Clinical Radiology[JOURNAL]
Sun
200 papers
Computed tomography features of polysplenia syndrome in adulthood: a case series.
Yang B, Wang P, Hao Y … +7 more , Su W, Li Y, Wang Y, Zou K, Zhou R, Qiu Y, Luo J
Clin Radiol · 2026 Jun · PMID 42000457 · Publisher ↗
AIM: Due to the rare condition of polysplenia syndrome (PS) in adulthood, this study aims to present the computed tomography (CT) features of PS in adulthood. MATERIALS AND METHODS: This retrospective study was conducted...
AIM: Due to the rare condition of polysplenia syndrome (PS) in adulthood, this study aims to present the computed tomography (CT) features of PS in adulthood. MATERIALS AND METHODS: This retrospective study was conducted from January 2010 and September 2024 in cases with CT-proven PS. Presentations in CT images, laboratory tests, and concomitant diseases were recorded. RESULTS: Twenty one cases (median age, 52 years; range, 23 to 79) were evaluated. According to the CT images, multiple spleens were observed in all cases with the median count of 4 and bizarre-shaped spleens were revealed in 7 (33.3%) cases. Nine (42.9%) cases presented with short pancreas and 2 of whom had the history of diabetes mellitus. Additionally, 3 (14.3%) cases had liver morphologic anomalies. There were 2 (9.5%) cases presented with left-sided inferior vena cava and 3 (14.3%) cases of dilation of azygos vein. None of these cases was found to have hypersplenism or cardiac anomaly. CONCLUSION: In adult cases with PS, bizarre-shaped spleens and short pancreas were more frequently observed than other anomalies. Absence of severe cardiac anomalies and congenital heart defects might be the reason why these cases survived into adulthood.
Pericoronary fat attenuation index is a potential indicator for the prognosis of coronary heart disease: a systematic review and meta-analysis.
Long Q, Yu M, Xiong YY … +7 more , Yang F, Yuan YF, Xu JH, Su CK, Yu LY, Wang L, Cheng X
Clin Radiol · 2026 Jun · PMID 41980471 · Publisher ↗
AIM: The aim of this comprehensive updated systematic review and meta-analysis was to evaluate the prognostic value of the pericoronary fat attenuation index (FAI) for major adverse cardiovascular events (MACEs) and its...
AIM: The aim of this comprehensive updated systematic review and meta-analysis was to evaluate the prognostic value of the pericoronary fat attenuation index (FAI) for major adverse cardiovascular events (MACEs) and its ability to differentiate vulnerable from stable plaques. MATERIALS AND METHODS: A comprehensive literature search was conducted in PubMed, the Cochrane library, and Embase with the search terms 'Epicardial Adipose Tissue' and 'Tomography, X-Ray Computed' until 28 May 2025. Data were extracted and methodological quality was assessed by two independent investigators according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Fifteen studies were included in this systematic review and meta-analysis. All statistical analyses were performed using Review Manager software, version 5.3 and R 4.5.2. RESULTS: The results indicated that higher pericoronary FAI values provided incremental prognostic value for MACE in studies with prospective follow-up (hazard ratio [HR]=3.28, 95% confidence interval [CI]: 2.03 to 5.32, P<0.001, I = 81%). When specifically evaluating cardiac death as an outcome, the HR increased to 4.02 (95% CI: 1.26 to 12.88, P=0.02, I = 92%), but this finding was not robust. Furthermore, FAI demonstrated a statistically significant elevation in vulnerable plaques compared to stable plaques, exhibiting a mean difference of 7.81 Hounsfield units (95% CI: 4.65 to 10.97, I = 85%). Dynamic FAI changes may help monitor therapeutic responses, but current evidence is too limited to support FAI as a surrogate endpoint for coronary anti-inflammatory interventions. CONCLUSION: These collective findings underscore the role of pericoronary FAI as a promising indicator for detecting coronary inflammation, distinguishing vulnerable plaques, and predicting MACE.
Detection of degenerative and inflammatory osseous changes on an magnetic resonance imaging (MRI) of the hands and wrists: T2-weighted Dixon imaging can replace pre-contrast T1-weighted images.
Pawlus K, Ensle F, Czermak ED … +4 more , Alexandre JS, Obermüller C, Frauenfelder T, Guggenberger R
Clin Radiol · 2026 May · PMID 41966532 · Publisher ↗
AIM: To evaluate whether pre-contrast T1-weighted magnetic resonance imaging (MRI) sequences can be omitted when using T2-weighted Dixon imaging to detect inflammatory and degenerative osseous changes in the hands and wr...
AIM: To evaluate whether pre-contrast T1-weighted magnetic resonance imaging (MRI) sequences can be omitted when using T2-weighted Dixon imaging to detect inflammatory and degenerative osseous changes in the hands and wrists. MATERIALS AND METHODS: Two radiologists retrospectively reviewed bilateral hand and wrist MRI examinations from 48 patients with hand pain. A standard protocol (coronal and axial T1-weighted images) was compared with a simplified protocol including coronal and axial fat-only, in-phase, and water-only T2-weighted Dixon images. Readers independently scored osteophytes, joint space narrowing, subchondral sclerosis, and subchondral bone defects across five articulation groups per hand. Item-specific and per-hand scores were summed. An inter-protocol agreement was assessed using Bland-Altman analysis (bias, 95% limits of agreement, and proportional bias), and inter-reader and inter-protocol reliability were evaluated using Cohen's kappa (κ). RESULTS: The inter-protocol agreement was substantial to almost perfect for all items (κ = 0.74-0.84), and inter-reader agreement ranged from moderate to almost perfect (κ = 0.56-0.81). Bland-Altman analysis showed minimal systematic bias for subchondral sclerosis (-0.04) and osteophytes (-0.43). Small but significant proportional bias was found for subchondral bone defects (P=.043), joint space narrowing (P=.017), and total scores (P=.009). The simplified protocol demonstrated significantly higher contrast-to-noise ratios (P<.05). CONCLUSION: T2-weighted Dixon imaging reliably detects inflammatory and degenerative osseous changes in the hands and wrists and may obviate the need for pre-contrast T1-weighted sequences.
Coronary computed tomography angiography (CCTA) evaluation of ramus intermedius and left coronary atherosclerosis: presence, distribution, and plaque characteristics.
Bekirçavuşoğlu AF, Bekirçavuşoğlu S, Turan Özsoy HG … +1 more , Erkan M
Clin Radiol · 2026 May · PMID 41962318 · Publisher ↗
AIM: This study aimed to assess the association between the ramus intermedius (RI) and left bifurcation atherosclerosis. MATERIALS AND METHODS: Between April 2021 and January 2025, 1380 patients who underwent coronary co...
AIM: This study aimed to assess the association between the ramus intermedius (RI) and left bifurcation atherosclerosis. MATERIALS AND METHODS: Between April 2021 and January 2025, 1380 patients who underwent coronary computed tomography angiography were included in the study. The bifurcation angle (<LAD-CX) was measured in each patient. The presence of RI, plaque in the left main coronary artery (LMCA), proximal segment of the left anterior descending artery (LAD), proximal segment of the left circumflex artery (LCX), and its severity (critical or noncritical) were noted. In cases of plaque presence, the plaque type was categorised as calcified, noncalcified, or mixed. The relationship between RI and atherosclerosis in the left bifurcation region was also evaluated. RESULTS: RI was present in 31.8 % of the patients (n=462). In univariate and multivariate analyses, RI was the strongest risk factor for plaque presence in the LMCA, proximal LAD, and proximal CX. The bifurcation angle was higher in the RI group than in the non-RI group. No association was found between RI and degree of stenosis in the plaques observed in the left bifurcation region. In the LAD, the "mixed plaque" type was more frequently observed in individuals with RI compared to those without RI (P=.020; P<.05). CONCLUSION: The RI affects atherosclerosis by altering vascular geometry in the left coronary bifurcation. Mixed-type plaques in the proximal LAD with RI suggest higher-risk plaque characteristics. Thus, the RI determines atherosclerotic distribution and plaque characteristics in the left main bifurcation region.
Computed tomography (CT) planning for Redo-transcatheter aortic valve implantation (TAVI): a step-by-step approach and structured reporting.
Vaz A, Serra VC, Ramos DOS
Clin Radiol · 2026 May · PMID 41962317 · Publisher ↗
The expansion of transcatheter aortic valve implantation (TAVI) indications to younger and lower-risk patients has led to an increasing incidence of late transcatheter valve failure. In this setting, redo-TAVI (TAV-in-TA...
The expansion of transcatheter aortic valve implantation (TAVI) indications to younger and lower-risk patients has led to an increasing incidence of late transcatheter valve failure. In this setting, redo-TAVI (TAV-in-TAV) has emerged as a less invasive alternative to surgical valve explantation, albeit with specific anatomical and technical challenges, particularly related to the risk of coronary obstruction. Computed tomography (CT) plays a pivotal role in preprocedural planning by enabling detailed characterisation of the index valve, identification of the failure mechanism, assessment of commissural and coronary alignment, accurate internal valve measurements, and definition of the neoskirt plane. This pictorial essay presents a step-by-step CT-based approach to redo-TAVI planning, illustrating the main implantation strategies and their relationship with the coronary risk plane. In addition, a structured reporting template is proposed to standardise CT interpretation and support multidisciplinary Heart Team decision-making.
Use of artificial intelligence and radiomics for diagnosis and prediction of osteoporotic fractures: a systematic review.
Jayasuriya AC, Skie M
Clin Radiol · 2026 May · PMID 41955646 · Publisher ↗
AIM: Osteoporosis (OP) is a prevalent metabolic bone disease causing millions of fractures annually, leading to significant healthcare and economic burdens. Early diagnosis and intervention are critical, particularly amo...
AIM: Osteoporosis (OP) is a prevalent metabolic bone disease causing millions of fractures annually, leading to significant healthcare and economic burdens. Early diagnosis and intervention are critical, particularly among postmenopausal women and the elderly. Traditional bone mineral density tests, while useful, are limited in predicting fracture risk and are not always accessible. This review summarises recent advancements in applying machine learning (ML) and radiomics techniques for fracture risk prediction and OP assessment using computed tomography and magnetic resonance imaging. MATERIALS AND METHODS: A comprehensive literature search was conducted in PubMed, Embase, and Web of Science using the keywords 'radiomics', 'osteoporosis', and 'fracture'. A total of 119 studies published between January 15, 2021, and March 15, 2025, were identified through PubMed (31), Embase (45), and Web of Science (43). After applying predefined inclusion and exclusion criteria, 20 studies were included for analysis. These studies used various ML algorithms and radiomics approaches to extract quantitative features from imaging data. RESULTS: Most studies included predominantly female participants and focussed on vertebral bones. Integrating radiomics features with clinical data improved the predictive accuracy of fracture risk models. Commonly used algorithms included logistic regression, extreme gradient boosting, support vector machines, random forests, and neural networks. Fourteen studies achieved area under the curve (AUC) or coefficient of determination (R) values ≥0.800. CONCLUSION: ML and radiomics show great potential for enhancing OP and fracture risk assessment. Future studies should emphasise larger, multicentre datasets and broader clinical integration to improve model robustness and clinical applicability.
Comparative study of different artificial intelligence (AI)-assisted compressed sensing factors in inner ear heavily T2-weighted imaging.
Wang W, Yang S, Ning K … +3 more , Wu K, Li X, Zhao P
Clin Radiol · 2026 May · PMID 41955645 · Publisher ↗
AIM: Artificial intelligence (AI)-assisted compressed sensing (ACS) is a cutting-edge magnetic resonance imaging (MRI) acceleration technique based on deep learning. High-quality imaging of the inner ear suffers from len...
AIM: Artificial intelligence (AI)-assisted compressed sensing (ACS) is a cutting-edge magnetic resonance imaging (MRI) acceleration technique based on deep learning. High-quality imaging of the inner ear suffers from lengthy acquisition time due to intricate and fine structure. The study aimed to compare the image quality of heavily T2-weighted inner ear imaging among ACS groups with different accelerated factors (AFs). MATERIALS AND METHODS: A total of 40 healthy volunteers were prospectively included. Using a heavily T2-weighted three-dimensional fast spin-echo sequence, images were acquired in a reference group (without acceleration) and four ACS groups, with AFs of 2.7, 3.87, 4.68, and 5.52, respectively. Image quality was qualitatively assessed using a four-point scale. The signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), and edge sharpness were compared across groups. RESULTS: Compared with the reference group (acquisition time: 354 secs), the acquisition times for the ACS, ACS, ACS and ACS groups were shortened to 39.83%, 28.81%, 23.73%, and 20.62%, respectively. The ACS3.87 group demonstrated superior imaging quality compared with the reference group and the ACS4.68 and ACS5.52 groups, but showed no significant difference from the ACS2.7 groups. The ACS3.87 group outperformed all other groups with respect to SNR and CNR. Regarding edge sharpness, it was only significantly better than that of the reference group. CONCLUSION: The ACS group improved imaging quality while substantially reduced acquisition time compared with other ACS groups. An AF of approximately 3.5- to 4-fold is recommended for clinical application in heavily T2-weighted inner ear imaging.
Thrombectomy versus conservative treatment for medium vessel occlusion ineligible for intravenous thrombolysis: effect modified by stroke severity.
Hu D, Yang M, Gu ZH … +4 more , Fan J, Yu LZ, Xia CC, Ren QG
Clin Radiol · 2026 May · PMID 41932079 · Publisher ↗
AIM: Neutral results from randomised trials of endovascular thrombectomy (EVT) in medium vessel occlusion (MeVO) may reflect treatment heterogeneity, particularly high intravenous thrombolysis (IVT) use in medical manage...
AIM: Neutral results from randomised trials of endovascular thrombectomy (EVT) in medium vessel occlusion (MeVO) may reflect treatment heterogeneity, particularly high intravenous thrombolysis (IVT) use in medical management arms. We aimed to evaluate the efficacy of EVT compared with conservative treatment in IVT-ineligible MeVO patients. MATERIALS AND METHODS: Consecutive IVT-ineligible MeVO patients from a single centre were retrospectively included and grouped according to the treatment received. The primary outcome was favourable outcome (90-day modified Rankin Scale score: 0-1). Inverse probability weighting (IPW) using propensity scores was applied to adjust for baseline differences. RESULTS: A total of 226 IVT-ineligible MeVO patients were included, with 54 receiving EVT and 172 receiving conservative treatment. After IPW adjustment, the effective sample sizes were 97 in the EVT group and 145 in the conservative group, with baseline covariates well balanced between groups (standardised mean differences <0.1 for all variables). No significant differences were observed in rates of favourable outcome (54.6% vs 51.0%, P=0.675) or functional independence (68.0% vs. 67.6%, P=0.998) between groups. Symptomatic intracranial haemorrhage occurred more frequently in the EVT group (8.2% vs 0%, P=0.002). In the subgroup analysis, a potential association between EVT and favourable outcome was observed among patients with a baseline National Institutes of Health Stroke Scale (NIHSS) score ≥6 (adjusted odds ratio [aOR]: 1.83; 95% confidence interval [CI]: 1.17-2.76). CONCLUSION: In IVT-ineligible patients with MeVO, there was no significant difference in functional outcomes between EVT and conservative management groups. In subgroup analyses, EVT showed a potential benefit in patients with a baseline NIHSS score ≥6.
The feasibility of apparent diffusion coefficient (ADC) histogram analysis in differentiating recurrences from postsurgical changes of soft tissue sarcoma.
Hu P, Chen L, Zhou Z
Clin Radiol · 2026 May · PMID 41926872 · Publisher ↗
AIM: To explore the feasibility of quantitative apparent diffusion coefficient (ADC) histogram values in the differentiation of recurrences and postsurgical changes of soft tissue sarcoma (STS). MATERIALS AND METHODS: Th...
AIM: To explore the feasibility of quantitative apparent diffusion coefficient (ADC) histogram values in the differentiation of recurrences and postsurgical changes of soft tissue sarcoma (STS). MATERIALS AND METHODS: The clinicopathological and magnetic resonance (MR) imaging (with diffusion-weighted imaging) data of 64 patients (37 with recurrences of STS and 27 with postsurgical changes) were prospectively reviewed. The MR features and ADC histogram values were compared between recurrences and postsurgical changes of STS. RESULTS: Recurrences of STS were larger and commonly accompanied by internal necrosis and neurovascular encasement. There were statistically significant differences between the mean ADC value, the 10 ADC value, 25 ADC value, 50 ADC value, 75 ADC value, 90 ADC value, and skewness value between recurrences and postsurgical changes. The cut-off values were ≤1.204 × 10mm/s, ≤0.835 × 10mm/s, ≤1.095 × 10mm/s, ≤1.238 × 10mm/s, ≤1.352 × 10mm/s, ≤1.637 × 10mm/s, and >-0.43, respectively. The 10 ADC value was the independent predictive factor with an odds ratio (OR) value of 0.99. The sensitivity, specificity, accuracy, and the area under the curve (AUC) of logistic regression were 78.38%, 100%, 84.37%, and 0.937 (95% confidence interval [CI]: 0.847-0.982), respectively. CONCLUSION: The ADC histogram values helps in differentiating recurrences from postsurgical changes of STS, and the 10 ADC value can serve as an independent predictive factor.
Dual-energy computed tomography (CT) bone marrow oedema and fat fraction maps for characterisation of lumbar vertebral endplate degeneration.
Shinohara Y, Sasaki F, Kominami M … +2 more , Sugawara T, Kinoshita T
Clin Radiol · 2026 May · PMID 41916239 · Publisher ↗
AIM: Nonsclerotic endplate degeneration (ED) is difficult to identify on single-energy computed tomography (CT), whereas magnetic resonance imaging (MRI) can demonstrate it as Modic changes type 1 (MC1) and 2 (MC2), whic...
AIM: Nonsclerotic endplate degeneration (ED) is difficult to identify on single-energy computed tomography (CT), whereas magnetic resonance imaging (MRI) can demonstrate it as Modic changes type 1 (MC1) and 2 (MC2), which pathologically correspond to inflammatory and fatty stages, respectively. The aim of this study is to investigate the potential of dual-energy CT (DECT) to evaluate ED. MATERIALS AND METHODS: Seventy-two patients who underwent noncontrast lumbar spine MRI and DECT were reviewed. Sagittal MR findings of all endplates were classified based on the MCs, and the vertical heights of MCs and their vertebral bodies were measured to calculate height rates (HRs) for ED. The HRs on the bone marrow image (BM) and fat fraction map (FF) were calculated to compare with those of MC1 and MC2, respectively. Quantitative evaluation was performed by setting ROIs in ED on BM and FF corresponding to the MC1 and MC2 lesions, respectively (P < 0.05 as statistically significant). RESULTS: Among the 31 endplates with MC1, BM visually showed high attenuation in 28 (90.3%), indicating an oedematous lesions. Among the 54 endplates with MC2, FF visualised a high fat percentage in 48 (88.9%), indicating fatty deposition. The HRs for ED on DECT were significantly correlated with those on MR images (MC1 and BM: r = 0.798, P < 0.05; MC2 and FF: r = 0.918, P < 0.05). The median DECT values in ED were significantly higher than those in normal vertebral bodies (BM [Hounsfield unit, HU]: 6.10 vs -44.4, P < 0.05; FF [%]: 101.30 vs 54.9, P < 0.05). CONCLUSION: DECT can detect inflammatory and fatty stages of lumbar ED, which respectively correspond to MC1 and MC2 on MRI.
Optimising prostate biopsy strategies: a propensity-score-matching analysis to compare the detection of prostate cancer and safety between transperineal 10-core and transrectal 12-core systematic biopsy.
Ye J, Zhi Z, Lan N … +6 more , Wu Z, Peng W, Huang T, Ou Y, Qiu Y, Huang W
Clin Radiol · 2026 May · PMID 41911614 · Publisher ↗
AIM: To optimise prostate biopsy strategies by comparing cancer detection rates and safety profiles between transperineal 10-core and transrectal 12-core systematic biopsy approaches. MATERIALS AND METHODS: In total, 903...
AIM: To optimise prostate biopsy strategies by comparing cancer detection rates and safety profiles between transperineal 10-core and transrectal 12-core systematic biopsy approaches. MATERIALS AND METHODS: In total, 903 patients who received systematic prostate biopsy between January 2017 and December 2023 were included. This cohort specifically comprised patients for whom the clinical pathway led to systematic biopsy without targeted sampling. Propensity score matching (PSM) analysis was performed to adjust for the baseline differences including age, prostate-specific antigen (PSA) level, prostate volume (PV), and PSA density (PSAD). The prostate cancer (PCa) and clinically significant PCa (csPCa) detection rates and complications were compared between the transperineal biopsy (TPB) group (n = 658) and transrectal biopsy (TRB) group (n = 245), which were stratified by clinical characteristics. RESULTS: After PSM, 231 patients in each group were matched in a 1:1 ratio. The TPB achieved a higher csPCa detection rate (33.8% vs 22.9%, P = 0.010) and a lower per-puncture complication rate (0.34% vs 0.79%, P = 0.039) than TRB after PSM. The csPCa detection rates in TPB were higher than those in TRB for patients with free PSA level ≤ 5 ng/ml (29.9% vs 17.7%, P = 0.024), with PV value of 25-100 ml (34.3% vs 21.9%, P = 0.049), and with PSAD value ≤ 0.6 ng/ml(24.6% vs 14.0%, P = 0.027). CONCLUSION: 10-core TPB was associated with a higher csPCa detection rate and lower complication risks than 12-core TRB. Nevertheless, given the elevated detection rates at specific PSA, PV, and PSAD level, it is imperative to tailor biopsy strategies in accordance with individual patient profiles to optimise outcomes.
Evaluating a low-dose protocol for computed tomography (CT) pulmonary angiography: combining reduced contrast medium, low tube voltage, and advanced image reconstruction.
Sun L, Jin KY, Luo XL … +2 more , Wang F, Li BG
Clin Radiol · 2026 May · PMID 41905018 · Publisher ↗
AIM: The aim of this study was to evaluate a comprehensive low-dose computed tomography pulmonary angiography (CTPA) protocol combining low tube voltage, iterative reconstruction (sinogram-affirmed iterative reconstructi...
AIM: The aim of this study was to evaluate a comprehensive low-dose computed tomography pulmonary angiography (CTPA) protocol combining low tube voltage, iterative reconstruction (sinogram-affirmed iterative reconstruction [SAFIRE]), and nonlinear blending and assess the feasibility of reducing contrast medium (CM) volume. MATERIALS AND METHOD: In this retrospective study, 166 patients were divided into four groups. Group A (conventional) received 120-kVp, 50 mL CM, filtered back projection, and linear blending. Groups B, C, and D (low-dose) underwent 80-kV/Sn140-kV dual-source scanning with SAFIRE and nonlinear blending and received 20, 30, and 50 mL CM, respectively. Objective image quality (attenuation, noise, contrast-to-noise ratio [CNR], and signal-to-noise ratio [SNR]), subjective scores, and radiation dose (volume computed tomography dose index [CTDIvol], dose-length product [DLP], and effective dose [ED]) were compared. RESULTS: The low-dose groups achieved approximately 63% radiation reduction versus group A (all P<0.05). Objective image quality was superior in groups C and D compared to that in groups A and B. Subjective image quality was diagnostic and comparable across all groups (κ>0.73). A 30-mL CM volume yielded objective and subjective image quality comparable to the 50-mL volume; the 20-mL volume remained diagnostic but with lower objective metrics. CONCLUSION: This synergistic low-dose protocol enables substantial reductions in both radiation and CM dose. Reducing CM to 30 mL yields image quality comparable to the conventional protocol, supporting its feasibility in a safer, patient-centred CTPA strategy.
Navigating the artificial intelligence (AI) revolution in radiology: a practical guide to medical-legal and ethical imperatives for the practising radiologist.
Siddi Ganie I, Ganie NS, Gibson J … +1 more , Raniga S
Clin Radiol · 2026 May · PMID 41875739 · Publisher ↗
Artificial intelligence (AI) is now routinely integrated into radiology workflows, including worklist prioritisation, image interpretation, quantification, and reporting support. While these tools may improve efficiency...
Artificial intelligence (AI) is now routinely integrated into radiology workflows, including worklist prioritisation, image interpretation, quantification, and reporting support. While these tools may improve efficiency and diagnostic performance, they introduce important medicolegal challenges for radiologists in relation to professional responsibility, liability, informed disclosure, data governance, and algorithmic bias. This review examines the medicolegal implications of AI use in radiology from a UK practice perspective, while acknowledging the influence of European and international regulatory frameworks. We outline how established principles of medical negligence and consent apply to AI-assisted imaging, and discuss the respective responsibilities of radiologists, healthcare organisations, and manufacturers. Key ethical and regulatory issues, including data protection, bias, and performance drift, are considered in the context of real-world clinical deployment. Finally, we propose two practical frameworks (INFORMED and RECORDS) to support defensible AI adoption through appropriate validation, human oversight, documentation, and audit. The aim is to provide radiologists with pragmatic guidance for integrating AI into clinical practice in a manner that is safe, transparent, and legally robust.
Fractal analysis and magnetic resonance imaging (MRI) semantic features to identify intracranial solitary fibrous tumours and atypical meningiomas.
Zhao Z, Bai R, Zhang J … +5 more , Yuan S, Zhang H, Yin H, Pan Y, Li Q
Clin Radiol · 2026 May · PMID 41875738 · Publisher ↗
AIM: Atypical meningioma (ATM) and solitary fibrous tumour (SFT) are two prevalent meningeal tumours that pose significant challenges in preoperative differentiation. This study aims to distinguish between them using fra...
AIM: Atypical meningioma (ATM) and solitary fibrous tumour (SFT) are two prevalent meningeal tumours that pose significant challenges in preoperative differentiation. This study aims to distinguish between them using fractal analysis and magnetic resonance imaging (MRI) semantic features. MATERIALS AND METHODS: This retrospective study included a total of 81 patients, comprising 30 SFTs and 51 ATMs, diagnosed between January 2019 and December 2023. At the maximal tumour cross-section, fractal dimension (FD) and lacunarity were computed for the tumour region using the open-source software ImageJ (version 1.53k; National Institutes of Health). A visual nomogram was subsequently developed to differentiate SFT from ATM by integrating clinical data, preoperative MRI semantic features, and fractal analysis parameters through logistic regression model. RESULTS: Compared with ATM, the SFT group exhibited a significantly lower prevalence of dural tail sign (P<.001) but a higher necrosis rate (P<.001), along with markedly elevated lacunarity. The area under the curve (AUC) for differentiating the two groups was 0.825 for dural tail sign, 0.741 for necrosis, and 0.770 for lacunarity. The diagnostic nomogram incorporating these features demonstrated further improved performance, achieving an AUC of 0.968, with corresponding accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of 0.914, 0.863, 1.000, 1.000, and 0.811, respectively. CONCLUSION: Preoperative MRI semantic features combined with fractal analysis enable noninvasive differentiation between SFT and ATM, providing a valuable theoretical foundation for optimising clinical treatment strategies and surgical decision-making.
Imaging diagnosis of soft-tissue tumours: current concepts and clinical guidance.
Sobrino-Souto R, Macía-Suárez D
Clin Radiol · 2026 May · PMID 41865650 · Publisher ↗
Soft tissue tumours (STTs) represent a heterogeneous group of lesions that go from benign entities to aggressive sarcomas. Their variable clinical presentation and low incidence of malignancy make imaging an indispensabl...
Soft tissue tumours (STTs) represent a heterogeneous group of lesions that go from benign entities to aggressive sarcomas. Their variable clinical presentation and low incidence of malignancy make imaging an indispensable tool to both diagnosis and management. This narrative review provides an updated, clinically oriented overview of the diagnostic role and appropriate use of conventional radiography, ultrasonography (US) computed tomography (CT), magnetic resonance imaging (MRI), and hybrid techniques such as positron emission tomography (PET)/CT and PET/MRI of STTs. Emphasis is placed on MRI as the modality of choice for local staging, with attention to emerging functional and multiparametric applications, including diffusion-weighted imaging and dynamic contrast-enhanced studies. The complementary role of CT in detecting calcifications and metastases, as well as the expanding potential of US with elastography and contrast-enhanced applications, are also addressed. In addition, image-guided biopsy (primarily US- and CT-guided) remains essential for histological confirmation and treatment planning. Recent advances such as radiomics and hybrid imaging approaches are discussed for their potential to refine diagnosis, guide therapy, and improve patient outcomes. Strengths and limitations of each modality are outlined, with particular focus on malignant lesions, underscoring the importance of early referral to specialised centres and multidisciplinary management.
Prediction of recurrence-free survival in patients with invasive ductal carcinoma of the breast on the basis of clinicopathological, conventional ultrasound and contrast-enhanced ultrasound imaging characteristics.
Kuang Y, Zheng Y, Li G … +5 more , Du Y, Jia C, Wu T, Diao X, Wu R
Clin Radiol · 2026 May · PMID 41865649 · Publisher ↗
AIM: This study aimed to incorporate clinicopathological, conventional ultrasound (US) and contrast-enhanced US (CEUS) imaging features to establish a predictive model for evaluating recurrence-free survival (RFS) in pat...
AIM: This study aimed to incorporate clinicopathological, conventional ultrasound (US) and contrast-enhanced US (CEUS) imaging features to establish a predictive model for evaluating recurrence-free survival (RFS) in patients with invasive ductal carcinoma (IDC) of the breast. MATERIALS AND METHODS: Patients confirmed with IDC in our hospital between 2016 and 2020 were retrospectively analysed. We performed Cox regression analyses based on the clinicopathological and USdata to identify independent factors. A nomogram model was constructed and verified to predict the 1-, 3-, and 5-year RFS. Nomogram performance, calibration, and clinical applicability were evaluated with the area under the receiver operating characteristic curve (AUC), calibration curves, and decision curve analysis. RESULTS: A total of 377 patients were included and divided into training group (n=226) and validation group (n=151). Axillary lymph node burden, oestrogen receptor status, colour Doppler flow imaging blood flow, maximum length diameter on CEUS, and perfusion defects were independent risk factors for poor RFS. The AUC values of nomogram model were 0.876, 0.823, and 0.753 in the training group and 0.731, 0.763, and 0.714 in the validation group. The calibration curves exhibited good concordance between the predicted survival probabilities and the actual values. CONCLUSION: The nomogram, which integrates clinicopathological and US features, serves as a supplementary prognostic tool for IDC patients. It offers individualised risk stratification to support clinical decision-making, potentially minimising interventions for low-risk patients and prioritising monitoring for high-risk cases, while complementing traditional staging systems.
The value of fluorine-18 fluorodeoxyglucose positron emission tomography/magnetic resonance imaging (F-FDG PET/MRI) in characterising pleural effusion and detecting pleural metastasis for staging lung cancer.
Zhang A, Kong X, Yao Y … +7 more , Zhou X, Xia L, Wang F, Zhou N, Yang Z, Meng X, Li N
Clin Radiol · 2026 May · PMID 41863190 · Publisher ↗
AIM: Positron emission tomography/magnetic resonance imaging (PET/MRI) combines the anatomical imaging of MRI with the metabolic information of PET. This study aimed to investigate the diagnostic value of PET/MRI in char...
AIM: Positron emission tomography/magnetic resonance imaging (PET/MRI) combines the anatomical imaging of MRI with the metabolic information of PET. This study aimed to investigate the diagnostic value of PET/MRI in characterising pleural effusions and detecting pleural nodules, which is critical for staging and management in patients with primary pulmonary masses. MATERIALS AND METHODS: A total of 29 patients were enrolled in the study from June 2021 to June 2023. A 3-T hybrid PET/MRI including axial respiratory-triggered fast-spin echo T2-weighted imaging (T2WI), axial respiratory triggered T2 fat-suppressing sequence (T2FS), and echo-planar imaging diffusion-weighted imaging (DWI) with b values of 50 and 800 sec/mm. The maximum standardised uptake value (SUVmax) for all lesions (including primary lung lesions and pleural effusion) was measured on PET images. The signal of pleural effusion on T2FS and localised high signals of the pleura on DWI sequences were evaluated by experienced physicians through visual assessment of the MRI sequences. RESULTS: SUVmax, T2FS signal, apparent diffusion coefficient (ADC), and DWI signal exhibit significant differences between inflammatory lesions and tumour-related pleural effusions, with sensitivities of 78.95%, 94.74%, 68.42%, and 84.21%, respectively; specificities of 100%, 50%, 80%, and 100%, respectively; and accuracies of 86.21%, 79.31%, 72.41%, and 89.66%, respectively. CONCLUSION: Fluorine-18 fluorodeoxyglucose (F-FDG) PET/MRI demonstrates high diagnostic performance in characterising pleural effusions and detecting malignant pleural involvement. Moreover, F-FDG PET/MRI showed a higher diagnostic performance compared with PET/CT in identifying pleural metastases for staging lung cancer combined with pleural effusion.
Therapeutic outcomes of ultrasound-guided microwave ablation and radioactive iodine-125 seed implantation for thoracoabdominal wall seeding tumours: a comparative study.
Li L, Qi E, Dong G … +7 more , Yan X, Cai Q, Liu F, Yu J, Liang P, Han Z, Yu X
Clin Radiol · 2026 May · PMID 41849927 · Publisher ↗
AIM: The aim of this study was to compare the therapeutic outcomes and safety of microwave ablation (MWA) with radioactive iodine-125 seed implantation (RISI) for the treatment of thoracoabdominal wall seeding tumours (T...
AIM: The aim of this study was to compare the therapeutic outcomes and safety of microwave ablation (MWA) with radioactive iodine-125 seed implantation (RISI) for the treatment of thoracoabdominal wall seeding tumours (TAWSTs). MATERIALS AND METHODS: A retrospective analysis of 93 TAWST patients treated with MWA (n=66) or RISI (n=27) was performed. We compared the local tumour progression (LTP), local recurrence-free survival (LRFS), overall survival (OS), and complication rates between the two groups. RESULTS: The median follow-up time was 36.0 months in the MWA group and 24.8 months in the RISI group. The LTP rate (30.3% vs 51.9 %, P=0.050) and mortality rate (33.3% vs 59.3%, P=0.021) in the MWA group were significantly lower than those in the RISI group. In TAWST patients, MWA was superior to RISI in terms of LRFS (hazard ratio [HR]: 0.499, 95% confidence interval [CI]: 0.251-0.992, P=0.04) and OS (HR: 0.437, 95% CI: 0.227-0.838, P=0.01). The subgroup analysis revealed higher incidences of LRFS for the inner abdominal wall (IAW) subgroup (P<0.001) and OS for the SAW subgroup (P=0.039). Similarly, in a subgroup analysis based on tumour size, MWA was associated with a greater incidence of LRFS in the ≤4-cm subgroup (P=0.012) and OS in the >4-cm subgroup (P=0.034). In the multivariate analysis, MWA was an independent protective factor for OS but not for LRFS. In addition, the use of assistive technologies in the MWA group was significantly greater than that in the RISI group (90.1% vs 11.1%, P<0.001). There were no significant differences between the two groups regarding complications (31.8% vs 14.8%, P=0.093). CONCLUSION: In patients with TAWST, MWA resulted in better tumour control, a greater assistive technology utilisation rate, and comparable complications than RISI.
Optimising contrast-enhanced ultrasound (CEUS) Liver Imaging Reporting and Data System (LI-RADS) for hepatocellular carcinoma diagnosis in non-cirrhotic hepatitis B virus infection patients: incorporating alpha-fetoprotein or adjusting washout criteria.
Gong W, Gong S, Chang H … +4 more , Ma C, Zhao Q, Zhou X, Zhou H
Clin Radiol · 2026 May · PMID 41849926 · Publisher ↗
AIM: To improve the diagnostic performance of contrast-enhanced ultrasound (CEUS) Liver Imaging Reporting and Data System (LI-RADS) for hepatocellular carcinoma (HCC) in non-cirrhotic hepatitis B virus (NC-HBV) patients...
AIM: To improve the diagnostic performance of contrast-enhanced ultrasound (CEUS) Liver Imaging Reporting and Data System (LI-RADS) for hepatocellular carcinoma (HCC) in non-cirrhotic hepatitis B virus (NC-HBV) patients by integrating serum alpha-fetoprotein (AFP) or adjusting washout thresholds. MATERIALS AND METHODS: A retrospective analysis included 105 pathologically confirmed focal liver lesions in NC-HBV patients. The diagnostic performance of the original CEUS LI-RADS (Criteria 1) was compared with three modified versions: reclassifying LR-M nodules with AFP > 200 ng/mL as LR-5 (Criteria 2), AFP > 400 ng/mL as LR-5 (Criteria 3), and reducing the early washout threshold for LR-M from 60 seconds to 45 seconds (Criteria 4). Sensitivity, specificity, and positive predictive value (PPV) were assessed. RESULTS: Criteria 1 showed high specificity (93.1%) and PPV (95.2%) but low sensitivity (52.6%) for HCC. Criteria 2, 3, and 4 significantly increased sensitivity to 68.4%, 67.1%, and 63.2%, respectively (all P < .05), without significantly reducing specificity or PPV (all P > .05). For non-HCC malignancies, the specificity of revised LR-M increased to 82.8%, 81.6%, and 82.8% with Criteria 2, 3, and 4, respectively, compared to Criterion 1 (69.0%; all P < .01), while sensitivities remained statistically unchanged (all P > .05). CONCLUSION: CEUS LR-5 has high specificity for characterising HCC in NC-HBV patients. Integrating AFP or modifying the early washout threshold can significantly improve the sensitivity of CEUS LR-5 for diagnosing HCC in NC-HBV patients, while maintaining high specificity and PPV.
From observer to contributor: multidisciplinary team meetings as a training environment in radiology.
Soon JJQ, Chew YC, Vora BMK … +2 more , Tan MO, Ganti S
Clin Radiol · 2026 May · PMID 41843954 · Publisher ↗
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