BACKGROUND & AIMS:To develop and validate a CT-based radiomics model to assess HVPG and predict a composite endpoint of liver-related events (LRE: decompensation and liver-related death) in patients with cirrhosis. METHODS:This retrospective study included 357 cirrhosis patients, who received invasive HVPG measurements, 120 liver-healthy controls (training cohort) and 85 and 100 cirrhosis patients (internal and external validation cohorts, respectively), and contrast-enhanced abdominal CTs. After volumetric segmentation of the liver and spleen on CT, Bayesian parameter optimization was used for selection of extracted features and hyperparameter tuning in random forest or elastic net models. Prediction accuracy was evaluated using Pearson correlation coefficients of predicted ('radio-HVPG') and invasive HVPG. Discrimination between relevant HVPG cut-offs was determined by receiver operating characteristic (ROC) analysis. The predictive value of radio-HVPG and invasive-HVPG for LRE was compared using Cox regression models. RESULTS:Radio-HVPG, predicted by an optimized random forest model based on 74 selected CT features, correlated with invasive-HVPG and detected clinically significant portal hypertension (CSPH: HVPG ≥ 10 mmHg) on the internal (Pearson r = 0.63, AUC 0.89 [95% CI: 0.81-0.96]) and external (Pearson r = 0.62, AUC 0.80 [95% CI: 0.64-0.91]) validation cohorts. Radio-HVPG predicted LRE when adjusting for MELD and albumin (adjusted HR: 1.14 [95% CI: 1.04-1.25], p = 0.005) and performed similarly to invasive-HVPG. CONCLUSIONS:Radiomic features accurately predict HVPG in patients with cirrhosis and allow risk stratification for LRE in a radiomics-clinical signature.

Die Diagnostik von Dünndarmerkrankungen stellt eine besondere Herausforderung dar, da dieser Darmabschnitt endoskopisch nur eingeschränkt zugänglich ist und die klinische Symptomatik häufig unspezifisch bleibt. Zudem wird die Beurteilung durch die Darmmotilität sowie die Abhängigkeit von einer Kontrastmittelgabe und einer luminalen Distension zusätzlich erschwert. Moderne Schnittbildverfahren, insbesondere die CT(Computertomographie)- und MR(Magnetresonanz)-Enterographie, haben die bildgebende Diagnostik von entzündlichen, neoplastischen und vaskulären Dünndarmerkrankungen revolutioniert. Die präzise Differenzierung der verschiedenen Pathologien des Dünndarms erfordert fundierte Kenntnisse charakteristischer Bildgebungsmuster. Wandverdickungen, deren Ausdehnung, Verteilung und Kontrastmittelaufnahmemuster, mesenteriale Gefäßveränderungen und begleitende extraintestinale Befunde liefern entscheidende diagnostische Hinweise. Die Integration klinischer Parameter mit morphologischen und funktionellen Bildgebungskriterien ermöglicht eine zeitnahe und zielgerichtete Therapieplanung.

The diagnostics of small bowel diseases represent a special challenge as this intestinal segment is not readily accessible endoscopically and the clinical symptoms are often nonspecific. The assessment is further complicated by the bowel motility and the dependency on contrast agent administration and luminal distension. Modern cross-sectional imaging techniques, particularly computed tomography (CT) and magnetic resonance (MR) enterography, have revolutionized the diagnostics of inflammatory, neoplastic and vascular small bowel diseases. The precise differentiation of the various small bowel pathologies requires thorough knowledge of characteristic imaging patterns. Bowel wall thickening, the extent, distribution and pattern of contrast enhancement uptake, mesenteric vascular changes and associated extraintestinal findings provide crucial diagnostic indications. The integration of clinical parameters with morphological and functional imaging criteria enables timely and targeted treatment planning.

Cross-sectional imaging procedures play a pivotal role in the assessment of the jejunum and ileum as these segments of the small intestine are less easily accessible to endoscopic evaluation compared to the stomach, duodenum and colon. The radiological diagnostics of the small bowel are, however, a special challenge as many small bowel diseases show similar imaging patterns making a differentiation difficult. Technical advances in imaging now enable a more precise characterization of the bowel wall, thereby providing the basis for increasingly more personalized medicine. An imaging pattern-based diagnostic approach can be helpful in narrowing down the spectrum of potential differential diagnoses and increasing the accuracy of radiological interpretation. The aim of this review article is to present the current diagnostic techniques, recent technological developments and characteristic radiological imaging features of small bowel diseases.

Background MR enterography (MRE) is increasingly used to guide treatment and improve outcomes in Crohn disease (CD). An abbreviated MRE (A-MRE) protocol-omitting contrast and antiperistaltic agents-may reduce scanning time and cost and improve compliance. Purpose To compare intrareader concordance and interreader agreement in detecting disease activity and disease-related complications using contrast-enhanced MRE (CE-MRE) versus an A-MRE protocol in participants with CD. Materials and Methods In this secondary analysis of a prospective study, 10 abdominal radiologists independently reviewed MRE examinations from a prospective study of participants with CD before and after treatment with biologics, using both A-MRE and CE-MRE protocols, at least 1 month apart. Interreader agreement and intrareader concordance were assessed using Gwet first agreement coefficient (AC1) at both the segment and participant levels for the presence of active inflammation, associated indicative features, and complications. Diagnostic accuracy of the simplified MR index of activity (sMaRIA) was evaluated against ileocolonoscopy when available. Results This study included 60 participants (median age, 36 years [IQR, 28-44 years]; 40 female; 80 examinations). Interreader agreement for detecting intestinal active disease was high and comparable between A-MRE and CE-MRE at the participant level (AC1, 0.87 [95% CI: 0.79, 0.95] vs 0.91 [95% CI: 0.85, 0.97]). For strictures, similar interreader agreement was observed between protocols (AC1: A-MRE, 0.61 [95% CI: 0.47, 0.74] vs CE-MRE, 0.50 [95% CI: 0.35, 0.65]). For penetrating complications, the interreader agreement was also similar between protocols (A-MRE, 0.71 [95% CI: 0.56, 0.86] vs CE-MRE, 0.76 [95% CI: 0.63, 0.90]). The intrareader concordance between protocols for detecting active inflammation and CD complications was almost perfect for all readers (AC1 range, 0.86-1.00). In the terminal ileum, sMaRIA showed high sensitivity (A-MRE, 96.4%; CE-MRE, 98.4%) and specificity (A-MRE, 68.1%; CE-MRE, 71.4%) for detecting inflammation. Conclusion An A-MRE protocol demonstrated comparable interreader agreement to conventional CE-MRE and high intrareader concordance for detecting active CD and related complications in participants with CD. © The Author(s) 2026. Published by the Radiological Society of North America under a CC BY 4.0 license. Supplemental material is available for this article. See also the editorial by Ohliger in this issue.

Schnittbildverfahren spielen eine zentrale Rolle bei der Untersuchung des Jejunums und des Ileums, da diese Abschnitte im Gegensatz zu Magen, Duodenum und Kolon endoskopisch weniger leicht zugänglich sind. Die radiologische Diagnostik des Dünndarms stellt jedoch eine besondere Herausforderung dar, da viele Dünndarmerkrankungen ähnliche Bildmuster aufweisen und sich daher nicht immer einfach voneinander unterscheiden lassen. Technische Fortschritte in der Bildgebung ermöglichen eine noch präzisere Charakterisierung der Darmwand und schaffen damit die Grundlage für eine zunehmend personalisierte Medizin. Ein bildmusterbasierter diagnostischer Ansatz hilft dabei, die Zahl möglicher Diagnosen einzugrenzen und die radiologische Beurteilung zu präzisieren. Ziel dieser Übersichtsarbeit ist es, aktuelle diagnostische Verfahren, neueste Entwicklungen und charakteristische radiologische Zeichen von Dünndarmerkrankungen darzustellen.

Dysphagia is a prevalent symptom of the upper gastrointestinal tract causing health related consequences, impacting quality of life and is associated with global economic burden. Swallowing difficulties are classified into oropharyngeal dysphagia (OD) and esophageal dysphagia. Despite its clinical importance, dysphagia is associated with several uncertainties regarding its optimal diagnostic work-up and management, particularly, considering the progress with diagnostic modalities and technologies. A Delphi consensus was performed with experts from various disciplines who conducted a literature summary and voting process on 41 statements. Quality of evidence was evaluated using the grading of recommendations, assessment, development, and evaluation criteria. Consensus was reached for all the statements. The panel agreed with the definition and prevalence of esophageal and OD types. The role of endoscopy, high-resolution manometry, EndoFLIP, barium swallow and other imaging tests in evaluating esophageal dysphagia has reached overall strong agreement. Videofluoroscopic swallow study, alongside fiber-endoscopic evaluation of swallowing, as the methods of choice for the instrumental assessment of oropharyngeal dysfunction is a strong recommendation. Regarding treatment, a weak recommendation was achieved for the use of PPIs, calcium-channel blockers, nitrates, phosphodiesterase type 5 inhibitors, antidepressants or peppermint oil for the treatment of hypercontractile esophagus. A strong recommendation exists for endoscopic and surgical treatment of achalasia, while a weak recommendation is provided for other esophageal motility disorders. Regarding OD, a weak recommendation was achieved for swallow therapy, to improve swallowing mechanics, reduce symptoms, and enhance quality of life. Swallow therapy could be more effective when using validated assessment tools, consistent treatment parameters, and considering long-term follow-up. A multinational group of European experts summarized the current state of consensus on the definition, diagnosis, and management of dysphagia.

BACKGROUND:Computed tomography colonography (CTC) is a minimally invasive examination for radiologic imaging of the entire colon and rectum. It has replaced the now obsolete barium enemas and represents an important option to colonoscopy for the detection of colorectal neoplasia. OBJECTIVES:The aim of this article is to review the current status of CTC for detection of colorectal cancer (CRC) and its precursors. MATERIALS AND METHODS:Based on an extensive literature research, the current role of CTC in colorectal cancer imaging is summarized. This includes not only CRC detection but also the role of CTC in CRC screening and surveillance. RESULTS:CTC is a well-developed, minimally invasive examination for the identification of colorectal neoplasia. The diagnostic accuracy for colorectal adenomas and cancer is comparable to that of optical colonoscopy. Missed CRC cases are rare and typically result from perceptual or technical errors. In addition to the detection and characterization of carcinomas, CTC enables the visualization of prestenotic colonic segments and extracolonic structures. This allows for the preoperative detection of synchronous colonic neoplasms that are not endoscopically assessable as well as evaluation of abdominal tumor spread. Due to its ability to detect benign precancerous adenomas with high sensitivity, CTC can be used for opportunistic colorectal cancer screening. In CRC follow-up, CTC may be used to diagnose recurrence if colonoscopy is incomplete or not feasible. CONCLUSION:CTC is the radiological examination of choice for the detection of colorectal neoplasia. It is typically used in patients where colonoscopy is incomplete, contraindicated or refused. Moreover, CTC serves as a noninvasive option for opportunistic colorectal cancer screening.

Abstract Background A primary objective in the management of Crohn's disease (CD) is the prevention of bowel tissue damage. The Lémann index (LI) characterizes structural bowel damage based on magnetic resonance enterography (MRE) or computed tomography enterography (CTE) and, for colonic CD, colonoscopy. Intestinal ultrasonography (IUS) provides a non-invasive imaging alternative, though its role in the LI assessment remains unexplored. This study aimed to establish a consensus on parameters and standardized acquisition for scoring small bowel and colonic damage using IUS in accordance with the LI. Methods Thirty international experts in IUS and/or MRE participated in a three-round Delphi process. Participants provided feedback and rated agreement with statements outlining IUS parameters and standardized acquisition in two virtual rounds. During the final in-person round, unresolved items were discussed and voted upon. Statements with at least 80% agreement were accepted. Results Twenty-two statements reached a consensus: 10 defined IUS parameters for stricturing and penetrating lesions for scoring LI-IUS, and 12 addressed optimal IUS cineloop acquisition for centralized review (Table 1). No consensus was reached regarding IUS equivalents for grade 1 stricturing lesions in the small bowel and colon. Conclusion Ultrasonographic equivalents for assessing small bowel and colonic damage in CD were derived to align with the validated LI criteria for MRE/CTE and colonoscopy. These statements mark the first phase of the EXTENT project, supporting the potential use of IUS in clinical practice and disease modification trials as an alternative tool for bowel damage assessment. The lack of consensus on grade 1 stricturing lesions suggests further exploration of IUS parameters is required.

The current consensus guideline offers a comprehensive and practical guidance on the diagnostic and monitoring of patients with inflammatory bowel disease (IBD). It provides recommendations on requirements for initial diagnosis, detection of complications, the use of monitoring tools in patients with IBD and diagnostics in specific situations, such as pregnancy, postoperatively and for cancer surveillance. The guideline is a joint project of the European Crohn's and Colitis Organization (ECCO), the European Society of Gastrointestinal and Abdominal Radiology, the European Society of Pathology, and the International Bowel Ultrasonography Group under the leadership of ECCO.

Die Computertomographie-Kolonographie (CTK) ist eine minimal-invasive radiologische Untersuchung zur Darstellung des gesamten Kolons und Rektums. Sie ersetzt den mittlerweile obsoleten Kolonkontrasteinlauf und stellt eine wichtige Ergänzung zur Koloskopie in der Dickdarmkrebsdiagnostik dar. Ziel dieser Arbeit ist es, einen Überblick über den aktuellen Stellenwert und den Nutzen der CTK zur minimal-invasiven bildgebenden Diagnostik kolorektaler Karzinome (KRK) zu bieten. Mittels einer ausführlichen Literaturrecherche wird der aktuelle Wissensstand zur Rolle der CTK in der Dickdarmkrebsdiagnostik zusammengefasst. Dies umfasst neben der Bildgebung manifester Karzinome auch den Einsatz der CTK in der Vor- und Nachsorge des KRK. Die CTK ist eine ausgereifte, minimal-invasive Untersuchung zur Abklärung kolorektaler Neoplasien. Die Detektionsrate für gutartige Krebsvorstufen und manifeste Karzinome ist vergleichbar mit der Detektionsrate der optischen Koloskopie. Fehldiagnosen bei KRK sind selten und meist durch Perzeptionsfehler und technische Fehler bedingt. Durch die Möglichkeit bei stenosierenden Karzinomen auch endoskopisch nicht einsehbare Darmabschnitte und extrakolische Strukturen darzustellen, können zusätzlich zur Tumordetektion auch synchrone Dickdarmneoplasien erkannt und die abdominale Tumorausbreitung beurteilt werden. Neben der Diagnose manifester Karzinome kann die CTK durch das rechtzeitige Erkennen benigner Krebsvorstufen zur Dickdarmkrebsvorsorge eingesetzt werden. In der KRK-Nachsorge kann die CTK bei nicht erfolgreicher Koloskopie alternativ zur Rezidivdiagnostik eingesetzt werden. Die CT-Kolonographie ist die radiologische Untersuchung der Wahl zur Detektion kolorektaler Neoplasien. Sie kommt meistens bei Personen zum Einsatz, bei denen eine Koloskopie nicht möglich oder nur unvollständig ist, kann aber auch zur opportunistischen Dickdarmkrebsvorsorge eingesetzt werden.

BACKGROUND & AIMS:A primary aim in managing Crohn's disease (CD) is preventing bowel damage. The Lémann index (LI) quantifies structural bowel damage using magnetic resonance enterography (MRE) or computed tomography enterography (CTE) and, for colonic CD, colonoscopy. Intestinal ultrasonography (IUS) provides a noninvasive imaging alternative, although its role in LI assessment remains unexplored. This study aimed to establish a consensus on parameters and acquisition protocol for scoring small bowel and colonic damage using IUS in evaluating the LI. METHODS:Thirty international experts in IUS and/or MRE participated in a 3-round Delphi process. Participants provided feedback and rated statements on IUS parameters and acquisition protocol in 2 online rounds. During the final in-person round, unresolved items were discussed and voted upon. Statements with at least 80% agreement were accepted. RESULTS:Twenty-two statements reached a consensus: 10 defined IUS parameters for stricturing and penetrating lesions for scoring LI-IUS, and 12 addressed optimal IUS cineloop acquisition for centralized review. No consensus on IUS equivalents for grade 1 stricturing lesions in the small bowel and colon was reached. CONCLUSIONS:Ultrasonographic equivalents for assessing small bowel and colonic damage in CD were derived to align with the validated LI criteria for MRE and colonoscopy. These statements mark the first phase of the EXTENT project, supporting the potential use of IUS in clinical practice and disease modification trials as an alternative tool for bowel damage assessment. The lack of consensus on grade 1 stricturing lesions suggests further exploration of IUS parameters is required.

Videofluoroscopic swallowing studies (VFSS) remain the gold standard for the instrumental assessment of oropharyngeal swallowing disorders alongside flexible endoscopic evaluation of swallowing (FEES), requiring a high standard of quality and correct implementation. The current best practice position statements aim to guide the clinical practice of VFSS in individuals experiencing swallowing disorders. An international expert consensus panel with expertise in oropharyngeal dysphagia, comprised of radiologists, speech-language therapists, otolaryngologists, and other professionals in the field, convened by the European Society of Swallowing Disorders (ESSD) and the European Society of Gastrointestinal and Abdominal Radiology (ESGAR), developed best practice position statements. They were established using an online Delphi methodology involving an online panel discussion and item preparation and three consecutive rounds. Consensus was reached when ≥ 80

Over the past two decades, contrast-enhanced ultrasound (CEUS) has been established as a method complementary to B-mode ultrasound and color Doppler sonography for diagnosing vascular liver pathologies and interventions.The objective of this review is to elucidate the application of CEUS in diagnosing vascular pathologies and interventional procedures.Considering the limitations of ultrasound, CEUS presents a similar alternative to other imaging modalities, such as computed tomography and magnetic resonance imaging, for evaluating vascular pathologies, guiding interventions, identifying complications, and assessing outcomes post intervention. Due to its widespread availability and the absence of radiation exposure, CEUS should be employed as a primary modality. · CEUS plays an important role in the detection of vascular liver pathologies.. · CEUS is helpful in characterizing vascular pathologies.. · CEUS is helpful in guiding interventions and identifying complications..

Oesophageal fluoroscopy is a radiological procedure that uses dynamic recording of the swallowing process to evaluate morphology and function simultaneously, a characteristic not found in other clinical tests. It enables a comprehensive evaluation of the entire upper gastrointestinal tract, from the oropharynx to oesophagogastric bolus transport. The number of fluoroscopies of the oesophagus and the oropharynx has increased in recent decades, while the overall use of gastrointestinal fluoroscopic examinations has declined. Radiologists performing fluoroscopies need a good understanding of the appropriate clinical questions and the methodological advantages and limitations to adjust the examination to the patient's symptoms and clinical situation. This review provides an overview of the indications for oesophageal fluoroscopy and the various pathologies it can identify, ranging from motility disorders to structural abnormalities and assessment in the pre- and postoperative care. The strengths and weaknesses of this modality and its future role within different clinical scenarios in the adult population are discussed. We conclude that oesophageal fluoroscopy remains a valuable tool in diagnostic radiology for the evaluation of oesophageal disorders.