Radiology最新文献

Background Evaluating the extent of invasiveness for nonsolid nodules (NSNs) in patients with lung adenocarcinoma at CT could affect clinical decision-making but can be challenging. Purpose To investigate CT characteristics of NSNs associated with pathologic invasiveness and to develop a radiologic ternary classification model for differentiating among preinvasive lesions, minimally invasive adenocarcinoma (MIA), and invasive adenocarcinoma (IAC). Materials and Methods This retrospective study enrolled patients with pathologically confirmed lung adenocarcinoma and suspicious malignant NSNs measuring 3.0-30.0 mm on preoperative CT scans between January 2012 and June 2024. For each NSN, the size, location, margin, shape, nodule CT attenuation, uniformity of density, lobulation sign, reticulation sign, intranodular vessels, bubble-like lucency sign, air bronchogram sign, and pleural retraction sign were independently evaluated by two radiologists blinded to clinical information and pathology results. Univariable ordinal regression and partial proportional odds model analyses were performed. Three nested mixed-effects models were compared in differentiating pathologic invasiveness subtypes. Results This study included 1683 patients (median age, 53 years [IQR, 45-61 years]; 1145 women) with 2125 NSNs. Partial proportional odds model analysis demonstrated that the independent radiologic factors for predicting pathologic invasiveness were average diameter (preinvasive lesion vs MIA: odds ratio [OR], 1.34; MIA vs IAC: OR, 1.54), intranodular vessels (one vessel: OR, 2.22; two vessels: OR, 3.06; more than two vessels: OR, 25.16), mean CT attenuation (OR, 1.54), heterogeneous density (OR, 2.45), spiculation (OR, 1.72), lobulation (OR, 1.50), pleural retraction (OR, 1.43), bubble lucency (OR, 1.81), and air bronchogram (OR, 1.74). The overall diagnostic performance of the radiologic ternary classification model was excellent (C index, 0.92; 95% CI: 0.91, 0.92). Incorporating mean CT attenuation and morphologic features improved model performance in predicting NSN pathologic invasiveness compared with using nodule diameter alone (all P < .001). Conclusion The radiologic ternary classification model demonstrated excellent diagnostic performance in differentiating among preinvasive lesions, MIA, and IAC in NSNs detected on CT images. © RSNA, 2025 Supplemental material is available for this article. See also the editorial by Arita and Schalekamp in this issue.

Background T2-weighted MRI is the standard for visualizing MRI-guided focused ultrasound (MRgFUS) thalamotomy lesions in essential tremor (ET) and tremor-dominant Parkinson disease (TDPD); however, chronic lesion visibility is often variable, including low-contrast or undetectable lesions, complicating long-term assessment, especially in patients with tremor recurrence. Purpose To determine whether T1/T2-weighted ratio imaging improves the lesion normalized contrast (NC) of chronic MRgFUS thalamotomy-induced lesions compared with T2-weighted imaging. Materials and Methods This retrospective study included patients with ET or TDPD who underwent MRgFUS thalamotomy (January 2019 to November 2023). Lesion NC was quantified on T1/T2-weighted ratio and T2-weighted images at the 6-month follow-up. Between-modality NC comparisons used paired t tests. Similar analyses in patients with tremor recurrence used the Wilcoxon signed rank test. Between-evaluator agreement for lesion segmentation was assessed by comparing the average intraclass correlation coefficients (ICCs) via bootstrapping (95% CI for the difference). Spearman-skipped correlation analysis was performed to assess whether lesion overlap with the ventrolateral posterior ventral thalamic nucleus (VLpv) correlated with tremor relief from baseline to the 6-month follow-up. Results A total of 54 patients were included, 27 with ET and 27 with TDPD (mean age, 71.3 years ± 9.2 [SD]; 32 male patients). Lesion NC was higher for T1/T2-weighted ratio images (mean, 36.3% ± 18.2) than for T2-weighted images (mean, 19.2% ± 8.9) (P < .001). Similar results were found in patients with tremor recurrence (median NC at T1/T2-weighted ratio imaging, 45.2% [IQR, 14%-64%]; median NC at T2-weighted imaging, 25.3% [IQR, 9%-31%]). T1/T2-weighted ratio imaging had higher between-evaluator agreement (ICC = 0.94) than T2-weighted imaging (ICC = 0.81; 95% CI for the difference: 0.01, 0.32). Lesion VLpv overlap was positively correlated with tremor relief in patients with ET (T2-weighted imaging: ρ = 0.47 [95% CI: 0.10, 0.74]; T1/T2-weighted ratio: ρ = 0.53 [95% CI: 0.13, 0.76]) and TDPD (T2-weighted imaging: ρ = 0.42 [95% CI: 0.08, 0.67]; T1/T2-weighted imaging ratio: ρ = 0.48 [95% CI: 0.17, 0.66]). Conclusion T1/T2-weighted ratio imaging substantially improved chronic lesion NC compared with T2-weighted imaging, reducing interobserver variability and measurement error. © RSNA, 2025 Supplemental material is available for this article.

Neoplastic vertebral compression fractures are a debilitating complication of cancer, causing pain, limiting function, and reducing quality of life. Image-guided percutaneous vertebral augmentation (PVA) involves the injection of bone cement with or without a device into the vertebra. This offers effective stabilization and pain relief but has limitations. The standard polymethylmethacrylate cement is stiffer than native bone and lacks the ability to promote bone regeneration, raising concerns about poor biointegration and increased risk of future fractures. Moreover, exothermic polymerization can only destroy tumor cells within a limited area. Novel materials, such as polysiloxane, ceramics, and composites, offer improved bone integration and release of antineoplastic drugs. Additionally, various strategies that can be combined with PVA, such as radiation therapy, ablation techniques, interventional tumor removal, and minimally invasive screw fixation, could not only address the underlying neoplasm but also provide additional vertebral stabilization and reduce complications. While these advances hold promise, further research is needed to establish their safety and efficacy compared with the standard approach. Future endeavors should prioritize improving the mechanical properties of alternative materials to standard bone cement and facilitating large, long-term randomized controlled trials to validate the clinical outcomes of combined approaches and optimize treatment selection.

Background Accurately diagnosing lymph node metastasis (LNM) in patients with rectal cancer preoperatively can guide treatment but remains challenging. Purpose To develop and validate an enhanced MRI model incorporating the so-called dark-light-dark sign on contrast-enhanced T1-weighted MRI scans, tumor features, and European Society of Gastrointestinal and Abdominal Radiology (ESGAR) criteria for predicting pathologic LNM (pLNM) and to compare its efficacy to a nonenhanced MRI model without the dark-light-dark sign, ESGAR size and lymph node features alone, and lymph node short-axis diameter alone. Materials and Methods This two-center retrospective study included patients with rectal cancer who underwent primary surgery (center 1, January 2016 to December 2024; center 2, January 2016 to January 2019). The dark-light-dark sign was defined as the presence of an inner hypointense tumor (dark), an intermediate hyperintense rim (light), and an outer hypointense muscularis propria (dark). Enhanced and plain scan models were developed by using logistic regression. Diagnostic performance was compared with the receiver operating characteristic curve. Results The training set consisted of 922 patients, 354 of whom were pLNM positive (mean age, 60 years ± 12 [SD]; 211 men) and 568 of whom were pLNM negative (mean age, 61 years ± 11; 347 men); the external test set consisted of 149 patients, 73 of whom were pLNM positive (mean age, 61 years ± 12; 51 men) and 76 of whom were pLNM negative (mean age, 62 years ± 11; 45 men). The enhanced model yielded areas under the receiver operating characteristic curve (AUCs) of 0.89 (95% CI: 0.86, 0.90) and 0.83 (95% CI: 0.76, 0.90) in the training and external test sets, respectively, outperforming lymph node short-axis diameter alone, ESGAR alone, and the nonenhanced model (all P < .001). The enhanced model outperformed ESGAR features in subgroups with lymph node short-axis diameters of less than 5 mm (training set: AUC, 0.88 [95% CI: 0.85, 0.92]; external test set: AUC, 0.90 [95% CI: 0.80, 0.96]) and pathologic T2 stage (training set: AUC, 0.89 [95% CI: 0.84, 0.93]; external test set: AUC, 0.91 [95% CI: 0.80, 1.00]). Conclusion Integrating tumor characteristics-especially the dark-light-dark sign-with ESGAR status improved preoperative LNM diagnosis, particularly in patients with lymph nodes smaller than 5 mm or who had stage T2 tumors. © The Author(s). Published by the Radiological Society of North America under a CC BY 4.0 license. Supplemental material is available for this article.

Background Radiology staging reports (ie, oncologic reports) are written for referring physicians using complex medical terminology. Large language models (LLMs) show promise for simplifying medical text for patient use, but controlled studies evaluating the impact of LLM simplification on patients' comprehension of radiology reports are lacking. Purpose To evaluate whether LLM-based simplification of oncologic CT reports improves patients' cognitive workload, text comprehension, perception, and reading time. Materials and Methods This prospective, controlled, open-label, quasi-randomized trial enrolled 200 adults with cancer who underwent routine CT restaging. Between April and May 2025, participants were alternately assigned to receive either standard CT reports (100 participants) or LLM-simplified versions created using Llama 3.3 70B (Meta) with mandatory radiologist review (100 participants). The primary outcomes were participant-reported scores on nine seven-point Likert scale items, and composite scores, in the domains of cognitive workload, text comprehension, and report perception, as well as reading time. Secondary outcomes included readability metrics and independent radiologist assessments of report errors, usefulness, and quality. Statistical analyses included logistic regression adjusted for participant characteristics. Results Among the 200 participants (mean age, 64 years ± 14 [SD]; 112 male participants), simplified reports reduced the median reading time from 7 minutes to 2 minutes (P < .001). Participants who received simplified reports reported lower cognitive workload (adjusted odds ratio [OR], 0.18 [95% CI: 0.13, 0.25]), better comprehension (adjusted OR, 13.28 [95% CI: 9.31, 18.93]), and better perception of report usefulness (adjusted OR, 5.46 [95% CI: 3.55, 8.38]) than did those who received standard reports (all P < .001). Simplification improved report readability (mean Flesch-Kincaid Grade Level, 8.89 ± 0.93 vs 13.69 ± 1.13; P < .001). Radiologist review revealed factual errors in 6% (moderate, 2%; severe, 4%), content omissions in 7% (minor, 2%; moderate, 1%; severe, 4%), and inappropriate additions in 3% (minor, 1%; moderate, 2%) of simplified reports. Conclusion LLM simplification of oncologic CT reports improved patient comprehension and reduced reading burden. However, clinically relevant errors were identified. © RSNA, 2025 Supplemental material is available for this article.

Background Football (also called soccer) is a global phenomenon, and its followers exhibit a broad spectrum of behaviors, from spectatorship to intense emotional engagement, providing a useful model for studying social identity and emotional processing in competitive contexts. Although social affiliation has been widely studied, the neurobiological mechanisms of social identity in competitive settings are unclear. Purpose To investigate the brain mechanisms associated with emotional responses in football fans to their teams' victories and losses via functional MRI. Materials and Methods This prospective study was conducted from April 2019 to October 2022 and included healthy male football fans who underwent brain functional MRI. On the basis of Football Supporters Fanaticism Scale scores, the participants were classified as spectators, fans, or fanatics. Functional neuroimaging data were acquired while participants watched 63 goal sequences from matches involving their favorite team, a rival, or a neutral team. A whole-brain analysis was performed using a general linear model to compare neural responses when the participant's favorite team scored against an archrival (significant victory) versus when the archrival scored against their team (significant defeat), with control conditions for nonrival goals. Multiple comparison corrections were performed using cluster correction using random field theory. Results Sixty-one male football followers aged 20-45 years participated in this study. Whole-brain analysis of blood oxygenation level-dependent signal intensity and cluster-level correction revealed that significant victory was associated with increased activation in the ventral striatum, medial prefrontal cortex, and fusiform face area, reflecting reward processing and social identity reinforcement. Significant defeat was associated with increased activation of the mentalizing network, visual areas, and precuneus, with lower activation in the dorsal anterior cingulate cortex, suggesting changes in cognitive control and emotional regulation. Conclusion Football followers demonstrated activation in regions of the brain's reward system when their team scored against rival teams compared with other teams, reflecting in-group bonding and reinforcement of social identity. © RSNA, 2025 Supplemental material is available for this article. See also the editorial by Lev and Rapalino in this issue.