Gabriele Masselli

Neonatal renal tumors are uncommon and generally associated with an excellent prognosis. We report the youngest patient to date with unilateral non-syndromic Wilms tumor successfully treated with nephron-sparing surgery rather than radical nephrectomy, which is the current standard of care. The patient subsequently received risk-adapted chemotherapy. At 18 months of follow-up, he remains asymptomatic and with symmetric differential renal volumes, consistent with preserved bilateral renal function. This case suggests that nephron-sparing surgery, when technically feasible, may represent a safe and effective treatment option for carefully selected neonatal renal tumors, offering a functional advantage over radical nephrectomy without compromising oncologic safety.

Background/Objectives: Acute pelvic pain in pediatric female patients is a common presentation in the emergency setting and poses significant diagnostic challenges. Ultrasonography is the first-line imaging modality, but a substantial proportion of examinations remain inconclusive. Magnetic resonance imaging (MRI) is increasingly used as a second-line modality in this context; however, evidence comparing the diagnostic performance of non-contrast-enhanced and contrast-enhanced MRI protocols in pediatric patients remains limited. The aim of this study was to assess the diagnostic accuracy of MRI in pediatric females with acute pelvic pain after inconclusive ultrasonography and to compare non-contrast-enhanced and contrast-enhanced MRI protocols. Methods: This single-center observational study included pediatric female patients presenting with acute pelvic pain who underwent MRI after inconclusive ultrasonography. MRI examinations were performed using a standardized protocol including non-contrast-enhanced sequences and diffusion-weighted imaging. Administration of contrast material was determined by the attending radiologist according to clinical indications. Three radiologists with different levels of experience independently reviewed all examinations in two separate reading sessions (without and with contrast). Diagnostic performance, interobserver and intraobserver agreement, diagnostic confidence, and examination duration were assessed using a composite clinical reference standard. Results: Eighty-eight patients (mean age, 13.5 years; range, 7–17 years) were included. MRI identified a specific cause of acute pelvic pain in 60 patients (68.2%), with gynecological conditions accounting for 75.0% of positive findings. Hemorrhagic ovarian cysts and adnexal torsion were the most frequent diagnoses. Both non-contrast-enhanced and contrast-enhanced MRI demonstrated high diagnostic accuracy across all readers, with no statistically significant differences in sensitivity or specificity between protocols (p > 0.05). Contrast-enhanced MRI was associated with higher diagnostic confidence for all readers (p < 0.001) but longer examination times. Conclusions: MRI is a reliable second-line imaging modality for evaluating acute pelvic pain in pediatric female patients after inconclusive ultrasonography. Non-contrast-enhanced MRI combined with diffusion-weighted imaging provides robust diagnostic performance in most cases, while contrast-enhanced MRI may be reserved for selected equivocal cases.

Pediatric congenital lung malformations (CLMs) comprise a spectrum of developmental anomalies of lung parenchyma, airways, and vasculature. CLMs are increasingly diagnosed prenatally but remain best characterized by postnatal cross-sectional imaging. During pregnancy, ultrasound (US) and fetal magnetic resonance imaging (MRI) are commonly used to monitor lung lesions. Management of CLMs, including imaging, in infants and young children depends on associated symptoms and institutional standards. Chest CT angiography (CTA) is usually the most appropriate initial postnatal imaging modality for assessing prenatally diagnosed or clinically suspected CLMs in asymptomatic infants and children. Magnetic resonance (MR) imaging/magnetic resonance angiography (MRA) may be considered as a complementary, problem-solving, imaging modality for evaluation of CLMs during fetal and neonatal periods. This article presents contemporary perspectives on the imaging approach to pediatric patients with suspected CLMs and reviews up-to-date radiologic findings and clinical characteristics of CLMs.

The combination of positron emission tomography (PET) and magnetic resonance imaging (MRI) is a modern, highly advanced diagnostic tool that offers numerous advantages in the treatment and management of some pediatric pathologies. The use of PET/MR in children provides high-resolution images with outstanding tissue characterization, as well as important metabolic and physiological information; it is not only essential for early diagnosis, but also for the assessment and management of oncological, neurological, and cardiovascular diseases. The hybrid PET/MR is a multimodal approach that reduces the need for separate examinations, minimizes radiation exposure, and improves the overall experience for pediatric patients. In addition, PET/MR, by combining functional data, allows for more precise therapeutic planning and monitoring of treatment responses, optimizing clinical interventions especially with regard to staging and follow-up. This review will explore the benefits, weaknesses, and emerging applications of PET/MR in pediatric patients.

The aim of this review is to provide an update on the imaging triage, safety considerations, and cancer-imaging features of common and uncommon gynecological tumors during pregnancy. Clinical examination can be inconclusive, especially for the evaluation of intra-abdominal diseases since symptoms related to cancer such as fatigue, vomiting, or nausea overlap with common pregnancy-associated symptoms. Delayed pregnancy, advanced maternal age, and improvements in diagnostic imaging in developed countries have increased the incidence of cancer diagnosis in gravid populations. Non-invasive diagnostic imaging has a central role in the initial diagnosis and management of pregnancy tumors. Sonography is the first modality for the abdominal evaluation of gravid patients because it is widely available, low cost, and lacks adverse effects on the mother and fetus. MR imaging is considered the imaging modality of choice for diagnosis and staging of gynecologic cancer during pregnancy due to its larger imaging field of view, better reproducibility, and excellent soft tissue contrast. Moreover, whole-body diffusion-weighted imaging (DWI) has been proposed for the oncologic staging of pregnant patients; however, large prospective studies are needed to support its clinical implementation. Gynecological cancer diagnosed during pregnancy requires accurate diagnosis and staging to determine optimal treatment based on gestational age, and therefore multidisciplinary team collaboration is pivotal.

Background: ⁶⁸Ga-PSMA PET/CT is superior to standard-of-care imaging for detecting regional and distant metastatic recurrent prostate cancer. The objective of our study was to evaluate the performance of ⁶⁸Ga-PSMAPET/CT in our patient population, using the new PSMA-RADS version 2.0. Methods: A total of 128 patients scanned with ⁶⁸Ga-PSMA PET/CT for detection of recurrence after RP were analyzed with PSMA-RADS version 2.0. For the analysis of the detection rate, categories PSMA-RADS 3 to 5 were considered as “positive for malignancy” and 1–2 as “negative”. Results: According to PSMA-RADS v2.0, we classified patients as follows: 23 patients without PSMA-RADS because they were negative; PSMA-RADS 1: 10 patients; PSMA-RADS 2: 4 patients; PSMA-RADS 3A: 11 patients; PSMA-RADS 3B: 2 patients; PSMA-RADS 3C: 2 patients; PSMA-RADS 3D: 2 patients; PSMA-RADS 4: 13 patients; PSMA-RADS 5: 61 patients. Conclusions: The overall detection rate of ⁶⁸Ga-PSMA PET/CT was 71%. By dividing the patients into fourgroups according to PSA level before examination, we obtained the following detection rates: PSA < 0.2 ng/mL 38%; 0.2 ≤ PSA < 0.5 ng/mL 57%; 0.5 ≤ PSA ≤ 1 ng/mL 77%; and PSA > 1 ng/mL 95%. Conclusion: Using PSMA-RADS version 2.0, we obtained detection rate values comparable with recent literature both in absolute terms and in relation to different PSA levels.

Emergency imaging in pregnancy and puerperium poses unique challenges both for clinicians and radiologists, requiring timely and accurate diagnosis. Delay in treatment may result in poor outcomes for both the patient and the foetus. Pregnant and puerperal patients may present in the emergency setting with acute abdominopelvic pain for various complications that can be broadly classified into obstetric and non-obstetric related diseases. Ultrasonography (US) is the primary diagnostic imaging test; however, it may be limited due to the patient’s body habitus and the overlapping of bowel loops. Computed tomography (CT) carries exposure to ionising radiation to the foetus, but may be necessary in selected cases. Magnetic resonance imaging (MRI) is a valuable complement to US in the determination of the etiology of acute abdominal pain and can be used in most settings, allowing for the identification of a broad spectrum of pathologies with a limited protocol of sequences. In this second section, we review the common non-obstetric causes for acute abdominopelvic pain in pregnancy and post partum, offering a practical approach for diagnosis and pointing out the role of imaging methods (US, MRI, CT) with the respective imaging findings.

Acute abdominopelvic pain in pregnant and postpartum patients presents clinical and therapeutic challenges, often requiring quick and accurate imaging diagnosis. Ultrasound remains the primary imaging investigation. Magnetic resonance imaging (MRI) has been shown to be a powerful diagnostic tool in the setting of acute abdominal pain during pregnancy and puerperium. MRI overcomes some drawbacks of US, avoiding the ionizing radiation exposure of a computed tomography (CT) scan. Although CT is not usually appropriate in pregnant patients, it is crucial in the emergency evaluation of postpartum complications. The aim of this article is to provide radiologists with a thorough familiarity with the common and uncommon pregnancy and puerperium abdominal emergencies by illustrating their imaging appearances. The present first section will review and discuss the imaging findings for acute abdominopelvic pain of obstetric (non-fetal) etiology.