The assessment of lymph node (LN) involvement with clinical imaging is a key factor in cancer staging. Node Reporting and Data System 1.0 (Node-RADS) was introduced in 2021 as a new system specifically tailored for classifying and reporting LNs on computed tomography (CT) and magnetic resonance imaging scans. The aim of this review is to compile the scientific evidence that has emerged since the introduction of Node-RADS, with a specific focus on its diagnostic performance and reliability. Node-RADS’s performance has been evaluated in various cancer types and anatomical sites, revealing a trend where higher Node-RADS scores correspond to a greater probability of metastatic LN with better diagnostic performances compared to using short axis diameter alone. Moreover, Node-RADS exhibits encouraging diagnostic value for both Node-RADS ≥ 3 and Node-RADS ≥ 4 cutoffs in predicting metastatic LN. In terms of Node-RADS scoring reliability, preliminary studies show promising but partially conflicting results, with agreement levels, mostly between two readers, ranging from fair to almost perfect. This review highlights a wide variation in methodologies across different studies. Thus, to fully realize the potential of Node-RADS in clinical practice, future studies should comprehensively evaluate its diagnostic accuracy, category-specific malignancy rates, and inter-observer agreement. Finally, although limited, promising evidence has suggested the following: a potential prognostic role for Node-RADS; the possible value of diffusion-weighted imaging for LNs classified as Node-RADS ≥ 3; a correlation between Node-RADS and certain texture features in CT; and improved diagnostic performance when Node-RADS is integrated into radiomics or clinical models.

Susceptibility-weighted imaging (SWI) is a magnetic resonance imaging (MRI) sequence sensitive to substances that alter the local magnetic field, such as calcium and iron, allowing phase information to distinguish between them. SWI is a 3D gradient–echo sequence with high spatial resolution that leverages both phase and magnitude effects. The interaction of paramagnetic (such as hemosiderin and deoxyhemoglobin), diamagnetic (including calcifications and minerals), and ferromagnetic substances with the local magnetic field distorts it, leading to signal changes. Neurodegenerative diseases are typically characterized by the progressive loss of neurons and their supporting cells within the neurovascular unit. This cellular decline is associated with a corresponding deterioration of both cognitive and motor abilities. Many neurodegenerative disorders are associated with increased iron accumulation or microhemorrhages in various brain regions, making SWI a valuable diagnostic tool in clinical practice. Suggestive SWI findings are known in Parkinson’s disease, Lewy body dementia, atypical parkinsonian syndromes, multiple sclerosis, cerebral amyloid angiopathy, amyotrophic lateral sclerosis, hereditary ataxias, Huntington’s disease, neurodegeneration with brain iron accumulation, and chronic traumatic encephalopathy. This review will assist radiologists in understanding the technical framework of SWI sequences for a correct interpretation of currently established MRI findings and for its potential future clinical applications.

Objectives: To test the Reason for Exam Imaging Reporting and Data System (RI-RADS) in assessing the quality of radiology requests in an Italian cohort of inpatients; to evaluate the interobserver reliability of RI-RADS. Methods: A single-center quality care study was designed to retrospectively identify consecutive radiology request forms for computed tomography, magnetic resonance imaging, and conventional radiography examinations. One radiologist scored the requests using the RI-RADS. The association between RI-RADS and clinical request variables (urgent request, on-call requests, indication for imaging, requesting specialty, imaging modality, and body region) was evaluated. We calculated interobserver agreement between four readers in a subset of 450 requests. Results: We included 762 imaging requests. RI-RADS grades A (adequate request), B (barely adequate request), C (considerably limited request), D (deficient request), and X were assigned to 8 (1%), 49 (7%), 237 (31%), 404 (53%), and 64 (8%) of cases, respectively. In the multivariate analysis, the indication for imaging, body region, and requesting specialty significantly influenced the RI-RADS. Indications for imaging with a high risk of poor RI-RADS grade were routine preoperative imaging and device check requests. The upper extremity was the body region with the highest risk of poor RI-RADS grade. Requesting specialties with a high risk of poor RI-RADS grade were cardiovascular surgery, intensive care medicine, and orthopedics. The analysis of the interobserver agreement revealed substantial agreement for the RI-RADS grade. Conclusion: The majority of radiology exam requests were inadequate according to RI-RADS, especially those for routine imaging. RI-RADS demonstrated substantial reliability, suggesting that it can be satisfactorily employed in clinical settings. Critical relevant statement: The implementation of RI-RADS can provide a framework for standardizing radiology requests, thereby enabling quality assurance and promoting a culture of quality improvement. Key Points: RI-RADS aims to grade the completeness of radiology requests. Over half of the imaging requests were RI-RADS D grade; RI-RADS demonstrated substantial reliability. Most radiology requests were inadequate and RI-RADS could classify them in clinical practice. Graphical

Glioblastoma is the most frequent form of adult-type diffuse gliomas, and it carries a very poor prognosis. Magnetic resonance imaging (MRI) is an indispensable tool for diagnosing and monitoring brain tumors, potentially influencing choices like repeat surgery, biopsy, or alternative management strategies. However, interpreting post-surgical MRI for gliomas can be particularly demanding, especially in differentiating between tumor progression and treatment effects. Recently, a novel score specifically designed for classifying and reporting post-treatment brain tumors on MRI was proposed by a team of neuroradiologists, neurosurgeons, and neuro-oncologists: the Brain Tumor Reporting and Data System (BT-RADS). This review examines the current body of evidence regarding the use of BT-RADS in monitoring adult-type diffuse gliomas following surgery. This classification has demonstrated a number of benefits in terms of prognostic value, treatment decisions, reliability, and the quality of radiology reports. On the other hand, despite the promising diagnostic value in identifying recurrent glioblastoma, there is still some uncertainty in defining the presence or absence of tumor recurrence in the intermediate category 3. In such a category, incorporating advanced techniques such as perfusion-weighted imaging and diffusion-weighted imaging may improve the stratification of patients, avoiding repeat surgery on false positive findings.

Leptomeningeal myelomatosis is a rare complication of multiple myeloma (<1% of the patients). There was an increase in the incidence of leptomeningeal myelomatosis during the last decade; the prognosis of leptomeningeal myelomatosis remains poor, (overall median survival from the time of diagnosis of 2 months). We discuss a rare case of a monoclonal gammopathy evolving into multiple myeloma and finally into a rapidly progressing leptomeningeal disease. A 76 year-old woman in hematologic follow-up for advanced stage multiple myeloma in sixth-line treatment had an episode of generalized tonic-clonic seizure with sphincter release followed by altered state of consciousness. The unenhanced head CT scan showed a mild enlargement of the ventricular system without intra-axial or extra-axial hemorrhages nor significant changes in brain parenchyma. The subsequent contrast-enhanced brain MRI revealed a widespread nodular leptomeningeal enhancement characterized by contrast-enhancement of the pia mater extended into the subarachnoid spaces of the sulci and cisterns, involving supra- and sub-tentorial regions and the statoacoustic nerve in the inner ear canal bilaterally. The fluid-attenuated inversion recovery MRI images demonstrated an abnormally elevated signal within the sulci in the parieto-occipital regions. The radiological diagnosis of leptomeningeal myelomatosis was made. The patient died 4 days after the examination. In patients with long-lasting multiple myeloma and onset of neurological signs or symptoms, a contrast-enhanced brain MRI should be performed to assess the actual burden of central nervous system involvement in leptomeningeal myelomatosis; CT may provide a clue to the diagnosis when progressive enlargement of the ventricles over time is noted.