Inter-observer agreement in identifying traction bronchiectasis on computed tomography: its improvement with the use of the additional criteria for chronic fibrosing interstitial pneumonia Abstract Purpose To assess inter-observer variability in identifying traction bronchiectasis on computed tomography (CT) using additional criteria for chronic fibrosing interstitial pneumonia. Methods Seven experts categorized CT image set representing 39 patients into three groups on the basis of the presence of traction bronchiectasis, using a three-point scale: 3—definitely/probably yes; 2—possibly yes; and 1—definitely/probably no. This scale served as a reference standard. The image set included cases of chronic fibrosing interstitial pneumonia, non-interstitial lung disease, and difficult-to-determine cases. Forty-eight observers similarly assessed the same image set, first according to the Fleischner Society definition, and second with additional criteria, in which traction bronchiectasis was observed exclusively in chronic fibrosing interstitial pneumonia. The agreement level between the reference standard and each observer’s evaluation in each session was calculated using weighted kappa values which were compared between the two sessions using a paired t test. Results The mean weighted kappa value for all observers was significantly higher in the second reading session (mean 0.75) than in the first reading session (mean 0.62) (p < 0.001). Conclusion Inter-observer agreement in identifying traction bronchiectasis improves when using the additional criteria which specify chronic fibrosing interstitial pneumonia as the underlying disease.

Four “fine” messages from four kinds of “fine” forgotten ligaments of the anterior abdominal wall: have you heard their voices? Abstract On the posterior aspect of the anterior abdominal wall, there are four kinds of “fine” ligaments. They are: the round ligament of the liver, median umbilical ligament (UL), a pair of medial ULs, and a pair of lateral ULs. Four of them (the round ligament, median UL, and paired medial ULs) meet at the umbilicus because they originate from the contents of the umbilical cord. The round ligament of the liver originates from the umbilical vein, the medial ULs from the umbilical arteries, and the median UL from the urachus. These structures help radiologists identify right-sided round ligament (RSRL) (a rare, but surgically important normal variant), as well as to differentiate groin hernias. The ligaments can be involved in inflammation; moreover, tumors can arise from them. Unique symptoms such as umbilical discharge and/or location of pathologies relating to their embryology are important in diagnosing their pathologies. In this article, we comprehensively review the anatomy, embryology, and pathology of the “fine” abdominal ligaments and highlight representative cases with emphasis on clinical significance.

Neuroimaging of Alzheimer’s disease: focus on amyloid and tau PET Abstract Although the diagnosis of dementia is still largely a clinical one, based on history and disease course, neuroimaging has dramatically increased our ability to accurately diagnose it. Neuroimaging modalities now play a wider role in dementia beyond their traditional role of excluding neurosurgical lesions and are recommended in most clinical guidelines for dementia. In addition, new neuroimaging methods facilitate the diagnosis of most neurodegenerative conditions after symptom onset and show diagnostic promise even in the very early or presymptomatic phases of some diseases. In the case of Alzheimer’s disease (AD), extracellular amyloid-β (Aβ) aggregates and intracellular tau neurofibrillary tangles are the two neuropathological hallmarks of the disease. Recent molecular imaging techniques using amyloid and tau PET ligands have led to preclinical diagnosis and improved differential diagnosis as well as narrowed subject selection and treatment monitoring in clinical trials aimed at delaying or preventing the symptomatic phase of AD. This review discusses the recent progress in amyloid and tau PET imaging and the key findings achieved by the use of this molecular imaging modality related to the respective roles of Aβ and tau in AD, as well as its specific limitations.

Hepatocellular carcinoma and macrovascular tumor thrombosis: treatment outcomes and prognostic factors for survival Abstract Purpose To determine the treatment outcome and prognostic factors for survival in patients with hepatocellular carcinoma (HCC) and macrovascular tumor thrombosis (MTT). Methods Between January 2010 and December 2018, 66 patients diagnosed with HCC and MTT, who received specific treatment were included. Various clinical and imaging data, treatment methods, outcomes, prognostic factors, and overall survival were evaluated. Outcomes were compared with those of 24 patients treated with supportive care. Results Most patients with HCC and MTT showed disease progression (80.3%) and a low 5-year survival rate. The median survival time after treatment was 13 months (vs. supportive care group 3 months, p < 0.001). Main branch MTT (p = 0.036), extent of tumor thrombus > 1 segment (p = 0.039), presence of ascites (p = 0.009) and among treatment methods, systemic therapy alone (p = 0.007), and supportive care (p < 0.001) compared with combined local with systemic therapies were prognostic factors for poor survival. Conclusions Although most patients with HCC and MTT showed disease progression, median survival time was significantly longer than that with supportive care. Main branch and > 1 segment involvement of MTT and presence of ascites were significant prognostic factors for poor survival. Combined local and systemic therapy over systemic therapy alone are recommended for patients with these advanced stage HCCs.

Detecting joints with erosion(s) in rheumatoid arthritis: a novel individualized-ultrasound method performs better than existing methods Abstract Purpose To determine if a novel individualized-ultrasound (IUS) method can detect more joints with erosion(s) in rheumatoid arthritis (RA) patients versus existing methods. Materials and methods The IUS method selects up to 7 or 14 ultrasonographically most inflamed joints whereas existing methods pre-fix 7 or 14 joints for ultrasonography. Using ultrasonography, the mean total inflammatory score (TIS), mean number of affected joints and mean number of joints with erosion(s) were compared between novel and existing methods among 30 RA patients using the paired Student t test. Results Using 7-joint approach, comparing IUS versus existing methods, the mean (95% CI) for TIS, number of affected joints, and number of joints with erosion(s) were: 2.18 (1.88, 2.48) versus 0.95 (0.78, 1.11); 7 (7, 7) versus 4.43 (3.93, 4.94); 3.20 (2.44, 3.96) versus 1.33 (0.94, 1.72), respectively. Using 14-joint approach, comparing IUS versus existing methods, the mean (95% CI) for TIS, number of affected joints, and number of joints with erosion(s) were: 3.17 (2.75, 3.6) versus 1.71 (1.38, 2.04); 13.5 (13.05, 13.95) versus 8.13 (7.24, 9.02); 4.23 (3.13, 5.34) versus 2.77 (2.03, 3.50), respectively. p values all < 0.0001. Conclusions A novel IUS method detects substantially more joints with erosion(s) in RA patients versus existing methods.

Development of a deep learning model to identify hyperdense MCA sign in patients with acute ischemic stroke Abstract Purpose The aim of this study was to develop an interactive deep learning-assisted identification of the hyperdense middle cerebral artery (MCA) sign (HMCAS) on non-contrast computed tomography (CT) among patients with acute ischemic stroke. Materials and methods 35 HMCAS-positive and 39 HMCAS-negative samples extracted by 50-pixel-diameter circular regions of interest were obtained as training and validation datasets according to the consensus decisions of two experienced neuroradiologists. Data augmentation was performed to increase the number of training samples. A deep convolutional neural network (DCNN) (Xception) was used to classify input images as HMCAS-positive or -negative. Leave-one-case-out cross-validation was achieved to estimate sensitivity, specificity, and accuracy of the deep learning-based training model for identifying HMCAS. Results In terms of diagnostic performance, DCNN for HMCAS offered 82.9% sensitivity, 89.7% specificity, and 86.5% accuracy in leave-one-case-out cross-validation. Area under the receiver operating characteristic curve for HMCAS was 0.947 (95% confidence interval 0.895–0.998; P < 0.05). Conclusion The deep learning method appears potentially beneficial for identifying HMCAS on non-contrast CT in patients with acute ischemic stroke.

Long-term outcomes of endovascular aortic aneurysm repair with the Zenith AAA endovascular graft: a single-center study Abstract Purpose To present long-term results obtained with endovascular abdominal aortic aneurysm (AAA) repair (EVAR) using the Zenith AAA endovascular graft from a single institution. Materials and methods Between 2007 and 2013, 95 consecutive patients (median age 77 years) underwent EVAR using Zenith. Data were prospectively collected and retrospectively analyzed until 2019. Primary outcomes were overall survival, freedom from AAA rupture, and freedom from AAA-related death. Secondary outcomes were freedom from late (> 30 days) re-intervention and surgical conversion, and freedom from aneurysm sac growth (> 5 mm). Results The initial technical success rate was 96.8%. There were no deaths or intraoperative conversions. Overall survival at 1, 3, 5, and 10 years was 90.8%, 81.7%. 74.3%, and 57.2%, respectively. AAA rupture occurred in one patient (1.1%). Freedom from AAA-related death was 100% during the follow-up period. Freedom from aneurysm sac growth at 1, 3, 5, and 10 years was 98.8%, 86.4%, 76.9%, 53.0%, respectively. Freedom from late re-intervention and open surgical conversion at 1, 3, 5, and 10 years was 98.9%, 88.9%, 86.7, and 57.9%, respectively. Conclusion EVAR with Zenith endografts represents a safe and durable means of AAA repair, and risk of rupture and aneurysm-related death are low.

Early volume reduction of the hippocampus after whole-brain radiation therapy: an automated brain structure segmentation study Abstract Purpose To assess atrophy differences among brain regions and time-dependent changes after whole-brain radiation therapy (WBRT). Materials and methods Twenty patients with lung cancer who underwent both WBRT and chemotherapy (WBRT group) and 18 patients with lung cancer who underwent only chemotherapy (control group) were recruited. Three-dimensional T1WI were analyzed to calculate volume reduction ratio after WBRT in various brain structures. The volume reduction ratio of the hippocampus was compared among following 3 periods: 0–3, 4–7, and 8–11 months after WBRT. Results The volume reduction ratio of the hippocampus was significantly higher in the WBRT group than in the control group (p < 0.05). In WBRT group, the volume reduction ratio of the hippocampus was significantly higher than that of the cortex and white matter (p < 0.05). There were significant differences in the volume reduction ratio between of 0–3 months and that of 4–7 months (p = 0.02) and between 4–7 months and that of 8–11 months (p = 0.01). Conclusion The hippocampus is more vulnerable to the radiation compared with other brain regions and may become atrophic even in the early stage after WBRT.

Computed tomography findings of ceftriaxone-associated biliary pseudocholelithiasis in adults Abstract Purpose This study aimed to characterize the computed tomography (CT) findings of pseudolithiasis and investigate the outcomes and natural history in adult patients receiving CTRX therapy. Methods A total of 17 patients were diagnosed with CTRX-associated biliary pseudolithiasis on CT between April 2013 and March 2017. The medical records, characteristics, complications, treatment options, and outcomes of these patients were examined. Serial CT images and the form, density, and location of pseudolithiasis were reviewed by two radiologists. Results Of the 17 patients with CTRX-associated pseudolithiasis, seven were men and ten were women. The median patient age was 78 years (range 31–88 years). The median interval from CTRX administration to the diagnosis of pseudolithiasis was 10 days (range 4–32 days). The CT findings of pseudolithiasis included a sludge pattern (11 patients [64.7%]), stone pattern (two patients [11.8%]), and stone plus sludge pattern (four patients [23.5%]). Seven patients (41.2%) showed gall bladder enlargement along with a common bile duct (CBD) stone. Two patients with CBD stones underwent endoscopic CBD stone removal. The median time to pseudolithiasis resolution after CTRX cessation was 69 days. Conclusion The high-density sludge pattern is the most common typical CT finding of CTRX-associated pseudolithiasis in adults.

Renal pelvic and ureteral wall thickening in renal cell carcinoma: prevalence, cause, and clinical significance Abstract Purpose This study was performed to characterize renal pelvic and ureteral wall thickening (PUWT) in renal cell carcinoma (RCC) patients, including prevalence, cause, and detailed radiological findings based on contrast-enhanced CT, and to correlate these features with corresponding pathological findings. Materials and methods 152 patients pathologically diagnosed with RCC by surgery were included. Two radiologists retrospectively evaluated the presence of PUWT and the radiological characteristics based on CT. Relationships among clinical characteristics, CT findings, and PUWT were evaluated. Pathological findings of PUWT were also investigated. Results The prevalence of RCC-related PUWT was 10% (N = 15). PUWT was frequently observed in cases with advanced TNM stage. Tumor thrombus, sinus extent, and peritumoral neovascularity were significantly more frequent in cases with PUWT. PUWT was observed at the pelvis or from the pelvis to the upper ureter. Fourteen of 15 cases in which the pelvic/ureteral wall was pathologically investigated did not show any pathological abnormalities. Conclusion The prevalence of PUWT was 10% and most cases were thought to be caused by temporary vascular dilatation in the pelvis and ureter, which is a secondary condition caused by hypervascular RCC, and not a direct result of tumor invasion.