Search Results (457)

Sjögren’s syndrome is a chronic autoimmune disease marked by lymphocytic infiltration of the exocrine glands and the development of sicca symptoms, yet some patients also develop extraglandular involvement. Imaging has become relevant for describing these systemic features and supporting clinical assessment. This review discusses the roles of ultrasonography, elastography, computed tomography, and magnetic resonance imaging in evaluating multisystem disease associated with Sjögren’s syndrome. Ultrasonography and elastography help assess muscular involvement by showing changes in echogenicity and stiffness that reflect inflammation and later tissue remodeling. In joints, ultrasound can detect synovitis, tenosynovitis, and early erosive changes, including abnormalities not yet evident on examination. Pulmonary disease, most often with interstitial lung involvement, is best evaluated with high-resolution computed tomography, which remains the most reliable imaging modality for distinguishing interstitial patterns. Magnetic resonance imaging is valuable in assessing neurological complications. It can reveal ischemic and demyelinating lesions, neuromyelitis optica spectrum features, or pseudotumoral appearances. Imaging is also essential for detecting lymphoproliferative complications, for which ultrasound and magnetic resonance imaging can reveal characteristic structural and diffusion-weighted imaging findings. When combined with clinical and laboratory information, these imaging methods improve early recognition of systemic involvement and support accurate monitoring of disease progression in Sjögren’s syndrome. Full article

Gliomas are a significant health problem with a lot of imaging challenges. The role of imaging is no longer limited to only providing anatomic details, but with the advancement of Magnetic Resonance Imaging (MRI) techniques, it now permits the assessment of the freedom of water molecule movement, the microvascular structure, the hemodynamic characteristics, and the chemical makeup of certain metabolites of lesions. These advanced imaging techniques include diffusion-weighted imaging, diffusion tensor imaging, dynamic contrast-enhanced MRI, Magnetic Resonance (MR) perfusion, MR angiography, and magnetic resonance spectroscopy. their role in the diagnosis, classification, and post-treatment follow-up of gliomas, as well as their application in radiogenomics and glioma analysis with the aid of artificial intelligence, is presented and discussed. Full article

Background/Objectives: Chronic pudendal neuralgia is a relatively rare condition in the general population, with an incidence of 1%. Although diagnosis of pudendal neuralgia is mainly clinical, Magnetic Resonance Imaging (MRI) is commonly performed to obtain further information. However, clear criteria and guidelines for MRI diagnosis and the clinical–radiological correlation are still not definite. Methods: We reviewed 81 patients with chronic pudendal neuralgia, studied by an MRI designed protocol for a pelvis and pelvic floor examination. A key element of the protocol was the use of a diffusion-weighted imaging (DWI) technique with echo planar imaging (EPI) sequence (b-values of 0, 100, and 600) for the neurographic evaluation of the nerve. Results: MRI examination revealed DWI abnormalities in 42/81 patients. Pudendal nerve abnormalities were unilateral in 33/42 patients and bilateral in 9/42. Moreover, in 23/42 patients, pathologies related to a high probability of neuropathy have been identified. Conclusions: This study highlights the role of pelvic MRI as a valuable imaging modality in the evaluation of patients with chronic pudendal neuralgia. In the study protocol we propose, an essential role is played by the DWI technique, which improves the visual definition of the pudendal nerve and related anatomical structures. By focusing on anatomical visualization and structured image interpretation, our work provides a practical imaging-oriented contribution to a field in which standardized MRI evaluation is still lacking. Full article

Background/Objectives: Diffusion-weighted imaging (DWI) is a magnetic resonance technique used to map the apparent diffusion coefficient ($ADC$) of water in human tissue. $ADC$ assessment plays a central role in clinical diagnostics, as malignant tissues typically exhibit reduced water mobility and, thus, lower $ADC$ values. Accurately measuring the $ADC$ requires effective fat suppression to prevent contamination from the residual fat signal, which is commonly believed to cause $ADC$ underestimation. This study aimed to demonstrate that $ADC$ overestimation may occur as well. Methods: Our theoretical analysis shows that out-of-phase conditions between fat and water signals lead to $ADC$ overestimations. We performed demonstration experiments on fat–water phantoms and the breasts of 10 healthy female volunteers. In particular, we considered three out-of-phase conditions: First and second, short-time inversion recovery (STIR) fat suppression with incorrect inversion time and incorrect flip angle, respectively. Third, phase differences due to spectral fat saturation. The $ADC$ values were assessed in regions of interest (ROIs) that included both water and residual fat signals. Results: In the phantoms and the volunteer data, ROIs containing both fat and water signals consistently exhibited lower $ADC$ values under in-phase conditions and higher $ADC$ values under out-of-phase conditions. Conclusions: We demonstrated that out-of-phase conditions can result in $ADC$ overestimation in the presence of residual fat signals, potentially resulting in false-negative classifications where malignant lesions are misinterpreted as benign due to an elevated $ADC$. Out-of-phase fat and water signals might also reduce lesion conspicuity in high b-value images, potentially masking clinically relevant findings. Full article

Background: Accurate preoperative staging is the cornerstone of therapeutic decision-making in gastric cancer (GC), yet standard modalities often fail to capture the full extent of disease, particularly in diffuse and poorly cohesive histotypes. This review aims to provide a comprehensive update on diagnostic imaging for GC, evaluating the established roles of CT, EUS, and PET/CT alongside the emerging capabilities of Magnetic Resonance Imaging (MRI) and Artificial Intelligence (AI). Methods: A structured narrative review was conducted by searching indexed biomedical databases for studies published between 2015 and 2024. A structured literature search screening process identified 410 relevant studies focusing on T, N, and M staging accuracy, quantitative imaging biomarkers, and radiomics. Results: While Multidetector CT remains the universal first-line modality, its sensitivity declines in infiltrative tumors and low-volume peritoneal carcinomatosis. EUS retains superiority for early (T1-T2) lesions but may offer limited value in advanced stages. Conversely, MRI (leveraging diffusion-weighted imaging (DWI) and multiparametric protocols) indicates superior soft-tissue contrast, potentially outperforming CT in the assessment of serosal invasion, nodal involvement, and occult peritoneal metastases. Furthermore, emerging fibroblast activation protein inhibitor (FAPI) PET tracers show promise in overcoming the limitations of FDG in mucinous and diffuse GC. Finally, radiomics and deep learning models are providing novel quantitative biomarkers for non-invasive risk stratification. Conclusions: Contemporary GC staging requires a tailored, multimodality approach. Evidence supports the increasing integration of MRI and quantitative imaging into clinical workflows to overcome the limitations of conventional techniques and support precision oncology. Full article

Background/Objectives: The tumor microenvironment (TME) of pancreatic ductal adenocarcinoma (PDAC) is characterized by an enriched stroma, hampering the effectiveness of therapy. This co-clinical study aimed to (1) provide insight into early post-treatment changes in the TME using multiparametric magnetic resonance imaging (mpMRI)-derived quantitative imaging biomarkers (QIBs) in a preclinical PDAC model treated with radiotherapy and correlate these QIBs with histology; (2) evaluate the feasibility of obtaining these QIBs in patients with PDAC using clinically approved mpMRI data acquisitions. Methods: Athymic mice (n = 12) at pre- and post-treatment as well as patients with PDAC (n = 11) at pre-treatment underwent mpMRI including diffusion-weighted (DW) and dynamic contrast-enhanced (DCE) data acquisition sequences. DW and DCE data were analyzed using monoexponential and extended Tofts models, respectively. DeepLIIF quantified the total percentage (%) of tumor cells in hematoxylin and eosin (H&E)-stained tissues from athymic mice. Spearman correlation and Wilcoxon signed rank tests were performed for statistical analysis. Results: In the preclinical PDAC model, mean pre- and post-treatment ADC and K^trans values differed significantly (p < 0.01), changing by 20.50% and 20.41%, respectively, and the median total tumor cells quantified by DeepLIIF was 24% (range: 15–53%). Post-treatment ADC values and relative change in v_e (rΔv_e) showed a significant negative correlation with total tumor cells (ρ = −0.77, p < 0.014 for ADC and ρ = −0.77, p = 0.009 for rΔv_e). In patients with PDAC, pre-treatment mean ADC and K^trans values were 1.76 × 10⁻³ (mm²/s) and 0.24 (min⁻¹), respectively. Conclusions: QIBs in both preclinical and clinical settings underscore their potential for future co-clinical research to evaluate emerging drug combinations targeting both tumor and stroma. 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/Objectives: This study examined the clinical utility of diffusion-weighted whole-body magnetic resonance imaging with background body signal suppression (DWIBS) for differentiating infectious from non-infectious aortitis. Methods: The study included 32 patients with suspected inflammatory aortitis who underwent non-contrast computed tomography (NCCT) and magnetic resonance imaging. We evaluated the diagnostic performance of DWIBS using the spinal cord as a reference, NCCT, and their combination. The diagnosis of infectious aortitis was adjudicated based on imaging, clinical, and laboratory findings. We conducted a sensitivity analysis using a stricter definition of infectious aortitis that required both surgical and microbiological confirmation. Results: Fifteen patients were diagnosed with infectious aortitis. The sensitivity, specificity, and areas under the receiver operating characteristic curves were 93.3%, 70.6%, and 0.82, respectively, for NCCT; 93.3%, 76.5%, and 0.85, respectively, for DWIBS; and 86.7%, 94.1%, and 0.90, respectively, for the combination of both modalities. In the sensitivity analysis, the combined DWIBS and NCCT approach demonstrated a specificity of 87.5% and a sensitivity of 70.8%. Conclusions: DWIBS using the spinal cord as a reference appears to be a promising diagnostic tool for differentiating infectious from non-infectious aortitis, especially when combined with NCCT. Full article

Oesophageal cancer remains a significant global health burden with poor survival outcomes despite multimodal treatment. Recent advances in magnetic resonance imaging (MRI) have opened opportunities to improve radiotherapy delivery. This review examines the role of MRI and MR-guided radiotherapy (MRgRT) in oesophageal cancer, focusing on applications in staging, treatment planning, and response assessment, with particular emphasis on magnetic resonance linear accelerator (MR-Linac)-based delivery. Compared to computed tomography (CT), MRI offers superior soft-tissue contrast, enabling more accurate tumour delineation and the potential for reduced treatment margins. Real-time MR imaging during treatment can facilitate motion management, while daily adaptive planning can accommodate anatomical changes throughout the treatment course. Functional MRI sequences, including diffusion-weighted and dynamic contrast-enhanced imaging, offer quantitative data for treatment response monitoring. Early clinical and dosimetric studies demonstrate that MRgRT can significantly reduce radiation dose to critical organs while maintaining target coverage. However, clinical evidence for MRgRT in oesophageal cancer is limited to small early-phase studies, with no phase II/III trials demonstrating improvements in survival, toxicity, or patient-reported outcomes. Long-term clinical benefits and cost-effectiveness remain unproven, highlighting the need for prospective outcome-focused studies to define the role for MRgRT within multimodality treatment pathways. Full article

Motor recovery after stroke is highly variable and closely linked to the extent of corticospinal tract (CST) damage. Neurophysiological biomarkers, such as motor evoked potentials (MEPs) and structural imaging markers, including CST lesion load and fractional anisotropy (FA), show promise for predicting motor outcomes. This scoping review evaluated the prognostic value of these biomarkers and the utility of multimodal models for individualized rehabilitation. A systematic search (April 2024) in PubMed, the Cochrane Library, and Scopus identified empirical studies examining biomarkers predictive of post-stroke motor recovery. Biomarkers were primarily derived from magnetic resonance imaging (resting-state functional connectivity and diffusion-weighted imaging) and transcranial magnetic stimulation. Nineteen studies (1219 patients) met the inclusion criteria. Structural biomarkers, particularly lower CST FA and higher weighted lesion load, were generally associated with poorer motor recovery. Combining neurophysiological measures, such as MEP status, with functional imaging and artificial intelligence-based analyses may improve prognostic precision. Multimodal approaches appeared promising in some studies, but evidence remains limited and heterogeneous. Integrating diverse biomarkers into multimodal prognostic models may enhance the prediction of motor recovery and support personalized rehabilitation after stroke, although heterogeneity in study design and outcome assessment highlights the need for standardized, large-scale longitudinal studies to enable clinical implementation. Full article

Background: Non-arteritic anterior ischemic optic neuropathy (NAION) is a neuroophthalmological disorder characterized by impaired blood flow to the optic nerve head. There is uncertainty about whether, in some cases, NAION may be caused by proximal embolism of the posterior ciliary arteries. Diffusion-weighted magnetic resonance imaging (DWI-MRI) can provide evidence of concurrent cerebral infarction that may indicate a common embolic etiology. Methods: Adults with ophthalmological diagnosis of NAION who underwent cerebral DWI-MRI within 14 days from onset of visual impairment were included in a retrospective cohort study (2013–2021). DWI-MRI images were assessed for presence, location, and type of ischemic stroke by a board-certified neuroradiologist blinded for clinical patient data. Results: Among 122 patients (mean age 64.6 ± 11.9 years), DWI-MRI indicated acute/subacute ischemic stroke in three cases (2.5%), all located within the anterior circulation in the territory of the left middle cerebral artery and ipsilateral to the affected eye in two cases (1.6%). Ischemic stroke location was cortical in one case (0.8%) and subcortical in two cases (1.6%). Acute ischemic stroke indicated by a hyperintense DWI signal and corresponding low ADC was present in one patient (0.8%). Two patients (1.6%) had subacute ischemic stroke (hyperintense DWI signal and normal or elevated ADC signal). Only one NAION patient (0.8%) had acute embolic stroke corresponding to the vascular territory of the affected eye. Conclusions: Concurrent embolic ischemic stroke in NAION is exceedingly rare. Our findings support the prevailing pathophysiological theory of NAION as a non-embolic disease. Full article

Background/Objectives: This study aimed to evaluate the diagnostic accuracy of Apparent Diffusion Coefficient (ADC) values, derived from Diffusion-Weighted Imaging (DWI), in differentiating benign and malignant ascites. Methods: This retrospective study included 150 patients (85 benign, 65 malignant) who underwent abdominal MRI. All patients were scanned on a DWI sequence (b-values: 0, 500, and 1000 s/mm²). Two experienced radiologists, blinded to clinical and cytological outcomes, measured the mean ADC (ADCmean) from three distinct ROIs and the minimum ADC (ADCmin) from the area of lowest signal intensity on the ADC map. The diagnostic performance of ADC parameters and the Serum-Ascites Albumin Gradient (SAAG) was assessed using Receiver Operating Characteristic (ROC) curve analysis. Results: The mean values of ADCmean (3162 ± 204 × 10⁻⁶ mm²/s) and ADCmin (2885 ± 148 × 10⁻⁶ mm²/s) in the malignant group were significantly lower than those in the benign group (3596 ± 239 and 3322 ± 218 × 10⁻⁶ mm²/s; p = 0.006 and p = 0.0016, respectively). Inter-observer agreement was good for both ADCmean (ICC = 0.844) and ADCmin (ICC = 0.879). In the ROC analysis, ADCmin demonstrated the highest diagnostic performance (AUC: 0.930). An optimal cut-off value for ADCmin of ≤ 2983 × 10⁻⁶ mm²/s yielded 81.5% sensitivity and 85.8% specificity. The diagnostic performance of ADCmin was found to be superior to that of ADCmean (AUC: 0.877) and SAAG (AUC: 0.919). Conclusions: ADC values derived from DWI, particularly ADCmin, represent a highly accurate, non-invasive, and reproducible biomarker for differentiating benign from malignant ascites. The identified ADCmin threshold provides quantitative parameter that can aid in patient triage, especially when cytology is inconclusive, potential surrogate for fluid characterization. Full article

Background/Objectives: This study explored the associations of normal breast tissue characteristics on multiparametric MRI with clinical assessments of breast cancer risk in women with dense breasts. Methods: Women with dense breasts who underwent multiparametric MRI were included. Breast cancer risk was determined based on Tyrer–Cuzick (TC) lifetime risk scores, categorized as high (TC ≥ 20%) or low risk. Qualitative background parenchymal enhancement (BPE) assessment was obtained from imaging reports. Quantitative imaging markers were calculated, including median BPE, median apparent diffusion coefficient, and volume measures of the whole breast, fibroglandular tissue (FGT), blood vessels, and BPE regions. The associations between imaging markers and TC risk groups were evaluated using age-adjusted logistic regression and summarized by area under the receiver operating characteristic curve (AUC). Results: Seventy-seven women were evaluated; a total of 20 (26%) were low risk, and 57 (74%) were high risk. After adjusting for age and multiple testing, BPE:breast ratio (adj. p = 0.037), FGT:breast ratio (adj. p = 0.046), and BPE:vessel ratio (adj. p = 0.037) were positively associated with risk, while qualitative BPE was not (adj. p = 0.11). Overall, risk categorizations based on imaging markers were concordant with TC score in up to 70% of women. Conclusions: In women with dense breasts, quantitative measures from multiparametric MRI (BPE:breast, FGT:breast, and BPE:vessel ratios) moderately discriminated high- and low-risk groups, warranting further investigation of their value to supplement conventional breast cancer risk assessment tools. Full article

Background/Objectives: Superior cerebellar artery (SCA) infarction is a rare but clinically significant subtype of posterior circulation stroke. Extensive swelling in the SCA territory may cause downward brainstem compression and appear as brainstem hypodensity on computed tomography, potentially leading to premature treatment withdrawal. Methods: We report the case of a 50-year-old woman with acute SCA-territory infarction (NIHSS = 7) presenting with vertigo, dysphagia, dysarthria, and diplopia. Initial computed tomography suggested extensive brainstem infarction, prompting withdrawal of treatment. Diffusion-weighted MRI revealed reversible edema with brainstem sparing. The patient underwent suboccipital decompressive craniectomy and ventricular drainage with favorable neurological recovery. In addition, a systematic literature search was conducted according to PRISMA 2020 guidelines in PubMed, Web of Science, and Scopus (studies published since 1 January 2015). Fifteen studies met predefined eligibility criteria. Results: Magnetic resonance imaging findings were decisive in avoiding a falsely dismal prognosis and inappropriate withdrawal of care. Across the literature, infarct volume (>30–35 mL), brainstem involvement and bilateral cerebellar infarction emerged as key predictors of malignant course. Early decompressive surgery was consistently associated with improved survival, though functional outcomes varied. Fast magnetic resonance imaging techniques and volumetric imaging improved risk stratification and surgical decision-making. Conclusions: SCA infarction can mimic brainstem infarction on computed tomography due to secondary compression rather than true ischemia. Magnetic resonance imaging is essential to guide treatment and prevent avoidable mortality. Multimodal imaging combined with interdisciplinary management allows for accurate prognostication and optimized surgical timing in malignant SCA infarction. Full article

To explore the relationship between magnetic resonance imaging (MRI) parameters, including T2-weighted intensity and apparent diffusion coefficient (ADC), and intraoperative tumor characteristics, particularly consistency, in vestibular schwannomas (VSs). The association between tumor consistency, facial nerve (FN) function, and postoperative outcomes was analyzed. A single-center retrospective analysis included newly diagnosed VS cases (2020–2023) with cisternal involvement (Samii T3a; volume ≥ 0.7 cm³). T2 and ADC maps from the perimetral region of interest were normalized, and tumors were categorized into 3 classes by combining qualitative consistency (soft, fibrous, or fibrous/hard), ultrasonic aspirator power, and adherence to neurovascular structures. FN function was assessed using the House–Brackmann scale at the immediate postoperative period and 12-month follow-up. MRIs of 33 VSs (18 solid and 15 cystic) were analyzed. Normalized values of both T2 (N-T2_mean) and ADC (N-ADC_min) maps predicted the classical radiological differentiation. N-ADC_min may have some role in predicting consistency (value 1.361, p = 0.017, accuracy 0.48) and demonstrated a significant association (p = 0.04) with the FN outcome in the immediate postoperative period. An augmented consistency could impair FN function by increasing the intrameatal pressure related to greater transmission of shocks derived from the dissection maneuvers of the cisternal component of the tumor. The possibility of non-invasively exploring VS consistency with a parameter easily calculable on MRI might be beneficial in surgical planning, modifying the timing of the opening of the meatus with respect to what could be the surgical routine in some centers. Full article