Introduction:Stereotactic radiosurgery (SRS) provides excellent tumor control in small and medium vestibular schwannomas (VS), but its impact on the vestibular system remains uncertain. This study examines the effects of SRS on subjective vestibular symptoms, vestibular function, and potential predictors of symptom worsening. Materials and methods:A retrospective analysis was conducted on adult VS patients treated with SRS over eight years. Vestibular symptoms were graded at baseline and six months post-SRS. The vestibular sensory organs (VSO) were defined as the combined volume of the saccule, utricle, and ampullae. Vestibular function was assessed with bithermal, bilateral caloric testing, video head impulse testing, and vestibular evoked myogenic potentials. Two illustrative treatment plans were generated to assess feasibility of vestibular dose reduction without compromising planning target volume (PTV) or cochlear constraints. Results:Among 45 VS patients (median age 61.4 years), 14 (31 %) reported worsened vestibular symptoms at six months. These patients had higher Dosemean to VSO (6.45 Gy vs 2.92 Gy, p < 0.0001). A Dosemean > 4 Gy was strongly associated with symptom worsening (OR = 27.3, 95 % CI [3.4-301.8], p = 0.0002). Similar associations were observed for Dosemax, with an 8 Gy threshold. Higher Dosemean to the lateral ampulla was correlated with a greater percentage change in caloric weakness (slope = 7.77, R2 = 0.38, p = 0.04). In two illustrative plans, VSO optimisation lowered vestibular dose without compromising PTV coverage or cochlear dose. Conclusion:Higher vestibular radiation dose is strongly associated with worsened vestibular symptoms and possibly with functional decline. Dose reduction to vestibular subunits is feasible without compromising the tumor dose, helping mitigate these effects.

Abstract Objectives Gender equity in medicine remains a topic of increasing attention. The aim was to investigate if gender influences the radiology profession, with a focus on career progression, leadership roles, work-life balance, research activity and perceived barriers. Materials and methods An anonymous online survey consisting of 22 questions was distributed by the European Society of Radiology (ESR) to its members between October and December 2024. The survey covered demographics, work schedules, family responsibilities, career development, leadership roles, research involvement, and perceived personal experiences. Quantitative data were analyzed using descriptive statistics, chi-square test, and rate differences with confidence intervals. Open-ended responses were explored qualitatively using thematic analysis. Results Among 830 respondents, 657 completed the questionnaire (63.3% female, 35.3% male, 1.3% others). Women more frequently reported caregiving responsibilities beyond childcare (4.1% vs 3%), longer parental leave (46.2% vs 21.5%), and experiences of harassing behaviors at work. Men held a higher proportion of leadership roles (33.2% vs 25.2%). Respondents involved in research were more likely to work > 30% extra hours (47.2% vs 29.0%). Although research activity rates were similar across genders, women more often reported barriers to attending conferences and a lack of protected research time. Career fulfillment increased with age among men but decreased among women. Gender was considered a career disadvantage by 44.5% of women versus 9.5% of men. Conclusion The survey reveals perceived gender disparities in radiology, particularly in leadership access, work conditions, and career satisfaction. Addressing structural barriers and promoting supportive workplace policies are essential to achieving true gender equity in the field. Critical relevance statement Despite improvements in the last few decades, gender inequity remains present in radiology. Variability between geographical regions suggests that key critical areas can be addressed to promote improvement and support a more equitable professional environment. Key Points Perceived gender disparities in radiology are present across career progression, leadership roles, and work-life balance. Women were significantly more likely than men to perceive gender as a career disadvantage (44.5% vs 9.5%; p < 0.0001 35.0% [95% CI: 28.9 to 41.1]). They reported slightly higher caregiving responsibilities and longer parental leave. Structural inequalities impact gender equity in radiology, requiring targeted institutional and cultural changes. Graphical Abstract

Head and neck squamous cell carcinoma (HNSCC) can either be examined with hybrid PET/MR imaging systems or sequentially, using PET/CT and MR imaging. Regardless of the acquisition technique, the superiority of MR imaging compared to CT lies in its potential to interrogate tumor and surrounding tissues with different sequences, including perfusion and diffusion. For this reason, PET/MR imaging is preferable for the detection and assessment of locoregional residual/recurrent HNSCC after therapy. In addition, MR imaging interpretation is facilitated when combined with PET. Nevertheless, distant metastases and distant second primary tumors are detected equally well with PET/MR imaging and PET/CT.

This systematic review addresses the clinical relevance of PET/MR in patients with head and neck (HN) tumors, highlighting studies conducted over the last three years to provide an updated perspective on integrating a hybrid PET/MR scan into different clinical scenarios. We employed a search algorithm, combining terms (“PET/MR” OR (“PET” AND (“MR” OR “MRI”)) OR “PET/MRI” OR “PET-MR” OR “PET-MRI” OR (“PET” AND “magnetic”)) AND (“head” AND “neck”). Studies written in English and published throughout 2021, 2022 and 2023 up to November 15th were considered if were focused on: suspected HN tumors; confirmed HN tumors before surgery/radiotherapy/chemotherapy; HN tumor recurrence or therapy response assessment. Reviews, editorials or letters, case report/series or any other original unrelated studies to the topics were excluded. Twenty out of 169 studies were deemed eligible. The HN tumor cohorts included sinonasal tumors, nasopharyngeal carcinoma and tumors in the oropharynx, oral cavity, hypopharynx and larynx, mostly of squamous cell carcinoma histology. Sixteen out of 20 articles focused on initial staging, including prognostic information before primary treatment, whereas 4/20 articles explored the clinical significance of PET/MR in restaging settings or other clinical purposes. This review consolidates previous findings by showing the relationship between morphology, metabolism, cellularity, and perfusion in HN tumors. Metrics provided by PET/MR are able to predict the histologic grade of HN tumors, EGFR status and patient outcome. PET/MR demonstrates high diagnostic performance for detecting locoregional tumor recurrence, distant metastases and second primary cancers.

BACKGROUND:A vestibular implant can partially restore vestibular function by providing motion information through implanted electrodes. During vestibular implantation, various obstructions of the semicircular canals, such as protein deposits, fibrosis, and ossification, can be encountered. The objective was to explore the relationship between preoperative imaging and intraoperative findings of semicircular canal obstruction and to develop surgical strategies for dealing with obstructions of the semicircular canal(s) in patients eligible for vestibular implantation. METHODS:Patients undergoing vestibulocochlear implantation (in an active clinical trial) were included in the current study when preoperative imaging indicated an obstruction in the semicircular canal. Preoperative imaging consisted of CT and MRI scans. During surgery, the bony semicircular canals were skeletonized ("bluelined") to identify the course of the canals and create a fenestration to insert the electrodes. The aim was to place the electrodes in the semicircular canal ampullae. Surgical strategies were developed to deal with the soft tissue obstructions. These procedures were evaluated intraoperatively with microscopic visualization, postoperatively with CT imaging. RESULTS:The three included patients suffered from bilateral vestibulopathy and hearing loss due to autosomal dominant nonsyndromic sensorineural deafness 9 (DFNA9). A soft tissue obstruction was predicted in one semicircular canal (2 patients) or two semicircular canals (1 patient), based on preoperative imaging. Intraoperatively, bluelining the semicircular canals aided in identifying these locations, by revealing a "whiteline" instead of blueline. Depending on the nature and location of the obstruction, different surgical procedures were employed to facilitate proper electrode insertion. These were as follows: a dummy electrode was used to probe the soft tissue, the obstructive tissue was removed, and/or a bypass fenestration was created. In all patients, the electrodes could be implanted in the semicircular canal ampullae. Based on these first experiences, a diagnostic and surgical guide to deal with obstructions of the semicircular canals during vestibular implantation was developed. CONCLUSIONS:Preoperative imaging can indicate locations of obstructions in the SCCs. Different surgical procedures can be applied to enable appropriate electrode positioning in the SCC ampulla. This article describes the first experiences with obstructions of the semicircular canals during intralabyrinthine vestibular implantation and presents a diagnostic and surgical guide. TRIAL REGISTRATION:ABR NL73492.068.20, METC20-087 (Maastricht University Medical Center) and NAC 11-080 (Geneva University Hospitals).

The European Society of Radiology (ESR) initially developed the ESR e-Book as an open-access digital teaching resource aligned with the undergraduate European Training Curriculum for Radiology. Over time, this initiative evolved into Modern Radiology, a rebranded and expanded version that now serves not only medical students and educators but also residents and other healthcare professionals. Unlike traditional textbooks, Modern Radiology follows a visually engaging and succinct format, emphasising key concepts through annotated images, attention points, hyperlinks, and self-assessment sections. It complements case-based and interactive learning methods, providing a systematic foundation for radiology education. By continuously updating its content to reflect advancements in the field, Modern Radiology has been widely adopted by universities across Europe and beyond. Furthermore, several translations are in progress, ensuring its accessibility to a broader audience.

Acute invasive fungal rhinosinusitis (AIFR) is a rare, severe, and life-threatening opportunistic infection associated with high mortality and morbidity. Rapid and accurate diagnosis and treatment are crucial for survival and effective disease management. Diagnosing AIFR is challenging because no single pathognomonic feature exists other than surgical biopsy showing fungal angioinvasion and necrosis. This narrative review focuses on the diagnostic challenges and pitfalls, emphasizing the critical clinical value of magnetic resonance imaging (MRI) for early diagnosis of AIFR. It includes selected cases that illustrate the significance of MRI. When AIFR is suspected, clinical symptoms, nasal endoscopy, blood samples, and facial computed tomography all provide non-specific information. In contrast, MRI can identify signs of devitalized sinonasal mucosa consistent with AIFR. The absence of mucosal enhancement on T1-weighted images, combined with restricted diffusivity, are characteristic MRI features of AIFR. The cases presented underscore the usefulness of MRI in supporting clinical suspicion of AIFR and accurately determining its topography, thereby guiding early surgical biopsies and debridement. In suspected cases of AIFR, MRI serves as a valuable supplementary, non-invasive tool to help determine whether prompt surgical biopsy or debridement is necessary, thereby enhancing early diagnosis and improving survival rates. Therefore, the threshold for conducting an MRI in these cases should be low.

Background and Clinical Significance: GLI1 gene alterations have recently been identified as a pathological phenomenon associated with a distinct novel entity of mesenchymal neoplasms. They have been reported to occur in any soft tissue of the body, with a specific affinity for the head and neck region. The aim of this article is to increase awareness of this entity and provide a detailed summary of the modes of presentation and diagnostic and therapeutic issues surrounding these tumours occurring in the head and neck region. Case Presentation: We report the case of a 39-year-old male patient with ACTB::GLI1 fusion-related mesenchymal tongue tumour who was successfully treated by surgery. Conclusions: GLI1-altered mesenchymal tumours in the head and neck may harbour various clinical presentations. Larger series are needed to better define the clinicopathological range of this novel entity. We suggest a follow-up period of at least 2 years with imaging, followed by a clinical follow-up of 3 years. Certain clinicopathological features may warrant further and more extensive follow-up.

Background: Peritonsillar abscess (PTA) is relatively common but challenging to diagnose clinically. Several clinical signs may be used, with unknown performances. We evaluated and compared the diagnostic performance of individual and combined clinical signs (trismus, edema, pharynx immobility, uvula deviation, hot potato voice, and overall clinical impression) assessed by an otolaryngologist and of contrast-enhanced computed tomography (CT) to detect acute PTA. Methods: Prospective study in 133 consecutive adult patients (77 males, mean age = 33 years) with suspected clinical PTA and CT obtained in the emergency setting of a tertiary care hospital between November 2020 and October 2022. The standard of reference consisted of surgically proven pus within 24 h of CT or a favorable clinical evolution at 48 h without surgical intervention. Results: PTA was present in 117/133 (88%) patients, with no difference between mean age or sex distribution between the groups with and without PTA. None of the evaluated clinical signs were associated with PTA (OR = 1.26–5.43, p > 0.05), whereas the CT finding “abscess” was significantly associated with PTA (OR = 67.2, p < 0.0001). The sensitivity of individual clinical signs varied between 19.7% and 73.5%, and the sensitivity of CT was significantly higher for all clinical signs (95.7%, p < 0.0001) except for overall clinical impression (97.4%, p = 0.7266). The specificity of clinical signs varied between 12.5% and 93.8%, and the specificity of CT was significantly higher (75%, p < 0.05) for overall clinical impression and edema. All clinical signs together yielded an area under the curve (AUC) = 0.677. Conclusions: In adults, clinical assessment alone using independent clinical signs and overall clinical impression does not allow a reliable diagnosis of PTA, even when performed by an otolaryngologist. CT is reliable in diagnosing PTA and, whenever available, should be the examination method of choice for diagnosing PTA, especially by a non-specialist.

The parapharyngeal space is a complex anatomical site in the head and neck which may harbour clinically occult pathology given its deep-seated location. The vast majority of parapharyngeal space lesions are of intermediate or hyperintense signal on T2W sequences. This review focuses on T2 hypointense parapharyngeal space lesions which are rare and may constitute a diagnostic dilemma. We present the differential diagnosis of these lesions, highlighting the pertinent radiological findings and identifying a histological correlation for the low T2 signal. A brief discussion of the physics principles accounting for these imaging features is also included. We propose a diagnostic algorithm to facilitate diagnosis and avoid unnecessary biopsy, whenever possible.

BACKGROUND:Although most patients with post-traumatic olfactory dysfunction (PTOD) undergo MRI, there is no consensus about its diagnostic or prognostic value. The aims were: 1) to classify the extent of post-traumatic neurodegeneration; 2) to determine its relationship with chemosensory dysfunction (smell, taste, trigeminal); and 3) to establish whether MRI can predict olfactory improvement.METHODOLOGY:We conducted a retrospective cohort study based on a series of 56 patients with PTOD. All patients underwent validated psychophysical tests of their smell, taste, and trigeminal functions, otorhinolaryngologic evaluation, and MRI. An experienced radiologist blinded to patient data evaluated 40 chemosensory-relevant brain regions according to a four-point scale (0=no lesion to 3=large lesion). Follow up data after 4 years (on average) were available in 46 patients.RESULTS:The cluster analysis showed 4 brain lesion patterns that differed in lesion localization and severity. They are associated with diagnostic categories: anosmia, hyposmia and normosmia. Two clusters were highly specific for anosmia (100% specificity)and could accurately predict this condition (100% positive predictive value). No clusters were associated with trigeminal or taste dysfunction. Regarding improvement, 72.7% of patients in the cluster with mild lesions experienced subjective and measurable olfactory improvement whereas this was only the case in 21.7-37.5% of patients with larger lesions. The odds of subjective smell improvement were 5.9 times higher in patients within the milder cluster compared to larger ones.CONCLUSIONS:The analysis of brain lesions in PTOD allows corroboration of smell test results and prediction of subjective and measurable improvement.

Purpose: The purpose of this study was to analyze the prevalence of and complications resulting from temporal bone fractures in adult and pediatric patients evaluated for cranio-facial trauma in an emergency setting. Methods: A retrospective blinded analysis of CT scans of a series of 294 consecutive adult and pediatric patients with cranio-facial trauma investigated in the emergency setting was conducted. Findings were compared between the two populations. Preliminary reports made by on-call residents were compared with the retrospective analysis, which was performed in consensus by two experienced readers and served as reference standard. Results: CT revealed 126 fractures in 116/294 (39.5%) patients, although fractures were clinically suspected only in 70/294 (23.8%); p < 0.05. Fractures were longitudinal, transverse and mixed in 69.5%, 10.3% and 19.8% of cases, respectively. Most fractures were otic-sparing fractures (95.2%). Involvement of the external auditory canal, ossicular chain and the osseous structures surrounding the facial nerve was present in 72.2%, 8.7% and 6.3% of cases, respectively. Temporal bone fractures extended into the venous sinuses/jugular foramen and carotid canal in 18.3% and 17.5% of cases, respectively. Vascular injuries (carotid dissection and venous thrombosis) were more common in children than in adults (13.6% versus 5.3%); however, the observed difference did not reach statistical significance. 79.5% of patients with temporal bone fractures had both brain injuries and fractures of the facial bones and cranial vault. Brain injuries were more common in adults (90.4%) than in children (63.6%), p = 0.001. Although on-call residents reliably detected temporal bone fractures (sensitivity = 92.8%), they often missed trauma-associated ossicular dislocation (sensitivity = 27.3%). Conclusions: Temporal bone fractures and related complications are common in patients with cranio-facial trauma and need to be thoroughly looked for; the pattern of associated injuries is slightly different in children and in adults.

Purpose: We aimed to evaluate whether virtual non-contrast cerebral computed tomography (VNCCT) reconstructed from intravenous contrast-enhanced dual-energy CT (iv-DECT) could replace non-contrast CT (NCCT) in patients with suspected acute cerebral ischemia. Method: This retrospective study included all consecutive patients in whom NCCT followed by iv-DECT were performed for suspected acute ischemia in our emergency department over a 1-month period. The Alberta Stroke Program Early CT Score (ASPECTS) was used to determine signs of acute ischemia in the anterior and posterior circulation, the presence of hemorrhage, and alternative findings, which were randomly evaluated via the consensus reading of NCCT and VNCCT by two readers blinded to the final diagnosis. An intraclass correlation between VNCCT and NCCT was calculated for the ASPECTS values. Both techniques were evaluated for their ability to detect ischemic lesions (ASPECTS <10) when compared with the final discharge diagnosis (reference standard). Results: Overall, 148 patients (80 men, mean age 64 years) were included, of whom 46 (30%) presented with acute ischemia, 6 (4%) presented with intracerebral hemorrhage, 11 (7%) had an alternative diagnosis, and 85 (59%) had no pathological findings. The intraclass correlation coefficients of the two modalities were 0.97 (0.96–0.98) for the anterior circulation and 0.77 (0.69–0.83) for the posterior circulation. The VNCCT’s sensitivity for detecting acute ischemia was higher (41%, 19/46) than that of NCCT (33%, 15/46). Specificity was similar between the two techniques, at 94% (97/103) and 98% (101/103), respectively. Conclusions: Our results show that VNCCT achieved a similar diagnostic performance as NCCT and could, thus, replace NCCT in assessing patients with suspected acute cerebral ischemia.

Abstract Objectives To elucidate the research training exposure of radiology residents across ESR country members. Methods A 30-question survey was constructed by the Radiology Trainee Forum and was distributed among residents and subspecialty fellows of countries members of the ESR. The survey examined the training environment, the status of research training and publications among trainees, the conditions under which research was conducted, and the exposure to activities such as grant proposal preparation and manuscript reviewing. Descriptive statistics and the chi-square test were used to assess the responses to survey questions and evaluate factors related to these responses. Results A total of 159 participants from 29 countries provided fully completed questionnaires. Only 12/159 trainees already had a PhD degree and nearly half had never published a PubMed-indexed manuscript (76/159, 47.8%). Among those who published their papers during radiology training, most did so in the first or second year of residency (n = 26 and n = 20 participants, respectively). Most participants (79%) did not receive further statistical training during residency, fifty-five out of 159 (34.59%) respondents never had any guidance/training on how to read a paper and 58 out of 159 (36.48%) had never been encouraged to participate in any research. Most of them had worked after hours to carry out research at least a few times (47/159, 29.56%) or always (82/159, 51.57%). Conclusion Analysis of research training among radiology trainees was performed. Areas for improvement were identified that can prompt changes in training curricula to prepare a highly competent European workforce. Critical relevance statement This survey has identified deficits in research training of radiology residents across countries members of ESR, pinpointing areas for improvement to fortify the future of radiology in Europe. Key Points Research exposure and training of radiology residents varies across countries and members of ESR. Radiology residents largely lack systematic research training, dedicated research time, and guidance. Areas for improvement in research training of radiology residents have been identified, aiding the fortification of radiology research across Europe. Graphical Abstract