Journal highlights

In 2024, more than 48,000 organ transplants were performed in the United States. Patients who receive kidney, liver, heart and other solid organ transplants (SOTs) typically need lifelong immunosuppressive therapy to prevent transplant rejection.

Although long-term outcomes have improved, cancer is now a leading cause of death in SOT recipients. De novo malignancies that occur after SOT include skin cancers, lymphoproliferative disorders and visceral solid tumors.

A recent Radiology review emphasizes that imaging is crucial for depicting, treating and monitoring posttransplant malignancy. Authors led by Samar Hajj, MD, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, describe the pathogenesis, classification and imaging findings of de novo malignancy after SOT.

For local disease, CT, MRI or US are used. For metastatic disease, whole-body approaches such as PET/CT are appropriate. The authors also discuss prevention strategies, such as administering vaccines before transplant, and the need for surveillance strategies, especially for new targeted therapies.

“Imaging plays an important role in screening, early diagnosis and monitoring of de novo posttransplant malignancies and helps guide appropriate therapy,” the authors summarize.

Read the full article, “Imaging of De Novo Malignancy after Solid Organ Transplant.”

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Evaluating Crohn’s Disease with Quantitative Imaging

Crohn’s disease (CD) is a chronic, relapsing and remitting inflammatory condition of the gastrointestinal tract. If left untreated, a majority of patients with small bowel disease and a substantial portion of those with colonic disease can develop complications such as strictures, fistulas or abscesses.

Diagnosis and treatment of CD centers on a multifactorial approach to endoscopic, histological, clinical and biologic evaluation. While mucosal healing remains the current treatment target, imaging assessment of transmural healing may be a better predictor of treatment response and long-term patient outcomes.

In a new RadioGraphics article, Richa D. Patel, MD, Stanford University School of Medicine, CA, and colleagues outline the quantitative imaging methods to help standardize treatment response assessment, including contrast-enhanced US, T1 mapping at MRI, standardized stricture assessment and velocity-encoded phase contrast imaging.

The authors describe how, despite documented endoscopic mucosal healing, up to 73% of patients may still have transmural inflammation at imaging and up to 70% of patients with transmural healing at imaging may still have mucosal disease at endoscopy. This suggests that endoscopy and imaging may play complementary roles in the evaluation of CD treatment response.

“Radiologists are valuable players in the treatment of CD including initial diagnosis, treatment response, and surveillance in patients on biologic therapy,” the authors conclude.

Read the full article, “Update on Novel Biologic Therapies for Crohn Disease and the Impact of Imaging on Clinical Decision Making.”  This article is also available for CME on EdCentral.

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Radiologist-led Framework for Whole-Body MRI Screening

Whole-body MRI (WB-MRI), once limited to select clinical indications and high-risk populations, is increasingly being promoted as a screening tool for early disease detection in average-risk, asymptomatic individuals. This growth is largely driven by consumer demand and direct-to-consumer marketing rather than outcome-based evidence.

While WB-MRI offers the promise of comprehensive assessment without ionizing radiation, its utility remains uncertain due to modest cancer detection rates, a high prevalence of incidental findings and associated downstream costs.

In a review recently published in Radiology Advances, Andrea S. Kierans, MD, from Weill Cornell Medical College in New York City, and colleagues examine the evidence, implementation and ethical and economic considerations of screening WB-MRI.

Across three systematic reviews/meta-analyses, WB-MRI detects cancer in approximately 1% to 2% of asymptomatic individuals, while incidental findings are reported in up to 97%. The findings underscore the need for careful patient selection, informed consent and standardized reporting and management pathways. The authors note that prospective studies are needed to establish downstream outcomes, cost-effectiveness and evidence-based management strategies.

“Radiologist-led programs can ensure methodological rigor, ethical oversight and consistency in exam quality, while reducing unnecessary testing through guideline-informed follow-up,” the authors conclude.

Read the full review, "How to Implement a Radiologist Led Whole-body MRI Screening Program.”

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