{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,4]],"date-time":"2026-03-04T07:58:32Z","timestamp":1772611112218,"version":"3.50.1"},"reference-count":32,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2026,3,2]],"date-time":"2026-03-02T00:00:00Z","timestamp":1772409600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100017268","name":"Berlin Institute of Health","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100017268","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100017268","name":"Berlin Institute of Health","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100017268","id-type":"DOI","asserted-by":"crossref"}]},{"name":"Ministry of Education and Research","award":["01KX2021 (RACOON)"],"award-info":[{"award-number":["01KX2021 (RACOON)"]}]},{"name":"Ministry of Education and Research","award":["01KX2121 (\u201cNUM 2.0\u201d, RACOON)"],"award-info":[{"award-number":["01KX2121 (\u201cNUM 2.0\u201d, RACOON)"]}]},{"name":"Ministry of Education and Research","award":["68GX21001A"],"award-info":[{"award-number":["68GX21001A"]}]},{"name":"Ministry of Education and Research","award":["01ZZ2315D"],"award-info":[{"award-number":["01ZZ2315D"]}]},{"name":"Ministry of Education and Research","award":["01KX2021 (NUM 3.0)"],"award-info":[{"award-number":["01KX2021 (NUM 3.0)"]}]},{"DOI":"10.13039\/501100001659","name":"German Research Foundation","doi-asserted-by":"crossref","award":["SFB 1340\/2"],"award-info":[{"award-number":["SFB 1340\/2"]}],"id":[{"id":"10.13039\/501100001659","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100000780","name":"European Union","doi-asserted-by":"crossref","award":["952172"],"award-info":[{"award-number":["952172"]}],"id":[{"id":"10.13039\/501100000780","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100000780","name":"European Union","doi-asserted-by":"crossref","award":["101100633"],"award-info":[{"award-number":["101100633"]}],"id":[{"id":"10.13039\/501100000780","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100017268","name":"Berlin Institute of Health","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100017268","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100011699","name":"Siemens Healthineers","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100011699","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100001659","name":"Deutsche Forschungsgemeinschaft","doi-asserted-by":"crossref","award":["372486779\u2014SFB 1340"],"award-info":[{"award-number":["372486779\u2014SFB 1340"]}],"id":[{"id":"10.13039\/501100001659","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100001659","name":"Deutsche Forschungsgemeinschaft","doi-asserted-by":"crossref","award":["428216905"],"award-info":[{"award-number":["428216905"]}],"id":[{"id":"10.13039\/501100001659","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100002839","name":"Charit\u00e9\u2014Universit\u00e4tsmedizin Berlin","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100002839","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Current Oncology"],"abstract":"<jats:p>Background: The use of [68Ga]Ga-PSMA-PET\/CT for prostate cancer (PCa) staging is limited by cost and availability. This study evaluates whether radiomic features from contrast-enhanced (CE) CT can predict PSMA-positive lymph nodes (LNs) as a surrogate for metastasis. Methods: A retrospective study of 447 patients included 2537 segmented LNs (425 PET-positive, 2112 PET-negative). Two uroradiologists assessed 417 LNs on CE-CT using a four-point Likert scale. Radiomic features were extracted, selected using four algorithms, and analyzed with six model-building methods. Model performance was compared to radiologist ratings. Results: Radiomic models achieved an accuracy of 0.77\u20130.85, sensitivity of 0.85\u20130.91, and specificity of 0.74\u20130.85. Compared to radiologists, models had higher NPV (0.97\u20130.98 vs. 0.96) and sensitivity (0.85\u20130.91 vs. 0.76), but radiologists had superior accuracy (0.95 vs. 0.77\u20130.85) and specificity (0.97\u20130.98 vs. 0.74\u20130.85). In a subanalysis of LNs rated as probably benign or malignant, expert radiologists outperformed the algorithm with greater specificity and PPV (p &lt; 0.005). A density threshold of &gt;27 HU predicted PSMA-positive LNs with 0.79 accuracy, 0.87 sensitivity, and 0.78 specificity. Conclusions: While radiomics did not outperform expert radiologists, the single first-order parameter CT density &gt;27 HU was predictive of PSMA-positive LNs. Clinical Relevance Statement: Radiomic models did not outperform expert uroradiologists. However, in high-volume or resource-limited settings lacking access to [68Ga]Ga-PSMA-PET\/CT, they may help improve LN assessment in PCa patients with CT alone.<\/jats:p>","DOI":"10.3390\/curroncol33030146","type":"journal-article","created":{"date-parts":[[2026,3,2]],"date-time":"2026-03-02T12:39:56Z","timestamp":1772455196000},"page":"146","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["CT Radiomics Models Did Not Outperform Experts in Predicting [68Ga]Ga-PSMA-PET Positivity in Prostate Cancer Lymph Node Staging"],"prefix":"10.3390","volume":"33","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2003-8351","authenticated-orcid":false,"given":"Thula Cannon","family":"Walter-Rittel","sequence":"first","affiliation":[{"name":"Department of Radiology, Charit\u00e9 Universit\u00e4tsmedizin Berlin, Corporate Member of Freie Universit\u00e4t Berlin and Humboldt Universit\u00e4t zu Berlin, Augustenburger Platz 1, 13353 Berlin, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Boris","family":"Gorodetski","sequence":"additional","affiliation":[{"name":"Department of Radiology, Charit\u00e9 Universit\u00e4tsmedizin Berlin, Corporate Member of Freie Universit\u00e4t Berlin and Humboldt Universit\u00e4t zu Berlin, Augustenburger Platz 1, 13353 Berlin, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexander","family":"Hartenstein","sequence":"additional","affiliation":[{"name":"Bayer AG, Kaiser-Wilhelm-Allee 1, 51373 Leverkusen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0817-6532","authenticated-orcid":false,"given":"Julian","family":"Rogasch","sequence":"additional","affiliation":[{"name":"Department of Nuclear Medicine, Charit\u00e9 Universit\u00e4tsmedizin Berlin, Corporate Member of Freie Universit\u00e4t Berlin and Humboldt Universit\u00e4t zu Berlin, Augustenburger Platz 1, 13353 Berlin, Germany"},{"name":"Berlin Institute of Health, Charit\u00e9 Platz 1, 10117 Berlin, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Imke","family":"Schatka","sequence":"additional","affiliation":[{"name":"Department of Nuclear Medicine, Charit\u00e9 Universit\u00e4tsmedizin Berlin, Corporate Member of Freie Universit\u00e4t Berlin and Humboldt Universit\u00e4t zu Berlin, Augustenburger Platz 1, 13353 Berlin, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4414-0657","authenticated-orcid":false,"given":"Holger","family":"Amthauer","sequence":"additional","affiliation":[{"name":"Department of Nuclear Medicine, Charit\u00e9 Universit\u00e4tsmedizin Berlin, Corporate Member of Freie Universit\u00e4t Berlin and Humboldt Universit\u00e4t zu Berlin, Augustenburger Platz 1, 13353 Berlin, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marcus","family":"Makowski","sequence":"additional","affiliation":[{"name":"Department of Radiology, Klinikum Rechts Der Isar, Technical University Munich, Ismaninger Str. 22, 81675 Munich, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4104-4758","authenticated-orcid":false,"given":"Charlie Alexander","family":"Hamm","sequence":"additional","affiliation":[{"name":"Department of Radiology, Charit\u00e9 Universit\u00e4tsmedizin Berlin, Corporate Member of Freie Universit\u00e4t Berlin and Humboldt Universit\u00e4t zu Berlin, Augustenburger Platz 1, 13353 Berlin, Germany"},{"name":"Berlin Institute of Health, Charit\u00e9 Platz 1, 10117 Berlin, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9591-8575","authenticated-orcid":false,"given":"Tobias","family":"Penzkofer","sequence":"additional","affiliation":[{"name":"Department of Radiology, Charit\u00e9 Universit\u00e4tsmedizin Berlin, Corporate Member of Freie Universit\u00e4t Berlin and Humboldt Universit\u00e4t zu Berlin, Augustenburger Platz 1, 13353 Berlin, Germany"},{"name":"Berlin Institute of Health, Charit\u00e9 Platz 1, 10117 Berlin, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,3,2]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1374","DOI":"10.1016\/j.ejca.2012.12.027","article-title":"Cancer incidence and mortality patterns in Europe: Estimates for 40 countries in 2012","volume":"49","author":"Ferlay","year":"2013","journal-title":"Eur. 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