Insights into Imaging最新文献

{"title":"Development and validation of an interpretable ultrasound radiomics model for benign and malignant classification of breast lesions: a multicenter large-sample study.","authors":"Di Zhang, Wen-Wu Lu, Xia-Chuan Qin, Wang Zhou, Xian-Ya Zhang, Yan-Hong Luo, Lin-Song Wu, Jun Wu, Jun-Li Wang, Jun-Jie Zhao, Lei Zhang, Chao-Xue Zhang","doi":"10.1186/s13244-026-02344-y","DOIUrl":"10.1186/s13244-026-02344-y","url":null,"abstract":"<p><strong>Objectives: </strong>To develop and validate a combined ultrasound-based radiomics-clinical model for differentiating benign and malignant breast lesions.</p><p><strong>Materials and methods: </strong>A total of 3142 patients from eight hospitals between February 2012 and September 2024 were included in this multicenter retrospective development and validation study, with an additional single-center prospective test cohort. Lesions were manually segmented, and radiomics features were automatically extracted to construct five machine learning models. The best-performing radiomics model was combined with clinical features to build a combined model. Model performance and its impact on Breast Imaging Reporting and Data System (BI-RADS)-based biopsy decisions were evaluated.</p><p><strong>Results: </strong>Logistic regression (LR) showed the best radiomics performance, with area under the curves (AUCs) of 0.83, 0.82, 0.81, and 0.82 across the training, internal test, external test, and prospective test sets. The clinical model achieved AUCs of 0.87, 0.85, 0.87, and 0.86, whereas the combined model achieved AUCs of 0.92, 0.90, 0.92, and 0.93, significantly outperforming both single-modality models (all p < 0.01). Decision curve analysis (DCA) showed that the combined model had a higher net benefit than the other models across a broad range of threshold probabilities (0.05-0.95) in this study. Performance remained stable across lesion size and age subgroups. In the reclassification analysis, the model suggested the potential to influence biopsy recommendations without a significant reduction in sensitivity and to increase the malignancy yield in BI-RADS 4a. Shapley additive explanations (SHAP) analysis provided clinically interpretable feature contributions.</p><p><strong>Conclusion: </strong>The interpretable ultrasound-based radiomics model enables reliable, noninvasive breast lesion diagnosis and may reduce unnecessary biopsies.</p><p><strong>Critical relevance statement: </strong>This work developed an interpretable radiomics-clinical combined model in a multicenter retrospective development and validation study, with additional testing in a single-center prospective cohort, and may support breast lesion risk stratification and biopsy decision-making after further prospective clinical utility evaluation.</p><p><strong>Key points: </strong>Conventional ultrasound diagnosis of breast cancer shows limited specificity. A multicenter radiomics-clinical combined model showed improved diagnostic performance, with additional validation in a prospective test cohort.</p>","PeriodicalId":13639,"journal":{"name":"Insights into Imaging","volume":"17 1","pages":""},"PeriodicalIF":5.6,"publicationDate":"2026-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13294407/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148317040","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":"Innovative competency-based education approach to radiology residency: integrating modular training in clinical practice and research.","authors":"Shang Wan, Lei Ye, Xibiao Yang, Zhengyan Li, Na Hu, Bin Song, Ningna Fan, Xijiao Liu, Zixing Huang","doi":"10.1186/s13244-026-02335-z","DOIUrl":"10.1186/s13244-026-02335-z","url":null,"abstract":"<p><strong>Objectives: </strong>This study aimed to design and evaluate a competency-based education (CBE)-oriented modular training model for radiology residents, emphasizing interdisciplinary integration and disease-focused instruction to enhance clinical competence.</p><p><strong>Materials and methods: </strong>This prospective controlled study included 75 radiology residents enrolled in standardized training from September 2020 to July 2024. A CBE-oriented modular training model was developed, structured around approximately 27 radiologic subspecialties and incorporating interdisciplinary instruction, clinical team rotations, and image post-processing skill training. The participants were assigned to either the experimental group (CBE training) or the control group (traditional training). Teaching effectiveness was evaluated by comparing theoretical and practical exam scores via statistical analysis.</p><p><strong>Results: </strong>Overall, there were no significant differences in theoretical (83.26 ± 6.99 vs 81.76 ± 7.54; p > 0.05) or practical scores (86.79 ± 8.90 vs 84.91 ± 10.71; p > 0.05) between the two groups. However, subgroup analysis revealed that, among residents in the non-graduate subgroup, the experimental group achieved significantly higher theoretical (p = 0.0179) and practical scores (p = 0.028) than the control group. No significant differences were observed in the enrolled-graduate subgroup (p > 0.05).</p><p><strong>Conclusions: </strong>The competency-based modular training model significantly improved clinical competence among residents in the non-graduate subgroup but showed less additional benefit in the enrolled-graduate subgroup. This study offers insights for advancing radiology residency training reform.</p><p><strong>Critical relevance statement: </strong>The distinct effectiveness of this approach was particularly beneficial for trainees with diverse educational backgrounds. This training model enhances residents' clinical competence and research capabilities and provides insights for global radiology education reform, aligning training paradigms with evolving clinical and technological advancements.</p><p><strong>Key points: </strong>A CBE-oriented modular training model for radiology residents was developed, integrating interdisciplinary learning, team-based clinical training, and image post-processing instruction. Although no overall difference in examination scores was observed between the two groups, residents in the non-graduate subgroup achieved significantly better theoretical and practical scores under the CBE model.</p>","PeriodicalId":13639,"journal":{"name":"Insights into Imaging","volume":"17 1","pages":""},"PeriodicalIF":5.6,"publicationDate":"2026-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13304376/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148328922","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 clinicoradiological and pathological-molecular characteristics associated with spread through air spaces in stage IA invasive lung adenocarcinoma.","authors":"Feng Xu, Xian Li, Wei-Hua Zhao, Ji-Wen Huo, Tian-You Luo, Qi Li","doi":"10.1186/s13244-026-02339-9","DOIUrl":"10.1186/s13244-026-02339-9","url":null,"abstract":"<p><strong>Objectives: </strong>To investigate the clinicoradiological and pathological-molecular characteristics associated with spread through air spaces (STAS) in stage IA invasive lung adenocarcinoma (ILADC).</p><p><strong>Materials and methods: </strong>We retrospectively analyzed clinicoradiological data from 765 surgically resected stage IA ILADC patients. STAS-positive/-negative group comparisons identified independent predictors for model development, which were externally validated. Model-derived threshold stratified patients into risk groups for RFS analysis. Additionally, pathological and molecular tumor characteristics were compared between STAS-positive and STAS-negative cases.</p><p><strong>Results: </strong>Univariate analysis revealed significant differences in three clinical characteristics and eight radiological features between STAS-positive and STAS-negative cases (p < 0.05). Binary logistic regression identified CTR ≥ 90%, bronchial truncation, pleural retraction, and satellite nodules as independent predictors of STAS. The model yielded area under the curve (AUC) 0.823/accuracy 76.70% (training cohort) and AUC 0.829/accuracy 70.10% (external validation cohort). High-risk patients, as classified by the model, had significantly shorter RFS in the training and external validation cohorts (all p < 0.05). Additionally, STAS-positive tumors had a higher prevalence of micropapillary/solid-predominant growth and KRAS/ALK mutations, while EGFR mutations were more common in STAS-negative tumors (p < 0.05).</p><p><strong>Conclusion: </strong>The proposed model demonstrates potential in preoperatively identifying STAS and stratifying recurrence risk for patients with stage IA ILADC, which may assist in selecting appropriate candidates for sublobar resection. Furthermore, the distinct pathological and molecular characteristics of STAS-positive tumors offer valuable insights for guiding personalized adjuvant therapy.</p><p><strong>Critical relevance statement: </strong>This validated clinicoradiological model utilizes preoperative CT to predict STAS and recurrence risk, optimizing surgical decision-making. Furthermore, it explores these underlying pathological-molecular features associated with STAS, supporting personalized adjuvant therapy selection.</p><p><strong>Key points: </strong>Preoperative identification of STAS remains a clinical challenge in stage IA lung adenocarcinoma. Our clinicoradiological model can simultaneously predict STAS and stratify recurrence risk. STAS-positive cases can be characterized by micropapillary/solid patterns and KRAS/ALK mutations. These findings may assist with surgical decision-making and facilitate tailored adjuvant therapy selection.</p>","PeriodicalId":13639,"journal":{"name":"Insights into Imaging","volume":"17 1","pages":""},"PeriodicalIF":5.6,"publicationDate":"2026-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13294424/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148317046","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":"Wrist arthro-CT: don't forget to check the foveal attachment.","authors":"Julien Dejean-Servieres, Stéphanie Delclaux, Elorie Adamski, Hélène Chiavassa-Gandois, Franck Lapegue, François Lafourcade, Céline Goumarre, Antoine Filliole, Constance Lambeaux, Viet-Tam Van, Rokia El Khalfi, Léo Millet, Elise Bouko-Levy, Nicolas Sans, Marie Faruch-Bilfeld","doi":"10.1186/s13244-026-02327-z","DOIUrl":"10.1186/s13244-026-02327-z","url":null,"abstract":"<p><strong>Objective: </strong>The aim of this study was to demonstrate that foveal lesions of the triangular fibrocartilage complex (TFCC) are underreported on wrist arthro-CT and to compare imaging review data with clinical and surgical findings to assess their impact on patient management.</p><p><strong>Materials and methods: </strong>One hundred forty-nine wrist arthro-CTs were reviewed by two musculoskeletal radiologists, who were blinded to the surgical data and initial reports. Discrepancies between TFCC lesions and the initial reports were analysed and compared with the clinical and surgical data.</p><p><strong>Results: </strong>TFCC lesions were identified in 59% of patients, including 43% ulnar, 33% central, and 3% radial lesions. A comparison with the initial reports revealed 45 underreported lesions, 89% of which involved ulnar lesions, including 69% affecting the foveal bundle. Patients with complete ulnar TFCC lesions reported significantly more ulnar-sided pain and radioulnar instability than those without TFCC lesions (p < 0.0001). Isolated foveal lesions were significantly associated with ulnar-sided pain (p = 0.0201), but not with radioulnar instability (p > 0.99). Among the 149 patients, 12 underwent TFCC surgery. In 8 patients, the lesions were identified in the initial radiological reports and confirmed intraoperatively. In 4 patients, surgery was performed despite negative initial reports. A retrospective imaging review confirmed the lesions, which were in agreement with the surgical findings.</p><p><strong>Conclusion: </strong>The application of new classifications and recent knowledge enabled the identification of previously unreported lesions in 28% of cases, including 69% involving the foveal attachment, highlighting the diagnostic challenges of this type of injury.</p><p><strong>Critical relevance statement: </strong>This study shows that foveal TFCC lesions are frequently underreported on wrist arthro-CT and that a structured review, incorporating recent classifications and multiplanar reconstructions, significantly improves lesion detection, particularly for foveal involvement.</p><p><strong>Key points: </strong>Foveal TFCC lesions are difficult to identify on wrist arthro-CT because of their subtle and variable imaging appearance. Re-evaluation of arthro-CT scans and comparison with initial reports, which used recent classifications and multiplanar reconstructions, revealed that 28% of the lesions were underreported. Improved detection of foveal involvement may lead to more accurate management of ulnar-sided wrist pain.</p>","PeriodicalId":13639,"journal":{"name":"Insights into Imaging","volume":"17 1","pages":""},"PeriodicalIF":5.6,"publicationDate":"2026-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13294428/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148317018","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":"Reduced environmental impact in body CT imaging with deep learning reconstruction: experience of a high-volume tertiary referral center.","authors":"Paolo Niccolò Franco, Cesare Maino, Davide Gandola, Cammillo Talei Franzesi, Rocco Corso, Elena De Ponti, Davide Ippolito","doi":"10.1186/s13244-026-02333-1","DOIUrl":"10.1186/s13244-026-02333-1","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the environmental impact associated with CT scanners equipped with deep-learning-based image reconstruction (DLIR) compared with scanners equipped with hybrid-iterative reconstruction (HIR), focusing on electricity consumption, carbon dioxide equivalent (CO₂e) emissions, and iodinated contrast media (ICM) utilization in a high-volume tertiary referral center.</p><p><strong>Materials and methods: </strong>In this retrospective single-center study, environmental data were collected over an 18-month period from four CT scanners: two using HIR (Group 1) and two using DLIR (Group 2), including body CT examinations. DLIR-based protocols were implemented with reduced tube voltage (80-100 kV vs 120 kV) and optimized ICM doses. Electricity consumption, CO₂e emissions, and ICM utilization were quantified and compared between groups. Environmental outcomes were analyzed at the scanner level and normalized per examination.</p><p><strong>Results: </strong>A total of 42,300 examinations were analyzed (23,096 in Group 1; 19,204 in Group 2). Electricity consumption was 123,000 kWh for Group 1 and 66,927 kWh for Group 2, corresponding to 30.75 and 16.73 tons of CO₂e emissions, respectively. At the scanner level, this represented a reduction of 28,037 kWh and 7.01 tons of CO₂e per scanner (4.67 tons/year). DLIR-based protocols were associated with an ICM saving of 434 L over 18 months, corresponding to 4.47 tons of avoided CO₂e emissions and 60,730 L of water preserved. Combined CO₂e emissions from electricity and ICM were 49.62 tons in Group 1 and 29.10 tons in Group 2.</p><p><strong>Conclusion: </strong>DLIR-based optimized protocols were associated with improved environmental metrics, supporting their potential contribution to more sustainable radiology practices in high-volume settings.</p><p><strong>Clinical relevance statement: </strong>Deep learning-based image reconstruction enables routine body CT protocols with lower tube voltage and reduced ICM dose, supporting a clinically feasible transition toward more sustainable CT practice in high-volume imaging workflows.</p><p><strong>Key points: </strong>DLIR was associated with the implementation of lower tube voltage and reduced ICM dose, supporting more sustainable CT imaging based on protocol adaptations. In a high-volume tertiary referral center, deep learning-based image reconstruction was associated with a substantial reduction in electricity consumption and overall CO₂-equivalent emissions compared with hybrid iterative reconstruction. Optimization of contrast media dosing with deep learning-based image reconstruction contributed meaningfully to environmental benefits.</p>","PeriodicalId":13639,"journal":{"name":"Insights into Imaging","volume":"17 1","pages":""},"PeriodicalIF":5.6,"publicationDate":"2026-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13294401/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148317020","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":"A review of radiological characteristics and patterns of fat necrosis after different autologous breast surgery techniques.","authors":"Nieke N P M Smeins, Zoë M A Kuijlaars, Silvia Pérez Rodrigo, Esther M Heuts, Andrzej Piatkowski, Thiemo J A van Nijnatten","doi":"10.1186/s13244-026-02330-4","DOIUrl":"10.1186/s13244-026-02330-4","url":null,"abstract":"<p><strong>Background: </strong>The aim of this systematic review was to compare the radiological characteristics of fat necrosis distribution and morphology of tissue flaps versus autologous fat transfer (AFT) on ultrasound (US), mammography (MG), and magnetic resonance imaging (MRI), in order to improve diagnostic accuracy and guide treatment decisions.</p><p><strong>Materials and methods: </strong>This systematic review was performed according to the PRISMA guidelines. A literature search was conducted in PubMed, Embase, and Scopus databases, identifying studies published after 2005. Eligible studies included female patients undergoing breast surgery using flaps or AFT, with fat necrosis assessed on US, MG, or MRI.</p><p><strong>Results: </strong>Seventeen studies (13 AFT, 4 flap surgery) were included. Imaging was performed 1 to 240 months postoperatively. The mean prevalence of fat necrosis ranged from 12.5 to 23.6% for studies on flap surgery (n = 4), versus 7.3 to 82.9% for AFT (n = 5). On US, fat necrosis exhibited diverse echogenicity and cystic components often without vascularity, for both flap surgery and AFT. MG characteristics included radiolucent oil cysts with calcifications. MRI showed nonenhancing hypointense lesions with hyperintense borders on T1-weighted and T2-weighted fat-suppressed images. After flap surgery, fat necrosis was predominantly located at the peripheral margins of the flap, whereas in AFT it was more diffusely distributed.</p><p><strong>Conclusion: </strong>Radiological characteristics of fat necrosis are generally comparable between tissue flaps and AFT, although a difference was observed in the prevalence and distribution of fat necrosis between the two techniques. However, literature is limited, and additional research is needed to be able to refine the radiological definition of fat necrosis.</p><p><strong>Key points: </strong>Identifying radiological differences between fat necrosis in tissue flaps and autologous fat transfer may improve diagnosis by distinguishing typical from atypical fat necrosis presentations. Radiological characteristics of fat necrosis are largely comparable between flaps and autologous fat transfer, although imaging features evolve over time and distribution patterns might differ. Understanding radiological characteristics of fat necrosis across breast surgery techniques is essential for accurate diagnosis, guiding treatment decisions, and reducing biopsies and patient distress. Distribution patterns of fat necrosis may aid in improving diagnostic consistency.</p>","PeriodicalId":13639,"journal":{"name":"Insights into Imaging","volume":"17 1","pages":""},"PeriodicalIF":5.6,"publicationDate":"2026-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13287354/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148295063","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":"Four-dimensional flow MRI for identifying high-risk esophageal varices: a comparison and combination with spleen volume and splenic extracellular volume fraction.","authors":"Xiaohuan Li, Yuhan Zhang, Zhiyuan Chen, Ke Wei, Yan Zhang, Xiying Zhao, Shuping Zhang, Ruhang Huang, Yupin Liu, Dongjing Zhou","doi":"10.1186/s13244-026-02341-1","DOIUrl":"10.1186/s13244-026-02341-1","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate the diagnostic performance of four-dimensional flow MRI alone and in combination with spleen volume and splenic extracellular volume fraction (ECV) for identifying high-risk esophageal variceal (HRV) in patients with liver cirrhosis.</p><p><strong>Materials and methods: </strong>A total of 58 cirrhosis patients who underwent four-dimensional flow MRI and endoscopy were prospectively recruited and were divided into HRV group (n = 25) and non-HRV (NHRV) group (n = 33). The hemodynamic parameters of the portal vein (PV), superior mesenteric vein (SMV), and splenic vein (SV) derived from four-dimensional flow MRI for identifying HRV were analyzed and compared with spleen volume and splenic ECV. Then a combined model for identifying HRV was constructed by using the least absolute shrinkage and selection operator (LASSO) regression and multivariate logistic regression analysis with stepwise forward.</p><p><strong>Results: </strong>The peak velocity and maximum pressure gradient of the PV, SMV, and SV, as well as the total volume of the SMV, were significantly greater in the HRV group than in the NHRV group. The SV peak velocity had the highest AUROC for identifying HRV and was comparable to the spleen volume and splenic ECV. The combined model incorporating these three indicators showed superior performance with an AUC of 0.945, outperforming individual imaging indicators and other laboratory-based models.</p><p><strong>Conclusion: </strong>Four-dimensional flow MRI is a valuable noninvasive technique for detecting HRV in cirrhosis patients. The combined model incorporating SV peak velocity, spleen volume, and splenic ECV provided an accurate prediction of HRV, which may help avoid unnecessary screening endoscopy.</p><p><strong>Critical relevance statement: </strong>The combined model incorporating spleen vein peak velocity derived by 4D flow MRI, spleen volume, and spleen ECV performed better than individual imaging indicators and laboratory-based models, which may help to avoid unnecessary screening endoscopy and aid in clinical decision-making.</p><p><strong>Key points: </strong>Noninvasive assessment of the risk of HRV in cirrhosis remains crucial but inadequate. Four-dimensional flow MRI can effectively identify HRV in patients with cirrhosis. Combining SV peak velocity, splenic volume, and ECV effectively identifies HRV.</p>","PeriodicalId":13639,"journal":{"name":"Insights into Imaging","volume":"17 1","pages":""},"PeriodicalIF":5.6,"publicationDate":"2026-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13287174/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148294648","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 vascular invasion in pancreatic ductal adenocarcinoma compared with intraoperative and histological findings.","authors":"Gala Nacul Mora, Andreas Andreou, Ziad Maksoud, Felix Becker, Barbara Heitplatz, Eva Wardelmann, Benjamin Strücker, Shadi Katou, Haluk Morgül, Andreas Pascher, Michael Köhler, Gesa Helen Pöhler","doi":"10.1186/s13244-026-02318-0","DOIUrl":"10.1186/s13244-026-02318-0","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;To assess the concordance of CT-based radiological, surgical, and histopathological determination of vascular invasion in pancreatic ductal adenocarcinoma (PDAC).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Materials and methods: &lt;/strong&gt;This retrospective single-center study included 103 treatment-naive PDAC patients (median age 68 years, male 61%) with arterial-/portal venous-contrast enhanced CT undergoing successful primary resection. Three radiologists independently assessed tumor-vessel contact according to NCCN criteria. Radiological vascular invasion was operationally defined as &gt; 180° or contour irregularity versus no invasion defined as no contact or contact ≤ 180° without contour irregularity, to compare to binary intraoperative and histological reference. Intraoperatively, venous and arterial invasion were defined as tumor adherence to or invasion of the vessel wall. Histopathologically, venous invasion (V0/1) was defined according to UICC-TNM. Additionally, as major arteries were not resected, microscopically seen periarterial perineural invasion (Pn&lt;sub&gt;art&lt;/sub&gt;) served as a surrogate marker for arterial invasion (Pn0/Pn1), intermodal concordance of CT-to-surgery ≤/ &gt; 4 weeks) was compared, Cohen's kappa and McNemar's-tests were used.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Median CT-to-surgery was 17 days (81% within 4 weeks). CT-based interobserver agreement was κ = 0.8 for venous, κ = 0.6 for arterial invasion determination. Intraoperatively, 35% patients showed venous, 5% arterial involvement. Histopathologically, 14% showed venous invasion, 3% Pn&lt;sub&gt;art&lt;/sub&gt;1-status. CT-surgery venous invasion concordance was 75%, arterial 96%. CT-histopathology venous invasion concordance was 81%, 96% for Pn&lt;sub&gt;art&lt;/sub&gt;-status. CT-to-surgery interval ≤4 weeks showed higher CT-surgery (77% vs 65%) and CT-histopathology venous invasion concordance (84% vs 60%) compared to &gt; 4 weeks interval.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;NCCN-derived, threshold-based radiological venous invasion determination was similar to binary intraoperative and histopathological findings and decreased with longer CT-to-surgery intervals.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Critical relevance statement: &lt;/strong&gt;NCCN-derived, threshold-based CT venous-invasion determination in PDAC is concordant with binary intraoperative and histopathological invasion, but depends on the selected threshold and decreases with longer CT-to-surgery interval, underlining the clinical need for standardized staging intervals in patients undergoing surgery.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Key points: &lt;/strong&gt;Comparison between CT vascular assessment and surgical/histopathological findings in PDAC remains highly complex, and current guidelines lack CT-to-surgery interval recommendations. Threshold-based CT venous invasion agreed moderately with surgery and strongly with histopathology, while CT-based arterial status correlated strongly with surgery, albeit in markedly low overall incidence. CT-vascular assessment precision decreases w","PeriodicalId":13639,"journal":{"name":"Insights into Imaging","volume":"17 1","pages":""},"PeriodicalIF":5.6,"publicationDate":"2026-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13283947/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148294265","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":"Dual-energy CT pulmonary angiography using dual-flow mixture bolus tracking: potential for contrast medium and radiation exposure reduction.","authors":"Mingjue Jian, Lisheng Huang, Chenxi Zhang, Xiang Qin, Haixia Li, Jiafang Wu, Mingwang Chen, Li Ding, Xiaomei Li, Yikai Xu, Zhao Chen, Chenggong Yan","doi":"10.1186/s13244-026-02329-x","DOIUrl":"10.1186/s13244-026-02329-x","url":null,"abstract":"<p><strong>Objectives: </strong>To assess the feasibility and image quality of a bolus tracking protocol with dual-flow mixture for contrast medium volume and radiation dose reduction in dual-energy CT pulmonary angiography (CTPA).</p><p><strong>Materials and methods: </strong>Patients with suspected pulmonary embolism (PE) were prospectively included and randomly divided into the dual low-dose or routine CTPA groups. Virtual monoenergetic imaging results at 40 keV for the dual low-dose CTPA group were compared to 100-kV polyenergetic CT images from the routine CTPA group. Attenuation, noise, contrast-to-noise ratio, and figure of merit were determined in multiple pulmonary arteries. Qualitative image quality and PE detection were independently rated by two radiologists.</p><p><strong>Results: </strong>The dual low-dose CTPA group showed a significantly higher attenuation in 40-keV virtual monoenergetic imaging (1027.0 ± 287.6 HU vs 391.8 ± 109.0 HU; p < 0.001) with a comparable median contrast-to-noise ratio (33.6 vs 41.0; p = 0.115) and superior figure of merit (711.4 vs 461.5; p = 0.006) in the pulmonary trunk in relation to that observed in the routine CTPA group. Superior vena cava artifacts were reduced (both p ≤ 0.002), while pulmonary branch visualization was preserved (p = 0.660 and 0.763). Effective radiation dose was lower in the dual low-dose CTPA group (1.61 mSv vs 3.62 mSv; p < 0.001), while PE diagnostic performance did not differ significantly between the two protocols.</p><p><strong>Conclusion: </strong>The dual-flow mixture bolus-tracking protocol showed technical feasibility for dual-energy CTPA, achieving substantial reductions in radiation exposure and contrast medium volume while maintaining diagnostically acceptable image quality.</p><p><strong>Critical relevance statement: </strong>The dual-flow mixture bolus-tracking protocol with dual-energy CT maintained feasible image quality for PE assessment, facilitating contrast medium volume and radiation exposure reduction.</p><p><strong>Trial registration: </strong>NFEC, NFEC-2025-021, approved on January 10, 2025.</p><p><strong>Key points: </strong>Radiation exposure and substantial contrast medium doses during CTPA increased patient risks. Virtual monoenergetic imaging at 40 keV derived from dual-energy CT enhanced pulmonary vascular visualization. The dual-flow mixture technique with dual-energy CT reduced radiation dose and contrast medium volume.</p>","PeriodicalId":13639,"journal":{"name":"Insights into Imaging","volume":"17 1","pages":""},"PeriodicalIF":5.6,"publicationDate":"2026-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13282423/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148283566","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":"Clinical relevance and governance of scout imaging data: a national survey of UK cross-sectional imaging radiographers.","authors":"Theophilus N Akudjedu, Julianna M Hapi, Wisdom S Mensah, Derrek A Pinto, Benard Ohene-Botwe, Filson Kapilya","doi":"10.1186/s13244-026-02306-4","DOIUrl":"10.1186/s13244-026-02306-4","url":null,"abstract":"<p><strong>Objectives: </strong>To examine the presence and content of standard policies and protocols for managing scout imaging data from cross-sectional imaging in the UK, including storage practices and required actions when clinical abnormalities are identified. The aim was to characterise current clinical processes and develop recommendations to address policy and knowledge gaps, thereby improving practice.</p><p><strong>Materials and methods: </strong>An online survey was distributed to cross-sectional radiographers in the United Kingdom between 23 May and 3 July 2022 using purposive sampling. Descriptive statistics were used to summarise quantitative data, and thematic analysis was applied to free-text responses.</p><p><strong>Results: </strong>Of 130 survey returns, 129 were valid. Most respondents worked in the NHS (83/129; 64.3%) and in England (104/129; 80.6%). The majority of cross-sectional radiographers (77/129; 59.7%) reported that all scout images are stored with the diagnostic image series. Overall, 61.2% (79/129) indicated that they had previously flagged abnormal findings on scout images. However, 45.7% (59/129) reported that their departments did not have clear policies and/or protocols governing the management of scout imaging data.</p><p><strong>Conclusions: </strong>Scout images may contribute to the detection of some abnormal findings. Nonetheless, the absence of clear local policies and protocols, and/or limited awareness of existing joint guidance, restricts their effective integration into diagnostic workflows and treatment planning. These findings indicate an urgent need for formalised departmental policies and targeted educational initiatives to support awareness creation for consistent, safe and effective management of scout images across UK radiology departments.</p><p><strong>Clinical relevance: </strong>Scout imaging data may contain clinically relevant information that could inform patient care. Standardisation of the governance and the awareness and creation of policies for the management of scout images among the clinical radiology workforce is urgently required.</p><p><strong>Key points: </strong>Scout images may hold significant diagnostic information that could contribute to patient care. Variation in the governance and protocols for management of scout imaging data reflects limited awareness of existing local and national guidance. Radiology workforce education is critical to creating awareness of policies and governance for scout imaging data management in practice.</p>","PeriodicalId":13639,"journal":{"name":"Insights into Imaging","volume":"17 1","pages":""},"PeriodicalIF":5.6,"publicationDate":"2026-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13283115/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148295019","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}