British Journal of Radiology最新文献

Objectives: To evaluate a multiparametric MRI protocol encompassing intravoxel incoherent motion diffusion-weighted imaging, diffusion kurtosis imaging, and dynamic contrast-enhanced MRI for discriminating aggressive (AEC) from non-aggressive type endometrial carcinoma (NAEC) according to the FIGO 2023 staging system.

Methods: This study involved retrospective analyses of a prospective dataset. 112 consecutive patients (77 NAEC and 35 AEC) underwent multiparametric MRI. Intratumoral and peritumoral quantitative MRI parameters were calculated. A multivariate logistic regression model comprising clinical data, conventional MRI features, and quantitative MRI metrics was constructed. Model performance was evaluated using receiver operating characteristic analysis, calibration curves, and bootstrap resampling (n = 1000).

Results: AEC demonstrated significantly lower perfusion fraction (f) and mean diffusivity (MD), but higher pseudo diffusion coefficient (D*) and peritumoral D* (D*_peri) compared to NAEC (all p < 0.05). Multivariate analysis identified f, peritumoral mean kurtosis (MK_peri), and peritumoral maximum slope of increase (MaxSlope_peri) as independent predictors of AEC (AUC = 0.791, 95% CI: 0.692-0.891). Integration of menopause status, tumor location and extension beyond corpus, and quantitative MRI parameters yielded a combined model with a stratified bootstrap AUC of 0.830 (95% CI: 0.800-0.846), particularly for FIGO 2023 stage I-II patients (AUC = 0.832, 95%CI: 0.742-0.922). Significant differences in D*, D*_peri, f, and MD were observed among NAEC with and without squamous differentiation and AEC groups.

Conclusions: Multiparametric MRI, incorporating advanced quantitative sequences and conventional MRI features, could help effectively predict AEC before surgery.

Advances in knowledge: The study bridges advanced imaging with the updated FIGO 2023 staging system, potentially offering a non-invasive assessment tool for endometrial carcinoma management.

Pericoronary adipose tissue (PCAT) is increasingly recognised as a biosensor of vascular inflammation. The guideline-driven widespread adoption of coronary computed tomography angiography (CCTA) as the first-line investigation for coronary artery disease (CAD) has created opportunities for evaluating the inflammatory burden through quantitative assessment of PCAT. Standardising raw PCAT imaging data for technical, anatomical, and biological variability provides the Fat-Attenuation Index (FAI) Score, which shows promise as a metric of coronary inflammation. Quantification of coronary inflammation has implications for the diagnosis, risk stratification, and monitoring of treatment in atherosclerotic cardiovascular disease. This review examines the anatomical and physiological basis of PCAT, highlighting the importance of standardising PCAT imaging for the implementation as a clinical biomarker, and reviews the role of artificial intelligence (AI) in enhancing precision and scalability. Emerging evidence on the modulation of FAI Score by therapeutic agents, including statins, biologics, and cardiometabolic drugs, and the potential utility of serial imaging in guiding clinical care is also discussed. With ongoing large-scale validation and emerging AI -based approaches, PCAT imaging is poised to complement traditional risk factors and plaque metrics; however, current evidence remains evolving, and the integration of inflammatory risk assessment could be useful to guide emerging anti-inflammatory treatments in personalised cardiovascular medicine.

Uptake of breast cancer screening varies between English regions despite adherence to similar screening protocols across regions and screening services. Poor uptake is thought to impair breast cancer outcomes, including the assumption of higher breast cancer mortality. There are known demographic differences between English regions, and there has been limited investigation into which characteristics are associated with behavior and outcomes in a single region compared with overall national performance. In this research letter, we outline the challenges we have faced when conducting this analysis using routinely collected data and provide recommendations to facilitate similar work in the future.

Objective: Breast cancer is the most prevalent cancer among UK women. Screening aims to detect cancer early, improving treatment options and survival. However, participation varies across England with lower participation and cancer detection rates in London than other regions. We postulate that demographic factors (age, ethnicity, deprivation, and migration) might explain some regional differences.

Methods: An ecological analysis of aggregated data compared English regions (April 2007 - March 2020). Primary outcomes were breast cancer mortality, coverage rate, and rate of screen-detected invasive cancers. Linear regression analyses compared outcomes between London and other English regions, adjusting for age, ethnicity, deprivation, and migration.

Results: Data included 104 observations aggregated from 26,202,645 screenings, of which 11.9% were in London. Coverage was lower in London (67.8%) than other English regions (73.6% - 79.8%). London had significantly lower rates of screen-detected invasive cancers (mean = 6.2 per 1000, SD = 0.2) compared to six of seven regions (ranging from 6.3 to 6.9 per 1000) and lower breast cancer mortality rate (mean = 31.7, SD = 0.8) than four regions (ranging from 33.4 to 36.1). Differences in coverage were attenuated and non-significant after adjustment for demographic factors.

Conclusion: Regional differences in screen participation are associated with demographic factors, but breast cancer outcomes in London are not worse than the rest of England. Targeted interventions to improve screening accessibility for underserved communities could reduce inequalities. We describe challenges associated with combining several sources of information when performing our analyses and further research using individual-level data is recommended to confirm results and explore additional predictors.

Advances in knowledge: This national ecological analysis demonstrates that lower breast screening coverage and invasive cancer detection rates in London are associated with demographic factors, particularly ethnicity, deprivation and migration. Despite poorer participation, breast cancer mortality in London is not worse than in other English regions. The findings emphasise the importance of demographic factors in breast screening outcomes and improved data linkage to address regional inequalities in breast cancer screening and outcomes.

Artificial intelligence (AI) models for diagnostic imaging face reproducibility challenges due to inconsistent reporting. Existing guidelines also lack specificity for imaging-based AI diagnostics, particularly regarding clinical usability and technical transparency. To address these gaps, the Completeness, Learnability, Applicability, Interpretability, Reproducibility, and Evaluation (CLAIRE) framework was developed as a practical reporting aid by a multidisciplinary team of clinicians and AI experts. CLAIRE was retrospectively validated on a subset of 10 imaging studies selected by theoretical saturation in medical and dental imaging. Internal validation demonstrated high reliability, with inter-rater agreement improving from Cohen's κ 0.286 to 0.987 (p < 0.01) after calibration, alongside a mean intra-rater reliability of 0.997 after a six-month washout period. This process yielded a 15-item structured checklist for standardising AI reporting, supported by an objective scoring system for quality categorisation and an editorial reference guide to facilitate systematic appraisal by reviewers and editors. CLAIRE aims to enhance clinician accessibility through plain-language technical summaries and assessments of real-world applicability. This proposal provides a unified and practical structure that improves reporting consistency, supports systematic assessment, and strengthens both reproducibility and clinical translation of AI-based imaging models.

Breast cancer is not just a disease; it is a global crisis that continues to claim lives, especially in low- and middle-income countries (LMICs), where late-stage diagnosis is the norm rather than the exception. Unlike high-income countries (HICs), where early detection has significantly improved survival rates, women in LMICs face an uphill battle against fragmented healthcare systems, limited diagnostic tools, cultural barriers, and financial constraints. The very technologies that revolutionized screening in HICs remain out of reach for many, leaving millions vulnerable to preventable deaths. This article calls for bold leadership and coordinated global efforts to ensure that every woman, regardless of geography or socioeconomic status, has access to life-saving early detection and treatment, in addition to highlighting the urgent need for equitable breast cancer screening in LMICs and exploring innovative approaches that have the potential to transform early detection and improve outcomes. Decentralized diagnostic hubs, AI-powered imaging, mobile screening units, and public-private partnerships are emerging as viable solutions to bridge the gap. Moreover, creative financing models and culturally tailored awareness campaigns offer hope for overcoming financial and social barriers. We can drive a paradigm shift toward equity in cancer care by reimagining breast cancer screening through technology and community engagement.

Objectives: The volar plate (VP) is critical for stabilizing the proximal interphalangeal joint (PIPJ) during flexion. However, its in vivo behaviour in individuals with generalized joint hyperlaxity (GJH) remains unclear. This study aimed to quantitatively assess VP displacement and its spatial relationship with the flexor digitorum profundus (FDP) tendon in individuals with/without GJH during PIPJ flexion and grasping conditions.

Methods: MRI scans of 64 index fingers (32 participants: 16 with GJH, 16 controls) were acquired at five PIPJ flexion angles (0°, 30°, 60°, 90°, full fist) under two stand,ardized loading conditions (grasping and forceful grasping). Measured parameters included distances from VP insertions to the PIPJ centre of rotation (CoR), between VP and FDP tendon, and between CoR and FDP. İnter-rater reliability was assessed via ICCs. Group × position effects were analysed using two-way repeated measures ANOVA with Greenhouse-Geisser correction, and correlations were examined for significant interactions.

Results: Most morphometric measures showed excellent reliability (ICC ≥ 0.76). CoR-VPTip and VP-FDP distances were significantly greater in the GJH group at specific angles, indicating altered VP dynamics (interaction p < 0.05). CoR-VPLip and VPLip-VPTip distances showed no group differences. VP-FDP correlation was weak to moderate (r = 0.41) during forceful grasping.

Conclusions: These findings suggest that GJH primarily modulates the deformation and positional dynamics of the VP's proximal portion and alters its interaction with the flexor tendon during PIPJ flexion.

Advances in knowledge: This MRI-based study reveals region-specific VP adaptations in GJH, emphasizing the clinical relevance of segmental soft tissue evaluation.

Objective: The objective of this systematic review is to investigate and synthesize the existing literature on the association of endometrial pathologies with infertility and malignant potential in premenopausal and postmenopausal women, with a specific emphasis on evaluating the diagnostic utility of transvaginal ultrasound.

Material and methods: Google Scholars and PubMed were searched systematically, in addition to manual searches, to compile the literature review. We came across 50 articles, only 35 made it past the initial screening. 24 items were left out because they were either non-English references, needed copyright clearance, or required a subscription. The final review had a total of 15 papers. Only original research papers and systematic reviews that sonographically examined the endometrial pathologies and papers that mentioned infertility risk and malignant potential of these diseases in pre and postmenopausal women were included.

Results: The results underscore the complex interplay between endometrial pathologies, infertility, and malignant potential, providing valuable insights for clinicians and researchers in the field.

Conclusion: Postmenopausal women are at increased risk of malignant potential as compared to premenopausal women. The malignant potential of endometrial cancer and endometrial hyperplasia is exceptionally high while lower in case of endometrial polyps and submucosal uterine leiomyomas. Some endometrial lesions, such as endometrial polyps, submucosal uterine leiomyoma and endometritis, are reportedly strongly associated with infertility.

Advances in knowledge: This review adds clarity to how different endometrial pathologies relate to infertility and cancer risk, and it underscores the value of transvaginal ultrasound in assessing these conditions across various reproductive stages.

Endocrine hypertension is an uncommon but treatable cause of secondary hypertension. It results from excessive hormone production by the endocrine glands or due to ectopic hormone production. The causes of abnormal hormonal production can be congenital or acquired. Specific syndromes can also predispose to the development of endocrine hypertension. Extensive catecholamine production can occur due to pheochromocytomas and paragangliomas. Excessive aldosterone secretion by the adrenal cortex commonly occurs due to idiopathic (bilateral) adrenal hyperplasia or aldosterone-producing adrenal adenomas. Excessive cortisol production can occur secondary to abnormalities in the adrenal gland, the pituitary gland, or ectopic hormone production, or it can be caused by exogenous steroid intake. Other endocrine conditions that can lead to hypertension include acromegaly, primary hyperparathyroidism, hyperthyroidism, and hypothyroidism. Imaging plays a vital role in diagnosing the cause of endocrine hypertension, leading to appropriate management. The clinical presentation and laboratory investigations serve as a guide to the appropriate imaging investigation that needs to be performed to confirm a diagnosis.