BackgroundPercutaneous transhepatic cholangiography (PTC) is essential when endoscopic retrograde cholangiopancreatography (ERCP) fails or is contraindicated. Despite emerging evidence favoring primary stenting, data directly comparing it with the traditional two-staged drainage approach remain scarce.PurposeTo evaluate the efficacy, complication rates, and reintervention burden of initial stent placement versus drainage.Material and MethodsA retrospective single-center analysis of 96 patients undergoing PTC (2021-2024) was conducted; 95 received intervention (primary stent n = 30, drain n = 65). Outcomes (bilirubin kinetics, clinical success, complications, reinterventions) were compared using Welch's t-test, chi-square test, or Fisher's exact test, with multivariable adjustment for baseline differences.ResultsMalignant obstruction accounted for 96.8% of cases; technical success was 97.9% (CIRSE standards). Bilirubin reduction was greater with stents (45.7% vs. 35.5%; mean difference 10.2 percentage points, 95% confidence interval = 0.3-20.0; P = 0.043), attenuated after adjustment (β = 9.8 pp; P = 0.093). Complications, all reinterventions, and combined adverse events were lower with stents (23.3% vs. 55.4%, 16.7% vs. 73.8%, and 30.0% vs. 86.2%; all P ≤0.004); adjusted analyses confirmed independently reduced odds (adjusted odds ratio = 0.26, 0.08, and 0.07, respectively). Clinical success trended higher with stents (46.7% vs. 38.5%) but was not statistically significant. Overall, 30-day mortality was 17.7% with 2% procedure-related. Median post-intervention survival was 101 days.ConclusionIn this retrospective single-center cohort, a stent-first approach was associated with greater bilirubin reduction and fewer complications and reinterventions than drainage-first, without compromising technical success or survival. Findings are hypothesis-generating and require prospective multicenter validation.
BackgroundPure ground-glass nodules (pGGNs) are increasingly detected on chest CT. Although most exhibit indolent behavior, a subset may harbor invasive features before obvious radiological progression, making early risk stratification clinically important.PurposeTo develop and externally validate a CT-based deep learning model with domain adaptation for cross-center risk stratification of pGGNs.Material and MethodsThis retrospective multicenter study included 1235 surgically confirmed pGGNs from two institutions. A deep learning model incorporating domain style-aware correction was developed to differentiate AAH/AIS-like lesions from MIA/IAC-like lesions using preoperative CT images. Data from one center were used for training and internal validation, and an independent external cohort was used for validation. Model performance was evaluated using AUC, accuracy, calibration, and decision curve analysis.ResultsThe model achieved an AUC of 0.93 and an accuracy of 90.4% in the internal validation set. In the external validation set, the AUC was 0.88 with an accuracy of 81.7%, demonstrating good cross-center generalization. Domain adaptation improved external AUC from 0.85 to 0.88. Calibration analysis showed good agreement between predicted and observed probabilities. Decision curve analysis indicated higher net benefit compared with treat-all and treat-none strategies across a range of thresholds.ConclusionThe proposed model demonstrates robust performance across centers and may serve as a noninvasive tool to support individualized surveillance strategies for patients with pGGNs.
BackgroundThe utility of saline flush in portal venous phase (PVP) contrast-enhanced computed tomography (CECT) for the liver remains controversial.PurposeTo investigate the effect of saline flush after contrast injection on liver and portal venous system enhancement in PVP CECT.Material and MethodsThe saline flush group prospectively included 97 consecutive patients (52 women; median age = 68 years) who underwent PVP CECT with saline flush. The control group retrospectively comprised 105 patients (63 women; median age = 65 years) who underwent PVP CECT without saline flush. Scanning protocols, including contrast injection protocol and scan timing (65 s), were standardized. In the saline flush group, 20 mL of saline, determined through a phantom study, was injected after contrast injection. Two radiologists measured increased CT attenuations (ΔHUs) of the liver, portal vein (PV), superior mesenteric vein (SMV), and splenic vein (SV), and compared them between the two groups. The proportions of cases with liver ΔHU above and below 50 HU were also compared.ResultsΔHUs were higher for the liver (69.4 HU vs. 64.4 HU; P = 0.004), PV (184.6 HU vs. 171.9 HU; P = 0.001), SMV (179.0 HU vs. 171.0 HU; P = 0.002), and SV (185.1 HU vs. 163.6 HU; P < 0.001) in the saline flush group than in the control group. The proportion of cases with liver ΔHU below 50 HU was not different between the two groups (5.2% in the saline flush group vs. 7.6% in the control group; P = 0.57).ConclusionSaline flush may increase liver and portal venous system enhancement on PVP CECT.
BackgroundIntraductal papillary mucinous neoplasms (IPMNs) are the most common pancreatic cystic neoplasms and are increasingly detected incidentally. Although they carry malignant potential, most lesions follow an indolent course, creating a clinical challenge in balancing early cancer detection with the risks of overtreatment. Existing international guidelines differ in surveillance strategies, thresholds for intervention, and recommendations for discontinuation.PurposeTo present Danish multidisciplinary consensus recommendations for the evaluation, surveillance, and management of pancreatic intraductal papillary mucinous neoplasms.Material and MethodsThe Danish Pancreatic Cancer Group consensus was developed by a multidisciplinary working group comprising radiologists and pancreatic surgeons. Recommendations were based on a narrative review of the literature, existing international guidelines, and clinical experience within a centralized healthcare setting. Consensus was achieved through iterative discussions without a formal Delphi process.RecommendationsMagnetic resonance imaging with MR cholangiopancreatography (MRI/MRCP) is recommended as the primary modality for diagnosis and surveillance, with computed tomography and endoscopic ultrasound used selectively. Risk stratification is based on high-risk stigmata and worrisome features, with emphasis on interval changes during follow-up. Surveillance strategies are primarily size-based and individualized according to patient age, comorbidities, and surgical eligibility. Surgical evaluation is recommended for cysts larger than 30 mm and for main-duct or mixed-type IPMNs with high-risk features, while a more selective approach is applied to branch-duct IPMN. Discontinuation of surveillance is supported in selected patients with stable disease, particularly in older individuals.ConclusionThe Danish multidisciplinary consensus provides a pragmatic, risk-adapted approach to IPMN management, emphasizing individualized care, multidisciplinary decision-making, and avoidance of unnecessary investigations and surgical overtreatment.
Background Right gastroepiploic artery lesions are rare but may cause life-threatening hemorrhage. They include not only aneurysms but also non-aneurysmal arterial injuries with diverse etiologies. Purpose To evaluate the clinical spectrum, embolization strategies, and outcomes of transcatheter arterial embolization for right gastroepiploic artery aneurysms and injuries. Materials and Methods This retrospective single-center study included 29 patients with right gastroepiploic artery aneurysms or injuries treated with transcatheter arterial embolization between 2005 and 2025. Clinical presentation, etiology, lesion location, embolic materials, technical success, complications, recurrence, and surgical conversion were reviewed. Results Ruptured lesions were observed in 10 patients and unruptured lesions in 19. Lesion size did not differ significantly between ruptured and unruptured lesions [13 mm (range, 3–28 mm) vs 15 mm (range, 4–35 mm), p = .46]. Etiologies included idiopathic or presumed true aneurysm, iatrogenic injury, trauma, segmental arterial mediolysis, tumor invasion, pancreatic fistula, and vasculitis. Technical success was achieved in 27 patients (93%), and clinical success in 26 (90%). One patient developed a small access-site hematoma. No clinically evident organ ischemia or lesion-related 30-day mortality occurred. Two patients required surgical conversion. Conclusion Transcatheter arterial embolization was technically and clinically successful in most patients with right gastroepiploic artery aneurysms and injuries, with a low rate of procedure-related complications. Treatment strategy should be tailored according to etiology, segmental location, collateral perfusion, and catheter accessibility.
BackgroundTransvenous embolization is the standard treatment for cavernous sinus dural arteriovenous fistulas (CS DAVFs). In some patients with CS DAVFs, selective embolization is possible if the shunted pouches can be accurately identified, avoiding the risk of cranial nerve damage due to excess coil use.PurposeTo evaluate the utility of three-dimensional (3D)-printed models in enhancing the spatial understanding of shunted pouches and approach routes and facilitating selective embolization for CS DAVFs.Material and MethodsThe 3D-printed models of the CS of five patients with CS DAVFs treated between 2022 and 2024 were printed with fused deposition modeling 3D printers using 3D data from 3D digital subtraction angiography (3D-DSA). Shunted pouches were identified using high-resolution cone-beam computed tomography and four-dimensional DSA. Embolization procedures were planned based on the tactile and spatial understanding provided by 3D-DSA and 3D-printed models. Five patients treated between 2018 and 2022 without 3D-printed models were used as controls.ResultsComplete shunt obliteration was observed in all five patients whose CS was 3D-printed. Two patients were treated successfully with selective embolization of the shunted pouch alone and three patients required additional partial sinus packing. In the control group, selective embolization was possible in only one patient, and only two patients achieved complete obliteration, including one requiring retreatment due to early recanalization.ConclusionThe use of 3D-printed models for CS DAVFs treatment may improve shunt point recognition and facilitate effective selective embolization.
BackgroundAtrophy of the medial temporal lobes and deep gray matter, along with ventricular enlargement, are typical structural magnetic resonance imaging (MRI) findings in the brains of patients with Alzheimer's disease (AD). However, there are few twin studies on this subject.PurposeTo determine whether the visual rating method (VRM) and tensor-based morphometry (TBM) can detect the structural brain changes in monozygotic and dizygotic twin pairs discordant for memory performance.Material and MethodsA total of 12 monozygotic and 24 same-sex dizygotic twin pairs discordant for memory performance and 44 cognitively healthy non-twin volunteers were studied.ResultsSignificant within-twin pair differences in brain atrophy were detected in the medial temporal lobes and ventricular areas (both with VRM and TBM), and in deep gray matter structures (TBM only). When monozygotic and dizygotic twin pairs were analyzed separately, the differences were not statistically significant.ConclusionOur study yielded promising TBM results in distinguishing memory-discordant co-twins in temporal and deep gray matter atrophy. In addition, the findings confirm the assumption that AD affects twins in the same way, independent of genes. Studies with larger twin cohorts would better reveal possible differences between monozygotic and dizygotic twin pairs.
Background Interval cancer, breast cancer detected after a negative screening examination but before the next scheduled appointment, represents a challenge in mammography screening programs due to less favorable histopathological characteristics compared to screen-detected cancer. Purpose To determine which interval cancers from digital breast tomosynthesis (DBT) were classified as missed and true by radiologists in a review, and to stratify the findings by risk scores and markings provided by an artificial intelligence (AI) model. Material and methods In this retrospective informed consensus-based review, radiologists assessed mammograms from 46 interval cancers and classified those as false negative, minimal-sign significant or non-specific, or true negative. An AI risk score (1–7, low; 8–9, intermediate; or 10, high risk of malignancy) was available for each examination. For cases with AI risk scores of 8–10, the location of AI-detected markings was compared with the true cancer site. Results A total of 17% (8/46) of interval cancers were classified as false negative, 22% (10/46) as minimal-sign significant, 20% (9/46) as minimal-sign non-specific, and 41% (19/46) as true negative. The AI model correctly identified 35% (16/46) and incorrectly located 24% (11/46). Considering false negative and minimal-sign significant as cases with the highest probability of being diagnosed at screening due to mammographic visibility, the proportion of cases correctly identified by the AI model was reduced from 35% to 22% (10/46). Conclusion About 20% of interval cancers have potential to be diagnosed earlier using AI in DBT screen-reading.
Introduction This scoping review aims to systematically map how outcomes are defined and operationalised in contemporary radiological randomised clinical trials (RCTs). The findings will inform a subsequent Delphi process to develop a core outcome set for clinical studies in radiology, including adaptive platform trials (APTs), conventional RCTs, and observational studies. Methods including end points The scoping review will be conducted in accordance with PRISMA-P and PRISMA-ScR guidelines and will encompass articles published from 1 January 2023 in select high-impact general medical and radiological journals, using a search strategy developed and vetted by an independent information specialist. The search strategy yielded 4,202 hits on 7 April 2026. All steps, from screening through data extraction, will be done in duplicate by two independent authors. Extracted trial data will include number of trial sites, number of participants, sub-speciality, intervention type, and interventions under study. For each outcome in each trial, we will extract the name and type of the outcome, operationalisation/definition/tool used, assessment of temporality (e.g. truncation, censoring, repeated sampling), missingness proportion, missingness handling, effect quantification, and statistical analyses of effects (e.g. unadjusted or regression-model based). Data extraction will start with a 10-trial pilot phase for maximised data quality. Data synthesis will be descriptive without risk of bias evaluation. Implications This scoping review will map how outcomes are defined and operationalised in contemporary radiological RCTs and inform a Delphi process to identify core outcomes for APTs and RCTs, supporting the advancement of value-based radiology.
BackgroundSelecting optimal brain magnetic resonance imaging (MRI) protocols is a manual, error-prone process, often complicated by incomplete clinical information. Automated AI-based analysis of initial imaging sequences offers a potential strategy for dynamic protocol adaptation while the patient is still in the scanner.PurposeTo evaluate the diagnostic performance and agreement with neuroradiologists of an AI tool designed to automatically adapt brain MRI protocols based on the detection of critical findings (brain infarcts, acute hemorrhages, and mass lesions) using three initial imaging sequences.Material and MethodsWe retrospectively collected consecutive cohorts of brain MRI scans from two tertiary medical centers. The cohorts were consecutively enriched with positive findings of brain infarcts, hemorrhages, and mass lesions. An AI tool and neuroradiologists independently assessed three sequences (diffusion-weighted imaging, T2-FLAIR, SWI/T2*-GRE) for critical findings and recommended protocol adaptations from seven options. Diagnostic performance was compared against reference findings based on radiological reports and de novo imaging review.ResultsA total of 752 patients were included (325 men; mean age=61 years). The AI tool's pooled sensitivity for detecting infarcts, hemorrhages, and mass lesions was 92% (95% CI=86-96), 75% (95% CI=64-84), and 71% (95% CI=61-79), with pooled specificity of 93% (95% CI=90-95), 86% (95% CI=83-88), and 90% (95% CI=87-92), respectively. Agreement on protocol adaptation between the AI and neuroradiologists was moderate (κ=0.47), though concordance was high (84%-87%) for scans requiring no further adaptations.ConclusionThe AI tool demonstrated reasonable pathology detection, relevant protocol recommendations, and potential to ensure appropriate imaging protocols in high-volume, low-risk scan scenarios, but expert oversight is required.
BackgroundThe PRORECT trial compares proton and photon radiotherapy in rectal cancer.PurposeTo evaluate inter-observer agreement in gross tumor volume (GTV) delineation between a radiation oncologist and a radiologist in the PRORECT trial. In addition, we evaluated baseline tumor volume and length as predictors of clinical complete response (cCR) and compared tumor length and tumor and nodal staging (TN-stage) between diagnostic magnetic resonance imaging (dMRI) and treatment planning MRI (tpMRI).Material and MethodsA total of 50 consecutive patients underwent dMRI and tpMRI. GTV on tpMRI were delineated by a radiation oncologist (GTVo) and a radiologist (GTVr). Tumor lengths and TN staging were determined by the radiologist on both dMRI and tpMRI.ResultsPatients underwent dMRI and tpMRI with a median interval of 23 days (range=10-51 days). Median GTVo and GTVr volumes were 41.3 cm3 (range=3.7-149.9 cm3) and 29.6 cm3 (range=1.1-137 cm3), respectively. The median Dice score was 0.75 (range=0.3-0.86). GTVo and GTVr were highly positively correlated (r(48) = 0.919; P < 0.001) and the median volume difference was significant (W, Z = -4.5214; P < 0.001). GTVr volume, but not tumor length, was significantly correlated with cCR (rpb = -0.395, n = 50; P = 0.005). Increasing GTVr was associated with reduced likelihood of achieving cCR. No changes in TN stage between dMRI and tpMRI were observed.ConclusionThe overall inter-observer agreement in GTV delineation between radiologist and radiation oncologist was good (median Dice score = 0.75 [range=0.3-0.86]). There was a small difference in measured tumor length between dMRI and tpMRI, but no change in TN stage between dMRI and tpMRI. GTVr was a significant predictor of achieving cCR.
BackgroundDeep learning (DL) has been increasingly applied to grade knee osteoarthritis (KOA) on radiographs, but reported diagnostic performance varies across Kellgren-Lawrence (K-L) grades.PurposeTo systematically evaluate the diagnostic performance of DL models for radiographic KOA grading.Material and MethodsPubMed, Embase, and Web of Science were searched through November 2024 for studies using DL algorithms to grade KOA on X-ray images. Sensitivity and precision were synthesized. Heterogeneity was assessed using the I2 statistic. Subgroup analyses and meta-regression were conducted according to transfer learning, external validation, multi-task learning, joint training strategy, and data splitting. Publication bias was assessed using funnel plots and Egger's test. Study quality was evaluated using the revised QUADAS-2 tool.ResultsOf 1004 records screened, 32 studies were included. Pooled sensitivity for K-L grades 0-4 was 0.90, 0.66, 0.80, 0.87, and 0.88, respectively, and pooled precision was 0.87, 0.71, 0.81, 0.86, and 0.91, respectively. Diagnostic performance was poorest for K-L grade 1, particularly in sensitivity, indicating limited reliability for early-stage KOA detection. Heterogeneity was high across outcomes and grades, particularly for sensitivity in K-L grades 1 and 2 and precision in K-L grades 0 and 1. Meta-regression identified transfer learning and data splitting as potential sources of heterogeneity. Egger's tests suggested no statistically significant small-study effects.ConclusionDL models showed better diagnostic performance for moderate-to-severe radiographic KOA than for early-stage disease. However, the poor sensitivity for K-L grade 1, substantial heterogeneity, and limited external validation suggest that current DL models are not yet reliable for early KOA detection or ready for routine clinical implementation. Further standardized reporting, robust validation, and multicenter external evaluation are required.
BackgroundRepeated transarterial chemoembolization (TACE) may lead to treatment refractoriness, in which tumors fail to respond despite technically adequate procedures. However, evidence to guide optimal management strategies for patients with TACE-refractory hepatocellular carcinoma (HCC) remains limited.PurposeTo assess the efficacy and safety of boosted transarterial radioembolization (TARE) in patients with TACE-refractory HCC.Material and MethodsA total of 41 consecutive patients with TACE-refractory HCC underwent boosted TARE between November 2021 and December 2025. Tumor response, time to local tumor progression (TTLTP), time to progression (TTP), overall survival (OS), and adverse events were retrospectively analyzed.ResultsIn total, 41 patients (36 men; mean age=66.1 ± 9.3 years) were evaluated. The median number of prior TACE sessions was 4 (range=2-11). Best index tumor response was complete response in 31 (75.6%) patients, partial response in 6 (14.6%), and stable disease in 3 (7.3%), yielding an objective response rate of 90.2%. Median TTLTP was not reached at the time of analysis. Median TTP was 6.5 months (95% confidence interval [CI]=3.1-8.8). Median OS was 31.8 months (95% CI=19.4-not reached). Among 25 patients with disease beyond the Milan criteria, 20 (80.0%) were successfully downstaged to within the Milan criteria, of whom seven subsequently underwent curative-intent surgery. Longer OS was observed in surgical patients compared with non-surgical patients (P = .048). Severe adverse events occurred in 4 (9.8%) patients. One patient died from sepsis after tumor rupture.ConclusionBoosted TARE may provide favorable local tumor control in selected patients with TACE-refractory HCC. Careful patient selection and dosimetry remain essential.
BackgroundImaging is crucial for the detection of pancreatic diseases. Photon-counting computed tomography (PCCT) is a recent improvement in CT detector technology that may improve pancreatic imaging quality.PurposeTo compare the image quality in pancreatic imaging with PCCT versus conventional CT (EIDCT) both subjectively and quantitatively.Material and MethodsWe retrospectively identified 35 patients scanned with both EIDCT and PCCT in multiple contrast phases. Image quality over 11 peripancreatic areas was rated on a 5-point Likert scale. One reader made quantitative measurements of density and noise. Data analysis was performed using R Studio. Continuous data were compared using a paired t-test and ordinal data with a Wilcoxon signed-rank test.ResultsImage quality was rated significantly higher on PCCT for the pancreatic parenchyma in the late arterial phase (3.87 vs. 2.77; P <0.01), the pancreatic parenchyma in the portal venous phase (3.31 vs. 2.53; P <0.01), pancreatic ducts (2.88 vs. 2.62; P <0.01), superior mesenteric artery (4.10 vs. 2.74; P <0.01), coeliac axis (4.04 vs. 2.70; P <0.01), and portal vein (3.29 vs. 2.52; P <0.01). Noise levels were significantly lower with PCCT with a mean reduction of 5.8 HU across all areas. Dose-length-product was significantly reduced in both the late arterial phase (31.8%; P <0.01) and the portal venous phase (21.5%; P <0.01).ConclusionImage quality was subjectively and quantitatively significantly improved for all evaluated pancreatic and peripancreatic structures with PCCT compared to EIDCT. In addition, radiation dose was significantly reduced.
BackgroundBreast cancer diagnoses are limited in low- and middle-income settings due to lack of medical resources. In these settings, point-of-care ultrasound (POCUS) combined with artificial intelligence (AI)-based interpretation could be a suitable approach.PurposeTo compare the performance of an AI-based breast cancer classification algorithm with radiologists and assess whether POCUS performs comparably to standard breast ultrasound (BUS) as a stand-alone imaging technique.Material and MethodsA total of 70 POCUS and 70 case-matched BUS images (11 malignant, 21 benign, 38 normal) from 40 women (mean age=50.3 ± 16.65) were interpreted by four breast radiologists in a multi-reader, multi-case setup. Readers rated risk of malignancy on single images on a 5-point scale similar to BI-RADS (≥3 considered positive, i.e. malignant). An in-house-developed AI-based algorithm also analyzed the images. The breast cancer detection performance for all modalities was assessed using area under the receiver operating characteristic curve (AUC), sensitivity, and specificity.ResultsOn BUS, AI and radiologists performed comparably (AUC=0.98 [95% confidence interval (CI)=0.93-1.00] vs. 0.97 [95% CI=0.93-1.00]; sensitivity 1.00 vs. 1.00; specificity 0.75 vs. 0.78). The performance was similar on POCUS, for both AI and radiologists (AUC 0.99 [95% CI=0.98-1.00] vs. 0.99 [95% CI=0.96-1.00]; sensitivity 1.00 vs. 1.00; specificity 0.92 vs. 0.77). No statistically significant differences were observed between BUS and POCUS or radiologists and AI.ConclusionThis study demonstrates the potential of reliable AI-based breast cancer detection, both in standard ultrasound imaging and in POCUS imaging.
Background Cystic adventitial disease is rare and often causes stenosis or even occlusion of the corresponding blood vessels. Purpose To investigate the diagnostic value of color Doppler ultrasound in cystic adventitial disease. Material and Methods A total of 40 patients with clinically suspected cystic adventitial disease were consecutively enrolled at Shandong Provincial Hospital Affiliated to Shandong First Medical University between May 2015 and October 2023. The ultrasonographic images of cystic adventitial disease were analyzed and the ultrasonographic features were summarized. All patients underwent both ultrasound and magnetic resonance imaging (MRI). MRI findings served as a reference standard and Kappa statistic was adopted to assess the level of agreement. The sensitivity, specificity, positive and negative predictive values, accuracy, and Youden index of color Doppler ultrasound as a diagnostic tool for the diagnosis of cystic adventitial disease were assessed. Results Ultrasonography findings were positive in 19 patients with clinical suspicion of cystic adventitial disease. The diagnosis was confirmed by MRI in 20 patients. There was one false-positive and two false-negative by ultrasonography. The κ level of agreement between color Doppler ultrasound and MRI for the diagnosis of cystic adventitial disease was high. The κ value was 0.85. The sensitivity, specificity, positive predictive value, negative predictive value, accuracy, and Youden Index of ultrasonography were 90%, 95%, 94.7%, 90.5%, 92.5%, and 0.85, respectively. Conclusion Color Doppler ultrasound can effectively evaluate the ultrasound characteristic of cystic adventitial disease and provide a reliable imaging basis for its early diagnosis and treatment.
BackgroundDifferentiating benign from malignant thyroid nodules is essential for effective patient management.PurposeTo evaluate the diagnostic performance of contrast-enhanced ultrasound (CEUS) for thyroid nodule characterization based on currently available evidence.Material and MethodsWe conducted a systematic review and meta-analysis of studies evaluating the diagnostic accuracy of CEUS for thyroid nodules. PubMed, Scopus, and Web of Science were searched through 31 March 2025. Studies using histopathologic or cytologic reference standards were included. Pooled estimates of sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy were calculated using random-effects models. Subgroup analyses and meta-regression were performed to explore potential effect modifiers. Studies evaluating contrast-enhanced computed tomography were included in the qualitative synthesis but were not incorporated into the quantitative meta-analysis.ResultsA total of 59 studies were included in the systematic review. Among these, 54 CEUS studies provided sufficient data for quantitative synthesis. CEUS demonstrated pooled sensitivity of 78.6% and specificity of 82.6%, with an overall diagnostic accuracy of 81.6%. Subgroup analyses indicated that examiner experience significantly influenced diagnostic performance, with higher sensitivity observed in studies involving more experienced operators. Meta-regression did not identify statistically significant independent associations between examined covariates and diagnostic outcomes.ConclusionThe available literature indicates that CEUS demonstrates favorable diagnostic performance for differentiating benign from malignant thyroid nodules. Further prospective studies using standardized imaging protocols and reporting frameworks are needed to better define the role of CEUS in thyroid nodule evaluation.
BackgroundYoung-onset breast cancer (≤40 years) may demonstrate distinct magnetic resonance imaging (MRI) features compared with older patients, and recognition of age-related phenotypes may improve radiologic-pathologic correlation.PurposeTo evaluate dynamic breast MRI features of young-onset breast cancer, assess their correlation with histopathological characteristics, and compare these findings with those observed in an older patient population.Material and MethodsThis retrospective study included 160 women with breast cancer (80 aged ≤40 years; 80 aged ≥50 years). Breast density, background parenchymal enhancement (BPE), edema, skin thickness, lesion margins, T2 signal intensity, rim enhancement, internal enhancement pattern, kinetic curve type, ADC values were assessed according to ACR BI-RADS MRI lexicon. Histopathological features were extracted from pathology reports. Statistical analyses were performed using SPSS.ResultsYounger women more frequently demonstrated dense fibroglandular tissue, higher BPE, rim enhancement, T2 iso- to hyperintense lesions, and persistent enhancement kinetics (P <0.05). In contrast, older patients more commonly showed irregular morphology, diffuse edema, T2 hypointensity, and increased skin thickness (P <0.05). In the young-onset cohort, rim enhancement was associated with HER2-positive tumors (P = 0.006), and heterogeneous enhancement was associated with diffuse edema (P = 0.002). An ADC threshold of <830 × 10-6 mm2/s predicted invasive carcinoma of no special type with 49.2% sensitivity and 80.0% specificity. In patients aged ≥50 years, rim enhancement was associated with triple-negative subtype (P = 0.006).ConclusionBreast cancer in women aged ≤40 years exhibits distinct MRI features compared with older patients. Findings such as circumscribed margins, T2 iso/hyperintensity, and persistent enhancement may still reflect aggressive tumor biology in young women.
BackgroundOxaliplatin is used in colorectal cancer treatment (CRC) but frequently causes chemotherapy-induced peripheral neuropathy (CIPN), a cumulative and potentially chronic adverse event. Reliable non-invasive methods for the early detection and monitoring of CIPN are lacking. Shear wave elastography (SWE) is an ultrasound-based technique that quantifies peripheral nerve stiffness and may enable CIPN assessment.PurposeTo evaluate the feasibility of SWE for detecting CIPN from oxaliplatin treatment in CRC.Material and MethodsIn this prospective, single-blinded study, patients with stage III-IV CRC receiving oxaliplatin-based (n = 18) or non-oxaliplatin chemotherapy (n = 12) were assessed at baseline, 3 months, and 6 months. Tibial nerve SWE, cross-sectional area, and diameter were measured using a standardized ultrasound protocol. CIPN symptoms were recorded through structured interviews, yielding composite scores (0-10), with possible CIPN defined as ≥2 points. Healthy controls (n = 9) underwent a single SWE evaluation. Linear mixed-effects models and non-parametric tests were used for longitudinal and group comparisons.ResultsNerve diameter increased over time in both groups (+1.50 mm, 95% confidence interval = 0.78-2.21; P <0.001) without between-group differences. SWE showed a trend toward higher tibial nerve stiffness at 6 months in oxaliplatin-treated patients (29.75 vs. 20.81 kPa). Possible CIPN occurred in 70% of oxaliplatin-treated patients versus none in the non-oxaliplatin (P <0.01). SWE correlated with CIPN scores (ρ = 0.55; P = 0.04).ConclusionSWE is a feasible, non-invasive method, and tibial nerve stiffness was modestly associated with CIPN symptom severity at 6 months. These findings are hypothesis-generating, and larger studies with validated neuropathy instruments are warranted to confirm clinical utility.
