Radiographics最新文献

Adenomyosis, characterized by heterotopic endometrial tissue within the myometrium, is a common yet poorly understood condition affecting patients of childbearing age. Although typical features of adenomyosis are extensively discussed in the literature, there is no consensus on its imaging classification. The Morphological Uterus Sonographic Assessment (MUSA) consensus statement is a valuable tool for identifying and describing typical adenomyosis imaging features at US. However, for MRI, there is still no standardized consensus for descriptors and subtypes. The diverse atypical manifestations of adenomyosis are a diagnostic challenge. Familiarity with these manifestations is essential for accurate diagnosis, avoiding misdiagnosis, and ensuring optimal clinical management. The authors examine the imaging appearances of typical and atypical adenomyosis at US and MRI, encompassing focal adenomyosis, diffuse adenomyosis, adenomyomas (solid and cystic types), polypoid adenomyomas, adenomyosis during pregnancy, and malignant transformation. The discussion includes clinical, surgical, and pathologic aspects in the differential diagnosis, with consideration of uterine contractions, deep endometriosis with myometrial infiltration, leiomyomas, and accessory cavitated uterine masses. Practical tips are provided to assist radiologists in distinguishing adenomyosis from other conditions. ^©RSNA, 2025 Supplemental material is available for this article.

Acute chest pain is a common concern for which patients present to the emergency department. Nonetheless, many patients with acute chest pain indicative of acute coronary syndrome (ACS) show nonobstructed coronary arteries at invasive coronary angiography or coronary CT angiography (CCTA), which is a clinical conundrum in day-to-day practice. Guidelines recommend that the initial course of action for patients experiencing acute chest pain is to exclude extracardiac and cardiac conditions that could cause nonischemic myocardial damage, including aortic dissection, pulmonary embolism, or septic shock. The generic term troponin-positive with nonobstructed coronary arteries (TpNOCA) was coined to refer to patients with nonobstructed coronary arteries who present with clinical symptoms and signs of ACS and increased cardiac troponin levels, electrocardiographic changes, or both. The causes of TpNOCA may be ischemic (eg, myocardial infarction with nonobstructed coronary arteries [MINOCA] or ischemia with nonobstructed coronary arteries [INOCA]) or nonischemic (eg, extracardiac and cardiac entities). MINOCA and INOCA are working diagnostic terms used until a definitive cause is established (eg, coronary plaque rupture, coronary artery dissection, or coronary microvascular disease). Noninvasive cardiac imaging techniques, notably CCTA and cardiac MRI, and ischemia testing are pivotal in evaluating and treating these patients through accurate identification of the underlying cause, improvement in risk stratification, and guidance for clinicians in decision making for treatment and follow-up. ^©RSNA, 2025.

Assessment of knee ligament reconstructions other than the anterior cruciate ligament is challenging due to limited data and continuously developing techniques. Imaging is vital to assessment, demonstrating expected postoperative findings, allowing detection of complications, and enabling differentiation of techniques from one another-information that is critical if revision is being contemplated. Stress radiography is useful for evaluating joint stability in the setting of ligament insufficiency. The three-dimensional and multiplanar reconstruction capabilities of CT are highly useful in multiligament reconstruction, allowing unhindered evaluation of the many intersecting bone tunnels. Susceptibility artifacts in MRI can be remedied by use of metal artifact reduction sequences. Each technique, graft, and choice of specific ligaments to reconstruct must be decided on a case-to-case basis. Anatomic reconstruction reproduces the native ligament's anatomy but is more technically complex. Nonanatomic reconstruction is easier to perform but potentially provides less stability. As for graft selection, an autograft weakens another knee stabilizer, but an allograft is more expensive and less readily available. The decision to perform a single-ligament versus combined-ligament reconstruction ultimately rests on the degree of instability and the desire to return to sport. In contrast to single-ligament reconstruction, combined-ligament procedures are at higher risk of postoperative stiffness, arthrofibrosis, and tunnel convergence. Renewed attention to repair along with improvements in patient selection and rehabilitation protocols may change the future of operative treatment of ligament injury, and along with it, radiologic appraisal and reporting. ^©RSNA, 2025 Supplemental material is available for this article.

Various cystic breast lesions are encountered during screening and diagnostic breast imaging. According to the Breast Imaging Reporting and Data System (BI-RADS) from the American College of Radiology, cystic breast lesions can be classified into the following categories based on sonographic findings: simple cysts, complicated cysts, clustered microcysts, and complex cystic and solid masses. With appropriate technique, simple cysts can be diagnosed easily by satisfying the diagnostic criteria, which include anechoic round or oval lesions with circumscribed margins and posterior enhancement on US images. Simple cysts are categorized as BI-RADS category 2, benign. Complicated cysts contain debris and satisfy all other sonographic criteria for simple cysts, except they are not anechoic. Clustered microcysts are defined as lesions comprising a cluster of small anechoic masses without a solid component. Based on recent investigations, complicated cysts are categorized as BI-RADS category 3, probably benign, whereas clustered microcysts are categorized as BI-RADS category 2. Complex cystic and solid masses contain fluid and solid components and include those with a thick wall, thick septations, an intracystic or mural mass, and both cystic and solid components. They usually are considered BI-RADS category 4, suspicious, and are accompanied by a biopsy recommendation. Radiologists must evaluate cystic lesions carefully, with meticulous technique, and provide appropriate assessment and management recommendations, thereby reducing unnecessary follow-up and biopsies while preventing cancers from being missed or dismissed. ^©RSNA, 2025 Supplemental material is available for this article.

Secondary postpregnancy hemorrhage (PPH) is increasing in incidence, especially in developed countries such as the United States. PPH occurs after 24 hours and up to 12 weeks in the postpregnancy period and may be associated with significant maternal morbidity. Common causes of secondary PPH are subinvolution of the placental site (SIPS) and retained or residual products of conception (RPOC). Other less common and rare causes include bleeding diathesis, endo(myo)metritis, gestational trophoblastic disease, and vascular anomalies such as congenital arteriovenous malformation (AVM), iatrogenic arteriovenous fistula, or pseudoaneurysm. A common finding encountered during imaging evaluation of secondary PPH is increased vascularity in the myometrium deep to an implantation site, termed enhanced myometrial vascularity (EMV). EMV typically represents the physiologic reversion of the uterus back to its prepregnancy state. The appearance of EMV varies from mild to marked and is also associated with SIPS and RPOC. Interpretation or reporting of EMV as an AVM or other rare uterine vascular anomaly may lead to unnecessary testing and overtreatment. The authors review placental physiology, describe the causes of secondary PPH and their imaging appearances, and present an algorithm to assist the radiologist in diagnosis of this important condition and management options. ^©RSNA, 2025 Supplemental material is available for this article. See the invited commentary by Gomez in this issue.