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Lymphoepithelial cyst of the pancreas is a rare, non-malignant lesion with a good prognosis. It is filled with keratinized material, lined by squamous epithelium, and surrounded by lymphoid tissue. The imaging appearance of lymphoepithelial cyst varies and sometimes similar to other pancreatic lesions. Therefore, the preoperative imaging diagnosis of the lymphoepithelial cyst is difficult. We present a case of surgically diagnosed lymphoepithelial cyst of the pancreas focused on MR imaging features.

Purpose: To evaluate the feasibility of ultra-low dose 80 kVp CT for the evaluation of inflammatory bowel disease (IBD) in a rabbit model and to investigate the effect of two different iterative reconstruction (IR) algorithms on 80 kVp CT in terms of image quality and diagnostic performance in comparison with same session conventional 120 kVp images.Materials and Methods: This study was approved by the Animal Care and Use Committee of our hospital. Twenty-eight New Zealand white rabbits were randomly divided into two groups: IBD group (n=18) and a control group (n=10). To create an acute IBD model, 3mL of a 5% w/v tri-nitrobenzene sulfonic acid solution was administered to the sigmoid colon of the rabbits. CT was performed at 80 kVp and 120 kVp and was reconstructed using filtered back projection (FBP), hybrid statistic-based IR, and full IR algorithms for 80 kVp and using FBP only for 120 kVp. Effective radiation dose, image noise, image quality, and diagnostic performance by two reviewers were recorded and compared using repeated measure analysis of variance, McNemar test, and receiver operating curve (ROC) analysis.Results: Mean effective radiation dose of 80 kVp CT (0.05 mSv) was significantly lower than that (0.285 mSv) of 120 kVp CT. Mean image noise was highest in the 80 kVp FBP setting (60.36) but significantly decreased with IR algorithms (47.02 with hybrid IR and 12.92 with full IR) (P

OBJECTIVE. The purpose of this study is to investigate the detection rate of transabdominal ultrasound (TAUS) for pancreatic cysts incidentally detected on CT or MRI as well as the factors that influence detection rates. SUBJECTS AND METHODS. Fifty-seven patients with low-risk pancreatic cysts (n = 77; cyst size, 5 mm to 3 cm) that were incidentally detected on CT or MRI were prospectively enrolled at five institutions. At each institution, TAUS was independently performed by two radiologists who assessed detection of cysts, cyst location and size, and the diameter of the main pancreatic duct (MPD). Cyst detection rates based on cyst size, location, and multiplicity and the body mass index of the patient were compared using the Mann-Whitney test. Kappa statistics and the interclass correlation coefficient were used to evaluate interobserver agreement regarding cyst detection and consistency of cyst size and the diameter of the MPD on TAUS versus prior CT or MRI. RESULTS. The detection rate for known low-risk pancreatic cysts was 81.8% (63/77) and 83.1% (64/77) for TAUS conducted by each of the two radiologists. The detection rate for larger (≥ 10 mm) cysts was significantly higher than that for smaller cysts (89.0% vs 63.6% for TAUS performed and interpreted by radiologist 1 [TAUS 1] and 89.0% vs 68.2% for TAUS conducted and interpreted by radiologist 2 [TAUS 2]; p < .05). A higher detection rate was noted for cysts located outside the tail of the pancreas compared with those located in the tail (89.5% vs 65.0% for TAUS 2; p = .01), and the detection rate was also significantly higher for single cysts than for multiple cysts (90.9% vs 69.7% for TAUS 1; p = .02). However, no significant difference was observed for body mass index. Interobserver agreement was excellent regarding the size of the detected cysts (inter-class correlation coefficient: 0.964 [95% CI, 0.940-0.979] for CT, TAUS 1, and TAUS 2 and 0.965 [95% CI. 0.924-986] for MRI, TAUS 1, and TAUS 2) and the diameter of the MPD (interclass correlation coefficient, 0.934; 95% CI, 0.898-0.959). CONCLUSION. TAUS could be a useful alternative imaging tool for surveillance of known low-risk pancreatic cysts, especially single pancreatic cysts and those that are of larger size (≥ 1 cm) or are located outside the tail.

To evaluate the diagnostic performance of whole-body MRI (WB-MRI) including contrast-enhanced T1-weighted imaging (T1WI) and WB-DWI in rectal cancer initial staging. This retrospective study was approved by the IRB and the requirement of informed consent was waived. From September 2013 to Feb 2015, patients who underwent rectal MRI including WB-MRI, as well as chest and abdominopelvic CT for initial staging, were included. WB-MRI consisted of contrast-enhanced T1-weighted imaging and DWI covering neck to the pelvis. Three radiologists reviewed WB-MRI and CECT independently for the M-classification. The diagnostic performance of CECT and WB-MRI was compared using a reference standard incorporating histology, FDG-PET results, and clinical follow-up. A total of 139 patients (male:female = 89:50, mean age 63.2 ± 12.4 years) were included and metastasis was observed in 15.2% (21/139). WB-MRI showed significantly higher specificity (96.7% [114/118] vs. 85.6% [101/118], p = 0.001) and positive predictive value (PPV) (80% [16/20] vs. 48.5% [16/33], p 0.99) and negative predictive value (95.3% [101/106] at CECT vs. 95.8% [114/119] at WB-MRI, p = 0.77) between CECT and WB-MRI. WB-MRI showed higher specificity and PPV than CECT in newly diagnosed rectal cancer. Adding WB-MRI to standard rectal MRI is a feasible option for initial staging workup of rectal cancer. • WB-MRI showed a higher specificity and PPV than those of CECT for identifying metastasis at initial staging workup of rectal cancer. • WB-MRI and CECT did not show a significant difference in sensitivity and NPV for the M-classification. • WB-MRI can be used as an alternative to CECT for the initial M-classification modality in newly diagnosed rectal cancer.

Benign gallbladder diseases usually present with intraluminal lesions and localized or diffuse wall thickening. Intraluminal lesions of the gallbladder include gallstones, cholesterol polyps, adenomas, or sludge and polypoid type of gallbladder cancer must subsequently be excluded. Polyp size, stalk width, and enhancement intensity on contrast-enhanced ultrasound and degree of diffusion restriction may help differentiate cholesterol polyps and adenomas from gallbladder cancer. Localized gallbladder wall thickening is largely due to segmental or focal gallbladder adenomyomatosis, although infiltrative cancer may present similarly. Identification of Rokitansky-Aschoff sinuses is pivotal in diagnosing adenomyomatosis. The layered pattern, degree of enhancement, and integrity of the wall are imaging clues that help discriminate innocuous thickening from gallbladder cancer. High-resolution ultrasound is especially useful for analyzing the layering of gallbladder wall. A diffusely thickened wall is frequently seen in inflammatory processes of the gallbladder. Nevertheless, it is important to check for coexistent cancer in instances of acute cholecystitis. Ultrasound used alone is limited in evaluating complicated cholecystitis and often requires complementary computed tomography. In chronic cholecystitis, preservation of a two-layered wall and weak wall enhancement are diagnostic clues for excluding malignancy. Magnetic resonance imaging in conjunction with diffusion-weighted imaging helps to differentiate xathogranulomatous cholecystitis from gallbladder cancer by identifying the presence of fat and degree of diffusion restriction. Such distinctions require a familiarity with typical imaging features of various gallbladder diseases and an understanding of the roles that assorted imaging modalities play in gallbladder evaluations.

The noninvasive diagnosis of hepatic steatosis is of increasing concern. This study investigated the association of hepatic steatosis determined by non-enhanced CT criteria with clinical parameters in a screening population. Asymptomatic patients who underwent abdominal CT at our healthcare center were retrospectively analyzed (n = 339). Two radiologists measured the attenuation values of the liver parenchyma and spleen using non-enhanced CT images. CT criteria for hepatic steatosis were (a) absolute liver attenuation value

Introduction: Small-duct (SD) and large-duct (LD) subtypes of cholangiocarcinoma have been investigated for their prognostic factors. This study aimed to evaluate the diagnostic value of liver magnetic resonance imaging (MRI) in differentiating SD and LD types of intrahepatic cholangiocarcinoma (iCCA) and its prognostic value in predicting survival outcomes. Methods: One hundred forty patients with surgically confirmed iCCAs (93 SD type and 47 LD type) who had available preoperative gadoxetic acid-enhanced liver MR images were retrospectively included. MRI features suggestive of the LD type over the SD type were analyzed using multivariate logistic analyses. Postoperative recurrence-free survival (RFS) and overall survival (OS) for 107 patients with available survival data were compared according to MRI features. Results: MRI features suggestive of the LD type included infiltrative contour (odds ratio [OR] 14.2, 95% confidence interval [CI]: 2.5–81.7, p = 0.003), diffuse biliary dilatation (OR 9.7, 95% CI: 1.2–76.9, p = 0.032), no arterial phase hyperenhancement (OR 17.8, 95% CI: 2.7–118.6, p = 0.003), and vascular invasion (OR 4.5, 95% CI: 1.3–15.4, p = 0.018). When two or more features were combined, sensitivity was 59.6% (28/47), and specificity was 95.7% (89/93) in discriminating the LD type. RFS/OS was significantly shorter in patients with two or more MRI features, compared to those with none or one (310 days vs. 529 days, p = 0.011/964 days vs. 2,023 days, p = 0.010). Conclusions: Preoperative liver MRI may help predict the pathological subtype of iCCAs as either the SD type or LD type, allowing preoperative identification of patients with poorer survival outcomes.

To compare the overall image quality and detectability of significant (malignant and pre-malignant) liver lesions of low-dose liver CT (LDCT, 33.3% dose) using deep learning denoising (DLD) to standard-dose CT (SDCT, 100% dose) using model-based iterative reconstruction (MBIR).In this retrospective study, CT images of 80 patients with hepatic focal lesions were included. For noninferiority analysis of overall image quality, a margin of - 0.5 points (scored in a 5-point scale) for the difference between scan protocols was pre-defined. Other quantitative or qualitative image quality assessments were performed. Additionally, detectability of significant liver lesions was compared, with 64 pairs of CT, using the jackknife alternative free-response ROC analysis, with noninferior margin defined by the lower limit of 95% confidence interval (CI) of the difference of figure-of-merit less than - 0.1.The mean overall image quality scores with LDCT and SDCT were 3.77 ± 0.38 and 3.94 ± 0.34, respectively, demonstrating a difference of - 0.17 (95% CI: - 0.21 to - 0.12), which did not cross the predefined noninferiority margin of - 0.5. Furthermore, LDCT showed significantly superior quantitative results of liver lesion contrast to noise ratio (p 0.05). However, although LDCT scored higher than the average score in qualitative image quality assessments, they were significantly lower than those of SDCT (p 0.05). Figure-of-merit for lesion detection was 0.859 for LDCT and 0.878 for SDCT, showing noninferiority (difference: - 0.019, 95% CI: - 0.058 to 0.021).LDCT using DLD with 67% radiation dose reduction showed non-inferior overall image quality and lesion detectability, compared to SDCT.• Low-dose liver CT using deep learning denoising (DLD), at 67% dose reduction, provided non-inferior overall image quality compared to standard-dose CT using model-based iterative reconstruction (MBIR). • Low-dose CT using DLD showed significantly less noise and higher CNR

To investigate clinical and CT factors associated with local resectability in patients with nonmetastatic pancreatic cancers after neoadjuvant chemotherapy ± radiation therapy (CRT). This retrospective study included consecutive patients with nonmetastatic pancreatic cancers who underwent neoadjuvant CRT between June 2009 and June 2019. Tumor size, tumor-vascular contact with artery/vein, and local resectability categories (resectable, borderline resectable, or locally advanced) were assessed at baseline and post-CRT CT. Baseline and post-CRT carbohydrate antigen (CA) 19-9 levels were also assessed. Clinical or imaging features related to R0 resection were determined using logistic regression analysis. A total of 179 patients (mean age, 62.4 ± 9.3 years; 92 men) were included. After neoadjuvant CRT, 105 (58.7%) patients received R0 resection, while 74 (41.3%) did not. R0 resection rates were significantly different according to post-CRT CT resectability categories (p < 0.001): 82.8% (48/58), 70.1% (47/67), and 18.5% (10/54) for resectable, borderline resectable, and locally advanced disease, respectively. For post-CRT borderline resectable disease, ≥ 50% decrease in CA 19-9 was significantly associated with R0 resection (odds ratio (OR), 3.160; p = 0.02). For post-CRT locally advanced disease, small post-CRT tumor size ≤ 2 cm (OR, 9.668; p = 0.026) and decreased tumor-arterial contact (OR, 24.213; p = 0.022) were significantly associated with R0 resection. Post-CRT CT resectability categorization may be useful for the assessment of R0 resectability in patients with pancreatic cancer following neoadjuvant CRT. Additionally, ≥ 50% decrease in CA 19-9 was associated with R0 resection in post-CRT borderline resectable disease, while small post-CRT tumor size and decreased tumor-arterial contact were with locally advanced disease. • R0 resection rates following neoadjuvant chemotherapy ± radiation therapy (CRT) were 82.8%, 70.1%, and 18.5% in resectable, borderline resectable, and locally advanced disease, respectively, at post-CRT CT (p < 0.001). • For post-CRT borderline resectable disease, ≥ 50% decrease in carbohydrate antigen (CA) 19-9 was significantly associated with R0 resection. • For post-CRT locally advanced disease, small post-CRT tumor size ≤ 2 cm and decreased tumor-arterial contact were significantly associated with R0 resection.

To determine if golden-angle radial sparse parallel (GRASP) dynamic contrast-enhanced (DCE)-MRI allows simultaneous evaluation of perfusion and morphology in liver fibrosis.Participants who were scheduled for liver biopsy or resection were enrolled (NCT02480972). Images were reconstructed at 12-s temporal resolution for morphologic assessment and at 3.3-s temporal resolution for quantitative evaluation. The image quality of the morphologic images was assessed on a four-point scale, and the Liver Imaging Reporting and Data System score was recorded for hepatic observations. Comparisons were made between quantitative parameters of DCE-MRI for the different fibrosis stages, and for hepatocellular carcinoma (HCCs) with different LR features.DCE-MRI of 64 participants (male = 48) were analyzed. The overall image quality consistently stood at 3.5 ± 0.4 to 3.7 ± 0.4 throughout the exam. Portal blood flow significantly decreased in participants with F2-F3 (n = 18, 175 ± 110 mL/100 mL/min) and F4 (n = 12, 98 ± 47 mL/100 mL/min) compared with those in participants with F0-F1 (n = 34, 283 ± 178 mL/100 mL/min, p0.05 for all). In participants with F4, the arterial fraction and extracellular volume were significantly higher than those in participants with F0-F1 and F2-F3 (p0.05). Compared with HCCs showing non-LR-M features (n = 16), HCCs with LR-M (n = 5) had a significantly prolonged mean transit time and lower arterial blood flow (p0.05).Liver MRI using GRASP obtains both sufficient spatial resolution for confident diagnosis and high temporal resolution for pharmacokinetic modeling. Significant differences were found between the MRI-derived portal blood flow at different hepatic fibrosis stages.A single MRI examination is able to provide both images with sufficient spatial resolution for anatomic evaluation and those with high temporal resolution for pharmacokinetic modeling. Portal blood flow was significantly lower in clinically significant hepatic fibrosis and mean transit time and extracellular volume increased in cirrhosis, compared with those in no or mild hepatic fibrosis. HCCs with different LR features showed different quantitative parameters of DCE-MRI: longer mean transit time and lower arterial flow were observed in HCCs with LR-M features.

Background/Aims: Postoperative abdominal fluid collection (PAFC) is a frequent complication of pancreatobiliary cancer surgery. The effects of the existence and duration of PAFC are not well known. This study aimed to assess the effects of PAFC on patient prognosis after surgery for pancreatobiliary adenocarcinoma and the association of longstanding PAFC with the recurrence of pancreatic cancer.Methods: We retrospectively analyzed the data of 194 consecutive patients with pancreatobiliary adenocarcinoma who underwent curative operations from August 2005 to December 2019. The presence of PAFC was assessed using computed tomography within a week of surgery; PAFC lasting > 4 weeks was defined as longstanding PAFC.Results: Among 194 patients, PAFC occurred in 165 (85.1%), and 74 of these had longstanding PAFC. The recurrence rate of pancreatobiliary adenocarcinoma was significantly higher in patients with longstanding PAFC than in patients with non-longstanding PAFC (p = 0.025). Recurrence was also significantly associated with high T stage (T3, T4; p = 0.040), lymph node involvement (p < 0.001), perineural invasion (p < 0.006), and non-receipt of adjuvant chemotherapy (p = 0.025). Longstanding PAFC was significantly associated with the recurrence of pancreatic adenocarcinoma (p = 0.016). However, cancer-specific survival was related to neither the presence nor the duration of PAFC.Conclusions: The presence of longstanding PAFC was associated with the recurrence of pancreatic adenocarcinoma. However, a larger prospective study is necessary to confirm the findings.

To evaluate the diagnostic performance of whole-body MRI (WB-MRI) including contrast-enhanced T1-weighted imaging (T1WI) and WB-DWI in rectal cancer initial staging.This retrospective study was approved by the IRB and the requirement of informed consent was waived. From September 2013 to Feb 2015, patients who underwent rectal MRI including WB-MRI, as well as chest and abdominopelvic CT for initial staging, were included. WB-MRI consisted of contrast-enhanced T1-weighted imaging and DWI covering neck to the pelvis. Three radiologists reviewed WB-MRI and CECT independently for the M-classification. The diagnostic performance of CECT and WB-MRI was compared using a reference standard incorporating histology, FDG-PET results, and clinical follow-up.A total of 139 patients (male:female = 89:50, mean age 63.2 ± 12.4 years) were included and metastasis was observed in 15.2% (21/139). WB-MRI showed significantly higher specificity (96.7% [114/118] vs. 85.6% [101/118], p = 0.001) and positive predictive value (PPV) (80% [16/20] vs. 48.5% [16/33], p 0.001) than CECT. However, there were no significant differences in sensitivity (76.2% [16/21] for both, p 0.99) and negative predictive value (95.3% [101/106] at CECT vs. 95.8% [114/119] at WB-MRI, p = 0.77) between CECT and WB-MRI.WB-MRI showed higher specificity and PPV than CECT in newly diagnosed rectal cancer. Adding WB-MRI to standard rectal MRI is a feasible option for initial staging workup of rectal cancer.• WB-MRI showed a higher specificity and PPV than those of CECT for identifying metastasis at initial staging workup of rectal cancer. • WB-MRI and CECT did not show a significant difference in sensitivity and NPV for the M-classification. • WB-MRI can be used as an alternative to CECT for the initial M-classification modality in newly diagnosed rectal cancer.

Purpose To evaluate modified Dixon MRI techniques in hepatic fat estimation and to assess the effect of cirrhosis. Methods 235 patients who underwent liver MRI were included. Correlation between modified Dixon techniques with MRS was assessed. Accuracy of MR techniques in hepatic fat estimation was calculated, and the result was compared between patients with/without liver cirrhosis. Results Correlation between modified Dixon and MRS was better in group without liver cirrhosis, and accuracy of modified Dixon method was higher in group without liver cirrhosis. Conclusions Modified Dixon techniques estimate hepatic fat fraction noninvasively, but the result can be influenced by the presence of liver cirrhosis.

To determine the diagnostic value of the cotton ball sign and other CT features in patients with gallbladder (GB) wall thickenings (WTs). Three blinded readers reviewed the preoperative CT and MR images of 101 patients with pathologically confirmed GB adenomyomatosis (GA) (n = 34) and other benign (n = 29), malignant (n = 41), and premalignant (n = 2) GBWTs. Three readers analysed the morphological features of GBWT and presence of the “cotton ball sign”, defined as fuzzy grey dots in GBWT or a dotted outer border of the inner enhancing layer on contrast-enhanced (CE) CT. In addition, the “pearl necklace sign” on MR was analysed. In the GA group (n = 34), prevalence of the cotton ball sign and pearl necklace sign was 74% (25/34) and 44% (15/34), respectively. Presence of the cotton ball sign, smooth contour of the mucosa, double-layering enhancement, and enhancement degree weaker than the renal cortex on CT images were significant predictors of benign GBWT (p < 0.01). When differentiating GA from GB malignancy or premalignancy, accuracy of the cotton ball sign and pearl necklace sign was 81% (62/77) and 74% (57/77), respectively. The cotton ball sign on CE-CT showed higher sensitivity and comparable specificity to those of the pearl necklace sign in differentiating GA from malignancy. • Prevalence of the cotton ball sign on CT was 74% in gallbladder adenomyomatosis. • The cotton ball sign was useful in differentiating gallbladder adenomyomatosis from gallbladder cancer. • The cotton ball sign was more sensitive than the pearl necklace sign for adenomyomatosis diagnosis.

Background Pancreatic neuroendocrine tumors (PNET) include heterogeneous tumors with a variable degree of inherent biologic aggressiveness represented by the histopathologic grade. Although several studies investigated the computed tomography (CT) characteristics which can predict the histopathologic grade of PNET, accurate prediction of the PNET grade by CT examination alone is still limited. Purpose To investigate the important CT findings and CT texture variables for prediction of grade of PNET. Material and Methods Sixty-six patients with pathologically confirmed PNETs (grade 1 = 45, grades 2/3 = 21) underwent preoperative contrast-enhanced CT. Two reviewers determined the presence of predefined CT findings. CT texture was also analyzed on arterial and portal phase using both two-dimensional (2D) and three-dimensional (3D) analysis. Multivariate logistic regression analysis was performed in order to identify significant predictors for tumor grade. Results Among CT findings and CT texture variables, the significant predictors for grade 2/3 tumors were an ill-defined margin (odds ratio [OR] = 7.273), lower sphericity (OR = 0.409) on arterial 2D analysis, higher skewness (OR = 1.972) and lower sphericity (OR = 0.408) on arterial 3D analysis, lower kurtosis (OR = 0.436) and lower sphericity (OR = 0.420) on portal 2D analysis, and a larger surface area (OR = 2.007) and lower sphericity (OR = 0.503) on portal 3D analysis ( P Conclusion CT is useful for predicting grade 2/3 PNET using not only the imaging findings including an ill-defined margin, but also the CT texture variables such as lower sphericity, higher skewness, and lower kurtosis.

Background To investigate the agreement between Kupffer phase of Sonazoid contrast-enhanced sonography (CEUS) and hepatobiliary phase of gadoxetic acid–enhanced MRI in the evaluation of focal liver lesions (FLLs). Methods One hundred fifty-four FLLs in 154 patients who underwent both Sonazoid CEUS and gadoxetic acid–enhanced liver MRI were included in this retrospective study. FLL visibility on the Kupffer-phase images was graded as one (invisible or isoenhancing), two (vaguely visible or vaguely hypoenhancing), or three (clearly visible or clearly hypoenhancing), and that on the hepatobiliary-phase images of MRI was graded as one (invisible or hyper/isointense), two (vaguely visible or weakly hypointense), or three (clearly visible or strongly hypointense). Pairwise comparison of lesion visibility between the two modalities was performed, and intermodality agreement was assessed. Results. On Kupffer-phase CEUS, 31 (20.1%) lesions were invisible, 17 (11.1%) were vaguely visible, and 106 (68.9%) were clearly visible. On the hepatobiliary-phase MRI, 9 (5.9%) lesions were invisible, 45 (29.2%) were vaguely visible, and 100 (64.9%) were clearly visible. Overall, lesion visibility scores were not significantly different between the two modalities (p = 0.121), but the visibility was significantly better on MRI in smaller lesions. Twenty-eight lesions (18.2%) showed discrepancy in the visibility on CEUS and MRI, and most of the cases (89.7%) were lesions that were invisible on CEUS but visible on MRI. Conclusions. The overall visibility of FLLs was comparable between the Kupffer phase of Sonazoid-CEUS and the hepatobiliary-phase images of gadoxetic acid–enhanced MRI, with a discrepancy between the two modalities in 18% of the cases. © 2017 Wiley Periodicals, Inc. J Clin Ultrasound, 2017

Background Whirlpool sign on computed tomography (CT) is pathognomic of adnexal torsion. Purpose To evaluate the visibility and common location of the whirlpool sign in adnexal torsion on CT. Material and Methods This retrospective study included 143 consecutive patients who underwent preoperative CT imaging and subsequent surgically confirmed as adnexal torsion. Two readers independently recorded the presence and location of whirlpool sign in adnexal torsion on CT. Patients with and without whirlpool sign were compared with regard to the size of the adnexal mass and the degree of torsion. Results Whirlpool sign was detected in 60 (42.0%) patients on the transverse CT plane and 79 (55.2%) patients on the coronal CT plane of 143 patients. The sign was significantly better detected on the coronal CT plane than on the transverse CT plane ( P = 0.03). The most common location of the sign included the posterolateral aspect of the adnexal mass on the transverse CT plane (25/60, 41.7%, P = 0.04) and the upper-lateral aspect of the adnexal mass on the coronal CT plane (45/79, 60.0%, P Conclusion Whirlpool sign of adnexal torsion is well detected at the upper-lateral aspect of adnexal mass on the coronal CT plane.

BACKGROUND Accurate detection of significant fibrosis (fibrosis stage 2 or higher on the METAVIR scale) is important especially for chronic hepatitis B (CHB) patients with high viral loads but with normal or mildly elevated alanine aminotransferase (ALT) levels because the presence of significant fibrosis is accepted as the indication for antiviral treatment. Liver biopsy is the reference standard for diagnosing significant fibrosis, but it is an invasive procedure. Consequently, noninvasive imaging-based measurements, such as magnetic resonance elastography (MRE) or two-dimensional shear-wave elastography (2D-SWE), have been proposed for the quantitative assessment of liver fibrosis. AIM To explore MRE and 2D-SWE to identify fibrosis stage, and to compare their performance with that of serum-based indices. METHODS The study enrolled 63 treatment-naïve CHB patients with high viral loads but with normal or mildly elevated ALT levels who underwent liver biopsy before a decision was made to initiate antiviral therapy. MRE and 2D-SWE were performed, and serum-based indices, such as FIB-4 and aspartate transaminase to platelet ratio index (APRI), were calculated. The diagnostic performances of MRE, 2D-SWE, FIB-4, and APRI for assessing significant fibrosis (≥ F2) and cirrhosis (F4) were evaluated with liver histology as the reference standard, using receiver operating characteristic analyses. RESULTS The liver fibrosis stage was F0/F1 in 19, F2 in 14, F3 in 14, and F4 in 16 patients, respectively. MRE significantly discriminated F2 from F0/1 (P = 0.022), whereas 2D-SWE showed a broad overlap in distinguishing those stages. MRE showed a higher correlation coefficient value with fibrosis stage than 2D-SWE with fibrosis stage (0.869 vs 0.649, Spearman test; P < 0.001). Multivariate linear regression analyses showed that fibrosis stage was the only factor affecting the values of MRE (P < 0.001), whereas body mass index (P = 0.042) and fibrosis stage (P < 0.001) were independent factors affecting 2D-SWE values. MRE performance for diagnosing significant fibrosis was better [area under the curve (AUC) = 0.906, positive predictive value (PPV) 97.3%, negative predictive value (NPV) 69.2%] than that of FIB-4 (AUC = 0.697, P = 0.002) and APRI (AUC = 0.717, P = 0.010), whereas the performance of 2D-SWE (AUC = 0.843, PPV 86%, NPV 65%) was not significantly different from that of FIB-4 or APRI. CONCLUSION Compared to SWE, MRE might be more precise non-invasive assessment for depicting significant fibrosis and for making-decision to initiate antiviral-therapy in treatment-naïve CHB patients with normal or mildly-elevated ALT levels.

Purpose To identify computed tomography (CT) findings for selection between conservative surgery and adnexectomy in patients of reproductive age with adnexal torsion. Methods This retrospective study included 54 consecutive patients who underwent preoperative CT imaging before undergoing either conservative surgery or adnexectomy to treat adnexal torsion. Results By multivariate analysis, CT finding of tubal thickening was significantly associated with the patients treated with adnexectomy (odds ratio=7.6, P =.008). Conclusion Although the majority of patients of reproductive age with adnexal torsion can be treated with conservative surgery, patients who require adnexectomy tend to have a tubal thickening on CT.

Background/Aims: A switch to systemic therapy, such as sorafenib, should be considered for hepatocellular carcinoma (HCC) pa­tients refractory to transarterial chemoembolization (TACE). On the other hand, treatment changes are difficult if the liver function worsens to Child-Pugh B or C. Therefore, predicting the risk factors for non-responsiveness to TACE and deteriorating liver function may be helpful. Methods: Newly diagnosed Child-Pugh A HCC patients who underwent TACE from January 2012 to June 2018 were included. After 1 year, this study evaluated whether there was a treatment response to TACE and whether the Child-Pugh class had worsened. Results: Among 121 patients, 65 were refractory and 56 responded to TACE. In multivariable logistic regression analysis, the tu­mor size, tumor number, and albumin at the time of the diagnosis of HCC were significant prognostic factors for the treatment re­sponse to TACE. Among 65 patients who presented TACE-refractoriness, 27 showed liver function deterioration from Child-Pugh class A to class B or C after TACE. In multivariable logistic regression analysis, bilirubin at the diagnosis of HCC was a significant prognostic factor for liver function deterioration. A predictive algorithm based on the regression equations revealed a sensitivity, specificity, positive predictive value, and negative predictive value of 74.1%, 74.5%, 45.5%, and 90.9%, respectively, for TACE-re­fractoriness and liver function deterioration. Conclusions: The prognostic model incorporating the tumor size, tumor number, albumin, and bilirubin at the diagnosis of HCC may help identify patients who show a poor response to TACE and aggravation of liver function after TACE, who may benefit from early switching into systemic therapy before liver function aggravation.

This study was conducted in order to determine the prognostic value of MRI for extramural venous invasion (EMVI) in rectal cancer compared to pathology and to assess the diagnostic performance of multireaders. We retrospectively enrolled 222 patients (M:F = 148:74; mean age ± standard deviation, 61.5 ± 12 years) with histopathologically proven rectal cancers who underwent preoperative MRI between 2007 and 2016. Among them, 74 patients had positive EMVI on pathology (pEMVI) and 148 patients had negative pEMVI. Three radiologists with 7 (reviewer 1), 3 (reviewer 2), and 1 (reviewer 3) year of experience in rectal MR imaging determined the presence of EMVI on MRI (mrEMVI) using a 5-point grading system. Using histopathologic results as the reference standard, radiologists’ performances were analyzed and compared with receiver operating characteristic (ROC) analysis. For assessment of interobserver variation, intraclass correlation coefficients (ICC) were used. Lastly, Kaplan–Meier estimation and Cox proportional hazard models were used for survival analysis. The area under the ROC curve (AUC) was highest in reviewer 1 (0.829), followed by reviewer 2 (0.798) and reviewer 3 (0.658). Differences in AUCs between reviewer 1 or 2 and reviewer 3 were statistically significant (p

The aims of this study were to observe the pattern of transient motion after gadoxetic acid administration including incidence, onset, and duration, and to evaluate the clinical feasibility of free-breathing gadoxetic acid-enhanced liver magnetic resonance imaging using golden-angle radial sparse parallel (GRASP) imaging with respiratory gating.In this institutional review board-approved prospective study, 59 patients who provided informed consents were analyzed. Free-breathing dynamic T1-weighted images (T1WIs) were obtained using GRASP at 3 T after a standard dose of gadoxetic acid (0.025 mmol/kg) administration at a rate of 1 mL/s, and development of transient motion was monitored, which is defined as a distinctive respiratory frequency alteration of the self-gating MR signals. Early arterial, late arterial, and portal venous phases retrospectively reconstructed with and without respiratory gating and with different temporal resolutions (nongated 13.3-second, gated 13.3-second, gated 6-second T1WI) were evaluated for image quality and motion artifacts. Diagnostic performance in detecting focal liver lesions was compared among the 3 data sets.Transient motion (mean duration, 21.5 ± 13.0 seconds) was observed in 40.0% (23/59) of patients, 73.9% (17/23) of which developed within 15 seconds after gadoxetic acid administration. On late arterial phase, motion artifacts were significantly reduced on gated 13.3-second and 6-second T1WI (3.64 ± 0.34, 3.61 ± 0.36, respectively), compared with nongated 13.3-second T1WI (3.12 ± 0.51, P0.0001). Overall, image quality was the highest on gated 13.3-second T1WI (3.76 ± 0.39) followed by gated 6-second and nongated 13.3-second T1WI (3.39 ± 0.55, 2.57 ± 0.57, P0.0001). Only gated 6-second T1WI showed significantly higher detection performance than nongated 13.3-second T1WI (figure of merit, 0.69 [0.63-0.76]) vs 0.60 [0.56-0.65], P = 0.004).Transient motion developed in 40% (23/59) of patients shortly after gadoxetic acid administration, and gated free-breathing T1WI using GRASP was able to consistently provide acceptable arterial phase imaging in patients who exhibited transient motion.

Background Parallel imaging (PI) techniques are used for overcoming lower spatial and time resolution for magnetic resonance imaging (MRI). There is clinical need to overcome inevitable noise by decreased voxel size and signal-to-noise issue by using high-acceleration factor (AF). Purpose To determine whether the combination of a modified Dixon three-dimensional (3D) T1-weighted (T1W) gradient echo technique (mDixon-3D-GRE) and high-acceleration ([HA], AF = 5) PI can provide breath-hold (BH) T1W imaging with better image quality than conventional fat-suppressed 3D-T1W-GRE (SPAIR-3D-GRE) for Gd-EOB-DTPA-enhanced liver MR. Material and Methods This retrospective study was approved by our institutional review board and informed consent was waived. There were 138 patients who underwent Gd-EOB-DTPA-enhanced liver MR at 3 T using either standard SPAIR-3D-GRE sequences with an AF of 2.6 ( n = 68, Standard group) or mDixon-3D-GRE with an AF of 5 ( n = 70, HA group). In the HA group, hepatobiliary phase was obtained three times using HA-mDixon-3D-GRE (AF = 5), HA-SPAIR-3D-GRE (AF = 5), and standard-SPAIR-3D-GRE (AF = 2.6). Image noise, quality, and anatomic depiction of dynamic phase were compared between standard and HA groups, and those of hepatobiliary phase were compared among the three image sets in HA group. Results As for dynamic imaging, the HA-mDixon-3D-GRE images showed better anatomic details and overall image quality than standard-SPAIR-3D-GRE sequence (arterial phase: 3.56 ± 0.63 vs. 2.66 ± 0.69, P Conclusion The combined use of mDixon-3D-GRE sequence and high-acceleration PI provided better quality BH-T1W imaging compared with conventional SPAIR-3D-GRE for Gd-EOB-DTPA-enhanced liver MRI.

Objective To evaluate the clinical impact of using registration software for ablative margin assessment on pre-radiofrequency ablation (RFA) magnetic resonance imaging (MRI) and post-RFA computed tomography (CT) compared with the conventional side-by-side MR-CT visual comparison. Materials and methods In this Institutional Review Board-approved prospective study, 68 patients with 88 hepatocellulcar carcinomas (HCCs) who had undergone pre-RFA MRI were enrolled. Informed consent was obtained from all patients. Pre-RFA MRI and post-RFA CT images were analyzed to evaluate the presence of a sufficient safety margin (≥ 3 mm) in two separate sessions using either side-by-side visual comparison or non-rigid registration software. Patients with an insufficient ablative margin on either one or both methods underwent additional treatment depending on the technical feasibility and patient's condition. Then, ablative margins were re-assessed using both methods. Local tumor progression (LTP) rates were compared between the sufficient and insufficient margin groups in each method. Results The two methods showed 14.8% (13/88) discordance in estimating sufficient ablative margins. On registration software-assisted inspection, patients with insufficient ablative margins showed a significantly higher 5-year LTP rate than those with sufficient ablative margins (66.7% vs. 27.0%, p = 0.004). However, classification by visual inspection alone did not reveal a significant difference in 5-year LTP between the two groups (28.6% vs. 30.5%, p = 0.79). Conclusion Registration software provided better ablative margin assessment than did visual inspection in patients with HCCs who had undergone pre-RFA MRI and post-RFA CT for prediction of LTP after RFA and may provide more precise risk stratification of those who are treated with RFA.

The purpose of the study was to investigate the clinical feasibility of free-breathing dynamic T1-weighted imaging (T1WI) using Cartesian sampling, compressed sensing, and iterative reconstruction in gadoxetic acid-enhanced liver magnetic resonance imaging (MRI).This retrospective study was approved by our institutional review board, and the requirement for informed consent was waived. A total of 51 patients at high risk of breath-holding failure underwent dynamic T1WI in a free-breathing manner using volumetric interpolated breath-hold (BH) examination with compressed sensing reconstruction (CS-VIBE) and hard gating. Timing, motion artifacts, and image quality were evaluated by 4 radiologists on a 4-point scale. For patients with low image quality scores (3) on the late arterial phase, respiratory motion-resolved (extradimension [XD]) reconstruction was additionally performed and reviewed in the same manner. In addition, in 68.6% (35/51) patients who had previously undergone liver MRI, image quality and motion artifacts on dynamic phases using CS-VIBE were compared with previous BH-T1WIs.In all patients, adequate arterial-phase timing was obtained at least once. Overall image quality of free-breathing T1WI was 3.30 ± 0.59 on precontrast and 2.68 ± 0.70, 2.93 ± 0.65, and 3.30 ± 0.49 on early arterial, late arterial, and portal venous phases, respectively. In 13 patients with lower than average image quality (3) on the late arterial phase, motion-resolved reconstructed T1WI (XD-reconstructed CS-VIBE) significantly reduced motion artifacts (P0.002-0.021) and improved image quality (P0.0001-0.002). In comparison with previous BH-T1WI, CS-VIBE with hard gating or XD reconstruction showed less motion artifacts and better image quality on precontrast, arterial, and portal venous phases (P0.0001-0.013).Volumetric interpolated breath-hold examination with compressed sensing has the potential to provide consistent, motion-corrected free-breathing dynamic T1WI for liver MRI in patients at high risk of breath-holding failure.

Background & aims To assess diagnostic accuracy of gadoxetic acid–enhanced MR for small hypervascular hepatocellular carcinoma (HCC) detected by C-arm CT and concordance rate of Liver Imaging Reporting and Data System (LI-RADS). Methods In this retrospective study, we recruited 4,544 patients suspected of having HCC underwent C-arm CT from November 2008 to May 2013. Among these patients, gadoxetic acid–enhanced MR was performed in 167 patients with HCC (n = 379; 257 > 1 cm, 122 ≤ 1 cm). HCC was confirmed by MR, CT, or follow-up images. Two radiologists graded likelihood of HCC and assessed MR features. Jackknife alternative free-response receiver operating characteristic (JAFROC) analysis was performed. All HCCs were evaluated concordance rate of LI-RADS. Results Mean JAFROC figure of merit for large (>1-cm) HCC was 0.948, while that for small HCC was 0.787 with fair agreement (κ = 0.409). Mean sensitivity and positive predictive value (PPV) were 91% and 90% for large HCC versus 63.0% and 79% for small HCC, respectively. Seventeen of 122 small HCCs (13.9%) were not visible on MR. Among 379 HCCs, 99 met LR-5, and 259 met LR-4. Common features for small HCC included arterial enhancement (81.9%), hepatobiliary phase hypointensity (80.3%), and delayed washout (72.9%). Conclusion Diagnostic accuracy of gadoxetic acid–enhanced MR imaging for small, hypervascular HCCs (Mean figure of merit = 0.787) was still low compared with large HCC (Mean figure of merit = 0.948). LR-5 and LR-4 covered 94% (358/379) of the HCCs.

To determine the diagnostic performance of magnetic resonance (MR) elastography in comparison to spleen length and dynamic contrast material-enhanced (DCE) MR imaging in association with esophageal varices in patients with liver cirrhosis by using endoscopy as the reference standard.This retrospective study received institutional review board approval, and informed consent was waived. One hundred thirty-nine patients with liver cirrhosis who underwent liver DCE MR imaging, including MR elastography, were included. Hepatic stiffness (HS) and spleen stiffness (SS) values assessed with MR elastography, as well as spleen length, were correlated with the presence of esophageal varices and high-risk varices by using Spearman correlation analysis. The diagnostic performance of MR elastography was compared with that of DCE MR imaging and combined assessment of MR elastography and DCE MR imaging by using receiver operating characteristic analysis. MR elastography reproducibility was assessed prospectively, with informed consent, in another 15 patients by using intraclass correlation coefficients.There were significant positive linear correlations between HS, SS, and spleen length and the grade of esophageal varices (r = 0.46, r = 0.48, and r = 0.36, respectively; all P.0001). HS and SS values (4.81 kPa and7.60 kPa, respectively) showed better performance than did spleen length in the association with esophageal varices (P = .0306 and P = .0064, respectively). Diagnostic performance of HS and SS in predicting high-risk varices was comparable to that of DCE MR imaging (P = .1282 and P = .1371, respectively). When MR elastography and DCE MR imaging were combined, sensitivity improved significantly (P = .0004). MR elastography was highly reproducible (intraclass correlation coefficient0.9).HS and SS are associated with esophageal varices and showed better performance than did spleen length in assessing the presence of esophageal varices. MR elastography is comparable to DCE MR imaging in predicting the presence of esophageal varices and high-risk varices, but, when assessed in combination, sensitivity is higher.

To determine whether application of a high-acceleration parallel acquisition can provide three-dimensional (3D)-fat-suppressed T1-weighted gradient-recalled-echo (T1W-GRE) imaging at 3T for liver MR imaging. This retrospective study was approved by our institutional review board. Seventy patients underwent liver MRI at a 3T scanner. After administration of a standard dose of Gadoxetic acid for 20 min, 3D-T1W-GRE images were obtained twice using sensitivity encoding with acceleration factors (AFs) 2.6 [332 × 298 matrix, 3-mm slice thickness (ST)] and 4 (380 × 320 matrix, 1.5-mm ST). The image qualities of the two image sets were graded using a five-point scale. The high-resolution (HR) 3D-T1W-GRE image sets were obtained with an AF 4 within a single breath-hold (18.5 s). It showed a better anatomic depiction than conventional 3D-T1W-GRE image sets with an AF 2.6 (p

PURPOSE The aim of this study was to demonstrate the clinical feasibility of a recently developed navigator-gated, 3-dimensional gradient echo (3D-GRE) sequence for high-resolution, T1-weighted imaging (HR-T1WI) during the hepatobiliary phase (HBP) of gadoxetic acid-enhanced liver magnetic resonance imaging (MRI). MATERIALS AND METHODS Eighty-seven consecutive patients who underwent gadoxetic acid-enhanced liver MRI were included in this study. To obtain HR-T1WI (acquired resolution, 1 × 1 × 2 mm), a gated 3D-GRE sequence (gated volumetric interpolated breath-hold examination [VIBE]; Siemens) with fat suppression was performed during the HBP and was then compared with standard breath-hold (BH)-GRE sequence (BH-VIBE). For the respiration gating, the phase ordering using the automatic window selection technique was used. Three readers independently scored the artifacts and the imaging quality (IQ) of both image sets and also classified BH-VIBE images into acceptable or unacceptable IQ. Noise and signal-noise ratio of the BH-VIBE and gated-VIBE sequences were compared, and image quality improvement using gated VIBE compared with BH-VIBE was determined when BH-VIBE shows unacceptable IQ. RESULTS The gated-VIBE sequence successfully provided HR-T1WI, having diagnosable image quality in all patients except 4 patients in 1 reader (95.4%, 83/87). The gated-VIBE sequence showed relatively higher levels of noise (mean [SD], 6.04 [3.18] vs. 3.57 [0.66]) but similar signal-noise ratio (93.60 [39.47] vs. 100.05 [28.94]) compared with BH-VIBE (P = 0.15). In the qualitative analysis, the gated 3D-GRE sequence showed higher scores for depicting focal liver lesions and the sharpness of the hepatic edges (P < 0.0001) but lower subjective overall IQ than did the BH-VIBE (P < 0.01). However, in the patients showing unacceptable BH-VIBE image quality, the degree of improvement of the IQ using the gated-VIBE technique was significantly higher than that seen in the patients showing acceptable BH-VIBE image quality (P < 0.01). CONCLUSIONS T1-weighted gated-VIBE showed technical feasibility for HR-T1WI during HBP imaging of gadoxetic acid-enhanced MRI.

PURPOSE This study aimed to determine whether an iterative model-based reconstruction (IMR) can improve lesion conspicuity and depiction on computed tomography (CT) compared with filtered back projection (FBP) and hybrid iterative reconstruction (iDose) using anthropomorphic phantoms. MATERIALS AND METHODS One small and one large anthropomorphic body phantoms, each containing 8 simulated focal liver lesions (FLLs), were scanned using a 256-channel CT scanner at 120 kVp with variable tube current-time products (10-200 mAs). Scans were divided into 3 groups based on radiation dose (RD) as follows: (a) full dose (FD), (b) low dose (FD50), and (c) ultralow dose (FD25 for the large phantom, FD15 for the small phantom). All images were reconstructed using FBP, iDose, and IMR. Image noise and lesion-to-liver contrast were assessed quantitatively and qualitatively. Thereafter, 6 radiologists independently evaluated conspicuity of FLLs, and then, compared the number of invisible FLLs on 3 image sets of each RD group. RESULTS Image noise was significantly lower with IMR than with FBP and iDose at the same RD. Iterative model-based reconstruction improved conspicuity of low-contrast FLLs in all RD groups compared to the others (P < 0.001). Furthermore, compared to FBP and iDose, the number of visible FLLs significantly increased on IMR images in the FD15 group of the small phantom 52.8% [38/72], 68.1% [49/72], and 84.8% [61/72], respectively; P < 0.001) and in the FD 25, FD50 groups of the large phantom (FD50: 56.9% [41/72], 76.4% [55/72], and 84.7% [61/72], respectively; P < 0.05). CONCLUSIONS Iterative model-based reconstruction reduced image noise and improved low-contrast FLL conspicuity, compared to FBP and iDose. Therefore, depiction of low-contrast FLLs on FBP could be improved using IMR.

The objective of this study was to investigate the image quality and diagnostic performance of model-based iterative reconstruction (MBIR) for hepatic vessel evaluation on low-tube-voltage (100 kilovolt [peak]) liver computed tomography (CT) for living donors.Fifty-one liver donor candidates (low-kilovolt group) underwent low-tube-voltage CT, which was reconstructed using filtered back projection, adaptive statistical iterative reconstruction, and MBIR. Additional 51 donor candidates who underwent 120-kilovolt (peak) CT using FBP were selected as matching control (standard group). The volume CT dose index, image noise, contrast-to-noise ratios, diagnostic accuracy, and confidence of hepatic vasculatures were evaluated.Significant dose reduction was obtained with low-tube-voltage CT. The MBIR images of the low-kilovolt group showed significantly lower image noise and higher contrast-to-noise ratios than did the other image sets (P0.001). Regarding diagnostic accuracy and confidence of hepatic vessel anatomic variations with surgical correlation, the MBIR images provided results equivalent to those of other images (P0.05).Low-tube-voltage liver CT using MBIR may increase image quality and preserve diagnostic performance of hepatic vessel evaluation at reduced radiation dose.

To investigate the agreement between Kupffer phase of Sonazoid contrast-enhanced sonography (CEUS) and hepatobiliary phase of gadoxetic acid-enhanced MRI in the evaluation of focal liver lesions (FLLs).One hundred fifty-four FLLs in 154 patients who underwent both Sonazoid CEUS and gadoxetic acid-enhanced liver MRI were included in this retrospective study. FLL visibility on the Kupffer-phase images was graded as one (invisible or isoenhancing), two (vaguely visible or vaguely hypoenhancing), or three (clearly visible or clearly hypoenhancing), and that on the hepatobiliary-phase images of MRI was graded as one (invisible or hyper/isointense), two (vaguely visible or weakly hypointense), or three (clearly visible or strongly hypointense). Pairwise comparison of lesion visibility between the two modalities was performed, and intermodality agreement was assessed.On Kupffer-phase CEUS, 31 (20.1%) lesions were invisible, 17 (11.1%) were vaguely visible, and 106 (68.9%) were clearly visible. On the hepatobiliary-phase MRI, 9 (5.9%) lesions were invisible, 45 (29.2%) were vaguely visible, and 100 (64.9%) were clearly visible. Overall, lesion visibility scores were not significantly different between the two modalities (p = 0.121), but the visibility was significantly better on MRI in smaller lesions. Twenty-eight lesions (18.2%) showed discrepancy in the visibility on CEUS and MRI, and most of the cases (89.7%) were lesions that were invisible on CEUS but visible on MRI.The overall visibility of FLLs was comparable between the Kupffer phase of Sonazoid-CEUS and the hepatobiliary-phase images of gadoxetic acid-enhanced MRI, with a discrepancy between the two modalities in 18% of the cases. © 2017 Wiley Periodicals, Inc. J Clin Ultrasound 45:542-550, 2017.

Purpose to show the variety of imaging findings of unusual foreign body related Ultrasound features of Breast. Materials & Methods We retrospectively collected the data and analyzed Ultrasound features and Mammography findings. We correlated Ultrasound images with surgical specimen and histo-pathological findings. Results We collected total seven cases of unusual foreign body related breast lesions. Age range was from 38 years to 72 years. Two cases of Sparganosis and two cases of implant rupture, one case of silicone granuloma, one case of oriental herbal metallic component mimicking microcalcification in fiboglandular tissue and one case of charcoal granuloma of breast. The parasite, Sparganosis related breast lesion is very rare. But the feature is very characteristic. Tubular, tortuous hypoechoic lesion is very unique sign of Sparganosis. Silicone granuloma shows hyperechoic mass with fine internal echoes as snowstorm appearnace. Oriental herbal metallic component is mimicking microcalcification. Medical history of breast abscess with treatment using oriental herbal attachment, 25-45 years ago is very useful for diagnosis. The reason hyperdense dots like microcalcification in mammography is that the oriental herb contains Ag++ component. Charcoal granuloma is difficult to be diagnosed pre-operatively. So medical history which got tattooing on breast for operation is very helpful. Increased echogenic nodular lesion involving premammarry layer is seen in Charcoal granuloma. The history of breast augmentation can be given much information to be diagnosed pre-operatively. We may search for the silicone related lesion in the breast. Internal echoes within fluid collected bag is seen in ruptured implant case. Conclusion the Knowledge of various image features of unusual foreign body related pathologic breast lesions can be very useful for accurate diagnosis and guiding treatment.

Background/Aims: Surgical resection or ablation is recommended for the treatment of early hepatocellular carcinoma (HCC), whereas transarterial chemoembolization (TACE) is frequently used in early HCC ineligible for curative resection. We evaluated the clinical effects and safety of radiofrequency ablation (RFA) shortly after TACE in patients with Barcelona clinic liver cancer (BCLC) stage A HCC. Methods: Sixty-seven BCLC stage A HCC patients who failed to achieve complete response to TACE as either a first line treatment and who subsequently received RFA at the Konkuk University Medical Center from January 2005 to December 2017 were included. Evaluation indices included treatment response, overall survival rate, recurrence-free survival, prognostic factors, and procedure-related complications. Results: Median follow-up was 46.9 months. Fifty-four (80.6%) patients were of Child-Pugh class A, and 13 (19.4%) were of class B. Modified UICC stages were I in 10 (14.9%), II in 46 (68.7%), and III in 11 (16.4%) patients. In the 67 study subjects, cumulative recurrence-free survival rates were 86.8%, 55.9% and 29.7% at 1, 3, and 5 years, respectively, and overall survival rates were 100%, 93.4%, and 83.5% at 1, 3, and 5 years, respectively. Tumor size significantly predicted recurrence. No treatment-related death occurred. Conclusions: Combination of RFA was an efficient and safe treatment for BCLC stage A HCC patients that failed to achieve complete response to initial TACE. We suggest TACE plus RFA be considered as a curative option for early HCC patients ineligible for curative resection of RFA. (Korean J Gastroenterol 2019;73:167-176)

The occurrence of incidentally detected pancreatic cystic lesions (PCLs) is continuously increasing. Radiologic examinations including computed tomography and magnetic resonance imaging with magnetic resonance cholangiopancreatography have been widely used as the main diagnostic and surveillance methods for patients with incidental PCLs. Although most incidentally detected PCLs are considered benign, they have the potential to become malignant. Currently, we have several guidelines for the management of incidental PCLs. However, there is still debate over proper management, in terms of accurate diagnosis, optimal follow-up interval, and imaging tools. Because imaging studies play a crucial role in the management of incidental PCLs, the 2017 consensus recommendations of the Korean Society of Abdominal Radiology for the diagnosis and surveillance of incidental PCLs approved 11 out of 16 recommendations. Although several challenges remain in terms of optimization and standardization, these consensus recommendations might serve as useful tools to provide a more standardized approach and to optimize care of patients with incidental PCLs.