BACKGROUND: The diagnostic accuracy of prostate magnetic resonance imaging (MRI) is highly dependent on image quality. Although the effects of spasmolytics and rectal preparation have been previously studied, the findings remain inconsistent and fail to address other critical modifiable factors. This study aimed to evaluate the impact of various modifiable factors on prostate MRI image quality and their subsequent influence on Prostate Imaging Reporting and Data System (PI-RADS) scoring. METHODS: Fifty-six consecutive patients who underwent 3T multiparametric MRI (mpMRI) with the administration of hyoscine butylbromide (HB+) and at least one 3T mpMRI without HB (HB-) ≤3 years earlier were retrospectively evaluated. Two radiologists performed morphometry of the prostate, bladder, rectum, and abdomen and evaluated image quality, artifacts, and motion on a five-point scale and T2 and diffusion-weighted imaging (DWI) PI-RADS v2.1 scores. The influence of HB, rectum and bladder distension, breathing motion, and examination hour were analyzed. RESULTS: The sharpness and overall image quality of T2 images were significantly better in HB+ compared to HB- (P=0.0047 and P=0.013). T2 motion artifacts were reduced earlier in the day (ρ=0.32, P=0.017). DWI susceptibility artifact correlated with patient diameter (ρ=0.40, P=0.002), but not with rectum diameter (ρ=0.09, P=0.51) or gas content (ρ=0.13, P=0.33). Examinations later in the day were associated with increased motion artifacts on T2 [hazard ratio (HR) =1.36]. T2 and DWI scores were influenced by bladder volume, breathing motion, and rectal air, but not by HB. Breathing motion negatively impacted overall image quality (HR =1.24), and DWI susceptibility artifacts (HR =1.22). CONCLUSIONS: HB administration, daytime, and breathing motion have significant influence on image quality of prostate MRI. The gas content of the rectum influences T2 image quality and T2 scores. Bladder filling is associated with reduced breathing motion, subsequently affecting DWI scores.
- Publikační typ
- časopisecké články MeSH
BACKGROUND: Whole-body magnetic resonance imaging (wbMRI) allows general assessment of systemic cancers including lymphomas without radiation burden. AIM: To evaluate the diagnostic performance of wbMRI in the staging of diffuse large B-cell lymphoma (DLBCL), determine the value of individual MRI sequences, and assess patients' concerns with wbMRI. METHODS: In this single-center prospective study, adult patients newly diagnosed with systemic DLBCL underwent wbMRI on a 3T scanner [diffusion weighted images with background suppression (DWIBS), T2, short tau inversion recovery (STIR), contrast-enhanced T1] and fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) (reference standard). The involvement of 12 nodal regions and extranodal sites was evaluated on wbMRI and PET/CT. The utility of wbMRI sequences was rated on a five-point scale (0 = not useful, 4 = very useful). Patients received a questionnaire regarding wbMRI. RESULTS: Of 60 eligible patients, 14 (23%) were enrolled and completed the study. The sensitivity of wbMRI in the nodal involvement (182 nodal sites) was 0.84, with 0.99 specificity, positive predictive value of 0.96, negative predictive value of 0.97, and 0.97 accuracy. PET/CT and wbMRI were concordant both in extranodal involvement (13 instances) and staging (κ = 1.0). The mean scores of the utility of MRI sequences were 3.71 ± 0.73 for DWIBS, 2.64 ± 0.84 for T1, 2.14 ± 0.77 for STIR, and 1.29 ± 0.73 for T2 (P < 0.0001). Patients were mostly concerned about the enclosed environment and duration of the MRI examination (27% of patients). CONCLUSION: The wbMRI exhibited excellent sensitivity and specificity in staging DLBCL. DWIBS and contrast-enhanced T1 were rated as the most useful sequences. Patients were less willing to undergo wbMRI as a second examination parallel to PET/CT, especially owing to the long duration and the enclosed environment.
- Publikační typ
- časopisecké články MeSH
- MeSH
- aorta thoracica diagnostické zobrazování patologie MeSH
- dilatace patologická diagnostické zobrazování patologie MeSH
- disekce aorty diagnostické zobrazování patologie MeSH
- echokardiografie klasifikace MeSH
- kardiologické zobrazovací techniky * klasifikace metody MeSH
- lidé MeSH
- magnetická rezonanční tomografie metody MeSH
- nemoci aorty * diagnostické zobrazování klasifikace patologie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
- MeSH
- dávka záření MeSH
- diagnostické zobrazování * metody MeSH
- diferenciální diagnóza MeSH
- lidé MeSH
- magnetická rezonanční tomografie metody MeSH
- pediatrie * metody MeSH
- pneumologie * metody MeSH
- počítačová rentgenová tomografie metody přístrojové vybavení MeSH
- pozitronová emisní tomografie metody MeSH
- radiografie metody přístrojové vybavení MeSH
- radioisotopová scintigrafie metody MeSH
- ultrazvuk metody MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
OBJECTIVES: To examine the diagnostic performance of CT of the pulmonary artery (CTPA) as a potential first-choice imaging modality in patients with pulmonary arterial hypertension and suspected chronic thromboembolic pulmonary hypertension (CTEPH). METHODS: A systematic review and meta-analysis were conducted in accordance with the PRISMA reporting checklist. Six scientific databases and registers (PubMed, EMBASE, Scopus, Web of Science, Cochrane, ClinicalTrials.gov ) were searched for studies evaluating the diagnostic performance of CTPA in suspected CTEPH in adult patients. Results were pooled separately for studies based on the evaluation of the pulmonary artery and those that relied solely on changes in parenchymal perfusion. RESULTS: Ten single-center studies with 734 patients were eligible for pooling of the diagnostic performance of CTPA by evaluation of the pulmonary artery. The pooled sensitivity, specificity, PPV, NPV, accuracy, and diagnostic odds ratio (DOR) estimates for CTPA in the detection of CTEPH were 0.98, 0.99, 0.94, 1.00, 0.96, 0.96, and 292. Evaluation of perfusion changes yielded pooled estimates for sensitivity, specificity, PPV, NPV, accuracy, and DOR of 0.99, 0.84, 0.79, 0.98, 0.89, 0.89, and 98 across four studies with 278 patients. Scintigraphy, SPECT, digital subtraction angiography, right heart catheterization, pulmonary endarterectomy, and international guidelines were used to establish the diagnosis. CONCLUSION: CTPA has high sensitivity and specificity in the detection of CTEPH when the examination is evaluated by expert radiologists. Evaluation of parenchymal perfusion alone is associated with slightly lower specificity. Further research is needed to determine the diagnostic performance of CTPA in excluding CTEPH in general radiology departments. KEY POINTS: • CT pulmonary angiography (CTPA) is recommended in the diagnostic workup of chronic thromboembolic pulmonary hypertension (CTEPH). • CTPA has high sensitivity and specificity in the detection of CTEPH when evaluated by an expert radiologist. • Evaluation of changes in parenchymal perfusion alone is associated with slightly lower specificity. • Little is known about the diagnostic performance of CTPA in the detection of CTEPH in general radiology departments.
- MeSH
- chronická nemoc MeSH
- CT angiografie metody MeSH
- digitální subtrakční angiografie MeSH
- dospělí MeSH
- lidé MeSH
- plicní embolie * komplikace diagnostické zobrazování MeSH
- plicní hypertenze * diagnóza MeSH
- senzitivita a specificita MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- metaanalýza MeSH
- přehledy MeSH
- systematický přehled MeSH
Background: Morphology highlighted by diffusion weighted imaging (DWI) is the basis of whole-body MRI (wbMRI). The aim of this study was to analyze current knowledge on the diagnostic performance of wbMRI in the pretreatment staging of patients with lymphoma. Methods: A search for original articles reporting the diagnostic performance (sensitivity, specificity) of pretreatment (first staging or staging in relapsed patients after complete remission) wbMRI in nodal and extranodal involvement by extracranial lymphoma and the agreement of stage by the Cotswolds-modified Ann Arbor classification in adult patients compared to the reference standard (PET/CT or enhanced reference standard) was conducted in PubMed, EMBASE, Cochrane Library, ClinicalTrials.gov. Results: Altogether 15 studies with 519 patients were included in the meta-analysis. The pooled sensitivity and specificity for nodal involvement were 0.93 (95% CI: 0.90 to 0.96) and 0.99 (95% CI: 0.98 to 1.00). For nodal staging, most studies used the size criterion of 10 mm in the short diameter (n=10) and the absence of prominent fatty hilum (n=4). Restricted diffusion on diffusion-weighted imaging as a sign of nodal involvement was either not used (n=5), used for detection (n=4), semi-quantitatively (n=4), or quantitatively (n=1). Only one study (7) relied solely on restricted diffusion as the main criterion for nodal involvement. The pooled sensitivity and specificity for extranodal involvement were 0.89 (95% CI: 0.79 to 0.98) and 0.99 (95% CI: 0.99 to 1.00). Seven studies considered diffuse splenic involvement when its long or vertical axis was greater than 13 cm regardless of the patient's physiognomy. The pooled agreement in staging (Cohen's kappa) was almost perfect (0.90, 95% CI: 0.84 to 0.95). Discussion: The sensitivity and specificity of wbMRI in the assessment of the nodal and extranodal involvement by lymphoma is high. The agreement of wbMRI with the reference standard is almost perfect.
- Publikační typ
- časopisecké články MeSH
BACKGROUND: Lung cancer screening in high-risk population increases the proportion of patients diagnosed at a resectable stage. AIMS: To optimize the selection criteria and quality indicators for lung cancer screening by low-dose CT (LDCT) in the Czech population of high-risk individuals. To compare the influence of screening on the stage of lung cancer at the time of the diagnosis with the stage distribution in an unscreened population. To estimate the impact on life-years lost according to the stage-specific cancer survival and stage distribution in the screened population. To calculate the cost-effectiveness of the screening program. METHODS: Based on the evidence from large national trials - the National Lung Screening Trial in the USA (NLST), the NELSON study, the recent recommendations of the Fleischner society, the American College of Radiology, and I-ELCAP action group, we developed a protocol for a single-arm prospective study in the Czech Republic for the screening of high-risk asymptomatic individuals. The study commenced in August 2020. RESULTS: The inclusion criteria are: age 55 to 74 years; smoking: ≥30 pack-years; smoker or ex-smoker <15 years; performance status (0-1). The screening timepoints are at baseline and 1 year. The LDCT acquisition has a target CTDIvol ≤0.5mGy and effective dose ≤0.2mSv for a standard-size patient. The interpretation of findings is primarily based on nodule volumetry, volume doubling time (and related risk of malignancy). The management includes follow-up LDCT, contrast enhanced CT, PET/CT, tissue sampling. The primary outcome is the number of cancers detected at a resectable stage, secondary outcomes include the average cost per diagnosis of lung cancer, the number, cost, complications of secondary examinations, and the number of potentially important secondary findings. CONCLUSIONS: A study protocol for early detection of lung cancer in Czech high-risk asymptomatic individuals (ELEGANCE) study using LDCT has been described.
- MeSH
- analýza nákladů a výnosů MeSH
- asymptomatické nemoci * ekonomika MeSH
- biopsie ekonomika metody MeSH
- časná detekce nádoru ekonomika metody MeSH
- hodnocení rizik ekonomika metody MeSH
- kvalitativně upravené roky života MeSH
- lidé středního věku MeSH
- lidé MeSH
- nádory plic diagnóza ekonomika etiologie MeSH
- PET/CT ekonomika metody MeSH
- plíce patologie MeSH
- počítačová rentgenová tomografie ekonomika metody MeSH
- prospektivní studie MeSH
- respirační funkční testy ekonomika metody MeSH
- rizikové faktory MeSH
- senioři MeSH
- staging nádorů ekonomika metody MeSH
- výběr pacientů MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- protokol klinické studie MeSH
- Geografické názvy
- Česká republika MeSH
