European Radiology最新文献

{"title":"Integration of AI lesion classification, age, and BI-RADS assessment to reduce benign biopsies on breast ultrasound.","authors":"Yan Ju, Ge Zhang, Yi Wan, Gang Wang, Rui Shu, Panpan Zhang, Hongping Song","doi":"10.1007/s00330-025-11467-7","DOIUrl":"https://doi.org/10.1007/s00330-025-11467-7","url":null,"abstract":"<p><strong>Objectives: </strong>To develop and test AI-integrated biopsy avoidance strategies to improve the specificity of screening breast ultrasound (US).</p><p><strong>Materials and methods: </strong>This retrospective study included consecutive asymptomatic women with BI-RADS 3, 4a, 4b, 4c, or 5 masses on screening breast US exams acquired from two hospitals between December 2019 and December 2020 (development cohort) and June 2020 and December 2020 (external validation cohort). If more than one lesion was present, the most suspicious lesion was analyzed. Logistic regression was used to develop the AI-integrated biopsy avoidance strategies in which BI-RADS 4a masses were downgraded to BI-RADS 3 if the AI classifications were \"both planes benign\" in all women or \"benign and malignant\" in the women ≤ 45 years of age. Diagnostic performance metrics were calculated for both cohorts and compared to initial assessments by radiologists using the Wilcoxon rank-sum test for noninferiority of sensitivity (relative noninferiority margin, 5%) and the McNemar test for specificity.</p><p><strong>Results: </strong>The development and external validation cohorts consisted of 393 women (median age, 45 years [IQR, 40-50 years]) with 101 malignancies and 166 women (median age, 47 years [IQR, 42-51 years]) with 31 malignancies, respectively. The developed strategy improved specificity from 53.3% (72/135; 95% CI: 45.0, 62.1) to 80.7% (109/135; [95% CI: 74.2, 87.5]; p < 0.001) while maintaining sensitivity (both 100% [31/31; 95% CI: 98.9, 100]), and would have avoided 61.7% (37/60 [95% CI: 48.2, 73.7]) of benign biopsies of BI-RADS 4a masses in the external validation cohort.</p><p><strong>Conclusion: </strong>A strategy integrating AI classification in two orthogonal planes, age, and BI-RADS classification improved the specificity of screening breast US while maintaining non-inferior sensitivity.</p><p><strong>Key points: </strong>Question How can integrating AI lesion classification, age, and BI-RADS assessment effectively reduce benign biopsies in screening breast ultrasound? Findings A strategy integrating AI classifications, age, and BI-RADS using multivariable logistic regression improved specificity while maintaining non-inferior sensitivity in breast ultrasound screening. Clinical relevance The integration of AI classification in two orthogonal planes, along with patient age and BI-RADS classification, shows potential for reducing benign breast biopsies without compromising sensitivity, leading to more efficient clinical decision-making, reduced patient anxiety, and decreased healthcare resource utilization.</p>","PeriodicalId":12076,"journal":{"name":"European Radiology","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143691525","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":"Carotid artery atherosclerosis and white matter lesions in the elderly: a community-based MR imaging study.","authors":"Ying Cai, Yang Liu, Huiyu Qiao, Huijun Chen, Rui Li, Ji Zhang, Xihai Zhao","doi":"10.1007/s00330-025-11509-0","DOIUrl":"https://doi.org/10.1007/s00330-025-11509-0","url":null,"abstract":"<p><strong>Objectives: </strong>This study sought to evaluate the relationship between morphological and compositional characteristics of carotid atherosclerotic plaques and white matter lesions (WMLs) in asymptomatic elderly adults using three-dimensional (3D) multicontrast magnetic resonance (MR) vessel wall imaging.</p><p><strong>Materials and methods: </strong>Asymptomatic elderly subjects (≥ 60 years) were recruited from a community-based study. Carotid arteries and the brain were imaged on a 3.0-T MR scanner. The morphological and compositional features of carotid atherosclerotic plaques were evaluated. The WMLs were scored using the Fazekas criteria. The characteristics of carotid plaque were compared among different WML severities and the associations between carotid plaque characteristics and WMLs were analyzed.</p><p><strong>Results: </strong>In total, 123 elderly subjects (mean age: 71.9 ± 6.0 years, 55 males) were included. A significant difference was found in carotid MWT, presence of calcification, and high-risk plaque among subjects with different severity of WMLs (all p < 0.05). Univariate logistic regression analysis showed that carotid plaque calcification (OR, 5.357; 95% CI: 1.556-18.437, p = 0.008), intraplaque hemorrhage (OR, 4.952; 95% CI: 1.089-22.514, p = 0.038), and high-risk plaque (OR, 7.214; 95% CI: 1.929-26.974, p = 0.003) in carotid arteries were significantly associated with severe WML. After adjusting for the confounding factors, the significance of these associations was attenuated and only the association of high-risk plaque with severe WML remained statistically significant (OR, 8.829; 95% CI: 1.566-49.787; p = 0.014).</p><p><strong>Conclusion: </strong>Carotid artery plaque compositional characteristics, especially high-risk plaque, were significantly associated with the severity of WMLs, suggesting that carotid vulnerable atherosclerotic plaque might be an independent indicator for cerebral small vessel disease in asymptomatic elderly adults.</p><p><strong>Key points: </strong>Question The relationship between carotid atherosclerotic plaque characteristics and WMLs in asymptomatic elderly adults remains unclear. Findings High-risk carotid plaques are significantly associated with the severity of WMLs in the asymptomatic elderly. Clinical relevance Identifying carotid plaque characteristics, particularly high-risk plaques, may serve as an indicator for cerebral small vessel disease, aiding in early detection and management of related risks in the asymptomatic elderly.</p>","PeriodicalId":12076,"journal":{"name":"European Radiology","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143662820","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":"Brain MRI changes in children and young adults with B-cell acute lymphoblastic leukemia following chimeric antigen receptor T-cell therapy.","authors":"Hyun Gi Kim, Kristen W Yeom, Iryna Vasyliv, Zahra Shokri Varniab, Courtney Erickson, Christina Baggott, Liora Michal Schultz, Heike E Daldrup-Link","doi":"10.1007/s00330-025-11515-2","DOIUrl":"https://doi.org/10.1007/s00330-025-11515-2","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate brain MRI findings in children and young adults after chimeric antigen receptor (CAR) T-cell therapy for B-cell acute lymphoid leukemia (B-ALL) and associate results with clinical and neurological symptoms.</p><p><strong>Methods: </strong>We reviewed pre- and post-CAR-T cell therapy brain MRIs of B-ALL patients aged 25 years or younger who underwent therapy between April 2015 and October 2023 at a single institution. MRI abnormalities were categorized as no change, exacerbation of preexisting lesion, or newly developed lesion. Clinical CAR-mediated toxicities, including cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS) grades, were recorded. Patients were grouped into those with and without 'exacerbated/new lesion,' and clinical and neurological symptoms were compared using Fisher's exact test.</p><p><strong>Results: </strong>Sixteen patients with pre- and post-CAR brain MRIs (median age 16 years [interquartile range, 11-21]; 9 males, 7 females) were included in the analysis. Post-CAR brain abnormalities were observed in 81% (13/16) of patients, including white matter (WM) signal changes (12/16), leptomeningeal enhancement (1/16), and cerebellar embolic infarction (1/16). Of the post-CAR WM lesions, 50% (6/12) were exacerbated, 33% (4/12) were newly developed, and 17% (2/12) remained unchanged compared to pre-CAR brain MRI. No difference in CRS (p = 0.079) or ICANS grades (p > 0.99) was observed between patients with and without 'exacerbated/new lesions'.</p><p><strong>Conclusion: </strong>Children and young adults with B-ALL can develop brain MRI abnormalities after CAR T-cell therapy, predominantly WM signal changes. These brain abnormalities did not show an association with higher CRS or ICANS grade.</p><p><strong>Key points: </strong>Question Brain MRI findings after chimeric antigen receptor (CAR) T-cell therapy for B-cell acute lymphoid leukemia (B-ALL) and their association with clinical and neurological symptoms are not well understood. Findings Brain MRI abnormalities, mostly white matter changes, were seen in 81% of patients but were not associated with CAR-mediated toxicities. Clinical relevance Brain MRI abnormalities, commonly observed post-CAR T-cell therapy, do not correlate with the severity of CAR-related toxicities, aiding in the clinical management and monitoring of these patients.</p>","PeriodicalId":12076,"journal":{"name":"European Radiology","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143668873","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":"Evaluation of induction chemotherapy response using multiphasic dual-energy CT in nasopharyngeal carcinoma.","authors":"Huanhuan Ren, Junhao Huang, Daihong Liu, Yao Huang, Xinying Ren, Jing Zhang, Yong Tan, Hong Yu, Jiahui Zheng, Lin Tang, Ying Wang, Jiuquan Zhang","doi":"10.1007/s00330-025-11512-5","DOIUrl":"https://doi.org/10.1007/s00330-025-11512-5","url":null,"abstract":"<p><strong>Objectives: </strong>To develop a nomogram that assists in selecting nasopharyngeal carcinoma (NPC) patients suitable for induction chemotherapy.</p><p><strong>Materials and methods: </strong>This retrospective study included NPC patients who underwent multiphasic contrast‑enhanced DECT (comprising non-contrast, arterial, and venous phase scanning) between May 2019 and December 2023. The relationships between quantitative DECT-derived parameters and treatment response to induction chemotherapy were analyzed using logistic regression analysis. The predictive performance of a nomogram integrating key predictors was assessed using the area under the receiver operating characteristic curve (AUC).</p><p><strong>Results: </strong>A total of 294 patients (median age, 53 years; interquartile range, 46-59 years; 224 men) were included. Among these, 215 were responders and 79 were non-responders. The normalized iodine concentration in the arterial phase (nIC_arterial) (odds ratio (OR), 0.71; 95% confidence interval (CI), 0.52-0.98; p = 0.036), arterial enhancement fraction (AEF) (OR, 1.45; 95% CI, 1.04-2.00; p = 0.026), and extracellular volume fraction (ECVf) (OR, 0.65; 95% CI, 0.15-0.87; p = 0.019) of tumors were identified as independent predictors of chemotherapy response. This nomogram demonstrated excellent performance (AUC = 0.803 [95% CI, 0.740-0.864]) across all participants, as well as in subgroup analyses of Epstein-Barr virus DNA (high and low) (AUC: 0.761, 0.799) and across five subgroups with different chemotherapy regimens (AUC, 0.773-0.833).</p><p><strong>Conclusions: </strong>We developed a comprehensive nomogram to predict treatment response to induction chemotherapy by integrating nIC_arterial, AEF, and ECVf. This nomogram demonstrated superior predictive performance compared to the individual parameters when assessed separately.</p><p><strong>Key points: </strong>Question To date, no reliable method has been established to predict the efficacy of induction chemotherapy for nasopharyngeal carcinoma prior to treatment. Findings nIC_arterial, AEF, and ECVf were the independent predictors of induction chemotherapy response, and the combined nomogram demonstrated strong performance to predict response. Clinical relevance The multiphasic contrast‑enhanced parameters derived from dual-energy CT offer a noninvasive approach to predict treatment response to induction chemotherapy and identify nasopharyngeal carcinoma patients who may benefit from induction chemotherapy.</p>","PeriodicalId":12076,"journal":{"name":"European Radiology","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143669131","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":"Influence of deep learning-based super-resolution reconstruction on Agatston score.","authors":"Tomoro Morikawa, Yuki Tanabe, Hiroshi Suekuni, Naoki Fukuyama, Wataru Toshimori, Hidetaka Toritani, Shun Sawada, Takuya Matsuda, Shota Nakano, Teruhito Kido","doi":"10.1007/s00330-025-11506-3","DOIUrl":"https://doi.org/10.1007/s00330-025-11506-3","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the impact of deep learning-based super-resolution reconstruction (DLSRR) on image quality and Agatston score.</p><p><strong>Methods: </strong>Consecutive patients who underwent cardiac CT, including unenhanced CT for Agatston scoring, were enrolled. Four types of non-contrast CT images were reconstructed using filtered back projection (FBP) and three strengths of DLSRR. Image quality was assessed by measuring image noise, signal-to-noise ratio (SNR) of the aorta, contrast-to-noise ratio (CNR), and edge rise slope (ERS) of coronary artery calcium (CAC). Agatston score and CAC volume were also measured. These results were compared among the four CT datasets. Patients were categorized into four risk levels based on the Coronary Artery Calcium Data and Reporting System (CAC-DRS), and the concordance rate between FBP and DLSRR classifications was evaluated.</p><p><strong>Results: </strong>For the 111 patients enrolled, DLSRR significantly reduced image noise (p < 0.001) and improved SNR and CNR (p < 0.001), with stronger effects at higher DLSRR strengths (p < 0.01). ERS was significantly enhanced using DLSRR compared with FBP (p < 0.001), whereas there was no significant difference among the three strengths of DLSRR (p = 0.90-0.98). Agatston score and CAC volume were not significantly affected by DLSRR (p = 0.952 and 0.901, respectively). The concordance rate of CAC-DRS classification between FBP and DLSRR was 93%.</p><p><strong>Conclusion: </strong>DLSRR significantly improves image quality by reducing noise and enhancing sharpness without significantly altering Agatston scores or CAC volumes. The concordance rate of CAC-DRS classification with FBP was high, although some reclassifications were observed.</p><p><strong>Key points: </strong>Question The utility of deep learning-based super-resolution reconstruction (DLSRR) in coronary CT angiography is well known, but its impact on the Agatston score remains unclear. Findings DLSRR significantly improved image quality without altering the Agatston scores, but some reclassifications of Coronary Artery Calcium Data and Reporting System (CAC-DRS) were observed. Clinical relevance DLSRR should be cautiously used in clinical settings owing to the occurrence of some cases of CAC-DRS reclassification.</p>","PeriodicalId":12076,"journal":{"name":"European Radiology","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143662828","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":"Bedside ultrasound-guided contrast enema for preterm infants with suspected meconium plug syndrome: a 10-year single-center experience.","authors":"Won-Seok Yoo, Haesung Yoon, In Geol Ho, Jisoo Kim, Hyun Ji Lim, Jung-Tak Oh, Hoseon Eun, Mi-Jung Lee","doi":"10.1007/s00330-025-11511-6","DOIUrl":"https://doi.org/10.1007/s00330-025-11511-6","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate the safety and efficacy of bedside ultrasound-guided contrast enema (US-enema) in the neonatal intensive care unit (NICU) and to assess factors associated with its outcome.</p><p><strong>Materials and methods: </strong>This retrospective study included preterm NICU babies who underwent US-enema for suspected meconium plug syndrome between 2014 and 2023. Patient characteristics, procedure-related factors, necrotizing enterocolitis (NEC) grades on US, presence of microcolon, and outcomes were reviewed. Group comparison and correlation analyses were performed.</p><p><strong>Results: </strong>Eighty-two patients (mean gestational age at birth, 27.1 ± 2.5 weeks; mean birth weight, 872.0 ± 378.5 g; 45 males) with 128 sessions of US-enema were enrolled. Forty patients had no NEC, 32 had grade 1 NEC, and 10 had grade 2 NEC. Enema was repeated in 37 patients (45.1%), up to four times. The mean age at initial US-enema was 17.3 days. US-enema was successful in 68.3% (56/82) of patients. There were three events (3/128, 2.3%) of bowel perforation during enema, all had microcolon (p = 0.02), and two cases (2/82, 2.4%) of bowel-related mortality. Patients with enema success had higher gestational age at birth (27.6 vs. 25.9 weeks; p = 0.006), were older at initial enema (19.3 vs. 13.0 days; p = 0.02), and showed microcolon less frequently (12.5% (7/56) vs. 61.5% (16/26); p < 0.001) than those with enema failure.</p><p><strong>Conclusion: </strong>US-enema is safe and effective for preterm NICU babies with suspected meconium plug syndrome. Higher gestational age at birth and older age at enema without microcolon were associated with successful enema.</p><p><strong>Key points: </strong>Question Bedside ultrasound-guided contrast enema (US-enema) is considered an effective technique for preterm neonates with meconium plug syndrome, but data on outcome-related factors are limited. Findings US-enema successfully treated 68.3% of patients, with a 2.3% rate of bowel perforation. Higher gestational/postnatal age and absence of microcolon were associated with successful enemas. Clinical relevance US-enema is an effective and safe technique for meconium plug syndrome with a low risk of complications. Preterm neonates with higher gestational age at birth, older age at the time of enema, and without microcolon showed better treatment responses.</p>","PeriodicalId":12076,"journal":{"name":"European Radiology","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143662819","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":"Incidence of temporal thumb sign in adult patients with idiopathic seizures with and without elevated opening cerebrospinal fluid pressure.","authors":"Kamand Khalaj, Michael A Jacobs, Larry A Kramer, Thierry A G M Huisman, Manish N Shah, Alireza Akhbardeh, Khader M Hasan, Ian J Butler, Xu Zhang, Arash Kamali","doi":"10.1007/s00330-025-11499-z","DOIUrl":"https://doi.org/10.1007/s00330-025-11499-z","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;The temporal thumb sign (TTS) has emerged as a potential distinct magnetic resonance imaging (MRI) finding in pediatric patients with new-onset idiopathic seizures which is characterized by the protrusion of the inferior temporal gyrus into the skull base. This study investigated the prevalence and clinical implications of TTS in adult patients with idiopathic seizures, with or without elevated opening cerebrospinal fluid (CSF) pressure, and those diagnosed with idiopathic intracranial hypertension (IIH) without seizures.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Materials and methods: &lt;/strong&gt;A retrospective study was conducted on 157 adults aged 18-40-years-old, divided into four distinct groups. Group 1 consisted of 52 patients diagnosed with idiopathic intracranial hypertension (IIH) without seizures. Group 2 included 27 patients with seizures and elevated opening CSF pressure. Group 3 comprised 39 patients with seizures but normal opening CSF pressure. Group 4 consisted of 39 controls. MRI or CT scans and lumbar puncture data were analyzed to evaluate the presence of TTS. Statistical analysis was performed to assess the prevalence, sensitivity, and specificity of TTS across groups. Significant differences were defined as p &lt; 0.05.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Significant differences in TTS prevalence were observed between all groups (p &lt; 0.001). TTS was most frequently detected in patients with seizures and elevated opening pressure (92.6%), followed by IIH patients without seizures (63.5%), and patients with seizures and normal opening pressure (61.5%). The control group exhibited a lower frequency of TTS (12.8%). Logistic regression demonstrated the association of TTS with seizure and elevated intracranial pressure (p &lt; 0.001). Inter-rater reliability analysis showed excellent agreement between observers.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;The results of this study suggest that the Kamali \"Temporal Thumb Sign\" is a novel neuroimaging feature associated with seizures and elevated opening CSF pressure in adult patients. High sensitivity (92.6%) of the TTS may yield it as a screening imaging marker in either brain CT or MRI scans in the emergency department, which could aid in suspecting possible elevated opening CSF pressure and proceeding with further workup. The association of TTS with seizures suggests a potential link between elevated intracranial pressure and structural alterations in the skull base with seizure presentation. The TTS may represent a distinct manifestation of intracranial hypertension, similar to temporal lobe encephaloceles.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Key points: &lt;/strong&gt;Question This study investigates the prevalence and clinical implications of TTS in adults with idiopathic seizures at a single institution. Findings TTS was detected in 92.6% of patients with seizures and elevated CSF pressure. Clinical relevance TTS may serve as a sensitive marker for identifying elevated intracranial pressure in patients presenting with","PeriodicalId":12076,"journal":{"name":"European Radiology","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143669187","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":"PSMA-avid rib lesions in prostate cancer patients: differentiating false positives from metastatic disease.","authors":"Sungmin Woo, Anton S Becker, Doris Leithner, Charlotte Charbel, Marius E Mayerhoefer, Kent P Friedman, Angela Tong, Sofya Murina, Matthew Siskin, Samir S Taneja, Michael J Zelefsky, David R Wise, Hebert A Vargas","doi":"10.1007/s00330-025-11514-3","DOIUrl":"https://doi.org/10.1007/s00330-025-11514-3","url":null,"abstract":"<p><strong>Objectives: </strong>Prostate-specific membrane antigen (PSMA)-PET/CT has become integral to management of prostate cancer; however, PSMA-avid rib lesions pose a diagnostic challenge. This study investigated clinicopathological and imaging findings that predict metastatic etiology of PSMA-avid rib lesions.</p><p><strong>Materials and methods: </strong>Consecutive patients with prostate cancer that underwent PET/CT with [¹⁸F]F-DCFPyL in 2021-2023 for newly diagnosed intermediate-/high-risk prostate cancer or recurrent/metastatic disease and had PSMA-avid rib lesions were included. Imaging findings assessed were: lesion number, PSMA expression (maximum standard uptake value (SUV_max), miPSMA score), CT features (sclerotic, lucent, fracture, no correlate), other sites of metastases, and primary tumor findings. A composite reference standard for rib lesion etiology (metastatic vs non-metastatic) based on histopathology, serial imaging, and clinical assessment was used.</p><p><strong>Results: </strong>One hundred and seventy-five men (median 71 years, IQR 65-77) with PSMA-avid rib lesions were included; 47/175 (26.9%) had rib metastases. Only 1/47 (2.1%) of these patients had isolated rib metastasis without PSMA-avid metastases in other bones, nodes, or visceral organs; the other 46/47 (97.9%) patients with rib metastases also had other sites of PSMA-avid disease. Patients with rib metastases were older, had higher prostate-specific antigen levels, and higher-grade tumors (p < 0.01). Metastatic rib lesions had higher uptake (SUV_max, miPSMA), more commonly involved multiple ribs, and were more often sclerotic (p < 0.01); lucency/fractures were only seen in benign lesions.</p><p><strong>Conclusion: </strong>Several imaging and clinicopathological factors differed between PSMA-avid metastatic and benign lesions. Isolated rib lesions without other sites of metastasis are almost always benign. Careful assessment of CT features can help diagnose benign lesions.</p><p><strong>Key points: </strong>Question While prostate-specific membrane antigen (PSMA)-PET/CT has become integral to the management of prostate cancer, PSMA-avid rib lesions pose a diagnostic challenge. Findings Approximately a quarter of patients who had PSMA-avid rib lesions were metastatic. However, only 2.1% of them had isolated rib metastasis (without PSMA-avid metastases elsewhere). Clinical relevance Isolated PSMA-avid rib lesions are almost always benign when there is no evidence of metastatic disease elsewhere. Scrutinizing CT features can help diagnose benign PSMA-avid lesions with greater certainty.</p>","PeriodicalId":12076,"journal":{"name":"European Radiology","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143662881","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":"Preoperative estimation of the pathological breast tumor size in architectural distortions: a comparison of DM, DBT, US, CEM, and MRI.","authors":"Javier Azcona Sáenz, Javier Molero Calafell, Marta Román Expósito, Elisenda Vall Foraster, Laura Comerma Blesa, Rodrigo Alcántara Souza, María Del Mar Vernet Tomás","doi":"10.1007/s00330-025-11502-7","DOIUrl":"https://doi.org/10.1007/s00330-025-11502-7","url":null,"abstract":"<p><strong>Objective: </strong>This study aims to compare the accuracy of digital mammography (DM), digital breast tomosynthesis (DBT), ultrasound (US), magnetic resonance imaging (MRI), and contrast-enhanced mammography (CEM) in the preoperative evaluation of breast cancer size in architectural distortions (ADs). Additionally, it assesses whether including thin spicules in mammography measurements affects accuracy.</p><p><strong>Materials and methods: </strong>We planned a retrospective analysis of invasive breast cancers presenting as ADs in our breast screening program between 2018 and 2022. Tumor size was measured in mm using DM, DBT, US, MRI, and CEM. Measurements were compared to the surgical specimen sizes. Two measurement approaches for DM and DBT were applied, considering and not considering thin spicules. T-student test was used to compare mean sizes across imaging techniques with the surgical specimen.</p><p><strong>Results: </strong>The study encompassed 59 female patients with 63 ADs. Mean age was 60.1 years (Standard Deviation (SD): 6.3). The cancers included four histological subtypes, ductal (69.8%), lobular (23.8%), tubular (4.8%), and micropapillary (1.6%). All imaging techniques, except for US (mean: 12.4 mm, SD: 5.7), overestimated tumor size compared to histology (mean: 16.40 mm, SD: 9). CEM, MRI, and DBT without thin spicules closely matched histological size. Including thin spicules in DM and DBT led to overestimation. Concordance was highest with CEM (75%) and MRI (67.6%). No significant differences were found between ductal and lobular carcinoma.</p><p><strong>Conclusion: </strong>For preoperative tumor size estimation of breast cancer in ADs, DBT excluding thin spicules, CEM, and MRI seemed most accurate. Including thin spicules in mammography leads to overestimation.</p><p><strong>Key points: </strong>Question Identifying the most accurate imaging technique for preoperative tumor staging of architectural distortions (ADs) is crucial now that contrast-enhanced mammography (CEM) is widely implemented. Findings Measuring thin wispy spicules in ADs on digital (DM) and digital breast tomosynthesis (DBT) should be avoided, as they consistently overestimate pathological tumor stage. Clinical relevance Precise tumor size estimation in ADs is critical for proper staging and treatment planning. This study favors the use of DBT excluding thin spicules, CEM, and magnetic resonance imaging (MRI) for optimal accuracy.</p>","PeriodicalId":12076,"journal":{"name":"European Radiology","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143669321","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: pseudolesions in head and neck-practice recommendations by the European Society of Head and Neck Radiology.","authors":"Darka Hadnadjev Šimonji, Aleksandar Spasić, Maja Stankov","doi":"10.1007/s00330-025-11477-5","DOIUrl":"https://doi.org/10.1007/s00330-025-11477-5","url":null,"abstract":"<p><p>The differentiation between pathological and physiological entities constitutes a fundamental aspect of daily radiological practice. Pseudolesions manifest as a transient phenomenon within this spectrum, displaying features of pathology within the context of normal or variant anatomy. A variety of structures, including vascular components, ectopic formations, or deviations from typical developmental patterns, can mimic pathological entities. It is crucial to discern between the two: lesions warranting treatment or ongoing radiological monitoring and pseudolesions where further analysis or treatment is unnecessary. Radiology plays a key role in classifying these entities. Comprehensive knowledge and accurate assessment of head and neck pseudolesions are necessary for radiologists to avoid unnecessary further diagnostic tests, treatments, and distress for the patient. KEY POINTS: Pseudolesions are an aspect of typical anatomy. Ectopic structures will have the same intensity/density no matter the location. Pursuit of a vascular origin can be a problem solver. Incorporate pseudolesions in the report.</p>","PeriodicalId":12076,"journal":{"name":"European Radiology","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143669140","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}