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A 45-year-old woman presented to the emergency department with acute worsening of prolonged unexplained nausea, nonbilious vomiting, and mild upper abdominal pain of 4 years duration. Her bowel habits were regular, and there was no history of diarrhea or fresh or altered blood in her stool. On further inquiry, there was no history of facial flushing, excessive diaphoresis, or asthmalike symptoms. Her history was unrevealing; in particular, there was no history of known malignancy. On clinical examination, her vital signs were stable. The abdomen was soft, with no focal tenderness or palpable mass. Routine blood investigations, including complete blood counts, and liver, kidney, and thyroid function tests yielded results that were within normal limits. Her 5-hydroxyindoleacetic acid and chromogranin A levels were not elevated. Initial evaluation with contrast-enhanced CT of the abdomen and pelvis was performed. Subsequently, an indium 111 (

A 45-year-old woman presented to the emergency department with acute worsening of prolonged unexplained nausea, nonbilious vomiting, and mild upper abdominal pain of 4 years duration. Her bowel habits were regular, and there was no history of diarrhea or fresh or altered blood in her stool. On further inquiry, there was no history of facial flushing, excessive diaphoresis, or asthmalike symptoms. Her history was unrevealing; in particular, there was no history of known malignancy. On clinical examination, her vital signs were stable. The abdomen was soft, with no focal tenderness or palpable mass. Routine blood investigations, including complete blood counts, and liver, kidney, and thyroid function tests yielded results that were within normal limits. Her 5-hydroxyindoleacetic acid and chromogranin A levels were not elevated. Initial evaluation with contrast-enhanced CT of the abdomen and pelvis was performed. Subsequently, an indium 111 octreotide scan was performed at the recommendation of the radiologist 1 month after CT (Figs 1, 2).

The objective of our study was to evaluate the diagnostic performance of CT in the identification of anastomotic leaks.This was a study of patients who underwent bowel surgery and a subsequent postoperative CT examination performed specifically for investigating for an anastomotic leak. The study group included patients with surgically confirmed anastomotic leaks (n = 59), and the control group included patients without anastomotic leaks (n = 48) confirmed by either repeat surgery or uneventful clinical follow-up for at least 6 months. Two radiologists and two radiology residents independently reviewed each CT examination for specific CT findings from a set of predetermined imaging predictors. The sensitivity and specificity for each imaging predictor were calculated for each reader, and the interobserver agreement was calculated using the Cohen kappa coefficient. Diagnostic performance was assessed using ROC curve analysis.The most sensitive imaging predictor was intraabdominal free fluid (95.3%). Leakage of intraluminal contrast agent was also a highly specific imaging predictor (96.6%). Substantial interobserver agreement was shown for intraabdominal free gas (κ = 0.76) and leakage of intraluminal contrast agent (κ = 0.76). Overall diagnostic performance in correctly identifying surgically confirmed leaks, as assessed by the area under the ROC curve, ranged from 0.76 to 0.86. Diagnostic performance was higher for all readers when intraluminal contrast agent was used and reached the anastomosis, with the exception of one reader, whose diagnostic performance remained unchanged.Diagnostic performance of CT was highest when an intraluminal contrast agent was used. Meticulous and careful use of an intraluminal contrast agent is therefore important in this patient population.

Rationale and Objectives Preservation of patient privacy and dignity are basic requirements for all patients visiting a hospital. The purpose of this study was to perform an audit of patients' satisfaction with privacy whilst in the Department of Medical Imaging (MI) at the Civic Campus of the Ottawa Hospital. Materials and Methods Outpatients who underwent magnetic resonance imaging (MRI), computed tomography (CT), ultrasonography (US), and plain film (XR) examinations were provided with a survey on patient privacy. The survey asked participants to rank (on a 6-point scale ranging from 6 = excellent to 1 = no privacy) whether their privacy was respected in 5 key locations within the Department of MI. The survey was conducted over a consecutive 5-day period. Results A total of 502 surveys were completed. The survey response rate for each imaging modality was: 55% MRI, 42% CT, 45% US, and 47% XR. For each imaging modality, the total percentage of privacy scores greater than or equal to 5 were: 98% MRI, 96% CT, 94% US, and 92% XR. Privacy ratings for the MRI reception and waiting room areas were significantly higher in comparison to the other imaging modalities ( P = .0025 and P = .0227, respectively). Conclusion Overall, patient privacy was well respected within the Department of MI.

Nephrolithiasis is the most common condition involving the ureters. However, various other entities can affect the ureters, albeit less frequently. Imaging plays a crucial role in diagnosis, management, and follow-up of ureteral pathology. In the past decade, computed tomography urography has replaced traditional methods of ureteral imaging due to its high spatial resolution, multiplanar imaging, and rapid acquisition time. More recently, magnetic resonance urography has also been explored in evaluating ureteral abnormalities. In this review, we briefly discuss current imaging techniques used in assessment of the ureters and present a diverse group of diseases affecting the ureters. We begin with primary and secondary ureteral malignancies, followed by uncommon infectious/inflammatory diseases that can involve the ureters including tuberculosis, xanthogranulomatous pyelonephritis, and graft-versus-host disease. We then discuss the imaging characteristics of endometriosis and retroperitoneal fibrosis as two important examples of pelvic and retroperitoneal processes that occasionally obstruct the ureters and present with clinical symptoms similar to that of renal stones. We end with a brief discussion of miscellaneous conditions that affect the ureters, including ureteral hemorrhage, ureteral intussusception, ureteral pseudodiverticulosis, Malacoplakia, and ureteritis cystica. Knowledge of these entities and their characteristic imaging manifestations along with patient's clinical presentation allows accurate diagnosis and timely patient management.

History A 24-year-old woman presented to the emergency department with a history of acute urinary retention, gross hematuria, and left flank pain for 2 days. Past history was unrevealing. Her last menstrual period occurred 2 weeks prior to presentation. At physical examination, she had a temperature of 38.4°C. A palpable mass was noted in the suprapubic region, and a second mass was palpated in the left upper quadrant. Blood work revealed a hemoglobin level of 4.7 g/dL (normal range, 11.5-15.5 g/dL). Her coagulation profile and white blood cell count were within normal limits. Ultrasonography (US) of the abdomen and pelvis was performed and was followed by contrast material-enhanced (80 mL of iopamidol) computed tomography (CT) of the chest, abdomen, and pelvis. Magnetic resonance (MR) imaging of the abdomen and pelvis also was performed.

Focal nodular hyperplasia (FNH) and hepatocellular adenomas (HCAs) constitute benign hepatic neoplasms in adults. HCAs are monoclonal neoplasms characterised by an increased predilection to haemorrhage and also malignant transformation. On the other hand, FNH is a polyclonal tumour-like lesion that occurs in response to increased perfusion and has an uneventful clinical course. Recent advances in molecular genetics and genotype-phenotype correlation in these hepatocellular neoplasms have enabled a new classification system. FNHs are classified into the typical and atypical types based on histomorphological and imaging features. HCAs have been categorised into four subtypes: (1) HCAs with HNF-1α mutations are diffusely steatotic, do not undergo malignant transformation, and are associated with familial diabetes or adenomatosis. (2) Inflammatory HCAs are hypervascular with marked peliosis and a tendency to bleed. They are associated with obesity, alcohol and hepatic steatosis. (3) HCAs with β-catenin mutations are associated with male hormone administration and glycogen storage disease, frequently undergo malignant transformation and may simulate hepatocellular carcinoma on imaging. (4) The final type is unclassified HCAs. Each of these except the unclassified subtype has a few distinct imaging features, often enabling reasonably accurate diagnosis. Biopsy with immunohistochemical analysis is helpful in difficult cases and has strong implications for patient management. • FNHs are benign polyclonal neoplasms with no risk of haemorrhage or malignancy. • HCAs are benign monoclonal neoplasms classified into four subtypes based on immunohistochemistry. • Inflammatory HCAs show an atoll sign with a risk of bleeding and malignant transformation. • HNF-1α HCAs are steatotic HCAs with minimal complications and the best prognosis. • β-Catenin HCA shows variable MRI features and a high risk of malignancy.

BackgroundOne of the many challenges facing emergency departments (EDs) across North America is timely access to emergency radiology services. Academic institutions, which are typically also regional referral centres, frequently require cross-sectional studies to be performed 24 hours a day with expedited final reports to accelerate patient care and ED flow.ObjectiveThe purpose of this study was to determine if the presence of an in-house radiologist, in addition to a radiology resident dedicated to the ED, had a significant impact on report turnaround time.MethodsPreliminary and final report turnaround times, provided by the radiology resident and staff, respectively, for patients undergoing computed tomography or ultrasonography of their abdomen/pelvis in 2008 (before the implementation of emergency radiology in-house staff service) were compared to those performed during the same time frame in 2009 and 2010 (after staffing protocols were changed).ResultsA total of 1,624 reports were reviewed. Overall, there was no statistically significant decrease in the preliminary report turnaround times between 2008 and 2009 (p = 0.1102), 2009 and 2010 (p = 0.6232), or 2008 and 2010 (p = 0.0890), although times consistently decreased from a median of 2.40 hours to 2.08 hours to 2.05 hours (2008 to 2009 to 2010). There was a statistically significant decrease in final report turnaround times between 2008 and 2009 (p < 0.0001), 2009 and 2010 (p < 0.0011), and 2008 and 2010 (p < 0.0001). Median final report times decreased from 5.00 hours to 3.08 hours to 2.75 hours in 2008, 2009, and 2010, respectively. There was also a significant decrease in the time interval between preliminary and final reports between 2008 and 2009 (p < 0.0001) and 2008 and 2010 (p < 0.0001) but no significant change between 2009 and 2010 (p = 0.4144).ConclusionOur results indicate that the presence of a dedicated ED radiologist significantly reduces final report turnaround time and thus may positively impact the time to ED patient disposition. Patient care is improved when attending radiologists are immediately available to read complex films, both in terms of health care outcomes and regarding the need for repeat testing. Providing emergency physicians with accurate imaging findings as rapidly as possible facilitates effective and timely management and thus optimizes patient care.

Minimally invasive gastrointestinal, genitourinary, and gynecological procedures are widely used in the clinical practice for diagnostic and therapeutic purposes. Complications both minor and major are not uncommon with these procedures. Imaging plays an important role in the detection and optimal management of these complications. Familiarity with the clinical and imaging features of these complications by radiologists can help in their timely detection.

Purpose We present an analysis of various types and strata of complaints received in a geographically isolated tertiary care center over a 2.5-year period. Methods Research ethics board approval was obtained. The institution described is a closed system with formalized procedures for submitting complaints. All complaints submitted between November 2010 and March 2013 were collected retrospectively. The following data were extracted: type of complainant, nature of the complaint, site or modality of concern, dates in question, and the response. The data were analysed in multiple subgroups and compared with patient and study volume data. Results The frequency of complaints equalled 0.01% (100/1,050,000). The largest group of those who submitted complaints were patients (69% [69/100]), followed by referring physicians (16%). Examination scheduling and interpersonal conflicts were equally of greatest frequency of concern (21% [21/100]), followed by issues with study reporting (16%). The average time interval between complaint submission and formal address was 15 days. Conclusions We present a low frequency of complaints, with the majority of these complaints submitted by patients; scheduling and personal interactions were most often involved. Effective communication, both with patients and referring physicians, was identified as a particular focus for improving satisfaction.

Small bowel obstruction is a common condition encountered by the radiologist in the emergency department. Though intestinal adhesions and obstructed hernias are the most common causes of acute small bowel obstruction, a variety of uncommon and rare conditions can cause acute and subacute bowel obstruction. Imaging plays a key role in the workup of bowel obstruction by identifying the cause, level, and degree of bowel obstruction. In this article, we present a comprehensive review of the multi-detector computed tomography features of common and uncommon causes of acute and subacute small bowel obstruction.

Objectives Although rectal cancer is by far and large the most common pathology involving the rectum that needs imaging, there are many other important but less common pathological conditions affecting anorectal region. The objective of this pictorial review is to discuss the cross-sectional imaging features of less common anorectal and perirectal diseases. Results Although a specific histological diagnosis cannot usually be made due to considerable overlap in the imaging appearances of anorectal diseases, this review illustrates the cross-sectional imaging findings with emphasis on magnetic resonance imaging (MRI) that can help in narrowing down the differentials to a reasonable extent. Teaching points • Variety of pathology exists in the anorectum apart from common rectal carcinoma • Anorectal diseases present as non-specific wall thickening indistinguishable from rectal carcinoma • Computed tomography (CT) and MRI can help in narrowing down the differentials, although often biopsy is warranted.

This article focuses on the cross-sectional imaging spectrum of abnormalities that affect the abdominal wall, with emphasis on magnetic resonance imaging (MRI). Cross-sectional imaging is valuable for diagnosing and evaluating the extent of abdominal-wall masses. With the increasing use of MRI, it is often possible to reach a diagnosis or narrow the differential diagnosis, thereby guiding effective management. Neoplastic and non-neoplastic pathologies will be illustrated, and the distinctive imaging characteristics of these entities will be highlighted.

Physiologic changes during pregnancy can alter presentations of common pathology. Women should be counseled that x-ray exposure from a single diagnostic procedure, typically less than 5 rad, has not been associated with an increase in fetal anomalies or pregnancy loss. Concern about possible effects of high-dose ionizing radiation exposure should not prevent medically indicated imaging modalities from being performed on a pregnant woman. The principle of as low as reasonably achievable (ALARA) should be followed while using imaging modalities that use ionizing radiation. During pregnancy, imaging procedures not associated with ionizing radiation such as ultrasonography and magnetic resonance imaging should be used in preference to modalities using ionizing radiation when appropriate.

Purpose To assess the percentage, type, and location of radiology fellowships chosen by graduating Canadian residents between 2009 and 2011. Methods A short e-mail questionnaire was sent to the radiology program directors at all 16 institutions in Canada that provide English or French residency. The responses were collected between December 6, 2010, and May 20, 2011. Results A 75% response rate was observed for the survey: 76%–79% residents were enrolled in radiology fellowship training. In 2009–2010, 72%–73% of residents remained in Canada. This dropped to 51% in 2011. In 2009–2010, 22%–23% of residents chose U.S.-based radiology training. This rose to 49% in 2011. Europe was chosen by 0%–4% of residents: all of whom were French-speaking residents, and all programs were in France. Relatively consistent percentages of radiology residents choose abdominal (19%–30%), cardiac (4%–7%), musculoskeletal (12%–20%), and pediatrics (2%–5%) from year to year. Greater variability was noted in chest (2%–9%), women's imaging (0%–14%), intervention radiology (6%–18%), and neuroradiology (2%–18%). Radiology fellowships in split subspecialties, which were available at a small number of institutions, were chosen by 8%–9% of the residents. Conclusions Nearly 4 of 5 residents choose radiology fellowship training. In 2011, there was a 2-fold increase in the number of residents who chose training in the United States. This may be a 1-year outlier but should be observed. A wide range of fellowships were chosen, with consistent numbers in some core fellowships and variability in others year to year. Limited exploration of the rationale for, or employability value of, radiology fellowship choices has been done in Canada. Nearly 1 of 10 residents chose split radiology fellowships, an option limited by availability at few centers. The value of expanding this option is worthy of investigation.

Small bowel malignancies are rare neoplasms, usually inaccessible to conventional endoscopy but detectable in many cases by cross-sectional imaging. Modern multidetector computed tomographies permit accurate diagnosis, complete pretreatment staging, and follow-up of these lesions. In this review, we describe the cross-sectional imaging features of the most frequent histologic subtypes of the small bowel malignancies.

There is a broad spectrum of primary pelvic retroperitoneal masses in adults that demonstrate characteristic epidemiologic and histopathologic features and natural histories. These masses may be classified into five distinct subgroups using a pattern-based approach that takes anatomic distribution and certain imaging characteristics into account, allowing greater accuracy in their detection and characterization and helping to optimize patient management. The five groups are cystic (serous and mucinous epithelial neoplasms, pelvic lymphangioma, tailgut cyst, ancient schwannoma), vascular or hypervascular (solitary fibrous tumor, paraganglioma, pelvic arteriovenous malformation, Klippel-Trénaunay-Weber syndrome, extraintestinal GIST [gastrointestinal stromal tumor]), fat-containing (lipoma, liposarcoma, myelolipoma, presacral teratoma), calcified (calcified lymphocele, calcified rejected transplant kidney, rare sarcomas), and myxoid (schwannoma, plexiform neurofibroma, myxoma).Cross-sectional imaging modalities help differentiate the more common gynecologic neoplasms from more unusual masses. In particular, the tissue-specific multiplanar capability of high-resolution magnetic resonance imaging permits better tumor localization and internal characterization, thereby serving as a road map for surgery.

This review illustrates a wide spectrum of gastric neoplasms with emphasis on imaging findings helpful in characterizing various gastric neoplasms. Both the malignant and benign neoplasms along with focal gastric masses mimicking tumour are illustrated. Moreover, imaging clues to reach an accurate diagnosis are emphasized.

This article provides a comprehensive review of the role of MDCT and MRI in the diagnosis of drug-induced complications in the abdomen and pelvis in adults. A systematic organ-based review of these complications is presented, including but not limited to hepatic changes after chemotherapy, renal complications such as tumor lysis syndrome and lithium nephropathy, gastrointestinal manifestations, various opportunistic infections and secondary neoplasms, mycotic aortic aneurysm from intravesical bacille Calmette-Guérin, complications of anticoagulant therapy, and oral contraceptives.Advancements in imaging have led to recognition of radiologic features of previously unsuspected diseases. Occasionally, imaging may also identify effects of treatments instituted for these diseases. Consequently, imaging plays a critical role in the accurate diagnosis of a broad spectrum of drug-induced complications in the abdomen, both in emergent and nonemergent settings. Knowledge of the natural history, clinical manifestations, and salient imaging features of these entities is crucial to facilitate accurate clinical diagnosis in a timely fashion.

RésuméBien que la carcinomatose péritonéale soit la pathologie la plus courante à l'origine de l'envahissement diffus du péritoine, un large éventail de pathologies inhabituelles peuvent également s'attaquer aux surfaces péritonéales. Ces pathologies peuvent être regroupées en infections, affections néoplasiques et diverses. L'imagerie transversale, incluant la tomodensitométrie et l'imagerie par résonnance magnétique, constitue un excellent moyen de définir plus précisément ces maladies peu communes. Dans certains cas, il est possible d'établir un diagnostic grâce à des trouvailles radiologiques spécifiques. Dans d'autres cas, par contre, c'est la combinaison des signes cliniques et radiologiques qui permet d'établir un diagnostic.

A wide variety of hepatic lesions contain fat within them in a proportion good enough to be demonstrable on imaging. With the biological behaviors quite different from each other, they form a clinico-radio-pathologic spectrum worth remembering. We present a review of common and uncommon focal hepatic lesions containing fat (micro- and macroscopic) within them and emphasize the role of imaging in their diagnosis.

Received June 1, 2009; accepted after revision October 16, 2009. 1Department of Radiology, UTHSCSA, 7703 Floyd Curl Dr., San Antonio, TX 78229. Address correspondence to S. Choudhary (choudhary@uthscsa.edu). 2Department of Radiology, The Ottawa Hospital, Ottawa, ON, Canada. AJR 2010;194:S89–S92 0361–803X/10/1946–S89 © American Roentgen Ray Society ABSTRACT The educational objectives for this self-assessment module are for the participant to exercise, self-assess, and improve his or her understanding of the imaging features of endometriosis and the role of imaging and various radiologic techniques in the clinical management of patients.

Acute pancreatitis is one of the most common conditions for which emergent imaging is indicated. Alcohol consumption and cholelithiasis are the most common causes of acute pancreatitis in adults, whereas the majority of cases in children are idiopathic or secondary to trauma. A wide variety of structural and biochemical abnormalities may also cause pancreatitis. Although in some cases it is difficult to identify the specific cause of the disease radiologically, certain uncommon types of acute or chronic pancreatitis may have unique imaging features that can help the radiologist make an accurate diagnosis. These unusual types include autoimmune pancreatitis, groove pancreatitis, tropical pancreatitis, hereditary pancreatitis, and pancreatitis in ectopic or heterotopic pancreatic tissue. Pancreatitis may occasionally be seen in association with cystic fibrosis or pancreas divisum, or secondary to worm infestation of the pancreaticobiliary tree (eg, by Ascaris lumbricoides). In addition, primary pancreatic and duodenal masses may occasionally manifest as acute or recurrent acute pancreatitis. Knowledge of the classic imaging findings of these entities allows prompt recognition of the relevant pathologic condition, thereby preventing misdiagnosis and subsequent inappropriate or delayed management.

Carcinoma of the rectum is one of the most common malignant tumours in the Western world. Preoperative knowledge of the local spread of rectal cancer is essential in the determination of the therapeutic strategy for this disease. Magnetic resonance imaging (MRI) has been described as being accurate in the detection of the extent of rectal cancer for staging. In particular, double-contrast material enhanced MRI of the rectum has been reported to better delineate tumours against the lumen and the normal mucosa [1]. Tissue characterization is excellent with MRI and can be improved further for staging of rectal cancer by enhancement of the mucosa with intravenously administered gadoliniumbased contrast combined with intraluminal contrast material to distend the bowel. Tumour detection and assessment of penetration through the rectal wall is important information for the surgeon [2]. Piippo et al [3] concluded that tumour detection may be problematic in an undistended bowel and may result in extended examination time and inadequate imaging planes that are not perpendicular to the tumour to allow accurate analysis. Several investigators have advocated the use of rectal contrast medium for improving the delineation of tumour and to estimate its extent within the rectum [3e7]. Contrast agents that have been used are superparamagnetic iron oxide solutions, methylcellulose, and barium suspensions [5]. Herein, we describe our experience with aqueous gel as intraluminal contrast material for preoperative staging of rectal cancer.

DESCRIPTION OF THE PROBLEM The past decade has seen sweeping changes to radiologic practice. Year-onyear increases in CT utilization [1,2] and the introduction of teleradiology [3] have inexorably shifted practice toward rapid reporting of cross-sectional imaging. An unintended effect of these changes has been a perceptible reduction in patient contact, with radiologists becoming increasingly remote from patient care [4,5] and feeling personally detached from patients [6]. To “personalize” the reporting process, the idea of presenting patient photographs to reporting radiologists was investigated in an unpublished study [7]. The authors suggested that radiologists produced longer reports containing more incidental findings, and subjectively reported more meticulously and empathetically, when presented with patients’ photographs. The study attracted considerable media attention and was even included in a published nonfiction book [8]. However, its significance remains unclear, because the incidental abnormalities were not classified in terms of clinical importance, and the findings have not been reproduced elsewhere. The purpose of this study was to assess whether presenting patients’

Autoimmune pancreatitis is a type of chronic pancreatitis characterized by an inflammatory process with lymphoplasmacytic infiltration associated with fibrosis of the pancreas. Various autoimmune extrapancreatic manifestations are associated with this condition which includes biliary pathologies like sclerosing cholangitis, inflammatory bowel disease, sialadenitis, renal and pulmonary lesions and retroperitoneal fibrosis. Autoimmune prostatitis is rarely associated with autoimmune pancreatitis with only a handful number of cases reported so far. Imaging plays a role in differentiating this entity from prostatic cancer and documenting the response to therapy. Increased uptake within the prostate has been described on FDG-PET imaging in cases of autoimmune pancreatitis. However, ultrasound and MRI findings of this entity have not been reported. Hereby, we report a case of autoimmune prostatitis with autoimmune pancreatitis, present ultrasound findings and review the relevant literature.

This article illustrates a wide spectrum of non-neoplastic gastric pathologies on cross-sectional imaging. Salient features of inflammatory, infectious, vascular, traumatic, and miscellaneous conditions of the stomach have been discussed and imaging clues to reach an accurate diagnosis are stressed upon.

There is an increasing incidence of both intra- and extra-thoracic manifestations of tuberculosis, in part due to the AIDS epidemic. Isolated tubercular involvement of the solid abdominal viscera is relatively unusual. Cross-sectional imaging with ultrasound, multidetector computed tomography (CT), and magnetic resonance imaging (MRI) plays an important role in the diagnosis and post treatment follow-up of tuberculosis. Specific imaging features of tuberculosis are frequently related to caseous necrosis, which is the hallmark of this disease. However, depending on the type of solid organ involvement, tubercular lesions can mimic a variety of neoplastic and nonneoplastic conditions. Often, cross-sectional imaging alone is insufficient in reaching a conclusive diagnosis, and image-guided tissue sampling is needed. In this article, we review the pathology and cross-sectional imaging features of tubercular involvement of solid abdominopelvic organs with a special emphasis on appropriate differential diagnoses.

To evaluate the yield of each phase in a triphasic CT protocol used to diagnose acute mesenteric ischaemia (AMI).Retrospective analysis of patients who underwent CT to exclude AMI was conducted. From 218 patients, 80 were randomly selected for analysis: 39 with proven AMI; 41 controls. Three readers evaluated the studies; two readers were provided with only portions of the examination to determine the yield of unenhanced CT (NECT) and CT angiography (CTA). The diagnostic accuracy of CT findings was calculated and compared between readers.The sensitivity and specificity of submucosal haemorrhage were 10 % and 98 %. Interobserver variability was poor (κ = 0.17). All true-positive cases had other CT findings of AMI (n = 4). There was no difference in the assessment of bowel enhancement between readers (P 0.05). There was no difference between readers (P 0.05) and interobserver variability was moderate to good when diagnosing arterial abnormalities without CTA. Sample size was small and errors occurred when using only the portal venous phase for this purpose.NECT is not required for diagnosis of AMI. Splanchnic arterial abnormalities can be diagnosed without CTA although errors occur when using only the portal venous phase for this purpose.• Triphasic CT is the current gold standard for diagnosing acute mesenteric ischaemia. • Multiphase CT multiplies the radiation dose when compared to single phase CT. • Each phase in a multiphase CT examination should be independently validated. • Unenhanced CT is not required for diagnosis of acute mesenteric ischaemia. • CT angiography should be performed for diagnosis of acute mesenteric ischaemia.

Recent advances in genetics and pathology have improved our understanding of diagnosis and staging of uterine sarcomas. The major types of uterine sarcomas include leiomyosarcoma, low-grade endometrial stromal sarcoma, undifferentiated endometrial sarcoma, adenosarcoma and carcinosarcoma. The distinctive biological behavior and poor overall survival of uterine sarcoma create challenges in the management of these tumors. We herein present a comprehensive review of taxonomy, epidemiology, pathology, imaging findings and natural history of a wide spectrum of uterine sarcomas.

OBJECTIVE. There is a wide spectrum of nonneoplastic causes of biliary stricture that can pose a significant challenge to clinicians and radiologists. Imaging plays a key role in differentiating benign from malignant strictures, defining the extent, and directing the biopsy. We describe the salient clinical and imaging manifestations of benign biliary strictures that will help radiologists to accurately diagnose these entities. CONCLUSION. Accurate diagnosis and management are based on correlating imaging findings with epidemiologic, clinical, and laboratory data. Cross-sectional imaging modalities permit precise localization of the site and length of the segment involved, thereby serving as a road map to surgery, and permit exclusion of underlying malignancy.

Ovarian epithelial carcinoma (OEC), the most common ovarian malignancy, is a heterogeneous disease with several histologic subtypes that show characteristic cytogenetic features, molecular signatures, oncologic signaling pathways, and clinical-biologic behavior. Recent advances in histopathology and cytogenetics have provided insights into pathophysiologic features and natural history of OECs. Several studies have shown that high- or low-grade serous, endometrioid, and clear cell carcinomas are characterized by mutations involving the TP53, K-ras/BRAF, CTNNB1, and PIK3CA genes, respectively. High-grade serous carcinomas, the most common subtype, often manifest with early transcoelomic spread of disease beyond the ovaries, whereas low-grade serous and mucinous carcinomas commonly manifest with early-stage disease, with a resultant excellent prognosis. On the basis of pathogenetic mechanisms, recent findings suggest a dualistic model of ovarian carcinogenesis consisting of types I and II. Type I (low-grade serous, mucinous, and endometrioid) cancers commonly arise from well-described, genetically stable precursor lesions (usually borderline tumors); manifest as large adnexal masses with early-stage disease; and have a relatively indolent clinical course, with an overall good prognosis. In contrast, type II carcinomas (high-grade serous, endometrioid, mixed, and undifferentiated variants) originate de novo from the adnexal epithelia, often demonstrate chromosomal instability, and have aggressive biologic behavior. Better knowledge of hereditary ovarian cancer syndromes and associated cytogenetic abnormalities has led to increased interest in novel biomarkers and molecular therapeutics. Genetic changes, pathologic features, imaging findings, and natural histories of a variety of histologic subtypes of OEC are discussed in this article.

Inflammatory pseudotumor refers to a nonmalignant or low-grade neoplastic lesion characterized by the presence of spindle-cell proliferation with abundant inflammatory cells. Lung and orbit are the most frequent sites of occurrence, but the lesions may originate in nearly every site in the body, including the abdomen. We present a rare and interesting case of inflammatory pseudotumor of the colon in a 21-year-old male who presented to the emergency room with abdominal pain.

Incidental splenic lesions are frequently encountered at imaging performed for unrelated causes. Splenic cysts, hemangiomas, and lymphomatous involvement are the most frequently encountered entities. Computed tomography and sonography are commonly used for initial evaluation with magnetic resonance imaging reserved as a useful problem-solving tool for characterizing atypical and uncommon lesions. The value of magnetic resonance imaging lies in classifying these lesions as either benign or malignant by virtue of their signal-intensity characteristics on T1- and T2-weighted imaging and optimal depiction of internal hemorrhage. Dynamic contrast-enhanced sequences may improve the evaluation of focal splenic lesions and allow characterization of cysts, smaller hemangiomas, and hamartomas. Any atypical or unexplained imaging feature related to an incidental splenic lesion requires additional evaluation and/or follow-up. Occasionally, biopsy or splenectomy may be required for definitive assessment given that some of tumours may demonstrate uncertain biologic behavior.

Functional ovarian neoplasms have unique clinical manifestations related to hormone overproduction and may give rise to a broad spectrum of clinical syndromes. Sex cord-stromal tumors, the most common functional ovarian neoplasms, are associated with either hyperestrogenism (as in granulosa cell tumor and thecoma) or hyperandrogenism (as in Sertoli-Leydig cell tumor and Leydig cell tumor). Other, less common ovarian neoplasms that may have endocrine or nonendocrine syndromic manifestations include germ cell tumors associated with the excessive production of human chorionic gonadotropin (eg, choriocarcinoma, dysgerminoma), monodermal teratomas (eg, carcinoid tumor, struma ovarii) associated with carcinoid syndrome and hyperthyroidism, and primary epithelial ovarian cancers associated with paraneoplastic syndromes. The application of diagnostic algorithms based on patient demographic information, clinical manifestations, laboratory findings, and cross-sectional imaging features may help identify ovarian neoplasms in complex clinical settings.

Ovarian vein thrombosis is an uncommon clinical entity, most familiar to radiologists as a source of postpartum sepsis, which, if unrecognized and left untreated, has the potential for septic shock, pulmonary thromboembolism, and death. Ovarian vein thrombosis also occurs with other common inflammatory and malignant conditions in the nonobstetrical patient. This article reviews the pathophysiology, predisposing conditions, clinical findings, imaging features on ultrasonography, computed tomography, and magnetic resonance imaging of acute and chronic ovarian vein thrombosis and its appropriate clinical management.

Hepatocellular carcinoma (hcc) is an uncommon tumour, but its incidence is increasing in Canada and elsewhere. Currently, there are no Canadian recommendations for diagnosis and treatment of hcc, and possible options may have regional limitations. A consensus symposium was held in the Ottawa region to consider current diagnostic and management options for hcc. These recommendations were developed: Diagnosis&mdash, with adequate imaging, a biopsy is not required pre-surgery, but is required before the start of systemic therapy, lesions smaller than 1 cm should be followed and not biopsied, repeat biopsies should be core tissue biopsies, magnetic resonance imaging is preferred, but triphasic computed tomography imaging can be useful Resection&mdash, recommended for localized hcc Radiofrequency ablation&mdash, recommended for unresectable or non-transplantable hcc, should not be performed in the presence of ascites Trans-arterial chemoembolization (tace)&mdash, doxorubicin with lipiodol is the agent of choice, trans-catheter embolization is an alternative for patients if tace is not tolerated or is contraindicated Medical management&mdash, first-line sorafenib should be considered the standard of care Transplantation&mdash, suitable patients meeting Milan criteria should be assessed for a graft regardless of other treatments offered

Uterine leiomyomas affect 20%-30% of women older than 35 years. Extrauterine leiomyomas are rarer, and they present a greater diagnostic challenge: These histologically benign tumors, which originate from smooth muscle cells, usually arise in the genitourinary tract (in the vulva, ovaries, urethra, and urinary bladder) but may arise in nearly any anatomic site. In addition, unusual growth patterns may be seen, including benign metastasizing leiomyoma, disseminated peritoneal leiomyomatosis, intravenous leiomyomatosis, parasitic leiomyoma, and retroperitoneal growth. In the presence of such a pattern, a synchronous uterine leiomyoma or a previous hysterectomy for removal of a primary uterine tumor may be indicative of the diagnosis. However, some extrauterine leiomyomas may mimic malignancies, and serious diagnostic errors may result. The most useful modalities for detecting extrauterine leiomyomas are ultrasonography, computed tomography, and magnetic resonance (MR) imaging. The superb contrast resolution and multiplanar capabilities of MR imaging make it particularly valuable for characterizing these tumors, which usually show low signal intensity similar to that of smooth muscle on T2-weighted images. The radiologist's recognition of this and other characteristic features may help steer the clinician toward timely, appropriate management and away from unnecessary, potentially harmful treatment.