https://www.um.edu.mt/library/oar/handle/123456789/74433 Thu, 07 May 2026 13:29:03 GMT 2026-05-07T13:29:03Z https://www.um.edu.mt/library/oar/handle/123456789/146111 Title: ESR essentials : imaging in nasal obstruction and epistaxis — practice recommendations by the European Society of Head and Neck Radiology Authors: Péporté, Anne R. J.; Vassallo, Edith; Preda, Lorenzo; Beale, Timothy; Hirvonen, Jussi Abstract: Nasal obstruction and epistaxis are common otorhinolaryngologic complaints with multiple etiologies ranging from benign anatomical variations and mucosal inflammation to severe neoplastic and vascular disorders. Clinical evaluation and nasal endoscopy are first-line diagnostic tools, with imaging reserved for selected indications. Imaging differentiates uncomplicated from complicated presentations, guiding management and surgical planning. Computed tomography (CT) is the primary modality for assessing sinonasal anatomical variants, bony pathology, and inflammatory or neoplastic disease. Magnetic resonance imaging (MRI) complements CT when soft tissue or intracranial extension is suspected. Imaging in epistaxis is not routinely indicated but is recommended in recurrent, severe, or posterior bleeding to detect underlying vascular lesions or tumors. CT angiography is preferred for vascular assessment and interventional planning. Implementing these recommendations can improve diagnostic accuracy, streamline patient management, and enhance surgical outcomes in patients presenting with nasal obstruction and epistaxis. Thu, 01 Jan 2026 00:00:00 GMT https://www.um.edu.mt/library/oar/handle/123456789/146111 2026-01-01T00:00:00Z https://www.um.edu.mt/library/oar/handle/123456789/141577 Title: ESR essentials : thyroid imaging — practice recommendations by the European Society of Head and Neck Radiology Authors: Vassallo, Edith; Péporté, Anne; McQueen, Andrew; Becker, Minerva; Hirvonen, Jussi Abstract: Thyroid nodules are frequently encountered at imaging, yet most are benign and do not require intervention. The clinical challenge lies in distinguishing nodules that warrant further investigation from those that do not, to avoid unnecessary biopsies, anxiety, and overtreatment. Ultrasound (US) is the primary imaging modality for thyroid nodule evaluation, supported by structured risk stratification systems such as ACR TI-RADS and EU-TIRADS, which incorporate specific sonographic features and size thresholds to guide clinical decision-making. Nodules without high-risk features can be safely monitored or ignored, especially in asymptomatic patients. Conversely, suspicious characteristics (e.g. irregular margins, microcalcifications, or marked hypoechogenicity) should prompt further assessment, including fine-needle aspiration (FNA). Diffuse thyroid disorders, including Hashimoto’s thyroiditis and Graves’ disease, are best assessed using US and thyroid function tests. In thyroid cancer, a multidisciplinary team approach involving radiologists, endocrinologists, pathologists, and nuclear medicine specialists is essential for optimal patient care. To implement these recommendations, radiologists should adopt standardised US reporting systems, apply evidence-based criteria for further workup, and collaborate closely with referring clinicians. This approach ensures accurate diagnosis, reduces unnecessary procedures, and aligns radiological practice with current guidelines to support high-value, patient-centred care. Wed, 01 Jan 2025 00:00:00 GMT https://www.um.edu.mt/library/oar/handle/123456789/141577 2025-01-01T00:00:00Z https://www.um.edu.mt/library/oar/handle/123456789/141466 Title: T2 hypointense lesions in the parapharyngeal space : a diagnostic challenge Authors: Vassallo, Edith; Tabone, Emma; Grech, Reuben; Ravanelli, Marco; Zorza, Ivan; Mazza, Valerio; Petrilli, Giulia; Ugga, Lorenzo; Farina, Davide; Maroldi, Roberto; Becker, Minerva Abstract: The parapharyngeal space is a complex anatomical site in the head and neck which may harbour clinically occult pathology given its deep-seated location. The vast majority of parapharyngeal space lesions are of intermediate or hyperintense signal on T2W sequences. This review focuses on T2 hypointense parapharyngeal space lesions which are rare and may constitute a diagnostic dilemma. We present the differential diagnosis of these lesions, highlighting the pertinent radiological findings and identifying a histological correlation for the low T2 signal. A brief discussion of the physics principles accounting for these imaging features is also included. We propose a diagnostic algorithm to facilitate diagnosis and avoid unnecessary biopsy, whenever possible. Wed, 01 Jan 2025 00:00:00 GMT https://www.um.edu.mt/library/oar/handle/123456789/141466 2025-01-01T00:00:00Z https://www.um.edu.mt/library/oar/handle/123456789/134672 Title: ESR Essentials : response assessment criteria in oncologic imaging — practice recommendations by the European Society of Oncologic Imaging Authors: Zamboni, Giulia A.; Cappello, Giovanni; Caruso, Damiano; Gourtsoyianni, Sofia; Cyran, Clemens; Schlemmer, Heinz-Peter; D'Anastasi, Melvin; Fournier, Laure; Neri, Emanuele Abstract: Assessing the response to oncological treatments is paramount for determining the prognosis and defining the best treatment for each patient. Several biomarkers, including imaging, can be used, but standardization is fundamental for consistency and reliability. Tumor response evaluation criteria have been defined by international groups for application in pharmaceutical clinical trials evaluating new drugs or therapeutic strategies. RECIST 1.1 criteria are exclusively based on unidimensional lesion measurements; changes in tumor size are used as surrogate imaging biomarkers to correlate with patient outcomes. However, increased tumor size does not always reflect tumor progression. The introduction of immunotherapy has led to the development of new criteria (iRECIST, Level of Evidence (LoE) Ib) that consider the possibility that an increase in disease burden is secondary to the immune response instead of progression, with the new concept of Unconfirmed Progressive Disease (a first progression event which must be confirmed on follow-up). Specific criteria were devised for HCC (mRECIST, LoE IV), which measure only enhancing HCC portions to account for changes after local therapy. For GIST treated with imatinib, criteria were developed to account for the possible increase in size reflecting a response rather than a progression by assessing both tumor size and density on CT (Choi, LoE II). This article provides concise and relevant practice recommendations aimed at general radiologists to help choose and apply the most appropriate criteria for assessing response to treatment in different oncologic scenarios. Though these criteria were developed for clinical trials, they may be applied in clinical practice as a guide for day-to-day interpretation. Wed, 01 Jan 2025 00:00:00 GMT https://www.um.edu.mt/library/oar/handle/123456789/134672 2025-01-01T00:00:00Z