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Penile MRI is a vital yet underutilized diagnostic tool that provides detailed information crucial for managing various penile pathologies. Due to its infrequent use, many radiology trainees lack confidence in interpreting these exams. This article reviews the anatomy, key technical considerations, and interpretive pearls for penile trauma, Peyronie's disease, priapism, penile neoplasms, prosthesis evaluation, and a few miscellaneous conditions. Through illustrative case examples, this review aims to enhance the understanding and proficiency of radiologists in performing and interpreting penile MRI in these clinical scenarios.
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Hepatic ductopenia is a pathologic diagnosis characterized by a decrease in the number of intrahepatic bile ducts as a consequence of various underlying etiologies. Some etiologies, such as primary sclerosing cholangitis, primary biliary cholangitis, and ischemic cholangitis, often have distinctive imaging findings. In contrast, other causes such as chronic rejection following liver transplantation, drug-induced biliary injury, infection, malignancy such as lymphoma, and graft-versus-host disease may only have ancillary or non-specific imaging findings. Thus, diagnosing ductopenia in conditions with nonspecific imaging findings requires a multidimensional approach, including clinical evaluation, serological testing, imaging, and liver histology to identify the underlying cause. These etiologies lead to impaired bile flow, resulting in cholestasis, liver dysfunction, and, ultimately, cirrhosis and liver failure if the underlying cause remains untreated or undetected. In the majority of instances, individuals diagnosed with ductopenia exhibit a positive response to treatment addressing the root cause or cessation of the causative agent. This article focuses on acquired causes of ductopenia, its clinical manifestation, histopathology, imaging diagnosis, and management.
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BACKGROUND: Discontinuation of the Codman 3000 pump in 2018 left no Food and Drug Administration (FDA)-approved hepatic artery infusion (HAI) device for unresectable colorectal liver metastases (uCLM) and intrahepatic cholangiocarcinoma (uIHC). Historically, HAI has been performed at academic medical centers in large metropolitan areas, which are often inaccessible to rural patients. Consequently, feasibility of dissemination of HAI to rural populations is unknown. PATIENTS AND METHODS: Under an FDA investigational device exemption, we opened the only HAI program in Kentucky and enrolled patients with uCLM and uIHC in a phase I clinical trial. The trial examined the safety of the hybrid Codman catheter/Medtronic SynchroMed II pump (hCMP) combination, defined as successful completion of one cycle of HAI chemotherapy. Rural feasibility was assessed by number of missed pump fills appointments. RESULTS: A total of 21 patients (n = 17 uCLM, n = 4 uIHC) underwent hCMP implantation before accrual was stopped early owing to FDA approval of the Intera 3000 pump. 20/21 (95%) patients met the primary safety endpoint. Serious adverse events (AEs) included a grade 5 coronavirus disease 2019 (COVID-19) infection (n = 1) and a grade 3 catheter erosion into the bowel (n = 1). Biliary sclerosis developed in two patients (9.5%). Median distance to infusion center was 47.6 miles (2-138 miles), and 62% were from Appalachia, yet there were no missed pump fill appointments. The 2-year overall survival was 82.4% (uCLM) and 50% (uIHC). CONCLUSIONS: The hCMP device had an acceptable safety profile. Despite the complexity of starting a new HAI program, early results showed feasibility for HAI delivery in a rural catchment area and comparable outcomes to larger urban-based HAI centers.
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Neoplasias de los Conductos Biliares , Neoplasias Colorrectales , Neoplasias Hepáticas , Dispositivos de Acceso Vascular , Humanos , Neoplasias Colorrectales/patología , Arteria Hepática/patología , Estudios de Factibilidad , Protocolos de Quimioterapia Combinada Antineoplásica , Neoplasias Hepáticas/secundario , Infusiones Intraarteriales , Conductos Biliares Intrahepáticos/patología , Neoplasias de los Conductos Biliares/tratamiento farmacológico , Neoplasias de los Conductos Biliares/etiologíaRESUMEN
The Kissing ovaries sign is a radiological sign seen in women with deep pelvic endometriosis. It refers to abutment of the ovaries within the cul-de-sac. The term kissing ovaries was first described by Ghezzi et al. (2005) and has been since used widely. When seen on imaging it indicates moderate to severe endometriosis with the ovaries tethered within abnormal pelvic soft tissue, which may warrant surgical management.
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Endometriosis , Ovario , Femenino , Humanos , Ovario/diagnóstico por imagen , Endometriosis/diagnóstico por imagen , Fondo de Saco Recto-Uterino/cirugía , PelvisRESUMEN
Primary sclerosing cholangitis is a rare chronic inflammatory disease affecting the bile ducts, which can eventually result in bile duct strictures, cholestasis and cirrhosis. Patients are often asymptomatic but may present with clinical features of cholestasis. Imaging plays an important role in the diagnosis and management. This review covers the pathophysiology, clinical features, imaging findings as well as methods of surveillance and post-transplant appearance.
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Colangitis Esclerosante , Colestasis , Humanos , Colangitis Esclerosante/diagnóstico por imagen , Colangitis Esclerosante/patología , Conductos Biliares/patología , Colestasis/diagnóstico por imagen , Colestasis/patología , Cirrosis Hepática/patología , RadiólogosRESUMEN
Liver transplantation is a potentially curative treatment for patients with acute liver failure, end-stage liver disease, and primary hepatic malignancy. Despite tremendous advancements in surgical techniques and immunosuppressive management, there remains a high rate of post-transplant complications, with one of the main complications being biliary complications. In addition to anastomotic leak and stricture, numerous additional biliary complications are encountered, including ischemic cholangiopathy due to the sole arterial supply of the bile ducts, recurrence of primary biliary disease, infections, biliary obstruction from stones, cast, or hemobilia, and less commonly cystic duct remnant mucocele, vanishing duct syndrome, duct discrepancy and kinking, post-transplant lymphoproliferative disorder, retained stent, and ampullary dysfunction. This article presents an overview of biliary anatomy and surgical techniques in liver transplantation, followed by a detailed review of post-transplant biliary complications with their corresponding imaging findings on multiple modalities with emphasis on magnetic resonance imaging and MR cholangiopancreatography.
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Sistema Biliar , Colestasis , Trasplante de Hígado , Complicaciones Posoperatorias , Humanos , Conductos Biliares/patología , Sistema Biliar/irrigación sanguínea , Sistema Biliar/diagnóstico por imagen , Colestasis/cirugía , Hígado , Trasplante de Hígado/efectos adversos , Complicaciones Posoperatorias/patología , Pancreatocolangiografía por Resonancia MagnéticaRESUMEN
Serous cystadenocarcinoma (SCAC) of the pancreas is rare, with only 35 cases reported in the literature. We present a case of SCAC, comparing the clinical presentation, management and molecular features of this case to a series of serous cystadenoma (SCA), which may be a precursor. Compared with SCAs (n = 5), SCAC was larger (11.5 vs median 3.6 cm). The case of SCAC invaded the spleen and exhibited distant metastasis, a requirement for diagnosis since pathologic features are otherwise indistinguishable from SCA. VHL mutations have been reported in about half of SCA in the literature. Accordingly, we identified either somatic or germline VHL mutations in 3 of 5 SCAs (60%), yet no pathogenic mutation was identified in the SCAC. A somatic mutation in IDH1 was found in SCAC only. This has been associated with multiple malignancies, is targetable with the drug ivosidenib and should be studied as a progression factor in SCAC.
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Endoscopic cystogastrostomy for mature pancreatic collections has long been recognized. However, FDA approval of newer lumen-apposing metallic stents in 2014 has now brought pancreatic necrosectomy to the endoscopic realm. Endoscopic drainage of Walled-off necrosis and direct endoscopic necrosectomy are technically challenging procedures with higher rates of complications. Collaborative clinical decision making both pre- and post-procedurally between the radiologist, endoscopist, and the surgeon can greatly improve outcomes in necrotizing pancreatitis. Herein, we review the basic pathophysiology that underlies progressive radiographic findings in NP, value of preprocedural imaging, current management algorithms, newer tools, and techniques as well as potential post-procedure complications on imaging follow-up after endoscopic interventions in necrotizing pancreatitis.
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Endoscopía Gastrointestinal/métodos , Pancreatitis Aguda Necrotizante/diagnóstico por imagen , Pancreatitis Aguda Necrotizante/cirugía , Algoritmos , Humanos , Conductos Pancreáticos/diagnóstico por imagen , Pancreatitis Aguda Necrotizante/clasificación , Pancreatitis Aguda Necrotizante/fisiopatología , Complicaciones Posoperatorias , Pronóstico , StentsAsunto(s)
Carcinoma Hepatocelular/diagnóstico por imagen , Neoplasias Hepáticas/diagnóstico por imagen , Pautas de la Práctica en Medicina/estadística & datos numéricos , Servicio de Radiología en Hospital/organización & administración , Sistemas de Información Radiológica , Técnicas de Apoyo para la Decisión , Humanos , Estudios RetrospectivosRESUMEN
The manifestations of endometriosis commonly present a diagnostic challenge to the gynecologist and radiologist. Familiarity with its varied presentations may allow for a more accurate diagnosis. The goal of this review is to the present the imaging spectrum of endometriosis, less common sites of involvement as well as the potential rare complications. Relevant surgical and histopathological correlation is also provided. In addition to clinical evaluation and sonography, MRI is a highly accurate imaging modality in the diagnosis of endometriosis. It possesses a distinctive advantage over other modalities in that it allows a complete survey of the pelvic compartments. The potentially devastating effects of endometriosis include pelvic pain and even infertility. Since standard treatment is surgical, the radiologist needs to be familiar with the various manifestations in order to aid diagnosis for appropriate management.
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Endometriosis/diagnóstico , Imagen por Resonancia Magnética/métodos , Dolor Pélvico/diagnóstico , Ultrasonografía/métodos , Endometriosis/complicaciones , Femenino , Humanos , Dolor Pélvico/etiologíaRESUMEN
Intravesical Bacillus Calmette-Guerin (BCG) immunotherapy is a proven, effective treatment for intermediate- and high-risk non-muscle-invasive bladder cancer. Minor side effects are common and expected but systemic effects can occur in <5% of treated patients. We present a rare case of a 49-year-old male that presented with fever and chills after 3 weeks of intravesical BCG therapy post transurethral resection of bladder tumor. New renal lesions were present on contrast-enhanced computed tomography scan which was histologically proven to be necrotizing renal granulomatosis.
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PURPOSE: To determine retrospectively the effectiveness of percutaneous radiofrequency ablation (RFA) alone, alcohol ablation alone, or combined RFA and alcohol ablation (hereafter, combined ablation) to treat pain in patients with visceral and soft-tissue malignancies. MATERIALS AND METHODS: This HIPAA-compliant study was institutional review board approved; the informed consent requirement was waived. Twenty patients, with 28 tumors, who underwent percutaneous computed tomography (CT) or magnetic resonance (MR)-guided RFA and/or alcohol ablation for pain relief over a 2-year period were retrospectively identified, and their medical and imaging data were studied: Nineteen patients were referred for ablation because of persistent pain despite use of analgesics, and one patient had refused analgesics. The 28 tumors were located in the liver, lung, adrenal gland, retroperitoneum, gluteal muscle, inguinal mass, and subcutaneous tissues on the back. Fifteen tumors were treated with RFA alone, 12 were treated with combined ablation (when lesions were > 4 cm in diameter, except in lung or renal tumors), and one was treated with alcohol ablation alone. Pain was quantified on a 0-10 scale before, 1 day after, and 1-6 weeks after ablation. On the basis of changes in pain score and pain medication use, pain was reported with a composite measure as complete, partial, or no pain response. Quantitative pain scale values were compared by using Friedman and Tukey post hoc tests to assess significant changes. RESULTS: At 1-6-week follow-up, pain relief was complete in nine patients (45%) and partial in six (30%); pain relief did not occur in five patients (25%). There was a significant (P < .05) decrease in pain at 1-day and 1-6-week follow-up compared with pain at baseline. Three adverse events were caused by therapy: Two were major complications (femoral neuropathy in one patient, perinephric hematoma and hemobilia in one patient), and one was a side effect of ablation (right shoulder pain) that resolved spontaneously. CONCLUSION: Percutaneous RFA alone or in combination with alcohol ablation provided pain relief from visceral tumors in most patients with intractable pain.
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Ablación por Catéter/métodos , Etanol/uso terapéutico , Dolor/etiología , Dolor/prevención & control , Cuidados Paliativos/métodos , Neoplasias de los Tejidos Blandos/complicaciones , Neoplasias de los Tejidos Blandos/terapia , Adulto , Anciano , Anciano de 80 o más Años , Terapia Combinada , Femenino , Humanos , Masculino , Persona de Mediana Edad , Dolor/diagnóstico , Dimensión del Dolor , Resultado del TratamientoRESUMEN
PURPOSE: To retrospectively determine the frequency and severity of various abnormal laboratory test values following percutaneous cryoablation of liver tumors and to estimate the correlation between laboratory test values and tumor and ablation volumes. MATERIALS AND METHODS: This HIPAA-compliant study had institutional review board approval. Informed consent was waived. Biochemical and hematologic laboratory values from 48 procedures in 39 patients (18 men and 21 women; age range, 29-86 years) who underwent magnetic resonance (MR) imaging-guided percutaneous cryoablation of 65 liver tumors (62 metastases, three hepatocellular carcinomas) were retrospectively reviewed. Changes in laboratory values at baseline and 0-6 hours and 1-2 weeks after the procedure were analyzed with respect to tumor and ablative margin volumes by using generalized estimating equations. Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels were correlated with percent maximal decrease in platelet count. RESULTS: Mean ablation zone volume was 67.3 cm(3) +/- 41.2 (standard deviation) (range, 7.3-191.4 cm(3)). AST and ALT values increased after all procedures and peaked at 6 hours (median change in AST value, +835 U/L; median change in ALT value, +614.5 U/L). Platelet count decreased after 47 procedures (mean maximal decrease, 92.3 x 10(9)/L [38%]), reaching a nadir at 12-24 hours after 24 procedures (50%) and returning to normal in 31 (84%) of 37 procedures at 1-2 weeks. One procedure was complicated by disseminated intravascular coagulation that necessitated transfusion and arterial embolization. Myoglobin values increased after 21 (44%) of 48 procedures and peaked at 6 hours (trimmed-mean value, 183.4 mug/L). Ablative margin volumes were predictive of changes at 0-6 hours in AST (P = .02), ALT (P = .003), and myoglobin (P < .001) values. Percent maximal decrease in platelet count correlated with peak change in AST (r = 0.72) (P < .001). CONCLUSION: Following percutaneous cryoablation of liver tumors, alterations in liver enzymes, myoglobin, and platelet count are common, are usually self-limited, and correlate with ablative margin volume--except for changes in platelet count, which correlate with changes in AST and ALT.
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Criocirugía/efectos adversos , Enfermedades Hematológicas/diagnóstico , Enfermedades Hematológicas/etiología , Neoplasias Hepáticas/complicaciones , Neoplasias Hepáticas/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Enfermedades Hematológicas/sangre , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
OBJECTIVE: The purpose of our study was to report our initial experience with patients who underwent percutaneous imaging-guided radiofrequency ablation of thoracic lesions, and to emphasize technical and multidisciplinary issues and adjunctive procedures specific to thoracic tumor ablation. MATERIALS AND METHODS: Our cohort consisted of 30 patients with a spectrum of primary (n=18) and secondary (n=11) lung tumors, mesothelioma (n=1), and five secondarily eroded, painful ribs who underwent ablation of 36 total lesions (one patient had two ablations). Patients either were nonsurgical candidates because of medical comorbidities or extent of disease, or had exhausted chemotherapy and radiation therapy options, or had refused surgery or undergone unsuccessful surgery. Patients were treated with radiofrequency ablation after agreement among oncologists, thoracic surgeons, and interventional radiologists. An array-style electrode under impedance control was used to treat 29 thoracic tumors and the adjacent rib metastases (n=5). A cool-tip radiofrequency probe was used for two patients. CT guidance and general anesthetic were used for all but one patient. Sonographic guidance and IV conscious sedation were used in one patient. Pain (n=11) and tumor cure or control (n=19) were the primary indications for the procedures. Adjunctive procedures to the radiofrequency ablations included the creation of saline or water windows (n=3); establishment of transosseous and transchondral routes (n=4); use of intercostal and paravertebral nerve blocks (n=15); and use of an intraprocedural catheter (n=1), needle (n=1), or sheath (n=3) for treatment of pneumothoraces. Follow-up was from 2 to 26 months. RESULTS: All ablations were technically successful. No periprocedural mortality occurred. Necrosis of tumor was greater than 90% in 26 of 30 lesions based on short-term follow-up imaging (CT, PET, MRI). In the 11 patients who underwent ablation for pain, relief was complete in four and partial in the other seven. One patient developed a local skin burn, four patients had self-limited hemoptysis up to 4 days after ablation, one had transient atrial fibrillation, one developed hoarseness, and two patients were transiently reintubated after extubation. Eight pneumothoraces developed; one patient underwent placement of a chest tube. Four patients died within 1 year of ablation from extrathoracic spread of tumor. CONCLUSION: Radiofrequency ablation for a variety of thoracic tumors can be performed safely and with a high degree of efficacy for pain control and tumor killing. The effect of ablation can be assessed with CT, MRI, or PET. Various technical issues differentiate thoracic tumor ablation from standard abdominal ablations. Numerous other thoracic interventional radiology procedures are beneficial to assist the radiofrequency ablation. A multidisciplinary approach offers valuable expertise for patient care.