European Radiology最新文献

{"title":"Correlation between tumor stroma ratio, prognosis, and apparent diffusion coefficient in alveolar soft part sarcoma.","authors":"Shaobo Fang, Junhui Yuan, Keshuo Yang, Fan Meng, Dongqiu Shan, Chunmiao Xu, Xuejun Chen, Meiyun Wang","doi":"10.1007/s00330-025-11490-8","DOIUrl":"https://doi.org/10.1007/s00330-025-11490-8","url":null,"abstract":"<p><strong>Objectives: </strong>To investigate the correlation between tumor stroma ratio (TSR) and survival in patients with alveolar soft part sarcoma (ASPS), and the application of apparent diffusion coefficient (ADC) histogram parameters in assessing TSR.</p><p><strong>Methods: </strong>This retrospective study collected 61 patients from May 2015 to December 2018. TSR was classified as stroma-rich (low TSR) or stroma-poor (high TSR) based on histology. The correlation between TSR and clinicopathological characteristics was analyzed. Prognostic value for 5-year progression-free survival (5-PFS) and 5-year overall survival (5-OS) were assessed using Kaplan-Meier analysis, log-rank test, and Cox regression. Independent sample t-tests or Mann-Whitney U-test and receiver operating characteristic curve analysis examined TSR and ADC histogram parameters.</p><p><strong>Results: </strong>Sixty-one patients met the inclusion criteria (mean age 25.5 ± 12.2 years; 30 males, 31 females). Low TSR was significantly associated with lymph node metastasis (p = 0.048). In multivariate analysis, low TSR was an independent adverse prognostic factor for 5-PFS (hazard ratios [HR] and 95% = 10.456, 95% confidence intervals [CI]: 1.816-60.208, p = 0.009) and 5-OS (HR = 4.789, 95% CI: 1.164-19.708, p = 0.030). Significant differences were found in ADC_25th, ADC_50th, and ADC_mean between TSR groups (p < 0.05). The combination of the three ADC values improved diagnostic efficiency (area under the curve = 0.781, sensitivity = 81.48%, specificity = 82.35%), with a Youden index of 0.638.</p><p><strong>Conclusion: </strong>TSR is an independent prognostic factor for PFS and OS in ASPS patients. ADC histogram parameters serve as imaging biomarkers for evaluating TSR.</p><p><strong>Key points: </strong>Question The prognostic value of TSR in ASPS remains unclear, with limited imaging biomarkers available for assessment. Findings Low TSR is associated with poorer 5-PFS and OS. ADC histogram parameters aid in TSR evaluation. Clinical relevance TSR as a prognostic factor, assessed through ADC histogram parameters, offers a non-invasive imaging method that may be useful in predicting the progression of alveolar soft tissue sarcoma.</p>","PeriodicalId":12076,"journal":{"name":"European Radiology","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143633981","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":"On-table monitoring of prostate MRI could enable tailored utilisation of gadolinium contrast.","authors":"Tom Syer, Bruno Carmo, Nimalam Sanmugalingam, Brooke Lawson, Wellington Chishaya, Christopher Shepherd, Tristan Barrett, Iztok Caglic","doi":"10.1007/s00330-025-11479-3","DOIUrl":"https://doi.org/10.1007/s00330-025-11479-3","url":null,"abstract":"<p><strong>Objectives: </strong>To compare the impact of on-table monitoring vs standard-of-care multiparametric MRI (mpMRI) for the utilisation of gadolinium contrast use in prostate MRI.</p><p><strong>Materials and methods: </strong>This retrospective observation study of prospectively acquired data was conducted at a single institution over an 18-month period. A cohort of patients undergoing MRI for suspected prostate cancer (PCa) underwent on-table monitoring where their T2 and DWI images were reviewed by a supervising radiologist during the scan to decide whether to acquire dynamic contrast-enhanced (DCE) sequences. MRI scans were reported using PI-RADS v2.1, patients were followed up with biopsy for at least 12 months. The rate of gadolinium administration, biopsy rates, and diagnostic accuracy were compared to that of a standard-of-care control group undergoing mpMRI during the same period using propensity score matching. Estimates of cost savings were also calculated.</p><p><strong>Results: </strong>1410 patients were identified and after propensity score matching 598 patients were analysed, with 178 undergoing on-table monitoring. Seventy-five and eight tenths (135/178) of patients did not receive gadolinium. Contrast was used mainly for indeterminate lesions (27/43) and significant artefacts on bpMRI (14/43). When comparing the monitored cohort to a non-monitored control group, there was a comparable number of biopsies performed (52.2% vs 49.5%, p = 0.54), PI-RADS 3/5 scoring rates (10.1% vs 7.4%, p = 0.27), sensitivity (98.3% vs 99.2%, p = 0.56), and specificity (63.9% vs 70.7%, p = 0.18) for detection of clinically-significant PCa. When acquired, DCE was deemed helpful in 67.4% (29/43) of cases and improved both PI-QUALv2 and reader confidence scores. There was an estimated saving of £56,677 over the 18-month study.</p><p><strong>Conclusion: </strong>On-table monitoring significantly reduced the need for gadolinium contrast without compromising diagnostic accuracy and biopsy rates.</p><p><strong>Key points: </strong>Question Default use of gadolinium contrast in prostate MRI is not always of clinical benefit and has associated side effects and healthcare costs. Findings On-table monitoring avoided the use of gadolinium in 75.8% of patients, reducing associated costs whilst maintaining clinically significant cancer detection, and diagnostic accuracy and improving reader confidence. Clinical relevance On-table monitoring offers personalised patient protocolling with a significant reduction in the use of gadolinium and its associated side effects and costs, potentially maximising the advantages of both multiparametric and biparametric prostate MRI.</p>","PeriodicalId":12076,"journal":{"name":"European Radiology","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143633982","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":"Reconsidering gadolinium in long-term glioma follow-up: is contrast always and unquestionably necessary?","authors":"Pablo Naval-Baudin, Albert Pons-Escoda","doi":"10.1007/s00330-025-11504-5","DOIUrl":"https://doi.org/10.1007/s00330-025-11504-5","url":null,"abstract":"","PeriodicalId":12076,"journal":{"name":"European Radiology","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143624067","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":"Liver function estimation using multiphase hepatic CT: diagnostic performance of iodine-uptake and volumetric parameters.","authors":"Yasunori Nagayama, Masamichi Hokamura, Narumi Taguchi, Yasuhiro Yokota, Takumi Osaki, Koji Ogasawara, Shinya Shiraishi, Ryuya Yoshida, Ryota Harai, Masafumi Kidoh, Seitaro Oda, Takeshi Nakaura, Toshinori Hirai","doi":"10.1007/s00330-025-11497-1","DOIUrl":"https://doi.org/10.1007/s00330-025-11497-1","url":null,"abstract":"<p><strong>Objectives: </strong>To investigate whether multiphase hepatic CT can predict liver function measured with indocyanine-green-retention test (ICG-R15) and identify patients with severe liver dysfunction contraindicating major hepatectomy, defined as ICG-R15 ≥ 20%, compared to technetium-^99m-galactosyl serum albumin (^99mTc-GSA) scintigraphy.</p><p><strong>Materials and methods: </strong>This retrospective study included 118 patients (84 men, mean age, 69.4 ± 11.3 years) who underwent ICG-R15, ^99mTc-GSA, and multi-phase CT including early portal-venous-phase and 3-min delayed-phase. CT-derived extracellular volume fraction (ECV), iodine washout rate (IWR), liver and spleen volumes normalized by body-surface-area (LV/BSA and SpV/BSA, respectively), and ^99mTc-GSA-derived blood clearance index (HH15) and liver receptor index (LHL15) were quantified. Each parameter was compared between ICG-R15 ≥ 20% (n = 22) and ICG-R15 < 20% (n = 96) groups. Correlations with ICG-R15 were analyzed. The diagnostic performance to predict ICG-R15 ≥ 20% was assessed with areas under the receiver operating characteristic curve (AUC). Multivariable logistic regression analysis was used to identify independent CT predictors, and combined performance was determined.</p><p><strong>Results: </strong>In the ICG-R15 ≥ 20% group, IWR (p < 0.001), LV/BSA (p = 0.026), LHL15 (p < 0.001) were lower and ECV (p = 0.001), SpV/BSA (p = 0.005), and HH15 (p < 0.001) were higher compared to ICG-R15 < 20% group. ICG-R15 showed positive correlations with ECV (r = 0.355), SpV/BSA (r = 0.248), and HH15 (r = 0.385), while negative correlations with IWR (r = -0.523), LV/BSA (r = -0.123, not statistically significant), and LHL15 (r = -0.504). The AUC of ECV, IWR, LV/BSA, SpV/BSA, HH15, and LHL15 were 0.719, 0.845, 0.653, 0.694, 0.844, and 0.878, respectively. IWR, SpV/BSA, and LV/BSA were independent predictors, with a combined AUC of 0.924.</p><p><strong>Conclusion: </strong>IWR predicted liver function better than ECV and hepatosplenic volumetry. The combined IWR and volumetry yielded an accurate prediction of severe liver dysfunction.</p><p><strong>Key points: </strong>Question Despite the widespread use of multiphase CT in patients with hepatobiliary diseases, its potential role in assessing liver function has been scarcely evaluated. Findings Iodine washout rate (IWR), liver volume indexed by body surface area, and spleen volume indexed by body surface area were independent predictors for severe liver dysfunction. Clinical relevance Combined IWR and hepatosplenic volumetry on routine hepatic CT may help assess hepatic function for optimizing treatment strategies and predicting patient prognosis.</p>","PeriodicalId":12076,"journal":{"name":"European Radiology","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143624065","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":"Correction: Spatiotemporal patterns of brain iron-oxygen metabolism in patients with Parkinson's disease.","authors":"Su Yan, Jun Lu, Yuanhao Li, Junghun Cho, Shun Zhang, Wenzhen Zhu, Yi Wang","doi":"10.1007/s00330-025-11435-1","DOIUrl":"https://doi.org/10.1007/s00330-025-11435-1","url":null,"abstract":"","PeriodicalId":12076,"journal":{"name":"European Radiology","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143604376","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":"Artificial intelligence (AI) in radiological paediatric fracture assessment: an updated systematic review.","authors":"Emily Ashworth, Emma Allan, Cato Pauling, Harsimran Laidlow-Singh, Owen J Arthurs, Susan C Shelmerdine","doi":"10.1007/s00330-025-11449-9","DOIUrl":"https://doi.org/10.1007/s00330-025-11449-9","url":null,"abstract":"<p><strong>Background: </strong>Recognising bone injuries in children is a critical part of children's imaging, and, recently, several AI algorithms have been developed for this purpose, both in research and commercial settings. We present an updated systematic review of the literature, including the latest developments.</p><p><strong>Methods/materials: </strong>Scopus, Web of Science, Pubmed, Embase, and Cochrane Library databases were queried for studies published between 1 January 2011 and 6 September 2024 matching search terms 'child', 'AI', 'fracture,' and 'imaging'. Retrieved studies were evaluated, and descriptive statistics were collated for diagnostic performance.</p><p><strong>Results: </strong>Twenty-six eligible articles were included; seventeen (17/26, 65.%) of these were published within the last two years. Six studies (6/26, 23.1%) used open-source datasets to train their algorithm, the remainder used local data. Sixteen studies (16/26, 61.5%) evaluated a single joint (wrist, elbow, or ankle); multiple bones within the appendicular skeleton were assessed in the other ten studies. Seven articles (7/26, 26.9%) related to the performance of a commercial AI tool. Accuracy of AI models ranged from 85.0 to 100.0%. Six studies (6/26, 23.1%) evaluated the accuracy of human readers with and without AI assistance, of which two studies found a statistically significant improvement when humans were assisted by AI. The largest pool of human readers in any paper consisted of 11 readers of varying experience.</p><p><strong>Conclusion: </strong>The pace of research in AI fracture detection in children's imaging has increased. Studies show high accuracy of AI models, but proof of clinical impact, cost-effectiveness, and any socioeconomic or ethical bias are still lacking.</p><p><strong>Key points: </strong>Question AI model development has rapidly increased in recent years. We present the latest developments in AI model diagnostic accuracy for paediatric fracture detection. Findings Studies now demonstrate performance improvement when AI is used to assist human interpretation of paediatric fractures, especially when aiding junior radiologists. Clinical relevance Studies show high accuracy for AI models; however, further research is needed to evaluate AI across diverse age groups, bone diseases, and fracture types. Evidence of real-world patient benefit for AI and any socioeconomic or ethical bias are still lacking.</p>","PeriodicalId":12076,"journal":{"name":"European Radiology","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143585230","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":"Correction: Imaging in pelvic exenteration-a multidisciplinary practice guide from the ESGAR-SAR-ESUR-PelvEx collaborative group.","authors":"Stephanie Nougaret, Doenja M J Lambregts, Geerard L Beets, Regina G H Beets-Tan, Lennart Blomqvist, David Burling, Quentin Denost, Maria A Gambacorta, Benedetta Gui, Ann Klopp, Yulia Lakhman, Kate E Maturen, Riccardo Manfredi, Iva Petkovska, Luca Russo, Atul B Shinagare, James A Stephenson, Damian Tolan, Aradhana M Venkatesan, Aaron J Quyn, Rosemarie Forstner","doi":"10.1007/s00330-025-11437-z","DOIUrl":"10.1007/s00330-025-11437-z","url":null,"abstract":"","PeriodicalId":12076,"journal":{"name":"European Radiology","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143585235","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":"Coronary CT angiography alone versus with CT perfusion: a systematic review and meta-analysis assessing approaches for chest pain.","authors":"Fabrizio D'Ascenzo, Riccardo Faletti, Gianluca Di Pietro, Riccardo Improta, Francesco Bruno, U Joseph Schoepf, Umberto Di Vita, Federico Giacobbe, Marco Nebiolo, Stefano Siliano, Andrea Solano, Arianna Morena, Elettra Pasinato, Marco Balducci, Ilaria Pagliassotto, Gaia Cura Curà, Mahmoud Mohamed, Gennaro Sardella, Nicola Galea, Marc Dewey, Marco Francone, Massimo Mancone, Paolo Fonio, Gaetano Maria De Ferrari, Ovidio De Filippo, Marco Gatti","doi":"10.1007/s00330-025-11459-7","DOIUrl":"https://doi.org/10.1007/s00330-025-11459-7","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate the prognostic value of stress Computed Tomography Perfusion (CTP) in patients with suspected or known coronary artery disease.</p><p><strong>Materials and methods: </strong>All studies evaluating patients with chest pain with CTP plus coronary computed tomography angiography (CCTA) alone or versus CCTA were included. The primary analysis included studies comparing CCTA plus CTP vs CCTA alone, while in the secondary analysis we analyzed the incidence of each outcome across all seven studies, two- and single-arm.</p><p><strong>Results: </strong>Seven double- and single-arm studies were included (two randomized controlled trials and five observational ones) with 3587 patients (2101 evaluated with CTP plus CCTA and 1486 with CCTA alone).In the primary analysis including 4 studies, after a median follow-up of 17 months, the rates of MACEs (OR 1.19, 95% CI 0.91-1.57, p = 0.21) and all-cause death (OR 0.41, 0.11-1.47, p = 0.17) were similar. Patients managed according to CCTA alone had higher rates of total ICA (OR 2.42, 1.99-2.94, p < 0.00001) and ICA without subsequent revascularization (OR 2.85, 1.23-6.61, p = 0.01). Conversely, the rate of ICA with subsequent revascularization was higher in patients who underwent CCTA plus CTP (OR 0.39, 0.22-0.69, p = 0.001). There were no significant differences in terms of recurrent MI (OR 0.94, 0.15-5.83, p = 0.95) and unplanned revascularization (OR 0.69, 0.19-2.51, p = 0.57, all CI 95%) between the two approaches. These results were confirmed in the secondary analysis.</p><p><strong>Conclusion: </strong>A coronary imaging approach based on perfusion evaluation in addition to anatomic assessment was comparable to CCTA alone in terms of MACE, myocardial infarctions and unplanned revascularizations up to 2 years. Patients evaluated with CTP less frequently underwent ICA, which did, however, result in a higher rate of stent implantation.</p><p><strong>Key points: </strong>Question Does the addition of stress Computed Tomography Perfusion (CTP) to coronary computed tomography angiography (CCTA) improve the diagnostic and prognostic evaluation of patients with chest pain compared to CCTA alone? Findings Stress CTP combined with CCTA reduces unnecessary invasive coronary angiography and increases revascularization rates without significantly impacting MACE, myocardial infarction, or unplanned revascularization. Clinical relevance Incorporating stress CTP into CCTA optimizes care by reducing unnecessary invasive procedures and improving tailored treatment strategies for patients with stable and unstable chest pain.</p>","PeriodicalId":12076,"journal":{"name":"European Radiology","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143585233","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":"AI and human interactions in prostate cancer diagnosis using MRI.","authors":"Anwar R Padhani, Nickolas Papanikolaou","doi":"10.1007/s00330-025-11498-0","DOIUrl":"https://doi.org/10.1007/s00330-025-11498-0","url":null,"abstract":"<p><p>This special report explores the integration of artificial intelligence (AI) into prostate MRI workflows to address limitations associated with single-reader interpretations, such as inter-reader variability and diagnostic errors. We review various AI-integrated workflow strategies, from AI-assisted decision support to fully autonomous analysis, examining their benefits and challenges. AI can act as a second reader, enhancing detection sensitivity and reducing false negatives or pre-screen cases for efficient triage, thereby optimising radiologist workload. Key advantages include the potential for improved lesion detection, streamlined workflows, and reduced reporting times. However, challenges such as automation bias and the potential for inaccurate AI outputs require careful consideration and mitigation strategies. The suitability of different AI workflows is dependent on the clinical context and desired performance, with high sensitivity and negative predictive value crucial for rule-out scenarios and high specificity and positive predictive value essential for rule-in scenarios. Increased AI autonomy mandates a higher performance benchmark. The need for rigorous prospective validation studies assessing AI safety and effectiveness in real-world clinical settings is emphasised. Furthermore, the complex dynamics of human-AI interaction, encompassing positive and negative consequences, warrant further investigation. Ultimately, the strategic implementation of collaborative AI-radiologist workflows has the potential to enhance diagnostic accuracy and efficiency and reduce missed cancers, leading to more timely and appropriate patient care. KEY POINTS: Question Single-reader prostate MRI interpretations have reader variability and missed cancer limitations. This report explores how prospective AI integration can improve diagnostic accuracy and workflow efficiency. Findings From decision support to autonomous analyses, AI workflows can improve cancer detection and streamline workflows. Mitigating errors requires tailored performance and high accuracy for greater autonomy. Clinical relevance Calibrated AI-radiologist collaborations can enhance prostate cancer diagnosis by improving accuracy and efficiency while reducing unnecessary biopsies and missed cancers. Prospective research evaluating the safety and efficacy of AI deployment is needed for responsible and beneficial AI adoption.</p>","PeriodicalId":12076,"journal":{"name":"European Radiology","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143585217","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":"Use of diagnostic vs low-dose computed tomography in positron emission tomography-CT examinations.","authors":"Matthew Malekhedayat, Carly Stewart, Philip W Chu, Yifei Wang, Nima Kasraie, Benjamin Franc, Rebecca Smith-Bindman","doi":"10.1007/s00330-025-11391-w","DOIUrl":"https://doi.org/10.1007/s00330-025-11391-w","url":null,"abstract":"<p><strong>Objectives: </strong>To examine CT radiation dose variation in PET-CT and understand how often providers use diagnostic vs lower doses for attenuation correction and anatomic localization (AC/AL).</p><p><strong>Methods: </strong>Retrospective, multi-centered study of PET-CT exams from 2010 to 2021. Exams were categorized as body or brain. Radiation dose was quantified using dose length product (DLP), adjusted for patient size (DLP_S-ADJ), and for size and scan length (DLP_SL-ADJ). DLP_S-ADJ variation was assessed by body region and facility. To ascertain whether sites use AC/AL or diagnostic doses, we compared each facility's DLP_S-ADJ in CTs from PET-CT vs diagnostic CT exams of analogous body regions (not associated with PET), controlling for scan length using DLP_SL-ADJ. Lastly, we categorized exams as likely diagnostic if they used multiple phases and/or contrast to compare dose and frequency with likely non-diagnostic exams.</p><p><strong>Results: </strong>Sixty-four thousand two hundred ten exams included 93% body, 7% brain. Doses were higher and more variable in the body than brain exams (adult mean DLP_S-ADJ = 1004 vs 341 mGy-cm, respectively). For body exams, DLP_S-ADJ was higher in older children than adults, and there was wide inter-facility variation (median DLP_S-ADJ range = 245-2391 mGy-cm). Most facilities used higher CT doses in body PET-CT than in diagnostic CT exams even controlling for scan length. Fifty-three percent of adult and 76% of child body exams were likely diagnostic based on the use of diagnostic techniques.</p><p><strong>Conclusion: </strong>While diagnostic CT is sometimes indicated for PET-CT, body exams generally do not use AC/AL protocols. Doses were higher than previously reported, higher than analogous diagnostic CT exams, and higher in older children than adults when size adjusted.</p><p><strong>Key points: </strong>Question How does CT radiation dose vary in PET-CT and how often do providers use diagnostic vs lower doses for AC/AL? Findings Most facilities did not use AC/AL protocols for body PET-CT, and CT effective doses were higher than previously reported. Clinical relevance The considerable inter-facility variation observed suggests ample opportunity to reduce ionizing radiation doses for CT in body PET-CT by adopting low-dose (AC/AL) protocols and other dose reduction techniques.</p>","PeriodicalId":12076,"journal":{"name":"European Radiology","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143585257","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}