Acute Ileal Diverticulitis: Computed Tomography and Ultrasound Findings.

BACKGROUND: Acute ileal diverticulitis is a rare disease mimicking acute appendicitis. Inaccurate diagnosis with a low prevalence and nonspecific symptoms leads to delayed or improper management. METHODS: This retrospective study aimed to investigate the characteristic sonographic (US) and computed tomography (CT) findings with clinical features in seventeen patients with acute ileal diverticulitis diagnosed between March 2002 and August 2017. RESULTS: The most common symptom was abdominal pain (82.3%, 14/17) localized to the right lower quadrant (RLQ) in 14 patients. The characteristic CT findings of acute ileal diverticulitis were ileal wall thickening (100%, 17/17), identification of inflamed diverticulum at the mesenteric side (94.1%, 16/17), and surrounding mesenteric fat infiltration (100%, 17/17). The typical US findings were outpouching diverticular sac connecting to the ileum (100%, 17/17), peridiverticular inflamed fat (100%, 17/17), ileal wall thickening with preserved layering pattern (94.1%, 16/17), and increased color flow to the diverticulum and surrounding inflamed fat on color Doppler imaging (100%, 17/17). The perforation group had a significantly longer hospital stay than non-perforation group (p = 0.002). In conclusion, acute ileal diverticulitis has characteristic CT and US findings that allow radiologists to accurately diagnose the disease.

Comparison between Two-Dimensional and Point Shear Wave Elastography Techniques in Evaluating Liver Fibrosis Using Histological Staging as the Reference Standard: A Prospective Pilot Study.

Evaluation of hepatic fibrosis is essential to prevent liver-related morbidity and mortality. Although various types of ultrasound shear wave elastography (SWE) have been used and validated, there are limited studies on the relatively newer technique, two-dimensional SWE (2D-SWE). Therefore, this study aimed to compare the diagnostic performances of 2D-SWE and point SWE (p-SWE) for evaluating liver fibrosis using histology as the reference standard. To measure liver stiffness (LS) values, 87 patients underwent 2D-SWE and p-SWE using the same machine. Technical failures and unreliable measurements were also evaluated. The diagnostic performances of 2D-SWE and p-SWE were compared using area under the receiver operating characteristic (AUROC) curve analysis. No technical failures were observed in either method; however, unreliable measurements were less frequent in 2D-SWE (1/87 [1.1%]) than in p-SWE (8/87 [9.2%]) (p < 0.001). The AUROC of the LS values of 2D-SWE were significantly higher than those of p-SWE for diagnosing significant fibrosis (0.965 vs. 0.872, p = 0.022) and cirrhosis (0.994 vs. 0.886, p = 0.042). In conclusion, 2D-SWE is more reliable and accurate than p-SWE for diagnosing hepatic fibrosis.

How many times should we repeat measurements of the ultrasound-guided attenuation parameter for evaluating hepatic steatosis?

PURPOSE: This retrospective study aimed to determine the number of times the ultrasound-guided attenuation parameter (UGAP) should be measured during the evaluation of hepatic steatosis. METHODS: Patients with suspected nonalcoholic fatty liver disease who underwent two UGAP repetition protocols (six-repetition [UGAP_6] and 12-repetition [UGAP_12]) and measurement of the controlled attenuation parameter (CAP) using transient elastography between October 2020 and June 2021 were enrolled. The mean attenuation coefficient (AC), interquartile range (IQR)/median, and coefficient of variance (CV) of the two repetition protocols were compared using the paired t test. Moreover, the diagnostic performances of UGAP_6 and UGAP_12 were compared using the area under the receiver operating characteristic (AUROC) curve, considering the CAP value as a reference standard. RESULTS: The study included 160 patients (100 men; mean age, 50.9 years). There were no significant differences between UGAP_6 and UGAP_12 (0.731±0.116 dB/cm/MHz vs. 0.734±0.113 dB/cm/MHz, P=0.156) and mean CV (7.6±0.3% vs. 8.0±0.3%, P=0.062). However, the mean IQR/median of UGAP_6 was significantly lower than that of UGAP_12 (8.9%±6.0% vs. 9.8%±5.2%, P=0.012). In diagnosing the hepatic steatosis stage, UGAP_6 and UGAP_12 yielded comparable AUROCs (≥S1, 0.908 vs. 0.897, P=0.466; ≥S2, 0.883 vs. 0.897, P=0.126; S3, 0.832 vs. 0.834, P=0.799). CONCLUSION: UGAP had high diagnostic performance in diagnosing hepatic steatosis, regardless of the number of repetitions (six repetitions vs. 12 repetitions), with maintained reliability. Therefore, six UGAP measurements seem sufficient for evaluating hepatic steatosis using UGAP.

Diagnostic Performance of 2-D Shear Wave Elastography on the Evaluation of Hepatic Fibrosis with Emphasis on Impact of the Different Region-of-Interest Methods.

The purpose of this study was to evaluate the impact of the different region-of-interest (ROI) methods of 2-D shear wave elastography (2-D SWE) on hepatic fibrosis diagnosis. In this retrospective study, 83 patients who underwent 2-D SWE with three ROI methods (a circle ROI, a box ROI and multiple ROIs in an elastogram) and transient elastography (TE) were included. Liver stiffness (LS) was measured five times with each ROI method. These LS values were compared, and their correlation with those obtained from TE was evaluated. The LS values obtained using the three different ROI methods differed statistically (p < 0.001). However, the LS values obtained using each ROI method of 2-D SWE were highly correlated with those obtained using TE (r > 0.7, p < 0.001). All three ROI methods of 2-D SWE had high areas under the receiver operating characteristic curve in diagnosing significant fibrosis and cirrhosis (0.841, 0.820 and 0.840, respectively; 0.962, 0.946 and 0.945, respectively). There were no significant differences in area under the receiver operating characteristic curve among the ROI methods of 2-D SWE. Regardless of the ROI method, 2-D SWE had high performance in diagnosing hepatic fibrosis.

Unusual, but important, peri- and extra-articular manifestations of rheumatoid arthritis: a pictorial essay.

Ultrasonography is a useful technique to detect soft tissue changes of rheumatoid arthritisnot only synovitis, but also tenosynovitis, bursitis, and enthesitis-even at a subclinical stage. However, radiologists tend to focus on synovitis in daily practice, and unusual peri- or extraarticular manifestations of rheumatoid arthritis are difficult to detect at the initial presentation. This pictorial essay describes a broad spectrum of ultrasonographic findings in tendons, bursae, ligaments, subcutaneous tissues, bones, and nerves to assist in the accurate diagnosis of rheumatoid arthritis.

Non-Pathological Opacification of the Cavernous Sinus on Brain CT Angiography: Comparison with Flow-Related Signal Intensity on Time-of-Flight MR Angiography.

Purpose: To investigate the non-pathological opacification of the cavernous sinus (CS) on brain computed tomography angiography (CTA) and compare it with flow-related signal intensity (FRSI) on time-of-flight magnetic resonance angiography (TOF-MRA). Methods: Opacification of the CS was observed in 355 participants who underwent CTA and an additional 77 participants who underwent examination with three diagnostic modalities: CTA, TOF-MRA, and digital subtraction angiography (DSA). Opacification of the CS, superior petrosal sinus (SPS), inferior petrosal sinus (IPS), and pterygoid plexus (PP) were also analyzed using a five-point scale. The Wilcoxon test was used to determine the frequencies of the findings on each side. Additionally, the findings on CTA images were compared with those on TOF-MRA images in an additional 77 participants without dural arteriovenous fistula (DAVF) using weighted kappa (κ) statistics. Results: Neuroradiologists identified non-pathological opacification of the CS (n = 100, 28.2%) on brain CTA in 355 participants. Asymmetry of opacification in the CS was significantly correlated with the grade difference between the right and left CS, SPS, IPS, and PP (p < 0.0001 for CS, p < 0.0001 for SPS, p < 0.0001 for IPS, and p < 0.05 for PP). Asymmetry of the opacification and FRSI in the CS was observed in 77 participants (CTA: n = 21, 27.3%; TOF-MRA: n = 22, 28.6%). However, there was almost no agreement between CTA and TOF-MRA (κ = 0.10, 95% confidence interval: -0.12-0.32). Conclusion: Asymmetry of non-pathological opacification and FRSI in the CS may be seen to some extent on CTA and TOF-MRA due to anatomical variance. However, it shows minimal reliable association with the FRSI on TOF-MRA.

Impact of respiratory motion on liver stiffness measurements according to different shear wave elastography techniques and region of interest methods: a phantom study.

PURPOSE: This study quantified the impact of respiratory motion on liver stiffness measurements according to different shear wave elastography (SWE) techniques and region of interest (ROI) methods, using liver fibrosis phantoms. METHODS: Three operators measured stiffness values in four phantoms with different stiffness on a moving platform with two SWE techniques (point-SWE [pSWE] and 2-dimensional SWE [2D-SWE]), three types of motion (static mode and moving mode at low and high speeds), and four ROI methods in 2D-SWE (circle, point, box, and multiple). The circular ROI method was used to compare the two SWE techniques. The occurrence of technical failure and unreliable measurements, stiffness values, and measurement time were evaluated. RESULTS: Technical failure was observed only in moving mode for pSWE and 2D-SWE (n=1 for both). Unreliable measurements were also only observed in moving mode and were significantly less common in 2D-SWE (n=1) than in pSWE (n=12) (P<0.001). No statistically significant differences in the technical failure rate or stiffness values were noted between the static and moving modes for both SWE techniques. The technical failure and unreliable measurement rates were not significantly different among the ROI methods for 2D-SWE. Stiffness values did not differ significantly according to the ROI method used in any moving mode. However, the multiple ROI method had significantly shorter measurement times than the circular ROI method for all moving modes. CONCLUSION: 2D-SWE may be preferable for evaluating liver fibrosis in patients with poor breath-hold. Furthermore, 2D-SWE with multiple ROIs enables rapid measurements, without affecting liver stiffness values.

Determination of optimum pixel size and slice thickness for tractography and ulnar nerve diffusion tensor imaging at the cubital tunnel using 3T MRI.

BACKGROUND: Small peripheral nerve tractography is challenging because of the trade-off among resolution, image acquisition time, and signal-to-noise ratio. PURPOSE: To optimize pixel size and slice thickness parameters for fiber tractography and diffusion tensor imaging (DTI) of the ulnar nerve at the cubital tunnel using 3T magnetic resonance imaging (MRI). MATERIAL AND METHODS: Fifteen healthy volunteers (mean age 30 ± 6.8 years) were recruited prospectively. Axial T2-weighted and DTI scans were acquired, covering the cubital tunnel, using different pixel sizes and slice thicknesses. Three-dimensional (3D) nerve tractography was evaluated for the median number and length of the reconstructed fiber tracts and visual score from 0 to 5. Two-dimensional (2D) cross-sectional DTI was evaluated for fractional anisotropy (FA) values throughout the length of the ulnar nerve. RESULTS: A pixel size of 1.3 mm2 revealed the highest number of reconstructed nerve fibers compared to that of 1.1 mm2 (P = 0.048), with a good visual score. A slice thickness of 4 mm had the highest number of reconstructed nerve fibers and visual score compared with other thicknesses (all P < 0.05). In 2D cross-sectional images, the median FA values were in the range of 0.40-0.63 at the proximal, central, and distal portions of the cubital tunnel. Inter-observer agreement for all parameters was good to excellent. CONCLUSION: For fiber tractography and DTI of the ulnar nerve at the cubital tunnel, optimal image quality was obtained using a 1.3-mm2 pixel size and 4-mm slice thickness under MR parameters of this study at 3T.

Comparison of point and 2-dimensional shear wave elastography for the evaluation of liver fibrosis.

PURPOSE: This study aimed to assess the technical performance of ElastQ Imaging compared with ElastPQ and to investigate the correlation between liver stiffness (LS) values obtained using these two techniques. METHODS: This retrospective study included 249 patients who underwent LS measurements using both ElastPQ and ElastQ Imaging equipped on the same machine. The applicability, repeatability (coefficient of variation [CV]), acquisition time, and LS values were compared using the chi-square or Wilcoxon signed-rank tests. In the development group, the correlation between the LS values obtained by the two techniques was assessed with Spearman correlation coefficients and linear regression analysis. In the validation group, the agreement between the estimated and real LS values was evaluated using a Bland-Altman plot. RESULTS: ElastQ Imaging had higher applicability (94.0% vs. 78.3%, P<0.001) and higher repeatability, with a lower median CV (0.127 vs. 0.164, P<0.001) than did ElastPQ. The median acquisition time of ElastQ Imaging was significantly shorter than that of ElastPQ (45.5 seconds vs. 96.5 seconds, P<0.001). The median LS value obtained using ElastQ Imaging was significantly higher than that obtained using ElastPQ (5.60 kPa vs. 5.23 kPa, P<0.001). The LS values between the two techniques exhibited a strong positive correlation (r=0.851, P<0.001) in the development group. The mean difference and 95% limits of agreement were 0.0 kPa (-3.9 to 3.9 kPa) in the validation group. CONCLUSION: ElastQ Imaging may be more reliable and faster than ElastPQ, with strongly correlated LS measurements.

Ultrasound and MRI Findings of Giant Cell Fibroblastoma in the Abdominal Wall: Radiologic-Pathologic Correlations.

Giant cell fibroblastoma (GCF) is a rare soft-tissue sarcoma of fibroblastic origin. To the best of our knowledge, only one brief description of the MRI findings of GCF exists in the pathologic literature. Herein, we report a case of histologically proven GCF in a 3-year-old boy who underwent ultrasonography and MRI of a superficial mass in the abdominal wall.

Quantitative analysis of cochlear signal intensity on three-dimensional and contrast-enhanced fluid-attenuated inversion recovery images in patients with Meniere's disease: Correlation with the pure tone audiometry test.

PURPOSE: The purpose of this study was to correlate the quantitative analysis of cochlear signal intensity (SI) on 3-dimensional fluid-attenuated inversion recovery (3D-FLAIR) and contrast-enhanced (CE) 3D-FLAIR images with results of the pure tone audiometry (PTA) test in patients with Meniere's disease (MD). MATERIALS AND METHODS: Over a 3-year period, 123 patients with MD underwent 3-Tesla (3 T) temporal magnetic resonance imaging (MRI), including 3D-FLAIR and CE-FLAIR sequences. The SI of membranous labyrinth of the cochlea in both ears of each patient was measured by drawing a region of interest (ROI) with a seed growing technique. The correlation between measured cochlear SIs on 3D-FLAIR and CE-FLAIR images, contrast enhancement index (CEI), and contrast enhancement ratio (CER) and clinical findings and pre- and post-treatment PTA results were assessed. RESULTS: Cochlear signal ratios of symptomatic ears on 3D-FLAIR and CE-FLAIR images were significantly higher than those of asymptomatic ears (P < 0.001). The area under the curve, from the receiver operating characteristic curve of cochlear SIs on 3D-FLAIR and CE-FLAIR images for discrimination between symptomatic and asymptomatic ears, was 0.729 and 0.728, respectively. Cochlear SIs on 3D-FLAIR and CE-FLAIR images were significantly correlated with patients' sex (P < 0.05 and P < 0.01, respectively), symptomatic ear (both P < 0.0001), and pre-treatment PTA (P < 0.0001 and P < 0.005, respectively), but were not significantly correlated with patients' age, post-treatment PTA or hearing threshold level at 0.5, 1.0, 2.0, or 4.0 kHz. CONCLUSION: Quantitative analysis of cochlear SI on 3D-FLAIR and CE-FLAIR images may be a helpful diagnostic adjunct for MD, but may be of little value in predicting the prognosis of MD.

High-pitch, 120 kVp/30 mAs, low-dose dual-source chest CT with iterative reconstruction: Prospective evaluation of radiation dose reduction and image quality compared with those of standard-pitch low-dose chest CT in healthy adult volunteers.

PURPOSE: Objective of this study was to evaluate the effectiveness of the iterative reconstruction of high-pitch dual-source chest CT (IR-HP-CT) scanned with low radiation exposure compared with low dose chest CT (LDCT). MATERIALS AND METHODS: This study was approved by the institutional review board. Thirty healthy adult volunteers (mean age 44 years) were enrolled in this study. All volunteers underwent both IR-HP-CT and LDCT. IR-HP-CT was scanned with 120 kVp tube voltage, 30 mAs tube current and pitch 3.2 and reconstructed with sinogram affirmed iterative reconstruction. LDCT was scanned with 120 kVp tube voltage, 40 mAs tube current and pitch 0.8 and reconstructed with B50 filtered back projection. Image noise, and signal to noise ratio (SNR) of the infraspinatus muscle, subcutaneous fat and lung parenchyma were calculated. Cardiac motion artifact, overall image quality and artifacts was rated by two blinded readers using 4-point scale. The dose-length product (DLP) (mGy∙cm) were obtained from each CT dosimetry table. Scan length was calculated from the DLP results. The DLP parameter was a metric of radiation output, not of patient dose. Size-specific dose estimation (SSDE, mGy) was calculated using the sum of the anteroposterior and lateral dimensions and effective radiation dose (ED, mSv) were calculated using CT dosimetry index. RESULTS: Approximately, mean 40% of SSDE (2.1 ± 0.2 mGy vs. 3.5 ± 0.3 mGy) and 34% of ED (1.0 ± 0.1 mSv vs. 1.5 ± 0.1 mSv) was reduced in IR-HP-CT compared to LDCT (P < 0.0001). Image noise was reduced in the IR-HP-CT (16.8 ± 2.8 vs. 19.8 ± 3.4, P = 0.0001). SNR of lung and aorta of IR-HP-CT showed better results compared with that of LDCT (22.2 ± 5.9 vs. 33.0 ± 7.8, 1.9 ± 0.4 vs 1.1 ± 0.3, P < 0.0001). The score of cardiac pulsation artifacts were significantly reduced on IR-HP-CT (3.8 ± 0.4, 95% confidence interval, 3.7‒4.0) compared with LDCT (1.6 ± 0.6, 95% confidence interval, 1.3‒1.8) (P < 0.0001). SNR of muscle and fat, beam hardening artifact and overall subjective image quality of the mediastinum, lung and chest wall were comparable on both scans (P ≥ 0.05). CONCLUSION: IR-HP-CT with 120 kVp and 30 mAs tube setting in addition to an iterative reconstruction reduced cardiac motion artifact and radiation exposure while representing similar image quality compared with LDCT.

The most-cited articles in pediatric imaging: a bibliometric analysis.

INTRODUCTION: The number of citations that an article has received reflects its impact on the scientific community. The purpose of our study was to identify and characterize the 51 most-cited articles in pediatric imaging. EVIDENCE ACQUISITION: Based on the database of Journal Citation Reports, we selected 350 journals that were considered as potential outlets for pediatric imaging articles. The Web of Science search tools were used to identify the most-cited articles relevant to pediatric imaging within the selected journals. EVIDENCE SYNTHESIS: The 51 most-cited articles in pediatric imaging were published between 1952 and 2011, with 1980-1989 and 2000-2009 producing 15 articles, each. The number of citations ranged from 576-124 and the number of annual citations ranged from 49.05-2.56. The majority of articles were published in pediatric and related journals (N.=26), originated in the USA (N.=23), were original articles (N.=45), used MRI as imaging modality (N.=27), and were concerned with the subspecialty of brain (N.=34). University College London School of Medicine (N.=6) and School of Medicine University of California (N.=4) were the leading institutions and Reynolds EO (N.=7) was the most voluminous author. CONCLUSIONS: Our study presents a detailed list and an analysis of the most-cited articles in the field of pediatric imaging, which provides an insight into historical developments and allows for recognition of the important advances in this field.

Comparison of the diagnostic performance of CT Hounsfield unit histogram analysis and dual-energy X-ray absorptiometry in predicting osteoporosis of the femur.

PURPOSE: To evaluate the diagnostic performance of Hounsfield unit histogram analysis (HUHA) of precontrast abdominal-pelvic CT scans for predicting osteoporosis. MATERIALS AND METHODS: The study included 271 patients who had undergone dual X-ray absorptiometry (DXA) and abdominal-pelvic CT within 1 month. HUHA was measured using commercial 3D analysis software (Aquarius iNtuition v4.4.12Ⓡ, TeraRecon) and expressed as a percentage of seven HU range categories related to the ROI: A < 0, 0 ≤ B < 25, 25 ≤ C < 50, 50 ≤ D < 75, 75 ≤ E < 100, 100 ≤ F < 130, and 130 ≤ G. A coronal reformatted precontrast CT image containing the largest Ward's triangle was selected and then the ROI was drawn over the femoral neck. Correlation (r) and ROC curve analyses were used to assess diagnostic performance in predicting osteoporosis using the femur T-score as the reference standard. RESULTS: When the femur T-score was used as the reference, the rs of HUHA-A and HUHA-G were 0.74 and -0.57, respectively. Other HUHA values had moderate to weak correlations (r = -0.33 to 0.27). The correlation of HUHA-A was significantly higher than that of HUHA-G (p = 0.03). The area under the curve (0.95) of HUHA-A differed significantly from that of HUHA-G (0.90; p < 0.01). A HUHA-A threshold ≥ 27.7% was shown to predict osteoporosis based on a sensitivity and specificity of 95.6% and 81.7%, respectively. CONCLUSION: The HUHA-A value of the femoral neck is closely related to osteoporosis and may help predict osteoporosis. KEY POINTS: • HUHA correlated strongly with the DXA femur T-score (HUHA-A, r = 0.74). • The diagnostic performance of HUHA for predicting osteoporosis (AUC = 0.95) was better than that of the average CT HU value (AUC = 0.91; p < 0.05). • HUHA may help predict osteoporosis and enable semi-quantitative measurement of changes in bone mineral density.

Validation of body composition using bioelectrical impedance analysis in children according to the degree of obesity.

This study aimed to validate body composition analysis using bioelectrical impedance analysis (BIA) against dual-energy X-ray absorptiometry (DXA) in children with obesity and to compare agreement between BIA and DXA according to their degree of obesity. Three hundred and sixteen children aged 6-17 years participated in the Intervention for Childhood and Adolescents Obesity via Activity and Nutrition study. We divided participants by body mass index (BMI) percentile (group 1: mild to moderate obesity; group 2: severe obesity) and compared body composition variables, eg, percentage of body fat (%BF), fat mass (FM), and fat-free mass (FFM) using BIA and DXA. The %BF and FM of BIA were significantly lower (-1.8% and -0.8 kg, respectively), and the FFM of BIA was significantly higher (1.4 kg) than those of DXA. There were significant negative relationships between the absolute value of differences from BIA and DXA and BMI z-scores in %BF, FM, and FFM (regression coefficient [ß]: -1.39, 95% confidence interval [CI]: -1.81 to -0.97; ß: -0.34, 95%CI: -0.61 to -0.06; ß: -0.73, 95%CI: -1.03 to -0.44, respectively). The gap of body compositions between BIA and DXA decreased as participants became more obese, and the differences of FM in boys with severe obesity and the differences of %BF and FFM in girls with severe obesity were much less than those in children with mild to moderate obesity. In conclusion, the agreement between DXA and BIA was better for children with severe obesity than for children with mild to moderate obesity.

Motion effects on the measurement of stiffness on ultrasound shear wave elastography: a moving liver fibrosis phantom study.

AIMS: To evaluate the differences between shear wave velocities (SWVs) measured with ultrasound elastography during the continuous motion using liver fibrosis phantoms. MATERIALS AND METHODS: Elasticities were measured with convex and linear transducers of supersonic shear wave imaging (SSI) and acoustic radiation force impulse imaging (ARFI) using liver elasticity phantoms (3.0 and 16.9 kPa) at depths of 2, 3, 4, and 5 cm. Motion velocities were 30 and 60 rpm with the phantoms in an upright position on the Orbital shaker. To simulate different directional motion, the phantoms were laid on their side on the shaker. The values between moving and static status were compared, and the number of measurement failure was counted. Results: In SSI, the convex transducer was less affected by motion at 30 rpm with the 3 kPa phantom. In the higher velocity motion and in the higher stiffness phantom, most values from SSI were different comparing with static status, and there was a tendency for elasticity values to increase during movement. In ARFI, there were frequent measurement failures without stable results during the motion. CONCLUSIONS: Motion affected the measurement of elasticity differently in SSI and ARFI, according to the velocity, direction of the motion, and phantom stiffness. The convex transducer of SSI was less affected by motion in lower velocity motion and when using normal liver stiffness phantom.

Ultrasound features of secondary appendicitis in pediatric patients.

PURPOSE: The purpose of this study was to evaluate the ultrasonographic findings of secondary appendicitis (SA) and to discuss the differential findings compared with primary appendicitis. METHODS: In this study, we analyzed the ultrasonographic findings of 94 patients under 15 years old of age treated at our institution from May 2005 to May 2014 who had bowel inflammation and an inflamed appendix with a maximal outer diameter >6 mm that improved with nonsurgical treatment (the SA group). Ninety-nine patients with pathologically proven acute appendicitis (the primary appendicitis [PA] group) from June 2013 to May 2014 and 44 patients with pathologically negative appendectomy results from May 2005 to May 2014 were also included to compare the ultrasonographic features of these conditions. A retrospective review of the ultrasonographic findings was performed by two radiologists. The clinical and laboratory findings were also reviewed. The results were statically analyzed using analysis of variance, the Pearson chi-square test, and the two-tailed Fisher exact test. RESULTS: Compared with PA, cases of SA had a smaller diameter (9.8 mm vs. 6.6 mm, P<0.001), and were less likely to show periappendiceal fat inflammation (98% vs. 6%, P<0.001) or an appendicolith (34% vs. 11%, P<0.001). SA showed mural hyperemia on color Doppler ultrasonography as frequently as PA (P=0.887). CONCLUSION: The ultrasonographic features of SA included an increased diameter compared to a healthy appendix and the same level of hyperemia as in PA. However, the diameter was commonly in the equivocal range (mean diameter, 6.6 mm), and periappendiceal fat inflammation was rarely present in SA.

Acute pancreatitis in hand, foot and mouth disease caused by Coxsackievirus A16: case report.

Coxsackievirus A16 (CA16), which primarily causes hand, foot, and mouth disease (HFMD), is associated with complications, such as encephalitis, acute flaccid paralysis, myocarditis, pericarditis, and shock. However, no case of pancreatitis associated with CA16 has been reported in children. We report a case of CA16-associated acute pancreatitis in a 3-year-old girl with HFMD. She was admitted because of poor oral intake and high fever for 1 day. Maculopapular rashes on both hands and feet and multiple vesicles on the soft palate were observed on physical examination. She was treated conservatively with intravenous fluids. On the fourth hospital day, she had severe abdominal pain and vomiting. The serum levels of amylase and lipase were remarkably elevated (amylase, 1,902 IU/L; reference range, 28-100 IU/L; lipase, >1,500 IU/L; reference range, 13-60 IU/L), and ultrasonography showed diffuse swelling of the pancreas with a small amount of ascites. The real-time reverse transcription polymerase chain reaction result from a stool sample was positive for CA16. CA16 can cause acute pancreatitis, and should be considered in the differential diagnosis of abdominal pain in children with HFMD.