Radiological assessment following pancreaticoduodenectomy is critical for the prompt diagnosis and management of postoperative complications, significantly influencing patient outcomes. Pancreaticoduodenectomy, or the Whipple procedure, is the standard surgical intervention for pancreatic and periampullary malignancies, but it involves notable risks, especially from complications like fistulas, bleeding, or leakage. Cross-sectional imaging, particularly contrast-enhanced computed tomography, serves as the primary diagnostic tool due to its rapid acquisition, high resolution, and effective delineation of postoperative anatomy and complications. Magnetic resonance imaging (with cholangiopancreatography and hepatobiliary contrast agents) complements CT by providing superior contrast resolution for specific complications, notably in the biliary system and pancreatic duct. This narrative review discusses various imaging techniques and their applications, highlighting characteristic radiological features of common postoperative complications. It underscores the importance of a multidisciplinary approach, emphasizing close collaboration between radiologists and surgeons to optimize surgical decision-making and improve patient management post-pancreatic surgery.

Background: Accurate preoperative staging is the cornerstone of therapeutic decision-making in gastric cancer (GC), yet standard modalities often fail to capture the full extent of disease, particularly in diffuse and poorly cohesive histotypes. This review aims to provide a comprehensive update on diagnostic imaging for GC, evaluating the established roles of CT, EUS, and PET/CT alongside the emerging capabilities of Magnetic Resonance Imaging (MRI) and Artificial Intelligence (AI). Methods: A structured narrative review was conducted by searching indexed biomedical databases for studies published between 2015 and 2024. A structured literature search screening process identified 410 relevant studies focusing on T, N, and M staging accuracy, quantitative imaging biomarkers, and radiomics. Results: While Multidetector CT remains the universal first-line modality, its sensitivity declines in infiltrative tumors and low-volume peritoneal carcinomatosis. EUS retains superiority for early (T1-T2) lesions but may offer limited value in advanced stages. Conversely, MRI (leveraging diffusion-weighted imaging (DWI) and multiparametric protocols) indicates superior soft-tissue contrast, potentially outperforming CT in the assessment of serosal invasion, nodal involvement, and occult peritoneal metastases. Furthermore, emerging fibroblast activation protein inhibitor (FAPI) PET tracers show promise in overcoming the limitations of FDG in mucinous and diffuse GC. Finally, radiomics and deep learning models are providing novel quantitative biomarkers for non-invasive risk stratification. Conclusions: Contemporary GC staging requires a tailored, multimodality approach. Evidence supports the increasing integration of MRI and quantitative imaging into clinical workflows to overcome the limitations of conventional techniques and support precision oncology.

Background: The fibrovascular stalk is characteristic of papillary bladder tumors and may be visualized on MRI as the inchworm sign. Contrast-enhanced ultrasound (CEUS) may depict the same structure dynamically by demonstrating pedicle perfusion before tumor enhancement. We hypothesized that CEUS would be more sensitive than the MRI inchworm sign for detecting a histologically confirmed fibrovascular stalk and that stalk presence would be associated with non-muscle-invasive bladder cancer without completely excluding detrusor muscle invasion. Methods: This retrospective study assessed 80 consecutive patients with one focal bladder lesion; 69 patients with technically adequate imaging and an adequate TURBT reference standard were included in the final paired analysis. Dedicated retrospective rereads of anonymized stored CEUS cine loops and complete mpMRI datasets were independently performed by two experienced readers per modality, who were blinded to the other imaging modality, histopathology, and each other’s assessments. A blinded pathologist assessed fibrovascular stalk presence and detrusor muscle invasion. Paired performance was evaluated using exact McNemar testing. Results: Histopathology identified a stalk in 48 lesions. CEUS detected 46 of 48 stalks, and MRI detected 36, corresponding to sensitivities of 95.8% and 75.0%, specificities of 90.5% and 81.0%, and accuracies of 94.2% and 76.8%, respectively. Interobserver agreement was 94.2% for both signs, with almost-perfect agreement for the CEUS vascular stalk sign (κ = 0.86) and the MRI inchworm sign (κ = 0.88). For MIBC detection, overall CEUS impression and VI-RADS 4–5 showed sensitivities of 66.7% and 87.5% (paired p = 0.063), specificities of 88.9% and 68.9% (paired p = 0.004), and accuracies of 81.2% and 75.4% (paired p = 0.424), respectively. Conclusions: However, the two signs are not operationally equivalent because the MRI inchworm sign additionally requires preservation of the underlying muscular layer, a criterion that may have contributed to its lower observed sensitivity. The stalk strongly favored non-muscle-invasive disease but did not exclude detrusor invasion. CEUS provides complementary perfusion information, whereas MRI-based VI-RADS remains central to local staging.

Introduction: Small hyperechoic renal masses are frequently detected incidentally on conventional ultrasound and are often presumed to represent benign lesions, particularly angiomyolipomas. However, malignant renal tumors, including renal cell carcinoma, may also appear hyperechoic when small, creating a diagnostic challenge at first-line imaging. This study aimed to evaluate the feasibility and exploratory diagnostic performance of B-mode ultrasound radiomics for differentiating benign and malignant small hyperechoic renal masses. Methods: This retrospective single-center study included adult patients with incidentally detected small hyperechoic renal masses measuring ≤3 cm and examined between July 2022 and April 2025. All lesions underwent standardized B-mode ultrasound assessment and multidisciplinary review. Final diagnosis was established by histopathology when available or by longitudinal ultrasound follow-up stability for lesions considered benign. Lesions were manually segmented on representative B-mode DICOM images, and original radiomic features were extracted using PyRadiomics version 3.0 according to standardized definitions compatible with the Image Biomarker Standardisation Initiative framework. A total of 114 original radiomic features were extracted from each lesion. The primary comparison was benign versus malignant lesions. Diagnostic performance was assessed using feature-level receiver operating characteristic analysis. Results: Forty-two lesions were included in the final radiomic cohort, including 26 malignant renal cell carcinomas and 16 benign angiomyolipomas. Malignant lesions included papillary renal cell carcinoma, chromophobe renal cell carcinoma, and clear-cell renal cell carcinoma. All malignant lesions were histologically confirmed. Among benign lesions, 14 angiomyolipomas were classified based on longitudinal ultrasound stability, whereas 2 were confirmed by ultrasound-guided percutaneous biopsy after mild dimensional increase during imaging surveillance. Among the extracted radiomic features, firstorder_Variance and firstorder_MeanAbsoluteDeviation showed the highest exploratory discriminatory performance, each achieving an area under the receiver operating characteristic curve of 0.837. Both features are first-order measures of gray-level dispersion within the segmented lesion. Higher values were observed in malignant lesions, suggesting greater intralesional grayscale heterogeneity compared with benign angiomyolipomas. Conclusions: B-mode ultrasound radiomics is feasible for the quantitative assessment of small hyperechoic renal masses and may provide complementary information for differentiating benign angiomyolipomas from malignant renal cell carcinomas. firstorder_Variance emerged as a representative candidate imaging biomarker of grayscale dispersion, with firstorder_MeanAbsoluteDeviation showing concordant performance as a related dispersion measure. These findings should be considered preliminary and hypothesis-generating and require validation in larger multicenter cohorts before clinical implementation.

Background: Ultra-high-frequency ultrasound (UHFUS), performed in the present study using 48 and 70 MHz transducers, enables high-resolution assessment of superficial tissues and may provide useful information on the morphology, internal architecture, vascularity, and anatomical relationships of oral cavity lesions. Methods: This retrospective single-center study included consecutive patients examined between January 2025 and June 2026. Of 137 eligible cases, five were excluded because of inadequate image or cine-loop quality, leaving 132 lesions for analysis. All examinations were performed by the same experienced radiologist using 48 and 70 MHz linear probes. Each lesion was assessed in B-mode in at least two orthogonal planes and with Color Doppler. Archived anonymized examinations were reviewed using a predefined structured form. Morphology, margins, echogenicity, echotexture, composition, posterior acoustic features, vascularity, dimensions, presumed plane of origin, and involvement of adjacent anatomic layers were evaluated. The qualitative synthesis was performed jointly by a radiologist and an oral pathologist, with disagreements resolved by consensus. Results: UHFUS allowed detailed visualization of mucosal, submucosal, muscular, and bone/periodontal interfaces and enabled qualitative characterization of lesion boundaries, internal structure, vascular patterns, and local extension. The combined use of 48 and 70 MHz probes provided complementary information according to lesion depth and tissue composition. Five representative histologically confirmed cases from the study cohort illustrated reactive/inflammatory, benign neoplastic, and malignant conditions. One additional clinically confirmed gingival fistula, not included in the analytical cohort, was presented solely as an illustrative example of a superficial fistulous tract detectable with UHFUS. Conclusions: UHFUS provides detailed, layer-based assessment of oral cavity lesions and may complement clinical examination and histopathology in lesion characterization and preoperative evaluation. Sonographic findings should be interpreted within a multimodal diagnostic framework rather than as stand-alone criteria.