Pancreatic pseudocysts are rare in children and typically arise after episodes of pancreatitis or abdominal trauma. Their diagnosis generally relies on imaging studies, where they are expected to appear as fluid-filled collections. We describe a case of a 3-year-old girl who has no previous occurrences of pancreatitis or trauma, in whom an unexpected heterogeneous, hypoechoic perigastric mass was incidentally detected during an ultrasound examination. The lesion demonstrated a consistent, firm appearance during an 8-month follow-up period and continued to be without symptoms. Laboratory examinations, including pancreatic enzymes assay, returned normal results, and imaging studies could not determine its characteristics. A laparoscopic excision was conducted for both diagnostic and treatment reasons. Histological and immunohistochemical analysis confirmed the diagnosis of a pancreatic pseudocyst. Postoperative recovery was uneventful. This case demonstrates a rare solid appearance of a pancreatic pseudocyst in a child who does not have previous pancreatic disease, emphasizing the critical importance of histopathological examination and surgical intervention when imaging results are unclear.

Contrast fluoroscopy of the upper gastrointestinal (GI) tract has become less common in the last decades, mainly due to the development of endoscopy and cross-sectional imaging methods. However, it remains an important imaging technique offering real-time dynamic acquisitions of the upper GI tract with a high temporal and spatial resolution and the ability to adjust the position of the child appropriately, thus being valuable and irreplaceable for addressing specific clinical queries such as tracheoesophageal fistula, aspiration, strictures, oesophageal injuries, hernias, achalasia, post-operative leaks, and duodenal anatomy. Therefore, junior radiologists should continue to seek and maintain expertise in performing and interpreting contrast fluoroscopy studies. The aim of this paper is to present a practical approach to contrast fluoroscopy of the upper GI tract in children, focused on its normal radiological anatomy and physiology. It lists current indications for the upper GI series and provides a list of indications where alternative imaging techniques have replaced fluoroscopy. Finally, basic hands-on procedural recommendations are presented.

To compare shear-wave elastography (SWE) and diffusion-weighted imaging (DWI)-derived apparent diffusion coefficient (ADC) values in the differentiation of benign and malignant breast lesions, and to assess the correlation and potential interchangeability between these imaging biomarkers. In this retrospective study, 53 female patients (mean age: 55.2 ± 11.7 years) with biopsy-proven BI-RADS 4 or 5 breast lesions underwent both SWE and breast MRI, including DWI. SWE parameters (Emax, Emean, Emin) and ADC values were quantitatively analyzed and compared using Mann–Whitney U tests. Diagnostic performance was evaluated via ROC analysis. Correlation and interchangeability between SWE and ADC were assessed using Spearman’s rank correlation, regression analysis, and Bland–Altman plots. Among 53 lesions (26 malignant, 27 benign), SWE Emax demonstrated the best diagnostic performance among SWE parameters (AUC = 0.74), with an optimal cut-off of > 69.47 kPa (sensitivity: 62

Artificial intelligence (AI) is increasingly shaping radiology, though its integration into paediatric radiology has progressed more slowly due to challenges specific to the paediatric population. This is especially true in the field of paediatric abdominal imaging. Key barriers include regulatory and ethical issues, the scarcity of large paediatric datasets necessary for algorithm training, reduced vendor interest linked to limited economic incentives, and the inherent differences in children throughout the developmental stages including organ size, signal/sonographic characteristics, and pathologies. Despite these obstacles, AI has the potential to enhance clinical care by augmenting radiologists’ workflow across both interpretive and non-interpretive tasks. Currently, most published research focuses on AI’s role in musculoskeletal imaging. Although AI is expanding its reach in other imaging domains, paediatric imaging lags behind, as does its potential in abdominal imaging. The use of AI in paediatric abdominal imaging has received limited attention in the existing literature. Emerging research applications cover multiple tasks: detection, classification, functional analysis, severity prediction, automated segmentation, image quality optimization, and acceleration of image acquisition. This review aims to provide practicing radiologists with a concise, simple, and clinically oriented overview of the potential applications and limitations of these new AI tools in paediatric abdominal imaging, categorized by organ. For the time being, most applications described in the literature remain confined to the research setting. To advance these approaches towards clinical utility, validation on larger and more heterogeneous datasets is required. Moving forward, it will be essential to integrate human expertise with AI systems to strengthen diagnostic capacity in paediatric abdominal radiology and to promote paediatric-specific regulatory standards, clear governance structures, and human-centred oversight.

Renal pathology is common in childhood. Imaging plays a critical role in the diagnosis of kidney diseases and encompasses a range of modalities. Advanced imaging is typically performed in specialised paediatric hospitals, where experienced paediatric radiologists are familiar with the relevant techniques, protocols, indications, and limitations. However, children are often first admitted to general hospitals, where radiologists may have more limited experience in paediatric imaging. Renal cysts in children differ from those in adults, most commonly presenting as cystic kidney diseases. In the majority of cases, ultrasound (US) is the sole diagnostic modality required. Imaging is not necessary for the diagnosis of urinary tract infection (UTI), but it is essential for detecting underlying anomalies and potential complications. Urinary tract dilatation is a common finding in children; however, only up to 30% of cases require further evaluation to diagnose urinary tract obstruction or vesicourinary reflux. Urolithiasis is relatively uncommon in children and is primarily diagnosed with US, although computed tomography (CT) may occasionally be necessary. Solid renal lesions identified on US should be further evaluated in highly specialised paediatric centres. Mild to moderate renal trauma can be diagnosed and monitored using US, whereas CT remains the modality of choice for assessing severe trauma. Clinical relevance statement This review provides general radiologists with a comprehensive overview of the normal renal appearance across paediatric age groups, including normal variants and imaging pathways for the most common renal pathologies in children. It also highlights scenarios where referral to specialised paediatric centres is necessary. Key Points US is the first-line imaging modality for diagnosing most renal pathologies in children . MRI is used in a variety of situations (e.g. complex congenital anomalies of the kidney and urinary tract, or focal lesions) when US is not sufficient . CT is reserved for emergencies and in selected cases of urolithiasis . Knowledge of normal renal features, including normal anatomical and morphological variants across different age groups, is essential .

The main objective was to assess the geographical distribution and main areas of use of dual-energy CT (DECT) scanners in Italy prior to the implementation of the National Recovery and Resilience Plan (NRRP) within the Next Generation EU (NGEU) framework. Secondary objectives included the level of knowledge of DECT among radiologists and some possible solutions to maximize its use. Between February and March 2022, an anonymous questionnaire was conducted among the members of the Italian Society of Medical and Interventional Radiology (SIRM), using the Google form platform. A total of 261 radiologists (mean age 41 ± 11.7 years) from 90 Italian cities participated in the questionnaire. 42

Anyone who has visited a radiology department in another continent, country, or even city has likely noticed subtle differences in how things are done compared to their own department. Many procedures become so ingrained in daily practice that we rarely stop to question whether they are truly supported by evidence. One such procedure is intussusception reduction. In this paper, we review the literature, examine the best reduction technique and the risks associated with general anaesthesia and sedation, and offer the Abdominal Task Force’s opinion on this common but very variable procedure, based on the current available literature.

Regorafenib is a multikinase inhibitor approved for treatment of patients with metastatic Colo-Rectal Cancer (mCRC) and Gastro-Intestinal Stromal Tumor (GIST) progression after the administration of other tyrosine-kinase inhibitors such as imatinib and sunitinib.Only a handful of severe side effects such as intestinal perforations and fistulas have been described in the literature in patients undergoing multikinase inhibitor treatment. We report a case of a patient with peritoneal mCRC who experienced an intestinal perforation during the administration of Regorafenib and review the literature. A 48-year-old man with previously resected sigmoid colon cancer and peritoneal metastatic disease under Regorafenib treatment presented to our Emergency Department with severe abdominal pain and asthenia. Abdominal X-ray and contrast-enhanced computed tomography examination revealed an intestinal perforation. The patient underwent emergency surgery which demonstrated acute diffuse peritonitis, necrosis, and perforation of a distal ileal loop affected by peritoneal metastatic disease. The necrosis of peritoneal implants on bowel walls could be regarded as a potential factor leading to intestinal perforation in metastatic colorectal cancer patients undergoing Regorafenib treatment complaining of severe abdominal pain and asthenia.Surgeons, radiologists and oncologists should always keep in mind this rare adverse event during Regorafenib administration. Appropriate diagnostic tests and treatments should be carried out.

Voiding cystourethrography (VCUG) is a fluoroscopic technique that allows the assessment of the urinary tract, including the urethra, bladder, and—if vesicoureteral reflux (VUR) is present—the ureters and the pelvicalyceal systems. The technique also allows for the assessment of bladder filling and emptying, providing information on anatomical and functional aspects. VCUG is, together with contrast-enhanced voiding urosonography (VUS), still the gold standard test to diagnose VUR and it is one of the most performed fluoroscopic examinations in pediatric radiology departments. VCUG is also considered a follow-up examination after urinary tract surgery, and one of the most sensitive techniques for studying anatomy of the lower genitourinary tract in suspected anatomical malformations. The international reflux study in 1985 published the first reflux-protocol and graded VUR into five classes; over the following years, other papers have been published on this topic. In 2008, the European Society of Paediatric Radiology (ESPR) Uroradiology Task Force published the first proposed VCUG Guidelines with internal scientific society agreement. The purpose of our work is to create a detailed overview of VCUG indications, procedural recommendations, and to provide a structured final report, with the aim of updating the 2008 VCUG paper proposed by the European Society of Paediatric Radiology (ESPR). We have also compared VCUG with contrast-enhanced VUS as an emergent alternative. As a result of this work, the ESPR Urogenital Task Force strongly recommends the use of contrast-enhanced VUS as a non-radiating imaging technique whenever indicated and possible.

Children are more sensitive to ionizing radiation than adults. Even though the risk is very low, exposure from radiological examinations can possibly cause them long-term side effects. Recent large epidemiological studies involving children and young adults have added evidence suggesting that even small doses of radiation, such as those from computed tomography scans, might slightly increase the risk of developing cancer later in life. Therefore, even though radiologic studies are essential for an accurate diagnosis and management of various conditions, it is crucial to minimize radiation exposure. This article addresses radiation protection for children in the medical use of ionizing radiation and it is set in the context of the European legislative framework regarding radiation protection. It advocates for a holistic approach to paediatric radiological tests. This approach includes the key principles of radiation protection, such as the justification of imaging procedures supported by referral guidelines, as well as the optimization of techniques (according to the ALARA principle) and effective communication with parents about the benefits and the risks of radiologic procedures. Protecting children from unnecessary radiation is not only a technical challenge, but also a moral obligation and a legal requirement.

Precocious puberty in girls is defined by the appearance of secondary sex characteristics before the age of 8 years. Precocious puberty is either peripheral or central. In most cases, the cause of central precocious puberty is unknown. Rapidly progressive forms of central precocious puberty may benefit from puberty suppression to prevent compromised final height and psychosocial problems related to the physical changes. Idiopathic central precocious puberty in girls can be a challenging diagnosis. Clinical examination, evaluation of growth charts, bone age, and hormonal tests are part of the workup. The role of pelvic ultrasound to evaluate pubertal features of the internal genitalia in this context is controversial. In this paper, we have reviewed the literature to find the scientific bases for several proposed ultrasound parameters and cutoff values for the determination of onset of puberty in girls with suspected central precocious puberty. There are no reliable cutoffs for the measurements of uterus and ovaries for the diagnosis of central precocious puberty and there is overlap in the appearance of the organs in both prepubertal and pubertal girls. The interpretation of the findings on pelvic ultrasound must be done with caution and always in close communication with the referring clinicians.

Objectives To collect real-world data about the knowledge and self-perception of young radiologists concerning the use of contrast media (CM) and the management of adverse drug reactions (ADR). Methods A survey (29 questions) was distributed to residents and board-certified radiologists younger than 40 years to investigate the current international situation in young radiology community regarding CM and ADRs. Descriptive statistics analysis was performed. Results Out of 454 respondents from 48 countries (mean age: 31.7 ± 4 years, range 25–39), 271 (59.7%) were radiology residents and 183 (40.3%) were board-certified radiologists. The majority (349, 76.5%) felt they were adequately informed regarding the use of CM. However, only 141 (31.1%) received specific training on the use of CM and 82 (18.1%) about management ADR during their residency. Although 266 (58.6%) knew safety protocols for handling ADR, 69.6% (316) lacked confidence in their ability to manage CM-induced ADRs and 95.8% (435) expressed a desire to enhance their understanding of CM use and handling of CM-induced ADRs. Nearly 300 respondents (297; 65.4%) were aware of the benefits of contrast-enhanced ultrasound, but 249 (54.8%) of participants did not perform it. The preferred CM injection strategy in CT parenchymal examination and CT angiography examination was based on patient’s lean body weight in 318 (70.0%) and 160 (35.2%), a predeterminate fixed amount in 79 (17.4%) and 116 (25.6%), iodine delivery rate in 26 (5.7%) and 122 (26.9%), and scan time in 31 (6.8%) and 56 (12.3%), respectively. Conclusion Training in CM use and management ADR should be implemented in the training of radiology residents. Critical relevance statement We highlight the need for improvement in the education of young radiologists regarding contrast media; more attention from residency programs and scientific societies should be focused on training about contrast media use and the management of adverse drug reactions. Key points • This survey investigated training of young radiologists about use of contrast media and management adverse reactions. • Most young radiologists claimed they did not receive dedicated training. • An extreme heterogeneity of responses was observed about contrast media indications/contraindications and injection strategy. Graphical Abstract

Abstract Objectives To validate the performance of Mirai, a mammography-based deep learning model, in predicting breast cancer risk over a 1–5-year period in Mexican women. Methods This retrospective single-center study included mammograms in Mexican women who underwent screening mammography between January 2014 and December 2016. For women with consecutive mammograms during the study period, only the initial mammogram was included. Pathology and imaging follow-up served as the reference standard. Model performance in the entire dataset was evaluated, including the concordance index (C-Index) and area under the receiver operating characteristic curve (AUC). Mirai’s performance in terms of AUC was also evaluated between mammography systems (Hologic versus IMS). Clinical utility was evaluated by determining a cutoff point for Mirai’s continuous risk index based on identifying the top 10% of patients in the high-risk category. Results Of 3110 patients (median age 52.6 years ± 8.9), throughout the 5-year follow-up period, 3034 patients remained cancer-free, while 76 patients developed breast cancer. Mirai achieved a C-index of 0.63 (95% CI: 0.6–0.7) for the entire dataset. Mirai achieved a higher mean C-index in the Hologic subgroup (0.63 [95% CI: 0.5–0.7]) versus the IMS subgroup (0.55 [95% CI: 0.4–0.7]). With a Mirai index score > 0.029 (10% threshold) to identify high-risk individuals, the study revealed that individuals in the high-risk group had nearly three times the risk of developing breast cancer compared to those in the low-risk group. Conclusions Mirai has a moderate performance in predicting future breast cancer among Mexican women. Critical relevance statement Prospective efforts should refine and apply the Mirai model, especially to minority populations and women aged between 30 and 40 years who are currently not targeted for routine screening. Key Points The applicability of AI models to non-White, minority populations remains understudied. The Mirai model is linked to future cancer events in Mexican women. Further research is needed to enhance model performance and establish usage guidelines. Graphical Abstract

Background: Breast cancer in pediatric patients is rare, but ultrasound (US) is widely utilized for symptomatic cases. Purpose: To determine biopsy and cancer detection rates of pediatric patients and to assess if breast US can be omitted. Material and Methods: A retrospective review of a 5-year period was conducted of single-center breast US performed in patients aged <19 years. Data regarding presentation, clinical opinion (P1-5 score), and US (U1-5 score) were collected. If biopsy or surgery was performed, pathology was reviewed (B1-5 score). Results: In total, 579 patients were included (19 boys, 560 girls; mean age=16.2 +/- 1.9 years; age range=0-18 years). Clinical examination was normal or benign (P1/P2) in all boys (100%) and 557/560 (99.5%) girls, and P3 in 3 (0.5%) girls. Of US, 52% demonstrated normal findings (U1) for both sexes (300/579); in the remaining cases, the most frequent findings were gynecomastia in 12/19 boys and well-defined breast masses in 208/560 girls. Of the 560 girls, 6 (1%) underwent US-guided biopsy, with final histology of fibroadenoma (B2) in all cases, while 27 (5%) had a surgical excision, with final histology of fibroadenoma (22/27, 81.5%), hamartoma (2/27, 7.4%), benign phyllodes tumor (2/27, 7.4%), and angiomyxoma skin lesion (1/27, 3.7%). No malignant lesions were diagnosed at the time of clinical referral or during the 18-month follow-up in patients with a well-defined mass on US. Conclusion: Breast malignancy is extremely rare in pediatric population. US can be safely omitted if clinical examination is normal; this approach would have avoided breast US in 52% of patients in this study.

Over the last decades, magnetic resonance imaging (MRI) has emerged as a valuable adjunct to prenatal ultrasound for evaluating fetal malformations. Several radiological societies advocate for standardised and structured reporting practices to enhance the uniformity of imaging language. Compared to narrative formats, standardised and structured reports offer enhanced content quality, minimise reader variability, have the potential to save reporting time, and streamline the communication between specialists by employing a shared lexicon. Structured reporting holds promise for mitigating medico-legal liability, while also facilitating rigorous scientific data analyses and the development of standardised databases. While structured reporting templates for fetal MRI are already in use in some centres, specific recommendations and/or guidelines from international societies are scarce in the literature. The purpose of this paper is to propose a standardised and structured reporting template for fetal MRI to assist radiologists, particularly those with less experience, in delivering systematic reports. Additionally, the paper aims to offer an overview of the anatomical structures that necessitate reporting and the prevalent normative values for fetal biometrics found in current literature.

Introduction: Chyloperitoneum arises from lymph leakage into the abdominal cavity, leading to an accumulation of milky fluid rich in triglycerides. Diagnosis can be challenging, and mortality rates vary depending on the underlying cause, with intestinal volvulus being just one potential acute cause. Despite its rarity, our case series highlights chyloperitoneum associated with non-ischemic small bowel volvulus. The aims of our study include assessing the incidence of this association and evaluating diagnostic and therapeutic approaches. Material and Methods: We present two cases of acute abdominal peritonitis with suspected small bowel volvulus identified via contrast-enhanced computed tomography (CT). Emergency laparotomy revealed milky-free fluid and bowel volvulus. Additionally, we conducted a systematic review up to 31 October 2023, identifying 15 previously reported cases of small bowel volvulus and chyloperitoneum in adults (via the PRISMA scheme). Conclusions: Clarifying the etiopathogenetic mechanism of chyloperitoneum requires specific diagnostic tools. Magnetic resonance imaging (MRI) may be useful in non-emergency situations, while contrast-enhanced CT is employed in emergencies. Although small bowel volvulus infrequently causes chyloperitoneum, prompt treatment is necessary. The volvulus determines lymphatic flow obstruction at the base of the mesentery, with exudation and chyle accumulation in the abdominal cavity. Derotation of the volvulus alone may resolve chyloperitoneum without intestinal ischemia.

The role of multiparametric MRI (mpMRI) in prostate cancer setting is increasingly consolidated and, as a result, its usage in clinical practice is in exponential growth. However, beyond the prostate gland, several key structures are included in the field of view of mpMRI scans. Consequently, various extra-prostatic incidental findings (IFs) belonging to different anatomical systems can be accidentally recognized. Therefore, it is mandatory for a radiologist to be familiar with the wide range of pathologies potentially encountered, to guide management and avoid patient anxiety and costs due to additional work-up prompted by clinically insignificant extra-prostatic findings. With this pictorial review, we aim to illustrate a wide range of IFs that can be detected when performing mpMRI of the prostate, focusing on their imaging characteristics, differential diagnosis, and clinical relevance. Additionally, we propose the CheckDEEP, the Checklist for DEtection of ExtraProstatic findings, to be used for a thorough evaluation of target areas within each anatomical system.

Barium inhalation usually relates to accidental aspiration during radiological procedures with an oral contrast agent. When present, barium lung deposits are visible as high-density opacities on chest X-ray or CT scan due to high atomic number, and they may be indistinguishable from calcifications. Dual-layer spectral CT has shown good material differentiation capabilities, due to its increased high-Z element range and smaller spectral separation between low- and high-energy spectral data. We present the case of a 17-year-old female with a history of tracheoesophageal fistula, who underwent chest CT angiography on a dual-layer spectral platform. Despite the close Z numbers and K-edge energy levels of the two different contrast materials, spectral CT was able to identify barium lung deposits from a previous swallowing study and to clearly distinguish them from calcium and the surrounding iodine-containing structures.

Pathological conditions affecting the male breast (MB) share some similarities with those found in women, while others are specific to men. The first part of this review provides an overview of MB disorders, exploring the most common types of MB diseases. The second part then emphasizes the state-of-the-art approaches proposed in the literature for screening and follow-up with MB cancer patients, which highlights the importance of tailored strategies for diagnosis, follow-up, and identifying high-risk populations. Considering the increasing attention in recent years on the topic, transgender individuals are also included in this review. Together with the MB, it is an understudied category thus far. This review aims to raise awareness among radiologists that MBs should be approached differently from female breasts, contributing to the advancement of medical knowledge, improving patient outcomes, and promoting early detection of MB disorders. The review also provides an update on breast cancer and screening in the transgender population.