Radiology最新文献

{"title":"Performance of Photon-counting CT for Assessing Pretreatment Breast Cancer: Comparison with Mammography, MRI, and ¹⁸F-FDG PET/CT.","authors":"Qiuyi Fu, Yufei Zeng, Rui Chang, Zhihan Xu, Ying Zhan, Ling Tan, Jiahao Zhou, Xiaosong Chen, Weimin Chai, Fuhua Yan","doi":"10.1148/radiol.253531","DOIUrl":"https://doi.org/10.1148/radiol.253531","url":null,"abstract":"<p><p>Background Photon-counting CT (PCCT) offers improved spatial resolution, contrast to noise ratio, and dose efficiency, but its clinical utility remains incompletely defined for breast cancer. Purpose To evaluate the feasibility of PCCT for pretreatment breast cancer assessment through comparisons with MRI, full-field digital mammography (FFDM), and fluorine 18 (¹⁸F) fluorodeoxyglucose (FDG) PET/CT. Materials and Methods In this prospective study (March-May 2025), female participants with breast lesions categorized as Breast Imaging Reporting and Data System 4C or higher at US or FFDM underwent breast MRI and multiphasic contrast-enhanced PCCT. ¹⁸F-FDG PET/CT was performed in a subset with locally advanced disease. Four radiologists independently evaluated lesion morphologic characteristics, additional findings, and clinical TNM stage. Agreement was analyzed using intraclass correlation coefficients (ICCs) and κ statistics. The diagnostic performance for additional lesions and nodal metastasis was compared with the reference standard (pathologic examination). Results Among 126 participants (mean age, 58.1 years ± 12.3 [SD]), interreader agreement across PCCT, MRI, and FFDM was good to excellent. PCCT agreed with MRI for lesion characterization (κ = 0.57-0.96) and clinical T categorization (κ = 0.86-0.88), with highest agreement with pathologic size (ICC, 0.70-0.81). For 46 pathologically confirmed additional lesions, PCCT was more sensitive than FFDM (difference, 44% [95% CI: 19, 66]) and similar to MRI (difference, 7% [95% CI: -5, 21]). Additionally, 44% (95% CI: 27, 52) of microcalcifications were missed at PCCT versus FFDM. For pathologically confirmed nodal metastasis, PCCT was more sensitive (difference, 10% [95% CI: 1, 20]) and accurate (difference, 6% [95% CI: 1, 11]) than MRI. For clinical N category, PCCT agreed with PET/CT (κ = 0.82 [95% CI: 0.62, 0.96]; <i>n</i> = 19). Two distant metastases identified at PCCT were consistent with ¹⁸F-FDG PET/CT and pathologic findings. Conclusion PCCT demonstrated similar performance to MRI for lesion characterization and detection of additional lesions, with better performance for nodal metastasis evaluation; however, detection of microcalcifications was limited. © RSNA, 2026 <i>Supplemental material is available for this article.</i></p>","PeriodicalId":20896,"journal":{"name":"Radiology","volume":"320 3","pages":"e253531"},"PeriodicalIF":17.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148866782","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ethical Implications of the Invisibility of Intracellular Electrolytes.","authors":"Juan Sebastián Rodríguez Sazipa","doi":"10.1148/radiol.260782","DOIUrl":"https://doi.org/10.1148/radiol.260782","url":null,"abstract":"","PeriodicalId":20896,"journal":{"name":"Radiology","volume":"320 3","pages":"e260782"},"PeriodicalIF":17.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148866829","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Convergence of Local and Systemic Therapies: A Comprehensive Society of Interventional Oncology Framework for ⁹⁰Y Radioembolization with Immunotherapy in HCC.","authors":"Rony Avritscher, Edward Kim, Valerie Chew, Ghassan K Abou-Alfa, Ahmed Kaseb, Beau Toskich, Terence Gade, Mishal Mendiratta-Lala, Sunil Krishnan, S Cheenu Kappadath, Riad Salem","doi":"10.1148/radiol.251415","DOIUrl":"https://doi.org/10.1148/radiol.251415","url":null,"abstract":"<p><p>Combination approaches using systemic immunotherapy agents are now standard of care for patients with advanced-stage hepatocellular carcinoma (HCC), resulting in improved overall survival. However, even with optimal systemic regimens, fewer than 40% of cases respond to treatment, presumably due to resistance mechanisms, including antidrug antibodies and acquired resistance related to alterations in the tumor immune microenvironment (TIME). As a result, new strategies are needed to improve immunotherapeutic efficacy in this setting. Early investigations into the local and systemic effects of yttrium 90 (⁹⁰Y) radioembolization using resin and glass microspheres demonstrated activation of both innate and adaptive immune systems, leading to sustained therapeutic efficacy in a subgroup of patients with HCC undergoing curative surgical resection after downstaging procedures. Preliminary prospective and retrospective studies have confirmed the safety of combining liver-directed interventions with immunotherapy. Based on these findings, clinical trials are being designed to evaluate the efficacy of different therapeutic strategies combining ⁹⁰Y radioembolization and immune checkpoint inhibitor therapy. The Society of Interventional Oncology is committed to advancing research on how local-regional therapies influence the TIME and systemic inflammatory response. This review aims to inform the interventional and medical oncology community about essential considerations and strategies for implementing these combination therapies involving ⁹⁰Y radioembolization and immunotherapy.</p>","PeriodicalId":20896,"journal":{"name":"Radiology","volume":"320 3","pages":"e251415"},"PeriodicalIF":17.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148866761","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Commercial Artificial Intelligence on Radiologist Reading Time for Pulmonary Nodule Evaluation at Chest CT.","authors":"Jasika Paramasamy, Arlette E Odink, Ties A Mulders, Daniel Bos, Aad van der Lugt, Joachim G J V Aerts, Jacob J Visser","doi":"10.1148/radiol.260484","DOIUrl":"https://doi.org/10.1148/radiol.260484","url":null,"abstract":"<p><p>Background Chest CT is a primary method for identifying pulmonary nodules, yet interpreting scans remains time-intensive and demanding. Currently, artificial intelligence (AI) is expected to reduce reading times, but the effect of AI on reporting times in this setting is unknown. Purpose To evaluate the impact of a commercial AI software on radiologists' reading time for pulmonary nodule assessment on chest CT scans within a real-world clinical setting. Materials and Methods This retrospective study included patients who underwent chest CT examinations at a tertiary medical center between September 2021 and May 2024. The study period was divided into pre- and post-AI phases. The primary outcome was radiology reporting time. The association between AI implementation and reporting time was evaluated using a multivariable parametric Weibull shared frailty survival model adjusted for reader function, examination type, patient location, and requesting specialty, with clustering at the radiologist level. Interaction analyses assessed heterogeneity across prespecified subgroups. An exploratory extrapolation estimated projected workforce and financial impact. Results This study included 19 433 patients (mean age, 62 years ± 14.2 [SD]; 21 814 men; 39 323 chest CT examinations, 19 190 pre-AI, and 20 133 post-AI). AI implementation was associated with faster report completion (adjusted hazard ratio, 1.17; 95% CI: 1.14, 1.21; <i>P</i> < .001). The adjusted median reporting time decreased from 21.3 minutes pre-AI to 18.2 minutes post-AI (14.6% reduction; <i>P</i> < .001). Heterogeneity was observed across reader function (<i>P</i> < .001), examination type (<i>P</i> = .048), and requesting specialty (<i>P</i> = .03). The largest relative reductions were observed for CT thorax electrocardiogram-gated examinations (-41.1%; <i>P</i> < .001) and thoracic radiologists (-25.0%; <i>P</i> < .001), whereas emergency department examinations showed increased median reporting time (7.1%; <i>P</i> < .001). At institutional scan volumes (approximately 20 000-22 000 chest CT examinations annually), exploratory modeling suggested an approximate reduction of 0.5 full-time equivalent radiologist workload. Conclusion Implementation of commercial AI-assisted pulmonary nodule assessment on chest CT scans reduced radiologist reporting time in a real-world clinical setting. © The Author(s) 2026. Published by the Radiological Society of North America under a CC BY 4.0 license. <i>Supplemental material is available for this article.</i> See also the editorial by Iwasawa in this issue.</p>","PeriodicalId":20896,"journal":{"name":"Radiology","volume":"320 3","pages":"e260484"},"PeriodicalIF":17.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148866843","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring the Diagnostic Utility of Ferumoxytol for Brachial Plexus MR Neurography.","authors":"Falko Ensle, Ek T Tan, Sophie C Queler, Yenpo Lin, Shu-Han Wang, Darryl B Sneag","doi":"10.1148/radiol.254051","DOIUrl":"https://doi.org/10.1148/radiol.254051","url":null,"abstract":"<p><p>Background Ferumoxytol has been described as an alternative contrast agent for vascular suppression in MR neurography (MRN), but its diagnostic utility in patients has yet to be evaluated. Purpose To evaluate the impact of ferumoxytol on vascular suppression, nerve conspicuity, and evaluation of nerve abnormalities at three-dimensional (3D) brachial plexus MRN, compared with noncontrast and gadolinium-enhanced MRN, in participants with suspected Parsonage-Turner syndrome (PTS) or thoracic outlet syndrome (TOS). Materials and Methods This prospective study included participants who underwent 3D MRN with and/or without gadolinium chelate for clinical suspicion of PTS or TOS and subsequently underwent 3D MRN with ferumoxytol (within 3 months of the clinical examination). Two musculoskeletal radiologists qualitatively evaluated 3D short-tau inversion-recovery fast spin-echo scans for the degree of vascular suppression, nerve conspicuity, and presence of nerve abnormalities. Wilcoxon signed-rank or McNemar tests were used for comparing noncontrast and gadolinium-enhanced scans with ferumoxytol-enhanced scans. Results This study included 18 participants (mean age, 42 years ± 15.2 [SD]; 10 men). Ferumoxytol-enhanced scans demonstrated improved vascular suppression compared with both noncontrast scans (both raters, <i>P</i> < .001) and gadolinium-enhanced scans (both <i>P</i> = .04). For rater 2, ferumoxytol-enhanced acquisitions demonstrated improved conspicuity of several nerve segments relative to the noncontrast scan, including segments of the suprascapular (<i>P</i> = .01), axillary (<i>P</i> = .02), and long thoracic nerves (<i>P</i> = .004). The distribution of scores for these nerve segments for rater 1 also favored ferumoxytol-enhanced versus noncontrast scans, but the differences were not statistically significant (all <i>P</i> ≥ .06). There was no evidence of a difference in nerve conspicuity between ferumoxytol-enhanced and gadolinium-enhanced scans (<i>P</i> ≥ .17 for all nerve segments) and also no evidence of discrepancies in abnormal nerve findings between the acquisitions (all <i>P</i> ≥ .48). Conclusion Ferumoxytol improved vascular suppression compared with noncontrast and gadolinium-enhanced 3D short-tau inversion-recovery fast spin-echo sequences in brachial plexus MRN, enhancing the conspicuity of several nerve branches versus noncontrast scans, with similar detection of abnormal nerve findings. © RSNA, 2026 <i>Supplemental material is available for this article.</i></p>","PeriodicalId":20896,"journal":{"name":"Radiology","volume":"320 3","pages":"e254051"},"PeriodicalIF":17.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148866808","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Styloid Process Elongation Leads to Carotid Artery Dissection in a Patient with Ankylosing Spondylitis.","authors":"Jibao Wu, Yue Zhang","doi":"10.1148/radiol.261271","DOIUrl":"https://doi.org/10.1148/radiol.261271","url":null,"abstract":"","PeriodicalId":20896,"journal":{"name":"Radiology","volume":"320 3","pages":"e261271"},"PeriodicalIF":17.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148866779","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Beyond Burnout in Radiology: A Call to Action in the AI Era.","authors":"Phillip M Boiselle","doi":"10.1148/radiol.261218","DOIUrl":"https://doi.org/10.1148/radiol.261218","url":null,"abstract":"","PeriodicalId":20896,"journal":{"name":"Radiology","volume":"320 3","pages":"e261218"},"PeriodicalIF":17.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148866698","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Brain MRI Assessment of Anterior Inferior Cerebellar Artery Aneurysm Formation after Stereotactic Radiosurgery for Vestibular Schwannomas.","authors":"Motoyuki Umekawa, Yuki Shinya, Hirotaka Hasegawa, Satoru Miyawaki, Takeru Hirata, Atsuto Katano, Nobuhito Saito","doi":"10.1148/radiol.261112","DOIUrl":"https://doi.org/10.1148/radiol.261112","url":null,"abstract":"","PeriodicalId":20896,"journal":{"name":"Radiology","volume":"320 3","pages":"e261112"},"PeriodicalIF":17.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148866730","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"CT Interpretation in the Artificial Intelligence Age: Turning Efficiency into Better Patient Care.","authors":"Tae Iwasawa","doi":"10.1148/radiol.262248","DOIUrl":"https://doi.org/10.1148/radiol.262248","url":null,"abstract":"","PeriodicalId":20896,"journal":{"name":"Radiology","volume":"320 3","pages":"e262248"},"PeriodicalIF":17.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148866803","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Radiologically Relevant Clinical History Summarization with Large Language Models: A Multireader Performance Study.","authors":"Adrian Serapio, Timothy L Chen, Brian Tangsombatvisit, Brandon K K Fields, Yannan Yu, Yue Guo, Soo Kyung Kim, Brenda Y Miao, Madhumita Sushil, Christopher P Hess, Sharmila Majumdar, Jae Ho Sohn","doi":"10.1148/radiol.253238","DOIUrl":"https://doi.org/10.1148/radiol.253238","url":null,"abstract":"<p><p>Background Clinical histories accompanying imaging orders guide protocol selection and diagnostic focus. However, they are often incomplete, potentially compromising diagnostic accuracy and workflow efficiency. Purpose To evaluate whether large language models (LLMs) can improve the clinical utility of provided imaging indications by leveraging clinical notes. Materials and Methods This retrospective study curated a dataset from deidentified electronic health records at the University of California San Francisco (January 2012 to August 2024), consisting of radiology reports with paired referring clinician-provided and radiologist-curated indications linked to clinical notes. The dataset was stratified across five body systems and five pathophysiologic categories to derive LLM selection and reader study internal test sets. For the reader study, 20 radiologists with 2-25 years of experience compared indications from the referring clinician, radiologist, and best-performing LLMs. Readers scored comprehensiveness, factuality, and conciseness and ranked indications for usefulness in protocoling, usefulness in interpretation, and overall ranking. Models and clinicians were compared using cumulative link mixed models with Tukey-adjusted post hoc comparisons. Results From 28 313 patients (mean age, 59 years ± 20.6 [SD]; 14 912 women), 250 examinations from 247 patients were sampled for the reader study. After nine exclusions, 241 examinations were analyzed, yielding 482 reader-examination evaluations. Indications from the best-performing proprietary (Claude 3.5 Sonnet; Anthropic) and open-source (Qwen 2.5-7B Instruct; Alibaba) LLM were rated as more comprehensive (Likert rating of 5: 37.14% and 28.42%, respectively; both <i>P</i> < .001) and factual (68.05% and 59.75%; both <i>P</i> < .001) than referring clinician indications. The proprietary LLM ranked most useful in protocoling (rank 1: 40.87%; all <i>P</i> < .001), useful in interpretation (44.61%; all <i>P</i> < .001), and overall ranking (44.19%, all <i>P</i> < .001). Comprehensiveness (65.77% of ratings; both <i>P</i> < .001) most strongly influenced overall rankings. Conclusion LLMs generated radiology-relevant indications from clinical notes that were more comprehensive and factual than clinician indications, and when generated by the proprietary LLM, were ranked most useful in protocoling and imaging interpretation. © RSNA, 2026 <i>Supplemental material is available for this article.</i> See also the editorial by Yilmaz and Cardoza-Ochoa in this issue.</p>","PeriodicalId":20896,"journal":{"name":"Radiology","volume":"320 2","pages":"e253238"},"PeriodicalIF":17.6,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148670590","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}