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Introduction/Background Endometrial cancer (EC) is currently the most frequent cancer affecting the female genital system. The treatment of choice is represented by surgery, which consists of bilateral hysterectomy and adnexectomy with lymphadenectomy (L) according to risk factor for recurrence. The systematic lymphadenectomy procedure is often associated with postoperative complications, such as lymphedema, lymphocysts, lymphorrhoea. Recently, sentinel lymph node mapping have overcome the complications associated with L, though there is limited access to this tecnique. The aim of the study was to evaluate the role of radiomic analysis of pelvic adipose tissue at CT in predicting the incidence of post-oeprative complications of L. Methodology Consecutive patients who underwent surgical treatment of endometrial cancer at Careggi University Hospital between January 2016 and Decemeber 2019 were enrolled. Only patients underwent to pelvic lymphadenectomy were enrolled. Exclusion criteria were bulky nodes at the preoperative imagings. Staging CT images were used fot the radiomic analysis; pelvic adipose tissue was identified and segmented, so the images were imported to the 3D Slicer software. Subsequently, the extractions of the three radiomics features (busyness, flatness, elongation) of the rea of interest were carried out. Results Twenty seven patients were enrolled. Five patients developed post-operative complications. The value of Busyness, Flatness and elongation correlated with postoperative complications (p= 0.04, p= 0.021, p=0.03, respectively). Conclusion Our preliminary study shows that radiomic might be useful to predict whether a patient will develop any complications associated with the lymphadenectomy. Consequently pre-operative imaging might be used also to select which patient benefit the most from sentinel node study instead of L. Disclosures The authors have no conflicts of interest to declare.

To evaluate the dependence on the b-values adopted of apparent diffusion coefficient (ADC), perfusion fraction (PF), slow and fast diffusion coefficient (Dslow, Dfast), corrected diffusion coefficient (D) and kurtosis (K), in healthy peripheral (HP) and peripheral cancerous (PCa) prostate tissues.Patients who underwent multiparametric prostate MR examination were retrospectively evaluated for possible inclusion. ADC, PF, Dslow, Dfast, D, and K were estimated both in HP and PCa tissues, using three different ranges of b-values: 0-2300, 0-1800, 0-800 s/mm2 (group A, B and C, respectively). Analysis of variance (ANOVA) and receiver operating characteristic (ROC) analysis were performed, to establish differences among groups and to evaluate sensitivity and specificity of every parameter in distinguishing HP and PCa tissues when calculated with different b-values.In all, 57 patients were included. ANOVA showed significant differences of all parameters between group A-B vs. C, both in HP and PCa tissues. In ROC analysis K showed the best area under the curve (AUC) when calculated in groups A and B (0.87 and 0.86), while it was comparable with the ADC one in group C (both 0.82).A significant dependence on the adopted b-values of DWI parameters is shown. The best performance in distinguishing HP from PCa tissues was obtained by K, calculated using a high b-value sequence.

The purpose of this review is the presentation of the proper orthopaedic treatment of the most frequent fragility fractures associated with low bone mineral density or established osteoporosis. In this particular group of patients, the surgical treatment is difficult for the poor quality of the broken bone that limits the reduction, the hardware fixation and the physiologic process of bone healing. Other important problems are the postoperative management of old patients with chronic diseases and more prone to develop local and general complications with big difficulties to conduct a good rehabilitation program.Some considerations will be made, lastly, about the role of the orthopaedic surgeon on the treatment of osteoporosis and on the possibility to prevent further fractures.

Basic knowledge in the interpretation of hepatic imaging is essential for the clinical hepatologist. In recent years, the availability of dynamic imaging studies of the liver using computed tomography or magnetic resonance has led to appreciate the importance of early changes in arterial perfusion for the interpretation of hepatic lesions. Transient Hepatic Parenchymal Enhancement (THPE) is defined as a normal area of liver parenchyma that enhances after injection of contrast agent during the arterial phase of perfusion. Appearance of this sign is mostly associated with a reduction in portal perfusion or with inflammation, and appears in different morphologic patterns. THPE should not be considered a radiological artefact, and its interpretation is essential to avoid misclassification of hepatic lesions that may have clinical significance, such as hepatocellular carcinoma or hepatic metastases. In this short review we provide essential information on the causes, pathophysiology and morphology of THPE, and discuss the relevance of these findings in a clinical perspective.

AJR 2012; 199:W662 0361–803X/12/1995–W662 © American Roentgen Ray Society Liver Lesion Characterization: The Wrong Choice of Contrast Agent Can Mislead the Diagnosis of Hemangioma Over the past few years, abdominal radiology experts studying the liver have increased the usage of liver-specific gadolinium-chelate contrast agents. These agents are gadobenate dimeglumine (MultiHance, Bracco) and gadoxetate (Primovist, Bayer HealthCare), with different biliary rate excretion (5% and 50%) and liver-specific phase acquisition time (120 and 20 minutes), respectively. This great difference in biliary clearance requires the radiologist’s consideration, especially in the study of focal lesions. In fact, with Primovist, the equilibrium phase (180 seconds) is an early-uptake stage because of the quick accumulation of the contrast agent in hepatic cells. Therefore, we must consider a false washout at the equilibrium phase, in which Primovist is retained in the hemangioma, which nonetheless appears isoor hypointense on T1-weighted images because of the increasing signal intensity of the surrounding healthy hepatic parenchyma. This implies that hemangiomas may have a misleading contrast imaging pattern with Primovist, without the usual, well-demonstrable fill in, as assessed by Gupta et al. [1] who showed the different contrast imaging pattern of hemangiomas with Primovist and MultiHance. This nontypical pattern of hemangiomas with Primovist does not represent a significant problem in detecting large masses, which are already well recognizable on unenhanced acquisitions. However, it can be difficult to properly characterize small lesions that may not be benign [2]. In particular, it can be complicated when we observe small multiple hemangiomas—sometimes with a prevalent fibrous component and relatively low signal intensity in heavily T2-weighted acquisitions—that have not been documented in previous examinations or, as often occurs in daily practice, in patients lacking an accurate clinical history or previous examination (e.g., occasional hepatic lesion seen on an ultrasound examination) (Fig. 1). These problems can be amplified if, to optimize examination time, the radiologist chooses to apply the Primovist inverse study protocol, in which only the T1-weighted sequences are acquired before the dynamic phase, and T2weighted and diffusion-weighted sequences are acquired in the contrast-enhanced phase before the hepatobiliary phase is acquired. Such an inverse modality is based on studies that have highlighted that Primovist does not influence the T2-weighted and diffusionweighted sequences, and our experience confirms these data [3]. Of course, the saving in time is relevant, but the risk of selecting an unsuitable contrast agent is increased. On the basis of these considerations, to avoid the risk of making mistakes or at least to deal with divergent patterns in patients without a clinical history or with a suspicion of hemangioma, we prefer the use of MultiHance, which can act as a non–liver-specific gadolinium chelate (with an appropriate dynamic phase) and, if necessary, make it possible to acquire a hepatobiliary phase. Silvia Pradella Silvia Lucarini Stefano Colagrande Azienda Ospedaliero-Universitaria Careggi, Florence, Italy DOI:10.2214/AJR.12.8951 WEB—This is a Web exclusive article.