S 10 - Students session 1

Author Block: I. Trapotsis, F. Georgopoulos; Nicosia/CY
Purpose: The aim of this presentation is to review specific radiological signs suggestive of Non-Accidental Injury (NAI) across different imaging modalities. Furthermore, it addresses the role of the radiologist in detecting and diagnosing NAIs in paediatric patients while emphasizing the importance of adherence to established imaging protocols as well as to an effective interdisciplinary communication with other physicians.
Methods or Background: This presentation examines current radiological protocols and imaging modalities used in suspected cases of paediatric NAI, including X-ray, CT, MRI, and ultrasound. The importance of a systematic approach for early detection and documentation of injury patterns suggestive of abuse is highlighted, alongside an overview of the typical injury patterns and their distinguishing features.
Results or Findings: Paediatric NAIs can be divided into CNS, skeletal and abdominal injuries. CNS injuries include most commonly subdural haematomas which are assessed with US, CT and MRI. Spinal cord injuries include spine compressions and subdural haematomas found along the spine, especially in the lumbar region. These are evaluated with MRI. Retinal haemorrhages are documented after an ophthalmologic examination alongside an MRI. Skeletal injuries, identified on X-ray, involve metaphyseal avulsion fractures [corner, bucket-handle], rib fractures [posterior, lateral], diaphyseal fractures and skull fractures described as 'eggshell' or occipital impression fractures. Abdominal injuries such as liver, duodenal and pancreatic lacerations are visualized on CT. Differential diagnoses include Accidental trauma, Coagulopathies, Osteogenesis imperfecta, Menke’s disease, Spondylometaphyseal dysplasia, Caffey’s disease, and Normal variants. An initial and a follow-up skeletal survey should always be performed.
Conclusion: All these radiologic signs, protocols and interdisciplinary communication play a critical role in the early diagnosis and treatment of NAIs. It is essential that every radiologist is well-versed in these aspects to avoid misdiagnosis and ensure best treatment.
Limitations: No limitations were identified.
Funding for this study: No funding was received for this study.
Has your study been approved by an ethics committee? Not applicable
Ethics committee - additional information:

Author Block: S. Bachigari, A. R. Menezes, T. Nguyen, A. W. Kajabi, J. Ellermann; Minneapolis, MN/US
Purpose: To reexamine the pathogenesis of juvenile osteochondritis dissecans by introducing novel MRI-based approaches that allow earlier detection, improved classification and effective treatment.
Methods or Background: JOCD has been traditionally understood as a stress-related subchondral bone disorder where focal areas of bone fragmentation lead to decreased vascularity and eventual detachment of subchondral bone. This view has shaped current paradigms, however, current clinical MRI has demonstrated limited reliability in guiding management. Emerging evidence through ultra high field MRI (Pixels) and pig models of subchondral vascular channels (Pigs) suggests that JOCD actually arises from disruptions in vascular supply within the epiphyseal cartilage. This understanding is crucial for improving diagnostic accuracy and treatment.
Results or Findings: Our advanced MRI techniques, particularly, quantitative susceptibility mapping and high-resolution T2* imaging at 9.4T enabled visualization of epiphyseal cartilage canal vessels, hence, identifying watershed areas that become future sites of JOCD. Comparative animal studies validated pig knee models as they closely resemble human vascular networks. MRI protocols incorporating T2* mapping then revealed early stages of JOCD as focal arrests of endochondral ossification within cartilage rather than late-stage osseous defects. Our clinical longitudinal also studies show that T2* metrics can identify non-operative patients as early-stage JOCD lesions maintain intact articular cartilage, conferring excellent prognosis if diagnosed before structural collapse.
Conclusion: Our findings reframe JOCD as a disease of epiphyseal cartilage vascular origin with subsequent osseous manifestation. Healing requires sequential steps through endochondral ossification stages. Novel MRI biomarkers can enable early identification, monitoring and prognosis, thereby providing the foundation for a paradigm shift in clinical management. Early, cartilage-focused diagnosis has the potential to preserve joint integrity, reduce unnecessary surgical interventions, and improve long-term outcomes for affected patients.
Limitations: No limitations were identified in this study
Funding for this study: NIH T32 AR050938, NIH R01 AR070020, NIH K01 AR070894, NIH P41 EB015894, W. M. Keck Foundation, Academy of Finland
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: IRB approval for retrospective chart review. Analysis of images and patient histories was approved by the institutional review board.

Author Block: A. Jordan, N. Craig; Edinburgh/UK
Purpose: Mitral annular calcification (MAC) associates with increased all-cause and cardiovascular mortality, yet its pathophysiology is incompletely understood, and no pharmacotherapy has altered its progression. This study aimed to investigate the relationship between fibroblast activation, a driver of aortic valve calcification, and MAC using the novel PET radiotracer [68Ga]FAPI-46.
Methods or Background: This observational, longitudinal cohort study comprised 93 participants (mean age 72 ± 8, 29% female) across the spectrum of aortic stenosis (severe=25, moderate=24, mild=24), aortic sclerosis (n=11) and controls (n=9). All participants underwent clinical assessment, transthoracic echocardiography and hybrid [68Ga]FAPI-46 PET-CT. A subset of patients received repeat imaging following a median of 453 days. CT calcium scoring quantified the presence and burden of MAC. [68Ga]FAPI-46 uptake (TBRmax) was measured in the mitral annulus.
Results or Findings: 35 (38%) participants had MAC. Patients with MAC were older (p<0.001) and had a higher NT-proBNP (p<0.01). Of the 87 participants with analysable PET images, 50 (57.5%) had visually discernible mitral annular [68Ga]FAPI-46 uptake, which was significantly higher in patients with MAC (81.8% positive, median TBRmax 1.45 [IQR 1.27-1.72]) than in those without (42.6% positive, median TBRmax 1.37 [IQR 1.17-1.42]; p<0.001). At follow-up, mitral annular [68Ga]FAPI-46 TBRmax increased over time (p<0.001) and positively correlated with faster annualised mitral annular calcium score progression (r=0.52, p<0.05).
Conclusion: This study provides novel in vivo evidence of fibroblast activation in MAC, suggesting an active disease process that may precede and predict disease progression. [68Ga]FAPI-46 PET-CT represents a promising tool for early risk stratification and monitoring the efficacy of therapies aimed at halting MAC progression.
Limitations: Limited to patients with calcific aortic valve disease, our sample size was modest. Follow-up attrition may also affect generalisability. Future studies should include more diverse cohorts and assess observer variability.
Funding for this study: British Heart Foundation RG/F/22/110093
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: The study was approved by the North of Scotland Research Ethics Committee and all participants provided written informed consent.

Author Block: Z. Somogyiné Nagy¹, B. K. Budai², A. I. Vigh¹, Á. Szücs¹, M. Benke¹, A. Szijártó¹, P. Maurovich-Horvat¹, I. Dudás¹; ¹Budapest/HU, ²Heidelberg/DE
Purpose: Differentiating pancreatic cystic lesions (PCLs) is a persistent diagnostic challenge. Photon-counting detector CT (PCD-CT) provides spectral imaging with virtual monoenergetic images (VMI) that enable quantitative assessment. This study evaluated whether mucinous and non-mucinous PCLs exhibit distinct spectral absorption patterns on postcontrast scans and examined the reproducibility and robustness of region of interest (ROI) measurements.
Methods or Background: We retrospectively analyzed 53 mucinous cystic neoplasms and 23 non-mucinous PCLs, each with arterial, pancreatic, and venous phase PCD-CT scans. Cyst fluid densities were measured on 40 keV and 70 keV VMIs, and the difference (HUΔ40–70keV) was calculated. Diagnostic performance was assessed with ROC curve analysis. After measuring 10-10 ROIs, bootstrap-based sampling and repeated five-fold cross-validation were used to determine the optimal number of ROIs and evaluate the stability of classification thresholds, sensitivity, specificity, and accuracy.
Results or Findings: We observed significantly higher HUΔ40–70keV values for mucinous PCLs across arterial (p=0.017), pancreatic (p<0.0001), and venous (p<0.0001) phases. The pancreatic phase yielded the best diagnostic performance (AUC 0.93, accuracy 82%, sensitivity 75%, specificity 96%). Robust classification required at least four ROI measures per lesion, with mean aggregation providing stable prediction probabilities and validation AUCs of 0.88–0.89.
Conclusion: Spectral measurements of cyst fluid using HUΔ40–70keV on PCD-CT VMI reconstructions differentiate mucinous from non-mucinous PCLs with promising accuracy. Using multiple ROI samples enhances reproducibility, suggesting that this non-invasive approach could serve as a complementary tool in the diagnostic evaluation of pancreatic cysts.
Limitations: This was a single-center study with a retrospective study design.
Funding for this study: No funding was received for this study.
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: The study was approved by the institutional ethics committee.

Author Block: D. Jagashvili; Rustavi/GE
Purpose: The purpose of this study was to evaluate the association between prior hysterectomy and the prevalence of osteopenia and osteoporosis in postmenopausal Georgian women, using dual-energy X-ray absorptiometry (DEXA).
Methods or Background: A retrospective cohort analysis was performed on DEXA results from 730 patients, focusing on 585 postmenopausal women aged 31-85 years, who underwent scanning at our facility between 2024-2025. The study focused on analyzing the BMD status of the patients with a history of hysterectomy. Data collected included patient age, number of osteoporosis risk factors (e.g., alcohol use, smoking, prior fractures, parental hip fracture, glucocorticoid therapy, rheumatoid arthritis, thyroid disorders, diabetes), and previous/on-going osteoporosis treatment. BMD was classified as normal, osteopenia, or osteoporosis based on WHO criteria.
Results or Findings: Among the 585 postmenopausal women scanned, 140 (23.90%) had normal BMD, 262 (44.8%) were diagnosed with osteopenia and 183 (31.30%) with osteoporosis. Of our patients, 27.9% women had undergone a hysterectomy. Within the hysterectomy group (n=163), 37 (22.7%) were diagnosed with osteoporosis and 78 (47.9%) with osteopenia, while 48 (29.4%) had normal BMD. The most commonly affected age group for poor BMD was 60–70 years. Among the 25 patients who had previously received osteoporosis treatment, 28% continued to meet the diagnostic criteria for osteoporosis. These patients typically had ≥2 additional risk factors, including prior fractures and/or glucocorticoid therapy.
Conclusion: A history of hysterectomy is significantly associated with decreased bone health, increasing the prevalence of both osteopenia and osteoporosis in postmenopausal Georgian women. These findings emphasize the importance of routine BMD screening using DEXA in this high-risk group, particularly with additional risk factors such as glucocorticoid therapy, which may influence treatment response and disease progression.
Limitations: A retrospective study.
Funding for this study: None
Has your study been approved by an ethics committee? Not applicable
Ethics committee - additional information:

Author Block: T. Zvar, P. Slak, D. Plut; Ljubljana/SI
Purpose: Female sex and congenital anomalies of the kidney and urinary tract (CAKUT) are major risk factors for urinary tract infections in children. UTI in combination with CAKUT increase the risk of developing chronic kidney disease. Ultrasound (US) is the first-line imaging tool for detection of CAKUT, but guidelines differ on its timing. The aim of our study was to evaluate US findings in children with first-time UTI.
Methods or Background: This observational, single-centre retrospective study included 1460 children who underwent urinary tract US following their first UTI between 2014 and 2024. We reviewed initial US results and all subsequent imaging. Based on US, children were classified into five groups: normal US, US signs of acute infection without CAKUT, CAKUT without dilatation, CAKUT with dilatation, and other. Children were further stratified by age into three groups. Categorical variables were analysed with chi-square test and group proportions with the two-proportion z-test.
Results or Findings: Girls predominated in the 7–24 month and >24 month groups (p<0.001). US detected CAKUT in 6.9% of children, 3.5% with dilatation which was more common in boys (p=0.003) and those ≤6 months (p=0.04). Normal US was most frequent in children 7–24 months (p<0.001), while US signs of acute infection without CAKUT were more common in those >24 months (p=0.011). Urinary tract dilatation was the most frequent CAKUT finding (p<0.001), with vesicoureteral reflux (VUR) the leading cause (1.6%). VUR was confirmed in 24 children after US, and another 34 were diagnosed during follow-up for recurrent UTIs, despite normal initial US.
Conclusion: Our findings suggest the current screening approach for CAKUT is not effective. US could be limited to children under 6-months and those with recurrent UTIs.
Limitations: Not all children had urine culture; pathogen–CAKUT association unanalysed.
Funding for this study: No funding was provided for this study.
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: The National Medical Ethics Committee of the Republic of Slovenia has approved this research. The notification can be found under the number: 0120-26/2025-2711-5.

Author Block: L. Ramos¹, H. I. d. S. Guerreiro², M. G. C. V. Cartucho³, D. A. P. D. A. P. Silva², C. N. M. d. Santos²; ¹Lagoa/PT, ²Faro/PT, ³Portimão/PT
Purpose: To develop and validate a 3D non-contrast breast MRI protocol (1.5T) for breast vascularization preoperative mapping establishing acquisition parameters, image quality criteria, and clinical reproducibility.
Methods or Background: Preoperative characterization of breast vascularization is crucial to preserve the viability of the skin flap and the nipple-areolar complex (NAC), preventing complications such as ischemia or necrosis.
The protocol was developed using a Philips Ingenia 1.5T Omega HP scanner, involving 10 female volunteers selected by strict inclusion and exclusion criteria. TOF and REACT sequences were employed, optimized to maximize acquisition time, vessel-to-tissue contrast, vascular border sharpness, fat suppression, and minimize artifacts, allowing precise characterization of the number of perforators, minimum detectable diameter, subcutaneous path, continuity to the NAC, distance to the NAC, anastomoses, and relevant anatomical variants.
Results or Findings: The optimized 3D non-contrast acquisitions enabled clear visualization of the internal mammary artery, measuring 2.6 mm in diameter, and perforator branches as small as 0.8 mm—a relevant finding since vessels <1.0 mm are usually described only in contrast-enhanced MRI. A continuous vascular path to the NAC was observed in both breasts analyzed.
Conclusion: The 3D non-contrast MRI technique proved effective in identifying clinically relevant vascular structures, enabling delimitation of areas of higher vascularization to preserve, planning incisions to avoid dominant vessels, and personalized ischemia risk assessment of the NAC. Future plans include integrating vascular maps into mixed reality platforms (e.g., Microsoft HoloLens) for preoperative marking/planning and intraoperative support, after validation with a larger sample.
Limitations: Small, healthy sample; single center; sequences still being optimized; not a diagnostic study nor a screening replacement.
Funding for this study: No funding.
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: Algarve Biomedical Center Ethics Committee approval.

Author Block: M. Al-muttairi, E. Salomon, S. Schröter, P. Homolka, J. Hummel; Vienna/AT
Purpose: The clinical adoption of contrast-enhanced mammography (CEM) raises concerns regarding cumulative iodine exposure and patient safety. Lowering the required contrast dose without compromising lesion visibility is a key priority. To support this, we developed and evaluated a 3D-printed contrast–detail phantom for systematic assessment of lesion detectability at decreasing iodine concentrations.
Methods or Background: Iodine-doped resin inlets were prepared by mixing Iomeron 400 (49% iodine) with a commercial resin to achieve seven concentrations (0.353–2.854 mg/cm²). Cylindrical test objects (1–5 mm, 2 mm thick) were fabricated, sanded, and mounted into a precision-cut PMMA plate, then integrated into an L2 phantom background. Dual-energy CEM imaging (TiCEM, Siemens Mammomat Revelation, 28–32 kV, AEC) was performed. A 4-alternative forced choice (4AFC) study was conducted with eight readers, each assessing 12 images per condition. Scores were aggregated into perception probabilities. Psychometric functions were fitted to determine 62.5% detection thresholds. Data were further analyzed to generate contrast-detail and size-detail curves.
Results or Findings: Detection followed the expected inverse relationship between lesion size and iodine concentration. At high concentrations (≥1.420 mg/cm²), 1 mm lesions were consistently detected. At 1.063 mg/cm², 1 mm lesions remained detectable for most readers. At 0.708 mg/cm², only lesions ≥3 mm reached threshold, while no lesions were detected at 0.353 mg/cm². Seven of eight readers detected 3 mm lesions at 0.708 mg/cm²; one required 1.063mg/cm². Similarly, seven readers detected 1 mm lesions at 1.063 mg/cm², while one required 1.420 mg/cm². Inter-reader variability was modest at high contrasts but increased at lower levels.
Conclusion: The phantom enabled reproducible and quantitative evaluation of CEM detectability, supporting protocol optimization towards reduced iodine dose.
Limitations: This study was limited to a single phantom and eight observers. Inter-phantom variability and clinical patient-related factors were not assessed.
Funding for this study: This project is part of, and is funded by the CD Laboratory for Patient-Centered Breast Imaging.
Has your study been approved by an ethics committee? Not applicable
Ethics committee - additional information:

Author Block: E. Līcis, A. Kratovska, N. Zdanovskis, A. Silovs; Riga/LV
Purpose: The accurate differentiation of renal tumor subtypes remains a clinical challenge. The aim of this single-center retrospective case-control study was to compare the radiological parameters of multiphase CT and histopathological subtypes and grades of renal tumors.
Methods or Background: A cohort of 40 patients with suspected renal tumors underwent multiphase CT imaging followed by histopathological verification with core biopsy. Demographic, morphological, and clinical data were collected. CT findings were analyzed for tumor size, location, radiological features, and HU values across CT phases. Statistical analyses included descriptive statistics, chi-square tests, Kruskal–Wallis tests with Bonferroni correction, independent-samples t-tests, and Spearman correlations.
Results or Findings: The most frequent renal tumor was clear cell renal cell carcinoma (RCC) (41.1%), followed by oncocytoma (12.5%) and papillary RCC (10.7%). The avarage tumor size was 2,24 ± 0,82cm, which did not significantly correlate with histological subtype (p = 0.961) or grade (p = 0.341). Morphological CT features (intratumoral necrosis, hemorrhage, fat, calcifications) showed no significant association with histological type or grade (p > 0.05), though tumor localization demonstrated a trend toward correlation with grade (p = 0.061).
Multiphase HU analysis revealed significant differences in enhancement across RCC subtypes in the arterial (p = 0.012) and venous phases (p = 0.042). ΔHU values confirmed papillary RCC showed consistently lower contrast enhancement, while oncocytomas demonstrated uniform and marked arterial enhancement (>20 HU) in all cases, similar to clear cell RCC.
Conclusion: In larger renal masses, specific radiological features often aid diagnosis, but these are typically absent in small tumors. Therefore ΔHU values become essential in differential diagnosis, especially for papillary RCC. Nevertheless, distinguishing small oncocytomas from clear cell RCC requires biopsy for verification.
Limitations: The limitations of the study are primarily related to the small cohort size.
Funding for this study: No funding was provided for this study.
Has your study been approved by an ethics committee? Not applicable
Ethics committee - additional information:

Author Block: R. Hardwick, A. Rasul; Oxford/UK
Purpose: Anatomical competency is essential for progression in medical education and remains a core skill for doctors and allied health professionals throughout their careers. In clinical practice, anatomy is frequently encountered through radiological studies; however, students and healthcare professionals often face challenges in translating theoretical anatomical knowledge into accurate interpretation of imaging—especially when abnormalities are present.
This project aimed to develop a segmented radiology atlas framework that links individual anatomical structures to detailed anatomy references, relevant clinical cases, and instructional educational tutorials.
Methods or Background: A custom, web-based platform was created to ensure universal access. The initial phase focused on musculoskeletal (MSK) MRI studies. Normal MRI scans were selected, uploaded, and systematically segmented to identify key anatomical structures. For each segmented structure, we wrote comprehensive anatomical factsheets, curated common clinical cases, and produced instructional tutorials. Subject matter experts contributed to the knowledge base, which was cross-referenced with each anatomical segment. A diverse group of users—including students and clinicians—were invited to test the platform and provide feedback on usability, educational value, and clinical applicability. The authors' role was limited to the academic evaluation of the platform; they were not involved in its design, development, or ownership.
Results or Findings: User feedback indicated that the platform was intuitive and easily navigable. Participants reported improved confidence in interpreting radiological images and found that the segmented atlas provided clear and relevant access to anatomical and clinical information. The educational content was targeted and supported deeper understanding of both normal anatomy and radiologic interpretation.
Conclusion: This project is a user-friendly, scrollable segmented radiology atlas framework that serves as an index linking anatomical structures to detailed references, clinical cases, and educational tutorials. This innovative and novel approach has the potential to significantly enhance anatomy and radiology education. The platform is currently hosted at radiologyplus.com, and future development aims to expand content coverage.
Limitations: No limitations were identified.
Funding for this study: No funding was received for this study.
Has your study been approved by an ethics committee? Not applicable
Ethics committee - additional information: