Insights into Imaging最新文献

Work-life balance has emerged as a central theme in modern medicine, particularly in radiology, where high burnout rates underscore the urgency for systemic change. This narrative review explores how perceptions of work-life balance vary across generations-Baby Boomers, Generation X, Millennials, and Generation Z-and how these differences shape workplace expectations and cultural evolution within healthcare. Baby Boomers often view medicine as a vocation requiring sacrifice and long hours, while Gen X emphasises flexibility and independence. Millennials prioritise purpose, inclusivity, and work-life integration, favouring fluid schedules and value-driven environments. Gen Z, as digital natives, seeks ethical workplaces, diversity, and clearly defined personal-professional boundaries. That paper started from a dedicated session at the European Congress of Radiology (ECR) 2025, combining literature references with reflections on evolving professional values. It highlights that while generational perspectives differ, common ground exists: across all groups, well-being, fulfilment, and supportive workplace structures are increasingly seen as essential rather than optional. The paper emphasises the importance of adapting institutional policies to accommodate generational needs through flexible scheduling, mentorship, protected time, and inclusive leadership. Ultimately, we aim for the embracing of intergenerational collaboration and recognition of the diverse definitions of professional success, which are key to building resilient radiology teams. Sustainable solutions must move beyond one-size-fits-all models to foster innovation, prevent burnout, and retain talent across all career stages. It is also calling for healthcare institutions to proactively integrate these perspectives to shape a more supportive and effective professional culture. CRITICAL RELEVANCE STATEMENT: This paper offers a narrative overview of generational perspectives on work-life balance in radiology, highlighting both shared values and evolving priorities across age groups KEY POINTS: Burnout remains a widespread issue in radiology, with high prevalence across all career stages, emphasising the need for systemic solutions rather than individual resilience alone. Generational views on work-life balance vary: Boomers value duty, Millennials seek purpose and flexibility, while Gen Z demands ethics, diversity, and personal sustainability. Intergenerational collaboration and adaptability are essential for building resilient teams, requiring healthcare institutions to embrace diverse expectations and implement inclusive, flexible work models.

Objectives: To determine the value of MRI in men with highly elevated PSA values for the exclusion of clinically significant prostate cancer (csPC).

Materials and methods: In this retrospective bicenter cohort study, consecutive men with PSA values ≥ 15 ng/mL and multiparametric (mp) MRI were included. We excluded patients with acute prostatitis and patients without histopathology or follow-up. Examinations were evaluated regarding MRI quality, PSAD, and PI-RADS classification. For all patients with subsequent biopsy, PC and csPC detection rates were determined. In a subgroup analysis, patients with and without the presence of csPC were compared regarding clinical and MRI parameters.

Results: Finally, 376 patients (median PSA 20 ng/mL) were included. MRI quality was excellent (median PI-QUAL 3). 26% of the patients revealed an MRI with a PI-RADS category 2, 16% were classified as category 3, 12% PI-RADS 4, and 46% showed a PI-RADS 5. A total of 280 patients underwent systematic screening with or without targeted prostate biopsy. Among these, 42% with PSA values ranging from 15 to 116 ng/mL (median 19.5 ng/mL) showed no presence of PC. Overall, csPC detection rates were 94% for PI-RADS 5 and 51% for PI-RADS 4. No csPC were identified in PI-RADS 2, and 8% in PI-RADS 3. Comparative analysis between patients with and without csPC revealed significant differences in age, PSA, PSAD, and PI-RADS (p ≤ 0.05).

Conclusions: mpMRI demonstrated excellent performance in the detection of csPC in this high-risk cohort with PSA levels ≥ 15 ng/mL. High-quality MRI helps to exclude csPC in cases with significantly elevated PSA levels to avoid unnecessary prostate biopsies. CRITICAL RELEVANCE STATEMENT: mpMRI demonstrated a high diagnostic accuracy for csPCs in men with PSA ≥ 15 ng/mL, and in cases of non-suspicious MRI findings, it can avoid unnecessary biopsies in these patients at risk.

Key points: MpMRI demonstrated high diagnostic accuracy in men with PSA values of ≥ 15 ng/mL. MpMRI enables the reliable exclusion of csPC in cases with non-suspicious MRI findings in these patients. In patients with significantly elevated PSA levels, mpMRI provides an effective risk stratification to avoid unnecessary biopsies.

Objectives: Postoperative survival outcomes vary substantially among patients diagnosed with stage I lung adenocarcinoma (LUAD). This study aimed to develop CT-based radiomic subtypes using unsupervised clustering to assess their association with overall survival (OS), systemic nutritional-inflammatory status, and adjuvant chemotherapy benefit.

Materials and methods: A total of 496 stage I LUAD patients from two independent centers were included. Preoperative CT radiomic features (n = 1218) were extracted, and subtypes were derived using the K-means clustering algorithm. The independent prognostic value of these subtypes, along with their capacity to predict the benefit of adjuvant chemotherapy, was evaluated through multivariable Cox regression and treatment-by-subtype interaction analyses.

Results: Three radiomic subtypes with significant prognostic differences in OS were identified. The high-risk subtype, Cluster 2, exhibited distinct clinical characteristics and was associated with markedly poorer OS (hazard ratio [HR] = 15.71, p < 0.001, compared to Cluster 0). Cluster 2 also showed an inflammatory imbalance, with elevated systemic immune-inflammation index and neutrophil-to-lymphocyte ratio, and  a decreased lymphocyte-to-monocyte ratio. Notably, a significant interaction was found between subtypes and adjuvant chemotherapy (interaction p < 0.001, Cluster 2 vs Cluster 0). Subgroup analysis indicated that stage IB patients within Cluster 2 derived a significant survival benefit from adjuvant chemotherapy (interaction p = 0.003 vs Cluster 0).

Conclusions: This study developed a CT-based radiomic subtype system using unsupervised clustering that identifies high-risk stage I LUAD patients with systemic inflammatory imbalance. Notably, these subtypes predict differential survival benefits from adjuvant chemotherapy in high-risk stage IB patients, thereby supporting personalized postoperative treatment strategies.

Critical relevance statement: This CT-based radiomic subtype system stratifies prognosis and identifies stage I LUAD patients who may benefit from adjuvant chemotherapy, enabling personalized treatment decisions in radiology.

Key points: Conventional tumor-node-metastasis (TNM) staging does not adequately capture tumor heterogeneity in stage I LUAD. Three CT-based radiomic subtypes were established, with the high-risk subgroup correlating with systemic inflammatory imbalance and poorer OS. CT-based radiomic stratification identifies stage IB patients who benefit from adjuvant chemotherapy, supporting personalized postoperative management.

Objectives: Whole-body computed tomography (WBCT) is the standard procedure for examining severely injured patients. In addition to trauma-caused pathologies, a high number of non-trauma-related pathologies, incidental findings (IFs) are found regularly but often underestimated in WBCT. A standardized image analysis and a classification of IFs regarding their clinical graduation is of paramount interest for both treatment concepts and outcomes. The present study is aimed at developing and validating a feasible classification system. We evaluated WBCT scans regarding IFs and classified the IFs into 5 degrees of severity.

Materials and methods: The present retrospective study included 1475 polytrauma patients from two maximum care hospitals who underwent a WBCT scan. Medical reports and CT scans were then reviewed for IFs.

Results: The 83.8% of patients had suffered trauma-related injuries, and in 83.9%, IFs were found. The patients' age and gender significantly influenced the number and severity of IFs. Older and female patients tended to have more IFs. IFs are not described more often in patients without trauma-related findings (15%) than in patients with traumatic injuries (6%). Based on an analysis of 476 literature sources, we classified 511 different IFs into 5 categories. Most of them fell into categories 1 (variant) and 2 (benign), but 24% fell into categories 3 (follow-up), 4 (needs clarification), and 5 (needs treatment), requiring monitoring, clarification, or immediate treatment.

Conclusion: Due to the high rate of IFs, standardized image analysis and IFs classification are of utmost importance for both the patients' further treatment and the healthcare system's refinancing of resources.

Critical relevance statement: IFs in polytrauma CT scans are common and, if not adequately addressed, can negatively impact patient outcomes-therefore, this 5-level classification standardizes interpretation and provides specific recommendations for further action, evaluation, or treatment.

Key points: In polytrauma, IFs are as common as trauma-related findings. There is a need for standardized classification. For IFs in WBCT scans, we propose a classification into 5 categories, labeled as IF-RADS 1-5.

A standardized guideline and scoring system are recommended for the imaging evaluation of musculoskeletal infections on MR imaging. The Musculoskeletal Infection Reporting and Data System (MSKI-RADS) is a recently developed and validated classification system using MR imaging that can be used to classify the severity and extent of musculoskeletal infections, improve radiology-pathology concordance, and outline the corresponding management recommendations. This review article explains MSKI-RADS and discusses the different elements of this system in detail with a review of pertinent literature so that the readers can apply it in their practices. The work outlines the technical considerations for optimal MR imaging for evaluating various musculoskeletal infectious lesions, details the severity scales with examples of various conditions that fall under each class, and outlines related patient management recommendations. The readers can learn about the MSKI-RADS classification system and apply the gained information from this article to improve MRI interpretations in their practice and increase the effectiveness of their multidisciplinary communications. This standardized system will also allow longitudinal data collection and tracking for future research purposes. CRITICAL RELEVANCE STATEMENT: MSKI-RADS is a recently developed and validated MRI-based guideline for musculoskeletal infections in extremities. A comprehensive understanding of these classifications can facilitate improved standardized diagnostic reporting of musculoskeletal infections on MRI and better patient outcomes. KEY POINTS: Current terminology for describing musculoskeletal infections on MRI is nonspecific, resulting in confusing diagnostic reports. A standardized guideline and scoring system are critical for improving diagnostic reporting of musculoskeletal infections on MRI. MSKI-RADS is a recently developed and validated MRI-based guideline that can be used to characterize musculoskeletal infections in extremities. MSKI-RADS is a meaningful tool that facilitates improvements in standardized reporting and treatment protocols, multidisciplinary communications, and longitudinal data collection.

Objective: To evaluate predictors of ischemic stroke in patients with primary angiitis of the central nervous system after initiation of immunosuppressive therapy.

Materials and methods: This retrospective study included 204 MRI examinations of 23 patients with primary angiitis of the central nervous system, treated with immunosuppressive therapy between 2015 and 2020 at the University Hospital Bern and the Cantonal Hospital St. Gallen, Switzerland. Two senior neuroradiologists evaluated the MRI exams with regard to the occurrence and location of ischemic stroke and hemorrhage, as well as the following characteristics of inflamed vessels on 3D time-of-flight angiography and T1 dark-blood post contrast: signal intensity of vessel walls, length of enhancement, circular extent of enhancement, and stenosis. After matching ischemic strokes to their corresponding vessel, the temporal relationship of vessel alterations in accordance with therapy initiation and stroke onset was calculated.

Results: The majority (77.6%) of observed strokes were in the vascular territory of an inflamed vessel. A significant, non-linear temporal relationship between the timing of MRI and the initiation of immunosuppression was found. The highest predicted probability of ischemic stroke was observed between 10 and 20 days after the initiation of immunosuppressant therapy, reaching approximately 12%. Out of all evaluated vessel characteristics, a higher degree of stenosis (Estimate: 0.93, p = 0.006) and a higher circularity of enhancement (Estimate: 0.76, p = 0.01) were significantly associated with a higher likelihood of stroke.

Conclusions: A better understanding of unfavorable constellations (critical timeframe, characteristic vessel wall changes) in patients treated for primary angiitis of the central nervous system may help to prevent secondary ischemic strokes.

Critical relevance statement: A better understanding of ischemic stroke predictors in patients treated for primary angiitis of the central nervous system may prompt closer monitoring or therapy adjustment.

Key points: To evaluate risk factors for ischemic stroke in patients treated for primary angiitis of the central nervous system. Higher degree of stenosis and circular enhancement are associated with a higher likelihood of ischemic strokes, which typically occur between 10 and 20 days after therapy onset. Data obtained from this may prompt closer monitoring or therapy adjustment.

Objectives: To investigate the value of qualitative and quantitative contrast-enhanced CT (CECT) features for noninvasive identification of two distinct vascular patterns, vessels that encapsulate tumor clusters (VETC) and/or microvascular invasion (MVI), in solitary early-stage (BCLC 0-A) hepatocellular carcinoma (HCC) and assess their prognostic implications.

Materials and methods: We retrospectively included 347 patients with solitary early-stage HCC who underwent preoperative CECT and subsequent resection at two centers. Patients were divided into V/M+ (MVI and/or VETC positive, n = 174) and VM- (both MVI and VETC negative, n = 173) groups based on histopathology. Four predictive models (clinical, CT quantitative, CT qualitative, and combined) integrating clinical and CECT features were developed and validated for identifying V/M+ status. The optimal model was further applied to predict 2-year recurrence-free survival (RFS). Sensitivity analysis was performed using propensity score matching (PSM). Models' performance was evaluated and compared using AUC analyses and DeLong tests.

Results: The combined model [serum AFP ≥ 200 ng/mL, non-smooth tumor margin, internal arteries, and lower tumor-to-liver density ratio in the portal venous phase (P-TLR)] achieved optimal predictive performance for V/M + HCC, with training AUC of 0.784 and 0.782 pre- and post-PSM, and external validating AUC of 0.794. A derived V/M+ score stratified patients, with higher scores associated with significantly shorter 2-year RFS. V/M+ score ≥ 34 and tumor size ≥ 60 mm were significant predictors of HCC recurrence (p < 0.05).

Conclusion: The combined model integrating clinical and CECT-based features, enables non-invasive assessment of V/M status in early-stage solitary HCC and effectively stratifies patients according to recurrence risk.

Critical relevance statement: Specific CT-based qualitative and quantitative features are associated with a distinct vascular pattern of BCLC stage 0-A HCC. The developed combined model and derived V/M+ score offer a reliable tool for clinicians to predict V/M + HCC and patients' 2-year RFS.

Key points: Specific CECT-based qualitative and quantitative features are associated with V/M + HCC at the BCLC stage 0-A. The developed combined model offers a reliable tool for clinicians to identify V/M + HCC. The derived V/M+ score helps stratify HCC patients into high- and low-risk groups for 2-year RFS, facilitating personalized management of HCC.

Objectives: To evaluate the publication outcomes of oral presentations delivered at the European Congress of Radiology (ECR) 2019 and examine factors influencing conversion to full-text articles; findings were also compared with ECR 2010.

Materials and methods: A total of 1817 oral presentations from ECR 2019 were analyzed. Publication status was determined by searching PubMed/MEDLINE up to December 2023. For each matched article, Journal Impact Factor (JIF) and Google Scholar citations/year were recorded. Additional variables included country of origin, collaboration type, imaging modality, and study design. Statistical analyses used chi-square and Kruskal-Wallis, with p < 0.05 considered significant.

Results: Of 1817 oral presentations, 844 (46.5%) were published, with no significant difference from ECR 2010 (43%, p = 0.091). Abstracts originated from 71 countries, with Italy (16.5%) and China (15.5%) contributing the most. Publications appeared in 254 journals. Publication rates varied significantly by country (p < 0.001), with Switzerland (74.4%) and the Netherlands (68.8%) achieving the highest rates. When analyzed by continent, abstracts from Asia showed a significantly higher publication rate than those from Europe (52.3% vs. 43.6%, p = 0.001). Publication outcomes also varied significantly by imaging modality (p = 0.002) and subspecialty (p < 0.001). Breast imaging achieved the highest median JIF (4.9), whereas Artificial Intelligence/Machine Learning (AI/ML) demonstrated the highest median annual citation count (10.5).

Conclusions: Nearly half of the ECR 2019 oral presentations achieved peer-reviewed publication, maintaining rates from 2010. The congress's contributor landscape has become more global, with greater participation from Asia. While traditional radiological fields remain prevalent, AI/ML abstracts demonstrated high citation rates. These findings reflect contemporary trends in radiological research.

Critical relevance statement: By analyzing the publication outcomes of ECR 2019, with comparisons to 2010 data, this study examines evolving global patterns in publication outcomes, offering insights to enhance the dissemination of radiological research.

Key points: Converting oral presentations to publications remains challenging in radiological research. Nearly half of the ECR 2019 oral presentations were published, showing a modest, non-significant increase from ECR 2010. The congress has become increasingly global, with notable growth in participation from Asia. This study reveals radiology's evolving scientific landscape and current research priorities.

Introduction: Intra-pancreatic fat deposition (IPFD) is associated with pancreatic diseases, but its systemic implications remain unclear.

Materials and methods: We analyzed 25,547 UK Biobank participants (median follow-up 6.27 years) with MRI-derived pancreatic proton density fat fraction. Multi-variable Cox models, causal mediation, restricted cubic splines, and subgroup analyses assessed IPFD-disease associations. Significant associations were examined through bidirectional Mendelian randomization (MR) using the UK Biobank and FinnGen data. Receiver operating characteristic curves and the Youden index were used to identify a clinically relevant and statistically optimal IPFD threshold.

Results: Higher IPFD independently increased the risk of 12 multi-systemic diseases: non-insulin-dependent diabetes, primary hypertension, heart failure, cerebral infarction, cholelithiasis, gastritis and duodenitis, diaphragmatic hernia, chronic renal failure, gonarthrosis, disorders of refraction and accommodation, senile cataract, and sleep disorders. Causal mediation by non-insulin-dependent diabetes was negligible. Nonlinear dose-response patterns and effect modifications by sex, race, smoking, and obesity emerged. MR analysis supported the potential causal effects of IPFD on refractive/accommodation disorders and gonarthrosis. An IPFD cutoff of 7.35% (95% CI: 5.68-9.23%) optimally stratified the risk.

Conclusion: IPFD is an independent risk factor for diverse conditions, including metabolic, cardiovascular, digestive, musculoskeletal, ophthalmologic, urinary, and mental/behavioral disorders. A pancreatic fat threshold of 7.35% may guide clinical screening and preventive strategies.

Critical relevance statement: This study critically establishes intra-pancreatic fat as a novel, causal multi-system disease risk factor and provides a 7.35% quantitative threshold to advance radiological screening and prevention protocols.

Key points: Limited research exists on the systemic effects of IPFD. Pancreatic fat deposition independently raises risk for 12 multi-system diseases. A 7.35% pancreatic fat threshold can guide clinical screening and prevention.