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A Best Evidence Topic review was undertaken to clarify whether patients with apparently isolated greater trochanter fracture on plain X-ray require urgent cross sectional imaging. A literature search was performed to establish what proportion of these patients have clinically important intertrochanteric extension. 11 papers were included showing intertrochanteric extension in 54% using magnetic resonance imaging and computed tomography and surgical management was in 37% but with marked disparity in the data. Further work is needed to completely answer this question, and to find the most clinically useful predictors of fracture completion and displacement.

Background and Aims The diagnosis and follow up of patients with inflammatory bowel disease [IBD] requires cross-sectional imaging modalities, such as intestinal ultrasound [IUS], magnetic resonance imaging [MRI] and computed tomography [CT]. The quality and homogeneity of medical reporting are crucial to ensure effective communication between specialists and to improve patient care. The current topical review addresses optimized reporting requirements for cross-sectional imaging in IBD. Methods An expert consensus panel consisting of gastroenterologists, radiologists and surgeons convened by the ECCO in collaboration with ESGAR performed a systematic literature review covering the reporting aspects of MRI, CT, IUS, endoanal ultrasonography and transperineal ultrasonography in IBD. Practice position statements were developed utilizing a Delphi methodology incorporating two consecutive rounds. Current practice positions were set when ≥80% of the participants agreed on a recommendation. Results Twenty-five practice positions were developed, establishing standard terminology for optimal reporting in cross-sectional imaging. Assessment of inflammation, complications and imaging of perianal CD are outlined. The minimum requirements of a standardized report, including a list of essential reporting items, have been defined. Conclusions This topical review offers practice recommendations to optimize and homogenize reporting in cross-sectional imaging in IBD.

Hearing loss in pediatric age group is associated with many congenital temporal bone disorders. Aberrant development of various ear structures leads into either conductive or sensorineural hearing loss. Knowledge of the embryology and anatomical details of various compartments of the ear help better understanding of such disorders. In general, abnormalities of external and middle ears result in conductive hearing loss. Whereas abnormalities of inner ear structures lead into sensorineural hearing loss. These abnormalities could occur as isolated or part of syndromes. Temporal bone disorders are a significant cause of morbidity and developmental delays in children. Imaging evaluation of children presented with hearing loss is paramount in early diagnosis and proper management planning. Our aim is to briefly discuss embryology and anatomy of the pediatric petrous temporal bones. The characteristic imaging features of commonly encountered congenital temporal bone disorders and their associated syndromes will be discussed.

"Incidentalomas" are a common part of daily practice for radiologists, and knowledge of appropriate management guidelines is important in ensuring that no potentially clinically relevant findings are missed or are lost to follow-up in asymptomatic patients. Incidental findings of the brain, spine, thyroid, lungs, breasts, liver, adrenals, spleen, pancreas, kidneys, bowel, and ovaries are discussed, including where to find guidelines for management recommendations, how to follow them, and medical-legal considerations.

Incidental splenic focal findings are commonly encountered in clinical practice and frequently represent a diagnostic dilemma due to nonspecific imaging features. Most are benign, particularly in patients without a history of malignancy and without symptoms of fever, weight loss, or left upper quadrant or epigastric pain. Incidental malignant splenic processes are exceedingly rare. This article reviews imaging characteristics of incidental focal splenic findings, and proposes a practical approach for management of such findings, which can prevent unnecessary workup and its related drawbacks in clinical practice.

Incidental adnexal masses and uterine findings occur with a high frequency on cross-sectional imaging examinations, particularly in postmenopausal women in whom imaging is performed for a different reason. These incidentalomas encompass a gamut of potential pelvic gynecologic disorders. Most are benign ovarian cysts; however, other less commonly encountered disorders and improperly positioned gynecologic devices may be seen. A knowledge of the management recommendations for such pelvic incidental findings is critical to avoid unnecessary imaging and surgical interventions, as well as to avoid failure in diagnosis and management of some of these conditions.

Pulmonary nodules are the most common incidental finding in the chest, particularly on computed tomographs that include a portion or all of the chest, and may be encountered more frequently with increasing utilization of cross-sectional imaging. Established guidelines address the reporting and management of incidental pulmonary nodules, both solid and subsolid, synthesizing nodule and patient features to distinguish benign nodules from those of potential clinical consequence. Standard nodule assessment is essential for the accurate reporting of nodule size, attenuation, and morphology, all features with varying risk implications and thus management recommendations.

OBJECTIVE. The objective of this article is to discuss the anatomy, embryonic origin, normal variants, and various attachments of the ligament of Treitz. We also describe the pathologic processes that develop along the ligament of Treitz and the role of cross-sectional imaging in identifying these conditions. CONCLUSION. The ligament of Treitz, also known as the suspensory ligament of the duodenum, is an important anatomic landmark in the abdomen. It is essential that radiologists understand the anatomic attachments, normal variants, and various pathologic conditions involving the ligament of Treitz as well as the role of cross-sectional imaging in the assessment of these conditions.

The detection rates of adrenal masses are increasing with the common and widespread use of cross-sectional imaging. Adrenal adenomas, myelolipomas, metastases, pheochromocytomas, and adrenocortical tumors are well-known and relatively common adrenal tumors. However, there are many less-known neoplastic and nonneoplastic adrenal diseases that might affect the adrenal glands in addition to these common lesions. These rare entities include, but are not limited to, hydatid cysts, congenital adrenal hyperplasia, Wolman disease, adrenal tuberculosis, primary adrenal lymphoma. This article aims to present imaging findings of these unusual lesions in accordance with their pathologic characteristics. We think that the simultaneous presentation of the pathological findings with the imaging features may facilitate the learning process and may potentially enhance the recognition of these entities.

Annemarie Klingenstein,1 Aylin Garip-Kuebler,1 Siegfried Priglinger,1 Christoph Hintschich,1 Ullrich G Mueller-Lisse2 1Department of Ophthalmology, Ludwig-Maximilians-University, Munich, Germany; 2Department of Radiology, Ludwig-Maximilians-University, Munich, GermanyCorrespondence: Annemarie KlingensteinLudwig-Maximilians-University, Department of Ophthalmology, Klinikum der Universität München, Campus Innenstadt, Mathildenstraße 8, Munich, D-80336, GermanyTel +49 89 44005 3811Fax +49 89 44005 5160Email Annemarie.Klingenstein@med.uni-muenchen.deAim: To detect radiological features that, in addition to clinical findings, may aid in correct differentiation between IgG4-related ophthalmic disease (IgG4-ROD) and ocular adnexal lymphoma (OAL).Methods: In this retrospective, single-center, comparative analysis, we compared cross-sectional imaging findings of 13 consecutive patients with histologically proven IgG4-ROD and a control group of 29 consecutive OAL-patients diagnosed between 10/2014 and 09/2019. Statistical significance was accepted at a p< 0.05 significance level.Results: IgG4-ROD-patients had longer time-to-diagnosis, higher orbital recurrence rates, but smaller lesions compared to OAL-patients (p=0.002; p=0.006 and p=0.006; Mann–Whitney U-test). Frequent cross-sectional imaging findings in both IgG4-ROD-patients and OAL-patients included extraocular muscle enlargement (92% and 93%, respectively; most often in the lateral rectus muscles and the levator-complex), and lacrimal-gland enlargement (85% and 83%, respectively). Other imaging findings comprised infraorbital nerve-involvement (IgG4-ROD, 23%, OAL, 17%) and orbital fat inflammation (IgG4-ROD, 23%, OAL, 28%). Bony infiltration and remodeling, heterogenous contrast-media distribution, and infiltration of the lacrimal system were seen slightly more often in IgG4-ROD (23%, 38%, 15% and 15% versus 17%, 14%, 3% and 7%). However, cross-sectional imaging features did not differ significantly between patient subgroups. Clinical symptoms predominantly occurred unilaterally (IgG4-ROD, 9/13, 69%, OAL, 24/29, 83%), while imaging findings were most often bilateral (IgG4-ROD, 11/13, 85%, OAL, 23/29, 79%, p< 0.001, McNemar test).Conclusion: No morphological cross-sectional imaging sign could reliably distinguish between IgG4-ROD and OAL, leaving histopathology indispensable for definite diagnosis. Yet, importantly, for both IgG4-ROD and OAL, cross-sectional imaging frequently detected bilateral orbital disease when only one eye was clinically affected.Keywords: IgG4, idiopathic orbital inflammation, CT, ocular adnexal lymphoma

Cystic pancreatic lesions are a frequent incidental finding on ultrasound or cross sectional imaging. The incidence of pancreatic lesions experience a steady climb in recent years due to an increased number of cross sectional imaging and an increasing life expectancy. The clinical challenge is to identify individuals bearing lesions with potentially malignant or pre-malignant features. Indeed, by far most cystic pancreatic lesions are not associated with an increased risk for the development of cancer. Taking into account the increasing incidence rates of cystic pancreatic lesions a rational and economic use of diagnostics is warranted. This review provides an overview on the different types of cystic lesions, the appropriate use of diagnostics and a clinical management algorithm balancing intervention and surveillance.

Background Imaging modalities for characterizing pancreatic cystic lesions (PCLs) is a known uncertainty. The aim of this prospective study was to compare the diagnostic performance of endoscopic ultrasound morphology, cytology and cyst fluid carcinoembryonic antigen (EUS-FNA-CEA) with cross-sectional imaging in resected PCLs. Methods The cross-sectional imaging and EUS-FNA-CEA results were collected in an academic tertiary referral centre using histology of the surgical specimen as the diagnostic standard. Results Of 289 patients undergoing evaluation for PCL with cross-sectional imaging and EUS-FNA between February 2007 and March 2017, 58 underwent surgical resection providing a final diagnosis of the PCLs: 45 mucinous, 5 serous, 1 pseudocyst, 2 endocrine, 2 solid pseudopapillary neoplasms and 3 other. EUS-FNA-CEA was more accurate than cross-sectional imaging in diagnosing mucinous PCLs (95% vs. 83%, p = 0.04). Ninety-two percent of the PCLs with high-grade dysplasia or adenocarcinoma were smaller than 3 cm in diameter. The sensitivity of EUS-FNA-CEA and cross-sectional imaging for detecting PCLs with high-grade dysplasia or adenocarcinoma were 33% and 5% (p = 0.03), respectively. However, there was no difference in accuracy between the modalities (62% vs. 66%, p = 0.79). The sensitivity for detecting pancreatic adenocarcinomas only was 64% for EUS-FNA-CEA and 9% for cross-sectional imaging (p = 0.03). Overall, EUS-FNA-CEA provided a correct diagnosis in more patients with PCLs than cross-sectional imaging (72% vs. 50%, p = 0.01). Conclusions EUS-FNA-CEA is accurate and should be considered a complementary test in the diagnosis of PCLs. However, the detection of PCLs with high-grade dysplasia or adenocarcinoma needs to be improved. Cyst size does not seem to be a reliable predictor of high-grade dysplasia or adenocarcinoma.

Disorders of the adrenal gland are rare and complex, with many potential pitfalls in management. An understanding of embryology, anatomy, physiology and biochemistry is crucial. There has been a dramatic increase in the incidental detection of adrenal lesions on cross sectional imaging in recent years. Surgical treatment may be required for syndromes of hormonal excess and/or suspicion of malignancy.

Coronavirus disease 2019 (COVID-19) disease has spread worldwide since it was first discovered in China's Hubei province in December 2019. Respiratory illness is the primary manifestation of COVID-19 disease, and its pathophysiology as well as the clinical and cross-sectional imaging manifestations has been adequately reported. However, there is emerging evidence of its multisystemic nature, with associated extrapulmonary manifestations including gastrointestinal, cardiovascular, renal, and neurological findings. There is still limited understanding with regard to the extrapulmonary involvement in this disease. This review aims to put together the prevalence, proposed pathophysiology, and the spectrum of clinical and cross-sectional imaging manifestations of associated extrapulmonary findings in COVID-19 disease.

Paragangliomas are extra-adrenal tumors that are derived from neuroendocrine chromaffin cells. The rare disease has a variable presentation depending upon its anatomic location and functionality. We describe the case of a 56-year-old female patient who had an incidental mass found on imaging. The patient underwent biochemical testing and a mediastinal biopsy due to the nonspecific imaging findings. The mediastinal mass was resected through hemisternotomy and found to be a functional paraganglioma. This case highlights the importance of radiologists to consider the prospect of paragangliomas in the differential diagnosis of an intra-thoracic mass.

Introduction Over the years, several guidelines have been introduced to guide management of mucinous pancreatic cystic neoplasms (mPCN). In this study, we aimed to evaluate and compare the clinically utility of the Sendai-06, Fukuoka-12, Fukuoka-17 and European-18 guidelines in predicting malignancy of mPCN. Methods One hundred and eighty-eight patients with mucinous cystic neoplasms (MCN) or intraductal papillary mucinous neoplasm (IPMN) who underwent surgery were retrospectively reviewed and classified under the 4 guidelines. Malignancy was defined as high grade dysplasia and invasive carcinoma. Results Raised CA19-9>37U/ml, enhancing mural nodule≥5 mm and main pancreatic duct≥10 mm were significantly associated with malignancy on multivariate analysis. Increasing number of high risk features, absolute indications (European-18), worrisome risk or relative indications (European-18) were significantly associated with an increased likelihood of malignancy. The positive predictive values (PPV) of high risk features for Sendai-06, Fukuoka-12, Fukuoka-17 and absolute indications (European-18) for malignancy were 53%, 76%, 78% and 78% respectively. The negative predictive values (NPV) of the Sendai-06, Fukuoka-12 and Fukuoka-17 were 100%, while that of the European-18 was 92%. Risk of malignancy for patients with ≥4 worrisome features (Fukuoka-17) and ≥3 relative indications (European-18) was 66.7% and 75.0% respectively. Conclusions All 4 guidelines studied were useful in the initial triage of mPCN for the risk stratification of malignancy. The Fukuoka-17 had the highest PPV and NPV.

The importance of fluoroscopy as an imaging modality has been minimized relative to other cross-sectional modalities, including high-resolution computed tomography (CT), magnetic resonance imaging (MRI) and ultrasound. Fluoroscopy examinations have decreased in clinical practice due to reduced appreciation of its usefulness, insufficient training of residents, fewer staff with adequate expertise, and poor reimbursements relative to other modalities. We revisit and build upon the prior literature and history of this decreased utilization. We then seek to prove continued value, through categorized examples and within multiple subspecialties, wherein fluoroscopy plays an integral part toward clinical diagnoses as well as optimizing patient outcomes. This is particularly true for motility and esophageal disorders, where structure and function with real-time evaluation is essential. We additionally show several post-operative cases where the synergy of fluoroscopy with CT and endoscopy is apparent. The fluoroscopic radiologist also has the unique ability to vary patient positioning, as opposed to traditional CT or MRI, where orthogonal views are employed without positional or temporal changes. We turn attention to the modern era, with synergistic and novel cases demonstrating that fluoroscopy remains instrumental toward achieving a diagnosis alongside other modalities. Our cases stress the need to maintain expertise in fluoroscopy skill, and underline its continued importance in residency training programs. We conclude that fluoroscopy is a relatively inexpensive modality that is often under-appreciated in diagnostic radiology. We suggest that competency in fluoroscopy is crucial for future generations of radiologists to both work with their peers, as well as to aid clinicians in the optimal treatment of patients.

Aim of our prospective pilot study was to assess the feasibility of computed tomography (CT) to visualize the normal parathyroid gland in dogs and provide a description of its CT appearance.A total of 25 dogs, which received CT imaging including the neck region for diseases unrelated to the thyroid or parathyroid glands, were enrolled. Inclusion criteria were a normal physical examination, an unremarkable complete blood count and serum chemistry profile. Pre and post contrast CT images were acquired using a 16-slice helical scanner with an 18 cm field of view, 1 mm slice thickness and a 512 × 512 matrix. Post contrast images were obtained 30-45 seconds following contrast medium injection (early venous phase). CT-images were independently reviewed by 2 radiologists. Visibility of the parathyroid gland was recorded and inter-observer agreement was calculated. For all visualized parathyroid glands the following parameters were assessed: size, density in Hounsfield units (HU) on pre and post contrast images, density of the thyroid gland and border definition (excellent, moderate, poor).Only 20 respectively 25 parathyroid glands could be visualized by the 2 observers. The number did not vary between pre and post contrast images. The inter-observer agreement for the identification was fair (κ = 0.40). Length, width and height (mean ± standard deviation) of the parathyroid gland were 4.2 × 2.5 × 2.9 mm ± 1.3 × 0.8 × 1.0 mm. The density was 39.7 ± 20.6 HU on pre contrast images and 103.1 ± 47.1 HU on post contrast images, thus the organ was hypoattenuating compared to the thyroid gland on pre (166.7 ± 34.3 HU) and post contrast (234.0 ± 60.1 HU) images.This study offers the first description of the CT appearance of the presumed normal canine parathyroid gland. However, the overall visibility was poor.Despite the overall poor visibility of the parathyroid gland it was occasionally visible and its CT dimensions were larger as described for ultrasound in this group of dogs, which showed no clinical signs of hyperparathyroidism. Thus, visibility of the parathyroid gland on CT may not necessarily imply parathyroid disease. However, further research is necessary.Ziel dieser prospektiven Pilotstudie war zu beurteilen, ob die physiologische Glandula parathyroidea beim Hund computertomografisch dargestellt werden kann, und eine Beschreibung ihres CT-Erscheinungsbildes zu geben.In die Studie wurden 25 Hunde aufgenommen, bei denen aufgrund von Erkrankungen im Halsbereich ohne Bezug zu Schild- oder Nebenschilddrüse ein CT-Scan erfolgte. Einschlusskriterium waren unauffällige Befunde bei der allgemeinen klinischen Untersuchung und der Blutuntersuchung (Blutbild und blutchemische Analyse). CT-Bilder vor und nach Kontrastmittelapplikation (30–45 Sekunden nach der Kontrastmittelinjektion, frühe venöse Phase) wurden mit einem 16-Schichten-Spiral-CT unter Verwendung eines Field of View von 18 cm, einer Schichtdicke von 1 mm und einer Matrix von 512 × 512 angefertigt. Zwei Radiologen begutachteten die CT-Aufnahmen unabhängig voneinander. Die Sichtbarkeit der Parathyreoidea wurde erfasst und die Interobserver-Reliabilität ermittelt. Bei den darstellbaren Nebenschilddrüsen wurden folgende Parameter bestimmt: Größe, Dichte (in Hounsfield Units [HU], vor und nach Kontrastmittelgabe), Dichte der Schilddrüse, Abgrenzung (exzellent, mäßig, schlecht).Nur 20 bzw. 25 Nebenschilddrüsen waren durch die beiden Untersucher erkennbar. Die Anzahl differierte zwischen Nativaufnahmen und Bildern nach Kontrastmittelgabe nicht. Die Interobserver-Reliabilität hinsichtlich der Erkennbarkeit war moderat (κ = 0,40). Für Länge, Breite und Höhe der Nebenschilddrüsen (Mittelwert ± Standardabweichung) ergaben sich 4,2 × 2,5 × 2,9 mm ± 1,3 × 0,8 × 1,0 mm. Die Dichte betrug 39,7 ± 20,6 HU vor und 103,1 ± 47,1 HU nach Kontrastmittelgabe. Damit stellten sich die Nebenschilddrüsen im Vergleich zur Schilddrüse (vor und nach Kontrastmittelgabe 166,7 ± 34,3 HU bzw. 234,0 ± 60,1 HU) hypoattenuierend dar.Diese Studie liefert die erste Beschreibung des CT-Erscheinungsbilds der angenommen physiologischen Nebenschilddrüse beim Hund. Die Sichtbarkeit des Organs war jedoch schlecht.Trotz der schlechten Visualisierung der Nebenschilddrüse im CT ist sie gelegentlich wahrnehmbar. Die ermittelten Dimensionen waren teilweise größer als bisher für sonografische Darstellung beschrieben, ohne dass die untersuchten Hunde erkennbare Symptome eines Hyperparathyreodismus aufwiesen. Eine computertomografisch sichtbare Nebenschilddrüse impliziert daher möglicherweise nicht unbedingt eine Erkrankung. Weitere Studien dazu sind notwendig.

This review considers how cross-sectional imaging, principally but not exclusively, post mortem computed tomography (PMCT) can and is used in forensic pathology practice today. It considers the origin of forensic radiology and the introduction of PMCT and questions the invasive autopsy as the gold standard for death investigation. It also considers, in broad terms, the role of cross sectional imaging in the four investigative areas of who, where, when and how a person came by their death. It summarises with a view where we may go next.

Determining the sequence of intersecting lines is a significant issue in the forensic document examination that can reveal the fraud or distinguish between different allegations. Optical coherence tomography (OCT) is a high-resolution cross-sectional imaging technique that has been introduced into forensic science field recently. The potential of OCT as a novel method to determine the sequence of intersecting lines was examined for the first time. In this study, a spectral-domain OCT system with a center wavelength of 900 nm was employed to perform nondestructive examination on determining the sequence of 18 heterogeneous intersecting line samples produced using three types of gel pens and three brands of stamp pad ink seals. Two-dimensional (2D) cross-sectional, and three-dimensional (3D) volumetric images of the intersecting lines were obtained by the OCT system. Several features were noted and analyzed to successfully determine the sequence of all the 18 samples. Blind tests were also conducted to demonstrate the effectiveness of OCT technique. The results illustrate that OCT technology can provide an effective and accurate method for sequencing intersecting lines of gel pen ink and seal ink, which may complement the conventional methods used in the examination of questioned documents.

Plain radiographs continue to play an important role in the assessment of the cervical spine, despite an ever-increasing uptake of cross sectional imaging. They are widely available and utilized in the setting of trauma to assess for cervical spine injury and stability as an integral part of the trauma series. Furthermore they can provide vital information such as dynamic stability in patients with underlying rheumatological conditions, most importantly rheumatoid arthritis. A systematic approach in analysing cervical spine radiographs can be used to glean important information regarding any underlying injury or instability, initiating further steps in the patient's management and crucially allowing the anaesthetist to take precautions in airway management. We outline some of the most important principles of reviewing such radiographs in the adult population in this article and also aim to outline some of the common pitfalls and limitations of assessing such studies in common practice. Finally we briefly review NICE guidelines on the imaging of cervical spine trauma.

Background: The purpose of this study was to determine the role of CT and MR imaging in demonstrating lesions of the tongue. Imaging can help to decide the further management of the patient, and when resection is considered, the precise extent of the lesion can be delineated, and also if organ conservation therapy can be suggested. Hence, knowing the differentiating characteristics of these lesions is essential for a Radiologist to narrow the differential diagnosis. The aim of the study is to describe the imaging findings of various tongue lesions, give radio-pathological correlation, and discuss the role of CT and MRI in planning further appropriate treatment, the extent of involvement of adjacent structures, resectability, postoperative reconstruction & prognosis. Subjects and Methods: Twenty patients with tongue masses were prospectively evaluated with CT & MRI for eighteen months from June 2018 - Nov 2019. Contrast-enhanced CT axial images with reconstruction were acquired. MRI plain & contrast study done. Imaging findings & diagnoses were later correlated with surgical and histopathological results in all possible cases. Results: Among twenty patients, three patients revealed no abnormality; seventeen patients with findings on imaging include twelve squamous cell carcinoma, two venous malformations, two thyroglossal cysts, one hemangioma & one fatty lipoma. Conclusion: Few specific lesion characteristics can aid in narrowing the differential diagnosis. Solid high-density lesions in the midline mostly represent lingual thyroids. Calcifications likely indicate goitrous transformation. Phleboliths are highly suggestive of venous malformations. Multinodular, thin-rim enhancing cystic lesions are indicative of lymphatic malformations, primarily when fluid-fluid levels are found. Fat/calcium content within a complex cystic lesion is specific for a dermoid cyst, whereas diffusion restriction within a pure cystic lesion is suggestive of an epidermoid cyst. Finally, when an injury is Trans spatial, three differentials to be considered are highly aggressive malignancies, congenital masses & aggressive infections.

Duodenal tumors are uncommon, but they can cause significant morbidity and mortality. As stomach and colon are more common sites of gastrointestinal malignancies, radiologists sometimes may neglect the duodenum. Multidetector computed tomography (MDCT) and magnetic resonance imaging (MRI) can accurately locate and characterize mass-forming duodenal lesions, making them invaluable for the differential diagnosis and determining management strategies such as biopsy or surgery. Although conventional endoscopy continues to play an important role in the diagnosis of duodenal tumors, MDCT and MRI are very useful for evaluating the duodenal wall, extraduodenal space, and surrounding viscera, as well as the intraluminal content seen on endoscopy. This pictorial review aims to illustrate the most common benign and malignant mass-forming duodenal lesions and to focus on the imaging features that are most helpful in reaching the correct diagnosis.

Purpose Carbohydrate antigen (CA) 19-9 has been established as the main serum marker for patients with intrahepatic cholangiocarcinoma (ICC). The aim of this study was to compare the prognostic value of CA 19-9 changes versus response determined by imaging in patients with ICC undergoing chemotherapy. Methods Between 2003 and 2018, 151 patients with histopathologically confirmed ICC underwent chemotherapy at our tertiary care center for non-resectable or recurrent ICC, of whom 121 were included in this study. Serum CA 19-9 levels and imaging were retrospectively evaluated during chemotherapy. Log-rank testing and optimal stratification were used to classify patients into risk groups. Results Prior to chemotherapy, baseline serum CA 19-9 levels above the previously published cut-off of 37 U/ml were associated with poor survival (median OS 8.7 vs. 12.4 months, p = 0.003). After the beginning of chemotherapy, an increase in CA 19-9 of more than 40 U/ml resulted in impaired residual survival (median OS 5.0 vs. 12.1 months, p p Conclusion In our study, the disease control rate—that is, the absence of progressive disease—was the strongest predictor of prolonged residual OS. To this end, both CA 19-9 changes and progressive disease on initial follow-up showed remarkable discriminatory power, with the latter slightly outperforming the former. Therefore, imaging should remain the mainstay of patient evaluation during follow-up.

The evaluation of inflammatory bowel activity in patients with Crohn’s disease has traditionally been a challenge, mainly because of the difficulty in gaining endoscopic access to the small bowel. Historically, barium-based contrast studies were the only option for the evaluation of inflammatory activity in Crohn’s disease. They were gradually replaced by cross-sectional imaging techniques, computed tomography enterography (CTE) and magnetic resonance enterography (MRE) now being the modalities of choice for such evaluations. Those two imaging methods have provided important information regarding intestinal wall involvement and extra-intestinal manifestations of Crohn’s disease, not only assessing lesion characteristics and complications but also quantifying inflammatory bowel activity. The objective of this article is to review the main technical aspects of CTE and MRE, together with their indications, contraindications, and limitations, as well as the CTE and MRE imaging characteristics of inflammatory activity in Crohn’s disease. Resumo A avaliação da atividade inflamatória intestinal em pacientes com doença de Crohn tem sido tradicionalmente um desafio, principalmente pela dificuldade do acesso endoscópico ao intestino delgado. Por muito tempo os estudos baritados foram a única opção disponível, tendo sido progressivamente substituídos por novas técnicas de imagens seccionais, sendo hoje a enterografia por tomografia computadorizada (entero-TC) e por ressonância magnética (entero-RM) as modalidades de escolha para essa avaliação. Esses dois métodos de imagem acrescentam informações importantes quanto ao acometimento da parede intestinal e às manifestações extraintestinais relacionadas à doença de Crohn, avaliando não somente as características das lesões e as complicações, mas também quantificando a atividade inflamatória intestinal. O objetivo deste artigo é revisar os principais aspectos técnicos dos exames, as suas indicações, contraindicações, limitações e características de imagem da entero-TC e entero-RM na avaliação da atividade inflamatória da doença de Crohn.

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.

BACKGROUND: Patients with head and neck cancer are at increased risk of developing low skeletal muscle mass (SMM), which is associated with adverse treatment outcomes and prognosis. Low SMM is most commonly assessed by the skeletal muscle cross sectional area (CSA) at the third lumbar vertebra (L3) or more recently the third cervical vertebra (C3). L3 is not routinely imaged and C3 may be impacted by disease or treatment. As an alternative we analyzed masseter muscle characteristics and their relationship with L3 and C3 skeletal muscle CSA and overall survival (OS). METHODS: In this single-center retrospective study, 99 patients with head and neck cancer who underwent whole body FDG-PET/CT-scans were reviewed. Of these patients, L3 CSA, C3 CSA, masseter CSA, masseter thickness, masseter volume, masseter Hounsfield Unit values, lumbar skeletal muscle index (LSMI), cervical skeletal muscle index (CSMI), and masseter skeletal muscle index (MSMI) were recorded and correlated with each other and with OS. RESULTS: We included 72 male and 27 female patients. The masseter muscle parameters differed significantly between sexes. The Spearman correlation coefficients for C3 CSA–Masseter volume and L3 CSA–Masseter volume were 0.639 and 0.531 (P

Pancreatic cystic lesions are very prevalent, especially in elderly patients and are increasingly being diagnosed because of the massive use of cross sectional imaging. Our knowledge about the natural history of these lesions is limited, especially in the case of intraductal papillary mucinous neoplasms. This fact explains why scientific societies guidelines statements are based on evidence graded as very low quality and helps the understanding of some of the different guidelines recommendations. Several guidelines have been recently revised to incorporate the new evidence published in the literature with the aim to help clinicians make the best decisions. American Gastroenterological Association guidelines, a revision of the International Consensus Guidelines, the American College of Gastroenterology and the European Study Group guidelines are the most recent. Herein we review the current guidelines on pancreatic cysts and focus our discussion on controversies and updates about the best imaging modalities, the indications for endoscopic ultrasound guided fine needle aspiration, cyst fluid analysis, indications for resection and surveillance strategies.

Since majority (80%) of ovarian cancer patients present at an advanced stage, imaging performed on these patients have numerous findings. The combination of multiple findings on imaging, complexity of anatomical structures which are involved in ovarian cancer, and the need to perceive certain subtle imaging features which would impact management often makes it challenging to systematically review images of these patients. Similarly, it is difficult to effectively communicate these findings in radiology reports. Structured reporting that is geared toward clinical decision-making has been an area of recognized need. An understanding of the review areas, which aid clinical decision-making in a multidisciplinary team setting at our institution led us to the proposed structured reporting template for ovarian cancer. Through this review, the authors would like to share this reporting template with examples.

OBJECTIVE. The purpose of this study is to provide a comprehensive review of the radiographic anatomy and cross-sectional imaging findings of the full gamut of nasolacrimal drainage apparatus disea...

Background and Objectives: The prevalence of choledocholithiasis in the high-risk group of choledocholithiasis has been reported to be slightly more than 50% when there is no definite cholangitis. Replacement of diagnostic endoscopic retrograde cholangiography (ERC) with an EUS-first approach may be beneficial in these patients. Materials and Methods: In this prospective, multicenter study, patients with dilated common bile duct and serum total bilirubin levels of 1.8–4 mg/dL were randomly allocated to undergo either EUS first, followed by subsequent ERC if necessary (EUS group) or ERC only (ERC group). The primary endpoint was the incidence of negative outcomes associated with a false-negative diagnosis of the choledocholithiasis or the endoscopic procedure. The secondary endpoints were the rate of diagnostic ERC and hospital stay length related to the endoscopic procedure. Results: Of 90 patients who were randomly assigned, the final analysis involved 42 in the EUS group and 44 in the ERC group. The negative outcomes were not significantly different between the EUS and ERC groups (2.4% vs. 6.8%; P = 0.62). The rate of diagnostic ERC was significantly lower in the EUS group (2.4% vs. 47.7%; P < 0.001). The hospital stay length related to the endoscopic procedure was significantly shorter in the EUS group (1.8 ± 1.0 vs. 2.5 ± 1.2 days; P = 0.001). Conclusion: In selected high-risk choledocholithiasis patients, an EUS-first strategy significantly decreased the rate of diagnostic ERC and hospital stay but did not achieve a significant reduction in negative endoscopic procedure outcomes.

Objectives To describe the diagnostic and surgical management of a cervical tracheal glomus tumour and to perform a contemporary systematic review. Materials and methods We describe the management of a patient with cervical tracheal glomus tumour. Subsequently, a literature search in the PubMed/MEDLINE database for the last 20 years, from January 2000 to June 2020 was performed. The primary objective studies were those with patients who have been diagnosed and treated for glomus tumour of the trachea. Using this framework, two reviewers retrieved studies and those were critically evaluated. Results A total of 68 reports were screened for eligibility and 33 were included based on inclusion-exclusion criteria with 36 patients included. The most common location was the thoracic segment (82.9%) being cough and dyspnoea the most prevalent presenting symptoms. No risk factors for tracheal glomus tumour were identified. Diagnostic techniques included cross sectional imaging and bronchoscopy. Surgical excision is the preferred treatment option. With a median follow up of 20.7 months, all patients were alive and free of recurrence. Conclusion Tracheal glomus tumour is extremely rare, especially those located in the cervical segment of the trachea. Due to the silent evolution of the disease and the difficulty of exploration, this tumour is normally diagnosed with severe tracheal obstruction. Although this is a benign process in the majority of cases, the best treatment option is surgical excision, or endoscopic resection in selected cases. The tumour reported in this article was in close relation with the thyroid gland and the recurrent laryngeal nerve, creating a new surgical challenge for the head and neck surgeon.

Objectives: To undertake the first systematic review examining the performance of artificial intelligence (AI) applied to cross-sectional imaging for the diagnosis of acquired pulmonary arterial hypertension (PAH). Methods: Searches of Medline, Embase and Web of Science were undertaken on 1 July 2020. Original publications studying AI applied to cross-sectional imaging for the diagnosis of acquired PAH in adults were identified through two-staged double-blinded review. Study quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies and Checklist for Artificial Intelligence in Medicine frameworks. Narrative synthesis was undertaken following Synthesis Without Meta-Analysis guidelines. This review received no funding and was registered in the International Prospective Register of Systematic Reviews (ID:CRD42020196295). Results: Searches returned 476 citations. Three retrospective observational studies, published between 2016 and 2020, were selected for data-extraction. Two methods applied to cardiac-MRI demonstrated high diagnostic accuracy, with the best model achieving AUC=0.90 (95% CI: 0.85–0.93), 89% sensitivity and 81% specificity. Stronger results were achieved using cardiac-MRI for classification of idiopathic PAH, achieving AUC=0.97 (95% CI: 0.89–1.0), 96% sensitivity and 87% specificity. One study reporting CT-based AI demonstrated lower accuracy, with 64.6% sensitivity and 97.0% specificity. Conclusions: Automated methods for identifying PAH on cardiac-MRI are emerging with high diagnostic accuracy. AI applied to cross-sectional imaging may provide non-invasive support to reduce diagnostic delay in PAH. This would be helped by stronger solutions in other modalities. Advances in knowledge: There is a significant shortage of research in this important area. Early detection of PAH would be supported by further research advances on the promising emerging technologies identified.

Magnetic resonance imaging (MRI) is a useful complementary imaging tool for the diagnosis and characterization of renal masses, as it provides both morphologic and functional information. A core MRI protocol for renal imaging should include a T1-weighted sequence with in- and opposed-phase images (or, alternatively with DIXON technique), T2-weighted and diffusion-weighted images as well as a dynamic contrast-enhanced sequence with subtraction images, followed by a delayed post-contrast T1-weighted sequence. The main advantages of MRI over computed tomography include increased sensitivity for contrast enhancement, less sensitivity for detection of calcifications, absence of pseudoenhancement, and lack of radiation exposure. MRI may be applied for renal cystic lesion characterization, differentiation of renal cell carcinoma (RCC) from benign solid renal tumors, RCC histologic grading, staging, post-treatment follow-up, and active surveillance of patients with treated or untreated RCC.

Aim of work The aim of the study is to show the feasibility of diffusion weighted (DWI) MRI with calculation of the apparent diffusion coefficient in characterization of hepatic focal lesions as well as differentiating benign from malignant lesions in cirrhotic patients. Patients and Methods The study included 35 patients (25 males and 10 females) by cross sectional study and convenient sampling at the Demerdash hospital, inclusion criteria: patients diagnosed by hepatic focal lesions on top of post-viral induced cirrhosis, detected by ultrasound, triphasic CT or dynamic MRI imaging. All patients to be included in the study underwent characterization of hepatic focal lesions to differentiate benign from malignant lesions using a combination of characteristic imaging criteria, including contrast enhancement patterns on MRI. Sequences used were T2 weighted imaging, T2 Spectral Attenuated Inversion Recovery (SPAIR), and diffusion weighted imaging sequences with estimation of the ADC map and calculation of the ADC values. Results Our study was carried on a total of 35 patients including 25 males and 10 female patients having a mean age of 59 ± 10.2 years (58.1 ± 11 and 61.2 ± 8 years for the male and female patients respectively). DWI and ADC showed statistically significant difference among the benign and malignant focal lesions in terms of their diffusion restriction criteria ( P Summary and conclusion DWI MRI and the calculation of the ADC are great non invasive possible tools to detect and characterize hepatic focal lesions as well as to differentiate benign from malignant lesions in cirrhotic patients especially in patients with renal impairment and allergy to contrast media also to avoid unnecessary biopsies.

INTRODUCTION AND OBJECTIVE:The AUA/ASTRO/SUO 2017 Guidelines recommend the use of cross sectional imaging (CT or MRI) and Nuclear Medicine Bone Scan(NMBS) for staging high-risk localized prostate c...

Background Cross-sectional imaging using MRI is most commonly used to evaluate the response to neoadjuvant chemotherapy. Furthermore, CT scan of chest, abdomen, and pelvis (CAP) is used in staging the breast cancer. This study seeks to evaluate the feasibility of using preoperative cross-sectional imaging in oncoplastic surgical planning for patients undergoing neoadjuvant chemotherapy for breast cancer. Method All female patients who underwent neoadjuvant chemotherapy for breast cancer between January 2019 and January 2020 and underwent breast MRI pre- and post-neoadjuvant chemotherapy and staging CTCAP were included. All images were independently reviewed and analysed by two consultant breast radiologists. Chest wall symmetry, breast volume differences, skin flap thickness, arterial supply to nipple, intercostal perforators and LD pedicle were assessed on both CT and MRI. Results Nineteen women were included in this study. Breast measurements were best made by MRI due to difficulty interpreting the CT images when supine. The majority of the patients had a dual arterial supply. There was substantial inter–observer agreement in visualisation of MICAP and AICAP. The inter–observer reliability reduced when the radiologists were asked to visualize the LICAP and the thoracodorsal artery with moderate inter–observer agreement, as the MRI images were difficult to interpret laterally. Conclusions This study shows that MRI is suitable to detect most intercostal perforators and is the first study to highlight cross-sectional modalities for assessment of intercostal perforators and may aid preoperative surgical planning and choice of perforator. We have suggested potential addition of CT angiography in cases where the surgeon plans oncoplastic surgery.

Introduction The present study aimed to review the epidemiologic, topographic, and morphometric aspects of the mental foramen (MF) and anterior loop (AL) on cone-beam computed tomographic imaging studies. Methods An International Prospective Register of Systematic Reviews (PROSPERO)-registered systematic review (CRD42018112991) was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Two reviewers independently performed data extraction from observational studies that evaluated MF and AL on 7 electronic databases. MedCalc (MedCalc Software bv, Ostend, Belgium) software was used to perform a meta-analysis with a 95% confidence level. Results Of 1545 articles, 66 met the inclusion criteria, totaling 14,233 patients from 5 continents, with a total of 6655 females and 5884 males (some studies did not report sex), with an age range between 8 and 89 years. The most prevalent shapes of MF were oval (48.72%) and circular (44.36%), and the most frequent horizontal positions were between premolars (43.66%) and in line with the long axis of the second premolar (43.12%). Conclusions Based on the articles that assessed AL, the mean prevalence was 43.18%, with most studies reporting bilateral localization as the most prevalent.

Knee trauma is a common presenting symptom in the emergency setting. Avulsive knee injuries are important to diagnose timely and accurately to avoid unnecessary patient morbidity. Many of these avulsive knee injuries have characteristic appearances on imaging. This article presents a comprehensive review of some of the most common types with real cases used for imaging correlation.

Background: Detection of residual, recurrent, or second primary malignancies in head and neck cancers treated patients can be challenging. Soft tissue changes and anatomical disfigurement seen after surgery, radiotherapy, and chemotherapy can distort the anatomy of the head and neck and make post treatment imaging reporting very complex.Aim of work: To evaluate the performance of the Neck imaging, and reporting data system template recently created by the American College of Radiology (ACR) Committee in the prediction of local and regional disease recurrence or persistence of head and neck squamous cell carcinoma after treatment by using CE MRI/ CT, and PET-CT in inconclusive cases. Patients and Methods: 116 scans for 55patients with head and neck squamous cell cancerswere included after finishing their treatment, reporting done using the ACR NI-RADS reporting template and lexicon and NI-RADS category was assigned to each scan, the accuracy of this categorization was done by correlation with our gold standard: tissue pathological examination and/ or three months interval follow up scan. Results: Out of the 116 scans included in our study, we had 232 targets for primary tumour sites and lymph nodes, the overall tumour recurrence have occurred in 53 targets out of the total of 232, with a total tumour recurrence rate of 22.8%, the recurrence rates for each NI-RADS category for the primary tumour site were: 3.9% (2/51) for NI-RADS 1 category, 17.6% (3/17) for NI-RADS 2a category, 18.2% (4/22) for NI-RADS 2b category , and 76.9% (20/26) for NI-RADS 3 category. Regarding the lymph nodes, the recurrence rates for the different NI-RADS categories were: 3.8% (3/80) for NI-RADS 1 category, 7.1% (1/14) for NI-RADS 2 category, and 81.8% (18/22) for NI-RADS 3 category. The recurrence rates for combined NI-RADS categories for both the primary tumour site and lymph nodes were (Table 7): 3.8% (5/131) for NI-RADS 1 category, 19.6% (10/51) forNI-RADS 2 category, and 76.2% (38/48) for NI-RADS 3 category. Conclusion: The performance of the ACR NI-RADS reporting system and its linked management recommendations is excellent, with statistically significant discrimination in between the different NIRADS categories for either the primary tumour site, lymph nodes and for both combined. The use of NI-RADS can help to direct the management plans towards more proper options.

Imaging plays a central role in the 2018 International Federation of Gynecology and Obstetrics staging system for uterine cervical cancer. The revision calls for a more precise measurement of primary tumor size, best assessed with imaging. Evaluation for abdominopelvic retroperitoneal lymphadenopathy, either with imaging alone or with pathologic analysis, is now also part of staging. Choice of modality depends on the technology available within the practice setting. In high-resource settings, pelvic MRI (to assess tumor size and central pelvic spread) and torso fluorodeoxyglucose PET/CT (to assess lymphadenopathy and distant metastases) are used to assign stage and to plan therapy. In lower-resource settings, analogous modalities are pelvic US and chest radiography. Although imaging is already a part of pretreatment planning in some high-resource settings, its incorporation into assigning stage is a new development.

Background Patients with primary aldosteronism undergo imaging of the adrenal glands after confirmation of the disease. Adrenal venous sampling (AVS) is a useful adjunct to imaging, and advocates believe that AVS should be performed before surgical management. Others argue that patients with unilateral lesions on imaging do not require AVS. Although AVS accuracy has been established, few studies have evaluated how AVS alters management. Our study aimed to determine how AVS affected management of these patients. Study Design Patient data were collected retrospectively from the electronic medical records at a single institution. Patients aged 18 years or older who underwent AVS with successful adrenal vein cannulation from 2007 to 2016 were included. The laterality of AVS was compared with laterality of preprocedural imaging for each patient. The management plan before AVS was determined by laterality on preprocedural imaging. The primary outcomes were management of primary aldosteronism, change in management compared with the plan before AVS, and antihypertensive medication use after therapy. Results Seventy-four patients had successful adrenal venous cannulation. Thirty-three (44.6%) patients had AVS lateralization that was concordant with preprocedural imaging. Forty-one (55.4%) patients had AVS lateralization that was non-concordant with preprocedural imaging. There was a change in management in 29 (39.2%) patients. Conclusions Adrenal venous sampling can delineate the source of aldosterone hypersecretion, and often this is not concordant with cross-sectional imaging. We found that many patients avoided a potentially non-curative operation due to AVS. Adrenal venous sampling frequently alters the management of aldosteronomas and should be highly considered in patients before surgical intervention.