Gallbladder opacification on gadoxetate disodium-enhanced CT scan.

This study aimed to evaluate the radiologist's ability to identify excreted gadoxetate disodium within the gallbladder on CT scan. Thirty three healthy adults underwent imaging of the liver during work-up for potential liver donation. Three patients had undergone prior cholecystectomy and therefore were excluded. Imaging consisted of gadoxetate disodium-enhanced magnetic resonance cholangiography (MRC) and multiphase contrast-enhanced CT scan of the abdomen and pelvis. Two fellowship-trained abdominal imaging radiologists, who were blinded to the MRC images and the contrast agent used during MRC, independently reviewed the CT scans of the 30 patients that were included. The scans were evaluated for the presence or absence of abnormal hyperdensity within the gallbladder. Three patients did not receive intravenous gadoxetate disodium, 4 patients had their MRC after the CT scan, and 1 patient had the CT scans 5 days following the MRC. Twenty two patients had the CT scan within 24 h following the gadoxetate disodium-enhanced MRC. Of the 22 patients expected to have gadolinium in the gallbladder, both reviewers identified hyperdensity in the same 20 patients (90%). Both reviewers reported no abnormal hyperdensity within the gallbladder in the remaining 10 patients. CT scan can reveal excreted gadoxetate disodium within the gallbladder lumen and therefore gadoxetate disodium-enhanced CT scan can potentially play a role in the evaluation of cystic duct patency and work-up of acute cholecystitis.

MRI Findings of Injury to the Longus Colli Muscle in Patients With Neck Trauma.

OBJECTIVE: The longus colli muscle (LCM) forms the bulk of the deep flexor muscles of the neck. To our knowledge, very little information on the effects of trauma on this muscle group has been published. We describe MRI findings related to injury of the LCM in patients with a history of neck trauma. MATERIALS AND METHODS: A radiology department database was searched to identify patient medical records from 2008 to 2013 that included the keywords "longus colli" and "deep flexors." Patients with fractures and ligament injuries were excluded. Patients with other obvious large soft-tissue injuries and nontraumatic conditions were also omitted. A total of 12 patients met the inclusion criterion of having an isolated or predominant injury to the LCM. Five patients had been involved in a motor vehicle accident, and seven patients had fallen. Eleven patients had undergone a CT examination before MRI was performed. RESULTS: No fractures were noted on CT. MRI examinations of the cervical spine were obtained for the following reasons: for increased prevertebral soft-tissue swelling noted on a CT scan plus neck pain (n = 6), for neck pain only (n = 4), or as part of a routine protocol for assessment of obtunded patients (n = 2). Eight of the 12 patients had isolated injury to the LCM. The remaining four patients also had minor injuries to the other neck muscles. The MR image showed swelling and T2 hyperintensity in the LCM and revealed free fluid in the prevertebral space. CONCLUSION: Isolated injury to the LCM may occur in neck injuries. The MRI findings indicating such injury include increased T2 signal, swelling of the muscle, and the presence of prevertebral fluid.

Transplant renal artery stenosis: utilization of machine learning to identify ancillary sonographic and doppler parameters to predict stenosis in patients with graft dysfunction.

PURPOSE: To determine if ancillary sonographic and Doppler parameters can be used to predict transplant renal artery stenosis in patients with renal graft dysfunction. MATERIALS AND METHODS: IRB-approved, HIPAA-compliant retrospective study included 80 renal transplant patients who had renal US followed by renal angiogram between January 2018 and December 2019. A consensus read of two radiologists recorded these parameters: peak systolic velocity, persistence of elevated velocity, grayscale narrowing, parvus tardus, delayed systolic upstroke, angle of the systolic peak (SP angle), and aliasing. Univariate analysis using t-test or chi-square was performed to determine differences between patients with and without stenosis. P values under 0.05 were deemed statistically significant. We used machine learning algorithms to determine parameters that could better predict the presence of stenosis. The algorithms included logistic regression, random forest, imbalanced random forest, boosting, and CART. All 80 cases were split between training and testing using stratified sampling using a 75:25 split. RESULTS: We found a statistically significant difference in grayscale narrowing (p = 0.0010), delayed systolic upstroke (p = 0.0002), SP angle (p = 0.0005), and aliasing (p = 0.0024) between the two groups. No significant difference was found for an elevated peak systolic velocity (p = 0.1684). The imbalanced random forest (IRF) model was selected for improved accuracy, sensitivity, and specificity. Specificity, sensitivity, AUC, and normalized Brier score for the IRF model using all parameters were 73%, 81%, 0.82, and 69 in the training set, and 78%, 58%, 0.78, and 80 in the testing set. VIMP assessment showed that the combination of variables that resulted in the most significant change of the training set performance was that of grayscale narrowing and SP angle. CONCLUSION: Elevated peak systolic velocity did not discriminate between patients with and without TRAS. Adding ancillary parameters into the machine learning algorithm improved specificity and sensitivity similarly in the training and testing sets. The algorithm identified the combination of lumen narrowing coupled with the angle of the systolic peak as better predictor of TRAS. This model may improve the accuracy of ultrasound for transplant renal artery stenosis.

Imaging spectrum of non-neoplastic and neoplastic conditions of the duodenum: a pictorial review.

Given its crucial location at the crossroads of the gastrointestinal tract, the hepatobiliary system and the splanchnic vessels, the duodenum can be affected by a wide spectrum of abnormalities. Computed tomography and magnetic resonance imaging, in conjunction with endoscopy, are often performed to evaluate these conditions, and several duodenal pathologies can be identified on fluoroscopic studies. Since many conditions affecting this organ are asymptomatic, the role of imaging cannot be overemphasized. In this article we will review the imaging features of many conditions affecting the duodenum, focusing on cross-sectional imaging studies, including congenital malformations, such as annular pancreas and intestinal malrotation; vascular pathologies, such as superior mesenteric artery syndrome; inflammatory and infectious conditions; trauma; neoplasms and iatrogenic complications. Because of the complexity of the duodenum, familiarity with the duodenal anatomy and physiology as well as the imaging features of the plethora of conditions affecting this organ is crucial to differentiate those conditions that could be managed medically from the ones that require intervention.

Precision analysis of a quantitative CT liver surface nodularity score.

PURPOSE: To evaluate precision of a software-based liver surface nodularity (LSN) score derived from CT images. METHODS: An anthropomorphic CT phantom was constructed with simulated liver containing smooth and nodular segments at the surface and simulated visceral and subcutaneous fat components. The phantom was scanned multiple times on a single CT scanner with adjustment of image acquisition and reconstruction parameters (N = 34) and on 22 different CT scanners from 4 manufacturers at 12 imaging centers. LSN scores were obtained using a software-based method. Repeatability and reproducibility were evaluated by intraclass correlation (ICC) and coefficient of variation. Using abdominal CT images from 68 patients with various stages of chronic liver disease, inter-observer agreement and test-retest repeatability among 12 readers assessing LSN by software- vs. visual-based scoring methods were evaluated by ICC. RESULTS: There was excellent repeatability of LSN scores (ICC:0.79-0.99) using the CT phantom and routine image acquisition and reconstruction parameters (kVp 100-140, mA 200-400, and auto-mA, section thickness 1.25-5.0 mm, field of view 35-50 cm, and smooth or standard kernels). There was excellent reproducibility (smooth ICC: 0.97; 95% CI 0.95, 0.99; CV: 7%; nodular ICC: 0.94; 95% CI 0.89, 0.97; CV: 8%) for LSN scores derived from CT images from 22 different scanners. Inter-observer agreement for the software-based LSN scoring method was excellent (ICC: 0.84; 95% CI 0.79, 0.88; CV: 28%) vs. good for the visual-based method (ICC: 0.61; 95% CI 0.51, 0.69; CV: 43%). Test-retest repeatability for the software-based LSN scoring method was excellent (ICC: 0.82; 95% CI 0.79, 0.84; CV: 12%). CONCLUSION: The software-based LSN score is a quantitative CT imaging biomarker with excellent repeatability, reproducibility, inter-observer agreement, and test-retest repeatability.

Ultrasonography of the scrotum in adults.

Ultrasonography is the ideal noninvasive imaging modality for evaluation of scrotal abnormalities. It is capable of differentiating the most important etiologies of acute scrotal pain and swelling, including epididymitis and testicular torsion, and is the imaging modality of choice in acute scrotal trauma. In patients presenting with palpable abnormality or scrotal swelling, ultrasonography can detect, locate, and characterize both intratesticular and extratesticular masses and other abnormalities. A 12-17 MHz high frequency linear array transducer provides excellent anatomic detail of the testicles and surrounding structures. In addition, vascular perfusion can be easily assessed using color and spectral Doppler analysis. In most cases of scrotal disease, the combination of clinical history, physical examination, and information obtained with ultrasonography is sufficient for diagnostic decision-making. This review covers the normal scrotal anatomy as well as various testicular and scrotal lesions.

Hepatocellular carcinoma recurrence pattern following liver transplantation and a suggested surveillance algorithm.

PURPOSE: This study aims to evaluate the recurrence pattern of hepatocellular carcinoma (HCC) following liver transplantation. MATERIALS AND METHODS: A total of 54 patients underwent liver transplantation for HCC; 9 patients developed biopsy-proven recurrent HCC (16.6%). The site of HCC recurrence along with other factors was analyzed. RESULTS: Seven patients were diagnosed with HCC prior to liver transplantation and 2 patients had incidental HCC in the explanted liver. Two patients had locoregional recurrence, 4 patients had distant metastasis, and 3 patients had synchronous locoregional recurrence and distant metastasis. CONCLUSION: A significant proportion of HCC recurrence following liver transplantation is extrahepatic.

Anatomy of smooth muscle cells in nonmalignant and malignant human prostate tissue.

Differently graded areas of human prostate adenocarcinoma were examined after Masson's trichrome staining or immunohistochemistry for smooth muscle alpha-actin, type IV collagen and laminin. In addition, the ultrastructure of the prostatic smooth muscle cells (SMC) during glandular proliferation and epithelial invasion in selected tumors was studied. The SMC formed a thick layer below the epithelial structures in unaffected areas and were closely associated with each other in homotypic interactions. As the tumor grade increased, the SMC gradually lost interactions with each other and became atrophic. With the growth of the epithelial compartment, the SMC initially segregated to the tumor periphery and the intercellular spaces increased. In high grade tumors, the epithelial cancer cells invaded the spaces between the SMC. Immunohistochemical analysis of the basal membrane revealed increased disruption of the usually thick basal membrane, which became thinner and faintly stained with each of the antibodies used. We conclude that most SMC become atrophic following epithelial invasion in human tumors and that degradation of the basal membrane is an important factor in this process. At the ultrastructural level, different SMC phenotypes occur in prostatic tissues during epithelial invasion. Interconversion between these phenotypes is suggested and a probable relationship among them is proposed.

Cálculo ureteral: retirada por ureteroscopia / Ureteral calculi: removal by ureteroscopy

Foram realizados 22 procedimentos de Ureteroscopia para retirada de cálculos ureterais em nossa Instituiçäo, entre janeiro e dezembro de 1989. Na grande maioria dos casos, meato ureteral näo foi dilatado. Meatotomia fez-se necessária em apenas 2 casos, na presença de meato puntiforme. O procedimento foi realizado no bloco cirúrgico, sem controle fluoroscópico devido à falta deste equipamento na sala cirúrgica. A ureteroscopia mostrou-se de grande utilidade na remoçäo de cálculos ureterais baixos, onde o sucesso obtido foi de 91 por cento, comparando com a retirada às cegas (sonda Dormiá)entre 40 e 59 por cento e pouco abaixo da literatura mundial, que é algo ao redor de 99 por cento. O tempo médio de internaçäo foi de 3 dias, variando de 1 a 14 dias. O procedimento tem-se mostrado eficaz e com significativa adiçäo ao arsenal terapêutico urológico. A Ureteroscopia está sendo a técnica de escolha para remoçäo de cálculos na porçäo distal do ureter

Ureter retrocava / Retro-cava ureter

O ureter Retrocava constitui anomalia congênita que determina sintomatologia relacionada à uropatia obstrutiva, impondo o diagnóstico diferencial. Relata-se caso, enfatizando os aspectos diagnósticos e terapêuticos

Papaverina: auto-injeçäo do corpo cavernoso na impotência sexual masculina / Papverine: auto-injection in corpora cavernosa in male sexual impotence

Analisou-se o resultado da auto-injeçäo de papaverina (50mg) no corpo cavernoso de 12 pacientes com disfunçäo sexual éretil. O tempo médio do início da tumescência peniana e início da ereçäo foi respectivamente de 45 segundos e 10 minutos. Todos os pacientes evidenciaram tumescência, mas somente 9 (75%) apresentaram ereçäo com rigidez suficiente para o coito. A ereçäo perdurou por tempo médio de 57 minutos. Dois pacientes tiveram ereçöes mais prolongadas, em uma única oportunidade, de 4 a 6 horas. Em seguimiento de 6 meses, as complicaçöes foram discretas: um hematoma e diversas equimoses. A papaverina injetada no corpo cavernoso de pacientes com disfunçäo sexual erétil, criteriosamente selecionados, especialmente neuropatas, poderá ser uma alternativa terapêutica válida e útil na obtençäo de ereçäo peniana

Endometriose de parede vesical / Endometriosis of bladder

A endometriose de bexiga é um achado raro. Acontece, geralmente, após ferimento da mesma. Nesse caso, surgiu após trauma vesical em cesariana. Formou-se um endometrioma no assoalho da bexiga, que causava disúria importante no período menstrual. O endometrioma foi ressecado e realizou-se histerectomia total. A paciente encontra-se assintomática após um ano de cirurgia

Pieloplastia Laparoscópica para tratamento de Estenose da junçäo pelve-ureteral: relato de caso / Uretero-pelvic junction Stenosis-Laparoscopic pyeloplasty: a case report

Relata-se caso de estenose da junçäo pelve-ureteral tratado por pieloplatia videolaparoscópica. Discutem-se as vantagens da via laparoscópica, assim como as demais técnicas que säo utilizadas atualmente. os autors sintetizam o quadro clínico, etiologia, diagnóstico e tratamento dessa patologia

Eletrovaporizaçäo da próstata com vaportrode / Transuretral ressection of prostate with electrovaporization

Estudou-se retrospectivamente 294 pacientes submetidos a ressecçäo transuretral de próstata seguida de eletrovaporizaçäo, num período de 4 anos e 3 meses. Do total de pacientes, observou-se uma prevalência de 72 por cento para a Hiperplasia Benigna de Próstata, 19,7 por cento para Prostatite Crônica Inespecífica e 10 por cento para Adenocarcinoma de Próstata. A totalizaçäo dos percentuais ultrapassa os 100 por cento devido à ocorrência simultânea de Hiperplasia Benigna de Próstata associada Prostatite Crônica Inespecífica em 5 pacientes. A média etária dos pacientes foi de 66,32 anos; o tamanho médio das próstatas aferido ultrassonograficamente foi de 57 g. O tempo médio de internaçäo foi de 3,5 dias e o tempo médio de sondagem vesical foi de 34,8 horas

Carcinoma de células renais / Renal cell carcinoma: a case report

O carcinoma de células renais é a neoplasia renal maligna mais frequente em adultos. Este tumor pode atingir a veia cava inferior e as câmaras direitas do coraçäo como um trombo intra-luminal. Os fatores de risco mais comumente relacionados säo a hereditariedade, agentes químicos, irradiaçäo, dieta, obesidade e o fumo. Este trabalho relata dois casos desta patologia que ocorreram com os filhos de um mesmo casal, tendo sido diagnosticados num intervalo de aproximadamente 15 dias