 18 lesions (mean PSA density : 0,078) were either biopsy-negative (n = 4) or deemed not requiring biopsy based on multidisciplinary consensus (n = 12), except for 1 case of non-clinically significant prostate cancer identified before PAE and 1 patient with a PIRADS 4 lesion who declined biopsy. The mean delay to post-PAE MRI was 120 days. After PAE, no new PI-RADS ≥ 3 lesions appeared, and no lesion was upgraded. Both initially classified as PI-RADS 5 lesions (negative on biopsies) were downgraded to PI-RADS 1. Among the 6 PI-RADS 4 lesions, 3 remained stable, 2 were downgraded to PI-RADS 3 and 1 to PI-RADS 2. Of the 10 PI-RADS 3 lesions, 8 achieved PI-RADS 1 status and 2 remained stable.

Conclusions: Following PAE, pre-existing PI-RADS ≥ 3 lesions demonstrate stability or reduction in PI-RADS on MRI. However, radiopathological correlation studies are warranted to estimate the diagnostic reliability of the PI-RADS score in the post-PAE settings.

Advances in knowledge: This study shows that PI-RADS ≥ 3 images are downgraded after PAE. It doesn't imply that potential prostate cancer can be cured by PAE.

This review explores the revolutionary impact of long axial field-of-view (LAFOV) PET/CT imaging in modern nuclear medicine and molecular imaging. LAFOV PET offers extended axial fields-of-view from 50 cm to 200 cm with unprecedented 3D sensitivity, enabling ultra-fast scans at regular doses or ultra-low dose scans at regular scan times as well as simultaneous whole-body dynamic imaging. We discuss the potential of these specifications in facilitating the clinical translation of multi-parametric whole-body PET imaging for superior quantification, lesion detectability, and treatment response assessments across a diverse range of clinical diagnostic and treatment response assessment applications, in oncology, cardiovascular diseases, inflammatory diseases, neurology as well as for systemic multi-organ assessments and other novel imaging applications. Furthermore, we present LAFOV PET's crucial role for optimizing personalized radionuclide therapy via quantitative precision dosimetry and development of theranostic digital twins. Challenges, such as high acquisition costs, large data volumes, and the need for more extensive validation and wider equitable adoption by enhancing cost-effectiveness through novel detector configurations, innovative data-driven correction methods and Artificial Intelligence are also discussed. Ultimately, LAFOV PET has the potential to redefine precision diagnostics and theranostics in nuclear medicine but its currently limited accessibility should be democratized to disseminate its benefits globally and equitably.

Histotripsy represents a paradigm shift in interventional oncology (IO) as the first non-invasive, non-ionising and non-thermal ultrasound-based ablation technology available for cancer therapy. Compared with thermal ablation techniques, advantages of histotripsy include tissue-selective ablation near critical structures, reduced collateral injury risk, and treatment which is unaffected by the heat sink phenomenon, ensuring predictable treatment margins. Ultrasound technology can be constrained by tissue attenuation depending on the depth of the target; however, the early phase feasibility and pivotal trial results have been promising for its application in liver cancers, with emerging translational trials in renal and pancreatic cancer. In the UK, two well-established IO sites have participated in the pivotal #HOPE4LIVER Trial that led to approval by the U.S. Food and Drug Administration (FDA) in liver tumours therapy in 2023 and obtained Medicines and Healthcare products Regulatory Agency (MHRA) Unmet Clinical Need Authorisation (UCNA) for treatment of liver tumours in UK (April, 2025) via the Innovative Devises Access Pathway (IDAP). The global-first feasibility in renal cancer (CAIN trial) was also led by the UK and completed in April 2024. This review provides an overview of histotripsy and highlights the clinical challenges in early NHS adoption such as the learning curve for operators and teams, regulatory processes, and synthesis of health economic evidence required for wider NHS commissioning. The review will also discuss the future directions of histotripsy, including combination immunomodulatory therapies, highlighting the need for continual national collaboration for successful integration in the NHS. Successfully integrating this technology into the NHS hinges on a unified national effort to navigate the clinical, regulatory and economic hurdles, ensuring its benefits reach patients nationwide.