Cílem tohoto článku je seznámit čtenáře s metodami miniinvazivní léčby benigních uzlů štítné žlázy, které zahrnují radiofrekvenční (RFA), mikrovlnnou (MWA), laserovou ablaci (LA) a terapii vysoce intenzivním fokusovaným ultrazvukem (HIFU). Benigní noduly štítné žlázy jsou v populaci velmi častým vedlejším nálezem ultrazvukového vyšetření. V případě, že způsobují pacientům symptomy či u nich dochází k progresi velikosti, je indikováno jejich chirurgické odstranění – částečná nebo totální tyroidektomie. Termální ablace představují novou, v podmínkách Evropy stále častěji využívanou alternativu, která poskytuje dostatečnou účinnost a srovnatelná rizika při léčbě tohoto onemocnění.
The aim of this article is to introduce readers to minimally invasive treatment methods for benign thyroid nodules including radiofrequency ablation (RFA), microwave ablation (MWA), laser ablation (LA) and high-intensity focused ultrasound (HIFU). Benign thyroid nodules are frequently encountered as incidental findings in ultrasound examinations. When they become symptomatic or exhibit progressive growth, surgical removal – either partial or total thyroidectomy – is indicated. Thermal ablation represents an emerging alternative, that is increasingly utilized in Europe and offers good efficacy with a risk profile comparable to surgical treatment.
BACKGROUND: Preoperative tumour size is a key prognostic marker in tailoring surgical treatment in early-stage cervical cancer. This post-hoc analysis assessed the accuracy of preoperative tumour size evaluation via imaging, utilizing data from the prospective, international, multicentre SENTIX study that evaluated safety of sentinel lymph node (SLN) biopsy without pelvic lymph node dissection in patients with early-stage cervical cancer. METHODS: Between 05/2016-09/2020, forty-seven sites across 18 countries enrolled cervical cancer patients (FIGO2018 stages 1A1/lymphovascular-space-invasion-positive to 1B2). Preoperative staging included pelvic MRI or ultrasound as mandatory imaging modalities. All patients underwent primary surgical treatment. Pathological assessment of surgical specimens served as reference standard for evaluating the accuracy of preoperative assessments. RESULTS: Among the 680 included patients, although the mean tumour size discrepancy between preoperative/pathological assessments was only 1.24 ± 8.891 mm, postoperative pT stage was upgraded in 187 (27.5 %) and downgraded in 74 (10.9 %) patients. Discrepancy of ≥10 mm was observed among 155 (22.8 %) patients across all stages, with underestimation in 105 (15.4 %), overestimation in 50 (7.4 %), and a positive correlation (P < 0.0001) between the pathological tumour size and the discrepancy in size assessment. If a maximum 2 cm tumour size threshold were applied to guide the decision between simple and radical hysterectomy, underestimation would result in inadequate surgical management for 9.0 % of patients, whereas overestimation would lead to unnecessarily radical procedures in 5.1 % of cases. CONCLUSIONS: The study highlights, that even with the use of modern imaging in preoperative staging, inaccuracies in tumour size assessment remain a common cause of up-/down-staging after surgery resulting in potential inappropriate planning of surgery, and thus in procedure that is either excessively or insufficiently radical. TRIAL REGISTRATION: ClinicalTrials.gov: NCT02494063.
- MeSH
- biopsie sentinelové lymfatické uzliny metody MeSH
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- magnetická rezonanční tomografie MeSH
- nádory děložního čípku * patologie chirurgie diagnostické zobrazování MeSH
- předoperační péče metody MeSH
- prospektivní studie MeSH
- senioři MeSH
- staging nádorů MeSH
- tumor burden MeSH
- ultrasonografie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
OBJECTIVES: This study aims to assess the accuracy of generative pre-trained transformer 4o (GPT-4o) in answering multiple response questions from the European Diploma in Radiology (EDiR) examination, comparing its performance to that of human candidates. MATERIALS AND METHODS: Results from 42 EDiR candidates across Europe were compared to those from 26 fourth-year medical students who answered exclusively using the ChatGPT-4o in a prospective study (October 2024). The challenge consisted of 52 recall or understanding-based EDiR multiple-response questions, all without visual inputs. RESULTS: The GPT-4o achieved a mean score of 82.1 ± 3.0%, significantly outperforming the EDiR candidates with 49.4 ± 10.5% (p < 0.0001). In particular, chatGPT-4o demonstrated higher true positive rates while maintaining lower false positive rates compared to EDiR candidates, with a higher accuracy rate in all radiology subspecialties (p < 0.0001) except informatics (p = 0.20). There was near-perfect agreement between GPT-4 responses (κ = 0.872) and moderate agreement among EDiR participants (κ = 0.334). Exit surveys revealed that all participants used the copy-and-paste feature, and 73% submitted additional questions to clarify responses. CONCLUSIONS: GPT-4o significantly outperformed human candidates in low-order, text-based EDiR multiple-response questions, demonstrating higher accuracy and reliability. These results highlight GPT-4o's potential in answering text-based radiology questions. Further research is necessary to investigate its performance across different question formats and candidate populations to ensure broader applicability and reliability. CRITICAL RELEVANCE STATEMENT: GPT-4o significantly outperforms human candidates in factual radiology text-based questions in the EDiR, excelling especially in identifying correct responses, with a higher accuracy rate compared to radiologists. KEY POINTS: In EDiR text-based questions, ChatGPT-4o scored higher (82%) than EDiR participants (49%). Compared to radiologists, GPT-4o excelled in identifying correct responses. GPT-4o responses demonstrated higher agreement (κ = 0.87) compared to EDiR candidates (κ = 0.33).
- Publikační typ
- časopisecké články MeSH
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
BACKGROUND: The aim was to evaluate the performance of the Peritoneal Cancer Index (PCI) using imaging (ultrasound, contrast-enhanced computed tomography (CT), and whole-body diffusion-weighted magnetic resonance imaging (WB-DWI/MRI) in assessing peritoneal carcinomatosis and predicting non-resectability in tubo-ovarian carcinoma patients. METHODS: This was a prospective multicenter observational study. We considered all patients with suspected primary ovarian/tubal/peritoneal cancer who underwent preoperative ultrasound, CT, and WB-DWI/MRI (if available). The optimal cut off value for assessing the performance of the methods in predicting non-resectability was identified at the point at which the sensitivity and specificity were most similar. The reference standard to predict non-resectability was surgical outcome in terms of residual disease >1 cm or surgery not feasible. Agreement between imaging methods and surgical exploration in assessing sites included in the PCI score was evaluated using the Intraclass Correlation Coefficient (ICC). RESULTS: 242 patients were included from January 2020 until November 2022. The optimal PCI cut-off for predicting non-resectability for surgical exploration was >12, which achieved the best AUC of 0.87, followed by ultrasound with a cut-off of >10 and AUC of 0.81, WB-DWI/MRI with a cut-off of >12 and AUC of 0.81, and CT with a cut-off of >11 and AUC of 0.74. Using ICC, ultrasound had very high agreement (0.94) with surgical PCI, while CT and WB-DWI/MRI had high agreement (0.86 and 0.87, respectively). CONCLUSION: Ultrasound performed by an expert operator had the best agreement with surgical findings compared to WB-DWI/MRI and CT in assessing radiological PCI. In predicting non-resectability, ultrasound was non-inferior to CT, while its non-inferiority to WB-DWI/MRI was not demonstrated.
- MeSH
- difuzní magnetická rezonance metody MeSH
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- nádory vaječníků * diagnostické zobrazování patologie chirurgie MeSH
- nádory vejcovodů diagnostické zobrazování patologie chirurgie MeSH
- peritoneální nádory * diagnostické zobrazování MeSH
- počítačová rentgenová tomografie * metody MeSH
- prediktivní hodnota testů MeSH
- prospektivní studie MeSH
- senioři MeSH
- ultrasonografie * metody MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
- pozorovací studie MeSH
Přehledový článek se věnuje především možnostem a limitacím moderních zobrazovacích metod v předoperační diferenciální diagnostice mezenchymových nádorů dělohy. Při plánování vhodného chirurgického výkonu se řídíme nejen klinickými symptomy, věkem a reprodukčními plány, ale i zobrazovacími metodami, zejména ultrazvukovým vyšetřením a magnetickou rezonancí (MR). U těchto dvou zobrazení lze na základě recentních studií definovat znaky, které svědčí pro přítomnost malignity. V případě ultrazvukového vyšetření se jedná o obraz objemného, většinou solitárního nádoru nehomogenní struktury s cystami nepravidelného tvaru, s porušeným zevním pouzdrem, absencí kalcifikací a akustických stínů a střední nebo vysokou vaskularizací intraparenchymatózně. Maligním znakem je rovněž rychlý růst nádoru v průběhu sledování, zvláště peri- a postmenopauzálně. Při zobrazení MR mají děložní sarkomy nepravidelné ohraničení, jsou patrné hyperintenzní oblasti na T1 i T2 vážených sekvencích a centrální nekrotická oblast bez sycení kontrastní látkou. Při difuzně váženém zobrazení (DWI/MR) je patrná výrazná restrikce, ale tento znak se může objevovat i u některých variant myomů. Při suspektních nálezech v rámci předoperačního zobrazení ultrazvukem či MR lze využít biopsii silnou jehlou či hysteroskopicky, a to zejména při plánování fertilitu zachovávajících výkonů, nebo zvažujeme-li konzervativní management u asymptomatických pacientek. Co se týče dalších zobrazovacích metod, přínos výpočetní tomografie (CT) nebo pozitronové emisní tomografie v kombinaci s CT (PET/CT) je v rámci diferenciální diagnostiky značně omezený. Obě metody slouží pouze pro stanovení rozsahu onemocnění. Význam laboratorních markerů, především laktátdehydrogenázy, v diferenciální diagnostice nebyl dosud prokázán. Závěr: Ultrazvukové vyšetření anebo magnetická rezonance mohou přispět k předoperačnímu rozlišení děložních sarkomů od mnohem častějších myomů na základě přítomnosti kombinace maligních znaků. V této skupině žen se suspektními nálezy je potřeba zvolit adekvátní typ a rozsah chirurgického výkonu, především je nutné vyvarovat se intraperitoneální morcelace, která by mohla vést k iatrogenní diseminaci a zhoršení prognózy.
The narrative review article is focused on the strengths and limitations of modern imaging methods in the preoperative differential diagnosis of uterine mesenchymal tumours. In order to tailor the surgical procedures, imaging methods, namely ultrasound and magnetic resonance imaging (MRI), should be taken into account as well as clinical symptoms, age, and fertility plans. On ultrasound scans, uterine sarcomas have the appearance of large, usually solitary tumours of non-homogenous structure with irregular cysts, ill-defined outline borders (interrupted capsule), absence of calcifications with acoustic shadowing, and moderate to rich internal vascularisation. Rapid growth between follow-ups or atypical growth in peri- or post-menopause is also a sign of malignancy. On MRI, uterine sarcomas are characterized by irregular borders, hyperintense areas on T1-weighted and T2- weighted images, and central non-enhancing necrotic areas. On diffusion-weighted imaging (DWI/MRI), sarcomas exhibit markedly restricted diffusion but there is a significant overlap with some variants of fibroids. Core-needle or hysteroscopic biopsy can be used preoperatively if suspicious features are detected on ultrasound or MRI scans, particularly before myomectomy if fertility preservation is required or when conservative management is considered in asymptomatic women. Other imaging methods, such as positron emission tomography fused with CT (PET-CT) or computed tomography (CT) have limited role to distinguish uterine sarcomas from myomas and are suitable only for staging purposes. The importance of tumour markers including lactate dehydrogenase in preoperative work-up have not been verified yet. Conclusion: Uterine sarcomas can be distinguished from much more common myomas based on a combination of malignant features on ultrasound or MR imaging. In these suspicious cases the type and extent of surgery should be adjusted, avoiding intraperitoneal morcellation, which could lead to iatrogenic tumour spread and worsening of the patient’s prognosis.
- MeSH
- biologické markery MeSH
- biopsie metody MeSH
- diferenciální diagnóza MeSH
- leiomyom chirurgie diagnóza MeSH
- lidé MeSH
- magnetická rezonanční tomografie metody MeSH
- nádory dělohy * chirurgie diagnostické zobrazování diagnóza MeSH
- předoperační vyšetření MeSH
- sarkom chirurgie diagnóza MeSH
- ultrasonografie metody MeSH
- Check Tag
- lidé MeSH
- ženské pohlaví MeSH
OBJECTIVES: To assess the diagnostic performance and interobserver agreement of CT pulmonary angiography (CTPA) in the detection of chronic thromboembolic pulmonary hypertension (CTEPH) and its features among radiologists of different levels of experience. MATERIALS AND METHODS: In this retrospective, single-center, single-blinded study, three radiologists with different levels of experience in CT imaging (R1:15 years, R2:6 years, and R3:3 years) evaluated CTPA of 51 patients ultimately diagnosed with CTEPH (European Society of Cardiology guidelines) and 49 patients without CTEPH in random order to assess the presence of CTEPH, its features in the pulmonary artery tree, proximal level of involvement, bronchial artery hypertrophy, mosaic perfusion, and right heart overload. RESULTS: CTPAs of 51 patients with CTEPH (median age, 66 years (IQR 56-72), 28 men) and 49 patients without CTEPH (median age, 65 years (IQR 50-74), 25 men) were evaluated. The sensitivity and specificity for the detection of CTEPH was 100% (all radiologists) and 100% (R1), 96% (R2), and 96% (R3) with almost perfect agreement (κ = 0.95). The sensitivity and specificity for detecting CTEPH by mosaic perfusion would be 89% (95%CI 83-93%) and 81% (74-87%). The level of pulmonary artery involvement was reported with moderate agreement (κ = 0.54, 95%CI 0.40-0.65). Substantial agreement was found in the evaluation of mosaic attenuation (κ = 0.75, 95%CI 0.64-0.84), right heart overload (κ = 0.68, 95%CI 0.56-0.79), and bronchial artery hypertrophy (0.71, 95%CI 0.59-0.82) which were the best predictors of CTEPH (p < 0.0001). CONCLUSIONS: CTPA has high sensitivity and specificity in detecting CTEPH and almost perfect agreement among radiologists of different levels of expertise. CLINICAL RELEVANCE: CT pulmonary angiography can be used as a first-line imaging modality in patients with suspected chronic thromboembolic pulmonary hypertension (CTEPH) even when interpreted by non-CTEPH experts. KEY POINTS: • CT pulmonary angiography has high sensitivity and specificity in detecting chronic thromboembolic pulmonary hypertension (CTEPH) and almost perfect interobserver agreement among radiologists of different levels of expertise. • Substantial agreement exists in the assessment of mosaic attenuation, right heart overload, and bronchial artery hypertrophy, which are the best predictors of CTEPH.
- MeSH
- angiografie metody MeSH
- chronická nemoc MeSH
- hypertrofie MeSH
- jednoduchá slepá metoda MeSH
- lidé středního věku MeSH
- lidé MeSH
- plicní embolie * komplikace diagnostické zobrazování MeSH
- plicní hypertenze * komplikace diagnostické zobrazování MeSH
- počítačová rentgenová tomografie metody MeSH
- retrospektivní studie MeSH
- senioři MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
