Radiographics最新文献

Although lymphoscintigraphy is most commonly used for sentinel lymph node mapping, it can also be helpful for evaluating lymphedema, lymphatic malformations, lymphatic leaks, chylous ascites, and chylothorax. Assessment for lymphedema is important because this condition poses significant clinical challenges, and early diagnosis is essential for timely intervention and prevention of complications. Lymphoscintigraphy is a valuable radiologic tool for distinguishing lymphatic causes of edema from nonlymphatic ones, with findings of lymphedema including absent, asymmetric, or delayed drainage from the injection site; dermal backflow; and reduced activity in the inguinal or axillary lymph nodes at lower extremity and upper extremity lymphoscintigraphy. Other supporting evidence of lymphedema may include collateral lymphatic channels and visualization of the deep lymphatic nodes. Additional imaging modalities, such as fluorescence lymphangiography, US, and MR lymphangiography, can also aid in lymphedema assessment. The authors provide an overview of lymphatic physiology, image acquisition, and image interpretation. ^©RSNA, 2025.

Breaking bad news to patients is a complex and delicate matter that is quite prevalent in medical practice. The ability to communicate with the patient is fundamental even for the radiologist, who must prepare for discussing difficult news in imaging environments. With that in mind, the authors provide a communication protocol and mnemonic for radiologists, RADNEWS, based on strategies reported in the literature so that communication happens in an efficient and empathetic way, minimizing questions or insecurities. Following this protocol can help patients and their family members navigate and process their reactions in the face of difficult news. ^©RSNA, 2025.

Interventional radiologists are key members of the multidisciplinary team involved in the care of patients with primary or metastatic neoplastic disease in the thorax. Percutaneous ablation is a safe and efficacious treatment of lung tumors, especially for patients with medical comorbidities or oligometastatic disease. Endovascular approaches can benefit patients with thoracic oncologic disease by allowing for primary arterial treatment, preoperative embolization, or embolization for tumor-related hemoptysis. Drainage and shunt procedures can help alleviate symptoms in patients with malignant pleural effusions, chylothoraces, and pericardial effusions. The authors summarize several available minimally invasive interventions to the thorax for tumor treatment and symptom palliation. ^©RSNA, 2025.

Three-dimensional (3D) US is an invaluable, rapidly evolving tool in gynecologic imaging. This examination, comparable to CT and MRI, enables volumetric data to be obtained, reconstructed, and displayed in multiple planes. It also enables the sonologist to better understand the spatial and anatomic relationships of uterine and adnexal abnormalities, thereby improving diagnostic accuracy. Three-dimensional US can be performed routinely following a two-dimensional (2D) transabdominal and/or transvaginal US examination or as an adjunctive troubleshooting technique, since no additional patient preparation is necessary. Performing additional 3D imaging adds only a few minutes to the original examination time while yielding information that is useful for reaching a diagnosis. Multiplanar reconstruction of volumetric data in the midcoronal plane is the cornerstone for diagnosing congenital uterine anomalies, as it allows visualization of the external uterine contour and shape of the endometrial cavity. It also enables early detection of endomyometrial junction abnormalities such as adenomyosis and focal adenomyomas. Combined with 3D power Doppler imaging, 3D US may help differentiate endometrial polyps, submucosal fibroids, endometrial hyperplasia, and endometrial carcinoma, aiding in clinical decision making. This examination also facilitates accurate localization of fibroids relative to the endometrial cavity and serosal surface of the uterus. The authors review the technique for acquisition of 3D volume datasets, image reconstruction, and new software techniques for data postprocessing that are applicable to gynecologic imaging. In addition, scenarios in which the addition of 3D US provides an advantage over routine 2D US, including imaging of congenital uterine anomalies, fibroid localization, and differentiation of endometrial diseases, are highlighted. ^©RSNA, 2025 Supplemental material is available for this article.

Surgery is an option for eligible patients with medically refractory epilepsy. Presurgical neuroimaging is tailored to allow identification of structural abnormalities in areas corresponding to the epileptogenic zone, which is identified with other techniques, impacting postsurgical outcomes toward seizure freedom. In some cases, it is also important to identify the eloquent cortex and critical white matter tracts, which aid in surgical planning and counseling for patients. Invasive procedures such as hemispherectomy, corpus callosotomy, and lobectomy have existed for decades for the management of refractory epilepsy, but the arsenal of surgical options for epilepsy has expanded recently, with the introduction of newer minimally invasive treatments such as laser interstitial thermal therapy, focused US, gamma knife radiosurgery, and neuromodulatory procedures such as vagal nerve stimulation, deep brain stimulation, and responsive neurostimulation. Invasive intracranial monitoring, which includes placement of subdural electrodes and stereoelectroencephalography, is another important surgical procedure used for more precise localization of the epileptogenic zone before planning definitive surgery. The authors outline the indications, expected imaging appearances, and complications of invasive and minimally invasive surgical treatments of epilepsy to create familiarity with these procedures in the imaging community. Also discussed are MRI safety concerns involved in imaging patients with medically refractive epilepsy. ^©RSNA, 2025 Supplemental material is available for this article. See the invited commentary by Pai and Jabhedar Maralani in this issue.

Just as radiography has been used in forensic medicine since shortly after the discovery of x-rays in 1895, CT was introduced to postmortem investigation not long after its introduction to medicine in the 1970s. In recent decades, forensic radiology has declared itself as a new subspecialty capable of revolutionizing death investigation and research. A variety of postmortem imaging techniques have emerged. Postmortem CT (PMCT) is widely accepted around the world as a supplementary tool and, in specific cases and settings, an alternative to full autopsy. As its popularity grows, however, it is important for radiologists and pathologists to expand their understanding of the applications, benefits, and limitations of these techniques, as well as the unique nuances of postmortem imaging interpretation. This will ensure high-quality interpretations and avoid potential pitfalls that could result in premature or erroneous conclusions. The authors introduce the reader, particularly the radiologist, to the growing subspecialty of forensic imaging (focusing on imaging of the deceased), specifically focusing on PMCT and its applications in death investigation in both clinical and forensic settings. The authors also discuss the benefits and limitations of PMCT as well as important nuances of PMCT interpretation, emphasizing the similarities and differences between clinical and postmortem studies, the necessity of conducting thorough death investigations, and the importance of pursuing specialized education or training in postmortem imaging interpretation. Applications of more specialized imaging techniques to postmortem and forensic investigations are described, including developing research in this area. ^©RSNA, 2025 Supplemental material is available for this article.