British Journal of Radiology最新文献

{"title":"Impact of deep inspiration breath-hold and fractionation on immune system exposure in breast radiotherapy.","authors":"Pierre Loap, Jeremi Vu-Bezin, Ludovic De Marzi, Youlia Kirova","doi":"10.1093/bjr/tqaf113","DOIUrl":"10.1093/bjr/tqaf113","url":null,"abstract":"<p><strong>Objective: </strong>The immune system has been recognized as an organ-at-risk in oesophageal and lung cancers. The potential impact of deep inspiration breath-hold (DIBH) and fractionation on immune system preservation in breast radiation therapy is presently unknown. The aim of this study was to assess the magnitude of the benefit of DIBH and hypofractionation on immune system exposure in adjuvant irradiation of right breast cancers.</p><p><strong>Methods: </strong>Ten consecutive patients treated volumetric-modulated arc therapy (VMAT) with DIBH for adjuvant locoregional irradiation of the right breast where included. The effective dose to the immune system (EDIC) was calculated for each patient (the absolute contribution of the lungs, heart, liver and total integral dose to the EDIC was evaluated) based on normo-fractionated and hypofractionated regimens, with or without DIBH.</p><p><strong>Results: </strong>EDIC was significantly lower in DIBH than in free breathing, both in standard fractionation (2.81 Gy [range: 2.44; 3.38] vs 3.1 Gy [2.63; 3.94], P < . 01) and hypofractionation (2.15 Gy [1.87; 2.58] vs 2.35 Gy [2.02; 2.96], P < .01), corresponding to a relative EDIC reduction of approximately 10% with DIBH. EDIC was lower with hypofractionation with free breathing than with conventional fractionation with DIBH (P < .01).</p><p><strong>Conclusion: </strong>DIBH significantly reduces the dose to the immune system by 10% in cases of locoregional irradiation of right breast cancers, and moderate hypofractionation results in an EDIC gain compared with any standard fractionation treatment. Pending formal demonstration of a relationship between dose to the immune system and survival, as is the case in other localizations, we suggest as a precaution the use of DIBH combined with hypofractionated treatment in cases where immune sparing seems most important, such as breast cancers with a poor response after preoperative immunotherapy.</p><p><strong>Advances in knowledge: </strong>DIBH significantly reduces the dose to the immune system by 10% in cases of locoregional irradiation of right breast cancers, and moderate hypofractionation results in an EDIC gain compared with any standard fractionation treatment. Pending formal demonstration of a relationship between dose to the immune system and survival, as is the case in other localizations, we suggest as a precaution the use of DIBH combined with hypofractionated treatment in cases where immune sparing seems most important, such as breast cancers with a poor response after preoperative immunotherapy.</p>","PeriodicalId":9306,"journal":{"name":"British Journal of Radiology","volume":" ","pages":"1390-1393"},"PeriodicalIF":3.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144149526","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pneumonitis after chemoradiation followed by durvalumab for locally advanced lung cancer: predictors and effect on survival.","authors":"Sarit Appel, Lee Wilk, Akram Saad, Damien Urban, Hadas Sorotsky, Guy Kalmanovitz, Amir Onn, Ori Haisraeli, Edith M Marom, Yaacov R Lawrence, Jeffery Goldstein, Jair Bar","doi":"10.1093/bjr/tqaf133","DOIUrl":"10.1093/bjr/tqaf133","url":null,"abstract":"<p><strong>Introduction: </strong>We hypothesized that pneumonitis during Pacific protocol (PDP) contributes to poor outcomes in patients with locally advanced non-small cell lung cancer (LANSCLC) treated with chemoradiation (ChRT) and durvalumab.</p><p><strong>Methods: </strong>We analysed cases with LANSCLC extracted from a single academic institution database to identify patient, tumour, and treatment characteristics predicting for development of PDP and its effect on oncologic outcomes.</p><p><strong>Results: </strong>Our database review identified 119 patients with LANSCLC that were treated with ChRT and durvalumab. Sixty-five percent were male and had a mean age of 66 years (SD 8); 58% stage IIB-IIIA, and 51% adenocarcinoma. PDP occurred in 35 (29.4%) cases, at a mean 2.6 months from durvalumab initiation (range 0.3-11 months), and was mostly low grade: G1-12, G2-18, G3-3, G4-1, G5-1. PDP resulted in treatment interruption in 24 cases (20%) with treatment discontinuation in 17 cases (14.3%). Multivariate analysis (MVA) showed all-grades PDP correlated with tumour stage, ipsilateral lung V5 ≥ 70%, and mean heart dose (MHD) ≥ 6 Gy. Grades 2-5 PDP correlated with total lungs V20 ≥ 27% and MHD ≥ 6 Gy. PDP did not correlate with a history of prior radiation pneumonitis (RP) (9/119). PDP was associated with decreased 3-year local control (LC) and progression-free survival (PFS); LC 53% vs 75.5% (HR 2.15, P = 0.031); PFS 35.5% vs 56.5% (HR 1.8, P = 0.04); and a trend for shorter overall survival (OS; 66% vs 77.5%, HR 1.5, P = 0.27).</p><p><strong>Conclusion: </strong>PDP correlated with ipsilateral lung V5 ≥ 70%, lungs V20 ≥ 27% and MHD ≥ 6 Gy. PDP was associated with inferior LC and PFS and trended for shorter OS.</p><p><strong>Advances in knowledge: </strong>PDP occurred in a third of patients resulting in treatment discontinuation in 14.3%. PDP grades 2-5 correlated with radiation dose to lungs V20 ≥ 27% and MHD ≥ 6 Gy. PDP was associated with inferior LC and PFS and trended for shorter OS.</p>","PeriodicalId":9306,"journal":{"name":"British Journal of Radiology","volume":" ","pages":"1436-1445"},"PeriodicalIF":3.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144511599","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Optimizing lymph node metastasis imaging in MR-guided radiotherapy for oligometastatic prostate cancer.","authors":"Darren M C Poon, Jing Yuan, Minsong Cao, Yingli Yang, Cindy Xue, John P Christodouleas","doi":"10.1093/bjr/tqaf142","DOIUrl":"10.1093/bjr/tqaf142","url":null,"abstract":"<p><p>MR-guided radiotherapy (MRgRT) using MRI integrated linear accelerator (MR-LINAC) is a critical advancement in prostate cancer (PC) treatment. Leveraging the superior soft tissue contrast of MR imaging (MRI), along with online adaptation capabilities and real-time MRI for advanced motion management, MRgRT has demonstrated efficacy in localized PC irradiation. Recent studies have demonstrated that MRgRT can effectively treat individual lymph node metastasis (LNM), with preliminary results showing excellent patient tolerability and safety as a novel metastasis-directed radiotherapy for oligometastatic PC (omPC). However, current LNM imaging on an MR-LINAC is limited and suboptimal, creating reliance on diagnostic MRI and positron emission tomography (PET) for differentiation, registration, contouring, and adaptation. The inherent uncertainty and errors within these processes impair the accuracy and precision of LNM irradiation in MRgRT. This review aims to provide an overview of the current imaging techniques employed in clinical MRgRT practice for omPC, highlighting the unmet clinical needs due to the limitations of LNM imaging using an MR-LINAC. Furthermore, it reviews promising advanced LNM MRI techniques potentially transferable to MR-LINAC. Lastly, it discusses future developments in LNM imaging on an MR-LINAC and its potential as a comprehensive one-stop imaging solution for future omPC MRgRT.</p>","PeriodicalId":9306,"journal":{"name":"British Journal of Radiology","volume":" ","pages":"1356-1368"},"PeriodicalIF":3.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144526505","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reference values and postural effects on pulmonary perfusion in dynamic chest radiography.","authors":"Noriko Mizoguchi, Yuzo Yamasaki, Daisuke Nishigake, Hiroshi Hamasaki, Koji Sagiyama, Hideki Yoshikawa, Toyoyuki Kato, Kousei Ishigami","doi":"10.1093/bjr/tqaf165","DOIUrl":"10.1093/bjr/tqaf165","url":null,"abstract":"<p><strong>Objectives: </strong>Dynamic chest radiography (DCR) is a novel non-invasive radiographic technique that measures pulmonary perfusion. A semi-quantitative assessment of perfusion distribution has recently been proposed to enhance its clinical utility. This study aimed to establish reference values of pulmonary perfusion distribution and its alterations due to postural changes.</p><p><strong>Methods: </strong>Forty-five healthy volunteers (24 males, 21 females) underwent DCR. Lungs were divided into 6 areas (upper, middle, and lower for both), and the percentage of lung perfusion was calculated for each area in the standing and supine positions.</p><p><strong>Results: </strong>Significant differences were observed in the pulmonary perfusion measurements between the standing position (right upper: 13.9 ± 1.9%, right middle: 30.6 ± 2.3%, right lower: 12.5 ± 2.1%, left upper: 14.2 ± 2.0%, left middle: 22.0 ± 2.8%, left lower: 6.8 ± 2.1%) and supine position (right upper: 15.7 ± 1.7%, right middle: 29.6 ± 3.1%, right lower: 11.5 ± 2.3%, left upper: 17.3 ± 2.7%, left middle: 20.6 ± 3.3%, left lower: 5.3 ± 1.6%). In particular, perfusion shifted to the upper lungs when measurements were taken from the standing to the supine position (P < 0.001).</p><p><strong>Conclusions: </strong>Reference values for pulmonary perfusion distribution on DCR in the standing and supine positions were established, demonstrating significant changes in distribution between the two.</p><p><strong>Advances in knowledge: </strong>The established normal distribution on DCR will aid in the identification of subtle changes or abnormal perfusion shifts.</p>","PeriodicalId":9306,"journal":{"name":"British Journal of Radiology","volume":" ","pages":"1511-1515"},"PeriodicalIF":3.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144688925","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A survey of UK standards of radiation protection amongst orthopaedic surgeons.","authors":"George Ninkovic-Hall, Anna Chapman, Athanasios Saratzis, Raghu Lakshminarayan, Dan Carradice, Kaji Sritharan","doi":"10.1093/bjr/tqaf162","DOIUrl":"10.1093/bjr/tqaf162","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate training in radiation protection, awareness of local policies, and current practices regarding safe working with ionizing radiation among UK orthopaedic surgeons.</p><p><strong>Methods: </strong>A 37-question online survey was distributed to UK orthopaedic resident doctors and consultants through social media platforms. The survey assessed demographics, use of radiation-guided procedures, training, knowledge of safety policies, access to and use of personal protective equipment (PPE), and monitoring of radiation exposure. Data were analysed using Stata software and Pearson's Chi-squared test.</p><p><strong>Results: </strong>Twenty-eight consultants and 79 resident doctors responded, comprising 0.4% and 5.3% of the orthopaedic workforce, respectively. Consultants were more likely to have completed formal radiation safety training (93% vs 38%; P < .001) and were more aware of local safety policies (56% vs 9%; P < .001). Access to dosimeters was limited (32% of consultants vs 6% of resident doctors; P < .005), with few receiving exposure feedback (20% of consultants vs 3% of resident doctors; P < .005). Awareness and application of the \"as low as reasonably achievable\" principles were poor, with 33% of resident doctors unfamiliar compared to 4% of consultants (P < .005). PPE use was inconsistent; 64% of consultants and 41% of resident doctors never used radiation protection glasses, and only 12% of consultants and 1.4% of resident doctors had custom-fitted lead aprons (P < .05).</p><p><strong>Conclusion: </strong>This study underscores deficiencies in radiation protection for UK orthopaedic surgeons, particularly resident doctors, highlighting the urgent need for mandatory radiation safety training, improved PPE provision, and monitoring of radiation exposure with regular exposure feedback.</p><p><strong>Advances in knowledge: </strong>This survey identifies deficiencies in radiation safety training and PPE access among UK orthopaedic surgeons, particularly resident doctors. It highlights the lack of substantial improvements since previous studies, underlining the need for high level systemic changes. The survey advocates for mandatory radiation safety training, consistent monitoring of radiation exposure, and the desire for the establishment of a national registry to record an individual's annual exposure to radiation.</p>","PeriodicalId":9306,"journal":{"name":"British Journal of Radiology","volume":" ","pages":"1504-1510"},"PeriodicalIF":3.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12377465/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144641864","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Consequences of Deep Learning Image Reconstruction at CT.","authors":"Meghan G Lubner, Perry J Pickhardt, Giuseppe V Toia, Timothy P Szczykutowicz","doi":"10.1093/bjr/tqaf152","DOIUrl":"https://doi.org/10.1093/bjr/tqaf152","url":null,"abstract":"<p><p>Deep learning reconstruction (DLR) offers a variety of advantages over the current standard iterative reconstruction techniques, including decreased image noise without changes in noise texture and less susceptibility to spatial resolution limitations at low dose. These advances may allow for more aggressive dose reduction in CT imaging while maintaining image quality and diagnostic accuracy. However, performance of DLRs is impacted by the type of framework and training data used. In addition, the patient size and clinical task being performed may impact the amount of dose reduction that can be reasonably employed. Multiple DLRs are currently FDA approved with a growing body of literature evaluating performance throughout this body; however, continued work is warranted to evaluate a variety of clinical scenarios to fully explore the evolving potential of DLR. Depending on the type and strength of DLR applied, blurring and occasionally other artifacts may be introduced. DLRs also show promise in artifact reduction, particularly metal artifact reduction. This commentary focuses primarily on current DLR data for abdominal applications, current challenges, and future areas of potential exploration.</p>","PeriodicalId":9306,"journal":{"name":"British Journal of Radiology","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144943827","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Not All Tumors Are Alike: Varying Efficacy of FLASH Across Tumor Types and Oxygenation Status in Spheroid Models.","authors":"Rebecka Dela, Liliana Lemos Da Silva, Sarah Beyer, Brita Singers Sørensen, Per Poulsen, Elise Konradsson, Filip Hörberger, Kristoffer Petersson, Crister Ceberg, Gabriel Adrian","doi":"10.1093/bjr/tqaf219","DOIUrl":"https://doi.org/10.1093/bjr/tqaf219","url":null,"abstract":"<p><strong>Objectives: </strong>Ultra-high dose rate irradiation (UHDR) has been shown to spare normal tissue in various model systems. This study evaluates its potential to sterilize cancer cells using spheroid tumor models.</p><p><strong>Methods: </strong>Spheroids from glioblastoma (U87), hypopharyngeal squamous cell carcinoma (two sizes, FaDusmall and FaDularge) and breast adenocarcinoma (T47D) cells were irradiated with electron beams using UHDR (>200Gy/s) or conventional dose rate (CONV,∼0.1 Gy/s) exposures under ambient or reduced oxygen (1%) conditions. U87 and FaDusmall were also irradiated with protons. Spheroids were monitored using imaging for up to 100 days to determine the dose required to cure 50% of spheroids (SCD50). These data were used to calculate dose-modifying factor estimates for UHDR at the 50% survival level (DMFSCD50).</p><p><strong>Results: </strong>A total of 3,230 spheroids were analyzed. Under ambient oxygen tension, UHDR and CONV showed no significant differences in U87 (DMFSCD50=0.98, p = 0.47), FaDusmall (DMFSCD50=1.01, p = 0.75), and T47D (DMFSCD50=1.04, p = 0.25), regardless of electron or proton irradiation. Under reduced oxygen levels, significantly higher UHDR doses were required to sterilize the spheroids, with DMFSCD50 1.14 (U87, p < 0.01), 1.07 (FaDusmall, p = 0.02) and 1.13 (T47D, p < 0.01) . FaDularge-spheroids irradiated under ambient oxygen showed a DMFSCD50 of 1.66 (p < 0.001).</p><p><strong>Conclusion: </strong>Using spheroid tumor models with long follow-up, we demonstrate that efficacy of UHDR varies across cancer types and conditions. Whereas small spheroids exhibit iso-efficacy, both reduced oxygen tension and increased spheroid size lead to higher DMF.</p><p><strong>Advances in knowledge: </strong>This preclinical study suggests that tumor iso-efficacy with UHDR may not hold true for all cancer types and is associated with oxygen level.</p>","PeriodicalId":9306,"journal":{"name":"British Journal of Radiology","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144943799","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Advances in CT technology and clinical applications - Introductory Editorial.","authors":"Cynthia H McCollough, Masahiro Jinzaki, Hatem Alkadhi","doi":"10.1093/bjr/tqaf216","DOIUrl":"https://doi.org/10.1093/bjr/tqaf216","url":null,"abstract":"","PeriodicalId":9306,"journal":{"name":"British Journal of Radiology","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144943841","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Upright MDCT with 320 Detector-Row Gantry: A Technical Innovation Providing Insights into Human Anatomy Under Gravity and Potential Clinical Implications.","authors":"Masahiro Jinzaki, Minoru Yamada, Yoichi Yokoyama, Takehiro Nakahara, Takeo Nagura, Yoko Inamoto, Fumiko Yagi, Orito Ikeda, Mohammed Alshahri, Katsuhiro Mizutani, Yoshitake Yamada","doi":"10.1093/bjr/tqaf196","DOIUrl":"https://doi.org/10.1093/bjr/tqaf196","url":null,"abstract":"<p><p>CT performed in the supine position has been highly effective in diagnosing organic diseases such as cancer, arteriosclerosis, and infections, significantly contributing to increased life expectancy. In an aging society, extending healthy life expectancy becomes more critical, requiring early diagnosis of functional disorders. We have led the industry-academia collaboration in developing an upright MDCT system. Although this system maintains the same physical specifications as conventional MDCT, it differs significantly in imaging configuration-allowing supine, upright, and sitting positions-and offers improved workflow while requiring only two-thirds of the installation space. Unlike conventional MDCT, it allows for the assessment of anatomical changes under gravity. It also enables the objective diagnosis and grading of functional diseases, in which findings were not apparent on conventional CT, and enable the study of the pathogenesis of functional diseases which worsen symptoms in the upright position. Furthermore, it allows for noninvasive evaluation of dynamic functions such as swallowing and voiding, which can only be assessed in standing or sitting positions.</p>","PeriodicalId":9306,"journal":{"name":"British Journal of Radiology","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144943834","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"CT Staging Performance in an International Trial of Neoadjuvant Chemotherapy for locally advanced Colon cancer.","authors":"James R Platt, Faye Elliott, Kelly Handley, Laura Magill, Philip Quirke, Matthew T Seymour, Nicholas P West, Dion Morton, Jenny Seligmann, Damian J M Tolan","doi":"10.1093/bjr/tqaf217","DOIUrl":"https://doi.org/10.1093/bjr/tqaf217","url":null,"abstract":"<p><strong>Objectives: </strong>In FOxTROT, neoadjuvant chemotherapy (NAC) significantly reduced recurrence risk, compared to upfront surgery, in locally advanced colon cancer. This analysis evaluates the correlation between radiological and pathological staging within the trial to support the adoption of CT-based patient selection.</p><p><strong>Methods: </strong>In this pre-planned analysis of prospectively collected data, local radiological and pathological staging were compared in upfront surgery participants. T stage, N stage and extramural venous invasion (EMVI) status were evaluated using overall agreement, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV). Subgroup analyses explored the impact of mismatch repair status and tumour side.</p><p><strong>Results: </strong>354 participants were included. T stage agreement was 63.0%; T3 and T4 tumours were correctly identified in 78.9% and 41.1% of participants, respectively. The PPV for T3-4 status was 94.5%. N stage agreement was 39.8%; for N status (positive vs. negative), overall agreement, sensitivity, specificity, PPV and NPV were 54.1%, 81.1%, 26.0%, 53.2% and 57.1%, respectively. For EMVI, these values were 54.9%, 71.0%, 41.2%, 50.7%, and 62.5%, respectively. Accuracy metrics did not differ significantly by tumour side or mismatch repair status.</p><p><strong>Conclusions: </strong>CT effectively predicted T3-4 status with minimal over-staging, but performed poorly for individual T stage, N stage and EMVI. We propose radiological T3-4 status should be adopted as the primary biomarker for neoadjuvant patient selection, with molecular biomarkers to guide treatment choice.</p><p><strong>Advances in knowledge: </strong>In this multi-centre trial, local radiologists accurately identified T3-4 status to select participants for NAC, indicating utility for future neoadjuvant trials and clinical practice.</p>","PeriodicalId":9306,"journal":{"name":"British Journal of Radiology","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144943860","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}