BACKGROUND & AIMS:The recent approval of pharmacological therapies for fibrotic metabolic dysfunction-associated steatohepatitis (MASH) has increased the need for accurate identification of treatment-eligible patients. Current recommendations increasingly rely on non-invasive tests (NITs), including vibration-controlled transient elastography (VCTE), while multiparametric ultrasound (MPUS) may provide additional opportunities for non-invasive assessment. However, agreement between histology and imaging-based approaches remains uncertain. We compared treatment eligibility based on histology, VCTE, and MPUS in two international biopsy-proven cohorts of metabolic dysfunction-associated steatotic liver disease (MASLD). METHODS:We analysed two biopsy-proven MASLD cohorts: CAP-IPDMA (n=1029), including VCTE and controlled attenuation parameter (CAP), and iLEAD (n=124), including MPUS. Treatment eligibility was assessed using histologically confirmed F2/F3 MASH and NIT-based recommendations from international expert panels. RESULTS:In CAP-IPDMA, 277/1029 patients (26.9%) met the histological definition of "at-risk MASH". Depending on the VCTE cut-off, 13.2-32.0% qualified for treatment. Overlap between histological "at-risk MASH" and VCTE thresholds was limited, reaching 27.8% when using VCTE 8-15 kPa, and decreasing when narrower or higher thresholds were applied. Among patients identified only by VCTE 8-15 kPa, males had lower median AST and ALT than those fulfilling only the histological indication (35 vs 48 IU/L p=0.034 and 45 vs 62 IU/L p=0.0072, respectively). In iLEAD, 21/124 patients (16.9%) met the histological definition, while 13.7-16.1% were eligible based on SWE thresholds, again with a similarly limited overlap. CONCLUSIONS:Histology and non-invasive tests capture partly distinct patient populations, meaning that both the number and type of patients selected for therapy depend on the chosen modality and cutoffs. As vibration-controlled transient elastography and multiparametric ultrasound become increasingly accessible in clinical practice, prospective validation is essential for establishing reliable non-invasive treatment pathways. IMPACT AND IMPLICATIONS:The current literature reflects a paradigm shift away from biopsy-based approaches toward NIT-based assessment of treatment eligibility in metabolic dysfunction-associated steatotic liver disease (MASLD), which may substantially affect which patients receive newly approved therapies. Our results are important for clinicians, researchers, and guideline developers because histology and current NIT cut-offs identify only partially overlapping patient populations, implying that different diagnostic strategies select different risk profiles. In practice, these findings support thoughtful implementation of NIT-based treatment pathways, the use of repeated measurements, and prospective validation of NIT thresholds to guide clinical care, trial design, and health policy decisions.

To analyze the intercontinental differences and inequities in the management of hepatocellular carcinoma (HCC), including surveillance, diagnosis, and treatment, through the survey responses from the participants of the Global Abdominal Imaging Forum on HCC, organized by the European Society of Gastrointestinal and Abdominal Radiology (ESGAR). An online anonymous survey was distributed to the attendees of the Global Abdominal Imaging Forum on HCC. The survey consisted of 14 multiple-choice questions, covering demographic, epidemiological and occupational data, and information on the management of HCC. Global differences and differences between European and non-European countries were analyzed. Of 1963 attendees from 110 countries, 408 (20.8

Vascular diseases of the liver include portal vein thrombosis (with or without cirrhosis), portosinusoidal vascular disorder, Budd-Chiari syndrome, sinusoidal obstruction syndrome, non-obstructive sinusoidal dilatation and peliosis, splanchnic artery aneurysms, and hepatic arteriovenous fistulas. Except for portal vein thrombosis in cirrhosis, these are all rare conditions. Since the last Clinical Practice Guidelines were issued by the European Association for the Study of the Liver in 2016, much data has been published on the diagnosis and management-medical and interventional-of patients with vascular liver diseases. Based on a thorough review of the relevant literature, recommendations are provided to address key clinical dilemmas. The document emphasises personalised care, considering individual risk factors and clinical presentation. Multidisciplinary management involving hepatologists, haematologists, pathologists, interventional radiologists and surgeons is essential in this area. Our aim is to provide guidance on the management of patients with vascular liver diseases based on the best available evidence. (c) 2025 European Association for the Study of the Liver. Published by Elsevier B.V. All rights are reserved, including those for text and data mining, AI training, and similar technologies.

The treatment of advanced primary liver cancer has seen major improvement in recent years. In hepatocellular carcinoma (HCC), immunotherapy has improved both survival and quality of life. In biliary tract cancers (BTC), immunotherapy has shown modest benefits, while molecular targeted therapies have had a major impact in selected populations defined by molecular alterations. These advances are now being tested at earlier disease stages. In this review, we first discuss the challenges in designing trials that combine local and systemic treatment at earlier stages, and the different endpoints that might be used. We then present the available data on the combination of intra-arterial and systemic treatments in HCC. We continue with a discussion of the available data on adjuvant and neoadjuvant systemic treatment in HCC. Finally, we review recent developments in the adjuvant and neoadjuvant settings for BTC. While promising data exist across these settings, uncertainties remain regarding whether these strategies will become standard of care in the coming years.

The development of liver imaging in past decades conditioned the investigation of hepatocyte transporter-mediated drug-drug interactions (ht-DDIs). Indeed, inhibition of basolateral uptake transporters in hepatocytes by a co-administered drug may decrease the hepatocyte concentrations of a victim drug, while the concomitant increased plasma concentrations may produce extrahepatic toxicity. Moreover, inhibition of canalicular efflux transporters by a co-administered drug may increase the hepatocyte concentrations of a victim drug without causing a measurable effect on plasma concentrations. Additionally, transporter inhibition may occur concomitantly on uptake and efflux membrane transporters. Numerous publications and reviews highlighted ht-DDIs using in vitro models, but few research groups investigated ht-DDIs with liver imaging. This review summarises how magnetic resonance imaging, positron emission tomography, and single-photon emission computed tomography can detect ht-DDIs in rodents and humans.

To compare pre- and post-therapy dosimetry in association with clinical outcomes in a large cohort of hepatocellular carcinoma treated with yttrium 90 (90Y) labelled resin-microspheres. This was a retrospective study from a single centre of data collected (146 patients) between March 2015 and October 2019. Pre-therapeutic tumour-absorbed doses was computed using technetium 99m (99mTc) macroaggregated human albumin SPECT/CT. Post therapeutic tumour-absorbed dose was computed using 90Y PET/CT. The mRECIST response criteria at 6 months was correlated to the tumour-absorbed doses by receiver-operator-curve (ROC) analysis and disease control probability modelling. Overall survival was stratified according to the results of the ROC analysis. One hundred and fourteen (114) patients (median age 67.5, 89 men) were evaluated in the study. Objective response was observed in 40

Despite growing clinical use of contrast-enhanced ultrasound (CEUS), inconsistency remains in the modality's role in clinical pathways for hepatocellular carcinoma (HCC) diagnosis and management. This AJR Expert Panel Narrative Review provides practical insights on the use of CEUS for the diagnosis of HCC across populations, including individuals at high risk for HCC, individuals with metabolic dysfunction-associated steatotic liver disease, and individuals not at high risk for HCC. Considerations addressed with respect to high-risk patients include CEUS diagnostic criteria for HCC, use of CEUS for differentiating HCC from non-HCC malignancy, use of CEUS for small (≤ 2 cm) lesions, use of CEUS for characterizing occult lesions on B-mode ultrasound, and use of CEUS for indeterminate lesions on CT or MRI. Representative literature addressing the use of CEUS for HCC diagnosis and gaps in knowledge requiring further investigation are highlighted. Throughout these discussions, the article distinguishes two broad types of ultrasound contrast agents used for liver imaging: pure blood-pool agents and a combined blood-pool and Kupffer-cell agent. Additional topics include the use of CEUS for treatment response assessment after nonradiation therapies and implications of artificial intelligence technologies. The article concludes with a series of consensus statements from the author panel.

Since 1930 it has been accepted that intravenous injection of iodinated contrast agent as part of contrast-enhanced computed tomography (CE-CT) imaging can induce a contrast-associated acute kidney injury (CA-AKI). For the last 10 years, studies have investigated this iatrogenia. However, those works didn’t concern patient hospitalised after emergency department (ED) visit. This study assessed the CA-AKI incidence and risk factors in patients hospitalised after a CE-CT in ED. This was a monocentric retrospective study, conducted in a University Hospital ED (Beaujon Hospital) between 2019 and 2022. Patients over 16 years old who received a CE-CT and two serum creatinine dosages, one pre-CT and one post-CT (2 to 7 days later), were included. Risk factors and protective factors of CA-AKI as well as population characteristics were analysed. After studying 5079 enhanced CT-scans, 1463 patients fulfilled the inclusion criteria. The incidence of CA-AKI was 4.1

Metabolic dysfunction-associated steatotic liver disease (MASLD) and its inflammatory form, metabolic dysfunction-associated steatohepatitis (MASH), are emerging as leading causes of hepatocellular carcinoma (HCC) development. This has important implications for evaluating patients with these conditions, including the potential for early diagnosis through screening techniques. Imaging techniques for the noninvasive diagnosis of HCC in the context of MASLD also present unique considerations. Notably, HCC development in patients without cirrhosis is more frequent in MASLD compared to other chronic liver disease etiologies. Moreover, the presence of liver steatosis, a common feature in MASLD patients, can modify the radiological appearance of the liver, giving HCC in MASLD/MASH uncommon imaging characteristics. Additionally, certain histological subtypes, particularly the steatohepatitic HCC, are more prevalent in MASLD/MASH, which may influence both diagnostic strategies and therapeutic decisions in these patients. This review article focuses on the radiological characteristics of HCC developed in patients with MASLD/MASH. It specifically addresses the roles of screening and surveillance, the radiological features of HCC in MASLD/MASH, the histological subtypes associated with these conditions, and the impact of imaging on treatment decisions. Finally, a brief summary of future directions and the role of new technologies in HCC diagnosis within the context of MASLD is provided.

OBJECTIVES:To study hepatobiliary expert ultrasound (US) in a cohort of suspected primary intrahepatic lithiasis (IHL) and to compare these findings with MRI/MRCP data. METHODS:All patients with a diagnosis of primary-IHL based upon biological and, or, clinical symptoms who underwent US between 2008 and 2023 were retrospectively enrolled in two tertiary hepatobiliary centers. Clinical characteristics, available genetic and radiological features (expert US and MRCP) were recorded. Data were compared for the presence of comet-tail images or stones on US, between US and MRCP features and between imaging and patients' genetic status. Statistical analyses were performed with R software environment version 4.2.1, by univariate and multivariate analysis. RESULTS:A total of 112 primary-IHL patients were included (mean age 43 years old ±14 and 55% women). US identified primary-IHL in 92/112 (82%) patients including intrahepatic biliary comet-tail in 82/112 (73%) and stones in 51/112 (46%). Among these, 66/112 (68%) had both US and MRCP. Lithiasis was identified in 60/76 US (79%) and 44/76 MRCP (58%). MRCP showed only stones in 22/76, 29%. Genetic testing was performed in 66/112 (58%) patients. Thirty-two (49%) of these patients had pathogenic ABCB4/MDR3 gene variants, 14/66 (21%) other pathogenic variants and 5/66 (5%) had unknown significant variants. No genetic abnormalities were found in 19/66 (29%). A multivariate logistic model with the comet-tail sign as an outcome showed that there was a significant negative correlation between other pathogenic genetic variants and the comet-tail phenotype ( P -value = 0.049). CONCLUSION:US, and not MRCP, should be the primary diagnostic tool in suspected primary-IHL patients.

ObjectivesThis study evaluates the perceived impact of European School of Radiology (ESOR) training programs on radiologists' professional development.MethodsA cross-sectional survey targeted alumni who participated in ESOR fellowships from 2011 to 2023. The survey included questions on demographics, professional background, ESOR program details, and career impact. Data were collected via a web-based questionnaire and analyzed using descriptive statistics and thematic analysis.ResultsA total of 916 alumni were invited to the survey, with a response rate of 21% (190 participants). The median age was 31 years (range 29-33), and 54% were female. Most worked in public healthcare (62%) and were involved in academic activities (24%). Fellowship types included the visiting scholarship program (44%), Bracco fellowship (32%), and exchange program for fellowships (25%). The majority (59%) reported the fellowship helped them reach their current position, and 35% noted it upgraded their CV. Significant application of learned skills was reported by 69%. Ongoing cooperation with former tutors was maintained by 54%. Financial support was crucial, with 41% stating they could not have completed the training without it, 33% considering it very important, and 13% important. Participants rated the impact on clinical skills with a median score of 9/10. Other areas of impact included research skills (median 7/10), subspecialization (median 9/10), exposure to diverse practices (median 9/10), networking (median 10/10), and personal and professional growth (median 10/10).ConclusionESOR training programs significantly enhance radiologists' professional development through comprehensive support, high-quality training, and substantial financial aid, ensuring participants are well-equipped for career advancement.Critical relevance statementThis study evaluates the perceived impact of ESOR training programs on radiologists' professional development, highlighting significant enhancements in clinical skills, career advancement, and the critical role of financial support in facilitating access to high-quality education.Key PointsThe ESOR offers various programs addressing both foundational and advanced training in radiology.Fifty-nine percent of participants reported that ESOR fellowships helped them achieve their current positions.Participants experienced a median improvement score of 9 out of 10 in clinical skills.Fifty-four percent of participants maintained ongoing cooperation with former tutors post-fellowship.ESOR financial support was perceived as crucial by many participants, ensuring access to high-quality education.

The aim of this study was to describe the imaging features on dynamic CT and MRI of a series of pathologically confirmed low-grade vascular neoplasia of the liver (LGVNL). In this retrospective multicenter study, patients diagnosed with pathologically proven LGVNL between January 2014 and August 2024 and with cross-sectional imaging (CT or MRI) were included. Based on prior studies, we divided the patients into two groups: a group with typical LGVNL features and a group with atypical tumors. Univariable analysis and the logistic regression model were used to evaluate the outcome of typical and atypical LGVNL features. Twenty-eight patients were included (20 men, mean age 53.7 ± 13.4 [SD] years old). The median size of tumors at diagnosis was 22 mm [IQR, 10–80]. A typical LGVNL pattern including thick continuous peripheral arterial phase “flower petal shape” enhancement was found on MRI in 67

Background & Aims:A combination of three immunohistological markers (Glypican 3, heat shock protein 70 [HSP70], and glutamine synthetase [GS]) is routinely used to differentiate hepatocellular carcinoma (HCC), but this panel's sensitivity is suboptimal. Our aim was to assess the diagnostic value of prostate-specific membrane antigen (PSMA) expression for diagnosing HCC in a series of hepatocellular nodules and compare its performance with that of routinely used markers. Methods:We included 320 hepatocellular nodules from 188 patients in a test cohort and 87 hepatocellular nodules from 48 patients in an external validation cohort distributed as follows: regenerative nodules (RN, n = 39+22), low-grade dysplastic nodules (LGDN, n = 38+16), high-grade dysplastic nodules (HGDN, n = 30+8), early HCC (≤2-cm nodules) (n = 107+24), HCC (n = 106+17), and corresponding non-tumour livers (NTL, n = 152+37). PSMA, HSP70, Glypican 3, and GS expression was assessed by immunohistochemistry on tissue microarrays. For each marker or combination of markers, sensitivity, specificity, and accuracy were calculated. Results:In the test cohort, PSMA was expressed in 83% of HCC (n = 88/106), 77% of early HCC (n = 82/107), 27% of HGDN (n = 8/30), 21% of LGDN (n = 8/38), 18% of RN (n = 7/39), and 3% of NTL (n = 5/152). In the validation cohort, the sensitivity and specificity of PSMA for HCC diagnosis were 0.95 and 0.77, respectively, and its accuracy was 0.83. The sensitivity and the specificity of the Glypican 3-HSP70-GS (≥2 positive markers) combination for HCC diagnosis were 0.41 and 0.99, respectively, and its accuracy was 0.80. Adding PSMA to this combination increased the sensitivity and accuracy to 0.85 and 0.86, respectively. Conclusions:PSMA alone has shown good performance in diagnosing HCC, outperforming the combination of the three routinely used markers. When sufficient material is available, adding Glypican 3, HSP70, and GS to PSMA could be recommended. Impact and implications:Differentiating hepatocellular nodules, particularly high-grade dysplastic nodules and hepatocellular carcinoma (HCC), based on histologic criteria remains challenging. In this study, we assess the diagnostic value of a new immunohistochemical marker, prostate-specific membrane antigen (PSMA), for diagnosing HCC in two independent series of hepatocellular nodules and compare its performance with that of routinely used markers (Glypican 3, heat shock protein 70 [HSP70], and glutamine synthetase [GS]). PSMA alone has demonstrated good performance in diagnosing HCC, superior to the combination of the three routinely used markers, and could be useful in practice for differentiating difficult-to-classify hepatocellular nodules. When the material is sparse, using PSMA alone could be recommended, whereas when sufficient material is available, adding PSMA to Glypican 3, HSP70, and GS may be advised, as this combination has shown the best performance for HCC diagnosis.