Amyloid deposition increases with age and can involve the brain and multiple body organs, causing heterogeneous clinical syndromes with diagnostic challenges. Imaging is central to the non-invasive detection of amyloid-related tissue changes, guiding subsequent laboratory testing and, when needed, biopsy. In the brain, amyloid positron emission tomography (PET) enables in vivo detection of β-amyloid pathology and Alzheimer’s Disease, whereas magnetic resonance imaging (MRI) remains pivotal for evaluating cerebral amyloid angiopathy, and is increasingly relevant for monitoring amyloid-related imaging abnormalities in patients treated with anti-amyloid agents. In the heart, bone-avid radiotracer scintigraphy (with single-photon emission computed tomography/computed tomography (SPECT/CT) when available), echocardiography and cardiac MRI provide complementary information on morphology, function, and tissue characterization. Across other body organs, computed tomography (CT) and MRI findings are often nonspecific but may suggest amyloidosis in the appropriate clinical context and help target tissue sampling. Recognizing imaging signatures of amyloid deposition and integrating them with clinical and laboratory data is essential for timely diagnosis and personalized management of age-related amyloid disorders.
This narrative review aims to compare the conceptual frameworks of two standardized MRI scoring systems—PI-RADS (Prostate Imaging Reporting and Data System) and VI-RADS (Vesical Imaging Reporting and Data System). Both systems translate multiparametric MRI findings into a shared, clinically actionable language by employing dominant-sequence logic (DWI for peripheral-zone prostate lesions, T2-weighted imaging for transition-zone prostate lesions, and bladder-wall layer assessment anchored to the detrusor line) with DCE serving as a problem-solving sequence. Additionally, this narrative review highlights the quality prerequisites for each system and explores how structured reporting can reduce inter-reader variability. A literature search was conducted using the electronic databases PubMed, Scopus, and Web of Science. The search strategy employed combinations of the following keywords: “PI-RADS,” “VI-RADS,” “multiparametric MRI,” “prostate cancer,” “bladder cancer,” “structured reporting,” and “imaging reporting and data system.” Adherence to PI-RADS and VI-RADS algorithms improves diagnostic accuracy and reproducibility across readers with varying experience levels. Key advances include refinement of dominant-sequence criteria, validation of DCE’s role as a tie-breaker rather than a primary sequence, and development of minimum technical standards for image acquisition. Both systems have shown high negative predictive values for ruling out clinically significant disease, though challenges remain in inter-reader agreement for equivocal (category 3) lesions and in transitioning from expert centers to community practice. Structured reporting using PI-RADS and VI-RADS provides a standardized lexicon that facilitates consistent lesion characterization, reduces unnecessary biopsies, and streamlines multidisciplinary care pathways. Despite differences in target organ anatomy and sequence weighting, both systems share core design principles—dominant-sequence anchoring, binary descriptor checklists, and progressive score escalation with increasing suspicion. Ongoing efforts should focus on validating these systems in prospective cohorts and integrating artificial intelligence tools to further harmonize interpretation. • PI-RADS and VI-RADS translate multiparametric MRI into a shared, clinically actionable 5-point likelihood language. • Dominant-sequence logic is central: DWI dominates peripheral-zone prostate scoring; T2WI dominates transition-zone scoring; DCE is supportive (in PI-RADS primarily for upgrading PZ PI-RADS 3 when positive). • Quality control is non-negotiable: standardized acquisition and on-table rescue of inadequate sequences. prevent “scores by compromise” and improve inter-reader reproducibility. • Structured reporting should state lesion location, size, dominant-sequence findings, and an explicit take-home message aligned with the clinical decision (biopsy, staging, or management). • VI-RADS is anatomically anchored to the hypointense detrusor (muscularis propria) line: focal muscle invasion supports VI-RADS 4, while extension beyond muscle into perivesical fat supports VI-RADS 5. • Considering PI-RADS and VI-RADS as a pelvic MRI toolbox supports harmonized MRI-driven.
Ionizing radiation exposure has increased substantially in older adults due to widespread use of diagnostic imaging and radiotherapy. While carcinogenic risks are well recognized, growing evidence suggests that ionizing radiation may also contribute to neurodegenerative processes in aging populations. This review examines current evidence linking medical and occupational radiation exposure to dementia and Parkinson’s disease in the elderly. Epidemiological studies and meta-analyses report modest but consistent associations between cumulative radiation exposure and increased risks of dementia and Parkinson’s disease, with relative risks of approximately 1.1 per 100 mSv. Experimental studies demonstrate that ionizing radiation accelerates oxidative stress, neuroinflammation, microvascular injury, and impaired DNA repair—mechanisms already compromised in the aging brain. Clinical evidence indicates high rates of cognitive decline following cranial radiotherapy, particularly in patients over 65 years of age. Ionizing radiation may act as an underrecognized contributor to neurodegeneration in older adults. Although absolute risks are modest, their population impact is relevant given widespread exposure. Personalized risk–benefit assessment, strict adherence to radiation protection principles, and increased use of non-ionizing imaging alternatives are essential to preserve neurological health in aging populations.
This review summarizes the recently reported SOUND and related trials results evaluating the implications of axillary imaging on the management of breast cancer patients. Nodal staging in breast cancer management is important for prognosis and treatment planning since lymph node metastasis indicate a higher risk. For the most part, sentinel lymph node biopsy in the axilla has replaced standard lymph node dissection for early-stage breast cancer staging, as shown by the ACSOG Z0011 and CALGB 9343 trials, which showed no significant difference in disease-free and overall survival. Axillary ultrasound is now routine, valued for its accuracy and biopsy guidance, despite varied sensitivity and specificity. When ultrasound of the axilla is combined with needle biopsy, the staging accuracy is enhanced. Recent trials, including NAUTILUS, BOOG 2013-08, SOUND, and INSEMA, investigate excluding axillary surgery in patients who are clinically node-negative and showed no decrement in disease-free survival. MRI, though evolving rapidly, presents mixed results in axillary lymph node evaluation. While promising in certain contexts, MRI shows no significant advantage over ultrasound for routine preoperative evaluation of the axilla in breast cancer patients. The SOUND and INSEMA trials showed that avoiding axillary surgery in appropriate breast cancer patients can be safe without impacting disease-free survival. This shift is consistent with the Choosing Wisely Guidelines, suggesting that advanced imaging techniques and standardized criteria can reduce the need for invasive procedures while at the same achieving enhanced patient results.
Neuroimaging, in particular magnetic resonance, has become a pivotal tool in understanding the pathophysiology of dementia, including Alzheimer’s disease (AD) and non-Alzheimer’s dementias (NAD). Combining structural and functional imaging techniques enables us to identify early brain changes, improve differential diagnosis, and monitor disease progression. This review focuses on the role of magnetic resonance imaging (MRI), especially functional MRI (fMRI), in supporting the clinical diagnosis of AD and distinguishing it from other forms of dementia. Advances in imaging techniques, such as structural MRI and fMRI, have significantly improved our ability to visualize pathological alterations associated with neurodegenerative conditions. While neuroimaging alone cannot provide a definitive diagnosis, it is a fundamental tool for clinicians in managing dementia, particularly in the early stages when clinical manifestations may be minimal or non-specific. MRI also plays a key role in monitoring responses to and side effects of therapies. Our work has focused on evaluating the role of functional MRI in the study of Alzheimer’s disease, particularly in supporting the clinical diagnosis process and differential diagnosis with other types of dementia, as well as how MRI helps to monitor the response to new therapies for Alzheimer’s disease, such as anti-amyloid monoclonal antibodies.
