AIM: Radiology reports are essential for clinical decision-making and must meet standards of clarity, completeness, and diagnostic accuracy. However, quality assessment is often subjective, time-consuming, and dependent...AIM: Radiology reports are essential for clinical decision-making and must meet standards of clarity, completeness, and diagnostic accuracy. However, quality assessment is often subjective, time-consuming, and dependent on expert reviewers. Large language models (LLMs) offer a promising alternative for automating this process. This study evaluates whether LLMs can objectively and consistently assess the formal and diagnostic quality of neuroradiology reports. MATERIALS AND METHODS: We analysed 277 neuroradiology reports, originally authored by 10 radiologists and subsequently evaluated by a different radiologist to assess formal and diagnostic quality. Reports were annotated using six quality criteria: diagnostic discrepancy, report structure, clarity, completeness, grading/staging system use, and recommendation of additional tests. Three locally deployed LLMs (LLaMA 3.2, DeepSeek R1:7B, and Gemma 3:4B) were evaluated for their ability to classify reports according to these criteria. RESULTS: LLMs showed strong performance in recognising positive categories, with DeepSeek achieving the highest accuracy in report structure (70.40%) and test recommendations (68.59%). However, performance declined significantly in detecting issues such as report completeness or diagnostic discrepancies, reflected in low F1-scores for those categories. CONCLUSION: While current models have limitations in identifying subtle errors or complex clinical nuances, LLMs may assist in automating aspects of radiology report quality control. With further refinement, they could help improve consistency and support clinical decision-making.
AIM: Transthoracic echocardiography (TTE) grades aortic valve stenosis (AS) severity. However, this is often discordant when velocity and aortic valve area (AVA) grade boundaries are considered. We evaluated computed tom...AIM: Transthoracic echocardiography (TTE) grades aortic valve stenosis (AS) severity. However, this is often discordant when velocity and aortic valve area (AVA) grade boundaries are considered. We evaluated computed tomography (CT) and TTE datasets to validate CT measures of AS. MATERIALS AND METHODS: A total of 168 sequential patients with symptomatic probable severe AS were included. CT and TTE measures of AS were made. The AVA was assessed by (1) the continuity equation, which measures the effective valve area (EOA) and (2) CT planimetry, which measures the anatomical valve area (CTP-AVA). The EOA as measured by TTE (TTE-EOA) or CT (CT-EOA) varied by whether the TTE or CT-derived left ventricular outlet area (LVOT) was used in the calculation with the TTE Doppler. Area relationships and CT aortic valve calcification (CT-AVC) data were also assessed. RESULTS: After exclusions, 157 datasets were analysed. 119 (75.8%) had tricuspid (TAV) and 38 (24.2%) had bicuspid (BAV) aortic valve. Mean CT-EOA (1.13 ± 0.42 cm) and CTP-AVA (1.13 ± 0.37 cm) were near identical and correlated (R 0.359, P<0.001). The TTE-EOA (0.82 ± 0.31 cm) was smaller as the TTE-LVOT area (3.66 ± 0.87 cm) was smaller than CT (5.04 ± 1.23 cm), P<0.001. Dimensionless velocity index (0.22 ± 0.07) matched an anatomical valve index (AVI) (planimetered valve area/LVOT area) (0.23 ± 0.08), R = 0.378, P<0.001. CT-AVC was unhelpful in confirming severe AS with weak correlations. CONCLUSION: We confirm the utility of CTP-AVA to assess aortic stenosis severity, quantify and highlight the variability of TTE-EOA, describe an AVI (explaining the DVI), and show that CT-AVC is inaccurate in assessing AS severity in individuals.
Lymphoscintigraphy is a commonly utilised imaging technique for mapping the lymphatic system and evaluating the lymphatic drainage, particularly in the context of malignancies. This modality plays a critical role in iden...Lymphoscintigraphy is a commonly utilised imaging technique for mapping the lymphatic system and evaluating the lymphatic drainage, particularly in the context of malignancies. This modality plays a critical role in identifying sentinel lymph nodes (SLNs), which are an important tool for accurate cancer staging, ultimately guiding clinical management decisions. Among the Food and Drug Administration (FDA)-approved radiotracers used for SLNs mapping, 99mTc-tilmanocept (Lymphoseek®) has gained clinical acceptance due to its receptor-targeted mechanism and favourable imaging characteristics, although its adoption varies by region and practice setting. In this paper, we discuss lymphoscintigraphy and its techniques, with a focus on cases of cutaneous malignant melanoma that illustrate typical and atypical lymphatic drainage patterns observed on lymphoscintigraphic imaging, particularly in the context of sentinel lymph node mapping.
AIM: To characterise clinical, imaging, and angioarchitectural features of spinal epidural arteriovenous malformations (SEAVMs) and report endovascular outcomes from a single-centre series. MATERIALS & METHODS: We retros...AIM: To characterise clinical, imaging, and angioarchitectural features of spinal epidural arteriovenous malformations (SEAVMs) and report endovascular outcomes from a single-centre series. MATERIALS & METHODS: We retrospectively reviewed spinal angiograms and clinical records from January 2010 to May 2025 and identified 24 patients with SEAVMs. Demographic, clinical, magnetic resonance imaging (MRI) and computed tomography (CT) findings, digital subtraction angiography characteristics, endovascular interventions, and Karnofsky Performance Status (KPS) before and after treatment were analysed. RESULTS: Twenty-four patients with a mean age of 25.8 years were included. Presenting complaints were motor weakness in 23/24 (95.8 %) cases, sensory symptoms in 17/24 (70.8 %) cases, radicular pain in 15/24 (62.5 %) cases and bladder or bowel dysfunction in 10/24 (41.7 %) cases. MRI detected an epidural venous sac in 20/24 (83.3 %) cases and cord signal change in 20/24 (83.3 %) cases; CT (n=18) showed vertebral osseous changes in 15/18 (83.3 %) cases. Angiography localised lesions predominantly to lower thoracic levels; five cases were metameric (SAMS) and intradural venous reflux was uncommon. Nineteen patients underwent endovascular embolizisation; N-butyl cyanoacrylateNBCA was used in 18/19 cases and venous sac penetration was achieved in 17/19 cases. There were no major periprocedural neurological complications. Angiographic degrees of obliteration among treated patients were complete/near- complete in 4 patients , substantial in 4 patients, moderate in 9 patients, and partial in 2 patients. Mean follow-up was 49.2 months; and mean KPS improved from 51.1 to 80.0 (mean increase: 28.9 points, P<0.001). CONCLUSION: SEAVMs occur in younger patients, frequently involve osseous structures, and are commonly associated with compressive epidural venous sacs. Targeted endovascular occlusion of the venous sac is safe and often yields substantial improvement with durable clinical benefit.
AIM: To evaluate the safety and efficacy of cone-beam CT (CBCT) guided prostatic artery embolization (PAE) combined with transurethral resection of the prostate (TURP) compared with TURP alone in the management of large-...AIM: To evaluate the safety and efficacy of cone-beam CT (CBCT) guided prostatic artery embolization (PAE) combined with transurethral resection of the prostate (TURP) compared with TURP alone in the management of large-volume (>80 mL) benign prostatic hyperplasia (BPH). MATERIALS AND METHODS: This retrospective propensity score matched study included 99 patients with large-volume BPH treated between January 2017 and June 2023. Thirty-three underwent CBCT-guided PAE followed by TURP, and 66 underwent TURP alone. Perioperative parameters, complication rates, and functional outcomes-including International Prostate Symptom Score (IPSS), Quality of Life (QoL) score, maximum urinary flow rate (Qmax), and post-void residual urine (PVR)-were compared between groups at baseline and at 3, 6, 12, and 24 months after surgery. RESULTS: The combination group demonstrated significantly shorter operative time (78.9 ± 21.0 vs. 101.4 ± 25.7 min, P<0.001), smaller perioperative hemoglobin decline (10.0 ± 8.6 vs. 15.7 ± 13.3 g/L, P=0.027), shorter bladder irrigation (1.9 ± 0.6 vs. 2.5 ± 0.9 days, P<0.001), and fewer complications (9.1 % vs. 24.2 %, P=0.049). Total hospitalization costs (Chinese Yuan, CNY) did not differ significantly between the two groups (30,231.3 ± 7,946.2 vs.26,514.9 ± 9,954.4, P=0.065). Functional outcomes were significantly better in the combination group from 6 months onward, with lower IPSS and QoL scores, higher Qmax, and reduced PVR at 6, 12, and 24 months (P<0.05). CONCLUSION: CBCT-guided PAE combined with TURP is a safe and effective strategy for large-volume BPH, providing reduced perioperative morbidity and sustained long-term improvements in urinary function compared with TURP alone.
AIM: To review the normal anatomy, imaging appearance, and associated pathologies of the 'W' configuration of the knee-formed by the biceps femoris tendon, fibular collateral ligament (FCL), anterolateral ligament (ALL),...AIM: To review the normal anatomy, imaging appearance, and associated pathologies of the 'W' configuration of the knee-formed by the biceps femoris tendon, fibular collateral ligament (FCL), anterolateral ligament (ALL), and iliotibial band (ITB)-and to highlight its value as an anatomical and imaging landmark in assessing lateral knee instability. MATERIALS AND METHODS: A structured review of the posterolateral and anterolateral corners of the knee was performed, focusing on the 'W' configuration. Emphasis was placed on magnetic resonance imaging (MRI) assessment, particularly coronal and sagittal planes, to evaluate normal anatomical features and detect structural disruptions. RESULTS: The posterolateral and anterolateral corners form a complex stabilising framework, with the 'W' configuration serving as a key anatomical and imaging landmark. MRI is the primary diagnostic modality for visualising this configuration. Disruption of the 'W' pattern commonly indicates injury, including biceps femoris tendon tears, FCL ruptures, ALL injuries, ITB syndrome, and ITB ruptures, frequently associated with cruciate ligament tears. Isolated injuries are uncommon, with most cases involving multiligamentous trauma. CONCLUSION: Recognition of the 'W' configuration improves diagnostic accuracy in evaluating lateral knee injuries. While mild injuries may be managed conservatively, high-grade tears-particularly those involving the posterolateral corner or causing rotational instability-often require surgical repair. Understanding this anatomical framework supports appropriate treatment planning and optimises patient outcomes in lateral knee instability.
Myometrial lesions are a common indication for pelvic imaging, with accurate characterisation crucial for guiding management. While ultrasonography remains the first-line modality, magnetic resonance imaging (MRI) offers...Myometrial lesions are a common indication for pelvic imaging, with accurate characterisation crucial for guiding management. While ultrasonography remains the first-line modality, magnetic resonance imaging (MRI) offers superior tissue contrast, multiplanar capability, and functional assessment, offering the highest accuracy for characterising uterine masses. This review highlights the pivotal role of MRI in differentiating benign from malignant myometrial lesions. We summarise characteristic imaging features of adenomyosis and the spectrum of leiomyomas, including atypical and degenerated leiomyomas, with reference to the Federation of Gynaecology and Obstetrics (FIGO) classification system. Emphasis is placed on MRI findings that help differentiate leiomyosarcoma (LMS) from atypical leiomyoma, a persistent diagnostic challenge due to their overlapping imaging appearances. Emerging approaches, including radiomics and machine learning, show promise in improving imaging-based differentiation of both entities. Rare myometrial lesions such as cysts and uterine arteriovenous malformations are also briefly reviewed. MRI remains the modality of choice for comprehensive evaluation and management planning of myometrial masses, supporting accurate diagnosis and effective multidisciplinary decision-making.
AIM: To evaluate the value of MULTIPLEX, a single-scan three-dimensional multiparametric magnetic resonance imaging (MRI) quantitative technique providing T1, T2∗, proton density (PD), and quantitative susceptibility map...AIM: To evaluate the value of MULTIPLEX, a single-scan three-dimensional multiparametric magnetic resonance imaging (MRI) quantitative technique providing T1, T2∗, proton density (PD), and quantitative susceptibility mapping (QSM) maps, in grading gliomas and assessing molecular subtypes. MATERIALS AND METHODS: We recruited 72 diffuse glioma patients who underwent conventional MRI and MULTIPLEX acquisition. Image preprocessing and automatic segmentation were applied to conventional structural data. The tumour region was automatically segmented into contrast-enhancing tumour, oedematous, and necrotic volumes. Distribution metrics (mean, standard deviation, skewness, and kurtosis) were extracted from quantitative maps (T1, T2∗, PD, and QSM) for each tumour region of interest (ROI) using histogram analysis. A total of 48 parameters representing the quantitative properties of tumour-related regions were obtained. The Mann-Whitney test was performed for each quantitative parameter between different tumour grades and molecular subtypes. RESULTS: Low-grade, isocitrate dehydrogenase (IDH) mutant, oxygen-methylguanine-DNA methyltransferase (MGMT) methylated, and epidermal growth factor receptor (EGFR) nonamplifying gliomas had significantly higher average T2∗ values in necrotic or enhanced areas than grade 4, IDH-wildtype, MGMT non-methylated, and EGFR extended gliomas. The skewness of T1 values and the standard deviation of QSM values in the necrotic area of low-grade tumours were significantly lower than those in grade 4 gliomas. There were significant differences in the skewness of oedema QSM values and the standard deviation of enhanced tumour PD between 1p/19q codeficient and non-co-deficient gliomas. CONCLUSION: MULTIPLEX can be used for comprehensive quantitative assessment of glioma-related regions captured in T1, T2∗, PD, and QSM parameters, especially T2∗ and QSM, which exhibit considerable promise in grading and molecular subtype assessment of diffuse gliomas.
OBJECTIVE: To report on the incremental value of MRI spine findings on the radiologic diagnostic certainty in axial spondyloarthritis. MATERIALS AND METHODS: MRI examinations of suspected axial spondyloarthritis patients...OBJECTIVE: To report on the incremental value of MRI spine findings on the radiologic diagnostic certainty in axial spondyloarthritis. MATERIALS AND METHODS: MRI examinations of suspected axial spondyloarthritis patients referred from a specialist tertiary rheumatology clinic were collected retrospectively. 29 patients and 10 controls were randomized and analyzed by three blinded musculoskeletal radiologists. Linear regression analyses were used to evaluate the association of spine and SIJ findings on diagnostic certainty levels. RESULTS: Mean patient age was 43.3 [range: 15-71] years. Good and excellent intra-observer agreement was demonstrated [κ = 0.8, 1] for SIJ and spinal lesions, while inter-observer agreement on final certainty was moderate [κ = 0.5]. SIJ structural lesions significantly impacted final certainty levels [p=0.03]. However, SIJ inflammatory changes and a combination of the two did not meet statistical significance [p=0.42, 0.40]. Combination of spinal structural and inflammatory findings had a significant impact on final diagnosis [p<0.01]. CONCLUSIONS: Our study highlights the diagnostic added value of spinal MRI. Spinal findings had a significant impact on the final diagnostic certainty level of radiologists; it reduces the level of uncertainty posed by SIJ inflammatory lesions. The findings suggest that spinal MRI has an important role in the diagnostic work up of Axial Spondyloarthritis.
AIM: To evaluate the safety, efficacy, and technical considerations in microwave ablation (MWA) of lung tumours close to the heart and aorta. MATERIALS AND METHODS: A retrospective cohort study at a high-volume intervent...AIM: To evaluate the safety, efficacy, and technical considerations in microwave ablation (MWA) of lung tumours close to the heart and aorta. MATERIALS AND METHODS: A retrospective cohort study at a high-volume interventional oncology centre between January 2017 and June 2024 was performed. Ablations of lung tumours <10 mm from the heart and/or aorta were included. Efficacy outcomes included technical success, ablation success, and oncological success. Safety outcomes included clinical success and complications. RESULTS: 40 patients with 44 tumours met the inclusion criteria. The median tumour size was 14 mm (interquartile range [IQR] 10-22 mm; range 5-50 mm). Technical success was 100%. Ablation success was 95.4%. The severe complication rate was 2.5%. The cardiac complication rate was 5%, including a case of systemic air embolism and a first-degree heart block. Oncological success at 1 year was 87.1%. The technical nuances contributing to the safe performance of these procedures were described. CONCLUSION: Percutaneous microwave ablation can be a safe and effective treatment for lung tumours close to the heart and aorta.
AIM: The clinical integration of four-dimensional flow magnetic resonance imaging (4D-flow MRI) for cardiovascular assessment remains a challenge due to the expertise and resources required for analysis, and there is no...AIM: The clinical integration of four-dimensional flow magnetic resonance imaging (4D-flow MRI) for cardiovascular assessment remains a challenge due to the expertise and resources required for analysis, and there is no large-scale systematic validation of the technique. We aim to evaluate the bulk flow measurements in the large vessels using 4D-flow MRI compared with conventional cardiac MRI in a large cohort as part of the prospective 4DCarE study. MATERIALS AND METHODS: We conducted a large cohort prospective study to compare the bulk flow measurements in the ascending aorta and main pulmonary artery using 4D-flow and 2D phase contrast (2D-PC) MRI and analysed the 4D-flow measurements using two different commercially available software packages. RESULTS: A total of 500 participants with a normal or pathological cardiac history were evaluated. Within the limitations of technical differences, 4D-flow demonstrated clinically consistent and reliable measurements compared with 2D-PC, although 4D-flow measurements showed a systematic bias towards undermeasurement compared with 2D-PC, irrespective of software used. Both 4D-flow and 2D-PC demonstrated good internal consistency for normal and pathological cases. The incorporation of artificial intelligence in the image annotation process showed early promises in reducing time and labour intensity and potentially improving the clinical integration of 4D-flow MRI, however, the technology remains nascent, and further development and validation are required. CONCLUSION: Bulk flow measurements in the large vessels were grossly clinically consistent between 4D-flow and 2D-PC in this large cohort study, although 4D-flow showed systematic undermeasurement compared with 2D-PC.
AIM: Anticoagulated patients presenting with head injury have previously undergone routine CT imaging, but the 2023 NICE guidelines now permit a more selective approach. Real-world data on CT yield in this cohort, partic...AIM: Anticoagulated patients presenting with head injury have previously undergone routine CT imaging, but the 2023 NICE guidelines now permit a more selective approach. Real-world data on CT yield in this cohort, particularly in the absence of other clinical risk factors, remain limited. We aim to evaluate the diagnostic yield of CT head imaging for intracranial haemorrhage (ICH) in anticoagulated patients presenting with head injury. MATERIALS AND METHODS: A retrospective cohort study was conducted at a large NHS Trust, identifying all CT head scans between January-March 2025 with clinical indications referencing anticoagulation. Manual review of clinical records confirmed trauma context, anticoagulant use, and presence of other NICE criteria. The primary outcome was diagnostic yield for ICH. RESULTS: Of 746 CT head scans, 450 anticoagulated trauma cases met inclusion criteria. The overall diagnostic yield for ICH was 2.9% (n=13). Among the 360 patients imaged solely due to anticoagulation, the yield was 2.2% (n=8). Most haemorrhages were subdural haematomas (n=8), and 11 of 13 ICH cases had visible head or facial trauma. Only one patient underwent neurosurgical intervention. Compliance with NICE guideline eligibility criteria was 73%. CONCLUSION: CT imaging in anticoagulated patients yields a low rate of ICH. Findings support a more selective and clinically integrated approach to imaging these patients, now that the updated NICE guidance allows for clinical discretion. With rising anticoagulant use in an ageing population, a move away from reflexive imaging and a more careful patient selection process is essential to ensure diagnostic value, support resource stewardship, and promote patient-centred care.
AIM: To evaluate the feasibility, safety, and outcomes of n-butyl-cyanoacrylate (nBCA) embolization in patients with iatrogenic femoral arteriovenous fistulas (AVFs). MATERIALS AND METHODS: This retrospective study inclu...AIM: To evaluate the feasibility, safety, and outcomes of n-butyl-cyanoacrylate (nBCA) embolization in patients with iatrogenic femoral arteriovenous fistulas (AVFs). MATERIALS AND METHODS: This retrospective study included 22 patients (13 men, 9 women; mean age 63.6 ± 8.0 years) who underwent nBCA embolization for femoral AVFs. Diagnosis was confirmed by Doppler ultrasound. Procedures involved selective catheterization and injection of an nBCA and ethiodized oil mixture under angiographic guidance. Follow-up was performed with Doppler ultrasound at 1 and 12 months. Technical success was defined as angiographic elimination of early venous filling without the need for additional treatment. Group comparisons used the Mann-Whitney U test, and the impact of tract length on outcomes was evaluated by ROC analysis. Effect size (Cohen's h) and post-hoc power analysis were performed. RESULTS: Technical success was achieved in 19 of 22 patients (86.3 %). The median fistula tract length was 13.5 mm (range: 6-36 mm). Success rates were significantly higher for tracts >6.5 mm (94.7 % vs. 33 %; p=0.035, Cohen's h ≈ 1.51). ROC analysis showed an AUC of 0.886 (95 % CI: 0.710-1.000), with 94.7 % sensitivity and 66.7 % specificity at a 6.5 mm cut-off. Post-hoc power was 76 %. Two patients required stent-graft placement for incomplete closure. One case of asymptomatic partial venous glue migration occurred, with no clinical sequelae. No major complications or recurrences were observed. CONCLUSION: nBCA embolization is a safe and effective treatment for iatrogenic femoral AVFs, especially with sufficient tract length. It is a promising alternative to surgery or stent-graft placement.
AIM: Transradial access (TRA) has become an alternative vascular access site for a range of procedures in interventional radiology. The aim of this systematic review and meta-analysis was to assess the safety and technic...AIM: Transradial access (TRA) has become an alternative vascular access site for a range of procedures in interventional radiology. The aim of this systematic review and meta-analysis was to assess the safety and technical success of TRA for prostate artery embolisation (PAE). MATERIALS AND METHODS: A systematic search of the Medline, Embase, and Scopus databases was performed in November 2024. Primary studies describing outcomes in TRA for PAE involving 10 or more adult patients were included. The primary efficacy outcome was technical success, defined as bilateral PAE meaning successful embolisation of both prostate arteries, and primary safety outcome was 30-day mortality. The ROBINS-I tool was used to assess risk of bias, and the Grading of Recommendations Assessment, Development, and Evaluation framework was used to assess the strength of evidence. RESULTS: Six retrospective studies were included in this review (n=1208 patients). A random-effects meta-analysis was performed, demonstrating a 96.5 % technical success rate of TRA for PAE. Four (0.3 %) major complications and 53 (4.4 %) minor complications occurred. Mean fluoroscopy time, procedure time, and air kerma via TRA were all comparable to other access sites. Moderate between-study heterogeneity was present (I = 41.3 %). The overall risk of bias was moderate; however, no significant publication bias was present. The strength of evidence was moderate. CONCLUSION: The findings of this study support TRA as a feasible alternative access route for PAE with similar complication rates, procedure times, and radiation doses compared to transfemoral access (TFA). However, further prospective, controlled studies are required to evaluate TRA head-to-head with TFA to establish whether one approach is superior.
AIM: This retrospective case series intends to summarise the F-fluorodeoxyglucose positron emission tomography/computed tomography (F-FDG PET/CT) imaging characteristics of TAFRO syndrome, providing imaging evidence for...AIM: This retrospective case series intends to summarise the F-fluorodeoxyglucose positron emission tomography/computed tomography (F-FDG PET/CT) imaging characteristics of TAFRO syndrome, providing imaging evidence for its clinical diagnosis and differential diagnosis to enhance early diagnostic accuracy and improve patient prognosis. MATERIALS AND METHODS: A retrospective analysis was conducted on the F-FDG PET/CT images and clinical data of 5 patients with TAFRO syndrome (3 males and 2 females, with an average age of 51.4 (39-58) years). Combined with domestic and international literature, the value of F-FDG PET/CT in the diagnosis and evaluation of TAFRO syndrome was summarised. RESULTS: All the cases were diagnosed as multicentric Castleman disease (MCD) and all showed typical imaging manifestations of TAFRO syndrome. The size of the affected lymph nodes and the maximum standardised uptake value (SUV) of the patients were measured. It was found that all showed varying degrees of enlargement accompanied by increased F-FDG metabolism (SUV > 2.5). In addition, spleen length was measured in the craniocaudal dimension for all patients and it was found that 2 patients had significant enlargement. Based on the analysis of the PET/CT images of the patients, the bone marrow showed varying degrees of metabolic activity, and pleural effusions and ascites were clearly identifiable. CONCLUSION: F-FDG PET/CT imaging, as a functional metabolic imaging technique, can detect metabolic abnormalities at the sub-centimetre level. Moreover, a single examination can cover the entire body, enabling better detection of occult lesions and providing significant assistance in the diagnosis and assessment of TAFRO syndrome.