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To evaluate the frequency, imaging findings, and patient demographics of synchronous elastofibroma dorsi (ED) and pelvic elastofibromas.Image archives between 2011 and 2021 were retrospectively searched for CT and MRI reports including the keyword "elastofibroma". Patients with concomitant CT and/or MRI of the chest and pelvic regions were included. The greatest thickness and side of ED were noted. Subsequently, pelvic soft tissues were evaluated for a soft tissue mass with similar radiological features to ED. When detected, its location, greatest transverse diameter, and ischiofemoral space widths were noted. Wilcoxon matched-pairs signed-rank and Mann-Whitney U-tests were performed when appropriate. Pearson's correlations were used to assess the association of presence of subgluteal-ischiofemoral elastofibromas (SGIFE) and ED thickness. The model discrimination of ED thickness was evaluated by calculating the AUC of the ROC.Eighty-eight patients (Male:Female = 8:80) with a mean age of 70.6 (±10.3) years were included. 96.6 % of patients had bilateral ED. 18.2 % of patients (all females) had at least one concomitant SGIFE. Patients with SGIFE had significantly thicker ED (p 0.001 right; p = 0.049 left). There was a significant positive correlation between the thickness of ED and presence of SGIFE (r = 0.43, p 0.001 right; r = 0.25, p = 0.019 left). An AUC of 0.781 (p 0.001, 95 %-CI:0.675-0.887) and 0.659 (p = 0.049, 95 %-CI:0.523-0.794) were revealed regarding the presence of ipsilateral right and left SGIFE, respectively.Concomitant SGIFE may accompany ED in up to 18.2% of cases, particularly in women with thick ED. Knowledge of this co-occurrence and the described SGIFE characteristics can facilitate correct diagnosis.

Objectives:To analyse the correlation between computed tomography (CT) features and histopathological findings of small lung adenocancers using the International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society Classification of Lung Adenocancer.Materials and Methods:A retrospective review of 34 nodules (size ≤2 cm) representing lung adenocancer was performed. Besides their attenuation type (solid, mixed, pure ground glass), tumours were defined as air-containing type if their vanishing ratio was ≥%50 and as solid-density type if the vanishing ratio was 0.05).Conclusion:Invasive adenocancer and NMIA lesions can be differentiated by their CT features. But greater study populations are needed for further confirmation.

Objectives: To present a routine contrast-enhanced chest CT protocol with a split-bolus injection technique achieving combined early- and delayed phase images with a single aquisition, and to compare this technique with a conventional early-phase single-bolus chest CT protocol we formerly used at our institution, in terms of attenuation of great thoracic vessels, pleura, included hepatic and portal venous enhancement, contrast-related artifacts, and image quality. Methods: A total of 202 patients, who underwent routine contrast-enhanced chest CT examination aquired with either conventional early-phase single-bolus technique (group A,n = 102) or biphasic split-bolus protocol (group B,n = 100), were retrospectively included. Attenuation measurements were made by two radiologists independently on mediastinal window settings using a circular ROI at the following sites: main pulmonary artery (PA) at its bifurcation level, thoracal aorta (TA) at the level of MPA bifurcation,portal vein (PV) at porta hepatis, left and right hepatic lobe, and if present, thickened pleura (>2 mm) at the level with the most intense enhancement. Respective normalized enhancement values were also calculated. Contrast-related artifacts were graded and qualitative evaluation of mediastinal lymph nodes was performed by both reviewers independently. Background noise was measured and contrast-to-noise ratios (CNRs) of the liver and TA were calculated. Results: While enhancement of thoracic vessels and normalised MPA enhancement did not differ significantly between both groups (p > 0.05), enhancement and normalised enhancement of pleura, liver parenchyma and PV was significantly greater in group B (p < 0.001). Perivenous artifacts limiting evaluation were less frequent in group B than in A and mediastinal lymph nodes were judged to be evaluated worse in group A than in group B with an excellent agreement between both observers. No significant difference was detected in CNRTA (p = 0.633), whereas CNR liver was higher in group B (p < 0.001). Conclusion: Our split-bolus chest CT injection protocol enables simultaneous enhancement for both vascular structures and soft tissues, and thus, might raise diagnostic confidence without the need of multiple acquisitions. Advances in knowledge: We think that this CT protocol might also be a promising alternative in lung cancer staging, where combined contrast-enhanced CT of the chest and abdomen is indicated. We therefore suggest to further evaluate its diagnostic utility in this setting, in particular in comparison with a late delayed chest-upper abdominal CT imaging protocol.

To assess and compare the multiphasic computed tomography (CT) features of neuroendocrine tumor (NET) liver metastases and to investigate the possibility to predict the histologic subtype of the primary tumor. Between January 2013 and December 2017 patients with biopsy proven NET with at least one liver metastasis who underwent multiphasic CT were enrolled in this study. All cases were acquired using a standardized multiphasic liver CT protocol, arterial, portal, and hepatic venous phases were obtained. Images were retrospectively analyzed in consensus by two abdominal radiologists blinded to clinical data and histologic subtype. The size, number, and location of lesions were noted. Enhancement patterns of each lesion on arterial, portal, and hepatic venous phases were assessed. For quantitative analysis, CT attenuation of tumors, liver parenchyma, and aorta were measured using a circular region of interest (ROI) on arterial, portal, and hepatic venous phases for reflecting the blood supply of the tumor. Tumor-to-aorta and tumor-to-liver ratio were calculated in all three phases. Differences between subtypes of NET liver metastases were studied using ROC analysis of clustered data. A total of 255 neuroendocrine tumor liver metastases divided into 101 (39.6%) pancreatic, 60 (23.5%) gastroenteric and 94 (36.8%) lung NET liver metastases were analyzed. Contrast enhancement of lesions was homogeneous in 78% of patients (n = 199), which was significantly more frequent in patients with pancreatic group than in those with gastroenteric origin (n = 90, 89.1% vs. n = 28, 46.7%; p

Donor anatomy is an essential part of donor selection and operative planning in living donor liver transplantation. In this study, variations of hilar structures, and the effects of variant anatomy on donor and recipient outcomes were evaluated. Living donor liver transplantations in a single center between January 2013 and December 2020 were retrospectively reviewed. In total, 203 liver transplantations were analyzed. Type 1 arterial anatomy, type 1 portal vein anatomy and type 1 bile duct anatomy were observed in 144 (70.9%), 173 (85.2%), and 129 (63.5%) donors, respectively. Variant biliary anatomy was observed more frequent in donors with variant portal vein branching than in those with type 1 portal anatomy (60.0% vs 32.3%, P = .004). The overall survival rates calculated for each hilar structure were similar between recipients receiving grafts with type 1 anatomy and those receiving grafts with variant anatomy. When donors with variant anatomy and donors with type 1 anatomy were compared in terms of hilar structure, no significant difference was observed in the frequency of complications and the frequency of serious complications. Biliary variations are more common in individuals with variant portal vein anatomy. Donor anatomic variations are not risk factors for inferior results of recipient survival or donor morbidity.

New ERS/ESC guidelines recommend assessment of right ventricular dysfunction (RVD) with transthoracic echocardiography (TTE) or computed tomography pulmonary angiography (CTPA) in patients with pulmonary embolism (PE). In this retrospective study, we investigated the agreement between TTE and CTPA for the detection of RVD. PE patients who underwent TTE within 24 hours after diagnosis were enrolled. Patients with a history of pulmonary hypertension, NYHA class IV heart failure and acute PE on chronic thromboembolic pulmonary hypertension were excluded. CTPA signs of RVD were defined as RV/LV ≥1, flattening/bulging of the interventricular septum (IVS), contrast reflux to inferior vena cava. TTE findings were defined as the enlarged right ventricle, flattened IVS, RV hypo/akinesia, pulmonary arterial systolic pressure ≥40 mmHg or right heart thrombus. 199 patients met the inclusion criteria. In 143 patients (71.9%) CTPA and TTE agreed on whether RVD was present or not. In 43 patients (21.6%), TTE was normal but CTPA showed RVD. In 13 (6.5%) patients, CTPA was normal but TTE showed RVD. There was a fair agreement between the two tests (Cohen’s Kappa=0.394). 17 patients died; 3 due to PE and both TTE and CTPA revealed RVD in these 3 patients. Remaining 14 died due to comorbidities. 13 had RVD on TTE and normal CTPA, 1 had normal TTE but RVD on CTPA. In conclusion, CTPA reported more RVD dysfunction than TTE in our cohort. This might be due to higher specificity of TTE.

OBJECTIVE The purpose of this study was to assess the diagnostic performance of multiphasic computed tomography (CT) in the discrimination of metastatic lymph nodes (LNs) of papillary thyroid cancer by using quantitative parameters. METHODS This study enrolled 272 pathologically proven metastatic and benign LNs. Multiphasic CT was utilized by using nonenhanced, arterial (25-second delay), and venous (80-second delay) phases. Mean tissue attenuation values (MAVs) of metastatic and benign LNs were measured, and normalized MAV (common carotid artery and paraspinal muscle) and wash-in and wash-out percentages were also calculated. RESULTS The arterial phase showed the highest diagnostic performance in differentiation (area under the curve ± standard error, 0.97 ± 0.02; 95% confidence interval, 0.94-1.0; P < 0.001). Cutoff values for MAVs, normalized MAVs, and wash-in and wash-out percentages to predict metastatic LNs were calculated as 109 HU, 0.33, 1.93, 122.5, and -5.6 (sensitivity: 93.4%, 93.3%, 90.4%, 94.1%, and 97.8%, and specificity: 99.3%, 90.4%, 98.5%, 92.6%, and 99.3%, respectively). CONCLUSIONS Early-phase enhanced CT and the use of quantitative parameters derived from multiphasic CT improve the detection of cervical lymph node metastasis from papillary thyroid cancer.

The purpose of this study was to determine whether the computed tomography (CT) features might be used in distinguishing pulmonary carcinoids from hamartomas.Ninety solid pulmonary nodules (43 carcinoids and 47 hamartomas) in 90 patients were evaluated. The following CT scan features were evaluated: size, location (peripheral/central), contour (lobulated/nodular), number of lobulation, attenuation, calcification, endobronchial status, bronchial extension and involvement, parenchymal abnormalities distal to the lesion e.g. hyperlucency, atelectasis, and nodularity. The final pathologic diagnosis of the lesions and bronchial extension were confirmed by review of histopathological specimens.Out of 43 carcinoids, 37 (86%) were typical. Twenty-three carcinoids and four hamartomas were central (p 0.001). Ten carcinoids and one hamartoma were endobronchial. The majority of tumors had lobulated contours (65% of carcinoids, 44% of hamartomas) and carcinoids tended to have more lobulations (p = 0.052). Distal nodularity (p = 0.001), distal hyperlucency (p 0.001), and atelectasis (p = 0.005) were significantly more common in carcinoids. Carcinoids had significantly more bronchial extension and involvement (p 0.001; respectively). In addition, a new sign that we call "bronchial triangle sign" differentiated carcinoids with a sensitivity and specificity of 84.9% (95% CI: 69,1%-93.4%) and 91% (95% CI: 79.7%-96.6%).To the best of our knowledge this is the first study on discrimination of carcinoids and hamartomas. A new CT sign called "bronchial triangle sign" might be used to differentiate carcinoids from hamartomas. Distal parenchymal abnormalities are more common in carcinoids than in hamartomas.

The purpose of this study is to evaluate the importance of neuro-ophthalmological magnetic resonance imaging (MRI) findings in the identification of the aetiology of rhinorrhoea, and the differentiation of spontaneous rhinorrhoea from non-spontaneous rhinorrhoea. MR images of 25 patients with spontaneous and 21 patients with non-spontaneous rhinorrhoea were evaluated for the presence of neuro-ophthalmological findings of intracranial hypertension (IHT). These include optic nerve vertical tortuosity, optic nerve sheath enlargement, flattening of the posterior sclera and optic nerve protrusion, as well as other MRI findings of ICH, such as partial empty sella, dilatation of Meckel’s cave and the presence of arachnoid pits. IHT findings were more common in the spontaneous group. Six criteria (optic nerve distention, optic nerve vertical tortuosity, posterior flattening of the sclera, partial empty sella, Meckel’s cave dilatation and presence of arachnoid pits) differentiate between patient and control groups. Patients with spontaneous cerebrospinal fluid (CSF) leaks should be evaluated for signs of IHT on MRI, as they are present in the majority of spontaneous CSF leaks and are representative of increased intracranial pressure.

We discuss an ectopic liver misdiagnosed as an abdominal mass and the importance of magnetic resonance imaging (MRI) in liver positional anomalies. A solid midline mass midline adjacent to the liver was found in a 45-year-old female at an external center during an ultrasound investigation conducted for occasional abdominal pain of many years. The patient was referred to us for MRI. MRI revealed a solid epigastric lesion adjacent to the liver but unrelated to the liver parenchyma. The mass was of similar intensity as the liver in all sequences and in postcontrast dynamic phases following hepatospecific contrast material administration. We also observed contrast material excretion into the solid lesion from the biliary ducts in the hepatobiliary phase. The lesion was diagnosed as ectopic liver tissue with these findings. Level of Evidence 5 J. Magn. Reson. Imaging 2016

To assess the diagnostic value of dynamic TA total of 28 patients with suspected biliary leakage who underwent routine TIn each patient, visualization of bile ducts was sufficient in the HBP. The accuracy, sensitivity and specificity of dynamic Gd-EOB-DTPA-enhanced T1w MRC in the detection of biliary leaks were 92.9%, 90.5% and 100%, respectively (p 0.001). 19 of 28 patients had bile leak findings in T1w Gd-EOB-DTPA-enhanced MRC [HBP group: N = 7 (36.8%), DP group: N = 12 (63.2%)]. There was no statistically significant difference in terms of laboratory test results and the presence of bile duct dilatation between HBP and DP group (p 0.05). Three patients, each of them in DP group, showed normal laboratory test results and bile duct diameters.Dynamic T1w Gd-EOB-DTPA-enhanced MRC is a useful non-invasive diagnostic tool to detect bile leak. Advances in knowledge: Prolonged DP imaging may be required for bile leak detection even if visualization of biliary tree is sufficient in HBP and liver function tests, total bilirubin levels and bile duct diameters are normal.