Characterization Of Lesions Research Articles

Diagnostic performance of the O-RADS MRI system for magnetic resonance imaging in discriminating benign and malignant adnexal lesions: a systematic review, meta-analysis, and meta-regression.

After the introduction of the Ovarian-Adnexal Reporting and Data System (O-RADS) for magnetic resonance imaging (MRI), several studies with diverse characteristics have been published to assess its diagnostic performance. This systematic review and meta-analysis aimed to assess the diagnostic performance of O-RADS MRI scoring for adnexal masses, accounting for the risk of selection bias. The PubMed, Scopus, Web of Science, and Cochrane databases were searched for eligible studies. Borderline or malignant lesions were considered malignant. All O-RADS MRI scores ≥4 were considered positive. The quality of the studies was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 tool. The pooled sensitivity, specificity, and likelihood ratio (LR) values were calculated, considering the risk of selection bias. Fifteen eligible studies were found, and five of them had a high risk of selection bias. Between-study heterogeneity was low-to-moderate for sensitivity but substantial for specificity (I2 values were 35.5% and 64.7%, respectively). The pooled sensitivity was significantly lower in the studies with a low risk of bias compared with those with a high risk of bias (93.0% and 97.5%, respectively; P = 0.043), whereas the pooled specificity was not different (90.4% for the overall population). The negative and positive LRs were 0.08 [95% confidence interval (CI) 0.05–0.11] and 10.0 (95% CI 7.7–12.9), respectively, for the studies with low risk of bias and 0.03 (95% CI 0.01–0.10) and 10.3 (95% CI 3.8–28.3), respectively, for those with high risk of bias. The overall diagnostic performance of the O-RADS system is very high, particularly for ruling out borderline/malignant lesions, but with a moderate ruling-in potential. Studies with a high risk of selection bias lead to an overestimation of sensitivity. The O-RADS system demonstrates considerable diagnostic performance, particularly in ruling out borderline or malignant lesions, and should routinely be used in practice. The high between-study heterogeneity observed for specificity suggests the need for improvement in the consistent characterization of the benign lesions to reduce false positive rates.

Value of digital breast tomosynthesis in characterization of breast lesions in dense breast

BackgroundPatients with dense breasts have a higher risk factor for developing breast cancer. Digital mammography (DM) exhibits a reduced sensitivity in dense breast tissue as a result of overlapping fibro-glandular tissue. Digital breast tomosynthesis (DBT) solves this problem, so allows better characterization of masses, asymmetries, and parenchymal distortion. It is useful in screening studies for early detection of breast lesions by accurate detection and description of their margins, shape, and extent as well as surrounding structures.ObjectiveWe aimed to evaluate the added value of DBT in characterizing of different breast lesions in dense breasts compared to DM.MethodsA Prospective Cohort study involved ninety female cases having dense breast parenchyma (ACR C & ACR D) having breast complaint lesions detected by DM or ultrasound or recalled from screening units, during the period from June 2021 to Jan 2023.All patient underwent DM and DBT with correlation with the pathological finding or follow up.ResultsAs regards the characterization of breast mass DBT had higher sensitivity, higher specificity (98%, 87% respectively). However, DM showed less sensitivity, less specificity (58%, 80%,) with (p < 0.0001, p = 0.0005 respectively).ConclusionsDBT effectively visualizes overlapping tissue in dense breasts. DBT is important due to its ability to detect breast cancer earlier, characterize lesions accurately, and inspect the margins of masses precisely, along with decreasing recall rates for false-positive results.

The Role of CT Perfusion in Differentiating Benign Versus Malignant Focal Pulmonary Lesions.

Contrast-enhanced CT scan is the standard imaging for the characterization and evaluation of focal parenchymal lung lesions. It relies on morphology and enhancement patterns for the characterization of lung lesions. However, there is significant overlap among imaging features of various malignant and benign lesions. Hence, it is often necessary to obtain tissue diagnosis with invasive percutaneous or endoscopic-guided tissue sampling. It is often desirable to have non-invasive techniques that can differentiate malignant and benign lung lesions. CT perfusion is an emerging CT technology that allows functional assessment of tissue vascularity through various parameters and can help in differentiating benign and malignant focal lung lesions. The purpose of this study was to assess the role of the CT perfusion technique in differentiating malignant and benign focal parenchymal lung lesions. In this prospective observational study, CT perfusion was performed on 41 patients with focal parenchymal lung lesions from December 2020 to June 2022. The four-dimensional range was planned to cover the entire craniocaudal extent of the lesion, followed by a volume perfusion CT (VPCT) of the lesion. A total of 27 dynamic datasets were acquired with a scan interval of 1.5 seconds and a total scan time of 42 seconds. CT perfusion parameters of blood flow (BF), blood volume (BV), and k-trans of the lesionwere measured withmathematical algorithms available in the Syngo.via CT perfusion software (Siemens Healthcare, Erlangen, Germany). The median BV in benign lesions was found to be 5.5 mL/100 g, with an interquartile range of 3.3-6.9 and a p-value < 0.001. The median BV in malignant lesions was found to be 11.35 mL/100 g, with an interquartile range of 9.57-13.21 and a p-value ≤ 0.001. The median BF for benign lesions was 45.5 mL/100 g/min, with an interquartile range of 33.8-48.5and a p-value ≤ 0.001. The median BF for malignant lesion was 61.77 mL/100 g/min, with an interquartile range of 33.8-48.5and a p-value ≤ 0.001. The median k-trans in the case of benign lesions was found to be 4.2 mL/100 g/min, with an interquartile range of 3.13-6.8 and a p-value ≤ 0.001. The median k-trans in the case of the malignant lesion was found to be 12.05 mL/100g/min, with an interquartile range of 7.20-33.42 and a p-value < 0.001. Our study has also shown BV to have an accuracy of 92.68%, sensitivity of 93.3%, and specificity of 90.01%. Our study has shown that CT perfusion values of BV, BF, and k-trans can be used to differentiate between benign and malignant focal lung parenchymal lesions. K-trans is the most sensitive parameter while BV and BF have greater accuracy and specificity.

The Role of Diffusion-weighted Magnetic Resonance as a Potential Biomarker in the Characterization of Ovarian Tumor Lesions and the Assessment of Post-treatment Evolution

This paper focuses on the role of diffusion-weighted MRI of ovarian tumors as a potential biomarker to detect and characterize malignancy, and to improve the accuracy of preoperative diagnosis and postoperative follow-up to optimize therapeutic management. This is an original retrospective study of 76 patients with ovarian masses who underwent surgery between May 2014 and March 2016 at the "Dr Carol Davila" Central Military University Gynaecology Department. Patients underwent preoperative, 6-month, and 12-month postoperative evaluation of ovarian tumors using diffusion-weighted MRI. Due to the accuracy of this method using specific sequences in tissue characterization, magnetic resonance imaging can be used in the diagnostic work-up of complex adnexal masses.

Value of green sign and chicken skin aspects for detecting malignancy of colorectal neoplasia in a prospective characterization study.

Background and study aims Accurate endoscopic characterization of colorectal lesions is essential for predicting histology but is difficult even for experts. Simple criteria could help endoscopists to detect and predict malignancy. The aim of this study was to evaluate the value of the green sign and chicken skin aspects in detection of malignant colorectal neoplasia. Patients and methods We prospectively characterized and evaluated the histology of all consecutive colorectal lesions detected during screening or referred for endoscopic resection (Pro-CONECCT study). We evaluated the diagnostic accuracy of the green sign and chicken skin aspects for detection of superficial and deep invasive lesions. Results 461 patients with 803 colorectal lesions were included. The green sign had a negative predictive value of 89.6% (95% confidence interval [CI] 87.1%-91.8%) and 98.1% (95% CI 96.7%-99.0%) for superficial and deep invasive lesions, respectively. In contrast to chicken skin, the green sign showed additional value for detection of both lesion types compared with the CONECCT classification and chicken skin (adjusted odds ratio [OR] for superficial lesions 5.9; 95% CI 3.4-10.2; P <0.001), adjusted OR for deep lesions 9.0; 95% CI 3.9-21.1; P <0.001). Conclusions The green sign may be associated with malignant colorectal neoplasia. Targeting these areas before precise analysis of the lesion could be a way of improving detection of focal malignancies and prediction of the most severe histology.

Advancing Breast Cancer Diagnosis: The Impact of Elastography Integration Into Breast Imaging Reporting and Data System (BIRADS) Categorization.

This study evaluates the impact of integrating elastography into the Breast Imaging Reporting and Data System (BIRADS) categorization on breast cancer diagnostics in an African population. It explores the association and agreement between traditional BIRADS and those modified by elastography, as well as between quantitative and qualitative elastography methods. A total of 200 participants who underwent breast imaging as part of their diagnostic evaluation for breast lesions were included in the study. Participant characteristics, including age distribution and indicators for breast cancer diagnoses, were analyzed. Brightness mode (B-mode) findings without elastography were assessed using the BIRADS classification. Elastography was integrated into the BIRADS categorization to evaluate its impact on breast cancer diagnostics.The association and agreement between BIRADS with and without elastography were analyzed. Participants predominantly aged 40-49 showed significant staging differences with the integration of elastography. Traditional B-mode staging identified 29 (49%) of participants in BIRADS stage IV and 14 (23%) in stage V, whereas elastography adjusted these figures significantly, enhancing diagnostic refinement. There was a fair agreement between BIRADS with and without elastography (kappa = 0.322), while a substantial agreement was found between quantitative and qualitative elastography (kappa = 0.674). The results of the study provide evidence that the integration of elastography into BIRADS categorization can significantly improve the accuracy of breast cancer diagnosis in African women. Elastography enhanced lesion characterization, supporting more personalized and precise clinical management. Continued research is needed to fully integrate elastography into routine diagnostic workflows and understand its broader clinical implications in Africa.

Magnetic Resonance Imaging Signal Intensity in the Characterization of Odontogenic Lesions: A Systematic Review

Magnetic Resonance Imaging Signal Intensity in the Characterization of Odontogenic Lesions: A Systematic Review

Contrast-Enhanced Ultrasound in the Diagnosis of Solid Renal Lesions.

The availability of imaging methods has enabled increased detection of kidney lesions, which are a common clinical problem. It is estimated that more than half of patients over the age of 50 have at least one undetermined mass in the kidney. The appropriate characterization and diagnosis of lesions imaged in the kidney allows for proper therapeutic management. Previously, contrast-enhanced computed tomography (CT) and contrast-enhanced magnetic resonance imaging (MRI) have been used in their extended diagnosis. However, the limitations of these techniques, such as radiation exposure, renal toxicity, and allergies to contrast agents, must be considered. Contrast-enhanced ultrasound (CEUS) is increasingly being used as an examination to resolve interpretive doubts that arise with other diagnostic methods. Indeed, it can be considered both as a problem-solving technique for diagnosing and distinguishing lesions and as a technique used for observation in preservative treatment. Evaluation of the enhancement curve over time on CEUS examination can help to differentiate malignant renal cell carcinoma (RCC) subtypes that should be resected from benign lesions, such as oncocytoma or angiomyolipoma (AML), in which surgery can be avoided. It allows for distinguishing between benign and malignant tumors, renal and pseudotumors, and solid and cystic tumors. Therefore, with recent advances in ultrasound technology, CEUS has emerged as a fast, reliable, and cost-effective imaging tool in the preoperative evaluation and diagnosis of solid renal masses.

The Role of SPECT/CT and PET/CT Hybrid Imaging in the Management of Ectopic Thyroid Carcinoma-A Systematic Review.

Thyroid ectopy represents a rare disease with an incidence of 0.3-1/100,000. It occurs due to the defective embryological process of the thyroid gland development. The thyroid ectopic tissue may suffer malignant transformation. This review aims to shed light on the roles that I-131 SPECT/CT (radioiodine 131 single-photon emission tomography fused with computed tomography) and F-18 PET/CT (fluorodeoxyglucose F18 positron emission tomography fused with computer tomography) may play in managing patients with ectopic thyroid carcinoma. A total number of 47 articles were identified on the PubMed and Google Scholar databases, and 3 other articles were selected from articles identified in the references cited in the retrieved articles. After refining the selection, the inclusion and exclusion criteria were applied, resulting in 10 articles that were included in the review. The cases of ectopy included in this review were localised as follows: four cases in the thyroglossal duct, two cases in the mediastinum, one case in the oesophagus, one case in the thorax, one case with a pre-tracheal location, and one case with a latero-cervical location. In all the cases, F-18 FDG PET/CT was used as a diagnostic tool. In one case, F-18 FDG PET/CT was combined with I-131 SPECT/CT and MRI (magnetic resonance imaging). In one case, it was combined with 68 Ga-FAPI PET/CT (Ga-68 radiolabelled FAP inhibitor positron emission tomography fused with computer tomography). The maximum SUVs (standardised uptake values) ranged from 5.5 to 25 g/mL. F-18 PET/CT and I-131 SPECT/CT hybrid nuclear imaging is of great value in assessing ectopic thyroid carcinoma. F-18 FDG PET/CT plays an important role in the primary tumour evaluation and distant disease detection. Ga-68 FAPIs are a promising alternative. I-131 SPECT/CT adds important information related to the anatomical characterization of primary and distant iodine-avid lesions.

Imaging of oral cavity and oropharyngeal masses: clinico-radiologic correlation

BackgroundClinical diagnosis of the masses of the oropharynx and the oral cavity is usually straightforward; however, deep extension of lesions should be assessed by imaging. Thirty patients with suspected masses in oral cavity and oropharynx were enrolled in the present study. Contrast-enhanced CT and MRI were used for imaging of all patients, and superficial ultrasound was used as screening (whether the mass was accessible to ultrasound or not). The aim of this study was to evaluate clinical impact of combined imaging modalities for assessment of intraoral and oropharyngeal masses.ResultsThere was a statistically significant difference between CT and MRI regarding the detected tumor size, lymph node and adjacent structures. CT had a sensitivity of 77.78% and specificity of 75% in the detection of malignancy. A low apparent diffusion coefficient can detect malignancy with 61.11% sensitivity and 91.67% specificity.ConclusionsThe radiographic diagnosis of the oral cavity presents a complex challenge. According to the unique presentation of each patient, combined CT and MRI imaging will enhance the identification and characterization of lesions in the oral cavity and oropharynx. There is a secondary, limited role for ultrasonography.

MRI Radiomics in Imaging of Focal Hepatic Lesions: A Narrative Review.

Magnetic resonance imaging (MRI) is generally used to identify, describe, and evaluate treatment responses for focal hepatic lesions.However, the diagnosis and differentiation of such lesions require considerable input from radiologists. In order to reduce these difficulties, radiomics is an artificial intelligence (AI)-based quantitative method that employs the extraction of image features to reliably detect and differentiate focal hepatic lesions. MRI radiomics is a novel technique for the characterization of focal hepatic lesions. It can aid in preoperative evaluation, treatment approach, and forecast microvascular invasion. Although many studies have illustrated its efficiency there are certain limitations such as the absence of a large diverse dataset, comparison with other AI models, integration with histopathological findings, clinical utility, and feasibility.

Elastography of the Male Pelvic Region-Perspectives on Malignant Lesions.

Ultrasound elastography is widely used to assess tissue stiffness for lesion characterization, including differentiation between benign and malignant lesions. This study focuses on the use of elastography in the male pelvis, including the prostate, testicles, and rectum, by comparing elastography types (shear wave and strain). This article provides a summary of the existing literature on the use of elastography in the male pelvic region and outlines the clinical perspective. Ultrasound elastography is a good technique for evaluating and monitoring lesions in the male pelvic region.

Characterization of early-stage lesions and investigation on the role of mucosal trauma in hemorrhagic bowel syndrome in cattle

Hemorrhagic bowel syndrome (HBS) is characterized by a dissecting intramucosal hematoma at the small bowel, causing obstruction and severe hemorrhage in dairy cattle. Recent investigation revealed the presence of early-stage lesions in cows affected by HBS. These are presumed to be the initial stage of the hematoma, as both share unique dissection of the lamina muscularis mucosae (LMM) as histological hallmark. Early-stage lesions of HBS have not been characterized in greater detail, and neither has the hypothesis of mucosal abrasion as etiology been explored. Therefore, the first objective of the present study was to characterize the morphology of early-stage lesions, by gross examination, histochemistry, immunohistochemistry and transmission electron microscopy. The second objective was to determine the effect of mucosal abrasion to the small intestine in an ex vivo model. A total of 86 early-stage lesions from 10 cows with HBS were characterized. No underlying alterations at the LMM were evident which could explain their occurrence. However, degeneration at the ultrastructural level of the LMM smooth muscle cells was present in 3 of 4 lesions, it is however unclear whether this is primary or secondary. Bacteriological examination did not reveal any association with a specific bacterium. Experimental-induced and early-stage lesions were gross and histologically evaluated and scored in three cows with HBS and seven controls. Experimentally induced lesions in both affected cows and controls, were histologically very similar to the naturally occurring early-stage lesions. Altogether, the results are suggestive for mucosal trauma to play a role in the pathogenesis of HBS.

Safety of Gadoxetate Disodium for Hepatobiliary MRI in Children and Adolescents.

Background Despite a proven role in the characterization of liver lesions, use of the gadolinium-based contrast agent (GBCA) gadoxetate disodium at MRI is limited in children due to a lack of comparative safety data. Purpose To evaluate the safety of the GBCA gadoxetate disodium (a linear ionic hepatobiliary contrast agent [HBA]) in children and adolescents, compared with extracellular contrast agents (ECA). Materials and Methods A retrospective analysis was conducted in children and adolescents aged 18 years or younger who underwent HBA-enhanced MRI at one of three tertiary hospitals from January 2010 to December 2022. The incidence of GBCA-associated acute adverse events was compared between MRI examinations with a HBA and those with ECA. Severity was categorized according to American College of Radiology guidelines (mild, moderate, or severe). (a) Propensity score matching using multivariable logistic regression models and (b) inverse probability of treatment weighting analysis based on nine covariates (age, sex, asthma, allergic rhinitis, chronic urticaria or atopy, food allergy, drug allergy, premedication, and history of GBCA-associated adverse events) were used for confounder adjustment. Results A total of 1629 MRI examinations (ECA, n = 1256; HBA, n = 373) in 1079 patients were included (mean age, 8.6 years ± 6.5; 566 girls). The per-examination incidence of GBCA-associated acute adverse events showed no evidence of a difference, with rates of 0.9% (11 of 1256 examinations) for ECA and 1.3% (five of 373 examinations) for HBA (odds ratio [OR], 1.55 [95% CI: 0.54, 4.46]; P = .42). Acute adverse events were all mild with ECA, whereas with HBA, they were mild for four patients and moderate for one patient. There was no evidence of a difference in the incidence of acute adverse events, even in propensity score matching (OR, 1.33 [95% CI: 0.30, 5.96]; P = .71) and inverse probability of treatment weighting analysis (OR, 0.84 [95% CI: 0.25, 2.86]; P = .78). Conclusion Gadoxetate disodium showed no difference in acute adverse events compared with ECA in children and adolescents, with further large-scale pediatric studies required to confirm its safety. © RSNA, 2024 Supplemental material is available for this article. See also the editorial by Otero in this issue.

Intraoperative and Postoperative Ultrasonographic Spinal Cord Evaluation of Cervical Double-Door Laminoplasty.

Ultrasonography is a useful tool for the localization, morphology, and characterization of lesions and is increasingly being applied to spinal cord evaluation in cervical spine diseases. However, in conventional cervical laminoplasty, detailed evaluation is difficult because of ultrasound attenuation. Therefore, the purpose of this study was to perform a cervical laminoplasty using a modified surgical technique and evaluate the spinal cord. The spinal cord was evaluated intraoperatively and one week postoperatively in 11 patients with cervical compressive myelopathy. Double-door laminoplasty was selected as the surgical method, and the shape and placement of the bone graft between the expanded laminas were devised to reduce ultrasonic attenuation, such that there was a large space in which the dura mater was visible. Intraoperative and postoperative spinal cord decompression, claudication, and pulsation were confirmed in all cases. A more precise diagnosis was possible using ultrasound attenuation using the grafted bone between the laminas as an indicator. Intraoperative and postoperative spinal cord decompression status and wave patterns of modified cervical double-door laminoplasty can be evaluated using ultrasonography. Ultrasound-based evaluations of the spinal cord may provide new insights.

Role of Ultrasound in Diagnosis of Fibrocystic Breast Disease

Background: Fibrocystic breast disease is the most typical benign breast disease, which is seen in women worldwide with features of pain and feeling of nodules. Its diagnosis is based on clinical symptoms, ultrasound, mammography, and in doubt cases, biopsy is indicated. For assessment of the breast, we clinically examined the breast, axilla, and both supra and infraclavicular regions for lymph node assessment, followed by ultrasound examination. Detection of lesions in any breast quadrant assessed by BIRADs, Breast Imaging Reporting, and Data System grouped in five brackets. Scanning by sonography using B-mode and Doppler study was improved for detecting and characterizing benign and malignant lesions. Objective: To assess a breast lesion by ultrasound with features suggestive of a benign or malignant nature. Method: This study included 210 women aged 20 - 45 who visited a clinic from October 2020 to April 2022 and were examined by ultrasound machine Samsung HS50 (KOREA) with an LA3-14AD probe. B-mode images obtained detection of the lesion, and we also used Doppler ultrasound for assessment of the vascularity of the lesion. The BI-RADS system was used for the categorization of all findings. Result: In 210 women, complaints of lumps were involved in our study. Imaging by B-mode ultrasound using the Doppler study assesses the vascularity of the lesion and provides more characterization of benign and malignant lesions. By B–mode imaging, 99 patients had regular ultrasound study, and 79 patients had simple cysts that appeared well defined, had familiar outlines, and had an anechoic rounded or oval shape with posterior enhancement. Twenty-eight patients with fibroadenoma visualized as round or oval-shaped hypoechoic lesions horizontally oriented to the planes of the breast with lateral shadowing. 2 patients had complex cysts that appear as well-defined, irregular outlines, rounded shape, a thick wall with internal echoes with posterior enhancement. 2 patients have a malignant lesion that appears ill-defined rough outline vertically oriented with breast planes and show posterior shadowing. Conclusion: Ultrasound was established as the most suitable imaging modality for the categorization of breast lesions and exclusion of malignancy, which is helpful for evading unnecessary biopsies.

Real-time characterization of radiofrequency lesions by local multifrequency impedance with thermal correction

Abstract Background/Introduction Recent studies have shown that measuring local impedance (LI) at a single frequency can be useful for real-time characterization of radiofrequency (RF) lesion size during arrhythmia ablation procedures. (1) However, these systems do not take into account the effect of the increase in tissue temperature on the impedance measurement itself, which could be avoided by comparing the impedance at different frequencies. Purpose The aim of this study was to evaluate the ability of local multifrequency impedance (LMI) to characterize the size of RF lesions in real-time, while correcting for the thermal effect on the measurement. Methods Lesions were performed on the epicardium in 5 anesthetized pigs while measuring IML (from 1 to 209 kHz) before, during, and after ablations (20W/30W/40W, 60s, &amp;gt;10g) through a conventional irrigated electrocatheter connected to a cardiac navigation system and a RF generator. In these measurements, the thermal effect on the tissue was corrected by assuming that the changes in impedance at high frequency were only due to the temperature variation and not to the injury itself. Local voltage (Vuni) was also measured before and after ablations, and catheter-measured temperature and contact force were monitored. At the end of the procedure, the animals were sacrificed, and a histological study of the lesions was performed. Results A total of 43 effective lesions (11±2 per animal) were performed. The 40W lesions were deeper and wider than the 20W lesions (6,6 ± 3,3 mm vs. 5,4 ± 2,0 mm vs. 4,0 ± 1,9 mm; ANOVA p&amp;lt;0.05) and presented a significant decrease in unipolar voltage that was similar among the different lesions (40W vs. 20W: 56% vs. 40%; ANOVA p=ns; Figure). Four seconds after the start of the ablation the 40W lesions had a greater decrease in IML than the 30W and 20W lesions (73±14Ω vs. 85±4Ω vs. 100±12Ω; ANOVA p&amp;lt;0.05). After thermal adjustment, IML recorded 30 and 55 seconds after the start of the ablation correlated better with the final depth of the lesion than IL or Vuni (Table). Conclusions The measure of IML during ablation allows a better quantification of the changes in the structural characteristics of myocardial tissue than local impedance at a single frequency. The increase in tissue temperature during ablation influences the values of local impedance and should be considered when creating new impedance-based metrics to predict the chronic size of the RF lesion.Figure.Lesion quantification by LMITable.Correlation analysis

Characterization of prostatic cancer lesion and gleason grade using a continuous-time random-walk diffusion model at high b-values

BackgroundDistinguishing between prostatic cancer (PCa) and chronic prostatitis (CP) is sometimes challenging, and Gleason grading is strongly associated with prognosis in PCa. The continuous-time random-walk diffusion (CTRW) model has shown potential in distinguishing between PCa and CP as well as predicting Gleason grading.PurposeThis study aimed to quantify the CTRW parameters (α, β &amp;amp; Dm) and apparent diffusion coefficient (ADC) of PCa and CP tissues; and then assess the diagnostic value of CTRW and ADC parameters in differentiating CP from PCa and low-grade PCa from high-grade PCa lesions.Study typeRetrospective (retrospective analysis using prospective designed data).PopulationThirty-one PCa patients undergoing prostatectomy (mean age 74 years, range 64–91 years), and thirty CP patients undergoing prostate needle biopsies (mean age 68 years, range 46–79 years).Field strength/SequenceMRI scans on a 3.0T scanner (uMR790, United Imaging Healthcare, Shanghai, China). DWI were acquired with 12 b-values (0, 50, 100, 150, 200, 500, 800, 1200, 1500, 2000, 2500, 3000 s/mm2).AssessmentCTRW parameters and ADC were quantified in PCa and CP lesions.Statistical testsThe Mann-Whitney U test was used to evaluate the differences in CTRW parameters and ADC between PCa and CP, high-grade PCa, and low-grade PCa. Spearman’s correlation of the pathologic grading group (GG) with CTRW parameters and ADC was evaluated. The usefulness of CTRW parameters, ADC, and their combinations (Dm, α and β; Dm, α, β, and ADC) to differentiate PCa from CP and high-grade PCa from low-grade PCa was determined by logistic regression and receiver operating characteristic curve (ROC) analysis. Delong test was used to compare the differences among AUCs.ResultsSignificant differences were found for the CTRW parameters (α, Dm) between CP and PCa (all P&amp;lt;0.001), high-grade PCa, and low-grade PCa (α:P=0.024, Dm:P=0.021). GG is correlated with certain CTRW parameters and ADC(α:P&amp;lt;0.001,r=-0.795; Dm:P&amp;lt;0.001,r=-0.762;ADC:P&amp;lt;0.001,r=-0.790). Moreover, CTRW parameters (α, β, Dm) combined with ADC showed the best diagnostic efficacy for distinguishing between PCa and CP as well as predicting Gleason grading. The differences among AUCs of ADC, CTRW parameters and their combinations were not statistically significant (P=0.051–0.526).ConclusionCTRW parameters α and Dm, as well as their combination were beneficial to distinguish between CA and PCa, low-grade PCa and high-grade PCa lesions, and CTRW parameters and ADC had comparable diagnostic performance.

Accuracy of optical diagnosis with narrow band imaging in the surveillance of ulcerative colitis: a prospective study comparing Kudo, Kudo-IBD and NICE classifications

PurposeThe diagnostic accuracy of Narrow Band Imaging (NBI) in the endoscopic surveillance of ulcerative colitis (UC) has been disappointing in most trials which used the Kudo classification. We aim to compare the performance of NBI in the lesion characterization of UC, when applied according to three different classifications (NICE, Kudo, Kudo-IBD).MethodsIn a prospective, real-life study, all visible lesions found during consecutive surveillance colonoscopies with NBI (Exera-II CV-180) for UC were classified as suspected or non-suspected for neoplasia according to the NICE, Kudo and Kudo-IBD criteria. The sensitivity (SE), specificity (SP), positive (+LR) and negative (-LR) likelihood ratios of the three classifications were calculated, using histology as the reference standard.Results394 lesions (mean size 6 mm, range 2–40 mm) from 84 patients were analysed. Twenty-one neoplastic (5%), 49 hyperplastic (12%), and 324 inflammatory (82%) lesions were found. The diagnostic accuracy of the NICE, Kudo and Kudo-IBD classifications were, respectively: SE 76%-71%-86%; SP 55-69%-79% (p < 0.05 Kudo-IBD vs. both Kudo and NICE); +LR 1.69-2.34-4.15 (p < 0.05 Kudo-IBD vs. both Kudo and NICE); -LR 0.43-0.41-0.18.ConclusionThe diagnostic accuracy of NBI in the differentiation of neoplastic and non-neoplastic lesions in UC is low if used with conventional classifications of the general population, but it is significantly better with the modified Kudo classification specific for UC.

Enhancing the Kaiser score for lesion characterization in unenhanced breast MRI

PurposeTo adapt the methodology of the Kaiser score, a clinical decision rule for lesion characterization in breast MRI, for unenhanced protocols. MethodIn this retrospective IRB-approved cross-sectional study, we included 93 consecutive patients who underwent breast MRI between 2021 and 2023 for further work-up of BI-RADS 0, 3–5 in conventional imaging or for staging purposes (BI-RADS 6). All patients underwent biopsy for histologic verification or were followed for a minimum of 12 months. MRI scans were conducted using 1.5 T or 3 T scanners using dedicated breast coils and a protocol in line with international recommendations including DWI and ADC. Lesion characterization relied solely on T2w and DWI/ADC-derived features (such as lesion type, margins, shape, internal signal, surrounding tissue findings, ADC value). Statistical analysis was done using decision tree analysis aiming to distinguish benign (histology/follow-up) from malignant outcomes. ResultsWe analyzed a total of 161 lesions (81 of them non-mass) with a malignancy rate of 40%. Lesion margins (spiculated, irregular, or circumscribed) were identified as the most important criterion within the decision tree, followed by the ADC value as second most important criterion. The resulting score demonstrated a strong diagnostic performance with an AUC of 0.840, providing both rule-in and rule-out criteria. In an independent test set of 65 lesions the diagnostic performance was verified by two readers (AUC 0.77 and 0.87, kappa: 0.62). ConclusionsWe developed a clinical decision rule for unenhanced breast MRI including lesion margins and ADC value as the most important criteria, achieving high diagnostic accuracy.