Frontiers in radiology最新文献

{"title":"Development and validation of a nomogram using interpretable machine learning to integrate CT radiomics and PET metabolic parameters for predicting benign-malignant differentiation of pulmonary space-occupying lesions.","authors":"Xue Liu, Xinghua Liu, Li Bin, Yu Zhang, Huiting Liu, Cailiang Gao","doi":"10.3389/fradi.2026.1782678","DOIUrl":"https://doi.org/10.3389/fradi.2026.1782678","url":null,"abstract":"<p><strong>Objective: </strong>To construct a multimodal machine learning model integrating computed tomography (CT) radiomics, Positron Emission Tomography (PET) metabolic parameters, and clinical data for differentiating benign from malignant pulmonary space-occupying lesions (PSOLs), and develop an interpretable nomogram for clinical application.</p><p><strong>Methodology: </strong>This study enrolled 384 patients with PSOLs who underwent dual-time-point <sup>1</sup>⁸F-FDG PET/CT examinations. The cohort was divided into a training set (<i>n</i> = 268, 145 malignant, 123 benign) and an independent temporal validation set (<i>n</i> = 116, 69 malignant, 47 benign) at a 7:3 ratio according to the chronological order of patient enrollment, to avoid data leakage and rigorously assess model generalizability. All malignant lesions were confirmed by pathological examination, while benign lesions were confirmed by pathology (82%) or clinical-imaging follow-up for at least 12 months (18%). CT radiomic features with Intraclass Correlation Coefficient (ICC) values >0.75 were selected, and a Radiomics-score (Rad-score) was generated using the Least Absolute Shrinkage and Selection Operator (LASSO) regression algorithm. Integrated models [Logistic regression, random forest (RF), support vector machine (SVM), eXtreme Gradient Boosting (XGBoost)] were developed by fusing the Rad-score, clinical variables, and PET metabolic parameters. Model performance was evaluated using the area under the receiver operating characteristic curve (AUC), accuracy, sensitivity, specificity, F1-score, and Brier score. Model calibration was assessed via calibration curves, and clinical utility was validated by decision curve analysis (DCA). Model interpretability was achieved using SHapley Additive exPlanations (SHAP) values for the optimal XGBoost model, and a clinically applicable, interpretable nomogram was constructed based on the core predictive features identified by SHAP analysis to facilitate clinical translation.</p><p><strong>Results: </strong>A Rad-score was constructed from 17 optimally selected features. In the independent temporal validation set, the single-modality models achieved AUCs of 0.808 (Radiomics Model), 0.732 (Clinical Model), and 0.874 (Metabolic Model). Among all tested models, the XGBoost integrated model achieved the highest AUC of 0.967, which was significantly higher than that of all other models (Bonferroni-adjusted <i>P</i> = 0.002-0.032, all adjusted <i>P</i> < 0.05). SHAP analysis identified <i>Δ</i>SUVmax, Rad-score, and delayed phase total lesion glycolysis (TLG_d) as the top three key predictive features.</p><p><strong>Conclusions: </strong>The predictive logic of the optimal XGBoost model was decoded via SHAP analysis to identify core predictive features, and a clinically applicable, interpretable nomogram was further established based on a multivariate logistic regression model using these core features, to facilitate the clinical translati","PeriodicalId":73101,"journal":{"name":"Frontiers in radiology","volume":"6 ","pages":"1782678"},"PeriodicalIF":2.3,"publicationDate":"2026-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13139110/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147847012","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Vietnamese expert consensus on the treatment of hepatocellular carcinoma with transarterial chemoembolization.","authors":"Vu Dang Luu, Do Dang Tan, Pham Minh Thong, Le Van Khang, Le Thanh Dung, Le Trong Binh, Nguyen Ngoc Trang, Nguyen Ngoc Cuong, Nguyen Dinh Luan, Ngo Le Lam, Trinh Ha Chau, Than Van Sy, Nguyen Duy Anh, Le Duc Tho, Tran Duc Huy, Dang Ngoc Hieu, Pham Quang Son, Le Doan Tri, Nguyen Dinh Huong, Pham Cam Phuong, Nguyen Tien Thinh, Vo Duy Thong, Ho Tan Phat, Phan Thi Hong Duc, Pham Gia Anh, Vo Hoi Trung Truc, Lam Quoc Trung, Le Ba Thao, Le Tuan Anh, Tran Cong Duy Long","doi":"10.3389/fradi.2026.1763042","DOIUrl":"https://doi.org/10.3389/fradi.2026.1763042","url":null,"abstract":"<p><p>Hepatocellular carcinoma (HCC) remains a major public health challenge in Vietnam and, according to GLOBOCAN 2022, accounted for 24,502 new cases in 2022, making it the second most common cancer and the leading cause of cancer-related mortality. Transarterial chemoembolization (TACE), introduced in 1977, is a pivotal treatment for unresectable HCC, delivering chemotherapeutic agents and embolic materials to induce tumor necrosis through cytotoxicity and ischemia. TACE is versatile and, in selected early-stage HCC (BCLC 0-A) treated with a highly selective approach, may achieve complete response; in intermediate-stage disease (BCLC B), it can prolong survival and enable downstaging, and in advanced-stage disease (BCLC C), it may complement systemic therapy. Despite its global use, TACE practices vary, and Vietnam lacks standardized guidelines tailored to its unique clinical landscape. The Vietnamese Society of Radiology and Nuclear Medicine and The Vietnamese Society of Interventional Radiology conducted three workshops in Da Nang, An Giang, and Can Tho between August and December 2024. These workshops engaged interventional radiologists from major hospitals and regional centers to develop consensus-based TACE recommendations. Through literature reviews, discussions, and physician voting, the recommendations cover pre-TACE diagnostic imaging, patient selection criteria, TACE techniques, choice of embolic materials and chemotherapeutic agents, intra- and post-procedure monitoring, and integration with combination therapies. This initiative aligns international standards with local needs, aiming to enhance the efficacy and consistency of TACE for HCC management in Vietnam.</p>","PeriodicalId":73101,"journal":{"name":"Frontiers in radiology","volume":"6 ","pages":"1763042"},"PeriodicalIF":2.3,"publicationDate":"2026-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13140673/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147847007","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"YOLO11-based detection of manometry sensors in video-fluoroscopy imaging for computer-aided multimodal assessment of swallowing.","authors":"Dionne S Brandsma, Manuel Maria Loureiro da Rocha, Lisette van der Molen, Maarten J A van Alphen, Michiel W M van den Brekel, Françoise J Siepel","doi":"10.3389/fradi.2026.1767875","DOIUrl":"https://doi.org/10.3389/fradi.2026.1767875","url":null,"abstract":"<p><strong>Purpose: </strong>Accurate assessment of swallowing function is essential in the diagnosis and monitoring of dysphagia following head and neck cancer (HNC). The simultaneous analysis of video-fluoroscopy swallow studies (VFSS) and high-resolution impedance manometry (HRIM) offers a more comprehensive evaluation, reducing subjectivity in VFSS and improving anatomical context of HRIM in HNC patients.</p><p><strong>Methods: </strong>The inherently low pharyngeal pressures in post-treatment HNC patients hinder the analysis of HRIM. As such, this study proposes a deep learning method for the automatic detection of HRIM sensors in VFSS using a YOLO11-based detector, aimed at enabling the automatic delineation of manometric regions. Detection performance was evaluated on 268 frames from 8 HNC patients using a leave-one-patient-out cross-validation approach. EigenCAM-based heatmaps were produced to analyze the model's attention patterns.</p><p><strong>Results: </strong>The model achieved 95.8% Precision, 97.4% Recall, 96.6% F1-score with minimal variation between folds. Under different noise levels and bolus-simulated obstructions, performance remained robust. Our method outperformed previous template-matching methods for manometric sensor detection in VFSS. EigenCAM visualizations confirmed consistent attention to catheter regions.</p><p><strong>Conclusion: </strong>The proposed YOLO11-based detector provides accurate and robust localization of manometric sensors in VFSS sequences to facilitate computer-assisted HRIM-VFSS fusion for objective swallowing assessment.</p>","PeriodicalId":73101,"journal":{"name":"Frontiers in radiology","volume":"6 ","pages":"1767875"},"PeriodicalIF":2.3,"publicationDate":"2026-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13121316/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147791131","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Combining computed tomography features and histogram analysis facilitates differentiation between solitary pulmonary invasive mucinous and non-mucinous adenocarcinomas.","authors":"Duiming Yang, Hao Hu, Zhimei Li, Shuilan Zhang, Jing Ai, Handan Zhang","doi":"10.3389/fradi.2026.1793604","DOIUrl":"https://doi.org/10.3389/fradi.2026.1793604","url":null,"abstract":"<p><strong>Objective: </strong>To assess the value of combining computed tomography (CT) morphological and histogram features for the differentiation of solitary pulmonary invasive mucinous adenocarcinoma (PIMA) from pulmonary invasive non-mucinous adenocarcinoma (PINMA).</p><p><strong>Methods: </strong>This retrospective study analyzed the CT images and clinical data of 58 and 105 patients with PIMA and PINMA, respectively. CT histogram features were extracted after delineating regions of interest using 3D Slicer software. CT morphological and histogram features were compared between the PIMA and PINMA groups, and those that differed significantly were included in multivariate logistic regression models. The independent predictive factors identified were used to create CT morphological, CT histogram-based, and combined prediction models. The best-performing model was visualized and evaluated by constructing a nomogram.</p><p><strong>Results: </strong>The CT morphological prediction model included nodule type, vacuole sign, and tumor location as factors predictive of PIMA and had an area under the curve of 0.754. The CT histogram-based prediction model included kurtosis and the 90th percentile as factors predictive of PIMA and had an area under the curve of 0.820. The combined prediction model, which included tumor location, vacuole sign, kurtosis, and the 90th percentile, had an area under the curve of 0.845, suggesting greater diagnostic accuracy than the separate models. The combined prediction model also exhibited good calibration and high clinical applicability.</p><p><strong>Conclusion: </strong>Integrating CT morphological features and histogram analysis improves the accuracy of differentiating PIMA from PINMA. The nomogram provides a practical and effective tool for the non-invasive diagnosis of lung cancer subtypes.</p>","PeriodicalId":73101,"journal":{"name":"Frontiers in radiology","volume":"6 ","pages":"1793604"},"PeriodicalIF":2.3,"publicationDate":"2026-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13121248/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147791091","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Coronary artery calcium scoring in 2026: strengths, limitations, and optimized clinical use.","authors":"Pierre Sabouret, Domenico Mario Giamundo, Julien Rosencher, Stefano Figliozzi","doi":"10.3389/fradi.2026.1822303","DOIUrl":"https://doi.org/10.3389/fradi.2026.1822303","url":null,"abstract":"<p><p>Coronary artery calcium (CAC) scoring on non-contrast ECG-gated CT remains a robust, reproducible marker of total coronary atherosclerotic burden with clear prognostic value and consistent risk reclassification beyond contemporary clinical calculators. Recent studies (2018-2026) reinforce the 'power of zero' for near-term risk de-escalation, identify very high CAC (≥1,000) as a distinct, very-high-risk phenotype, and, importantly, provide randomized evidence that CAC-guided treatment reduces plaque progression. Advances in artificial intelligence (AI), spectral CT, and standardized reporting (SCCT/STR; CAC-DRS) expand opportunities for automated and incidental CAC detection. This mini-review summarizes updated strengths, limitations, and practice guidance; synthesizes new evidence (2024-2026); and includes a practical clinical decision flowchart for the selective use of CAC in prevention pathways.</p>","PeriodicalId":73101,"journal":{"name":"Frontiers in radiology","volume":"6 ","pages":"1822303"},"PeriodicalIF":2.3,"publicationDate":"2026-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13111553/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147791056","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"CT-based subchondral bone microstructural analysis in knee osteoarthritis via MR-guided distillation learning.","authors":"Yuqi Hu, Xiangyu Zhao, Gaowei Qing, Kai Xie, Chenglei Liu, Lichi Zhang","doi":"10.3389/fradi.2026.1798348","DOIUrl":"https://doi.org/10.3389/fradi.2026.1798348","url":null,"abstract":"<p><p>Reliable analysis of subchondral trabecular microstructure is critical for knee osteoarthritis assessment. However, this analysis largely relies on high-resolution MRI acquired using balanced fast field echo (BFFE) sequences, which are rarely included in routine clinical protocols. Clinical CT is widely acquired, yet its limited spatial resolution and soft-tissue contrast makes direct trabecular parameter estimation unreliable. Therefore, it is specifically demanded to enable accurate trabecular microstructural analysis and osteoarthritis diagnosis using routine clinical CT, while also approaching the reliability of MR-based analysis. In this paper, we propose CT-based Subchondral Microstructural Analysis (CT-SMA) method, which utilizes distillation learning technology to transfer high-resolution structural knowledge from MR to CT while enforcing CT-only inference. The core idea of CT-SMA is to transfer microstructural knowledge learned from high-resolution MR to CT through cross-modal knowledge distillation, using a pre-trained MR-based teacher model to supervise CT-based student model on feature maps. To support effective distillation, CT-SMA further introduces a synthesis-based, multi-stage MR-CT registration strategy that establishes patch-level correspondences across modalities, despite substantial differences in resolution, contrast, and appearance. Experiments on a clinical knee imaging cohort demonstrate that CT-SMA substantially improves CT-based trabecular parameter estimation, achieving strong agreement (ICC = 0.742) with MR-derived references across key trabecular biomarkers. Moreover, when aggregated using a Transformer-based model, the regressed CT-derived parameters enable patient-level osteoarthritis diagnosis with an AUC of 0.883, substantially outperforming CT-based prediction without distillation (AUC = 0.778). These results indicate that routine clinical CT can support reliable subchondral bone analysis via proposed CT-SMA, establishing a practical foundation for large-scale studies.</p>","PeriodicalId":73101,"journal":{"name":"Frontiers in radiology","volume":"6 ","pages":"1798348"},"PeriodicalIF":2.3,"publicationDate":"2026-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13106955/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147791122","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Case Report: Embolization of a cognard type V cavernous sinus dural arteriovenous fistula via occluded Inferior petrosal sinus.","authors":"Zhaolong Zhang, Yanan Jiang, Qi Zhang, Liming Shao, Hongzhang Xu, Yixing Xie, Xiaolong Zhao, Chengjian Sun, Rui Xu","doi":"10.3389/fradi.2026.1795775","DOIUrl":"https://doi.org/10.3389/fradi.2026.1795775","url":null,"abstract":"<p><strong>Background: </strong>Cavernous sinus dural arteriovenous fistula (CS-DAVF) with cortical venous drainage to the spinal perimedullary veins (Cognard type V) is a rare clinical entity. The treatment becomes particularly challenging when such a case is complicated by occlusion of the inferior petrosal sinus. We report a rare case of Cognard type V cavernous sinus dural arteriovenous fistula (CS-DAVF) embolized with Onyx via the occluded inferior petrosal sinus (IPS).</p><p><strong>Case description: </strong>A 62-year-old woman presented to our hospital with nausea, vomiting and progressive weakness in both lower limbs. Magnetic resonance imaging (MRI) revealed extensive edema of pons and medulla oblongata with flow voids. Cerebral angiography demenstrated a dural arteriovenous fistula (DAVF) in the left cavernous sinus, supplied by the meningohypophyseal trunk and branches of the middle meningeal artery. The fistula drained into the intercavernous sinus and right cavernous sinus, ultimately draining into the spinal perimedullary veins. Transarterial approach was tried first. Onyx-18 was injected into the branches of middle meningeal artery, partially casting the fistula. However, the DAVF was not completely occluded due to residual supply from the meningohypophyseal trunk. The second operation was performed using transvenous approach. The microcatheter was successfully navigated to the fistulous point via the occluded right IPS and the intercavernous sinus. Left cavernous sinus (CS) and intercavernous sinus were casted using Onyx-18 and the DAVF was completely eliminated.</p><p><strong>Conclusion: </strong>We report a Cognard type V CS-DAVF that was embolized with Onyx through an occluded IPS, demonstrating that this technique is a feasible and effective treatment option.</p>","PeriodicalId":73101,"journal":{"name":"Frontiers in radiology","volume":"6 ","pages":"1795775"},"PeriodicalIF":2.3,"publicationDate":"2026-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13106297/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147791094","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Systematic review of pituitary gland and pituitary adenoma automatic segmentation techniques in magnetic resonance imaging.","authors":"Mubaraq Yakubu, Navodini Wijithilake, Jonathan Shapey, Andrew King, Alexander Hammers","doi":"10.3389/fradi.2026.1737075","DOIUrl":"https://doi.org/10.3389/fradi.2026.1737075","url":null,"abstract":"<p><p>Accurate segmentation of both the pituitary gland and adenomas from magnetic resonance imaging (MRI) is essential for diagnosis and treatment of pituitary adenomas. This systematic review evaluates automatic segmentation methods for improving the accuracy and efficiency of MRI-based segmentation of pituitary adenomas and the gland itself. We analysed 34 studies that employed automatic and semi-automatic segmentation methods out of 353 reviewed studies. We extracted and synthesized data on segmentation techniques and performance metrics (such as Dice overlap scores). The majority of reviewed studies utilized deep learning approaches, with U-Net-based models being the most prevalent. Automatic methods yielded Dice scores of 0%-89% for pituitary gland and 4%-96% for adenoma segmentation. Semi-automatic methods reported 80%-92% for pituitary gland and 75%-88% for adenoma segmentation. Most studies did not report important metrics such as MR field strength, age and adenoma size (macro/micro/giant) or even adenoma type and human subject numbers. Automated segmentation techniques such as U-Net-based models show promise, especially for adenoma segmentation, but further improvements are needed to achieve consistently good performance in small structures like the normal pituitary gland. Future progress will require methodological innovation and larger, more diverse datasets to enhance clinical applicability. <b>Systematic Review Registration:</b> https://www.crd.york.ac.uk/PROSPERO/view/CRD42023407127, PROSPERO CRD42023407127.</p>","PeriodicalId":73101,"journal":{"name":"Frontiers in radiology","volume":"6 ","pages":"1737075"},"PeriodicalIF":2.3,"publicationDate":"2026-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13106132/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147791134","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Persistent vessel wall enhancement and progression of cerebral microbleeds in CADASIL: a case report.","authors":"Wenjuan Xu, Chao Zhang, Xiaomin Liu, Xiaoyu Zhang","doi":"10.3389/fradi.2026.1782068","DOIUrl":"10.3389/fradi.2026.1782068","url":null,"abstract":"<p><p>Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is the most prevalent hereditary cerebral small vessel disease (cSVD), primarily caused by pathogenic variants in the <i>NOTCH3</i> gene. Neuroimaging features, including white matter hyperintensities (WMH), lacunar infarcts, and cerebral microbleeds (CMBs), typically progress with disease advancement. However, the pathophysiological mechanisms underlying this neuroimaging progression remain poorly understood. Here we present a patient with a <i>NOTCH3</i> mutation who exhibited persistent vessel wall enhancement on serial high-resolution vessel wall MRI (VWMRI), alongside progression of CMBs. This finding supports a critical role of blood-brain barrier (BBB) disruption in CADASIL pathophysiology. In conclusion, persistent intracranial vessel wall enhancement may be observed in patients with CADASIL. Further studies are needed to investigate the relationship between this imaging biomarker and clinical as well as neuroimaging outcomes.</p>","PeriodicalId":73101,"journal":{"name":"Frontiers in radiology","volume":"6 ","pages":"1782068"},"PeriodicalIF":2.3,"publicationDate":"2026-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13083007/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147724929","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prophylactic transarterial embolization after endoscopic hemostasis in patients with non-variceal upper gastrointestinal bleeding - is it time to act?","authors":"Francesco Tiralongo, Roberto Minici, Makoto Taninokuchi Tomassoni, Corrado Ini', Davide Giuseppe Castiglione, Francesco Vacirca, Cristina Mosconi, Stefania Tamburrini, Giuseppe Messina, Emanuele David, Pietro Valerio Foti, Stefano Palmucci, Antonio Basile","doi":"10.3389/fradi.2026.1719448","DOIUrl":"10.3389/fradi.2026.1719448","url":null,"abstract":"<p><strong>Background: </strong>Non-variceal upper gastrointestinal bleeding (NVUGIB) continues to present a significant clinical burden due to rebleeding after apparently successful endoscopic hemostasis, particularly in ulcers overlying large-caliber arterial territories. Prophylactic transarterial embolization (pTAE) has been proposed as a strategy to prevent rebleeding in high-risk patients. This mini-review evaluates the evidence for pTAE after successful endoscopic control in NVUGIB, focusing on patient selection, technical approaches, outcomes, and complications.</p><p><strong>Methods: </strong>A literature search of PubMed and Scopus (January 2010-September 2025) was conducted, yielding 10 studies (two randomized trials, three prospective, and five retrospective) evaluating pTAE. Only studies addressing prophylactic, not empiric, embolization were included.</p><p><strong>Results: </strong>Evidence suggests that pTAE is technically feasible and generally safe when guided by ulcer location, size (≥15-20 mm), Rockall score (≥5), and arterial territory (GDA or LGA). While randomized trials did not show overall superiority in intention-to-treat analyses, per-protocol data and observational studies suggest reduced rebleeding and a lower need for surgical rescue in well-selected patients. Complications are infrequent when standardized techniques and early timing (≤24 h) are applied.</p><p><strong>Conclusion: </strong>Routine pTAE is not supported by current guidelines or RCT-level evidence. However, in anatomically and clinically high-risk ulcers, pTAE may offer meaningful benefits. Further multicenter randomized trials with uniform protocols are warranted to clarify its role and optimize patient selection.</p>","PeriodicalId":73101,"journal":{"name":"Frontiers in radiology","volume":"6 ","pages":"1719448"},"PeriodicalIF":2.3,"publicationDate":"2026-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13083153/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147724868","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}