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  • Correction to: Machine learning classifiers can predict Gleason pattern 4 prostate cancer with greater accuracy than experienced radiologists.
    Eur. Radiol. (IF 3.962) Pub Date : null
    Michela Antonelli,Edward W Johnston,Nikolaos Dikaios,King K Cheung,Harbir S Sidhu,Mrishta B Appayya,Francesco Giganti,Lucy A M Simmons,Alex Freeman,Clare Allen,Hashim U Ahmed,David Atkinson,Sebastien Ourselin,Shonit Punwani

    The original version of this article, published on 11 June 2019, unfortunately contained a mistake. The following correction has therefore been made in the original: In section "Multiparametric MRI review," the readers mentioned in the first sentence were partly incorrect.

    更新日期:2020-01-14
  • Optimization of radiation dose for CT detection of lytic and sclerotic bone lesions: a phantom study.
    Eur. Radiol. (IF 3.962) Pub Date : null
    J Greffier,J Frandon,F Pereira,A Hamard,J P Beregi,A Larbi,P Omoumi

    OBJECTIVES To determine the best compromise between low radiation dose and suitable image quality for the detection of lytic and sclerotic bone lesions of the lumbar spine and pelvis. METHODS A phantom was scanned using the routine protocol (STD, 13 mGy) and six decreasing dose levels. Raw data were reconstructed using level 3 of iterative reconstruction (IR3) with 1-mm slice thickness for the STD protocol and highest IR levels with 3-mm slice thickness for the others. CTDIvol was used for radiation dose assessment. Quantitative criteria (noise power spectrum [NPS], task-based transfer function [TTF], and the detectability index [d']), as well as qualitative analysis, were used to compare protocols. NPS and TTF were computed using specific software (imQuest). d' was computed for two imaging tasks: lytic and sclerotic bone lesions. A subjective analysis was performed to validate the image quality obtained on the anthropomorphic phantom with the different dose values. RESULTS Similar d' values were found for CTDIvol from 3 to 4 mGy with IR4 and from 1 to 2 mGy for IR5 compared with d' values using the STD protocol. Image quality was validated subjectively for IR4 but rejected for IR5 (image smoothing). Finally, for the same d', the dose was reduced by 74% compared with the STD protocol, with the CTDIvol being 3.4 mGy for the lumbar spine and for the pelvis. CONCLUSION A dose level as low as 3.4 mGy, in association with high levels of IR, provides suitable image quality for the detection of lytic and sclerotic bone lesions of the lumbar spine and pelvis. KEY POINTS • A CTDI vol of 3.4 mGy, in association with high iterative reconstruction level, provides suitable image quality for the detection of lytic and sclerotic bone lesions, both at objective and subjective analysis. • Compared with the standard protocol, radiation dose can be reduced up to 74% for the lumbar spine and pelvis. • A task-based image quality assessment using the detectability index represents an objective method for the assessment of image quality and bridges the gap between complex physical metrics and subjective image analysis.

    更新日期:2020-01-14
  • Closing the gender gap in academic radiology: reasons for hope?
    Eur. Radiol. (IF 3.962) Pub Date : 2019-12-03
    Hedvig Hricak, Rahel A. Kubik-Huch, Yves Menu

    Abstract This Editorial Comment refers to the article by Bernard C. et al, Gender gap in articles published in European Radiology and CardioVascular and Interventional Radiology: evolution between 2002 and 2016, European Radiology, doi: 10.1007/s00330-019-06390-7.

    更新日期:2020-01-14
  • Robotic assistance in interventional radiology: dream or reality?
    Eur. Radiol. (IF 3.962) Pub Date : 2019-12-04
    Vania Tacher, Thierry de Baere

    Key Points • Robotic assistance in medicine has been a revolution. • The use of robots has naturally extended to interventional radiology for percutaneous and endovascular interventions. • The guidance is mainly performed with a remote (computer or joystick) allowing the operator and his team not to be exposed to X-rays.

    更新日期:2020-01-14
  • Pretreatment ADC is not a prognostic factor for local recurrences in head and neck squamous cell carcinoma when clinical T-stage is known.
    Eur. Radiol. (IF 3.962) Pub Date : null
    Boris Peltenburg,Juliette P Driessen,Jeanine E Vasmel,Frank A Pameijer,Luuk M Janssen,Chris H J Terhaard,Remco de Bree,Marielle E P Philippens

    OBJECTIVES Pretreatment identification of radio-insensitive head and neck squamous cell carcinomas (HNSCC) would affect treatment modality selection. The apparent diffusion coefficient (ADC) of a tumor could be a predictor of local recurrence. However, little is known about its prognostic value next to known factors such as clinical T-stage. The aim of the present study is to determine the added value of pretreatment ADC to clinical T-stage as a prognostic factor for local recurrence. METHODS This retrospective cohort study included 217 patients with HNSCC treated with (chemo)radiotherapy between April 2009 and December 2015. All patients underwent diffusion-weighted MRI prior to treatment. Median ADC values of all tumors were obtained using a semi-automatic delineation method. Univariate models containing ADC and T-stage were compared with a multivariable model containing both variables. RESULTS Fifty-eight patients experienced a local recurrence within 3 years. On average, the ADC value in the group of patients with a recurrence was 1.01 versus 1.00 (10-3 mm2/s) in the group without a recurrence. Univariate analysis showed no significant association between tumor ADC and local recurrence within 3 years after (chemo)radiotherapy (p = 0.09). Cox regression showed that clinical T-stage was an independent predictor of local recurrence and adding ADC to the model did not increase its performance. CONCLUSION Pretreatment ADC has no added value as a prognostic factor for local recurrence to clinical T-stage. KEY POINTS • Pretreatment identification of head and neck squamous cell carcinoma patients who do not benefit from (chemo)radiotherapy could improve personalized cancer care. • The apparent diffusion coefficient (ADC) obtained from diffusion-weighted MRI has been reported to be a prognostic factor for local recurrence. • In this study, ADC has no added value as a prognostic factor compared with clinical T-stage.

    更新日期:2020-01-14
  • 3D black-blood 3T-MRI for the diagnosis of abdominal large vessel vasculitis.
    Eur. Radiol. (IF 3.962) Pub Date : null
    Stefan Maurus,Nora N Sommer,Hendrik Kooijman,Eva Coppenrath,Matthias Witt,Hendrik Schulze-Koops,Michael Czihal,Ulrich Hoffmann,Tobias Saam,Karla M Treitl

    OBJECTIVES To assess the value of a T1-3D black-blood turbo spin echo (TSE) sequence for the diagnosis of abdominal large vessel vasculitis (LVV). MATERIALS AND METHODS The study included 20 patients with abdominal LVV and 17 controls, who underwent a 3T-MRI scan using a modified T1-3D volumetric isotropic TSE acquisition and a segmented T1-3D turbo field echo sequence (T1-mVISTA/T1-eTHRIVE). Two radiologists independently analyzed the aorta for concentric contrast enhancement, concentric wall thickening, image quality, and flow artifact intensity (CCE/CWT/IQ/FAI; 4-point scales). The mean aortic wall thickness (MAWT) in post-contrast T1-mVISTA was compared between patients and controls. RESULTS IQ of T1-mVISTA was rated good to excellent in 91.5% of 282 evaluated vessel segments with no or minor FAI present in 85.5%. The inter-observer reproducibility for the identification of CCE/CWT on T1-mVISTA was 0.92 and 0.93 (p < 0.001). The distribution of segmental inflammation in T1-mVISTA significantly correlated with T1-eTHRIVE (CCE, κ = 0.768; CWT, κ = 0.715; p < 0.001), resulting in a sensitivity, specificity, and positive predictive value of 100%, 81.3%, and 83.3%. The MAWT significantly differed between patients and controls (3.29 ± 0.81 vs. 2.24 ± 0.45 mm; p < 0.001). CONCLUSIONS T1-mVISTA enables the evaluation of the MAWT and allows the detection of abdominal LVV. KEY POINTS • 3D T1w-mVISTA accurately depicted the large abdominal vessels. • 3D T1w-mVISTA enables accurate measurements of the abdominal aortic wall thickness. • 3D T1w-mVISTA is useful for the detection of abdominal LVV.

    更新日期:2020-01-14
  • Differentiation between subcentimeter carcinomas and benign lesions using kinetic parameters derived from ultrafast dynamic contrast-enhanced breast MRI.
    Eur. Radiol. (IF 3.962) Pub Date : null
    Natsuko Onishi,Meredith Sadinski,Peter Gibbs,Katherine M Gallagher,Mary C Hughes,Eun Sook Ko,Brittany Z Dashevsky,Dattesh D Shanbhag,Maggie M Fung,Theodore M Hunt,Danny F Martinez,Amita Shukla-Dave,Elizabeth A Morris,Elizabeth J Sutton

    OBJECTIVES This study aims to evaluate ultrafast DCE-MRI-derived kinetic parameters that reflect contrast agent inflow effects in differentiating between subcentimeter BI-RADS 4-5 breast carcinomas and benign lesions. METHODS We retrospectively reviewed consecutive 3-T MRI performed from February to October 2017, during which ultrafast DCE-MRI was performed as part of a hybrid clinical protocol with conventional DCE-MRI. In total, 301 female patients with 369 biopsy-proven breast lesions were included. Ultrafast DCE-MRI was acquired continuously over approximately 60 s (temporal resolution, 2.7-7.1 s/phase) starting simultaneously with the start of contrast injection. Four ultrafast DCE-MRI-derived kinetic parameters (maximum slope [MS], contrast enhancement ratio [CER], bolus arrival time [BAT], and initial area under gadolinium contrast agent concentration [IAUGC]) and one conventional DCE-MRI-derived kinetic parameter (signal enhancement ratio [SER]) were calculated for each lesion. Wilcoxon rank sum test or Fisher's exact test was performed to compare kinetic parameters, volume, diameter, age, and BI-RADS morphological descriptors between subcentimeter carcinomas and benign lesions. Univariate/multivariate logistic regression analyses were performed to determine predictive parameters for subcentimeter carcinomas. RESULTS In total, 125 lesions (26 carcinomas and 99 benign lesions) were identified as BI-RADS 4-5 subcentimeter lesions. Subcentimeter carcinomas demonstrated significantly larger MS and SER and shorter BAT than benign lesions (p = 0.0117, 0.0046, and 0.0102, respectively). MS, BAT, and age were determined as significantly predictive for subcentimeter carcinoma (p = 0.0208, 0.0023, and < 0.0001, respectively). CONCLUSIONS Ultrafast DCE-MRI-derived kinetic parameters may be useful in differentiating subcentimeter BI-RADS 4 and 5 carcinomas from benign lesions. KEY POINTS • Ultrafast DCE-MRI can generate kinetic parameters, effectively differentiating breast carcinomas from benign lesions. • Subcentimeter carcinomas demonstrated significantly larger maximum slope and shorter bolus arrival time than benign lesions. • Maximum slope and bolus arrival time contribute to better management of suspicious subcentimeter breast lesions.

    更新日期:2020-01-14
  • Carpal tunnel ultrasound: is the "safe zone" on the ulnar side of the median nerve really avascular?
    Eur. Radiol. (IF 3.962) Pub Date : null
    Anne-Charlotte Sergeant,Sammy Badr,Marc Saab,Xavier Demondion,Anne Cotten,Thibaut Jacques

    INTRODUCTION Numerous publications have studied the regional anatomy of the carpal tunnel to define a "safe zone" to reduce the risk of perioperative neurovascular complications. This zone, located between the ulnar neurovascular bundle and the median nerve, is considered to be safe mainly because of the absence of vascular structures. This study aims to assess the presence of arterioles within this area using superb microvascular imaging (SMI). MATERIALS AND METHODS The images from patients who underwent a bilateral routine wrist ultrasound with SMI, between January 28 and February 28, 2019, were retrospectively reviewed by two radiologists to evaluate the presence and location of arterioles in the safe zone. In addition, cadaveric wrists injected with intra-arterial red latex underwent dissection of the carpal tunnel. RESULTS The images from 27 patients (54 wrists) were reviewed. In the safe zone, arterioles were seen superficial to the retinaculum in 36 wrists (36/54; 66.7%) and deep to the retinaculum in 21 wrists (21/54; 38.9%). The arterioles located deep to the retinaculum were more frequently found close to the median nerve (21/54; 38.9%) than to the ulnar artery (9/54; 16.7%). In five cadaveric wrists, arterioles were detected superficial to the retinaculum in 3 wrists (3/5; 60%) and deep to the retinaculum in 2 wrists (2/5; 40%). CONCLUSION Arterioles can be seen in the safe zone both superficial and deep to the flexor retinaculum. Deep to the retinaculum, they are mainly observed in the proximal aspect of the carpal tunnel and more frequently close to the median nerve. KEY POINTS • Superb microvascular imaging (SMI) enables the visualization of arterioles within the "safe zone" of the carpal tunnel (visible both superficial and deep to the flexor retinaculum). • Arterioles were more frequently observed in the proximal aspect of the carpal tunnel. • Deep to the retinaculum, arterioles were more frequently seen in proximity to the median nerve.

    更新日期:2020-01-14
  • Evidence-based MR imaging follow-up strategy for desmoid-type fibromatosis.
    Eur. Radiol. (IF 3.962) Pub Date : null
    P A Gondim Teixeira,H Biouichi,W Abou Arab,M Rios,F Sirveaux,G Hossu,A Blum

    OBJECTIVES To propose a follow-up strategy for desmoid-type fibromatosis (DF) based on tumor growth behavior and the signal on T2-weighted MRI. METHODS We retrospectively reviewed 296 MRI studies of 34 patients with histologically proven DF. In each study, tumor volume and T2 signal relatively normal striated muscle were assessed. Volume variation and monthly growth rates were analyzed to determine lesion growth behavior (progressing versus stable/regressing lesions). Growth behavior was correlated with T2 signal, tumor location, β-catenin status, treatment strategy, and follow-up duration. Interobserver variability of volume measurements and interobserver measurement variation ratio were assessed. RESULTS There were 25 women and 9 men with a mean age of 39.9 ± 19 (4-73) years. Mean follow-up time in the patients included was 55 ± 41 (12-148) months. In progressing lesions, the mean average monthly growth ratio was 10.9 ± 9.2 (1.1-42.5) %. Interobserver variability of volume measurements was excellent (ICC = 0.96). Mean interobserver measurement variation ratio was 20.4 ± 23.6%. The only factor correlated with tumor growth behavior was T2 signal ratio (p < 0.0001). Seventeen out of 34 (50%) patients presented a signal change over the threshold of 1 during follow-up. There were five occurrences of secondary growth after a period of stability with a mean delay until growth of 38.2 ± 44.2 (17-116) months. CONCLUSION DF growth rate was quantitatively assessed. A threshold for volume variation detection was established. DF growth behavior was significantly related to T2 signal. An evidence-based follow-up strategy is proposed. KEY POINTS • In progressing desmoid fibromatosis, the mean average monthly growth ratio was 10.9 ± 9.2%. • Lesions with muscle/tumor T2 signal ratios lower than 1 tended to be stable or regress over time. • Given the interobserver measurement variability and MRI in-plane spatial resolution, a variation higher than 42.6% in tumor volume is required to confirm punctual progression.

    更新日期:2020-01-14
  • Learning curve of liver stiffness measurement using a new hybrid machine composed of transient elastography interfaced with ultrasound.
    Eur. Radiol. (IF 3.962) Pub Date : null
    Christophe Cassinotto,Marie-Ange Pierredon-Foulongne,Ali Belgour,Julien Delicque,Laure Escal,Nicolas Molinari,Sophie Anselme,Tony Jacq,Ugo Chamard-Champliaud,Bastien Nicolan,Carole Allimant,Boris Guiu

    OBJECTIVES To assess the learning curve for performing reliable liver stiffness measurements using a new hybrid machine composed of transient elastography (TE) interfaced with an ultrasound device for radiographers and radiologists with different levels of expertise in ultrasound imaging. METHODS Ten novice operators who had never performed TE measurements were prospectively evaluated from April to October 2018: senior radiologists, young radiologists, fellows, radiographers, and residents, with different levels of experience in abdominal ultrasound imaging. All operators had a short theoretical training followed by a training session under supervision in three patients. Then, each operator had to perform TE in 50 consecutive patients with chronic liver disease, using beforehand ultrasound examination to select measurement area in the right liver lobe, and if needed, the XL probe. Percentages of failures and reliable measurements were compared. RESULTS The rates of failures of measurements, poorly reliable, reliable, and very reliable results, were of 4.2% (21/500), 2.4% (12/500), 47.6% (238/500), and 45.8% (229/500), respectively. The rates of reliable plus very reliable results were excellent, ranging from 91 to 96% among all the subgroups. The rates of very reliable, reliable, and unreliable results did not differ between operator subgroups and especially between junior radiologists, senior radiologists, and radiographers. No breaking point was observed in the interquartile range/median values over time. CONCLUSION TE interfaced with ultrasound in this hybrid machine presents no learning curve effect. After a short initial training session, a novice observer is able to perform high rates of reliable and very reliable TE measurements. KEY POINTS • When performing liver stiffness measurements using a new hybrid machine composed of transient elastography interfaced with ultrasound, the rate of failures of measurements is very low, below 5%. • After a short training session and using ultrasound planning, a novice operator, whatever its expertise in ultrasound imaging, is capable of performing high rates of reliable and very reliable measurements. • No learning curve is needed for performing reliable liver stiffness measurements using this new hybrid machine.

    更新日期:2020-01-14
  • Low-dose CT angiography using ASiR-V for potential living renal donors: a prospective analysis of image quality and diagnostic accuracy.
    Eur. Radiol. (IF 3.962) Pub Date : null
    Woong Kyu Han,Joon Chae Na,Sung Yoon Park

    PURPOSE To assess image quality and diagnostic accuracy of low-dose computed tomography (CT) angiography using adaptive statistical iterative reconstruction V (ASiR-V) for evaluating the anatomy of renal vasculature in potential living renal donors. MATERIALS AND METHODS Eighty of 100 potential living renal donors were prospectively enrolled and underwent multiphase CT angiography (e.g., unenhanced, arterial, and venous phases) to evaluate the kidney for donation. Either low-dose using ASiR-V or standard protocol was randomly applied. Image quality was analyzed qualitatively and quantitatively with contrast-to-noise ratio (CNR) and signal-to-noise ratio (SNR). Renal artery and vein number, early branching vessel from renal arteries, and drainage of left-sided ascending lumbar vein to left renal vein were assessed. Reference standard for renal vasculature was surgical confirmation. RESULTS Size-specific dose estimate of low-dose CT angiography (9.5 ± 0.8 mGy) was significantly lower than standard CT angiography (22.7 ± 4.1 mGy) (p < 0.001). Thus, radiation dose was reduced by 58.2% with low-dose CT. Both CNR and SNR of low-dose CT were significantly higher than those of standard CT (p < 0.001). Between the two CT methods, image quality was similar qualitatively (p > 0.05). Of 80 participants, 44 (55.0%) underwent nephrectomy. Both CT methods accurately predicted the anatomy of renal vasculature (standard CT, 100% for all variables; low-dose CT, 96.6% for renal vessel number or early branching vessel and 85.7% for drainage of left-sided ascending lumbar vein to left renal vein; p > 0.05 for all comparisons). CONCLUSION Low-dose CT angiography using ASiR-V is useful to evaluate renal vasculature for potential living renal donors. KEY POINTS • In this prospective study, adaptive statistical iterative reconstruction V (ASiR-V) allowed 58.2% dose reduction while maintaining diagnostic image quality for renal vessels. • As compared with the standard protocol, the dose with ASiR-V was significantly lower (9.5 ± 0.8 mGy) than with standard computed tomography (CT) angiography (22.7 ± 4.1 mGy). • Low-dose CT using ASiR-V is useful for living donor evaluation before nephrectomy.

    更新日期:2020-01-14
  • How intrahepatic cholestasis affects liver stiffness in patients with chronic hepatitis B: a study of 1197 patients with liver biopsy.
    Eur. Radiol. (IF 3.962) Pub Date : null
    Huanyi Guo,Mei Liao,Jieyang Jin,Jie Zeng,Shuoyang Li,Darrell R Schroeder,Jian Zheng,Rongqin Zheng,Shigao Chen

    OBJECTIVES To evaluate the impact of intrahepatic cholestasis on liver fibrosis staging using liver stiffness measurements (LSM). METHODS Between July 2011 and September 2016, a total of 1197 patients with chronic hepatitis B (CHB) infection were enrolled to collect clinical, biological, 2D shear wave elastography (SWE), and histological (METAVIR scoring system) data. LSM was compared in patients with normal total bilirubin (TB) versus abnormal TB for each group of fibrosis stage, alanine aminotransferase (ALT) levels, and inflammation grade. Logistic regression and ROC analyses were performed to assess the benefit of adding TB and to LSM for fibrosis staging. RESULTS Nine hundred and seventy-three patients were analyzed. Within the same fibrosis stage, LSMs showed significantly higher value in patients with abnormal TB than those with normal TB. Increased LSM for abnormal TB was generally found within different sub-groups of patients (≤ F2 or ≥ F3; ALT < 2 × upper limit of normal (ULN) or ALT ≥ 2 × ULN; METAVIR activity grade ≤ 1 or ≥ 2). Patients with abnormal TB level showed higher optimal cutoff values: 10.46 kPa for ≥ F2, 10.94 kPa for ≥ F3, and 15.88 kPa for F4, than those with normal TB (7.62 kPa, 8.26 kPa, and 11.01 kPa, respectively). LSM assessed fibrosis stage (≥ F2, ≥ F3, F4) showed higher false positive rate in patients with abnormal TB level (44.6%, 45.1%, 39.6%) than those with normal TB (20.7%, 17.1%, 14.4%). However, the area under the ROC curve did not change appreciably when adding TB to LSM for fibrosis stage. CONCLUSION Intrahepatic cholestasis showed slight effect on LSM in patients with CHB, also leading to overestimation of liver fibrosis stages. But adding TB level to LSM did not improve the overall diagnostic performance of liver fibrosis stage. KEY POINTS • Intrahepatic cholestasis showed slight effect on liver stiffness measurements (LSMs) in chronic HBV patients. • Patients with abnormal total bilirubin (TB) level showed higher optimal cutoff values and false positive rate. • When taking into account intrahepatic cholestasis, the diagnostic performance of LSM for liver fibrosis staging in patients with chronic HBV infection will not improve.

    更新日期:2020-01-14
  • Cortical quantitative MRI parameters are related to the cognitive status in patients with relapsing-remitting multiple sclerosis.
    Eur. Radiol. (IF 3.962) Pub Date : null
    Alexandra van Wijnen,Franca Petrov,Michelle Maiworm,Stefan Frisch,Christian Foerch,Elke Hattingen,Helmuth Steinmetz,Johannes C Klein,Ralf Deichmann,Marlies Wagner,René-Maxime Gracien

    OBJECTIVES We aimed to assess cortical damage in patients with relapsing-remitting multiple sclerosis (RRMS)/clinically isolated syndrome (CIS) with a multiparametric, surface-based quantitative MRI (qMRI) approach and to evaluate the correlation of imaging-derived parameters with cognitive scores, hypothesizing that qMRI parameters are correlated with cognitive abilities. METHODS Multiparametric qMRI-data (T1, T2 and T2* relaxation times and proton density (PD)) were obtained from 34 patients/24 matched healthy control subjects. Cortical qMRI values were analyzed on the reconstructed cortical surface with Freesurfer. We tested for group differences of cortical microstructural parameters between the healthy and patient collectives and for partial Pearson correlations of qMRI parameters with cognitive scores, correcting for age. RESULTS Cortical T2-/T2*-/PD values and four cognitive parameters differed between groups (p ≤ 0.046). These cognitive scores, reflecting information processing speed, verbal memory, visuospatial abilities, and attention, were correlated with cortical T2 (p ≤ 0.02) and T2* (p ≤ 0.03). Cortical changes appeared heterogeneous across the cortex and their distribution differed between the parameters. Vertex-wise correlation of T2 with neuropsychological parameters revealed specific patterns of cortical damage being related to distinct cognitive deficits. CONCLUSIONS Microstructural changes are distributed heterogeneously across the cortex in RRMS/CIS. QMRI has the potential to provide surrogate parameters for the assessment of cognitive impairment in these patients for clinical studies. The characteristics of cognitive impairment in RRMS might depend on the distribution of cortical changes. KEY POINTS • The goal of the presented study was to investigate cortical changes in RRMS/CIS and their relation to the cognitive status, using multiparametric quantitative MRI. • Cortical T2, T2*, and PD increases observed in patients appeared heterogeneous across the cortex and their distribution differed between the parameters. • Vertex-wise correlation of T2 with neuropsychological scores revealed specific patterns of cortical changes being related to distinct cognitive deficits.

    更新日期:2020-01-14
  • Robotic needle insertion during computed tomography fluoroscopy-guided biopsy: prospective first-in-human feasibility trial.
    Eur. Radiol. (IF 3.962) Pub Date : null
    Takao Hiraki,Tetsushi Kamegawa,Takayuki Matsuno,Jun Sakurai,Toshiyuki Komaki,Takuya Yamaguchi,Koji Tomita,Mayu Uka,Yusuke Matsui,Toshihiro Iguchi,Hideo Gobara,Susumu Kanazawa

    INTRODUCTION This was a prospective, first-in-human trial to evaluate the feasibility and safety of insertion of biopsy introducer needles with our robot during CT fluoroscopy-guided biopsy in humans. MATERIALS AND METHODS Eligible patients were adults with a lesion ≥ 10 mm in an extremity or the trunk requiring pathological diagnosis with CT fluoroscopy-guided biopsy. Patients in whom at-risk structures were located within 10 mm of the scheduled needle tract were excluded. Ten patients (4 females and 6 males; mean [range] age, 72 [52-87] years) with lesions (mean [range] maximum diameter, 28 [14-52] mm) in the kidney (n = 4), lung (n = 3), mediastinum (n = 1), adrenal gland (n = 1), and muscle (n = 1) were enrolled. The biopsy procedure involved robotic insertion of a biopsy introducer needle followed by manual acquisition of specimens using a biopsy needle. The patients were followed up for 14 days. Feasibility was defined as the distance of ≤ 10 mm between needle tip after insertion and the nearest lesion edge on the CT fluoroscopic images. The safety of robotic insertion was evaluated on the basis of machine-related troubles and adverse events according to the Clavien-Dindo classification. RESULTS Robotic insertion of the introducer needle was feasible in all patients, enabling pathological diagnosis. There was no machine-related trouble. A total of 11 adverse events occurred in 8 patients, including 10 grade I events and 1 grade IIIa event. CONCLUSION Insertion of biopsy introducer needles with our robot was feasible at several locations in the human body. KEY POINTS • Insertion of biopsy introducer needles with our robot during CT fluoroscopy-guided biopsy was feasible at several locations in the human body.

    更新日期:2020-01-14
  • Contrast-enhanced modified 3D T1-weighted TSE black-blood imaging can improve detection of infectious and neoplastic meningitis.
    Eur. Radiol. (IF 3.962) Pub Date : null
    Nora Navina Sommer,Romina Pons Lucas,Eva Coppenrath,Hendrik Kooijman,Franziska Galiè,Nina Hesse,Wieland H Sommer,Karla M Treitl,Tobias Saam,Matthias F Froelich

    OBJECTIVES To evaluate the diagnostic value of a contrast-enhanced 3D T1-weighted-modified volumetric isotropic turbo spin-echo acquisition sequence (T1-mVISTA) in comparison with a conventional 3D T1-weighted magnetization-prepared rapid gradient-echo (T1-MP-RAGE) sequence for the detection of meningeal enhancement in patients with meningitis. METHODS Thirty patients (infectious meningitis, n = 12; neoplastic meningitis, n = 18) and 45 matched controls were enrolled in this retrospective case-control study. Sets of randomly selected T1-mVISTA and T1-MP-RAGE images (both with 0.8-mm isotropic resolution) were read separately 4 weeks apart. Image quality, leptomeningeal and dural enhancement, grading of visual contrast enhancement, and diagnostic confidence were compared using the Kruskal-Wallis rank sum test. RESULTS Image quality was rated to be good to excellent in 75 out of 75 cases (100%) for T1-mVISTA and 74 out of 75 cases (98.7%) for T1-MP-RAGE. T1-mVISTA detected significantly more patients with leptomeningeal enhancement (p = 0.006) compared with T1-MP-RAGE (86.7 vs. 50.0%, p < 0.001), each with specificity of 100%. Similarly, sensitivity of T1-mVISTA for the detection of dural and/or leptomeningeal enhancement was also significantly higher compared with that of T1-MP-RAGE (96.7 vs. 80.0%, p = 0.025) without significant differences regarding specificity (97.8 vs. 95.6%, p = 0.317). No significant differences were found for dural enhancement alone. Diagnostic confidence in T1-mVISTA was significantly higher (p = 0.01). Visual contrast enhancement was tendentially higher in T1-mVISTA. CONCLUSIONS T1-mVISTA may be an adequate and probably better alternative to T1-MP-RAGE for detection of leptomeningeal diseases. KEY POINTS • Black-blood T1-mVISTA showed a significant higher sensitivity for the detection of leptomeningeal enhancement compared with MP-RAGE without losses regarding specificity. • Diagnostic confidence was assessed significantly higher in T1-mVISTA. • T1-mVISTA should be considered a supplement or an alternative to T1-MP-RAGE in patients with suspected leptomeningeal diseases.

    更新日期:2020-01-14
  • Multiparametric PET/MR (PET and MR-IVIM) for the evaluation of early treatment response and prediction of tumor recurrence in patients with locally advanced cervical cancer.
    Eur. Radiol. (IF 3.962) Pub Date : null
    Si Gao,Siyao Du,Zaiming Lu,Jun Xin,Song Gao,Hongzan Sun

    OBJECTIVES To assess the value of 18F-FDG PET and MR-IVIM parameters before and during concurrent chemoradiotherapy (CCRT) for evaluating early treatment response and predicting tumor recurrence in patients with locally advanced cervical cancer (LACC) using a hybrid PET/MR scanner. METHODS Fifty-one patients with LACC underwent pelvic PET/MR scans with an IVIM sequence at two time-points (pretreatment [pre] and midtreatment [mid]). Pre- and mid-PET parameters (SUVmax, MTV, TLG) and IVIM parameters (D, F, D*) and their percentage changes (Δ%SUVmax, Δ%MTV, Δ%TLG, Δ%D, Δ%F, Δ%D*) were calculated. We selected independent imaging parameters and built a combined prediction model incorporating imaging parameters and clinicopathological risk factors. The performance of the combinative evaluation for tumor early shrinkage rates (TESR) and the prediction model for tumor recurrence was assessed. RESULTS Thirty-two patients were classified into the good response (GR) group with TESR ≥ 50%, and 19 patients were categorized into the poor response (PR) group with TESR < 50%. Δ%D (p = 0.013) and Δ%F (p = 0.006) are independently related to TESR with superior combined diagnostic ability (AUC = 0.901). Pre-TLG, Δ%D, and suspicious lymph node metastasis (SLNM) were selected for the construction of the combined prediction model. The model for identifying the patients with high risk of tumor recurrence reached a moderate predictive ability and good stability with c-index of 0.764 (95% CI, 0.672-0.855). CONCLUSION The combined prediction model based on pretreatment PET metabolic parameter (pre-TLG), IVIM-D percentage changes, and LNs status provides great potential to identify the LACC patients with high risk of recurrence at early stage of CCRT. KEY POINTS • PET/MR plus IVIM offers various complementary information for LACC. • IVIM-D and IVIM-F percentage changes are independently related to tumor early shrinkage rates. • The combined prediction model can help identify the LACC patients with high risk of tumor recurrence.

    更新日期:2020-01-14
  • Clinical evaluation of in silico planning and real-time simulation of hepatic radiofrequency ablation (ClinicIMPPACT Trial).
    Eur. Radiol. (IF 3.962) Pub Date : null
    Michael Moche,Harald Busse,Jurgen J Futterer,Camila A Hinestrosa,Daniel Seider,Philipp Brandmaier,Marina Kolesnik,Sjoerd Jenniskens,Roberto Blanco Sequeiros,Gaber Komar,Mika Pollari,Martin Eibisberger,Horst Rupert Portugaller,Philip Voglreiter,Ronan Flanagan,Panchatcharam Mariappan,Martin Reinhardt

    OBJECTIVES To evaluate the accuracy and clinical integrability of a comprehensive simulation tool to plan and predict radiofrequency ablation (RFA) zones in liver tumors. METHODS Forty-five patients with 51 malignant hepatic lesions of different origins were included in a prospective multicenter trial. Prior to CT-guided RFA, all patients underwent multiphase CT which included acquisitions for the assessment of liver perfusion. These data were used to generate a 3D model of the liver. The intra-procedural position of the RFA probe was determined by CT and semi-automatically registered to the 3D model. Size and shape of the simulated ablation zones were compared with those of the thermal ablation zones segmented in contrast-enhanced CT images 1 month after RFA; procedure time was compared with a historical control group. RESULTS Simulated and segmented ablation zone volumes showed a significant correlation (ρ = 0.59, p < 0.0001) and no significant bias (Wilcoxon's Z = 0.68, p = 0.25). Representative measures of ablation zone comparison were as follows: average surface deviation (absolute average error, AAE) with 3.4 ± 1.7 mm, Dice similarity coefficient 0.62 ± 0.14, sensitivity 0.70 ± 0.21, and positive predictive value 0.66 ± 0. There was a moderate positive correlation between AAE and duration of the ablation (∆t; r = 0.37, p = 0.008). After adjustments for inter-individual differences in ∆t, liver perfusion, and prior transarterial chemoembolization procedures, ∆t was an independent predictor of AAE (ß = 0.03 mm/min, p = 0.01). Compared with a historical control group, the simulation added 3.5 ± 1.9 min to the procedure. CONCLUSION The validated simulation tool showed acceptable speed and accuracy in predicting the size and shape of hepatic RFA ablation zones. Further randomized controlled trials are needed to evaluate to what extent this tool might improve patient outcomes. KEY POINTS • More reliable, patient-specific intra-procedural estimation of the induced RFA ablation zones in the liver may lead to better planning of the safety margins around tumors. • Dedicated real-time simulation software to predict RFA-induced ablation zones in patients with liver malignancies has shown acceptable agreement with the follow-up results in a first prospective multicenter trial suggesting a randomized controlled clinical trial to evaluate potential outcome benefit for patients.

    更新日期:2020-01-14
  • Advanced imaging parameters improve the prediction of diffuse lower-grade gliomas subtype, IDH mutant with no 1p19q codeletion: added value to the T2/FLAIR mismatch sign.
    Eur. Radiol. (IF 3.962) Pub Date : 2019-08-26
    Min Kyoung Lee,Ji Eun Park,Youngheun Jo,Seo Young Park,Sang Joon Kim,Ho Sung Kim

    OBJECTIVES A combination of T2/FLAIR mismatch sign and advanced imaging parameters may improve the determination of molecular subtypes of diffuse lower-grade glioma. We assessed the diagnostic value of adding the apparent diffusion coefficient (ADC) and cerebral blood volume (CBV) to the T2/FLAIR mismatch sign for differentiation of the IDH mutation or 1p/19q codeletion. MATERIALS AND METHODS Preoperative conventional, diffusion-weighted, and dynamic susceptibility contrast imaging were performed on 110 patients with diffuse lower-grade gliomas. The study population was classified into three groups using molecular subtype, namely IDH mutation and 1p/19q codeletion (IDHmut-Codel), IDH wild type (IDHwt) and IDH mutation and no 1p/19q codeletion (IDHmut-Noncodel). T2/FLAIR mismatch sign and the histogram parameters of apparent diffusion coefficient (ADC) and normalised cerebral blood volume (nCBV) values were assessed. A multivariate logistic regression model was constructed to distinguish IDHmut-Noncodel from IDHmut-Codel and IDHwt and from IDHwt, and the performance was compared with that of single parameters using the area under the receiver operating characteristics curve (AUC). RESULTS Positive visual T2/FLAIR mismatch sign and higher nCBV skewness were significant variables to distinguish IDHmut-Noncodel from the other two groups (AUC, 0.88; 95% CI, 0.81-0.96). A lower ADC10 was a significant variable for distinguishing IDHmut-Noncodel from the IDHwt group (AUC, 0.75; 95% CI, 0.62-0.89). Adding ADC or CBV histogram parameters to T2/FLAIR mismatch sign improved performance in distinguishing IDHmut-Noncodel from the other two groups (AUC 0.882 vs. AUC 0.810) or from IDHwt (AUC 0.923 vs. AUC 0.868). CONCLUSIONS The combination of the T2/FLAIR mismatch sign with ADC or CBV histogram parameters can improve the identification of IDHmut-Noncodel diffuse lower-grade gliomas, which can be easily applied in clinical practice. KEY POINTS • The combination of the T2/FLAIR mismatch sign with the ADC or CBV histogram parameters can improve the identification of IDHmut-Noncodel diffuse lower-grade gliomas. • The multivariable model showed a significantly better performance for distinguishing the IDHmut-Noncodel group from other diffuse lower-grade gliomas than the T2/FLAIR mismatch sign alone or any single parameter. • The IDHmut-Noncodel type was associated with intermediate treatment outcomes; therefore, the identification of IDHmut-Noncodel diffuse lower-grade gliomas could be helpful for determining the clinical approach.

    更新日期:2020-01-14
  • Deep learning with ultrasonography: automated classification of liver fibrosis using a deep convolutional neural network.
    Eur. Radiol. (IF 3.962) Pub Date : null
    Jeong Hyun Lee,Ijin Joo,Tae Wook Kang,Yong Han Paik,Dong Hyun Sinn,Sang Yun Ha,Kyunga Kim,Choonghwan Choi,Gunwoo Lee,Jonghyon Yi,Won-Chul Bang

    OBJECTIVES The aim of this study was to develop a deep convolutional neural network (DCNN) for the prediction of the METAVIR score using B-mode ultrasonography images. METHODS Datasets from two tertiary academic referral centers were used. A total of 13,608 ultrasonography images from 3446 patients who underwent surgical resection, biopsy, or transient elastography were used for training a DCNN for the prediction of the METAVIR score. Pathological specimens or estimated METAVIR scores derived from transient elastography were used as a reference standard. A four-class model (F0 vs. F1 vs. F23 vs. F4) was developed. Diagnostic performance of the algorithm was validated on a separate internal test set of 266 patients with 300 images and external test set of 572 patients with 1232 images. Performance in classification of cirrhosis was compared between the DCNN and five radiologists. RESULTS The accuracy of the four-class model was 83.5% and 76.4% on the internal and external test set, respectively. The area under the receiver operating characteristic curve (AUC) for classification of cirrhosis (F4) was 0.901 (95% confidence interval [CI], 0.865-0.937) on the internal test set and 0.857 (95% CI, 0.825-0.889) on the external test set, respectively. The AUC of the DCNN for classification of cirrhosis (0.857) was significantly higher than that of all five radiologists (AUC range, 0.656-0.816; p value < 0.05) using the external test set. CONCLUSIONS The DCNN showed high accuracy for determining METAVIR score using ultrasonography images and achieved better performance than that of radiologists in the diagnosis of cirrhosis. KEY POINTS • DCNN accurately classified the ultrasonography images according to the METAVIR score. • The AUROC of this algorithm for cirrhosis assessment was significantly higher than that of radiologists. • DCNN using US images may offer an alternative tool for monitoring liver fibrosis.

    更新日期:2020-01-14
  • Automated volumetric assessment with artificial neural networks might enable a more accurate assessment of disease burden in patients with multiple sclerosis
    Eur. Radiol. (IF 3.962) Pub Date : 2020-01-03
    Gianluca Brugnara, Fabian Isensee, Ulf Neuberger, David Bonekamp, Jens Petersen, Ricarda Diem, Brigitte Wildemann, Sabine Heiland, Wolfgang Wick, Martin Bendszus, Klaus Maier-Hein, Philipp Kickingereder

    Abstract Objectives Patients with multiple sclerosis (MS) regularly undergo MRI for assessment of disease burden. However, interpretation may be time consuming and prone to intra- and interobserver variability. Here, we evaluate the potential of artificial neural networks (ANN) for automated volumetric assessment of MS disease burden and activity on MRI. Methods A single-institutional dataset with 334 MS patients (334 MRI exams) was used to develop and train an ANN for automated identification and volumetric segmentation of T2/FLAIR-hyperintense and contrast-enhancing (CE) lesions. Independent testing was performed in a single-institutional longitudinal dataset with 82 patients (266 MRI exams). We evaluated lesion detection performance (F1 scores), lesion segmentation agreement (DICE coefficients), and lesion volume agreement (concordance correlation coefficients [CCC]). Independent evaluation was performed on the public ISBI-2015 challenge dataset. Results The F1 score was maximized in the training set at a detection threshold of 7 mm3 for T2/FLAIR lesions and 14 mm3 for CE lesions. In the training set, mean F1 scores were 0.867 for T2/FLAIR lesions and 0.636 for CE lesions, as compared to 0.878 for T2/FLAIR lesions and 0.715 for CE lesions in the test set. Using these thresholds, the ANN yielded mean DICE coefficients of 0.834 and 0.878 for segmentation of T2/FLAIR and CE lesions in the training set (fivefold cross-validation). Corresponding DICE coefficients in the test set were 0.846 for T2/FLAIR lesions and 0.908 for CE lesions, and the CCC was ≥ 0.960 in each dataset. Conclusions Our results highlight the capability of ANN for quantitative state-of-the-art assessment of volumetric lesion load on MRI and potentially enable a more accurate assessment of disease burden in patients with MS. Key Points • Artificial neural networks (ANN) can accurately detect and segment both T2/FLAIR and contrast-enhancing MS lesions in MRI data. • Performance of the ANN was consistent in a clinically derived dataset, with patients presenting all possible disease stages in MRI scans acquired from standard clinical routine rather than with high-quality research sequences. • Computer-aided evaluation of MS with ANN could streamline both clinical and research procedures in the volumetric assessment of MS disease burden as well as in lesion detection.

    更新日期:2020-01-04
  • Accurate prediction of responses to transarterial chemoembolization for patients with hepatocellular carcinoma by using artificial intelligence in contrast-enhanced ultrasound
    Eur. Radiol. (IF 3.962) Pub Date : 2020-01-03
    Dan Liu, Fei Liu, Xiaoyan Xie, Liya Su, Ming Liu, Xiaohua Xie, Ming Kuang, Guangliang Huang, Yuqi Wang, Hui Zhou, Kun Wang, Manxia Lin, Jie Tian

    Abstract Objectives We aimed to establish and validate an artificial intelligence–based radiomics strategy for predicting personalized responses of hepatocellular carcinoma (HCC) to first transarterial chemoembolization (TACE) session by quantitatively analyzing contrast-enhanced ultrasound (CEUS) cines. Methods One hundred and thirty HCC patients (89 for training, 41 for validation), who received ultrasound examination (CEUS and B-mode) within 1 week before the first TACE session, were retrospectively enrolled. Ultrasonographic data was used for building and validating deep learning radiomics-based CEUS model (R-DLCEUS), machine learning radiomics-based time-intensity curve of CEUS model (R-TIC), and machine learning radiomics-based B-Mode images model (R-BMode), respectively, to predict responses (objective-response and non-response) to TACE with reference to modified response evaluation criteria in solid tumor. The performance of models was compared by areas under the receiver operating characteristic curve (AUC) and the DeLong test was used to compare different AUCs. The prediction robustness was assessed for each model. Results AUCs of R-DLCEUS, R-TIC, and R-BMode were 0.93 (95% CI, 0.80–0.98), 0.80 (95% CI, 0.64–0.90), and 0.81 (95% CI, 0.67–0.95) in the validation cohort, respectively. AUC of R-DLCEUS shows significant difference compared with that of R-TIC (p = 0.034) and R-BMode (p = 0.039), whereas R-TIC was not significantly different from R-BMode. The performance was highly reproducible with different training and validation cohorts. Conclusions DL-based radiomics method can effectively utilize CEUS cines to achieve accurate and personalized prediction. It is easy to operate and holds good potential for benefiting TACE candidates in clinical practice. Key Points • Deep learning (DL) radiomics-based CEUS model can accurately predict responses of HCC patients to their first TACE session by quantitatively analyzing their pre-operative CEUS cines. • The visualization of the 3D CNN analysis adopted in CEUS model provided direct insight into what computers “see” on CEUS cines, which can help people understand the interpretation of CEUS data. • The proposed prediction method is easy to operate and labor-saving for clinical practice, facilitating the clinical treatment decision of HCCs with very few time costs.

    更新日期:2020-01-04
  • Functional and metabolic imaging in transthoracic biopsies guided by computed tomography
    Eur. Radiol. (IF 3.962) Pub Date : 2020-01-03
    Charles E. Zurstrassen, Chiang J. Tyng, Marcos D. Guimarães, Paula N. V. P. Barbosa, Clovis A. L. Pinto, Almir G. V. Bitencourt, Jeffersson L. Gross, Eduardo N. P. Lima, Aline C. B. S. Cavalcante, João P. K. Matushita Junior, Rubens Chojniak

    CT-guided biopsy of indeterminate lung lesions sometimes provides insufficient histological results due to tumor necrosis. Functional and metabolic methods such as DWI-MR and PET-CT may help by directing sample collection to a lesion area of greater biological representativeness. The objective is to evaluate the histopathological results based on findings on ADC and SUV levels in lung lesions suspected for primary cancer.

    更新日期:2020-01-04
  • Digital breast tomosynthesis for breast cancer detection: a diagnostic test accuracy systematic review and meta-analysis
    Eur. Radiol. (IF 3.962) Pub Date : 2020-01-03
    Mostafa Alabousi, Nanxi Zha, Jean-Paul Salameh, Lucy Samoilov, Anahita Dehmoobad Sharifabadi, Alex Pozdnyakov, Behnam Sadeghirad, Vivianne Freitas, Matthew D. F. McInnes, Abdullah Alabousi

    Abstract Objectives No consensus exists on digital breast tomosynthesis (DBT) utilization for breast cancer detection. We performed a diagnostic test accuracy systematic review and meta-analysis comparing DBT, combined DBT and digital mammography (DM), and DM alone for breast cancer detection in average-risk women. Methods MEDLINE and EMBASE were searched until September 2018. Comparative design studies reporting on the diagnostic accuracy of DBT and/or DM for breast cancer detection were included. Demographic, methodologic, and diagnostic accuracy data were extracted. Risk of bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS)-2 tool. Accuracy metrics were pooled using bivariate random-effects meta-analysis. The impact of multiple covariates was assessed using meta-regression. PROSPERO ID: CRD 42018111287. Results Thirty-eight studies reporting on 488,099 patients (13,923 with breast cancer) were included. Eleven studies were at low risk of bias. DBT alone, combined DBT and DM, and DM alone demonstrated sensitivities of 88% (95% confidence interval [CI] 83–92), 88% (CI 83–92), and 79% (CI 75–82), as well as specificities of 84% (CI 76–89), 81% (CI 73–88), and 79% (CI 71–85), respectively. The greater sensitivities of DBT alone and combined DBT and DM compared to DM alone were preserved in the combined meta-regression models accounting for other covariates (p = 0.003–0.006). No significant difference in diagnostic accuracy between DBT alone and combined DBT and DM was identified (p = 0.175–0.581). Conclusions DBT is more sensitive than DM, while the addition of DM to DBT provides no additional diagnostic benefit. Consideration of these findings in breast cancer imaging guidelines is recommended. Key Points • Digital breast tomosynthesis with or without additional digital mammography is more sensitive in detecting breast cancer than digital mammography alone in women at average risk for breast cancer. • The addition of digital mammography to digital breast tomosynthesis provides no additional diagnostic benefit in detecting breast cancer compared to digital breast tomosynthesis alone. • The specificity of digital breast tomosynthesis with or without additional digital mammography is no different than digital mammography alone in the detection of breast cancer.

    更新日期:2020-01-04
  • A nomogram to predict survival of patients with intermediate-stage hepatocellular carcinoma after transarterial chemoembolization combined with microwave ablation
    Eur. Radiol. (IF 3.962) Pub Date : 2020-01-03
    Jia-yan Ni, Zhu-ting Fang, Hong-liang Sun, Chao An, Zhi-mei Huang, Tian-qi Zhang, Xiong-ying Jiang, Yao-ting Chen, Lin-feng Xu, Jin-hua Huang

    Abstract Objectives To develop a prognostic nomogram based on the albumin–bilirubin (ALBI) grade for prediction of the long-term survival of patients with intermediate-stage hepatocellular carcinoma (HCC) after transarterial chemoembolization combined with microwave ablation (TACE-MWA). Methods We retrospectively studied 546 consecutive patients with intermediate-stage HCC according to the Barcelona Clinic Liver Cancer guidelines who underwent TACE-MWA between January 2000 and December 2016. Overall survival (OS) and progression-free survival (PFS) were analyzed. The predictive value of the ALBI grade was investigated. The prognostic nomogram was constructed using the independent predictors assessed by the multivariate Cox proportional hazards model. Results After a median follow-up of 35.0 months (range, 4.0–221.0 months), 380 patients had died. The median OS was 35.0 months (95% confidence interval (CI), 30.84–39.16 months), and the median PFS was 6.5 months (95% CI, 6.13–6.87 months). The ALBI grade was validated as an independent predictor of OS (p < 0.001). Multivariate analyses showed that Eastern Cooperative Oncology Group performance status score more than 0, presence of liver cirrhosis, a-fetoprotein level above 400 ng/mL, tumor size greater than 5 cm, tumor number more than 3, advanced ALBI grade, and treatment sessions of TACE or MWA fewer than 3 were independently associated with overall mortality. The prognostic nomogram incorporating these eight predictors achieved good calibration and discriminatory abilities with a concordance index of 0.770 (95% CI, 0.746–0.795). Conclusions The prognostic nomogram based on the ALBI grade resulted in reliable efficacy for prediction of individualized OS in patients with intermediate-stage HCC after TACE-MWA. Key Points • TACE-MWA was associated with a median overall survival of 35.0 months for patients with intermediate-stage HCC. • A prognostic nomogram was built to predict individualized survival of patients with intermediate-stage HCC after TACE-MWA. • The prognostic nomogram incorporating eight predictors achieved good calibration and discriminatory abilities with a concordance index of 0.770.

    更新日期:2020-01-04
  • Degenerative lumbar scoliosis: added value of coronal images to routine lumbar MRI for nerve root compromise
    Eur. Radiol. (IF 3.962) Pub Date : 2020-01-03
    Seul Ki Lee, Joon-Yong Jung

    Abstract Objectives Radiating pain in degenerative scoliosis is primary indication for surgery. However, axial and sagittal MR images are limited for identifying nerve root compromise. Therefore, we aimed to assess the value of coronal images for evaluating nerve root compromise in degenerative scoliosis. Methods Forty-six patients (mean 70 years; range 41–91 years; 8 men) with degenerative scoliosis were enrolled. Coronal images were added to routine MRI. Two radiologists independently reviewed 350 nerve roots in two MRI sets: sagittal images alone (set 1) and coronal and sagittal images combined (set 2). The following features were evaluated: interpedicular height, lateral osteophyte, asymmetric bulging disc, lateral listhesis, anterolisthesis, axial rotation angle, facet arthrosis, ligamentum flavum thickening, and pseudoarticulation. Symptomatic levels were determined by transforaminal selective nerve root block. Results There were 80 symptomatic and 270 asymptomatic nerve roots. The sensitivity (86%) and accuracy (93%) of set 2 were significantly higher than set 1 (53% and 87%) for radiculopathy, while specificity was similar between two sets (set 1, 97%; set 2, 95%). The AUC was significantly different between two sets (set 1, 0.853; set 2, 0.942). The negative interpedicular height difference, longer lateral osteophyte, asymmetric bulging disc, lateral listhesis, negative axial rotation angle difference, and pseudoarticulation were associated with change of grades between set 1 and set 2. Conclusion Coronal images are helpful for diagnosing nerve root compromise in patients with degenerative scoliosis. Key Points • Sagittal and axial images have low sensitivity for detection of extraforaminal nerve root compromise in degenerative scoliosis. • Addition of coronal images may improve the sensitivity in nerve root compromise. • The structural changes that may contribute to nerve root compromise can also be easily assessed with coronal images.

    更新日期:2020-01-04
  • Updated 10-year outcomes of percutaneous radiofrequency ablation as first-line therapy for single hepatocellular carcinoma < 3 cm: emphasis on association of local tumor progression and overall survival
    Eur. Radiol. (IF 3.962) Pub Date : 2020-01-03
    Min Woo Lee, Danbee Kang, Hyo Keun Lim, Juhee Cho, Dong Hyun Sinn, Tae Wook Kang, Kyoung Doo Song, Hyunchul Rhim, Dong Ik Cha, David S. K. Lu

    Abstract Objectives The purpose of this study was to evaluate the 10-year overall survival and local tumor progression (LTP) of percutaneous radiofrequency ablation (RFA) for single nodular hepatocellular carcinoma (HCC) < 3 cm using a large longitudinal hospital registry and clinical factors associated with overall survival and LTP. Methods A total of 467 newly diagnosed patients with single nodular HCC < 3 cm who underwent RFA as first-line therapy between January 2008 to December 2016 were analyzed. Overall survival and LTP were estimated using the Kaplan-Meier method. Cox regression and competing risks Cox regression analysis were performed to identify prognostic factors for overall survival and LTP, respectively. Results The 5- and 10-year overall survival rates after RFA were 83.7% and 74.2%, respectively. LTP (hazard ratio (HR), 2.03; 95% confidence interval (CI), 1.19–3.47) was one of the important factors for overall survival after RFA. The 5- and 10-year LTP rates after RFA were 20.4% and 25.1%, respectively. Periportal location (subdistribution HR, 2.29; 95% CI, 1.25–4.21), subphrenic location (2.25, 1.34–3.86), size ≥ 1.5–< 2.0 cm (1.88, 1.05–3.39), and size ≥ 2.0 cm (2.10, 1.14–3.86) were independent factors for LTP. Conclusion Ten-year therapeutic outcomes of percutaneous RFA as first-line therapy were excellent for single HCC < 3 cm. LTP was an important prognostic factor for overall survival after RFA. Periportal and subphrenic location of HCCs and tumor size were predictors for the development of LTP after RFA. Key Points • Updated 10-year survival outcome of percutaneous radiofrequency ablation as first-line therapy for single hepatocellular carcinoma < 3 cm was higher than previously reported. • Local tumor progression was an important prognostic factor for overall survival after percutaneous radiofrequency ablation. • Periportal and subphrenic location of hepatocellular carcinomas and tumor size were predictors for the development of local tumor progression after percutaneous radiofrequency ablation.

    更新日期:2020-01-04
  • Test-retest reproducibility of a deep learning–based automatic detection algorithm for the chest radiograph
    Eur. Radiol. (IF 3.962) Pub Date : 2020-01-03
    Hyungjin Kim, Chang Min Park, Jin Mo Goo

    Abstract Objectives To perform test-retest reproducibility analyses for deep learning–based automatic detection algorithm (DLAD) using two stationary chest radiographs (CRs) with short-term intervals, to analyze influential factors on test-retest variations, and to investigate the robustness of DLAD to simulated post-processing and positional changes. Methods This retrospective study included patients with pulmonary nodules resected in 2017. Preoperative CRs without interval changes were used. Test-retest reproducibility was analyzed in terms of median differences of abnormality scores, intraclass correlation coefficients (ICC), and 95% limits of agreement (LoA). Factors associated with test-retest variation were investigated using univariable and multivariable analyses. Shifts in classification between the two CRs were analyzed using pre-determined cutoffs. Radiograph post-processing (blurring and sharpening) and positional changes (translations in x- and y-axes, rotation, and shearing) were simulated and agreement of abnormality scores between the original and simulated CRs was investigated. Results Our study analyzed 169 patients (median age, 65 years; 91 men). The median difference of abnormality scores was 1–2% and ICC ranged from 0.83 to 0.90. The 95% LoA was approximately ± 30%. Test-retest variation was negatively associated with solid portion size (β, − 0.50; p = 0.008) and good nodule conspicuity (β, − 0.94; p < 0.001). A small fraction (15/169) showed discordant classifications when the high-specificity cutoff (46%) was applied to the model outputs (p = 0.04). DLAD was robust to the simulated positional change (ICC, 0.984, 0.996), but relatively less robust to post-processing (ICC, 0.872, 0.968). Conclusions DLAD was robust to the test-retest variation. However, inconspicuous nodules may cause fluctuations of the model output and subsequent misclassifications. Key Points • The deep learning–based automatic detection algorithm was robust to the test-retest variation of the chest radiographs in general. • The test-retest variation was negatively associated with solid portion size and good nodule conspicuity. • High-specificity cutoff (46%) resulted in discordant classifications of 8.9% (15/169; p = 0.04) between the test-retest radiographs.

    更新日期:2020-01-04
  • MRI and clinical features of acute fungal discitis/osteomyelitis
    Eur. Radiol. (IF 3.962) Pub Date : 2020-01-03
    F. Joseph Simeone, Jad S. Husseini, Kaitlyn J. Yeh, Santiago Lozano-Calderon, Sandra B. Nelson, Connie Y. Chang

    To compare imaging and clinical features of fungal and Staphylococcus aureus discitis-osteomyelitis (DO) for patients presenting for CT-guided biopsies.

    更新日期:2020-01-04
  • Cone-beam breast CT features associated with HER2/neu overexpression in patients with primary breast cancer
    Eur. Radiol. (IF 3.962) Pub Date : 2020-01-03
    Yueqiang Zhu, Yuwei Zhang, Yue Ma, Haijie Li, Aidi Liu, Peng Han, Lu Yin, Nan Lv, Zhijun Li, Hong Lu, Peifang Liu, Zhaoxiang Ye

    To identify the relationship between human epidermal growth factor receptor 2 (HER2) status and cone-beam breast CT (CBBCT) characteristics in surgically resected breast cancer.

    更新日期:2020-01-04
  • Magnetisation transfer imaging adds information to conventional MRIs to differentiate inflammatory from fibrotic components of small intestinal strictures in Crohn’s disease
    Eur. Radiol. (IF 3.962) Pub Date : 2020-01-03
    Zhuang-nian Fang, Xue-hua Li, Jin-jiang Lin, Si-yun Huang, Qing-hua Cao, Zhi-hui Chen, Can-hui Sun, Zhong-wei Zhang, Florian Rieder, Jordi Rimola, Min-hu Chen, Zi-ping Li, Ren Mao, Shi-Ting Feng

    Identifying inflammation- or fibrosis-predominant strictures in Crohn’s disease (CD) is crucial for treatment strategies. We evaluated the additive value of magnetisation transfer (MT) to conventional MRI for differentiating CD strictures using surgical histopathology as a reference standard.

    更新日期:2020-01-04
  • Imaging protocols for renal multiparametric MRI and MR urography: results of a consensus conference from the French Society of Genitourinary Imaging
    Eur. Radiol. (IF 3.962) Pub Date : 2020-01-03
    Olivier Rouvière, François Cornelis, Serge Brunelle, Catherine Roy, Marc André, Marie-France Bellin, Isabelle Boulay, David Eiss, Nicolas Girouin, Nicolas Grenier, Olivier Hélénon, Jean-François Lapray, Arnaud Lefèvre, Xavier Matillon, Jean-Michel Ménager, Ingrid Millet, Sébastien Ronze, Thomas Sanzalone, Jean Tourniaire, Laurence Rocher, Raphaële Renard-Penna, on behalf of the “French Society of Genitourinary Imaging Consensus group”

    To develop technical guidelines for magnetic resonance imaging aimed at characterising renal masses (multiparametric magnetic resonance imaging, mpMRI) and at imaging the bladder and upper urinary tract (magnetic resonance urography, MRU).

    更新日期:2020-01-04
  • 18 F-FDG uptake velocity but not uptake level is associated with progression of carotid plaque
    Eur. Radiol. (IF 3.962) Pub Date : 2020-01-03
    Yuefeng Li, Yi Liang, Ping Yang, Yuhao Xu, Ningning Zhang, Yan Zhu, Xiaolan Zhu, Jinchuan Yan, Shenghong Ju

    Abstract Objectives The objective of this study was to evaluate whether baseline 18F-fluorodeoxyglucose (FDG) uptake is associated with carotid plaque progression. Methods A total of 156 subjects with carotid plaque were enrolled and underwent carotid magnetic resonance imaging (MRI) (at baseline and the 12-month follow-up) and positron emission tomography-computed tomography (PET-CT) (baseline). Carotid plaque progression was evaluated by two indices (the incidence of plaque progression and percentage of plaque increase) with three-dimensional (3D) imaging, while the 18F-FDG uptake was evaluated by the 18F-FDG uptake levels and 18F-FDG uptake velocity. The association between plaque progression and 18F-FDG uptake was investigated by the trend test and multivariate logistic regression analysis. Results Of the 156 subjects, 80 (51.3%) showed carotid plaque progression during the 12-month follow-up. Firstly, no association was found between 18F-FDG uptake levels and plaque progression. Secondly, significant differences in the incidence of plaque progression were observed among the groups with different uptake velocities, showing a significant decreasing trend ranging from high to intermediate to low (p = 0.002, trend test). After adjusting for covariates, an adequate prediction of the 18F-FDG uptake velocity for the incidence of plaque progression was revealed (OR = 0.682, p < 0.05). In addition, no association was found between the 18F-FDG uptake velocity and the percentage of plaque increase in the subjects with plaque progression (p = 0.757, trend test). Conclusions Our findings suggest 18F-FDG uptake velocity is independently associated with the incidence of carotid plaque progression. Additionally, the 18F-FDG uptake velocity, as another important parameter of PET-CT, warrants further study in future clinical research. Key Points • The18F-FDG uptake levels were not associated with the carotid plaque progression. • The18F-FDG uptake velocity could predict the incidence of carotid plaque progression. • The18F-FDG uptake velocity with related factors warrants more attention in future clinical research.

    更新日期:2020-01-04
  • Risk stratification in GIST: shape quantification with CT is a predictive factor
    Eur. Radiol. (IF 3.962) Pub Date : 2020-01-03
    Sheng-cai Wei, Liang Xu, Wan-hu Li, Yun Li, Shou-fang Guo, Xiao-rong Sun, Wen-wu Li

    Abstract Background Tumor shape is strongly associated with some tumor’s genomic subtypes and patient outcomes. Our purpose is to find the relationship between risk stratification and the shape of GISTs. Methods A total of 101 patients with primary GISTs were confirmed by pathology and immunohistochemistry and underwent enhanced CT examination. All lesions’ pathologic sizes were 1 to 10 cm. Points A and B were the extremities of the longest diameter (LD) of the tumor and points C and D the extremities of the small axis, which was the longest diameter perpendicular to AB. The four angles of the quadrangle ABCD were measured and each angle named by its summit (A, B, C, D). For regular lesions, we took angles A and B as big angle (BiA) and small angle (SmA). For irregular lesions, we compared A/B ratio and D/C ratio and selected the larger ratio for analysis. The chi-square test, t test, ROC analysis, and hierarchical or binary logistic regression analysis were used to analyze the data. Results The BiA/SmA ratio was an independent predictor for risk level of GISTs (p = 0.019). With threshold of BiA at 90.5°, BiA/SmA ratio at 1.35 and LD at 6.15 cm, the sensitivities for high-risk GISTs were 82.4%, 85.3%, and 83.8%, respectively; the specificities were 87.1%, 71%, and 77.4%, respectively; and the AUCs were 0.852, 0.818, and 0.844, respectively. LD could not effectively distinguish between intermediate-risk and high-risk GISTs, but BiA could (p < 0.05). Shape and Ki-67 were independent predictors of the mitotic value (p = 0.036 and p < 0.001, respectively), and the accuracy was 87.8%. Conclusions Quantifying tumor shape has better predictive efficacy than LD in predicting the risk level and mitotic value of GISTs, especially for high-risk grading and mitotic value > 5/50HPF. Key Points • The BiA/SmA ratio was an independent predictor affecting the risk level of GISTs. LD could not effectively distinguish between intermediate-risk and high-risk GISTs, but BiA could. • Shape and Ki-67 were independent predictors of the mitotic value. • The method for quantifying the tumor shape has better predictive efficacy than LD in predicting the risk level and mitotic value of GISTs.

    更新日期:2020-01-04
  • Prenatal magnetic resonance imaging within the 26th week of gestation may predict the fate of isolated upward rotation of the cerebellar vermis: insights from a multicentre study
    Eur. Radiol. (IF 3.962) Pub Date : 2020-01-03
    Giorgio Conte, Luca Caschera, Cecilia Parazzini, Claudia Cinnante, Giana Izzo, Giacomo Talenti, Mariasavina Severino, Francesca Ormitti, Giovanni Palumbo, Lorenzo Pinelli, Amanda Antonelli, Lucia Manganaro, Simona Boito, Andrea Rossi, Fabio Triulzi, Andrea Righini

    We investigated whether prenatal magnetic resonance imaging (MRI) within 26 weeks of gestation (GW) may predict the fate of isolated upward rotation of the cerebellar vermis (URCV).

    更新日期:2020-01-04
  • Sharp margin of antero-inferior lateral femoral condyle as a risk factor for patellar tendon-lateral femoral condyle friction syndrome
    Eur. Radiol. (IF 3.962) Pub Date : 2020-01-03
    Jia Li, Bo Sheng, Xin Liu, Fan Yu, Fajin Lv, Furong Lv, Haitao Yang

    Abstract Objective To determine the correlation between patellar tendon-lateral femoral condyle friction syndrome (PLFFS) and the morphological characteristics of the antero-inferior part of the lateral femoral condyle (ALFC) to explore the potential pathogenesis. Methods A total of 170 knees of 140 patients with PLFFS (PLFFS group) were retrospectively analyzed using magnetic resonance imaging (MRI) data for a 4-year period from our database. The Insall–Salvati ratio, shape of the ALFC (SALFC, defined as two subtypes: sharp versus blunt), lateral femoral condyle angle (LFCA), lateral trochlear length (LTL), and lateral trochlear height (LTH) were measured on MRI. Two groups were enrolled as controls: pure patella alta group (n = 192) and normal group (n = 172). All the parameters of the PLFFS group were compared with those of the two control groups. Results The LFCA was significantly lower (p < 0.001) in the PLFFS group than in the pure patella alta group. The SALFC was significantly different (p < 0.001) in these two groups, whereas the Insall–Salvati ratio, LTH, and LTL showed no significant difference. The LFCA, LTH, SALFC, and the Insall–Salvati ratio in the PLFFS group were also significantly different (p < 0.001) with the normal group. Receiver operating characteristic (ROC) analysis showed the efficacy of the Insall–Salvati ratio and SALFC was better than that of the other parameters. Conclusions The morphological characteristics of ALFC are correlated with PLFFS. The sharp shape of ALFC may be an important causative co-factor along with patella alta in the pathogenesis of PLFFS. Key Points • A sharp margin of the antero-inferior lateral femoral condyle is an important risk factor for the development of PLFFS in patients with patella alta. • Antero-inferior femoral condyle shape can easily be assessed with high intra- and inter-reader reliability PLFFS. • PLFFS is more common in young adults.

    更新日期:2020-01-04
  • Correction to: Towards clinical grating-interferometry mammography
    Eur. Radiol. (IF 3.962) Pub Date : 2020-01-02
    Carolina Arboleda, Zhentian Wang, Konstantins Jefimovs, Thomas Koehler, Udo Van Stevendaal, Norbert Kuhn, Bernd David, Sven Prevrhal, Kristina Lång, Serafino Forte, Rahel Antonia Kubik-Huch, Cornelia Leo, Gad Singer, Magda Marcon, Andreas Boss, Ewald Roessl, Marco Stampanoni

    The article Towards clinical grating-interferometry mammography, written by Carolina Arboleda, Zhentian Wang, Konstantins Jefimovs, Thomas Koehler, Udo Van Stevendaal, Norbert Kuhn, Bernd David, Sven Prevrhal, Kristina Lång, Serafino Forte, Rahel Antonia Kubik-Huch, Cornelia Leo

    更新日期:2020-01-04
  • Correction to: T1 mapping for liver function evaluation in gadoxetic acid–enhanced MR imaging: comparison of look-locker inversion recovery and B1 inhomogeneity–corrected variable flip angle method
    Eur. Radiol. (IF 3.962) Pub Date : 2019-07-29
    Ji Eun Kim, Hyun Ok Kim, Kyungsoo Bae, Dae Seob Choi, Dominik Nickel

    The original version of this article, published on 22 March 2019, unfortunately contained a mistake. The following correction has therefore been made in the original: Affiliations 1 and 2 were presented incorrectly.

    更新日期:2020-01-04
  • Radiology and patient communication: if not now, then when?
    Eur. Radiol. (IF 3.962) Pub Date : 2019-07-29
    Julie Cox, Yitka Graham

    • Communication with patients in radiology is, in general, indirect using the referrer as a conduit.

    更新日期:2020-01-04
  • Distinguishing intrahepatic cholangiocarcinoma from hepatocellular carcinoma in patients with and without risks: the evaluation of the LR-M criteria of contrast-enhanced ultrasound liver imaging reporting and data system version 2017
    Eur. Radiol. (IF 3.962) Pub Date : 2019-07-11
    Fei Li, Qing Li, Yubo Liu, Jing Han, Wei Zheng, Yini Huang, Xueyi Zheng, Longhui Cao, Jian-hua Zhou

    Abstract Purpose To assess the diagnostic performance of the LR-M criteria of Contrast-Enhanced Ultrasound Liver Imaging Reporting and Data System version 2017 in differentiating intrahepatic cholangiocarcinoma (ICC) from hepatocellular carcinoma (HCC) in patients with and without risk factors for HCC. Methods Fifty-four ICC in patients with risks and 55 ICC in patients without risks and matched control cases of HCC with and without risks (n = 59 and n = 55, respectively) were enrolled. The enhanced features of the lesions were retrospectively analyzed according to LR-M criteria. The diagnostic performances including the area under the receiver operating characteristic curve (AUC), sensitivity, and specificity of LR-M criteria were assessed. Result Peripheral rim-like hyperenhancement, early washout (< 45 or 60s), and marked washout did not differ between ICCs with and without risks, while all of these features were more common in ICCs than in HCCs (p < 0.05) no matter if patients were with and without risk factors. Using the LR-M criteria to differentiate ICC from HCC, the AUC, sensitivity, specificity, and accuracy were 0.92, 97.25%, 87.72%, and 92.38%, respectively. If early washout onset was adjusted to < 45 s, the specificity was significantly increased to 95.61% (p = 0.004) without losing sensitivity (96.33%, p = 0.945). The rate of HCCs misdiagnosed as ICCs would decrease from 12.3 to 4.4%. Conclusion Although the LR-M criteria showed high sensitivity in distinguishing ICCs from HCCs in patients with and without risks, the specificity would be significantly increased after adjustments to current criteria. Key Points • The LR-M criteria of CEUS-LI-RADS v2017 could be used for distinguishing ICC from HCC not only in patients with risk factors for HCC but also in those without risk factors. • The diagnostic performance of differentiating ICC from HCC by using the LR-M criteria showed high AUC (0.92), high sensitivity (97.25%), intermediate specificity (87.72%), and high accuracy (92.38%). • If the onset of early washout was adjusted to < 45 s, the specificity was significantly increased from 87.72 to 95.61% (p = 0.004) without losing sensitivity (p = 0.945), and the rate of HCCs misdiagnosed as ICCs would decrease from 12.3 to 4.4%.

    更新日期:2020-01-04
  • Patients undergoing recurrent CT scans: assessing the magnitude.
    Eur. Radiol. (IF 3.962) Pub Date : null
    Madan M Rehani,Kai Yang,Emily R Melick,John Heil,Dušan Šalát,William F Sensakovic,Bob Liu

    OBJECTIVES To assess percent of patients undergoing multiple CT exams that leads to cumulative effective dose (CED) of ≥ 100 mSv and determine their age distribution. METHODS Data was retrieved retrospectively from established radiation dose monitoring systems by setting the threshold value of 100 mSv at four institutions covering 324 hospitals. The number of patients with CED ≥ 100 mSv only from recurrent CT exams during a feasible time period between 1 and 5 years was identified. Age and gender distribution of these patients were assessed to identify the magnitude of patients in the relatively lower age group of ≤ 50 years. RESULTS Of the 2.5 million (2,504,585) patients who underwent 4.8 million (4,819,661) CT exams during the period of between 1 and 5 years, a total of 33,407 (1.33%) patients received a CED of ≥ 100 mSv with an overall median CED of 130.3 mSv and maximum of 1185 mSv. Although the vast majority (72-86%) of patients are > 50 years of age, nearly 20% (13.4 to 28%) are ≤ 50 years. The minimum time to accrue 100 mSv was a single day at all four institutions, an unreported finding to date. CONCLUSIONS We are in an unprecedented era, where patients undergoing multiple CT exams and receiving CED ≥ 100 mSv are not uncommon. While underscoring the need for imaging appropriateness, the consideration of the number and percent of patients with high exposures and related clinical necessities creates an urgent need for the industry to develop CT scanners and protocols with sub-mSv radiation dose, a goal that has been lingering. KEY POINTS • We are in an era where patients undergoing multiple CT exams during a short span of 1 to 5 years are not uncommon and a sizable fraction among them are below 50 years of age. • This leads to cumulative radiation dose to individual patients at which radiation effects are of real concern. • There is an urgent need for the industry to develop CT scanners with sub-mSv radiation dose, a goal that has been lingering.

    更新日期:2019-11-01
  • Patients undergoing recurrent CT exams: assessment of patients with non-malignant diseases, reasons for imaging and imaging appropriateness.
    Eur. Radiol. (IF 3.962) Pub Date : null
    Madan M Rehani,Emily R Melick,Raza M Alvi,Ruhani Doda Khera,Salma Batool-Anwar,Tomas G Neilan,Michael Bettmann

    OBJECTIVE To determine percent of patients without malignancy and ≤ 40 years of age with high cumulative radiation doses through recurrent CT exams and assess imaging appropriateness. METHODS From the cohort of patients who received cumulative effective dose (CED) of ≥ 100 mSv over a 5-year period, a sub-set was identified with non-malignant disease. The top 50 clinical indications leading to multiple CTs were determined. Clinical decision support (CDS) system scores were analyzed using a widely adopted standard of 1-3 (red) as "not usually appropriate," 4-6 (yellow) "may or may not be appropriate," and 7-9 (green) "usually appropriate." Clinicians reviewed patient records to assess compliance with appropriate use criteria (AUC). RESULTS 9.6% of patients in our series were with non-malignant conditions and 1.4% with age ≤ 40 years. CDS scores (rounded) were 2% red, 38% yellow, 27% green, and 33% unscored CTs. Clinical society guidelines for CT exams, wherever available, were followed in 87.5 to 100% of cases. AUCs were not available for several clinical indications as also referral guidelines for serial CT imaging. More than half of CT exams were unrelated to follow-up of a primary chronic disease. CONCLUSIONS We are faced with a situation wherein patients in age ≤ 40 years require or are thought to require many CT exams over the course of a few years but the radiation risk creates concern. There is a fair number of conditions for which AUC are not available. Suggested solutions include development of CT scanners with lesser radiation dose and further development of appropriateness criteria. KEY POINTS We are faced with a situation wherein patients in age group 0-40 years and with non-malignant diagnosis require or are thought to require many CT exams over the course of a few years. More than half of CT exams were unrelated to follow-up of a primary chronic disease. Imaging guidelines and appropriateness use criteria are not available for many conditions. Wherever available, they are for initial work-up and diagnosis and there is a lack of guidance on serial CT imaging.

    更新日期:2019-11-01
  • Multinational data on cumulative radiation exposure of patients from recurrent radiological procedures: call for action.
    Eur. Radiol. (IF 3.962) Pub Date : null
    Marco Brambilla,Jenia Vassileva,Agnieszka Kuchcinska,Madan M Rehani

    OBJECTIVES To have a global picture of the recurrent use of CT imaging to a level where cumulative effective dose (CED) to individual patients may be exceeding 100 mSv at which organ doses typically are in a range at which radiation effects are of concern METHODS: The IAEA convened a meeting in 2019 with participants from 26 countries, representatives of various organizations, and experts in radiology, medical physics, radiation biology, and epidemiology. Participants were asked to collect data prior to the meeting on cumulative radiation doses to assess the magnitude of patients above a defined level of CED. RESULTS It was observed that the number of patients with CED ≥ 100 mSv is much larger than previously known or anticipated. Studies were presented in the meeting with data from about 3.2 million patients who underwent imaging procedures over periods of between 1 and 5 years in different hospitals. It is probable that an additional 0.9 million patients reach the CED ≥ 100 mSv every year globally. CONCLUSIONS There is a need for urgent actions by all stakeholders to address the issue of high cumulative radiation doses to patients. The actions include development of appropriateness criteria/referral guidelines by professional societies for patients who require recurrent imaging studies, development of CT machines with lower radiation dose than today by manufacturers, and development of policies by risk management organizations to enhance patient radiation safety. Alert values for cumulative radiation exposures of patients should be set up and introduced in dose monitoring systems. KEY POINTS • Recurrent radiological imaging procedures leading to high radiation dose to patients are more common than ever before. • Tracking of radiation exposure of individual patients provides useful information on cumulative radiation dose. • There is a need for urgent actions by all stakeholders to address the issue of high cumulative radiation doses to patients.

    更新日期:2019-11-01
  • Correlation between MRI phenotypes and a genomic classifier of prostate cancer: preliminary findings.
    Eur. Radiol. (IF 3.962) Pub Date : 2019-03-09
    Andrei S Purysko,Cristina Magi-Galluzzi,Omar Y Mian,Sarah Sittenfeld,Elai Davicioni,Marguerite du Plessis,Christine Buerki,Jennifer Bullen,Lin Li,Anant Madabhushi,Andrew Stephenson,Eric A Klein

    OBJECTIVES We sought to evaluate the correlation between MRI phenotypes of prostate cancer as defined by PI-RADS v2 and the Decipher Genomic Classifier (used to estimate the risk of early metastases). METHODS This single-center, retrospective study included 72 nonconsecutive men with prostate cancer who underwent MRI before radical prostatectomy performed between April 2014 and August 2017 and whose MRI registered lesions were microdissected from radical prostatectomy specimens and then profiled using Decipher (89 lesions; 23 MRI invisible [PI-RADS v2 scores ≤ 2] and 66 MRI visible [PI-RADS v2 scores ≥ 3]). Linear regression analysis was used to assess clinicopathologic and MRI predictors of Decipher results; correlation coefficients (r) were used to quantify these associations. AUC was used to determine whether PI-RADS v2 could accurately distinguish between low-risk (Decipher score < 0.45) and intermediate-/high-risk (Decipher score ≥ 0.45) lesions. RESULTS MRI-visible lesions had higher Decipher scores than MRI-invisible lesions (mean difference 0.22; 95% CI 0.13, 0.32; p < 0.0001); most MRI-invisible lesions (82.6%) were low risk. PI-RADS v2 had moderate correlation with Decipher (r = 0.54) and had higher accuracy (AUC 0.863) than prostate cancer grade groups (AUC 0.780) in peripheral zone lesions (95% CI for difference 0.01, 0.15; p = 0.018). CONCLUSIONS MRI phenotypes of prostate cancer are positively correlated with Decipher risk groups. Although PI-RADS v2 can accurately distinguish between lesions classified by Decipher as low or intermediate/high risk, some lesions classified as intermediate/high risk by Decipher are invisible on MRI. KEY POINTS • MRI phenotypes of prostate cancer as defined by PI-RADS v2 positively correlated with a genomic classifier that estimates the risk of early metastases. • Most but not all MRI-invisible lesions had a low risk for early metastases according to the genomic classifier. • MRI could be used in conjunction with genomic assays to identify lesions that may carry biological potential for early metastases.

    更新日期:2019-11-01
  • Effects of thalamic infarction on the structural and functional connectivity of the ipsilesional primary somatosensory cortex.
    Eur. Radiol. (IF 3.962) Pub Date : 2019-03-07
    Li Chen,Tianyou Luo,Kangcheng Wang,Yong Zhang,Dandan Shi,Fajin Lv,Yang Li,Yongmei Li,Qi Li,Weidong Fang,Zhiwei Zhang,Juan Peng,Hanfeng Yang

    OBJECTIVES To identify regions causally influenced by thalamic stroke by measuring white matter integrity, cortical volume, and functional connectivity (FC) among patients with thalamic infarction (TI) and to determine the association between structural/functional alteration and somatosensory dysfunction. METHODS Thirty-one cases with TI-induced somatosensory dysfunction and 32 healthy controls underwent magnetic resonance imaging scanning. We reconstructed the ipsilesional central thalamic radiation (CTR) and assessed its integrity using fractional anisotropy (FA), assessed S1 ipsilesional changes with cortical volume, and identified brain regions functionally connected to TI locations and regions without TI to examine the potential effects on somatosensory symptoms. RESULTS Compared with controls, TI patients showed decreased FA (F = 17.626, p < 0.001) in the ipsilesional CTR. TI patients exhibited significantly decreased cortical volume in the ipsilesional top S1. Both affected CTR (r = 0.460, p = 0.012) and S1 volume (r = 0.375, p = 0.049) were positively correlated with somatosensory impairment in TI patients. In controls, the TI region was highly functionally connected to atrophic top S1 and less connected to the adjacent middle S1 region in FC mapping. However, T1 patients demonstrated significantly increased FC between the ipsilesional thalamus and middle S1 area, which was adjacent to the atrophic S1 region. CONCLUSIONS TI induces remote changes in the S1, and this network of abnormality underlies the cause of the sensory deficits. However, our other finding that there is stronger connectivity in pathways adjacent to the damaged ones is likely responsible for at least some of the recovery of function. KEY POINTS • TI led to secondary impairment in the CTR and cortical atrophy in the ipsilesional top of S1. • TI patients exhibited significantly higher functional connectivity with the ipsilateral middle S1 which was mainly located within the non-atrophic area of S1. • Our results provide neuroimaging markers for non-invasive treatment and predict somatosensory recovery.

    更新日期:2019-11-01
  • Adnexal mass staging CT with a disease-specific structured report compared to simple structured report.
    Eur. Radiol. (IF 3.962) Pub Date : 2019-03-02
    Andrea Franconeri,Johannes Boos,Jieming Fang,Anuradha Shenoy-Bhangle,Michelle Perillo,Catherine J Wei,Leslie Garrett,Katharine Esselen,Liu Fong,Olga R Brook

    OBJECTIVES To assess a disease-specific structured report (dsSR) for CT staging of ovarian malignancy compared to a simple structured report (sSR). METHODS This is a HIPAA-compliant, IRB-approved study with waiver of informed consent. An adnexal mass-specific structured reporting CT template was developed in collaboration between gynecologic oncologists and diagnostic radiologists. The study population included 24 consecutive women who had a staging CT prior to undergoing debulking surgery for a primary ovarian malignancy. Objective evaluation by radiologists for the presence of 19 key features and subjective evaluation by gynecologic oncologists were performed to assess the clarity and usefulness for procedural planning of dsSR and sSR. Accuracy, sensitivity, and specificity were assessed using operating room notes and pathology reports as the reference standard. RESULTS Fewer key features were missing from dsSR than sSR: 0.2 ± 0.8 (range 0-2) vs.10.2 ± 1.7 (range 7-14), respectively (p < 0.0001). Compared to sSR, gynecologic oncologists deemed dsSR more helpful (4.3 ± 0.7 vs. 3.7 ± 0.8, p < 0.0001) and easier to understand (4.3 ± 0.6 vs. 3.9 ± 0.7, p = 0.0057) (on a scale 0-5, 0 not helpful/very difficult to understand; 5 extremely helpful/very clear to understand). Gynecologic oncologists reported a higher rate of potential to modify their surgical approach based on dsSR (33-42%) compared to sSR (13-17%), p = 0.004. CONCLUSIONS Disease-specific structured reports were more reliable than simple structured reports in describing key features essential for procedural planning. dsSR was described as more helpful and easier to understand and more likely to lead to modification of the surgical approach by gynecologic oncologists compared to sSR. KEY POINTS • Disease-specific structured report is easier to understand and more helpful for planning gynecological surgery as compared with simple structured report. • Disease-specific structured report for pre-operative evaluation of ovarian cancer provides better documentation of essential features required for surgical planning as compared with simple structured report. • Disease-specific structured report has the potential to modify the surgical approach as assessed by gynecologic oncologists.

    更新日期:2019-11-01
  • Multilobulated thymoma with an acute angle: a new predictor of lung invasion.
    Eur. Radiol. (IF 3.962) Pub Date : 2019-02-28
    Daniel B Green,Sarah Eliades,Alan C Legasto,Gulce Askin,Jeffrey L Port,James F Gruden

    OBJECTIVE Imaging features of thymomas such as lobulation, infiltration into lung, and adjacent lung abnormality have been associated with lung invasion but are unreliable. The goal of this study was to develop a more objective and reproducible method for predicting lung invasion by thymomas. SUBJECTS AND METHODS Fifty-four thymomas resected from 2007 to 2017 were included for analysis. Pre-operative CT scans for these thymomas were reviewed, and multiple features were evaluated, including the interface of each thymoma with the adjacent lung. A multilobulated thymoma with at least one acute angle between lobulations was considered suspicious for lung invasion. Two blinded radiologists then tested this hypothesis by reviewing all 54 CT scans and using this single criterion to predict lung invasion. RESULTS Twelve thymomas invaded the lung. All lung-invasive thymomas were multilobulated. Twenty-nine thymomas had a multilobulated interface with the lung. Multilobulated thymomas were more likely to invade the lung than thymomas with a single lobulation or no lobulation (p = 0.0008). Using the criterion of multilobulation with at least one acute angle between lobulations to predict lung invasion, the two readers achieved a sensitivity of 67-83%, specificity of 93-98%, positive predictive value of 77-89%, and negative predicted value of 91-95%. Nine lung-invasive thymomas also invaded mediastinal structures or disseminated to the pleura. CONCLUSIONS A multilobulated thymoma with at least one acute angle between lobulations predicts lung invasion with a high degree of accuracy. When lung invasion is suspected, the findings are indicative of a locally aggressive tumor, and the pleura and mediastinal structures should also be closely inspected for invasion. KEY POINTS • A multilobulated thymoma with at least one acute angle between lobulations is predictive of lung invasion. • Coronal and sagittal reformations and thin sections are helpful in challenging cases. • Lung invasion indicates a locally aggressive tumor, and the pleura and other mediastinal structures should also be closely inspected for invasion.

    更新日期:2019-11-01
  • Multiple unilateral subcapsular cortical hemorrhagic cystic disease of the kidney: CT and MRI findings and clinical characteristic.
    Eur. Radiol. (IF 3.962) Pub Date : 2019-02-27
    Kotaro Yoshida,Naoki Takahashi,Bernard F King,Akira Kawashima,Peter C Harris,Lynn D Cornell,Emilie Cornec-Le Gall,Dai Inoue,Ichiro Mizushima,Mitsuhiro Kawano,Eric Thervet,Paul René de Cotret,Vicente E Torres

    PURPOSE The aim of this study was to clarify the radiologic and clinical characteristics of multiple unilateral subcapsular cortical hemorrhagic cystic disease of the kidney. METHOD Fourteen patients with unique and characteristic multiple hemorrhagic subcapsular cortical cysts of the kidney, not categorized in any existing renal cystic diseases, were retrospectively reviewed. The clinical information including age, sex, symptom, family history of renal or renal cystic disease, and laboratory data were collected. CT and MRI findings including distribution, number and size of cysts, and CT attenuation and signal intensity on T1- and T2-weighted MRI of cysts were analyzed. RESULTS All patients except one were young and none had a family history of renal or renal cystic disease. Common clinical symptoms were flank or abdominal pain and hematuria. In all cases, only the left kidney was involved at initial presentation. Cysts were small (median cyst size, 4-15 mm), numerous, and distributed mainly along the subcapsular cortex of the kidney. Cysts were hyper-attenuated on unenhanced CT, extremely hypointense on T2-weighted MRI, and mildly hyperintense on T1-weighted MRI. All patients except one had normal renal function. Imaging follow-up revealed stable or mildly progressive disease in seven patients. Two patients developed several hemorrhagic subcapsular cortical cysts in the right kidney at follow-up. Three of five patients with a renal pathology specimen showed concurrent IgA nephropathy. CONCLUSION We have identified a unique renal cystic disease with multiple unilateral subcapsular cortical hemorrhagic cystic disease of the kidney that has a characteristic manifestation both radiologically and clinically. KEY POINTS • Multiple unilateral subcapsular cortical hemorrhagic cystic disease of the kidney is a unique non-familial renal cystic disease with a characteristic manifestation both radiologically and clinically. • Most cases of multiple unilateral subcapsular cortical hemorrhagic cystic disease of the kidney are stable or slowly progressive, and do not require invasive intervention.

    更新日期:2019-11-01
  • Longer-term outcomes of radiofrequency ablation for locally recurrent papillary thyroid cancer.
    Eur. Radiol. (IF 3.962) Pub Date : 2019-02-26
    Sae Rom Chung,Jung Hwan Baek,Young Jun Choi,Jeong Hyun Lee

    OBJECTIVES The purpose of this study was to evaluate the longer-term efficacy of ultrasound (US)-guided radiofrequency ablation (RFA) for treating locally recurrent papillary thyroid cancer (PTC). METHODS We retrospectively reviewed 29 patients who underwent RFA for 46 recurrent PTC between September 2008 and April 2012 and were subsequently followed up for at least 5 years. Follow-up included size change on US and thyroglobulin (Tg) level at 1, 3, 6, and 12 months and every 6-12 months thereafter. Any complications were reported during follow-up. RESULTS The mean follow-up duration after RFA was 80 ± 17.3 months (range, 60-114 months). Tumor volume decreased significantly, from 0.25 ± 0.42 mL before ablation to 0.01 ± 0.08 mL at the final evaluation (p < 0.001), with a mean volume reduction of 99.5% ± 2.9%. Forty-two of the 46 treated tumors (91.3%) had completely disappeared by the final evaluation. The mean serum Tg level decreased from 2.55 ± 4.7 to 0.75 ± 1.83 ng/dL (p < 0.001). There were no delayed complications associated with RFA during the follow-up period. CONCLUSIONS RFA seems to be an effective minimally invasive therapy for the treatment of locally recurrent PTC even in the longer-term period. KEY POINTS • RFA is an effective local control treatment option for recurrent PTCs even in the longer-term period with mean tumor VRR of 99.5% and the complete disappearance of the treated tumors in 91.3%. • The mean serum Tg level decreased significantly after RFA and biochemical remission rate was 51.7%. • No delayed complication after RFA for local recurrent PTC.

    更新日期:2019-11-01
  • Clinical significance of evaluating coronary atherosclerosis in adult patients with hypertrophic cardiomyopathy who have chest pain.
    Eur. Radiol. (IF 3.962) Pub Date : 2019-02-24
    Yoon Joo Shin,Jae Hwan Lee,Jin Young Yoo,Jeong A Kim,Yongho Jeon,Yeonyee E Yoon,Eun Ju Chun

    OBJECTIVE Chest pain is a common symptom in patients with hypertrophic cardiomyopathy (HCM), causing difficulty determining whether there is coexistent coronary artery disease (CAD). We investigated whether coronary computed tomography angiography (CCTA) can assess the prevalence and clinical significance of CAD in adult patients with HCM showing chest pain through longitudinal follow-up. METHODS In 238 adult patients with HCM, who underwent CCTA for chest pain, we analyzed the degree of stenosis and adverse plaque characteristics (APCs) as CCTA variables. Three prediction models for adverse cardiovascular events (ACEs: all-cause mortality, myocardial infarction, unstable angina, heart failure, implantable cardioverter-defibrillator implantation, and stroke) were assessed using the combination of clinical risk factors, echocardiographic parameters, and CCTA variables. RESULTS The prevalence of obstructive CAD (≥ 50% in luminal stenosis) and APC was 14.7% and 18.9%, respectively. During the follow-up period (median, 37 months; range, 2-108 months), there were 31 occurrences of ACEs (13.0%). Using multivariate Cox regression analysis, age, atrial fibrillation, low ejection fraction, obstructive CAD, and APCs were associated with ACEs (all p < 0.05). Among the prediction models for ACEs, the area under the curve (AUC) was higher (AUC = 0.92) when CCTA variables were added to the clinical (AUC = 0.84) and echocardiographic factors (AUC = 0.88) (p < 0.001). CONCLUSIONS Using CCTA, about 20% of symptomatic HCM patients were associated with clinically significant atherosclerosis. Adding these CCTA variables to the clinical and echocardiographic variables may increase the predictions of ACEs; therefore, evaluating coronary atherosclerosis using CCTA may be helpful for symptomatic HCM patients. KEY POINTS • Chest pain in adult patients with hypertrophic cardiomyopathy (HCM) remains challenging to distinguish from coronary artery disease. • Coronary computed tomography angiography (CCTA) can assess the severity and characteristics of coronary atherosclerosis in symptomatic HCM patients. • Adding CCTA variables to clinical and echocardiographic factors may increase the predictions of adverse cardiac events in HCM patients, and thus evaluating coronary atherosclerosis using CCTA may be helpful for HCM patients with chest pain.

    更新日期:2019-11-01
  • Agreement between magnetic resonance imaging and computed tomography in the postnatal evaluation of congenital lung malformations: a pilot study.
    Eur. Radiol. (IF 3.962) Pub Date : 2019-02-24
    Salvatore Zirpoli,Alice Marianna Munari,Alessandra Primolevo,Marco Scarabello,Sara Costanzo,Andrea Farolfi,Gianluca Lista,Elena Zoia,Gian Vincenzo Zuccotti,Giovanna Riccipetitoni,Andrea Righini

    OBJECTIVES To compare postnatal magnetic resonance imaging (MRI) with the reference standard computed tomography (CT) in the identification of the key features for diagnosing different types of congenital lung malformation (CLM). METHODS Respiratory-triggered T2-weighted single-shot turbo spin echo (ss-TSE), respiratory-triggered T1-weighted turbo field echo (TFE), balanced fast field echo (BFFE), and T2-weighted MultiVane sequences were performed at 1.5 T on 20 patients prospectively enrolled. Two independent radiologists examined the postnatal CT and MRI evaluating the presence of cysts, hyperinflation, solid component, abnormal arteries and/or venous drainage, and bronchocele. Diagnostic performance of MRI was calculated and the agreement between the findings was assessed using the McNemar-Bowker test. Interobserver agreement was measured with the kappa coefficient. RESULTS CT reported five congenital pulmonary airway malformations (CPAMs), eight segmental bronchial atresias, five bronchopulmonary sequestrations (BPS), one congenital lobar overinflation, one bronchogenic cyst, and three hybrid lesions. MRI reported the correct diagnosis in 19/20 (95%) patients and the malformation was correctly classified in 22/23 cases (96%). MRI correctly identified all the key findings described on the CT except for the abnormal vascularization (85.7% sensitivity, 100% specificity, 100% PPV, 94.1% NPV, 95% accuracy for arterial vessels; 57.1% sensitivity, 100% specificity, 100% PPV, 84.2% NPV, 87% accuracy for venous drainage). CONCLUSIONS MRI can represent an effective alternative to CT in the postnatal assessment of CLM. In order to further narrow the gap with CT, the use of contrast material and improvements in sequence design are needed to obtain detailed information on vascularization, which is essential for surgical planning. KEY POINTS • Congenital lung malformations (CLMs) can be effectively studied by MRI avoiding radiation exposure. • Crucial features of CLM have similar appearance when comparing CT with MRI. • MRI performs very well in CLM except for aberrant vessel detection and characterization.

    更新日期:2019-11-01
  • Clinical usefulness of right ventricular 3D area strain in the assessment of treatment effects of balloon pulmonary angioplasty in chronic thromboembolic pulmonary hypertension: comparison with 2D feature-tracking MRI.
    Eur. Radiol. (IF 3.962) Pub Date : 2019-02-23
    Masateru Kawakubo,Yuzo Yamasaki,Takeshi Kamitani,Koji Sagiyama,Yuko Matsuura,Takuya Hino,Kohtaro Abe,Kazuya Hosokawa,Hidetake Yabuuchi,Hiroshi Honda

    OBJECTIVES To evaluate the usefulness of right ventricular (RV) area strain analysis via cardiac MRI (CMRI) as a tool for assessing the treatment effects of balloon pulmonary angioplasty (BPA) in inoperable chronic thromboembolic pulmonary hypertension (CTEPH), RV area strain was compared to two-dimensional (2D) strain with feature-tracking MRI (FTMRI) before and after BPA. METHODS We retrospectively analyzed 21 CTEPH patients who underwent BPA. End-systolic global area strain (GAS), longitudinal strain (LS), circumferential strain (CS), and radial strain (RS) were measured before and after BPA. Changes in GAS and RV ejection fraction (RVEF) values after BPA were defined as ΔGAS and ΔRVEF. Receiver operating characteristic (ROC) analyses were performed to determine the optimal cutoff of the strain at after BPA for detection of improved patients with decreased mean pulmonary artery pressure (mPAP) less than 30 mmHg and increased RVEF more than 50%. RESULTS ROC analysis revealed the optimal cutoffs of strains (GAS, LS, CS, and RS) for identifying improved patients with mPAP < 30 mmHg (cutoff (%) = - 41.2, - 13.8, - 16.7, and 14.4: area under the curve, 0.75, 0.56, 0.65, and 0.75) and patients with RVEF > 50% (cutoff (%) = - 37.2, - 29.5, - 2.9, and 14.4: area under the curve, 0.81, 0.60, 0.56, and 0.56). CONCLUSIONS Area strain analysis via CMRI may be a more useful tool for assessing the treatment effects of BPA in patients with CTEPH than 2D strains with FTMRI. KEY POINTS • Area strain values can detect improvement of right ventricular (RV) pressure and function after balloon pulmonary angioplasty (BPA) equally or more accurately than two-dimensional strains. • Area strain analysis is a useful analytical method that reflects improvements in complex RV myocardial deformation by BPA. • Area strain analysis is a robust method with reproducibility equivalent to that of 2D strain analysis.

    更新日期:2019-11-01
  • Core-needle biopsy in thyroid nodules: performance, accuracy, and complications.
    Eur. Radiol. (IF 3.962) Pub Date : 2019-02-21
    Miguel Paja,Jose Luis Del Cura,Rosa Zabala,Igone Korta,Aitziber Ugalde,José I López

    OBJECTIVE To evaluate the performance of core-needle biopsy (CNB) in thyroid using a cohort of patients in which it was used as first choice. METHODS Our institutional review board approved this retrospective study. We reviewed all CNB performed in our center over a period of 11 years. Ultrasound-guided CNBs were performed using a spring-loaded 18-gauge biopsy needle. We used a classification with four diagnostic categories for CNB results: insufficient, benign, follicular lesion (indeterminate), and malignant. Final diagnosis was based on surgical diagnosis or follow-up of at least 2 years in non-operated patients. RESULTS The study included 4412 CNB in 4112 nodules of 3768 patients, 300 of them repeated biopsies. Results were 148 insufficient (3.4%), 3706 benign (84%), 278 follicular lesions (6.3%), and 280 malignant (6.3%). Considering follicular lesion and malignancy CNB results as positive (both lead to the recommendation of surgery) sensitivity was 96% (CI 93.2-97.8) and specificity 93.7% (CI 92.9-94.5). Predictive positive value for a follicular lesion diagnosis was 12.2% and for a malignancy diagnosis, 98.6%. CNB likelihood ratio for malignancy of a malignant diagnosis was 841.9 (CI 315.8-2313.3), of a malignant/follicular lesion diagnosis was 23.4 (CI 20.1-27.3), and of a benign diagnosis was 0.04 (CI 0.02-0.07). Repeated CNB in 53 insufficient biopsies obtained 50 diagnostic results. Minor complications occurred in 2.2% of CNB, and major in four procedures (0.09%). CONCLUSIONS CNB in thyroid nodules is accurate and has few complications and a low rate of non-diagnostic and indeterminate diagnoses. It can be an alternative method when FNAC has poor performance. Repeating biopsy is useful after non-diagnostic biopsies. KEY POINTS • Core-needle biopsy of thyroid has a low ratio non-diagnostic and indeterminate results. • Core-needle biopsy results are highly reliable, especially benign results. • Complication rate of core-needle biopsy of thyroid is low.

    更新日期:2019-11-01
  • Age-dependent diagnostic accuracy of clinical scoring systems and D-dimer levels in the diagnosis of pulmonary embolism with computed tomography pulmonary angiography (CTPA).
    Eur. Radiol. (IF 3.962) Pub Date : 2019-02-21
    Sebastian N Nagel,Ingo G Steffen,Stefan Schwartz,Bernd Hamm,Thomas Elgeti

    OBJECTIVE The aim of this study was to compare the age-dependent diagnostic performance of clinical scores and D-dimer testing to identify patients with suspected pulmonary embolism (PE). METHODS Consecutive patients with suspected PE referred from the emergency department for computed tomography pulmonary angiography (CTPA) were retrospectively evaluated. Diagnostic scores (classic Wells score (WS), modified WS, simplified WS, revised Geneva score (GS), simplified GS, and YEARS score) were calculated from medical records. Results of D-dimer testing were retrieved from the laboratory database. CTPA was the diagnostic reference standard. Four age groups were analyzed (< 50, 50-64, 65-74, and ≥ 75 years). Statistical analysis used receiver operating characteristics as well as uni- and multivariate analyses with calculation of prediction models. The study was IRB approved. RESULTS One thousand consecutive patients were included. Areas under the curve (AUC) and accuracies were superior in patients < 50 years. For the classic WS, the AUC decreased by 11% with the optimal cutoff dropping 1.5 points in patients ≥ 75 years; for D-dimer levels, the optimal cutoff was 900 μg/L higher in both ≥ 65 years groups with a max. decrease of the AUC of 9%. In terms of accuracy, the YEARS score performed best across all groups. Classic WS and D-dimer level showed a significant interaction with patient age in prediction models. CONCLUSION D-dimer measurement and clinical scores perform best in patients < 50 years. The YEARS score performs best across all age groups and is therefore recommended. KEY POINTS • The probability of pulmonary embolism predicted by fibrin fibrinogen degradation products and clinical scores shows the highest accuracy in patients < 50 years. • The probability of pulmonary embolism predicted by the YEARS score shows the highest accuracy in each age group. • Classic Wells score and fibrin fibrinogen degradation products show a significant interaction with patient age in a logistic regression model.

    更新日期:2019-11-01
  • FLAIR vascular hyperintensity in acute stroke is associated with collateralization and functional outcome.
    Eur. Radiol. (IF 3.962) Pub Date : 2019-02-15
    Liang Jiang,Yu-Chen Chen,Hong Zhang,Mingyang Peng,Huiyou Chen,Wen Geng,Quan Xu,Xindao Yin,Yuehu Ma

    PURPOSE Fluid-attenuated inversion recovery vascular hyperintensity (FVH) is frequently found in stroke patients after intracranial arterial occlusion, but the prognostic value of FVH findings is unclear. We assessed whether FVH is associated with cerebral collateral status and functional outcome in patients with acute stroke patients receiving endovascular therapy. METHODS FVH score, American Society of Interventional and Therapeutic Neuroradiology (ASITN) grade, the functional outcome at 3 months (modified Rankin Scale (mRS)), and other clinical data were collected for 37 acute stroke patients with large vessel occlusion (LVO) receiving MRI before and after endovascular therapy. Statistical analysis was performed to predict functional outcome after stroke. RESULTS The good functional outcome group (n = 16) had a higher FVH1 (FVH before therapy) score (4.63 ± 1.20 vs 3.14 ± 1.15; p = 0.001) and ASITN grade (3.31 ± 0.48 vs 2.00 ± 1.22; p < 0.001) and a lower FVH2 (FVH after therapy) score than the poor functional outcome group (n = 21; 0.125 ± 0.50 vs 1.44 ± 2.16; p = 0.030). mRS at 3 months was negatively correlated with FVH1 (r = - 0.525, p = 0.001) and the ASITN grade (r = - 0.478, p = 0.003) and positively correlated with FVH2 (r = 0.376, p = 0.034). FVH1 (OR, 0.085; 95% CI, 0.013-0.577; p = 0.012) and FVH2 (OR, 2.724; 95% CI, 1.061-6.996; p = 0.037) were independently associated with functional outcome in multivariable logistic regression analysis. CONCLUSIONS Assessing FVH before and after therapy in acute stroke patients with LVO might be useful for predicting functional outcome after stroke. KEY POINTS • Fluid-attenuated inversion recovery vascular hyperintensity is a circular or serpentine brightening in the brain parenchyma or cortical surface bordering the subarachnoid space on MR imaging. • A prospective study showed that fluid-attenuated inversion recovery vascular hyperintensity is associated with cerebral collateral circulation and prognosis. • Fluid-attenuated inversion recovery vascular hyperintensity helps clinicians to predict the prognosis of patients with acute stroke.

    更新日期:2019-11-01
  • Performance measures among non-immigrants and immigrants attending BreastScreen Norway: a population-based screening programme.
    Eur. Radiol. (IF 3.962) Pub Date : 2019-02-15
    Sameer Bhargava,Lars Andreas Akslen,Ida Rashida Khan Bukholm,Solveig Hofvind

    OBJECTIVES To explore performance measures among non-immigrants and immigrants attending BreastScreen Norway. METHODS We analysed data from 2,951,375 screening examinations among non-immigrants and 153,026 among immigrants from 1996 to 2015. Immigrants were categorised into high- and low-incidence countries according to the incidence of breast cancer in their birth country. Performance measures, including attendance and recall rates, rates of screen-detected cancer (SDC) and interval breast cancer (IBC), positive predictive value (PPV) and histopathological tumour characteristics, were analysed. We used Fisher's exact model and t tests for descriptive statistics, and Poisson regression, adjusting for age and screening history, comparing results for non-immigrants versus immigrants. RESULTS Attendance rates were 78% for non-immigrants and 56% for immigrants (p < 0.001). Rates of prevalent screens were 24% for non-immigrants and 32% for immigrants (p < 0.001). Immigrants from low-incidence countries were younger at diagnosis than non-immigrants (57 years versus 60 years, p < 0.001). Recall rates were 3.1% for non-immigrants and 3.8% for immigrants (p < 0.001), while PPVs were 17% and 14% (p < 0.001), respectively. IBCs in immigrants from low-incidence countries were more often triple negative (RRadj 1.81, 95% CI 1.11-2.94) than those in non-immigrants. Both SDC and IBC in immigrants from low-incidence countries tended more often to be histological grade 3 than those in non-immigrants. CONCLUSION Immigrants had lower attendance rates, higher recall rates and lower PPV than non-immigrants. The optimal age range and screening interval for immigrant women from low-incidence countries need to be further investigated. KEY POINTS • Immigrants from countries with a low incidence of breast cancer had their breast cancer diagnosed at a younger age than non-immigrants. • Interval breast cancers detected in immigrants from countries with a low incidence of breast cancers were more often triple negative than those in non-immigrants. • The optimal age range and screening interval for immigrant women from low-incidence countries and non-immigrants might differ.

    更新日期:2019-11-01
  • Feasibility of low-dose CT with spectral shaping and third-generation iterative reconstruction in evaluating interstitial lung diseases associated with connective tissue disease: an intra-individual comparison study.
    Eur. Radiol. (IF 3.962) Pub Date : 2019-02-10
    Xiaoli Xu,Xin Sui,Lan Song,Yao Huang,Yingqian Ge,Zhengyu Jin,Wei Song

    OBJECTIVES To investigate the feasibility of low-dose CT (LDCT) with tin filtration and third-generation iterative reconstruction (IR) in evaluating interstitial lung diseases associated with connective tissue disease (CTD-ILD). METHODS Fifty-three consecutive adult patients with CTD-ILD underwent regular-dose chest CT (RDCT) at 110 kVp followed by LDCT with tin-filtered 100 kVp. RDCT was reconstructed with filtered back projection (FBP) and advanced modeled iterative reconstruction (ADMIRE); LDCT was reconstructed with ADMIRE. Image noise, streak artifact, image quality, and visualization of normal and abnormal CT features were evaluated and compared among RDCT-ADMIRE, RDCT-FBP, and LDCT-ADMIRE groups. RESULTS The mean radiation dose of LDCT was reduced to 20% of RDCT. Objective image noise of RDCT-ADMIRE (38.08 ± 6.37 HU), LDCT-ADMIRE (51.68 ± 9.06 HU), and RDCT-FBP (62.09 ± 10.95 HU) increased progressively (p < 0.001 in any two pairs). RDCT-ADMIRE significantly improved subjective image noise, streak artifact, and overall image quality compared with RDCT-FBP and LDCT-ADMIRE (all p < 0.001), while no significant difference was noted between the latter two groups. All abnormal lung structures were better scored in RDCT-ADMIRE compared with those in RDCT-FBP (all p < 0.001). LDCT-ADMIRE was inferior to RDCT-FBP in visualizing peripheral bronchi and vessels as well as reticulation (all p < 0.001); other normal and abnormal structures were similar between the two groups. CONCLUSION LDCT with tin filtration and third-generation IR was applicable in evaluating ILD lesions of CTD. Image quality was significantly improved after applying ADMIRE algorithm to CT protocols. KEY POINTS • Optimization of CT radiation dose is a clinical concern in patients with connective tissue disease. • Spectral shaping and third-generation iterative reconstruction emerge as promising techniques in reducing radiation dose and acquiring desired image quality of CTD-ILD patients. • The third-generation iterative reconstruction algorithm can optimize visualization of ILD patterns in low-dose CT.

    更新日期:2019-11-01
  • Optimal beam quality for chest flat panel detector system: realistic phantom study.
    Eur. Radiol. (IF 3.962) Pub Date : 2019-02-10
    Chie Kuwahara,Takatoshi Aoki,Nobuhiro Oda,Jun Kawabata,Koichiro Sugimoto,Michiko Kobayashi,Masami Fujii,Yukunori Korogi

    OBJECTIVE To investigate optimal beam quality for chest flat panel detector (FPD) system by semi-quantitatively assessment using a realistic lung phantom. MATERIALS AND METHODS Chest FPD radiographs were obtained on a realistic lung phantom with simulated lung opacities using various X-ray tube voltage levels (90-140 kV) with/without copper filter. Entrance skin dose was set to maintain identical for all images (0.1 mGy). Three chest radiologists unaware of the exposure settings independently evaluated the image quality of each simulated opacity and normal structure using a 5-point scale (+ 2: clearly superior to the standard; + 1: slightly superior to the standard; 0: equal to the standard; - 1: slightly inferior to the standard; - 2: clearly inferior to the standard). The traditional FPD image obtained at a tube voltage of 120 kV was used as the standard. The scores of image quality were statistically compared using the Wilcoxon rank test with Bonferroni correction. RESULTS FPD images using 90-kV shot with copper filter were superior to the traditional 120-kV shot without filter with respect to the visibility of vertebra, pulmonary vessels, and nodules overlapping diaphragm and heart (p < 0.05). There was no significant difference with respect to the visibility of all other simulated lung opacities (lung nodules except for overlying diaphragm/heart and honeycomb opacity) between each tube voltage level with/without copper filter and the traditional 120-kV shot without filter. CONCLUSION Image quality of FPD images using 90 kV with copper filtration is superior to that using standard tube voltage when dose is identical. KEY POINTS • FPD image quality using 90 kV with filter is superior to that using traditional beam. • Ninety-kilovolt shot with copper filter may be suitable for chest FPD image. • Clinical study dealing with chest FPD beam optimization would be warranted.

    更新日期:2019-11-01
  • Fine needle aspiration biopsy indications for thyroid nodules: compare a point-based risk stratification system with a pattern-based risk stratification system.
    Eur. Radiol. (IF 3.962) Pub Date : 2019-02-05
    Jing-Liang Ruan,Hai-Yun Yang,Rong-Bin Liu,Ming Liang,Ping Han,Xiao-Lin Xu,Bao-Ming Luo

    OBJECTIVES We aim to compare the diagnostic performance to assess thyroid nodules and reliability for recommending fine needle aspiration biopsy (FNAB) between American College of Radiology thyroid image reporting and data system (ACR TI-RADS) and American Thyroid Association (ATA) guidelines. METHODS In total, this retrospective study included 1001 consecutive thyroid nodules in 918 patients from May 2016 to December 2017. US features of the thyroid nodules, including composition, echogenicity, shape, margins, echogenic foci, and size, were reviewed and were classified according to ACR TI-RADS and ATA guidelines, respectively. The diagnostic performance to assess thyroid nodules and reliability for recommending fine needle aspiration biopsy were compared between ACR TI-RADS and ATA guidelines. RESULTS Of the 1001 thyroid nodules, 609 (60.8%) were benign and 392 (39.2%) were malignant. The sensitivity, specificity, PPV, NPV, and accuracy were 96.7%, 77.3%, 73.3%, 97.3%, and 84.9%, respectively, for ACR TI-RADS and 99.2%, 16.1%, 43.2%, 97.0%, and 48.7%, respectively, for ATA guidelines. AUC of ACR TI-RADS was significantly greater than ATA guidelines (0.935 (0.918, 0.949) vs 0.884 (0.862, 0.903), p < 0.001). Biopsy yield of malignancy, biopsy rate of malignancy, and unnecessary FNAB rate were 59.5%, 91.3%, and 40.5%, respectively, for ACR TI-RDS and 38.5%, 97.4%, and 61.5%, respectively, for ATA guidelines. CONCLUSIONS ACR TI-RADS was more accurate than ATA guidelines for differentiating malignant thyroid nodules from benign nodules and more reliable than ATA guidelines for recommending thyroid nodules for FNAB. KEY POINTS • Malignant risk of thyroid nodules can be stratified by ultrasound. • American College of Radiology guidelines were more accurate for differentiating malignant thyroid nodules from benign nodules. • American College of Radiology guidelines were more reliable for recommending thyroid nodules for biopsy.

    更新日期:2019-11-01
  • Noise reduction and motion elimination in low-dose 4D myocardial computed tomography perfusion (CTP): preliminary clinical evaluation of the ASTRA4D algorithm.
    Eur. Radiol. (IF 3.962) Pub Date : 2019-02-05
    Steffen Lukas,Sarah Feger,Matthias Rief,Elke Zimmermann,Marc Dewey

    OBJECTIVES To propose and evaluate a four-dimensional (4D) algorithm for joint motion elimination and spatiotemporal noise reduction in low-dose dynamic myocardial computed tomography perfusion (CTP). METHODS Thirty patients with suspected or confirmed coronary artery disease were prospectively included and underwent dynamic contrast-enhanced 320-row CTP. A novel deformable image registration method based on the principal component analysis (PCA) of the ante hoc temporally smoothed voxel-wise time-attenuation curves (ASTRA4D) is presented. Quantitative (standard deviation, signal-to-noise ratio (SNR), temporal variation, volumetric deformation) and qualitative (motion, contrast, contour sharpness [1, poor; 5, excellent]) measures of CTP quality were assessed for the original and motion-compensated sequences (without and with temporal filtering, PCA/ASTRA4D). Following myocardial perfusion deficit detection by two readers, diagnostic accuracy was evaluated using magnetic resonance myocardial perfusion imaging (MR-MPI) as the reference standard in 15 patients. RESULTS Registration using ASTRA4D was successful in all 30 patients and resulted in comparison with the benchmark PCA in significantly (p < 0.001) reduced noise over time (- 83%, 178.5 vs 29.9) and spatially (- 34%, 21.4 vs 14.1) as well as improved SNR (+ 47%, 3.6 vs 5.3) and subjective image quality (motion, contrast, contour sharpness [+ 1.0, + 1.0, + 0.5]). ASTRA4D had significantly improved per-segment sensitivity of 91% (58/64) and similar specificity of 96% (429/446) compared with PCA (52%, 33/64; 98%, 435/446; p = 0.011) in the visual detection of perfusion deficits. CONCLUSIONS The ASTRA4D registration algorithm improved the spatiotemporal noise profile and CTP sequence image quality, resulting in significantly improved sensitivity of 4D CTP in the detection of myocardial ischemia. KEY POINTS • ASTRA4D combines local temporal regression and deformable image registration. • Quantitative and qualitative measures of CTP quality are improved compared to PCA. • Improved spatiotemporal differentiation of ischemic regions leads to an excellent perfusion deficit concordance of ASTRA4D with MRI.

    更新日期:2019-11-01
  • Automated 3D segmentation and diameter measurement of the thoracic aorta on non-contrast enhanced CT.
    Eur. Radiol. (IF 3.962) Pub Date : 2019-01-24
    Zahra Sedghi Gamechi,Lidia R Bons,Marco Giordano,Daniel Bos,Ricardo P J Budde,Klaus F Kofoed,Jesper Holst Pedersen,Jolien W Roos-Hesselink,Marleen de Bruijne

    OBJECTIVES To develop and evaluate a fully automatic method to measure diameters of the ascending and descending aorta on non-ECG-gated, non-contrast computed tomography (CT) scans. MATERIAL AND METHODS The method combines multi-atlas registration to obtain seed points, aorta centerline extraction, and an optimal surface segmentation approach to extract the aorta surface around the centerline. From the extracted 3D aorta segmentation, the diameter of the ascending and descending aorta was calculated at cross-sectional slices perpendicular to the extracted centerline, at the level of the pulmonary artery bifurcation, and at 1-cm intervals up to 3 cm above and below this level. Agreement with manual annotations was evaluated by dice similarity coefficient (DSC) for segmentation overlap, mean surface distance (MSD), and intra-class correlation (ICC) of diameters on 100 CT scans from a lung cancer screening trial. Repeatability of the diameter measurements was evaluated on 617 baseline-one year follow-up CT scan pairs. RESULTS The agreement between manual and automatic segmentations was good with 0.95 ± 0.01 DSC and 0.56 ± 0.08 mm MSD. ICC between the diameters derived from manual and from automatic segmentations was 0.97, with the per-level ICC ranging from 0.87 to 0.94. An ICC of 0.98 for all measurements and per-level ICC ranging from 0.91 to 0.96 were obtained for repeatability. CONCLUSION This fully automatic method can assess diameters in the thoracic aorta reliably even in non-ECG-gated, non-contrast CT scans. This could be a promising tool to assess aorta dilatation in screening and in clinical practice. KEY POINTS • Fully automatic method to assess thoracic aorta diameters. • High agreement between fully automatic method and manual segmentations. • Method is suitable for non-ECG-gated CT and can therefore be used in screening.

    更新日期:2019-11-01
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