Current problems in diagnostic radiology最新文献

Purpose: Assessing tumour-vessel contact in pancreatic adenocarcinoma on CT is challenging for trainees and time-intensive for educators. Semi-automating feedback on this task may optimize radiologist time and standardize resident education. We hypothesized that residents who reviewed expert annotations of tumour-vessel contact would outperform those without feedback on an independent test set.

Methods: We retrospectively reviewed pre-operative staging CTs from 60 patients who underwent upfront surgical resection for pancreatic adenocarcinoma. Two resident groups (control and test) independently annotated tumour contact with the superior mesenteric artery. The test group received feedback-annotations from three expert radiologists-for the first 30 cases; the control group received none. Resident performance on the remaining 30 cases was compared against both surgical pathology and expert annotations.

Results: Test group residents demonstrated higher sensitivity than control group residents (mean sensitivity = 93 % vs. 79 %), with comparable specificity and accuracy relative to surgical pathology. While both groups performed similarly relative to expert consensus, the test group showed greater consistency in sensitivity (mean variation = 29 % vs. 46 %).

Conclusion: Virtual expert feedback improved resident sensitivity in identifying tumour-vessel contact without compromising specificity or accuracy. These findings support the use of semi-automated educational tools to enhance radiology training efficiency and effectiveness.

Background: Core needle biopsy (CNB) has emerged as a less invasive alternative to open biopsy for diagnosing soft tissue sarcomas (STS). However, its accuracy in determining tumor grade and distinguishing between benign and malignant lesions remains a subject of ongoing research.

Objective: To assess the diagnostic accuracy of image-guided CNB for soft tissue sarcomas, focusing on grade determination and benign vs. malignant distinction.

Methods: This retrospective study analysed 83 patients who underwent both CNB and surgical excision for soft tissue tumors between 2020 and 2024. CNB results were compared with final histopathology findings. Diagnostic accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated. ROC curve analysis was performed to evaluate diagnostic performance.

Results: The overall accuracy of CNB was 95.18 % (95 % CI: 88.11 % - 98.71 %) for distinguishing between benign and malignant lesions, with a sensitivity of 96.34 % (95 % CI: 89.68 % - 99.24 %) and PPV of 98.75 % (95 % CI: 93.23 % - 99.97 %). For grade determination, CNB showed an accuracy of 86.75 % (95 % CI: 77.52 % - 93.19 %), with sensitivity of 85.92 % (95 % CI: 75.67 % - 93.03 %) and specificity of 91.67 % (95 % CI: 61.52 % - 99.79 %) for high-grade tumors. ROC curve analysis demonstrated excellent discriminatory ability with AUC of 0.982 for benign vs. malignant distinction and 0.888 for grade determination. Diagnostic accuracy varied across sarcoma subtypes, with some rare types showing perfect accuracy and more common types demonstrating moderate to good sensitivity and high specificity.

Conclusion: Image-guided CNB demonstrates high overall accuracy in diagnosing and grading soft tissue sarcomas, particularly in identifying malignant lesions. While performance varies across sarcoma subtypes, these findings support the use of CNB as a reliable diagnostic tool in the management of suspected soft tissue sarcomas.

Pulmonary embolism (PE) remains a diagnostic challenge due to its nonspecific clinical presentation and overlapping imaging features with a wide array of conditions. Computed tomography pulmonary angiography (CTPA) is the gold standard for diagnosing PE, but technical limitations and mimicking entities may lead to false-positive interpretations. This review highlights key radiologic mimics of acute and chronic PE, grouped into artifacts and slow-flow phenomena, tumoral mimics, pseudo-defects from adjacent structures, and chronic PE mimics. Particular focus is placed on common pitfalls such as motion artifacts, pulmonary artery opacification artifacts, and transient interruption of contrast. We outline distinctive imaging features and offer practical strategies to optimize acquisition protocols and interpretative accuracy, including the use of dual-source CT, ECG-gating, and attenuation-based criteria. Recognizing these mimics is essential to avoid misdiagnosis and ensure appropriate clinical management. This review aims to equip radiologists and trainees with a structured diagnostic framework to improve confidence and accuracy when interpreting CTPA in suspected PE.

The expanding clinical application of immune checkpoint inhibitors (ICIs) across oncologic therapeutics has revealed a spectrum of pulmonary toxicities, with reported incidence rates ranging from 2 % to 19 % depending on the therapeutic regimen. Computed tomography (CT) imaging is the cornerstone for diagnostic evaluation, reliably identifying characteristic radiographic patterns such as organizing pneumonia, hypersensitivity pneumonitis-like reactions, and diffuse alveolar damage. The diagnostic challenge lies in distinguishing these immune-mediated pulmonary injuries from infectious etiologies, radiation-induced lung injury, and neoplastic progression, each requiring distinct therapeutic interventions. Contemporary management protocols employ glucocorticoid therapy dosed according to toxicity severity, while investigational approaches explore targeted immunomodulators. This review synthesizes current evidence regarding radiographic manifestations, diagnostic pathways, and therapeutic algorithms, offering radiologists a structured approach to evaluating ICI-associated pulmonary complications. We highlight recent advances, including quantitative CT analysis and serum biomarkers, that promise to refine early detection and risk stratification.

The primary aim of this study is to assess how well ultrasonography and 99mTc-sestamibi scintigraphy perform as diagnostic tools for hyperparathyroidism (HPT) when compared to the clinical measurements of parathyroid hormone (PTH) levels. This evaluation is intended to help formulate the most effective preoperative plan and guide clinical decision-making. A retrospective study of 350 HPT cases in King Abdul-Aziz University Hospital over a period spanning 2012 to 2023 was carried out. Sensitivity, specificity, and receiver operator characteristic curve AUC were used to determine the diagnostic performance of ultrasonography, 99mTc-sestamibi scintigraphy, and combined imaging to the standard of biochemical PTH levels. The statistical tests involved the McNemar test and logistic regression to evaluate the predictors such as chronic kidney disease (CKD). The combined imaging demonstrated diagnostic accuracy of 0.69 compared to 0.74 and 0.64 of scintigraphy and ultrasonography respectively. The scintigraphy had a total of 161 true positives and 73 false negative results whereas ultrasonography had a total of 139 true positives and 95 false negative results. CKD was also a good determinant in HPT (odds ratio = 1.988, p = 0.026). According to the McNemar test, there was no significant difference between ultrasonography and scintigraphy (p = 0.494). The diagnostic inaccuracy of ultrasonography is lower in diagnosing HPT as compared to scintigraphy, however using combined imaging may provide more reliability in diagnosis hence it can be used in preoperative planning, especially in patients with CKD.

Background and purpose: Accurate preoperative staging is essential for guiding surgical planning and optimizing outcomes in early-stage breast cancer. Magnetic resonance imaging (MRI) is considered the gold standard but is often limited by cost and availability. This study aimed to prospectively compare the diagnostic performance of full-field digital mammography (FFDM), digital breast tomosynthesis (DBT), contrast-enhanced mammography (CEM), and MRI for tumor detection and size estimation in patients eligible for upfront surgery.

Materials and methods: This single-center, prospective study included 46 women with histologically confirmed early-stage invasive breast cancer. All patients underwent FFDM, DBT, CEM, and MRI within one week prior to surgery. Histopathology served as the reference standard. Tumor size measurements were compared using Pearson's correlation coefficients (r), with concordance defined as a size difference within ±10 mm. Detection rates, size accuracy, and ability to identify multifocal lesions were evaluated.

Results: The mean patient age was 55.4 years. FFDM identified the primary tumor in 89.1% of cases, DBT in 97.8%, and both CEM and MRI in 100%. Tumor size correlation with pathology was highest for MRI (r=0.811), followed by CEM (r=0.660), DBT (r=0.636), and FFDM (r=0.314). Concordance with pathology was 80.4% for MRI, 71.7% for CEM and DBT, and 58.7% for FFDM. Multifocal disease was detected in 15.2% of cases by MRI, 8.7% by DBT, and 6.5% by CEM.

Conclusion: CEM and DBT showed strong diagnostic performance and may serve as accessible and cost-effective alternatives to MRI for preoperative staging in early-stage breast cancer. These modalities offer valuable imaging options in settings where MRI is limited or contraindicated.

Objectives Follicular bronchiolitis (FB) is a rare and often under-recognized small airway disease characterized by lymphoid hyperplasia in the bronchiolar walls. We aimed to compare chest CT findings in patients with FB by underlying disease: rheumatoid arthritis (RA), Other connective tissue diseases (CTDs), and those without CTD. Methods A retrospective cohort of patients with pathologically-proven follicular bronchiolitis was classified into three groups: RA (n = 9), Other CTDs (n = 6), and non-CTD (n = 13). Chest CT were reviewed for findings including tree-in-bud nodules and air trapping (small airway disease), ground glass opacities, fibrosis, and bronchiectasis. Chi-square test was performed to evaluate the frequency differences across three groups. Fisher's exact test was performed to compare RA group and non-RA group. Results In all patients, the most common CT finding was bronchiectasis (17/28, 61 %), followed by small airway disease features (14/28, 50.0 %), fibrosis (13/28, 46.4 %), and ground glass opacities (7/28, 25.0 %). In three-group comparison (RA vs. Other CTD vs. non-CTD), small airway disease was significantly more prevalent in other CTD (3/6, 50.0 %) and non-CTD (10/13, 76.9 %) groups compared to the RA group (1/9, 11.1 %) (p = 0.01). In two-group analysis (RA vs. non-RA), fibrosis (7/9, 77.8 % vs. 6/19, 31.6 %; p = 0.041) and bronchiectasis (8/9, 88.9 % vs. 9/19, 47.4 %; p = 0.049) were significantly more common in the RA group compared to non-RA patients. Conclusion Chest CT findings of FB vary significantly depending on the underlying disease. Small airway disease features predominate in non-RA patients, while patients with RA and FB more frequently show fibrosis and bronchiectasis, likely reflecting coexistent pulmonary manifestations of RA. Recognizing these imaging patterns may improve diagnostic accuracy and inform appropriate management.

Biopsy plays a pivotal role in the diagnosis and management of soft-tissue masses. Conventional ultrasound-guided biopsies offer advantages such as real-time imaging and avoidance of radiation exposure, yet they present challenges in precise targeting, operator experience, and complications. In response to these challenges, a novel technique, ultrasound contrast agent coated needle biopsy, has emerged, harnessing the power of microbubble contrast agents to enhance imaging. This technique was applied in five cases to address the difficulties encountered during routine ultrasound-guided biopsies. These cases encompassed a diverse range of clinical scenarios, including soft tissue tumors, bone metastasis, and post-treatment changes. Challenges included obscured needle visualization due to various factors such as rib shadows, fragmented bony fragments, and background fibrosis.

Aims: To evaluate the quality and inter-rater reliability of CT-definable chronic obstructive pulmonary disease (COPD) subtype reporting in CT chest reports in a real-world setting, and assess concordance with Fleischner Society guidelines.

Methods: We undertook a retrospective review of 100 randomly selected CT chest scans containing the terms 'emphysema' or 'COPD'. Existing reports were evaluated for the description of emphysema phenotype, severity, and location, as well as the presence of associated findings, benchmarked against the Fleischner Society guidelines for CT reporting. The scans were then read independently by two consultant thoracic radiologists and two radiology specialty residents, blinded to the original reports and each other's assessments. Inter-rater variability was assessed using Light's Kappa for categorical variables and intraclass correlation coefficient (ICC) for ordinal variables.

Results: Emphysema phenotype was described in 51 % of the pre-existing reports, with centrilobular emphysema being the most frequently reported subtype. Only 26 % of reports included all three key descriptors of phenotype, severity and location. Inter-rater agreement was fair for emphysema phenotype (κ = 0.371) and moderate for the grading of paraseptal emphysema (ICC = 0.733), but was more variable for associated features such as large airways disease (κ = 0.0646) and bronchiectasis (κ = 0.0996).

Conclusion: This study shows variability in the quality of CT reporting for COPD in a real-world setting, with frequent omissions of key descriptors and marked inter-rater variability. These findings highlight the need for standardisation in CT reporting, particularly in the context of increasing reliance on imaging for COPD diagnosis and management.

Objective: The primary outcome of this investigation was to describe the frequency and types of ultimate frisbee-related injuries at a single institution over an 11-year period. The secondary outcomes were to report rates of radiographic utilization and surgical intervention.

Materials and methods: TriNetX was utilized to identify patients with ultimate-frisbee related injuries from 2010 to 2021 at a single institution. Injured body parts were recorded and further classified by type of injury. Imaging utilization, including plain radiograph, computed tomography (CT), and magnetic resonance imaging (MRI) were recorded. Rate of subsequent surgery was also recorded.

Results: A total of 187 distinct injury encounters were identified. The most common anatomic regions injured were the knee (23.5 %), shoulder (14.8 %), and ankle (12.2 %). Among knee injuries, anterior cruciate ligament (ACL) tear was the most common type of injury (20.5 %). Sprains were the most common type of injury to the shoulder (34.5 %) and the ankle (64 %). 71.1 % of patients were imaged with radiographs, 16.6 % were imaged with MRI, and 3.7 % of patients were imaged with CT. Additionally, 14.4 % of patients required surgery due to their ultimate frisbee-related injury.

Conclusion: As ultimate frisbee increases in popularity among the general population so does the incidence of ultimate-related injuries. Although these injuries have many similarities with those associated with other non-contact team sports, knowledge of the gameplay and commonly associated injury patterns is integral to initiating effective treatment and management of these injuries.