European Radiology最新文献

{"title":"Reply to the Letter to the Editor: Reevaluating DECT in early spondylodiscitis for comprehensive diagnosis.","authors":"Giovanni Foti, Raffaele Augelli, Guglielmo Manenti, Leonardo Motta, Stefania Marocco","doi":"10.1007/s00330-025-11590-5","DOIUrl":"10.1007/s00330-025-11590-5","url":null,"abstract":"","PeriodicalId":12076,"journal":{"name":"European Radiology","volume":" ","pages":"6615-6617"},"PeriodicalIF":4.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143985446","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Uncertainty-aware quantitative CT evaluation of emphysema and mortality risk from variable radiation dose images.","authors":"David Baraghoshi, Matthew J Strand, Stephen M Humphries, David A Lynch, Alexander M Kaizer, Antonio R Porras","doi":"10.1007/s00330-025-11525-0","DOIUrl":"10.1007/s00330-025-11525-0","url":null,"abstract":"<p><strong>Objective: </strong>To develop an automated method for the joint and consistent evaluation of emphysema and mortality risk that provides quantification of data and model uncertainty.</p><p><strong>Materials and methods: </strong>Participants from the prospective COPDGene study who underwent both full radiation dose (FD) and reduced radiation dose (RD) chest CT scans at 5-year follow-up were included and divided into training (80%), validation (10%), and testing (10%) datasets. We trained a multi-task Bayesian neural network (BNN) to estimate the FD volume-adjusted lung density (ALD) regardless of acquisition protocol, in addition to the 5-year mortality risk. The data and model uncertainty were quantified in the testing dataset. Our deep learning ALD (DL-ALD) was compared to the conventional ALD.</p><p><strong>Results: </strong>In total, 1350 participants (mean age 64.4 years ± 8.7; 659 female) were included. Compared to conventional ALD, DL-ALD was more consistent between FD and RD CT images (mean difference: 1 g/L ± 3.1 versus 14.8 g/L ± 5.3, p < 0.001). The predicted 5-year mortality was similar between image protocols (mean difference: 0.0007 ± 0.02, p = 0.76). The uncertainty associated with image variability when quantifying DL-ALD was lower in participants with severe emphysema (Pearson's rho = 0.79, p < 0.001), and the model uncertainty for mortality risk was lower both for severe and early-stage participants compared to other participants (p < 0.001).</p><p><strong>Conclusion: </strong>The presented multi-task BNN provides an increased robustness to imaging protocol compared to conventional methods for CT evaluation of emphysema. Additionally, it provides direct measurements of uncertainty for its generalization to diverse imaging protocols and patient populations.</p><p><strong>Key points: </strong>Question Quantitative CT evaluation of emphysema is highly sensitive to CT protocol, which increases uncertainty in disease evaluation and impacts the clinical utility of traditional metrics. Findings Uncertainty-aware deep learning improved consistency in emphysema quantification between fixed and reduced dose CT scans compared to traditional histogram analysis. Clinical relevance CT evaluation of emphysema severity and mortality risk using uncertainty-aware deep learning methods is more consistent across variable radiation dose protocols compared to conventional methods while also providing measurement reliability metrics, improving the evaluation of COPD using CT.</p>","PeriodicalId":12076,"journal":{"name":"European Radiology","volume":" ","pages":"6115-6126"},"PeriodicalIF":4.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12353449/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143788186","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preoperative prediction of malignant transformation in sinonasal inverted papilloma: a novel MRI-based deep learning approach.","authors":"Cong Ding, Baohong Wen, Qinghe Han, Na Hu, Yue Kang, Yuchen Wang, Chengshuo Wang, Luo Zhang, Junfang Xian","doi":"10.1007/s00330-025-11655-5","DOIUrl":"10.1007/s00330-025-11655-5","url":null,"abstract":"<p><strong>Objective: </strong>To develop a novel MRI-based deep learning (DL) diagnostic model, utilizing multicenter large-sample data, for the preoperative differentiation of sinonasal inverted papilloma (SIP) from SIP-transformed squamous cell carcinoma (SIP-SCC).</p><p><strong>Methods: </strong>This study included 568 patients from four centers with confirmed SIP (n = 421) and SIP-SCC (n = 147). Deep learning models were built using T1WI, T2WI, and CE-T1WI. A combined model was constructed by integrating these features through an attention mechanism. The diagnostic performance of radiologists, both with and without the model's assistance, was compared. Model performance was evaluated through receiver operating characteristic (ROC) analysis, calibration curves, and decision curve analysis (DCA).</p><p><strong>Results: </strong>The combined model demonstrated superior performance in differentiating SIP from SIP-SCC, achieving AUCs of 0.954, 0.897, and 0.859 in the training, internal validation, and external validation cohorts, respectively. It showed optimal accuracy, stability, and clinical benefit, as confirmed by Brier scores and calibration curves. The diagnostic performance of radiologists, especially for less experienced ones, was significantly improved with model assistance.</p><p><strong>Conclusions: </strong>The MRI-based deep learning model enhances the capability to predict malignant transformation of sinonasal inverted papilloma before surgery. By facilitating earlier diagnosis and promoting timely pathological examination or surgical intervention, this approach holds the potential to enhance patient prognosis.</p><p><strong>Key points: </strong>Questions Sinonasal inverted papilloma (SIP) is prone to malignant transformation locally, leading to poor prognosis; current diagnostic methods are invasive and inaccurate, necessitating effective preoperative differentiation. Findings The MRI-based deep learning model accurately diagnoses malignant transformations of SIP, enabling junior radiologists to achieve greater clinical benefits with the assistance of the model. Clinical relevance A novel MRI-based deep learning model enhances the capability of preoperative diagnosis of malignant transformation in sinonasal inverted papilloma, providing a non-invasive tool for personalized treatment planning.</p>","PeriodicalId":12076,"journal":{"name":"European Radiology","volume":" ","pages":"6160-6170"},"PeriodicalIF":4.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143985219","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":"Efficacy and safety of radiofrequency ablation for hyperparathyroidism: a meta-analysis and systematic review.","authors":"So Yeong Jeong, Kyung Hoon Lee, Ji Ye Lee, Taehyuk Ham, Hunjong Lim, Minjung Ryu, Young Hun Jeon, Inpyeong Hwang, Tae Jin Yun, Jung Hee Kim, Se Jin Cho, Ji-Hoon Kim","doi":"10.1007/s00330-025-11581-6","DOIUrl":"10.1007/s00330-025-11581-6","url":null,"abstract":"<p><strong>Objective: </strong>Radiofrequency ablation (RFA) is increasingly being investigated as a treatment for parathyroid lesions, with favorable outcomes, especially in patients who are ineligible for surgery or decline surgery. We aimed to assess the efficacy and safety of RFA in treating hyperparathyroidism.</p><p><strong>Materials and methods: </strong>PubMed and Embase were searched for original literature published on or before July 18, 2024. We included 14 eligible studies with 593 patients (241 with primary hyperparathyroidism [PHPT], 310 with secondary hyperparathyroidism [SHPT], and 42 with tertiary hyperparathyroidism [THPT]). Serial pooled means of biochemical indexes (parathyroid hormone [PTH], calcium, phosphorus), volume reduction ratio (VRR) after RFA, and complication rate were calculated.</p><p><strong>Results: </strong>In PHPT, the pooled mean baseline PTH value of 158.7 pg/mL and serum calcium value of 10.96 mg/dL significantly decreased to 57.3 pg/mL and 9.55 mg/dL, respectively, at 12 months (both p < 0.001), with both being within normal ranges. The pooled mean VRR gradually increased, reaching 95.6% at 12 months. In SHPT, the pooled mean baseline PTH value of 1683.7 pg/mL significantly decreased to 267.2 pg/mL at 12 months (p < 0.001), which was within the target reference level (PTH ≤ 585 pg/mL). In THPT, the mean baseline PTH value of 1284.9 pg/mL decreased to 161.6 pg/mL at 1 year (p < 0.001). The pooled incidence rates of total, major, and minor complications were 27.9%, 7.5%, and 20.0%, respectively.</p><p><strong>Conclusions: </strong>RFA showed promising effectiveness and safety profiles, particularly for patients who are ineligible for surgery or decline surgical intervention.</p><p><strong>Key points: </strong>Question What is the efficacy and safety of RFA in treating hyperparathyroidism? Findings In PHPT, pooled mean values of biochemical indexes (serum PTH, calcium) were normal throughout 12-month follow-up. In SHPT and THPT, pooled mean PTH stayed within target ranges throughout 12-month follow-up. Clinical relevance RFA showed efficacy and safety in treating hyperparathyroidism, maintaining biochemical indexes within normal or target ranges throughout 12-month follow-ups. RFA would be a valuable treatment option for patients who are ineligible for surgery or who decline surgical intervention.</p>","PeriodicalId":12076,"journal":{"name":"European Radiology","volume":" ","pages":"6583-6597"},"PeriodicalIF":4.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12417237/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143985026","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":"Fetal dose in pregnant CT patients: a comparison of four software packages.","authors":"Joël Greffier, Asma Arjoun, Chris Serrand, Jean-Paul Beregi, Djamel Dabli","doi":"10.1007/s00330-025-11594-1","DOIUrl":"10.1007/s00330-025-11594-1","url":null,"abstract":"<p><strong>Objectives: </strong>To compare the fetal dose (FD) as calculated by four different software packages for pregnant women who have undergone CT acquisitions directly exposing the whole fetus to X-rays.</p><p><strong>Materials and methods: </strong>Pregnant women who underwent CT abdomen-pelvis and/or thorax-abdomen-pelvis acquisitions from February 2018 to May 2024 and for whom the uterine dose and/or FD was calculated by a medical physicist were retrospectively included. FDs were computed per CT acquisition with VirtualDose-CT™ (VDCT), Duke Organ Dose (DOD), fetaldose.org, and COnceptus Dose Estimation (CODE) software, using phantoms taking the stage of pregnancy into account. FDs calculated by each software package were then compared.</p><p><strong>Results: </strong>A total of 51 pregnant women with a mean age of 30.2 ± 5.7 years at 17.5 ± 10.0 weeks of pregnancy were included. The mean number of CT acquisitions per pregnant patient was 1.4 ± 0.7 with a mean CTDI_vol of 6.77 ± 3.04 [2.34-15.64] mGy, and FDs were computed for a total of 69 acquisitions. For all CT acquisitions, the median FD was 8.6 (6.8; 10.3) mGy for VDCT, 7.7 (6.1; 9.7) mGy for DOD, 6.3 (4.9; 7.6) mGy for fetaldose.org, and 7.1 (4.6; 8.8) mGy for CODE. Differences between each software package were significant (p < 0.01), except between VDCT and DOD (p = 0.025) and between CODE and fetaldose.org (p = 0.15). The concordance of calculated FD values between the software packages was poor (ICC < 0.50), except between VDCT and CODE and between fetaldose.org and CODE.</p><p><strong>Conclusion: </strong>The choice of software used affects the calculation of the FD.</p><p><strong>Key points: </strong>Question Differences between calculation software in terms of morphologies and types of phantoms used have an impact on FD calculations? Findings Software choice has an impact on calculated FD, but is not expected to alter patient management except for extreme cases with multiple CT exams. Clinical relevance The FD limit of 100 mGy, defined by the International Commission on Radiological Protection, cannot be reached with a single CT examination, and may only be of concern in cases where the patient undergoes multiple exams with the whole fetus exposed.</p>","PeriodicalId":12076,"journal":{"name":"European Radiology","volume":" ","pages":"6258-6267"},"PeriodicalIF":4.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12417268/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143980656","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":"Lung microvasculopathy in chronic thromboembolic pulmonary hypertension: high-resolution findings with photon-counting detector CT in 29 patients.","authors":"Martine Remy-Jardin, Alain Duhamel, Marie Delobelle, Jean-François Bervar, Thomas Flohr, Jacques Remy","doi":"10.1007/s00330-025-11561-w","DOIUrl":"10.1007/s00330-025-11561-w","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate CT findings suggestive of lung microvasculopathy in patients with chronic thromboembolic pulmonary hypertension (CTEPH).</p><p><strong>Materials and methods: </strong>Twenty-nine patients were scanned with high-spatial resolution on a photon-counting detector (PCD)-CT unit. A maximum of three pairs per patient, each composed of hyper- and hypo-attenuating areas of mosaic perfusion, were selected.</p><p><strong>Results: </strong>Comparative analysis of the 86 selected pairs showed: (a) a higher frequency of ill-defined micronodules (p = 0.008), lobular ground-glass opacities (p = 0.01) and haziness (p = 0.003) in hypoattenuated areas; (b) there was no significant difference in the frequency of neovascularity (p = 0.43). Similar trends were observed in hypoattenuating areas of the 66 pairs studied in the 22 patients with central and peripheral CTEPH; an absence of ill-defined micronodules, lobular ground-glass opacities, and haziness in hyperattenuating areas was noticed in the 20 pairs studied in the 7 patients with peripheral CTEPH. Patients with a mean pulmonary artery pressure ≤ 42 mmHg (i.e., the median value of mean pulmonary artery pressure) had 45 pairs compared, showing a higher frequency of ill-defined micronodules (p = 0.003) and haziness (p < 0.001) in hypoattenuated areas, together with a higher frequency of subpleural systemic-to-pulmonary anastomoses (p = 0.02). There were no statistical differences in the frequency of CT findings between hypo- and hyper-attenuating areas in the 41 pairs of patients with a mean pulmonary artery pressure > 42 mm Hg.</p><p><strong>Conclusion: </strong>CT features suggestive of microvasculopathy were more frequent in areas of hypoperfusion, with a trend toward homogenization of CT findings in patients with severe PH.</p><p><strong>Key points: </strong>Question Lung microvascular lesions play a crucial role in the origin of residual pulmonary hypertension after successful thromboendarterectomy, currently beyond the scope of imaging. Findings The expected morphological abnormalities at the level of distal pulmonary circulation in CTEPH were found to be depictable in each zone of mosaic perfusion. Clinical relevance This study suggests that the high-spatial resolution of PCD-CT has the capability of approaching the complex pathophysiology of small-vessel disease in CTEPH, providing important information prior to therapeutic decisions.</p>","PeriodicalId":12076,"journal":{"name":"European Radiology","volume":" ","pages":"6369-6381"},"PeriodicalIF":4.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12417283/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143975246","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":"Comparison of CT referral justification using clinical decision support and large language models in a large European cohort.","authors":"Mor Saban, Yaniv Alon, Osnat Luxenburg, Clara Singer, Monika Hierath, Alexandra Karoussou Schreiner, Boris Brkljačić, Jacob Sosna","doi":"10.1007/s00330-025-11608-y","DOIUrl":"10.1007/s00330-025-11608-y","url":null,"abstract":"<p><strong>Background: </strong>Ensuring appropriate use of CT scans is critical for patient safety and resource optimization. Decision support tools and artificial intelligence (AI), such as large language models (LLMs), have the potential to improve CT referral justification, yet require rigorous evaluation against established standards and expert assessments.</p><p><strong>Aim: </strong>To evaluate the performance of LLMs (Generation Pre-trained Transformer 4 (GPT-4) and Claude-3 Haiku) and independent experts in justifying CT referrals compared to the ESR iGuide clinical decision support system as the reference standard.</p><p><strong>Methods: </strong>CT referral data from 6356 patients were retrospectively analyzed. Recommendations were generated by the ESR iGuide, LLMs, and independent experts, and evaluated for accuracy, precision, recall, F1 score, and Cohen's kappa across medical test, organ, and contrast predictions. Statistical analysis included demographic stratification, confidence intervals, and p-values to ensure robust comparisons.</p><p><strong>Results: </strong>Independent experts achieved the highest accuracy (92.4%) for medical test justification, surpassing GPT-4 (88.8%) and Claude-3 Haiku (85.2%). For organ predictions, LLMs performed comparably to experts, achieving accuracies of 75.3-77.8% versus 82.6%. For contrast predictions, GPT-4 showed the highest accuracy (57.4%) among models, while Claude demonstrated poor agreement with guidelines (kappa = 0.006).</p><p><strong>Conclusion: </strong>Independent experts remain the most reliable, but LLMs show potential for optimization, particularly in organ prediction. A hybrid human-AI approach could enhance CT referral appropriateness and utilization. Further research should focus on improving LLM performance and exploring their integration into clinical workflows.</p><p><strong>Key points: </strong>Question Can GPT-4 and Claude-3 Haiku justify CT referrals as accurately as independent experts, using the ESR iGuide as the gold standard? Findings Independent experts outperformed large language models in test justification. GPT-4 and Claude-3 showed comparable organ prediction but struggled with contrast selection, limiting full automation. Clinical relevance While independent experts remain most reliable, integrating AI with expert oversight may improve CT referral appropriateness, optimizing resource allocation and enhancing clinical decision-making.</p>","PeriodicalId":12076,"journal":{"name":"European Radiology","volume":" ","pages":"6150-6159"},"PeriodicalIF":4.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143964856","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":"Letter to the Editor: ABO incompatibility in liver transplantation-how should we face it?","authors":"Saiyu Gao, Hanwen Yang","doi":"10.1007/s00330-025-11591-4","DOIUrl":"10.1007/s00330-025-11591-4","url":null,"abstract":"","PeriodicalId":12076,"journal":{"name":"European Radiology","volume":" ","pages":"6618-6619"},"PeriodicalIF":4.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143957930","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":"Shading light in the black box of hepatobiliary imaging.","authors":"Aristeidis Grigoriadis, Annika Bergquist, Nikolaos Kartalis","doi":"10.1007/s00330-025-11740-9","DOIUrl":"10.1007/s00330-025-11740-9","url":null,"abstract":"","PeriodicalId":12076,"journal":{"name":"European Radiology","volume":" ","pages":"6541-6543"},"PeriodicalIF":4.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144233613","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":"Detection rates for prostate cancer using PI-RADS 2.1 upgrading rules in transition zone lesions align with risk assessment categories: a systematic review and meta-analysis.","authors":"Georgios Agrotis, Eduardo Pais Pooch, Kostas Marsitopoulos, Marianna Vlychou, Matthias Benndorf, Regina G H Beets-Tan, Ivo G Schoots","doi":"10.1007/s00330-025-11618-w","DOIUrl":"10.1007/s00330-025-11618-w","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate and compare cancer detection rates (CDRs) of transition zone (TZ) lesions upgraded from PI-RADSv2.1 score 2 to 3 (\"2 + 1\") or from 3 to 4 (\"3 + 1\") using DWI and assess their clinical impact.</p><p><strong>Materials and methods: </strong>A systematic literature search was performed in Embase, Medline, and Web of Science for studies assessing TZ lesions with DWI in PI-RADSv2.1, with histology-confirmed grade group ≥ 2 cancer (GG ≥ 2) as the primary outcome. Risk of bias was evaluated using QUADAS-2. Pooled sensitivity, specificity, CDRs, and odds ratios (ORs) were estimated at the lesion level using a bivariate binomial random-effects model.</p><p><strong>Results: </strong>Eight studies with 1535 TZ lesions were included. GG ≥ 2 CDRs for PI-RADS scores of 1, 2, 2 + 1, 3, 3 + 1, 4, and 5 were 2% (95%CI: 0%-12%), 6% (4%-10%), 13% (6%-23%), 19% (15%-25%), 37% (24%-52%), 49% (32%-67%), and 73% (66%-79%), respectively. Scores of 2 + 1 had higher GG ≥ 2 CDRs than 2 (OR 3.37 (1.53-7.44), p = 0.003) but were similar to 3 (OR 0.80 (0.44-1.45), p = 0.46). Scores of 3 + 1 had higher GG ≥ 2 CDRs than 3 (OR 2.67 (1.27-5.59), p = 0.009) but were similar to 4 (OR 0.68 (0.33-1.44), p = 0.32). False-positive rates remained substantial (≥ 2 + 1: 69% (55%-80%); ≥ 3: 54% (46%-62%)).</p><p><strong>Conclusion: </strong>The risk of having significant prostate cancer in \"2 + 1\" and \"3 + 1\" TZ lesions, with an upgrading based on DWI images, is appropriately categorized within the PI-RADS v2.1 scoring system, as shown by this meta-analysis.</p><p><strong>Key points: </strong>Question PI-RADS v2.1 incorporates rules allowing scores of some transition zone (TZ) lesions to be increased. Literature on the clinical impact of these rules is scarce. Findings For TZ lesions upgraded with DWI: \"2 + 1\" lesions show a cancer detection rate (CDR) of 13%, and \"3 + 1\" lesions show a CDR of 37%. Clinical relevance Upgraded TZ lesions may impact individualized biopsy-decisions, especially as \"3 + 1\" lesions harbor significant disease in 2-out-of-5 patients. Still, the high rate of grade group = 1 and benign findings in these sub-categories emphasizes the need for strategies to minimize overdiagnosis.</p>","PeriodicalId":12076,"journal":{"name":"European Radiology","volume":" ","pages":"6454-6465"},"PeriodicalIF":4.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12417277/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143998264","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}