Diagnostics

Research

20 pages, 14752 KiB

Open AccessArticle

Multimodality Imaging Features of Papillary Renal Cell Carcinoma

by Rosita Comune, Francesco Tiralongo, Eleonora Bicci, Pietro Paolo Saturnino, Francesco Michele Ronza, Chandra Bortolotto, Vincenza Granata, Salvatore Masala, Mariano Scaglione, Giacomo Sica, Fabio Tamburro and Stefania Tamburrini

Diagnostics 2025, 15(7), 906; https://doi.org/10.3390/diagnostics15070906 - 1 Apr 2025

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Abstract

Objectives: To describe the US, CEUS, CT, and MRI features of papillary renal cell carcinoma (PRCC) and to underline the imaging characteristics that are helpful in the differential diagnosis. Methods: Patients with histologically proven papillary renal cell carcinoma who underwent at least two [...] Read more.

Objectives: To describe the US, CEUS, CT, and MRI features of papillary renal cell carcinoma (PRCC) and to underline the imaging characteristics that are helpful in the differential diagnosis. Methods: Patients with histologically proven papillary renal cell carcinoma who underwent at least two imaging examinations (US, CEUS, CT, and MRI) were included in the study. Tumor size, homogeneity, morphology, perilesional stranding, contrast enhancement locoregional extension were assessed. A comparison and the characteristics of the imaging features for each imaging modality were analyzed. Results: A total of 27 patients with an histologically confirmed diagnosis of PRCC were included in the study. US was highly accurate in distinguishing solid masses from cystic masses, supporting the differential diagnosis of PRCC, as well as in patients with a poor representation of the solid component. CEUS significantly increased diagnostic accuracy in delineating the solid intralesional component. Furthermore, when using CEUS, in the arterial phase, PRCC exhibited hypo-enhancement, and in the late phase it showed an inhomogeneous and delayed wash-out compared with the surrounding renal parenchyma. At MRI, PRCC showed a marked restiction of DWI and was hypointense in the T2-weighted compared to the renal parenchyma. Conclusions: In our study, the characteristic hypodensity and hypoenhancement of PRCC make CT the weakest method of their recognition, while US/CEUS and MRI are necessary to reach a definitive diagnosis. Knowledge of the appearance of PRCC can support an early diagnosis and prompt management, and radiologists should be aware that PRCC, when detected using CT, may resemble spurious non-septate renal cyst. Full article

(This article belongs to the Special Issue Imaging Diagnosis in Abdomen, 2nd Edition)

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13 pages, 9228 KiB

Open AccessArticle

Comparison of Non-Contrast CT vs. Contrast-Enhanced CT with Both Intravenous and Rectal Contrast Application for Diagnosis of Acute Colonic Diverticulitis: A Multireader, Retrospective Single-Center Study

by Dorottya Móré, Stella Erdmann, Arved Bischoff, Verena Wagner, Hans-Ulrich Kauczor, Lukas F. Liesenfeld, Katharina Abbasi Dezfouli, Athanasios Giannakis, Miriam Klauß and Philipp Mayer

Diagnostics 2025, 15(1), 29; https://doi.org/10.3390/diagnostics15010029 - 26 Dec 2024

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Abstract

Objectives: To evaluate the non-inferiority of non-contrast CT compared to contrast-enhanced CT with both intravenous and rectal contrast application for the diagnosis of acute colonic diverticulitis. Methods: Five readers retrospectively evaluated the non-contrast and contrast-enhanced series of CTs of 205 consecutive [...] Read more.

Objectives: To evaluate the non-inferiority of non-contrast CT compared to contrast-enhanced CT with both intravenous and rectal contrast application for the diagnosis of acute colonic diverticulitis. Methods: Five readers retrospectively evaluated the non-contrast and contrast-enhanced series of CTs of 205 consecutive patients with clinical suspicion of acute diverticulitis. Two randomized reading sessions, both containing all 205 cases as either contrast-enhanced or non-contrast (1:1) series, were performed with ≥8 weeks washout between them. The non-inferiority margin was set to 0.1. Results: The pooled prevalence (all readers) of diverticulitis was similar for non-contrast CT (63.9%, range: 60.5–65.0%) and contrast-enhanced CT (64.4%, 61.5–67.8%). Non-contrast CT was non-inferior for the diagnosis of diverticulitis (accuracy 0.90 [95% confidence interval: 0.89, 0.92]) compared to contrast-enhanced CT (0.92 [0.90, 0.94]; the difference in accuracy: −0.01 [−0.04, 0.01]) (normal deviate test: p-value_one-sided = 5.20 × 10⁻⁶). Sensitivities for perforation and abscess were slightly but significantly lower for the non-contrast CT than for the contrast-enhanced CT (differences: −0.15 [−0.20, −0.05], −0.17 [−0.27, −0.07]), while no differences in accuracies and specificities were observed. Conclusions: Non-contrast CT is non-inferior to contrast-enhanced CT (intravenous and rectal contrast) for the diagnosis of acute colonic diverticulitis. Contrast-enhanced CT is associated with significantly higher sensitivities for the presence of an abscess or perforation. Full article

(This article belongs to the Special Issue Imaging Diagnosis in Abdomen, 2nd Edition)

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16 pages, 2728 KiB

Open AccessArticle

Machine Learning and Radiomics Analysis for Tumor Budding Prediction in Colorectal Liver Metastases Magnetic Resonance Imaging Assessment

by Vincenza Granata, Roberta Fusco, Maria Chiara Brunese, Gerardo Ferrara, Fabiana Tatangelo, Alessandro Ottaiano, Antonio Avallone, Vittorio Miele, Nicola Normanno, Francesco Izzo and Antonella Petrillo

Diagnostics 2024, 14(2), 152; https://doi.org/10.3390/diagnostics14020152 - 9 Jan 2024

Cited by 3 | Viewed by 2337

Abstract

Purpose: We aimed to assess the efficacy of machine learning and radiomics analysis using magnetic resonance imaging (MRI) with a hepatospecific contrast agent, in a pre-surgical setting, to predict tumor budding in liver metastases. Methods: Patients with MRI in a pre-surgical setting were [...] Read more.

Purpose: We aimed to assess the efficacy of machine learning and radiomics analysis using magnetic resonance imaging (MRI) with a hepatospecific contrast agent, in a pre-surgical setting, to predict tumor budding in liver metastases. Methods: Patients with MRI in a pre-surgical setting were retrospectively enrolled. Manual segmentation was made by means 3D Slicer image computing, and 851 radiomics features were extracted as median values using the PyRadiomics Python package. Balancing was performed and inter- and intraclass correlation coefficients were calculated to assess the between observer and within observer reproducibility of all radiomics extracted features. A Wilcoxon–Mann–Whitney nonparametric test and receiver operating characteristics (ROC) analysis were carried out. Balancing and feature selection procedures were performed. Linear and non-logistic regression models (LRM and NLRM) and different machine learning-based classifiers including decision tree (DT), k-nearest neighbor (KNN) and support vector machine (SVM) were considered. Results: The internal training set included 49 patients and 119 liver metastases. The validation cohort consisted of a total of 28 single lesion patients. The best single predictor to classify tumor budding was original_glcm_Idn obtained in the T1-W VIBE sequence arterial phase with an accuracy of 84%; wavelet_LLH_firstorder_10Percentile was obtained in the T1-W VIBE sequence portal phase with an accuracy of 92%; wavelet_HHL_glcm_MaximumProbability was obtained in the T1-W VIBE sequence hepatobiliary excretion phase with an accuracy of 88%; and wavelet_LLH_glcm_Imc1 was obtained in T2-W SPACE sequences with an accuracy of 88%. Considering the linear regression analysis, a statistically significant increase in accuracy to 96% was obtained using a linear weighted combination of 13 radiomic features extracted from the T1-W VIBE sequence arterial phase. Moreover, the best classifier was a KNN trained with the 13 radiomic features extracted from the arterial phase of the T1-W VIBE sequence, obtaining an accuracy of 95% and an AUC of 0.96. The validation set reached an accuracy of 94%, a sensitivity of 86% and a specificity of 95%. Conclusions: Machine learning and radiomics analysis are promising tools in predicting tumor budding. Considering the linear regression analysis, there was a statistically significant increase in accuracy to 96% using a weighted linear combination of 13 radiomics features extracted from the arterial phase compared to a single radiomics feature. Full article

(This article belongs to the Special Issue Imaging Diagnosis in Abdomen, 2nd Edition)

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Review

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25 pages, 5530 KiB

Open AccessReview

Ultrasound of Bile Ducts—An Update on Measurements, Reference Values, and Their Influencing Factors

by Claudia Lucius, Anja Flückiger, Jennifer Meier, Kathleen Möller, Christian Jenssen, Barbara Braden, Michael Kallenbach, Benjamin Misselwitz, Christian Nolsøe, Michael Sienz, Constantinos Zervides and Christoph Frank Dietrich

Diagnostics 2025, 15(7), 919; https://doi.org/10.3390/diagnostics15070919 - 2 Apr 2025

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Abstract

Objective: To provide an overview of the technique and normal values of ultrasound studies of the bile system based on the published literature. Methods: A literature search for ultrasound studies with measurements of the bile ducts in healthy subjects was performed. Relevant data [...] Read more.

Objective: To provide an overview of the technique and normal values of ultrasound studies of the bile system based on the published literature. Methods: A literature search for ultrasound studies with measurements of the bile ducts in healthy subjects was performed. Relevant data published between 1975 and end of 2024 were extracted, discussed, and complemented with the own experiences of the authors. The clinical implications are presented and discussed. Results: For the diameter of the common bile duct, reference values between 5 and 9 mm have been published. The main influencing factors are age and history of cholecystectomy, and other factors to be considered are discussed here. The cut-off for the common bile duct wall is set at 1.5 mm. The literature on measurements of intrahepatic bile ducts is scarce. A diameter of <2–3 mm can be considered normal. The method of ultrasound examination is presented here, as well as a comparison with other imaging methods and their clinical implications. Conclusions: Standardized measurement techniques and normal values in the context of influencing factors are crucial for the ultrasound examination of the bile system. Full article

(This article belongs to the Special Issue Imaging Diagnosis in Abdomen, 2nd Edition)

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15 pages, 8272 KiB

Open AccessReview

Computed Tomography and Magnetic Resonance Enterography: From Protocols to Diagnosis

by Cesare Maino, Ilaria Mariani, Silvia Girolama Drago, Paolo Niccolò Franco, Teresa Paola Giandola, Francescamaria Donati, Piero Boraschi and Davide Ippolito

Diagnostics 2024, 14(22), 2584; https://doi.org/10.3390/diagnostics14222584 - 18 Nov 2024

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Abstract

Both Magnetic Resonance Enterography (MRE) and Computed Tomography Enterography (CTE) are crucial imaging modalities in the diagnosis and treatment of inflammatory bowel disease (IBD). CTE is often used in acute scenarios, such as when complications (such as abscesses, perforations, or bowel obstructions) are [...] Read more.

Both Magnetic Resonance Enterography (MRE) and Computed Tomography Enterography (CTE) are crucial imaging modalities in the diagnosis and treatment of inflammatory bowel disease (IBD). CTE is often used in acute scenarios, such as when complications (such as abscesses, perforations, or bowel obstructions) are suspected. It can also help determine the degree and extent of pathological processes. Although CTE is rapid, generally accessible, and offers precise images that are useful in emergencies, it does expose patients to ionizing radiation. Nevertheless, MRE is very useful in assessing perianal illness and the small intestine, and it is frequently used in patients who need repeated follow-ups or are pregnant to minimize radiation exposure. Moreover, MRE can demonstrate oedema, fistulas, abscesses, and the thickening of the bowel wall. In addition, MRE offers superior soft tissue contrast resolution without ionizing radiation, which helps identify complications such as fistulas and abscesses. With their respective advantages and disadvantages, both approaches play essential roles in assessing IBD. The primary goal of this review is to provide an overview of the technical specifications, benefits, drawbacks, and imaging findings of CTE and MRE. Full article

(This article belongs to the Special Issue Imaging Diagnosis in Abdomen, 2nd Edition)

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17 pages, 7664 KiB

Open AccessReview

Diagnostic Role of Multi-Detector Computed Tomography in Acute Mesenteric Ischemia

by Francesco Michele Ronza, Teresa Letizia Di Gennaro, Gianfranco Buzzo, Luciana Piccolo, Marina Della Noce, Giovanni Giordano, Giuseppe Posillico, Luigi Pietrobono, Francesco Giuseppe Mazzei, Paolo Ricci, Salvatore Masala, Mariano Scaglione and Stefania Tamburrini

Diagnostics 2024, 14(12), 1214; https://doi.org/10.3390/diagnostics14121214 - 7 Jun 2024

Cited by 3 | Viewed by 1664

Abstract

Mesenteric ischemia diagnosis is challenging, with an overall mortality of up to 50% of cases despite advances in treatment. The main problem that affects the outcome is delayed diagnosis because of non-specific clinical presentation. Multi-Detector CT Angiography (MDCTA) is the first-line investigation for [...] Read more.

Mesenteric ischemia diagnosis is challenging, with an overall mortality of up to 50% of cases despite advances in treatment. The main problem that affects the outcome is delayed diagnosis because of non-specific clinical presentation. Multi-Detector CT Angiography (MDCTA) is the first-line investigation for the suspected diagnosis of vascular abdominal pathologies and the diagnostic test of choice in suspected mesenteric bowel ischemia. MDCTA can accurately detect the presence of arterial and venous thrombosis, determine the extent and the gastrointestinal tract involved, and provide detailed information determining the subtype and the stage progression of the diseases, helping clinicians and surgeons with appropriate management. CT (Computed Tomography) can differentiate forms that are still susceptible to pharmacological or interventional treatment (NOM = non-operative management) from advanced disease with transmural necrosis in which a surgical approach is required. Knowledge of CT imaging patterns and corresponding vascular pathways is mandatory in emergency settings to reach a prompt and accurate diagnosis. The aims of this paper are 1. to provide technical information about the optimal CTA (CT Angiography) protocol; 2. to explain the CTA arterial and venous supply to the gastrointestinal tract and the relevant ischemic pattern; and 3. to describe vascular, bowel, and extraintestinal CT findings for the diagnosis of acute mesenteric ischemia. Full article

(This article belongs to the Special Issue Imaging Diagnosis in Abdomen, 2nd Edition)

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Other

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22 pages, 7900 KiB

Open AccessSystematic Review

What the Radiologist Needs to Know About Sport Hernias: A Systematic Review of the Current Literature

by Gian Nicola Bisciotti, Andrea Bisciotti, Alessandro Bisciotti and Alessio Auci

Diagnostics 2025, 15(6), 785; https://doi.org/10.3390/diagnostics15060785 - 20 Mar 2025

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Abstract

Introduction: The sports hernia (SH) is one of the most important causes of groin pain syndrome (GPS). However, despite its importance in GPS etiopathogenesis, SH is one of the least understood and poorly defined clinical conditions in sports medicine. The aim of this [...] Read more.

Introduction: The sports hernia (SH) is one of the most important causes of groin pain syndrome (GPS). However, despite its importance in GPS etiopathogenesis, SH is one of the least understood and poorly defined clinical conditions in sports medicine. The aim of this systematic review is to clearly define SH from a radiological point of view and to clarify the relationship between the radiological presentation of SH and its clinical manifestation. Methods: The PubMed/MEDLINE, Scopus, ISI, Cochrane Database of Systematic Reviews, and PEDro databases were consulted for systematic reviews on the role of SH in the onset of GPS. The inclusion and exclusion criteria were based on PICO tool. Results: After screening 560 articles, 81 studies were included and summarized in this systematic review. All studies were checked to identify any potential conflict of interest. The quality assessment of each individual study considered was performed in agreement with the Joanna Briggs Institute quantitative critical appraisal tools. Conclusions: The correct definition of SH is “weakness of the posterior wall of the inguinal canal”, which, in response to a Valsalva maneuver, forms a bulging that compresses the nerves passing along the inguinal canal. Thus, from an anatomical point of view, SH represents a direct inguinal hernia “in fieri”. Furthermore, an excessive dilation of the external inguinal ring represents an indirect sign of possible posterior inguinal canal wall weakness. Full article

(This article belongs to the Special Issue Imaging Diagnosis in Abdomen, 2nd Edition)

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4 pages, 1572 KiB

Open AccessInteresting Images

Protein-Losing Enteropathy Demonstrated by ^99mTc-ASC Lymphoscintigraphy

by Jingnan Wang, Hongli Jing and Fang Li

Diagnostics 2025, 15(5), 583; https://doi.org/10.3390/diagnostics15050583 - 27 Feb 2025

Viewed by 452

Abstract

A 30-year-old woman presented with progressive edema and mild diarrhea. Laboratory examination revealed hypoalbuminemia. She underwent ^99mTc-antimony sulphide colloid (^99mTc-ASC) lymphoscintigraphy to evaluate potential loss of protein through gastrointestinal tract caused by lymphatic leakage and detect abnormalities in the lymphatic [...] Read more.

A 30-year-old woman presented with progressive edema and mild diarrhea. Laboratory examination revealed hypoalbuminemia. She underwent ^99mTc-antimony sulphide colloid (^99mTc-ASC) lymphoscintigraphy to evaluate potential loss of protein through gastrointestinal tract caused by lymphatic leakage and detect abnormalities in the lymphatic systems. The images showed abnormal leakage of radiotracers in the bowel, suggestive of protein loss through the gastrointestinal tract. Abnormal visualization of the lower part of thoracic duct and bilateral venous angle was also demonstrated on ^99mTc-ASC scintigraphy. It suggested secondary intestinal lymphangiectasis caused by lymphatic obstruction and reflux. Enhanced CT reconstruction of the small intestine revealed roughness and thickening of intestinal wall, consistent with the diagnosis of protein-losing enteropathy. Full article

(This article belongs to the Special Issue Imaging Diagnosis in Abdomen, 2nd Edition)

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