Radiology最新文献

{"title":"Histotripsy for Hepatocellular Carcinoma: From Bench to Bedside.","authors":"Susu Luo, Xingyu Wei, Xinyu Lu, Zhenguang Wang, Jinmin Zhang, Zhenlun Li, Xin Li, Hui Liu","doi":"10.1148/radiol.254050","DOIUrl":"https://doi.org/10.1148/radiol.254050","url":null,"abstract":"<p><p>Hepatocellular carcinoma (HCC) remains a leading cause of cancer mortality, with limited curative options. Histotripsy is a noninvasive focused ultrasound ablation technique that destroys tumors through acoustic cavitation rather than heat-based methods, offering an alternative to radiofrequency and microwave ablation. This review traces histotripsy from preclinical development to U.S. Food and Drug Administration (FDA) approval for liver tumors. Unlike thermal methods, histotripsy creates precise mechanical tissue fractionation while preserving critical structures, including blood vessels and bile ducts. The technology uses short, high-pressure ultrasound pulses to generate cavitation bubble clouds that liquefy targeted tissue without thermal damage. Preclinical studies demonstrated complete tumor ablation with robust immune cell infiltration, suggesting potential abscopal effects. Clinical trials, including THERESA and #HOPE4LIVER, confirmed safety, with #HOPE4LIVER demonstrating short-term efficacy, achieving approximately 95% technical success and approximately 90% 1-year local control rates. Histotripsy received FDA approval in October 2023 for treating liver cancer. The technology shows promise for perivascular lesions where heat-sink effects compromise thermal ablation. Current evidence supports optimal outcomes for tumors 3 cm or smaller, with ongoing research exploring combinations with immunotherapy and applications beyond HCC. Histotripsy represents a paradigm shift in local ablation, offering mechanical precision combined with potential systemic immunostimulatory benefits. © The Author(s) 2026. Published by the Radiological Society of North America under a CC BY 4.0 license.</p>","PeriodicalId":20896,"journal":{"name":"Radiology","volume":"320 3","pages":"e254050"},"PeriodicalIF":17.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148907076","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":"Case 354.","authors":"Jordan Haidey, Xu Jing Qian, Mitchell P Wilson, Gavin Low","doi":"10.1148/radiol.260544","DOIUrl":"https://doi.org/10.1148/radiol.260544","url":null,"abstract":"<p><p>History An asymptomatic 45-year-old man with sickle cell disease and coinherited α-thalassemia was referred to the hepatology department for workup of an indeterminate hepatic mass discovered incidentally at screening cardiac MRI. The patient was diagnosed with sickle cell disease in childhood and required several hospitalizations with blood transfusions. During adulthood, disease management was suboptimal, with infrequent transfusion therapy and undertreated chronic hemolytic anemia. There was no history of malignancy, hepatitis B or C infection, alcohol consumption, metabolic syndrome, diabetes, or fatty liver disease. There was no evidence of tuberous sclerosis, glycogen storage disease, or anabolic steroid use. Laboratory investigations demonstrated chronic hemolytic anemia, with a hemoglobin level of 98-109 g/L (reference range, 135-175 g/L) and markedly elevated reticulocyte count (207.9 × 10⁹/L to 247.8 × 10⁹/L; reference range, 25 × 10⁹/L to 75 × 10⁹/L). Peripheral blood smear showed sickle cells, target cells, and Howell-Jolly bodies. Liver enzymes, synthetic liver function, and tumor markers (α-fetoprotein, carbohydrate antigen 19-9, and carcinoembryonic antigen) were within normal limits. There was no evidence of systemic iron overload. Abdominal US (Fig 1), abdominal MRI (Figs 2, 3), and chest CT (Fig 4) were performed.</p>","PeriodicalId":20896,"journal":{"name":"Radiology","volume":"320 3","pages":"e260544"},"PeriodicalIF":17.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149075372","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":"Case 350: Retained Appendicolith.","authors":"Shimwoo Lee, Joseph Miller","doi":"10.1148/radiol.253735","DOIUrl":"https://doi.org/10.1148/radiol.253735","url":null,"abstract":"<p><p>History A 16-year-old girl presented to the emergency department with a 1-month history of right lower back pain. She was originally seen at an urgent care clinic, where a lumbar radiograph was reportedly normal, and she was prescribed naproxen. However, she came to the emergency department once pain had escalated to 10 out of 10. Over the past month, the patient's right flank had increased in size and \"hardened\" to touch. She reported no trauma or other inciting incident. She had a prior history of laparoscopic appendectomy for perforated appendicitis more than 6 years earlier at an outside hospital. A prior contrast-enhanced abdominal CT scan, obtained 2 weeks after the appendectomy, was available for review. At evaluation, the patient was febrile and mildly tachycardic (104 beats per minute). Examination of the right flank revealed a 4-cm area of erythema and tenderness with 10-cm surrounding induration. She had leukocytosis (white blood cell count, 12 × 10⁹/L; reference range, <9.44 × 10⁹/L) and elevated C-reactive protein (23 mg/L; reference range, <9 mg/L). US followed by contrast-enhanced MRI of the abdomen was performed. Based on the imaging findings, the patient underwent a percutaneous drainage procedure. All cultures, including aerobic, anaerobic, fungal, and acid fast, were negative, with the caveat that the patient had been started on intravenous antibiotics before the procedure. She was discharged and prescribed 10 days of amoxicillin and clavulanate to complete antibiotic therapy, and the drain was removed 6 weeks later. One month after drain removal, the patient returned to the emergency department with return of severe flank pain, erythema, and purulent drainage. The patient was afebrile with a white blood cell count of 9.8 × 10⁹/L. Contrast-enhanced abdominal CT was performed.</p>","PeriodicalId":20896,"journal":{"name":"Radiology","volume":"320 3","pages":"e253735"},"PeriodicalIF":17.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149075422","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":"Updated European Respiratory Society-American Thoracic Society (ERS-ATS) Classification of Interstitial Pneumonias: The Radiologic Perspective.","authors":"Sara Piciucchi, Christopher J Ryerson, Takeshi Johkoh, Amita Sharma, Nicola Sverzellati, Lida P Hariri, Simon L F Walsh, Ayodeji Adegunsoye, William D Travis, Andrew G Nicholson, Ella Kazerooni","doi":"10.1148/radiol.253791","DOIUrl":"https://doi.org/10.1148/radiol.253791","url":null,"abstract":"<p><p>This review aims to summarize the key features of the 2025 update of the European Respiratory Society-American Thoracic Society Classification of Interstitial Pneumonias from a radiologic perspective. It highlights the revised terminology, pattern definitions, and conceptual framework, which moves beyond the previous focus on idiopathic interstitial pneumonias toward a broader radiologic-pathologic pattern-based approach that includes both idiopathic and secondary causes. Three major interstitial patterns are defined: usual interstitial pneumonia, nonspecific interstitial pneumonia, and bronchiolocentric interstitial pneumonia. The last is introduced as a unifying descriptor for airway-centered diseases, including hypersensitivity pneumonitis and akin conditions. Within the alveolar filling disorders, the term <i>desquamative interstitial pneumonia</i> is replaced by the more pathologically consistent term <i>alveolar macrophage pneumonia</i>. A further key update is the formal incorporation of diagnostic confidence levels, encouraging the explicit reporting of uncertainty to better guide additional investigations and therapeutic decisions.</p>","PeriodicalId":20896,"journal":{"name":"Radiology","volume":"320 3","pages":"e253791"},"PeriodicalIF":17.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149075761","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":"Evaluating the Effect of Neighborhood-level Disadvantage on Brain Health: An Imaging Epidemiology Study.","authors":"Ethan H Willbrand, Elizabeth M Stoeckl, Daryn Belden, Sheena Y Chu, Eleanna M Melcher, Daniil Zhitnitskii, Elena Bonke, Jussi Mattila, Usman Iftikhar, Juha Koikkalainen, Antti Tolonen, Jyrki Lötjönen, Richard Bruce, John-Paul J Yu","doi":"10.1148/radiol.260693","DOIUrl":"10.1148/radiol.260693","url":null,"abstract":"<p><p>Background The relationship between neighborhood-level socioeconomic disadvantage and brain health is an emerging area of research with critical implications for public health and clinical practice, yet its association with brain structure remains unclear. Purpose To investigate the epidemiologic association between neighborhood-level socioeconomic disadvantage (measured using the Area Deprivation Index [ADI]) and morphometric neuroimaging variables in a real-world clinical population. Materials and Methods This retrospective study, conducted at an academic medical center and associated community partners, used consecutive cross-sectional brain MRI neuroimaging data from patients without radiologic evidence of disease. ADI, a geospatially determined index of neighborhood-level disadvantage, was calculated per patient. Linear regressions was used to test the relationship between ADI and multiple morphometric variables: brain age gap (BAG; estimated minus chronologic brain age), total brain volume (TBV; total gray plus white matter), total white matter hyperintensity volume (WMHV), five subcortical region volumes (hippocampus, thalamus, caudate, putamen, and nucleus accumbens), and four cortical region volumes (anterior cingulate cortex, posterior cingulate cortex, medial frontal cortex, and dorsolateral prefrontal cortex [DLPFC]). Volumetric measures were normalized to intracranial volume. Models controlled for age and sex. Results This study evaluated 2826 patients (mean age, 53 years ± 18.8 [SD]; 1732 female). Residence in the most disadvantaged neighborhoods (national, 116 of 2826 patients; state, 129 of 2826) was associated with higher BAG (adjusted differences, β value, national: 2.72 years [<i>P</i> < .001]; state: 3.02 years [<i>P</i> < .001]) and lower TBV (β value, national: -6.33 normalized mL [<i>P</i> = .01]; state: -7.46 [<i>P</i> = .002]). WMHV was higher among those in the most disadvantaged neighborhoods (β value, national: 0.31 log-transformed normalized mL [<i>P</i> < .001]; state: 0.32 [<i>P</i> < .001]). Interaction models showed increased negative associations between WMHV and striatal (β value, -0.02; <i>P</i> = .01) and DLPFC volumes (β value, -0.40; <i>P</i> = .008) among those in the most disadvantaged neighborhoods. Conclusion Residence in the most disadvantaged neighborhoods was associated with adverse brain morphometry, including higher BAG, lower TBV, and higher WMHV at brain MRI. © RSNA, 2026 <i>Supplemental material is available for this article.</i> See also the editorial by Meltzer in this issue.</p>","PeriodicalId":20896,"journal":{"name":"Radiology","volume":"320 3","pages":"e260693"},"PeriodicalIF":17.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13631678/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148970941","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnostic Accuracy of Bosniak v2019 for Predicting Cancer and Unfavorable Histology in Class III-IV Cystic Renal Masses.","authors":"Justin R Tse, Shokoufeh Khalatbari, Matheos Yosef, Chen Abitbol, Asser M Abou Elkassem, Emin Albayrak, Ronaldo Hueb Baroni, Rajesh Bhayana, Jennie J Cao, Fernando Morbeck Almeida Coelho, Sina Houshmand, Aya Kamaya, Katherine M Krajewski, Satheesh Krishna, Scott J Lee, Thais Caldara Mussi, Suman Prabhakar, Nicola Schieda, Luyao Shen, Atul B Shinagare, Stuart G Silverman, Andrew D Smith, Geoffrey A Sonn, Mahsa Taherzadeh, Zhen Jane Wang, Joshua D Warner, Andrew L Wentland, Ivan Pedrosa, Matthew S Davenport","doi":"10.1148/radiol.252603","DOIUrl":"10.1148/radiol.252603","url":null,"abstract":"<p><p>Background The current Bosniak classification system (Bosniak Classification version 2019 [Bosniak v2019]) helps predict cancer, but it is unknown whether it also helps predict unfavorable histologic features. Purpose To determine whether Bosniak v2019 and nodule size help predict cancer and unfavorable histologic features. Materials and Methods This retrospective study included Bosniak III or IV cystic renal masses across 10 institutions and three countries (January 2007 to February 2024). Pretreatment renal CT or MRI scans obtained within 1 year of resection were independently reviewed by two radiologists per site. The reference standard was surgical histopathologic findings. Generalized linear mixed models and multivariable analyses were used to estimate the probability of cancer and cancer with unfavorable histologic features by Bosniak class, subclass, and nodule size, adjusted for mass size. Reader agreement was assessed with the Gwet agreement coefficient (ie, AC1) and intraclass correlation coefficient. Results A total of 419 patients with 421 masses (264 male; median age, 59 years [IQR, 50-67 years]) were included. The probabilities of cancer were 74.8% (95% CI: 69.7, 79.4) and 91.0% (95% CI: 88.2, 93.1) for Bosniak classes III and IV, respectively. The probabilities of cancer with unfavorable histologic features were 10.3% (95% CI: 7.4, 14.2) and 32.3% (95% CI: 28.5, 36.4) for Bosniak classes III and IV, respectively. Bosniak IV subclasses were associated with a greater probability of cancer and unfavorable histologic features than were Bosniak III subclasses (<i>P</i> < .001 to <i>P</i> = .006). There was no evidence of a difference in the odds of cancer or unfavorable histologic features within the Bosniak III (<i>P</i> = .56-.995) or IV (<i>P</i> = .10-.50) subclasses. Nodule size was the strongest predictor of cancer (odds ratio [OR], 4.1 per 10 mm; <i>P</i> = .001) and unfavorable histologic features (OR, 1.9 per 10 mm; <i>P</i> < .001). Interrater agreement was substantial for Bosniak class (Gwet AC1, 0.70 [95% CI: 0.63, 0.77]) and good for nodule size (intraclass correlation coefficient, 0.89 [95% CI: 0.85, 0.91]). Conclusion Bosniak v2019 helps predict cancer and cancer with unfavorable histologic features. Nodule size was strongly associated with unfavorable histologic features. © RSNA, 2026 <i>Supplemental material is available for this article.</i></p>","PeriodicalId":20896,"journal":{"name":"Radiology","volume":"320 3","pages":"e252603"},"PeriodicalIF":17.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149075606","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":"Improving Recognition Performance and Reader Efficiency for Femoral-Neck Fracture Detection on Pelvic or Hip Radiographs Using Artificial Intelligence.","authors":"Xin-Xiao Lin, Yu-Rui Qian, Shi-Hao Zhou, Han-Bin Shen, Yu-Long Zhang, Jia-Wei Huang, Yu-Han Chen, Nai-Feng Tian","doi":"10.1148/radiol.253931","DOIUrl":"10.1148/radiol.253931","url":null,"abstract":"<p><p>Background Radiographs sometimes do not depict femoral-neck fractures, particularly radiograph-negative or indeterminate femoral-neck fractures, leading to delayed treatment and complications. Purpose To develop and externally evaluate a deep learning model, OccuNet, for detecting femoral-neck fractures on pelvic or hip radiographs, compare its performance and accuracy with those of radiologists and emergency medicine physicians, and evaluate its effect on reader performance and accuracy. Materials and Methods This multicenter retrospective study included adults suspected of having hip trauma who underwent pelvic or hip radiography and same-episode CT or MRI at four hospitals (January 2009-August 2025). Patients were split into a training set, an internal test set, and three external test sets. A two-stage model, OccuNet, was trained: Stage 1 used contrastive pretraining on paired original and artifact-augmented versions of the same radiograph to learn artifact-robust features, and stage 2 fine-tuned a fracture detector. Performance and accuracy were compared with those of 10 readers (five musculoskeletal radiologists, five emergency medicine physicians), and artificial intelligence (AI) assistance was tested for sensitivity, specificity, area under the receiver operating characteristic curve (AUC), and reading time. Results This study included 2576 patients (mean age [±SD], 69 years ± 11.2; 1380 women). In the pooled group (<i>n</i> = 1766), the model achieved a sensitivity of 97.5% (913 of 936), specificity of 98.8% (820 of 830), and excellent performance (AUC, 0.99 [95% CI: 0.99, 0.99]). For radiograph-negative or indeterminate fractures (<i>n</i> = 189), sensitivity of the model (94.7% [179 of 189]) was higher than that of radiologists (86.2% [163 of 189]; <i>P</i> < .001) and emergency medicine physicians (68.8% [130 of 189]; <i>P</i> < .001). With AI assistance, radiologist and emergency medicine physician sensitivities increased from 93.7% (877 of 936) to 97.2% (910 of 936; <i>P</i> < .001) and from 84.3% (789 of 936) to 95.6% (895 of 936; <i>P</i> < .001), respectively, and mean reading times shortened by 14.9% and 18.9% (both <i>P</i> < .001), respectively. Conclusion OccuNet demonstrated excellent performance for femoral-neck fracture detection on pelvic or hip radiographs, maintained high sensitivity in radiograph-negative or indeterminate (Garden I-II) fractures, and improved reader sensitivity and efficiency.</p>","PeriodicalId":20896,"journal":{"name":"Radiology","volume":"320 3","pages":"e253931"},"PeriodicalIF":17.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148907024","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":"Evaluation of Super-Resolution Contrast-enhanced US in Crohn Disease Activity Assessment.","authors":"Saidaitiguli Aihemaiti, Manying Li, Ming Xu, Ren Mao, Xiaoyan Xie, Yujun Chen","doi":"10.1148/radiol.253558","DOIUrl":"https://doi.org/10.1148/radiol.253558","url":null,"abstract":"<p><p>Background Measurement of Crohn disease (CD) activity is crucial for guiding treatment decisions. Super-resolution contrast-enhanced US (SRCEUS) is an emerging technique that can be used to assess vascularity at micrometer scale; however, its performance in differentiating CD activity stages is not yet known. Purpose To evaluate SRCEUS in the assessment of disease activity in participants with CD. Materials and Methods This prospective study included participants with CD involving the terminal ileum or colon who underwent intestinal SRCEUS imaging between January 2025 and June 2025. Participants were classified into remission/mild or moderate/severe activity groups based on the Simple Endoscopic Score for Crohn's Disease. B-mode US, color Doppler flow imaging (CDFI), conventional contrast-enhanced US (CEUS), and SRCEUS were performed. SRCEUS parameters were calculated. Logistic regression modeling, receiver operating characteristic analysis, and the DeLong test were used to evaluate and compare diagnostic performance. Results This study included 54 participants (mean age, 30 years ± 8.5 [SD]; 42 men). Key SRCEUS vascular parameters were higher in the moderate/severe activity group than the remission/mild activity group, including maximum density (mean, 63.4 ± 13.1 vs 51.1 ± 15.6; <i>P</i> = .003), mean density (mean, 26.9 ± 5.3 vs 21.1 ± 8.0; <i>P</i> = .007), mean velocity (mean, 40.2 mm/sec ± 27.3 vs 23.0 mm/sec ± 14.9; <i>P</i> = .01), vascular density ratio (mean, 73.2% ± 12.8 vs 38.5% ± 17.8; <i>P</i> < .001), and fractal dimension (mean, 1.7 ± 0.1 vs 1.5 ± 0.1; <i>P</i> < .001). SRCEUS performed well in distinguishing participants with remission/mild activity from those with moderate/severe activity (area under the receiver operating characteristic curve [AUC], 0.92; sensitivity, 94.1%; specificity, 95.0%). SRCEUS performed better than conventional CEUS (AUC, 0.78; <i>P</i> = .03). Clinical, B-mode US, CEUS, and SRCEUS parameters were included in a combined model, in which the International Bowel Ultrasound Segmental Activity Score and vascular density ratio were identified as influential factors. The combined model had an AUC of 0.94, demonstrating superior performance to both CDFI (AUC, 0.82; <i>P</i> = .04) and conventional CEUS (<i>P</i> = .002) and similar performance to SRCEUS (<i>P</i> = .51). Conclusion SRCEUS demonstrated excellent performance in differentiating CD activity through high-resolution depiction of microstructural changes, with superior performance to conventional CEUS. © RSNA, 2026 <i>Supplemental material is available for this article.</i> See also the editorial by Katwal and Chernyak in this issue.</p>","PeriodicalId":20896,"journal":{"name":"Radiology","volume":"320 3","pages":"e253558"},"PeriodicalIF":17.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148907065","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":"Deceptive Eloquence in AI-assisted Thoracic Radiology.","authors":"Alan B McMillan","doi":"10.1148/radiol.262291","DOIUrl":"https://doi.org/10.1148/radiol.262291","url":null,"abstract":"","PeriodicalId":20896,"journal":{"name":"Radiology","volume":"320 3","pages":"e262291"},"PeriodicalIF":17.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148907070","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}