ACTA Radiologica (Test)

Acta Radiologica, Ahead of Print. <br/>BackgroundAcute ischemic stroke (AIS) refers to a sudden loss of blood flow in a region of the brain, which leads to a loss of neurological function.PurposeTo unveil the efficacy of neuromuscular electrical stimulation (NMES) with modern rehabilitation techniques in AIS patients with post-motor dysfunction.Material and MethodsA total of 200 AIS patients with post-motor dysfunction were divided into groups A, B, C, and D (n = 50). Patients in the four groups were routinely treated with medicine, on this basis: group B received NMES treatment; group C received modern rehabilitation technology treatment; and group D was treated with NMES and modern rehabilitation technology. Rehabilitation effect, cerebral hemodynamic indices, neurological function recovery, Fugl–Meyer Assessment (FMA) and Motor Assessment Scale (MAS) scores, self-care, and quality of life were compared.ResultsAfter treatment, the total effective rate of group D was 96% higher than that of group A (64%), group B (82%), and group C (84%). Bilateral middle cerebral artery Vm and Vs and scores of FMA, MAS, functional independence measure, and modified Barthel index increased; RI and NHISS scores decreased; and all group D improved significantly versus groups A, B, and C, and both groups B and C improved significantly versus group A.ConclusionNMES with modern rehabilitation technologies synergistically treat motor dysfunction after AIS with ideal rehabilitation effect, improving cerebral hemodynamics, neurological and limb motor function recovery, and self-care ability and quality of life.

Acta Radiologica, Ahead of Print. <br/>BackgroundThe role of imaging in autoimmune encephalitis (AIE) remains unclear, and there are limited data on the utility of magnetic resonance imaging (MRI) to diagnose, treat, or prognosticate AIE.PurposeTo evaluate whether MRI is a diagnostic and prognostic marker for AIE and assess its efficacy in distinguishing between various AIE subtypes.Material and MethodsWe analyzed data from 96 AIE patients from our prospective autoimmune registry. MRI sequences examined were FLAIR, diffusion, SWI, T2WI, ASL, and contrast enhancement. Short-term outcomes were measured using the Modified Rankin Scale (mRS) at discharge; long-term outcomes were assessed with the Functional Independence Measure (FIM) at 6 months.ResultsMRI confirmed AIE in cases of new-onset seizures (82.1%, P < 0.001) and dementia (100%, P = 0.02). Antibody-negative AIE exhibited significant multifocal FLAIR abnormalities compared to antibody-positive cases (P = 0.002). LGI1 and CASPR2 encephalitis frequently involved the mesial temporal region (P = 0.004), while ASL revealed hyperperfusion of the contralateral basal ganglia in faciobrachial dystonic seizures (P = 0.016). GAD65 encephalitis predominantly affected the cerebellum (P = 0.002), and NMDA encephalitis showed contrast enhancement in five cases (P = 0.045). MRI was not useful for predicting short-term outcomes but was associated with long-term outcomes; specifically, a normal MRI was linked to a better long-term outcome in 47.8% of patients (P = 0.035), and resolution of abnormalities correlated with a favorable FIM score (>54) in 76.7% (P = 0.016).ConclusionMRI is valuable for early detection of seizures or dementia as initial manifestations of AIE and for differentiating AIE subtypes. Follow-up MRI is significant in predicting long-term outcomes.

Acta Radiologica, Ahead of Print. <br/>BackgroundIn-stent restenosis (ISR) is a potential severe complication that occurs in patients with severe carotid artery narrowing after carotid angioplasty and stent placement. However, this phenomenon has not been fully studied in the context of interventional treatment for chronic internal carotid artery occlusion (CICAO).PurposeTo quantify the ISR rate and identify the risk factors leading to this event.Material and MethodsThis study included 69 patients with symptomatic CICAO who underwent successful intravascular recanalization at our institution. Clinical information, outcomes, and prognosis of the patients were recorded. The related factors of ISR were analyzed through univariate and multivariate analysis.ResultsA total of 11 (15.9%) patients developed a significant ISR > 70% during the follow-up period. Among them, five patients with ISR experienced symptomatic restenosis. Our study found hyperlipidemia (P = 0.017), contralateral internal carotid artery occlusion (P = 0.041), and prolonged radiologic occlusion to recanalization time (P = 0.049) could contribute to the risk of ISR in patients with CICAO.ConclusionISR is not rare in patients with CICAO after successful intervention. Hyperlipidemia, contralateral ICA occlusion, and prolonged radiologic occlusion to recanalization time are the risk factors for ISR after treatment in patients with CICAO.

Acta Radiologica, Ahead of Print. <br/>BackgroundLiver dysfunction has been reported as a risk factor for predicting complications after hepatectomy. In patients with liver cirrhosis (LC) who underwent hepatectomy, a Functional Liver Imaging Score (FLIS), derived from gadoxetic acid–enhanced magnetic resonance imaging (MRI), has never been investigated as a predictor of clinically significant post-hepatectomy complications.PurposeTo evaluate whether FLIS can predict post-hepatectomy complications in patients with LC.Material and MethodsA retrospective review was conducted of patients with LC who underwent gadoxetic acid–enhanced MRI and hepatectomy. Univariable and multivariable logistic regression was used to identify clinicopathological and radiologic findings associated with the development of major complication (Clavien–Dindo classification [CDC] ≥ III). Receiver operating characteristic (ROC) curve analysis was performed to determine the cutoff value of FLIS for predicting CDC ≥ III.ResultsOf the finally included 106 patients (77 men; mean age = 62.5 ± 8.3 years), 12 patients had a CDC ≥ III. Multivariable analysis showed that only FLIS independently predicted post-hepatectomy complications (odds ratio = 0.02; P = 0.01). ROC analysis suggested the FLIS ≤ 4 was the optimal cutoff for predicting CDC ≥ III (AUC value = 0.94; sensitivity = 91.67%; specificity = 95.74%; positive likelihood ratio = 21.54; and negative likelihood ratio = 0.09).ConclusionIn patients with LC, FLIS was an independent predictor of post-hepatectomy complications. FLIS showed excellent diagnostic performance in predicting post-hepatectomy complications.

Acta Radiologica, Ahead of Print. <br/>BackgroundTriple rule-out computed tomography angiography (CTA) provides imaging of the coronary arteries, pulmonary arteries, and thoracic aorta filled with contrast material (CM) to exclude or diagnose the pathologies of these three systems. Although dual rule-out adapted to exclude aortic and pulmonary pathologies. Iodinated CM may result in contrast-induced nephropathy, which lengthens hospital stay.PurposeTo compare image quality of dual/triple rule-out CTA by reducing the radiation dose by using relatively high mAs with less contrast material and low kilovoltage without affecting the diagnostic value.MethodsWe acquired standard dual/triple rule-out CTA 120 kilovoltage peak (kVp) with 95 mL contrast material. The low-dose group acquired 80 Kvp with total 60 contrast material. There were 91 patients in the standard-dose group and 88 patients in the low-dose group.ResultsSignal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were calculated separately. There was no significant difference in CNR values between the two groups in the aorta and pulmonary and coronary arteries; however, a significant difference was found in SNR values. In subjective image quality evaluation, no significant difference was found between the standard- and low-dose patients. The radiation dose was reduced by 63.80% and the contrast material by 31.5% in the low-dose group in comparison to the standard dose.ConclusionOur study showed that dual/triple rule-out CTA can be performed with low-dose radiation and low-volume contrast material. Low-dose CTA may be preferred in emergencies situations that patients with borderline renal function tests or the risk group.

Acta Radiologica, Ahead of Print. <br/>BackgroundSpread through air spaces (STAS) is a well-established factor associated with poor oncological outcomes in patients undergoing surgery for solid lung adenocarcinoma. There could potentially be a disparity in iodine uptake between patients with positive and negative airway spread of solid lung adenocarcinoma.PurposeTo explore the associations and find correlations of iodine uptake with STAS status in patients who underwent surgery for solid lung adenocarcinoma.Material and MethodsPatients who underwent solid lung adenocarcinoma resection between January and June 2022 were included in this retrospective study. Iodine concentration and CT features were assessed using contrast-enhanced dual-energy computed tomography (DECT) scans, and these were compared with the status of STAS.ResultsOf 52 patients included, 25 (48%) were STAS-positive and 27 (52%) were STAS-negative. There were no statistically significant differences in CT features between the two groups (P > 0.05). STAS-positive was significantly associated with low arterial phase iodine concentration (ICA), normalized arterial phase iodine concentration (NICA), and venous phase iodine concentration (ICV), with a cutoff established at 1.15 mg/mL, 0.11, and 1.35 mg/mL, respectively (P < 0.05). The AUCs for ICA, NICA, and ICV in predicting STAS in solid lung adenocarcinoma were 0.82, 0.83, and 0.73, respectively. ICA and NICA were identified as independent risk factors for STAS in solid lung adenocarcinoma, with a combined AUC of 0.89.ConclusionThis study suggests that solid lung adenocarcinoma patients with low ICA, NICA, and ICVA were associated with STAS-positive, as well as a worse survival outcomes.

Acta Radiologica, Ahead of Print. <br/>BackgroundPatellar instability (PI) or patellar dislocation (PD) is challenging to diagnose accurately based on medical history and clinical manifestations alone. While X-ray, computed tomography (CT), and magnetic resonance imaging (MRI) are commonly employed for detecting PI or PD, computer vision has not yet been widely utilized for this purpose.PurposeTo explore the feasibility of computer vision, specifically the You Only Look Once (YOLO) algorithm, in identifying patellar instability or dislocation.Material and MethodsA total of 550 patients (190 diagnosed with patellar instability or dislocation) were divided into a training set (n = 360), validation set (n = 90), and external test set (n = 100). Four indicators were measured on transverse knee MRI scans to determine the presence of patellar instability, and 450 images were labeled using Labelme software. YOLO version 8 (YOLOv8) was refined using these labeled images and validated on 100 unlabeled images. The diagnostic accuracy of YOLOv8 was compared with that of a junior radiologist.ResultsThe sensitivity, specificity, and accuracy of the refined YOLO model and the junior radiologist were 62%, 97%, and 83%, and 62%, 82%, and 74%, respectively. Although the YOLO model demonstrated slightly higher accuracy, the difference did not reach statistical significance (P = 0.093). The YOLO model required approximately 14.01 ± 10.34 ms to interpret each image, significantly shorter than the 9.55 ± 2.39 s required by the radiologist (P < 0.001).ConclusionThe refined YOLOv8 model is not inferior to junior radiologists in identifying patellar instability or dislocation and offers a significantly faster interpretation time.

Acta Radiologica, Ahead of Print. <br/>BackgroundCongenital coronary artery to pulmonary artery fistulas (CPAFs) are extremely rare congenital vascular malformations.PurposeTo give a practical approach and consider technical challenges and pitfalls for endovascular embolization of CPAF.Material and MethodsAnatomic, technical, and pathophysiologic considerations are given and demonstrated for antegrade and retrograde endovascular embolization of CPAF.ResultsAntegrade embolization is easier to perform, saves radiation exposure, and is recommended especially in younger patients. In case of a single dominant feeder, antegrade embolization of this feeder might sufficiently treat the CPAF. Retrograde embolization from the pulmonary orifice is technically more challenging but leads to a complete and definite closure of the fistula in one single step.ConclusionPatient age and fistula configuration must be taken into consideration for appropriate treatment approach in CPAF. Prerequisite for successful embolization of CPAF is profound clinical and interventional experience, why we highly recommend to both plan and carry out embolization of CPAF as interdisciplinary procedure.

Acta Radiologica, Ahead of Print. <br/>Background68Ga-labled fibroblast activating protein inhibitor (68Ga-FAPI) represents a new and exciting positron emission tomography-computed tomography/magnetic resonance (PET-CT/MR) radiotracer.PurposeTo compare the diagnostic efficacy of 68Ga-FAPI PET CT/MR and 18F-fluorodeoxyglucose (18F-FDG) PET/CT in metastatic lesions of gynecological cancers (GCs).Material and MethodsThe PubMed, Embase, and Web of Science databases were thoroughly investigated from inception until 22 December 2023. A head-to-head contrast between 18F-FDG PET/CT as well as 68Ga-FAPI PET CT/MR for the assessment of GCs was presented by the included studies. A random variable model was employed to examine the sensitivity in detection of lymph node (LN) and peritoneal metastases (PM).ResultsThe pooled sensitivity for 68Ga-FAPI PET CT/MR and 18F-FDG PET/CT in lymph node metastases (LNM) of GC were 0.98 (95% confidence interval [CI] = 0.86–1) and 0.85 (95% CI = 0.65–0.98), respectively, while the results about peritoneal metastases in ovarian cancer were 0.98 (95% CI = 0.93–1) and 0.71 (95% CI = 0.55–0.86). Compared with 18F-FDG PET/CT, 68Ga-FAPI PET CT/MR exhibited a better sensitivity in peritoneal involvement of ovarian cancer with a relative risk of 0.24 (95% CI = 0.09–0.40) and P = 0.002.Conclusion68Ga-FAPI PET CT/MR displayed a superior sensitivity over 18F-FDG PET/CT in detecting metastatic lesions of ovarian cancer. However, there was insufficient evidence to favor the superiority of 68Ga-FAPI PET CT/MR in LNM of CC. Further studies are needed for evaluating primary and metastatic lesions of 68Ga-FAPI PET CT/MR in different GC.

Acta Radiologica, Ahead of Print. <br/>BackgroundRadiofrequency ablation (RFA) of subphrenic hepatocellular carcinomas (HCCs) using ultrasound (US) guidance presents a challenge.PurposeTo evaluate local tumor progression (LTP) and overall survival (OS) after RFA of right posterior subphrenic HCCs, and to identify the risk factors for LTP and OS after RFA.Material and MethodsWe screened patients who underwent US-guided RFA for a single HCC <3 cm in the right posterior subphrenic area. Cumulative rates of LTP and OS were compared between multiple- and single-electrode treatments and artificial pleural effusion versus no-effusion groups using Kaplan–Meier curves and the log-rank test. The risk factors for LTP and OS were assessed.ResultsA total of 36 patients were included. The cumulative 5-year and 10-year LTP rates were 32.9% and 39.6%, respectively, and the corresponding OS rates were 72.2% and 48.7%, respectively. The multiple-electrode group had significantly lower cumulative LTP rates compared to the single-electrode group (P < 0.001). The group receiving artificial pleural effusion showed a trend towards lower LTP rates than the no-effusion group (P = 0.076). The albumin-bilirubin (ALBI) grade was the only risk factor for LTP (hazard ratio [HR] = 4.17, 95% confidence interval [CI] = 1.26–14.55; P = 0.020). A lower albumin level was a risk factor for mortality (HR = 0.24, 95% CI = 0.07–0.79; P = 0.020).ConclusionUS-guided RFA with multiple electrodes and artificial pleural effusion tends to be linked with lower LTP rates. The ALBI grade and serum albumin level are risk factors for LTP and OS, respectively.