British Journal of Radiology最新文献

Objective: Primary and secondary hepatic malignancies are a significant cause of cancer-related mortality worldwide. Radioembolization with yttrium-90 (90Y) microspheres has emerged as a promising treatment option for unresectable hepatic tumours. However, the high cost of commercially available Y-90 microspheres, such as 90Y-TheraSphere or 90Y-SirSphere, limits their accessibility in developing countries. We present the first Indian clinical experience of indigenously developed [90Y] Yttria alumino silicate glass microspheres, known as "90Y-BhabhaSphere," for radioembolization of hepatic malignancies.

Methods: "90Y-BhabhaSphere" formulation developed at Bhabha Atomic Research Centre (BARC), Mumbai, was used to treat a small cohort of 5 patients with unresectable hepatic malignancies. The 90Y-BhabhaSphere delivery system was developed through a rigorous process and in vitro tested using a microcatheter connection to simulate the transarterial radioembolization (TARE) procedure. Feasibility, safety, delivery efficiency, and preliminary efficacy of treatment using 90Y-BhabhaSphere were assessed.

Results: Our initial clinical experience with 90Y-BhabhaSphere demonstrates its safety and feasibility in treating hepatic malignancies. 90Y-BhabhaSphere demonstrated excellent delivery efficiency, reaching 99% in vitro (dummy run) and 97% in vivo (clinical delivery) 90Y-BhabhaSphere was successfully administered to 4 patients, whereas in 1 patient, the delivery had to be terminated due to a leakage in the delivery system. The treatment was well-tolerated, with minimal adverse effects. Preliminary efficacy analysis shows promising results, with a significant reduction in tumour size and improvement in liver function.

Conclusion: 90Y-BhabhaSphere offers a cost-effective alternative to commercially available 90Y-microspheres. Our initial clinical experience demonstrates its safety, feasibility, and preliminary efficacy in treating hepatic malignancies. Large clinical trials need to be conducted to establish the long-term efficacy and safety of 90Y-BhabhaSphere.

Advances in knowledge: This study highlights a key advantage of 90Y-BhabhaSphere: its significantly higher specific activity (approximately 6000 Bq/sphere) compared to commercially available 90Y-TheraSphere (2700 Bq/sphere). This suggests a potential for delivering higher tumour doses while minimizing radiation exposure to healthy liver tissue, thereby reducing the risk of radiation-induced liver damage.

Radiotherapy providers are dependent on capital investment in equipment, which makes up 62% of the cost of delivering radiotherapy. The commissioning of radiotherapy services and duty to replace equipment is currently held by NHS England, but this responsibility and funding will be delegated to all Integrated Care Boards (ICBs). With constraints in national health capital spend over the past decade leaving radiotherapy infrastructure depleted, ICBs are set to inherit an expensive task of updating and replacing radiotherapy equipment. The upcoming National Cancer Plan presents the opportunity for a long-term solution to the renewal and investment in radiotherapy equipment, through rolling ringfenced funding from Government.This paper is part of a series of three papers, on (1) radiotherapy tariff, (2) radiotherapy capital spending and (3) holistic aspects of radiotherapy funding, which together consider what a sustainable, innovative and person centred radiotherapy funding model looks like as specialised services are delegated to Integrated Care Boards.

Objectives: This study aimed to describe pregnancy and maternal outcomes according to radiation doses received to the uterus during photon beam therapy in the French Childhood Cancer Survivor Study (FCCSS) cohort.

Methods: Of the 7670 5-years survivors, 1159 women treated by radiotherapy and with no hysterectomy, followed between 2006 and 2018 were included. Uterus dose were reconstructed within phantoms modelling patient's anatomy in treatment position. A statistical analysis was performed including demographic information, treatment variables, and co-factors.

Results: Among 1159 women, 297 (25.6%) had at least 1 pregnancy, of whom 105/297 (35.3%) had a uterine dose of Dmedian > 1Gy. The proportion of ectopic pregnancy, spontaneous and medical abortions was 20.3% (101/498) and increased to 39% if Dmedian_uterus > 20Gy, versus 12% reported in the French's general population. When medical pregnancy terminations were excluded, significant associations with an increase in risks were found for women who were older than 40 at the time of pregnancy and Dmedian_uterus > 20Gy. Two women whose entire uterus received over 40 Gy had 1 pregnancy, resulting in a live birth. One woman passed away due to haemorrhage during delivery, treated at age 16 with D80%uterus = 35Gy. No other delivery-related deaths were reported.

Conclusion: Assessing the dose to the uterus for pelvic irradiation treatments is necessary, and volume receiving 20 Gy should be minimized. Even if pregnancy is feasible after really high dose received on the uterus (Dmean > 40Gy), a close obstetrical monitoring is recommended, and home delivery should be contraindicated due to the risk of vital haemorrhage.

Advances in knowledge: This article provides valuable data between radiation dose to the uterus and pregnancy outcomes.

Objectives: Axial spondyloarthritis (axSpA) is a chronic inflammatory disease affecting the sacroiliac joints. MRI detects inflammation, but conventional sequences are non-quantitative. Intravoxel incoherent motion (IVIM) imaging quantifies diffusion and perfusion without contrast agents and may address this limitation. We evaluated whether IVIM parameters distinguish active from inactive sacroiliitis and from healthy controls.

Methods: This systematic review and meta-analysis followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Literature searches in Web of Science, PubMed, Embase, and Scopus identified studies reporting the diagnostic performance of IVIM parameters, Dslow (pure diffusion), Dfast (pseudodiffusion), and perfusion fraction (f), for sacroiliitis, up to August 2025. Pooled sensitivity, specificity, and area under the curve (AUC) were calculated with a bivariate random-effects model; heterogeneity with I2.

Results: Six studies comprising 541 participants (178 active sacroiliitis, 277 inactive sacroiliitis, 86 healthy controls) were included. Dslow demonstrated the highest accuracy for differentiating active from inactive sacroiliitis (Sensitivity: 86.3%, Specificity: 88.1%, AUC: 0.93) and from healthy controls (Sensitivity: 89.3%, Specificity: 96.3%, AUC: 0.98). Diagnostic accuracy declined for distinguishing inactive sacroiliitis from controls (AUC: 0.72). Dfast and f showed lower diagnostic performances.

Conclusion: Clinically, IVIM-especially Dslow-may serve as a non-contrast adjunct for activity stratification and follow-up; confirmation requires prospective multicentre studies with pre-specified thresholds, direct comparisons with apparent diffusion coefficient and dynamic contrast-enhanced MRI, and assessment of management and cost impact.

Advances in knowledge: This is the first study to meta-analyse and systematically review IVIM for SpA activity monitoring. It confirms the potential capability of IVIM-especially Dslow-as a potential imaging biomarker.

Objective: To evaluate the mid- and long-term outcome of recanalization of accessory hepatic vein (AHV) secondary to hepatic venous outflow obstruction and to compare the mid- and long-term outcome and technical efficacy and safety of AHV recanalization with native hepatic vein (HV) recanalization in hepatic vein outflow tract obstruction (HVOTO) patients.

Methods: This retrospective observational study, conducted at a single-centre, evaluated the mid- and long-term outcomes of AHV recanalization compared to native HV recanalization in 170 HVOTO patients treated between January 2013 and October 2020.

Results: Patients were divided into 2 groups based on the type of recanalization performed: AHV (n = 26) and native HV (n = 144). Technical success was achieved in 100% of AHV cases and 95.8% of native HV cases. The primary patency rates at 1, 3, and 5 years were 95.9%, 92.3%, and 76.9% for AHV and 96.5%, 93%, and 79.1% for native HV, respectively. Significant improvements in liver stiffness, clinical symptoms, and hepatic function were observed post-intervention in both groups, with no significant differences in outcomes. Transplant-free survival rates at 1, 3, and 5 years were also comparable between groups.

Conclusion: This study demonstrates that AHV recanalization is a safe and effective alternative to native HV recanalization, providing comparable long-term outcomes.

Advances in knowledge: It offers a promising option for HVOTO patients with dominant AHV and extensive intrahepatic collaterals, further supporting its integration into the stepwise management of HVOTO.

Objective: This study aims to assess and compare the diagnostic accuracy of MRI cine-tagging and magnetic resonance elastography (MRE) for staging histologically confirmed liver fibrosis in patients with chronic liver disease.

Methods: MRI cine-tagging evaluates liver strain as the deformation induced by intrinsic cardiac motion on the left liver lobe, whereas MRE captures liver stiffness in response to externally applied vibrations from a mechanical driver. A head-to-head comparison of MRI cine-tagging and MRE was performed in 76 participants with biopsy-proven chronic liver disease. Spearman's rank correlation coefficients and areas under the receiver operating characteristic curve (AUC) were assessed. AUCs were compared using the Delong method.

Results: MRE-derived shear modulus increased, while strain obtained from tagged cine MRI decreased with higher fibrosis stages (ρ = 0.73 and ρ = -0.67, respectively; P < .0001). Both shear modulus and strain values exhibited significant differences across fibrosis stages (P < .0001) and correlated with each other (ρ = -0.44, P < .0001). MRE provided higher AUCs than MRI cine-tagging only for distinguishing stages ≤F3 vs. F4 (0.91 vs. 0.87, P = .043). There were no significant differences in AUCs for differentiating other dichotomized fibrosis stages, including stages F0 vs. ≥F1 (0.87 vs. 0.81, P = .083), ≤F1 vs. ≥F2 (0.84 vs. 0.84, P = .889), and ≤F2 vs. ≥F3 (0.89 vs. 0.86, P = .116).

Conclusion: MRI cine-tagging provided a similar diagnostic performance compared to MRE for staging liver fibrosis, except for the diagnosis of cirrhosis (F4). It is possible to assess liver strain as part of abdominal MRI screening, offering additional insight into the left lobe without the need for additional equipment.

Advances in knowledge: A head-to-head comparison of magnetic resonance elastography (MRE), the most accurate technique for the noninvasive staging of liver fibrosis, and MRI cine-tagging has not been performed yet. We found that MRI cine-tagging, having the advantage of not requiring any additional hardware, provides a similar diagnostic performance compared to MRE for staging liver fibrosis, except for the diagnosis of cirrhosis in patients with chronic liver disease.

Radiotherapy practices have changed significantly over recent decades with the introduction of increasingly personalised approaches to preparation and treatment and the use of a wider range of imaging technology, treatment techniques and software such as Artificial Intelligence (AI). The lack of development of the radiotherapy tariff, which remunerates services for radiotherapy delivery, has contributed to poor adoption rates and inequitable access for patients to new advanced treatment technologies and software across England. The radiotherapy tariff has a potential to be a lever to drive innovation across the system, if it is routinely updated to respond to latest clinical consensus. The commissioning of radiotherapy services is being transferred from NHS England to Integrated Care Boards (ICBs), in their emerging role as 'strategic commissioners'. Along with wider reform to funding mechanisms set out in the 10 Year Health Plan, this presents an opportunity to reshape the commissioning and tariff structures for radiotherapy services to better reflect contemporary radiotherapy practice. This paper explores the limitations of current funding arrangements for radiotherapy. It proposes recommendations to ensure that providers are supported to deliver more productive, innovative and value-based radiotherapy.

Fibro-osseous tunnels allow the unhindered passage of the neurovascular bundle and sliding tendons across the mobile joint. Release of the fibro-osseous tunnels is performed for entrapment neuropathy and stenosing tenosynovitis which occur as a result of increase in the volume/pressure within these tunnels. The common surgical principle in all these pathologies is releasing the pressure by transecting the fascial covering. Primarily these pathologies are treated with open surgery but are potentially amenable to curative percutaneous ultrasound (US)-guided release procedures. US is the preferable guiding modality due to its high resolution and real-time demonstration of the anatomy and needle positioning. The advantages of these minimally invasive techniques are lower risk of wound breakdown, quicker healing, reduced post-procedural pain, reduced complications, and a quicker return to normal activity. The release of the tunnel may be achieved by sectioning the thickened pulley or retinaculum with the aid of the needle bevel or surgical-grade thread which are universally available, economical, and equally effective. This article reviews the literature, our institutional experience and the rationale of US-guided percutaneous release procedures in wrist and hand including thread and partial needle carpal tunnel release for carpal tunnel syndrome, needle release for trigger finger, partial needle release for de Quervain's tenosynovitis, and needle aponeurotomy for Dupuytren's contracture.

Objective: To compare transabdominal and transvaginal ultrasound for the assessment of cervical length (CL) in the third trimester of pregnancy.

Methods: In this cross-sectional analytical study, a total of 500 pregnant women were screened, out of which 223 women, aged 18-45 years, with a gestational age of 26-30 weeks in the third trimester, were enrolled. Prior to participation, all subjects provided written informed consent and were made aware of the potential risks and benefits associated with the procedure. Clinical and demographic data, including risk factors and medical history, were collected using a predesigned data collection form. Gestational age was determined based on the last menstrual period.

Results: Transabdominal ultrasound (TAS) and transvaginal ultrasound (TVS) measurements of CL were made on 229 pregnancies of 26-40 weeks gestation. Out of 223 patients, 102 females had lower abdominal pain, 100 females had bleeding, and 126 females had cephalic position and breech 97. About 223 women were initially enrolled in the study. Paired TAS and TVS measurements were obtained in 123 (51.3%) women. The mean TVS CL was 35.2 ± 6.8 mm, and the mean TAS CL was 34.7 ± 6.5 mm. Significant differences were identified between the mean CL measurements of the 2 techniques (P < .05).

Conclusion: Both TAS and TVS are valuable tools for CL assessment, TVS should be considered the gold standard for more accurate and reliable measurements, especially in clinical settings where precise monitoring of CL is necessary.

Advances in knowledge: By providing a novel comparison between transvaginal and transabdominal ultrasonography for the assessment of CL in the third trimester, this study advances our understanding of how to optimize measuring methods for the reduction of preterm birth risks.