British Journal of Radiology最新文献

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.

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 = 0.0184) and ISUP grade 3-5 (P < 0.0001), and demonstrated lower Dmean, ADCmin and ADCmean (P = 0.0209, P = 0.0160, P = 0.0302) than TZ cancers. There was significant differences in zonal origin, Dmean, ADCmin and ADCmean between the two ISUP risk groups (P < 0.0001, P < 0.0001, P = 0.0024, P = 0.0017). 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%.

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

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

Introduction: Ultrasound elastography is a promising non-invasive imaging technology that quantifies tissue elasticity. Only two studies have investigated ultrasound elastography for pneumothorax, both in strain elastography, reporting positive results and describing the novel elasto-lung point sign to aid in identifying the lung point. The objectives of this study are to confirm the existence of the elasto-lung point using two-dimensional shear-wave elastography (2D-SWE), and to evaluate the utility of elastography in pneumothorax cases lacking a detectable lung point.

Methods: prospective single-center study of thirty-two consecutive patients with imaging-confirmed pneumothorax. 2D-SWE measurements were collected from the pneumothorax area and the contralateral lung for comparative analysis. Ultrasound elastography was preferably performed during forced inspiration; when infeasible, measurements were collected during end-expiration or spontaneous breathing.

Results: 2D-SWE measurements were collected primarily during spontaneous breathing (93.8%) and showed no significant differences in elasticity between pneumothorax and healthy lung. The lung point was detected in 14 patients, with the elasto-lung point identified in 13 (93% sensitivity; Cohen's Kappa = 0.936, p < 0.001). 2D-SWE did not differentiate pneumothorax from healthy lung in absence of elasto-lung point.

Conclusion: 2D-SWE is a useful complement to ultrasound for detecting the lung point through visualization of the elasto-lung point. However, 2D-SWE could not distinguish pneumothorax from a healthy lung when the lung point was absent, contrasting with previously published results in strain elastography.

Advances in knowledge: this study confirms the existence of the elasto-lung point sign in 2D-SWE. However, 2D-SWE did not differentiate pneumothorax from healthy lung in absence of lung point.

Objectives: To evaluate the performance and technical parameters of whole body (WB)-MRI for staging and follow-up of primary musculoskeletal tumors.

Methods: A systematic review was done in PubMed and Embase through July 2025. Eligible studies reported WB-MRI for staging or follow-up of bone/soft tissue sarcomas. Extracted data were study design, patient characteristics, MRI protocols, scan duration and diagnostic performance. Methodological quality was assessed with QualSyst.

Results: A total of 10 studies, published between 2016 and 2024, were included from 432 records. Most were retrospective (90%), with study populations ranging from 9 to 319 patients (total n = 790, age range 2-80 years). Half of the studies focused on myxoid liposarcoma, while others addressed osteosarcoma, Ewing sarcoma and chondrosarcoma. WB-MRI protocols employed 1.5T and/or 3T scanners. Non-contrast protocols (8/10 studies) mostly included T1 and STIR sequences. Exam durations ranged from 30 to 78 minutes, with outliers up to 250 minutes. Reference standards included CT, PET-CT and bone scintigraphy. Diagnostic accuracy was investigated in only two studies, reporting 100% sensitivity, 96.3% specificity, and 97.3% accuracy for extrapulmonary metastases, 83%-88% sensitivity and 94%-95% specificity for bone metastases. The studies demonstrated high methodological rigor, with scores ranging from 16 to 19 out of 20.

Conclusions: : WB-MRI is a feasible and promising modality for staging and follow-up of primary musculoskeletal tumors. Evidence is still limited, based on heterogeneous and mostly retrospective studies. Larger, prospective, and standardized studies are needed to validate its accuracy, optimize imaging protocols and clarify its role in sarcoma imaging.

Endometriosis and adenomyosis are prevalent chronic inflammatory conditions that significantly impact reproductive-age women, leading to debilitating symptoms such as pelvic pain, dysmenorrhea, and infertility. Endometriosis is characterized by ectopic endometrial tissue outside the uterus, while adenomyosis involves endometrial deposits within the myometrium, often causing overlapping symptoms. Accurate diagnosis is essential for effective management, yet challenges persist due to variability in lesion location and presentation. Imaging plays a crucial role in the diagnosis, staging, and management of these conditions. While transvaginal ultrasound (TVUS) remains a reliable first-line tool with high specificity, magnetic resonance imaging (MRI) offers superior sensitivity, particularly for endometriomas and deep endometriosis. Both modalities have their limitations but are complementary in preoperative assessment and treatment planning. Emerging imaging protocols, classification systems, and advancements such as dynamic TVUS and improved MRI techniques are discussed. Despite significant progress, the lack of a universally accepted classification system and standardized imaging protocols highlights the need for further research. Advancing diagnostic accuracy and treatment strategies through imaging holds promise for improving patient outcomes. This article reviews the pathophysiology, staging and subtypes of endometriosis and adenomyosis. Recent society guidelines are addressed and readers are provided with updates on imaging technologies with insights into future directions.

Objectives: Direct Magnetic Resonance Arthrography (MRA) is widely used for joint distension to assess intra-articular structures. Gadolinium based contrast agents (GdCA) have been used widely but concerns have emerged regarding their safety and cost. This study assesses current practice of UK musculoskeletal radiologists within the context of these recent changes.

Methods: A questionnaire was disseminated to members of the British Society of Skeletal Radiology. This assessed whether responders performed MRA and-if so-investigated the techniques used. Responses were aggregated and compared to those from a comparator study from 2019.

Results: Of 45 survey respondents, 43 regularly perform direct MRA with 24 (56%) doing over three a month. Of the 43, 72% use gadolinium with 11 using a licenced preparation and 19 using an off-licence preparation. Twelve respondents (28%) used saline instead of gadolinium. Many respondents had recently changed their practice, most commonly due to logistics (15 respondents - 33%) with concerns over bioaccumulation (14 respondents) a close second. Financial cost and environmental impact concerns were less common. Additional comments highlighted the impact of Magnevist discontinuation and improvements in conventional MRI.

Conclusions: Although MRA remains prevalent, practice has changed for various reasons with a notable reduction in GdCA use. These considerations and alternatives to GdCA-MRA are discussed with reference to the existing literature and our tertiary centre experience.

Advances in knowledge: This study outlines the evolving state of MRA use by radiologists across the UK and discusses options to optimise safety in its use, particularly referencing GdCA use.

Objectives: Determine differences in quantitative stenosis severity measurements for ultra-high-resolution (UHR) photon-counting detector (PCD) coronary CT angiography (cCTA) relative to energy-integrating detector (EID) cCTA in a large patient cohort.

Methods: Adult participants seen between November 2022 and March 2023 underwent a clinical dual-source EID-CT cCTA and a research dual-source PCD-CT cCTA on the same day. Percent diameter stenosis (PDS) was measured, and stenosis severity was assigned based on the PDS of the most severe lesion per patient to determine a coronary artery disease reporting and data system (CAD-RADS) score. Agreement between EID-CT and PCD-CT for PDS and CAD-RADS was determined.

Results: A total of 112 participants were enrolled, yielding 82 subjects with at least 1 stenosis at PCD-CT (mean age, 68.0 ± 10.8 years; 69.5% [57/82] males). A total of 177 paired stenoses were quantified. The percent decrease in mean PDS from PCD-CT (24.3%) to EID-CT (29.4%) was 17.3% (median difference in PDS: -5.0%, 95% CI: -5.7% to -4.0%). The assigned CAD-RADS score changed in 31/82 subjects. In 11/31 subjects, the most severe stenosis was missed at EID-CT due to partial volume averaging of a small calcification, yet PCD clearly identified stenosis at those locations. In 20/31 subjects, the CAD-RADS score decreased at PCD-CT due to the decreased calcium blooming resulting from the improved spatial resolution.

Conclusions: UHR PCD cCTA decreases quantitative measures of stenosis severity when a stenosis is identified at EID, leading to decreases in CAD-RADS assignments.

Advances in knowledge: With its improved spatial resolution, PCD-CT identifies stenoses missed on EID-CT.