Recent studies indicate that atrial fibrillation (AF) burden has prognostic implications. We aimed to assess the ability of clinical and cardiac imaging variables to stratify between high and low AF burden. Data from the prospective, multicenter Swiss-AF Burden study were analyzed. Patients underwent a 7-day Holter electrocardiogram and native cardiac magnetic resonance imaging. AF burden, defined as the percentage of time in AF during the 7-day Holter electrocardiogram, was dichotomized into low (<10%) or high (≥10%). Logistic regression models were built, and discriminative performance was evaluated by comparing the area under the curve (AUC). A total of 170 patients were enrolled (median age 72 years; 18% female); 26% (n = 44) had high AF burden. Variables selected for the clinical model were age (odds ratio 1.09; 95% confidence interval 0.40-2.74), male sex (1.05; 1.00-1.11), and body mass index (1.14; 1.06-1.24). The imaging model included left atrial maximal volume index (1.04; 1.01-1.06), left ventricular end-diastolic volume index (0.93; 0.90-0.96), right atrial fractional area change (0.94; 0.89-0.98), and left ventricular ejection fraction (0.87; 0.81-0.94). The AUCs for the clinical and imaging models were 0.67 (0.58-0.77) and 0.91 (0.84-0.98), respectively. Combining both models yielded an AUC of 0.92 (0.86-0.99), with no substantial improvement over the imaging model alone. Cardiac imaging variables clearly outperformed clinical variables in their ability to stratify between high and low AF burden, suggesting their potential as a tool for estimating AF burden.
The benefits and risks of intravenous thrombolysis (IVT) with alteplase for acute ischemic stroke (AIS) beyond 4.5 h are unclear. Decision-making is further limited by the lack of comparisons between imaging strategies used for patient selection, including magnetic resonance imaging with diffusion-weighted imaging (MRI/DWI) and perfusion-guided approaches such as MRI with perfusion-weighted imaging (MRI/PWI) or computed tomography perfusion (CTP). This study aims to evaluate the efficacy and safety of alteplase administered beyond 4.5 h and to compare MRI/DWI- and perfusion-guided IVT. Databases were searched for RCTs enrolling AIS patients treated with alteplase beyond 4.5 h. Efficacy outcomes included excellent (mRS 0-1) and favorable (mRS 0-2) functional outcomes at 90 days, and major neurological improvement up to 72 h. Safety outcomes included any intracranial hemorrhage (aICH), symptomatic ICH (sICH), parenchymal hemorrhage (PH), and 90-day mortality. Seven RCTs comprising 1685 patients were included. There were no differences between imaging strategies in any efficacy or safety outcome. Alteplase administered beyond 4.5 h was associated with higher rates of excellent (RR 1.24; 95% CI 1.12-1.38) and favorable (RR 1.17; 95% CI 1.09-1.26) functional outcomes, and increased major neurological improvement (RR 1.28; 95% CI 1.11-1.49). The risks of aICH (RR, 2.82; 95% CI 1.17-6.80), sICH (RR, 3.31; 95% CI 1.42-7.74), and PH (RR, 2.95; CI 95% 1.33-6.53) were higher in the alteplase group, while mortality showed no difference (RR 1.27; 95% CI 0.91-1.76). This network meta-analysis did not detect a statistically significant difference between perfusion-guided and DWI/FLAIR mismatch-guided selection; however, this comparison was indirect, based on a limited number of trials, and not powered to demonstrate equivalence, and should not be interpreted as evidence that the two paradigms are interchangeable.
Ischemic stroke is sexually dimorphic. Biological sex can influence injury progression and response to treatment. Extracellular vesicles (EV) derived from three-dimensional (3D) human mesenchymal stem cell aggregates (3D-EV) are a promising candidate as a treatment, but their efficacy across these biological variables and in vivo behavior needs to be characterized. This study evaluated whether 3D-EV therapy enhances recovery following ischemic stroke in female and male models using ultra-high-field MRI and their influence on structural, ionic, and metabolic recovery. A preclinical model of transient middle cerebral artery occlusion was used to longitudinally evaluate the efficacy of ultrasmall superparamagnetic iron oxide (USPIO)-labeled 3D-EV or saline at reperfusion through intra-arterial injection. MRI was performed at 21.1 T, which included T2-weighted, diffusion-weighted imaging, gradient-recalled echo imaging, and ²³Na chemical shift imaging. Proton magnetic resonance spectroscopy (¹H-MRS) was used to quantify changes in lactate, N-acetylaspartate, creatine, and choline within peri-infarct tissue. Imaging and behavioral outcomes were assessed over 21 days. USPIO-labeled 3D-EV resulted in localized hypointense contrast in the ischemic striatum, indicating delivery of treatment. T2-weighted MRI showed progressive lesion reduction, with a trend toward better recovery in females. ²³Na MRI revealed reduced sodium accumulation, with earlier ionic normalization in 3D-EV-treated animals. Diffusion recovery was observed with sex-dependent trajectories. ¹H-MRS showed lower lactate concentrations and preservation of other metabolites in EV-treated females. Behavioral differences were not significant. 3D-EV therapy showed trends toward structural, ionic, and metabolic recovery following an ischemic insult. Ultra-high-field MRI and MRS can provide sensitive biomarkers to resolve these differences and support 3D-EV as a potential cell-free therapeutic candidate for ischemic stroke.
Deep brain stimulation (DBS) is a well-established therapy for adult neurological disorders, most commonly Parkinson's disease, and is increasingly being explored for medically refractory conditions in the pediatric population. Magnetic Resonance Imaging (MRI) is essential for DBS safety and efficacy through precise surgical targeting and trajectory planning, yet MRI protocols and reporting vary substantially and are constrained by pediatric-specific considerations. We aimed to systematically characterize MRI use and reporting practices in pediatric DBS studies and clinical trial registries. We systematically reviewed the published literature and the clinical trials registry to characterize MRI use in pediatric patients undergoing DBS, identify common imaging practices, and evaluate reporting of MRI sequence parameters (e.g., TR, TE). Preoperative MRI was primarily used for anatomical targeting and surgical planning. Most studies used 1.5T scanners (86%) versus 3T (14%), with T1-weighted (54%) and T2-weighted (53%) sequences most common. Despite MRI's ubiquity, 78% of studies did not report sequence parameters. However, only 4% were published in imaging-related specialty journals, which may explain the limited methodological detail. gov data reflected the same pattern, where DBS trials that mention imaging, rarely specify sequences or acquisition parameters. Heterogeneous MRI protocols and frequent under-reporting limit reproducibility and comparison of targeting approaches across pediatric DBS studies. We advocate for standardized MRI reporting guidelines to strengthen methodological rigour and accelerate collaborative progress in pediatric DBS research.
To assess the utility of lung magnetic resonance imaging (MRI) for monitoring interstitial lung disease (ILD) in patients with systemic sclerosis (SSc), using high-resolution CT (HRCT) as the reference. Additionally, we explored associations between MRI sequences and common imaging and functional parameters in SSc-ILD evaluation. SSc patients with ILD requiring treatment initiation or change underwent lung assessment at baseline and after 6 months, including MRI (T2-weighted, T1 post-contrast, and T2 star sequences), HRCT, lung ultrasound, and pulmonary function tests. Six-month MRI and HRCT were qualitatively evaluated for improvement, stability, or progression. A follow-up HRCT was performed 2 years after enrolment. Fourteen SSc-ILD patients (64.3% female, mean age 48.3 years) were enrolled. MRI showed improvement in 1 patient, stability in 9, and progression in 4; in 2 progressed cases, inflammation decreased while fibrotic features increased. T1 contrast sequence significantly correlated with pleural irregularities on ultrasound (ρ=0.55; p=0.04) and DLCO (ρ=-0.65; p=0.01). MRI and HRCT findings at 6 months were concordant in 64.3% of cases, with fair agreement (weighted κ=0.25). MRI outcomes at 6 months matched HRCT findings at 2 years in 92.8% of patients (13/14). Lung MRI is a promising adjunctive tool for monitoring SSc-ILD and may provide complementary information to HRCT on early imaging changes, particularly the transition from inflammation to fibrosis. Among MRI sequences, T1 post-contrast best correlated with functional and ultrasound findings, supporting its role in fibrosis assessment.
To explore whether bone marrow proton density fat fraction (PDFF) mediates the relationship between liver iron concentration (LIC), assessed via magnetic resonance imaging (MRI)-derived R2∗, and lumbar spine (LS) bone mineral density (BMD) in women. This prospective study included 103 female volunteers (median age 50 years, range 20-80) recruited between June 2019 and January 2021. All participants underwent 3.0T MRI (liver R2∗ mapping and lumbar VIBE-Dixon sequences) and dual-energy X-ray absorptiometry (DXA) on the same day. Mediation analysis was performed using the PROCESS macro, with age as covariate. Among the 103 participants (median age 50 years, IQR 38-60; 44% with elevated liver R2∗ > 67.7 s-1), liver R2∗ was positively associated with bone marrow PDFF (β = 0.36, P < 0.001) and negatively associated with LS BMD (β = -0.273, P = 0.004). Bone marrow PDFF showed a negative association with LS BMD (β = -0.286, P = 0.006). Mediation analysis revealed that bone marrow PDFF significantly mediated 37.6% of the liver R2∗-BMD relationship (indirect effect = -0.103; 95% CI: 0.210 to -0.028). Subgroup analyses revealed that these associations were statistically significant only in participants aged ≥ 50 years. Bone marrow PDFF partially mediates the inverse relationship between liver iron and BMD in women, particularly in those aged ≥ 50 years, suggesting a potential link between iron metabolism and bone loss that warrants further investigation. Combined MRI assessment of liver R2∗ and bone marrow PDFF may enhance osteoporosis risk stratification.
The study sought to evaluate changes in left ventricular (LV) strain and native T1/T2 mapping characteristics on cardiac magnetic resonance imaging (CMR) in patients with high-normal blood pressure (HNBP). A prospective case-control study including 25 cases having HNBP and 25 age- and sex-matched healthy controls was conducted. LV strain was evaluated on CMR using feature tracking and 2-dimensional and 3-dimensional longitudinal, circumferential and radial strain values were calculated. Native T1/T2 mapping values were also calculated. Subclinical impairment of LV mechanics was evident in the form of deranged LV strain parameters in cases with HNBP compared to controls. The two-dimensional global radial (25.34±3.06 vs. 28.52±5.69; P=0.0323), global circumferential (-16.05±1.31 vs. -17.27±2.23; P=0.0241) and global longitudinal strain (-16.33±2.24 vs. -16.49±7.25); P=0.0193) and three-dimensional global circumferential strain (-13.94±10.81 vs. -17.84±2.78; P=0.0133) values were significantly impaired in cases compared to controls. No significant difference was observed in the native T1/T2 mapping parameters. LV strain parameters are significantly deranged in patients with HNBP, compared to healthy controls, in the absence of other morphological changes or interstitial fibrosis. Impaired LV strain parameters can serve as a new marker for detection of subclinical myocardial dysfunction in patients with HNBP having preserved chamber function.
Amyotrophic Lateral Sclerosis (ALS) is a progressive neuromuscular disease with multifaceted phenotypic presentation thus obstructing objective disease staging. The D50 disease progression model is a framework to comprehensively dissect biomarker-signals towards their relevance regarding disease accumulation/phase (rD50), or disease aggressiveness (D50). Based on previous findings using 1.5-Tesla Magnetic-Resonance-Imaging (MRI), this study hypothesized that high-resolution MRI markers of Grey-Matter (GM) structural integrity would enable quantification of disease accumulation, independent of aggressiveness. A separate cohort of 75 patients with ALS and 73 Healthy Controls (HC) underwent T1-weighted 3-Tesla MRI. Voxel-Based-Morphometry measured GM and White-Matter (WM) density and Surface-Based-Morphometry assessed Cortical Thickness (CT). Non-parametric Threshold-Free-Cluster-Enhancement with 5000 permutations was applied for inter-group and regression contrasts, whilst correcting for possibly interfering co-variates and applying Family-Wise-Error-adjustment. Compared with HC, the ALS cohort showed widespread decreases of CT and GM/WM density (p < 0.001). These case-control effects were driven by patients scanned during rD50-defined disease Phase 2 (p < 0.001). Within the ALS-cohort, direct Phase 2 versus Phase 1 contrasts revealed spatially-distributed decreases, reflecting higher disease accumulation (p < 0.05). These were independent of disease aggressiveness (and onset-region), as corrected for in the models. Accordingly, all contrasts assessing aggressiveness did not yield significant results. These semi-automated analyses of T1-weighted-images captured disease accumulation related GM structural integrity-loss in this cohort scanned with 3-Tesla MRI, independent of the underlying disease aggressiveness. This principle was validated across different scanners and field strengths, supporting its application for objective and non-invasive staging of patients with ALS, whereby true longitudinal studies are necessary.
Sickle cell disease is a hereditary hemoglobinopathy characterized by hemoglobin S polymerization, leading to recurrent vaso-occlusive episodes and multiorgan complications. Osteoarticular involvement is a major cause of morbidity in children. We report the case of a 10-year-old girl with homozygous sickle cell disease (HbSS) who presented with acute right leg pain, fever, and localized swelling. Magnetic resonance imaging (MRI) demonstrated a metaphyseal bone infarction associated with an adjacent soft tissue collection. This case highlights the pivotal role of MRI in evaluating bone marrow abnormalities and surrounding soft tissues and in differentiating infarction from osteomyelitis.
The utilization of stress perfusion cardiac magnetic resonance (CMR) in patients with cardiac implantable electronic devices (CIEDs) is still limited. The study was registered in the Prospective Register of Systematic Reviews (PROSPERO) with ID CRD42023457308. PubMed, Scopus, Embase, Web of Science, ProQuest, and CINAHL databases were searched using the Mesh and related terms of CMR imaging, stress, and CIEDs. Out of the 1695 papers we found, eight met our inclusion criteria. We reviewed the included studies and provided a concluding remark concerning (a) image quality; (b) CMR compatibility, scanner, and safety; (c) device protocols and exclusion criteria; (d) vasodilator choices, effects, and safety; and (e) clinical outcomes. This study has demonstrated a positive trend in the utilization of stress CMR in MR-conditional devices. However, the review has identified multiple research gaps that warrant further investigation.
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Cervical lymph node metastases in oral cancer patients are a frequent occurrence and important prognostic factor. Anatomical and molecular imaging modalities can identify neck metastases with varying sensitivity and specificity but perform poorly in clinically negative neck nodes with microscopic disease. Herein we investigate the use of porphyrin-lipid nanotheranostics (PS) for multimodal detection of neck disease in preclinical models of oral cancer. Xenograft models of tongue cancer were established in nude rats using MOC2 mouse oral squamous cells. PS nanoparticles were radiolabelled with positron-emitting Copper-64 (64Cu-PS) and administered either IT (100 MBq 64Cu, 0.5 mg) or IV (250-500 MBq 64Cu/kg, 0.5-1.0 mg/kg). Uptake in the tumour and cervical lymph nodes was measured with serial PET/MR imaging and at endpoint with in situ fluorescence (FL) imaging. In the IV cohort, 64Cu-PS uptake was compared to 18F-FDG (46 MBq 18F/kg) PET performed prior to nanoparticle injection. After imaging, neck nodes were harvested for pathological staging. Receiver operating characteristics were compared in the IV cohort between 18F-FDG vs 64Cu-PS PET imaging vs FL imaging. The tongue tumour model yielded micrometastases to 54% of neck nodes by 14 d post-implantation. Following IT injection, sentinel and metastatic lymph nodes were visible with 64Cu-PS PET for 72 h. Following IV injection, 64Cu-PS PET signal in the tumour and neck nodes was clearest at 24 h and significant differences in the pooled SUVs of benign vs metastatic nodes were obtained. On FL imaging, metastatic neck nodes had significantly higher fluorescent signal (S/B) compared to benign nodes. Overall, FL S/Bmean gave the best prediction of nodal disease with 75% SEN, 79% SPC, and 71% NPV. 64Cu-PS PET (SUVmax: 77% SEN, 68% SPC, 68% NPV) performed slightly worse than FL imaging for identifying metastatic nodes but still better compared to 18F-FDG PET (SUVmax: 81% SEN, 43% SPC, 59% NPV). Inflamed nodes were the commonest source of false positives for both 64Cu-PS PET and FL imaging modalities. Nanotheranostic 64Cu-PS permitted more accurate multimodal detection of microscopic neck disease in preclinical oral cancer models and can offer valuable guidance for planning and performing neck dissections.
To investigate the value of modified regional leptomeningeal collateral (rLMC) scores based on high-resolution 3D time-of-flight magnetic resonance angiography with magnetization transfer contrast (MRA-MTC-rLMC) and susceptibility-weighted angiography (SWAN-rLMC) in assessing collateral circulation and predicting clinical outcomes in patients with unilateral chronic middle cerebral artery occlusion (CMCAO). In this retrospective analysis of 39 CMCAO patients, we developed enhanced rLMC scores by incorporating the posterior cerebral artery territory and deep medullary veins into traditional scoring. The resulting MRA-MTC-rLMC (10 regions, 22 points) and SWAN-rLMC (11 regions, 24 points) scores were evaluated for predicting poor outcomes (TIA, cerebral infarction, or death) using ROC curve analysis. Among 39 patients, 20 (51.3%) experienced poor outcomes. Both modified scores demonstrated excellent predictive performance, with AUCs of 0.938 for MRA-MTC-rLMC and 0.886 for SWAN-rLMC (both P < 0.001). The optimal cut-off of ≤ 11 for MRA-MTC-rLMC achieved 100% sensitivity and 89.5% specificity, while ≤ 12 for SWAN-rLMC showed 90% sensitivity and 89.5% specificity. Patients stratified by these cut-offs showed significant prognostic differences (P < 0.001). The modified MRA-MTC-rLMC and SWAN-rLMC scores may serve as potentially effective, yet preliminary, imaging tools for assessing collateral circulation in CMCAO. A favorable prognosis is indicated by high arterial compensation (elevated MRA-MTC-rLMC score) combined with preserved venous oxygenation (reduced SWAN-rLMC score), establishing their clinical utility for risk stratification.
The aberrant aggregation of amyloid-β (Aβ) is a central pathological marker of Alzheimer's disease (AD) and shows different neurotoxic properties in various forms, such as monomers, oligomers, fibers and plaques. In recent years, great progress has been achieved in the molecular design and the development of magnetic resonance imaging (MRI) probes targeting Aβ species. They provide powerful tools for the early diagnosis and pathological investigation of AD. Here, we systematically review the molecular design strategies and recent advances in Aβ-targeted MRI probes. First, we introduce the molecular pathological basis of Aβ aggregation and the importance of Aβ as an imaging target. Second, we detail the core components of probe design, including the selection of targeting ligands (e.g., peptide mimetics, small molecules, and antibody fragments), optimization of signal units (e.g., Gd(III), Mn(II), superparamagnetic iron oxide nanoparticles (SPIONs), and ¹⁹F), and the delivery strategies to enhance blood-brain barrier (BBB) penetration. We focus on how the probes achieve the transition from high-affinity binding in vitro to high-contrast imaging in vivo by means of changes in proton relaxation times (T1/T2) or the chemical exchange saturation transfer (CEST) effect upon binding to Aβ. Furthermore, the imaging performance of various probes (small molecule probes, nanoprobes, and smart responsive probes) in transgenic AD models is compared and evaluated, and the challenges related to sensitivity, specificity, and biosafety are discussed. Finally, we discuss future directions for Aβ-targeted MRI probes, including oligomer-specific probes, multimodal imaging probes, and theranostic platforms that include both diagnostic and therapeutic functions. Through interdisciplinary innovation in molecular design, the next generation of MRI probes is expected to play a key role in preclinical research, early diagnosis, and therapeutic evaluation of AD.
Background Takotsubo syndrome (TTS) is an acute heart failure phenotype characterized by transient left ventricular dysfunction and modest Troponin release. Mechanisms of myocardial injury remain unclear. We aimed to investigate relationships between Troponin T release, myocardial edema by cardiac magnetic resonance (CMR) T2 mapping, and systemic inflammatory biomarkers in TTS. Methods N = 94 patients with acute TTS underwent CMR (median 4 days after admission) and serial blood sampling during the index hospitalization. Patients were stratified by a previously defined prognostic relevant peak high-sensitivity Troponin T cut-off (≥ 28.8× upper limit of normal [ULN] vs. <28.8× ULN). Full blood count was obtained at admission and on the day of CMR. Results Mean age of the study population was 74 years, 7% male. Patients with higher Troponin release presented with more severe left ventricular systolic dysfunction (admission LVEF 36% vs. 41%, p = 0.005) and higher T2 mapping values (60 vs. 57 ms, p < 0.05). On the CMR day, higher NLR (3.7 ± 2.4 vs. 2.7 ± 1.4, p = 0.020) and lymphocyte-to-monocyte ratio (LMR) (3.2 ± 1.0 vs. 3.9 ± 1.6, p = 0.020) were observed in the high-Troponin release subgroup. Multivariable linear regression analysis identified admission LVEF (β=-0.524, p < 0.001), T2 mapping (β = 0.171, p = 0.045), NLR (β = 0.262, p = 0.032), and LMR (β=-0.282, p = 0.033) as independent correlates of Troponin release as a continuous variable. Conclusions Troponin release in TTS reflects an interplay between ventricular dysfunction, myocardial edema, and systemic inflammatory activation, supporting a non-ischemic pattern of myocardial injury. Troponin may serve as a simple surrogate marker of myocardial and systemic inflammation.
Endometriosis is a chronic, estrogen-dependent inflammatory disease defined by the presence of endometrial-like tissue outside the uterus, affecting approximately 10% of women of reproductive age as well as a notable proportion of adolescents and postmenopausal patients. Although traditionally considered a pelvic disorder, it is increasingly recognized as a multisystem condition with a broad spectrum of extrapelvic locations and atypical clinical and imaging presentations, which contribute to significant diagnostic delay. This review provides a comprehensive overview of the imaging spectrum of endometriosis beyond the pelvis, emphasizing the central role of magnetic resonance imaging (MRI) in lesion detection, characterization, and preoperative mapping. Particular attention is given to the diverse manifestations of extrapelvic disease, including gastrointestinal, genitourinary, thoracic, musculoskeletal, and neural involvement, each of which may present with nonspecific or misleading findings and mimic other pathological entities. Additionally, uncommon presentations such as infection, malignant transformation, and decidualization, as well as variations across different patient populations, further increase diagnostic complexity. Recognizing these patterns and understanding their imaging features are essential to avoid misdiagnosis and delays in care. A systematic approach combining clinical suspicion, tailored imaging protocols, and structured reporting is key to improving diagnostic accuracy and guiding appropriate management. Greater awareness of the multisystem nature of endometriosis is crucial to optimize patient outcomes and reduce the burden of this frequently underrecognized disease.
Tentorial hypoplasia is a rare congenital condition characterized by underdevelopment or absence of the tentorium cerebelli, a dural structure separating the cerebrum from the cerebellum. It is often detected incidentally on computed tomography (CT) or magnetic resonance imaging (MRI) and may be associated with conditions such as Dandy-Walker syndrome and Chiari malformation, although many cases remain asymptomatic. Imaging plays an essential role in identifying associated abnormalities when present. Case 1: A 16-year-old male presented with a left subdural hematoma following a road traffic accident. Neuroimaging incidentally revealed tentorial hypoplasia with brain herniation into the quadrigeminal cistern, though he remained asymptomatic. Case 2: A 3-year-old child with metastatic neuroblastoma had incidentally discovered tentorial hypoplasia with brain herniation on CT and MRI, with no neurological deficits. Tentorial hypoplasia is often an incidental finding with a favorable prognosis, though early imaging is essential for identifying associated central nervous system (CNS) malformations and guiding management.
Portal hypertension leads to the development of a complex and heterogeneous network of portosystemic collateral pathways, which represent adaptive responses to increased portal pressure. Although traditionally considered compensatory mechanisms, growing evidence indicates that Spontaneous Portosystemic Shunts (SPSS) are ineffective in normalizing portal pressure and may contribute to adverse clinical outcomes. In patients with cirrhosis, particularly those with preserved liver function, the presence and extent of SPSS are independently associated with hepatic encephalopathy, variceal bleeding, portal vein thrombosis, and reduced transplant-free survival, highlighting their prognostic relevance. Cross-sectional imaging with computed tomography (CT) and magnetic resonance imaging (MRI) plays a central role in the noninvasive assessment of portal hypertension by enabling comprehensive mapping of collateral circulation, including shunt size, anatomical course, and drainage pathways. These imaging characteristics are key determinants of clinical impact and therapeutic planning. This pictorial review illustrates the major portosystemic collateral pathways encountered in portal hypertension using representative clinical cases, emphasizing key imaging features and common diagnostic pitfalls, as well as highlighting the clinical significance in each context. Accurate recognition and standardized reporting of SPSS are essential to optimize risk stratification, guide management decisions, and improve outcomes in patients with portal hypertension.
Renal cell carcinoma (RCC) is increasingly managed with a broad range of systemic and local therapies, creating new challenges for imaging-based response assessment in metastatic disease. While conventional size-based criteria such as RECIST v1.1 remain widely used, they incompletely capture the diverse morphologic and functional changes induced by modern treatment. Targeted therapies, including vascular endothelial growth factor receptor tyrosine kinase inhibitors and other pathway-directed agents, may produce necrosis, devascularisation, and prolonged disease stability without substantial tumour shrinkage. Immune checkpoint inhibitors introduce additional atypical response patterns, including pseudoprogression, mixed response, and rarely hyperprogression, which can complicate early interpretation of surveillance imaging. Combination regimens may demonstrate features of both targeted and immune-mediated response. In parallel, stereotactic body radiotherapy has emerged as an important treatment for oligometastatic and oligoprogressive RCC, with imaging appearances that may include lesion shrinkage, stability, or transient enlargement following treatment. This review summarises the current treatment landscape for metastatic RCC and the imaging manifestations of response across chemotherapy, targeted therapy, immunotherapy, combination systemic therapy, and stereotactic radiotherapy. It discusses the strengths and limitations of conventional and modified response criteria, including RECIST v1.1, iRECIST, attenuation-based CT criteria, and morphology-based approaches. The review also highlights the evolving role of functional and novel imaging techniques, including diffusion-weighted whole-body MRI, dual-energy and spectral CT, and PET/CT, as potential tools for improving response assessment beyond size alone. In addition, key imaging features of treatment-related toxicity are reviewed. Familiarity with these response patterns and complications is essential for radiologists involved in the care of patients with metastatic RCC, particularly as treatment strategies become increasingly multimodal and biologically complex.
To explore the imaging features of histopathologically confirmed ovarian Brenner tumors (BTs) and to improve the accuracy of differential diagnosis between benign and borderline or malignant variants. A retrospective analysis was conducted on clinical and imaging data from patients with pathologically confirmed ovarian BTs, collected from five medical centers between January 2014 and December 2024. Univariate and multivariate logistic regression analyses were utilized to identify independent risk factors associated with borderline or malignant BTs. Clinically, the incidence of elevated serum CA125 levels was significantly greater in the borderline/malignant group compared to the benign group (p < 0.05). Regarding imaging characteristics, variables including maximum tumor diameter, tumor composition, tumor margin, presence of papillary projections, calcification pattern, degree of enhancement, as well as CT attenuation values between the non-contrast and the arterial or venous phases, demonstrated statistically significant differences between benign and malignant tumors (p < 0.05). Tumor maximum diameter, papillary projections and venous-phase CT net enhancement were identified as independent risk factors associated with borderline/malignant BTs. The combined model showed promising discriminative ability (AUC 0.956), but this result requires extreme caution. In pathology-confirmed BTs, maximum tumor diameter, presence of papillary projections, and venous-phase CT net enhancement are valuable markers for differentiating benign from borderline or malignant subtypes. These features may assist in preoperative imaging assessment and risk categorization.