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Sage Journals: Table of Contents Table of Contents for Acta Radiologica. List of articles from ahead of print issues.

  • Acute pancreatitis and computed tomography: Interest of portal venous phase alone in the initial phase
    by Wilfried Ansel-Wallois on 14. juni 2024 at 8:28

    Acta Radiologica, Ahead of Print. <br/>BackgroundThere are no guidelines in the literature for the use of a computed tomography (CT) protocol in the initial phase of acute pancreatitis (AP).PurposeTo evaluate the contribution of single portal venous phase CT compared to triple-phase CT protocol, performed in the initial phase of AP for severity assessment.Material and MethodsIn this retrospective study, a total of 175 patients with acute pancreatitis who underwent initial triple-phase CT protocol (non-contrast, arterial phase, and portal venous phase) between D3 and D7 after the onset of symptoms were included. Analysis of AP severity and complications was independently assessed by two readers using three validated CT severity scores (CTSI, mCTSI, EPIC). All scores were applied to the triple-phase CT protocol and compared to the single portal venous phase. Inter-observer analyses were also performed.ResultsNo significant difference whatever the severity score was observed after analysis of the single portal venous phase compared with the triple-phase CT protocol (interstitial edematous pancreatitis: CTSI: 2 vs. 2, mCTSI: 2 vs. 2, EPIC: 1 vs. 1; necrotizing pancreatitis: CTSI: 6 vs. 6, mCTSI: 8 vs. 8, EPIC: 5 vs. 5). Inter-observer agreement was excellent (ICC = 0.96–0.99), whatever the severity score.ConclusionA triple-phase CT protocol performed at the initial phase of AP was no better than a single portal venous for assessing the severity of complications and could lead to a 63% reduction in irradiation.

  • Artificial intelligence iterative reconstruction in abdominal CT of patients with irregular arm positioning: a case-by-case evaluation
    by Jin Li on 14. juni 2024 at 8:27

    Acta Radiologica, Ahead of Print. <br/>BackgroundStreak artifacts induced by irregular arm positioning have been an issue in diagnosing the abdomen.PurposeTo illustrate the risk of misdiagnosis in abdominal computed tomography (CT) of patients with irregular arm positioning through a case-by-case evaluation and to test if it can be solved by the artificial intelligence iterative reconstruction (AIIR) algorithm.Material and MethodsBy reviewing 5220 cases of chest and thoracoabdominal CT, 64 patients with irregular arm positioning were enrolled, whose image data were reconstructed using AIIR in addition to routine hybrid iterative reconstruction (HIR). Lesion detection for livers, spleens, kidneys, gallbladders, and pancreas on AIIR images, performed by two radiologists, was compared with those on HIR images. Discrepancies arising from AIIR images included both cases with additional abnormalities and those with corrections made on previous detections. For cases with discrepancies, artifact scores for organs where discrepancies were found, and contrast-to-noise ratios (CNRs) of cysts with discrepancies were compared between two image sets.ResultsAdditional abnormalities were detected for 15 cases: additional liver cirrhosis (n=2); additional gallbladder stone (n=1); additional cholecystitis (n=1), additional spleen nodule (n=1); additional kidney cysts (n=8); additional liver cysts (3); and additional spleen cyst (n=1). A spleen contusion was corrected for one case. All involved artifact scores were improved on AIIR images. CNRs of involved liver, kidney, and spleen cysts were improved by up to 539.7%, 538.5%, and 245.5%, respectively.ConclusionIrregular arm positioning may induce a variety of misdiagnoses in abdominal CT, which is almost totally avoidable by the AIIR algorithm.

  • Silicone implant and fibrous capsule assessment based on water-fat-silicone chemical shift encoding-based species separation in breast MRI
    by Tabea Borde on 14. juni 2024 at 6:38

    Acta Radiologica, Ahead of Print. <br/>BackgroundWith rising breast augmentations worldwide, there is an increasing clinical need for an early and accurate detection of implant complications.PurposeTo compare the quality of chemical shift encoding-based (CSE) water-fat-silicone separation compared to double inversion recovery (DIR) silicone-only imaging in breast magnetic resonance imaging (MRI).Material and MethodsThis retrospective, single-center study included women with silicone implants subjected to 3-T MRI between January 2021 and March 2022. MRI included (i) two-dimensional silicone-only T2-weighted turbo spin echo DIR acquisition and (ii) three-dimensional CSE imaging based on multi-echo gradient-echo sequence enabling water-, fat-, and silicone-image separation. Images were evaluated and compared by three independent radiologists using a clinically established rating including differentiability of the silicone implant, visibility and contouring of the adjacent fibrous capsule, and accuracy of intralesional folds in a ranking of 1–5. The apparent contrast-to-noise (aCNR) was calculated.ResultsIn 71 women, the average quality of water-fat-silicone images from CSE imaging was assessed as “good” (assessment 4 ± 0.9). In 68 (96%) patients, CSE imaging achieved a concise delineation of the silicone implant and precise visualization of the fibrous capsule that was not distinguishable in DIR imaging. Implant ruptures were more easily detected in CSE imaging. The aCNR was higher in CSE compared to DIR imaging (18.43 ± 9.8 vs. 14.73 ± 2.5; P = 0.002).ConclusionIntrinsically co-registered water-fat-silicone-separated CSE-based images enable a reliable assessment of silicone implants. The simultaneously improved differentiability of the implant and fibrous capsule may provide clinicians with a valuable tool for an accurate evaluation of implant integrity and early detection of potential complications.

  • Role of neuroimaging markers on predicting of idiopathic intracranial hypertension
    by Ayşe Özlem Balık on 13. juni 2024 at 6:22

    Acta Radiologica, Ahead of Print. <br/>BackgroundThe goals of neuroimaging in idiopathic intracranial hypertension (IIH) are the exclusion of mimickers and effective management of disease. In recent studies, several imaging markers have been identified as potential predictors of IIH.PurposeTo investigate the predictive roles of novel radiological markers as the Meckel's cave area, alongside classical radiologic markers in identifying IIH such as the empty sella.Material and MethodsThe patients were classified according to cerebrospinal fluid (CSF) opening pressure as the IIH group and control group. The observational, case-control study included 22 patients with IIH and 22 controls. Groups were compared for presence of empty sella, Meckel's cave area, fat area of posterior neck, fat thickness of scalp, presence of transverse sinus stenosis, and ophthalmic markers, such as increase of optic nerve (ON) sheath diameter.ResultsIn the IHH group, higher occurrences of increased ON sheath diameter, ON tortuosity, flattening of the scleral surface, and transverse sinus stenosis were observed (P < 0.001, P < 0.001, P = 0.046, and P = 0.021, respectively). Meckel's cave area and fat area of posterior neck were similar in both groups (P = 0.444 and P = 0.794).ConclusionOphthalmic markers and transverse sinus stenosis could be utilized as radiologic features supporting early and precise diagnosis of IIH. However, enlargement of Meckel's cave area and measurements of fatty area of posterior neck are not helpful for diagnosis of IIH.

  • The value of synthetic MRI for quantitative analysis in the diagnosis of cervical lymph node metastasis in thyroid cancer
    by Mei Wei on 13. juni 2024 at 6:22

    Acta Radiologica, Ahead of Print. <br/>BackgroundPreoperative effective assessment of cervical lymph node metastasis in thyroid cancer plays an important role in formulating the surgical plan.PurposeTo investigate the significance of synthetic magnetic resonance imaging (MRI) for quantitatively analyzing cervical lymph node metastasis in thyroid cancer.Material and MethodsA retrospective analysis was conducted on 30 patients with thyroid cancer, consisting of 19 thyroid cancer nodules, 45 metastatic lymph nodes, and 47 non-metastatic lymph nodes. Regions of interest (ROIs) for each type of nodule were manually delineated using a workstation. Quantitative parameters, such as T1, T2, and proton density (PD) values, were automatically extracted from synthetic MRI scans. Statistical tests and regression analysis were performed to assess differences and correlations among the quantitative parameters.ResultsThere were no significant differences in the quantitative parameter values between the primary tumor and metastatic lymph node tissues (P > 0.05). However, significant differences were observed in the quantitative parameters between the primary tumor and non-metastatic lymph node tissues and between the metastatic and non-metastatic lymph node tissues (P < 0.05). The diagnostic accuracy for cervical lymph node metastasis in thyroid cancer was 94.4% for the T1 and T2 combined index, 91.9% for T2, 86.8% for T1, and 71.7% for PD values.ConclusionThe application of quantitative parameters from synthetic MRI can assist clinicians in accurately planning surgical interventions for thyroid cancer patients before surgery.

  • Clinical value of contrast-enhanced ultrasound versus conventional ultrasound in biopsy of focal liver lesions
    by Cheng Lou on 10. juni 2024 at 12:27

    Acta Radiologica, Ahead of Print. <br/>BackgroundFocal liver lesions (FLLs) are a common form of liver disease, and identifying accurate pathological types is required to guide treatment and evaluate prognosis.PurposeTo compare and analyze the application effect of contrast-enhanced ultrasound (CEUS) and conventional ultrasound (US) in the clinical diagnosis of focal liver lesions.Material and MethodsA retrospective analysis was performed on 682 patients with space-occupying liver lesions admitted to our hospital between December 2015 and August 2021. Of these, 280 underwent CEUS-guided biopsies and 402 underwent conventional US biopsies, with the results of each biopsy subsequently compared between the two groups. The success rate and accuracy of the biopsies and their relationship with different pathological features were also analyzed.ResultsThe success rate, sensitivity, diagnostic accuracy, positive predictive value, and negative predictive value of the CEUS group were significantly higher than those of the US group (P < 0.05). Lesion size accuracy in the CEUS group was significantly higher than that in the US group (89.29% vs. 40.55%; P < 0.05). Lesion type accuracy in the CEUS group was significantly higher than that in the US group (86.49% vs. 43.59%), and the difference between the two groups was statistically significant (P < 0.05). The logistic regression analysis indicated that malignant lesions, lesions ≥5 cm, and lesions ≤1 cm were independent factors affecting the success rate of the puncture procedure (P < 0.05).ConclusionThe sensitivity, specificity, and diagnostic accuracy of lesion size and type in the CEUS group were higher than those in the US group.

  • Improving intracranial aneurysms image quality and diagnostic confidence with deep learning reconstruction in craniocervical CT angiography
    by Kun Bai on 6. juni 2024 at 12:38

    Acta Radiologica, Ahead of Print. <br/>BackgroundThe diagnostic impact of deep learning computed tomography (CT) reconstruction on intracranial aneurysm (IA) remains unclear.PurposeTo quantify the image quality and diagnostic confidence on IA in craniocervical CT angiography (CTA) reconstructed with DEep Learning Trained Algorithm (DELTA) compared to the routine hybrid iterative reconstruction (HIR).Material and MethodsA total of 60 patients who underwent craniocervical CTA and were diagnosed with IA were retrospectively enrolled. Images were reconstructed with DELTA and HIR, where the image quality was first compared in noise, signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR). Next, two radiologists independently graded the noise appearance, arterial sharpness, small vessel visibility, conspicuity of calcifications that may present in arteries, and overall image quality, each with a 5-point Likert scale. The diagnostic confidence on IAs of various sizes was also graded.ResultsSignificantly lower noise and higher SNR and CNR were found on DELTA than on HIR images (all P < 0.05). All five subjective metrics were scored higher by both readers on the DELTA images (all P < 0.05), with good to excellent inter-observer agreement (κ = 0.77–0.93). DELTA images were rated with higher diagnostic confidence on IAs compared to HIR (P < 0.001), particularly for those with size ≤3 mm, which were scored 4.5 ± 0.6 versus 3.4 ± 0.8 and 4.4 ± 0.7 versus 3.5 ± 0.8 by two readers, respectively.ConclusionThe DELTA shows potential for improving the image quality and the associated confidence in diagnosing IA that may be worth consideration for routine craniocervical CTA applications.

  • Meta-analysis of clinical and safety profiles after reperfusion therapy in acute posterior circulation strokes: insights and implications
    by Ashek Chowdhury on 6. juni 2024 at 12:38

    Acta Radiologica, Ahead of Print. <br/>BackgroundPosterior circulation stroke (PCS) accounts for approximately 20% of all acute ischemic strokes. The optimal reperfusion therapy for PCS management remains uncertain.PurposeTo evaluate the prevalence and outcomes of intravenous thrombolysis (IVT), endovascular thrombectomy (EVT), and bridging therapy in PCS patients.Material and MethodsWe conducted a meta-analysis of 19 studies examining reperfusion therapy outcomes in PCS patients, including 9765 individuals. We pooled prevalence data and assessed associations between reperfusion therapies and clinical, safety, and recanalization outcomes using random-effects models.ResultsThe pooled prevalence of reperfusion therapies post-acute PCS was 39% for IVT, 54% for EVT, and 48% for bridging therapy. EVT was associated with significantly higher odds of favorable functional outcomes (modified Rankin Score [mRS] 0–3) at 90 days compared to standard medical therapy (odds ratio [OR] = 5.68; 95% confidence interval [CI]=2.07–15.59; P = 0.001). Conversely, bridging therapy was linked to reduced odds of favorable functional outcomes at 90 days compared to EVT (OR = 0.35; 95% CI=0.26–0.47; P < 0.001). Bridging therapy was also significantly associated with lower odds of good functional outcomes (mRS 0–2) (OR = 0.25; 95% CI=0.11–0.54; P < 0.001), reduced risk of symptomatic intracranial hemorrhage (OR = 0.26; 95% CI=0.07–0.68; P = 0.009), lower mortality (OR = 0.13; 95% CI=0.04–0.44; P = 0.001), and less successful recanalization (OR = 0.35; 95% CI=0.13–0.94; P = 0.038) relative to EVT.ConclusionOur meta-analysis underscores the favorable outcomes associated with EVT in PCS cases. With notable reperfusion rates, understanding factors influencing PCS outcomes can inform patient selection and prognostic considerations.

  • CT angiography of the lower limbs: combining small field of view with large matrix size and iterative reconstruction further improves image quality of below-the-knee arteries
    by Michael Scheschenja on 6. juni 2024 at 8:07

    Acta Radiologica, Ahead of Print. <br/>BackgroundImage quality and diagnostic accuracy in computed tomography angiography (CTA) reach their limits in imaging of below-the-knee vessels.PurposeTo evaluate whether image quality in CTA of lower limbs is further improvable by combining side-separate reconstruction with a larger matrix size and whether resulting noise can be compromised with iterative reconstruction (IR).Material and MethodsFrom CTA of the lower extremities of 26 patients (5 women, 21 men; mean age = 68.5 ± 10.3 years), the lower legs were reconstructed side-separately with different reconstruction algorithms and matrix sizes including filtered back projection (FBP) with a 512 × 512 matrix, FBP with a 1024 × 1024 matrix, IR (SAFIRE) with a 512 × 512 matrix, and IR (SAFIRE) with a 1024 × 1024 matrix. A total of 208 CT series were evaluated. Subjective image quality was assessed by two readers using a 5-point Likert scale. Image noise was assessed by measuring signal-to-noise and contrast-to-noise ratios.ResultsSubjective image quality was rated significantly higher when using a 1024 × 1024 matrix (P < 0.001) and could further be increased with IR. Vessel sharpness was rated significantly better with a larger matrix (P < 0.001). Visible and measured image noise was significantly higher with a 1024 × 1024 matrix but could be reduced by using IR (P < 0.001), even to a level below FBP with a 512 × 512 matrix while reconstructing with a larger matrix (P < 0.001).ConclusionImage quality, image noise, and vessel sharpness can be further improved in CTA of the lower extremities with side-separate reconstruction using a 1024 × 1024 matrix size and IR.

  • Augmentation of perivascular space visualization in basal ganglia and white matter hyperintensity lesion is a meaningful finding for subsequent cognitive decline
    by Yasuhiro Sugai on 6. juni 2024 at 8:04

    Acta Radiologica, Ahead of Print. <br/>BackgroundCerebral small vessel disease (CSVD) causes cognitive decline and perivascular space enlargement is one of the image markers for CSVD.PurposeTo search for clinical significance in the time-course augmentation of perivascular space in basal ganglia (BG-PVS) for cognitive decline.Material and MethodsThis study population included 179 participants from a community-based cohort, aged 70 years at baseline. They had undergone magnetic resonance imaging (MRI) studies two or three times between 2000 and 2008. Based on the severity of BG-PVS or white matter hyperintensity lesions (WMHL) in 2000, the participants were divided into low-grade or high-grade groups, respectively. In addition, their time-course augmentation was evaluated, and we created a categorical BG-PVS WMHL change score based on their augmentation (1 = neither, 2 = BG-PVS augmentation only, 3 = WMHL augmentation only, 4 = both). Cognitive function was assessed based on the Mini-Mental State Examination (MMSE); the change was defined as the difference between scores in 2000 and 2008. We used simple or multiple regression analysis for MMSE score change according to MRI findings and clinical characteristics that were probably related to cognitive decline.ResultsIn univariate analysis, MMSE score change was negatively associated with BG-PVS high grade at baseline and BG-PVS WMHL change score 4; this remained significant in multivariate analysis. In the final model based on the Akaike Information Criterion, BG-PVS WMHL change score 4 was associated with a 3.3-point decline in subsequent MMSE score.ConclusionsThis study suggested that augmentation in both BG-PVS and WMHL was associated with subsequent cognitive decline.