The diagnostic value of DMSA scan in differentiating functional pseudo-tumors from malignancies in scarred kidneys: case series and literature review.

BACKGROUND: The terms "renal regenerating nodule" and "nodular compensatory hypertrophy" are used in the literature to describe functioning pseudo-tumors (FPT) in the setting of an extensively scarred kidney. FPTs are usually discovered incidentally during routine renal imaging. Differentiating these FPTs from renal neoplasms is critical but can be challenging in the setting of chronic kidney disease (CKD) given the limitations related to using contrast-based imaging. CASE SUMMARIES: We report a pediatric case series of 5 CKD patients, with history of urinary tract infections, in which tumor-like lesions evolved in scarred kidneys and were incidentally discovered on routine renal imaging. These were diagnosed as FPT by utilizing dimercaptosuccinic acid (DMSA) imaging and showed stable size and appearance upon follow-up with ultrasound and MRI. CONCLUSION: FPTs can be picked up on routine imaging of pediatric patients with CKD. Although larger cohort studies are needed to confirm these conclusions, our case series supports the evidence that DMSA scan showing uptake at the site of the mass can be a useful tool to suggest the diagnosis of FPTs in children with kidney scarring, and that SPECT DMSA scan adds more precision in picking up and accurately localizing FPTs compared to planar DMSA.

Case Report: Hepatic Adenomatosis in a Patient With Prader-Willi Syndrome.

Prader-Willi syndrome (PWS) is a genetic disorder caused by the lack of expression of genes on the paternally inherited chromosome region 15q11.2-q13. It is a multisystem disorder that is characterized by severe hypotonia with poor suck and feeding difficulties in early infancy, followed in early childhood by excessive eating and gradual development of morbid obesity. The incidence of type 2 diabetes mellitus is high, particularly in obese patients. Non-alcoholic fatty liver disease has also been reported in some patients with PWS. Liver adenomatosis is a benign vascular lesion of the liver, defined by the presence of >10 adenomas, in the otherwise healthy liver parenchyma. We report the first case of a patient with PWS with severe obesity, type 2 diabetes mellitus, and non-alcoholic fatty liver who also developed liver adenomatosis, review the pediatric literature on liver adenomatosis, and discuss the potential underlying mechanisms.

Breast Reconstruction Combining Lipofilling and Prepectoral Prosthesis after Radiotherapy.

Prosthetic reconstruction in previously irradiated breasts has been associated with a higher risk of complications. Here we describe the surgical and cosmetic outcome of our breast reconstruction process based on primary fat grafting combined with prosthetic placement. METHODS: In this multicenter retrospective study, 136 patients who underwent mastectomy and external chest wall radiotherapy between 2014 and 2018 were benefited from chest wall lipofilling and silicone implant placement were chosen. Patients were assessed for skin trophicity, thickness, and mobility and were allowed to undergo several lipofilling sessions before implant placement, if required. No patient had >3 lipofilling sessions. Cosmetic outcome was evaluated by the patient, surgeon, and nurse, using a Likert-type ordinal scale. RESULTS: We included 136 patients: 79 patients (58%) received only 1 session of lipofilling before implant placement, 33 (24.6%) had 2 sessions, and 24 (17.4%) had 3 sessions. The volume of the third lipofilling was significantly higher and the volume of the prosthesis of these patients was significantly lower than those of patients undergoing 1 or 2 lipofillings. Reconstruction failure rate was 2.2% (3 patients had explantation); however, all benefited from prosthesis reconstruction a year after the initial procedures. The average satisfaction score was 4.7 out of 5 as evaluated by patients, 4.8 out of 5 by surgeons, and 4.8 out of 5 by nurses. CONCLUSIONS: Primary lipofilling combined with prosthesis placement after radiotherapy is a reconstructive method that yields a satisfactory cosmetic outcome with a low complication rate. Such minimally invasive breast reconstruction approach can be an alternative to flap-based reconstruction.

The Hippocratic Oath: A Radiologic Perspective.

OBJECTIVE. The purpose of this article is to revisit the Hippocratic Oath, the oldest extant document of medical ethics, and refamiliarize ourselves with the foundation of our profession of radiology. CONCLUSION. Many radiologists have taken the Hippocratic Oath. However, for many, it has been years, even decades, since they last read it. At a time when the field of radiology is undergoing rapid changes, it is important for radiologists to ponder the ethical foundation of radiology.

Skin trophicity improvement by mechanotherapy for lipofilling-based breast reconstruction postradiation therapy.

BACKGROUND: Post-mastectomy irradiation severely impairs skin trophicity resulting in poor prosthetic implant outcome. Autologous fat grafting improves skin quality allowing minimally invasive approach with prosthetic reconstruction. Here, we report our pilot experience of preoperative mechanotherapy to optimize lipofilling and subsequent prosthetic reconstruction outcome. METHODS: We retrospectively included 65 women that had breast reconstruction using autologous fat grafting and implant placement from 2012 to 2018 benefiting or not from mechanotherapy before the reconstructive procedure. Demographic and surgical outcomes were recorded. RESULTS: The volume of fat injected was significantly superior in the mechanotherapy group compared with the controls for the first and second lipofilling (259.3 mL vs 150.6 mL and 251.8 mL vs 154 mL, respectively). Sixteen patients among controls required a pre-expansion prosthesis compared with none in the endermology group. The prosthesis volume was smaller in the endermology group. Six patients in the endermology group had a reconstruction without prosthesis. The aesthetic score evaluated by patients was 4.8 with no statistically significant difference between the two groups. CONCLUSION: Preoperative skin mechanotherapy and postoperative skin mechanotherapy increase skin compliance. It is associated with a higher volume of fat injection and lower prosthesis volume. If confirmed in a prospective study, endermology could become a standard in patients' preparation for lipofilling-based reconstruction.

MR Imaging Evaluation of Pediatric Genital Disorders:: MR Technologic Overview and Interpretation.

MR imaging is frequently used to assess pediatric genital disorders. The ability to obtain 3-dimensional sequences allowing for multiplanar reformations and sequences designed to minimize motion artifact have aided in the imaging evaluation in the pediatric population. For certain genital disorders, such as Müllerian duct anomalies, MR imaging has become the standard imaging technique. This article discusses up-to-date MR imaging techniques and the interpretation of findings including normal anatomy, as well as congenital and acquired genital disorders seen in the pediatric population.

A mathematical simulation to assess variability in lung nodule size measurement associated with nodule-slice position.

The purpose of this study is to assess the variance and error in nodule diameter measurement associated with variations in nodule-slice position in cross-sectional imaging. A computer program utilizing a standard geometric model was used to simulate theoretical slices through a perfectly spherical nodule of known size, position, and density within a background of "lung" of known fixed density. Assuming a threshold density, partial volume effect of a voxel was simulated using published slice and pixel sensitivity profiles. At a given slice thickness and nodule size, 100 scans were simulated differing only in scan start position, then repeated for multiple node sizes at three simulated slice thicknesses. Diameter was measured using a standard, automated algorithm. The frequency of measured diameters was tabulated; average errors and standard deviations (SD) were calculated. For a representative 5-mm nodule, average measurement error ranged from +10 to -23% and SD ranged from 0.07 to 0.99 mm at slice thicknesses of 0.75 to 5 mm, respectively. At fixed slice thickness, average error and SD decreased from peak values as nodule size increased. At fixed nodule size, SD increased as slice thickness increased. Average error exhibited dependence on both slice thickness and threshold. Variance and error in nodule diameter measurement associated with nodule-slice position exists due to geometrical limitations. This can lead to false interpretations of nodule growth or stability that could affect clinical management. The variance is most pronounced at higher slice thicknesses and for small nodule sizes. Measurement error is slice thickness and threshold dependent.

Ultrasound strain elastography in assessment of cortical mechanical behavior in acute renal vein occlusion: in vivo animal model.

To assess the correlation of quantitative ultrasound strain parameters with the severity of cortical edema in renal vein occlusion, we prospectively performed ultrasound strain elastography on a canine acute renal vein occlusion model prior to and following 10, 20, and 40min of renal vein ligation. Strain and strain relaxation time representing the deformation and relaxation of the renal cortices and reference soft tissue were produced by the external compression with the ultrasound transducer and estimated using commercially available 2-D speckle tracking software. Cortical thickness was additionally measured. Repeated-measures analysis of variance was used to examine the difference in cortical thickness, strain ratio (mean cortical strain divided by mean reference tissue strain), and strain relaxation time ratio (cortical relaxation time divided by reference tissue relaxation time) prior to and after renal vein ligation. Pearson's correlation coefficient was applied to test the relationship between strain parameters and the time of the renal vein ligation. There was a strong positive correlation between the duration of renal vein ligation and strain (R(2)=0.97) and strain relaxation time (R(2)=0.98) ratios. Significant differences in strain and strain relaxation time ratios were found at all measured timepoints (all P≪.001). Cortical thickness, however, showed no significant difference between timepoints (P=.065). Our result suggest that strain and strain relaxation time ratios may be used as quantitative markers for the assessment of the renal cortical mechanical behavior in subclinical acute renal vein occlusion.