OBJECTIVE: The Laudo Estruturado e Léxico em Oncologia (LELEX, Lexicon and Structured Reporting in Oncology) initiative was established to develop a standardized lexicon and structured reporting system applicable across cancer types.
METHODS: The São Paulo Radiology Society and Brazilian Society of Medical Oncology assembled a 27-member multidisciplinary consensus panel that included radiologists, medical and radiation oncologists, surgeons, and a patient representative. A literature review identified relevant oncologic reporting frameworks to guide the creation of a draft template and lexicon by the LELEX executive committee. Panelists were surveyed to assess current reporting practices and preferences between free-text and structured reports. Consensus (i.e., agreement by more than 80% of panelists) on the final lexicon and reporting system was reached through post-survey panel discussions.
RESULTS: Compared with a traditional free-text report, a structured report incorporating the LELEX lexicon received significantly higher ratings for precision and was deemed better for guiding clinical decisions by > 88% of panelists. In post-survey discussions, consensus was achieved for all lexicon components, including diagnostic certainty terms, lesion count descriptors, and longitudinal comparison language. The structured report template was also agreed upon by the panel members.
CONCLUSION: The LELEX initiative established a consensus-driven structured reporting system and lexicon for general oncologic imaging baseline and follow-up assessments.

Keywords: Radiology information systems; Radiology/education; Medical records/standards; Terminology as topic; Neoplasms/diagnostic imaging; Medical oncology/education; Decision making; Uncertainty; Longitudinal studies; Follow-up studies.

OBJECTIVE: To evaluate a radiomics workflow applied to chest computed tomography (CT), examining its feasibility and performance across the steps of lung lesion segmentation, feature extraction, and clustering, as well as exploring its potential to distinguish between benign and malignant lung lesions.
MATERIALS AND METHODS: This was a retrospective study including CT images of 32 histopathology-confirmed lesions (11 benign; 21 malignant). Lesions were segmented by using syngo.via Frontier Radiomics software, after which > 900 radiomic features were extracted with the same software. Data processing—including normalization, dimensionality reduction (principal component analysis), and unsupervised (k-means) clustering—was conducted in Python.
RESULTS: The best clustering solution was obtained with a k = 2 (silhouette score = 0.4668), effectively separating benign lesions, which exhibited low heterogeneity, from malignant lesions, which exhibited complex patterns of texture and shape.
CONCLUSION: The application of a radiomics workflow proved feasible and potentially useful for differentiating between benign and malignant lung lesions on CT, underscoring its value as a complementary tool in thoracic oncology. However, future studies using multicenter datasets, blinded evaluations, and more structured integration environments are warranted in order to support clinical validation and prototyping.

Keywords: Radiomics; Lung neoplasms; Tomography, X-ray computed; Radiographic image interpretation, computer-assisted; Cluster analysis; Biomarkers; Machine learning.

OBJECTIVE: To critically analyze evidence-based alternatives to sedation in patients with radiology-related phobias, focusing on clinical efficacy, feasibility, and implementation challenges.
METHODS: This is a narrative review of the scientific literature published between 1985 and 2025, based on indexed databases (PubMed, Scopus, Embase, Scientific Electronic Library Online, and PsycINFO) and clinical guidelines. We included observational studies, clinical trials, systematic reviews, and expert consensus statements.
RESULTS: Effective nonpharmacological interventions include mock scanner training, cognitive-behavioral therapy, virtual reality exposure, breathing/relaxation techniques, environmental modifications, and therapeutic communication. These approaches significantly reduce the need for sedation, particularly in pediatric, geriatric, and neurodivergent populations. However, implementation remains limited by structural, economic, and cultural barriers.
CONCLUSION: Nonpharmacological strategies are clinically effective and ethically desirable for managing patient anxiety and phobias in the setting of magnetic resonance imaging. Their systematic incorporation requires institutional restructuring, interdisciplinary training, and investment in supportive technology.

Keywords: Magnetic resonance imaging; Phobic disorders; Hypnotics and sedatives/adverse effects; Anxiety/prevention & control.

OBJECTIVE: To propose a novel ultrasound-based classification system for muscle injuries in soccer players, termed the Sonographic Muscle Injury Classification in Soccer (SOMICS), and to evaluate its association, ordinal consistency, and agreement with the British Athletics Muscle Injury Classification (BAMIC).
MATERIALS AND METHODS: This was a cross-sectional observational study including 51 adolescent male soccer players (11–19 years of age) with suspected acute myotendinous injuries. All athletes underwent ultrasound and magnetic resonance imaging (MRI) within 24 h after injury. Four experienced radiologists, working independently, reviewed the images.
RESULTS: Interobserver agreement was substantial for ultrasound (κ = 0.65) and MRI (κ = 0.70). A strong ordinal correlation was observed between SOMICS and BAMIC categories (ρ = 0.80; p < 0.001), with a statistically significant association (χ² = 52.53; p < 0.001).
CONCLUSION: The SOMICS demonstrated significant association, ordinal consistency, and substantial agreement with the BAMIC for severity stratification of muscle injuries. Although not intended to replace MRI-based classifications for prognostic decision-making, the SOMICS provides a structured, reproducible ultrasound-based approach that may be useful in clinical settings where MRI is not readily available or as a first-line imaging tool.

Keywords: Ultrasonography; Muscle; Soccer; Classification; Magnetic resonance imaging.

OBJECTIVE: To describe the contributions of conventional single-photon emission computed tomography (SPECT) and subtraction ictal-interictal SPECT coregistered to magnetic resonance imaging (SISCOM) for the preoperative identification of the epileptogenic zone (EZ) in patients with frontal lobe epilepsy (FLE).
MATERIALS AND METHODS: In this retrospective study, we reviewed medical records of all patients with refractory FLE who underwent frontal lobectomy at our institution between 2015 and 2020, all of whom had undergone at least one ictal SPECT, one interictal SPECT, one high-resolution magnetic resonance imaging examination, SISCOM, and at least one year of follow-up. Fourteen patients met the inclusion criteria.
RESULTS: After a mean follow-up of 32 months (range, 14–60 months), surgical outcomes were classified as good in five patients (35.7%) and poor in nine (64.3%). For localizing the EZ, SISCOM achieved the highest sensitivity (80%), negative predictive value (85%), and overall diagnostic accuracy (71%), whereas ictal SPECT had the highest specificity (70%) and interictal SPECT had the lowest performance overall.
CONCLUSION: In patients with FLE, ictal and interictal SPECT alone do not seem to predict the surgical outcome. However, SISCOM seems to perform better for that purpose.

Keywords: Epilepsy; Epilepsy, frontal lobe; Seizures, Tomography, emission-computed, single-photon; Drug resistant epilepsy/surgery.

Interventional radiology has advanced significantly in recent decades, enhancing quality of life with treatments that are safer and less invasive. Despite these benefits, public awareness about vascular procedures remains limited, which affects the adoption of these therapeutic interventions by patients and physicians alike. Behavioral science theories, such as the theory of planned behavior (TPB) and the technology acceptance model (TAM), offer a robust framework to address this gap by shaping patient health-seeking behaviors. The TPB examines how attitudes, norms, and perceived control influence behavior, whereas the TAM focuses on technology acceptance based on ease of use and usefulness. Attitudes reflect opinions, subjective norms indicate social pressure, and perceived control relates to confidence in performing the behavior. Applying these models can improve patient acceptance and health care outcomes. Collectively, these models are instrumental frameworks in medical innovation, offering a systematic approach to evaluating and promoting the acceptance of new technologies. As health care continues to evolve, with rapid technological advancements, this narrative review underscores the potential role of these models in facilitating the successful integration of medical innovations, enhancing patient care, and optimizing health care practices.

Keywords: Vascular surgical procedures; Radiology, interventional; Behavior therapy; Educational technology; Diffusion of innovation; Quality improvement.

Magnetic resonance imaging (MRI) is the gold-standard imaging modality for evaluating perianal fistulas, playing a pivotal role in characterizing fistula anatomy and guiding optimal surgical strategies. Appropriate preoperative MRI assessment can significantly reduce recurrence rates and minimize the risk of complications, such as fecal incontinence. This article reviews the most relevant information that an MRI report should contain to aid effective surgical decision-making for perianal fistulas. These features influence therapeutic choices, including decisions regarding the suitability of techniques like fistulotomy, ligation of the intersphincteric fistula tract (LIFT), video-assisted anal fistula treatment (VAAFT), fistula-tract laser closure (FiLaC), and advancement flaps. The emerging role of three-dimensional (3D) modeling from MRI data is also discussed, highlighting its potential to enhance surgeons’ spatial understanding of complex fistulous anatomy, thereby improving surgical planning, reducing operative time, and ultimately improving outcomes. However, the generation of accurate 3D models depends on meticulous image segmentation and interpretation by experienced radiologists. Future research directions, including the integration of 3D models with intraoperative navigation and standardized assessment of inflammatory activity, are also addressed in this review.

Keywords: Rectal fistula/diagnostic imaging; Anal canal/surgery; Magnetic resonance imaging; Imaging, three-dimensional; Colorectal surgery.

In May 2025, the World Health Assembly adopted Resolution WHA78.13, formally recognizing medical imaging as a fundamental pillar of universal health coverage. Brazil, as a co-sponsor of the Resolution, plays a decisive role in promoting equitable access to imaging services throughout Latin America. This article explores the implications of the resolution for Brazil, highlighting its leadership and the need to address regional disparities in imaging infrastructure and workforce distribution. On the basis of data from the 2025 Atlas of Radiology in Brazil, the article highlights the unequal distribution of radiologists and imaging equipment, especially in underserved areas. Strategic priorities for regional action are outlined, including workforce development, infrastructure investments, and public policy integration. The Brazilian College of Radiology and Diagnostic Imaging is positioned to participate in national efforts, advocating for medical imaging as a public health priority. By aligning national initiatives with global strategies and embracing innovation, Brazil and Latin America can transform diagnostic equity and improve health outcomes.

Keywords: Diagnostic imaging; Delivery of health care/organization & administration; Health personnel/organization & administration; Global health; Health policy; World Health Organization; Radiology/statistics & numerical data; Brazil.

The postmortem diagnosis of drowning is a challenge for forensic medicine. The objective of this review was to list the findings described in reports of postmortem computed tomography (PMCT) examinations and autopsies of drowning victims, as well as to show how PMCT facilitates the diagnosis. The PubMed, Google Scholar, the Brazilian Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES, Office for the Advancement of Higher Education) Journals, and the International Prospective Register of Systematic Reviews (PROSPERO) databases were searched. The 17 studies included evaluated a collective total of 726 bodies of drowning victims and 477 bodies of people who died from other causes. Different PMCT protocols were used, some encompassing whole-body scans and others including scans only from the skull to the pelvis, with different slice thicknesses, all without the use of contrast. The finding most commonly described was fluid in the paranasal sinuses, mastoid air cells, and airways, referred to as specific for drowning if frothy, containing dense sediment, or both. A cutoff of 37.77 HU for the density of fluid in the paranasal sinuses was suggested to characterize drowning in salt water. Paltauf spots were detected only at autopsy. Although PMCT has proven to be a useful tool in making this diagnosis, it is too early to predict whether it can replace conventional autopsy. Current limitations include the absence of established protocols, a shortage of forensic radiologists, and low availability of CT scanners at forensic medicine facilities.

Keywords: Drowning; Postmortem imaging; Forensic imaging; Autopsy; Tomography, X-ray computed.

OBJECTIVE: To review the recommended imaging modalities for pre-transplant evaluation in patients with sickle cell disease (SCD) undergoing allogeneic hematopoietic stem cell transplantation (HSCT). MATERIALS AND METHODS: This was a narrative review focusing on key imaging techniques employed to assess organ damage and stratify risks prior to HSCT in patients with SCD, including transcranial Doppler (TCD) ultrasonography, brain magnetic resonance imaging (MRI) with magnetic resonance angiography (MRA), MRI for osteonecrosis evaluation, and MRI-based hepatic iron quantification. Results and discussion: TCD, including blind Doppler and TCD imaging (TCDI), plays a critical role in detecting increased cerebral blood flow velocities associated with stroke risk. Brain MRI/MRA is essential for identifying silent cerebral infarcts and intracranial vasculopathy, even in patients with normal TCDI velocities. Bone MRI allows early detection of osteonecrosis, which is frequently asymptomatic in SCD. Liver MRI, using R2 relaxometry and T2*- weighting, provides accurate quantification of hepatic iron overload, an important risk factor for transplant-related complications. Cardiac MRI, chest computed tomography, and liver ultrasound are also recommended to help stratify pre-HSCT risk and identify organ damage. CONCLUSION: A structured imaging protocol is essential for pre-HSCT assessment in SCD. Radiologists play a pivotal role in identifying subclinical organ damage and providing information critical to transplant candidacy and perioperative management.

Keywords: Anemia, sickle cell; Stem cell transplantation; Magnetic resonance imaging; Ultrasonography, Doppler; Iron overload.

Congenital anomalies of the digestive system, particularly in the esophagus and stomach, present significant challenges to neonatal health due to their complex management and associated risks of morbidity and mortality. This narrative review explores esophageal and gastric anomalies, addressing the embryology, prevalence, diagnostic methods, and treatment approaches, with an emphasis on early detection and improved outcomes. Because of recent advances in prenatal imaging, such as ultrasonography and magnetic resonance, diagnostic accuracy has increased, allowing better clinical planning and management. Studies reveal that gastrointestinal anomalies account for approximately 20% of congenital malformations globally, having a substantial impact on neonatal health and healthcare systems. This review discusses critical anomalies, including esophageal atresia, tracheoesophageal fistula, antral stenosis, and antral atresia, with a focus on diagnostic criteria, surgical interventions, and prognostic factors. By highlighting current knowledge and best practices, we aim to underscore the importance of early, accurate diagnosis and continuous follow-up, which can ultimately improve neonatal outcomes and quality of life.

Keywords: Congenital abnormalities; Esophageal atresia; Tracheoesophageal fistula; Pyloric stenosis, hypertrophic; Digestive system abnormalities.

In recent years, noninvasive methods for assessing liver fibrosis have significantly transformed hepatology practices, reducing the need for liver biopsy. Among these, elastography techniques have become widely used tools for staging fibrosis in patients with chronic liver disease. Currently, various modalities are available, including transient elastography, point shear wave elastography, two-dimensional shear wave elastography, and magnetic resonance elastography; the first three are ultrasound-based techniques, whereas the last is a magnetic resonance imaging-based technique. In this context, ultrasound-based liver elastography stands out as a reliable, reproducible method with high accuracy. This narrative review aims to present the technical principles of ultrasound-based shear wave elastography, discuss the factors that influence measurement reliability, and provide practical guidance for result interpretation. The topics addressed include acquisition protocols, methodological limitations, potential confounding factors, and clinically relevant cutoff values. In conclusion, when applied under appropriate indications with adequate technical quality and interpretation, ultrasound-based liver elastography is a valuable, complementary tool for managing chronic liver disease.

Keywords: Elasticity imaging techniques/standards; Ultrasonography; Liver cirrhosis/diagnostic imaging; Liver diseases/diagnostic imaging.

Breast cancer is the most common malignancy among women in Brazil and the leading cause of cancer-related death in the female population of the country. Despite advances in treatment and the implementation of mammography screening programs, mortality rates have continued to rise. This increase is particularly evident among women under 50 years of age and those 70 years of age or older, groups that account for a substantial proportion of diagnosed cases and registered deaths in the country. Until recently, these age groups were not included in the screening guidelines established by the Brazilian National Ministry of Health, although consistent scientific evidence demonstrates significant benefits of early detection in these populations, including reduced mortality, a higher proportion of early-stage diagnoses, and less aggressive therapeutic interventions. This article analyzes epidemiological data, the socioeconomic impacts of breast cancer, and the scientific evidence regarding mammography screening, discussing the outcomes and limitations of national programs in Brazil. On the basis of that analysis, we advocate for the revision and expansion of public breast cancer screening policies to include women 40–49 and ≥ 70 years of age, as an essential strategy to reduce mortality, improve clinical outcomes, and promote greater equity in access to diagnosis and treatment of breast cancer in Brazil.

Keywords: Breast neoplasms; Mammography; Mass screening; Brazil; Middle aged; Aged.

This study presents a systematic review of the role of imaging in the diagnosis of central nervous system toxoplasmosis, in addition to a case series from a tertiary university hospital. The review was conducted in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines and registered in the International Prospective Register of Systematic Reviews (ID: CRD420251107718). Studies published after January 1, 2000 were retrieved from the PubMed, Embase, Scopus, and Latin-American and Caribbean Health Sciences Literature databases. Two authors, working independently, selected studies that met the eligibility criteria, which were organized with Rayyan software. Imaging findings were described using computed tomography (CT), conventional magnetic resonance imaging (MRI), advanced MRI sequences or nuclear imaging, focusing on single-photon-emission computed tomography, with and without thallium-201, and positron-emission tomography/CT. Extracted data focused on lesion topography, signal characteristics, enhancement, restricted diffusion, and when available, spectroscopy and perfusion MRI findings. To illustrate typical and atypical imaging features, a complementary case series was included, evaluating patients with confirmed cerebral toxoplasmosis. The review demonstrates that CT and MRI remain essential for diagnosis and follow-up, whereas advanced MRI sequences provide additional value in differentiating toxoplasmosis from other opportunistic infections and neoplastic processes.

Keywords: Toxoplasma; Toxoplasmosis, cerebral/diagnosis; Toxoplasmosis/diagnostic imaging; Neuroimaging.

OBJECTIVE: Point-of-care ultrasound (POCUS) has been employed to assist with invasive techniques, such as suprapubic aspiration (SPA). We aimed to conduct a meta-analysis to compare the effectiveness of suprapubic bladder aspiration in children, with and without the use of POCUS.
METHODS: We conducted a systematic search across the MEDLINE, EMBASE and Cochrane Central Register of Controlled Trials databases for articles published through February 2025. Eligible studies included randomized controlled trials (RCT) comparing SPA with and without POCUS in pediatric populations. Data extraction focused on overall procedural success rates, as well as rates of success at first and second attempts.
RESULTS: We analyzed seven trials collectively evaluating 468 suprapubic bladder aspirations. POCUS-guided SPA showed higher overall success rates (OR = 4.88; 95% CI: 2.36–10.09; p < 0.0001; I² = 10%). Although no significant difference was found in first-attempt success, POCUS improved success within two attempts (OR = 7.75; 95% CI: 1.54–39.09; p = 0.01; I² = 61%), although without significantly reducing the mean number of attempts. However, sensitivity analysis showed a benefit after the exclusion of one outlier study.
CONCLUSIONS: POCUS improves SPA success in children and may enhance sterile urine collection, although training and equipment access remain challenges.

Keywords: Point-of-care systems; Ultrasonography; Urine specimen collection; Infant; Infant, newborn.

Glenohumeral cartilage lesions represent a significant challenge in both diagnosis and management due to the complex anatomy of the joint and the variability in lesion presentation. In this review, we elucidate the anatomical considerations of the glenohumeral joint, discuss multimodal diagnostic imaging strategies, and highlight imaging features critical for the effective management of focal and diffuse cartilage lesions in the glenohumeral joint, especially in the preoperative context. We also present the role of advanced magnetic resonance imaging techniques and the crucial parameters that radiologists must report in preoperative planning, in order to optimize outcomes in clinical practice.

Keywords: Shoulder joint; Osteoarthritis; Cartilage, articular; Diagnostic imaging; Preoperative care.

Fasciculations are a key manifestation of lower motor neuron dysfunction in amyotrophic lateral sclerosis (ALS). Although electromyography is considered the gold-standard method for the detection of fasciculations, its sensitivity for that purpose depends on the muscle sampled and the examination time. Muscle ultrasound has emerged as a dynamic, noninvasive technique with high sensitivity for detecting spontaneous muscle activity. This updated systematic review compares ultrasound and electromyography in terms of their performance for the detection of muscle fasciculations in ALS, with stratification by muscle group and observation time. A comprehensive search of the literature identified studies evaluating both techniques. Data were synthesized descriptively and, when possible, quantitatively. Ultrasound demonstrated higher or comparable detection rates across most muscle groups, particularly in muscles that are large or deep, such as the biceps brachii, tibialis anterior, and vastus lateralis. Longer ultrasound observation times, especially 60 s, were associated with substantially higher detection rates without a loss of specificity. Although electromyography is still essential for electrophysiological characterization, ultrasound offers broader muscle coverage, excellent reproducibility, and a noninvasive approach. These findings support muscle ultrasound as a valuable complementary tool for the detection and assessment of fasciculations in patients with motor neuron disease.

Keywords: Ultrasonography; Electromyography; Fasciculation; Amyotrophic lateral sclerosis; Motor neuron disease.

Primary vertebral tumors and tumor-like lesions in skeletally immature patients are uncommon yet clinically consequential causes of pain, deformity, and neurological compromise. Compared with adults, pediatric lesions arise in a spine with open physes, evolving marrow composition, and substantial remodeling capacity—features that shape tumor biology and imaging appearance. This pictorial review summarizes malignant tumors, benign tumors, and tumor-like lesions of the pediatric spine, adopting a modality-first, compartment-aware approach. Useful highlights include vertebra plana in Langerhans cell histiocytosis, posterior-element bias in lesions such as osteoid osteoma/osteoblastoma, and the role of whole-body magnetic resonance imaging patterns in chronic nonbacterial osteomyelitis/chronic recurrent multifocal osteomyelitis. We also update terminology and concepts for entities such as vertebral hemangioma (venous malformation) and aneurysmal bone cyst. Throughout, we couple modality choice with pediatric anatomy and growth considerations, as well as illustrating the discussion with real-life cases from our teaching files.

Keywords: Spinal neoplasms; Bone neoplasms; Pediatrics; Magnetic Resonance Imaging; Tomography, X-ray computed; Osteomyelitis/physiopathology.

Although lesions of the mandible and maxilla are relatively common findings on imaging examinations, they still pose a diagnostic challenge for radiologists in clinical practice. Many of these lesions share similar radiographic characteristics, making it difficult to differentiate between benign, infectious, and malignant entities, which can delay appropriate management. This article aims to illustrate the main imaging findings and present a systematic approach based on radiological patterns, such as attenuation type, margins, relationship with dental structures, and anatomical distribution, in order to facilitate the differential diagnosis, as well as to guide clinical and therapeutic management.

Keywords: Mandible; Magnetic resonance imaging; Tomography, X-ray computed; Maxilla.

Neuro-Behçet’s disease (NBD) is a rare but serious manifestation of Behçet’s disease, categorized into parenchymal and non-parenchymal forms, each with distinct clinical and imaging characteristics. Parenchymal NBD primarily affects the brainstem, basal ganglia, and diencephalon. On magnetic resonance imaging (MRI), acute or subacute lesions appear hyperintense on T2-weighted or fluid-attenuated inversion recovery sequences and isointense to hypointense on T1-weighted sequences, whereas chronic lesions may present as asymmetrical atrophic changes. Non-parenchymal NBD may present as cerebral venous thrombosis, arterial involvement, and meningeal inflammation. Here, we provide a pictorial essay on MRI central nervous system studies, mostly following an international consensus classification of NBD. Although NBD is rare, recognizing its characteristic imaging features is crucial for early diagnosis and treatment, potentially improving prognosis and reducing long-term neurological complications.

Keywords: Behçet syndrome; Magnetic resonance imaging; Vasculitis, central nervous system.

The assessment of response to neoadjuvant systemic therapy (NST) is a critical pillar in defining the multidisciplinary therapeutic strategy in breast cancer. This consensus aimed to establish national guidelines for imaging assessment of NST, based on the best scientific evidence adapted to the Brazilian context. To this end, a panel of experts was formed, composed of breast radiologists, breast surgeons, oncologists, onco-radiotherapists and breast pathologists. The methodology was based on a systematic literature review, followed by face-to-face discussions and rounds of virtual voting (adapted Delphi method), defining consensus when agreement was ≥75%. As a result, radiological response criteria were standardized, and accuracy, false-negative, and positive rates were determined, as well as the role of mammography, ultrasound, magnetic resonance imaging, and tomosynthesis, stratified by molecular subtypes. Additionally, recommendations were established for marking the breast lesion and axillary lymph nodes before the start of treatment. Finally, the role of other imaging techniques, such as contrast-enhanced mammography and positron-emission tomography/computed tomography, was discussed, as well as the impact of artificial intelligence as tools for evaluating the response to SNRT.

Keywords: breast neoplasm; neoadjuvant systemic therapy; imaging assessment; breast magnetic resonance imaging