Radiology最新文献

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Optimizing Large Language Models for Automated Protocoling of Abdominal and Pelvic CT Scans: The Power of Context. 优化腹部和骨盆CT扫描自动协议的大型语言模型：上下文的力量。

IF 19.7 1区医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

Radiology

Pub Date : 2026-01-01 DOI: 10.1148/radiol.252105

Bryan W Buckley,Adriano B Dias,Yangqing Deng,Heidi Schmidt,Ania Kielar,Satheesh Krishna,Rajesh Bhayana

Background Accurate protocoling is critical for imaging accuracy. Manual protocoling is time-consuming and error prone. Purpose To evaluate the performance of large language models (LLMs) in automatically assigning protocols for abdominal and pelvic CT scans after optimization with context engineering and fine-tuning and to compare performance with that of radiologists in practice. Materials and Methods This retrospective study included patients with abdominal or pelvic CT scans obtained between January 2024 and June 2024. Requisition data, human-selected protocol, and training level (resident, fellow, or radiologist) were extracted. Reference standard protocols were defined by radiologists in consultation with institutional guidelines. Context engineering involved detailed prompt instructions using a prompt set with GPT-4o (version 2024-08-06; Open AI). A subset of patients was reserved for fine-tuning (training set and validation set) and another for testing (internal test set). Two models were tested (prompting-only and fine-tuned). Model-selected protocols and original human-selected protocols were categorized compared with the reference standard after review by blinded radiologists as follows: exact match, equal alternative, reasonable but inferior, or inappropriate. Exact match and equal alternative were considered optimal. Performance of models and radiologists were compared using the McNemar test. Results This study included 1448 patients (mean age, 61 years ± 17 [SD]; 728 female patients). GPT-4o with prompting only selected optimal protocols more frequently than humans (96.2% [527 of 548 patients] vs 88.3% [484 of 548 patients]; P < .001), but there was no evidence of a difference in inappropriate protocols (1.3% [seven of 548 patients] vs 2.4% [13 of 548 patients]; P = .21). Fine-tuning GPT-4o did not improve the proportion of optimal protocols over prompting only (96.2% [527 of 548 patients] vs 96.2% [527 of 548 patients]; P > .99). In subgroup analyses, the proportion of protocols matching the reference standard was similar among radiologists (79.4% [173 of 218 patients]), fellows (74.9% [164 of 219 patients]), and residents (72.1% [80 of 111 patients]; P = .30). Conclusion For protocoling abdominal and pelvic CT scans, the LLM, GPT-4o, selected optimal protocols more frequently than radiologists when optimized with detailed prompting, and fine-tuning of the model did not further improve performance. © RSNA, 2026 Supplemental material is available for this article.

准确的协议是成像精度的关键。手动协议处理既耗时又容易出错。目的评估大型语言模型（LLMs）在经过上下文工程和微调优化后自动分配腹部和骨盆CT扫描方案的性能，并将其与放射科医生在实践中的性能进行比较。材料和方法本回顾性研究纳入了2024年1月至2024年6月期间进行腹部或骨盆CT扫描的患者。提取了申请数据、人为选择的方案和培训水平（住院医师、研究员或放射科医生）。参考标准方案由放射科医生在咨询机构指南后确定。上下文工程涉及使用gpt - 40（版本2024-08-06；Open AI）的提示集的详细提示说明。保留一部分患者用于微调（训练集和验证集），另一部分用于测试（内部测试集）。测试了两个模型（仅提示和微调）。经盲法放射科医师评审后，将模型选择方案和原始人工选择方案与参考标准进行分类：完全匹配、同等替代、合理但较差、不合适。精确匹配和相等选择是最优选择。使用McNemar测试比较模型和放射科医生的表现。结果共纳入1448例患者，平均年龄61岁±17岁[SD]，女性728例。提示的gpt - 40只比人类更频繁地选择最佳方案（96.2%[527 / 548例患者]vs 88.3%[484 / 548例患者]；P < .001），但没有证据表明不适当方案的差异（1.3%[7 / 548例患者]vs 2.4%[13 / 548例患者]；P = .21）。与提示相比，微调gpt - 40并没有提高最佳方案的比例（96.2%[548例患者中的527例]vs 96.2%[548例患者中的527例]；P < 0.05）。在亚组分析中，符合参考标准的方案比例在放射科医师（79.4%[218例患者中的173例]）、研究员（74.9%[219例患者中的164例]）和住院医师（72.1%[111例患者中的80例]；P = 0.30）中相似。对于腹部和骨盆CT扫描的方案，在详细的优化提示下，LLM gpt - 40比放射科医生更频繁地选择最佳方案，并且模型的微调并没有进一步提高性能。©RSNA， 2026本文提供补充材料。

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引用次数: 0

Clinical Guidelines and Their Role in Trauma-related Cervical Spine Imaging. 临床指南及其在创伤相关颈椎影像学中的作用。

IF 19.7 1区医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

Radiology

Pub Date : 2026-01-01 DOI: 10.1148/radiol.252327

Masis Isikbay,Jason Talbott

引用次数: 0

Ensuring Sound Human-AI Collaboration through Uncertainty Indicators. 通过不确定性指标确保良好的人类与人工智能协作。

IF 15.2 1区医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

Radiology

Pub Date : 2026-01-01 DOI: 10.1148/radiol.252631

Seong Ho Park

引用次数: 0

Prevalence, Co-occurrence, and Prognostic Implications of S Modifiers in the Korean National Lung Cancer Screening Program. 韩国国家肺癌筛查项目中S修饰剂的患病率、共发率和预后意义

IF 19.7 1区医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

Radiology

Pub Date : 2026-01-01 DOI: 10.1148/radiol.251656

Hyungjin Kim,Eunseo Jo,Jinseob Kim,Soon Ho Yoon,Eui Jin Hwang,Hyewon Choi,Kwang Nam Jin,Kyung Hee Lee,Yeun-Chung Chang,Hyae Young Kim,Jin Mo Goo

Background The documentation of clinically significant incidental findings (S modifiers) in low-dose CT lung cancer screening varies among radiologists. Although the Korean National Lung Cancer Screening Program adopted structured reporting for seven standardized S modifiers, the prognostic value of standardized S modifiers has not been evaluated comprehensively. Purpose To evaluate the implementation of structured reporting for prespecified S modifiers by analyzing their prevalence, mortality associations, and co-occurrence patterns. Materials and Methods This retrospective study included baseline screening participants from the Korean National Lung Cancer Screening Program between August 2019 and December 2020. The prevalence of seven S modifiers was calculated, and their prognostic value for all-cause mortality was assessed using multivariable Cox regression. Latent class analysis (LCA) was performed to identify co-occurrence patterns, which were analyzed for mortality risk stratification. Results Among 125 600 participants (mean age ± SD, 62 years ± 5.3; 123 331 men), 2.69% (n = 3380) died over a median follow-up of 3.7 years. Coronary artery calcification was most prevalent (15.07% [18 892 of 125 366 participants]), followed by emphysema (13.77% [17 300 of 125 600 participants]), interstitial lung abnormalities (ILAs) (2.65% [3324 of 125 600 participants]), and pulmonary infection (0.90% [1123 of 124 477 participants]). Extrapulmonary malignancy (74 of 125 257 participants), aortic aneurysm (78 of 125 256 participants), and pleural and/or pericardial effusion (75 of 125 253 participants) were each observed in less than 0.1% of participants. All S modifiers were associated with increased all-cause mortality, with adjusted hazard ratios (HRs) of 8.28 (95% CI: 5.48, 12.51) for pleural and/or pericardial effusion, 3.58 (95% CI: 1.97, 6.49) for extrapulmonary malignancy, 3.28 (95% CI: 1.71, 6.32) for aortic aneurysm, 2.16 (95% CI: 1.89, 2.47) for ILAs, 1.41 (95% CI: 1.30, 1.53) for coronary artery calcification, and 1.15 (95% CI: 1.05, 1.25) for emphysema (P < .001 for all except for emphysema, with P = .002). LCA helped identify four distinct classes with a stepwise increase in mortality from isolated emphysema (adjusted HR, 1.22; 95% CI: 1.10, 1.36; P < .001) to high-risk modifiers (adjusted HR, 5.35; 95% CI: 3.40, 8.41; P < .001). Conclusion In a nationwide lung cancer screening group, structured reporting using seven standardized S modifiers revealed both their prevalence and associations with all-cause mortality, validating their clinical utility in identifying clinically significant abnormalities. © RSNA, 2026 Supplemental material is available for this article. See also the editorial by White and Gierada in this issue.

背景低剂量CT肺癌筛查中有临床意义的偶然发现（S modifiers）的记录在不同的放射科医生之间存在差异。虽然韩国国家肺癌筛查计划采用了7种标准化S修饰因子的结构化报告，但标准化S修饰因子的预后价值尚未得到全面评估。目的通过分析S修饰因子的患病率、死亡率关联和共现模式，评估预指定S修饰因子结构化报告的实施情况。材料和方法本回顾性研究纳入了2019年8月至2020年12月期间韩国国家肺癌筛查计划的基线筛查参与者。计算7种S修饰因子的流行率，并使用多变量Cox回归评估其对全因死亡率的预后价值。进行潜在分类分析（LCA）以确定共发生模式，并对其进行死亡风险分层分析。结果在12600名参与者（平均年龄±SD， 62岁±5.3岁；12331名男性）中，2.69% （n = 3380）在中位随访3.7年期间死亡。冠状动脉钙化最为常见（15.07%[18892 / 12366]），其次是肺气肿（13.77%[17300 / 12600]）、肺间质异常（2.65%[3324 / 12600]）和肺部感染（0.90%[1123 / 12477]）。肺外恶性肿瘤（125 257名参与者中的74名）、主动脉瘤（125 256名参与者中的78名）和胸膜和/或心包积液（125 253名参与者中的75名）在不到0.1%的参与者中均被观察到。所有S修饰因子均与全因死亡率增加相关，胸膜和/或心包积液的校正危险比（hr）为8.28 (95% CI: 5.48, 12.51)，肺外恶性肿瘤的校正危险比（hr）为3.58 (95% CI: 1.97, 6.49)，主动脉瘤的校正危险比（hr）为3.28 (95% CI: 1.71, 6.32)， ILAs的校正危险比（hr）为2.16 (95% CI: 1.89, 2.47)，冠状动脉钙化的校正危险比（hr）为1.41 (95% CI: 1.30, 1.53)，肺气肿的校正危险比（hr）为1.15 (95% CI: 1.05, 1.25)（除肺气肿外，所有校正危险比P < 0.001, P = 0.002）。LCA有助于确定孤立性肺气肿死亡率逐步增加的四种不同类型（校正后的风险比，1.22;95% CI: 1.10, 1.36; P < .001）到高危因素（校正后的风险比，5.35;95% CI: 3.40, 8.41; P < .001）。结论：在全国范围的肺癌筛查组中，使用7个标准化S修饰词的结构化报告揭示了其患病率及其与全因死亡率的关联，验证了其在识别临床显著异常方面的临床应用。©RSNA， 2026本文提供补充材料。参见怀特和吉拉达在本期的社论。

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引用次数: 0

Pediatric-onset Lupus Mesenteric Vasculitis. 小儿狼疮肠系膜血管炎。

IF 15.2 1区医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

Radiology

Pub Date : 2026-01-01 DOI: 10.1148/radiol.252508

Yajie Wang, Yuhan Zhou

引用次数: 0

Editor's Note: January 2026. 编者按：2026年1月。

IF 15.2 1区医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

Radiology

Pub Date : 2026-01-01 DOI: 10.1148/radiol.269001

Suhny Abbara

引用次数: 0

Survival Outcomes of Microwave Ablation Compared with Repeat Liver Resection in the Treatment of Recurrent Intrahepatic Cholangiocarcinoma. 微波消融与重复肝切除术治疗复发性肝内胆管癌的生存期比较。

IF 15.2 1区医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

Radiology

Pub Date : 2026-01-01 DOI: 10.1148/radiol.243254

Chuan Pang, Jianming Li, Chao An, Zhen Wang, Zhishuai Li, Qi Chen, Ruizhao Qi, Fan Xiao, Jing Liu, Xiaopeng Gao, Maoping Li, Haitao Lv, Dongrui Li, Xinglan Liu, Guoyong Hua, Minghui Yang, Feng Liang, Jie Yu, Ping Liang

Background Only a minority of patients with recurrent intrahepatic cholangiocarcinoma (iCCA) are eligible for repeat resection. However, whether they benefit from minimally invasive ablation treatment is unclear. Purpose To compare the survival outcomes in microwave ablation (MWA) and repeat liver resection (rLR) in the treatment of first recurrent iCCA. Materials and Methods In this secondary analysis of a prospective study (Microwave Ablation and Liver Resection for Intrahepatic Cholangiocarcinoma [MALRIC]) from January 2009 to June 2024, participants from 10 hospitals who underwent curative-intent MWA or rLR for recurrent iCCA within Milan-equivalent criteria were identified. One-to-many propensity score matching and overlap weighting were used to balance baseline characteristics. The primary and secondary outcomes were overall survival (OS) and disease-free survival (DFS), respectively. Log-rank test and Cox stratified modeling on matched sets tested survival differences. Results MWA (n = 375) or rLR (n = 119) was performed in 494 participants (mean age, 57.8 years ± 10.7 [SD]; 344 men). Compared with rLR, participants who underwent MWA had similar OS (MWA vs rLR median, 29.8 vs 34.0 months, respectively; hazard ratio [HR], 0.89; 95% CI: 0.68, 1.17; P = .31) and DFS (MWA vs rLR median, 10.7 vs 14.8 months; HR, 0.78; 95% CI: 0.61, 1.00; P = .07). RLR showed improved DFS compared with MWA when the primary tumor was the large duct subtype (HR, 0.51; 95% CI: 0.32, 0.91; P = .03); there were no surgical complications after the initial resection (HR, 0.72; 95% CI: 0.52, 0.98; P = .04), and the DFS was less than 12 months (HR, 0.65; 95% CI: 0.46, 0.92; P = .02). Compared with rLR, participants who underwent MWA had shorter hospitalization (median, 9 vs 14 days; P < .001) and fewer complications above Clavien-Dindo grade II (rLR vs MWA, 31.3% vs 5.5%, respectively; P < .001). Conclusion Compared with rLR, MWA resulted in similar OS and DFS, and better perioperative outcomes. Clinical trial registration no. NCT06462742 © RSNA, 2026 Supplemental material is available for this article. See also the editorial by Georgiades in this issue.

背景：只有少数复发性肝内胆管癌（iCCA）患者符合重复切除的条件。然而，他们是否受益于微创消融治疗尚不清楚。目的比较微波消融术（MWA）与重复肝切除术（rLR）治疗首次复发iCCA的生存率。在2009年1月至2024年6月的一项前瞻性研究（微波消融和肝切除术治疗肝内胆管癌[MALRIC]）的二级分析中，确定了来自10家医院的复发性胆管癌患者，他们在米兰等效标准下接受了治疗意图MWA或rLR。使用一对多倾向评分匹配和重叠加权来平衡基线特征。主要和次要终点分别是总生存期（OS）和无病生存期（DFS）。配对集的Log-rank检验和Cox分层模型检验了生存差异。结果494名参与者（平均年龄57.8岁±10.7 [SD]，男性344名）进行了MWA （n = 375）或rLR （n = 119）。与rLR相比，接受MWA的参与者具有相似的OS （MWA vs rLR中位数，分别为29.8 vs 34.0个月；风险比[HR]， 0.89; 95% CI: 0.68, 1.17; P = 0.31）和DFS （MWA vs rLR中位数，10.7 vs 14.8个月；HR, 0.78; 95% CI: 0.61, 1.00; P = 0.07）。原发肿瘤为大导管亚型时，RLR与MWA相比，DFS有所改善（HR, 0.51; 95% CI: 0.32, 0.91; P = 0.03）；首次切除后无手术并发症（HR, 0.72; 95% CI: 0.52, 0.98; P = 0.04）， DFS小于12个月（HR, 0.65; 95% CI: 0.46, 0.92; P = 0.02）。与rLR相比，接受MWA的参与者住院时间更短（中位数，9天vs 14天，P < 0.001）， Clavien-Dindo II级以上并发症更少（rLR vs MWA，分别为31.3% vs 5.5%, P < 0.001）。结论与rLR相比，MWA的OS和DFS相似，围手术期预后更好。临床试验注册号：NCT06462742©RSNA， 2026本文提供补充材料。另见乔治亚德斯在本期的社论。

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引用次数: 0

Intrahepatic Cholangiocarcinoma: Local-Regional Therapies Join the Fight. 肝内胆管癌：局部-区域治疗加入战斗。

IF 15.2 1区医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

Radiology

Pub Date : 2026-01-01 DOI: 10.1148/radiol.253806

Christos Georgiades

引用次数: 0

Symptomatic Nonacute Intracranial Artery Occlusion: Challenges in Treatment Despite Advances. 症状性非急性颅内动脉闭塞：尽管有进展，但治疗的挑战。

IF 19.7 1区医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

Radiology

Pub Date : 2026-01-01 DOI: 10.1148/radiol.253630

Neeraj Chaudhary,Zachary M Wilseck

引用次数: 0

Imaging Subclinical Fibrosis from Air Pollution: Hidden Burden, Visible Signal. 空气污染引起的亚临床纤维化成像：隐藏的负担，可见信号。

IF 15.2 1区医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

Radiology

Pub Date : 2025-12-01 DOI: 10.1148/radiol.252193

Can Xu, Xinyu Nie, Dongjin Wang

引用次数: 0

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