Abstract:The increasing complexity of interventional radiology procedures, combined with limited anesthesiology resources, makes it essential for interventional radiologists to independently provide safe and effective sedation and analgesia. To ensure responsible and timely patient care, a structured and comprehensive development of these competencies within interventional radiology is necessary. While established guidelines and training curricula exist in fields like gastroenterology and cardiology, comparable standards are still lacking in German-speaking countries for radiology. This position paper highlights the urgent need to develop a unified curriculum for sedation and pain management tailored to interventional radiology. This curriculum should be integrated into specialist and assistant training programs. Beyond clinical education, the availability of adequate infrastructure, standardized workflows, clear documentation, and emergency protocols are critical for ensuring patient safety. Collaboration with anesthesiology departments, particularly in complex or deep sedation cases, remains indispensable. Sedation performed by radiology teams is not intended to compete with anesthesiology, but rather to augment patient care capacity in a structured and safe manner. Expanding these competencies strengthens the autonomy of interventional radiology, supports the broader trend toward outpatient care, and enables timely, efficient, and comfortable procedures. This represents an important step in establishing interventional radiology as an independent clinical discipline actively involved in patient treatment. Key Points:· Growing need for autonomous analgosedation in IR - The increasing complexity of interventional radiology procedures combined with limited anesthesiology capacity makes competent sedation and analgesia performed by the IR team itself essential for timely and patient-centered care.. · International evidence supports safety and feasibility - Multiple guidelines (CIRSE, ASA, ESAIC, RCR) and recent studies - including CT-guided brachytherapy and percutaneous tumor ablation - confirm that non-anesthesiologist-administered sedation can be performed safely and effectively.. · Clear risk stratification and sedation boundaries - Minimal and moderate sedation in ASA I/II patients can be independently performed by trained interventional radiologists; deep sedation remains the domain of anesthesiologists or intensivists. Standardized patient selection and pre-procedural risk assessment are mandatory.. · Infrastructure, training, and documentation as minimum requirements - Standardized operating procedures, continuous monitoring, dedicated sedation personnel, regular simulation-based training, and structured post-procedural care - including a recovery unit and discharge management - are non-negotiable prerequisites.. · Urgent need for binding standards in the DACH region - While internationally established guidelines exist, comparable mandatory curricula and standards for IR are currently absent in German-speaking countries. This position paper provides the first practice-oriented recommendations and calls for the rapid development of competency frameworks within IR departments.. Citation Format:· Minko P, Auer TA, Gebauer B et al. Analgosedation in interventional radiology. Rofo 2026; DOI 10.1055/a-2863-2198.
Purpose:Differentiating malignant from benign peripheral nerve sheath tumors (PNSTs) is challenging due to overlapping imaging features. To develop and internally validate an MRI-based model to differentiate malignant from benign PNSTs and guide biopsy decisions. Materials and methods:We retrospectively analyzed 139 consecutive adults with histologically proven PNSTs (121 benign, 18 malignant) discussed at a tertiary referral tumor board (2015-2024). Pre-treatment MRI examinations were independently assessed by two experienced musculoskeletal radiologists blinded to clinical and histopathological data. Based on prior knowledge and sample size limitations, a parsimonious logistic regression model was prespecified, including tumor volume, presence of a well-defined margin, and presence of cystic degeneration. Model performance was evaluated for discrimination, calibration, and clinical utility, with internal validation using 500 bootstrap resamples and uniform shrinkage. Results:Malignant tumors were substantially larger, less often well-circumscribed, and more frequently cystic than benign lesions. The final three-predictor model demonstrated good discrimination (area under the curve [AUC] 0.944; optimism-corrected 0.936). At a 20% biopsy threshold, the model would prevent 68 unnecessary biopsies per 100 patients while missing three malignancies. Findings were robust in sensitivity analyses. Conclusion:A simple MRI-based model using three available features - tumor volume, margin definition, and cystic change - distinguished malignant from benign PNSTs with high accuracy. This proof-of-concept provides a practical framework for biopsy decision-making and merits external validation in multicenter cohorts. Key Points:· A simple MRI-based model estimates malignancy risk in peripheral nerve tumors.. · The model combines tumor volume, margin irregularity, and cystic degeneration.. · An internally validated model may help prioritize biopsy decisions in specialized centers.. Citation Format:· Ghali Gataa K, Dabrowska K, Kader M et al. MRI-based prediction of malignancy in peripheral nerve tumors: model development and internal validation in a biopsy-confirmed cohort. Rofo 2026; DOI 10.1055/a-2852-8884.
Purpose:To evaluate imaging features and clinicopathologic correlation in florid reactive periostitis (FP) and parosteal osteosarcoma (PO), emphasizing diagnostic pitfalls in surface bone lesions. Patients and Methods:Four patients (two FP, two PO) underwent radiography, CT, and MRI, including dynamic contrast-enhanced sequences in selected cases. Histopathology with immunohistochemical analysis of MDM2 and CDK4, including gene amplification testing, was performed in all cases. Results:FP demonstrated solid or layered periosteal reaction, soft-tissue swelling, and bone marrow edema without atypia or MDM2/CDK4 amplification. PO presented as lobulated ossified masses with cortical attachment or cleavage plane and positive MDM2/CDK4 expression. DCE-MRI showed overlapping enhancement patterns and did not reliably differentiate the entities. Conclusion:Differentiation between FP and PO requires careful evaluation of conventional imaging features combined with histopathological confirmation. Multidisciplinary assessment remains essential to prevent diagnostic overtreatment or undertreatment. Key Points:· FP may mimic PO on MRI. · Cleavage plane favors parosteal osteosarcoma. · DCE-MRI shows overlapping enhancement patterns. · MDM2/CDK4 are essential in equivocal cases. Citation Format:· Igrec J, Stranger N, Puseljic M et al. Imaging Pitfalls in Surface Bone Lesions: Florid Reactive Periostitis Mimicking Parosteal Osteosarcoma - A Multimodality Case Series. Rofo 2026; DOI 10.1055/a-2864-1949.
Purpose:To retrospectively evaluate the diagnostic performance and confidence of photon-counting computed tomography (PCCT) for detecting bone marrow edema (BME) in trauma patients, using magnetic resonance imaging (MRI) as the reference standard. Materials and Methods:In this exploratory, bone-region-level analysis, a selected pilot cohort of ten patients (mean age 56.2 years, 80% female) underwent both PCCT and MRI of peripheral joints within a 10-day interval. A total of 123 bone regions across the knee, pelvis/hip, wrist/hand, and elbow were analyzed. Two readers, blinded to clinical and MRI findings, independently assessed BME on PCCT using color-coded maps and standard images, recording diagnostic confidence on a 5-point Likert scale. MRI served as the reference for BME. Sensitivity, specificity, predictive values, accuracy, and interrater agreement (weighted Cohen's κ) were calculated. Results:BME was present in all patients and in 28.5% (35/123) of bone regions on MRI. For PCCT, Reader 1 achieved a sensitivity of 0.63 (95% CI: 0.46-0.77), specificity of 0.97 (0.90-0.99), and accuracy of 0.87 (0.80-0.92) and Reader 2 achieved a sensitivity of 0.57 (0.41-0.72), specificity of 0.97 (0.91-0.99), and accuracy of 0.85 (0.78-0.91). Diagnostic specificity exceeded 0.93 across all joints, with the highest sensitivity in the knee. Inter-rater agreement was substantial (κ = 0.74). Both readers reported high diagnostic confidence. Reader 1 showed significantly higher confidence in correct classifications (p = 0.0017), whereas Reader 2 showed no significant difference between correct and incorrect classifications (p = 0.89). Conclusion:PCCT showed high specificity but only moderate sensitivity for BME detection at the bone-region level, particularly in large joints. These preliminary findings suggest that the high specificity of PCCT may support confirmation of BME in selected clinical scenarios when MRI is unavailable, contraindicated, or redundant. However, moderate sensitivity requires continued clinical vigilance and MRI confirmation for negative or equivocal findings. Larger validation studies are warranted. Key Points:· PCCT shows high specificity for bone marrow edema detection. · Moderate sensitivity of PCCT limits standalone clinical use. · First multi-joint bone-region evaluation in a selected cohort of mainly trauma patients. · Substantial interrater agreement supports feasibility. · Positive PCCT findings are highly specific for BME; negative findings require MRI confirmation. Citation Format:· Shahzadi I, Reimann G, Schneider C et al. Exploratory Evaluation of Photon-Counting CT for Bone Marrow Edema Detection Across Multiple Joints: A Pilot Study. Rofo 2026; DOI 10.1055/a-2888-7989.
Purpose:To investigate volumetric alterations of the basal ganglia and thalamus in patients with Parkinson's disease (PD) and to evaluate the relationships between regional brain volumes, motor symptom severity, and cognitive performance. Materials and Methods:60 patients with PD (20 females, 40 males) and 51 age-matched healthy control participants (26 females, 25 males) were included. Patients with PD were classified according to initial motor phenotype (tremor-dominant vs. bradykinetic-rigid) and cognitive status based on Mini-Mental State Examination (MMSE) scores (21-26 indicating cognitive impairment; ≥27 indicating normal cognition). High-resolution three-dimensional T1-weighted SPGR MRI data were analyzed using the VolBrain automated segmentation pipeline to obtain volumetric measurements of the putamen, caudate nucleus, globus pallidus, and thalamus. All volumetric measures were normalized to total intracranial volume (TIV). Associations between regional brain volumes and Unified Parkinson's Disease Rating Scale (UPDRS) sub-scores were assessed. Results:The mean age of the PD group was 61.2 ± 11.2 years, compared with 60.4 ± 12.0 years in the control group. Right (p = 0.001), left (p = 0.002), and total (p = 0.004) putamen volumes were significantly reduced in patients with PD relative to controls. No significant differences were observed in thalamic volumes between groups (p > 0.05). Within the PD cohort, individuals with MMSE-defined cognitive impairment exhibited significantly smaller thalamic volumes than cognitively normal patients (right: p = 0.002; left: p = 0.001; total: p = 0.001). UPDRS-III scores showed significant negative correlations with putamen volumes (right: r = -0.42, p = 0.001; left: r = -0.43, p = 0.001; total: r = -0.42, p = 0.001), while UPDRS-I scores were negatively correlated with thalamic volumes (right: r = -0.31, p = 0.016; left: r = -0.29, p = 0.041; total: r = -0.30, p = 0.015). Conclusion:Putamen volume reduction is associated with motor dysfunction in PD, whereas thalamic volumetric changes are more closely related to cognitive impairment. TIV-normalized automated MRI volumetry may provide complementary neuroimaging biomarkers for assessing disease severity and monitoring clinical progression. Key Points:· Basal ganglia and thalamic volumes show distinct patterns in Parkinson's disease.. · Putamen volume reduction is associated with motor symptom severity.. · Thalamic volume changes are associated with cognitive impairment in PD.. · TIV-normalized VolBrain-based volumetric MRI analysis may support clinical disease assessment.. Citation Format:· Yıldız H, Atalay B, özdilek b. Basal Ganglia and Thalamic Volumes as MRI Markers of Motor and Cognitive Dysfunction in Parkinson's Disease. Rofo 2026; DOI 10.1055/a-2871-1475.
Purpose:This study aimed to investigate morphological features on magnetic resonance cholangiopancreatography (MRCP) that may help distinguish benign from malignant causes of isolated main pancreatic duct (MPD) dilation detected without a visible mass or obstructive pathology, and to propose a management strategy applicable in clinical practice. Materials and Methods:Ninety-two patients with isolated MPD dilation detected on MRCP at our institution between November 2015 and March 2025 were retrospectively evaluated. The following MRCP parameters were assessed: maximum pancreatic duct diameter, location of dilation, dilation pattern, presence of duct stricture and stricture segment length with termination pattern if present, parenchymal atrophy, pancreatic duct anomalies, common bile duct-pancreatic duct junction configurations, and presence of branch duct dilation or cysts. Results:Cases were classified as benign in 85.9% (n=79) and malignant in 14.1% (n=13). Stricture segment length was significantly greater in the malignant group, with a median of 7.0 mm (Q1-Q3: 5.0-12.0) compared to 3.7 mm (Q1-Q3: 2.5-7.0) in the benign group. Although branch duct dilation/cyst size was larger in the malignant group (median: 9.6 mm vs. 6.8 mm), this difference was not statistically significant (p > 0.05). Regarding dilation location, the segment with maximum dilation was predominantly at the pancreatic neck in malignant cases (53.8%), whereas the pancreatic head was predominant in benign cases (88.6%). Stricture termination patterns differed significantly between groups: abrupt termination predominated in malignant cases (88.9%), while tapering termination was more frequent in the benign group (72.7%). Conclusion:MRCP is a valuable non-invasive tool for the further characterization of isolated MPD dilation. Findings such as increased stricture segment length (≥7 mm), dilation localized to the pancreatic neck, and abrupt stricture termination may help distinguish malignant from benign causes. These morphological features may support clinical decision-making when determining the need for further invasive investigations. Key Points:· Stricture segment length ≥7 mm and abrupt duct termination are significant morphological features suggestive of malignancy in isolated MPD dilation.. · Maximum dilation localized to the pancreatic neck may raise suspicion for an underlying malignancy, though further validation is required.. · MRCP serves as a valuable adjunct in the diagnostic work-up of pancreatic duct changes, potentially helping to identify cases that require invasive investigations such as Endoscopic ultrasound (EUS) or surgical consultation.. · Serum biomarkers (CA 19-9, CEA) showed no significant difference between benign and malignant groups, highlighting the importance of morphological evaluation.. Citation Format:· Çınar E, Uysal FT, Gürbüz AF et al. Evaluation of MRCP Findings in Distinguishing Benign from Malignant Causes of Isolated Main Pancreatic Duct Dilation. Rofo 2026; DOI 10.1055/a-2863-2316.
Purpose:To evaluate MRI findings of the extensor mechanism - including tendinopathy, fat pad edema, and enthesophytes - in patients with varying grades of trochlear dysplasia (TD), and to investigate the relationship between TD severity, TT-TG distance, and patellofemoral maltracking. Materials and Methods:This retrospective cross-sectional study included 138 knees from 127 patients with MRI-confirmed TD. TD was graded on axial images using the Dejour classification (types A-D) and grouped as low-grade (type A) or high-grade (types B-D). TT-TG distances and lateral trochlear inclination (LTI) angles were measured on axial MRI. Extensor mechanism findings, including quadriceps and patellar tendinopathy, fat pad edema, insertional bone marrow edema, and enthesophytes, were assessed and compared across TD grades. Statistical analyses included chi-square, Mann-Whitney U, and Spearman correlation tests. Associations between TD severity and MRI findings were further evaluated using generalized estimating equation (GEE) models adjusting for age and sex, with additional models including TT-TG distance and LTI angle to assess independence from maltracking parameters. Results:Increasing TD severity was associated with a greater TT-TG distance and lower TI angle (both p <0.001). In multivariable analysis, increasing TD severity was independently associated with distal quadriceps tendinopathy (OR = 2.19 per grade increase, 95% CI: 1.41-3.41; p <0.001), and this association remained significant after adjustment for TT-TG distance and LTI angle (OR = 1.11 per grade increase, 95% CI: 1.02-1.21; p = 0.012). No independent association was observed between TD severity and other extensor mechanism findings. Superior pole enthesophytes were associated with age rather than TD severity. Conclusion:In conclusion, higher-grade trochlear dysplasia is associated with a greater TT-TG distance, a lower LTI angle, and a higher likelihood of distal quadriceps tendinopathy. Trochlear dysplasia is associated with a greater TT-TG distance and lower LTI angle. In addition, increasing TD severity is independently associated with distal quadriceps tendinopathy. These findings suggest that trochlear morphology may contribute to extensor mechanism stress beyond geometric maltracking parameters and highlight the role of MRI in detecting secondary soft-tissue changes in patellofemoral malalignment. Key points:· Increased trochlear dysplasia severity independently correlates with distal quadriceps tendinopathy prevalence.. · Higher-grade dysplasia significantly associates with an increased TT-TG distance and a lower LTI angle.. · Superior pole enthesophytes correlate primarily with patient age rather than dysplasia grade.. Citation Format:· Peker AA, Yılmaz TF, Akçay A et al. MRI Findings of the Extensor Mechanism According to Trochlear Dysplasia Grade. Rofo 2026; DOI 10.1055/a-2854-8806.
Purpose:Artificial intelligence is increasingly integrated in clinical practice. In radiological imaging, deep-learning (DL)-based image reconstruction techniques show potential for accelerating and enhancing the quality of examination procedures in magnetic resonance imaging (MRI). This study evaluated the impact of DL on MRI workflows and protocols over a one-year period following clinical implementation. Materials and Methods:This retrospective, single-center study included 8,183 MRI examinations performed between 2023 and 2024 to assess daily examination volume, examination duration, and rates of repeated and aborted scans. Furthermore, 43 comparable sequences and 34 protocols on a 1.5T MRI (Siemens Magnetom Sola) were analyzed and surveys were conducted among 23 medical staff members to evaluate the perceived effects of DL on workflow efficiency, diagnostic performance, stress levels, and technology acceptance. Results:88% of the DL-reconstructed sequences demonstrated reduced acquisition times, yielding an overall 13% reduction in protocol duration, despite higher resolution or reduced slice thickness. On days without anesthesia support, the average examination time decreased by 11%, accompanied by increased patient throughput (+7.2%) and fewer repeats (-25%) and aborts (-100%). Medical staff reported high levels of technology acceptance (90%), perceived improvements in image quality (90.5%), and reduced stress levels. Shorter times required for generating medical reports were noted by 45.5% of respondents, particularly among residents (70%). Conclusion:DL enables significant potential for MRI-workflow optimization and protocol improvements, while maintaining high staff satisfaction, thereby highlighting the great potential of DL in radiology practice. Key Points:· While maintaining or increasing image quality, DL reduced examination duration (-11%) and protocol length (-13%).. · Patient throughput increased (+7.2%), while repeats (-25%) decreased.. · Staff reported high technology acceptance, lower stress and faster report generation, particularly residents.. Citation Format:· Rizzetti M, Michael AE, Almansour H et al. Impact of Deep-Learning Reconstruction on MRI Workflows: A Retrospective Analysis at a Large Academic Tertiary Center. Rofo 2026; DOI 10.1055/a-2857-0974.
Objectives:Magnetic particle imaging (MPI) is a tracer-based imaging modality enabling radiation-free visualization of superparamagnetic iron oxide nanoparticles with high temporal resolution. Despite extensive preclinical development, in-vivo application in humans has not previously been reported so far. This study aimed to demonstrate the feasibility of first-in-human MPI angiography and to compare it with conventional X-ray digital subtraction angiography (DSA). Materials and Methods:A first-in-human MPI angiography was performed in a healthy volunteer using a human-scale interventional MPI scanner and clinically approved ferucarbotran tracer. Imaging of the upper extremity veins was conducted under clinical angiography laboratory conditions with continuous physiological monitoring. Conventional DSA of the same region was performed under identical procedural conditions for direct comparison. MPI data were acquired in real time with 2 frames per second and co-registered with DSA images. Results:MPI successfully visualized major superficial and deep veins, including inflow, branching patterns, venous valve filling, collateral pathways, and tracer clearance dynamics. Spatial and temporal visualization was comparable to DSA for clinically relevant vascular structures. No adverse events occurred, and safety monitoring remained unremarkable throughout the procedure. Conclusions:This first in-vivo human demonstration shows that MPI enables real-time, radiation-free angiographic visualization of vascular structures with clinically relevant temporal resolution. MPI has potential as a novel imaging modality for selected vascular and interventional applications and represents an important step toward clinical translation. Key Points:· First in-human magnetic particle imaging angiography demonstrated feasibility. · Real-time vascular imaging without ionizing radiation achieved. · Comparable visualization to digital subtraction angiography. · Potential for interventional and vascular clinical applications. Citation Format:· Vogel P, Kampf T, Rückert MA et al. First In-vivo Human Magnetic Particle Imaging. Rofo 2026; DOI 10.1055/a-2856-9878.
Purpose:Abdominal aortic aneurysm (AAA) is a progressive vascular disease associated with high morbidity and mortality. Translational imaging and interventional research are limited by the availability of standardized large-animal models. This exploratory study compared different endovascular and pharmacological strategies for AAA induction in swine and characterized associated morphological and inflammatory vessel wall changes. Materials and Methods:19 female German Landrace swine were enrolled, with 18 included in the final analysis (n = 3 per group). Animals were assigned to five intervention groups and one untreated control group. Interventions comprised combinations of mechanical aortic dilation, intra-aortic administration of collagenase (6,000 IU), elastase (500 IU), calcium chloride (CaCl2, 25%; group-specific dosing), and oral β-aminopropionitrile (BAPN; 0.05-0.15 mg/kg). Aortic diameter changes and molecular markers of inflammation and vascular remodeling were assessed. Given the limited group size, analyses were considered exploratory and hypothesis-generating. Results:Mechanical dilation combined with enzymatic and CaCl2 exposure resulted in the largest mean increase in aortic diameter (1.63 ± 0.25 cm vs. 0.61 ± 0.04 cm in controls). This group was associated with increased Galectin-3 expression (89.69 ± 7.02%). BAPN alone was associated with smaller aortic dilations (0.73 ± 0.06 cm) and marked reduction of vascular smooth muscle cell markers, including α-smooth muscle actin (23.50 ± 4.82%), consistent with active extracellular matrix remodeling. Conclusion:Within this exploratory large-animal setting, combined mechanical and enzymatic injury was associated with more pronounced structural remodeling compared to isolated approaches, whereas BAPN predominantly induces early vessel wall degeneration. The graded phenotypes observed across groups provide a comparative framework for future preclinical imaging-based and interventional AAA research. Key Points:· The porcine models enable comparative preclinical investigation of graded abdominal aortic aneurysm phenotypes.. · Combined mechanical dilation and enzymatic injury is associated with more pronounced structural remodeling in swine.. · Greater structural remodeling is accompanied by increased macrophage-associated inflammatory markers.. · Vascular smooth muscle cell markers are reduced in association with vessel wall degeneration.. Citation Format:· Ranner-Hafferl M-LHH, Mangarova DB, Heyl JL et al. Characterization of Aortic Degeneration and Inflammatory Profiles in Porcine Models of Abdominal Aortic Aneurysm. Rofo 2026; 10.1055/a-2854-8724.
Purpose:The diagnosis of primary sclerosing cholangitis remains difficult, particularly in the absence of typical bile duct strictures. This study aims to assess the diagnostic performance of MRI T1 and T2 mapping with regard to differentiating PSC patients from matched controls. Materials and Methods:In this IRB-approved study, we retrospectively included all patients with primary sclerosing cholangitis who underwent multiparametric MRI with T1 and T2 mapping (1.5T and/or 3T) between 09/2018-05/2020 at our institution. Sex-, age-, and field strength-matched patients were selected, without focal or diffuse liver disease and without significant liver steatosis, based on a proton density fat fraction <10%. T1 and T2 relaxation times were compared between patients and controls using a paired Wilcoxon test. Receiver operating characteristic (ROC) curve analysis was performed for the T1 and T2 relaxation times at 1.5T and 3T to discriminate between PSC and non-PSC patients. The cut-off corresponding to the highest Youden index was selected as the optimal threshold. Results:A total of 132 MRI exams were included: 66 from PSC patients (29 at 1.5T and 37 at 3T), and 66 age-, sex-, and field strength-matched controls. The T2 relaxation time was significantly higher in PSC patients at 3T (38 ms [35-40 ms] vs. 35 ms [31-38 ms]) and 1.5T (53 ms [51-57 ms] vs. 50 ms [46-54 ms]). The T1 relaxation time was significantly higher in PSC patients at 3T (830 ms [793-898 ms] vs. 808 ms [745-864 ms]; p=.01), but not at 1.5 T (620 ms [576-658 ms] vs. 583 ms [544-645 ms]; p=.23). The highest diagnostic performance was observed with T2-weighted sequences at 1.5T (AUC = 0.69, p = .013), followed by T1-weighted sequences at 3T (AUC = 0.65, p = .024). T1-weighted imaging at 1.5T showed a trend toward significance (AUC = 0.64, p = .070), while T2-weighted imaging at 3T did not demonstrate significant discriminative ability (AUC = 0.55, p = .433). For parametric T2 mapping at 1.5T, a >47 ms cut-off showed high sensitivity (89.7%) and moderate specificity (48.3%). For parametric T1 mapping at 3T, a >869 ms cut-off showed high specificity (89.2%) but lower sensitivity (40.5%). Conclusion:MRI T2 relaxation times were significantly increased in PSC patients both at 3T and 1.5T, while T1 relaxation time was significantly increased at 3T, but not at 1.5T. T2-weighted imaging at 1.5T demonstrated the highest diagnostic performance. Key Points:· T2 relaxation time is increased in PSC patients both at 1.5T and 3T.. · T1 relaxation time is increased in PSC patients at 3T, but not at 1.5T.. · T2 relaxation time at 1.5T offers the best diagnostic performance.. · T2 mapping represents a promising diagnostic tool for PSC patients, complementing T1 mapping.. Citation Format:· Huber A, Erb S, Ardoino M etal. Liver MRI with T1 and T2 parametric mapping to characterize patients with primary sclerosing cholangitis. Rofo 2026; 10.1055/a-2836-6899.
Purpose:Two new contrast types for diffusion weighted imaging (DWI) have recently been proposed: diffusion-derived "vessel density" (DDVD) and slow diffusion coefficient (SDC). DDVD reflects tissue perfusion while SDC reflects slow tissue diffusion. This study evaluates the DDVD and SDC signal features of mass-forming intrahepatic cholangiocarcinoma (ICC). Materials and methods:Liver DWI data were prospectively collected. The DDVD weighted image was calculated from b=0 and b=10 s/mm2 images, and the SDC weighted image was derived with b=500 and b=800 s/mm2 images, or with b=600 and b=800 s/mm2 images or with b=400 and b=600 s/mm2 images. A semi-quantitative (SQ) scoring was conducted on DDVD map and SDC map. A liver mass lesion signal was divided into six SQ score categories: low signal (score: 0), iso-signal (score: 1), slightly high signal (score: 1.5), high signal (score: 2), higher signal (score: 2.5), and markedly high signal (score: 3). The "higher signal" was a signal notably higher than the spleen signal but lower than the liquid signal and possibly close to the kidney signal; the "markedly high signal" was close to the liquid or blood vessel signal. This study included a total of 27 patients with mass-forming ICC, 76 patients with hepatocellular carcinoma (HCC), and 30 patients with liver metastasis (Mets). Results:86.4% of ICC lesions had a DDVD score of 0, 1 or 1.5, and 70.4% had an SDC score ≥ 2.5. 60.9% of Mets lesions had a DDVD score ≥ 2.0, and 58.6% had an SDC score ≥ 2.5. If we use "(SDC ≥ 2.5) and (DDVD of 0, or 1.0 or 1.5)" to define ICC, then it had an odds ratio of 34.7 in favor of ICC over HCC, an odds ratio of 14.4 in favor of ICC over Mets. If we use "(SDC ≥ 2.5) and (DDVD of 2.0 or 2.5)" to define Mets, then it had an odds ratio of 6.1 in favor of Mets over HCC. Conclusion:When a solid liver mass has an SDC score ≥ 2.5, the possibility of its being a mass-forming ICC or Mets should be considered. If the lesion also has an iso-signal or only slightly signal on the DDVD map, then this lesion is likely to be an ICC. If the lesion also has an SQ score ≥ 2 on the DDVD, then this lesion has the possibility of being Mets. Key Points:· ICC typically shows iso-signal or only slightly signal on DDVD map and notably higher SDC signal than that of spleen.. · High DDVD signal (SQ score ≥ 2.0) and higher SDC signal (SQ score ≥ 2.5) suggest the possibility of liver metastasis.. · Integration of DDVD and SDC into practice can contribute to liver mass lesion classification.. Citation Format:· Wáng XYJ, Zheng CJ, Xu XY, et al. Diffusion-derived "Vessel Density" (DDVD) and Slow Diffusion Coefficient (SDC) Signal Features of Mass-forming Intrahepatic Cholangiocarcinoma Compared to Those of Hepatocellular Carcinoma and Liver Metastases: Preliminary Results. Rofo 2026; DOI 10.1055/a-2830-5742.
Purpose:The effect of iodine preparation concentration on vascular attenuation during computed tomography angiography (CTA) is a topic of controversy. Iodine-based contrast media (CM) formulations are used in different iodine preparation concentrations and, accordingly, their viscosity varies considerably. This study aimed to investigate the influence of CM formulations with different iodine preparation concentrations on image quality under conditions of a constant iodine dose and constant iodine delivery rate (IDR) in low-dose, low-kVp thoracoabdominal CTA using a standardized animal model. Materials and Methods:A cohort of six healthy Göttingen minipigs underwent three low-dose CTA scans (90 kV, CTDIvol = 1.7 ± 0.5 mGy) using three CM formulations with different iodine preparation concentrations (300, 370, and 400 mgI/mL). All formulations were injected at a constant IDR of 1.3 gI/s and at a constant total iodine dose of 252 mgI/kg in a randomized sequence. Quantitative image quality was assessed using contrast-to-noise ratio (CNR) and image similarity metrics. Subjective image quality was evaluated by two experienced radiologists using a 5-point Likert scale. Results:No significant differences in CNR were observed between the CM formulations (300 mgI/mL = 15.6 ± 2.8, 370 mgI/mL= 15.0 ± 3.8, 400 mgI/mL = 15.0 ± 4.9). The subjective image quality evaluations revealed no significant differences between the groups, except for a slight tendency towards higher ratings for the 300 mgI/mL formulation for sharpness (300 mgI/mL=5 (4.3-5), 370 mgI/mL = 4 (4-5), 400 mgI/mL = 4 (4-5)) and diagnostic acceptability (300 mgI/mL = 4 (3-4), 370 mgI/mL = 3.5 (3-4), 400 mgI/mL = 3.5 (2.3-4)). Conclusion:Under the investigated conditions of constant iodine delivery rate and constant iodine dose, CM formulations with iodine preparation concentrations ranging from 300 to 400 mgI/mL do not lead to significant differences in objective or subjective image quality in low-dose, low-kVp CTA. These findings represent a proof-of-concept under controlled experimental conditions. Key Points:· A standardized animal model allowed a controlled analysis of CM formulations with different iodine preparation concentrations.. · At a constant IDR and total iodine dose, image quality remained comparable across the investigated CM formulations.. · A higher iodine preparation concentration did not result in a measurable image quality benefit with a fixed IDR.. Citation Format:· Holtkamp M, Jost G, Salhöfer L et al. The Effect of Contrast Media Formulations with Different Iodine Preparation Concentrations at a Constant Iodine Delivery Rate in Low-kV CT Angiography: An Experimental Animal Study. Rofo 2026; DOI 10.1055/a-2818-5244.
Purpose:Photon-counting computed tomography (PCCT) offers new possibilities for optimizing image quality while reducing radiation dose. However, the influence of acquisition parameters such as tube voltage and spectral shaping with tin filtration on chest imaging remains insufficiently understood. Materials and Methods:Adult male and female anthropomorphic phantoms were scanned using a dual-source PCCT system across a broad range of image quality levels (IQL 1-100). Radiation dose and signal-to-noise ratio (SNR) were evaluated for protocols using 120 kVp and 140 kVp without tin filtration, and 100 kVp with tin filtration. Results:The male phantom required a significantly higher tube current and radiation dose than the female, reflecting sex-based attenuation differences. Increasing the tube voltage to 140 kVp raised the radiation dose with minimal SNR improvement. Tin filtration substantially reduced the dose despite a higher mAs, with the radiation dose and tube current plateauing near IQL 80. In the low-dose range (IQL 1-20), tin filtration enabled dose reduction without saturation. Slight SNR trade-offs between bone and mediastinum highlight the need for tissue-specific considerations when optimizing PCCT chest protocols. Conclusion:Sex- and tissue-specific differences with tin filtration and varying tube voltages underscore baseline differences in radiation dose and image quality behavior between representative adult body geometries. These baseline relationships provide a technical foundation for future patient-specific protocol optimization. Key Points:· A higher tube voltage increased the radiation dose with limited image quality benefit.. · Tin filtration enables substantial radiation dose reduction in low-dose adult chest PCCT.. · Tin filtration causes image quality and dose plateaus at image quality levels around 80.. · Baseline radiation dose and image quality relationships support future patient-specific chest PCCT optimization.. Citation Format:· Klüner LV, Zensen S, aus der Wiesche H et al. Influence of Tube Voltage, Tin Filtration, and Sex on Radiation Dose and Image Quality in Adult Chest Photon-Counting CT: A Phantom-Based Signal-to-Noise-Based Analysis. Rofo 2026; DOI 10.1055/a-2829-0195.
Purpose:This study investigates the relationship between sarcopenia index (SMI), quantitative muscle and adipose tissue parameters obtained from abdominal CT, and treatment response to biological agents in patients with ankylosing spondylitis (AS). Materials and Methods:In this retrospective study, 62 patients (May 2015-May 2024) with an initial diagnosis of AS and available abdominal CT scans at the L2 vertebral level were included. Quantitative parameters including visceral adipose tissue (VAT, cm²), subcutaneous adipose tissue (SAT, cm²), total abdominal muscle area (TAMA), psoas muscle area (PsoA), sarcopenia index (SMI), and tissue attenuation values (HU) were measured. Changes in scores after biological therapy based on the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) were used to assess treatment response. Comparative and correlation analyses were performed between body composition metrics and clinical parameters. Results:Patients who achieved full recovery exhibited significantly higher TAMA, PsoA, and SMI values compared to those with partial recovery (p < 0.05). These findings suggest that preserved muscle mass and quality are associated with a better response to biological therapy in AS. Conclusion:Opportunistic CT-based body composition analysis provides valuable prognostic information in AS. SMI, TAMA, and psoas muscle volume may serve as potential imaging biomarkers for predicting biological treatment response, supporting personalized management strategies. Key Point:Quantitative assessment of abdominal muscle metrics on routine CT can offer a non-invasive and accessible tool for predicting biological treatment outcomes in ankylosing spondylitis. Key Point:· This is the first study to investigate the association between CT-derived abdominal fat and muscle cross-sectional areas and biologic treatment response in ankylosing spondylitis.. · CT-derived SI, TAMA, and psoas muscle area measurements may serve as adjunct markers alongside clinical parameters in evaluating biologic treatment response.. · CT-detected sarcopenia may be associated with reduced response to biologic therapy in AS patients.. Citation Format:· Kastan N, Erdem Toslak İ, Yavuz A et al. Qualitative and Quantitative Evaluation of Abdominal Fat and Muscle Tissue Volume in Patients with Ankylosing Spondylitis and Investigation of Their Possible Effects on Biological Agent Treatment Response. Rofo 2026; DOI 10.1055/a-2838-0022.
Abstract:Pathologies of the thumb metacarpophalangeal joint (MCPJ) frequently affect both the general population and high-level athletes. Early and accurate diagnosis of injuries involving the stabilizing structures of the thumb MCPJ is essential for effective treatment. Delayed or missed diagnosis, as well as inadequate management, can lead to joint instability, osteoarthritis, and functional impairment. Initial evaluation includes standard static and dynamic radiographs under fluoroscopy. Computed tomography (CT) and cone-beam CT (CBCT) provide detailed analysis of osseous structures. High-resolution dynamic ultrasound (US) is the preferred technique for soft tissue assessment, while high-resolution magnetic resonance imaging (MRI) offers comprehensive visualization of all anatomical elements with excellent spatial resolution. This educational review describes the pathology of the thumb MCPJ through various imaging modalities, details injury mechanisms, and highlights the role of imaging in diverse conditions such as ulnar collateral ligament (UCL) and radial collateral ligament (RCL) injuries and instabilities, trigger thumb, pulley system lesions, dislocations, osteoarthritis, fractures of the proximal phalanx (P1) head or base, sesamoid disorders, volar plate lesions, rheumatic diseases, and osseous or soft-tissue tumors. Practical recommendations are provided to emphasize the clinical relevance of imaging findings and offer clear guidance for their application in patient care. Early and precise diagnosis is crucial for appropriate management, thereby preventing long-term complications such as instability, osteoarthritis, and functional decline. Key Points:· Injuries of the thumb collateral ligaments require early evaluation to ensure stability.. · Trigger thumb can be promptly diagnosed using ultrasound.. · Injuries of the thumb MCPJ pulley system are primarily diagnosed using ultrasound.. · Thumb MCPJ dislocations require precise and comprehensive imaging.. · Volar plate lesions are best visualized with ultrasound, with MRI if needed.. Citation Format:· Bouredoucen H, Taihi L. Thumb Metacarpophalangeal Joint - Part II: Pathologies and Imaging Findings. Rofo 2026; DOI 10.1055/a-2830-5647.
Purpose:Forensic age estimation has become increasingly important in recent years due to its wide range of applications in both legal and clinical contexts, such as immigration procedures, criminal investigations, and the protection of minors. Radiological evaluation plays a key role in this process, and the methods recommended in current guidelines are predominantly X-ray-based. However, because of the potential risks of ionizing radiation, particularly for younger individuals, research on alternative radiological techniques has gained increasing attention. In this study, we aimed to evaluate the ossification stages of the distal tibial epiphysis and calcaneal apophysis in ankle MRI examinations in the context of forensic age estimation and to contribute to the existing data by comparing our results with those of previous studies. Materials and Methods:The ankle MR images of subjects between 8 and 25 years old (71 females and 105 males), obtained with a 3.0 T MRI scanner, were evaluated retrospectively according to the staging method utilized by Saint-Martin et al. On T1-weighted images, the distal tibial epiphysis and calcaneal apophysis were independently assessed by two observers using a three-stage classification system. Results:According to the results of our study, the interobserver and intraobserver agreement in the assessment of the distal tibial epiphysis and calcaneal apophysis was very good. All cases observed with stage 1 in the distal tibia and calcaneus were under 15 years of age. All cases observed with stage 2 in the calcaneus were under 18 years of age. Conclusion:The three-stage MRI method allows detailed assessment of ankle maturation and may provide supportive information for forensic age estimation. However, given the limitations with regard to defining some age thresholds, particularly at 18 years, this method should be regarded as a complementary rather than a stand-alone tool. Further studies with larger cohorts are required to better clarify its applicability at legally relevant ages. Key Points:· A three-stage method using ankle MRI scans may be useful for forensic age estimation.. · High inter- and intraobserver agreement supports the reliability of the method.. · MRI provides a safer, radiation-free alternative to X-ray.. Citation Format:· Altinsoy HB, Has B, Gurses MS et al. Assessment of Ankle Ossification for Forensic Age Estimation via 3 T MRI: A Preliminary Study. Rofo 2026; DOI 10.1055/a-2837-8981.
Purpose:The increasing use of coronary CT angiography (CCTA) in the diagnosis of coronary artery disease (CAD) necessitates the evaluation of non-coronary findings (NCFs) and the investigation of the origin of patients' symptoms. This study aims to analyze NCFs detected in patients undergoing CCTA for suspected CAD. Materials and Methods:The study retrospectively evaluated a total of 1503 patients who underwent CCTA procedures at our clinic between January 2020 and January 2024. All images were evaluated visually by a single reader. No automated detection system was used. Benign conditions, anatomical variations, and all findings deemed to require follow-up or treatment within the imaging field were noted. NCFs identified in the CCTA examinations were analyzed based on patients' gender and age, NCF location, and clinical significance (no/mild, moderate, and severe). Results:At least one NCF was identified in 1460 out of 1503 patients (97.2%), with a total of 7822 NCFs detected. 45.4% of the patients (n=682) were male and 54.6% (n=821) were female. The median age was found to be 52 [19-87] years for males and 57 [22-84] years for females. The most common NCFs observed in all patients were, respectively, spinal degenerative changes (65.4%, n=983), parenchymal bands-subpleural lines (47.2%, n=709), increased CTR (41.4%, n=622), hiatal hernia (36.7%, n=552), and esophageal thickening (30.9%, n=464). Certain NCFs, including nodules >8 mm (p=0.007), hiatal hernia (p=0.027), pulmonary artery dilatation (p=0.048), breast lesions (p=0.010), hyperdense liver lesions (p=0.024), and adrenal gland thickening (p=0.035), showed statistically significant differences between genders. Among NCFs, only scoliosis and age were found to have a significant but weak negative correlation (p<0.048, r=-0.051). The most common findings of no/mild, moderate, and severe clinical significance were spinal degenerative changes (n=983), thoracic aortic calcification (n=622), and pulmonary parenchymal infiltration (n=78), respectively. Conclusion:Awareness of the variability in the distribution of NCFs based on age, gender, location, and clinical significance is crucial when evaluating CCTA scans performed for suspected CAD. Key Points:· NCFs vary according to gender, location, and clinical severity.. · Symptoms caused by NCFs can be confused with cardiac symptoms, leading to further investigations such as CCTA.. · The frequency and potential clinical significance of NCFs necessitate a holistic evaluation of CCTA.. Citation Format:· Isik Mİ, TAŞAR M. Analysis of non-coronary findings in coronary CT angiography: differences in gender, age, location, and clinical significance in the Turkish population. Rofo 2026; 10.1055/a-2826-0659.
