The Journal of Computer Assisted Tomography (2025)

08/08/2025

Response Assessment in Hepatocellular Carcinoma: A Primer for Radiologists: Hepatocellular carcinoma (HCC) is the third leading cause of cancer-related deaths worldwide, necessitating accurate and early diagnosis to guide therapy, along with assessment of treatment response. Response assessment criteria have evolved from traditional morphologic approaches, such as WHO criteria and Response Evaluation Criteria in Solid Tumors (RECIST), to more recent methods focused on evaluating viable tumor burden, including European Association for Study of Liver (EASL) criteria, modified RECIST (mRECIST) and Liver Imaging Reporting and Data System (LI-RADS) Treatment Response (LI-TR) algorithm. This shift reflects the complex and evolving landscape of HCC treatment in the context of emerging systemic and locoregional therapies. Each of these criteria have their own nuanced strengths and limitations in capturing the detailed characteristics of HCC treatment and response assessment. The emergence of functional imaging techniques, including dual-energy CT, perfusion imaging, and rising use of radiomics, are enhancing the capabilities of response assessment. Growth in the realm of artificial intelligence and machine learning models provides an opportunity to refine the precision of response assessment by facilitating analysis of complex imaging data patterns. This review article provides a comprehensive overview of existing criteria, discusses functional and emerging imaging techniques, and outlines future directions for advancing HCC tumor response assessment.

iteria and Response Evaluation Criteria in Solid Tumors (RECIST), to more recent methods focused on evaluating viable tumor burden, including European Association for Study of Liver (EASL) criteria, modified RECIST (mRECIST) and Liver Imaging Reporting and Data System (LI-RADS) Treatment Response (L...

07/08/2025

A Clinical and Imaging-based Model for Distinguishing Mild From Moderately Severe/Severe Hypertriglyceridemic Acute Pancreatitis: Development and Validation: Background:

Hypertriglyceridemic acute pancreatitis (HTG-AP) is a distinct subtype of acute pancreatitis with a wide spectrum of clinical severity, ranging from mild to moderately severe or severe disease. Timely identification of patients at higher risk is essential for informing early clinical decisions and improving outcomes. However, reliable tools specifically designed to stratify HTG-AP severity remain limited.

Objective:

To develop and validate a predictive model for distinguishing mild from moderately severe/severe hypertriglyceridemic acute pancreatitis (HTG-AP) using routine clinical and imaging parameters.

Methods:

This retrospective study included 106 patients diagnosed with HTG-AP at Guangzhou First People’s Hospital from January 2018 to April 2023. Patients were categorized into mild (HTG-MAP) and moderately severe/severe (HTG-MSAP/SAP) groups based on the revised Atlanta classification. Clinical data, laboratory results, and imaging findings, including peak C-reactive protein (CRP), serum calcium levels, and Modified CT Severity Index (MCTSI) scores, were analyzed. Univariate and multivariate logistic regression analyses were performed to identify independent predictors of disease severity. Model performance was assessed through 10-fold cross-validation and bootstrap calibration.

Results:

Among the 106 patients (median age: 38 y; 82.1% male), 46 had HTG-MAP and 60 had HTG-MSAP/SAP. Multivariate analysis identified peak CRP (OR: 1.0082, P=0.011), serum calcium (OR: 0.05, P=0.014), and MCTSI score ≥6 (OR: 4.91, P=0.008) as independent predictors of severe disease. The final logistic regression model demonstrated excellent discrimination, with an AUC of 0.900 in the overall cohort and a mean cross-validated AUC of 0.87. Calibration was satisfactory (Hosmer-Lemeshow P=0.774), and overall diagnostic accuracy reached 84.91%.

Conclusions:

The proposed model, incorporating peak CRP, serum calcium, and MCTSI score, effectively distinguishes between HTG-MAP and HTG-MSAP/SAP. Compared with conventional scoring systems such as Bedside Index for Severity in Acute Pancreatitis (BISAP), it demonstrates superior specificity and overall diagnostic accuracy, providing clinicians with a practical tool for risk stratification and clinical decision-making in HTG-AP.

al decisions and improving outcomes. However, reliable tools specifically designed to stratify HTG-AP severity remain limited. Objective: To develop and validate a predictive model for distinguishing mild from moderately severe/severe hypertriglyceridemic acute pancreatitis (HTG-AP) using routine cl...

06/08/2025

Current Issue: Leveraging Virtual Containers for High-Powered, Collaborative AI Research in Radiology: Numerous obstacles confront radiologists interested in the use of artificial intelligence (AI) models within the field of radiology. For example, discrepancies between the radiologist's and an AI developer's hardware and software specifications pose a substantial hindrance to using AI models. Additionally, accessing and using GPU computers can lead to compatibility issues and add to these challenges. Finally, the dissemination of AI models and the ability to download preexisting AI models are not simple tasks due to the size and complexity of most programs. Virtual containers offer a solution to such compatibility issues and provide a simplified way for radiologists to use AI models. Virtual containers are software tools that bundle code, required programs, and necessary software packages to ensure that a program runs identically for all users, regardless of their computing environment. This article outlines the features of virtual containers (compatibility, versatility, and portability) and highlights an applied use case for virtual containers in the development of an AI model.

itionally, accessing and using GPU computers can lead to compatibility issues and add to these challenges. Finally, the dissemination of AI models and the ability to download preexisting AI models are not simple tasks due to the size and complexity of most programs. Virtual containers offer a soluti...

05/08/2025

Current Issue: Resident Education in the Age of AI: Artificial intelligence (AI) is a rapidly expanding field of interest to radiologists for its utility as an adjunct in detecting and reporting disease and its potential influence on the role of radiologists and their practices. As radiology educators, we are responsible for developing and providing access to curricular elements that will prepare residents to be good stewards of artificial intelligence resources while also acquiring fundamental knowledge and skills that are essential to daily practice. Residency programs should consider collaborative approaches as well as solicit support from national societies in the development and curation of their AI curricula.

ng access to curricular elements that will prepare residents to be good stewards of artificial intelligence resources while also acquiring fundamental knowledge and skills that are essential to daily practice. Residency programs should consider collaborative approaches as well as solicit support fro...

05/08/2025

Musculoskeletal Myeloid Sarcoma: Clinical, Imaging, Management, and Outcomes in 41 Adult Patients: Objective:

To analyze symptoms, imaging features, management, and outcomes of musculoskeletal myeloid sarcoma in adult leukemic patients.

Materials and Methods:

This is a retrospective analysis of clinical symptoms, imaging features, management, and outcomes in 41 adult leukemic patients with biopsy-proven myeloid sarcomas of bones and muscles.

Results:

Nineteen patients had acute, and 15 had chronic myeloid leukemia. Additional 5 previously treated leukemia patients included 1 with chronic myeloid leukemia, 3 with myelofibrosis, and 1 with myelodysplastic syndrome. The remaining 2 patients had isolated myeloid sarcoma with normal marrow without a history of hematologic disorder. Twenty-nine patients had bone tumors only, 3 muscle tumors only, 8 both bone and soft tissue tumors, and 1 intraarticular synovial tumor of an ankle. Of the 71 focal bone tumors, 68 were lytic and 3 were sclerotic. In addition, diffuse sclerotic bone lesions were present in 1 patient, and diffuse mixed lytic/sclerotic bone lesions in 2 patients. Most tumors were asymptomatic and were discovered incidentally on imaging. Local pain, mass, and pathologic fractures were the most common complaints when present. Vertebral bone and paravertebral soft tissue tumors caused neurological symptoms. Muscle tumors became symptomatic when they involved adjoining bone, nerve, or spinal cord. Only 3 among 13 muscle tumors presented as palpable masses. The imaging features of these musculoskeletal tumors were nonspecific. On MRI, both muscle and lytic bone MSs were hypo-to-iso-intense on T1WI, hyperintense on fat-suppressed T2WI, and enhanced on post-contrast fat-suppressed T1WI. A synovial myeloid sarcoma of the ankle showed diffusely thickened synovium on MRI. F-18 FDG PET-CT was helpful in the detection, monitoring of treatment response, and post-treatment surveillance in 5 patients. All patients were treated with cytarabine-based systemic anti-leukemic treatment and optional radiation, surgical resection, bone marrow transplant, and/or a combination of these. The known mean survival time of 35 dead patients after the appearance of musculoskeletal MS was 12.1 months.

Conclusions:

Musculoskeletal myeloid sarcoma, which can occasionally precede it, is a rare complication of AML. Most tumors are asymptomatic. Imaging, particularly MRI and 18-F FDG PET-CT, plays a crucial role in detecting and monitoring treatment response, as well as post-treatment surveillance. The disease has poor clinical outcomes and short-term survival.

with biopsy-proven myeloid sarcomas of bones and muscles. Results: Nineteen patients had acute, and 15 had chronic myeloid leukemia. Additional 5 previously treated leukemia patients included 1 with chronic myeloid leukemia, 3 with myelofibrosis, and 1 with myelodysplastic syndrome. The remaining 2....

04/08/2025

Current Issue: Diagnostic Value of the Color Doppler Ultrasound Standardized Semiquantitative Score Combined With Sound Touch Elastography in Liver Fibrosis in Patients With Chronic Hepatitis B: A Retrospective Cohort Study: Purpose:

This study aims to evaluate the diagnostic value of standardized semiquantitative scoring of color Doppler ultrasound combined with liver stiffness measurement (LSM) of sound touch elastography (STE) in chronic hepatitis B (CHB) patients, providing a reference for the liver fibrosis diagnosis.

Methods:

We performed ultrasound and STE on CHB patients, with liver biopsies as the benchmark. We compared the differences in ultrasound standardized semiquantitative scoring and LSM among patients with different stages of liver fibrosis, and evaluated the diagnostic efficacy of significant liver fibrosis using receiver operating characteristic (ROC) curves and the area under the ROC curve alone or in combination.

Results:

The total scores of ultrasound semiquantitative scoring and LSM showed statistically significant differences among patients with different stages of liver fibrosis (P 0.05). However, the total scores and LSM values for patients at stages S2 and S3 were both higher than those at stage S0, and increased with the severity of fibrosis staging, with statistically significant differences (P

iagnosis. Methods: We performed ultrasound and STE on CHB patients, with liver biopsies as the benchmark. We compared the differences in ultrasound standardized semiquantitative scoring and LSM among patients with different stages of liver fibrosis, and evaluated the diagnostic efficacy of significa...

03/08/2025

Current Issue: Utility of Multiparametric Breast MRI Radiomics to Predict Cyclin D1 and TGF-β1 Expression: Objective:

To develop a machine learning model that integrates clinical features and multisequence MRI radiomics for noninvasively predicting the expression status of prognostic-related factors cyclin D1 and TGF-β1 in breast cancer, providing additional information for the clinical development of personalized treatment plans.

Methods:

A total of 123 breast cancer patients confirmed by surgical pathology were retrospectively enrolled in our Hospital from January 2016 to July 2022. The patients were randomly divided into a training group (87 cases) and a validation group (36 cases). Preoperative routine and dynamic contrast-enhanced magnetic resonance imaging scans of the breast were performed for treatment subjects. The region of interest was manually outlined, and texture features were extracted using AK software. Subsequently, the LASSO algorithm was employed for dimensionality reduction and feature selection to establish the MRI radiomics labels. The diagnostic efficacy and clinical value were assessed through receiver operating characteristic (ROC) curve analysis and decision curve analysis (DCA).

Results:

In the cyclin D1 cohort, the area under the receiver operating characteristic (ROC) curve in the clinical prediction model training and validation groups was 0.738 and 0.656, respectively. The multisequence MRI radiomics prediction model achieved an AUC of 0.874 and 0.753 in these respective groups, while the combined prediction model yielded an AUC of 0.892 and 0.785. In the TGF-β1 cohort, the ROC AUC for the clinical prediction model was found to be 0.693 and 0.645 in the training and validation groups, respectively. For the multiseries MRI radiomics prediction model, it achieved an AUC of 0.875 and 0.760 in these respective groups; whereas for the combined prediction model, it reached an AUC of 0.904 and 0.833. Decision curve analysis (DCA) demonstrated that both cohorts indicated a higher clinical application value for the combined prediction model compared with both individual models—clinical prediction model alone or radiomics model.

Conclusion:

The integration of clinical features and multisequence MRI radiomics in a combined modeling approach holds significant predictive value for the expression status of cyclin D1 and TGF-β1. The model provides a noninvasive, dynamic evaluation method that provides effective guidance for clinical treatment.

of personalized treatment plans. Methods: A total of 123 breast cancer patients confirmed by surgical pathology were retrospectively enrolled in our Hospital from January 2016 to July 2022. The patients were randomly divided into a training group (87 cases) and a validation group (36 cases). Preoper...

02/08/2025

Current Issue: The Clinical Value of the MAR+ Metal Artifact Reduction Algorithm for Postoperative Assessment of Lumbar Internal Fixation: Background:

With the widespread use of lumbar pedicle screws for internal fixation, the morphology of the screws and the surrounding tissues should be evaluated. The metal artifact reduction (MAR) technique can reduce the artifacts caused by pedicle screws, improve the quality of computed tomography (CT) images after pedicle fixation, and provide more imaging information to the clinic.

Purpose:

To explore whether the MAR+ method, a projection-based algorithm for correcting metal artifacts through multiple iterative operations, can reduce metal artifacts and have an impact on the structure of the surrounding metal.

Materials and Methods:

A total of 57 patients who underwent lumbar spine CT examination after lumbar internal fixation from January to December 2023 in our hospital were retrospectively enrolled. The CT images were reconstructed using MAR+ and non-MAR+ techniques and were subdivided into MAR+ and non-MAR+ groups. The CT number (in Hounsfield units) and the SD noise values of the spinal canal, vertebral body, psoas major muscle, and adjacent fat were measured in the 2 groups of CT images, and the signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were calculated. The subjective score was evaluated by two diagnostic radiologists using a double-blind method for image quality evaluation of the MAR+ group and the non-MAR+ group, and the image quality was classified on a 5-point scale. The rank-sum test was utilized to compare the subjective and objective scores of the 2 groups.

Results:

The SD values of the spinal canal (Z=−4.12, P

graphy (CT) images after pedicle fixation, and provide more imaging information to the clinic. Purpose: To explore whether the MAR+ method, a projection-based algorithm for correcting metal artifacts through multiple iterative operations, can reduce metal artifacts and have an impact on the structur...

01/08/2025

Current Issue: Validation of a Deep Learning Tool for Detection of Incidental Vertebral Compression Fractures: Objective:

This study evaluated the performance of a deep learning-based vertebral compression fracture (VCF) detection tool in patients with incidental VCF. The purpose of this study was to validate this tool across multiple sites and multiple vendors.

Methods:

This was a retrospective, multicenter, multinational blinded study using anonymized chest and abdominal CT scans performed for indications other than VCF in patients ≥50 years old. Images were obtained from 2 teleradiology companies in France and United States and were processed by CINA-VCF v1.0, a deep learning algorithm designed for VCF detection. Ground truth was established by majority consensus across 3 board-certified radiologists. Overall performance of CINA-VCF was evaluated, as well as subset analyses based on imaging acquisition parameters, baseline patient characteristics, and VCF severity. A subgroup was also analyzed and compared with available clinical radiology reports.

Results:

Four hundred seventy-four CT scans were included in this study, comprising 166 (35.0%) positive and 308 (65.0%) negative VCF cases. CINA-VCF demonstrated an area under the curve (AUC) of 0.97 (95% CI: 0.96-0.99), accuracy of 93.7% (95% CI: 91.1%-95.7%), sensitivity of 95.2% (95% CI: 90.7%-97.9%), and specificity of 92.9% (95% CI: 89.4%-96.5%). Subset analysis based on VCF severity resulted in a specificity of 94.2% (95% CI: 90.9%-96.6%) for grade 0 negative cases and a specificity of 64.3% (95% CI: 35.1%-87.2%) for grade 1 negative cases. For grades 2 and 3 positive cases, sensitivity was 89.7% (95% CI: 79.9%-95.8%) and 99.0% (95% CI: 94.4%-100.0%), respectively.

Conclusions:

CINA-VCF successfully detected incidental VCF and even outperformed clinical reports. The performance was consistent among all subgroups analyzed. Limitations of the tool included various confounding pathologies such as Schmorl’s nodes and borderline cases. Despite these limitations, this study validates the applicability and generalizability of the tool in the clinical setting.

multicenter, multinational blinded study using anonymized chest and abdominal CT scans performed for indications other than VCF in patients ≥50 years old. Images were obtained from 2 teleradiology companies in France and United States and were processed by CINA-VCF v1.0, a deep learning algorithm ...

30/07/2025

Current Issue: Spectrum of Otological Manifestations in Treacher Collins Syndrome: A Case Series of 9 Patients: Treacher Collins syndrome (TCS) is an uncommon congenital disorder predominantly involving craniofacial, orbital, and otological structures. The various ear malformations seen in 9 patients with TCS are described. TCS predominantly affects the external and middle ear structures, with inner ear structures being relatively spared, not unexpected given the dual embryological origin of the human ear. The external and middle ear malformations were categorized and graded as those involving the ear pinna, external auditory canal, tympanic cavity, ossicles, facial nerve canal, oval window, and bony labyrinth for all 9 patients. The ear malformations were symmetric in the majority, and the patients with higher grades of microtia were found to have a more severe category of other otological malformations.

ructures being relatively spared, not unexpected given the dual embryological origin of the human ear. The external and middle ear malformations were categorized and graded as those involving the ear pinna, external auditory canal, tympanic cavity, ossicles, facial nerve canal, oval window, and bony...

30/07/2025

Association Between Sarcopenia Measurement in Pectoral Region and Immediate Complications Following Percutaneous Transthoracic Lung Biopsy: Purpose:

Measurement of the skeletal muscle area (SMA) at the T4 vertebra level on thoracic computed tomography (CT) has emerged as a novel marker for predicting sarcopenia. This study aimed to investigate the association between complications following percutaneous transthoracic lung biopsy and sarcopenia.

Materials and Methods:

Patients who underwent CT-guided percutaneous transthoracic lung biopsy to make a definitive diagnosis of suspected lung cancer were included in this study. The factors that are effective in predicting pneumothorax and parenchymal hemorrhage, which are the most common complications that may occur after lung biopsy, were investigated. For this purpose, statistically evaluated the relationship between the incidence of pneumothorax and parenchymal hemorrhage postbiopsy and factors including age, s*x, lesion localization, lesion size, procedure duration, depth of lesion, number of pleural insertions of the biopsy needle, method of biopsy (fine needle aspiration biopsy or core needle biopsy ), and sarcopenia. The effects of these factors on complications occurring after biopsy were evaluated by univariate and multivariate regression analysis.

Results:

Three hundred twenty patients (M/F: 226/94) were enrolled in this retrospective study conducted between January 2016 and August 2023. The average age of the patients included was 65.18±12.62 SD (range: 43 to 88 y). The most common complications after CT-guided biopsy were pneumothorax (n=58, 18.1%) and parenchymal hemorrhage (n=21, 6.6%). Statistically significant associations were found between the incidence of complications and factors such as lesion size, distance from the pleura, and the most important factor as thoracic skeletal muscle area.

Conclusion:

The findings suggest that sarcopenia, along with certain clinical and procedural factors, may play a role in the prediction of complications following transthoracic lung biopsy. Further research is warranted to elucidate these associations’ mechanisms and optimize patient care strategies.

nd sarcopenia. Materials and Methods: Patients who underwent CT-guided percutaneous transthoracic lung biopsy to make a definitive diagnosis of suspected lung cancer were included in this study. The factors that are effective in predicting pneumothorax and parenchymal hemorrhage, which are the most....

30/07/2025

Something to Chew On: Neuroimaging Findings of Pediatric Masticator Space Pathologies: Diseases involving the pediatric masticator space often vary from those encountered in adults, with congenital abnormalities encountered more commonly and the assortment of benign and malignant neoplasms encountered differing in type and frequency. Familiarity with the imaging findings for these diseases is important for timely and accurate diagnosis and management. This article briefly reviews masticator space anatomy and provides detailed description of the imaging findings associated with benign and malignant diseases that may be encountered in the pediatric masticator space.

diseases is important for timely and accurate diagnosis and management. This article briefly reviews masticator space anatomy and provides detailed description of the imaging findings associated with benign and malignant diseases that may be encountered in the pediatric masticator space....

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