Abdominal Radiology最新文献

Objective

Primary liver carcinosarcoma (CS) and sarcomatoid carcinoma (SC) are rare malignant tumors of the liver. Although the two tumors often overlap in clinical and imaging manifestations, there are currently no reports comparing the imaging features of these two tumors. Our study aims to compare the clinical characteristics and imaging features of these two tumors to further describe their distinct features, thereby enhancing understanding and diagnostic accuracy.

Methods

A retrospective analysis was conducted on the clinical and imaging data of 17 patients with CS and 27 patients with SC diagnosed by surgical or needle biopsy between September 2010 and December 2024 at our hospital. The data were summarized and statistically analyzed.

Results

Both groups were predominantly male, with a lower mean age (56.65 ± 11.82) in the CS group compared to the SC group (64.93 ± 8.15) (P = 0.01). Compared to the SC group, the CS group more commonly presented with hepatitis B, cirrhosis, and elevated AFP levels. Both groups were more commonly located in the right hepatic lobe, with larger tumors that were often solitary, irregularly shaped, and lobulated. Most tumors exhibited necrosis and hemorrhage. Calcification was observed in two cases in the CS group on CT scans. The tumor margins were predominantly indistinct, and the majority of tumors did not show a capsule. Approximately half of the patients in the SC group had lymph node involvement, which was significantly higher than in the CS group (P = 0.023). After contrast enhancement, all cases in both groups showed heterogeneous enhancement in the arterial phase. Regarding enhancement distribution, the CS group more commonly exhibited enhancement at the margins and in the solid components, while most cases in the SC group showed enhancement at the margins and in the septa. In terms of dynamic enhancement patterns, the CS group more commonly exhibited partial or complete regression in the delayed phase, while the SC group more commonly exhibited progressive or persistent enhancement in the delayed phase, with statistical significance (P = 0.042).

Conclusion

Patients in the SC group had significantly higher age and lymph node involvement than those in the CS group. In terms of tumor enhancement patterns, the CS group primarily exhibited delayed-phase regression or partial regression, while the SC group primarily exhibited delayed-phase persistent or progressive enhancement.

Purpose

This study evaluates the diagnostic performance of quantitative diffusion-weighted imaging (DWI), including both conventional and intravoxel incoherent motion (IVIM)-derived parameters, in differentiating hepatocellular carcinoma (HCC) from intrahepatic cholangiocarcinoma (ICC).

Method

A systematic review and meta-analysis were conducted following a pre-registered protocol (https://osf.io/9yhrg). Relevant studies were identified through PubMed, Web of Science, Cochrane Library, and Embase up to March 8, 2025. Quantitative DWI parameters, including apparent diffusion coefficient (ADC), pure diffusion coefficient (D), pseudo-diffusion coefficient (pseudo-D), and perfusion fraction (f), were compared between HCC and ICC using a random-effects model. Sensitivity analysis and publication bias tests were performed.

Results

Twenty-one studies encompassing 1109 HCC and 838 ICC lesions were included. Pooled ADC values did not differ significantly between HCC (1.10, 95% CI = 1.03 to 1.17) and ICC (1.16, 95% CI = 1.06 to 1.25) groups (p = 0.156). In contrast, D showed significant differentiation between HCC (0.89, 95% CI = 0.77 to 1.02) and ICC (1.04, 95% CI = 0.93 to 1.16), with p < 0.001. Moreover, the pseudo-D parameter demonstrated comparable values in ICC (53.3; 95% CI, 22.47–84.13) and HCC (49.35; 95% CI, 23.28–75.41) lesions (p = 0.912). Finally, the f parameter revealed significantly (p = 0.022) lower values for ICC (19.21, 95% CI = 12.98 to 25.44) compared to HCC (23.78, 95% CI = 14.76 to 32.8). For each parameter, we calculated pooled mean differences, standardized mean differences, percentage differences, sensitivity, specificity, and area under the curve.

Conclusion

While ADC retains clinical utility due to widespread availability, this meta-analysis establishes D as a superior biomarker over ADC for distinguishing ICC from HCC focal liver lesions. These findings support the integration of non-Gaussian DWI techniques in clinical practice for improved tumor characterization.

Percutaneous image-guided interventions are minimally invasive alternatives to surgery for diagnosis and management of various abdominal disease processes. However, persistent misconceptions about these procedures continue to hinder their appropriate use. This review addresses common myths that can lead to unnecessary treatment delays or use of more invasive interventions, including concerns about the safety of splenic biopsy, rigid contraindications for antiplatelet medication use, bleeding risks with direct liver mass puncture, tumor seeding from renal biopsies, complications from multiple liver biopsy passes, and increased risk of liver biopsy in the setting of ascites. By clarifying these issues, this article aims to promote evidence-based use of percutaneous procedures.

Stress urinary incontinence (SUI) is a common condition characterized by involuntary urine leakage during physical exertion, affecting up to 50% of women over 40 years of age globally and significantly impacting their quality of life. Treatment options include both nonsurgical and surgical approaches, with synthetic midurethral slings being the most widely used surgical technique. While clinical history, physical examination, and urodynamic studies remain the cornerstone of SUI evaluation, ultrasound has gained increasing prominence as a complementary imaging modality. It is cost-effective and provides real-time assessment of both anatomical and functional aspects of the lower urinary tract. Notably, ultrasound also enables detailed evaluation of sling positioning and function, as well as identification and management of postoperative complications. This article aims to review the role of ultrasound in assessing synthetic slings, encompassing both preoperative planning and postoperative follow-up.

Purpose

This prospective study aimed to compare the diagnostic accuracy of hepatic lesions between contrast-enhanced computed tomography (CE-CT) and gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid-enhanced magnetic resonance imaging (Gd-EOB-MRI). We also examined the final diagnosis of equivocal lesions.

Methods

In each patient undergoing hepatectomy for liver tumors, 2 radiologists (readers A and B) assessed CE-CT and Gd-EOB-MRI. Hepatic lesions were scored as 1, 2, 3, 4, or 5, which corresponded to categorization as benign, probably benign, equivocal, probably malignant, or malignant, respectively. Those scored as 1/2 and 4/5 were defined as benign and malignant, respectively. The lesions left unresected were confirmed as benign when they remained unchanged for ≥ 1 year after hepatectomy. The false-positive rate was defined as the number of lesions finally confirmed as benign among those assessed as malignant preoperatively.

Results

Among 105 enrolled patients (colorectal liver metastases, 72; hepatocellular carcinoma, 29; other, 4), 886 lesions were recognized on either CT or MRI preoperatively; another 26 lesions were identified only on intraoperative ultrasonography or pathologic examination. The sensitivity of malignant lesion detection was significantly higher for Gd-EOB-MRI than CE-CT for both reader A (90.3% vs. 68.3%; P < 0.001) and reader B (88.1% vs. 70.2%; P < 0.001). The false-positive rate with CE-CT and Gd-EOB-MRI was 2.3% and 3.7%, respectively, for reader A (P = 0.580), and 0.5% and 4.2%, respectively, for reader B (P = 0.033). There were 142 lesions judged as equivocal in at least one of the imaging studies by either reader. Sixty-eight lesions (49%) were recognized as malignant by any of the alternative assessments; among these, 61were confirmed as malignant.

Conclusion

Gd-EOB-MRI was superior to CE-CT for detecting liver lesions. The false-positive rate was low for both modalities. Equivocal lesions were encountered frequently, but routine use of alternate modalities and evaluation by 2 or more radiologists could enhance the accuracy of diagnosis.

Abdominal compartment syndrome (ACS) is a life-threatening condition characterized by sustained increased intra-abdominal pressure (IAP) greater than 20 mmHg leading to organ dysfunction. Although intraabdominal pressure measurements, usually with an intravesical catheter, remains the diagnostic gold standard, ACS is frequently underdiagnosed due to its nonspecific clinical presentation and overlap with other critical illnesses. This review provides an overview of the pathophysiology, clinical features and imaging findings of ACS and emphasizes the importance of raising this diagnosis of ACS on CT scans performed on ill patients.

Objective

The Node-RADS score was proposed and provided a standardized, comprehensive assessment of lymph nodes (LNs), accounting for both size and configuration criteria. This study aimed to evaluate the diagnostic performance of the Node-RADS in LN metastasis of ovarian cancer (OC).

Methods

From December 2018 to April 2023, 81 OC patients who underwent MRI and debulking surgery were included. The likelihood of LN metastasis was assessed by the Node-RADS with MRI. The chi-square test and Fisher’s exact test were used to assess the differences in size and configuration between LNs with and without metastasis. The diagnostic performance of Node-RADS and its different criteria for LN metastasis was assessed with receiver operating characteristic (ROC) and area under the curve (AUC).

Results

Among all Node-RADS evaluation criteria, textural changes had the best performance with a sensitivity of 84.6%, a specificity of 78.7%, and a Youden’s index of 0.63. At the LN level, the incidence of LN metastasis with Node-RADS scores 1, 2, 3, 4, and 5 was 3.2%, 4.5%, 13.0%, 85.7%, and 86.7%, respectively. The best performance in assessing LN status was observed at Node-RADS scores > 3, with sensitivity, specificity, and Youden’s index of 73.1%, 97.8%, and 0.71, respectively. In addition, at the patient and LN levels, the AUC for Node-RADS assessment of LNs was 0.869 and 0.895, respectively.

Conclusion

Node-RADS could be an appropriate choice for structured reporting of LN metastasis in OC. The diagnostic performance of LN metastasis in OC at a Node-RADS score > 3 was satisfactory.

LR-M is a category within the Liver Imaging Reporting and Data System (LI-RADS) that refers to liver observations that are probably or definitely malignant but are not specific to hepatocellular carcinoma (HCC). It includes etiologies such as atypical HCC, intrahepatic cholangiocarcinoma, combined hepatocellular cholangiocarcinoma and metastases. The primary aim of LR-M is to ensure a high sensitivity for detecting all hepatic malignancies while preserving a high specificity for HCC in LR-5. The imaging criteria for LR-M encompass a variety of targetoid and non-targetoid features. LR-M is often less well understood by end-users compared to more prominent categories such as LR-4 and LR-5, which have garnered greater attention and familiarity. In this review written from an end-user perspective, we examine the critical role that LR-M plays within LI-RADS for CT/MRI, the prevalence of HCC and non-HCC malignancies in LR-M, and demonstrate how LR-M can impact prognosis and treatment outcomes. We discuss the current imaging criteria for LR-M and the challenges faced by end-users in LI-RADS v2018 for CT/MRI. Finally, we explore future directions for improving the application of LR-M in clinical practice.

Objective

To investigate the clinical value of a nomogram integrating placental MR radiomics features, MR sign scores, and clinical indicators for prenatal diagnosis of placenta accreta spectrum disorders (PAS) and risk assessment of adverse clinical outcomes.

Methods

This retrospective study analyzed clinical and imaging data from 167 pregnant women (89 PAS cases, 78 non-PAS) randomly allocated into training (n = 119) and validation (n = 48) sets. Subjective MR signs were evaluated to establish an MR scoring system. Radiomics features were extracted from two sequences. The least absolute shrinkage and selection operator (LASSO) algorithm selected features to construct a radiomics model, generating a radiomics score (Radscore). Multivariate logistic regression combined clinical indicators, MR scores, and Radscore to develop joint prediction models. Model performance was assessed using ROC curves, bootstrap validation, and decision curve analysis. The optimal model was visualized as a nomogram (Nomoscore), which was further evaluated for PAS subtype differentiation and adverse outcome prediction.

Results

Among all models, the combined model incorporating induced abortion number, MR scores, and Radscore demonstrated superior diagnostic performance, achieving AUCs of 0.857 (95% CI: 0.792 ~ 0.922) and 0.848 (95% CI: 0.74 ~ 0.956) in the training and validation sets, respectively. At a threshold > 0.452, this outperformed standalone models (MR score, clinical model, clinical-MR score model, radiomics model; Z values were 2.764, 3.218, 2.470, 2.213, all p < 0.05). The nomogram effectively differentiated placenta accreta (PA) from placenta increta (PI) (AUC = 0.837, 95% CI: 0.769 ~ 0.905) and PI from placenta percreta (PP) (AUC = 0.879, 95% CI: 0.807 ~ 0.951), while predicting adverse outcomes with an AUC of 0.822 (95% CI: 0.753 ~ 0.891) at optimal thresholds (> 0.628, > 0.966, and > 0.710, respectively). Decision curve analysis confirmed higher clinical net benefit compared to alternative models.

Conclusion

The nomogram integrating MR radiomics, MR signs, and induced abortion number offers potential clinical utility for prenatal PAS diagnosis, subtype classification, and risk stratification of adverse outcomes.

Background

Fully automated AI-based algorithms can quantify adipose tissue on abdominal CT images. The aim of this study was to investigate the clinical value of these biomarkers by determining the association between adipose tissue measures and all-cause mortality.

Methods

This retrospective study included 151,141 patients who underwent abdominal CT for any reason between 2000 and 2021. A validated AI-based algorithm quantified subcutaneous (SAT) and visceral (VAT) adipose tissue cross-sectional area. A visceral-to-subcutaneous adipose tissue area ratio (VSR) was calculated. Clinical data (age at the time of CT, sex, date of death, date of last contact) was obtained from a database search of the electronic health record. Hazard ratios (HR) and Kaplan–Meier curves assessed the relationship between adipose tissue measures and mortality. The endpoint of interest was all-cause mortality, with additional subgroup analysis including age and gender.

Results

138,169 patients were included in the final analysis. Higher VSR was associated with increased mortality; this association was strongest in younger women (highest compared to lowest risk quartile HR 3.32 in 18-39y). Lower SAT was associated with increased mortality regardless of sex or age group (HR up to 1.63 in 18-39y). Higher VAT was associated with increased mortality in younger age groups, with the trend weakening and reversing with age; this association was stronger in women.

Conclusion

AI-based CT measures of SAT, VAT, and VSR are predictive of mortality, with VSR being the highest performing fat area biomarker overall. These metrics tended to perform better for women and younger patients. Incorporating AI tools can augment patient assessment and management, improving outcome.