Standardization of dermoscopic terminology and basic dermoscopic parameters to evaluate in general dermatology (non-neoplastic dermatoses): an expert consensus on behalf of the International Dermoscopy Society.

BACKGROUND: Over the last few years, several articles on dermoscopy of non-neoplastic dermatoses have been published, yet there is poor consistency in the terminology among different studies. OBJECTIVES: We aimed to standardize the dermoscopic terminology and identify basic parameters to evaluate in non-neoplastic dermatoses through an expert consensus. METHODS: The modified Delphi method was followed, with two phases: (i) identification of a list of possible items based on a systematic literature review and (ii) selection of parameters by a panel of experts through a three-step iterative procedure (blinded e-mail interaction in rounds 1 and 3 and a face-to-face meeting in round 2). Initial panellists were recruited via e-mail from all over the world based on their expertise on dermoscopy of non-neoplastic dermatoses. RESULTS: Twenty-four international experts took part in all rounds of the consensus and 13 further international participants were also involved in round 2. Five standardized basic parameters were identified: (i) vessels (including morphology and distribution); (ii) scales (including colour and distribution); (iii) follicular findings; (iv) 'other structures' (including colour and morphology); and (v) 'specific clues'. For each of them, possible variables were selected, with a total of 31 different subitems reaching agreement at the end of the consensus (all of the 29 proposed initially plus two more added in the course of the consensus procedure). CONCLUSIONS: This expert consensus provides a set of standardized basic dermoscopic parameters to follow when evaluating inflammatory, infiltrative and infectious dermatoses. This tool, if adopted by clinicians and researchers in this field, is likely to enhance the reproducibility and comparability of existing and future research findings and uniformly expand the universal knowledge on dermoscopy in general dermatology. What's already known about this topic? Over the last few years, several papers have been published attempting to describe the dermoscopic features of non-neoplastic dermatoses, yet there is poor consistency in the terminology among different studies. What does this study add? The present expert consensus provides a set of standardized basic dermoscopic parameters to follow when evaluating inflammatory, infiltrative and infectious dermatoses. This consensus should enhance the reproducibility and comparability of existing and future research findings and uniformly expand the universal knowledge on dermoscopy in general dermatology.

Preoperative evaluation of small bowel complications in Crohn's disease: comparison of diffusion-weighted and contrast-enhanced MR imaging.

PURPOSE: To compare the accuracy of MR enterography (MRE) using combined T2-weighted and contrast-enhanced (CE) sequences with that of combined T2- and diffusion-weighted (DW) sequences for the detection of complex enteric Crohn's disease (CD). MATERIALS: Thirty-eight patients who underwent surgery for CD complications and preoperative MRE from 2011 to 2016 were included. MRE examinations were blindly analyzed independently by one junior and one senior abdominal radiologist for the presence of fistula, stenosis and abscesses. During a first reading session, T2-weighted images (WI), steady-state sequences and DW-MRE were reviewed (set 1). During a separate distant session, T2-WI, True-FISP and CE-MRE were reviewed (set 2). Performance of each reader was evaluated by comparison with the standard of reference established using intraoperative and pathological findings. RESULTS: Forty-eight fistulas, 43 stenoses and 11 abscesses were found. For the senior radiologist, sensitivity for the detection of fistula, stenosis and abscess ranged from 80% to 100% for set 1 and 88% to 100% for set 2 and specificity ranged from 56% to 70% for set 1 and 53% to 93% for set 2, with no significant difference between the sets (p = 0.342-0.429). For the junior radiologist, sensitivity ranged from 53% to 63% for set 1 and 64% to 88% for set 2 and specificity ranged from 0% to 25% for set 1 and 17% to 40% for set 2 (p = 0.001 and 0.007, respectively). CONCLUSION: For a senior radiologist, DW-MRE has similar sensitivity as CE-MRE for the detection of CD complications. For a junior radiologist, CE-MRE yields the best results compared with DW-MRE. KEY POINTS: • For experienced readers, DWI has similar diagnostic capability as contrast-enhanced MR imaging for the diagnosis of Crohn's disease complications. • For senior radiologists, gadolinium chelate injection could be waived for the diagnosis of Crohn's disease complications. • The interpretation of DWI for Crohn's disease complications requires some experience.

Evaluation of the peritoneal carcinomatosis index with CT and MRI.

BACKGROUND: The aim was to determine the incremental value of MRI compared with CT in the preoperative estimation of the peritoneal carcinomatosis index (PCI). METHODS: CT and MRI examinations of patients with peritoneal carcinomatosis were evaluated. CT images were first analysed by two observers who determined a first PCI (PCICT ). Then, the two observers reviewed MRI examinations in combination with CT and determined a second PCI (PCICT+MRI ). The sensitivity and negative predictive value of the two imaging sets were determined using surgery as a reference standard (PCIRef ). RESULTS: CT plus MRI was more accurate in predicting the surgical PCI than CT alone. The absolute difference between PCICT+MRI and PCIRef was lower than that between PCICT and PCIRef (mean(s.d.) 3·96(4·10) versus 4·89(4·73); P = 0·010). The number of true-positive findings increased from 106 to 125 for reader 1 and from 117 to 132 for reader 2 with the adjunct of MRI. For both readers, an increased sensitivity was obtained when both MRI and CT were used (from 63 to 81 per cent for reader 1; from 44 to 81 per cent for reader 2). The increase in sensitivity was greater for patients with a moderate volume of disease. CONCLUSION: The combination of CT and MRI improved the preoperative estimation of PCI compared with CT alone.

Imaging of the postoperative liver: review of normal appearances and common complications.

Several benign and malignant liver diseases may require surgical treatment for cure, including anatomical resections based on the segmental anatomy of the liver, non-anatomical (wedge) resections, and surgical management of biliary cysts. The type of surgery depends not only on the location and the nature of the disease, but also on the expertise of the surgeon. Whereas ultrasonography is often the first-line imaging examination in case of suspected postoperative complication, multidetector computed tomography (MDCT) is of greater value for identifying normal findings after surgery, early postoperative pathologic fluid collections and vascular thromboses, and tumor recurrence in patients who have undergone hepatic surgery. Magnetic resonance cholangiopancreatography (MRCP) is the imaging modality of choice for depicting early postoperative bile duct injuries and ischemic cholangitis that may occur in the late postoperative phase. Both MDCT and MRCP can accurately depict tumor recurrence. Radiologists should become familiar with these surgical procedures to better understand postoperative changes, and with the normal imaging appearances of various postoperative complications to better differentiate between complications and normal findings.

Local colorectal cancer recurrence: pelvic MRI evaluation.

Surveillance of colorectal cancer is currently based on dosage of tumoral markers, colonoscopy and multidetector row computed tomography. However, pelvic magnetic resonance imaging (MRI) and PET-CT are two second-line useful imaging modalities to assess colorectal cancer local recurrence (LR). The anatomical information derived from MRI combined to the functional information provided by diffusion-weighted imaging currently remain of value. Pelvic MRI is accurate not only for detection of pelvic colorectal recurrence but also for the prediction of absence of tumoral invasion in pelvic structures, and it may thus provide a preoperative road map of the recurrence to allow for appropriate surgical planning. As always, correlation of imaging and clinical findings in the multidisciplinary forum is paramount. MRI can also be used to follow-up LR treated with radiofrequency ablation. The aim of this review is to discuss clinical practice and application of MRI in the assessment or pelvic recurrence from colorectal cancer.

Accuracy of imaging for predicting operative approach in Crohn's disease.

BACKGROUND: The aim of this study was to assess the accuracy of preoperative imaging in detecting the extent of disease and predicting the operative approach in patients with Crohn's disease. METHODS: Patients with Crohn's disease who were scheduled to undergo operation were evaluated before operation using computed tomography enteroclysis (CTE) and magnetic resonance enterography (MRE). Preoperative imaging findings were correlated with intraoperative and pathological findings to estimate the capabilities of preoperative imaging in detecting lesions due to Crohn's disease. The operative approach determined before surgery was compared with the procedure actually performed, which was based on intraoperative findings. RESULTS: Fifty-two patients with Crohn's disease were studied; 26 were evaluated before surgery with CTE and 26 with MRE. Eighty-nine lesions due to Crohn's disease were confirmed surgically (60 small bowel stenoses, 21 fistulas and 8 abscesses). CTE confirmed the presence of 38 of 41 lesions (sensitivity 93 per cent) and MRE 48 of 48 lesions (sensitivity 100 per cent); a correct estimation of the disease with an exact prediction of the operative approach was obtained in 49 (94 per cent) of 52 patients. Discrepant findings between preoperative imaging and operative findings were observed in three patients (6 per cent), who had CTE. CONCLUSION: Preoperative imaging using CTE or MRE is highly accurate for assessing Crohn's disease lesions before operation, allowing correct prediction of the operative approach.

Diagnosis and treatment of focal splenic lesions.

The spleen can be affected by many conditions, some of which are easily diagnosed by conventional imaging, mainly using computed tomography scans and magnetic resonance imaging. Despite the contribution of functional radiology techniques such as positron emission tomography, it is sometimes difficult to diagnose certain focal splenic lesions and definitive diagnosis sometimes requires histological confirmation by percutaneous biopsy or more rarely by diagnostic intervention. Once a diagnosis has been established, treatment is based mainly on surgery: total splenectomy for malignant lesions, or partial splenectomy whenever possible for benign lesions benign that are symptomatic and/or at risk of rupture.

[Embolization of intracranial aneurysms: reimbursement and perspectives]. / Embolisations des anévrismes cérébraux: évolutions du financement et perspectives.

PURPOSE: To determine the costs related to the embolization of intracranial aneurysms compared to "rates per activity" (T2A) reimbursements. MATERIALS AND METHODS: The hospital admissions of patients with intracranial aneurysms treated with embolization and classified under diagnosis-related group (DRG) 01K02Z in 2007 were included. The costs related to the single-use devices, neurointerventional suite and hospital stay were calculated by analytical accounting. Revenues were calculated based on DRG-based medical information system (PMSI) and medical data using the diagnosis-related groups and reimbursements from 2007 (V10 of DRG) and 2009 (V11). RESULTS: Fifty-seven patients were included. The total cost was 932.278 euro and hospital revenues were 655.648 euro in 2007 and would have been 825.211 euro in 2009. The financial loss was on average 4.853 euro per admission in 2007 and 1.878 euro in 2009, and even more in two cases of ruptured aneurysm. CONCLUSION: In 2001, embolization of intracranial aneurysms, the treatment of choice for this pathology, results in a financial loss for the hospital, larger for ruptured aneurysms compared to non-ruptured aneurysms. The updated DRG, while improving the situation, remains insufficient.

Interobserver agreement issues in radiology.

Agreement between observers (i.e., inter-rater agreement) can be quantified with various criteria but their appropriate selections are critical. When the measure is qualitative (nominal or ordinal), the proportion of agreement or the kappa coefficient should be used to evaluate inter-rater consistency (i.e., inter-rater reliability). The kappa coefficient is more meaningful that the raw percentage of agreement, because the latter does not account for agreements due to chance alone. When the measures are quantitative, the intraclass correlation coefficient (ICC) should be used to assess agreement but this should be done with care because there are different ICCs so that it is important to describe the model and type of ICC being used. The Bland-Altman method can be used to assess consistency and conformity but its use should be restricted to comparison of two raters.

Computed tomography features of acinar cell carcinoma of the pancreas.

PURPOSE: To report the computed tomography (CT) features of pancreatic acinar cell carcinoma (ACC) and identify CT features that may help discriminate between pancreatic ACC and pancreatic ductal adenocarcinoma (PDA). MATERIALS AND METHODS: The CT examinations of 20 patients (13 men, 7 women; mean age, 66.5±10.7 [SD] years; range: 51-88 years) with 20 histopathologically proven pancreatic ACC were reviewed. CT images were analyzed qualitatively and quantitatively and compared to those obtained in 20 patients with PDA. Comparisons were performed using univariate analysis with a conditional logistic regression model. RESULTS: Pancreatic ACC presented as an enhancing (20/20; 100%), oval (15/20; 75%), well-delineated (14/20; 70%) and purely solid (13/20; 65%) pancreatic mass with a mean diameter of 52.6±28.0 (SD) mm (range: 24-120mm) in association with visible lymph nodes (14/20; 70%). At univariate analysis, well-defined margins (Odds ratio [OR], 7.00; P=0.005), nondilated bile ducts (OR, 9.00; P=0.007), visible lymph nodes (OR, 4.33; P=0.028) and adjacent organ involvement (OR, 5.67; P=0.02) were the most discriminating CT features to differentiate pancreatic ACC from PDA. When present, lymph nodes were larger in patients with pancreatic ACC (14±4.8 [SD]; range: 7-25mm) than in those with PDA (8.8±4.1 [SD]; range: 5-15mm) (P=0.039). CONCLUSION: On CT, pancreatic ACC presents as an enhancing, predominantly oval and purely solid pancreatic mass that most frequently present with no bile duct dilatation, no visible lymph nodes, no adjacent organ involvement and larger visible lymph nodes compared to PDA.

Prediction of tumor grade and lymphovascular space invasion in endometrial adenocarcinoma with MR imaging-based radiomic analysis.

PURPOSE: To evaluate the capabilities of two-dimensional magnetic resonance imaging (MRI)-based texture analysis features, tumor volume, tumor short axis and apparent diffusion coefficient (ADC) in predicting histopathological high-grade and lymphovascular space invasion (LVSI) in endometrial adenocarcinoma. MATERIALS AND METHODS: Seventy-three women (mean age: 66±11.5 [SD] years; range: 45-88 years) with endometrial adenocarcinoma who underwent MRI of the pelvis at 1.5-T before hysterectomy were retrospectively included. Texture analysis was performed using TexRAD® software on T2-weighted images and ADC maps. Primary outcomes were high-grade and LVSI prediction using histopathological analysis as standard of reference. After data reduction using ascending hierarchical classification analysis, a predictive model was obtained by stepwise multivariate logistic regression and performances were assessed using cross-validated receiver operator curve (ROC). RESULTS: A total of 72 texture features per tumor were computed. Texture model yielded 52% sensitivity and 75% specificity for the diagnosis of high-grade tumor (areas under ROC curve [AUC]=0.64) and 71% sensitivity and 59% specificity for the diagnosis of LVSI (AUC=0.59). Volumes and tumor short axis were greater for high-grade tumors (P=0.0002 and P=0.004, respectively) and for patients with LVSI (P=0.004 and P=0.0279, respectively). No differences in ADC values were found between high-grade and low-grade tumors and for LVSI. A tumor short axis≥20mm yielded 95% sensitivity and 75% specificity for the diagnosis of high-grade tumor (AUC=0.86). CONCLUSION: MRI-based texture analysis is of limited value to predict high grade and LVSI of endometrial adenocarcinoma. A tumor short axis≥20mm is the best predictor of high grade and LVSI.

[Management of ileal stenosis in patients with Crohn's disease]. / Prise en charge des sténoses iléales de maladie de Crohn.

Stenosis is the most frequent complication during Crohn's disease. The lesion can be inflammatory, or due to a fibrosing or neoplastic process. The medical treatment with anti-inflammatory drugs is usually sufficient as first line treatment; fibrous lesions require endoscopic or surgical procedures while neoplastic lesions require surgery. A multidisciplinary approach (radiologic, medical, surgical and endoscopic) is needed. In a first part, we discuss the definition of stenosis and the modalities of imaging (particularly MRI) and of treatment (particularly with TNFalpha antagonists). Then we expose the strategy for the management of the most frequent clinical situations: occlusion, ileal inflammatory stenosis, stenosis of an ileocolonic anastomosis and chronic fibrous stenosis. The treatment decision takes into account the results of radiological assessment, CRP level and the effects of the previous treatments.

[Imaging of gastrointestinal stromal tumors]. / Imagerie des tumeurs stromales digestives.

Gastrointestinal stromal tumors (GIST) arising from interstitial cells of Cajal, represent the first type of solid tumor, which is very sensitive to a specific molecularly targeted tyrosine kinase receptor blocker (i. e., imatinib). On CT, which is considered as the reference technique, GISTs typically present as large, well-delineated, heterogeneous and sometimes exophytic masses. In contrast with the absence of lymph node involvement, hepatic metastasis as well as mesenteric involvement can be observed. MR-enteroclysis is indicated to investigate the local extent of the disease in specific cases whereas MR imaging is used to detect hepatic metastasis. Because of a specific treatment, contrast-enhanced imaging is needed for the follow-up of treated tumors. Evaluation of tumor response to treatment is best assessed with CT which still remains the reference imaging technique whereas FDG-PET imaging is used in specific cases.

[Why should an abdominal CT scan be performed for suspected appendicitis in the adult patient? Lessons from ten clinical cases]. / Pourquoi faire un scanner en cas de suspicion d'appendicite aiguë de l'adulte?

Ten years after its introduction, the contribution and indications for computed tomography (CT) in the diagnosis of appendicitis remain the subject of controversy among surgeons. Many argue that CT is frequently superfluous and costly, results in excessive radiation exposure, and delays surgical treatment. On our service, we perform 150 to 180 adult appendectomies annually. We feel that CT helps us to avoid unnecessary appendectomy, to clear up diagnostic uncertainty, and, most importantly, to guide the choice of surgical approach. We illustrate our experience through ten clinical cases in which the use of preoperative imaging has resulted in improved care.

MR imaging features of pancreatic acinar cell carcinoma.

PURPOSE: This study aimed to report the magnetic resonance imaging (MRI) features of acinar cell carcinoma (ACC) of the pancreas including diffusion-weighted MRI findings. MATERIALS AND METHODS: The MRI examinations of five patients (3 men, 2 women; median age, 61years) with histopathologically proven ACC of the pancreas were retrospectively reviewed. MR images were analyzed qualitatively (location, shape, homogeneity, signal intensity, vascular involvement and extrapancreatic extent of ACC) and quantitatively (tumor size, apparent diffusion coefficient [ADC] and normalized ADC of ACC). RESULTS: All ACC were visible on MRI, presenting as an oval pancreatic mass (5/5; 100%), with moderate and heterogeneous enhancement (5/5; 100%), with a median transverse diameter of 43mm (Q1, 35; Q3, 82mm; range: 30-91mm). Tumor capsule was visible in 4/5 ACC (80%) and Wirsung duct enlargement in 2/5 ACC (40%). On diffusion-weighted MRI, all ACC (5/5; 100%) were hyperintense on the 3 b value images. Median ADC value of ACC was 1.061×10-3mm2/s (Q1, 0.870×10-3mm2/s; Q3, 1.138×10-3mm2/s; range: 0.834-1.195×10-3mm2/s). Median normalized ADC ratio of ACC was 1.127 (Q1, 1.071; Q3, 1.237; range: 1.054-1.244). CONCLUSIONS: On MRI, ACC of the pancreas presents as a large, oval pancreatic mass with moderate and heterogeneous enhancement after intravenous administration of a gadolinium chelate, with restricted diffusion and a median ADC value of 1.061×10-3mm2/s on diffusion-weighted MRI. Further studies however are needed to confirm our findings obtained in a limited number of patients.

A proposal for standardized magnetic resonance imaging (MRI) descriptors of abnormally invasive placenta (AIP) - From the International Society for AIP.

Abnormally invasive placenta (AIP) is used to describe a placenta that does not separate naturally after delivery and cannot be extirpated without causing abnormally high blood loss. Recently, the use of a standardized terminology for descriptors of AIP signs seen on ultrasound has been prosed but to date no such unified descriptors have been developed for magnetic resonance imaging (MRI). The purpose of this paper is to propose a unified terminology based on a consensus opinion from the members of the International Society for AIP (IS-AIP) that include obstetricians, gynecologists, radiologists, pathologists, anesthesiologists and basic science researchers. We assume that using these standardized MRI descriptors for AIP will be useful for clinical use, education, teaching and future research projects, thus assumably improving care of patients with this condition. In addition, using a uniform terminology for AIP should become the first step of a standardized MRI report.

[Gastrointestinal stromal tumors: role of computed tomography before and after treatment]. / Tumeurs stromales digestives: rôle de la tomodensitometrie avant et apres traitement.

Gastrointestinal stromal tumors (GIST) are the most frequent mesenchymal tumors of the gastrointestinal tract. They are generally located in the stomach or the small bowel and the potential for becoming malignant varies. Due to their expression of c-kit protein, a positive diagnosis as well as a specific targeted treatment by molecular biology (imatinib) are available. Computed tomography is the best imaging method for diagnosis, staging and follow-up of GIST. They appear as a well-defined exophytic mass with heterogeneous enhancement after intravenous injection of iodinated contrast material. They may contain areas of necrosis and/or haemorrhage and enlarged lymph nodes are exceedingly rare. Most common metastatic sites are the liver and mesentery. Large tumour size and liver or mesenteric metastases are computed tomography criteria for a high malignant potential. After treatment, decrease in tumour size, number and density of lesions and the disappearance of enhancing nodules suggest a positive response to imatinib therapy, whereas a new enhancing nodule within a mass is the usual pattern of recurrence. Positron emission tomography may be useful in specific cases when clinical data are inconsistent with computed tomography criteria.

[Complete cost of surgery for postpartum haemorrhage]. / Coût total des actes chirurgicaux dans la prise en charge des hémorragies de la délivrance.

OBJECTIVE: Reduction of maternal mortality is a major priority in the public health domain. One of the main causes of maternal mortality is postpartum haemorrhage. Because economic pressures favour the use of less expensive strategies, it is becoming now critical to know exactly the cost of the surgical procedures involved in the treatment of postpartum haemorrhage, in order to provide future guidelines in Implementing reforms in hospital. MATERIALS AND METHODS: Evaluation was made on multiple data collected in the Gynecology-Obstetrics and Central Sterile Supplies departments of a tertiary care Hospital. Analysis of the production costs was made based on the actual costs. The receipts were figured on the basis of applicable reimbursement in France in 2005, taking into account the financial decisions of the producers. RESULTS: From January 2004 to December 2005, 262 patients were treated for postpartum hemorrhage and patients files were available for review in 255 cases. Of these, surgery was performed in 52 cases. The costs of surgery in the postpartum care ranged from 275.04 euro per manual exploration of the uterine cavity (n=8), 302.48 euro per exploration with valve (n=26), 601.55 euro per vascular ligation (n=3), 725.53 euro per vaginal packing or unpacking (n=10) to 875.06 euro per hysterectomy (n=5). Cleaning and sterilizing of surgical instruments represented a substantial burden, ranging from 7.5% to 11.4% of the total cost of surgery. DISCUSSION AND CONCLUSION: The costs of surgery for postpartum haemorrhage have been calculated to provide future guidelines for the directions and follow-up of these activities in light of the T2A-EPRD and poles of activity. The actual costs could be used to determine the bases of one or more French DRGs (PMSI) "postpartum hemorrhage" evolution.

[Percutaneous abdominopelvic interventional procedures using real-time CT fluoroscopy guidance at 21 mAs: an analysis of 99 consecutive cases]. / Procédures interventionnelles percutanées abdominales et pelviennes sous contrôle TDM à l'aide d'un système de guidage fluoroscopique intégré à 21 mA: analyse de 99 cas.

PURPOSE: The purpose of our study was to retrospectively evaluate the efficacy, the limitations and the complications of real-time CT fluoroscopy (Carevision) as an adjunct to CT guidance for percutaneous abdominopelvic interventional procedures. Materials and methods. During a 28 month period, 99 patients (55 men, 44 women) with a mean age of 59 years had percutaneous abdominopelvic interventional procedure under CT guidance using CT fluoroscopy. Sixty-four patients had a percutaneous drainage of an abdominopelvic fluid collection with a Seldinger technique using an 8.5- to 14-F drainage catheter and 35 patients had a percutaneous biopsy using an 18-G automatic core biopsy needle. RESULTS: In all cases, the quality of the real-time CT fluoroscopic images allowed to securely monitor needle advancement towards the target lesion and to confirm correct position of the needle tip. The diameters of target lesions ranged from 1.5 to 10 cm, with a mean value of 4.75 cm. No immediate complications were observed. The real-time CT fluoroscopy times ranged from 25 to 242 sec, with a mean time of 117 sec. All percutaneous procedures (100%) were successfully performed. CONCLUSION: Our initial clinical experience suggests that real-time CT fluoroscopy allows to perform effective and secure percutaneous abdominopelvic interventional procedures. However, because of substantial radiation exposure, its use has to be limited to specific et selected cases.

[Linear or bubbly: a pictorial review of CT features of intestinal pneumatosis in adults]. / Linéaire ou kystique: une revue iconographique des aspects tomodensitométriques de la pneumatose intestinale de l'adulte.

Pneumatosis intestinalis is a rare condition, which is defined by the presence of gas within the bowel wall. In adult patients, pneumatosis intestinalis can be depicted in various circumstances. Owing to the routine use of CT to investigate patients with abdominal pain, pneumatosis intestinalis can be seen as an incidental finding or can be observed in association with a life-threatening disease such as bowel infarction. On CT images, pneumatosis intestinalis can display two different appearances; one that has a cystic or bubbly appearance can be considered as a chronic pneumatosis and is suggestive for a benign cause while the other, which has a linear appearance can be considered as a symptom and is more frequently secondary to a life-threatening cause. However, none of these two CT characteristics can be considered pathognomonic for any of these two categories of causes. In such situations, the analysis of the location, extent and, if any, associated findings may help to differentiate between benign and life-threatening causes. In these patients who present with abdominal signs that mimic symptoms that would warrant surgical exploration, the analysis of associated findings is critical to rule out a life-threatening cause of pneumatosis intestinalis and to obviate the need for unnecessary laparotomy. In adult patients with a known specific disease such as celiac disease, chronic pseudointestinal obstruction or other chronic diseases, even with accompanying pneumoperitoneum, pneumatosis intestinalis does not uniformly mandate surgical exploration. This pictorial review presents the more and the less common pneumatosis intestinalis CT features in adult patients, with the aim of making the reader more familiar with this potentially misleading sign.