AI as biopsy triage on prostate MRI, and imaging the aggressive small HCC

The edition in brief

Today's radiology edition leads on where AI actually fits in prostate MRI. In a multicentre study of 787 men, a commercial AI risk classifier matched PI-RADS for patient-level sensitivity (97.6% vs 92.6%) and had slightly higher patient-level discrimination (area under the curve 0.80 vs 0.77), but was less sensitive at the lesion level (78.8% vs 88.8%); its best use is biopsy triage, especially for equivocal PI-RADS 3 lesions, where a targeted strategy avoided 18.9% of biopsies while keeping 98.4% sensitivity. A single-centre study found FDG PET-CT and contrast-enhanced CT comparable for restaging stage after neoadjuvant chemotherapy in oesophagogastric adenocarcinoma, but PET-CT was better for response assessment and metastasis detection. An updated ACR Appropriateness Criteria document guides imaging surveillance of indolent subsolid lung nodules. A clinic pearl restates the unenhanced-CT threshold for a benign adrenal adenoma. The practice-changer: in small hepatocellular carcinoma, three Gd-EOB-DTPA-enhanced MRI features (a hypovascular component of at least 20%, an intratumoral artery and an incomplete capsule) predicted the aggressive macrotrabecular-massive subtype and higher three-year recurrence, flagging tumours that may warrant closer follow-up.