Thrombophlebitis of abdominal veins as an unusual cause for acute abdomen: avoiding the diagnostic pitfalls.

The purpose of this pictorial essay is to review the imaging appearances of the spectrum of thrombophlebitis of abdominal veins on computed tomography (CT) scans. Thrombophlebitis of abdominal veins is rare but mimics other more common conditions presenting with acute abdomen. Due to non-specific presenting symptoms, signs and laboratory findings, diagnosis is largely reliant on imaging, particularly CT which is readily available in the emergency setting.

Randomized trial comparing effects of weight loss by liraglutide with lifestyle modification in non-alcoholic fatty liver disease.

BACKGROUND & AIMS: We compared the effects of weight loss induced with the glucagon-like peptide-1 agonist liraglutide, with that of lifestyle modification, followed by weight maintenance after discontinuing intervention, in obese adults with non-alcoholic fatty liver disease (NAFLD). METHODS: Thirty obese (mean age 40.7 ± 9.1 years, BMI 33.2 ± 3.6 kg/m2 , 90% male) adults with NAFLD defined as liver fat fraction (LFF) > 5% on magnetic resonance imaging without other causes of hepatic steatosis were randomized to a supervised programme of energy restriction plus moderate-intensity exercise to induce ≥ 5% weight loss (DE group, n = 15), or liraglutide 3 mg daily (LI group, n = 15) for 26 weeks, followed by 26 weeks with only advice to prevent weight regain. RESULTS: Diet and exercise and LI groups had significant (P < 0.01) and similar reductions in weight (-3.5 ± 3.3 vs -3.0 ± 2.2 kg), LFF (-8.1 ± 13.2 vs -7.0 ± 7.1%), serum alanine aminotransferase (-39 ± 35 vs -26 ± 33 U/L) and caspase-cleaved cytokeratin-18 (cCK-18) (-206 ± 252 vs -130 ± 158 U/L) at 26 weeks. At 52 weeks, the LI group significantly (P < 0.05) regained weight (1.8 ± 2.1 kg), LFF (4.0 ± 5.3%) and cCK-18 (72 ± 126 U/L), whereas these were unchanged in the DE group. CONCLUSIONS: Liraglutide was effective for decreasing weight, hepatic steatosis and hepatocellular apoptosis in obese adults with NAFLD, but benefits were not sustained after discontinuation, in contrast with lifestyle modification. Continuing the exercise learned in the structured programme contributed to the maintenance of liver fat reduction.

Comparative effects of liraglutide 3 mg vs structured lifestyle modification on body weight, liver fat and liver function in obese patients with non-alcoholic fatty liver disease: A pilot randomized trial.

We compared the effects of weight loss induced by the glucagon-like peptide 1-agonist liraglutide with a structured lifestyle intervention in obese adults with non-alcoholic fatty liver disease (NAFLD). Obese (body mass index ≥30 kg/m2 , mean weight 96.0 ± 16.3 kg) non-diabetic Asian adults, with NAFLD diagnosed by liver fat fraction (LFF) ≥ 5.5% on magnetic resonance imaging without other causes of hepatic steatosis, were randomized to a supervised program of dieting (restriction by 400 kilocalories/d) plus moderate-intensity aerobic exercise (~200 min/wk; DE group, n = 12), or liraglutide at the 3 mg daily dose approved for weight loss (LI group, n = 12), for 26 weeks. Both DE and LI groups had significant (P < .01) and similar reductions in weight (-3.5 ± 3.3 vs -3.5 ± 2.1 kg, respectively, P = .72), LFF (-8.9 ± 13.4 vs -7.2% ± 7.1%, P = .70), serum alanine aminotransferase (-42 ± 46 vs -34 ± 27 U/L, P = .52) and aspartate aminotransferase (-23 ± 24 vs -18 ± 15 U/L, P = .53). In this first randomized study comparing the 2 weight-loss modalities for improving NAFLD, liraglutide was as effective as structured lifestyle modification.

Imaging findings and clinical features of abdominal vascular compression syndromes.

OBJECTIVE: This article describes the typical imaging findings and clinical features that are associated with four abdominal vascular compression syndromes. We explain the underlying pathophysiology that results in these clinical syndromes so that the patient subset who will benefit from treatment can be identified. CONCLUSION: The abdominal vascular compression syndromes discussed here are uncommon and are potentially easily missed on a cursory review of radiologic examinations, particularly in a nonspecific and vague clinical setting. Hence, knowledge of the typical imaging findings and associated clinical symptoms is essential so that the they can be carefully sought and excluded. However, because these findings may also exist in healthy individuals as anatomic variants, it is important to correlate radiologic findings with clinical symptoms to identify the subset of patients who will benefit from treatment.

Solitary necrotic nodule of the liver: radiologic-pathologic correlation in a case with unusual imaging features.

Solitary necrotic nodule of the liver (SNNL) is rare. Generally thought to be nonmalignant, it is often mistaken for malignancy based on imaging findings alone. We present a case of a hepatitis B carrier who was found to have a new sonographically detected hepatic lesion. The lesion was further evaluated with CT and MRI, and as appearances were suggestive of a hypovascular hepatoma, the lesion was surgically resected. This case is unique in that while it demonstrates several characteristic features of SNNL, several other imaging and histological features have not been previously described.

Common and less-common renal masses and masslike conditions.

As an increasing number of imaging examinations are performed, a greater number of incidental renal lesions are detected. Apart from the usual cysts and solid renal cell carcinomas, a variety of unusual benign and malignant renal lesions exist. Imaging is invaluable in characterizing these lesions and is confirmatory in some benign lesions. Renal cell carcinoma remains the diagnosis of exclusion; however, assessment of the imaging pattern in the appropriate clinical context can improve diagnostic accuracy. The objective of this article is to familiarize the radiologist with the imaging appearance of unusual non-neoplastic and neoplastic lesions and correlate with histopathologic studies when available.

Utility of multiplanar and three-dimensional reconstructions from computed tomography performed for maternal indications for visualizing fetal anatomy and estimating gestational age.

OBJECTIVE: The purpose of this article was to determine the usefulness of multiplanar and 3-dimensional (3D) reconstructions of computed tomographic (CT) data from scans performed for maternal indications for visualizing fetal anatomy and estimating gestational age. MATERIALS AND METHODS: Eighteen pregnant patients who had abdominopelvic CT scanning performed for maternal indications formed the study group. Two independent reviewers created multiplanar and 3D-reconstructed images of the fetus from these CT scans and analyzed them for fetal anatomy and gestational age. Fetal dose estimates were also obtained. RESULTS: Computed tomographic fetal biometry generally agreed well with ultrasound estimates. Computed tomographic and ultrasound estimates were within 3 to 4 weeks of each other 95% of the time for the 2 reviewers. Pearson correlation coefficients were 0.989 for reviewer 1 and 0.985 for reviewer 2. Fetal anatomic survey revealed that it was easier to see bones and fluid-filled structures such as the stomach and urinary bladder than intracranial, intrathoracic, and intra-abdominal soft tissue structures. Estimated fetal dose was 28.5 (10.7) mGy using the Imaging Performance Assessment of CT Scanner calculator and 23.7 (7.7) mGy when taking maternal perimeter and fetal depth into account with the method of Angel et al. CONCLUSIONS: It is technically feasible to produce clinically useful images of the fetus using standard multiplanar reconstructions and 3D algorithms already in place for CT scanning. As CT scans continue to be performed under certain circumstances, particularly the emergency department setting, evaluation of maternal CT scans for potentially useful information about the fetus such as gestational age and gross anatomic survey can be obtained at estimated fetal radiation doses much lower than the actionable level of 150 mGy.