This prospective study aimed to perform a qualitative and quantitative comparison of deep learning (DL) and conventional T2-weighted Half-Fourier Acquisition Single-shot Turbo spin Echo (HASTE) sequences for 3T MRI acquisition of the upper abdomen. From January 2024 to April 2024, 166 patients (60 ± 14 years) scheduled for MRI of the upper abdomen were prospectively enrolled. Each patient underwent two MRI examinations: one using a conventional T2-weighted HASTE sequence, followed by a fast T2-weighted HASTE sequence reconstructed with DL. Image quality, anatomical structure visualization, and diagnostic performance were independently assessed by three readers using a 5-point Likert scale. Quantitative analysis included measurements of signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) for both sequences. Additionally, radiomic features were extracted and analyzed for significant variations. Interreader agreement was evaluated using Fleiss' Kappa. The DL HASTE sequence showed significantly superior overall image quality (p < 0.001), fewer artifacts (p < 0.001), and improved delineation of anatomical structures (p < 0.01) compared to the conventional T2-weighted HASTE sequence. DL sequences exhibited better SNR (p < 0.001), whereas CNR values did not show a difference between the two acquisition types. Radiomics feature analysis unveiled significant differences in contrast and gray-level characteristics (p ≤ 0.001). DL HASTE demonstrated a significant time reduction of 62.5% together with significant energy cost savings of 0.34 kW per scan compared to the conventional sequence acquisition. The DL HASTE sequence enhanced image quality and diagnostic confidence while minimizing artifacts, time, and energy costs, enabling a more accurate detection of pathologies than the conventional T2-weighted product solution with potential clinical impact.

This study compared image quality and radiation dose between cone-beam computed tomography (CBCT) and multidetector computed tomography (MDCT) under equivalent scanning settings, focusing on postoperative imaging after upper extremity osteosynthesis. A distal radius plate was implanted in a cadaveric forearm to simulate postoperative conditions. A total of twenty-four scans were performed using both modalities. Radiation dose was quantified with seven dosimeters placed at various anatomical locations and scan parameters were adjusted to ensure comparability. Subjective image quality was evaluated by five independent radiologists, while objective image quality was assessed using signal-to-noise ratio and contrast-to-noise ratio. Significant differences were found in radiation exposure and image quality. CBCT showed a slightly higher radiation dose (dose-length product: CBCT, 56.97 mGy*cm; MDCT, 46.19 mGy*cm; p < 0.0001). No significant difference was observed in cortical bone assessment (p = 0.28), but CBCT was rated higher for cancellous bone visualization (p = 0.005), artifact reduction (p = 0.003), and overall image quality (p = 0.009). Objectively, CBCT demonstrated lower image noise with superior signal-to-noise ratio (p = 0.0004) and contrast-to-noise ratio (p < 0.0001). This research offers a direct comparison of CBCT and MDCT using matched scan parameters on the same anatomical specimen, providing practical insights into image quality and radiation dose for optimizing postoperative orthopedic imaging protocols. CBCT demonstrates advantages in bone imaging and artifact management, while MDCT has superior potential for radiation dose reduction without compromising image quality.

Objectives: The objective of this study was to evaluate the impact of virtual monoenergetic image (VMI) reconstructions derived from photon-counting computed tomography (PCCT) on the assessment of carotid arteries, with a focus on optimizing keV selection based on plaque composition. Methods: This retrospective study included 111 patients (mean age 80 ± 7.5 years; 64 men; 47 women) with carotid sclerosis who underwent PCCT between April 2022 and February 2023. One lesion was analyzed per patient, each containing both calcified and non-calcified components. Quantitative measurements were performed in calcified plaque across energy levels from 40 to 120 keV and comprised attenuation, signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), corrected image noise (CIN) and artifact index (AIX). Two radiologists independently rated image quality, artifacts, and diagnostic assessability of both components using five-point scales. Results: Attenuation and CNR were highest at 40 to 50 keV, where CIN and AIX were also greatest. SNR followed a U-shaped course, lowest at 90 keV and highest at 110 to 120 keV, where intraluminal attenuation was too low for reliable luminal delineation. Reader ratings were highest at 40 to 50 keV for non-calcified components and at 70 to 80 keV for calcified plaque, with good interobserver agreement throughout (κ 0.74 to 0.92). After correction for multiple testing, adjacent energy levels were frequently indistinguishable. Conclusions: Optimal PCCT VMI energy levels depend on plaque composition. The findings support implementing standardized protocols with automatic dual-range reconstructions (40–50 keV and 70–80 keV) to enable efficient, individualized carotid plaque assessment in clinical practice.

Background/Objectives: Differentiating focal nodular hyperplasia (FNH) from hepatic adenoma (HA) remains challenging, as FNH is benign whereas HA carries risks of hemorrhage and malignant transformation. This prospective single-center pilot study evaluated the diagnostic performance of three-dimensional magnetic resonance elastography (3D-MRE) using a gravitational transducer for non-invasive differentiation of FNH and HA. Methods: Thirty-three participants (23 FNH, 10 HA) underwent 3D-MRE using the gravitational transducer. Viscoelastic parameters—stiffness, shear wave speed (Cs), wave attenuation, and phase angle—were quantified for lesions and background parenchyma. Δ-values were calculated by subtracting background liver measurements from lesion values. Results: FNH demonstrated significantly higher stiffness than HA (median 3.16 vs. 2.58 kPa; p = 0.02) and higher Cs (median 1.81 vs. 1.64 m/s; p = 0.001). Normalized stiffness differences (Δ stiffness) were significantly greater in FNH than HA (median 0.83 vs. 0.10 kPa; p = 0.001). Generalized additive models revealed divergent volume-dependent stiffening behaviors. In ROC analysis, Δ stiffness and Δ Cs each achieved an AUC of 0.87, indicating that single background-normalized viscoelastic parameters carry the principal diagnostic signal. An exploratory multivariable combination of Δ stiffness with patient age produced an apparent AUC of 0.93 with wide odds-ratio confidence intervals, and is presented as hypothesis-generating rather than as a clinical prediction model. Conclusions: In this pilot cohort, 3D-MRE using the gravitational transducer showed encouraging parameter-level separation between FNH and HA, with background normalization enhancing discrimination. Wave attenuation and phase angle did not differ significantly between lesion types. Given the small sample size (particularly the HA subgroup of ten patients), the mixed reference standard (histological confirmation in only 14 of 33 lesions; definitive hepatobiliary-phase MRI criteria in 19 of 33), the single-slice ROI used for lesion measurement, and the incomplete characterization of background liver parenchyma, these findings should be regarded as hypothesis-generating and require external validation in larger, multicenter cohorts before any clinical application.

Abstract Purpose To evaluate therapeutic effectiveness and safety of lipiodol-based conservative transpedal lymphangiography in sealing persistent inguinal lymphatic fistulas after lymphadenectomy and to determine whether therapeutic success is influenced by the amount of injected Lipiodol or the volume of lymphatic drainage. Materials and methods From January 2003 to June 2023, 184 patients underwent lymphangiography. Of these, 35 patients (24 males, 11 females; aged 24 to 87 years) met inclusion criteria (age ≥ 18 years, persistent lymphatic leakage after inguinal lymphadenectomy (> 3 weeks), following unsuccessful conservative management) and were subsequently included for statistical analysis. Lipiodol lymphangiography was performed via transpedal lymphatic vessel cannulation. Data collected included the following: age, sex, underlying disease, drainage volume before lymphangiography, Lipiodol amount, procedural details, time to fistula closure, imaging follow-ups, technical success, therapeutic success and its correlation with the volume of lymphatic leakage and the volume of the applied iodised oil, complications, and additional interventions. Statistical analysis utilised the Wilcoxon–Mann–Whitney and logistic regression tests (significance at p ≤ 0.05). Results Therapeutic success was achieved in 22 patients (62.86%) without complications, with a mean resolution time of 7.13 days. Thirteen patients (37.14%) required additional interventions. No significant correlation was found between therapeutic success and either the amount of Lipiodol used (p = 0.51 and p = 0.49) or drainage volume (p = 0.82 and p = 0.79). Conclusion Lipiodol-based lymphangiography is an effective and safe treatment for inguinal lymphatic fistulas. The lack of association of therapeutic outcome with Lipiodol or drainage volume appears to be more related to anatomical and disease-specific factors, suggesting individualised patient assessment is warranted.

To assess the diagnostic performance, predictors, and clinical utility of MRI-guided prostate biopsy over an 18 year period in a real-world tertiary care setting. We retrospectively analyzed patients who underwent MRI-guided prostate biopsy between 2006 and 2024 at a German tertiary care center. Clinical data, PI-RADS, PSA levels, prostate volume, and biopsy outcomes were evaluated. Logistic regression models assessed associations between clinical variables and cancer detection, clinical significance (ISUP ≥ 3), and upgrading after radical prostatectomy (RPE). Among 496 patients (mean age 66 ± 8 years; PSA, median (IQR): 7.2 ng/ml (5–10)), cancer was detected in 33

Myocardial and aortic stiffness are increasingly recognized as clinically relevant biomarkers for cardiovascular disease, yet their noninvasive quantification remains challenging. Magnetic resonance elastography (MRE) has emerged as a promising technique for the spatial mapping of tissue biomechanics by visualizing and analyzing propagating shear waves. This narrative review summarizes the current state of cardiovascular MRE, spanning technical developments in wave generation (acoustic, electromagnetic, gravitational, and transducer-free approaches), pulse sequence design (echo-planar imaging, gradient-recalled echo, spiral, and free-breathing three-dimensional acquisitions), and inversion algorithms (local frequency estimation, direct inversion, finite element methods, and multifrequency elastography). We present evidence from phantom validation, animal models (myocardial infarction, hypertension, right ventricular hypertrophy), and human studies encompassing cardiac amyloidosis, hypertrophic cardiomyopathy, diastolic dysfunction, and abdominal aortic aneurysm. Additionally, we discuss current challenges, including waveguide effects, standardization needs, and clinical translation barriers, and highlight emerging solutions through artificial intelligence, multifrequency methods, and transducer-free cardiac MRE.

To assess whether virtual non-contrast (VNC) images are diagnostically equivalent to true non-contrast (TNC) images in differentiating adrenal adenomas from metastases. Consecutive oncologic patients who underwent staging CT examinations performed on a third-generation dual-source CT scanner between January 2016 and February 2023 with adrenal lesion with histopathologic or MRI confirmation were retrospectively included. Adrenal lesion attenuation values were measured on TNC and VNC reconstructions and directly compared. Subsequently, the diagnostic accuracy of both reconstructions for differentiating adrenal adenomas from metastases was evaluated at predefined attenuation thresholds, including ≤ 10 HU (ACR threshold) and ≤ 20 HU (optimized threshold). Diagnostic performance was assessed using ROC curve analysis, while Bland–Altman analysis was performed to evaluate agreement between TNC and VNC measurements. A total of 439 patients (mean age: 63 ± 11 years) with incidental adrenal lesions were included. TNC and VNC showed significant difference in attenuation values with clear discrimination between adenomas and metastases based on attenuation distributions (all p < 0.0001). Bland–Altman analysis demonstrated close agreement between techniques (mean difference: − 0.4 HU; LoA: − 3.5–2.8 HU). ROC curve demonstrated excellent diagnostic accuracy for both TNC and VNC, with AUC values of 0.923 and 0.928, respectively. Using ACR threshold (≤ 10 HU), VNC showed slightly higher specificity (94.3

Background/Aim In professional soccer, comprehensive musculoskeletal assessments are performed prior to player transfers to evaluate both the current condition and future risk of injury. MRI plays a crucial role in this process, effectively revealing musculoskeletal findings even in the absence of symptoms. This study presents common musculoskeletal MRI findings in professional soccer players undergoing pre-signing assessments and their associations with age, playing position and footedness.Methods In this retrospective study, musculoskeletal 3 Tesla MRI scans obtained during pre-signing medical assessments of professional soccer players from August 2019 to March 2025 were included. Clinical data were extracted from medical records and supplemented with publicly available player information. Structural abnormalities exceeding expected physiological or age-related adaptations were systematically recorded and categorised according to institutional reporting practice.Results A total of 50 professional soccer players (mean age 25.4±4.7 years) were included. The most frequent MRI findings were secondary cleft signs and lumbar degenerative disc changes (in 21/50 and 20/50 players), followed by chondropathy of the knee (34%), labral degeneration (26%), femoroacetabular impingement (22%) and other soft tissue or bone-related changes. The prevalence of secondary clefts differed significantly across playing positions (χ²=8.07, p=0.045) with strikers showing the highest proportion (68.75%) compared with other groups.Conclusions Routine MRI screening in professional soccer players revealed typical frequent structural changes, even in the absence of symptoms. While most findings were consistently distributed across positions, some showed variation depending on playing position. These results highlight the value of early imaging in guiding individualised monitoring and injury prevention strategies.

RATIONALE AND OBJECTIVES:This study aims to evaluate the effectiveness of a deep learning (DL)-enhanced four-fold parallel acquisition technique (P4) in improving prostate MR image quality while optimizing scan efficiency compared to the traditional two-fold parallel acquisition technique (P2). MATERIALS AND METHODS:Patients undergoing prostate MRI with DL-enhanced acquisitions were analyzed from January 2024 to July 2024. The participants prospectively received T2-weighted sequences in all imaging planes using both P2 and P4. Three independent readers assessed image quality, signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR). Significant differences in contrast and gray-level properties between P2 and P4 were identified through radiomics analysis (p <.05). RESULTS:A total of 51 participants (mean age 69.4 years ± 10.5 years) underwent P2 and P4 imaging. P4 demonstrated higher CNR and SNR values compared to P2 (p <.001). P4 was consistently rated superior to P2, demonstrating enhanced image quality and greater diagnostic precision across all evaluated categories (p <.001). Furthermore, radiomics analysis confirmed that P4 significantly altered structural and textural differentiation in comparison to P2. The P4 protocol reduced T2w scan times by 50.8%, from 11:48 min to 5:48 min (p <.001). CONCLUSION:In conclusion, P4 imaging enhances diagnostic quality and reduces scan times, improving workflow efficiency, and potentially contributing to a more patient-centered and sustainable radiology practice.

INTRODUCTION:Osteoporosis is a major cause of spinal insufficiency fractures but often remains underdiagnosed. Dual-energy CT (DECT) enables reliable assessment of bone mineral density (BMD), but its limited accessibility highlights the need for alternative metrics. This study investigates the association between vertebral fracture status, DECT-derived BMD and alternative bone quality assessments, including Hounsfield Unit (HU)-based assessment and cortical thickness ratio. METHODS:A total of 180 patients who underwent non-contrast DECT of the spine between January 2016 and December 2021 were retrospectively analyzed. All imaged vertebrae were assessed for acute insufficiency fractures. DECT-based BMD was assessed using a dedicated postprocessing software that applies material decomposition and compared with HU-based assessment and cortical thickness ratio. Statistical analysis included correlation analysis, logistic regression adjusted for age and sex, ROC and PR curve analyses. RESULTS:Among 180 patients (97 females, median age of 65 years), 126 subjects (70 %) were confirmed to have insufficiency fractures. Patients with fractures had significantly lower values for DECT-based BMD (98.3 vs. 123.7 mg/cm3, p < 0.001), trabecular HU (93.5 vs. 159.5 HU, p < 0.001), and cortical thickness ratio (1.065 vs. 1.05, p < 0.001). Cortical HU showed no significant difference between patients with and without fractures (p = 0.35). DECT-based BMD provided the highest diagnostic accuracy for detecting insufficiency fractures, yielding an AUC of 0.8 for the ROC curve and an AUC of 0.9 for the PR curve. HU-based measurements (trabecular HU: Spearman ρ = 0.17; cortical HU: ρ = 0.2) and the cortical thickness ratio (ρ = -0.01) demonstrated only weak correlations with the reference standard, DECT-derived BMD. CONCLUSION:DECT-based BMD demonstrated the highest diagnostic accuracy for insufficiency fractures. HU-based assessments and cortical thickness ratio showed only weak correlations with DECT-based BMD, limiting their reliability as alternatives.

RATIONALE AND OBJECTIVES:The objective of this study was to evaluate a combination of deep learning (DL)-reconstructed parallel acquisition technique (PAT) and simultaneous multislice (SMS) acceleration imaging in comparison to conventional knee imaging. MATERIALS AND METHODS:Adults undergoing knee magnetic resonance imaging (MRI) with DL-enhanced acquisitions were prospectively analyzed from December 2023 to April 2024. The participants received T1 without fat saturation and fat-suppressed PD-weighted TSE pulse sequences using conventional two-fold PAT (P2) and either DL-enhanced four-fold PAT (P4) or a combination of DL-enhanced four-fold PAT with two-fold SMS acceleration (P4S2). Three independent readers assessed image quality, signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), and radiomics features. RESULTS:34 participants (mean age 45±17years; 14 women) were included who underwent P4S2, P4, and P2 imaging. Both P4S2 and P4 demonstrated higher CNR and SNR values compared to P2 (P<.001). P4 was diagnostically inferior to P2 only in the visualization of cartilage damage (P<.005), while P4S2 consistently outperformed P2 in anatomical delineation across all evaluated structures and raters (P<.05). Radiomics analysis revealed significant differences in contrast and gray-level characteristics among P2, P4, and P4S2 (P<.05). P4 reduced time by 31% and P4S2 by 41% compared to P2 (P<.05). CONCLUSION:P4S2 DL acceleration offers significant advancements over P4 and P2 in knee MRI, combining superior image quality and improved anatomical delineation at significant time reduction. Its improvements in anatomical delineation, energy consumption, and workforce optimization make P4S2 a significant step forward.

RATIONALE AND OBJECTIVES:To assess the impact of a deep learning-based noise reduction (DLD) technique on image quality and diagnostic accuracy for the evaluation of coronary arteries in transcatheter aortic valve implantation (TAVI) CT imaging. MATERIALS AND METHODS:Two hundred patients with severe aortic stenosis who underwent CT scans for pre-TAVI planning between October 2022 and April 2024 were retrospectively enrolled. Conventional images were reconstructed and denoised images were generated using dedicated software. Objective image quality was evaluated by measuring the mean Hounsfield unit (HU) and standard deviation (SD) in regions of interest within the aortic root, coronary arteries, and subcutaneous fat to calculate signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR). For subjective assessment, two readers used a 5-point Likert scoring system to evaluate sharpness, noise, contrast and overall image quality. The diagnostic performance of both datasets was assessed using invasive coronary angiography as reference standard. RESULTS:Denoised reconstructions showed significantly higher SNR (37.5±12.8 vs.12.3±4.1) and CNR (45.3±15.4 vs. 14.7±4.4), and lower noise (16.9±7.9 vs. 47.9±11.6 HU) (all p<0.001). Subjective assessment demonstrated that denoised images received the highest score for sharpness, noise, contrast and overall image quality (all p<0.001). For the evaluation of diagnostic accuracy, a total of 800 vessels and 1787 segments were analyzed. The per-segment diagnostic performance of the DLD for detection of CAD revealed an AUC of 90% (95% CI: 88.5-91.3), with accuracy of 93.9% (95% CI: 92.7-95), 85.7% (95% CI: 78.7-90.4) sensitivity and 94.7% (95% CI: 93.5-95.7) specificity, in the absence of a statistically significant difference compared with the evaluation performed on standard images (p=0.056). CONCLUSION:The DLD substantially improves image quality without affecting diagnostic accuracy for the evaluation of coronary arteries in patients undergoing pre-TAVI CT scans.

Accurate detection of intracranial hemorrhage (ICH) on non-contrast CT is critical in emergency settings, where missed diagnoses may delay treatment and worsen outcomes. While artificial intelligence (AI) models demonstrate high standalone performance, their additive value as a second reader for radiology residents is not well-established. This retrospective study included 1,337 non-contrast head CT scans from 2015 to 2019 (670 ICH-positive and 667 ICH-negative). A previously validated AI model was used for ICH detection. Two radiology residents reviewed all scans in consensus, first without and later with AI support after a 30-day washout. Ground truth was established by expert consensus. Diagnostic performance metrics were calculated. AI assistance significantly improved radiology residents’ diagnostic performance. Sensitivity increased from 0.85 to 0.94 and specificity from 0.87 to 0.97 (both p < 0.01), ROC-AUC rose from 0.86 to 0.95, and PR-AUC from 0.83 to 0.95 (p < 0.0001). The number of false negatives dropped from 101 to 41 with AI support. The greatest benefit was observed in subdural hematomas (SDH), where misses declined from 32 to 9 (20.3–5.7

Computed tomography (CT) is widely used for bone health assessment, impacting osteoporosis diagnosis and treatment. However, the influence of intravenous contrast agents on CT-based bone mineral density (BMD) measurements remains debated. This study evaluates the effect of contrast agents on Hounsfield measurements, T-scores, and Z-scores, assessing their impact on diagnostic accuracy to reduce misclassification and optimize CT-based BMD assessment. A retrospective analysis of 597 patients (median age: 66 years, 157 females, 440 males) was performed using dual-energy CT (DECT) scans of the abdomen and chest. All patients underwent non-contrast, arterial, and venous phase CT. Automated segmentation (nnU-Net) delineated L1 and L1–L4 trabecular bone, validated by two radiologists. T-scores were calculated according to DEXA-equivalent guidelines. Based on non-contrast CT, 35

BACKGROUND:Radiology reports play a crucial role in clinical decision-making. High report quality and completeness are essential for efficient patient care. However, the clarity and comprehensiveness of radiology reports are often points of contention among referring physicians. This study evaluated referring physicians' views on the quality and clinical utility of radiology reports. METHODS:A prospective, anonymous online survey was conducted from June 2023 to March 2025, targeting 258 practicing physicians in Germany, including 93 internists, 90 surgeons and 75 general practitioners. The survey included rating scales, multiple-choice questions and net promoter scores (NPS). RESULTS:Referring physicians' satisfaction with the completeness of radiology reports was moderate, with an average score of 38.4 ± 24.3 on a scale from -100 to + 100. Among the specialties surveyed, surgeons reported the highest level of dissatisfaction (p < 0.05). Internists and surgeons showed significantly stronger preferences for structured reporting compared to general practitioners (p < 0.05). According to the surveyed referring physicians, the most frequently missing information in reports included "determination of a diagnosis" (39 %) and "recommendations for further diagnostic measures or follow-up examinations" (23 %). A large majority of referring physicians (84.9 %) found multidisciplinary case conferences to be valuable (5-7 out of 7 stars) for enhancing their understanding of reports. CONCLUSION:Reporting preferences vary across specialties and radiologists must address the clinical needs of referring physicians, who are the primary audience for radiology reports. Integrating imaging into multidisciplinary meetings can further improve radiology report comprehension of referring physicians.

AI offers considerable potential to improve diagnostic accuracy and efficiency in radiology. However, its successful implementation depends largely on the trust and acceptance of referring physicians. This study examines physicians’ attitudes toward AI in radiology, identifying key facilitators and barriers to its clinical integration. A total of 169 licensed physicians in Germany, including surgeons, internists, and general practitioners who frequently refer patients to radiology, were surveyed. Participants were recruited via a systematic review of hospital and practice websites. A structured online questionnaire assessed perceptions of AI, focusing on trust-related factors, preferred applications, and adoption barriers. Statistical analysis was conducted using R and Python. Overall, 60

BACKGROUND:Magnetic resonance elastography (MRE) can quantify tissue biomechanics noninvasively, including pathological hepatic states like metabolic dysfunction-associated steatohepatitis. PURPOSE:To compare the performance of 2D/3D-MRE using the gravitational (GT) transducer concept with the current commercial acoustic (AC) solution utilizing a 2D-MRE approach. Additionally, quality index markers (QIs) were proposed to identify image pixels with sufficient quality for reliably estimating tissue biomechanics. STUDY TYPE:Prospective. POPULATION:One hundred seventy participants with suspected or confirmed liver disease (median age, 57 years [interquartile range (IQR), 46-65]; 66 females), and 11 healthy volunteers (median age, 31 years [IQR, 27-34]; 5 females). FIELD STRENGTH/SEQUENCE:Participants were scanned twice at 1.5 T and 60 Hz vibration frequency: first, using AC-MRE (2D-MRE, spin-echo EPI sequence, 11 seconds breath-hold), and second, using GT-MRE (2D- and 3D-MRE, gradient-echo sequence, 14 seconds breath-hold). ASSESSMENT:Image analysis was performed by four independent radiologists and one biomedical engineer. Additionally, superimposed analytic plane shear waves of known wavelength and attenuation at fixed shear modulus were used to propose pertinent QIs. STATISTICAL TESTS:Spearman's correlation coefficient (r) was applied to assess the correlation between modalities. Interreader reproducibility was evaluated using Bland-Altman bias and reproducibility coefficients. P-values <0.05 were considered statistically significant. RESULTS:Liver stiffness quantified via GT-2D/3D correlated well with AC-2D (r ≥ 0.89 [95% CI: 0.85-0.92]) and histopathological grading (r ≥ 0.84 [95% CI: 0.72-0.91]), demonstrating excellent agreement in Bland-Altman plots and between readers (κ ≥ 0.86 [95% CI: 0.81-0.91]). However, GT-2D showed a bias in overestimating stiffness compared to GT-3D. Proposed QIs enabled the identification of pixels deviating beyond 10% from true stiffness based on a combination of total wave amplitude, temporal sinusoidal nonlinearity, and wave signal-to-noise ratio for GT-3D. CONCLUSION:GT-MRE represents an alternative to AC-MRE for noninvasive liver tissue characterization. Both GT-2D and 3D approaches correlated strongly with the established commercial approach, offering advanced capabilities in abdominal imaging compared to AC-MRE. EVIDENCE LEVEL:1 TECHNICAL EFFICACY: Stage 2.