Radiology最新文献

{"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":"Prognostic Value of Cardiac MRI-derived Diastolic Function for Adverse Cardiovascular Outcomes: Insights from UK Biobank.","authors":"Adil Mahmood, Sucharitha Chadalavada, Kerrick Hesse, Kenneth Fung, Simon P Woodbridge, Mohammed Y Khanji, Magnus T Jensen, Pankaj Garg, Patricia B Munroe, Steffen E Petersen, Nay Aung","doi":"10.1148/radiol.253712","DOIUrl":"https://doi.org/10.1148/radiol.253712","url":null,"abstract":"<p><p>Background Although diastolic function markers can help predict adverse outcomes in cardiac disease, the prognostic value of cardiac MRI-derived metrics at a population level remains unclear. Purpose To assess the independent and incremental prognostic value of cardiac MRI-derived diastolic function metrics for adverse cardiovascular outcomes in the UK Biobank. Materials and Methods This secondary analysis of the UK Biobank used data from participants enrolled between March 2006 and August 2010. Univariable and multivariable Cox models were used to evaluate the prognostic influence of each diastolic function marker (peak early to peak late mitral filling rate ratio [E/A], peak early diastolic longitudinal strain rate [e'SR], peak early mitral filling rate to peak e'SR ratio [E/e'SR], and maximum left atrial volume [LAV_max]) on adverse outcomes, including heart failure (HF), arrhythmia, and all-cause death. Multivariable models were adjusted for clinical cardiovascular risk factors (age, sex, smoking, body mass index, hypertension, diabetes, and hyperlipidemia) and known prognostic imaging markers (left ventricular [LV] ejection fraction [LVEF], global longitudinal strain [GLS], LV end-diastolic volume index, and LV mass index). Results The cohort included 59 416 individuals (mean age, 65.4 years ± 7.7 [SD]; 30 887 women) with a median follow-up of 6 years. Peak e'SR, E/A, and LAV_max were independently associated with incident HF and arrhythmia, with peak e'SR showing the strongest association (hazard ratio [HR], 0.55 [95% CI: 0.50, 0.61] for HF, 1.37 [95% CI: 1.26, 1.49] for E/e'SR, and 1.28 [95% CI: 1.17, 1.40] for LAV_max; all <i>P</i> < .001). E/e'SR provided incremental value beyond LVEF and GLS. There was no evidence that diastolic markers were associated with incident all-cause death in fully adjusted models. Conclusion Cardiac MRI-derived diastolic function metrics independently predicted HF and arrhythmia in the UK Biobank with incremental value beyond established imaging markers. © RSNA, 2026 <i>Supplemental material is available for this article.</i> See also the editorial by Ishida in this issue.</p>","PeriodicalId":20896,"journal":{"name":"Radiology","volume":"320 3","pages":"e253712"},"PeriodicalIF":17.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149075806","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":"A 5-year Follow-up on the Persistence of Post-COVID-19 Lung Injury.","authors":"Namkug Kim","doi":"10.1148/radiol.262429","DOIUrl":"https://doi.org/10.1148/radiol.262429","url":null,"abstract":"","PeriodicalId":20896,"journal":{"name":"Radiology","volume":"320 3","pages":"e262429"},"PeriodicalIF":17.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149075971","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":"Reliability and Validity of Imaging-derived Extranodal Extension Grading Using CT and MRI in Nasopharyngeal Carcinoma.","authors":"Pae Sun Suh, Jinna Kim, Dong Eon Kim, Kyunghwa Han, Kyung Hwan Kim, Hye Ryun Kim, Sun Och Yoon, Yoon Woo Koh","doi":"10.1148/radiol.260053","DOIUrl":"10.1148/radiol.260053","url":null,"abstract":"<p><p>Background Imaging-derived extranodal extension (iENE) was added to the N3 criteria for nasopharyngeal carcinoma (NPC) in the ninth version of the tumor-node-metastasis (TNM) staging system. Purpose To evaluate the reliability and prognostic value of a proposed joint task force iENE grading system in NPC. Materials and Methods This retrospective single-center study included patients with NPC treated between January 2007 and March 2025. For patients with cervical lymph node metastases, three radiologists independently graded iENE at pretreatment CT and/or MRI using the proposed four-tier classification system. Inter- and intrarater reliability was assessed using the intraclass correlation coefficient (ICC) and weighted κ. Overall survival (OS), disease-free survival, local-regional recurrence-free survival, and distant metastasis-free survival (DMFS) were evaluated across iENE grades using Kaplan-Meier and multivariable Cox regression analyses adjusted for age, sex, T and M categories, and chemotherapy status. Results A total of 401 patients (median age, 52 years [IQR, 44-60 years]; 296 male patients) were included. According to the consensus-based final iENE grades, 223, 36, 94, and 48 patients were classified as having iENE grade 0, 1, 2, and 3, respectively. Interrater reliability (ICC, 0.87 [95% CI: 0.85, 0.89]) and intrarater reliability (κ = 0.95) for iENE grading were excellent. Compared with patients with iENE grade 0, patients with iENE grade 3 had shorter OS (hazard ratio, 3.30 [95% CI: 1.70, 6.41]; <i>P</i> < .001). In addition, patients with iENE grade 1, 2, and 3 had shorter DMFS than patients with iENE grade 0, with hazard ratios of 2.33 (95% CI: 1.12, 4.87; <i>P</i> = .02), 2.11 (95% CI: 1.24, 3.60; <i>P</i> = .006), and 2.39 (95% CI: 1.28, 4.45; <i>P</i> = .006), respectively. There was no evidence of a difference in prognostic performance between the TNM-8 and TNM-9 systems. Conclusion The joint task force iENE grading system had excellent reliability and good prognostic value in patients with NPC. © RSNA, 2026 <i>Supplemental material is available for this article.</i></p>","PeriodicalId":20896,"journal":{"name":"Radiology","volume":"320 3","pages":"e260053"},"PeriodicalIF":17.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149017752","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":"Five-year Quantitative Chest CT and Hyperpolarized Xenon 129 Ventilation MRI Findings in Survivors of COVID-19 Pneumonia.","authors":"Xiaoyu Han, Yiwan Guo, Wenliang Fan, Zhuang Nie, Ruiyao Tang, Yingqi Luo, Qiuyue Li, Fan Pu, Yanqiao Ren, Wenjuan Tang, Hongying Wu, Yimeng He, Yuting Zheng, Licheng Zhu, Lijie Zhang, Qinyue Luo, Lei Chen, Shiqi Li, Heshui Shi, Qun Yu, Chuansheng Zheng, Fan Yang","doi":"10.1148/radiol.261153","DOIUrl":"10.1148/radiol.261153","url":null,"abstract":"<p><p>Background Whether pulmonary sequelae persist 5 years after COVID-19 pneumonia remains unknown. Purpose To evaluate 5-year pulmonary abnormalities in survivors of COVID-19 pneumonia with use of longitudinal chest CT, inspiratory-expiratory quantitative CT, pulmonary function testing, and hyperpolarized xenon 129 (¹²⁹Xe) ventilation MRI and to compare findings with those in matched healthy controls. Materials and Methods This prospective longitudinal study performed a 5-year follow-up from September to December 2025, enrolling survivors of severe and nonsevere COVID-19 pneumonia along with age-, sex-, and body mass index-matched healthy controls. Survivors underwent serial chest CT during the acute phase and at 6-month, 1-year, 2-year, and 5-year follow-ups. At 5 years, participants underwent inspiratory-expiratory CT, pulmonary function testing, symptom assessment, and hyperpolarized ¹²⁹Xe ventilation MRI. Quantitative CT and ventilation parameters were compared among controls and both survivor groups with use of covariate-adjusted linear regression models, and associations of these parameters with pulmonary function and symptoms were determined with adjusted regression models. Results This study included 143 participants (mean age, 62 years ± 11.0 [SD]; 74 male; 83 survivors of severe COVID-19 pneumonia, 21 survivors of nonsevere COVID-19 pneumonia, and 39 healthy controls). After 5 years, residual lesions persisted in 35.6% of survivors (37 of 104), and abnormal diffusing capacity remained present in 25.5% (26 of 102). Prespecified comparison between 2- and 5-year follow-ups showed no evidence of change in respiratory symptoms (all <i>P</i> ≥ .88), pulmonary function (all <i>P</i> ≥ .67), or conventional CT abnormalities (all <i>P</i> ≥ .81) among survivors. At 5 years, ventilation defect percentage as well as parametric response mapping measures of functional small airway disease and emphysema differed among controls and both survivor groups (all <i>P</i> ≤ .01), with greater abnormalities generally observed in survivors of severe COVID-19 pneumonia (all <i>P</i> ≤ .005 vs controls). Conclusion Five years after COVID-19 pneumonia, some survivors showed persistent respiratory symptoms, abnormal diffusion capacity, and ventilation defects, with stable pulmonary function and no change in CT abnormalities between 2 and 5 years. Clinical trial registration no. ChiCTR2000038609 © RSNA, 2026 <i>Supplemental material is available for this article.</i></p>","PeriodicalId":20896,"journal":{"name":"Radiology","volume":"320 3","pages":"e261153"},"PeriodicalIF":17.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149017815","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":"Large Language Models in Radiology Workflow: Refinement of Differential Diagnosis-An Early Career Perspective.","authors":"Farzaneh Rahmani, Cyrus A Raji","doi":"10.1148/radiol.262484","DOIUrl":"https://doi.org/10.1148/radiol.262484","url":null,"abstract":"","PeriodicalId":20896,"journal":{"name":"Radiology","volume":"320 3","pages":"e262484"},"PeriodicalIF":17.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149075628","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 Photon-counting CT: Multienergy CT across the Breast Cancer Pathway.","authors":"Carla Meeuwis, Monique D Dorrius","doi":"10.1148/radiol.262427","DOIUrl":"https://doi.org/10.1148/radiol.262427","url":null,"abstract":"","PeriodicalId":20896,"journal":{"name":"Radiology","volume":"320 3","pages":"e262427"},"PeriodicalIF":17.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149075956","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":"Opportunistic Chest CT Paraspinal Muscle Biomarkers to Predict Longitudinal Thoracic Vertebral Bone Mineral Density Loss: Results from MESA.","authors":"Quincy A Hathaway, Elena Ghotbi, Tommy Pan, Sara Momtazmanesh, Joshua G Klein, Matthew Allison, Eduardo J Mortani Barbosa, R Graham Barr, David A Bluemke, João A C Lima, Wendy Post, Geoffrey H Tison, Bharath Ambale-Venkatesh, Matthew Budoff, Shadpour Demehri","doi":"10.1148/radiol.260238","DOIUrl":"10.1148/radiol.260238","url":null,"abstract":"<p><p>Background Muscle and bone loss commonly coexist with aging, but the role of paraspinal muscle in predicting longitudinal thoracic vertebral bone mineral density (BMD) remains poorly understood. Purpose To evaluate whether CT-derived paraspinal muscle attenuation and volume independently predict longitudinal thoracic vertebral BMD loss in a prospective, multicenter cohort. Materials and Methods In this secondary analysis of the Multi-Ethnic Study of Atherosclerosis (MESA), noncontrast chest CT scans from examinations 5 (baseline, April 2010) and 6 (September 2016) were analyzed after excluding participants with incomplete Fracture Risk Assessment Tool without BMD (FRAXnb) data or failed segmentations. Multilevel (T1 through T10) deep learning (DL)-based three-dimensional segmentation was used to derive paraspinal muscle volume and attenuation, which were compared with manual segmentation (reference standard). Paraspinal muscle volume and attenuation were dichotomized (quartile 1 vs quartiles 2-4) for multivariable regression models predicting follow-up vertebral BMD and incident vertebral fracture (VF), adjusted for clinical risk factors and compared with baseline BMD. Results A total of 1316 participants (mean age, 67.2 years [IQR, 60-74 years]; 694 female) were included. DL-derived three-dimensional segmentations correlated with manual segmentations (Dice score, 0.94). At baseline, participants with low versus high attenuation (quartile 1 vs quartiles 2-4; 4 HU vs 27 HU) were older (70.7 years vs 66.0 years) and were more often White (49% [162 of 328 participants] vs 30% [295 of 988 participants]) and female (77% [254 of 328 participants] vs 45% [440 of 988 participants]). Compared with quartiles 2-4, low attenuation (176 mg/cm³ vs 205 mg/cm³; <i>P</i> < .001) and volume (180 mg/cm³ vs 203 mg/cm³; <i>P</i> < .001) were associated with lower BMD. Muscle attenuation at baseline was the strongest predictor of follow-up BMD beyond FRAXnb (adjusted <i>R</i>², 0.27 vs 0.20; <i>P</i> < .001) and improved prediction of incident VF beyond BMD alone (area under the receiver operating characteristic curve, 0.82 [95% CI: 0.76, 0.88] vs 0.76 [95% CI: 0.67, 0.85]; <i>P</i> = .02). Conclusion CT-derived paraspinal muscle attenuation provided independent and incremental value for predicting longitudinal thoracic vertebral BMD loss. ClinicalTrials.gov NCT00005487 © RSNA, 2026 <i>Supplemental material is available for this article.</i> See also the editorial by Roemer in this issue. See also the editorial by Rai and Janu in this issue.</p>","PeriodicalId":20896,"journal":{"name":"Radiology","volume":"320 3","pages":"e260238"},"PeriodicalIF":17.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13631676/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148970981","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":"Deep Learning-derived Bone Mineral Density and Longitudinal White Matter Microstructure and Cognitive Decline: Multi-Ethnic Study of Atherosclerosis.","authors":"Sara Momtazmanesh, Quincy A Hathaway, Michael P Bancks, David A Bluemke, R Graham Barr, Wendy S Post, Mohamad Habes, Ilya Nasrallah, Susan R Heckbert, R Nick Bryan, Jose A Luchsinger, Mei Wan, Matthew Budoff, João A C Lima, Timothy M Hughes, Christos Davatzikos, Shadpour Demehri","doi":"10.1148/radiol.260656","DOIUrl":"10.1148/radiol.260656","url":null,"abstract":"<p><p>Background White matter (WM) microstructural degeneration and WM hyperintensities (WMH) are imaging markers of brain aging. Low bone mineral density (BMD) and brain aging co-occur, but longitudinal evidence linking skeletal health to WM injury and cognitive decline remains limited. Purpose To determine whether deep learning-derived thoracic vertebral BMD (vBMD) from noncontrast chest CT is associated with longitudinal changes in WM integrity, WMH burden, and cognitive decline. Materials and Methods This secondary analysis of a prospective study conducted from September 2016 to March 2024 included participants without clinically recognized cardiovascular disease from the Multi-Ethnic Study of Atherosclerosis. Participants underwent noncontrast chest CT, multimodal brain MRI (diffusion tensor imaging and fluid-attenuated inversion recovery), and cognitive testing. Thoracic vBMD was quantified at baseline using a validated deep learning algorithm. Linear mixed-effects models related baseline vBMD to longitudinal changes in WMH volume, WM fractional anisotropy, and cognition, adjusting for demographics, apolipoprotein E-ε4, cardiometabolic risk factors, lifestyle, and medications. Results This study included 715 participants (median age [IQR], 69 years [65-75 years]; 397 men and 318 women). Lower baseline vBMD was associated with faster decline in total WM fractional anisotropy (<i>n</i> = 405; β = -0.036 SD/year/0.1 g/cm³ vBMD decrease [95% CI: -0.065, -0.006]; nominal <i>P</i> = .02), although this did not survive false discovery rate correction (adjusted <i>P</i> = .07). Regionally, lower vBMD was associated with faster fractional anisotropy decline in the anterior limb of the internal capsule (β = -0.048 SD/year; adjusted <i>P</i> = .006) and faster WMH accumulation in the corpus callosum (<i>n</i> = 408; β = 12.8%/year; adjusted <i>P</i> = .04). Lower vBMD was also associated with faster decline in the global cognitive composite (<i>n</i> = 639; β = -0.025 SD/year; <i>P</i> = .002) and the Cognitive Abilities Screening Instrument (<i>n</i> = 675; β = -0.320/year; <i>P</i> < .001). Diabetes amplified associations with WMH progression (β = 4.99%; <i>P</i> = .03). Conclusion Lower vBMD from noncontrast chest CT was associated with modestly accelerated regional WM injury and faster cognitive decline, particularly among participants with diabetes, suggesting utility for detecting accelerated brain aging. ClinicalTrials.gov: NCT00005487 © RSNA, 2026 <i>Supplemental material is available for this article.</i></p>","PeriodicalId":20896,"journal":{"name":"Radiology","volume":"320 3","pages":"e260656"},"PeriodicalIF":17.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13631679/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149017783","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}