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Objectives Radiomics image data analysis offers promising approaches in research but has not been implemented in clinical practice yet, partly due to the instability of many parameters. The aim of this study is to evaluate the stability of radiomics analysis on phantom scans with photon-counting detector CT (PCCT). Methods Photon-counting CT scans of organic phantoms consisting of 4 apples, kiwis, limes, and onions each were performed at 10 mAs, 50 mAs, and 100 mAs with 120-kV tube current. The phantoms were segmented semi-automatically and original radiomics parameters were extracted. This was followed by statistical analysis including concordance correlation coefficients (CCC), intraclass correlation coefficients (ICC), as well as random forest (RF) analysis, and cluster analysis to determine the stable and important parameters. Results Seventy-three of the 104 (70%) extracted features showed excellent stability with a CCC value > 0.9 when compared in a test and retest analysis, and 68 features (65.4%) were stable compared to the original in a rescan after repositioning. Between the test scans with different mAs values, 78 (75%) features were rated with excellent stability. Eight radiomics features were identified that had an ICC value greater than 0.75 in at least 3 of 4 groups when comparing the different phantoms in a phantom group. In addition, the RF analysis identified many features that are important for distinguishing the phantom groups. Conclusion Radiomics analysis using PCCT data provides high feature stability on organic phantoms, which may facilitate the implementation of radiomics analysis likewise in clinical routine. Key Points • Radiomics analysis using photon-counting computed tomography provides high feature stability. • Photon-counting computed tomography may pave the way for implementation of radiomics analysis in clinical routine.

The complex anatomy of the temporal bone is difficult to understand and constitutes a challenge in the daily diagnostic routine even for experienced neuroradiologists. In the context of otoneurological (oVEMP) and preoperative diagnostics, the diagnosis of superior semicircular canal dehiscence (SSCD) is of great importance for Ear, Nose, and Throat (ENT) specialists. The gold standard for this diagnosis is a high-resolution CT (HRCT) of the temporal bone. In order to correctly diagnose SSCD, special oblique reconstructions are necessary in addition to standard (axial, coronal, sagittal) reconstructions. We evaluated the frequency of diagnosis and its location in HRCT in correlation with otoneurological examination. From this analysis, we present a new SSCD classification. This classification yields the potential of a differentiated analysis of the patient's clinical symptoms with correlation to the cross-sectional anatomy and may lead to a differentiated therapy approach. We evaluated 1370 temporal bone scans of patients with residual hearing and verified 343 superior semicircular canal dehiscence (SSCD). We conducted a subgroup analysis of these 343 HRCT scans displaying a SSCD and used them as a basis to create a classification. Three location types of SSCD were identified. These were anterior type 1, superior type 2 and posterior type 3. Type 2 were significantly more frequent in both sexes. SSCD at this location can be overlooked if diagnosis is performed only in the standard axial plane, since it can only be visualized by means of double oblique reconstruction. We present a standardized reconstruction algorithm. In total, three types of SSCD with differing incidences can be extrapolated from the locations. Superior type 2 is the most frequent one. Both sexes are affected with roughly equal incidence. The use of standardized double oblique reconstruction algorithm ensures that all three types are diagnosed in the HRCT.

Objectives To investigate the cost-effectiveness of supplemental short-protocol brain MRI after negative non-contrast CT for the detection of minor strokes in emergency patients with mild and unspecific neurological symptoms. Methods The economic evaluation was centered around a prospective single-center diagnostic accuracy study validating the use of short-protocol brain MRI in the emergency setting. A decision-analytic Markov model distinguished the strategies “no additional imaging” and “additional short-protocol MRI” for evaluation. Minor stroke was assumed to be missed in the initial evaluation in 40% of patients without short-protocol MRI. Specialized post-stroke care with immediate secondary prophylaxis was assumed for patients with detected minor stroke. Utilities and quality-of-life measures were estimated as quality-adjusted life years (QALYs). Input parameters were obtained from the literature. The Markov model simulated a follow-up period of up to 30 years. Willingness to pay was set to $100,000 per QALY. Cost-effectiveness was calculated and deterministic and probabilistic sensitivity analysis was performed. Results Additional short-protocol MRI was the dominant strategy with overall costs of $26,304 (CT only: $27,109). Cumulative calculated effectiveness in the CT-only group was 14.25 QALYs (short-protocol MRI group: 14.31 QALYs). In the deterministic sensitivity analysis, additional short-protocol MRI remained the dominant strategy in all investigated ranges. Probabilistic sensitivity analysis results from the base case analysis were confirmed, and additional short-protocol MRI resulted in lower costs and higher effectiveness. Conclusion Additional short-protocol MRI in emergency patients with mild and unspecific neurological symptoms enables timely secondary prophylaxis through detection of minor strokes, resulting in lower costs and higher cumulative QALYs. Key Points • Short-protocol brain MRI after negative head CT in selected emergency patients with mild and unspecific neurological symptoms allows for timely detection of minor strokes. • This strategy supports clinical decision-making with regard to immediate initiation of secondary prophylactic treatment, potentially preventing subsequent major strokes with associated high costs and reduced QALY. • According to the Markov model, additional short-protocol MRI remained the dominant strategy over wide variations of input parameters, even when assuming disproportionally high costs of the supplemental MRI scan.

Feature stability and standardization remain challenges that impede the clinical implementation of radiomics. This study investigates the potential of spectral reconstructions from photon-counting computed tomography (PCCT) regarding organ-specific radiomics feature stability. Abdominal portal-venous phase PCCT scans of 10 patients in virtual monoenergetic (VM) (keV 40–120 in steps of 10), polyenergetic, virtual non-contrast (VNC), and iodine maps were acquired. Two 2D and 3D segmentations measuring 1 and 2 cm in diameter of the liver, lung, spleen, psoas muscle, subcutaneous fat, and air were obtained for spectral reconstructions. Radiomics features were extracted with pyradiomics. The calculation of feature-specific intraclass correlation coefficients (ICC) was performed by comparing all segmentation approaches and organs. Feature-wise and organ-wise correlations were evaluated. Segmentation-resegmentation stability was evaluated by concordance correlation coefficient (CCC). Compared to non-VM, VM-reconstruction features tended to be more stable. For VM reconstructions, 3D 2 cm segmentation showed the highest average ICC with 0.63. Based on a criterion of ≥ 3 stable organs and an ICC of ≥ 0.75, 12—mainly non-first-order features—are shown to be stable between the VM reconstructions. In a segmentation-resegmentation analysis in 3D 2 cm, three features were identified as stable based on a CCC of > 0.6 in ≥ 3 organs in ≥ 6 VM reconstructions. Certain radiomics features vary between monoenergetic reconstructions and depend on the ROI size. Feature stability was also shown to differ between different organs. Yet, glcm_JointEntropy, gldm_GrayLevelNonUniformity, and firstorder_Entropy could be identified as features that could be interpreted as energy-independent and segmentation-resegmentation stable in this PCCT collective. PCCT may support radiomics feature standardization and comparability between sites.

Our retrospective single-center study aims to evaluate the impact of structured reporting (SR) using a self-developed template on report quality compared to free-text reporting (FTR) in [ 18 F]SiTATE Positron Emission Tomography/Computer Tomography (PET/CT) for the primary staging and therapy monitoring of patients diagnosed with neuroendocrine tumors (NET). In total 50 patients were included. FTRs and SRs were generated post-examination. All reports were evaluated by a radiologist and a surgeon through a questionnaire to determine their contribution to facilitating clinical decision-making and to assess their completeness, linguistic quality, and overall quality. SR significantly increased the capacity of facilitating therapy decision-making from 32% in FTR to 55% in SR ( p  < 0.001). Trust in the report was significantly higher in SR with a mean of 5.0 (SD = 0.5) vs. 4.7 (SD = 0.5) for FTR ( p  < 0.001). SR received significantly higher mean ratings regarding linguistic quality with 4.7 for SR vs. 4.4 for FTR ( p  = 0.004) and overall report quality with a mean of 4.9 for SR vs. 4.6 for FTR ( p  < 0.001). Concluding that SR enhances the overall quality of reports in [ 18 F]SiTATE-PET/CTs for NET staging, serving as a tool to streamline clinical decision-making and enhance interdisciplinary communication in the future.

Background Accurate imaging plays a crucial role for prognostic assessment and treatment allocation in soft tissue sarcoma (STS). Guidelines recommend contrast-enhanced magnetic resonance imaging (MRI) including diffusion-weighted imaging (DWI) for tumor assessment. This study aims to evaluate the extent to which the MRI protocols used in clinical practice align with the sequences specified in the guideline in the diagnostic work-up of sarcoma patients. Methods We analyzed a cohort of patients treated at the Sarcoma Center of the University Medical Center Mannheim (UMM). Pretherapeutic MRI protocols were compared with the recommendations of the German sarcoma guideline. Results We analyzed 64 MRI examinations of patients with STS of the extremities and trunk, notably 62 performed at external radiology centers and 2 at UMM. A pretherapeutic contrast-enhanced MRI was available in 51 of 64 cases (79.7%), of which 40 referrals explicitly indicated a soft tissue tumor. In 3.1% of the cases, the complete set of guideline-recommended sequences was not performed. At least two of the required sequences were consistently available. The most frequently absent sequences were the T1-weighted sequence without fat saturation acquired before and after contrast administration using identical acquisition parameters (82.8%) and DWI sequences (78.1%). Conclusions MRI protocol selection is primarily guided by the clinical referral question. Our analysis indicates that a substantial proportion of examinations deviated from recommended protocols. Contributing factors may include inaccurate clinical referral questions, limited guideline awareness, reimbursement constraints in outpatient settings, or diagnostic considerations. Standardized imaging represents a key instrument for quality assurance in the diagnosis of STS and forms the foundation for clinical and translational studies. In the future, the recommendations should be re-evaluated and published in a clear, accessible format to ensure broad implementation.

In recent years, there has been an increasing recognition of coronary computed tomographic angiography (CCTA) and gated non-contrast cardiac CT in the workup of coronary artery disease in patients with low and intermediate pretest probability, through the readjustment guidelines by medical societies. However, in routine clinical practice, these CT data sets are usually evaluated dominantly regarding relevant coronary artery stenosis and calcification. The implementation of radiomics analysis, which provides visually elusive quantitative information from digital images, has the potential to open a new era for cardiac CT that goes far beyond mere stenosis or calcification grade estimation. This review offers an overview of the results obtained from radiomics analyses in cardiac CT, including the evaluation of coronary plaques, pericoronary adipose tissue, and the myocardium itself. It also highlights the advantages and disadvantages of use in routine clinical practice.

This study evaluated segmentation accuracy, efficiency, and radiomic feature stability for manual (MD), artificial intelligence-based (AI), and hybrid (MD + AI) contouring of pelvic organs on planning CT (pCT) and HyperSight cone-beam CT (hCBCT) for adaptive radiotherapy. Dice similarity and 95th percentile Hausdorff distance (HD95) quantified segmentation agreement, while radiomic feature stability was assessed using the concordance correlation coefficient (CCC). Agreement between segmentation approaches was highest for bladder and femora (median Dice 0.95–0.96; HD95 1.88–2.17 mm), intermediate for prostate and rectum (median Dice 0.92; HD95 2.22–2.62 mm), and lowest for seminal vesicles and penile bulb (median Dice 0.76–0.83; HD95 3.01–3.41 mm). AI and MD + AI reduced contouring times by about 90% and 60% compared to MD. Radiomic feature stability differed significantly between segmentation modes (all p adj ≤ 0.05). GLRLM features exhibited significantly higher stability than other features, whereas morphological features showed lower stability. Median radiomic feature stability was highest for bladder and femora, and intermediate for prostate and rectum. In conclusion, AI-based and hybrid contouring achieved high accuracy and substantial time savings, while texture- and intensity-based radiomic features showed robustness with AI segmentation. This study demonstrated feasibility of extracting distinct, reliable quantitative parameters based on AI-only contouring of pelvic structures.

Computed tomography (CT) scans represent the gold standard in the planning of functional endoscopic sinus surgeries (FESS). Yet, radiologists and otolaryngologists have different perspectives on these scans. In general, residents often struggle with aspects involved in both reporting and operation planning. The aim of this study was to compare the completeness of structured reports (SR) of preoperative CT images and structured operation planning (SOP) to conventional reports (CR) and conventional operation planning (COP) to potentially improve future treatment decisions on an individual level. In total, 30 preoperative CT scans obtained for surgical planning of patients scheduled for FESS were evaluated using SR and CR by radiology residents. Subsequently, otolaryngology residents performed a COP using free texts and a SOP using a specific template. All radiology reports and operation plannings were evaluated by two experienced FESS surgeons regarding their completeness for surgical planning. User satisfaction of otolaryngology residents was assessed by using visual analogue scales. Overall radiology report completeness was significantly higher using SRs regarding surgically important structures compared to CRs (84.4 vs. 22.0%, p<0.001). SOPs produced significantly higher completeness ratings (97% vs. 39.4%, p<0.001) regarding pathologies and anatomical variances. Moreover, time efficiency was not significantly impaired by implementation of SR (148 s vs. 160 s, p = 0.61) and user satisfaction was significantly higher for SOP (VAS 8.1 vs. 4.1, p<0.001). Implementation of SR and SOP results in a significantly increased completeness of radiology reports and operation planning for FESS. Consequently, the combination of both facilitates surgical planning and may decrease potential risks during FESS.

CT-guided adaptive radiotherapy (aRT) based on HyperSight TM -CBCT provides high-quality imaging, allowing quantitative radiomic feature analysis as a monitoring tool. This study comprehensively evaluates the stability of radiomic features, as potential imaging biomarkers, in pelvic structures of prostate cancer patients treated with adaptive stereotactic body radiation therapy (SBRT). Between December 2023 and July 2024, 32 patients with localized prostate cancer underwent adaptive SBRT at the Ethos ® linear accelerator (Varian, Siemens Healthineers) with HyperSight-CBCT imaging. Longitudinal stability was assessed by intraclass correlation coefficient (ICC) over five fractions of aRT for target structures and non-hollow organs at risk. In pooled organs at risk, 93.0% of features showed very high stability (ICC > 0.9) compared to 67.4% in pooled target structures, indicating significantly lower stability for target structures ( p  = 0.00009129). Second-order features demonstrated greater stability than conventional and shape-based features ( p  = 0.0433, p  = 0.0252). Fraction number significantly affected longitudinal prostate feature variability ( p  = 0.0135). This study comprehensively analyzed HyperSight-CBCT imaging to evaluate longitudinal stability of radiomic features during adaptive SBRT for prostate cancer. The trends observed will provide a framework for future CT-guided aRT studies, facilitating quantitative imaging analysis of radiological biomarkers for clinical translation and improving personalized treatment.