Radiology最新文献

Lung cancer is the leading cause of cancer deaths globally. In various trials, the ability of low-dose CT screening to diagnose early lung cancers leads to high cure rates. It is widely accepted that the potential benefits of low-dose CT screening for lung cancer outweigh the harms. The ability to reliably predict the benignity of nodules, especially at the baseline round, further reduces the potential for harm. Pleural-attached nodules are an important subgroup that represents nodules attached (distance from any pleural surface, 0 mm) to any pleural surfaces (fissural, costal, mediastinal, and diaphragmatic). Pleural-attached solid nodules less than 10 mm in average diameter with smooth margins and triangular, lentiform, oval, or semicircular shapes have a high likelihood of benignity. The 2019 Lung CT Screening Reporting and Data System (Lung-RADS) version 1.1 assigned pleural-attached nodules with these features to categories 3 (probably benign, recommend follow-up in 6 months) or 4 (suspicious for malignancy, recommend follow-up in 3 months or PET/CT). However, Lung-RADS version 2022 now recommends annual follow-up rather than short-term follow-up. These changes downgrade these nodules to category 2 (benign) and limits additional workup. This review article summarizes the terminology used to describe these nodules, characteristics for determining benignity, and the accuracy of the evidence used to make these recommendations.

Over the past decade, advancements in rectal cancer research have reshaped treatment paradigms. Historically, treatment for locally advanced rectal cancer has focused on neoadjuvant long-course chemoradiotherapy, followed by total mesorectal excision. Interest in organ preservation strategies has been strengthened by the introduction of total neoadjuvant therapy with improved rates of complete clinical response. The administration of systemic induction chemotherapy and consolidation chemoradiotherapy in the neoadjuvant setting has introduced a new dimension to the treatment landscape and patients now face a more intricate decision-making process, given the expanded therapeutic options. This complexity underlines the importance of shared decision-making and brings to light the crucial role of radiologists. MRI, especially high-spatial-resolution T2-weighted imaging, is heralded as the reference standard for rectal cancer management because of its exceptional ability to provide staging and prognostic insights. A key evolution in MRI interpretation for rectal cancer is the transition from the DISTANCE mnemonic to the more encompassing DISTANCED-DIS, distal tumor boundary; T, T stage; A, anal sphincter complex; N, nodal status; C, circumferential resection margin; E, extramural venous invasion; D, tumor deposits. This nuanced shift in the mnemonic captures a wider range of diagnostic indicators. It also emphasizes the escalating role of radiologists in steering well-informed decisions in the realm of rectal cancer care.

Background Endovascular thrombectomy (EVT) is an effective method for vertebrobasilar artery occlusion (VBAO) in patients with moderate to severe deficits but has unclear benefits in patients with low National Institutes of Health Stroke Scale (NIHSS) scores at hospital admission. Purpose To compare the clinical outcomes of best medical management (BMM) alone versus BMM and early EVT (door-to-puncture time [DPT] ≤ 120 minutes) versus BMM and late EVT (DPT > 120 minutes) in patients with VBAO who have NIHSS scores of 10 or less at admission. Materials and Methods This retrospective study evaluated patients with VBAO and admission NIHSS score of 10 or less who were seen at 65 stroke centers in China from December 2015 to June 2022. The primary outcome was whether the patient achieved a favorable functional outcome (a modified Rankin scale [mRS] score of 0-3 at 90 days). Adjusted multivariable logistic regression analyses were used to assess the association between treatment (BMM alone vs early EVT and BMM vs late EVT and BMM) and outcomes. Results Among 1365 patients (mean age ± SD, 65 years ± 12; 951 male) with VBAO and an NIHSS score of 10 or less at admission, 489 patients (35.8%) received EVT. Of these, 382 (78.1%) received early EVT, and 107 (21.9%) received late EVT. After adjustment for confounders, compared with BMM alone, early EVT plus BMM was associated with increased rates of favorable functional outcome (odds ratio [OR], 1.41 [95% CI: 1.05, 1.87]; P = .02), whereas late EVT plus BMM did not outperform BMM alone (OR, 0.83 [95% CI: 0.54, 1.28]; P = .39). Conclusion In patients with VBAO admitted with an NIHSS score of 10 or less, early EVT (DPT ≤ 120 minutes) combined with BMM outperformed BMM alone, whereas late EVT (DPT > 120 minutes) combined with BMM did not outperform BMM alone. © RSNA, 2025 Supplemental material is available for this article.

History: A 61-year-old male patient without prior history of ophthalmologic problems presented with pain and redness in the left eye associated with slowly progressive proptosis over the previous 6 months. The patient also had diplopia in rightward and downward gaze. There was no vision loss. Mild fullness was seen in the periorbital tissues without any redness or fluctuance and with no purulent discharge from the left eye. The patient was otherwise healthy, with a 6-year history of diabetes mellitus and an 8-year history of hypertension managed well with medication. There was no history of trauma to the head or face. At clinical examination, conjunctival edema and redness with proptosis were noted. The cornea was clear. Evaluation of eye movements revealed restricted motion of the left eye in medial gaze and downward gaze. Ophthalmoscopic evaluation did not show any substantial abnormality. The retina and retinal vascularity were unremarkable. The right eye was unremarkable. Uncorrected visual acuity was 20/30 in the right eye and 20/40 in the left eye. Corrected visual acuity was 20/20 in both eyes. Complete blood cell count, as well as liver and kidney function test results, were within normal limits. The erythrocyte sedimentation rate and C-reactive protein level were normal. Thyroid function test results were normal. The patient subsequently underwent CT of the orbits without and with contrast enhancement followed by further evaluation with MRI of the orbits without and with contrast enhancement.

Background The increasing workload of radiologists can lead to burnout and errors in radiology reports. Large language models, such as OpenAI's GPT-4, hold promise as error revision tools for radiology. Purpose To test the feasibility of GPT-4 use by determining its error detection, reasoning, and revision performance on head CT reports with varying error types and to validate its clinical utility by comparison with human readers. Materials and Methods A total of 10 300 head CT reports were retrospectively extracted from the Medical Information Mart for Intensive Care III public dataset. In experiment 1, among the 300 unaltered reports and 300 versions with applied errors, GPT-4 optimization was initially conducted with 200 reports. The remaining 400 were used for evaluation of error type detection, reasoning, and revision, as well as the analysis of reports with undetected errors. The performance was also compared with that of human readers. In experiment 2, the detection performance of GPT-4 was validated on 10 000 unaltered reports that were deemed error-free by physicians, and an analysis of false-positive results was conducted. A permutation test was conducted to assess differences in performance. Results GPT-4 demonstrated commendable performance in error detection (sensitivity, 84% for interpretive error and 89% for factual error), reasoning, and revision. Compared with GPT-4, human readers had worse factual error detection sensitivity (0.33-0.69 vs 0.89; P = .008 for radiologist 4, P < .001 for others) and took longer to review (82-121 seconds vs 16 seconds, P < .001). In 10 000 reports, GPT-4 detected 96 errors, with a low positive predictive value of 0.05, yet 14% of the false-positive responses were potentially beneficial. Conclusion GPT-4 effectively detects, reasons, and revises errors in radiology reports. While it shows excellent performance in identifying factual errors, its ability to prioritize clinically significant findings is limited. Recognizing its strengths and limitations, GPT-4 could serve as a feasible tool. © RSNA, 2025 Supplemental material is available for this article. See also the editorial by Choi in this issue.