Radiology

NSF risk after contemporary GBCAs in advanced CKD/ESRD is extremely low

This TriNetX study included 73,022 adults with stage 4–5 CKD or ESRD who received contemporary GBCAs from 2010–2025. Propensity-matched controls without advanced CKD showed identical possible NSF coding rates, 0.05% in both groups (RR 1.00; 95% CI 0.63–1.59). NSF-confounder codes were similarly rare and not increased versus controls, including for ACR group II and macrocyclic agents. These data indicate that diagnostic coding for NSF after modern GBCA use in severe renal dysfunction is exceedingly uncommon and not measurably elevated. Clinically, this supports performing necessary contrast MRI in advanced CKD/ESRD with standard agent selection and targeted counseling rather than blanket avoidance. 1

MRI-first, contrast-free prostate screening improves csPCa detection vs PSA-triggered MRI

The PROSA randomized trial assigned 759 asymptomatic men to bpMRI-first screening or PSA-triggered bpMRI. Arm A underwent biparametric MRI regardless of PSA, while arm B had MRI only if PSA exceeded risk-adjusted thresholds. Biopsy and clinically significant PCa detection were higher with MRI-first (biopsy 10.8%, csPCa 4.6%) than PSA-triggered MRI (5.2% and 1.8%; RR 2.6). MRI-first improved grade selectivity, biopsy efficiency, and biopsy avoidance, with no serious adverse events reported. From a payer perspective, MRI-first yielded an incremental cost-effectiveness ratio of about €2200 per additional csPCa detected in this single-round, short-follow-up study. 2

Dynamic chest radiography shows promise as a low-dose COPD screening alternative

This prospective study enrolled 553 participants, including 191 with COPD and 362 controls, to compare dynamic chest radiography with pulmonary function testing. Bilateral projected lung area change during deep breathing correlated with FEV1 percent predicted (r=0.65) and FEV1/FVC (r=0.64) in COPD patients. This single DCR parameter achieved an AUC of 0.78, improving to 0.82 when three DCR features were combined in a model. A model integrating a DCR parameter with smoking status reached an AUC of 0.85 and was implemented as a nomogram. These findings suggest DCR could provide a practical low-radiation COPD screening tool where spirometry is unavailable, with external validation still needed. 3

DECT VNC plus iodine maps can replace true non-contrast CT in GI bleeding

This retrospective study of 100 triphasic CT examinations for suspected GI bleeding compared conventional CT with a DECT protocol using VNC and iodine maps. Among 50 bleeding and 50 control cases, DECT achieved sensitivity and specificity of 94.4% and 96.0% versus 91.6% and 94.4% for conventional CT, meeting non-inferiority. Diagnostic confidence increased and mean reading time decreased slightly with DECT, while inter-reader agreement remained almost perfect (κ=0.82). Omitting true non-contrast reduced total dose–length product by about 20% without sacrificing diagnostic performance. These results support replacing true non-contrast with DECT-derived VNC and iodine maps in GI bleeding protocols to lower radiation dose. 4