Accurate staging and appropriate follow-up imaging of pancreatic neuroendocrine tumors (PNET) are essential for guiding management and optimizing outcomes. This document provides evidence-based recommendations for the imaging evaluation of patients with PNET across six clinical variants: local staging, staging for metastatic disease, surveillance postresection, follow-up after treatment of liver-dominant and non-liver dominant disease, and follow-up of untreated disease. Contrast-enhanced CT is usually appropriate in most scenarios and commonly used as the first-line imaging modality in assessing tumor size, locoregional extent, vascular involvement, and metastatic spread. MRI is also usually appropriate, particularly for liver evaluation. MRI with hepatobiliary contrast agents and diffusion-weighted imaging improves detection and characterization of liver metastases, especially in liver-dominant disease. DOTATATE PET/CT is usually appropriate for staging and treatment planning in patients with suspected or known metastatic disease. FDG-PET/CT is reserved for select cases, such as high-grade tumors. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer-reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.

Gastric cancer requires optimal imaging for staging and surveillance. This document provides evidence-based recommendations for four scenarios: suspected gastric adenocarcinoma, staging of confirmed disease, posttreatment evaluation, and surveillance. For suspected gastric cancer, CT abdomen/pelvis with contrast and FDG-PET/CT are usually appropriate for initial staging. For confirmed disease staging, these modalities are usually appropriate for evaluating locoregional and distant metastases. For posttreatment evaluation, CT abdomen/pelvis with contrast is usually appropriate for treatment response assessment and recurrence detection, particularly in high-risk patients. FDG-PET/CT is usually appropriate for treatment response evaluation and distant recurrence detection. MRI with diffusion-weighted imaging may be appropriate when radiation exposure is a concern. For surveillance following curative surgical resection of gastric adenocarcinoma, CT abdomen and pelvis with contrast is usually appropriate as the primary imaging modality. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.

Screening for early-onset colorectal cancer is a growing public health concern, driven by a rising incidence in younger adults. As trends shift, screening guidelines continue to evolve. In this article, we examine recent epidemiologic patterns and potential causes of this shift. We also explore recent updates on current screening modalities, both structural and nonstructural, highlighting their efficancy, advantages, limitations, and cost-effectiveness to inform future clinical and policy decisions, with a focus on CT colonogrpahy. Additionally, we discuss the evolving complementary role of artificial intelligence in enhancing the accuracy of screening tests.

Chronic pancreatitis (CP) is a progressive disorder of the pancreas characterized by irreversible parenchymal and ductal changes, leading to chronic pain and pancreatic insufficiency. Its impact on quality of life can be profound and may further be complicated by acute inflammation superimposed on CP (ACP), potentially accelerating functional decline and increasing morbidity. Imaging plays an important role in diagnosing both CP and ACP, determining severity, identifying underlying causes, and detecting complications. CT is particularly effective at detecting parenchymal calcifications, typically seen in later disease, and for rapid evaluation of ACP. MRI with MRCP is more sensitive for early ductal and parenchymal changes, with secretin-stimulated MRCP further improving detection in mild or early disease. In certain cases, endoscopic ultrasound adds diagnostic value and offers therapeutic intervention. Early and accurate imaging, paired with clinical and laboratory evaluation, is essential for guiding effective patient care in CP.The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.

Computed tomography colonography, also known as virtual colonoscopy, is a minimally invasive imaging technique developed in the early 1990s to evaluate the colon for polyps, cancer, and other abnormalities. Advances in multidetector computed tomography, bowel preparation protocols, and three-dimensional reconstruction rapidly improved diagnostic performance. Landmark trials demonstrating sensitivity for clinically significant adenomas comparable to optical colonoscopy led to its acceptance as a colorectal cancer screening option. Standardized reporting further accelerated clinical uptake. The CT Colonography Reporting and Data System (C-RADS), introduced in 2005, provided a structured lexicon for colonic and extracolonic findings, allowing more consistent communication and management. Prior to structured reporting, early clinical implementation of computed tomography colonography was challenged by wide variability in terminology and follow-up thresholds. C-RADS addressed these issues by categorizing colonic findings according to adequacy of evaluation and likelihood of neoplastic disease and stratifying extracolonic observations based on clinical significance. The system enhanced clarity, increased reproducibility, and supported longitudinal research efforts by enabling systematic outcome tracking. Experience gained over the next decade and a half led to the C-RADS 2023 update. Notable changes included subdivision of intermediate colonic findings to distinguish likely benign diverticular-associated soft tissue thickening from indeterminate lesions, and simplification of extracolonic categories to reduce over-reporting of clinically unimportant findings. Future directions include broader adoption across health systems, automated detection and computer-assisted interpretation, and integration with artificial intelligence to improve polyp identification and extracolonic assessment. Together, these advances are expected to expand access, improve efficiency, and further solidify computed tomography colonography within evidence-supported screening practice.

BACKGROUND:Given the Centers for Medicare and Medicaid Services' coverage of screening CT colonography (CTC) beginning in January 2025, we evaluated the cost-effectiveness of CTC for colorectal cancer (CRC) screening by race (Black and White) and gender, considering real-world screening adherence. METHODS:A microsimulation model compared CRC screening strategies in average-risk adults by race and gender, incorporating 2010-2019 U.S. data on disease progression and real-world screening adherence for colonoscopy and fecal immunochemical test (FIT). Five strategies were compared: (1) status quo (choice between colonoscopy and FIT); (2) CTC every 5 years; (3) colonoscopy every 10 years; (4) annual FIT; and (5) multitarget stool DNA test every 3 years, plus no screening. Lifetime costs, quality-adjusted life years gained (QALYG), and incremental cost-effectiveness ratios were projected. A willingness-to-pay threshold of $100,000/QALYG was used. RESULTS:Under the status quo, Black adults showed higher CRC cases and greater utilization for FIT over colonoscopy than White adults. Compared to the status quo, the CTC strategy yielded more QALYG and fewer CRC cases among Black adults, but fewer QALYG and more CRC cases among White adults. Both status quo and CTC strategies outperformed other strategies across races. The CTC strategy was the dominant strategy for Black adults. For White adults, the status quo was cost-effective with incremental cost-effectiveness ratios of $34,998-$73,428/QALYG, while the CTC strategy was cost saving compared to no screening. CONCLUSIONS:CTC could be cost-effective for CRC screening in Black adults under real-world screening adherence, supporting Medicare coverage to address specific population needs and structural barriers to screening.

Colorectal cancer (CRC) is the second leading cause of cancer-related deaths in the United States. Most cases arise from polyps, which can be detected and removed before becoming cancerous. Computed tomography colonography (CTC), also known as virtual colonoscopy, was first introduced in 1994 as a minimally invasive method for CRC screening and diagnosis. This 2025 update on CTC will focus on (1) techniques and dose reduction strategies, (2) image display methods, (3) reporting and classification systems, (4) tumor staging capabilities, (5) integration of advanced imaging techniques, and (6) cost-effectiveness and reimbursement.

Neoadjuvant therapy (NAT) for patients with rectal cancer is intended to reduce the risk of local recurrence and distant metastasis while preserving quality of life. Choosing the optimal approach after NAT is complex, requiring a personalized plan that considers the unique characteristics of each patient and their tumor, as well as the resources and capabilities of the treating institution. Advances in treatment, guided by insights from randomized clinical trials and increasing acceptance of organ preservation strategies, also known as nonoperative management or the watch-and-wait approach, emphasize the importance of precise treatment response assessment and multidisciplinary communication. A comprehensive evaluation using digital rectal examination, endoscopy, and MRI with a dedicated rectal cancer protocol ensures accurate clinical and locoregional response assessment. This integrative approach enables clinicians to make decisions regarding organ preservation, surgery, treatment de-escalation, or even additional NAT, with MRI having a critical role in surgical planning when resection is needed. The authors provide a comprehensive guide for interpreting postneoadjuvant rectal cancer MRI and applying the Society of Abdominal Radiology Colorectal and Anal Cancer Disease-focused Panel (SAR DFP) synoptic MRI restaging report template. The aim is to improve the quality, consistency, and clarity of MRI interpretations across different readers and institutions. Each section corresponds to the SAR DFP synoptic MRI restaging report template, addressing common areas of confusion and providing essential background material to ensure that clinically relevant information is clearly communicated to the treatment team, supporting effective decision making and enhancing patient outcomes. ©RSNA, 2025 Supplemental material is available for this article.

Acute abdominal pain is one of the most common chief complaints encountered in the emergency department and outpatient setting. Across all sites, the left upper quadrant (LUQ) is the least common location for abdominal pain with reportedly the lowest physical examination interrater agreement. The limited sensitivity of physical examination, combined with an uncommon and nonspecific clinical presentation, make assessment of LUQ pain challenging. Acute LUQ pain may arise directly from the spleen or infections in the LUQ, or represent referred pain from other organs such as stomach, bowels, pancreas, or kidney. This document aims to address acute pain with suspected splenomegaly, with fever, and not otherwise specified. CT abdomen and pelvis with contrast is usually appropriate for detection of a broad range of pathologies. In patients with suspected splenomegaly, ultrasound abdomen is also usually an appropriate alternate for initial imaging. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.

Background: Among patients with alcoholic liver disease (ALD), homelessness poses significant medical and psychosocial risks; however, less is known about the effects of race and sex on the hospital outcomes of admitted homeless patients with ALD. Methods: The National Inpatient Sample database from 2012 to 2017 was used to isolate homeless patients with ALD, and the cohort was further stratified by race and sex for comparisons. Propensity score matching was utilized to minimize covariate confounding. The primary endpoints of this study include mortality, hospital length of stay, and hospital costs; secondary endpoints included the incidence of liver complications. Results: There were 3972 females/males postmatch, as well as 2224 Blacks/Whites and 4575 Hispanics/Whites postmatch. In multivariate, there were no significant differences observed in mortality rate, length of stay, and costs between sexes. Comparing liver outcomes, females had a higher incidence of hepatic encephalopathy [adjusted odds ratio (aOR) 1.02, 95% CI: 1.01-1.04, P<0.001]. In comparing Blacks versus Whites, Black patients had higher hospitalization costs (aOR 1.13, 95% CI: 1.03-1.24, P=0.01); however, there were no significant differences in mortality, length of stay, or liver complications. In comparing Hispanics versus Whites, Hispanic patients had longer length of hospital stay (aOR 1.12, 95% CI: 1.06-1.19, P<0.001), greater costs (aOR 1.15, 95% CI: 1.09-1.22, P<0.001), as well as higher prevalence of liver complications including varices (aOR 1.04, 95% CI: 1.02-1.06, P<0.001), hepatic encephalopathy (aOR 1.03, 95% CI: 1.02-1.04, P<0.001), and hepatorenal syndrome (aOR 1.01, 95% CI 1.00-1.01, P=0.03). However, there was no difference in mortality between White and Hispanic patients. Conclusions: Black and Hispanic ALD patients experiencing homelessness were found to incur higher hospital charges; furthermore, Hispanic patients also had greater length of stay and higher incidence of liver-related complications compared with White counterparts.

BACKGROUND. Approximately one-third of the eligible U.S. population have not undergone guideline-compliant colorectal cancer (CRC) screening. Guidelines recognize various screening strategies to increase adherence. CMS provides coverage for all recommended screening tests except CT colonography (CTC). OBJECTIVE. The purpose of this study was to compare CTC and other CRC screening tests in terms of associations of utilization with income, race and ethnicity, and urbanicity in Medicare fee-for-service beneficiaries. METHODS. This retrospective study used CMS Research Identifiable Files from January 1, 2011, through December 31, 2020. These files contain claims information for 5% of Medicare fee-for-service beneficiaries. Data were extracted for individuals 4585 years old, and individuals with high CRC risk were excluded. Multivariable logistic regression models were constructed to determine the likelihood of undergoing CRC screening tests (as well as of undergoing diagnostic CTC, a CMS-covered test with similar physical access as screening CTC) as a function of income, race and ethnicity, and urbanicity while controlling for sex, age, Charlson comorbidity index, U. S. census region, screening year, and related conditions and procedures. RESULTS. For 12,273,363 beneficiary years (mean age, 70.5 +/- 8.2 [SD] years; 2,436,849 unique beneficiaries: 6,774,837 female beneficiaries, 5,498,526 male beneficiaries), there were 785,103 CRC screenings events, including 645 for screening CTC. Compared with individuals living in communities with per capita income of less than US$25,000, individuals in communities with income of US$100,000 or more had OR for undergoing screening CTC of 5.73, optical colonoscopy (OC) of 1.36, sigmoidoscopy of 1.03, guaiac fecal occult blood test or fecal immunochemical test of 1.50, stool DNA of 1.43, and diagnostic CTC of 2.00. The OR for undergoing screening CTC was 1.00 for Hispanic individuals and 1.08 for non-Hispanic Black individuals compared with non-Hispanic White individuals. Compared with the OR for undergoing screening CTC for residents of metropolitan areas, the OR was 0.51 for residents of micropolitan areas and 0.65 for residents of small or rural areas. CONCLUSION. The association with income was substantially larger for screening CTC than for other CRC screening tests or for diagnostic CTC. CLINICAL IMPACT. Medicare's noncoverage for screening CTC may contribute to lower adherence with CRC screening guidelines for lower-income beneficiaries. Medicare coverage of CTC could reduce income-based disparities for individuals avoiding OC owing to invasiveness, need for anesthesia, or complication risk.

The CT Colonography Reporting and Data System (C-RADS) has withstood the test of time and proven to be a robust classification scheme for CT colonography (CTC) findings. C-RADS version 2023 represents an update on the scheme used for colorectal and extracolonic findings at CTC. The update provides useful insights gained since the implementation of the original system in 2005. Increased experience has demonstrated confusion on how to classify the mass-like appearance of the colon consisting of soft tissue attenuation that occurs in segments with acute or chronic diverticulitis. Therefore, the update introduces a new subcategory, C2b, specifically for mass-like diverticular strictures, which are likely benign. Additionally, the update simplifies extracolonic classification by combining E1 and E2 categories into an updated extracolonic category of E1/E2 since, irrespective of whether a finding is considered a normal variant (category E1) or an otherwise clinically unimportant finding (category E2), no additional follow-up is required. This simplifies and streamlines the classification into one category, which results in the same management recommendation.

Background and aim In this study, we used a national cohort of patients with Wilson’s disease (WD) to investigate the admissions, mortality rates, and costs over the captured period to assess specific subpopulations at higher burden. Methods Patients with WD were selected using 2016–2019 National Inpatient Sample (NIS). The weighted estimates and patient data were stratified using demographics and medical characteristics. Regression curves were graphed to derive goodness-of-fit for each trend from which R 2 and P values were calculated. Results Annual total admissions per 100 000 hospitalizations due to WD were 1075, 1180, 1140, and 1330 (R 2 = 0.75; P = 0.13) from 2016 to 2019. Within the demographics, there was an increase in admissions among patients greater than 65 years of age (R 2 = 0.90; P = 0.05) and White patients (R 2 = 0.97; P = 0.02). Assessing WD-related mortality rates, there was an increase in the mortality rate among those in the first quartile of income (R 2 = 1.00; P < 0.001). The total cost for WD-related hospitalizations was $20.90, $27.23, $24.20, and $27.25 million US dollars for the years 2016, 2017, 2018, and 2019, respectively (R 2 = 0.47; P = 0.32). There was an increasing total cost trend for Asian or Pacific Islander patients (R 2 = 0.90; P = 0.05). Interestingly, patients with cirrhosis demonstrated a decreased trend in the total costs (R 2 = 0.97; P = 0.02). Conclusion Our study demonstrated that certain ethnicity groups, income classes and comorbidities had increased admissions or costs among patients admitted with WD.