British Journal of Radiology最新文献

Objectives: To determine the diagnostic accuracy of ultrasonography for the evaluation of proximal hamstring injury.

Methods: A cross-sectional observational study was carried out in the Department of Radiodiagnosis and Interventional Radiology in a tertiary care center, over a period of 18 months. Patients (20-50 years age) with clinical suspicion of proximal hamstring injury were included, after subjecting them to the selection criteria. Ultrasonography was performed using the 9-12 and 12-18 MHZ linear transducers on Siemens S-3000 machine, while MR imaging was done on 3 Tesla GE Discovery machine.

Results: 50 patients (M: F = 33:17) were included in the study. USG detected proximal hamstring injuries in 34 (68%) participants, consistent with MRI findings. Tendinopathy emerged as the most prevalent diagnosis (42%), followed by isolated tears (14%) and combined tendinopathy and tears (12%). USG demonstrated a sensitivity of 91.2% and a specificity of 81.2%, with an overall diagnostic accuracy of 88%. The PPV and NPV were 91.2% and 81.2% respectively. A Cohen's Kappa coefficient of 0.724 indicated substantial agreement between USG and MRI findings.

Conclusion: Ultrasonography is a reliable and cost-effective diagnostic tool for proximal hamstring injuries, demonstrating high concordance with MRI. Its integration into clinical practice has the potential to improve accessibility and expedite diagnosis while reducing healthcare costs.

Advances in knowledge: In our study, high diagnostic accuracy was obtained through a combination of clinical and USG examination, therefore, USG can be used as a first line investigative modality for suspected Hamstring injury.

Objectives: To test the feasibility and quantify the performance of low-dose CT urography (CTU) with artificial intelligence iterative reconstruction (AIIR) for bladder cancer (BC) evaluation.

Methods: A total of 122 patients undergoing CTU examination were prospectively enrolled, where the routine-dose scan (120 kVp, ref 100 mAs) at corticomedullary phase (CMP) was followed immediately by a low-dose scan (120 kVp, ref 20 mAs). Routine-dose images were reconstructed with hybrid iterative reconstruction (HIR, RD-HIR), while low-dose images were with AIIR (LD-AIIR) and HIR (LD-HIR). The image quality was first evaluated regarding streak artifacts around the bladder and then in contrast-to-noise ratio (CNR) for various manifestations of bladder wall. The diagnostic performance of BC was characterized using receiver operating characteristic (ROC) analysis, in respect to the clinical diagnostic report.

Results: The effective dose at low-dose CMP was 80.2% lower than routine-dose scan (7.6 ± 1.2 vs 1.5 ± 0.3 mSv). Nineteen cases in LD-HIR were deemed clinically unacceptable for presenting severe artifacts around the bladder, while found well above the basic requirement in LD-AIIR. The highest CNR was found in LD-AIIR in all scenarios (all p < 0.001). The area under ROC curve in LD-AIIR was comparable to RD-HIR (0.988 vs. 0.990, p = 0.172) and significantly higher than LD-HIR (0.988 vs. 0.831, p < 0.001).

Conclusions: The low-dose AIIR protocol allows for a profound dose reduction (80.2%) while maintaining reliable diagnosis of bladder cancer on corticomedullary phase CTU images.

Advances in knowledge: Corticomedullary phase CTU with AIIR permits 80.2% dose reduction while preserving reliable BC diagnosis.

Objectives: To assess whether 3D photoacoustic tomography (PAT) using the Fabry-Perot (FP) scanner can (i) reliably detect synovitis in participants with rheumatoid arthritis (RA), and (ii) assess the severity of active inflammation.

Methods: A total of 247 3D-PAT images of the finger and wrist joint from 11 healthy volunteers and 9 patients with RA were obtained using the FP scanner. Patients underwent power doppler ultrasound (PDUS) assessment of RA disease activity. 3D-PAT images were acquired over a 15x15x10mm3 volume in < 15 s. The images were assessed quantitatively by segmentation of the vasculature using k-means clustering followed by skeletonisation to measure vascular path length (PAT-VPL). Patient and volunteer PAT-VPL were compared using t-tests and area under the receiver operating characteristic curve (ROC-AUC).

Results: 3D-PAT differentiates between unaffected and affected joints in patients with RA, showing a statistically significant difference in PAT-VPL (unaffected joint: 11.88 mm, affected joints: 45.7 mm, p < 0.001). The ROC-AUC was 0.91 (95% confidence interval (CI) 0.81-0.96), with sensitivity and specificity of 86% (95%CI 72%-95%) and 78% (95%CI 60%-90%), respectively. PAT-VPL was associated with PDUS-based clinical severity grade, with a correlation coefficient of 0.74 (95% CI: 0.67-0.8). Significant differences in PAT-VPL were observed between each clinical severity group.

Conclusions: The FP scanner generates rapid high-resolution quantitative 3D-PAT images of the synovial microvasculature that can be used to distinguish between inflamed and non-inflamed joints, and assess the severity of active inflammation.

Advances in knowledge: The 3D-PAT FP scanner reliably distinguishes between affected and unaffected finger and wrist joints in patients with rheumatoid arthritis. Compared to previous 2D PAT scanners used to image joint inflammation, it offers superior image quality and the prospect of mitigating operator-dependent variations in probe positioning by virtue of its 3D imaging capability.

Objectives: To systematically review existing MRI-safe lower limb traction methodology and describe a simple, accessible technique that provides an economically viable alternative to specialised equipment.

Methods: Embase, Emcare, HMIC, Medline, and Ovid Journal databases were queried without time or language limitations (registered protocol INPLASY2025100045). Studies with lower limb traction-enhanced MRI were included, studies without traction methodology were excluded. The novel MRI-safe-traction setup consisted of a pillow "traction-hill" supporting the leg, a rolled-up blanket fulcrum and saline weights. In-line traction forces were experimentally measured at different weights and "traction-hill" angles.

Results: Included studies (n = 31; 22 hip, 6 ankle, 4 knee, 1 foot; 2321 joints total) demonstrated four main types of MRI-safe-traction methods. Custom components were common (n = 24), bias and traction method reporting completeness varied. Excluded studies (n = 31) mainly lacked traction-enhanced MRIs (n = 16) or traction method description (n = 11). The described novel technique provided adequate pain relief and satisfactory MRI image quality for a paediatric midshaft femoral fracture patient. Mechanical in-line traction force validation was at least equal to or greater than the suspended weight.

Conclusion: A wide variety of approaches exist for MRI-safe lower limb traction, many relying on custom or special kit. We have described a successful compact MRI-safe lower limb traction setup utilising only commonly available items, enhancing accessibility.

Advances in knowledge: Traction enhanced MRIs (used to improve visualisation of joint space pathologies) frequently utilise custom or specialised MRI-safe traction equipment. This paper systematically reviews lower limb MRI safe traction methodology, and describes a clinically successful, compact traction technique utilising commonly available items.

Objectives: We performed a retrospective study comparing two 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 three radiation therapists, 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 < 0.001). 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: Management guidelines for incidental aortic dilation detected on low-dose chest computed tomography (LDCT) lung cancer screening (LCS) are lacking. Therefore, this study aims to validate artificial intelligence (AI) software for automated aortic measurements and assess aortic dilation distribution in screening participants.

Methods: Baseline LDCT scans from two tertiary centers (April 2017 to December 2023) were reviewed. In 100 randomly selected cases, radiologist- and AI-measured maximum aortic diameters (MADs) were compared at the ascending thoracic aorta (ATA), aortic arch (AACH), descending thoracic aorta (DTA), and abdominal aorta (AA). AI then analyzed all scans, and coronary artery calcification (CAC) was assessed using the Agatston method to evaluate correlations with MADs.

Results: Overall, 1,204 patients (99.2% men; mean age ± SD: 62.7 ± 5.4 years) were included. Intraclass correlation coefficients between radiologists and AI were 0.950, 0.758, 0.933, and 0.931 for ATA, AACH, DTA, and AA, respectively. Mean maximum diameters were: ATA, 38.7 ± 3.7 mm (33.4% ≥ 40 mm, 18.5% ≥ 42 mm, and 5.6% ≥ 45 mm); AACH, 37.3 ± 3.3 mm; DTA, 29.4 ± 2.9 mm; and AA, 26.3 ± 2.3 mm. MADs significantly correlated with CAC severity (p ≤  0.001).

Conclusion: AI software reliably measures MADs. Aortic dilation distribution may serve as a reference in LDCT LCS, and its association with CAC highlights the clinical importance of incorporating MADs into patient management.

Advances in knowledge: Validated AI software enables reliable MAD assessment; reported aortic dilation prevalence offers valuable reference data for LDCT LCS.

Objectives: This work aimed to introduce Advanced intelligence Clear-IQ Engine (Canon, Japan) (AiCE) reconstruction to the clinical workflow by assessing the image quality and impact on Radiotherapy treatment planning. This introduction would then allow for optimisation of CT scanning doses.

Methods: A CT scan of an electron density phantom was performed using clinical protocols using AIDR3D and AiCE reconstructions at different mAs values. Clinical scans were reconstructed using AiCE and the dose distributions of the clinical plans recalculated. An optimisation project was initiated for Breast Radiotherapy patients after the phantom testing proved the image quality is stable with reducing dose.

Results: In the electron density phantom the difference between the Hounsfield Number of water for AIDR3D and AiCE images was 5-6HU depending on the mAs. This was within IPEM 91 tolerances for HU variation. When comparing the clinical goals of plans calculated the dose difference was a maximum of 0.45 Gy. The median dose difference was a 0.02 Gy difference. The clinical doses were successfully reduced to the limit of what was tested in phantom measurements with the image quality being clinically acceptable and a 12% reduction in mean DLP.

Conclusion: AiCE has been evaluated to demonstrate HU stability that is suitable for use in Radiotherapy treatment planning. The breast CT protocol was optimised with the introduction of AiCE and the doses were reduced without affecting image quality.

Advances in knowledge: AiCE is a novel reconstruction technique and has been used for clinical treatment planning and for optimising CT doses.

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 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 < 0.05) and clinical model (AUC of 0.855, P < 0.05).

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

Advances in knowledge: This study highlight 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.

Objective: To evaluate solid volume ratio (SVR) in predicting long-term postoperative outcomes in lung adenocarcinoma patients.

Methods: This study retrospectively analyzed the clinical, pathological, and CT data of patients with lung adenocarcinoma who underwent surgical resection and were pathologically confirmed in the Department of Thoracic Surgery of our hospital from June 2014 to June 2023. Multivariate COX analysis was also conducted to identify independent factors that affect treatment effect. P < 0.05 was considered statistically significant.

Results: A total of 154 patients (82 males and 72 females) were included in this study. The average age was 62.11 ± 8.74 years. There were 60 patients (38.96%) who smoked, and 63 patients (40.90%) had positive pleural invasion. The 3-year DFS rate and OS rate after surgical resection were 87.5% and 92.0%, respectively; the 5-year DFS rate and OS rate after surgical resection were 81.6% and 89.1%, respectively. Multiple COX regression analysis showed that gender (P = 0.009, OR: 4.197, 95% CI: 1.426-12.353), and the solid volume ratio (P = 0.004, OR: 1.021, 95% CI: 1.007-1.036) were identified as an independent predictor of recurrence. Multivariate COX analysis showed that SVR (P = 0.003, OR: 1.028, 95% CI: 1.009-1.046) was identified as an independent predictor of postoperative survival in patients with lung cancer.

Conclusion: In this study, compared with consolidation tumor rate (CTR), the SVR has certain value in evaluating the therapeutic efficacy of lung adenocarcinoma.

Advances in knowledge: SVR is an independent predictor of postoperative recurrence and survival in lung cancer, and provides new ideas for postoperative efficacy evaluation.

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

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: 77 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%). 100% of Trusts 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 = 0.023).

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

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