Objectives: This study aimed to examine the association between MRI radiomics features of malignant breast masses and their histopathological, molecular characteristics, and response to neoadjuvant treatments. Materials and methods: A retrospective cohort of 70 breast cancer patients was analyzed. Texture analysis was performed on preoperative MRI scans, extracting features such as entropy, contrast, and homogeneity. These features were analyzed against histopathological and clinical targets (e.g., lymph node metastasis) and molecular profiles. Statistical analyses and machine learning algorithms, including logistic regression and support vector machines, were employed to evaluate the predictive power of MRI texture features for molecular subtypes and the association of radiomics markers with neoadjuvant treatments. Results: The findings revealed significant associations between MRI texture features and the histopathological and molecular characteristics of breast tumors. Certain texture parameters correlated with aggressive phenotypes and poor chemotherapy response. Despite the limited dataset, machine learning models performed well in classifying tumors and predicting outcomes, highlighting the potential of MRI texture analysis in clinical decision‑making. Conclusion: MRI texture analysis emerges as a non‑invasive tool for personalized breast cancer management. The significant associations between MRI texture features and critical tumor characteristics suggest that these features could serve as biomarkers for predicting tumor behavior and treatment efficacy. Further large‑scale research is needed to integrate MRI texture analysis into clinical practice and improve patient outcomes.
Purpose: To compare balloon-occluded retrograde transvenous obliteration (BRTO) using sodium tetradecyl sulfate and plug-assisted retrograde transvenous obliteration (PARTO), for treating symptomatic gastric varices. Materials and methods: A retrospective review of 51 consecutive patients (age: 63.7 ± 12.1 years; male: 72.6%) who underwent retrograde transvenous obliteration for gastric varices between June 2018 and July 2023 was conducted. Patients underwent BRTO (n = 26) or PARTO (n = 25) according to the preference of the attending interventional radiologist. The primary endpoint was complete obliteration. Secondary endpoints included technical and clinical success, post-embolization syndrome (PES), complications, and recurrent bleeding. Results: Technical success was achieved in 100% of BRTO group and 96% of PARTO group. Clinical success was achieved in all patients with technical success. One major complication in the PARTO group was due to shunt rupture during sheath passage, requiring fluid resuscitation and blood transfusion. In the BRTO group, there was a minor complication involving a balloon rupture, but the patient remained asymptomatic. PES was more frequent in the PARTO group (56%) compared to the BRTO group (23.1%) (p = 0.034). The median follow-up duration was 7 months. Complete obliteration rate was significantly higher in the BRTO group (100%) than in the PARTO group (80%) (p = 0.023). Recurrent bleeding occurred in one patient with remnant varix in the PARTO group. Conclusions: Both techniques achieved high technical and clinical success rates in the treatment of symptomatic gastric varices. However, BRTO demonstrated higher complete variceal obliteration and lower PES, suggesting a clinical advantage over PARTO.
Objectives: To assess the safety, efficacy, and mid‑term clinical and radiological outcomes of computerized tomography (CT)‑guided cryoablation of malignant T1 renal lesions. Methods: Consecutive patients who underwent percutaneous cryoablation (PCA) under CT guidance between January 2018 and January 2024 for one or multiple renal masses were included. Technical success and primary and secondary treatment efficacy were calculated. Complications were categorized according to the Clavien-Dindo classification system. Overall survival (OS) and local progression‑free survival (LPFS) were assessed based on Kaplan-Meier analysis. Results: A total of 72 renal lesions, with a mean size of 23.4 mm (SD: 9.8, range 7-45), were treated in 59 patients (41 males and 18 females, mean age: 69 years [range 45-88]). A total of 25 patients (42.4%) had a history of radical and/or partial nephrectomy. Primary treatment efficacy was 91.0% and increased to 95.6% with the re‑ablation of two lesions. The overall complication rate was 10.8%, with a major complication (Clavien-Dindo grade ≥ III) rate of 3.1%. The estimated LPFS at 15 months was 92.9%. Local progression occurred in four lesions, of which two had already been ablated. The estimated OS at 1 year was 95.9% (standard error [SE] of 2.8%) and 91.6% (SE: 5.0%) at 3 years. Conclusion: Percutaneous CT‑guided cryoablation is a safe and effective treatment for small renal cell carcinoma.
A high cumulative radiation dose (3394 mGy.cm, 51 mSv) delivered by two acquisitions on the abdomen and pelvis and corresponding to more than 10 times the local median dose for this examination was retrospectively detected thanks to the Dose Archiving and Communicating System (DACS). Retrospective analysis of the examination showed that the cause of this high dose was an off-centering of the patient-the table being in a too high position-disabling a correct diagnosis of an umbilical herniation that was visible on a repeated acquisition. Interestingly, the CTDIvol of the second acquisition was 40% lower than that of the first acquisition, a well-known effect of off-centering on automatic exposure control systems.
Bizarre parosteal osteochondromatous proliferation (BPOP), or Nora lesion, is a rare benign condition that can mimic other pathologies. A case is described of a 66-year-old man with a slowly enlarging nodule on his finger over five years. Imaging showed a parosteal lesion without continuity with the trabecular bone, strongly suggestive of BPOP. The diagnosis was histologically confirmed. This case highlights the importance of recognizing the characteristic imaging features of BPOP. Teaching point: BPOP may appear as a worrisome lesion on imaging, but its typical location and lack of continuity with the trabecular bone should raise awareness for BPOP.
Objectives: To evaluate the impact of patient-specific contrast volume adjustments on preoperative aortic computed tomography angiography (CTA) image quality after adjusting and reducing the total, injected contrast volume based on patients' body surface area (BSA) and heart rate (HR) and after adapting the CT-scanner's kilovoltage (kV). Methods: Prospective study included 80 surgery-naive patients. Three study groups were included: Group 1 (n = 56 patients): the injected contrast dose, calculated from BSA and HR, was reduced by 50%; Group 2 (n = 11 patients): the injected contrast dose, calculated from BSA and HR, was reduced by 50%, and an additional volume reduction was based on the kV values; Group 3 (n = 13 patients): the injected contrast dose, calculated from BSA and HR, was reduced by 50% and additionally diluted to 80% contrast and 20% saline. Image quality was evaluated by quantitative analysis (Hounsfield units) and qualitative analysis (five-point visual score). Results: The mean injected contrast dose was 46.1 ml, 28.3 ml, and 35.0 ml in Groups 1, 2, and 3, respectively, with a significant difference between Group 1 vs Group 2 (P < 0.001) and between Group 1 vs Group 3 (P < 0.001). A linear relationship between the Hounsfield units and the given contrast dose for all study groups was observed. The mean image quality score for Group 1 was 4.34/5. The mean image quality score for Group 2 was 2.8/5 and for Group 3 was 3.5/5. Conclusions: Significant contrast dose reduction, based on HR and BSA, in preoperative aortic CTA is associated with acceptable diagnostic quality.
Human dirofilariasis is caused by infection with a parasite relatively common in dogs. Occasional transmission of larvae to humans occurs via an insect bite and development of an immature worm at the bite site. The disease, once confined to southern Europe, is becoming increasingly widespread, particularly due to global warming. Clinical signs are nonspecific and laboratory findings usually normal. Imaging shows pseudotumor features also nonspecific on computed tomography (CT) and magnetic resonance imaging (MRI) scans. Ultrasound may suggest the diagnosis by the presence of double echogenic 'rail' images. However, only spontaneous motility of the parasite observation can confirm the diagnosis.
Teaching point: Albeit rare, IPMN-B should be considered and excluded when encountering a large hepatic cystic lesion, especially in the setting of associated biliary dilatation, because in contrast to 95% of other hepatic cystic lesions, it has significant risk of harboring invasive carcinoma and therefore mandates early accurate diagnosis and complete surgical resection.
Fracture of the polyethylene tibial post is a rare complication of posterior-stabilized total knee arthroplasty and is frequently missed on conventional radiography due to the radiolucent nature of polyethylene. We report a case of post-traumatic instability in which computed tomography demonstrated a displaced polyethylene fragment with characteristic low attenuation values. The diagnosis was confirmed intraoperatively, and isolated polyethylene exchange resulted in a good clinical outcome. Teaching point: CT attenuation measurements can aid in identifying displaced polyethylene fragments and facilitate the diagnosis of tibial post fracture in posterior-stabilized knee arthroplasty.
Intravenous leiomyomatosis is a rare benign uterine smooth muscle tumor with intravascular growth through pelvic veins or lymphatics. A case is reported of a 42-year-old woman with intermittent spotting and progressive abdominal enlargement. Pelvic magnetic resonance imaging showed a heterogeneous myometrial mass with serpiginous extensions along iliac veins. The lesion had high signal on high b-value diffusion-weighted images and high apparent diffusion coefficient values, indicating the absence of diffusion restriction. After surgery, histopathology confirmed the diagnosis of intravenous leiomyomatosis. Teaching point: Recognition of serpiginous intravascular extensions and the absence of diffusion restriction on magnetic resonance imaging should raise suspicion for intravenous leiomyomatosis.
Assessment of cortical bone and mineralized tissue in athletes traditionally relied on radiographs and CT, as conventional MRI provides limited/no signal from cortical bone. Recent advances, particularly zero echo time (ZTE) MRI, enable CT-like visualization of osseous structures within routine MRI protocols. This pictorial essay highlights the added value of ZTE in sports imaging, illustrating its role in the evaluation of stress injuries, occult fractures, osteoid osteoma, osteochondral lesions, calcified tendon pathology, hip and groin pathologies, and relevant differential diagnosis. ZTE complements conventional MRI by improving the depiction of cortical and mineralized abnormalities relevant to athletic populations.
Teaching point: The case highlights the importance of identifying gastric complications after RFCA and the need for prompt diagnosis and treatment of gastroparesis with gastrokinetic medication, such as mosapride citrate.
Pulmonary carcinoid tumors are rare and may lead to severe paraneoplastic syndromes. A case is reported of an inoperable 78‑year‑old patient with ACTH‑dependent Cushing's syndrome successfully treated with microwave ablation. The procedure resulted in rapid clinical improvement without complications and radiological stability. Teaching point: The role of microwave ablation as a minimally invasive alternative for selected inoperable patients, offering an effective tumor control strategy with minimal morbidity.
We report a case of calcaneal osteomyelitis caused by a retained foreign body-a coral fragment. The patient presented with nonspecific heel pain 12 years after the initial injury. MRI revealed an intraosseous lesion demonstrating the 'penumbra' sign, consistent with chronic osteomyelitis and abscess formation. CT demonstrated a foreign body embedded within the abscess cavity. Surgical exploration confirmed the presence of a coral fragment. Teaching point: Retained foreign bodies in bone can remain asymptomatic for many years, eventually presenting with signs of osteomyelitis.
Gymnast's wrist is an uncommon stress‑related injury of the distal radial physis caused by repetitive axial loading in skeletally immature athletes. We report the case of a 16‑year‑old elite gymnast presenting with progressive wrist pain without acute trauma. Magnetic resonance imaging demonstrated focal widening of the volar distal radial physis with adjacent metaphyseal and epiphyseal bone marrow edema, consistent with a stress‑related physeal injury. Conservative management with activity modification and physical therapy resulted in symptom resolution. Teaching point: In young athletes with wrist pain, stress‑related physeal injury should be considered, and MRI allows early diagnosis and appropriate management.
Teaching point: Detection of intraosseous gas with a bubbly or irregular pattern on imaging should raise a strong suspicion for emphysematous osteomyelitis and prompt urgent antimicrobial treatment, particularly in immunocompromised patients without a history of trauma or surgery.
Photon-counting computed tomography is the newest technological advancement in CT imaging allowing for an improved spatial resolution, inherent spectral information, and significant radiation dose reduction. These benefits may enhance diagnostic confidence and accuracy for radiologists and clinicians. Multiple clinical applications in musculoskeletal radiology benefit from this technology, including the reduction of metal artifacts, improved visualization of bone marrow edema, and better assessment of crystal arthropathies. This narrative review presents a comprehensive summary of the current advancements and applications of this emerging technology within musculoskeletal radiology using several illustrative cases.
Carcinoid heart disease (CHD) is a serious and potentially life‑limiting complication of neuroendocrine tumors (NETs), resulting from prolonged systemic exposure to serotonin and other vasoactive substances, leading to fibrotic valvular degeneration. We report the case of a 71‑year‑old woman with metastatic small‑intestinal NET and associated carcinoid syndrome presenting with progressive exertional intolerance. Transthoracic echocardiography revealed severe tricuspid and moderate pulmonary regurgitation with right‑sided ventricular dilation. Cardiac MRI confirmed regurgitation and right‑heart remodeling consistent with CHD. Teaching point: This case highlights the diagnostic value of multimodal imaging, particularly cardiac MRI, in confirming and characterizing CHD in patients with metastatic NETs.
Teaching point: Combined MRI and ultrasound allow accurate identification of isolated digital Dupuytren's cords, thereby supporting diagnosis and surgical planning.
Teaching point: Desmoid tumors are rare locally aggressive soft tissue tumors that can occur anywhere in the body and have a varying imaging appearance.