Background Clear cell renal cell carcinoma (ccRCC) is a highly heterogeneous cancer requiring a large number of biopsies to correctly characterize the tumor. Multiple biopsies are rarely feasible in the clinical setting, and therefore imaging methods offer the potential to evaluate the whole tumor non-invasively. For example, metabolic imaging offers the potential to probe the altered metabolism and metabolic heterogeneity that is characteristic of ccRCC. In this study we have explored and validated the use of hyperpolarized carbon-13 MRI (HP- 13 C-MRI) as a non-invasive clinical tool to probe metabolic heterogeneity in ccRCC patients and to more accurately identify which metabolic pathways are altered in vivo . Methods 58 tumor and healthy tissues biopsies were acquired postoperatively from 6 ccRCC patients imaged following injection of hyperpolarized [1- 13 C]pyruvate. MRI parameters were correlated with the metabolomic (146 metabolites) and transcriptomic (2523 metabolic genes) data obtained from these biopsies, split across 34 metabolic pathways. The results were used to generate metabologram projections as a visual representation of these metabolic differences. For each metabolic pathway, we generated a novel metabolic consensus scoring system for the identification of key altered metabolic pathways in ccRCC and their relationship to the imaging parameters. Results We show that the apparent exchange constant between pyruvate and lactate ( k PL ) and the lactate to pyruvate ratio (LP r ) on MRI can be used to measure differential metabolic pathways: they correlated positively with glycolysis and the pentose phosphate pathway, negatively with the TCA cycle, while also correlating with other pathways. Dichotomizing the imaged signal based on high and low k PL measurements was sufficient to discriminate metabolic distinct regions on biopsy and this could be a simple tool to assess metabolism clinically. Furthermore, metabolic heterogeneity increased in regions with a higher k PL and could be used to assess metabolic divergence. Conclusion This work validated the role of HP- 13 C-MRI to measure not only glycolysis, but also a range of other altered metabolic pathways in ccRCC. This could improve tumor stratification and provide novel methods to monitor treatment response. Metabolic imaging can also be used to guide biopsy acquisition based on metabolic alterations, and therefore could improve tumour characterization.

Abstract MRI has a central role in the diagnosis and management of prostate cancer, including active surveillance (AS) of low- and favourable intermediate-risk cancer. Robust evidence supports its use to guide biopsies and stratify the risk of progression at the inclusion stage. The Prostate Cancer Radiological Estimation of Change in Sequential Evaluation (PRECISE) criteria provide the foundation for standardised assessment on serial imaging during AS. Despite potential reductions in the number of unnecessary follow-up biopsies, uncertainty about the degree to which follow-up strategies can be defined by MRI leads to variation in international guidelines and their implementation. Here, the European Society of Urogenital Radiology (ESUR)–Prostate MRI Working Group reviews the evidence for the use of MRI in AS and provides practical guidance on its use. Additional research is needed to personalise AS strategies by integrating patient-specific factors, including family history and ethnicity, as well as emerging biomarkers such as genomic profiling and technological innovations like artificial intelligence. Critical relevance statement MRI is an integral part of AS, and initiatives to standardise image acquisition and reporting are underway. Further research is needed to better define MRI’s role during follow-up and to personalise AS, which could help achieve better harmonisation among international guidelines. The European Society of Urogenital Radiology (ESUR) prostate working group provides suggestions for practical implementation. Patient summary Active surveillance is a safe and effective management strategy for indolent prostate cancer. It avoids complications associated with surgery and radiation treatment. MRI has a central role in selecting which patients will benefit most from active surveillance and helping choose the most appropriate follow-up strategy. Acquiring standardised images and using reporting systems like PRECISE improves prostate cancer assessment and may help reduce the number of unnecessary biopsies. Key Points MRI plays a central role during active surveillance, but its implementation varies widely across centres. This ESUR position statement offers practical guidance on MRI acquisition, reporting, and interpretation tailored to active surveillance. Use of MRI—including the PRECISE score for active surveillance and the PI-QUAL score for image quality—can improve consistency and accuracy in monitoring prostate cancer over time. Graphical Abstract

This prospective trial investigated extended [¹⁸F]FDG kinetics in lymphoma to provide in-vivo insights into glucose metabolism with potential relevance for staging and risk stratification. Fifteen consecutive, treatment- naïve lymphoma patients (4 Hodgkin, 11 non-Hodgkin) underwent routine whole-body [18F]FDG-PET/CT at 1 h post injection (p.i., injected activity 3.02 ± 0.34 MBq/kg) followed by additional Long Axial Field-Of-View (LAFOV)-PET/CT scans at 3 h and 6 h p.i. (Biograph Vision Quadra®, Siemens Healthineers; acquisition 5/15/30 min). Standardised uptake values (SUV) of lymphoma, benign lymph nodes, organs and reference tissues were quantified and multi time-point kinetics were described using Retention Indices (RI) and linear/quadratic trajectory analyses. Image quality was rated by two blinded readers on a 5-point Likert scale. Image quality remained diagnostic in all datasets. Median Tumour-to-Background Ratio (TBR) increased significantly from 4.1 (1 h p.i.) to 12.5 (3 h p.i.) and 23.9 (6 h p.i.), p < 0.001. High-grade lymphoma exhibited an almost linear SUV rise, whereas low-grade entities followed a parabolic course, peaking at 3 h p.i. Benign lymph nodes demonstrated constant uptake (1 h: 0.9 ± 0.3, 3 h: 0.8 ± 0.5, 6 h: 0.8 ± 0.4). RIs showed a significant increase in [¹⁸F]FDG uptake over time in lymphoma, compared with a decline in benign lymph nodes (1–3 h p.i.: 19.4

Prostate magnetic resonance imaging (MRI) has become a crucial tool in diagnosing and managing prostate cancer, mainly by helping to avoid unnecessary biopsies and enhancing the detection of clinically significant disease. However, its clinical usefulness is often limited by wide variation in how images are acquired, interpreted, and reported worldwide. This inconsistency affects diagnostic accuracy and patient outcomes. In response, the Quality Improvement Subgroup of the European Society of Urogenital Radiology (ESUR) Prostate MRI Working Group has created a practical, three-step quality-improvement framework aimed at standardising and improving prostate MRI practices. This framework consists of: Step 1: ‘Build it right’, establishing a foundation of technical excellence through adherence to the Prostate Imaging Reporting and Data System (PI-RADS) technical standards, objective quality assessment using the Prostate Imaging Quality (PI-QUAL) score, and systematic artefact reduction. Step 2: ‘See it right’, emphasising interpretive excellence via structured training, institutional quality assurance metrics, and multidisciplinary collaboration. Step 3: ‘Improve and innovate’, promoting continual refinement through emerging technologies such as AI-driven assessment, deep learning reconstruction, and remote supervision. By incorporating this structured approach into daily practice, this framework aims to ensure that prostate MRI consistently fulfils its promise of accurate, reproducible, and patient-centred care. A coordinated effort towards international implementation, benchmarking, and outcome-based validation represents the next critical step to maximise global impact. Question Wide variation in prostate MRI acquisition, image quality, and reporting undermines diagnostic accuracy. A structured roadmap is needed to ensure consistent quality and reproducible practice. Findings The ESUR Prostate MRI Working Group outlines a three-step framework — ‘Build it right’, ‘See it right’, ‘Improve and innovate’ — to standardise acquisition, interpretation, and quality assurance. Clinical relevance Applying this roadmap in clinical practice aims to enhance diagnostic confidence and promote consistent, high-quality prostate cancer care across diverse healthcare settings.

New therapies are needed for patients who experience primary or secondary resistance to renal cell cancer (RCC) treatment. Pre-clinical data suggests PARP inhibitors may be effective for RCC in combination with VEGF inhibitors. Neoadjuvant clinical trials offer an opportunity to understand the mechanisms of new therapies by comparing tumour and blood before and after treatment. WIRE is a window of opportunity, phase II, multi-centre, multi-arm, non-randomised, neoadjuvant clinical trial platform (NCT03741426). Arms 1-3 comprised: 1. cediranib (VEGF inhibitor), 2. cediranib + olaparib (PARP inhibitor), 3. olaparib. Eligible patients (pts) have cT1b+, cN0/1, cM0/1 clear cell RCC, planned for surgery, with no contraindication to IMP. A Bayesian adaptive design optimises recruitment to arms based on interim analyses of treatment effects. Pts receive 14-28 days of IMP to fit with the planned surgery date. Primary endpoint for arms 1-3 is a ≥30% reduction in DCE-MRI assessed capillary permeability (median Ktrans) post-treatment compared to baseline. Secondary endpoints include RECIST v1.1 primary tumour response and adverse events. Translational analysis will include blood profiling and multi-region tissue analysis by transcriptomics and digital pathology. 29 pts were recruited (arm 1=6, arm 2=16, arm 3=7), 28/29 were male, median age 61y (range 48-75y). All pts were treatment naïve with ECOG PS of 0 or 1. 8/29 pts had M1 disease. All surgeries were completed within the planned window. 3/29 pts were not evaluable for the primary endpoint due to inadequate dose of IMP. The numbers of evaluable pts which met the primary endpoint were arm 1: 4/6 (67%), arm 2: 4/14 (29%), arm 3: 0/6 (0%). Table 1 shows changes in Ktrans, RECIST response and adverse events. Plasma angiogenic factors were significantly induced on treatment in the combination therapy arm 2. There was no correlation between angiogenic factor induction and Ktrans change. Positive responses in median Ktrans were observed in both the cediranib monotherapy and cediranib and olaparib combination therapy arms. Therapy was well tolerated, with no substantial toxicity or delays to surgery. Greater induction of angiogenic factors in the combination arm indicates possible synergy between cediranib and olaparib. Ongoing translational analysis of tissue and blood samples will investigate the mechanisms of response to these agents. James O. Jones, Ines Horvat Menih, Martin Thomas, Helen Mossop, Rebecca Wray, Maria Aquino, James Armitage, Harriet Baker, Carley Batley, James Blackmur, Sarah Burge, Anita Chhabra, Farhana Easita, Tim Eisen, Kate Fife, Angela Godoy, Richard Goodwin, Will Ince, Rose John, Alexander Laird, Natalia Lukashchuk, Athena Matakidou, Thomas J. Mitchell, Andrew N. Priest, Andrew Protheroe, Sreenidhi Ranjit, Anthony Riddick, Sulekha Said, Jamal Sipple, Amy Strong, Helen Su, Mark Sullivan, Silvia Tarantino, Gemma Tsang-Pells, Stephan Ursprung, Balaji Venugopal, Lauren Wallis, Anne Y. Warren, James Wason, Sarah J. Welsh, Younghwa Kim, John Stone, Mireia Crispin-Ortuzar, Ferdia A. Gallagher, Brent O'Carrigan, Grant D. Stewart, on behalf of the WIRE Trial Group. Neoadjuvant olaparib and cediranib in renal cancer: Outcomes of the WIndow-of-opportunity in REnal cancer (WIRE) Trial [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2025; Part 2 (Late-Breaking, Clinical Trial, and Invited Abstracts); 2025 Apr 25-30; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2025;85(8_Suppl_2):Abstract nr CT175.

Objective Multiparametric MRI is a promising technique for noninvasive structural and functional imaging of the kidneys that is gaining increasing importance in clinical research. Still, there are no standardized recommendations for analyzing the acquired images and there is a need to further evaluate the accuracy and repeatability of currently recommended MRI parameters. The aim of the study was to evaluate the test-retest repeatability of functional renal MRI parameters using different image analysis strategies. Methods Ten healthy volunteers were examined twice with a multiparametric renal MRI protocol including arterial spin labeling (ASL), diffusion-weighted imaging (DWI) with intravoxel incoherent motion (IVIM), blood-oxygen-dependent (BOLD) imaging, T1 and T2 mapping, and volumetry with an interval of one week. The quantitative results of both kidneys were determined by manual organ segmentation, ROI analysis, and automatic segmentation based on the nnUNet framework. Test-retest repeatability of each parameter was computed using the within-subject coefficient of variance (wCV) and the intraclass coefficient (ICC). Segmentation accuracy and inter-reader agreement were evaluated using the dice score. Results Structural tissue parameters (T1, T2) showed wCV (%) between 4 and 11 and an ICC between 0.2 and 0.8. Functional parameters (ASL, BOLD and DWI) showed wCV (%) between 3 and 38 and an ICC between 0.0 and 0.7. The highest variances between test-retest scans were observed in perfusion measurements with ASL and IVIM (wCV: 17-37%). Quantitative analysis of the cortex and medulla showed a better repeatability when acquired using manual segmentation compared to ROI-based image analysis. Comparable repeatability was achieved with manual and automatic segmentation of the total kidney. Conclusion Reasonable repeatability was achieved for all MR parameters. Structural MR parameters showed better repeatability compared to functional parameters. ROI-based image analysis showed overall lower repeatability compared to manual segmentation. Comparable repeatability to manual segmentation as well as acceptable segmentation accuracy could be achieved with automatic segmentation.

To evaluate the capability of hyperpolarized [1-13C] pyruvate MRI to predict pathologic response to neoadjuvant treatment in multi-site abdominopelvic disease of high-grade serous ovarian cancer (HGSOC) patients and to compare 13C MRI and [18F]-FDG PET/CT measurements for detecting early treatment response. We recruited eight patients with HGSOC in this prospective study who underwent 13C MRI and [18F]-FDG PET/CT before and after the first cycle of neoadjuvant chemotherapy treatment (NACT). Imaging parameters were compared with clinical and histophatologic parameters. We demonstrate here that 13C MRI of hyperpolarized [1-13C]pyruvate metabolism in multiple abdominal metastases resulted in rapid labeling of the endogenous tumor lactate pool. The rate of labeling was similar between the different anatomical disease sites and independent of tumor volume. The apparent rate constant describing exchange of 13C label between pyruvate and lactate (kPL) was positively correlated with PET standard uptake values (SUVmax) for [18F]-FDG in metastatic tumor deposits in the ovary/pelvis (R = 0.471, P = 0.02). Decreased lactate labeling could be detected after the first cycle of neoadjuvant chemotherapy and was associated with pathological response. There was no overall decrease in lactate labeling in a single patient who lacked a complete histopathologic response. kPL was associated with cancer tissue LDHA concentration (rho = 0.641; P = 0.02). This exploratory study demonstrates the potential of 13C MRI measurements for assessing early response to neoadjuvant chemotherapy in patients with HGSOC.

Purpose:To evaluate the diagnostic quality and detection of anatomical variants in branching patterns of the renal arteries for non-contrast quiescent-interval slice-selective (QISS) MR Angiography (MRA) compared to CT Angiography (CTA). Methods:Patients who underwent a QISS MRA of the renal arteries as well as CTA as reference standard were included in this retrospective study. Signal-to-noise ratio (SNR), contrast-to-noise ratio (SNR), and vessel diameter were determined in the left and right renal arterial systems. Image quality and diagnostic confidence were assessed with a standardized five-point Likert scale. Sensitivity, specificity and accuracy for the detection of anatomical variants in branching patterns (accessory renal artery, aberrant renal artery and early branching) of the renal arterial system were determined compared to CTA as reference standard. Results:30 patients (59 renal arteries) were included in this retrospective study. CTA reached significantly higher median SNR compared to QISS MRA (10.96, inter-quartile range (IQR) 6.70-16.11 vs. 5.65, IQR 4.38-8.76, respectively, p < 0.001). Median CNR was significantly higher in QISS MRA (16.75, IQR 13.09-20.96) compared to CTA (13.22, IQR 7.49-18.57), p = 0.006. Diameters of the renal arteries were similar between QISS MRA and CTA (5.8 mm, IQR 4.90-6.60 versus 5.8 mm, IQR 4.75, 6.70, p = 0.893). Diagnostic confidence was rated excellent for both, though significantly higher for CTA (5, IQR 5-5,) compared to QISS MRA (5, IQR 4-5), p = 0.003). 19 of 20 variants in branching pattern could be detected successfully by QISS. Conclusion:QISS MRA offers similar diagnostic confidence and image quality to CTA as reference standard. Further, QISS MRA demonstrates excellent diagnostic accuracy in detecting anatomical variants of branching patterns of the renal arterial vasculature.

This study aimed to compare a conventional three-dimensional (3-D) magnetic resonance cholangiopancreatography (MRCP) sequence with a deep learning (DL)-accelerated MRCP sequence (hereafter, MRCPDL) regarding acquisition time and image quality. We conducted a prospective study of consecutive patients referred for MRCP between November 2023 and April 2024 at a single tertiary center. Each participant underwent 1.5T 3-D T2-weighted turbo spin echo MRCP using both a conventional sequence (threefold acceleration) and MRCPDL (eightfold acceleration). Three blinded readers independently evaluated image quality, including background signal suppression, bile and pancreatic duct visibility, artifact level, and diagnostic confidence on an ordinal four-point scale. Acquisition times were compared using a paired t-test. Image quality parameters were assessed with repeated measures ANOVA. Interreader agreement was analyzed using Fleiss' κ. Out of 419 consecutive patients, 30 participants were evaluated (mean age, 63 ± 15 years; 16 men, 14 women). The mean acquisition time was 10:30 ± 03:04 min for conventional MRCP and 3:57 ± 01:13 min for MRCPDL, P < 0.001. MRCPDL reduced acquisition time by 62.4

Purpose:Deep-learning (DL)-based image reconstruction (DLR) is a key technique for reducing acquisition time (TA) and increasing morphologic resolution in abdominal magnetic resonance imaging (MRI). We aim to compare the performance of a standard ( VIBE Std ) gradient echo (GRE) sequence with Dixon fat separation versus an accelerated ultra-fast ( VIBE UF ) and high-resolution ( VIBE HR ) T1-weighted GRE sequence with Dixon fat separation and DLR. Approach:A total of 50 patients with an abdominal 1.5T MRI, with a mean age of 59 ± 11 years, were prospectively included from January to July 2023. Each examination protocol included VIBE Std , VIBE UF , and VIBE HR . Both DL sequences use more aggressive parallel imaging and partial Fourier sampling to reduce TA (slice thickness VIBE Std and VIBE UF 3 mm, VIBE HR 2 mm). Evaluation of each contrast-enhanced datasets for noise, artifacts, sharpness/contrast, overall image quality, and diagnostic confidence was performed independently by four radiologists using a Likert scale of 1 to 5 (5 = best). Results:VIBE UF significantly reduced TA (mean 7.3 s versus 15.0 s ( VIBE Std ) and 14.5 s ( VIBE HR ); p < 0.001 ). Both DL sequences provided significantly better sharpness/contrast for all organs compared with VIBE Std (median 5 versus 4; p < 0.001 ). VIBE UF showed less noise than VIBE Std (median 5 versus 4; p < 0.001 ), but VIBE Std was less artifact-affected than both DL sequences (median 5 versus 4; p < 0.001 ). Overall image quality was superior in both DL sequences compared with VIBE Std (median 5 versus 4; p < 0.001 ). Diagnostic confidence and lesion detectability were not significantly different ( p > 0.05 ). Conclusion:DL-based image reconstruction significantly improves overall image quality for VIBE UF and VIBE HR , with VIBE UF reducing TA by ∼ 50 % .

Background: The recent introduction of whole-body positron emission tomography/ computed tomography (PET/CT) scanners and multi-bed, multi-time point acquisition technique enable calculating fluorodeoxyglucose (FDG) kinetics in the whole body. However, validating parametric, Patlak-derived data is difficult on phantoms. Methods: This prospective study investigated the effect of quantification methods mean, max, and peak on the metabolic rate (MR-FDG) and distribution volume (DV-FDG) quantification, as well as the diagnostic accuracy of parametric Patlak FDG-PET scans in diagnosing lung lesions and lymph node metastases, using histopathology and follow-up as reference standards. Dynamic whole-body FDG PET was acquired for 80 minutes in 34 patients with indeterminate lung lesions and kinetic parameters extracted from lung lesions and representative mediastinal and hilar lymph nodes. Results: All quantification methods—mean, max, and peak—demonstrated high diagnostic accuracy (AUC: MR-FDG: 0.987–0.991 and 0.893–0.905; DV-FDG: 0.948–0.975 and 0.812–0.825) for differentiating benign from malignant lymph nodes and lung lesions. Differences in the magnitude of MR-FDG (−4.76–14.09) and DV-FDG (−10.64–46.10%) were substantial across methods. Variability was more pronounced in lymph nodes (MR-FDG: 1.37–3.48) than in lung lesions (MR-FDG: 3.31–5.04). The variability was lowest between mean and max quantification, with percentage differences of 40.87 ± 5.69% for MR-FDG and 39.26 ± 7.68% for DV-FDG. Conclusions: The choice of method to measure MR-FDG and DV-FDG greatly influences the results, especially in smaller lesions with large and systematic differences. For lung lesions, a conversion factor between mean and max methods of 40% provides acceptable agreement, facilitating retrospective comparisons of measurements, e.g., in meta-analyses.

PurposeThis study evaluates the impact of high-resolution T2-weighted imaging (T2HR) combined with deep learning image reconstruction (DLR) on image quality, lesion delineation, and extraprostatic extension (EPE) assessment in prostate multiparametric MRI (mpMRI).Materials and methodsThis retrospective study included 69 patients who underwent mpMRI of the prostate on a 3 T scanner with DLR between April 2023 and March 2024. Routine mpMRI protocols adhering to the Prostate Imaging Reporting and Data System (PI-RADS) v2.1 were used, including an additional T2HR sequence [2 mm slice thickness, 4:31 min vs. 4:12 min for standard T2 (T2S)]. The image datasets were evaluated by two radiologists using a Likert scale ranging from 1 to 5, with 5 being the best for sharpness, lesion contours, motion artifacts, prostate border delineation, overall image quality, and diagnostic confidence. PI-RADS scoring and EPE suspicion were analyzed. The statistical methods used included the Wilcoxon signed-rank test and Cohen's kappa for inter-reader agreement.ResultsT2HR significantly improved lesion contours (medians of 5 vs. 4, p < 0.001), prostate border delineation (medians of 5 vs. 4, p < 0.001), and overall image quality (medians of 5 vs. 4, p < 0.001) compared to T2S. However, motion artifacts were significantly worse in T2HR. Substantial inter-reader agreement was observed in the PI-RADS scoring. EPE detection marginally increased with T2HR, though histopathological validation was limited.ConclusionT2HR imaging with DLR enhances image quality, lesion delineation, and diagnostic confidence without significantly prolonged acquisition time. It shows potential for improving EPE assessment in prostate cancer but requires further validation in larger studies.

Venous tumour thrombus (VTT), where the primary tumour invades the renal vein and inferior vena cava, affects 10-15% of renal cell carcinoma (RCC) patients. Curative surgery for VTT is high-risk, but neoadjuvant therapy may improve outcomes. The NAXIVA trial demonstrated a 35% VTT response rate after 8 weeks of neoadjuvant axitinib, a VEGFR-directed therapy. However, understanding non-response is critical for better treatment. Here we show that response to axitinib in this setting is characterised by a distinct and predictable set of features. We conduct a multiparametric investigation of samples collected during NAXIVA using digital pathology, flow cytometry, plasma cytokine profiling and RNA sequencing. Responders have higher baseline microvessel density and increased induction of VEGF-A and PlGF during treatment. A multi-modal machine learning model integrating features predict response with an AUC of 0.868, improving to 0.945 when using features from week 3. Key predictive features include plasma CCL17 and IL-12. These findings may guide future treatment strategies for VTT, improving the clinical management of this challenging scenario.

Objective Deep learning (DL)–enabled magnetic resonance imaging (MRI) reconstructions can enable shortening of breath-hold examinations and improve image quality by reducing motion artifacts. Prospective studies with DL reconstructions of accelerated MRI of the upper abdomen in the context of pancreatic pathologies are lacking. In a clinical setting, the purpose of this study is to investigate the performance of a novel DL-based reconstruction algorithm in T1-weighted volumetric interpolated breath-hold examinations with partial Fourier sampling and Dixon fat suppression (hereafter, VIBE-DixonDL). The objective is to analyze its impact on acquisition time, image sharpness and quality, diagnostic confidence, pancreatic lesion conspicuity, signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR). Methods This prospective single-center study included participants with various pancreatic pathologies who gave written consent from January 2023 to September 2023. During the same session, each participant underwent 2 MRI acquisitions using a 1.5 T scanner: conventional precontrast and postcontrast T1-weighted VIBE acquisitions with Dixon fat suppression (VIBE-Dixon, reference standard) using 4-fold parallel imaging acceleration and 6-fold accelerated VIBE-Dixon acquisitions with partial Fourier sampling utilizing a novel DL reconstruction tailored to the acquisition. A qualitative image analysis was performed by 4 readers. Acquisition time, image sharpness, overall image quality, image noise and artifacts, diagnostic confidence, as well as pancreatic lesion conspicuity and size were compared. Furthermore, a quantitative analysis of SNR and CNR was performed. Results Thirty-two participants were evaluated (mean age ± SD, 62 ± 19 years; 20 men). The VIBE-DixonDL method enabled up to 52% reduction in average breath-hold time (7 seconds for VIBE-DixonDL vs 15 seconds for VIBE-Dixon, P < 0.001). A significant improvement of image sharpness, overall image quality, diagnostic confidence, and pancreatic lesion conspicuity was observed in the images recorded using VIBE-DixonDL (P < 0.001). Furthermore, a significant reduction of image noise and motion artifacts was noted in the images recorded using the VIBE-DixonDL technique (P < 0.001). In addition, for all readers, there was no evidence of a difference in lesion size measurement between VIBE-Dixon and VIBE-DixonDL. Interreader agreement between VIBE-Dixon and VIBE-DixonDL regarding lesion size was excellent (intraclass correlation coefficient, >90). Finally, a statistically significant increase of pancreatic SNR in VIBE-DIXONDL was observed in both the precontrast (P = 0.025) and postcontrast images (P < 0.001). Also, an increase of splenic SNR in VIBE-DIXONDL was observed in both the precontrast and postcontrast images, but only reaching statistical significance in the postcontrast images (P = 0.34 and P = 0.003, respectively). Similarly, an increase of pancreas CNR in VIBE-DIXONDL was observed in both the precontrast and postcontrast images, but only reaching statistical significance in the postcontrast images (P = 0.557 and P = 0.026, respectively). Conclusions The prospectively accelerated, DL-enhanced VIBE with Dixon fat suppression was clinically feasible. It enabled a 52% reduction in breath-hold time and provided superior image quality, diagnostic confidence, and pancreatic lesion conspicuity. This technique might be especially useful for patients with limited breath-hold capacity.

Despite recent therapeutic advances, renal cell carcinoma (RCC) has a high mortality rate. The development of new neoadjuvant strategies requires reliable companion biomarkers of early and successful response to treatment. A change in tumor size is a late measure of response and novel targeted imaging-based biomarkers may be more accurate for treatment response prediction. Here we evaluated the potential of hyperpolarized carbon-13 MRI (HP 13C-MRI), following the injection of hyperpolarized 13C-pyruvate, to assess response to neoadjuvant treatment in four patients with clear cell RCC as an exploratory outcome within a prospective clinical trial. The change in the tumor lactate-to-pyruvate ratio (LAC/PYR) following treatment varied across the patients: mean percentage change ± S.D. = +6 ± 27

Purpose: The purpose of this study was to compare a conventional T1-weighted volumetric interpolated breath-hold examination (VIBE) sequence with a DL-reconstructed accelerated high-resolution VIBE sequence (HR-VIBEDL) in terms of image quality, lesion conspicuity, and lesion detection. Materials and methods: Consecutive patients referred for upper abdominal MRI between December 2023 and March 2024 at a single tertiary center were prospectively enrolled. Participants underwent 1.5 T upper abdominal MRI with acquisition of spectrally fat-saturated unenhanced and gadobutrol-enhanced conventional VIBE (fourfold acceleration, 3.0 mm slice thickness, 72 axial slices) and HR-VIBEDL (sixfold acceleration, 2.0 mm, 108 slices). Both sequences had an identical acquisition time of 16 s. Image analysis was performed by three readers in a blinded and randomized fashion, with respect to image quality, lesion conspicuity, and lesion detection in liver, pancreas, spleen, lymph nodes and adrenal glands. Image quality parameters were compared using repeated measures analysis of variance. Lesion detection rates were compared using Fisher exact test. Inter-reader agreement was assessed using Fleiss kappa test. Results: Among 744 consecutive patients, 50 participants were evaluated. There were 30 men and 20 women, with a mean age of 60 +/- 15 (standard deviation [SD]) years (age range: 18-88 years). HR-VIBEDL images demonstrated superior signal-to-noise ration and edge sharpness by comparison with conventional VIBE images (P < 0.001 for both), with substantial interreader agreement (kappa: 0.70-0.90). Lesion conspicuity was higher with for HR-VIBEDL images (3.50 +/- 0.83 [SD]) by comparison with conventional VIBE images (3.21 +/- 0.98 [SD]) (P = 0.005). There were 171 upper abdominal lesions, yielding a total of 513 for all three readers. HR-VIBEDL images yielded higher lesion detection rate (97.5 %; 500/513) compared to conventional VIBE images (93.2 %; 478/513) (P = 0.002). Conclusion: HR-VIBEDL images of the upper abdomen result in superior image quality, better lesion conspicuity, and improved lesion detection without time penalty by comparsion with conventional VIBE images.