Research Publications

March 2026

Bhupathy S, Pierce J, Goldstein J, Ghahremani Koureh S

Neuroblastoma is the most common extracranial pediatric solid tumor and arises most often from the adrenal glands. However, this tumor can occur anywhere along the sympathetic nervous system. Its clinical presentation is variable and depends on the location and extent of the mass. We present the case of an infant who initially had a palpable mass on his back, later developed lower extremity weakness, and was subsequently diagnosed with a paraspinal neuroblastoma. MRI was key in visualizing compression of the lower thoracic spinal cord by the tumor, explaining the patient's symptoms and necessitating tumor debulking. The course of the patient's treatment was complicated by a tumoral hemorrhage that required emergent embolization by an interventional radiologist. This case highlights options for the management of neuroblastoma, including chemotherapy, embolization, and surgical resection, with an emphasis on interdisciplinary decision-making.

March 2026

Cankurtaran CZ, Fotos J, Ozkan M, Viswanathan VS, Zhu D, Sin JM, Cheng M, Brofman N, Rozenshtein A, Retrouvey M.

Recent advancements in imaging technologies are poised to redefine the diagnostic and therapeutic role of radiology. In part 2 of this review series, we outline emerging innovations with transformative clinical potential, including photon-counting detector CT for ultra-high-resolution, spectral imaging; ultra-high-field MRI systems (≥7T); and the expanding field of theranostics. We also examine nanotechnology-enhanced imaging agents, the integration of AI-driven opportunistic screening, and radiogenomics to enable precision diagnostics and early disease detection. Together, these developments represent a paradigm shift toward more personalized, data-rich, and preventative imaging approaches. Challenges in implementation, such as safety, cost, and workflow integration, are discussed with an emphasis on collaboration and infrastructure to support sustained clinical translation.

March 2026

Huang LT, Yang CC, Wang G, Zhang H, Zhang R, Ho H, Malagi A, Huang Y, Li X, Yoosefian G, Zhang X, Long Z, Bi X, Wei J, Kwan AC, Nelson MD, Merz CNB, Berman D, Christodoulou A, Li D, Dharmakumar R, Yang HJ.

Relentless mechanical work of the heart is powered by continuous oxygen consumption. How the heart uses oxygen is a defining feature of its health. Invasive studies have established that impaired oxygen consumption by the myocardium predicts contractile dysfunction and adverse outcomes. Despite its importance, noninvasive quantification of myocardial oxygen use remains limited. Magnetic resonance imaging (MRI) signal is known to be sensitive to blood oxygenation and has the potential to quantify myocardial oxygen consumption noninvasively, without exogenous contrast agents and free of ionizing radiation. However, its clinical translation has been impeded by the need for complex biophysical calibration, vulnerability to imaging artifacts and consistent vital motions, and the requirement of lengthy acquisition times. Here, we introduce a rapid, self-calibrated cardiac MRI framework that overcomes these barriers through high-resolution, motion-resolved coronary sinus oximetry, which can quantify myocardial oxygen extraction of the whole heart within 3 minutes. We optimized the imaging parameters via numerical simulations and validated them against invasive coronary sinus catheterization in a porcine model. We combined the method with clinical MRI sequences and demonstrated the feasibility of quantifying myocardial oxygen consumption and myocardial oxygen efficiency in patients with and without heart failure secondary to myocardial infarction in a single institution. This needle-free approach establishes a practical framework for noninvasive characterization of myocardial oxygen metabolism. It holds the potential to facilitate early disease detection, inform personalized therapeutic strategies, and guide the development of cardiometabolic therapies aimed at addressing the ongoing heart failure epidemic.

March 2026

Keshavarz P, Mohammadigoldar Z, Bedayat A, Raman SS, Tai R.

Rationale and objectives: The purpose of this systematic review study was to characterize the current landscape of various artificial intelligence (AI) education in radiology, summarizing existing curricula, outcomes, challenges, and future directions for effective integration into residency training. MATERIALS AND METHODS: A comprehensive search of PubMed, Web of Science, Embase, and Google Scholar identified relevant published studies up to June 19, 2025.

March 2026

Lateef S, Oh A, Chung JH, Fazio J, Kamangar N, Gandhi S, Tallaksen RJ, Viragh K.

Silicosis, the most common form of pneumoconiosis, results from the inhalation of respirable crystalline silica dust, which is defined as silicon dioxide particles small enough to penetrate lung tissue (<5 µm). Once considered a historical occupational disease primarily affecting miners, silicosis is reemerging among workers who process engineered stone countertops because of the higher silica content of engineered stone compared with natural stone materials (often termed engineered stone pneumoconiosis). The authors discuss imaging features of engineered stone silicosis based on a cohort of patients employed as engineered stone countertop workers in Southern California, one of the largest cohorts in the United States. Historically, silicosis has been described as predominantly chronic silicosis with upper lung-predominant small solid nodules with or without fibrosis, occasional accelerated silicosis, and rarely, acute silicosis. In the engineered stone worker patient cohort described in this article, accelerated silicosis and atypical imaging features at presentation (such as diffuse centrilobular-predominant nodules, superimposed ground-glass opacities, lower lung or cavitary large opacities, and concomitant infections) were more common than expected, which contributed to the initial underdiagnosis and misdiagnosis of silicosis. Furthermore, many patients demonstrated relevant extrapulmonary disease, such as cardiovascular and autoimmune disease. The radiologist plays a pivotal role in recognizing silicosis and including it in their differential diagnosis at patient presentation. Early diagnosis is crucial to prevent further exposure, since silicosis is currently considered incurable. The authors highlight the imaging findings of silicosis to raise awareness among radiologists about this emerging occupational lung disease. ©RSNA, 2026.

March 2026

Lee Y, Feng J, Rahrooh A, Bui AAT, Cooper CB, Hsu JJ.

BACKGROUND: Cardiorespiratory fitness, as measured by peak oxygen uptake during cardiopulmonary exercise testing, is a prognostic indicator. We aim to predict peak oxygen uptake from submaximal variables on cardiopulmonary exercise testing to assess cardiorespiratory fitness when maximal exertion is not possible. METHODS: Data from 13535 cardiopulmonary exercise testings were collected, and patients were divided into a normal group (NG; n=1076) and other group (OG; n=9823). Regression models to predict maximum oxygen consumption were trained and evaluated on the NG, OG, and combined groups (NG+OG) using stratified 5-fold cross-validation. We trained different models using demographic, resting and submaximal variables.

March 2026

Lojo-Lendoiro S, Heymann G, Moriarty HK, Wojno M, Kashef E, Plotnik A, Kassamali R, Mahnken AH, Fornazari VA, Clements W.

Uterine fibroids are the most common benign tumour of the female reproductive tract. For decades, surgery has been the standard treatment for symptomatic fibroids. However, minimally invasive options such as Uterine Artery Embolisation (UAE) have now emerged as a less invasive, but equally effective treatment. Despite this, access to UAE remains uneven worldwide. This cross-section from ten countries representing all inhabited continents across the globe, highlights several challenges that still exist, despite the abundance of evidence to support the long-term quality of life improvements for women treated with UAE. This narrative review considers enabling factors as well as barriers to treatment in each region, putting forward local strategies to improve access to UAE moving forward.

March 2026

Oh AS, Humphries SM, Chung A, Weigt SS, Brown M, Kim GHJ, Lee D, Belperio JA, Goldin JG.

Computed tomography (CT) is routinely used in diagnosing and managing patients with chronic lung diseases such as chronic obstructive pulmonary disease (COPD) and fibrosing interstitial lung disease (ILD). Visual assessment of disease morphology/phenotype and extent correlates with lung function and patient prognosis, but it is limited by reader subjectivity and interobserver variability. Quantitative CT (QCT) techniques based on density and texture-based features of the lungs have shown stronger correlations with physiologic and survival outcomes in both COPD and ILD cohort studies. Moreover, recent advances in computer processing capabilities have led to the implementation of machine and deep learning-based approaches, allowing for greater robustness and reproducibility beyond visual assessment and density-based methods. This review focuses on QCT and artificial intelligence (AI) techniques for COPD, ILD, and bronchiolitis obliterans syndrome in lung and hematopoietic stem cell transplant recipients. Current challenges and limitations for adoption of these techniques and future directions of QCT and AI in thoracic imaging are also discussed.

February 2026

Farmakis IT, Horbal S, Moriarty JM, Elder M, Todoran T, Rosovsky RP, Lehr E, Langston MD, Sokol SI, Rosenfield K, Lookstein R, Secemsky E, Christodoulou KC, Hobohm L, Valerio L, Barco S, Konstantinides SV.

AIMS: Multidisciplinary pulmonary embolism response teams (PERTs) are being established in hospitals worldwide to address the increasing complexity in acute PE management. To identify recent trends in PERT decisions regarding advanced treatment of acute severe PE. METHODS AND RESULTS: We analysed data from the prospective multicentre PERT™Consortium registry (years 2018-2024), focusing on catheter-directed treatment (CDT) and including systemic thrombolysis, surgical embolectomy, and extracorporeal membrane oxygenation (ECMO). An age-, sex-, and PE risk-matched population from the US Nationwide Inpatient Sample (NIS) was used for comparison. Among 11 436 patients enrolled at 51 sites (median age, 65 years; 13.7% high-risk and 62.5% intermediate-risk PE), 2639 (23.1%) underwent CDT. Of those, 140 (5.3%) underwent catheter-directed thrombolysis without ultrasound, 851 (32.2%) ultrasound-assisted catheter thrombolysis, and 1534 (58.1%) mechanical thrombectomy/aspiration. Systemic thrombolysis was used in 5.6%, surgical embolectomy in 1.1%, and ECMO in 1.6% of all patients. Trends of CDT increased over time (+0.36% quarterly by linear regression; P = 0.002), with increase in mechanical thrombectomy (+0.83%; P < 0.001) and decrease in catheter-directed thrombolysis (-0.4%; P = 0.001). Matching 10 883 patients from the PERT™ Consortium registry to the NIS population, we found a 22% (95% CI, 21-23%) standardized mean difference in CDT use, 1.3% (0.6-2.0%) lower in-hospital mortality, and 0.75 (0.2-1.3) fewer days of hospital stay among PERT™ Consortium registry patients.

February 2026

Kanai S, Daida A, Zhang Y, Ding Y, Monsoor T, Qiao JX, Salamon N, Ronne E, Ahn SS, Hussain SA, Sankar R, Fallah A, Speier W, Roychowdhury V, Engel J Jr, Staba RJ, Nariai H.

OBJECTIVE: This study was undertaken to determine whether interictal high-frequency oscillations (HFOs) and phase-amplitude coupling (PAC) can serve as spatial biomarkers on intracranial electroencephalography (iEEG) to guide responsive neurostimulation (RNS) targeting. METHODS: We conducted a retrospective study of patients with drug-resistant epilepsy who underwent iEEG monitoring and subsequent RNS implantation. Eligible participants had ≥60 min of slow-wave sleep iEEG data and ≥6 months of post-RNS follow-up. Patients with simultaneous or subsequent resective surgery or exclusively thalamic RNS electrodes were excluded. Interictal HFOs and delta-HFO PAC (via modulation index [MI]) were calculated using open-source tools (PyHFO, PACTv0.31). Weighted median distances from each iEEG electrode to the nearest RNS electrode were computed, adjusted by the proportion of HFO and MI. The primary outcome was ≥50% seizure reduction (good outcome group [G]) vs. <50% reduction (poor outcome group [P]) at the last follow-up. Predictive performance was evaluated using receiver operating characteristic (ROC) analysis with leave-one-out cross-validation.

February 2026

Raman SS, Cutler NR, Sramek JJ, Hecht JR, Finn RS, Anand SR, Chiang J, Lu DS.

Liver tumors, including hepatocellular carcinoma (HCC), intrahepatic cholangiocarcinoma (iCCA), and liver-dominant metastases, remain associated with high mortality despite advances in systemic therapy. Intratumoral therapies have emerged as a promising strategy to achieve high local drug concentrations, modulate the tumor microenvironment, and enhance systemic anti-tumor immunity while limiting systemic toxicity. Although intratumoral approaches have demonstrated clinical success in melanoma, their translation to liver malignancies presents unique biological, immunologic, and technical challenges. This review synthesizes clinical evidence from the past decade evaluating intratumoral therapies for primary and metastatic liver tumors, including oncolytic viruses, cell-based immunotherapies, in situ immunomodulators, intratumoral chemotherapy, and combination strategies with locoregional or systemic treatments. Across early- and late-phase trials, intratumoral therapies have produced heterogeneous outcomes, ranging from tumor necrosis and disease stabilization to occasional systemic (abscopal) responses, while several large studies have failed to demonstrate survival benefit. These mixed results reflect the liver's highly tolerogenic immune microenvironment, characterized by abundant myeloid-derived suppressor cells, regulatory T cells, and abnormal vasculature that limit immune activation and drug distribution. We highlight key determinants of efficacy, including tumor biology, delivery technique, dosing strategy, and rational therapeutic combinations. Technical considerations such as image-guided injection, intratumoral pressure, and standardization of administration are reviewed, alongside emerging biomarkers, including immune, molecular, and imaging-based markers, that may enable improved patient selection. Overall, current evidence suggests that intratumoral therapies alone are rarely sufficient for liver tumors but may provide meaningful benefit when integrated into multimodal regimens. Future progress will depend on optimized combination strategies, standardized delivery approaches, and validated biomarkers to support personalized application in liver cancer.

February 2026

Schiff D, Ye X, Li J, Ellingson BM, Wen PY, Walbert T, Campian J, Nabors LB, Ozer BH, Desai A, Omuro A, Desideri S, Danda N, Grossman S, Bindra RS.

BACKGROUND: Preclinical studies demonstrate activity of poly(adenosine 5'-diphosphate-ribose) polymerase (PARP) inhibitors in isocitrate dehydrogenase (IDH) mutant gliomas. We investigated safety, tolerability, pharmacokinetics, and efficacy of the PARP inhibitor pamiparib in conjunction with metronomic low-dose temozolomide in patients with recurrent IDH mutant (IDHmt) gliomas in a multicenter Phase I/II/window of opportunity study. METHODS: Patients received pamiparib in conjunction with daily temozolomide. Following Phase I determination of maximum tolerated dose (MTD), we enrolled 2 patient cohorts (Arm A, multiple prior chemotherapy regimens; Arm B, single prior regimen) in a 2-stage design. Exploratory cohorts examined grade 4 IDHmt patients and intratumoral pharmacokinetics of pamiparib. The primary endpoint was objective radiographic response (ORR) by RANO criteria.

February 2026

Thummala AR, Moriarty JM, Yang EH, Natour SJ.

Transthoracic echocardiography is used frequently in the management of pulmonary embolism, but transesophageal studies are seldom used in this context. In this case, we describe a saddle pulmonary embolism which was incidentally discovered on transesophageal echocardiography prior to synchronized cardioversion and subsequently prompted successful percutaneous mechanical thrombectomy.

January 2026

Bahr-Hosseini M, Asghariahmadabad M, Bikson M, Saver JL, Liebeskind DS, Nael K.

In the first-in-human proof-of-concept TESSERACT study (Transcranial Electrical Stimulation in Stroke Early After Onset Clinical Trial), delivering high-definition cathodal transcranial direct current stimulation (HD C-tDCS) to penumbral tissue was shown to be a feasible and tolerable treatment strategy for acute ischemic stroke.¹ Additionally, in this dose-escalation study, signals of efficacy were observed: patients receiving active HD C-tDCS had a higher proportion of penumbral salvage (median, 66%) compared with sham patients (median, 0%) on standard hemodynamic perfusion imaging. The mechanisms through which HD C-tDCS may salvage penumbra are collateral enhancement via electrical current-induced pial arterial vasodilation and direct cytoprotection via inhibition of peri-infarct excitotoxicity.²

January 2026

Hagiwara A, Uchida W, Ozawa T, Takabayashi K, Zou R, Ellingson BM, Andica C, Kikuta J, Akashi T, Wada A, Kumamaru KK, Kamagata K, Akiyama O, Kondo A, Aoki S.

BACKGROUND: Glioblastoma (GBM) may disrupt glymphatic function and neurofluid dynamics locally and in distant brain regions. However, the prognostic relevance of such alterations remains unclear. We investigated whether diffusion tensor image analysis along the perivascular space (DTI-ALPS) and free water (FW) imaging serve as biomarkers of glymphatic dysfunction and survival in patients with IDH wild-type GBM. METHODS: We retrospectively analyzed preoperative MRI data from 277 patients in the UPENN-GBM and 269 patients in the UCSF-PDGM cohorts. The ALPS index was quantified in tumor regions and normal-appearing white matter (NAWM) in both hemispheres, and the FW volume fraction in the contralateral NAWM. Data harmonization was performed using ComBat to adjust for intersite variability. Survival analyses were conducted using log-rank tests and Cox regression models. Optimal ALPS index and FW thresholds were derived from the UPENN-GBM dataset and validated in the UCSF-PDGM.

January 2026

Lookstein RA, Konstantinides SV, Weinberg I, Dohad SY, Rosol Z, Kopeć G, Moriarty JM, Parikh SA, Holden A, Channick RN, McDonald B, Nagarsheth KH, Yamada K, Rosovsky RP; STORM-PE Trial Investigators.

BACKGROUND: Patients with intermediate-high risk pulmonary embolism (PE) have an elevated right ventricular (RV) to left ventricular (LV) diameter ratio and are at risk of early clinical decompensation and mortality. Reperfusion therapy aims to rapidly relieve acute RV pressure overload and to normalize hemodynamics. STORM-PE (A Prospective, Multicenter, Randomized Controlled Trial Evaluating Anticoagulation Alone Versus Anticoagulation Plus Mechanical Aspiration With the Indigo Aspiration System for the Treatment of Intermediate-High Risk Acute Pulmonary Embolism) is the first reported randomized controlled trial to test the efficacy and to evaluate the safety of mechanical thrombectomy, specifically computer-assisted vacuum thrombectomy (CAVT) with anticoagulation compared to anticoagulation alone. METHODS: STORM-PE is an international randomized controlled trial with 1:1 randomization to CAVT with anticoagulation or anticoagulation alone. Eligible adults had acute-onset (symptoms ≤ 14 days), intermediate-high risk PE and were normotensive, with an RV/LV ratio ≥ 1.0 on computed tomographic pulmonary angiography and elevated cardiac biomarkers. The primary end-point analysis tested for a difference between groups for the change in RV/LV ratio at 48 hours, assessed by a blinded independent imaging core laboratory. Secondary end points included major adverse events within 7 days (a composite of clinical deterioration necessitating rescue therapy, PE-related mortality, symptomatic recurrent PE, and major bleeding), adjudicated by an external clinical events committee. Additional outcomes included change in vital signs and core laboratory-assessed pulmonary artery obstruction at 48 hours.

January 2026

May FP, McEwan JA, Tuan JJ, Crespi CM, Maehara CK, Yang JO, Uy A, Gupta S, Kang Y, Myint A, Naini BV, Elmore JG, Kadiyala S, Ong MK, Bui AAT, Hamilton AB, Chang LC, Gelvezon A, Hsu W, Bastani R.

INTRODUCTION: Colorectal cancer (CRC) is largely preventable through the removal of precancerous polyps from the colon and rectum. Polyp surveillance guidelines recommend that individuals with polyps categorized as high-risk neoplasia (HRN) undergo surveillance colonoscopy 3 years after HRN diagnosis. However, over half of patients fail to receive their surveillance colonoscopy within this recommended timeframe, highlighting the need for effective interventions to improve 3-year colonoscopy surveillance rates. METHODS: A hybrid type 1 effectiveness-implementation, 2-group cluster-randomized trial is being conducted at 30 primary health care clinics in a large, urban academic health center in Southern California. The study includes two arms: (1) a multilevel intervention arm in which a natural language processing (NLP) algorithm processes electronic health record (EHR) data to facilitate the identification of patients with HRN and providers and patients receive electronic notification when surveillance colonoscopy is due; and (2) a usual care arm, where no intervention is applied.

January 2026

Padia SA, Modi S, Wehrenberg-Klee E, Adamo RD, Ahmed A, Orloff M, Helmerhorst HJF, Chmielowski B, Ozkan OS, Burgmans MC, Grözinger G, Lewandowski RJ, Krishnasamy VP.

Uveal melanoma frequently metastasizes to the liver, with over 90% of metastatic cases involving hepatic spread. Despite systemic therapy advances, prognosis remains poor in hepatic-dominant disease. Percutaneous hepatic perfusion (PHP) with melphalan, now U.S. Food and Drug Administration (FDA)-approved via the Hepzato Kit, delivers high-dose chemotherapy directly to the liver while reducing systemic toxicity through extracorporeal filtration. This review outlines PHP's rationale, technique, patient selection, and institutional requirements. Ideal candidates have multifocal, bilobar liver metastases and limited extrahepatic disease. PHP requires coordinated care across interventional radiology, anesthesia, perfusion, and pharmacy. Clinical data show encouraging survival and disease control with manageable hematologic toxicity and rapid recovery. Research into improved filtration, optimized dosing, and immunotherapy integration may further improve outcomes.

January 2026

Roberts DG, Ramakrishnan A, Joglekar A, Sayre J, Haber Z, Srinivasa R.

BACKGROUND AND AIMS: Benign biliary strictures (BBSs) are associated with poor long-term patency, substantial morbidity, and high health-care costs. Despite a multitude of available treatment options-peroral endoscopic, percutaneous transhepatic, and surgical reconstruction-recurrence rates remain high. This study assesses the safety and efficacy of percutaneous transhepatic cholangioscopy (PTCS)-assisted holmium laser stricturotomy for BBS management. METHODS: The Percutaneous Endoscopic Benign Biliary Laser study is a prospective, single-arm, open-label pilot trial conducted at a single academic institution. Between October 2022 and August 2023, 5 patients with BBSs underwent PTCS-assisted laser stricturotomy, with or without lithotripsy, using a holmium:yttrium-aluminum-garnet laser fiber. Patients were followed for 12 months. Primary endpoints included technical success and 30-day adverse events, while secondary endpoints assessed 12-month primary patency (freedom from stricture recurrence) and cumulative device-free survival. Data were gathered through imaging (magnetic resonance cholangiopancreatography or CT), clinical visits, and laboratory tests at 3, 6, and 12 months.

January 2026

Shahrvini T, Wood EJ, Joines MM, Nguyen H, Hoyt AC, Chalfant JS, Capiro NM, Fischer CP, Sayre J, Hsu W, Milch HS.

BACKGROUND. Insights into the nature of false-positive findings flagged by contemporary mammography artificial intelligence (AI) systems could inform the potential use of AI to reduce false-positive recall rates. OBJECTIVE. The purpose of this study was to compare AI and radiologists in terms of characteristics of false-positive digital breast tomosynthesis (DBT) examinations in a breast cancer screening population. METHODS. This retrospective study included 2977 women (mean age, 55 years) who were participating in an observational population-based screening study and underwent 3183 screening DBT examinations from January 2013 to June 2017. A commercial AI tool analyzed DBT examinations. Positive examinations were defined as having an elevated-risk result for AI and as having been assigned BI-RADS category 0 for interpreting radiologists. False-positive examinations were defined as the absence of a breast cancer diagnosis within 1 year. Radiologists rereviewed the imaging for AI-flagged false-positive findings.

January 2026

Welland SH, Kim GHJ, Yadav A, Nael K, Hoffman JM, Brown MS, McNitt-Gray MF, Hsu W.

PURPOSE: There are multiple commercially available, Food and Drug Administration (FDA)-cleared, artificial intelligence (AI)-based tools automating stroke evaluation in noncontrast computed tomography (NCCT). This study assessed the impact of variations in reconstruction kernel and slice thickness on two outputs of such a system: hypodense volume and Alberta Stroke Program Early CT Score (ASPECTS). APPROACH: The NCCT series image data of 67 patients imaged with a CT stroke protocol were reconstructed with four kernels (H10s-smooth, H40s-medium, H60s-sharp, and H70h-very sharp) and three slice thicknesses (1.5, 3.0, and 5.0 mm) to create 1 reference condition (H40s/5.0 mm) and 11 nonreference conditions. The 12 reconstructions per patient were processed with a commercially available FDA-cleared software package that yields total hypodense volume (mL) and ASPECTS. A mixed-effect model was used to test the difference in hypodense volume, and an ordered logistic model was used to test the difference in e-ASPECTS.

January 2026

Zhang W, Kafali SG, Adamos T, Kuwahara K, Dong A, Li J, Shih SF, Delgado-Esbenshade T, Chowdhury S, Loong S, Moretz J, Barnes SR, Li Z, Ghahremani S, Calkins KL, Wu HH.

BACKGROUND: Pediatric abdominal visceral and subcutaneous adipose tissue (VAT, SAT) quantified on magnetic resonance imaging (MRI) can assess risk for metabolic diseases. However, the complex structure of VAT in children and the lack of sufficient MRI datasets pose challenges for developing automated segmentation methods. PURPOSE: To achieve accurate and rapid automated segmentation of pediatric abdominal VAT and SAT on motion-robust free-breathing (FB) 3D Dixon MRI by developing a cross-cohort federated learning (FL) framework that leverages adult datasets. MATERIALS AND METHODS: 3D FB-MRI datasets were prospectively acquired in children 6-18 years old (single center, 2 scanners; 2016-2023) and used to train 3D neural network models for segmenting abdominal VAT and SAT. The FL model was trained across the pediatric cohort and a separate adult cohort (5 centers, 7 scanners) without requiring direct data sharing. Segmentation performance of the FL model was assessed by Dice scores with respect to references and compared with standalone local training and joint training with full data access. Quantification of VAT and SAT volume and proton-density fat fraction (PDFF) was compared against references using intraclass correlation coefficients (ICCs) and Bland-Altman analysis. Differences between training approaches were analyzed using the Kruskal-Wallis test followed by paired Wilcoxon signed-rank tests.