British Journal of Radiology最新文献

Nowadays, the use of advanced MRI sequences such as diffusion-weighted imaging or perfusion-weighted imaging in the field of musculoskeletal radiology remains limited compared to other anatomical regions and subspecialties. Several reasons underpin this, primarily technical challenges, and a longstanding reliance on conventional and morphological evaluations of soft tissue and bone lesions. Experienced radiologists often assert that these advanced sequences do not offer added diagnostic value, claiming that a morphological approach suffices. However, in our opinion, the role of these advanced MRI sequences extends beyond merely naming an MSK lesion. In this commentary, we elucidate how these sequences can aid radiologists in various scenarios, from determining patient prognosis and tracking treatment progress to enhancing clinical-radiological correlations or guiding less experienced radiologists in evaluating soft tissues or bone tumours.

Magnetoencephalography (MEG) is a non-invasive neuroimaging technique that assesses neurophysiology through the detection of the magnetic fields generated by neural currents. In this way, it is sensitive to brain activity, both in individual regions and brain-wide networks. Conventional MEG systems employ an array of sensors that must be cryogenically cooled to low temperature, in a rigid one-size-fits-all helmet. Systems are typically designed to fit adults and are therefore challenging to use for paediatric measurements. Despite this, MEG has been employed successfully in research to investigate neurodevelopmental disorders, and clinically for presurgical planning for paediatric epilepsy. Here, we review the applications of MEG in children, specifically focussing on autism spectrum disorder and attention-deficit hyperactivity disorder. Our review demonstrates the significance of MEG in furthering our understanding of these neurodevelopmental disorders, while also highlighting the limitations of current instrumentation. We also consider the future of paediatric MEG, with a focus on newly developed instrumentation based on optically pumped magnetometers (OPM-MEG). We provide a brief overview of the development of OPM-MEG systems, and how this new technology might enable investigation of brain function in very young children and infants.

Objectives: Cyclin-dependent kinase 4/6 inhibitors (CDK4/6i) have significantly improved the survival of patients with hormone receptor-positive HER2-negative advanced breast cancer (ABC). Although stereotactic ablative radiotherapy (SABR) is used more often in routine clinical practice, data on the safety and efficacy of combining SABR with CDK4/6i are lacking. Herein, we present the results of SABR combined with CDK4/6i in ABC.

Methods: Patients with ABC who received CDK4/6i and SABR between 2018 and 2023 were analysed.

Results: Among 384 patients treated with CDK4/6i, 34 patients received 44 courses of SABR. Two-year progression-free survival (PFS) was 63.6% (95% CI, 45.8-88.3), and the median PFS was 32 months. Three-year overall survival (OS) was 88.9% (95% CI, 77.7-100). Two-year local control (LC) was 92.7% (95% CI, 83.4-100). Median OS and LC were not reached. The subgroup analysis showed the difference in survival between oligometastatic patients (OMD) and non-OMD subgroup. Two-year PFS was 69.2% (95% CI, 44.5-100) in OMD compared with 57.4% (95% CI, 36-91.7) in the non-OMD (P = .042). Three-year OS was 90% (95% CI, 73.2-100) in OMD compared with 86.2% (95% CI, 70-100) in the non-OMD (P = .67). Median PFS and OS in the non-OMD were 26 and 56 months, respectively, and were not reached in OMD. Fifteen patients required CDK4/6i dose reduction, and 2 discontinued treatment due to toxicity. No difference in high-grade toxicity was observed between the sequential and concurrent SABR.

Conclusion: The addition of SABR to CDK4/6i seems to be safe and effective, especially in patients with oligometastatic disease.

Advances in knowledge: In advanced breast cancer patients treated with CDK4/6i, SABR provides a high local control and may provide additional benefit in an oligometastatic setting.

Objective: This study aims to assess the microstructural abnormalities in white matter (WM) among Behcet's disease (BD) patients, both with and without neurological involvement, utilising tract-based spatial statistics (TBSS) to elucidate the underlying causes of WM microstructural changes.

Methods: This prospective study comprised 43 BD patients without neurological involvement, 15 neuro-Behcet's disease (NBD) patients with normal conventional MRI, and 54 healthy controls matched for age and sex. TBSS was applied in this diffusion tensor imaging study to conduct a whole-brain voxel-wise analysis of fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD), and radial diffusivity (RD) of WM.

Results: Compared to the control group, BD patients exhibited decreased FA and increased MD and RD in nearly all WM tracts, along with increased AD in the left corticospinal tract (CST), left inferior longitudinal fasciculus (ILF), and left superior longitudinal fasciculus (SLF). NBD patients also showed a widespread decrease in FA and increased MD and RD, similar to BD patients without neurological involvement. Additionally, NBD patients had increased AD in the left CST, left ILF, left SLF, left inferior fronto-occipital fasciculus (IFOF), and right CST. Compared to BD patients without neurological involvement, NBD patients exhibited a greater reduction in FA and an increase in MD and RD in WM tracts, with no significant differences in AD.

Conclusion: These results suggest that the main mechanism of microstructural changes in the WM of BD patients may be related to impaired fibre integrity, demyelination, and decreased myelin sheath integrity.

Advances in knowledge: This study demonstrated BD patients without neurological involvement and NBD patients a decrease in FA and an increase in MD and RD were observed in larger areas of major WM tracts, while an increase in AD values was observed in fewer tracts. Our findings may be useful in understanding the pathophysiology underlying subclinical parenchymal involvement and neurological dysfunction in BD patients and the management of BD patients.

Objective: To determine whether adding elastography strain ratio (SR) and a deep learning based computer-aided diagnosis (CAD) system to breast ultrasound (US) can help reclassify Breast Imaging Reporting and Data System (BI-RADS) 3 and 4a-c categories and avoid unnecessary biopsies.

Methods: This prospective, multicentre study included 1049 masses (691 benign, 358 malignant) with assigned BI-RADS 3 and 4a-c between 2020 and 2022. CAD results was dichotomized possibly malignant vs. benign. All patients underwent SR and CAD examinations and histopathological findings were the standard of reference. Reduction of unnecessary biopsies (biopsies in benign lesions) and missed malignancies after reclassified (new BI-RADS 3) with SR and CAD were the outcome measures.

Results: Following the routine conventional breast US assessment, 48.6% (336 of 691 masses) underwent unnecessary biopsies. After reclassifying BI-RADS 4a masses (SR cut-off <2.90, CAD dichotomized possibly benign), 25.62% (177 of 691 masses) underwent an unnecessary biopsies corresponding to a 50.14% (177 vs. 355) reduction of unnecessary biopsies. After reclassification, only 1.72% (9 of 523 masses) malignancies were missed in the new BI-RADS 3 group.

Conclusion: Adding SR and CAD to clinical practice may show an optimal performance in reclassifying BI-RADS 4a to 3 categories, and 50.14% masses would be benefit by keeping the rate of undetected malignancies with an acceptable value of 1.72%.

Advances in knowledge: Leveraging the potential of SR in conjunction with CAD holds immense promise in substantially reducing the biopsy frequency associated with BI-RADS 3 and 4A lesions, thereby conferring substantial advantages upon patients encompassed within this cohort.

Objective: To analyze the potential impact of patients' sex, race and region/country on the risk of hypersensitivity reactions after intra-venous or intra-arterial administration of iopromide.

Methods: Two analyses were performed. 1.) The "Phase-IV-Analysis" evaluated an integrated pooled database of 4 non-interventional studies. 2.) The "GPV-Analysis" evaluated case reports from the company's pharmacovigilance database.The Phase-IV-Analysis was a nested case-control analysis of patients who received an injection of iopromide 300/370 mg iodine/mL. Cases had typical/unequivocal HSRs as defined by the ACR Committee on Drugs and Contrast Media 2018.The GPV-Analysis was based on HSR case reports in the company database. Exposure estimates were derived from sales/market research data.

Results: The Phase-IV-Analysis comprised 152,233 patients from 37 countries. In the full-analysis-set 145,033, 59,412 and146,649 patients were included in the sex, race and region/country cohort, respectively. The GPV-Analysis was based on 78.72 million administrations for sex and 118.56 million administrations for region/country. No GPV exposure data by race was available.

Sex: Phase-IV-Analysis: The HSR-incidence was significantly higher for women (0.72%) vs. men (0.55%) (p ≤ 0.0001). The unadjusted odds ratio (OR) was 1.3 (CI 1.154; 1.499), the adjusted OR was 1.156 (CI 1.006; 1.328) (p = 0.04).GPV-Analysis: Reporting rates were 0.0102% for women and 0.0075% for men (p < 0.0001). OR: 1.36 (CI 1.3; 1.43).

Race: Phase-IV-Analysis: No significantly different HSR incidences for white (0.70%) and Asian (0.61%) patients (p = 0.3094) were detected.

Region/country: Phase-IV-Analysis: The overall world HSR-incidence was 0.62%. Europe: 0.52%, Asia: 0.70%, USA: 0.75%, Germany: 0.51%, China: 0.41%, South Korea: 0.76%.GPV-Analysis: The overall world HSR-reporting rate was 0.015%, varying across regions/countries.

Conclusion: Women showed a slightly higher risk for HSRs than men. Impact of race was not found. HSR-reporting varied by region/country.

Advances in knowledge: Risk for HSRs was increased by female sex but not by race or region/country.

Objectives: To propose a histological-grades-based Osseous Tumor Radiological Interpretation and Management System (OT-RIMS) that would simplify the radiological evaluation of bone tumors, categorize key radiological features into severity levels, and inform corresponding patient management actions.

Methods: This retrospective study between January 2015 and August 2022 evaluated patients with solitary bone tumors confirmed by pathology and imaging follow-up received two or three imaging modalities of radiographs, CT, or MRI. Three radiologists independently assessed radiological features, categorized bone lesions based on OT-RIMS criteria, and reached a consensus. Kappa statistics and observed agreement were calculated.

Results: A total of 341 patients (mean age, 26.0 years; 159 women) were included, with 102 malignant, 177 benign, and 62 intermediate or low-grade malignant bone lesions. Sensitivity and specificity of readers 1, 2, and 3, respectively, in the identification of malignant tumors into OT-RIMS 4 were 93.1% (95 of 102) and 93.3% (223 of 239), 96.1% (98 of 102) and 91.6% (219 of 239), 92.2% (94 of 102) and 89.5% (214 of 239). Inter-reader agreement of OT-RIMS category for three readers was considered excellent (Kendall's W = 0.924, p < 0.001) with a kappa value of reproducibility in categories 1&2, 3, and 4 of 0.764, 0.528, and 0.930, respectively.

Conclusion: The OT-RIMS category demonstrated excellent reproducibility despite the reader's expertise level in categorizing the risk stratification of bone tumors and informing patient management, with histological grades used as the reference standard.

Advances in knowledge: The OT-RIMS category reliably stratifies bone tumors into four categories corresponding to histological grades and standardized patient management.

Haemato-radiology represents a relatively newly emerging, vast and complex area of diagnostic imaging. Its complexity arises from the multimodality nature of patient assessment, the multisystem presentation of haematological malignancies and their complications, and the volume of imaging required for diagnosis and follow-up of the 5th most common malignancy type in the UK. Decisive and accurate assessment of disease by radiologists is at the heart of the haemato-oncology MDT and therefore essential for providing optimal patient care. We hope to support radiologists leading the MDT by streamlining the vast information in this field, emphasising the most recent, evidence-based guidelines and internationally accepted criteria for reporting imaging of lymphoma and myeloma. We also cover the various disease and treatment complications frequently presented to the MDT.

Objectives: The aim of this study was to compare pathological response rates after reoperative hyperfractionated radiotherapy with co-administration of chemotherapy based on 5FU (HART-CT) vs. preoperative hyperfractionated radiotherapy (HART) in patients with resectable rectal cancer.

Methods: Patients with T2/N+ or T3/any N rectal cancer were randomized either to HART twice a day (28 fractions of 1.5 Gy) to total dose 42 Gy or to HART-CT. Tumor regression grade was postoperatively assessed according to the 4-point scale as recommended by the AJCC. The secondary endpoints included overall survival (OS), disease-free survival (DFS), toxicity of preoperative treatment, locoregional and distant failure rates. There were 187 patients eligible for analysis: 95 in HART and 92 in the HART-CT. Median follow-up was 5.6 years.

Results: The analysis demonstrated a significantly higher chance of achieving pCR in HART-CT arm: complete response was achieved in 4/95, 4% (HART) and 11/92, 12% (HART-CT) (p = 0.045). The differences in OS and DFS, while tending to favor HART-CT, were not significant (p = 0.13, HR = 0.82, 95% CI 0.63-1.06) and (p = 0.32; HR = 0.88, 95% CI 0.69-1.13), respectively. The locoregional failure and distant metastases rates did not statistically differ between the trial arms. The rate of late complications were similar (p = 0.51), grade 3+ being 8% versus 11% in the HART/HART-CT group, respectively.

Conclusions: The hyperfractionated preoperative radiotherapy with concurrent 5-Fu based chemotherapy (HART-CT) improved pathological response rate compared to HART. This translated into favorable OS and DFS in HART-CT, but the differences did not reach the threshold for significance.

Advances in knowledge: A new hyperfractionated chemo-RT scheme is proposed. Histopathological major response (TRG 0-1) is associated with better clinical outcome.

Purpose: To clarify the differences between struma ovarii (SO) and mucinous carcinomas (MC) on CT and MRI, including T2*-based images, diffusion-weighted images (DWI), and time-intensity curve (TIC) patterns, which have not been previously reported.

Methods: We retrospectively compared the presence of low intensity on T2-weighted and T2*-based images, high intensity on T1-weighted images, hyperattenuation on non-contrast CT, TIC pattern, T2 ratio, T1 ratio, CT value, and apparent diffusion coefficient (ADC) value in 15 patients with SO and 27 patients with MC.

Results: SO exhibited a significantly higher frequency of low intensity on T2-weighted and T2*-based images, and hyperattenuation on non-contrast CT than MC (P < 0.001, <0.001, and 0.006, respectively). The T2 ratios and CT attenuation of the locules were also significantly different (P < 0.001, and 0.006, respectively). In SO, sites of low intensity on T2-weighted and T2*-based images and sites of hyperattenuation on CT images always coincided. Regarding the TIC pattern, most SO showed a high-risk pattern, with a significant difference (P = 0.003). The ADC values of SO were significantly lower, and only one case of SO showed high signal intensity on DWI.

Conclusion: SO were more frequently with low intensity on T2-weighted and T2*-based images, and hyperattenuation on non-contrast CT, and showed high-risk TIC patterns without diffusion restriction.

Advances in knowledge: SO shows a high-risk TIC pattern, but can be specifically diagnosed in combination with the lack of diffusion restriction and loculi with marked hypointensity on T2-weighted and T2*-based images consistent with hyperattenuation on non-contrast CT.