Diagnostic and interventional radiology最新文献

{"title":"Preoperative CT and MRI assessment of the longitudinal tumor extent of extrahepatic bile duct cancer after biliary drainage","authors":"Seo-Bum Cho, Yeun-Yoon Kim, June Park, Hye Jung Shin","doi":"10.4274/dir.2024.232601","DOIUrl":"10.4274/dir.2024.232601","url":null,"abstract":"<p><strong>Purpose: </strong>To examine the diagnostic performance for the longitudinal extent of extrahepatic bile duct (EHD) cancer on computed tomography (CT) after biliary drainage (BD) and investigate the appropriate timing of magnetic resonance imaging (MRI) acquisition.</p><p><strong>Methods: </strong>This retrospective study included patients who underwent curative-intent surgery for EHD cancer and CT pre- and post-BD between November 2005 and June 2021. The biliary segment-wise longitudinal tumor extent was evaluated according to the 2019 Korean Society of Abdominal Radiology consensus recommendations, with pre-BD CT, post-BD CT, and both pre- and post-BD CT. The performance for tumor detectability was compared using generalized estimating equation (GEE) method. When preoperative MRI was performed, patients were divided into two subgroups according to the timing of MRI with respect to BD, and the performance of MRI obtained pre- and post-BD was compared.</p><p><strong>Results: </strong>In 105 patients (mean age: 67 ± 8 years; 74 men and 31 women), the performance for tumor detectability was superior using both CT scans compared with using post-BD CT alone (reader 1: sensitivity, 72.6% vs. 64.6%, <i>P</i> < 0.001; specificity, 96.9% vs. 94.8%, <i>P</i> = 0.063; reader 2: sensitivity, 77.2% vs. 72.9%, <i>P</i> = 0.126; specificity, 97.5% vs. 94.2%, <i>P</i> = 0.003), and it was comparable with using pre-BD CT alone. In biliary segments with a catheter, higher sensitivity and specificity were observed using both CT scans than using post-BD CT (reader 1: sensitivity, 74.4% vs. 67.5%, <i>P</i> = 0.006; specificity, 92.4% vs. 88.0%, <i>P</i> = 0.068; reader 2: sensitivity, 80.5% vs. 74.4%, <i>P</i> = 0.013; specificity, 94.3% vs. 88.0%, <i>P</i> = 0.016). Post-BD MRI (n = 30) exhibited a comparable performance to pre-BD MRI (n = 55) (reader 1: sensitivity, 77.9% vs. 75.0%, <i>P</i> = 0.605; specificity, 97.2% vs. 94.9%, <i>P</i> = 0.256; reader 2: sensitivity, 73.2% vs. 72.6%, <i>P</i> = 0.926; specificity, 98.4% vs. 94.9%, <i>P</i> = 0.068).</p><p><strong>Conclusion: </strong>Pre-BD CT provided better diagnostic performance in the preoperative evaluation of EHD cancer. The longitudinal tumor extent could be accurately assessed with post-BD MRI, which was similar to pre-BD MRI.</p><p><strong>Clinical significance: </strong>The acquisition of pre-BD CT could be beneficial for the preoperative evaluation of EHD cancer when BD is planned. Post-BD MRI would not be significantly affected by BD in terms of the diagnostic performance of the longitudinal tumor extent.</p>","PeriodicalId":11341,"journal":{"name":"Diagnostic and interventional radiology","volume":" ","pages":"212-219"},"PeriodicalIF":1.4,"publicationDate":"2024-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11589511/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139905259","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":"Cystic renal mass screening: machine-learning-based radiomics on unenhanced computed tomography","authors":"Lesheng Huang, Yongsong Ye, Jun Chen, Wenhui Feng, Se Peng, Xiaohua Du, Xiaodan Li, Zhixuan Song, Tianzhu Liu","doi":"10.4274/dir.2023.232386","DOIUrl":"10.4274/dir.2023.232386","url":null,"abstract":"<p><strong>Purpose: </strong>The present study compares the diagnostic performance of unenhanced computed tomography (CT) radiomics-based machine learning (ML) classifiers and a radiologist in cystic renal masses (CRMs).</p><p><strong>Methods: </strong>Patients with pathologically diagnosed CRMs from two hospitals were enrolled in the study. Unenhanced CT radiomic features were extracted for ML modeling in the training set (Guangzhou; 162 CRMs, 85 malignant). Total tumor segmentation was performed by two radiologists. Features with intraclass correlation coefficients of >0.75 were screened using univariate analysis, least absolute shrinkage and selection operator, and bidirectional elimination to construct random forest (RF), decision tree (DT), and k-nearest neighbor (KNN) models. External validation was performed in the Zhuhai set (45 CRMs, 30 malignant). All images were assessed by a radiologist. The ML models were evaluated using calibration curves, decision curves, and receiver operating characteristic (ROC) curves.</p><p><strong>Results: </strong>Of the 207 patients (102 women; 59.1 ± 11.5 years), 92 (41 women; 58.0 ± 13.7 years) had benign CRMs, and 115 (61 women; 59.8 ± 11.4 years) had malignant CRMs. The accuracy, sensitivity, and specificity of the radiologist's diagnoses were 85.5%, 84.2%, and 91.1%, respectively [area under the (ROC) curve (AUC), 0.87]. The ML classifiers showed similar sensitivity (94.2%-100%), specificity (94.7%-100%), and accuracy (94.3%-100%) in the training set. In the validation set, KNN showed better sensitivity, accuracy, and AUC than DT and RF but weaker specificity. Calibration and decision curves showed excellent and good results in the training and validation set, respectively.</p><p><strong>Conclusion: </strong>Unenhanced CT radiomics-based ML classifiers, especially KNN, may aid in screening CRMs.</p>","PeriodicalId":11341,"journal":{"name":"Diagnostic and interventional radiology","volume":" ","pages":"236-247"},"PeriodicalIF":1.4,"publicationDate":"2024-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11589516/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139073638","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 interventional radiology in the management of iatrogenic urinary tract injury: the factors affecting the outcome","authors":"Selin Ardalı Düzgün, Emre Ünal, Türkmen Turan Çiftçi, Ebru Öztürk, Okan Akhan, Devrim Akıncı","doi":"10.4274/dir.2023.232129","DOIUrl":"10.4274/dir.2023.232129","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the efficacy of interventional radiological (IR) procedures in iatrogenic urinary tract injury and investigate the factors affecting the outcome.</p><p><strong>Methods: </strong>Fifty-eight patients (21 male) with a mean age of 50.3 ± 15.8 years referred for iatrogenic urinary tract injury were enrolled in this study. Technical success was defined as (i) successful placement of a nephrostomy catheter within the renal pelvis and/or (ii) successful antegrade ureteral stent placement (double J stent) between the renal pelvis and bladder lumen. Complete resolution was defined as maintained ureteral patency without an external drain and ureteral stent. The factors that may affect complete resolution [ureteral avulsion, ureterovaginal fistula (UVF), history of malignancy/radiotherapy, and time to IR management] were also investigated. The receiver operating characteristic analysis was performed to estimate the cut-off time point for the IR management timing affecting complete resolution.</p><p><strong>Results: </strong>The technical success rate for nephrostomy and ureteral stent placement was 100% (n = 58/58) and 78% (n = 28/36), respectively. In 14 patients, non-dilated pelvicalyceal systems were evident. In 18 patients, no further intervention after percutaneous nephrostomy was performed due to (i) poor performance status (n = 6) and (ii) reconstruction surgery upon clinicians' and/or patients' request (n = 12). Reconstruction surgery was required in 11 of the remaining 40 patients due to failure of percutaneous treatment (n = 11/40, 27.5%). In six of the patients, ureteral stents could not be removed due to the development of benign ureteral strictures (n = 6/40, 15%). Our complete resolution rate was 57.5% (n = 23/40). Age, gender, type of surgery (endoscopic or open), side and location of the injury did not statistically affect the complete resolution rate. The presence of ureteral avulsion, history of malignancy and radiotherapy individually or in combination significantly affected the complete resolution rate negatively. The presence of UVF also had a negative effect on the complete resolution rate; however, it did not reach statistical significance. Delayed intervention was also a significant factor related to lower complete resolution. The optimal cut-off point of the time interval for favorable clinical outcome was found to be 0–19^th day following the surgery.</p><p><strong>Conclusion: </strong>IR procedures are safe and effective in the management of iatrogenic urinary tract injuries. Antegrade ureteral stenting should be performed as soon as possible to establish ureteral integrity without the development of stricture.</p>","PeriodicalId":11341,"journal":{"name":"Diagnostic and interventional radiology","volume":" ","pages":"256-261"},"PeriodicalIF":1.4,"publicationDate":"2024-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11589513/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10676741","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":"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":"https://doi.org/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":""},"PeriodicalIF":1.4,"publicationDate":"2024-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","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":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"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":""},"PeriodicalIF":1.4,"publicationDate":"2024-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","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":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Renal bleeding: imaging and interventions in patients with tumors.","authors":"Emad D Singer, Niloofar Karbasian, Douglas S Katz, Vincenzo K Wong, Mohamed E Abdelsalam, Nir Stanietzky, Trinh T Nguyen, Anuradha S Shenoy-Bhangle, Mohamed Badawy, Margarita V Revzin, Mostafa A Shehata, Mohamed Eltaher, Khaled M Elsayes, Brinda Rao Korivi","doi":"10.4274/dir.2024.242822","DOIUrl":"https://doi.org/10.4274/dir.2024.242822","url":null,"abstract":"<p><p>In patients with cancer, spontaneous renal bleeding can stem from a range of underlying factors, necessitating precise diagnostic tools for effective patient management. Benign and malignant renal tumors are among the primary culprits, with angiomyolipomas and renal cell carcinomas being the most common among them. Vascular anomalies, infections, ureteral obstructions, and coagulation disorders can also contribute to renal-related bleeding. Cross-sectional imaging techniques, particularly ultrasound and computed tomography (CT), play pivotal roles in the initial detection of renal bleeding. Magnetic resonance imaging and CT are preferred for follow-up evaluations and aid in detecting underlying enhancing masses. IV contrast-enhanced ultrasound can provide additional information for active bleeding detection and differentiation. This review article explores specific disorders associated with or resembling spontaneous acute renal bleeding in patients with renal tumors; it focuses on the significance of advanced imaging techniques in accurately identifying and characterizing renal bleeding in these individuals. It also provides insights into the clinical presentations, imaging findings, and treatment options for various causes of renal bleeding, aiming to enhance the understanding, diagnosis, and management of the issue.</p>","PeriodicalId":11341,"journal":{"name":"Diagnostic and interventional radiology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2024-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141317156","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":"Non-routine thrombectomy in pediatric arterial ischemic stroke.","authors":"Sinan Balcı, Nesibe Gevher Eroğlu-Ertuğrul, Ahmet Ziya Birbilen, Dilek Yalnızoğlu, Selman Kesici, Tevfik Karagöz, Anıl Arat","doi":"10.4274/dir.2024.242675","DOIUrl":"https://doi.org/10.4274/dir.2024.242675","url":null,"abstract":"<p><strong>Purpose: </strong>Unlike in adults, the indications and techniques for mechanical thrombectomy for arterial ischemic stroke (AIS) in children are not clearly established. The medical and interventional management of children with acute large vessel occlusion may entail the modification of the standardized management of this condition in adults. We present six cases of children who underwent non-routine thrombectomy for AIS.</p><p><strong>Methods: </strong>We retrospectively reviewed the records of children diagnosed with AIS between 2015 and 2023 and evaluated patient characteristics, procedural technical data, and final clinical outcomes. Procedures deviating from the current definition and indications for AIS treatment in adults as well as previously reported pediatric thrombectomy cases were defined as non-routine thrombectomy.</p><p><strong>Results: </strong>Seven non-routine thrombectomy procedures in six children were included in the study. The National Institutes of Health Stroke Scale scores on admission ranged from 4 to 35; no procedure-related mortality or major neurologic morbidity occurred. One child died of causes related to the initial severe heart failure and stroke; otherwise, all the children had a modified Rankin scale score of 0 to 1 at follow-up. Unique clinical and procedural features in our case series included presentation with acute stent occlusion (two children), bilateral simultaneous internal carotid artery occlusions associated with a unilateral tandem middle cerebral artery (MCA) occlusion (one child), MCA occlusion caused by thromboembolism of the atrial myxoma (one child), and very distal (one child) or delayed thrombectomy (two children).</p><p><strong>Conclusion: </strong>Modifications to the standard medical and interventional algorithms may be required for mechanical thrombectomy in children.</p><p><strong>Clinical significance: </strong>Referral centers specialized in pediatric neurology, pediatric anesthesia, and pediatric intervention are optimal for treating children using mechanical thrombectomy and for modifying the treatment, if required.</p>","PeriodicalId":11341,"journal":{"name":"Diagnostic and interventional radiology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2024-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141247620","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":"Predictability of the radiological response to Yttrium-90 transarterial radioembolization by dynamic magnetic resonance imaging-based radiomics analysis in patients with intrahepatic cholangiocarcinoma","authors":"Hüseyin Tuğsan Ballı, Ferhat Can Pişkin, Sevinç Püren Yücel, Sinan Sözütok, Duygu Özgül, Kairgeldy Aikimbaev","doi":"10.4274/dir.2023.222025","DOIUrl":"10.4274/dir.2023.222025","url":null,"abstract":"<p><strong>Purpose: </strong>The study aims to investigate the predictability of the radiological response in intrahepatic cholangiocarcinoma (iCC) patients undergoing Yttrium-90 transarterial radioembolization (TARE) with a combined model built on dynamic magnetic resonance imaging (MRI)-based radiomics and clinical features.</p><p><strong>Methods: </strong>Thirty-six naive iCC patients who underwent TARE were included in this study. The tumor segmentation was performed on the axial T2-weighted (T2W) without fat suppression, axial T2W with fat suppression, and axial T1-weighted (T1W) contrast-enhanced (CE) sequence in equilibrium phase (Eq). At the sixth month MRI follow-up, all patients were divided into responders and non-responders according to the modified Response Evaluation Criteria in Solid Tumors. Subsequently, a radiomics score (rad-score) and a combined model of the rad-score and clinical features for each sequence were generated and compared between the groups.</p><p><strong>Results: </strong>Thirteen (36.1%) patients were considered responders, and the remaining 23 (63.9%) were non-responders. Responders exhibited significantly lower rad-scores than non-responders (<i>P</i> < 0.050 for all sequences). The radiomics models showed good discriminatory ability with an area under the curve (AUC) of 0.696 [95% confidence interval (CI), 0.522–0.870] for the axial T1W-CE-Eq, AUC of 0.839 (95% CI, 0.709–0.970) for the axial T2W with fat suppression, and AUC of 0.836 (95% CI, 0.678–0.995) for the axial T2W without fat suppression.</p><p><strong>Conclusion: </strong>Radiomics models created by pre-treatment MRIs can predict the radiological response to Yttrium- 90 TARE in iCC patients with high accuracy. Combining radiomics with clinical features could increase the power of the test. Large-scale studies of multi-parametric MRIs with internal and external validations are needed to determine the clinical value of radiomics in iCC patients.</p>","PeriodicalId":11341,"journal":{"name":"Diagnostic and interventional radiology","volume":" ","pages":"193-199"},"PeriodicalIF":1.4,"publicationDate":"2024-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11095063/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9240342","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":"Establishment of local diagnostic reference levels for computed tomography with cloud-based automated dose-tracking software in Türkiye","authors":"Gökhan Kahraman, Kemal Murat Haberal, Ahmet Muhteşem Ağıldere","doi":"10.4274/dir.2023.232265","DOIUrl":"10.4274/dir.2023.232265","url":null,"abstract":"<p><strong>Purpose: </strong>The purpose of this study is to establish local diagnostic reference levels (LDRLs) for computed tomography (CT) procedures using cloud-based automated dose-tracking software.</p><p><strong>Methods: </strong>The study includes the dose data obtained from a total of 104,272 examinations performed on adult patients (>18 years) using 8 CT scanners over 12 months. The protocols included in our study were as follows: head CT without contrast, cervical spine CT without contrast, neck CT with contrast, chest CT without contrast, abdomen-pelvis CT without contrast, lumbar spine CT without contrast, high-resolution computed tomography (HRCT) of the chest, and coronary CT angiography (CTA). Dose data were collected using cloud-based automatic dose-tracking software. The 75^th percentiles of the distributions of the median volume CT dose index (CTDIvol) and dose length product (DLP) values were used to determine the LDRLs for each protocol. The LDRLs were compared with national DRLs (NDRLs) and DRLs set in other countries. Inter-CT scanner variability, which is a measure of how well clinical practices are standardized, was determined for each protocol. Median values for each protocol were compared with the LDRLs for dose optimization in each CT scanner.</p><p><strong>Results: </strong>The LDRLs (for DLP and CTDIvol, respectively) were 839 mGy.cm and 41.2 mGy for head CT without contrast, 530.6 mGy.cm and 19.8 mGy for cervical spine CT without contrast, 431.9 mGy.cm and 15.5 mGy for neck CT with contrast, 364.8 mGy.cm and 9.3 mGy for chest CT without contrast, 588.9 mGy. cm and 11.2 mGy for abdomen-pelvis CT without contrast, 713 mGy.cm and 24.3 mGy for lumbar spine CT without contrast, 326 mGy.cm and 9.5 mGy for HRCT, and 642.3 mGy.cm and 33.4 mGy for coronary CTA. The LDRLs were comparable to or lower than NDRLs and DRLs set in other countries for most protocols. The comparisons revealed the need for immediate initiation of an optimization process for CT protocols with higher dose distributions. Furthermore, protocols with high inter-CT scanner variability revealed the need for standardization.</p><p><strong>Conclusion: </strong>There is a need to update the NDRLs for CT protocols in Turkey. Until new NDRLs are established, local institutions in Turkey can initiate the optimization process by comparing their dose distributions to the LDRLs established in our study. Automated dose-tracking software can play an important role in establishing DRLs by facilitating the collection and analysis of large datasets.</p>","PeriodicalId":11341,"journal":{"name":"Diagnostic and interventional radiology","volume":" ","pages":"205-211"},"PeriodicalIF":2.1,"publicationDate":"2024-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11095070/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10125053","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":"Long-term follow-up results of multiparametric prostate MRI and the prognostic value of PI-RADS: a single-center retrospective cohort study","authors":"Ömer Önder, Müjdat Ayva, Yasin Yaraşır, Volkan Gürler, Mustafa Sertaç Yazıcı, Bülent Akdoğan, Ali Devrim Karaosmanoğlu, Muşturay Karçaaltıncaba, Mustafa Nasuh Özmen, Deniz Akata","doi":"10.4274/dir.2023.232414","DOIUrl":"10.4274/dir.2023.232414","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;We aim to examine the long-term outcomes of patients who underwent multiparametric prostate magnetic resonance imaging (mp-MRI) for suspected prostate cancer (PCa), specifically based on their initial Prostate Imaging Reporting and Data System (PI-RADS) categories and various clinical factors. Our secondary aim is to evaluate the prognostic value of the PI-RADS through the National Comprehensive Cancer Network (NCCN) risk group distribution.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This research was conducted as a single-center retrospective cohort study in a tertiary care hospital. A total of 1,359 cases having at least one histopathological examination after the initial mp-MRI and/or adequate clinical/radiological follow-up data were included in the clinically significant PCa (cs-PCa) diagnosis-free survival analysis. Initial mp-MRI dates were accepted as the start of follow-up for the time-to-event analysis. The event was defined as cs-PCa diagnosis (International Society of Urological Pathology ≥2). Patients who were not diagnosed with cs-PCa during follow-up were censored according to predefined literature-based criteria at the end of the maximum follow-up duration with no reasonable suspicion of PCa and no biopsy indication. The impact of various factors on survival was assessed using a log-rank test and multivariable Cox regression. Subsequently, 394 cases diagnosed with PCa during follow-up were evaluated, based on initial PI-RADS categories and NCCN risk groups.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Three main risk factors for cs-PCa diagnosis during follow-up were an initial PI-RADS 5 category, initial PI-RADS 4 category, and high MRI-defined PSA density (mPSAD), with average hazard ratios of 29.52, 14.46, and 3.12, respectively. The PI-RADS 3 category, advanced age group, and biopsy-naïve status were identified as additional risk factors (hazard ratios: 2.03, 1.54-1.98, and 1.79, respectively). In the PI-RADS 1-2 cohort, 1, 3, and 5-year cs-PCa diagnosis-free survival rates were 99.1%, 96.5%, and 93.8%, respectively. For the PI-RADS 3 cohort, 1, 3, and 5-year cs-PCa diagnosis-free survival rates were 94.9%, 90.9%, and 89.1%, respectively. For the PI-RADS 4 cohort, 1, 3, and 5-year cs-PCa diagnosis-free survival rates were 56.6%, 55.1%, and 55.1%, respectively. These rates were found to all be 24.2% in the PI-RADS 5 cohort. Considering the 394 cases diagnosed with PCa during follow-up, PI-RADS ≥4 cases were more likely to harbor unfavorable PCa compared to PI-RADS ≤3 cases (&lt;i&gt;P&lt;/i&gt; &lt; 0.001). In the PI-RADS 3 subgroup analysis, a low mPSAD (&lt;0.15 ng/mL&lt;sup&gt;2&lt;/sup&gt;) was found to be a protective prognostic factor against unfavorable PCa (&lt;i&gt;P&lt;/i&gt; = 0.005).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;The PI-RADS category has a significant impact on patient management and provides important diagnostic and prognostic information. Higher initial PI-RADS categories are associated with decreased follow-up losses, a shorter time to PCa diag","PeriodicalId":11341,"journal":{"name":"Diagnostic and interventional radiology","volume":" ","pages":"139-151"},"PeriodicalIF":2.1,"publicationDate":"2024-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11095067/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41106174","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}