Mickey mouse sign

The “cogwheel” sign of hydrosalpinx

The “hemorrhage exclusion” sign

Jejunoileal fold pattern reversal in celiac disease

The “curlicue” ureter

2D shear wave elastography: measurement acquisition and reliability criteria in noninvasive assessment of liver fibrosis Abstract Purpose The objective was to evaluate the accuracy of 2D shear wave elastography (SWE) in predicting stages of liver fibrosis using five individual versus grouped measurements and different reliability criteria. Materials and methods This is a prospective study of 109 patients who underwent hepatic 2D SWE (Canon Aplio 500) prior to liver biopsy for varied indications. Liver fibrosis was staged using the METAVIR scoring system (F = 0–4). Propagation mapping was used to guide ten SWE measurements from the liver parenchyma: five individual measurements and five grouped measurements. IQR/median, SD/median, and SD/mean were examined as quality criteria for patient inclusion at various thresholds (IQR/median ≤ 0.15, 0.2, 0.3, 0.4, 0.5; SD/median ≤ 0.15, 0.2, 0.3; SD/mean ≤ 0.2, 0.3, 0.5). Threshold for clinically significant fibrosis (F ≥ 2) was determined with receiver operating characteristic (ROC) analysis. Results There was high agreement between individual and grouped measurements without statistically significant differences (intraclass correlation coefficient = 0.82; p = 0.26–0.96). When no quality criterion was used (n = 103), the optimal threshold was 11.3 kPa [AUROC 0.78, 95% CI (0.69, 0.88)] with sensitivity and specificity of 80% and 66%, respectively. All quality criteria were associated with equal or higher AUROC ranging from 0.78 to 0.87. IQR/median ≤ 0.5 (n = 88) achieved the highest sensitivity of 85% and only excluded a small subset of patients. The AUROC and specificity were 0.83 [95% CI (0.74, 0.92)] and 72%, respectively. Significance Quality criterion IQR/median ≤ 0.5 increases sensitivity and specificity in prediction of clinically significant liver fibrosis while excluding only a small subset of patients. Grouped measurements are comparable to individual measurements and may help increase procedural efficiency.

Current concepts in portal vein thrombosis: etiology, clinical presentation and management Abstract Objective The aim of this article is to focus on etiology, risk factors, clinical presentation and classification systems of acute and chronic PVT as well as focusing on current diagnostic and therapeutic options for the management of acute and chronic PVT. Results PVT represents a serious clinical concern in cirrhotic patients and in those with specific local or systemic risk factors. The rate and extent of thrombus formation can significantly impact patient presentation and the resulting clinical outcomes. The presentation of acute PVT can range from abdominal pain to intestinal ischemia/infarction and even death, while chronic PVT can remain clinically silent. A number of imaging modalities including US, CT and MRI can be used to confirm the diagnosis. In addition to addressing underlying risk factors, AC therapy forms a cornerstone of treatment and has demonstrated efficacy in both acute and chronic settings. Proper caution should be used when initiating AC therapy in cirrhotic patients given their underlying coagulopathic status with attention now being paid to NOACs and LMWH. For patients with bowel ischemia, extensive thrombosis, contraindications or poor response to AC, or for those with co-morbidities that preclude AC, minimally invasive endovascular techniques offer alternative treatment options. Conclusion Familiarity with the etiology, clinical presentation and classification of PVT optimize early detection and incorporate effective therapeutic options, the management of these complex patients should be undertaken by a multidisciplinary team. Minimally invasive catheter-based therapies and endovascular portosystemic shunt creation demonstrated efficacy in the treatment of AC-resistant patients and for patients with extensive or complicated disease.

Prostate cancer aggressive prediction: preponderant diagnostic performances of intravoxel incoherent motion (IVIM) imaging and diffusion kurtosis imaging (DKI) beyond ADC at 3.0 T scanner with gleason score at final pathology Abstract Purpose To explore the preponderant diagnostic performances of IVIM and DKI in predicting the Gleason score (GS) of prostate cancer. Methods Diffusion-weighted imaging data were postprocessed using monoexponential, lVIM and DK models to quantitate the apparent diffusion coefficient (ADC), molecular diffusion coefficient (D), perfusion-related diffusion coefficient (Dstar), perfusion fraction (F), apparent diffusion for Gaussian distribution (Dapp), and apparent kurtosis coefficient (Kapp). Spearman’s rank correlation coefficient was used to explore the relationship between those parameters and the GS, Kruskal–Wallis test, and Mann–Whitney U test were performed to compare the above parameters between the different groups, and a receiver-operating characteristic (ROC) curve was used to analyze the differential diagnosis ability. The interpretation of the results is in view of histopathologic tumor tissue composition. Results The area under the ROC curves (AUCs) of ADC, F, D, Dapp, and Kapp in differentiating GS ≤ 3 + 4 and GS > 3 + 4 PCa were 0.744 (95% CI 0.581–0.868), 0.726 (95% CI 0.563–0.855), 0.732 (95% CI 0.569–0.860), and 0.752 (95% CI 0.590–0.875), 0.766 (95% CI 0.606–0.885), respectively, and those in differentiating GS ≤ 7 and GS > 7 PCa were 0.755 (95% CI 0.594–0.877), 0.734 (95% CI 0.571–0.861), 0.724 (95% CI0.560–0.853), and 0.716 (95% CI 0.552–0.847), 0.828 (95% CI 0.676–0.929), respectively. All the P values were less than 0.05. There was no significant difference in the AUC for the detection of different GS groups by using those parameters. Conclusion Both the IVIM and DKI models are beneficial to predict GS of PCa and indirectly predict its aggressiveness, and they have a comparable diagnostic performance with each other as well as ADC.

Reducing radiation dose for multi-phase contrast-enhanced dual energy renal CT: pilot study evaluating prior iterative reconstruction Abstract Purpose Prior iterative reconstruction (PIR) uses spatial information from one phase of enhancement to reduce image noise in other phases. We sought to determine if PIR could reduce radiation dose while preserving observer performance and CT number at multi-phase dual energy (DE) renal CT. Methods CT projection data from multi-phase DE renal CT examinations were collected. Images corresponding to 40% radiation dose were reconstructed using validated noise insertion and PIR. Three genitourinary radiologists examined routine and 40% dose PIR images. Probability of malignancy was assessed [from 0 to 100] with malignancy assumed at probability ≥ 75. Observer performance was compared on a per patient and per lesion level. CT number accuracy was measured. Results Twenty-three patients had 49 renal lesions (11 solid renal neoplasms). CT number was nearly identical between techniques (mean CT number difference: unenhanced 2 ± 2 HU; enhanced 4 ± 4 HU). AUC for malignancy was similar between multi-phase routine dose DE and lower dose PIR images [per patient: 0.950 vs. 0.916 (p = 0.356); per lesion: 0.931 vs. 0.884 (p = 0.304)]. Per patient sensitivity was also similar (78% routine dose vs. 82% lower dose [p ≥ 0.99]), as was specificity (91% routine dose vs. 93% lower dose PIR [p > 0.99]), with similar findings on a per lesion level. Subjective image quality was also similar (p = 0.34). Conclusions Prior iterative reconstruction is a new reconstruction method for multi-phase CT examinations that promises to facilitate radiation dose reduction by over 50% for multi-phase DE renal CT exams without compromising CT number or observer performance.

Baseline perfusion CT parameters as potential biomarkers in predicting long-term prognosis of localized clear cell renal cell carcinoma Abstract Purpose We aimed to explore the relationship among baseline perfusion CT parameters, clinical, and pathological factors with post-nephrectomy long-term progression-free survival in localized clear cell renal cell carcinoma. Materials and methods This study retrospectively collected 127 patients from March 2005 to May 2007 who undertook perfusion CT. 61 patients were confirmed of pT1N0M0 or pT2N0M0 ccRCC. The mean follow-up time is 118.8 months (± 13.1 m, range 72–135 m). We compared clinical, pathological factors (gender, T stage, age, Fuhrmann grade, VEGF level, and MVD), and perfusion parameters before treatment [blood flow (BF), blood volume, mean transition time, and permeability surface-area product] between groups with post-nephrectomy metastasis and without metastasis. Association between covariates and progression-free survival (PFS) were analyzed using Cox proportional regression. Results Among 61 patients, 11 developed distant metastasis (10 in the lung, one in the bone). BF in metastatic group [429.1 (233.8, 570.1) ml/min/100 g] was significantly higher than non-metastatic group [214.3 (153.3, 376.5) ml/min/100 g] (p = 0.011). Metastatic group also had more patients with higher Fuhrmann grade. Multi-covariant Cox regression demonstrated T staging, Fuhrmann grade, and BF were significantly associated with PFS [hazard ratio (HR) 3.35, 3.08, and 1.006]. In another model, BF > 230 ml/min/100 g was associated with PFS (HR 12.90), along with T staging and Fuhrmann grade (HR 4.73, 3.69). Conclusion Baseline tumor BF is a potential biomarker in prediction long-term metastasis of localized ccRCC and may help screening for higher risk localized ccRCC patients who need personalized surveillance strategy after nephrectomy.