Polish journal of radiology最新文献

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.

Introduction: Neurofibromatosis type 1 (NF-1) is an autosomal dominant genetic disorder notably linked to the development of central nervous system neoplasms - predominantly low-grade glial tumours like pilocytic astrocytoma. High-grade glial neoplasms (HGG) are rarer and more prevalent in adults, with very few comprehensive studies on imaging features of the same. This study aims to investigate the imaging characteristics of HGG in patients with NF-1, to identify alarming imaging features that potentially indicate higher-grade tumours.

Material and methods: Conducting a retrospective analysis, we examined histologically confirmed cases of HGG within clinically diagnosed NF-1 patients over 8 years. Our analysis scrutinised various imaging parameters, and histopathological and molecular data.

Results: Eight cases of NF-1-associated HGG were identified. Predominant features included large tumour size (> 5 cm) in most (77.8%), intra-tumoral necrosis (77.8%), and moderate to marked perilesional oedema (55.55%). Notably, more than half were centred in midline structures. Molecular analysis highlighted diverse statuses of ATRX, IDH1R132H, and P53.

Conclusions: This retrospective analysis of the largest single-centre dataset on imaging of HGG in NF-1 patients reported in the literature underscores that it may be more common than previously surmised. The need to look for alarming imaging indicators and raise suspicion in atypical locations like midline structures is essential for early detection and appropriate treatment.

Purpose: Accurate geometrical measurements of ankle joint (AJ) X-rays are essential for planning and executing orthopaedic procedures like alloplasty. Reliable assessment of the projection correctness of the AJ radiograms has to precede such measurements, and it is thus a vital step in the process. To create an artificial intelligence-based tool for automatic assessment of the correctness of the X-ray image projection of AJ.

Material and methods: 1062 antero-posterior and lateral AJ X-rays were categorized into correct and rotated groups based on the literature. The database was split with an 80 : 10 : 10 ratio for training, validation, and test sets, respectively. Data analysis was conducted using 32 targeted neural networks, evaluating with binary metrics: accuracy, precision, recall, and F1 score.

Results: The Xception neural network yielded the best results. Accuracies of 1.0, 0.849, and 0.888 were obtained for the training, validation, and test sets, respectively. The test set metrics achieved by Xception were as follows: precision - 0.935, recall - 0.879, and F1 score - 0.906.

Conclusions: The model achieved high accuracy in recognizing the projection correctness compared to literature reports, which can directly result in a reduction in the workload for radiologists or orthopaedic specialists, as well as a reduced risk of misdiagnosis.

Purpose: Hepatic fibrosis can be predicted using fibrosis-4 (FIB-4) and fibrosis-5 (FIB-5) scores. Functional liver imaging score (FLIS) provides valuable information regarding hepatic function. We aimed to assess whether easily obtained blood parameters (FIB-4 and FIB-5) may be used to discriminate preserved and impaired hepatic function based on FLIS.

Material and methods: Patients who underwent dynamic upper abdominal MRI with gadoxetic acid were retrospectively reviewed (n = 101, mean age 61.0 ± 11.3 years). FLIS values were categorized as FLIS < 4 (impaired hepatic function) and FLIS ≥ 4 (preserved hepatic function). The discriminative potential of FIB-4 and FIB-5 was assessed by plotting ROC curves.

Results: While FIB-4 was significantly higher, FIB-5 was significantly lower in patients with FLIS < 4. They had significant discriminative value in distinguishing patients with preserved and impaired hepatic function (area under the ROC curves 0.794 for FIB-4 and 0.748 for FIB-5, p-values < 0.001). Comparison of the area under the 2 ROC curves revealed that FIB-4 and FIB-5 had similar discriminative values (p = 0.405). For FIB-4, a cut-off value of 4.2 had a sensitivity of 88.9%, specificity of 66.3%, PPV of 20.5%, and NPV of 98.4%, meaning that FIB-4 values of < 4.2 are valuable in ruling out FLIS < 4 (poor hepatic function). For FIB-5, a cut-off value of 36.2 had a sensitivity of 88.9%, specificity of 60.9%, PPV of 18.2%, and NPV of 98.2%, meaning that FIB-5 values of > 36.2 are valuable in ruling out FLIS < 4.

Conclusions: FIB-4 and FIB-5 are valuable in discriminating preserved and impaired hepatic function based on FLIS scoring with similar diagnostic performance.

Purpose: The aim of the study was to evaluate the interventions in endoAVF created with the WavelinQ 4-F EndoAVF system to clarify the role of this method in personalised vascular access strategy for end-stage renal disease patients.

Material and methods: Endovascular fistula creation was performed in 16 patients. The type of additional endovascular procedures during fistula creation was evaluated. Postoperative surgical and endovascular intervention was divided into maintenance and enhanced maturation procedures. The necessity of using assisted maturation was examined by Kaplan-Meier analysis, the rate of interventions per patients per year and evaluation of the type, time, and the relationship between intraoperative and postoperative interventions.

Results: Access primary patency was significantly lower than access cumulative and functional patency (p < 0.001). During endoAVF creation 73.3% patients required 16 additional endovascular procedures. After endoAVF creation 73.3% patients needed endovascular 22 procedures and 20% underwent surgical interventions. Nine (81.8%) out of 11 patients required intravascular procedures due to lack of fistula maturation - 9 (45%) angioplasties and 11 (55%) vein embolisations. The postoperative venous embolisation rate was significantly dependent on vein embolisation during endoAVF creation (p < 0.04). After endoAVF creation significantly more patients - 11 (73.3%) - required endovascular interventions compared to 3 (20%) with surgical interventions (p < 0.01). Postoperative endovascular and surgical interventions was 0.09 and 0.02 per patients per year, respectively.

Conclusions: Maturation of endoAVFs required significantly more endovascular than surgical interventions. Venous embolisation combined with fistula creation reduced postoperative embolisation.