Abdominal Radiology最新文献

Background

Magnetic Resonance Enterography (MRE) has emerged as a tool in diagnosing and monitoring Crohn’s disease. Despite its importance, no comprehensive bibliometric analysis has focused on MRE’s impact in this field. This study addresses this gap by analyzing the 100 most-cited articles related to MRE in Crohn’s disease, revealing key trends and influential research in the field.

Methods

Two independent researchers utilized Scopus to identify relevant articles using predefined keywords. The articles were ranked by citation count, and detailed bibliographic data was collected. Advanced statistical analyses were conducted to identify research trends and evaluate article influence using citation metrics.

Results

Our study analyzed trends from 1990 to 2024, revealing a peak in research activity between 2008 and 2018, with the most articles (n = 52) published in 5 years from 2010 to 2014. Citation activity mirrored the trends with 100 most cited articles between 2008 and 2016, peaking in 2011 at nearly 7000 citations with a sharp decline after 2016. No significant correlation (p = 0.40) was identified between citation count and journal impact factor. Our study identified the shift in past research trends from fluoroscopy to MRE and the saturation in research on MRE in recent years.

Conclusion

Our study highlights a shift from fluoroscopy toward advanced MR techniques for managing Crohn’s disease.

Advances in knowledge

Our study highlights a shift from fluoroscopy to MRE research in recent years. However, the plateau in MRE research underscores the need for innovative investigative approaches and novel research directions.

Graphical abstract

The prevalence of cancer continues to increase both in the United States and worldwide. Oncologic emergencies are potentially life-threatening conditions in cancer patients, and these may be directly or indirectly related to the underlying malignancy. Radiologists must be well-versed not only in cancer staging, but also in potential cancer related complications and emergencies to guide prompt appropriate management. Oncologic emergencies may occur due to direct local effects by the tumor or metastasis, associated systemic manifestations, or due to treatment related effects. These emergencies may sometimes be the first presentation of the underlying malignancy. The various gastrointestinal oncologic emergencies include airway-esophageal fistula, intestinal obstruction, intestinal ischemia, intestinal perforation, intussusception, inflammatory/infectious bowel changes, torsion, and tumor-related gastrointestinal bleeding. This review article aims to highlight the clinical and key imaging manifestations of oncologic emergencies along with implications for management, with a particular focus on the gastrointestinal system.

Objective

In nodule-negative primary aldosteronism (PA), quantitative CT findings in unilateral PA differed from those in bilateral PA. We attempted to identify PA by quantitative parameters of contrast-enhanced CT.

Methods

A retrospective search was performed for 81 patients with nodule-negative PA who underwent contrast-enhanced CT between January 2021 and November 2024 and adrenal vein sampling thereafter at XXXX. The test cohort and validation cohort were enrolled separately based on the PA type. The optimal cutoff value for identifying PA was analyzed and calculated in the test cohort, and its diagnostic performance was subsequently evaluated in the validation cohort.

Results

In the venous phase of the test cohort, the SD difference or ratio was significantly higher in unilateral-left PA than in bilateral PA [SD difference: 6.3 (4.4, 8.8) Hu vs. 2.5 (1.5, 4.4) Hu, P < 0.001; SD ratio: 1.2 (1.1, 1.3) vs. 1.1 (1.0, 1.1), P < 0.001]. At a cutoff value of 4.90 Hu, the sensitivity and specificity of the SD difference in predicting PA type were 0.733 and 0.957, respectively. The sensitivity and specificity of the SD ratio were 0.867 and 0.723 at a cutoff value of 1.130, respectively. In the validation cohort, the diagnostic performance of the SD difference in identifying PA type was similar to that of the SD ratio (0.801 vs. 0.917, P = 0.06).

Conclusion

Patients with nodule-negative PA can be further differentiated by bilateral adrenal heterogeneity on contrast-enhanced CT. The SD difference has similar predictive ability as the SD ratio.

Background and purpose

To appraise the inclusion of CEUS resection site evaluation in LI-RADS CEUS Nonradiation Treatment Response Assessment (TRA) v2024, currently applied for ablative therapy. We highlight the specific benefits afforded by CEUS in this effort.

Methods

Retrospective chart review was performed for 102 patients following surgical resection of HCC and ICC with post-operative CEUS at our center. Demographic data, surgical history, CT/MR findings, and resection site appearances on greyscale and CEUS were documented. The resection site where the tumor was originally positioned was designated as the treatment site and the resection margin as the perilesional tissue to establish equal assessment to TRA for ablative therapy. The morphology of the resection site was assigned one of three appearances, using novel descriptors: EDGE, VOID, or SURFACE DIVOT. Resection sites were evaluated for benign appearances, post-surgical changes, and tumor recurrence, and then categorized with a CEUS LI-RADS TRA score.

Results

102 patients had 120 resection sites following 115 operations for 94 HCC and 8 ICC. On CEUS, 59 (49%) were characterized as EDGE, 46 (38%) as VOID, and 15 (13%) as SURFACE DIVOT, n = 120. 23 (19%) of resection sites were LR-TR VIABLE for recurrence, 91 (76%) LR-TR NONVIABLE, and 6 (5%) EQUIVOCAL, n = 120. Benign post-surgical changes developed in 23 (19%) resection sites, n = 120. 63/115 surgeries (55%) had post-operative recurrence, 40 De Novo, 17 Perilesional, and 6 Intralesional.

Conclusion

Our conclusions are in two categories: the first assessing the success of CEUS in the assessment of post-surgical treatment sites following liver resections. CEUS can successfully distinguish between unique post-operative appearances such as benign tissue migration, resection VOIDs resembling an intrinsic mass, and true recurrence. CEUS is thus strongly recommended for secondary surveillance following HCC and ICC resection. The second conclusion evaluates the inclusion of resection sites into the CEUS LI-RADS TRA algorithm for ablative therapies. In this regard, we believe that our study was highly successful, improving the perspective of all our staff as to what is important in the assessment of the post-surgical liver on CEUS and the method whereby this information is communicated to our referring clinicians.

Graphical Abstract

Radical prostatectomy and radiation therapy, which are standard treatments for prostate cancer, are associated with various short- and long-term complications. Early post-prostatectomy complications include bleeding, vesicourethral anastomotic dehiscence, and anorectal injury, while late sequelae include urinary incontinence, anastomotic stenosis, urinary strictures and fistulas, osteomyelitis, and cancer recurrence. Radiation therapy can lead to bladder and bowel toxicity and, in rare cases, secondary malignancies. Imaging plays a crucial role in detecting and managing these complications. Multiphasic CT is preferred for detecting acute hemorrhage and urine leaks, while MRI is the modality of choice for evaluating urinary strictures, fistulas, and recurrent malignancies. Dynamic MR cystourethrography further enhances the assessment of urethral mobility and function, improves the detection of urinary fistula, and helps in surgical planning. MRI and PSMA PET imaging are key modalities for detecting post-treatment recurrence. As survival rates continue to improve for prostate cancer patients, the emphasis is shifting toward preserving quality of life and managing long-term treatment-related complications. In this review, we present a detailed overview of post-treatment surgical bed complications, emphasizing the role of various imaging modalities in the detection, characterization, and management of these complications.

Choledochal cysts are congenital anomalies of the bile ducts that are most often diagnosed in the pediatric population but are increasingly being detected in adults presenting with complications related to an underlying cyst burden and biliary malignancy. The Modified Todani Classification is commonly used to subdivide choledochal cysts into five groups based on anatomical locations and morphological characteristics. Magnetic resonance imaging (MRI) and magnetic resonance cholangiopancreatography (MRCP) demonstrate high diagnostic performance for choledochal malformations and early detection of cyst complications. MRI and MRCP are crucial for preoperative planning to delineate anatomy and exclude malignant transformation. This pictorial review will illustrate the spectrum of MR imaging for Todani classification of bile duct cysts and describe the various complications of choledochal cysts in adults.

Cystic lesions of the genitourinary (GU) tract in the pelvis represent a diverse group of entities that can be challenging to characterize due to overlapping anatomy and variable imaging appearances. While most lesions are benign, accurate identification is critical to guide appropriate clinical management and avoid misdiagnosis. This review presents a comprehensive, image-rich overview of cystic pelvic lesions, focusing on the anterior and middle compartments in both male and female patients. Imaging modalities such as ultrasound, CT, and MRI each provide distinct advantages depending on the clinical context and lesion characteristics. Key entities include bladder, urethral, and ureteral diverticula; urachal anomalies; prostatic utricle and Müllerian duct cysts; seminal vesicle and ejaculatory duct cysts; Gartner duct and Bartholin gland cysts; and infectious processes. Less common pathologies, such as lymphangiomas, benign cystic tumors, and mimics of cystic lesions, including bulking agents, hydrogel spacers, hernias, and cystic degeneration of solid tumors, are also addressed. This manuscript offers practical pearls and highlights potential pitfalls in the evaluation of cystic GU lesions. Familiarity with typical imaging features and potential mimics is essential to ensure diagnostic accuracy and improve patient outcomes.

Oncological imaging in the abdomen and pelvis can be complex. Several imaging pitfalls and mimics of oncology can create diagnostic uncertainty. A pitfall is a malignancy that is missed, either not visualized or misdiagnosed as a benign finding. A mimic is a benign entity that is misinterpreted as malignancy. This article will provide a case-based review with teaching tips to avoid various oncologic pitfalls and mimics in the abdomen and pelvis. The categories of pitfalls to be reviewed include spontaneous regression of primary malignancy, neoplasms resembling benign entities, eye-catching benign pathology with superimposed malignancy, false negative tumor markers, infiltrative malignancy, nuances with disease progression, and concomitant complications. The categories of mimics to be reviewed include benign neoplasms with aggressive growth pattern, benign entities with malignancy appearing enhancement patterns, infectious/inflammatory conditions, iatrogenic/foreign body reactions, and anatomic structures. Insight regarding certain pitfalls and mimics can help the radiologist improve diagnostic precision.

Purpose

To localize PSMA-avid lesions identified by PSMA PET-CT on separately performed prostate MRI and evaluate imaging findings on fused PET-CT/MRI.

Methods

Patients without prior history of clinically significant prostate cancer (csPCa: Gleason score [GS] 3 + 4 or higher) who had (1) PI-RADS 3 on prostate MRI between 2021 and 2023, (2) MRI/US fusion targeted biopsy for PI-RADS 3 lesion(s) and systemic biopsy, and (3) subsequent PSMA PET-CT were identified. PSMA PET-CT images were fused onto prostate MRI. PI-RADS 3 lesions were categorized by PRIMARY score. Discordant PSMA-avid lesions with PRIMARY scores 2–5 outside of PI-RADS 3 lesions were identified. Fisher’s exact test was used to compare the proportion of csPCa on targeted biopsy between PSMA-positive (PRIMARY score 3 or more) and PSMA-negative (PRIMARY score 1 or 2) PI-RADS 3 lesions. P < 0.05 was considered statistically significant.

Results

30 patients (mean age 67 years) with 38 PI-RADS 3 lesions were identified. 29 patients had csPCa, and one patient had GS 6. 22 PI-RADS 3 lesions were PSMA-positive (PRIMARY score 3 or more), of which 18 (81.8%) were csPCa on targeted biopsy; 16 PI-RADS 3 lesions were PSMA-negative, of which 4 (25.0%) were csPCa on targeted biopsy (p < 0.001). Sensitivity and specificity for the presence of csPCa on targeted biopsy was 81.8% and 75.0%. Out of 30 patients, 12 (40.0%) had 16 discordant PSMA-avid (PRIMARY score 2 or more) lesions and 10 patients had 10 discordant PSMA-positive lesions outside PI-RADS 3 lesions In 5 of those 12 (41.7%), discordant PSMA-avid lesions had higher PRIMARY score than PI-RADS 3 lesions. In 4 of those 5 (80%), systemic biopsy showed higher GS than targeted biopsy.

Conclusion

Lesion-level analysis showed PSMA-positive PI-RADS 3 lesions had higher probability of csPCa than PSMA-negative PI-RADS 3 lesions. Discordant PSMA-avid lesions with higher PRIMARY score than that of PI-RADS 3 lesions often represented another more aggressive focus not initially identified on MRI.

Purpose

To compare the clinical, MRI, and prognostic features of intrahepatic cholangiocarcinoma (ICCA) between patients with and without hepatitis B virus (HBV) infection.

Methods

We retrospectively analyzed 211 patients with ICCA who underwent preoperative MRI and curative-intent surgical resection between 2015 and 2018. Two radiologists independently reviewed MRI features. Clinicopathologic and MRI characteristics were compared according to HBV status. Recurrence-free survival (RFS) and overall survival (OS) were assessed using the Kaplan-Meier method and log-rank test. Recurrence rates were compared according to tumor site, and logistic regression analysis was used to identify independent predictors of intrahepatic recurrence.

Results

Among the 211 patients (mean age, 63.4 ± 10.5 years; 126 men), 81 (38.4%) were HBV-positive and 130 (61.6%) were HBV-negative. The purely mass-forming type of ICCA was more common in the HBV-positive group (91.4% vs. 76.9%; p = 0.007), whereas combined types were more frequent in the HBV-negative group. On MRI, peripheral tumor location was more frequent in the HBV-positive group (55.5% vs. 34.6%; p = 0.011), while bile duct invasion/dilatation (p < 0.001), secondary confluence involvement (p = 0.005), and periductal tumor infiltration (p = 0.030) were less common. Rim or non-rim arterial-phase enhancement (85.2% vs. 68.5%; p = 0.024) and radiologically-evident cirrhosis (19.8% vs. 8.5%; p = 0.017) were more frequent in HBV-positive patients. Although RFS and OS did not significantly differ between the groups (p ≥ 0.327), the intrahepatic recurrence rate was significantly higher in the HBV-positive group (37.0% vs. 23.1%; p = 0.029). HBV positivity was also identified as an independent predictor of intrahepatic recurrence (odds ratio, 1.93; p = 0.047).

Conclusion

HBV-associated ICCA demonstrates distinct MRI features and is associated with a higher rate of intrahepatic recurrence following curative resection.