Top Images in 'Radiology' Offers Striking Demonstrations of Advanced Imaging Technologies with Clear Clinical Impact
Unexpected presentations, striking appearances and unique views offer educational opportunities for radiologists
Selections have been made for the 2025 Images in Radiology, an online medical imaging collection that is part of the journal Radiology. Each year, Images in Radiology publishes captivating images demonstrating important medical diagnoses and state-of-the-art medical imaging technology. These images exemplify the significant contributions made by radiology to the field of medicine.
Images in Radiology is the second most popular manuscript submission type, after original research submissions, with 770 cases submitted between July 1, 2024, and June 30, 2025. The Radiology In Training editorial board has reviewed the Images in Radiology collection and a total of 48 articles were published, garnering more than 100,000 cumulative downloads. The 30 most popular articles based on the number of downloads and their Altmetric scores were shortlisted.
The top three images, second runner-up, first-runner-up and winner, were selected by the Radiology in Training editorial board based on aggregate scores from individual editorial board members’ rankings. The images were selected based on three criteria: novel technology or unusual pathology, educational or thought-provoking and visually compelling.
The winner of the 2025 Top Images in Radiology is “Cerebrofacial Arteriovenous Metameric Syndrome” by Dhairya A. Lakhani, MD, and Majid Khan, MD, which exceptionally shows this syndrome in a 15-year-old patient with an enlarging facial mass, visual disturbance, and epistaxis (1). The images demonstrated in exquisite detail the multitude of diffuse multifocal arteriovenous malformations of the intracranial and extracranial vasculature, including a massively dilated right ophthalmic vein, using cinematic and multiplanar rendering of CT angiograms of the head and neck. The article underscores the pivotal role of imaging in mapping these complicated embryologic defects of craniofacial vasculogenesis, demonstrating how a single imaging modality can elegantly capture and display the intricate appearance of this multifocal disease.
Figure 1: (A) Axial, (B) coronal, and (C) sagittal CT angiograms of the head and (D) axial, (E) coronal, and (F) sagittal cinematically rendered sections show diffuse, multifocal, large arteriovenous malformations of the brain, involving the supratentorial and infratentorial brain parenchyma, with multiple arterial feeders from the internal carotid, ex[1]ternal carotid, and vertebral arteries and prominent draining veins extending into both superficial and deep venous drainage systems. There is severe dilatation of the right superior ophthalmic vein, which receives increased flow from the vascular malformations via the cavernous sinus and drains into the right external and internal jugular veins via angular and facial veins. High vascular flow in the veins has resulted in remodeling and widening of diploic spaces of the frontal calvarium and the right orbit, with resultant mild right proptosis. Multiple arteriovenous malformations are also present in the scalp—the largest in the occipital region, receiving arterial flow from the external carotid artery via the occipital artery and draining into the external jugular vein via the occipital vein. ©RSNA 2025
The first runner-up for this year’s Top Images in Radiology is entitled, “Where is the Canal of Gratiolet?” by Cong Huang, MD, and Yu-Jun Wang, MD. The article makes superb use of susceptibility-weighted imaging to demonstrate blood products in the transversely oriented canal of Gratiolet, a structure characterized by gray matter bridging the bilateral basal ganglia through the anterior commissure. The case illustrates how the canal forms a conduit for hemorrhage from the right basal ganglia to spread to the contralateral side. The strength of the article lies in its effective use of an advanced MRI sequence to reveal a previously described but rarely demonstrated pathway of bilateral basal ganglia hemorrhage.
Figure 2: (A) MRI scan obtained with a susceptibility-weighted sequence in a 77-year-old male with spontaneous basal ganglia hemorrhage with contralateral extension. Image shows susceptibility artifact in the bilateral basal ganglia, with a large hemorrhage on the right side and a small amount of hemorrhage on the left (solid arrows). There is a tubular region of artifact connecting both regions together (dashed arrow). (B) Illustration shows an axial view of the canal of Gratiolet among surrounding structures. ©RSNA 2025
The second runner-up this year is “Calcified Osteosarcoma Lung Metastases” by Paolo Spinnato, MD. The case presents striking CT images of both lungs filled with multiple calcified lung nodules, metastasized from a paraosteal femoral osteosarcoma in a 59-year-old patient. Its significance lies in the vivid reminder that, although calcification in pulmonary nodules is often an indicator of a benign nature of the lesion, the ability of osteosarcoma to produce calcified lung metastases represents an important exception.
Figure 3: Unenhanced chest CT shows osteosarcoma lung metastases. (A) Select axial (1.25-mm thickness) sections displayed in the bone window through the superior (left), mid (center), and inferior (right) chest. (B) Whole-chest maximal intensity projection (left) depicts the overall pulmonary metastatic burden. Three-dimensional volume rendering with chest wall removal (right) shows the intrathoracic lesions in isolation. ©RSNA 2025
The other articles ranked within the top 10 images ordered alphabetically include:
• Bilateral Partial Anomalous Pulmonary Venous Return (4)
• Caroli Syndrome (5)
• Cinematic Rendering of Gout (6)
• Dural Arteriovenous Fistula at Photon-Counting CT Angiography (7)
• Hepatic Langerhans Cell Histiocytosis (8)
• Multisystem Lymphangioleiomyomatosis (9)
• Osteitis Fibrosa Cystica of the Skull Caused by Vitamin D Deficiency (10)
For More Information
Access the Radiology article, “2025 Top Images in Radiology: Radiology in Training Editors’ Choices.”
Access the 2024 winners.
Access the 2023 winners.