British Journal of Radiology最新文献

Objectives: To evaluate trends in CT utilization and recurrent exam frequency among elderly patients and assess implications for radiation risk.

Methods: We retrospectively analyzed CT exams performed at a quaternary-care academic hospital from 2014 to 2024. Patients were stratified into decade-based age groups, with the elderly defined as ≥ 60 years. Annual CT volume share and per-patient exam frequencies were computed, with emphasis on high-frequency use (≥2, ≥3, ≥5, and ≥10 exams/year). Temporal trends were assessed using centered log-ratio transformation and linear regression analysis.

Results: The proportion of CTs performed in patients aged 60-90 years rose from 50.4% in 2014 to 58.3% in 2024 (+7.9%). Elderly patients undergoing ≥2 exams/year increased from 25.6% to 26.6% (+1.0%), while for non-elderly patients it decreased from 17.4% to 12.7% (-4.8%). Similar trends were observed for those undergoing ≥10 exams/year. Elderly patients represent the largest group receiving recurrent CTs. The proportion of CTs in elderly is expected to rise to nearly 66% in 2035, a projected 7.2% increase from 58.3% in 2024.

Conclusions: CT imaging is becoming increasingly concentrated in elderly populations, reflecting both demographic and clinical drivers. While the radiation risk per individual exam remains small, cumulative exposure and the growing demand for imaging in older adults highlight the need for balanced strategies that ensure clinical benefit while maintaining optimized, justified radiation use.

Advances in knowledge: CT utilization among elderly patients is projected to reach two-thirds of all CTs by 2035, underscoring that radiation safety considerations for the elderly should not be neglected.

Objectives: The purpose of this study was to compare the actual bladder capacity of children undergoing voiding cystourethrogram (VCUG) with existing formula-derived estimates and to describe any adverse effects of bladder overdistention during VCUG.

Methods: This retrospective study involved review of 884 consecutive VCUG performed over 3 years. Cases with underlying conditions that could artificially increase bladder capacity, such as neurogenic bladders or vesicoureteral reflux, were excluded.

Results: Included were 440 normal VCUG procedures. Bladder volumes exceeded the expected bladder capacity set by the American Academy of Pediatrics (AAP) and American College of Radiology in 284 VCUG (65%). Of 261 VCUG performed on children <2 years of age, 164 (63%) VCUG exceeded the expected capacity. In the 2- to 14-year-old age group, 113 (68%) of the 165 VCUG performed exceeded the expected bladder capacity. Among the 14 VCUG performed on children >14 years of age, 7 (50%) exceeded the bladder capacity. No adverse effects were found after the VCUG in the 32 VCUG (7.3%) requiring a contrast volume of more than 2 times the AAP estimates and in the 22 VCUG studies (5%) requiring a contrast volume of more than 3 times the AAP estimates.

Conclusion: This study suggests that current guidelines often underestimate bladder capacity, and exceeding the expected bladder capacity appears to be reasonably safe without the occurrence of complications.

Advances in knowledge: Current AAP guidelines often underestimate the capacity of the urinary bladder. Exceeding the expected bladder capacity appears to be reasonably safe.

Objectives: To evaluate a multi-parametric dual-energy CT (DECT) radiomics model combined with clinical factors and DECT findings for differentiating between laryngeal benign and malignant lesions.

Methods: For this retrospective study, the radiomic models were constructed based on a whole cohort of 282 patients underwent DECT examination. The radiomics signature was selected based on reproducible features by using the least absolute shrinkage and selection operator method, and highly related radiomic, clinical features and DECT findings were selected to establish the radiomics-clinical model by using multivariable logistic regression analysis. Nomogram performance was evaluated by its discrimination, calibration, and clinical use.

Results: Compared with the single-parametric DECT radiomic models, the multi-parametric model can improve the diagnostic efficacy for differentiating laryngeal benign from malignant lesions, with area under the curves (AUCs) of 0.938 in training set and 0.920 in test set, respectively. Moreover, multi-parametric DECT-based radiomics-clinical model incorporates the radiomics signature and DECT-reported lesion size showed the best diagnostic performance (AUC of 0.945) in the whole cohort, when compared with the radiomics model (AUC of 0.933, P <.05) and clinical model (AUC of 0.855, P <.05).

Conclusions: The multi-parametric DECT-based radiomics-clinical model can serve as an important modality for non-invasively differentiating laryngeal benign lesions from malignant ones.

Advances in knowledge: This study highlights the value of DECT-based radiomics model for differentiating laryngeal benign from malignant lesions. Moreover, the combination of radiomic, clinical features and DECT findings demonstrated good performance for differential diagnosing in laryngeal lesions.

Objectives: We performed a retrospective study comparing 2 rectal preparation regimens, Polyethylene Glycol 3350 (PEG) and Fleet Enema (FE), in patients undergoing prostate stereotactic body radiation therapy (SBRT).

Methods: The study included 24 patients receiving prostate SBRT (40 Gy in 5 fractions), for a total of 120 treatment fractions. Patients received either FE (N = 73) or PEG (N = 47) for rectal preparation. Outcomes included: (1) treatment time, measured from the initial setup cone-beam CT (CBCT) to the post-treatment CBCT (including rectal-related interventions, excluding machine delays); (2) intra-fraction motion, defined as the displacement vector between verification and post-treatment CBCTs registered to fiducial markers; and (3) clinical acceptability, determined by blinded review of all setup CBCTs by 3 radiation therapists (RTs), who scored each scan as either "Acceptable" (proceed directly to treatment) or "Need Intervention." Regression analysis was used to compare regimens.

Results: Population-averaged median treatment times were 14 minutes (95% CI, 5.8-22.2) for PEG and 11 minutes (95% CI, 9.6-12.3) for FE, with greater time variability in PEG (P < .001). Intra-fraction motion did not differ significantly between regimens. All 3 RTs judged the setup CBCTs as clinically acceptable for treatment 47.7% of the time (95% CI, 31.6%-63.8%) for the PEG regimen and 74.4% of the time (95% CI, 61%-87.8%) for the FE regimen.

Conclusions: Overall, the FE regimen showed greater consistency in all outcome measures. This suggests an operational advantage for using FE since it results in more consistent patient treatment times without negatively impacting treatment quality and precision.

Advances in knowledge: Daily FE improves the consistency of prostate SBRT treatment and enhances the clinical workflow by minimizing unplanned disruptions.

Objectives: To characterize contemporary UK practice in prostate MRI reporting and pathways, and identify priorities for standardization.

Methods: Between February and April 2025, a questionnaire was distributed by the British Society of Urogenital Radiology to UK-based consultant radiologists who report prostate MRI. It contained 34 questions, covering 6 domains: demographics; MRI protocols; biopsy; reporting preferences; imaging pathways; and attitudes towards accreditation.

Results: Seventy-seven radiologists representing 52 NHS Trusts across all nations of the UK responded. Key findings include variable patient preparation for MRI including anti-spasmodic medication (69.2% administering) and instruction related to bowel preparation (13.5%). Trusts (100) were performing MRI prior to biopsy for suspected cancer; 73.1% using multiparametric MRI. When reporting prostate MRI for suspected cancer, 28.6% document only a PI-RADS score, 27.3% only a Likert score, with 44.1% stating both. The PI-QUAL score is moderately well known (71.4% of respondents) but not in routine use (7.8%). Transperineal prostate biopsy was performed at 88.5% of Trusts, with biopsy more likely to be performed by urologists (98.1% of Trusts) or urology nurses (36.5%) than radiologists (26.9%). Patients with high- or very high-risk prostate cancer undergo variable staging pathways, with university teaching hospitals more likely to offer PSMA PET/CT than other settings (33.3% vs 12.0%, P = .023).

Conclusions: This survey shows the current state of UK prostate MRI practice, including universal pre-biopsy MRI. It identifies areas for standardization, including MRI protocols, scoring systems, and national staging guidelines.

Advances in knowledge: Provides an up-to-date snapshot on prostate MRI within the UK.

Interventional oncology has gained a lot of traction as an attractive alternative treatment for various musculoskeletal tumours by offering minimally invasive image-guided therapies. In this domain, thermal ablation is increasingly being used malignant tumours, including bone metastatic disease. Thermal ablation therapies such as radiofrequency ablation, microwave ablation, cryoablation and high intensity focused ultrasound therapy achieve excellent local tumour control and pain palliation, whilst structural stability is ensured through the combination with bone augmentation techniques such as standard or reinforced osteoplasty. Many factors are affecting the results including the biology of the disease the treatment intent (curative or palliative) as well as the potential for complications, like thermal injury to surrounding tissues, highlight the need for meticulous procedural planning. This review highlights the pathophysiology, the current repertoire of thermal ablation techniques, clinical outcomes and the future directions for the treatment of metastatic bone disease.

Objectives: Indocyanine green lymphography (ICGL) has emerged as a potentially powerful tool for the study of the superficial lymphatic system and to support the diagnosis of lymphoedema. However, detailed descriptions of ICGL findings in healthy individuals are limited. In this study, we imaged a series of healthy participants using ICGL, attempting to establish quantitative and qualitative ICGL parameters of the lower limb.

Methods: Sixteen healthy individuals aged 20-55 years were recruited to undergo lower limb ICGL after 0.1 mL injections of 1 g/L ICG were administered intradermally to 5 locations around the foot. Outcome measures included: (1) the drainage routes of contractile lymphatic collectors observed, (2) the number of lymphatic vessels crossing the anterior ankle, and (3) the pumping frequency of lymphatic vessels. Abnormal features, such as highly tortuous or vessels with retrograde lymph flow, were noted.

Results: Propulsion of ICG containing lymph could be seen in all individuals, with drainage via the anteromedial and anterolateral drainage pathways predominating (observed in 31/32 and 25/32 limbs, respectively). The number of lymphatic vessels crossing the anterior ankle was 3.4 ± 1.1 with an average rate of 1 propulsion every 66 seconds in the vessels investigated. Isolated cases of highly tortuous and refluxing vessels were observed.

Conclusions: Although limited by absorption and scatter of infrared light, ICGL facilitated the characterization of normal lower limb lymphatic vessels through a rigorous set of objective measures. This in turn will allow better identification of pathological changes.

Advances in knowledge: Establishment of normal lower limb lymphatic anatomy and function.

Objectives: To establish a 3D V-Net-based segmentation model for adrenal glands on abdominal CT images and validate its performance in multicentre datasets, including chest CT images.

Methods: CT images of adrenal glands were retrospectively collected for the training of the adrenal segmentation model. Abdominal CT scans with normal and abnormal adrenal glands (N = 5660) were recruited as the model development cohort and were split into training, internal validation, and internal test sets for the development of the segmentation model. Two groups of health screening subjects were included for model validation: 1 from the same institution (N = 6126, validation cohort 1) and 1 from an outside institution (N = 931, validation cohort 2). Their chest CT images were used for model validation. The Dice similarity coefficient (DSC) was used to evaluate the efficacy of the model.

Results: The DSC of the test set for left and right adrenal segmentation were 0.920 (0.890-0.930) and 0.910 (0.890-0.930), respectively. In the validation cohorts, the DSC were 0.816 (0.744-0.866) for the left adrenal gland and 0.819 (0.743-0.865) for the right adrenal gland in validation cohort 1, and 0.752 (0.666-0.820) for the left adrenal gland and 0.747 (0.673-0.812) for the right adrenal gland in validation cohort 2.

Conclusions: The 3D V-Net-based adrenal segmentation model achieves considerable segmentation efficacy and demonstrates generalizability from abdominal CT to chest CT, making it suitable for use in CT images with various scanning protocols.

Advances in knowledge: The study developed a deep learning model using 3D V-Net for the segmentation of adrenal glands on CT images, achieving good performance of normal and abnormal glands in validation cohorts with different scanning protocols and from multiple institutions, demonstrating its potential as a "flagging" system aiding diagnosis.

Objectives: To investigate the value of combining zonal origin with intravoxel incoherent motion (IVIM) parameters in predicting the International Society of Urological Pathology (ISUP) risk groups of prostate cancer.

Methods: The retrospective study enrolled 351 prostate cancer patients who underwent mpMRI including IVIM. Patients were stratified into low-risk and high-risk group according to ISUP grades, and divided into peripheral zone (PZ) and transition zone (TZ) cancer group according to zonal origins of lesions. Clinicopathological characteristics and IVIM-derived parameters between groups were compared. Logistic regression was performed to identify variables associated with ISUP high-risk group. The predictive accuracy of the variables for ISUP risk groups was evaluated using receiver operating characteristic (ROC) analysis.

Results: PZ cancers exhibited higher proportion of pathological stage ≥pT3 (P = .0184) and ISUP grade 3-5 (P < .0001), and demonstrated lower Dmean, ADCmin, and ADCmean (P = .0209, P = .0160, P = .0302) than TZ cancers. There was significant differences in zonal origin, Dmean, ADCmin, and ADCmean between the 2 ISUP risk groups (P < .0001, P < .0001, P = .0024, P = .0017). Zonal origin, prostate-specific antigen (PSA), Dmean, and ADCmin were identified as independent predictors of ISUP high-risk disease. The comprehensive model combining zonal origin, PSA, Dmean, and ADCmin demonstrated superior predictive performance (AUC = 0.956, 95% CI: 0.930-0.981) with a sensitivity of 90.63% and a specificity of 76.04%.

Conclusions: The combined diagnostic model demonstrates high efficiency for predicting the ISUP risk group preoperatively for prostate cancer.

Advances in knowledge: The multiparameter predictive model including anatomical zones offers a non-invasive and effective tool for preoperative risk stratification for prostate cancer, thereby improving decision-making precision, and reducing unnecessary invasive procedures.