Xinyi Chen, Yanfeng Zhao, Yunchong Han, Kai Wei, Shufang Cheng, Yongjun Ye, Jie Feng, Xinchen Huang, Jingjing Xu
{"title":"A diagnostic model based on magnetic resonance imaging for Menière’s disease: a multicentre study","authors":"Xinyi Chen, Yanfeng Zhao, Yunchong Han, Kai Wei, Shufang Cheng, Yongjun Ye, Jie Feng, Xinchen Huang, Jingjing Xu","doi":"10.4274/dir.2025.253293","DOIUrl":"10.4274/dir.2025.253293","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the diagnostic performance of delayed post-gadolinium enhancement magnetic resonance imaging (DEMRI) in diagnosing Menière’s disease (MD) and to establish an effective MRI-based diagnostic model.</p><p><strong>Methods: </strong>This retrospective multicenter study assessed DEMRI descriptors in patients presenting with Ménièriform symptoms who were examined consecutively between May 2022 and May 2024. A total of 162 ears (95 with MD, 67 controls) were included. Each ear was randomly assigned to either a training set (n = 98) or a validation set (n = 64). In the training cohort, diagnostic models for MD were developed using logistic regression. The area under the curve (AUC) was used to evaluate the diagnostic performance of the different models. The Delong test was applied to compare AUC estimates between models.</p><p><strong>Results: </strong>The proposed DEMRI diagnostic model demonstrated strong diagnostic performance in both the training cohort (AUC: 0.907) and the validation cohort (AUC: 0.887), outperforming the clinical diagnostic model (<i>P</i> = 0.01231; 95% confidence interval: 0.033–0.269) in the validation cohort. The AUC of the DEMRI model was also higher than that of the combined DEMRI-clinical model (AUC: 0.796), although the difference was not statistically significant (<i>P</i> = 0.054). In the training set, the sensitivity and specificity of the DEMRI model were 78.9% and 88.5%, respectively.</p><p><strong>Conclusion: </strong>A diagnostic model based on DEMRI features for MD is more effective than one based solely on clinical variables. DEMRI should, therefore, be recommended when MD is suspected, given its significant diagnostic potential.</p><p><strong>Clinical significance: </strong>This model may improve the accuracy and timeliness of MD diagnosis, as it is less influenced by the attending physician’s level of inquiry or the patient’s self-reporting ability. It may also contribute to more effective disease management in patients with MD.</p>","PeriodicalId":11341,"journal":{"name":"Diagnostic and interventional radiology","volume":" ","pages":"347-358"},"PeriodicalIF":1.4,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12239533/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144173051","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}
Nir Stanietzky, Ahmed Ebada Salem, Khaled M Elsayes, Maryam Rezvani, Kurt Fraivillig, Usama Salem, Sergio Klimkowski, Mahmoud Diab, Sagar Naik, Ahmed Sobieh, Christine O Menias, Akram M Shaaban
{"title":"Tumor-like conditions that mimic liver tumors","authors":"Nir Stanietzky, Ahmed Ebada Salem, Khaled M Elsayes, Maryam Rezvani, Kurt Fraivillig, Usama Salem, Sergio Klimkowski, Mahmoud Diab, Sagar Naik, Ahmed Sobieh, Christine O Menias, Akram M Shaaban","doi":"10.4274/dir.2024.242826","DOIUrl":"10.4274/dir.2024.242826","url":null,"abstract":"<p><p>Non-neoplastic tumor-like conditions of the liver can appear similar to hepatic neoplasms. In many cases, a biopsy is required to confirm the pathology. However, several tumor-like conditions can be correctly diagnosed or suggested prospectively, thus saving patients from unnecessary anxiety and expense. In this image-focused review, we present the ultrasound, computed tomography, magnetic resonance imaging, and positron emission tomography scan features of eight such entities. Clues that indicate the correct pathology are discussed, and the usual clinical setting is described. Many of these lesions are treated differently from true neoplasms, and the current treatment plan is discussed in many of the cases presented. After reviewing this article, the reader will have a better understanding of these lesions and the situations in which they should be included in the differential diagnosis.</p>","PeriodicalId":11341,"journal":{"name":"Diagnostic and interventional radiology","volume":" ","pages":"285-294"},"PeriodicalIF":1.4,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12239536/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141317157","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}
Parth Patel, Emre Altınmakas, Görkem Ayas, Rachel Stanietzky, Madeline L Stewart, Abdelrahman Elshikh, Disha Ram, Hrishika Bhosale, Mohamed Eltaher, Serageldin Kamel, Munevver N Duran, Umut Yücel, Mohamed Badawy, Scott Rohren, Khaled M Elsayes
{"title":"Multidisciplinary approach to diagnostic radiology education: a novel educational intervention for Turkish medical students","authors":"Parth Patel, Emre Altınmakas, Görkem Ayas, Rachel Stanietzky, Madeline L Stewart, Abdelrahman Elshikh, Disha Ram, Hrishika Bhosale, Mohamed Eltaher, Serageldin Kamel, Munevver N Duran, Umut Yücel, Mohamed Badawy, Scott Rohren, Khaled M Elsayes","doi":"10.4274/dir.2024.242828","DOIUrl":"10.4274/dir.2024.242828","url":null,"abstract":"<p><p>Teleconferencing can facilitate a multidisciplinary approach to teaching radiology to medical students. This study aimed to determine whether an online learning approach enables students to appreciate the interrelated roles of radiology and other specialties during the management of different medical cases. Turkish medical students attended five 60–90-minute online lectures delivered by radiologists and other specialists from the United States and Canada through Zoom meetings between November 2020 and January 2021. Student ambassadors from their respective Turkish medical schools recruited their classmates with guidance from the course director. Students took a pretest and posttest to assess the knowledge imparted from each session and a final course survey to assess their confidence in radiology and the value of the course. A paired t-test was used to assess pretest and posttest score differences. A 4-point Likert-type scale was used to assess confidence rating differences before and after attending the course sessions. A total of 1,458 Turkish medical students registered for the course. An average of 437 completed both pre- and posttests when accounting for all five sessions. Posttest scores were significantly higher than pretest scores for each session (<i>P</i> < 0.001). A total of 546 medical students completed the final course survey evaluation. Students’ rating of their confidence in their radiology knowledge increased after taking the course (<i>P</i> < 0.001). Students who took our course gained an appreciation for the interrelated roles of different specialties in approaching medical diagnoses and interpreting radiological findings. These students also reported an increased confidence in radiology topics and rated the course highly relevant and insightful. Overall, our findings indicated that multidisciplinary online education can be feasibly implemented for medical students by video teleconferencing.</p>","PeriodicalId":11341,"journal":{"name":"Diagnostic and interventional radiology","volume":" ","pages":"342-346"},"PeriodicalIF":1.4,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12239527/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141491312","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":"Efficacy of endovascular circulating false lumen occlusion in chronic aneurysmal descending aortic dissections","authors":"Emeric Gremen, Mathieu Finas, Eliott Mathieu, Frédéric Thony, Mathieu Rodiere, Julien Ghelfi","doi":"10.4274/dir.2025.242986","DOIUrl":"10.4274/dir.2025.242986","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the efficacy of endovascular circulating false lumen occlusion (CFLO) in inducing positive aortic remodeling in chronic aneurysmal descending aortic dissection (AD).</p><p><strong>Methods: </strong>This retrospective monocentric study included patients treated by CFLO between 2003 and 2022 in the context of chronic AD with progressive descending aneurysmal evolution and persistent circulating false lumen (FL). The procedure was achieved with coils, plugs, and/or glue at the entry tear or in the FL and/or with covered stenting in the supra-aortic trunk. The primary endpoint evaluated the positive aortic remodeling, defined as stabilization or a decrease in the aortic diameter on a computed tomography scan at the 1-year follow-up after the procedure. The FL circulating status, safety, and occurrence of aneurysm events during follow-up were also evaluated.</p><p><strong>Results: </strong>Twenty patients [median age: 65.4 years, interquartile range (IQR): 58.4–69.9; 13 men] were included, with a median duration from an acute AD of 32.5 months (IQR: 8.8–76.5). Twelve patients (60%) achieved complete FL thrombosis after CFLO, whereas 8/20 patients (40.0%) experienced partial thrombosis. Additionally, positive aortic remodeling was observed in 13 patients (65%). Following the procedure, the aneurysmal aortic diameter decreased in 8/20 patients (40.0%) and remained stable in 5/20 patients (25.0%). Two patients (10%) had complications related to the procedure. Two patients (10%) had secondary aneurysm events during follow-up.</p><p><strong>Conclusion: </strong>CFLO is a feasible and efficient method to induce FL thrombosis and reduce aneurysmal progression in chronic AD.</p><p><strong>Clinical significance: </strong>The positive outcomes observed highlight the potential of this technique to improve patient management in complex aortic pathologies. This approach offers a valuable option in the management of chronic AD and emphasizes the importance of endovascular interventions in enhancing patient outcomes.</p>","PeriodicalId":11341,"journal":{"name":"Diagnostic and interventional radiology","volume":" ","pages":"384-391"},"PeriodicalIF":1.4,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12239530/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143647683","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}
Benjamin D Simon, Kutsev Bengisu Ozyoruk, David G Gelikman, Stephanie A Harmon, Barış Türkbey
{"title":"The future of multimodal artificial intelligence models for integrating imaging and clinical metadata: a narrative review","authors":"Benjamin D Simon, Kutsev Bengisu Ozyoruk, David G Gelikman, Stephanie A Harmon, Barış Türkbey","doi":"10.4274/dir.2024.242631","DOIUrl":"10.4274/dir.2024.242631","url":null,"abstract":"<p><p>With the ongoing revolution of artificial intelligence (AI) in medicine, the impact of AI in radiology is more pronounced than ever. An increasing number of technical and clinical AI-focused studies are published each day. As these tools inevitably affect patient care and physician practices, it is crucial that radiologists become more familiar with the leading strategies and underlying principles of AI. Multimodal AI models can combine both imaging and clinical metadata and are quickly becoming a popular approach that is being integrated into the medical ecosystem. This narrative review covers major concepts of multimodal AI through the lens of recent literature. We discuss emerging frameworks, including graph neural networks, which allow for explicit learning from non-Euclidean relationships, and transformers, which allow for parallel computation that scales, highlighting existing literature and advocating for a focus on emerging architectures. We also identify key pitfalls in current studies, including issues with taxonomy, data scarcity, and bias. By informing radiologists and biomedical AI experts about existing practices and challenges, we hope to guide the next wave of imaging-based multimodal AI research.</p>","PeriodicalId":11341,"journal":{"name":"Diagnostic and interventional radiology","volume":" ","pages":"303-312"},"PeriodicalIF":1.4,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12239537/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142361318","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":"Machine learning models for discriminating clinically significant from clinically insignificant prostate cancer using bi-parametric magnetic resonance imaging","authors":"Hakan Ayyıldız, Okan İnce, Esin Korkut, Merve Gülbiz Dağoğlu Kartal, Atadan Tunacı, Şükrü Mehmet Ertürk","doi":"10.4274/dir.2024.242856","DOIUrl":"10.4274/dir.2024.242856","url":null,"abstract":"<p><strong>Purpose: </strong>This study aims to demonstrate the performance of machine learning algorithms to distinguish clinically significant prostate cancer (csPCa) from clinically insignificant prostate cancer (ciPCa) in prostate bi-parametric magnetic resonance imaging (MRI) using radiomics features.</p><p><strong>Methods: </strong>MRI images of patients who were diagnosed with cancer with histopathological confirmation following prostate MRI were collected retrospectively. Patients with a Gleason score of 3+3 were considered to have clinically ciPCa, and patients with a Gleason score of 3+4 and above were considered to have csPCa. Radiomics features were extracted from T2-weighted (T2W) images, apparent diffusion coefficient (ADC) images, and their corresponding Laplacian of Gaussian (LoG) filtered versions. Additionally, a third feature subset was created by combining the T2W and ADC images, enhancing the analysis with an integrated approach. Once the features were extracted, Pearson’s correlation coefficient and selection were performed using wrapper-based sequential algorithms. The models were then built using support vector machine (SVM) and logistic regression (LR) machine learning algorithms. The models were validated using a five-fold cross-validation technique.</p><p><strong>Results: </strong>This study included 77 patients, 30 with ciPCA and 47 with csPCA. From each image, four images were extracted with LoG filtering, and 111 features were obtained from each image. After feature selection, 5 features were obtained from T2W images, 5 from ADC images, and 15 from the combined dataset. In the SVM model, area under the curve (AUC) values of 0.64 for T2W, 0.86 for ADC, and 0.86 for the combined dataset were obtained in the test set. In the LR model, AUC values of 0.79 for T2W, 0.86 for ADC, and 0.85 for the combined dataset were obtained.</p><p><strong>Conclusion: </strong>Machine learning models developed with radiomics can provide a decision support system to complement pathology results and help avoid invasive procedures such as re-biopsies or follow-up biopsies that are sometimes necessary today.</p><p><strong>Clinical significance: </strong>This study demonstrates that machine learning models using radiomics features derived from bi-parametric MRI can discriminate csPCa from clinically insignificant PCa. These findings suggest that radiomics-based machine learning models have the potential to reduce the need for re-biopsy in cases of indeterminate pathology, assist in diagnosing pathology–radiology discordance, and support treatment decision-making in the management of PCa.</p>","PeriodicalId":11341,"journal":{"name":"Diagnostic and interventional radiology","volume":" ","pages":"313-320"},"PeriodicalIF":1.4,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12239529/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142361316","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":"Letter to the editor re: evaluating Microsoft Bing with ChatGPT-4 for the assessment of abdominal computed tomography and magnetic resonance imaging","authors":"Hinpetch Daungsupawong, Viroj Wiwanitkit","doi":"10.4274/dir.2024.242994","DOIUrl":"10.4274/dir.2024.242994","url":null,"abstract":"","PeriodicalId":11341,"journal":{"name":"Diagnostic and interventional radiology","volume":" ","pages":"329-330"},"PeriodicalIF":1.4,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12239532/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142497018","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":"Amide proton transfer-weighted magnetic resonance imaging for the evaluation of testicular spermatogenic function: a preliminary study.","authors":"Guanglei Tang, Shulin Ma, Wenhao Fu, Weijian Yun, Yang Peng, Jian Guan","doi":"10.4274/dir.2025.253248","DOIUrl":"10.4274/dir.2025.253248","url":null,"abstract":"<p><strong>Purpose: </strong>To determine the amide proton transfer-weighted (APTw) imaging features in testes with age, and to assess the feasibility of APTw magnetic resonance imaging (MRI) in assessing testicular spermatogenic function.</p><p><strong>Methods: </strong>A total of 23 male patients with clinically confirmed hypospermatogenesis caused by epididymo-orchitis were included in the case group (group A) and another 93 men (age range, 20-80 years) were included in the control group. The control group was divided into four subgroups: group B1 (20-34 years, n = 25), group B2 (35-49 years, n = 23), group B3 (50-64 years, n = 21), and group B4 (65-80 years, n = 24). All participants underwent 3.0T MRI scan, and the APT signal intensity (SI) and apparent diffusion coefficient (ADC) value of each testis were examined. The ADC and APT SI were independently measured by two radiologists blinded to clinical data, and average values were calculated. A power analysis was conducted to determine the required sample size.</p><p><strong>Results: </strong>APT SI was negatively correlated with age (r = -0.510, <i>P</i> < 0.001), whereas ADC was positively correlated with age (r = 0.317, <i>P</i> = 0.006). The APT SI was significantly higher in group A (1.77 ± 0.41) than in group B1 (1.43 ± 0.21), group B2 (1.37 ± 0.31), group B3 (1.30 ± 0.35), and group B4 (1.20 ± 0.35) (all <i>P</i> < 0.01). The ADC was significantly higher in group A [(0.549 ± 0.091) × 10<sup>-3</sup> mm<sup>2</sup>/s] compared with group B1 [(0.449 ± 0.047) × 10<sup>-3</sup> mm<sup>2</sup>/s], group B2 [(0.475 ± 0.022) × 10<sup>-3</sup> mm<sup>2</sup>/s], and group B3 [(0.488 ± 0.051) × 10<sup>-3</sup> mm<sup>2</sup>/s] (all <i>P</i> < 0.01), whereas no statistically significant difference was found between group A and group B4 (<i>P</i> > 0.05).</p><p><strong>Conclusion: </strong>The APT SI of the normal testes decreased with age, whereas a significant elevation of APT SI was detected in patients with hypospermatogenesis caused by epididymo-orchitis.</p><p><strong>Clinical significance: </strong>Hypospermatogenesis caused by degeneration or inflammation can be differentiated by APT quantity combined with ADC value.</p>","PeriodicalId":11341,"journal":{"name":"Diagnostic and interventional radiology","volume":" ","pages":"392-398"},"PeriodicalIF":1.4,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12239520/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144110116","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":"Physiological indices for evaluating balloon angioplasty outcomes in below-the-knee artery lesions of patients with chronic limb-threatening ischemia.","authors":"Murat Canyiğit, Muhammed Said Beşler, Turan Kaya","doi":"10.4274/dir.2025.253406","DOIUrl":"https://doi.org/10.4274/dir.2025.253406","url":null,"abstract":"<p><strong>Purpose: </strong>To assess the potential use of resting distal pressure/aortic pressure (Pd/Pa) and constant resistance ratio (cRR) physiological indices in the treatment of tibial artery lesions with balloon angioplasty in patients with chronic limb-threatening ischemia (CLTI).</p><p><strong>Methods: </strong>In this single-center retrospective study, resting Pd/Pa and cRR measurements were performed using a pressure microcatheter after balloon angioplasty. Procedures were conducted using balloons with diameters of 3 and/or 3.5 mm. The optimal group was defined as patients with either resting Pd/Pa or cRR ≥0.9, whereas the acceptable group included those with both values between 0.8 and 0.9. Clinical improvement in patients with rest pain (Rutherford 4) was defined as at least a 1-point category improvement, indicating a reduction or resolution of rest pain.</p><p><strong>Results: </strong>The study population consisted of 40 patients (75% men; mean age 64 ± 11.2 years), with a follow-up duration of 92 ± 40.5 days. Foot ulcers were present in 90% of the patients. During follow-up, wound healing was observed in 69.7% of patients. The optimal group exhibited higher rates of wound healing and clinical improvement than the acceptable group, although the difference was not statistically significant (80% vs. 50%, <i>P</i> = 0.151). No patient required target vessel revascularization. The overall limb salvage rate during follow-up was 94.6%.</p><p><strong>Conclusion: </strong>Short-term follow-up demonstrated favorable rates of wound healing, patency, and limb salvage. The optimal group showed a trend toward improved wound healing and clinical improvement.</p><p><strong>Clinical significance: </strong>This study highlights the utility of resting Pd/Pa and cRR as reproducible physiological indices for objectively evaluating the success of balloon angioplasty in below-the-knee arteries in patients with CLTI. Physiological assessment can guide procedural decisions, contributing to improved limb salvage and high patency rates.</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":"144583396","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}
Cihan Özgür, Baran Serdar Sunal, Savaş Hereklioğlu, Meltem Öznur, Sibel Özkan Gürdal
{"title":"Diagnostic value of the flare sign in predicting extracapsular extension in metastatic axillary lymph nodes and nodal status on breast magnetic resonance imaging","authors":"Cihan Özgür, Baran Serdar Sunal, Savaş Hereklioğlu, Meltem Öznur, Sibel Özkan Gürdal","doi":"10.4274/dir.2024.242906","DOIUrl":"10.4274/dir.2024.242906","url":null,"abstract":"<p><strong>Purpose: </strong>This study aimed to evaluate the diagnostic performance of breast magnetic resonance imaging (MRI) in predicting extracapsular extension (ECE) and axillary nodal status in the axillary metastatic lymph nodes of patients with breast cancer.</p><p><strong>Methods: </strong>The preoperative MRI scans of 92 patients with breast cancer and axillary metastases who did not receive neoadjuvant treatment between January 2018 and January 2024 were retrospectively examined. The presence of an increased signal in the axillary fatty tissue surrounding the lymph node (flare sign) on T2-weighted images, irregular nodal contour (shaggy margin), axillary asymmetry (difference in the number and size of lymph nodes compared with the unaffected axilla), loss of the fatty hilum in the most suspicious lymph node, and morphological features on T1-weighted images were assessed. Each dissected axillary lymph node was examined for ECE, and the histopathological results were recorded.</p><p><strong>Results: </strong>Axillary flare sign was significantly associated with the presence of ECE (<i>P</i> < 0.001), number of lymph nodes with ECE (<i>P</i> < 0.001), the presence of ≥4 axillary metastatic lymph nodes (<i>P</i> < 0.001), size of the primary tumor (<i>P</i> = 0.033), lymphovascular invasion in the primary tumor (<i>P</i> < 0.001), and presence of perineural invasion (<i>P</i> = 0.001). The flare sign exhibited 65.7% sensitivity, 96% specificity, 97.8% positive predictive value, 51.1% negative predictive value, and 73.9% accuracy in predicting ECE. Additionally, the receiver operating characteristic curve analysis revealed an area under the curve of 0.808 (95% confidence interval: 0.719–0.898).</p><p><strong>Conclusion: </strong>The flare sign has high performance in predicting ECE and axillary nodal status and is associated with primary tumor aggressiveness, indicating its potential utility in preoperative evaluation.</p><p><strong>Clinical significance: </strong>The flare sign on breast MRI may play a crucial role in preoperative planning, surgical decision-making, and axillary status assessment by accurately predicting ECE.</p>","PeriodicalId":11341,"journal":{"name":"Diagnostic and interventional radiology","volume":" ","pages":"333-339"},"PeriodicalIF":1.4,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12239531/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142589760","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}