Polish journal of radiology最新文献

Purpose: Acute adrenal haemorrhage is a rare occurrence caused most commonly by trauma or ruptured neoplasms. In the case of the latter, rapid adrenal tumour growth resulting in elevated intracapsular pressure leads to capsular tear and massive retroperitoneal bleeding. Endovascular embolisation has been reported as a successful and safe method of treatment in selected patients. The aim of this paper was to report multicentre experience with endovascular treatment of patients presenting with acute adrenal gland haemorrhages caused by neoplasms.

Material and methods: This is a multi-centre retrospective study focusing on patients treated by endovascular embolisation because of malignant adrenal haemorrhages in an acute setting from 2012 to 2024.

Results: In total, 13 patients (10 men and 3 women, mean age: 65.4 years) were included in the study. All subjects presented with neoplastic haemorrhages - 8 presented with adrenal metastasis and 5 were primary neoplasms. In all cases a contrast-enhanced computed tomography confirmed the bleeding. Procedures were performed under local anaesthesia via femoral access. Embolic agents were adopted according to the type of vessel lesion and operator preference. Technical success, defined as cessation of adrenal bleeding detectable at control angiography, was 100%; 1 patient required a second embolisation after 24 hours due to recurrence. Clinical success considered as haemodynamic stability and clinical improvement was obtained in 85% (11/13 patients). No major complications were observed.

Conclusions: Malignant acute adrenal haemorrhages can be safely and effectively treated with endovascular means after thorough and careful anatomical examination of the arterial supply.

Magnetic resonance imaging (MRI) is an important diagnostic tool in oral and maxillofacial surgery due to its superior ability to visualise soft tissue and complex anatomical structures without ionising radiation. This narrative review, conducted using a structured literature search following PRISMA guidelines, aims to provide oral and maxillofacial surgery trainees with a structured guide for understanding and interpreting MRI of the head and neck region. Emphasis is placed on enhancing the ability to read common MRI sequences, particularly T1- and T2-weighted images, and on appreciating the value of MRI in diagnosing a range of conditions, including soft tissue lesions, temporomandibular joint disorders, vascular abnormalities, and tumours. To support learning, a selection of case examples is included to illustrate both normal structures and pathological changes. The review also draws attention to the current lack of formal MRI education in oral and maxillofacial surgery training and stresses the need for more organised, interdisciplinary teaching approaches.

Purpose: The aim of this study was to evaluate the performance of the ChatGPT-o1-preview language model in solving the Polish National Specialization Exam (PES) in radiology and imaging diagnostics and compare its results with previous versions of the model.

Material and methods: A set of 119 valid radiology exam questions from Spring 2023 was analyzed. Each question was classified by type, subtype, and clinical relevance. ChatGPT answered each question five times using a standardized prompt with a 5-point confidence scale. Performance was assessed using accuracy and declared and calculated difficulty indices. Statistical analysis was performed in Python with a significance level of p < 0.05, and results were compared with a previous model version.

Results: The model achieved a score of 93.33% correct answers, comparable to the average physician score of 94.86%. ChatGPT-o1-preview showed exceptional accuracy in "memory" questions, with over 96% correct answers. This result, significantly higher than that of the older ChatGPT-3.5 model (52%), demonstrates progress in artificial intelligence (AI) capabilities. The model also exhibited higher confidence in its responses, indicating better adaptation to medical exams.

Conclusions: Despite its high accuracy, the study was based on a relatively small set of questions, which limits the ability to fully assess the model's effectiveness. The results indicate the potential of AI as a tool to support clinical work, but further, more extensive research is necessary to evaluate its applicability and reliability in the medical environment.

Purpose: To evaluate the relationship between different techniques, lesion characteristics, and the development of pneumothorax (Ptx), chest tube-requiring Ptx, and type 1 parenchymal contusion (T1PC) in computed tomography-guided transthoracic lung biopsies (CTTB).

Material and methods: This retrospective study included 510 patients who underwent CTTB between 2015 and 2020. Patients were classified according to needle system (coaxial (Cx)/non-coaxial (NCx)), needle gauge, use of autologous blood clot (OBC), lesion size, location, approach path, pleural puncture count, number of specimens, and presence of emphysema along the needle tract. Complications were assessed with post-procedural CT. Univariate and multivariate logistic regression analyses were performed.

Results: Ptx was more frequent in males, in the presence of emphysema along the needle tract, with middle lobe lesions, lateral approach, ≥ 3 pleural passes, ≥ 3 samples, and when using 18G NCx or 19G Cx needles. OBC use reduced Ptx risk. Chest tube-requiring Ptx was significantly associated with ≥ 3 pleural passes, ≥ 3 samples, and 19G Cx needles. T1PC was most common with 17G Cx needle use and when ≥ 3 samples were obtained. Multivariate analysis showed that 18G NCx and 19G Cx needles reduced T1PC risk, while the absence of Ptx increased its likelihood.

Conclusion: In CT-guided lung biopsies, complication risk can be reduced by optimizing technique, limiting pleural punctures and specimen numbers, and considering OBC use, needle gauge, and patient-specific factors.

Purpose: To determine the efficacy of magnetic resonance elastography (MRE) in predicting the presence and the severity of oesophageal varices in patients with chronic liver disease (CLD).

Material and methods: This is a retrospective, cross-sectional study. A total of 165 consecutive adult patients with CLD were examined with multiparametric liver magnetic resonance imaging, including MRE. Among them, 57 patients fulfilled the inclusion criteria. Liver stiffness measurement (LSM) was performed with MRE.

Results: Forty-two patients had oesophageal varices, 31 of which were endoscopically grade 2 or 3. The median LSM was 4.8 kPa in patients with oesophageal varices, whereas it was 3.2 kPa in patients without varices (p < 0.001). A statistically significant correlation was found between LSMs and the presence of oesophageal varices (p = 0.016). When the threshold stiffness value was set as 4 kPa, the area under the ROC curve, the sensitivity, and the specificity of MRE in predicting oesophageal varices were 0.80, 69%, and 73%, respectively. Sensitivity was 81% for predicting high-risk varices. Multivariable logistic regression showed that LSMs by MRE and high Fibrosis-4 (FIB-4) Index scores were predictors of oesophageal varices in patients.

Conclusion: As a non-invasive method, MRE can predict the presence of oesophageal varices in patients with CLD.

Purpose: The objective of this study is to analyse the characteristics of hepatic haemodynamics disturbances identified through perfusion computed tomography (PCT) in patients with portal hypertension of various aetiologies.

Material and methods: The study included 110 individuals aged 18 to 67 years, divided into 4 groups based on the degree of portal circulation impairment: 63 patients with intrahepatic postsinusoidal occlusion associated with liver cirrhosis; 10 patients with intrahepatic presinusoidal occlusion associated with liver fibrosis (LF); 13 patients with intrahepatic occlusion in extrahepatic portal hypertension (EPH); and a control group of 24 healthy volunteers. The average age of the participants was 38.6 ± 1.1 years.

Results: PCT of the liver is a valuable diagnostic tool for assessing the arterial fraction (AF), portal fraction (PF), and portal index (PI), providing insights into haemodynamic changes in portal hypertension. In presinusoidal obstruction (as in LF), the PF increases, while in cirrhosis with post-sinusoidal obstruction, it decreases with a compensatory rise in arterial perfusion and PI. The most significant changes occur in infrahepatic obstruction, marked by reduced or absent portal flow and a sharply elevated PI.

Conclusions: In LF, preserved PF with slight AF and moderate PI increases suggests early vascular remodeling with limited arterial compensation. Cirrhosis showed reduced PF and elevated AF and PI, reflecting increased sinusoidal resistance. In EPH, PF was markedly decreased with pronounced AF and PI elevations, indicating strong arterial compensation. In congenital cavernous transformation, AF exceeded cirrhotic levels, pointing to early and dominant arterial substitution.

Purpose: Foetal alcohol spectrum disorder (FASD) is a broad term describing a range of conditions that may be caused by prenatal exposure to alcohol. The aim of this study is to assess the relationship between the metabolism in the frontal lobes of the brain and the IQ in children with FASD.

Material and methods: The study assessed a total of 124 children of both genders, aged 5-17 years, with diagnosed FASD, including 62 children with foetal alcohol syndrome (FAS), 34 children with partial foetal alcohol syndrome (pFAS), and 28 children with alcohol-related neurodevelopmental disorder (ARND). The Wechsler Intelligence Scale for Children (WISC-R) and proton magnetic resonance spectroscopy (¹H-MRS) in frontal lobes were performed.

Results: There was a statistically significant difference in IQ scores between the group of children with FASD (mean 90.42) and the control group (mean 121.26). In ¹H-MRS, significantly higher Lip/Cr levels were observed in the children with FASD than in the controls in the left frontal lobe. There is a significant negative correlation between IQ scores and Lip/Cr concentrations in the right frontal lobe and in both frontal lobes in children with FASD.

Conclusions: Children with FASD have a significantly lower IQ than their peers from a healthy control group. This may be linked to the changes in the frontal lobes caused by prenatal alcohol consumption, in particular the elevated lipid levels.

Purpose: Lung cancer is one of the most common types of cancer, and the presence of brain metastases has a significant impact on the clinical course and prognosis. EGFR, BRAF, ALK, and ROS1 mutations have previously been identified in lung cancer, and knowing the tumour mutation status is important for molecular therapy. In our study, we investigated the performance of radiomics in predicting the status of brain metastases detected by brain magnetic resonance imaging (MRI), a noninvasive method, in with brain metastases patients diagnosed with lung cancer.

Material and methods: Lung cancer cases with brain metastasis in our hospital between 2014 and 2024 were analysed retrospectively. Histopathological data were obtained from tissue biopsy results, and EGFR, BRAF, ALK, and ROS1 mutation status were recorded. A total of N = 84 patients were included in the study, and 107 original radiomics parameters were obtained from the segmentation files extracted from the patient images. Due to the class unbalance, the performance of the model was tested using the stratified folding method.

Results: Five (6.02%) of the patients had EGFR, 3 (4.17%) had ALK, and 2 (2.78%) had ROS1 mutations. Model 1 used for EGFR mutation prediction showed high performance with 93.82% accuracy, Model 2 used for ALK with 84.76% accuracy, and Model 3 used for ROS1 with 79.33% accuracy.

Conclusion: Our study showed that EGFR mutations, in particular, can be detected with high accuracy by radiomics in lung cancer patients with brain metastases without additional invasive procedures.

Purpose: Deep vein thrombosis (DVT) is a prevalent vascular condition that can lead to serious complications, including pulmonary embolism and post-thrombotic syndrome. Despite advances in endovascular therapies, the absence of a standardised method for evaluating venous recanalisation impedes consistent outcome reporting and inter-study comparisons. We developed the DVT Recanalisation Scale (DVT RS), integrating anatomical and functional criteria to provide a reproducible method for assessing recanalisation following endovascular treatment of DVT.

Material and methods: This retrospective pilot study included 31 patients with predominantly iliofemoral DVT treated via catheter-directed thromboaspiration and other endovascular techniques. Recanalisation was assessed using phlebographic imaging acquired in multiple projections with compression manoeuvres. Four independent operators (three interventional radiologists, one interventional angiologist) scored recanalisation using the DVT RS. The scale classifies recanalisation into five grades: Grade 0 (no recanalisation), Grade 1 (partial recanalisation without spontaneous flow), Grade 2A (flow with stenosis > 50%), Grade 2B (flow with residual stenosis < 50%), and Grade 3 (complete recanalisation with normal flow). A supplemental "(S)" suffix indicates use of stenting. Interobserver reliability was measured using Cohen's k.

Results: Interobserver agreement exceeded 90%, with Cohen's k > 0.90 (p < 0.001), indicating excellent reproducibility based on phlebographic evaluation. While this analysis relied solely on phlebography, we recommend incorporating multimodal imaging - including intravascular ultrasound and Dyna-CT - for optimal assessment of residual stenosis and flow.

Conclusions: The DVT RS is a reproducible and adaptable tool for standardising the assessment of venous recanalisation. It supports improved outcome reporting and facilitates robust comparisons between clinical endpoints and intravascular results. Prospective validation in larger cohorts is needed.

Purpose: Giant hepatic haemangiomas are among the most common benign liver tumours, with an incidence ranging from 4.0% to 20.0%. Large hepatic haemangiomas can cause symptoms such as pain and bleeding. There is currently no gold standard in their treatment. One of the methods is transarterial bleomycin-lipiodol embolisation (B/LE). The aim of this study is to evaluate the efficacy of treating hepatic haemangiomas with B/LE.

Material and methods: We retrospectively reviewed 44 patients treated with B/LE between February 2021 and June 2022 in the Department of Interventional Radiology and Neuroradiology, Medical University of Lublin. Before the procedure, all patients were examined by magnetic resonance imaging (MRI) or computed tomography. Vascularised lesions were embolised by intraarterial administration of a mixture of bleomycin and lipiodol, closing the vascularisation of the lesion, which was confirmed by control angiography. All patients were followed up clinically and by MRI for an average of 6 months.

Results: The size of the examined haemangiomas before the procedure ranged from 5 to 16 cm. After the first procedure, 28 out of 44 patients had an essential reduction in the size of the haemangioma, while 16 patients had the procedure repeated. Eventually, the size of the haemangiomas decreased significantly (p ≤ 0.05). The average reduction in volume was 67.22%. Technical success, described as the reduction of blood supply to the haemangioma, was achieved in all the cases.

Conclusions: Transarterial B/LE is an effective procedure resulting in reduced size of haemangiomas and alleviation of symptoms.