Methodological insights into ChatGPT's screening performance in systematic reviews.

BACKGROUND: The screening process for systematic reviews and meta-analyses in medical research is a labor-intensive and time-consuming task. While machine learning and deep learning have been applied to facilitate this process, these methods often require training data and user annotation. This study aims to assess the efficacy of ChatGPT, a large language model based on the Generative Pretrained Transformers (GPT) architecture, in automating the screening process for systematic reviews in radiology without the need for training data. METHODS: A prospective simulation study was conducted between May 2nd and 24th, 2023, comparing ChatGPT's performance in screening abstracts against that of general physicians (GPs). A total of 1198 abstracts across three subfields of radiology were evaluated. Metrics such as sensitivity, specificity, positive and negative predictive values (PPV and NPV), workload saving, and others were employed. Statistical analyses included the Kappa coefficient for inter-rater agreement, ROC curve plotting, AUC calculation, and bootstrapping for p-values and confidence intervals. RESULTS: ChatGPT completed the screening process within an hour, while GPs took an average of 7-10 days. The AI model achieved a sensitivity of 95% and an NPV of 99%, slightly outperforming the GPs' sensitive consensus (i.e., including records if at least one person includes them). It also exhibited remarkably low false negative counts and high workload savings, ranging from 40 to 83%. However, ChatGPT had lower specificity and PPV compared to human raters. The average Kappa agreement between ChatGPT and other raters was 0.27. CONCLUSIONS: ChatGPT shows promise in automating the article screening phase of systematic reviews, achieving high sensitivity and workload savings. While not entirely replacing human expertise, it could serve as an efficient first-line screening tool, particularly in reducing the burden on human resources. Further studies are needed to fine-tune its capabilities and validate its utility across different medical subfields.

Efficacy and Safety of Preoperative Embolization in Glomus Jugulare Tumors: A Systematic Review and Meta-analysis of Clinical Outcomes and Complications.

PURPOSE: This study aims to provide a comprehensive review of the clinical benefits, complications, and safety profile associated with preoperative embolization in Glomus jugulare tumors (GJTs). MATERIALS AND METHODS: A comprehensive search in PubMed, Embase, and Web of Science was conducted for English articles published up to March 2023, focusing on GJTs and preoperative embolization. Included studies involved patients over 18 with GJTs. We excluded studies that explored embolization methods other than the standard endovascular approach, as well as studies involving paragangliomas that did not provide specific data related to GJTs. Key variables such as hemorrhage volume and surgical time, as well as clinical outcomes, were analyzed. Data were analyzed using a random-effects model meta-analysis, assessing heterogeneity with the I2 statistic. RESULTS: This review encompasses 19 studies with a total of 328 patients. The studies incorporated into our meta-analysis display considerable differences and inconsistencies in their data. The findings of the meta-analysis show a mean hemorrhage volume of 636 ml (95% confidence interval (CI) 473-799) following preoperative embolization, and a mean surgical duration of 487 min (95% CI 350-624). The study also notes potential complications: facial nerve deficits occurred in 20% of cases (95% CI 11-32%), and vagal nerve deficits in 22% (95% CI 13-31%). CONCLUSION: This study suggests that preoperative embolization could decrease surgery duration and blood loss, but emphasizes the importance of evaluating risks like nerve damage. However, the generalizability of these findings is restricted due to the diversity of available data.

Long-Term Clinical and Imaging Findings in Patients with Lower Extremity Varicose Veins Treated with Endovenous Laser Treatment: A Follow-Up Study of up to 12 Years.

Introduction: This study investigates the long-term effectiveness and safety of endovenous laser treatment (EVLT) for chronic venous insufficiency (CVI), a condition commonly caused by dysfunctional valves in the venous circulation system. Materials and Methods: In this retrospective cohort study, patients underwent EVLT and were followed up for successive short intervals and one last time after a median duration of 9-year postprocedural. Pre- and postprocedure duplex ultrasound was used to assess changes in the great saphenous vein (GSV) diameter, reflux, and saphenofemoral junction incompetence. Quality of life was evaluated using the SF-36 and Aberdeen Varicose Vein Questionnaire (AVVQ). Results: Sixty-eight patients with a mean age of 52.4 ± 12.4 years were enrolled in the study. The mean follow-up time was 8.9 ± 2.1 years, ranging from 5 to 12 years. The mean GSV diameter significantly decreased in all patients (whole group) across proximal (from 5.8 ± 2.3 mm to 4.2 ± 2.1 mm), middle (from 4.7 ± 1.6 mm to 2.8 ± 2.2 mm), and distal (from 4.5 ± 2.3 mm to 2.2 ± 2.2 mm) segments, with P < 0.001. A disease recurrence rate of 33.8% was noted, predominantly in male patients and those with larger middle GSV diameters (OR = 5.2 (95%CI = 1.3-20.4) and OR = 1.5 (95%CI = 1-2.1), respectively). The average follow-up time for patients without recurrence was 8.8 ± 2.1 years. Almost half of the patients without recurrence were followed up for 10 years or more (49%). Conclusion: The efficacy of EVLT in managing varicose veins is demonstrated by its relatively low recurrence rate over a 10-year follow-up period, highlighting EVLT as a viable long-term treatment strategy.

Outcome after Neuro-interventional Treatment of Intracranial Aneurysm (as a First Treatment Modality).

Endovascular treatment is widely applied as the first-line treatment for intracranial aneurysms and includes simple coiling (SC), stent-assisted coiling (SAC), flow diversion stent, and flow disruption stent. The present study is a retrospective cohort study performed in Imam Khomeini Hospital, Department of Neurovascular Intervention, between March 2016 and March 2021. A total number of 229 patients with intracranial aneurysms who underwent therapeutic intravascular interventions were enrolled, of which 89 were treated with SC, 111 with SAC, 25 with flow diversion stent, and 4 with flow disruption stent. The mean age of the subjects was 51.8±12.6 years, and 51.1% were male. Modified Raymond-Roy classification (MRRC) was used to define the occlusion outcome. The success rate, considered as Class I and Class II of MRRC at treatment time was 89% (94.4% in SC, and 84.7% in SAC), which was increased to 90.9% (94% in SC, 93% in SAC, 69.6% in flow diversion stenting, 100% in flow disruption) at 6-month follow-up, and 84.6% (80.8% in SC, 87.8% in SAC, 78.3% in flow diversion stenting, and 100% in flow disruption) at 12-month follow-up. The mean modified Rankin Scale (mRS) before the procedure was 0.05±0.26 which was increased to 0.22±0.76 after the procedure, 0.22±0.76 at 6 months, and 0.30±0.95 at 12 months (P<0.001). Similar to previous studies, the present study demonstrates that neurovascular intervention can treat ruptured aneurysms as the first therapeutic modality with favourable outcomes. A double-blind, randomized clinical trial is needed to eliminate the confounding factors and better demonstrate the outcome.

The Role of Multimodal Imaging in Differentiating Vasogenic from Infiltrative Edema: A Systematic Review.

Background High-grade gliomas (HGGs) are the most prevalent primary malignancy of the central nervous system. The tumor results in vasogenic and infiltrative edema . Exact anatomical differentiation of these edemas is so important for surgical planning. Multimodal imaging could be used to differentiate the edema type. Purpose The aim of this study was to investigate the role of multimodal imaging in the differentiation of vasogenic edema from infiltrative edema in patients with HGG (grade III and grade IV). Data Sources A search on PubMed, EMBASE, Scopus, and ISI Web of Science Core Collection up to June 2022 using terms related to (a) multimodal imaging AND (b) HGG AND (c) edema. (PROSPERO registration number: CRD42022336131) Study Selection Two reviewers screened the articles and independently extracted the data. We included original articles assessing the role of multimodal imaging in differentiating vasogenic from infiltrative edema in patients with HGG. Six high-quality articles remained for the narrative synthesis. Data Synthesis Dynamic susceptibility contrast imaging showed that relative cerebral blood volume and relative cerebral blood flow were higher in the infiltrative edema component than in the vasogenic edema component. Diffusion tensor imaging revealed a dispute on fractional anisotropy. The apparent diffusion coefficient was comparable between the two edematous components. Magnetic resonance spectroscopy exhibited an increment in choline/creatinine ratio and choline/N-acetyl aspartate ratio in the infiltrative edema component. Limitations Strict study selection, low sample size of relevant published studies, and heterogeneity in endpoint variables were the major drawbacks. Conclusions Multimodal imaging, including dynamic susceptibility contrast and magnetic resonance spectroscopy, might help differentiate between vasogenic and infiltrative edema.

Pregnancy Rate and Outcomes following Uterine Artery Embolization for Uterine Arteriovenous Malformations: A Systematic Review and Meta-Analysis.

PURPOSE: To systematically review published studies on the pregnancy rate and outcomes after uterine artery embolization (UAE) for uterine arteriovenous malformations (UAVMs). MATERIALS AND METHODS: International medical databases were searched for all English-language studies published between 2000 and 2022 on patients with UAVMs who had undergone embolization and had a subsequent pregnancy. Data on the pregnancy rate, pregnancy complications, and physiologic status of newborns were extracted from the articles. Ten case series were included in the meta-analysis, and 18 case reports on pregnancy following UAE were reviewed. RESULTS: In the case series, 44 pregnancies were reported in 189 patients. The pooled estimate of pregnancy rate was 23.3% (95% confidence interval [CI], 17.3%-29.3%). The pregnancy rate was higher in studies of women with a mean age of ≤30 years (50.6% vs 22.2%; P < .05). The pooled estimate of live birth rate was 88.6% (95% CI, 78.6%-98.7%). CONCLUSIONS: All published series report preservation of fertility and successful pregnancies after embolization of UAVMs. The live birth rate in these series does not differ substantially from that of the general population.

Evaluation of multimodal MR imaging for differentiating infiltrative versus reactive edema in brain gliomas.

OBJECTIVE: To determine the border of glial tumors by diffusion weighted imaging (DWI), apparent diffusion co-efficient (ADC), magnetic resonance spectroscopy (MRS) and perfusion brain MRI. PATIENTS AND METHODS: Ten patients with brain gliomas were enrolled [mean age: 35.3 ± 13.2, range: 20-62]. Conventional MRI was performed for all patients. Besides, tumor mapping based on Choline (Cho)/Creatine (Cr) color map in MRS, perfusion and diffusion color maps, were gathered. Different tumoral and peritumoral regions [normal tissue, reactive edema, infiltrative edema, and tumor core] were defined. MRI criteria were evaluated in areas targeted for biopsy and histopathologic evaluation was determined. RESULTS: Tumor cell positive samples [one necrosis, 26 infiltrative and nine tumor cores] composed 36 (75%) of the 48 samples. Seven (19.4%) of the positive samples were interpreted as not tumor on MRI. Five were identified as reactive edema and two as normal tissue] [kappa: .67, p-value < .001]. Mean of ADC, median of N-acetylaspartate (NAA) and NAA/Cho were statistically different between positive and negative samples (p = .02 and p < .001, respectively). Mean ADC and median Cho/NAA were statistically different in missed tumor containing tissue presented as reactive edema compared to normal and correctly diagnosed reactive edema samples together (p-values < .05). CONCLUSIONS: Multimodal MRI could define infiltrated borders of brain gliomas.

Prevalence of complications associated with polymer-based alloplastic materials in nasal dorsal augmentation: a systematic review and meta-analysis.

BACKGROUND: Various techniques with different grafts and implants have been proposed to establish a smooth and symmetric nasal dorsum with adequate function. Broadly, two categories of materials have been used in this regard: alloplastic implant materials and autograft materials. The aim of these meta-analyses is to explore the incidence of complications after dorsum augmentation surgery using alloplastic materials. MATERIALS AND METHODS: After duplication removal 491 papers remained that title and abstract were assessed for eligibility. Regarding the study type, 27 observational studies were included, 21 retrospective and 6 prospective case series. A total of 3803 cases were enrolled in this systematic review and meta-analysis. RESULT: Twenty-seven articles reported on complications and outcomes of dorsal augmentation rhinoplasty with synthetic materials. In a random-effects model, the weighted mean percentage was 2.75% (95% CI 1.61 to 4.17%). the weighted mean percentage were 1.91% (95% CI 0.77 to 3.54%), 0.72% (95% CI 0.316 to 1.31%), and 0.78% (95% CI 0.43 to 1.24%) respectively. CONCLUSION: The widely used alloplasts were expanded polytetrafluoroethylene (ePTFE), high-density polyethylene, and silicone. The total rates for complications, infection, deviation, irregularity, hematoma, extrusion, and overcorrection were 2.75%, 1.91%, 0.72%, 0.70%, 0.78%, and 0.49%, respectively. The revision rate, based on the random effects model, was 6.40% with 95%CI (3.84 to 9.57). TRIAL REGISTRATION: This meta-analysis was registered at the International Prospective Register of Systematic Reviews (PROSPERO, registration number CRD42020209644 ).

A Systematic Review and Meta-Analysis of Complications Associated With Autogenous Diced Cartilage Wrapped in Fascia Used in Nasal Dorsum Augmentation.

BACKGROUND: Nasal dorsum augmentation is a highly challenging rhinoplastic procedure. Problems encountered in this surgery, such as residual humps, irregularities, and asymmetry, account for a significant number of revision rhinoplasties. OBJECTIVES: The aim of this meta-analysis was to assess complication rates and graft harvesting site morbidity and revision rates. METHODS: We carried out a systematic review of the literature for pertinent materials in PubMed/Medline and Google Scholar up to and including August 2020. In addition, the reference list of included studies was searched manually. The criteria used were those described in the PRISMA Declaration for performing systematic reviews. RESULTS: The initial search yielded 236 results. After 3 stages of screening, 16 papers (18 groups) were included in the systematic review and meta-analysis. Our results indicated that the total rates for the complications studied were as follows: graft resorption, 2.52%; insufficient augmentation, 3.93%; deviation (graft displacement), 1.77%; infection, 2.30%; irregularity, 1.36%; supra-tip depression, 1.13%; overcorrection, 3.06%; hematoma at recipient site, 1.36%; and visible bulging of the graft, 2.64%. The total rates for donor site hypertrophic scar and donor site hematoma were 2.64% and 3.58%, respectively. The rate of the revision surgery was 3.03%. CONCLUSIONS: Current findings suggest the overall complications and revision rates with the use of diced cartilage wrapped in fascia for dorsum augmentation were relatively low and this technique is a reliable treatment choice for patients with primary/secondary dorsum deficiencies. Further studies with larger sample sizes and long-term follow-ups, clearer definitions of complications, and objective measurements are warranted to draw reliable practical conclusions.

Clinical and chest CT features as a predictive tool for COVID-19 clinical progress: introducing a novel semi-quantitative scoring system.

OBJECTIVE: Proposing a scoring tool to predict COVID-19 patients' outcomes based on initially assessed clinical and CT features. METHODS: All patients, who were referred to a tertiary-university hospital respiratory triage (March 27-April 26, 2020), were highly clinically suggestive for COVID-19 and had undergone a chest CT scan were included. Those with positive rRT-PCR or highly clinically suspicious patients with typical chest CT scan pulmonary manifestations were considered confirmed COVID-19 for additional analyses. Patients, based on outcome, were categorized into outpatient, ordinary-ward admitted, intensive care unit (ICU) admitted, and deceased; their demographic, clinical, and chest CT scan parameters were compared. The pulmonary chest CT scan features were scaled with a novel semi-quantitative scoring system to assess pulmonary involvement (PI). RESULTS: Chest CT scans of 739 patients (mean age = 49.2 ± 17.2 years old, 56.7% male) were reviewed; 491 (66.4%), 176 (23.8%), and 72 (9.7%) cases were managed outpatient, in an ordinary ward, and ICU, respectively. A total of 439 (59.6%) patients were confirmed COVID-19 cases; their most prevalent chest CT scan features were ground-glass opacity (GGO) (93.3%), pleural-based peripheral distribution (60.3%), and multi-lobar (79.7%), bilateral (76.6%), and lower lobes (RLL and/or LLL) (89.1%) involvement. Patients with lower SpO2, advanced age, RR, total PI score or PI density score, and diffuse distribution or involvement of multi-lobar, bilateral, or lower lobes were more likely to be ICU admitted/expired. After adjusting for confounders, predictive models found cutoffs of age ≥ 53, SpO2 ≤ 91, and PI score ≥ 8 (15) for ICU admission (death). A combination of all three factors showed 89.1% and 95% specificity and 81.9% and 91.4% accuracy for ICU admission and death outcomes, respectively. Solely evaluated high PI score had high sensitivity, specificity, and NPV in predicting the outcome as well. CONCLUSION: We strongly recommend patients with age ≥ 53, SpO2 ≤ 91, and PI score ≥ 8 or even only high PI score to be considered as high-risk patients for further managements and care plans. KEY POINTS: • Chest CT scan is a valuable tool in prioritizing the patients in hospital triage. • A more accurate and novel 35-scale semi-quantitative scoring system was designed to predict the COVID-19 patients' outcome. • Patients with age ≥ 53, SpO2 ≤ 91, and PI score ≥ 8 or even only high PI score should be considered high-risk patients.

Perfusion Computed Tomography Scan Imaging in Differentiation of Benign from Malignant Parotid Lesions

Abstract Introduction The most common site of salivary gland tumors is the parotid gland. Computed tomography (CT), magnetic resonance imaging (MRI), and sonography are imaging modalities to differentiate benign from malignant parotid tumors. Objective The aim of this study is the evaluation of the diagnostic value of perfusion CT for differentiating histological categorization of benign and malignant parotid tumors. Methods A total of 29 patients with parotid neoplasms were enrolled in this study. Mean age and all CT perfusion variables (gradient and permeability, blood flow[BF], blood volume [BV], mean transit time [MTT], permeability surface [PS], maximum intensity projection [MIP], time-density curve [TDC], and time to peak [TTP]) were compared among three groups (malignant tumors [MTs],Warthin's tumor [WT] and pleomorphic adenomas [PA]). Results The mean age of the patients was 55.9±14.1 (26-77), and 15 of them were male (51.7%). Eleven lesions were PAs [37.9%], 8 lesions were WTs (27.6%0 and 10 lesions (34.5%) were MTs (6 acinic cell carcinomas [ACCs], 3 adenocystic carcinomas [AdCCs], and 1 mucoepidermoid carcinoma [MEC]). The mean age of the patients with WTs was 62±7.5 years; 52±14.2 for patients with Pas, and 55.2±17.2 for those with MTs (p=0.32). The mean MIP was 122.7±12.2 in WT, while it was 80.5±19.5 in PA, and 76.2±27.1 in MTs (p<0.001); The mean MIP for WT was higher than for PAs and MTs; the values of MTs and PAs were not statistically different. The average of BF, BV, and curve peak were higher inWTs in comparison with the other two groups, and curve time 2 and TTP were higher in PAs in comparison with MTs. Conclusion Based on this study, perfusion CT of the parotid gland and its parameters can distinguish between benign and malignant parotid masses.

Pregnancy and its Outcomes in Patients After Uterine Fibroid Embolization: A Systematic Review and Meta-Analysis.

Uterine artery embolization (UAE) has been introduced for uterine fibroid treatment for two decades. Most of the patients are in reproductive age and many want future pregnancy. In this study, we will assess fertility, pregnancy and its outcomes in patients who have undergone UAE. In this systematic review, a systematic search was performed on important databases including PubMed and Medline, Web of Knowledge, Google Scholar, EMBASE and Scopus. Studies reported enough data about pregnancy after UAE were considered to be enrolled in the review. We assessed obstetric indices (pregnancy and delivery rates, pregnancy losses, complications and fetal outcomes). Study evaluation was done based on STROBE checklist by two reviewers. Totally, 24 original papers were included. Data were analyzed by Stata and MedCalc softwares. Among women wishing fertility, totally 40.5% experienced at least one pregnancy after UAE (95% confidence interval [CI]: 33.3%-48.2%). Pooled estimate of pregnancy loss rate was 33.5% (95% CI: 26.3-41%). Most pregnancy losses were due to spontaneous abortion (81.3% of all losses (95% CI = 76%-86.1%)). Rate of obstetrical complications was 25.4% (95% CI = 13-40.2%) among all finished pregnancies. Pooled estimate of preterm labor was 12.8% (95% CI = 8.7%-17.5%), and pooled estimate of low birth weight (LBW) was 10% (95% CI = 6.2-14.6%). Considering the findings of the study, a safe pregnancy after UAE is obviously possible resulting to a healthy and normal baby delivery. In addition, pooled obstetrical complication rates, pregnancy losses, preterm labor and LBW seem to be mostly similar to the general population. Registration: The study was registered in International Prospective Register of Systematic Reviews (PROSPERO) on Nov 3, 2017, and was confirmed with a registration code of CRD42017076074.

Perfusion Computed Tomography Scan Imaging in Differentiation of Benign from Malignant Parotid Lesions.

Introduction The most common site of salivary gland tumors is the parotid gland. Computed tomography (CT), magnetic resonance imaging (MRI), and sonography are imaging modalities to differentiate benign from malignant parotid tumors. Objective The aim of this study is the evaluation of the diagnostic value of perfusion CT for differentiating histological categorization of benign and malignant parotid tumors. Methods A total of 29 patients with parotid neoplasms were enrolled in this study. Mean age and all CT perfusion variables (gradient and permeability, blood flow [BF], blood volume [BV], mean transit time [MTT], permeability surface [PS], maximum intensity projection [MIP], time-density curve [TDC], and time to peak [TTP]) were compared among three groups (malignant tumors [MTs], Warthin's tumor [WT] and pleomorphic adenomas [PA]). Results The mean age of the patients was 55.9 ± 14.1 (26-77), and 15 of them were male (51.7%). Eleven lesions were PAs [37.9%], 8 lesions were WTs (27.6%0 and 10 lesions (34.5%) were MTs (6 acinic cell carcinomas [ACCs], 3 adenocystic carcinomas [AdCCs], and 1 mucoepidermoid carcinoma [MEC]). The mean age of the patients with WTs was 62 ± 7.5 years; 52 ± 14.2 for patients with Pas, and 55.2 ± 17.2 for those with MTs ( p = 0.32). The mean MIP was 122.7 ± 12.2 in WT, while it was 80.5 ± 19.5 in PA, and 76.2 ± 27.1 in MTs ( p < 0.001); The mean MIP for WT was higher than for PAs and MTs; the values of MTs and PAs were not statistically different. The average of BF, BV, and curve peak were higher in WTs in comparison with the other two groups, and curve time 2 and TTP were higher in PAs in comparison with MTs. Conclusion Based on this study, perfusion CT of the parotid gland and its parameters can distinguish between benign and malignant parotid masses.

Coronary CT Angiography and Dual-Energy Computed Tomography in Ischemic Heart Disease Suspected Patients.

BACKGROUND: Advanced computed tomography (CT) scanners enable concurrent assessment of coronary artery anatomy and myocardial perfusion. The purpose of this study was to assess dual-energy CT images in a group of patients suspected for ischemic heart disease and to evaluate agreement of cardiac computed tomography perfusion (CTP) images with CT angiography results in a single dual-energy computed tomography (DECT) acquisition. METHODS: Thirty patients (mean age: 53.8 ± 12.9 years, 60% male) with angina pectoris or atypical chest pain, suspected for ischemic heart disease, were investigated using a 384-row detector CT scanner in dual-energy mode (DECT). Firstly, resting CTP images were acquired, and then from the same raw data, computed tomography angiography (CTA) studies were reconstructed for stenosis detection. CT-based dipyridamole-stress myocardial perfusion imaging was then performed in patients who exhibited coronary stenosis >50% or had myocardial bridge (MB). A color-coded iodine map was used for evaluation of myocardial perfusion defects using the 17-segment model. Two independent blinded readers analyzed all images for stenosis and myocardial perfusion defects. Different myocardial iodine content (mg/mL) was calculated by parametric tests. The kappa agreement was calculated between results of two methods in cardiac scans. RESULTS: All 30 CT angiograms were evaluated and assessment ability was 100% for combined CTA/CTP. According to the combined CT examination, 17 patients (56.7%) exhibited significant coronary stenosis and/or deep MB (DMB). A total of 510 myocardial segments and 90 vascular territories were analyzed. Coronary CTA demonstrated significant stenosis in 22 vessels (24.4% of all main coronary arteries) among 12 patients (40%), DMB in 6 vessels (6.7% of all main coronary arteries) in 17 out of 30 patients (56.7%). Twenty-eight out of 90 vascular territories (31.1%) and 41 out of 510 segments (8%) showed reversible perfusion defects on stress DECT. Kappa agreement between CTA and CTP results in whole heart was 0.79 (95% confidence interval=0.57-1). There were significant differences in mean iodine concentration between ischemic (0.59 ± 0.07 mg/mL) and normal segments (2.2 ± 0.15) with P < 0.001. CONCLUSION: Agreement of CTA and CTP in whole heart and in LAD considering DMB and significant CAD together were good to excellent; however, considering sole pathologies, most of the agreements were weak (<0.5). DECT with iodine quantification may provide a valuable method in comparison with previous methods for identifying both coronary stenosis and myocardial ischemia.

Differentiation of Benign from Malignant Adnexal Masses by Dynamic Contrast-Enhanced MRI (DCE-MRI): Quantitative and Semi-quantitative analysis at 3-Tesla MRI

Background: To evaluate the utility of the pharmacokinetic modeling derived from dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) in differentiating benign from malignant adnexal masses. Methods: A total of 43 patients with 49 complex adnexal masses (27 benign, 3 borderline, and 19 malignant lesions) underwent preoperative DCE-MRI examinations on a 3 Tesla MRI. Using extended Tofts' model, quantitative analysis was performed in the solid components of all tumors. Three pharmacokinetic parameters were defined as volume transfer coefficient (Ktrans), the rate constant (Kep), and the plasma volume (Vp). Semi-quantitative analysis was also performed and the values of relative signal intensity (SI rel) wash-in-rate (WIR), the initial area under the curve (iAUC60), time-to-peak (TTP) and wash-out-rate (WOR) were calculated. Receiver operating characteristic (ROC) curve analysis was performed to evaluate diagnostic characteristics of each DCE-MRI parameter in differentiating borderline/malignant tumors from benign lesions and to provide the optimal cutoff values for these variables. Results: SI rel had the highest diagnostic value (AUC=0.872; p<0.001; cut-off=121.4 associated with an overall accuracy=79.6%, sensitivity=95.5%, specificity=66.7%, NPV=94.8% and PPV=70.0%). Ktrans had the second highest AUC=0.836 (p<0.001; cut-off=0.034 associated with an overall accuracy=79.6%, sensitivity=86.4%, specificity=74.1%, NPV=87.0% and PPV=73.1%). The other factors found to be acceptable diagnostic parameters for borderline/malignant lesions included WIR (AUC=0.816; p<0.001), iAUC60 (AUC=0.808; p<0.001), Vp (AUC=0.795; p<0.001), SI max (AUC=0.737, p=0.005), SI peak (AUC=0.737; p=0.005) and Kep (AUC=0.681; p=0.031). Conclusion: Quantitative DCE-MRI is a relevant tool for differentiating benign from malignant adnexal masses. Among all the DCE parameters, SI rel and Ktrans are the most accurate discriminators.

Diagnostic investigation of breast magnetic resonance imaging in malignant and benign mass lesions.

INTRODUCTION: Breast magnetic resonance imaging (BMRI) has been identified as a valuable modality in the diagnosis of breast cancer and monitoring the response to chemotherapy. The aim of this study was to evaluate the relative importance of different descriptors of breast masses in contrast-enhanced breast MRI. MATERIAL AND METHODS: In a database of pathologically proven breast lesions, in total 433 masses in 312 patients detected by contrast-enhanced breast MRI were selected. All images were assessed according to the MRI BI-RADS lexicon and those with significant positive MRI findings (BI-RADS categories 3, 4, 5) were enrolled in the study. RESULTS: Mean age of patients was 45.09 ±10.5 years. The most frequent BI-RADS score was 4 (60.7%), followed by 3 (27%). Among the morphologic descriptors of the enhancing masses, the findings most strongly associated with malignancy included spiculated margin (60.6%) and irregular shape (38%). Considering the dynamic descriptors, a wash-out pattern in the time-intensity curve was the most powerful finding associated with malignancy (27.9%). Among all breast MRI descriptors, the best odds ratio (OR) in association with malignancy was noted for speculated margin (OR = 10.2) followed by wash-out or plateau curves (OR = 6.1), size greater than 1 cm (OR = 4.3) and irregular shape (OR = 3.1). CONCLUSIONS: It seems that morphologic descriptors of MRI BI-RADS for enhancing masses are quite specific, while dynamic descriptors of the masses are highly sensitive. Appropriate consideration and combination of different BI-RADS findings could help in better characterization of enhancing masses on breast MRI, lowering the rate of false positive reports and avoiding unnecessary biopsies.

Assessing the Relation of Epicardial Fat Thickness and Volume, Quantified by 256-Slice Computed Tomography Scan, With Coronary Artery Disease and Cardiovascular Risk Factors.

BACKGROUND: This study aimed to investigate the association between epicardial adipose tissue (EAT) and coronary artery disease (CAD) as well as cardiovascular risk factors. METHODS: Complete medical records of subjects were reviewed and cardiovascular risk factors were recorded. Epicardial fat volume (EFV) and epicardial fat thickness (EFT) were measured using digital volumetry of acquired images using a 256-slice CT-scanner. Calcium score was measured using Agatston method in non-contrast images. After contrast administration, bolus-tract images were obtained. Coronary arteries were assessed using reconstructed images in arterial phase of contrast-enhanced images. EFV and EFT measurements were compared to computed tomography angiography (CTA) findings of coronary arteries. RESULTS: A total of 269 patients (Mean age: 55.5 ± 12.1, 44% female) were included. Higher means of EFT and EFV were associated with coronary artery stenosis. However, the correlation coefficients of the arterial stenosis with EFT and EFV were weak. EFV and EFT had a significant association with age (P < 0.001, P < 0.001 respectively), body mass index (BMI) (P < 0.001, P < 0.001 respectively) and hypertension (P < 0.016, P < 0.003 respectively). Diabetes mellitus (DM) and hyperlipidemia were not significantly associated with EFV (P = 0.069 and 0.639 respectively) and EFT (P = 0.103 and 0.366 respectively). EFV and EFT showed a weak correlation coefficient with calcium scoring (Spearman correlation coefficients: 0.26 and 0.22 respectively, both P < 0.001). In multivariate logistic regression models considering coronary stenosis as dependent variable and EFV, EFT and other CAD risk factors as independent variables, EFV and EFT did not show significant P values and were omitted from the model by other CAD risk factors. CONCLUSION: Increased EFV and EFT are associated with CAD, age, BMI and hypertension. However, no remarkable association was found between them and calcium score, hyperlipidemia or DM. These variables could weakly predict CAD in univariate models but they are not independent predictive factors for CAD in multivariate models consisting of other CAD risk factors. Hence, EFT and EFV are not independent predictors for CADs when they are considered simultaneously with other CAD risk factors.

Differentiation between benign and malignant thyroid nodules using diffusion-weighted imaging, a 3-T MRI study.

BACKGROUND: Preoperative differentiation of benign from malignant thyroid nodules remains a challenge. Aims: This study assessed the accuracy of diffusion-weighted imaging (DWI) for differentiation between benign and malignant thyroid nodules. MATERIALS AND METHODS: Preoperative DWI was performed in patients with thyroid nodule by means of a 3-T scanner magnetic resonance imaging (MRI). Images were obtained at b value of 50, 500, and 1000 mm2/s to draw an ADC (apparent diffusion coefficient) map. Findings were compared with postoperative histopathologic results. Receiver operating characteristic curve was used to assess the accuracy of different cutoff points. RESULTS: Forty-one thyroid nodules (26 benign and 15 malignant) were included in this study. None of static MRI parameters such as signal intensity, heterogeneity, and nodule border was useful to discriminate between benign and malignant lesions. Mean ADC value was (1.94 ± 0.54) × 10-3 mm2/s and (0.89 ± 0.29) × 10-3 mm2/s in benign and malignant nodules, respectively (P-value < 0.005). ADC value cutoff of 1 × 10-3 mm2/s yielded an accuracy, sensitivity, and specificity of 93%, 87%, and 96% to discriminate benign and malignant nodules. CONCLUSION: DWI is highly accurate for discrimination between benign and malignant thyroid nodules.

Diagnostic Efficacy of Coronary Artery Three-Dimensional Steady-State Free Precession Magnetic Resonance Angiography in Comparison with Invasive Coronary Angiography for Detecting Coronary Artery Disease.

PURPOSE: To assess the diagnostic value of three-dimensional steady-state free precession magnetic resonance angiography (3D-SSFP MRA) for detecting coronary artery disease (CAD). MATERIALS AND METHODS: Patients suspected of CAD based on clinical evaluation, underwent invasive coronary angiography (CAG) and Cardiac MRA (CMRA). Collected data in favor of any CAD findings in CMRA were compared to CAG results as the standard diagnostic method in CAD detection. Analysis was performed on per-patient, per-vessel and per-segment bases. RESULTS: A total of 30 patients (mean age: 43 ± 10 years, 19 men) were enrolled for analysis. On per-patient analysis, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and area under receiver operator characteristic (ROC) curve of CMRA for detection of coronary artery stenosis were 100% (CI95%: 75% - 100%), 50% (CI95%: 18% - 81%), 73.33% (CI95%: 46% - 90%), 100% (CI95%: 47% - 100%) and 0.827, respectively. On per-vessel analysis, CMRA had a sensitivity of 89.29% (CI95%: 71%-97%), specificity of 80.56% (CI95%: 63% - 91%), PPV of 78.13% (CI95%: 60% - 90%), NPV of 90.63% (CI95%: 74% - 98%) and area under ROC curve of 0.845. On per-segment analysis, sensitivity, specificity, PPV and NPV of CMRA for segmental stenosis detection were 77.78% (CI95%: 60% - 89%), 87% (CI95%: 81% - 92%), 62% (CI95%: 46% - 76%), and 93.89% (CI95%:  88% - 97%), respectively. Area under ROC curve was 0.835 on per-segment analysis. CONCLUSION: 3D SSFP CMRA provides a promising non-invasive diagnostic tool for assessing coronary artery disease.

Erratum: Magnetic Resonance Imaging Features of Adenosis in the Breast.

[This corrects the article on p. 187 in vol. 18, PMID: 26155296.].