European Radiology最新文献

{"title":"Reporting turn-around-times are growing: interval scanning anxiety and other harms need mitigation.","authors":"Thomas C Booth, Florien W Boele","doi":"10.1007/s00330-025-11357-y","DOIUrl":"10.1007/s00330-025-11357-y","url":null,"abstract":"","PeriodicalId":12076,"journal":{"name":"European Radiology","volume":" ","pages":"4415-4416"},"PeriodicalIF":4.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143032745","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":"Challenges and variability in breast cancer screening: diagnostic work-up and strategies for standardization across Europe.","authors":"Petra Valkovic Zujic","doi":"10.1007/s00330-025-11425-3","DOIUrl":"10.1007/s00330-025-11425-3","url":null,"abstract":"","PeriodicalId":12076,"journal":{"name":"European Radiology","volume":" ","pages":"3961-3963"},"PeriodicalIF":4.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143556387","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":"Optimizing prostate cancer diagnosis: combining imaging modalities for tailored treatment.","authors":"Laura Evangelista, Carlo Vallone, Priscilla Guglielmo","doi":"10.1007/s00330-025-11551-y","DOIUrl":"10.1007/s00330-025-11551-y","url":null,"abstract":"","PeriodicalId":12076,"journal":{"name":"European Radiology","volume":" ","pages":"4040-4042"},"PeriodicalIF":4.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143709308","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":"A visual scale to rate amygdalar atrophy on MRI.","authors":"Francesca B Pizzini, Federica Ribaldi, Valerio Natale, Max Scheffler, Vittoria Rossi, Giovanni B Frisoni","doi":"10.1007/s00330-024-11249-7","DOIUrl":"10.1007/s00330-024-11249-7","url":null,"abstract":"<p><strong>Background: </strong>Visual rating scales are routinely used in clinical radiology to assess brain atrophy on scans of patients with suspected neurodegenerative conditions. Limbic predominant age-related TDP-43 encephalopathy (LATE) has recently been described, featuring early and severe atrophy of the amygdala. However, there is currently no scoring system specifically designed to assess amygdalar atrophy on MRI.</p><p><strong>Objectives: </strong>to develop and validate a visual rating scale for amygdalar atrophy.</p><p><strong>Materials and methods: </strong>Stringent criteria were developed for no, mild/moderate, and severe amygdalar atrophy based on axial and coronal volumetric T1-weighted MRI scans. Inter- and intra-rater reliabilities were estimated by three independent expert neuroradiologists in 100 randomly selected scans from the Geneva Memory Center cohort selected to be representative of the variability of medial temporal atrophy. Convergent validity was evaluated versus amygdalar volumes extracted by FreeSurfer on 1943 consecutive patients. Criterion validity versus autopsy-confirmed LATE neuropathologic changes were studied in the pathological subset of the Alzheimer's Disease Neuroimaging Initiative (ADNI) cohort (N = 96).</p><p><strong>Results: </strong>Intra- and inter-rater agreements of amygdalar visual ratings were between substantial and almost perfect (weighted Cohen's Kappa 0.71 to 0.93). Visual ratings were strongly associated with amygdalar volumes (p ≤ 0.001 on the Kruskal-Wallis test). LATE neuropathologic changes were associated with visual ratings of amygdalar atrophy (p = 0.057 on a test for trend).</p><p><strong>Conclusion: </strong>The proposed visual amygdalar atrophy scale is a reliable and valid tool to assess amygdalar atrophy on MRI and can be a useful adjunct in routine radiological reporting.</p><p><strong>Key points: </strong>Question Assessment of amygdalar atrophy is crucial for diagnosing neurodegenerative diseases, as the limbic predominant age-related TDP-43 encephalopathy, yet no validated visual rating scale exists. Findings The proposed amygdalar atrophy scale demonstrated high intra-rater and inter-rater reliability, strong correlation with amygdalar volumetry, and association with limbic predominant age-related TDP-43 encephalopathy (LATE). Clinical relevance The amygdalar atrophy scale provides a reliable practical assessment tool that enhances diagnostic accuracy for dementia-related conditions, particularly aiding in identifying limbic predominant age-related TDP-43 encephalopathy.</p>","PeriodicalId":12076,"journal":{"name":"European Radiology","volume":" ","pages":"4246-4256"},"PeriodicalIF":4.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12165972/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142853518","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":"Evaluation of MRI characterisation of histopathologically matched lymph nodes and other mesorectal nodal structures in rectal cancer.","authors":"Miriam Kheira Rutegård, Malin Båtsman, Lennart Blomqvist, Martin Rutegård, Jan Axelsson, Wendy Wu, Ingrid Ljuslinder, Jörgen Rutegård, Richard Palmqvist, Fredrik Brännström, Katrine Riklund","doi":"10.1007/s00330-025-11361-2","DOIUrl":"10.1007/s00330-025-11361-2","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate current MRI-based criteria for malignancy in mesorectal nodal structures in rectal cancer.</p><p><strong>Method: </strong>Mesorectal nodal structures identified on baseline MRI as lymph nodes were anatomically compared to their corresponding structures histopathologically, reported as lymph nodes, tumour deposits or extramural venous invasion. All anatomically matched nodal structures from patients with primary surgery and all malignant nodal structures from patients with neoadjuvant treatment were included. Mixed-effects logistic regression models were used to evaluate the morphological criteria irregular margin, round shape, heterogeneous signal and nodal size, as well as the combined 2016 European Society of Gastrointestinal and Abdominal Radiology (ESGAR) consensus criteria, with histopathological nodal status as the gold standard.</p><p><strong>Results: </strong>In total, 458 matched nodal structures were included from 46 patients (mean age, 67.7 years ± 1.5 [SD], 27 men), of which 19 received neoadjuvant treatment. The strongest associations in the univariable model were found for short-axis diameter ≥ 5 mm (OR 21.43; 95% CI: 4.13-111.29, p < 0.001) and heterogeneous signal (OR 9.02; 95% CI: 1.33-61.08, p = 0.024). Only size remained significant in multivariable analysis (OR 12.32; 95% CI: 2.03-74.57, p = 0.006). When applying the ESGAR consensus criteria to create a binary classification of nodal status, the OR of malignant outcome for nodes with positive ESGAR was 8.23 (95% CI: 2.15-31.50, p = 0.002), with corresponding sensitivity and specificity of 54% and 85%, respectively.</p><p><strong>Conclusion: </strong>The results confirm the role of morphological and size criteria in predicting lymph node metastases. However, the current criteria might not be accurate enough for nodal staging.</p><p><strong>Key points: </strong>Question Pretreatment lymph node staging in rectal cancer is challenging, and the ESGAR consensus criteria are not fully validated. Findings Although the ESGAR criteria correlated with malignant outcomes, diagnostic performance in terms of particular sensitivity, but also specificity, was not high. Clinical relevance Accurate nodal staging in rectal cancer is crucial for individual treatment planning. However, this validation of the current ESGAR consensus criteria suggests that these should be used with caution.</p>","PeriodicalId":12076,"journal":{"name":"European Radiology","volume":" ","pages":"4080-4090"},"PeriodicalIF":4.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12165870/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143001737","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":"CXR-LLaVA: a multimodal large language model for interpreting chest X-ray images.","authors":"Seowoo Lee, Jiwon Youn, Hyungjin Kim, Mansu Kim, Soon Ho Yoon","doi":"10.1007/s00330-024-11339-6","DOIUrl":"10.1007/s00330-024-11339-6","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to develop an open-source multimodal large language model (CXR-LLaVA) for interpreting chest X-ray images (CXRs), leveraging recent advances in large language models (LLMs) to potentially replicate the image interpretation skills of human radiologists.</p><p><strong>Materials and methods: </strong>For training, we collected 592,580 publicly available CXRs, of which 374,881 had labels for certain radiographic abnormalities (Dataset 1) and 217,699 provided free-text radiology reports (Dataset 2). After pre-training a vision transformer with Dataset 1, we integrated it with an LLM influenced by the LLaVA network. Then, the model was fine-tuned, primarily using Dataset 2. The model's diagnostic performance for major pathological findings was evaluated, along with the acceptability of radiologic reports by human radiologists, to gauge its potential for autonomous reporting.</p><p><strong>Results: </strong>The model demonstrated impressive performance in test sets, achieving an average F1 score of 0.81 for six major pathological findings in the MIMIC internal test set and 0.56 for six major pathological findings in the external test set. The model's F1 scores surpassed those of GPT-4-vision and Gemini-Pro-Vision in both test sets. In human radiologist evaluations of the external test set, the model achieved a 72.7% success rate in autonomous reporting, slightly below the 84.0% rate of ground truth reports.</p><p><strong>Conclusion: </strong>This study highlights the significant potential of multimodal LLMs for CXR interpretation, while also acknowledging the performance limitations. Despite these challenges, we believe that making our model open-source will catalyze further research, expanding its effectiveness and applicability in various clinical contexts.</p><p><strong>Key points: </strong>Question How can a multimodal large language model be adapted to interpret chest X-rays and generate radiologic reports? Findings The developed CXR-LLaVA model effectively detects major pathological findings in chest X-rays and generates radiologic reports with a higher accuracy compared to general-purpose models. Clinical relevance This study demonstrates the potential of multimodal large language models to support radiologists by autonomously generating chest X-ray reports, potentially reducing diagnostic workloads and improving radiologist efficiency.</p>","PeriodicalId":12076,"journal":{"name":"European Radiology","volume":" ","pages":"4374-4386"},"PeriodicalIF":4.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12166004/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142983017","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":"Risk of acute kidney injury after contrast-enhanced MRI examinations in a pediatric population.","authors":"Hana Jeong, Pyeong Hwa Kim, Ah Young Jung, Jin Seong Lee, Young Ah Cho, Chong Hyun Suh, Jiwon Jung, Hee Mang Yoon","doi":"10.1007/s00330-024-11315-0","DOIUrl":"10.1007/s00330-024-11315-0","url":null,"abstract":"<p><strong>Objectives: </strong>To investigate the associations between gadolinium-based contrast agent (GBCA) administration and the occurrence of acute kidney injury (AKI) in pediatric patients, and to determine the risks associated with AKI.</p><p><strong>Materials and methods: </strong>This retrospective study was conducted on pediatric patients who underwent contrast-enhanced or unenhanced MRI between January 1st, 2015, and June 30th, 2021. Examinations were included if they had data on height and serum creatinine levels within 3 months before and 2 days after the examinations. AKI was defined according to the AKI Network criteria. Multivariable generalized estimating equations, propensity score analyses, and inverse probability of treatment weighting analysis were used to evaluate associations between GBCA and AKI. Subgroup analyses were conducted to evaluate the interaction effects of GBCA and each subgroup variable (age, sex, examination type, admission type, chronic kidney disease stage, diabetes mellitus, cardiovascular disease, or surgery or contrast-enhanced CT performed 7 days before and 2 days after MRI).</p><p><strong>Results: </strong>A total of 2508 examinations were included (1996 with contrast-enhanced, 512 with unenhanced MRI). AKI occurred in 1.5% of the contrast group and 1.2% of the noncontrast group. Multivariable analysis showed no significant difference in AKI incidence between the groups (adjusted OR, 1.29 [95% CI: 0.53, 3.11]; p = 0.58). Propensity score matching and inverse probability of treatment weighting analysis also showed no significant association (p = 0.22 and p = 0.21, respectively). Subgroup analysis showed no significant interaction between GBCA and any of the subgroup variables.</p><p><strong>Conclusion: </strong>The study found no significant association between gadolinium-based contrast agent administration and the occurrence of acute kidney injury in pediatric patients.</p><p><strong>Key points: </strong>Question There is limited data on the development of acute kidney injury following exposure to gadolinium-based contrast agent in pediatric patients. Findings There was no significant association between the administration of gadolinium-based contrast agent and occurrence of acute kidney injury in pediatric patients. Clinical relevance The administration of gadolinium-based contrast agents does not increase the risk of acute kidney injury in pediatric patients following MRI.</p>","PeriodicalId":12076,"journal":{"name":"European Radiology","volume":" ","pages":"4171-4179"},"PeriodicalIF":4.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142876675","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 calcium score and emphysema extent on different CT radiation dose protocols in lung cancer screening.","authors":"Roberta Eufrasia Ledda, Gianluca Milanese, Maurizio Balbi, Federica Sabia, Camilla Valsecchi, Margherita Ruggirello, Andrea Ciuni, Giulia Tringali, Nicola Sverzellati, Alfonso Vittorio Marchianò, Ugo Pastorino","doi":"10.1007/s00330-024-11254-w","DOIUrl":"10.1007/s00330-024-11254-w","url":null,"abstract":"<p><strong>Objectives: </strong>To assess the consistency of automated measurements of coronary artery calcification (CAC) burden and emphysema extent on computed tomography (CT) images acquired with different radiation dose protocols in a lung cancer screening (LCS) population.</p><p><strong>Materials and methods: </strong>The patient cohort comprised 361 consecutive screenees who underwent a low-dose CT (LDCT) scan and an ultra-low-dose CT (ULDCT) scan at an incident screening round. Exclusion criteria for CAC measurements were software failure and previous history of CVD, including coronary stenting, whereas for emphysema assessment, software failure only. CT images were retrospectively analyzed by a fully automated AI software for CAC scoring, using three predefined Agatston score categories (0-99, 100-399, and ≥ 400), and emphysema quantification, using the percentage of low attenuation areas (%LAA). Demographic and clinical data were obtained from the written questionnaire completed by each participant at the first visit. Agreement for CAC and %LAA categories was measured by the k-Cohen Index with Fleiss-Cohen weights (K_w) and Intraclass Correlation Coefficient (ICC) with 95% Confidence Interval (CI).</p><p><strong>Results: </strong>An overlap of CAC strata was observed in 275/327 (84%) volunteers, with an almost perfect agreement (K_w = 0.86, 95% CI 0.82-0.90; ICC = 0.86, 95% CI 0.79-0.90), while an overlap of %LAA strata was found in 204/356 (57%) volunteers, with a moderate agreement (K_w = 0.57, 95% CI 0.51-0.63; ICC = 0.57, 95% CI 0.21-0.75).</p><p><strong>Conclusion: </strong>Automated CAC quantification on ULDCT seems feasible, showing similar results to those obtained on LDCT, while the quantification of emphysema tended to be overestimated on ULDCT images.</p><p><strong>Key points: </strong>Question Evidence demonstrating that coronary artery calcification and emphysema can be automatedly quantified on ultra-low-dose chest CT is still awaited. Findings Coronary artery calcification and emphysema measurements were similar among different CT radiation dose protocols; their automated quantification is feasible on ultra-low-dose CT. Clinical relevance Ultra-low-dose CT-based LCS might offer an opportunity to improve the secondary prevention of cardiovascular and respiratory diseases through automated quantification of both CAC burden and emphysema extent.</p>","PeriodicalId":12076,"journal":{"name":"European Radiology","volume":" ","pages":"3781-3787"},"PeriodicalIF":4.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12165900/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142863666","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":"Tumour growth rate and invasive interval cancer characteristics in a UK breast cancer screening population.","authors":"Muzna Nanaa, Roido Manavaki, Thiemo J A van Nijnatten, Natalia Stranz, Serena Carriero, William A Coleman, Iris Allajbeu, Nicholas R Payne, Elisabetta Giannotti, Sarah E Hickman, Otso Arponen, Fiona J Gilbert","doi":"10.1007/s00330-024-11342-x","DOIUrl":"10.1007/s00330-024-11342-x","url":null,"abstract":"<p><strong>Objectives: </strong>To estimate tumour volume doubling time (TVDT) of interval cancers (ICs).</p><p><strong>Methods: </strong>Two radiologists retrospectively reviewed prior screening and diagnostic mammograms and measured mean diameter on \"visible\" ICs. Univariate analyses of clinicopathological variables (ER, HER2, grade, age at diagnosis, and breast density) were undertaken, and those with p < 0.1 were included in a generalised linear model to estimate TVDT, cancer size at screening, and time of cancer visibility for \"non-visible\" tumours.</p><p><strong>Results: </strong>From 2011 to 2018, 476 ICs were diagnosed, almost half in the third year after screening with 86% grade 2 or 3. A visible abnormality at screening was identified in 281/476 (59%) cases. Significant differences in TVDT were found with age (p < 0.02), ER status (p < 0.0001). Median TVDTs of grade 1, 2 and 3 cancers were 317, 288, and 195 days, respectively (p < 0.001). For non-visible cancers, the median estimated size at screening was 1.7 mm (IQR 1.0-2.5) for grade 1, 2.5 mm (IQR 1.5-5.9) for grade 2, and 0.9 mm (IQR 0.4-2.0) for grade 3 cancers, p < 0.001. The estimated time for cancer visibility was 489 days (IQR 229-682) after screening and 645 days (IQR 527-798) for cancers diagnosed in the third year after screening.</p><p><strong>Conclusion: </strong>Using TVDT of retrospectively visible interval cancers, non-visible interval cancer sizes can be estimated at the time of screening. Increasing the frequency of screening from three-yearly to two-yearly invitations would reduce the number of interval cancers significantly.</p><p><strong>Key points: </strong>Question Growth modelling of visible interval cancers (ICs) at screening helps to track the likely progression of non-visible ICs over the screening interval. Findings Tumour doubling time of visible ICs at screening is positively associated with age and ER status and inversely associated with cancer grade. Clinical relevance Interval cancer characterisation and growth modelling can be helpful to better predict the benefits of supplemental screening and the frequency of screening, given a minimum detectable size.</p>","PeriodicalId":12076,"journal":{"name":"European Radiology","volume":" ","pages":"4001-4012"},"PeriodicalIF":4.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12165881/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143002564","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":"Associations of ventriculomegaly and white matter hyperintensities with glymphatic dysfunction in idiopathic normal pressure hydrocephalus.","authors":"Qian Wu, Jiakuan Chen, Xiaolin Yang, Xiejun Zhang, Wenjie He, Jun Xia","doi":"10.1007/s00330-024-11320-3","DOIUrl":"10.1007/s00330-024-11320-3","url":null,"abstract":"<p><strong>Objectives: </strong>To investigate glymphatic function in idiopathic normal pressure hydrocephalus (iNPH) using the diffusion tensor image analysis along the perivascular space (DTI-ALPS) method and to explore the associations of ALPS index with ventriculomegaly and white matter hyperintensities (WMH).</p><p><strong>Materials and methods: </strong>This study included 41 patients with iNPH and 40 age- and sex-matched normal controls (NCs). All participants underwent brain MRI. Based on DTI, we then calculated the ALPS index to obtain the water diffusivity along the perivascular space. Ventricular volume and WMH were also determined. Differences in the diffusivities and ALPS indexes between the iNPH and NC groups were investigated; associations of the DTI-ALPS index with ventriculomegaly and WMH were analysed.</p><p><strong>Results: </strong>Patients with iNPH had a lower ALPS index than NCs (p < 0.001). The ALPS index was significantly correlated with the normalised ventricular volume (r = -0.446, p = 0.004), but not with total WMH volume (r = -0.246, p = 0.126). Further regression analyses indicated that the reduced ALPS index was associated with increased ventricular volume (β = -7.158, p = 0.016), but not with normalised WMH volume (β = -2.796, p = 0.161). The receiver operating characteristic analysis demonstrated the ALPS index's excellent diagnostic performance for iNPH (the optimal cut-off point = 1.322; sensitivity, 100.0%; specificity, 87.5%; AUC = 0.980).</p><p><strong>Conclusions: </strong>Patients with iNPH had a lower ALPS index, which may suggest impaired glymphatic function. This study demonstrated an association of DTI-ALPS index with ventriculomegaly, but not WMH in patients with iNPH.</p><p><strong>Key points: </strong>Question Glymphatic dysfunction is crucial in idiopathic normal pressure hydrocephalus (iNPH) development, yet its associations with neuroimaging features remains unclear. Findings Diffusion tensor image analysis along the perivascular space (DTI-ALPS) revealed a reduced ALPS index in idiopathic normal pressure hydrocephalus, negatively correlating with ventricular volume. Clinical relevance DTI-ALPS enables non-invasive assessment of glymphatic function and its relationship with neuroimaging characteristics in idiopathic normal pressure hydrocephalus, facilitating the investigation of glymphatic dysfunction in iNPH pathophysiology.</p>","PeriodicalId":12076,"journal":{"name":"European Radiology","volume":" ","pages":"4315-4324"},"PeriodicalIF":4.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12166017/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143002770","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}