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Thoracic pain: From guidelines to clinical practice 胸痛:从指南到临床实践
Pub Date : 2025-05-01 DOI: 10.1016/j.rxeng.2024.05.007
A.I. Barrio Alonso , J. Broncano Cabrero , A.M. Villán González , Y. López Suárez , C. López Muñiz , A. Luna Alcalá
Thoracic pain is the most prevalent symptom in patients with cardiovascular diseases. Diagnosis and patient management are guided by the pain attributes, analytical parameters, and several different imaging modalities. Invasive imaging tests and cardiac magnetic resonance are highly relevant in this context, as set out in the 2023 European guidelines for the management of acute coronary syndromes, the 2023 American guidelines for the management of patients with chronic coronary disease, and the 2021 American guidelines for the evaluation and diagnosis of chest pain. This article focuses on the role that these guidelines attribute to non-invasive cardiac imaging (computed tomography and cardiac magnetic resonance) in the management of both acute and chronic coronary syndrome.
胸痛是心血管疾病患者最常见的症状。诊断和患者管理是由疼痛属性,分析参数和几种不同的成像模式指导。正如2023年欧洲急性冠状动脉综合征管理指南、2023年美国慢性冠状动脉疾病患者管理指南和2021年美国胸痛评估和诊断指南所规定的那样,侵入性成像检查和心脏磁共振在这方面具有高度相关性。这篇文章的重点是这些指南在急性和慢性冠状动脉综合征治疗中非侵入性心脏成像(计算机断层扫描和心脏磁共振)的作用。
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引用次数: 0
A commercial AI tool untrained for COVID-19 demonstrates slight improvement in the interpretation of COVID-19 pneumonia x-rays, especially among inexperienced readers 未经COVID-19训练的商业人工智能工具在解释COVID-19肺炎x射线方面略有改善,特别是在没有经验的读者中
Pub Date : 2025-05-01 DOI: 10.1016/j.rxeng.2025.01.001
M. Pérez Laencina , J.M. Plasencia Martínez , M. Sánchez Canales , C. Jiménez Pulido , R. Rodríguez Mondéjar , L. Martínez Encarnación , C. García Hidalgo , D. Galdo Galián , P. Hernández Madrid , L. Chico Caballero , E. Guillén García , M.N. Plasencia Martínez , S. Martínez Romero , J. García Molina , J.M. García Santos

Introduction

Our objective is to evaluate how useful an artificial intelligence (AI) tool is to chest radiograph readers with various levels of expertise for the diagnosis of COVID-19 pneumonia when the tool has been trained on a non-COVID-19 pneumonia pathology.

Methods

Data was collected for patients who had previously undergone a chest radiograph and digital tomosynthesis due to suspected COVID-19 pneumonia. The gold standard consisted of the readings of two expert radiologists who assessed the presence and distribution of COVID-19 pneumonia on the images. Six medical students, two radiology trainees, and two other expert thoracic radiologists participated as additional readers. Two radiograph readings and a third supported by the AI Thoracic Care Suite tool were performed. COVID-19 pneumonia distribution and probability were assessed along with the contribution made by AI. Agreement and diagnostic performance were analysed.

Results

The sample consisted of 113 cases, of which 56 displayed lung opacities, 52.2% were female, and the mean age was 50.70 ± 14.9. Agreement with the gold standard differed between students, trainees, and radiologists. There was a non-significant improvement for four of the six students when AI was used. The use of AI by students did not improve the COVID-19 pneumonia diagnostic performance but it did reduce the difference in diagnostic performance with the more expert radiologists. Furthermore, it had more influence on the interpretation of mild pneumonia than severe pneumonia and normal radiograph findings. AI resolved more doubts than it generated, especially among students (31.30% vs 8.32%), followed by trainees (14.45% vs 5.7%) and radiologists (10.05% vs 6.15%).

Conclusion

For expert and lesser experienced radiologists, this commercial AI tool has shown no impact on chest radiograph readings of patients with suspected COVID-19 pneumonia. However, it aided the assessment of inexperienced readers and in cases of mild pneumonia.
我们的目标是评估人工智能(AI)工具在接受过非COVID-19肺炎病理培训后,对具有不同专业水平的胸片读者诊断COVID-19肺炎的有用程度。方法收集疑似COVID-19肺炎的患者既往行胸片和数字断层合成的数据。金标准包括两名放射科专家的读数,他们评估了图像上COVID-19肺炎的存在和分布。六名医学生、两名放射学实习生和另外两名胸椎放射科专家作为额外的读者参与了研究。进行了两次x线片读数和第三次由AI胸腔护理套件工具支持的x线片读数。评估新冠肺炎的分布和概率,以及人工智能的贡献。分析了一致性和诊断性能。结果113例患者中56例出现肺混浊,女性占52.2%,平均年龄50.70 ± 14.9岁。对金标准的认同在学生、实习生和放射科医生之间存在差异。当使用人工智能时,六名学生中有四名没有显著改善。学生使用人工智能并没有提高COVID-19肺炎的诊断性能,但确实缩小了与更专业的放射科医生的诊断性能差异。此外,它对轻度肺炎的解释比严重肺炎和正常x线表现的影响更大。人工智能解决的问题比产生的问题更多,尤其是在学生中(31.30%对8.32%),其次是实习生(14.45%对5.7%)和放射科医生(10.05%对6.15%)。结论对于专家和经验不足的放射科医生来说,该商业人工智能工具对疑似COVID-19肺炎患者的胸片读数没有影响。然而,它有助于评估没有经验的读者和轻度肺炎的情况下。
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引用次数: 0
European Diploma in Radiology (EDiR) clinical cases 欧洲放射学文凭(EDiR)临床病例
Pub Date : 2025-05-01 DOI: 10.1016/j.rxeng.2025.03.002
Editorial Board of Radiology
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引用次数: 0
Pulmonary neuroendocrine cells: Spectrum of diseases and their radiological-pathological correlations 肺神经内分泌细胞:疾病谱及其放射-病理相关性
Pub Date : 2025-05-01 DOI: 10.1016/j.rxeng.2024.04.007
E. Baettig , M.F. Molina-Centelles , A. Amr-Rey , N. Mancheño-Franch , C. Muñoz-Núñez
Pulmonary neuroendocrine cells, which constitute a small percentage (0.4%) of airway epithelial cells, play a key role in hypoxia detection, epithelial growth and regeneration, and in lung organogenesis through the synthesis and secretion of amines and peptides. Lesions resulting from pulmonary neuroendocrine cell proliferation range from benign and indolent to malignant and highly aggressive. The recently updated WHO classification of pulmonary neuroendocrine neoplasms includes typical and atypical carcinoid tumours as well as high-grade neuroendocrine carcinomas: large cell neuroendocrine carcinomas and small cell carcinomas. This classification also recognises a condition known as diffuse idiopathic pulmonary neuroendocrine cell hyperplasia (DIPNECH) as a distinct entity. Radiologists need to become familiar with these pathologies as the symptoms often lack specificity, and thus imaging plays a crucial role in diagnosis. An understanding of the correlation between the radiological and pathological examinations of these pathologies can enhance our awareness of the wide spectrum of imaging manifestations.
肺神经内分泌细胞仅占气道上皮细胞的0.4%,在缺氧检测、上皮生长和再生、肺器官发生等方面发挥着关键作用,主要通过合成和分泌胺类和多肽。肺神经内分泌细胞增生引起的病变范围从良性和惰性到恶性和高度侵袭性。最近更新的世卫组织肺神经内分泌肿瘤分类包括典型和非典型类癌以及高级别神经内分泌癌:大细胞神经内分泌癌和小细胞癌。这种分类也承认弥漫性特发性肺神经内分泌细胞增生(DIPNECH)是一种独特的疾病。放射科医生需要熟悉这些病理,因为这些症状往往缺乏特异性,因此影像学在诊断中起着至关重要的作用。了解这些病理的放射学和病理学检查之间的相关性可以增强我们对广泛的影像学表现的认识。
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引用次数: 0
Radiological findings of adenoid cystic carcinoma of the breast 乳腺腺样囊性癌的影像学表现
Pub Date : 2025-05-01 DOI: 10.1016/j.rxeng.2024.11.005
M. Fresno Vallespir , I. Vázquez de las Heras , D. Gasior , A. Morales Rosa , X. Bargalló Castelló
Adenoid cystic carcinoma (ACC) of the breast is a rare tumour that represents less than 0.1% of breast carcinomas. It has a triple-negative phenotype; however, it is associated with a benign course, and both lymph node involvement and distant metastasis are rare. We present seven cases of ACC of the breast diagnosed in our centre. We describe their radiological characteristics, and specifically highlight the findings from magnetic resonance imaging.
乳腺腺样囊性癌(ACC)是一种罕见的肿瘤,占乳腺癌的不到0.1%。它具有三阴性表型;然而,它与良性病程相关,淋巴结累及和远处转移是罕见的。我们提出7例乳腺ACC的诊断在我们的中心。我们描述了它们的放射学特征,并特别强调了磁共振成像的发现。
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引用次数: 0
The role of gynecologic sonography in sexual development assessment of girls and adolescents 妇科超声检查在女童和青少年性发育评估中的作用
Pub Date : 2025-03-01 DOI: 10.1016/j.rxeng.2023.08.006
G. Rahman , M.A. Urrutia , M.I. Salaberry , P. Risso , D.C. Ocampo , V.G. Gonzalez , A.V. Rubinstein

Introduction and objectives

Transabdominal ultrasonography (US) is the technique of choice for pelvis evaluation in paediatric population. The results of studies regarding US findings show a wide variation. The objectives of our study were: to estimate and correlate uterine and ovarian ultrasound measures (longitudinal diameter and volume) with chronological age, breast Tanner stage (TS) and gynaecological age (GA); to evaluate presence and size of follicles in patients according to their pubertal stage; and to determine the endometrial length in prepubertal and pubertal girls.

Material and methods

Unicentric, observational, retrospective, analytical study, conducted between 2010 and 2019. Healthy girls between 8.0 and 16.0 years, attended in the deparment of radiology were evaluated. Breast Tanner's stage (TS) was evaluated and gynaecological age was determined. Ultrasounds were performed by a paediatric diagnostic radiospecialist. Uterus length (UL) and ovarian length (OL) were measured; uterus and ovarian volume were calculated (UV and OV). Diameter of the largest follicle and endometrial thickness were measured.

Results

292 patients were analyzed, mean age was 12.5 years (SD: 2.1). A significant correlation was observed between uterine and ovarian measurements with chronological age (CA), TS and GA (p < 0.0001). A significant increase in DLU and VU is described as the CA intervals increase, also in ovarian measurements. No significant differences in measurements were observed between TS I and II. An increase was evidenced at menarche. In 30.9% of pubertal patients and 11.8% of prepubertal patients showed ovarian follicles. The endometrium was not measurable in 88.24% of the pre-pubertal population and was always measurable in patients with TS IV and V.

Conclusions

Uterine and ovarian measurements increased with CE and ET (except ETI and II). The greatest increase occurred with menarche. Ovarian follicles and endometrium thickness less than or equal to 1 mm were presented in prepubertal patients.
简介与目的经腹超声检查(US)是儿童骨盆检查的首选技术。有关美国调查结果的研究结果显示了很大的差异。本研究的目的是:估计子宫和卵巢超声测量(纵向直径和体积)与实足年龄、乳房Tanner分期(TS)和妇科年龄(GA)之间的相关性;根据不同的青春期阶段评价患者卵泡的存在和大小;并测定青春期前和青春期女孩的子宫内膜长度。材料与方法:2010年至2019年间进行的一项中心、观察、回顾性、分析性研究。对在放射科就诊的8.0 ~ 16.0岁健康女童进行评价。评估乳腺Tanner分期(TS)并确定妇科年龄。超声检查由儿科诊断放射专家进行。测量子宫长度(UL)和卵巢长度(OL);计算子宫和卵巢体积(UV和OV)。测量最大卵泡直径和子宫内膜厚度。结果共分析292例患者,平均年龄12.5岁(SD: 2.1)。子宫和卵巢测量值与实足年龄(CA)、TS和GA之间存在显著相关性(p <; 0.0001)。DLU和VU的显著增加被描述为CA间隔的增加,卵巢测量也是如此。在TS I和TS II之间没有观察到显著的测量差异。在月经初潮时明显增加。30.9%的青春期患者和11.8%的青春期前患者出现卵巢卵泡。88.24%的青春期前人群子宫内膜未检出,而tsiv和tsv患者子宫内膜均可检出。结论子宫内膜和卵巢内膜随CE和ET升高(ETI和ET除外),以月经初潮升高最多。青春期前患者卵巢卵泡和子宫内膜厚度小于或等于1 mm。
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引用次数: 0
New-onset hepatic lesions in oncological patients: A challenging diagnosis 肿瘤患者新发肝脏病变:一个具有挑战性的诊断
Pub Date : 2025-03-01 DOI: 10.1016/j.rxeng.2023.07.009
H. Peris Alvà, C. Cano Rodríguez, F. Bosch Barragan, A. Framis Utset, F. Novell Teixidó, M.J. Prieto del Rey
The appearance of new-onset liver lesions is frequent during imaging follow-up of oncological patients. Most of these lesions will be metastases. But in the presence of atypical radiological findings, there are other diagnoses to consider. Hepatic abscesses, focal nodular hyperplasia-like in patients treated with platinum salts, or hepatocarcinoma in cirrhotic patients are examples of lesions that may appear in the imaging follow-up and should not be confused with metastases. It is essential to establish the nature of the lesion as this will determine the therapeutic management and might avoid unnecessary invasive procedures. The evaluation of previous radiological studies and the global vision of the patient will be primordial. While liver MRI is mainly the indicated imaging technique for these cases, sometimes a biopsy will be unavoidable. In this article, we will discuss through clinical cases some new-onset liver lesions in oncological patients that generated diagnostic doubts and will explain how to orient the diagnosis.
在肿瘤患者的影像学随访中,新发肝脏病变的出现是常见的。这些病变大多会发生转移。但如果有不典型的影像学表现,就需要考虑其他的诊断。肝脓肿、铂盐治疗患者的局灶性结节样增生或肝硬化患者的肝癌都是影像学随访中可能出现的病变,不应与转移相混淆。确定病变的性质至关重要,因为这将决定治疗管理,并可能避免不必要的侵入性手术。对先前的放射学研究和患者的全局视野的评估将是原始的。虽然肝脏MRI是这些病例的主要指示成像技术,但有时活检是不可避免的。在本文中,我们将通过临床病例讨论一些肿瘤患者新发肝脏病变产生的诊断疑虑,并将解释如何定位诊断。
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引用次数: 0
Percutaneous cystogastrostomy for treatment of pancreatic collections 经皮囊胃造口术治疗胰腺积液
Pub Date : 2025-03-01 DOI: 10.1016/j.rxeng.2024.02.004
J.H. García Vila, L. Grimalt García, A. Lorenzo Górriz, A. Tamayo Vasquez, R. Diaitz-Usetxi Laplaza, A. Boscá Ramón

Objective

Acute pancreatitis (AP) is an inflammatory condition associated with a potential torpid evolution comprising multiple organ failure, pancreatic necrosis, infected collections and high mortality. Current management tends use the step-up approach, with endoscopic collection drainage, followed by percutaneous drainage by an interventional radiologist and video-assisted necrosectomy. We present our experience with a new percutaneous technique of establishing an anastomosis of the pancreatic collection with the closest loop, stomach, duodenum or jejunum that uses balloon dilation and drainage in cases of infection.

Material and methods

Between 2009 and 2023 we have applied this technique in 30 patients, aged between 32 and 82 years (mean = 67 years), 14 with pseudocysts (infected in six cases) and 16 with encapsulated necrosis (all infected). We use dilation balloons of different calibre, to establish the anastomosis between the digestive loop and the collection, as well as different drainages.

Results

The intervention had a primary technical success of 93%. In two patients the cystogastrostomy had to be repeated due to initial technical failure; in both cases a good result was achieved. One patient had a severe postintervention haemorrhage (3%) that required embolisation. Length of follow-up has ranged from between three months and 10 years (mean = 4 years), with no recurrence of the anastomosed collection or cutaneous fistula observed in any case.

Conclusion

Percutaneous cystogastrostomy is a technique that allows infected collections to be resolved and pancreatic fistulas to be avoided, with few complications, which can be resolved by interventional vascular radiologists.
目的:急性胰腺炎(AP)是一种与潜在的迟钝演变相关的炎症性疾病,包括多器官衰竭、胰腺坏死、集合感染和高死亡率。目前的治疗倾向于采用逐步的方法,内镜下收集引流,然后由介入放射科医生进行经皮引流和视频辅助的坏死切开术。我们介绍了一种新的经皮技术,在感染的情况下,使用球囊扩张和引流的方法,将胰腺集合与最近的袢、胃、十二指肠或空肠建立吻合。材料和方法在2009年至2023年间,我们应用该技术治疗了30例患者,年龄在32岁至82岁之间(平均67岁),其中14例为假性囊肿(6例感染),16例为囊性坏死(均感染)。我们使用不同口径的扩张气球,建立消化道与集合之间的吻合,以及不同的引流。结果干预的初步技术成功率为93%。2例患者由于最初的技术故障不得不重复进行囊胃造口术;在这两种情况下都取得了良好的结果。1例患者有严重的干预后出血(3%),需要栓塞。随访时间从3个月到10年(平均4年)不等,在任何情况下均未观察到吻合集或皮瘘复发。结论经皮囊胃造口术是一种治疗胰腺感染、避免胰腺瘘的技术,并发症少,可由介入血管放射科医师解决。
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引用次数: 0
Artificial intelligence in cardiovascular magnetic resonance imaging 心血管磁共振成像中的人工智能
Pub Date : 2025-03-01 DOI: 10.1016/j.rxeng.2025.03.001
A. Castellaccio, N. Almeida Arostegui, M. Palomo Jiménez, D. Quiñones Tapia, M. Bret Zurita, E. Vañó Galván
Artificial intelligence is rapidly evolving and its possibilities are endless. Its primary applications in cardiac magnetic resonance imaging have focused on: image acquisition (in terms of acceleration and quality improvement); segmentation (in terms of saving time and reproducibility); tissue characterisation (including radiomic techniques and the non-contrast assessment of myocardial fibrosis); automatic diagnosis; and prognostic stratification. The aim of this article is to attempt to provide an overview of the current situation as preparation for the significant changes currently underway or imminent in the very near future.
人工智能正在迅速发展,它的可能性是无限的。它在心脏磁共振成像中的主要应用集中在:图像采集(在加速和质量改善方面);分割(在节省时间和可重复性方面);组织表征(包括放射技术和心肌纤维化的非对比评估);自动诊断;以及预后分层。本文的目的是试图提供当前形势的概述,为当前正在进行或即将在不久的将来发生的重大变化做准备。
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引用次数: 0
A new year, a new hope 新的一年,新的希望
Pub Date : 2025-03-01 DOI: 10.1016/j.rxeng.2025.01.003
C. García-Villar
{"title":"A new year, a new hope","authors":"C. García-Villar","doi":"10.1016/j.rxeng.2025.01.003","DOIUrl":"10.1016/j.rxeng.2025.01.003","url":null,"abstract":"","PeriodicalId":94185,"journal":{"name":"Radiologia","volume":"67 2","pages":"Pages 113-114"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143760819","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
期刊
Radiologia
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