Francesca Maccioni

Purpose: Dynamic magnetic resonance defecography (MRD) is a key imaging modality for comprehensive evaluation of pelvic floor dysfunction, enabling detailed multiplanar anatomical and functional assessment without ionizing radiation. However, despite its established clinical role, MRD reporting is heterogeneous among centers, hindering standardized interpretation, multidisciplinary communication, and comparison across studies. This modified Delphi consensus study aimed to develop a standardized referral dataset and structured reporting framework for MRD. Methods: A multidisciplinary panel of 20 Italian experts (radiologists, colorectal surgeons, gynecologists, urologists, gastroenterologists, physiatrists, and a methodologist) conducted a three-round Delphi process to develop consensus-based templates for MRD referral and reporting. Consensus was set at ≥75% agreement. A total of 36 items were evaluated, covering technical parameters, anatomical/functional findings, and reporting format. Results: Consensus was achieved for 21 items (58%), including technical parameters, standardized measurements (anorectal angle, pubococcygeal line), and clinically relevant descriptors (prolapse, dyssynergia, rectocele, rectal inertia). A structured referral template was also developed to improve information transfer from clinicians to radiologists. Both tools were unanimously endorsed. Conclusions: This modified Delphi consensus study provides a multidisciplinary framework for standardized MRD referral and reporting. The proposed reporting template may facilitate greater consistency in image interpretation, reporting terminology, and multidisciplinary communication. These recommendations may serve as a foundation for the harmonization of MRD practice and future validation studies in pelvic floor imaging.

Background: A combination of morphological and functional imaging plays a crucial role for neuroendocrine tumors (NETs) management. Diffusion-weighted magnetic resonance imaging (DWI-MRI) is an emerging key imaging technique in the NET field. Aim: to evaluate the diagnostic and prognostic role of DWI-MRI in liver metastases (LMs) from NETs compared with multiparametric MRI and functional imaging with ⁶⁸ Ga-DOTA peptides positron emission tomography (PET)-computed tomography (CT). Methods: This is a monocentric, observational, both retrospective and prospective study including patients with histologically proven diagnosis of gastroenteropancreatic (GEP) NET with LM evaluated with MRI and ⁶⁸ Ga-DOTA peptides PET-CT, performed within 6 months apart at diagnosis or follow-up. We collected clinical, pathological, imaging data including lesions number detected on (a)MRI-gold standard, (b)DWI images, (c) ⁶⁸ Ga-DOTA peptides PET-CT. Apparent diffusion coefficient (ADC) was calculated on target lesions. Results: 426 LMs were analyzed from 17 patients (11 males, mean age 57.2 ± 12.6 years) meeting the inclusion criteria (11.8% G1, 64.7% G2, and 23.5% G3); MRI detected a median of 15 (IQR 2.5–40) lesions per patient, DWI 15 (IQR 2.5–36.5) lesions, while PET-CT 6 (IQR 2.5–20) lesions. Non-parametric analyses suggested that DWI had a detection rate comparable to MRI ( p = 0.068) and superior to 68Ga-DOTA peptides PET-CT ( p = 0.004), whereas mixed-effects modelling accounting for within-patient clustering showed no statistically significant pairwise differences between imaging modalities after multiple-comparison correction. Moderate-to-good consistency in lesion burden estimation across imaging modalities supported the reproducibility of lesion quantification. Correlation analyses suggested MRI lesion load may reflect the aggressiveness of disease. Conclusions: DWI-MRI can be a useful time-saving imaging technique in the diagnosis and follow-up of LMs from NETs, with a potentially favorable cost-effectiveness ratio.

Background: Pancreatic ductal adenocarcinoma (PDAC) belongs to the group of killer human cancers. Its ferocity is sustained by an unusual mix of genetic changes—primarily in KRAS and TP53—a hypoxic as well as desmoplastic tumor microenvironment, plus metabolic and redox adaptations that allow tumor life amidst intense stress situations. Content: This paper will discuss the molecular networks of wild-type and mutant p53, wild-type and mutant KRAS, PUMA, TIGAR, PRMT5, NRF2, oxygen tension, reactive oxygen species (ROS), and oxidative stress pathways that contribute to pancreatic cancer. It will describe how these factors help set the tumor’s redox state and control apoptosis and therapeutic resistance. This shall therefore specifically discuss what role oxygen gradients play in pancreatic tissues, as well as retinoic acid, together with redox-targeted therapies that are specific to vulnerabilities within such types of networks. Summary and Outlook: An understanding of the crosstalk of these molecular pathways will be critical in designing rational therapeutic strategies. Genetics, metabolism, and microenvironmental integration may open a path toward combinatorial therapies that would resensitize PDAC to apoptosis and overcome resistance to current treatments.

Crohn’s disease (CD) is a complex inflammatory bowel disease, defined by chronic transmural inflammation and marked heterogeneity in both anatomical distribution and disease behavior, with potential involvement of any segment of the gastrointestinal tract and multiple phenotypes. Advanced cross-sectional imaging nowadays plays a central role in CD management, reliably assessing both luminal and extraluminal inflammatory manifestations, supporting initial diagnosis, phenotypic characterization, and longitudinal monitoring of disease activity, complications and treatment response. Over the last two decades, Intestinal Ultrasound (IUS), MR Enterography (MRE), and Computed Tomography Enterography (CTE) have become central components of the diagnostic pathway. MRE has emerged as the most comprehensive, radiation-free modality for evaluating intestinal extent, inflammatory activity, and complications in Crohn’s disease. Multiparametric MRE, combining T2-weighted imaging, contrast-enhanced sequences, diffusion-weighted imaging, and cine acquisitions, enables a real “Crohn’s disease staging”, namely a thorough evaluation of the transmural inflammation, of fibrotic and fistulizing lesions in the small and large bowel, as well as in the perianal region. IUS provides a dynamic, widely accessible, safe and repeatable imaging technique that is particularly well suited for tight-monitoring strategies, early assessment of therapeutic response, and routine follow-up, especially in experienced centers. Notably CTE, despite concerns related to cumulative ionizing radiation exposure, remains indispensable in acute clinical settings owing to its rapid acquisition, broad availability, and high diagnostic accuracy for detecting abscesses, perforation, and bowel obstruction. Combined, these three modalities offer a complementary and patient-tailored framework for optimal CD management. This review outlines the pathological complexity of Crohn’s disease, traces the evolution of imaging approaches, and provides a comparative overview highlighting the specific strengths and limitations of each modality.

Purpose: With the advent of CFTR modulators for cystic fibrosis (CF) like Trikafta®, robust, radiation-sparing imaging strategies are urgently needed for monitoring therapeutic effects in both adult and pediatric patients. We investigated whether low-dose and ultra-low-dose lung CT could serve as innovative tool for short-term monitoring of treatment response in adults and children, respectively. Methods: A total of 30 CF patients (15 adults, 15 paediatric) initiated Trikafta® and underwent baseline CT and 12–18-month follow-up scans. Adults and children were imaged with low- and ultra-low-dose protocols, respectively. Disease severity and extent were quantified using Brody score through both qualitative and quantitative analysis. Pre- and post-treatment CT data were compared (paired t-tests), and results were correlated with spirometry and sweat chloride values. Results: Remarkably, low and ultra-low-dose protocols maintained high diagnostic quality while reducing radiation exposure (effective dose 2.4 and 0.56 mSv respectively). The Brody score showed significant improvements across all patients, demonstrating substantial decreases in mucous plugging (73%) and bronchial thickening (51%). Each patient exhibited a drop in Brody score after therapy, paralleled by better lung function ( r _s = − 0.71, p < 0.0001) and sweat test outcomes ( r _s = 0.7, p < 0.0001). Conclusions: Low- and ultra-low-dose lung CT protocols represent an important advancement in cystic fibrosis imaging, providing sufficient detail to evaluate disease status while substantially reducing cumulative radiation exposure. By enabling reliable short-term assessment of CFTR modulator efficacy through established disease scoring systems, these protocols fill a critical gap in the routine follow-up of patients who require frequent imaging.

Crohn’s disease (CD) is a complex inflammatory bowel disease, defined by chronic transmural inflammation and marked heterogeneity in both anatomical distribution and disease behavior, with potential involvement of any segment of the gastrointestinal tract and multiple phenotypes. Advanced cross sectional imaging nowadays plays a central role in CD management, reliably assessing both luminal and extraluminal inflammatory manifestations, supporting initial diagnosis, phenotypic characterization, and longitudinal monitoring of disease activity, complications and treatment response. Over the last two decades, Intestinal Ultrasound (IUS), MR Enterography (MRE), and Computed Tomography Enterography (CTE) have become central components of the diagnostic pathway. MRE has emerged as the most comprehensive, radiation-free modality for evaluating intestinal extent, inflammatory activity, and complications in Crohn’s disease. Multiparametric MRE, combining T2-weighted imaging, contrast-enhanced sequences, diffusion-weighted imaging, and cine acquisitions, enables a real “Crohn’s disease staging”, namely a thorough evaluation of the transmural inflammation, of fibrotic and fistulizing lesions in the small and large bowel, like in the perianal region. IUS provides a dynamic, widely accessible, safe and repeatable imaging technique that is particularly well suited for tight-monitoring strategies, early assessment of therapeutic response, and routine follow-up, especially in experienced centers. Notably CTE, despite concerns related to cumulative ionizing radiation exposure, remains indispensable in acute clinical settings owing to its rapid acquisition, broad availability, and high diagnostic accuracy for detecting abscesses, perforation, and bowel obstruction. Combined, these three modalities offer a complementary and patient-tailored framework for optimal CD management. This review outlines the pathological complexity of Crohn’s disease, traces the evolution of imaging approaches, and provides a comparative overview highlighting the specific strengths and limitations of each modality.

This review presents an updated overview of recent advances in Magnetic Resonance Imaging (MRI) techniques for gastrointestinal (GI) tract evaluation, with particular emphasis on technological progress achieved in Italy. MRI has become a cornerstone in the diagnosis, staging, and follow-up of numerous GI conditions, especially inflammatory bowel disease, rectal cancer, and graft- versus-host disease. The review focuses on MR-Enterography, high-resolution rectal MRI, functional pelvic floor imaging, and MRI applications in small bowel and rectal tumor assessment. Recent advances in the MRE technique for IBD evaluation are more detailed, including patient preparation, imaging protocols, and the application of standardized scoring systems for Crohn’s disease activity. Additional attention is given to emerging applications, including intestinal motility imaging and Artificial Intelligence, which offer new opportunities for evaluating functional disorders and diagnosis through predictive modeling and radiomics. The review highlights the contributions of Italian research groups, protocol standardization, and multidisciplinary collaboration. These developments aim to support clinicians and radiologists in delivering more accurate diagnoses and personalized care, and in integrating innovative imaging tools into routine clinical practice.

Background/Objectives: Small bowel tumors (SBTs) encompass a diverse range of tumor types, with benign tumors being the most prevalent. However, the incidence of malignant SBTs is increasing, particularly small bowel adenocarcinoma; this poses a diagnostic challenge for clinicians and radiologists due to the varied and nonspecific clinical and radiological presentations associated with SBTs. In fact, SBTs can present differently in emergencies, often mimicking inflammatory diseases or manifesting as complications such as intussusception, small bowel obstruction (SBO), intestinal ischemia, perforation, gastrointestinal bleeding, or metastatic disease. These tumors can remain asymptomatic for extended periods. Methods: We present a pictorial review on the role of imaging in evaluating SBTs, focusing on the emergency setting where diagnosis can be incidental. We also include some representative cases that may be useful for radiologists and residents in clinical practice. Results: Despite these challenges, contrast-enhanced computed tomography (CECT) is usually the best modality to use in emergencies for evaluating SBTs, and in some cases, a diagnosis can be made incidentally. However, when possible, multimodal imaging through cross-sectional imaging remains crucial for the non-invasive diagnosis of SBTs in stable patients, as endoscopic procedures may also be impractical. A complementary CT study with distension using negative oral contrast media, such as water, polyethylene glycol, or mannitol solutions, can improve the characterization of SBTs and rule out multiple SBT locations, particularly in small bowel neuroendocrine tumor (NET) and gastrointestinal tumor (GIST) localization. Positive water-soluble iodine-based oral contrast, such as Gastrografin (GGF), can be used to evaluate and monitor the intestinal lumen during the nonsurgical management of small bowel obstruction (SBO) or in suspected cases of small bowel perforations or the presence of fistulas. Magnetic resonance enterography (MRE) can aid in improving the characterization of SBTs through a multiplanar and multisequence study. Positron emission tomography combined with CT is generally an essential modality in evaluating metastatic disease and staging and assessing tumor prognosis, but it has limitations for indolent lymphoma and small NETs. Conclusions: Therefore, the integration of multiple imaging modalities can improve patient management and provide a preoperative risk assessment with prognostic and predictive indicators. In the future, radiomics could potentially serve as a “virtual biopsy” for SBTs, allowing for better diagnosis and more personalized management in precision medicine.

Graft-versus-host disease (GVHD) is an expected and relatively common complication after allogeneic hematopoietic stem cell transplantation. It may affect different organs and typically involves the skin, liver, and gastrointestinal tract (GI-GVHD). GI-GVHD may show heterogeneous presentations with peculiar diagnostic implications. Although an endoscopic biopsy is considered the “gold standard” for the diagnosis of GI-GVHD, its broad application is limited due to the poor clinical conditions usually present in these patients, including thrombocytopenia. In the emergency department, enhanced computed tomography (CECT) has emerged as the best imaging modality for the evaluation of GI damage in frail patients. However, the role of CT in the context of either acute or chronic GI-GVHD has not been systematically investigated. Herein, we focus on the radiological features found on CECT in five patients with GI-GVHD confirmed on histology. CECT was performed for the persistence of GI symptoms in three cases (case 1, case 3, and case 4), for small bowel occlusion in one case (case 5), and for acute GI symptoms in one case (case 2). Serpiginous intestinal wall appearance with multisegmental parietal thickness and homogeneous, mucosal, or stratified small bowel enhancement were common features. Colic involvement with segmental or diffuse parietal thickness was also present. One patient (case 5) presented with inflammatory jejunal multisegmental stenosis with sub-occlusion as a chronic presentation of GI-GVHD. Regarding mesenterial findings, all five patients presented comb signs in the absence of lymphadenopathy. Extraintestinal findings included biliary tract dilatation in two cases (case 2 and case 4). These data support the utility of appropriate radiological investigation in GI-GVHD, paving the way for further serial and systematic investigations to track the appearance and evolution of GI damage in GVHD patients.