{"title":"Comparison of three-tesla magnetic resonance imaging with pathology in detecting deep myometrial invasion in endometrial cancer and revealing causes of discrepancy.","authors":"Murat Ağırlar, İlkay Çamlıdağ, Murat Danacı","doi":"10.4274/dir.2025.253306","DOIUrl":"https://doi.org/10.4274/dir.2025.253306","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the accuracy of three-tesla (3T) magnetic resonance imaging (MRI) in determining deep myometrial invasion (DMI) in endometrial cancer (EC) cases and to reveal possible causes of discrepancy.</p><p><strong>Methods: </strong>Patients with EC who underwent preoperative pelvic MRI examination at a tertiary hospital were independently and blindly reviewed for DMI by two radiologists with differing levels of expertise. On MRI, the invasion of the endometrial mass into the myometrium was defined as superficial or deep (<50% or ≥50%) and was compared with the gold standard pathology reports, evaluated using the same criteria. Cases with discrepancies between MRI and pathology were re-evaluated, and the causes of the discrepancies were identified.</p><p><strong>Results: </strong>A total of 226 patients were included. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of MRI in detecting DMI were calculated as 77%, 93%, 84%, 88%, and 87%, respectively. In cases where radiology and pathology results were incompatible, expansile masses were found in 38%, myomas located near the lesion in 27%, masses located in the uterine horn in 21%, and in 14%, a specific cause explaining the error could not be identified.</p><p><strong>Conclusion: </strong>MRI is the definitive diagnostic method for determining DMI. Awareness of these causes of discrepancy in MRI reporting can increase the value of the examination and contribute to patient management.</p><p><strong>Clinical significance: </strong>This study highlights that 3T MRI has a high accuracy (87%) in detecting DMI in EC and demonstrates that analyzing misinterpretations can enhance reliability in patient management.</p>","PeriodicalId":11341,"journal":{"name":"Diagnostic and interventional radiology","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144674144","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":"Safety and efficacy of flow diverter stents in the treatment of bifurcation cerebral aneurysms: single-center experience","authors":"Yerbol Makhambetov, Aiman Maidan, Chingiz Nurimanov, Assylbek Kaliyev, Baurzhan Kunakbayev, Nurtay Nurakay, Serik Dyussembayev, Nursultan Makhambetov","doi":"10.4274/dir.2024.242903","DOIUrl":"10.4274/dir.2024.242903","url":null,"abstract":"<p><strong>Purpose: </strong>The use of flow diverter (FD) stents is continually expanding. Aneurysms on arterial bifurcation typically have an undesirable anatomical form, are frequently wide-necked, and include one or more side-branch arteries. In recent years, the off-label use of flow diversion in treating intracranial aneurysms beyond the internal carotid artery has become increasingly popular. This study reports our center's initial experience treating bifurcation aneurysms with FD devices, documenting occlusion outcomes using the O'Kelly-Marotta and modified Cekirge-Saatci scales, as well as the safety of FD usage in bifurcation locations.</p><p><strong>Methods: </strong>This retrospective, single-center study analyzed a prospectively maintained database of patients with cerebral aneurysms treated endovascularly. The study identified bifurcation aneurysms that were treated between January 2019 and May 2022 by placing an FD device covering the neck of the aneurysm.</p><p><strong>Results: </strong>Our short series suggests that flow diversion is a viable therapeutic option for bifurcation aneurysms with favorable angiographic outcomes.</p><p><strong>Conclusion: </strong>In highly selective cases, flow diversion may be considered for treating bifurcation aneurysms in patients who will undergo follow-up examinations in the future.</p><p><strong>Clinical significance: </strong>Flow diversion has emerged as a valuable technique in the management of bifurcation aneurysms, offering the potential for satisfactory occlusion and long-term outcomes.</p>","PeriodicalId":11341,"journal":{"name":"Diagnostic and interventional radiology","volume":" ","pages":"366-371"},"PeriodicalIF":1.4,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12239522/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142497020","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Merve Nur Taşdemir, Uluhan Eryürük, Ural Oğuz, Birgül Tok, Serdar Aslan
{"title":"The role of multiparametric magnetic resonance imaging in the differentiation of low- and high-grade non-muscle invasive bladder cancer","authors":"Merve Nur Taşdemir, Uluhan Eryürük, Ural Oğuz, Birgül Tok, Serdar Aslan","doi":"10.4274/dir.2024.243004","DOIUrl":"10.4274/dir.2024.243004","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the diagnostic efficacy of apparent diffusion coefficient (ADC) measurements and semi-quantitative dynamic contrast enhancement (DCE) parameters in predicting the differentiation between low- and high-grade tumors in non-muscle invasive bladder cancers (NMIBC).</p><p><strong>Methods: </strong>Patients with NMIBC, who were histopathologically confirmed between August 2020 and July 2023, were analyzed by 2 radiologists with different levels of experience. DCE semi-quantitative parameters such as wash-in rate (WiR), wash-out ratio (WoR), time to peak (TTP), and peak enhancement (PE) were calculated. ADC measurements were performed using the three-region-of-interest (ADCt) and whole volume (ADCw) methods; ADCt ratio (ADCtR) and ADCw ratio (ADCwR) were also calculated. Receiver operating characteristic curve analysis was performed to demonstrate the cut-off values of ADCt, ADCw, ADCtR, and ADCwR to differentiate low- and high-grade tumors. The intraclass correlation coefficient was used to evaluate inter-reader agreement.</p><p><strong>Results: </strong>A total of 89 patients were included in this study. Of these patients, 48 had low-grade NMIBC, and 41 had high-grade NMIBC. There was no significant difference in mean WoR, WiR, TTP, and PE values between low- and high-grade NMIBC (<i>P</i> > 0.05). The ADCt, ADCw, ADCtR, and ADCwR values of high-grade NMIBC were significantly lower than those of low-grade NMIBC (<i>P</i> < 0.001). With cut-off values of 0.449 and 0.435, ADCtR had the best diagnostic value for both readers, showing better accuracy, sensitivity, specificity, and area under the curve (85.4%–83.1%, 87.5%–85.4%, 82.9%–80.4%, and 0.879–0.857, respectively, with confidence intervals). Additionally, ADCtR and ADCt showed acceptable diagnostic performance for both readers, with cut-off values of 0.439 and 0.431, respectively, for differentiating Ta- and T1-stages. The inter-reader agreement was almost perfect for ADC measurements.</p><p><strong>Conclusion: </strong>While DCE semiquantative parameters did not yield significant outcomes in distinguishing between low and high grades, ADCtR holds promise for enhancing patient management in NMIBC cases and stands as a potential preoperative radiological asset.</p><p><strong>Clinical significance: </strong>Individuals diagnosed with NMIBC may require different treatment approaches; therefore, it is very important to distinguish between low- and high-grade cases preoperatively. The differentiation between the Ta- and T1-stages is recognized as crucial in patient treatment strategies. Furthermore, ADCtR shows promise for improving patient management in NMIBC cases.</p>","PeriodicalId":11341,"journal":{"name":"Diagnostic and interventional radiology","volume":" ","pages":"295-302"},"PeriodicalIF":1.4,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12239538/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142709260","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Computed tomography-guided cryoablation in treating adrenal metastases: a retrospective single-center study","authors":"Claudio Pusceddu, Eliodoro Faiella, Claudio Cau, Pierluigi Rinaldi, Luca Melis, Salvatore Marsico","doi":"10.4274/dir.2024.242956","DOIUrl":"10.4274/dir.2024.242956","url":null,"abstract":"<p><strong>Purpose: </strong>To assess the effectiveness and safety of computed tomography (CT)-guided cryoablation for treating adrenal metastases (AMs).</p><p><strong>Methods: </strong>This study included 12 patients treated with 13 CT-guided cryoablation procedures for AMs between 2016 and 2020. Patients were selected based on specific criteria, including tumor size ≤5 cm and suitability for surgery. Procedures were performed by expert radiologists, with comprehensive monitoring for complications and regular post-treatment evaluations.</p><p><strong>Results: </strong>The primary technical success rate was 91.7%, with a secondary success rate of 100% following repeat procedures. Over an 8-24-month follow-up period, local tumor recurrence was observed in 16.7% of patients, and systemic progression occurred in five (41.6%) patients. The average overall survival duration was 26.4 ± 5.6 months.</p><p><strong>Conclusion: </strong>CT-guided cryoablation is a feasible and effective treatment option for AMs, demonstrating high technical success rates and manageable complications.</p><p><strong>Clinical significance: </strong>This study highlights CT-guided cryoablation as a promising treatment for AMs, offering a minimally invasive alternative to surgery with good local control and safety profile. Further research, including multi-center studies, is needed to confirm these findings.</p>","PeriodicalId":11341,"journal":{"name":"Diagnostic and interventional radiology","volume":" ","pages":"372-376"},"PeriodicalIF":1.4,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12239519/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142497015","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Reply: evaluating Microsoft Bing with ChatGPT-4 for the assessment of abdominal computed tomography and magnetic resonance images","authors":"Alperen Elek, Duygu Doğa Ekizalioğlu, Ezgi Güler","doi":"10.4274/dir.2024.243123","DOIUrl":"10.4274/dir.2024.243123","url":null,"abstract":"","PeriodicalId":11341,"journal":{"name":"Diagnostic and interventional radiology","volume":" ","pages":"331-332"},"PeriodicalIF":1.4,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12239534/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142970015","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Tugba Akinci D'Antonoli, Christian Bluethgen, Renato Cuocolo, Michail E Klontzas, Andrea Ponsiglione, Burak Kocak
{"title":"Foundation models for radiology: fundamentals, applications, opportunities, challenges, risks, and prospects.","authors":"Tugba Akinci D'Antonoli, Christian Bluethgen, Renato Cuocolo, Michail E Klontzas, Andrea Ponsiglione, Burak Kocak","doi":"10.4274/dir.2025.253445","DOIUrl":"https://doi.org/10.4274/dir.2025.253445","url":null,"abstract":"<p><p>Foundation models (FMs) represent a significant evolution in artificial intelligence (AI), impacting diverse fields. Within radiology, this evolution offers greater adaptability, multimodal integration, and improved generalizability compared with traditional narrow AI. Utilizing large-scale pre-training and efficient fine-tuning, FMs can support diverse applications, including image interpretation, report generation, integrative diagnostics combining imaging with clinical/laboratory data, and synthetic data creation, holding significant promise for advancements in precision medicine. However, clinical translation of FMs faces several substantial challenges. Key concerns include the inherent opacity of model decision-making processes, environmental and social sustainability issues, risks to data privacy, complex ethical considerations, such as bias and fairness, and navigating the uncertainty of regulatory frameworks. Moreover, rigorous validation is essential to address inherent stochasticity and the risk of hallucination. This international collaborative effort provides a comprehensive overview of the fundamentals, applications, opportunities, challenges, and prospects of FMs, aiming to guide their responsible and effective adoption in radiology and healthcare.</p>","PeriodicalId":11341,"journal":{"name":"Diagnostic and interventional radiology","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144583395","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}
Katelyn Gill, Sarah Aleman, Alexandra H Fairchild, Bahri Üstünsöz, Dan Laney, Alison A Smith, Hector Ferral
{"title":"Splenic artery embolization in the treatment of blunt splenic injury: single level 1 trauma center experience","authors":"Katelyn Gill, Sarah Aleman, Alexandra H Fairchild, Bahri Üstünsöz, Dan Laney, Alison A Smith, Hector Ferral","doi":"10.4274/dir.2024.242789","DOIUrl":"10.4274/dir.2024.242789","url":null,"abstract":"<p><strong>Purpose: </strong>To describe the experience of a single level 1 trauma center in the management of blunt splenic injuries (BSI).</p><p><strong>Methods: </strong>This is a retrospective study with Institutional Review Board approval. The medical records of 450 patients with BSI treated between January 2016 and December 2022 were reviewed. Seventy-two patients were treated with splenic artery embolization (SAE), met the study criteria, and were eligible for data analysis. Spleen injuries were graded in accordance with the American Association for the Surgery of Trauma Organ Injury Scale. Univariate data analysis was performed, with <i>P</i> < 0.05 considered statistically significant.</p><p><strong>Results: </strong>The splenic salvage rate was 90.3% (n = 65/72). Baseline demographics were similar between the groups (<i>P</i> > 0.05). Distal embolization with Gelfoam<sup>®</sup> had similar rates of splenic salvage to proximal embolization with coils (90% vs. 94.1%, <i>P</i> > 0.05). There was no significant difference in the rate of splenic infarction between distal embolization with Gelfoam<sup>®</sup> (20%, 4/20) and proximal embolization with coils (17.6%, 3/17) (<i>P</i> > 0.05). There was no significant difference in procedure length (68 vs. 75.8 min) or splenic salvage rate (88.5% vs. 92.1%) between proximal and distal embolization (<i>P</i> > 0.05). There was no significant difference in procedure length (69.1 vs. 73.6 min) or splenic salvage rate (93.1% vs. 86.4%) between Gelfoam<sup>®</sup> and coil embolization (<i>P</i> > 0.05). Combined proximal and distal embolization was associated with a higher rate of splenic abscess formation (25%, 2/8) when compared with proximal (0%, 0/26) or distal (0%, 0/38) embolization alone (<i>P</i> = 0.0003). The rate of asymptomatic and symptomatic splenic infarction was significantly higher in patients embolized at combined proximal and distal locations (<i>P</i> = 0.04, <i>P</i> = 0.01).</p><p><strong>Conclusion: </strong>The endovascular management of BSI is safe and effective. The overall splenic salvage rate was 90.3%. Distal embolization with Gelfoam<sup>®</sup> was not associated with higher rates of splenic infarction when compared with proximal embolization with coils. Combined proximal and distal embolization was associated with a higher incidence of splenic infarction and splenic abscess formation.</p><p><strong>Clinical significance: </strong>Distal splenic embolization with Gelfoam<sup>®</sup> is safe and may be beneficial in the setting of blunt splenic trauma.</p>","PeriodicalId":11341,"journal":{"name":"Diagnostic and interventional radiology","volume":" ","pages":"359-365"},"PeriodicalIF":1.4,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12239535/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141579209","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Reproducibility and interpretability in radiomics: a critical assessment","authors":"Aydın Demircioğlu","doi":"10.4274/dir.2024.242719","DOIUrl":"10.4274/dir.2024.242719","url":null,"abstract":"<p><p>Radiomics aims to improve clinical decision making through the use of radiological imaging. However, the field is challenged by reproducibility issues due to variability in imaging and subsequent statistical analysis, which particularly affects the interpretability of the model. In fact, radiomics extracts many highly correlated features that, combined with the small sample sizes often found in radiomics studies, result in high-dimensional datasets. These datasets, which are characterized by containing more features than samples, have different statistical properties than other datasets, thereby complicating their training by machine learning and deep learning methods. This review critically examines the challenges of both reproducibility issues and interpretability, beginning with an overview of the radiomics pipeline, followed by a discussion of the imaging and statistical reproducibility issues. It further highlights how limited model interpretability hinders clinical translation. The discussion concludes that these challenges could be mitigated by following best practices and by creating large, representative, and publicly available datasets.</p>","PeriodicalId":11341,"journal":{"name":"Diagnostic and interventional radiology","volume":" ","pages":"321-328"},"PeriodicalIF":1.4,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12239541/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142497019","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Role of ureteral wall thickness and computed tomography imaging in predicting spontaneous passage of ureteral stones.","authors":"Özlem Kadırhan, Sonay Aydın, Ercüment Keskin, Mecit Kantarcı","doi":"10.4274/dir.2025.253304","DOIUrl":"https://doi.org/10.4274/dir.2025.253304","url":null,"abstract":"<p><strong>Purpose: </strong>Urolithiasis is a common health problem with a high recurrence rate, and effectively balancing follow-up with intervention is important for patient safety. In this context, our study aims to identify criteria that can predict the likelihood of spontaneous passage (SP) of ureteral stones.</p><p><strong>Methods: </strong>A retrospective analysis was performed on 2,773 patients who presented to our hospital with renal colic over a 4-year period. The study included 897 patients with unilateral ureteral stones measuring ≤10 mm, identified using non-contrast computed tomography, and inflammatory serum markers assessed through biochemical testing. Variables analyzed to predict the likelihood of SP included stone size, lateralization and location, ureteral wall thickness (UWT) at the stone site, stone density, degree of hydronephrosis (HN), ureteral length, parenchymal thickness and density, and various biochemical parameters.</p><p><strong>Results: </strong>It was determined that the SP of ureteral stones was considerably affected by larger stone size (right >6.5 mm, left >6 mm), higher stone density (>957 Hounsfield units), increased UWT (>1.7 mm), presence of high-grade HN (grade ≥2), and elevated neutrophil-lymphocyte ratio (NLR) (>2.15) and platelet-lymphocyte ratio (PLR) (>10.28) values in blood. No statistically significant relationship was observed between SP and ureteral length, renal parenchymal thickness, or renal parenchymal density. It was found that when the UWT at the level of the ureteral stone exceeded 1.7 mm, the risk of the stone not passing spontaneously increased by 706.5 times in univariate logistic regression (LR) analysis and by 337.9 times in multivariate LR analysis compared with individuals with a wall thickness below this threshold.</p><p><strong>Conclusion: </strong>Our study demonstrated that, in addition to stone size and location, increased UWT at the stone level, higher stone density, the presence of concomitant high-grade HN, and elevated NLR and PLR values in the blood could be used as criteria to determine the likelihood of SP of ureteral stones. According to our results, UWT was shown to be a stronger risk factor for failure of SP than stone size.</p><p><strong>Clinical significance: </strong>The findings indicate that wall thickness around ureteral stones is a risk factor with a higher negative predictive value for SP than the stone size and location.</p>","PeriodicalId":11341,"journal":{"name":"Diagnostic and interventional radiology","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144583397","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}