Journal highlights
The following are highlights from the current issues of RSNA’s peer-reviewed journals.
Guide to Updated TNM Staging for Pleural Mesothelioma
Pleural mesothelioma is a rare but lethal thoracic malignancy primarily caused by asbestos exposure, with a median overall survival of nine months. CT is the primary imaging modality used for clinical staging; however, staging is challenging due to complex tumor morphologic characteristics.
Previous TNM editions relied on qualitative descriptors of tumor invasion that demonstrated poor interobserver agreement and highlighted the need for a more objective approach.
In a review published in Radiology, David J. Murphy, MD, St. Vincent’s University Hospital and University College Dublin, and colleagues describe the updates to the International Association for the Study of Lung Cancer TNM staging system for pleural mesothelioma. These updates were jointly published by the American Joint Committee on Cancer and Union for International Cancer Control.
The ninth edition introduces quantitative measurements of pleural and fissural thickness into the T category. The authors encourage radiologists to incorporate the new measurements into their reports.
“These updates will hopefully improve the accuracy and reproducibility of clinical staging for pleural mesothelioma, impacting therapeutic decision-making and future clinical trials,” the authors conclude.
Read the full article, “Radiologist’s Guide to the Ninth Edition TNM Staging System for Quantitative and Qualitative Assessment of Pleural Mesothelioma.”
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Images in a 66-year-old male patient with left-sided pleural mesothelioma (clinical T1) and N2 with contralateral mediastinal fluorodeoxyglucose-avid nodes at PET/CT. (A–C) Axial PET/CT images show left-sided pleural effusion with PET-avid ipsilateral and contralateral mediastinal lymph nodes (arrows in A and B) and left hilar lymph node (arrow in C). (D) Three-dimensional volume rendered image shows distribution of N2 lymph nodes (yellow shading).
https://doi.org/10.1148/radiol.250531 © RSNA 2025
Standardizing Contrast-Enhanced Mammography Reporting
Contrast-enhanced mammography (CEM) is a functional breast imaging technique that combines iodinated contrast material with digital mammography. Clinical use of CEM is increasing, in part, due to its ease and accessibility.
In 2022, the American College of Radiology (ACR) published a CEM supplement to the fifth edition of the Breast Imaging Reporting and Data System (BI-RADS) manual. Greater familiarity with the lexicon is essential for radiologists who interpret and report breast imaging findings.
In a new RadioGraphics article, Brandy M. Griffith, DO, The Ohio State University Wexner Medical Center in Columbus, and colleagues systemically compare the CEM lexicon with existing mammography and MRI lexicons. They also discuss potential limitations of CEM and challenging diagnostic scenarios.
The authors conclude that adoption of the ACR BI-RADS CEM lexicon is necessary to standardize reporting, improve accuracy, and reduce interobserver variability. “Learning to read CEM images can be straightforward, especially when radiologists apply their knowledge of and experience with full-field digital mammography and MRI to CEM,” the authors write.
Read the full article, “Applying the Contrast-enhanced Mammography BI-RADS Lexicon to Clinical Practice.” This article is also available for CME on EdCentral.
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Evaluation of extent of disease at CEM in an 80-year-old woman. (A) Craniocaudal low-energy CEM image shows two sites of biopsy-proven malignancy in the inferior central left breast, with linear tissue (arrowheads) extending posteriorly from the site of malignancy. The posterior mass (white arrow) is a 1.3-cm, ER- and PR-positive, HER2-negative, grade 2 IDC with mucin. The anterior mass (black arrow) is a 0.6-cm solid papillary carcinoma. (B) Craniocaudal recombined (RC) CEM image shows enhancement of the posterior mass (white arrow) and anterior mass (black arrow), with linear posterior tissue (arrowheads) with linear NME. US correlate was identified, and biopsy revealed ER- and PR-positive, HER2-negative, grade 2 IDC with intermediate-nuclear-grade, cribriform, and papillary type DCIS. The patient underwent antiestrogen medication. (C) Craniocaudal RC CEM image 6 months later shows a response to treatment, with a decrease in the size and conspicuity of the two masses and resolution of the linear NME.
https://doi.org/10.1148/rg.240136 © RSNA 2025
Study Explores Strategic Use of LLMs in Practice
Radiology is experiencing unprecedented transformation fueled by the rise of large language models (LLMs) which present an opportunity to automate complex cognitive tasks within radiology clinical workflows.
Full implementation of LLMS in daily practice requires careful consideration of some vulnerabilities with the technology, including its tendency to hallucinate, producing plausible yet inaccurate and/or misleading information rather than admitting uncertainty.
In a review paper published in Radiology Advances, Sanaz Vahdati, MD, Mayo Clinic AI Lab in Rochester, MN, and colleagues address the strategic application of LLMs by looking at two key techniques: fine-tuning and prompt engineering.
“As LLMs continue to evolve, fine-tuning and prompt optimization are emerging as building blocks for reducing hallucinations and adapting models to specific radiology tasks,” the authors conclude.
Read the full review, “Decoding large language models for radiology: strategies for fine-tuning and prompt engineering.”
Contribute to the Future of Pancreatic Imaging
Share your latest advances and discoveries in pancreatic imaging in the Radiology: Imaging Cancer new special collection on pancreatic adenocarcinoma, pancreatic neuroendocrine and hepatobiliary cancers.
We welcome original research articles, reviews and brief reports encompassing imaging and image-guided therapy from cell-based models with organoids, pre-clinical, translational and clinical research. Submissions may address innovations in imaging probes, imaging technologies, image-guided therapies, data analysis methods, public policy and AI/machine learning.
Accepted manuscripts are immediately published and will be presented on the Radiology: Imaging Cancer website.
Top Reviewers Earn a Free Pass
The Radiology: Imaging Cancer Editorial Board introduced a new benefit for recipients of its annual Editor’s Recognition Award, which honors reviewers who consistently deliver prompt, high-quality manuscript reviews.
Award recipients receive a Free Pass, allowing one co-authored manuscript to skip the initial editorial screening protocol and proceed directly to peer review.
Each Free Pass comes with a unique identification code to be included in the cover letter of the submitted manuscript. Passes are valid for 12 months from the date of the award.
Learn more about this exciting new opportunity to accelerate your research!
Become a Peer Reviewer for an RSNA Journal
Contribute your expertise by becoming a peer reviewer for one of RSNA’s prestigious journals. Play a vital role in ensuring the quality, accuracy and clinical relevance of manuscript submissions. Peer reviewers also have the opportunity to earn CME credit.