{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T14:15:53Z","timestamp":1783433753885,"version":"3.54.6"},"reference-count":35,"publisher":"Springer Science and Business Media LLC","issue":"8","license":[{"start":{"date-parts":[[2026,4,4]],"date-time":"2026-04-04T00:00:00Z","timestamp":1775260800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,4,4]],"date-time":"2026-04-04T00:00:00Z","timestamp":1775260800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/100014988","name":"Institute of Science and Technology Austria","doi-asserted-by":"publisher","award":["LS22-028"],"award-info":[{"award-number":["LS22-028"]}],"id":[{"id":"10.13039\/100014988","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Eur Radiol"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Dynamic contrast-enhanced MRI (DCE-MRI) enhances both suspicious lesions and normal tissue, known as background parenchymal enhancement (BPE). There is controversial evidence regarding whether BPE compromises the accuracy of breast MRI. Our aim was to investigate the influence of BPE in the detection of breast lesions by DCE-MRI using an ROI-based approach.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and methods<\/jats:title>\n                    <jats:p>MRI Images of consecutive patients with indeterminate or suspicious findings on mammography or ultrasound (BI-RADS 0, 3, 4, 5). tested between May 2020 and September 2023 were retrospectively analyzed. Both breasts were divided into 10 regions of interest (ROIs), and BPE, BI-RADS and lesion type were assessed according to the MRI BI-RADS lexicon for each ROI by two blinded readers. BPE was dichotomized into minimum\/mild (BPE1) and moderate\/marked (BPE2). Patients without a standard reference were excluded. The standard reference was defined as histology or 1 year follow-up. The MRI performance was assessed using ROC analysis in an ROI-based analysis. Inter-reader agreement was assessed using k statistics.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 316 patients (mean of 54 years, SD 10.6; range 31\u201384) were included. Among the 282 lesions histopathologically analyzed, 129 were malignant and 153 were benign. BPE1 was observed in 78% of patients and BPE2 in 22%. AUC did not differ between BPE1 (0.989) and BPE2 (0.988),\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&gt;\u20090.05. Sensitivity was 98.1% for BPE1 and 100% for BPE2, with comparable specificity: 95.5% (BPE1) vs. 92.6% (BPE2),\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&gt;\u20090.05.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Our study demonstrated that BPE does not have a negative impact on the detection and identification of suspicious lesions on breast MRI.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Key Points<\/jats:title>\n                    <jats:p>\n                      <jats:bold>\n                        <jats:italic>Question<\/jats:italic>\n                      <\/jats:bold>\n                      <jats:italic>What is the role of background parenchymal enhancement on DCE-MRI in terms of potential masking or mimicking remains a challenging issue?<\/jats:italic>\n                    <\/jats:p>\n                    <jats:p>\n                      <jats:bold>\n                        <jats:italic>Findings<\/jats:italic>\n                      <\/jats:bold>\n                      <jats:italic>The diagnostic accuracy of DCE-MRI for detecting breast lesions is not affected by elevated BPE levels.<\/jats:italic>\n                    <\/jats:p>\n                    <jats:p>\n                      <jats:bold>\n                        <jats:italic>Clinical relevance<\/jats:italic>\n                      <\/jats:bold>\n                      <jats:italic>Systematic evaluation of DCE-MRI using ROI-based analysis improves breast cancer detection and ensures diagnostic accuracy across different levels of background parenchymal enhancement.<\/jats:italic>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00330-026-12474-y","type":"journal-article","created":{"date-parts":[[2026,4,4]],"date-time":"2026-04-04T16:28:01Z","timestamp":1775320081000},"page":"6669-6678","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Impact of background parenchymal enhancement on the diagnosis of enhancing lesions in breast MRI: a systematic approach"],"prefix":"10.1007","volume":"36","author":[{"given":"Ambra","family":"Santonocito","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sonja","family":"Bechyna","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paola","family":"Clauser","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas H.","family":"Helbich","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3755-5398","authenticated-orcid":false,"given":"Pascal A. T.","family":"Baltzer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,4,4]]},"reference":[{"key":"12474_CR1","doi-asserted-by":"publisher","first-page":"520","DOI":"10.1148\/radiol.2019182947","volume":"292","author":"RM Mann","year":"2019","unstructured":"Mann RM, Cho N, Moy L (2019) Breast MRI: state of the art. Radiology 292:520\u2013536. https:\/\/doi.org\/10.1148\/radiol.2019182947","journal-title":"Radiology"},{"key":"12474_CR2","doi-asserted-by":"publisher","first-page":"607","DOI":"10.1016\/j.rcl.2023.12.013","volume":"62","author":"SA Chikarmane","year":"2024","unstructured":"Chikarmane SA, Smith S (2024) Background parenchymal enhancement. Radiol Clin North Am 62:607\u2013617. https:\/\/doi.org\/10.1016\/j.rcl.2023.12.013","journal-title":"Radiol Clin North Am"},{"key":"12474_CR3","doi-asserted-by":"publisher","first-page":"41","DOI":"10.1016\/j.clinimag.2021.11.021","volume":"83","author":"E Bauer","year":"2022","unstructured":"Bauer E, Levy MS, Domachevsky L et al (2022) Background parenchymal enhancement and uptake as breast cancer imaging biomarkers: a state-of-the-art review. Clin Imaging 83:41\u201350. https:\/\/doi.org\/10.1016\/j.clinimag.2021.11.021","journal-title":"Clin Imaging"},{"key":"12474_CR4","doi-asserted-by":"publisher","first-page":"234","DOI":"10.1148\/rg.341135034","volume":"34","author":"CS Giess","year":"2014","unstructured":"Giess CS, Yeh ED, Raza S, Birdwell RL (2014) Background parenchymal enhancement at breast MR imaging: normal patterns, diagnostic challenges, and potential for false-positive and false-negative interpretation. Radiographics 34:234\u2013247. https:\/\/doi.org\/10.1148\/rg.341135034","journal-title":"Radiographics"},{"key":"12474_CR5","doi-asserted-by":"publisher","first-page":"43","DOI":"10.1002\/jmri.26762","volume":"51","author":"GJ Liao","year":"2020","unstructured":"Liao GJ, Henze Bancroft LC, Strigel RM et al (2020) Background parenchymal enhancement on breast MRI: a comprehensive review. Magn Reson Imaging 51:43\u201361. https:\/\/doi.org\/10.1002\/jmri.26762","journal-title":"Magn Reson Imaging"},{"key":"12474_CR6","unstructured":"Morris EA, Comstock CE, Lee CH et al (2013) ACR BI-RADS magnetic resonance imaging. In: ACR BI-RADS Atlas, Breast Imaging Reporting and Data System. American College of Radiology, Reston"},{"key":"12474_CR7","doi-asserted-by":"publisher","first-page":"e654","DOI":"10.1016\/j.crad.2023.05.006","volume":"78","author":"H Sallam","year":"2023","unstructured":"Sallam H, Lenga L, Solbach C et al (2023) Correlation of background parenchymal enhancement on breast MRI with breast cancer. Clin Radiol 78:e654\u2013e659. https:\/\/doi.org\/10.1016\/j.crad.2023.05.006","journal-title":"Clin Radiol"},{"key":"12474_CR8","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejrad.2024.111903","volume":"183","author":"F Ferrara","year":"2025","unstructured":"Ferrara F, Santonocito A, Vogel W et al (2025) Background parenchymal enhancement in CEM and MRI: is there always a high agreement? Eur J Radiol 183:111903. https:\/\/doi.org\/10.1016\/j.ejrad.2024.111903","journal-title":"Eur J Radiol"},{"key":"12474_CR9","doi-asserted-by":"publisher","first-page":"823","DOI":"10.1002\/ijc.31370","volume":"143","author":"JD Brooks","year":"2018","unstructured":"Brooks JD, Sung JS, Pike MC et al (2018) MRI background parenchymal enhancement, breast density and serum hormones in postmenopausal women. Int J Cancer 143:823\u2013830. https:\/\/doi.org\/10.1002\/ijc.31370","journal-title":"Int J Cancer"},{"key":"12474_CR10","doi-asserted-by":"publisher","first-page":"356","DOI":"10.1148\/radiol.2442051620","volume":"244","author":"C Kuhl","year":"2007","unstructured":"Kuhl C (2007) The current status of breast MR imaging Part I. Choice of technique, image interpretation, diagnostic accuracy, and transfer to clinical practice. Radiology 244:356\u2013378. https:\/\/doi.org\/10.1148\/radiol.2442051620","journal-title":"Radiology"},{"key":"12474_CR11","doi-asserted-by":"publisher","first-page":"W373","DOI":"10.2214\/AJR.10.6272","volume":"198","author":"WB DeMartini","year":"2012","unstructured":"DeMartini WB, Liu F, Peacock S et al (2012) Background parenchymal enhancement on breast MRI: impact on diagnostic performance. AJR Am J Roentgenol 198:W373\u2013W380. https:\/\/doi.org\/10.2214\/AJR.10.6272","journal-title":"AJR Am J Roentgenol"},{"key":"12474_CR12","doi-asserted-by":"publisher","first-page":"663","DOI":"10.1016\/j.acra.2019.06.020","volume":"27","author":"DA Sippo","year":"2020","unstructured":"Sippo DA, Rutledge GM, Mercaldo SF et al (2020) Impact of background parenchymal enhancement on diagnostic performance in screening breast MRI. Acad Radiol 27:663\u2013671. https:\/\/doi.org\/10.1016\/j.acra.2019.06.020","journal-title":"Acad Radiol"},{"key":"12474_CR13","doi-asserted-by":"publisher","first-page":"822","DOI":"10.1148\/radiol.2017170811","volume":"286","author":"KM Ray","year":"2018","unstructured":"Ray KM, Kerlikowske K, Lobach IV et al (2018) Effect of background parenchymal enhancement on breast MR imaging interpretive performance in community-based practices. Radiology 286:822\u2013829. https:\/\/doi.org\/10.1148\/radiol.2017170811","journal-title":"Radiology"},{"key":"12474_CR14","doi-asserted-by":"publisher","first-page":"19","DOI":"10.1177\/0284185118770918","volume":"60","author":"P Clauser","year":"2019","unstructured":"Clauser P, Dietzel M, Weber M et al (2019) Motion artifacts, lesion type, and parenchymal enhancement in breast MRI: what does really influence diagnostic accuracy? Acta Radiol 60:19\u201327. https:\/\/doi.org\/10.1177\/0284185118770918","journal-title":"Acta Radiol"},{"key":"12474_CR15","doi-asserted-by":"publisher","first-page":"2261","DOI":"10.1007\/s00330-011-2175-6","volume":"21","author":"T Uematsu","year":"2011","unstructured":"Uematsu T, Kasami M, Watanabe J (2011) Does the degree of background enhancement in breast MRI affect the detection and staging of breast cancer? Eur Radiol 21:2261\u20132267. https:\/\/doi.org\/10.1007\/s00330-011-2175-6","journal-title":"Eur Radiol"},{"key":"12474_CR16","doi-asserted-by":"publisher","first-page":"6384","DOI":"10.21037\/qims-23-113","volume":"13","author":"H Wang","year":"2023","unstructured":"Wang H, Gao L, Chen X, Wang S-J (2023) Quantitative evaluation of Kaiser score in diagnosing breast dynamic contrast-enhanced magnetic resonance imaging for patients with high-grade background parenchymal enhancement. Quant Imaging Med Surg 13:6384\u20136394. https:\/\/doi.org\/10.21037\/qims-23-113","journal-title":"Quant Imaging Med Surg"},{"key":"12474_CR17","doi-asserted-by":"publisher","first-page":"1434","DOI":"10.1177\/0284185117698860","volume":"58","author":"SH Baek","year":"2017","unstructured":"Baek SH, Choi WJ, Cha JH et al (2017) Comparison of mammography, ultrasound, and MRI in size assessment of ductal carcinoma in situ with histopathologic correlation. Acta Radiol 58:1434\u20131441. https:\/\/doi.org\/10.1177\/0284185117698860","journal-title":"Acta Radiol"},{"key":"12474_CR18","doi-asserted-by":"publisher","first-page":"584","DOI":"10.1007\/s00330-009-1590-4","volume":"20","author":"NA Obuchowski","year":"2010","unstructured":"Obuchowski NA, Mazzone PJ, Dachman AH (2010) Bias, underestimation of risk, and loss of statistical power in patient-level analyses of lesion detection. Eur Radiol 20:584\u2013594. https:\/\/doi.org\/10.1007\/s00330-009-1590-4","journal-title":"Eur Radiol"},{"key":"12474_CR19","doi-asserted-by":"publisher","DOI":"10.1148\/radiol.241919","volume":"315","author":"S Bechyna","year":"2025","unstructured":"Bechyna S, Baltzer PAT (2025) Impact of background parenchymal enhancement on diagnostic performance of breast MRI: a systematic review and meta-analysis. Radiology 315:e241919. https:\/\/doi.org\/10.1148\/radiol.241919","journal-title":"Radiology"},{"key":"12474_CR20","doi-asserted-by":"publisher","first-page":"315","DOI":"10.1016\/j.diii.2015.12.006","volume":"97","author":"M Telegrafo","year":"2016","unstructured":"Telegrafo M, Rella L, Stabile Ianora AA et al (2016) Effect of background parenchymal enhancement on breast cancer detection with magnetic resonance imaging. Diagn Interv Imaging 97:315\u2013320. https:\/\/doi.org\/10.1016\/j.diii.2015.12.006","journal-title":"Diagn Interv Imaging"},{"key":"12474_CR21","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejrad.2024.111442","volume":"175","author":"H Wang","year":"2024","unstructured":"Wang H, van Der Velden BHM, Verburg E et al (2024) Automated rating of background parenchymal enhancement in MRI of extremely dense breasts without compromising the association with breast cancer in the DENSE trial. Eur J Radiol 175:111442. https:\/\/doi.org\/10.1016\/j.ejrad.2024.111442","journal-title":"Eur J Radiol"},{"key":"12474_CR22","doi-asserted-by":"publisher","first-page":"2575","DOI":"10.3390\/diagnostics12112575","volume":"12","author":"D Song","year":"2022","unstructured":"Song D, Kang BJ, Kim SH et al (2022) The frequency and causes of not-detected breast malignancy in dynamic contrast-enhanced MRI. Diagnostics (Basel) 12:2575. https:\/\/doi.org\/10.3390\/diagnostics12112575","journal-title":"MRI. Diagnostics (Basel)"},{"key":"12474_CR23","doi-asserted-by":"publisher","first-page":"218","DOI":"10.2214\/AJR.10.4550","volume":"196","author":"NM Hambly","year":"2011","unstructured":"Hambly NM, Liberman L, Dershaw DD et al (2011) Background parenchymal enhancement on baseline screening breast MRI: impact on biopsy rate and short-interval follow-up. AJR Am J Roentgenol 196:218\u2013224. https:\/\/doi.org\/10.2214\/AJR.10.4550","journal-title":"AJR Am J Roentgenol"},{"key":"12474_CR24","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejrad.2023.111185","volume":"169","author":"M Dietzel","year":"2023","unstructured":"Dietzel M, Bernathova M, Clauser P et al (2023) Added value of clinical decision rules for the management of enhancing breast MRI lesions: a systematic comparison of the Kaiser score and the G\u00f6ttingen score. Eur J Radiol 169:111185. https:\/\/doi.org\/10.1016\/j.ejrad.2023.111185","journal-title":"Eur J Radiol"},{"key":"12474_CR25","doi-asserted-by":"publisher","first-page":"516","DOI":"10.1016\/s1076-6332(00)80324-4","volume":"7","author":"NA Obuchowski","year":"2000","unstructured":"Obuchowski NA, Lieber ML, Powell KA (2000) Data analysis for detection and localization of multiple abnormalities with application to mammography. Acad Radiol 7:516\u2013525. https:\/\/doi.org\/10.1016\/s1076-6332(00)80324-4","journal-title":"Acad Radiol"},{"key":"12474_CR26","doi-asserted-by":"publisher","first-page":"2156","DOI":"10.1007\/s00330-013-2789-y","volume":"23","author":"M Wagner","year":"2013","unstructured":"Wagner M, Maggiori L, Ronot M et al (2013) Diffusion-weighted and T2-weighted MR imaging for colorectal liver metastases detection in a rat model at 7 T: a comparative study using histological examination as reference. Eur Radiol 23:2156\u20132164. https:\/\/doi.org\/10.1007\/s00330-013-2789-y","journal-title":"Eur Radiol"},{"key":"12474_CR27","doi-asserted-by":"publisher","first-page":"1157","DOI":"10.1002\/jmri.26335","volume":"49","author":"P Clauser","year":"2019","unstructured":"Clauser P, Helbich TH, Kapetas P et al (2019) Breast lesion detection and characterization with contrast-enhanced magnetic resonance imaging: prospective randomized intraindividual comparison of gadoterate meglumine (0.15 mmol\/kg) and gadobenate dimeglumine (0.075 mmol\/kg) at 3T. Magn Reson Imaging 49:1157\u20131165. https:\/\/doi.org\/10.1002\/jmri.26335","journal-title":"Magn Reson Imaging"},{"key":"12474_CR28","doi-asserted-by":"publisher","first-page":"2641","DOI":"10.1007\/s00330-012-2553-8","volume":"22","author":"V King","year":"2012","unstructured":"King V, Gu Y, Kaplan JB et al (2012) Impact of menopausal status on background parenchymal enhancement and fibroglandular tissue on breast MRI. Eur Radiol 22:2641\u20132647. https:\/\/doi.org\/10.1007\/s00330-012-2553-8","journal-title":"Eur Radiol"},{"key":"12474_CR29","doi-asserted-by":"publisher","first-page":"441","DOI":"10.1055\/s-0029-1246072","volume":"183","author":"P Baltzer","year":"2011","unstructured":"Baltzer P, Dietzel M, Vag T et al (2011) Clinical MR mammography: impact of hormonal status on background enhancement and diagnostic accuracy. Rofo 183:441\u2013447. https:\/\/doi.org\/10.1055\/s-0029-1246072","journal-title":"Rofo"},{"key":"12474_CR30","doi-asserted-by":"publisher","first-page":"677","DOI":"10.1007\/s12282-022-01345-1","volume":"29","author":"S Yuen","year":"2022","unstructured":"Yuen S, Monzawa S, Gose A et al (2022) Impact of background parenchymal enhancement levels on the diagnosis of contrast-enhanced digital mammography in evaluations of breast cancer: comparison with contrast-enhanced breast MRI. Breast Cancer 29:677\u2013687. https:\/\/doi.org\/10.1007\/s12282-022-01345-1","journal-title":"Breast Cancer"},{"key":"12474_CR31","doi-asserted-by":"publisher","first-page":"e0158573","DOI":"10.1371\/journal.pone.0158573","volume":"11","author":"B Bennani-Baiti","year":"2016","unstructured":"Bennani-Baiti B, Dietzel M, Baltzer PA (2016) MRI background parenchymal enhancement is not associated with breast cancer. PLoS One 11:e0158573. https:\/\/doi.org\/10.1371\/journal.pone.0158573","journal-title":"PLoS One"},{"key":"12474_CR32","doi-asserted-by":"publisher","DOI":"10.1259\/bjr.20160542","volume":"90","author":"B Bignotti","year":"2017","unstructured":"Bignotti B, Signori A, Valdora F et al (2017) Evaluation of background parenchymal enhancement on breast MRI: a systematic review. Br J Radiol 90:20160542. https:\/\/doi.org\/10.1259\/bjr.20160542","journal-title":"Br J Radiol"},{"key":"12474_CR33","doi-asserted-by":"crossref","unstructured":"Thomassin-Naggara I, Trop I, Chopier J et al (2011) Nonmasslike enhancement at breast MR imaging: the added value of mammography and US for lesion categorization. Radiology 261:69\u201379","DOI":"10.1148\/radiol.11110190"},{"key":"12474_CR34","doi-asserted-by":"publisher","first-page":"51","DOI":"10.1016\/j.ejrad.2019.02.033","volume":"114","author":"M Dietzel","year":"2019","unstructured":"Dietzel M, Wenkel E, Hammon M et al (2019) Does higher field strength translate into better diagnostic accuracy? A prospective comparison of breast MRI at 3 and 1.5 Tesla. Eur J Radiol 114:51\u201356. https:\/\/doi.org\/10.1016\/j.ejrad.2019.02.033","journal-title":"Eur J Radiol"},{"key":"12474_CR35","doi-asserted-by":"publisher","first-page":"277","DOI":"10.1016\/j.mric.2007.06.002","volume":"15","author":"BJ Soher","year":"2007","unstructured":"Soher BJ, Dale BM, Merkle EM (2007) A review of MR physics: 3T versus 1.5T. Magn Reson Imaging Clin North Am 15:277\u2013290. https:\/\/doi.org\/10.1016\/j.mric.2007.06.002","journal-title":"Magn Reson Imaging Clin North Am"}],"container-title":["European Radiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00330-026-12474-y.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00330-026-12474-y","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00330-026-12474-y.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T13:30:11Z","timestamp":1783431011000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00330-026-12474-y"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,4]]},"references-count":35,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2026,8]]}},"alternative-id":["12474"],"URL":"https:\/\/doi.org\/10.1007\/s00330-026-12474-y","relation":{},"ISSN":["1432-1084"],"issn-type":[{"value":"1432-1084","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,4]]},"assertion":[{"value":"12 June 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"10 February 2026","order":2,"name":"revised","label":"Revised","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"1 March 2026","order":3,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"4 April 2026","order":4,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Compliance with ethical standards"}},{"value":"The scientific guarantor of this publication is Pascal A.T. Baltzer.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Guarantor"}},{"value":"Non-competitive grant from Bracco Imaging.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"One of the authors has significant statistical expertise.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Statistics and biometry"}},{"value":"Written informed consent was obtained from all subjects (patients) in this study.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Informed consent"}},{"value":"Institutional Review Board approval was obtained.","order":6,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"Not applicable.","order":7,"name":"Ethics","group":{"name":"EthicsHeading","label":"Study subjects or cohorts overlap"}},{"order":8,"name":"Ethics","group":{"name":"EthicsHeading","label":"Methodology"}}]}}