Search

This article, published in Seminars in Musculoskeletal Radiology, aims to assess the accuracy of magnetic resonance imaging (MRI) in diagnosing tears of the posterior horn of the lateral meniscus (PHLM) in correlation with clinical stability and arthroscopy. The study included 41 patients with surgically verified PHLM tears, and the MRI scans were initially reviewed by radiologists without specialization in musculoskeletal imaging. The results showed that radiologists without musculoskeletal imaging experience only detected 45.2% of the PHLM injuries, while radiologists with musculoskeletal imaging experience detected 85.7% of the injuries. The most commonly missed injuries were root avulsions and tears close to the root of the lateral meniscus. This study highlights the importance of specialized radiologists in accurately diagnosing PHLM tears. [Extracted from the article]

Aim: This study aimed to evaluate perceptions and expectations towards artificial intelligence (AI) applications in diagnostic radiology among radiologists across academic, non-academic and private practice settings in the Federal State of Styria, Austria. It also sought to determine how participant's characteristics and AI-specific knowledge might influence these views., Methods: An online quantitative survey comprising 20 multiple-choice questions in German language was distributed via email to radiologists in outpatient and hospital settings throughout Styria in 2024., Results: Out of 149 radiologists contacted, 66 responded. Of these, 75.4% reported having basic knowledge of AI, 13.8% indicated good to very good knowledge and only 10.8% had minimal AI-specific knowledge. The majority (84.4%) expressed willingness to use certified AI software in diagnostics. About half of the respondents (50.8%) believed that AI would not fully replace radiologists in the next 10-15 years, although 46.0% anticipated partial replacement. Additionally, 87.7% did not foresee a decrease in professional income due to AI integration. 64.6% anticipated improvement in diagnostic tasks through AI, with this expectation being significantly linked to an academic career (χ 2  = 8.97, p   =  0.01). However, opinions varied on AI's potential to outperform radiologists in diagnostics in the near future. There was no statistically significant relationship between participant's AI-specific knowledge and perceptions and expectations towards AI., Conclusion: The study reveals a generally positive attitude towards AI among radiologists, with uncertainties about its future performance compared to human radiologists. Although AI is anticipated to positively influence workload without reducing income, there may be a discrepancy between these expectations and actual outcomes., Competing Interests: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2024.)

Purpose: The aim of the study is to assess the influence of manual adjustment of the Patlak range in computed tomography (CT) perfusion analysis of rectal carcinoma compared with default range of the perfusion software., Methods: This study was approved by the institutional review board and informed consent was obtained. Twenty-one patients (12 male, 9 female; mean age ± SD, 59 ± 11 years) with rectal cancer were included and underwent perfusion CT before preoperative chemoradiotherapy. Equivalent blood volume (BV) and flow-extraction (FE) were calculated using the Patlak plot model. Two perfusion sets were calculated per patient, a perfusion set using the default setting as provided by the software (dBV, dFE) and an optimized perfusion set after manual adaption of the Patlak range (aBV, aFE), which was limited to the intravascular space clearance of contrast to the extravascular space. Perfusion values calculated with both methods were compared for significance in differences using the Wilcoxon test. A P value of 0.05 or less was defined as statistically significant., Results: Adjustment of the Patlak range statistically significantly influenced BV and FE calculation. Median dBV was 23.2 mL/100 mL (interquartile range [IQR], 12.1 mL/100 mL), whereas median aBV was 20.3 mL/100 mL (IQR, 10.9 mL/100 mL). The difference in BV was statistically significant ( P = 0.021). Median dFE was 8.3 mL/min/100 mL (IQR, 4.7 mL/min/100 mL), whereas median aFE was 15.4 mL/min/100 mL (IQR, 5.8 mL/min/100 mL). The difference in FE was statistically significant ( P < 0.001)., Conclusions: Our findings indicate that in perfusion CT of rectal carcinoma, adjustment of the Patlak range may significantly influence BV and FE compared with default setting of the software. This may contribute to standardization in the use of this technique for functional imaging of rectal cancer., Competing Interests: The authors declare no conflict of interest., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Purpose: To investigate whether CT texture analysis allows differentiation between adenocarcinomas, squamous cell carcinomas, carcinoids, small cell lung cancers and organizing pneumonia and between carcinomas and neuroendocrine tumors., Method: This retrospective study included patients 133 patients (30 patients with organizing pneumonia, 30 patients with adenocarcinoma, 30 patients with squamous cell carcinoma, 23 patients with small cell lung cancer, 20 patients with carcinoid), who underwent CT-guided biopsy of the lung and had a corresponding histopathologic diagnosis. Pulmonary lesions were segmented in consensus by two radiologists with and without a threshold of -50HU in three dimensions. Groupwise comparisons were performed to assess for differences between all five above-listed entities and between carcinomas and neuroendocrine tumors., Results: Pairwise comparisons of the five entities revealed 53 statistically significant texture features when using no HU-threshold and 6 statistically significant features with a threshold of -50HU. The largest AUC (0.818 [95%CI 0.706-0.930]) was found for the feature wavelet-HHH&#95;glszm&#95;SmallAreaEmphasis for discrimination of carcinoid from the other entities when using no HU-threshold. In differentiating neuroendocrine tumors from carcinomas, 173 parameters proved statistically significant when using no HU threshold versus 52 parameters when using a -50HU-threshold. The largest AUC (0.810 [95%CI 0.728-0,893]) was found for the parameter original&#95;glcm&#95;Correlation for discrimination of neuroendocrine tumors from carcinomas when using no HU-threshold., Conclusions: CT texture analysis revealed features that differed significantly between malignant pulmonary lesions and organizing pneumonia and between carcinomas and neuroendocrine tumors of the lung. Applying a HU-threshold for segmentation substantially influenced the results of texture analysis., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Objectives: To assess the frequency of anterolateral ligament (ALL) tears and ramp lesions (RL) detected with MRI in patients with anterior cruciate ligament (ACL) tears and to describe associated injuries indicative for these lesions., Methods: In this retrospective study, 164 patients with surgically verified ACL tears were included. Preoperative MRI scans were reviewed for ALL tears and different types of RL. All coexisting meniscal tears, tears of the medial (MCL) and lateral collateral band (LCL), and posterior-medial tibial bone marrow edema (BME) were recorded. The frequency of ALL tears and RL was assessed and coexisting injuries were correlated using Pearson's chi-square test. A p < 0.05 was defined as statistically significant. In cases of multiple testing, Bonferroni's correction was applied., Results: ALL tears and RL combined were detected in 28 patients (17.1%), ALL tears in 48 patients (29.3%), and RL in 54 patients (32.9%) which were significantly associated to each other. ALL tears were significantly associated with tears of the posterior horn of the lateral meniscus (PHLM), BME, and with tears of the LCL and MCL. RL were significantly associated with tears of the posterior horn of the medial (PHMM) and PHLM, with BME, and with tears of the LCL., Conclusions: ACL tears are associated with RL or ALL tears in about one-third of cases and with both lesions combined in about one-fifth of cases. ALL tears and RL are significantly associated with additional posttraumatic injuries, which can thus be indicative of these lesions., Key Points: • ACL tears were associated with ramp lesions or ALL tears in about one-third of the cases. • Ramp lesions and ALL tears were significantly associated with each other, tear in the PHLM, tear in the LCL, and BME. • ALL tears were more frequently associated with instable classified ramp lesion type 4b and type 5., (© 2023. The Author(s).)

Objective: Reproducibility problems are a known limitation of radiomics. The segmentation of the target lesion plays a critical role in texture analysis variability. This study's aim was to compare the interobserver reliability of manual 2D vs. 3D lung lesion segmentation with and without pre-definition of the volume using a threshold of - 50 HU., Methods: Seventy-five patients with histopathologically proven lung lesions (15 patients each with adenocarcinoma, squamous cell carcinoma, small cell lung cancer, carcinoid, and organizing pneumonia) who underwent an unenhanced CT scan of the chest were included. Three radiologists independently segmented each lesion manually in 3D and 2D with and without pre-segmentation volume definition by a HU threshold, and shape parameters and original, Laplacian of Gaussian-filtered, and wavelet-based texture features were derived. To assess interobserver reliability and identify the most robust texture features, intraclass correlation coefficients (ICCs) for different segmentation settings were calculated., Results: Shape parameters had high reliability (64-79% had excellent and good ICCs). Texture features had weak reliability levels, with the highest ICCs (38% excellent or good) found for original features in 3D segmentation without the use of a HU threshold. A small proportion (4.3-11.5%) of texture features had excellent or good ICC values at all segmentation settings., Conclusion: Interobserver reliability of texture features from CT scans of a heterogeneous collection of manually segmented lung lesions was low with a small proportion of features demonstrating high reliability independent of the segmentation settings. These results indicate a limited applicability of texture analysis and the need to define robust texture features in patients with lung lesions., Key Points: • Our study showed a low reproducibility of texture features when 3 radiologists independently segmented lung lesions in CT images, which highlights a serious limitation of texture analysis. • Interobserver reliability of texture features was low regardless of whether the lesion was segmented in 2D and 3D with or without a HU threshold. • In contrast to texture features, shape parameters showed a high interobserver reliability when lesions were segmented in 2D vs. 3D with and without a HU threshold of - 50., (© 2023. The Author(s).)

Myocardial infarction (MI) may be visible on contrast-enhanced multidetector computed tomography (MDCT) scans of the abdomen. In the previous literature, potentially missed MI in abdominal MDCTs was not perceived as an issue in radiology. This retrospective single-center study assessed the frequency of detectable myocardial hypoperfusion in contrast-enhanced abdominal MDCTs. We identified 107 patients between 2006 and 2022 who had abdominal MDCTs on the same day or the day before a catheter-proven or clinically evident diagnosis of MI. After reviewing the digital patient records and applying the exclusion criteria, we included 38 patients, with 19 showing areas of myocardial hypoperfusion. All MDCT studies were non ECG-gated. The delay between the MDCT examination and MI diagnosis was shorter in studies with myocardial hypoperfusion ( 7.4 ± 6.5 hours and 13.8 ± 12.5 hours) but not statistically significant p = 0.054 . Only 2 of 19 (11%) of these pathologies had been noted in the written radiology reports. The most common cardinal symptom was epigastric pain (50%), followed by polytrauma (21%). STEMI was significantly more common in cases of myocardial hypoperfusion p = 0.009 . Overall, 16 of 38 (42%) patients died because of acute MI. Based on extrapolations using local MDCT rates, we estimate several thousand radiologically missed MI cases worldwide per year., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2023 Talakić, Schöllnast, Kaufmann-Bühler, Hohenberg, Mijovic, Nagy, Fuchsjaeger and Tschauner.)

Competing Interests: E. Talakić, AK. Kaufmann-Bühler, E. Janek, P. Mrak, M, Fuchsjäger, H. Schöllnast declare that they have no competing interests.

Purpose: To evaluate the utility of non-contrast-enhanced CT texture analysis (CTTA) for predicting the histopathological differentiation of pancreatic ductal adenocarcinomas (PDAC) and to compare non-contrast-enhanced CTTA texture features between primary PDAC and hepatic metastases of PDAC., Methods: This retrospective study included 120 patients with histopathologically confirmed PDAC. Sixty-five patients underwent CT-guided biopsy of primary PDAC, while 55 patients underwent CT-guided biopsy of hepatic PDAC metastasis. All lesions were segmented in non-contrast-enhanced CT scans for CTTA based on histogram analysis, co-occurrence matrix, and run-length matrix. Statistical analysis was conducted for 372 texture features using Mann-Whitney U test, Bonferroni-Holm correction, and receiver operating characteristic (ROC) analysis. A p value < 0.05 was considered statistically significant., Results: Three features were identified that differed significantly between histopathological G2 and G3 primary tumors. Of these, "low gray-level zone emphasis" yielded the largest AUC (0.87 ± 0.04), reaching a sensitivity and specificity of 0.76 and 0.83, respectively, when a cut-off value of 0.482 was applied. Fifty-four features differed significantly between primary and hepatic metastatic PDAC., Conclusion: Non-contrast-enhanced CTTA of PDAC identified differences in texture features between primary G2 and G3 tumors that could be used for non-invasive tumor assessment. Extensive differences between the features of primary and metastatic PDAC on CTTA suggest differences in tumor microenvironment., (© 2022. The Author(s).)

Objective: Guidelines for previous negative biopsy (PNB) cohorts with a suspicion of prostate cancer (PCa) after positive multiparametric (mp) magnetic-resonance-imaging (MRI) often favour the fusion-guided targeted prostate-biopsy (TB) only approach for Prostate Imaging-Reporting and Data System (PI-RADS) ≥3 lesions. However, recommendations lack direct biopsy performance comparison within biopsy naïve (BN) vs. PNB patients and its prognostication of the whole mount pathology report (WMPR), respectively. We suppose, that the combination of TB and concomitant TRUS-systematic biopsy (SB) improves the PCa detection rate of PI-RADS 2, 3, 4 or 5 lesions and the International Society of Urological Pathology (ISUP)-grade predictability of the WMPR in BN- and PNB patients., Methods: Patients with suspicious mpMRI, elevated prostate-specific-antigen and/or abnormal digital rectal examination were included. All PI-RADS reports were intramurally reviewed for biopsy planning. We compared the PI-RADS score substratified TB, SB or combined approach (TB/SB) associated BN- and PNB-PCa detection rate. Furthermore, we assessed the ISUP-grade variability between biopsy cores and the WMPR., Results: According to BN ( n  = 499) vs. PNB ( n  = 314) patients, clinically significant (cs) PCa was detected more frequently by the TB/SB approach (62 vs. 43%) than with the TB (54 vs. 34%) or SB (57 vs. 34%) (all p  < 0.0001) alone. Furthermore, we observed that the TB/SB strategy detects a significantly higher number of csPCa within PI-RADS 3, 4 or 5 reports, both in BN and PNB men. In contrast, applied biopsy techniques were equally effective to detect csPCa within PI-RADS 2 lesions. In case of csPCa diagnosis the TB approach was more often false-negative in PNB patients (BN 11% vs. PNB 19%; p  = 0.02). The TB/SB technique showed in general significantly less upgrading, whereas a higher agreement was only observed for the total and BN patient cohort., Conclusion: Despite csPCa is more frequently found in BN patients, the TB/SB method always detected a significantly higher number of csPCa within PI-RADS 3, 4 or 5 reports of our BN and PNB group. The TB/SB strategy predicts the ISUP-grade best in the total and BN cohort and in general shows the lowest upgrading rates, emphasizing its value not only in BN but also PNB patients., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2022 Mischinger, Schöllnast, Zurl, Geyer, Fischereder, Adelsmayr, Igrec, Fritz, Merdzo-Hörmann, Elstner, Schmid, Triebl, Trimmel, Reiter, Steiner, Rosenlechner, Seles, Pichler, Pichler, Riedl, Schöpfer-Schwab, Strobl, Hutterer, Zigeuner, Pummer, Augustin, Ahyai, Mannweiler, Fuchsjaeger and Talakic.)

Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht.

Purpose: To assess correlations of lean body weight (LBW) calculated with various formulas, total body weight (TBW), body height (BH), body mass index (BMI), body surface area (BSA) and fat-free mass (FFM) with vascular and parenchymal enhancement in multiphasic CT of the liver., Method: Thirty consecutive patients underwent multiphasic CT of the liver using constant iodine dose and flow rate. Contrast enhancement of aorta, portal vein and liver was calculated by measuring mean vascular and parenchymal attenuation in pre-contrast and post-contrast phases. Correlations of TBW, BH, BMI, BSA, FFM, and LBW (calculated with formulas of Boer, Hume, James and Green&Duffull) with enhancement were tested using Spearman's correlation coefficient. The method of Fieller et al. was used to calculate 95 % confidence intervals. A p-value ≤ 0.05 was considered statistically significant., Results: Aortal enhancement correlated strongly with TBW, BSA, LBW Boer and LBW Hume and moderately with BH, BMI, FFM, LBW James and LBW Green&Duffull . Liver enhancement in the late arterial phase correlated moderately with TBW, FFM, LBW Boer , LBW Hume and LBW Green&Duffull and weakly with BSA. Liver enhancement in the portal venous phase correlated strongly with TBW, BSA, FFM, LBW Boer , LBW Hume and LBW Green&Duffull , whereby overlap of the 95 % CI graphs demonstrated that the differences in the correlation coefficients were not statistically significant. Liver enhancement in the delayed phase correlated moderately with BH but did not correlate significantly with any other parameter., Conclusion: Regardless of the form used for calculation, LBW did not correlate statistically significantly stronger than TBW with vascular or parenchymal enhancement of the liver., (Copyright © 2021. Published by Elsevier B.V.)

Background/aim: The liver is a frequent site for metastases of colorectal cancer. Approximately 15% of patients have hepatic metastases at the time of diagnosis and another 50% develop them over the course of their disease. Only 10-25% of patients are candidates for liver resection. The aim of this study was to assess the benefit of preoperative computed tomography (CT)-guided wire marking of disappearing colorectal liver metastases (CRLMs) (radiological disappearance of metastases) before surgical resection., Patients and Methods: Between January 2011 and January 2014, 20 patients with potentially disappearing CRLMs were selected for CT-guided wire marking. Following treatment with neoadjuvant chemotherapy, disappearing CRLMs were marked via CT guidance. Afterwards, the marked sites were resected., Results: Complete histological response to neoadjuvant chemotherapy was only in 10 resected sites (18%), and 46 (82%) resected liver metastases showed metastatic tissue present. Both overall survival and the disease-free rates in patients after using our method were 55%., Conclusion: This study demonstrated the usefulness of CT-guided wire marking to mark disappearing CRLMs in order to improve long-term effectiveness of surgical treatment., (Copyright© 2019, International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.)

Rapid advances in imaging technology have improved the detection, characterization and staging of colorectal liver metastases, hepatocellular carcinoma and cholangiocarcinoma. A variety of imaging modalities are available and play a pivotal role in the work-up of patients, particularly as imaging findings determine resectability. Surgery often represents the only measure that can render long-term survival possible. Imaging is also indispensable for the assessment of responses to neoadjuvant treatment and for the detection of recurrence. At a consensus meeting held in June 2017 in Vienna, Austria, Austrian experts in the fields of surgery and radiology discussed imaging requirements prior to and after hepatic surgery for malignant liver lesions. This consensus was refined by online voting on a total of 47 items. Generally, the degree of consensus was high. The recommendations relate to the type of preferred preoperative imaging modalities, technical settings with respect to computed tomography and magnetic resonance imaging, use of contrast agents, reporting, postoperative follow-up, and long-term follow-up. Taking local resources into account, these consensus recommendations can be implemented in daily clinical practice at specialized centers as well as outpatient diagnostic institutes in Austria.

Gastroenteropancreatic neuroendocrine tumors are known for their aggressiveness. Diagnosis of various bile duct pathologies, like biliar intraepithelial neoplasm, mixed adenoneuroendocrine carcinomas or small cell carcinomas, is challenging. This case report focuses on a rare case of a focal primary minute small cell carcinoma in the vicinity of the extrahepatic bile duct, presenting itself next to an extensive biliar intraepithelial neoplasm. This finding led to adjuvant chemotherapy, followed by major surgery. Therapeutic approach was based on CT and MRI scans but most importantly on immunohistochemistry and histological evaluation. Initially CR seemed achievable, but metastases were to be found rapidly. The authors want to underline the fact that major clinical decisions are based on sometimes tiny specimens; as literature shows it is absolutely advisable to use markers to differentiate the dignity of investigated areas. The authors call for keeping collision of tumors in mind and adding KOC staining and using it in a routine manner examining biliary duct lesions., (Copyright© 2015 International Institute of Anticancer Research (Dr. John G. Delinassios), All rights reserved.)