google ads
May 2025 Imaging Pearls - Educational Tools | CT Scanning | CT Imaging | CT Scan Protocols - CTisus

Imaging Pearls ❯ May 2025
-- OR --

3D and Workflow

  • The “client brain” is, as noted, logic driven, risk averse, and analytical and remains the main area of focus for a chief marketing officer who manages day-to-day operations. That perspective takes on the traditional, straightforward method of business decision making by evaluating important metrics such as return on investment, risk factors, cash flow, total revenue, and sales and gross margin growth, while focusing on rational arguments and due diligence. There is no question about the value that perspective holds for making smart, calculated, and safe business decisions. However, it can lead to hesitation or “paralysis by analysis.”
    The Power of Corporate Psychology in Advertising Sales: How Emotion and the Consumer Brain Drive Client Decisions
    Geoff Schiller, Elliot K. Fishman,  Linda C. Chu, Steven P. Rowe, Charles K. Crawford
    JACR 2025 (in press)
  • The “consumer brain,” in contrast, is everything that the “client brain” is not. That is the side of the brain that can start to influence behavior when chief marketing officers are contemplating solutions provided by advertising services. It is emotion driven, childlike, and impulsive, prioritizing feelings such as excitement, nostalgia, and personal connection. That perspective seeks experiences, storytelling, and emotional engagement. As expected, the consumer brain leads to faster, more instinctive decision making.
    The Power of Corporate Psychology in Advertising Sales: How Emotion and the Consumer Brain Drive Client Decisions
    Geoff Schiller, Elliot K. Fishman,  Linda C. Chu, Steven P. Rowe, Charles K. Crawford
    JACR 2025 (in press)
  • Timing plays a significant role, and current research reports that decisions are first made emotionally and justified rationally. Decisions are very much the result of our emotional state and heavily influence our perception of an experience and our rapid response. Strategies that lead with emotion establish stronger connections and more robust partnerships that have greater potential for long-term value. Activating the “consumer brain” is the first essential step for building excitement and capturing childlike curiosity and hope that drives people to embrace innovative solutions. Simply put, emotion sells.
    The Power of Corporate Psychology in Advertising Sales: How Emotion and the Consumer Brain Drive Client Decisions
    Geoff Schiller, Elliot K. Fishman,  Linda C. Chu, Steven P. Rowe, Charles K. Crawford
    JACR 2025 (in press)
  • “Storytelling is an active way to begin a pitch that instantaneously makes it more personal and engages the consumer with the sale. In many ways, storytelling can naturally incorporate other strategies, like referencing the past. Referencing  successes and positive emotional triggers can return consumers to a place of personal sentiment regarding the past. Other senses can entice emotional responses, such as visuals, sounds, and experiences that can engage different areas of the brain.”  
    The Power of Corporate Psychology in Advertising Sales: How Emotion and the Consumer Brain Drive Client Decisions
    Geoff Schiller, Elliot K. Fishman,  Linda C. Chu, Steven P. Rowe, Charles K. Crawford
    JACR 2025 (in press)
  • It is important to remember that activating the emotional aspect of decision making is not to trick or manipulate potential prospects into making reckless decisions with no reasonable consideration of facts. Advertising is as much of a relationship business as any, and respecting the integrity of the relationship is fundamental to the success of the potential partnership. What we hope to gain with this strategy is an even more intimate connection with clients by activating the inspirational and curious aspect of the consumer mindset, which, in turn, elevates the potential of the relationship and fosters an emotionally driven and logically supported dedication toward an end goal.
    The Power of Corporate Psychology in Advertising Sales: How Emotion and the Consumer Brain Drive Client Decisions
    Geoff Schiller, Elliot K. Fishman,  Linda C. Chu, Steven P. Rowe, Charles K. Crawford
    JACR 2025 (in press)
  • Perhaps no field of medicine has been more commoditized than radiology. The advent of the PACS led to the dissociation of radiology from realtime decision making and fueled the move into teleradiology, a potential death spiral that was accelerated by the coronavirus disease 2019 pandemic. Furthermore, the widespread adoption of structured reporting templates and interpretive criteria has driven home the point that radiologists should all be the “same” and provide the same output from a given scan. All of that makes logical sense and appeals to the “client brain.”
    The Power of Corporate Psychology in Advertising Sales: How Emotion and the Consumer Brain Drive Client Decisions
    Geoff Schiller, Elliot K. Fishman,  Linda C. Chu, Steven P. Rowe, Charles K. Crawford
    JACR 2025 (in press)
  • “However, to maximize our impact on patient care and outcomes, and to drive the value proposition of radiologists in the current era, we should strive to also activate the “consumer brains” in our referral base. Being available for phone calls for wet reads when our colleagues have anxious patients in the clinic; showing up to tumor boards and multidisciplinary conferences well versed in the potential clinical questions and then confidently helping guide therapeutic decisions; participating in research projects, from retrospective chart reviews to central reads for prospective multicenter trials; or, generally, just being a part of the care team and sharing in the responsibility for the patient would all activate our colleagues “consumer brains.” As a field, we should remember to leverage those emotional connections to prove our invaluable place in the medical community.”
    The Power of Corporate Psychology in Advertising Sales: How Emotion and the Consumer Brain Drive Client Decisions
    Geoff Schiller, Elliot K. Fishman,  Linda C. Chu, Steven P. Rowe, Charles K. Crawford
    JACR 2025 (in press)
  • “Work-life balance is an experience highly sought after by many today, especially since the coronavirus disease 2019 pandemic. Sayings like “work hard, play hard” are commonly used to describe techniques for achieving balance between time spent working and time spent doing other activities. With the modern age of technology, this sometimes takes the form of something called revenge bedtime procrastination, a phenomenon the medical world recognizes as delaying sleep to make up “me” time. However, many of us realize that the familiar “work hard, play hard” methodology is unsustainable for most individuals, leading to myriad complications and, most important, faster rates of burnout. The question then arises: how do we combat the increasing rates of burnout we observe today?”
    The Elevation Approach for Work-Life Harmony
    Tina Wells,  Elliot K. Fishman,  Linda C. Chu,  Steven P. Rowe,  Charles K. Crawford
    JACR 2025 (in press)
  • “Attempting to achieve balance by overloading one side of the scale to equal the other is not only a waste of valuable energy but also counterproductive, adding stress and accelerating burnout. A much better way of tackling this issue is by focusing on work-life harmony. By concentrating on harmony instead of balance, the important parts of our lives are invited to work together instead of against each other. With this framework in mind, the Elevation Approach was designed to guide individuals in their quest to address burnout by achieving work-life harmony”
    The Elevation Approach for Work-Life Harmony
    Tina Wells,  Elliot K. Fishman,  Linda C. Chu,  Steven P. Rowe,  Charles K. Crawford
    JACR 2025 (in press)
  • “Before graduating to the Elevation Approach, it is important to understand individual goals and motivations. Without that knowledge, the Elevation Approach has no direction. The first step is to make sure your goals are aligned with the feelings and environment you wish to create. Some simple goal-setting tips are as follows: (1) Your goal should help you lead a more joyous life, (2) your goal should address something that is missing from your life, (3) your goal should align with your values, (4) start with a small goal, (5) choose a goal you want, and (6) choose a goal that does not feel like work.”
    The Elevation Approach for Work-Life Harmony
    Tina Wells,  Elliot K. Fishman,  Linda C. Chu,  Steven P. Rowe,  Charles K. Crawford
    JACR 2025 (in press)
  • Literally every radiologist—whether a  aiming for partner, a seasoned partner who is helping guide the practice, a junior academic faculty member looking to build their reputation, a senior academic faculty member trying to ensure their lasting impact, or an academic leader who is helping empower their faculty and trainees—understands that the jobcomes with tremendous responsibility and will require a lot of work. One could even suggest that the Elevation Approach might need a phase 1.5: Perspiration, when the key principles of the Preparation phase (Decluttering, Get Curious, and Know Your Numbers) are carried over into a necessary, but time-limited, grind.
    The Elevation Approach for Work-Life Harmony
    Tina Wells,  Elliot K. Fishman,  Linda C. Chu,  Steven P. Rowe,  Charles K. Crawford
    JACR 2025 (in press)
  • “In that context, the importance of emphasizing “work-life harmony” over “work-life balance” is particularly crucial. If there are periods of time during which there will be imbalance and a necessary single-minded focus on work, ensuring that friends and family understand and support the radiologist during that period is paramount. Ultimately, with supportive friends and family and the right work environment, we can achieve “work-life harmony,” whereby a successful professional life improves our mental well-being and feeds into healthy personal relationships, while at the same time the healthy personal relationships free us mentally to focus on work and excel professionally.”
    The Elevation Approach for Work-Life Harmony
    Tina Wells,  Elliot K. Fishman,  Linda C. Chu,  Steven P. Rowe,  Charles K. Crawford
    JACR 2025 (in press)
Adrenal

  • “In conclusion, AMH is a rare disorder with limited literature available to support clinical decision-making. This study demonstrated that AMH is more often sporadic; associated with MEN2 in about one-quarter of patients; more often diagnosed as unilateral; associated with 1 or more symptoms of catecholamine excess; and often detectable on imaging. Adrenalectomy was the most common method of treatment with most patients achieving cure postsurgery. Future analyses of larger samples should enable improved delineation of patterns of presentation and better predictors of health outcomes that could assist in the clinical management of patients.”
    Adrenal Medullary Hyperplasia: A Systematic Review and Meta-analysis
    Rafal Ganni, David J Torpy, Henrik Falhammar, R Louise Rushworth,
    The Journal of Clinical Endocrinology & Metabolism, Volume 108, Issue 9, September 2023, Pages e885–e892,
  • Context Adrenal medullary hyperplasia (AMH) is a rare, incompletely described disorder of the adrenal medulla that is associated with catecholamine excess.
    Results A total of 66 patients, median age of 48 years, were identified from 29 reports. More than one-half were male (n = 39, 59%). The majority had unilateral (73%, n = 48) disease; 71% (n = 47) were sporadic and 23% (n = 15) were associated with the MEN2. Most (91%, n = 60) displayed signs and symptoms of excess catecholamine secretion, particularly hypertension. Elevated catecholamine concentrations (86%, n = 57) and adrenal abnormalities on imaging were common (80%, n = 53). More than one-half (58%, n = 38) had concurrent tumors: pheochromocytoma (42%, n = 16/38); medullary thyroid cancer (24%, n = 9/38); and adrenocortical adenoma (29%, n = 11/38). Most (88%, n = 58) underwent adrenalectomy with 45/58 achieving symptom resolution. Adrenalectomy was less common in patients under 40 years and those with bilateral disease (both P < .05).
    Conclusion AMH may be sporadic or associated with MEN2, most have catecholamine excess and imaging abnormalities. Unilateral involvement is more common. Most reported patients have been treated with adrenalectomy, which is usually curative with regard to catecholamine hypersecretion.  
    Adrenal Medullary Hyperplasia: A Systematic Review and Meta-analysis
    Rafal Ganni, David J Torpy, Henrik Falhammar, R Louise Rushworth,
    The Journal of Clinical Endocrinology & Metabolism, Volume 108, Issue 9, September 2023, Pages e885–e892,
  • “Adrenal medullary hyperplasia (AMH) is a rare benign condition of the adrenal gland, the epidemiology of which is poorly described. AMH is characterized by the presence of diffuse or nodular radiologically detectable lesions in the adrenal medulla, with episodic or persistent signs and symptoms of catecholamine excess. Clinical features include hypertension, sweating, palpitations, headache, and anxiety. AMH can be sporadic or familial, resulting from germline mutations of genes known to cause pheochromocytoma, such as the RET gene in multiple endocrine neoplasia type 2 (MEN2) syndrome, or in the NF1, SDHB, and MAX genes (4). Although clinical and biochemical findings of excess catecholamines (urine or blood) and imaging such as ultrasound, computed tomography, magnetic resonance imaging, and meta-iodobenzylguanidine (MIBG) scanning may help detect an expansion in the adrenal medulla, histological examination revealing a decrease in corticomedullary thickness ratio (<10:1) is diagnostic for AMH.”  
    Adrenal Medullary Hyperplasia: A Systematic Review and Meta-analysis
    Rafal Ganni, David J Torpy, Henrik Falhammar, R Louise Rushworth,
    The Journal of Clinical Endocrinology & Metabolism, Volume 108, Issue 9, September 2023, Pages e885–e892,
  • “AMH bears a symptomatologic resemblance to pheochromocytoma, a benign or malignant tumor of the adrenal medulla characterized also by proliferation of medullary cells with an atypical polygonal shape as opposed to normal cellular architecture seen in AMH. Thus, pheochromocytoma is the main differential diagnosis for AMH. AMH is considered a precursor for pheochromocytoma in patients with MEN2. Catecholamine α- and β-adrenergic receptor blockers are used to ameliorate the clinical features of catecholamine excess in AMH. However, surgical removal of the adrenal gland is the preferred treatment to control catecholamine excess and prevent progression to pheochromocytoma, particularly in patients with MEN2.”  
    Adrenal Medullary Hyperplasia: A Systematic Review and Meta-analysis
    Rafal Ganni, David J Torpy, Henrik Falhammar, R Louise Rushworth,
    The Journal of Clinical Endocrinology & Metabolism, Volume 108, Issue 9, September 2023, Pages e885–e892,
  • Computed tomography imaging revealed an enlarged adrenal gland or an adrenal tumor in 46% (n = 30) of the patients. Results of alternative imaging modalities included abnormal I-123 MIBG uptake in 39% (n = 26); hypervascularity on adrenal angiography (n = 3); adrenal growth in 3 of the 4 patients who had a magnetic resonance imaging scan; bilateral adrenal involvement in 1 of the 2 patients who had a fluorodopa positron emission tomography scan; a normal ultrasound in most cases (94%, n = 62); and an increased single-photon emission computed tomography uptake in 4 patients.  
    Adrenal Medullary Hyperplasia: A Systematic Review and Meta-analysis
    Rafal Ganni, David J Torpy, Henrik Falhammar, R Louise Rushworth,
    The Journal of Clinical Endocrinology & Metabolism, Volume 108, Issue 9, September 2023, Pages e885–e892,
Cardiac

  • BACKGROUND: Hypoattenuated leaflet thickening (HALT), identified on functional cardiac computed tomography (CTA), can affect valve function and clinical outcomes. The objective of this study was to assess the impact of HALT on clinical outcomes in patients treated with transcatheter aortic valve replacement (TAVR)
    RESULTS: Of 856 patients undergoing TAVR during the study period, 638 (75%) underwent CTA post-TAVR (median time 31 [30–37] days). HALT+ was evident in 79 (12.3%). HALT+ patients were more likely prescribed warfarin at 1, 3, and 12 months (all P<0.001) and had similar gradients compared with HALT− patients. After a median follow-up of 2.2 years (1.5- 3.2), HALT+ patients had increased mortality (30% versus 20%; P=0.001). In Cox regression analysis, presence of HALT (hazard ratio, 1.83 [95% CI, 1.13–2.97]; P=0.014) remained independently associated with long-term mortality.
    CONCLUSIONS: In a large, real-world cohort of patients receiving TAVR followed by systematic screening with CTA 30-days post-procedure, HALT was found in 12% of patients and independently associated with long-term mortality. Findings of this nonrandomized, observational cohort study require independent validation.
    Clinical Impact of Hypoattenuating Leaflet Thickening After Transcatheter Aortic Valve Replacement.  
    Garcia S, Fukui M, Dworak MW, et al
    Circ Cardiovasc Interv. 2022 Mar;15(3):e011480. doi: 10.1161/CIRCINTERVENTIONS.121.011480. 
  • WHAT IS KNOWN
    • It is unclear whether hypoattenuated leaflet thickening (HALT) can impact valve function and clinical outcomes.
    • Previous studies described the natural history of untreated HALT, but little is known about the effects of treatment with warfarin.
    WHAT THE STUDY ADDS
    • Using a large, prospective cohort of patients systematically screened and treated for HALT, our study shows a possible association with adverse cardiovascular outcomes.
    • This study warrants further investigation through dedicated clinical trials to test preventative and treatment strategies for HALT positive patients with a control arm of untreated patients, to establish optimal screening and treatment protocols for HALT.
  • Etiologies of Massive Myocardial Calcification
    Metastatic
    - Calcium or vitamin D deficiency
    - Hyperparathyroidsim
    - Oxaluria
    - Renal failure
    Dystrophic
    - Drug-induced (eg, steroids, cyclosporine)
    - Infectious (myocarditis, tuberculosis)
    - Inflammatory (sarcoidosis, rheumatic heart disease, sepsis, endomyocardial fibrosis)
    - Ischemic (myocardial infarction)
    - Mitral annular calcification
    - Neoplastic Traumatic (cardiac surgery, hemorrhage)
    - Idiopathic
Chest

  •  Liposarcomas are common malignant neoplasms arising in mesenchymal cells. However, mediastinal occurrence is very rare, accounting for less than 1% of all liposarcoma presentations. Patients are often diagnosed incidentally or may initially present with nonspecific symptoms arising due to mass effect and compression of nearby mediastinal structures. Liposarcomas are broadly classified by the World Health Organization (WHO) into 4 histological subtypes, including well-differentiated, dedifferentiated, myxoid/round cell and pleomorphic liposarcoma (PLS). Due to rapid growth and a high likelihood of local recurrence of mediastinal liposarcomas, complete excision is the primary method of treatment, sometimes requiring adjuvant chemotherapy and radiotherapy supplementation depending on aggressiveness and local tissue involvement.  
    Dedifferentiated liposarcoma of the anterior mediastinum: An uncommon case presentation and complex diagnosis  
    Charles K. Crawford, Hajra Arshad, Elliot K. Fishman
    R a d i o l o g y Cas e R e p o r t s 2 0 ( 2 0 2 5 ) 3 0 7 6 – 3 0 8 0   
  • ”Liposarcomas have various histological subtypes and the possibility of mixed subtypes contribute to the complexity of diagnosing specific liposarcomas. Studies have reported cases of all 4 subtypes in the mediastinum, along with few un- usual variants including PLS, myxoid well-differentiated li- posarcoma, thymoliposarcoma, and sclerosing high-grade li- posarcoma. Dedifferentiated liposarcoma (DDLS) are most commonly location is the retroperitoneum and the extremities. DDLS often presents with compressive symptoms due to its large size at initial diagnosis.”  
    Dedifferentiated liposarcoma of the anterior mediastinum: An uncommon case presentation and complex diagnosis  
    Charles K. Crawford, Hajra Arshad, Elliot K. Fishman
    R a d i o l o g y Cas e R e p o r t s 2 0 ( 2 0 2 5 ) 3 0 7 6 – 3 0 8 0   

  • Dedifferentiated liposarcoma of the anterior mediastinum: An uncommon case presentation and complex diagnosis  
    Charles K. Crawford, Hajra Arshad, Elliot K. Fishman
    R a d i o l o g y Cas e R e p o r t s 2 0 ( 2 0 2 5 ) 3 0 7 6 – 3 0 8 0   
Deep Learning

  • Objective: Multicancer Detection (MCD) tests, such as the GRAIL Galleri, offer a novel approach to cancer screening by detecting cancer-specific methylation patterns in cell-free DNA through a single blood sample. This study evaluated an 18-month implementation of MCD testing in a tertiary ambulatory internal medicine clinic.  
    Patients and Methods: Between June 2022 and November 2023, 2244 asymptomatic (without symptoms attributed to cancer) patients underwent MCD testing. The study focused on operational workflows, patient and physician education, and diagnostic follow-up of positive results. Standardized materials, including electronic health record (EHR) workflows, FAQs, and diagnostic pathways, were developed to facilitate implementation. Challenges included managing false positives, patient anxiety, costs, and ethical considerations.  
    Results:  Of the 2244 patients tested, 17 (0.76%) had positive results, and 15 underwent further diagnostic evaluation. Cancer was confirmed in 11 (73.3%) patients, including cases of breast, colon, esophageal, lymphoma, ovarian, and pancreatic cancers. Four patients had no identifiable malignancy despite comprehensive work-up.
    Conclusions: MCD testing is feasible in routine clinical workflows, with 73% of positive cases yielding cancer diagnoses. While promising, further research is required to assess long-term outcomes, cost-effectiveness, and optimal implementation strategies of cancer interception in broader healthcare settings.
    Implementation of a Multicancer Detection (MCD) Test in a Tertiary Referral Center in Asymptomatic Patients: An 18-Month Prospective Cohort Study
    Ryan T. Hurt et al.
    Journal of Primary Care & Community Health Volume 16: 1–18
  • “The concept of cancer interception is the proactive approach to identifying and intervening early in cancer development and progression to invasive disease. Currently, population-wide screening is only recommended for a few cancers, such as breast, colorectal, cervical, and (in high-risk individuals) lung. Cancers that have demonstrated increased mortality rates, such as pancreas and ovarian, have had no reliable biomarkers for interception or population-based screening tests in asymptomatic patients.”  
    Implementation of a Multicancer Detection (MCD) Test in a Tertiary Referral Center in Asymptomatic Patients: An 18-Month Prospective Cohort Study
    Ryan T. Hurt et al.
    Journal of Primary Care & Community Health Volume 16: 1–18
  • “Blood is inherently well suited as a potential biomarker source for cancer screening as it may contain circulating tumor cells, microRNA, and/or cell-free DNA (cfDNA) “shed” from a hitherto occult cancer. This potential has led to the development of novel blood-based, high-performance genomic technologies allowing for early detection of signals from multiple cancers, giving rise to a new paradigm of screening tests called multi-cancer detection (MCD) tests. MCD blood tests rely on analyses from cancer-specific DNA methylation patterns and have the potential to detect numerous cancer types in a single blood sample.”  
    Implementation of a Multicancer Detection (MCD) Test in a Tertiary Referral Center in Asymptomatic Patients: An 18-Month Prospective Cohort Study
    Ryan T. Hurt et al.
    Journal of Primary Care & Community Health Volume 16: 1–18
  • The current MCD program has subsequently updated these recommendations using an iterative process involving institution-wide specialist opinion. In addition, a standardized Epic order set was developed to efficiently select the best initial test after a positive MCD result. In situations where the initial diagnostic evaluation did not yield an answer to the positive MCD signal, we strongly considered escalating to a full-body PET scan in many scenarios. For patients with a positive MCD and a negative workup (including negative PET) conducted at MC, we recommend a follow-up MCD test within 6 months (cost covered by the MCD company) with a subsequent workup if the signal persists.  
    Implementation of a Multicancer Detection (MCD) Test in a Tertiary Referral Center in Asymptomatic Patients: An 18-Month Prospective Cohort Study
    Ryan T. Hurt et al.
    Journal of Primary Care & Community Health Volume 16: 1–18

  • Implementation of a Multicancer Detection (MCD) Test in a Tertiary Referral Center in Asymptomatic Patients: An 18-Month Prospective Cohort Study
    Ryan T. Hurt et al.
    Journal of Primary Care & Community Health Volume 16: 1–18
  • “Of the 15 remaining MCD-positive patients who went on to receive complete diagnostic workups, 11 (73.3%) patients were found to have cancer, representing true positives. These cancers included breast (n = 1), colon (n = 2), esophageal (n = 1), lymphoma (n = 2), oropharyngeal, for example, glossotonsillar sulcus cancer (n = 1), ovarian (n = 1), pancreatic (n = 1), tonsillar (N = 1). Diagnostic evaluation for 4 patients with MCD-positive signals did not reveal a source of the signal. These patients received repeat MCD testing in 6 months, with the plan of repeating diagnostic workup if the testing remained positive. Of the 17 patients with positive MCD testing, 13 (76.5%) had more than 1 positive cancer signal localization (eg, head and neck, lung, lymphoid). In total, the 17 patients had 30 positive cancer signal localizations .”  
    Implementation of a Multicancer Detection (MCD) Test in a Tertiary Referral Center in Asymptomatic Patients: An 18-Month Prospective Cohort Study
    Ryan T. Hurt et al.
    Journal of Primary Care & Community Health Volume 16: 1–18
  • “The study demonstrated that less than 1% of patients in this population undergoing the test have a positive MCD test. Among those patients who tested positive, 73% were true positives with breast, esophageal, lymphoma, oropharyngeal, ovarian, and pancreas cancers being diagnosed. The remaining 27% of patients with a positive test and negative diagnostic work-up are being followed with a defined plan of repeat testing in 6 months and continued follow-up.”  
    Implementation of a Multicancer Detection (MCD) Test in a Tertiary Referral Center in Asymptomatic Patients: An 18-Month Prospective Cohort Study
    Ryan T. Hurt et al.
    Journal of Primary Care & Community Health Volume 16: 1–18
  • ”One of the challenges to the pragmatic implementation of MCD and other novel tests is the buy-in needed from primary care physicians (PCP). The Vanguard study was a pilot that utilized focus group evaluations to report on the perceptions of PCP and laypersons of different clinical trial designs and their willingness to participate. It was found that both primary care physicians and laypersons expressed concerns and reluctance about a study design in which MCD test results would not be returned to the Vanguard control group (intended effect).Still, they also noted that they were open to participation in MCD clinical trials if there was transparency regarding whether MCD testing would be run on provided biospecimens and if results would be eventually returned so that they could deliver those results to their patients. The findings of this study provided insights to guide clinical trial designs and plan prospective evaluation of MCD testing.”
    Implementation of a Multicancer Detection (MCD) Test in a Tertiary Referral Center in Asymptomatic Patients: An 18-Month Prospective Cohort Study
    Ryan T. Hurt et al.
    Journal of Primary Care & Community Health Volume 16: 1–18
  • “The 18-month prospective cohort study highlights the feasibility of implementing MCD testing within a tertiary referral center. The findings demonstrate that MCD testing can effectively identify cancers in asymptomatic (without symptoms attributed to cancer) populations, with 73% of positive cases yielding a new cancer diagnosis. These results underscore the potential of MCD testing to complement existing cancer screening protocols, enabling earlier detection and intervention. However, challenges such as false positives, patient anxiety, cost considerations, and the integration of MCD testing into routine clinical practice require further investigation. As the role of MCD testing continues to evolve, its potential to transform cancer interception and improve patient outcomes remains a promising frontier in precision medicine.”
    Implementation of a Multicancer Detection (MCD) Test in a Tertiary Referral Center in Asymptomatic Patients: An 18-Month Prospective Cohort Study
    Ryan T. Hurt et al.
    Journal of Primary Care & Community Health Volume 16: 1–18
  • “Cancer is the leading cause of death globally, with nearly 20 million new cases and 9.7 million deaths in 2022. Due to its vague initial symptoms, cancer is often difficult to detect in its early stages. Liquid biopsy, a revolutionary approach in oncology, provides a minimally invasive, real-time method for cancer detection, monitoring, and characterization by examining circulating tumor components in body fluids. This review presents current technologies and clinical applications of liquid biopsy, focusing particularly on its value for early cancer diagnosis. Liquid biopsy enables molecular profiling of cancer for precision oncology by isolating circulating extracellular nucleic acids (cell-free DNA), circulating tumor DNA, and circulating tumor cells from blood and other body fluids. Cell-free DNA, which circulates freely in the blood, may or may not be tumor-derived, while circulating tumor DNA is specifically of tumor origin. Additionally, circulating tumor cells can be isolated from blood; these cells, shed from tumors into the bloodstream, typically survive only 1–2.5 h before immune clearance, though a small fraction can persist and metastasize to distant sites. Exosomes, small membrane-bound vesicles secreted by tumor cells, also carry molecular information about the tumor and have become a valuable source of biomarkers in liquid biopsy. Advances in detection technologies for these analytes have expanded the utility of liquid biopsy, facilitating the identification of somatic mutations and actionable genomic alterations in tumors.”
    Liquid Biopsy: A Breakthrough Technology in Early Cancer Screening
    Xuexin Liang, Qingqing Tang, Jiawei Chen and Yanghui Wei*
    Cancer Screening and Prevention 2025 (in press)
  • “Blood-based tests present a promising strategy to enhance cancer screening through two distinct approaches. In the traditional paradigm of “one test for one cancer”, single-cancer early detection (SCED) tests a feature high true positive rate (TPR) for individual cancers, but high false-positive rate (FPR). Whereas multi-cancer early detection (MCED) tests simultaneously target multiple cancers with one low FPR, offering a new “one test for multiple cancers” approach. However, comparing these two approaches is inherently non-intuitive. We developed a framework for evaluating and comparing the efficiency and downstream costs of these two blood-based screening approaches at the general population level.”
    Estimating the Burden of False Positives and Implementation Costs From Adding Multiple Single Cancer Tests or a Single Multi-Cancer Test to Standard-Of-Care Screening.
    Madhavan S, Hackshaw A, Hubbell E, et al..  
    Cancer Med. 2025 Mar;14(6):e70776. doi: 10.1002/cam4.70776. 
  • Methods: We developed two hypothetical screening systems to evaluate the performance efficiency of each blood-based screening approach. The “SCED-10” system featured 10 hypothetical SCED tests, each targeting one cancer type; the “MCED-10” system included a single hypothetical MCED test targeting the same 10 cancer types. We estimated the number of cancers detected, cumulative false positives, and associated costs of obligated testing for positive results for each system over 1 year when added to existing USPSTF-recommended cancer screening for 100,000 US adults aged 50–79.
    Results: Compared with MCED-10, SCED-10 detected 1.4x~ more cancers (412 vs. 298), but had 188x~ more diagnostic investigations in cancer-free people (93,289 vs. 497), lower efficiency (positive predictive value: 0.44% vs. 38%; number needed to screen: 2062 vs. 334), 3.4x~ the cost ($329 M vs. $98 M), and 150x~ higher cumulative burden of false positives per annual round of screening (18 vs. 0.12).
    Estimating the Burden of False Positives and Implementation Costs From Adding Multiple Single Cancer Tests or a Single Multi-Cancer Test to Standard-Of-Care Screening.
    Madhavan S, Hackshaw A, Hubbell E, et al..  
    Cancer Med. 2025 Mar;14(6):e70776. doi: 10.1002/cam4.70776. 
  • Conclusions: A screening system for average-risk individuals using multiple SCED tests has a higher rate of false positives and associated costs compared with a single MCED test. A set of SCED tests with the same sensitivity as standard-of- care screening detects only modestly more cancers than an MCED test limited to the same set of cancers.
    Estimating the Burden of False Positives and Implementation Costs From Adding Multiple Single Cancer Tests or a Single Multi-Cancer Test to Standard-Of-Care Screening.
    Madhavan S, Hackshaw A, Hubbell E, et al..  
    Cancer Med. 2025 Mar;14(6):e70776. doi: 10.1002/cam4.70776. 

  • Estimating the Burden of False Positives and Implementation Costs From Adding Multiple Single Cancer Tests or a Single Multi-Cancer Test to Standard-Of-Care Screening.
    Madhavan S, Hackshaw A, Hubbell E, et al..  
    Cancer Med. 2025 Mar;14(6):e70776. doi: 10.1002/cam4.70776. 
  • As shown in our analysis, an MCED test that is limited to target the same 10 cancer types would detect 27% fewer incremental cancers than multiple SCED tests but is more efficient because this screening system would have substantially fewer incremental false positives—approximately 400 for MCED-10 versus nearly 100,000 for SCED-10.Because this comparison was based on the same 10 cancer types, it demonstrates clearly that a single MCED test simultaneously covering multiple cancer types is more efficient than implementing multiple SCED tests. This comparison illustrates that a single MCED test with a single FPR, as opposed to multiple FPRs from multiple independent SCED tests, is far more efficient and should be more cost-effective in a general population setting.
    Estimating the Burden of False Positives and Implementation Costs From Adding Multiple Single Cancer Tests or a Single Multi-Cancer Test to Standard-Of-Care Screening.
    Madhavan S, Hackshaw A, Hubbell E, et al..  
    Cancer Med. 2025 Mar;14(6):e70776. doi: 10.1002/cam4.70776. 
  • Evaluation of genetic information leading to early cancer diagnosis and management involves analysis of cell-free DNA analyzed via liquid biopsy through various laboratory methods. Cell-free DNA (cfDNA) refers to DNA fragments found freely in body fluids that can be derived from both healthy and cancerous cells. Fragments of cfDNA derived from healthy cells average around 160 base pairs in length, and are distinguishable from tumor-associated cfDNA, termed circulating tumor DNA (ctDNA), which averages a slightly shorter fragment length of 140 base pairs
    Translating the multifaceted use of liquid biopsy to management of early disease in pancreatic adenocarcinoma.  
    Cox M, Vitello D, Chawla A.  
    Front Oncol. 2025 Mar 13;15:1520717. doi: 10.3389/fonc.2025.1520717. 
  • The consensus on the origin of ctDNA involves primary tumor cells that have undergone apoptosis, necrosis, or are actively metastasizing. In addition to ctDNA, circulating tumor cells (CTCs) as well as other cellular components such as RNA or proteins may be present and provide information indicative of malignancy and of the primary tumor’s characteristics . With a half-life of less than 2 hours, ctDNA analysis provides an accurate reflection of the current genetic landscape and behavior of the primary tumor in real-time. From first identification of its relevance in cancer patients in the landmark paper by Leon et al. in 1977, ctDNA has grown in its significance to be at current the most established liquid biopsy analyte for use in cancer management with multiple large clinical trials and FDA-approved device panels evaluating its validity in early diagnosis, prognostication, targeted treatment selection, and residual disease monitoring.
    Translating the multifaceted use of liquid biopsy to management of early disease in pancreatic adenocarcinoma.  
    Cox M, Vitello D, Chawla A.  
    Front Oncol. 2025 Mar 13;15:1520717. doi: 10.3389/fonc.2025.1520717. 
  • “Early diagnosis of PDAC is difficult for many reasons. For one, screening of individuals at average risk for pancreatic cancer is not standard of care. Around 70-90% of individuals who will be diagnosed with PDAC are at average risk . Many of the most common factors are only weakly associated with an increase in risk and are largely related to a patient’s lifestyle (e.g. smoking use, uncontrolled diabetes, alcohol use, obesity). Screening for PDAC often involves time-consuming and expensive procedures such as yearly MRI, esophagogastroduodenoscopy and endoscopic ultrasound, repeat fine needle aspirations and blood draws that have not been shown to identify enough early PDAC cases to justify the extent of invasive procedures that individuals will undergo throughout their lifetime .”
    Translating the multifaceted use of liquid biopsy to management of early disease in pancreatic adenocarcinoma.  
    Cox M, Vitello D, Chawla A.  
    Front Oncol. 2025 Mar 13;15:1520717. doi: 10.3389/fonc.2025.1520717. 
  • Monitoring of pancreatic intraepithelial neoplasms (PanINs), histologically identified areas within the pancreas that in rare cases progress to malignancy, is also not a possibility as these lesions are not directly evaluable except in pathologic specimens, and data is lacking to clearly understand the percentage of patients with PanINs that will progress to PDAC. Some studies have estimated the likelihood of PanIN progression to PDAC to be less than 2% and taking up to 35 years or more, making screening of these lesions minimally beneficial even if feasible . Additionally, PanINs are found in nearly three-fourths of pancreatectomy and autopsy specimens by age 80, as well as in multiple individuals in their 20’s with low rates of progression to cancer.
    Translating the multifaceted use of liquid biopsy to management of early disease in pancreatic adenocarcinoma.  
    Cox M, Vitello D, Chawla A.  
    Front Oncol. 2025 Mar 13;15:1520717. doi: 10.3389/fonc.2025.1520717. 
  • “Conversely, another well-known precursor lesion in PDAC, intraductal papillary mucinous neoplasms (IPMNs), are estimated to be detectable in around 3%–6% of the general population and 10% of the population over 70, and can be monitored as compared to PanINs which cannot. Additionally, IPMNs demonstrate much higher progression rates to malignancy depending on the subtype, with rates as high as 90% in mixed-type types and as low as 3.3% in branch-duct types. However, there is difficulty in differentiating IPMNs that will progress to PDAC from those that will not, and further studies are needed to identify genetic differences, histological differences, or both to clearly stratify patients and avoid overtreating when unlikely to mitigate risk.”  
    Translating the multifaceted use of liquid biopsy to management of early disease in pancreatic adenocarcinoma.  
    Cox M, Vitello D, Chawla A.  
    Front Oncol. 2025 Mar 13;15:1520717. doi: 10.3389/fonc.2025.1520717. 
  • For the 5-10% of diagnosed PDAC patients that have known genetic risk based on family history (defined as at least one first degree relative or two second-degree relatives diagnosed with pancreatic cancer in their lifetime) as well as an additional 3-5% of individuals that carry a predisposing genetic mutation (most commonly Hereditary Breast and Ovarian Cancer Syndrome (BRCA1/2), Fanconi Anemia, Familial Adenomatous Polyposis (FAP), Peutz-Jeghers Syndrome, Li-Fraumeni Syndrome, Familial Atypical Multiple Mole Melanoma Syndrome (FAMMM) or Lynch Syndrome (MLH1, MSH2/6 or PMS2 variants)), there is identified benefit from screening .”
    Translating the multifaceted use of liquid biopsy to management of early disease in pancreatic adenocarcinoma.  
    Cox M, Vitello D, Chawla A.  
    Front Oncol. 2025 Mar 13;15:1520717. doi: 10.3389/fonc.2025.1520717. 
  • In addition, analysis of ctDNA is much more specific than other blood-based biomarkers that are typically present at various levels as detection of any measurable amount of tumor DNA indicates the presence of malignancy. While studies provide evidence supporting ctDNA as a strong and even independent diagnostic marker, it is present in considerably smaller quantities in early disease which poses an obstacle to its use as an early diagnostic tool. However, its use alongside current biomarkers shows strong promise for improving precision in early diagnosis. A study by Cohen et al. in 2018 demonstrated that a combined assay combining both CA 19-9 and ctDNA abundance demonstrated superior precision over use of any biomarker alone as  diagnostic tool for early PDAC, demonstrating the ability to detect disease in 60% of patients who had no traditional presenting symptoms of PDAC as well as 41% of PDAC patients who wouldbe diagnosed with Stage I disease.
    Translating the multifaceted use of liquid biopsy to management of early disease in pancreatic adenocarcinoma.  
    Cox M, Vitello D, Chawla A.  
    Front Oncol. 2025 Mar 13;15:1520717. doi: 10.3389/fonc.2025.1520717. 
  • Another significant issue is the biological variability inherent in PDAC tumors. Many patients may not shed detectable levels of ctDNA in addition to PDAC lacking a strong molecular profile outside of KRAS aberrations, which happens to be the most mutated oncogene in all human malignancies. With minimal amounts of tumor shedding in PDAC along with a limited molecular profile, ctDNA analysis may serve little to no benefit for individuals with nonspecific mutations or undetectable ctDNA. Additionally, with the majority of PDAC patients not having surgically resectable disease at diagnosis, it is unclear how disease properties and thus ctDNA are altered as disease progresses.  
    Translating the multifaceted use of liquid biopsy to management of early disease in pancreatic adenocarcinoma.  
    Cox M, Vitello D, Chawla A.  
    Front Oncol. 2025 Mar 13;15:1520717. doi: 10.3389/fonc.2025.1520717. 
  • “While challenges remain in the field of ctDNA analysis for pancreatic adenocarcinoma, the potential for its advancement and use in clinical practice is vast. Continued evaluation of its potential and validity in large trials will be paramount for moving the benefits provided by liquid biopsy and circulating tumor DNA analysis to patients, paving the way for early diagnosis and more effective treatment strategies to ultimately improve patient outcomes for such an aggressive disease.”
    Translating the multifaceted use of liquid biopsy to management of early disease in pancreatic adenocarcinoma.  
    Cox M, Vitello D, Chawla A.  
    Front Oncol. 2025 Mar 13;15:1520717. doi: 10.3389/fonc.2025.1520717. 
  • Multicancer early detection (MCED) tests are an emerging technology for cancer screening. MCED tests can detect cancer signals from multiple cancers concurrently in biological samples such as blood, urine, saliva, or other bodily fluids. Some tests can suggest the most likely cancer origin, whereas others report cancer detected somewhere in the body. Although some MCED tests are currently commercially available, none are approved by the Food and Drug Administration or endorsed by any clinical practice guideline or recommendation. Most insurance companies do not currently cover MCED testing. MCED tests have not yet been evaluated for safety and effectiveness in randomized controlled trials. Because patients already are asking for MCED test prescriptions or for interpretation of results from tests acquired elsewhere, clinicians should be prepared to discuss what is known about the benefits, risks, and uncertainties of MCED testing, including performance characteristics in screening populations and preferred follow-up strategies for positive test results.
    Multicancer early detection testing: Guidance for primary care discussions with patients.  
    Hoffman RM, Wolf AMD, Raoof S, et al.  
    Cancer. 2025 Apr 1;131(7):e35823. doi: 10.1002/cncr.35823. PMID: 40170549; 
  • Because patients already are asking for MCED test prescriptions or for interpretation of results from tests acquired elsewhere, clinicians should be prepared to discuss what is known about the benefits, risks, and uncertainties of MCED testing, including performance characteristics in screening populations and preferred follow-up strategies for positive test results. At this time, clinicians should not feel obligated to initiate discussions about MCED testing with their patients. However, clinicians should engage patients who inquire about getting tested or previous MCED test results in shared decision-making, and take the opportunity to offer and help patients complete age- and sex-appropriate guideline-recommended cancer screenings.
    Multicancer early detection testing: Guidance for primary care discussions with patients.  
    Hoffman RM, Wolf AMD, Raoof S, et al.  
    Cancer. 2025 Apr 1;131(7):e35823. doi: 10.1002/cncr.35823. PMID: 40170549; 
  • Nearly half (1,016,900) of the cancer diagnoses and approximately three fifths (358,230) of the cancer deaths projected for 2025 are in cancers for which there are no recommended screening tests. Such cancers are commonly diagnosed at an advanced stage, when the prognosis is poor. Both the absence of screening strategies for these cancers and the suboptimal uptake and adherence for the few recommended screening tests, which target specific age ranges, lead to diagnosing only a minority of some of the most lethal cancers at a localized stage. The former category includes pancreatic (13.7%), ovarian (17.5%), esophageal (21.6%), and liver (40.8%) cancers, whereas the latter includes lung (25.8%) and colorectal (36.5%) cancers.
    Multicancer early detection testing: Guidance for primary care discussions with patients.  
    Hoffman RM, Wolf AMD, Raoof S, et al.  
    Cancer. 2025 Apr 1;131(7):e35823. doi: 10.1002/cncr.35823. PMID: 40170549; 
  • There is also a paucity of data on conventional screening outcomes, including measures of sensitivity for any or specific cancers, true- and false-positive rates, indeterminate findings, incidental findings, and the range of potential harms, including complications from diagnostic procedures, overdiagnosis (finding cancers that will never cause symptoms), and overtreatment (unnecessary treatment for indolent cancers). The impacts of MCED testing on adherence to recommended screening and costs to patients, payers, as well as health care systems are also unknown. Finally, the performance of MCED tests varies between and within tests because companies use different diagnostic algorithms and sets of measured analytes, which are continuously being refined.
    Multicancer early detection testing: Guidance for primary care discussions with patients.  
    Hoffman RM, Wolf AMD, Raoof S, et al.  
    Cancer. 2025 Apr 1;131(7):e35823. doi: 10.1002/cncr.35823. PMID: 40170549; 
  • The Exact Sciences CancerSEEK MCED test (now called Cancerguard), which is currently not commercially available to the public, was evaluated in the DETECT-A study, which screened 10,006 women aged 65–75 years with no history of cancer, enrolled from a population with high adherence to recommended screening.40 Abnormalities in baseline tests were confirmed with more rigorous blood testing; if the confirmatory testing was positive, then the participant underwent a total-body combined positron emission and computed tomography (PET-CT) scan because this MCED test did not report a CSO. Participants with an abnormal PET-CT scan were referred to specialists. Overall, 134 participants (1.34%) had a confirmed positive blood test, and 26 of these had a cancer diagnosed within 12 months of enrollment. A confirmed positive blood test (without a PET-CT scan) had a PPV of 19.4% (95% CI, 13.1%–27.1%) for cancer detection. Eight cancers (30.8%) were detected at stage I or II, including three cancers (uterine, ovarian, and thyroid) with no recommended screening tests.  
    Multicancer early detection testing: Guidance for primary care discussions with patients.  
    Hoffman RM, Wolf AMD, Raoof S, et al.  
    Cancer. 2025 Apr 1;131(7):e35823. doi: 10.1002/cncr.35823. PMID: 40170549; 
  • The PPVs for MCED tests are generally substantially higher than the PPVs for currently used single-cancer tests (e.g., mammography, stool blood tests, and low-dose CT scans) because the cancer prevalence is higher as a result of the aggregate detection of multiple cancers and because MCED test specificity is much higher than that seen with recommended screening tests. Given proof of efficacy, this would be a general benefit of multicancer detection relative to single-cancer testing. However, the tradeoff is that the sensitivity for detecting localized cancers is much lower than for recommended screening tests, and precancers cannot be detected. Notably, more than two thirds of the cancers diagnosed in the two prospective observational studies were diagnosed clinically or with recommended screening tests.
    Multicancer early detection testing: Guidance for primary care discussions with patients.  
    Hoffman RM, Wolf AMD, Raoof S, et al.  
    Cancer. 2025 Apr 1;131(7):e35823. doi: 10.1002/cncr.35823. PMID: 40170549; 
  • “Multicancer early detect We believe that clinicians are not obligated to initiate discussions on MCED testing until more is known about their effectiveness. Given the many uncertainties surrounding MCED testing at this time, patients who initiate a discussion about MCED testing should engage in a shared decision-making (SDM) process before undergoing testing. The goal of SDM is to inform a patient about the potential benefits, limitations, harms, and uncertainties around MCED testing to enable the patient to make decisions that align with their personal values and preferences. Factors to consider in ordering MCED tests include an individual’s reason for seeking an MCED test and their cancer risk factors, including age, sex, family history, and exposures, as well as life expectancy, and their willingness and ability to participate in the downstream evaluations of abnormal tests and, potentially, to undergo cancer treatment.”
    Guidance for primary care discussions with patients.  
    Hoffman RM, Wolf AMD, Raoof S, et al.  
    Cancer. 2025 Apr 1;131(7):e35823. doi: 10.1002/cncr.35823. PMID: 40170549; 
  • “Patients should be informed about and agree to undergo diagnostic testing to evaluate a positive test result before embarking on MCED testing. A positive MCED test indicates that the patient is at a high risk for having cancer given the test’s high specificity. The ordering clinician, working in concert with health systems and specialist colleagues, is responsible for ensuring that a complete diagnostic evaluation is conducted. The follow-up of a positive MCED test depends on whether the test indicates a likely CSO. The predicted primary CSO reported by Galleri can be used to guide targeted evaluations toward a particular cancer, including imaging, laboratory testing, endoscopy, and, if indicated, tissue diagnoses. If that evaluation is unrevealing, a Galleri study protocol suggested that the next step could be either a targeted evaluation of the secondary predicted CSO or obtaining whole-body imaging.For tests that do not predict a cancer site of origin, such as the Exact Sciences multianalyte blood test, the manufacturer recommends total-body imaging with PET-CT scans.”
    Guidance for primary care discussions with patients.  
    Hoffman RM, Wolf AMD, Raoof S, et al.  
    Cancer. 2025 Apr 1;131(7):e35823. doi: 10.1002/cncr.35823. PMID: 40170549; 
  • A negative workup could suggest that the initial blood test result was a false positive and the risk of cancer could be low, although the sensitivity of PET-CT scans as a second-stage screen for general cancers is unknown. The DETECT-A study reported that 95 of 98 participants with a false-positive result remained cancer free during a median 3.6 years of follow-up.However, a negative workup result could be misleading, particularly if the diagnostic evaluation was limited—or lacked the sensitivity to detect the cancer site of origin. This scenario could create enduring anxiety for many individuals. The next steps could be to repeat the MCED test, although the timing of subsequent testing after an apparent false-positive test result is uncertain, or to watchfully wait for symptoms. GRAIL offers a free retest at 3–6 months if the initial diagnostic evaluation of a cancer signal is negative.
    Guidance for primary care discussions with patients.  
    Hoffman RM, Wolf AMD, Raoof S, et al.  
    Cancer. 2025 Apr 1;131(7):e35823. doi: 10.1002/cncr.35823. PMID: 40170549; 
  • Abnormal blood testing may lead to imaging studies, including PET-CT scans, which may detect one or more incidental findings in some patients. Primary care clinicians will need to use their clinical judgment, ideally supported by professional practice guidelines and guidance from multidisciplinary teams, to determine the next steps in the diagnostic workup. Diagnosing and treating incidental findings may be beneficial to patients if they are clinically significant. Conversely, findings may be clinically inconsequential or consequential without any potential for successful intervention, which may lead to complications from testing and treatments, anxiety, overdiagnosis, and additional costs, which all represent potential harms from any cancer screening, including MCED testing.  
    Guidance for primary care discussions with patients.  
    Hoffman RM, Wolf AMD, Raoof S, et al.  
    Cancer. 2025 Apr 1;131(7):e35823. doi: 10.1002/cncr.35823. PMID: 40170549; 
  • The gold standard study design for evaluating a screening program is an RCT with cancer mortality as an end point.28 One ongoing RCT is the NHS-Galleri study, which has collected blood from 140,000 asymptomatic participants in the United Kingdom.50 Half of the participants are being randomized to an intervention arm to have blood tested with an MCED test, and the other half are being randomized to the control arm to have blood stored. Intervention arm participants will be notified if a cancer signal is detected, and referred for further evaluation. Follow-up is expected to be for up to 4 years, and the primary, surrogate end point is the overall reduction in the incidence rates of stage III and IV cancers. Cancer-specific mortality is a secondary, delayed end point.  
    Guidance for primary care discussions with patients.  
    Hoffman RM, Wolf AMD, Raoof S, et al.  
    Cancer. 2025 Apr 1;131(7):e35823. doi: 10.1002/cncr.35823. PMID: 40170549; 
  • MCED testing represents a potential paradigm shift in cancer screening that provides an opportunity to detect numerous cancers with a single test. Although tests are commercially available, they are being evaluated in clinical trials, and data are not yet available to determine whether MCED testing for cancer screening meets many of the criteria that have been adopted and recognized as the standards for population screening.Because MCED testing is becoming increasingly available as new tests continue to be developed and evaluated,clinicians should be prepared to help patients make informed decisions about testing . Clinicians should further inform patients that MCED testing does not replace recommended cancer screening tests, and encourage them to make appropriate lifestyle changes to reduce cancer risk. MCED testing offers the potential to reduce the burden of suffering and premature death from cancer, although it will be some time before we know whether this potential can be realized. In the meantime, this article offers guidance to health care providers in their discussions with patients who inquire about MCED testing    
    Guidance for primary care discussions with patients.  
    Hoffman RM, Wolf AMD, Raoof S, et al.  
    Cancer. 2025 Apr 1;131(7):e35823. doi: 10.1002/cncr.35823. PMID: 40170549; 
  •  The Liquid Biopsy (LB) represents an ideal surrogate of tumor Tissue Biopsy (TB) when the aim is to obtain useful information on patient prognosis and personalized therapy. This technique renders it possible to isolate circulating tumor cells, circulating tumor DNA and other molecules from biological fluids. The most commonly used fluid for liquid biopsy is blood, but depending on the case it could be necessary to isolate the tumor components from other biological fluids such as urine, pleural effusion, cerebrospinal fluid, and others. The main advantages of liquid biopsy are the minimally invasive nature of the procedure and the possibility of analyzing all tumor clones. Limitations include difficulties in the isolation of tumor components and the requirement for highly sensitive analysis methods to avoid the risk of technical artifacts.  
    Liquid biopsy: An innovative tool in oncology. Where do we stand?  
    Serafina Martella  et al.  
    Seminars in Oncology 52 (2025) 152343  
  • CTCs (circulating tumor cells) are tumor cells that detach early from the primary tumor or metastatic sites and circulate in the bloodstream before clinical or radiological signs of metastasis appear . Their half-life ranges from 1 to 4 hours before being destroyed by the immune system, although a fraction can escape destruction and spread to distant sites in the body. The concentration of CTCs in biological fluids depends on the type of tumor , but in general, it is low ( < 10 cells/mL of blood). For this reason, their identification is particularly challenginging and requires cell enrichment methods that use specific markers on other cell surface (e.g., epithelial adhesion proteins for positive selection or the CD45 marker for negative selection) or biophysical properties (such as cell size).  
    Liquid biopsy: An innovative tool in oncology. Where do we stand?  
    Serafina Martella  et al.  
    Seminars in Oncology 52 (2025) 152343  
  • CtDNA is a highly fragmented, double-stranded DNA of 160–200 base pairs, with a half-life of about 114 minutes . While it has adequate sensitivity and specificity as a tumor biomarker, its proportion relative to ccfDNA varies widely, from < 0.1% to > 90% [40] . Factors influencing ctDNA levels include tumor characteristics and metastatic load (e.g., location, size, vascular infiltration, tumor status, and stage), with higher concentrations observed in patients with liver metastases and in lung and colorectal tumors. Additionally, it has been observed that advanced-stage tu- mors present higher ctDNA levels compared to localized tumors . The greater the tumor load , the greater the amount of ctDNA.”  
    Liquid biopsy: An innovative tool in oncology. Where do we stand?  
    Serafina Martella  et al.  
    Seminars in Oncology 52 (2025) 152343   

  • Liquid biopsy: An innovative tool in oncology. Where do we stand?  
    Serafina Martella  et al.  
    Seminars in Oncology 52 (2025) 152343  

  • Liquid biopsy: An innovative tool in oncology. Where do we stand?  
    Serafina Martella  et al.  
    Seminars in Oncology 52 (2025) 152343  
  • Liquid biopsy represents an innovative opportunity for tumor monitoring and management, but there are still several gaps that limit its widespread use. One of the main issues is the lack of large-scale clinical studies. Most available data comes from pilot studies or small cohort studies, which, although useful for gathering preliminary information, are insufficient to validate liquid biopsy in broader clinical contexts. Therefore, it is crucial to conduct large-scale research involving more patients and diverse clinical situations to confirm the reliability and reproducibility of the results. Only through such studies will it be possible to develop comprehensive genomic databases capable of accurately tracking the molecular evolution of the tumor over time, thus improving the predictive capacity of liquid biopsy.  
    Liquid biopsy: An innovative tool in oncology. Where do we stand?  
    Serafina Martella  et al.  
    Seminars in Oncology 52 (2025) 152343  
  • However, despite advancements, liquid biopsy still has several limitations that hinder its widespread adoption: •Limited sensitivity and specificity: Current technologies are not always able to detect very low concentrations of ctDNA or identify biomarkers in patients with early-stage tumors, where ctDNA levels are low. •Difficulty in tumor localization: While liquid biopsy can identify the presence of tumors and mutations, it cannot always accurately localize the tumor or specify its primary origin. This limits its ability to assign biomarkers to specific tissues or organs. •Challenges in detecting tumor heterogeneity: Tumors are highly heterogeneous and contain different populations of cancer cells with varying mutations. Liquid biopsy may not capture this complexity, leading to an incomplete view of tumor biology. •Complex interpretation of analytical results: Data obtained from liquid biopsy can be challenging to interpret due to the variety of biomarkers involved and their variability between patients. The analysis of biomarkers must be performed with a very precise approach, considering comprehensive clinical data.  
    Liquid biopsy: An innovative tool in oncology. Where do we stand?  
    Seminars in Oncology 52 (2025) 152343  
  • ”Artificial intelligence in radiology critically depends on vast amounts of quality data, and there are controversies surrounding the topic of data ownership. In the current clinical framework, the secondary use of clinical data should be treated as a form of public good to benefit future patients. In this article, we propose that the physicians' input in data curation and interpretation adds value to the data and is crucial for building clinically relevant artificial intelligence models.”
    The radiologist and data: Do we add value or is data just data?
    Fishman EK, Soyer P, Hellmann DB, Chu LC.  
    Clin Imaging. 2025 Apr 10;122:110481. doi: 10.1016/j.clinimag.2025.110481. Epub ahead of print. PMID: 40252272. 
  • “ The integration and discovery need to be performed by those who are the knowledge keepers and who can expand on the data, as the physicians create in their work. We are concerned by the notion that computer scientists will simply take the data and use it as if they were making the discoveries or as if all the hard work that went into collecting, curating, and interpreting the data and treating our patients has little value. This scenario must be addressed. Interestingly, despite public criticism of companies like Microsoft, Google, and NVIDIA, which work carefully with researchers for AI development, it is our experience that the people who work with these companies truly respect the physicians and what they do and are only looking for a win-win.”
    The radiologist and data: Do we add value or is data just data?
    Fishman EK, Soyer P, Hellmann DB, Chu LC.  
    Clin Imaging. 2025 Apr 10;122:110481. doi: 10.1016/j.clinimag.2025.110481. Epub ahead of print. PMID: 40252272. 
  • “Another problem with non-physicians is the lack of medical background. Imagine non-physicians building an AI model to predict response to therapy of breast cancer using publicly available breast MRI data. We often see AI models that show impressive area under the curves, but we know nothing about the population of patients from whom the data was obtained. How many cancers were of the tubular, invasive cribriform, mucinous, medullary or of other types? What was the distribution of p53 mutations, ESR1 mutations or BRCA mutations in the patients included to build the model? What was the specific therapy used to treat breast cancers? This information is critical for further generalizability of the AI model.”
    The radiologist and data: Do we add value or is data just data?
    Fishman EK, Soyer P, Hellmann DB, Chu LC.  
    Clin Imaging. 2025 Apr 10;122:110481. 
  • “However, the issue is not one limited to radiologists but potentially affects all of our colleagues as well. Think briefly about the patient who has unexplainable symptoms involving multiple organs and is referred to a rheumatologist who begins the task of combining a detailed physical examination, past medical history, with laboratory studies and imaging studies to try to ascertain the source of the patient's symptoms. After much work, including speaking to other specialists, the rheumatologist arrives at a diagnosis that had eluded others for over a decade. The patient is treated and most of the symptoms resolve. Then the total summary of the physician's knowledge is swept up by a machine algorithm that some computer scientist claims is their discovery. Yet there is no discovery without the rheumatologist and their knowledge.”
    The radiologist and data: Do we add value or is data just data?
    Fishman EK, Soyer P, Hellmann DB, Chu LC.  
    Clin Imaging. 2025 Apr 10;122:110481. 
  • “We do not want to be held hostage by those claiming everyone's experience is just data points and they are entitled to collect it as if it were not the source of knowledge. To reverse the trend of commoditization of radiology, radiologists to be actively and visibly involved in all relevant steps of the diagnostic and therapeutic management of patients. We review all relevant clinical information to determine imaging appropriateness and optimal protocol, ensure technical quality of imaging exams, systematically describe imaging findings, formulate diagnoses, and provide clinically meaningful structured report. This should reduce commoditization of radiology and should foster research and collaboration between radiologists and other specialists. This collaborative spirit will ease the development of imaging biobanks and clinically relevant medical AI tool.”
    The radiologist and data: Do we add value or is data just data?
    Fishman EK, Soyer P, Hellmann DB, Chu LC.  
    Clin Imaging. 2025 Apr 10;122:110481. 
  • “Most adults, including the majority of those who used AI, weren’t confident that the health information provided by AI chatbots was accurate. Six in 10 adults reported being “not too confident” or “not at all confident” in the accuracy of AI-generated health information. Only 5% of total adults said they were “very confident” in it. Although confidence in AI for health information did not vary widely by age, younger adults were more confident in the health advice given by AI chatbots than their older counterparts.”
    Poll: Trust in AI for Accurate Health Information Is Low.
    Orrall A, Rekito A.  
    JAMA. 2025 Mar 21. doi: 10.1001/jama.2024.22951. Epub ahead of print. PMID: 40116838.
  • The bottom line? “People aren’t quite ready to trust AI blindly when it comes to health information,” Lopes said. She added that she’s uncertain about what the future will bring, as the technology— and its usage—grows. “As people use AI more frequently, are they going to become more confident in their own skills of being able to differentiate what’s true vs what’s false? Or will it become an even greater challenge for people to determine what’s true and false from these AI models?”
    Poll: Trust in AI for Accurate Health Information Is Low.
    Orrall A, Rekito A.  
    JAMA. 2025 Mar 21. doi: 10.1001/jama.2024.22951. Epub ahead of print. PMID: 40116838.

  • Poll: Trust in AI for Accurate Health Information Is Low.
    Orrall A, Rekito A.  
    JAMA. 2025 Mar 21. doi: 10.1001/jama.2024.22951. Epub ahead of print. PMID: 40116838.

  • Poll: Trust in AI for Accurate Health Information Is Low.
    Orrall A, Rekito A.  
    JAMA. 2025 Mar 21. doi: 10.1001/jama.2024.22951. Epub ahead of print. PMID: 40116838.

  • Poll: Trust in AI for Accurate Health Information Is Low.
    Orrall A, Rekito A.  
    JAMA. 2025 Mar 21. doi: 10.1001/jama.2024.22951. Epub ahead of print. PMID: 40116838.

  •   Poll: Trust in AI for Accurate Health Information Is Low.
    Orrall A, Rekito A.  
    JAMA. 2025 Mar 21. doi: 10.1001/jama.2024.22951. Epub ahead of print. PMID: 40116838.
  • BACKGROUND The diagnosis of celiac disease (CD), an autoimmune disorder with an estimated global prevalence of around 1%, generally relies on the histologic examination of duodenal biopsies. However, interpathologist agreement for CD diagnosis is estimated at no more than 80%. We aim to improve CD diagnosis by developing an accurate, machine-learning-based diagnostic classifier.  
    METHODS We present a machine learning model that diagnoses the presence or absence of CD from a set of duodenal biopsies representative of real-world clinical data. Our model was trained on a diverse dataset of 3383 whole-slide images of hematoxylin- and eosin-stained duodenal biopsies from four hospitals featuring five different WSI scanners along with their clinical diagnoses. We trained our model using the multiple-instance-learning paradigm in a weakly supervised manner with cross-validation. We evaluated it on an independent test set featuring 644 unseen scans from a different regional NHS trust. In addition, we compared the model’s predictions with independent diagnoses from four specialist pathologists on a subset of the test data.    
    Machine Learning Achieves Pathologist-Level Celiac Disease Diagnosis  
    Florian Jaeckle , James Denholm , Benjamin Schreiber et al.
    NEJM AI 2025;2(4)   
  • RESULTS Our model diagnosed CD in an independent test set from a previously unseen source with accuracy, sensitivity, and specificity exceeding 95% and an area under the receiver operating characteristic curve exceeding 99%. These results indicate that the model has the potential to outperform pathologists. In comparing the model’s predictions with diagnoses on unseen test data from four independent pathologists, we found statistically indistinguishable results between pathologist–pathologist and pathologist–model interobserver agreement (P>96%).  
    CONCLUSIONS Our model achieved pathologist-level performance in diagnosing the presence or absence of CD from a representative set of duodenal biopsies, including biopsies from a previously unseen hospital. We concluded that our model has the potential to accurately identify or rule out CD, thereby significantly reducing the time required for pathologists to make a diagnosis.  
    Machine Learning Achieves Pathologist-Level Celiac Disease Diagnosis  
    Florian Jaeckle , James Denholm , Benjamin Schreiber et al.
    NEJM AI 2025;2(4)   
  • Our machine learning model, which achieved human-level performance, demonstrates significant potential in addressing these critical issues. It achieved an accuracy, sensitivity, and specificity exceeding 95% on an independent test set composed of cases from sources not included in the training and validation data. This study shows AI achieving human-level performance in CD diagnosis on a genuine, multicenter, clinically representative cohort of patient samples. This level of generalizability is crucial for deploying AI models in real-world clinical environments, where variability in staining protocols and scanner technology can significantly impact diagnostic accuracy. We also show that our model worked equally well for patients of all sexes and ages above 19 years of age.  
    Machine Learning Achieves Pathologist-Level Celiac Disease Diagnosis  
    Florian Jaeckle , James Denholm , Benjamin Schreiber et al.
    NEJM AI 2025;2(4)    
  • In conclusion, we present a machine learning diagnostic tool for CD that achieves human-level accuracy on images of duodenal biopsies from a hospital that was not used for training. We demonstrate that the concordance between the model and pathologists is similar to the agreement among pathologists. Furthermore, we demonstrate that our model is unbiased and performs equally well for male and female patients for all ages over 19 years.  
    Machine Learning Achieves Pathologist-Level Celiac Disease Diagnosis  
    Florian Jaeckle , James Denholm , Benjamin Schreiber et al.
    NEJM AI 2025;2(4)
  • Radiomics holds potential to transform pancreatic imaging by allowing precise quantification and texture analysis beyond what is visible to the naked eye. This property improves not only PDAC detection, but also facilitates classification and risk assessment of pancreatic cystic neoplasms and the discrimination of aggressiveness in pancreatic neuroendocrine neoplasms. The use of a radiomics models with DECT has been shown to be a powerful tool for nodal metastases detection in PDAC. Most interestingly, radiomics can also predict overall survival and disease-free survival in patients post-PDAC resection, outperforming traditional clinical models for prognosis.
    CT Innovation in Pancreatic Imaging: A Bright Future, But Are We There Yet?  
    Drucker Iarovich M, Gladkikh M, van der Pol CB.
    Can Assoc Radiol J. 2025 Apr. Epub ahead of print. PMID: 40165682.
  • Artificial intelligence (AI), including convolutional neural networks with radiomics, has been shown to improve tumour characterization, personalized treatment, and prediction of treatment response. Emerging research indicates that deep learning models may detect pancreatic tumours on prediagnostic CT scans months before clinical presentation—a finding that, if confirmed, could greatly influence patient outcomes.4 While promising, these algorithms must first prove their generalizability and undergo external validation. Furthermore, a major barrier to adoption remains suboptimal integration of AI into a busy clinical workflow.
    CT Innovation in Pancreatic Imaging: A Bright Future, But Are We There Yet?  
    Drucker Iarovich M, Gladkikh M, van der Pol CB.
    Can Assoc Radiol J. 2025 Apr. Epub ahead of print. PMID: 40165682.
  • Radiomics has demonstrated multiple uses in liver cancers.One large, prospective study demonstrated that a radiomics signature derived from CRLM CT scans outperformed the Response Evaluation Criteria in Solid Tumors (RECIST) criteria for predicting folinic acid, fluorouracil, and irinotecan (FOLFIRI) and bevacizumab response. These findings were  supported by another study, where radiomicsfeatures outperformed RECIST and KRAS sequence variation status, with the radiomics signature predicting response to FOLFIRI and cetuximab with an area under the curve (AUC) of 0.80 compared with only 0.67 for KRAS status and 0.75 for 8-week tumor shrinkage measured by RECIST.2 This information can guide early chemotherapy regimen switching in nonresponders and identify patients for resection based on favorable biology.
    A. Radiomics for Treatment Planning in Liver Cancers.  
    Mian A, Kamnitsas K, Gordon-Weeks A.
    JAMA Surg. 2025 Feb 26. doi: 10.1001/jamasurg.2024.4346. Epub ahead of print. PMID: 40009391.
  • “In HCC, radiomics and clinical features predicted transarterial chemoembolization (TACE) response with an AUC of 0.90, which was linked to improved survival in the external validation cohort (hazard ratio, 2.43; P < .05). This study, which focused on patients with BCLC stage B disease, raises the question of whether a selection of patients may benefit from liver transplant outside the Milan criteria vs palliative TACE alone. For cholangiocarcinoma, a combination of radiomics and clinical features improved recurrence-free survival prediction (C index: 0.75) vs clinical features alone (C index: 0.69) in external validation. Given high rates of postsurgical recurrence in this patient cohort, further improvements will identify a subset of high-risk patients who should be offered neoadjuvant systemic therapy as a test of biological behavior rather than up-front resection.”
    A. Radiomics for Treatment Planning in Liver Cancers.  
    Mian A, Kamnitsas K, Gordon-Weeks A.
    JAMA Surg. 2025 Feb 26. doi: 10.1001/jamasurg.2024.4346. Epub ahead of print. PMID: 40009391.
  • A major challenge in radiomics is limited generalizability of models due to reliance on single-center data, which fails to account for variability in patient characteristics (eg, ethnicity, age, tumor biology),imaging protocols, and scanners differences. Some radiomic features are sensitive to these variations, reducing reproducibility across institutions. Solutions include using robust features, multiinstitutional data, standardized imaging protocols, data augmentation (eg, generative adversarial networks), and harmonization techniques likeComBat. The Image Biomarker Standardization Initiative has played a key role in standardizing radiomic biomarker nomenclature and definitions.  
    A. Radiomics for Treatment Planning in Liver Cancers.  
    Mian A, Kamnitsas K, Gordon-Weeks A.
    JAMA Surg. 2025 Feb 26. doi: 10.1001/jamasurg.2024.4346. Epub ahead of print. PMID: 40009391.

  • A. Radiomics for Treatment Planning in Liver Cancers.  
    Mian A, Kamnitsas K, Gordon-Weeks A.
    JAMA Surg. 2025 Feb 26. doi: 10.1001/jamasurg.2024.4346. Epub ahead of print. PMID: 40009391.
  • Routine application of radiomics in oncological liver treatment planning depends on outcomes of prospective studies and regulatory approval. Multi-institutional collaborative networks are required to harness data for generalizable models. We anticipate routine use within the next decade if these challenges are addressed.  
    A. Radiomics for Treatment Planning in Liver Cancers.  
    Mian A, Kamnitsas K, Gordon-Weeks A.
    JAMA Surg. 2025 Feb 26. doi: 10.1001/jamasurg.2024.4346. Epub ahead of print. PMID: 40009391.
  • Background: As pancreatic cystic neoplasms (PCN) differ in current standard of care, and these treatments can affect quality of life to varying degrees, a definitive preoperative diagnosis must be reliable. Current diagnostic approaches, specifically traditional cross- sectional imaging techniques, face certain limitations. But radiomics has been shown to have high diagnostic accuracy across a range of diseases. Objective to conduct a comprehensive review of the literature on the use of radiomics to differentiate Mucinous Cystic Neoplasm (MCN) from Serous Cystic Neoplasm (SCN).
    Methods: This study was comprehensively searched in Pubmed, Scopus and Web of Science databases for meta-analysis of studies that used radiomics to distinguish MCN from SCN. Risk of bias was assessed using the diagnostic accuracy study quality assessment method and combined with sensitivity, specificity, diagnostic odds ratio, and summary receiver operating characteristic (SROC)curve analysis.  
    Pancreatic Mucinous Cystic Neoplasm from Serous Cystic Neoplasm: Systematic Review and Meta-Analysis  
    Longjia Zhang1, Boyu Diao1, Zhiyao Fan1, Hanxiang Zhan, M.D, Ph.D  
    Acad Radiol 2025; 32:2679–2688    
  • Results: A total of 884 patients from 8 studies were included in this analysis, including 365 MCN and 519 SCN. The Meta-analysis found that radiomics identified MCN and SCN with high sensitivity and specificity, with combined sensitivity and specificity of 0.84(0.82–0.87) and 0.82(0.79–0.84). The positive likelihood ratio (PLR) and the negative likelihood ratio (NLR) are 5.61(3.72, 8.47) and 0.14(0.09–0.26). In addition, the area under the SROC curve (AUC) was drawn at 0.93. No significant risk of publication bias was detected through the funnel plot analysis. The performances of feature extraction from the volume of interest (VOI) or Using AI classifier in the radiomics models were superior to those of protocols employing region of interest (ROI) or absence of AI classifier. Conclusion: This meta-analysis demonstrates that radiomics exhibits high sensitivity and specificity in distinguishing between MCN and SCN, and has the potential to become a reliable diagnostic tool for their identification.  
    Pancreatic Mucinous Cystic Neoplasm from Serous Cystic Neoplasm: Systematic Review and Meta-Analysis  
    Longjia Zhang1, Boyu Diao1, Zhiyao Fan1, Hanxiang Zhan, M.D, Ph.D  
    Acad Radiol 2025; 32:2679–2688   
  •  • The pooled sensitivity and specificity of radiomics for differentiating Mucinous Cystic Neoplasm from Serous Cystic Neoplasms were 84% and 82%, respectively.  
    • The field of radiomics lacks standardization, resulting in substantial variations in statistical analysis where such studies are conducted.  
    •Radiomics has an excellent diagnostic effect in distinguishing MCN from SCN and providing more critical information.    
    Pancreatic Mucinous Cystic Neoplasm from Serous Cystic Neoplasm: Systematic Review and Meta-Analysis  
    Longjia Zhang1, Boyu Diao1, Zhiyao Fan1, Hanxiang Zhan, M.D, Ph.D  
    Acad Radiol 2025; 32:2679–2688    
  • MCN is an uncommon tumor that usually occurs in middle-aged women. Surgery is the treatment of choice, and prognosis is excellent in the absence of invasive carcinoma (8). For SCN, the vast majority are benig. Studies have shown that most patients with SCN do not need surgery unless they have significant symptoms or a preoperative diagnosis is unclear. Therefore, some patients can choose to follow-up. Compared with SCN, MCN has considerable malignant potential, so the guidelines recommend resections for all patients who are suitable for surgery. Therefore, it is important to distinguish MCN from SCN in clinic, but current diagnostic approach (ie, traditional cross-sectional imaging) has limitations. It has been reported that the discrimination efficacy of CT for SCNs was ranged from 43% to 67%  
    Pancreatic Mucinous Cystic Neoplasm from Serous Cystic Neoplasm: Systematic Review and Meta-Analysis  
    Longjia Zhang1, Boyu Diao1, Zhiyao Fan1, Hanxiang Zhan, M.D, Ph.D  
    Acad Radiol 2025; 32:2679–2688  
  • “ Our study discovered that radiomics possesses a high degree of accuracy in distinguishing PCNs, particularly in detecting MCN and SCN, making it worthy of promotion for broader application. However, we require additional high-quality research to further validate these findings, and its practical efficiency and clinical applicability also need to be explored further. Moreover, we anticipate establishing standardized radiomics guidelines in the future to provide more evidence for the diagnosis and treatment of pancreatic cystic neoplasms.”  
    Pancreatic Mucinous Cystic Neoplasm from Serous Cystic Neoplasm: Systematic Review and Meta-Analysis  
    Longjia Zhang1, Boyu Diao1, Zhiyao Fan1, Hanxiang Zhan, M.D, Ph.D  
    Acad Radiol 2025; 32:2679–2688   
Esophagus

  • Achalasia is a rare, idiopathic motor disorder of the esophagus (incidence of 0.001% and prevalence 0.01%) that develops due to poor peristaltic movements of the smooth muscles and failure of lower esophageal sphincter (LES) to open and allow passage of food bolus across the GE junction. This leads to progressive dysphagia and an eventual backup of solid and liquid food content. Patients often present with dysphagia to solids and then liquids, in addition to vomiting, regurgitation, aspiration, and even gnawing chest pain.  
    CT of the esophagus in the ER: what you need to know and what you need to remember.  
    Yasrab M, Crawford CK, Chu LC, Kawamoto S, Fishman EK.
    Emerg Radiol. 2025 Apr 16.Epub ahead of print. PMID: 40238070.
  • Imaging features suggestive of perforation (include periesophageal foci of gas and fluid, pneumomediastinum, and extravasation of oral contrast. Lacerations of the mucosa, either directly from trauma or a result of severe vomiting (Mallory-Weiss tear), can additionally show signs of hemorrhage near the site of injury. Outside of the esophagus, pleural effusions, usually unilateral, can also be appreciated. Mortality for perforation remains under 25% if diagnosed within the first 24 h, but increases substantially to 60% if management is delayed any further.
    CT of the esophagus in the ER: what you need to know and what you need to remember.  
    Yasrab M, Crawford CK, Chu LC, Kawamoto S, Fishman EK.
    Emerg Radiol. 2025 Apr 16.Epub ahead of print. PMID: 40238070.
  • While radiography has conventionally been the first diagnostic test in suspected foreign body impaction, studies have shown poor sensitivity with normal findings in up to half of all foreign body cases and in most cases where a food bolus has been lodged. Complications such as perforation, esophagitis, abscess formation, or intramural bleeding are also poorly evaluated on radiographs, whereas CT with multiplanar reconstruction and 3D rendering can achieve sensitivity and specificity close to between 90–100% for the detection and characterization of foreign body injury. Fish/ chicken bones are particularly notorious for causing perforation and should be identified promptly, which often appear as a linear focus of hyperattenuation with surrounding wall thickening and fat stranding.
    CT of the esophagus in the ER: what you need to know and what you need to remember.  
    Yasrab M, Crawford CK, Chu LC, Kawamoto S, Fishman EK.
    Emerg Radiol. 2025 Apr 16.Epub ahead of print. PMID: 40238070.
  • “Water is often administered orally as a neutral contrast to ensure proper distension of the esophagus, although a CT esophagogram may also be performed by administering a single bolus of  iodinated oral contrast that is swallowed at the start of the acquisition for adequately visualizing the esophagus.”  
    CT of the esophagus in the ER: what you need to know and what you need to remember.  
    Yasrab M, Crawford CK, Chu LC, Kawamoto S, Fishman EK.
    Emerg Radiol. 2025 Apr 16.Epub ahead of print. PMID: 40238070.
  • Among the most severe esophageal emergencies is that of esophageal rupture or perforation. Spontaneous perforation can be caused by severe vomiting, retching, or even straining, owing to an acute increase in intraesophageal pressure contrasted with the negative intrathoracic pressure, in which case it is recognized as Boerhaave syndrome. On the other hand, mechanical injury to the esophageal wall caused by iatrogenic trauma, impacted food or true foreign body ingestion can also pose a high risk for subsequent perforation. Impaction is typically at the level of the cricopharyngeus muscle or the gastroesophageal (GE) junction due to increased external compression and anatomical narrowing.
    CT of the esophagus in the ER: what you need to know and what you need to remember.  
    Yasrab M, Crawford CK, Chu LC, Kawamoto S, Fishman EK.
    Emerg Radiol. 2025 Apr 16.Epub ahead of print. PMID: 40238070.
  • Computed tomography (CT) imaging is a crucial diagnostic tool in the emergency department (ED) for evaluating nontraumatic esophageal conditions. Advanced imaging techniques such as multidetector CT (MDCT) quickly provide detailed 3D images with high spatial resolution, making it ideal for rapid assessment of a variety of esophageal pathologies. This pictorial essay presents 10 illustrative cases to highlight the clinical applications of MDCT and its critical role in diagnosing conditions like perforation, foreign body impaction, inflammatory or infectious esophagitis, achalasia, fistulae, and neoplasms. Optimized CT protocols, such as contrast-enhanced imaging and advanced postprocessing techniques like maximum intensity projection (MIP) images and volumetric rendering technique (VRT), in addition to 3D cinematic rendering, are  crucial in improving diagnostic accuracy and enhancing the visualization of anatomical structures
    CT of the esophagus in the ER: what you need to know and what you need to remember.  
    Yasrab M, Crawford CK, Chu LC, Kawamoto S, Fishman EK.
    Emerg Radiol. 2025 Apr 16.Epub ahead of print. PMID: 40238070.
  • “Compared to conventional double-contrast upper GI studies or endoscopy, MDCT provides a detailed overview of surrounding  anatomical structures and extramural involvement of the pathology. However, evaluation of the esophagus has generated less interest even though the esophagus has a range of pathologies and clinical presentations, and due to overlapping presentations with other emergencies involving mediastinal structures and pathologies, esophageal processes may be further down the list of differential diagnosis at first. Delay in diagnosis and management of esophageal emergencies is a leading cause of mortality and morbidity, necessitating the need for timely diagnosis and early prognosticationof the injury or disease process .”
    CT of the esophagus in the ER: what you need to know and what you need to remember.  
    Yasrab M, Crawford CK, Chu LC, Kawamoto S, Fishman EK.
    Emerg Radiol. 2025 Apr 16.Epub ahead of print. PMID: 40238070.
  • “Esophagitis refers to inflammation of the esophagus predominantly in the mucosa but occasionally involves the underlying submucosa and muscularis and can present acutely in the emergency setting with odynophagia, dysphagia, retrosternal pain, hematemesis, and regurgitation. There are several etiologies, including infectious, GE reflux disease, medication-related, and caustic ingestion. Infectious etiologies are common in immunocompromised patients, such as those with HIV/AIDS, malignancy, autoimmune diseases, or posttransplant status.”
    CT of the esophagus in the ER: what you need to know and what you need to remember.  
    Yasrab M, Crawford CK, Chu LC, Kawamoto S, Fishman EK.
    Emerg Radiol. 2025 Apr 16.Epub ahead of print. PMID: 40238070.
  • Aortoesophageal (AE) fistulae are a life-threatening pathology that can present in the ED, with symptoms classically ranging from hematemesis and melena to chest pain and massive upper GI hemorrhage following a symptom free interval. They can develop primarily due to aortic aneurysms, or more commonly, secondarily after aortic reconstructive interventions as abnormal connections develop between the repaired aortic segment and the esophageal walls. As discussed below, neoplastic processes are responsible for over half of all acquired tracheoesophageal (TE) fistulae in adults; both esophageal and lung malignancies can lead to a fistulous connection, while other causes include esophagitis and traumatic injury, and occasionally congenital TE fistulae that are not diagnosed until later in adulthood.
    CT of the esophagus in the ER: what you need to know and what you need to remember.  
    Yasrab M, Crawford CK, Chu LC, Kawamoto S, Fishman EK.
    Emerg Radiol. 2025 Apr 16.Epub ahead of print. PMID: 40238070.
  • While esophageal neoplasms develop more insidiously, they can present with sudden onset symptoms leading to an ED visit. Esophageal neoplasms, primarily squamous cell carcinoma (SCC) and adenocarcinoma, can present acutely with dysphagia, chest pain, hematemesis, or fistula-related complications such as aspiration . SCC  typically affects the upper/mid esophagus and is linked to smoking and alcohol use, while adenocarcinoma commonly arises in the distal esophagus, often in the setting of Barrett’s esophagus and chronic gastroesophageal reflux disease (GERD). CT findings include asymmetric wall thickening, luminal narrowing, and mediastinal lymphadenopathy, with advanced cases showing invasion into adjacent structures or distant metastases. Differentiating malignancy from severe esophagitis can be challenging, as both may exhibit mucosal irregularity and enhancement, necessitating endoscopic biopsy.
    CT of the esophagus in the ER: what you need to know and what you need to remember.  
    Yasrab M, Crawford CK, Chu LC, Kawamoto S, Fishman EK.
    Emerg Radiol. 2025 Apr 16.Epub ahead of print. PMID: 40238070.
  • CT imaging of the esophagus in the emergency setting is invaluable in assessing a wide range of non-traumatic esophageal conditions. From life-threatening perforations and neoplastic processes to esophagitis and functional disorders like achalasia, MDCT allows for rapid and accurate diagnosis. Correlation with endoscopic findings, clinical history, and laboratory parameters allows the radiologists and treating Physicians to devise an appropriate management strategy. CT imaging of the esophagus in the emergency setting is invaluable in assessing a wide range of non-traumatic esophageal conditions. From life-threatening perforations and neoplastic processes to esophagitis and functional disorders like achalasia, MDCT allows for rapid and accurate diagnosis. Correlation with endoscopic findings, clinical history, and laboratory parameters allows the radiologists and treating physicians to devise an appropriate management strategy.
    CT of the esophagus in the ER: what you need to know and what you need to remember.  
    Yasrab M, Crawford CK, Chu LC, Kawamoto S, Fishman EK.
    Emerg Radiol. 2025 Apr 16.Epub ahead of print. PMID: 40238070.
Kidney

  • “Upper tract urothelial carcinoma (UTUC) is a rare and challenging subset of the more frequently encountered urothelial carcinomas (UCs), comprising roughly 5–7% of all UCs and less than 10% of all renal tumors. Hematuria is a common presenting symptom in the emergency setting, often prompting imaging to rule out serious etiologies, with UTUC especially posing as a diagnostic challenge. These UTUC lesions of the kidney and ureter are often small, mimicking other pathologies, and are more aggressive than typical UC of the bladder, emphasizing the importance of timely and accurate diagnosis. Multidetector computed tomography urography (CTU) is the standard imaging modality for diagnosis, tumor staging, and surgical planning. Various postprocessing techniques like multiplanar reconstructions, maximal intensity projection (MIP) images, and 3D volumetric rendering technique (VRT) are crucial for accurate detection. In addition, 3D cinematic rendering (CR) is a novel technique that employs advanced illumination models, producing images with realistic shadows and increased surface detail, outperforming traditional VRT.”
    Hematuria in the ER patient: optimizing detection of upper tract urothelial cancer – A pictorial essay
    Mohammad Yasrab · Charles K. Crawford · Linda C. Chu · Satomi Kawamoto · Elliot K. Fishman
    Emerg Radiol (2025). https://doi.org/10.1007/s10140-024-02308-z
  • UTUCs have an estimated incidence of 2 cases per 100,000 population in developed countries and are increasingly found incidentally. They comprise 5–7% of all UC and less than 10% of all renal tumors. They are mostly seen in patients older than 60 years (mean age of 73) and are 2–3times more common in males as opposed to females. Significant risk factors include tobacco and smoking, alcohol, occupational carcinogens (e.g., aniline dyes), medication toxicity (e.g., cyclophosphamide), and known history of UC. Up to 2/3 of UTUCs develop in the renal pelvis, making it the second most common site for UC after the bladder. Multifocal in nature, up to 50% of patients with a UTUC develop a metachronous bladder UC and up to 4% of patients with a bladder UC develop a metachronous UTUC.
    Hematuria in the ER patient: optimizing detection of upper tract urothelial cancer – A pictorial essay
    Mohammad Yasrab · Charles K. Crawford · Linda C. Chu · Satomi Kawamoto · Elliot K. Fishman
    Emerg Radiol (2025). https://doi.org/10.1007/s10140-024-02308-z 
  • The CTU protocol at least includes non-contrast, nephrographic, and excretory phases, which ensure optimal visualization of the renal parenchyma, collecting system, and any potential urothelial abnormalities. Ideally, we want to maximize the distension and opacification of the urinary tract during the excretory phase, which is crucial for detecting lesions such as urothelial thickening, focal filling defects, and mass-forming tumors. Similarly, sufficient sensitivity for other causes of hematuria, including calculi, infectious etiologies, andrenal cell carcinoma (RCC) should also be ensured. The corticomedullary phase in particular is helpful for ruling out infections, infarctions, and providing an overview of the vascular supply, while the nephrogenic phase helps further characterize lesions and tumors.
    Hematuria in the ER patient: optimizing detection of upper tract urothelial cancer – A pictorial essay
    Mohammad Yasrab · Charles K. Crawford · Linda C. Chu · Satomi Kawamoto · Elliot K. Fishman
    Emerg Radiol (2025). https://doi.org/10.1007/s10140-024-02308-z
  • “The standard volumetric dataset is then sent for postprocessing at independent workstations for postprocessing via MIP, VRT, and/or 3D CR. Maximal intensity projection (MIP) images can provide a global perspective of the collecting system and ureters, while VRT helps define spatialand anatomic relationships. The 3D cinematic rendering (CR) technique has been previously described in detail, but briefly, it is based on a global lighting model with path tracing that simulates numerous photons and their realistic interactions with the volumetric dataset. The enhanced depth perception and appreciation of spatial relationships results in a more intuitive visualization of anatomy. Virtual ureteroscopy is another 3D postprocessing technique to visualize areas of subtle urothelial thickening, especially in obstructed systems, although its use is variable across institutes and lessso in the ED .”
    Hematuria in the ER patient: optimizing detection of upper tract urothelial cancer – A pictorial essay
    Mohammad Yasrab · Charles K. Crawford · Linda C. Chu · Satomi Kawamoto · Elliot K. Fishman
    Emerg Radiol (2025). https://doi.org/10.1007/s10140-024-02308-z
  • “Benign conditions like chronic inflammation, xanthogranulomatous pyelonephritis, chronic infection such as tuberculosis, and intraluminal blood clots and fungus balls, as well as other neoplasms such RCC, oncocytic neoplasm, lymphoma, and metastases can mimic UTUCs on CTU. Notably, benign entities like blood clots, sloughed papillae, and fungus balls remain intraluminal and lack attachment to the urothelial wall. Their absence of enhancement on post-contrastimaging further helps distinguish them from UTUCs, which may show enhancement and adherence to surrounding tissues.”
    Hematuria in the ER patient: optimizing detection of upper tract urothelial cancer – A pictorial essay
    Mohammad Yasrab · Charles K. Crawford · Linda C. Chu · Satomi Kawamoto · Elliot K. Fishman
    Emerg Radiol (2025). https://doi.org/10.1007/s10140-024-02308-z 
  • Accurate diagnosis and staging of upper tract urothelial carcinoma in patients presenting with hematuria in the ED requires a combination of optimized imaging protocols, including CTU and advanced 3D postprocessing, as well as clinical correlation. While multidetector CT urography remains the cornerstone of evaluation, awareness of imaging pitfalls and mimics is essential to prevent diagnostic errors. Use of correct and optimal scan protocols can strongly impact the diagnostic accuracy, and it is essential to ensure this consistently to be certain that a diagnosis will be made in a timely fashion. Tailoring the imaging strategy to patient presentation and leveraging postprocessing tools improves diagnostic precision and outcomes in UTUC management.
    Hematuria in the ER patient: optimizing detection of upper tract urothelial cancer – A pictorial essay
    Mohammad Yasrab · Charles K. Crawford · Linda C. Chu · Satomi Kawamoto · Elliot K. Fishman
    Emerg Radiol (2025). https://doi.org/10.1007/s10140-024-02308-z 
Liver

  • Radiomics has demonstrated multiple uses in liver cancers.One large, prospective study demonstrated that a radiomics signature derived from CRLM CT scans outperformed the Response Evaluation Criteria in Solid Tumors (RECIST) criteria for predicting folinic acid, fluorouracil, and irinotecan (FOLFIRI) and bevacizumab response. These findings were  supported by another study, where radiomicsfeatures outperformed RECIST and KRAS sequence variation status, with the radiomics signature predicting response to FOLFIRI and cetuximab with an area under the curve (AUC) of 0.80 compared with only 0.67 for KRAS status and 0.75 for 8-week tumor shrinkage measured by RECIST.2 This information can guide early chemotherapy regimen switching in nonresponders and identify patients for resection based on favorable biology.
    A. Radiomics for Treatment Planning in Liver Cancers.  
    Mian A, Kamnitsas K, Gordon-Weeks A.
    JAMA Surg. 2025 Feb 26. doi: 10.1001/jamasurg.2024.4346. Epub ahead of print. PMID: 40009391.
  • “In HCC, radiomics and clinical features predicted transarterial chemoembolization (TACE) response with an AUC of 0.90, which was linked to improved survival in the external validation cohort (hazard ratio, 2.43; P < .05). This study, which focused on patients with BCLC stage B disease, raises the question of whether a selection of patients may benefit from liver transplant outside the Milan criteria vs palliative TACE alone. For cholangiocarcinoma, a combination of radiomics and clinical features improved recurrence-free survival prediction (C index: 0.75) vs clinical features alone (C index: 0.69) in external validation. Given high rates of postsurgical recurrence in this patient cohort, further improvements will identify a subset of high-risk patients who should be offered neoadjuvant systemic therapy as a test of biological behavior rather than up-front resection.”
    A. Radiomics for Treatment Planning in Liver Cancers.  
    Mian A, Kamnitsas K, Gordon-Weeks A.
    JAMA Surg. 2025 Feb 26. doi: 10.1001/jamasurg.2024.4346. Epub ahead of print. PMID: 40009391.
  • A major challenge in radiomics is limited generalizability of models due to reliance on single-center data, which fails to account for variability in patient characteristics (eg, ethnicity, age, tumor biology),imaging protocols, and scanners differences. Some radiomic features are sensitive to these variations, reducing reproducibility across institutions. Solutions include using robust features, multiinstitutional data, standardized imaging protocols, data augmentation (eg, generative adversarial networks), and harmonization techniques likeComBat. The Image Biomarker Standardization Initiative has played a key role in standardizing radiomic biomarker nomenclature and definitions.  
    A. Radiomics for Treatment Planning in Liver Cancers.  
    Mian A, Kamnitsas K, Gordon-Weeks A.
    JAMA Surg. 2025 Feb 26. doi: 10.1001/jamasurg.2024.4346. Epub ahead of print. PMID: 40009391.

  • A. Radiomics for Treatment Planning in Liver Cancers.  
    Mian A, Kamnitsas K, Gordon-Weeks A.
    JAMA Surg. 2025 Feb 26. doi: 10.1001/jamasurg.2024.4346. Epub ahead of print. PMID: 40009391.
  • Routine application of radiomics in oncological liver treatment planning depends on outcomes of prospective studies and regulatory approval. Multi-institutional collaborative networks are required to harness data for generalizable models. We anticipate routine use within the next decade if these challenges are addressed.  
    A. Radiomics for Treatment Planning in Liver Cancers.  
    Mian A, Kamnitsas K, Gordon-Weeks A.
    JAMA Surg. 2025 Feb 26. doi: 10.1001/jamasurg.2024.4346. Epub ahead of print. PMID: 40009391.
  • “Portal vein aneurysm (PVA) is a rare vascular abnormality, representing 3% of all venous aneurysms in the human body, and is not well understood. It can be congenital or acquired, located mainly at the level of confluence, main trunk, branches and bifurcation. A PVA as an abnormality of the portal venous system was first reported in 1956 by Barzilai and Kleckner. A review from 2015 entitled “Portal vein aneurysm: What to know” considered fewer than 200 cases.”
    .Portal vein aneurysm-etiology, multimodal imaging and current management.  
    Kurtcehajic A, Zerem E, Alibegovic E, et al.
    World J Clin Cases. 2023 Feb 6;11(4):725-737. 
  • “A portal vein aneurysm (PVA) is the abnormal focal saccular or fusiform dilatation of the portal venous system, and it is defined as a PV diameter exceeding 19 mm in cirrhotic patients and 15 mm in a normal liver. It is a rare vascular abnormality, representing 3% of all venous aneurysms in the human body, and is not well understood. Douglass et al studied 92 autopsies and reported that the diameter of the PV was between 0.64 mm and 12.1 mm in patients without cirrhosis and those without portal hypertension. In 1976, Doust et al conducted a vascular study of 53 patients to assess the size of the PV and underlying liver status through abdominal ultrasound, and they detected that the maximum calibre of the PV was 19 mm in cirrhotic patients and 15 mm in patients with normal livers. Hence, a portal vein diameter of > 20 mm is universally regarded as the threshold for diagnosis of a PVA.”
    Portal vein aneurysm-etiology, multimodal imaging and current management.  
    Kurtcehajic A, Zerem E, Alibegovic E, et al.
    World J Clin Cases. 2023 Feb 6;11(4):725-737. 
  • “ In terms of aetiology, the frequency of congenital PVAs was 29 (46.7%), and it was 17 (27.4%) for acquired PVAs. In 16 (25.8%) patients, the aetiology of the PVAs was unclear. Regarding the location of PVAs, 27.41% were at the level of the splenomesenteric confluence; 19.35% were at the main trunk; 17.74% were at branches; 6.45% were at the PV bifurcation; 6.45% were at the SV; and 4.83% were at the SMV; 14.51% were classified as intrahepatic PVAs.”
    Portal vein aneurysm-etiology, multimodal imaging, and current management.  
    Kurtcehajic A, Zerem E, Alibegovic E, et al.
    World J Clin Cases. 2023 Feb 6;11(4):725-737. 
  • “Contrast-enhanced CT with angiography shows the filling of PVA. On a CT and magnetic resonance imaging (MRI) scan, a PVA will appear as a well-defined contrast-enhanced focal saccular anomaly or fusiform dilatation of the portal venous system during the portal venous phase.”
    Portal vein aneurysm-etiology, multimodal imaging, and current management.  
    Kurtcehajic A, Zerem E, Alibegovic E, et al.
    World J Clin Cases. 2023 Feb 6;11(4):725-737. 
  • “PVA can be congenital or acquired, located mainly at the level of confluence, main trunk, branches and bifurcation. Up to 30% of patients can be asymptomatic, and non-specific abdominal pain should be investigated to exclude other pathological causes, such as cholecystitis or peptic ulcer disease, etc. Thrombosis complications occur in approximately 19%-23% of patients, and biliopathy occurs in approximately 4%-6% of patients. Other complications can also arise from compression due to a PVA, including thrombosis of the ICV and intestinal obstruction. Diagnosis of a PVA is based on spectral and colour Doppler sonography, and CT and MRI. EUS and IDU have also been used as a diagnostic tool. If a PVA is asymptomatic, it does not require any active treatment, and monitoring (a policy of “wait and see”) should be adopted. ”
    Portal vein aneurysm-etiology, multimodal imaging, and current management.  
    Kurtcehajic A, Zerem E, Alibegovic E, et al.
    World J Clin Cases. 2023 Feb 6;11(4):725-737. 
Pancreas

  • Radiomics holds potential to transform pancreatic imaging by allowing precise quantification and texture analysis beyond what is visible to the naked eye. This property improves not only PDAC detection, but also facilitates classification and risk assessment of pancreatic cystic neoplasms and the discrimination of aggressiveness in pancreatic neuroendocrine neoplasms. The use of a radiomics models with DECT has been shown to be a powerful tool for nodal metastases detection in PDAC. Most interestingly, radiomics can also predict overall survival and disease-free survival in patients post-PDAC resection, outperforming traditional clinical models for prognosis.
    CT Innovation in Pancreatic Imaging: A Bright Future, But Are We There Yet?  
    Drucker Iarovich M, Gladkikh M, van der Pol CB.
    Can Assoc Radiol J. 2025 Apr. Epub ahead of print. PMID: 40165682.
  • Artificial intelligence (AI), including convolutional neural networks with radiomics, has been shown to improve tumour characterization, personalized treatment, and prediction of treatment response. Emerging research indicates that deep learning models may detect pancreatic tumours on prediagnostic CT scans months before clinical presentation—a finding that, if confirmed, could greatly influence patient outcomes.4 While promising, these algorithms must first prove their generalizability and undergo external validation. Furthermore, a major barrier to adoption remains suboptimal integration of AI into a busy clinical workflow.
    CT Innovation in Pancreatic Imaging: A Bright Future, But Are We There Yet?  
    Drucker Iarovich M, Gladkikh M, van der Pol CB.
    Can Assoc Radiol J. 2025 Apr. Epub ahead of print. PMID: 40165682.
  •  Background: As pancreatic cystic neoplasms (PCN) differ in current standard of care, and these treatments can affect quality of life to varying degrees, a definitive preoperative diagnosis must be reliable. Current diagnostic approaches, specifically traditional cross- sectional imaging techniques, face certain limitations. But radiomics has been shown to have high diagnostic accuracy across a range of diseases. Objective to conduct a comprehensive review of the literature on the use of radiomics to differentiate Mucinous Cystic Neoplasm (MCN) from Serous Cystic Neoplasm (SCN). Methods: This study was comprehensively searched in Pubmed, Scopus and Web of Science databases for meta-analysis of studies that used radiomics to distinguish MCN from SCN. Risk of bias was assessed using the diagnostic accuracy study quality assessment method and combined with sensitivity, specificity, diagnostic odds ratio, and summary receiver operating characteristic (SROC)curve analysis.  
    Pancreatic Mucinous Cystic Neoplasm from Serous Cystic Neoplasm: Systematic Review and Meta-Analysis  
    Longjia Zhang1, Boyu Diao1, Zhiyao Fan1, Hanxiang Zhan, M.D, Ph.D  
    Acad Radiol 2025; 32:2679–2688 
  • Results: A total of 884 patients from 8 studies were included in this analysis, including 365 MCN and 519 SCN. The Meta-analysis found that radiomics identified MCN and SCN with high sensitivity and specificity, with combined sensitivity and specificity of 0.84(0.82–0.87) and 0.82(0.79–0.84). The positive likelihood ratio (PLR) and the negative likelihood ratio (NLR) are 5.61(3.72, 8.47) and 0.14(0.09–0.26). In addition, the area under the SROC curve (AUC) was drawn at 0.93. No significant risk of publication bias was detected through the funnel plot analysis. The performances of feature extraction from the volume of interest (VOI) or Using AI classifier in the radiomics models were superior to those of protocols employing region of interest (ROI) or absence of AI classifier. Conclusion: This meta-analysis demonstrates that radiomics exhibits high sensitivity and specificity in distinguishing between MCN and SCN, and has the potential to become a reliable diagnostic tool for their identification.  
    Pancreatic Mucinous Cystic Neoplasm from Serous Cystic Neoplasm: Systematic Review and Meta-Analysis  
    Longjia Zhang1, Boyu Diao1, Zhiyao Fan1, Hanxiang Zhan, M.D, Ph.D  
    Acad Radiol 2025; 32:2679–2688   
  • • The pooled sensitivity and specificity of radiomics for differentiating Mucinous Cystic Neoplasm from Serous Cystic Neoplasms were 84% and 82%, respectively.  
    • The field of radiomics lacks standardization, resulting in substantial variations in statistical analysis where such studies are conducted.  
    •Radiomics has an excellent diagnostic effect in distinguishing MCN from SCN and providing more critical information.    
    Pancreatic Mucinous Cystic Neoplasm from Serous Cystic Neoplasm: Systematic Review and Meta-Analysis  
    Longjia Zhang1, Boyu Diao1, Zhiyao Fan1, Hanxiang Zhan, M.D, Ph.D  
    Acad Radiol 2025; 32:2679–2688    
  • MCN is an uncommon tumor that usually occurs in middle-aged women. Surgery is the treatment of choice, and prognosis is excellent in the absence of invasive carcinoma (8). For SCN, the vast majority are benig. Studies have shown that most patients with SCN do not need surgery unless they have significant symptoms or a preoperative diagnosis is unclear. Therefore, some patients can choose to follow-up. Compared with SCN, MCN has considerable malignant potential, so the guidelines recommend resections for all patients who are suitable for surgery. Therefore, it is important to distinguish MCN from SCN in clinic, but current diagnostic approach (ie, traditional cross-sectional imaging) has limitations. It has been reported that the discrimination efficacy of CT for SCNs was ranged from 43% to 67%  
    Pancreatic Mucinous Cystic Neoplasm from Serous Cystic Neoplasm: Systematic Review and Meta-Analysis  
    Longjia Zhang1, Boyu Diao1, Zhiyao Fan1, Hanxiang Zhan, M.D, Ph.D  
    Acad Radiol 2025; 32:2679–2688   
  • “ Our study discovered that radiomics possesses a high degree of accuracy in distinguishing PCNs, particularly in detecting MCN and SCN, making it worthy of promotion for broader application. However, we require additional high-quality research to further validate these findings, and its practical efficiency and clinical applicability also need to be explored further. Moreover, we anticipate establishing standardized radiomics guidelines in the future to provide more evidence for the diagnosis and treatment of pancreatic cystic neoplasms.”  
    Pancreatic Mucinous Cystic Neoplasm from Serous Cystic Neoplasm: Systematic Review and Meta-Analysis  
    Longjia Zhang1, Boyu Diao1, Zhiyao Fan1, Hanxiang Zhan, M.D, Ph.D  
    Acad Radiol 2025; 32:2679–2688   
  • SCAs can also present in the context of Von Hippel– Lindau (VHL) disease, which is characterized by the development of multiple simple cysts, and sometimes even a more extensive cystic replacement of the pancreas. Multiple cysts were seen in more than 60% of VHL patients, and both serous cystadenomas and PNETs were present in over 10% of VHL cases. Compared to the general population, VHL patients tend to present much earlier with the pancreatic lesions than the general population (second to third decade of life vs. sixth decade of life for SCAs) . It is especially important to keep VHL disease in mind when multiple cystic lesions are seenin a younger patient, because these lesions may be its only manifestation for several years, with pancreatic involvement seen in nearly 80% of patients.”
    Misdiagnosis of pancreatic intraductal papillary mucinous neoplasms and the challenge of mimicking lesions: imaging diagnosis and differentiation strategies.
    Yasrab M, Kwak SJ, Khoshpouri P, Fishman EK, Zaheer A.  
    Abdom Radiol (NY). 2025 May;50(5):2241-2257. 
  • Cystic pancreatic neuroendocrine tumors (PNETs) have recently been categorized as a distinct entity as small lesions that occur more commonly in the pancreatic body and tail. These lesions are usually non-functioning have a less aggressive behaviour with a lower ki-67 index. Other features include a roughly equal predilection for both sexes and a mean age of 55. The small size andcystic nature can mimic an IPMN and Singhi et al. in their review noted that of 53 cystic PNETs, 23 were misdiagnosed, and IPMNs were the most common misdiagnosis. An important distinguishing feature from IPMN is the peripheral hypervascular rim seen on arterial phase CT  which highlights the importance of dedicated dual phase pancreatic protocol CT as the enhancement may only be appreciable transiently. This feature may sometimes be difficult to appreciate on post contrast MRI due to the inherent bright signal of the pancreas on T1WI.
    Misdiagnosis of pancreatic intraductal papillary mucinous neoplasms and the challenge of mimicking lesions: imaging diagnosis and differentiation strategies.
    Yasrab M, Kwak SJ, Khoshpouri P, Fishman EK, Zaheer A.  
    Abdom Radiol (NY). 2025 May;50(5):2241-2257. 
  • Borderline resectable pancreatic cancer remains a concept in continued evolution. Accurate imaging-based identification of the subset of patients who would benefit most from neoadjuvant therapy is imperative to improve treatment outcomes and overall survival. Critically, this includes an understanding of the key evolving imaging thresholds of disease severity, both between resectable/ borderline and borderline/locally advanced disease, as they specifically relate to increasing risk of positive margin at surgery.Due to the potential for overestimating the extent of vascular involvement following neoadjuvant therapy, radiologists should focus on excluding disease progression rather than expecting tumor regression in response to therapy.
    Borderline resectable pancreatic cancer: conceptual evolution and current approach to image-based classification
    J. W. Gilbert, B. Wolpin, T. Clancy et al.
    Annals of Oncology 28: 2067–2076, 2017
  • The rising prevalence of pancreatic cystic lesions (PCLs), particularly intraductal papillary neoplasms (IPMNs), has been attributed to increased utilization of advanced imaging techniques. Incidental detection of PCLs is frequent in abdominal CT and MRI scans, with IPMNs representing a significant portion of these lesions. Surveillance of IPMNs is recommended due to their malignant potential; however, their overlapping imaging features with benign entities can lead to misdiagnosis, overtreatment, and overutilization of healthcare resources. This paper aims to highlight and differentiate lesions often mistaken for IPMNs, providing insight into their imaging characteristics, diagnostic challenges, and distinctive features while highlighting the incidence of wrong diagnosis for these lesions. These lesions include serous cystadenomas, cystic pancreatic neuroendocrine tumors, mucinous cystic neoplasms, lymphoepithelial cysts, duodenal diverticula, pancreatic schwannomas, chronic pancreatitis, retention cysts, intrapancreatic accessory spleens, pancreatic lipomas, choledochal cysts, and others.
    Misdiagnosis of pancreatic intraductal papillary mucinous neoplasms and the challenge of mimicking lesions: imaging diagnosis and differentiation strategies.
    Yasrab M, Kwak SJ, Khoshpouri P, Fishman EK, Zaheer A.  
    Abdom Radiol (NY). 2025 May;50(5):2241-2257. 
  • “Calcifications (frequently punctate but can be coarse) are present in up to 20% of IPMNs. BD-IPMNs can be singular lesions or multifocal and are described as having a grape-like appearance with a communication with the MPD, which is best appreciated on MRI/MRCP, although it can be difficult to visualize in some cases. In one study involving 89 patients, 84% of patients were found to have communication with the main pancreatic duct on MRCP with secretin while the remaining 16% of patients did not demonstrate communication with the main pancreatic duct. On endoscopic ultrasonography (EUS), they appear as single or multicystic lesions with hypoechoic contents representing mucin. FNA, cyst fluid analysis, histological studies, and molecular analysis of different mutations can all help in definitive diagnosis and also assess malignant potential when imaging reveals worrisome or high-risk features according to the surveillance guidelines.”
    Misdiagnosis of pancreatic intraductal papillary mucinous neoplasms and the challenge of mimicking lesions: imaging diagnosis and differentiation strategies.
    Yasrab M, Kwak SJ, Khoshpouri P, Fishman EK, Zaheer A.  
    Abdom Radiol (NY). 2025 May;50(5):2241-2257. 
  • “On CT, they can be visualized as low-attenuation cystic lesions with or without a thin enhancing rim and may display possible septations that exhibit enhancement. They are more often peripancreatic and present as exophytic lesions with sharply demarcated borders, which is also described as a characteristic feature when comparing with other cystic lesions like IPMNs.”
    Misdiagnosis of pancreatic intraductal papillary mucinous neoplasms and the challenge of mimicking lesions: imaging diagnosis and differentiation strategies.
    Yasrab M, Kwak SJ, Khoshpouri P, Fishman EK, Zaheer A.  
    Abdom Radiol (NY). 2025 May;50(5):2241-2257. 
  • Accurate diagnosis of IPMN-mimicking lesions is crucial to guide proper management and prevent unnecessary interventions. The intricate nature of pancreatic cystic lesions necessitates a multidisciplinary approach, integrating advanced imaging techniques, fluid analysis, cytology, and molecular markers. This approach effectively distinguishes between benign and malignant conditions, minimizing misdiagnosis-related burdens. Appreciating subtle imaging nuances like the grape-like appearance of IPMNs and the “extracapsular cystic sign” of serous cystadenomas highlighted in Table 2 aids in differentiation. Emerging technologies, such as radiomics and AI, hold promise in refining complex diagnoses. Challenges arise from overlapping features, evolving diagnostics, and lesion variability, warranting ongoing research and collaboration. Rectifying misdiagnoses, especially with unexpected mimics, refines radiology, benefiting patient care. A comprehensive, collaborative strategy is vital as understanding of pancreatic cystic lesions advances, reducing overdiagnosis, optimizing outcomes, and easing healthcare burdens.
    Misdiagnosis of pancreatic intraductal papillary mucinous neoplasms and the challenge of mimicking lesions: imaging diagnosis and differentiation strategies.
    Yasrab M, Kwak SJ, Khoshpouri P, Fishman EK, Zaheer A.  
    Abdom Radiol (NY). 2025 May;50(5):2241-2257. 
  • New visualization techniques, such as cinematic rendering, create possibilities for improved surgical planning. The ability to generate photorealistic, three-dimensional representations of the pancreas and vasculature is a valuable tool to optimize preoperative assessment, refine surgical precision and improve patient outcomes.
    CT Innovation in Pancreatic Imaging: A Bright Future, But Are We There Yet?  
    Drucker Iarovich M, Gladkikh M, van der Pol CB.
    Can Assoc Radiol J. 2025 Apr. Epub ahead of print. PMID: 40165682.
  • One promising development in recent years has been the description of a new subgroup of approximately 5%–10% of patients with borderline resectable disease who have disease that is too advanced achieve a negative margin with immediate surgery but potentially can reach a margin-negative resection after neoadjuvant therapy, although the true benefits of neoadjuvant therapy remain incompletely characterized. There is disagreement about how this group should be defined, but its relationship to disease status can be conceptualized as a continuum of disease severity with two key thresholds (Figure 1). The first is between resectable and borderline resectable disease, beyond which there is a continually increasing risk of margin-positive resection that potentially can be mitigated by neoadjuvant therapy.
    Borderline resectable pancreatic cancer: conceptual evolution and current approach to image-based classification
    J. W. Gilbert, B. Wolpin, T. Clancy et al.
    Annals of Oncology 28: 2067–2076, 2017
  • “Solid pseudopapillary neoplasm (SPN) of the pancreas, are rare low-grade malignant pancreatic tumors, most commonly occurring in young women during their second or third decade of life. They can present with vague abdominal symptoms like pain, discomfort, and nausea, or it can be incidentally discovered on imaging studies. There has been limited literature on ruptured SPN, which can be spontaneous or traumatic. In this paper, we present three cases of ruptured SPN, one traumatic and two spontaneous, to add to the scarcity of knowledge regarding this condition and its radiologic features, along with a detailed review of current literature.”
    Spontaneous rupture of solid pseudopapillary neoplasm (SPN) of the Pancreas - imaging insights and review of the literature.  
    Arshad H, Chu LC, Fishman EK, Kawamoto S.  
    Emerg Radiol. 2025 Mar 19.. Epub ahead of print. PMID: 40106120.
  • Solid pseudopapillary neoplasms (SPNs) of the pancreas, formerly referred to as solid and cystic tumors of the pancreas, Frantz tumors, solid and papillary epithelial neoplasms, Hamoudi tumors, and papillary-cystic tumors, are rare low-grade malignant pancreatic tumors. They represent about 1- 2% of exocrine pancreatic tumors and 5% of cystic pancreatic lesions in adults, most commonly occurring in young women during their second or third decade of life. A significantly high proportion, ranging from 6 to 17%, has been reported in pediatric populations. SPN is often found incidentally by imaging or can manifest with various clinical symptoms, including abdominal discomfort, pain, or a palpable mass.”
    Spontaneous rupture of solid pseudopapillary neoplasm (SPN) of the Pancreas - imaging insights and review of the literature.  
    Arshad H, Chu LC, Fishman EK, Kawamoto S.  
    Emerg Radiol. 2025 Mar 19.. Epub ahead of print. PMID: 40106120.
  • SPNs usually have a long asymptomatic period before presenting with non-specific symptoms of abdominal pain, discomfort, diarrhea, nausea, or rarely, gastrointestinal obstruction, due to its mass effect on nearby organs. All three cases presented in this article had a prolonged history of vague abdominal symptoms. In rare occasions of ruptured SPN, these patients can present with acute abdomen, withsevere abdominal pain associated with shock.
    Spontaneous rupture of solid pseudopapillary neoplasm (SPN) of the Pancreas - imaging insights and review of the literature.  
    Arshad H, Chu LC, Fishman EK, Kawamoto S.  
    Emerg Radiol. 2025 Mar 19.. Epub ahead of print. PMID: 40106120.
  • “On CT scan, SPNs typically present as large, encapsulated, hypovascular, hypodense tumors, with mixed density, both solid and cystic components and may have septations and calcifications. Cystic areas appear as they outgrow their blood supply. Another characteristic feature of SPN is internal hemorrhage found in 29% to 41% of cases on MRI based on T1 and T2 signal characteristic. However, incidentally found SPNs on imaging studies may be small, and tend to be more solid than larger tumors. A review of the literature including 718 patients with SPN reported that it ranges in size from 0.5 to 34.5 cm with a mean diameter of 6.08 cm”.
    Spontaneous rupture of solid pseudopapillary neoplasm (SPN) of the Pancreas - imaging insights and review of the literature.  
    Arshad H, Chu LC, Fishman EK, Kawamoto S.  
    Emerg Radiol. 2025 Mar 19.. Epub ahead of print. PMID: 40106120.
  • “Cinematic rendering (CR) offers transformative advantages in imaging SPNs, particularly in complex cases involving trauma-associated rupture. CR produces photorealistic 3-dimensional images with unparalleled depth and detail, enhancing visualization of morphology and internal architecture. It outperforms standard CT scan in depicting features such as solid and cystic components, septations, textures, internal hemorrhage and its spatial relationship with surrounding organs and vasculature. This is especially crucial in ruptured cases, where understanding tumor integrity, extent, and the spread of blood in the peritoneal or retroperitoneal cavity is essential.”
    Spontaneous rupture of solid pseudopapillary neoplasm (SPN) of the Pancreas - imaging insights and review of the literature.  
    Arshad H, Chu LC, Fishman EK, Kawamoto S.  
    Emerg Radiol. 2025 Mar 19.. Epub ahead of print. PMID: 40106120.
  • “It is crucial to differentiate SPN from other pancreatic and peripancreatic masses with similar presentation including mucinous cystic neoplasm, neuroendocrine tumor, serous cystadenoma, pancreatoblastoma, hemorrhagic pseudocyst, and gastrointestinal stromal tumor. The classic presentation of SPN is a young female with an encapsulated pancreatic mass with both cystic and solid components, with usually abnormal caliber of pancreatic duct. Fluid debris levels can also be seen on CT and MR imaging representing hemorrhagic degeneration and cystic cavities.”
    Spontaneous rupture of solid pseudopapillary neoplasm (SPN) of the Pancreas - imaging insights and review of the literature.  
    Arshad H, Chu LC, Fishman EK, Kawamoto S.  
    Emerg Radiol. 2025 Mar 19.. Epub ahead of print. PMID: 40106120.
  • “SPNs of the pancreas are rare, low malignant potency tumors mostly presenting in young women. Ruptured cases are uncommon and can occur spontaneously or due to trauma. In traumatic cases, it could be confused with a trauma-associated hematoma, thus, it is important to understand their radiological features and report such cases correctly for early identification and surgical resection as SPNs have an overall excellent prognosis after resection. However, ruptured SPNs require long-term follow-up due to the potential risk of peritoneal metastasis. In cases of trauma, when ruptured SPN is difficult to differentiate from hematoma, follow-up imaging should be conducted to distinguish between the two entities. CR provides a better visualization of tumor anatomy and morphology, assisting both radiologists and surgeons in early decision making and surgical planning, especially in cases of rupture.”
    Spontaneous rupture of solid pseudopapillary neoplasm (SPN) of the Pancreas - imaging insights and review of the literature.  
    Arshad H, Chu LC, Fishman EK, Kawamoto S.  
    Emerg Radiol. 2025 Mar 19.. Epub ahead of print. PMID: 40106120.
  • Overall Comment
  • Workup
  • CT Scan Protocols
  • Resectability Definitions
  • Arterial Mapping
  • Venous Mapping
  • Evaluation of genetic information leading to early cancer diagnosis and management involves analysis of cell-free DNA analyzed via liquid biopsy through various laboratory methods. Cell-free DNA (cfDNA) refers to DNA fragments found freely in body fluids that can be derived from both healthy and cancerous cells. Fragments of cfDNA derived from healthy cells average around 160 base pairs in length, and are distinguishable from tumor-associated cfDNA, termed circulating tumor DNA (ctDNA), which averages a slightly shorter fragment length of 140 base pairs
    Translating the multifaceted use of liquid biopsy to management of early disease in pancreatic adenocarcinoma.  
    Cox M, Vitello D, Chawla A.  
    Front Oncol. 2025 Mar 13;15:1520717. doi: 10.3389/fonc.2025.1520717. 
  • The consensus on the origin of ctDNA involves primary tumor cells that have undergone apoptosis, necrosis, or are actively metastasizing. In addition to ctDNA, circulating tumor cells (CTCs) as well as other cellular components such as RNA or proteins may be present and provide information indicative of malignancy and of the primary tumor’s characteristics . With a half-life of less than 2 hours, ctDNA analysis provides an accurate reflection of the current genetic landscape and behavior of the primary tumor in real-time. From first identification of its relevance in cancer patients in the landmark paper by Leon et al. in 1977, ctDNA has grown in its significance to be at current the most established liquid biopsy analyte for use in cancer management with multiple large clinical trials and FDA-approved device panels evaluating its validity in early diagnosis, prognostication, targeted treatment selection, and residual disease monitoring.
    Translating the multifaceted use of liquid biopsy to management of early disease in pancreatic adenocarcinoma.  
    Cox M, Vitello D, Chawla A.  
    Front Oncol. 2025 Mar 13;15:1520717. doi: 10.3389/fonc.2025.1520717. 
  • “Early diagnosis of PDAC is difficult for many reasons. For one, screening of individuals at average risk for pancreatic cancer is not standard of care. Around 70-90% of individuals who will be diagnosed with PDAC are at average risk . Many of the most common factors are only weakly associated with an increase in risk and are largely related to a patient’s lifestyle (e.g. smoking use, uncontrolled diabetes, alcohol use, obesity). Screening for PDAC often involves time-consuming and expensive procedures such as yearly MRI, esophagogastroduodenoscopy and endoscopic ultrasound, repeat fine needle aspirations and blood draws that have not been shown to identify enough early PDAC cases to justify the extent of invasive procedures that individuals will undergo throughout their lifetime .”
    Translating the multifaceted use of liquid biopsy to management of early disease in pancreatic adenocarcinoma.  
    Cox M, Vitello D, Chawla A.  
    Front Oncol. 2025 Mar 13;15:1520717. doi: 10.3389/fonc.2025.1520717. 
  • Monitoring of pancreatic intraepithelial neoplasms (PanINs), histologically identified areas within the pancreas that in rare cases progress to malignancy, is also not a possibility as these lesions are not directly evaluable except in pathologic specimens, and data is lacking to clearly understand the percentage of patients with PanINs that will progress to PDAC. Some studies have estimated the likelihood of PanIN progression to PDAC to be less than 2% and taking up to 35 years or more, making screening of these lesions minimally beneficial even if feasible . Additionally, PanINs are found in nearly three-fourths of pancreatectomy and autopsy specimens by age 80, as well as in multiple individuals in their 20’s with low rates of progression to cancer.
    Translating the multifaceted use of liquid biopsy to management of early disease in pancreatic adenocarcinoma.  
    Cox M, Vitello D, Chawla A.  
    Front Oncol. 2025 Mar 13;15:1520717. doi: 10.3389/fonc.2025.1520717. 
  • “Conversely, another well-known precursor lesion in PDAC, intraductal papillary mucinous neoplasms (IPMNs), are estimated to be detectable in around 3%–6% of the general population and 10% of the population over 70, and can be monitored as compared to PanINs which cannot. Additionally, IPMNs demonstrate much higher progression rates to malignancy depending on the subtype, with rates as high as 90% in mixed-type types and as low as 3.3% in branch-duct types. However, there is difficulty in differentiating IPMNs that will progress to PDAC from those that will not, and further studies are needed to identify genetic differences, histological differences, or both to clearly stratify patients and avoid overtreating when unlikely to mitigate risk.”  
    Translating the multifaceted use of liquid biopsy to management of early disease in pancreatic adenocarcinoma.  
    Cox M, Vitello D, Chawla A.  
    Front Oncol. 2025 Mar 13;15:1520717. doi: 10.3389/fonc.2025.1520717. 
  • For the 5-10% of diagnosed PDAC patients that have known genetic risk based on family history (defined as at least one first degree relative or two second-degree relatives diagnosed with pancreatic cancer in their lifetime) as well as an additional 3-5% of individuals that carry a predisposing genetic mutation (most commonly Hereditary Breast and Ovarian Cancer Syndrome (BRCA1/2), Fanconi Anemia, Familial Adenomatous Polyposis (FAP), Peutz-Jeghers Syndrome, Li-Fraumeni Syndrome, Familial Atypical Multiple Mole Melanoma Syndrome (FAMMM) or Lynch Syndrome (MLH1, MSH2/6 or PMS2 variants)), there is identified benefit from screening .”
    Translating the multifaceted use of liquid biopsy to management of early disease in pancreatic adenocarcinoma.  
    Cox M, Vitello D, Chawla A.  
    Front Oncol. 2025 Mar 13;15:1520717. doi: 10.3389/fonc.2025.1520717. 
  • In addition, analysis of ctDNA is much more specific than other blood-based biomarkers that are typically present at various levels as detection of any measurable amount of tumor DNA indicates the presence of malignancy. While studies provide evidence supporting ctDNA as a strong and even independent diagnostic marker, it is present in considerably smaller quantities in early disease which poses an obstacle to its use as an early diagnostic tool. However, its use alongside current biomarkers shows strong promise for improving precision in early diagnosis. A study by Cohen et al. in 2018 demonstrated that a combined assay combining both CA 19-9 and ctDNA abundance demonstrated superior precision over use of any biomarker alone as  diagnostic tool for early PDAC, demonstrating the ability to detect disease in 60% of patients who had no traditional presenting symptoms of PDAC as well as 41% of PDAC patients who wouldbe diagnosed with Stage I disease.
    Translating the multifaceted use of liquid biopsy to management of early disease in pancreatic adenocarcinoma.  
    Cox M, Vitello D, Chawla A.  
    Front Oncol. 2025 Mar 13;15:1520717. doi: 10.3389/fonc.2025.1520717. 
  • Another significant issue is the biological variability inherent in PDAC tumors. Many patients may not shed detectable levels of ctDNA in addition to PDAC lacking a strong molecular profile outside of KRAS aberrations, which happens to be the most mutated oncogene in all human malignancies. With minimal amounts of tumor shedding in PDAC along with a limited molecular profile, ctDNA analysis may serve little to no benefit for individuals with nonspecific mutations or undetectable ctDNA. Additionally, with the majority of PDAC patients not having surgically resectable disease at diagnosis, it is unclear how disease properties and thus ctDNA are altered as disease progresses.  
    Translating the multifaceted use of liquid biopsy to management of early disease in pancreatic adenocarcinoma.  
    Cox M, Vitello D, Chawla A.  
    Front Oncol. 2025 Mar 13;15:1520717. doi: 10.3389/fonc.2025.1520717. 
  • “While challenges remain in the field of ctDNA analysis for pancreatic adenocarcinoma, the potential for its advancement and use in clinical practice is vast. Continued evaluation of its potential and validity in large trials will be paramount for moving the benefits provided by liquid biopsy and circulating tumor DNA analysis to patients, paving the way for early diagnosis and more effective treatment strategies to ultimately improve patient outcomes for such an aggressive disease.”
    Translating the multifaceted use of liquid biopsy to management of early disease in pancreatic adenocarcinoma.  
    Cox M, Vitello D, Chawla A.  
    Front Oncol. 2025 Mar 13;15:1520717. doi: 10.3389/fonc.2025.1520717. 
  • Pancreatic cancer is a highly lethal disease due to its aggressive tumour biology that frequently presents with non-specific symptoms and has a high rate of metastatic disease at diagnosis. A multidisciplinary approach is mandatory to adequately stage and treat patients with pancreatic cancer with tumour-targeted therapy and concomitant supportive care. Chemotherapy combined with surgical resection is the cornerstone of treatment, but only a small set of patients are candidates for surgery. Given the complexity of pancreatic cancer care, patients should be managed at expert centres. The introduction of multi-agent chemotherapy, either as palliative chemotherapy for metastatic disease or as (neo)adjuvant or induction therapy in patients with localised pancreatic cancer, has improved the survival of patients with pancreatic cancer. Given the prospect that pancreatic cancer will become the second leading cause of cancer-related deaths by 2030, there is an urgent need for novel tumour-targeted therapies with promising results from new generation immunotherapies and KRAS-directed therapies.  
    Pancreatic cancer  
    Thomas F Stoop, Ammar A Javed, Atsushi Oba, et al  
    Lancet 2025; 405: 1182–202 
  •  Pancreatic cancer is frequently a lethal disease with an aggressive tumour biology often presenting with non-specific symptoms. Median survival is approximately 4 months with a 5-year survival of 13%. Surveillance is recommended in individuals with familial pancreatic cancer, specific mutations, and high-risk intraductal papillary mucinous neoplasm, as they are at high risk of developing pancreatic cancer. Chemotherapy combined with surgical resection remains the cornerstone of treatment. However, only a small subset of patients are candidates for surgery. Multi-agent chemotherapy has improved survival in the palliative setting for patients with metastatic disease, as (neo) adjuvant and induction therapy have in patients with borderline resectable and locally advanced pancreatic. Given that pancreatic cancer is predicted to become the second leading cause of cancer-related death by 2030, novel therapies are urgently needed.  
    Pancreatic cancer  
    Thomas F Stoop, Ammar A Javed, Atsushi Oba, et al  
    Lancet 2025; 405: 1182–202 
  • Approximately 95% of these tumours arise from precancerous lesions called pancreatic intraepithelial neoplasias.15 Other precursor lesions are pancreatic cysts, including intraductal papillary mucinous neoplasms (IPMNs) and mucinous cystic neoplasms. In about half of patients with pancreatic cancer and a concomitant IPMN, the invasive tumour is not derived from IPMN.15,16 In the general population, pancreatic cysts are estimated to occur in 16% (95% CI 13–18) of individuals, and IPMN is the most common and has the highest risk of malignant transformation.17 IPMNs with low-risk features has a cumulative incidence of malignant transformation of 8% (4–12) at 10 years, although the risk can be up to 25% (15–36) for patients with high-risk features.  
    Pancreatic cancer  
    Thomas F Stoop, Ammar A Javed, Atsushi Oba, et al  
    Lancet 2025; 405: 1182–202 
  •  The most common somatic mutations are KRAS (~88%), TP53 (61–74%), CDKN2A (16–44%), and SMAD4 (20–22%). The major genetic event in the development of pancreatic ductal adenocarcinoma is the somatic KRAS oncogene mutation,22 which is observed in more than 90% of patients with low-grade pancreatic intraepithelial neoplasia.23 The KRAS mutation remains active during the progression from epithelial cell to invasive cancer, contributing to the processes of proliferation, survival, migration, and invasion. By its effect on the tumour stroma and microenvironment, the KRAS protein plays an important role in the process of metastatic spread and chemotherapy resistance.  
    Pancreatic cancer  
    Thomas F Stoop, Ammar A Javed, Atsushi Oba, et al  
    Lancet 2025; 405: 1182–202 
  • “Diabetes is considered to be another risk factor for pancreatic cancer (RR 1·5, 95% CI 1·4–1·6). However, diabetes can also be a prodrome of pancreatic cancer (ie, type 3c or pancreatogenic diabetes). The fact that diabetes can be both a risk factor and a prodome of pancreatic cancer is illustrated by a possibly stronger association of new-onset diabetes (ie, ≤3–4 years) with pancreatic cancer compared with long-standing diabetes (ie, >3–4 years). Elevated HbA1c in individuals with new-onset diabetes is associated with an increased risk of pancreatic cancer.54 Even in individuals with normal glucose concentrations, increased fasting glucose concentrations are associated with an increased risk of pancreatic cancer.”  
    Pancreatic cancer  
    Thomas F Stoop, Ammar A Javed, Atsushi Oba, et al  
    Lancet 2025; 405: 1182–202 
  • “Surveillance aims to detect high-grade precursors or pancreatic cancer at an early stage, generally started after an age of 50 years or 10 years earlier than the age of diagnosis in the youngest affected relative.The recommended screening modalities are endoscopic ultrasonography (EUS) and MRI with magnetic resonance cholangiopancreatography (MRCP) once per year. The diagnostic accuracy of EUS and MRI in detecting high-grade dysplasia or early-stage pancreatic adenocarcinoma seems to be similar.71 However, the value of MRI/MRCP in addition to EUS is debated. Accurate liquid biomarkers are not available.”  
    Pancreatic cancer  
    Thomas F Stoop, Ammar A Javed, Atsushi Oba, et al  
    Lancet 2025; 405: 1182–202 

  •  Pancreatic cancer  
    Thomas F Stoop, Ammar A Javed, Atsushi Oba, et al  
    Lancet 2025; 405: 1182–202 
  • “Approximately 57% of patients with pancreatic cancer present with metastatic disease at the time of diagnosis,105 with cancer predominantly located in the liver (75–80%), peritoneum (13–30%), lung (15–18%), and extra-regional lymph nodes (12%).106 In the absence of metastases, the primary tumour is anatomically staged as resectable (RPC), borderline resectable (BRPC), or locally advanced (LAPC), depending on the presence and extent of involvement of peripancreatic major vasculature including the superior mesenteric artery, coeliac axis, hepatic artery branches, and portomesenteric venous axis.”  
    Pancreatic cancer  
    Thomas F Stoop, Ammar A Javed, Atsushi Oba, et al  
    Lancet 2025; 405: 1182–202 
  • “Palliative chemotherapy is the standard of care in patients with metastatic pancreatic cancer, with (m)FOLFIRINOX and gemcitabine-nab-paclitaxel as preferred regimens. Table 2 shows key randomised controlled phase 3 trials on palliative chemotherapy regimens. Both (m)FOLFIRINOX and gemcitabine-nab-paclitaxel are superior to gemcitabine alone. Median and 1-year overall survival in the FOLFIRINOX group was 11 months (95% CI 9–13) and 48%, respectively, and 9 months (8–10) and 35% in the gemcitabine-nab-paclitaxel group, compared with a median and 1-year overall survival of about 7 months and 21–22% after gemcitabine alone.”  
    Pancreatic cancer  
    Thomas F Stoop, Ammar A Javed, Atsushi Oba, et al  
    Lancet 2025; 405: 1182–202 
  • “Surgery combined with systemic chemotherapy provides by far the best chance to achieve long-term overall survival. However, after surgical resection 5-year overall survival is still only 17%. This is due to high rates of locoregional and distant recurrence; 48% at 12 months and 86% at 5 years postoperatively. Predicting early recurrence is difficult as the presence of unfavourable parameters does not preclude long-term overall survival.  High-level evidence about the oncological benefit of active surveillance strategies after surgical resection is not available.”    
    Pancreatic cancer  
    Thomas F Stoop, Ammar A Javed, Atsushi Oba, et al  
    Lancet 2025; 405: 1182–202 
  • “The most common resection is a pancreatoduodenectomy, followed by left pancreatectomy (ie, distal pancreatectomy)178 and total pancreatectomy. Pancreatoduodenectomy is associated with a 90-day major morbidity rate of 26% and a mortality of 5%. A lower failure to rescue rate is seen in high-volume centres with experienced multidisciplinary teams and round-the-clock interventional radiology and interventional endoscopy services.”  
    Pancreatic cancer  
    Thomas F Stoop, Ammar A Javed, Atsushi Oba, et al  
    Lancet 2025; 405: 1182–202 
Radiation Dose

  • CONCLUSIONS AND RELEVANCE This study found that at current utilization and radiation dose levels, CT examinations in 2023 were projected to result in approximately 103 000 future cancers over the course of the lifetime of exposed patients. If current practices persist, CT-associated cancer could eventually account for 5% of all new cancer diagnoses annually.
    Projected Lifetime Cancer Risks From Current Computed Tomography Imaging
    Rebecca Smith-Bindman et al.
    JAMA Intern Med. doi:10.1001/jamainternmed.2025.0505 
  • Question How many future cancers could result from radiation exposure from annual computed tomography (CT) examinations in the United States?
    Findings In this risk model, the 93 million CT examinations performed in 62 million patients in 2023 were projected to result in approximately 103,000 future cancers. Although the per-examination cancer risk was higher in children, higher CT utilization among adults accounted for the majority of the projected cancers.
    Meaning These findings suggest that if current radiation dosing and utilization practices continue, CT-associated cancers could eventually account for 5% of all new cancer diagnoses annually.
    Projected Lifetime Cancer Risks From Current Computed Tomography Imaging
    Rebecca Smith-Bindman et al.
    JAMA Intern Med. doi:10.1001/jamainternmed.2025.0505 
  • “This study has several strengths, including detailed data on CT utilization and associated radiation dose, detailed calculation of risks with uncertainty limits, and sensitivity analyses that provide a range of estimates under widely varying assumptions. There are several limitations: first, the BEIR VII risk estimated model parameters are based primarily on the Japanese survivor outcomes, and questions remain about the transfer of radiation risks from the mid-20th century Japanese population to the current US population.”
    Projected Lifetime Cancer Risks From Current Computed Tomography Imaging
    Rebecca Smith-Bindman et al.
    JAMA Intern Med. doi:10.1001/jamainternmed.2025.0505 
  • “Second, our risk calculations factored in average life expectancies, and the degree to which patients who undergo CT have shorter life expectancy due to underlying illness may overestimate future cancer risk. However, we excluded on average 10.6% of CTs that were likely performed during the last year of life, given these patients are not at risk of a radiation-induced cancer. A recent analysis found that 9.6% of patients who undergo CT died within 1 year, similar to our estimate. Third, while the CT categorization algorithm was 90% accurate compared with expert review, some examinations in the registry may have been miscategorized; however, this is unlikely to significantly impact our results.”
    Projected Lifetime Cancer Risks From Current Computed Tomography Imaging
    Rebecca Smith-Bindman et al.
    JAMA Intern Med. doi:10.1001/jamainternmed.2025.0505 
  • “In this study, approximately 5% of annual cancer diagnoses or 100000 cancers were projected to result from CT utilization in 2023. Despite public attention to the potential adverse effects, CT use has grown significantly in the United States since 2009. In 2023, 93 million CT examinations were performed in the United States, in 2007, the number was 68.7 million—a 35% increase incompletely explained by population growth.38 Justification of use and optimization of dose, including consideration of the need for multiphase examinations, are the tenets of CT imaging and must be applied uncompromisingly to mitigate potential harm.”
    Projected Lifetime Cancer Risks From Current Computed Tomography Imaging
    Rebecca Smith-Bindman et al.
    JAMA Intern Med. doi:10.1001/jamainternmed.2025.0505 
  • Use of computed tomography was once relatively rare. In the 1980s, approximately 3 million CT scans were performed annually.2 The marked growth of computed tomography— about 30-fold over 40 years—reflects its diagnostic value. CT scanning is accurate, quick, well-tolerated, and relatively inexpensive. Its success as an imaging modality is also what makes it so challenging to constrain. CT has become essential to the diagnostic process for many serious conditions, from trauma to cancer. Emergency departments and hospitals have come to rely on prompt and accurate diagnosis for efficient patient flow and management. Patients likewise expect timely and accurate diagnoses. CT is now inextricably woven into the fabric of modern medicine.
    Balancing Computed Tomography's Benefits With Radiation Risks.  
    Richman IB, Katz MH.  
    JAMA Intern Med. 2025 Apr 14. doi: 10.1001/jamainternmed.2025.0514. Epub ahead of print. PMID: 40227674.
  • How, then, might we balance the benefits of CT with its risks? As with all complex problems, there will be no simple solution. First, despite our reliance on CT, physician behavior is still malleable, and specific interventions designed to Reducing low-yield CT use has been effective. For example, Incorporating diagnostic algorithms at the point of care can reduce CT use among low-risk patients, A process that can be facilitated with artificial intelligence and informatics. Offering alternative imaging modalities that do not use ionizing radiation, including ultrasound and magnetic resonance Imaging can also be useful—a strategy that has been particularly successful in pediatrics, where computed tomography use is rare.  
    Balancing Computed Tomography's Benefits With Radiation Risks.  
    Richman IB, Katz MH.  
    JAMA Intern Med. 2025 Apr 14. doi: 10.1001/jamainternmed.2025.0514. Epub ahead of print. PMID: 40227674.
  • Third, reducing radiation dose, such as with digitization, and reducing variation in radiation technique and dose with standardization and training across imaging centers can mitigate risk. Lastly, educating clinicians about avoiding low-value testing and, in circumstances where alternatives are readily available, involving patients in the decision to do a CT scan may help shift culture and practice.
    Balancing Computed Tomography's Benefits With Radiation Risks.
     Richman IB, Katz MH.  
    JAMA Intern Med. 2025 Apr 14. doi: 10.1001/jamainternmed.2025.0514. Epub ahead of print. PMID: 40227674.
Stomach

  • GE, characterized by the presence of gas within the gastric wall, is a rare medical phenomenon, documented sparsely in the literature over the past decade. While a true etiological mechanism is still uncertain, many predisposing factors have been identified that might explain the presence of pneumatosis. This condition typically arises as a consequence of significant stress and trauma exerted on the gastric wall, often attributable to severe vomiting episodes, ischemia, gastrointestinal bleeding, diabetic ketoacidosis, and anorexia nervosa. While instances of GE are typically self-resolving and amenable to conservative therapeutic approaches, they represent a noteworthy clinical concern.
    Differentiating Gastric Emphysema vs Emphysematous Gastritis: A Review of Literature
    Sahil Sabharwal,MD1,Wade Arthur,DO1, Dylan Travis et al.
    ACG Case Rep J 2025;12:e01655
  • EG manifests as intramural gas formation within the gastric wall due to the activity of gas-forming microorganisms, notably Staphylococcus, Clostridium, and other gas-forming aerobic bacterial species.This condition is frequently associated with predisposing factors such as diabetes mellitus, recent abdominal surgery, cancer, neutropenic sepsis, prolonged usage of nonsteroidal anti-inflammatory drugs (NSAIDs) or corticosteroids, and renal insufficiency. Timely and accurate diagnosis is imperative, necessitating urgent surgical consultation and the prompt initiation of broad-spectrum antibiotic therapy.
    Differentiating Gastric Emphysema vs Emphysematous Gastritis: A Review of Literature
    Sahil Sabharwal,Wade Arthur, Dylan Travis et al.
    ACG Case Rep J 2025;12:e01655
Vascular

  • “Portal vein aneurysm (PVA) is a rare vascular abnormality, representing 3% of all venous aneurysms in the human body, and is not well understood. It can be congenital or acquired, located mainly at the level of confluence, main trunk, branches and bifurcation. A PVA as an abnormality of the portal venous system was first reported in 1956 by Barzilai and Kleckner. A review from 2015 entitled “Portal vein aneurysm: What to know” considered fewer than 200 cases.”
    .Portal vein aneurysm-etiology, multimodal imaging and current management.  
    Kurtcehajic A, Zerem E, Alibegovic E, et al.
    World J Clin Cases. 2023 Feb 6;11(4):725-737. 
  • “A portal vein aneurysm (PVA) is the abnormal focal saccular or fusiform dilatation of the portal venous system, and it is defined as a PV diameter exceeding 19 mm in cirrhotic patients and 15 mm in a normal liver. It is a rare vascular abnormality, representing 3% of all venous aneurysms in the human body, and is not well understood. Douglass et al studied 92 autopsies and reported that the diameter of the PV was between 0.64 mm and 12.1 mm in patients without cirrhosis and those without portal hypertension. In 1976, Doust et al conducted a vascular study of 53 patients to assess the size of the PV and underlying liver status through abdominal ultrasound, and they detected that the maximum calibre of the PV was 19 mm in cirrhotic patients and 15 mm in patients with normal livers. Hence, a portal vein diameter of > 20 mm is universally regarded as the threshold for diagnosis of a PVA.”
    Portal vein aneurysm-etiology, multimodal imaging and current management.  
    Kurtcehajic A, Zerem E, Alibegovic E, et al.
    World J Clin Cases. 2023 Feb 6;11(4):725-737. 
  • “ In terms of aetiology, the frequency of congenital PVAs was 29 (46.7%), and it was 17 (27.4%) for acquired PVAs. In 16 (25.8%) patients, the aetiology of the PVAs was unclear. Regarding the location of PVAs, 27.41% were at the level of the splenomesenteric confluence; 19.35% were at the main trunk; 17.74% were at branches; 6.45% were at the PV bifurcation; 6.45% were at the SV; and 4.83% were at the SMV; 14.51% were classified as intrahepatic PVAs.”
    Portal vein aneurysm-etiology, multimodal imaging, and current management.  
    Kurtcehajic A, Zerem E, Alibegovic E, et al.
    World J Clin Cases. 2023 Feb 6;11(4):725-737. 
  • “Contrast-enhanced CT with angiography shows the filling of PVA. On a CT and magnetic resonance imaging (MRI) scan, a PVA will appear as a well-defined contrast-enhanced focal saccular anomaly or fusiform dilatation of the portal venous system during the portal venous phase.”
    Portal vein aneurysm-etiology, multimodal imaging, and current management.  
    Kurtcehajic A, Zerem E, Alibegovic E, et al.
    World J Clin Cases. 2023 Feb 6;11(4):725-737. 
  • “PVA can be congenital or acquired, located mainly at the level of confluence, main trunk, branches and bifurcation. Up to 30% of patients can be asymptomatic, and non-specific abdominal pain should be investigated to exclude other pathological causes, such as cholecystitis or peptic ulcer disease, etc. Thrombosis complications occur in approximately 19%-23% of patients, and biliopathy occurs in approximately 4%-6% of patients. Other complications can also arise from compression due to a PVA, including thrombosis of the ICV and intestinal obstruction. Diagnosis of a PVA is based on spectral and colour Doppler sonography, and CT and MRI. EUS and IDU have also been used as a diagnostic tool. If a PVA is asymptomatic, it does not require any active treatment, and monitoring (a policy of “wait and see”) should be adopted. ”
    Portal vein aneurysm-etiology, multimodal imaging, and current management.  
    Kurtcehajic A, Zerem E, Alibegovic E, et al.
    World J Clin Cases. 2023 Feb 6;11(4):725-737. 

Privacy Policy

Copyright © 2025 The Johns Hopkins University, The Johns Hopkins Hospital, and The Johns Hopkins Health System Corporation. All rights reserved.