Imaging-guided percutaneous ablative treatments, such as radiofrequency ablation (RFA), cryoablation and microwave ablation (MWA), have been developed for the treatment of unresectable primary and secondary lung tumors in patients with advanced-stage disease or comorbidities contraindicating surgery. Among these therapies, MWA has recently shown promising results in the treatment of pulmonary neoplasms. The potential advantages of MWA over RFA include faster ablation times, higher intra-tumoral temperatures, larger ablation zones and lower susceptibility to the heat sink effect, resulting in greater efficacy in proximity to vascular structures. Despite encouraging results supporting its efficacy, there is a relative paucity of data in the literature regarding the role of computer tomography (CT) to monitor MWA-treated lesions, and the CT appearance of their morphologic evolution and complications. For both interventional and non-interventional radiologists, it is crucial to be familiar with the CT features of such treated lesions in order to detect incomplete therapy or recurrent disease at early stage, as well as to recognize initial signs of complications. The aim of this pictorial essay is to describe the typical CT features during follow-up of lung lesions treated with percutaneous MWA and how to interpret and differentiate them from other radiological findings, such as recurrence and complications, that are commonly encountered in this setting.

Sarcopenia has been associated with an increased incidence of adverse outcomes, including higher mortality, after endovascular aortic repair (EVAR). We aim to use computed tomography (CT) to quantify changes in total psoas muscles area (PMA) and psoas muscle density (PMD) after EVAR, and to evaluate the reproducibility of both measurements. PMA and PMD were assessed via manual segmentation of the psoas muscle on pre- and post-operative CT scans belonging to consecutive patients who underwent EVAR. Wilcoxon test was used to compare PMA and PMD before and after EVAR, and inter- and intra-reader agreements of both methods were evaluated through Bland–Altman analysis. A total of 50 patients, 42 of them males (84%), were included in the study. PMA changes from 1243 mm² (1006–1445 mm²) to 1102 mm² (IQR 937–1331 mm²), after EVAR (p < 0.001). PMD did not vary between pre-EVAR (33 HU, IQR 26.5–38.7 HU) and post-EVAR (32 HU, IQR 26–37 HU, p = 0.630). At inter-reader Bland–Altman analysis, PMA showed a bias of 64.0 mm² and a coefficient of repeatability (CoR) of 359.2 mm², whereas PMD showed a bias of −2.43 HU and a CoR of 6.19 HU. At intra-reader Bland–Altman analysis, PMA showed a bias of −81.1 mm² and a CoR of 394.6 mm², whereas PMD showed a bias of 1.41 HU and a CoR of 6.36 HU. In conclusion, PMA decreases after EVAR. A good intra and inter-reader reproducibility was observed for both PMA and PMD. We thus propose to use PMA during the follow-up of patients who underwent EVAR to monitor muscle depletion after surgery.

This study aims to evaluate the role of MRI-based radiomic analysis and machine learning using both DWI with multiple B-values and dynamic contrast-enhanced T1-weighted sequences to differentiate benign (B) and malignant (M) parotid tumors. Patients underwent DCE- and DW-MRI. An expert radiologist performed the manual selection of 3D ROIs. Classification of malignant vs. benign parotid tumors was based on radiomic features extracted from DCE-based and DW-based parametric maps. Care was taken in robustness evaluation and the no-bias selection of features. Several classifiers were employed. Sensitivity and specificity ranged from 0.6 to 0.8. The combination of LASSO + neural networks achieved the highest performance (0.76 sensitivity and 0.75 specificity). Our study identified a few robust DCE-based radiomic features with respect to ROI selection that can effectively be adopted in classifying malignant vs. benign parotid tumors.

Reason to report Aicardi-Goutières syndrome is a rare congenital multisystem disease of genetic origin, and its manifestations resemble those of an intrauterine infection; therefore, TORCH infection (toxoplasmosis, others, rubella, cytomegalovirus, herpes) is its main differential diagnosis. The classic brain imaging features—leukoencephalopathy, striatal necrosis, intracranial calcifications and atrophy—are well known. Recently, another radiological pattern characterized by large-vessel stenosis, including moyamoya syndrome, and ischaemic lesions, has been reported, mainly with SAMHD1 mutation. What was unique We report a case of a moyamoya syndrome from this unusual cause, in a young child. Ramification of this report The radiologist must be aware of such arterial anomalies, which are poorly reported in the radiological literature, and search for them when performing brain magnetic resonance for Aicardi-Goutières syndrome, even in the absence of a genetic diagnosis. Moreover, in an infant or young child with moyamoya syndrome, Aicardi-Goutières syndrome should be included in the differential diagnoses.

Background: Percutaneous Microwave Ablation (MWA) of lung malignancies is a procedure with many technical challenges, among them the risk of residual disease. Recently, dedicated software able to predict the volume of the ablated area was introduced. Cone-beam computed tomography (CBCT) is the imaging guidance of choice for pulmonary ablation in our institution. The volumetric prediction software (VPS) has been installed and used in combination with CBCT to check the correct position of the device. Our study aimed to compare the results of MWA of pulmonary tumours performed using CBCT with and without VPS. Methods: We retrospectively reviewed 1-month follow-up enhanced contrast-enhanced computed tomography (CECT) scans of 10 patients who underwent ablation with the assistance of VPS (group 1) and of 10 patients who were treated without the assistance of VPS (group 2). All patients were treated for curative purposes, the maximum axial diameter of lesions ranged between 5 and 22 mm in group 1 and between 5 and 25 mm in group 2. We compared the presence of residual disease between the two groups. Results: In group 1 residual disease was seen in only 1 patient (10%) in which VPS had ensured complete coverage of the tumour. In group 2 residual disease was found in 3 patients (30%). Conclusions: Using this software during MWA of lung malignancies could improve the efficacy of the treatment compared to the conventional only CBCT guidance.