British Journal of Radiology最新文献

Objectives: The diagnostic performance of 99mTc-HYNIC-PSMA-11 whole body SPECT/CT versus 68Ga-PSMA PET/CT was evaluated in prostate cancer patients.

Methods: As a part of the diagnostic workup, all the prostate cancer (PCa) patients (n = 10; mean age 66.4 ± 9.6 years) underwent whole-body 68Ga-PSMA-11 PET/CT followed by serial whole body (anterior and posterior) 99mTc-HYNIC-PSMA-11 imaging The serial whole body imaging was performed at multiple time points of 10 min, 2 h, 4 h, 6 h, 24 h and the whole body SPECT/CT was acquired at 3 h. The whole-body SPECT/CT data was analyzed for lesions detection and to calculate the standardized uptake values (SUVmax) for 99mTc-HYNIC-PSMA-11 avid lesions using the Q- Metrix software. These values were compared with the corresponding SUVmax values obtained from 68Ga-PSMA-11 PET/CT. The serial whole body imaging data were used for estimating the radiation absorbed doses (mSv/MBq) to various organs using the MIRD schema and the OLINDA/EXM software.

Results: 68Ga-PSMA-11 PET/CT identified a total of 64 metastatic lesions, while 99mTc- HYNIC-PSMA-11 SPECT/CT detected 49/64 metastatic lesions, presenting a sensitivity of 76.6%. Notably, the mean SUVmax values for 68Ga-PSMA-11 PET/CT and 99mTc-HYNIC- PSMA-11 were comparable and a highly significant positive correlation (r > 0.93; p < 0.01) The average absorbed doses to the salivary glands, lungs, kidneys, urinary bladder, and liver were found to be comparable with 99mTc-MDP bone scanning.

Conclusion: The diagnostic performance of whole-body 99mTc-HYNIC PSMA-11 SPECT/CT is fairly comparable to 68Ga-PSMA PET/CT and offers a favorable dosimetry indicating its potential for PCa evaluation.

Advances in knowledge: 99mTc-PSMA-11 SPECT/CT may be an alternative and cost-effective tool for evaluation of initial PSMA disease burden as well as for response evaluation to PSMA targeted therapies.

Objectives: Adaptive radiotherapy (ART) is increasingly recognized for its potential to optimize treatment accuracy by adjusting to anatomical changes during therapy. In children, who are particularly sensitive to radiation-induced toxicities and experience rapid anatomical changes, ART could be especially beneficial. We conducted an online survey to assess the current state of ART in children across Europe.

Methods: A 21-question survey regarding ART implementation, techniques, indications, and technical infrastructure was distributed online to SIOP-Europe affiliated centres.

Results: Sixty responses from 18 European countries were received. ART was available for children in 68% of centres. Most frequent sites for implementation were pelvis, abdomen, and head-and-neck, with an average of 20% of respondents using ART for >75% of these cases. Higher-volume centres were more likely to implement ART (r = 0.34, p = 0.048). Fifteen percent performed daily adaptation, while 75% applied it only for major anatomical changes. Half of the centres used offline and 24% online ART. Specific infrastructure included Ethos (21%), MR-LINAC (5%), and Tomotherapy (13%). Automatic contouring was mostly used for OARs (57%). Barriers to implementation included a need for more evidence (50%), specialized equipment (52%) and guidelines (39%).

Conclusions: ART use in paediatric patients is highly variable and remains limited. Only a subset of centres reported routine use of ART, with notable variation in frequency and criteria for adaptation.

Advances in knowledge: This is the first Europe-wide survey to comprehensively map ART practices in paediatric oncology, revealing substantial heterogeneity and identifying key barriers to wider adoption, representing a base to guide standardization and future clinical validation.

Objectives: To develop and validate a deep learning model for whole breast clinical target volume (CTV) contouring and evaluate clinical features affecting its performance.

Methods: Five datasets with 857 patients from a single center were used. Dataset 1 (n = 300) trained and tested the model. Dataset 2 (n = 10) evaluated contouring time and dosimetric parameters. Datasets 3 (n = 20) and 4 (n = 10) were for clinical evaluation. Dataset 5 (n = 517) identified clinical factors influencing auto-contouring accuracy. Model performance was assessed using Dice Similarity Coefficient (DSC) and 95th percentile Hausdorff Distance (HD95).

Results: The median DSC and HD95 for left- and right-sided models in Dataset 1 were 0.941, 1.75 mm and 0.937, 2.47 mm, respectively. In Dataset 2, both auto-contouring and auto-contouring with manual corrections were significantly faster than manual contouring (P = 0.005 for both), while still achieving clinically acceptable dosimetric results. In Dataset 3, two physicians rated automatic and manual contours as equivalent (P = 0.214, P = 0.075), while the other rated auto-contouring higher (P < 0.001). In Dataset 4, the auto-contouring model outperformed 1/5 physicians by DSC (P = 0.009) and 3/5 by HD95 (P = 0.015, P = 0.007, P = 0.017). In Dataset 5, peripheral tumor-bed and low-density breast tissue were associated with lower DSC (P < 0.001 for both) and higher HD95 (P < 0.001 for both). Cases without unfavorable factors performed better than those with (P < 0.001 for both).

Conclusions: The proposed model demonstrated acceptable accuracy, consistency, and efficiency in breast CTV contouring. Peripheral tumor-bed and low-density breast tissue reduced auto-contouring performance.

Advances in knowledge: The characteristics of challenging cases in whole breast CTV auto-contouring should be identified.

Objectives: comparing risk grouping, target delineation, and dosimetric parameters between RT plans based on conventional imaging (CT and/or MRI pelvis with bone scan) versus 18F-PSMA PET/CT in the same patients.

Methods: A 75 newly diagnosed PCa patients treated with definitive RT between January 2019 and December 2022 at our center were included. Each underwent standard imaging and 18F-PSMA PET/CT. Two RT plans were generated; one from conventional imaging and another from PSMA PET/CT data using IMRT or RapidArc on the Eclipse (Varian, USA) system. Plans were compared regarding target volumes (TVs), dose-volume histograms (DVH), and doses to organs at risk (OARs).

Results: Mean age was 69.6 ± 8.1 years, and mean pretreatment PSA was 33.47 ± 42.05 ng/mL. Gleason score (GS) was 7 in 50.7% and 8-10 in 26.6%. PSMA -PET/CT altered TVs in 26 patients (34.7%). PSMA-based RT plans showed significantly higher rectal V60% (19.96% vs. 18.1%, p = 0.024), femoral maximum dose (46.37 Gy vs. 41.98 Gy, p = 0.006), and bowel maximum dose (54.7 Gy vs. 46.3 Gy, p = 0.014). Upstaged patients had larger mean prostate volumes (77.53 ± 34.76 cc vs. 59.76 ± 30.6 cc; p = 0.026).

Conclusion: 18F-PSMA -PET/CT significantly impacts staging and RT planning in prostate cancer, leading to altered TVs and dosimetry, significantly in patients with larger prostates, but non significantly in patients with GS ≥ 8, and higher PSA levels.

Advances in knowledge: PSMA PET/CT meaningfully changes staging, TVs, and dosimetry. It highlights the modality's value in improving accuracy in definitive RT planning.

As a group of diverse co-authors working in the fields of clinical radiology and oncology, we have first-hand experience of the systems that impact medical careers. Women remain underrepresented in most spaces and often face a complex set of obstacles exacerbated by additional protected characteristics such as race, disability and sexual orientation. The impact of flexible working and care giving responsibilities on career development as well as leadership opportunities further widens the gap between under- and overrepresented groups. In this commentary we describe the intersectional challenges faced by women in our specialties and the challenge of navigating these spaces to achieve career success. We explore the various forms of discrimination and its impact on representation in medicine. Potential strategies and solutions aimed at promoting a more equitable specialty are also highlighted.

Objectives: To investigate the efficacy of balloon-occluded retrograde transvenous obliteration (BRTO) for duodenal varices.

Methods: Twenty-two consecutive cases of BRTO for duodenal varices between January 2001 and September 2020 were retrospectively reviewed. Preoperative patient characteristics, anatomical features of duodenal varices, treatment outcomes and technical aspects of BRTO, long-term results (bleeding-free survival and recurrence-free survival), overall survival, and complications were evaluated.

Results: Technical success was achieved in 77.3% (17/22) of cases. The technical success rate was 87.5% (14/16) in prophylactic cases, and 50.0% (3/6) in emergency cases. Clinical success was achieved in all 17 technically successful cases. After 6, 12, and 24 months of successful BRTO, bleeding-free survival remained 100% at all time points, recurrence-free survival was 100%, 92.3%, and 83.1% and overall survival was 86.7%, 86.7%, and 78.0%, respectively. Overall survival was significantly lower in ruptured cases than in non-ruptured cases (p = 0.0002). Within 3 months of BRTO, ascites worsened in 29.4% (5/17) of patients, and other gastrointestinal varices worsened in 25.0% (4/16) of patients. Post-BRTO portal vein thrombosis was detected within 1 week in 5.9% (1/17) cases.

Conclusion: BRTO appears to be a safe and effective primary prophylactic treatment option for duodenal varices.

Advances in knowledge: This study provides evidence of the efficacy of balloon-occluded retrograde transvenous obliteration (BRTO) in treating duodenal varices. Since duodenal variceal rupture has the possibility of worsening patient prognosis, prophylactic BRTO might be performed to prevent rupture.

Objectives: To evaluate the accuracy of CT-derived fat fraction (CDFF) software for quantifying hepatic steatosis at various radiation doses, using MRI-derived proton density fat fraction (MRI-PDFF) as the reference standard, and examines the impact of deep learning (DL)-based noise reduction on CDFF accuracy in low-dose CT (LDCT) scans.

Methods: We conducted a retrospective analysis of 125 living liver donor candidates who underwent non-contrast CT and MRI between July 2016 and December 2017. CDFF was measured on full-dose and simulated LDCT scans at 50%, 25%, and 10% radiation doses. Deep learning-based denoising reconstruction (DLDR) was applied to LDCT scans for CDFF recalculation. The accuracy of CDFF was compared with MRI-PDFF using Pearson correlation coefficients and receiver operating characteristic (ROC) curve analysis, focusing on the effects of radiation dose and DLDR.

Results: : Of the 125 participants (mean age 38 ± 10 years; 77 males), 29 (23%) had hepatic steatosis (MRI-PDFF ≥5%). Full-dose CDFF showed moderate correlation with MRI-PDFF (r = 0.728; P < .001). Correlation decreased with lower doses (r = 0.684-0.725) but improved with DLDR (r = 0.725-0.736). ROC AUC for diagnosing hepatic steatosis was 0.82 for full-dose CDFF, with similar performance across other doses except 10%.

Conclusion: CDFF accuracy declines at lower radiation doses, but DLDR enhances accuracy, improving alignment with MRI-PDFF, especially at reduced doses.

Advances in knowledge: DLDR significantly enhances the accuracy of CDFF accuracy at lower radiation doses, enabling high diagnostic performance for hepatic steatosis while potentially reducing patient radiation exposure.

Objectives: Ultra-high dose rate (UHDR) irradiation spares normal tissues while achieving similar tumor control compared to conventional dose rate (CONV) irradiation in preclinical setting. However, the underlying biological mechanisms remain unclear. In this study, we examined the relationship between DNA damage and UHDR proton irradiation in both normal and cancerous pancreatic cells.

Methods: Normal human pancreatic cells (H6c7) and human pancreatic adenocarcinoma cells (PANC-1) were exposed to 3 and 15 Gy of 4 MeV protons (LET = 10 keV/µm) at 0.025 Gy/s (CONV) or 375 Gy/s (UHDR) under normoxic (21% O2) or hypoxic (1% O2) conditions. DNA damage was assessed by yH2AX immunofluorescence and by the alkaline comet assay.

Results: Following 3 Gy irradiation no significant differences in DNA damage were found between UHDR- and CONV-irradiated cells. In contrast, 15 Gy of UHDR irradiation significantly reduced DNA damage in H6c7 cells compared to CONV irradiation under hypoxia but not normoxia. No statistically significant FLASH sparing was found in PANC-1 cells irradiated with 15 Gy under either normoxic or hypoxic conditions.

Conclusions: UHDR proton irradiation shows potential in reducing radiation-induced DNA damage in normal but not cancer cells compared to CONV proton irradiation at relatively high doses and low oxygen levels.

Advances in knowledge: This is the first study that compared the responses of normal and cancerous cells-from the same background-to UHDR and CONV proton irradiation. In addition, our data confirm the importance of dose and oxygen concentration for observing the FLASH effect in normal cells.

Objective: To investigate the diagnostic value of MRI combined with distal radioulnar joint (DRUJ) stability characteristics and ulnar styloid bone marrow edema (BME) in differentiating peripheral vs. central triangular fibrocartilage complex (TFCC) injuries, and to establish a multiparametric MRI diagnostic model to optimize preoperative classification accuracy.

Methods: A retrospective analysis of 76 patients with arthroscopically confirmed TFCC injuries (55 peripheral tears, 21 central tears) was conducted. Preoperative MRI evaluated DRUJ stability and BME. Chi-square tests analyzed intergroup differences, binary logistic regression identified predictors, diagnostic efficacy metrics were calculated, and MRI-based classification, DRUJ stability, BME, and combined models were compared using arthroscopy as the gold standard.

Results: The peripheral tear group exhibited significantly higher BME positivity (82.9% vs. 11.1%) and DRUJ instability rates (70.9% vs. 9.5%) compared to the central tear group (both p < 0.001). Logistic regression identified BME positivity (OR = 0.140, 95% CI: 0.044-0.444) and DRUJ instability (OR = 0.103, 95% CI: 0.013-0.428) as independent predictors of peripheral tears (p = 0.001). The combined model (MRI+DRUJ+BME) demonstrated superior diagnostic performance (AUC = 0.898, 95% CI: 0.818-0.978; sensitivity = 76.2%, specificity = 94.6%) compared to MRI alone (AUC = 0.810) or DRUJ+BME models (AUC = 0.822).

Conclusion: The combined model integrating anatomic stability improves diagnostic specificity, providing critical guidance for preoperative stratification, surgical planning, and personalized treatment.

Advances in knowledge: Bone marrow edema (BME) and distal radioulnar joint (DRUJ) stability hold potential as supplementary MRI imaging biomarkers for TFCC injuries classification.

Artificial intelligence (AI), particularly deep learning (DL), is transforming the field of medical imaging and holds substantial promise for advancing breast cancer screening. This narrative review explores current and emerging AI applications in mammography screening, including image-based cancer detection, risk prediction, and workflow optimization, with attention to technical foundations, performance metrics, and clinical utility. Evidence indicates that AI may enhance diagnostic accuracy, enable more personalized risk assessment and screening strategies, and reduce radiologist workload, which has implications for accessibility, especially in resource-limited settings with radiologist shortages. However, real-world implementation of these tools remains challenging due to limitations in algorithm generalizability to diverse populations, calibration and reader response behavior concerns, as well as regulatory, ethical and legal obstacles. While the potential impact is considerable, broader adoption will depend on prospective validation, transparent performance reporting, and strong governance mechanisms to maintain safety, equity, and public trust.