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A special issue of Diagnostics (ISSN 2075-4418). This special issue belongs to the section "Medical Imaging and Theranostics".

Deadline for manuscript submissions: 30 April 2026 | Viewed by 16834

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Dr. Ruxandra Mare

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1. Department of Internal Medicine II, Division of Gastroenterology and Hepatology, “Victor Babeș” University of Medicine and Pharmacy, 300041 Timișoara, Romania
2. Advanced Regional Research Center in Gastroenterology and Hepatology, “Victor Babeș” University of Medicine and Pharmacy, 300041 Timișoara, Romania
Interests: liver diseases; portal hypertension; multiparametric ultrasound; elastography; contrast-enhanced ultrasound; endoscopic ultrasound
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Prof. Dr. Ioan Sporea

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Guest Editor

1. Advanced Regional Research Center in Gastroenterology and Hepatology, “Victor Babeș” University of Medicine and Pharmacy, 300041 Timișoara, Romania
2. Advanced Hepatology Research Center of the Medical Science Academy, 300223 Timisoara, Romania
Interests: liver cirrhosis; hepatitis; hepatocellular carcinoma; elastography; gastroenterology; liver diseases; viral hepatitis; ultrasound; hepatology; liver biopsy
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

It is our pleasure to invite you to contribute to this Special Issue “Diagnostic Imaging in Gastrointestinal and Liver Diseases”.

Imaging is critical in the management of gastrointestinal and liver diseases because it allows for early detection, accurate diagnosis, and disease progression monitoring. A general approach for evaluating a patient with gastrointestinal or liver disease begins with either an endoscopy or an transabdominal ultrasound, followed by more sensitive imaging modalities used for the detection of structural changes, such as with endoscopic ultrasound, computer tomography, or MRI.

Over the last decade, we have witnessed an increase in non-invasive ultrasound techniques, such as contrast-enhanced ultrasound or elastography for evaluating the liver and advances in endoscopic ultrasound imaging (which have allowed us to better understand and diagnose gastrointestinal diseases).

This Special Issue, “Diagnostic Imaging in Gastrointestinal and Liver Diseases”, aims to include research that will advance current knowledge in this field. The papers should explore diagnostic challenges, present new challenges or validate existing ones, and provide new insights into how imaging can improve the health and quality of life in subjects with gastrointestinal and liver diseases.

In this Special Issue, original research articles, reviews, and case presentations are welcome.

We look forward to receiving your contributions.

Dr. Ruxandra Mare
Prof. Dr. Ioan Sporea
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 250 words) can be sent to the Editorial Office for assessment.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Diagnostics is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

ultrasonography
elastography
multiparametric ultrasound
contrast-enhanced ultrasound
endoscopic ultrasound
contrast-enhanced endoscopic ultrasound
computer tomography
magnetic resonance imaging, gastrointestinal diseases
diffuse liver disease
focal liver lesions

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Published Papers (8 papers)

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23 pages, 3022 KB

Open AccessArticle

Multiparametric Quantitative Ultrasound for Hepatic Steatosis: Comparison with CAP and Robustness Across Breathing States

by Alexandru Popa, Ioan Sporea, Roxana Șirli, Renata Bende, Alina Popescu, Mirela Dănilă, Camelia Nica, Călin Burciu, Bogdan Miutescu, Andreea Borlea, Dana Stoian, Felix Maralescu, Eyad Gadour and Felix Bende

Diagnostics 2025, 15(24), 3119; https://doi.org/10.3390/diagnostics15243119 - 8 Dec 2025

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Abstract

Background: Practical, quantitative ultrasound-based tools for measuring hepatic steatosis are needed in everyday MASLD care. We evaluated a new multiparametric quantitative ultrasound (QUS) platform that integrates ultrasound-guided fat fraction (UGFF), attenuation coefficient (AC), backscatter coefficient (BSC), and signal-to-noise ratio (SNR), using Controlled Attenuation Parameter (CAP) as the reference and examining the effect of breathing. Methods: In a prospective single-center study, adult patients underwent same-day liver QUS and FibroScan. QUS measurements were performed during breath-hold and during normal breathing. Regions of interest were placed in right-lobe parenchyma 2 cm below the capsule, avoiding vessels. Primary outcomes were correlation with CAP and ROC performance at CAP cutoffs for S1 (≥230 dB/m), S2 (≥275 dB/m), and S3 (≥300 dB/m). Results: QUS was feasible in almost all examinations. UGFF, BSC, and SNR were consistent across breathing conditions, while AC was slightly higher during normal breathing. UGFF showed strong correlation with CAP and high accuracy for detecting steatosis. Across grades, AUCs were around 0.89–0.91, with cutoffs (UGFF ≈ 4% for ≥S1 and ≈11% for ≥S3). Conclusions: Multiparametric QUS provides reliable liver fat quantification that aligns closely with CAP and remains robust in practice whether patients hold their breath or breathe normally. These findings support UGFF as a practical, reliable point-of-care alternative for liver fat quantification that can be embedded in routine ultrasound in real time. Validation against MRI-PDFF or histology and multicenter studies will further define cutoffs and generalizability. Full article

(This article belongs to the Special Issue Diagnostic Imaging in Gastrointestinal and Liver Diseases)

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20 pages, 3627 KB

Open AccessArticle

Delta-Radiomics Biomarker in Colorectal Cancer Liver Metastases Treated with Cetuximab Plus Avelumab (CAVE Trial)

by Valerio Nardone, Vittorio Patanè, Luca Marinelli, Luca D’Ambrosio, Sara Del Tufo, Marco De Chiara, Maria Chiara Brunese, Dino Rubini, Roberta Grassi, Anna Russo, Maria Paola Belfiore, Fortunato Ciardiello, Salvatore Cappabianca, Erika Martinelli and Alfonso Reginelli

Diagnostics 2025, 15(22), 2914; https://doi.org/10.3390/diagnostics15222914 - 18 Nov 2025

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Abstract

Background: Radiomics enables the extraction of quantitative imaging biomarkers that can non-invasively capture tumor biology and treatment response. Delta-radiomics, by assessing temporal changes in radiomic features, may improve reproducibility and reveal early therapy-induced alterations. This study investigated whether delta-texture features from contrast-enhanced CT could predict progression-free survival (PFS) and overall survival (OS) in patients with metastatic colorectal cancer (mCRC) liver metastases treated with cetuximab rechallenge plus avelumab within the CAVE trial. Methods: This retrospective substudy included 42 patients enrolled in the multicenter CAVE phase II trial with evaluable liver metastases on baseline and first restaging CT. Liver lesions were manually segmented by two readers, and radiomic features were extracted according to IBSI guidelines. Delta-values were calculated as relative changes between baseline and post-treatment scans. Reproducibility (ICC > 0.70), univariate and multivariable analyses, ROC/AUC, bootstrap resampling, cross-validation, and decision curve analysis were performed to evaluate predictive performance and clinical utility. Results: Among reproducible features, delta-GLCM Homogeneity emerged as the most robust predictor. A decrease in homogeneity independently correlated with longer PFS (HR = 0.32, p = 0.003) and OS (HR = 0.41, p = 0.021). The combined clinical–radiomic model achieved good discrimination (AUC 0.94 training, 0.74 validation) and stable performance on internal validation (bootstrap C-index 0.77). Decision curve analysis indicated greater net clinical benefit compared with clinical variables alone. Conclusions: This exploratory study provides preliminary evidence that delta-GLCM Homogeneity may serve as a reproducible imaging biomarker of response and survival in mCRC patients receiving cetuximab plus avelumab rechallenge. If validated in larger, independent cohorts, delta-radiomics could enable early identification of non-responders and support personalized treatment adaptation in immuno-targeted therapy. Given the small sample size, the potential for overfitting should be considered. Future work should prioritize prospective multicenter validation with a pre-registered, locked model and explore multimodal integration (radiogenomics, circulating biomarkers, and AI-driven fusion of imaging with clinical/omic data) to strengthen translational impact. Beyond imaging advances, these findings align with broader trends in personalized oncology, including response-adaptive strategies, multimodal biomarker integration, and AI-enabled decision support. Full article

(This article belongs to the Special Issue Diagnostic Imaging in Gastrointestinal and Liver Diseases)

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15 pages, 3635 KB

Open AccessArticle

Comparison of Apparent Diffusion Coefficient Values on Diffusion-Weighted MRI for Differentiating Hepatocellular Carcinoma and Intrahepatic Cholangiocarcinoma

by Katrīna Marija Konošenoka, Nauris Zdanovskis, Aina Kratovska, Artūrs Šilovs and Veronika Zaiceva

Diagnostics 2025, 15(15), 1861; https://doi.org/10.3390/diagnostics15151861 - 24 Jul 2025

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Abstract

Background and Objectives: Accurate noninvasive differentiation between hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (ICC) remains a clinical challenge. This study aimed to assess the dignostic performance of apparent diffusion coefficient (ADC) values from diffusion-weighted MRI in distinguishing between HCC and ICC, with histological confirmation as the gold standard. Materials and Methods: A retrospective analysis was performed on 61 patients (41 HCC, 20 ICC) who underwent liver MRI and percutaneous biopsy between 2019 and 2024. ADC values were measured from diffusion-weighted sequences (b-values of 0, 500, and 1000 s/mm²), and regions of interest were placed over solid tumor areas. Statistical analyses included t-tests, one-way ANOVA, and ROC curve analysis. Results: Mean ADC values did not differ significantly between HCC (1.09 ± 0.19 × 10⁻³ mm²/s) and ICC (1.08 ± 0.11 × 10⁻³ mm²/s). ROC analysis showed poor discriminative ability (AUC = 0.520; p = 0.806). In HCC, ADC values decreased with lower differentiation grades (p = 0.008, η² = 0.224). No significant trend was observed in ICC (p = 0.410, η² = 0.100). Immunohistochemical markers such as CK-7, Glypican 3, and TTF-1 showed significant diagnostic value between tumor subtypes. Conclusions: ADC values have limited utility for distinguishing HCC from ICC but may aid in HCC grading. Immunohistochemistry remains essential for accurate diagnosis, especially in poorly differentiated tumors. Further studies with larger cohorts are recommended to improve noninvasive diagnostic protocols. Full article

(This article belongs to the Special Issue Diagnostic Imaging in Gastrointestinal and Liver Diseases)

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13 pages, 2033 KB

Open AccessArticle

Relationship Between Sigmoid Volvulus Subtypes, Clinical Course, and Imaging Findings

by Kemal Bugra Memis and Sonay Aydin

Diagnostics 2025, 15(6), 784; https://doi.org/10.3390/diagnostics15060784 - 20 Mar 2025

Cited by 1 | Viewed by 2981

Abstract

Background: Recent studies indicate that the organo-axial subtype of a sigmoid volvulus is more prevalent than the conventional mesentero-axial subtype. Our study aimed to assess the clinical and radiological findings that differentiate between these two subtypes, as well as to ascertain treatment outcomes and prognostic characteristics. Methods: A retrospective review included 54 patients, during which abdominal plain radiographs and computed tomography images were analyzed by two radiologists, and data on recurrence, mortality, and treatment outcomes were documented. Results: The mesentero-axial subtype comprised 40 cases (74%). No distinct radiographic findings were observed to differentiate between the two groups. In computed tomography, the sole significant parameter for differentiation was the number of transition zones. The diameter of the segment exhibiting a volvulus was greater in instances of the mesentero-axial subtype. The endoscopic detorsion treatment proved ineffective in five patients within the mesentero-axial sigmoid volvulus cohort. Conclusions: Identifying these two types of SV on CT images is essential because of their distinct prognoses and therapeutic results. Full article

(This article belongs to the Special Issue Diagnostic Imaging in Gastrointestinal and Liver Diseases)

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17 pages, 3140 KB

Open AccessArticle

Abbreviated Multiparametric MR Solution (the “Liver Triple Screen”), the Future of Non-Invasive MR Quantification of Liver Fat, Iron, and Fibrosis

by Gavin Low, Ryan K. W. Chee, Yu Jun Wong, Puneeta Tandon, Florin Manolea, Stephanie Locas, Craig Ferguson, Wendy Tu and Mitchell P. Wilson

Diagnostics 2024, 14(21), 2373; https://doi.org/10.3390/diagnostics14212373 - 24 Oct 2024

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Abstract

Background/Objectives: To review the findings of a multiparametric MRI (the “liver triple screen”) solution for the non-invasive assessment of liver fat, iron, and fibrosis in patients with chronic liver disease (CLD). Methods: A retrospective evaluation of all consecutive triple screen MRI cases was performed at our institution over the last 32 months. Relevant clinical, laboratory, and radiologic data were analyzed using descriptive statistics. Results: There were 268 patients, including 162 (60.4%) males and 106 (39.6%) females. The mean age was 54 ± 15.2 years (range 16 to 71 years). The most common cause of CLD was metabolic dysfunction-associated steatotic liver disease (MASLD) at 45.5%. The most common referring physician group was Gastroenterology at 62.7%. In 23.9% of cases, the reason for ordering the MRI was a pre-existing failed or unreliable US elastography. There were 17 cases (6.3%) of MRI technical failure. Our analysis revealed liver fibrosis in 66% of patients, steatosis in 68.3%, and iron overload in 22.1%. Combined fibrosis and steatosis were seen in 28.7%, steatosis and iron overload in 16.8%, fibrosis and iron overload in 6%, and combined fibrosis, steatosis, and iron overload in 4.1%. A positive MEFIB index, a predictor of liver-related outcomes, was found in 57 (27.5%) of 207 patients. Incidental findings were found in 14.9% of all MRIs. Conclusions: The liver triple screen MRI is an effective tool for evaluating liver fat, iron, and fibrosis in patients with CLD. It provides essential clinical information and can help identify MASLD patients at risk for liver-related outcomes. Full article

(This article belongs to the Special Issue Diagnostic Imaging in Gastrointestinal and Liver Diseases)

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17 pages, 1926 KB

Open AccessSystematic Review

Quantitative Ultrasound for Hepatic Steatosis: A Systematic Review Highlighting the Diagnostic Performance of Ultrasound-Derived Fat Fraction

by Dimitrios Kavvadas, Vasileios Rafailidis, Aris Liakos, Emmanouil Sinakos, Sasan Partovi, Theodora Papamitsou and Panos Prassopoulos

Diagnostics 2025, 15(20), 2640; https://doi.org/10.3390/diagnostics15202640 - 20 Oct 2025

Cited by 1 | Viewed by 3083

Abstract

Background/Objectives: Metabolic-dysfunction-associated steatotic liver disease (MASLD) is a leading cause of chronic liver disease worldwide, requiring accurate and accessible diagnostic tools. Methods: A systematic review evaluated the diagnostic performance of Ultrasound-Derived Fat Fraction (UDFF), with a primary focus on prospective studies comparing UDFF to MRI Proton Density Fat Fraction (MRI-PDFF) as the reference standard and a secondary appraisal of its performance against other modalities. Additional parameters, such as technical feasibility, inter-observer agreement, and proposed thresholds, were summarized to support clinical applicability. Results: Seven prospective MRI-based studies (n = 862) demonstrated excellent correlation (average r = 0.848) and reproducibility (inter-observer intraclass correlation coefficient ICC = 0.978, intra-observer ICC = 0.980) of UDFF, with high diagnostic accuracy across steatosis grades (AUCs ≥ 0.89). Additional studies comparing UDFF with Controlled Attenuation Parameter (CAP), histology, and other quantitative ultrasound techniques (attenuation- or backscatter-based methods) confirmed high sensitivity and specificity, particularly for advanced steatosis, and emphasized the potential of UDFF as a comprehensive quantitative biomarker. Proposed UDFF cut-offs for mild, moderate, and severe steatosis ranged from 5% to 23%, demonstrating high sensitivity and specificity. Factors like body position, probe pressure, and visceral fat influenced measurements, underscoring the need for standardized protocols. Conclusions: UDFF seems to offer a reliable and cost-effective quantitative ultrasound modality. So far, it correlates strongly with MRI-PDFF and accurately grades steatosis, especially for S2–S3. Given cut-off variability and protocol sensitivity, broad routine adoption may be premature. Therefore, we recommend further studies focusing on standardized acquisition and cut-off calibration to MRI-PDFF. Full article

(This article belongs to the Special Issue Diagnostic Imaging in Gastrointestinal and Liver Diseases)

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40 pages, 1040 KB

Open AccessSystematic Review

Comparing FIB-4, VCTE, pSWE, 2D-SWE, and MRE Thresholds and Diagnostic Accuracies for Detecting Hepatic Fibrosis in Patients with MASLD: A Systematic Review and Meta-Analysis

by Mitchell Patrick Wilson, Ranjit Singh, Shyam Mehta, Mohammad Hassan Murad, Christopher Fung and Gavin Low

Diagnostics 2025, 15(13), 1598; https://doi.org/10.3390/diagnostics15131598 - 24 Jun 2025

Cited by 1 | Viewed by 4660

Abstract

Objectives: To compare thresholds and accuracies of FIB-4, vibration-controlled transient elastography (VCTE), point shear wave elastography (pSWE), 2D shear wave elastography (2D-SWE), and MR elastography (MRE) for detecting hepatic fibrosis in patients with MASLD. Materials and Methods: Systematic searching of MEDLINE, EMBASE, Cochrane Library, Scopus, and the gray literature from inception to March 2024 was performed. Studies evaluating accuracies of FIB-4, VCTE, 2D-SWE, pSWE, and/or MRE for detecting significant (≥F2) and/or advanced (≥F3) hepatic fibrosis in MASLD patients compared to histology were identified. Full-text review and data extraction were performed independently by two reviewers. Multivariate meta-analysis and subgroup analyses were performed using index test and fibrosis grading. Risk of bias was assessed using QUADAS-2. Results: 207 studies with over 80,000 patient investigations were included. FIB-4 1.3 threshold sensitivity was 71% (95% CI 66–75%) for detecting advanced hepatic fibrosis, which improved to 88% (85–91%) using a <0.75 threshold. FIB-4 specificity using a 2.67 threshold was 96% (94–97%). Sensitivities of 88–91% were achieved using thresholds of 3.2 kPa for pSWE, 4.92 kPa for 2D-SWE, 7.18 kPa for VCTE, and 2.32 kPa for MRE. No significant differences were identified for sensitivities in subgroup analysis with thresholds between 7 and 9 kPa. Most imaging-based studies were high risk of bias for the index test. Conclusions: A FIB-4 threshold of <0.75 and modality-dependent thresholds (VCTE < 7 kPa; pSWE <3 kPa; 2D-SWE <5 kPa; and MRE <2.5 kPa) would achieve sensitivities of around 90% when defining low-risk MASLD in population screening. A modified two-tier algorithm aligning with existing Society of Radiologists in Ultrasound guidelines would improve risk stratification accuracies compared to existing guidelines by European and American liver societies. Full article

(This article belongs to the Special Issue Diagnostic Imaging in Gastrointestinal and Liver Diseases)

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5 pages, 3431 KB

Open AccessInteresting Images

Atypical ¹⁸F-FDG PET-CT Findings in a Rare Case of Primary Hepatic Leiomyosarcoma

by Miju Cheon, Hyunkyung Yi, Joo Young Ha and Min A Kim

Diagnostics 2024, 14(14), 1502; https://doi.org/10.3390/diagnostics14141502 - 12 Jul 2024

Cited by 3 | Viewed by 1460

Abstract

The primary hepatic leiomyosarcoma is a rare malignant tumor arising from the smooth muscle cells in the hepatic vessels, bile ducts, and ligamentum teres. It is considered a subtype of hepatic sarcomas. We report awkward ¹⁸F-FDG PET-CT findings of a primary hepatic leiomyosarcoma masquerading as a benign hepatic tumor, which were confirmed by histopathological and immunohistochemical examinations in a 78-year-old woman. Full article

(This article belongs to the Special Issue Diagnostic Imaging in Gastrointestinal and Liver Diseases)

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