Background Recurrence following resection of colorectal cancer liver metastases remains a major obstacle to prolonged patient survival, often resulting in treatment-refractory disease with limited understanding of the underlying evolutionary drivers.To investigate these mechanisms, we performed an in-depth, patient-specific study of genomic and microenvironmental alterations in relapsed colorectal cancer liver metastases from nine individuals. Methods Clonal deconvolution and phylogenetic analysis was conducted on DNA sequencing data from multiregion liver metastasis and relapse samples from the same patient. Archived primary tumor specimens were included to trace the clonal lineages responsible for relapse. In parallel, transcriptomic data from the liver metastasis and relapse samples were analyzed to characterize tumor-infiltrating immune cell populations. Results Phylogenetic analyses of relapsed metastases revealed two distinct patterns: (1) relapses that retain a clone already present in ancestral liver metastasis, and (2) relapses with no evident clonal link to the original metastasis. Relapses in the first group carried a chemotherapy-associated mutational signature, which then appeared across all relapse samples. In one patient, the relapsing clone had already diversified within the primary tumor. Tumor microenvironment analyses exposed heterogeneous responses followwing relapse, ranging from decreased to markedly increased infiltration by multiple immune cell types, accompanied by shifts in consensus molecular subtypes and altered neoantigen profiles. Conclusions Our study reveals patient-specific evolutionary trajectories underlying relapse in colorectal cancer, highlighting diverse routes to recurrence, including chemotherapy-driven clonal expansion and early divergence from the primary tumor. Our findings reveal a landscape of patient-specific evolutionary trajectories in relapsed colorectal cancer, underscoring the potential value of personalized approaches for understanding and monitoring recurrent disease.

The WHO expert group for echinococcosis recommends percutaneous treatment for the treatment of unilocular echinococcal cysts. In the rare case a hyperergic reaction occurs, it occurs as a type I immediate allergic reaction immediately after the cyst wall puncture. A 6-year-old boy with a unilocular echinococcal cyst in the left hepatic lobe, was treated with cyst puncture / drainage via the right hepatic lobe and falciform ligament under coverage with praziquantel and albendazole. No allergic reaction occurred during the procedure, but three hours later an acute severe hyperergic reaction occurred. Patients who have undergone an invasive therapy or suffered an acute leakage of an echinococcal cyst must be closely surveilled with the possibility of intensive care for at least 24 h after intervention.

Although quantitative ultrasound has crossed the threshold from research tool to routine clinical adjunct, current techniques still only interrogate tissue at the millimeter scale. Direct, micrometer-resolved insight into tissue structure, comparable to histology, remains an unmet need. The Scatterer Reconstruction (ScatRec) method, a non-stationary, deconvolution-based technique, shows promise in addressing this need. We improved the ScatRec algorithm and introduced three upgrades to improve its robustness: (i) Anisotropic total-variation, (ii) a Gaussian-noise fidelity term, and (iii) amplitude bound constraints. Additionally we bridge the gap to real work application by utilizing a spatially invariant point spread function. We then evaluated the enhanced reconstruction capabilities usingin silicoscatterer phantoms. For the first time, we analyzed the resolution limits with several two-scatterer phantoms with different scatterer distances. We tested the reconstruction quality and accuracy with phantoms containing randomly distributed scatterers and a signal-to-noise ratio (SNR) ranging from infinity to 10. Our two-scatterer phantoms showed that our proposed method at 18 MHz has an effective scatterer resolution of 38.5 μm × 156 μm in the axial and lateral directions, respectively, which is 2.6 times better than conventional B-mode. For randomly distributed scatterers, we quantified the reconstruction quality (measured by the normalized correlation coefficient, NCC) and the accuracy (indicated by the relative deviation of the effective acoustic concentration, EAC, compared to the ground truth). Compared to the original ScatRec, the NCC improved 3.7-fold, and the EAC 15.5-fold across realistic SNR of 40. Our feasibility analysis suggests thatin vivomicro-structural ultrasound for scatterer reconstruction is within reach, opening a path toward "ultrasonic histology" for diseases that are currently diagnosed only by biopsy.

Abstract Background To compare subjective and objective image quality and resolution between time-optimized standard knee MRI (sMRI) with image quality-optimized DL-enhanced (DL-MRI) at 3 Tesla. Methods A retrospective single-centre study of 150 knee MRI examinations (75 sMRI, 75 DL-MRI) was conducted. Protocols included Proton density–weighted sequence with fat suppression (PD-FS) (coronal/sagittal/axial), T1 (coronal or sagittal), and T2 (axial) optimized for time in sMRI and for image quality in DL-MRI. Three blinded readers with different levels of experience rated overall image quality, anatomical delineation, fat saturation, motion artefacts, and foreign-body artefacts on 5-point Likert scales. Quantitative analysis was performed to calculate SNR, CNR, and generalised metrics (gSNR, gCNR). Group differences were assessed using two-sided Welch’s t-tests. Results Readers rated DL higher in nearly all categories and sequences, with mean gains of ~ 0.48–0.70 for overall image quality and ~ 0.38–0.54 for anatomical delineation (all p ≤ 0.001). Fat saturation improved for PD-FS coronal and axial, motion artefacts improved for PD-FS coronal and sagittal (and slightly for axial), and foreign-body artefacts were comparable. Quantitatively, PD-FS showed higher muscle SNR and higher gSNR/gCNR with DL (bone SNR non-significant); T2 showed higher bone SNR and higher CNR/gCNR but lower muscle SNR/gSNR; and T1 showed lower SNR/gSNR with preserved CNR. Compared with sMRI, DL-MRI achieved a twofold improvement in in-plane resolution (0.4 × 0.4 mm² vs. 0.2 × 0.2 mm²) and reduced slice thickness (3.0 mm vs. 2.5 mm. and down to 1.0 mm for T2-weighted sequences), while slightly shortening total scan time (10:14 min vs. 9:30 min). Conclusion DL-MRI provided superior image quality and higher resolution over time-optimized standard knee MRI at 3 Tesla. Trial registration Not applicable.

BACKGROUND & AIMS:Perineural invasion (PNI) is a recognized marker of tumor aggressiveness in several malignancies, but its prevalence and prognostic significance in intrahepatic cholangiocarcinoma (ICC) remain uncertain. This systematic review and meta-analysis aimed to estimate the pooled prevalence of PNI and evaluate its association with overall survival (OS) in ICC. METHODS:Following PRISMA guidelines, PubMed, Web of Science, and the Cochrane Library were searched through August 2025. The PNI prevalence was pooled using a random-effects model. Where available, multivariable hazard ratios for OS were pooled using a random-effects meta-analysis. Heterogeneity was assessed and potential moderators were explored using meta-regression. Pairwise ecological correlations between PNI and other tumor features were analyzed using Pearson's correlation coefficient. RESULTS:We analyzed 61 studies including 15,502 patients. The pooled prevalence of PNI was 36.0% (95% CI 31.0-41.0%), with substantial heterogeneity (I2 = 98.5%). Meta-regression identified publication year and study size as independent moderators, with more recent and larger studies reporting lower PNI prevalence. PNI positively correlated with lymph node metastasis, lymphovascular invasion, and vascular invasion (all p <0.001), and inversely correlated with the proportion of mass-forming ICC (p = 0.025). Of 44 studies assessing OS, 23 were included in meta-analysis, demonstrating that PNI was associated with worse survival (hazard ratio 1.79, 95% CI 1.38-2.19, p <0.001). CONCLUSIONS:PNI occurs in approximately one-third of patients with ICC, is associated with poorer outcomes, and clusters with lymph node metastasis and vascular invasion, reflecting aggressive tumor biology. Despite the heterogeneity of the available data, its adverse prognostic impact is consistent. IMPACT AND IMPLICATIONS:Perineural invasion (PNI) is a proposed marker of tumor aggressiveness in intrahepatic cholangiocarcinoma (ICC); however, its prevalence and prognostic significance have remained uncertain, warranting systematic evaluation. This study provides the most comprehensive synthesis to date of PNI in ICC demonstrating that PNI occurs in approximately one-third of ICC cases and clusters with adverse pathological features, although its independent impact on survival remains debatable. These findings are relevant for clinicians and researchers involved in ICC management, as they suggest that PNI may contribute to more refined risk stratification, particularly in early-stage disease. In practice, PNI assessment could support clinical decision-making and patient counseling. However, future standardized and prospective studies are needed to clarify its prognostic value and potential role in guiding treatment strategies.

OBJECTIVES:Gadolinium-based contrast agents (GBCAs) are widely used in magnetic resonance imaging. Concerns exist regarding gadolinium deposition and its potential histopathologic tissue alterations, especially after repeated administrations of linear, less stable GBCAs. This study aimed to quantify gadolinium mass fractions in liver specimens of subjects exposed to GBCAs in correlation with histopathologic features. MATERIALS AND METHODS:In this Institutional Review Board-approved study, mass fractions of gadolinium in human liver specimens ω(Gd) from 25 subjects who underwent liver tumor resection surgery and had received GBCA (1 to 9 times over 4 y), were quantitatively analyzed using inductively coupled plasma-mass spectrometry (ICP-MS). Histomorphology was assessed based on the nonalcoholic fatty liver disease activity score (NAS). Linear regression analyses were performed with ω(Gd), time and dosage metrics, and histopathologic parameters. RESULTS:The median interval between last GBCA administration and surgery (T) was 14 days (range: 1 to 69 d). Gadolinium was detected in all liver samples (ω(Gd), median: 0.348 µg/g; range: 0.120 to 0.874 µg/g). No significant correlation was found between ω(Gd) and histologic scores, including inflammation and fibrosis. A strong negative correlation was found between ω(Gd) and ln(T) ( P < 0.001). A positive correlation existed between ω(Gd) and the number ( P = 0.010) but not the cumulative dose of previous GBCA administrations ( P = 0.205). CONCLUSIONS:Our results suggest that after intravenous administration of GBCA, a small fraction of gadolinium is retained in the liver over a time period of at least several weeks. A relationship was observed between Gadolinium retention and the number of GBCA administrations, but not with the cumulative dose and the degree of fatty liver disease.

In this study, pre-treatment target lesion vascularisation in either contrast-enhanced (CE) CT or MRI and post-treatment lipiodol deposition in native CT scans were compared in HCC patients who underwent their first cTACE treatment. We analysed the impact of stratification according to cTACE selectivity on these correlations. Seventy-eight HCC patients who underwent their first cTACE procedure were retrospectively included. Pre-treatment tumour vascularisation in arterial contrast phase and post-treatment lipiodol deposition in native CT scans were evaluated using the qEASL (quantitative tumour enhancement) method. Correlations were analysed using scatter plots, the Pearson correlation coefficient (PCC) and linear regression analysis. Subgroup analysis was performed according to lobar, segmental and subsegmental execution of cTACE. Arterial tumour volumes in both baseline CE CT (R2 = 0.83) and CE MR (R2 = 0.82) highly correlated with lipiodol deposition after cTACE. The regression coefficient between lipiodol deposition and enhancing tumour volume was 1.39 for CT and 0.33 for MR respectively, resulting in a ratio of 4.24. After stratification according to selectivity of cTACE, the regression coefficient was 0.94 (R2 = 1) for lobar execution, 1.38 (R2 = 0.96) for segmental execution and 1.88 (R2 = 0.89) for subsegmental execution in the CE CT group. Volumetric lipiodol deposition can be used as a reference to compare different imaging modalities in detecting vital tumour volumes. That approach proved CE MRI to be more sensitive than CE CT. Selectivity of cTACE significantly impacts the respective regression coefficients which allows for an innovative approach to the assessment of technical success after cTACE with a multitude of possible applications. • Lipiodol deposition after cTACE highly correlates with pre-treatment tumour vascularisation and can be used as a reference to compare different imaging modalities in detecting vital tumour volumes. • Lipiodol deposition also correlates with the selectivity of cTACE and can therefore be used to quantify the technical success of the intervention.

Background:Metabolic dysfunction-associated steatohepatitis (MASH) is a progressive liver disease associated with an increased risk of liver fibrosis, liver cirrhosis, and the development of hepatocellular carcinoma. Magnetic resonance elastography (MRE) has been established for non-invasively grading hepatic fibrosis and is increasingly used for assessing inflammation in research studies. The first pharmaceutical treatment of MASH -Resmetirom - was approved in the United States in March 2024 and received approval in Europe in August 2025. This circumstance will increase the demand for clinical and research MRE examinations. Therefore, this scoping review aims to provide an overview of the current research on the use of MRE in MASH for assessing fibrosis and inflammation. Materials and Methods:A structured literature search was carried out within the MEDLINE and Embase + Embase Classic databases. A total of 11 studies within the last five years were included based on predefined criteria, such as prospective study design, histopathological validation as reference standard or comparisons with other non-invasive procedures. Results:The included studies encompassed diverse populations, methods, and outcome criteria. MRE demonstrated excellent diagnostic performance for liver fibrosis (AUC up to 0.97), outperforming many other non-invasive fibrosis tests. Additionally, preliminary studies suggest good performance for hepatic inflammation (AUC up to 0.83). Multiparametric approaches that combine MRE with other quantitative MRI-based methods, such as proton density fat fraction (PDFF) and corrected T1 (cT1), could further improve diagnostic performance in MASH. Conclusion:These findings show that MRE is a reliable tool for non-invasively assessing hepatic fibrosis in MASH and shows promise to assess inflammation in the future. Key Points:· MRE shows excellent accuracy for fibrosis and good accuracy for inflammation in MASH.. · Multiparametric MRI improves diagnostic accuracy for steatosis, fibrosis, and inflammation.. · Further research needed to establish MRE as biopsy alternative for MASH.. Citation Format:· Widmann FP, Häseli SP, Schattenfroh J et al. Current Evidence on MR Elastography in Metabolic Dysfunction-Associated Steatohepatitis: A Scoping Review. Rofo 2024; DOI 10.1055/a-2807-9946.

Abstract Background We assessed the safety and efficacy of computed tomography (CT)-guided high-dose-rate (HDR) brachytherapy in treating hepatocellular carcinoma (HCC) with portal vein tumor thrombosis (PVTT). Methods From January 2010 to January 2022, 56 patients (median age 67.5 years) with HCC and PVTT underwent 64 procedures. PVTT was further classified according to the Japan liver cancer study group into VP1–VP4. Tumor response was evaluated by cross-sectional imaging 6 weeks after CT-guided HDR brachytherapy and every 3 months thereafter. Local tumor control (LTC), progression-free survival (PFS), and overall survival (OS) were assessed using Kaplan–Meier curves. The severity of procedure-related complications was classified according to the Society of Interventional Radiology guidelines. Results Patients were available for imaging evaluation for a median follow-up of 14.0 months. The median diameter of the largest lesion was 56 mm. Estimated median PFS, LTC, and OS were 7.0 (95% CI 5.0–13.0), 14.0 (95% CI 7.0–21.0), and 20.0 (95% CI 13.0–26.0) months respectively. Actuarial 1-, 2-, and 3-year OS rates were 66%, 41%, and 27%, respectively. Subclassified for VP1, VP2, VP3, and VP4 estimated OS was 38.0 (95% CI 9.0-Not-a-number), 21.5 (95% CI 15.0–25.0), 15.0 (95% CI 7.0–33.0), and 13.0 (95% CI 6.0–34.0) months, respectively. Considering the 64 procedures, we recorded no complications for 49 (76.6%), mild-to-moderate complications for 12 (18.8%), and major complications for 3 (4.7%). Conclusion CT-guided HDR brachytherapy was safe and effective for locoregional treatment in patients with advanced HCC due to PVTT, achieving long-lasting local tumor control. Relevance statement CT-guided HDR brachytherapy is an option to be considered for locoregional treatment of patients with advanced HCC due to PVTT. Key Points Evaluation of CT-guided high-dose-rate (HDR) brachytherapy in treating HCC patients with portal vein tumor thrombosis (PVTT). Median OS was 20.0 months ranging between 13.0 and 38.0 months. CT-guided HDR brachytherapy seems to be a safe and effective treatment option in HCC patients with PVTT. Graphical Abstract

To assess the efficacy of segmental right portal vein embolization (SRPVE) versus main right portal vein embolization (MRPVE) in preoperative preparation for major hepatectomy. This retrospective single-center study included 220 consecutive patients who underwent portal vein embolization (PVE) before (extended) right hemihepatectomy between January 2014 and June 2021. Seventy-one patients underwent selective segmental embolization (SRPVE) and 149 patients underwent MRPVE. Volumetric analysis was conducted before PVE and before surgery. Key endpoints included evaluation of future liver remnant (FLR) hypertrophy, intraoperative complexity, and postoperative complications, technical success, clinical success, complications (Clavien-Dindo and CIRSE classifications), as well as evaluation of different factors which may influence hypertrophy of the FLR. Technical success rate was 100

Body composition analysis (BCA) is a recognized indicator of patient frailty. Apart from the established bioelectrical impedance analysis (BIA), computed tomography (CT)-derived BCA is being increasingly explored. The aim of this prospective study was to directly compare BCA obtained from BIA and CT. A total of 210 consecutive patients scheduled for CT, including a high proportion of cancer patients, were prospectively enrolled. Immediately prior to the CT scan, all patients underwent BIA. CT-based BCA was performed using a single-slice AI tool for automated detection and segmentation at the level of the third lumbar vertebra (L3). BIA-based parameters, body fat mass (BFMBIA) and skeletal muscle mass (SMMBIA), CT-based parameters, subcutaneous and visceral adipose tissue area (SATACT and VATACT) and total abdominal muscle area (TAMACT) were determined. Indices were calculated by normalizing the BIA and CT parameters to patient’s weight (body fat percentage (BFPBIA) and body fat index (BFICT)) or height (skeletal muscle index (SMIBIA) and lumbar skeletal muscle index (LSMICT)). Parameters representing fat, BFMBIA and SATACT + VATACT, and parameters representing muscle tissue, SMMBIA and TAMACT, showed strong correlations in female (fat: r = 0.95; muscle: r = 0.72; p < 0.001) and male (fat: r = 0.91; muscle: r = 0.71; p < 0.001) patients. Linear regression analysis was statistically significant (fat: R2 = 0.73 (female) and 0.74 (male); muscle: R2 = 0.56 (female) and 0.56 (male); p < 0.001), showing that BFICT and LSMICT allowed prediction of BFPBIA and SMIBIA for both sexes. CT-based BCA strongly correlates with BIA results and yields quantitative results for BFP and SMI comparable to the existing gold standard. Question CT-based body composition analysis (BCA) is moving more and more into clinical focus, but validation against established methods is lacking. Findings Fully automated CT-based BCA correlates very strongly with guideline-accepted bioelectrical impedance analysis (BIA). Clinical relevance BCA is currently moving further into clinical focus to improve assessment of patient frailty and individualize therapies accordingly. Comparability with established BIA strengthens the value of CT-based BCA and supports its translation into clinical routine.

RATIONALE AND OBJECTIVES:The aim of this study was to evaluate image quality for contrast-enhanced (CE) neck MRI with a deep learning-reconstructed VIBE sequence with acceleration factors (AF) 4 (DL4-VIBE) and 6 (DL6-VIBE). METHODS:Patients referred for neck MRI were examined in a 3-Tesla scanner in this prospective, single-center study. Four CE fat-saturated (FS) VIBE sequences were acquired in each patient: Star-VIBE (4:01 min), VIBE (2:05 min), DL4-VIBE (0:24 min), DL6-VIBE (0:17 min). Image quality was evaluated by three radiologists with a 5-point Likert scale and included overall image quality, muscle contour delineation, conspicuity of mucosa and pharyngeal musculature, FS uniformity, and motion artifacts. Objective image quality was assessed with signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), and quantification of metal artifacts. RESULTS:68 patients (60.3% male; mean age 57.4±16 years) were included in this study. DL4-VIBE was superior for overall image quality, delineation of muscle contours, differentiation of mucosa and pharyngeal musculature, vascular delineation, and motion artifacts. Notably, DL4-VIBE exhibited exceptional FS uniformity (p<0.001). SNR and CNR were superior for DL4-VIBE compared to all other sequences (p<0.001). Metal artifacts were least pronounced in the standard VIBE, followed by DL4-VIBE (p<0.001). Although DL6-VIBE was inferior to DL4-VIBE, it demonstrated improved FS homogeneity, delineation of pharyngeal mucosa, and CNR compared to Star-VIBE and VIBE. CONCLUSION:DL4-VIBE significantly improves image quality for CE neck MRI with a fraction of the scan time of conventional sequences.

Background: Deep learning (DL) accelerated controlled aliasing in parallel imaging results in higher acceleration (CAIPIRINHA)-volumetric interpolated breath-hold examination (VIBE), provides high spatial resolution T1-weighted imaging of the upper abdomen. We aimed to investigate whether DL-CAIPIRINHA-VIBE can improve image quality, vessel conspicuity, and lesion detectability compared to a standard CAIPIRINHA-VIBE in renal imaging at 3 Tesla. Methods: In this prospective study, 50 patients with 23 solid and 45 cystic renal lesions underwent MRI with clinical MR sequences, including standard CAIPIRINHA-VIBE and DL-CAIPIRINHA-VIBE sequences in the nephrographic phase at 3 Tesla. Two experienced radiologists independently evaluated both sequences and multiplanar reconstructions (MPR) of the sagittal and coronal planes for image quality with a Likert scale ranging from 1 to 5 (5 =best). Quantitative measurements including the size of the largest lesion and renal lesion contrast ratios were evaluated. Results: DL-CAIPIRINHA-VIBE compared to standard CAIPIRINHA-VIBE showed significantly improved overall image quality, higher scores for renal border delineation, renal sinuses, vessels, adrenal glands, reduced motion artifacts and reduced perceived noise in nephrographic phase images (all p < 0.001). DL-CAIPIRINHA-VIBE with MPR showed superior lesion conspicuity and diagnostic confidence compared to standard CAIPIRINHA-VIBE. However, DL-CAIPIRINHA-VIBE presented a more synthetic appearance and more aliasing artifacts (p < 0.023). The mean size and signal intensity of renal lesions for DL-CAIPIRINHA-VIBE showed no significant differences compared to standard CAIPIRINHA-VIBE (p > 0.9). Conclusions: DL-CAIPIRINHA-VIBE is well suited for kidney imaging in the nephrographic phase, provides good image quality, improved delineation of anatomic structures and renal lesions.

Background: Prior studies suggest that patients’ body composition changes following transjugular intrahepatic portosystemic shunt (TIPS) implantation, potentially influencing complications and survival. Method: A prototype artificial intelligence (AI)-based, automated computed tomography (CT) body composition analysis tool was used to assess body composition imaging parameters in pre- and postinterventional scans of TIPS patients: visceral (VAT) and subcutaneous adipose tissue (SAT) areas, psoas muscle area (PMA), and total abdominal muscle area (TAMA). Sarcopenia was defined as a lumbar skeletal muscle index (LSMI) ≤ 38.5 cm2/m2 in women and ≤52.4 cm2/m2 in men. We analyzed longitudinal changes in body composition and investigated the impact of sarcopenia at TIPS implantation on the risk of TIPS thrombosis, hepatic encephalopathy, complications, and death using Cox regression models. Results: No clear trend emerged regarding changes in body composition parameters during postinterventional follow-up. Sarcopenia at TIPS implantation increased the instantaneous risk of postinterventional complications (hazard ratio (HR) 1.67; 95% confidence interval (CI) 0.95–2.93), development of hepatic encephalopathy (HR 1.65; 0.81–3.33), as well as the risk of dying within one year (HR 1.39; 0.66–2.92). Conclusions: CT body composition analysis may help in identifying high-risk patients undergoing TIPS implantation. Sarcopenia was associated with increased mortality and a higher incidence of postinterventional complications, particularly hepatic encephalopathy.

Body composition (BC) analysis is performed to quantify the relative amounts of different body tissues as a measure of physical fitness and tumor cachexia. We hypothesized that relative changes in body composition (BC) parameters, assessed by an artificial intelligence–based, PACS-integrated software, between baseline imaging before the start of radioligand therapy (RLT) and interim staging after two RLT cycles could predict overall survival (OS) in patients with metastatic castration-resistant prostate cancer. We conducted a single-center, retrospective analysis of 92 patients with mCRPC undergoing [177Lu]Lu-PSMA RLT between September 2015 and December 2023. All patients had [68 Ga]Ga-PSMA-11 PET/CT at baseline (≤ 6 weeks before the first RLT cycle) and at interim staging (6–8 weeks after the second RLT cycle) allowing for longitudinal BC assessment. During follow-up, 78 patients (85