Objectives
To compare the impact of laxative enema preparation versus air/gas suction through a small catheter on image quality of prostate DWI.
Methods
In this single-center study, 200 consecutive ...patients (100 in each arm) with either enema or catheter preparation were retrospectively included. Two blinded readers independently assessed aspects of image quality on 5-point Likert scales. Scores were compared between groups and the influence of confounding factors evaluated using multivariable logistic regression. Prostate diameters were compared on DWI and T
2
-weighted imaging using intraclass correlation coefficients.
Results
Image quality was significantly higher in the enema group regarding the severity of susceptibility-related artifacts (reader 1: 0.34 ± 0.77 vs. 1.73 ± 1.34, reader 2: 0.38 ± 0.86 vs. 1.76 ± 1.39), the differentiability of the anatomy (reader 1: 3.36 ± 1.05 vs. 2.08 ± 1.31, reader 2: 3.37 ± 1.05 vs. 2.09 ± 1.35), and the overall image quality (reader 1: 3.66 ± 0.77 vs. 2.26 ± 1.33, Reader 2: 3.59 ± 0.87 vs. 2.23 ± 1.38) with almost perfect inter-observer agreement (
κ
= 0.92–0.95). In the enema group, rectal distention was significantly lower and strongly correlated with the severity of artifacts (reader 1:
ρ
= 0.79, reader 2:
ρ
= 0.73). Furthermore, there were significantly fewer substantial image distortions, with odds ratios of 0.051 and 0.084 for the two readers which coincided with a higher agreement of the prostate diameters in the phase-encoding direction (0.96 vs. 0.89).
Conclusions
Enema preparation is superior to catheter preparation and yields substantial improvements in image quality.
Key Points
• Enema preparation is superior to decompression of the rectum using air/gas suction through a small catheter.
• Enema preparation markedly improves the image quality of prostate DWI regarding the severity of susceptibility-related artifacts, the differentiability of the anatomy, and the overall image quality and considerably reduces substantial artifacts that may impair a reliable diagnosis.
Aims of the study The novel coronavirus pandemic has affected emergency department consultations for surgical pathologies. The aim of our study was to compare the number of acute appendicitis cases ...and the proportion of complicated appendicitis before and during the COVID-19 pandemic. Methods We retrospectively analyzed all data collected from a multi-center database of patients presenting to the emergency department for acute appendicitis during the COVID-19 pandemic from March 12 to June 6, 2020, and compared these data with those from the same periods in 2017, 2018, and 2019. The number of acute appendicitis cases, proportion of complicated appendicitis, and pre- and postoperative patient characteristics were evaluated. Results A total of 306 patients were included in this evaluation. Sixty-five patients presented during the 2020 COVID-19 pandemic lockdown (group A), and 241 patients in previous years (group B: 2017-2019). The number of consultations for acute appendicitis decreased by almost 20 percent during the pandemic compared with previous periods, with a significant increase in complicated appendicitis (52% in group A versus 20% in group B, p 48h in 61% and 26%, p 2 days in 63% and 32%, p 3 days in 36% and 24% p = 0.001). Conclusions The COVID-19 pandemic resulted in a decreased number of consultations for acute appendicitis, with a higher proportion of complicated appendicitis, most likely due to patient delay in consulting the emergency department at symptom onset. Patients and general practitioners should be aware of this problem to avoid a time delay from initial symptoms to consultation.
Hepatic infections are frequent in clinical practice. Although epidemiological, clinical and laboratory data may suggest hepatic infection in certain cases, imaging is nearly always necessary to ...confirm the diagnosis, assess disease extension and its complications, evaluate the response to treatment, and sometimes to make differential diagnoses such as malignancies. Ultrasound (US) is usually the first-line investigation, while computed tomography (CT) and magnetic resonance imaging (MRI) provide better characterization and a more precise assessment of local extension, especially biliary and vascular. The purpose of this article is to describe the typical features and main complications of common hepatic infections. Familiarity with the radiological features of this entity can help suggest the correct diagnosis and the need for further studies as well as determine appropriate and timely treatment.
Background
Abdominal aortic aneurysm (AAA) is a complex degenerative disease, which leads to morbidity and mortality in a large portion of the elderly population. Current treatment options for AAA ...are quite limited as there is no proven indication for pharmacological therapy and surgery is recommended for AAA larger than 5·5 cm in luminal diameter. Thus, there is a great need to elucidate the underlying pathophysiological cellular and molecular mechanisms to develop effective therapies. In this narrative review, we will discuss recent findings concerning some potential molecular and clinical aspects of the renin–angiotensin system (RAS) in AAA pathophysiology.
Materials and methods
This narrative review is based on the material found on MEDLINE and PubMed up to April 2013. We looked for the terms ‘angiotensin, AT1 receptor, ACE inhibitors’ in combination with ‘abdominal aortic aneurysm, pathophysiology, pathways’.
Results
Several basic research and clinical studies have recently investigated the role of the RAS in AAA. In particular, the subcutaneous infusion of Angiotensin II has been shown to induce AAA in Apo56 knockout mice. On the other hand, the pharmacological treatments targeting this system have been shown as beneficial in AAA patients.
Conclusions
Emerging evidence suggests that RAS may act as a molecular and therapeutic target for treating AAA. However, several issues on the role of RAS and the protective activities of angiotensin‐converting enzyme (ACE) inhibitors and Angiotensin 1 receptors blockers against AAA require further clarifications.
Objectives:
To report a new classification scheme for acute aortic dissection (AAD) that considers the aortic arch as a separate entity and integrates patterns of malperfusion syndrome (MPS). The ...proposed classification was evaluated retrospectively in a large population.
Materials and Methods:
We retrospectively reviewed pre-therapy CT angiograms of 226 consecutive patients (mean ± SD age: 64 ± 12 years) with AAD. AADs were reclassified with a new classification scheme that included three aortic dissection types (A, involving at least the ascending aorta; B, involving exclusively the descending aorta; and C, involving the aortic arch with/without the descending aorta) and four malperfusion grades (0: no MPS; 1: dynamic MPS; 2: static MPS; 3: static and dynamic MPS). AAD features were assessed and correlated to patient outcomes.
Results:
According to the new classification, we identified 152 type A dissections (92 A0, 11 A1, 38 A2, 11 A3); 50 type B (38 B0, 5 B1, 6 B2, 1 B3); and 24 type C (17 C0, 6 C2, 1 C3). Type C represented 11% of all AADs. MPS occurred in 39, 24, and 29% in type A, B, and C, respectively. Type C was treated with significantly more endovascular or hybrid interventions (37%) than in types A (3%) and B (20%) (
p
< 0.001).
Conclusion:
The new AAD classification was feasible, and type C was easily identified (“non-A, non-B”). Preliminary findings supported the usefulness of this classification for the decision-making process and subsequent treatments.
Purpose
Percutaneous embolization and surgical repair are the current treatment options for varicocele, but determining method superiority remains controversial. In this retrospective study, we ...evaluate the technical success, complication and recurrence rates following percutaneous embolization in a pediatric group, which were compared to reported outcomes for surgical repairs.
Methods
Thirty children treated for percutaneous varicocele embolization were recruited. The side and grade of varicocele, symptoms, testicular asymmetry, mean recurrence time, total radiation dose and complications were evaluated. Recurrence and follow-up complications due to embolization were also reviewed.
Results
The venography showed retrograde filling of the internal spermatic vein with the identification of aberrantly fed vessels in 23 % of patients. None of the patients suffered from procedure complications except one who had venous injury which was treated with a sclerosing agent. The technical success rate was 93 % (28 patients) with a recurrence rate of 13 % (4 patients). Interestingly, the mean radiation dose used was 862.5 µGy m
2
, 3 times lower than abdominal CT.
Conclusion
Considering the intravascular nature of embolization, which aims to avoid testicular artery and spermatic cord damage (difficult to avoid with the surgical method), and consequently a lower complication rate, along with the same success rate and recurrence rate, our study supports that embolization is a superior method to surgical interventions.
Cardiac metastasis is known as a rare complication of head and neck malignancy.
We present a 58-year-old woman patient with a history of tongue carcinoma who was admitted in emergency department for ...sudden chest pain. Imaging work-up by computed tomography (CT) and positron emission tomography-computed tomography (PET-CT) diagnosed a cardiac metastasis complicated by intraventricular thrombus and pulmonary embolism.
Cardiac metastasis from tongue carcinoma complicated by pulmonary embolism.
After undergoing 2 cycles of palliative chemotherapy, the patient declined any further treatment.
Patient died 3 months after the diagnosis of cardiac metastasis.
Cardiac metastasis should be considered as a differential diagnosis in patients with a history of head and neck malignancy who present non-specific cardiac symptoms.
•Abbreviated MRI protocol (AP) is a short acquisition protocol including T2WI and 3D MRCP omitting contrast-enhanced images and DWI.•Radiologists can confidently apply abbreviated protocol in ...follow-up of patients with BD-IPMN, with a negligible rate of overestimation of degeneration signs.•Despite no additional value for DWI in the evaluation of IPMN, its inclusion in AP may be considered in some groups of patients to detect associated pancreatic cancer.
To assess the diagnostic value of abbreviated protocol (AP) MRI to detect the degeneration signs in branch-duct intraductal papillary mucinous neoplasms (BD-IPMNs) in patients undergoing a routine MRI follow-up.
This dual-center retrospective study include patients with BD-IPMN diagnosed on initial comprehensive protocol (CP) MRI who underwent routine MRI follow-up. CP included axial and coronal T2-weighted images (T2WI), axial T1-weighted images (T1WI) before and after contrast administration, 3D MR cholangiopancreatography (MRCP) and diffusion-weighted images (DWI). Two APs, eliminating dynamic sequences ± DWI, were extracted from CP. Two radiologists evaluated the APs separately for IPMN degeneration signs according to Fukuoka criteria and compared the results to the follow-up CP. In patients who underwent EUS, imaging findings were correlated with pathological results. Per-patient and per-lesion sensitivity, specificity, PPV, NPV, and accuracy of APs were calculated. Additionally, the acquisition time for different protocols was calculated.
One hundred-fourteen patients (56.1 % women, median age: 71 years) with 256 lesions were included. Degeneration signs were observed in 24.6 % and 12.1 % per-patient and per-lesion, respectively. Regarding APs, the per patient sensitivity, specificity, PPV, NPV, and accuracy in the detection of the degeneration signs were 100 %, 93.5 %, 83.3 %, 100 %, and 95.1 %, respectively. No additional role for DWI was detected. AP without DWI economized nearly half of CP acquisition time (388 versus 663 s, respectively).
AP can confidently replace CP for BD-IPMN follow-up with high sensitivity and PPV while offering benefits such as patient comfort, improved MRI accessibility, and reduced dedicated time for image analysis. DWI necessitates special consideration.
Our data suggest that APs safely detect all degeneration signs of IPMN. While there is an overestimation of mural nodules due to the lack of contrast injection, this occurs in a negligible number of patients.
Objectives
To compare four previously published methods for rectal tumor response evaluation after chemoradiotherapy on MRI.
Methods
Twenty-two radiologists (5 rectal MRI experts, 17 ...general/abdominal radiologists) retrospectively reviewed the post-chemoradiotherapy MRIs of 90 patients, scanned at 10 centers (with non-standardized protocols). They applied four response methods; two based on T2W-MRI only (MRI tumor regression grade (mrTRG); split-scar sign), and two based on T2W-MRI+DWI (modified-mrTRG; DWI-patterns). Image quality was graded using a 0–6-point score (including slice thickness and in-plane resolution; sequence angulation; DWI b-values, signal-to-noise, and artefacts); scores < 4 were classified below average. Mixed model linear regression was used to calculate average sensitivity/specificity/accuracy to predict a complete response (versus residual tumor) and assess the impact of reader experience and image quality. Group interobserver agreement (IOA) was calculated using Krippendorff’s alpha. Readers were asked to indicate their preferred scoring method(s).
Results
Average sensitivity/specificity/accuracy was 57%/64%/62% (mrTRG), 36%/79%/66% (split-scar), 40%/79%/67% (modified-mrTRG), and 37%/82%/68% (DWI-patterns); mrTRG showed higher sensitivity but lower specificity and accuracy (
p
< 0.001) compared to the other methods. IOA was lower for the split scar method (0.18 vs. 0.39–0.43). Higher reader experience had a significant positive effect on diagnostic performance and IOA (except for the split scar sign); below-average imaging quality had a significant negative effect on diagnostic performance. DWI pattern was selected as the preferred method by 73% of readers.
Conclusions
Methods incorporating DWI showed the most favorable results when combining diagnostic performance, IOA, and reader preference. Reader experience and image quality clearly impacted diagnostic performance emphasizing the need for state-of-the-art imaging and dedicated radiologist training.
Key Points
•
In a multireader study comparing 4 MRI methods for rectal tumor response evaluation, those incorporating DWI showed the best results when combining diagnostic performance, IOA, and reader preference.
•
The most preferred method (by 73% of readers) was the “DWI patterns” approach with an accuracy of 68%, high specificity of 82%, and group IOA of 0.43.
• Reader experience level and MRI quality had an evident effect on diagnostic performance and IOA.
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