Investigative Radiology最新文献

{"title":"The Discovery of Gadopiclenol: An Example of Rational Drug Design?","authors":"Marc Port","doi":"10.1097/RLI.0000000000001169","DOIUrl":"https://doi.org/10.1097/RLI.0000000000001169","url":null,"abstract":"<p><strong>Abstract: </strong>Gadopiclenol was initially developed as a high-relaxivity, nonspecific magnetic resonance imaging contrast agent to enhance image quality and thereby improve diagnostics. This design required a highly demanding Drug Target Profile, addressing not only relaxivity but also factors such as physicochemical properties of the injectable solution (viscosity, osmolality, heat sterilization compatibility), pharmacokinetics and toxicity, particularly related to the stability of the complex. These considerations led to a multiparametric molecular design based on a gadolinium complex characterized by the following features: (1) a macrocyclic, nonionic structure based on the PCTA framework with 2 water molecules in the inner sphere; (2) the introduction of steric constraints around the gadolinium to enhance stability and reduce relaxivity quenching by endogenous ions; (3) slowed rotational diffusion due to gadolinium's position at the center of the complex; and (4) the incorporation of 3 hydrophilic amino polyol pendant arms to ensure aqueous solubility, reduce binding with endogenous proteins, and enhance product safety.This rational design led to the creation of a first prototype, P03277V1. However, the occurrence of nephrogenic systemic fibrosis necessitated modifications to the Drug Target Profile, aimed at improving the complex's stability and reducing production costs. This was achieved through the discovery of an isomerization process for P03277V1, resulting in gadopiclenol, which demonstrated excellent kinetic stability.The rational design of gadopiclenol thus exemplifies the concept of Property-Based Drug Design used in medicinal chemistry. It also highlights that the complexity of designing a diagnostic agent is comparable to that of a therapeutic agent. Furthermore, the case of gadopiclenol illustrates that the medical positioning of a drug candidate can evolve during clinical development. Gadopiclenol's medical positioning shifted from being a product with high relaxivity to improve signal strength, to one intended for use at a half dose to limit gadolinium injection and minimize risks to patients, such as nephrogenic systemic fibrosis or accumulation in specific areas of the brain. Currently, gadopiclenol is approved for clinical use at a dose of 0.05 mmol/kg to minimize gadolinium exposure to patients. Whether the 0.1 mmol/kg dose can be used to enhance clinical diagnostics and improve patient management in the future remains to be seen.</p>","PeriodicalId":14486,"journal":{"name":"Investigative Radiology","volume":" ","pages":""},"PeriodicalIF":7.0,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143604818","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Effect of X-ray Dose Photon-Counting Detector Computed Tomography on Nodule Properties in a Lung Cancer Screening Cohort: A Prospective Study.","authors":"Bjarne Kerber, Falko Ensle, Jonas Kroschke, Cecilia Strappa, Ricarda Stolzmann-Hinzpeter, Christian Blüthgen, Marc Marty, Anna Rita Larici, Thomas Frauenfelder, Lisa Jungblut","doi":"10.1097/RLI.0000000000001174","DOIUrl":"https://doi.org/10.1097/RLI.0000000000001174","url":null,"abstract":"<p><strong>Objectives: </strong>The aim of the study was to evaluate the effect of photon-counting detector (PCD-)CT dose reduction to x-ray equivalent levels on nodule detection, diameter, volume, and density compared to a low-dose reference standard using semiautomated and manual methods.</p><p><strong>Materials and methods: </strong>Between February and July 2023, 101 prospectively enrolled participants underwent noncontrast same-study low- and chest x-ray-dose CT scans using PCD-CT. Patients who were not referred for lung cancer screening or nodule follow-up, as well as those with nodules smaller than 5 mm in diameter, were excluded. Nodule detection and measurement of nodule diameters and volumes was semiautomatically performed for low- and x-ray-dose scans using computer-aided diagnosis software. Additionally, 2 blinded readers manually measured largest nodule diameters and examined nodule density. Nodules were classified using Lung-RADS v2022. Image quality was assessed with subjective and objective measures.</p><p><strong>Results: </strong>Mean CTDIvol for x-ray dose scans was 0.11 ± 0.03 mGy, compared to 0.65 ± 0.15 mGy for low-dose images (P < 0.001). One hundred seventy-two nodules larger than 5 mm were detected in 53 of the 101 participants (32 male, 61.6 ± 12.5 years; 21 female, 60.3 ± 12.5 years). The semiautomated method had high overall sensitivity for nodule detection (0.94) on x-ray dose scans, with a higher sensitivity for solid nodules (>0.95) and lower for subsolid nodules (>0.86). Nodules not detected on x-ray dose scans were significantly smaller. Semiautomated measurements underestimated nodule diameter for solid nodules on x-ray dose scans (P = 0.01), but no significant effect for nodule volume was found (P = 0.775). Readers rated nodule density less dense on x-ray dose scans (R1: P < 0.001, R2: P = 0.006). There was no significant difference in nodule diameter for both readers between scan doses (R1: P = 0.141; R2: P = 0.554). There were good to excellent correlations between semiautomated and reader nodule diameters. Agreement and accuracy between low-dose and x-ray dose Lung-RADS classifications across methods were good (Cohens' к = 0.73, 0.62, 0.76 for semiautomated method, R1 and R2; resp. Accuracy: 0.82, 0.78, 0.85). No Lung-RADS classification changes were observed with semiautomated volumetric measurements of nodules.</p><p><strong>Conclusions: </strong>Semiautomated nodule detection is highly sensitive in PCD-CT x-ray dose scans. Semiautomated nodule volume measurement is more robust to image quality changes than nodule diameter. Accurate semiautomated and manual nodule measurements are feasible on x-ray dose scans, but nodule density was in tendency underestimated. Nodule classification using Lung-RADS was shown to be accurate on x-ray dose scans.</p>","PeriodicalId":14486,"journal":{"name":"Investigative Radiology","volume":" ","pages":""},"PeriodicalIF":7.0,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143575710","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of Iron(III)-Trans-1,4-Diaminocyclohexane-tCDTA and Iron(III)-Trans-1,4-Diaminocyclohexane-tCDTA-Dimer With Gadobutrol for T1 Contrast Enhancement in DCE-MRI.","authors":"Fei Ni, Akvile Haeckel, Hamidreza Hojjat, Honglan Mi, Harald Kratz, Jing Xie, Eyk Schellenberger","doi":"10.1097/RLI.0000000000001172","DOIUrl":"https://doi.org/10.1097/RLI.0000000000001172","url":null,"abstract":"<p><strong>Purpose: </strong>This study evaluated the T1 enhancement of the 2 iron-based contrast agents (IBCAs), [Fe(trans-tCDTA)]+ and [Fe(trans-Di-tCDTA)], in blood and other organs compared with a gadolinium-based contrast agent (GBCA) in DCE-MRI, as well as their in vitro toxicity and the stability of the IBCAs compared to [Fe-(tCDTA)]-.</p><p><strong>Methods: </strong>Iron(III) chelates of trans-tCDTA and trans-Di-tCDTA were synthesized and characterized. The T1 relaxivity of IBCAs and gadobutrol was measured at 3T using human whole blood samples. In vitro toxicity was assessed by cytotoxicity of IBCAs and gadobutrol against BRL-3A using MTT viability assays. Kinetic stability was evaluated spectrophotometrically using a zinc stress test (2.5 mM ZnCl2). The T1 contrast in mice was measured using a dynamic T1-weighted gradient-echo sequence. DCE-MRI was performed with 0.17 mmol/kg or 0.35 mmol/kg [Fe(trans-tCDTA)]+, 0.1 mmol/kg [Fe(trans-Di-tCDTA)], and 0.1 mmol/kg gadobutrol. DCE time curves in different organs were evaluated using a 2-phase exponential decay function.</p><p><strong>Results: </strong>[Fe(trans-tCDTA)]+ and [Fe(trans-Di-tCDTA)] showed T1 relaxivities in human whole blood at 3T comparable to gadobutrol. No significant differences in short-term cytotoxicity were found between gadobutrol and iron chelates. [Fe(trans-Di-tCDTA)] had a higher kinetic stability than [Fe-(tCDTA)]-, and [Fe(trans-tCDTA)]+ had a lower stability in the presence of zinc chloride and phosphate. [Fe(trans-tCDTA)]+ showed lower relative blood enhancement at 0.17 mmol/kg (P = 0.0025) but comparable at 0.35 mmol/kg (P = 0.4739) versus gadobutrol at 0.1 mmol/kg. [Fe(trans-Di-tCDTA)] showed a similar enhancement to gadobutrol at 0.1 mmol/kg (P = 0.5238). Max relative enhancement (RE%) were 131.0 ± 18.0, 93.6 ± 9.4, 144.0 ± 15.4, and 143.2 ± 12.3; blood half-lives (rapid phase/slow phase) were 2.3/15.0 minutes, 1.5/59.7 minutes, 1.9/177.1 minutes, and 1.5/27.5 minutes for gadobutrol, [Fe(trans-tCDTA)]+ at 0.17 mmol/kg or 0.35 mmol/kg, and [Fe(trans-Di-tCDTA)].</p><p><strong>Conclusion: </strong>[Fe(trans-Di-tCDTA)] provided comparable contrast enhancement and kinetics to gadobutrol at the same molecular dose (double the metal dose), is very stable, and could serve as an alternative to nonspecific GBCA, thereby avoiding potential long-term gadolinium toxicity and retention concerns as well as environmental gadolinium deposition. [Fe(trans-tCDTA)]+ required a higher dose and showed delayed clearance in blood and other organs.</p>","PeriodicalId":14486,"journal":{"name":"Investigative Radiology","volume":" ","pages":""},"PeriodicalIF":7.0,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143566596","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Photon-Counting Detector CT Applications in Musculoskeletal Radiology.","authors":"Jan-Peter Grunz, Henner Huflage","doi":"10.1097/RLI.0000000000001108","DOIUrl":"10.1097/RLI.0000000000001108","url":null,"abstract":"<p><strong>Abstract: </strong>Photon-counting detectors (PCDs) have emerged as one of the most influential technical developments for medical imaging in recent memory. Surpassing conventional systems with energy-integrating detector technology in many aspects, PCD-CT scanners provide superior spatial resolution and dose efficiency for all radiological subspecialities. Demanding detailed display of trabecular microarchitecture and extensive anatomical coverage frequently within the same scan, musculoskeletal (MSK) imaging in particular can be a beneficiary of PCD-CT's remarkable performance. Since PCD-CT provides users with a plethora of customization options for both image acquisition and reconstruction, however, MSK radiologists need to be familiar with the scanner to unlock its full potential. From filter-based spectral shaping for artifact reduction over full field-of-view ultra-high-resolution scans to postprocessing of single- or dual-source multienergy data, almost every imaging task can be met with an optimized approach in PCD-CT. The objectives of this review were to give an overview of the most promising applications of PCD-CT in MSK imaging to date, to state current limitations, and to highlight directions for future research and developments.</p>","PeriodicalId":14486,"journal":{"name":"Investigative Radiology","volume":" ","pages":"198-204"},"PeriodicalIF":7.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11801470/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141859720","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gadopiclenol: A q = 2 Gadolinium-Based MRI Contrast Agent Combining High Stability and Efficacy.","authors":"Ilham Maimouni, Céline Henoumont, Marie-Christine De Goltstein, Jean-François Mayer, Anissa Dehimi, Yamina Boubeguira, Christina Kattenbeck, Torben J Maas, Nathalie Decout, Izabela Strzeminska, Gwénaëlle Bazin, Christelle Medina, Cécile Factor, Olivier Rousseaux, Uwe Karst, Sophie Laurent, Sarah Catoen","doi":"10.1097/RLI.0000000000001121","DOIUrl":"10.1097/RLI.0000000000001121","url":null,"abstract":"<p><strong>Objectives: </strong>Gadopiclenol is a q = 2 pyclen gadolinium-based contrast agent (GBCA) recently approved by the Food and Drug Administration, European Medicines Agency, and other European countries. The aim of this report is to demonstrate its stability in multiple stressed in vitro conditions and in vivo, in rat kidney, while maintaining its higher relaxivity compared with conventional GBCAs on the market.</p><p><strong>Materials and methods: </strong>Both gadopiclenol and its chemical precursor Pi828-Gd were characterized and compared with q = 1 gadolinium (Gd) complexes. The number of water molecules coordinated to the Gd (the hydration number, q) was determined by luminescence. 17 O NMR (Nuclear Magnetic Resonance) measurements gave access to the water residence time τ M . These parameters were used for the fitting of the nuclear magnetic relaxation dispersion profiles in water. Proton relaxivities of the complexes were determined in different media at 60 MHz (1.4 T), at different pH and temperature. The kinetic inertness was investigated in human serum, acidic media, under zinc competition in the presence of phosphate, and under ligand competition. The in vivo stability was evaluated in rat kidneys 12 months after repeated injections.</p><p><strong>Results: </strong>The presence of 2 inner-sphere water molecules per Gd complex was confirmed for both pyclen derivatives. The high relaxivity of the complexes in water is maintained under physiological conditions, even under stressed conditions (ionic media, extreme pH, and temperature), which guarantees their efficiency in a large range of in vivo situations. Gd release from the q = 2 complexes was investigated in different potentially destabilizing conditions. Either no Gd release or a slower one than with \"q = 1\" stable macrocyclic GBCA (acidic conditions) was observed. Their kinetic inertness was demonstrated in physiological conditions, and the Gd release was below the lower limit of quantification of 0.1 μM after 12 days at 37°C in human serum. It was also demonstrated that gadopiclenol is stable in vivo in rat kidney 12 months after repeated injections.</p><p><strong>Conclusions: </strong>Thanks to its optimized structural design, gadopiclenol is a highly stable and effective macrocyclic q = 2 GBCA.</p>","PeriodicalId":14486,"journal":{"name":"Investigative Radiology","volume":" ","pages":"234-243"},"PeriodicalIF":7.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11801443/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142894277","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Deep Learning-Enhanced Accelerated 2D TSE and 3D Superresolution Dixon TSE for Rapid Comprehensive Knee Joint Assessment.","authors":"Céline Smekens, Quinten Beirinckx, Frederik Bosmans, Floris Vanhevel, Annemiek Snoeckx, Jan Sijbers, Ben Jeurissen, Thomas Janssens, Pieter Van Dyck","doi":"10.1097/RLI.0000000000001118","DOIUrl":"10.1097/RLI.0000000000001118","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;The aim of this study was to evaluate the use of a multicontrast deep learning (DL)-reconstructed 4-fold accelerated 2-dimensional (2D) turbo spin echo (TSE) protocol and the feasibility of 3-dimensional (3D) superresolution reconstruction (SRR) of DL-enhanced 6-fold accelerated 2D Dixon TSE magnetic resonance imaging (MRI) for comprehensive knee joint assessment, by comparing image quality and diagnostic performance with a conventional 2-fold accelerated 2D TSE knee MRI protocol.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Materials and methods: &lt;/strong&gt;This prospective, ethics-approved study included 19 symptomatic adult subjects who underwent knee MRI on a clinical 3 T scanner. Every subject was scanned with 3 DL-enhanced acquisition protocols in a single session: a clinical standard 2-fold in-plane parallel imaging (PI) accelerated 2D TSE-based protocol (5 sequences, 11 minutes 23 seconds) that served as a reference, a DL-reconstructed 4-fold accelerated 2D TSE protocol combining 2-fold PI and 2-fold simultaneous multislice acceleration (5 sequences, 6 minutes 24 seconds), and a 3D SRR protocol based on DL-enhanced 6-fold accelerated (ie, 3-fold PI and 2-fold simultaneous multislice) 2D Dixon TSE MRI (6 anisotropic 2D Dixon TSE acquisitions rotated around the phase-encoding axis, 6 minutes 24 seconds). This resulted in a total of 228 knee MRI scans comprising 21,204 images. Three readers evaluated all pseudonymized and randomized images in terms of image quality using a 5-point Likert scale. Two of the readers (musculoskeletal radiologists) additionally evaluated anatomical visibility and diagnostic confidence to assess normal and pathological knee structures with a 5-point Likert scale. They recorded the presence and location of internal knee derangements, including cartilage defects, meniscal tears, tears of ligaments, tendons and muscles, and bone injuries. The statistical analysis included nonparametric Friedman tests, and interreader and intrareader agreement assessment using the weighted Fleiss-Cohen kappa (κ) statistic. P values of less than 0.05 were considered statistically significant.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The evaluated DL-enhanced 4-fold accelerated 2D TSE protocol provided very similar image quality and anatomical visibility to the standard 2D TSE protocol, whereas the 3D SRR Dixon TSE protocol scored less in terms of overall image quality due to reduced edge sharpness and the presence of artifacts ( P &lt; 0.001). Subjective signal-to-noise ratio, contrast resolution, fluid brightness, and fat suppression were good to excellent for all protocols. For 1 reader, the Dixon method of the 3D SRR protocol provided significantly better fat suppression than the spectral fat saturation applied in the standard 2D TSE protocol ( P &lt; 0.05). The visualization of knee structures with 3D SRR Dixon TSE was very similar to the standard protocol, except for cartilage, tendons, and bone, which were affected by the presence of reconstruct","PeriodicalId":14486,"journal":{"name":"Investigative Radiology","volume":" ","pages":"220-233"},"PeriodicalIF":7.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11801463/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142080308","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Decoding Brain Development and Aging: Pioneering Insights From MRI Techniques.","authors":"Akifumi Hagiwara, Satoru Kamio, Junko Kikuta, Moto Nakaya, Wataru Uchida, Shohei Fujita, Stikov Nikola, Toshiaki Akasahi, Akihiko Wada, Koji Kamagata, Shigeki Aoki","doi":"10.1097/RLI.0000000000001120","DOIUrl":"10.1097/RLI.0000000000001120","url":null,"abstract":"<p><strong>Abstract: </strong>The aging process induces a variety of changes in the brain detectable by magnetic resonance imaging (MRI). These changes include alterations in brain volume, fluid-attenuated inversion recovery (FLAIR) white matter hyperintense lesions, and variations in tissue properties such as relaxivity, myelin, iron content, neurite density, and other microstructures. Each MRI technique offers unique insights into the structural and compositional changes occurring in the brain due to normal aging or neurodegenerative diseases. Age-related brain volume changes encompass a decrease in gray matter and an increase in ventricular volume, associated with cognitive decline. White matter hyperintensities, detected by FLAIR, are common and linked to cognitive impairments and increased risk of stroke and dementia. Tissue relaxometry reveals age-related changes in relaxivity, aiding the distinction between normal aging and pathological conditions. Myelin content, measurable by MRI, changes with age and is associated with cognitive and motor function alterations. Iron accumulation, detected by susceptibility-sensitive MRI, increases in certain brain regions with age, potentially contributing to neurodegenerative processes. Diffusion MRI provides detailed insights into microstructural changes such as neurite density and orientation. Neurofluid imaging, using techniques like gadolinium-based contrast agents and diffusion MRI, reveals age-related changes in cerebrospinal and interstitial fluid dynamics, crucial for brain health and waste clearance. This review offers a comprehensive overview of age-related brain changes revealed by various MRI techniques. Understanding these changes helps differentiate between normal aging and pathological conditions, aiding the development of interventions to mitigate age-related cognitive decline and other symptoms. Recent advances in machine learning and artificial intelligence have enabled novel methods for estimating brain age, offering also potential biomarkers for neurological and psychiatric disorders.</p>","PeriodicalId":14486,"journal":{"name":"Investigative Radiology","volume":" ","pages":"162-174"},"PeriodicalIF":7.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11801466/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142893965","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hot Topics in Diagnostic Imaging-Encompassing Advances in MR, Photon-Counting CT, and Ultrasound.","authors":"Val M Runge, Johannes T Heverhagen","doi":"10.1097/RLI.0000000000001124","DOIUrl":"10.1097/RLI.0000000000001124","url":null,"abstract":"","PeriodicalId":14486,"journal":{"name":"Investigative Radiology","volume":" ","pages":"161"},"PeriodicalIF":7.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142390500","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Focused Ultrasound: Noninvasive Image-Guided Therapy.","authors":"Chrit T W Moonen, Joseph P Kilroy, Alexander L Klibanov","doi":"10.1097/RLI.0000000000001116","DOIUrl":"10.1097/RLI.0000000000001116","url":null,"abstract":"<p><strong>Abstract: </strong>Invasive open surgery used to be compulsory to access tumor mass to perform excision or resection. Development of minimally invasive laparoscopic procedures followed, as well as catheter-based approaches, such as stenting, endovascular surgery, chemoembolization, brachytherapy, which minimize side effects and reduce the risks to patients. Completely noninvasive procedures bring further benefits in terms of reducing risk, procedure time, recovery time, potential of infection, or other side effects. Focusing ultrasound waves from the outside of the body specifically at the disease site has proven to be a safe noninvasive approach to localized ablative hyperthermia, mechanical ablation, and targeted drug delivery. Focused ultrasound as a medical intervention was proposed decades ago, but it only became feasible to plan, guide, monitor, and control the treatment procedures with advanced radiological imaging capabilities. The purpose of this review is to describe the imaging capabilities and approaches to perform these tasks, with the emphasis on magnetic resonance imaging and ultrasound. Some procedures already are in clinical practice, with more at the clinical trial stage. Imaging is fully integrated in the workflow and includes the following: (1) planning, with definition of the target regions and adjacent organs at risk; (2) real-time treatment monitoring via thermometry imaging, cavitation feedback, and motion control, to assure targeting and safety to adjacent normal tissues; and (3) evaluation of treatment efficacy, via assessment of ablation and physiological parameters, such as blood supply. This review also focuses on sonosensitive microparticles and nanoparticles, such as microbubbles injected in the bloodstream. They enable ultrasound energy deposition down to the microvascular level, induce vascular inflammation and shutdown, accelerate clot dissolution, and perform targeted drug delivery interventions, including focal gene delivery. Especially exciting is the ability to perform noninvasive drug delivery via opening of the blood-brain barrier at the desired areas within the brain. Overall, focused ultrasound under image guidance is rapidly developing, to become a choice noninvasive interventional radiology tool to treat disease and cure patients.</p>","PeriodicalId":14486,"journal":{"name":"Investigative Radiology","volume":" ","pages":"205-219"},"PeriodicalIF":7.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11801465/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142008851","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What Is the Added Value of DWI Compared With Structured Assessment of BI-RADS Criteria by the Kaiser Score? A Systematic Review and Meta-analysis.","authors":"Matthias Dietzel, Giulia Vatteroni, Pascal A T Baltzer","doi":"10.1097/RLI.0000000000001123","DOIUrl":"10.1097/RLI.0000000000001123","url":null,"abstract":"<p><strong>Objective: </strong>This systematic review and meta-analysis investigated the added value of DWI compared with the structured assessment of BI-RADS criteria using the Kaiser score.</p><p><strong>Materials and methods: </strong>Articles published in English until May 2024 were included. Two independent reviewers extracted data on the characteristics of studies evaluating the added value of DWI to distinguish benign from malignant breast lesions compared with structured assessment of the BI-RADS criteria. Using bivariate random-effects models, the sensitivity and specificity were calculated. I2 statistics, Deek's funnel plot asymmetry test for publication bias, and meta-regression were applied for the data analysis.</p><p><strong>Results: </strong>Five studies comprising 1005 malignant and 846 benign lesions were eligible for data synthesis. The pooled sensitivity and specificity estimates of structured BI-RADS assessment were 95.7% (95% confidence interval [CI], 92.6%-97.5%) and 68.7% (95% CI, 60.9%-75.6%), respectively. Adding DWI to the structured BI-RADS assessment achieved a pooled sensitivity of 94.4% (95% CI, 90.5%-96.7%) and a pooled specificity of 74.9% (95% CI, 68.8%-80.2%). Adding DWI to the structured BI-RADS assessment significantly changed neither the sensitivity ( P = 0.52) nor the specificity ( P = 0.20).</p><p><strong>Conclusions: </strong>This systematic review and meta-analysis revealed only a limited, statistically nonsignificant added value of DWI compared with the structured assessment of BI-RADS criteria using the Kaiser score.</p>","PeriodicalId":14486,"journal":{"name":"Investigative Radiology","volume":" ","pages":"175-183"},"PeriodicalIF":7.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142894300","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}