Abdominal Radiology最新文献

Introduction: Up to 22% of pediatric patients with testicular torsion (TT) present initially with lower abdominal pain, which progresses to scrotal pain over time. Misdiagnosis can lead to testicular loss. This study examines the frequency of this presentation in adults and its clinical implications.

Materials and methods: We retrospectively analyzed 92 adult patients diagnosed with TT at our Emergency Departments (EDs). Clinical presentations, diagnostic procedures, and outcomes were reviewed, focusing on cases with abdominal pain as the initial symptom.

Results: Seven of 92 patients (6.44%) presented with abdominal pain alone. Testicular viability was preserved in three cases, highlighting the importance of early recognition, of those: two had early testicular pain (< 6 h) which prompted surgery; the third had TT discovered during urologic consultation requested because of recent history of testicular pain, even if no scrotal symptoms were present at that moment. In four cases, delayed diagnosis led to testicular necrosis. Three had late (> 7 h) development of testicular pain; the fourth had testicular pain at < 6 h but, a false negative US examination misinterpreted as epididymitis.

Conclusion: Although this study is retrospective and reconstructing the exact onset of symptoms is difficult and this may lead to potential bias; the study identifies abdominal pain as a rare but clinically significant first symptom of TT in adults. TT should be considered in differential diagnosis of all adults with lower abdominal pain and testes should be always assessed during physical examination of any male with such symptoms.

Background: Hepatocellular carcinoma (HCC) exhibits a high recurrence rate, and early recurrence significantly jeopardizes patient prognosis, necessitating reliable methods for early recurrence prediction.

Methods: Utilizing multi-institutional data and integrating deep learning (DL) techniques, we established a neural network based on DenseNet capable of concurrently processing patients' triphasic enhanced CT scans. By incorporating an attention mechanism, the model automatically focuses on regions that significantly impact patient survival. Performance metrics were first evaluated using the concordance index (C-index), calibration curves, and decision curves based on the training and validation cohorts. Finally, class activation map (CAM) techniques were employed to visualize the regions of interest identified by the model. After model construction, five-fold cross-validation was performed to assess overfitting risks and further evaluate model stability.

Results: We retrospectively collected data from 302 cases across five centers, including patients who underwent Partial Hepatectomy between December 2016 and December 2022. During model development, 180 patients from Institution I formed the training cohort, while the remaining patients comprised the validation cohort. The area under the ROC curve (AUC) for two-year outcomes was 0.797 in the validation cohort. Calibration curves, survival curves, and decision curve analysis (DCA) demonstrated the model's robust performance. CAMs revealed that the model primarily focuses on intra-abdominal solid organs, consistent with clinical experience. After model development, datasets were merged for cross-validation. The best model achieved a C-index of 0.774 in the validation cohort, with five-fold cross-validation yielding an average C-index of 0.778. The 95% confidence interval (CI) for the C-index, derived from cross-validation, ranged from 0.762 to 0.793.

Conclusion: Our DL-based enhanced CT network shows promise in predicting early recurrence in patients, representing a potential new strategy for early recurrence prediction in HCC.

Purpose: To investigate the etiology of spontaneous percutaneous nephrostomy (PCN) catheter dislodgements and evaluate factors potentially associated with these dislodgements, including muscle-to-fat composition and tissue characteristics of catheter traces.

Materials and methods: Data from 92 patients (63 males, 29 females; mean age 63.9 ± 11.4 years, range 28-88) undergoing 151 PCN catheter replacements between January 2016 and June 2021 were analyzed. Patients were divided into Group 1 (prophylactic replacements every 3 months, n = 41) and Group 2 (at least one spontaneous dislodgement, n = 51). Associations were evaluated for factors including intraabdominal visceral adipose tissue index (IAVATI), subcutaneous adipose tissue index (SATI), and abdominal perimeter. Other variables assessed were Eastern Cooperative Oncology Group (ECOG) performance status scores, psoas muscle index (PMI), renal size, renal parenchymal thickness, renal cortex-to-skin distance, posterolateral abdominal wall muscle thickness, and PCN replacement frequency.

Results: No significant differences were identified between Group 1 and Group 2 in IAVATI, SATI, or abdominal perimeter values (p = 0.210-0.412). A significant difference in ECOG performance status scores (p = 0.0001), PMI (p = 0.04) and lower renal size, renal parenchymal thickness, renal cortex-to-skin distance, and posterolateral abdominal muscle thickness (p = 0.0001-0.039) were observed in Group 2. PCN replacements were significantly more frequent in Group 2 (p = 0.0001). Multivariate regression identified renal parenchymal thickness and abdominal wall muscle thickness as significant independent predictors (p = 0.0001, p = 0.02). ROC analysis yielded an AUC of 0.843 (95% CI: 0.769-0.917) for renal parenchymal thickness and 0.694 (95% CI: 0.610-0.778) for abdominal wall muscle thickness. Sensitivity and specificity rates were 73.1% and 96.4% for a 16 mm cutoff in renal parenchymal thickness, and 50.7% and 79.8% for an 8 mm cutoff in abdominal wall muscle thickness.

Conclusion: A significant association was identified between spontaneous PCN catheter dislodgement and both the psoas muscle index and ECOG performance status scores, while no notable relationship was observed with abdominal visceral or subcutaneous fat tissue volumes or abdominal perimeter. The risk of dislodgement was found to increase with reduced renal parenchymal and abdominal wall muscle thickness, as well as with more frequent nephrostomy replacements, suggesting these parameters may serve as useful markers for identifying patients at higher risk.

Purpose: To assess the value of secondary lesion-targeted biopsy (SLx) in detecting prostate cancer (PCa) among patients with multifocal disease.

Methods: A total of 298 biopsy-naïve patients with 612 lesions (all with Prostate Imaging Reporting and Data System [PI-RADS] v2.1 ≥ 3) underwent cognitive fusion-targeted biopsy (TB) combined with systematic biopsy (SB). Our primary endpoints were to compare the detection rates of PCa and clinically significant PCa (csPCa) across different biopsy strategies (Index lesion-targeted biopsy [ILx] vs. ILx + SLx and ILx + SB vs. ILx + SLx + SB) and to define potential indications for SLx using PI-RADS and PSA density (PSAD). Secondary endpoint was to evaluate the predictive performance of index lesion (IL)- and SL-based multivariate logistic regression (MVA) models for csPCa.

Results: The overall detection rates for PCa and csPCa were 71% and 60%, with ILx + SLx + SB as the gold standard. Adding SLx to ILx modestly increased detection rates for PCa (63% vs. 65%, P = 0.016) and csPCa (55% vs. 58%, P = 0.004), but offered no significant advantage over ILx + SB. Stratification by PI-RADS and PSAD revealed that focusing on 80% intermediate- to high-risk lesions detected 39% csPCa while reducing 20% low-risk SLx at the cost of missing 1.6% csPCa. IL-based models outperformed SL-based models in predicting csPCa (Hosmer-Lemeshow P = 0.653 vs. 0.461).

Conclusion: SLx provides limited benefit in csPCa detection when ILx and SB have already been performed. Combining PI-RADS scores and PSAD helps identify patients who could benefit from SLx while avoiding unnecessary procedures in low-risk cases.

Clinical trial registration: No. 2016 - 1252, January 2017.

The duodenum, the initial segment of the small intestine, is divided into four parts: the superior (D1), descending (second) (D2), horizontal (D3), and ascending (D4) segments. Despite its short length, the descending part (D2 segment) holds clinical significance due to its anatomical proximity to structures such as the gallbladder, right kidney, colon, and pancreas. This anatomical localization and contiguity give rise to various pathologies, including congenital, inflammatory, infectious, neoplastic, vascular, and traumatic conditions. Cross-sectional imaging modalities play a pivotal role in evaluating pathologies of the second (D2) segment of the duodenum. This article aims to provide a comprehensive overview of these pathologies and delineate their imaging characteristics.

Littre hernia is an inguinal or abdominal wall herniation that contains a Meckel's diverticulum alone or with other intestinal loops. The diagnosis is usually made at surgery, but its pre-operative radiological recognition has been a challenge due to inherent difficulties in detecting the Meckel's diverticulum within hernial content. The aim of this article is to present 8 adults in whom a Meckel's diverticulum protruding into their inguinal, umbilical or incisional hernia had been demonstrated by barium examination of the small bowel or colon, or on computed tomography and magnetic resonance imaging of the abdomen and pelvis. This series included 7 men and 1 woman, who ranged in age from 34 to 78 years (mean age:57 years). Seven patients had subsequent hernia repair, when the diverticulum was visualized and resected. This report highlights the imaging features of these 8 Littre hernias since only 5% of published cases had been diagnosed pre-operatively because the Meckel's diverticulum had resulted in complications. It also reviews the pertinent literature regarding the prevalence and clinical implications of this rare entity.

Objectives: To develop and validate a clinicoradiological model integrating clinical and computed tomography (CT) features to preoperative predict histological classification in patients with epithelial ovarian cancers (EOCs).

Methods: This retrospective study included 470 patients who were pathologically proven EOCs and performed by contrast enhanced CT before treatment from center I (training cohort, N = 329; internal test cohort, N = 141) and 83 EOC patients who were included as an external test cohort from center II. The univariate analysis and multivariate logistic regression analysis were used to select significant clinical and CT features. The significant clinical model was developed based on clinical characteristics. The significant radiological model was established by CT features. The significant clinical and CT features were used to construct the clinicoradiological model. Model performances were evaluated using the area under the receiver operating characteristic curve (AUC), calibration curve, the Brier score and decision curve analysis (DCA). The AUCs were compared by net reclassification index (NRI) and integrated discrimination improvement (IDI).

Results: The significant clinical and CT parameters including age, transverse diameter, morphology, margin, ascites and lymphadenopathy were incorporated to build the clinicoradioligical model. The clinicoradiological model showed relatively satisfactory discrimination between type I and type II EOCs with the AUC of 0.841 (95% confidence interval [CI] 0.797-0.886), 0.874 (95% CI 0.811-0.937) and 0.826 (95% CI 0.729-0.923) in the training, internal and external test cohorts, respectively. The NRI and IDI showed the clinicoradiological model significantly performed than those of the clinical model (all P < 0.05). No statistical significance was found between radiological and clinicoradiological model. The clinicoradiological model demonstrated optimal classification accuracy and clinical application value.

Conclusion: The easily accessible nomogram based on the clinicoradiologic model showed favorable performance in distinguishing between type I and type II EOCs and could therefore be used to improve the clinical management of EOC patients.

Spontaneous abdominal hemorrhage (SAH) refers to acute intra-abdominal or pelvic hemorrhages occurring from non-traumatic or non-iatrogenic causes. Early recognition of SAH with prompt surgical or interventional management is necessary to prevent morbidity and mortality. The initial clinical presentations are often misleading, and the diagnosis is generally made based on radiological imaging. In this article, we discuss the anatomy of abdominal and pelvic compartments, etiology/pathogenesis, and characteristic imaging findings of spontaneous hemorrhage in each of these compartments, thus aiding the radiologist to make a prompt diagnosis, to direct clinical management and facilitate patient care.

Purpose: To evaluate the efficacy of a simple method based on qualitative MRI features for characterizing clear cell renal cell carcinoma (ccRCC) in small renal masses (SRMs).

Materials and methods: This retrospective multicenter study included pathologically confirmed SRM patients who underwent multiparametric MRI between March 2017 and November 2023 at three institutions. Univariable logistic regression and Fleiss κ coefficient were employed to determine features with significant diagnostic value and high consistency for ccRCC. A simple method was developed based on the selected features using multivariable logistic regression. The performance of the method was compared with the clear cell likelihood score (ccLS) using DeLong test and McNemar test.

Results: A total of 200 SRMs from 194 patients (116 men; median age: 54 years) were included. Intense corticomedullary enhancement, microscopic fat, and pseudocapsule were selected to construct the simple method, which considered a mass to be ccRCC if any two of the aforementioned three signs were present. Compared with ccLS, our method demonstrated similar sensitivity (0.824 versus 0.725, P = 0.227) and specificity (0.840 versus 0.860, P > 0.999). The AUC for the simple method and ccLS was 0.832 (95% CI 0.744, 0.899) and 0.793 (95% CI 0.701, 0.867), respectively (P = 0.864). For ccRCC cases assigned a score of 1 to 3 by the ccLS, 57.1% (8/14) were diagnosed correctly by the simple method.

Conclusion: The simple method can accurately characterize ccRCC in SRM with comparable efficacy to ccLS. Atypical ccRCC scored 1 to 3 by ccLS may benefit from the method.

Purpose: This study aims to evaluate the advantages of administering 200 ml of 5% dextrose water in improving pre-examination training efficiency, examination efficiency, success rate, and image quality of MRI scans in patients with gastric cancer.

Method: This study included 122 gastric cancer patients who underwent upper abdominal MRI from March 2022 to March 2024. These patients were divided into two groups: a study group of which patients had 200 ml of 5% dextrose water before MRI scan (n = 59) and a control group with only routine preparations (n = 63). Group differences in the pre-examination training efficiency, examination efficiency, examination success rate and image quality of MRI scan were performed using chi-square test and T-test.

Results: We found there were statistically significant group differences in the success rate of MRI examination (96.6% in the study group and 85.7% in the control group, P = 0.036), the average time of pre-examination training before MRI examination (7.73 ± 6.35 min in the study group and 12.03 ± 5.39 min in the control group, P = 0.001), the average completion time of MRI examination (45.22 ± 5.85 min in the study group and 50.25 ± 8.45 min in the control group, P = 0.001), the rate of excellent image quality (66.1% in the study group and 44.4% in the control group, P = 0.038), the scores of image quality (3.92 ± 0.96 in the study group and 3.13 ± 1.33 in the control group, P = 0.0006).

Conclusion: Our findings demonstrated that administering 200 ml of 5% glucose water before MRI examination in gastric cancer patients improved the pre-examination training efficiency, the efficiency and success rate of MRI examination and image quality, highlighting its potential to optimize the patient care in radiological examinations.