Polish journal of radiology最新文献

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.

Purpose: This study aimed to investigate the relationship between radiomic features extracted from computed tomography (CT) images and the mean standardised uptake value (SUV_mean) obtained from salivary gland single-photon emission computed tomography (SPECT/CT), focusing on differences between Sjögren's syndrome and submandibular sialolithiasis.

Material and methods: Thirteen patients (7 with Sjögren's syndrome and 6 with submandibular sialolithiasis) underwent CT and SPECT/CT imaging. SUV_mean was calculated pre- and post-stimulation using technetium-99 m. Radiomic features were extracted from CT images using PyRadiomics, excluding shape-related features due to the impact of metal artifacts. Spearman's correlation coefficients were used to evaluate the relationship between pre/poststimulation SUV_mean ratios and radiomic features. Regression models were created for features strongly correlated with SUV_mean ratios.

Results: The median pre/post SUV_mean ratios were 1.30 (1.02-1.57) for Sjögren's syndrome and 2.35 (2.23-3.01) for sialolithiasis. In Sjögren's syndrome, 4 radiomic features correlated strongly with the SUV_mean ratio: busyness (r = 0.78, p < 0.01), energy (r = 0.70, p < 0.01), total energy (r = 0.66, p = 0.01), and high grey level emphasis (r = -0.60, p = 0.02). No significant correlations were observed in sialolithiasis.

Conclusions: Specific radiomic features in CT images showed strong correlations with SUV ratios in Sjögren's syndrome but not in sialolithiasis. These findings suggest the potential utility of CT radiomics in evaluating salivary gland function, particularly in Sjögren's syndrome, providing insights into functional assessments without SPECT/CT.

Purpose: This study aimed to assess the diagnostic performance of multiphase contrast-enhanced computed tomography (MCECT) in differentiating benign and malignant solid and cystic small renal masses (SRMs), predicting histologic subtypes, and grading, using signal intensity (SI) and tumour-to-cortex signal intensity (TCSI) ratio.

Material and methods: A retrospective analysis was conducted on 181 patients with solid and cystic SRMs (≤ 4 cm). MCECT imaging across 4 phases (non-contrast, corticomedullary, nephrographic, and excretory) was performed. SI and TCSI values were measured, and their diagnostic performance was evaluated using receiver operating characteristic (ROC) analysis. Solid, Bosniak IIF, III, and IV SRMs underwent histopathological confirmation.

Results: Among solid SRMs, excretory phase SI achieved an area under the curve (AUC) of 0.848 for differentiating RCC from other SRMs, with 100% sensitivity and 61.3% specificity. For distinguishing renal cell carcinoma (RCC) from benign SRMs, the most effective parameter was the TCSI ratio obtained from computed tomography excretory phase (88.6% sensitivity, 52.4% specificity, 0.763 AUC). For Bosniak IIF cysts, the corticomedullary phase SI provided an AUC of 0.902, with 93% sensitivity and 87.5% specificity. RCC subtyping showed distinct SI characteristics across phases, particularly for clear cell RCC. Nephrographic phase SI differentiated low- versus high-grade RCC, with an AUC of 0.901, 90.2% sensitivity, and 86.4% specificity.

Conclusions: MCECT-derived imaging biomarkers, particularly SI and TCSI, are effective non-invasive tools for characterising SRMs, aiding in the differentiation of benign and malignant lesions, histological subtypes, and tumour grades. Their integration with advanced radiomics could further enhance diagnostic accuracy.

Purpose: To analyse the risk and factors associated with false-negative (FN) and false-positive (FP) positron emission tomography-computed tomography (PET-CT) results in the mediastinal staging of non-small cell lung cancer.

Material and methods: This retrospective cohort study analysed data from a prospective database. It included patients with lung cancer who underwent preoperative staging with PET-CT, endobronchial ultrasound, and endoscopic ultrasound, followed by curative-intent anatomical lung resection with systematic lymph node dissection. Statistical analyses were performed to identify factors associated with FN and FP PET-CT results.

Results: Data from 781 patients were analysed. FN results were significantly associated with more advanced PET-CT-based stages and CT-based stage IIB. FP results were significantly associated with male sex, adenocarcinoma histology, CT-based disease stage, and SUV_max values of the primary tumour and lymph nodes.

Conclusions: False-negative PET-CT results in the diagnosis of mediastinal lymph node involvement were more likely to occur in PET-CT-based stages IB and IIB and less likely to occur in stage IIIA. FP results were more likely to be expected in men, with higher SUV_max values of the primary tumour and a more advanced CT-based stage of the disease.

Purpose: Endovascular procedures have become the method of choice for treating splenic artery aneurysms (SSAs). However, there is no consensus regarding the intervals and imaging methods for follow-up examinations in patients with true SAAs treated with coil embolisation. We aimed to evaluate the utility of digital subtraction angiography (DSA), computed tomography angiography (CTA), magnetic resonance angiography (MRA), contrast-enhanced ultrasound, and duplex ultrasound (DUS) for follow-up screening of patients with SAAs treated with coil embolisation.

Material and methods: We conducted a systematic review according to the PRISMA 2020 Statement. We searched 5 databases: Embase, Medline Ultimate, PubMed, Scopus, and Web of Science, each up to 10 April 2024. Eventually, 20 relevant original studies were included.

Results: DSA is an invasive procedure that requires ionising radiation and should not be performed as a routine check-up. CTA is an appropriate examination method in patients immediately after coil embolisation in whom severe complications, primarily bleeding, are suspected. Still, it is unsuitable for assessing persistent aneurysmal sac perfusion. MRA is a promising noninvasive technique that does not require ionising radiation. Several studies have demonstrated the superiority of MRA over DSA in detecting small aneurysmal sac reperfusion. DUS, while not a standalone method, may supplement MRA in patients at low risk of reintervention.

Conclusions: The evidence regarding follow-up imaging methods after SAAs coil embolisation is limited and of low quality. MRA should be preferred over DSA for detecting aneurysmal sac reperfusion. Due to artifacts, CTA is suitable for emergency cases but not for routine follow-up.

Purpose: To assess the influence of long- and short-segment spinal ankylosis on the characteristics and course of acute thoracolumbar fractures.

Material and methods: Computed tomography (CT) studies of 372 patients who were diagnosed with acute thoracolumbar spine fracture in our hospital between 2014 and 2020 were retrospectively reviewed. Demographic data, presence or absence of rigid spine conditions, location, and fracture morphology according to the Arbeitsgemeinschaft für Osteosynthesefragen (AO) spine classification were assessed. Statistical analysis was performed using the χ² test.

Results: A total of 65 patients with fractures through ankylosed segment or immediately adjacent segment (rigid spine group) and 307 controls were identified. Most rigid spine patients suffered minor trauma. In both groups most of the fractures were located in the thoracolumbar junction, and type A1 fractures were most common, followed by types A3 and A4. Multilevel fractures were more common in rigid spine patients (41.54% vs. 30.29%). Most of the rigid spine fractures (46.96%) were located within the fused spinal segment, with the midportion of the fused spinal segment being the most common location of types B and C fractures. Long-segment fusion was associated with unstable type B and C fractures. In short-segment fusion, single level type A fractures were most common. Spinal cord injury occurred only in patients with delayed diagnosis.

Conclusions: When plain films are used as a first-line diagnostic test for thoracolumbar spine trauma in stable patients without abnormal neurological signs or symptoms, and long-segment spinal ankylosis is observed, thoracolumbar CT should be used for further evaluation.

Purpose: This study compares breast carcinoma (BC) clinical tumour staging by contrast-enhanced mammography (CEM), full-field digital mammography (FFDM), and ultrasound (US). Clinical staging is essential for multidisciplinary teams to develop optimal treatment plans and for cancer registries to generate accurate analyses of cancer epidemiology.

Material and methods: Data on tumour size and the presence of multiplicity were extracted from radiology reports. Primary tumour staging (cT category) was established for each imaging modality. Enrolled cases (n = 78, adult females) had FFDM and US performed up to a month prior to CEM. Fisher's exact test was used to examine the relationship between cT stage determination and diagnostic methods.

Results: Tumour size was largest in CEM (median 47 mm), followed by FFDM (median 33 mm), and smallest in US (median 23 mm). There were statistically significant differences in the distribution of cT categories between the 3 imaging modalities, with cT2 and cT1 being most common in US (46% and 41%, respectively) and FFDM (53% and 19%, respectively). Staging by CEM followed a different pattern, with cT2 and cT3 being most common (both 38%). The multiplicity rate was equal for CEM and US (42%), with fewer cases in FFDM (13%).

Conclusions: The tumour size measured by CEM is greater compared to measurements obtained through US and FFDM. Given the strong correlation between CEM and histopathology reported in the literature, CEM enhances the accuracy of local tumour staging in BC, thereby minimising the risk of understaging.