Imaging Guidelines Research Articles

The prevalence of distant metastasis on initial imaging after negative or non-localizing sentinel lymph node biopsy in patients with T3 or greater melanoma.

The diagnostic workup for T3 or greater melanoma includes sentinel lymph node biopsy (SLNB) for staging purposes. However, it is unclear if a negative SLNB in this subset of patients is adequate to rule out distant metastases (DMs) in the absence of imaging. Furthermore, current guidelines for imaging in these cases are ambiguous. Therefore, we aim to report and compare the prevalence of DMs found on imaging in patients with T3 or greater melanoma, stratified by SLNB result. In addition, we aim to qualitatively investigate the effect on time to treatment if imaging is delayed in these patients. This is a retrospective study of 140 patients with T3 or greater melanoma who underwent workup and treatment at our institution from 2009 to 2022. Diagnostic data, primary tumor characteristics, and demographics were collected. Descriptive statistics were applied to describe the cohort with granular detail. An independent Fisher's exact test was performed to compare the prevalence of DMs detected on imaging stratified by SLNB result. A student's t test was performed to compare average time to treatment within a subset of patients with negative or non-localizing SLNB to assess for any benefit with staging imaging completed prior to SLNB. The prevalence of DMs detected using advanced imaging in patients with T3 or greater melanoma was similar between groups, where 4 of 33 (12.12%) patients with negative or non-localizing SLNB were found to have DMs compared to 6 of 50 (12%) patients with positive SLNB (two-tailed p = 1). For those who had a negative or non-localizing SLNB and underwent adjuvant therapy, a student's t-test revealed no significant difference in time to treatment initiation between those who had imaging prior to SLNB (56 days) and those who had imaging after SLNB (86 days) was completed (p = 0.2317). Given the similar prevalence of DMs regardless of SLNB result, patients with T3 or greater melanoma may benefit from more extensive imaging alongside SLNB upon initial diagnosis to prevent potential delays in detection of DMs and prompt initiation of appropriate treatment.

Ultrasound Imaging Protocol for Latissimus Dorsi and Teres Major in Overhead Athletes: A Comprehensive Approach.

Ultrasound imaging is vital for musculoskeletal assessment due to its real-time, high-resolution capabilities and safety. While protocols exist for rotator cuff evaluation, comprehensive guidelines for imaging the latissimus dorsi and teres major muscles are lacking. This article fills this gap by presenting a detailed ultrasound protocol for these muscles, essential for shoulder stability and movement in overhead athletes. We review their anatomy, propose a standardized examination approach, and discuss clinical indications, aiming to improve diagnostic accuracy and management of these injuries.

Misinterpretation of indeterminate diastolic dysfunction: awareness and insights from a nationwide survey among Brazilian cardiologists

Abstract Introduction Cardiac diastolic dysfunction is highly prevalent and is associated with significant morbidity and mortality. The latest American Society of Echocardiography and European Association of Cardiovascular Imaging (ASE/EACVI) guidelines have simplified the definition of diastolic dysfunction and introduced the classification of indeterminate diastolic dysfunction (IDF). Despite these advancements, IDF remains poorly understood in clinical practice, with variable prevalence rates. Purpose This study aims to assess the understanding of IDF among non-echocardiographer cardiologists across Brazil, eight years after the guideline update. Methods A nationwide online survey was conducted among non-echocardiography readers cardiologists, distributed via mobile messaging platforms. A brief questionnaire, using anonymous responses, assessed awareness and interpretation of IDF. Results A total of 570 cardiologists participated from all regions of Brazil, with good representation across Southeast (29.65%), Central-West (23.80%), Northeast (18.77%), South (16.14%), and North (11.58%). Most participants (64.21%) had over ten years of clinical experience. While 71% correctly identified degrees 2 or 3 as indicative of elevated filling pressures, only 34.21% accurately understood the criteria for reporting IDF. Misconceptions attributing IFD included presence of pathologies that interfere with accurate assessment (49.12%) or technical limitations of echocardiography machines (3.33%) or lack of knowledge among echocardiographers (4.91%). Additionally, 46.7% encountered IDF rarely in reports, 33.51% believed it influenced patient management, and 43.51% felt that the examination could have been better executed. Conclusion Despite widespread knowledge of diastolic dysfunction grading, misinterpretation of DIF persists among Brazilian non-echocardiographer cardiologists. Enhanced education and perhaps clearer guidelines are necessary to improve clinical echocardiographic collaboration and accurate diagnosis.

Left atrial stiffness and its association to left ventricular geometry in resistance trained athletes using anabolic-androgenic steroids

Abstract Background Anabolic-Androgenic Steroids (AAS) are commonly used in resistance trained (RT) individuals despite the negative impact on left ventricular (LV) structure and function. Purpose Due to the inter-dependence of the left atrium (LA) and the LV, alongside the importance of the atria contributing to LV filling and cardiac output, this study aimed to assess the relationship between LV geometry and LA stiffness in young RT users of AAS. Methods Utilising a cross-sectional design, male (n=99) and female (n=19) RT individuals aged 29±6yrs were grouped based on self-reported AAS user status: current (CU; n=70), past (PU; n=22) and non-users (NU; n=27). All participants underwent transthoracic echocardiography with strain imaging. Left ventricular geometry was defined based on LV mass index and relative wall thickness as per European Association of Cardiovascular Imaging guidelines. Left atrial stiffness index (LASi) was calculated as the ratio of E/E’ to LA reservoir strain (LARes) and concentricity as the ratio of LV mass to end-diastolic volume^0.67. Ejection Fraction (EF) was calculated using Simpsons biplane method. All data was presented as mean ± standard deviation with group differences assessed using a one-way ANOVA with post-hoc Bonferroni adjustment and Kruskal-Wallis test for non-normally distributed indices. A Fishers exact test was used to compare geometry between groups. Relationships between LASi and concentricity were assessed using multi linear regression Results Current users presented greater LV remodelling compared to PU and NU (eccentric hypertrophy (45%, 9% and 0%), concentric remodelling (2%, 0% and 0%) and concentric hypertrophy (8%, 0% and 0% respectively; p<0.001). EF was lower in those with concentric (52±9, p=.006) and eccentric (53±5, p<.001) hypertrophy than with normal geometry (58±5), but no difference between concentric and eccentric hypertrophy. LARes was lower in CU (32.0±7.5) compared to PU (39.1±8.3, p=.001) and NU (40.2±7.7, p<.001). E/E’ and LASi were higher in CU than PU (p=.006, p=.001) and NU (p<.001, p<.001; E/E’: 6.7±1.8, 5.9±1.5, and 5.7±1.4; LA stiffness index: 0.21±0.08, 0.16±0.05, and 0.15±0.05). Concentricity was higher in CU than PU (p<.001) and NU (p<.001; 8.3±2.2; 6.4±1.4 and 5.7±2.2 respectively). Controlling for user status, concentricity predicted LASi (R²=0.23, F(2,109)=16.1, p<.001) with a 0.1 increase in LASi for each 10g.ml^-0.667 increase in concentricity. Conclusions Although current users of AAS presented with more eccentric hypertrophy, those with increased concentricity and concentric hypertrophy had higher LA stiffness index. These data highlight 1) the potential greater negative functional impact of concentric compared to eccentric hypertrophy in young RT individuals using AAS, 2) the added value of LASi above conventional indices such as EF and 3) the possible reversible nature of LV and LA remodelling following cessation of AAS use.

A novel multimodality anthropomorphic phantom enhances compliance with quality assurance guidelines for magnetic resonance imaging in radiotherapy

A novel multimodality anthropomorphic phantom enhances compliance with quality assurance guidelines for magnetic resonance imaging in radiotherapy

Recommendations from Imaging, Oncology, and Radiology Organizations to Guide Management in Prostate Cancer: Summary of Current Recommendations.

Prostate cancer is the second most common malignancy among male individuals in the United States and requires careful imaging approaches because of its varied presentations. This review examines prostate cancer imaging guidelines from leading organizations, including the American College of Radiology, American Urological Association, European Association of Urology, American Society of Clinical Oncology, and National Comprehensive Cancer Network, and serves as a reference highlighting commonalities and divergences in current imaging recommendations across prostate cancer states. We outline these organizations and their methods, focusing on their approaches to panel expertise, guideline development, evidence grading, and revision schedules. We then compare and contrast the role of various imaging modalities across states of prostate cancer management in the following categories: clinically suspected prostate cancer, clinically established prostate cancer: active surveillance or staging, monitoring metastatic disease, and posttreatment follow-up: recurrent or residual disease. Overall, there is consensus on the importance of multiparametric MRI in diagnosis and staging prior to active surveillance and the emerging role of prostate-specific membrane antigen (PSMA) PET/CT in metastatic and recurrent disease. However, there is disparity in imaging recommendations for detecting metastases in unfavorable intermediate-risk prostate cancer and views on current applications of PSMA PET/CT. Ultimately, variations in radiologic expertise exist among guideline panels, and there continue to be inconsistencies in imaging recommendations in prostate cancer. Keywords: Prostate, Genital/Reproductive, Oncology Supplemental material is available for this article. © RSNA, 2025.

International perspectives on LI-RADS.

Given the crucial role of imaging in HCC diagnosis, LI-RADS CT/MRI was developed to standardize the imaging interpretation and reporting of HCC in patients at risk for HCC and categorize hepatic observations on an ordinal scale according to the likelihood of HCC. LI-RADS has since been expanded to include 5 algorithms: LI-RADS US Surveillance, contrast-enhanced US (CEUS) LI-RADS, LI-RADS CT/MRI, and LI-RADS Treatment Response Assessment. LI-RADS has been adopted broadly in North America, however with less ubiquitous adoption outside of North America. Further elucidation of the perceived strengths and weakness of the LI-RADS algorithm, as it pertains to various geographic regions, will continue to inform a future system that may be more readily adopted globally. Therefore, the aim of this article is to summarize HCC risk factors and imaging guidelines in select geographically disparate regions, and to solicit feedback from liver imaging experts on the limitations and barriers to adoption of LI-RADS algorithms in their patient populations.

Soft tissue tumor imaging in adults: European Society of Musculoskeletal Radiology-Guidelines 2024: imaging immediately after neoadjuvant therapy in soft tissue sarcoma, soft tissue tumor surveillance, and the role of interventional radiology.

An update of the first European Society of Musculoskeletal Radiology (ESSR) consensus on soft tissue tumor imaging in 2015 became necessary due to technical advancements, further insights into specific entities, and the revised WHO classification (2020) and AJCC staging system (2017). The third part of the revised guidelines covers algorithms and techniques beyond initial imaging: (1) Imaging after neoadjuvant therapy in soft tissue sarcoma, (2) sarcoma surveillance, and (3) special aspects, including surveillance of non-malignant entities and the role of interventional radiology. A validated Delphi method based on peer-reviewed literature was used to derive consensus among a panel of 46 specialized musculoskeletal radiologists from 12 European countries. Statements that had undergone interdisciplinary revision were scored online by level of agreement (0 to 10) during two iterative rounds that could result in either 'group consensus,' 'group agreement,' or 'lack of agreement.' The three sections contain 47 statements with comments. Group consensus was reached in 91.5%, group agreement in 6.4%, lack of agreement in 2.1%. In sarcoma, imaging immediately after neoadjuvant therapy is pivotal for determining the therapy effects and for resection-planning; surveillance should include imaging at fixed grade- and type-dependent intervals. In general, MRI is the method of choice for loco-regional surveillance of soft tissue sarcomas, and chest CT to assess metastatic disease. Interventional radiology has a role, especially in oligometastatic disease, palliative tumor control and local recurrences. Strategies for standardized soft tissue tumor imaging regarding therapy control, surveillance, and useful interventional procedures are provided. Question An ESSR consensus update on soft tissue tumor imaging regarding surveillance became necessary due to technical advancements, further entity-specific insights, and revised WHO- and AJCC-classifications. Findings Imaging immediately after neoadjuvant therapy in soft tissue sarcoma is pivotal. Post-therapeutic surveillance should include imaging at regular intervals, stratified for tumor grade and type. Clinical relevance The updated ESSR soft tissue tumor imaging guidelines aim to provide best practice expert consensus for standardized imaging, to support radiologists in their decision-making, and to improve examination comparability, both in individual patients and in future studies on individualized strategies.

Feasibility of three dimensional and strain transthoracic echocardiography in a single-centre dedicated NHS cardio-oncology clinic

BackgroundFollowing the publication of international cardio-oncology (CO) imaging guidelines, standard echocardiographic monitoring parameters of left ventricular systolic function have been endorsed. Recommendations highlight that either two-dimensional (2D) or three-dimensional (3D) left ventricular ejection fraction (LVEF), alongside global longitudinal strain (GLS) should be routinely performed for surveillance of patients at risk of cancer therapy-related cardiac dysfunction (CTRCD). We studied the feasibility of 3D-LVEF, 2D-GLS and 2D-LVEF in a dedicated CO service.MethodsThis was a single-centre prospective analysis of consecutive all-comer patients (n = 105) referred to an NHS CO clinic. Using a dedicated Philips EPIQ CVx v7.0, with X5-1 3D-transducer and 3DQA software, we sought to acquire and analyse 2D- and 3D-LVEF and 2D-GLS, adhering to the British Society of Echocardiography (BSE) and British Cardio-Oncology Society (BCOS) transthoracic echocardiography protocol.ResultsA total of 105 patients were enrolled in the study; 5 were excluded due to carcinoid heart disease (n = 5). Calculation of 3D-LVEF was achieved in 40% (n = 40), 2D-GLS in 73% (n = 73), and 2D-LVEF in 81% (n = 81). LV quantification was not possible in 19% (n = 19) due to poor myocardial border definition. Strong correlation existed between 2D-LVEF and 3D-LVEF (r = 0.94, p < 0.0001). Bland–Altman plot demonstrated no statistical differences in that the mean deviation between 2D-LVEF and 3D-LVEF were consistent throughout a range of LVEF values. The most persistent obstacle to 3D-LVEF acquisition was insufficient myocardial border tracking (n = 30, 50%).ConclusionThis study demonstrates the high feasibility of 2D-GLS and 2D-LVEF, even in those with challenging echocardiographic windows. The lower feasibility of 3D-LVEF limits its real-world clinical application, even though only a small difference in agreement with 2D-LVEF calculation was found when successfully performed.

A decision support system to increase the compliance of diagnostic imaging examinations with imaging guidelines: focused on cerebrovascular diseases.

Diagnostic imaging decision support (DI-DS) system has emerged as an innovative evidence-based solution to decrease inappropriate diagnostic imaging. The aim of the present study was to design and evaluate a DI-DS system for cerebrovascular diseases. The present study was an applied piece of research. First, the conceptual model of the DI-DS system was designed based on its functional and non-functional requirements. Afterwards, to create the system's knowledge base, cerebrovascular diseases diagnostic imaging algorithms were extracted from the American College of Radiology Appropriateness Criteria (ACR-AC). Subsequently, the system was developed based on the obtained conceptual model and the extracted algorithms. The software was programmed by means of the C#. After debugging the system, it was evaluated regarding its performance and also the users' satisfaction with it. Assessing the users' satisfaction with the system demonstrated that all the evaluation criteria met the acceptable threshold (85 %). The retrospective evaluation of the system's performance indicated that from among 76 imaging examinations, which had previously been performed for 30 patients, 12 (15.78 %) were deemed inappropriate. And, the system accurately identified all the inappropriate physicians' decisions. The concurrent evaluation of the system's performance indicated that the system's recommendations helped the physicians remove 100 % (4 out of 4) of the inappropriate and 40 % (2 out of 5) of the inconclusive imaging examinations from their initial choices. A DI-DS system could increase the compliance of the physicians' decisions with diagnostic imaging guidelines, and also improve treatment outcomes through correct diagnosis and providing timely care.

Enhancing Lesion Detection in Inflammatory Myelopathies: A Deep Learning-Reconstructed Double Inversion Recovery MRI Approach.

The imaging of inflammatory myelopathies has advanced significantly over time, with MRI techniques playing a pivotal role in enhancing lesion detection. However, the impact of deep learning (DL)-based reconstruction on 3D double inversion recovery (DIR) imaging for inflammatory myelopathies remains unassessed. This study aims to compare acquisition time, image quality, diagnostic confidence, and lesion detection rates among sagittal T2WI, standard DIR, and DL -reconstructed DIR in patients with inflammatory myelopathies. In this observational study, patients diagnosed with inflammatory myelopathies were recruited between June 2023 and March 2024. Each patient underwent sagittal conventional turbo spin-echo sequences and standard 3D DIR (T2WI and standard 3D DIR used as references for comparison), followed by an undersampled accelerated DIRDL examination. Three neuroradiologists evaluated the images using a four-point Likert scale (from 1 to 4) for overall image quality, perceived signal-tonoise ratio, sharpness, artifacts, and diagnostic confidence. The acquisition times, and lesion detection rates were also compared between the acquisition protocols. A total of 149 participants were evaluated (mean age 40.6 ± 16.8 years; 71 females). The median acquisition time for DIRDL was significantly lower than for standard DIR (298 seconds [interquartile range (IQR), 288-301] vs 151 seconds [IQR, 148-155]; P < 0.001), showing a 49%time reduction. DIRDL images scored higher in overall quality, perceived signal-to-noise ratio, and artifact noise reduction (all P < 0.001). There were no significant differences in sharpness (P = 0.07), or diagnostic confidence (P = 0.06) between the standard DIR and DIRDL protocols. Additionally, DIRDL detected 37% more lesions compared to T2WI (300 vs. 219; P < 0.001). DIRDL significantly reduces acquisition time and improves image quality compared to standard DIR without compromising diagnostic confidence. Additionally, DIRDL enhances lesion detection in patients with inflammatory myelopathies, making it a valuable tool in clinical practice. These findings underscore the potential for incorporating DIRDL into future imaging guidelines. DL = deep learning; DIR = double inversion recovery; IQR = interquartile range; MS = multiple sclerosis; AQP4+NMOSD = AQP4-IgG positive neuromyelitis optica spectrum disorders; MOG = myelin oligodendrocyte glycoprotein; MOGAD = MOG antibody-associated diseases.

Recommendations for the use of nuclear medicine imaging in patients with neuroblastoma.

Neuroblastoma (NB) is the most common extracranial solid cancer in children. Despite intensive multimodality treatment, long-term survival of patients with high-risk NB, which comprises more than half of all cases, remains poor. Nuclear medicine is key in diagnosis, staging, response assessment and long-term follow-up of NB. The emergence of novel tracers and the increasing complexity of studies require updated guidelines for nuclear medicine imaging in NB. Standardising diagnostic techniques are essential for improving study comparability and ensuring test quality. This article aims to provide a comprehensive review of NB radionuclide diagnostic imaging, including its characteristics, accuracy, advantages, and limitations. It offers practical recommendations to multidisciplinary teams responsible for treating patients with NB. This review summarises the opinions of leading experts from the Neuroblastoma Spanish Group within the Spanish Society of Paediatric Haematology and Oncology (SEHOP) and the Spanish Society of Nuclear Medicine and Molecular Imaging (SEMNIM).

Health care utilization among Medicare beneficiaries with newly diagnosed back pain

BackgroundLow back pain (LBP) is the most common medical cause of disability among adults 65 or older. No previous study has characterized health care costs and treatment patterns of LBP among Medicare beneficiaries. MethodsThis retrospective cohort study quantifies health care utilization costs among Medicare beneficiaries with newly diagnosed LBP, compares costs between patients managed operatively and nonoperatively, identifies costs associated with treatment guideline nonadherence, and characterizes opioid prescribing patterns. Patients were queried via ICD codes from a 20% random sample of Medicare claims records. Patients with concomitant or previous “red flag” diagnoses, neurological deficits, or diagnoses that could cause nondegenerative LBP were excluded. Total costs of care in the year of diagnosis were calculated and stratified by operative versus nonoperative management. To assess for guideline adherence, utilization and costs of different services were tabulated. Opioid prescription patterns were characterized by quantity, cost, duration, and medication type. ResultsAbout 1,269,896 patients were identified; 23,919 (1.8%) underwent surgery. These accounted for 7% of the cohort's total cost ($514 million total, $21,496 per person). Patients treated nonoperatively accounted for over $7 billion in costs ($5,880 per person; p<.001). Within the nonoperative cohort, 626,896 (50.3%) patients were nonadherent to current guidelines for conservative management of LBP. Guideline nonadherence increased total annual costs by $4,012 per person ($7,873 for nonadherent vs. $3,861 for adherent patients, p<.001). About 460,867 opioid prescriptions were filled for 303,796 unique patients (23.9%) within 30 days of LBP diagnosis. Within the nonsurgical cohort, patients nonadherent to imaging guidelines were more likely to have an opioid prescription within this window than adherent patients (26.5% vs. 21.2%; p<.001). ConclusionsNonoperative management of LBP is associated with significantly lower costs per patient. Early imaging and opioid prescription are significant drivers of excess cost. Adherence to proposed treatment guidelines can save over $2.8 billion in total health care costs.

Cross-Modal Vertical Federated Learning for MRI Reconstruction.

Federated learning enables multiple hospitals to cooperatively learn a shared model without privacy disclosure. Existing methods often take a common assumption that the data from different hospitals have the same modalities. However, such a setting is difficult to fully satisfy in practical applications, since the imaging guidelines may be different between hospitals, which makes the number of individuals with the same set of modalities limited. To this end, we formulate this practical-yet-challenging cross-modal vertical federated learning task, in which data from multiple hospitals have different modalities with a small amount of multi-modality data collected from the same individuals. To tackle such a situation, we develop a novel framework, namely Federated Consistent Regularization constrained Feature Disentanglement (Fed-CRFD), for boosting MRI reconstruction by effectively exploring the overlapping samples (i.e., same patients with different modalities at different hospitals) and solving the domain shift problem caused by different modalities. Particularly, our Fed-CRFD involves an intra-client feature disentangle scheme to decouple data into modality-invariant and modality-specific features, where the modality-invariant features are leveraged to mitigate the domain shift problem. In addition, a cross-client latent representation consistency constraint is proposed specifically for the overlapping samples to further align the modality-invariant features extracted from different modalities. Hence, our method can fully exploit the multi-source data from hospitals while alleviating the domain shift problem. Extensive experiments on two typical MRI datasets demonstrate that our network clearly outperforms state-of-the-art MRI reconstruction methods.

Unusual Signal of Lymphadenopathy in Children with Nodular Sclerosing Hodgkin Lymphoma.

The current guidelines for initial cross-sectional imaging in pediatric lymphomas involve computed tomography (CT) of the chest, abdomen, and pelvis. However, whole-body magnetic resonance imaging (MRI) can be favored over CT for diagnosing and staging the disease, given its lack of ionizing radiation and its higher tissue contrast. Imaging characteristics of lymphoid tissue on MRI include a high T2/short tau inversion recovery (STIR) signal. A low or intermediate signal of lymphadenopathy on T2 and STIR images is an unexpected finding, noted anecdotally in nodular sclerosing Hodgkin lymphoma. This signal may be characteristic of a histological subtype of the disease and, if confirmed, could potentially be used to avoid biopsy. In this study, we aimed to review signal characteristics of lymphadenopathy in patients with biopsy-confirmed nodular sclerosing Hodgkin lymphoma. We undertook a retrospective review of relevant MR studies of patients with nodular sclerosing Hodgkin lymphoma. Studies were reviewed by an experienced pediatric radiologist regarding lymph node signal, especially on T2/STIR. Eleven children with nodular sclerosing Hodgkin lymphoma were included. Median age at the time of MRI was 14.3 (IQR: 13.9-16.1) years, and nine were boys. Five patients showed some lymphadenopathy with a low T2/STIR signal, and six showed an intermediate T2/STIR signal. Central gadolinium non-enhancement was observed in four patients. All eleven patients (100%) with a diagnosis of nodular sclerosing Hodgkin lymphoma showed some lymphadenopathy with a low or intermediate T2/STIR signal, and five children (45.5%) showed a frank low signal of some lymphadenopathy, a feature which may prove to be a biomarker for this histology.

Optimizing Multiparametric MRI Protocols for Prostate Cancer Detection: A Comprehensive Assessment Aligned with PI-RADS Guidelines.

Multiparametric magnetic resonance imaging (mpMRI) is recognized as the most indicative method for diagnosing prostate cancer. The purpose of this narrative review is to provide a comprehensive evaluation aligned with the Prostate Imaging and Reporting Data System (PI-RADS) guidelines, offering an in-depth insight into the various MRI sequences used in a standard mpMRI protocol. Additionally, it outlines the critical technical requirements necessary to perform a standard mpMRI examination of the prostate, as defined by the PI-RADS specifications. European Society of Urogenital Radiology has released PI-RADS guideline detailing its suggestions aimed at improving the standards of the procedure. The purpose of this guideline is to establish a standard strategy for MRI protocols and image interpretation, aiming to prevent variability in each of the imaging and interpretation stages. A standard mpMRI protocol comprises morphological sequences and functional sequences. Morphological sequences which encompass T1- and T2-weighted images, and various functional sequences include diffusion-weighted imaging, and dynamic contrast-enhanced MRI. The PI-RADS recommendations assert that having a standard and uniform protocol for all MRI centers is imperative. Furthermore, the existence of a standardized checklist for interpreting MRI images can foster greater consensus in the process of diagnosing and treating patients. Standardized protocols and checklists for mpMRI interpretation are essential for achieving greater consensus among radiologists, ultimately leading to improved diagnostic outcomes in prostate cancer.

Cardiovascular Computed Tomography and Magnetic Resonance Imaging Guideline of the Brazilian Society of Cardiology and the Brazilian College of Radiology - 2024.

Cardiovascular Computed Tomography and Magnetic Resonance Imaging Guideline of the Brazilian Society of Cardiology and the Brazilian College of Radiology - 2024.

Diastolic dysfunction and survival in patients with preserved or mildly reduced left ventricular ejection fraction

Abstract Background Left ventricular ejection fraction (LVEF) is relatively indiscriminate for prognosis in patients with preserved or mildly reduced LVEF (&amp;gt;40%) following myocardial infarction (MI). Aims This study sought to determine the value of guideline-based assessment of diastolic dysfunction (DD) in predicting all-cause and cardiac mortality in patients with a first-ever MI and LVEF&amp;gt;40%. Methods A retrospective single centre study involving 2234 patients with a first-ever MI (STEMI or NSTEMI) with LVEF&amp;gt;40% was performed. Clinical, angiographic, and echocardiographic data were obtained from prospectively maintained institutional databases. Outcomes data were obtained from the state-wide registry. Echocardiography was performed early post-admission for all patients. Significant diastolic dysfunction (DD) was defined as grade 2+3 diastolic dysfunction according to current American Society of Echocardiography/ European Association of Cardiovascular Imaging guidelines. Results The mean age of patients was 61.4±12.3 years, 70.7% were males, and 12.1% had 3-vessel disease. The mean LVEF was 55.8±7.2% and 9.1% had significant DD. At a median follow up of 4.5 years, there were 219 deaths (46 cardiac deaths). On Cox proportional hazards multivariable analyses incorporating significant clinical, angiographic, and echocardiographic variables, significant DD was an independent predictor of both all-cause (HR 2.01,95%CI 1.37-2.94, p&amp;lt;0.001) and cardiac (HR 3.97,95%CI 1.98-7.99, p&amp;lt;0.001) mortality. Conclusions Significant DD is an independent predictor of all-cause and cardiac mortality following MI in patients with preserved or mildly reduced LVEF and thus effectively re-stratifies prognosis in a subgroup where the LVEF is relatively indiscriminate for survival. The benefit of further investigation and/or treatment in this subgroup needs further study.

MR staging of rectal cancer: Comparison between the 2012 and 2016 European Society of Gastrointestinal and Abdominal Radiology (ESGAR) Guidelines

PurposeTo compare the adherence of the interpretation and reporting staging system, respectively proposed in the 2012 and 2016 European Society of Gastrointestinal and Abdominal Radiology (ESGAR) Guidelines for Magnetic Resonance Imaging (MRI) staging of rectal cancer, focusing on the improvement offered by the criteria introduced by 2016 ESGAR guidelines. MethodFifty-six patients affected by rectal cancer were included; 25/56 patients underwent upfront surgery; 31 underwent to neo-adjuvant chemo-radiotherapy before surgery. All patients underwent 3 T MRI examination for local staging. All MR exams were evaluated by two radiologists with 20- and 4-years’ experience, who were blinded to each other; the T and N stages, the Mesorectal Fascia (MRF) status and the Extramural Vascular Invasion (EMVI) were assessed according to both 2012 and 2016 ESGAR guidelines. The correlation between radiological and pathological findings, as well as the MRI staging were evaluated. ResultsAs to the expert reviewer, no significant differences were found by comparing the MR T and N stages, T and N restaging, MRF status and EMVI according to 2012 and 2016 ESGAR guidelines. As to the 4-years’ experience radiologist the MR staging agreement between 2012 and 2016 guidelines was “moderate” in N-stage evaluation and “fair” in T-restaging evaluation. No significant discrepancies were found for other parameters. ConclusionsMRI is a reliable method in rectal cancer staging/restaging. The assessment of T-restaging is improved by adopting the 2016 ESGAR guidelines, especially for non-expert readers; this result could be justified by the introduction of diffusion-weighted imaging. On the contrary, the newest guidelines do not improve the diagnostic performance in assessing nodal staging and restaging.

Response assessment in pediatric neurooncology (RAPNO) criteria revisited: a practical navigation guide for neuroradiologists.

The Response Assessment in Pediatric Neuro-Oncology (RAPNO) Working Group is an international, collaborative network of experts dedicated to pediatric central nervous system (CNS) tumors that was created in 2011. Since then, six RAPNO articles with imaging guidelines for response assessment in diverse pediatric tumor subgroups have been published, namely: 1) medulloblastomas and leptomeningeal seeding tumors (2018), 2) pediatric high-grade gliomas (2020), 3) pediatric low-grade gliomas (2020), 4) diffuse intrinsic pontine gliomas (2020), 5) pediatric intracranial ependymomas (2022) and 6) pediatric craniopharyngiomas (2023). The purpose of this article is to review all current available RAPNO criteria using a systematized and comparative approach centered on the role of neuroradiologists and supported by neuroimaging examples. Special emphasis will be placed on clarification of core concepts as well as practical adoption aspects of the RAPNO guidelines, namely how and when to image the brain and/or the spine; how to interpret the imaging findings; which other clinical, therapeutic and laboratory variables to consider; and finally how to apply the information to attribute the final appropriate response assessment classification.