Osteoid osteoma is a common benign bone tumor that typically involves the diaphysis of long bones, though it can also occur in epiphyseal or intracapsular locations, which can make diagnosis difficult. Imaging relies on identifying a nidus, of variable appearance, associated with reactive sclerosis and bone marrow or soft-tissue edema. While radiographs are often the first step, they lack sensitivity. Computed tomography, and especially ultra-high-resolution computed tomography, is essential for nidus detection, and magnetic resonance imaging, particularly dynamic contrast-enhanced images, provides complementary diagnostic value. Treatment emphasizes the effectiveness of minimally invasive techniques, which are safe, cost-effective, and associated with minimal functional impairment. Unlike most review articles that focus on specific aspects of diagnostic imaging or interventional radiology techniques, this article provides a comprehensive overview of osteoid osteoma, covering both conventional imaging findings and current advances in imaging and interventional radiology.
To investigate the etiology of chronic sialadenitis, and to analyze their clinical and imaging characteristics. This retrospective analysis reviewed the clinical and imaging data of patients with chronic sialadenitis who underwent sialendoscopy at the Peking University Hospital of Stomatology between January 2021 and August 2023. (1) with a history of recurrent swelling of major salivary glands; (2) complete medical records with detailed information about potential causes; (3) sialography images were available; and (4) patients had undergone interventional endoscopy. (1) salivary stones; (2) juvenile recurrent parotitis; (3) IgG4-related sialadenitis; (4) Sjögren syndrome; and (5) neoplastic diseases. Based on the latest research results and clinical data, chronic sialadenitis was classified into radioactive iodine-induced sialadenitis (RAIS), allergy-related sialodochitis (ARS), adult chronic recurrent parotitis (ACRP), sialadenosis with sialodochitis, and idiopathic sialadenitis. Idiopathic sialadenitis was defined as a type of chronic sialadenitis with duct stenosis of unknown etiology (allergic causes, autoimmune disorders, radioactive iodine exposure, history of "parotitis" in childhood, etc.). The proportions of five types of sialadenitis were calculated, and their relationships with age, gender, type of affected glands, number of affected glands, duration of symptoms, and imaging characteristics were statistically analyzed. A total of 544 consecutive patients diagnosed with chronic sialadenitis were enrolled in this study. They consisted of 192 males and 352 females, and their ages ranged from 14 to 83 years [mean age: (47.44±13.52) years]. Idiopathic sialadenitis accounted for the largest proportion (71.7%, 390 cases), followed by ARS (12.5%, 68 cases), RAIS (6.4%, 35 cases), ACRP (4.8%, 26 cases), and sialadenosis with sialodochitis (4.6%, 25 cases). Among the 2 176 available glands of the 544 patients, 1 120 (51.5%) glands were affected, including 880 (78.6%) parotid glands and 240 (21.4%) submandibular glands. These five types of sialadenitis exhibited significant differences in gender, age, type and number of affected glands, and duration of symptoms (P < 0.05). Among them, RAIS patients showed the lowest male to female ratio (male ∶ female=1 ∶ 4.83), ARCP patients were the youngest [(32.50±8.60) years], and RAIS and ARS patients had relatively higher number of affected glands. Sialography showed ductal atresia in 23.2% of affected glands with ARIS, "snowflake" pattern in 46.5% of affected glands with ARS, "punctate and globular" ectasia of terminal ducts in 80.4% of affected glands with ARCP, and clustered branch ducts in 71.4% of affected glands with sialadenosis with sialodochitis. Moreover, stenosis and/or dilatation of the main and branch ducts represented the most typical sialography appearance of idiopathic sialadenitis. Idiopathic sialadenitis, RAIS, ARS, ACRP, and sialadenosis with sialodochitis are the five common types of chronic sialadenitis. Among these, idiopathic sialadenitis is the most common type of chronic sialadenitis. Clarification of the etiology, clinical manifestations and imaging characteristics of chronic sialadenitis is important for clinicians to develop personalized treatment plans and improve treatment outcomes. 探索临床上常见的几类不同病因导致的慢性唾液腺炎的占比，并分析其临床和影像学特点。 回顾性分析2021年1月至2023年8月就诊于北京大学口腔医院并行唾液腺内镜治疗的各类慢性唾液腺炎患者的临床及影像资料，除外干燥综合征伴感染、IgG4相关唾液腺炎、结石病伴感染等，根据现有研究结果和资料，初步将唾液腺炎分为131I相关唾液腺炎、过敏相关唾液腺炎、成人复发性腮腺炎、腮腺良性肥大伴管炎、原发性导管狭窄性唾液腺炎(指未发现目前已知的可能病因，并存在导管狭窄的慢性唾液腺炎)，统计分析各类慢性唾液腺炎的占比和主要临床、影像学特点。 共纳入544例患者，男性192例、女性352例，平均年龄(47.44±13.52)岁(14~83岁)。其中，原发性导管狭窄性唾液腺炎最多，占71.7%(390例)；过敏相关唾液腺炎次之，占12.5%(68例)；131I相关唾液腺炎占6.4%(35例)，成人复发性腮腺炎占4.8%(26例)，腮腺良性肥大伴管炎占4.6%(25例)。544例患者共1 120侧腺体受累，包括腮腺880侧(78.6%)及下颌下腺240侧(21.4%)。这五类唾液腺炎在性别、年龄、受累腺体类别、受累腺体数目及病程上差异均存在统计学意义(P < 0.05)，131I相关唾液腺炎患者的女性占比最高(男∶女=1 ∶ 4.83)，成人复发性腮腺炎患者的平均年龄最小[(32.50±8.60)岁]，131I相关唾液腺炎和过敏相关唾液腺炎的受累腺体数目相对较多。从造影表现看，131I相关唾液腺炎中23.2%的受累腺体发生导管闭锁，过敏相关唾液腺炎中46.5%的受累腺体分支导管呈“雪花样”扩张表现，成人复发性腮腺炎中80.4%的受累腺体可见末梢导管“点球状扩张”，腮腺良性肥大伴管炎的受累腺体分支导管呈丛簇状表现者占71.4%，原发性导管狭窄性唾液腺炎的造影表现以主导管(主导管和分支导管)狭窄和(或)扩张为主。 原发性导管狭窄性唾液腺炎、131I相关唾液腺炎、过敏相关唾液腺炎、成人复发性腮腺炎、腮腺良性肥大伴管炎是临床上常见的五类慢性唾液腺炎，其中原发性导管狭窄性唾液腺炎占比最大。明确各类慢性唾液腺炎的病因、临床及影像学特征，将有利于临床医师制定个性化治疗方案，改善治疗效果。
Low-field MRI has recently gained interest due to its potential for increased accessibility, reduced cost, and improved safety. However, high-quality anatomical imaging and robust tissue characterization remains an active area of research, particularly when aiming for a simple, one-click scan that captures all relevant information in a single acquisition. Bright-blood imaging is widely used for visualizing cardiac structures and coronary arteries, whereas black-blood is optimal for delineating the myocardium, atrial and vessel walls. High-resolution imaging is required for the accurate detection and segmentation of small anatomical structures, such as the coronary arteries, to enable assessment of narrowing or blockages. Co-registered T 1 / T 2 $$ {T}_1/{T}_2 $$ mapping enables quantitative myocardial tissue characterization, offering valuable clinical information for the detection of myocardial abnormalities. In this study, we sought to develop a novel free-breathing, motion-compensated 3D multi-contrast high-resolution cardiac MR sequence for simultaneous assessment of whole-heart cardiovascular anatomy via bright- and black-blood imaging and myocardial tissue quantification by joint T 1 $$ {T}_1 $$ and T 2 $$ {T}_2 $$ mapping at 0.55 T in a single scan. Data were acquired over six interleaved contrasts with various preparation modules using a variable flip angle bSSFP spiral-like readout with 2D image-based navigation for translational motion correction, resulting in a predictable acquisition time of ≈ 12 $$ \approx 12 $$ min. Images were reconstructed using non-rigid motion corrected iterative sensitivity encoding followed by high-dimensional patch-based low-rank denoising, resulting in the acquisition, reconstruction and quantitative mapping time of ≈ 31 $$ \approx 31 $$ min. In the phantom study, sequence performance was evaluated using correlation and Bland-Altman analysis against reference gold-standard and clinical mapping methods. In vivo, 3D bright- and black-blood volumes were assessed in multiple views, and vessel sharpness was quantified from multiplanar images. For joint T 1 / T 2 $$ {T}_1/{T}_2 $$ mapping, bull's-eye plots were generated to evaluate the mean, standard deviation, and coefficient of variation for apical, mid-cavity, and basal segments, and results were summarized using violin plots. Differences between the proposed 3D sequence and established 2D methods were analyzed with a two-tailed t $$ t $$ -test. In the phantom study, a small positive bias in T 1 $$ {T}_1 $$ of 6 . 3 ms $$ 6.3\kern0.3em \mathrm{ms} $$ was observed compared with inversion recovery spin-echo and 23 . 5 ms $$ 23.5\kern0.3em \mathrm{ms} $$ with MOLLI, while for T 2 $$ {T}_2 $$ biases of 7 . 3 ms $$ 7.3\kern0.3em \mathrm{ms} $$ compared with spin-echo and 0 . 8 ms $$ 0.8\kern0.3em \mathrm{ms} $$ with T 2 $$ {T}_2 $$ prep bSSFP were found. In vivo, statistically similar T 1 $$ {T}_1 $$ values of ( 648 ± 26 ) ms $$ \left(648\pm 26\right)\kern0.3em \mathrm{ms} $$ and T 2 $$ {T}_2 $$ values of ( 56 . 9 ± 3 . 2 ) ms $$ \left(56.9\pm 3.2\right)\kern0.3em \mathrm{ms} $$ were obtained, with differences versus MOLLI of - 3 ms ± 15 ms $$ -3\kern0.3em \mathrm{ms}\pm 15\kern0.3em \mathrm{ms} $$ ( p = 0 . 75 $$ p=0.75 $$ ) and versus T 2 $$ {T}_2 $$ prep bSSFP of - 0 . 5 ms ± 2 . 1 ms $$ -0.5\kern0.3em \mathrm{ms}\pm 2.1\kern0.3em \mathrm{ms} $$ ( p = 0 . 63 $$ p=0.63 $$ ). The proposed sequence demonstrated high image quality and accurate mapping despite the inherent limitations of low-field strength, suggesting its feasibility for comprehensive cardiac assessment in resource-limited environments.
Artificial intelligence (AI) is transforming medical imaging and radiation oncology, yet limited understanding and access to education hinder adoption. This study, led by the European Society of Medical Imaging Informatics (EuSoMII) in collaboration with the European Federation of Radiographer Societies (EFRS), aimed to create an accessible, centralised, searchable database including all AI courses in Europe. An electronic survey was developed to collect data on European AI course characteristics, such as format, delivery, content, target audience and European Qualifications Framework (EQF) level. This was disseminated via purposive sampling through social media and mailing lists of the EuSoMII and the EFRS between September 2024 and January 2025. Quantitative data were analysed using descriptive statistics and visual representations using Python Seaborn and Geopandas. This study identified 29 AI courses in Europe. Of them, 53.6% were offered by universities. Courses targeted radiographers (59%), medical physicists (52%), and radiologists (41%), mainly at EQF level 7 (44.4%). Most courses were standalone (65.6%) and online (55.1%), while 41.3% were free of charge. English was the primary language of delivery (79%). Different AI courses across Europe offer some entry-level knowledge but are often short in duration. Expanding formats, building practical competencies, providing multilingual access, and European-wide reach are essential for meaningful, practical, and equitable AI integration. With the scaling-up of AI adoption in medical imaging and radiation oncology, there is a variety of AI education provisions currently available. Accessing these options via an open, centralised, regularly updated database enables people to make an informed decision about their training and practise safely and meaningfully. We identified 29 different AI European courses varying in language, content, and delivery. Many clinical practitioners and researchers are unaware of these resources. We need a centralised database for customising AI learning choices and guiding future course design.
The purpose of this study was to develop a machine learning-based algorithm based on a combination of magnetic resonance imaging (MRI) and color-Doppler ultrasound (CDUS) to characterize lacrimal gland lesions. All patients with a lacrimal gland lesion who underwent MRI examination and CDUS between 2014 and 2025 were retrospectively included. Thirty-four imaging features were systematically assessed. A machine learning algorithm was trained with repeated nested cross-validation (RNCV) using random forest classifiers. Shapley additive explanations values were used to assess feature contributions. Simplified models using top 5 and top 10 best features were also developed. Diagnostic performance of the models was assessed using area under the receiver operating characteristic curve (AUC), area under the precision-recall curve (PR AUC), balanced accuracy, precision, sensitivity, specificity, Brier score, Matthew's correlation coefficient and F1-score. One hundred patients (mean age, 49.6 years ± 17.8 [standard deviation] years) with 130 lesions (101 non-epithelial (NEL) and 29 epithelial (EL); 45 malignant) were included. The random forest binary machine learning model yielded 75.9% sensitivity (95% confidence interval [CI]: 39-100), 86.0% specificity (95% CI: 62.4-100), and an AUC of 0.883 (95% CI: 0.692-1.0) for differentiating between malignant and benign lesions and 73.2% sensitivity (95% CI: 33.5-100), 92.9% specificity (95% CI: 69.9-100), and an AUC of 0.93 (95% CI: 0.683-1) for differentiating between EL and NEL. In multiclass analysis (benign NEL, benign EL, malignant NEL and malignant EL), the random forest yielded a macro-averaged AUC of 0.857 (95% CI: 0.722-0.972) for the all-features model. A 5-top features signature comprising apparent diffusion coefficient and resistance index values, echogenicity, age and lesion type (infiltrative vs. well-delineated mass), yielded an AUC of 0.785 (95% CI: 0.641-0.941) to distinguish between the four classes. A combination of MRI and CDUS features demonstrated high diagnostic performance for characterizing lacrimal gland lesions. A simplified 5-feature signature showed similar diagnostic performance compared to the all-features model and warrants prospective multicenter validation for clinical application.
To establish national diagnostic reference levels (DRLs) for interventional neuroradiology (INR) procedures in Portugal. A multicentre retrospective study was performed in six reference centres, including the six most common INR procedures: cerebral thrombectomy, cerebral arteriography, cerebral aneurysm embolisation, arteriovenous malformation (AVM) and arteriovenous fistula (AVF) embolisation, cerebral vasospasm treatment, and carotid artery stenting. Additionally, retinoblastoma embolisation, performed in a single Portuguese centre, was included. DRLs were defined as the 75th percentile (P75) of air kerma-area product (PKA, Gy·cm2), air kerma at the patient entrance reference point (Ka,r, mGy), and fluoroscopy time (FT, min). Dose variability and trigger value exceedances were analysed according to procedural complexity and pathology. Data of 1409 cases were analysed. The national DRLs in terms of PKA were: 109 Gy.cm2 cerebral thrombectomy, 72 Gy.cm2 for cerebral arteriography, 180 Gy.cm2 cerebral aneurysm embolisation, 366 Gy.cm2 AVM/AVF embolisation, 87 Gy.cm2 cerebral vasospasm, and 74  Gy.cm2 for carotid stenting. The corresponding Ka,r values were 746 mGy, 488 mGy, 2652 mGy, 4282,9 mGy, 511,0 mGy, and 520,3 mGy, and FT values were 16, 9, 39, 62, 9, 22  min, respectively. Procedural complexity factors assessed: thrombectomy attempts, aneurysm location, device selection, catheterised vessels. Retinoblastoma embolisation, demonstrated PKA 9,5 Gy.cm2, Ka,r 75,7 mGy, and FT 7,1 min. This first Portuguese INR DRL study provides a national benchmark for the most common cerebral and neck procedures. AVM/AVF embolisation showed the highest percentage of trigger value exceedances. These results will support protocol optimisation and harmonisation of radiation protection practice across centres.
Transcatheter aortic valve replacement (TAVR) is an established alternative to surgical aortic valve replacement for symptomatic severe aortic stenosis, but long-term, comparative clinical outcomes and echocardiography data are lacking. Our goal was to compare 10-year clinical and echocardiographic outcomes after balloon-expandable TAVR or surgery in intermediate-risk surgical patients in the PARTNER 2A randomized trial. Between 2011 and 2013, patients with severe, symptomatic aortic stenosis at intermediate surgical risk were randomized at 57 centers to TAVR with the balloon-expandable SAPIEN XT system (Edwards Lifesciences) or to surgery. Randomization was stratified by anatomical suitability for transfemoral (TF) or transthoracic (transapical/transaortic [TA/TAo]) access. Ten-year outcomes were evaluated in the valve implant population and included all-cause mortality, aortic valve reintervention, and core laboratory-adjudicated echocardiographic outcomes. To obtain 10-year data, patient reconsent at 5 years was required, and vital status sweeps were implemented to improve data completeness for all-cause mortality. Among 1,910 randomized patients who received a valve, 974 underwent TAVR (TF: 749/974 [76.9%]) and 936 had surgery. Mean patient age was 81.6 years, 45.4% were women, and the mean Society of Thoracic Surgeons score was 5.8%. At 10 years, vital status was available for 881 of 974 patients (90.5%) and 838 of 936 patients (89.5%). All-cause 10-year mortality with vital status sweeps was 86.1% after TAVR and 82.8% after surgery (HR: 1.13; 95% CI: 1.02-1.25; P = 0.02). When stratified by access route, rates of all-cause mortality for TAVR and surgery in the TF group were similar (83.9% vs 82.1%, respectively; P = 0.27), whereas mortality was higher for TAVR in the TA/TAo group (93.2% vs 85.1%; P < 0.01; P for interaction = 0.03). Cumulative incidence rates of aortic valve reintervention at 10 years were 6.3% for TAVR and 1.6% for surgery (P < 0.001). Of the 24 TAVR and 35 surgical patients with available echocardiographic data at 10 years, mean gradients were 12.6 mm Hg and 12.7 mm Hg, respectively. At the 10-year follow-up, TAVR in intermediate-risk patients with the SAPIEN XT prosthesis compared with surgery was associated with lower survival rates, with differences predominantly observed in the TA/TAo access cohort. TAVR with the XT valve was also associated with significantly higher rates of aortic valve reintervention. (PARTNER II Trial: Placement of AoRTic TraNscathetER Valves II - XT Intermediate and High Risk [PII A]; NCT01314313).
Carotid atherosclerotic disease represents one of the leading causes of ischemic stroke. It should be considered as a pathological continuum that includes increased intima-media thickness, development of atherosclerotic plaque and progression to clinically significant carotid stenosis. Non-invasive imaging techniques currently allow accurate characterization of carotid plaque in terms of composition, echogenicity, echostructure, presence of intraplaque hemorrhage, ulceration and vascular remodeling, all factors closely associated with plaque instability and the risk of ischemic events. At the same time, advances in medical therapy and revascularization techniques have improved clinical outcomes but have also increased the complexity of therapeutic decision-making in individual patients, requiring the integration of clinical, anatomical, hemodynamic and imaging data. Despite the availability of international guidelines, areas of uncertainty and significant heterogeneity remain in clinical practice, terminology, risk stratification criteria and indications for revascularization, particularly in asymptomatic patients or those with intermediate-grade stenosis. The aim of the present SICOA-GISE consensus document is to harmonize terminology between the different disciplines involved (cardiology, neurology, radiology and vascular surgery), promote a multidisciplinary approach and provide practical guidance on the appropriate use of imaging techniques, identification of high-risk carotid plaque and integration of medical and interventional therapy.
Pulmonary embolism response teams (PERTs) are multidisciplinary care teams that perform rapid assessment and recommendations for patients with pulmonary embolism (PE). Challenges in creating and maintaining a PERT include physician buy-in and availability at all hours. One potential solution is to share PE interventions across specialty services. Patients with acute PE who received a PERT consultation and subsequent mechanical thrombectomy (MT) were included in this single-center, retrospective study. Patients from January 2021 to June 2024 were divided into two cohorts: one that received MT from interventional radiology (IR) and another that received MT from vascular surgery (VS). Outcomes included 30-day mortality, bleeding, 6-minute follow-up walk distance, time to intervention, total procedure time, and complication rates. A total of 76 patients were included in this analysis. IR and VS performed 61.8% (n = 47) and 38.2% (n = 29) of MTs, respectively. Of patients treated with MT, 46.1% (n = 35) had high-risk status and 53.9% (n = 41) had intermediate-high-risk status. In patients who received MT from IR, there was a 6.4% (three of 47) 30-day mortality rate compared to 6.9% (two of 29) from VS (p = 0.938). The occurrence of complications after MTs performed by IR and VS were 4.3% (two of 47) and 6.9% (two of 29), respectively (p = 0.792). Major procedure-related adverse events were 4.3% (two of 47) for IR and 6.9% (two of 29) for VS (p = 0.792). Outcomes of PE thrombectomy did not differ by whether the proceduralist was IR or VS. Intervention-sharing among different provider groups within PERTs could alleviate provider burden and make response team implementation more feasible.
Musculoskeletal (MSK) anatomy education is a critical foundation for developing competency among radiologists, physiatrists, rheumatologists, and orthopedic surgeons. However, current undergraduate medical curricula often exhibit significant deficiencies in instructional hours, integration of diverse teaching modalities, and clinical relevance. This narrative review synthesizes recent evidence (March 2021-March 2026) identified through a targeted search of Medline, Embase, and Scopus, with an emphasis on consensus guidelines, validation studies, and clinically focused publications related to MSK anatomy, imaging modalities (ultrasound, magnetic resonance imaging, computed tomography), and curriculum design for medical students in relevant specialties. Multimodal interventions, including cadaveric dissection, radiological anatomy, case-based rheumatologic and rehabilitation modules, and technology-enhanced platforms such as 3D virtual models and AI-driven adaptive learning, have been associated with improvements in knowledge retention, spatial reasoning, diagnostic accuracy, and procedural confidence compared with didactic instruction alone. Persistent knowledge gaps undermine interpretive proficiency in MSK imaging, including the identification of synovitis and enthesopathy, and are linked to reduced clinical preparedness. Objective assessments reveal suboptimal performance despite completion of conventional preclinical training. Cadaveric dissection fosters practical skills and ethical professionalism, while early integration of imaging connects theoretical morphology with three-dimensional relational understanding and pathological correlations in MSK and rheumatic diseases. Implementation frameworks recommend phased rollouts that incorporate stakeholder needs assessments, faculty development through train-the-trainer models, resource reallocation for point-of-care ultrasound and virtual reality, and strategies to address barriers, such as grants for low-resource settings and modularization to reduce curricular congestion. These evidence-based approaches support scalable reforms that produce MSK-literate clinicians prepared for precision diagnostics and interventional practice.
Differentiating adrenal adenomas from non-adenomatous lesions remains a critical challenge in the management of adrenal incidentalomas. Conventional unenhanced CT relies on attenuation thresholds of 10 HU and 20 HU, which present trade-offs between sensitivity and specificity. To evaluate the diagnostic performance of unenhanced Spectral CT using the attenuation difference between 40 keV and 140 keV virtual monoenergetic images for differentiating adrenal adenomas from non-adenomatous lesions. In this retrospective single-center study, 60 patients with adrenal lesions who underwent unenhanced dual-energy CT were included. Mean attenuation values were measured on conventional images and on virtual monoenergetic images at 40 keV and 140 keV. The spectral attenuation difference (Δ40-140 keV) was calculated. ROC analysis was performed to determine the optimal threshold and diagnostic performance. Additional analyses included DeLong comparison of correlated ROC curves and bootstrap resampling to estimate 95% confidence intervals for the area under the curve. Forty-nine lesions were adenomas and eleven were non-adenomatous. The optimal threshold for Δ40-140 keV was -17 HU. When evaluated as a continuous variable, Δ40-140 keV yielded an area under the curve of 0.940 (95% confidence interval: 0.851-1.000), compared with 0.939 (95% confidence interval: 0.870-0.992) for conventional unenhanced attenuation. DeLong comparison showed no statistically significant difference between the two curves (p = 0.980). Diagnostic performance was as follows: HU ≤ 10 (AUC 0.816, diagnostic accuracy 0.70), HU ≤ 20 (AUC 0.883, diagnostic accuracy 0.87), and Δ40-140 keV ≤ -17 HU (AUC 0.940, diagnostic accuracy 0.90). The spectral attenuation difference demonstrated the highest overall diagnostic accuracy. Unenhanced Spectral CT using Δ40-140 keV improves discrimination between adrenal adenomas and non-adenomatous lesions compared with conventional attenuation thresholds. This technique may reduce indeterminate findings and limit the need for additional imaging.
The unpaired visceral branches of the abdominal aorta (AA) are the coeliac artery (CA), superior mesenteric (SMA), and inferior mesenteric (IMA) arteries. In endovascular surgery and interventional radiology, it is crucial to understand the positions of these arteries and the distance between them and the aortic bifurcation (AB). This study aims to determine the vertebral positions of AA unpaired visceral branches, their distances from each other, and male-female differences in a large sample group using three-dimensional multi-detector computed tomography angiography (MDCTA) images. This study was performed in a retrospective manner using radio-anatomical planes and included 500 MDCTA images with an equal gender distribution. The most common CA, SMA, IMA, and AB vertebral positions were determined as T12-L1 disc, L1-middle, L3-middle, and L4-lower in females and males, respectively. The median values of CA-SMA, CA-IMA, CA-AB, SMA-IMA, SMA-AB, and IMA-AB distances were obtained as 1.55, 1.65, 8.62, 9.07, 12.09, 13.01, 7.04, 7.32; 10.47, 11.20; 3.48, 3.84 cm in females and males, respectively. The difference between females and males was statistically significant in each measurement (p < 0.05). Arteries were positioned closer to each other in females than in males. When radio navigators are unavailable, the positions of IMA and AB can be used by both genders to detect CA and SMA. We believe that this MDCTA-based study, conducted in a relatively large clinical imaging cohort, may provide descriptive anatomical reference data that could contribute to the understanding of vascular relationships in radiological and surgical contexts.
This study aimed to comparatively evaluate the morphological and morphometric characteristics of the right atrial appendage (RAA) and left atrial appendage (LAA) in the same individuals using multidetector computed tomography (CT) and to investigate age- and sex-related differences. Pulmonary multidetector CT angiography images of 300 patients (167 women, 133 men; mean age, 54.0 ± 15.9 years) without pathological findings were retrospectively evaluated to assess the morphological and morphometric characteristics of both atrial appendages. Detailed morphometric measurements, including appendage length, width, orifice dimensions, orifice area, and volume, were performed for the RAA and LAA in each individual. RAA and LAA measurements were compared, and age- and sex-based analyses were performed. Interobserver agreement was assessed using kappa statistics. The most common RAA morphologies were sailboat (triangular) (48.3%) and horsehead (quadrangular) (25%), whereas the most frequent LAA types were chicken wing (55.7%) and windsock (20%). All morphometric parameters, including length, width, orifice dimensions, orifice area, and volume, were significantly greater in the RAA than in the LAA (all p < 0.001). No significant sex-related differences were observed for any RAA or LAA measurements. Age-based analysis revealed no significant changes in RAA parameters; however, LAA width (p = 0.002), orifice length (p = 0.027), orifice area (p = 0.031), and volume (p = 0.036) increased significantly, particularly in individuals older than 65 years. Interobserver agreement was excellent for all measurements. The RAA has significantly larger morphometric dimensions than the LAA in the same individuals and does not appear to be affected by age or sex. In contrast, several LAA parameters show age-related increases. These distinct morphometric differences provide clinically relevant anatomical reference data and may have important implications for interventional planning and the assessment of atrial appendage-related pathologies.
Contrast-enhanced computed tomography (CE-CT) and dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) are commonly used for tissue characterization, with CE-CT typically preferred in human studies and DCE-MRI in murine models. This raises the question of comparability of intra-and cross-species study results, as techniques differ and signal intensities following contrast agent (CA) administration reflect a complex interplay of systemic physiology and local tissue characteristics. This pilot study compares in vivo mean values of regions of interest (ROIs) obtained from CE-µCT (NanoScan® SPECT/CT) and 7 T DCE-MRI (Agilent Discovery MR901 magnet with Bruker AVANCE III HD electronics) and evaluates ex vivo CA distribution using laser ablation-inductively coupled plasma-mass spectrometry (LA-ICP-MSI). A genetically engineered mouse model of pancreatic ductal adenocarcinoma (PDAC) served as the experimental system. Image-derived regional mean Hounsfield unit (HU) and area under the curve at 60 s (AUC₆₀) values were correlated with mean local iodine (iomeprol) and gadolinium (gadopentetate dimeglumine) concentrations. Semi-quantitative analysis of HU and AUC₆₀ enabled excellent distinction of histologically defined tumor regions with low versus high tumor cellularity (p < 0.0001 for both). A strong intermodal correlation was observed between regional HU and AUC₆₀ values (r = 0.91, 95% CI = 0.78-0.97), as well as between iodine and gadolinium ion concentrations (r = 0.86, 95% CI = 0.55-0.96). These findings demonstrate that CE‑µCT and DCE‑MRI show comparable trends as prognostic imaging biomarkers of tumor cellularity in murine PDAC, underscoring their complementary value for cross‑species translational imaging research.
Background Studies have demonstrated that large language models (LLMs) can perform differential diagnosis based on textual radiologic findings; however, it is unclear how variations in reader-generated inputs affect LLM performance and clinical utility. Purpose To evaluate how reader experience influences the diagnostic benefit of LLM assistance in brain MRI differential diagnosis. Materials and Methods In this retrospective multireader study, neuroradiologists (n = 4), radiology residents (n = 4), and neurology/neurosurgery residents (n = 4) provided textual radiologic findings and their top three differential diagnoses for brain MRI scans with confirmed diagnoses obtained between January 2009 and April 2024 from a single academic center. Confirmed diagnoses were established histopathologically or through consensus of at least two neuroradiologists. Three LLMs (GPT-4.1 [OpenAI], Gemini 2.5 Pro [Google DeepMind], and DeepSeek-R1 [Hangzhou DeepSeek Artificial Intelligence Basic Technology Research]) generated differential diagnoses based on reader-provided findings. Readers revised their diagnoses after reviewing the suggestions of GPT-4.1. A cumulative link mixed model was fitted to evaluate the association between reader experience and diagnostic benefit, with change in diagnostic result as an ordinal outcome, reader experience as a predictor, and random intercepts for rater and patient. Results Forty brain MRI scans (mean patient age, 50 years ± 18 [SD]; 23 female) were included. LLM-generated diagnoses achieved the highest top-three accuracy based on imaging findings from neuroradiologists (78.8%-83.8% across LLMs), followed by radiology residents (71.8%-77.6%) and neurology/neurosurgery residents (63.2%-67.1%). Mean absolute gains in top-three accuracy with LLM assistance diminished with increasing experience: +19.4% for neurology/neurosurgery residents (from 43.2% to 62.6%), +14.7% for radiology residents (from 59.6% to 74.4%), and +4.4% for neuroradiologists (from 83.1% to 87.5%). Models demonstrated a negative association between reader experience and diagnostic benefit from LLM assistance (β = -0.10; P = .005) and a positive association of reader experience with correctness (β = 0.11; P < .001) and completeness (β = 0.18; P = .002) of imaging findings. Conclusion With increasing reader experience, LLM accuracy with reader-generated input improved, whereas accuracy gains from LLM assistance diminished. © RSNA, 2026 Supplemental material is available for this article. See also the editorial by McMillan in this issue.
To systematically describe the observed safety and pain outcomes of genicular artery embolization (GAE) for symptomatic knee osteoarthritis (KOA), compare embolic agent classes, and critically appraise the methodological quality of available evidence, including sham-controlled randomized controlled trial (RCT) design. Adults with radiographic KOA who underwent transcatheter GAE and reported ≥ 1 patient-reported outcome measure were eligible. The primary outcome was VAS pain reduction at 12 months. Secondary outcomes included WOMAC and KOOS scores, technical success, and adverse events. Random-effects meta-analysis with REML estimation was used; prediction intervals were computed. Pre-specified subgroup analysis compared imipenem/cilastatin versus permanent microspheres. 22 studies (3 RCTs, 19 single-arm or comparative cohorts) comprising 633 patients and 719 knees were included. Pooled within-group VAS WMD at 12 months: -39.6 mm (95% CI, -47.1 to - 32.1; 95% prediction interval [PI], -58.4 to - 20.8; I2 = 76%; p < 0.001). IPM/CS and permanent microspheres produced equivalent observed outcomes (between-subgroup p = 0.73). Technical success: 98.7%. Pooled minor adverse event rate: 18.3%. RCT-pooled between-group SMD versus sham: -0.23 (95% CI, -0.71 to + 0.25; p = 0.34; I2 = 38%). GAE is consistently associated with large within-group pain reductions; however, these pre-post estimates are descriptive and do not establish procedure-specific causal efficacy. Three sham-controlled RCTs did not demonstrate significant between-group benefit, representing the highest-quality evidence currently available. Embolic agent class does not significantly influence pain-reduction outcomes; however, safety profiles are not equivalent-focal asymptomatic osteonecrosis was reported exclusively with permanent microspheres, warranting prospective imaging surveillance and explicit patient counseling. Adequately powered RCTs with pharmacologically inert controls, standardized technique protocols, and systematic safety imaging are required before definitive conclusions can be drawn.
BrainAge models hold promise as a clinical biomarker for developmental brain health, especially in childhood when there is the potential for early intervention. To distinguish between normative developmental variance and pathological divergence, BrainAge models should reflect the dynamic and diverse neurodevelopmental processes that occur in distinct developmental windows across childhood. We utilized multi-modal neuroimaging data from three pediatric cohorts covering ages 4 to 13 years (n = 1005, 2126 scans), split into Train and Test datasets. Twelve sex-stratified BrainAge models were built stratified by type and different combinations of neuroimaging features. Model types were "Full-Span" models covering the full age range, and "Phase-Specific" models split into early- and late-childhood. We first compared BrainAge estimates in the Test dataset amongst our candidate models, then benchmarked the best-performing model against published pre-trained models and DNA-based biological age measures. Our findings show that a BrainAge model that was phase-specific and consisted of both structural and functional features (cortical thickness, subcortical volumes, and functional network integration measures) showed good prediction of age and best distinguished between healthy and symptomatic subgroups. We present a proof-of-concept for developmental models supporting building BrainAge models of higher temporal resolution that align to different childhood developmental phases.
The diagnostic accuracy of dual-phase cone-beam computed tomography (DP-CBCT) via celiac arteriography during transarterial chemoembolization (TACE) was compared with preprocedural dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) for detecting and characterizing hepatocellular carcinoma (HCC). A total of 67 patients with HCC were enrolled who underwent TACE. Patients first underwent angiography after catheter placement in the celiac trunk, followed by DP-CBCT scanning. Finally, they received TACE, during which lipiodol was administered to mark the lesion. Lipiodol computed tomography (CT) was acquired one week after TACE and served as a reference for assessing the detection of intrahepatic lesions compared with preoperative DCE-MRI and DP-CBCT. Using lipiodol CT as a reference, 172 HCC tumors were detected, including 167 by DP-CBCT and 136 by DCE-MRI. DP-CBCT showed superior diagnostic performance compared with DCE-MRI, with a higher sensitivity (95.9% vs. 76.7%), specificity (60.0% vs. 20.0%), accuracy (94.9% vs. 75.1%), and comparable precision (98.8% vs. 97.1%), respectively. The average lesion diameter was 33.14 mm in the DP-CBCT portal venous phase and 31.10 mm in the DCE-MRI portal venous phase. Compared with lipiodol CT, DCE-MRI had a different Barcelona Clinic Liver Cancer stage in 20.9% of patients compared with only 1.5% for DP-CBCT. DP-CBCT administered during celiac arteriography contributes to the accurate diagnosis of HCC.
AKI is commonly seen among hospitalized patients, many of which the VIR is consulted to assess for a potential intervention. Rates are increased for critically ill patients and those with pre-existing CKD, advanced age, or significant comorbidities. Developing an AKI is associated with increased morbidity, mortality, and risk of progression to chronic kidney disease. Physiologically, renal function depends on the coordinated activity of nephrons, which regulate fluid balance, electrolyte homeostasis, and metabolic waste filtration. Disruption of renal perfusion, injury to the microscopic and macroscopic renal structures, or obstruction of urinary outflow can impair these processes and lead to AKI. Clinical evaluation includes a focused history and physical examination, laboratory testing, urine analysis, and imaging studies to determine the underlying cause and guide management. The VIR will frequently encounter patients at risk for or experiencing AKI. For informed discussion with patients and other providers, optimal procedural planning, and enhanced post-procedural care, understanding the distinction between contrast-associated AKI and contrast-induced AKI and possible preventative strategies is vital. Given the enormous negative clinical impact of AKI, the VIR plays an important role in its prevention, diagnosis, and management.
Cerebral palsy (CP) encompasses various movement disorders, most commonly spasticity, although other motor phenotypes such as dystonia may occur. Certain structural magnetic resonance imaging (MRI) findings, such as periventricular leukomalacia, are strongly correlated with spasticity. Due to their contributions in motor system modulation, thalamic structures and deep cerebellar nuclei (DCN) are appealing volumes of interest for investigating spasticity and CP-related motor pathway injuries. The goal of this study is to determine the validity of using scaled volumetric analysis of thalamic and deep cerebellar nuclei for distinguishing patients with spastic cerebral palsy. All MRI scans were processed with FreeSurfer's recon-any pipeline, which integrates the deep-learning tools SynthSeg and SynthSR to generate standardized 1 mm isotropic T1-weighted images and robust segmentations independent of input contrast or resolution. DCN volumes were obtained using the SUIT toolbox, which employs an atlas-based segmentation of the cerebellum. To account for individual differences in brain size, volumes were allometrically scaled relative to total brain volume (TBV). Age-matched healthy controls were used from the Calgary Preschool MRI Dataset to ensure that observed volumetric differences reflected pathology rather than typical developmental variation. Statistical analyses were performed using Welch t test to account for unequal variances and sample size, as well as Spearman rank correlation analyses to evaluate the monotonic relationship between DCN and Gross Motor Function Classification System (GMFCS) scores. Relative to TBV, all 14 thalamic nuclei were significantly smaller in the spastic CP group. Scaled DCN volumes revealed a heterogeneous and lateralized pattern. Overall, this cohort demonstrated reduced left dentate volume and relative enlargement of the left interposed and bilateral fastigial nuclei. This enlargement was confined to individuals with mild motor impairment, while more severe impairment was associated with progressively reduced volumes. Patients with spastic CP demonstrate widespread reductions in TBV-adjusted thalamic volumes and a lateralized pattern of DCN volume alterations, which may reflect compensatory or maladaptive plasticity following cerebellothalamic pathway injury. Allometrically scaled volumetric analysis of these subcortical structures may provide a reliable approach for characterizing CP-related movement disorders and identifying potential neuroanatomical targets for future surgical interventions, including deep brain stimulation.