Hellenic Journal of Radiology Hellenic Journal of Radiology (“HJR”) is the official journal of the Hellenic Radiological Society, first published in 1968. This revived edition of HJR, published in English, aspires to promote scientific knowledge in Radiology both at diagnosis and image guided therapy, worldwide. It is a peer-reviewed Journal, aiming at raising the profile of current evidence-based imaging practice and at improving the scientific multidisciplinary dialogue. HJR presents clinically pertinent, original research and timely review articles. It is open to International authors and readers and offers a compact forum of communication to medical imaging and related science specialists.
An Uncommon Coronary Finding in a Chest Pain Patient
A 58-year-old male, an active smoker presented to the hospital with chest discomfort and palpitations following alcohol consumption. His vital signs were stable, though physical examination was unremarkable. Laboratory investigations revealed a markedly elevated Troponin I level of 1852.1 ng/L. His electrocardiogram (ECG) showed a partial right bundle branch block. He was diagnosed with a non-ST elevation myocardial infarction (NSTEMI) and started on dual antiplatelet therapy and subcutaneous Fondaparinux. Coronary angiography (Fig 1) followed by multislice coronary CT angiogram (CCTA) (Fig 2 and 3) was performed to assess the extent of coronary artery disease in the next day.
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Retroperitoneal abscess with an unexpected extension
This Clinical Case – Test Yourself presents a retroperitoneal abscess with uncommon posterior extension into the gluteal region and posterior thigh.
Tenosynovial Giant Cell Tumours: MRI Imaging Pearls - A Pictorial Review
Tenosynovial giant cell tumours (TSGCTs) are uncommon synovial neoplasms arising from the synovium of joints, bursae, and tendon sheaths. Although histologically benign, these lesions may exhibit locally aggressive behaviour, particularly in diffuse forms, leading to progressive joint destruction, functional impairment, and frequent recurrence after surgical treatment. Early recognition and accurate characterization are therefore essential for appropriate management. Magnetic resonance imaging (MRI) is the imaging modality of choice for the evaluation of TSGCT due to its excellent soft tissue contrast and its ability to demonstrate characteristic features related to the tumour’s histopathological composition. Typical MRI findings include low-to-intermediate signal intensity on T1-weighted images, relatively low or heterogeneous signal intensity on T2-weighted sequences, and susceptibility-related blooming artefacts caused by intralesional hemosiderin deposition. Additional features such as synovial proliferation, joint effusion, and bone erosions may further support the diagnosis, particularly in diffuse disease. This pictorial essay provides a comprehensive overview of the imaging spectrum of TSGCT with emphasis on MRI findings and their correlation with underlying pathology. The different subtypes according to the current World Health Organization classification are illustrated. In addition, the complementary role of other imaging modalities such as ultrasound, radiography, and computed tomography is discussed.
Radiological Characterization of Rare Congenital Malformations of the Mesonephric Duct: Imaging and Developmental Considerations
Purpose: To describe and analyze congenital anomalies of the mesonephric (Wolffian) duct persistence identified in pediatric patients, including one previously undescribed anomaly, through detailed radiological evaluation and embryological interpretation. These may present with non-specific symptoms or be incidentally discovered. Material and Methods: Retrospective research was conducted over a 5-year period. Inclusion criteria required availability of complete clinical and imaging records and histopathological confirmation of mesonephric duct remnants after surgical excision. Clinical image and radiological findings were analyzed in conjunction with pathophysiology mechanisms and embryological development to understand the origin and implications of the anomalies. Results: Three pediatric patients met the initial screening criteria, but one was excluded due to incomplete clinical records. From the remaining two cases, the first case involved a novel congenital variant not previously reported in the literature, presenting as isolated mesonephric duct persistence along its entire length without associated anomalies. The second case demonstrated a rare mesonephric anomaly characterized by incomplete metanephric development coexisting with mesonephric duct persistence. Conclusion: Congenital anomalies of the mesonephric duct are rare and often extremely challenging to diagnose. Radiologic imaging, particularly when interpreted in the context of embryological development, plays a key role in their identification and classification. The mesonephric duct anomalies presented in this research article expand the known spectrum of mesonephric malformations and may contribute to improved diagnostic recognition in pediatric urogenital disorders as well as future classification systems.
Role of Automated Breast 3D Ultrasound and Post-Contrast Mammography in Detection and Characterization of Different Breast Lesions Referred to Pathological Results
Purpose: To evaluate and compare the diagnostic performance of Automated Breast Ultrasound (ABUS) and Contrast-Enhanced Digital Mammography (CEDM) in the detection and characterization of breast lesions, using histopathological findings as the reference standard, and to assess their complementary roles—particularly in patients with dense breast tissue or non-mass enhancement patterns. Material and Methods: In this prospective study, 42 women with clinically or radiologically suspicious breast lesions underwent both ABUS and CEDM, between September 2022 and April 2024. Histopathological diagnosis was used as the reference standard. Diagnostic performance metrics, including sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV), were calculated for both modalities. Results: Among 53 detected lesions, 38 (72%) were malignant and 15 (28%) benign. ABUS achieved 100% sensitivity, 73.33% specificity, 90.48% PPV, and 100% NPV, with an overall accuracy of 92.45%. CEDM demonstrated 100% sensitivity, 60% specificity, 86.36% PPV, and 100% NPV, with an accuracy of 88.68%. ABUS was particularly effective in identifying key morphological features such as lesion orientation, retraction phenomena, and ductal extension. CEDM provided enhanced detection of non-mass enhancement patterns often linked to early-stage malignancies. Conclusions: Both ABUS and CEDM exhibit high diagnostic accuracy and sensitivity in breast lesion evaluation. ABUS offers higher specificity and structural detail, while CEDM enhances vascular visualization. Their combined use may significantly improve diagnostic confidence, especially in patients with dense breast tissue.
Association of Computed Tomography Findings with Severity of Chronic Kidney Disease
Objective: To assess the diagnostic performance of CT-derived renal cortical thickness and CT density values for predicting the severity of chronic kidney disease (CKD) and to explore their potential usefulness in early detection and disease staging. Materials and Methods: This cross-sectional study included 100 CKD patients of varying stages who underwent CT scans using a 64-slice CT scanner at the radiology department of our institute from June 2023 to August 2024. CT scanning was performed in cortical, nephrogenic, and secretory phases. Morphological parameters including kidney length, width, volume, cortical thickness, and cortical density were assessed and correlated with CKD stages. Kruskal-Wallis test was used to examine statistical differences among stages. A p value of < 0.05 was considered statistically significant. Results: Among 100 patients (54 males, 46 females), mean age was 45.9 ± 11.0 years, and mean BMI was 22.74 ± 2.58 kg/m². Differences in kidney length, width, and volume were significant among CKD stages (P < 0.001). Statistically significant differences were not seen in cortical thickness (P = 0.3351). CT cortical phase density was significantly related to the severity of kidney disease (r = 0.835, P < 0.001). Conclusion: CT imaging parameters cortical phase density, as well as kidney volume, correlate strongly with the severity of CKD. This suggests that CT can be used for prediction as well as CKD staging.
LLM-Standardised CTA Impressions for PAD Revascularisation Planning: Blinded Single-Centre Agreement, Accuracy, and Efficiency Study
Purpose: Lower-extremity CT angiography (CTA) reports are often narrative and slow to interpret for peripheral arterial disease (PAD) revascularisation planning. Large language models (LLMs) may standardise key anatomic descriptors. Our study is aimed to evaluate agreement, diagnostic accuracy, and decision-making efficiency of an LLM that converts narrative CTA reports into a predefined structured impression. Material and Methods: In this retrospective, blinded, single-centre study (June–October 2025), consecutive adults undergoing CTA for PAD were included. Of 94 eligible patients, 86 (142 limbs) were analysed after exclusions for poor image quality (n=5) and incomplete reports (n=3). The LLM output a limb schema capturing ≥50% stenosis/occlusion, femoropopliteal lesion-length class (<5 cm, 5–15 cm, ≥15 cm), popliteal trifurcation involvement, and distal runoff (0–3). Comparator impressions were produced by an image-only expert reader. Reference standard was consensus of two vascular radiologists. Agreement used Cohen’s kappa (weighted for runoff). Timing per limb compared use of the LLM impression versus the full narrative report. Results: Agreement between LLM and expert was near-perfect for ≥50% stenosis (κ=0.82) and occlusion (κ=0.88), and substantial for lesion-length class (κ=0.76), trifurcation involvement (κ=0.83), and distal runoff (weighted κ=0.74). Versus reference standard, LLM accuracy was 94% for ≥50% stenosis and 96% for occlusion. Median decision time decreased from 96 s (IQR 74–122) to 28 s (IQR 21–39) per limb (P<0.001). Conclusion: An LLM can standardise CTA impressions for PAD planning, preserving diagnostic performance while improving efficiency by ~1 minute per limb.