European Radiology最新文献

{"title":"The Screening Tomosynthesis Trial with Advanced Reader Methods (STREAM): design and rationale of a population-based breast cancer screening trial.","authors":"Lindy Kregting, Daan van den Oever, Lian Pennings, Ruud Pijnappel, Nicolien van Ravesteyn, Ellen Verschuur, Marja van Oirsouw, Loes Dunning, Hans 't Mannetje, Ruben van Engen, Adriana Bluekens, Maartje Smid-Geirnaerdt, Cary van Landsveld-Verhoeven, Nehmat Houssami, Ioannis Sechopoulos, Mireille Broeders","doi":"10.1007/s00330-024-11324-z","DOIUrl":"10.1007/s00330-024-11324-z","url":null,"abstract":"<p><strong>Objectives: </strong>It is uncertain what the effects of introducing digital breast tomosynthesis (DBT) in the Dutch breast cancer screening programme would be on detection, recall, and interval cancers (ICs), while reading times are expected to increase. Therefore, an investigation into the efficiency and cost-effectiveness of DBT screening while optimising reading is required.</p><p><strong>Materials and methods: </strong>The Screening Tomosynthesis trial with advanced REAding Methods (STREAM) aims to include 17,275 women (age 50-72 years) eligible for breast cancer screening in the Netherlands for two biennial DBT screening rounds to determine the short-, medium-, and long-term effects and acceptability of DBT screening and identify an optimised strategy for reading DBT. The control group will consist of 86,400 women selected from the database of the Dutch breast cancer screening programme screened with digital mammography. The intervention group will undergo DBT examinations only. Four different reading strategies will be evaluated on a subset of first-round screening exams. These four strategies will also be evaluated combined with replacing one of the two readers with AI predictions. The Microsimulation Screening Analysis (MISCAN)-Breast model will be used to estimate the long-term outcomes of DBT screening assuming the best-performing reading method.</p><p><strong>Results: </strong>The primary outcome measure is the IC and advanced cancer rate at the second round (combined endpoint) in the DBT group compared to the control group. Secondary outcome measures are participation, recall and detection rates, positive predictive value, acceptability, reading method with the best case-based area under the curve and reading time, predicted breast cancer mortality, number of cancers overdiagnosed, and cost-effectiveness.</p><p><strong>Key points: </strong>Question The short-, medium-, and long-term effects of digital breast tomosynthesis (DBT) imaging in the Dutch breast cancer screening programme are unknown, but essential to decide about implementation. Findings This protocol paper describes the primary endpoint of the STREAM trial: the combined interval and advanced cancer detection rate at the second DBT round. Clinical relevance The STREAM trial is a prospective, non-randomised, population-based study in the Dutch breast cancer screening programme, that aims to evaluate the effects and acceptability of two rounds of DBT screening to determine if DBT can enhance the programme's outcomes.</p>","PeriodicalId":12076,"journal":{"name":"European Radiology","volume":" ","pages":"3979-3986"},"PeriodicalIF":4.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12165985/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142946790","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multi-site, multi-vendor development and validation of a deep learning model for liver stiffness prediction using abdominal biparametric MRI.","authors":"Redha Ali, Hailong Li, Huixian Zhang, Wen Pan, Scott B Reeder, David Harris, William Masch, Anum Aslam, Krishna Shanbhogue, Anas Bernieh, Sarangarajan Ranganathan, Nehal Parikh, Jonathan R Dillman, Lili He","doi":"10.1007/s00330-024-11312-3","DOIUrl":"10.1007/s00330-024-11312-3","url":null,"abstract":"<p><strong>Background: </strong>Chronic liver disease (CLD) is a substantial cause of morbidity and mortality worldwide. Liver stiffness, as measured by MR elastography (MRE), is well-accepted as a surrogate marker of liver fibrosis.</p><p><strong>Purpose: </strong>To develop and validate deep learning (DL) models for predicting MRE-derived liver stiffness using routine clinical non-contrast abdominal T1-weighted (T1w) and T2-weighted (T2w) data from multiple institutions/system manufacturers in pediatric and adult patients.</p><p><strong>Materials and methods: </strong>We identified pediatric and adult patients with known or suspected CLD from four institutions, who underwent clinical MRI with MRE from 2011 to 2022. We used T1w and T2w data to train DL models for liver stiffness classification. Patients were categorized into two groups for binary classification using liver stiffness thresholds (≥ 2.5 kPa, ≥ 3.0 kPa, ≥ 3.5 kPa, ≥ 4 kPa, or ≥ 5 kPa), reflecting various degrees of liver stiffening.</p><p><strong>Results: </strong>We identified 4695 MRI examinations from 4295 patients (mean ± SD age, 47.6 ± 18.7 years; 428 (10.0%) pediatric; 2159 males [50.2%]). With a primary liver stiffness threshold of 3.0 kPa, our model correctly classified patients into no/minimal (< 3.0 kPa) vs moderate/severe (≥ 3.0 kPa) liver stiffness with AUROCs of 0.83 (95% CI: 0.82, 0.84) in our internal multi-site cross-validation (CV) experiment, 0.82 (95% CI: 0.80, 0.84) in our temporal hold-out validation experiment, and 0.79 (95% CI: 0.75, 0.81) in our external leave-one-site-out CV experiment. The developed model is publicly available ( https://github.com/almahdir1/Multi-channel-DeepLiverNet2.0.git ).</p><p><strong>Conclusion: </strong>Our DL models exhibited reasonable diagnostic performance for categorical classification of liver stiffness on a large diverse dataset using T1w and T2w MRI data.</p><p><strong>Key points: </strong>Question Can DL models accurately predict liver stiffness using routine clinical biparametric MRI in pediatric and adult patients with CLD? Findings DeepLiverNet2.0 used biparametric MRI data to classify liver stiffness, achieving AUROCs of 0.83, 0.82, and 0.79 for multi-site CV, hold-out validation, and external CV. Clinical relevance Our DeepLiverNet2.0 AI model can categorically classify the severity of liver stiffening using anatomic biparametric MR images in children and young adults. Model refinements and incorporation of clinical features may decrease the need for MRE.</p>","PeriodicalId":12076,"journal":{"name":"European Radiology","volume":" ","pages":"4362-4373"},"PeriodicalIF":4.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142947032","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":"ESR Essentials: imaging of lymphoma-practice recommendations by the European Society of Oncologic Imaging.","authors":"Doris Leithner, Emanuele Neri, Melvin D'Anastasi, Heinz-Peter Schlemmer, Michael Winkelmann, Wolfgang G Kunz, Clemens C Cyran, Dania Cioni, Evis Sala, Marius E Mayerhoefer","doi":"10.1007/s00330-024-11213-5","DOIUrl":"10.1007/s00330-024-11213-5","url":null,"abstract":"<p><p>Imaging is used for lymphoma detection, Ann Arbor/Lugano staging, and treatment response assessment. [¹⁸F]FDG PET/CT should be used for most lymphomas, including Hodgkin lymphoma, aggressive/high-grade Non-Hodgkin lymphomas (NHL) such as diffuse large B-cell lymphoma, and many indolent/low-grade NHLs such as follicular lymphoma. Apart from these routinely FDG-avid lymphomas, some indolent NHLs, such as marginal zone lymphoma, are variably FDG-avid; here, [¹⁸F]FDG PET/CT is an alternative to contrast-enhanced CT at baseline and may be used for treatment response assessment if the lymphoma was FDG-avid at baseline. Only small lymphocytic lymphoma/chronic lymphocytic leukemia (SLL/CLL) should exclusively undergo CT at baseline and follow-up unless transformation to high-grade lymphoma is suspected. While [¹⁸F]FDG PET/CT is sufficient to rule out bone marrow involvement in Hodgkin lymphoma, biopsy may be needed in other lymphomas. The 5-point (Deauville) score for [¹⁸F]FDG PET that uses the liver and blood pool uptake as references should be used to assess treatment response in all FDG-avid lymphomas; post-treatment FDG uptake ≤ liver uptake is considered complete response. In all other lymphomas, CT should be used to determine changes in lesion size; for complete response, resolution of all extranodal manifestations, and for lymph nodes, long-axis decrease to ≤ 1.5 cm are required. KEY POINTS: [¹⁸F]FDG-PET/CT and contrast-enhanced CT are used to stage lymphoma depending on type. Imaging is required for staging, and biopsies may be required to rule out bone marrow involvement. For treatment response assessment, the 5-PS (Deauville) score should be used; in a few indolent types, CT is used to determine changes in lesion size.</p>","PeriodicalId":12076,"journal":{"name":"European Radiology","volume":" ","pages":"4387-4394"},"PeriodicalIF":4.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12165998/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142920876","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ovarian cancer staging and follow-up: updated guidelines from the European Society of Urogenital Radiology female pelvic imaging working group.","authors":"Stefania Rizzo, Giacomo Avesani, Camilla Panico, Lucia Manganaro, Benedetta Gui, Yulia Lakhman, Pamela Causa Andrieu, Nishat Bharwani, Andrea Rockall, Isabelle Thomassin-Naggara, Teresa Margarida Cunha, Evis Sala, Rosemarie Forstner, Stephanie Nougaret","doi":"10.1007/s00330-024-11300-7","DOIUrl":"10.1007/s00330-024-11300-7","url":null,"abstract":"<p><strong>Objective: </strong>To provide up-to-date European Society of Urogenital Radiology (ESUR) guidelines for staging and follow-up of patients with ovarian cancer (OC).</p><p><strong>Methods: </strong>Twenty-one experts, members of the female pelvis imaging ESUR subcommittee from 19 institutions, replied to 2 rounds of questionnaires regarding imaging techniques and structured reporting used for pre-treatment evaluation of OC patients. The results of the survey were presented to the other authors during the group's annual meeting. The lexicon was aligned with the Society of American Radiology (SAR)-ESUR lexicon; a first draft was circulated, and then comments and suggestions from the other authors were incorporated.</p><p><strong>Results: </strong>Evaluation of disease extent at diagnosis should be performed by chest, abdominal, and pelvic CT. The radiological report should map the disease with specific mention of sites that may preclude optimal cytoreductive surgery. For suspected recurrence, CT and [¹⁸F]FDG PET-CT are both valid options. MRI can be considered in experienced centres, as an alternative to CT, considering the high costs and the need for higher expertise in reporting.</p><p><strong>Conclusions: </strong>CT is the imaging modality of choice for preoperative evaluation and follow-up in OC patients. A structured radiological report, including specific mention of sites that may preclude optimal debulking, is of value for patient management.</p><p><strong>Key points: </strong>Question Guidelines were last published for ovarian cancer (OC) imaging in 2010; here, guidance on imaging techniques and reporting, incorporating advances in the field, are provided. Findings Structured reports should map out sites of disease, highlighting sites that limit cytoreduction. For suspected recurrence, CT and 18FDG PET-CT are options, and MRI can be considered. Clinical relevance Imaging evaluation of OC patients at initial diagnosis (mainly based on CT), using a structured report that considers surgical needs is valuable in treatment selection and planning.</p>","PeriodicalId":12076,"journal":{"name":"European Radiology","volume":" ","pages":"4029-4039"},"PeriodicalIF":4.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12165971/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142964328","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementation of the 9th TNM for lung cancer: practical insights for radiologists.","authors":"Gianluca Argentieri, Clara Valsecchi, Francesco Petrella, Lisa Jungblut, Thomas Frauenfelder, Filippo Del Grande, Stefania Rizzo","doi":"10.1007/s00330-024-11345-8","DOIUrl":"10.1007/s00330-024-11345-8","url":null,"abstract":"<p><p>Lung cancer is the most common and deadly cancer worldwide. The 9th edition of the tumor node meta (TNM) classification system, effective from January 1, 2025, introduces significant updates. Notably, the N2 category is newly divided into N2a (single-station involvement) and N2b (multiple-station involvement), which reflects distinct prognostic implications. Additionally, the M1c category is now subcategorized into M1c1 (multiple metastases in a single organ system) and M1c2 (metastases in multiple organ systems), affecting stage classification. This reclassification allows for potential downstaging, which could expand treatment options for affected patients. Accurate imaging remains crucial for the classification of anatomical stages. As the TNM system evolves, enhanced imaging precision will play a key role in implementing these updates and ultimately improve patient outcomes. KEY POINTS: Question The 9th TNM for lung cancer introduces changes in the N2 and M1c descriptors, to better align with new therapeutic options and outcome studies. Findings Proper knowledge of the key changes of the 9th TNM can help radiologists offer clinicians a meaningful report. Clinical relevance Radiologists should incorporate the 9th TNM classification into their reports and discussions in multidisciplinary meetings, thus ensuring a common language across disciplines to enable clearer communication with other specialists, supporting more precise and cohesive decision-making in patient care.</p>","PeriodicalId":12076,"journal":{"name":"European Radiology","volume":" ","pages":"4395-4402"},"PeriodicalIF":4.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12165876/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143002141","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of artificial intelligence-aided differentiation of adenomatous and non-adenomatous colorectal polyps at CT colonography on radiologists' therapy management.","authors":"Sergio Grosu, Matthias P Fabritius, Michael Winkelmann, Daniel Puhr-Westerheide, Maria Ingenerf, Stefan Maurus, Anno Graser, Christian Schulz, Thomas Knösel, Clemens C Cyran, Jens Ricke, Philipp M Kazmierczak, Michael Ingrisch, Philipp Wesp","doi":"10.1007/s00330-025-11371-0","DOIUrl":"10.1007/s00330-025-11371-0","url":null,"abstract":"<p><strong>Objectives: </strong>Adenomatous colorectal polyps require endoscopic resection, as opposed to non-adenomatous hyperplastic colorectal polyps. This study aims to evaluate the effect of artificial intelligence (AI)-assisted differentiation of adenomatous and non-adenomatous colorectal polyps at CT colonography on radiologists' therapy management.</p><p><strong>Materials and methods: </strong>Five board-certified radiologists evaluated CT colonography images with colorectal polyps of all sizes and morphologies retrospectively and decided whether the depicted polyps required endoscopic resection. After a primary unassisted reading based on current guidelines, a second reading with access to the classification of a radiomics-based random-forest AI-model labelling each polyp as \"non-adenomatous\" or \"adenomatous\" was performed. Performance was evaluated using polyp histopathology as the reference standard.</p><p><strong>Results: </strong>77 polyps in 59 patients comprising 118 polyp image series (47% supine position, 53% prone position) were evaluated unassisted and AI-assisted by five independent board-certified radiologists, resulting in a total of 1180 readings (subsequent polypectomy: yes or no). AI-assisted readings had higher accuracy (76% +/- 1% vs. 84% +/- 1%), sensitivity (78% +/- 6% vs. 85% +/- 1%), and specificity (73% +/- 8% vs. 82% +/- 2%) in selecting polyps eligible for polypectomy (p < 0.001). Inter-reader agreement was improved in the AI-assisted readings (Fleiss' kappa 0.69 vs. 0.92).</p><p><strong>Conclusion: </strong>AI-based characterisation of colorectal polyps at CT colonography as a second reader might enable a more precise selection of polyps eligible for subsequent endoscopic resection. However, further studies are needed to confirm this finding and histopathologic polyp evaluation is still mandatory.</p><p><strong>Key points: </strong>Question This is the first study evaluating the impact of AI-based polyp classification in CT colonography on radiologists' therapy management. Findings Compared with unassisted reading, AI-assisted reading had higher accuracy, sensitivity, and specificity in selecting polyps eligible for polypectomy. Clinical relevance Integrating an AI tool for colorectal polyp classification in CT colonography could further improve radiologists' therapy recommendations.</p>","PeriodicalId":12076,"journal":{"name":"European Radiology","volume":" ","pages":"4091-4099"},"PeriodicalIF":4.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12165980/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143037723","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pathway plaques and diffusion-weighted lesion analysis after endovascular treatment of unruptured intracranial aneurysms: a prospective study.","authors":"Qianmei Jiang, Jing Jing, Zhu Hao, Yan Gao, Tao Liu, Xinjian Yang, Ming Lv, Shuo Chen, Zhe Zhang, Xinyao Liu, Xiaomeng Yang, Sili Jiang, Zhaobin Wang, Lian Liu","doi":"10.1007/s00330-024-11310-5","DOIUrl":"10.1007/s00330-024-11310-5","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate the prevalence and predictors of ischemic lesions on thin-slice DWI (2 mm) in endovascular treatments for unruptured intracranial aneurysms (UIA), particularly explore the potential relationship with pathway plaques.</p><p><strong>Methods: </strong>Participants eligible for endovascular treatments with UIA at a national stroke center between March 2023 and August 2023 were prospectively enrolled. All participants performed thin-slice DWI (slice thickness of 2 mm) before and after procedures. Three-dimensional joint intra-and extracranial vessel wall MRI (3D-vwMRI, voxel size 0.6 × 0.6 × 0.6 mm³) was scheduled to evaluate the pathway plaques for all participants. The DWI-positive numbers were ordered and divided into four equal parts, with each quartile representing 25% of the data set.</p><p><strong>Results: </strong>A total of 106 participants were included. Overall, none of the participants exhibited preoperative DWI-positive lesions. Following the intervention, 93.4% (99/106) of participants exhibited new DWI-positive lesions on postoperative MRI, including 5.7% (6/106) with symptomatic ischemic stroke. Compared with the lowest quartile of ischemic lesions, the highest quartile was associated with increased odds of the presence of plaque (OR = 9.4, 95% CI: 2.0-45.4; p = 0.005). The history of previous stroke (OR = 4.6, 95% CI: 1.6-14.6; p = 0.007) and the presence of plaque in the pathway (OR = 3.4, 95% CI: 1.6-7.7; p = 0.002) were identified as independent predictors of higher quartiles of DWI-positive numbers.</p><p><strong>Conclusions: </strong>As revealed by thin-slice DWI, ischemic lesions related to the endovascular treatments for UIA occurred more frequently than anticipated. A history of the previous stroke and the pathway plaques were independent predictors of higher quartiles of DWI-positive numbers.</p><p><strong>Key points: </strong>Question Previous studies using conventional MRI may underestimate DWI-positive lesions. The procedural risk of UIA coexisting with atherosclerotic plaques is still unclear. Findings Thin-slice DWI showed ischemic lesions occurred frequently (93.4%). Three-dimensional-intra-and extracranial Vessel Wall MRI revealed a positive correlation between pathway plaques and DWI lesions. Clinical relevance Neuro-interventionalists should exercise caution when managing patients with a history of previous stroke in the presence of plaques in the treatment pathway. More vigilant pre-procedural imaging should be considered to assess unstable plaque in high-risk patients.</p>","PeriodicalId":12076,"journal":{"name":"European Radiology","volume":" ","pages":"4141-4151"},"PeriodicalIF":4.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142871792","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":"Incidental pancreatic cystic lesions: retrospective analysis of natural history and efficacy of imaging surveillance guidelines.","authors":"Victoria Linehan, Andreu F Costa","doi":"10.1007/s00330-024-11307-0","DOIUrl":"10.1007/s00330-024-11307-0","url":null,"abstract":"<p><strong>Objectives: </strong>To assess the natural history of incidental pancreatic cystic lesions (PCLs) and the sensitivity of surveillance guidelines to detect malignancy.</p><p><strong>Materials and methods: </strong>We performed a single-center retrospective analysis of incidental PCLs discovered between 2012 and 2017. Patients were identified by searching radiology reports for relevant keywords, then search results were manually reviewed to exclude patients with < 5 years of follow-up, non-incidental PCLs, known pancreatic cancer, or pancreatitis. Baseline and follow-up imaging was reviewed to record size, growth (as defined by the American College of Radiology (ACR)), high-risk stigmata, and incidence of malignancy. Four major guidelines (International Consensus, European, ACR, and Canadian Association of Radiologists (CAR)) were retrospectively applied to assess sensitivity to detect invasive disease. Benign and malignant PCL outcomes were compared (Fisher's exact test), and PCL growth was modeled (mixed-effects regression).</p><p><strong>Results: </strong>Four hundred and forty-nine patients (67 ± 12 years, 284 women) with 556 PCLs were included. PCL natural growth was 0.33 mm/year (0.26-0.40 mm 95% CI), which overlaps with significant growth thresholds for ACR and CAR guidelines. Nine patients over 21,996 patient-years of follow-up developed pancreatic cancer (4.1 cases/10,000 patient-years). Malignancy was not associated with significant growth (4/9 vs 107/547, p = 0.084) but was with high-risk stigmata (3/9 vs 3/547, p < 0.001). Guideline sensitivities ranged from 33.3 to 66.7% (2-4/6 cases).</p><p><strong>Conclusion: </strong>PCLs are common, overwhelmingly benign, and grow slowly. Development of high-risk stigmata is associated with malignancy but not \"significant growth,\" which can overlap with natural PCL growth. Despite differences in recommended duration and frequency of follow-up, surveillance guidelines still miss 1/3-2/3 of cancers.</p><p><strong>Key points: </strong>Question There is limited evidence on the natural growth and malignant potential of incidental pancreatic cystic lesions. Findings Incidental pancreatic cystic lesions grew slowly (0.3 mm/year) and were uncommonly malignant (2%). Retrospective application of surveillance guidelines missed 1/3-2/3 of cancers. Clinical relevance Radiologists and imaging surveillance guidelines should account for the natural growth of incidental pancreatic cystic lesions. Given the low rate of malignancy, high proportion of missed cancers, and risk of overtreatment, the effectiveness of imaging surveillance guidelines remains unclear.</p>","PeriodicalId":12076,"journal":{"name":"European Radiology","volume":" ","pages":"4100-4110"},"PeriodicalIF":4.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142871226","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":"Interhospital variations in diagnostic work-up following recall at biennial screening mammography-a population-based study.","authors":"Eline L van der Veer, Fenna Rozemond, Manon I Generaal, Adriana M J Bluekens, Angela M P Coolen, Adri C Voogd, Lucien E M Duijm","doi":"10.1007/s00330-024-11302-5","DOIUrl":"10.1007/s00330-024-11302-5","url":null,"abstract":"<p><strong>Objectives: </strong>Quality control in breast cancer screening programmes has been subject of several studies. However, less is known about the clinical diagnostic work-up in recalled women with a suspicious finding at screening mammography. The current study focuses on interhospital differences in diagnostic work-up strategies.</p><p><strong>Materials and methods: </strong>In this retrospective analysis, using a prospectively obtained database, we included 17,809 women who participated in the Dutch national screening programme between 2009 and 2019 and were recalled to a hospital for analysis of a suspicious mammographic abnormality. The diagnostic work-up (e.g., type and frequency of additional imaging and biopsy) in the different hospitals were compared and analysed by multivariable analysis to correct for confounders.</p><p><strong>Results: </strong>Use of biopsy varied from 36.7% to 48.7% (p < 0.001) between hospitals, and the use of problem-solving magnetic resonance imaging (MRI) from 2.1% to 6.9% (p < 0.001). These interhospital differences remained after correction for patients and tumour characteristics. The percentage of women with a delayed breast cancer diagnosis, defined as histopathological confirmation of breast cancer more than three months after recall or first analysis in the hospital, varied from 2.7% to 6.1% between hospitals (p = 0.07).</p><p><strong>Conclusions: </strong>In our screening region interhospital differences were observed in diagnostic work-up following recall at biennial screening mammography. Though statistically significant, absolute differences were small, and therefore, their clinical impact appears to be limited.</p><p><strong>Key points: </strong>Question It is unclear how diagnostic work-up strategies vary between hospitals for women recalled after suspicious findings in breast cancer screening. Findings Significant differences in biopsy techniques and the use of problem-solving MRI were observed, though the clinical impact of these variations is likely to be marginal. Clinical relevance Evaluation of interhospital variation in the diagnostic work-up strategies after recall may aid in optimising the quality of breast cancer care and, indirectly, the effectiveness of the screening programme.</p>","PeriodicalId":12076,"journal":{"name":"European Radiology","volume":" ","pages":"3964-3978"},"PeriodicalIF":4.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142871773","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":"Prognostic value of interim [¹⁸F]FDG PET/CT after immunotherapy-based combinations in extranodal NK/T-cell lymphoma, nasal type.","authors":"Lei Liu, Shihui Hao, Wanqi Chen, Ming Jing, Shatong Li, Weiguang Zhang, Liping Liang, Wei Fan, Yujing Zhang","doi":"10.1007/s00330-024-11276-4","DOIUrl":"10.1007/s00330-024-11276-4","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the prognostic value of interim [¹⁸F]Fluorodeoxyglucose positron emission tomography/computed tomography ([¹⁸F]FDG PET/CT) after immunotherapy-based systemic therapies in extranodal natural killer/T-cell lymphoma (ENKTL).</p><p><strong>Patients and methods: </strong>We retrospectively recruited 133 newly diagnosed nasal-type ENKTL patients who underwent interim [¹⁸F]FDG PET/CT scans after 2-4 cycles of immunotherapy-based treatments. Interim PET/CT was interpreted by maximum standardized uptake value (SUV_max), Deauville 5-point scale (DS), and early treatment response. The prognostic value of overall survival (OS) and progression-free survival (PFS) was assessed with survival curves generated using Kaplan-Meier analysis and compared using the log-rank test. Univariate and multivariate Cox proportional hazards analyses were performed to evaluate the independent effects for survival. Model performance was assessed with a time-dependent area under the curve (time-AUC), concordance index (C-index), and the Akaike information criterion (AIC).</p><p><strong>Results: </strong>Patients with high SUV_max (> 9.2), DS 5, or with stable disease (SD) or relapsed/progressive disease (PD) on interim PET/CT showed significantly unfavorable OS and PFS with the Kaplan-Meier estimate, respectively. The interim PET/CT parameters remained independent predictors for both OS and PFS after univariate and multivariate analysis. We combined interim DS with the prognostic index for natural killer cell lymphoma-Epstein-Barr virus (PINK-E) model to stratify our cohort into 3 risk categories: low-risk (0-2 risk factors), intermediate-risk (3 risk factors), and high-risk (≥ 4 risk factors), which showed significant and superior stratifications of OS and PFS than PINK-E.</p><p><strong>Conclusion: </strong>Interim PET/CT after immunotherapy-based systemic treatments showed independent prognostic value for ENKTL. The model combining interim PET/CT with PINK-E might be an effective prognostic tool.</p><p><strong>Key points: </strong>Question The prognostic value of interim [¹⁸F]FDG PET/CT in extranodal natural killer/T-cell lymphoma remains uncertain, especially after the introduction of immunotherapy. Findings Deauville 5-point scale on interim [¹⁸F]FDG PET/CT after immunotherapy-based systemic therapies was an independent predictor for newly diagnosed extranodal natural killer/T-cell lymphomas. Clinical relevance Interim [¹⁸F]FDG PET/CT alone or combined with the prognostic index for natural killer cell lymphoma-Epstein-Barr virus (PINK-E) model is an effective and superior prognostic tool for clinical application in the era of immunotherapy.</p>","PeriodicalId":12076,"journal":{"name":"European Radiology","volume":" ","pages":"4213-4222"},"PeriodicalIF":4.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143002624","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}