Abdominal radiology (New York)最新文献

{"title":"A radiology trainee's guide to perianal fistulas.","authors":"Benjamin Q Spangler, Shreeti H Patel, Sally Midani, Alana Brown, Mark D Ehrhart, Jonathan W Revels, Dana C Galvan","doi":"10.1007/s00261-026-05798-2","DOIUrl":"https://doi.org/10.1007/s00261-026-05798-2","url":null,"abstract":"<p><p>Perianal fistulas are abnormal epithelialized connections between the anal canal to the perineal skin. Magnetic resonance imaging (MRI) has become the gold standard for both pre- and postoperative evaluation, offering excellent soft tissue contrast and superior delineation of fistulous tracts, sphincteric involvement, tract extensions, abscesses, and associated complications. Despite its diagnostic value, interpretation of perianal fistula MRI can be challenging, particularly for radiology trainees, as it requires detailed understanding of complex perianal anatomy, as well as familiarity with optimized MRI acquisition planes and interpretation techniques. This pictorial review aims to provide a structured and practical approach to perianal fistulous disease on MRI. It highlights key imaging features of fistulas, illustrates essential anatomic landmarks of the anal canal and surrounding spaces, and reviews current pathogenesis theories of fistula formation to serve as foundational knowledge. The Parks classification system will be systematically reviewed with case examples and illustrations. Finally, key reporting considerations are presented using a stepwise, trainee-oriented approach, providing a structured MRI interpretation framework to promote accurate and consistent assessment, improve communication with surgeons, and support standardized reporting in clinical practice.</p>","PeriodicalId":520541,"journal":{"name":"Abdominal radiology (New York)","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149032867","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"MRI assessment of extramural venous invasion in rectal cancer: a practical pictorial review.","authors":"Italo Ribeiro Cruz, Tábata Xavit Souza E Silva, Eduardo Medeiros Portela de Araújo, Júlia Azevedo Miranda, Kamila Seidel Albuquerque, Luís Gabriel Campos Pires, João Miranda","doi":"10.1007/s00261-026-05758-w","DOIUrl":"https://doi.org/10.1007/s00261-026-05758-w","url":null,"abstract":"<p><p>Extramural venous invasion (EMVI), the spread of rectal tumor cells into veins beyond the muscularis propria, is one of the most prognostically powerful preoperative findings detectable on pelvic magnetic resonance imaging (MRI). Meta-analytic evidence indicates that baseline mrEMVI is associated with an approximately fourfold increased risk of metachronous metastases (OR 3.91; 95% CI 2.61-5.86), and it independently predicts inferior disease-free and overall survival. Despite this evidence, MRI-based EMVI assessment remains inconsistently applied in routine practice. This pictorial review provides a structured, image-focused approach to MRI-detected EMVI, covering the technical requirements for reliable detection, relevant venous anatomy, imaging hallmarks on high-resolution T2-weighted and diffusion-weighted imaging, the validated five-point grading scale, the most clinically significant mimics and pitfalls, and the specific challenges of restaging after neoadjuvant therapy. We also summarize the clinical implications of EMVI grading for treatment intensification, lateral lymph node management, and organ-preservation decisions. Graded MRI assessment of EMVI provides clinically meaningful prognostic information beyond binary positive/negative reporting and is increasingly used to inform multidisciplinary decisions in rectal cancer, although evidence that grade-directed treatment modification improves outcomes remains limited. Reproducible interpretation requires attention to key pitfalls, including equivocal grade 2 findings, small-caliber vessels, and reduced diagnostic reliability after neoadjuvant therapy.</p>","PeriodicalId":520541,"journal":{"name":"Abdominal radiology (New York)","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149032909","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early liver parameter increase after transjugular intrahepatic portosystemic shunt (TIPS): hepatic vascular risk factors and development of an exploratory prediction model.","authors":"Felix Schön, Marco Berning, Sophia Freya Ulrike Blum, Marie-Luise Kromrey, Patricia Hahlbohm, Stefan Sulk, Christoph Georg Radosa, Steffen Löck, Jens-Peter Kühn, Thomas Maximilian Helmberger, Ralf-Thorsten Hoffmann","doi":"10.1007/s00261-026-05792-8","DOIUrl":"https://doi.org/10.1007/s00261-026-05792-8","url":null,"abstract":"<p><strong>Purpose: </strong>To investigate early laboratory changes following Transjugular Intrahepatic Portosystemic Shunt (TIPS) and their associations with hepatic vessel diameters. Additionally, to develop a model to predict patients at high-risk for excessive liver parameter increase.</p><p><strong>Materials and methods: </strong>A total of 256 TIPS procedures performed between 2017 and 2024 were retrospectively enrolled and divided into a development (n = 208) and temporally separated internal validation cohort (n = 48). Diameters of portal vein and hepatic arteries were measured in pre-procedural computed tomography scans. Laboratory parameters (INR, ALAT, ASAT, GGT, and bilirubin) were assessed pre-procedurally, on post-procedural days 1-2, and between days 4-7. Patients with ≥ 2 parameters exceeding the 85th percentile of percentage change on days 1-2 were classified as high-risk. A prediction model for the identification of high-risk patients was developed and validated.</p><p><strong>Results: </strong>All laboratory parameters significantly increased post-procedurally (p < 0.001), with 41 patients classified as high-risk. ALAT and ASAT showed the highest increase (up to +392 +/- 1118% and +474 +/- 1125%, respectively). Hepatic artery and portal vein diameters were predominantly negatively correlated with laboratory changes (p < 0.05). The prediction model identified common hepatic artery diameter, portal vein thrombosis, and baseline bilirubin as independent high-risk predictors, achieving an AUC of 0.782 and 0.748 in the development and internal validation cohort, respectively.</p><p><strong>Conclusion: </strong>TIPS significantly impacts liver metabolism, with marked early alterations in liver parameters that inversely correlate with hepatic vessel diameters. A prediction model based on common hepatic artery diameter, portal vein thrombosis status, and baseline bilirubin may support identification of high-risk patients and potentially help optimize post-procedural management.</p>","PeriodicalId":520541,"journal":{"name":"Abdominal radiology (New York)","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149027314","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Biphasic CT clustering-based habitat radiomics predicts WHO/ISUP nuclear grade in clear cell renal cell carcinoma.","authors":"Shiwei Luo, Quan Quan, Youlan Shang, Yanyao Du, Wei Zhao, Xiao Lin, Jun Liu","doi":"10.1007/s00261-026-05793-7","DOIUrl":"https://doi.org/10.1007/s00261-026-05793-7","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate a biphasic CT clustering-based habitat radiomics approach for predicting the World Health Organization/International Society of Urological Pathology (WHO/ISUP) nuclear grade in clear cell renal cell carcinoma (ccRCC) and assess the discriminatory value of different tumor subregions.</p><p><strong>Methods: </strong>This retrospective study collected 473 ccRCC patients (training: n = 337; test: n = 136). Thin-section corticomedullary phase (CMP) and excretory phase (EP) CT images were preprocessed and registered. NnU-Net was used for automated segmentation of tumor. Tumor habitats were generated via k-means clustering of three parameters: CMP attenuation values (CMP_HU), EP attenuation values (EP_HU), and their interphase difference (ΔHU). Radiomics features were extracted from whole-tumor volumes, individual subregions, and subregional combinations, followed by feature selection and model development.</p><p><strong>Results: </strong>Five distinct subregions were identified. Subregion 4 ( representing the tumor viable-necrosis transition zone ) -based Random Forest model achieved diagnostic performance statistically comparable to whole-tumor-based model in both CMP ( AUC: 0.773 vs. matched whole-tumor AUC 0.819, DeLong' p = 0.152 ) and EP ( AUC: 0.810 vs. matched whole-tumor AUC 0.827, DeLong' p = 0.593 ). Subregion 2 ( necrotic core ) -based model showed similar efficacy to whole-tumor model in EP ( AUC: 0.771 vs. matched whole-tumor AUC 0.802, DeLong' p = 0.219 ). Multi-subregion models containing Subregion 4 maintained statistically comparable performance with whole-tumor models, with Subregion 1+4 demonstrating optimal performance.</p><p><strong>Conclusion: </strong>Biphasic CT clustering-based habitat analysis reveals that specific tumor subregions-particularly the tumor viable-necrosis transitional zone-can approximate whole-tumor diagnostic performance for ccRCC nuclear grading. This method provides spatial mapping of tumor heterogeneity through visualizable CT subregions, offering a potential complementary tool for non-invasive ccRCC characterization. Further prospective multicenter validation with histopathological correlation is needed before clinical implementation.</p>","PeriodicalId":520541,"journal":{"name":"Abdominal radiology (New York)","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149027281","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Spectral CT predicts initial bleeding risk in cirrhotic patients with esophagogastric varices.","authors":"Rong Gao, Hai-Sheng Wang, Yang Yu, Shang-di Zhang, Feng Wang, Da-Guo Shi, Guang-Yao Liu, Jun-Lin Zhou, Hong Liu","doi":"10.1007/s00261-026-05803-8","DOIUrl":"https://doi.org/10.1007/s00261-026-05803-8","url":null,"abstract":"<p><strong>Purpose: </strong>To develop a multiparametric model integrating spectral CT quantitative metrics, venous morphometrics, and clinical biomarkers for the noninvasive prediction of initial bleeding risk in cirrhotic patients with esophagogastric varices (EGV).</p><p><strong>Materials and methods: </strong>This retrospective study evaluated a cohort of 195 cirrhotic patients with EGV who underwent portal venous spectral CT. Univariable and multivariable logistic regression analyses were conducted to screen spectral CT metrics, venous morphometrics, and clinical biomarkers, aiming to identify independent predictive factors for initial bleeding. A joint diagnostic model was subsequently constructed based on these independent predictors and formulated as a nomogram. Model discrimination was quantified via the area under the receiver operating characteristic curve (AUC) and compared using the DeLong test, calibration was visually assessed using calibration plots, and clinical utility was evaluated using decision curve analysis (DCA). Internal validation was performed using bootstrap resampling (200 repetitions).</p><p><strong>Results: </strong>Following feature selection, six predictors of initial bleeding were identified: EGV normalized iodine concentration (EGV NIC), liver effective atomic number (Liver Eff-Z), superior mesenteric vein diameter (SMVD), portal vein diameter (PVD), lymphocyte count, and alanine aminotransferase (ALT). The integrated multiparametric model demonstrated high apparent discriminative performance, with an AUC of 0.912 (95% CI, 0.864-0.960), significantly exceeding the AUCs of all individual predictors (AUC range, 0.636-0.835; all P < 0.05 by pairwise DeLong tests). Calibration analysis showed good agreement between predicted probabilities and observed bleeding outcomes. Bootstrap internal validation yielded an optimism-corrected AUC of 0.880 (95% CI, 0.787-0.951). Decision curve analysis suggested that the joint model provided greater net benefit across a range of clinically relevant threshold probabilities.</p><p><strong>Conclusion: </strong>A multiparametric nomogram synergizing selected spectral CT hemodynamics, portal morphometrics, and clinical profiles provides a highly accurate and noninvasive tool for predicting initial bleeding risk in cirrhotic patients with EGV.</p>","PeriodicalId":520541,"journal":{"name":"Abdominal radiology (New York)","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149027268","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Abdominal CT findings on the day of death in patients with solid organ malignancies.","authors":"Mark Kliewer, Karla Wetley, Daniel Schroeder, Lu Mao","doi":"10.1007/s00261-026-05781-x","DOIUrl":"https://doi.org/10.1007/s00261-026-05781-x","url":null,"abstract":"<p><strong>Purpose: </strong>Evidence on imaging of imminent death could complement clinical and laboratory predictors, provide insight into the biology of dying, and possibly help clinicians advise patient families. The purpose of this study was to identify findings on abdominopelvic CT that are associated with imminent death in patients with solid organ malignancies.</p><p><strong>Methods: </strong>The electronic record was searched over a ten-year period for patients with solid organ cancers who had an abdominopelvic CT within 24 h of death and at least one prior CT. The CT studies of 28 patients were evaluated for third-spacing (pleural fluid, ascites, anasarca), body wall fat attenuation, psoas muscle attenuation, and psoas muscle size. Imaging findings were compared to laboratory values obtained at the time of the scans; these included sodium, creatinine, alkaline phosphatase, bilirubin, hemoglobin, white blood cell count, neutrophil count, and prealbumin. Statistical analysis included the Wilcoxon signed rank test for changes in third-spacing scores and linear regression for all other variables.</p><p><strong>Results: </strong>Third-spacing scores increased significantly on CT examinations obtained within 24 h of death compared with prior CT examinations (p < 0.0001), driven primarily by increases in pleural effusions and anasarca. Measurements of ascites, psoas muscle size, psoas attenuation, and body wall fat attenuation were not significantly associated with proximity to death. Among laboratory values, only neutrophil count increased significantly (p = 0.03).</p><p><strong>Conclusion: </strong>Marked increases in pleural effusions and anasarca were observed on CT examinations obtained within 24 h of death in this cohort of patients with advanced solid organ malignancies. The specificity of these findings for imminent death would require validation in controlled prospective studies.</p>","PeriodicalId":520541,"journal":{"name":"Abdominal radiology (New York)","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149027287","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"MRI of spermatic cord lesions: a practical pattern-based approach.","authors":"Shuji Nagata, Yuki Shouji, Akiko Koga, Tomonori Chikasue, Akiko Sumi, Yusuke Uchiyama, Kiminori Fujimoto, Shuichi Tanoue","doi":"10.1007/s00261-026-05794-6","DOIUrl":"https://doi.org/10.1007/s00261-026-05794-6","url":null,"abstract":"<p><p>Spermatic cord lesions are rare and may present as inguinal or paratesticular masses, sometimes extending along the inguinal canal or retroperitoneal pathway. Ultrasonography is usually the first-line imaging modality for scrotal and paratesticular abnormalities; however, MRI provides additional information regarding lesion localization, tissue composition, disease extent, and features suggestive of malignancy. In this review article, we review the anatomy and constituent structures of the spermatic cord and illustrate the MRI findings of selected benign, inflammatory, vascular, and malignant conditions. We propose a practical three-step MRI-based diagnostic approach that first establishes the lesion's anatomic origin and relationship to the spermatic cord, then classifies it according to MRI pattern findings, and finally integrates these findings to narrow the differential diagnosis. These patterns include cystic/fluid-filled, tubular/ductal, serpiginous venous, fibrous, fat-containing, and predominantly solid lesions. This approach is intended to help radiologists distinguish true spermatic cord lesions from adjacent paratesticular mimics, narrow the differential diagnosis, and identify findings relevant to clinical management. Ultrasonography remains the first-line examination, with MRI serving primarily as a problem-solving modality when localization, characterization, or assessment of extent remains uncertain. The proposed categories are intended as overlapping pattern descriptors rather than mutually exclusive diagnostic entities.</p>","PeriodicalId":520541,"journal":{"name":"Abdominal radiology (New York)","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149027330","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A knowledge-guided dual-path framework for automated liver MRI series classification.","authors":"Sizhuo Han, Hui Xu, Jiahui Lv, Chao Zheng, Gong Lun, Xibin Jia, Zhenchang Wang, Dawei Yang, Zhenghan Yang","doi":"10.1007/s00261-026-05790-w","DOIUrl":"https://doi.org/10.1007/s00261-026-05790-w","url":null,"abstract":"<p><strong>Purpose: </strong>Accurate identification of liver MRI series is crucial for streamlining clinical workflows, yet current automated methods remain limited in coverage and robustness for real-world practice. This study aims to develop a clinically feasible automated classification system for liver MRI series.</p><p><strong>Methods: </strong>We developed a knowledge-guided dual-path (KDP) framework that integrates two complementary information sources: CNN-extracted imaging features and metadata (e.g., acquisition time, series description, b-value) from DICOM headers. A rule-based fusion module, built on predefined clinical rules, then determines the processing pathway for each sequence type based on these inputs, enabling reliable classification across all 18 series categories (including non-contrast, dynamic contrast-enhanced (DCE) phases, quantitative maps, coronal series, and others). This approach was externally validated on a multicenter test set of 2,208 series from 123 cases across 22 hospitals.</p><p><strong>Results: </strong>The proposed method demonstrated excellent performance, with macro-average F1-scores of 97.63% (95% CI: 97.09%-98.09%) on the internal test set (n = 7,141 series) and 96.76% (95% CI: 95.78%-97.64%) on the external multicentric test set (n = 2,208 series). The KDP framework significantly outperformed the image-only model, with a macro F1-score of 96.50% (95% CI: 95.05%-97.68%) versus 91.54% (95% CI: 89.67%-93.12%) on the 12 shared categories (McNemar's test, χ² = 53.6, p < 0.001).</p><p><strong>Conclusion: </strong>The proposed method provides accuracy and fully automated discrimination of liver MRI series. Its validated robustness across multicentric data highlights its potential for clinical integration.</p>","PeriodicalId":520541,"journal":{"name":"Abdominal radiology (New York)","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149003309","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Thickening of the internal anal sphincter: correlation with external rectal intussusception and associated features at MR proctography and anal manometry.","authors":"Mariana Yalon, David J Bartlett, Ramesh Lamichhane, David N Jacobson, Avinash K Nehra, Kristina T Flicek, Michael L Wells, Shannon P Sheedy, Ahmed O El Sadaney, Yong S Lee, Blake A Kassmeyer, William R G Perry, Adil E Bharucha, Joel G Fletcher","doi":"10.1007/s00261-026-05756-y","DOIUrl":"https://doi.org/10.1007/s00261-026-05756-y","url":null,"abstract":"<p><strong>Objectives: </strong>To determine if internal anal sphincter (IAS) thickness can be reproducibly measured with endoanal MRI in conjunction with MR defecography, and if IAS thickening is associated with external rectal intussusception (i.e., external rectal prolapse) at MR defecography or high-resolution anal manometry (HRM) measurements.</p><p><strong>Methods: </strong>In this case-control study, 119 patients underwent clinical endoanal MRI, dynamic MR defecography, and HRM. Patients with intra-anal or external rectal intussusception (cases) were matched to those who had neither (controls). Five radiologists, blinded to all clinical information and MR defecography images, measured the maximum lateral IAS thickness on endoanal MR images (≤ 3 mm considered normal). Intraclass correlation coefficient (ICC) estimated inter-rater reliability. Between-group differences and associations among IAS thickness, external rectal intussusception, and anorectal pressures at HRM were analyzed.</p><p><strong>Results: </strong>Among 52 cases, 40 had external and 12 had intra-anal rectal intussusception. Median IAS thickness was 2.5 mm (1.1-7.3) with good/moderate inter-rater agreement/reliability (ICC = 0.623). IAS thickening was more frequent in patients with external rectal intussusception (18/40; 45%) than in patients with intra-anal, intra-rectal, or no rectal intussusception (25%, 17%, 10%, respectively; p < 0.002). External rectal intussusception was associated with lower mean anal resting pressure (48 ± 29 mmHg), compared to controls and patients with other degrees of intussusception (75-81 mm Hg, p < 0.004). Anal resting pressure was also lower in patients with thickened IAS (53.5 mmHg vs. 73.8 mmHg; p =0.003). In multivariable analysis, only external rectal intussusception independently predicted anal resting pressure (β-coefficient = -28.9 mmHg, P < 0.0001). IAS thickening was associated with increased anterior-posterior separation of the sphincters and circumferential morphology of external rectal intussusception (P[Formula: see text] 0.015).</p><p><strong>Conclusion: </strong>IAS thickening can be reliably measured on endoanal MRI and is strongly associated with external rectal intussusception on MR defecography and reduced anal resting pressure at HRM.</p>","PeriodicalId":520541,"journal":{"name":"Abdominal radiology (New York)","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148993543","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Determining malignant potential of pancreatic intraductal papillary mucinous neoplasm with CT: interobserver variability and diagnostic performance.","authors":"Jisun Lee, Seo-Youn Choi, Jung Hoon Kim, Na Yeon Han, Mihyeon Park, Ho Sig Jang, Chan-Seop Kim, Seong Gyeong Ju, Ji Eun Moon, Ji Hye Min","doi":"10.1007/s00261-026-05783-9","DOIUrl":"https://doi.org/10.1007/s00261-026-05783-9","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate interobserver agreement and diagnostic performance of computed tomography (CT) in assessing the malignant potential of pancreatic intraductal papillary mucinous neoplasms (IPMNs) based on the 2024 International evidence-based Kyoto guidelines, focusing on the impact of reviewer experience.</p><p><strong>Methods: </strong>In this multicenter retrospective study, CT images of 120 patients with pathologically confirmed IPMNs (53 malignant, 44.2%) were independently reviewed by eight observers (four experienced abdominal radiologists and four radiology residents). Malignant potential was graded using a five-point scale based on high-risk stigmata (HRS) and worrisome features (WF) defined by the 2024 Kyoto guidelines. Diagnostic performance (AUC) and interobserver agreement were compared between experience-based and guideline-based interpretations according to reviewer experience.</p><p><strong>Results: </strong>Among 120 patients (mean age, 65.9 ± 10.5 years; range, 41-87), 53 (44.2%) had malignant IPMNs. Interobserver agreement was substantial (α = 0.66) using the Kyoto guidelines and was higher among more experienced reviewers (α = 0.73 vs. 0.66; p < 0.001). Diagnostic performance was good (AUC, 0.75-0.89), with no statistically significant difference between more and less experienced reviewer groups (p = 0.26). For less experienced reviewers, guideline-based interpretation improved diagnostic performance (AUC 0.71-0.80 to 0.75-0.85; p < 0.001) and interobserver agreement (α = 0.43 to 0.66; p < 0.001) compared with experience-based assessment. In contrast, for more experienced reviewers, guideline-based interpretation did not result in a statistically significant change in diagnostic performance (AUC 0.88-0.92 to 0.82-0.89; p = 0.08), while interobserver agreement showed a modest decrease (α = 0.81 to 0.73; p < 0.001).</p><p><strong>Conclusion: </strong>The 2024 Kyoto guidelines demonstrated an experience-dependent effect, improving diagnostic performance and interobserver agreement among less experienced readers, with limited additional benefit for experienced radiologists.</p>","PeriodicalId":520541,"journal":{"name":"Abdominal radiology (New York)","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148993472","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}