Abstract Objectives To evaluate the accuracy of CT-derived fat fraction (CDFF) software for quantifying hepatic steatosis at various radiation doses, using MRI-derived proton density fat fraction (MRI-PDFF) as the reference standard, and examines the impact of deep learning (DL)-based noise reduction on CDFF accuracy in low-dose CT (LDCT) scans. Methods We conducted a retrospective analysis of 125 living liver donor candidates who underwent non-contrast CT and MRI between July 2016 and December 2017. CDFF was measured on full-dose and simulated LDCT scans at 50%, 25%, and 10% radiation doses. DL-based denoising reconstruction (DLDR) was applied to LDCT scans for CDFF recalculation. The accuracy of CDFF was compared with MRI-PDFF using Pearson correlation coefficients and receiver operating characteristic (ROC) curve analysis, focusing on the effects of radiation dose and DLDR. Results Of the 125 participants (mean age 38 ± 10 years; 77 males), 29 (23%) had hepatic steatosis (MRI-PDFF ≥5%). Full-dose CDFF showed moderate correlation with MRI-PDFF (r = 0.728; P < .001). Correlation decreased with lower doses (r = 0.684-0.725) but improved with DLDR (r = 0.725-0.736). ROC AUC for diagnosing hepatic steatosis was 0.82 for full-dose CDFF, with similar performance across other doses except 10%. Conclusions CDFF accuracy declines at lower radiation doses, but DLDR enhances accuracy, improving alignment with MRI-PDFF, especially at reduced doses. Advances in knowledge DLDR significantly enhances the accuracy of CDFF accuracy at lower radiation doses, enabling high diagnostic performance for hepatic steatosis while potentially reducing patient radiation exposure.

Abstract Objectives To validate the diagnostic accuracy of pelvic floor ultrasound (PFUS) for pelvic organ prolapse (POP) and its correlation with the Pelvic Organ Prolapse Quantification (POP-Q) staging system by performing a rigorous quantitative comparison of anatomical measurements between women with POP and asymptomatic controls. Methods In this prospective observational study, 80 women with clinically confirmed POP and 60 asymptomatic controls underwent standardized PFUS and POP-Q examinations. PFUS was utilized to measure bladder, uterine, and rectal positions during maximal Valsalva maneuver. POP-Q staging was conducted by two blinded urogynecologists (inter-rater reliability κ = 0.87). Statistical analyses included Spearman’s correlation (ρ), diagnostic performance metrics (sensitivity, specificity, accuracy), and group comparisons using t-tests or chi-square tests. Results The POP group exhibited significant organ descent versus controls, including mean bladder descent (4.5 ± 1.2 cm vs. 1.8 ± 0.3 cm; P = 0.004) and uterine descent (5.2 ± 1.4 cm vs. 2.05 ± 0.40 cm; P = 0.012). PFUS measurements demonstrated strong correlation with POP-Q stages (compartment-specific ρ = 0.87–0.91). Overall agreement was 90.0% (ρ = 0.92, P < 0.001), with high diagnostic accuracy (93.5%), sensitivity (>90%), and specificity (>96%). Conclusions PFUS is a reliable, non-invasive method to quantify pelvic organ displacement, showing excellent agreement with the clinical standard POP-Q system. Its high diagnostic performance supports its integration into clinical practice for objective diagnosis, severity grading, and comprehensive anatomical characterization of POP. Advances in knowledge This study provides robust evidence validating PFUS as a reproducible objective tool for POP assessment.

This study aimed to establish the first-ever MRI classification of uterosacral ligament (USL) involvement in deep infiltrating endometriosis (DIE), based on reliable preoperative MRI features correlated with positive predictive values (PPVs) determined through histopathological analysis. Twenty-two women underwent surgery with histopathology due to symptoms highly suggestive of endometriosis. The 22 preoperative MRIs were analysed retrospectively, blinded to histopathology, and a classification of the preoperative aspect of USLs linked to PPVs was designed. According to their aspects, 6 radiological types of USL were identified. The "L-category" corresponded to linear types with regular or irregular margins, including types 1, 2, 3A, and 3B. The "N-category" corresponded to haemorrhagic or nodular types, including types 4, 5A, 5B, and 6. For the L-category, PPVs ranged from 75% to 88%, depending on the USL radiological type. For the N-category, PPVs were 100% for each type. In women with endometriosis symptoms, MRI underestimated USL involvement, especially for type 1. Among the 6 uteri with lateral deviation, only one false-positive result concerning the stretched USL was induced. In women with endometriosis symptoms, our MRI classification identified 2 USL categories, corresponding to 2 kinds of PPV; in these symptomatic patients, a normal MRI does not rule out a DIE diagnosis. Our MRI classification of USL involvement in endometriosis may be used as a non-invasive staging of the disease, making it much clearer for clinicians and patients. Hence, we are able to propose a suitable diagnostic and therapeutic procedure for each radiological type.

Becker muscular dystrophy (BMD) is a relatively less investigated neuromuscular disease, partially overlapping the phenotype of Duchenne dystrophy (DMD). Physiopathological and anatomical patterns are still not comprehensively known, despite recent effort in the search of early biomarkers. Aim of this study was to selectively compare normal appearing muscles of BMD with healthy controls. Among a pool of 40 BMD patients and 20 healthy controls, Sartorius and gracilis muscles were selected on the basis of a blinded clinical quantitative/qualitative evaluation, if classified as normal (0 or 1 on Mercuri scale) and subsequently segmented on diffusion tensor MRI scans with a tractographic approach. Diffusion derived parameters were extracted. Non-parametric testing revealed significant differences between normal and normal appearing BMD derived parameters in both muscles, the difference being more evident in sartorius. Bonferroni-corrected P-values (<.05) of Mann-Whitney test could discriminate between BMD and controls for standard deviation of all diffusion parameters (mean diffusivity, fractional anisotropy, axial and radial diffusivity) in both sartorius and gracilis, while in sartorius the significant difference was found also in the average values of the same parameters (with exception of RD). This method could identify microstructural alterations in BMD normal appearing sartorius and gracilis. Diffusion based MRI could be able to identify possible early or subclinical microstructural alterations in dystrophic patients with BMD.

Surface guided radiotherapy (SGRT) is increasingly being implemented to track patient's surface movement and position during radiation therapy. However, limited information is available on the SGRT use in paediatrics. The aim of this double survey was to map SIOPE (European Society for Paediatric Oncology)-affiliated centres using SGRT and to gain information on potential indications, observed, or expected benefits. A double online survey was distributed to 246 SIOPE-affiliated radiotherapy (RT) centres. Multiple choices, yes/no, and open answers were included. The first survey (41 questions) was active from February to March 2021. A shortened version (13 questions) was repeated in March 2023 to detect trends in SGRT use within the same community. Respectively, 76/142 (54%) and 28/142 (20%) responding centres used and planned to use SGRT clinically, including 4/34 (12%) new centres since 2021. Among the SGRT users, 33/76 (43%) already applied this technology to paediatric treatments. The main benefits of improved patient comfort, better monitoring of intrafraction motion, and more accurate initial patient set-up expected by future users did not differ from current SGRT-users (P = .893). Among non-SGRT users, the main hurdles to implement SGRT were costs and time for installation. In paediatrics, SGRT is applied to all anatomical sites. This work provides information on the practice of SGRT in paediatrics across SIOPE-affiliated RT centres which can serve as a basis for departments when considering the purchase of SGRT systems. Since little information is available in the literature on the use of SGRT in paediatrics, the results of this double survey can serve as a basis for departments treating children when considering the purchase of an SGRT system.

A 2021 safety alert restricted endovascular gelfoam use in Australia and resulted in an embargo on gelfoam sales to Interventional Radiology departments. This study aimed to show that gelfoam is safe in a population of trauma patients with pelvic injury, and discuss the basis of the recent controversies. Retrospective cohort study was conducted between 1 January 2010 and 21 May 2021 for the patients who underwent gelfoam embolization for pelvic arterial haemorrhage. Primary outcome was the rate of adverse events related to intravascular gelfoam administration. Inclusion criteria met in 50 patients, comprising 58% males median age 59.9 years, and median injury severity score 31. There were 0 complications related to gelfoam use and 100% technical success. Thirty-five patients (70%) received a non-targeted embolization approach. All-cause mortality was observed in 5 patients (10%), unrelated to gelfoam. Gelfoam is a safe and effective embolic agent in pelvic trauma. Patients are in urgent need of universal on-label registration of endovascular gelfoam products, as it is life-saving in major haemorrhage after trauma. Endovascular gelfoam is mandatory for a high-quality trauma service, and this study shows that it is safe to use intentionally in the endovascular space. Companies should work with interventional radiologists, sharing and collaborating to ensure positive outcomes for patients.

Hypertrophic Cardiomyopathy (HCM) is an inherited myocardial disease characterised by left ventricular hypertrophy, which carries an increased risk of life-threatening arrhythmias and sudden cardiac death. The age of presentation and the underlying aetiology have a significant impact on the prognosis and quality of life of children with HCM, as childhood-onset HCM is associated with high mortality risk and poor long-term outcomes. Accurate cardiac assessment and identification of the HCM phenotype are therefore crucial to determine the diagnosis, prognostic stratification, and follow-up. Cardiac magnetic resonance (CMR) is a comprehensive evaluation tool capable of providing information on cardiac morphology and function, flow, perfusion, and tissue characterisation. CMR allows to detect subtle abnormalities in the myocardial composition and characterise the heterogeneous phenotypic expression of HCM. In particular, the detection of the degree and extent of myocardial fibrosis, using late-gadolinium enhanced sequences or parametric mapping, is unique for CMR and is of additional value in the clinical assessment and prognostic stratification of paediatric HCM patients. Additionally, childhood HCM can be progressive over time. The rate, timing, and degree of disease progression vary from one patient to the other, so close cardiac monitoring and serial follow-up throughout the life of the diagnosed patients is of paramount importance. In this review, an update of the use of CMR in childhood HCM is provided, focussing on its clinical role in diagnosis, prognosis, and serial follow-up.

Breast cancer screening programmes frequently detect early, good prognosis breast cancers with significant treatment burden for patients, and associated health-cost implications. Emerging evidence suggests a role for minimally invasive techniques in the management of these patients enabling many women to avoid surgical intervention. Minimally invasive techniques include vacuum-assisted excision, cryoablation, and radiofrequency ablation. We review published evidence in relation to the risks and benefits of each technique and discuss ongoing trials. Data to date are promising, and we predict a trend towards minimally invasive treatment for early, good-prognosis breast cancer as technical skills, suitability criteria, and follow-up protocols are established.

We found unintentional errors while reviewing the data in the published article.The panels of V5, V10, and V20 of normal liver were incorrect because the correct percentage was not recorded based on the appropriate equivalent dose in 2Gy fractions (EQD2).Moreover, the bottom right panel depicting the mean normal liver dose of proton beam therapy (PBT) was incorrect because the recorded data was incorrect in some cases.We would like to correct these parts of Figure 1, as shown below.These corrections do not affect the interpretation of the results and conclusions.

To compare the diagnostic value of histogram features of multiple diffusion metrics in predicting early renal impairment in chronic kidney disease (CKD). A total of 77 patients with CKD (mild group, estimated glomerular filtration rate (eGFR) ≥60 mL/min/1.73m2) and 30 healthy controls (HCs) were enrolled. Diffusion-weighted imaging was performed by using single-shot echo planar sequence with 13 b values (0, 20, 50, 80, 100, 150, 200, 500, 800, 1000, 1500, 2000, and 2500 s/mm2). Diffusion models including mono-exponential (Mono), intravoxel incoherent motion (IVIM), stretched-exponential (SEM), and kurtosis (DKI) were calculated, and their histogram features were analysed. All diffusion models for predicting early renal impairment in CKD were established using logistic regression analysis, and diagnostic efficiency was compared among the models. All diffusion models had high differential diagnosis efficiency between the mild group and HCs. The areas under the curve (AUCs) of Mono, IVIM, SEM, DKI, and the combined diffusion model for predicting early renal impairment in CKD were 0.829, 0.809, 0.760, 0.825, and 0.861, respectively. There were no significant differences in AUCs except SEM and combined model, SEM, and DKI model. There were significant correlations between eGFR/serum creatinine and some of histogram features. Histogram analysis based on multiple diffusion metrics was practicable for the non-invasive assessment of early renal impairment in CKD. Advanced diffusion models provided microstructural information. Histogram analysis further reflected histological characteristics and heterogeneity. Histogram analysis based on multiple diffusion models could provide an accurate and non-invasive method to evaluate the early renal damage of CKD.