Medvedev S, McInnes MDF, Lam E
… +3 more, Fung CI, van der Pol CB, Harper K
Can Assoc Radiol J
· 2026 Jun · PMID 42381394
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OBJECTIVES: To evaluate the impact of the Canadian Association of Radiologists (CAR) guidelines on MRI surveillance burden for incidental pancreatic cystic lesions compared with Fukuoka guidelines. METHODS: This retrospe...OBJECTIVES: To evaluate the impact of the Canadian Association of Radiologists (CAR) guidelines on MRI surveillance burden for incidental pancreatic cystic lesions compared with Fukuoka guidelines. METHODS: This retrospective single-center study included 1000 asymptomatic patients aged ≥40 years with incidental pancreatic cystic lesions identified on abdominal MRI between January 2010 and March 2025. Patients with high-risk features, cysts ≥3 cm, or a history of pancreatic cancer were excluded. Surveillance recommendations were retrospectively simulated according to CAR and Fukuoka guidelines. The primary outcome was the mean number of recommended MRI examinations over 5- and 10-year follow-up periods. Comparisons were performed using paired -tests. RESULTS: A total of 1205 consecutive patients were reviewed between January 1, 2010 and March 31, 2025. Of these, 205 patients were excluded based on study criteria, yielding a final cohort of 1000 patients for analysis. At 5 years, the mean number of recommended MRI examinations was lower under CAR guidelines compared with Fukuoka guidelines (1.45 ± 1.5 vs 3.89 ± 0.99; < .001). At 10 years, the difference further increased (1.45 ± 1.5 vs 6.23 ± 1.64; < .001). CONCLUSION: Application of CAR guidelines is associated with a reduction in MRI surveillance utilization over 5- and 10-year follow-up periods compared with Fukuoka guidelines. These findings have important implications in the setting of MRI resource constraints within the Canadian healthcare system.
Scaglione M, Masala SA, Di Grezia G
… +12 more, Tiralongo F, Basile A, Sica G, Comune R, Tamburrini S, Mazzei MA, Klain M, Amadu AM, Piscopo L, Turilli D, Iacobellis F, Patlas MN
Can Assoc Radiol J
· 2026 Jun · PMID 42333807
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Acute non-traumatic urinary tract emergencies are a frequent cause of emergency department presentation and may result in significant morbidity if not promptly diagnosed. Imaging plays a pivotal role in identifying the u...Acute non-traumatic urinary tract emergencies are a frequent cause of emergency department presentation and may result in significant morbidity if not promptly diagnosed. Imaging plays a pivotal role in identifying the underlying pathology, assessing disease severity, and guiding patient management. This review provides a comprehensive imaging-based overview of the most common acute non-traumatic urinary tract emergencies. Obstructive, infectious, vascular, and hemorrhagic conditions, as well as urinary leaks, are discussed with emphasis on their characteristic imaging findings. The roles of ultrasound, computed tomography, and magnetic resonance imaging are reviewed, highlighting appropriate modality selection in the emergency setting. In addition, the emerging role of photon-counting computed tomography (PCCT) is discussed. Owing to its improved spatial resolution, enhanced tissue contrast, and spectral imaging capabilities, PCCT may allow better detection of subtle parenchymal abnormalities, small calculi, vascular alterations, and urinary leaks, while potentially enabling dose optimization. Key diagnostic features, common pitfalls, and practical reporting considerations are presented to assist radiologists in achieving timely and accurate diagnoses. This review aims to support a systematic and clinically relevant imaging approach to acute non-traumatic urinary tract emergencies.
Kazi S, Kashif Al-Ghita M, Dawit H
… +8 more, Osman H, Ansari D, Islam N, Lam E, Korevaar DA, Bossuyt PM, Cohen JF, McInnes MDF
Can Assoc Radiol J
· 2026 Jun · PMID 42318989
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INTRODUCTION: This meta-review aims to evaluate meta-analyses on adherence of diagnostic test accuracy (DTA) studies to the STAndards for Reporting of Diagnostic Accuracy Studies (STARD) 2015 checklist. METHODS: We searc...INTRODUCTION: This meta-review aims to evaluate meta-analyses on adherence of diagnostic test accuracy (DTA) studies to the STAndards for Reporting of Diagnostic Accuracy Studies (STARD) 2015 checklist. METHODS: We searched MEDLINE and EMBASE and included reviews using STARD 2015 to evaluate completeness of reporting of primary DTA studies in humans in any field of research and presented their results quantitatively. We extracted data independently, in duplicate. Random-effects meta-analysis models using restricted maximum likelihood estimation were used to determine overall mean and 95% confidence intervals (CI) of adherence to STARD 2015, compare fields of research, and evaluate adherence over time. Subgroup analyses to compare adherence across fields of research (diagnostic imaging, lab/biomarker, and other), were performed with pairwise differences between subgroups tested using meta-regression models with field of research as a categorical moderator. RESULTS: A total of 14 reviews evaluating 1115 primary DTA studies were included. The range of primary studies evaluated in each review was 6 to 158. Included reviews were from Canada (n = 6), Germany (n = 3), Australia (n = 1), USA (n = 2), Spain (n = 1), and South Korea (n = 1). Field of research of included reviews were diagnostic imaging (n = 7), lab/biomarker (n = 4), and other (n = 3). The overall mean STARD 2015 adherence was 53.2% (95% CI: 45.9-60.5). Mean adherence was higher among diagnostic imaging studies (61.7% [95% CI: 56.8-66.6]) compared to lab/biomarker studies (48.5% [95% CI: 33.5-63.4]; = .02) and other fields of research (39.4% [95% CI: 23.9-54.9]; < .001). Time trends analysis found that STARD adherence did not change over time ( = .28). CONCLUSION: Adherence of primary DTA studies to STARD 2015 was evaluated to be incomplete.
Gupta N, Rozovsky K, Hurrell C
… +8 more, Ahmad T, Ahmad W, Carpineta L, Kraus MS, Lacroix C, Pauranik A, Wei XC, Miller E
Can Assoc Radiol J
· 2026 Jun · PMID 42281550
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Focused Abbreviated Survey Technique (FAST) MRI protocols address the clinical challenges of prolonged scan times, sedation requirements, and ionizing radiation exposure in pediatric neuroimaging. These guidelines, devel...Focused Abbreviated Survey Technique (FAST) MRI protocols address the clinical challenges of prolonged scan times, sedation requirements, and ionizing radiation exposure in pediatric neuroimaging. These guidelines, developed by the Canadian Society of Pediatric Radiology (CanSPR), provide evidence-informed recommendations to assist practitioners in the selective application of abbreviated MRI protocols across diverse clinical scenarios. Based on comprehensive literature review and expert consensus, the working group established a framework for using FAST MRI as a targeted, CT-sparing strategy. The guideline outlines protocols and indications for the follow-up of hydrocephalus, arachnoid cysts, and syringomyelia. It also addresses its application in acute settings, including suspected stroke, first-time seizures, and accidental trauma, as well as its role in evaluating macrocrania following inconclusive ultrasound and headaches. While FAST MRI facilitates timely diagnosis and improves safety by minimizing anesthesia, it may have lower spatial resolution than conventional protocols. Consequently, these recommendations emphasize its use for targeted diagnostic questions rather than as a replacement for comprehensive MRI examinations.
Yilmaz E, DesRoche C, Masselot P
… +6 more, Kirpalani A, Ertl-Wagner B, Aguet J, Schmidt H, Patlas MN, Hanneman K
Can Assoc Radiol J
· 2026 Jun · PMID 42273721
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BACKGROUND: The impact of climate-driven warming on future demand for medical imaging remains unclear. PURPOSE: To project temperature-attributable excess imaging volumes requested by emergency departments (ED) under fut...BACKGROUND: The impact of climate-driven warming on future demand for medical imaging remains unclear. PURPOSE: To project temperature-attributable excess imaging volumes requested by emergency departments (ED) under future climate scenarios. METHODS: Associations between ambient temperature and imaging utilization were estimated during the baseline period (2013-2022) using data from 5 EDs in Toronto. Baseline exposure-response relationships were applied to statistically downscaled, bias-corrected daily temperature projections through 2092 from an ensemble of 23 general circulation models. Temperature-attributable excess ED imaging volumes were projected by decade under 3 Shared Socioeconomic Pathways (SSPs). RESULTS: Higher ambient temperature was associated with increased imaging utilization at baseline (incidence rate ratio 1.033; 95% CI, 1.028-1.037; < .001). Temperature-attributable emergency medical imaging utilization is projected to increase under all climate scenarios. Relative increases ranged from 0.04% to 0.10% in the early period (2023-2032), with a 3- to 12-fold increase over the study period. By 2083 to 2092, temperature-attributable emergency imaging utilization is projected to increase by 0.32% (95% CI, 0.28-0.37) under the SSP1-2.6 low-emissions scenario and by 1.25% (95% CI, 1.08-1.43) under the SSP3-7.0 high-emissions scenario. This corresponds to annual excess imaging studies attributable to rising temperatures of 570 (95% CI, 488-655) to 2219 (95% CI, 1922-2528) locally, and 13 900 (95% CI, 11 900-15 950) to 55 475 (95% CI, 48 050-63 200) across Canada. CONCLUSION: Climate-driven warming is projected to increase emergency imaging utilization across all emissions scenarios. These findings support the need for climate-informed radiology planning and integration of adaptation and mitigation strategies to sustain health system capacity.
Can Assoc Radiol J
· 2026 Jun · PMID 42239999
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Idiopathic normal pressure hydrocephalus (iNPH) is a potentially reversible neurological disorder characterized by the triad of gait disturbance, cognitive decline, and urinary dysfunction in association with ventriculom...Idiopathic normal pressure hydrocephalus (iNPH) is a potentially reversible neurological disorder characterized by the triad of gait disturbance, cognitive decline, and urinary dysfunction in association with ventriculomegaly and normal or mildly elevated cerebrospinal fluid (CSF) pressure. Although first described by Hakim in 1957, the condition remains underdiagnosed, partly because its clinical manifestations are common in the elderly population and are often attributed to more prevalent age-related conditions. The pathophysiology of iNPH is complex and incompletely understood, involving alterations in CSF dynamics, reduced vascular compliance, periventricular ischemia, and dysfunction of the glymphatic system, potentially leading to the accumulation of neurotoxic metabolites and neuronal impairment. Neuroradiological studies, particularly MRI, play a central role in diagnosis. MRI is essential to exclude alternative causes of ventriculomegaly and to identify characteristic imaging features such as a reduced callosal angle and the disproportionately enlarged subarachnoid space hydrocephalus (DESH) pattern, which support the diagnosis, although their predictive value for treatment response remains limited. Complementary non-imaging tests are often required to identify patients most likely to benefit from CSF shunting. Recent MRI advances have introduced biomarkers of glymphatic dysfunction, such as diffusion tensor imaging along perivascular spaces (DTI-ALPS), which may improve understanding of disease mechanisms and refine patient selection. Early recognition and accurate imaging assessment are crucial, given the potential reversibility of symptoms after shunt surgery.
Flegg C, Crivellaro PS, Fienberg S
… +5 more, Koberstein W, Kornecki A, Mnyusiwalla A, Zahra S, Fleming R
Can Assoc Radiol J
· 2026 May · PMID 42198851
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This guideline presents Part V of the Canadian Association of Radiologists (CAR) Practice Guidelines on Breast Imaging and Intervention and addresses image-guided breast intervention and biopsy procedures. This guideline...This guideline presents Part V of the Canadian Association of Radiologists (CAR) Practice Guidelines on Breast Imaging and Intervention and addresses image-guided breast intervention and biopsy procedures. This guideline provides comprehensive recommendations for stereotactic-, tomosynthesis-, ultrasound-, and MRI-guided biopsy, as well as preoperative localization and post-procedural management. Key areas include indications and contraindications, biopsy device and needle selection, tissue marker placement, documentation, radiologic-pathologic correlation, quality assurance, and personnel qualifications. Emphasis is placed on minimally invasive, image-guided procedures as the standard of care for diagnosing palpable and nonpalpable breast lesions. This guideline is intended to be used in conjunction with the other components of the CAR Breast Practice Guidelines series, which together replace the 2016 CAR Breast guidelines and reflect the current evidence base and clinical landscape in Canadian breast imaging. While outlining best practices and minimum standards, this guideline acknowledges variability in patient needs, lesion characteristics, and institutional resources, with ultimate responsibility for procedural decision-making residing with the supervising radiologist.
Fienberg S, Crivellaro PS, Fleming R
… +5 more, Koberstein W, Kornecki A, Mnyusiwalla A, Zahra S, Flegg C
Can Assoc Radiol J
· 2026 May · PMID 42198835
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This guideline presents Part III of the Canadian Association of Radiologists (CAR) Practice Guidelines on Breast Imaging and Intervention and focuses on breast ultrasound. Recommendations address the diagnostic, suppleme...This guideline presents Part III of the Canadian Association of Radiologists (CAR) Practice Guidelines on Breast Imaging and Intervention and focuses on breast ultrasound. Recommendations address the diagnostic, supplemental screening, and interventional roles of ultrasound in contemporary breast imaging practice. Topics include clinical indications, equipment and technical performance, axillary assessment, documentation, structured reporting using BI-RADS, quality assurance, and personnel qualifications, with attention to both handheld and automated whole-breast ultrasound techniques. This guideline emphasizes the importance of multimodality correlation, timely diagnostic assessment, and appropriate integration of ultrasound into the overall breast imaging pathway. It is intended to be used in conjunction with the other components of the CAR Breast Practice Guidelines series and complements the CAR Breast Disease Imaging Referral Guidelines. While outlining consensus-based best practices and minimum standards, this guideline acknowledges that local expertise, patient characteristics, and resource availability may influence implementation, with final responsibility for interpretation and management decisions resting with the radiologist.
Crivellaro PS, Fienberg S, Flegg C
… +5 more, Fleming R, Koberstein W, Mnyusiwalla A, Zahra S, Kornecki A
Can Assoc Radiol J
· 2026 May · PMID 42198829
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This guideline presents Part II of the Canadian Association of Radiologists (CAR) Practice Guidelines on Breast Imaging and Intervention and addresses the clinical application of contrast-enhanced mammography (CEM). Refl...This guideline presents Part II of the Canadian Association of Radiologists (CAR) Practice Guidelines on Breast Imaging and Intervention and addresses the clinical application of contrast-enhanced mammography (CEM). Reflecting the expanding evidence base and increasing clinical adoption of CEM since 2016, this guideline provides updated recommendations on indications, examination technique, contrast administration, image interpretation, reporting standards, quality control, and patient safety. Particular emphasis is placed on the role of CEM in diagnostic problem-solving, preoperative staging, and selected screening scenarios when breast MRI is unavailable or contraindicated. This guideline is intended to be used in conjunction with the other 4 components of the CAR Breast Practice Guidelines series, which together replace the previous consolidated guidelines and align with national and international best practices. While establishing minimum standards and best practices, this guideline recognizes the influence of evolving technology, regional resources, and patient-specific considerations, and affirms that clinical judgment remains the responsibility of the supervising radiologist.
Flegg C, Crivellaro PS, Fleming R
… +5 more, Koberstein W, Kornecki A, Mnyusiwalla A, Zahra S, Fienberg S
Can Assoc Radiol J
· 2026 May · PMID 42198826
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This guideline presents Part IV of the Canadian Association of Radiologists (CAR) Practice Guidelines on Breast Imaging and Intervention and addresses breast magnetic resonance imaging (MRI). As the most sensitive imagin...This guideline presents Part IV of the Canadian Association of Radiologists (CAR) Practice Guidelines on Breast Imaging and Intervention and addresses breast magnetic resonance imaging (MRI). As the most sensitive imaging modality for breast cancer detection, MRI plays an established and expanding role in screening, staging, problem-solving, and treatment monitoring. This guideline provides updated recommendations on indications, technical requirements, contrast administration, reporting standards, quality assurance, patient safety, and facility readiness for MRI-guided intervention. Emphasis is placed on bilateral imaging protocols, multimodality correlation, and integration within multidisciplinary breast care. This guideline is intended to be used alongside the other components of the CAR Breast Practice Guidelines series, which collectively replace the 2016 consolidated guidelines and reflecting current evidence and clinical practice in Canada. While defining best practices and minimum expectations, this guideline supports flexibility in application based on patient factors, available resources, and evolving knowledge, with clinical judgment remaining the responsibility of the supervising radiologist.
Fleming R, Crivellaro PS, Fienberg S
… +5 more, Koberstein W, Kornecki A, Mnyusiwalla A, Zahra S, Flegg C
Can Assoc Radiol J
· 2026 May · PMID 42198822
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This guideline presents Part I of the Canadian Association of Radiologists (CAR) Practice Guidelines on Breast Imaging and Intervention and focuses on mammography and digital breast tomosynthesis (DBT). Developed by the...This guideline presents Part I of the Canadian Association of Radiologists (CAR) Practice Guidelines on Breast Imaging and Intervention and focuses on mammography and digital breast tomosynthesis (DBT). Developed by the CAR Breast Imaging Working Group, this guideline provides updated, evidence-based recommendations for screening and diagnostic mammography, reflecting advances in digital imaging, tomosynthesis, artificial intelligence, and quality assurance since the previous consolidated guidelines published in 2016. Key areas addressed include clinical indications, equipment and technical standards, radiation dose considerations, reporting using BI-RADS, personnel qualifications, and performance benchmarks. This guideline emphasizes the central role of mammography and DBT in breast cancer detection while supporting the integration of emerging technologies to improve diagnostic accuracy and efficiency. It is intended to be used in conjunction with the other 4 components of the CAR Breast Practice Guidelines on Breast Imaging and Intervention and alongside the CAR Breast Disease Imaging Referral Guidelines. While outlining best practices and minimum expectations, this guideline acknowledges that practice variation may be appropriate based on patient factors and available resources, with ultimate responsibility for clinical decision-making resting with the supervising radiologist.
Flegg C, Barczak A, Fienberg S
… +6 more, Fleming R, Hapgood C, Kamran R, Koberstein W, Zahra S, Zhang M
Can Assoc Radiol J
· 2026 May · PMID 42175918
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Axillary lymphadenopathy following vaccination has long been recognized as a benign, self-limited immune response, but its increased frequency during the COVID 19 vaccination campaign created diagnostic uncertainty and c...Axillary lymphadenopathy following vaccination has long been recognized as a benign, self-limited immune response, but its increased frequency during the COVID 19 vaccination campaign created diagnostic uncertainty and contributed to delays in breast imaging and unnecessary follow-up. Early conservative guidance, issued in the context of limited evidence, led to postponed screening examinations and increased patient anxiety. Since then, robust prospective and longitudinal data have demonstrated an extremely low, near-zero risk of malignancy in asymptomatic patients with isolated ipsilateral axillary lymphadenopathy following recent COVID 19 vaccination and no suspicious breast imaging findings, even when lymphadenopathy persists for many months. In response to this evolving evidence base, the Canadian Association of Radiologists (CAR) and Breast Radiologists of Canada (BRC) have developed updated, evidence-based recommendations for the management of axillary lymphadenopathy following COVID 19 vaccination. These recommendations emphasize that breast imaging examinations should not be delayed because of vaccination, outline the importance of documenting vaccination history, and provide clear guidance for classifying and managing ipsilateral, contralateral, palpable, and persistent lymphadenopathy across breast imaging modalities. Special considerations for patients with a personal history of breast cancer or other malignancies are also addressed. Adoption of these recommendations is intended to promote consistent national practice, reduce unnecessary imaging and biopsy, support patient reassurance, and maintain the effectiveness of breast cancer screening programs.