Diagnostic and interventional radiology最新文献

{"title":"Ultrasound-guided coaxial aspiration for retrieval and repositioning of breast localization markers.","authors":"Cihan Özgür","doi":"10.4274/dir.2026.264282","DOIUrl":"https://doi.org/10.4274/dir.2026.264282","url":null,"abstract":"<p><p>Breast localization marker migration or malposition may create a practical need for image-guided retrieval or repositioning. The technique was performed in two patients using a coaxial needle system and aspiration-assisted marker capture. In both cases, the displaced marker was identified sonographically and accessed with a coaxial needle. Controlled aspiration drew the marker into the coaxial needle, followed by repositioning to the targeted area or removal from the body. No immediate complications occurred. Ultrasound-guided coaxial aspiration may represent an alternative in selected cases of migrated or malpositioned markers when standard vacuum-assisted excision is technically disadvantageous.</p>","PeriodicalId":11341,"journal":{"name":"Diagnostic and interventional radiology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149105639","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"From signal to reasoning: Computational bottlenecks in the evolution of artificial intelligence in radiology.","authors":"Şükrü Mehmet Ertürk, Sıtkı Safa Taflan","doi":"10.4274/dir.2026.264457","DOIUrl":"https://doi.org/10.4274/dir.2026.264457","url":null,"abstract":"<p><p>Artificial intelligence (AI) in radiology is often described as a sequence of architectures. This conceptual narrative review instead organizes its evolution around two questions: Which computational constraint was relaxed, and where did the resulting capability enter the radiologic chain from signal formation to recommendation? We identify five analytical epochs: handcrafted computer-aided detection, deep and volumetric learning, a branching stage of global-context modeling and learned reconstruction, multimodal foundation models, and an emerging stage of inference-stage reasoning. Epochs I-IV are characterized primarily by changes in representation or image formation; Epoch V shifts the frontier toward adaptive case-specific inference, for which radiology-specific evidence remains largely preclinical. The framework also generates a clinical prediction: Verification should be matched to the level of participation and its characteristic failure mode. Existing studies provide partial empirical support, but later-stage verification requirements remain framework-derived proposals rather than established standards.</p>","PeriodicalId":11341,"journal":{"name":"Diagnostic and interventional radiology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149079712","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes of ultrasound-guided and conventional Angio-Seal closure following antegrade femoral artery access: a systematic review and meta-analysis of observational studies with an exploratory indirect comparison.","authors":"Krishna Prasad Bellam Premnath, Mohd Shariq, Shubhada Yadavrao Bansode, Mahmoud Elsakhawy, Mohd Shadab Siddique","doi":"10.4274/dir.2026.264087","DOIUrl":"https://doi.org/10.4274/dir.2026.264087","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;Vascular closure devices (VCDs), particularly the Angio-Seal device, are widely used for rapid hemostasis following antegrade femoral artery access during peripheral vascular interventions. However, the comparative safety and efficacy of ultrasound-guided vs. conventional non-ultrasound-guided antegrade femoral access closure with Angio-Seal have not been quantified. This meta-analysis synthesizes available evidence comparing these approaches in patients undergoing antegrade femoral artery access closure with Angio-Seal devices.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Relevant studies were systematically identified through searches of the PubMed and Google Scholar databases. Studies examining the Angio-Seal closure device for antegrade femoral artery access closure with ultrasound-guided and conventional (without ultrasound guidance) techniques and comparing the two techniques were included. Given the limited direct comparative evidence, pooled outcomes from ultrasound-guided and non-ultrasound-guided cohorts were evaluated. The primary endpoints were technical success rates, major complications, and minor complications. Study quality was assessed using the Newcastle-Ottawa Scale, and data were extracted systematically. A meta-analysis was conducted using random-effects models, with odds ratios (ORs) and 95% confidence intervals (CIs) as effect measures. In addition, Grading of Recommendations Assessment, Development, and Evaluation (GRADE) analysis of the certainty of the obtained evidence was performed.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The search identified 15 studies comprising 4,782 antegrade femoral access closures using the Angio-Seal device. The pooled technical success rate was 96.3% (95% CI: 0.93-0.98), with considerable heterogeneity (I&lt;sup&gt;2&lt;/sup&gt;: 86%). Major complications were rare, with a pooled rate of 1.1% (95% CI: 0.01-0.02), whereas minor complications occurred in 3.4% (95% CI: 0.03-0.09) of procedures. Substantial and considerable hetereneity was observed for major and minor complications (I&lt;sup&gt;2&lt;/sup&gt;: 66% and 90%, respectively). Comparative analysis demonstrated higher technical succes with ultrasound-guided closure than with conventional techniques, corresponding to significantly lower odds of technical failure with ultrasound guidance (OR: 0.13, 95% CI: 0.019-0.962; P = 0.014; GRADE certainty: very low) and significant reduction in the rate of major complications(OR: 0.2, 95% CI: 0.072-0.558; P = 0.00027; GRADE analysis: low); minor complication rates were similar between techniques (OR: 0.82, 95% CI: 0.567-1.19; &lt;i&gt;P&lt;/i&gt; = 0.3).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Angio-Seal closure following antegrade femoral access demonstrates high technical success and low complication rates across available studies. Ultrasound-guided deployment was associated with higher technical success and reduced major complications in the pooled analysis. However, the evidence is derived primarily from observational studies wi","PeriodicalId":11341,"journal":{"name":"Diagnostic and interventional radiology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149073867","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"When the radiologist remains: Reverse alignment and the final biological component.","authors":"Şükrü Mehmet Ertürk","doi":"10.4274/dir.2026.262809","DOIUrl":"https://doi.org/10.4274/dir.2026.262809","url":null,"abstract":"","PeriodicalId":11341,"journal":{"name":"Diagnostic and interventional radiology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149073897","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pediatric thoracic magnetic resonance imaging: current evidence, technical advances, and clinical integration.","authors":"Emre Ruhat Avcı, Fatma Ceren Sarıoğlu, Beste Özsezen, Handan Güleryüz Uçar","doi":"10.4274/dir.2026.264257","DOIUrl":"https://doi.org/10.4274/dir.2026.264257","url":null,"abstract":"<p><p>This review summarizes established, emerging, and investigational techniques in pediatric thoracic magnetic resonance (MR) imaging (MRI), with emphasis on practical protocol optimization, motion mitigation, clinical implementation, and modality selection relative to computed tomography (CT). Thoracic MRI remains technically challenging because of low proton density, short apparent transverse relaxation time, and continuous cardiorespiratory motion. Conventional fast and motion- robust sequences, including single-shot T2-weighted imaging, three-dimensional T1-weighted spoiled gradient echo imaging, short tau inversion recovery, balanced steady-state free precession, and periodically rotated overlapping parallel lines with enhanced reconstruction/BLADE, are well established and form the basis of routine clinical protocols. Contrast-enhanced MR angiography, perfusion imaging, diffusion-weighted imaging, and dynamic functional imaging are clinically available for selected indications, particularly in experienced centers. In contrast, ultrashort and zero echo time imaging remain emerging techniques because availability, reconstruction, and implementation vary across vendors and institutions. Non-contrast functional approaches, including Fourier decomposition and arterial spin labelling, remain predominantly investigational, and hyperpolarized gas MRI is primarily research-oriented and requires specialized infrastructure. Protocols should be adapted to patient age, cooperation, and the clinical question, using coaching, feed-and-wrap, sedation, or anesthesia when necessary. Magnetic resonance imaging can replace or complement CT in selected settings, including serial assessment of complicated pneumonia, cystic fibrosis, congenital thoracic abnormalities, mediastinal lesions, chest wall disorders, and selected vascular conditions. However, CT remains the reference standard for rapid emergency assessment, subtle interstitial abnormalities, and very small pulmonary nodules. Wider adoption of advanced MRI techniques will require protocol standardization, automated reconstruction and post-processing, cross-platform reproducibility, and prospective multicenter validation.</p>","PeriodicalId":11341,"journal":{"name":"Diagnostic and interventional radiology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149069388","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors associated with histologic upgrade following surgical excision of breast papillomas: a retrospective multicenter study.","authors":"Nurper Denizoğlu, Füsun Taşkın, Gül Esen İçten, Ayşenur Oktay, Özge Aslan, Nermin Tunçbilek, Pınar Balcı, Erkin Arıbal, Levent Çelik, Şebnem Örgüç, Figen Demirkazık, Serap Gültekin, Ayşe Murat Aydın, Emel Durmaz, Sibel Kul, Figen Binokay, Meltem Çetin, Ganime Dilek Emlik, Meltem Gülsün Akpınar, Nuray Voyvoda, Ahmet Veysel Polat, Işıl Başara Akın, Şeyma Yıldız, Necdet Poyraz, Arzu Özsoy, Pelin Öztekin, Eda Elverici, İlkay Koray Bayrak, Türkan İkizceli, Alev Dolu, Funda Dinç, Gülten Sezgin, Gökçe Gülşen, Işıl Tunçbilek, Sabiha Rabia Yalçın, Gül Çolakoğlu, Serpil Ağlamış, Ravza Yılmaz, Günay Rona, Gamze Durhan, Davut Can Güner, Fatma Çelik Yabul, Leman Günbey Karabekmez, Burçin Tutar, Muhammet Göktaş, Onur Buğdaycı, Fatma Tokat, Mustafa Ege Şeker, Cihan Uras","doi":"10.4274/dir.2026.264219","DOIUrl":"https://doi.org/10.4274/dir.2026.264219","url":null,"abstract":"<p><strong>Purpose: </strong>This study aimed to determine malignant, high-risk, and overall diagnostic upgrade rates after surgical excision of image-guided biopsy-proven intraductal papillomas and to identify factors associated with overall diagnostic upgrade.</p><p><strong>Methods: </strong>In this retrospective multicenter study, 527 surgically excised papillary lesions from 30 centers were evaluated. Malignant upgrade was defined as malignancy at excision after a biopsy diagnosis of papilloma with or without atypia; high-risk upgrade was defined as a high-risk lesion at excision after papilloma without atypia. Overall diagnostic upgrade comprised either outcome. Multivariable logistic regression assessed age, lesion size, risk status, presence of symptoms, and radiologic-pathologic concordance.</p><p><strong>Results: </strong>Papilloma without atypia accounted for 407 lesions, and papilloma with atypia for 120. The overall malignant upgrade rate was 21.4% (113/527). Among papillomas without atypia, high-risk and malignant upgrade rates were 19.7% (80/407) and 14.2% (58/407), respectively; among papillomas with atypia, malignant upgrade was 45.8% (55/120). Overall diagnostic upgrade occurred in 36.6% (193/527). Multivariable analysis identified older age [odds ratio (OR), 1.03 per year; 95% confidence interval (CI), 1.02-1.05], larger lesion size (OR, 1.02 per mm; 95% CI, 1.00-1.03), presence of symptoms (OR, 1.69; 95% CI, 1.15-2.49), and radiologic-pathologic discordance (concordance OR, 0.54; 95% CI, 0.35-0.84) as independent predictors of upgrade. Microcalcifications (OR, 2.47; 95% CI, 1.27-4.85) and asymmetry (OR, 2.18; 95% CI, 1.12-4.25) on mammography were also significantly associated with upgrade.</p><p><strong>Conclusion: </strong>In this retrospective multicenter cohort of surgically excised, biopsy-proven papillary lesions, atypia and several clinical and imaging factors were associated with diagnostic upgrade. These findings may support individualized management decisions in patients with papillary breast lesions.</p><p><strong>Clinical significance: </strong>Identifying clinical and imaging predictors of upgrade may facilitate risk-adapted management of papillary breast lesions and help avoid unnecessary surgical excision in carefully selected patients.</p>","PeriodicalId":11341,"journal":{"name":"Diagnostic and interventional radiology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149024319","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Catheter-directed aspiration thrombectomy with the indigo system for intermediate- and high-risk pulmonary embolism in older patients: preliminary findings from a single-center experience.","authors":"Xiaojiang Wang, Yingjie Chen, Wei Yu, Jixiang Liu, Ziyang Zhu, Lu Sun, Hui Wei, Min Liu, Fajiu Li, Chenghong Li","doi":"10.4274/dir.2026.264127","DOIUrl":"https://doi.org/10.4274/dir.2026.264127","url":null,"abstract":"<p><strong>Purpose: </strong>Percutaneous mechanical thrombectomy (PMT) is a promising treatment for pulmonary embolism (PE), especially in older patients at high bleeding risk. This study assessed its safety and efficacy in patients with acute PE aged over 75 years.</p><p><strong>Methods: </strong>Using data from the prospective, multicenter China Pulmonary Thromboembolism Registry Study (NCT02943343), this study included all consecutive patients aged > 75 years with confirmed PE who underwent catheter-directed aspiration thrombectomy using the Indigo Aspiration System at the Affiliated Hospital of Jianghan University between April 2020 and November 2024. The efficacy of PMT included improvements in hemodynamics, vital signs, dyspnea, and cardiac function. The safety endpoints were the incidence of major adverse events and major bleeding.</p><p><strong>Results: </strong>Of the 673 patients screened, 202 received PMT, and the data of 60 patients were analyzed. After the procedure, heart rate significantly decreased by an average of 4.40 bpm (5.1%, <i>P</i> = 0.007) and mean pulmonary arterial pressure significantly improved by 3.40 mmHg (13.3%, <i>P</i> < 0.001). At 48 hours post-procedure, N-terminal pro-brain natriuretic peptide (NT-proBNP) levels significantly decreased from 2,102.3 (556.5, 3,772.0) to 898.6 (561.1, 1,670.6) pg/mL (<i>P</i> < 0.001) and Modified Medical Research Council dyspnea scores improved from 2.52 ± 1.24 pre-procedure to 1.22 ± 1.03 (<i>P</i> < 0.001). Subgroup analysis revealed that patients with a low clot burden also had significant improvements in heart rate, NT-proBNP, and dyspnea score after surgery. No major bleeding occurred within 3 months.</p><p><strong>Conclusion: </strong>PMT is safe and effective for older patients with acute PE. Potential advantages include immediate hemodynamic improvements, significant symptom alleviation, and recovery of right ventricular function, accompanied by minimal adverse events.</p><p><strong>Clinical significance: </strong>Percutaneous mechanical thrombectomy is safe and effective in elderly patients with acute pulmonary embolism, including those at high bleeding risk, providing rapid hemodynamic and functional improvement with low major adverse events. Even patients with low clot burden derive clinical benefit.</p>","PeriodicalId":11341,"journal":{"name":"Diagnostic and interventional radiology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148976231","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of contrast-enhanced ultrasound-guided fine needle aspiration biopsy in thyroid nodule diagnosis: a study from two tertiary referral centers.","authors":"Ke-Xin Lou, Yi-Feng Zhang, Ji Ma, Long Liu, Rong Wu, Jia Zhan","doi":"10.4274/dir.2026.264246","DOIUrl":"10.4274/dir.2026.264246","url":null,"abstract":"<p><strong>Purpose: </strong>This study aimed to compare the final definitive diagnosis (FDD) rate and accuracy of contrast-enhanced ultrasound (CEUS)-guided fine-needle aspiration biopsy (FNAB) with conventional US-guided FNAB.</p><p><strong>Methods: </strong>A two-center study was conducted to compare the diagnostic performance of FNAB with or without CEUS guiding between April 2014 and April 2024. In center 1, 1,074 patients with thyroid nodules who had undergone FNAB were retrospectively evaluated. Among them, 526 nodules were guided by CEUS, and 548 nodules were guided by conventional US. In center 2, 382 patients were included for a prospective study; 91 nodules received CEUS-guided FNAB and 291 nodules received conventional US-guided FNAB. The rate of non-diagnosis and indeterminate results of the two kinds of FNAB were calculated, and the FDD rate and diagnostic accuracy were compared in the two centers.</p><p><strong>Results: </strong>In the retrospective study, there were significant differences between FNABs guided by CEUS and those guided by conventional US in the non-diagnostic rates (0.4% vs. 6.2%, <i>P</i> < 0.001) and indeterminate rates (4.4% vs. 11.1%, <i>P</i> < 0.001); the rates of FDD were 93.3% vs. 77.9%, (<i>P</i> < 0.001), and the accuracy was 99.8% vs. 98.1 (<i>P</i> = 0.015). In the prospective study, the non-diagnostic rates were 8.8% vs. 11.0% in the two groups (<i>P</i> = 0.695), and the indeterminate rates were 1.1% vs. 9.6% (<i>P</i> < 0.001); the rate of FDD was 80.2% vs. 69.7%, (<i>P</i> = 0.018), and the accuracy was 100% vs. 94.4, (<i>P</i> = 0.039).</p><p><strong>Conclusion: </strong>CEUS-guided FNAB appears to have additional benefits in FDD and accuracy compared with conventional US-guided FNAB.</p><p><strong>Clinical significance: </strong>CEUS-guided FNAB can reduce repeat FNABs and diagnostic surgeries.</p>","PeriodicalId":11341,"journal":{"name":"Diagnostic and interventional radiology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148976189","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Arteriography- and portography-guided vascular mapping for clustered electrode placement in pancreatic irreversible electroporation.","authors":"Man-Deuk Kim, Joon Ho Kwon, Jiwon Suk, Seung Jeong","doi":"10.4274/dir.2026.264280","DOIUrl":"https://doi.org/10.4274/dir.2026.264280","url":null,"abstract":"<p><strong>Purpose: </strong>To assess the feasibility, safety, and early imaging outcomes of an intraprocedural vascular mapping workflow integrating selective arteriography and/or portography to guide clustered electrode irreversible electroporation (IRE) for locally advanced pancreatic cancer (LAPC).</p><p><strong>Methods: </strong>In this single-center retrospective study, 48 patients with LAPC underwent percutaneous IRE (August 2024-December 2025). Selective arteriography (97.9%) and portography (75.0%) delineated the peripancreatic vascular anatomy. Clustered electrodes were supplemented as required. Technical success was defined as completion of the angiographic mapping workflow with planned electrode placement. The ablation zone-to-tumor size ratio was measured using intraprocedural computed tomography (CT) and early imaging response on the first follow-up CT.</p><p><strong>Results: </strong>The technical success rate was 100%. Selective arteriography was performed in 47/48 patients (97.9%) and portography in 36/48 (75.0%). Supplemented clustered electrode configurations were used in 44/48 patients (91.7%), and electrode repositioning was required in 3/48 (6.3%). Intraprocedural complications, both bleeding events, occurred in 2/48 patients (4.2%). Portal vein (PV) stent placement was performed in 11/48 patients (22.9%), with stent-related complications in 2/11 (18.2%)-one with systemic sepsis and one with PV thrombosis with intrahepatic extension. The ablation zone-to-tumor size ratio was ≥ 1.0 in all 48 patients (median, 1.29; range, 1.12-1.69). Imaging response was evaluable in 40/48 patients (83.3%) at a median of 85 days, with stable disease in 38/40 (95.0%) and progressive disease in 2/40 (5.0%).</p><p><strong>Conclusion: </strong>Standardized vascular mapping supports consistent clustered electrode placement during pancreatic IRE in patients with LAPC, achieving complete ablation zone coverage in all patients.</p><p><strong>Clinical significance: </strong>A standardized intraprocedural vascular mapping workflow using selective arteriography and portography supports reproducible clustered electrode placement during pancreatic IRE, achieving complete ablation zone coverage on intraprocedural CT in all cases and providing real-time anatomic guidance for safer electrode trajectory planning. This technical success provides a procedural framework for further evaluation of oncologic outcomes in prospective studies.</p>","PeriodicalId":11341,"journal":{"name":"Diagnostic and interventional radiology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148967190","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Examining the current image-guided biopsy and empiric antibiotic paradigm for suspected spondylodiscitis.","authors":"Frederick W Ott, Caleb D Hoover, Jordan A Helmer, Tanner L Nordseth, Kevin Ehlers, Russell Pluhm, Mark Folkertsma, Can Özütemiz, Jeffrey B Rykken","doi":"10.4274/dir.2026.263922","DOIUrl":"https://doi.org/10.4274/dir.2026.263922","url":null,"abstract":"<p><strong>Purpose: </strong>This study aims to identify factors associated with successful pathogen isolation via percutaneous image-guided biopsy (IGB) in suspected spondylodiscitis, compare diagnostic value between fluoroscopy and computed tomography (CT) guided IGB, evaluate the influence of empiric antibiotics prior to biopsy, and assess the impact of IGB results on clinical management and patient outcomes.</p><p><strong>Methods: </strong>This retrospective study examined 81 IGBs (62 CT-guided, 19 fluoroscopy-guided) performed for suspected spondylodiscitis between March 2014 and February 2025. Retrospective diagnosis was determined using a composite of biopsy microbiology, clinical criteria, and radiologic findings. Primary analyses included IGB culture yield (procedural diagnostic return), as well as sensitivity, specificity, and diagnostic accuracy. Subgroup analyses included biopsy modality and prior antibiotic administration.</p><p><strong>Results: </strong>The overall culture yield was 37.0%, with a sensitivity of 44.4% and a specificity of 88.9%. Culture yield did not differ significantly among patients who received antibiotics prior to biopsy (36.4%) and those who did not (37.8%; <i>P</i> = 0.890). Similarly, no significant difference in yield was observed between CT-guided (38.7%) and fluoroscopic IGB (31.6%; <i>P</i> = 0.586). No significant difference was observed between the coaxial devices used for either transpedicular bone biopsy (<i>P</i> = 0.604) or disc biopsy/aspiration (<i>P</i> = 1.000). Excluding tuberculosis (TB) case, 97% of cultured organisms were susceptible to the institution's standard empiric antibiotic regimen of vancomycin and ceftriaxone.</p><p><strong>Conclusion: </strong>In cases of suspected spondylodiscitis, IGB demonstrated low sensitivity and rarely altered clinical management during the study. Culture yield was not significantly diminished by prior antibiotic therapy, and 97% of cultured organisms (excluding TB) were susceptible to this institution's standard empiric antibiotics. Furthermore, the relative infrequency of positive cultures suggests that empiric antibiotic initiation should not be delayed solely for the purpose of biopsy in clinically stable patients with characteristic magnetic resonance imaging findings and elevated inflammatory markers. Although the findings in this single-center retrospective study support consideration of a more selective use of IGB, further multicenter studies and meta-analyses are warranted.</p><p><strong>Clinical significance: </strong>If additional larger studies corroborate these findings, this could result in a paradigm shift for the clinical management of suspected spondylodiscitis.</p>","PeriodicalId":11341,"journal":{"name":"Diagnostic and interventional radiology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148967139","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}