Radiographics最新文献

{"title":"Carcinoma of the Vulva.","authors":"Priya Pathak, Mia Lundgren, Ileasa Green, Ibrahim Abdalla, Rajesh Thampy, Colleen Rivard Hunt, Fatemeh Behnia","doi":"10.1148/rg.250139","DOIUrl":"https://doi.org/10.1148/rg.250139","url":null,"abstract":"<p><p>Vulvar cancer is a rare gynecologic malignancy with a higher incidence in postmenopausal women. Squamous cell carcinoma is the most common histologic subtype (>90% of cases). The majority of affected patients are symptomatic and present with vulvar pruritus, bloody discharge, pain, and/or a palpable mass. The disease is staged by using the International Federation of Gynecology and Obstetrics (FIGO) classification system, which was most recently revised in 2021. The characteristic pattern of local vulvar cancer spread involves infiltrative tumor extension to the urethra, anorectum, vagina, and urinary bladder (less commonly). Lymphatic spread is the primary route of metastasis and a critical prognostic factor. The authors review the vulvar anatomy, as well as the pathogenesis, routes of spread, and key imaging findings of vulvar malignancy. In addition, the roles of multiple imaging modalities including lymphoscintigraphy, MRI, fluorine 18-fluorodeoxyglucose PET/CT, and PET/MRI in diagnosing vulvar cancer and acquiring the information needed for accurate staging, treatment planning, determining the prognosis, and assessing treatment response are outlined. ^©RSNA, 2026 Supplemental material is available for this article.</p>","PeriodicalId":54512,"journal":{"name":"Radiographics","volume":"46 5","pages":"e250139"},"PeriodicalIF":5.5,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147789524","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"MRI and US of Normal and Abnormal Digital Nerves.","authors":"Roddie Moraes Neto, Eduarda C B A Bernal, Alex Carvalho Dias, Renata Vidal Leão Sanford, Raul Omena Martins, Viviane Sayuri Yamachira Dwan, Eduardo Luis Bizetto, Denise T Amaral, Avneesh Chhabra, Marcos Felippe D P Correa, Renata Fernandes B Pereira","doi":"10.1148/rg.250158","DOIUrl":"https://doi.org/10.1148/rg.250158","url":null,"abstract":"<p><p>Digital nerves provide essential sensory innervation to the fingers and toes, playing a crucial role in tactile sensation and proprioception. Injury, inflammation, or entrapment of these nerves can result in sensory deficits, paresthesia, and neuropathic pain. Imaging the digital nerves is technically challenging due to their small caliber, adjacent and similarly appearing vascular bundles, and distal location in the extremities. Accurate evaluation requires detailed anatomic knowledge and optimized protocols using high-frequency US or MRI to ensure proper nerve visualization. Common pathologic conditions of digital nerves include traumatic injuries, inflammatory or infectious causes, compressive neuropathies caused by space-occupying lesions, and neoplastic lesions. Traumatic injuries are the most common digital nerve lesions, often requiring US to assess nerve continuity, caliber changes, and neuroma formation. MRI, including MR neurography, is especially useful in complex cases for evaluating nerves and associated soft-tissue or bone abnormalities. Although rare, neoplastic lesions, such as schwannomas and neurofibromas, are usually benign. Other tumorlike space-occupying lesions, including ganglion, lipoma, and hematoma, can cause nerve compression. The digital nerves of the foot are more commonly affected by trauma or interdigital neuromas, which represent a distinct entity characterized by perineural fibrosis rather than true neoplasia. The authors present a comprehensive case-based review of the digital nerves of the hands and feet, emphasizing anatomic considerations, proper imaging techniques with protocol suggestions, and key pathologic conditions. Readers can incorporate this knowledge into their practices for timely management of patients with digital nerve lesions. ^©RSNA, 2026 Supplemental material is available for this article.</p>","PeriodicalId":54512,"journal":{"name":"Radiographics","volume":"46 5","pages":"e250158"},"PeriodicalIF":5.5,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147789512","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"PRECISE Version 2: Essential Tips for Prostate Cancer Monitoring Using MRI.","authors":"Arthur Ogata, Giorgio Brembilla, Adriano B Dias, Tristan Barrett, Isadora B Canedo, Rossano Girometti, Gabriel Lion Gouvea, Thalyne A Lima, Caroline M Moore, Refky Nicola, Valeria Panebianco, R Renard-Penna, Antonio C Westphalen, Valdair F Muglia, Francesco Giganti","doi":"10.1148/rg.250126","DOIUrl":"https://doi.org/10.1148/rg.250126","url":null,"abstract":"<p><p>Active surveillance (AS) is an increasingly adopted strategy for men with low-risk or selected favorable intermediate-risk prostate cancer and is aimed at avoiding overtreatment while maintaining close monitoring. MRI has been integrated into AS protocols to help improve risk stratification, identify clinically significant disease, and guide targeted biopsies. During AS, MRI is integral to assessing the stability or interval progression of imaging findings. It can also allow identification of new lesions, potentially prompting a reassessment of treatment strategies. The PRECISE (Prostate Cancer Radiologic Estimation of Change in Sequential Evaluation) criteria, recently updated to version 2, offer a structured reporting system for serial MRI evaluations during AS. PRECISE version 2 introduced simplified guidelines for assessing longitudinal changes in MRI examination of the prostate, which focus on lesion size, appearance, and the development of new lesions. It involves a 1-5 Likert scoring system to categorize the likelihood of changes at MRI over time to standardize communication between radiologists and clinicians. The authors provide an overview of the rationale and criteria for patient selection for an AS protocol, review the foundations and evolution of the PRECISE system, and demonstrate how to integrate clinical and MRI findings, including a series of practical cases. ^©RSNA, 2026 Supplemental material is available for this article.</p>","PeriodicalId":54512,"journal":{"name":"Radiographics","volume":"46 5","pages":"e250126"},"PeriodicalIF":5.5,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147823421","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multimodality Evaluation of Regional Breast Lymph Nodes: Impact of Expected Changes in the Upcoming BI-RADS Sixth Edition.","authors":"Tara A Retson, Bradley C Phillips, Soudabeh Fazeli, Azideh Elmi, Nathan Spengler, James E Stepenosky, Haydee Ojeda-Fournier","doi":"10.1148/rg.250188","DOIUrl":"https://doi.org/10.1148/rg.250188","url":null,"abstract":"<p><p>Evaluating regional breast lymph nodes is a critical aspect of breast cancer imaging, directly affecting staging, treatment planning, and overall patient outcomes. Clinical practice is moving toward de-escalation in the axilla, fueled by evidence of unchanged survival rates and low local recurrence rates, as well as the risk of lymphedema. Radiologists need to be skilled at identifying and characterizing suspicious lymph nodes and guiding interventions on them. This approach aligns with the American Society of Breast Surgeons' Choosing Wisely initiative, which advocates for less invasive management when appropriate. Although the sixth edition of the Breast Imaging Reporting and Data System (BI-RADS) atlas has not yet been published, the BI-RADS committee has previewed expected changes at multiple national meetings. A key anticipated update is introduction of a dedicated lymph node category across imaging modalities, accompanied by expanded guidance on lymph node morphology and location. The authors review the expected changes in the context of multimodality imaging, including mammography, US, and MRI, with a focus on axillary, intramammary, internal mammary, and supraclavicular lymph nodes. They present a systematic approach to lymph node evaluation, highlighting modality selection, imaging features suggestive of metastasis, and the role of US-guided core biopsy or fine-needle aspiration for histologic confirmation. Differential considerations and nodal staging are also discussed. ^©RSNA, 2026.</p>","PeriodicalId":54512,"journal":{"name":"Radiographics","volume":"46 5","pages":"e250188"},"PeriodicalIF":5.5,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147823453","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Articular and Periarticular Disease of the Adult Hip: What Are the Strengths and Weaknesses of US?","authors":"Sarah J Allred, Lisa M Billone, Andrew J Grainger, Theodore T Miller, Robert S D Campbell","doi":"10.1148/rg.250168","DOIUrl":"https://doi.org/10.1148/rg.250168","url":null,"abstract":"","PeriodicalId":54512,"journal":{"name":"Radiographics","volume":"46 5","pages":"e250168"},"PeriodicalIF":5.5,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147823497","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intramuscular Epinephrine as First-Line Management for Contrast Agent-related Anaphylaxis: Safety Perspective for Radiology Trainees.","authors":"Yoshito Tsushima, Ayako Taketomi-Takahashi","doi":"10.1148/rg.260026","DOIUrl":"https://doi.org/10.1148/rg.260026","url":null,"abstract":"","PeriodicalId":54512,"journal":{"name":"Radiographics","volume":"46 5","pages":"e260026"},"PeriodicalIF":5.5,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147789455","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Undifferentiated Small Round Cell Sarcomas: Radiologic-Pathologic Correlation for the Updated WHO Classification Fifth Edition (2020).","authors":"Koichiro Mori, Ryo Kurokawa, Toru Motoi, Mariko Kurokawa, Toshihide Hirai, Yasunobu Takaki","doi":"10.1148/rg.250087","DOIUrl":"10.1148/rg.250087","url":null,"abstract":"<p><p>The World Health Organization introduced substantial revisions in the 2020 fifth edition of the classification system for bone and soft-tissue tumors, reorganizing what were previously called the Ewing sarcoma family of tumors or Ewing-like sarcomas into a new category of \"undifferentiated small round cell sarcomas\" based on molecular genetic characteristics. This reclassification established four distinct entities: Ewing sarcoma (ES), <i>CIC</i>-rearranged sarcoma, sarcoma with <i>BCOR</i> genetic alterations, and sarcoma with <i>EWSR1-</i>non<i>-ETS</i> fusion genes. Each subtype may demonstrate specific clinical, pathologic, and imaging features, with different treatment responses and prognoses. ES primarily affects children and young adults, with characteristic \"moth-eaten\" lytic bone destruction, aggressive periosteal reactions, and extensive surrounding soft-tissue masses. <i>CIC</i>-rearranged sarcomas typically manifest as well-circumscribed lobulated soft-tissue masses with extensive internal necrosis and hemorrhage but no calcification. Sarcomas with <i>BCOR</i> genetic alterations commonly occur in adolescent boys as osteolytic or sclerotic lesions in the long bones or the pelvis, often with calcification in the extraosseous component. Sarcomas with <i>EWSR1-</i>non<i>-ETS</i> fusion genes may manifest as osteolytic lesions with cortical expansion and saucer-like surface erosion in long bone diaphyses. Radiologic recognition of <i>CIC</i>-rearranged sarcomas enables oncologists to anticipate their aggressive nature and poor response to standard ES treatments, which may necessitate more intensive initial surgical interventions. In comparison, identifying <i>BCOR-CCNB3</i> sarcomas through imaging allows clinicians to inform patients of their potentially more favorable outcomes compared with those of ES while still applying appropriate comprehensive treatment approaches. The authors provide an overview of the clinical features, pathologic findings, imaging characteristics, differential diagnosis, and treatment outcomes of each entity. ^©RSNA, 2026.</p>","PeriodicalId":54512,"journal":{"name":"Radiographics","volume":"46 4","pages":"e250087"},"PeriodicalIF":5.5,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147522815","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Imaging Findings in Parasitic and Vector-borne Infections of the Head, Neck, and Spine.","authors":"Nadia Solomon, Francisco Calle, Shreyas Reddy Kankara, Anne Sailer, Mine Sorkun, Pedro Lourenço Lino, Irene Dixe de Oliveira Santo, Vikram Singh Dogra, Angel Donato, Maria Cristina Chammas, Jonathan Russell, Nishant Aswani, Archana Rijhsinghani, Douglas S Katz, Yashant Aswani, Margarita V Revzin","doi":"10.1148/rg.250108","DOIUrl":"10.1148/rg.250108","url":null,"abstract":"<p><p>While many parasitic and vector-borne infections have traditionally been considered to have geographically limited distribution, factors including climate change, the immigration and world travel of individuals, and the importing and exporting of goods continue to shift ecosystems and expand the geographic distributions of parasites and insect vectors and the infections they transmit. Because they may be unexpected, cases emerging in regions of nonendemicity can result in a medical mystery, and because appropriate management relies on an accurate diagnosis, identification of these diseases is vital. Radiologists should be aware of these infections and their potential sequelae to help limit the delays in diagnoses and potentially lifesaving treatment that can occur if the diagnosis is not promptly suggested and investigated. Although some imaging findings are nonspecific, a knowledgeable radiologist can play a crucial role in correlating imaging features or patterns of features with laboratory findings and available clinical information to reveal the diagnosis and/or develop a differential diagnosis. The authors describe a variety of parasitic and vector-borne infections that affect humans, with a specific focus on those that manifest in the head, neck, and spine. A brief introduction to these infections is provided and includes relevant epidemiologic factors, clinical presentations, and potential complications, with the sequelae associated with head, neck, and nervous system infections more thoroughly described. Case examples are included to demonstrate the imaging features associated with acute and chronic and common and uncommon sequelae of these infections across multiple imaging modalities. ^©RSNA, 2026 Supplemental material is available for this article.</p>","PeriodicalId":54512,"journal":{"name":"Radiographics","volume":"46 4","pages":"e250108"},"PeriodicalIF":5.5,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147488376","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Single Ventricle: Radiology Primer for Preprocedural Evaluation.","authors":"Prabhakar Shantha Rajiah, Vineeta Ojha, Shravan Sridhar, Alastair Moore, Kianoush Ansari Gilani, Ravi Ashwath","doi":"10.1148/rg.250070","DOIUrl":"10.1148/rg.250070","url":null,"abstract":"<p><p>Single ventricle is an uncommon congenital abnormality characterized by a single anatomic or functional ventricle that cannot sustain two separate serial circulations. Imaging plays an important role in classifying a single ventricle, quantitating ventricular and valvular function, detecting associated cardiovascular anomalies, and identifying critical factors for management. Echocardiography is the first-line imaging modality. MRI and CT are useful when echocardiography is indeterminate or suboptimal, especially for evaluation of vascular anatomy. Morphologically, two atria can connect to a single ventricle; two atria can connect to separate ventricles with hypoplasia of one ventricle; or both atria and ventricles can be present, but single ventricle physiology exists due to a common atrioventricular canal or decreased function of one ventricle. Common forms of a single ventricle include hypoplastic left heart syndrome, tricuspid atresia, double-inlet ventricle, double-outlet right ventricle, unbalanced atrioventricular canal, and pulmonary atresia with intact septum. Examples of a functional single ventricle include pulmonary atresia with ventricular septal defect, severe Ebstein anomaly, and severe obstructive lesions. Grouping diverse congenital heart defects as \"single ventricle physiology\" is clinically important due to their shared hemodynamic challenges and management strategy centered on three-stage univentricular palliation. Alternatively, biventricular or one-and-a-half ventricular repair can be performed in select patients, with heart transplant being the last option. Critical imaging parameters for presurgical evaluation include anatomy, atrial septal restriction, ventricular and valvular function, bulboventricular foramen, outlet obstruction, pulmonary vascular resistance, patency of ductus arteriosus, pulmonary artery anatomy, venous connections, and collaterals. ^©RSNA, 2026 Supplemental material is available for this article. See the invited commentary by Kabakus and Baruah in this issue.</p>","PeriodicalId":54512,"journal":{"name":"Radiographics","volume":"46 4","pages":"e250070"},"PeriodicalIF":5.5,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147522740","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Updates on Adult Transcranial Doppler, Gray-Scale, and Contrast-enhanced US Techniques.","authors":"Mateus A Esmeraldo, Emanoel R de Melo, Matheus Fritzen, Karina Braga, Matheus F Brunetto, Paulo S C Ferreira, Eduardo D Chiovatto, Renato D Chiovatto, Colbey W Freeman, Andrea Cavalanti Gomes, Maria Cristina Chammas","doi":"10.1148/rg.250182","DOIUrl":"10.1148/rg.250182","url":null,"abstract":"<p><p>Transcranial US is a noninvasive, portable, real-time imaging technique that enables targeted evaluation of the intracranial circulation and select brain parenchymal structures through cranial bone windows. Traditionally, transcranial Doppler (TCD) has been used in well-established clinical scenarios, including vasospasm monitoring, stroke risk assessment, and ancillary testing for brain death. TCD encompasses two main techniques: nonimaging TCD (niTCD) and TCD imaging (TCDi). niTCD is a \"blind\" US technique that relies on standardized depths for vessel localization, guided by characteristic flow waveforms. In contrast, TCDi is a triplex approach that integrates gray-scale (B-mode) US, color Doppler US, and spectral Doppler US into an image-guided examination, enabling direct visualization of the intracranial anatomy and improving diagnostic confidence and reproducibility. In parallel, transcranial B-mode sonography (TCS), incorporated into modern TCDi, has demonstrated promising applications in adult patients, both in the neurointensive care unit and in outpatient practice. In addition, contrast-enhanced US (CEUS) has emerged as a powerful adjunct, markedly enhancing the Doppler signal in patients with poor bone windows, and has expanded the scope of transcranial US toward new exploratory vascular and cerebral perfusion applications. This article provides a comprehensive update on transcranial US in adults, including gray-scale imaging, Doppler techniques, and CEUS applications. With a focus on evidence-based indications and practical techniques, this article aims to support broader awareness and clinical adoption of transcranial US in contemporary adult neuroimaging, with a particular emphasis on TCDi, which remains underrecognized and underused despite its demonstrated clinical value in select indications. © The Author(s) 2026. Published by the Radiological Society of North America under a CC BY 4.0 license.</p>","PeriodicalId":54512,"journal":{"name":"Radiographics","volume":"46 4","pages":"e250182"},"PeriodicalIF":5.5,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147445870","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}