European Radiology最新文献

{"title":"Reply to the Letter to the Editor: Deep learning TMJ MRI-reader-level equivalence is a foundation, not a finish line.","authors":"Gyu-Dong Jo, Kug Jin Jeon, Yoon Joo Choi, Chena Lee, Sang-Sun Han","doi":"10.1007/s00330-026-12607-3","DOIUrl":"10.1007/s00330-026-12607-3","url":null,"abstract":"","PeriodicalId":12076,"journal":{"name":"European Radiology","volume":" ","pages":"7377-7378"},"PeriodicalIF":6.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147835483","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":"High risk score of breast cancer by artificial intelligence (AI) on screening mammograms: a review of negative and cancer cases.","authors":"Marit A Martiniussen, Marie B Bergan, Merete U Kristiansen, Nataliia Moshina, Anne Sofie F Larsen, Marthe Larsen, Fredrik A Dahl, Solveig Hofvind","doi":"10.1007/s00330-026-12579-4","DOIUrl":"10.1007/s00330-026-12579-4","url":null,"abstract":"<p><strong>Objectives: </strong>To investigate mammographic features associated with high artificial intelligence (AI) risk scores as provided by two AI models applied to screening mammograms.</p><p><strong>Materials and methods: </strong>This retrospective study included 130,031 screening mammograms from 42,371 women attending BreastScreen Norway, 2008-2018. Two AI models (A and B) developed for cancer detection on screening mammograms were applied. An informed radiological review was conducted for mammograms within the highest 5% of AI risk scores by both models in two study samples: (1) High AI risk score, but no breast cancer detected within 6 years (n = 120), and (2) High AI risk score in mammograms with screen-detected cancers (n = 120). Mammographic density (BI-RADS a-d), features (mass, spiculated mass, asymmetry, architectural distortion, calcification alone, and density with calcification), and radiologists' interpretation scores (1-5) were analyzed descriptively.</p><p><strong>Results: </strong>Mammographic density was higher in sample 1 compared to sample 2 (BI-RADS d: 11% vs 3%, respectively). In sample 1, calcifications alone were the most frequent AI-marked feature (model A: 72%; model B: 68%), predominantly with amorphous morphology and a cluster distribution, and 76% were interpreted as benign by the radiologists (interpretation score 1). In sample 2, a spiculated mass was the most frequent mammographic feature among the screen-detected cancers (29%).</p><p><strong>Conclusion: </strong>Mammograms assigned high AI risk scores exhibit distinct features depending on screening outcome. Systematic characterization of these features may help refine AI thresholds, improve specificity, reduce AI false-positive findings, and decrease the recall rate in breast cancer screening.</p><p><strong>Key points: </strong>Question Knowledge about mammographic features associated with high AI risk scores is essential for distinguishing cancer from non-cancer cases. Findings Calcifications were the dominant feature in non-cancers in screening mammograms with high AI risk score, whereas spiculated mass was the most frequent feature among cancers. Clinical relevance Calcifications in non-cancer screening mammograms with a high AI risk score were frequently interpreted as benign or probably benign by radiologists. This knowledge may help refine AI thresholds and thereby improve specificity and reduce false-positive results in mammographic screening.</p>","PeriodicalId":12076,"journal":{"name":"European Radiology","volume":" ","pages":"7210-7220"},"PeriodicalIF":6.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13451454/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147835520","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":"CT-based lung ventilation metrics: reference ranges and pulmonary function test correlations in healthy individuals.","authors":"Charlotte E van den Berg, Julian Dittrich, Sarah C Scharm, Cornelia Schaefer-Prokop, Sabine Dettmer, Anna Hunkemoeller, Jan Eckstein, Julian Glandorf, Frank K Wacker, Gesa H Pöhler, Hoen-Oh Shin","doi":"10.1007/s00330-026-12559-8","DOIUrl":"10.1007/s00330-026-12559-8","url":null,"abstract":"<p><strong>Objectives: </strong>CT-derived assessment of regional ventilation is possible with paired inspiration and expiration scans. Normative reference values for CT-derived ventilation remain undefined. The aim of this study is to establish reference values for pulmonary ventilation using CT, with pulmonary function tests (PFTs) as the clinical standard.</p><p><strong>Materials and methods: </strong>In this prospective, single-center study (December 2022-April 2024), 103 healthy adults underwent spirometry-guided inspiratory and expiratory CT. Lobes were segmented automatically using TotalSegmentator. Voxel-wise ventilation was quantified as the relative air volume change between inspiration and expiration via nonlinear registration, normalized to inspiratory lung volume. CT-derived lung volumes were compared with PFT-derived total lung capacity (TLC), residual volume (RV), and vital capacity (VC). Reference intervals were reported as mean ± standard deviation and 5th-95th percentiles. Multivariable analyses assessed the effects of sex, age, height, lung region, and gravitational orientation.</p><p><strong>Results: </strong>Ninety-one participants (mean age, 53 ± 12 years; 49 men) were included. Mean ventilation was 59.5% ± 8.5% (5th-95th percentile, 42.1-72.5%). CT-derived volumes were systematically lower than PFT values but strongly correlated: CT-TLC (-13.8%, r = 0.89), CT-RV (-2.5%, r = 0.80), and CT-VC (-20.8%, r = 0.82). Ventilation decreased with age (p < 0.001) and increased with height (p < 0.05). Regionally, ventilation was higher in the lower lobes (p < 0.003) and posterior regions (p < 0.001).</p><p><strong>Conclusion: </strong>CT-derived ventilation correlates strongly with PFT-indices but yields lower absolute values. Demographic and anatomical factors significantly influence ventilation distribution. These normative data provide a reference framework for clinical functional lung assessment.</p><p><strong>Key points: </strong>Question Can normative reference values for CT-derived regional lung ventilation be established, and how do these metrics relate to pulmonary function tests and anatomical/demographic factors? Findings Mean CT-derived ventilation was 59.5% ± 8.5% with strong pulmonary function test correlations. Ventilation exhibited significant regional heterogeneity and systemic variations by anatomical location, age, and sex. Clinical relevance Normative reference values enable objective classification of CT-derived ventilation, standardizing interpretation and reducing subjectivity. They facilitate earlier detection of regional dysfunction, quantitative phenotyping, risk stratification, longitudinal monitoring, and comparability with pulmonary function testing and other imaging.</p>","PeriodicalId":12076,"journal":{"name":"European Radiology","volume":" ","pages":"7152-7163"},"PeriodicalIF":6.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13451287/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147766469","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":"Open-weight language models for procedural impression generation.","authors":"Xuerong Jia, Wusheng Zhu, Kangmo Huang","doi":"10.1007/s00330-026-12612-6","DOIUrl":"10.1007/s00330-026-12612-6","url":null,"abstract":"","PeriodicalId":12076,"journal":{"name":"European Radiology","volume":" ","pages":"7353-7355"},"PeriodicalIF":6.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147835505","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":"Radiation exposure in transradial versus transfemoral access in endovascular treatment of intracranial aneurysms.","authors":"Gregor Peter, Christian Thaler, Luca Meucci, Felix Schlicht, Matthias Bechstein, Vincent Geest, Helge Kniep, Maxim Bester, Jens Fiehler, Lukas Meyer","doi":"10.1007/s00330-026-12603-7","DOIUrl":"10.1007/s00330-026-12603-7","url":null,"abstract":"<p><strong>Objectives: </strong>To compare radiation exposure between transradial (TRA) and transfemoral (TFA) access and identify treatment-related factors associated with radiation exposure in endovascular treatment of intracranial aneurysms.</p><p><strong>Materials and methods: </strong>This retrospective single-center study analyzed consecutively treated patients receiving endovascular aneurysm treatment (EAT) from May 2023 to April 2025 at the University Medical Center Hamburg-Eppendorf. EAT was performed by nine experienced board-certified neuroradiologists. The primary outcome was the radiation exposure defined as dose area product (DAP) (Gy·cm²). In addition to access route (TRA vs. TFA), patient-related (e.g. age, gender, aneurysm location) and procedure-related (e.g., interventionalist, incidental vs. symptomatic, used device) characteristics were analyzed with regard to radiation exposure using uni- and multivariable linear regression analysis.</p><p><strong>Results: </strong>A total of 209 patients (156 female, 53 male; median age 59 [51-68]) were analyzed. Median DAP was 72.2 (51.6-96.7). Multivariable linear regression analyses revealed that radiation exposure did not differ significantly between TRA and TFA (β = 8.13 [-3.79 to 20.01]; p = 0.18). Stent-assisted coiling (β = 55.82 [34.91-76.74]; p < .001) and female gender (β = -14.95 [-27.5 to -22.41]; p = 0.02) were associated with increased DAP. Further patient- and procedure-related variables were not significantly associated with radiation exposure.</p><p><strong>Conclusion: </strong>In this study, the choice between TRA and TFA had no significant impact on radiation exposure during endovascular aneurysm treatment. Stent-assisted coiling was independently associated with increased radiation exposure during endovascular treatment of intracranial aneurysms.</p><p><strong>Key points: </strong>Question Understanding and minimizing radiation exposure in endovascular aneurysm treatment is essential, as the increasing use of transradial access necessitates comparison with the established transfemoral route. Findings Radiation exposure did not differ between transradial and transfemoral access, while higher doses were independently associated with stent-assisted coiling procedures of increased complexity. Clinical relevance Our findings support the safety of transradial access regarding radiation exposure, allowing operators to select the most suitable access route based on patient anatomy and preference without increasing radiation risk.</p>","PeriodicalId":12076,"journal":{"name":"European Radiology","volume":" ","pages":"7305-7312"},"PeriodicalIF":6.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13451452/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147812807","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":"Utility of multi-echo MRI for differentiating neonatal hemochromatosis from other causes of neonatal liver failure.","authors":"Diana Veiga-Canuto, Mar Miserachs, Iram Siddiqui, Christopher Tomlinson, Logi Vidarsson, Govind B Chavhan","doi":"10.1007/s00330-026-12553-0","DOIUrl":"10.1007/s00330-026-12553-0","url":null,"abstract":"<p><strong>Objective: </strong>To assess whether multi-echo T2* MRI can differentiate neonatal hemochromatosis (NH) from other causes of neonatal liver failure (NLF) by evaluating siderosis in the liver and extrahepatic organs.</p><p><strong>Materials and methods: </strong>This retrospective study evaluated 26 infants ≤ 20 weeks of age, who underwent MRI with Gradient-Recalled (GRE) multi-echo T2* sequence for liver failure. Two radiologists noted the degree of siderosis in the liver, pancreas, thyroid, spleen and renal cortex using a semiquantitative scale. Kendall's tau was used to assess the correlation between siderosis grades and final diagnosis. Consensus review by hepatologist, neonatologist, and pathologist using integrated clinical, biochemical, imaging and histopathologic data served as the reference standard for the final diagnosis.</p><p><strong>Results: </strong>Of 26 patients, 7 had NH and 19 had other causes of NLF. Interobserver agreement was highest for liver (κ = 0.97), followed by kidney (κ = 0.87), spleen (κ = 0.84), thyroid (κ = 0.80), and pancreas (κ = 0.73). Significant positive correlations between siderosis grades and NH diagnosis were found for thyroid (Kendall's tau = 0.70, p < 0.01), pancreas (Kendall's tau = 0.67, p < 0.01), and liver (Kendall's tau = 0.42, p = 0.03), while spleen showed a significant negative correlation (Kendall's tau = -0.51, p < 0.01). MRI demonstrated 100% sensitivity, 89.5% specificity, 77.8% positive predictive value, 100% negative predictive value, and 92.3% overall accuracy for NH diagnosis. There were significant differences among groups in R2* values for the pancreas, thyroid and spleen, with no differences in the liver.</p><p><strong>Conclusion: </strong>Multi-echo T2* MRI reliably distinguishes NH from other causes of NLF by revealing significant siderosis in the thyroid and pancreas, with relative sparing of the spleen.</p><p><strong>Key points: </strong>Question Neonatal hemochromatosis (NH) is a rare but often fatal condition causing neonatal liver failure (NLF), and differentiating it from other causes of NLF is challenging. Finding Pancreatic and thyroid iron deposition, as seen on MRI, strongly correlated with NH, and splenic iron deposition correlated inversely with NH. Clinical relevance Multi-echo T2* MRI is a highly accurate, non-invasive technique for early differentiation of neonatal hemochromatosis from other liver failure causes, potentially enabling earlier diagnosis of NH and guiding crucial management decisions in affected neonates.</p>","PeriodicalId":12076,"journal":{"name":"European Radiology","volume":" ","pages":"7329-7340"},"PeriodicalIF":6.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147766622","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":"Increasing pulmonary artery visibility and diagnostic confidence with ultra-high resolution photon-counting detector CT pulmonary angiography.","authors":"Pauline Pannenbecker, Camilla Rüth, Jan-Peter Grunz, Alena Kollmann, Philipp Gruschwitz, Julius Frederik Heidenreich, Andreas Steven Kunz, Thorsten Alexander Bley, Henner Huflage","doi":"10.1007/s00330-026-12588-3","DOIUrl":"10.1007/s00330-026-12588-3","url":null,"abstract":"<p><strong>Objectives: </strong>Photon-counting detector (PCD) CT allows for ultra-high-resolution (UHR) imaging of the pulmonary vasculature. The aim of this study was to assess the benefits of UHR-PCD-CT pulmonary angiography (CTPA) over dual-energy energy-integrating-detector (EID) CTPA.</p><p><strong>Materials and methods: </strong>Comparing UHR-PCD-CTPA (n = 76 at image quality index (IQ) 50, n = 76 at IQ25) and dual-energy EID-CTPA (n = 75) acquired between April and October 2024, a total of 227 examinations were analyzed in this retrospective single-center study after excluding 56 ineligible studies. Hounsfield unit measurements and subjective image quality ratings of three radiologists (e.g., peripheral pulmonary artery visibility and diagnostic confidence) were investigated.</p><p><strong>Results: </strong>Peripheral pulmonary artery visibility, overall image quality, and self-reported diagnostic confidence were higher in UHR-PCD-CTPA than in EID-CTPA (all p < 0.01), with no relevant differences between IQ25 and IQ50 scans (all p > 0.05). Diagnostic confidence was stronger in UHR-PCD-CTPA vs. EID-CTPA (the two highest confidence scores reported by readers after viewing CTPAs and iodine-maps in 92.1-100% of IQ50, 94.6-100% of IQ25 and 66.6-73.3% of EID cases). Median attenuation in the pulmonary trunk was higher in UHR-PCD-CTPA (IQ25: 623.3 HU, IQ50: 567.8 HU) compared with EID-CTPA (397.2 HU, all p < 0.01). CT dose index was highest for IQ50 UHR-PCD-CTPA (6.7 ± 2.4 mGy), compared to EID-CTPA (4.7 ± 2.7 mGy) and IQ25 UHR-PCD-CTPA (3.0 ± 1.0 mGy; all p < 0.01).</p><p><strong>Conclusion: </strong>Image quality of CTPA benefits greatly from employing the UHR-mode in PCD-CT. Compared to EID-CTPA, even UHR-PCD-CTPA scans with a markedly lower radiation dose facilitate superior intraluminal attenuation, peripheral pulmonary artery visibility, and diagnostic confidence.</p><p><strong>Key points: </strong>Question With the introduction of a UHR scan option for PCD-CT of the pulmonary vasculature, the question arises whether patients benefit from this recent technological advancement. Findings UHR-PCD-CTPA offers improved image quality, increased pulmonary artery visibility, and higher diagnostic confidence, even with significant dose reduction compared to conventional EID-CTPA. Clinical relevance The advantages in subjective and objective image quality described for UHR-PCD-CTPA suggest potential for superior diagnostic performance in the work-up of pulmonary embolism.</p>","PeriodicalId":12076,"journal":{"name":"European Radiology","volume":" ","pages":"7174-7185"},"PeriodicalIF":6.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13451506/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147835465","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":"Photon-counting CT vs V/Q SPECT for lobar perfusion quantification in chronic thromboembolic pulmonary hypertension.","authors":"Matthias M V Moeskes, Thorsten Derlin, Anna M Hunkemöller, Cornelia Schäfer-Prokop, Norman Kornemann, Jan W Eckstein, Bernhard Meyer, Jens Vogel-Claussen, Frank K Wacker, Hoen-Oh Shin","doi":"10.1007/s00330-026-12547-y","DOIUrl":"10.1007/s00330-026-12547-y","url":null,"abstract":"<p><strong>Background: </strong>Ventilation/perfusion single-photon emission computed tomography (V/Q-SPECT) is the standard first-line imaging method for chronic thromboembolic pulmonary hypertension (CTEPH), but it lacks anatomical detail. Photon-counting computed tomography (PCCT) enables high-resolution assessment of perfusion, vasculature, and parenchyma in one scan, potentially improving diagnostic accuracy.</p><p><strong>Objectives: </strong>To compare quantitative lobar lung perfusion between PCCT and V/Q-SPECT in patients with suspected or confirmed CTEPH.</p><p><strong>Materials and methods: </strong>This retrospective single-centre study included twenty-three patients (ten females, thirteen males; mean age 67.9 ± 10.7 years). The median interval between PCCT and V/Q-SPECT imaging was 3 days (range: 0-11 days). Lung perfusion was analysed on a lobar basis using PCCT-derived perfused blood volume (PBV) maps and V/Q-SPECT perfusion images. Data were normalised using a z-score approach based on the 95% confidence interval. Lobar segmentation was performed with TotalSegmentator. Pearson correlation and Bland-Altman analyses compared lobar and whole-lung perfusion metrics. Perfusion defect volumes were quantified from normalised maps.</p><p><strong>Results: </strong>Whole-lung perfusion correlated strongly between PCCT and V/Q-SPECT (r = 0.72, p < 0.05). Lobar correlations ranged from r = 0.62 to r = 0.85. PCCT yielded slightly higher perfusion values (mean PBV 0.50 ± 0.04) than V/Q-SPECT (0.49 ± 0.09). Bland-Altman analysis showed a bias of +0.015 (limits -0.13 to +0.16). Perfusion defect volumes correlated moderately (whole-lung r = 0.60, lobes r = 0.49-0.77, p < 0.05).</p><p><strong>Conclusion: </strong>PCCT-based perfusion imaging shows high concordance with V/Q-SPECT in this cohort, supporting its feasibility as a single-modality tool for functional and anatomical lung evaluation in CTEPH.</p><p><strong>Key points: </strong>Question PCCT perfusion may address the unmet need for a combined functional and anatomical evaluation of CTEPH in a single examination. Findings PCCT showed strong correlation with V/Q-SPECT for lobar and whole-lung perfusion, with minimal bias and consistent quantitative agreement. Clinical relevance PCCT enables simultaneous high-resolution assessment of perfusion, vasculature, and parenchyma, potentially improving diagnostic confidence and streamlining CTEPH work-up in clinical practice.</p>","PeriodicalId":12076,"journal":{"name":"European Radiology","volume":" ","pages":"7139-7151"},"PeriodicalIF":6.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13451419/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147766543","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":"Semantic CT features and differentiation model: new primary lung cancer versus metastasis after previous malignancy.","authors":"Hardeep Singh Kalsi, Kristofer Linton-Reid, Changhyun Kim, Mitchell Chen, Victoria Crowe, Esubalew Alemu, Samir Mahboobani, David Gibeon, Alexander Procter, Mohsen Hajhosseiny, Cara Owens, Emily C Bartlett, Nuria Porta, Thesha Thavaraja, Simon Doran, Anand Devaraj, Bhupinder Sharma, Arjun Nair, Eric O Aboagye, Richard W Lee","doi":"10.1007/s00330-026-12557-w","DOIUrl":"10.1007/s00330-026-12557-w","url":null,"abstract":"<p><strong>Objectives: </strong>New pulmonary lesions after prior cancer present a diagnostic challenge, potentially representing malignancy relapse or new primary lung cancer due to shared risk factors and/or impact of prior oncological therapies. This study evaluated radiologist-defined semantic features for differentiation of second primary lung cancer (SPLC) versus lung metastasis (LM).</p><p><strong>Materials and methods: </strong>651 single-timepoint, pre-treatment CT thorax scans from the multicentre retrospective AI-SONAR biomarker study (IRAS 331656 REC 23/NE/0151) were divided for review by nine thoracic oncology radiologists to evaluate eight semantic features. Logistic regression analysis was undertaken to identify significant features and a developed 'Second Malignancy Aetiology Recognition Tool' model (SMART) was compared to real-world clinical reader performance using McNemar's test.</p><p><strong>Results: </strong>649 scans were technically usable, 299 SPLC and 350 LM. Emphysema (p < 0.0001, OR 0.20 [95% CI 0.14-0.29]), irregular contour (p < 0.0001, OR 0.31 [95% CI 0.20-0.48]) and spiculation (p = 0.013, OR 0.51 [95% CI 0.30-0.89]) were more prevalent in SPLC (OR < 1 indicates association with SPLC). Peripheral lung distribution (p = 0.003, OR 1.80 [95% CI 1.20-2.68]) was more common in LM (OR > 1 indicates metastasis). SMART model AUC was 0.81 (95% CI 0.78-0.84), LM classification accuracy 75% vs 69% by radiology reader and McNemar p-value < 0.01 for comparative accuracy. 550/649 cases were predicted SPLC or LM by radiologists, in which the SMART model LM classification accuracy was 74% vs 77% by reader and McNemar p-value 0.20.</p><p><strong>Conclusion: </strong>In new lesions after prior treated cancer, radiologist readers called SPLC more often than LM. The SMART model performed comparably with expert thoracic radiologists in the diagnosis of LM.</p><p><strong>Key points: </strong>Question Differentiating the malignant aetiology of indeterminate lung lesions after prior cancer presents a growing diagnostic challenge. The literature and nodule guidelines are sparse for this setting. Findings A SMART model derived from semantic CT imaging features correctly classified malignant lung lesions as metastasis or lung cancer, more often than thoracic radiologists. Clinical relevance The SMART model could improve the stratification of malignant new lung lesions after prior cancer. This may lead to earlier diagnosis and optimise patient management, treatment selection and downstream outcomes.</p>","PeriodicalId":12076,"journal":{"name":"European Radiology","volume":" ","pages":"6969-6980"},"PeriodicalIF":6.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13451270/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147835533","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":"The evolving role of MR black-blood thrombus imaging in the diagnosis of cerebral venous thrombosis.","authors":"Mehran Arab Ahmadi, Farzad Ashrafi, Melika Boroomand-Saboor","doi":"10.1007/s00330-026-12544-1","DOIUrl":"10.1007/s00330-026-12544-1","url":null,"abstract":"","PeriodicalId":12076,"journal":{"name":"European Radiology","volume":" ","pages":"7349-7350"},"PeriodicalIF":6.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147716491","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}