Polish journal of radiology最新文献

Purpose: The incidence of renal cell carcinoma has been steadily increasing over the past two decades, raising the need for minimally invasive approaches. We sought to present the methodology of the percutaneous cryoablation (PCA) procedure developed based on one year of experience with 81 PCA procedures.

Material and methods: The percutaneous cryoablation programme at Wroclaw Medical University Hospital has been successfully operating for a year. During this period, patients who were ineligible for partial nephrectomy either because of numerous comorbidities or strong preference against surgery were treated with PCA. Each procedure was conducted with the close cooperation of an interventional radiologist and a urologist.

Results: Over the past year, 81 procedures in 74 individuals have been performed and thoroughly analysed. The mean and median effective radiation doses were 12.57 mSv and 10.76 mSv, respectively. Comprehensive details of our workflow are described within the body of the manuscript.

Conclusions: Percutaneous cryoablation is a technically effective treatment approach for carefully selected individuals with small renal masses. However, starting a PCA programme from scratch necessitates creation of detailed protocols, as well as close interventional radiologist and urologist cooperation. This review outlines the established workflow and shares insights gained from one year of experience with percutaneous cryoablation.

Purpose: Diagnosis of perianal fistula represents a challenge for surgeons. It is well known that magnetic resonance imaging (MRI) plays an important role in that. The new 3D MRI sequence VISTA (Volume ISotopic Turbo spin echo Acquisition) can improve detection and characterization of perianal fistula compared with two-dimensional (2D) sequences. The aim of the study was to compare the diagnostic performance of the new 3D MRI sequence VISTA with the widely routinely used T2 FSE pulse sequence in depiction and characterization of perianal fistula by using the contrast-enhanced (CE) 3D T1 sequence THRIVE (T1-weighted high-resolution isotropic volume examination) as a reference standard.

Material and methods: Forty adult patients were enrolled in this prospective study. They underwent MRI perianal region examination using routine T2 TSE and CE 3D T1 sequence THRIVE with addition of the new 3D MRI sequence VISTA. T2, 3D VISTA and (CE) 3D T1 sequence THRIVE images were evaluated by two radiologists separately for detection and characterization of perianal fistula, then comparison between of T2 and 3D VISTA sequences was done using (CE) 3D T1 sequence THRIVE as a reference. Each sequence sensitivity, specificity and accuracy were calculated by both readers.

Results: For reader 1, the sensitivity, specificity and accuracy were 92.5%, 90.5% and 93.6% for 3D VISTA and 84.1%, 83.7% and 87.3% for T2 FSE. For reader 2, the sensitivity, specificity and accuracy were 91.5%, 92.8% and 94.8% for 3D VISTA and 82.9%, 84.5% and 86.7% for T2 FSE.

Conclusions: Using CE 3D T1 sequence THRIVE as the reference standard, 3D VISTA pulse sequence on the perianal region has better diagnostic performance in the detection and characterization of perianal fistula as compared to the routinely used T2 FSE sequence.

This study evaluates diverse educational resources to address the gaps in diagnostic radiology education for medical students, aiming to identify tools that enhance theoretical knowledge and practical diagnostic skills. Employing a multi-faceted review, we analyzed digital platforms, academic databases, and social media for resources beneficial to medical students in radiology, assessing their accessibility, content quality, and educational value. Our investigation uncovered a broad spectrum of resources, from foundational platforms to advanced simulation tools, varying in their approach to teaching radiology. Traditional resources provide essential theoretical knowledge, while digital tools, including interactive case studies and multimedia content, offer immersive learning experiences. Notably, resources integrating machine learning and social media facilitate dynamic, peer-to-peer learning and up-to-date case discussions. Despite the minimal current focus on VR, its role in enhancing interactive learning is notable. The diversity in educational tools highlights the evolving nature of radiology education, reflecting a shift towards more engaging and practical learning methodologies. Identifying and integrating a variety of educational resources into radiology education can significantly enhance learning outcomes for medical students, preparing them for the complexities of modern diagnostic radiology with a well-rounded educational approach.

Purpose: Chylous leakage is a serious and challenging postoperative complication. The purpose of this study was to explore the application of ultrasound-guided intranodal lymphangiography in the diagnosis and treatment of chylous ascites following abdominal surgery.

Material and methods: Ten patients with chylous ascites after abdominal surgery after ineffective conservative treatment such as low-fat diet, parenteral nutrition, and negative pressure drainage were included in this single-center retrospective study. Of these 10 patients, 9 developed chylous ascites after liver surgery, and 1 after a radical gastrectomy.

Results: Lymphangiography was successfully performed in all 10 patients. The average dosage of lipiodol used was 4.5 ml (range 3.5-7.0 ml). No procedure-related complications were observed after excluding unrelated factors. During lymphangiography, lipiodol leakage was directly observed in 3 cases, and in the other 5 cases, it was detected through abdominal computed tomography post-lymphangiography. Chylous ascites resolved solely through lymphangiography in 6 patients without requiring additional surgical intervention.

Conclusions: Lymphangiography may help identify leakage sites in patients with chylous ascites unresponsive to conservative treatment and could potentially be effective in treating chylous ascites following abdominal surgery.

In this review the authors focus on abnormal brain magnetic resonance imaging caused by drugs given to patients in any age group for any disease. The review includes viral infections with fever in children/infections in general, epilepsy, psychiatric diseases, multiple sclerosis, neoplasms, bone marrow/organ transplantations, total parenteral nutrition, vaccinations, oral contraceptives and other prothrombotic drugs, and gadolinium deposition. Knowledge of patients' diseases and medications they receive is crucial to establish the correct diagnosis. The absence of these data in a referral for a brain MRI scan can result in completely wrong suspicions and unleash unnecessary, complicated, time-consuming and expensive diagnostics, causing additional stress in patients and their guardians.

Glioblastomas are the most common and aggressive form of malignant primary brain tumors in adults. The standard treatment is surgical resection followed by radiotherapy and chemotherapy. Despite optimal treatment methods, the prognosis for patients remains poor. Preoperative determination of glioblastoma margins remains beneficial for the complete removal of the tumor mass. Radiotherapy is essential for post-surgery treatment, but radioresistance is a significant challenge contributing to high mortality rates. Advanced imaging technologies are used to analyze the changes in the peritumoral brain zone (PTZ). Consequently, they may lead to the development of novel therapeutic options, especially targeting the marginal parts of a tumor, which could improve the prognosis of glioblastoma patients. The clinical presentation of glioblastoma is heterogeneous and mostly depends on the location and size of a tumor. Glioblastomas are characterized by both intratumoral cellular heterogeneity and an extensive, diffuse infiltration into the normal tissue bordering a tumor called the PTZ. Neuroimaging techniques, such as diffusion-weighted imaging (DWI), diffusion tensor imaging (DTI), perfusion-weighted imaging (PWI), proton magnetic resonance spectroscopy (¹H MRS), and chemical exchange saturation transfer (CEST) are useful methods in the evaluation of the tumor infiltration and thus the resection margin.

Purpose: This study aimed to evaluate the diagnostic value of contrast-enhanced ultrasound (CEUS) in diagnosing and monitoring hepatic abscesses (HA).

Material and methods: This retrospective study included 29 patients (9 females, 20 males) with 64 HA. Computed tomography (CT) served as the diagnostic benchmark, compared with CEUS and B-mode ultrasound (B-mode). Two radiologists assessed the presence, size, and characteristics of the HA.

Results: The contrast enhancement pattern on CEUS matched post-contrast CT. Lesion size detected by CEUS ranged from 1.16 cm to 15.33 cm (median 5.74 cm). CT classified lesions into four types: I (tumor-like) - 2, II (honeycomb) - 5, III (lacunar) - 23, IV (cystic-like) - 34. CEUS fully agreed with these classifications. B-mode missed two type I lesions. For type III abscesses, agreement with CEUS was perfect (κ = 1, 100%), and moderate with B-mode (κ = 0.50, 79.7%). For type IV abscesses, agreement with CEUS was perfect (κ = 1, 100%), and high with B-mode (κ = 0.88, 93.75%). Pus enhancement remained stable (± 15 dB), while the abscess pouch background varied (± 11 dB to ± 6 dB). The Mann-Whitney U test confirmed these observations (arterial: p = 1.02e-14, portal: p = 3.79e-12, late venous: p = 4.53e-13). No significant difference in enhancement values was found based on abscess size (> 4 cm vs. < 4 cm).

Conclusions: CEUS is superior to B-mode for diagnosing and monitoring HA, offering clearer views of the abscess pouch, septa, and liver parenchyma. The purulent part lacks contrast, allowing accurate assessment. CEUS can replace CT for monitoring and aid in patient selection for percutaneous intervention.

Purpose: Ultrasonography is the primary diagnostic tool for evaluating thyroid nodules. The Thyroid Imaging Reporting & Data System (TIRADS) aims to standardise assessment and reduce fine-needle aspiration biopsies through risk stratification. This pilot study examined knowledge and utilisation of TIRADS among Polish physicians, their perception of the usefulness of TIRADS application and the extent of knowledge of individual nodule features included.

Material and methods: An internet-based questionnaire about TIRADS use in clinical practice was sent out to Polish Ultrasound Society members. Information on the responder's experience with thyroid ultrasound and knowledge and use of TIRADS was assessed and analysed.

Results: Out of 159 physicians, 66.6% did not use TIRADS despite 43.4% being aware of its existence. EU-TIRADS was the most commonly adopted classification (50.9%). Participants who adopted TIRADS were younger (p = 0.047) and more likely to be radiologists (p < 0.01). TIRADS use was more prevalent in university clinical hospitals (p = 0.02), among physicians doing thyroid ultrasound as their primary professional activity (p < 0.01), those performing > 100 thyroid ultrasound examinations per year (p < 0.01) and those involved with thyroid fine-needle aspiration biopsy (p < 0.01). The purposes of TIRADS adoption (p < 0.01) and included imaging features (p < 0.01) were more accurately recognized by TIRADS users.

Conclusions: TIRADS utilization among Polish clinicians is limited, despite awareness of the classification's existence. Knowledge of TIRADS components and the purpose of its application among users is satisfactory. Further training and TIRADS adoption should be encouraged, especially in the light of the recent EU-TIRADS-PL guidelines recommended by the Polish Scientific Societies.

Purpose: The aim of our study was to analyse the histological differentiation and computed tomography imaging features of pancreatic neuroendocrine neoplasms (PNENs).

Material and methods: We performed a retrospective single-centre cohort study of 157 patients with histologically confirmed PNEN. We compared the results of the preoperative biopsy from the tumour with reports of the multi-slice computed tomography performed by a radiologist with 30 years of clinical practice.

Results: Specific computed tomography (CT) features are associated with histological differentiation, such as enhancement in the arterial phase (p = 0.032), Wirsung's duct dilatation (p = 0.001), other organ infiltration (p < 0.001), distant metastases (p < 0.001), and enlarged regional lymph nodes (p = 0.018). When there is an organ infiltration, the likelihood of the tumour having histological malignancy grades G2 or G3 triples (95% CI: 1.21-8.06). Likewise, the existence of distant metastases increases the risk almost fourfold (95% CI: 1.44-10.61), and a tumour size of 2 cm or larger is linked to a nearly threefold rise in the risk of histological malignancy grades G2 or G3 (95% CI: 1.21-6.24).

Conclusions: Certain CT characteristics: enhancement during the arterial phase, Wirsung's duct dilatation, organ infiltration, distant metastases, and the enlargement of regional lymph nodes are linked to histological differentiation.