2023 Top Images in Radiology: Radiology In Training Editors’ Choices

The power of images shines through the brilliant cases brought forth by radiologists around the world every year for our Images in Radiology collection. In the field of radiologic imaging, we constantly strive to update our knowledge with the advances in imaging tools and technologies. Therefore, dissemination of the unexpected presentations of common disease pathologies, striking appearances of rare entities, and everything in between along the spectrum, is essential for the continued medical education of radiologists and their referring physicians. Moreover, Images in Radiology showcases visually stunning and clinically relevant applications of cutting-edge imaging technologies.

Every published Images in Radiology case is handpicked among an ever-increasing number of submissions, reviewed, and edited by our Radiology In Training and Images in Radiology editors under the mentorship of the Editor of Radiology, formerly Dr David Bluemke and now Dr Linda Moy. Images in Radiology is the second most popular manuscript submission type, after original research submissions, with more than 500 cases submitted between January 1, 2023, and October 31, 2023. With the conclusion of 2022–2023 academic year, our Radiology In Training editorial board has reviewed the Images in Radiology collection published from July 2022 through June 2023 for the 2023 Top Images designation. Thirty eligible publications have been ranked on the basis of visual appeal, novel application or development of an imaging technique, and educational value.

The 2023 Top Images in Radiology winner is entitled “Sack of Marbles Appearance of a Scalp Teratoma” by Sumit Thakar and Pavan Vasoya (1). The radiologic-pathologic correlation of sebumlike material found in mature cystic teratomas, depicted on the MR and gross specimen images (Fig 1), is visually impressive, eye-opening, and educational. The illustration of this somewhat common entity in a less-common location embodies the core principles of radiology as a macropathology diagnostic specialty.

Figure 1:

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The first runner-up for this year’s Top Images in Radiology is entitled “Cinematic Rendering of Complex Coronary Artery Left Atrial Fistula” by Mingxi Liu and Xiaojuan Guo (2). The axial images showing multiple sinuses draining into the left atrium from the coronary arteries, although striking, may not allow for easy tracing of the vasculature. The crisp images postprocessed with cinematic rendering (Fig 2), however, carefully depict this unusual entity of complex coronary artery left atrial fistula and help the interpreting radiologists reach the final diagnosis.

Figure 2:

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The second runner-up for the 2023 Top Images in Radiology is the publication entitled “Cerebral Aneurysm Imaging at 7 T with Use of Compressed Sensing” by Amit Desai and Erik Middlebrooks (3). The authors’ direct comparison of the MR angiogram time-of-flight assessments at 7 T versus 1.5 T of an intracranial aneurysm (Fig 3) is an illustrative example of the incremental benefit that higher-field-strength MRI can offer, when available.

Figure 3:

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The other articles ranked among our top 10 images for the academic year, in alphabetical order, included:

• “Anomalous Origin of the Right Pulmonary Artery from the Aorta” (4)

• “CT-based Age Estimation of a Mammoth Tusk” (5)

• “High-resolution (7-T) Liver MRI for Pathologic Examination” (6)

• “Idiopathic Mesenteric Phlebosclerosis” (7)

• “Kawasaki Disease with Unusual Systemic Arterial Aneurysms” (8)

• “Thoracic Outlet Syndrome Associated with a Rib Synostosis” (9)

• “Total Anomalous Pulmonary Venous Return” (10).

We applaud all the submitting authors of our Images in Radiology collection and thank them for their contributions to Radiology. We heartily congratulate this year’s winners for their stunning presentations. We look forward to the upcoming year and welcome all members of our readership to submit cases for review!

Disclosures of conflicts of interest: N.C. Member of the Radiology In Training editorial board. P.L. RSNA R&E fellow research grant; patients planned, issued, or pending on imaging biomarkers based on ratio between diffusion and perfusion; member of the Radiology In Training editorial board. S.L. Author and speaker honoraria from Amboss; patents planned, issued, or pending with Universitätsklinikum Köln; member of the Radiology In Training editorial board. V.C. Consulting fees from Bayer and Giliad; Editor of Radiology In Training.