Current problems in diagnostic radiology最新文献

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.

The aim of this systematic review is to highlight the reasons for a significant underrepresentation of women in radiology. We systematically examined the gender disparity within radiology across career stages, including medical school, residency training, and faculty positions. A comprehensive literature analysis was conducted to identify the determinants influencing female medical students' and physicians' pursuit of radiology. Despite women making up approximately half of medical school graduates, their representation in radiology remains disproportionately low. Contributing factors include a scarcity of female mentors and insufficient exposure to radiology during medical training, leading to persistent misconceptions about the specialty. Additionally, female radiology faculty members encounter challenges, including gender bias and difficulty advancing in leadership positions, which contribute to professional dissatisfaction. Strategies like the formation of Women in Radiology groups and institutional initiatives have been established to increase mentorship for female trainees and progression of faculty in their careers. The underrepresentation of women is a concern that warrants attention due to the unique collaborative and empathetic dimensions that women contribute to patient care and education. Throughout their careers, women encounter numerous obstacles that affect their exposure to, involvement in, and satisfaction with the field. Addressing these barriers is crucial for enhancing the presence and influence of women in radiology.

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.

Inflammatory breast cancer (IBC) is an uncommon, locally aggressive breast cancer with rapid onset of symptoms and an unfavorable prognosis. Diagnosis remains challenging and is frequently delayed; imaging plays an important role in disease detection and characterization. Contrast Enhanced Mammography (CEM) combines conventional mammography with a dual energy technique utilizing iodinated contrast, producing a set of recombined images that demonstrate contrast enhancement similar to magnetic resonance imaging (MRI) at a fraction of the cost and time. Current applications of CEM include the evaluation of abnormal findings on screening mammography, monitoring response to neoadjuvant chemotherapy, and assessment for tumor recurrence. CEM is mostly utilized in patients who are unable to undergo MRI. To our knowledge, CEM applications in IBC are scarce in the published literature. The following cases provide additional information on CEM use in the setting of IBC, from staging to guiding subsequent procedures to treatment response evaluation, emphasizing imaging findings and lessons learned. These cases also highlight the feasibility of CEM use in the setting of IBC, with potential incorporation into the future protocols for those patients unable to undergo MRI.

Rationale and objectives: This study aimed to evaluate the socioeconomic and demographic factors that predict overall survival (OS) and progression-free survival (PFS) of patients undergoing transarterial chemoembolization (TACE) for primary and metastatic hepatic disease.

Materials and methods: Retrospective review from 2016 to 2022 identified 322 patients with hepatocellular carcinoma (HCC) (n = 234) and metastatic liver lesions (n = 98), treated with TACE. Patients were stratified by demographic factors, including mean income, insurance status, race, and social vulnerability index (SVI), a Center for Disease control (CDC) composite measure from geographic census data. Primary outcomes measures included OS and PFS. Correlation, multivariate regression, and Kaplan Meier analyses were performed.

Results: Of the studied population, 67 % were male, 85 % were White, and 62 % had Medicare coverage, with a mean age of 64 years. Mean OS was 25.6 months, and PFS was 19.9 months. The liver-specific disease progression rate and overall mortality rate were 71.7 % and 56.9 %, respectively. Lower SVI group, indicating less social vulnerability, was positively correlated with OS (p = 0.033), and a similar trend was observed for PFS (p = 0.0676) in the overall population. Co-variate analysis demonstrated statistically significant relationship between SVI and OS (HR=3.880, p = 0.01), controlling for underlying disease (HCC vs. metastatic disease) and baseline health characteristics.

Conclusions: Findings highlight underexplored relationships between social factors and treatment outcomes, revealing SVI as a predictive factor of OS following TACE. Further work is warranted to better understand disparities associated with procedural interventions to target mitigation strategies.

Imaging and pathological evaluation are indispensable for the evaluation of breast pathologies. It is imperative to achieve clinical, radiological, and pathological concordance before initiation of any treatment regimen. Although image-guided biopsies are usually obtained from the most suspicious area of the lesion, we often encounter discordant lesions. This rad-path discordance needs to be addressed in multidisciplinary team meetings to review the clinical, imaging, and pathology findings together to ascertain the next step of evaluation. In this article, we aim to highlight a variety of such results which needed reassessment and provided us with a learning opportunity to deepen our understanding of various breast diseases.

Objective: To systematically determine the diagnostic performance of diffusion weighted imaging (DWI) in early imaging assessment following Y-90 transarterial radioembolization (TARE) of HCC.

Materials and methods: Searches were conducted in PubMed and Cochrane library electronic databases up to July 2024 to identify original studies that reported the diagnostic performance of DWI/apparent diffusion coefficient (DWI/ADC) for assessing early treatment response following TARE. The summary measures of diagnostic accuracy were estimated using bivariate random effect meta-analysis.

Results: Our search identified 194 titles, of which 5 studies with data from 104 patients were included in the meta-analysis. The pooled sensitivity and specificity were 0.90 (95%-confidence interval [CI] 0.75,0.96) and 0.81 (95%-CI 0.58,0.92) with a diagnostic odds ratio (DOR) of 45.4 (95% CI 10.2, 132). The area under the summary receiver-operating characteristic curve was 0.919 (95%-CI 0.708,0.924). Exploratory analysis of predictive values projected DWI/ADC to have a NPV of 46.4% (95%-CI 26.8%,69.4%) and projected PPV of 97.6% (95%-CI 95.1%,99.0%), assuming a 90% treatment response rate. The diagnostic performance for early response assessment was comparable with that of traditional imaging criteria reported in literature.

Conclusion: Restricted diffusion has high diagnostic accuracy in early response assessment after TARE. Our study validates the inclusion of restricted diffusion as an ancillary criterion in the LI-RADS TR 2024 algorithm for radiation-based treatment.