Radiology最新文献

Lung cancer in individuals who have never smoked (LCINS) constitutes a growing global health challenge, accounting for 10%-25% of lung cancer cases and ranking as the fifth leading cause of cancer-related death worldwide. LCINS is especially common in East Asian women. LCINS arises from multiple nonsmoking-related risk factors, including secondhand smoke, air pollution, radon exposure, genetic susceptibility, and aging. LCINS exhibits unique biologic characteristics, with a predominance of adenocarcinoma, a high prevalence of actionable driver mutations (EGFR, ALK, ROS1), and a lower tumor mutational burden. Although chest low-dose CT (LDCT) screening has shown potential for early detection of LCINS, its widespread application in populations at low risk for developing lung cancer raises concerns about overdiagnosis, overtreatment, and radiation exposure, with mortality benefits yet to be demonstrated. Future screening strategies should focus on ensuring precise risk stratification, optimizing screening intervals, and minimizing potential harm. Incorporating demographic, clinical, genetic, and environmental data-potentially supported by artificial intelligence-may enable more personalized approaches. Given the indolent nature of many screen-detected LCINS, there is a need to shift the clinical mindset toward prioritizing active surveillance instead of immediate surgery. Overall, LDCT screening for LCINS requires careful balancing of potential benefits and harms, underscoring the need for tailored, evidence-based strategies.

Background The risk of nephrogenic systemic fibrosis (NSF) following administration of contemporary gadolinium-based contrast agents (GBCAs) in patients with advanced chronic kidney disease (CKD) or end-stage renal disease (ESRD) is thought to be low; however, existing reports have involved relatively few participants compared with the number of patients who might benefit from contrast-enhanced MRI in the United States. Purpose To estimate the risk of NSF with contemporary GBCAs in real-world practice in patients with advanced CKD or ESRD. Materials and Methods Adult patients with preexisting diagnoses of stage 4 or 5 CKD or ESRD who received GBCAs between January 2010 and January 2025 were identified retrospectively from the TriNetX U.S. Network. Propensity score matching (PSM) with a control group regarding demographic characteristics and comorbidities was performed to reduce confounding. The primary endpoint (possible NSF [International Statistical Classification of Diseases and Related Health Problems, 10th Revision, code L90.8]) and secondary endpoint (possible NSF confounders) were assessed within 1 year. Risk ratios (RRs) were calculated to assess the occurrence and mortality rates of possible NSF, and the Kaplan-Meier log-rank test was used to compare cumulative occurrence rates. Results A total of 73 022 adults (mean age, 64.1 years ± 15.1 [SD]; 39 359 [53.9%] male) with advanced CKD or ESRD who received GBCAs were identified. After PSM, 36 (0.05%) and 542 (0.74%) patients with advanced CKD or ESRD with possible NSF and NSF confounder codes, respectively, were retained, compared with 36 (0.05%) and 518 (0.71%) in controls, respectively (RR, 1.00 [95% CI: 0.63, 1.59] [P > .99] and 1.05 [95% CI: 0.93, 1.18] [P = .46]). Diagnostic code rates were similar for patients who received American College of Radiology group II GBCAs and macrocyclic GBCAs, with no evidence of a difference from those of the controls without advanced CKD or ESRD. Conclusion In this real-world database analysis, the probability of a diagnostic code for possible NSF following contemporary GBCA administration in patients with advanced CKD or ESRD was exceedingly low and not significantly greater than that of matched controls without renal dysfunction. © The Authors 2025. Published by the Radiological Society of North America under a CC BY 4.0 license. Supplemental material is available for this article. See also the editorial by Li in this issue.

Background Prostate-specific membrane antigen (PSMA)-targeted PET has revolutionized prostate cancer imaging, but the sensitivity at low prostate-specific antigen levels is lacking. Copper 61 (⁶¹Cu) is a positron emitter with favorable physical characteristics that allow for delayed imaging, which may result in improved sensitivity. Purpose To evaluate the safety, dosimetry, optimal imaging parameters, and initial efficacy of a novel ⁶¹Cu-labeled PSMA-targeting radiotracer, ⁶¹Cu-1,4,7-triazacyclononane,1-glutaric acid-4,7-acetic acid (NODAGA)-PSMA for imaging and therapy (I&T) (hereafter, ⁶¹Cu-PSMA I&T). Materials and Methods This was a phase 1 trial of the ⁶¹Cu-labeled PSMA-targeting radiotracer, ⁶¹Cu-PSMA I&T (NCT06736054). Between October 2024 and February 2025, participants with PSMA-avid disease at fluorine 18 (¹⁸F)-piflufolastat PET/CT performed within 30 days of ⁶¹Cu-PSMA I&T PET/CT were administered 155-318 MBq of ⁶¹Cu-PSMA and then underwent PET/CT 1, 2, and 4 hours after administration and blood sampling for dosimetry. The number of suspected malignant lesions and the degree of radiotracer uptake in lesion and background tissues were compared between ⁶¹Cu-PSMA I&T and ¹⁸F-piflufolastat. Results Eight male participants (mean age, 73 years ± 10.9 [SD]) completed the trial. No adverse events were noted. A low dose of 155 MBq of ⁶¹Cu-PSMA I&T was adequate for imaging. Dosimetry calculations demonstrated that the kidney (mean, 0.30 mGy/MBq) and lacrimal glands (mean, 0.17 mGy/MBq) received the highest doses, whereas the whole-body mean effective dose was 0.029 mSv/MBq. ⁶¹Cu-PSMA I&T PET/CT images obtained 4 hours after tracer administration showed the largest number of suspected malignant lesions, the highest radiotracer uptake in the lesions, and the lowest radiotracer uptake in the background tissues. In four of the eight participants, more suspected malignant lesions were identified with ⁶¹Cu-PSMA I&T than with ¹⁸F-piflufolastat. Conclusion ⁶¹Cu-PSMA I&T was well tolerated, and no adverse events were reported in this phase 1 trial. ⁶¹Cu-PSMA I&T demonstrated acceptable dosimetry and was used for successful imaging in patients with metastatic prostate cancer. Optimal images were obtained 4 hours after tracer administration. ClinicalTrials.gov identifier no. NCT06736054. © RSNA, 2025 Supplemental material is available for this article. See also the editorial by Sinha and El Khouli in this issue.