This paper describes the rationale and radiology considerations in the implementation of the Preventing Liver Cancer Mortality through Imaging with Ultrasound versus MRI (PREMIUM) study. PREMIUM is a multicenter, randomized controlled trial sponsored by the Department of Veterans Affairs comparing dynamic contrast-enhanced (DCE) abbreviated MRI (aMRI) plus serum AFP versus ultrasound (US) plus serum AFP for hepatocellular carcinoma (HCC) screening in patients with cirrhosis. PREMIUM aims to randomize 4,700 participants across over 47 Veterans Affairs Medical Centers to semiannual surveillance for up to eight years, with HCC-related mortality as the primary endpoint. To date, 35 sites have been activated with 1,085 patients randomized. To ensure uniform implementation and reporting of per-protocol screening, the PREMIUM Radiology Workgroup developed standardized imaging protocols, structured LI-RADS–based reporting templates, and a centralized training program for radiologists and technologists. They also perform ongoing quality control on both scans and reports. The aMRI protocols utilize multiphasic post-contrast imaging to allow LI-RADS scoring. A non-contrast-enhanced aMRI protocol is available for participants who develop renal impairment or contrast allergy during the study. US protocols conform to US LI-RADS standards. Structured reporting promotes consistency in documentation of findings, visualization scores, and follow-up recommendations. A centralized Image Repository was established, incorporating advanced de-identification methods to remove metadata and pixel-embedded protected health information from imaging files. More than 20,000 curated liver MRI and US exams are anticipated, supporting both trial outcomes and future radiomics and artificial intelligence research. PREMIUM aims to determine whether screening for HCC with a DCE aMRI protocol reduces HCC-related mortality and also facilitates ancillary studies utilizing the Image Repository.
To investigate the value of extracellular volume fraction (ECV) derived from T1 mapping and apparent diffusion coefficient (ADC) for non-invasive assessment of tumor stroma percentage (TSP) in rectal cancer. This prospective study enrolled 158 patients (104 men, 54 women; mean age 65.96 ± 10.87 years) with rectal adenocarcinoma. All patients underwent 3.0T MRI including pre- and post-contrast T1 mapping and diffusion-weighted imaging. ECV was calculated from native and post-contrast T1 values. TSP was histopathologically assessed on surgical specimens. Interobserver reproducibility, correlations with TSP, diagnostic performance for stroma-rich tumors (TSP > 50
To evaluate the safety and short-term efficacy of magnetic resonance-guided high-intensity focused ultrasound surgery (MRgFUS) for adenomyosis-associated dysmenorrhea. This retrospective single-center cohort included 62 patients with MRI-confirmed adenomyosis and dysmenorrhea who underwent MRgFUS between October 2018 and March 2021. Uterine volume, adenomyosis lesion volume, and non-perfused volume (NPV) were measured on MRI. The non-perfused volume ratio (NPVR) was calculated as NPV divided by lesion volume. Dysmenorrhea severity was assessed using the visual analogue scale (VAS). Follow-up data were analyzed as available cases at 3, 6, and 12 months. All 62 patients completed MRgFUS. The mean immediate NPVR was 69.12
Pancreatic schwannomas (PSs) are rare, benign nerve sheath tumors that can be encountered as incidental findings on imaging, and their imaging features overlap with other solid and cystic pancreatic lesions. This often leads to preoperative misdiagnosis. On computed tomography (CT), which is often the first modality to detect these tumors, PS classically appears as a well-defined, round or oval, encapsulated mass without pancreatic ductal dilation when small. Degenerative changes in larger lesions can produce cystic change, septations, calcification, and hemorrhage. In this pictorial essay, we present the CT spectrum of PS through a series of illustrative cases, spanning typical and atypical appearances, to help radiologists recognize this rare tumor and include it as a benign differential diagnosis for pancreatic masses.
Evaluates the safety, efficacy, and nutritional outcomes of needle puncture sequential coaxial dilation technique in high-risk patients requiring long-term enteral nutrition. This retrospective single-center study included 127 consecutive patients (mean age 67.4 ± 12.3 years; mean ASA 3.2 ± 0.7) who underwent CT-guided percutaneous gastrostomy using the needle puncture sequential coaxial dilation technique between January 2020 and December 2025. Notably, 89 patients (70.1
Destructive spinal change that directly abuts an aneurysm or vascular graft should first be read as a vascular sign. The key distinction is noninfectious chronic contained rupture, in which pulsatile pressure or contained hematoma causes smooth vertebral scalloping, versus infected aneurysm or graft, in which contiguous spread produces osteomyelitis or spondylodiscitis. Coxiella burnetii is an important cause of the latter because chronic Q fever can produce indolent, culture-negative vascular infection with adjacent spinal extension. Reported Q fever vertebral osteomyelitis frequently coexists with aneurysmal disease, including 23 of 34 cases (68
To evaluate the usefulness of ultrasonography and liver and spleen elastography (point shear-wave elastography) for predicting the presence of esophageal varices in patients with schistosomiasis-associated non-cirrhotic portal hypertension (NCPH), and to identify which non-invasive parameters best correlate with the presence of esophageal varices. A prospective and cross-sectional study involving patients with NCPH related to schistosomiasis, with and without upper gastrointestinal bleeding history, conducted at the Gastroenterology Division on a referall hospital in Pernambuco, Brazil. All patients underwent upper abdominal ultrasonography and hepatic and splenic stiffness by pSWE, both performed with Siemens Acuson S2000 system, and upper gastrointestinal endoscopy. Among 71 patients, the median age was 57 years, and 50.7
We aimed to provide a comprehensive review on magnetic resonance imaging (MRI) and its utility to postoperatively assess visibility and deformation of surgical mesh in patients with groin hernia or pelvic organ prolapse (POP). PubMed, Web of Science and Embase were searched on July 7th, 2026 using the keywords “surgical mesh” AND (“groin hernia” OR “POP”) AND “MRI”. Observational studies were considered eligible if they included patients with an implanted mesh, performed static MRI, and reported mesh features, visibility, or provided information on its segmentation in groin hernia or POP patients. Results were narratively synthesized, and the quality of studies was assessed via the appropriate JBI tool. Of 3,090 retrieved articles, 18 original studies fulfilled the eligibility criteria. Mesh for groin hernia was assessed in eight studies (796 groins in 592 patients) and mesh for POP in 10 studies (300 patients). Conventional meshes were used in seven studies, in which the mesh recognition rate by the reader ranged from 68.1
To evaluate the utility of multiparametric MRI combined with clinical and laboratory biomarkers in predicting pathologic response to neoadjuvant chemoradiotherapy (nCRT) in patients with locally advanced rectal cancer (LARC). This retrospective study included 88 LARC patients who received nCRT followed by total mesorectal excision (TME). Based on pathological tumor regression grade (pTRG), patients were categorized into a good response group (GR, pTRG 0–1, n = 30) and a non-good response group (nGR, pTRG 2–3, n = 58). Independent predictors of GR were identified through univariable and multivariable logistic regression analyses. A combined predictive model was developed, and its predictive performance and calibration were evaluated using receiver operating characteristic curve (ROC) analysis and a calibration curve, with internal validation performed using 1000 bootstrap resamples. Compared with the nGR group, the GR group had a higher proportion of female patients, a lower rate of carcinoembryonic antigen positivity, a higher proportion of patients with good magnetic resonance tumor regression grade (mrTRG-good), lower ADCₚᵣₑ, higher ADCₚₒₛₜ, and greater ΔADC
Percutaneous transhepatic biliary drainage (PTBD) is a standard palliative intervention for malignant obstructive jaundice, yet 60–75
To report the first detailed description of the radiological features of tuberous sclerosis complex 2/polycystic kidney disease 1 (TSC2/PKD1) contiguous gene deletion syndrome (CGS), a rare and poorly reported or described syndrome. This multicenter retrospective study included 9 adult patients (6 women, 3 men; mean age, 29±8 years) with genetically confirmed TSC2/PKD1 CGS. Clinical data and imaging studies (MRI, CT, ultrasound) were reviewed independently by two radiologists. Radiological features assessed included kidney length, total kidney volume (TKV), height-adjusted TKV (hTKV), cyst burden, angiomyolipomas (AMLs), and extrarenal manifestations. All patients presented with enlarged polycystic kidneys (mean TKV: 2134 ± 904 mL; mean hTKV: 1260 ± 471 mL/m) and a high cyst burden (median 45 cysts per kidney); 7 of 8 classifiable patients (88
Accurate assessment of hepatic steatosis is crucial for preoperative risk stratification in patients with liver tumors. However, the diagnostic performance of the noninvasive ultrasound-derived fat fraction (UDFF) remains uncertain, where tissue heterogeneity can impair measurement reliability. Using histopathology as the reference standard, this study aimed to evaluate the ability of UDFF to detect and grade background hepatic steatosis. In this prospective study, 64 adults scheduled for hepatic surgery were enrolled. All patients underwent preoperative UDFF assessment, and postoperative histopathology of non-tumorous liver tissue served as the reference. Diagnostic performance, incremental predictive value, and clinical utility were evaluated using ROC analysis (Youden index for cutoff determination), multivariable regression (ΔAUC assessment), and decision curve analysis. UDFF values increased progressively with histological steatosis grades (p < 0.0001). The AUCs for detecting S ≥ 1 and S ≥ 2 steatosis were 0.885 and 0.967, with corresponding optimal cutoffs of 4.75
Non-palpable undescended testes require accurate localisation, but the role of magnetic resonance imaging (MRI) combined with diffusion-weighted imaging (DWI) remains uncertain. We evaluated the diagnostic accuracy of MRI-DWI for detecting clinically non-palpable undescended testes. This PROSPERO (CRD420261411862) registered review searched PubMed, Embase, Web of Science, and CENTRAL to June 6, 2026. Eligible diagnostic-accuracy studies assessed MRI-DWI against diagnostic laparoscopy or operative exploration. Two reviewers extracted 2 × 2 data, and assessed QUADAS-2 risk of bias. Sensitivity and specificity were pooled using bivariate random-effects models, with hierarchical summary receiver operating characteristic (HSROC) analysis, likelihood ratios, diagnostic odds ratios, and Fagan nomograms used to summarise diagnostic performance. Fifteen studies were included. In seven testis-level studies (340 testes), pooled sensitivity and specificity were 92.6
To characterize the transabdominal ultrasound (US) features of pancreatic serous cystic neoplasm (SCN) morphological subtypes, evaluate US-MRI agreement, and explore reducing overtreatment. This retrospective study included 125 patients with pathologically confirmed pancreatic SCNs who underwent preoperative US. Lesions were morphologically classified into macrocystic, microcystic, mixed, and solid subtypes. US-MRI concordance (71 patients, 56.8
To evaluate the feasibility, safety, and short-term outcomes of ultrasound-guided radiofrequency ablation (RFA) for abdominal wall endometriosis (AWE). This retrospective single-center study included 19 patients with AWE (mean age, 35.5 ± 5.0 years) with 29 lesions who underwent ultrasound-guided RFA between December 2023 and January 2026. AWE was diagnosed based on clinical symptoms and imaging findings on ultrasonography and magnetic resonance imaging; biopsy was performed in atypical cases. RFA was performed using an 18-gauge electrode with the moving-shot technique under local anesthesia combined with intravenous analgesia. Complications were classified according to the SIR classification. Short-term technical efficacy was assessed at 3 months based on clinical symptoms and changes in lesion size on imaging. All patients presented with abdominal pain, including 14 patients (73.7
Patients with inflammatory bowel disease (IBD) are at increased risk of gastrointestinal and hepatobiliary malignancies arising in the setting of chronic inflammation, dysplasia, stricturing disease, and fistulizing complications. Although endoscopic surveillance remains the cornerstone for dysplasia detection, imaging plays an increasingly important complementary role in identifying invasive malignancy, evaluating transmural and extra-intestinal disease, and detecting lesions in segments inaccessible or poorly amenable to endoscopic assessment. Distinguishing malignant transformation from chronic inflammatory change remains challenging because imaging findings frequently overlap. In practice, malignancy is often suggested less by a single defining feature than by deviation from the expected imaging behaviour of inflammatory disease over time. This review summarizes the imaging manifestations of malignancy in IBD across the small bowel, colon, rectum, perianal region, and hepatobiliary system, with emphasis on Crohn’s disease–associated small bowel adenocarcinoma, colitis-associated colorectal carcinoma, fistula-associated anorectal malignancy, and cholangiocarcinoma in primary sclerosing cholangitis. Key diagnostic pitfalls, mimics, and structured reporting considerations are discussed, together with emerging quantitative and molecular imaging techniques including diffusion-weighted MRI, dual-energy CT, radiomics, elastography, and fibroblast activation protein inhibitor (FAPI)-based imaging. Recognition of subtle interval morphologic change and discordance from expected inflammatory behaviour is central to earlier detection of IBD-associated malignancy. Careful longitudinal comparison and multidisciplinary correlation remain essential, with radiologists playing a critical role in identifying imaging features that warrant intensified surveillance, tissue sampling, or further intervention.
Pelvic magnetic resonance imaging (MRI) plays an important role in the evaluation of suspected gynecologic malignancies, providing high soft tissue contrast and multiparametric capabilities, including diffusion-weighted imaging and dynamic contrast enhancement, aiding in diagnosis and management strategies. However, a variety of benign entities and non-neoplastic conditions may demonstrate overlapping imaging features with malignant tumors on MRI, creating potential diagnostic pitfalls and delaying treatment or prompting unnecessary interventions. These include endometriosis, atypical leiomyoma variants, ovarian fibromatosis, and treatment- or procedure-related changes, among others. Furthermore, rare malignant entities may mimic more common malignant entities or occasionally have features that overlap with benign entities, both of which can have important implications in determining the appropriate management plan. This pictorial essay highlights key MRI findings of selected gynecologic conditions that represent common and uncommon diagnostic pitfalls. Emphasis is placed on imaging patterns, multiparametric MRI features, and correlation with clinical presentation. By illustrating characteristic findings and highlighting distinguishing features, this review aims to enhance radiologists' confidence in differentiating benign mimics from true malignancy.
Within LI-RADS categorization, LR-M nodules are probably or definitely malignant, but not specific for hepatocellular carcinoma (HCC). HCC is variably encountered within the LR-M category, representing 36 to 44
Abdominal vascular calcification is increasingly recognized as a clinically relevant marker of systemic atherosclerotic burden and regional vascular disease. Because the abdominal aorta and its major branches are frequently captured on routine abdominal, oncologic, vascular, and preoperative CT examinations, CT provides a practical opportunity for opportunistic assessment of vascular calcium beyond the coronary circulation. This review summarizes current approaches to CT-based evaluation of abdominal vascular calcification, with a focus on abdominal aortic, renal artery, mesenteric and celiac artery, and aortoiliac calcification. We discuss imaging sources, acquisition protocols, anatomic coverage, and quantitative and semiquantitative scoring methods, including Agatston-based, volume-based, and length-adjusted metrics. We also review the clinical implications of calcification across abdominal vascular territories, including its associations with cardiovascular events, renal dysfunction, mesenteric ischemia, peripheral arterial disease, perioperative complications, and mortality. Finally, we highlight the emerging role of automated and artificial intelligence–based quantification in scalable risk stratification. Standardized definitions, harmonized scoring methods, validated thresholds, and prospective outcome-based studies are needed before abdominal vascular calcification can be fully integrated into routine clinical reporting. For AI-enabled opportunistic screening to be widely adopted, future multicenter validation studies should establish standardized anatomical definitions and scoring frameworks, assess algorithm performance in independent external datasets spanning diverse CT acquisition protocols and scanner platforms, and prioritize clinically meaningful outcome-based endpoints with sufficient follow-up rather than relying solely on segmentation accuracy.
To investigate structural imaging features of non-occlusive hepatic artery hypoperfusion syndrome (NHAHS) in pediatric liver transplant recipients. This retrospective single-center study included 78 pediatric liver transplant recipients, divided into NHAHS (n = 17) and non-NHAHS (n = 61) groups. Preoperative and postoperative multidetector CT was used to assess arterial and portal venous parameters, splenic size, and vascular ratios. Doppler ultrasonography was used to evaluate portal venous flow velocity. NHAHS diagnosis was confirmed by digital subtraction angiography. Interobserver agreement was assessed using intraclass correlation coefficients. ROC curve analysis was performed to evaluate the discriminatory performance of imaging parameters for identifying NHAHS. Patients with NHAHS had significantly larger preoperative splenic artery diameter and splenic volume (p = 0.044 and p = 0.024, respectively). Although portal venous diameters did not differ significantly between groups, the distribution of portal vein thrombosis subtypes and portosystemic shunt types differed significantly, with chronic thrombosis and splenoportosystemic shunts more frequent in the NHAHS group (p = 0.020 and p < 0.001, respectively). Postoperatively, recipient hepatic artery diameter and portal vein flow velocity were significantly higher in patients with NHAHS (p = 0.010 and p = 0.021, respectively). On preoperative donor CT, the donor hepatic artery and donor portal vein diameters were significantly smaller in the NHAHS group (p = 0.024 and p < 0.001, respectively). ROC analysis showed that postoperative recipient hepatic artery diameter had moderate discriminatory performance for identifying NHAHS (AUC = 0.716; 95
