Polish journal of radiology最新文献

The year 2023 marks 60 years since the first pacemaker was implanted in Poland. The number of implantable cardiac electrotherapy devices (CIEDs), including pacemakers, cardioverter-defibrillators, and resynchronization therapy systems, has been systematically increasing in the subsequent decades. It is estimated that nearly 500,000 Poles have an implanted cardiac electrotherapy device, making optimal diagnostic imaging with the use of magnetic resonance imaging (MRI) a clinically and epidemiologically important issue. MRI has become a gold diagnostic standard in many disease states. In this situation, it is believed that 50-70% of patients who have a cardiac electrotherapy device may have indications for an MRI examination later in life. For many years, an implanted cardiac electrotherapy device was considered a definite contraindication to MRI. However, MRI has become possible in most patients with CIED if certain procedures and precautions are followed. In these guidelines, we describe the basic rules that should be followed in order to perform a safe MRI examination in patients with different CIEDs. Despite all the risks and organizational factors described in the text, it seems that for many MRI departments, MRI in patients with CIEDs is achievable and should be implemented immediately. A second important issue is the need for dedicated financial support for these procedures from public health insurance.

Purpose: We aimed to conduct a systematic review and meta-analysis of studies examining the performance of cone-beam computed tomography (CBCT) imaging in apical periodontitis (AP) prediction. This was done to address the contradictory results reported in the existing literature on this topic.

Material and methods: We searched the Embase, PubMed, Cochrane library, and Scopus databases for literature published from inception to 30 June 2023 without language restriction using appropriate keywords. We included studies that reported the diagnostic accuracy values of CBCT in AP detection among humans by comparing AP diagnosis with a control group without lesions. We pooled the diagnostic accuracy values using a random effects model and presented the estimates as percentage and 95% confidence interval (CI). The heterogeneity between the surveys was explored by I² statistic.

Results: Out of 301 citations initially identified, a total of 8 eligible studies were finally included. According to the analyses, the overall pooled sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) estimated for CBCT were 94.6% (95% CI: 90.2-97.1; I² = 55.9%, p = 0.026), 91.2% (95% CI: 81.7-96.0; I² = 81.6%, p < 0.001), 93.0% (95% CI: 87.4-96.2; I² = 56.5%, p = 0.024), and 92.3% (95% CI: 82.3-96.8; I² = 86.4%, p < 0.001), respectively. The overall pooled sensitivity, specificity, PPV, and NPV of digital radiography were 61.0% (95% CI: 38.3-79.8; I² = 94.4%, p < 0.001), 97.3% (95% CI: 85.6-99.5; I² = 86.7%, p < 0.001), 98.3% (95% CI: 92.0-99.6; I² = 74.4%, p = 0.002), and 41.6% (95% CI: 28.0-56.6; I² = 89.5%, p < 0.001), respectively.

Conclusions: CBCT imaging has excellent diagnostic accuracy in AP prediction. Also, CBCT has better discriminant test performance for AP than digital radiography.

Purpose: We investigated the diagnostic power of texture analysis (TA) performed on MRI (T2-weighted, gadolinium-enhanced, and diffusion-weighted images) to differentiate between focal nodular hyperplasia (FNH) and hepatocellular adenoma (HCA).

Material and methods: This was a retrospective single-centre study. Patients referred for liver lesion characterization, who had a definitive pathological diagnosis, were included. MRI images were taken by a 3-Tesla scanner. The values of TA parameters were obtained using the ImageJ platform by an observer blinded to the clinical and pathology judgments. A non-parametric Mann-Whitney U test was applied to compare parameters between the 2 groups. With receiver operating characteristic (ROC) analysis, the area under the curve (AUC), sensitivity, and specificity were calculated. Finally, we performed a binary logistic regression analysis. A p-value <0.05 was reported as statistically significant.

Results: A total of 62 patients with 106 lesions were enrolled. T2 hyperintensity, Atoll sign, and intralesional fat were encountered more in HCAs, and central scars were more frequent in FNHs. Multiple TA features showed statistically significant differences between FNHs and HCAs, including skewness on T2W and entropy on all sequences. Skewness on T2W revealed the most significant AUC (0.841, good, p < 0.0001). The resultant model from binary logistic regression was statistically significant (p < 0.0001) and correctly predicted 84.1% of lesions. The corresponding AUC was 0.942 (excellent, 95% CI: 0.892-0.992, p < 0.0001).

Conclusion: Multiple first-order TA parameters significantly differ between these lesions and have almost fair to good diagnostic power. They have differentiation potential and can add diagnostic value to routine MRI evaluations.

Neurosarcoidosis is a complex and multifaceted inflammatory disorder affecting the nervous system. The disease, characterized by non-caseating granulomas, primarily involves the central and peripheral nervous systems. Neuro-logical manifestations vary widely and can include cranial nerve palsies, meningeal involvement, parenchymal lesions, hydrocephalus, and more. Diagnosis remains challenging due to the lack of specific imaging features, necessitating a combination of clinical evaluation, cerebrospinal fluid analysis, imaging studies, and sometimes tissue biopsy. This review article underscores the importance of the identification of various imaging features to mitigate the mortality and morbidity associated with neurosarcoidosis.

Multiple sclerosis (MS) is a chronic, demyelinating disease affecting the central nervous system. Diagnosis of MS is based on the proof of disease dissemination in time (DIT) and dissemination in space (DIS) and excluding other disorders that can mimic multiple sclerosis in laboratory tests and clinical manifestation. Over the years the diagnostic criteria have evolved; the introduction of magnetic resonance in the McDonald's 2001 criteria was revolutionary. Since then, the criteria have been modified up to the currently used McDonald 2017. The aim of this review is to analyse the 2017 McDonald criteria, assess what has changed from the 2010 criteria, and present the impact of revised criteria on rapid and accurate diagnosis of MS. The main differences are as follows: inclusion of oligoclonal bands in cerebrospinal fluid as a DIT criterion, and symptomatic and cortical lesions in magnetic resonance imaging are counted in the determination of DIS and DIT. We present also the newest recommendations of the Polish Medical Society of Radiology and the Polish Society of Neurology and international group of North American Imaging in Multiple Sclerosis and Consortium of Multiple Sclerosis Centers, as well as future directions for further investigations. A proper diagnosis is crucial for the patient's quality of life, to give the possibility of early treatment, and to help avoid misdiagnosis and unnecessary therapy.

Purpose: To evaluate the feasibility of using a deep learning (DL) model to generate fat-suppression images and detect abnormalities on knee magnetic resonance imaging (MRI) through the fat-suppression image-subtraction method.

Material and methods: A total of 45 knee MRI studies in patients with knee disorders and 12 knee MRI studies in healthy volunteers were enrolled. The DL model was developed using 2-dimensional convolutional neural networks for generating fat-suppression images and subtracting generated fat-suppression images without any abnormal findings from those with normal/abnormal findings and detecting/classifying abnormalities on knee MRI. The image qualities of the generated fat-suppression images and subtraction-images were assessed. The accuracy, average precision, average recall, F-measure, sensitivity, and area under the receiver operator characteristic curve (AUROC) of DL for each abnormality were calculated.

Results: A total of 2472 image datasets, each consisting of one slice of original T1WI, original intermediate-weighted images, generated fat-suppression (FS)-intermediate-weighted images without any abnormal findings, generated FS-intermediate-weighted images with normal/abnormal findings, and subtraction images between the generated FS-intermediate-weighted images at the same cross-section, were created. The generated fat-suppression images were of adequate image quality. Of the 2472 subtraction-images, 2203 (89.1%) were judged to be of adequate image quality. The accuracies for overall abnormalities, anterior cruciate ligament, bone marrow, cartilage, meniscus, and others were 89.5-95.1%. The average precision, average recall, and F-measure were 73.4-90.6%, 77.5-89.4%, and 78.4-89.4%, respectively. The sensitivity was 57.4-90.5%. The AUROCs were 0.910-0.979.

Conclusions: The DL model was able to generate fat-suppression images of sufficient quality to detect abnormalities on knee MRI through the fat-suppression image-subtraction method.

Purpose: Ileocolonoscopy aids in the diagnosis of ileocecal region pathologies when typical mucosal lesions are seen. However, in many cases the mucosal lesions of the ileocaecal region are atypical, rendering themselves to diagnostic dilemma. The present study aimed to study the role of computed tomography (CT) enterography in the evaluation of symptomatic patients who demonstrated ileocecal mucosal lesions of uncertain diagnosis on ileocolonoscopy.

Material and methods: Symptomatic patients who had ileocolonoscopy documented ileocecal mucosal lesions of uncertain diagnosis were enrolled. Patients were subjected to CT enterography within 10 days of ileocolonoscopy. On CT enterography a diagnosis of Crohn's disease (CD) or ileocaecal tuberculosis (ITB) was made. The diagnosis obtained by CT enterography was correlated with the final diagnosis obtained from histopathology. Using descriptive statistics, the diagnostic performance of CT enterography was evaluated.

Results: A total of 153 cases were enrolled in the study. CT enterography findings were present in 147 cases, resulting in a diagnostic yield of 96%. Out of these, 58.16% (89/153) had CD, 26.14% (40/153) had ITB, 6.5% (10/153) had infectious ileitis, and 9.15% (14/153) were indeterminate on histopathology. CT enterography correctly identified 78.65% (70/89) of CD and 75% (30/40) of ITB. CT enterography had a sensitivity of 78.65% and 75%, specificity of 67.19% and 87.61%, positive predictive value of 76.92% and 68.18%, and diagnostic accuracy of 73.86% and 84.31% for diagnosing CD and ITB, respectively.

Conclusions: CT enterography provided a high diagnostic yield in ileocaecal mucosal lesions of uncertain significance on endoscopy. CD and ITB were the predominant diseases detected in these individuals. CT enterography had a good diagnostic performance in the detection of these 2 disorders.

Purpose: To assess the efficacy and safety of a low-dose, computed tomography (CT)-guided transthoracic biopsy of lung and pleural lesions.

Material and methods: A total of 135 low-dose, CT-guided transthoracic lung and pleural lesions biopsies were performed. A cutting needle was utilized in 124 cases, and fine needle aspiration biopsy was performed in 14 cases. In all cases, 14- to 22-gauge biopsy needles were used.

Results: Diagnostic material was obtained in 111 (82.2%) patients. In 97 (71.8%) cases neoplastic lesions were found, predominantly adenocarcinoma and non-small cell carcinoma. In 14 (12.6%) cases non atypical cells were reported. Biopsy failed to obtain material suitable for histopathological examination in 24 (17.7%) cases. Complications occurred in 31 patients, including pneumothorax in 28 patients and haematoma in 3 cases.

Conclusions: Based on the obtained results, it can be stated that low-dose, CT-guided transthoracic biopsy of lung and pleural tissues is an accurate and safe procedure. Also, it is linked to a low risk of complications such as a small pneumothorax.

In recent years, imaging studies have become increasingly used at various stages in the management of patients with various conditions and disorders. This process results in a necessity to provide an increasing number of exams, which involves a growing role of radiologists in assessing and reporting those exams. The article discusses tele-radiology as a method that can improve access to radiology services, presenting its potential benefits, as well as the risks involved. It analyses access to radiology healthcare services in Poland in the context of the international and Polish legal provisions concerning the right to healthcare. While funding for imaging studies for patients is widely available and imaging equipment in Poland is improving despite some shortages, the main barrier is identified in the number of specialists capable of assessing the exams. Teleradiology can alleviate this shortage, so the article presents legal provisions and international good practice guidelines in this area, focusing on documents issued by the European Society of Radiology, the American College of Radiology, and the British Royal College of Radiologists. The guidelines concerning such aspects as patients' rights, teleradiologists' qualifications, communication and reporting, responsibility, and technical requirements may help make teleradiology a safe and valuable component of the healthcare system in Poland.