Pulmonary sarcoidosis is a multisystemic granulomatous disease with a broad spectrum of pulmonary manifestations, ranging from reversible hilar lymphadenopathy and perilymphatic nodules to irreversible pulmonary fibrosis. The heterogeneity complicates clinical and radiological differentiation.This review presents the typical radiological patterns of pulmonary sarcoidosis, evaluates diagnostic modalities, and highlights the importance for prognosis and therapy of distinguishing between reversible and irreversible lesions.A comprehensive literature search focused on recent publications and guidelines, emphasizing imaging techniques and clinically relevant correlations.Conventional chest radiography using Scadding criteria provides a simple and cost-effective method of stage classification, but it also has limitations in terms of accuracy and in correlation with lung function. Computed tomography (CT) is the most precise imaging modality, showing characteristic features such as symmetrical hilar and mediastinal lymphadenopathy, multiple micro- and macronodules with confluent consolidations, and upper lobe predominance. Advanced stages reveal fibrotic remodeling with linear opacities, traction bronchiectasis, and prognostically relevant honeycombing. Complications include pulmonary hypertension, venous compressions, and secondary fungal infections. Magnetic resonance imaging (MRI) is used primarily for cardiac sarcoidosis detection, while positron emission tomography (PET) can better assess inflammatory activity and therapy monitoring. Differential diagnosis with regard to other granulomatous, infectious, and neoplastic diseases is essential, and it requires an interdisciplinary approach.Pulmonary sarcoidosis requires a multimodal diagnostic approach, with CT playing a central role in staging and prognosis. Differentiation between reversible and fibrotic lesions is critical for therapeutic decisions. Future research should optimize imaging and integrate clinical, radiological, and functional parameters to improve patient care. · Pulmonary sarcoidosis presents a wide spectrum of pulmonary manifestations ranging from reversible nodules and lymphadenopathy to irreversible fibrotic patterns, with diagnosis being clinically and radiologically challenging.. · Computed tomography is the most precise imaging modality for stage classification and prognosis.. · Differentiating reversible inflammatory from irreversible fibrotic lesions is crucial for therapy planning.. · Differential diagnosis from other granulomatous, infectious, and neoplastic diseases requires an interdisciplinary approach.. · Kostova J, Andreisek G, Müller MA. Pulmonary Sarcoidosis: Imaging and Diagnostic Limitations. Rofo 2025; DOI 10.1055/a-2722-6934.

In photon-counting CT (PCCT), image quality is adjusted using image quality levels (IQLs). While the radiation dose increases linearly with IQLs, the signal-to-noise ratio (SNR) shows a non-linear trend. This study aims to investigate the relationship between radiation dose and SNR in adult and pediatric head phantoms using PCCT showing potential IQL ranges for radiation dose optimization.Adult and pediatric anthropomorphic phantoms were scanned across multiple IQLs. The relationship between IQL, radiation dose (mAs, CTDI, DLP, organ doses), and SNR (brain parenchyma, bone) was assessed. Group comparisons were performed at matched IQLs.Radiation dose increased linearly with IQL (all R²=1.00), whereas SNR demonstrated a more variable course with minor deviations from linearity. Quadratic or exponential fits provided slightly better modeling for some pediatric phantoms (5-year-old and 10-year-old), whereas 1-year-old and adult phantoms followed almost linear trends (R² ≥ 0.90). Pediatric phantoms showed a significantly higher SNR in brain and bone at lower effective mAs and radiation dose levels compared to adults (p<0.05). Among pediatric phantoms, the SNR values for brain parenchyma and bone differed significantly (p=0.002 and p=0.021), with the 1-year-old phantom exhibiting the highest SNR values in both tissues.In PCCT head imaging, pediatric phantoms reach higher SNR values at lower radiation doses than adult phantoms, suggesting the potential for further protocol optimization. SNR-radiation dose curves indicate diminishing returns at higher IQLs, highlighting the importance of cautious radiation dose management to avoid unnecessary exposure. · In PCCT, image quality levels correlate linearly with radiation dose.. · Higher image quality levels give diminishing SNR gains, indicating optimization thresholds.. · Pediatric protocols achieve equal or higher SNR values at lower doses than adult protocols.. · Phantom-based results support age-specific PCCT protocols to avoid unnecessary exposure.. · Klüner LV, Opitz MK, Peuster H et al. Investigating Radiation Dose and Signal-To-Noise-Ratio in Pediatric and Adult Head Photon-Counting CT: A Phantom-Based Study. Rofo 2025; DOI 10.1055/a-2740-4588.

Interventional therapies for hepatocellular carcinoma (HCC) include various methods such as transarterial chemoembolization (TACE), radiofrequency and microwave ablation (RFA, MWA), selective internal radiotherapy (SIRT), and stereotactic body radiation therapy (SBRT). Imaging follow-up using magnetic resonance imaging (MRI) is essential for the early detection of recurrence, but requires profound knowledge of therapy-related imaging changes.A structured PubMed literature search covering the period from 2000 to 2025 was conducted using the keywords "hepatocellular carcinoma," "magnetic resonance imaging," "thermal ablation," "transarterial chemoembolization," "transarterial radioembolization," "stereotactic body radiotherapy," and "treatment response." In addition, the study incorporated current national and international guidelines, as well as institutional clinical experience.Post-interventional imaging changes on MRI vary depending on the therapeutic approach applied. Typical morphological changes are observed immediately after thermoablation and TACE, whereas therapeutic effects of SIRT and SBRT become clearly evident only after weeks to months. Profound knowledge of standardized evaluation systems such as mRECIST, EASL, and LI-RADS-TR is crucial to ensure a precise and structured assessment of therapeutic response.Knowledge of specific MRI findings and standardized assessment systems is essential for structured follow-up of hepatocellular carcinoma after interventional therapy. Limitations arise from the heterogeneity of imaging findings, variable temporal patterns, and potential influences of combination therapies. Systemic therapies were not considered, restricting generalizability. · Magnetic resonance imaging is essential for assessing treatment response and for the early detection of recurrence after interventional therapy of hepatocellular carcinoma.. · Morphological changes after therapy are procedure-dependent and show marked differences over time: SIRT and SBRT demonstrate delayed changes, whereas TACE and thermal ablation present immediate effects.. · Standardized classification systems (mRECIST, EASL, LI-RADS-TR) provide a structured and reproducible framework for evaluating treatment response.. · Knowledge of characteristic imaging findings and potential pitfalls is crucial to reliably differentiate between residual tumor, recurrence, and therapy-induced changes.. · This review contributes to the current body of knowledge by systematically consolidating available evidence and presenting it in a practice-oriented manner in the context of MRI follow-up imaging.. · Kübler J, Ashkar A, Winkelmann MT et al. MRI after Interventional Therapy of Hepatocellular Carcinoma: Typical Changes over Time. Rofo 2025; DOI 10.1055/a-2724-6488.

Peripheral arterial disease (PAD) is a prevalent and increasingly common condition associated with high morbidity and a growing number of patients worldwide. Atherectomy, a minimally invasive technique to remove or modify atherosclerotic plaques, has gained popularity as an adjunct to vessel preparation before balloon angioplasty, particularly in combination with drug-coated balloons (DCB). Its therapeutic role in PAD appears promising but requires further investigation.A systematic literature search was conducted in the PubMed database. Randomized controlled trials, meta-analyses, registry data, and guideline recommendations regarding atherectomy in PAD were included. The aim was to evaluate evidence on efficacy, safety, and clinical relevance across different anatomical regions and different atherectomy devices.Atherectomy shows promise as an adjunctive technique in the endovascular treatment of PAD, particularly for complex and calcified lesions in the femoropopliteal segment. While some observational and registry data suggest improved procedural success, luminal gain and reduced need for bailout stenting, randomized controlled trials yield mixed results regarding long-term patency and clinical benefit. In below-the-knee interventions, evidence remains limited and complication rates are of concern.Overall, atherectomy represents a valuable tool within a tailored treatment approach but requires further clinical validation through high-quality trials to clearly define its therapeutic role. · Atherectomy improves vessel preparation especially in complex femoropopliteal lesions. · Randomized trials show promise but no consistent long-term benefit.. · Below-the-knee use is limited; complication rates remain relatively high.. · Device selection and operator experience are critical for procedural success.. · Atherectomy is valuable in selected cases, pending further evidence.. · Limbrock M, Sunderdiek U, Haage P et al. The Role of Atherectomy in the Treatment of Peripheral Artery Disease. Rofo 2025; DOI 10.1055/a-2718-7990.