Acta radiologica open最新文献

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.

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.

We report a case demonstrating the evolution of diffusion lacunae (DL) into thrombus, supported by serial MRI and MR-pathologic correlation. A 36-year-old woman with a pregnancy achieved via frozen-thawed embryo transfer presented with complete placenta previa and vaginal bleeding. MRI at 27 weeks of gestation revealed an irregular intraplacental hypointense area on diffusion-weighted imaging corresponding to DL. Follow-up MRI at 32 weeks showed that the DL had become less discernible and appeared hyperintense, similar to the surrounding placenta. On the following day, the patient developed hemorrhagic shock and underwent emergency cesarean delivery, without evidence of placental adherence and decidual deficiency, indicating that the DL represented a placental lake rather than placental lacunae. Histopathologic examination demonstrated a paucity of chorionic villi and thrombus formation with lines of Zahn in the DL area. These findings provide direct evidence that DL may undergo thrombus formation over time, reflecting dynamic changes related to blood flow stasis within the placenta.

Background: Gastroepiploic artery aneurysms (GEAAs) and their rupture are very rare but often serious. However, emergency management has yet to be standardized.

Purpose: To clarify the clinical features of GEAAs and outcomes of transcatheter arterial embolization (TAE).

Materials and methods: This is a retrospective, single-center 12 case series of GEAAs experienced between 2006 and 2023. We reviewed medical records to determine the case background, angiographic images, TAE techniques and success rate, and outcomes. Abdominal angiography was performed via the femoral artery to identify the inflow and outflow vessels of the GEAAs. Subsequently, a microcatheter was advanced to the target site, and embolization was performed with microcoils and/or NBCA-Lipiodol mixture.

Results: Nine ruptured and one unruptured pseudo-GEAA cases were treated by emergency TAE, while the remaining two unruptured cases were treated electively. The average diameter of the ruptured GEAAs was 7.9 mm. The most common underlying diseases were segmental arterial mediolysis in 4 cases. Morphological classification revealed 5 cases of dissecting, 4 of pseudo, and 3 of true. TAE was successful in seven of the nine ruptured and in all three unruptured cases. Two patients with ruptured GEAAs after unsuccessful TAE were subsequently saved by surgery. TAE using the triple coaxial catheter system was performed in 7 cases with good results.

Conclusions: Even small-diameter GEAAs can rupture, resulting in life-threatening conditions, but emergency TAE is safe and effective. However, there are some cases in which TAE fails, so it is important to make a prompt decision to proceed to surgical treatment.

Background: Sacroiliac joint (SIJ) disorders are among the most common causes of chronic low back pain. Imaging-guided SIJ injections are widely used as an early diagnostic tool, with corticosteroid often added to provide a therapeutic component. Evidence of factors predicting the therapeutic outcome of these injections remains scarce.

Purpose: To evaluate the effect of SIJ osteoarthritis and other potentially relevant demographic, imaging, and procedural factors on the patient-reported therapeutic outcome of imaging-guided SIJ injection.

Material and methods: This retrospective single-center study included 101 patients who underwent specialist-referred imaging-guided SIJ injection between 2010 and 2023. Medical records and procedural reports were reviewed to collect relevant patient information, and associated SIJ MRIs and CT scans were reanalyzed for osteoarthritis, sacroiliitis, and bone marrow edema by an experienced musculoskeletal radiologist. The association of demographic, imaging, and procedural factors with the therapeutic injection outcome was assessed using logistic regression modeling.

Results: Of 101 patients who underwent an imaging-guided SIJ injection, 72 (71.3%) met the inclusion criteria. The mean age was 52.2 (SD 14.2) years, and 30 patients (41.7%) achieved a positive therapeutic response. Increasing age was significantly associated with a lower likelihood of a positive outcome, with the probability decreasing on average by 9.4% for each additional year of age (OR 0.91 [95% CI 0.84-0.99]). Neither SIJ osteoarthritis grade nor other demographic, imaging, or procedural factors showed a significant association with injection outcome.

Conclusion: Increasing age was significantly associated with a lower likelihood of achieving a positive therapeutic SIJ injection outcome, while SIJ osteoarthritis grade showed no association.

Background: CT-guided percutaneous bone biopsy is a minimally invasive and effective procedure for evaluating and diagnosing bone lesions.

Purpose: To evaluate the diagnostic yield, tumor types, and complication rates of CT-guided percutaneous bone biopsy procedures at a single tertiary institution.

Materials and methods: This retrospective study analyzed 508 biopsy procedures performed on 473 patients between March 2019 and March 2024. Patients were identified through the RIS/PACS system at Aarhus University Hospital. Data on diagnostic yield, tumor types, and complications were retrospectively reviewed and collected from electronic health and histopathology records. Complications were classified according to the Society of Interventional Radiology (SIR) and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) classification systems.

Results: The most common findings were metastatic lesions (n = 234), with breast cancer being the most frequent primary tumor. The procedures resulted in an overall diagnostic yield of 88.7% and a total complication rate of 5.5%.

Conclusion: This study demonstrates that CT-guided percutaneous bone biopsy is a reliable method with a high diagnostic yield and a low complication rate. These findings support its continued role as a key diagnostic tool in the clinical management of bone lesions.

Background: Calcification of abdominal arteries is an important risk marker in vascular disease. Automated, objective quantification methods could improve reproducibility and reduce observer dependency in clinical practice.

Purpose: To develop and evaluate a deep learning method for quantifying abdominal arterial calcification from contrast-enhanced CT angiography (CTA).

Material and methods: We retrospectively collected 223 CTA volumes, divided into 147 training and 76 test cases. Ground truth calcification segmentations were manually annotated, while vessel segmentations were generated by a previously trained neural network and manually refined. Two nnU-Net models were trained, one for artery segmentation and one for calcification segmentation. Renal, mesenteric, and common iliac arteries were shortened algorithmically. Performance of the models was evaluated using Dice score, volumetric similarity, sensitivity, precision, and Jaccard index. Calcification burden was defined as the ratio of calcified volume to artery volume. The amount and the average size of calcification clusters were investigated. The performance of the method was benchmarked against an idealized threshold-based approach and a more clinically realistic approach.

Results: The neural network achieved performance comparable to the optimized threshold-based method, with slight improvements across several segmentation metrics. Dice scores and volumetric similarity demonstrated reliable vessel and calcification detection. The predicted calcification burden score showed high correlation with the ground truth calcification burden score.

Conclusion: The proposed deep learning tool enables fast, reproducible, and observer-independent quantification of calcification in major abdominal vessels, offering a practical alternative to manual or threshold-based scoring methods.

A 41-year-old woman with placenta previa and a prior cesarean delivery presented with placenta accreta spectrum (PAS). MRI at 26 weeks of gestation demonstrated an intraplacental hypointense region on diffusion-weighted imaging corresponding to diffusion lacunae (DL). Additionally, irregular hypointense areas on T2-weighted imaging corresponding to T2 dark bands were observed. The entire placenta and uterine wall were sectioned through close collaboration between pathologists and radiologists to match the axial MRI slice plane. MR-pathologic correlation was performed using representative axial MRI and histopathologic findings. Histopathology revealed that DL corresponded to villous-devoid areas suggesting placental lacunae with recent thrombi, whereas T2 dark bands predominantly represented thrombi with lines of Zahn, reflecting the gradual development of thrombi under conditions of blood stasis with residual blood flow. These two MRI findings may therefore represent sequential stages within the same pathological process in PAS.

Musculoskeletal complications secondary to pancreatitis, including polyarthritis, panniculitis, and bone infarction (Pancreatitis Panniculitis Polyarthritis syndrome), are rare and under-recognized. We report a case of a 31-year-old man with alcohol use disorder who initially presented with acute pancreatitis. Two months later, he developed migratory polyarthritis and subcutaneous nodules. Radiographs revealed permeative bone lesions, and MRI demonstrated multiple bone infarcts. Subcutaneous biopsy confirmed panniculitis. His clinical course was complicated by infected pancreatic necrosis and splanchnic vein thromboses. Joint symptoms improved with aggressive treatment of pancreatitis. Early imaging evaluation is essential in patients with pancreatitis and musculoskeletal symptoms. Recognition of bone infarctions and panniculitis should prompt consideration of systemic pancreatic complications.