Myeloma Spine and Bone Damage Score (MSBDS) on Whole-Body Computed Tomography (WBCT): Multiple Reader Agreement in a Multicenter Reliability Study.

Objective: To assess the reliability of the myeloma spine and bone damage score (MSBDS) across multiple readers with different levels of expertise and from different institutions. Methods: A reliability exercise, including 104 data sets of static images and complete CT examinations of patients affected by multiple myeloma (MM), was performed. A complementary imaging atlas provided detailed examples of the MSBDS scores, including low-risk and high-risk lesions. A total of 15 readers testing the MSBDS were evaluated. ICC estimates and their 95% confidence intervals were calculated based on mean rating (k = 15), absolute agreement, a two-way random-effects model and Cronbach's alpha. Results: Overall, the ICC correlation coefficient was 0.87 (95% confidence interval: 0.79-0.92), and the Cronbach's alpha was 0.93 (95% confidence interval: 0.94-0.97). Global inter- and intra-observer agreement among the 15 readers with scores below or equal to 6 points and scores above 6 points were 0.81 (95% C.I.: 0.72-0.86) and 0.94 (95% C.I.:0.91-0.98), respectively. Conclusion: We present a consensus-based semiquantitative scoring systems for CT in MM with a complementary CT imaging atlas including detailed examples of relevant scoring techniques. We found substantial agreement among readers with different levels of experience, thereby supporting the role of the MSBDS for possible large-scale applications. Significance and Innovations • Based on previous work and definitions of the MSBDS, we present real-life reliability data for quantitative bone damage assessment in multiple myeloma (MM) patients on CT. • In this study, reliability for the MSBDS, which was tested on 15 readers with different levels of expertise and from different institutions, was shown to be moderate to excellent. • The complementary CT imaging atlas is expected to enhance unified interpretations of the MSBDS between different professionals dealing with MM patients in their routine clinical practice.

There are more anatomical variants in heaven and earth, Horatio, than are dreamt of in our philosophy: the precaval left renal artery.

AIM: To describe the CT findings in eight patients with left-sided inferior vena cava (IVC) in whom the left renal artery presented a precaval course (pLRA). MATERIALS AND METHODS: We searched the teaching files of six radiology departments for patients with pLRAs. Eight patients were found, and the available imaging studies and clinical histories were reviewed. Associated vascular and renal anomalies were noted. RESULTS: No patient had been examined for problems related to the vascular anomaly found. Four had a double IVC and two a solitary left IVC; in all, the left-sided IVCs had hemiazygos continuation. One patient had situs viscerum inversus. In one case, there was a left kidney in left iliac fossa. CONCLUSION: Although rare and probably overlooked, a pLRAs can be encountered in patients with situs viscerum inversus or presenting a left-sided IVC with hemiazygos continuation. These vessels can cause technical problems during surgery at the left renal hilum and should be specifically searched for in patients with vascular anomalies.

Epiploic appendage torsed within a spigelian hernia: US and CT findings.

We report the sonographic and CT findings in a patient with an epiploic appendage strangulated within a Spigelian hernia sac. The patient presented with a small, tender, palpable mass, which, at sonography, was located within the abdominal wall, lateral to the rectus abdominis muscle, and had the appearance of an inflamed epiploic appendage. The same findings were confirmed by unenhanced CT. Surgery showed an epiploic appendage of the sigmoid colon within a small Spigelian hernia; the appendage was torsed around its pedicle at the entrance into the hernia sac.

Pre- and post-operative work-up in patients affected by early cervical cancer and eligible for fertility-sparing treatment: role of MRI with saline hydrocolpos.

Nowadays young women affected by early invasive uterine cervical cancer (stage IA2-IB1) may be offered a fertility-sparing treatment: the radical trachelectomy with pelvic lymph node dissection. This procedure consists in surgical removal of cervix uteri, proximal parametrial tissue, and vaginal cuff. The morphology and the functions of corpus uteri are preserved. Women candidates for trachelectomy must be closely selected. Gynecologist oncologist needs an imaging modality that can accurately value the tumoral diameter and which can demonstrate proximal extension of tumor to ensure surgical clear resection margins (especially the cranial one). Magnetic resonance imaging (MRI) is a very useful examination in pre-operative study of women affected by early cervical cancer. The aim of this study is to evaluate the role of MRI with hydrocolpos about pre- and post-operative work-up in women eligible for fertility-sparing treatment.

Synchronous parenchymal renal tumors of different histology in the same kidney.

BACKGROUND: Synchronous primary cortical tumors of different histology in the same kidney are rare. Preoperative awareness of this coexistence is important, since it can help in planning the surgical approach. PURPOSE: To describe the imaging findings observed in five patients with two parenchymal malignant tumors of different histology in the same kidney. MATERIAL AND METHODS: We reviewed the pathology reports of 381 patients operated for renal tumors from January 2000 to March 2007. The medical records of all patients with multiple, synchronous, primary lesions of different histology in the same kidney were reviewed with special attention to imaging findings and indications on the nature of the disease process. Computed tomography (CT) examinations were retrospectively evaluated for tumor detection, size, location, and enhancement pattern. RESULTS: We found seven patients with synchronous tumors of different histology in the same kidney (1.8%). Among these, five (1.3%) had two malignancies of different subtypes and represent our study group. Four had preoperative ultrasound; all had CT. Imaging allowed identification of multifocality in 4/5 cases and, in 3/4 patients with visible double tumors, recognition of differences in lesion appearance. In only one patient did the two tumors have similar enhancement patterns. CONCLUSION: It is possible to suspect preoperatively the presence of tumors of different histologic subtypes within the same kidney. Imaging findings may provide information regarding the presence of lesions with different aggressiveness within the kidney, which may be helpful in therapeutic planning.

Crohn disease obstruction of the biliopancreatic limb in a patient operated for biliopancreatic diversion for morbid obesity.

Although rare, patients with biliopancreatic diversion for morbid obesity will be subject to obstruction of the biliopancreatic limb. This condition is commonly due to postoperative adhesions and intussusception and usually presents with misleading clinical and radiographic features that can delay the diagnosis and the treatment. We recently encountered a patient with obstruction of the biliopancreatic limb due to involvement from Crohn disease. We report this case to highlight the clinical and imaging findings of this rare condition.