Radiology最新文献

{"title":"Automated Opportunistic Bone Mineral Density Assessment at Low-Dose CT Lung Cancer Screening: Incident Vertebral Fractures and Mortality.","authors":"Maximilian T Löffler, Sebastian Rühling, Nico Sollmann, Matthias Jung, Susanne Rospleszcz, Marco Reisert, Fabian Bamberg, Jan S Kirschke, Jakob Weiß","doi":"10.1148/radiol.260323","DOIUrl":"https://doi.org/10.1148/radiol.260323","url":null,"abstract":"<p><p>Background Low-dose CT (LDCT) for lung cancer screening enables opportunistic volumetric bone mineral density (vBMD) assessment, but its prognostic value is unclear. Purpose To evaluate fully automated LDCT-derived vBMD for predicting vertebral fractures and its association with mortality in individuals who heavily smoke. Materials and Methods This secondary analysis included 55-74-year-old individuals who heavily smoked (≥30 pack-years) from the CT arm of the National Lung Screening Trial (NLST), a multicenter randomized controlled trial of LDCT versus radiography (participants recruited August 2002 to April 2004). Automated SpineQ software (Bonescreen) was used to measure thoracic and lumbar vBMD (normal, ≥120 mg/cm³; low bone mass [osteopenia], 80 to <120 mg/cm³; osteoporosis, <80 mg/cm³) and vertebral fractures (Genant scale). The outcomes included 1- and 2-year incident vertebral fractures and 6-year mortality (active follow-up to 2009). Poisson and Cox models were adjusted for demographic variables, available comorbidities, and baseline vertebral fractures. Results The NLST included 26 722 participants in the CT arm, with 21 856 included in the present analysis (mean age, 61 years ± 5 [SD]; 12 854 male participants). The 2-year vertebral fracture incidence (<i>n</i> = 18 211 participants with 2-year LDCT) was 0.9% for those with normal bone mass, 2.0% for those with low bone mass (adjusted relative risk, 2.07 [95% CI: 1.70, 2.53]), and 5.9% for those with osteoporosis (adjusted relative risk, 3.40 [95% CI: 2.69, 4.30]). Mortality risk (<i>n</i> = 21 447 participants with completed follow-up [median, 6.65 years]) was associated with osteoporotic vBMD in men (adjusted hazard ratio, 1.24 [95% CI: 1.02, 1.50]). Conclusion Fully automated opportunistic assessment of spinal vBMD predicted vertebral fracture risk and was associated with mortality in men after adjustment. Individuals with osteoporotic vBMD who heavily smoked had a 2-year fracture incidence above the 5% treatment threshold according to current osteoporosis guidelines. Clinical trial registration no. NCT00047385 © RSNA, 2026 <i>Supplemental material is available for this article.</i> See also the editorial by Bredella in this issue.</p>","PeriodicalId":20896,"journal":{"name":"Radiology","volume":"321 1","pages":"e260323"},"PeriodicalIF":17.6,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149272669","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":"Implications for Hepatocellular Carcinoma Ablation beyond the Tumor Margin: An Early Career Perspective","authors":"Omid Shafaat,Stephen P. Reis","doi":"10.1148/radiol.262757","DOIUrl":"https://doi.org/10.1148/radiol.262757","url":null,"abstract":"","PeriodicalId":20896,"journal":{"name":"Radiology","volume":"166 1","pages":""},"PeriodicalIF":19.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149088768","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":"Virtual Noncontrast Lung Densitometry with Photon-counting CT: The Importance of Breathing-An Early Career Perspective.","authors":"Yu-Xiang Ye, Jonathan D Dodd","doi":"10.1148/radiol.262352","DOIUrl":"https://doi.org/10.1148/radiol.262352","url":null,"abstract":"","PeriodicalId":20896,"journal":{"name":"Radiology","volume":"321 1","pages":"e262352"},"PeriodicalIF":17.6,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149184095","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":"Agentic AI Systems in Radiology: Design, Applications, Evaluation, and Challenges.","authors":"Christian Bluethgen, Dave Van Veen, Daniel Truhn, Jakob Nikolas Kather, Michael Moor, Małgorzata Połacin, Akshay Chaudhari, Thomas Frauenfelder, Curtis P Langlotz, Michael Krauthammer, Farhad Nooralahzadeh","doi":"10.1148/radiol.253226","DOIUrl":"https://doi.org/10.1148/radiol.253226","url":null,"abstract":"<p><p>Building agents that perceive and act on their environment with a degree of autonomy has long been a focus of artificial intelligence research. This pursuit has become far more practical with the emergence of large language models (LLMs) capable of using natural language to integrate information, follow instructions, and perform forms of reasoning and planning across a wide range of tasks. With its multimodal data streams and orchestrated workflows spanning multiple systems, radiology is uniquely suited to benefit from agents that can adapt to context and automate complex, repetitive tasks. In radiology, LLMs and their multimodal variants have already demonstrated promising performance for individual tasks such as information extraction and report summarization. However, using LLMs in isolation underutilizes their potential to support complex, multistep workflows where decisions depend on evolving context from multiple information sources. Equipping LLMs with external tools and feedback mechanisms enables them to drive systems that exhibit a spectrum of autonomy, ranging from semiautomated workflows to more adaptive agents capable of managing complex processes. This review article examines the design of LLM-driven agentic systems, explores representative radiology applications, discusses evaluation frameworks, and outlines key challenges, including error cascades, tool-use effectiveness, and integration with health information technology infrastructure.</p>","PeriodicalId":20896,"journal":{"name":"Radiology","volume":"321 1","pages":"e253226"},"PeriodicalIF":17.6,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149272622","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":"Black-White Racial Differences at Breast MRI.","authors":"Pascal A T Baltzer, Paola Clauser","doi":"10.1148/radiol.260622","DOIUrl":"https://doi.org/10.1148/radiol.260622","url":null,"abstract":"","PeriodicalId":20896,"journal":{"name":"Radiology","volume":"320 3","pages":"e260622"},"PeriodicalIF":17.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148906927","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":"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":"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":"Helical 3D DSA for Whole-Head-and-Neck Vascular Imaging: Technical Development and First-in-Human Application.","authors":"Yingkun He, Mengqi Li, Yaping Wu, Yao Tang, Weilong Mao, Baolin Mao, Qingfang Wang, Huikai Liu, Yang Yang, Ranran Ban, Huizhen Peng, Wei Wei, Yan Bai, Yinsheng Li, Xiaojie Lin, Xuming Zhang, Canzhen Ma, Jun Xiang, Meiyun Wang","doi":"10.1148/radiol.260398","DOIUrl":"10.1148/radiol.260398","url":null,"abstract":"<p><p>Background Conventional three-dimensional (3D) digital subtraction angiography (DSA) has limited longitudinal coverage, requiring multiple selective injections and acquisitions for head-and-neck vascular assessment, increasing procedural complexity and contrast material use. Purpose To develop and evaluate the feasibility of a helical 3D DSA technique for panoramic 3D angiography of the entire head-and-neck vasculature using a single contrast material injection and a single acquisition. Materials and Methods A continuous helical scanning trajectory was implemented on a robotic C-arm system using 400° rotation with simultaneous axial translation. The technique was evaluated in phantom experiments to assess geometric accuracy and imaging performance, in vivo imaging in two swine to optimize contrast material injection protocols, and a feasibility study in a human patient with bilateral carotid disease. Results The helical scan achieved a longitudinal coverage of 419.4 mm within 7.6 seconds (conventional 3D DSA: 174.0 mm within 5.0 seconds). Spatial resolution was preserved at 11 line pairs per centimeter on Catphan 700 testing, equivalent to that of conventional 3D DSA. In a simulated head-and-neck vascular phantom, the mean absolute percentage error in contrast to noise ratio between the two techniques was 2.18% ± 0.68 (SD). In two swine, undiluted contrast agent injected at 10 mL/sec produced diagnostically adequate image quality, with high interreader agreement among three readers (intraclass correlation coefficient > 0.90). In the human case, helical 3D DSA enabled continuous 3D angiography from the aortic arch to the cranial vertex in a single acquisition. Stenosis rate measurements in the ophthalmic segment of the left internal carotid artery showed strong agreement between methods, with a mean absolute error of 2.57% ± 0.90. Conclusion This study demonstrated the feasibility of a helical scanning trajectory in 3D DSA, achieving panoramic 3D angiography from the aortic arch to the cranial vertex in a single acquisition while preserving high spatial resolution and contrast fidelity. © 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></p>","PeriodicalId":20896,"journal":{"name":"Radiology","volume":"320 3","pages":"e260398"},"PeriodicalIF":17.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148970939","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":"Falling Fruit Sign: Pelvic Splenosis Supplied by the Celiac Trunk.","authors":"Ji Zhang, Jiaji Liu","doi":"10.1148/radiol.261804","DOIUrl":"https://doi.org/10.1148/radiol.261804","url":null,"abstract":"","PeriodicalId":20896,"journal":{"name":"Radiology","volume":"320 3","pages":"e261804"},"PeriodicalIF":17.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148907057","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":"Closing the Gap in Femoral-Neck Fracture Detection: AI Assistance with Pelvic and Hip Radiographs.","authors":"Dyan V Flores, Tatiane Cantarelli","doi":"10.1148/radiol.262353","DOIUrl":"https://doi.org/10.1148/radiol.262353","url":null,"abstract":"","PeriodicalId":20896,"journal":{"name":"Radiology","volume":"320 3","pages":"e262353"},"PeriodicalIF":17.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148907067","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}