Objectives: to assess the ability of high-performing open-weight large language models (LLMs) in extracting key radiological features from prostate MRI reports. Methods: Five LLMs (Llama3.3, DeepSeek-R1-Llama3.3, Phi4, Gemma-2, and Qwen2.5-14B) were used to analyze free-text MRI reports retrieved from clinical practice. Each LLM processed reports three times using specialized prompts to extract (1) dimensions, (2) volume and PSA density, and (3) lesion characteristics. An experienced radiologist manually annotated the dataset, defining entities (Exam) and sub-entities (Lesion, Dimension). Feature- and physician-level performance were then assessed. Results: 250 MRI exams reported by 7 radiologists were analyzed by the LLMs. Feature-level performances showed that DeepSeek-R1-Llama3.3 exhibited the highest average score (98.6% ± 2.1%), followed by Phi4 (98.1% ± 2.2%), Llama3.3 (98.0% ± 3.0%), Qwen2.5 (97.5% ± 3.9%), and Gemma2 (96.0% ± 3.4%). All models excelled in extracting PSA density (100%) and volume (≥98.4%), while lesions’ extraction showed greater variability (88.4–94.0%). LLMs’ performance varied among radiologists: Physician B’s reports yielded the highest mean score (99.9% ± 0.2%), while Physician C’s resulted in the lowest (94.4% ± 2.3%). Conclusions: LLMs showed promising results in automated feature-extraction from radiology reports, with DeepSeek-R1-Llama3.3 achieving the highest overall score. These models can improve clinical workflows by structuring unstructured medical text. However, a preliminary analysis of reporting styles is necessary to identify potential challenges and optimize prompt design to better align with individual physician reporting styles. This approach can further enhance the robustness and adaptability of LLM-driven clinical data extraction.

Prostate cancer (PCa) is one of the most common tumors diagnosed in men worldwide, with approximately 1.7 million new cases expected by 2030. Most cancerous lesions in PCa are located in the peripheral zone (PZ); therefore, accurate identification of the location of the lesion is essential for effective diagnosis and treatment. Zonal segmentation in magnetic resonance imaging (MRI) scans is critical and plays a key role in pinpointing cancerous regions and treatment strategies. In this work, we report on the development of three advanced neural network-based models: one based on ensemble learning, one on Meta-Net, and one on YOLO-V8. They were tailored for the segmentation of the central gland (CG) and PZ using a small dataset of 90 MRI scans for training, 25 MRIs for validation, and 24 scans for testing. The ensemble learning method, combining U-Net-based models (Attention-Res-U-Net, Vanilla-Net, and V-Net), achieved an IoU of 79.3% and DSC of 88.4% for CG and an IoU of 54.5% and DSC of 70.5% for PZ on the test set. Meta-Net, used for the first time in segmentation, demonstrated an IoU of 78% and DSC of 88% for CG, while YOLO-V8 outperformed both models with an IoU of 80% and DSC of 89% for CG and an IoU of 58% and DSC of 73% for PZ.

Photon-counting computed tomography (PCCT) represents a detector-level transformation in CT imaging. Unlike conventional energy-integrating detectors, photon-counting detectors directly convert individual X-ray interactions into electrical pulses and classify them according to energy. This architecture enables electronic-noise rejection, smaller detector pixels, improved geometric dose efficiency, and intrinsic spectral acquisition. However, the images available to radiologists are not produced directly by the detector; energy-resolved photon counts must first undergo calibration, correction, projection formation, reconstruction, and material decomposition. This narrative review provides an educational framework linking X-ray attenuation physics, detector materials and architectures, energy thresholds, and detector nonidealities to the resulting PCCT images. It describes conventional polyenergetic and ultra-high-resolution images, virtual monoenergetic imaging, iodine maps, virtual non-contrast imaging, calcium and bone subtraction, virtual non-calcium imaging, effective atomic number maps, electron-density maps, and emerging K-edge techniques. Particular emphasis is placed on the clinical purpose and limitations of each reconstruction, including noise, artifacts, partial-volume effects, misregistration, incomplete subtraction, calibration dependence, and limited cross-platform comparability. Practical considerations for protocol design, image selection, interpretation workflow, and spectral-data archiving are also discussed. Understanding the pathway from photon detection to image formation is essential for selecting the appropriate reconstruction, avoiding misinterpretation, and integrating PCCT effectively into clinical radiology.