Background Right gastroepiploic artery lesions are rare but may cause life-threatening hemorrhage. They include not only aneurysms but also non-aneurysmal arterial injuries with diverse etiologies. Purpose To evaluate the clinical spectrum, embolization strategies, and outcomes of transcatheter arterial embolization for right gastroepiploic artery aneurysms and injuries. Materials and Methods This retrospective single-center study included 29 patients with right gastroepiploic artery aneurysms or injuries treated with transcatheter arterial embolization between 2005 and 2025. Clinical presentation, etiology, lesion location, embolic materials, technical success, complications, recurrence, and surgical conversion were reviewed. Results Ruptured lesions were observed in 10 patients and unruptured lesions in 19. Lesion size did not differ significantly between ruptured and unruptured lesions [13 mm (range, 3–28 mm) vs 15 mm (range, 4–35 mm), p = .46]. Etiologies included idiopathic or presumed true aneurysm, iatrogenic injury, trauma, segmental arterial mediolysis, tumor invasion, pancreatic fistula, and vasculitis. Technical success was achieved in 27 patients (93%), and clinical success in 26 (90%). One patient developed a small access-site hematoma. No clinically evident organ ischemia or lesion-related 30-day mortality occurred. Two patients required surgical conversion. Conclusion Transcatheter arterial embolization was technically and clinically successful in most patients with right gastroepiploic artery aneurysms and injuries, with a low rate of procedure-related complications. Treatment strategy should be tailored according to etiology, segmental location, collateral perfusion, and catheter accessibility.
Background Interval cancer, breast cancer detected after a negative screening examination but before the next scheduled appointment, represents a challenge in mammography screening programs due to less favorable histopathological characteristics compared to screen-detected cancer. Purpose To determine which interval cancers from digital breast tomosynthesis (DBT) were classified as missed and true by radiologists in a review, and to stratify the findings by risk scores and markings provided by an artificial intelligence (AI) model. Material and methods In this retrospective informed consensus-based review, radiologists assessed mammograms from 46 interval cancers and classified those as false negative, minimal-sign significant or non-specific, or true negative. An AI risk score (1–7, low; 8–9, intermediate; or 10, high risk of malignancy) was available for each examination. For cases with AI risk scores of 8–10, the location of AI-detected markings was compared with the true cancer site. Results A total of 17% (8/46) of interval cancers were classified as false negative, 22% (10/46) as minimal-sign significant, 20% (9/46) as minimal-sign non-specific, and 41% (19/46) as true negative. The AI model correctly identified 35% (16/46) and incorrectly located 24% (11/46). Considering false negative and minimal-sign significant as cases with the highest probability of being diagnosed at screening due to mammographic visibility, the proportion of cases correctly identified by the AI model was reduced from 35% to 22% (10/46). Conclusion About 20% of interval cancers have potential to be diagnosed earlier using AI in DBT screen-reading.
Introduction This scoping review aims to systematically map how outcomes are defined and operationalised in contemporary radiological randomised clinical trials (RCTs). The findings will inform a subsequent Delphi process to develop a core outcome set for clinical studies in radiology, including adaptive platform trials (APTs), conventional RCTs, and observational studies. Methods including end points The scoping review will be conducted in accordance with PRISMA-P and PRISMA-ScR guidelines and will encompass articles published from 1 January 2023 in select high-impact general medical and radiological journals, using a search strategy developed and vetted by an independent information specialist. The search strategy yielded 4,202 hits on 7 April 2026. All steps, from screening through data extraction, will be done in duplicate by two independent authors. Extracted trial data will include number of trial sites, number of participants, sub-speciality, intervention type, and interventions under study. For each outcome in each trial, we will extract the name and type of the outcome, operationalisation/definition/tool used, assessment of temporality (e.g. truncation, censoring, repeated sampling), missingness proportion, missingness handling, effect quantification, and statistical analyses of effects (e.g. unadjusted or regression-model based). Data extraction will start with a 10-trial pilot phase for maximised data quality. Data synthesis will be descriptive without risk of bias evaluation. Implications This scoping review will map how outcomes are defined and operationalised in contemporary radiological RCTs and inform a Delphi process to identify core outcomes for APTs and RCTs, supporting the advancement of value-based radiology.
We report a case demonstrating the evolution of diffusion lacunae (DL) into thrombus, supported by serial MRI and MR-pathologic correlation. A 36-year-old woman with a pregnancy achieved via frozen-thawed embryo transfer presented with complete placenta previa and vaginal bleeding. MRI at 27 weeks of gestation revealed an irregular intraplacental hypointense area on diffusion-weighted imaging corresponding to DL. Follow-up MRI at 32 weeks showed that the DL had become less discernible and appeared hyperintense, similar to the surrounding placenta. On the following day, the patient developed hemorrhagic shock and underwent emergency cesarean delivery, without evidence of placental adherence and decidual deficiency, indicating that the DL represented a placental lake rather than placental lacunae. Histopathologic examination demonstrated a paucity of chorionic villi and thrombus formation with lines of Zahn in the DL area. These findings provide direct evidence that DL may undergo thrombus formation over time, reflecting dynamic changes related to blood flow stasis within the placenta.
Background Gastroepiploic artery aneurysms (GEAAs) and their rupture are very rare but often serious. However, emergency management has yet to be standardized. Purpose To clarify the clinical features of GEAAs and outcomes of transcatheter arterial embolization (TAE). Materials and Methods This is a retrospective, single-center 12 case series of GEAAs experienced between 2006 and 2023. We reviewed medical records to determine the case background, angiographic images, TAE techniques and success rate, and outcomes. Abdominal angiography was performed via the femoral artery to identify the inflow and outflow vessels of the GEAAs. Subsequently, a microcatheter was advanced to the target site, and embolization was performed with microcoils and/or NBCA-Lipiodol mixture. Results Nine ruptured and one unruptured pseudo-GEAA cases were treated by emergency TAE, while the remaining two unruptured cases were treated electively. The average diameter of the ruptured GEAAs was 7.9 mm. The most common underlying diseases were segmental arterial mediolysis in 4 cases. Morphological classification revealed 5 cases of dissecting, 4 of pseudo, and 3 of true. TAE was successful in seven of the nine ruptured and in all three unruptured cases. Two patients with ruptured GEAAs after unsuccessful TAE were subsequently saved by surgery. TAE using the triple coaxial catheter system was performed in 7 cases with good results. Conclusions Even small-diameter GEAAs can rupture, resulting in life-threatening conditions, but emergency TAE is safe and effective. However, there are some cases in which TAE fails, so it is important to make a prompt decision to proceed to surgical treatment.
BackgroundSacroiliac joint (SIJ) disorders are among the most common causes of chronic low back pain. Imaging-guided SIJ injections are widely used as an early diagnostic tool, with corticosteroid often added to provide a therapeutic component. Evidence of factors predicting the therapeutic outcome of these injections remains scarce.PurposeTo evaluate the effect of SIJ osteoarthritis and other potentially relevant demographic, imaging, and procedural factors on the patient-reported therapeutic outcome of imaging-guided SIJ injection.Material and methodsThis retrospective single-center study included 101 patients who underwent specialist-referred imaging-guided SIJ injection between 2010 and 2023. Medical records and procedural reports were reviewed to collect relevant patient information, and associated SIJ MRIs and CT scans were reanalyzed for osteoarthritis, sacroiliitis, and bone marrow edema by an experienced musculoskeletal radiologist. The association of demographic, imaging, and procedural factors with the therapeutic injection outcome was assessed using logistic regression modeling.ResultsOf 101 patients who underwent an imaging-guided SIJ injection, 72 (71.3%) met the inclusion criteria. The mean age was 52.2 (SD 14.2) years, and 30 patients (41.7%) achieved a positive therapeutic response. Increasing age was significantly associated with a lower likelihood of a positive outcome, with the probability decreasing on average by 9.4% for each additional year of age (OR 0.91 [95% CI 0.84-0.99]). Neither SIJ osteoarthritis grade nor other demographic, imaging, or procedural factors showed a significant association with injection outcome.ConclusionIncreasing age was significantly associated with a lower likelihood of achieving a positive therapeutic SIJ injection outcome, while SIJ osteoarthritis grade showed no association.
Background: CT-guided percutaneous bone biopsy is a minimally invasive and effective procedure for evaluating and diagnosing bone lesions. Purpose: To evaluate the diagnostic yield, tumor types, and complication rates of CT-guided percutaneous bone biopsy procedures at a single tertiary institution. Materials and Methods: This retrospective study analyzed 508 biopsy procedures performed on 473 patients between March 2019 and March 2024. Patients were identified through the RIS/PACS system at Aarhus University Hospital. Data on diagnostic yield, tumor types, and complications were retrospectively reviewed and collected from electronic health and histopathology records. Complications were classified according to the Society of Interventional Radiology (SIR) and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) classification systems. Results: The most common findings were metastatic lesions (n = 234), with breast cancer being the most frequent primary tumor. The procedures resulted in an overall diagnostic yield of 88.7% and a total complication rate of 5.5%. Conclusion: This study demonstrates that CT-guided percutaneous bone biopsy is a reliable method with a high diagnostic yield and a low complication rate. These findings support its continued role as a key diagnostic tool in the clinical management of bone lesions.
Background Calcification of abdominal arteries is an important risk marker in vascular disease. Automated, objective quantification methods could improve reproducibility and reduce observer dependency in clinical practice. Purpose To develop and evaluate a deep learning method for quantifying abdominal arterial calcification from contrast-enhanced CT angiography (CTA).Material and Methods We retrospectively collected 223 CTA volumes, divided into 147 training and 76 test cases. Ground truth calcification segmentations were manually annotated, while vessel segmentations were generated by a previously trained neural network and manually refined. Two nnU-Net models were trained, one for artery segmentation and one for calcification segmentation. Renal, mesenteric, and common iliac arteries were shortened algorithmically. Performance of the models was evaluated using Dice score, volumetric similarity, sensitivity, precision, and Jaccard index. Calcification burden was defined as the ratio of calcified volume to artery volume. The amount and the average size of calcification clusters were investigated. The performance of the method was benchmarked against an idealized threshold-based approach and a more clinically realistic approach. Results The neural network achieved performance comparable to the optimized threshold-based method, with slight improvements across several segmentation metrics. Dice scores and volumetric similarity demonstrated reliable vessel and calcification detection. The predicted calcification burden score showed high correlation with the ground truth calcification burden score. Conclusion The proposed deep learning tool enables fast, reproducible, and observer-independent quantification of calcification in major abdominal vessels, offering a practical alternative to manual or threshold-based scoring methods.
A 41-year-old woman with placenta previa and a prior cesarean delivery presented with placenta accreta spectrum (PAS). MRI at 26 weeks of gestation demonstrated an intraplacental hypointense region on diffusion-weighted imaging corresponding to diffusion lacunae (DL). Additionally, irregular hypointense areas on T2-weighted imaging corresponding to T2 dark bands were observed. The entire placenta and uterine wall were sectioned through close collaboration between pathologists and radiologists to match the axial MRI slice plane. MR-pathologic correlation was performed using representative axial MRI and histopathologic findings. Histopathology revealed that DL corresponded to villous-devoid areas suggesting placental lacunae with recent thrombi, whereas T2 dark bands predominantly represented thrombi with lines of Zahn, reflecting the gradual development of thrombi under conditions of blood stasis with residual blood flow. These two MRI findings may therefore represent sequential stages within the same pathological process in PAS.
Musculoskeletal complications secondary to pancreatitis, including polyarthritis, panniculitis, and bone infarction (Pancreatitis Panniculitis Polyarthritis syndrome), are rare and under-recognized. We report a case of a 31-year-old man with alcohol use disorder who initially presented with acute pancreatitis. Two months later, he developed migratory polyarthritis and subcutaneous nodules. Radiographs revealed permeative bone lesions, and MRI demonstrated multiple bone infarcts. Subcutaneous biopsy confirmed panniculitis. His clinical course was complicated by infected pancreatic necrosis and splanchnic vein thromboses. Joint symptoms improved with aggressive treatment of pancreatitis. Early imaging evaluation is essential in patients with pancreatitis and musculoskeletal symptoms. Recognition of bone infarctions and panniculitis should prompt consideration of systemic pancreatic complications.
BackgroundAlthough intraoperative magnetic resonance imaging (iMRI) is well established in neurosurgery, its role in musculoskeletal oncology remains unclear.PurposeTo assess the feasibility and safety of iMRI in bone and soft tissue tumor surgery, focusing on giant cell tumor of bone (GCTB) after denosumab.Material and MethodsFourteen patients (12 GCTB, 1 undifferentiated pleomorphic sarcoma [UPS], 1 chondroblastoma) underwent tumor resection with intraoperative 0.4 T MRI between 2017 and 2024. Outcomes included residual tumor detection, recurrence, and safety.ResultsiMRI identified residual tumor in 7 of 12 GCTB patients (58.3%), all histologically confirmed. At a median follow-up of 42 months, recurrence occurred in one GCTB case (8.3%). iMRI guided complete resection in a femoral head chondroblastoma, enabling full functional recovery. Soft tissue assessment was limited in the UPS case. No iMRI-related complications occurred.ConclusioniMRI is a feasible and safe adjunct in bone tumor surgery, enhancing detection of residual tumor and supporting joint-preserving procedures, particularly in GCTB after denosumab.
Fetal magnetic resonance imaging (MRI) has become a valuable noninvasive method for evaluating congenital anomalies of the fetus and can serve as an important adjunct to the prenatal ultrasound, particularly where the ultrasound is unable to exclude or detect fetal abnormalities. This pictorial review will describe the utilization of three-dimensional fast imaging employing steady-state acquisition (3D-FIESTA) in various clinical entities, specifically at 3T, and how to generate clinically valuable information.
Extrapulmonary tuberculosis represents 15-20% of all tuberculosis infections and can involve nearly any organ, earning tuberculosis a reputation as one of the great mimickers in medicine. Imaging plays a critical role in diagnosing extrapulmonary tuberculosis, which presents with a wide range of manifestations. We present a pictorial essay comprising cases from Asia, where tuberculosis remains endemic, illustrating the imaging characteristics of extrapulmonary tuberculosis with a focus on thoracoabdominal pathology. Differential diagnoses that exhibit similar imaging findings are also discussed. We aim to raise awareness among radiologists about the importance of considering extrapulmonary tuberculosis for accurate diagnosis and timely management.
Background:Magnetic resonance imaging (MRI) enables the non-invasive assessment of myocardial tissue properties through the T1, T2, and T2* relaxation mapping. Establishing population-specific normal reference values enhances diagnostic accuracy. Purpose:To study the effect of sex and age on the T1, T2, and T2* relaxation time constants in a healthy Finnish population. Methods:We recruited 47 healthy volunteers aged 18-60 years from Eastern Finland from 2023 to 2024 and categorised them by sex and age (18-30 years, 31-41 years, and 42-60 years). The participants underwent a comprehensive screening process to eliminate the possibility of cardiac disease. MRI scans were conducted on 40 participants at 1.5 T. The T1, T2, and T2* relaxation time constants were calculated for basal, mid-ventricular, and apical short-axis slices. Results:The T1 and T2 relaxation time constants were higher in females than males (T1: 1040 ± 29 vs 1020 ± 17 ms, p < .01; T2: 51 ± 4 vs 48 ± 3 ms, p < .001). The 95% normal T1 range was 981-1098 ms for females and 985-1054 ms for males. The normal T2 range was 44-58 ms for females and 43-53 ms for males. No sex differences were found in the T2* relaxation times. The septal T2* across the whole population was 36 ± 7 ms (95% normal limit: 22-49 ms). Conclusion:This study established age-independent and sex-specific reference values for the native myocardial T1, T2, and T2* relaxation time constants at 1.5 T. Females had higher T1 and T2 values than males, and age did not affect these values.
Background:Computed tomography (CT)-guided transthoracic biopsy is essential for diagnosing pulmonary lesions but exposes patients to considerable radiation from repeated image acquisitions. With the growing emphasis on radiation safety, applying validated low-dose CT protocols to interventional procedures has become a key clinical priority. Purpose:To assess the feasibility, safety, diagnostic yield, and radiation dose of low-dose computed tomography-guided transthoracic biopsies using an 80 kVp protocol compared with standard 120 kVp protocols. Methods:A retrospective review was performed on 183 consecutive computed tomography-guided transthoracic biopsies of lung nodules or masses, including 143 procedures with the standard 120 kVp protocol and 40 procedures with a low-dose 80 kVp protocol at 30 mAs. Procedural characteristics, image quality, histopathological adequacy, radiation exposure, and complications were analyzed. Both subjective and objective image quality assessments, including signal-to-noise and contrast-to-noise ratios, and cellular analyses of specimens were compared. Results:The low-dose protocol reduced mean effective radiation dose from 5.89 ± 2.88 millisieverts to 0.19 ± 0.06 millisieverts, a 96.8% reduction. Biopsy specimen adequacy was 85% in the low-dose group versus 79% in the standard-dose group. Complication rates were comparable, 45% versus 43.4%. Subjective image quality was lower in the low-dose group, but objective signal-to-noise and contrast-to-noise ratios remained sufficient for accurate diagnosis. Conclusion:Computed tomography-guided transthoracic biopsies with an 80 kVp and 30 mAs protocol significantly reduce radiation exposure without compromising diagnostic yield or safety. This low-dose approach is a viable alternative to conventional protocols and can be adopted in routine interventional radiology practice.
Radiofrequency ablation (RFA) for hepatocellular carcinoma (HCC) located in the caudate lobe is technically challenging because of the tumor's deep location and proximity to major vascular structures. A 71-year-old woman with a 2-cm HCC in segment I underwent conventional transcatheter arterial chemoembolization (TACE) via the femoral artery. Immediate RFA was not feasible because CT arterial portography revealed no safe puncture route due to surrounding vasculature. On the following day, angiography using a left transradial approach was performed with the patient in the prone position, enabling identification of a safe dorsal puncture path. After creation of an artificial pneumothorax, percutaneous CT-guided RFA was successfully completed without complications. Prone transradial angiography can facilitate safe RFA for hepatic tumors in anatomically challenging locations such as the caudate lobe. This approach may broaden treatment options when conventional supine access is not possible.
Background:Although plain chest x-rays (CXRs) have become standard examinations in many countries, they vary greatly and are recognized as potentially inappropriate imaging procedures. Purpose:To enhance the safety, quality, effectiveness, and efficiency of healthcare services, by providing knowledge of the temporal and geographical variations in the use of CXRs. Materials and methods:Outpatient and inpatient data for CXRs was collected for Norway for the years 2013-2022. Data included patients' age and sex, NCRP code, examination name, modality, hospital/imaging centre, and whether they were in- or outpatients. Results:On average 648,005 CXRs were performed per year in Norway. This amounts to 123 CXRs per 1000 persons per year (2022). 92% of the examinations were performed at public hospitals, and 39% were outpatient examinations. There was a 17% reduction in CXRs from 2013 to 2022. More male than female patients (54%) got a CXR, especially for the age years 60-79. Geographical variations with a factor of 3.7 and 4.7 were observed for inpatient and outpatient examinations, respectively. The differences between catchment areas decreased from 2013 to 2022. Conclusions:This is the first study of the number of CXRs from a whole nation for as long as 10 years. It documents substantial geographical variations in number of examinations and a temporal reduction in the total number of examinations. Information of the temporal and geographical variations is crucial for addressing the issue of appropriate imaging and to increase the safety, quality, effectiveness, and efficiency of the healthcare services.
Erdheim–Chester disease (ECD) is a rare non-Langerhans cell histiocytosis. Mixed ECD–Langerhans cell histiocytosis (LCH) is uncommon, with fewer than 200 cases reported. Diagnosis is challenging and relies on clinical, radiological, and histopathological correlation. We present the case of a 61-year-old man with night sweats, weight loss, and recently diagnosed type 2 diabetes. Imaging revealed cystic lung lesions, perirenal infiltration, and circumferential aortic wall thickening. FDG PET-CT demonstrated multifocal hypermetabolism involving lymph nodes, perirenal soft tissues, and the aortic wall, but no bone involvement. These lesions were shown to progress on subsequent imaging. A lymph node and perirenal biopsies confirmed a mixed form of ECD-LCH with BRAFV600 E mutation and associated chronic myelomonocytic leukemia. The patient was started on targeted therapy with cobimetinib, a MEK inhibitor. Mixed ECD-LCH is a rare entity that typically demonstrates more frequent and widespread organ involvement, particularly affecting the lungs. Its clinical and radiological presentation can have features of both disorders, such as bone, lung, kidney, and vascular involvement. The diagnosis is challenging and requires biopsy with histopathology and genetic testing to be confirmed. Treatment is generally targeted therapy guided by the driver mutations that are identified. We present a rare case of mixed ECD-LCH with thoraco-abdominal and pulmonary involvement. Comprehensive diagnostic workup including histopathology and molecular profiling is crucial for accurate diagnosis and initiation of targeted therapy.
Metaplastic breast cancer (MBC) is a rare and heterogeneous malignancy characterized by the presence of both epithelial and mesenchymal elements. Among its variants, MBC with osteoclastic giant cells is extremely uncommon and presents diagnostic challenges because of its diverse histopathological and imaging features. We report the imaging features of a patient with pathologically proven MBC with osteoclastic giant cells as follows: a high-density mass with microcalcification was revealed on mammography; and a microlobulated, mixed cystic and solid mass with posterior acoustic enhancement was revealed on ultrasound. MRI revealed a round mass with circumscribed margins, rim enhancement and high T1-weighted signal intensity due to internal haemorrhage, heterogeneous T2-weighted high-signal intensity and initial fast enhancement and rapid washout kinetics that was classified as BI-RADS 5. Left mastectomy was performed, and the final diagnosis was consistent with that of MBC.
Background:Transjugular intrahepatic portosystemic shunt (TIPS) is effective for portal decompression, but its effect on splenic congestion is not proven. Platelet changes and spleen size following TIPS are controversially reported while the exact volume of the spleen has rarely been investigated. Purpose:To analyze the effect of TIPS placement on portosystemic gradient (PSG), platelet count (PLT), and exact spleen volume (SV) using contrast-enhanced computed tomography (CT). Methods:For study inclusion, successful TIPS placements in adult patients with liver cirrhosis and portal hypertension who received CT within 3 months prior and 12 months after TIPS-placement were reviewed (12/2013-09/2021). Exclusion criteria were additional liver/portal interventions, TIPS-dysfunction, progressive portal/liver vein occlusion and hepatic malperfusion or progressive portosystemic collaterals, and active bleeding on CT. Additionally, patients with splenic/hematological disorders, hemodialysis, and clinical apparent infections/multi-organ-failure/death were excluded. PSG and PLT were recorded. Exact SV were segmented on pre-/post-TIPS-CT. Data were compared before and after TIPS placement. Mean ± standard deviation and significance level (p) were given. Results:Overall, data of 18 TIPS procedures were available for comparison. PSG reduction following TIPS placement was significant (pre: 18 ± 7 mmHg, post: 5 ± 2 mmHg; p < .001). SV tended to decrease (pre: 832 ± 412 cm3, post: 772 ± 345 cm3; p = .112) and PLT did not change (pre: 130 ± 64Tsd/µL, post: 116 ± 61Tsd/µL; p = .160). Conclusion:When exact SV is assessed and confounders are excluded using CT, neither a significant SV reduction nor a PLT-increase are detected following TIPS. Patients without PLT increase and SV reduction after TIPS might benefit from additional interventions (e.g., splenic artery embolization).
