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Objective: It is now recognized that ovarian cancer includes a heterogeneous group of malignant epithelial tumors originating from the ovaries, fallopian tubes, or peritoneum. This development has prompted the International Federation of Gynecology and Obstetrics (FIGO) to issue a revised staging system that can provide prognostic information and guidance on personalized management of ovarian cancer., Conclusion: We review the epidemiology of ovarian cancer, the new FIGO staging system, and the role of imaging in the assessment, staging, and follow-up of ovarian cancer.

Objective: The purpose of this article is to describe the imaging features of diseases that may closely simulate pancreatic adenocarcinoma, either radiologically or pathologically., Conclusion: Neoplastic and inflammatory diseases that can closely simulate pancreatic adenocarcinoma include neuroendocrine tumor, metastasis to the pancreas, lymphoma, groove pancreatitis, autoimmune pancreatitis, and focal chronic pancreatitis. Atypical imaging findings that should suggest diagnoses other than adenocarcinoma include the absence of significant duct dilatation, incidental detection, hypervascularity, large size (> 5 cm), IV tumor thrombus, and intralesional ducts or cysts.

Objective: Repeat imaging at the transfer of care between institutions is a potential source of overutilization. The purpose of this study was to assess whether importing images obtained at one institution to the PACS at another institution reduces the number of repeat imaging examinations performed, sparing patients unnecessary cost and radiation., Materials and Methods: Informed consent was waived for this retrospective study, which included 267 patients who had undergone CT or MRI of the abdomen at our or another institution within 4 months before transarterial chemoembolization. Patients were divided into the following four groups based on the availability of their images from institutions other than ours (outside images): outside imaging performed but images not available; outside images available on CD or film but not imported; outside images imported to PACS; and no outside imaging, that is, all imaging performed at our institution. The rates of repeat imaging in the four groups were compared., Results: When outside images were not available, 72% (13/18) of patients underwent repeat imaging; when outside images were available but not imported, 52% (14/27); when outside images were imported to PACS, 11% (9/79); and when imaging was performed only at our institution, 13% (18/143). Patients whose outside images were imported were significantly less likely to undergo repeat imaging than were both groups whose outside images were not imported (p < 0.001), and their rate of repeat imaging was similar to that of patients who did not undergo outside imaging (p = 0.79). After adjustment for potential confounders, including age, sex, referring institution, and size and number of lesions, the odds that a patient whose images were imported would undergo repeat imaging were significantly lower than those of a patient whose outside images were not imported (odds ratios, 31 for images not available and 9.0 for images available but not imported; both p < 0.001) and were similar to those of a patient who underwent all imaging at our institution (odds ratio, 0.71; p = 0.51)., Conclusion: Importing outside images to PACS reduces the rate of repeat imaging.

Objective: The purpose of this article is to develop and validate a chemical-shift imaging-derived color mapping system for evaluation of liver steatosis., Materials and Methods: Opposed phase MRI was evaluated for 85 subjects (51 with presumed nonalcoholic fatty liver disease and 34 healthy volunteers). Liver signal intensity loss was compared with histologic analysis for 52 subjects, assuming grade 0 steatosis for healthy volunteers, to determine signal-intensity-loss threshold points differentiating steatosis grades and subsequent Spearman correlation. Color scale grading was then applied for 78 subjects. Interpretation of color maps for steatosis severity and heterogeneity was performed by three readers. Analyses of agreement among readers and of color map steatosis grade with biopsy were performed using weighted kappa values., Results: The numbers of subjects with steatosis grades 0, 1, 2, and 3 were 41, 12, 13, and 19, respectively. A correlation of 0.90 was obtained using selected threshold values of 5.9% or less, 6-26.1%, 26.2-36.8%, and greater than 36.8% for steatosis grades 0, 1, 2, and 3, respectively. Interobserver agreement for color map grading of steatosis was excellent (κ = 0.93-0.94). Color map interpretation for all readers also showed excellent agreement with histologic findings for whole liver (κ = 0.82-0.86) and estimated biopsy site location (κ = 0.81-0.86; anterior region of right lobe). Heterogeneous steatosis on color maps was identified in 56-60% of subjects with nonalcoholic fatty liver disease and in 7% of healthy volunteers and was associated with greater disagreement between color map and histology grading (61-74%) compared with the whole group (37-40%)., Conclusion: MRI-derived color map estimation of liver steatosis grade appears to be reproducible and accurate.

Objective: The objective of our study was to determine the role and relative accuracy of CT and MRI in the characterization of cystic pancreatic masses., Materials and Methods: We retrospectively identified 58 patients with histopathologically proven cystic pancreatic masses at our institution who underwent preoperative CT (n = 40), MRI (n = 6), or both (n = 12). Two radiologists independently recorded their leading diagnoses with levels of diagnostic certainty (0-100%), their estimates of overall likelihood of malignancy (0-100%), and the morphologic characteristics of the tumors. Data were analyzed to determine relative accuracy in the diagnosis of malignancy, relationship between diagnostic certainty and accuracy, and frequency of malignancy in unilocular thin-walled cysts smaller than 4 cm., Results: Twenty-one (36%) of 58 masses were malignant. CT and MRI were equally accurate in establishing the diagnosis of malignancy (area under the receiver operating characteristic curve [A(z)] = 0.91 and 0.85 for reviewers 1 and 2 at MRI vs 0.82 and 0.76 at CT, respectively; p > 0.05). The leading diagnosis given by reviewers 1 and 2 was correct in 46% (32/70) and 43% (30/70) of the studies, respectively. When reviewer diagnostic certainty was 90% or more, the corresponding values were not significantly (p > 0.05) improved at 55% (12/22) and 48% (10/21), respectively. Two (15%) of 13 unilocular thin-walled cysts smaller than 4 cm were frankly malignant., Conclusion: CT and MRI are reasonably and similarly accurate in the characterization of cystic pancreatic masses as benign or malignant; limitations include a substantial rate of misdiagnosis even when reviewer certainty is high and a moderate frequency of malignancy in small morphologically benign-appearing cysts.

Objective: The purpose of this study was to determine the accuracy of CT in differentiating adenomyomatosis from gallbladder cancer., Materials and Methods: We retrospectively identified the cases of 36 patients with pathologically proven adenomyomatosis (n = 22) or gallbladder cancer (n = 14) who had undergone preoperative abdominal CT. Two reviewers independently evaluated the presence and nature of morphologic gallbladder abnormalities, including the presence of intramural diverticula (i.e., small cystic-appearing spaces within the gallbladder wall). The reviewers used a five-point scale (1, definitely absent; 5, definitely present) to rate the overall likelihood of the presence of adenomyomatosis and gallbladder cancer. Ratings were dichotomized such that a diagnosis was considered present at a rating of 4 or 5 and considered absent at lower ratings., Results: Reviewer 1 detected a morphologic gallbladder abnormality in 17 patients and correctly characterized the abnormality in 14 (82%) of the patients (eight with adenomyomatosis and six with gallbladder cancer). Reviewer 2 detected an abnormality in 18 patients and was correct for 13 (72%) of the patients (eight with adenomyomatosis and five with gallbladder cancer). In particular, reviewer 1 detected intramural diverticula in eight patients, and all had the pathologic diagnosis of adenomyomatosis, whereas reviewer 2 detected intramural diverticula in 11 patients, and eight (73%) had the pathologic diagnosis of adenomyomatosis., Conclusion: CT is limited in the detection and differentiation of adenomyomatosis and gallbladder cancer, but the diagnosis of adenomyomatosis can be made with reasonable accuracy when thickening of the gallbladder wall is seen to contain small cystic-appearing spaces.

Objective: The objective of our study was to determine the accuracy of endorectal MRI and MR spectroscopic imaging (MRSI) in the diagnosis of prostate cancer in patients with an elevated serum prostate-specific antigen (PSA) level., Materials and Methods: We retrospectively identified 40 patients with an elevated serum PSA level and without a histologic diagnosis of prostate cancer who underwent endorectal MRI and MRSI at our institution. On the basis of MRI findings alone and then combined MRI and MRSI findings, a single experienced observer rated the presence or absence of prostate cancer in each side of the prostate on a 5-point scale (1 = definitely absent, 5 = definitely present). Areas under the receiver operating characteristic (ROC) curve were calculated using the hemiprostate as the unit of analysis. The presence or absence of cancer on subsequent endorectal sonographically guided sextant biopsy was used as the standard of reference., Results: Biopsy revealed no cancer in 24 patients, bilateral cancer in 11, and unilateral cancer in five. The areas under the ROC curve for the diagnosis of prostate cancer by hemigland was 0.70 for MRI alone and 0.63 for combined MRI and MRSI (no significant difference, p = 0.32)., Conclusion: Endorectal MRI and MRSI are reasonably accurate for the diagnosis of prostate cancer in patients with an elevated serum PSA level, but the remaining limitations suggest that MRI and MRSI should be used as a supplement rather than a replacement for biopsy using the current technology and diagnostic criteria.

Objective: The purpose of this pictorial essay is to review the differential considerations when an adnexal mass is detected on CT or MRI in a patient with a primary nonovarian malignancy., Conclusion: Such adnexal masses may be metastases to the ovaries, primary ovarian malignancy, or incidental benign disorders. Solid masses are more likely metastases, but metastases can be predominantly cystic and primary ovarian cancers can be solid. MRI may help characterize incidental benign entities such as endometriosis, fibroma, and peritoneal inclusion cysts.

Objective: The purpose of this article is to describe the appearance and causes of inferior vena cava (IVC) filling defects, how such findings may be accurately characterized, and the clinical significance of IVC filling defects. Filling defects in the IVC observed at MDCT and MRI may be a result of flow artifacts, anatomic variants, or bland or malignant thrombus., Conclusion: Familiarity with anatomy and flow effects is critical for distinguishing true from false filling defects in the IVC. Delayed imaging after administration of IV contrast material and dedicated MRI sequences may be helpful for further characterization of such findings. Once a true filling defect of the IVC is established, identification of the cause, whether benign or malignant, and extent will guide clinical treatment.

Objective: Our aim was to determine the supplemental value of MRI in fetal abdominal disease detected on prenatal sonography., Conclusion: Our preliminary results suggest the primary supplemental value of MRI relative to sonography in fetal abdominal disease lies in improved tissue characterization rather than in improved anatomic characterization.

Objective: We sought to investigate the concordance between second-order portal venous and biliary tract anatomies using MDCT angiography and MDCT cholangiography., Materials and Methods: We retrospectively identified 56 living related potential liver donors who underwent both MDCT angiography and MDCT cholangiography. Two reviewers independently rated axial images and 3D reconstructions of MDCT angiograms and cholangiograms as diagnostic or nondiagnostic with respect to depiction of second-order portal venous and biliary tract anatomies. In images rated as diagnostic, second-order portal venous and biliary tract anatomies were categorized as conventional or variant. The concordance between portal venous and biliary tract anatomies was analyzed using McNemar exact chi-square test., Results: All examinations were diagnostic. Second-order portal venous variants were seen in 10 (18%) and biliary branch variants were seen in 23 (41%) of the 56 patients. Patients with variant portal venous anatomy (6/10, 60%) were more likely to have variant biliary tract anatomy than patients with conventional portal venous anatomy (17/46, 37%; p < 0.01). The sensitivity of variant portal venous anatomy as a marker for variant biliary anatomy was 26% (6/23 patients)., Conclusion: Concordance between second-order portal venous and biliary tract anatomies is statistically significant. However, in our series, a number of patients with conventional portal venous anatomy had variant biliary anatomy; therefore, the finding of conventional portal venous anatomy does not obviate preoperative biliary tract imaging in patients before liver donation.

Objective: The purpose of this report is to describe the frequency and histopathologic basis of benign hypervascular liver nodules seen on CT in patients with autoimmune hepatitis., Conclusion: Benign hypervascular liver nodules may be seen on CT in patients with cirrhosis due to autoimmune hepatitis and may represent large regenerative nodules. This phenomenon is important to recognize because of the potential for confusion with hepatocellular carcinoma.

Objective: The purpose of this investigation was to explore the clinical relevance of retrograde inferior vena cava or hepatic vein opacification during contrast-enhanced CT., Materials and Methods: We retrospectively identified 127 patients who underwent contemporaneous contrast-enhanced CT of the chest or abdomen and echocardiography. On CT, the presence of retrograde inferior vena cava or hepatic vein opacification and the rate of IV contrast injection (> 3 mL/sec, high; < or = 3 mL/sec, low) were recorded. On echocardiography, the presence of tricuspid regurgitation, pulmonary hypertension, or right ventricular systolic dysfunction was recorded., Results: Retrograde inferior vena cava or hepatic vein opacification was more common in studies performed with a high rather than a low contrast injection rate (28/56 vs 6/71 patients, respectively; p < 0.01). This finding was 31% sensitive (5/16) and 98% specific (54/55) for right-sided heart disease at low contrast injection rates, and 81% sensitive (17/21) and 69% specific (24/35) at high injection rates. Multivariate logistic regression models showed that high injection rate, tricuspid regurgitation, pulmonary hypertension, and right ventricular systolic dysfunction were independent predictors of retrograde inferior vena cava or hepatic vein opacification (p < 0.05 for each)., Conclusion: Retrograde opacification of the inferior vena cava or hepatic veins on CT is a specific but insensitive sign of right-sided heart disease at low contrast injection rates, but the usefulness of this classic sign decreases with high injection rates. This realization is important because many centers increasingly use high-injection-rate CT.

Objective: Our aim was to determine the effect of prior transrectal biopsy on endorectal MRI and MR spectroscopic imaging findings in patients with organ-confined prostate cancer., Materials and Methods: Endorectal MRI and MR spectroscopic imaging were performed in 43 patients with biopsy-proven prostate cancer before radical prostatectomy confirming organ-confined disease. For each sextant, two independent reviewers scored the degree of hemorrhage on a scale from 1 to 5 and recorded the presence or absence of capsular irregularity. A spectroscopist recorded the number of spectrally degraded voxels in the peripheral zone. The outcome variables of capsular irregularity and spectral degradation were correlated with the predictor variables of time from biopsy and degree of hemorrhage after biopsy., Results: Capsular irregularity was unrelated to time from biopsy or to degree of hemorrhage. Spectral degradation was inversely related to time from biopsy (p < 0.01); the mean percentage of degraded peripheral zone voxels was 18.5% within 8 weeks of biopsy compared with 7% after 8 weeks. Spectral degradation was unrelated to the degree of hemorrhage., Conclusion: In organ-confined prostate cancer, capsular irregularity can be seen at any time after biopsy and is independent of the degree of hemorrhage, whereas spectral degradation is seen predominantly in the first 8 weeks after biopsy. MRI staging criteria and guidelines for scheduling studies after biopsy may require appropriate modification.

Objective: Our aim was to determine whether parallel imaging and diffusion tensor imaging affect the measurement of apparent diffusion coefficient (ADC) during diffusion-weighted MRI of the liver in healthy volunteers., Subjects and Methods: We performed breath-hold single-shot echo-planar diffusion-weighted MRI of the liver in 10 healthy volunteers using conventional diffusion, conventional diffusion with parallel imaging, and diffusion tensor with parallel imaging sequences. TE values for the three sequences were 83, 74, and 63, respectively. Liver signal intensity was measured on all sequences and normalized to the SD of the measurement. Hepatic ADC was calculated by acquiring all sequences with b values of 0 and 500 sec/mm(2)., Results: The normalized liver signal intensity was higher on diffusion tensor with parallel imaging and conventional diffusion with parallel imaging than on conventional diffusion without parallel imaging for a b value of 500 sec/mm(2) (13.0 and 10.1 vs 9.1, respectively; p < 0.03) and for a b value of 0 sec/mm(2) (9.0 and 7.6 vs 6.9, respectively; without reaching a significant difference, p = 0.12). Hepatic ADC was not significantly different between sequences (p = 0.16)., Conclusion: Higher signal intensity can be obtained when using parallel imaging and diffusion tensor imaging during diffusion-weighted MRI of the liver without compromising hepatic ADC measurement.

Objective: We sought to describe the role of opposed-phase MRI in the diagnosis of nodular fatty sparing in the liver., Conclusion: Nodular fatty sparing of the liver displays characteristic findings on opposed-phase MRI. Because the lesion may otherwise mimic a hepatic tumor, knowledge of these findings may prevent unnecessary biopsy or inappropriate treatment.

Objective: We undertook this study to determine the causes of peritoneal calcification seen on CT and to investigate which CT features distinguish benign from malignant peritoneal calcification., Materials and Methods: Seventeen patients with peritoneal calcification were identified through retrospective review of reports from 74765 abdominopelvic CT examinations performed during a 7-year period. We determined the cause of peritoneal calcification by examining medical and histopathologic records. Calcification morphology was classified as nodular or sheetlike on the basis of the consensus interpretation by two independent radiologists. The radiologists also recorded the presence or absence of associated soft-tissue components or lymph node calcification. The association between the CT findings and the cause of calcification was assessed using chi-square analysis., Results: Peritoneal calcification was due to peritoneal dialysis (n = 4), prior peritonitis (n = 3), cryptogenic origin (n = 1), or peritoneal spread of ovarian carcinoma (n = 9). Sheet-like calcification was more common in patients with benign calcification (seven of eight patients) than in those with malignant calcification (two of nine patients, p < 0.05). Nodal calcification was seen only in patients with malignant calcification (five of nine patients vs none of eight, p < 0.05)., Conclusion: Common causes of peritoneal calcification are dialysis, prior peritonitis, or ovarian cancer; sheetlike calcification indicates a benign cause, whereas associated lymph node calcification strongly suggests malignancy.

Objective: We investigated whether CT signs can be used to predict hepatofugal flow in the main portal vein in patients with cirrhosis., Materials and Methods: We retrospectively identified 36 patients with cirrhosis, 18 with hepatopetal and 18 with hepatofugal flow in the main portal vein, who underwent contemporaneous abdominal sonography and CT. Two independent observers evaluated the following features on the randomized CT studies: diameter of the portal, splenic, and superior mesenteric veins; spleen size; and the presence of ascites, varices, or arterial phase portal venous enhancement. These data were correlated with the flow direction seen on sonography., Results: A small main portal vein was the only sign significantly (p

Objective: The objective of this article is to describe the MR imaging appearances of retained products of conception., Conclusion: Retained products of conception appear on MR imaging as an intracavitary uterine soft-tissue mass with variable amounts of enhancing tissue and variable degrees of myometrial thinning and obliteration of the junctional zone. These findings should not be misinterpreted as indicating gestational trophoblastic disease, particularly in the setting of a postpartum patient with a normal or minimally elevated beta-human chorionic gonadotropin level. MR imaging may also be helpful in showing anatomic variants that hinder successful instrumentation of the uterine cavity in patients with suspected retained products of conception.

Objective: Our study aimed to correlate the dynamic contrast-enhanced MR appearance of infiltrating lobular carcinoma of the breast with histopathologic findings., Materials and Methods: We retrospectively reviewed the high-resolution, fat-suppressed and dynamic contrast-enhanced MR images of 13 of 20 women diagnosed with pathologically proven infiltrating lobular carcinoma of the breast. Twelve of the 13 women presented with breast symptoms and underwent mammography. Five of the women also had breast sonography. MR imaging was performed for evaluation of disease extent before the patients underwent modified radical mastectomy (n = 11) or lumpectomy (n = 2). Three experienced radiologists reviewed the MR scans. The tumor pattern types described on imaging were correlated with a detailed analysis of the pathology., Results: We found three patterns of infiltrating lobular carcinoma on MR imaging. The tumor pattern on imaging correlated with pathologic tumor morphology. We found the following patterns of infiltrating lobular carcinoma: a solitary mass with irregular margins (n = 4) that corresponded to the same appearance at pathology; multiple lesions, either connected by enhancing strands (n = 6) or separated by nonenhancing intervening tissue (n = 2), that correlated with the pathologic appearance of noncontiguous tumor foci, with malignant cells streaming in single-file fashion in the breast stroma or small tumor aggregates separated by normal tissue; and enhancing septa only, which were correlated with the histopathologic appearance of tumor cells streaming in the breast stroma (n = 1)., Conclusion: Infiltrating lobular carcinoma may be detected on MR imaging as solitary or multiple lesions that correspond to tumor morphology on pathologic examination. The appearance of multiple lesions or of enhancing fibroglandular breast elements on MR imaging is suggestive of infiltrating lobular carcinoma.