Background: Accurate characterization of complex renal cystic lesions is essential for individualized patient management, as enhancement patterns of septa and walls determine Bosniak classification, malignancy risk, and tailored follow-up strategies. While contrast-enhanced ultrasound (CEUS) is widely used to assess enhancement, Superb Microvascular Imaging (SMI) offers a non-contrast alternative that is capable of detecting slow-flow microvascular signals. This study aimed to evaluate the diagnostic concordance, accuracy, and reproducibility of SMI compared with CEUS in the Bosniak 2019 classification, and to explore its role in personalized imaging pathways for patients with contraindications to contrast media. Methods: Eighty patients (92 cystic renal lesions) who underwent both SMI and CEUS between January 2024 and July 2025 were retrospectively analyzed. Lesions were categorized using the Bosniak 2019 criteria. CEUS served as the reference standard. Concordance between modalities was evaluated using Cohen’s κ, and diagnostic accuracy was determined by ROC analysis. Inter- and intra-reader agreement were assessed with κ and intraclass correlation coefficients (ICC), respectively. Histopathologic confirmation was available for resected Bosniak III–IV lesions. Results: SMI showed excellent concordance with CEUS (κ = 0.84, 95% CI 0.76–0.91; overall agreement 83.7%). Concordance was perfect for Bosniak I–II, good for IIF (85%), and moderate for III (68%) and IV (64%) categories. Using CEUS as the reference, SMI achieved a sensitivity of 88.5%, specificity of 90.0%, and AUC of 0.94 for distinguishing low- from high-risk lesions. Inter-reader (κ = 0.83) and intra-reader (ICC = 0.91) agreements were excellent. Among 18 surgically resected Bosniak III–IV lesions, 14 (77.8%) were malignant; SMI correctly identified 12/14 malignant and 3/4 benign cases. Conclusions: SMI shows high diagnostic accuracy and reproducibility in the assessment of complex renal cystic lesions, with strong concordance to CEUS within the Bosniak 2019 system. By providing vascular characterization without contrast administration, SMI supports more personalized renal cyst management, enabling safer imaging for patients at risk from contrast agents and potentially reducing unnecessary interventions. Further multicenter validation is warranted to define its integration into precision-oriented multiparametric renal ultrasound protocols.

Introduction: Ductal carcinoma in situ (DCIS) is a non-invasive precursor of breast cancer, usually detected on mammography as clustered microcalcifications. Many cases, however, lack calcifications and require complementary imaging. This study aimed to describe the multimodal imaging features of DCIS and evaluate the radiology–pathology correlation. Methods: We retrospectively reviewed 75 women (aged 36–52 years) with biopsy-proven DCIS (January 2023–June 2025). All underwent mammography, targeted ultrasound, and dynamic contrast-enhanced 1.5T MRI. Imaging findings were correlated with histopathology, and logistic regression was used to explore predictors of MRI kinetics. Results: Mammography detected microcalcifications in 53.8% of patients, while 46.2% showed no calcifications. Ultrasound frequently revealed non-mass, duct-oriented hypoechoic abnormalities in non-calcified cases. MRI consistently demonstrated non-mass enhancement, with weak or persistent kinetics without washout in 69.2% and washout in 30.8%. A moderate correlation between MRI and histological extent was found (r = 0.62, p < 0.001), with MRI tending to overestimate lesion size. Oral contraceptive use was common (61.5%) but not significantly associated with kinetic pattern or grade. Conclusions: Mammography remains essential for calcified DCIS, whereas MRI enhances detection of non-calcified lesions. Persistent kinetics without washout may represent a typical imaging feature of DCIS. However, moderate radiology–pathology concordance and frequent overestimation highlight the need for careful interpretation. These findings support a multimodal diagnostic approach that can improve detection accuracy and assist in more tailored surgical planning.

Background: We tested whether a contrast-free protocol can reproduce contrast-enhanced VI-RADS scoring and whether reader expertise influences results. Methods: In this retrospective single-center study (January–December 2024), 65 patients (69 lesions) underwent bladder multiparametric MRI. Two blinded radiologists assigned VI-RADS scores using only T2-weighted and diffusion-weighted imaging (biparametric, non-contrast MRI): an expert (>15 years in urogenital radiology) in genitourinary MRI and a non-expert (5 years of experience in genitorurinary radiology). Two complementary reference standards were used. For reproducibility analysis, the reference standard was the VI-RADS score from the original clinical report based on the full multiparametric examination including contrast-enhanced imaging. For diagnostic accuracy analysis, histopathology was used as the reference standard for muscle-invasive versus non-muscle-invasive disease. Agreement was evaluated with confusion matrices, overall agreement, and weighted Cohen’s kappa. Discrimination for high likelihood of muscle invasion (VI-RADS ≥ 4) was assessed with receiver operating characteristic analysis. Results: Reference scores were VI-RADS 2 (34.8%), 3 (14.5%), 4 (20.3%), and 5 (30.4%). Agreement was higher for the expert than the non-expert (73.9% vs. 56.5%; weighted kappa 0.74 [95% confidence interval 0.56–0.89] vs. 0.58 [0.37–0.75]). The area under the curve for VI-RADS ≥ 4 was 0.87 (0.78–0.95) for the expert and 0.81 (0.69–0.91) for the non-expert. Sensitivity at a biparametric threshold of VI-RADS ≥ 4 was 88.6% for both readers; specificity was 85.3% vs. 73.5%. Post-resection cases showed more discrepancies, mainly overstaging. Conclusions: Contrast-free biparametric MRI may approximate multiparametric VI-RADS scoring only in treatment-naïve pre-TURBT cases with clearly low-risk, non-equivocal imaging features, but performance is reader-dependent and less reliable in equivocal, higher-risk, and post-resection examinations. Contrast-enhanced multiparametric MRI remains preferred for staging.