British Journal of Radiology最新文献

Artificial intelligence (AI) holds great promise for advancing diagnostics and treatment in nuclear medicine. The rapid growth of AI over the past decade largely driven by advances in hardware components such as graphics processing units (GPUs) and the introduction of Deep Learning (DL) and convolutional neural networks (CNN). The integration of AI and medical imaging has the potential to revolutionize nuclear medicine by, e.g., accelerating image acquisition, enhancing image quality, enabling advanced image generation, assisting image interpretation, and aiding treatment planning. Clinical applications have been demonstrated for most medical specialties, including oncology, neurology and radionuclide therapy. The utilization of AI to provide automated, standardized procedures can help bring advanced imaging from major university centers to smaller local clinics, thus benefiting a broader range of patients. Additionally, AI has vast potential for predicting optimal treatment strategies, assessing risk, optimizing patient flow and outcome, and even improving productivity, but these capabilities have yet to be fully utilized. The fraction of clinical AI applications in general healthcare reaching beyond the prototyping phase are reported as low as 2% [1]. Indeed, in nuclear medicine very few AI developments have reached commercial maturity. Currently, most AI applications in nuclear medicine follow the imaging flow from image acquisition and reconstruction, post-processing and image preparation, image analysis, and decision support for clinical interpretation. Below we will briefly review selected areas and comment on challenges and opportunities for AI in nuclear medicine, with a special focus on the transition from development to clinical implementation.

Objectives: FLASH radiotherapy (FLASH-RT), characterized by ultra-high dose rate irradiation (>40 Gy/s), has demonstrated the potential to spare normal tissues while maintaining tumor control. Most proton and electron FLASH studies have focused on whole-organ irradiation, and the normal tissue-sparing effects of high-dose proton FLASH-RT in localized thoracic settings remain unclear.

Methods: A preclinical mouse model was developed to evaluate localized high-dose (60 Gy) proton FLASH irradiation to the left lung using spot-size transmission at FLASH (500 Gy/s) or conventional (2 Gy/s) dose rates. Lung and skin responses were assessed by histology, flow cytometry, and enzyme-linked immunosorbent assays.

Results: FLASH-irradiated lungs exhibited decreased pneumonitis and fibrosis compared to conventional irradiation, with faster resolution of tissue damage. Skin toxicity, including epidermal thickening and dermal fibrosis, was significantly reduced after FLASH-RT. At the molecular level, FLASH-RT reduced oxidative stress and inflammatory injury, demonstrated by lower Nrf2 activation, reduced 8-OHdG levels, and decreased MPO expression. Systemically, FLASH-RT led to lower neutrophil-to-lymphocyte ratios and decreased serum IL-6, TNF-α, and IFN-γ, indicating reduced inflammation.

Conclusions: Our findings provide the first evidence that proton FLASH-RT at ablative dose levels (>60 Gy) confers localized protection against radiation-induced lung and skin injury in a preclinical setting. These results support the potential of high-dose proton FLASH-RT for thoracic application, though further studies are needed to establish dose-response relationships and optimize clinical beam configurations.

Advances in knowledge: High-dose proton FLASH-RT preserves lung and skin, and mitigates oxidative and inflammatory responses, offering insights into mechanisms underlying the FLASH effect.

Objectives: Given the heterogeneous nature of Alzheimer's Disease (AD) and its higher prevalence in females, it is crucial to understand sex-related differences in AD presentation and changes in the brain.

Methods: : This systematic review investigates sex differences in AD and summarizes key findings from neuroimaging studies over the past two decades to examine how genetics, hormones, and lifestyle factors influence neuroimaging biomarkers and their correlation with cognitive decline and AD progression. A comprehensive literature search was conducted across several databases for human studies from 2004 to 2024 related to AD, biological sex differences, and neuroimaging.

Results: : After a three-step review process, the final extraction included 120 peer-reviewed studies using various neuroimaging modalities, such as Magnetic Resonance Imaging (MRI), amyloid-beta Positron Emission Tomography (PET), tau-PET, and Fluorodeoxyglucose (FDG) PET, to investigate sex as a biological predictor variable in adults with or at risk for AD. Over 90% of the reviewed studies identified clear sex-specific patterns of imaging biomarkers related to cognitive reserve, hormonal changes, APOE-ɛ4 genotype, inflammation, vascular health, and lifestyle factors. Machine learning studies increasingly incorporate sex as a key variable, revealing sex-specific biomarkers and improving model performance in predicting disease status and progression.

Conclusions: Considering biological sex in AD research is essential for improving diagnostic accuracy, tailoring interventions, and health outcomes.

Advances in knowledge: This systematic review identifies sex-specific patterns in neuroimaging biomarkers of Alzheimer's Disease, influenced by cognitive reserve, hormones, APOE-ɛ4 genotype, inflammation, vascular health, and lifestyle. Recognizing these differences is crucial for understanding, diagnosis, and treatment efficacy.

Interventional oncology has gained a lot of traction as an attractive alternative treatment for various musculoskeletal tumors by offering minimally invasive image-guided therapies. In this domain, thermal ablation is increasingly being used malignant tumors, including bone metastatic disease. Thermal ablation therapies such as radiofrequency ablation, microwave ablation, cryoablation and high intensity focused ultrasound therapy achieve excellent local tumor 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.

Cardiovascular disease (CVD) is the leading global cause of morbidity and mortality. Beyond clinical risk factors and cardiac imaging, extracardiac imaging biomarkers provide complementary insight into cardiometabolic health. Routine noncardiac imaging often depicts the liver, kidneys, pancreas, lung, brain, adipose tissue, muscle, vasculature, breast, and bone, enabling opportunistic risk assessment. Nonalcoholic fatty liver disease (NAFLD), detectable on MRI, CT, and ultrasound, independently predicts major adverse cardiovascular events (MACE). Chronic kidney disease-related markers including kidney size, vascular calcification, and renal resistive index also correlate with adverse outcomes. Reduced pancreas volume is similarly associated with cardiovascular disease. CT-quantified emphysema and lung hyperinflation are associated with coronary artery disease and cardiovascular mortality. Cerebral small vessel disease markers, such as white matter hyperintensities and silent brain infarcts, demonstrate associations with cardiovascular events. Ectopic adiposity and sarcopenia quantified by CT, MRI, and ultrasound add prognostic value beyond body mass index. Extracardiac vascular and skeletal biomarkers, such as breast arterial calcification and low bone mineral density, further associate with cardiovascular morbidity and mortality. Collectively, these markers improve risk stratification and enable screening without added cost or radiation. Future priorities include standardization, external validation, and integration into risk prediction models to advance precision cardiovascular medicine.

"Women are overall underrepresented in high-level leadership positions across organisations, particularly in the fields of healthcare, medical imaging, and oncology, despite the majority of the workforce in these industries being female. Women leaders often remain in these roles for shorter times, despite evidence documenting their value in increasing team wellbeing, productivity and collaboration and supporting organisational integrity, sustainability, diversity and inclusion. The reasons are complex, but often due to a lack of ongoing support or poor local culture. There is an urgent need to harness the potential of female leadership, not only to leverage equity and diversity, but mainly to solve the complex healthcare challenges of our diverse society now and in the future. Customised training and mentoring, clearer career pathways, flexible work, workplace adaptations and male allyship are key to raising, nurturing and supporting female leaders in the long term."

Objective: We evaluated whether automated CT-based adiposity tools can predict all-cause mortality in a large retrospective adult population.

Methods: This study included 151,177 patients who underwent abdominal CT between 2000 and 2021. An AI-based algorithm measured abdominal visceral adipose tissue (VAT) cross-sectional area and density at the L3. Kaplan-Meier survival curves and hazard ratios assessed VAT and mortality.

Results: Among 136,895 patients included, 9,059 died within one year and 18,829 died within 2 to 20 years post-CT. Higher VAT density predicted 1-year mortality (hazard ratio [HR] up to 3.8) and over 2-20 years (HR up to 2.1). In contrast, VAT area did not significantly predict mortality. High VAT density was associated with the poorest survival, regardless of area. Low VAT density predicted better survival, regardless of area. VAT density consistently predicted mortality across age groups and sexes, whereas BMI did not differentiate risk.

Conclusions: AI-enabled CT measures of VAT density are superior to VAT area for predicting all-cause mortality. Furthermore, we analyzed VAT density vs. BMI in our largest age group (40-59) and found BMI was unable to adequately predict risk of mortality. Automated assessment of VAT density may enhance patient risk assessment and management.

Advances in knowledge: Assessing visceral fat density using fully automated AI-based CT tools offers a significant advancement in predicting health risk, leading to targeted interventions and improved management strategies. This study is novel due to its large patient population, offering evidence that prognostication with VAT density is broadly generalizable across varying patient populations.

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 five locations around the foot. Outcome measures included: i) the drainage routes of contractile lymphatic collectors observed, ii) the number of lymphatic vessels crossing the anterior ankle and iii) 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 characterisation 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.

Ultrasonography, especially Transvaginal sonography (TVS) is an effective, non-invasive and reliable investigation for the diagnosis of adenomyosis. The Morphological Uterus Sonographic Assessment group consensus terminology provides a standardised lexicon for the description of myometrial lesions and has been recently revised to include direct and indirect features of adenomyosis on sonography. In this article, we aim to provide a simplified framework for the practical application of the MUSA group consensus terminology in the ultrasonographic evaluation of adenomyosis, aiding in accurate diagnosis and informed decision-making.

Objectives: Postoperative radiotherapy (RT) for breast cancer (BC) improves survival by preventing local recurrence but can lead to radiation-induced pulmonary fibrosis (RIPF). RIPF typically appears within 6-12 months post-RT and may progress over two years. This study assessed RIPF development in BC patients undergoing hypofractionated RT and evaluated the effects of rehabilitation interventions.

Methods: A total of 209 BC patients were observed: 106 in the study group received rehabilitation, while 103 in the control group followed the standard protocol. Rehabilitation included medications (Aquadetrim, Adenorin, Contimax, Magnesium B6) and topical sodium nucleonate spray. All patients received an average dose of 42.56 Gy over 16 sessions.

Results: RIPF developed in 90.3% of patients, with an average onset at 8.7 months post-RT. Rehabilitation delayed RIPF onset-by 8.9 months in the control group vs. 9.8 months in the rehabilitation group-showing a 9.9% improvement (p = 0.034). Body mass index (BMI) was a significant factor: patients with BMI >25 developed RIPF earlier (7.5 months) than those with BMI <25 (11.3 months, p = 0.005). Age and cancer side had no significant effect, though right-sided BC showed slightly earlier onset. Grade 2 skin reactions were linked to higher fibrosis incidence, though not statistically significant.

Conclusions: Rehabilitation may delay RIPF onset, and BMI appears to be a strong predictor of its development. Future research should explore additional risk factors for RIPF in BC patients post-RT.

Advances in knowledge: This study is among the first to show that targeted rehabilitation protocols may effectively delay RIPF onset after hypofractionated RT in BC patients.