PURPOSE:Differences in severity and complexity among polytrauma patients remain a major challenge for clinicians and radiologists worldwide. We aimed to provide a descriptive analysis of patient characteristics, trauma mechanisms, and severity in connection with the need for intensive care in polytrauma patients undergoing computed tomography (CT). METHODS:This retrospective monocentric analysis consecutively included 1993 patients (1305 males, mean age 50.67±23.40 years) with 2002 emergency room cases between 12/2015 and 06/2021. Nine patients were examined twice during the study period. CT was performed in 1897/2002 cases (94.8%). Additional magnetic resonance imaging (MRI) was obtained in 438/2002 cases. For subgroup analysis, trauma mechanisms were compared. Besides conventional trauma causes also critically ill non-trauma patients (CINT) were included. Admission time, day of the week, and month were also analyzed. RESULTS:Traffic accidents constituted the largest trauma group, accounting for 847/2002 cases (42.3%). CINT with non-traumatic emergency died significantly more often (p < 0.001) than patients within the other trauma subgroups. In patients with an injury at the neck area, significantly more often an intubation was registered (p < 0.001). MRI was significantly more frequently performed in cases involving injuries to the cranium (p < 0.001), face (p < 0.001), or neck (p < 0.001). Mean time spent in the hospital was 9.96±13.49 days, and the mean time in the intensive care unit (ICU) was 6.58±9.67 days. Overall, 1171/2002 patients (58.5%) required at least one night in the ICU. A total of 233 patients died following trauma (11.6%), with a mean age of 69.92±18.67years. CONCLUSION:Imaging strategies in polytrauma patients vary depending on the mechanism of injury and the affected body region. Especially additional MRI was more often needed when brain, face, or neck trauma was present.

Background: Structural and functional alterations resulting from radial access for cerebral diagnostic catheter angiography might contribute to impaired wrist function. This study aimed to evaluate the impact of the transradial approach for diagnostic cerebral procedures on wrist function, using prospective follow-up assessments. Methods: Wrist function was prospectively assessed by using the Patient-Rated Wrist Evaluation (PRWE) questionnaire at baseline (pre-procedural assessment), as well as at 1-month and 3-month follow-up assessments (PRWE: 0 to 100, with 0 indicating no functional impairment). Association analyses with demographic and clinical parameters were performed using univariate logistic regression models. Results: During the 12-month observation period, 35 patients were enrolled in the study. At baseline, 25 patients (71.4%) reported no wrist impairment, while 10 patients (28.6%) had PRWE scores of up to 51. At the 1-month assessment, seven participants (20%) experienced a worsening in wrist function, reflected by increased PRWE scores. Of these, five patients showed deterioration exceeding the minimum clinically important difference. Another eight participants (22.9%) showed an improvement. A worsening of wrist function between the baseline and 1-month follow-up was not significantly associated with age, sex, prior neurosurgical status, body mass index (BMI), total procedure duration, dose area product, or fluoroscopy time (p > 0.05). At the 3-month follow-up, none of the patients reported any wrist-related impairments. Conclusions: In this exploratory cohort, the use of the transradial approach for cerebral angiography resulted in no wrist-related impairment at the 3-month follow-up. Transient worsening occurred in 20%, including clinically relevant cases, underscoring the need for larger studies with objective outcome measures.

Background: Sarcopenia is a known negative prognostic factor in oncology and is frequently observed in patients with pancreatic ductal adenocarcinoma (PDAC). Computed tomography (CT) enables longitudinal muscle assessment and may provide additional prognostic information. This study aims to assess their association with prognosis in pancreatic cancer and explore the diagnostic and prognostic value of CT radiomics. Methods: A retrospective single-center study included 62 patients with primary PDAC who underwent at least three abdominal CT scans: baseline (t0), 3 months (t1), 6 months (t2), and, in 35 patients, 12 months (t3). CT-based sarcopenia was assessed using the psoas muscle index (PMI) based on reference cutoffs and cohort-specific sex-specific quartiles. Skeletal muscles at the L3 level were semi-automatically segmented. Radiomic features of the psoas were extracted and analyzed using k-nearest neighbor, decision tree, and random forest models. Prognostic relevance was evaluated using logistic regres sion and feature selection via least absolute shrinkage and selection operator (LASSO) regression. Tumor progression was assessed radio-logically according to RECIST 1.1 criteria. Results: CT-based sarcopenia prevalence was 45.3% using reference-based PMI thresholds. PMI declined significantly from baseline to t1 and remained stable thereafter, with women exhibiting consistently lower values. Outcome analysis showed a higher proportion of disease progression at t1 in sarcopenic patients using reference cutoffs, whereas cohort-specific quartiles demonstrated no consistent differences. Random forest models predicted sarcopenia with up to 0.73 accuracy and receiver operating characteristics area under the curve (ROC-AUC) of 0.81. LASSO regression identified the psoas short axis and cross-sectional area as the most informative features. Logistic regression using baseline radiomic features predicted disease progression status at 12 months with 0.85 accuracy, weighted F1 0.841, and AUC 0.823. Interobserver agreement for psoas measurements was high (r = 0.86). Conclusion: Longitudinal CT-based assessment of PMI demonstrates progressive sarcopenia within the studied PDAC cohort, with sex-specific declines. Radiomic analysis of skeletal muscle provides complementary information and predictive insights, highlighting their potential to enhance the characterization of muscle status and its association with disease course in patients able to undergo repeated imaging.

Background: With increasing demand for ambulatory catheter angiography, interest in the transradial approach for diagnostic cerebral procedures has grown markedly. This study aimed to evaluate the effect of the transradial approach for catheter-based diagnostic cerebral procedures on wrist function. Methods: Wrist function was quantified by the Patient-Rated Wrist Evaluation (PRWE) questionnaire. The PRWE score ranged from 0 to 100, with 0 indicating no functional impairment. Association analyses with demographic and clinical parameters were performed using univariate logistic regression models. Results: A total of 88 patients underwent ambulatory diagnostic cerebral angiography during the 15-month observation period; of these, 40 (45%) participated in a telephone interview. Overall, 47.5% (n = 19) of patients reported no wrist impairment (PRWE = 0) after the transradial approach. The remaining 52.5% (n= 21) showed a mean PRWE score of 21.3 ± 22.5 (standard deviation), with a median value of 11.0 and a range from 1.0 to 87.0. Interestingly, univariate logistic regression models revealed a trend towards association between the dichotomized PRWE score and body mass index (p = 0.051). No associations were found with age, sex, prior neurosurgical status, total procedure duration, dose area product, fluoroscopy time, or dominant hand (p > 0.05). Conclusions: Following transradial cerebral catheter angiography, 52.5% of patients reported some degree of wrist impairment at follow-up; whether this represents procedure-related deterioration cannot be determined without baseline values.

To investigate lumbar vertebral volumetric bone mineral density (vBMD) from ex vivo opportunistic multi-detector computed tomography (MDCT) scans using different protocols, and compare it to dedicated quantitative CT (QCT) values from the same specimens. Cadavers from two female donors (ages 62 and 68 years) were scanned (L1–L5) using six different MDCT protocols and one dedicated QCT scan. Opportunistic vBMD was extracted using an artificial intelligence-based algorithm. The vBMD measurements from the six MDCT protocols, which varied in peak tube voltage (80–140 kVp), tube load (72–200 mAs), slice thickness (0.75–1 mm), and/or slice increment (0.5–0.75 mm), were compared to those obtained from dedicated QCT. A strong positive correlation was observed between vBMD from opportunistic MDCT and reference QCT (ρ = 0.869, p < 0.01). Agreement between vBMD measurements from MDCT protocols and the QCT reference standard according to the intraclass correlation coefficient (ICC) was 0.992 (95

With the rising number of angiographic interventional procedures, occupational radiation exposure is becoming increasingly relevant. As even low doses may contribute to stochastic health effects, enhanced radiological protection measures are warranted. This study aimed to systematically quantify the radiation exposure of radiologic technologists under routine clinical conditions and in an experimental setting. Radiation dose exposure was monitored over one month using three official dosimeters placed at defined locations within the angiography suite, using the floor-mounted C-arm as a reference point. Dose values were extrapolated to estimate annual exposure. Additionally, experimental dose rate measurements were performed at eight locations and three height levels (foot, torso, eye) under standardized conditions using both standard and low-dose DSA protocols. Official dosimeter readings averaged less than 2

Background: The increase in multiparametric magnetic resonance imaging (mpMRI) examinations as a fundamental tool in prostate cancer (PCa) diagnostics raises the need for supportive computer-aided imaging analysis. Therefore, we evaluated the performance of a commercially available AI-based algorithm for prostate cancer detection and classification in a multi-center setting. Methods: Representative patients with 3T mpMRI between 2017 and 2022 at three different university hospitals were selected. Exams were read according to the PI-RADSv2.1 protocol and then assessed by an AI algorithm. Diagnostic accuracy for PCa of both human and AI readings were calculated using MR-guided ultrasound fusion biopsy as the gold standard. Results: Analysis of 91 patients resulted in 138 target lesions. Median patient age was 67 years (range: 49–82), median PSA at the time of the MRI exam was 8.4 ng/mL (range: 1.47–73.7). Sensitivity and specificity for clinically significant prostate cancer (csPCa, defined as ISUP ≥ 2) were 92%/64% for radiologists vs. 91%/57% for AI detection on patient level and 90%/70% vs. 81%/78% on lesion level, respectively (cut-off PI-RADS ≥ 4). Two cases of csPCa were missed by the AI on patient-level, resulting in a negative predictive value (NPV) of 0.88 at a cut-off of PI-RADS ≥ 3. Conclusions: AI-augmented lesion detection and scoring proved to be a robust tool in a multi-center setting with sensitivity comparable to the radiologists, even outperforming human reader specificity on both patient and lesion levels at a threshold of PI-RADS ≥3 and a threshold of PI-RADS ≥ 4 on lesion level. In anticipation of refinements of the algorithm and upon further validation, AI-detection could be implemented in the clinical workflow prior to human reading to exclude PCa, thereby drastically improving reading efficiency.

CT-based opportunistic screening using artificial intelligence finds a high prevalence (43

CT-based fractional flow reserve (CT-FFR) is a promising noninvasive method for the functional assessment of coronary stenosis. It expands the diagnostic capabilities of coronary CT angiography (cCTA) by providing hemodynamic information and potentially reducing unnecessary invasive coronary angiography examinationsThis review summarizes current technological developments, study results, and clinical applications of CT-FFR. It also discusses the advantages and disadvantages of various software solutions, including artificial intelligence (AI)-based on-site analyses, and their potential integration into the clinical routine.Studies show that CT-FFR improves diagnostic accuracy compared to cCTA and can optimize patient management. Advances in artificial intelligence and new imaging techniques such as photon-counting CT could further refine CT-FFR and expand its applicability. Despite promising results, further research is needed regarding long-term validation, standardized workflows, and economic feasibility.CT-FFR is a promising complementary tool for assessing the hemodynamic relevance of coronary stenoses. CT-FFR is particularly helpful in complex, long-segment, or consecutive stenosis, because a purely anatomical visual examination is not always sufficient. The combination of technical innovations and AI-assisted image analysis could have the potential to transform noninvasive coronary diagnostics. · CT-FFR increases specificity and diagnostic accuracy compared to cCTA alone.. · Technological advances could further refine CT-FFR and expand its applicability.. · The increasing adoption and improved applicability of CT-FFR in routine clinical practice is promising.. · Kloth C, Brendel JM, Kübler J et al. CT-FFR: How a new technology could transform cardiovascular diagnostic imaging. Rofo 2025; DOI 10.1055/a-2697-5413.

Background Arterial spin labeling (ASL) is a magnetic resonance imaging (MRI)-based technique using labeled blood-water of the brain-feeding arteries as an endogenous tracer to derive information about brain perfusion. It enables the assessment of cerebral blood flow (CBF). Method This review aims to provide a methodological and technical overview of ASL techniques, and to give examples of clinical use cases for various diseases affecting the central nervous system (CNS). There is a special focus on recent developments including super-selective ASL (ssASL) and time-resolved ASL-based magnetic resonance angiography (MRA) and on diseases commonly not leading to characteristic alterations on conventional structural MRI (e. g., concussion or migraine). Results ASL-derived CBF may represent a clinically relevant parameter in various pathologies such as cerebrovascular diseases, neoplasms, or neurodegenerative diseases. Furthermore, ASL has also been used to investigate CBF in mild traumatic brain injury or migraine, potentially leading to the establishment of imaging-based biomarkers. Recent advances made possible the acquisition of ssASL by selective labeling of single brain-feeding arteries, enabling spatial perfusion territory mapping dependent on blood flow of a specific preselected artery. Furthermore, ASL-based MRA has been introduced, providing time-resolved delineation of single intracranial vessels. Conclusion Perfusion imaging by ASL has shown promise in various diseases of the CNS. Given that ASL does not require intravenous administration of a gadolinium-based contrast agent, it may be of particular interest for investigations in pediatric cohorts, patients with impaired kidney function, patients with relevant allergies, or patients that undergo serial MRI for clinical indications such as disease monitoring. Key Points: