Search Results (176)

Magnetic resonance imaging (MRI) uses radiofrequency (RF) energy to generate diagnostic images. RF–tissue interactions lead to energy absorption and tissue heating, quantified by the specific absorption rate (SAR). Although SAR limits are strictly regulated for patient safety, actual in vivo tissue temperature changes during clinical MRI examinations in humans have not been directly measured. A patient with a histologically confirmed soft tissue sarcoma of the thigh underwent a clinically indicated 3 T MRI examination 24 h prior to resection. During imaging with whole-body SAR of 2.27 W/kg, direct temperature measurements (invasive and on the skin) were obtained. Temperatures increased by 2.0 °C within the tumor and at the skin surface was 3.4 °C at the skin surface. No technical difficulties or adverse events were observed, and the patient tolerated the examination well. This first-in-human case demonstrates the feasibility and safety of direct intratumoral temperature measurement during standard 3T MRI. While MRI was performed within safety limits of SAR as a surrogate for true tissue temperature, non-invasive temperature monitoring during MRI needs improvement. Controlled RF-induced heating during MRI may open new therapeutic possibilities, including MR-guided hyperthermia for sarcomas and other solid tumors or modulation of blood–brain barrier through transient RF-induced temperature elevations facilitating drug delivery. Full article

Background: Multifocal osteonecrosis involving three or more anatomical sites is an uncommon but severe manifestation of glucocorticoid-associated osteonecrosis and may be associated with systemic clinical backgrounds. This study investigated the clinical characteristics and exploratory serum proteomic profiles of multifocal osteonecrosis using clinical and proteomic analyses. Methods: We analyzed 107 patients who underwent surgery for osteonecrosis of the femoral head between 2019 and 2024. Whole-body MRI was used to detect multifocal lesions. Patients were classified into glucocorticoid-related osteonecrosis of the femoral head (GO) and multifocal glucocorticoid-related osteonecrosis (MGO). Clinical variables were compared, and multivariate logistic regression identified clinical factors associated with multifocal osteonecrosis. Serum proteomic profiling using nanoLC–MS/MS was performed as an exploratory analysis to compare protein expression among GO, MGO, and osteoarthritis controls. Results: Multifocal osteonecrosis was identified in 31 patients (29.0%). Patients with MGO were younger (42.6 vs. 50.9 years, p = 0.021) and had higher glucocorticoid doses (59.5 vs. 48.5 mg, p = 0.005). Hematologic diseases (OR 14.51, 95% CI 3.42–86.69, p < 0.001) and skin manifestations (OR 3.17, 95% CI 1.05–10.44, p = 0.046) were independently associated with multifocal osteonecrosis. Exploratory proteomic analysis showed protein expression patterns related to fibrinolysis, coagulation, inflammation, and vascular homeostasis in MGO. Conclusions: Multifocal osteonecrosis was associated with systemic clinical backgrounds and showed exploratory vascular- or coagulation-related proteomic patterns within glucocorticoid-associated osteonecrosis. Full article

[¹⁸F]-PSMA PET/CT is a high-impact modality for the staging and restaging of prostate cancer, but its wide anatomic coverage and tracer biology generate frequent incidental findings on both PET and the accompanying low-dose CT (LDCT). This narrative review is restricted in scope to fluorine-18 PSMA tracers because tracer-specific biodistribution and pitfall profiles shape what is perceived as incidentaloma: how confidently lesions can be categorized, and how often borderline findings trigger downstream testing, particularly for skeletal foci with [¹⁸F]-PSMA-1007. Specifically, [¹⁸F]-PSMA-1007 shows substantially higher rates of focal unspecific bone uptake than [⁶⁸Ga]-PSMA-11—reported in multicenter studies as affecting up to 40–50% of patients—which directly inflates the pool of potential incidentalomas and creates a tracer-specific false-positive problem with no parallel in gallium-68 practice. Additionally, [¹⁸F]-DCFPyL has different urinary clearance kinetics that affect bladder and ureteral uptake patterns, altering what qualifies as physiologic versus incidental in the pelvis. These differences mean that the threshold for Category B versus C classification—and the appropriate cascade-resistant language—must be tuned to the specific tracer in use. A framework built on [⁶⁸Ga]-PSMA-11 data would systematically underestimate bone pitfall frequency in [¹⁸F]-PSMA-1007 practice and could therefore paradoxically increase rather than reduce cascades if applied uncritically across tracers. These biodistribution differences have direct and concrete consequences for reporting behaviour and downstream management. In [¹⁸F]-PSMA-1007 practice, a focal bone uptake without a CT correlate in a mechanically plausible location—such as an anterior rib or vertebral endplate—should trigger Category B language in the report conclusion: the finding is documented in the body with explicit safety netting (“most consistent with unspecific uptake; no routine workup unless interval growth, new pain, or aggressive CT morphology”), and no referral to bone scintigraphy or MRI is generated. Without tracer-specific awareness, the same finding would typically prompt a reflex bone scan or whole-body MRI referral, delaying definitive prostate cancer management by weeks and adding imaging costs without diagnostic gain. By contrast, in [⁶⁸Ga]-PSMA-11 practice, an equivalent focal bone uptake without a CT correlate carries a higher prior probability of true metastatic disease given the lower background rate of unspecific uptake and should more often be reported at Category B with a lower threshold for escalation or more cautious language. For [¹⁸F]-DCFPyL, the higher urinary activity in the pelvis means that ureteral segments can mimic lymph node disease; recognizing this as a physiologic variant (Category C) rather than an equivocal nodal finding (Category B) avoids unnecessary pelvic MRI referrals that would otherwise be triggered by an uncontextualized report. In practical terms, the tracer-specific calibration of the overlay therefore changes not only the category assigned but also the specific safety-netting language and the escalation trigger, which directly modifies the downstream management pathway for each affected finding type. The scanned population—predominantly older men with a high prevalence of degenerative, inflammatory, and vascular abnormalities—creates substantial background noise that can drive low-value diagnostic cascades if incidental findings are communicated without actionability context. We integrate society-endorsed frameworks (EANM/SNMMI procedure guideline 2.0; E-PSMA; PSMA-RADS; and PROMISE/miTNM with miPSMA score) and propose a cascade-aware overlay for incidental findings that can be appended to existing PSMA reporting standards rather than replacing them. The A/B/C actionability overlay is a structured expert-consensus framework informed by existing evidence-based guidelines for specific finding types and by tracer-specific cohort data; it has not yet been prospectively validated as a standalone tool, and its current level of evidence is therefore analogous to a structured expert recommendation rather than an evidence-based clinical guideline. We operationalize a three-tier actionability scheme across PET- and CT-dominant findings, provide cascade-resistant language for conclusions, and clarify why SUVmax-only “probability scales” for lymph nodes are not recommended in routine reports. Three practical tables summarize PET incidental findings, lymph node reporting frameworks, and LDCT incidental findings, and two structured report templates are provided (concise and extended), with the extended version explicitly labelling actionability tiers and escalation triggers. Finally, we outline concrete AI use cases for standardization and triage while emphasizing governance to avoid the amplification of false positives and paradoxical growth of cascades. Full article

Background/Objectives: To evaluate the diagnostic potential of apparent diffusion coefficient (ADC) values for classifying lymph nodes as benign or malignant in breast cancer patients undergoing [¹⁸F]FDG-PET/MRI staging. Methods: Mean ADC values and short-axis diameters (±standard deviation) of 199 thoracic lymph nodes in 113 newly diagnosed breast cancer patients were retrospectively analyzed. All patients underwent [¹⁸F]FDG-PET/MRI staging, between July 2017 and June 2021. A node-by-node comparison was performed with respect to pathological node status. Nodal FDG uptake in whole-body [¹⁸F]FDG-PET/MRI served as reference standard for nodal malignancy. Group comparison using Mann–Whitney U test, receiver operating characteristic curve (ROC) analysis and diagnostic performance were calculated. p values below 0.05 were defined as statistically significant. Confidence intervals (CI; 95%) were calculated. Results: Ninety-three lymph nodes were FDG-negative while 106 lymph nodes were FDG-positive. FDG-negative lymph nodes had significantly lower short-axis diameters ((5.1 ± 1.5 mm versus 12.3 ± 5.3 mm); p < 0.01; U: 405.50; Z: −11.24). ADC values were significantly lower in FDG-positive lymph nodes (0.72 ± 0.14 × 10⁻³ mm²/s) than in FDG-negative lymph nodes ((1.18 ± 0.18 × 10⁻³ mm²/s); p < 0.01; U: 173.00; Z: −11.80). ROC analysis and Youden’s index revealed an ADC cut-off of 0.95 × 10⁻³ mm²/s (AUC: 0.98; p < 0.01; 95% CI: 0.96–1.01). According to the calculated cut-off, sensitivity, specificity, and accuracy of ADC values for differentiating FDG-negative from FDG-positive lymph nodes were 98%, 97% and 97%, respectively. Conclusions: ADC values derived from MRI were significantly associated with FDG uptake in this retrospective cohort and may serve as a complementary imaging biomarker for lymph node characterization. Full article

Prostate cancer (PCa) is predominantly an acinar adenocarcinoma arising from the prostatic glandular epithelium, with tumor grade assessed using the International Society of Urological Pathology (ISUP) Grade Group classification, reflecting the degree of glandular differentiation and underlying molecular heterogeneity. PCa exhibits wide clinical behavior heterogeneity, ranging from indolent disease to aggressive forms with poor outcomes. Accurate prognostic assessment is, therefore, essential for guiding treatment selection and monitoring disease progression. This review examines recent advances in imaging and non-imaging biomarkers that contribute to improved risk stratification, treatment planning, and disease monitoring. Particular attention is given to multiparametric magnetic resonance imaging (mpMRI), whole-body magnetic resonance imaging (WB-MRI), positron emission tomography/computed tomography (PET/CT), positron emission tomography/magnetic resonance imaging (PET/MRI), computed tomography (CT), and transrectal ultrasound (TRUS), evaluated for their capacity not only to detect disease but also to predict recurrence, progression, and survival outcomes. In parallel, the prognostic role of non-imaging biomarkers is discussed, including the prostate-specific antigen (PSA), histopathological grading, biochemical and inflammatory biomarkers, as well as genomic classifiers and circulating tumor DNA (ctDNA). Emerging approaches such as radiomics, liquid-biopsy-derived molecular profiles, and artificial intelligence (AI)-based multimodal integration are highlighted for their potential to enhance individualized decision making. This review underscores the importance of combining imaging and molecular information to refine prognostic models and accelerate the translation of precision medicine in PCa. Full article

(1) Background: Creutzfeldt–Jakob disease (CJD) is a progressive neurodegenerative disorder, characterized by cognitive decline, and motor and psychiatric symptoms; it primarily affects the central nervous system; however, peripheral nervous system involvement has rarely been described, particularly as an atypical presentation. (2) Methods: A 78-year-old Caucasian man, a retired farmer with no family history of neurological disease, presented with diarrhea followed by progressive lower limb weakness, which eventually evolved into encephalopathy and generalized areflexia. An initial diagnosis of inflammatory neuropathy was considered; the diagnostic assessment included blood and cerebrospinal fluid testing, a CT whole body scan, brain MRI, neuropsychological testing, electroencephalography, a nerve conduction study and electromyography. (3) Results: Neurophysiological studies demonstrated an acute asymmetrical sensorimotor, predominantly axonal polyneuropathy, initially suggestive of an axonal form of inflammatory polyradiculoneuritis. This pattern was confirmed on follow-up neurophysiological assessment performed three weeks later. Unexpectedly, the diagnostic course ultimately led to a diagnosis of sporadic Creutzfeldt–Jakob disease, confirmed by post-mortem neuropathological examination. Based on these findings, we conducted a literature review to summarize the current evidence on CJD-related neuropathy. (4) Conclusions: Our case emphasizes the importance of maintaining clinical suspicion for CJD even in patients presenting with progressive lower limb weakness and suggests that peripheral neuropathy may be concomitant or even precede the CNS manifestations. Careful consideration is required to avoid misdiagnosis of inflammatory neuropathy in the context of neurodegenerative diseases such as CJD. Full article

Objective: Back pain is a multifactorial condition commonly associated with degenerative spinal changes. Spondylophytes are frequent outgrowths of the vertebral bodies that may be influenced by arterial hypertension via a possible increased pulsation of the aorta and its effects on bone remodeling. If it can be demonstrated that an increased pulse pressure in the aorta due to hypertension promotes the growth of spondylophytes and thereby increases the likelihood of back pain, future studies may investigate how the effectiveness of blood pressure management can be improved in order to reduce the prevalence of degenerative changes in the spine and, consequently, prevent back pain. This study investigated the association between arterial hypertension and thoracic spondylophyte formation using whole-body MRI data from the population-based Study of Health in Pomerania (SHIP). Materials and Methods: Spondylophyte presence and area were assessed for their association with hypertension status in 859 SHIP-START-3 participants who underwent whole-body MRI. Right-sided spondylophytes at T8-T11 were measured on axial T2-weighted sequences. Hypertension was defined by self-report or antihypertensive medication use; a sensitivity analysis was conducted using the 2024 European Society of Cardiology definition (systolic blood pressure ≥ 140 mmHg). Multivariate regression models adjusted for age, sex, obesity, and smoking were used to assess associations. Machine learning algorithms were applied for validation. Results: Spondylophytes were present in 87.7% of participants. Hypertension was significantly associated with spondylophyte presence (OR = 2.07, 95% CI: 1.15–3.81) but not consistently associated with spondylophyte size. Spondylophyte size increased from T8 to T11, and was associated with age, male sex, and obesity. Sensitivity analyses widely confirmed robustness of the analysis. Conclusions: This population-based MRI study investigates the still insufficiently studied relationship between arterial hypertension and the formation of thoracic spondylophytes. The findings are consistent with the hypothesis that hypertension may be associated with spinal bone remodelling, though causal inference remains limited by the cross-sectional study design. Further longitudinal studies are needed to clarify causality and clinical relevance for spinal degeneration and back pain. Full article

Background: Extracranial metastasis (EM) from glioblastoma (GB), IDH-wildtype (WHO CNS 2021 grade 4) is rare and often under-recognized, yet it has immediate implications for staging and management. We report a case series integrating advanced neuroimaging, whole-body imaging, and pathology/biomarkers to characterize imaging–pathology correlates of EM and highlight practical clinical triggers that should prompt systemic evaluation. Case presentation: We report three patients with adult-type, IDH-wildtype GB who developed EM confirmed by cytology/histology and/or concordant multimodality imaging. Brain MRI (1.5T/3T) demonstrated aggressive primary tumors with qualitative elevation of DSC-perfusion and frequent tumor–surface contact (dural, ependymal/leptomeningeal contact). Intratumoral susceptibility signal reached grade 3 where assessed. All patients underwent surgical resection followed by temozolomide-based chemoradiation; two received fotemustine and bevacizumab, and one underwent re-irradiation. EM presented with clinical triggers including severe axial/back pain, palpable cervical masses, and/or cytopenias. Initial EM sites were bone marrow/vertebrae (n = 1) and cervical lymph nodes (n = 2); staging revealed additional osseous disease in both nodal cases and a small pulmonary nodule in one. Nodal and osseous lesions were FDG-avid on 18F-FDG PET/CT. OLIG2-positive cytology confirmed cervical nodal metastases, and bone marrow aspiration with GFAP/OLIG2 positivity confirmed medullary infiltration. All tumors shared a molecular profile of TERT-promoter mutation, ATRX wild-type, TP53 mutation, and MGMT-promoter methylation. Despite attempts at second- and third-line therapies, disease progression was rapid, and all patients succumbed within 8–16 months of diagnosis. Discussion: This series underscores that EM can occur despite MGMT-promoter methylation and supports the concept of heterogeneous metastatic phenotypes in GB. Our cases reinforce that new axial/back pain or hematologic abnormalities may signal osseous or marrow involvement, and necrotic cervical lymphadenopathy in GB patients warrants dedicated imaging and tissue confirmation with glial markers. Integrating brain MRI features (high perfusion, surface contact, susceptibility burden) with FDG-PET/CT and targeted cytology/pathology can expedite diagnosis and inform multidisciplinary care. Conclusions: EM can arise despite MGMT-promoter methylation in IDH-wildtype GBM. Imaging red flags (high perfusion, surface contact, necrotic/FDG-avid cervical nodes) and clinical cues (axial pain, cytopenias, neck masses) should prompt early systemic staging (CT/PET-CT) and targeted tissue confirmation to advance management. Full article

Introduction and Aim: Assessment of antitumor activity in preclinical models remains challenging when relying solely on conventional size-based imaging, particularly for complex agents such as cannabinoids, whose biological effects may not translate into early volumetric tumor changes. Cannabinoid formulations, including the synthetic cannabinoid JWH-182, Cannabixir^® Medium dried flowers, and Cannabixir^® THC full extract, exhibit diverse and potentially subtle effects on tumor biology. Radiomics enables high-throughput extraction of quantitative imaging features that capture intratumoral heterogeneity beyond gross tumor volume. The primary aim of this study was to evaluate the utility of MRI-based radiomics as a sensitive tool for detecting cannabinoid-associated tumor phenotypic modulation in a preclinical breast cancer model. Methods: Orthotopic breast tumors were induced in mice using the 4T1 cell line. Animals received cannabinoid formulations in combination with chemotherapy according to a predefined protocol. Tumor burden was assessed at baseline and post-treatment using ultrasonography and whole-body MRI to calculate tumor doubling time. T1- and T2-weighted MRI datasets were segmented and analyzed using radiomics to extract morphometric and signal-based features. Results: Conventional imaging revealed no significant differences in tumor doubling time between most cannabinoid-treated groups and controls, except for accelerated growth in animals treated with Cannabixir^® THC full extract. In contrast, radiomics identified distinct, compound-specific tumor phenotypes, including structural features consistent with reduced aggressiveness, in JWH-182-treated tumors, despite similar volumetric growth patterns. Conclusion: MRI-based radiomics sensitively captures cannabinoid-associated tumor phenotype alterations beyond volumetric assessment, supporting its value as a pharmaco-imaging tool for characterizing treatment-related tumor biology in preclinical oncology. Full article

Background/Objectives: Complex Regional Pain Syndrome (CRPS) is a debilitating pain condition with complex pathophysiology and limited treatment efficacy. Whole-body cryostimulation (WBC) has shown promising results in other chronic pain syndromes, but no studies to date have examined its use in CRPS. To evaluate the safety, feasibility, and potential benefits of WBC in a female patient with CRPS of the ankle. Methods: A 65-year-old female outpatient with type I CRPS at the right ankle underwent 15 WBC sessions (3 min at −110 °C) over two weeks, without any concurrent pharmacological or rehabilitative interventions. Assessments at baseline and post-intervention included standardized measures of pain (VAS, SF-MPQ), disability (PDI), catastrophizing (PCS), mobility (TUG, Chair Stand Test), strength and ROM (goniometry, MRC), psychosocial status (SF-36, WHO-5, PSQI, BDI, STAI), and MRI of the right knee and ankle. Results: Post-treatment, the patient showed substantial improvements in pain (VAS −66.7%, SF-MPQ −51.7%), function (TUG −31.8%), muscle strength, psychological well-being, and quality of life. MRI and edema measurements indicated stabilization or regression of inflammatory features. No adverse effects were reported. Conclusions: This case suggests that WBC may represent a safe, well-tolerated, non-pharmacological intervention for CRPS, with potential to improve pain, function, and well-being. Full article

Background/Objectives: Physical activity (PA) has been associated with better inhibitory control (IC), which may support self-regulatory processes related to eating. However, whether regular PA is related to food-specific IC and its neural correlates remains insufficiently understood. This cross-sectional study aimed to examine the relationship between regular PA, behavioral performance, and neural correlates of IC, with a focus on high-reward food-related contexts. Methods: Sixty-one healthy right-handed young Chinese adults were classified into a regular physical activity group (RPG; n = 30, 24 males) or an inactive group (IAG; n = 31, 17 males) based on self-reported frequency and volume of PA. Stop-signal tasks performed during functional MRI under high-calorie food and neutral image conditions were used to assess IC. Stop-signal reaction time (SSRT) indexed IC performance. Neural correlates of IC were examined using whole-brain and region-of-interest analyses, with brain activation values derived from general linear models including age, sex, body mass index, depressive scores, and subjective appetite ratings as covariates. Given the relatively small sample size and unbalanced distribution of sex and body mass index, sensitivity analyses were performed by varying covariate adjustments to assess the robustness of the primary results. Results: RPG demonstrated significantly shorter SSRT than IAG across both high-calorie food and neutral stimulus conditions. In contrast to successful-stop trials relative to baseline, IAG showed lower activation in the bilateral precuneus than RPG under the high-calorie food condition. In comparison, RPG showed lower activation than IAG under the neutral condition. In contrast to failed-stop trials relative to successful-go trials, IAG exhibited greater activation in the left caudate than RPG under the high-calorie food condition. These behavioral and neural patterns were generally robust across sensitivity analyses. Conclusions: Regular PA was associated with superior general IC, and this advantage was maintained in the presence of high-calorie food cues. At the neural level, regular PA was associated with stimulus-dependent neural responses in the bilateral precuneus and left caudate. Future studies using larger, more representative samples, objective measures of PA, and stratification by sex or BMI are warranted. Full article

Objective: We present the first clinical experience with the BIOGRAPH One next-generation PET/MRI system scanner, evaluating its performance for body and brain imaging in patients across multiple tracers. Methods: A total of 59 patients were scanned on the BIOGRAPH One PET/MRI following standard clinical PET/CT (n = 52) or first-generation PET/MRI (Biograph mMR, n = 7). Scans comprised 30 total body (TB), whole body (WB), or regional scans with [¹⁸F]FDG, and 29 brain scans with either [¹⁸F]FDG (n = 5), [¹⁸F]FE-PE2I (n = 10), [¹⁸F]FET (n = 4), or [⁶⁸Ga]Ga-DOTATOC (n = 10). The PET image quality was visually assessed using a 5-point Likert scale (1 = very good to 5 = very bad) and compared with clinical scans acquired on either a current-generation digital PET/CT or a first-generation PET/MRI system, including evaluation of diagnostic concordance. PET quantification and image noise was compared in brain and WB/TB [¹⁸F]FDG PET scans. Results: PET image quality was rated as good or very good in 93% of scans with a median [inter-quartile range] score of 1.5 [1.5;2]. In 99% of cases, image quality was judged equal to or better than the clinical reference scan (median score 3 [2.5;3]). Diagnostic concordance was observed in 99% of readings. Imaging metrics revealed the anticipated regional bias in brain imaging, while no significant bias was observed in body imaging. Image noise was comparable to that observed with digital PET/CT and demonstrated superiority over first-generation PET/MRI despite potential degradation related to isotope decay in BIOGRAPH One PET/MRI acquisitions scans performed at the end of the imaging workflow. Conclusions: Within the study limitations related to sequential imaging, the BIOGRAPH One PET/MRI scanner demonstrated improved PET sensitivity and workflow potential over its first-generation predecessor, which may allow for broader clinical and research applications. Full article

Background/Objective: The aim of the present study is to compare diagnostic accuracies of MRI, PET/CT and fused PET/MRI in the assessment of cervical lymph nodes in patients with head and neck cancer (HNC). Methods: Imaging data of 37 patients who underwent MRI, PET/CT, and surgery at our center were retrospectively merged into PET/MR images. Histopathological results of neck dissections and lymph node resections served as the gold standard. Results: MRI and PET/CT were performed on the same day. The mean interval between imaging and surgery was 20 (±19.5) days. All three imaging modalities identified the same number of true positive and false negative cases, resulting in identical sensitivity estimates of 66.7%. Specificities were 90.9% for MRI, 95.5% for PET/CT, and 100% for PET/MRI. The corresponding positive predictive values (PPVs) were 83.3%, 80.7%, and 81.5%, while the negative predictive values (NPVs) were 80.0%, 90.9%, and 100%, respectively. Ten false results are further analyzed regarding side and level of the affected lymph node, and intersections of the three modalities are displayed. In 12 (32.4%) cases, additional findings are depicted in PET/CT, 5 (13.5%) of which are histologically confirmed to be further malignancies. Conclusions: Software-based PET/MRI is an easy-to-perform procedure and provides valuable clinical information in select clinical questions. Furthermore, whole-body acquisition by PET/CT leads to a notable number of additional malignant diagnoses, which especially favors its use in high-risk patients. Full article

Background and Objective: Clavicular pain and swelling in children can have multiple causes and often require a multidisciplinary approach. We aimed to describe the characteristics and final diagnoses of children with clavicular involvement and to review the literature on this topic. Methods: We retrospectively reviewed patients younger than 18 years who were evaluated for clavicular symptoms at two pediatric rheumatology centers and one pediatric oncohematology center. These data were then descriptively compared with findings from 63 patients reported across 7 published articles. Results: Twelve patients (9 females, median age 10 years [IQR 9.4–10.5]) were included. Final diagnoses were chronic nonbacterial osteomyelitis (CNO; 8), Langerhans cell histiocytosis (LCH; 2), reactive arthritis (1), and Tietze syndrome (1). Clavicular involvement was mostly unilateral and localized to the medial clavicle in CNO. The most frequent presenting symptom was local swelling (11/12), followed by pain (9/12). Diagnostic delay was a median of 4 months (IQR 1–10.5). Whole-body MRI revealed multifocal lesions in 6/8 CNO patients. Biopsy was often required for diagnosis primarily to exclude malignancy and to clarify atypical or unifocal presentations. The literature review confirmed CNO as the most frequent cause, followed by rare tumors. Conclusions: CNO predominates among pediatric non-traumatic clavicular lesions, but LCH and rare conditions are not uncommon, underscoring the need for careful differential diagnosis and targeted imaging. Full article

A 74-year-old man with type 2 diabetes presented with fever, urinary retention, and urinary difficulties. Initial abdominal Computed Tomography (CT) suggested acute pyelonephritis, but a low-density area in the prostate was overlooked. Following the confirmation of methicillin-resistant Staphylococcus aureus (MRSA) in blood and urine cultures, comprehensive screening for metastatic abscesses was necessitated. Diffusion-weighted whole-body imaging with background suppression (DWIBS) was utilized and clearly identified a prostatic abscess (PA), nephritis, urethritis, and subcutaneous cysts. These findings also raised suspicion of pyogenic vertebral osteomyelitis. Crucially, the PA, urethritis, subcutaneous cysts, and potentially the vertebral osteomyelitis were either overlooked or not detected by initial CT imaging. DWIBS allows for simultaneous whole-body screening and serves as a useful adjunctive tool for identifying minute abscesses, which may assist in detecting inflammatory foci that are sometimes overlooked by conventional imaging. Unlike CT, DWIBS avoids radiation and contrast agents, and is significantly more cost-effective than positron emission tomography-CT (PET-CT). DWIBS can thus serve as a useful, non-invasive tool for the early detection and exclusion of abscesses in other organs when metastatic abscess formation is suspected or cultures are positive for microorganisms causing metastatic abscesses. Full article