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OBJECTIVES: To compare translabial three-dimensional (3D) ultrasound with magnetic resonance imaging (MRI) for the measurement of levator hiatus biometry at rest in women with pelvic organ prolapse, and to determine the interobserver reliability between two independent observers for ultrasound and MRI measurements. METHODS: In a multicentre prospective cohort study, women planned for conventional anterior colporrhaphy underwent translabial 3D ultrasound and MRI prior to surgery. Intraclass Correlation Coefficients (ICC) were calculated to estimate the interobserver reliability between two independent observers and to calculate the agreement between ultrasound and MRI measurements. Bland-Altman plots were created to visualize the agreement between ultrasound and MRI measurements. RESULTS: One hundred thirty-nine women were included in 9 hospitals. The interobserver reliability between the assessments on ultrasound at rest, during Valsalva and during contraction and on MRI at rest by two independent observers was good. The agreement between ultrasound and MRI for the measurements of levator hiatus biometry at rest was moderate with an ICC of 0.52 (95% confidence interval (CI) 0.32-0.66) for levator hiatal area, an ICC of 0.44 (95% CI 0.21-0.60) for the anteroposterior diameter and an ICC of 0.44 (95% CI 0.22-0.60) for the transversal diameter. MRI measurements were statistically significantly larger than on translabial 3D ultrasound. CONCLUSIONS: The agreement between translabial 3D ultrasound and MRI for the measurement of the levator hiatus biometry at rest in women with pelvic organ prolapse was only moderate. The results of translabial 3D ultrasound and MRI should therefore not be interchangeably used in daily practice or in clinical research.

Five years ago, we reported on the use of 1H-magnetic resonance spectroscopy (MRS-PDFF) as a non-invasive means of determining the amount of liver fat. Liver biopsy, the current reference method, has several shortcomings (e.g. risk of complications and large interobserver variability), which are less pronounced or absent in MRS-PDFF. In RCT's, MRS-PDFF is currently used as an outcome measure to assess therapy response. Its successor is already being deployed: MRI-PDFF. This is a short whole-liver MRI scan, which takes approximately 18 seconds. The use of MRS- or MRI-PDFF has not boomed in the Netherlands. Reasons include unfamiliarity with the technique amongst both clinicians and radiologists, as well as increased reliance on ultrasound imaging with Fibroscan by hepatologists in particular. This latter method, however, is less accurate in classifying the various steatosis grades than MRS- and MRI-PDFF

Image registration of medical images in the presence of large intra-image signal fluctuations is a challenging task. Our paper addresses this problem by introducing a new concept based on the structure tensor of the local phase. The local phase is calculated from the monogenic signal representation of the images. The local phase image is hardly affected by unwanted signal fluctuations due to a space-variant background and a space-variant contrast. The boundary structure tensor combines the responses of edges and corners/junctions in one tensor, which has several advantages, compared to other structure tensors. We reorient the structure tensor during the registration by means of the finite-strain technique. The structure tensor is only calculated once during a preprocessing step. The results demonstrate that the proposed method effectively deals with large signal fluctuations. It performs significantly better than competing techniques.

OBJECTIVE: Nonalcoholic fatty liver disease (NAFLD) has been recognized as an independent risk factor for cardiovascular disease in adults. It has not been established whether NAFLD is related to early atherosclerotic changes in children. METHODS: In a cross-sectional study, 78 non diabetic, non smoking children with severe obesity were evaluated for NAFLD. Proton magnetic resonance spectroscopy was used to detect liver steatosis and serum ALT was used as a surrogate marker for steatohepatitis. Carotid intima-media thickness (CIMT) and arterial wall stiffness were measured using ultrasound. RESULTS: Steatosis was present in 41 (53%) of subjects. Of these children, 26 out of 41 (63%) had elevated ALT levels. No differences in CIMT and arterial wall stiffness were observed between those without and with steatosis and those with steatosis plus elevated ALT levels [CIMT = 0.47 (+/-0.06), 0.48 (+/-0.06) and 0.48 (+/-0.07) mm, respectively; stiffness = 2.78 (+/-0.50), 3.00 (+/-0.81), and 2.90 (+/-0.78), respectively]. Steatosis and ALT were not correlated to CIMT (r = -0.02 and -0.14, respectively) or arterial wall stiffness (r = 0.13 and -0.11, respectively). CONCLUSIONS: In this study, no relationship between NAFLD and early atherosclerotic changes in children was observed. An atherogenic effect of steatohepatitis (NASH) on pediatric age and long-term atherogenic consequences of simple steatosis cannot be excluded based on this study.

BACKGROUND: Accurate prediction scores for liver steatosis are demanded clinicians to noninvasively screen for nonalcoholic fatty liver disease Several prediction scores have been developed, however external lacking. OBJECTIVE: The aim was to determine the diagnostic accuracy of existing prediction scores in severely obese children, to develop a new prediction score using novel biomarkers and to compare these results to performance of ultrasonography. DESIGN AND RESULTS: Liver steatosis was using proton magnetic resonance spectroscopy in 119 severely obese age 14.3 +/- 2.1 years, BMI z-score 3.35 +/- 0.35). Prevalence of 47%. The four existing predictions scores ("NAFLD liver fat score," index," "hepatic steatosis index," and the pediatric prediction score) moderate diagnostic accuracy in this cohort (positive predictive value 61, 61, 69% and negative predictive value (NPV) 77, 69, 68, 75%, new prediction score was built using anthropometry, routine biochemistry novel biomarkers (leptin, adiponectin, TNF-alpha, IL-6, CK-18, FGF-21, adiponutrin polymorphisms). The final model included ALT, HOMA, sex, and This equation (PPV 79% and NPV 80%) did not perform substantially better four other equations and did not outperform ultrasonography for (NPV 82%). CONCLUSION: The conclusion is in severely obese children and adolescents existing prediction scores and the tested novel biomarkers insufficient diagnostic accuracy for diagnosing or excluding NAFLD.

Sarah L Gans,1 Jaap Stoker,2 Marja A Boermeester11Department of Surgery, 2Department of Radiology, Academic Medical Center, University of Amsterdam, Amsterdam, The NetherlandsAbstract: Several studies have demonstrated that a diagnosis based solely on a patient’s medical history, physical examination, and laboratory tests is not reliable enough, despite the fact that these aspects are essential parts of the workup of a patient presenting with acute abdominal pain. Traditionally, imaging workup starts with abdominal radiography. However, numerous studies have demonstrated low sensitivity and accuracy for plain abdominal radiography in the evaluation of acute abdominal pain as well as various specific diseases such as perforated viscus, bowel obstruction, ingested foreign body, and ureteral stones. Computed tomography, and in particular computed tomography after negative ultrasonography, provides a better workup than plain abdominal radiography alone. The benefits of computed tomography lie in decision-making for management, planning of a surgical strategy, and possibly even avoidance of negative laparotomies. Based on abundant available evidence, major advances in diagnostic imaging, and changes in the management of certain diseases, we can conclude that there is no place for plain abdominal radiography in the workup of adult patients with acute abdominal pain presenting in the emergency department in current practice.Keywords: abdominal x-ray, acute abdomen, acute abdominal pain, emergency department, diagnostic imaging, abdominal radiography

In a relatively high percentage of patients with a clinically suspected diverticulitis a different diagnosis is established after imaging tests, such as 'appendicitis' or 'intestinal obstruction'. The clinical diagnosis 'acute diverticulitis' is correct for between 43% and 68% of suspected patients. Strongly predictive variables for the diagnosis are tenderness in the left lower abdomen only, CRP > 50 mg/l and absence of vomiting. This triad has a positive predictive value of 97% (95% CI: 83-99) for the final diagnosis 'diverticulitis'. The negative predictive value is much lower, namely 47%: the absence of 1 of the 3 factors does not (sufficiently) exclude 'diverticulitis'. This triad can be an easy-to-use decision rule to rule in diverticulitis

Objective: The purpose of this study was to evaluate the added value of plain radiographs on top of clinical assessment in unselected patients presenting with acute abdominal pain at the emergency department (ED). Methods: In a multicenter prospective trial, patients with abdominal pain more than 2 hours and less than 5 days presented at the ED were evaluated clinically, and a diagnosis was made by the treating physician. Subsequently, all patients underwent supine abdominal and upright chest radiographs, after which the diagnosis was reassessed by the treating physician. A final (reference) diagnosis was assigned by an expert panel. The number of changes in the primary diagnosis, as well as the accuracy of these changes, was calculated. Changes in the level of confidence were evaluated for unchanged diagnoses. Results: Between March 2005 and November 2006, 1021 patients, 55% female, mean age 47 years (range, 19-94 years), were included. In 117 of 1021 patients, the diagnosis changed after plain radiographs, and this change was correct in 39 patients (22% of changed diagnoses and 4% of total study population). Overall, the clinical diagnosis was correct in 502 (49%) patients. The diagnosis after evaluation of the radiographs was correct in 514 (50%) patients, a nonsignificant difference (P = .14). In 65% of patients with unchanged diagnosis before and after plain radiography, the level of confidence of that diagnosis did not change either. Conclusion: The added value of plain radiographs is too limited to advocate their routine use in the diagnostic workup of patients with acute abdominal pain, because few diagnoses change and the level of confidence were mostly not affected. (C) 2011 Elsevier Inc. All rights reserved.

Hepatic steatosis is characterized by accumulation of fat in the liver. The prevalence of hepatic steatosis is increasing wordwide due to the close relation between obesity and insulin resistance in non-alcoholic fatty liver disease (NAFLD). The reference standard for determination of hepatic steatosis is liver biopsy with histological assessment. The objections to this are increased risk of complications, patient discomfort and inter-observer variability. Proton MR spectroscopy (1H-MRS) provides information about the chemical constitution of tissues in a spectrum. In this way, 1H-MRS is able to non-invasively measure the amount of fat in the liver. 1H-MRS is precise and reproducible for the assessment of hepatic fat and is useful in all patients for whom an assessment of hepatic steatosis is required, except for those in which MRI is contra-indicated. 1H-MRS is not difficult to learn, but one has to gain some experience with the data-acquisition to obtain good quality MR spectra