Radiology

Biparametric prostate MRI is noninferior to multiparametric MRI for csPCa at the patient level

This meta-analysis pooled 40 head-to-head studies including 9403 men with suspected prostate cancer undergoing both bpMRI and mpMRI. For clinically significant prostate cancer, bpMRI sensitivity was only 2.3% lower and specificity 1.8% higher than mpMRI at the patient level, meeting noninferiority margins. Per-lesion analysis showed noninferiority for specificity but not sensitivity, likely due to fewer studies and heterogeneity rather than clear inferiority. These data support omitting dynamic contrast in many clinical settings, provided robust image quality and quality-control standards are in place. 1

Photon-counting CT enables “quadruple-low” lung cancer imaging with less dose and contrast but better images

In 425 lung cancer patients, photon-counting CT using a quadruple-low protocol halved radiation dose versus conventional energy-integrating CT (3.49 vs 7.82 mSv). Contrast injection rate, volume, and iodine concentration were also significantly reduced, yet signal-to-noise and contrast-to-noise ratios in lesions improved. Subjective image quality scores and diagnostic confidence for lesion features were higher with photon-counting CT than with standard CT protocols. Notably, contrast-induced nephropathy occurred in 7.9% of conventional CT patients but in none of those imaged with photon-counting CT. These results support photon-counting CT as a safer, higher-quality option for lung cancer imaging where available. 2

CCTA is guideline-endorsed for intermediate-risk acute chest pain with inconclusive troponins

This review summarizes evidence and guidelines positioning coronary CT angiography for emergency department acute chest pain evaluation. The 2023 ESC guidelines recommend CCTA or functional imaging for patients without ECG changes and uncertain high-sensitivity troponin results (class IIa, level A). US guidelines endorse CCTA or functional testing to rule out obstructive coronary disease in intermediate-risk patients after inconclusive initial workup (class I, level A). The article emphasizes how CCTA can streamline resource use, shorten ED stays, and maintain diagnostic safety in carefully selected patients. 3

LI-RADS T2+F/A criterion improves MRI diagnosis of small HCC across Western and Eastern guidelines

This multicenter study of 1414 at-risk patients evaluated LI-RADS v2018 ancillary features and alpha-fetoprotein for hepatocellular carcinoma ≤30 mm. Combining mild–moderate T2 hyperintensity with either intralesional fat or AFP ≥200 ng/mL (“T2+F/A”) was tested against multiple international guidelines. Across extracellular and gadoxetic acid–enhanced MRI datasets, adding T2+F/A increased sensitivities of LR-5 and major Western and Eastern guidelines by several percentage points. Specificity was generally preserved, with only a modest decrease for the APASL 2017 guideline in one gadoxetic acid validation set. Radiologists can integrate these ancillary features and AFP to confidently upgrade small lesions while remaining aligned with existing guideline frameworks. 4