Imaging biomarkers are quantifiable features extracted from medical images that indicate health status, disease characteristics, or treatment response. Their value depends on rigorous standardization and validation-efforts advanced by QIBA and EIBALL. Variability in existing inventories highlights the need for a FAIR (Findable, Accessible, Interoperable, Reusable)-compliant catalog to enable systematic discovery, comparison, and adoption. We focused on defining the essential variables to describe imaging biomarkers across research, regulatory, and clinical settings. A three-phase approach was undertaken: (1) key resources-including FDA-NIH BEST, QIBA, EMA, ESR-EIBALL, relevant regulations, and scientific literature-were reviewed; (2) attributes were extracted and compared, with redundancies resolved by expert consensus; and (3) consolidated variables were organized into domains aligned with FAIR principles. A unified biomarker descriptor set was established across five domains: core identification (imaging biomarker name, surrogation, clinical relevance), clinical context (main target, organ(s), disease/substrate, range(s), actionability), imaging and technical information (image modality, acquisition technique, technical parameters, extraction, association type, dimensionality, units), validation (robustness and use endorsed by publications, endorsed by professional societies, regulatory qualifications), and administrative data (repository, version/author). The catalog was tested across representative imaging biomarkers in inflammatory diseases, including ADC, FDG-PET, CT-based radiomics signatures, and Doppler ultrasound indices, demonstrating coherent descriptions across diseases and organs. Diagnostic and prognostic roles were clarified, transparency and reproducibility were promoted, and the need for context-adapted entries was shown. This work proposes a harmonized, scalable approach for cataloging imaging biomarkers. Consistent descriptors across contexts facilitate integration into research, regulatory, and clinical workflows. This work proposes a unified catalog structure for imaging biomarkers that improves standardization, comparability, and reusability across clinical, research, and regulatory domains. Lack of standardization limits the integration of imaging biomarkers into research, regulatory, and clinical workflows. A harmonized catalog was developed using unified descriptors across the main identified domains. This structure enhances traceability, cross-disease comparability, and regulatory readiness of imaging biomarkers.
This study aimed to identify and synthesize imaging findings in the temporomandibular joint (TMJ) complex following radiation therapy (RT) for head and neck cancer (HNC). A systematic search of five databases retrieved studies reporting post-RT imaging of TMJ structures. Extracted data included patient demographics, RT dose and technique, imaging modality, imaging changes and clinical findings. Risk of bias was assessed using ROBINS-I V2 (Risk of bias in non-randomized studies-of interventions, version 2). Eleven retrospective studies (282 patients; mean age 52.7 years; RT dose 30-110 Gy) were included. Post-RT analysis was evaluated by imaging modalities of MRI (7 studies), CT (4), US (1), and panoramic images (1). The most commonly described structural changes in the muscles of mastication included MRI signal abnormalities (43 patients), atrophy (20 patients) and hypertrophy (20 patients), while condylar changes included erosion (11 patients), surface irregularity (12 patients) or sclerosis (6 patients). Trismus was identified in 126 patients (44.7%). No study described changes to the glenoid fossa or articular eminence or direct osteoradionecrosis (ORN) of TMJ structures. All studies exhibited moderate to critical risk of bias, limiting the certainty of associations. RT can induce structural changes across TMJ components detectable on imaging, which may contribute to trismus and functional impairment. Current evidence is limited, heterogeneous and retrospective, underscoring the need for prospective studies with standardized imaging and clinical correlation. Radiation therapy for head and neck cancer can affect jaw structures. Imaging shows changes in muscles and joints that are involved with chewing and mouth opening. These changes may lead to trismus (difficulty opening the mouth). Nearly half of patients in reviewed studies experienced this condition, impacting daily life. Current evidence is limited and inconsistent. Prospective studies with standardized imaging approaches are needed to further clarify radiation-related TMJ changes.
The 2025 ECCO-ESGAR-ESP-IBUS multisociety guidelines mark a paradigm shift in IBD management, positioning imaging as a central element of the treat-to-target strategy. This critical review analyzes these updates from a radiological perspective. Magnetic resonance enterography (MRE) and intestinal ultrasound (IUS) are now established as co-first-line modalities for diagnosis and monitoring, reflecting their proven accuracy and safety. Evidence from trials such as METRIC, TRUST-UC, and PISA-II demonstrates that cross-sectional imaging reliably detects disease activity, complications, and therapeutic response, enabling proactive, non-invasive disease control. The guidelines promote early imaging-based assessment and incorporate transmural healing as an achievable therapeutic target. However, practical barriers remain, including limited access to MRE, operator dependence on IUS, and heterogeneity in the definition of transmural healing and fibrosis. Implementing standardized protocols and structured training is essential to realize the guidelines' vision. By positioning imaging at the core of IBD care, the 2025 guidelines transform radiology from a diagnostic adjunct to a strategic driver of precision therapy. CRITICAL RELEVANCE STATEMENT: Cross-sectional imaging, particularly MRE and IUS, has become indispensable for comprehensive IBD assessment. The 2025 ECCO-ESGAR-ESP-IBUS guidelines integrate imaging into every phase of patient management, underscoring its value for diagnosis, monitoring, and achieving transmural remission. This shift requires structured training and harmonization across Europe. KEY POINTS: MRE and IUS have become co-first-line modalities for IBD diagnosis and follow-up with imaging now embedded within the treat-to-target framework, emphasizing early response and transmural healing. MRE is preferred for baseline staging and complex complications; IUS excels in dynamic, point-of-care monitoring. Standardization and training remain major barriers to implementation.
This study aimed to develop and validate a deep learning prediction model using longitudinal multimodal ultrasound imaging for early identification of treatment-sensitive and treatment-resistant carotid plaques in patients receiving lipid-lowering therapy. This prospective study enrolled 802 patients with vulnerable carotid plaques or stenosis ≥ 50%. Patients underwent serial multimodal ultrasound examinations, including B-mode imaging, superb microvascular imaging, and shear wave elastography at baseline and 3, 6, 9, and 12 months after initiating statin therapy. The dataset was divided into training and testing sets using stratified sampling with data augmentation. A hybrid DL model combining convolutional neural networks and long short-term memory networks analyzed longitudinal imaging sequences integrated with baseline clinical data. Five progressive prediction models were constructed for baseline and each follow-up time point, sharing identical architecture but trained independently on temporal sequences of varying lengths using 5-fold cross-validation. Model performance was assessed for discrimination ability, calibration consistency, and clinical utility. Five progressive prediction models demonstrated characteristic temporal performance patterns, with significant improvement from 3 to 6 months (AUC 0.866), followed by marginal gains. The 6-month model emerged as the most clinically practical assessment time point, achieving high specificity (93.7%) for early therapeutic decisions. Ablation experiments confirmed imaging features as primary predictive determinants, while attention mapping revealed consistent focus on plaque-adjacent regions, validating that treatment response prediction relies on morphological changes within target plaques. A hybrid DL model enables reliable carotid plaque treatment response prediction within six months, optimizing personalized therapy through earlier identification of treatment-resistant patients. This study validates deep learning algorithms to predict carotid plaque treatment response within six months, advancing clinical radiology practice by enabling earlier therapeutic optimization through objective ultrasound-based assessment. Conventional imaging requires 12 months to reliably assess plaque treatment response. Deep learning model predicts treatment response at six months with high accuracy. Earlier prediction enables timely therapeutic adjustments for resistant patients.
Breast cancer is the most commonly diagnosed malignancy among women worldwide. Contrast-enhanced imaging is central to diagnosis, staging, and treatment monitoring, yet its increasing use raises important environmental concerns. This review critically compares the sustainability of contrast-enhanced mammography (CEM) and breast magnetic resonance imaging (bMRI), focusing on contrast medium ecotoxicity, energy consumption, data storage, digital infrastructure, patient access, and travel-related emissions. Both iodinated and gadolinium-based contrast media persist in aquatic environments and contribute to water pollution. Although standard wastewater treatment removes a higher proportion of iodinated contrast, the injected dose is substantially larger, resulting in a greater overall environmental load. Gadolinium-based media are used in smaller quantities but are poorly removed by conventional treatment processes and may release toxic free gadolinium ions after excretion. While CEM involves ionizing radiation and a smaller field of view, it consumes markedly less energy per examination, generates smaller data volumes, and can be integrated into existing mammography infrastructure-enhancing accessibility, enabling decentralized deployment, and reducing patient travel. CEM is also faster, more cost-effective, and often preferred by patients due to greater comfort and shorter examination time. In contrast, bMRI, though radiation-free and offering wider anatomical coverage, has a significantly higher energy demand and digital footprint. Overall, CEM demonstrates advantages in environmental, economic, and social sustainability without compromising diagnostic performance in selected clinical indications. Radiology departments can meaningfully reduce healthcare's carbon footprint by incorporating sustainability principles into modality selection, contrast-media management, and workflow optimization. CRITICAL RELEVANCE STATEMENT: CEM and bMRI address similar clinical indications with comparable diagnostic accuracy. CEM offers potential sustainability advantages through lower energy use, smaller data volumes, and easier integration into existing infrastructure, although it involves ionizing radiation, a limited field of view, and a higher environmental load from iodinated contrast. Considering sustainability alongside clinical factors can help radiology departments reduce environmental impact while maintaining high diagnostic standards. KEY POINTS: Sustainability should be an integral factor when selecting imaging modalities for breast cancer care. Both iodinated and gadolinium-based contrast media show environmental persistence and ecotoxic potential, with iodinated contrast producing a higher total environmental load despite greater removal in wastewater treatment. CEM consumes markedly less energy per examination and produces smaller data volumes than bMRI, reducing its digital and carbon footprint. CEM can be implemented on existing mammography systems, reducing patient travel, exam time, and costs.
Equity, diversity, and inclusion (EDI) are fundamental to achieving fairness and representation in radiological research and practice. This review aims to examine how structural inequities related to race, sex, gender, age, disability, and socioeconomic status shape imaging research, workforce composition, and clinical outcomes. Racial disparities persist through outdated diagnostic assumptions and unequal access to imaging, while the limited representation of minority clinicians in leadership continues to affect research priorities and inclusivity. Similarly, sex and gender inequities also remain, with women being underrepresented in academic and interventional radiology, and transgender and gender diverse individuals often excluded from research and clinical systems. These gaps highlight the importance of inclusive mentorship, equitable leadership opportunities and consistent use of inclusive terminology. Differences in age, disability, and socioeconomic status affect participation and outcomes in imaging research. Older adults, children and people with disabilities are often excluded from imaging datasets, reducing generalisability and limiting the safe application of new technologies such as artificial intelligence. Socioeconomic inequities affect access to timely imaging and distort normative datasets, leading to misinterpretation of results in deprived populations. Inclusive recruitment, adaptive imaging protocols, and explicit consideration of social context in research design are essential to address these disparities. To address this, radiology must prioritise inclusive recruitment, adapt imaging protocols for underrepresented groups, and integrate EDI principles into study design, dataset curation, and peer review. Embedding these practices will enhance scientific validity, ethical integrity, and patient-centred care, ensuring that imaging research truly reflects the diverse populations it serves. CRITICAL RELEVANCE STATEMENT: This review highlights how addressing equity, diversity, and inclusion in radiological research and practice is essential for improving the relevance, accuracy, and fairness of imaging data and emerging technologies across diverse patient populations. KEY POINTS: Persistent gaps in diversity affect fairness within radiological research and clinical practice. Inequities hinder equitable representation and limit the generalisability of radiological findings. Inclusive practices better serve the diverse populations we care for.
There are well-established and widely accepted criteria for determining the presence of excessive myocardial trabeculation (ET) in the left ventricle in patients undergoing cardiac imaging studies. ET has been documented in healthy individuals, as well as in patients with cardiomyopathies. It is also associated with clinical conditions that increase preload and afterload, as well as various neuromuscular and systemic diseases. There is sufficient scientific evidence demonstrating that the development of ET is not due to an embryologic interruption in myocardial compaction. Therefore, the term "ventricular non-compaction" is now outdated, and its classification as an independent cardiomyopathy is discouraged. However, significant controversy remains regarding the clinical relevance of this phenotypic trait and its implications for the management of patients with suspected or diagnosed cardiovascular disease. This review aims to provide a comprehensive and updated overview of current knowledge on myocardial trabeculation, including diagnostic criteria, prognostic implications, and its associations with other conditions, with a particular focus on differences between adult and pediatric populations. Furthermore, it discusses the potential adverse cardiovascular events linked to ET and highlights the importance of differential diagnosis to distinguish myocardial ET from other mimicking conditions. CRITICAL RELEVANCE STATEMENT: This review critically appraises current knowledge on myocardial trabeculation, integrating imaging and clinical perspectives, to clarify diagnostic criteria, highlight differential diagnoses, and improve diagnostic accuracy and clinical decision-making. KEY POINTS: ET does not necessarily represent a pathological imaging finding and may be related to a normal phenotypic trait. Hemodynamic stressors may trigger excessive trabeculation, though its cause and clinical significance remain unclear. Excessive trabeculation imaging must combine with clinical and genetic information for accurate prognostic stratification.
Guidelines recommend MRI before prostate biopsy in men with suspected prostate cancer (PCa). However, real-world data on clinical use are scarce. This study aims to provide comprehensive insight into the nationwide use of pre-biopsy MRI across the Netherlands. Men with biopsy-proven primary PCa diagnosed between 2019 and 2023, were identified through the Netherlands Cancer Registry (main cohort; n = 50,987). A historical cohort included similar cases from 2015 to 2016 (n = 5183). Four MRI-related periods were defined: historical (2015-2016), pre-implementation (2019), implementation (2020), and post-implementation (2021-2023). Mixed-effects logistic regression analyses assessed factors associated with pre-biopsy MRI use and heterogeneity across periods. Inter-hospital variation was quantified using case-mix (age, PSA, clinical disease stage) adjusted hospital-specific probabilities. Pre-biopsy MRI use increased from 17 to 74% between 2015 and 2023. Across all periods (main cohort), men over 70 and those with a PSA > 50 µg/L or cT3-4 disease were significantly less likely to undergo pre-biopsy MRI than younger men, those with PSA < 10 µg/L, or cT1 disease, respectively. Heterogeneity in effect size across periods was observed for all factors except age. Inter-hospital variation was present in all MRI-related periods, although it significantly decreased over time. Estimated 75% midrange rates varied from 9.7-86% (pre-implementation) to 62-88% (post-implementation). Pre-biopsy MRI use in PCa diagnosis has markedly increased and has become more consistent across hospitals. Over time, its use became more targeted, focusing on patients without signs of advanced disease, in accordance with EAU guidelines recommendations. Continued efforts to standardize MRI use may improve equity and optimize patient outcomes. This study evaluates the nationwide implementation of pre-biopsy MRI in PCa diagnosis, revealing increased and more targeted use, demonstrating consistency across hospitals, and providing insights to guide standardization and optimize patient outcomes. Comprehensive population-level data on the uptake of pre-biopsy MRI after implementing guideline recommendations are essential for clinical practice evaluations on a national level. In the Netherlands, these data show an increase in the uptake of pre-biopsy MRI over time, demonstrate consistent patterns across hospitals, and illustrate a shift towards use in patients without advanced disease, aligning with EAU guidelines recommendations. Ongoing efforts to implement and standardize pre-biopsy MRI use in routine clinical practice are critical to promote equity and optimize patient outcomes on a population-based level.
Extraprostatic extension (EPE) significantly impacts surgical planning for prostate cancer (PCa) patients, influencing nerve-sparing surgery and neoadjuvant therapy decisions. However, Likert-scale-based radiological (r)EPE assessment lacks sufficient diagnostic accuracy for reliable clinical decision-making. Therefore, the aim was to evaluate rEPE scoring alongside clinical parameters to develop a clinically feasible decision tree for preoperative risk stratification. This retrospective single-center study included 429 consecutive PCa patients undergoing radical prostatectomy between January 2012 and October 2018. All patients underwent multiparametric MRI with PI-RADS scoring and rEPE grading (grades 0-3). Clinical parameters included PSA density (PSAD) and ISUP grade group (GG) at biopsy. Univariate and multivariate logistic regression identified predictors of EPE. A clinical decision tree was developed using binary classification to stratify patients into risk groups. EPE was confirmed in 145 patients (33.8%). Multivariate analysis identified rEPE grade (OR 2.64, p < 0.001) and GG at biopsy (OR 1.41, p < 0.001) as independent predictors. The decision tree assigned 48% of patients to the high-risk (rEPE grade 3: 89% EPE risk) and low-risk group (rEPE < 3 + PSAD < 0.2 ng/mL² + GG < 4: 13% EPE risk), while 52% showed intermediate risk (28-45% EPE risk). The developed decision tree combining MRI-derived rEPE grading, PSAD, and biopsy GG enables reliable identification of patients at high and low risk for EPE. This tool supports informed decision-making regarding nerve-sparing surgery and neoadjuvant therapy, potentially contributing to personalized treatment planning. Decision tree combining routine MRI-based and clinical markers reliably stratifies prostate cancer patients into high-risk and low-risk groups for EPE, supporting personalized surgical planning. EPE affects surgical planning decisions in prostate cancer patients. Combining EPE grade at MRI, PSAD, and biopsy grade improves risk stratification. The developed decision tree reliably stratified every second patient into distinct EPE-risk groups, potentially improving personalized surgical planning.
To prospectively evaluate the correlation between the attenuation imaging (ATI) parameter and hepatic steatosis in overweight (OW)/obese (OB) children, and to establish normal ATI reference values from a prospectively enrolled cohort of healthy children. A total of 653 prospectively enrolled children were categorized into OW, OB, and normal control groups based on body mass index (BMI). Ultrasonographic hepatic steatosis grading and ATI measurements were independently assessed by two radiologists. Hepatic steatosis was graded visually as none, mild, moderate, or severe. The final study cohort consisted of 97 OW, 292 OB, and 264 control children. Median attenuation coefficient obtained with ATI for normal control group, OW group, and OB group were 0.51, 0.54, and 0.64 dB/cm/MHz, respectively. Statistically significant differences in ATI values were observed among all three groups (all p < 0.001). In the combined OW/OB subgroup, ATI values demonstrated a significant weak to strong positive correlation with age, height, weight, BMI, skin-to-liver distance, serum alanine aminotransferase, aspartate aminotransferase, triglycerides, and uric acid (all p < 0.05). Additionally, ATI values increased stepwise with the severity of hepatic steatosis and showed a statistically significant positive correlation with steatosis grade, with higher grades corresponding to greater ATI values (η² = 0.626, p < 0.001). ATI values exhibit a significant stepwise increase across healthy, OW, and OB pediatric cohorts, and correlate with anthropometric/metabolic profiles and ultrasonographic steatosis severity. This evidence positions ATI as a non-invasive tool to grade severity and monitor treatment response in metabolic-associated steatotic liver disease. ATI shows significant increases across pediatric weight groups, correlating with metabolic profiles and steatosis severity, positioning it as a non-invasive metabolic-associated steatotic liver disease assessment tool. The ATI value increased significantly in a stepwise manner from healthy controls to OW and OB children, confirming its sensitivity to fat-related liver changes. ATI correlates significantly with most metabolic and anthropometric parameters in OW and OB children, suggesting its utility in reflecting metabolic status. ATI values increase progressively with hepatic steatosis severity and show a strong positive correlation with ultrasonographic steatosis grade.
The integration of the multitude of ultrasound techniques into a "one-stop" liver clinic model will revolutionize the management of liver diseases. This approach streamlines patient care by providing immediate imaging assessment, facilitating prompt diagnosis, and expediting treatment plans. The traditional ultrasound methods of B-mode imaging and Doppler techniques have been supplemented by the newer techniques of tissue elastography, fat quantification, and contrast-enhanced ultrasound-termed multiparametric ultrasound. The deployment of these techniques to establish in more detail the underlying status of liver disease has been profound. The encompassing ultrasound techniques have allowed the ultrasound practitioner to establish a comprehensive assessment of liver disease, allowing further accurate management, and negating the need for additional, often more expensive, imaging to establish the diagnosis. This paper explores the implementation, benefits, and challenges of ultrasound-based one-stop liver clinics, emphasizing their impact on patient outcomes and healthcare efficiency. A detailed assessment of the techniques and their position in the diagnostic armamentarium is reviewed with a comprehensive overview established. CRITICAL RELEVANCE STATEMENT: Multiparametric liver ultrasound integrating B-mode, Doppler, CEUS, elastography and fat quantification provides a practical, low-cost one-stop pathway for staging chronic liver disease, assessing portal hypertension surrogates and characterizing incidental lesions, thereby speeding up treatment. KEY POINTS: Ultrasound is the first-line imaging investigation for liver disease, with established criteria on B-mode imaging for steatosis and cirrhosis. Multiparametric ultrasound integrates morphology, hemodynamics, fibrosis, steatosis, and lesion assessment. A one-stop liver ultrasound clinic accelerates decisions and reduces additional imaging.
The pathophysiological changes of lung perfusion and ventilation in fibrosing interstitial lung diseases (F-ILD) remain inadequately characterized. This study aimed to analyze lung perfusion and ventilation characteristics in F-ILD patients using phase-resolved functional lung magnetic resonance imaging (PREFUL MRI) as well as their correlation with the severity of F-ILD. This cross-sectional study prospectively included 30 patients diagnosed with F-ILD (19 males, 64.6 ± 9.5 years) and 30 age- and sex-matched normal controls. All participants underwent PREFUL MRI as well as pulmonary function tests. High-resolution CT (HRCT) was performed for the patient cohort. Ventilation and perfusion-related parameters obtained from PREFUL MRI were analyzed and correlated with PFTs and fibrotic lesions identified on HRCT. Compared with normal controls, F-ILD patients showed significant differences in mean perfusion (7.55% vs 4.60%), Mean Ventilation (13.95% vs 18.65%), Perfusion Defect (QDPexclusive) (3.65% vs 15.50%), ventilation-perfusion matched non-defect percentage (VQMnon-defect) (87.55% vs 70.10%), and ventilation-perfusion matched defect percentage (VQMdefect) (0.15% vs 1.35%) (all p < 0.05). Mean perfusion correlated positively with DLCO SB (single breath) %pred (ρ = 0.682, p < 0.001) and DLCO/VA (alveolar volume) %pred (ρ = 0.634, p < 0.001), while QDPexclusive correlated negatively with these parameters. Mean perfusion showed negative correlations with honeycombing, fibrotic lesions, and total interstitial lesion burden on HRCT, whereas QDPexclusive correlated positively with these abnormalities (all p < 0.05). PREFUL MRI provides a quantitative functional evaluation of ventilation and perfusion in F-ILD patients, demonstrating strong correlations with pulmonary function parameters and fibrotic lesions. It shows potential as a valuable monitoring tool enabling severity assessment of F-ILD. PREFUL MRI provides a non-invasive, free-radiation method in the assessment of ventilation and perfusion in F-ILD, enabling severity evaluation. In patients with F-ILD, lung perfusion decreased, and ventilation increased. Lung ventilation and perfusion correlated with lung function parameters in F-ILD; however, they are similar between idiopathic pulmonary fibrosis (IPF) and other types of F-ILD. After controlling demographics, PREFUL MRI perfusion parameters (mean perfusion and QDPexclusive) remain significant, independent predictors of gas-exchange capacity and fibrotic burden.
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Endometriosis is a complex, multicompartmental disease in which accurately conveying the extent of involvement to the surgical team is essential for preoperative planning and patient counseling. In this context, medical illustrations have gained increasing popularity as a valuable complement to traditional radiology reports. These drawings provide a visual summary of imaging findings, which are often lengthy and challenging to interpret in written form alone. By translating complex imaging data into accessible visual representations, illustrations can enhance communication between radiologists and surgeons, ultimately leading to improved surgical outcomes. Surgeons may also use these illustrations during patient consultations to explain the disease's involvement and the planned surgical approach. They can also be applied to patients conservatively managed to monitor treatment efficacy and clinical evolution. This not only improves patient understanding but also saves valuable time during appointments-time that can instead be dedicated to addressing patient concerns and strengthening the physician-patient relationship. Importantly, in modern, patient-centered care models, individuals are encouraged to take an active role in treatment decisions. By helping patients visualize and better understand their condition, medical illustrations empower them to engage more meaningfully in shared decision-making processes. These visual tools enhance treatment adherence and facilitate a more compassionate and efficient clinical workflow. CLINICAL RELEVANCE STATEMENT: Endometriosis imaging is complex to communicate due to the multifocal nature of the disease and anatomic distortion. Drawings can complement reports, thereby improving surgical planning and patients' understanding while also enhancing radiologist engagement. KEY POINTS: Endometriosis imaging reporting can be complex, and illustrations can help convey its extent in imaging for effective surgical planning. Medical illustrations also offer multiple benefits for patients, surgeons and radiologists. Multiple tools are currently available to assist with creating drawings, eliminating the need for specific artistic skills.
Referring physicians' experiences with imaging coordination remain underexplored. This study compares imaging coordination experiences between general practitioners (GPs) as outpatient referrers and hospital-based physicians as inpatient referrers. A nationwide cross-sectional survey was conducted in Germany (June 2023-June 2024), including 220 physicians in the final analytical cohort (79 GPs, 141 hospital-based physicians). GPs had significantly more professional experience than hospital-based physicians (20 ± 14 vs. 7 ± 9 years; p < 0.001), with no gender differences (p = 0.71). GPs rated the impact of imaging delays on patient care (4.4 ± 1.5) and coordination challenges with radiology services (4.6 ± 1.4) significantly above the neutral midpoint of 4.0 (whereas hospital-based physicians did so only for coordination challenges. Hospital-based physicians preferred real-time workflow tracking (34.8% vs. 9.0%; p < 0.001) and automated reminders of radiological appointments (20.6% vs. 6.5%; p = 0.006), whereas GPs favored centralized scheduling (33.3% vs. 19.2%; p = 0.02) and urgent case prioritization (42.3% vs. 23.4%; p = 0.005). Short-term appointment availability was the highest-ranked priority among the five evaluated categories by referring physicians, accounting for 25.0% of weighted rankings (p < 0.001). Scheduling delays remain a major barrier to timely diagnostics and reflect multifactorial system constraints. Referrer-specific appointment strategies may improve coordination across outpatient and inpatient settings. This survey identifies barriers to radiology appointment scheduling among outpatient and inpatient referrers in German hospital radiology departments, providing a basis for targeted strategies to reduce imaging delays. Short-term availability ranks highest priority across groups of referrers. GPs reported higher perceived impact of imaging delays on patient care than hospital doctors. Referrer preferences vary: GPs favor centralized scheduling. Hospital-based physicians prefer real-time workflow tracking. Referrer-specific interventions may improve perceived reliability of imaging coordination.
Stereotactic radiosurgery (SRS) is widely used for brain metastases, but differentiating tumour progression from radiation necrosis on conventional MRI remains difficult. Percentage signal recovery (PSR), derived from dynamic susceptibility contrast (DSC) perfusion MRI, reflects signal recovery post-contrast and offers insights into capillary permeability. This study aimed to evaluate PSR and relative cerebral blood volume (rCBV) and assess their combined diagnostic value in post-SRS brain metastases. Patients with enlarging post-SRS brain metastases and diagnostic uncertainty were retrospectively included. PSR and rCBV were extracted from DSC-MRI and normalised to contralateral white matter. The dataset was split into training and validation cohorts using stratified sampling. Logistic regression with 5-fold cross-validation and bootstrap validation was used. Diagnostic performance was assessed by ROC analysis. Sixty-one patients (62 lesions; 26 progression, 36 necrosis) were included. Inter-rater reliability was excellent (ICC > 0.90). Progression showed higher rCBV (2.84 vs. 0.76) and lower PSR (95% vs. 176%) (both p < 0.001). Both were significant in univariate analysis; PSR remained independently predictive (p = 0.04) in multivariate analysis. PSR outperformed rCBV and the combined model in ROC analysis (validation AUCs: 0.960, 0.898, and 0.945, respectively), while the combined PSR and rCBV model maintained excellent sensitivity, specificity, and overall accuracy. Bootstrap-derived thresholds were 108% (PSR) and 1.96 (rCBV). A nomogram was developed for individualised risk estimation. PSR and rCBV provide complementary diagnostic information for post-SRS lesion assessment. PSR may offer additional value without requiring extra image acquisition, and integration of both parameters could enhance diagnostic confidence. Routine inclusion of PSR and rCBV in post-SRS imaging protocols could be recommended. This study demonstrates that combining DSC MRI-derived rCBV and PSR improves accuracy and efficiency in distinguishing tumour recurrence from radiation necrosis, offering a practical dual-parameter approach to enhance diagnosis and guide timely clinical decision-making in neurooncology. DSC MRI-derived rCBV and PSR may aid in improving diagnostic accuracy and reducing time-to-diagnosis in post-SRS brain metastases. PSR can be derived from the same DSC acquisition without additional scanning or correction and represents a practical parameter for post-SRS lesion assessment. Combining rCBV and PSR may improve diagnostic confidence, especially in equivocal cases, supporting routine use of this dual-parameter model.
An acute scrotum with a focal intratesticular lesion represents a diagnostic challenge and may lead to misdiagnosis and inappropriate management, such as unnecessary orchidectomy or empirical antibiotic therapy. In an emergency setting of acute scrotal pain, a wide spectrum of underlying conditions may be encountered, including testicular tumors with necrotic changes, abscesses, infarctions, and spontaneous hematomas. The latter are uncommon and frequently underrecognized entities, carrying a significant risk of mismanagement; therefore, particular emphasis is placed on their imaging features. Multiparametric ultrasound (US), including contrast-enhanced ultrasound and shear wave elastography (SWE), combined with multiparametric enhanced magnetic resonance imaging (MRI), plays a pivotal role in establishing an accurate diagnosis and guiding appropriate treatment decisions. This pictorial review illustrates the broad spectrum of focal intratesticular lesions presenting in the context of acute scrotum, emphasizing the role of imaging in differentiating benign conditions-such as spontaneous hematomas, which can be managed conservatively-from malignant tumors requiring prompt surgery. CRITICAL RELEVANCE STATEMENT: Multiparametric ultrasound and MRI improve the diagnostic accuracy of focal intratesticular lesions in acute scrotum, particularly spontaneous hematomas, helping avoid misdiagnosis and unnecessary surgical intervention. KEY POINTS: Acute scrotum associated with a focal intratesticular lesion is a diagnostic pitfall that may lead to inappropriate management, including unnecessary surgery. Multiparametric ultrasound (including CEUS and elastography) and MRI are complementary for distinguishing benign from malignant lesions and guiding management. Spontaneous testicular hematomas are rare benign entities characterized by T1-weighted image hyperintensity with a hypointense core and no enhancement on subtraction imaging, supporting conservative treatment. Lack of internal enhancement and geographic margins are keys for diagnosing segmental infarction, whereas enhancing thickened or nodular walls and increased stiffness suggest necrotic or hemorrhagic tumors; abscesses typically show dominant inflammatory changes with extra-testicular involvement.
Over the last few years, with the introduction of advanced MR imaging techniques, increasing exam demand and the growth of multi-center clinical trials and artificial intelligence (AI)-driven analysis, it has become increasingly difficult to guarantee image quality across time and institutions. Quality Assurance (QA) and Quality Control (QC) programs have therefore become essential. The aim of the survey was to map how MRI QA and QC are implemented in routine clinical practice and, where applicable, in research settings, across Europe, to identify the points where harmonization, coordination, or further education is needed. An anonymous survey was distributed between October and December 2024 through ESR, EFOMP, EFRS member societies and ESMRMB to healthcare professionals, addressing five broad categories: characteristics of participants and their institutions, national MRI QA/QC guidelines/legislation and awareness, local organization for MRI QA, local (institute level) organization for MRI system performance QCs, conventional imaging QCs and qMRI QCs. 269 responses were obtained from 37 different countries. Respondents were radiologists (52%), followed by Medical Physics Experts/Physicists/Engineers (30%), and radiographers (17%). Only a few countries have mandated national legislation addressing MRI QA/QC, while many others rely on voluntary guidelines or lack formal protocols. Most respondents recognized the importance of robust QA/QC programs. There is a strong consensus among respondents on the need for harmonized guidelines from organizations like ESR, multidisciplinary collaboration, and easily accessible training. The European landscape regarding MRI quality is very heterogeneous, with different regulations across countries, and different penetration of MRI QA and QC training and regulation. The European Society of Radiology is optimally positioned with partners to play an active role in the harmonization of MRI quality education and practices across Europe, and we propose the development of a set of recommendations for MRI quality control and assurance. There is scope for raising awareness of both MRI Quality Control (QC) and Quality Assurance (QA) issues and improvement in these fields to ensure patient safety, reduce diagnostic errors, and allow more patients to benefit from MR imaging. Our survey of MRI QA and QC practices across Europe revealed significant heterogeneity in regulations and practices between countries and institutions. There is a widespread lack of awareness and implementation of MRI quality guidelines. The ESR MR Safety and Quality Committee advocates for the standardization and enhancement of MRI quality training for all professionals involved in this issue.