Radiology最新文献

The United States is facing shortages in a myriad of medical fields, including diagnostic radiology (DR). The increasing number of imaging studies, owing to advancing technology and an aging population, is outgrowing the capacity of radiologists. However, there have not been effective long-term solutions to manage this issue, which could have a looming effect on patient care and radiology residents' education. The alternate pathway introduced by the American Board of Radiology (ABR) allows international medical graduates (IMGs) who have completed DR residency outside the U.S. and Canada to be eligible for board certification after 4 additional years of training in the U.S. This eligibility requirement can be met by a combination of fellowships, up to 3 years of residency, and/or faculty appointments at the same time. The criteria were updated in 2022, facilitating the certification process for applicants. The changes included completing the 4 years of training within 8 years instead of the preapproved 4 consecutive years, omitting the obligatory 4 months of nuclear radiology training, and the ability to retrospectively include 2 years of training before the date of application. Considering the lack of reliable, up-to-date data in the literature and to highlight the importance of this pathway for the radiology community, this special report discusses the contribution of IMGs to the different aspects of the health care system in the U.S., with a focus on DR, as well as the newly updated alternate pathway criteria. Potential critical logistic challenges the IMG applicants may face are reviewed. Finally, the report proposes actions that could facilitate the ABR certification process and help integrate these highly qualified IMG radiologists into the American health care system.

Background The ScreenTrustCAD trial was a prospective study that evaluated the cancer detection rates for combinations of artificial intelligence (AI) computer-aided detection (CAD) and two radiologists. The results raised concerns about the tendency of radiologists to agree with AI CAD too much (when AI CAD made an erroneous flagging) or too little (when AI CAD made a correct flagging). Purpose To evaluate differences in recall proportion and positive predictive value (PPV) related to which reader flagged the mammogram for consensus discussion: AI CAD and/or radiologists. Materials and Methods Participants were enrolled from April 2021 to June 2022, and each examination was interpreted by three independent readers: two radiologists and AI CAD, after which positive findings were forwarded to the consensus discussion. For each combination of readers flagging an examination, the proportion recalled and the PPV were calculated by dividing the number of pathologic evaluation-verified cancers by the number of positive examinations. Results The study included 54 991 women (median age, 55 years [IQR, 46-65 years]), among whom 5489 were flagged for consensus discussion and 1348 were recalled. For examinations flagged by one reader, the proportion recalled after flagging by one radiologist was larger (14.2% [263 of 1858]) compared with flagging by AI CAD (4.6% [86 of 1886]) (P < .001), whereas the PPV of breast cancer was lower (3.4% [nine of 263] vs 22% [19 of 86]) (P < .001). For examinations flagged by two readers, the proportion recalled after flagging by two radiologists was larger (57.2% [360 of 629]) compared with flagging by AI CAD and one radiologist (38.6% [244 of 632]) (P < .001), whereas the PPV was lower (2.5% [nine of 360] vs 25.0% [61 of 244]) (P < .001). For examinations flagged by all three readers, the proportion recalled was 82.6% (400 of 484) and the PPV was 34.2 (137 of 400). Conclusion A larger proportion of participants were recalled after initial flagging by radiologists compared with those flagged by AI CAD, with a lower proportion of cancer. ClinicalTrials.gov Identifier: NCT04778670 © RSNA, 2025 See also the editorial by Grimm in this issue.

Background The Liver Imaging Reporting and Data System (LI-RADS) criteria have not been validated for patients with noncirrhotic chronic hepatitis C (CHC), who are at a greater risk for hepatocellular carcinoma (HCC) than the general population. Purpose To evaluate the diagnostic performance of LI-RADS category 5 (LR-5, indicating definite HCC) observations for HCC using CT and MRI in patients with noncirrhotic CHC and to compare these findings with those in patients with cirrhotic CHC. Materials and Methods This retrospective study included patients without cirrhosis with CHC with focal hepatic nodules of 1 cm or greater on dynamic CT or MRI scans who underwent pathologic confirmation at two university hospitals from August 2002 to February 2022. This group served as the test dataset. The primary outcome was the diagnostic performance of LR-5 for HCC using CT and MRI. When LI-RADS categorization differed between CT and MRI, the MRI-based classification was used as the definitive category. Results were validated using a dataset of patients with CHC from two additional hospitals based on the clinical composite reference standard. Sensitivity, specificity, and area under the receiver operating characteristic curve (AUC) were calculated. Results The test dataset comprised 458 patients (mean age, 64 years ± 9 [SD]; 350 male; 219 without cirrhosis, 239 with cirrhosis). For noncirrhotic livers, the LR-5 criteria achieved an AUC, accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of 0.90 (95% CI: 0.86, 0.93), 85.1% (95% CI: 80.6, 89.7), 82.4% (95% CI: 77.0, 87.8), 97.6% (95% CI: 93.0, 100.0), 99.4% (95% CI: 98.2, 100.0), and 54.7% (95% CI: 43.4, 65.9), respectively. The AUC for LR-5 observations in diagnosing HCC was higher in the noncirrhotic liver group compared with the cirrhotic liver group (AUC, 0.90 [95% CI: 0.86, 0.93] vs 0.79 [95% CI: 0.74, 0.84]; P = .002). The diagnostic performance of the LR-5 criteria for diagnosing HCC was also excellent in patients with noncirrhotic CHC in the validation dataset, which included 155 lesions from 103 patients (mean age, 68 years ± 12; 146 male). The AUC, accuracy, sensitivity, specificity, PPV, and NPV in the validation dataset were 0.91 (95% CI: 0.84, 0.97), 96.1% (95% CI: 93.1, 99.2), 82.9% (95% CI: 70.4, 95.3), 100%, 100%, and 95.2% (95% CI: 91.5, 99.0), respectively. Conclusion The diagnostic performance of LR-5 for HCC in patients with noncirrhotic CHC was comparable to that in patients with cirrhosis across various clinical settings. © RSNA, 2025 Supplemental material is available for this article. See also the editorial by Schöllnast in this issue.

History: A 66-year-old male patient with a background history of hypertension and no history of liver disease was found to have mildly deranged liver function test results as part of his annual hypertension review. Clinical examination findings were unremarkable, the patient was afebrile (36.8 °C), and other vital observations were within normal limits. Full blood count and urea and creatinine levels were within normal limits; however, liver function tests revealed a mildly elevated alanine aminotransferase level of 61 IU/L (1.02 µkat/L) (reference range, 0-40 IU/L [0-0.67 µkat/L]), and a mildly elevated γ-glutamyltransferase level of 52 IU/L (0.88 µkat/L) (reference range, 0-50 IU/L [0-0.83 µkat/L]). The patient subsequently underwent US examination of the abdomen, which revealed a large liver lesion in an otherwise normal liver with no imaging features of cirrhosis. MRI of the liver was performed for further characterization (Fig 1). The patient subsequently underwent resection of the large mass and surgical pathology. Surveillance MRI was performed 4 months after surgery (Fig 2).

Despite the successful application of Imaging Reporting and Data Systems to improve the radiologic description and management of disease in many organs, one does not yet exist for the kidney. Instead, the radiologic approach to the kidney has focused on the Bosniak classification system, which is based on imaging characteristics for cystic renal masses, and detecting macroscopic fat within solid renal masses. Radiologically, cystic and solid renal masses are categorized and evaluated separately because of historical precedent, differences in appearance at imaging, and differences in biologic behavior. However, the World Health Organization classification of renal neoplasms does not support such separation. Further, the primary goal has been cancer diagnosis. Differentiating benign from malignant masses is important, but data show that many renal cancers, particularly when small, will not cause harm. Therefore, a critical goal of any unifying, single, imaging-based classification of kidney masses (ie, a Kidney Imaging Reporting and Data System) should be predicting the biologic behavior or aggressiveness of suspected kidney cancer. This system could inform the need for treatment or active surveillance and reduce prevalent overdiagnosis and overtreatment. This review describes the rationale for and challenges in creating such a system and the research needed for it to be developed.

Background The clinical, radiologic, and prognostic implications of interstitial pneumonia with autoimmune features (IPAF) in patients with idiopathic interstitial pneumonia and pathologic usual interstitial pneumonia (UIP) have not been fully evaluated. Purpose To compare autoimmune features according to CT patterns for the diagnosis of idiopathic pulmonary fibrosis (IPF) and to assess the diagnostic and prognostic implications of IPAF in patients with IPF-UIP. Materials and Methods This retrospective study included patients with UIP confirmed by surgical lung biopsy between January 2013 and February 2020. Data regarding clinical, radiologic, and pathologic autoimmune features were collected, and patients were diagnosed with IPAF according to current guidelines. CT signs for connective tissue disease (CTD; anterior upper lobe, straightedge, and exuberant honeycombing signs) were also evaluated. Overall survival (OS) was evaluated using Cox proportional hazards models. Results Among 210 patients included (median age, 64 years; IQR, 60-68 years; 158 male patients), 23 (11.0%) had IPAF. Patients with an alternative diagnosis or CT pattern indeterminate for UIP showed a higher prevalence of autoimmune features that were pathologic (38% [33 of 87] vs 20.3% [25 of 123]; P = .005) and serologic (20% [17 of 87] vs 9.8% [12 of 123]; P = .04) and IPAF (4.1% [five of 123] vs 21% [18 of 87]; P < .001) compared with patients with UIP or probable UIP pattern. However, IPAF was not predictive of OS (hazard ratio [HR], 0.81; 95% CI: 0.38, 1.72; P = .58). Lymphoid follicles (HR, 0.59; 95% CI: 0.37, 0.93; P = .02), CT signs for CTD (HR, 0.31; 95% CI: 0.09, 0.99; P = .047), and use of an antifibrotic agent (HR, 0.31; 95% CI: 0.19, 0.51; P < .001) were independently associated with higher OS, and greater extent of fibrosis on CT scans was associated with worse OS (HR, 1.08; 95% CI: 1.05, 1.11; P < .001). Conclusion In patients with IPF-pathologic UIP, serologic and pathologic autoimmune features were associated with indeterminate or alternative CT patterns. Certain histopathologic and radiologic autoimmune features, but not current IPAF criteria, were associated with survival. © RSNA, 2025 Supplemental material is available for this article. See also the editorial by Ackman in this issue.