British Journal of Radiology最新文献

Objectives: incidental thyroid nodules (ITNs) are found in up to 25% of CT scans. Increased use of cross-sectional imaging has contributed to the increased incidence of thyroid cancer worldwide. ITNs pose a management dilemma since nodule malignancy rate is 5-15% but most cancers are indolent and prognosis in differentiated thyroid cancer is excellent. Study aims are to determine prevalence of ITNs ≥1 cm on CT scans, evaluate reporting practices, assess for emergence of clinically evident thyroid cancer during 13-year follow-up and assess interim nodule growth and clinical outcomes in nodules that were further investigated.

Methods: direct image review of 1499 consecutive CT scans that included the thyroid, performed during January 2009 in a large NHS health board was performed. Clinical data up to January 2022 was analysed in 150 patients with at least one ITN > =1cm.

Results: ITN prevalence was 11% with mean patient age 70 years and mean nodule diameter 17.5 mm. 30% of ITNs were mentioned in the CT report. During the follow-up period 11% proceeded to thyroid ultrasound, 5% fine needle aspiration and 2% diagnostic hemithyroidectomy with no thyroid malignancy found. 120 patients (80%) were deceased by the study endpoint, none from thyroid malignancy. No patients presented with clinically evident thyroid malignancy during follow-up.

Conclusions: None of150 ITN cases developed clinically evident thyroid malignancy in a 13-year follow-up period with 80% of patients deceased by the study endpoint from non-thyroid causes.

Advances in knowledge: This would suggest that ITNs detected on CT do not require further investigation unless malignant appearances or significant clinical concern for thyroid malignancy.

Objectives: This systematic review aims to evaluate the use of Indocyanine Green Lymphography (ICGL) for the investigation of the lymphatics in the lower limbs of primary lymphoedema patients.

Methods: MEDLINE and EMBASE articles from 01/01/2000 to 01/09/2023 were searched for. A total of 11 studies were included in the review after a two-stage screening process.

Results: Data on patient demographics, ICG contrast injection technique, imaging protocols and imaging outcomes were summarised and reviewed in detail. The review highlights the lack of commonality in protocols used. Factors important for good imaging are highly variable, particularly the number of injections, their location and whether they are delivered intradermally or subcutaneously.

Conclusions: ICGL has strong potential to become a diagnostic tool to diagnose lymphoedema, due to its non-ionising nature and cost-effectiveness. However due to the lack of thorough phenotyping and genotyping of patients included in the studies, uncertainty still exists as to the value of the described imaging features such as splash, starburst and diffuse dermal rerouting patterns. Future studies, therefore, should aim to explore the diagnostic utility of ICGL for lymphoedema further through the imaging of primary lymphoedema patients with a confirmed genetic diagnosis and using standardised imaging protocols.

Advances in knowledge: ICGL is a strong candidate for advancing the diagnosis and understanding of primary lymphoedema, and monitoring response to treatment, but protocol heterogeneity and a lack of consistency in reporting imaging details and patient phenotyping currently hold it back.

Objectives: Body composition assessment includes the parameter skeletal muscle mass, subcutaneous and visceral adipose tissue (SAT and VAT). The purpose of this study was to elucidate associations of body composition parameters with mortality in patients with acute bleeding undergoing transarterial embolization (TAE).

Methods: A mixed cohort of patients from 2018 to 2022 with acute bleeding requiring treatment with a TAE was retrospectively evaluated. In every case, the triphasic computed tomography (CT) to diagnose the source of bleeding was used to calculate the body composition parameters.

Results: A total of 251 patients (93 female, 37.1%) with a mean age of 65.5 ± 14.3 years, 30-d mortality of 40.2%, and 24-h mortality of 7.6% were included in the analysis. In the Cox regression analysis, no statistically significant correlations were found between the body composition parameters and 24-hour or 30-day mortality. In the subgroup analysis of patients aged older than 65 years, SMI was associated with short-term 24-hour mortality HR of 0.95 (95%CI 0.90;0.99, p = 0.035).

Conclusions: The present study demonstrated the prognostic impact of clinical, laboratory, aniography-related, and CT-defined body composition in patients with acute hemorrhage undergoing endovascular therapy. Although the overall effect of CT-defined body composition appears to be small, skeletal muscle index was a prognostic factor in the age group over 65 years.

Advances in knowledge: This is a large single center study to investigate the prognostic relevance of CT-defined body composition in patients undergoing TAE. The effect is overall small but might be further investigated in older patients in further trials.

Purpose: Abdominal wall endometriosis consists of endometrial tissue between the peritoneum and the abdominal wall. The established treatment involves amenorrheic drugs-not always successful and tolerated-or invasive surgery. In this scenario, minimally invasive techniques such as cryoablation are a potential option. In this study, we primarily aimed to evaluate the efficacy of percutaneous cryoablation in reducing pain scores of abdominal wall endometriosis patients and analyze their satisfaction with the procedure and its related adverse events.

Materials and methods: MEDLINE, EMBASE, and Cochrane's databases were systematically searched for studies that employed percutaneous cryoablation therapy for abdominal wall endometriosis and reported any of the outcomes of interest. The primary outcome was the reduction in the visual analog scale score after treatment. R Software was used for the statistical analysis. Heterogeneity was assessed using I2 statistics. The Risk Of Bias In Non-Randomized Studies-of Interventions framework assessed potential bias in each selected study.

Results: We included 4 studies, containing 126 patients. All articles were retrospective studies. The difference between the visual analog scale scores before and after treatment was on average 5.97 points (95% CI 5.42-6.52; p < 0.01; I2 = 0%). The pooled satisfaction rate among patients in the selected studies was 93.1% (95% CI 88.66-97.34; p = 0.51; I2=0%). The pooled prevalence of adverse events was only 5.48% (95% CI 1.71-11.20; p = 0.58; I2=0%). Bias analysis showed an overall moderate risk in all included articles.

Conclusion: Our study demonstrated that cryoablation could reduce pain complaints in patients, while presenting a low incidence rate of adverse effects. Randomized clinical trials with a larger number of patients are necessary for greater conclusions.

Objectives: This study aimed to investigate the impact of changing inspiratory depth from end- to mid-inspiratory level on the iodine concentration of lung parenchyma and main pulmonary artery in dual-energy CT pulmonary angiography.

Methods: This retrospective study included patients who underwent dual-energy CT pulmonary angiography from July 2020 to June 2023. Patients were instructed to hold their breath at end- and mid-inspiratory levels before and after January 2022, respectively. By placing regions of interest on the lung lobes and main pulmonary artery in the iodine map, their iodine concentration was recorded.

Results: In end- and mid-inspiratory command, 173 (mean age: 63.4 ± 17.0 years; 68 males) and 179 (mean age: 65.1 ± 15.4 years; 62 males) patients, respectively were included. The mean iodine concentrations of the right upper, right middle, right lower, left upper, and left lower lobes were 0.81/0.91, 0.67/0.74, 1.06/1.07, 0.85/0.95, and 1.07/1.11 mgI/ml, respectively for the end-/mid-inspiratory level. The multivariable regression analysis revealed inspiratory depth as a significant factor for iodine concentration of the right upper, right middle, and left upper lobes. Main pulmonary artery iodine concentration in mid-inspiratory depth (13.21 mgI/ml) was higher than that in end-inspiratory depth (12.51 mgI/ml) (p = 0.129), and a statistically significant difference was observed in the patient group with a body weight of ≥ 70 kg (p = 0.015).

Conclusions: Changing inspiratory depth from end- to mid-inspiratory level has a significant impact on the iodine concentration of the upper and right middle lobes in dual-energy CT pulmonary angiography.

Advances in knowledge: Changing inspiratory depth from end- to mid-inspiratory level has significantly increased the iodine concentration of the right upper, right middle, and left upper lobes.

Objectives: To develop a predictive score for the prediction of successful endovascular crossing in femoropopliteal artery chronic total occlusions (CTOs).

Methods: In this retrospective study, 84 patients were divided 70%:30% into a training and a testing cohort. Parameters such as cap morphology, side branches, bridging collaterals, flush occlusion, and length were derived from preprocedural CT angiography. Lesions were segmented and calcification burden was assessed by thresholding. A score (EVACROSS-CTO) was built based on multivariate logistic regression. Receiver Operating Characteristics (ROC) curve analysis determined the optimal score threshold, with reported accuracy, sensitivity, specificity, and AUC.

Results: Factors including age > 50 years (P = 0.036, OR = 53.7), calcification percentage >10% (P = 0.011, OR = 16.63), the presence of a flush occlusion (P = 0.02, OR = 15.564), the presence of a distal side branch (P = 0.018, OR = 9.879) and the presence of a proximal side branch (P = 0.064, OR = 23.369) were identified as suitable for inclusion in the score. Score values were assigned based on the relative odds ratio for each factor with a maximum score of 22. EVACROSS-CTO was able to predict the success of endovascular recanalization with an AUC-ROC of 79.8% (95%CI 58.5-100%). A score >16 yielded a sensitivity of 75% with a specificity of 70.6% for the prediction of treatment failure.

Conclusions: A score was developed by incorporating variables derived from pre-procedural CT angiography, demonstrating promising predictive capacity in determining the success of endovascular recanalization of CTOs.

Advances in knowledge: EVACROSS-CTO incorporates imaging variables for the prediction of endovascular recanalization success. This score will allow improved pre-procedural planning for femoropopliteal chronic total occlusion management.

Over the last two decades the development of small probes has enabled percutaneous use of cryotherapy. Cryotherapy, also known as cryoablation, enables the treatment of much larger lesions than other thermal ablation techniques, particularly when using multiple evenly spaced probes. Using rapid cooling to as low as -200 degrees Celsius (at the tip of the probe), reliable, and predictable necrosis can be induced. Probes are usually percutaneously inserted under computed tomography (CT) guidance under sedation or general anaesthesia, often as a day case. The procedure is safe with severe complications occurring rarely; the commonest complication is neural injury in lesions closely related to neurovascular bundles. Cryotherapy has been applied to the symptomatic and occasionally curative treatment of bone metastases and a range of primary bone lesions. This review summarises the published evidence base for the use of cryotherapy in metastatic and primary bone lesions and describes the experience with cryotherapy at the Royal Orthopaedic Hospital, Birmingham, a quaternary bone tumour referral hospital, where cryotherapy has been used for 3 years.

Objectives: To study the correlation between sarcopenia and hypertrophy of the future liver remnant(FLR) in patients undergoing portal vein embolization(PVE) before liver resection, and to assess the outcomes after resection.

Methods: This retrospective study examined patients underwent PVE from May 2012 to May 2023. Demographic, clinical and laboratory features were documented and total liver volumes(TLV) and FLR volumes were measured before and 2-4 weeks after PVE. Degree of hypertrophy(DH), percentage hypertrophy(PH) and kinetic growth rate(KGR) of the FLR were calculated. Sarcopenia was defined using the skeletal muscle index(SMI) at the L3 vertebral level. Subcutaneous adipose index(SAI), visceral adipose index(VAI), cross sectional area of psoas muscle at the largest diameter(CSPM) and L3 vertebral level mean muscle attenuation(MA) were also assessed.

Results: Forty patients were included in the analysis and the median age was 57.5(IQR 51-64) and majority were males 27/40(67.5%). Twenty two patients were non-sarcopenics and 18 were sarcopenics. All patients showed hypertrophy of FLR(p = 0.001). SMI demonstrated moderate positive correlations with DH(r = 0.46, p = 0.003), PH(r = 0.47, p = 0.002) and KGR(r = 0.44, p = 0.004). VAI showed weak positive correlations with DH(r = 0.22, p = 0.17), PH(r = 0.18, p = 0.27), and KGR(r = 0.14, p = 0.37). Pre-PVE FLR demonstrated a weak negative correlation with PH(r=-0.35, p = 0.03) and KGR(r=-0.12, p = 0.47).

Conclusions: Sarcopenia, specifically SMI, significantly correlates with FLR hypertrophy after PVE. Assessment of sarcopenia and body compartments prior to PVE could help in stratifying and treats patients with impaired FLR growth.

Advances in knowledge: This study with data spanning over 11-years, is the first in the Indian population to demonstrate a significant correlation between SMI, a marker of sarcopenia, and FLR hypertrophy following PVE.

Objective: This retrospective study aimed to evaluate the predictive value of the preoperative dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) and diffusion-weighted imaging (DWI) findings of mass lesions for predicting sentinel lymph node (SLN) metastasis in early breast cancer.

Methods: A total of 310 patients with suspicious mass lesions detected in preoperative MRI who subsequently underwent surgery and SLN biopsy (SLNB) between September 2015 and September 2022 were analyzed. The relationship between DCE-MRI and DWI findings and SLNB positivity was analyzed.

Results: SLNB was positive for SLN metastasis in 108 of 310 lesions. Younger age (p = 0.001) and larger lesion size (p < 0.001) were found to be associated with SLNB positivity. Findings associated with SLN metastasis included peritumoral edema in 53%, adjacent vessel sign (AVS) in 81%, and increased whole-breast vascularity (WBV) in 58% of patients with positive SLNB (p < 0.001). The SLNB positivity rate was higher in mass lesions with DCE-MRI findings of heterogenous enhancement pattern (p = 0.003), medium or rapid initial phase enhancement (p = 0.001), and washout delayed phase kinetic curve (p = 0.001). It was found that lower tumoral apparent diffusion coefficient (ADC) values (p = 0.003) and higher peritumoral/tumoral ADC ratios (p = 0.018) increased the probability of encountering SLN metastasis.

Conclusion: Patient age, presence of peritumoral edema, presence of AVS, increased WBV, and initial phase kinetic curve of the lesions on MRI were found to be associated with SLN metastasis.

Advances in knowledge: We found that younger age and MR findings obtained from the perilesional area of breast cancer may be helpful in the preoperative prediction of SLN metastasis.

Objectives: To survey kilovoltage (kV) radiotherapy in the UK, updating a 2016 study, focussing on radiotherapy physics, including equipment quality control (QC) and radiation dosimetry, with information on installed equipment and clinical activity.

Methods: All UK radiotherapy physics departments (n = 68) were invited to complete a comprehensive survey. An analysis of the installed equipment base, patient numbers, clinical activity, QC testing and radiation dosimetry processes were undertaken.

Results: 91% of centres (n = 62) responded to the survey. kV radiotherapy was available in 70% of UK radiotherapy departments, with a wide variation in workload; 7 to 436 patients/centre annually. There has been an increase in the centres using treatment calculation software rather than manual methods, up from 36% in 2016 to 50% in the current study. Only 50% of centres use a calculation check method different to the primary method. There was also an increase in use of the addendum to the UK dosimetry code of practice, enabling medium energy calibration in-air rather than at depth in phantom, citing "clinical relevance". Appropriate levels of quality control testing were being conducted at UK centres, with IPEM Report 81 cited as a primary source of guidance. Good consensus for the frequency and tolerance values used for QC was seen across UK centres.

Conclusions: A comprehensive review of consensus practice for quality control and dosimetry in kV radiotherapy across the UK is presented, with supporting information on equipment installation and clinical use.

Advances in knowledge: Updated data is presented on kV radiotherapy treatment in the UK, with focus on physics aspects of QC and dosimetry.