British Journal of Radiology最新文献

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.

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.

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.

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.

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.

Objectives: To analyse the different imaging manifestations of prostatitis and prostate cancer (PCa), and propose systematic differentiation and validate its diagnostic performance.

Methods: Men with histologically proven prostatitis or PCa who had pretreatment multiparametric MRI and lesions in the peripheral zone were retrospectively identified from January 2018 to May 2022. The images were evaluated by 2 experienced radiologists, and key imaging features for differential diagnosis were summarized and analysed via univariable and multivariable logistic regression. The best differentiating model was generated via refining the original Prostate Imaging Reporting and Data System (PI-RADS) standard (rPI-RADS). Two inexperienced radiologists reevaluated the images according to the PI-RADS and rPI-RADS criteria, then compared.

Results: A total of 315 patients were enrolled in this study, including 181 patients with clinically significant PCa (67.3 ± 7.7 years) and 134 patients with prostatitis (64.8 ± 9.6 years). The differentiated model was based on diffuse distribution, wedge shape, T1 iso-hyperintensity, rim enhancement, and delayed periprostatic enhancement, thus forming the rPI-RADS standard according to these features. Paired comparison study showed that 22 out of 121 (18.2%, P < .001) inflammatory lesions were corrected from PI-RADS category 4-5 to rPI-RADS category 2, and 20 out of 121 (16.5%, P < .001) were corrected from PI-RADS category 4-5 to rPI-RADS category 1-3 by 2 inexperienced radiologists.

Conclusions: The supplementary descriptions of wedge-shaped and diffuse distributed lesions were helpful for inexperienced radiologists. The refined principle of score reduction may reduce false-positive PI-RADS scores for prostatitis.

Advances in knowledge: A systematic differentiation of PCa from prostatitis was proposed, and validated by inexperienced radiologists.

Sustainable nuclear medicine practice tends to focus on "greener" practices. A holistic framework requires a multi-dimensional approach that considers the entire nuclear medicine pipeline beyond "green" initiatives and through a global lens. There is a paucity of nuclear medicine sustainability literature although documented sustainability strategies in radiology provide transferability. For nuclear medicine practice, there are a number of interconnected sustainability domains. While AI may provide solutions for improved sustainability through workflow efficiencies, cost reductions, and decreased carbon footprint, there are a number of other easy to implement strategies for waste reduction, energy consumption reduction, and improved efficiencies. Carbon offsets represent a potential strategy to create carbon neutrality of nuclear medicine services and represent a commitment to planetary health and global "net zero by 2030" sustainability targets.

Objectives: In the Fluorouracil, Oxaliplatin and Targeted Receptor pre-Operative Therapy (FOxTROT) trial, neoadjuvant chemotherapy (NAC) significantly reduced recurrence risk, compared to upfront surgery, in locally advanced colon cancer. This analysis evaluates the correlation between radiological and pathological staging within the trial to support the adoption of CT-based patient selection.

Methods: In this preplanned analysis of prospectively collected data, local radiological and pathological staging were compared in upfront surgery participants. T stage, N stage, and extramural venous invasion (EMVI) status were evaluated using overall agreement, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV). Subgroup analyses explored the impact of mismatch repair status and tumour side.

Results: A total of 354 participants were included. T stage agreement was 63.0%; T3 and T4 tumours were correctly identified in 78.9% and 41.1% of participants, respectively. The PPV for T3-4 status was 94.5%. N stage agreement was 39.8%; for N status (positive vs. negative), overall agreement, sensitivity, specificity, PPV, and NPV were 54.1%, 81.1%, 26.0%, 53.2%, and 57.1%, respectively. For EMVI, these values were 54.9%, 71.0%, 41.2%, 50.7%, and 62.5%, respectively. Accuracy metrics did not differ significantly by tumour side or mismatch repair status.

Conclusions: CT effectively predicted T3-4 status with minimal overstaging, but performed poorly for individual T stage, N stage, and EMVI. We propose radiological T3-4 status should be adopted as the primary biomarker for neoadjuvant patient selection, with molecular biomarkers to guide treatment choice.

Advances in knowledge: In this multicentre trial, local radiologists accurately identified T3-4 status to select participants for NAC, indicating utility for future neoadjuvant trials and clinical practice.