ACTA Radiologica (Test)

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Sage Journals: Table of Contents Table of Contents for Acta Radiologica. List of articles from ahead of print issues.

  • Morphological remodeling of the repaired sigmoid sinus bone wall in patients with pulsatile tinnitus after successful surgical reconstruction: an ultra-high-resolution CT study
    by Chihang Dai on 12. november 2024 at 5:45

    Acta Radiologica, Ahead of Print. <br/>BackgroundSigmoid sinus wall reconstruction (SSWR) is an effective treatment for pulsatile tinnitus (PT). However, follow-up postoperative imaging manifestations have not been extensively reported.PurposeTo evaluate the morphological changes in patients with PT after successful SSWR using ultra-high-resolution computed tomography (U-HRCT).Material and MethodsData were retrospectively analyzed from 10 patients with PT who underwent successful SSWR primarily with autologous bone powder. U-HRCT scans were performed within 3 days of surgery and repeated 6 months later. The integrity, relative density, extent, and shape of the repaired wall were analyzed. The chi-square test was used to compare the categorical variables and the Phi (φ) coefficient was used to represent the magnitude of the correlation.ResultsAmong the 10 patients with PT, 1 (10%) achieved complete coverage of the defect with the residual bone, 8 (80%) had partial coverage, and 1 (10%) showed complete separation. A gap between the repaired wall and residual bone in the initial U-HRCT was linked to incomplete defect coverage in the subsequent U-HRCT scan (P < 0.001, φ = 0.903). The repaired wall shrank from the periphery to the center and the density increased. The repaired wall compressed into the sigmoid sinus retracts over time, reshaping into a naturally curved sigmoid sinus sulcus.ConclusionMorphological remodeling is a typical characteristic of the repaired sigmoid sinus wall in patients with PT. Short-term incomplete repair may imply incomplete coverage of the defect in the future, but this is not correlated with recurrence.

  • A survey of bridging bone on chest radiography shows a greater than expected prevalence of marginal syndesmophytes
    by Ankur Srivastava on 7. november 2024 at 6:17

    Acta Radiologica, Ahead of Print. <br/>BackgroundThe recognition of thin marginal spinal syndesmophytes is important, in part due to their association with non-traumatic or mildly traumatic vertebral fractures.PurposeTo determine a lower limit on the prevalence of marginal spinal syndesmophytes using chest radiographs.Material and MethodsWe conducted a retrospective analysis of 500 chest radiographs, assessing the prevalence of thin marginal syndesmophytes, bridging or near-bridging osteophytes, and flowing paravertebral ossifications in the thoracic intervertebral discs among individuals aged 16 years and older in a North American city.ResultsAmong the 500 participants, we observed that thin vertical marginal syndesmophytes were present in 17 (3.4%) cases, bridging or near-bridging osteophytes were present in 126 (25.2%) cases, and flowing paravertebral ossifications were present in 37 (7.4%) cases. Out of the 17 participants with thin marginal syndesmophytes, 10 exhibited a bamboo-like spine appearance, defined as the presence of ≥4 contiguous levels of bridging marginal syndesmophytes. Analysis of syndesmophyte distribution per vertebral level indicated a higher frequency of involvement in the mid to lower thoracic spine, maximal at T9/10.ConclusionsThe presence of thin marginal syndesmophytes in the thoracic spine on routine chest radiographs is substantially more prevalent than would be anticipated based on the existing literature. The feasibility of reliably identifying these syndesmophytes in the spine and the impact of this on morbidity should be further investigated due to their association with advanced ankylosing spondylitis and their susceptibility to fractures.

  • Can the second phase of contrast-enhanced MRA of the neck provide additional information in the acute stroke setting?
    by P Shah on 6. november 2024 at 6:50

    Acta Radiologica, Ahead of Print. <br/>BackgroundDouble-concentration magnetic resonance imaging (MRI) contrast agents are frequently used in contrast-enhanced MR angiography (CE-MRA) of the head and neck. To avoid mistiming the peak concentration of intraluminal contrast (due to shorter duration of peak), a second acquisition is sometimes performed.PurposeTo evaluate additional information from the second acquisition of CE-MRA and compare the collateral scoring to the hypoperfusion index obtained on MR perfusion, and to investigate presence of pseudo-occlusion using the second phase of CE-MRA.Material and MethodsA retrospective study was conducted. CE-MRA of the brain/neck, dynamic susceptibility contrast (DSC) MR perfusion scan (in majority) and subsequent digital subtraction angiography (DSA) were evaluated in patients with previous acute internal carotid artery (ICA)/middle cerebral artery (MCA) occlusion. Evaluation of CE-MRA/MR perfusion and DSA was performed by three experienced neuroradiologists and one neurointerventionist, respectively.ResultsThe site of ICA occlusion was seen to be distal to the site noted on early arterial phase (pseudo-occlusion of ICA) in 28.5% of patients. A significant negative correlation was seen between a higher HIR and collateral score.ConclusionEvaluation of second phase CE-MRA can provide valuable information that may be otherwise lost if only the early arterial phase is evaluated.

  • Inter-reader agreement of LI-RADS treatment response algorithm among three readers with different seniorities for hepatocellular carcinoma after locoregional therapy
    by Yuxin Wang on 4. november 2024 at 6:22

    Acta Radiologica, Ahead of Print. <br/>BackgroundThe accurate evaluation of tumor response after locoregional therapy is crucial for adjusting therapeutic strategy and guiding individualized follow-up.PurposeTo determine the inter-reader agreement of the LR-TR algorithm for hepatocellular carcinoma treated with locoregional therapy among radiologists with different seniority.Material and MethodsA total of 275 treated observations on 249 MRI scans from 99 patients were retrospectively collected. Three readers of different seniorities (senior, intermediate, and junior with 10, 6, and 2 years of experience in hepatic imaging, respectively) analyzed the presence or absence of features (arterial-phase hyperenhancement and washout) and evaluated LR-TR category.ResultsThere were substantial inter-reader agreements for overall LR-TR categorization (kappa = 0.704), LR-TR viable (kappa = 0.715), and LR-TR non-viable (kappa = 0.737), but fair inter-reader agreement for LR-TR equivocal (kappa = 0.231) among three readers. The inter-reader agreement was substantial for arterial-phase hyperenhancement (kappa = 0.725), but moderate for washout (kappa = 0.443) among three readers. The inter-reader agreements between two readers were substantial for overall LR-TR categorization (kappa = 0.734, 0.727, 0.652), LR-TR viable (kappa = 0.719, 0.752, 0.678), and LR-TR non-viable (kappa = 0.758, 0.760, 0.694), which were at the same level as the inter-reader agreements among three readers. In addition, the inter-reader agreements between two readers were substantial for arterial-phase hyperenhancement (kappa = 0.733, 0.766, 0.678), but moderate for washout (kappa = 0.473, 0.422, 0.446), which were at the same level as the inter-reader agreements among three readers.ConclusionLR-TR algorithm demonstrated overall substantial inter-reader agreement among radiologists with different seniority.

  • Visual assessment of cerebrospinal fluid flow dynamics using 3D T2-weighted SPACE sequence-based classification system
    by İbrahim Feyyaz Naldemir on 4. november 2024 at 6:21

    Acta Radiologica, Ahead of Print. <br/>BackgroundFlow-related signal void artifacts can be visualized on the T2-weighted (T2W) three-dimensional sampling perfection with application-optimized contrast (3D-SPACE) sequence. Flow void artifacts in the cerebral aqueduct and the fourth ventricle can provide information about cerebrospinal fluid (CSF) flow dynamics.PurposeIn this study, we aimed to test the performance of the T2W 3D-SPACE sequence in assessing the CSF flow in the aqueduct and/or fourth ventricle.Material and MethodsA total of 137 patients (age range = 3–89 years) who underwent CSF flow study were included. The amount of signal loss on T2W 3D-SPACE due to flow in the aqueduct and fourth ventricle was assessed and graded using a 4-point scale of 0 (absence of flow void) to 3 (signal void filling the aqueduct and entire fourth ventricle). A correlation was then sought between the quantitative values obtained by phase-contrast magnetic resonance imaging (PC-MRI) and the amount of signal void in the 3D-SPACE sequence.ResultsAt the aqueduct level, there was a statistically significant difference in the forward flow velocity and the flow volume among different grades (all P < 0.001). In the grade 3 group, CSF peak systolic flow velocity and mean flow volume were found to be significantly higher than in the other grades (P < 0.001). The mean aqueduct area in the grade 0 group was found to be significantly different from that in the other classes (P < 0.001).ConclusionThe amount of signal loss in the fourth ventricle observed on T2W 3D-SPACE is correlated with the peak systolic velocity and flow volume measured quantitatively in PC-MRI.

  • Dynamic susceptibility contrast-enhanced MRI with USPIO in evaluating angiogenesis of the peri-infarction zones in subacute ischemic stroke in a permanent middle cerebral artery occlusion rat model
    by Yuanchao Li on 25. oktober 2024 at 6:50

    Acta Radiologica, Ahead of Print. <br/>BackgroundDynamic susceptibility contrast-enhanced magnetic resonance imaging (DSC-MRI) can reflect the angiogenesis of ischemic stroke.PurposeTo investigate the value of DSC-MRI with ultrasmall superparamagnetic particles of iron oxides (USPIO) in evaluating angiogenesis in the peri-infarction zones in subacute ischemic stroke in a permanent middle cerebral artery occlusion (pMCAO) rat model.Material and MethodsA total of 21 Sprague–Dawley rats were randomly divided into the pMCAO and sham operation groups. Every rat in each group underwent DSC-MRI with USPIO at 3, 5, and 7 days. DSC-MRI parameters of the relative cerebral blood volume (rCBV), relative cerebral blood flow (rCBF), relative mean transit time (rMTT), and relative time to peak (rTTP) were measured, calculated, and compared among the different times. Sequential correlations were analyzed among the histopathological indexes with the microvascular density (MVD) and percentage of vascular area (%VA), the serum factors with vascular endothelial growth factor (VEGF), vascular cell adhesion molecule 1 (VCAM-1), and perfusion parameters, respectively.ResultsThe rCBV and rCBF in the peri-infarction area of pMCAO rats were significantly higher on day 7 than on day 3, whereas no significant changes in rMTT and rTTP were observed at 3, 5, and 7 days. Significantly positive correlations were found between rCBV and MVD, %VA, VEGF, VCAM-1, between rCBF and MVD, %VA, VEGF, and VCAM-1 at 3, 5, and 7 days in the pMCAO group.ConclusionThe rCBV and rCBF deriving from USPIO-DSC may be potentially useful for evaluating the angiogenesis of the peri-infarction zones in the subacute phase of ischemic stroke.

  • Prognostic performance of the Bova, sPESI, and Qanadli scores in patients with acute pulmonary embolism
    by Mustafa Korkut on 25. oktober 2024 at 6:49

    Acta Radiologica, Ahead of Print. <br/>BackgroundAcute pulmonary embolism (PE) is a disease with a serious prognosis and a high probability of death in the emergency department.PurposeTo investigate the prediction of PE-related mortality and intensive care admission (ICU) of Qanadli (Qscore), Bova, and simplified Pulmonary Embolism Severity Index (sPESI) scores.Material and MethodsThis retrospective observational study consisted of all patients diagnosed with acute PE who were imaged under computed tomography pulmonary angiography (CTPA) for a total of 5 years between 1 June 2018 and 1 June 2023. The prediction of radiological and clinical scores for mortality and ICU admission was examined.ResultsA total of 95 patients were analyzed. Patients who died and those who were admitted to the ICU had a significantly higher frequency of being found to have a high-risk (≥1) sPESI score (P = 0.04 and P = 0.016, respectively). For mortality, the sPESI score was found to be significant; the sensitivity and specificity were observed as 54% and 66% (area under the curve [AUC]=0.670, 95% confidence interval [CI]=0.527–0.814; P = 0.020). For ICU admission, the sensitivity and specificity of the Qscore, sPESI, and Bova scores were 35%, 77%, and 58%, and 78%, 65%, and 84% respectively (AUC=0.626, 95% CI=0.511–0.740, P = 0.031; AUC=0.769, 95% CI=0.674–0.865, P < 0.001; and AUC=0.767, 95% CI=0.671–0.862, P < 0.001, respectively).ConclusionIt was found that the sPESI score was effective at predicting mortality in patients with acute PE. Qscore, sPESI, and Bova scores have been shown to be useful in predicting ICU admission.

  • Castellvi classification of lumbosacral transitional vertebrae: comparison between conventional radiography, CT, and MRI
    by Jaakko Hanhivaara on 24. oktober 2024 at 8:07

    Acta Radiologica, Ahead of Print. <br/>BackgroundThe reliability and diagnostic accuracy of commonly used diagnostic imaging modalities in the classification of lumbosacral transitional vertebrae (LSTV) are poorly known, and comparative studies are scarce.PurposeTo compare the diagnostic performance of conventional radiography (CR), computed tomography (CT), and magnetic resonance imaging (MRI) in classifying LSTVs.Material and MethodsIn this retrospective cross-sectional study, a total of 852 patients undergoing lumbar imaging studies using all three modalities were initially assessed for the presence of LSTV using CT scans. In total, 100 patients with LSTV anatomy were identified. Four readers performed blinded and independent evaluations of these 100 patients on each modality, and an experienced fellowship-trained radiologist performed a gold standard read using all three modalities. Inter-reader reliability metrics were analyzed in comparison to the gold standard. Statistical software R (4.2.1) was used for the analyses.ResultsWe found superior diagnostic efficacy for CT: the sensitivity, specificity, accuracy, and balanced accuracy were 76%, 93%, 77%, and 84%, respectively. For MRI, the metrics were 54%, 88%, 56%, and 68%, and for CR 32%, 85%, 42%, and 59%, respectively. Inter-reader reliability was found to be good for CT (κ = 0.63–0.71) and fair for both CR (κ = 0.16–0.32) and MRI (κ = 0.24–0.56).ConclusionCT had the highest diagnostic performance in all measured metrics with good inter-reader reliability. MRI and CR showed fairly poor sensitivity and accuracy, and thus consideration should be used when classifying LSTVs with these two modalities.

  • Deep-learning reconstruction enhances image quality of Adamkiewicz Artery in low-keV dual-energy CT
    by Fuminari Tatsugami on 22. oktober 2024 at 8:41

    Acta Radiologica, Ahead of Print. <br/>BackgroundLow-keV virtual monoenergetic images (VMIs) of dual-energy computed tomography (CT) enhances iodine contrast for detecting small arteries like the Adamkiewicz artery (AKA), but image noise can be problematic. Deep-learning image reconstruction (DLIR) effectively reduces noise without sacrificing image quality.PurposeTo evaluate whether DLIR on low-keV VMIs of dual-energy CT scans improves the visualization of the AKA.Material and MethodsWe enrolled 29 patients who underwent CT angiography before aortic repair. VMIs obtained at 70 and 40 keV were reconstructed using hybrid iterative reconstruction (HIR), and 40 keV VMIs were reconstructed using DLIR. The image noise of the spinal cord, the maximum CT values of the anterior spinal artery (ASA), and the contrast-to-noise ratio (CNR) of the ASA were compared. The overall image quality and the delineation of the AKA were evaluated on a 4-point score (1 = poor, 4 = excellent).ResultsThe mean image noise of the spinal cord was significantly lower on 40-keV DLIR than on 40-keV HIR scans; they were significantly higher than on 70-keV HIR images. The CNR of the ASA was highest on the 40-keV DLIR images among the three reconstruction images. The mean image quality scores for 40-keV DLIR and 70-keV HIR scans were comparable, and higher than of 40-keV HIR images. The mean delineation scores for 40-keV HIR and 40-keV DLIR scans were significantly higher than for 70-keV HIR images.ConclusionVisualization of the AKA was significantly better on low-keV VMIs subjected to DLIR than conventional HIR images.

  • The association between ultrasonographic findings and pain, physical function, and symptoms in patients with shoulder pain
    by Onur Engin on 22. oktober 2024 at 6:39

    Acta Radiologica, Ahead of Print. <br/>BackgroundShoulder ultrasonography (US) is commonly employed to differentiate the causes of shoulder pain. However, the correlation between ultrasonographic findings and the individual's functional disability and daily activities remains unexplored.PurposeTo investigate the relationship between shoulder US findings and physical function, disability, and pain.Material and MethodsThe study investigated patients with shoulder pain. Tendons of supraspinatus, infraspinatus, subscapularis, and long head of biceps brachii, acromiohumeral distance, and acromioclavicular joint (ACJ) degeneration were evaluated using US. The QuickDASH questionnaire was employed to evaluate physical function, symptoms, and disability, while the visual analog scale (VAS) was utilized to assess pain levels.ResultsThe study included 84 patients (69 [82.1%] women, mean age = 55.7 ± 11.9 years). Ultrasonographic examination revealed ACJ degeneration in 61 (21.4%) patients and biceps tendinitis in 21 (25%) patients. In addition, supraspinatus tendinosis was identified in 51 (61%) patients, while 28 (33%) exhibited a supraspinatus tear. The patients demonstrated a mean VAS score of 7.03 ± 1.49 and mean QuickDASH score of 45.6 ± 15.3. Individuals with a supraspinatus tear exhibited higher VAS (P = 0.008) and QuickDASH (P = 0.016) scores. Patients presenting with ACJ degeneration demonstrated increased VAS scores (P = 0.014), whereas those with biceps tendinopathy showed higher QuickDASH scores (P = 0.035).ConclusionThe results obtained from our research demonstrate significant correlations between ultrasonographic data and pain, disability, and physical manifestations. The findings of this study indicate that shoulder US provides valuable information regarding the difficulties individuals face in their daily tasks and the degree of pain they endure.