Diagnostic and interventional radiology最新文献

{"title":"Performance of a magnetic resonance imaging-based radiomics score combined with apparent diffusion coefficient in predicting hepatocellular carcinoma recurrence and disease-free survival: a retrospective cohort study.","authors":"Ece Zengin, Elif Çiğdem Karataylı, Murat Beyhan, Sonay Aydın","doi":"10.4274/dir.2026.264201","DOIUrl":"https://doi.org/10.4274/dir.2026.264201","url":null,"abstract":"<p><strong>Purpose: </strong>This study aimed to evaluate the prognostic value of apparent diffusion coefficient (ADC) measurements and a predefined magnetic resonance imaging (MRI)-based radiomics score for predicting early recurrence and disease-free survival (DFS) in patients with hepatocellular carcinoma (HCC) undergoing curative surgical resection.</p><p><strong>Methods: </strong>This retrospective study included 200 patients who underwent curative-intent resection for HCC between January 2021 and January 2025, with follow-up data reviewed through January 2026. Preoperative multiparametric MRI examinations, including DWI, ADC maps, and dynamic contrast-enhanced sequences, were reviewed. The predefined radiomics score was derived from a validated institutional MRI-based radiomics pipeline using ADC maps and contrast-enhanced MR images. In the present cohort, the score was analyzed together with region-of-interest (ROI)-based ADC measurements as a fixed imaging biomarker, without any additional feature selection, model training, or model retraining. Early recurrence was defined as recurrence within 12 months after surgery. Univariable and multivariable logistic regression analyses were performed to identify predictors of recurrence. Prognostic performance was evaluated using receiver operating characteristic analysis, and model discrimination was compared using the DeLong test. The DFS was assessed using Kaplan-Meier and Cox proportional hazards analyses.</p><p><strong>Results: </strong>Early recurrence occurred in 66 of 200 patients (33.0%). In multivariable logistic regression analysis, tumor size [odds ratio (OR): 1.55, 95% confidence interval (CI): 1.27-1.89, <i>P</i> < 0.001), ADC (OR: 0.29, 95% CI: 0.18-0.46, <i>P</i> < 0.001), and radiomics score (OR: 4.74, 95% CI: 2.85-7.89, <i>P</i> < 0.001) were independent predictors of recurrence. The radiomics score alone achieved an area under the curve (AUC) of 0.767, whereas ADC achieved an AUC of 0.707. Combining the ADC and radiomics score significantly improved predictive performance (AUC: 0.837), outperforming both ADC alone (<i>P</i> < 0.001) and the radiomics score alone (<i>P</i> = 0.008). The full multivariable model demonstrated the highest discriminatory performance (AUC: 0.892). For survival analysis, larger tumor size, multiple lesions, lower ADC values, and higher radiomics scores were independently associated with shorter DFS. Patients classified as high-risk according to the optimal radiomics score cut-off exhibited significantly worse DFS than low-risk patients (log-rank <i>P</i> < 0.001).</p><p><strong>Conclusion: </strong>Measurements of the ADC and a predefined MRI-based radiomics score provided complementary prognostic information in patients with HCC. The combined ADC-radiomics score improved prediction of early recurrence and DFS compared with either parameter alone. These findings support further validation of quantitative MRI biomarkers for non-invasive risk stratificati","PeriodicalId":11341,"journal":{"name":"Diagnostic and interventional radiology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148430111","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":"Diagnostic accuracy and safety of cone-beam computed tomography-guided percutaneous transthoracic lung biopsy: an updated systematic review and meta-analysis.","authors":"Yoojin Nam, Hye Ree Cho, Eunji Kim, Pa Hong","doi":"10.4274/dir.2026.264084","DOIUrl":"https://doi.org/10.4274/dir.2026.264084","url":null,"abstract":"<p><strong>Purpose: </strong>To update the pooled diagnostic accuracy and safety of cone-beam computed tomography (CBCT)-guided percutaneous transthoracic needle biopsy (PTNB) for pulmonary lesions.</p><p><strong>Methods: </strong>PubMed, Embase, and Cochrane CENTRAL were searched through April 2026 for studies of CBCT-guided PTNB including ≥ 10 patients. Sensitivity and specificity were pooled using a bivariate random-effects model. Complication rates (pneumothorax and pulmonary hemorrhage, encompassing both clinically significant hemoptysis and radiographic perilesional change) were pooled using generalized linear mixed models. Heterogeneity and publication bias were assessed. The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses of Diagnostic Test Accuracy Studies, used the Quality Assessment of Diagnostic Accuracy Studies 2, and was prospectively registered in PROSPERO (CRD420261370382).</p><p><strong>Results: </strong>Twenty-four studies were eligible (k: 22 with extractable 2 × 2 data; n = 3,681; 2010-2026). Pooled sensitivity was 92.2% [95% confidence interval (CI): 90.4-93.7] and pooled specificity was 96.7% (95% CI: 94.3-98.2). The summary receiver operating characteristic area under the curve was 0.974. Pneumothorax incidence was 18.4% [95% CI: 15.5-21.7; prediction interval (PI) 8.3-35.8%]. Hemorrhage incidence (k: 19) pooled at 6.1% (95% CI: 3.5-10.6); high heterogeneity (I²: 90.9%) reflected variation in outcome definitions.</p><p><strong>Conclusion: </strong>CBCT-guided PTNB demonstrates high diagnostic accuracy for pulmonary lesions. The pooled specificity should be interpreted as a plausible upper-bound estimate because of universal differential verification bias across the included studies.</p><p><strong>Clinical significance: </strong>The wide pneumothorax PI (8-36%) indicates that complication rates may vary substantially across centers despite the precise pooled estimate.</p>","PeriodicalId":11341,"journal":{"name":"Diagnostic and interventional radiology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148419627","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":"Preoperative prediction of occult high-volume central lymph node metastasis in clinically node-negative papillary thyroid carcinoma using a multimodal practical model: development, temporal validation, and external validation.","authors":"Ziwei Zhang, Cailing Lin, Jing Ning, Xiaochen Liu, Chenshan Dong, Hang Ling","doi":"10.4274/dir.2026.264048","DOIUrl":"https://doi.org/10.4274/dir.2026.264048","url":null,"abstract":"<p><strong>Purpose: </strong>Preoperative risk estimation of occult high-volume central lymph node metastasis (CLNM) in clinically node-negative (cN0) papillary thyroid carcinoma (PTC) remains challenging. We aimed to develop and validate a practical multimodal model integrating conventional ultrasound and radiomics for individualized preoperative risk stratification.</p><p><strong>Methods: </strong>In this retrospective, two-center, multicohort study, 814 patients with cN0 PTC were included and assigned to a development cohort (n = 470), a temporal validation cohort (n = 202), and an external validation cohort (n = 142). Preoperative clinical variables and grayscale ultrasound radiomics features were evaluated. Least absolute shrinkage and selection operator regression was used for feature selection. Four candidate machine-learning algorithms were compared in the development cohort, and the selected classifier was used to construct clinical, radiomics, and fusion models. Model performance was assessed in terms of discrimination, calibration, and clinical utility. SHapley Additive exPlanations (SHAPs) analysis and a web-based calculator were used to improve interpretability and applicability.</p><p><strong>Results: </strong>Three clinical predictors and 20 radiomics features were retained. Random forest was selected for final model construction. In the temporal validation cohort, the clinical, radiomics, and fusion models achieved area under the curve (AUC) values of 0.703, 0.755, and 0.845, respectively; in the external validation cohort, the corresponding AUC values were 0.676, 0.730, and 0.817. For the fusion model, sensitivity, specificity, and accuracy were 0.837, 0.695, and 0.755 in the temporal validation cohort and 0.769, 0.761, and 0.764 in the external validation cohort, respectively. SHAPs analysis identified radiomics score and maximum tumor diameter as the major contributors to model output.</p><p><strong>Conclusion: </strong>A practical multimodal model integrating conventional ultrasound and radiomics showed favorable performance for preoperative risk estimation of occult high-volume CLNM in cN0 PTC and may support individualized risk stratification, pending further prospective validation.</p><p><strong>Clinical significance: </strong>This multimodal model may refine preoperative risk estimation for patients with cN0 PTC who harbor occult high-volume CLNM, thereby providing an adjunctive tool for individualized perioperative risk assessment.</p>","PeriodicalId":11341,"journal":{"name":"Diagnostic and interventional radiology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148411106","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":"Association between magnetic resonance imaging-based prostatic tissue morphology and changes in International Prostate Symptom Score and maximum urinary flow rate after prostatic artery embolization.","authors":"Chen Wang, Kun Liang, Jiasheng Qin, Xin Shu, Lihua Yuan, Jianfei Dong","doi":"10.4274/dir.2025.253652","DOIUrl":"10.4274/dir.2025.253652","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate whether baseline multiparametric magnetic resonance imaging (mpMRI)-defined prostate morphological phenotypes are associated with changes in the International Prostate Symptom Score (ΔIPSS) and maximum urinary flow rate (ΔQmax) following prostatic artery embolization (PAE) in patients with benign prostatic hyperplasia (BPH).</p><p><strong>Methods: </strong>This retrospective single-center study included patients who underwent technically successful PAE with preprocedural mpMRI performed within 8 weeks of intervention. Prostate morphology was classified as glandular-dominant, stromal-dominant, or mixed phenotype based on the predominant nodule signal characteristics on T2-weighted imaging (T2WI), with supplemental assessment using diffusion-weighted and contrast-enhanced sequences when available. Symptomatic and functional outcomes-ΔIPSS and ΔQmax-were assessed at 3, 6, 12, and 24 months post-procedure. Associations between morphology and outcomes were evaluated using multivariable regression and subgroup analysis.</p><p><strong>Results: </strong>A total of 152 patients (mean age, 70.0 ± 9.9 years) who underwent technically successful PAE were included in the study, all of whom had preprocedural MRI performed within 8 weeks prior to the intervention. All MRI-defined morphological phenotypes demonstrated improvements in the Qmax and IPSS after PAE. The glandular-dominant phenotype exhibited the most pronounced and earliest response, with peak improvements at 6 months (ΔQmax: 10.45 mL/s; ΔIPSS: 14.11 points) and sustained benefits through 24 months (ΔQmax: 8.78 mL/s; ΔIPSS: 13.04 points). Stromal-dominant and mixed phenotypes showed smaller, delayed improvements, typically peaking at 12 months. Morphology-related phenotype differences remained statistically significant at 24 months in unadjusted comparisons, particularly between glandular and stromal phenotypes, although ΔIPSS differences were attenuated in multivariable models (24-month β: 0.104, <i>P</i> = 0.547). Glandular morphology was consistently associated with a greater ΔQmax across all timepoints (e.g., 24-month β: 0.450, <i>P</i> < 0.001) and significantly interacted with baseline symptom severity (IPSS ≥ 20) to predict enhanced 24-month ΔIPSS (interaction β: 0.349, <i>P</i> = 0.045). Subgroup analyses stratified by prostate volume (< 80 vs. ≥ 80 mL) corroborated these findings, with glandular morphology consistently outperforming that of stromal and mixed phenotypes.</p><p><strong>Conclusion: </strong>Baseline MRI-defined prostate morphology, assessed primarily on T2WIs, was significantly associated with clinical outcomes after PAE; glandular-dominant morphology was linked to larger and more sustained improvements in both the Qmax and IPSS. Therefore, MRI-based phenotypes offer a practical imaging biomarker for patient stratification, warranting prospective validation.</p>","PeriodicalId":11341,"journal":{"name":"Diagnostic and interventional radiology","volume":" ","pages":"463-472"},"PeriodicalIF":2.7,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13320303/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146046226","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":"Association of patellofemoral malalignment with early trochlear and patellar chondromalacia: a prospective T2* mapping study.","authors":"Uğurcan Süner, Atilla Hikmet Çilengir, Tuğrul Bulut, Merve Gürsoy, Yılmaz Önder, Berna Dirim Mete","doi":"10.4274/dir.2025.253386","DOIUrl":"10.4274/dir.2025.253386","url":null,"abstract":"<p><strong>Purpose: </strong>To investigate the association between patellofemoral malalignment and early-stage trochlear and patellar chondromalacia using the T2* mapping method.</p><p><strong>Methods: </strong>Seventy-five patients were included in the study and divided into two groups based on the presence (patient group) or absence (control group) of patellofemoral malalignment on magnetic resonance imaging. The T2* mapping measurements were evaluated by dividing patellar and trochlear cartilage into 12 quadrants on sagittal slices. The groups were first compared based on the mean T2* relaxation times of the cartilage. Subsequently, the 12 quadrants were compared individually between the two groups. Cut-off values were calculated for the quadrants, with significant differences observed.</p><p><strong>Results: </strong>The patient group included 39 patients, and the control group included 36 patients. There was no significant difference between the groups in terms of mean T2* relaxation values for the trochlear and patellar cartilage. However, in the separate comparison of the 12 quadrants, T2* relaxation values in the upper-outer-outer (P1, T1) and upper-outer-inner (P2, T2) quadrants of both the trochlear and patellar cartilage were found to be statistically significantly higher in the patient group. Similarly, significant cut-off values were identified for the T1, P1, and P2 quadrants.</p><p><strong>Conclusion: </strong>Early chondromalacia can be quantitatively detected using T2* mapping. In patients with elevated T2* relaxation values in the superior-lateral regions of the patellar and trochlear cartilage, patellofemoral malalignment should be considered in the etiology.</p><p><strong>Clinical significance: </strong>Chondromalacia caused by patellofemoral malalignment may exhibit an asymmetric onset, with the superior-lateral quadrant as the initial site of cartilage damage in both trochlear and patellar cartilage.</p>","PeriodicalId":11341,"journal":{"name":"Diagnostic and interventional radiology","volume":" ","pages":"492-499"},"PeriodicalIF":2.7,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13319726/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144871973","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":"Minimizing radiation exposure in children: the role of spot region of interest imaging in venous access procedures.","authors":"Özhan Özgür, Cemil Oktay, Demet Gündüz, Erhan Heperenler, Hakkı Timur Sindel","doi":"10.4274/dir.2025.253623","DOIUrl":"10.4274/dir.2025.253623","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the effectiveness of the spot region of interest (ROI) technique in reducing radiation exposure during fluoroscopically guided venous access procedures in pediatric patients.</p><p><strong>Methods: </strong>This retrospective study included pediatric patients who underwent central venous access procedures in an interventional radiology unit of a tertiary care center. Data collected included patient demographics, procedure type, target vein, dose area product (DAP), cumulative dose, fluoroscopy time, and the DAP/fluoroscopy time ratio.</p><p><strong>Results: </strong>A total of 131 patients (mean age: 8 ± 4.91; 48.9% women) were included, of whom 44 (33.6%) underwent procedures using the spot ROI technique. The spot ROI group demonstrated significantly lower DAP and cumulative dose than the non-ROI group (reduction ratios: 63.8% and 67.2%, respectively, <i>P</i> < 0.001 for all). When normalized to fluoroscopy time, the DAP/fluoroscopy time ratio was also significantly reduced in the spot ROI group [15.34 (7.18-23.57) vs. 25.17 (18.49-42.03); <i>P</i> < 0.001].</p><p><strong>Conclusion: </strong>Spot ROI is an effective and safe technique for reducing radiation exposure during pediatric venous access procedures without compromising procedural success. Given the high radiation sensitivity of pediatric patients and the potential need for repeated interventions in those with chronic conditions, spot ROI represents a valuable tool for dose optimization and aligns with the As Low As Reasonably Achievable (ALARA) principle.</p><p><strong>Clinical significance: </strong>Spot ROI-based fluoroscopy significantly reduces radiation exposure in pediatric central venous catheterization without compromising procedural success. This hardware-based dose reduction technique complements the traditional ALARA principle and is particularly valuable for children requiring repeated interventions. These findings support broader clinical adoption and warrant validation in future prospective multicenter studies.</p>","PeriodicalId":11341,"journal":{"name":"Diagnostic and interventional radiology","volume":" ","pages":"487-491"},"PeriodicalIF":2.7,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13320282/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145762467","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":"Photon-counting detector computed tomography in thoracic oncology: revolutionizing tumor imaging through precision and detail.","authors":"Masahiro Yanagawa, Midori Ueno, Rintaro Ito, Daiju Ueda, Tsukasa Saida, Ryo Kurokawa, Koji Takumi, Kentaro Nishioka, Shunsuke Sugawara, Satoru Ide, Maya Honda, Mami Iima, Mariko Kawamura, Akihiko Sakata, Keitaro Sofue, Seitaro Oda, Tadashi Watabe, Kenji Hirata, Shinji Naganawa","doi":"10.4274/dir.2025.253550","DOIUrl":"10.4274/dir.2025.253550","url":null,"abstract":"<p><p>Photon-counting detector computed tomography (PCD-CT) is an emerging imaging technology that promises to overcome the limitations of conventional energy-integrating detector (EID)-CT, particularly in thoracic oncology. This narrative review summarizes technical advances and clinical applications of PCD-CT in the thorax with emphasis on spatial resolution, dose-image-quality balance, and intrinsic spectral imaging, and it outlines practical implications relevant to thoracic oncology. A literature review of PubMed through May 31, 2025, was conducted using combinations of \"photon counting,\" \"computed tomography,\" \"thoracic oncology,\" and \"artificial intelligence.\" We screened the retrieved records and included studies with direct relevance to lung and mediastinal tumors, image quality, radiation dose, spectral/iodine imaging, or artificial intelligence-based reconstruction; case reports, editorials, and animal-only or purely methodological reports were excluded. PCD-CT demonstrated superior spatial resolution compared with EID-CT, enabling clearer visualization of fine pulmonary structures, such as bronchioles and subsolid nodules; slice thicknesses of approximately 0.4 mm and <i>ex vivo</i> resolvable structures approaching 0.11 mm have been reported. Across intraindividual clinical comparisons, radiation-dose reductions of 16%-43% have been achieved while maintaining or improving diagnostic image quality. Intrinsic spectral imaging enables accurate iodine mapping and low-keV virtual monoenergetic images and has shown quantitative advantages versus dual-energy CT in phantoms and early clinical work. Artificial intelligence-based deep-learning reconstruction and super-resolution can complement detector capabilities to reduce noise and stabilize fine-structure depiction without increasing dose. Potential reductions in contrast volume are biologically plausible given improved low-keV contrast-to-noise ratio, although clinical dose-finding data remain limited, and routine K-edge imaging has not yet translated to clinical thoracic practice. In conclusion, PCD-CT provides higher spatial and spectral fidelity at lower or comparable doses, supporting earlier and more precise tumor detection and characterization; future work should prioritize outcome-oriented trials, protocol harmonization, and implementation studies aligned with \"Green Radiology\".</p>","PeriodicalId":11341,"journal":{"name":"Diagnostic and interventional radiology","volume":" ","pages":"437-447"},"PeriodicalIF":2.7,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13319926/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145130364","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: Comment on the diagnostic sensitivity of ChatGPT for detecting hemorrhages in cranial computed tomography scans.","authors":"Yiğit Can Kartal","doi":"10.4274/dir.2026.263854","DOIUrl":"10.4274/dir.2026.263854","url":null,"abstract":"","PeriodicalId":11341,"journal":{"name":"Diagnostic and interventional radiology","volume":" ","pages":"519-520"},"PeriodicalIF":2.7,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13320053/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146200443","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":"The final biological component: AI and radiology's mechanistic drift.","authors":"Şükrü Mehmet Ertürk","doi":"10.4274/dir.2026.261305","DOIUrl":"10.4274/dir.2026.261305","url":null,"abstract":"","PeriodicalId":11341,"journal":{"name":"Diagnostic and interventional radiology","volume":" ","pages":"351-353"},"PeriodicalIF":2.7,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13319725/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147927499","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":"Impact of biopsy route, muscle pathway, and cortex target on safety and diagnostic yield in ultrasound-guided renal parenchymal biopsy.","authors":"Kadir Han Alver, Halil Serdar Aslan, Muhammet Arslan, Muhammed Tekinhatun, Mahmut Demirci, Nagihan Yalçın, Ahmet Baki Yağcı","doi":"10.4274/dir.2025.253699","DOIUrl":"10.4274/dir.2025.253699","url":null,"abstract":"<p><strong>Purpose: </strong>To compare the safety and diagnostic yield of two ultrasound (US)-guided percutaneous renal biopsy (PRB) approaches, lateral to medial and medial to lateral, which differ in access route, muscle groups traversed, and cortical targets.</p><p><strong>Methods: </strong>This retrospective study included 490 patients (mean age: 38.2 ± 21.2 years; 267 men, 223 women) who underwent US-guided PRB between 2019 and 2024 and had abdominal computed tomography (CT)/magnetic resonance imaging (MRI) within 1 year. At the left kidney lower pole level (L3-L4), anterior-posterior thicknesses of the traversed muscle groups were measured on CT/MRI. Complications were classified according to the Society of Interventional Radiology guidelines. Diagnostic yield was categorized as optimal (≥ 12 glomeruli), suboptimal (≥ 3 glomeruli), and pathologist based (diagnostic according to final pathology assessment). Group comparisons were performed using the chi-square test, Fisher's exact test, and t-test.</p><p><strong>Results: </strong>In 490 PRBs (237 lateral to medial, 253 medial to lateral), the medial-to-lateral approach, despite traversing thicker muscles (35.7 vs. 11.5 mm, <i>P</i> = 0.001), produced smaller hematomas (8.6 vs. 17.3 mm, <i>P</i> = 0.001) with similar complication rates (major: 3.6% vs. 3.4%, <i>P</i> = 0.913; minor: 36% vs. 33.8%, <i>P</i> = 0.608). Diagnostic adequacy was comparable, but optimal yield was higher with the medial-to-lateral route (85.0% vs. 73.0%, <i>P</i> = 0.001).</p><p><strong>Conclusion: </strong>Both approaches demonstrated comparable safety. However, the medial-to-lateral route was associated with smaller hematomas and a higher proportion of optimal biopsies from the lateral cortex, but suboptimal and pathologist-based adequacy remained high in both techniques.</p><p><strong>Clinical significance: </strong>When standard lower pole lateral cortex biopsy is not feasible due to cortical scarring, cysts, overlying skin lesions, or anatomic limitations-especially in patients for whom contralateral biopsy is not possible (e.g., solitary or ectopic pelvic kidney, severe unilateral hydronephrosis)-alternative cortical targets must be used. Understanding how different access routes and muscle pathways influence hemorrhage control and diagnostic yield helps operators choose the safest and most effective technique in these situations.</p>","PeriodicalId":11341,"journal":{"name":"Diagnostic and interventional radiology","volume":" ","pages":"479-486"},"PeriodicalIF":2.7,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13320128/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145699919","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}