Cross-sectional imaging of pancreatic leak: a pictorial review.

Pancreatic leaks occur when a disruption in the pancreatic ductal system results in the leakage of pancreatic enzymes such as amylase, lipase, and proteases into the abdominal cavity. While often associated with pancreatic surgical procedures, trauma and necrotizing pancreatitis are also common culprits. Cross-sectional imaging, particularly computed tomography, plays a crucial role in assessing postoperative conditions and identifying both early and late complications, including pancreatic leaks. The presence of fluid accumulation or hemorrhage near an anastomotic site strongly indicates a pancreatic fistula, particularly if the fluid is connected to the pancreatic duct or anastomotic suture line. Pancreatic fistulas are a type of pancreatic leak that carries a high morbidity rate. Early diagnosis and assessment of pancreatic leaks require vigilance and an understanding of its imaging hallmarks to facilitate prompt treatment and improve patient outcomes. Radiologists must maintain vigilance and understand the imaging patterns of pancreatic leaks to enhance diagnostic accuracy. Ongoing improvements in surgical techniques and diagnostic approaches are promising for minimizing the prevalence and adverse effects of pancreatic fistulas. In this pictorial review, our aim is to facilitate for radiologists the comprehension of pancreatic leaks and their essential imaging patterns.

Distinct CT imaging features of new liver metastases from primary genitourinary cancers.

PURPOSE: To apply natural language processing (NLP) to a large volume of structured radiology reports in the investigation of CT imaging features of new liver metastases from primary genitourinary cancers. METHODS: In this retrospective study, a previously reported NLP model was applied to consecutive structured CT reports from 2016 to 2022 to predict those patients with primary genitourinary cancer who developed liver metastasis. Pathology or imaging follow-up served as the reference standard for validating NLP predictions. Subsequently, diagnostic CTs of the identified patients were qualitatively assessed by two radiologists, whereby several imaging features of new liver metastasis were assessed. Proportions of the assessed imaging features were compared between primary genitourinary cancers using the Chi-square or Fisher's exact test. RESULTS: In 112 patients (mean age = 72 years; 83 males), the majority of new liver metastases were hypovascular (73.2%), well defined (76.6%), homogenous (66.9%), and without necrotic/cystic component (73.2%). There was a higher proportion of iso- to hyperdense liver metastases for primary kidney cancer vs other primary genitourinary cancers (42.5% in kidney cancer; 2.3% in ureter/bladder cancer, 8% in prostate cancer, and 0% in testicular cancer; p < 0.05) and a higher proportion of new liver metastases with ill-defined margin for primary prostate cancer vs other primary genitourinary cancers (44.0% in prostate cancer, 15.0% in kidney cancer, 18.6% in ureter/bladder cancer, and 25.0% in testicular cancer; p < 0.05). CONCLUSION: New liver metastases from primary genitourinary cancers tend to be hypovascular and show several distinct imaging features between different primary genitourinary cancers.

Small colorectal liver metastases: detection with SPIO-enhanced MRI in comparison with gadobenate dimeglumine-enhanced MRI and CT imaging.

The aim of this prospective study was to compare the diagnostic role of superparamagnetic iron oxide (SPIO)-enhanced liver magnetic resonance imaging (MRI) versus gadobenate dimeglumine (GbD)-enhanced MRI and computed tomography (CT) investigations for detection of small (less than 1cm) colorectal liver metastases (LMs) of colorectal cancer. Seventy-eight LMs in 16 patients were evaluated with dynamic CT imaging, GbD-enhanced dynamic MR imaging and SPIO-enhanced MR imaging. Two radiologists were reviewed the LMs separately. Agreement between the readers and three algorithms was analyzed. Differences between the lesion detection ratios of the methods were analyzed by two proportion z test. Sensitivity values of each modality were also calculated. Interobserver agreement values with kappa analysis were found to be the best for three modalities and kappa values were 0.866, 0.843, and 1.0 respectively. For all 78 LMs, SPIO-enhanced MRI detected all lesions (100% sensitivity). This sensitivity value was higher than GbD-enhanced MRI, and there was a significant difference (p < 0.05). GbD-enhanced MRI depicted 71 lesions and this modality could not detected 7 lesions (91% sensitivity). This modality had moderate sensitivity, and this value is greater than CT imaging, so there was a significant difference also (p < 0.05). Dynamic triphasic CT imaging detected 64 (R1) and 65 (R2) LMs. This modality had the lowest sensitivity (R1: 0.82, R2: 0.83 respectively). Only SPIO-enhanced MRI was able to detect all LMs less than 1cm. LMs were the best detected with SPIO-enhanced MRI. We recommend SPIO-enhanced MRI to be the primary alternative modality especially for diagnosis of small colorectal LMs.

Fast MRI evaluation of pulmonary progressive massive fibrosis with VIBE and HASTE sequences: comparison with CT.

PURPOSE: The aim of this prospective study was to evaluate the diagnostic utility of volumetric interpolated breath-hold examination (VIBE) and half-Fourier-acquisition single-shot turbo spin-echo (HASTE) fast magnetic resonance imaging (MRI) sequences in the evaluation of pulmonary progressive massive fibrosis (PMF) in comparison with computed tomography (CT) imaging. If fast MRI is proven to be diagnostically significant, this modality can be used for diagnosis and follow-up studies of PMF patients. MATERIALS AND METHODS: Twenty-two PMF lesions from 20 coal workers were evaluated. After CT imaging, patients underwent pre-contrast VIBE, contrast-enhanced VIBE, and HASTE MRI studies for detection and evaluation of the PMF lesions. Measurements of the three groups were evaluated with intra-class coefficients. Correlation levels between sizes, image quality, and artifact were evaluated with linear Pearson correlation analysis. RESULTS: There was almost perfect agreement among radiologists for lesion detection with kappa analysis. There was significant agreement between three MRI study groups and gold standard CT images. We found the best agreement values with contrast- enhanced VIBE images for lesion detection and image quality in comparison with CT imaging. Presence of artifact was also lowest with this protocol. CONCLUSION: With fast MRI sequences in pulmonary imaging, image quality has significantly improved being very close to that of CT studies. In this study, contrast-enhanced VIBE protocol provided the best depiction of PMF lesions. This protocol may be an alternative choice for CT, avoiding the use of iodinated contrast material and minimizing exposure to ionizing radiation for follow-up studies.

Evaluation of cervical computed tomography findings in oropharyngeal tularaemia.

Cervical contrast-enhanced computed tomography (CECT) was performed in 16 cases (5M, 11F) of oropharyngeal tularaemia, diagnosed at Zonguldak Karaelmas University, Turkey, between January 2004 and March 2006. All patients showed lymphadenopathy with contrast enhancement, 12 of them with peripheral contrast enhancement. Lymph node necrosis was found in 13 of the patients, abscess formation in 9 and cyst formation in 13. This appears to be the largest series of cervical CECT in oropharyngeal tularaemia reported to date. Tularaemia is a differential diagnosis of massive adenotonsillar enlargement and extensive necrotic cervical lymphadenopathy.