Polish journal of radiology最新文献

Diffusion tensor imaging (DTI) and tractography are powerful non-invasive techniques for studying the human brain's white matter pathways. The uncinate fasciculus (UF) is a key frontotemporal tract involved in emotion regulation, memory, and language. Despite advancements, challenges persist in accurately mapping its structure and function due to methodological limitations in data acquisition and analysis. This review aims to provide a comprehensive overview of the strengths and limitations of DTI and tractography in studying the UF, focusing on its anatomy, data acquisition techniques, and associated neurological and psychiatric disorders. A systematic review of over 30 years of literature on UF was conducted, encompassing anatomical studies, DTI methodologies, and clinical applications. Studies involving both postmortem dissections and in vivo imaging were analysed, with particular attention to different DTI acquisition parameters, fibre tracking algorithms, and their impact on imaging accuracy. DTI has significantly improved our understanding of UF anatomy and its role in neurocognitive functions. However, methodological constraints such as low spatial resolution, crossing fibres, and inter-subject variability limit its precision. Advances in higher-field magnetic resonance imaging, improved diffusion models, and artificial intelligence-enhanced tractography offer promising solutions. UF abnormalities have been linked to various disorders, including schizophrenia, depression, autism spectrum disorders, and neurodegenerative diseases. While DTI and tractography are invaluable tools for studying the UF, their limitations necessitate cautious interpretation of results. Future research should focus on refining imaging techniques to enhance accuracy and clinical applicability, paving the way for better diagnostic and therapeutic strategies.

Purpose: To evaluate the effectiveness of head magnetic resonance imaging (MRI) with the diffusion weighted imaging without echo-planar imaging (DWI non-EPI) sequence in detecting cholesteatoma recurrence, focusing on the analysis of false results.

Material and methods: A retrospective study was conducted involving 156 patients diagnosed with cholesteatoma, who underwent reoperation between 2015 and 2021. All patients underwent preoperative MRI with the DWI non-EPI sequence. Data from surgical protocols, medical histories, outpatient records, and imaging results were analysed. MRI scans were reviewed by experienced radiologists and otosurgeons. The study was approved by the local Bioethics Committee.

Results: Clinical and radiological concordance was found in 80% of patients. True positive results were observed in 77.5% of cases, while true negative results were noted in 2.5%. False positive results occurred in 8% of cases, mainly due to wax in the external auditory canal. False negative results were found in 12% of cases, often due to small or mural cholesteatomas. The sensitivity of MRI DWI non-EPI in detecting cholesteatoma was 87%.

Conclusions: MRI DWI non-EPI is an effective tool for detecting cholesteatoma recurrence, potentially avoiding unnecessary second-look surgeries. Awareness of false positive and negative results is crucial, and correlation of MRI findings with clinical examinations is recommended. To minimise false results, ear cleaning before MRI and repeated examinations at intervals are advised.

X-ray velocimetry (XV) is a novel imaging technique that allows for real-time viewing and dynamic analysis of air and blood flow. Traditional imaging techniques frequently cannot capture high-resolution, real-time flow patterns, which limits their diagnostic utility. This evaluation assesses the efficacy and dependability of XV compared to traditional imaging techniques. Our principal aim was to conduct a systematic review of studies that compare the accuracy of dynamic flow measurements of XV in comparison to existing imaging methods. A systematic review was conducted according to PRISMA criteria. Fourteen papers from indexed journals, including ScienceDirect and PubMed, were examined to determine the benefits of XV for capturing dynamic flow patterns. The data show that XV outperforms traditional imaging techniques by providing higher spatial and temporal resolution, allowing for exact tracking of airflow and blood flow dynamics. These enhanced visuals help to improve diagnosis accuracy and comprehension of physiological processes. XV is a significant improvement in medical imaging, providing real-time, high-resolution insights that help with patient evaluation and clinical decision-making. Its application may improve diagnostic capabilities and patient outcomes in pulmonary and vascular examinations.

Quantitative magnetic resonance imaging (MRI) volumetry has become a pivotal component in modern neurology, bridging the gap between detailed neuroimaging and clinical decision-making. By employing advanced imaging techniques like 3D T1-weighted, T2-weighted, and fluid-attenuated inversion recovery (FLAIR) sequences, MRI volumetry enables clinicians to objectively quantify brain volume changes associated with neurological conditions such as Alzheimer's disease, multiple sclerosis, epilepsy, and myotonic dystrophy. Automated segmentation tools, including FreeSurfer, NeuroQuant, volBrain, and AccuBrain, facilitate precise and reproducible analysis of structural brain changes, contributing significantly to early diagnosis, patient monitoring, and therapeutic planning. In Alzheimer's disease, volumetric MRI enables the detection of early hippocampal and temporal lobe atrophy, providing a crucial biomarker for diagnosis and monitoring disease progression. Similarly, in multiple sclerosis, volumetric analyses quantify grey and white matter degeneration, reflecting motor and cognitive impairment severity. Moreover, quantitative MRI techniques precisely delineate structural abnormalities like hippocampal sclerosis and focal cortical dysplasia in epilepsy, crucial for accurate surgical intervention. Ongoing advances in artificial intelligence and machine learning are set to further enhance these volumetric approaches, addressing current limitations such as inter-observer variability and expanding their clinical applicability. This review outlines the existing landscape and future trajectory of quantitative MRI volumetry, underscoring its expanding role in clinical neurology and personalised medicine.

The aim of this study is to determine the usefulness of contrast-enhanced ultrasound (CEUS) in liver biopsy. The popularisation of imaging techniques that visualise the abdominal cavity, especially ultrasonography (USG), has resulted in an increase in the detection of focal liver lesions (FLL). If the results of other imaging modalities (magnetic resonance imaging [MRI] or computed tomography [CT]) are inconclusive, percutaneous liver biopsy should be considered. Taking into account the limitations of using MRI and CT in liver biopsy, this procedure is mostly performed with ultrasound. It is economical, safe, and swift. Whenever it is impossible to visualise lesions in B-mode (a condition necessary for a safe and effective biopsy), it is advisable to use advanced ultrasound techniques - CEUS or fusion imaging. Limitations of fusion imaging include prolonged time of data processing and difficulties in achieving optimal overlap of images. Conversely, CEUS enhances lesion visualisation but is devoid of the mentioned limitations - it is rapid and requires no additional processing. Furthermore, considering the potential of CEUS in the visualisation of focal liver lesions and differentiation of necrotic areas, accompanied by the ability to detect neuroendocrine tumours or its metastasis, we strongly believe that biopsy procedures - especially core needle biopsies - with CEUS assistance are potent tools in contemporary diagnostics. In this paper we want to share the experience of our centre and review the available literature on performing liver biopsies under CEUS guidance.

Neurofibromatosis type 1 (NF1) is a genetically determined disorder with a complex clinical picture, including disorders of many systems and organs, that predisposes to the development of various cancers. Approximately 10-30% of patients with NF1 develop plexiform neurofibromas (PN), non-malignant tumours growing along the nerves, tending to infiltrate nerves and nerve plexuses, and may grow into internal organs, the spinal canal, and middle ear, deforming bones and various regions of the body. Magnetic resonance imaging (MRI) plays a key role in the management of individuals during the course of PN, as a screening tool at baseline, for surveillance (in individuals with known PN), to evaluate treatment response, and for preoperative assessment for surgical planning. The practical recommendations presented in this article aim to standardise the protocol for MRI examination of PN in the course of NF1 for the purpose of treatment in a clinical program in Poland. The protocol, covering volumetric MRI examination, imaging schedule, determination of the target change, the technique for measuring the volume of lesions, and suspected malignant transformation, is intended to be the minimum set of MRI sequences and views that must be included in every examination of these patients.

Colorectal cancer is a prevalent malignancy, with colorectal liver metastases (CLM) being a common and challenging clinical issue. Traditionally, surgical resection was the only curative treatment; however, percutaneous ablation (radiofrequency, microwave, and irreversible electroporation) has emerged as a treatment option for select patients. Early trials demonstrated the efficacy of thermal ablation, leading to its inclusion in international guidelines. Currently, for small tumours, it is considered a viable alternative to resection. Recent studies demonstrate the non-inferiority of thermal ablation compared to resection in select cases and emphasize the importance of achieving an adequate ablation margin. Advancements in imaging techniques, ablative modalities, the use of image fusion, as well as ablation confirmation software, allow for a more patient-tailored approach. Additionally, tumour biology, including genetic mutations, influences both overall survival and local control, highlighting the need for personalised treatment strategies. As randomised trials continue to provide more data, the role of ablation in CLM management is evolving. This paper aims to provide a narrative review of factors predicting local control and overall survival in patients treated with ablation. Future research focusing on molecular markers, advanced imaging, and ablation verification techniques may further refine patient selection, and optimise treatment outcomes and follow-up imaging.

Purpose: Chronic thromboembolic pulmonary hypertension (CTEPH) is a life-threatening but curable form of pulmonary hypertension. Early diagnosis is crucial for effective management and improved outcomes. Computed tomography pulmonary angiography (CTPA), characterised by high sensitivity and specificity, is integral to diagnosing CTEPH by identifying thrombi and associated pulmonary and mediastinal abnormalities. However, radiological features often overlap with other diseases, and their detection depends on radiologist expertise. This study aims to assess the frequency of characteristic radiological features in CTEPH, compare their prevalence with chronic thromboembolic disease (CTED), pulmonary arterial hypertension (PAH), and acute pulmonary embolism (APE), and evaluate their diagnostic predictive value.

Material and methods: This retrospective study analysed 115 patients divided into CTEPH (n = 35), CTED (n = 20), PAH (n = 24), and APE (n = 36) groups, matched by age and sex. CTPA scans were reviewed for signs of chronic embolism, pulmonary hypertension, and right heart overload. Sensitivity, specificity, accuracy, and predictive values were assessed using ROC analysis, expressed as the area under the curve (AUC).

Results: CTEPH patients exhibited vessel narrowing, intimal irregularities, bands, and webs in all cases (100%), with the highest diagnostic value at the segmental level (AUC = 0.906). Mosaic perfusion and variability in vessel size demonstrated moderate predictive value (AUC = 0.740 and AUC = 0.788, respectively).

Conclusions: CTPA is essential for differentiating CTEPH from other pulmonary vascular conditions. While no single feature achieves 100% predictive value, a comprehensive approach integrating vascular, parenchymal, and cardiac findings is critical for accurate diagnosis.

Purpose: To evaluate the diagnostic value of X-ray in detecting acute thoracolumbar (TL) fractures in minor trauma patients, using computed tomography (CT) as the reference standard, and to assess the impact of rigid spine conditions and reader experience on performance.

Material and methods: This retrospective single-centre study included patients with acute TL fractures from minor trauma between July 2014 and December 2020, who underwent both X-ray and CT. On CT, the presence or absence of rigid spine conditions, location, and fracture morphology were assessed. Two independent readers (a radiology resident and an attending radiologist) evaluated the radiographs, blinded to CTs. Sensitivity, specificity, and accuracy were calculated, and interobserver agreement was assessed using Cohen's κ coefficient.

Results: Sixty-three patients (32 with rigid spines, 31 without) with 84 fractures were included. The resident radiologist showed lower diagnostic accuracy than the attending radiologist, with more false positives in the rigid-spine group. In both groups, unrecognised fractures were more common for the resident radiologist (61.2% in rigid-spine patients and 48.6% in non-rigid-spine patients) compared to the attending radiologist (51.0% and 40.0%, respectively). Thoracic fractures were more frequently missed than lumbar fractures. Interobserver agreement was moderate (κ = 0.44) in the rigid-spine group and substantial (κ = 0.67) in the non-rigid-spine group.

Conclusions: Radiographs cannot reliably exclude unstable TL fractures in minor trauma patients. Attention should be paid to the lower thoracic region when evaluating lumbar radiographs.