Pub Date : 2025-06-01DOI: 10.1053/j.sult.2025.04.007
Eleonora Salles-Silva MD , Paula Lemos de Castro MD , Luiza Carvalho Ambrozino MD , Antonio Luis-Eiras de Araújo MD, PhD , Daniel Lahan-Martins MD, PhD , Maria Fernanda Arruda Almeida MD, PhD , Fabiano Rubião Lucchesi MD, PhD , Eduardo Oliveira Pacheco MD , Ulysses S. Torres MD, PhD , Giuseppe D’Ippolito MD, PhD , Daniella Braz Parente MD, PhD
Rare malignant liver tumors (RMLTs) comprise a diverse group of neoplasms with distinct imaging features and significant diagnostic challenges due to their low prevalence and overlap with more common hepatic lesions. This review highlights the main radiologic characteristics of selected rare malignant liver tumors—including fibrolamellar hepatocellular carcinoma, hepatic lymphoma, hepatocellular carcinoma in non-cirrhotic liver, mucinous cystic neoplasm, intraductal papillary neoplasm of the bile duct, epithelioid hemangioendothelioma, angiosarcoma, malignant hepatic adenoma, neuroendocrine tumor, hepatocholangiocarcinoma, hepatoblastoma, undifferentiated embryonal sarcoma, and infantile hepatic hemangioendothelioma—focusing on their presentation in computed tomography and magnetic resonance imaging. Recognizing specific imaging findings, such as arterial hyperenhancement, biliary communication, target and lollipop signs, and tumor morphology, can help narrow differential diagnoses and guide appropriate clinical management. Despite advancements in imaging, histopathologic confirmation is often required due to nonspecific features. Improved radiologic awareness of these rare entities is essential to facilitate early diagnosis and individualized treatment planning.
{"title":"Rare Malignant Liver Tumors: Current Insights and Imaging Challenges","authors":"Eleonora Salles-Silva MD , Paula Lemos de Castro MD , Luiza Carvalho Ambrozino MD , Antonio Luis-Eiras de Araújo MD, PhD , Daniel Lahan-Martins MD, PhD , Maria Fernanda Arruda Almeida MD, PhD , Fabiano Rubião Lucchesi MD, PhD , Eduardo Oliveira Pacheco MD , Ulysses S. Torres MD, PhD , Giuseppe D’Ippolito MD, PhD , Daniella Braz Parente MD, PhD","doi":"10.1053/j.sult.2025.04.007","DOIUrl":"10.1053/j.sult.2025.04.007","url":null,"abstract":"<div><div>Rare malignant liver tumors (RMLTs) comprise a diverse group of neoplasms with distinct imaging features and significant diagnostic challenges due to their low prevalence and overlap with more common hepatic lesions. This review highlights the main radiologic characteristics of selected rare malignant liver tumors—including fibrolamellar hepatocellular carcinoma, hepatic lymphoma, hepatocellular carcinoma in non-cirrhotic liver, mucinous cystic neoplasm, intraductal papillary neoplasm of the bile duct, epithelioid hemangioendothelioma, angiosarcoma, malignant hepatic adenoma, neuroendocrine tumor, hepatocholangiocarcinoma, hepatoblastoma, undifferentiated embryonal sarcoma, and infantile hepatic hemangioendothelioma—focusing on their presentation in computed tomography and magnetic resonance imaging. Recognizing specific imaging findings, such as arterial hyperenhancement, biliary communication, target and lollipop signs, and tumor morphology, can help narrow differential diagnoses and guide appropriate clinical management. Despite advancements in imaging, histopathologic confirmation is often required due to nonspecific features. Improved radiologic awareness of these rare entities is essential to facilitate early diagnosis and individualized treatment planning.</div></div>","PeriodicalId":49541,"journal":{"name":"Seminars in Ultrasound Ct and Mri","volume":"46 3","pages":"Pages 161-176"},"PeriodicalIF":1.5,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144054747","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-06-01DOI: 10.1053/j.sult.2025.04.009
Cynthia Lopes Pereira de Borborema MD , Julia Tagliaferri e Paletta MD , Eduardo O. Pacheco MD , Ulysses S. Torres MD, PhD , Giuseppe D’Ippolito MD, PhD
The periampullary region, defined as the area within 2 cm of the major papilla of the duodenum, is associated with various benign and malignant conditions. Although periampullary cancers are rare, they are the third leading cause of cancer-related deaths in the Western world. Tumors in this area often mimic benign lesions due to overlapping clinical presentations. Diagnostic imaging techniques, including computed tomography, magnetic resonance imaging, ultrasonography, and MR cholangiopancreatography, are commonly used in clinical practice and typically confirmed by pathological analysis. Therefore, evaluating imaging characteristics of rare and atypical periampullary conditions and classifying them into 4 categories (anatomical variations, tumors, inflammatory conditions, and miscellaneous disorders) can aid in the differential diagnosis and improve understanding of these lesions.
{"title":"Beyond the Common: A Pictorial Review of Rare and Atypical Periampullary Lesions","authors":"Cynthia Lopes Pereira de Borborema MD , Julia Tagliaferri e Paletta MD , Eduardo O. Pacheco MD , Ulysses S. Torres MD, PhD , Giuseppe D’Ippolito MD, PhD","doi":"10.1053/j.sult.2025.04.009","DOIUrl":"10.1053/j.sult.2025.04.009","url":null,"abstract":"<div><div>The periampullary region, defined as the area within 2 cm of the major papilla of the duodenum, is associated with various benign and malignant conditions. Although periampullary cancers are rare, they are the third leading cause of cancer-related deaths in the Western world. Tumors in this area often mimic benign lesions due to overlapping clinical presentations. Diagnostic imaging techniques, including computed tomography, magnetic resonance imaging, ultrasonography, and MR cholangiopancreatography, are commonly used in clinical practice and typically confirmed by pathological analysis. Therefore, evaluating imaging characteristics of rare and atypical periampullary conditions and classifying them into 4 categories (anatomical variations, tumors, inflammatory conditions, and miscellaneous disorders) can aid in the differential diagnosis and improve understanding of these lesions.</div></div>","PeriodicalId":49541,"journal":{"name":"Seminars in Ultrasound Ct and Mri","volume":"46 3","pages":"Pages 189-203"},"PeriodicalIF":1.5,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144051864","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-06-01DOI: 10.1053/j.sult.2025.04.006
Eleonora Salles-Silva MD , Paula Lemos de Castro MD , Luiza Carvalho Ambrozino MD , Luiza Labrunie MD , Mauricio Zapparoli MD , Mayra Veloso Ayrimoraes Soares MD , Antonio Luis-Eiras de Araújo MD, PhD , Daniel Lahan-Martins MD, PhD , Maria Fernanda Arruda Almeida MD, PhD , Eduardo Oliveira Pacheco MD , Ulysses S. Torres MD, PhD , Giuseppe D’Ippolito MD, PhD , Daniella Braz Parente MD, PhD
Rare benign liver tumors are often incidental findings on imaging and may mimic malignancies, posing diagnostic challenges. This review highlights the imaging features of uncommon benign hepatic lesions—including angiomyolipoma, inflammatory pseudotumor, paraganglioma, mesenchymal hamartoma, sclerosed hemangioma, solitary fibrous tumor, and lipoma—on multiphasic computed tomography and magnetic resonance imaging. While certain tumors exhibit characteristic features, others require close clinicopathological correlation for accurate diagnosis. Familiarity with their imaging presentations is essential to guide management, avoid unnecessary interventions, and distinguish these benign entities from malignant liver tumors.
Pub Date : 2025-06-01DOI: 10.1053/j.sult.2025.04.005
Gabriela Gayer MD
{"title":"Letter From the Editor","authors":"Gabriela Gayer MD","doi":"10.1053/j.sult.2025.04.005","DOIUrl":"10.1053/j.sult.2025.04.005","url":null,"abstract":"","PeriodicalId":49541,"journal":{"name":"Seminars in Ultrasound Ct and Mri","volume":"46 3","pages":"Page 153"},"PeriodicalIF":1.5,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143995169","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Wrist pain is a frequent clinical challenge with diverse etiologies requiring precise imaging assessment. Magnetic resonance imaging is the gold standard for evaluating soft tissue and osseous pathology, facilitating accurate classification and diagnosis. This review presents a structured magnetic resonance imaging-based framework for interpreting wrist pain, emphasizing clinically relevant findings in triangular fibrocartilage complex injuries, interosseous ligament pathology, ulnocarpal impaction, and midcarpal instability. By integrating anatomical insights with imaging characteristics, this approach enhances diagnostic accuracy and aids in optimizing patient management.
{"title":"Deciphering Wrist Pain: A Comprehensive MRI-Based Classification and Interpretation Approach","authors":"Akhileshwar R. Ginnaram , Suryansh Bajaj , Aditi Chaurasia , Shiva Singh , Aysha Lamis Vattoth , Caroline Tomanek , Ishan Pandey , Tarun Pandey","doi":"10.1053/j.sult.2025.04.003","DOIUrl":"10.1053/j.sult.2025.04.003","url":null,"abstract":"<div><div>Wrist pain is a frequent clinical challenge with diverse etiologies requiring precise imaging assessment. Magnetic resonance imaging is the gold standard for evaluating soft tissue and osseous pathology, facilitating accurate classification and diagnosis. This review presents a structured magnetic resonance imaging-based framework for interpreting wrist pain, emphasizing clinically relevant findings in triangular fibrocartilage complex injuries, interosseous ligament pathology, ulnocarpal impaction, and midcarpal instability. By integrating anatomical insights with imaging characteristics, this approach enhances diagnostic accuracy and aids in optimizing patient management.</div></div>","PeriodicalId":49541,"journal":{"name":"Seminars in Ultrasound Ct and Mri","volume":"46 3","pages":"Pages 225-263"},"PeriodicalIF":1.5,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144003335","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-06-01DOI: 10.1053/j.sult.2025.04.010
Ana Paula Fraga Cintra Gonzaga MD , Eduardo O. Pacheco MD , Larissa Rossini Favaro MD , Ulysses S. Torres MD, PhD , Giuseppe D’Ippolito MD, PhD
Solid pseudopapillary neoplasms (SPNs) of the pancreas are rare tumors that predominantly affect young women and are characterized by encapsulated lesions with a mixture of solid and cystic components. Although typically indolent with a favorable prognosis after surgical resection, SPNs can exhibit atypical features that complicate diagnosis, including dense calcifications, multiplicity, or occurrence in male and elderly patients. Magnetic resonance imaging plays a pivotal role in distinguishing SPNs from other pancreatic lesions, leveraging its superior contrast resolution to identify hallmark findings such as hemorrhage, cystic degeneration, and enhancement patterns. This review highlights both typical and atypical imaging presentations of SPNs and discusses key differential diagnoses, including pancreatic adenocarcinoma, neuroendocrine tumors, and mucinous cystic neoplasms. By broadening awareness of the variable manifestations of SPNs and integrating imaging with clinical and epidemiological data, this study aims to improve diagnostic accuracy and guide effective management strategies for ambiguous pancreatic lesions.
{"title":"Solid Pseudopapillary Neoplasm of the Pancreas: Typical, Atypical, and Mimicking Lesions—A Pictorial Review","authors":"Ana Paula Fraga Cintra Gonzaga MD , Eduardo O. Pacheco MD , Larissa Rossini Favaro MD , Ulysses S. Torres MD, PhD , Giuseppe D’Ippolito MD, PhD","doi":"10.1053/j.sult.2025.04.010","DOIUrl":"10.1053/j.sult.2025.04.010","url":null,"abstract":"<div><div>Solid pseudopapillary neoplasms (SPNs) of the pancreas are rare tumors that predominantly affect young women and are characterized by encapsulated lesions with a mixture of solid and cystic components. Although typically indolent with a favorable prognosis after surgical resection, SPNs can exhibit atypical features that complicate diagnosis, including dense calcifications, multiplicity, or occurrence in male and elderly patients. Magnetic resonance imaging plays a pivotal role in distinguishing SPNs from other pancreatic lesions, leveraging its superior contrast resolution to identify hallmark findings such as hemorrhage, cystic degeneration, and enhancement patterns. This review highlights both typical and atypical imaging presentations of SPNs and discusses key differential diagnoses, including pancreatic adenocarcinoma, neuroendocrine tumors, and mucinous cystic neoplasms. By broadening awareness of the variable manifestations of SPNs and integrating imaging with clinical and epidemiological data, this study aims to improve diagnostic accuracy and guide effective management strategies for ambiguous pancreatic lesions.</div></div>","PeriodicalId":49541,"journal":{"name":"Seminars in Ultrasound Ct and Mri","volume":"46 3","pages":"Pages 204-212"},"PeriodicalIF":1.5,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144056890","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-06-01DOI: 10.1053/j.sult.2025.04.008
Abrahão Elias-Neto MD , Thais Fellinger Trindade MD , Mariana Helena do Carmo MD , Raquel Nascimento Lopes MD , Mayara Rayssa Mendes dos Santos Cruz MD , Ana Paula Fraga Cintra Gonzaga MD , Felipe Peres Caldas Barony de Oliveira MD , Aley Talans MD , Gabriella Souza e Silva MD , Carlos Alberto Matsumoto MD , Eduardo Oliveira Pacheco MD , Daniel Bekhor MD , Ulysses S. Torres MD, PhD , Giuseppe D’Ippolito MD, PhD
Abdominal inflammatory lesions may closely mimic malignancies on imaging, leading to diagnostic uncertainty and potentially unnecessary interventions. This pictorial review presents a series of cases involving diverse inflammatory conditions—including autoimmune pancreatitis, xanthogranulomatous cholecystitis, diverticulitis, peritoneal tuberculosis, and others—that radiologically resembled neoplastic processes. Key imaging findings, such as mass-forming patterns, enhancement characteristics, and diffusion restriction, are discussed alongside clinical and laboratory correlations. Recognizing these mimickers is essential, as accurate diagnosis often depends on a multidisciplinary approach that integrates imaging expertise with clinical context, ultimately improving patient care and avoiding misdiagnosis.
{"title":"Abdominal Inflammatory Lesions Mimicking Malignancy: Imaging Pitfalls and Clues","authors":"Abrahão Elias-Neto MD , Thais Fellinger Trindade MD , Mariana Helena do Carmo MD , Raquel Nascimento Lopes MD , Mayara Rayssa Mendes dos Santos Cruz MD , Ana Paula Fraga Cintra Gonzaga MD , Felipe Peres Caldas Barony de Oliveira MD , Aley Talans MD , Gabriella Souza e Silva MD , Carlos Alberto Matsumoto MD , Eduardo Oliveira Pacheco MD , Daniel Bekhor MD , Ulysses S. Torres MD, PhD , Giuseppe D’Ippolito MD, PhD","doi":"10.1053/j.sult.2025.04.008","DOIUrl":"10.1053/j.sult.2025.04.008","url":null,"abstract":"<div><div>Abdominal inflammatory lesions may closely mimic malignancies on imaging, leading to diagnostic uncertainty and potentially unnecessary interventions. This pictorial review presents a series of cases involving diverse inflammatory conditions—including autoimmune pancreatitis, xanthogranulomatous cholecystitis, diverticulitis, peritoneal tuberculosis, and others—that radiologically resembled neoplastic processes. Key imaging findings, such as mass-forming patterns, enhancement characteristics, and diffusion restriction, are discussed alongside clinical and laboratory correlations. Recognizing these mimickers is essential, as accurate diagnosis often depends on a multidisciplinary approach that integrates imaging expertise with clinical context, ultimately improving patient care and avoiding misdiagnosis.</div></div>","PeriodicalId":49541,"journal":{"name":"Seminars in Ultrasound Ct and Mri","volume":"46 3","pages":"Pages 177-188"},"PeriodicalIF":1.5,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143993618","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-04-01DOI: 10.1053/j.sult.2025.05.001
Kim M. Cecil PhD , Muhammad G. Saleh PhD
Magnetic resonance spectroscopy (MRS) of the brain provides the clinician an in vivo neurochemical assessment within the clinical magnetic resonance imaging setting. This information can yield specificity when addressing questions pertaining to brain health and metabolism while characterizing disease and injury, evaluating treatment response, and prognosticating outcome. Proton MRS techniques can be useful in narrowing the diagnostic differential and capturing time-sensitive information for the continually developing pediatric brain. This paper provides a review of key proton MRS topics relevant for usage in pediatric populations. We discuss magnetic field strength, pediatric-sized head coils, water suppression techniques, localization pulse sequences, post-processing methods, analysis, and interpretation. These elements all require special consideration, particularly for the immature brain. We introduce the fundamentals of spectral editing. Finally, we present illustrative examples employing proton MRS in clinical practice to begin to synthesize these concepts into practical application.
{"title":"Proton Magnetic Resonance Spectroscopy for Pediatric Neuroimaging: Key Concepts for Practice","authors":"Kim M. Cecil PhD , Muhammad G. Saleh PhD","doi":"10.1053/j.sult.2025.05.001","DOIUrl":"10.1053/j.sult.2025.05.001","url":null,"abstract":"<div><div>Magnetic resonance spectroscopy (MRS) of the brain provides the clinician an in vivo neurochemical assessment within the clinical magnetic resonance imaging setting. This information can yield specificity when addressing questions pertaining to brain health and metabolism while characterizing disease and injury, evaluating treatment response, and prognosticating outcome. Proton MRS techniques can be useful in narrowing the diagnostic differential and capturing time-sensitive information for the continually developing pediatric brain. This paper provides a review of key proton MRS topics relevant for usage in pediatric populations. We discuss magnetic field strength, pediatric-sized head coils, water suppression techniques, localization pulse sequences, post-processing methods, analysis, and interpretation. These elements all require special consideration, particularly for the immature brain. We introduce the fundamentals of spectral editing. Finally, we present illustrative examples employing proton MRS in clinical practice to begin to synthesize these concepts into practical application.</div></div>","PeriodicalId":49541,"journal":{"name":"Seminars in Ultrasound Ct and Mri","volume":"46 2","pages":"Pages 117-138"},"PeriodicalIF":1.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144095512","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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