BACKGROUND:Objective criteria for selecting Huber needle length for totally implantable venous access ports (TIVAPs) are limited. This study primarily described skin-to-septum distance using ultrasonography and its correlation with body habitus. METHODS:Thirty-three patients with TIVAPs for chemotherapy were included. Skin-to-septum distance was measured by ultrasonography in two positions: supine with arms at the sides and with shoulder flexion. Pearson's correlation coefficient assessed correlation between body mass index (BMI) and septal depth. Excess needle length beyond the port base was calculated. RESULTS:Mean skin-to-septum distance was 1.7 ± 0.4 mm (arms at sides) and 1.8 ± 0.5 mm (shoulder flexion). A 16-mm Huber needle was used in 97.0%. The median excess needle length was 2.4 mm. BMI showed weak correlation with septal depth (r = 0.33, p = 0.062). CONCLUSIONS:Septal depth was shallow, and BMI alone was not a reliable predictor. Ultrasound may support Huber needle selection.

Accurate identification of peripancreatic arteries in pancreatic ductal adenocarcinoma (PDAC) is essential for determining surgical strategy and prognosis. This study compared super-resolution deep learning reconstruction (SR-DLR) with normal-resolution deep learning reconstruction (NR-DLR) and hybrid iterative reconstruction (HIR) in the depiction of peripancreatic arteries in patients with PDAC undergoing pancreatic dynamic CT. This retrospective study included 40 patients (mean age, 70.8 ± 9.3 years) with pathologically confirmed PDAC who underwent pancreatic dynamic CT. Images were reconstructed using SR-DLR, NR-DLR, and HIR. In quantitative image analyses, CT attenuation, image noise, contrast-to-noise ratio (CNR), edge rise slope (ERS), and edge rise distance (ERD) were assessed. In qualitative image analyses, five radiologists independently evaluated arterial depiction of major arteries and small peripancreatic arteries, tumor–vessel interface, image noise, image sharpness, diagnostic acceptability, and tumor conspicuity. Statistical analyses were performed using paired t-tests and the Wilcoxon signed-rank test with Bonferroni correction. SR-DLR showed higher CT attenuation, lower image noise, and higher CNR than NR-DLR and HIR (all p < 0.001). For both the superior mesenteric artery and pancreatic parenchyma, ERS was higher with SR-DLR than with NR-DLR and HIR (all p ≤ 0.002), whereas ERD was lower than with NR-DLR and HIR (all p ≤ 0.001). In qualitative image analyses, SR-DLR achieved the highest scores for small peripancreatic arteries and all qualitative items except for the depiction of major peripancreatic arteries (p < 0.001). SR-DLR improved quantitative image quality and enhanced the qualitative depiction of small peripancreatic arteries and the tumor–vessel interface in pancreatic dynamic CT for patients with PDAC.

BackgroundManual data curation was necessary to extract radiology reports due to the ambiguities of natural language.PurposeTo develop a fine-tuned large language model that classifies computed tomography (CT)-guided interventional radiology reports into technique categories and to compare its performance with that of the readers.Material and MethodsThis retrospective study included patients who underwent CT-guided interventional radiology between August 2008 and November 2024. Patients were chronologically assigned to the training (n = 1142; 646 men; mean age = 64.1 ± 15.7 years), validation (n = 131; 83 men; mean age = 66.1 ± 16.1 years), and test (n = 332; 196 men; mean age = 66.1 ± 14.8 years) datasets. In establishing a reference standard, reports were manually classified into categories 1 (drainage), 2 (lesion biopsy within fat or soft tissue density tissues), 3 (lung biopsy), and 4 (bone biopsy). The bi-directional encoder representation from the transformers model was fine-tuned with the training dataset, and the model with the best performance in the validation dataset was selected. The performance and required time for classification in the test dataset were compared between the best-performing model and the two readers.ResultsCategories 1/2/3/4 included 309/367/270/196, 30/42/40/19, and 75/124/78/55 patients for the training, validation, and test datasets, respectively. The model demonstrated an accuracy of 0.979 in the test dataset, which was significantly better than that of the readers (0.922-0.940) (P ≤0.012). The model classified reports within a 49.8-53.5-fold shorter time compared to readers.ConclusionThe fine-tuned large language model classified CT-guided interventional radiology reports into four categories demonstrating high accuracy within a remarkably short time.

The purpose of the study is to investigate the degree and performance in the differential diagnosis of bronchiectasis/airspace enlargement in an iodine map obtainable from CT pulmonary angiography compared with monochromatic images. This retrospective study included 62 patients with a lung nodule who underwent CT pulmonary angiography. The iodine map and monochromatic image (70 keV) were reconstructed. Three readers evaluated the degree of bronchiectasis/airspace enlargement with a 4-point scale. A reference standard was established in 39 patients, and the performance of bronchiectasis/airspace enlargement in the differential diagnosis was evaluated in them. The degree of bronchiectasis/airspace enlargement in the iodine map (median score = 1/2/1 for reader 1/2/3) was significantly more prominent than that in the monochromatic image (median score = 0/1/0 for reader 1/2/3) (p < 0.001 for all readers). Using bronchiectasis/airspace enlargement, primary lung carcinoma and malignant lymphoma could be differentiated from other diseases, excluding lung infarct, with an area under the receiver operating characteristic curve (AUC) (reader 1/2/3) of 0.718/0.867/0.803 in the combinations of iodine map plus monochromatic image and 0.496/0.828/0.450 in the monochromatic image (p ≤ 0.047 for two readers). Lung metastasis from colorectal carcinoma could be differentiated from other diseases with an AUC of 0.851/0.976/0.838 in the combinations of iodine map plus monochromatic image, which was significantly superior to the monochromatic image (0.378/0.780/0.459) (p ≤ 0.012 for all readers). Bronchiectasis/airspace enlargement was more prominently observed in the iodine map than in the monochromatic image. This image finding in the iodine map provided added value in the differential diagnosis of malignant lung nodules compared with monochromatic images alone.

Cowden syndrome (CS) is a rare hereditary disorder caused by a germline variant of the phosphatase and tensin homolog, associated with multiple hamartomatous lesions occurring in various organs. Additionally, although rare, arteriovenous malformations (AVMs) with CS are found in the skin, brain, and spinal cord; however, peribronchial AVMs have not been previously reported. Herein, we report a rare case of a peribronchial AVM in a 30-year-old man with CS who presented with hemoptysis. Computed tomography (CT) revealed an AVM around the left upper bronchus, which was mainly fed by the left bronchial artery and drained into the left inferior pulmonary vein. Under video-assisted thoracic surgery, ligation of the feeding and draining vessels was performed. The AVM remarkably decreased in size one month after the surgery. This case highlights the need for whole-body contrast-enhanced CT to screen for AVMs and the importance of identifying feeding and draining vessels for optimal treatment methods.

PURPOSE:To evaluate the safety and degree of pain relief of 3 rapidly biodegraded embolic materials, including imipenem (IPM)/cilastatin sodium (CS), quick-soluble gelatin sponge particles (QS-GSPs), and resorbable microsphere (RMs), in transcatheter arterial embolization (TAE) for degenerative, inflammatory, and overuse joint disorders. MATERIALS AND METHODS:Consecutive 431 patients, 527 joints with refractory overuse injuries, knee osteoarthritis, frozen shoulder, symptomatic rotator cuff tear, synovitis of the foot joints, and persistent pain after knee joint arthroplasty who underwent TAE between March 2020 and May 2023 were included in this retrospective study. IPM/CS, QS-GSPs, and RMs were used in 140 patients (176 TAEs), 136 patients (163 TAEs), and 155 patients (182 TAEs), respectively. Adverse events were monitored immediately after the procedure. Changes in pain numeric rating scale (NRS) score were evaluated at 1, 3, and 6 months after TAE. RESULTS:No severe adverse events were observed. Increased pain at the site of embolization after the procedure lasting more than 7 days occurred in 7.1%, 22.1%, and 5.8% of patients with IPM/CS, QS-GSPs, and RMs, respectively, more commonly in the elbow joint. The NRS score improved from the baseline to 1, 3, and 6 months with IPM/CS (6.9 [SD ± 1.3] vs 4.4 [SD ± 2.2], 3.6 [SD ± 2.3], and 3.1 [SD ± 2.4], respectively; all P < .0001), QS-GSPs (6.4 [SD ± 1.5] vs 4.3 [SD ± 2.1], 3.6 [SD ± 2.2], and 3.0 [SD ± 2.1], respectively; all P < .0001), and RMs (7.0 [SD ± 1.3] vs 4.4 [SD ± 2.2], 3.2 [SD ± 2.1], and 2.3 [SD ± 1.8], respectively; all P < .0001). CONCLUSIONS:IPM/CS, QS-GSPs, and RMs demonstrated acceptable safety profiles and effectively alleviated pain in TAE for degenerative, inflammatory, and overuse joint disorders.

Although various embolic agents are used for transcatheter arterial embolization (TAE) of colonic diverticular bleeding (CDB), comparative outcome data for different embolic agents are limited. We aimed to assess the association between embolic agent choice and early rebleeding and intestinal ischemia after TAE for CDB. We conducted a nationwide retrospective cohort study using the Japanese Diagnosis Procedure Combination database between July 2010 and March 2022. Adults who underwent a first TAE for CDB with coils, gelatin sponge (GS) particles, or n‑butyl‑2‑cyanoacrylate (NBCA) were included. Multivariate logistic regression analyses were performed to evaluate the association of embolic agent choice with early rebleeding requiring intervention and intestinal ischemic complications, while adjusting for covariates and within-hospital clustering. The cohort comprised 5625 patients (mean age 72 years ± 12 [standard deviation], 4020 men). Coils, GS particles, and NBCA were used in 59

Air emboli represent rare but severe complications of computed tomography (CT)-guided lung biopsy (CTLB). No reports exist regarding the behavior of air during the early stages of air emboli. We present a case of air emboli following CTLB, evaluated by intermittent CT over a 2-hour period, spanning from onset to resolution.A man in his 60s underwent CTLB for diagnosis of a slowly enlarging pulmonary nodule in the right lower lobe. Immediately post-biopsy, chest CT revealed air emboli in the right coronary artery and apex of the ascending aorta. The patient was in the head-down position on the CT table, and intermittent CT scans were performed over a 2-hour period until the air emboli resolved. Subsequently, the patient was discharged without any complications.

To investigate the preliminary treatment outcomes of transcatheter arterial embolization (TAE) for chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). This retrospective study included patients with refractory CP/CPPS who underwent TAE between April 2022 and February 2023. All patients had persistent pelvic pain for at least 3 months, a total score of at least 15 on the NIH-Chronic Prostatitis Symptom Index (NIH-CPSI), and lacked evidence of infection. All procedures were performed by injecting imipenem/cilastatin sodium (IPM/CS) from bilateral prostatic arteries ± internal pudendal arteries. NIH-CPSI, pain numeric rating scale (NRS), and complications were evaluated at 1, 3, and 6 months after the initial TAE and at the final follow-up. Out of 48 patients, 44 were included in this study, with four excluded because of loss of follow-up. No severe procedure-related complications were observed. Pretreatment and post-treatment evaluations at 1, 3, and 6 months after the initial TAE and at the final follow-up (mean 16.6 months) revealed a decrease in the mean NIH-CPSI scores from 27 ± 6 to 21 ± 8, 20 ± 9, 17 ± 9, and 18 ± 9, respectively (all P < 0.001). Pain NRS scores were also decreased from 7.0 ± 1.6 to 4.8 ± 2.5, 4.1 ± 2.6, 3.7 ± 2.4, and 3.4 ± 2.3, respectively (all P < 0.001). The proportions of clinical success, defined as a reduction of at least 6 points from baseline in the NIH-CPSI, at 6 months after TAE and at the final follow-up were 70 and 64

Objective: This study aimed to investigate whether deep-learning reconstruction (DLR) improves interobserver agreement in the evaluation of honeycombing for patients with interstitial lung disease (ILD) who underwent high-resolution computed tomography (CT) compared with hybrid iterative reconstruction (HIR). Methods: In this retrospective study, 35 consecutive patients suspected of ILD who underwent CT including the chest region were included. High-resolution CT images of the unilateral lung with DLR and HIR were reconstructed for the right and left lungs. A radiologist placed regions of interest on the lung and measured standard deviation of CT attenuation (i.e., quantitative image noise). In the qualitative image analyses, 5 blinded readers assessed the presence of honeycombing and reticulation, qualitative image noise, artifacts, and overall image quality using a 5-point scale (except for artifacts which was evaluated using a 3-point scale). Results: The quantitative and qualitative image noise in DLR was remarkably reduced compared to that in HIR ( P < .001). Artifacts and overall DLR quality were significantly improved compared to those of HIR ( P < .001 for 4 out of 5 readers). Interobserver agreement in the evaluations of honeycombing and reticulation for DLR (0.557 [0.450-0.693] and 0.525 [0.470-0.541], respectively) were higher than those for HIR (0.321 [0.211-0.520] and 0.470 [0.354-0.533], respectively). A statistically significant difference was found for honeycombing ( P = .014). Conclusions: DLR improved interobserver agreement in the evaluation of honeycombing in patients with ILD on CT compared to HIR.

This study aimed to develop a large multimodality model (LMM) that can detect breast and esophageal carcinomas on chest contrast-enhanced CT. In this retrospective study, CT images of 401 (age, 62.9 ± 12.9 years; 169 males), 51 (age, 65.5 ± 11.6 years; 23 males), and 120 (age, 64.6 ± 14.2 years; 60 males) patients were used in the training, validation, and test phases. The numbers of CT images with breast carcinoma, esophageal carcinoma, and no lesion were 927, 2180, and 2087; 80, 233, and 270; and 184, 246, and 6919 for the training, validation, and test datasets, respectively. The LMM was fine-tuned using CT images as input and text data (“suspicious of breast carcinoma”/ “suspicious of esophageal carcinoma”/ “no lesion”) as reference data on a desktop computer equipped with a single graphic processing unit. Because of the random nature of the training process, supervised learning was performed 10 times. The performance of the best performing model on the validation dataset was further tested using the time-independent test dataset. The detection performance was evaluated by calculating the area under the receiver operating characteristic curve (AUC). The sensitivities of the fine-tuned LMM for detecting breast and esophageal carcinomas in the test dataset were 0.929 and 0.951, respectively. The diagnostic performance of the fine-tuned LMM for detecting breast and esophageal carcinomas was high, with AUCs of 0.890 (95

Purpose Sterile inflammation along the tunneled catheter is a characteristic complication associated with trabectedin infusion via a central venous port (CVP). To date, no studies have evaluated the differences in sterile inflammation incidence according to the CVP system used. This study evaluated the differences in sterile inflammation incidence between two different CVP systems. Methods This study was conducted at The University of Tokyo Hospital, Bunkyo-Ku, Tokyo, Japan. Patients with trabectedin infusion using CVP via the internal jugular vein between April 2016 and February 2024 were retrospectively evaluated. Sterile inflammation was characterized as skin erythema, swelling, pain, or induration along the tunneled catheter after infusion of trabectedin from the CVP and negative for various infection tests. The incidence of sterile inflammation was compared using two different CVP systems: Anthron® polyurethane catheter with Celsite port (P-U Celsite; Toray Medical, Tokyo, Japan) and DewX Eterna (Terumo, Tokyo, Japan). Results Of the 21 patients, 12 and nine patients used P-U Celsite and DewX Eterna for trabectedin infusion, respectively. Sterile inflammation occurred in five patients; of these, four underwent CVP removal because of worsened pain, making trabectedin infusion difficult. Sterile inflammation occurred in 0 (0/12) and 56% (5/9) of patients using P-U Celsite and DewX Eterna, respectively, with a significantly lower incidence in patients using P-U Celsite (P = 0.006). Conclusion Sterile inflammation incidence was significantly lower in patients using P-U Celsite compared to those using DewX Eterna.

To investigate the effects of mid-inspiratory respiration commands and other factors on transient interruption of contrast (TIC) incidence on CT pulmonary angiography. In this retrospective study, 824 patients (mean age, 66.1 ± 15.3 years; 342 males) who had undergone CT pulmonary angiography between January 2021 and February 2023 were included. Among them, 545 and 279 patients were scanned at end- and mid-inspiratory levels, respectively. By placing a circular region of interest, CT attenuation of the main pulmonary artery (CTMPA) was recorded. Associations between several factors, including patient age, body weight, sex, respiratory command vs. TIC and severe TIC incidence (defined as CTMPA < 200 and 150 HU, respectively), were assessed using logistic regression analyses with stepwise regression selection based on Akaike’s information criterion. Mid-inspiratory respiration command, in addition to patient age and lighter body weight, had negative association with the incidence of TIC. Only patient age, lighter body weight, female sex, and larger cardiothoracic ratio were negatively associated with severe TIC incidence. Mid-inspiratory respiration commands helped reduce TIC incidence among patients aged < 65 years (p = 0.039) and those with body weight ≥ 75 kg (p = 0.005) who were at high TIC risk. Changing the respiratory command from end- to mid-inspiratory levels, as well as patient age and body weight, was significantly associated with TIC incidence.

Changing a window width (WW) alters appearance of noise and contrast of CT images. The aim of this study was to investigate the impact of adjusted WW for deep learning reconstruction (DLR) in detecting hepatocellular carcinomas (HCCs) on CT with DLR. This retrospective study included thirty-five patients who underwent abdominal dynamic contrast-enhanced CT. DLR was used to reconstruct arterial, portal, and delayed phase images. The investigation of the optimal WW involved two blinded readers. Then, five other blinded readers independently read the image sets for detection of HCCs and evaluation of image quality with optimal or conventional liver WW. The optimal WW for detection of HCC was 119 (rounded to 120 in the subsequent analyses) Hounsfield unit (HU), which was the average of adjusted WW in the arterial, portal, and delayed phases. The average figures of merit for the readers for the jackknife alternative free-response receiver operating characteristic analysis to detect HCC were 0.809 (reader 1/2/3/4/5, 0.765/0.798/0.892/0.764/0.827) in the optimal WW (120 HU) and 0.765 (reader 1/2/3/4/5, 0.707/0.769/0.838/0.720/0.791) in the conventional WW (150 HU), and statistically significant difference was observed between them (p < 0.001). Image quality in the optimal WW was superior to those in the conventional WW, and significant difference was seen for some readers (p < 0.041). The optimal WW for detection of HCC was narrower than conventional WW on dynamic contrast-enhanced CT with DLR. Compared with the conventional liver WW, optimal liver WW significantly improved detection performance of HCC.

Trabectedin is an antineoplastic drug used to treat soft tissue sarcomas. Trabectedin is mainly infused from the central venous port (CVP) because trabectedin leakage causes serious skin and soft tissue complications. Characteristic sterile inflammation has recently been reported after infusion of trabectedin from the CVP. Here, we report a case of sterile inflammation along a tunneled catheter pathway after trabectedin infusion from the CVP, with residual postinflammatory changes even after CVP removal.A 57-year-old man with myxoid liposarcoma developed skin erythema, swelling, and induration along a tunneled catheter pathway of the CVP after 16 cycles of trabectedin infusion through the CVP. The patient was diagnosed with sterile inflammation because various tests were negative for infection. The CVP was removed because the increasing injection resistance made trabectedin infusion difficult. The catheter firmly adhered to the surrounding tissue during removal. The induration and pigmentation along the catheter persisted for 4 months after CVP removal.

Purpose: The central venous port (CVP) is widely used for intravenous chemotherapy (IVC) in adult patients because of its lower infection rates and easier management than that of a central venous catheter. However, the feasibility and safety of the CVP for IVC in infants remain unknown. This study evaluated the usefulness of CVP for IVC in infants with retinoblastoma. Methods: The usefulness of CVP was retrospectively evaluated using technical success rates, the safety of CVP placement, and postoperative procedure-related complications in 18 infants with retinoblastoma. This study was conducted at the National Cancer Center Hospital, Chuo-Ku, Tokyo, Japan. Results: The technical success rate was 100% (18/18) without any procedure-related complications. The sum duration of CVP implantation was 12,836 days (mean: 713 +/- 453 days, range: 10-1,639 days). Postoperative complications were observed in two cases; one was a port reversal after 20 days, which was reversed by incisional surgery, and another was a catheter-related bloodstream infection after eight days, resulting in CVP removal. The total incidence of CVP-related infections was 5.6% (1/18) and 0.08/1000 catheter days. No other CVP-related complications were noted. Conclusion: The use of the CVP for IVC in infants with retinoblastoma was feasible with few complications.

The aim of this study is to develop a fine-tuned large language model that classifies interventional radiology reports into technique categories and to compare its performance with readers. This retrospective study included 3198 patients (1758 males and 1440 females; age, 62.8 ± 16.8 years) who underwent interventional radiology from January 2018 to July 2024. Training, validation, and test datasets involved 2292, 250, and 656 patients, respectively. Input data involved texts in clinical indication, imaging diagnosis, and image-finding sections of interventional radiology reports. Manually classified technique categories (15 categories in total) were utilized as reference data. Fine-tuning of the Bidirectional Encoder Representations model was performed using training and validation datasets. This process was repeated 15 times due to the randomness of the learning process. The best-performed model, which showed the highest accuracy among 15 trials, was selected to further evaluate its performance in the independent test dataset. The report classification involved one radiologist (reader 1) and two radiology residents (readers 2 and 3). The accuracy and macrosensitivity (average of each category’s sensitivity) of the best-performed model in the validation dataset were 0.996 and 0.994, respectively. For the test dataset, the accuracy/macrosensitivity were 0.988/0.980, 0.986/0.977, 0.989/0.979, and 0.988/0.980 in the best model, reader 1, reader 2, and reader 3, respectively. The model required 0.178 s required for classification per patient, which was 17.5–19.9 times faster than readers. In conclusion, fine-tuned large language model classified interventional radiology reports into technique categories with high accuracy similar to readers within a remarkably shorter time.

OBJECTIVE:To investigate the effectiveness of a deep learning model in helping radiologists or radiology residents detect esophageal cancer on contrast-enhanced CT images.METHODS:This retrospective study included 250 and 25 patients with and without esophageal cancer, respectively, who underwent contrast-enhanced CT between December 2014 and May 2021 (mean age, 67.9 ± 10.3 years; 233 men). A deep learning model was developed using data from 200 and 25 patients with esophageal cancer as training and validation data sets, respectively. The model was then applied to the test data set, consisting of additional 25 and 25 patients with and without esophageal cancer, respectively. Four readers (one radiologist and three radiology residents) independently registered the likelihood of malignant lesions using a 3-point scale in the test data set. After the scorings were completed, the readers were allowed to reference to the deep learning model results and modify their scores, when necessary.RESULTS:The area under the curve (AUC) of the deep learning model was 0.95 and 0.98 in the image- and patient-based analyses, respectively. By referencing to the deep learning model results, the AUCs for the readers were improved from 0.96/0.93/0.96/0.93 to 0.97/0.95/0.99/0.96 (p = 0.100/0.006/<0.001/<0.001, DeLong's test) in the image-based analysis, with statistically significant differences noted for the three less-experienced readers. Furthermore, the AUCs for the readers tended to improve from 0.98/0.96/0.98/0.94 to 1.00/1.00/1.00/1.00 (p = 0.317/0.149/0.317/0.073, DeLong's test) in the patient-based analysis.CONCLUSION:The deep learning model mainly helped less-experienced readers improve their performance in detecting esophageal cancer on contrast-enhanced CT.ADVANCES IN KNOWLEDGE:A deep learning model could mainly help less-experienced readers to detect esophageal cancer by improving their diagnostic confidence and diagnostic performance.

Pulmonary artery aneurysms (PAAs) occurring in the distal branch of the pulmonary artery are rare, and there are only a few reports of transcatheter embolization of unruptured idiopathic peripheral PAAs. We report a case of a 66-year-old woman with a history of surgery for pulmonary arteriovenous malformations who presented with an idiopathic peripheral PAA of A10 confirmed by contrast-enhanced computed tomography and pulmonary artery angiography. Transcatheter embolization was performed to prevent rupture, and the aneurysm was successfully embolized. Although there is no consensus on the indications and treatment for unruptured idiopathic peripheral PAAs, transcatheter embolization may be a favorable treatment option.