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A new micellar electrokinetic capillary chromatographic (MEKC) method has been developed and optimized for simultaneous quantitation of doxorubicin (Dox) and fullerenol (Frl) in rat serum. The separation was carried out in a capillary (48.5–40 cm to the detector – 50 µm id fused-silica capillary with bubble cell, 150 µm) at an applied voltage of 25 kV and temperature of 25 °C. For the background electrolyte 10 mmol L–1 borate buffer pH 9.3 plus 15 mmol L–1 phosphate buffer pH 7.0 (with the final pH of the mixture adjusted to 7.0 with HCl), with added 10 % (V/V) methanol, and 15 mmol L–1 sodium dodecyl sulfate as a surfactant, were used. The hydrodynamic injection was carried out at 5.0 kPa during the period of 100 s. Linear calibration curves were established over the concentration range 0.5–500.0 mg L–1 for Dox and 10.0–500.0 mg L–1 for Frl (at 234 nm). The proposed MEKC procedure was fully validated and applied for the deter mination of Dox and Frl in Wistar rats after intra pe ritoneal administration of both molecules.

A new headspace gas chromatographic method with flame ionization detection (HSS--GC--FID) was developed and validated for the determination of methanol as the main volatile impurity present in ethanolic pharmaceutical preparations. The use of static headspace sampling minimized the interference of other volatile matrix components and provided satisfactory results in purity assessment of different complex samples. The developed procedure revealed to be rapid, sensitive, reproducible and accurate. The detection and quantification limits of methanol were 0.0003 and 0.0011% (v/v), respectively, and were sufficiently low to enable the estimation of organic volatile impurity according to the ICH guideline as well as the examination of methanol limit specified in European Pharmacopoeia for liquid pharmaceutical preparations. The proposed method was successfully applied to the analysis of diverse alcoholic herbal extracts and tinctures as well as ethanolic dermatological lotions. Keywords: static headspace, gas chromatography, quality control, methanol limit, liquid pharmaceutical preparations DOI: 10.1134/S1061934813120071, Quality control monitoring ensures the safety, efficacy and quality of pharmaceutical preparations. Therefore, quality control consists of a regular testing of the quality of medicines regarding the identification and determination [...]

Solid-phase extraction (SPE) coupled with capillary electrophoresis (CE) for the determination of macrolide antibiotics (azithromycin, clarithromycin, roxithromycin, tylosin) and tiamulin in water samples was described in this article. These compounds were extracted with different types of sorbents ( Oasis HLB, C18, C8, SDB, and Strata-X) and different masses of sorbents (60 mg, 200 mg, and 500 mg) using different organic solvents (methanol, ethanol, and acetonitrile) and different pH values of water samples (pH 7.00, 8.00, and 9.00). It was found that the highest extraction efficiency of the studied compounds was obtained with 200 mg/3 mL C18 cartridges with methanol as eluent at pH 9.00 of the water sample. The developed SPE-CE method for macrolide antibiotics and tiamulin was validated for linearity, precision, repeatability, the limit of detection (LOD), the limit of quantification (LOQ), and recovery. Good linearity was obtained in the range of 0.3–30 mg L−1 depending on the drug, with correlation coefficients higher than 0.9958 in all cases except clarithromycin (0.9873). Expanded measurement uncertainties were calculated for each pharmaceutical, accounting for 20.31 % (azithromycin), 38.33 % (tiamulin), 28.95 % (clarithromycin), 26.99 % (roxithromycin), and 21.09 % (tiamulin). Uncertainties associated with precision and calibration curves contributed the most to the combined measurement uncertainty. The method was successfully applied to the analysis of production waste-water from the pharmaceutical industry.

Treatment adherence is crucial for optimal outcomes in advanced breast cancer, but can be challenging due to various factors, i.e. patients’ attitudes and behavior upon diagnosis, and complex therapies with high adverse effect rates. Our aim was to explore the adherence to oral anticancer medications (OAM) in women with advanced breast cancer, focusing on cyclin-dependent kinase 4 and 6 inhibitors (CDKI), and identify factors associated with the adherence. We conducted a cross-sectional study at the University Hospital Centre Zagreb, Croatia, involving women with stage IV advanced breast cancer receiving OAM. Data collection included a questionnaire assessing socio-demographic and clinical information, Beck Depression Inventory-II for depressive symptoms, Medication Adherence Report Scale (MARS-5) for adherence to OAM, and Beliefs about Medicines Questionnaire. Plasma concentrations of CDKI were confirmed by LC-MS/MS in three randomly selected participants. A total of 89 women were included. The most prescribed OAMs were anti-estrogen (71.3 %) and CDKI (60.9 %). MARS-5 scores (mean: 24.1 ± 1.6) correlated with CDKI plasma concentrations. Forgetfulness was the primary reason for non-adherence (25.9 %). Women receiving CDKI (p = 0.018), without depressive symptomatology (p = 0.043), and with more positive beliefs about medicines were more adherent (p < 0.05). This study enhances understanding of medication adherence in advanced breast cancer and identifies influential factors.

Background CT deep learning image reconstruction (DLIR) improves image quality by reducing noise compared with adaptive statistical iterative reconstruction-V (ASIR-V). However, objective assessment of low-contrast lesion detectability is lacking. Purpose To investigate low-contrast detectability of hypoattenuating liver lesions on CT scans reconstructed with DLIR compared with CT scans reconstructed with ASIR-V in a patient and a phantom study. Materials and Methods This single-center retrospective study included patients undergoing portal venous phase abdominal CT between February and May 2021 and a low-contrast-resolution phantom scanned with the same protocol. Four reconstructions (ASIR-V at 40% strength [ASIR-V 40] and DLIR at three strengths) were generated. Five radiologists qualitatively assessed the images using the five-point Likert scale for image quality, lesion diagnostic confidence, conspicuity, and small lesion (≤1 cm) visibility. Up to two key lesions per patient, confirmed at histopathologic testing or at prior or follow-up imaging studies, were included. Lesion-to-background contrast-to-noise ratio was calculated. Interreader variability was analyzed. Intergroup qualitative and quantitative metrics were compared between DLIR and ASIR-V 40 using proportional odds logistic regression models. Results Eighty-six liver lesions (mean size, 15 mm ± 9.5 [SD]) in 50 patients (median age, 62 years [IQR, 57-73 years]; 27 [54%] female patients) were included. Differences were not detected for various qualitative low-contrast detectability metrics between ASIR-V 40 and DLIR ( P > .05). Quantitatively, medium-strength DLIR and high-strength DLIR yielded higher lesion-to-background contrast-to-noise ratios than ASIR-V 40 (medium-strength DLIR vs ASIR-V 40: odds ratio [OR], 1.96 [95% CI: 1.65, 2.33]; high-strength DLIR vs ASIR-V 40: OR, 5.36 [95% CI: 3.68, 7.82]; P < .001). Low-contrast lesion attenuation was reduced by 2.8-3.6 HU with DLIR. Interreader agreement was moderate to very good for the qualitative metrics. Subgroup analysis based on lesion size of larger than 1 cm and 1 cm or smaller yielded similar results ( P > .05). Qualitatively, phantom study results were similar to those in patients ( P > .05). Conclusion The detectability of low-contrast liver lesions was similar on CT scans reconstructed with low-, medium-, and high-strength DLIR and ASIR-V 40 in both patient and phantom studies. Lesion-to-background contrast-to-noise ratios were higher for DLIR medium- and high-strength reconstructions compared with ASIR-V 40. © RSNA, 2024 Supplemental material is available for this article.

Gender-affirming surgery (GAS) is increasingly being performed. GAS is tailored to the patient leading to a diverse spectrum of radiologic post-operative findings. Radiologists who are unfamiliar with expected anatomic alterations after GAS may misdiagnose important complications leading to adverse patient outcomes. This collaborative multi-institutional review aims to: Describe relevant embryology and native anatomy. Describe relevant Gender-Affirming Surgery (GAS) techniques and expected neo-anatomy with associated complications, including common terminology. Review expected imaging appearance of neo-anatomy/postoperative findings. Review multi-modality [ultrasound, plain film, retrograde urethrogram, computed tomography] emergent imaging findings. Understand unique patient evaluation and imaging protocol considerations in the GAS population. Discuss pearls and pitfalls of imaging in the acute post-GAS setting., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Objectives: To perform a multi-reader comparison of multiparametric dual-energy computed tomography (DECT) images reconstructed with deep-learning image reconstruction (DLIR) and standard-of-care adaptive statistical iterative reconstruction-V (ASIR-V)., Methods: This retrospective study included 100 patients undergoing portal venous phase abdominal CT on a rapid kVp switching DECT scanner. Six reconstructed DECT sets (ASIR-V and DLIR, each at three strengths) were generated. Each DECT set included 65 keV monoenergetic, iodine, and virtual unenhanced (VUE) images. Using a Likert scale, three radiologists performed qualitative assessments for image noise, contrast, small structure visibility, sharpness, artifact, and image preference. Quantitative assessment was performed by measuring attenuation, image noise, and contrast-to-noise ratios (CNR). For the qualitative analysis, Gwet's AC2 estimates were used to assess agreement., Results: DECT images reconstructed with DLIR yielded better qualitative scores than ASIR-V images except for artifacts, where both groups were comparable. DLIR-H images were rated higher than other reconstructions on all parameters (p-value < 0.05). On quantitative analysis, there was no significant difference in the attenuation values between ASIR-V and DLIR groups. DLIR images had higher CNR values for the liver and portal vein, and lower image noise, compared to ASIR-V images (p-value < 0.05). The subgroup analysis of patients with large body habitus (weight ≥ 90 kg) showed similar results to the study population. Inter-reader agreement was good-to-very good overall., Conclusion: Multiparametric post-processed DECT datasets reconstructed with DLIR were preferred over ASIR-V images with DLIR-H yielding the highest image quality scores., Clinical Relevance Statement: Deep-learning image reconstruction in dual-energy CT demonstrated significant benefits in qualitative and quantitative image metrics compared to adaptive statistical iterative reconstruction-V., Key Points: Dual-energy CT (DECT) images reconstructed using deep-learning image reconstruction (DLIR) showed superior qualitative scores compared to adaptive statistical iterative reconstruction-V (ASIR-V) reconstructed images, except for artifacts where both reconstructions were rated comparable. While there was no significant difference in attenuation values between ASIR-V and DLIR groups, DLIR images showed higher contrast-to-noise ratios (CNR) for liver and portal vein, and lower image noise (p value < 0.05). Subgroup analysis of patients with large body habitus (weight ≥ 90 kg) yielded similar findings to the overall study population., (© 2024. The Author(s), under exclusive licence to European Society of Radiology.)

Abstract: Neuroendocrine neoplasms (NENs) are a diverse group of tumors that express neuroendocrine markers and primarily affect the lungs and digestive system. The incidence of NENs has increased over time due to advancements in imaging and diagnostic techniques. Effective management of NENs requires a multidisciplinary approach, considering factors such as tumor location, grade, stage, symptoms, and imaging findings. Treatment strategies vary depending on the specific subtype of NEN. In this review, we will focus on treatment strategies and therapies including the information relevant to clinicians in order to undertake optimal management and treatment decisions, the implications of different therapies on imaging, and how to ascertain their possible complications and treatment effects., Competing Interests: The authors declare no conflict of interest., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

BACKGROUND. The 2022 Society of Radiologists in Ultrasound (SRU) consensus conference recommendations for small gallbladder polyps support management that is less aggressive than earlier approaches and may help standardize evaluation of polyps by radiologists. OBJECTIVE. The purpose of the present study was to assess the interreader agreement of radiologists in applying SRU recommendations for management of incidental gallbladder polyps on ultrasound. METHODS. This retrospective study included 105 patients (75 women and 30 men; median age, 51 years) with a gallbladder polyp on ultrasound (without features highly suspicious for invasive or malignant tumor) who underwent cholecystectomy between January 1, 2003, and January 1, 2021. Ten abdominal radiologists independently reviewed ultrasound examinations and, using the SRU recommendations, assessed one polyp per patient to assign risk category (extremely low risk, low risk, or indeterminate risk) and make a possible recommendation for surgical consultation. Five radiologists were considered less experienced (< 5 years of experience), and five were considered more experienced (≥ 5 years of experience). Interreader agreement was evaluated. Polyps were classified pathologically as nonneoplastic or neoplastic. RESULTS. For risk category assignments, interreader agreement was substantial among all readers (k = 0.710), less-experienced readers (k = 0.705), and more-experienced readers (k = 0.692). For surgical consultation recommendations, inter-reader agreement was substantial among all readers (k = 0.795) and more-experienced readers (k = 0.740) and was almost perfect among less-experienced readers (k = 0.811). Of 10 readers, a median of 5.0 (IQR, 2.0-8.0), 4.0 (IQR, 2.0-7.0), and 0.0 (IQR, 0.0-0.0) readers classified polyps as extremely low risk, low risk, and indeterminate risk, respectively. Across readers, the percentage of polyps classified as extremely low risk ranged from 32% to 72%; as low risk, from 24% to 65%; and as indeterminate risk, from 0% to 8%. Of 10 readers, a median of zero change to 0 (IQR, 0.0-1.0) readers recommended surgical consultation; the percentage of polyps receiving a recommendation for surgical consultation ranged from 4% to 22%. Of a total of 105 polyps, 102 were nonneo-plastic and three were neoplastic (all benign). Based on readers' most common assessments for nonneoplastic polyps, the risk category was extremely low risk for 53 polyps, low risk for 48 polyps, and indeterminate risk for one polyp; surgical consultation was recommended for 16 polyps. CONCLUSION. Ten abdominal radiologists showed substantial agreement for polyp risk categorizations and surgical consultation recommendations, although areas of reader variability were identified. CLINICAL IMPACT. The findings support the overall reproducibility of the SRU recommendations, while indicating opportunity for improvement.

Cholangiocarcinoma (CCA), a highly aggressive primary liver cancer arising from the bile duct epithelium, represents a substantial proportion of hepatobiliary malignancies, posing formidable challenges in diagnosis and treatment. Notably, the global incidence of intrahepatic CCA has seen a rise, necessitating a critical examination of diagnostic and management strategies, especially due to presence of close imaging mimics such as hepatocellular carcinoma (HCC) and combined hepatocellular carcinoma-cholangiocarcinoma (cHCC-CCA). Hence, it is imperative to understand the role of various imaging modalities such as ultrasound, computed tomography (CT), and magnetic resonance imaging (MRI), elucidating their strengths, and limitations in diagnostic precision and staging accuracy. Beyond conventional approaches, there is emerging significance of functional imaging tools including positron emission tomography (PET)-CT and diffusion-weighted (DW)-MRI, providing pivotal insights into diagnosis, therapeutic assessment, and prognostic evaluation. This comprehensive review explores the risk factors, classification, clinical features, and role of imaging in the holistic spectrum of diagnosis, staging, management, and restaging for CCA, hence serving as a valuable resource for radiologists evaluating CCA., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Hybrid positron emission tomography (PET)/magnetic resonance imaging (MRI) is highly suited for abdominal pathologies. A precise co-registration of anatomic and metabolic data is possible thanks to the simultaneous acquisition, leading to accurate imaging. The literature shows that PET/MRI is at least as good as PET/CT and even superior for some indications, such as primary hepatic tumors, distant metastasis evaluation, and inflammatory bowel disease. PET/MRI allows whole-body staging in a single session, improving health care efficiency and patient comfort., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Ovarian sex cord-stromal tumors (OSCSTs) are a rare group of ovarian neoplasms that can be benign or malignant. They are classified into pure sex cord tumors, pure stromal tumors, and mixed SCST. The most common malignant OSCSTs are adult granulosa cell tumors. In contrast to the more common ovarian epithelial malignancies, OSCSTs present in younger patients, often at early stages, with better prognoses. Imaging features are variable, and pathology is required for diagnosis. However, certain tumors demonstrate characteristic imaging appearances that can be useful in narrowing the differential diagnosis., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Imaging plays an important role in the diagnosis and treatment of women with uterine cervical and endometrial cancers. Quantitative imaging, through MRI, PET/CT, and hybrid PET/MRI, allows for characterization of primary tumors beyond anatomic and qualitative descriptors. MRI diffusion-weighted imaging (DWI) yields an apparent diffusion coefficient (ADC), which can be applied in both the pre-and post-treatment assessment of uterine tumors. PET/CT assesses metabolic activity, and measurement of tumor standardized uptake value (SUV) is a useful metric in the staging of uterine malignancies. Hybrid PET/MRI is an emerging modality that combines the soft tissue contrast of MRI with the molecular imaging capability of PET. This review provides an overview of these quantitative imaging modalities, and their current and potential roles in the assessment of uterine cervical and cancer., (© 2021. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Purpose: To assess guideline compliance and quality of hepatocellular carcinoma, (HCC) diagnostic imaging within community hospitals (CH) and their Tertiary referral center (TRC) in a moderately high incidence region., Methods: Initial diagnostic workup CT/MRI scans of 251 patients (122 CH, 112 TRC, 17 Non-TRC academic) with HCC over a 15-month period were assessed for Liver reporting and Data System (LI-RADS) guideline compliance. 269 scans (182 CT, 87 MRI) were qualitatively evaluated by 2 independent blinded radiologists for arterial timing, overall image quality, noise and sharpness, with quantification of interobserver variability. The contrast enhancement ratio (CER) for the largest HCC on each scan was calculated using pre- and post-contrast images., Results: 103/104 (99%) of TRC and 44/78 (56%) of CH CTs adhered to LI-RADS imaging guidelines (P < 0.0001). Lack of delayed phase accounted for 32/34 (94%) of noncompliant CH CTs. Regarding MRI, 19/19 (100%) of TRC and 60/68 (88%) of CH scans were adherent (P = 0.12). For both modalities, overall image quality, noise and sharpness were rated significantly higher for TRC than CH. There was moderate interobserver agreement with intraclass correlation coefficient of 0.73, 0.70 and 0.63, respectively. Arterial-phase timing was rated adequate for CT in 75/104 TRC (72%) and 10/68 (14%) CH scans (P < 0.0001) and for MRI in 8/19 (42%) TRC and 23/68 (33%) CH scans (P = 0.17). The CER was significantly higher for TRC versus CH (2.9 vs. 1.9, P < 0.001) and MRI (0.9 vs. 0.7, P = 0.03)., Conclusions: Community hospital HCC diagnostic scans significantly lag in critical quality parameters of tumor enhancement, arterial phase timing, perceived image quality, and LI-RADS CT technique compliance compared to a TRC.

Purpose: In suspected spondylodiscitis and vertebral osteomyelitis, computed tomography (CT)-guided biopsies are often performed to determine a causative organism and guide antimicrobial therapy. The aim of this study is to determine the diagnostic culture yield of CT-guided biopsies performed in cases of suspected spinal infections., Methods: A literature search of PubMed and MEDLINE up to April 2017 was performed for keywords "CT guided vertebral biopsy infection," "CT-guided spine biopsy infection," "CT guided spine biopsy yield," and "CT guided vertebral biopsy yield." Inclusion criteria primarily consisted of studies exclusively using CT-guided biopsies in cases of suspected infectious lesions only. After study selection, published articles were analysed to determine diagnostic culture yield. Descriptive statistics were applied., Results: 220 search results were screened; 11 met our inclusion criteria and were reviewed. In total, 647 biopsies of suspected infectious spinal lesions were performed. Positive cultures were obtained in 241 cases. Upon excluding one paper's skewed results, the net pooled results culture yield was 33%. Several cultures grew multiple organisms, leading to a total of 244 species identified. Most common isolated organisms include Staphylococcus aureus (n = 83), coagulase-negative Staphylococcus (n = 45), and Mycobacteria (n = 38)., Conclusions: The diagnostic culture yield of CT-guided biopsies in cases of suspected spinal infection is 33%. In the majority of cases, a causative organism is not identified. This suggests that improvements can be made in biopsy technique and specimen transfer to optimize culture yield and increase the clinical value of the procedure., (Copyright © 2018 The Authors. Published by Elsevier Inc. All rights reserved.)

Purpose: To analyze technique, outcomes, and complications of a large series of pediatric percutaneous nephrostomy (PCN) procedures performed at 4 tertiary pediatric centers., Materials and Methods: Retrospective multicenter study of PCNs performed during an 11-year period. Six hundred seventy-five PCNs were performed on 441 patients (median age: 4 y, range: 1 d-18 y, median weight: 17 kg, range: 0.7-112 kg); 31% were younger than 1 year. The most frequent indications for PCN procedures included hydronephrosis (57%), calculus (14%), and infection (12%). Forty-five percent of patients had severe and 32% had moderate hydronephrosis., Results: Technical success was 99% (n = 668); 7 failures occurred from lost access, during tract dilatation (n = 5) and during staghorn calculi without dilatation (n = 2). General anesthesia was used in 73% of procedures. Combined ultrasound and fluoroscopy was used in 98% of procedures. Of the 668 procedures, 561 (84%) were primary nephrostomy insertions, and 107 (16%) were a variety of exchanges (secondary catheter insertions). Twenty-four of 675 (4%) were transplanted kidneys. Access sites included lower (47%), mid (28%), and upper (12%) poles and pelvis (11%). Catheters were predominantly 7-8 French (n = 352). The mean catheter dwell time was 25 days (0-220 d). Total primary catheter days were 14,482, with an additional 2,241 days after secondary procedures. Follow-up in 653/668 (98%) procedures documented elective removal (79%) and salvage procedures (21%), which included wire exchange (8.7%), nephroureteral stent/catheter conversion (8.8%), and tube upsizing (3.5%). Periprocedural complications occurred in 30/668 (4.5%) procedures: 1 major (0.1%) self-limiting hematuria requiring transfusion and 29 (4.4%) minor complications., Conclusions: PCN is safe and successful in children of all ages, with few major complications. PCN in children is associated with specific technical challenges and requires ongoing management tailored to the very young to achieve good outcomes., (Copyright © 2017 SIR. Published by Elsevier Inc. All rights reserved.)

High-flow ports have been used for apheresis in adults. The purpose of this study was to demonstrate the efficacy of ports for apheresis in children and to survey satisfaction of patients and their families with their use. A retrospective review of clinical details was combined with a prospective assessment of the experience of patients and their families. Eight patients (mean age, 10.4 y; mean weight, 35 kg) had nine ports placed for long-term apheresis. All 246 treatment sessions were completed successfully. Access difficulties occurred in eight of 246 sessions (3%). Alarms occurred in 40 of 246 sessions (16%), resulting in delays in 10 of 246 sessions (4%). A survey of early experience indicated overall satisfaction with and a preference for ports for apheresis., (Copyright © 2015 SIR. Published by Elsevier Inc. All rights reserved.)

Purpose: To report the technical success and complication rates for double J ureteric stent placements by interventional radiologists in children., Materials and Methods: A retrospective analysis of double J ureteric stents placed between January 2001 and December 2011 was conducted. Data collected included patient demographics, procedural details (indication, double J stent size, access approach, concurrent procedures), technical and functional success, tube dwell time, and procedure-related complications. Descriptive statistics were employed. Placement of 59 double J ureteric stents was attempted in 49 procedures performed on 35 pediatric patients (26 boys and 9 girls) with a mean age of 7.3 years (range, 22 d-17.9 y; median age, 4 y) and a mean weight of 22 kg (range, 2.5-70 kg)., Results: There were 44 de novo double J stent insertion attempts: 20 one-stage procedures (17 anterograde, 3 retrograde through the urethra) and 24 two-stage anterograde procedures through an existing nephrostomy tube. There were 15 exchanges; 11 were anterograde, and 4 were retrograde (2 urethral, 2 Mitrofanoff). Of 49 procedures, 15 were performed as combined procedures with a urologist. Technical success was 95% (56 of 59), and primary functional success was 95% (53 of 56). Complications included two minor complications occurring during the procedure and four complications occurring after the procedure., Conclusions: Image-guided insertion of a double J ureteric stent is an effective treatment for pediatric urologic obstructive conditions. The procedure is both technically and functionally successful in a high percentage of pediatric patients., (Copyright © 2014 SIR. Published by Elsevier Inc. All rights reserved.)

Retrograde radiologic gastrostomy is one of several techniques used for placing a gastrostomy and is a common technique used in children. The use of a retention anchor suture (RAS) is an important component of this procedure. This pictorial essay explores the normal course and passage of the RAS, as well as abnormal migration, various complications and the implications of the RAS with regard to MRI safety.