European Journal of Radiology最新文献_第7页

Diagnostic performance of iodine map for differentiating colorectal cancer from benign colorectal wall thickening 碘图鉴别结直肠癌与良性结肠壁增厚的诊断价值。

IF 3.3 3区医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

European Journal of Radiology

Pub Date : 2026-03-01 Epub Date: 2026-01-31 DOI: 10.1016/j.ejrad.2026.112709

Sonaz Malekzadeh , Ioannis Rotas , Ian Fournier , Philippe Hiroz , Floryn Cherbanyk , Dominic Staudenmann , Roberto Cannella , Lucien Widmer

Objectives

To evaluate the diagnostic performance of iodine density map (IDM) using dual-energy CT (DECT) in differentiating colorectal cancer from benign colorectal wall thickening.

Material and Methods

This IRB-approved dual-center retrospective exploratory study included 71 consecutive patients with colorectal wall thickening due to tumoral or non-tumoral origin, confirmed by colonoscopy and assessed with DECT. Thirty-eight had pathology-proven colorectal adenocarcinoma, and 33 had non-neoplastic thickening (inflammation, physiologic collapse, or post-radiotherapy change). Iodine density values were measured from regions of interest on three consecutive CT slices on portal venous phase, normalized to aortic iodine concentration. Diagnostic performance was determined by ROC analysis, and inter-reader agreement was evaluated with intraclass correlation coefficients (ICC) and limits of agreement (LOA).

Results

Mean IDM value was significantly higher in tumors than in benign thickening (2.31 ± 0.42 vs 1.43 ± 0.24 mg/mL; p < 0.001). Mean normalized iodine density map (NIDM) value was likewise elevated in tumors (0.46 ± 0.10 vs 0.31 ± 0.07; p < 0.001). ROC analysis demonstrated excellent performance for both IDM (AUC 0.98; optimal cutoff 1.72 mg/mL; sensitivity 92.1%, specificity 90.9%, NPV 90.9%) and NIDM (AUC 0.88; cutoff 0.35; sensitivity 92.1%, specificity 69.7%, NPV 88.7%). There was no significant difference between the inflammatory and collapsed-wall subgroups. Inter-reader agreement was excellent (ICC: 0.93 for IDM; 0.92 for NIDM).

Conclusion

IDM and NIDM on DECT provide robust, reproducible markers that differentiate colorectal carcinoma from benign wall thickening with high diagnostic accuracy. These quantitative parameters may improve diagnostic confidence and reduce unnecessary colonoscopies, supporting their integration into colorectal cancer evaluation.

目的：探讨双能CT （DECT）碘密度图（IDM）对结直肠癌与良性结肠壁增厚的鉴别诊断价值。材料和方法：这项经irb批准的双中心回顾性探索性研究纳入了71例连续的因肿瘤或非肿瘤源性结肠壁增厚的患者，经结肠镜检查证实并经DECT评估。38例病理证实为结直肠癌，33例为非肿瘤性增厚（炎症、生理性塌陷或放疗后改变）。在门静脉期连续三次CT切片感兴趣的区域测量碘密度值，归一化为主动脉碘浓度。通过ROC分析确定诊断效能，并用类内相关系数（ICC）和一致限（LOA）评估读者间一致性。结果：肿瘤的平均IDM值明显高于良性壁增厚的平均值（2.31±0.42 vs 1.43±0.24 mg/mL）；结论：DECT上的IDM和NIDM为区分结直肠癌和良性壁增厚提供了可靠的、可重复的标记，诊断准确率高。这些定量参数可以提高诊断的可信度，减少不必要的结肠镜检查，支持将其纳入结直肠癌评估。

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引用次数: 0

Clinical-Radiomics hybrid prediction of the Risks of pedicle screw loosening after posterior lumbar fusion 临床-放射组学混合预测后路腰椎融合术后椎弓根螺钉松动的风险。

IF 3.3 3区医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

European Journal of Radiology

Pub Date : 2026-03-01 Epub Date: 2026-02-05 DOI: 10.1016/j.ejrad.2026.112718

Weitao Han , Songbo Gao , Shun Han , Xiaolin Zhong , Penghui Zhang , Yuliang Wu , Haotian Tian , Fuxin Wei , Shifeng Wen , Shen Zhao , Wei Ye

Objective

We aimed to construct a risk prediction model for PSL after posterior lumbar fusion using machine learning and radiomic methods.

Summary Of Background Information

Posterior lumbar fusion surgery is a routine procedure for the treatment of lumbar degenerative disease (LDD). Pedicle screw loosening (PSL) is a common complication after posterior lumbar fusion that can lead to postoperative pain and infection in the implant area.

Methods

A total of 304 patients who underwent posterior lumbar fusion for LDD at Sun Yat-sen Memorial Hospital were reviewed in this study. 80 patients at the Seventh Affiliated Hospital of SYSU and Guangzhou First People’s Hospital made up the external validation datasets. Preoperative demographic and surgical information was collected. One-year-postoperative radiological follow-up was conducted, and patients were divided into PSL and non-PSL groups. Clinical and surgical information was subjected to Student’s t test for feature selection. Lumbar CT images were analyzed using radiomic methods, and PSL prediction models were constructed by machine learning methods. The best model was selected and externally validated on the data from the two other hospitals.

Results

All 304 patients were included. Age (p＜0.001), Preoperative lumbar lordosis (LL) (p = 0.006), mean CT Hounsfield units (p = 0.007), and number of fixed segments (p < 0.001) differed between the two groups. Logistic regression revealed that the number of fixed segments was an independent risk factor (OR = 2.147, p < 0.001). Radiomic features were selected after feature extraction and selection. After model training and testing, the clinical + radiomic model showed acceptable predictive performance (AUC 0.894). Its AUCs in the two external validation datasets were 0.821 and 0.892 respectively.

Conclusion

Combining clinical and radiomic features can better predict the risk of PSL after posterior lumbar fusion surgery. This investigation revalidated the risk factors for PSL after posterior lumbar fusion as well.

目的：利用机器学习和放射学方法建立后路腰椎融合术后PSL的风险预测模型。背景资料概述：后路腰椎融合手术是治疗腰椎退行性疾病（LDD）的常规手术。椎弓根螺钉松动（PSL）是后路腰椎融合术后常见的并发症，可导致术后疼痛和植入区感染。方法：对在中山纪念医院行后路腰椎融合术治疗LDD的304例患者进行回顾性分析。外部验证数据集由中山大学附属第七医院和广州市第一人民医院的80例患者组成。收集术前人口统计学和手术信息。术后1年影像学随访，将患者分为PSL组和非PSL组。临床和手术信息采用学生t检验进行特征选择。采用放射学方法对腰椎CT图像进行分析，并采用机器学习方法构建PSL预测模型。选择最佳模型，并在其他两家医院的数据上进行外部验证。结果：304例患者全部纳入。年龄（p<0.001）、术前腰椎前凸（LL）（p = 0.006）、CT平均Hounsfield单位（p = 0.007）、固定节段数(p)结论：结合临床和放射学特征可以更好地预测后路腰椎融合术后PSL的发生风险。这项研究也再次验证了后路腰椎融合术后发生PSL的危险因素。

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引用次数: 0

Evaluation of Age-Related compositional changes in the infrapatellar fat pad using MRI-Derived PDFF and T2* at 1.5 T 利用mri衍生PDFF和1.5 T时T2*评估髌下脂肪垫年龄相关成分变化。

IF 3.3 3区医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

European Journal of Radiology

Pub Date : 2026-03-01 Epub Date: 2026-01-01 DOI: 10.1016/j.ejrad.2025.112632

Kecheng Yuan , Qingyun Liu , Weijie Zheng , Xiaoqiong Tang , Chuang Zhang , Jiantai Zhou , Penghui Luo , Fulang Qi , Lin Chen , Bensheng Qiu

Purpose

To investigate age-related compositional changes in the infrapatellar fat pad (IFP) using chemical shift-encoded MRI-derived proton density fat fraction (PDFF) and T₂* at 1.5 T, and to evaluate their associations with clinical symptoms and structural abnormalities.

Methods

A cross-sectional study was performed in 100 adults (mean age: 44 ± 14 years; 54 men, 46 women) who underwent 1.5 T MRI using a six-echo spoiled gradient-echo sequence for quantitative assessment of PDFF and T₂* in the IFP. Clinical symptoms were assessed using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and structural abnormalities were evaluated using the Whole-Organ Magnetic Resonance Imaging Score (WORMS). Spearman correlation and mediation analyses were performed.

Results

Age showed a strong negative correlation with IFP PDFF (r = − 0.46, p < 0.001) and a moderate inverse association with T₂* (r = − 0.30, p = 0.003). Lower PDFF was associated with worse WOMAC pain (r = − 0.33, p = 0.001) and WORMS scores (r = − 0.41, p < 0.001). The mediation analysis revealed a significant indirect pathway linking age to both pain (ACME = 0.19, 95 % CI: 0.02–0.38) and WORMS scores (ACME = 0.24, 95 % CI: 0.06–0.45) through PDFF. In contrast, the indirect pathway through T₂* was weaker and less precise (ACME = 0.12, 95 % CI: 0.01–0.28).

Conclusions

PDFF and T₂* reflect age-related compositional and microstructural changes in the IFP, with PDFF demonstrating stronger associations with clinical symptoms and joint degeneration. These findings indicate PDFF as a superior imaging biomarker for early detection, monitoring, and potential therapeutic targeting in age-related musculoskeletal degeneration.

目的：利用化学位移编码mri衍生质子密度脂肪分数（PDFF）和T2*在1.5 T时研究年龄相关的髌下脂肪垫（IFP）组成变化，并评估其与临床症状和结构异常的关系。方法：对100名成年人（平均年龄：44±14岁；男性54名，女性46名）进行横断面研究，这些成年人接受1.5 T MRI检查，使用六回波破坏梯度回波序列定量评估IFP中的PDFF和T2*。临床症状采用西安大略和麦克马斯特大学骨关节炎指数（WOMAC）进行评估，结构异常采用全器官磁共振成像评分（WORMS）进行评估。进行Spearman相关分析和中介分析。结果：年龄与IFP PDFF呈显著负相关(r = - 0.46, p 2* (r = - 0.30, p = 0.003)。较低的PDFF与较差的WOMAC疼痛（r = - 0.33, p = 0.001）和WORMS评分(r = - 0.41， p 2*较弱且较不精确（ACME = 0.12, 95% CI: 0.01-0.28）相关。结论：PDFF和T2*反映了IFP中与年龄相关的组成和微观结构变化，其中PDFF与临床症状和关节退变有更强的相关性。这些发现表明PDFF是一种优越的成像生物标志物，可用于年龄相关性肌肉骨骼变性的早期检测、监测和潜在的治疗靶点。

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引用次数: 0

Economic evaluation of bulk packaging and single-dose packaging of contrast media for contrast-enhanced CT 增强CT造影剂散装包装和单剂量包装的经济评价

IF 3.3 3区医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

European Journal of Radiology

Pub Date : 2026-03-01 Epub Date: 2026-01-10 DOI: 10.1016/j.ejrad.2026.112665

Jie Jia , Yuxin Peng , Zhixu Zhu , Dunming Xiao , Yingyao Chen , Yan Wei

Objective

To conduct an economic evaluation of bulk-packaged contrast media in the CT rooms from multiple perspectives, assess its economic benefits, and provide a evidence to support hospital cost control and pharmacy management.

Methods

Based on on-site investigations and the database constructed by the hospital management information system, information from 1,169 patients regarding contrast media utilization and medical insurance reimbursements was analyzed. We assessed the impact of different contrast media packaging formats on the hospital’s scanning volume and waste disposal costs using descriptive statistical methods and a decision-tree mode. In addition, cost-minimization analysis was conducted for the economic evaluation.

Results

Based on the average number of scans per hospital (49,807 per year), the 500 ml (400 mg/ml) vial saved an average of 29.60 s per patient compared with the 100 ml (400 mg/ml) vial, resulting in an annual increase of 3,890 patients scanned and potentially generating additional hospital revenue of approximately US$424,163, assuming sufficient appointment availability and operational capacity. In addition, the 500 ml (400 mg/ml) vial reduced medical insurance expenditures by US$1,701,280 to US$1,804,260 annually per hospital (a reduction of 52.19%–55.38%). The switch to bulk packaging also reduced medical waste by an average of 3,832 kg per year, corresponding to savings of US$1,904 in waste disposal costs. Qualitative interview indicated that imaging bulk-packaged contrast media can simultaneously reduce hospital costs and maintain patient safety under current technological conditions.

Conclusion

The use of bulk-packaged contrast media in contrast-enhanced CT was shown to be more effective in controlling hospital costs compared with single-dose packaging.

目的从多个角度对CT室散装包装造影剂进行经济评价，评价其经济效益，为医院成本控制和药房管理提供依据。方法通过现场调查和医院管理信息系统建立的数据库，对1169例患者的造影剂使用情况和医保报销情况进行分析。我们使用描述性统计方法和决策树模型评估了不同造影剂包装格式对医院扫描量和废物处理成本的影响。并进行了成本最小化分析，进行了经济性评价。结果：根据每家医院的平均扫描次数（每年49,807次），500毫升（400毫克/毫升）小瓶比100毫升（400毫克/毫升）小瓶平均每位患者节省29.60秒，导致每年增加3,890名扫描患者，并可能产生约424,163美元的额外医院收入，假设有足够的预约可用性和运营能力。此外，500毫升（400毫克/毫升）小瓶使每家医院每年的医疗保险支出减少1 701 280至1 804 260美元（减少52.19%-55.38%）。改用散装包装还使医疗废物平均每年减少3 832公斤，相当于节省1 904美元的废物处理费用。定性访谈表明，在目前的技术条件下，成像散装包装造影剂可以同时降低医院成本和维护患者安全。结论在增强CT中使用散装包装造影剂比单剂量包装更能有效控制医院费用。

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引用次数: 0

A comprehensive quantitative and qualitative assessment of TGSE-BLADE DWI in postoperative imaging following intracranial tumor resection TGSE-BLADE DWI在颅内肿瘤切除术后影像学中的综合定量和定性评价

IF 3.3 3区医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

European Journal of Radiology

Pub Date : 2026-03-01 Epub Date: 2026-01-07 DOI: 10.1016/j.ejrad.2026.112659

Christer Ruff , Till-Karsten Hauser , Paula Bombach , Daniel Vogl , Constantin Roder , Frank Paulsen , Deborah Staber , Vivien Richter , Leonie Zerweck , Ulrike Ernemann , Georg Gohla

Purpose

Postoperative MRI plays a pivotal role in assessing residual disease and planning therapy after intracranial tumor resection. As acute perioperative infarction may mimic enhancing and non-enhancing tumor tissue in follow-up imaging, the initial postoperative MRI examination is essential for this purpose. However, conventional DWI techniques like RESOLVE are often impaired by artifacts from intracranial air. This study compares RESOLVE DWI with TGSE-BLADE DWI within early postoperative scans to improve diagnostic confidence in identifying ischemic changes.

Method

In a retrospective, institutional review board–approved study, 33 patients (mean age 52.3 ± 25.1 years) underwent a 1.5-Tesla MRI within 48 h of resection. RESOLVE and TGSE-BLADE DWI sequences were acquired in the same orientation and slice thickness of 5 mm. Two neuroradiologists blindly evaluated geometric distortion, susceptibility artifacts, overall image quality, and diagnostic confidence. Quantitative analysis included measuring signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), apparent diffusion coefficient (ADC) values, image quality metrics and resection defect dimensions against T1-weighted images.

Results

TGSE-BLADE DWI exhibited significantly reduced geometric distortions and susceptibility artifacts near the resection site compared with RESOLVE DWI, producing superior qualitative image quality and diagnostic confidence (p < 0.001). Conversely, RESOLVE DWI yielded slightly higher SNR and CNR. Measurements of the resection defect on TGSE-BLADE DWI closely matched those on T1-weighted images (p = 0.974), while RESOLVE DWI showed a significant discrepancy (p < 0.001).

Conclusions

TGSE-BLADE DWI significantly minimizes artifacts and geometric distortions in intracranial postoperative imaging, thereby improving the detection of perioperative ischemic changes. This robust technique serves as an effective alternative to conventional EPI-based sequences in challenging settings with pronounced B₀ inhomogeneities, ultimately enhancing diagnostic confidence and patient care.

目的术后MRI在颅内肿瘤切除术后残留病变评估和治疗规划中发挥关键作用。由于急性围手术期梗死可能在随访成像中模拟增强和非增强肿瘤组织，因此术后初始MRI检查至关重要。然而，像RESOLVE这样的传统DWI技术经常受到颅内空气伪影的损害。本研究比较了术后早期扫描中的RESOLVE DWI和TGSE-BLADE DWI，以提高诊断缺血性改变的信心。方法在一项回顾性研究中，33例患者（平均年龄52.3±25.1岁）在切除后48小时内接受了1.5特斯拉MRI检查。在相同的方向和5 mm的切片厚度下获得RESOLVE和TGSE-BLADE DWI序列。两名神经放射学家盲目地评估几何畸变、敏感性伪影、整体图像质量和诊断信心。定量分析包括测量信噪比（SNR）、噪比（CNR）、表观扩散系数（ADC）值、图像质量指标和针对t1加权图像的切除缺陷尺寸。结果与RESOLVE DWI相比，stgse - blade DWI在切除部位附近的几何畸变和敏感性伪影明显减少，产生了更好的定性图像质量和诊断置信度（p < 0.001）。相反，RESOLVE DWI产生略高的信噪比和信噪比。TGSE-BLADE DWI上切除缺损的测量结果与t1加权图像非常吻合（p = 0.974），而RESOLVE DWI显示显著差异（p < 0.001）。结论stgse - blade DWI可明显减少术后颅内图像的伪影和几何畸变，提高围手术期缺血性改变的检测水平。这种强大的技术可以作为传统epi序列的有效替代方案，在具有明显B0不均匀性的具有挑战性的环境中，最终提高诊断信心和患者护理。

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引用次数: 0

Impact of DSA-based postoperative cerebral blood flow cascades on outcomes in acute ischemic stroke patients undergoing successful endovascular thrombectomy 基于dsa的术后脑血流级联对成功进行血管内血栓切除术的急性缺血性卒中患者预后的影响

IF 3.3 3区医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

European Journal of Radiology

Pub Date : 2026-03-01 Epub Date: 2026-01-11 DOI: 10.1016/j.ejrad.2026.112664

Jin Liu , Chen Gong , Yuetao Wen , Jing Guo , Junling Fu , You Wang , Jinxian Yuan , Tao Xu , Lina Zhang , Shuyu Jiang

Background

Half of patients with acute ischemic stroke caused by large vessel occlusion (AIS-LVO) fail to achieve functional independence after endovascular treatment (EVT), which may be related to the ineffective restoration of cerebral blood flow in ischemic brain tissue despite revascularization. Therefore, a comprehensive model to assess postoperative cerebral blood flow cascade (pCBF) may provide additional information for treatment.

Methods

This was a retrospective cohort study. All patients underwent standard cerebral angiography immediately after EVT. pCBF consisted of expanded Thrombolysis in Cerebral Infarction, microvascular cerebral circulation time, and Cortical Vein Opacification Score based on immediate DSA images after EVT. The primary outcome was functional independence at 90 days, defined as an mRS score of 0–2.

Results

156 patients were enrolled in this study after strict screening. In multivariate regression analysis, compared with the unfavorable pCBF group, the favorable pCBF group had a higher rate of functional independence at 90 days (82.1 % vs 26.0 %, aOR 12.94, 95 % CI 5.28–31.73, P < 0.001). In addition, the pCBF demonstrated good discrimination and calibration in this cohort, as well as the fivefold cross-validation.

Conclusion

Favorable pCBF may better reflect true reperfusion in AIS-LVO patients after achieving successful recanalization and was associated with functional outcomes.

背景大血管闭塞（AIS-LVO）所致急性缺血性脑卒中患者中，有一半患者在血管内治疗（EVT）后未能实现功能独立，这可能与尽管进行了血运重建，但缺血脑组织的脑血流未能恢复有关。因此，一个综合的模型来评估术后脑血流级联（pCBF）可能为治疗提供额外的信息。方法回顾性队列研究。所有患者在EVT后立即接受标准脑血管造影。pCBF包括脑梗死扩大溶栓、微血管脑循环时间、EVT后即刻DSA图像皮质静脉混浊评分。主要终点是90天的功能独立性，定义为mRS评分0-2。结果156例患者经严格筛选入组。多因素回归分析显示，与不良pCBF组相比，不良pCBF组90天功能独立率更高（82.1% vs 26.0%, aOR 12.94, 95% CI 5.28-31.73, P < 0.001）。此外，pCBF在该队列中表现出良好的判别和校准，以及五倍交叉验证。结论良好的pCBF能更好地反映AIS-LVO患者再通成功后的真实再灌注情况，并与功能预后相关。

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引用次数: 0

Shap-interpretable predictive modeling of microvascular invasion and early recurrence in hepatocellular carcinoma using MRI habitat imaging combined with clinical features 利用MRI栖息地成像结合临床特征对肝细胞癌微血管侵袭和早期复发进行形状可解释的预测建模。

IF 3.3 3区医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

European Journal of Radiology

Pub Date : 2026-03-01 Epub Date: 2026-01-11 DOI: 10.1016/j.ejrad.2026.112667

Hongmei Yu , Min Chen , Depeng Kong , Xiang Qiu , Jingang Yang , Fa Wu , Yi Huang , Rui Jiang

Objective

To develop and validate an integrated model combining Gd-EOB-DTPA–enhanced MRI habitat imaging with clinical features for preoperative prediction of microvascular invasion (MVI) and early recurrence in hepatocellular carcinoma (HCC).

Methods

This retrospective study enrolled 230 pathologically confirmed HCC patients, classified as MVI-positive or −negative. Radiomics features were extracted from the total tumor volume and a 3-mm peritumoral region. Tumor regions were segmented into three spatial habitats via K-means clustering, and habitat-specific features were obtained. Key features were selected using least absolute shrinkage and selection operator (LASSO) regression. Seven machine learning algorithms were trained; the intratumoral heterogeneity (ITH) score model showed optimal performance. Four models were developed: Clinical, Peritumoral Radiomics, ITH Score, and Combined (ITH + Peritumoral Radiomics + Clinical). Performance was assessed with ROC analysis, calibration, decision curve analysis (DCA), and SHapley Additive exPlanations (SHAP). A prognostic model was developed using the DeepSurv network to assess early recurrence-free survival (RFS) following HCC resection, with Kaplan-Meier curves plotted for evaluation.

Results

Extreme Gradient Boosting (XGBoost) achieved the best performance for ITH and traditional radiomics models. The ITH score model outperformed the Peritumoral Radiomics model. The Combined model achieved the highest performance on the training set (AUC: 0.925; sensitivity: 0.926; specificity: 0.785; accuracy: 0.863; F1-score: 0.882). Calibration and DCA confirmed reliability and clinical benefit. SHAP analysis clarified feature contributions.The HCC prognostic model-defined MVI-High risk patients, who exhibited significantly different risk scores, also had a significantly poorer early RFS per Kaplan-Meier analysis (P < 0.001).

Conclusion

The integrated MRI habitat–clinical model outperformed standalone approaches, showing promise for individualized surgical planning and recurrence risk stratification in HCC.

目的：建立并验证gd - eob - dtpa增强MRI栖息地成像与临床特征相结合的肝细胞癌（HCC）微血管侵袭（MVI）及早期复发术前预测模型。方法：本回顾性研究纳入230例病理证实的HCC患者，分为mvi阳性或阴性。从肿瘤总体积和肿瘤周围3mm区域提取放射组学特征。通过K-means聚类方法将肿瘤区域划分为3个空间生境，得到肿瘤的生境特异性特征。使用最小绝对收缩和选择算子（LASSO）回归选择关键特征。训练了7种机器学习算法；肿瘤内异质性（ITH）评分模型表现最佳。建立了临床、肿瘤周围放射组学、ITH评分和联合（ITH +肿瘤周围放射组学+临床）四种模型。采用ROC分析、校准、决策曲线分析（DCA）和SHapley加性解释（SHAP）评估绩效。使用DeepSurv网络建立预后模型，评估HCC切除术后的早期无复发生存（RFS），绘制Kaplan-Meier曲线进行评估。结果：极限梯度增强（XGBoost）在ITH和传统放射组学模型中获得了最佳性能。ITH评分模型优于肿瘤周围放射组学模型。组合模型在训练集上的表现最高（AUC: 0.925，灵敏度：0.926，特异性：0.785，准确率：0.863,F1-score: 0.882）。校准和DCA证实了可靠性和临床效益。SHAP分析澄清了特征的贡献。根据Kaplan-Meier分析，HCC预后模型定义的mvi -高风险患者表现出明显不同的风险评分，其早期RFS也明显较差（P < 0.001）。结论：综合MRI栖息地-临床模型优于单独的方法，显示出HCC个体化手术计划和复发风险分层的希望。

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引用次数: 0

Radiation segmentectomy for treatment of hepatic oligometastases greater than 3 cm 放射节段切除术治疗大于3cm的肝少转移瘤

IF 3.3 3区医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

European Journal of Radiology

Pub Date : 2026-03-01 Epub Date: 2026-01-05 DOI: 10.1016/j.ejrad.2026.112657

Qian Yu , Ali Ahmed , Wali Badar , Daniel Kwak , Aaron William Lyon , Yating Wang , Carla Harmath , Mikin Patel , Divya Kumari , Thuong Van Ha , Osman Ahmed

Purpose

The effectiveness of percutaneous thermoablation as curative treatment of hepatic oligometastases greater than 3 cm can be limited by the ability to achieve adequate ablation coverage. Radiation segmentectomy (RS) using yttrium-90 (Y90) microspheres is an established treatment and potentially curative for hepatocellular carcinoma (HCC) up to 8 cm. This study evaluates the safety and effectiveness of RS for secondary liver tumors larger than 3 cm.

Methods

A retrospective review at a single institution was performed from December 2017 to February 2024 to include patients treated with transarterial radioembolization (TARE) for liver metastases using glass Y90 microspheres. RS was defined as a target dose > 200 Gy to no more than two liver segments. The following outcomes were retrieved: overall survival (OS), radiologic response, progression-free survival (PFS), adverse events, and 3-month serum toxicity.

Results

A total of 14 patients (mean age: 64.2 ± 18.5, M:F = 5:9) with secondary liver tumors (mean diameter: 4.7 ± 1.4 cm; single hepatic lesion: 57.1 %[8/14]), including 5 colorectal cancer (35.7 %), 2 renal cell carcinoma (14.3 %), 2 uveal melanoma (14.3 %), 2 adenoid cystic carcinoma (14.3 %), 1 pancreatic adenocarcinoma (7.1 %), 1 endometrial carcinoma (7.1 %), and 1 tonsillar adenocarcinoma (7.1 %). The mean segmentectomy dose was 352.6 ± 149.1 Gy. Response rate and disease control rate were 42.9 % (6/14) and 85.7 % (12/14), respectively. The 1-yr and 3-yr target tumor response rates were 51.4 % (95 %CI: 21.9–74.8 %) and 34.2 % (95 %CI: 7.1–64.9 %), respectively, with a median PFS of 16.3 months 95 %CI: 5.4 months-not reached). The 1-yr and 3-yr OS were 80.8 % (95 %CI: 42.4–94.9 %) and 40.4 % (95 %CI: 9.8–70.2 %), respectively, with a median OS of 24.3 months (95 %CI: 8.9-not reached). One patient developed grade 3 thrombocytopenia, requiring holding of systemic treatment (7.1 %). No additional grade 3 or above adverse events occurred.

Conclusion

Preliminary results suggest that RS is a feasible treatment option for secondary liver tumors > 3 cm with few major adverse events.

目的经皮热消融治疗大于3cm的肝少转移瘤的有效性可能受到足够消融覆盖能力的限制。使用钇-90 （Y90）微球进行放射节段切除术（RS）是一种成熟的治疗方法，对于8厘米以下的肝细胞癌（HCC）具有潜在的治愈作用。本研究评估RS治疗大于3cm的继发性肝肿瘤的安全性和有效性。方法回顾性分析2017年12月至2024年2月在一所医院接受经动脉放射栓塞（TARE）治疗肝转移瘤的患者，使用玻璃Y90微球。RS定义为目标剂量为200 Gy，不超过两个肝段。以下结果被检索：总生存期（OS）、放射学反应、无进展生存期（PFS）、不良事件和3个月血清毒性。结果共14例继发性肝脏肿瘤患者（平均年龄：64.2±18.5,M:F = 5:9），平均直径：4.7±1.4 cm，单肝病变：57.1%[8/14])，其中结直肠癌5例（35.7%），肾细胞癌2例（14.3%），葡萄膜黑色素瘤2例（14.3%），腺样囊性癌2例（14.3%），胰腺腺癌1例（7.1%），子宫内膜癌1例（7.1%），扁桃体腺癌1例（7.1%）。平均节段切除剂量为352.6±149.1 Gy。有效率为42.9%(6/14)，疾病控制率为85.7%（12/14）。1年和3年目标肿瘤缓解率分别为51.4% （95% CI: 21.9 - 74.8%）和34.2% (95% CI: 7.1 - 64.9%)，中位PFS为16.3个月（95% CI: 5.4个月-未达到）。1年和3年的OS分别为80.8% （95% CI: 42.4 - 94.9%）和40.4% (95% CI: 9.8 - 70.2%)，中位OS为24.3个月（95% CI: 8.9-未达到）。1例患者出现3级血小板减少症，需要全身治疗（7.1%）。未发生其他3级或以上不良事件。结论初步结果表明，RS是一种可行的治疗3 cm继发性肝肿瘤的方法，且主要不良事件较少。

{"title":"Radiation segmentectomy for treatment of hepatic oligometastases greater than 3 cm","authors":"Qian Yu , Ali Ahmed , Wali Badar , Daniel Kwak , Aaron William Lyon , Yating Wang , Carla Harmath , Mikin Patel , Divya Kumari , Thuong Van Ha , Osman Ahmed","doi":"10.1016/j.ejrad.2026.112657","DOIUrl":"10.1016/j.ejrad.2026.112657","url":null,"abstract":"<div><h3>Purpose</h3><div>The effectiveness of percutaneous thermoablation as curative treatment of hepatic oligometastases greater than 3 cm can be limited by the ability to achieve adequate ablation coverage. Radiation segmentectomy (RS) using yttrium-90 (Y90) microspheres is an established treatment and potentially curative for hepatocellular carcinoma (HCC) up to 8 cm. This study evaluates the safety and effectiveness of RS for secondary liver tumors larger than 3 cm.</div></div><div><h3>Methods</h3><div>A retrospective review at a single institution was performed from December 2017 to February 2024 to include patients treated with transarterial radioembolization (TARE) for liver metastases using glass Y90 microspheres. RS was defined as a target dose > 200 Gy to no more than two liver segments. The following outcomes were retrieved: overall survival (OS), radiologic response, progression-free survival (PFS), adverse events, and 3-month serum toxicity.</div></div><div><h3>Results</h3><div>A total of 14 patients (mean age: 64.2 ± 18.5, M:F = 5:9) with secondary liver tumors (mean diameter: 4.7 ± 1.4 cm; single hepatic lesion: 57.1 %[8/14]), including 5 colorectal cancer (35.7 %), 2 renal cell carcinoma (14.3 %), 2 uveal melanoma (14.3 %), 2 adenoid cystic carcinoma (14.3 %), 1 pancreatic adenocarcinoma (7.1 %), 1 endometrial carcinoma (7.1 %), and 1 tonsillar adenocarcinoma (7.1 %). The mean segmentectomy dose was 352.6 ± 149.1 Gy. Response rate and disease control rate were 42.9 % (6/14) and 85.7 % (12/14), respectively. The 1-yr and 3-yr target tumor response rates were 51.4 % (95 %CI: 21.9–74.8 %) and 34.2 % (95 %CI: 7.1–64.9 %), respectively, with a median PFS of 16.3 months 95 %CI: 5.4 months-not reached). The 1-yr and 3-yr OS were 80.8 % (95 %CI: 42.4–94.9 %) and 40.4 % (95 %CI: 9.8–70.2 %), respectively, with a median OS of 24.3 months (95 %CI: 8.9-not reached). One patient developed grade 3 thrombocytopenia, requiring holding of systemic treatment (7.1 %). No additional grade 3 or above adverse events occurred.</div></div><div><h3>Conclusion</h3><div>Preliminary results suggest that RS is a feasible treatment option for secondary liver tumors > 3 cm with few major adverse events.</div></div>","PeriodicalId":12063,"journal":{"name":"European Journal of Radiology","volume":"196 ","pages":"Article 112657"},"PeriodicalIF":3.3,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146035314","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Relationship between resource utilization and diagnostic accuracy of large language models for efficient multimodal reasoning in radiologic image interpretation 资源利用与多模态推理大语言模型诊断准确性的关系

IF 3.3 3区医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

European Journal of Radiology

Pub Date : 2026-03-01 Epub Date: 2026-01-14 DOI: 10.1016/j.ejrad.2026.112677

Taewon Han , Jeong Hyun Lee , Woo Kyoung Jeong, Jaeseung Shin, Yun Hwa Roh, Min Je Kim

Objectives

We evaluated the diagnostic performance and resource efficiency of three multimodal-reasoning-models for radiological image interpretation.

Methods

Using three multimodal-reasoning-models, we analyzed 73 cases under different conditions (Imaging-Only and Combined-Descriptive-Text) with three system prompt types (basic [without system prompt], original [specialized-role], and chain-of-thought [CoT] prompts). Quiz cases were extracted from the Korean Society of Ultrasound in Medicine Website, along with corresponding human benchmark data. Diagnostic performance was assessed through Multiple-Choice (MCQ) and Differential-Diagnosis (DDx) outputs. Resource utilization was measured by token consumption for each case across all scenarios. Pearson correlation coefficients were calculated to evaluate associations between token usage and diagnostic accuracy.

Results

For imaging-only input, under CoT prompt, o1 demonstrated superior accuracy of 56.2 %, surpassing the 55.9 % human benchmark compared to Claude-3.7-Sonnet (49.3 %) and Gemini-2.0-Flash-Thinking-Experimental (37 %) for MCQ. The integration of descriptive-text inputs substantially increased performance across all models, with o1 achieving the highest accuracy (71.2 %, with basic and original). This performance advantage was most pronounced in DDx. Original prompts utilized fewer output tokens while maintaining comparable accuracy for o1 (Imaging-Only with DDx: original vs. basic, CoT prompts, all p < 0.01). Intra-model analysis revealed a negative correlation between accuracy and output token for o1 (r = -0.41), while inter-model analysis showed strong positive correlations between total token and accuracy (r = 0.93 for Imaging-Only with MCQ).

Conclusion

The paradoxical relationship between resource utilization and diagnostic accuracy suggests that model architecture fundamentally determines baseline performance, while prompt optimization influences efficiency within architectural constraints on multimodal-reasoning-models.

目的评价三种多模态推理模型在影像学判读中的诊断性能和资源效率。方法采用3种多模态推理模型，对73例不同情况下（仅图像和组合描述文本）的系统提示类型（基本[无系统提示]、原始[专业角色]和思维链[CoT]提示）进行分析。测试案例提取自韩国超声医学学会网站，以及相应的人类基准数据。通过多项选择（MCQ）和鉴别诊断（DDx）输出评估诊断表现。通过所有场景中每个案例的令牌消耗来衡量资源利用率。计算Pearson相关系数以评估标记使用与诊断准确性之间的关联。结果在CoT提示下，仅图像输入，01的准确率为56.2%，超过了MCQ的Claude-3.7-Sonnet（49.3%）和Gemini-2.0-Flash-Thinking-Experimental（37%）的人类基准55.9%。描述性文本输入的集成大大提高了所有模型的性能，其中01达到了最高的准确率（基本和原始准确率为71.2%）。这种性能优势在DDx中最为明显。原始提示使用更少的输出标记，同时保持与01相当的准确性（仅使用DDx成像：原始与基本，CoT提示，所有p <； 0.01）。模型内分析显示准确率与输出令牌之间呈负相关（r = -0.41），而模型间分析显示总令牌与准确率之间呈强正相关（r = 0.93）。结论资源利用率与诊断准确性之间的矛盾关系表明，模型架构从根本上决定了基线性能，而在多模态推理模型的架构约束下，快速优化影响效率。

{"title":"Relationship between resource utilization and diagnostic accuracy of large language models for efficient multimodal reasoning in radiologic image interpretation","authors":"Taewon Han , Jeong Hyun Lee , Woo Kyoung Jeong, Jaeseung Shin, Yun Hwa Roh, Min Je Kim","doi":"10.1016/j.ejrad.2026.112677","DOIUrl":"10.1016/j.ejrad.2026.112677","url":null,"abstract":"<div><h3>Objectives</h3><div>We evaluated the diagnostic performance and resource efficiency of three multimodal-reasoning-models for radiological image interpretation.</div></div><div><h3>Methods</h3><div>Using three multimodal-reasoning-models, we analyzed 73 cases under different conditions (Imaging-Only and Combined-Descriptive-Text) with three system prompt types (basic [without system prompt], original [specialized-role], and chain-of-thought [CoT] prompts). Quiz cases were extracted from the Korean Society of Ultrasound in Medicine Website, along with corresponding human benchmark data. Diagnostic performance was assessed through Multiple-Choice (MCQ) and Differential-Diagnosis (DDx) outputs. Resource utilization was measured by token consumption for each case across all scenarios. Pearson correlation coefficients were calculated to evaluate associations between token usage and diagnostic accuracy.</div></div><div><h3>Results</h3><div>For imaging-only input, under CoT prompt, o1 demonstrated superior accuracy of 56.2 %, surpassing the 55.9 % human benchmark compared to Claude-3.7-Sonnet (49.3 %) and Gemini-2.0-Flash-Thinking-Experimental (37 %) for MCQ. The integration of descriptive-text inputs substantially increased performance across all models, with o1 achieving the highest accuracy (71.2 %, with basic and original). This performance advantage was most pronounced in DDx. Original prompts utilized fewer output tokens while maintaining comparable accuracy for o1 (Imaging-Only with DDx: original vs. basic, CoT prompts, all p < 0.01). Intra-model analysis revealed a negative correlation between accuracy and output token for o1 (r = -0.41), while inter-model analysis showed strong positive correlations between total token and accuracy (r = 0.93 for Imaging-Only with MCQ).</div></div><div><h3>Conclusion</h3><div>The paradoxical relationship between resource utilization and diagnostic accuracy suggests that model architecture fundamentally determines baseline performance, while prompt optimization influences efficiency within architectural constraints on multimodal-reasoning-models.</div></div>","PeriodicalId":12063,"journal":{"name":"European Journal of Radiology","volume":"196 ","pages":"Article 112677"},"PeriodicalIF":3.3,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146035636","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Prospective evaluation of artificial intelligence (AI) in lumbar spine magnetic resonance imaging (MRI) workflow: from deep learning (DL)-enhanced accelerated acquisition to simultaneous vision-language model (VLM)-based automated report generation 人工智能（AI）在腰椎磁共振成像（MRI）工作流程中的前瞻性评估：从深度学习（DL）增强的加速采集到基于同步视觉语言模型（VLM）的自动报告生成

IF 3.3 3区医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

European Journal of Radiology

Pub Date : 2026-03-01 Epub Date: 2026-01-21 DOI: 10.1016/j.ejrad.2026.112695

Jiwoo Park , Kyunghwa Han , Ji Seon Oh , Hee Dong Chae , Ahram Kim , Si Young Park , Hye Jin Yoo , Young Han Lee

Objectives

To evaluate the diagnostic interchangeability of DL-enhanced accelerated lumbar (L)-spine magnetic resonance imaging (MRI) with conventional imaging and to assess the diagnostic agreement and feasibility of vision-language-model (VLM)-based automated reporting.

Methods

The Institutional Review Boards oftwo participating institutions approved this prospective study. Seventy patients were enrolled from these two institutions. All the participants underwent both conventional and accelerated L-spine MRI during the same session, resulting in 140 MRI scans. Quantitative analyses included signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR), whereas qualitative image quality assessments were conducted by four radiologists blinded to the scan type and patient information. The interchangeability between conventional and accelerated MRI with DL-based enhancement protocols was evaluated for five key pathologic findings. Automated structured reports were generated using a commercially available VLM-based spine interpretation software and compared with radiologist consensus reports. Statistical analyses were performed, with p < 0.05 considered statistically significant.

Results

Accelerated L-spine MRI with DL-based enhancement reduced the acquisition time by approximately 80–86% when compared with conventional MRI, while maintaining diagnostic interchangeability. Quantitative analyses revealed superior SNRs and CNRs, and qualitative evaluations supported comparable image quality. Automated reporting demonstrated substantial to almost perfect agreement across key pathologies.

Conclusions

DL-enhanced accelerated MRI produced high-quality diagnostic images within 2 min, and VLM-based automated reporting demonstrated strong agreement with the radiologists. These findings provide prospective evidence supporting the clinical feasibility of integrating AI into both the acquisition and interpretation workflows in L-spine MRI, with the potential to enhance the efficiency, consistency, and scalability of musculoskeletal imaging.

目的评价dl增强加速腰椎-脊柱磁共振成像（MRI）与常规成像诊断的互换性，并评价基于视觉语言模型（VLM）的自动报告诊断的一致性和可行性。方法两个参与研究机构的机构审查委员会批准了这项前瞻性研究。从这两个机构招募了70名患者。所有的参与者都在同一时段接受了常规和加速的l -脊柱MRI扫描，共进行了140次MRI扫描。定量分析包括信噪比（SNR）和对比噪声比（CNR），而定性图像质量评估由四名不知道扫描类型和患者信息的放射科医生进行。常规和加速MRI与基于dl的增强方案之间的互换性评估了五个关键的病理发现。使用市售的基于vmm的脊柱解释软件生成自动结构化报告，并与放射科医生的共识报告进行比较。进行统计学分析，p <； 0.05认为有统计学意义。结果与常规MRI相比，基于dl增强的加速l -脊柱MRI采集时间缩短了约80-86%，同时保持了诊断的互换性。定量分析显示了优越的信噪比和信噪比，定性评价支持可比的图像质量。自动化的报告显示了关键病理之间几乎完美的一致性。结论：sdl增强的加速MRI在2分钟内产生高质量的诊断图像，基于vmm的自动报告与放射科医生非常一致。这些发现提供了前瞻性证据，支持将人工智能集成到l -脊柱MRI采集和解释工作流程中的临床可行性，并有可能提高肌肉骨骼成像的效率、一致性和可扩展性。

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引用次数: 0