Editorial: Emergency radiology: between unsolved problems and new challenges

Several contributions highlight the central role of imaging in the early detection of rare or rapidly progressive emergencies. The case of spontaneous splenic rupture reported by Romano et al. 1 illustrates the diagnostic challenge posed by conditions that mimic more common presentations. Contrast-enhanced CT remains essential for distinguishing traumatic from non-traumatic etiologies and guiding the choice between conservative and surgical management 23456. Similarly, acute portal vein thrombosis in non-cirrhotic patients, described by Zhou et al. 7, demonstrates how timely CT evaluation enables rapid diagnosis and stratification of therapeutic options. In both scenarios, imaging functions as the first decisive step in recognizing high-risk conditions.Once detected, acute conditions require accurate characterization to guide management.Weng et al. 8 describe pediatric duodenal intramural hematoma, a condition in which multimodal imaging-CT for rapid assessment, MRI for detailed evaluation, and ultrasound for monitoringallows a comprehensive understanding of lesion extent and evolution. Karimialavijeh et al. 9 address acute myocarditis, emphasizing the value of cardiac MRI in tissue characterization. Their exploration of low-field MRI systems highlights how technological innovation can expand access to advanced diagnostic tools, even in emergency settings.Imaging does not merely diagnose; it increasingly directs treatment. In portal vein thrombosis, imaging findings determine whether patients are candidates for systemic thrombolysis or require more complex interventional approaches. Usai et al. 10 extend this concept beyond the emergency domain, presenting a hybrid model that integrates interventional radiology, functional imaging, and robotic surgery. Selective prostatic artery embolization with ICG-Lipiodol, followed by fluorescence-guided lymphadenectomy, exemplifies how imaging can refine surgical precision and reduce unnecessary dissections. Although elective, this model anticipates future applications in acute care.Sustainability emerges as a transversal value across all contributions. In pediatrics, ultrasound provides a radiation-free tool for dynamic follow-up of duodenal hematoma, reducing the need for repeated CT examinations. In cardiac imaging, AI-enhanced low-field MRI offers a promising avenue for accessible, repeatable follow-up of myocarditis, especially in resource-limited settings. These approaches demonstrate how imaging can support long-term patient management while minimizing exposure and optimizing resources.Taken together, the contributions of this Research Topic outline a radiology that evolves along a coherent pathway: detection, characterization, intervention, and sustainable follow-up, all centered on the patient. As Editors, we hope that this collection will stimulate further collaborations, promote the dissemination of sustainable models, and contribute to building an emergency radiology that is more prepared, more accessible, and more innovative.