European Radiology最新文献

{"title":"Reply to the Letter to the Editor: \"An unenhanced 3D-FLAIR sequence using long repetition time and constant flip angle to image endolymphatic hydrops\".","authors":"Menglong Zhao, Huaili Jiang, Shujie Zhang, Kai Liu, Lei Zhou, Di Wu, Xixi Wen, Junpu Hu, Xuan Wang, Zhuang Liu, Yan Sha, Mengsu Zeng","doi":"10.1007/s00330-025-11537-w","DOIUrl":"https://doi.org/10.1007/s00330-025-11537-w","url":null,"abstract":"","PeriodicalId":12076,"journal":{"name":"European Radiology","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143795046","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Real-life benefit of artificial intelligence-based fracture detection in a pediatric emergency department.","authors":"Maria Ziegner, Johanna Pape, Martin Lacher, Annika Brandau, Tibor Kelety, Steffi Mayer, Franz Wolfgang Hirsch, Maciej Rosolowski, Daniel Gräfe","doi":"10.1007/s00330-025-11554-9","DOIUrl":"https://doi.org/10.1007/s00330-025-11554-9","url":null,"abstract":"<p><strong>Objectives: </strong>This study aimed to evaluate the performance of an artificial intelligence (AI)-based software for fracture detection in pediatric patients within a real-life clinical setting. Specifically, it sought to assess (1) the stand-alone AI performance in real-life cohort and in selected set of medicolegal relevant fractures and (2) its influence on the diagnostic performance of inexperienced emergency room physicians.</p><p><strong>Materials and methods: </strong>The retrospective study involved 1672 radiographs of children under 18 years, obtained consecutively (real-life cohort) and selective (medicolegal cohort) in a tertiary pediatric emergency department. On these images, the stand-alone performance of a commercially available, deep learning-based software was determined. Additionally, three pediatric residents independently reviewed the radiographs before and after AI assistance, and the impact on their diagnostic accuracy was assessed.</p><p><strong>Results: </strong>In our cohort (median age 10.9 years, 59% male), the AI demonstrated a sensitivity of 92%, specificity of 83%, and accuracy of 87%. For medicolegally relevant fractures, the AI achieved a sensitivity of 100% for proximal tibia fractures, but only 68% for radial condyle fractures. AI assistance improved the residents' patient-wise sensitivity from 84 to 87%, specificity from 91 to 92%, and diagnostic accuracy from 88 to 90%. In 2% of cases, the readers, with the assistance of AI, erroneously discarded their correct diagnosis.</p><p><strong>Conclusion: </strong>The AI exhibited strong stand-alone performance in a pediatric setting and can modestly enhance the diagnostic accuracy of inexperienced physicians. However, the economic implications must be weighed against the potential benefits in patient safety.</p><p><strong>Key points: </strong>Question Does an artificial intelligence-based software for fracture detection influence inexperienced physicians in a real-life pediatric trauma population? Findings Addition of a well-performing artificial intelligence-based software led to a limited increase in diagnostic accuracy of inexperienced human readers. Clinical relevance Diagnosing fractures in children is especially challenging for less experienced physicians. High-performing artificial intelligence-based software as a \"second set of eyes,\" enhances diagnostic accuracy in a common pediatric emergency room setting.</p>","PeriodicalId":12076,"journal":{"name":"European Radiology","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143795043","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter to the Editor: An unenhanced 3D-FLAIR sequence using long repetition time and constant flip angle to image endolymphatic hydrops.","authors":"Barton F Branstetter, Barry E Hirsch","doi":"10.1007/s00330-025-11536-x","DOIUrl":"https://doi.org/10.1007/s00330-025-11536-x","url":null,"abstract":"","PeriodicalId":12076,"journal":{"name":"European Radiology","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143795030","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diffusion levels for quantitative assessment of the apparent diffusion coefficient value in prostate MRI: a proof-of-concept bicentric study.","authors":"Rossano Girometti, Valeria Peruzzi, Paola Clauser, Nina Pötsch, Maria De Martino, Miriam Isola, Gianluca Giannarini, Alessandro Crestani, Chiara Zuiani, Lorenzo Cereser, Pascal At Baltzer","doi":"10.1007/s00330-025-11547-8","DOIUrl":"https://doi.org/10.1007/s00330-025-11547-8","url":null,"abstract":"<p><strong>Objectives: </strong>To investigate the performance of Diffusion levels (DLs) in diagnosing clinically significant prostate cancer (csPCa) when combined with the PI-RADS version 2.1.</p><p><strong>Materials and methods: </strong>This retrospective, bicentric study included 261 men who underwent 3.0-T prostate MRI between March 2020 and April 2023, receiving systematic and target prostate biopsy on PI-RADS ≥ 3 lesions. Two readers measured the Apparent diffusion coefficient (ADC) of PI-RADS 1-5 findings in the peripheral zone. By plotting the cumulative frequency of csPCa versus ADCs and using ROC analysis, we derived four DLs expressing levels of restricted diffusion, i.e., very low DL (VL-DL), low DL (L-DL), intermediate DL (I-DL), and high DL (H-DL). We compared the per-lesion diagnostic performance in assessing csPCa (grading group ≥ 2 cancer) assuming to biopsy PI-RADS ≥ 3 lesions (strategy 1), PI-RADS ≥ 3 lesions adjusted with ADC values (strategy 2-4), and PI-RADS ≥ 3 lesions adjusted with DLs (strategy 5-7). Net benefit was assessed with decision curve analysis.</p><p><strong>Results: </strong>csPCa was found in 79/261 men (30.3%) and 152/528 lesions (28.8%). There was a negative correlation (p < 0.0001) between ADC versus malignancy rate (tau -0.970) and DLs versus csPCa grading group (tau -0.614). csPCa prevalence was highest in VL-DL (72.2%) and L-DL (54.4%). Most DLs-based strategies increased specificity, positive predictive value (PPV), and net benefit compared to ADC-based strategies or PI-RADS alone. The best strategy showed 94.7% sensitivity, 82.9% specificity, 69.2% PPV, and 97.5% negative predictive value.</p><p><strong>Conclusion: </strong>While larger-scale validation is needed, DLs have the potential to improve PI-RADS-based biopsy decisions for detecting csPCa in the peripheral zone.</p><p><strong>Key points: </strong>Question It is still unclear how to incorporate quantitative information from diffusion-weighted imaging (DWI) into prostate MRI. Findings Combining DWI-derived diffusion levels (DLs) with the PI-RADS version 2.1 categorization reduced false positives while preserving high sensitivity for clinically significant prostate cancer. Clinical relevance DLs permit to easily account for ADC values of prostate lesions and, in turn, refine biopsy decisions.</p>","PeriodicalId":12076,"journal":{"name":"European Radiology","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143795028","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"MRI-detected extranodal extension as a marker of prostate cancer aggressiveness.","authors":"Aline Araújo Naves, Gabriel de Lion Gouvea, Camila V B Machado, Leandro Machado Colli, Fernando Chahud, Rodolfo B Reis, Valdair F Muglia","doi":"10.1007/s00330-025-11532-1","DOIUrl":"https://doi.org/10.1007/s00330-025-11532-1","url":null,"abstract":"<p><strong>Objective: </strong>Extranodal extension (ENE) is a histological marker of aggressiveness for various cancers. We evaluated if clinical ENE, detected by Magnetic Resonance Imaging, can also serve as a biological marker of Prostate Cancer (PCa) aggressiveness.</p><p><strong>Materials and methods: </strong>This retrospective, single-center study analyzed patients diagnosed with PCa and had MRI on a 3-T scanner from January 2013 to December 2017. After exclusions, 461 patients were included and divided into: Group 1, no lymph node involvement (LNI), Group 2 (LNI without ENE), and Group 3 (LNI and ENE). Two experienced radiologists assessed the MRI scans for primary lesion characteristics, LNI and ENE. Reproducibility assessment was calculated for ENE and PI-RADS. Clinical outcomes, including Overall Survival (OS), Specific Survival Rate (SSR), and Progression-Free Survival (PFS), were analyzed.</p><p><strong>Results: </strong>Group 1 included 410 patients, Group 2, 32 patients, and Group 3, 19 patients. The prevalence of ENE was 4.1%. Significant differences between groups were observed for age, PSA, dPSA, ISUP scores, clinical risk stratification, and staging (all p < 0.01). The Kappa coefficient for ENE was 0.75 (95% CI: 0.56-0.90), and 0.48 (0.14-1.0) for PI-RADS. Cox proportional hazards model showed PSA (HR: 1.009; 95% CI = 1.003-1.015, p < 0.01) and ENE (HR: 8.50; 1.76-40.98, p < 0.01) were associated with SSR, and both ENE (HR: 8.18; 2.34-28.58, p < 0.01) and LNI (HR: 5.99, 1.97-18.17, p < 0.01) were linked to poor PFS.</p><p><strong>Conclusion: </strong>MRI-detected ENE, despite low prevalence, is a predictor of SSR and PFS in PCa. These findings support ENE as an independent prognostic marker. Further prospective, multi-institutional studies are required to validate these results.</p><p><strong>Key points: </strong>Question Pathological extranodal extension (pENE) has been described as a marker of worrisome prognosis in prostate cancer (PCa), but clinical ENE has not been evaluated as a marker of prognosis in PCa. Findings MRI-detected clinical ENE, had a low prevalence in our cohort (4.1%), but it was a predictor of specific survival rate and progression-free survival. Clinical relevance MRI-detected clinical ENE, a reproducible imaging feature, may serve as a non-invasive biomarker for aggressive prostate cancer. It correlates with poorer progression-free survival and specific survival rates, offering valuable prognostic insights for patient management.</p>","PeriodicalId":12076,"journal":{"name":"European Radiology","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143788051","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Percutaneous image-guided cryoablation of venous malformation and fibro-adipose vascular anomaly: prognostic factors of clinical efficacy.","authors":"Clément Marcelin, Thomas Linet, Eva Jambon, Rim Maaloum, Yann Le Bras, Vincent Pinsolle, Christine Labreze, François H Cornelis","doi":"10.1007/s00330-025-11545-w","DOIUrl":"https://doi.org/10.1007/s00330-025-11545-w","url":null,"abstract":"<p><strong>Objective: </strong>To assess the prognostic factors for clinical and radiological responses to percutaneous image-guided cryoablation (CA) in treating venous malformation (VM) and fibro-adipose vascular anomaly (FAVA).</p><p><strong>Materials and methods: </strong>Fifty-five patients (12 males, 43 females; median age: 30 years) with symptomatic lesions (median VAS pain score: 70; median initial volume: 12.2 mm³) underwent CA between 2012 and 2023. CA was a first-line treatment in 23 patients (42%) and second-line in 32 (58%). Lesions were Goyal grade 1 in 24 cases (43%) and located on extremities in 44 (80%). Technical efficacy was assessed using MRI and applying RECIST criteria, while clinical efficacy was based on changes in VAS pain scores. Prognostic factors for residual pain were analyzed using univariable and multivariable analyses.</p><p><strong>Results: </strong>With a median follow-up of 13 months, technical success was achieved in all cases, and 20% of patients underwent multiple sessions. Technical efficacy was observed in 69% of cases, with 33% achieving complete response and 36% partial response (mean volume reduction: 47%). Clinical efficacy was reached in 72% of cases. Univariable analysis linked residual pain to sex (female, p = 0.013), initial pain level (p = 0.014), Goyal grade (p = 0.029), and residual volume (p = 0.012). Multivariable analysis revealed that grade (p = 0.035), post-therapeutic volume (p = 0.048), and completeness of treatment (p = 0.029) were statistically significant predictors.</p><p><strong>Conclusion: </strong>Cryoablation is an effective management strategy for venous malformation and FAVA, with residual volume emerging as a significant indicator of clinical success.</p><p><strong>Key points: </strong>Question Venous malformations (VA) and fibro-adipose vascular anomalies (FAVA) often cause chronic pain, with limited effective treatment options. Identifying predictors of pain relief following cryoablation could optimize patient outcomes. Findings Cryoablation achieved 72% pain relief for VA and FAVA. High lesion grade, treatment completeness, and residual volume were significantly associated with residual pain. Clinical relevance Cryoablation provides an effective, minimally invasive treatment for VA and FAVA, achieving significant pain relief while identifying predictors to optimize patient selection and outcomes.</p>","PeriodicalId":12076,"journal":{"name":"European Radiology","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143788077","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Super-resolution ultrasound imaging of intranodal lymphatic sinuses for predicting sentinel lymph node metastasis in breast cancer: a preliminary study.","authors":"ShuJun Xia, Qing Hua, YanYan Song, CongCong Yuan, YuHang Zheng, RuoLin Tao, JiaLe Xu, EnHeng Cai, YuLu Zhang, FangGang Wu, Wei Guo, Yuan Tian, YiJie Dong, JianQiao Zhou","doi":"10.1007/s00330-025-11520-5","DOIUrl":"https://doi.org/10.1007/s00330-025-11520-5","url":null,"abstract":"<p><strong>Objectives: </strong>Accurate preoperative localization and characterization of sentinel lymph nodes (SLNs) is vital in breast cancer management. The application of super-resolution ultrasound (SRUS) imaging to visualize intranodal lymphatic sinuses for the prediction of SLN metastasis has yet to be investigated. The study aimed to assess the value of SRUS imaging of intranodal lymphatic sinuses in predicting SLN metastasis in breast cancer patients.</p><p><strong>Methods: </strong>A total of 154 SLNs from 143 patients with breast cancer were prospectively included. All patients underwent conventional US of axillary lymph nodes and SRUS imaging of lymph sinus by percutaneous microbubble injection. Qualitative and quantitative analysis were performed for SRUS imaging, with qualitative analysis focusing on identifying perfusion defects and quantitative analysis including parameters such as lymphatic sinus density, sinus diameter, sinus distance, and lymph flow velocity. The areas under the receiver operating characteristic curve (AUC), sensitivity, and specificity were calculated for conventional US, SRUS, and combined conventional US and SRUS.</p><p><strong>Results: </strong>Among the 154 SLNs, 73 were metastatic and 81 were reactive. In predicting metastatic SLNs, the AUC for SRUS (0.824; 95% CI: 0.761-0.888) was significantly higher than that for conventional US (0.661; 95% CI: 0.596-0.726) (p < 0.001). The combination of SRUS and conventional US achieved the highest AUC (0.844; 95% CI: 0.785-0.904), which was significantly higher than conventional US alone (p < 0.001), but not significantly different from SRUS alone (p = 0.2).</p><p><strong>Conclusion: </strong>Imaging lymphatic sinuses by SRUS has the potential to predict metastatic SLNs in patients with breast cancer.</p><p><strong>Key points: </strong>Question Super-resolution ultrasound (SRUS) used for visualizing intranodal lymphatic sinuses for the prediction of sentinel lymph nodes (SLNs) metastasis has yet to be investigated. Findings Microlymphatic circulation of SLNs were imaged by SRUS at ten microns scale. SRUS showed better performance for predicting metastatic SLNs than conventional ultrasound. Clinical relevance SRUS is a reliable tool to image lymphatic sinuses and characterize metastatic SLNs in patients with breast cancer. It helps diagnosis of lymph node status and clinical decision-making of breast cancer.</p>","PeriodicalId":12076,"journal":{"name":"European Radiology","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143788179","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ultra-low-dose CT-a new imaging modality in the diagnostic workflow of an emergency department?","authors":"Maria Tækker, Ole Graumann","doi":"10.1007/s00330-025-11569-2","DOIUrl":"https://doi.org/10.1007/s00330-025-11569-2","url":null,"abstract":"","PeriodicalId":12076,"journal":{"name":"European Radiology","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143788182","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Uncertainty-aware quantitative CT evaluation of emphysema and mortality risk from variable radiation dose images.","authors":"David Baraghoshi, Matthew J Strand, Stephen M Humphries, David A Lynch, Alexander M Kaizer, Antonio R Porras","doi":"10.1007/s00330-025-11525-0","DOIUrl":"https://doi.org/10.1007/s00330-025-11525-0","url":null,"abstract":"<p><strong>Objective: </strong>To develop an automated method for the joint and consistent evaluation of emphysema and mortality risk that provides quantification of data and model uncertainty.</p><p><strong>Materials and methods: </strong>Participants from the prospective COPDGene study who underwent both full radiation dose (FD) and reduced radiation dose (RD) chest CT scans at 5-year follow-up were included and divided into training (80%), validation (10%), and testing (10%) datasets. We trained a multi-task Bayesian neural network (BNN) to estimate the FD volume-adjusted lung density (ALD) regardless of acquisition protocol, in addition to the 5-year mortality risk. The data and model uncertainty were quantified in the testing dataset. Our deep learning ALD (DL-ALD) was compared to the conventional ALD.</p><p><strong>Results: </strong>In total, 1350 participants (mean age 64.4 years ± 8.7; 659 female) were included. Compared to conventional ALD, DL-ALD was more consistent between FD and RD CT images (mean difference: 1 g/L ± 3.1 versus 14.8 g/L ± 5.3, p < 0.001). The predicted 5-year mortality was similar between image protocols (mean difference: 0.0007 ± 0.02, p = 0.76). The uncertainty associated with image variability when quantifying DL-ALD was lower in participants with severe emphysema (Pearson's rho = 0.79, p < 0.001), and the model uncertainty for mortality risk was lower both for severe and early-stage participants compared to other participants (p < 0.001).</p><p><strong>Conclusion: </strong>The presented multi-task BNN provides an increased robustness to imaging protocol compared to conventional methods for CT evaluation of emphysema. Additionally, it provides direct measurements of uncertainty for its generalization to diverse imaging protocols and patient populations.</p><p><strong>Key points: </strong>Question Quantitative CT evaluation of emphysema is highly sensitive to CT protocol, which increases uncertainty in disease evaluation and impacts the clinical utility of traditional metrics. Findings Uncertainty-aware deep learning improved consistency in emphysema quantification between fixed and reduced dose CT scans compared to traditional histogram analysis. Clinical relevance CT evaluation of emphysema severity and mortality risk using uncertainty-aware deep learning methods is more consistent across variable radiation dose protocols compared to conventional methods while also providing measurement reliability metrics, improving the evaluation of COPD using CT.</p>","PeriodicalId":12076,"journal":{"name":"European Radiology","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143788186","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Building trust: improving evidence levels in breast MRI radiomics.","authors":"Valeria Romeo, Renato Cuocolo","doi":"10.1007/s00330-025-11573-6","DOIUrl":"https://doi.org/10.1007/s00330-025-11573-6","url":null,"abstract":"","PeriodicalId":12076,"journal":{"name":"European Radiology","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143788043","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}