Gadolinium-based contrast agents (GBCAs) have helped to improve the role of magnetic resonance imaging (MRI) for the diagnosis and treatment of diseases. There are currently nine different commercially available gadolinium-based contrast agents (GBCAs) that can be used for body MRI cases, and which are classifiable according to their structures (cyclic or linear) or biodistribution (extracellular-space agents, target/specific-agents, and blood-pool agents). The aim of this review is to illustrate the commercially available MRI contrast agents, their effect on imaging, and adverse reaction on the body, with the goal to lead to their proper selection in different clinical contexts. When we have to choose between the different GBCAs, we have to consider several factors: (1) safety and clinical impact; (2) biodistribution and diagnostic application; (3) higher relaxivity and better lesion detection; (4) higher stability and lower tissue deposit; (5) gadolinium dose/concentration and lower volume injection; (6) pulse sequences and protocol optimization; (7) higher contrast-to-noise ratio at 3.0 T than at 1.5 T. Knowing the patient’s clinical information, the relevant GBCAs properties and their effect on body MRI sequences are the key features to perform efficient and high-quality MRI examination.

Errors in emergency ultrasound (US) have been representing an increasing problem in recent years thanks to several unique features related to both the inherent characteristics of the discipline and to the latest developments, which every medical operator should be aware of. Because of the subjective nature of the interpretation of emergency US findings, it is more prone to errors than other diagnostic imaging modalities. The misinterpretation of US images should therefore be considered as a serious risk in diagnosis. The etiology of error is multi-factorial: it depends on environmental factors, patients and the technical skills of the operator; it is influenced by intrinsic US artifacts, poor clinical correlation, US-setting errors and anatomical variants; and it is conditioned by the lack of a methodologically correct clinical approach and excessive diagnostic confidence too. In this review, we evaluate the common and uncommon sources of diagnostic errors in emergency US during clinical practice, showing how to recognize and avoid them.

Aim: To non-invasively predict Oncotype DX recurrence scores (ODXRS) in patients with ER+ HER2- invasive breast cancer (IBC) using dynamic contrast-enhanced (DCE) MRI-derived radiomics features extracted from primary tumor lesions and a ML algorithm. Materials and Methods: Pre-operative DCE-MRI of patients with IBC, no history of neoadjuvant therapy prior to MRI, and for which the ODXRS was available, were retrospectively selected from a public dataset. ODXRS was obtained on histological tumor samples and considered as positive if greater than 16 and 26 in patients aged under and over 50 years, respectively. Tumor lesions were manually annotated by three independent operators on DCE-MRI images through 3D ROIs positioning. Radiomic features were therefore extracted and selected using multistep feature selection process. A logistic regression ML classifier was then employed for the prediction of ODXRS. Results: 248 patients were included, of which 87 with positive ODXRS. 166 (66%) patients were grouped in the training set, while 82 (33%) in the test set. A total of 1288 features was extracted. Of these, 1244 were excluded as 771, 82 and 391 were excluded as not stable (n = 771), not variant (n = 82), and highly intercorrelated (n = 391), respectively. After the use of recursive feature elimination with logistic regression estimator and polynomial transformation, 92 features were finally selected. In the training set, the logistic regression classifier obtained an overall mean accuracy of 60%. In the test set, the accuracy of the ML classifier was 63%, with a sensitivity of 80%, specificity of 43%, and AUC of 66%. Conclusions: Radiomics and ML applied to pre-operative DCE-MRI in patients with IBC showed promises for the non-invasive prediction of ODXRS, aiding in selecting patients who will benefit from NAC.

Trauma is one of the most common causes of death or permanent disability in young people, so a timely diagnostic approach is crucial. In polytrauma patients, CEUS (contrast enhanced ultrasound) has been shown to be more sensitive than US (ultrasound) for the detection of solid organ injuries, improving the identification and grading of traumatic abdominal lesions with levels of sensitivity and specificity similar to those seen with MDCT (multidetector tomography). CEUS is recommended for the diagnostic evaluation of hemodynamically stable patients with isolated blunt moderate-energy abdominal traumas and the diagnostic follow-up of conservatively managed abdominal traumas. In this pictorial review, we illustrate the advantages and disadvantages of CEUS and the procedure details with tips and tricks during the investigation of blunt moderate-energy abdominal trauma as well as during follow-up in non-operative management.

Biliary atresia (BA) is a rare obliterative cholangiopathy and Kasai portoenterostomy (KP) represents its first-line treatment; clinical and laboratory parameters together with abdominal ultrasound (US) are usually performed during the follow-up. Shear-wave elastography (SWE) is able to evaluate liver parenchyma stiffness; magnetic resonance imaging (MRI) has also been proposed to study these patients. To correlate US, SWE, and MRI imaging findings with medical outcome in patients with BA who are native liver survivors after KP. We retrospectively enrolled 24 patients. They were divided in two groups based on “ideal” (n = 15) or “non-ideal” (n = 9) medical outcome. US, SWE, and MRI exams were analyzed qualitatively and quantitatively for imaging signs suggestive of chronic liver disease (CLD). Significant differences were found in terms of liver surface (P = 0.007) and morphology (P = 0.013), portal vein diameter (P = 0.012) and spleen size (P = 0.002) by US, liver signal intensity (P = 0.013), portal vein diameter (P = 0.010), presence of portosystemic collaterals (P = 0.042), and spleen size (P = 0.001) by MRI. The evaluation of portal vein diameter (moderate, κ = 0.44), of portosystemic collaterals (good, κ = 0.78), and spleen size (very good, κ = 0.92) showed the best agreement between US and MRI. A significant (P = 0.01) difference in liver parenchyma stiffness by SWE was also found between the two groups (cut-off = 9.6 kPa, sensitivity = 55.6%, specificity = 100%, area under the ROC curve = 0.82). US, SWE, and MRI findings correlate with the medical outcome in native liver survivor patients with BA treated with KP.