Since the release of the Evidence-based guidelines for diagnosis and treatment of demyelinating optic neuritis in China (2021), significant progress has been achieved in the diagnostic classification, biomarker detection and targeted therapy of optic neuritis. A quantitative evaluation system combining multimodal imaging and serological antibody testing has been established for clinical application. The updated McDonald criteria have incorporated the optic nerve into the lesion localization of multiple sclerosis. Detection of aquaporin-4 (AQP4) and myelin oligodendrocyte glycoprotein (MOG) antibodies serves as a key tool for the definitive diagnosis of neuromyelitis optica spectrum disorder and MOG antibody-associated disease. Plasma exchange can improve the prognosis of severe cases, and biological agents represent the first-line therapeutic strategy for AQP4-positive patients. Considering the current domestic status of antibody detection capabilities and drug accessibility, this article proposes implementing routine antibody screening at initial diagnosis, optimizing multidisciplinary collaboration models, and constructing a real-world clinical data system.

To design a diagnostic nomogram model integrating the Ultrasound Ovarian-Adnexal Reporting and Data System (US O-RADS) and serum indexes for predicting malignancy in patients with ovarian masses. This was a retrospective study including 201 benign ovarian masses patients [median age: 36(29-53)] and 136 ovarian cancer (OC) patients [median age: 53(46-60)]. Before surgical resection, all patients underwent ultrasound examination, and US O-RADS were assessed. Meanwhile, cancer antigen 125 (CA125) and neutrophil to lymphocyte ratio (NLR) were tested. All patients were pathologically diagnosed. The differences in these indexes between two groups were analysed. Meanwhile, ROC curves were firstly graphed to determine their optimal cut-off values. Logistic regression analyses were used to identify CA125, NLR and US O-RADS for OC. Then, the nomogram model was established. Finally, we evaluated the model and performed internal validation. CA125, NLR and US O-RADS in the malignant group were higher compared to the benign group. These parameters were incorporated to develop a nomogram model with an area under the ROC curve (AUC) of 0.950 (95% confidence interval [CI], 0.927-0.973), 94.1% sensitivity and 84.6% specificity. The calibration curve displayed a satisfactory fitting degree. Meanwhile, Decision curve analysis (DCA) provided a net benefit for a range of threshold probabilities. This nomogram model yielded a favourable diagnostic accuracy for predicting malignancy in patients with ovarian masses. This was the first nomogram model integrating US O-RADS and serum indexes, which showed satisfactory discrimination, calibration abilities and clinical net benefit for predicting malignancy in patients with ovarian masses.

The selection of ultrasound (US) plane for evaluating the taller-than-wide (TTW) shape remains controversial. This study aimed to determine whether the diagnostic value of TTW criteria differs when used alone or in combination with other US features, and to identify the optimal TTW criterion across four major Thyroid Imaging Reporting and Data Systems (TIRADS: Chinese (C)-TIRADS, American College of Radiology (ACR)-TIRADS, European (EU)-TIRADS and Korean (K)-TIRADS). Preoperative US images of thyroid nodules were reviewed retrospectively. Four TTW criteria were defined as follows: transverse plane only (T-only), longitudinal plane only (L-only), both planes (Dual-plane), and either one or both planes (Single- or dual-plane). Diagnostic performance was assessed using the area under the receiver operating characteristic curve (AUC) and net reclassification improvement (NRI) for malignancy prediction and fine-needle aspiration (FNA) guidance. Among 1125 nodules, 558 (49.6%) were benign and 567 (50.4%) were malignant. Using the TTW shape alone, Single- or dual-plane achieved the highest AUC for malignancy (0.813). Within TIRADS, Dual-plane demonstrated the highest AUCs in C-TIRADS (0.884) and EU-TIRADS (0.874) and improved reclassification, whereas in ACR-TIRADS and K-TIRADS, Dual-plane and Single- or dual-plane performed similarly and outperformed the T-only and L-only. For FNA guidance, the Dual-plane also showed improvements in C-TIRADS and ACR-TIRADS. The optimal TTW US plane differs when applied alone versus when combined with other suspicious US features. Within the TIRADS, assessment of the TTW shape in both transverse and longitudinal planes achieves superior accuracy and contributes to improving malignancy diagnosis and FNA decision-making. Question Which TTW criterion provides the best diagnostic performance for malignancy risk stratification and FNA guidance across the four major TIRADS? Findings Dual-plane TTW yielded the best performance in C-TIRADS and EU-TIRADS, and improved FNA guidance in C-TIRADS and ACR-TIRADS versus other TTW criteria. Clinical relevance The stricter criterion not only improves the malignancy diagnosis but also provides better guidance for biopsy, offering valuable evidence for refining future guideline recommendations and standardizing the evaluation of thyroid nodules.

Automated O-RADS Risk Stratification Using a Large Language Model Analysis of Narrative Ultrasound Reports.

Comparison of Node-RADS for regional lymph node metastasis in pancreatic ductal adenocarcinoma via CT and MRI.

Purpose To evaluate breast density changing trajectories in women age 60 years or older and identify their associated factors. Materials and Methods Data were obtained from the Korean National Health Insurance Service Database, which includes six biennial mammography screenings from January 2009 to December 2020. Women age 60 years or older who participated in screenings in 2009-2010 and 2019-2020 and at least two screenings in between were included. Breast density was classified using the Breast Imaging Reporting and Data System (BI-RADS). Group-based trajectory modeling was used to identify patterns of breast density changes across the six screening cycles. Logistic regression was used to examine breast cancer risk factors associated with the increasing or decreasing breast density trajectories. Results Among 674 993 women (mean age, 65.0 years ± 4.3 [SD]; 51% BI-RADS 1 at baseline), five distinct breast density change trajectories were identified: persistent fatty (20.5%), persistent BI-RADS 2 (36.1%), and persistent BI-RADS 3 (15.4%). Group 2 (17.2%) showed increased density, and group 3 (10.8%) demonstrated decreased density. Several breast cancer risk factors were associated with the breast density trajectories. For example, older women (adjusted odds ratio, 0.98; 95% CI: 0.97, 0.98; P < .001) and women with a higher baseline body mass index and a greater increase in body mass index over time were less likely to have increased breast density. Conclusion Five distinct breast density change trajectories were identified among Korean women who were age 60 years or older. Women with initially low breast density and more breast cancer risk factors were more likely to show increasing trajectory, whereas those with initially high density and fewer risk factors tended to show decreasing density. Keywords: Breast Density, Breast Density Change, Older Women, Reproductive Factors, Breast Cancer © RSNA, 2026.

Effect of [68Ga]Ga-PSMA-11 PET-CT in the diagnosis of prostate cancer in men with equivocal or clinically high-risk non-suspicious findings on multiparametric MRI (PRIMARY2): a multicentre, non-inferiority, phase 3, randomised controlled trial.

Hepatic lesions develop in nearly half of the Fontan population, yet clinicians lack tools to distinguish benign lesions from malignancy, including hepatocellular carcinoma (HCC). Standard Liver Imaging Reporting and Data System (LI-RADS) criteria are not applicable to Fontan-associated liver disease (FALD). To address this critical diagnostic gap, risk-stratified surveillance approaches have been proposed. We review the spectrum of hepatic lesions in FALD, emphasizing the diagnostic challenge in distinguishing benign from malignant nodules. Noninvasive fibrosis assessment, including transient elastography, is discussed for risk stratification, though liver biopsy remains the only reliable tool for characterizing suspicious lesions. HCC in FALD demonstrates distinct features and carries poor prognosis primarily due to presentation with advanced disease. Despite treatment modalities, outcomes remain suboptimal, with most therapies limited by cardiac comorbidities, abnormal hemodynamics, and advanced FALD. The optimal surveillance and diagnostic strategy for hepatic lesions in patients with FALD remains undefined. Multimodal assessment, multidisciplinary care, and a low threshold for biopsy are essential. Liver biopsy remains the only reliable method for characterizing suspicious lesions and staging fibrosis severity in the context of FALD. FALD-specific diagnostic criteria and evidence-based surveillance protocols are urgently needed to guide early detection and improve outcomes.

Towards interpretable AI in personalized medicine through a radiological-biological radiomics dictionary linking semantic Lung-RADS and imaging radiomics features.

To quantify the relative contribution of radiologists and urologists to variability in clinically significant prostate cancer (CSPC) detection across multiparametric magnetic resonance imaging (mpMRI)-guided prostate fusion biopsies and to determine whether this differed across Prostate Imaging-Reporting And Data System (PI-RADS) categories. We analysed biopsy-naïve men within the Michigan Urological Surgery Improvement Collaborative (MUSIC) who underwent fusion biopsy between August 2017 and November 2021. The primary outcome was the proportion of variance in CSPC detection (Gleason score ≥3 + 4) at targeted regions of interest that was explained by individual urologists and radiologists. We used generalised linear mixed-effects models to partition variance and estimate intraclass correlation coefficients (ICCs) for radiologist- and urologist-level effects for PI-RADS score 3-5 lesions. We calculated the median odds ratio (MOR) to quantify the expected difference in odds of CSPC detection when comparing a randomly selected higher- vs lower-detecting provider from the same distribution. Among 1544 men with 2045 targeted lesions, mpMRIs were interpreted by 115 radiologists and biopsies performed by 86 urologists. For PI-RADS score 3 lesions, urologists (ICC = 0.15, MOR = 2.07) accounted for greater variance in CSPC detection than radiologists (ICC = 0.07, MOR = 1.61). For PI-RADS score 4, both urologist (ICC = 0.05, MOR = 1.49) and radiologist (ICC = 0.07, MOR = 1.61) contributed modestly. For PI-RADS score 5, radiologists (ICC = 0.17, MOR = 2.19) explained a larger proportion of variance than urologists (ICC = 0.01, MOR = 1.19), suggesting individual radiologists meaningfully impact CSPC detection of high-risk lesions. For PI-RADS score 3 lesions, the specific urologist performing the biopsy was a strong source of variation, while for PI-RADS score 5 lesions, the radiologist had greater influence on CSPC detection rates. Optimising MRI acquisition and interpretation, ensuring accurate fusion registration, and improving biopsy accuracy are critical to improving diagnostic consistency.

Characterization of biomarker profiles in patients with coronary artery disease: A prospective coronary computed tomography angiography study.

Prostate magnetic resonance imaging (MRI) has become a crucial tool in diagnosing and managing prostate cancer, mainly by helping to avoid unnecessary biopsies and enhancing the detection of clinically significant disease. However, its clinical usefulness is often limited by wide variation in how images are acquired, interpreted, and reported worldwide. This inconsistency affects diagnostic accuracy and patient outcomes. In response, the Quality Improvement Subgroup of the European Society of Urogenital Radiology (ESUR) Prostate MRI Working Group has created a practical, three-step quality-improvement framework aimed at standardising and improving prostate MRI practices. This framework consists of: Step 1: 'Build it right', establishing a foundation of technical excellence through adherence to the Prostate Imaging Reporting and Data System (PI-RADS) technical standards, objective quality assessment using the Prostate Imaging Quality (PI-QUAL) score, and systematic artefact reduction. Step 2: 'See it right', emphasising interpretive excellence via structured training, institutional quality assurance metrics, and multidisciplinary collaboration. Step 3: 'Improve and innovate', promoting continual refinement through emerging technologies such as AI-driven assessment, deep learning reconstruction, and remote supervision. By incorporating this structured approach into daily practice, this framework aims to ensure that prostate MRI consistently fulfils its promise of accurate, reproducible, and patient-centred care. A coordinated effort towards international implementation, benchmarking, and outcome-based validation represents the next critical step to maximise global impact. KEY POINTS: Question Wide variation in prostate MRI acquisition, image quality, and reporting undermines diagnostic accuracy. A structured roadmap is needed to ensure consistent quality and reproducible practice. Findings The ESUR Prostate MRI Working Group outlines a three-step framework-'Build it right', 'See it right', 'Improve and innovate'-to standardise acquisition, interpretation, and quality assurance. Clinical relevance Applying this roadmap in clinical practice aims to enhance diagnostic confidence and promote consistent, high-quality prostate cancer care across diverse healthcare settings.

Index lesion-focused ipsilateral systematic biopsy (iSB) has been proposed as a core-reduction alternative to MRI-targeted biopsy combined with systematic biopsy (TB+SB) for prostate cancer, but prospective multicenter validation is limited. This prospective multicenter trial (NCT06584279) enrolled biopsy-naive men with Prostate Imaging Reporting and Data System (PI-RADS) ≥4 lesions or PI-RADS 3 plus prostate-specific antigen (PSA) density ≥0.15 ng/mL/cm3. All underwent MRI-targeted biopsy (≥2 cores/lesion) with 12-core SB. Through core-level reclassification, the authors simulated TB+iSB (targeted biopsy combined with index lesion-ipsilateral systematic biopsy). The primary outcome was cancer detection rate (CDR) of clinically significant prostate cancer (csPCa; Grade Group ≥2) with a noninferiority margin of -3%. Secondary outcomes included clinically insignificant prostate cancer (cisPCa; Grade Group 1) detection and pathological concordance after radical prostatectomy. Among 564 men (median age, 69 years; median PSA, 7.3 ng/mL), TB+iSB demonstrated a noninferior csPCa CDR versus TB+SB (40.78% vs. 42.38%; difference, -1.6 percentage points; 95% CI, -2.69 to -0.50), with the lower bound above the -3% noninferiority margin. The cisPCa CDR was slightly lower with TB+iSB than with TB+SB (13.83% vs. 14.36%; difference, -0.53 percentage points; 95% CI, -2.01 to 0.92). Among 189 surgical patients, pathological concordance was similar, whereas upgrading was numerically more frequent and downgrading numerically less frequent under simulated TB+iSB. TB+iSB met the prespecified noninferiority criterion for csPCa detection relative to TB+SB and may represent a promising core-reduction strategy in transperineal MRI-guided biopsy, although the full protocol still provided additional contralateral information.

To compare the malignancy risk stratification performance and inter-reader reliability of four Reporting and Data System (RADS) algorithms for solitary bone lesions: CT Bone-RADS, MRI Bone-RADS, Osseous Tumor (OT)-RADS, and Bone Tumor Imaging (BTI)-RADS. This retrospective analysis included patients with solitary bone lesions who underwent both CT and MRI between March 2005 and September 2021. Three radiologists independently categorized each lesion using CT Bone-RADS (1-4), MRI Bone-RADS (1-4), OT-RADS (2-5), and BTI-RADS (1-4). Categories were dichotomized into high- versus low-risk for malignancy. Diagnostic performance metrics and area under the receiver operating characteristic curve (AUC) were calculated for each reader as well as for a consensus interpretation generated using a majority-vote method. The reference standard was either histopathologic confirmation or imaging surveillance. Inter-reader reliability was assessed using Gwet's AC1 statistic. A total of 207 patients (mean age, 49 ± 18 years; 111 men and 96 women) were included. Consensus malignancy risk stratification performance (AUC; sensitivity/specificity/positive predictive value/negative predictive value/accuracy, %) was as follows: CT Bone-RADS (0.52; 95/9/43/73/44), MRI Bone-RADS (0.60; 98/12/44/88/47), OT-RADS (0.91; 93/71/69/94/80), and BTI-RADS (0.89; 98/39/53/96/63). Inter-reader reliability (AC1) was excellent for CT Bone-RADS (0.978), MRI Bone-RADS (0.931), and BTI-RADS (0.822), and moderate for OT-RADS (0.585). Among the evaluated bone tumor-RADS, OT-RADS demonstrated the most balanced diagnostic performance with moderate inter-reader reliability. CT Bone-RADS, MRI Bone-RADS, and BTI-RADS showed excellent inter-reader reliability. Question Evaluation of solitary bone lesions is important but often challenging. This study compared four bone tumor-RADS algorithms to determine which provides the best malignancy risk stratification. Findings Among the four RADS algorithms, OT-RADS demonstrated the most balanced overall diagnostic performance in consensus analysis, while CT Bone-RADS, MRI Bone-RADS, and BTI-RADS showed excellent inter-reader reliability. Clinical relevance Knowledge of each RADS system's performance characteristics helps clinicians apply these algorithms appropriately to optimize the assessment of solitary bone lesions.

Artificial intelligence for marine oil spill management: Recent advances and future directions.

Active surveillance (AS) is the preferred approach for low-risk prostate cancer (PCa). Recent efforts have explored new biomarkers to reduce the frequency of surveillance biopsy. This study assessed Stockholm3 for predicting PCa upgrading during surveillance biopsies. The prospective STHLM3-AS NorDCaP trial included 199 men with International Society of Urological Pathologists grade group 1 (ISUP GG 1) PCa under AS in Sweden, Denmark, and Norway (2019-2022). All men had ISUP GG 1 PCa and received a Stockholm3 test before surveillance biopsies. The primary outcome was ISUP upgrading, defined as ISUP GG 2 or higher. At surveillance biopsy, 72 of the 199 (36%) men were upgraded. Men with upgraded PCa had higher median Stockholm3 (35; interquartile range [IQR] 26-50) than those without upgrading (23; IQR 14-34, P < 0.01). The area under the receiver operating characteristic curve (AUC) for Stockholm3 was 0.71 (95% confidence interval [CI] 0.64-0.79). For Stockholm3 ≥15, sensitivity, specificity, and negative-predictive value (NPV) were 0.93 (95% CI 0.85-0.98), 0.26 (95% CI 0.19-0.35), and 0.87 (95% CI 0.72-0.96), respectively, sparing 19% of biopsies while missing five cases (7% of upgrades), none of which were ISUP GG ≥3. At a lower threshold (≥11), sensitivity increased to 0.99 (95% CI 0.93-1.00) with lower specificity (0.11; 95% CI 0.06-0.18) and an NPV of 0.93 (95% CI 0.68-1.00). Prostate-specific antigen density ≥0.15 showed a sensitivity of 0.60 (95% CI 0.48-0.72), specificity of 0.72 (95% CI 0.63-0.80), and NPV of 0.75 (95% CI 0.66-0.83), with an AUC of 0.71 (95% CI 0.63-0.79). Prostate Imaging-Reporting and Data System score ≥3 demonstrated a sensitivity of 0.92 (95% CI 0.83-0.97), specificity of 0.33 (95% CI 0.22-0.44), and NPV of 0.84 (95% CI 0.66-0.95), with an AUC of 0.72 (95% CI 0.65-0.79). In men with low-risk PCa under AS, Stockholm3 may enhance risk stratification and reduce unnecessary biopsies. Prostate-specific antigen density and multiparametric magnetic resonance imaging showed comparable performance, with Stockholm3 providing a potentially practical blood-based complement in a multimodal strategy.

Cervical cancer remains a major public health concern in Morocco. Since 2012, the national program for early detection, based on visual inspection with acetic acid (VIA), has targeted women aged 30 to 49 years. This study assesses the program's performance in the Souss-Massa region in 2024, focusing on screening coverage, diagnostic quality, and therapeutic management. A retrospective descriptive analysis was conducted across six provinces using routinely collected indicators: coverage of cervical screening by visual inspection with acetic acid (VIA), referral rate, colposcopy completion, treatment uptake, and histopathology outcomes. Data completeness was assessed, and adjusted coverage estimates were computed to correct under-reporting using proportional imputation. Analyses used both raw and adjusted data, with 95% confidence intervals (CI) and appropriate non-parametric or categorical tests. In 2024, 31,034 women were screened (crude coverage 7.07% [95% CI 6.99-7.15]). After under-reporting was adjusted for using proportional imputation - an exploratory correction given that 70% of the data was missing - the regional coverage was estimated at 28.85% (95% CI: 28.60-29.10). However, this figure should be treated as an illustrative estimate rather than a definitive programme indicator. Overall, 1,975 women were referred (referral rate 5.52% [95% CI 5.28-5.76]), 1,615 underwent colposcopy (completion 81.77% [95% CI 79.92-83.62]), and 330 cervical abnormalities were diagnosed (300 CIN1; 30 CIN2+), including 33 histologically confirmed CIN2 + when pathology was available. The CIN2 + detection rate was 1.04 per 1,000 women screened. Treatment uptake among women with diagnosed lesions was 44.85% [95% CI 39.33-50.37], with marked inter-provincial disparities. Only 0.58% of screened women were migrants. Statistically significant differences were observed between provinces for multiple indicators. However, these differences suggest an association with structural and organisational factors rather than indicating a causal relationship. Program performance in Souss-Massa remains below WHO-recommended thresholds for both coverage and treatment. Strengthening medicalization and workforce capacity, improving digital data systems, and piloting a transition to primary HPV testing - including self-sampling and a test-and-treat approach - are key priorities to improve equity and detection performance.

Objectives. To identify nutritional characteristics associated with the perceived addictive potential of commonly consumed foods in the US food supply, the majority of which are ultraprocessed foods (UPFs). Methods. In a demographically diverse sample of US adults (n = 1664; 55.2% female), participants rated the perceived addictiveness of 297 commonly consumed foods (74.4% UPFs). Data were collected through Prolific in June 2024. Machine-learning models identified nutritional predictors of addictiveness using both the 15 variables required on US Nutrition Facts labels and an expanded set of 166 nutrient characteristics from the Nutrition Data System for Research. Results. Models performed comparably and revealed consistent nonlinear associations between nutrient content and perceived addictiveness. Foods higher in carbohydrates, glycemic load, energy density, and fat were rated as more addictive. These nutrient profiles were rare in minimally processed foods but common in UPFs, which frequently exceeded multiple addictive nutrient thresholds simultaneously. Conclusions. This study identifies a nutritional signature linked to perceived addictive potential. Findings provide a data-driven framework for identifying foods most likely to promote compulsive intake and inform policies aimed at creating a healthier, less addictive food environment. (Am J Public Health. 2026;116(7):950-959. https://doi.org/10.2105/AJPH.2026.308500).

Patients receiving dialysis who have diabetes have a high burden of dysglycemia. Whereas traditional glycemic markers have limited accuracy and convenience in dialysis, continuous glucose monitoring (CGM) provides automated, less invasive, and more comprehensive glycemic data than do conventional measures. However, it remains unclear whether CGM is associated with improved clinical outcomes in patients undergoing dialysis. We examined the association between CGM use versus non-CGM use and survival among U.S. veterans receiving dialysis who also have diabetes, using linked national Veterans Affairs, U.S. Renal Data System, and Medicare data. We examined data from veterans undergoing dialysis and with diabetes with incident CGM use (newly prescribed CGM) versus non-CGM use over the period January 2012 to December 2023 matched by propensity score (PS) to address confounding by indication and who were followed for all-cause mortality events through February 2025. Associations of CGM use versus non-CGM use with death were evaluated using complete case analysis and multiple imputation. Among 2,008 patients in the complete case analysis cohort, CGM use was associated with a lower mortality risk in PS-matched unadjusted and doubly adjusted Cox models (reference: non-CGM use; hazard ratio [HR] 0.86 [95% CI 0.76, 0.98]; and 0.83 [95% CI 0.75, 0.92], respectively). Among 3,088 patients in the multiple imputation cohort, CGM use was also associated with greater survival in PS-matched unadjusted and doubly adjusted Cox models (HR 0.88 [95% CI 0.77, 0.99]; and 0.84 [95% CI 0.73, 0.96], respectively). In veterans receiving dialysis who also had diabetes, incident CGM use was associated with better survival versus non-CGM use. Further studies are needed to determine underlying mechanisms and the impact of CGM on other dialysis outcomes.

Opioid agonist treatment and risk of mortality in French primary care: a nationwide, retrospective cohort study.