British Journal of Radiology最新文献

{"title":"Imaging and Endovascular Interventions in Renal Arteriovenous Shunts.","authors":"Divij Agarwal, Sanchita Gupta, Chandan J Das, Pradeep Hatimota, Sai Krishna Gadwal","doi":"10.1093/bjr/tqaf154","DOIUrl":"https://doi.org/10.1093/bjr/tqaf154","url":null,"abstract":"<p><p>Renal arteriovenous shunts are rare vascular anomalies that develop due to aberrant communication between the renal arteries and veins, bypassing intervening capillaries. They fall into the broad categories of arteriovenous malformations (usually congenital) and, more commonly, arteriovenous fistula (usually acquired). When symptomatic, they can lead to the development of hematuria, high-output cardiac failure, hypertension, renal impairment or retroperitoneal hematoma. Imaging techniques, such as Doppler ultrasound, Digital subtraction angiography, CT angiography, and MR angiography, can help accurately identify and categorize these renal arteriovenous shunts. While open surgery was once the standard of care, endovascular embolization has gained popularity due to its efficacy and minimally invasive nature. Embolization of these lesions is tailored to the type, severity, and flow dynamics of the shunt. Detailed imaging assessment and meticulous pre-procedural planning are critical for optimal management, including preservation of residual renal function. This article describes the causes, classification, imaging findings and endovascular management of renal arteriovenous shunts.</p>","PeriodicalId":9306,"journal":{"name":"British Journal of Radiology","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144625395","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":"Intravascular Ultrasound (IVUS) in Transjugular Intrahepatic Portosystemic Shunt (TIPS) Creation: A Systematic Review and Meta-Analysis Comparing Conventional TIPS with IVUS-Guided TIPS.","authors":"Pooya Torkian, Reza Talaie, Siobhan Flanagan, Ashkan Heshmatzadeh Behzadi","doi":"10.1093/bjr/tqaf158","DOIUrl":"https://doi.org/10.1093/bjr/tqaf158","url":null,"abstract":"<p><strong>Objectives: </strong>This systematic review and meta-analysis evaluate the clinical and procedural benefits of intravascular ultrasound (IVUS)-guided portal vein access during transjugular intrahepatic portosystemic shunt (iTIPS) creation compared to the conventional TIPS (cTIPS) technique.</p><p><strong>Methods: </strong>A comprehensive search of Medline and Google Scholar through August 30, 2024, was conducted to identify retrospective studies comparing iTIPS and cTIPS. A total of six studies, involving 418 patients (180 undergoing iTIPS and 238 undergoing cTIPS), met inclusion criteria. Matched comparison groups were used to analyze outcomes.</p><p><strong>Results: </strong>Technical success rates were similar between iTIPS and cTIPS groups. One study reported a significantly lower complication rate with iTIPS, while three studies found no differences in complications. Notably, iTIPS significantly reduced fluoroscopy time by 9.74 minutes (p < 0.001) and radiation exposure by 583.4 mGy (p < 0.001) compared to cTIPS. The total procedure time and portal venous access time were shorter by 21 minutes (p < 0.001) and 15.49 minutes (p < 0.001), respectively, with IVUS guidance. Additionally, contrast agent use was 69.62 cc lower (p < 0.001) in iTIPS cases.</p><p><strong>Conclusion: </strong>Although based on a limited number of studies, these findings support IVUS-guided TIPS as a superior technique for improving procedural efficiency and reducing radiation exposure, procedure times, and contrast agent usage without compromising success rates. Its benefits are particularly pronounced in patients with complex anatomy or heightened risk factors.</p><p><strong>Advances in knowledge: </strong>IVUS-guided TIPS demonstrates potential procedural and safety advantages over conventional techniques, particularly in anatomically complex or high-risk patients. These findings support further investigation and prospective validation.</p>","PeriodicalId":9306,"journal":{"name":"British Journal of Radiology","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144616301","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":"Seeing is Believing-On the Utility of CT in Phenotyping COPD.","authors":"Hira A Awan, Muhammad F A Chaudhary, Joseph M Reinhardt","doi":"10.1093/bjr/tqaf160","DOIUrl":"https://doi.org/10.1093/bjr/tqaf160","url":null,"abstract":"<p><p>Chronic obstructive pulmonary disease (COPD) is a heterogeneous condition with complicated structural and functional impairments. For decades now, chest computed tomography (CT) has been used to quantify various abnormalities related to COPD. More recently, with the newer data-driven approaches, biomarker development and validation have evolved rapidly. Studies now target multiple anatomical structures including lung parenchyma, the airways, the vasculature, and the fissures to better characterize COPD. This review explores the evolution of chest CT biomarkers in COPD, beginning with traditional thresholding approaches that quantify emphysema and airway dimensions. We then highlight some of the texture analysis efforts that have been made over the years for subtyping lung tissue. We also discuss image registration-based biomarkers that have enabled spatially-aware mechanisms for understanding local abnormalities within the lungs. More recently, deep learning has enabled automated biomarker extraction, offering improved precision in phenotype characterization and outcome prediction. We highlight the most recent of these approaches as well. Despite these advancements, several challenges remain in terms of dataset heterogeneity, model generalizability, and clinical interpretability. This review lastly provides a structured overview of these limitations and highlights future potential of CT biomarkers in personalized COPD management.</p>","PeriodicalId":9306,"journal":{"name":"British Journal of Radiology","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144616302","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":"Hybrid Procedure Suites: Combining Computed Tomography and Conventional Angiography.","authors":"Yasuaki Arai","doi":"10.1093/bjr/tqaf151","DOIUrl":"https://doi.org/10.1093/bjr/tqaf151","url":null,"abstract":"<p><p>The effectiveness of a combined computed tomography and angiography system in interventional radiology was evaluated based on imaging information required at each step. During the planning phase, three-dimensional visualisation of the target and surrounding organs is essential, making computed tomography superior to X-ray fluoroscopy and ultrasound. Real-time imaging with high spatial resolution is crucial for target access; however, X-ray fluoroscopy, ultrasound, and computed tomography alone cannot fully meet these requirements. When manipulating interventional radiology devices, high spatial resolution and real-time capabilities are essential, making X-ray fluoroscopy the preferred modality. To confirm the outcome of the procedure, three-dimensional imaging without hidden areas is necessary with computed tomography being the most suitable option. In conclusion, although no single imaging modality is ideal for all steps of interventional radiology, considering the mobility of US, angiography-computed tomography system, which integrates angiography and CT on a single table, is useful for accurately carrying out various treatments in interventional radiology.</p>","PeriodicalId":9306,"journal":{"name":"British Journal of Radiology","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144616299","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":"Hypofractionated whole-breast radiation therapy with simultaneous integrated boost after breast conserving surgery: preliminary real-life experience of the Radiation Therapy Oncology Group (RTOG) 1005 trial.","authors":"Gokoulakrichenane Loganadane, Pierre Loap, Sofiane Allali, Jihane Bouziane, Kim Cao, Ryan Bouaita, Jeremi Vu-Bezin, Youlia Kirova","doi":"10.1093/bjr/tqaf157","DOIUrl":"https://doi.org/10.1093/bjr/tqaf157","url":null,"abstract":"<p><strong>Purpose: </strong>This study aimed to report cosmetic and oncological outcomes for patients who underwent adjuvant hypofractionated whole-breast radiation therapy (WBRT) (40Gy in 15 fractions) with simultaneous integrated boost (SIB) (48Gy) using IMRT (Intensity Modulated Radiation Therapy) or VMAT (Volumetric Modulated Arc Therapy) after breast-conserving surgery at our institution as per the experimental arm of the RTOG 1005 trial.</p><p><strong>Materials and methods: </strong>170 patients who underwent adjuvant moderate hypofractionated WBRT with SIB after breast-conserving surgery were identified between 29 July 2019 and 22 September 2024.</p><p><strong>Results: </strong>The median age was 57 (range: 33-84). The pTstage distribution was as follows: Tis: 18.2%, T0: 9.4%, T1: 57.1%, T2: 14.1% and T3: 1.2%. pN0: 82.9% and pN1mic: 17.1%. Neoadjuvant/adjuvant chemotherapy and adjuvant endocrine therapy were administered in 17.6%, 26.5% and 58.2% of cases respectively. IMRT and VMAT techniques were used in 79.4% and 20.6% of cases respectively. The median mean heart dose was 0.9Gy (0,2-4,7). The median V16 and V8 of the ipsilateral lung were 12.8% (0-60.5) and 19.1% (0-63). Grade 1 and grade 2 radiodermitis and edema were reported in 58.8%, 4.7%, 3.5% and 0.6% of cases respectively. With a median follow-up of 14 months (0-55), the one-year local relapse free survival (LRFS), the locoregional relapse free survival (LRRFS), the metastases recurrence free survival (MRFS) and overall survival were all 100%.</p><p><strong>Conclusion: </strong>Our preliminary data suggests that routine use of SIB with WBRT using IMRT or VMAT was feasible with a favorable risk-benefit ratio. Longer follow-up can confirm the safety of this approach.</p>","PeriodicalId":9306,"journal":{"name":"British Journal of Radiology","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144616300","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":"Suspected infection of unclear origin at the emergency department: diagnostic yield of thoraco-abdominal-pelvic CT in non-severe patients.","authors":"Marine Dumon, Sybille Fotso Tambue, Ingrid Millet, Thibaut Markarian, Xavier Bobbia, Fanchon Herman, Patrice Taourel, Juliette Coutureau","doi":"10.1093/bjr/tqaf150","DOIUrl":"https://doi.org/10.1093/bjr/tqaf150","url":null,"abstract":"<p><strong>Objectives: </strong>To assess the diagnostic yield of thoraco-abdominal-pelvic CT (TAP-CT) in suspected infection of unclear origin in the Emergency Department (ED) and identify predictive factors for normal TAP-CT to optimize its use.</p><p><strong>Methods: </strong>We retrospectively categorized 517 TAP-CT studies of adult patients with non-severe infection of unclear origin based on the presence of an infectious focus or significant findings, such as neoplasia or thrombosis. Descriptive analysis, correspondence assessment between CT results and final diagnosis, and statistical modeling were performed to identify predictors of normal TAP-CT.</p><p><strong>Results: </strong>An infectious focus was identified in 55% TAP-CT scans, mainly pulmonary (46%), bilio-digestive (25%), and genitourinary (23%). Significant noninfectious findings were detected in 20%, including thrombosis (7%) and neoplasia (12%). TAP-CT showed a sensitivity of 73%, specificity of 88%, PPV of 94%, and NPV of 57%, with moderate agreement (Kappa= 0.53) between TAP-CT findings and final diagnosis. Overall, 67% of patients had an identifiable cause for infection-like symptoms. Although C-reactive protein <128 mg/L was associated with normal TAP-CT, no model reliably predicted a normal scan.</p><p><strong>Conclusions: </strong>TAP-CT identified a relevant finding in over two-thirds of cases, reinforcing its role in diagnosing both infectious and mimicking conditions. No specific criteria could safely exclude TAP-CT, making it a valuable tool for managing patients with suspected infections of unclear origin.</p><p><strong>Advances in knowledge: </strong>This study is the first to assess TAP-CT's value in suspected non-severe infections of unclear origin in the ED, highlighting its role in detecting infectious and noninfectious conditions and optimizing diagnostic strategies.</p>","PeriodicalId":9306,"journal":{"name":"British Journal of Radiology","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144599457","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":"Long-Term Breast Cancer Risk Post Childhood Cancer Radiotherapy: Data-Driven Screening Recommendations for Survivors.","authors":"Charlotte Demoor-Goldschmidt, Mathilde Lefresne, Emmanuel Jouglar, Luc Ollivier, Stéphanie Bolle, Claire Alapetite, Gilles Truc, Laetitia Padovani, Anne Laprie, Valérie Bernier-Chastagner","doi":"10.1093/bjr/tqaf131","DOIUrl":"https://doi.org/10.1093/bjr/tqaf131","url":null,"abstract":"<p><strong>Objective: </strong>Modern radiotherapy techniques have significantly reduced radiation exposure to healthy tissues. This study analysed breast tissue radiation doses in a national pediatric radiotherapy database, explored the discrepancy between prescribed and actual doses and analysed shortcomings of current breast screening guidelines.</p><p><strong>Methods: </strong>We analysed PediaRT database data on radiotherapy dose distributions for 5,079 French childhood cancer patients (2013-present), focusing on photon therapy plans with available breast dose data (n = 428). Biological equivalent dose (BED) was calculated, and statistical analyses (t-tests, chi-square, Mann-Whitney U, Fisher's exact, and logistic regression) identified factors associated with breast dose exposure.</p><p><strong>Results: </strong>Among patients receiving supra-diaphragmatic radiotherapy, 99.3% had a prescribed dose >10 Gy, but 62.1% received a maximum dose greater than 10 Gy to at least one breast, and 25.5% received a mean dose greater than 10 Gy. As pediatric treatments often use fraction sizes <2 Gy, BED analysis revealed that 51.29% to 80.47% of patients prescribed >10 Gy received <10 Gy as minimal, maximal, or mean dose. These discrepancies suggest that current breast cancer screening guidelines, based on prescribed doses, may overestimate risk in survivors treated with modern techniques.</p><p><strong>Discussion: </strong>Our findings support a shift toward dose-specific screening recommendations based on actual tissue exposure. Relying solely on prescribed doses and fields may lead to unnecessary screenings and increased burden for patients.</p><p><strong>Advances in knowledge: </strong>This study is the first to assess actual breast tissue radiation doses using a national multicenter pediatric radiotherapy database. It highlights how current breast cancer screening guidelines based on prescribed doses may overestimate risk in survivors treated with modern radiotherapy techniques.</p>","PeriodicalId":9306,"journal":{"name":"British Journal of Radiology","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144599456","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":"Aligning Systematic Reviews: The Role of PET in Detecting Histological Transformation in Follicular Lymphoma.","authors":"Marc Sorigue, Milos Miljkovic, Pablo Mozas","doi":"10.1093/bjr/tqaf144","DOIUrl":"https://doi.org/10.1093/bjr/tqaf144","url":null,"abstract":"","PeriodicalId":9306,"journal":{"name":"British Journal of Radiology","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144583176","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":"Author response to Letter manuscript BJR-D-25-00310 \"Aligning Systematic Reviews: The Role of PET in Detecting Histological Transformation in Follicular Lymphoma\".","authors":"Osher N Y Lee","doi":"10.1093/bjr/tqaf145","DOIUrl":"https://doi.org/10.1093/bjr/tqaf145","url":null,"abstract":"","PeriodicalId":9306,"journal":{"name":"British Journal of Radiology","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144583177","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":"Real-World Performance Evaluation of Commercial Autocontouring Software for Head and Neck Cancer Radiotherapy.","authors":"Tom Young, Victoria Butterworth, Sarah Misson, Delali Adjogatse, Anthony Kong, Imran Petkar, Miguel Reis Ferreira, Mary Lei, Andy King, Teresa Guerrero Urbano","doi":"10.1093/bjr/tqaf098","DOIUrl":"https://doi.org/10.1093/bjr/tqaf098","url":null,"abstract":"<p><strong>Objectives: </strong>To comprehensively evaluate the ability of ART-Plan™ (autocontouring software using Artificial Intelligence (AI)) to contour Head and Neck Cancer (HNC) radiotherapy structures (organs-at-risk and elective nodal volumes) in a real-world setting, as required by NICE guidelines.</p><p><strong>Methods: </strong>Retrospective evaluation (n = 60) compared clinically-used contours to AI-contours, using Volumetric Dice Similarity Coefficient (VDSC) and blinded Radiation Oncologist (RO) contour preference assessment. AI-contours were then generated prospectively for HNC radiotherapy patients (n = 61), before review by ROs. ROs recorded qualitative scoring and review/editing time. Geometric and dosimetric comparison of AI-contours and final contours was undertaken. Correlation coefficients between all metrics were calculated.</p><p><strong>Results: </strong>Retrospective median VDSC varied widely for different structures (0.23-0.88). 31.4% blinded contour assessments preferred clinician-generated contours, 32.9% preferred AI-generated contours, 35.7% saw no significant difference. Prospective evaluation showed AI-contour yielded significant time-saving in reviewing/editing for all structures compared to manual contouring. Qualitative scores demonstrated most structures had median scoring ≥4 (indicating no editing required). Geometric metrics showed high similarity for all structures except larynx. Dosimetric evaluation demonstrated clinically significant dose differences for larynx and elective nodal volumes. Strong correlation was seen between qualitative scoring and all geometric metrics.</p><p><strong>Conclusions: </strong>AI-contours showed excellent qualitative performance and facilitated time-saving. Protocol differences exist between commercial AI-solutions and implementing centres. Ongoing final clinician review of AI-contours remains essential.</p><p><strong>Advances in knowledge: </strong>This is the first study demonstrating ART-Plan™'s capability for excellent qualitative ratings and significant time-savings for HNC radiotherapy contouring in a real-world workflow setting. 5-point Likert-scale qualitative scoring correlates strongly with geometric metrics.</p>","PeriodicalId":9306,"journal":{"name":"British Journal of Radiology","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144583078","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}