Interventional Radiology and Imaging in Cancer Diagnosis

Background and Objectives: Prostate cancer is the second most common cancer in men worldwide, with 1,466,680 new cases and 396,792 deaths reported in 2022. Accurate preoperative grading is critical, as the grade assessed on biopsy cores may be underestimated compared to radical prostatectomy specimens. The aim of this study was to assess the ability of quantitative diffusion parameters derived by the standard monoexponential model (ADC—apparent diffusion coefficient) and kurtosis model (Dapp—apparent diffusion coefficient corrected for non-Gausion behavior and K-kurtosis) to predict Gleason Grade Group (GG) upgrading from transrectal ultrasound-guided (TRUS) biopsy to radical prostatectomy within each GG. Materials and Methods: This retrospective study included 128 patients with prostate cancer who underwent systematic TRUS biopsies and multiparametric magnetic resonance imaging (mpMRI) at 3T before prostatectomies between 2017 and 2021. Mean values of quantitative diffusion parameters (ADC, Dapp, K) were compared between upgraded and non-upgraded cohorts within each Grade Group obtained at biopsy. Results: Significant differences in ADC and K values were found between upgraded and non-upgraded lesions in GG1 and GG2 cohorts at biopsy, with lower ADCs and higher K values indicating a higher likelihood of upgrading. In GG1, ADC demonstrated an AUC of 0.762 (p < 0.05) and K an AUC of 0.846 (p < 0.05). In GG2, ADC showed an AUC of 0.814 (p < 0.001) and K an AUC of 0.755 (p < 0.001). No significant differences were observed in GG3 and GG4 cohorts. Conclusions: Quantitative diffusion parameters—particularly ADC and kurtosis (K)—demonstrated significant predictive value for Grade Group upgrading in patients with biopsy-proven GG1 (AUC: K = 0.846, ADC = 0.762) and GG2 (AUC: ADC = 0.814, K = 0.755, D = 0.810) prostate cancer. These findings suggest that incorporating quantitative DWI parameters into preoperative assessments may improve risk stratification and support clinical decision-making, particularly regarding the selection of patients for active surveillance. Validation in larger, multicenter cohorts is warranted. Full article

Background and Objectives: Müllerian duct anomalies (MDAs) are congenital malformations of the female genital tract for which several classification systems have been proposed. The objective of this study is to estimate the interrater reliability of the American Fertility Society (AFS), European Society of Human Reproduction and Embryology/European Society for Gynaecological Endoscopy (ESHRE/ESGE), American Society for Reproductive Medicine (ASRM) and Congenital Uterine Malformation by Experts (CUME) classification systems for Müllerian duct anomalies. Materials and Methods: This retrospective cohort study was conducted at a tertiary care hospital and included 71 patients aged up to 45 years who were assessed for a Müllerian duct anomaly between January 2000 and April 2023. Pelvic MRI images were independently evaluated by four readers, followed by a consensus meeting. The primary outcome was interrater reliability (Krippendorff’s α), and the secondary outcomes were the proportions of indeterminate and unclassifiable cases after consensus meeting. Results: The interrater reliability for MDA diagnosis was very low for all the classification systems (AFS α 0.63, 95% CI [0.57, 0.67]; ASRM α 0.46, 95% CI [0.41, 0.52]; ESHRE/ESGE α 0.33, 95% CI [0.29, 0.38]; CUME α 0.57, 95% CI [0.45, 0.72]). After consensus meeting, the ESHRE/ESGE system had more indeterminate cases (9.9%) and the ASRM system had more unclassifiable cases (20.6%). Conclusions: All the classification systems for Müllerian duct anomalies had a very low interrater reliability, with more indeterminate cases in the ESHRE/ESGE system and more unclassifiable cases in the ASRM system. We present our recommendations for the improvement of each classification system. The ultimate goal of future research should be the development of a single uniform system integrating the best features of these systems and with clinically relevant cut-off values, considering patients’ reproductive outcomes. Full article

Background and Objectives: Soft tissue sarcomas account for approximately 7% of all malignant tumors in the pediatric population. Diffusion-weighted imaging (DWI) with apparent diffusion coefficient (ADC) measurements may provide early functional biomarkers of treatment response by reflecting changes in tumor cellularity. This study evaluated whether ADC-derived parameters can serve as quantitative biomarkers of neoadjuvant chemotherapy response in pediatric rhabdomyosarcoma. Materials and Methods: This retrospective single-center study included 14 patients aged ≤18 years with histopathologically confirmed rhabdomyosarcoma who underwent MRI before treatment and after three cycles of chemotherapy. Twenty-five patients were initially identified; eleven were excluded due to imaging artifacts or absence of baseline examination. ADC maps were generated on 1.5T and 3T scanners. Regions of interest were placed over the entire lesion and areas with the lowest ADC signal. Relative ADC (rADC) was calculated by normalizing tumor ADC to adjacent healthy muscle. Paired t-tests were used to compare pre- and post-treatment values. Results: At baseline, 13/14 patients (93%) demonstrated diffusion restriction. Mean ADC increased from 1.11 × 10⁻³ mm²/s (SD ± 0.48) at baseline to 1.63 × 10⁻³ mm²/s (SD ± 0.67) after treatment. The paired t-test for rADC yielded t = −3.089 (p = 0.0086, 95% CI: −0.79 to −0.14), indicating a statistically significant change. There was a significant difference between the ADC values of the entire lesion and the areas with the lowest signal in tumors with a heterogenic structure, t = 2.862, p = 0.013. Conclusions: ADC and rADC increased significantly after neoadjuvant chemotherapy in pediatric rhabdomyosarcoma, suggesting potential utility as early functional biomarkers of treatment response. These preliminary findings require validation in larger multicenter prospective studies with correlation to histopathological response and clinical outcomes before clinical implementation. Full article

Background and Objectives: Bladder neck stenosis (BNS) and vesicourethral anastomotic stenosis (VUAS) are challenging complications following prostate surgery and radiation therapy, with recurrence rates reaching 30–60% after conventional endoscopic management. The Optilume^® paclitaxel drug-coated balloon (DCB) has emerged as a novel minimally invasive treatment combining mechanical dilation with local anti-fibrotic drug delivery. This narrative review synthesizes current evidence on Optilume DCB specifically for BNS and VUAS. Materials and Methods: A comprehensive literature search identified eight relevant publications (2024–2026), including randomized controlled trials, prospective and retrospective cohort studies, and case series addressing Optilume DCB for posterior urethral stenoses. Results: Across the reviewed studies, freedom from reintervention for BNS ranged from 77.5% to 100% at 12 months, while VUAS outcomes were more variable (40–81%). A comparative study of 141 patients demonstrated significantly improved recurrence-free survival with DCB versus standard endoscopic treatment (HR 0.40, p = 0.021). Radiation-induced posterior urethral stenosis showed 81.1% freedom from repeat intervention. Complications were predominantly minor (Clavien-Dindo grade I), with no de novo incontinence attributable to the device. Conclusions: Optilume DCB represents a promising minimally invasive option for BNS and VUAS, particularly in patients with recurrent disease or those unsuitable for reconstructive surgery. BNS appears to respond more favorably than VUAS, likely reflecting distinct pathophysiological mechanisms. Prior radiation therapy remains a negative prognostic factor. Prospective randomized trials with longer follow-up are needed to define the role of DCB in posterior urethral stenosis management. Full article

Background/Objectives: Cysts are the most common kidney lesions identified in patients undergoing abdominal imaging, with ultrasound (US) typically serving as the initial diagnostic tool. Contrast-enhanced ultrasound (CEUS) has emerged as a highly effective modality for the evaluation of cystic renal lesions, particularly when conventional B-mode ultrasound (US) or CE-CT are inconclusive. While simple renal cysts are readily characterised on US, cystic renal lesions require further assessment. Methods: The Bosniak classification, originally developed for CE-CT, remains the cornerstone for categorising cystic renal lesions, guiding management from surveillance to surgical intervention. Recent efforts to standardise CEUS-specific imaging parameters and adapt the Bosniak criteria aim to improve interobserver agreement, reduce subjectivity, and enhance diagnostic accuracy. Results: CEUS offers superior sensitivity for detecting slow blood flow and minimal vascularity within septa, wall or solid components, often outperforming CE-CT in real-time vascular assessment. However, the high sensitivity of CEUS can reveal additional septa or subtle enhancement, potentially leading to lesion overscoring, if the different sensitivity of CEUS and CT/MRI for detecting enhancement is not taken into account. CEUS also plays a crucial role in the follow-up of non-surgical cystic lesions, providing a radiation-free and cost-effective alternative for long-term monitoring. Certain scenarios, such as post-interventional changes, traumatic cystic rupture, or infected cysts, fall outside the scope of the Bosniak system and require careful clinical correlation. Conclusions: By integrating CEUS into the diagnostic pathway, sonologists can achieve accurate lesion characterisation, optimise patient management, and minimise unnecessary invasive procedures, reinforcing CEUS as an essential tool in the evaluation and follow-up of complex renal cystic masses. Full article

Background and Objectives: Bladder cancer is one of the most common malignancies of the urinary tract and poses a significant clinical challenge due to its biological heterogeneity and high rates of recurrence and progression. Urothelial carcinoma represents the predominant histological subtype, ranging from non-muscle-invasive disease with relatively favorable outcomes to aggressive muscle-invasive and metastatic forms associated with poor prognosis. Accurate diagnosis, staging, prognostic stratification, and assessment of treatment response are therefore essential for optimal patient management. The objective of this review is to summarize and critically evaluate the current evidence on the role of positron emission tomography/computed tomography (PET/CT) in bladder cancer, with particular emphasis on [¹⁸F]FDG PET/CT and non-FDG radiotracers. Materials and Methods: A narrative review of the available literature was performed, focusing on clinical studies, review articles, and guideline documents addressing the use of PET/CT in bladder cancer. The literature search included articles published between 2000 and 2025, while earlier landmark studies were selectively included if considered historically important for understanding the development of PET/CT imaging in bladder cancer. The initial search yielded over 500 records; after screening titles and abstracts, more than 100 articles were selected for full-text evaluation. The analyzed evidence encompasses the clinical applications of [¹⁸F]FDG PET/CT and alternative radiotracers, including choline-, acetate-, methionine-, and sodium fluoride-based tracers, and fibroblast activation protein inhibitors (FAPI), across different stages of disease and clinical settings. Results: Conventional imaging modalities, such as computed tomography and magnetic resonance imaging, provide important anatomical information but remain limited in the evaluation of lymph node involvement, early metastatic disease, treatment response, and disease recurrence. Despite limitations related to physiological urinary excretion, [¹⁸F]FDG PET/CT has demonstrated clinical value in selected scenarios, particularly for staging, prognostic assessment, detection of recurrence, and response evaluation. To overcome FDG-related constraints, several non-FDG radiotracers have been investigated. Among these, FAPI PET/CT has emerged as a promising modality due to its ability to target the tumor stroma, potentially improving lesion detectability and tumor-to-background contrast. Conclusions: This review summarizes and critically evaluates current evidence on the role of PET/CT in bladder cancer, with a focus on [¹⁸F]FDG PET/CT and non-FDG radiotracers. The discussed studies highlight their applications in primary diagnosis, staging, prognostic assessment, detection of recurrence, and evaluation of treatment response, as well as their respective advantages and limitations. Furthermore, potential future directions for PET/CT imaging in clinical practice are outlined, emphasizing the need for further research to clarify the optimal use of established and emerging radiotracers. Full article