Reporting System Research Articles

Tumour-pleura relationship on computed tomography (CT) provides effective risk stratification for peripheral pulmonary nodules with Lung Imaging Reporting and Data System (Lung-RADS) score of 4X.

Pulmonary nodules with Lung Imaging Reporting and Data System (Lung-RADS) 4X are of greater clinical significance, and accurate differentiation of pathological types and visceral pleural invasion (VPI) of Lung-RADS 4X peripheral pulmonary nodules before treatment can aid in stratification. This study set out to investigate whether the tumour-pleura relationship on computed tomography (CT) can provide effective risk stratification for peripheral pulmonary nodules with Lung-RADS 4X. This was a single institution, retrospective study of 482 consecutive patients with Lung-RADS score 4X, who were pathologically diagnosed with tuberculous granuloma and adenocarcinoma from January 2019 to December 2023. We assessed clinical factors (baseline characteristics and tumour markers) and CT findings. Univariate and multivariate logistic regression analyses were used to determine the classification of pulmonary nodules and predictors of VPI. Multivariate analysis revealed that gender [odds ratio (OR) =0.392; P<0.001], carcinoembryonic antigen (CEA) level (OR =8.331; P<0.001), type of nodules (OR =13.551 and 7.478; P<0.001 and P=0.016) and maximum base width of soft tissue component on the pleura side (OR =0.857; P=0.005) were significant independent factors for distinguishing tuberculous granuloma from adenocarcinoma. And the type of linear connection between lesion and pleura (OR =3.936; P<0.001), and the maximum base width of soft tissue components on the pleura side (OR =1.359; P=0.001) were correlated independently with VPI. The area under the curve (AUC) for predicting pulmonary nodules classification was 82.60% [95% confidence interval (CI): 78.85-86.35%), and the AUC for predicting VPI was 76.10% (95% CI: 69.83-82.38%). The tumour-pleura relationship will be helpful in further risk stratification for peripheral pulmonary nodules with a score of Lung-RADS 4X.

Intraindividual Comparison of Ultrahigh-Spatial-Resolution Photon-Counting Detector CT and Energy-Integrating Detector CT for Coronary Stenosis Measurement.

A recent simulation study proposed that stenosis measurements on coronary computed tomography (CT) angiography are influenced by the improved spatial resolution of photon-counting detector (PCD)-CT. The aim of the current study was to evaluate the impact of ultrahigh-spatial-resolution (UHR) on coronary stenosis measurements and Coronary Artery Disease Reporting and Data System (CAD-RADS) reclassification rates in patients undergoing coronary CT angiography on both PCD-CT and energy-integrating detector (EID)-CT and to compare measurements against quantitative coronary angiography. Patients with coronary calcification on EID-CT (collimation, 192×0.6 mm) were prospectively enrolled for a research coronary CT angiography with UHR PCD-CT (collimation, 120×0.2 mm) within 30 days (between April 1, 2023 and January 31, 2024). PCD-CT was acquired with the same or lower CT dose index and equivalent contrast media volume as EID-CT. Percentage diameter stenosis (PDS) for calcified, partially calcified, and noncalcified lesions were compared between scanners. Patient-level reclassification rates for CAD-RADS were evaluated. The accuracy of PDS measurements was validated against quantitative coronary angiography in patients who underwent invasive coronary angiography. In total, PDS of 278 plaques were quantified in 49 patients (calcified, 202; partially calcified, 51; noncalcified, 25). PCD-CT-based PDS values were lower than EID-CT measurements for calcified (45.1±20.7 versus 54.6±19.2%; P<0.001) and partially calcified plaques (44.3±19.6 versus 54.9±20.0%; P<0.001), without significant differences for noncalcified lesions (39.1±15.2 versus 39.0±16.0%; P=0.98). The reduction in stenosis degrees led to a 49.0% (24/49) reclassification rate to a lower CAD-RADS with PCD-CT. In a subset of 12 patients with 56 lesions, UHR-based PDS values showed higher agreement with quantitative coronary angiography (mean difference, 7.3%; limits of agreement, -10.7%/25.2%) than EID-CT measurements (mean difference, 17.4%; limits of agreement, -6.9%/41.7%). Compared with conventional EID-CT, UHR PCD-CT results in lower PDS values and more accurate stenosis measurements in coronary plaques with calcified components and leads to a substantial Coronary Artery Disease Reporting and Data System reclassification rate in 49.0% of patients.

The Ovarian-Adnexal Reporting and Data System (O-RADS) US Score Effect on Surgical Resection Rate.

Background The Ovarian-Adnexal Imaging Reporting and Data System (O-RADS) US risk score can be used to accurately stratify ovarian lesions based on morphologic characteristics. However, there are no large multicenter studies assessing the potential impact of using O-RADS US version 2022 risk score in patients referred for surgery for an ovarian or adnexal lesion. Purpose To retrospectively determine the proportion of patients with ovarian or adnexal lesions without acute symptoms who may have been managed conservatively by using the O-RADS US version 2022 risk score. Materials and Methods This multicenter retrospective study included patients with ovarian cystic lesions and nonacute symptoms who underwent surgical resection after US before the introduction of O-RADS US between January 2011 and December 2014. Investigators blinded to the final diagnoses recorded lesion imaging features and O-RADS US risk scores. The frequency of malignancy and the diagnostic performance of the risk score were calculated. The Mann-Whitney test and Fisher exact test were performed, with P < .05 indicating a statistically significant difference. Results A total of 377 patients with surgically resected lesions were included. Among the resected lesions, 42% (157 of 377) were assigned an O-RADS US risk score of 2. Of the O-RADS US 2 lesions, 54% (86 of 157) were nonneoplastic, 45% (70 of 157) were dermoids or other benign tumors, and less than 1% (one of 157) were malignant. Using O-RADS US 4 as the optimal threshold for malignancy prediction yielded a 94% (68 of 72) sensitivity, 64% (195 of 305) specificity, 38% (68 of 178) positive predictive value, and 98% (195 of 199) negative predictive value. Conclusion In patients without acute symptoms who underwent surgery for ovarian and adnexal lesions before the O-RADS US risk score was published, nearly half (42%) of surgically resected lesions retrospectively met the O-RADS US 2 version 2022 criteria. In these patients, imaging follow-up or conservative management could have been offered. © RSNA, 2024 Supplemental material is available for this article. See also the editorial by Fournier in this issue.

The role of foraging pollinators in assembling the flower microbiota and transmitting the fire blight pathogen Erwinia amylovora.

Flowers serve as hubs for biotic interactions with pollinators and microbes, which can significantly impact plant reproduction and health. Previous studies have shown that the flower microbiota undergoes dynamic assembly processes during anthesis. However, the influence of foraging pollinators on the assembly and dispersal of the flower microbiota and the transmission of plant pathogens remains poorly understood. In this study, we used insect exclusion netting to investigate the role of pollinators in the assembly of the microbiota on apple stigma and the transmission of the fire blight pathogen Erwinia amylovora. We found that excluding pollinators had a minor impact on the community diversity and composition of the apple stigma microbiota, while the flower's developmental stage had a strong influence. Additionally, pollinator exclusion altered bacterial dispersal and the relative abundance of different bacterial species, including E. amylovora, suggesting that pollinators play a role in transmitting plant pathogens. Using a reporter system, we demonstrated that bumble bees can transmit the fire blight pathogen from an infected flower under controlled growth conditions. Our study highlights the importance of intrinsic and pollinator-independent microbes as sources of inoculum for the stigma microbiota and underscores the role of foraging pollinators in vectoring plant pathogens.

Sonographic characteristics of thyroid nodules with a Halo

ObjectiveTo investigate the sonographic characteristics of thyroid nodules with a halo, explore the value of contrast-enhanced ultrasound (CEUS) combined with fine needle aspiration (FNA) in identifying nodules with a halo, and predict the risk of metastasis by analyzing the pathological features of the halo.MethodsA retrospective analysis was conducted on 185 postoperative cases of thyroid nodules accompanied by halos between January 2019 and December 2022. After describing the ultrasound characteristics of the thyroid nodules and their halos, all patients were divided into three groups, the first group (group I = CEUS only) of patients underwent CEUS, the second group (group II = CEUS + FNA) underwent FNA based on the first group, and the third group (group III = FNA only) underwent FNA directly. The CEUS and FNA results were graded using the Chinese Thyroid Imaging Report and Data System (C-TIRADS) and Bethesda Reporting System for Thyroid Cytopathology, respectively. Those graded below C-TIRADS 4b or Bethesda IV were defined as benign, and the results of FNA were referenced when the two methods were combined. The surgical pathology results were used as the gold standard. We plotted working curves to compare the diagnostic efficacy of CEUS and FNA alone and in combination in the diagnosis of thyroid nodules with halos. The pathological features of the halo were analyzed and the number of patients with cervical lymph node metastases was recorded.ResultsOne hundred and sixty patients met the requirements. Benign nodules were mainly characterized by a thin (0.75 ± 0.31 mm) and uniform halo with good integrity, while malignant nodules had a thicker (1.48 ± 0.51 mm) halo with uneven and irregular margins (P < 0.05). The sensitivity and specificity were highest when the cutoff value was 1.09 mm, with 76.08% and 84.29%, respectively. The halos of benign nodules were mostly hyper- or iso-enhanced, whereas the halos of malignant nodules were predominantly hypo-enhanced (P < 0.05). The areas under the curve (AUCs) for CEUS, FNA, and CEUS + FNA were 0.751(95% CI = 0.642–0.841), 0.863(95% CI = 0.767–0.929), and 0.918(95% CI = 0.834–0.967), respectively. Cervical lymph node metastasis occurred in only 13 (11.5%) malignant nodes with halos. The primary pathological components of the halo around malignant nodules were almost reactive hyperplastic fibrous tissue.ConclusionThe halo surrounding malignant thyroid nodules is thicker, with uneven and irregular margins, and shows hypo-enhancement on CEUS. Combining CEUS with FNA improves the diagnostic efficacy of thyroid nodules with halos. The reactive hyperplastic fibrous halo may be one of the reasons why malignant nodules are less likely to metastasize.

Evaluating Biparametric Versus Multiparametric Magnetic Resonance Imaging for Diagnosing Clinically Significant Prostate Cancer: An International, Paired, Noninferiority, Confirmatory Observer Study

Background and objectiveBiparametric magnetic resonance imaging (bpMRI), excluding dynamic contrast-enhanced (DCE) magnetic resonance imaging (MRI), is a potential replacement for multiparametric MRI (mpMRI) in diagnosing clinically significant prostate cancer (csPCa). An extensive international multireader multicase observer study was conducted to assess the noninferiority of bpMRI to mpMRI in csPCa diagnosis. MethodsAn observer study was conducted with 400 mpMRI examinations from four European centers, excluding examinations with prior prostate treatment or csPCa (Gleason grade [GG] ≥2) findings. Readers assessed bpMRI and mpMRI sequentially, assigning lesion-specific Prostate Imaging Reporting and Data System (PI-RADS) scores (3–5) and a patient-level suspicion score (0–100). The noninferiority of patient-level bpMRI versus mpMRI csPCa diagnosis was evaluated using the area under the receiver operating curve (AUROC) alongside the sensitivity and specificity at PI-RADS ≥3 with a 5% margin. The secondary outcomes included insignificant prostate cancer (GG1) diagnosis, diagnostic evaluations at alternative risk thresholds, decision curve analyses (DCAs), and subgroup analyses considering reader expertise. Histopathology and ≥3 yr of follow-up were used for the reference standard. Key findings and limitationsSixty-two readers (45 centers and 20 countries) participated. The prevalence of csPCa was 33% (133/400); bpMRI and mpMRI showed similar AUROC values of 0.853 (95% confidence interval [CI], 0.819–0.887) and 0.859 (95% CI, 0.826–0.893), respectively, with a noninferior difference of –0.6% (95% CI, –1.2% to 0.1%, p < 0.001). At PI-RADS ≥3, bpMRI and mpMRI had sensitivities of 88.6% (95% CI, 84.8–92.3%) and 89.4% (95% CI, 85.8–93.1%), respectively, with a noninferior difference of –0.9% (95% CI, –1.7% to 0.0%, p < 0.001), and specificities of 58.6% (95% CI, 52.3–63.1%) and 57.7% (95% CI, 52.3–63.1%), respectively, with a noninferior difference of 0.9% (95% CI, 0.0–1.8%, p < 0.001). At alternative risk thresholds, mpMRI increased sensitivity at the expense of reduced specificity. DCA demonstrated the highest net benefit for an mpMRI pathway in cancer-averse scenarios, whereas a bpMRI pathway showed greater benefit for biopsy-averse scenarios. A subgroup analysis indicated limited additional benefit of DCE MRI for nonexperts. Limitations included that biopsies were conducted based on mpMRI imaging, and reading was performed in a sequential order. Conclusions and clinical implicationsIt has been found that bpMRI is noninferior to mpMRI in csPCa diagnosis at AUROC, along with the sensitivity and specificity at PI-RADS ≥3, showing its value in individuals without prior csPCa findings and prostate treatment. Additional randomized prospective studies are required to investigate the generalizability of outcomes.

Racial Disparities and Strategies for Improving Equity in Diagnostic Follow-Up for Abnormal Screening Mammograms.

Black and White women undergo screening mammography at similar rates, but racial disparities in breast cancer outcomes persist. To assess potential contributors, we investigated delays in follow-up after abnormal imaging by race/ethnicity. Women who underwent screening mammography at our urban academic center from January 2015 to February 2018 and received a Breast Imaging Reporting and Data System 0 assessment were included. Kaplan-Meier estimates described distributions of time between diagnostic events from (1) screening to diagnostic imaging and (2) diagnostic imaging to biopsy. Multivariable logistic regression models estimated the associations between race/ethnicity and receipt of follow-up within 15 and 30 days. Two thousand five hundred and fifty-four women were included (48.6% non-Hispanic [NH] Black, 38.2% NH White, 13.1% other/unknown). Median time between screening and diagnostic imaging varied by race/ethnicity (White: 7 days [IQR, 2-14]; Black: 12 days [IQR, 7-23]; other/unknown: 9 days [IQR, 5-21]). There were similar disparities in days between diagnostic imaging and biopsy (White: 12 [IQR, 7-24]; Black: 21 [IQR, 13-37]; other/unknown: 16 [IQR, 9-30]) and between screening and biopsy (White: 20 [IQR, 11-41]; Black: 35 [IQR, 22-63]; other/unknown: 27.5 [IQR, 17-42]). After adjustment, odds of diagnostic imaging follow-up within 15 days of screening were lower for Black versus White women (odds ratio, 0.59 [95% CI, 0.44 to 0.80]; P < .001). In this diverse cohort, disparities in timely diagnostic follow-up after abnormal breast screening were observed, with Black women waiting 1.75 times as long as White women to obtain a tissue diagnosis. National guidelines for time to diagnostic follow-up may facilitate more timely breast cancer care and potentially affect outcomes.

Performance and Clinical Implications of VI-RADS in detecting muscle invasion in bladder tumors: A prospective observational study

ABSTRACT Introduction: Bladder cancer staging is pivotal for guiding therapeutic decisions. In this study, the primary objective was to assess the diagnostic accuracy of multiparametric magnetic resonance imaging (mpMRI), The study aimed to classify bladder tumors as either nonmuscle-invasive bladder cancers or muscle-invasive bladder cancers (MIBC) using the Vesical Imaging Reporting and Data System (VI-RADS) scoring. A secondary objective of the study focused on the accuracy of biparametric magnetic resonance imaging (bpMRI) in comparison to mpMRI. Methods: Thirty-three patients with bladder tumors were enrolled and underwent both mpMRI and bpMRI scoring assessments. VI-RADS scores were assigned and subsequently compared with histopathological findings posttransurethral resection of bladder tumor., Statistical measures included sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy for VI-RADS scores at cutoff thresholds of ≥4 and 5. Results: MpMRI at a VI-RADS cutoff of ≥4 yielded an 83.33% sensitivity and 100% specificity, with a diagnostic accuracy of 90.91%. At a cutoff of 5, sensitivity was 100%, specificity was 77.27%, and diagnostic accuracy was 84.85%. bpMRI at a cutoff of ≥4 showed an 80% sensitivity and 100% specificity, with diagnostic accuracy matching mpMRI at 90.91%. Conclusions: This prospective analysis demonstrates that VI-RADS scoring with mpMRI provides reliable diagnostic accuracy for bladder cancer staging. mpMRI exhibits high sensitivity and specificity at a cutoff of ≥ 4, making it a robust tool for MIBC detection. bpMRI is an effective alternative in select patients. The study validates the use of VI-RADS scoring in clinical practice for effective treatment planning.

Perfluorobutane-Enhanced CEUS in Intrahepatic Cholangiocarcinoma: Correlating Imaging Features With Liver Backgrounds and Tumor Sizes

ObjectiveTo investigate Sonazoid contrast-enhanced ultrasound (CEUS) features of intrahepatic cholangiocarcinoma (ICC) based on liver backgrounds and tumor sizes. MethodsA retrospective analysis was conducted on patients with histopathologically diagnosed ICC at two centers. Patients underwent Sonazoid CEUS examination at a dose of 0.0165 mL/kg before surgery or biopsy. Continuous imaging was recorded for the first 70 s, followed by intermittent scanning every 15–20 s for 5 min, with a Kupffer phase captured after an 8-min delay. Patients were categorized by liver backgrounds and tumor sizes. Two ultrasound experts evaluated the enhancement patterns of ICCAs during the arterial, portal, delayed, and Kupffer phases according to current guidelines. ResultsFrom February 2019 to July 2022, a total of 85 ICC lesions were included. ICCs were categorized into normal liver (n = 24), chronic liver disease with fibrosis (n = 40), and cirrhosis (n = 21) groups based on different liver backgrounds, and into groups measuring ≤30 mm (n = 22), 31–50 mm (n = 32), and >50 mm (n = 31) based on tumor sizes. Most ICCs in liver fibrosis or liver cirrhosis tended to show non-rim enhancement in arterial phase (p = 0.022) and relatively later washout (39.9 ± 8.5 s vs. 39.7 ± 13.0 s) compared with those on a normal liver background (28.1 ± 5.6 s) (p < 0.001). Based on CEUS Liver Imaging Reporting and Data System, the diagnostic performance of LR-M criteria showed an accuracy of 100% in our high-risk populations. ICCs of ≤30 mm more commonly showed non-rim enhancement in arterial phase (p = 0.003) and relatively later washout (41.3 ± 12.5 s) compared with larger ICCs (p = 0.046). In the Kupffer phase, all ICCs showed marked washout with sharp margin delineation on Sonazoid CEUS, regardless of liver backgrounds and tumor sizes. ConclusionSonazoid CEUS features of ICCs differ according to different liver backgrounds and tumor sizes. Arterial phase non-rim enhancement and relatively later washout were more commonly observed in ICCs on liver fibrosis or cirrhosis background or smaller ICCs (≤30 mm).

The “Hungry Judge” effect on prostate MRI reporting: Chronobiological trends from 35’004 radiologist interpretations

AimTo investigate the associations between the hour of the day and Prostate Imaging–Reporting and Data System (PI-RADS) scores assigned by radiologists in prostate MRI reports. Materials and methodsRetrospective single-center collection of prostate MRI reports over an 8-year period. Mean PI-RADS scores assigned between 0800 and 1800 h were examined with a regression model. ResultsA total of 35′004 prostate MRI interpretations by 26 radiologists were included. A significant association between the hour of day and mean PI-RADS score was identified (β2 = 0.005, p < 0.001), with malignant scores more frequently assigned later in the day. ConclusionThese findings suggest chronobiological factors may contribute to variability in radiological assessments. Though the magnitude of the effect is small, this may potentially add variability and impact diagnostic accuracy.

The Clinical Utility of a Hand-Held Piezoelectric Scanner in the Detection of Early Tumor and Changes in Breast Texture.

Background Breast cancer (BC) is one of the leading causes of cancer death in females worldwide. Screening with mammography (MMG) is limited in low- and middle-income countries (LMICs). The implementation of an affordable and effective screening method is crucial. The intelligent breast examination (iBE) has emerged as a portable device with a glove shape using piezoelectricity.This experimental study evaluates the effectiveness of the device by comparing it with mammography (MMG), breast magnetic resonance imaging (MRI), and clinical breast examination (CBE). Methods This study included patients admitted to the senology unit who were under surveillance in a medical oncology unit. iBE was performed after each CBE and compared with Breast Image Reporting and Data System (BI-RADS) classifications. MMG/MRI was classified as negative (BI-RADS ≤2) or positive (BI-RADS ≥3). Measures of accuracy and agreement between tests were calculated. Results A total of 103 females were included between September 2022 and September 2023, who underwent iBE, CBE, and MMG/MRI. CBE and MMG showed moderate agreement in categorization (ρ=0.99). With a specificity for predicting a negative MMG of 90.8% and a negative predictive value of 79.7%. Benign findings, cysts, fibroadenoma, and benign microcalcifications were presented in 80 patients (seromas and non-suspicious hypoechogenic images). The performance of iBE was evaluated by comparing the breast with alterations to the control breast within each BI-RADS categorization. Conclusion As of now, iBE does not identify breast changes. The improvement proposals emphasized the incorporation of accelerometer sensors, signal conditioning to allow for the collection of compression and decompression data from the sensors, and consideration of pressure stress. These improvements are crucial to optimize the iBE's ability to detect changes in breast texture, enhancing the iBE's effectiveness in the early detection of BC.

Feasibility and Clinical Application of 5-T Noncontrast Dixon Whole-Heart Coronary MR Angiography: A Prospective Study.

Background Coronary MR angiography (CMRA) at 3 T offers higher signal to noise ratio and contrast to noise ratio compared with 1.5 T. CMRA at 5 T may provide better diagnostic performance. Purpose To assess the feasibility and clinical application of 5-T noncontrast whole-heart CMRA and compare 5-T acquisition with 3-T acquisition. Materials and Methods From September 2023 to April 2024, patients scheduled for coronary CT angiography (CCTA) and volunteers were prospectively recruited. CCTA served as the reference standard in patients. CMRA was performed using a 3-T spectral attenuated inversion-recovery (3TSPAIR) sequence and 3-T Dixon (3TDixon) sequence with routine spatial resolution (3TSPAIR-routine and 3TDixon-routine, respectively), and 5-T Dixon (5TDixon) with routine and high spatial resolution (5TDixon-routine and 5TDixon-high, respectively). The study evaluated image quality, coronary artery calcium (CAC), the severity of coronary artery disease (CAD) graded according to Coronary Artery Disease Reporting and Data System, and the presence of ≥50% coronary stenosis. The nonparametric paired Wilcoxon signed rank test, McNemar test, generalized estimating equation model, and kappa test were used. Results Eight volunteers and 79 patients were included (mean age, 52 years ± 11 [SD]; 48 male). Image quality was higher for 5TDixon-routine compared with 3TSPAIR-routine and 3TDixon-routine (P < .001 for both) and similar for 5TDixon-high (P = .60). The per-segment sensitivity for CAC was higher at 5TDixon-high than 5TDixon-routine (78.3% vs 53.3%; P < .001), with no difference in specificity (98.6% vs 98.6%; P > .99). In grading the severity of CAD, 5TDixon-routine showed better consistency with CCTA than 3TSPAIR-routine (κ = 0.46 vs 0.13) and 3TDixon-routine (κ = 0.55 vs 0.42). For detecting ≥50% stenosis, the per-patient sensitivity, specificity, and accuracy were as follows: 5TDixon-routine versus 3TSPAIR-routine, 88.9% versus 55.6%, 86.5% versus 62.2%, and 87.0% versus 60.9% (P = .55, .01, and .18, respectively); 5TDixon-routine versus 3TDixon-routine, 90.0% versus 80.0%, 86.8% versus 71.1%, and 87.5% versus 72.9%, respectively (P > .05 for all). Conclusion Noncontrast CMRA at 5 T shows potential to evaluate CAC and coronary stenosis simultaneously and demonstrates superior diagnostic performance compared with at 3 T. © RSNA, 2024 Supplemental material is available for this article. See also the editorial by Rahsepar and Kim in this issue.

Inter-reader reliability and diagnostic accuracy of PI-RADS scoring between academic and community care networks: How wide is the gap?

ImportanceThe Prostate Imaging Reporting & Data System (PI-RADS) scoring guidelines were developed to address the substantial variation in interpretation and reporting of prostate cancer (PCa) multiparametric MRI (mpMRI) results, and subsequent updates have sought to further improve inter-reader reliability. Nonetheless, the variability of PI-RADS scoring in real-world settings may represent a continuing challenge to the widespread standardization of prostate mpMRI and limit its overall clinical benefit. ObjectiveTo assess variability in mpMRI interpretation and reporting of PCa, we evaluated the discrepancies in PI-RADS scoring between community practices and a tertiary academic care center. Design, setting, and participantsWe identified 262 mpMRI studies from nonacademic facilities, reinterpreted by radiologists at our institution between January 2016 and July 2022. Results of targeted MRI fusion biopsy were identified for 193 of these patients, totaling 302 lesions. PI-RADS scoring from both community and academic interpreters were recorded in addition to presence of clinically significant PCa (csPCa) on pathological analysis of targeted cores. Main Outcome and measuresThe primary outcome was inter-reader reliability via intraclass correlation (ICC) and the kappa statistic. We also assessed the diagnostic accuracy of PI-RADS scoring for detecting csPCa for both cohorts via receiver operator characteristics (ROC) analysis and compared these findings using paired-sample area difference under curve analysis. ResultsInter-reader agreement and reliability of PI-RADS scoring per lesion was generally poor (absolute agreement ICC = 0.393, 95% CI: 0.288–0.488; consistency ICC = 0.407, 95% CI: 0.308–0.497; kappa = 0.336, 95% CI: 0.267–0.406). Reliability results from studies obtained after the publication of PI-RADSv2.1 were similar to those of the overall analysis. No agreement was observed in the subgroup of lesions scored as PIRADS 3 by community interpreters. No statistically significant difference in diagnostic accuracy was observed between cohorts (ROC area under curve [AUC]: 0.759 vs. 0.785, respectively; P = 0.337). PI-RADS 3 was determined to be the optimal cutoff for detecting clinically significant disease in both cohorts. Conclusions and relevanceOur results suggest that mpMRI diagnostic accuracy for detecting csPCa is not significantly different between academic and community practices. However, significantly poor reliability of mpMRI was observed between cohorts, suggesting the risk of introducing practice variation for community prostate cancer management. Variability, particularly for PI-RADS 3 lesions, can lead to inconsistent biopsy recommendations, which may result in missed csPCa or unnecessary biopsies.

Thyroid Imaging Reporting and Data System (TI-RADS) Stratification for Thyroid Incidentalomas in Iraqi Sample

Thyroid Imaging Reporting and Data System (TI-RADS) Stratification for Thyroid Incidentalomas in Iraqi Sample

AI-derived Tumor Volume from Multiparametric MRI and Outcomes in Localized Prostate Cancer.

Background An artificial intelligence (AI)-based method for measuring intraprostatic tumor volume based on data from MRI may provide prognostic information. Purpose To evaluate whether the total volume of intraprostatic tumor from AI-generated segmentations (VAI) provides independent prognostic information in patients with localized prostate cancer treated with radiation therapy (RT) or radical prostatectomy (RP). Materials and Methods For this retrospective, single-center study (January 2021 to August 2023), patients with cT1-3N0M0 prostate cancer who underwent MRI and were treated with RT or RP were identified. Patients who underwent RT were randomly divided into cross-validation and test RT groups. An AI segmentation algorithm was trained to delineate Prostate Imaging Reporting and Data System (PI-RADS) 3-5 lesions in the cross-validation RT group before providing segmentations for the test RT and RP groups. Cox regression models were used to evaluate the association between VAI and time to metastasis and adjusted for clinical and radiologic factors for combined RT (ie, cross-validation RT and test RT) and RP groups. Areas under the receiver operating characteristic curve (AUCs) were calculated for VAI and National Comprehensive Cancer Network (NCCN) risk categorization for prediction of 5-year metastasis (RP group) and 7-year metastasis (combined RT group). Results Overall, 732 patients were included (combined RT group, 438 patients; RP group, 294 patients). Median ages were 68 years (IQR, 62-73 years) and 61 years (IQR, 56-66 years) for the combined RT group and the RP group, respectively. VAI was associated with metastasis in the combined RT group (median follow-up, 6.9 years; adjusted hazard ratio [AHR], 1.09 per milliliter increase; 95% CI: 1.04, 1.15; P = .001) and the RP group (median follow-up, 5.5 years; AHR, 1.22; 95% CI: 1.08, 1.39; P = .001). AUCs for 7-year metastasis for the combined RT group for VAI and NCCN risk category were 0.84 (95% CI: 0.74, 0.94) and 0.74 (95% CI: 0.80, 0.98), respectively (P = .02). Five-year AUCs for the RP group for VAI and NCCN risk category were 0.89 (95% CI: 0.80, 0.98) and 0.79 (95% CI: 0.64, 0.94), respectively (P = .25). Conclusion The volume of AI-segmented lesions was an independent, prognostic factor for localized prostate cancer. © RSNA, 2024 Supplemental material is available for this article.

Noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP): Prevalence, cyto-histo correlation, and molecular and ultrasonographic profile

Non-invasive follicular thyroid neoplasm with papillary like nuclear features (NIFTP) was introduced in 2017 WHO Classification of Endocrine Tumors. In this study, we aim to characterize the molecular and ultrasonographic profiles of NIFTP and evaluate the performance of fine needle aspiration (FNA) cytology. Consecutive thyroid resections at our institution between 2018 and 2022 were collected; 1282 thyroid resections were identified. NIFTP was diagnosed in 109 cases (prevalence: 8.5 %); 65 (60 %) were the targeted nodules with an average size of 2.5 cm. Among these 65 targeted, 27 had Afirma testing results, 44 had Thyroid Imaging Reporting and Data System (TIRADS) scores, and 53 had FNA results. Of the 27 cases with Afirma reports, 23 were labeled “suspicious”, including 5 with RAS-related mutations (risk of malignancy (ROM) 75 %) and 17 without a reportable genetic alternation (ROM 50 %). 60 % cases with TIRADS scores were classified as TIRADS 4, while 16 % were classified as TIRADS 5. The majority of the 53 FNA cases had a diagnosis of AUS/FLUS (53.7 %) or FN (31.5 %). One additional targeted nodule with a diagnosis of NIFTP had BRAFV600E mutation and was reclassified as papillary thyroid carcinoma. In summary, the majority of the targeted NIFTPs had “suspicious” Afirma testing results (85 %), TIRADS 4 scores (60 %) and either AUS/FLUS (53.7 %) or FN (31.5 %) FNA results. The sensitivity and specificity of cytology for diagnosing NIFTP were 90 % and 57 %, respectively, with a positive predictive value (PPV) of 16 % and negative predictive value of 98 %.

Avoidable biopsies? Validating artificial intelligence–based decision support software in indeterminate thyroid nodules

BackgroundMultiple artificial intelligence (AI) systems have been approved to risk-stratify thyroid nodules through sonographic characterization. We sought to validate the ability of one such AI system, Koios DS (Koios Medical, Chicago, IL), to aid in improving risk stratification of indeterminate thyroid nodules. MethodsA retrospective single-institution dataset was compiled of 28 cytologically indeterminate thyroid nodules having undergone molecular testing and surgical resection, with surgical pathology categorized as malignant or benign. Nodules were retrospectively evaluated with Koios DS. After nodule selection, automated and AI-adapter–derived Thyroid Imaging Reporting and Data System (TI-RADS) levels were recorded, and agreement with radiologist-derived levels was assessed using Cohen’s κ statistic. The performance of malignancy classification was compared between the radiologist and AI-adapter. Biopsy thresholds were re-evaluated using the AI-adapter. ResultsIn this cohort, 7 (25%) nodules were malignant on surgical pathology. The median nodule size was 2.4 cm (interquartile range: 1.8–2.9 cm). Median radiologist and automated TI-RADS levels were both 4, with κ 0.25 (“fair agreement”). Malignancy classification by the radiologist provided sensitivity 100%, specificity 33.3%, positive predictive value (PPV) 33.3%, and negative predictive value (NPV) 100%, compared with the AI-adapter’s performance with sensitivity 85.7%, specificity 76.2%, PPV 54.5%, and NPV 94.1%. Using the AI-adapter, 14 of 28 biopsies would have been deferred, 13 of which were surgically benign. ConclusionKoios automated and radiologist-derived TI-RADS levels were in consistent agreement for indeterminate thyroid nodules. Malignancy reclassification with the AI-adapter improved PPV at minimal cost to NPV. Risk stratification with the addition of the AI-adapter may allow for more accurate patient counseling and the avoidance of biopsies in select cases that would otherwise be cytologically indeterminate.

Machine learning model based on dynamic contrast-enhanced ultrasound assisting LI-RADS diagnosis of HCC: A multicenter diagnostic study

BackgroundTo enhance the accuracy of hepatocellular carcinoma (HCC) diagnosis using contrast-enhanced (CE) US, the American College of Radiology developed the CEUS Liver Imaging Reporting and Data System (LI-RADS). However, the system still exhibits limitations in distinguishing between HCC and non-HCC lesions. PurposeTo investigate the viability of employing machine learning methods based on quantitative parameters of contrast-enhanced ultrasound for distinguishing HCC within LR-M nodules. Materials and methodsThis retrospective analysis was conducted on pre-treatment CEUS data from liver nodule patients across multiple centers between January 2013 and June 2022. Quantitative analysis was performed using CEUS images, and the machine learning diagnostic models based on quantitative parameters were utilized for the classification diagnosis of LR-M nodules. The performance of the model was assessed using the area under the receiver operating characteristic curve (AUC) and compared with the performance of four radiologists. ResultsThe training and internal testing datasets comprised 168 patients (median age, 53 years [IQR, 18 years]), while the external testing datasets from two other centers included 110 patients (median age, 54 years [IQR, 16 years]). In the internal independent test set, the top-performing Random Forest model achieved an AUC of 0.796 (95%CI: 0.729–0.853) for diagnosing HCC. This model exhibited a sensitivity of 0.752 (95%CI: 0.750–0.755) and a specificity of 0.761 (95%CI: 0.758–0.764), outperforming junior radiologists who achieved an AUC of 0.619 (95%CI: 0.543–0.691, p < .01) with sensitivity and specificity of 0.716 (95%CI: 0.713–0.718) and 0.522 (95%CI: 0.519–0.526), respectively. ConclusionSignificant differences in contrast-enhanced ultrasound quantitative parameters are observed between HCC and non-HCC lesions. Machine learning models leveraging these parameters effectively distinguish HCC categorized as LR-M, offering a valuable adjunct for the accurate classification of liver nodules within the CEUS LI-RADS framework.

Exploring the accuracy of embedded ChatGPT-4 and ChatGPT-4o in generating BI-RADS scores: a pilot study in radiologic clinical support

This study evaluates the accuracy of ChatGPT-4 and ChatGPT-4o in generating Breast Imaging Reporting and Data System (BI-RADS) scores from radiographic images. We tested both models using 77 breast cancer images from radiopaedia.org, including mammograms and ultrasounds. Images were analyzed in separate sessions to avoid bias. ChatGPT-4 and ChatGPT-4o achieved a 66.2 % accuracy across all BI-RADS cases. Performance was highest in BI-RADS 5 cases, with ChatGPT-4 and ChatGPT4o scoring 84.4 % and 88.9 %, respectively. However, both models struggled with BIRADS 1–3 cases, often assigning higher severity ratings. This study highlights the limitations of current LLMs in accurately grading these images and emphasizes the need for further research in these technologies before clinical integration.

Pathological response following neoadjuvant immune checkpoint inhibitors in patients with hepatocellular carcinoma: a cross-trial, patient-level analysis

Neoadjuvant use of immune checkpoint inhibitors (ICIs) before liver resection results in pathological tumour regression in patients with hepatocellular carcinoma. We aimed to describe the characteristics of pathological responses after preoperative ICI therapy for hepatocellular carcinoma and to evaluate the association between the depth of tumour regression and relapse-free survival. In this cross-trial, patient-level analysis, we performed a pooled analysis of data from patients with hepatocellular carcinoma receiving ICI therapy before liver resection as part of a global collaborative consortium (NeoHCC) of five phase 1 and 2 clinical trials and standardised observational protocols conducted in 12 tertiary referral centres across the USA, UK, and Taiwan. Eligible patients were adults (aged ≥18 years) diagnosed with hepatocellular carcinoma by tissue core biopsy before treatment initiation, a Liver Imaging Reporting and Data System score of 5 on imaging, or both, with an Eastern Cooperative Oncology Group performance status score of 0-1, and no extrahepatic spread or previous ICI treatment. Pathological response was measured as the percentage of non-viable tumour in the resected surgical specimen, with major pathological response corresponding to at least 70% tumour regression and pathological complete response corresponding to 100% tumour regression. We correlated pathological response with radiological overall response using RECIST criteria (version 1.1) and relapse-free survival, and evaluated the threshold of tumour regression that could be optimally associated with relapse-free survival. At data cutoff on Jan 31, 2024, 111 patients were included in the study, of whom data on pathological response were available for 104 (94%) patients. Patients received treatment from Oct 5, 2017, to Nov 15, 2023, mostly ICI combinations (76 [69%]), for a median of 1·4 months (IQR 0·7-2·9). 87 (78%) patients were men and 24 (22%) were women. Most patients had underlying viral chronic liver disease (73 [66%]) and Barcelona Clinic Liver Cancer stage A hepatocellular carcinoma (61 [55%]), without portal vein thrombosis (87 [78%]). We observed major pathological response in 33 (32%) patients and pathological complete response in 19 (18%) patients. Radiological overall response was associated with major pathological response, with 23 (74%) of 31 patients with radiological response showing major pathological response compared with ten (14%) of 73 patients without radiological response (p<0·0001). However, ten (30%) of 33 major pathological responses were not predicted by radiological response. After a median follow-up of 27·2 months (95% CI 22·3-32·1), median relapse-free survival for the whole cohort was 43·6 months (95% CI 28·3-not evaluable). Relapse-free survival was significantly longer in patients with major pathological response than in those who did not have a major pathological response (not reached [95% CI not evaluable-not evaluable] vs 28·3 months [12·8-43·8]; hazard ratio 0·26 [0·10-0·66]; p=0·0024) and in patients with pathological complete response than in those who did not have a pathological complete response (NR [95% CI not evaluable-not evaluable] vs 32·8 months [15·0-50·5]; 0·19 [0·05-0·78]; p=0·010). Unbiased recursive partitioning of the cohort for the risk of relapse, death, or both identified a threshold of 90% as the optimal cutoff of pathological tumour regression to predict improved relapse-free survival. The extent of tumour regression following neoadjuvant ICI therapy could identify patients with improved relapse-free survival following liver resection. The threshold of at least 90% tumour regression should be validated for its surrogate role for relapse-free survival in phase 3 randomised controlled trials. None.