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Abdominal Radiology (New York) Jul 2024The broad range of disease aggressiveness together with imperfect screening, diagnostic, and treatment options in prostate cancer (PCa) makes medical decision-making...
The broad range of disease aggressiveness together with imperfect screening, diagnostic, and treatment options in prostate cancer (PCa) makes medical decision-making complex. The primary goal of a multidisciplinary conference is to improve patient outcomes by combining evidence-based data and expert opinion to discuss optimal management, including for those patients with challenging presentations. The primary purpose of the genitourinary imaging specialist in the prostate cancer multidisciplinary conference is to use imaging findings to reduce uncertainty by answering clinical questions. In this review, we discuss the role and the opportunities for an imaging specialist to add value in the care of men with prostate cancer discussed at multidisciplinary conferences.
PubMed: 38951230
DOI: 10.1007/s00261-024-04433-2 -
European Radiology Jul 2024To assess the performance of computed tomography (CT)/magnetic resonance imaging (MRI) Liver Imaging Reporting and Data System (LI-RADS) among patients with...
OBJECTIVE
To assess the performance of computed tomography (CT)/magnetic resonance imaging (MRI) Liver Imaging Reporting and Data System (LI-RADS) among patients with non-cirrhotic steatotic liver disease (SLD).
MATERIALS AND METHODS
This IRB-approved, retrospective study included 119 observations from 77 adult patients (36 women, 41 men; median 64 years) who underwent liver CT or MRI from 2010 to 2023. All patients had histopathologic evidence of SLD without cirrhosis. Three board-certified abdominal radiologists blinded to tissue diagnosis and imaging follow-up assessed observations with LI-RADS. The positive predictive value (PPV), sensitivity, specificity, accuracy, and inter-reader agreement were calculated.
RESULTS
Seventy-five observations (63%) were benign and 44 (37%) were malignant. PPV for hepatocellular carcinoma (HCC) was 0-0% for LR-1, 0-0% for LR-2, 0-7% for LR-3, 11-20% for LR-4, 75-88% for LR-5, 0-8% for LR-M, and 50-75% for LR-TIV. For LR-5 in identifying HCC, sensitivity was 79-83%, specificity was 91-97%, and accuracy was 89-92%. For composite categories of LR-5, LR-M, or LR-TIV in identifying malignancy, sensitivity was 86-89%, specificity was 85-96%, and accuracy was 86-93%. The most common false positives for LR-5 were hepatocellular adenomas. Only 59-65% of HCCs showed non-peripheral washout at CT versus 67-83% at MRI, though nearly all had an enhancing capsule. PPV and accuracy of LR-5 for HCC did not differ by modality. Inter-reader agreement for major features ranged from 0.667 to 0.830 and was 0.766 for the final category.
CONCLUSION
Despite challenges such as the lower prevalence of non-peripheral washout at CT and overlapping imaging features between HCC and hepatocellular adenomas, LI-RADS may serve as an effective tool in assessing focal liver lesions in SLD.
CLINICAL RELEVANCE STATEMENT
LI-RADS in non-cirrhotic steatotic liver disease can effectively diagnose hepatocellular carcinoma and malignancy at computed tomography and magnetic resonance imaging, thereby guiding clinical management decisions and expediting patient care pathways.
KEY POINTS
Performance of LI-RADS is unknown in non-cirrhotic patients with steatotic liver disease. LI-RADS 5 category showed a high pooled specificity of 91-97% for hepatocellular carcinoma. LI-RADS can non-invasively risk stratify focal liver observations in non-cirrhotic patients with steatotic liver disease.
PubMed: 38951191
DOI: 10.1007/s00330-024-10846-w -
IEEE Transactions on Medical Imaging Jul 2024Radiology report generation (RRG) is crucial to save the valuable time of radiologists in drafting the report, therefore increasing their work efficiency. Compared to...
Radiology report generation (RRG) is crucial to save the valuable time of radiologists in drafting the report, therefore increasing their work efficiency. Compared to typical methods that directly transfer image captioning technologies to RRG, our approach incorporates organ-wise priors into the report generation. Specifically, in this paper, we propose Organ-aware Diagnosis (OaD) to generate diagnostic reports containing descriptions of each physiological organ. During training, we first develop a task distillation (TD) module to extract organ-level descriptions from reports. We then introduce an organ-aware report generation module that, for one thing, provides a specific description for each organ, and for another, simulates clinical situations to provide short descriptions for normal cases. Furthermore, we design an auto-balance mask loss to ensure balanced training for normal/abnormal descriptions and various organs simultaneously. Being intuitively reasonable and practically simple, our OaD outperforms SOTA alternatives by large margins on commonly used IU-Xray and MIMIC-CXR datasets, as evidenced by a 3.4% BLEU-1 improvement on MIMIC-CXR and 2.0% BLEU-2 improvement on IU-Xray.
PubMed: 38949933
DOI: 10.1109/TMI.2024.3421599 -
JAMA Oncology Jul 2024Prostate-specific membrane antigen (PSMA) demonstrates overexpression in prostate cancer and correlates with tumor aggressiveness. PSMA positron emission tomography...
IMPORTANCE
Prostate-specific membrane antigen (PSMA) demonstrates overexpression in prostate cancer and correlates with tumor aggressiveness. PSMA positron emission tomography (PET) is superior to conventional imaging for the metastatic staging of prostate cancer per current research but studies of second-generation PSMA PET radioligands for locoregional staging are limited.
OBJECTIVE
To determine the accuracy of fluorine-18 PSMA-1007 PET/computed tomography (18F-PSMA-1007 PET/CT) compared to multiparametric magnetic resonance imaging (MRI) in the primary locoregional staging of intermediate-risk and high-risk prostate cancers.
DESIGN, SETTING, AND PARTICIPANTS
The Next Generation Trial was a phase 2 prospective validating paired cohort study assessing the accuracy of 18F-PSMA-1007 PET/CT and MRI for locoregional staging of prostate cancer, with results of histopathologic examination as the reference standard comparator. Radiologists, nuclear medicine physicians, and pathologists were blinded to preoperative clinical, pathology, and imaging data. Patients underwent all imaging studies and radical prostatectomies at 2 tertiary care hospitals in Alberta, Canada. Eligible participants included men with intermediate-risk or high-risk prostate cancer who consented to radical prostatectomy. Participants who underwent radical prostatectomy were included in the final analysis. Patients were recruited between March 2022 and June 2023, and data analysis occurred between July 2023 and December 2023.
EXPOSURES
All participants underwent both 18F-PSMA-1007 PET/CT and MRI within 2 weeks of one another and before radical prostatectomy.
MAIN OUTCOMES AND MEASURES
The primary outcome was the correct identification of the prostate cancer tumor stage by each imaging test. The secondary outcomes were correct identification of the dominant nodule, laterality, extracapsular extension, and seminal vesical invasion.
RESULTS
Of 150 eligible men with prostate cancer, 134 patients ultimately underwent radical prostatectomy (mean [SD] age at prostatectomy, 62.0 [5.7] years). PSMA PET was superior to MRI for the accurate identification of the final pathological tumor stage (61 [45%] vs 38 [28%]; P = .003). PSMA PET was also superior to MRI for the correct identification of the dominant nodule (126 [94%] vs 112 [83%]; P = .01), laterality (86 [64%] vs 60 [44%]; P = .001), and extracapsular extension (100 [75%] vs 84 [63%]; P = .01), but not for seminal vesicle invasion (122 [91%] vs 115 [85%]; P = .07).
CONCLUSIONS AND RELEVANCE
In this phase 2 prospective validating paired cohort study, 18F-PSMA-1007 PET/CT was superior to MRI for the locoregional staging of prostate cancer. These findings support PSMA PET in the preoperative workflow of intermediate-risk and high-risk tumors.
PubMed: 38949926
DOI: 10.1001/jamaoncol.2024.3196 -
Radiologie (Heidelberg, Germany) Jun 2024Interstitial lung abnormalities (ILA) are incidental findings on computed tomography (CT), particularly in elderly patients and smokers. They describe mild interstitial... (Review)
Review
Interstitial lung abnormalities (ILA) are incidental findings on computed tomography (CT), particularly in elderly patients and smokers. They describe mild interstitial abnormalities that can be progressive and turn into overt interstitial lung disease (ILD). In recent years, ILA have increasingly come into focus because several large cohort studies have shown poorer clinical outcomes and increased mortality for patients with ILA compared to those without ILA. The radiological classification into nonsubpleural, subpleural nonfibrotic and subpleural fibrotic as well as the assessment over time can-together with clinical risk factors-help estimate clinical outcome. Clinical management of patients with ILA includes exclusion of ILD and risk-adapted control intervals, especially in the presence of risk factors.
PubMed: 38949668
DOI: 10.1007/s00117-024-01336-7 -
Journal of Magnetic Resonance Imaging :... Jul 2024Myocardial T1-rho (T1ρ) mapping is a promising method for identifying and quantifying myocardial injuries without contrast agents, but its clinical use is hindered by...
BACKGROUND
Myocardial T1-rho (T1ρ) mapping is a promising method for identifying and quantifying myocardial injuries without contrast agents, but its clinical use is hindered by the lack of dedicated analysis tools.
PURPOSE
To explore the feasibility of clinically integrated artificial intelligence-driven analysis for efficient and automated myocardial T1ρ mapping.
STUDY TYPE
Retrospective.
POPULATION
Five hundred seventy-three patients divided into a training (N = 500) and a test set (N = 73) including ischemic and nonischemic cases.
FIELD STRENGTH/SEQUENCE
Single-shot bSSFP T1ρ mapping sequence at 1.5 T.
ASSESSMENT
The automated process included: left ventricular (LV) wall segmentation, right ventricular insertion point detection and creation of a 16-segment model for segmental T1ρ value analysis. Two radiologists (20 and 7 years of MRI experience) provided ground truth annotations. Interobserver variability and segmentation quality were assessed using the Dice coefficient with manual segmentation as reference standard. Global and segmental T1ρ values were compared. Processing times were measured.
STATISTICAL TESTS
Intraclass correlation coefficients (ICCs) and Bland-Altman analysis (bias ±2SD); Paired Student's t-tests and one-way ANOVA. A P value <0.05 was considered significant.
RESULTS
The automated approach significantly reduced processing time (3 seconds vs. 1 minute 51 seconds ± 22 seconds). In the test set, automated LV wall segmentation closely matched manual results (Dice 81.9% ± 9.0) and closely aligned with interobserver segmentation (Dice 82.2% ± 6.5). Excellent ICCs were achieved on a patient basis (0.94 [95% CI: 0.91 to 0.96]) with bias of -0.93 cm ± 6.60. There was no significant difference in global T1ρ values between manual (54.9 msec ± 4.6; 95% CI: 53.8 to 56.0 msec, range: 46.6-70.9 msec) and automated processing (55.4 msec ± 5.1; 95% CI: 54.2 to 56.6 msec; range: 46.4-75.1 msec; P = 0.099). The pipeline demonstrated a high level of agreement with manual-derived T1ρ values at the patient level (ICC = 0.85; bias +0.52 msec ± 5.18). No significant differences in myocardial T1ρ values were found between methods across the 16 segments (P = 0.75).
DATA CONCLUSION
Automated myocardial T1ρ mapping shows promise for the rapid and noninvasive assessment of heart disease.
EVIDENCE LEVEL
3 TECHNICAL EFFICACY: Stage 1.
PubMed: 38949101
DOI: 10.1002/jmri.29502 -
ANZ Journal of Surgery Jul 2024Invasive lobular carcinoma (ILC) is challenging to stage accurately using mammography (MG) and ultrasound (US) with undiagnosed ipsilateral and contralateral cancer...
BACKGROUND
Invasive lobular carcinoma (ILC) is challenging to stage accurately using mammography (MG) and ultrasound (US) with undiagnosed ipsilateral and contralateral cancer resulting in poor patient outcomes including return to surgery. Our institution employs routine staging breast MRI in ILC for this reason. However, increased time for further imaging/biopsies contributes to patient anxiety and potentially delays definite management. We aimed to quantify the frequency of staging MRI-detected additional lesions requiring biopsy or follow-up, the added cancer detection rate and MRI prompted change in surgical management.
METHODS
An observational study on staging breast MRI for newly diagnosed ILC at a tertiary Western Australian hospital from January 2019 to August 2022. Standardized 3T MRI protocol was performed, double read by unblinded fellowship-trained radiologists. Histopathology from biopsy, surgery, or first annual surveillance was the reference standard for additional MRI-detected lesions.
RESULTS
One hundred ten MRI studies demonstrated 49 (45%) patients had at least one additional clinically significant MRI-detected lesion. Thirty-one patients had an additional ipsilateral lesion detected, of which 18 (58%) proved malignant; 14 (45%) multifocal and 4 (13%) multicentric ILC. Additional work-up of MRI-detected lesions averaged a 9-day delay to definitive surgery compared to patients with a negative or definitively benign MRI. MRI changed surgical planning in 11 of 110 cases from breast conservation surgery (BCS) to mastectomy and there were two contralateral cancers diagnosed. BCS reoperation rate was 11%.
CONCLUSION
Staging MRI for ILC identifies clinically significant lesions in nearly half of patients, predominantly ipsilateral multifocal disease, without significant delay to definitive surgery.
PubMed: 38949091
DOI: 10.1111/ans.19140 -
Frontiers in Endocrinology 2024Chest computed tomography (CT) is used to determine the severity of COVID-19 pneumonia, and pneumonia is associated with hyponatremia. This study aims to explore the...
PURPOSE
Chest computed tomography (CT) is used to determine the severity of COVID-19 pneumonia, and pneumonia is associated with hyponatremia. This study aims to explore the predictive value of the semi-quantitative CT visual score for hyponatremia in patients with COVID-19 to provide a reference for clinical practice.
METHODS
In this cross-sectional study, 343 patients with RT-PCR confirmed COVID-19, all patients underwent CT, and the severity of lung lesions was scored by radiologists using the semi-quantitative CT visual score. The risk factors of hyponatremia in COVID-19 patients were analyzed and combined with laboratory tests. The thyroid function changes caused by SARS-CoV-2 infection and their interaction with hyponatremia were also analyzed.
RESULTS
In patients with SARS-CoV-2 infection, the total severity score (TSS) of hyponatremia was higher [M(range), 3.5(2.5-5.5) vs 3.0(2.0-4.5) scores, =0.001], implying that patients with hyponatremia had more severe lung lesions. The risk factors of hyponatremia in the multivariate regression model included age, vomiting, neutrophils, platelet, and total severity score. SARS-CoV-2 infection impacted thyroid function, and patients with hyponatremia showed a lower free triiodothyronine (3.1 ± 0.9 vs 3.7 ± 0.9, =0.001) and thyroid stimulating hormone level [1.4(0.8-2.4) vs 2.2(1.2-3.4), =0.038].
CONCLUSION
Semi-quantitative CT score can be used as a risk factor for hyponatremia in patients with COVID-19. There is a weak positive correlation between serum sodium and free triiodothyronine in patients with SARS-CoV-2 infection.
Topics: Humans; COVID-19; Hyponatremia; Cross-Sectional Studies; Male; Female; Middle Aged; Risk Factors; Tomography, X-Ray Computed; Aged; SARS-CoV-2; Severity of Illness Index; Adult; Pneumonia, Viral; Coronavirus Infections; Pandemics; Betacoronavirus; Aged, 80 and over
PubMed: 38948513
DOI: 10.3389/fendo.2024.1342204 -
Imaging Science in Dentistry Jun 2024Ameloblastic fibrodentinoma (AFD) is a rare benign odontogenic tumor that resembles an ameloblastic fibroma with dysplastic dentin. This report presents a rare case of...
Ameloblastic fibrodentinoma (AFD) is a rare benign odontogenic tumor that resembles an ameloblastic fibroma with dysplastic dentin. This report presents a rare case of mandibular AFD with imaging features in a young patient. Panoramic radiography and computed tomography revealed a well-defined lesion with internal septa and calcified foci, causing inferior displacement of the adjacent molars as well as buccolingual cortical thinning and expansion of the posterior mandible. The lesion was surgically removed via mass excision, and the involved tooth was extracted under general anesthesia. During the 5-year follow-up period, no evidence of recurrence was observed. Radiologic features of AFD typically reveal a moderately to well-defined mixed lesion with varying degrees of radiopacity, reflecting the extent of dentin formation. Radiologists should consider AFD in the differential diagnosis when encountering a multilocular lesion with little dense radiopacity, particularly if it is associated with delayed eruption, impaction, or absence of involved teeth, on radiographic images of young patients.
PubMed: 38948190
DOI: 10.5624/isd.20230247 -
Imaging Science in Dentistry Jun 2024The aim of this study was to explore the correlations of cone-beam computed tomographic findings with the apnea-hypopnea index in patients with obstructive sleep apnea.
PURPOSE
The aim of this study was to explore the correlations of cone-beam computed tomographic findings with the apnea-hypopnea index in patients with obstructive sleep apnea.
MATERIALS AND METHODS
Forty patients with obstructive sleep apnea were selected from the ear-nose-throat (ENT) outpatient clinic, Faculty of Medicine, Mansoura University. Cone-beam computed tomography was performed for each patient at the end of both inspiration and expiration. Polysomnography was carried out, and the apnea-hypopnea index was obtained. Linear measurements, including cross-sectional area and the SNA and SNB angles, were obtained. Four oral and maxillofacial radiologists categorized pharyngeal and retropalatal airway morphology and calculated the airway length and volume. Continuous data were tested for normality using the Kolmogorov-Smirnov test and reported as the mean and standard deviation or as the median and range. Categorical data were presented as numbers and percentages, and the significance level was set at <0.05.
RESULTS
The minimal value of the cross-sectional area, SNB angle, and airway morphology at the end of inspiration demonstrated a statistically significant association (<0.05) with the apnea-hypopnea index, with excellent agreement. No statistically significant difference was found in the airway volume, other linear measurements, or retropalatal airway morphology.
CONCLUSION
Cone-beam computed tomographic measurements in obstructive sleep apnea patients may be used as a supplement to a novel radiographic classification corresponding to the established clinical apnea-hypopnea index classification.
PubMed: 38948186
DOI: 10.5624/isd.20230249