Amyloid deposition increases with age and can involve the brain and multiple body organs, causing heterogeneous clinical syndromes with diagnostic challenges. Imaging is central to the non-invasive detection of amyloid-related tissue changes, guiding subsequent laboratory testing and, when needed, biopsy. In the brain, amyloid positron emission tomography (PET) enables in vivo detection of β-amyloid pathology and Alzheimer’s Disease, whereas magnetic resonance imaging (MRI) remains pivotal for evaluating cerebral amyloid angiopathy, and is increasingly relevant for monitoring amyloid-related imaging abnormalities in patients treated with anti-amyloid agents. In the heart, bone-avid radiotracer scintigraphy (with single-photon emission computed tomography/computed tomography (SPECT/CT) when available), echocardiography and cardiac MRI provide complementary information on morphology, function, and tissue characterization. Across other body organs, computed tomography (CT) and MRI findings are often nonspecific but may suggest amyloidosis in the appropriate clinical context and help target tissue sampling. Recognizing imaging signatures of amyloid deposition and integrating them with clinical and laboratory data is essential for timely diagnosis and personalized management of age-related amyloid disorders.
This narrative review aims to compare the conceptual frameworks of two standardized MRI scoring systems—PI-RADS (Prostate Imaging Reporting and Data System) and VI-RADS (Vesical Imaging Reporting and Data System). Both systems translate multiparametric MRI findings into a shared, clinically actionable language by employing dominant-sequence logic (DWI for peripheral-zone prostate lesions, T2-weighted imaging for transition-zone prostate lesions, and bladder-wall layer assessment anchored to the detrusor line) with DCE serving as a problem-solving sequence. Additionally, this narrative review highlights the quality prerequisites for each system and explores how structured reporting can reduce inter-reader variability. A literature search was conducted using the electronic databases PubMed, Scopus, and Web of Science. The search strategy employed combinations of the following keywords: “PI-RADS,” “VI-RADS,” “multiparametric MRI,” “prostate cancer,” “bladder cancer,” “structured reporting,” and “imaging reporting and data system.” Adherence to PI-RADS and VI-RADS algorithms improves diagnostic accuracy and reproducibility across readers with varying experience levels. Key advances include refinement of dominant-sequence criteria, validation of DCE’s role as a tie-breaker rather than a primary sequence, and development of minimum technical standards for image acquisition. Both systems have shown high negative predictive values for ruling out clinically significant disease, though challenges remain in inter-reader agreement for equivocal (category 3) lesions and in transitioning from expert centers to community practice. Structured reporting using PI-RADS and VI-RADS provides a standardized lexicon that facilitates consistent lesion characterization, reduces unnecessary biopsies, and streamlines multidisciplinary care pathways. Despite differences in target organ anatomy and sequence weighting, both systems share core design principles—dominant-sequence anchoring, binary descriptor checklists, and progressive score escalation with increasing suspicion. Ongoing efforts should focus on validating these systems in prospective cohorts and integrating artificial intelligence tools to further harmonize interpretation. • PI-RADS and VI-RADS translate multiparametric MRI into a shared, clinically actionable 5-point likelihood language. • Dominant-sequence logic is central: DWI dominates peripheral-zone prostate scoring; T2WI dominates transition-zone scoring; DCE is supportive (in PI-RADS primarily for upgrading PZ PI-RADS 3 when positive). • Quality control is non-negotiable: standardized acquisition and on-table rescue of inadequate sequences. prevent “scores by compromise” and improve inter-reader reproducibility. • Structured reporting should state lesion location, size, dominant-sequence findings, and an explicit take-home message aligned with the clinical decision (biopsy, staging, or management). • VI-RADS is anatomically anchored to the hypointense detrusor (muscularis propria) line: focal muscle invasion supports VI-RADS 4, while extension beyond muscle into perivesical fat supports VI-RADS 5. • Considering PI-RADS and VI-RADS as a pelvic MRI toolbox supports harmonized MRI-driven.
Ionizing radiation exposure has increased substantially in older adults due to widespread use of diagnostic imaging and radiotherapy. While carcinogenic risks are well recognized, growing evidence suggests that ionizing radiation may also contribute to neurodegenerative processes in aging populations. This review examines current evidence linking medical and occupational radiation exposure to dementia and Parkinson’s disease in the elderly. Epidemiological studies and meta-analyses report modest but consistent associations between cumulative radiation exposure and increased risks of dementia and Parkinson’s disease, with relative risks of approximately 1.1 per 100 mSv. Experimental studies demonstrate that ionizing radiation accelerates oxidative stress, neuroinflammation, microvascular injury, and impaired DNA repair—mechanisms already compromised in the aging brain. Clinical evidence indicates high rates of cognitive decline following cranial radiotherapy, particularly in patients over 65 years of age. Ionizing radiation may act as an underrecognized contributor to neurodegeneration in older adults. Although absolute risks are modest, their population impact is relevant given widespread exposure. Personalized risk–benefit assessment, strict adherence to radiation protection principles, and increased use of non-ionizing imaging alternatives are essential to preserve neurological health in aging populations.
This review summarizes the recently reported SOUND and related trials results evaluating the implications of axillary imaging on the management of breast cancer patients. Nodal staging in breast cancer management is important for prognosis and treatment planning since lymph node metastasis indicate a higher risk. For the most part, sentinel lymph node biopsy in the axilla has replaced standard lymph node dissection for early-stage breast cancer staging, as shown by the ACSOG Z0011 and CALGB 9343 trials, which showed no significant difference in disease-free and overall survival. Axillary ultrasound is now routine, valued for its accuracy and biopsy guidance, despite varied sensitivity and specificity. When ultrasound of the axilla is combined with needle biopsy, the staging accuracy is enhanced. Recent trials, including NAUTILUS, BOOG 2013-08, SOUND, and INSEMA, investigate excluding axillary surgery in patients who are clinically node-negative and showed no decrement in disease-free survival. MRI, though evolving rapidly, presents mixed results in axillary lymph node evaluation. While promising in certain contexts, MRI shows no significant advantage over ultrasound for routine preoperative evaluation of the axilla in breast cancer patients. The SOUND and INSEMA trials showed that avoiding axillary surgery in appropriate breast cancer patients can be safe without impacting disease-free survival. This shift is consistent with the Choosing Wisely Guidelines, suggesting that advanced imaging techniques and standardized criteria can reduce the need for invasive procedures while at the same achieving enhanced patient results.
Neuroimaging, in particular magnetic resonance, has become a pivotal tool in understanding the pathophysiology of dementia, including Alzheimer’s disease (AD) and non-Alzheimer’s dementias (NAD). Combining structural and functional imaging techniques enables us to identify early brain changes, improve differential diagnosis, and monitor disease progression. This review focuses on the role of magnetic resonance imaging (MRI), especially functional MRI (fMRI), in supporting the clinical diagnosis of AD and distinguishing it from other forms of dementia. Advances in imaging techniques, such as structural MRI and fMRI, have significantly improved our ability to visualize pathological alterations associated with neurodegenerative conditions. While neuroimaging alone cannot provide a definitive diagnosis, it is a fundamental tool for clinicians in managing dementia, particularly in the early stages when clinical manifestations may be minimal or non-specific. MRI also plays a key role in monitoring responses to and side effects of therapies. Our work has focused on evaluating the role of functional MRI in the study of Alzheimer’s disease, particularly in supporting the clinical diagnosis process and differential diagnosis with other types of dementia, as well as how MRI helps to monitor the response to new therapies for Alzheimer’s disease, such as anti-amyloid monoclonal antibodies.
To describe the physiological aging processes of the pancreas, such as increased fat deposition, fibrosis, volume reduction, and to understand these age-related changes with imaging (US, CT, MRI) from birth to senesence. Aging of the pancreas is a physiological process, but certain pathological conditions and lifestyle habits can accelerate this process. Morover, aging of the pancreas represents a factor of developing neoplastic changes with an increasing risk of pancreatic ductal adenocarcinoma (PDAC). Imaging of the pancreas differs significantly between age groups due to physiological changes and the prevalence of certain conditions. In children, the pancreas is generally easier to image with ultrasound and appears homogeneous on CT and MRI. In adults and the elderly, the aging pancreas commonly shows normal structural changes like volume loss, increased fat deposition and fibrosis, visible on US, CT, and especially MRI, which offers better tissue characterization. While imaging reveals these findings, it’s crucial to distinguish these common age/lifestyle changes from pathology like chronic pancreatitis or malignancy precursors.
Inflammatory and infectious diseases of the breast are common with overlapping clinical and imaging features. This comprehensive review outlines the epidemiology, pathogenesis, clinical and imaging features of these conditions including puerperal and non-puerperal periductal mastitis, idiopathic granulomatous mastitis, infected dermal lesions and other uncommon causes of breast infection. Finally, we outline treatment strategies and highlight special considerations for consent and percutaneous intervention in these patients. Treatment of these diseases requires a collaborative, multidisciplinary approach with close clinical follow-up. Apart from idiopathic granulomatous mastitis, the mainstays for treatment have not changed substantially in the previous ten years. A comprehensive diagnostic approach to managing women who present with infectious or inflammatory conditions of the breast is key to making the diagnosis. In many cases, the radiologist acts not only as a diagnostician but plays a major role in treating these patients through percutaneous intervention.
This article will review several cases demonstrating breast imaging findings following the use of glucagon-like peptide-1 (GLP-1) agonists, including the relevant implications in changing breast density and supplemental screening. GLP-1 agonists may be associated with breast changes and symptoms that warrant further breast imaging, including supplemental screening and/or for problem solving in the appropriate clinical scenario. Breast imaging findings following the use of GLP-1 agonists may vary, including both significant and insignificant increases in breast density. Patients with increased breast density may warrant further evaluation with supplemental screening. Following the use of GLP-1 agonists, patients may also present with symptoms warranting further targeted imaging evaluation. Knowledge of the spectrum of breast changes associated with GLP-1 agonists is necessary to adequately assess the need for supplemental screening and/or additional targeted breast imaging.
This review explores the current landscape of AI applications in imaging for TAVR, emphasizing the potential and limitations of these tools for (1) automating the image analysis and reporting process, (2) improving procedural planning, and (3) offering additional insight into post-TAVR outcomes. Finally, the direction of future research necessary to bridge these tools towards clinical integration is discussed. Transcatheter aortic valve replacement (TAVR) has become a pivotal treatment option for select patients with severe aortic stenosis, and its indication for use continues to broaden. Noninvasive imaging techniques such as CTA and MRA have become routine for patient selection, preprocedural planning, and predicting the risk of complications. As the current methods for pre-TAVR image analysis are labor-intensive and have significant inter-operator variability, experts are looking towards artificial intelligence (AI) as a potential solution. AI has the potential to significantly enhance the planning, execution, and post-procedural follow up of TAVR. While AI tools are promising, the irreplaceable value of nuanced clinical judgment by skilled physician teams must not be overlooked. With continued research, collaboration, and careful implementation, AI can become an integral part in imaging for TAVR, ultimately improving patient care and outcomes.
The purpose of this review is to examine the application of various devices used in Left Atrial Appendage Occlusion (LAAO) and to explore the critical role of computed tomography (CT) imaging in the preprocedural planning and postprocedural evaluation of LAAO. Recent findings indicate that multiple devices have been developed for LAAO. Despite these advancements, the deployment of these devices can result in life threatening complications that necessitate careful attention and diagnosis through advanced imaging modalities. LAAO is a sophisticated procedure aimed at minimizing the stroke risk in patients with atrial fibrillation (AF). However, LAAO device deployment can lead to complications that require precise imaging diagnosis. CT imaging is particularly vital for pre-LAAO planning and post-LAAO complication management. This paper reviews the use of various LAAO devices and the essential role of CT imaging in ensuring procedural success, device selection and placement, and patient safety.
It has been 20 years since four-dimensional computed tomography (4DCT) was adopted in radiation oncology. By acquiring respiratory-correlated CT images, 4DCT allows characterization of tumour motion during radiotherapy target delineation. This technology has improved tumour delineation accuracy, in fact, it is now considered essential for highly conformal, high radiation, and precise radiotherapy treatment delivery. Nevertheless, due to the sampling of irregular patient breathing cycles, 4DCT suffers from image artefacts that can compromise tumour delineation accuracy. Addressing this challenge has been the driving motivation behind the latest advancements in 4DCT implementations. The purpose of this review is to provide a practical overview on 4DCT technology, its developments, and how it is used in radiation oncology. The most significant hardware advancement in helical CT scanner technology has been the increase of CT-slices from 16 to 256/320-slice, allowing faster scan times. In terms of software developments, reconstruction algorithms have greatly improved, and a multitude of artefact reduction techniques has been demonstrated to be beneficial—though not all are commercially available. Nowadays, it is possible to significantly reduce artefacts to nearly non-discernible levels. This is achievable through recent innovations in 4DCT which merge advanced hardware and software tools to implement patient-specific models that account for breathing irregularities to efficiently acquire high-integrity CT data. This article provides a practical review of how 4DCT technology has evolved in radiation oncology, from both a technical and logistical point of view.
Architectural distortion (AD) of the breast is a problematic imaging finding because it is difficult to perceive since it mimics the fibroglandular tissue. AD is the third most common form of presentation of breast cancer in mammography, only preceded by masses and calcifications. Once AD is detected and determined to be a candidate for a biopsy, it is necessary to know the biopsy options available, with the preferred biopsy method being image-guided biopsy. Furthermore, the differential diagnosis for AD is broad, and it is crucial to perform pathology-radiological correlation post-biopsy. There is controversy regarding the management of AD when the histopathological diagnosis is a radial scar or complex sclerosing lesion. An option for management includes recommendations based on the size of the lesion and the presence or absence of atypia. This article will review the spectrum of imaging presentation of breast AD, biopsy recommendations, and management options.
The article represents the value of imaging including conventional multidetector computed tomography (MDCT) and dual-energy computed tomography (DECT) in the evaluation and diagnosis of various pathologies associated with acute abdominal pain in the elderly population. Advances in DECT have dramatically improved the diagnostic value of CT. The various post-processing techniques offer diagnostic capability for different pathologies, not inherently available when solely using conventional MDCT. Additionally, DECT serve a complimentary role increasing confidence of the radiologist to reach an accurate diagnosis. The geriatric population is vastly growing with visits to the emergency department increasing over time. This subset of the population exhibit higher rate of mortality approximately reaching 10
Purpose of Review This article will review several cases of histologically-proven primary and secondary breast lymphomas to demonstrate the multimodal radiologic features, as well as to discuss the approach to diagnostic work up of lymphomas encountered during imaging of the breast and axilla. Recent Findings Imaging findings of breast lymphoma can overlap with those of primary breast cancer. When there is any clinical suspicion for lymphoma in indeterminate or suspicious breast or axillary findings, definitive tissue diagnosis should be pursued with flow cytometry in addition to routine histologic analysis. Summary Breast lymphomas can have varied clinical presentations and nonspecific mammographic and sonographic findings. It can be challenging to radiologically differentiate lymphomas seen in the breast and axilla from primary breast cancers or benign lesions. Without pathognomonic imaging features, tissue sampling via imaging guided biopsy is frequently required. Knowledge of the spectrum of imaging findings and clinical presentations are fundamental to ensure appropriate clinical management.
Purpose of Review To describe the difference between recurrent and primary breast cancer, define and review the expected breast imaging findings after breast conservation therapy and oncoplastic reconstruction, provide current imaging recommendations for patients with a personal history of breast cancer, and provide a case-based review of imaging features of breast cancer recurrence on mammography, sonography, magnetic resonance imaging, contrast-enhanced mammography, and molecular breast imaging after breast conservation therapy. Recent Findings An increasing number of patients undergo breast conservation therapy due to the evolution of breast cancer treatment. New functional imaging modalities, such as contrast-enhanced mammography and molecular breast imaging, have recently become part of the expanding repertoire of breast imaging modalities that can be utilized in screening patients after breast conservation therapy. Summary As surgical techniques for breast cancer have evolved, more patients are undergoing breast conservation therapy with oncoplastic reconstruction. Accurate and prompt diagnosis is critical in guiding the appropriate management of breast cancer recurrence as it impacts treatment decisions, prognosis, and patient outcomes. Breast radiologists should have knowledge of expected postoperative imaging findings and of findings that are suspicious for recurrence on all available breast imaging modalities.
This article addresses the complexities involved in targeted ultrasound for lesions identified in mammograms and MRIs. We aim to provide clarity and guidance in performing targeted ultrasound by utilizing simple schematics and adopting a case-based approach. Targeted ultrasound is a vital component of diagnostic breast imaging, particularly for nonpalpable abnormalities detected on mammograms. In addition, with the increasing use of MRI in high-risk screening and staging breast cancer, second-look ultrasound is increasingly employed to evaluate incidental findings from MRI and guide tissue sampling, offering cost, availability, and patient comfort advantages. While the accuracy and technical aspects of second-look ultrasound for MRI-detected enhancements have been extensively examined, less attention has been given to targeted ultrasound for mammographically detected lesions. Accurately targeting nonpalpable lesions presents challenges due to the differences in patient positioning and breast compression between mammography, MRI, and ultrasound. Mental fallacies, mainly caused by the non-orthogonal tube angling in mammography, can cloud judgment and impact targeting accuracy. This article provides forthright explanations and practical solutions for accurately targeted ultrasounds on nonpalpable lesions found in mammograms and MRIs. It utilizes diagrams and everyday case examples to illustrate the concepts effectively. The goal is to offer practical solutions that can be readily applied in real-world scenarios.
Purpose of Review This review aims to consolidate knowledge and recent research findings related to the potential clinical applications of dual-energy computed tomography (DECT) for the identification and characterization of bone lesions. The purpose is to explore the advantages of DECT over traditional imaging techniques in musculoskeletal radiology, particularly in the context of oncologic care for cancer patients. Recent Findings DECT has emerged as a state-of-the-art imaging technique that offers significant benefits in the detection and assessment of skeletal lesions. It provides improved sensitivity in identifying hidden lesions, including metastatic ones that are often concealed within the marrow space. DECT's advanced technology enables material decomposition and color-coded overlays, allowing for the differentiation of various types of soft tissue mineralization and the evaluation of bone marrow edema and infiltrative skeletal neoplasms. Furthermore, DECT can aid in distinguishing between malignant and benign skeletal lesions, providing valuable diagnostic information for treatment planning and patient care. Summary Dual-energy computed tomography (DECT) is a promising tool in musculoskeletal radiology, particularly for oncologic care and disease staging in cancer patients. DECT's ability to differentiate, enhance, or suppress various types of tissues through material decomposition and spectral data analysis makes it a valuable imaging technique for identifying and characterizing bone lesions. With its advanced technology, DECT offers improved sensitivity in detecting hidden lesions and provides valuable diagnostic information without increasing radiation exposure. By addressing the limitations of other imaging modalities, DECT has the potential to enhance patient care and improve outcomes in the field of musculoskeletal radiology.
Purpose of Review The purpose of this paper is to review a novel technique for stereotactic-guided breast biopsies utilizing the lateral arm approach. Recent Findings Successful stereotactic-guided biopsies require careful consideration of lesion location and patient anatomy. Cases that cannot be safely performed are often referred for surgical biopsy, which can increase patient anxiety and delay diagnosis. The lateral arm approach provides an alternative needle approach for biopsy that can mitigate some of the most common exclusion criteria for standard techniques. Although there are many benefits to the lateral arm approach, it has not yet been widely adopted. This article reviews the lateral arm approach, including patient selection, procedural technique, advantages, and disadvantages. Case examples utilizing the technique will also be discussed to illustrate our institutional experience (including procedural tips) and how the lateral arm approach can be integrated into breast imaging practice. Summary The lateral arm approach can expand the patient population that can undergo stereotactic-guided breast biopsy, which may obviate the need for surgical biopsy or short-term follow-up. The technique also allows for a creative approach to biopsy in challenging cases. Proficiency with the lateral arm approach can expand a breast imager’s interventional skills, improve patient care, and allow for more expedient diagnosis of suspicious breast findings.
Purpose of Review This article aims to review some of the recent advances and utilization of different CT techniques in the assessment of major neurovascular emergences such as acute ischemic stroke, traumatic brain injuries, blunt cerebrovascular injuries, ruptured intracranial aneurysms, ruptured arteriovenous malformation, and cerebral venous thrombosis, which constitute a large number of patients presenting to the emergency room. Recent Findings Many advanced imaging techniques have been developed in the past two decades aiming to improve the diagnosis of neurovascular emergencies, including CT angiography, CT perfusion, dual-energy CT, subtraction CTA, and imaging-related artificial intelligence. Summary Reviewing and understanding the concepts and interpretation of new imaging techniques will help improve the diagnostic yield and provide prompt information vital for the triage and management of patients. Advanced, accurate, safe, and cost-effective imaging techniques are required to expedite the diagnosis and patient management process to achieve the best possible clinical outcomes.
