Insights into Imaging最新文献

Objectives: To evaluate gender representation among editors-in-chief and deputy editors of radiology journals indexed in the 2024 Journal Citation Reports (JCR) and to analyze associations with bibliometric indicators and global economic classification.

Materials and methods: A cross-sectional study was performed using publicly available data from radiology-related journals listed in the 2024 JCR (released June 2025). Journals were included if the editorial board composition was accessible online. Gender was identified through institutional profiles and standardized databases. Descriptive statistics summarized gender distribution. Associations between gender, editorial role, bibliometric performance, and World Bank income classification were tested using chi-square, Mann-Whitney U, Spearman's correlation, and nominal logistic regression.

Results: Of 204 eligible journals, 135 met the inclusion criteria, comprising 387 editorial members. Women represented 20.2% of all editors, 21.4% of deputy editors, and 18.4% of editors-in-chief. Female representation was highest in Q1 journals (26.0%) and lowest in Q2 (15.1%). A significant association was observed between Eigenfactor Score and female representation (p = 0.0494), whereas no association was found with journal impact factor or income classification. Geographic disparities were evident, with some countries achieving parity while others had no female representation.

Conclusions: Gender inequities remain pronounced in radiology editorial leadership, particularly at the editor-in-chief level. Higher Eigenfactor Scores may modestly correlate with improved inclusion. Transparent policies and targeted interventions are required to address structural inequities and advance diversity in academic publishing.

Critical relevance statement: Gender disparities exist in radiology editorial leadership, and the Eigenfactor Score was found to be associated with female representation. By providing a comprehensive overview, the findings underscore the structural barriers that limit diversity and the importance of transparent, equity-focused editorial policies.

Key points: Gender disparities persist in radiology editorial boards, with women underrepresented at both deputy editor and editor-in-chief levels. Eigenfactor Score, but not impact factor or national income classification, was significantly associated with increased female representation. Gender disparities persist across editorial leadership roles in radiology, underscoring the need for transparent policies and structural reforms to promote greater equity.

Objectives: To compare understandability, readability, and communication characteristics of radiology report explanations generated by three freely accessible large language models-ChatGPT, Gemini, and Copilot-based on a standardized prompt, as assessed by expert reviewers.

Materials and methods: In this retrospective single-center study, 100 anonymized radiology reports were randomly selected from five subspecialties. Each report was submitted to ChatGPT (GPT-3.5), Gemini, and Copilot between May 23 and May 30, 2025, using the prompt, "Can you explain my radiology report?". Responses were evaluated for medical correctness on a 3-point scale (0-2), understandability using the patient education materials assessment tool for understandability (PEMAT-U), and readability using Flesch Reading Ease (FRE), Automated Readability Index (ARI), and Gunning Fog Index (GFI). Communicative features-including uncertainty language, patient guidance, and clinical suggestions-were also assessed. Anxiety-inducing potential was rated on a 3-point Likert scale.

Results: All models demonstrated high medical correctness (mean: 1.97 ± 0.17/2). ChatGPT produced the most readable (FRE: 60.33 ± 3.65; ARI: 9.66 ± 1.01; GFI: 9.1 ± 1.04) and understandable (PEMAT-U: 89.58 ± 3.90%) responses (p < 0.01). Copilot included the most uncertainty language (1.62 ± 0.62) and clinical suggestions (1.69 ± 0.60), while Gemini provided the strongest patient guidance (1.62 ± 0.58) (all p < 0.01). Only Copilot showed subspecialty-related variation in readability (GFI; p = 0.048). Anxiety potential was low across all models (mean: 0.07 ± 0.33).

Conclusion: ChatGPT offered superior readability and understandability. Copilot delivered more clinical detail with cautious language, while Gemini emphasized patient-centered guidance. These differences support context-specific use of language models in radiology communication.

Critical relevance statement: This study shows that freely accessible large language models produce radiology report explanations with varying levels of readability, understandability, and communication quality. Expert-based findings may help inform future strategies to optimize patient-facing applications of AI in radiological communication.

Key points: This study compared how freely available AI chatbots respond to patient queries about radiology reports. Significant differences were found in understandability, readability, patient guidance, and use of uncertainty or clinical suggestions. Findings support context-specific use of AI tools to improve radiology communication and patient understanding.

Objectives: Multi-material decomposition (MMD), a key application of dual-energy computed tomography (DECT), has shown potential in musculoskeletal research. This study aimed to compare the diagnostic performance of DECT-based MMD with standard CT and MRI in detecting rotator cuff disease.

Materials and methods: This retrospective study evaluated patients diagnosed with rotator cuff disease who underwent third-generation dual-source DECT and 3.0-T MRI within a 2-week interval between December 2023 and November 2024. Shoulder arthroscopy served as the reference standard. Six readers independently assessed rotator cuff tears and determined the degree of supraspinatus tendon diseases using standard CT, DECT-based MMD and MRI. Area under the curve (AUC), sensitivity, specificity, positive/negative predictive values and accuracy were calculated for the diagnosis of rotator cuff disease. Friedman test was used to analyze the radiologists' diagnostic confidence across the three image types.

Results: In total of 103 patients (mean age: 50.0 ± 15.6 years) underwent shoulder arthroscopy. MMD demonstrated a higher average AUC for diagnosing rotator cuff tears (88% vs. 65%, p < 0.001) and supraspinatus tendon disease (86% vs. 63%, p < 0.001) compared to standard CT. Its diagnostic performance for supraspinatus tendon disease (91% vs. 90%, p = 0.35) and full-thickness tears (95% vs. 93%, p = 0.11) was comparable to that of MRI.

Conclusion: DECT-based MMD demonstrated superior diagnostic performance and reliability for detecting rotator cuff diseases compared to standard CT, with accuracy comparable to that of MRI in detecting supraspinatus tendon tears. DECT-based MMD offers a promising approach for the opportunistic detection of rotator cuff diseases.

Critical relevance statement: Dual energy CT-based multi-material decomposition demonstrated accuracy comparable to that of MRI in detecting supraspinatus tendon tears, and may provide an alternative for patients with contraindications to MRI, facilitating early detection of injuries and accurate diagnosis of rotator cuff diseases.

Key points: Dual energy (DE) CT multi-material decomposition (MMD) improves diagnostic performance for rotator cuff tears and supraspinatus tendon injuries. Radiologists with varying experience levels benefited from MMD, with experienced readers achieving MRI-level diagnostic performance. DECT MMD offers a promising alternative for patients with contraindications for MRI.

Background: Research activities often compete with clinical work and personal life for the time of physician-scientists. To overcome barriers to research, examining the factors affecting research productivity is important.

Objectives: To identify potential personal, physician-dependent, and external physician-independent factors affecting researcher productivity in a cohort of Nordic radiologists.

Methods: A prospective survey was open to responders from 10 May 2023 to 23 June 2023. The survey was distributed to radiologists and radiology residents in the Nordic countries (Denmark, Finland, Norway, and Sweden) through multiple channels. We collected demographic information, details about work and academic careers, and opinions and attitudes on work, research, and personal life using a Likert-scale questionnaire.

Results: A total of 192 participants responded (mean age 46.4 (SD: 11.03), 88 (45.8%) males, 103 (53.6%) females). Of the 134 (69.8%) respondents who reported having made any past academic contribution, 88 (46.4%) indicated active research participation. Active researchers expressed more agreement that they have the skills (p < 0.001) and resources (p < 0.001) for research and are able to maintain expertise (p = 0.003). Responders most frequently reported that having time for research (n = 94/155, 60.6%), motivation (n = 56/155, 36.1%), more funding (n = 36/155, 23.2%), and a higher salary (n = 36/155, 23.2%) would increase research involvement.

Conclusions: We identified several differences between radiologists who are active in research and those who are not. The participants identified time, financial means, and motivation as key factors that could increase research involvement.

Critical relevance statement: Academic radiologists with active research careers report having the necessary skills and resources for research, teaching, and learning more frequently than radiologists less active in research.

Key points: Active researchers are more in agreement with having the skills and resources for research. Active researchers expressed more agreement with interest in teaching, keeping expertise up to date, getting enough sleep, and being less distracted by social media. Researchers with a recent history of funding reported more publications. There may be research potential for physicians engaged in self-financed research.

Extracorporeal membrane oxygenation (ECMO) is a vital life support technique employed in patients experiencing pulmonary or cardiopulmonary failure. This procedure entails the use of a pump to replace heart function and an oxygenator to ensure adequate blood oxygenation. ECMO systems are categorized into two main configurations: veno-venous (VV) and veno-arterial (VA) circuits. VV-ECMO is employed for isolated respiratory failure, while VA-ECMO provides temporary mechanical circulatory support for patients with cardiogenic shock or cardiac arrest. A less common alternative, veno-arterial-venous (VAV) ECMO, may be used in complex cases, reducing left ventricular afterload, leading to an improvement of pulmonary edema. Imaging plays a pivotal role in ECMO management, particularly in confirming proper cannula placement, detecting malposition or migration, and identifying complications such as hemorrhage, thrombosis, vascular injury, or infections. Chest X-ray serves as the first-line imaging modality, while computed tomography (CT) is essential for a more detailed evaluation in cases of suspected complications. Tailored CT protocols, adapted to specific ECMO configurations, contrast injection site, cardiac output, and ECMO flow rate, are essential to account for possible ECMO-induced hemodynamic changes and ensure accurate diagnosis. This review provides a comprehensive guide for radiologists, offering detailed descriptions of ECMO system configurations, cannula positioning, and imaging techniques. It highlights the importance of understanding ECMO-specific challenges and outlines strategies to optimize imaging protocols, including modifications in contrast administration and flow-rate adjustments, ultimately improving diagnostic accuracy and patient outcomes. CRITICAL RELEVANCE STATEMENT: Radiologists must be familiar with VV- and VA-ECMO systems, utilize tailored CT protocols, and apply non-invasive imaging modalities to assess cannula positioning and complications, ensuring accurate evaluation and management of critically ill patients relying on these advanced life-support techniques. KEY POINTS: ECMO is a life support technique used in patients with pulmonary or cardiopulmonary failure. CT protocols should be customized based on the study indication, ECMO configuration, contrast injection site, cardiac output, and ECMO flow rate. Non-invasive imaging is crucial for evaluating cannula placement and identifying complications. Approximately 50% of ECMO patients develop complications, the most frequent being hemorrhage, thromboembolic disease, renal failure, sepsis, and vascular injury.

The falciform ligament and the ligamentum teres hepatis (LTH) have historically been regarded as embryological remnants with minimal clinical significance. However, their complex anatomical relationships with the liver, diaphragm, retroperitoneum, and abdominal and thoracic walls make them susceptible to various pathological conditions. This review highlights the anatomy of the falciform ligament and the LTH, their significance in surgical procedures, and pathologies of these structures on cross-sectional imaging. We will discuss the normal anatomy, congenital variations, inflammatory and infectious processes, neoplastic conditions, and vascular anomalies affecting these structures. Recognition of the imaging characteristics of the falciform ligament and the LTH pathologies is crucial for accurate diagnosis and management. CRITICAL RELEVANCE STATEMENT: Recognition of the falciform ligament and the ligamentum teres hepatis pathologies is critical for accurate diagnosis, surgical planning, and avoiding misinterpretation of pseudolesions. Cross-sectional imaging helps identify pathologies of these structures, guide management, and avoid unnecessary interventions. KEY POINTS: The falciform ligament and the ligamentum teres hepatis have critical anatomical relationships that make them susceptible to various pathologies. Cross-sectional imaging is essential for the diagnosis of pathologies affecting these structures. Pseudolesions associated with these structures can mimic true liver pathology on CT and MRI.

Background: Pathologies affecting the conus medullaris and cauda equina can present with overlapping clinical symptoms, making an accurate diagnosis essential. Conus medullaris syndrome results from damage at the T12-L2 level, while cauda equina syndrome arises from nerve root compression below the conus. Both conditions may cause motor deficits, sensory disturbances, and autonomic dysfunction, necessitating a detailed differential diagnosis.

Objective: This educational review highlights common and rare etiologies of conus medullaris and cauda equina lesions, emphasizing imaging characteristics and diagnostic considerations. A comprehensive review of tumors, infections, inflammatory, vascular, and degenerative conditions affecting these regions was performed. Contrast-enhanced MRI was identified as the gold standard for diagnosis.

Revised pathologies: Tumors: myxopapillary ependymomas and schwannomas are the most frequent neoplasms, while drop metastases and glioblastomas represent rarer entities.

Infections: tuberculous arachnoiditis, bacterial radiculitis, schistosomiasis, and neurocysticercosis may mimic neoplastic processes. Inflammatory disorders: Guillain-Barré syndrome, neurosarcoidosis, and MOGAD may cause nerve root thickening and enhancement. Vascular lesions: spinal dural arteriovenous fistulas, infarcts, and arteriovenous malformations can produce conus and cauda equina symptoms. Miscellaneous causes: developmental anomalies like diastematomyelia and ventriculus terminalis, along with degenerative diseases, can mimic other conditions.

Conclusion: Radiologists play a pivotal role in differentiating conus medullaris and cauda equina pathologies. A thorough understanding of imaging findings is essential for accurate diagnosis and effective management.

Critical relevance statement: Conus medullaris and cauda lesions present with overlapping clinical symptoms but show some distinct imaging patterns. It is essential to recognize characteristic features that differentiate neoplastic from infectious or vascular etiologies.

Key points: Conus and cauda lesions have varied causes; MRI with contrast is vital for accurate diagnosis. Myxopapillary ependymomas cause vertebral scalloping; schwannomas may be cystic; intramedullary gliomas expand the cord. Conus medullaris and cauda lesions overlap clinically; imaging helps distinguish neoplastic from infectious or vascular causes.

Objectives: Approximately 30% of patients with Crohn's disease (CD) experience primary loss of response (PLR) to ustekinumab. However, studies integrating imaging parameters to predict PLR remain limited. This study aimed to quantify endoluminal and intestinal wall parameters using computed tomography enterography (CTE) and assess their predictive value for PLR to ustekinumab.

Materials and methods: This multicenter study analyzed 466 intestinal segments from 161 patients with CD between March 2020 and May 2024. A national survey identified 10 CTE parameters for evaluating disease activity and predicting PLR. Logistic regression models were used to assess predictive performance in a validation cohort.

Results: Ten CTE parameters related to lesion characterization-including length, luminal narrowing, and bowel wall thickness-were defined, with newly introduced metrics, including length, area, effective luminal diameter (EffLD), mean bowel wall thickness, and stenosis. A total of 352 baseline and 114 follow-up segments from 161 patients across six centers were analyzed to assess changes following ustekinumab treatment. Paired analysis across all patients showed significant improvements in eight parameters (p < 0.001); in contrast, unpaired comparisons between PLR and non-PLR groups revealed significant differences in six parameters (p < 0.001), with greater improvements in the non-PLR group. EffLD emerged as an independent predictor of ustekinumab response, with an AUC of 0.858 and an accuracy of 0.780 in the validation cohort.

Conclusions: Novel endoluminal parameters, particularly EffLD, provide a detailed characterization of intestinal lesions in inflammatory bowel disease and exhibit strong predictive value for PLR in ustekinumab-treated patients with CD.

Critical relevance statement: This study first applied cardiovascular imaging software to quantify endoluminal CT enterography parameters, establishing effective luminal diameter as a novel, clinically applicable predictor of ustekinumab response in Crohn's disease.

Key points: Cardiovascular imaging software can facilitate image analysis in Crohn's disease. Endoluminal CT enterography parameters predict primary loss of response in Crohn's disease. Effective luminal diameter independently predicts ustekinumab response.

Objectives: The study investigated the potential association between tumor size and inflammation from the standpoint of apparent diffusion coefficient (ADC) and the prognostic significance of ADC in hepatocellular carcinoma (HCC) patients treated with immune checkpoint inhibitors (ICIs).

Materials and methods: This retrospective study ultimately included 255 HCC patients receiving ICIs, among whom 168 underwent posttreatment diffusion-weighted imaging at three months. The study analyzed the correlations among pretreatment tumor maximum diameter, inflammatory markers (neutrophil to lymphocyte ratio, NLR; platelet to lymphocyte ratio, PLR), and ADC (substantial tumor ADC, sADC; whole tumor ADC, wADC), as well as exploring the association between tumor maximum diameter and inflammatory markers regarding ADC. This study further focused on the prognostic value of baseline and relative change in ADC in HCC patients receiving ICIs.

Results: The study found a potential relationship between tumor maximum diameter and inflammatory markers regarding sADC. Multivariate Cox regression showed that higher sADC was associated with longer overall survival (OS) (HR: 0.63, 95% CI: 0.43-0.91, p = 0.015). Additionally, the relative change in sADC (ΔsADC) positive group exhibited better progression-free survival (12 vs 6.4 months, p < 0.001) and OS (20.5 vs 13.3 months, p < 0.001) compared to the ΔsADC non-positive group, serving as an independent prognostic factor for HCC patients receiving ICIs.

Conclusions: The association between tumor burden and inflammatory markers was observed regarding sADC, with baseline sADC and relative change promising as prognostic imaging biomarkers in HCC patients receiving ICIs.

Critical relevance statement: The substantial tumor ADC is an important imaging feature revealing the potential association between tumor burden and inflammation, and its prognostic role for patients with HCC receiving ICIs.

Key points: The sADC could indirectly reflect tumor microenvironment characteristics. The association between tumor burden and inflammatory markers was observed regarding sADC. Baseline sADC and its change predict prognosis in ICI-treated HCC patients.

Objectives: Periprocedural aspirin or unfractionated heparin during endovascular treatment in acute ischemic stroke increases symptomatic intracranial hemorrhage (sICH) risk without improving functional outcome. White matter lesions (WMLs) are associated with higher sICH risk and poor functional outcome following stroke. We aimed to assess whether WML volume modifies the effect of aspirin or heparin.

Materials and methods: In this post-hoc analysis of the MR CLEAN-MED trial, WML volume was automatically determined using deep learning-based segmentation on baseline non-contrast CT scans. Outcomes included good functional outcome (modified Rankin Scale 0-2 at 90 days), any ICH, asymptomatic ICH (aICH), and sICH. Patients received either aspirin or not, and either heparin or not. Multivariable logistic regression evaluated treatment effect and effect modification.

Results: Of 628 patients, 614 with baseline CT were included. Median WML volume was 0.59 mL without significant differences between treatment arms. WML volume significantly modified the effect of aspirin on sICH (p = 0.01), but not on functional outcome (p = 0.95), any ICH (p = 0.52), or aICH (p = 0.30). Aspirin was associated with increased sICH risk, which decreased with increasing WML volume (aOR 0.96 [95% CI: 0.93-0.99] per 1 mL). For patients with large WML volumes, aspirin showed no significant effect on sICH risk. The effect of heparin on functional outcome, any ICH, aICH, and sICH was not modified by WML volume (p = 0.53, p = 0.26, p = 0.08, p = 0.63, respectively).

Conclusions: WML volume significantly modified the effect of aspirin on sICH risk, with aspirin-associated risk decreasing as WML volume increased. WML volume did not modify the effect of aspirin or heparin on other outcomes.

Critical relevance statement: WML volume on non-contrast CT modifies the effect of aspirin during endovascular thrombectomy on sICH risk, yet no WML-based patient subgroup showed save benefits from periprocedural aspirin or heparin treatment.

Key points: Periprocedural aspirin and unfractionated heparin during endovascular treatment cause a higher hemorrhage risk. WML volume is associated with worse functional outcome and WML volume significantly modifies the effect of aspirin on symptomatic hemorrhage risk, with aspirin-associated risk decreasing with increasing WML volume. No WML-volume-based patient subgroup was identified where aspirin or heparin treatment demonstrated safe clinical benefit.