Investigative Radiology最新文献

{"title":"Multimodal AI Combining Clinical and Imaging Inputs Improves Prostate Cancer Detection.","authors":"Christian Roest, Derya Yakar, Dorjan Ivan Rener Sitar, Joeran S Bosma, Dennis B Rouw, Stefan Johannes Fransen, Henkjan Huisman, Thomas C Kwee","doi":"10.1097/RLI.0000000000001102","DOIUrl":"10.1097/RLI.0000000000001102","url":null,"abstract":"<p><strong>Objectives: </strong>Deep learning (DL) studies for the detection of clinically significant prostate cancer (csPCa) on magnetic resonance imaging (MRI) often overlook potentially relevant clinical parameters such as prostate-specific antigen, prostate volume, and age. This study explored the integration of clinical parameters and MRI-based DL to enhance diagnostic accuracy for csPCa on MRI.</p><p><strong>Materials and methods: </strong>We retrospectively analyzed 932 biparametric prostate MRI examinations performed for suspected csPCa (ISUP ≥2) at 2 institutions. Each MRI scan was automatically analyzed by a previously developed DL model to detect and segment csPCa lesions. Three sets of features were extracted: DL lesion suspicion levels, clinical parameters (prostate-specific antigen, prostate volume, age), and MRI-based lesion volumes for all DL-detected lesions. Six multimodal artificial intelligence (AI) classifiers were trained for each combination of feature sets, employing both early (feature-level) and late (decision-level) information fusion methods. The diagnostic performance of each model was tested internally on 20% of center 1 data and externally on center 2 data (n = 529). Receiver operating characteristic comparisons determined the optimal feature combination and information fusion method and assessed the benefit of multimodal versus unimodal analysis. The optimal model performance was compared with a radiologist using PI-RADS.</p><p><strong>Results: </strong>Internally, the multimodal AI integrating DL suspicion levels with clinical features via early fusion achieved the highest performance. Externally, it surpassed baselines using clinical parameters (0.77 vs 0.67 area under the curve [AUC], P < 0.001) and DL suspicion levels alone (AUC: 0.77 vs 0.70, P = 0.006). Early fusion outperformed late fusion in external data (0.77 vs 0.73 AUC, P = 0.005). No significant performance gaps were observed between multimodal AI and radiologist assessments (internal: 0.87 vs 0.88 AUC; external: 0.77 vs 0.75 AUC, both P > 0.05).</p><p><strong>Conclusions: </strong>Multimodal AI (combining DL suspicion levels and clinical parameters) outperforms clinical and MRI-only AI for csPCa detection. Early information fusion enhanced AI robustness in our multicenter setting. Incorporating lesion volumes did not enhance diagnostic efficacy.</p>","PeriodicalId":14486,"journal":{"name":"Investigative Radiology","volume":" ","pages":"854-860"},"PeriodicalIF":7.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141792489","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":"Accelerated High-Resolution Deep Learning Reconstruction Turbo Spin Echo MRI of the Knee at 7 T.","authors":"Adrian Alexander Marth, Constantin von Deuster, Stefan Sommer, Georg Constantin Feuerriegel, Sophia Samira Goller, Reto Sutter, Daniel Nanz","doi":"10.1097/RLI.0000000000001095","DOIUrl":"10.1097/RLI.0000000000001095","url":null,"abstract":"<p><strong>Objectives: </strong>The aim of this study was to compare the image quality of 7 T turbo spin echo (TSE) knee images acquired with varying factors of parallel-imaging acceleration reconstructed with deep learning (DL)-based and conventional algorithms.</p><p><strong>Materials and methods: </strong>This was a prospective single-center study. Twenty-three healthy volunteers underwent 7 T knee magnetic resonance imaging. Two-, 3-, and 4-fold accelerated high-resolution fat-signal-suppressing proton density (PD-fs) and T1-weighted coronal 2D TSE acquisitions with an encoded voxel volume of 0.31 × 0.31 × 1.5 mm 3 were acquired. Each set of raw data was reconstructed with a DL-based and a conventional Generalized Autocalibrating Partially Parallel Acquisition (GRAPPA) algorithm. Three readers rated image contrast, sharpness, artifacts, noise, and overall quality. Friedman analysis of variance and the Wilcoxon signed rank test were used for comparison of image quality criteria.</p><p><strong>Results: </strong>The mean age of the participants was 32.0 ± 8.1 years (15 male, 8 female). Acquisition times at 4-fold acceleration were 4 minutes 15 seconds (PD-fs, Supplemental Video is available at http://links.lww.com/RLI/A938 ) and 3 minutes 9 seconds (T1, Supplemental Video available at http://links.lww.com/RLI/A939 ). At 4-fold acceleration, image contrast, sharpness, noise, and overall quality of images reconstructed with the DL-based algorithm were significantly better rated than the corresponding GRAPPA reconstructions ( P < 0.001). Four-fold accelerated DL-reconstructed images scored significantly better than 2- to 3-fold GRAPPA-reconstructed images with regards to image contrast, sharpness, noise, and overall quality ( P ≤ 0.031). Image contrast of PD-fs images at 2-fold acceleration ( P = 0.087), image noise of T1-weighted images at 2-fold acceleration ( P = 0.180), and image artifacts for both sequences at 2- and 3-fold acceleration ( P ≥ 0.102) of GRAPPA reconstructions were not rated differently than those of 4-fold accelerated DL-reconstructed images. Furthermore, no significant difference was observed for all image quality measures among 2-fold, 3-fold, and 4-fold accelerated DL reconstructions ( P ≥ 0.082).</p><p><strong>Conclusions: </strong>This study explored the technical potential of DL-based image reconstruction in accelerated 2D TSE acquisitions of the knee at 7 T. DL reconstruction significantly improved a variety of image quality measures of high-resolution TSE images acquired with a 4-fold parallel-imaging acceleration compared with a conventional reconstruction algorithm.</p>","PeriodicalId":14486,"journal":{"name":"Investigative Radiology","volume":" ","pages":"831-837"},"PeriodicalIF":7.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141498073","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":"Molecular Ultrasound Imaging With Clinically Translatable cRGD-Coated Microbubbles to Assess αvβ3-Integrin Expression in Inflammatory Bowel Disease.","authors":"Jinwei Qi, Junlin Chen, Saskia von Stillfried, Patrick Kozcera, Yang Shi, Anne Rix, Fabian Kiessling","doi":"10.1097/RLI.0000000000001143","DOIUrl":"https://doi.org/10.1097/RLI.0000000000001143","url":null,"abstract":"<p><strong>Objectives: </strong>Inflammatory bowel disease (IBD) subdivides into Crohn disease (CD) and ulcerative colitis (UC), and is characterized by unpredictable periods of inflammation and results in significant patient suffering and even death. Conventional diagnostic methods, for example, colonoscopy, computed tomography, or magnetic resonance imaging, have limitations such as invasiveness, patient discomfort, and limited sensitivity and accuracy. Therefore, we propose ultrasound molecular imaging (USMI) to detect and characterize IBD. First, we evaluated integrin-αvβ3 as a biomarker of IBD in human samples and then used clinically translatable cyclic Arg-Gly-Asp-D-Phe-Lys (cRGDfK)-coupled poly(butyl)cyanoacrylate microbubbles (cRGD-MB) to assess IBD in mice.</p><p><strong>Materials and methods: </strong>Vascular integrin-αvβ3 expression in human colon tissue samples (healthy, CD and UC, n = 10 per group) was analyzed by immunofluorescence staining. In mice, acute colitis was induced by administration of 4% dextran sodium sulfate in drinking water for 5 days. On day 7, USMI with cRGD-MB was performed in colitis (n = 6) and healthy (n = 5) mice. The signal of bound cRGD-MB was assessed by the destruction-replenishment method. Ex vivo analysis of mouse colon tissue was performed to assess the degree of colitis by hematoxylin-eosin staining and the vascular expression of integrin-αv by immunofluorescence.</p><p><strong>Results: </strong>Human samples showed a significantly higher vascular integrin-αvβ3 expression in CD and UC tissue, when compared with healthy samples (P < 0.005). In mice, a higher binding of cRGD-MB to inflamed colon was detected by USMI compared with healthy controls (P < 0.005). Immunofluorescence staining confirmed these findings, showing stronger integrin-αv expression in acute colitis, with a good correlation between USMI signal intensity and integrin-αv expression (r = 0.8, P = 0.0016).</p><p><strong>Conclusions: </strong>Integrin-αvβ3 on vessels is a suitable marker for IBD. USMI using cRGD-MB accurately detects this marker and correlates well with histology. These encouraging results support clinical translation of this imaging method as a noninvasive and cost-effective monitoring tool.</p>","PeriodicalId":14486,"journal":{"name":"Investigative Radiology","volume":" ","pages":""},"PeriodicalIF":7.0,"publicationDate":"2024-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142750691","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":"Improved MR Detection of Optic Nerve Demyelination With MP2RAGE-FLAWS Compared With T2-Weighted Fat-Saturated Sequences.","authors":"Randa Aichour, Thibaut Emorine, Nadia Oubaya, Imen Megdiche, Alain Créange, Augustin Lecler, Tobias Kober, Aurélien Massire, Blanche Bapst","doi":"10.1097/RLI.0000000000001140","DOIUrl":"https://doi.org/10.1097/RLI.0000000000001140","url":null,"abstract":"<p><strong>Objectives: </strong>Nonenhanced T1-w sequences such as magnetization-prepared 2 rapid acquisition gradient echo (MP2RAGE) and derived fluid and white matter suppression (FLAWS) have demonstrated high performance for detecting brain parenchymal and cervical spine demyelinating lesions in multiple sclerosis. However, their potential for identifying optic nerve (ON) demyelination remains unexplored. The aim of this study was to evaluate the performance of compressed sensing-accelerated (CS) MP2RAGE-FLAWS imaging for detection of ON demyelination lesions compared with T2-w fat-saturated (FS) TSE imaging in a clinical setting.</p><p><strong>Materials and methods: </strong>We conducted a retrospective study of magnetic resonance scans acquired on patients with central nervous system demyelinating disorders between January and December 2022. Inclusion criteria were the acquisition in the same session of a brain CS-MP2RAGE-FLAWS imaging and a combination of axial + coronal T2-w FS orbital sequences. A 4-step radiological analysis-including blinded and consensus readings-assessed ON lesion detection. The reference standard was the final reading session of radiologists using the entire patient file. Sensitivities and specificities of both sequences were computed and compared using McNemar χ2 tests.</p><p><strong>Results: </strong>Thirty-nine patients (mean age: 43 ± 14 years; 25 women) were analyzed, including 34 with multiple sclerosis, 2 with MOGAD (myelin oligodendrocyte glycoprotein antibody-associated disease), 1 with NMOSD (neuromyelitis optica spectrum disorder), and 2 with indeterminate demyelinating disease. Among the 78 ONs analyzed, 64 lesions were detected with CS-MP2RAGE-FLAWS as opposed to 37 with 2D T2-w FS imaging, corresponding to a total of 41 and 27 affected nerves, respectively. CS-MP2RAGE-FLAWS exhibited higher sensitivity for overall detection of ON lesions compared with 2D T2-w FS imaging (97.5% vs 67.5%, P = 0.001) without reducing the specificity. Improved lesion detectability with CS-MP2RAGE-FLAWS was significant compared with 2D T2-w FS in intraorbital and intracanalicular segments (respectively, 92.3% vs 50% and 96.3% vs 66.7%; P < 0.05). There was no difference in sensitivity (P = 0.69) or specificity (P = 0.99) regarding the intracranial segment analysis.</p><p><strong>Conclusions: </strong>CS-MP2RAGE-FLAWS sequence improves ON lesion detection compared with conventional 2D T2-w FS, especially in the intraorbital segment, while simultaneously providing whole-brain and cervical spinal cord imaging at no additional time cost.</p>","PeriodicalId":14486,"journal":{"name":"Investigative Radiology","volume":" ","pages":""},"PeriodicalIF":7.0,"publicationDate":"2024-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142739363","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":"Safety of Gadopiclenol After Its First Year of Clinical Use.","authors":"Alberto Spinazzi, Eric Lancelot, Letizia Vitali, Christophe Cot, Gianpaolo Pirovano, Alvin Joseph, Miles A Kirchin, Elisabeth Darmon-Kern, Philippe Bourrinet","doi":"10.1097/RLI.0000000000001144","DOIUrl":"10.1097/RLI.0000000000001144","url":null,"abstract":"<p><strong>Abstract: </strong>Gadopiclenol is a novel, macrocyclic high-relaxivity gadolinium-based contrast agent recently approved for use in magnetic resonance imaging of the central nervous system and body organs at a dose of 0.05 mmol/kg body weight. Postmarketing surveillance of its first year of clinical use in the United States of America showed no serious adverse events (AEs) following over 882,550 administrations and a very low rate of nonserious AEs (1 case every 27,580 exposures). The types of observed AEs were similar to those reported for other gadolinium-based contrast agents in clinical use. Safety data from postmarketing surveillance of gadopiclenol further confirm its positive benefit-risk profile demonstrated in preapproval clinical studies.</p>","PeriodicalId":14486,"journal":{"name":"Investigative Radiology","volume":" ","pages":""},"PeriodicalIF":7.0,"publicationDate":"2024-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142846440","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":"Leveraging Phase Information of 3D Isotropic Ultrashort Echo Time Pulmonary MRI for the Detection of Thoracic Lymphadenopathy: Toward an All-in-One Scan Solution.","authors":"Sebastian Ziegelmayer, Anh Tu Van, Kilian Weiss, Alexander W Marka, Tristan Lemke, Florian Scheuerer, Thomas Huber, Andreas Sauter, Ryan Robison, Joshua Gawlitza, Marcus R Makowski, Dimitrios C Karampinos, Markus Graf","doi":"10.1097/RLI.0000000000001135","DOIUrl":"10.1097/RLI.0000000000001135","url":null,"abstract":"<p><strong>Background: </strong>Ultrashort echo time (UTE) allows imaging of tissues with short relaxation times, but it comes with the expense of long scan times. Magnitude images of UTE magnetic resonance imaging (MRI) are widely used in pulmonary imaging due to excellent parenchymal signal, but have insufficient contrast for other anatomical regions of the thorax. Our work investigates the value of UTE phase images (UTE-Ps)-generated simultaneously from the acquired UTE signal used for the magnitude images-for the detection of thoracic lymph nodes based on water-fat contrast. It employs an advanced imaging sequence and reconstruction allowing isotropic 3D UTE MRI in clinically acceptable scan times.</p><p><strong>Methods: </strong>In our prospective study, 42 patients with 136 lymph nodes had undergone venous computed tomography and pulmonary MRI scans with UTE within a 14-day interval. 3D isotropic UTE images were acquired using FLORET (fermat looped, orthogonally encoded trajectories). Background-corrected phase images (UTE-P) and magnitude images were reconstructed simultaneously from the UTE-Signal. Three radiologists performed a blinded reading in which all lymph nodes with a short-axis diameter (SAD) of at least 0.5 cm were detected. Detection rates and performance metrics of UTE-P for all lymph node regions and for pathologic (SAD ≥10 mm) and nonpathologic lymph nodes (SAD <10 mm) were calculated using computed tomography as a reference. The interreader agreement defined as the presence or absence of lymph nodes based on patient and region was calculated using Fleiss kappa (κ).</p><p><strong>Findings: </strong>In the phase images, pathologic lymph nodes in the mediastinal and hilar region were detected with a high diagnostic confidence due to the achieved water-fat contrast (average sensitivity, specificity, positive predictive value, and negative predictive value of 95.83% [confidence interval (CI), 92.76%-98.91%], 100%, 100%, and 99.32% [CI, 98.08%-100%]). Stepwise inclusion of all lymph node regions and nonpathologic lymph nodes was associated with a moderate decrease resulting in an average sensitivity, specificity, positive predictive value, and negative predictive value of 77.9% (CI, 70.9%-84.7%), 99.4% (CI, 98.7%-99.9%), 97.0% (CI, 93.4%-99.7%), and 94.7% (CI, 92.8%-96.4%) for the inclusion of all lymph nodes sizes and regions. Interreader agreement was almost perfect (κ = 0.92).</p><p><strong>Conclusions: </strong>Pathological lymph nodes in the mediastinal and hilar region can be detected in phase-images with high diagnostic confidence, thanks to the ability of the phase images to depict water-fat contrast in combination with high spatial 3D resolution, extending the clinical applicability of UTE into the simultaneous assessment of lung parenchyma and lymph nodes.</p>","PeriodicalId":14486,"journal":{"name":"Investigative Radiology","volume":" ","pages":""},"PeriodicalIF":7.0,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142836663","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":"Metastasis Detection Using True and Artificial T1-Weighted Postcontrast Images in Brain MRI.","authors":"Robert Haase, Thomas Pinetz, Erich Kobler, Zeynep Bendella, Daniel Paech, Ralf Clauberg, Martha Foltyn-Dumitru, Verena Wagner, Kai Schlamp, Gudula Heussel, Claus Peter Heussel, Martin Vahlensieck, Julian A Luetkens, Heinz-Peter Schlemmer, Louisa Specht-Riemenschneider, Alexander Radbruch, Alexander Effland, Katerina Deike","doi":"10.1097/RLI.0000000000001137","DOIUrl":"10.1097/RLI.0000000000001137","url":null,"abstract":"<p><strong>Objectives: </strong>Small lesions are the limiting factor for reducing gadolinium-based contrast agents in brain magnetic resonance imaging (MRI). The purpose of this study was to compare the sensitivity and precision in metastasis detection on true contrast-enhanced T1-weighted (T1w) images and artificial images synthesized by a deep learning method using low-dose images.</p><p><strong>Materials and methods: </strong>In this prospective, multicenter study (5 centers, 12 scanners), 917 participants underwent brain MRI between October 2021 and March 2023 including T1w low-dose (0.033 mmol/kg) and full-dose (0.1 mmol/kg) images. Forty participants with metastases or unremarkable brain findings were evaluated in a reading (mean age ± SD, 54.3 ± 15.1 years; 24 men). True and artificial T1w images were assessed for metastases in random order with 4 weeks between readings by 2 neuroradiologists. A reference reader reviewed all data to confirm metastases. Performances were compared using mid- P McNemar tests for sensitivity and Wilcoxon signed rank tests for false-positive findings.</p><p><strong>Results: </strong>The reference reader identified 97 metastases. The sensitivity of reader 1 did not differ significantly between sequences (sensitivity [precision]: true, 66.0% [98.5%]; artificial, 61.9% [98.4%]; P = 0.38). With a lower precision than reader 1, reader 2 found significantly more metastases using true images (sensitivity [precision]: true, 78.4% [87.4%]; artificial, 60.8% [80.8%]; P < 0.001). There was no significant difference in sensitivity for metastases ≥5 mm. The number of false-positive findings did not differ significantly between sequences.</p><p><strong>Conclusions: </strong>One reader showed a significantly higher overall sensitivity using true images. The similar detection performance for metastases ≥5 mm is promising for applying low-dose imaging in less challenging diagnostic tasks than metastasis detection.</p>","PeriodicalId":14486,"journal":{"name":"Investigative Radiology","volume":" ","pages":""},"PeriodicalIF":7.0,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142836665","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":"A Quantitative Comparison Between Human and Artificial Intelligence in the Detection of Focal Cortical Dysplasia.","authors":"Lennart Walger, Tobias Bauer, David Kügler, Matthias H Schmitz, Fabiane Schuch, Christophe Arendt, Tobias Baumgartner, Johannes Birkenheier, Valeri Borger, Christoph Endler, Franziska Grau, Christian Immanuel, Markus Kölle, Patrick Kupczyk, Asadeh Lakghomi, Sarah Mackert, Elisabeth Neuhaus, Julia Nordsiek, Anna-Maria Odenthal, Karmele Olaciregui Dague, Laura Ostermann, Jan Pukropski, Attila Racz, Klaus von der Ropp, Frederic Carsten Schmeel, Felix Schrader, Aileen Sitter, Alexander Unruh-Pinheiro, Marilia Voigt, Martin Vychopen, Philip von Wedel, Randi von Wrede, Ulrike Attenberger, Hartmut Vatter, Alexandra Philipsen, Albert Becker, Martin Reuter, Elke Hattingen, Josemir W Sander, Alexander Radbruch, Rainer Surges, Theodor Rüber","doi":"10.1097/RLI.0000000000001125","DOIUrl":"10.1097/RLI.0000000000001125","url":null,"abstract":"<p><strong>Objectives: </strong>Artificial intelligence (AI) is thought to improve lesion detection. However, a lack of knowledge about human performance prevents a comparative evaluation of AI and an accurate assessment of its impact on clinical decision-making. The objective of this work is to quantitatively evaluate the ability of humans to detect focal cortical dysplasia (FCD), compare it to state-of-the-art AI, and determine how it may aid diagnostics.</p><p><strong>Materials and methods: </strong>We prospectively recorded the performance of readers in detecting FCDs using single points and 3-dimensional bounding boxes. We acquired predictions of 3 AI models for the same dataset and compared these to readers. Finally, we analyzed pairwise combinations of readers and models.</p><p><strong>Results: </strong>Twenty-eight readers, including 20 nonexpert and 5 expert physicians, reviewed 180 cases: 146 subjects with FCD (median age: 25, interquartile range: 18) and 34 healthy control subjects (median age: 43, interquartile range: 19). Nonexpert readers detected 47% (95% confidence interval [CI]: 46, 49) of FCDs, whereas experts detected 68% (95% CI: 65, 71). The 3 AI models detected 32%, 51%, and 72% of FCDs, respectively. The latter, however, also predicted more than 13 false-positive clusters per subject on average. Human performance was improved in the presence of a transmantle sign ( P < 0.001) and cortical thickening ( P < 0.001). In contrast, AI models were sensitive to abnormal gyration ( P < 0.01) or gray-white matter blurring ( P < 0.01). Compared with single experts, expert-expert pairs detected 13% (95% CI: 9, 18) more FCDs ( P < 0.001). All AI models increased expert detection rates by up to 19% (95% CI: 15, 24) ( P < 0.001). Nonexpert+AI pairs could still outperform single experts by up to 13% (95% CI: 10, 17).</p><p><strong>Conclusions: </strong>This study pioneers the comparative evaluation of humans and AI for FCD lesion detection. It shows that AI and human predictions differ, especially for certain MRI features of FCD, and, thus, how AI may complement the diagnostic workup.</p>","PeriodicalId":14486,"journal":{"name":"Investigative Radiology","volume":" ","pages":""},"PeriodicalIF":7.0,"publicationDate":"2024-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142500556","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 CT Iodine Maps for Diagnosing Chronic Pulmonary Thromboembolism: A Pilot Study.","authors":"Bjarne Kerber, Thomas Flohr, Silvia Ulrich, Mona Lichtblau, Thomas Frauenfelder, Sabine Franckenberg","doi":"10.1097/RLI.0000000000001134","DOIUrl":"https://doi.org/10.1097/RLI.0000000000001134","url":null,"abstract":"<p><strong>Objectives: </strong>The aim of this study was to evaluate the feasibility and efficacy of chronic pulmonary thromboembolism assessment using photon-counting detector computed tomography (PCD-CT) iodine maps of the lung parenchyma.</p><p><strong>Materials and methods: </strong>This institutional review board-approved retrospective study included 83 subjects (49.4% male, aged 62.4 ± 13.4 years; 50.6% female, aged 59.9 ± 17.1 years) who underwent clinically indicated PCD-CT scan to rule out chronic thromboembolic pulmonary hypertension (CTEPH). Two blinded readers used iodine maps and corresponding sharp-kernel CT reconstructions in the lung window to evaluate perfusion defects and identify patients with chronic pulmonary thromboembolism (CTEPH, CTEPH overlap with other causes of pulmonary hypertension [PH], chronic thromboembolic disease [CTED]). No other clinical or imaging information was given. Discordance was resolved in a subsequent consensus read. The clinical diagnosis was reviewed in an interdisciplinary clinical setting. The accuracy, sensitivity, and specificity of radiologic evaluation and clinical diagnosis were calculated.</p><p><strong>Results: </strong>Of the 83 subjects included, 32 were diagnosed with CTEPH, CTEPH overlap, or CTED, 35 were diagnosed with PH caused by other pathologic mechanisms, 10 had no PH, and 6 had suffered previous acute pulmonary embolism, which resolved. The interreader agreement was good (Cohen κ = 0.74). The consensus reached high accuracy (0.88), sensitivity (0.94), and specificity (0.84), as well as good agreement with interdisciplinary clinical diagnosis (Cohen κ = 0.75). No cases with confirmed CTEPH as the primary cause of PH or CTED were missed. Patients with pulmonary arterial hypertension were most frequently rated false-positive. The mean effective dose (±standard deviation) was 1.3 (±0.76) mSv.</p><p><strong>Conclusions: </strong>Accurate, sensitive, and specific diagnosis of pulmonary chronic thromboembolism at low radiation dose is possible using iodine maps reconstructed from PCD-CT scans.</p>","PeriodicalId":14486,"journal":{"name":"Investigative Radiology","volume":" ","pages":""},"PeriodicalIF":7.0,"publicationDate":"2024-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142604398","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":"Epineural Scarring Visualization and Noninvasive Quantification of a Severe Posttraumatic Complication: An Experimental Magnetic Resonance Neurography Study.","authors":"Merle Brunnée, Martin Aman, Maximilian Mayrhofer-Schmid, Manuel Fischer, Simeon C Daeschler, Tess Klemm, Ulrich Kneser, Kianush Karimian-Jazi, Michael O Breckwoldt, Leila Harhaus, Sabine Heiland, Martin Bendszus, Arne H Boecker, Daniel Schwarz","doi":"10.1097/RLI.0000000000001132","DOIUrl":"https://doi.org/10.1097/RLI.0000000000001132","url":null,"abstract":"<p><strong>Aim: </strong>Peripheral nerve scarring is a severe yet common complication following nerve injury or surgery that can lead to impaired nerve function, including chronic pain and sensory or motor deficits. In this study, we aimed to establish high-resolution magnetic resonance neurography (MRN) to accurately visualize and monitor de novo-formed epineural fibrotic adhesions (EFAs) of the sciatic nerve in a rat nerve injury model.</p><p><strong>Methods: </strong>Employing an established model to induce overshooting EFA, the study included 3 experimental groups of animals (n = 6 each): a positive control group (PC), an intervention group (IG), and a sham group. All groups underwent surgical nerve exposure: both PC and IG received an application of 10 μL 2.5% glutaraldehyde to induce EFA, but only IG received an additional preventive wrapping of the nerve with a collagen-containing matrix. Magnetic resonance imaging was performed 6, 8, and 12 weeks postoperatively using a standardized protocol including T2w and T1w without and with contrast media. Motor function and nerve regeneration was assessed using the visual static sciatic index. Histological specimens were obtained 12 weeks postoperatively and correlated with imaging.</p><p><strong>Results: </strong>On high-resolution MRN, prominently contrast-enhancing epineural sleeves were present in vivo, which corresponded to histologically confirmed EFA (ratio of EFA to nerve area MRN 1.512 ± 0.106 vs histological ratio 1.459 ± 0.208, nonsignificant). As expected, average EFA in IG (0.310 ± 0.118 mm2) was smaller than in PC (0.909 ± 0.212 mm2, P < 0.01). Also, the average EFA in sham (0.386 ± 0.030 mm2) was less pronounced than in PC (P < 0.01). There was no significant difference in the average EFA between IG und sham. The EFA correlated with the functional outcome, which was measured by visual static sciatic index (correlation coefficient -0.59, P < 0.05).</p><p><strong>Conclusions: </strong>The results of the present study for the first time confirm the clinical observation that epineural thickening on contrast-enhanced T1w imaging following manipulation to a nerve indeed corresponds to overshooting epineural scarring, which may be linked to impaired nerve function. This can be followed noninvasively in vivo over time providing an important basis for clinical decision-making in cases where further invasive therapies may be necessary.</p>","PeriodicalId":14486,"journal":{"name":"Investigative Radiology","volume":" ","pages":""},"PeriodicalIF":7.0,"publicationDate":"2024-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142604397","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}