Clinical Radiology[JOURNAL]
Sun
200 papers
Radiological features and formation mechanisms of periosteal proliferation in osteogenesis imperfecta type V.
Zhang Y, Liu J, Zhang Z … +4 more , Zhang Y, Huang X, Li M, Yu W
Clin Radiol · 2026 May · PMID 42287861 · Publisher ↗
AIM: This study investigates the radiological features and formation mechanisms of periosteal proliferation caused by disordered osteogenesis and mineralisation in osteogenesis imperfecta (OI) type V. MATERIALS AND METHO...
AIM: This study investigates the radiological features and formation mechanisms of periosteal proliferation caused by disordered osteogenesis and mineralisation in osteogenesis imperfecta (OI) type V. MATERIALS AND METHODS: A total of 24 patients (mean age: 6.3 ± 5.2 years; 62.5% females) underwent X-ray and dual-energy X-ray absorptiometry, yielding 134 images of 180 long bones. Bones were categorised into fracture and nonfracture groups. Fracture patterns and the subsequent healing process during follow-up were assessed. Periosteal proliferation morphology (thin, lamellated, solid, thick, circular, butterfly, shell, spindle, and irregular), boundary (well defined or ill defined), distribution (focal or diffuse), thickness, bone enlargement, bone cortex, and soft-tissue mass were assessed. Relevant clinical and laboratory data on bone metabolism and inflammation were also recorded. RESULTS: Fractures healed gradually through callus formation (median follow-up: 2 years). All periosteal proliferations showed intact cortex and no soft-tissue mass; the solid type accounted for 63.8%. Ill-defined proliferation thickness was 2.3 times greater than well-defined (10.7 [5.1, 46.4] and 4.6 [3.5, 7.7], respectively; P = 0.003). Diffuse proliferation more often accompanied bone enlargement than focal (36.7% vs. 7.8%, P = 0.001) and progressed more frequently (73.7% vs. 42.9%, P = 0.030). The patients with elevated C-reactive protein (CRP) or erythrocyte sedimentation rate (ESR) are more likely to exhibit diffuse periosteal proliferation than the normal inflammatory markers (66.7% vs 0%), although not statistically significant (P = 0.147). CONCLUSION: OI type V shows delayed fracture healing or nonunion. Nonfracture cases present unique periosteal proliferation. Diffuse type correlates with bone enlargement and progression. Inflammatory markers' role needs further confirmation.
Neuromelioidosis in a nutshell-Pattern and Endemicity.
Janet Preethi Philomina P, Sunitha VC, Adithan S
Clin Radiol · 2026 Jul · PMID 42284690 · Publisher ↗
Timely and accurate imaging diagnosis is critical in cases of fever, altered sensorium, seizures, or headaches that do not respond to conventional clinical management. This pictorial essay aims to highlight, through case...
Timely and accurate imaging diagnosis is critical in cases of fever, altered sensorium, seizures, or headaches that do not respond to conventional clinical management. This pictorial essay aims to highlight, through case illustrations, the critical role of imaging in identifying Burkholderia pseudomallei-a rare but significant infectious agent responsible for a characteristic pattern of brain and spinal cord involvement. The condition, known as neuromelioidosis, is endemic in the tropical regions of Southeast Asia and Northern Australia including coastal regions of Tamil Nadu and Karnataka in South India. This review underscores the importance of recognising patterns associated with this disease, with emphasis on the characteristic and specific feature of corticospinal tract involvement. Correct diagnosis is necessary to guide the initiation of targeted antibiotic therapy, which is a critical step in initiating the urgent management required to improve survival outcomes. Furthermore, we provide a discussion of differential diagnoses associated with similar imaging findings, emphasising the need for a nuanced approach to diagnosis and management in such complex cases. By raising awareness of the geographical prevalence and imaging hallmarks of neuromelioidosis, this study aims to enhance clinical decision-making and improve outcomes in affected patients.
Internet image search for musculoskeletal neoplasms: do results return the correct MR sequences?
Zhu A, Gulati V, Qadri S … +4 more , Thakur U, Pezeshk P, Chhabra A, Ashikyan O
Clin Radiol · 2026 Apr · PMID 42275688 · Publisher ↗
AIM: When radiologists encounter an unfamiliar musculoskeletal neoplasm on conventional and advanced MR images, they now have an option to search the internet for MRI image examples. The purpose of this project was to sy...
AIM: When radiologists encounter an unfamiliar musculoskeletal neoplasm on conventional and advanced MR images, they now have an option to search the internet for MRI image examples. The purpose of this project was to systematically evaluate the quality of images returned by a widely used general search engine. MATERIALS AND METHODS: Systematic internet searches were conducted for 16 benign and malignant musculoskeletal neoplasms, focusing on T1-weighted (T1W), T2-weighted (T2W), contrast-enhanced, diffusion-weighted (DWI), and out-of-phase MR images. The top five images from each search were evaluated for image quality and clinical relevance using a 5-point scoring key. RESULTS: General internet engine returned correct sequence among the top five results for 88% of lesions when searched for T1W images, 100% for T2W images, 100% for contrast-enhanced images, 63% for DWI, and 25% for out-of-phase images. Fleiss Kappa statistic demonstrated substantial agreement (Kappa = 0.72) for binary "useful" vs "not useful" image designation, and moderate agreement (Kappa = 0.48) for all five categories. CONCLUSION: The general internet search engine returned useful results when searching for conventional MRI sequences but performed sub-optimally when searching for advanced MR image examples.
Software-assisted magnetic resonance imaging-transrectal ultrasound (MRI-TRUS) fusion-guided transperineal prostate biopsy: is there still a need for contralateral systematic biopsy?
Claerhoudt F, De Vulder N, Libeert A … +7 more , Gieraerts K, Meersschaert J, Kalmar A, Marrannes J, Dekimpe P, Uvin P, Villeirs G
Clin Radiol · 2026 Jun · PMID 42263549 · Publisher ↗
AIM: Combined biopsy (CBx) of the prostate, integrating magnetic resonance imaging (MRI)-targeted biopsy (TBx) with systematic biopsy (SBx), is widely used for detecting clinically significant prostate cancer (csPCa) but...
AIM: Combined biopsy (CBx) of the prostate, integrating magnetic resonance imaging (MRI)-targeted biopsy (TBx) with systematic biopsy (SBx), is widely used for detecting clinically significant prostate cancer (csPCa) but carries a risk of overdiagnosis. This study evaluated whether SBxs contralateral to the MRI target can be omitted in men with unilateral MRI-visible prostate lesions by comparing CBx with targeted biopsy plus ipsilateral systematic biopsy (TBx + SBxIpsi). MATERIALS AND METHODS: In this prospective, single-centre study, 582 magnetic resonance imaging-transrectal ultrasound (MRI-TRUS) fusion-guided transperineal biopsy sessions were analysed. Inclusion criteria were a single unilateral prostate lesion on MRI, not overlapping the midline, with a Prostate Imaging Reporting and Data System (PI-RADS) v2.1 score of 3-5. Patients underwent CBx, consisting of 5 TBx cores and 10 SBx cores (SBx; 5 per hemigland). Detection rates of csPCa (International Society of Urological Pathology [ISUP] grade group ≥2) and clinically insignificant prostate cancer (cisPCa, ISUP grade group 1) using TBx + SBxIpsi were compared with CBx using McNemar's test with Holm-Bonferroni correction. RESULTS: A total of 582 men (mean age: 69 ± 9 years) underwent biopsy. CBx detected csPCa in 383 of 582 patients (65.8%; 95% confidence interval [CI]: 61.8-69.7%). TBx + SBxIpsi detected csPCa in 381 of 582 patients (65.5%; 95% CI: 61.4-69.3%), identifying 99.5% of csPCa cases detected by CBx, with no statistically significant difference (P=0.4795). Detection of cisPCa was lower with TBx + SBxIpsi than with CBx (80/582 vs. 87/582; P=0.0455). CONCLUSION: Omitting SBxs contralateral to the MRI target maintains comparable csPCa detection while reducing cisPCa detection and the number of biopsy cores.
Magnetic Resonance Neurography (MRN): part 1- basic concepts, technical considerations, interpretation, and clinical utility.
Cheraya G, Tejani AS, Prakash M … +2 more , Lutz A, Chhabra A
Clin Radiol · 2026 May · PMID 42250318 · Publisher ↗
AIM: To review the technical foundations of Magnetic Resonance Neurography (MRN), outline key hardware and sequence considerations for high‑quality peripheral nerve imaging, and introduce the NS‑RADS reporting system as...
AIM: To review the technical foundations of Magnetic Resonance Neurography (MRN), outline key hardware and sequence considerations for high‑quality peripheral nerve imaging, and introduce the NS‑RADS reporting system as part of a two‑part series on MRN. MATERIALS AND METHODS: This narrative review synthesizes current literature on peripheral neuropathies and MRN, including studies evaluating electrodiagnostic testing, ultrasonography, conventional MRI, and advanced MRN techniques. Technical parameters, sequence design, fat and vascular suppression strategies, and 3D isotropic acquisitions were examined to provide a comprehensive overview of MRN optimization. Relevant classification and reporting frameworks, including NS‑RADS, were also reviewed. RESULTS: Peripheral neuropathies arise from diverse traumatic, compressive, inflammatory, metabolic, and neoplastic etiologies, often presenting with overlapping clinical features that complicate diagnosis. Electrodiagnostic studies offer functional assessment but have limitations in localizing and characterizing lesions. Ultrasonography provides complementary structural information but is constrained by operator dependence and reduced sensitivity for deep nerves. MRN has emerged as a transformative modality, enabling high‑resolution visualization of peripheral nerves, fascicular architecture, and denervation patterns through advanced hardware, robust suppression techniques, and nerve‑selective sequences. This article summarizes the technical principles underlying MRN and introduces NS‑RADS to enhance reporting consistency and diagnostic confidence. CONCLUSION: MRN addresses key limitations of conventional imaging and electrodiagnostic evaluation by providing detailed structural and fascicular assessment of peripheral nerves. Understanding its technical foundations and standardized reporting framework is essential for accurate interpretation and optimal clinical application. The companion article in this series focuses on clinical utility, characteristic imaging features, and hallmark MRN signs across common and uncommon neuropathies.
Magnetic resonance neurography: part 2- interpretation decoded: a guide to Neuropathy Score Reporting and Data System and imaging signs for efficient diagnosis of peripheral nerve lesions.
Tejani AS, Cheraya G, Prakash M … +2 more , Lutz A, Chhabra A
Clin Radiol · 2026 May · PMID 42250317 · Publisher ↗
AIM: To describe the Neuropathy Score Reporting and Data System (NS‑RADS), outline its practical application in interpreting peripheral neuropathies on magnetic resonance neurography (MRN), and integrate hallmark MRN ima...
AIM: To describe the Neuropathy Score Reporting and Data System (NS‑RADS), outline its practical application in interpreting peripheral neuropathies on magnetic resonance neurography (MRN), and integrate hallmark MRN imaging signs that aid diagnostic evaluation. MATERIALS AND METHODS: This narrative review synthesizes current literature on MRN‑based assessment of peripheral neuropathies, including classification frameworks, pattern‑based interpretation strategies, and characteristic imaging signs. NS‑RADS categories and criteria were examined alongside established MRN descriptors to provide a structured approach to evaluating nerve and muscle abnormalities. RESULTS: Accurate interpretation of peripheral neuropathies on MRN requires high‑quality imaging and a reproducible framework for assessing nerve signal, caliber, fascicular distortion, and denervation. NS‑RADS offers a standardized MRI‑based system for classifying diffuse neuropathy, entrapment, traumatic injury, neoplastic processes, and post‑intervention changes, improving communication and diagnostic confidence. Integrating NS‑RADS with hallmark MRN signs-such as the target, spaghetti, honeycomb, garland, hourglass, Mount Fuji, meandering, zigzag, and triple‑B patterns-enhances recognition of common etiologies including traumatic, compressive, inflammatory, and neoplastic neuropathies. These imaging patterns provide valuable clues to lesion severity, chronicity, and underlying pathophysiology. CONCLUSION: NS‑RADS, combined with pattern‑based MRN interpretation, provides a practical and efficient framework for evaluating peripheral nerve lesions and differentiating overlapping neuropathic entities. Incorporating standardized reporting with characteristic imaging signs strengthens diagnostic accuracy and supports consistent clinical decision‑making in routine practice.
Undifferentiated pancreatic cancer with osteoclast-like giant cells: imaging features.
Sandrasegaran K, Chughtai K, Yano M … +3 more , McHugh K, Maheswari S, Miller FH
Clin Radiol · 2026 Jul · PMID 42241747 · Publisher ↗
AIM: The 2019 WHO classification of pancreatic ductal adenocarcinoma (PDAC) recognizes undifferentiated carcinoma with osteoclast-like giant cells (UCOG) as a rare subset. There is sparse literature on the imaging appear...
AIM: The 2019 WHO classification of pancreatic ductal adenocarcinoma (PDAC) recognizes undifferentiated carcinoma with osteoclast-like giant cells (UCOG) as a rare subset. There is sparse literature on the imaging appearances of this type of cancer. Pathologists also increasingly recognize that poorly-differentiated PDAC may occasionally contain osteoclast-like giant cells (PDO). This study aims to compare the imaging features and natural history of these two groups. MATERIALS AND METHODS: In this retrospective case-controlled study, we searched the Institutional pathology and imaging databases for "pancreas cancer" and "osteoclasts." Of the 59 subjects identified, preoperative imaging (CT or MRI) and acceptable pathology data were available in 25 patients who formed the final study cohort. Two specialist abdominal radiologists independently reviewed the imaging findings. The cohort included 10 patients with PDO and 15 with UCOG. RESULTS: There were no differences in age or gender between these groups. On logistic regression analysis, only the presence of tumor hemorrhage (p=0.007), and pancreatic duct obstruction (p=0.02) were significantly different between the groups. UCOG had fewer metastases at presentation and follow-up, though the differences were not significant. UCOG had significantly higher overall survival (median 35.4 months vs. 10.7 months, p=0.007) and progression-free survival (median 33.0 months vs. 9.1 months, p=0.003), compared to PDO. CONCLUSION: The presence of a large (>6 cm) solid pancreatic mass that shows hemorrhage, exophytic growth, and lack of pancreatic duct obstruction may raise the possibility of UCOG. Despite larger size at presentation, these tumors generally have a better prognosis than the published prognosis for conventional PDAC.
Dynamic changes in magnetic resonance imaging (MRI) features improve sensitivity for diagnosing small recurrent hepatocellular carcinoma after resection.
Chen J, Chen X, Wang W … +5 more , Sun W, Dong S, Yang G, Zeng M, Rao S
Clin Radiol · 2026 Jul · PMID 42241746 · Publisher ↗
AIM: To establish improved diagnostic criteria for small recurrent hepatocellular carcinoma (HCC) (<20 mm) presenting with indeterminate findings on postoperative surveillance magnetic resonance imaging (MRI). MATERIALS...
AIM: To establish improved diagnostic criteria for small recurrent hepatocellular carcinoma (HCC) (<20 mm) presenting with indeterminate findings on postoperative surveillance magnetic resonance imaging (MRI). MATERIALS AND METHODS: Patients who underwent curative resection for primary HCC between January and December 2018 were retrospectively reviewed. Newly detected hepatic nodules with atypical imaging features on surveillance MRI were included. Logistic regression analyses were performed to identify imaging features independently associated with recurrent HCC at the time of initial detection. The diagnostic performance of newly emerged MRI features (newly emerged arterial phase hyperenhancement, washout, enhancing 'capsule', threshold growth, mild-to-moderate T2 hyperintensity, restricted diffusion, and T1 hypointensity), threshold growth on 3-month follow-up MRI, and the liver imaging reporting and data system (LI-RADS) category were assessed and compared. RESULTS: A total of 398 patients with 460 newly detected nodules were analysed, of which 351 (76.3%) were confirmed as recurrent HCC. Restricted diffusion (odds ratio [OR], 2.18; 95% confidence interval [CI], 1.20-3.95; P = 0.01) and T1 hypointensity (OR, 20.48; 95% CI, 11.53-36.36; P < 0.001) were independent predictors of recurrence at initial detection. Compared with threshold growth alone (sensitivity, 60.6%) and LI-RADS 5 (sensitivity, 45.6%), newly emerged MRI features demonstrated significantly higher sensitivity (94.9%; P < 0.001 for both) while maintaining comparable specificity (96.3% vs. 98.2% vs. 98.2%; P > 0.99). The area under the receiver operating characteristic (ROC) curve for newly emerged features was 0.96 (0.94 after excluding LI-RADS 5 nodules). CONCLUSION: Newly emerged MRI features offer higher sensitivity than threshold growth and LI-RADS 5 categorisation, while maintaining high specificity for the early diagnosis of recurrent HCC.
Superiority of ultrasound-DSP fusion over CT guidance for percutaneous nephrostomy in complex hydronephrosis: a propensity-matched multicenter cohort study demonstrating enhanced procedural efficiency and secondary ureteroscopy success.
Shen SW, Li P, Wang FA … +3 more , Chen FJ, Zhang TL, Yuan P
Clin Radiol · 2026 Jul · PMID 42229072 · Publisher ↗
AIM: To compare the procedural efficiency, clinical outcomes, and economic impact of one-stop US-DSP (ultrasound-digital subtraction pyelography) fusion-guided percutaneous nephrostomy (PCN) versus conventional staged CT...
AIM: To compare the procedural efficiency, clinical outcomes, and economic impact of one-stop US-DSP (ultrasound-digital subtraction pyelography) fusion-guided percutaneous nephrostomy (PCN) versus conventional staged CT-guided PCN for complex hydronephrosis. MATERIALS AND METHODS: This retrospective, propensity-score matched, multicenter study included consecutive patients with complex hydronephrosis (Society for Fetal Urology grade ≥3 and/or complicated by anatomical/malignant factors) who underwent urgent PCN between 2022 and 2023. Patients were stratified by guidance method (US-DSP fusion vs. CT) and matched 1:1. Primary endpoints were procedural time, number of needle passes, and 2-week secondary ureteroscopy success rate. Secondary outcomes included decompression efficacy, 30-day complications, direct medical costs, and radiation dose. RESULTS: Sixty matched patient pairs were analyzed. The US-DSP fusion group showed superior performance: 38% shorter median procedural time (22.2 vs. 35.6 min, P<.001), fewer needle passes (1.7 vs. 2.2, P=.005), higher single-pass success rate (65.0% vs. 38.3%, P=.003), and higher secondary ureteroscopy success rate (93.3% vs. 75.0%, P=.002). It also reduced median radiation dose by 58% (9.2 vs. 22.0 mSv, P<.001) and direct costs by 19.3% (¥5,862 vs. ¥7,266, P<.001), without increasing complications (5.0% vs. 10.0%, P=.310). CONCLUSION: US-DSP fusion-guided one-stop PCN outperforms CT-guided staged PCN for complex hydronephrosis, enhancing efficiency, facilitating downstream treatment, and reducing radiation exposure and costs, supporting its adoption as the preferred approach.
Diagnosis of cardiac pathology on acute electrocardiographic-gated thoracic computed tomography: guidance for the general radiologist.
Manghat NE, Greco F, Harries I … +3 more , Karteszi H, Kulshrestha R, Hamilton MCK
Clin Radiol · 2026 Jul · PMID 42208403 · Publisher ↗
The use of electrocardiographic-gated thoracic aortic computed tomographic angiography has become a routine clinico-radiological tool and has subsequently been incorporated into subspeciality national recommendations. Wh...
The use of electrocardiographic-gated thoracic aortic computed tomographic angiography has become a routine clinico-radiological tool and has subsequently been incorporated into subspeciality national recommendations. Whilst the prevalence of acute aortic syndrome is relatively low, the same dataset provides the opportunity to identify the cause of the acute presentation, including coronary artery atheromatous disease and its consequences. Potentially life-threatening cardiac pathology continues to be overlooked and/or misinterpreted by radiologists despite being a required core competency. In the interest of minimising avoidable error and learning from previous errors, we aim to present some guidance for the general radiologist to assist in the image acquisition and interpretation of acute electrocardiographic -gated thoracic imaging.
Beyond the pedal-plantar loop: alternative inframalleolar endovascular routes for lower limb angioplasty.
Ong ETE, Pua U
Clin Radiol · 2026 Jul · PMID 42202722 · Publisher ↗
Revascularisation angioplasty plays a key role in the management of chronic limb-threatening ischaemia. Over the past two decades, the pedal-plantar loop has emerged as the primary inframalleolar anastomosis for endovasc...
Revascularisation angioplasty plays a key role in the management of chronic limb-threatening ischaemia. Over the past two decades, the pedal-plantar loop has emerged as the primary inframalleolar anastomosis for endovascular treatment with promising outcome data for wound healing, limb salvage, and overall survival. This review highlights alternative anastomoses that can serve as targets for angioplasty and routes for retrograde wiring when the pedal-plantar loop is absent or impassable. Each alternative anastomosis is described with key anatomical landmarks, schematic diagrams, imaging examples, and practical considerations. Recognising these vascular variations and their radiographic landmarks enhances the effectiveness of endovascular interventions, providing additional conduits in cases of difficult occlusions or anatomical variants.
Withdrawal notice to "Relationship between coronary microvascular dysfunction (CMD) and left ventricular diastolic function in patients with symptoms of myocardial ischemia with non-obstructive coronary artery disease (INOCA) by cardiovascular magnetic resonance feature-tracking"[ClinRad 79(7) (July 2024) 536-543.
Kong H, Cao J, Tian J … +4 more , Yong J, An J, Song X, He Y
Clin Radiol · 2026 Jul · PMID 42202721 · Publisher ↗
Abstract loading — click title to view on PubMed.
A deep learning lung cancer segmentation pipeline to facilitate CT-based radiomics.
So ACP, Cheng D, Aslani S … +7 more , Azimbagirad M, Yamada D, Bille A, Sivarasan N, Pennycuick A, Karapanagiotou E, Jacob J
Clin Radiol · 2026 Jul · PMID 42190286 · Publisher ↗
AIM: CT-based radio-biomarkers could provide non-invasive insights into tumour biology to risk-stratify patients. One of the limitations is the laborious manual segmentation of regions-of-interest (ROI). We present a dee...
AIM: CT-based radio-biomarkers could provide non-invasive insights into tumour biology to risk-stratify patients. One of the limitations is the laborious manual segmentation of regions-of-interest (ROI). We present a deep learning auto-segmentation pipeline for radiomic analysis. MATERIALS AND METHODS: 153 patients with resected stage 2A-3B non-small cell lung cancer (NSCLC) had tumours segmented using nnU-Net with review by two clinicians. The nnU-Net was pretrained with anatomical priors in non-cancerous lungs and finetuned on NSCLCs. Three ROIs were segmented: intra-tumoural, peri-tumoural, and whole lung. A total of 1967 features were extracted using PyRadiomics. Feature reproducibility was tested using segmentation perturbations. Features were selected using minimum-redundancy-maximum-relevance with Random Forest-recursive feature elimination nested in 500 bootstraps. RESULTS: Auto-segmentation time was ∼36 seconds/series. Mean volumetric and surface Dice-Sørensen coefficient (DSC) scores were 0.84 (±0.28), and 0.79 (±0.34) respectively. DSC scores were significantly correlated with tumour shape (sphericity, diameter) and location (with worse performance associated with chest wall adherence), but not with batch effects (e.g. reconstruction kernel). Overall, 6.5% of cases had 'missed' segmentations; 6.5% required major changes. Pre-training on anatomical priors resulted in better segmentations compared to training on tumour-labels alone (p<0.001) and tumour plus anatomical labels (p<0.001). Most radiomic features were not reproducible following perturbations and resampling. Adding radiomic features did not significantly improve the clinical model in predicting 2-year disease-free survival: AUCs were 0.67 (95%CI 0.59-0.75) vs 0.63 (95%CI 0.54-0.71) respectively (p=0.28). CONCLUSION: Our study demonstrates that integrating auto-segmentation into radio-biomarker discovery is feasible with high efficiency and accuracy. Whilst traditional radiomics show limited reproducibility, our auto-segmentation pipeline can facilitate future novel radio-biomarker development.
Development and internal validation of a semiautomated HRCT-based tool for quantification of interstitial lung disease in systemic sclerosis.
Muangchan C, Wonglaksanapimon S, Thiravit P … +7 more , Butnian K, Yodprom P, Chomphuphun A, Boonrueng N, Saiviroonporn P, Disayabutr S, Teerapuncharoen K
Clin Radiol · 2026 Jul · PMID 42184707 · Publisher ↗
AIM: Interstitial lung disease (ILD) is a major cause of morbidity and mortality in systemic sclerosis (SSc), and HRCT disease extent is central to clinical stratification. Visual assessment, however, is subject to inter...
AIM: Interstitial lung disease (ILD) is a major cause of morbidity and mortality in systemic sclerosis (SSc), and HRCT disease extent is central to clinical stratification. Visual assessment, however, is subject to interobserver variability. This study aimed to develop and internally validate a semiautomated HRCT-based programme for quantitative assessment of SSc-ILD. MATERIALS AND METHODS: In this retrospective single-centre study, HRCT scans from patients with SSc-ILD were analysed using a semiautomated programme. Pulmonary parenchyma was segmented and classified into ground-glass opacity, reticulation, honeycombing, and normal lung tissue. Intra- and interobserver reproducibility were assessed. Internal validation was performed against expert clinical assessment of ILD extent and pulmonary function test parameters. RESULTS: Seventy-eight patients with SSc-ILD were included. Intra- and interobserver reproducibility was excellent, with intraclass correlation coefficients exceeding 0.9 for lung segmentation and lesion quantification. Mean global ILD extent was 21.8% by programme and 17.7% by expert assessment. Programme-derived global extent correlated strongly with expert-assessed extent (r=0.74, p<0.0001). A programme-derived threshold of 19.5% identified expert-assessed extent exceeding 20%, with an area under the receiver operating characteristic curve of 0.885. CONCLUSION: The semiautomated programme provides reproducible quantitative assessment of SSc-ILD on HRCT and shows good agreement with expert clinical evaluation. It may serve as a quantitative adjunct to visual assessment. This was a single-centre study with a relatively small sample size and reliance on a single expert assessor.
Assessment of left atrioventricular coupling index in hypertrophic cardiomyopathy: improving risk stratification with cardiac magnetic resonance (CMR).
Zhang D, Qian Y, Gu Z … +3 more , Zhao L, Wu L, Wang Y
Clin Radiol · 2026 Jul · PMID 42176596 · Publisher ↗
AIM: To assess the prognostic value of the left atrioventricular coupling index (LACI) in predicting sudden cardiac death (SCD) events in patients with hypertrophic cardiomyopathy (HCM), and to evaluate whether LACI prov...
AIM: To assess the prognostic value of the left atrioventricular coupling index (LACI) in predicting sudden cardiac death (SCD) events in patients with hypertrophic cardiomyopathy (HCM), and to evaluate whether LACI provides incremental prognostic information beyond guideline-based risk models. MATERIALS AND METHODS: In this retrospective study, 2,240 HCM patients were analysed. Clinical and cardiac magnetic resonance (CMR) parameters, including LACI, late gadolinium enhancement (LGE), and left ventricular ejection fraction (LVEF), were evaluated. LACI was defined as the ratio of left atrial end-diastolic volume to left ventricular end-diastolic volume. Univariable and multivariable Cox regression analyses assessed associations of LACI with SCD events and guideline-based models (European Society of Cardiology [ESC] and American College of Cardiology/American Heart Association [ACC/AHA]). RESULTS: Over a mean follow-up of 4.0 ± 2.5 years, 128 patients (5.7%) experienced SCD events. Event patients had higher LACI (39% ± 28% vs. 33% ± 23%, P = 0.04), greater LGE (12.1 ± 8.6% vs 6.4 ± 4.3%, P < 0.001), and lower LVEF (48 ± 15% vs 65 ± 13%, P < 0.001). LACI independently predicted SCD events after adjusting for LGE and conventional risk factors (multivariable hazard ratio [HR] 1.44-1.46, 95% confidence interval [CI]: 1.3-1.6; P < 0.001) in both ESC- and ACC/AHA-adjusted models. Adding LACI and LGE to the ESC model improved the area under the curve [AUC] (0.69 vs 0.53) and specificity (82.6% vs 57.9%). CONCLUSION: CMR-derived LACI independently predicts adverse outcomes in HCM and provides incremental prognostic value beyond LGE and guideline-based models.
Analysis of cardiac magnetic resonance characteristics in patients with ejection fraction preserved heart failure.
Zhang Y, Li Y, Yang X … +6 more , Wang X, Chen S, Liu T, Liu C, Wu J, Sun Y
Clin Radiol · 2026 Jul · PMID 42161171 · Publisher ↗
AIM: The rising prevalence of heart failure with preserved ejection fraction (HFpEF) underscores the importance of epicardial adipose tissue (EAT). This study employs cardiac magnetic resonance (CMR) to quantify EAT volu...
AIM: The rising prevalence of heart failure with preserved ejection fraction (HFpEF) underscores the importance of epicardial adipose tissue (EAT). This study employs cardiac magnetic resonance (CMR) to quantify EAT volume and investigate its association with left ventricular function and patient prognosis, aiming to inform clinical strategies. MATERIALS AND METHODS: We retrospectively analysed 117 HFpEF patients, 65 healthy controls, and 62 high-risk individuals using CMR. A follow-up cohort (n = 228), consisting of HFpEF and high-risk participants, was assessed for the primary endpoint of heart failure readmission or all-cause death. EAT volume and left ventricular strain were measured using CVI42 software. RESULTS: The epicardial adipose tissue index (EATi) increased progressively across control, high-risk, and HFpEF groups (median: 20.32, 31.98, and 48.21 mL/m, P < 0.001). In a multivariable logistic regression model including three strain parameters, EATi and left ventricular global longitudinal strain (LV-GLS) were independently associated with HFpEF. EATi effectively discriminated control from high-risk individuals (area under the curve [AUC] = 0.818, cutoff 23.96 mL/m) and high-risk from HFpEF patients (AUC = 0.784, cutoff 45.90 mL/m). Over a median follow-up of 31 months, higher EATi was independently associated with an increased risk of the composite endpoint (hazard ratio [HR] = 1.05 per mL/m increase, 95% confidence interval [CI]: 1.02-1.07, P = 0.0002). CONCLUSION: CMR-quantified EAT volume is strongly associated with HFpEF severity and predicts adverse outcomes, providing incremental diagnostic and prognostic value beyond conventional metrics. EAT represents a promising imaging biomarker for risk stratification in HFpEF, warranting validation in prospective studies.
Cardiac magnetic resonance-derived atrioventricular coupling index for predicting left ventricular reverse remodeling in dilated cardiomyopathy.
Ke J, Zhang C, Wang X … +3 more , Wu C, Zhou Y, Wang J
Clin Radiol · 2026 Jul · PMID 42155308 · Publisher ↗
AIM: To investigate the value of the cardiac magnetic resonance (CMR)-derived left atrioventricular coupling index (LACI) in predicting left ventricular reverse remodeling (LVRR) in patients with dilated cardiomyopathy (...
AIM: To investigate the value of the cardiac magnetic resonance (CMR)-derived left atrioventricular coupling index (LACI) in predicting left ventricular reverse remodeling (LVRR) in patients with dilated cardiomyopathy (DCM) receiving standardized medical therapy. MATERIALS AND METHODS: This retrospective study enrolled 64 hospitalized DCM patients managed with guideline-directed therapy. Within a one-year follow-up, patients were stratified into LVRR and non-LVRR groups using echocardiographic criteria. Three multivariable models were constructed from predictors identified in univariable analysis (p<0.2), each uniquely integrating either the LACI, left atrial strain, or left ventricular strain. The Delong test was used to compare model performance. RESULTS: In our study, the LVRR group exhibited significantly lower LACI, serum creatinine, uric acid, and all cardiac volumetric parameters (left ventricular and atrial volumes) (all p<0.05). Conversely, the LVRR group showed higher left ventricular and atrial ejection fractions, all left ventricular strains, and all left atrial strains (all p<0.05). LACI was an independent predictor of LVRR (odds ratio = 0.585; 95% confidence interval [CI]: 0.391-0.874; p=0.009). The combined model incorporating LACI demonstrated the best predictive performance, with an area under the curve (AUC) of 0.825, outperforming the models incorporating left ventricular strain (AUC = 0.805) or left atrial strain (AUC = 0.791). CONCLUSION: For predicting LVRR in DCM, LACI provides value comparable to or superior to than strain parameters when incorporated into models based on clinical and conventional CMR parameters.
Imaging acute abdominal presentations in pregnancy - a British society of urogenital radiology and British society of gastrointestinal and abdominal radiology survey of UK radiology practice.
Wiles R, Cuthbert F, Balasubramaniam R … +2 more , Pakpoor J, Withey S
Clin Radiol · 2026 Jul · PMID 42150284 · Publisher ↗
AIM: Acute abdominal presentations in pregnancy (AAPP) are common and require rapid diagnostic decisions. Imaging plays a critical role, but concerns regarding fetal safety complicate decision-making. While international...
AIM: Acute abdominal presentations in pregnancy (AAPP) are common and require rapid diagnostic decisions. Imaging plays a critical role, but concerns regarding fetal safety complicate decision-making. While international guidelines exist, no UK-specific guidance is currently available. To inform forthcoming UK guidance from BSUR, BSGAR, and RCR, a national survey was conducted to describe current imaging access, pathways and reporting practices. MATERIALS AND METHODS: An electronic survey was distributed to BSUR and BSGAR members between May and August 2025. Questions addressed modality availability, imaging pathways, practicalities of imaging (including consent and CT and MRI techniques) and reporting arrangements. Responses were anonymous. RESULTS: A total of 91 responses were received from 63 UK institutions. Access to ultrasound and MRI was highest during weekday "in-hours", declining at other times. CT access remained consistently high (>95% at all times). Formal imaging pathways for AAPP were limited, with the majority of institutions lacking dedicated protocols. Consent and patient information practices were highly variable. Use of contrast in MR/CT imaging varied, and supervision, dose protocols, and reporting responsibilities differed across institutions and time of day. Confidence in discussing imaging risks was moderate to high, yet up to 96% of respondents indicated that formal guidance would be valuable. CONCLUSION: This national survey highlights variation in the imaging of AAPP across the UK, including access to imaging, pathways, and reporting. These findings underscore the need for clear guidance to support evidence-based imaging. Forthcoming joint BSUR, BSGAR, and RCR guidelines aim to address these gaps, promoting consistent, high-quality care for pregnant patients presenting with suspected acute abdominal pathology.
Corrigendum to "Ultrasound-guided attenuation parameter: a liver fat quantification technique for forecasting the progression of metabolic dysfunction-associated steatotic liver disease in overweight/obese patients?" [Clin Radiol 84 (2025) 106854].
Meng F, Pian L, Wang Q … +3 more , Chen J, Liu Y, Zhao J
Clin Radiol · 2026 Jul · PMID 42150283 · Publisher ↗
Abstract loading — click title to view on PubMed.
On-call simulation in diagnostic radiology; an underused medical education tool.
Bhardwaj A, Stephenson K, FunsoFayomi C … +2 more , Mistry T, Pervez A
Clin Radiol · 2026 Jul · PMID 42142517 · Publisher ↗
AIM: On-call responsibilities are fundamental to radiology training; requiring competence in managing workload, communication, prioritisation, and reporting. Simulation is a well-established medical education tool, but t...
AIM: On-call responsibilities are fundamental to radiology training; requiring competence in managing workload, communication, prioritisation, and reporting. Simulation is a well-established medical education tool, but there are limited published studies on its application in diagnostic radiology. Existing research largely focuses on technical reporting, neglecting nontechnical skills, which are equally essential for safe on-call practice. MATERIALS AND METHODS: Design of a simulation course for junior radiology trainees prior to stepping onto an on-call rota. Participants were given real-life cases to report, while being interrupted by phone calls for clinical queries. They were expected to communicate urgent findings to facilitators in real-time. Rotating participants observed via video link and contemporaneously reviewed cases themselves. The simulation was facilitated by senior radiology trainees in a 'near-peer' format. A postsimulation debrief utilised a feedback cycle with relevant teaching and advice. RESULTS: Improvement in confidence and preparedness for on-call work was demonstrated through pre- and post-course feedback, with confidence in preparedness for on-calls increasing from 5.1 to 7.1/10, vetting confidence increasing from 7.2 to 8.2/10, and confidence in reporting on call studies increasing from 4.8 to 6.7/10. General feedback themes included the usefulness of personalised feedback, the use of real-life on-call cases with challenging but realistic expectations, and the benefit of having near-peer facilitators promoting a psychologically safe learning environment. CONCLUSION: Simulation training that incorporates both technical and nontechnical aspects of on-call work is a highly effective strategy to enhance trainee readiness and improve confidence. Integrating such programs into radiology curricula, with near-peer facilitation, ensures a structured, safe, and impactful learning experience.
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