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Background: The test-retest/interobserver repeatability and diagnostic value of 4D flow MRI in liver disease is underreported.Purpose: To determine the reproducibility/repeatability of flow quantification in abdominal vessels using a spiral 4D flow MRI sequence; to assess the value of 4D flow parameters in diagnosing cirrhosis and degree of portal hypertension.Study Type: Prospective.Subjects: Fifty-two patients with chronic liver disease.Field Strength/sequence: 1.5T/spiral 4D flow acquired in one breath-hold.Assessment: Thirteen abdominal vessels were identified and segmented by two independent observers to measure maximum and time-averaged through-plane velocity, net flow, and vessel cross-section area. Interobserver agreement and test-retest repeatability were evaluated in 15 and 4 cases, respectively. Prediction of the presence and severity of cirrhosis and portal hypertension was assessed using 4D flow parameters.Statistical Tests: Cohen's kappa coefficient, coefficient of variation (CV), Bland-Altman, Mann-Whitney tests, logistic regression.Results: For all vessels combined, measurements showed acceptable agreement between observers, with Cohen's kappa = 0.70 (P < 0.001), CV < 21%, Bland-Altman bias <5%, but high limits of agreement ([-75%,75%]). Test-retest repeatability was excellent in large vessels (CV = 1-15%, bias = 1-25%, Bland-Altman limits of agreement [BALA] = [4%,150%]), and poor in small vessels (CV = 7-130%, bias = 10-200%, BALA = [8%,190%]). Average velocity in the right hepatic vein and average area of the splenic vein were higher in cirrhosis (P = 0.027/0.0039). Flow in the middle hepatic vein strongly correlated with Child-Pugh score (ρ = 0.84, P = 0.0238), while flow in the splenic vein (ρ = 0.43, P = 0.032), time-average (ρ = 0.46, P = 0.02) and peak velocity in the superior mesenteric vein (ρ = 0.45, P = 0.032), and peak velocity in the infrarenal IVC (ρ = 0.39, P = 0.032) positively correlated with an imaging-based portal hypertension score. Average area of the splenic vein predicted cirrhosis (P = 0.019; area under the curve AUC [95% confidence interval, CI] = 0.87 [0.71,1.00]) and clinically significant portal hypertension (P = 0.042; AUC [95% CI] = 0.78 [0.57-0.99]).Data Conclusion: Spiral 4D flow allows comprehensive assessment of abdominal vessels in one breath-hold, with substantial interobserver reproducibility, but variable test-retest repeatability. 4D flow may potentially reflect vascular changes due to cirrhosis and portal hypertension.Level Of Evidence: 2 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2019;49:994-1005. [ABSTRACT FROM AUTHOR]

Imaging has a key role in tumor response assessment, either in clinical trial or daily practice. The RECIST criteria, based on unidimensional measurement of tumor lesions, are still the most often used in 2018, despite their known limitations, especially since the development of targeted therapies. Other criteria, including the CHOI criteria for GIST evaluation, the modified RECIST criteria (mRECIST) for hepatocellular carcinoma evaluation and the CHUN criteria for colorectal liver metastases evaluation, have been developed and are available alternatives. More recently, the introduction of immunotherapies showed different types of response to this kind of treatment and highlighted the concept of pseudo-progression. In this context, the iRECIST criteria were created. They are used more and more, and they need to be known and applied to avoid missing delayed responses. Finally, functional imaging techniques, such as diffusion- weighted imaging or perfusion imaging, as well as the concept of depth of response and early tumor shrinkage, are imaging tools that are available for tumor evaluation; however, they are still in the research phase. [ABSTRACT FROM AUTHOR]

Purpose: To determine the in vitro accuracy, test‐retest repeatability, and interplatform reproducibility of T1 quantification protocols used for dynamic contrast‐enhanced MRI at 1.5 and 3 T. Methods: A T1 phantom with 14 samples was imaged at eight centers with a common inversion‐recovery spin‐echo (IR‐SE) protocol and a variable flip angle (VFA) protocol using seven flip angles, as well as site‐specific protocols (VFA with different flip angles, variable repetition time, proton density, and Look‐Locker inversion recovery). Factors influencing the accuracy (deviation from reference NMR T1 measurements) and repeatability were assessed using general linear mixed models. Interplatform reproducibility was assessed using coefficients of variation. Results: For the common IR‐SE protocol, accuracy (median error across platforms = 1.4–5.5%) was influenced predominantly by T1 sample (P < 10−6), whereas test‐retest repeatability (median error = 0.2–8.3%) was influenced by the scanner (P < 10−6). For the common VFA protocol, accuracy (median error = 5.7–32.2%) was influenced by field strength (P = 0.006), whereas repeatability (median error = 0.7–25.8%) was influenced by the scanner (P < 0.0001). Interplatform reproducibility with the common VFA was lower at 3 T than 1.5 T (P = 0.004), and lower than that of the common IR‐SE protocol (coefficient of variation 1.5T: VFA/IR‐SE = 11.13%/8.21%, P = 0.028; 3 T: VFA/IR‐SE = 22.87%/5.46%, P = 0.001). Among the site‐specific protocols, Look‐Locker inversion recovery and VFA (2–3 flip angles) protocols showed the best accuracy and repeatability (errors < 15%). Conclusions: The VFA protocols with 2 to 3 flip angles optimized for different applications achieved acceptable balance of extensive spatial coverage, accuracy, and repeatability in T1 quantification (errors < 15%). Further optimization in terms of flip‐angle choice for each tissue application, and the use of B1 correction, are needed to improve the robustness of VFA protocols for T1 mapping. Magn Reson Med 79:2564–2575, 2018. © 2017 International Society for Magnetic Resonance in Medicine. [ABSTRACT FROM AUTHOR]

Rationale and objectives: Automated evaluation of abdominal computed tomography (CT) scans should help radiologists manage their massive workloads, thereby leading to earlier diagnoses and better patient outcomes. Our objective was to develop a machine-learning model capable of reliably identifying suspected bowel obstruction (BO) on abdominal CT. Materials and methods: The internal dataset comprised 1345 abdominal CTs obtained in 2015–2022 from 1273 patients with suspected BO; among them, 670 were annotated as BO yes/no by an experienced abdominal radiologist. The external dataset consisted of 88 radiologist-annotated CTs. We developed a full preprocessing pipeline for abdominal CT comprising a model to locate the abdominal-pelvic region and another model to crop the 3D scan around the body. We built, trained, and tested several neural-network architectures for the binary classification (BO, yes/no) of each CT. F1 and balanced accuracy scores were computed to assess model performance. Results: The mixed convolutional network pretrained on a Kinetics 400 dataset achieved the best results: with the internal dataset, the F1 score was 0.92, balanced accuracy 0.86, and sensitivity 0.93; with the external dataset, the corresponding values were 0.89, 0.89, and 0.89. When calibrated on sensitivity, this model produced 1.00 sensitivity, 0.84 specificity, and an F1 score of 0.88 with the internal dataset; corresponding values were 0.98, 0.76, and 0.87 with the external dataset. Conclusion: The 3D mixed convolutional neural network developed here shows great potential for the automated binary classification (BO yes/no) of abdominal CT scans from patients with suspected BO. Clinical relevance statement: The 3D mixed CNN automates bowel obstruction classification, potentially automating patient selection and CT prioritization, leading to an enhanced radiologist workflow. Key Points: • Bowel obstruction's rising incidence strains radiologists. AI can aid urgent CT readings. • Employed 1345 CT scans, neural networks for bowel obstruction detection, achieving high accuracy and sensitivity on external testing. • 3D mixed CNN automates CT reading prioritization effectively and speeds up bowel obstruction diagnosis. [ABSTRACT FROM AUTHOR]

Introduction: It has been suggested that in patients with hepatocellular carcinoma (HCC) of metabolic aetiology, the efficacy of immunotherapy may be reduced. The aim was to investigate the impact of metabolic‐associated steatotic liver disease (MASLD) and metabolic risk factors (MRF) on the outcomes of Atezolizumab‐Bevacizumab (AtezoBev). Methods: We collected data from 295 AtezoBev‐treated patients, starting in 2020. MASLD was defined by the current/past presence of MRF, namely BMI ≥ 30 kg/m2, type 2 diabetes, arterial hypertension or dyslipidaemia and no other cause of liver disease (daily alcohol ≤30 g in males and ≤20 g in females). The influence of baseline characteristics on progression (PFS) and overall survival (OS) was assessed by uni/multivariate analysis using the Cox model. Results: Risk factors for cirrhosis were viral infection in 47%, excessive alcohol consumption in 45% and MASLD in 13%. In the whole cohort, 27% had 1 MRF, 23% had 2 MRF, 15% had 3 MRF and 6% had 4 MRF. Median PFS and OS were 6.5 and 15.6 months, respectively, and similar in patients with or without MASLD in Log rank analysis. The number of MRF or MALSD was not associated with PFS or OS in the univariate analysis. Factors associated with PFS in multivariate analysis included ALBI grade 3 (HR = 1.60, p =.03), AFP (HR = 1.01, p =.01) and metastasis (HR = 1.77, p <.001). During follow‐up, 10% of patients experienced immune‐related adverse events, with age and female gender, but not MRF or MASLD, as independent predictors. Conclusion: Our study suggests that the presence of MASLD or the number of MRF did not lead to worse outcomes in advanced HCC patients treated with AtezoBev. [ABSTRACT FROM AUTHOR]

Purpose: To perform an international survey on current practices in imaging-based surveillance, diagnosis, staging, and assessment of treatment response for HCC. Materials and methods: Three themes were covered in this international survey: demographics of respondents and liver imaging expertise; imaging practices for screening, surveillance, diagnosis, staging, and assessment of treatment response for HCC; and diagnostic imaging systems used. Descriptive summaries were created. Results: Of 151 respondents, 22.5% were from Asia, 6.0% from Europe, 19.9% from North America, 26.5% from South America, and 25.2% from Australasia; 57.0% respondents worked in academic and 34.4% in private or mixed settings. Non-contrast ultrasound was most commonly used for screening and surveillance of HCC (90.7%), and multiphase computed tomography was used for diagnosis (96.0%). Extracellular contrast agents (69.5%) were the most commonly used MRI contrast agents and Lumason/SonoVue (31.1%) is the most commonly used contrast-enhanced ultrasound contrast agent. A majority (94.0%) of respondents use ancillary imaging features for assessment of liver lesions in at-risk patients. Usage of diagnostic imaging systems for HCC varied by region. RECIST or mRECIST criteria were most commonly used for assessing HCC treatment response (48.3%). Most respondents agreed that a standardized classification for the diagnosis of HCC is needed (68.9%) and that an atlas and lexicon would help improve inter-reader agreement (71.5%). Conclusion: Practices and recommendations for imaging of HCC vary between geographical regions. Future efforts to develop a unified system should address regional differences and potential barriers for adoption of a standardized diagnostic system for HCC. [ABSTRACT FROM AUTHOR]

Purpose: To determine the impact of the COVID-19 on the CT activities in French radiological centers during the epidemic peak. Materials and methods: A cross-sectional prospective CT scan survey was conducted between March 16 and April 12, 2020, in accordance with the local IRB. Seven hundred nine radiology centers were invited to participate in a weekly online survey. Numbers of CT examinations related to COVID-19 including at least chest (CTcovid) and whole chest CT scan activities (CTchest) were recorded each week. A sub-analysis on French departments was performed during the 4 weeks of the study. The impact of the number of RT-PCRs (reverse transcriptase polymerase chain reactions) on the CT workflow was tested using two-sample t test and Pearson's test. Results: Five hundred seventy-seven structures finally registered (78%) with mean response numbers of 336 ± 18.9 (323; 351). Mean CTchest activity per radiologic structure ranged from 75.8 ± 133 (0–1444) on week 12 to 99.3 ± 138.6 (0–1147) on week 13. Mean ratio of CTcovid on CTchest varied from 0.36 to 0.59 on week 12 and week 14 respectively. There was a significant relationship between the number of RT-PCR performed and the number of CTcovid (r = 0.73, p = 3.10−16) but no link with the number of positive RT-PCR results. Conclusion: In case of local high density COVID-19, CT workflow is strongly modified and redirected to the management of these specific patients. Key Points: • Over the 4-week survey period, 117,686 chest CT (CTtotal) were performed among the responding centers, including 61,784 (52%) CT performed for COVID-19 (CTcovid). • Across the country, the ratio CTcovid/CTtotalvaried from 0.36 to 0.59 and depended significantly on the local epidemic density (p = 0.003). • In clinical practice, in a context of growing epidemic, in France, chest CT was used as a surrogate to RT-PCR for patient triage. [ABSTRACT FROM AUTHOR]

Objectives: Early tumor shrinkage (ETS) has been reported to be associated with survival of metastatic colorectal cancer (mCRC) patients. Our aim was to analyze long-term tumor-size evolution, according to early mCRC best responses during the first-line therapy, to evaluate first best response-survival links.Methods: Sixty-five patients with unresectable mCRCs, treated between 2010 and 2015, were included retrospectively in this descriptive monocenter study and grouped according to their RECIST 1.1 first-line best responses: progressive disease (PDfl), stable disease with tumor-size evolution between 0 and + 19% (SDfl+) or 0 and - 29% (SDfl-), and partial responders (PRs), who were classed PR with ETS (ETSfl) or without (PRfl). Tumor-size evolution and best tumor responses to each chemotherapy line were analyzed.Results: Tumor loads of ETSfl or PRfl mCRCs tended to remain inferior to their initial values: 60% of patients died with target lesion sums below baseline. For first-line SDfl+ or PDfl mCRCs, rapid tumor load increases continued during successive lines: > 80% died with target lesion sums above baseline. ETSfl mCRCs responded better to subsequent lines (37.5% second-line PR), whereas PDfl mCRCs remained refractory to other therapies (0% second- and third-line PR). Overall survival rates were significantly (p = 0.03) longer for the ETSfl group (29.9 [95% CI: 12.6-47.1] months) and shorter for the PDfl group (17.1 [95% CI: 1.5-37.5] months).Conclusion: Tumors responding to first-line chemotherapy also responded better to subsequent lines, whereas PDfl mCRCs remained refractory, which may explain the better survival associated with ETSfl.Key Points: • Early shrinking tumors under first-line chemotherapy responded better to subsequent lines, maintaining low tumor loads, potentially explaining the link between early tumor shrinkage and overall survival of metastatic colorectal cancer (mCRC) patients. • mCRCs progressing under first-line chemotherapy remained refractory to other therapies and their tumor loads increased rapidly. • Even outside a clinical trial, an early first CT scan reevaluation with RECIST criteria 8 weeks after starting first-line therapy is crucial to determine long-term mCRC evolution. [ABSTRACT FROM AUTHOR]

Background: Histologic microscopic positive resection margin is a debated prognostic factor in patients resected for colorectal liver metastases. This study aimed to assess whether patients with R1 resection experience recurrence at the site of the resection (on-site recurrence) and to identify predictive factors for recurrence profiles in patients with R1 margins after resection of colorectal liver metastases., Methods: All surgical colorectal liver metastasis resection cases with R1 parenchymal margin from September 2014 to March 2020 in our center were retrospectively included. Imaging was reviewed for each metastasis. All the analyses were performed per metastasis. Recurrence location was examined for each metastasis according to the site of the R1 margin and defined as on-site when recurrence was at the same place of the resected lesion. Prognostic factors for recurrence type were assessed using logistic regression., Results: Of 700 patients who underwent liver resection for colorectal liver metastases, 105 (15%) had at least 1 metastasis with R1 resection margin, representing 6.8% per metastasis. The median follow-up was 34 months. Overall recurrence occurred in 130 metastases (83.3%) with intrahepatic recurrence in 106 metastases (80.9%). On-site recurrence was observed for 49 metastases (31.4%) and isolated (without an additional recurrence site) for 20 metastases (12.8%). The on-site recurrence did not impact overall survival. Three predictive factors for on-site recurrence were found in the multivariate logistic regression: synchronous metastases, nonanatomic resection, and pathologic response tumor regression grade 4-5., Conclusion: Intrahepatic localization of recurrence is more frequent than on-site recurrence after R1 parenchymal resection. Synchronous metastases, nonanatomic resection, and tumor regression grade 4-5 may impact the risk of on-site recurrence., Competing Interests: Conflict of Interest/Disclosure The authors have no related conflicts of interest to declare., (Copyright © 2025 Elsevier Inc. All rights reserved.)

Introduction: We aimed to investigate the parameters associated with portal hypertension (PHT)-related complications occurrence in hepatocellular carcinoma (HCC) patients treated by transarterial chemoembolization (TACE), with a focus on non-selective beta blockers (NSBBs) due to their impact on preventing liver decompensation., Methods: We included all patients with HCC for whom endoscopy was available the day of first TACE (2013-2023). The occurrence of PHT-related complications was defined as the appearance of ascites, acute variceal bleeding or hepatic encephalopathy (HE) post-TACE treatment and prior to HCC progression. Inappropriate treatment by NSBBs was defined by the lack of NSBBs in patients with small/large esophageal varices (EV)., Results: 109 patients were included (age 67 years, 80 % male) and 65 % had EV. No NSBBs prescription despite indication was observed in 32 % and 81 % of patients with large and small size EV, respectively. Median progression free survival and overall survival were 10 and 23 months, respectively, and 27 % of patients underwent LT. During the follow-up, 20 patients presented PHT-related complications with an incidence of 18 % at 12months (90 % with EV,67 % not treated by NSBB while indicated). Among them, 11 presented HCC progression, 2 were transplanted and 78 % presented liver decompensation that impaired the access to further HCC treatment. In multivariate analysis, a history of HE (HR=55.39,95 %CI[7.42-413.26]) and inappropriate NSBBs treatment (HR=4.16,95 %CI[1.45-11.81]) were associated with PHT-related complications occurrence., Conclusion: The lack of NSBBs was independently associated with PHT-related complications after TACE, precluding access to further HCC treatment in 78 % of patients with HCC progression. Appropriate screening and PHT prophylaxis are needed in HCC patients who undergo TACE to improve their outcomes., Competing Interests: Declaration of competing interest None., (Copyright © 2024 Elsevier Masson SAS. All rights reserved.)

Background: Treatment of locally advanced non small cell lung cancer (LA-NSCLC) is based on (chemo)radiotherapy, which may cause acute lung toxicity: radiation pneumonitis (RP). Its frequency seems to increase by the use of adjuvant durvalumab therapy., Aims: To identify clinical, dosimetric, and radiomic factors associated with grade (G)≥2 RP and build a prediction model based on selected parameters., Patients and Methods: This is a retrospective multicenter cohort study including patients receiving radiation therapy between 2015 and 2019 for LA-NSCLC. Baseline computed tomography scanners were segmented to extract radiomic features from the "Lung - Tumor" volume. Variables associated with the risk of G≥2 RP in the descriptive analysis were then selected for explanatory analysis, followed by predictive analysis., Results: 153 patients were included in 4 centers (51 with G≥2 RP). Factors associated with G≥2 RP included a high initial hemoglobin level, dosimetric factors (mean dose to healthy lungs, lung V20Gy and V13Gy), the addition of maintenance durvalumab, and 7 radiomic features (intensity distribution and texture). Other factors were associated with an increased risk of G≥2 RP in our explanatory model, such as older age, low Tiffeneau ratio, and a decreased initial platelet count. The best-performing predictive model was a random forest-based learning model using clinical, dosimetric, and radiomic variables, with an area under the ROC curve of 0.72 (95%CI [0.63; 0.80]) versus 0.64 for models using one type of data., Conclusion: The addition of radiomic features to clinical and dosimetric ones improves prediction of the occurrence of G≥2 RP in patients receiving radiotherapy for lung cancer., Competing Interests: Disclosure Cécile Evin: Merck, Léo Razakamanantsoa : none, François Gardavaud: none, Léa Papillon: employed by SOPHiA GENETICS, Hamza Boulaala: employed by SOPHiA GENETICS, Loïc Ferrer: employed by SOPHiA GENETICS, Olivier Gallinato: employed by SOPHiA GENETICS, Thierry Colin: employed by SOPHiA GENETICS, Sondos Ben Moussa: none, Yara Harfouch: none, Jean-Noël Foulquier: none, Sophie Guillerm: none, Jean-Emmanuel Bibault: none, Florence Huguet : BMS, Merck, MSD, Amgen, Mathilde Wagner: none, Eleonor Rivin del Campo: none., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Purpose: The purpose of the 2023 SFR data challenge was to invite researchers to develop artificial intelligence (AI) models to identify the presence of a pancreatic mass and distinguish between benign and malignant pancreatic masses on abdominal computed tomography (CT) examinations., Materials and Methods: Anonymized abdominal CT examinations acquired during the portal venous phase were collected from 18 French centers. Abdominal CT examinations were divided into three groups including CT examinations with no lesion, CT examinations with benign pancreatic mass, or CT examinations with malignant pancreatic mass. Each team included at least one radiologist, one data scientist, and one engineer. Pancreatic lesions were annotated by expert radiologists. CT examinations were distributed in balanced batches via a Health Data Hosting certified platform. Data were distributed into four batches, two for training, one for internal evaluation, and one for the external evaluation. Training used 83 % of the data from 14 centers and external evaluation used data from the other four centers. The metric (i.e., final score) used to rank the participants was a weighted average of mean sensitivity, mean precision and mean area under the curve., Results: A total of 1037 abdominal CT examinations were divided into two training sets (including 500 and 232 CT examinations), an internal evaluation set (including 139 CT examinations), and an external evaluation set (including 166 CT examinations). The training sets were distributed on September 7 and October 13, 2023, and evaluation sets on October 15, 2023. Ten teams with a total of 93 members participated to the data challenge, with the best final score being 0.72., Conclusion: This SFR 2023 data challenge based on multicenter CT data suggests that the use of AI for pancreatic lesions detection is possible on real data, but the distinction between benign and malignant pancreatic lesions remains challenging., Competing Interests: Declaration of competing interest The authors declare that they have no competing interest in relation with this article., (Copyright © 2024 Société française de radiologie. Published by Elsevier Masson SAS. All rights reserved.)