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  • Elastography in the evaluation of liver allograft
    Abdom. Radiol. (IF 2.147) Pub Date : 2020-01-16
    P. J. Navin, M. C. Olson, J. M. Knudsen, S. K. Venkatesh

    Abstract Elastography is an established technique in the evaluation of chronic liver diseases. While there is a large clinical experience and data available regarding the performance of elastography in native liver, elastography experience with liver grafts is limited and still growing. Both ultrasound-based elastography techniques and MR Elastography (MRE) are useful in the assessment of liver fibrosis in liver transplants. Technical modifications for performing elastography will be required for optimum evaluation of the graft. In general, caution needs to be exercised regarding the use of elastography immediately following transplantation as post-operative changes, perioperative conditions/complications, inflammation, and rejection can cause increased stiffness in the graft. In the follow-up, detection of increased stiffness with elastography is useful for predicting development of fibrosis in the graft. Adjunctive MRI or ultrasound with Doppler also provides comprehensive evaluation of anatomy, vascular anastomosis and patency, biliary tree, and stiffness for fibrosis. In this review, we provide a brief overview of elastography techniques available followed by the literature review of elastography in the evaluation of grafts and illustration with clinical examples.

    更新日期:2020-01-16
  • Performance of CT-based radiomics in diagnosis of superior mesenteric vein resection margin in patients with pancreatic head cancer
    Abdom. Radiol. (IF 2.147) Pub Date : 2020-01-13
    Yun Bian, Hui Jiang, Chao Ma, Kai Cao, Xu Fang, Jing Li, Li Wang, Jianming Zheng, Jianping Lu

    Abstract Objectives To accurately identify the relationship between a portal radiomics score (rad-score) and pathologic superior mesenteric vein (SMV) resection margin and to evaluate the diagnostic performance in patients with pancreatic head cancer. Materials and methods A total of 181 patients with postoperatively and pathologically confirmed pancreatic head cancer who underwent multislice computed tomography within one month of resection between January 2016 and December 2018 were retrospectively investigated. For each patient, 1029 radiomics features of the portal phase were extracted, which were reduced using the least absolute shrinkage and selection operator (LASSO) logistic regression algorithm. Multivariate logistic regression models were used to analyze the association between the portal rad-score and SMV resection margin. Results Patients with negative (R0) and positive (R1) margins accounted for 70.17% (127) and 29.83% (54) of the cohort, respectively. The rad-score was significantly associated with the SMV resection margin status (p < 0.05). Multivariate analyses confirmed a significant and independent association between the portal rad-score and SMV resection margin (OR 4.62; 95% CI 2.19–9.76; p < 0.0001). The portal rad-score had high accuracy (area under the curve = 0.750). The best cut point based on maximizing the sum of sensitivity and specificity was − 0.741 (sensitivity = 64.8%; specificity = 74.0%; accuracy = 71.3%). Decision curve analysis indicated the clinical usefulness of radiomics score. Conclusions The portal rad-score is significantly associated with the pathologic SMV resection margin, and it can accurately and noninvasively predict the SMV resection margin in patients with pancreatic cancer.

    更新日期:2020-01-13
  • The added value of dual-time-point 18F-FDG PET/CT imaging in the diagnosis of colorectal cancer liver metastases
    Abdom. Radiol. (IF 2.147) Pub Date : 2020-01-11
    Wujian Mao, Jun Zhou, Lin Qiu, Hongyan Yin, Hui Tan, Hongcheng Shi

    To investigate the added value of dual-time-point 18F-FDG PET/CT imaging in the diagnosis of colorectal cancer liver metastases (CRLM).

    更新日期:2020-01-13
  • Contrast-enhanced ultrasound applications in liver transplant imaging
    Abdom. Radiol. (IF 2.147) Pub Date : 2020-01-10
    Giuseppe Como, Luca Montaldo, Umberto Baccarani, Dario Lorenzin, Chiara Zuiani, Rossano Girometti

    Abstract Contrast-enhanced ultrasound (CEUS) is gaining ever-increasing acceptance in the preoperative and postoperative evaluation of liver-transplanted patients. While indications are still a matter of research, CEUS is used in tertiary centers to supplement ultrasound (US) and Color Doppler US examination, with the potential of providing a comprehensive first-line ultrasound-based diagnosis. Alternatively, CEUS is used as a problem-solving tool when previous cross-sectional or US imaging was inconclusive, especially in assessing hepatocellular carcinoma, parenchymal perfusion abnormalities, the vascular status, and even the biliary tree. This review describes the potential use for CEUS in the setting of orthotopic liver transplantation (OLT).

    更新日期:2020-01-11
  • Navigator-triggered and breath-hold 3D MRCP using compressed sensing: image quality and method selection factor assessment
    Abdom. Radiol. (IF 2.147) Pub Date : 2020-01-10
    Daisuke Morimoto, Tomoko Hyodo, Ken Kamata, Tomoya Kadoba, Makoto Itoh, Hiroyuki Fukushima, Yasutaka Chiba, Mamoru Takenaka, Tomohiro Mochizuki, Yu Ueda, Keizou Miyagoshi, Masatoshi Kudo, Kazunari Ishii

    To examine whether MRCP using a combination of compressed sensing and sensitivity encoding with navigator-triggered and breath-hold techniques (NT C-SENSE and BH C-SENSE, respectively) have comparable image quality to that of navigator-triggered MRCP using only sensitivity encoding (NT SENSE) at 1.5-T.

    更新日期:2020-01-11
  • The role of imaging as a guide to the surgical treatment of endometriosis
    Abdom. Radiol. (IF 2.147) Pub Date : 2020-01-10
    Tatnai L. Burnett, Myra K. Feldman, Jian Qun Huang

    Minimally invasive surgery for complex endometriosis requires preoperative planning that intimately connects the gynecologic surgeon to the radiologist. Understanding the surgeon’s perspective to endometriosis treatment facilitates a productive relationship that ultimately benefits the patient. We examine minimally invasive surgery for endometriosis and the key radiologic information which enable the surgeon to successfully negotiate patient counseling, preoperative planning, and an interdisciplinary approach to surgery.

    更新日期:2020-01-11
  • Radiomics of hepatocellular carcinoma
    Abdom. Radiol. (IF 2.147) Pub Date : 2020-01-10
    Sara Lewis, Stefanie Hectors, Bachir Taouli

    Abstract The diagnosis of hepatocellular carcinoma relies largely on non-invasive imaging, and is well suited for radiomics analysis. Radiomics is an emerging method for quantification of tumor heterogeneity by mathematically analyzing the spatial distribution and relationships of gray levels in medical images. The published studies on radiomics analysis of HCC provide encouraging data demonstrating potential utility for prediction of tumor biology, molecular profiles, post-therapy response, and outcome. The combination of radiomics data and clinical/laboratory information provides added value in many studies. Radiomics is a multi-step process that requires optimization and standardization, the development of semi-automated or automated segmentation methods, robust data quality control, and refinement of algorithms and modeling approaches for high-throughput data analysis. While radiomics remains largely in the research setting, the strong associations of predictive models and nomograms with certain pathologic, molecular, and immune markers with tumor aggressiveness and patient outcomes, provide great potential for clinical applications to inform optimized treatment strategies and patient prognosis.

    更新日期:2020-01-11
  • Imaging of scrotal masses
    Abdom. Radiol. (IF 2.147) Pub Date : 2020-01-09
    Kedar G. Sharbidre, Mark E. Lockhart

    Abstract Testicular cancer is responsible for approximately 0.1% of all cancer deaths in the USA, and seminoma is the most common type of testicular tumor. Ultrasonography is the primary imaging modality for accessing testicular and extratesticular lesions, while magnetic resonance imaging can be used for problem solving in lesion characterization in certain cases. CT imaging is usually performed for retroperitoneal staging of testicular cancer metastasis and follow-up after treatment. Extratesticular masses are common, yet rarely malignant. Imaging plays an important role in primary diagnosis of testicular cancer and differentiating it from common non-neoplastic findings. The purpose of this article is to review various imaging findings in testicular and extratesticular masses.

    更新日期:2020-01-11
  • Genitourinary manifestations of endometriosis with emphasis on the urinary tract
    Abdom. Radiol. (IF 2.147) Pub Date : 2020-01-09
    A. Agely, C. Bolan, A. Metcalfe, W. VanBuren, C. Menias

    Endometriosis is a common benign condition affecting women. The disease has a broad spectrum of presentations from incidental lesions in asymptomatic women to causing significant and debilitating morbidity in others. Ectopic endometrial glands are located in predictable locations throughout the pelvis, including implantation on the ovaries and in the rectouterine cul-de-sac. Less commonly, the urinary tract may be involved. As genitourinary manifestations may remain symptomatically occult or masquerade as other diagnoses, it is essential for the radiologist to be aware of the imaging features, consider this diagnosis, and potentially save the patient from delayed treatment.

    更新日期:2020-01-09
  • Encyclopedia of endometriosis: a pictorial rad-path review
    Abdom. Radiol. (IF 2.147) Pub Date : 2020-01-09
    Brandon R. Mason, Deyali Chatterjee, Christine O. Menias, Premal H. Thaker, Cary Lynn Siegel, Motoyo Yano

    Endometriosis affects approximately 10% of reproductive age women and represents a significant cause of pelvic pain and infertility. Unfortunately, the diagnosis of endometriosis is often delayed by years. Endometriosis may manifest as cystic lesions in the ovaries known as endometriomas. Superficial endometriosis is typically detected by laparoscopy along the pelvic peritoneum as these lesions tend to be difficult to detect by imaging. Deep infiltrative endometriosis may be detected by ultrasound, CT or MRI in classic locations within the pelvis, such as the posterior cul-de-sac and uterosacral ligaments. Endometriosis may also involve the thorax, gastrointestinal and urinary tracts, and locations such as the abdominal wall and abdominal organs. We present MRI and CT case examples, together with corresponding laparoscopic and histopathology images to enhance radiologists’ understanding of this disease.

    更新日期:2020-01-09
  • Cross-sectional anatomy of the male pelvis
    Abdom. Radiol. (IF 2.147) Pub Date : 2020-01-09
    Lyndon Luk, Myles T. Taffel

    Abstract The visceral organs of the male pelvis have complex anatomic relationships with the surrounding extraperitoneal spaces, supplying arteries and adjacent pelvic musculature. Since various neoplastic, vascular, and traumatic pathologies can often involve multiple organs and spread into adjacent pelvic spaces, a keen understanding of this intricate anatomy can help radiologists to accurately characterize findings and improve recognition of the routes in which these conditions can spread. The purpose of this review is to examine the relationships between the anatomic compartments of the pelvic extraperitoneal space, summarize the pelvic arterial anatomy, and identify the pelvic muscles that support normal genitourinary function.

    更新日期:2020-01-09
  • Gender-affirming surgical techniques, complications, and imaging considerations for the abdominal radiologist
    Abdom. Radiol. (IF 2.147) Pub Date : 2020-01-08
    Justin T. Stowell, Jeanne M. Horowitz, Stephen Thomas

    Abstract Gender-affirming surgery is a group of surgical procedures that alters the physical appearance of a transgender person to resemble that socially associated with their identified gender. Masculinization and feminization surgeries include chest and breast surgery as well as genital reconstruction. The genital reconstruction surgeries have unique anatomic imaging features and are associated with complications that may require radiologic evaluation. This review provides a review of the imaging anatomy, expected findings, and complications associated with gender-affirming surgeries.

    更新日期:2020-01-08
  • 18 F-FDG PET/CT feature of pancreatic adenosquamous carcinoma with pathological correlation
    Abdom. Radiol. (IF 2.147) Pub Date : 2020-01-06
    Weiwei Su, Shuai Zhao, Ying Chen, Changjing Zuo, Bin Cui, Minjie Wang, Fangyuan Ren

    To investigate 18F-FDG PET/CT feature of pancreatic adenosquamous carcinoma (PASC) in contrast with conventional pancreatic ductal adenocarcinoma (PDAC), and its correlation with pathological findings.

    更新日期:2020-01-06
  • Investigating the equivalent performance of biparametric compared to multiparametric MRI in detection of clinically significant prostate cancer
    Abdom. Radiol. (IF 2.147) Pub Date : 2020-01-06
    Baojun Wang, Jie Gao, Qing Zhang, Chengwei Zhang, Guangxiang Liu, Wang Wei, Haifeng Huang, Yao Fu, Danyan Li, Bing Zhang, Hongqian Guo

    PIRADS v2 stipulates that dynamic contrast-enhanced (DCE) imaging be used to categorize diffusion-weighted-imaging (DWI) score 3 (DWI 3) peripheral zone (PZ) lesions as PIRADS score 3 (PIRADS 3; DCE −) or PIRADS 4 (DCE +). It’s controversial for the value of DCE in improving clinically significant prostate cancer (csPCa) detection. We aimed to figure out whether DCE improves csPCa detection and explore new available measures to improve csPCa detection.

    更新日期:2020-01-06
  • CT and MR imaging evaluation of living liver donors
    Abdom. Radiol. (IF 2.147) Pub Date : 2020-01-03
    Federica Vernuccio, Susan A. Whitney, Kadiyala Ravindra, Daniele Marin

    Abstract Preoperative cross-sectional imaging evaluation of potential living liver donors allows to exclude donors with an increased risk for morbidity and mortality, and to assure that a suitable graft for the recipient can be obtained, minimizing the risk of complications in both the donor and the recipient. CT is routinely performed to delineate the anatomy of the liver, relevant vasculature, and liver volumes in whole right or left lateral segment donation. MR imaging is the gold standard for the assessment of biliary anatomy and allows a better quantification of hepatic steatosis compared to CT. Knowledge of normal and variant vascular and biliary anatomy and their surgical relevance for liver transplantation is of paramount importance for the radiologist. The purpose of this review is to outline the current role of CT and MR imaging in the assessment of hepatic parenchyma, hepatic vascular anatomy, biliary anatomy, and hepatic volumetry in the potential living liver donor with short notes on acquisition protocols and the relevant reportable findings.

    更新日期:2020-01-04
  • Pitfalls in the MDCT of pancreatic cancer: strategies for minimizing errors
    Abdom. Radiol. (IF 2.147) Pub Date : 2020-01-02
    Arya Haj-Mirzaian, Satomi Kawamoto, Atif Zaheer, Ralph H. Hruban, Elliot K. Fishman, Linda C. Chu

    Abstract Multidetector computed tomography (MDCT) is a widely used cross-sectional imaging modality for initial evaluation of patients with suspected pancreatic ductal adenocarcinoma (PDAC). However, diagnosis of PDAC can be challenging due to numerous pitfalls associated with image acquisition and interpretation, including technical factors, imaging features, and cognitive errors. Accurate diagnosis requires familiarity with these pitfalls, as these can be minimized using systematic strategies. Suboptimal acquisition protocols and other technical errors such as motion artifacts and incomplete anatomical coverage increase the risk of misdiagnosis. Interpretation of images can be challenging due to intrinsic tumor features (including small and isoenhancing masses, exophytic masses, subtle pancreatic duct irregularities, and diffuse tumor infiltration), presence of coexisting pathology (including chronic pancreatitis and intraductal papillary mucinous neoplasm), mimickers of PDAC (including focal fatty infiltration and focal pancreatitis), distracting findings, and satisfaction of search. Awareness of pitfalls associated with the diagnosis of PDAC along with the strategies to avoid them will help radiologists to minimize technical and interpretation errors. Cognizance and mitigation of these errors can lead to earlier PDAC diagnosis and ultimately improve patient prognosis.

    更新日期:2020-01-04
  • Pancreatic neuroendocrine tumors (pNETs): the predictive value of MDCT characteristics in the differentiation of histopathological grades
    Abdom. Radiol. (IF 2.147) Pub Date : 2020-01-02
    Faeze Salahshour, Mohammad-Mehdi Mehrabinejad, Ali Zare Dehnavi, Abbas Alibakhshi, Habibollah Dashti, Mohammad-Ali Ataee, Niloofar Ayoobi Yazdi

    To investigate the correlation between multiple detector computed tomography (MDCT) features of pancreatic neuroendocrine tumors (pNETs) and histopathologic grade and find valuable imaging criteria for grade prediction.

    更新日期:2020-01-04
  • Prostate MRI–TRUS fusion biopsy: a review of the state of the art procedure
    Abdom. Radiol. (IF 2.147) Pub Date : 2020-01-02
    Chandan J. Das, Abdul Razik, Arjunlokesh Netaji, Sadhna Verma

    Prostate cancer is the fourth most common cancer and population-based screening programmes are being increasingly adopted worldwide. Screening-positive patients undergo routine transrectal ultrasound (TRUS)-guided systematic biopsy, which is the current diagnostic standard for prostate cancer. However, systematic biopsies suffer from poor sensitivity, especially for the tumors of the anterior prostate and apex as well as in large volume glands. In the past decade, MRI-guided targeted biopsies have come up, which utilize the multiparametric capability of MRI to target lesions for sampling. MRI/TRUS fusion biopsies combine the advantages of MRI-targeting with that of real-time guidance made possible by TRUS. MRI–TRUS fusion biopsies are being increasingly used in men with high clinical suspicion of prostate cancer who have had prior negative systematic biopsies. A large number of fusion biopsy platforms are currently available commercially. Although the basic workflow is similar, there are differences in the operational software, biopsy routes offered, TRUS acquisition technique, type of correction applied at the time of fusion and in the probe tracking hardware. The article describes the current role and indications of MRI–TRUS fusion biopsy followed by a discussion on the workflow, patient preparation, biopsy procedure and complications.

    更新日期:2020-01-04
  • Cross-sectional imaging of seminal vesicles and vasa deferentia
    Abdom. Radiol. (IF 2.147) Pub Date : 2020-01-02
    Roberta Catania, Navya Dasyam, Alessandro Furlan, Amir A. Borhani

    Abstract A wide spectrum of pathologies, ranging from inconsequential degenerative and senile changes to clinically significant neoplasms, can affect seminal vesicles (SVs). With rapid rise in use of magnetic resonance imaging for evaluation of prostate in recent years an increasing number of cases of incidental SV pathologies are encountered by radiologists. Despite the high contrast resolution and high spatial resolution offered by multiparametric pelvic MRI, accurate diagnosis of SV processes can at times be challenging. In this article, we review the anatomy and embryology of the SVs and vasa deferentia and then explore the spectrum of diseases affecting them.

    更新日期:2020-01-04
  • MRI-targeted biopsy versus standard transrectal ultrasound-guided biopsy: a systematic review and meta-analysis of randomized controlled trials
    Abdom. Radiol. (IF 2.147) Pub Date : 2020-01-02
    Xu Hu, Zhi-Qiang Yang, Yan-Xiang Shao, Wei-Chao Dou, San-Chao Xiong, Wei-Xiao Yang, Xiang Li

    Abstract Purpose For men with a suspicion of prostate cancer (PCa), the transrectal ultrasound-guided biopsy (TRUS-Bx) was recommended. Multi-parametric magnetic resonance imaging (mp-MRI) could be more useful to more accurately selected patients who are with a clinical suspicion of PCa and eligible for biopsy, and avoid a biopsy if the result was negative. In the present study, we compared the MRI-targeted biopsy (MRI-TBx) with TRUS-Bx. Methods We searched the following online database: PubMed, Embase, and Cochrane Library, and the search was updated to March 2019. Results Finally, a total of 8 randomized controlled trials (RCTs) comprising 2593 patients were enrolled in the final analysis. MRI-TBx and TRUS-Bx did not significantly differ in overall PCa (RR = 1.30; 95% CI 0.98–1.72; P = 0.067), clinically significant PCa (RR = 1.35; 95% CI 0.98–1.86; P = 0.065), and clinically insignificant PCa (RR = 0.76; 95% CI 0.40–1.46; P = 0.416). While in patients with initial biopsy, MRI-TBx had a significantly higher detection rate of overall PCa (RR = 1.40; 95% CI 1.01–1.94; P = 0.045). Conclusion In the present study, we found that MRI-TBx potentially benefits the detection of overall and clinically significant PCa compared with TRUS-Bx in patients with a suspicion of PCa. Furthermore, in patients with initial biopsy, MRI-TBx had a significantly higher detection rate of overall PCa and a potentially higher detection rate of clinically significant PCa. While for patients with prior negative biopsy, we did not detect significant differences in overall and clinically significant PCa between two groups. More large and multicenter RCTs are further required.

    更新日期:2020-01-04
  • MRI findings of obstructive azoospermia: lesions in and out of pelvic cavity
    Abdom. Radiol. (IF 2.147) Pub Date : 2020-01-02
    Huanjun Wang, Yang Peng, Wenhao Fu, Xiaoxiao Hu, Chang Li, Jian Guan

    Obstructive azoospermia (OA) is caused by excurrent duct obstruction, which can occur anywhere along the course of the male reproductive tract and is classically characterized by normal spermatogenesis. To be familiar with the imaging anatomy of normal and abnormal male genital ducts is essential to the diagnosis of OA. In some circumstances, OA can also be related to some specific syndromes; thus, making an accurate diagnosis may require an integral view of the whole abdomen and pelvis. MR is a great complementary imaging modality either for the detection of obstructive factors, especially for characterization of those indeterminate features on ultrasound, or for the identification of specific syndromes related to OA. In this article, a series of patients with OA caused by different kinds of lesions in and out of the pelvic cavity (abdomen) shown on MR imaging were included, and some cases of specific syndromes related to OA were also reviewed.

    更新日期:2020-01-04
  • Hysterosalpingography in endometriosis: performance and interpretation
    Abdom. Radiol. (IF 2.147) Pub Date : 2020-01-02
    Aoife Kilcoyne, Aileen O’Shea, Debra A. Gervais, Susanna I. Lee

    Abstract Endometriosis is often seen and sometimes initially diagnosed on hysterosalpingography (HSG), an imaging exam routinely performed on patients with infertility. Here we discuss the role of HSG in the evaluation of patients with infertility with a focus on patients with endometriosis. The HSG technique, including patient preparation as well as potential risks and complications, is detailed. Imaging findings in patients with endometriosis are illustrated and a template for exam reporting is presented. Common imaging pitfalls are described with examples.

    更新日期:2020-01-04
  • Cost-effectiveness of dual-energy CT versus multiphasic single-energy CT and MRI for characterization of incidental indeterminate renal lesions
    Abdom. Radiol. (IF 2.147) Pub Date : 2020-01-02
    Bhavik N. Patel, Artem T. Boltyenkov, Maria G. Martinez, Domenico Mastrodicasa, Daniele Marin, R. Brooke Jeffrey, Benjamin Chung, Pari Pandharipande, Avinash Kambadakone

    To evaluate the cost-effectiveness of DECT versus multiphasic CT and MRI for characterizing small incidentally detected indeterminate renal lesions using a Markov Monte Carlo decision-analytic model.

    更新日期:2020-01-04
  • Impact of evaluation in interventional radiology clinic prior to uterine artery embolization: changes in management
    Abdom. Radiol. (IF 2.147) Pub Date : 2020-01-02
    Masoud Nakhaei, Salomao Faintuch, Olga R. Brook

    Abstract Purpose To assess the impact of pre-procedural evaluation of patients with symptomatic uterine fibroids and adenomyosis in interventional radiology (IR) clinic. Method In this IRB-approved, HIPAA-compliant retrospective study, consecutive patients evaluated in the IR clinic in a tertiary academic hospital between 1/1/2015 and 9/30/2018 by a single board-certified interventional radiologist were included. Medical records were reviewed to obtain medical history, imaging and endometrial biopsies results. Impact of IR clinic assessment of clinical, imaging, and pathological findings on patient’s clinical course was assessed. Descriptive statistics were used. Results 208 consecutive patients were evaluated in clinic for uterine fibroids 176/208 (85%), adenomyosis 8/208 (4%) or both 24/208 (11%) with age of 44.4 ± 5.8 years and BMI of 30.1 ± 8.6 kg/m2. Leading presenting symptom was menorrhagia in 172/208 (80%) patients, pelvic pain in 91/208 (44%), and urinary symptoms in 88/208 (42%) patients. 159/208 (76%) patients underwent UAE, 12/208 (6%) patients underwent surgery, and 37/208 (18%) patients chose conservative management. 189/208 (91%) patients had pelvic MRI that altered management course in 7/189 (4%) patients due to intracavitary fibroids in two patients, endometrial polyps in two patients, non-enhancing fibroids in two patients, and adnexal mass in one patient. 166/208 (80%) underwent endometrial biopsy that altered management course in one patient (0.6%) due to endometrial intraepithelial neoplasia. Conclusion Endometrial biopsy and pelvic MRI are helpful to detect cases of non-enhancing fibroids, intracavitary fibroids, and ovarian and endometrial malignancies and thus altered management of five percent of patients with symptomatic fibroids and adenomyosis.

    更新日期:2020-01-04
  • Percutaneous cryoablation of abdominal wall endometriosis: the Mayo Clinic approach
    Abdom. Radiol. (IF 2.147) Pub Date : 2020-01-01
    Brian T. Welch, Eric C Ehman, Wendaline M VanBuren, Adela G Cope, Tasha L Welch, David A Woodrum, A Nick Kurup, Tatnai L Burnett

    Abdominal wall endometriosis (AWE) is a rare form of endometriosis that often results in substantial pain and debility. The current treatment algorithm for AWE is not well established. The purpose of this review is to describe the Mayo Clinic experience with thermal ablation of symptomatic AWE as well as to review current imaging and interventional literature regarding the diagnosis and treatment of AWE.

    更新日期:2020-01-04
  • Eosinophilic esophagitis: imaging features with endoscopic and pathologic correlation
    Abdom. Radiol. (IF 2.147) Pub Date : 2020-01-01
    Patricia V. Hernandez, Syed Amer, Dora M. Lam-Himlin, David J. DiSantis, Christine O. Menias, Jennifer L. Horsley-Silva

    Abstract Objective We aim to review the imaging features of eosinophilic esophagitis on fluoroscopy and present how they can correlate with endoscopic and pathologic findings. Results Eosinophilic esophagitis is a chronic immune-mediated disease that results in esophageal dysfunction. Upper esophagogastroduodenoscopy is high yield and required for biopsies to demonstrate the hallmark histologic findings of eosinophil-predominant inflammation. While esophagogastroduodenoscopy is currently mandatory for diagnosis, imaging findings can provide valuable information regarding the structural and functional properties of the esophagus. In addition, fluoroscopic studies may be very helpful in the setting of subtle findings and to evaluate fibrotic remodeling changes. Conclusion Radiologic examinations are a valuable tool in the assessment of eosinophilic esophagitis and can highlight changes of fibrostenotic disease, as overall narrowing can be more conspicuous fluoroscopically than endoscopically. As the disease increases in prevalence, it is critical that physicians recognize this condition and facilitate diagnosis and treatment.

    更新日期:2020-01-04
  • A retrospective study of pyogenic liver abscess caused primarily by Klebsiella pneumoniae vs. non- Klebsiella pneumoniae : CT and clinical differentiation
    Abdom. Radiol. (IF 2.147) Pub Date : 2020-01-01
    Jin Hwan Lee, Young Rock Jang, Su Joa Ahn, Seung Joon Choi, Hyung Sik Kim

    Abstract Purpose The incidence of Klebsiella pneumoniae pyogenic liver abscesses (KP-PLA) is increasing. However, its diagnosis and treatment are often delayed, leading to complications. In this study, we aimed to retrospectively compare computed tomographic (CT) features of KP-PLAs with those of abscesses caused by other bacterial pathogens (non-KP-PLAS) and to further identify prognostic factors for PLA. Methods Data of 219 study patients including clinical presentation, comorbid conditions, metastatic infection, treatment duration, and mortality were retrospectively collated. CT characteristics of abscesses were recorded. Etiology was established by pus and/or blood culture. The differentiating CT features and clinical findings were compared between the monomicrobial KP-PLA and non-KP-PLA groups. Furthermore, factors related to in-hospital case fatality were analyzed. Results Multivariate analysis identified thin-walled abscesses, absent rim enhancement, metastatic infection, and absence of underlying biliary tract disease as significant predictors of KP-PLA. With 3/4 criteria applied in combination, a specificity of 96.5% was achieved for KP-PLA diagnosis. The in-hospital mortality rate was 3.7%. Multivariate analysis revealed that diabetes mellitus (P = 0.031), multiple abscesses (P = 0.026), internal gas bubble (P = 0.041), metastatic infection (P = 0.004), and septic shock (P = 0.002) were significantly associated with mortality. Conclusion Thin-walled abscess, metastatic infection, absence of rim enhancement, and absence of underlying biliary tract disease are potentially useful CT findings for early KP-PLA diagnosis.

    更新日期:2020-01-04
  • Pancreatic extracellular volume fraction using T1 mapping in patients with impaired glucose intolerance
    Abdom. Radiol. (IF 2.147) Pub Date : 2020-01-01
    Yoshifumi Noda, Satoshi Goshima, Yusuke Tsuji, Kimihiro Kajita, Yuta Akamine, Nobuyuki Kawai, Hiroshi Kawada, Yukichi Tanahashi, Masayuki Matsuo

    Abstract Purpose To evaluate pancreatic T1 mapping and extracellular volume (ECV) fraction’s feasibility to assess impaired glucose tolerance (IGT) patients. Methods A total of 45 consecutive patients with known or suspected pancreatic disease underwent contrast-enhanced magnetic resonance (MR) imaging, including T1 mapping, using saturation recovery sequence. Patients were classified into three groups based on the American Diabetes Association criteria: no-diabetes subjects, HbA1c < 5.7%; pre-diabetes, 5.7% ≤ HbA1c < 6.5%; and type 2 diabetes mellitus (T2DM), HbA1c ≥ 6.5%. Pre-contrast pancreatic T1 value and ECV of the pancreas were computed, and then pre-contrast pancreatic T1 value, ECV and HbA1c values were compared. The present prospective study was approved by our institutional review board. Written informed consent was obtained from all patients. Results A positive correlation between HbA1c values and both pre-contrast pancreatic T1 value and ECV (r = 0.79, P < 0.001 and r = 0.60, P < 0.001, respectively) were observed. The pre-contrast pancreatic T1 value and ECV were significantly higher in T2DM vs. no-diabetes subjects and pre-diabetes (P < 0.001). No significant difference between two qualitative values (P = 0.14) was found, however, the sensitivity, specificity, and area under the receiver-operating-characteristic curve differentiating no-diabetes subjects and pre-diabetes from T2DM were superior in ECV (100%, 93.5%, and 0.990) vs. pre-contrast pancreatic T1 values (84.6%, 96.8%, and 0.906). Conclusions The ECV of the pancreas could serve as a potential imaging biomarker for the assessment of pancreatic fibrosis leading to IGT.

    更新日期:2020-01-04
  • Comparison of liver stiffness measurement with MRE and liver and spleen volumetry for prediction of disease severity and hepatic decompensation in patients with primary sclerosing cholangitis
    Abdom. Radiol. (IF 2.147) Pub Date : 2020-01-01
    Ilkay S. Idilman, Hsien Min Low, Zeinab Bakhshi, John Eaton, Sudhakar K. Venkatesh

    To compare liver stiffness measurement (LSM) with magnetic resonance elastography (MRE) and liver and spleen volumetry for prediction of disease severity and hepatic decompensation in primary sclerosing cholangitis (PSC).

    更新日期:2020-01-04
  • Adrenal cortical carcinoma: pathology, genomics, prognosis, imaging features, and mimics with impact on management
    Abdom. Radiol. (IF 2.147) Pub Date : 2020-01-01
    Ayahallah A. Ahmed, Aaron J. Thomas, Dhakshina Moorthy Ganeshan, Katherine J. Blair, Chandana Lall, James T. Lee, Ali I. Morshid, Mouhammed A. Habra, Khaled M. Elsayes

    Abstract Adrenocortical carcinoma (ACC) is a rare tumor with a poor prognosis. Most tumors are either metastatic or locally invasive at the time of diagnosis. Differentiation between ACC and other adrenal masses depends on clinical, biochemical, and imaging factors. This review will discuss the genetics, pathological, and imaging feature of ACC.

    更新日期:2020-01-04
  • T1 mapping, T2 mapping and MR elastography of the liver for detection and staging of liver fibrosis
    Abdom. Radiol. (IF 2.147) Pub Date : 2019-12-24
    David H. Hoffman, Abimbola Ayoola, Dominik Nickel, Fei Han, Hersh Chandarana, Krishna Prasad Shanbhogue

    Abstract Purpose To compare liver stiffness measurements obtained from MR elastography with liver T1 relaxation times obtained from T1 mapping and T2 relaxation times obtained from T2 mapping for detection and staging of liver fibrosis. Materials and methods 223 patients with known or suspected liver disease underwent MRI of the liver with T1 mapping (Look-Locker sequence) and 2D SE-EPI MR elastography (MRE) sequences. 139 of these patients also underwent T2 mapping with radial T2 TSE sequence. Two readers (R1 & R2) measured liver stiffness, T1 relaxation times and T2 relaxation times. T1 and T2 times were correlated with stiffness measurements. ROC analysis was used to compare the performance of both techniques in discriminating fibrosis stage in 23 patients who underwent liver biopsy. Results For each reader there was significant moderate positive correlation between liver MRE and liver T1 mapping (r = 0.49 and 0.36). There was significant moderate positive correlation between liver T2 mapping and each of MRE and T1 mapping for one of the readers (r = 0.40 and 0.27). AUC for differentiating early (F0–F2) from advanced (F3–F4) fibrosis in biopsied patients was 0.975 (R1) and 0.925 (R2) for MRE, 0.671 (R1) and 0.642 (R2) for T1 mapping and 0.671 (R1) and 0.743 (R2) for T2 mapping. Inter-reader agreement was good for MRE (ICC = 0.84) substantial for T1 mapping (0.94) and T2 mapping (0.96). Conclusions Liver T1 and T2 mapping showed moderate positive correlation with MR elastography. Accuracy of MRE is however superior to T1 and T2 mapping in the subset of patients who underwent liver biopsy. Accuracy of combination of MRE and T1 mapping/T2 mapping was not superior to MRE alone.

    更新日期:2020-01-04
  • Urinary bladder fistulae and the role of CT cystography: a pictorial review
    Abdom. Radiol. (IF 2.147) Pub Date : 2019-12-24
    Daniel F. Fouladi, Shahab Shayesteh, Elliot K. Fishman, Linda C. Chu

    Abstract Various conditions such as inflammation, malignancy, surgical manipulations, and radiation therapy can lead to the development of urinary bladder fistulae. Although many of these fistulae are suspected clinically, imaging plays a major role in confirmation and planning of subsequent treatment. Computed tomography (CT) cystoscopy provides useful details regarding the fistulous track and the anatomy of the region. This article aims to provide a succinct review of bladder fistulae and the role of CT cystography in their management.

    更新日期:2020-01-04
  • Primary sclerosing cholangitis: diagnostic performance of MRI compared to blood tests and clinical scoring systems for the evaluation of histopathological severity of disease
    Abdom. Radiol. (IF 2.147) Pub Date : 2019-12-16
    Christopher Song, Sara Lewis, Amita Kamath, Stefanie Hectors, Juan Putra, Shingo Kihira, Octavia Bane, Jawad Ahmad, James Babb, Swan Thung, Bachir Taouli

    Abstract Purpose To assess the diagnostic performance of magnetic resonance imaging (MRI) compared to blood tests and clinical scoring systems for the evaluation of histopathologic severity in patients with primary sclerosing cholangitis (PSC). Materials Fifty-one patients (M/F 37/14, mean age 41 years) with PSC who underwent MRI and liver histopathology were included in this IRB-approved retrospective study. Two radiologists independently graded the severity of biliary abnormalities on magnetic resonance cholangiopancreatography (MRCP) using a standardized scoring system, parenchymal enhancement, and diffusion-weighted imaging (DWI) signal. Liver function tests, Mayo Risk score, APRI, FIB-4 Index, MELD, and Child–Pugh scores were recorded. Histopathology was assessed using a modified Nakanuma’s scoring system. Correlation and diagnostic performance of MRI scores and blood tests for assessment of PSC histopathologic disease severity were evaluated. Results Findings of cirrhosis and portal hypertension were the only imaging features diagnostic of advanced PSC (stages 3 and 4) with AUC up to 0.90 (p < 0.001) for both observers. Parenchymal enhancement and overall qualitative biliary ductal abnormality identified advanced PSC stage with AUC up to 0.767 (p = 0.002) only for one observer. There was weak correlation between the overall qualitative biliary ductal abnormality on MRCP and histopathologic stage (r = 0.36, p = 0.01) for one observer. FIB-4 index, Child–Pugh, MELD, Mayo Risk, APRI, and alkaline phosphatase demonstrated good to excellent performance for advanced PSC stage (AUCs 0.672–0.915, p < 0.045). Conclusions MRI findings of cirrhosis/portal hypertension, blood tests, and clinical scoring systems had high performance for advanced histopathologic PSC stage diagnosis, while the severity of biliary abnormalities on MRI did not.

    更新日期:2020-01-04
  • Imaging-guided percutaneous thrombin injection for the treatment of iatrogenic femoral artery pseudoaneurysms.
    Abdom. Radiol. (IF 2.147) Pub Date : 2019-02-11
    Wendy L Ehieli,Erol Bozdogan,Gemini Janas,Tracy A Jaffe,Chad M Miller,Mustafa R Bashir,Brian C Allen

    PURPOSE To evaluate factors that may affect successful ultrasound-guided percutaneous thrombin injection of iatrogenic femoral artery pseudoaneurysms (PSA). MATERIALS AND METHODS This was an IRB-approved, HIPAA-compliant retrospective study of 326 consecutive subjects (138 males, 188 females; mean age 68 years, range 18-95) who underwent thrombin injection for treatment of femoral PSA; follow-up ultrasound was available in 145 subjects. The number of PSA lobes and dimensions, pre-procedure laboratory values (international normalized ratio [INR], activated partial thromboplastin time [aPTT], platelet count), and concomitant anticoagulation therapy were recorded. RESULTS Technical success was achieved in 98.2% (320/326) of subjects. Primary effectiveness (complete thrombosis at 24 h) was achieved in 74.5% (108/145). Twenty-five subjects underwent repeat thrombin injection, successful in 21 subjects, for a total effectiveness rate of 97.0% (129/133). No imaging factor was associated with technique failure, including number of lobes (p = 0.898), largest dimension (p = 0.344), or volume (p = 0.697). No statistically significant difference in pre-procedure INR, aPTT, or platelet count was found between subjects with CT and those with IT (p > 0.138). Anticoagulation therapy was associated with incomplete thrombosis (35.5% [38/107] for CT vs. 63.9% [23/26] for IT; p = 0.002). CONCLUSION Imaging-guided percutaneous thrombin injection has high technical success and effectiveness rates for the treatment of iatrogenic femoral artery PSA. Anticoagulation therapy was the only factor associated with incomplete thrombosis.

    更新日期:2019-11-01
  • Cardiovascular findings on cross-sectional imaging: spectrum of incidental and critical findings and clinical relevance for the abdominal radiologist.
    Abdom. Radiol. (IF 2.147) Pub Date : 2019-02-10
    Kevin Kalisz,Michael Enzerra,Kianoush Ansari-Gilani

    Although not the primary focus of the exams, cardiovascular structures are included to some extent on all abdominal or whole-body cross-sectional studies. Cardiovascular findings often present incidentally and may range from chronic to acute and emergent pathologies. Among the most common cardiovascular findings are the presence of cardiac calcifications, most commonly coronary, which correlate with the presence of coronary artery and valvular disease. Signs of myocardial ischemia, both acute and chronic, and its complications may also be visualized. Cardiac filling defects most commonly represent thrombus and are associated with systemic arterial embolic complications. Pericardial findings often manifest as effusion or thickening, which may lead to hemodynamic consequences visible at imaging. Incidental pulmonary emboli and systemic venous thrombi may be incidentally detected, particularly in hospitalized and oncologic patients, and warrant immediate attention. This review will highlight the appearance of common and important incidental cardiovascular findings and related pitfalls and discuss reporting and follow-up recommendations relevant to the abdominal radiologist.

    更新日期:2019-11-01
  • False positives in PIRADS (V2) 3, 4, and 5 lesions: relationship with reader experience and zonal location.
    Abdom. Radiol. (IF 2.147) Pub Date : 2019-02-10
    Tineke T Stolk,Igle Jan de Jong,Thomas C Kwee,Henk B Luiting,Shekar V K Mahesh,Benjamin H J Doornweerd,Peter-Paul M Willemse,Derya Yakar

    PURPOSE To investigate the effect of reader experience and zonal location on the occurrence of false positives (FPs) in PIRADS (V2) 3, 4, and 5 lesions on multiparametric (MP)-MRI of the prostate. MATERIALS AND METHODS This retrospective study included 139 patients who had consecutively undergone an MP-MRI of the prostate in combination with a transrectal ultrasound MRI fusion-guided biopsy between 2014 and 2017. MRI exams were prospectively read by a group of inexperienced radiologists (cohort 1; 54 patients) and an experienced radiologist (cohort 2; 85 patients). Multivariable logistic regression analysis was performed to determine the association of experience of the radiologist and zonal location with a FP reading. FP rates were compared between readings by inexperienced and experienced radiologists according to zonal location, using Chi-square (χ2) tests. RESULTS A total of 168 lesions in 139 patients were detected. Median patient age was 68 years (Interquartile range (IQR) 62.5-73), and median PSA was 10.9 ng/mL (IQR 7.6-15.9) for the entire patient cohort. According to multivariable logistic regression, inexperience of the radiologist was significantly (P = 0.044, odds ratio 1.927, 95% confidence interval [CI] 1.017-3.651) and independently associated with a FP reading, while zonal location was not (P = 0.202, odds ratio 1.444, 95% CI 0.820-2.539). In the transition zone (TZ), the FP rate of the inexperienced radiologists 59% (17/29) was significantly higher (χ2P = 0.033) than that of the experienced radiologist 33% (13/40). CONCLUSION Inexperience of the radiologist is significantly and independently associated with a FP reading, while zonal location is not. Inexperienced radiologists have a significantly higher FP rate in the TZ.

    更新日期:2019-11-01
  • Volumetric quantitative histogram analysis using diffusion-weighted magnetic resonance imaging to differentiate HCC from other primary liver cancers.
    Abdom. Radiol. (IF 2.147) Pub Date : 2019-02-04
    Sara Lewis,Steven Peti,Stefanie J Hectors,Michael King,Ally Rosen,Amita Kamath,Juan Putra,Swan Thung,Bachir Taouli

    OBJECTIVE To evaluate the ability of volumetric quantitative apparent diffusion coefficient (ADC) histogram parameters and LI-RADS categorization to distinguish hepatocellular carcinoma (HCC) from other primary liver cancers [intrahepatic cholangiocarcinoma (ICC) and combined HCC-ICC]. METHODS Sixty-three consecutive patients (44 M/19F; mean age 62 years) with primary liver cancers and pre-treatment MRI including diffusion-weighted imaging (DWI) were included in this IRB-approved single-center retrospective study. Tumor type was categorized pathologically. Qualitative tumor features and LI-RADS categorization were assessed by 2 independent observers. Lesion volume of interest measurements (VOIs) were placed on ADC maps to extract first-order radiomics (histogram) features. ADC histogram metrics and qualitative findings were compared. Binary logistic regression and AUROC were used to assess performance for distinction of HCC from ICC and combined tumors. RESULTS Sixty-five lesions (HCC, n = 36; ICC, n = 17; and combined tumor, n = 12) were assessed. Only enhancement pattern (p < 0.015) and capsule were useful for tumor diagnosis (p < 0.014). ADC 5th/10th/95th percentiles were significant for discrimination between each tumor types (all p values < 0.05). Accuracy of LI-RADS for HCC diagnosis was 76.9% (p < 0.0001) and 69.2% (p = 0.001) for both observers. The combination of male gender, LI-RADS, and ADC 5th percentile yielded an AUROC/sensitivity/specificity/accuracy of 0.90/79.3%/88.9%/81.5% and 0.89/86.2%/77.8%/80.0% (all p values < 0.027) for the diagnosis of HCC compared to ICC and combined tumors for both observers, respectively. CONCLUSION The combination of quantitative ADC histogram parameters and LI-RADS categorization yielded the best prediction accuracy for distinction of HCC compared to ICC and combined HCC-ICC.

    更新日期:2019-11-01
  • The LACSEMS: what radiologists need to know.
    Abdom. Radiol. (IF 2.147) Pub Date : 2019-02-03
    Pat W Whitworth,Brenda L Holbert,Rishi Pawa,Neeraj Lalwani,Rafel Tappouni

    Endoscopic drainage is increasingly used in lieu of percutaneous or surgical drainage of pancreatitis-related fluid collections. The lumen-apposing, covered, self-expanding, metallic stent (LACSEMS) is a newly produced stent for the transmural drainage of such fluid collections. The use of LACSEMS devices requires close coordination between knowledgeable radiologic and gastrointestinal providers. We review pancreatitis-related fluid collections and show examples from our experience with LACSEMS and the appropriate case selection, planning, deployment, and follow-up for this novel device.

    更新日期:2019-11-01
  • Comparative accuracy of qualitative and quantitative 18F-FDG PET/CT analysis in detection of lymph node metastasis from anal cancer.
    Abdom. Radiol. (IF 2.147) Pub Date : 2019-01-30
    Thitinan Chulroek,Hamed Kordbacheh,Dearada Wangcharoenrung,Kamonwon Cattapan,Pedram Heidari,Mukesh G Harisinghani

    PURPOSE To compare the diagnostic performance of qualitative and quantitative 18F-FDG PET/CT in detection of regional and distant lymph node metastasis in patients with anal cancer. METHODS Between 2004 and 2017, 28 patients with anal cancer who had staging PET/CT and pathological assessment of suspicious lymph nodes were included. For qualitative analysis, positive lymph nodes were defined as uptake visually higher than the liver reference uptake. For quantitative study, lymph nodes were contoured to determine maximum standard uptake value (SUVmax) and metabolic tumor volume (MTV). Receiver operating characteristic (ROC) curves were plotted to extract the optimal cut-offs and area under the curve (AUC) of SUVmax, lesion to background (L/B) ratio, short axis diameter (SAD), and MTV of lymph nodes. Histopathologic analysis was a reference standard. RESULTS A total of 28 lymph nodes (24 inguinal, 2 external iliac, 1 internal iliac, and 1 paraaortic nodes) in 28 patients on PET/CT were included. With the qualitative visual analysis, 19 patients were categorized as positive for nodal metastasis with sensitivity, specificity, and accuracy of 85%, 75%, and 82%. The optimal SUVmax and L/B ratio cut-offs were 2.6 and 1.0 with both sensitivity and specificity of 95% and 75% (AUC of SUVmax = 0.893, AUC of L/B ratio = 0.912). Using the best cut-off of 1.6 cm for SAD and 3.65 cm3 for MTV, both sensitivity and specificity were 80% and 100% (AUC of SAD = 0.950, AUC of MTV = 0.931). CONCLUSIONS SUVmax optimization may be helpful in enhancing the diagnostic accuracy of 18F-FDG PET/CT in nodal staging patients with anal cancer.

    更新日期:2019-11-01
  • Development and validation of an imaging and clinical scoring system to predict early mortality in spontaneous ruptured hepatocellular carcinoma treated with transarterial embolization.
    Abdom. Radiol. (IF 2.147) Pub Date : 2019-01-12
    Kam-Ho Lee,Man-Lap Donald Tse,Martin Law,Andrew Kai-Chun Cheng,Ho-Yuen Frank Wong,Man-Leung Yu,Yan-Lin Li,Yuen-Chi Ho,Ferdinand Chu,Wendy Wai-Man Lam

    PURPOSE To develop and validate a scoring system using a combination of imaging and clinical parameters to predict 30-day mortality in ruptured HCC (rHCC) patients after transarterial embolization (TAE). METHODS 98 consecutive patients with rHCC who underwent abdominal CT and subsequent TAE between January 2007 and December 2016 were retrospectively reviewed. The CT scans were reviewed by two radiologists blinded to the patient outcome. Clinical parameters including serum bilirubin, albumin, INR, creatinine, and hemoglobin were recorded. Independent risk factors for 30-day mortality after TAE were identified using multivariate binary logistic regression, for development of a scoring system. The scoring system was then validated in 20 patients between January 2017 and May 2018. RESULTS In the development cohort, bilobar tumor distribution (OR = 29.6), clinical parameters of bilirubin > 2.5 mg/dL (OR = 5.9), and albumin < 30 g/L (OR = 4.1) were independent predictors for 30-day mortality. A 6-point score was derived and yielded area-under-the-receiver-operating-characteristic-curve (AUC) of 0.904. A score ≥ 4 resulted in sensitivity of 80.5% and specificity of 91.2% for 30-day mortality. In the validation cohort, AUC for 30-day mortality was 0.939. A score ≥ 4 resulted in sensitivity of 81.2% and specificity of 88.9%. In both development and validation cohorts, the proposed scoring system was better than biochemical components of Child-Pugh score and serum bilirubin to predict 30-day mortality. CONCLUSION Imaging and clinical parameters can be combined into a scoring system to accurately predict 30-day mortality after TAE in rHCC patients. The score may help identify and counsel high-risk patients.

    更新日期:2019-11-01
  • Differentiation of pancreatic neuroendocrine tumors from pancreas renal cell carcinoma metastases on CT using qualitative and quantitative features.
    Abdom. Radiol. (IF 2.147) Pub Date : 2019-01-04
    Christian B van der Pol,Stefanie Lee,Scott Tsai,Natasha Larocque,Abdullah Alayed,Phillip Williams,Nicola Schieda

    PURPOSE To assess qualitative and quantitative imaging features on enhanced CT that may differentiate pancreatic neuroendocrine tumors (PNETs) from pancreatic renal cell carcinoma (RCC) metastases. METHODS This IRB-approved multi-center retrospective case-control study compared 43 resected PNETs and 28 resected RCC metastases with pre-operative enhanced CT identified consecutively between 2003 and 2017. Two blinded radiologists (R1/R2) independently assessed tumor location, attenuation (relative to pancreas), composition (solid/cystic/mixed), homogeneity (homogeneous/heterogeneous), calcification, multiplicity, and for main pancreatic duct (MPD) dilation. Tumors were segmented for quantitative texture analysis. Data were analyzed with Chi square, logistic regression, and receiver operating characteristic (ROC). Inter-observer agreement was assessed (Cohen's kappa). RESULTS There was no difference in age, gender, location, attenuation, or composition (P > 0.05) between groups. PNETs were larger than RCC metastases (37 ± 23 mm vs. 26 ± 21 mm, P = 0.038), more frequently solitary (P < 0.001), subjectively more heterogeneous (P = 0.033/0.144, R1/R2), and associated with calcification (P = 0.002/0.004) and MPD dilation (P = 0.025/0.006). Agreement for subjective features was moderate-to-almost perfect (K = 0.4879-0.9481). Quantitative texture analysis showed higher entropy in PNETs (6.32 ± 0.49 versus 5.96 ± 0.53; P = 0.004) with no difference in other features studied (P > 0.05). Entropy had ROC area under the curve for diagnosis of PNET of 0.77 ± 0.06, with optimal sensitivity/specificity of 71.4/79.1%. CONCLUSIONS Compared to pancreatic RCC metastases, PNETs are larger, more frequently solitary, contain calcification, show MPD dilation, and are subjectively and quantitatively more heterogeneous tumors.

    更新日期:2019-11-01
  • Magnetic resonance elastography SE-EPI vs GRE sequences at 3T in a pediatric population with liver disease.
    Abdom. Radiol. (IF 2.147) Pub Date : 2019-01-03
    Juan S Calle-Toro,Suraj D Serai,Erum A Hartung,David J Goldberg,Bradley D Bolster,Kassa Darge,Sudha A Anupindi

    PURPOSE The goal of our study is to compare hepatic stiffness measures using gradient-recalled echo (GRE) versus spin-echo echo planar imaging (SE-EPI)-based MR Elastography (MRE) at 3T used to measure hepatic stiffness in a patients with suspected liver diseases. MATERIALS AND METHODS This retrospective study included 52 patients with liver disease who underwent a 3T MRE exam including both an investigational SE-EPI-based technique and a product GRE-based technique. Regions of interest (ROI) were placed on the elastograms to measure elastography-derived liver stiffness as well as the area included within the ROIs. The mean liver stiffness values and area of ROIs were compared. RESULTS The mean liver stiffness was 3.72 kilopascal (kPa) ± 1.29 using GRE MRE and 3.78 kPa ± 1.13 using SE-EPI MRE. Measurement of liver stiffness showed excellent agreement between the two pulse sequences with a mean bias of - 0.1 kPa (range - 1.8 to 1.7 kPa) between sequences. The mean measurable ROI area was higher with SE-EPI (313.8 cm2 ± 213.8) than with the GRE technique (208.6 cm2 ± 114.8), and the difference was statistically significant (P < 0.05). CONCLUSIONS Our data shows excellent agreement of measured liver stiffness between GRE and SE-EPI-based sequences at 3T. Our results show the advantage of a SE-EPI MRE sequence in terms of image quality, ROI size and acquisition time with equivalent liver stiffness measurements as compared to GRE-MRE sequence.

    更新日期:2019-11-01
  • Sarcopenia predicts 90-day mortality in elderly patients undergoing emergency abdominal surgery.
    Abdom. Radiol. (IF 2.147) Pub Date : 2019-01-03
    Erik Brandt,Line Toft Tengberg,Morten Bay-Nielsen

    PURPOSE Image-based measurement of sarcopenia is an established predictor of a decreased outcome for a large variety of surgical procedures. Sarcopenia in elderly patients undergoing emergency abdominal surgery has not been well studied. This study aims to investigate the association between the total psoas area (TPA) and postoperative mortality after 90 days in a group of elderly emergency laparotomy patients. METHODS We retrospectively reviewed the emergency CT-scans of 150 elderly patients from a consecutive cohort undergoing emergency abdominal surgery at our surgical center. TPA was measured manually at the level of L3 and indexed to patient height. Sarcopenia was defined as having a TPA index below the first quartile for gender in the cohort. Other collected variables were age, vital status/date of death, ASA-score, surgical procedure, and WHO performance score. RESULTS Overall 90-day mortality was 42.7%. Sarcopenic patients had a higher 90-day mortality (60.5%) than non-sarcopenic patients (36.6%), corresponding to an odds ratio of 2.66 (95% confidence interval 1.2-5.7, p = 0.01). Sarcopenic patients had an increased mortality compared with non-sarcopenic patients (p = 0.0009, Log-rank test), with a clear separation of the two groups within 30 days postoperatively. In a multivariate logistic regression model, with age, ASA-score, and WHO performance score as covariates, sarcopenia was independently associated with 90-day mortality. CONCLUSION Manual measurement of TPA on an abdominal CT-scan is a relevant risk factor for postoperative mortality in elderly patients undergoing high-risk emergency abdominal surgery. Incorporation of sarcopenia in postoperative risk-prediction models in emergency abdominal surgery should be considered.

    更新日期:2019-11-01
  • Double-barrel shotgun sign.
    Abdom. Radiol. (IF 2.147) Pub Date : 2019-01-03
    Venkatraman Indiran,Jagannathan Kokilavani

    更新日期:2019-11-01
  • 更新日期:2019-11-01
  • The "expanded gallbladder fossa sign" in liver cirrhosis.
    Abdom. Radiol. (IF 2.147) Pub Date : 2019-01-03
    Giuseppe Mamone,Roberto Miraglia

    更新日期:2019-11-01
  • Evaluation of diagnostic accuracy: multidetector CT image noise correction improves specificity of a Gaussian model-based algorithm used for characterization of incidental adrenal nodules.
    Abdom. Radiol. (IF 2.147) Pub Date : 2019-01-03
    Toshimasa J Clark,Larson D Hsu,Daniel Hippe,Sophie Cowan,Jonathan Carnell,Carolyn L Wang

    OBJECTIVES To investigate whether the histogram analysis method of characterizing adrenal nodules as adenomas is affected by increased noise with modern CT technique, and if an extension that allows for noise correction will improve diagnostic performance. MATERIALS AND METHODS This is a HIPAA-compliant, IRB-approved retrospective study performed on 58 total patients. The first group of 29 patients had 33 adrenal lesions that were pathology-proven non-adenomas. The second group had 29 patients with 33 pathology-proven or presumed adenomas based on established imaging criteria. The nodules were evaluated using the histogram method, mean attenuation method, and a Gaussian model-based algorithm without (uncorrected Gaussian algorithm) and with correction (corrected Gaussian algorithm) for image noise. Sensitivity, specificity, and accuracy for identifying adenoma were derived. RESULTS There were no significant differences in identifying adenoma from non-adenoma when using the histogram analysis method and the uncorrected Gaussian algorithm, both of which had low specificities of 42.4% and 47.0%, respectively (p = 0.30). Adding noise correction to the Gaussian algorithm resulted in a statistically significant increase in specificity relative to the histogram method (86.4% vs. 42.4%, p < 0.001). The corrected Gaussian algorithm improved sensitivity compared to the mean attenuation method (71.2% vs. 54.5%, p < 0.001), but had lower specificity (86.4% vs. 100%, p < 0.001), and similar overall accuracy (78.8% vs. 77.3%, p = 0.74). CONCLUSION With modern low-dose CT technique, the specificity scores of the histogram method for discrimination of adrenal adenomas and non-adenomas are lower than with previous higher dose scans. The specificity and accuracy of a histogram-equivalent method can be increased mathematically through image noise correction, and the corrected Gaussian algorithm has improved sensitivity to the mean attenuation with similar accuracy albeit with lower specificity. Although this suggests limited utility for histogram analysis in adrenal nodule characterization, our study demonstrates the potential mathematical application for other noise-dependent CT characterization methods.

    更新日期:2019-11-01
  • Beaded bile ducts in primary sclerosing cholangitis.
    Abdom. Radiol. (IF 2.147) Pub Date : 2019-01-03
    Dario Giambelluca,Claudio Leto,Francesco D'Arpa,Massimo Midiri,Giuseppe Salvaggio

    更新日期:2019-11-01
  • Distribution and correlation of pancreatic gland size and duct diameters on MRCP in patients without evidence of pancreatic disease.
    Abdom. Radiol. (IF 2.147) Pub Date : 2019-01-03
    Qiushi Wang,Jordan Swensson,Maoqing Hu,Enming Cui,Temel Tirkes,Samuel G Jennings,Fatih Akisik

    PURPOSE To use MRCP to investigate age-related changes and gender differences of the pancreas and to correlate pancreatic gland size and duct diameter. METHODS In this institutional review, board-approved, HIPAA-compliant study, 280 patients (age 20-88 years) without a history of pancreatic or liver disease who had undergone MRI/MRCP from 2004 to 2015 were identified. The anteroposterior size and main duct diameter of the pancreatic head, body, and tail were measured. The pancreatic gland and duct sizes were compared between genders, and among seven age subgroups (20-29, 30-39, 40-49, 50-59, 60-69, 70-79, 80-89). RESULTS The pancreatic head and body were significantly larger in males than females (head, p < 0.01; body, p = 0.03), while the tail and the duct diameters of the pancreatic head, body, and tail showed no gender difference. As the age of male participants increased, there was an associated increase in size of the pancreatic gland initially (largest at age 50-59 (body) and 60-69 (head)), followed by subsequent decline in size thereafter. Additionally, the pancreatic duct diameter was found to increase gradually. In females, the size of the pancreatic gland decreased, while the diameter of the pancreatic duct increased with age. Moderate positive correlation for gland size and strong positive correlation for duct diameter among different pancreatic regions were found. Weak negative correlation was found between gland size and duct diameter. CONCLUSIONS There are gender differences in the gland size of the pancreatic head and body. The pancreatic gland size increases until the sixth decade in males, with a more continuous decrease in gland size with age in females. Both males and females demonstrate a marked decrease in gland size after the eighth decade. The duct diameter increases with age in both males and females.

    更新日期:2019-11-01
  • The Courvoisier's sign.
    Abdom. Radiol. (IF 2.147) Pub Date : 2019-01-03
    Dario Giambelluca,Mariangela Dimarco,Giuseppe Salvaggio,Massimo Midiri

    更新日期:2019-11-01
  • Radiographic stool quantification: an equivalence study of 484 symptomatic and asymptomatic subjects.
    Abdom. Radiol. (IF 2.147) Pub Date : 2018-12-16
    Omar Khan,Prasad R Shankar,Adish D Parikh,Richard H Cohan,Nahid Keshavarzi,Shokoufeh Khalatbari,Richard J Saad,Matthew S Davenport

    PURPOSE To determine if symptomatic patients referred for radiographic stool quantification have equivalent stool burden to asymptomatic patients. METHOD This was an IRB-approved HIPAA-compliant retrospective equivalence cohort study. An a priori equivalence power calculation was performed. Consecutive abdominal radiographs performed in adult outpatients with bloating, constipation, diarrhea, or abdominal pain to assess "fecal loading" [n = 242 (fecal cohort)] were compared to those performed in asymptomatic adult outpatients to assess "renal stones" [n = 242 (renal cohort)]. Radiographs were randomized and reviewed by two blinded independent abdominal radiologists. Exclusion criteria, designed to avoid unblinding, included urinary tract calculi ≥ 0.5 cm, multiple urinary tract calculi, and ureteral stent(s). Readers scored all radiographs (n = 484) for stool burden using validated Leech criteria [scale: 0 (none) to 15 (extreme diffuse)]. Mean Leech scores and 95% confidence intervals were calculated. Multivariable generalized linear modeling was performed to adjust for baseline medication use, age, and gender. The adjusted parameter estimate was used to test for equivalence in the mean difference between cohorts using Schuirmann's method of two one-sided t-tests. Inter-reader agreement was assessed with intraclass correlation coefficients. RESULTS Overall mean Leech scores for fecal [6.9 (95% CI 6.7, 7.2)] and renal [7.3 (95% CI 7.1, 7.5)] cohorts were equivalent within a margin of 0.75 (adjusted mean difference: - 0.4 [90% CI - 0.7, - 0.04]; p value = 0.02). Inter-reader agreement was good [ICC: 0.62 (95% CI 0.56, 0.68)]. CONCLUSION Radiographic stool quantification produces equivalent results in symptomatic and asymptomatic adults and is of uncertain value.

    更新日期:2019-11-01
  • Pancreatic neuroendocrine tumors: MR imaging features preoperatively predict lymph node metastasis.
    Abdom. Radiol. (IF 2.147) Pub Date : 2018-12-13
    Haitao Sun,Jianjun Zhou,Kai Liu,Tingting Shen,Xingxing Wang,Xiaolin Wang

    PURPOSES Predictive factors of lymph node metastasis (LNM) in pancreatic neuroendocrine tumors (pNETs) are not well established. We sought to identify the value of MR imaging features in preoperatively predicting the lymph node metastasis of pNETs. MATERIALS AND METHODS In this study, we enrolled 108 consecutive patients with pNETs between January 2009 and June 2018. MR morphologic features and quantitative data were evaluated. Predictors of LNM were evaluated using univariate and multivariate logistic regression models. RESULTS A total of 108 patients with pNETs were finally enrolled, including 82 LNM-negative and 26 LNM-positive patients. Features significantly related to the LNM of pNETs at univariate analysis were tumor size > 2 cm (P = 0.003), Ki-67 > 5% (P = 0.002), non-enhancement pattern (P < 0.001), apparent diffusion coefficient value (P < 0.001), main pancreatic duct dilation (P < 0.001) and pancreatic atrophy (P = 0.032) and extrapancreatic tumor spread (P = 0.001), CNRs during arterial, portal and delay phase (P = 0.005, 0.047, and 0.045, respectively), and histological classification (P = 0.006). At multivariate analysis, non-enhancement pattern (P = 0.019; odds ratio, 6.652; 95% CI 1.369, 32.321) and main pancreatic duct dilation (P = 0.018; odds ratio, 6.745; 95% CI 1.379, 32.991) were independent risk factors for predicting the LNM of pNETs. CONCLUSION The non-enhancement characteristic and main pancreatic duct dilation appear to be linked with LNM in pNETs. These radiological predictors can be easily obtained preoperatively, and may help to avoid missing pNETs with a high risk of LNM.

    更新日期:2019-11-01
  • Serum tumor markers and testicular germ cell tumors: a primer for radiologists.
    Abdom. Radiol. (IF 2.147) Pub Date : 2018-12-13
    Colin Marshall,Michael Enzerra,Amir Ata Rahnemai-Azar,Nikhil H Ramaiya

    Serum tumor markers (STMs) play a critical role in the diagnosis, staging and follow-up of both seminomatous and nonseminomatous testicular germ cell neoplasms. Levels of alpha-fetoprotein (AFP), human chorionic gonadotropin (HCG), and lactate dehydrogenase (LDH), especially those measured after orchiectomy, also have implications for patient prognosis. Given that testicular germ cell tumors represent the most common solid tumor in men aged 20-34, radiologists must have familiarity with the clinical utilization and implications of these STMs. This article will review the classical patterns of STM elevation most commonly seen in pure seminomatous and nonseminomatous germ cell tumors while also providing case-based examples highlighting the importance of STM correlation with imaging. The role of STMs in clinical staging and disease surveillance will also be discussed.

    更新日期:2019-11-01
  • Caveat regarding CMS Merit-based Incentive Payment Systems incidental adrenal nodule measure.
    Abdom. Radiol. (IF 2.147) Pub Date : 2018-12-14
    Joseph Holman,Roberto Salvatori,Elliot K Fishman,Pamela T Johnson

    Current Medicare MIP measures encourage radiologists not to recommend follow-up for ≤ 1 cm adrenal nodules. However, a radiologist may be the first to discover a small, subclinical pheochromocytoma. As such, recognition of the enhancement pattern of pheochromocytoma is important to ensure detection and properly guide management, which begins with clinical and laboratory assessment for elevated catecholamines.

    更新日期:2019-11-01
  • Structured versus narrative reporting of pelvic MRI in perianal fistulizing disease: impact on clarity, completeness, and surgical planning.
    Abdom. Radiol. (IF 2.147) Pub Date : 2018-12-07
    Ozum Tuncyurek,Alejandro Garces-Descovich,Adrian Jaramillo-Cardoso,Elena Esteban Durán,Thomas E Cataldo,Vitaliy Y Poylin,Said Fettane Gómez,Atenea Morcillo Cabrera,Tarek Hegazi,Kevin Beker,Koenraad J Mortele

    OBJECTIVE To evaluate clarity, completeness, and impact on surgical planning of MRI reporting of perianal fistulizing disease using a structured disease-specific template versus narrative reporting for planning of disease treatment by colorectal surgeons. MATERIALS AND METHODS In this HIPAA-compliant, IRB-approved study with waiver of informed consent, a structured reporting template for perianal fistulizing disease MRIs was developed based on collaboration between colorectal surgeons and abdominal radiologists. The study population included 45 consecutive patients who underwent pelvic MRI for perianal fistulizing disease prior to implementation of structured reporting, and 60 consecutive patients who underwent pelvic MRI for perianal fistulizing disease after implementation of structured reporting. Objective evaluation of the reports for the presence of 12 key features was performed, as also subjective evaluation regarding the clarity and completeness of reports, and impact on surgical planning. RESULTS Significantly more key features were absent in narrative reports [mean: 6.3 ± 1.8 (range 3-11)] than in structured reports [mean: 0.3 ± 0.9 (range 1-5)] (p ≤ 0.001). The use of structured reporting also increased the percentage of completeness (72.5-88.3% for surgeon 1, and 61.2-81.3% for surgeon 2; p = 0.05 and 0.03, respectively), helpfulness in surgical planning (7.1 ± 1.5-7.6 ± 1.5 for surgeon 1, and 5.8 ± 1.4-7.1 ± 1.1 for surgeon 2; p = 0.05 and p < 0.001, respectively), and clarity (7.6 ± 1.3-8.3 ± 1.1 for surgeon 1, and 5.2 ± 1.4-7.1 ± 1.3 for surgeon 2; p = 0.006 and p < 0.001, respectively) of the reports. CONCLUSION Structured MRI reports in patients with perianal fistulizing disease miss fewer key features than narrative reports. Moreover, structured reports were described as more complete and clear, and more helpful for treatment planning.

    更新日期:2019-11-01
  • Periportal pattern of primary hepatic lymphoma: a rare entity.
    Abdom. Radiol. (IF 2.147) Pub Date : 2018-12-05
    Surabhi Vyas,Sundeep Malla

    更新日期:2019-11-01
  • The inner tube sign in Ascariasis.
    Abdom. Radiol. (IF 2.147) Pub Date : 2018-12-01
    Kabilan Chokkappan,Manickam Subramanian

    更新日期:2019-11-01
  • The "spoke wheel" sign in hepatic focal nodular hyperplasia.
    Abdom. Radiol. (IF 2.147) Pub Date : 2018-11-30
    Dario Giambelluca,Adele Taibbi,Massimo Midiri,Tommaso Vincenzo Bartolotta

    更新日期:2019-11-01
  • The "zebra spleen".
    Abdom. Radiol. (IF 2.147) Pub Date : 2018-11-30
    Dario Giambelluca

    更新日期:2019-11-01
  • Abdominal and pelvic imaging findings associated with sex hormone abnormalities.
    Abdom. Radiol. (IF 2.147) Pub Date : 2018-11-30
    Nicole Kurzbard-Roach,Priyanka Jha,Liina Poder,Christine Menias

    Hormones are substances that serve as chemical communication between cells. They are unique biological molecules that affect multiple organ systems and play a key role in maintaining homoeostasis. In this role, they are usually produced from a single organ and have defined target organs. However, hormones can affect non-target organs as well. As such, biochemical and hormonal abnormalities can be associated with anatomic changes in multiple target as well as non-target organs. Hormone-related changes may take the form of an organ parenchymal abnormality, benign neoplasm, or even malignancy. Given the multifocal action of hormones, the observed imaging findings may be remote from the site of production, and may actually be multi-organ in nature. Anatomic findings related to hormone level abnormalities and/or laboratory biomarker changes may be identified with imaging. The purpose of this image-rich review is to sensitize radiologists to imaging findings in the abdomen and pelvis that may occur in the context of hormone abnormalities, focusing primarily on sex hormones and their influence on these organs.

    更新日期:2019-11-01
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