Radiologie (Heidelberg, Germany)最新文献

Background: Trauma-related rotator cuff tears are a common cause of shoulder pain and functional impairment, particularly in younger and middle-aged adults. Accurate imaging is essential for appropriate diagnosis and management. Magnetic resonance arthrography (MRA) is considered superior for evaluating rotator cuff pathology and serves as a reference standard for comparison.

Objective: The aim of this study was to assess the diagnostic accuracy of magnetic resonance imaging (MRI) and ultrasonography in detecting trauma-related rotator cuff tears among adults aged 18-52 years, taking MRA as the gold standard. The study also aimed to evaluate the agreement between imaging modalities within this specific cohort.

Method: A total of 60 shoulders with rotator cuff injuries that were scanned for MRA, MRI, and ultrasound were included in the study. Frequency analysis, cross-tabulation, sensitivity, specificity, and kappa statistics were used to assess the level of agreement between imaging techniques. Paired comparisons between imaging modalities were analyzed using McNemar's test to assess differences in diagnostic performance.

Results: Overall, MRI showed a higher proportion of true-positive detections for supraspinatus (SSP) tears (30.0%) compared to ultrasonography (28.3%), while ultrasonography demonstrated a higher detection rate for subscapularis (SSC) tears. The a sensitivity of MRI for detecting SSP tears was 81.2% and 75% for SSC tears. Age- and gender-based analysis revealed that ultrasonography showed higher true-positive detection in younger patients, whereas MRI showed greater sensitivity in older patients. Kappa statistics demonstrated substantial agreement between MRI and MRA (κ = 0.892) and moderate agreement between ultrasonography and MRA (κ = 0.751).

Conclusion: Ultrasonography and MRI are reliable for diagnosing trauma-related rotator cuff tears in adults aged 18-52 years. Within this age range, MRI performs better in older patients, while ultrasonography is more effective in younger individuals; MRA remains the reference standard.

Radiology has been profoundly transformed by artificial intelligence (AI) over the past decade, enabling automated detection, enhanced diagnostic accuracy, and more personalized patient care. In this study, we performed a bibliometric analysis of the scientific literature on AI in radiology from 2010, aiming to map research trends, identify influential authors and institutions, and uncover emerging thematic areas. Our results show a rapid growth of publications since 2016, with the United States, China, and Germany leading in output. Journals such as the European Journal of Radiology, Academic Radiology, and Clinical Radiology have been the most productive, while keyword analysis revealed emerging topics including explainable AI, multimodal imaging, and AI-assisted clinical decision-making. Collaborative networks among countries and institutions have expanded, reflecting increasing international cooperation. This bibliometric overview highlights the evolving landscape of AI in radiology and provides insights to guide future research and clinical integration.

Objective: To evaluate the clinical value of ultra-low-dose CT (ULDCT) with deep learning image reconstruction (DLIR) in the diagnosis of pulmonary nodules.

Materials and methods: This was a prospective study that included 115 patients with suspected pulmonary nodules who provided informed consent to participate. All patients were examined by both standard-dose CT (SDCT) and ULDCT. The SDCT images were reconstructed with adaptive statistical iterative reconstruction‑V at 40% (ASIR-V40%; group A), while the ULDCT images were reconstructed with ASIR-V40% (group B) and with high-strength DLIR (DLIR‑H; group C). The radiation dose and the number of detected lung nodules of both scanning modes were recorded. The CT values and noise values (SD) of lung tissue, aorta, and muscle were measured, and the signal-to-noise ratio (SNR) was calculated. Overall image quality and malignant signs of lung nodules were evaluated in a double-blind manner and analyzed using the pathological diagnosis as the gold standard. Measurements were statistically compared between ULDCT and SDCT.

Results: The radiation dose of ULDCT was 0.25 ± 0.08 mSv, that is, a 92.6% reduction compared with the 3.38 ± 0.97 mSv of SDCT (P < 0.001). There was no significant difference in CT values of the lung, aorta, and muscle among the three groups (all P > 0.05). There was no difference in SD, SNR, subjective diagnostic confidence, and malignant signs of pulmonary nodules between groups A and C (P > 0.05), but these parameters were all better than in group B (P < 0.05). The agreement between the two observers on malignant signs was high (kappa = 0.81). The number of pulmonary nodules detected in groups A, B, and C was 247, 238, and 247, respectively.

Conclusion: Image quality obtained using ULDCT with DLIR‑H is comparable to that of SDCT with ASIR-V40%. The ULDCT method enables excellent detection and diagnosis of nodules with significant dose reduction.

Background and aim: Preserving accessory pudendal arteries (APAs) after radical prostatectomy is crucial for optimal postoperative sexual function. Our study aimed to describe the detailed anatomy of the APA and its anatomical variations using computed tomography angiography (CTA), thereby providing crucial information for surgical planning and potentially improving postoperative outcomes.

Materials and methods: This retrospective study evaluated the cases of 65 male patients (130 hemipelves) who underwent CTA examination for peripheral vascular disease between January and June 2017. The requirement for informed consent was waived due to the retrospective nature of the study. The mean age of the participants was 52.50 ± 19.09 years (range: 36-84 years). All CTA examinations were performed using 128 multislice CT scanners with patients in the supine position.

Results: Accessory pudendal arteries were detected in 96 (74%) hemipelves. Among in hemipelves, 30 (23%) followed an apical course and 66 (77%) followed an anterolateral course. Of the remaining anterolateral APAs, 18 were left-sided, 26 were right-sided, and 22 were bilateral. Of the apical APAs, 12 were left-sided, 10 were right-sided, and eight were bilateral. Most APAs originated from the inferior vesical artery, followed by the internal obturator artery.

Conclusion: Computed tomography angiography represents a useful noninvasive imaging tool for identifying APAs before prostate surgery, aiding preoperative planning and potentially supporting the preservation of postoperative sexual function. The prevalence of APAs detected by CTA was similar to that reported in cadaveric studies and higher than that observed in laparoscopic reports, highlighting the value of CTA in preoperative assessment.

Clinical/methodical issue: Allergic bronchopulmonary aspergillosis (ABPA) is a rare but potentially severe hypersensitivity reaction to Aspergillus fumigatus, primarily affecting patients with asthma or cystic fibrosis. Early diagnosis is crucial to prevent irreversible lung damage.

Standard radiological methods: High-resolution computed tomography (HRCT) is the standard imaging method for detecting bronchiectasis and other typical findings. Common features include central, saccular bronchiectasis, mucus impaction, and centrilobular micronodules. Radiological assessment must be closely integrated with clinical and laboratory parameters.

Methodical innovations: The revised 2024 International Society for Human and Animal Mycology (ISHAM) criteria further emphasize the diagnostic importance of radiological features. High-attenuation mucus (HAM) is considered a highly specific finding and may confirm the diagnosis. Modern classification systems allow more precise disease staging.

Performance: HRCT provides extremely high sensitivity for the radiological hallmarks of ABPA. Detection of HAM is regarded as nearly pathognomonic. Fleeting infiltrates and reversible changes are reliably visualized. Correlating radiological findings with laboratory parameters significantly improves diagnostic accuracy.

Achievements: HRCT remains the indispensable imaging modality for diagnosing and monitoring ABPA.

Practical recommendations: In cases of clinical suspicion, early HRCT of the thorax should be performed. A combination of radiological findings and serological criteria is recommended to confirm the diagnosis. HRCT can be used to detect reversible infiltrates and assess response to treatment.

Clinical/methodical issue: Eosinophilic pneumonias are rare inflammatory lung diseases with heterogeneous clinical presentation and variable computer tomography (CT) patterns. Overlap with infectious, drug-induced, or neoplastic entities poses a diagnostic challenge in radiological practice.

Standard radiological methods: High-resolution computed tomography (HRCT) is the key imaging modality. Typical findings range from transient ground-glass opacities to peripheral, nonsegmental consolidations. CT allows assessment of distribution, temporal evolution, and relevant differential diagnoses.

Methodical innovations: Advanced imaging techniques currently play a minor role. Quantitative CT and artificial intelligence (AI)-based pattern analysis are under investigation but not yet implemented in routine clinical practice.

Performance: CT provides high sensitivity for detecting parenchymal abnormalities but limited specificity. Diagnostic accuracy relies on the integration of imaging findings with clinical data, laboratory results, and response to corticosteroid therapy.

Achievements: CT is a well-established and indispensable tool for diagnosis and follow-up. Novel techniques remain largely experimental.

Practical recommendations: In the presence of characteristic CT patterns and compatible clinical findings, eosinophilic pneumonia should be considered early. Lack of response to corticosteroids should prompt reassessment of the diagnosis.

Drug-induced hypersensitivity reactions (DIHR) represent a broad spectrum of immune-mediated disorders that occur after exposure to medications and can affect various organ systems. The most important entities include drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome, Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN, Lyell's syndrome), serum sickness, drug-induced eosinophilic pneumonias, and hypersensitivity pneumonitis. Pulmonary manifestations are common and can have a decisive impact on the clinical course. This review article explains the immunological foundations, pathogenesis, and etiology of drug-induced hyperreactivity disorders, describes their clinical relevance, and presents the typical thoracic manifestations and imaging patterns in chest computed tomography (CT). The focus is on the importance of radiological diagnostics for the early detection and differentiation of these potentially life-threatening conditions.

The imaging-based assessment of response to treatment is essential for treatment planning and outcome prediction in oncology. Standardized classification systems enable reproducible follow-up assessments and improve comparability in the clinical practice and research. Depending on the tumor type and treatment approach different evaluation criteria and imaging modalities are applied. Metabolic information plays a central role in the assessment of hematological diseases and is gaining relevance in the assessment of solid tumors, which have previously been evaluated primarily based on their size. Additionally, the mechanism of action of the respective treatment should be considered, such as an expected size reduction after chemotherapy, altered contrast agent uptake after locoregional therapy or atypical response patterns, such as pseudoprogression after immunomodulatory therapy, which make repeated follow-up imaging mandatory. This article provides a structured overview of clinically relevant imaging-based response criteria and their specific applications.