Prevalence, distribution, and hepatic fibrosis burden of the different subtypes of steatotic liver disease in primary care settings.

BACKGROUND AND AIM: In relation to the new umbrella terminology for steatotic liver disease (SLD), we aimed to elucidate the prevalence, distribution, and clinical characteristics of the SLD subgroups in the primary care setting. APPROACH AND RESULTS: We retrospectively collected data from 2535 individuals who underwent magnetic resonance elastography and MRI proton density fat fraction during health checkups in 5 primary care health promotion clinics. We evaluated the presence of cardiometabolic risk factors according to predefined criteria and divided all the participants according to the new SLD classification. The prevalence of SLD was 39.13% in the total cohort, and 95.77% of the SLD cases had metabolic dysfunction (one or more cardiometabolic risk factors). The prevalence of metabolic dysfunction-associated steatotic liver disease (MASLD) was 29.51%, with those of metabolic dysfunction and alcohol associated steatotic liver disease (MetALD) and alcohol-associated liver disease (ALD) at 7.89% and 0.39%, respectively. According to the old criteria, the prevalence of NAFLD was 29.11%, and 95.80% of the NAFLD cases fulfilled the new criteria for MASLD. The distribution of SLD subtypes was highest for MASLD, at 75.40%, followed by MetALD at 20.06%, cryptogenic SLD at 3.33%, and ALD at 1.01%. The MetALD group had a significantly higher mean magnetic resonance elastography than the MASLD or ALD group. CONCLUSION: Almost all the patients with NAFLD met the new criteria for MASLD. The fibrosis burden of the MetALD group was higher than those of the MASLD and ALD groups.

Diagnostic Performance of Noninvasive Tests for Advanced Hepatic Fibrosis in Young Age Population.

BACKGROUND & AIMS: Most noninvasive tests (NITs) for hepatic fibrosis are designed for middle-aged patients with chronic liver disease. We compared the diagnostic performance of major NITs (aspartate aminotransferase-to-platelet ratio index [APRI], Fibrosis-4 index, and nonalcoholic fatty liver disease fibrosis score) for a community-based cohort. METHODS: This cross-sectional study analyzed 8775 participants who underwent magnetic resonance elastography at community health check-up centers. Advanced hepatic fibrosis (≥F3) was defined by magnetic resonance elastography thresholds of 3.6 kPa. The diagnostic performance of 3 NITs was evaluated according to the etiology of liver disease, sex, metabolic syndrome, obesity, and increased aminotransferase levels in 4 age groups. RESULTS: The APRI generally showed the best area under the receiver operating characteristic curve in patients aged 45 years or younger, and it was statistically significant in patients with chronic viral hepatitis and alcoholic fatty liver disease (P < .043). The best APRI cut-off value for detecting advanced hepatic fibrosis was 0.4, with a sensitivity and specificity of 75.8% and 73.5%, respectively, in the community-based cohort. The APRI showed balanced sensitivity and specificity across all age groups, whereas the other metrics showed low sensitivity in those aged <45 and low specificity in those >65 years. CONCLUSIONS: The APRI showed better sensitivity and negative predictive value than the Fibrosis-4 index and the nonalcoholic fatty liver disease fibrosis score in community-based populations with mixed etiology, and, thus, can be performed as the primary test in young adults (age, ≤45 y).

A Reappraisal of the Diagnostic Performance of B-Mode Ultrasonography for Mild Liver Steatosis.

INTRODUCTION: Previous studies have shown that ultrasonography has high specificity (80%-100%) but low sensitivity (50%-70%) in diagnosing fatty liver; sensitivity is especially low for mild steatosis. In this study, we aimed to reappraise the diagnostic performance of B-mode ultrasonography (B-USG) for fatty liver disease. METHODS: We performed a retrospective, multinational, multicenter, cross-sectional, observational study (6 referral centers from 3 nations). We included 5,056 participants who underwent both B-USG and magnetic resonance proton density fat fraction (MRI-PDFF) within a 6-month period. The diagnostic performance of B-USG was compared with that of MRI-PDFF as a reference standard for fatty liver diagnosis, using sensitivity, specificity, positive and negative predictive values, diagnostic accuracy, and area under the receiver operating characteristic curve (AUC). RESULTS: B-USG showed a sensitivity of 83.4%, specificity of 81.0%, and AUC of 0.822 in diagnosing mild liver steatosis (6.5% ≤MRI-PDFF ≤14%). The sensitivity, specificity, and AUC in diagnosing the presence of fatty liver disease (MRI-PDFF ≥6.5%) were 83.4%, 81.0%, and 0.822, respectively. The mean PDFF of B-USG-diagnosed nonfatty liver differed significantly from that of diagnosed mild liver steatosis (3.5% ± 2.8% vs 8.5% ± 5.0%, P < 0.001). The interinstitutional variability of B-USG in diagnosing fatty liver was similar in diagnostic accuracy among the 6 centers (range, 82.8%-88.6%, P = 0.416). DISCUSSION: B-USG was an effective, objective method to detect mild liver steatosis using MRI-PDFF as comparison, regardless of the etiologies and comorbidities.

Sarcopenia assessed with DXA and CT increases the risk of perioperative complications in patients with gastrectomy.

OBJECTIVES: We investigated sarcopenia prevalence using various diagnostic criteria based on dual-energy X-ray absorptiometry (DXA) and computed tomography (CT) in gastric cancer patients who underwent gastrectomy, and evaluated the association between sarcopenia and perioperative complications. METHODS: This retrospective study included consecutive patients with gastric cancer who underwent gastrectomy, and preoperative DXA and CT from January 2013 to November 2020. Body composition was measured using DXA and CT. Height-adjusted DXA-based Appendicular Skeletal Muscle Mass Index (ASMI) and CT-based skeletal muscle cross-sectional area at the L3 level (SMI) were measured. Sarcopenia and sarcopenic obesity were defined using reported cutoff values. The chi-square test and univariate analysis were performed to determine risk factors for significant and severe perioperative complications (Clavien-Dindo Grades ≥ 2 and ≥ 3, respectively). RESULTS: In total, 77 males and 43 females aged 61.4 ± 11.0 years were included. ASMI and SMI were correlated (r = 0.819), but sarcopenia prevalence varied (20.0-63.3%), depending on the criteria applied. Univariate analysis revealed sarcopenia defined using the Asian Working Group on Sarcopenia (AWGS) criteria and sarcopenic obesity as risk factors for significant (odds ratio [OR] 2.76, p = 0.030 vs. OR 4.31, p = 0.002) and severe perioperative complications (OR 3.77, p = 0.036 vs. OR 4.78, p = 0.010). In subgroup analyses, sarcopenia and sarcopenic obesity were significantly associated with perioperative complications only in males. CONCLUSION: Perioperative complication risk can be predicted from sarcopenia defined using the AWGS criteria and sarcopenic obesity measured using DXA and CT, particularly in males. KEY POINTS: • The prevalence of sarcopenia varies due to definition differences. • Sarcopenia and sarcopenic obesity are risk factors for significant and severe perioperative complications, particularly in males. • Our results suggest that physicians need to pay attention to perioperative complications after surgical treatment of male patients with sarcopenia and sarcopenic obesity.

High-resolution pancreatic computed tomography for assessing pancreatic ductal adenocarcinoma resectability: a multicenter prospective study.

OBJECTIVE: This prospective multicenter study aimed to evaluate the diagnostic performance of 80-kVp thin-section pancreatic CT in determining pancreatic ductal adenocarcinoma (PDAC) resectability according to the recent National Comprehensive Cancer Network (NCCN) guidelines. METHODS: We prospectively enrolled surgical resection candidates for PDAC from six tertiary referral hospitals (study identifier: NCT03895177). All participants underwent pancreatic CT using 80 kVp tube voltage with 1-mm reconstruction interval. The local resectability was prospectively evaluated using NCCN guidelines at each center and classified into three categories: resectable, borderline resectable, and unresectable. RESULTS: A total of 138 patients were enrolled; among them, 60 patients underwent neoadjuvant therapy. R0 resection was achieved in 103 patients (74.6%). The R0 resection rates were 88.7% (47/53), 52.4% (11/21), and 0.0% (0/4) for resectable, borderline resectable, and unresectable disease, respectively, in 78 patients who underwent upfront surgery. Meanwhile, the rates were 90.9% (20/22), 76.7% (23/30), and 25.0% (2/8) for resectable, borderline resectable, and unresectable PDAC, respectively, in patients who received neoadjuvant therapy. The area under curve of high-resolution CT in predicting R0 resection was 0.784, with sensitivity, specificity, and accuracy of 87.4% (90/103), 48.6% (17/35), and 77.5% (107/138), respectively. Tumor response was significantly associated with the R0 resection after neoadjuvant therapy (odds ratio [OR] = 38.99, p = 0.016). CONCLUSION: An 80-kVp thin-section pancreatic CT has excellent diagnostic performance in assessing PDAC resectability, enabling R0 resection rates of 88.7% and 90.9% for patients with resectable PDAC who underwent upfront surgery and patients with resectable PDAC after neoadjuvant therapy, respectively. KEY POINTS: • The margin-negative (R0) resection rates were 88.7% (47/53), 52.4% (11/21), and 0.0% (0/4) for resectable, borderline resectable, and unresectable pancreatic ductal adenocarcinoma (PDAC), respectively, on 80-kVp thin-section pancreatic CT in the 78 patients who underwent upfront surgery. • Among the 60 patients who underwent neoadjuvant therapy, the R0 rates were 90.9% (20/22), 76.7% (23/30), and 25.0% (2/8) for resectable, borderline resectable, and unresectable PDAC, respectively. • Tumor response, along with the resectability status on pancreatic CT, was significantly associated with the R0 resection rate after neoadjuvant therapy.

Effect of Contrast Level and Image Format on a Deep Learning Algorithm for the Detection of Pneumothorax with Chest Radiography.

Under the black-box nature in the deep learning model, it is uncertain how the change in contrast level and format affects the performance. We aimed to investigate the effect of contrast level and image format on the effectiveness of deep learning for diagnosing pneumothorax on chest radiographs. We collected 3316 images (1016 pneumothorax and 2300 normal images), and all images were set to the standard contrast level (100%) and stored in the Digital Imaging and Communication in Medicine and Joint Photographic Experts Group (JPEG) formats. Data were randomly separated into 80% of training and 20% of test sets, and the contrast of images in the test set was changed to 5 levels (50%, 75%, 100%, 125%, and 150%). We trained the model to detect pneumothorax using ResNet-50 with 100% level images and tested with 5-level images in the two formats. While comparing the overall performance between each contrast level in the two formats, the area under the receiver-operating characteristic curve (AUC) was significantly different (all p < 0.001) except between 125 and 150% in JPEG format (p = 0.382). When comparing the two formats at same contrast levels, AUC was significantly different (all p < 0.001) except 50% and 100% (p = 0.079 and p = 0.082, respectively). The contrast level and format of medical images could influence the performance of the deep learning model. It is required to train with various contrast levels and formats of image, and further image processing for improvement and maintenance of the performance.

Prevalence of advanced hepatic fibrosis and comorbidity in metabolic dysfunction-associated fatty liver disease in Korea.

BACKGROUND & AIMS: There are several reports on the prevalence of metabolic dysfunction-associated fatty liver disease (MAFLD). However, the prevalence of advanced hepatic fibrosis in MAFLD is largely unknown. We aimed to evaluate the prevalence of advanced fibrosis in MAFLD. METHODS: A total of 6775 subjects from nationwide 13 health check-up centres were included in this cross-sectional study. Fatty liver was evaluated using ultrasonography. Significant (≥F2) and advanced (≥F3) hepatic fibrosis were defined by MRE thresholds of 3.0 kPa (range: 2.99-3.65 kPa) and 3.6 kPa (range: 3.4-3.9 kPa) respectively. The sex- and age-standardized prevalence of MAFLD and hepatic fibrosis was estimated. RESULTS: The sex- and age-standardized prevalence of MAFLD was 33.9%. The prevalence of obesity (BMI ≥25 kg/m2 ) in MAFLD was 71.1%, and 79.0% of obese subjects had MAFLD. The prevalence of diabetes in MAFLD was 13.3%, and 73.6% of subjects with diabetes had MAFLD. The sex- and age-standardized prevalence of significant (≥F2) and advanced hepatic fibrosis (≥F3) amongst MAFLD was 9.7% (range: 3.0-9.8%) and 3.0% (range: 2.6-4.6%) respectively. The prevalence of advanced hepatic fibrosis in overweight/obese (group I), lean (group II) and diabetic (group III) MAFLD was 2.3%, 3.1% and 9.5% respectively. CONCLUSION: The sex- and age-standardized prevalence of advanced fibrosis was 3.0% (range: 2.6-4.6%) in subjects with MAFLD.

Differentiation of Small Hepatic Abscess From Hepatic Metastasis With a Combination of Imaging Parameters.

OBJECTIVE: We aimed to evaluate the diagnostic performance of the combination imaging features to differentiate small (the lesion size of 3 cm or less) hepatic abscess from metastasis. METHODS: This retrospective study included patients with preexisting malignancy and small hepatic lesions who underwent contrast-enhanced computed tomography (CT) and gadoxetic acid-enhanced magnetic resonance imaging (MRI) within 4 days between March 2017 and July 2020. Two radiologists independently evaluated the imaging features of each focal hepatic lesion. Laboratory parameters were also recorded. Significant parameters differentiating hepatic abscess from hepatic metastasis were identified by univariate generalized estimating equation regression. We compared the diagnostic performances of laboratory parameters, imaging features, and their combinations. RESULTS: We included 16 patients (10 males and 6 females) with 35 hepatic abscesses and 21 patients (13 males and 8 females) with 62 metastases with a mean age of 70.3 years in this study. Abnormal segmental neutrophil, pathy parenchymal enhancement on CT, and absence of dark rim on MRI were associated with hepatic abscess (all P < 0.01). The combination of CT and MRI parameters showed significantly higher specificity and positive predictive value than CT alone ( P ≤ 0.031), without significant difference in sensitivity and negative predictive value. CONCLUSIONS: We have demonstrated that the combination of CT and MRI imaging features is helpful for the differentiation of small hepatic abscess from metastasis.

Population-based and Personalized Reference Intervals for Liver and Spleen Volumes in Healthy Individuals and Those with Viral Hepatitis.

Background Reference intervals guiding volumetric assessment of the liver and spleen have yet to be established. Purpose To establish population-based and personalized reference intervals for liver volume, spleen volume, and liver-to-spleen volume ratio (LSVR). Materials and Methods This retrospective study consecutively included healthy adult liver donors from 2001 to 2013 (reference group) and from 2014 to 2016 (healthy validation group) and patients with viral hepatitis from 2007 to 2017. Liver volume, spleen volume, and LSVR were measured with CT by using a deep learning algorithm. In the reference group, the reference intervals for the volume indexes were determined by using the population-based (ranges encompassing the central 95% of donors) and personalized (quantile regression modeling of the 2.5th and 97.5th percentiles as a function of age, sex, height, and weight) approaches. The validity of the reference intervals was evaluated in the healthy validation group and the viral hepatitis group. Results The reference and healthy validation groups had 2989 donors (mean age ± standard deviation, 30 years ± 9; 1828 men) and 472 donors (mean age, 30 years ± 9; 334 men), respectively. The viral hepatitis group had 158 patients (mean age, 48 years ± 12; 95 men). The population-based reference intervals were 824.5-1700.0 cm3 for liver volume, 81.1-322.0 cm3 for spleen volume, and 3.96-13.78 for LSVR. Formulae and a web calculator (https://i-pacs.com/calculators) were presented to calculate the personalized reference intervals. In the healthy validation group, both the population-based and personalized reference intervals were used to classify the volume indexes of 94%-96% of the donors as falling within the reference interval. In the viral hepatitis group, when compared with the population-based reference intervals, the personalized reference intervals helped identify more patients with volume indexes outside the reference interval (liver volume, 21.5% [34 of 158] vs 13.3% [21 of 158], P = .01; spleen volume, 29.1% [46 of 158] vs 22.2% [35 of 158], P = .01; LSVR, 35.4% [56 of 158] vs 26.6% [42 of 158], P < .001). Conclusion Reference intervals derived from a deep learning approach in healthy adults may enable evidence-based assessments of liver and spleen volume in clinical practice. © RSNA, 2021 Online supplemental material is available for this article. See also the editorial by Ringl in this issue.

Assessment of liver fibrosis severity using computed tomography-based liver and spleen volumetric indices in patients with chronic liver disease.

OBJECTIVES: To evaluate whether the liver and spleen volumetric indices, measured on portal venous phase CT images, could be used to assess liver fibrosis severity in chronic liver disease. METHODS: From 2007 to 2017, 558 patients (mean age 48.7 ± 13.1 years; 284 men and 274 women) with chronic liver disease (n = 513) or healthy liver (n = 45) were retrospectively enrolled. The liver volume (sVolL) and spleen volume (sVolS), normalized to body surface area and liver-to-spleen volume ratio (VolL/VolS), were measured on CT images using a deep learning algorithm. The correlation between the volumetric indices and the pathologic liver fibrosis stages combined with the presence of decompensation (F0, F1, F2, F3, F4C [compensated cirrhosis], and F4D [decompensated cirrhosis]) were assessed using Spearman's correlation coefficient. The performance of the volumetric indices in the diagnosis of advanced fibrosis, cirrhosis, and decompensated cirrhosis were evaluated using the area under the receiver operating characteristic curve (AUC). RESULTS: The sVolS (ρ = 0.47-0.73; p < .001) and VolL/VolS (ρ = -0.77-- 0.48; p < .001) showed significant correlation with liver fibrosis stage in all etiological subgroups (i.e., viral hepatitis, alcoholic and non-alcoholic fatty liver, and autoimmune diseases), while the significant correlation of sVolL was noted only in the viral hepatitis subgroup (ρ = - 0.55; p < .001). To diagnose advanced fibrosis, cirrhosis, and decompensated cirrhosis, the VolL/VolS (AUC 0.82-0.88) and sVolS (AUC 0.82-0.87) significantly outperformed the sVolL (AUC 0.63-0.72; p < .001). CONCLUSION: The VolL/VolS and sVolS may be used for assessing liver fibrosis severity in chronic liver disease. KEY POINTS: • Volumetric indices of liver and spleen measured on computed tomography images may allow liver fibrosis severity to be assessed in patients with chronic liver disease.

Analysis of Electrical and Nano-Mechanical Properties of Cu-Fe Thin Foil Using Dynamic Nanoindentation.

A Cu-Fe thin foil for high-performance leadframe semiconductor packaging was prepared by powder metallurgy and mechanical rolling, and its nano-mechanical and electrical properties were analyzed. The phases in the final Cu-Fe thin foil were Cu (Fm-3m), Fe (Im-3m), and Cu0.8Fe0.2 (Fm-3m). The nano-hardness, stiffness, and fatigue limit values of the Cu-Fe thin foil based on the Oliver and Alekhin models were 2.3 GPa, 158.1 MPa, and 0.17, respectively, while its surface resistivity was 6.953 Ω/sq.

Correlation of Clinical and Histopathologic Parameters with Ultrasonographic Grades in Pediatric Non-Alcoholic Fatty Liver Disease.

BACKGROUND: Liver biopsy is the gold standard for diagnosing non-alcoholic steatohepatitis (NASH), but liver biopsy in children is not available in many institutes and many parents are reluctant to agree with the procedure. We investigated the correlation of clinical and pathologic parameters with the severity of non-alcoholic fatty liver disease (NAFLD) in pediatric patients using ultrasonographic examination methods and measured the prevalence of fatty pancreas in pediatric NAFLD. METHODS: Liver biopsy and abdominal ultrasound (US) examinations were performed in 58 children (42 boys, 16 girls; mean age, 12 years; age range, 4-19 years) between March 2006 and August 2017. Fatty liver and fatty pancreas were evaluated by two independent radiologists using US according to 4- and 3-point scales, respectively. We then analyzed the correlations of clinical, laboratory, and histopathologic parameters with the ultrasonographic grade of steatosis. RESULTS: Forty-two children showed simple steatosis (NAFLD activity score [NAS] ≤ 5) while 16 showed NASH (NAS > 5). Higher body mass index (BMI) percentile, waist circumference, hematocrit, insulin resistance, and lower insulin sensitivity index were significantly positively correlated with the grade of fatty liver. NAFLD activity score, amount of steatosis, and fibrosis significantly worsened as the fatty liver grade increased. Higher BMI, lower insulin sensitivity index, and boy were significantly positively correlated with the fatty pancreas grade. CONCLUSION: Altogether, ultrasonographic severity of fatty liver shows good correlation with that of clinical parameters and hepatic pathology.

Development and Validation of a Deep Learning System for Staging Liver Fibrosis by Using Contrast Agent-enhanced CT Images in the Liver.

Purpose To develop and validate a deep learning system (DLS) for staging liver fibrosis by using CT images in the liver. Materials and Methods DLS for CT-based staging of liver fibrosis was created by using a development data set that included portal venous phase CT images in 7461 patients with pathologically confirmed liver fibrosis. The diagnostic performance of the DLS was evaluated in separate test data sets for 891 patients. The influence of patient characteristics and CT techniques on the staging accuracy of the DLS was evaluated by logistic regression analysis. In a subset of 421 patients, the diagnostic performance of the DLS was compared with that of the radiologist's assessment, aminotransferase-to-platelet ratio index (APRI), and fibrosis-4 index by using the area under the receiver operating characteristic curve (AUROC) and Obuchowski index. Results In the test data sets, the DLS had a staging accuracy of 79.4% (707 of 891) and an AUROC of 0.96, 0.97, and 0.95 for diagnosing significant fibrosis (F2-4), advanced fibrosis (F3-4), and cirrhosis (F4), respectively. At multivariable analysis, only pathologic fibrosis stage significantly affected the staging accuracy of the DLS (P = .016 and .013 for F1 and F2, respectively, compared with F4), whereas etiology of liver disease and CT technique did not. The DLS (Obuchowski index, 0.94) outperformed the radiologist's interpretation, APRI, and fibrosis-4 index (Obuchowski index range, 0.71-0.81; P ˂ .001) for staging liver fibrosis. Conclusion The deep learning system allows for accurate staging of liver fibrosis by using CT images. © RSNA, 2018 Online supplemental material is available for this article.

Higher visceral fat area/subcutaneous fat area ratio measured by computed tomography is associated with recurrence and poor survival in patients with mid and low rectal cancers.

PURPOSE: Obesity is thought to influence postoperative complications and recurrence of mid and low rectal cancer (MLRC) because of intraoperative technical difficulties. However, few reports have described the relationship between obesity indices and the clinical outcomes of MLRC. This study aimed to investigate the association between visceral obesity on computed tomography (CT) and oncolofical outcomes after surgery for MLRC and identify the obesity index that most accurately reflects clinical outcomes. METHODS: We investigated 125 patients who underwent curative resection for MLRC between 2004 and 2010. Visceral fat area (VFA) was defined as the umbilicus-level intra-abdominal adipose tissue area measured by CT. Body mass index (BMI), total fat area, VFA, subcutaneous fat area (SFA) and VFA/SFA ratio (V/S ratio) were analysed. RESULTS: The median follow-up time was 60.3 months (range, 38.2-122.6 months). Recurrence was detected in 28 (22.4%) patients. Among the various obesity indices, recurrence was significantly associated with V/S ratio only (1.02 ± 0.45 versus 0.86 ± 0.34; P = 0.046). Stage, preoperative carcinoembryonic antigen level, V/S ratio, lymphatic invasion and perineural invasion were significantly associated with recurrence on univariate analysis, while only V/S ratio (P = 0.019; 95% confidence interval, 1.22 to 9.09) was significantly associated with recurrence on multivariate analysis. Disease-free and overall survival of the obese group (V/S ratio > 1.0) were shorter than those of the non-obese group. CONCLUSIONS: V/S ratio is the optimal obesity index for predicting stage I-III MLRC recurrence.

Spontaneous Renal Artery Dissection as a Cause of Acute Renal Infarction: Clinical and MDCT Findings.

The purpose of this study was to assess the incidence of spontaneous renal artery dissection (SRAD) as a cause of acute renal infarction, and to evaluate the clinical and multidetector computed tomography (MDCT) findings of SRAD. From November 2011 to January 2014, 35 patients who were diagnosed with acute renal infarction by MDCT were included. We analyzed the 35 MDCT data sets and medical records retrospectively, and compared clinical and imaging features of SRAD with an embolism, using Fisher's exact test and the Mann-Whitney test. The most common cause of acute renal infarction was an embolism, and SRAD was the second most common cause. SRAD patients had new-onset hypertension more frequently than embolic patients. Embolic patients were found to have increased C-reactive protein (CRP) more often than SRAD patients. Laboratory results, including tests for lactate dehydrogenase (LDH) and blood urea nitrogen (BUN), and the BUN/creatinine ratio (BCR) were significantly higher in embolic patients than SRAD patients. Bilateral renal involvement was detected in embolic patients more often than in SRAD patients. MDCT images of SRAD patients showed the stenosis of the true lumen, due to compression by a thrombosed false lumen. None of SRAD patients progressed to an estimated glomerular filtration rate < 60 mL/min/1.73 m² or to end-stage renal disease during the follow-up period. SRAD is not a rare cause of acute renal infarction, and it has a benign clinical course. It should be considered in a differential diagnosis of acute renal infarction, particularly in patients with new-onset hypertension, unilateral renal involvement, and normal ranges of CRP, LDH, BUN, and BCR.

MR Enterography for the Evaluation of Small-Bowel Inflammation in Crohn Disease by Using Diffusion-weighted Imaging without Intravenous Contrast Material: A Prospective Noninferiority Study.

PURPOSE: To determine whether magnetic resonance (MR) enterography performed with diffusion-weighted imaging (DWI) without intravenous contrast material is noninferior to contrast material-enhanced (CE) MR enterography for the evaluation of small-bowel inflammation in Crohn disease. MATERIALS AND METHODS: Institutional review board approval and informed consent were obtained for this prospective noninferiority study. Fifty consecutive adults suspected of having Crohn disease underwent clinical assessment, MR enterography, and ileocolonoscopy within 1 week. MR enterography included conventional imaging and DWI (b = 900 sec/mm(2)). In 44 patients with Crohn disease, 171 small-bowel segments that were generally well distended and showed a wide range of findings, from normalcy to severe inflammation (34 men, 10 women; mean age ± standard deviation, 26.9 years ± 6.1), were selected for analysis. Image sets consisting of (a) T2-weighted sequences with DWI and (b) T2-weighted sequences with CE T1-weighted sequences were reviewed by using a crossover design with blinding and randomization. Statistical analyses included noninferiority testing regarding proportional agreement between DWI and CE MR enterography for the identification of bowel inflammation with a noninferiority margin of 80%, correlation between DWI and CE MR enterography scores of bowel inflammation severity, and comparison of accuracy between DWI and CE MR enterography for the diagnosis of terminal ileal inflammation by using endoscopic findings as the reference standard. RESULTS: The agreement between DWI and CE MR enterography for the identification of bowel inflammation was 91.8% (157 of 171 segments; one-sided 95% confidence interval: ≥88.4%). The correlation coefficient between DWI and CE MR enterography scores was 0.937 (P < .001). DWI and CE MR enterography did not differ significantly regarding the sensitivity and specificity for the diagnosis of terminal ileal inflammation (P > .999). DWI and CE MR enterography concurred in the diagnosis of penetrating complications in five of eight segments. CONCLUSION: DWI MR enterography was noninferior to CE MR enterography for the evaluation of inflammation in Crohn disease in generally well-distended small bowel, except for the diagnosis of penetration.

Cholecystectomy Causes Ultrasound Evidence of Increased Hepatic Steatosis.

BACKGROUND: Cholecystectomy might contribute to the development of hepatic steatosis through metabolic changes. The biologic alteration of the enterohepatic circulation of bile acids and the alteration of the metabolic activity of bile acid that follows cholecystectomy may contribute to hepatic steatosis. This prospective study was conducted to clarify the possibility of steatosis development after cholecystectomy. METHODS: From October 2013 to July 2014, 82 consecutive patients with a presumptive diagnosis of gallbladder disease were cholecystectomized. Liver parenchymal steatosis was measured using ultrasound and the hepatic steatosis index. RESULTS: In all 82 patients, the hepatic steatosis index was found to be significantly correlated with the US fatty liver grade (Spearman's correlation r (2) = 0.331, P < 0.001). A total of 62 patients were followed up for 3 months. Comparison with the initial grade showed that 12 (18.5 %) patients had worsened from normal to mild (n = 10), from mild to moderate (n = 1), and from mild to severe (n = 1). The other patients stayed at their initial grade except one patient who improved (from moderated to mild). Analysis of laboratory findings showed that white blood cell count, aspartate transaminase, alanine transaminase level, and total bilirubin level were decreased. However, serum albumin and high-density lipoprotein cholesterol levels significantly increased. CONCLUSIONS: Hepatic steatosis significantly developed 3 months after cholecystectomy. Therefore, cholecystectomy might be considered a risk factor for hepatic steatosis, but the relationship should be confirmed with long-term follow-up from a large group of patients.

Diffusion-weighted MRI: usefulness for differentiating intrapancreatic accessory spleen and small hypervascular neuroendocrine tumor of the pancreas.

BACKGROUND: Image findings of intrapancreatic accessory spleen (IPAS) can closely resemble those of neuroendocrine tumor (NET) of the pancreas. PURPOSE: To investigate the usefulness of diffusion-weighted imaging (DWI) for differentiating IPAS from small (≤3 cm) hypervascular NET of the pancreas. MATERIAL AND METHODS: The visually assessed signal intensity of pancreatic lesions compared with the spleen on DWI (b value of 1000 s/mm(2)) and the apparent diffusion coefficient (ADC) values were compared in 25 patients with IPAS and 31 patients with small hypervascular NET. Two blinded radiologists independently rated their confidence in differentiating the two conditions and compared the diagnostic performance of contrast-enhanced magnetic resonance imaging (CE-MRI) alone with that of combined CE-MRI and DWI. RESULTS: The isointensity of the pancreatic lesions compared with the spleen on DWI was more frequently observed in IPAS than in NET (92% vs. 12.9%, P < 0.001). The mean ADC value was significantly lower in IPAS than in NET (0.90 × 10(-3) mm(2)/s vs. 1.44 × 10(-3) mm(2)/s, P < 0.001). The sensitivity and specificity of ADC quantification for differentiating the two conditions when using 1.07 × 10(-3) mm(2)/s as the cut-off value were 96% and 93.5%, respectively. For both readers, the area under the receiver operating characteristic curve and accuracy in differentiating the two conditions of combined CE-MRI and DWI were significantly greater than those of CE-MRI alone (P ≤ 0.039). CONCLUSION: Visual assessment of DWI and ADC quantification were useful in differentiating IPAS from small hypervascular NET of the pancreas.

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Rectal syphilis is a rare form of syphilis presentation and its symptoms, endoscopic and radiologic findings are nonspecific. Rectal syphilis typically presents with features such as concentric rectal wall thickening, mucosal hyperemia, perirectal fat stranding, and lymphadenopathy. Rectal cancer exhibits asymmetric wall thickening and lymph node necrosis, aiding in the differentiation between these two diseases. However, due to the considerable overlap in their respective manifestations, distinguishing between rectal syphilis and rectal cancer is extremely challenging without considering the patient's medical history. Rectal syphilis often leads to unnecessary tests or delayed treatment, as it can be mistaken for other benign diseases such as inflammatory bowel diseases in addition to rectal cancer. In this case report, we aim to provide a detailed report on the endoscopic, imaging, and pathological findings based on our experience with a case of suspected rectal malignancy that turned out to be rectal syphilis.

Retroperitoneal Ectopic Pregnancy Detected by CT: A Case Report.

Retroperitoneal ectopic pregnancy is a rare form of ectopic pregnancy. Owing to its rarity and nonspecific symptoms, diagnosing retroperitoneal ectopic pregnancy at the initial presentation poses a significant challenge. Typically, the diagnosis relies on non-radiation imaging modalities, such as ultrasonography and MRI, whereas CT is infrequently used. Herein, we report a rare case of a retroperitoneal ectopic pregnancy, which was diagnosed using CT.