Visit-to-visit variability of metabolic parameters and progression of atherosclerosis in computed tomography: follow up of an asymptomatic cohort.

Background: We aimed to examine whether intra-individual variability in traditional risk factors affects the progression of atherosclerosis on subsequent coronary computed tomography angiography (CCTA). Methods: We conducted a retrospective cohort study using asymptomatic health examination cohort data from Haeundae Paik Hospital in Korea collected between 2010-2020. A total of 387 adults met the inclusion criteria of having at least two CCTAs without specific symptoms with an interval of more than one year and having completed three or more health examinations. Visit-to-visit variability was evaluated using the average real variability (ARV) of body mass index, waist circumference, systolic and diastolic blood pressure, and plasma glucose, total cholesterol, triglyceride, high-density lipoprotein (HDL)-cholesterol, and low-density lipoprotein (LDL)-cholesterol. Progression of coronary artery atherosclerosis was defined as worsening of coronary artery stenosis from baseline to final CCTA. ARV values for various metabolic parameters were stratified into quartiles, and hazard ratios (HRs) and 95% confidence intervals (CIs) for coronary atherosclerosis progression were analyzed using multiple Cox proportional hazards models. Results: There were 126 cases of coronary artery stenosis progression (32.56%) assessed using the Coronary Artery Disease Reporting and Data System during a mean follow up of 3.91 (range, 1-9) years. In the multivariate analysis comparing ARV quartiles for LDL-cholesterol after adjusting for covariates, individuals with higher variability showed an increased risk of stenosis progression: HR 2.23 (95% CI: 1.33-3.73) for the third quartile, HR 1.56 (95% CI: 0.91-2.66) for the fourth quartile (P for trend =0.005). Triglycerides also showed a significant linear trend (P for trend =0.04), and Q4 had a greater risk of stenosis progression (HR, 2.09; 95% CI: 1.24-3.52). Meanwhile, the risk of stenosis progression was significantly reduced as the ARV of HDL-cholesterol increased: HR 0.56 (95% CI: 0.35-0.89) for the third quartile, HR 0.47 (95% CI: 0.27-0.81) for the fourth quartile (P for trend =0.01). Conclusions: High variability in LDL-cholesterol and triglyceride was an independent predictor of coronary artery stenosis progression on subsequent CCTA in our cohort. This finding highlights the importance of maintaining stable state to effectively prevent the progression of coronary artery stenosis in clinical settings.

Placental transmogrification of the lung: CT findings with pathologic correlation in six patients.

Background: Placental transmogrification of the lung is a very rare benign lung disease with a characteristic finding being alveoli resembling chorionic villi of the placenta. The purpose of this study was to assess the computed tomography (CT) findings of placental transmogrification of the lung in six patients and their relation to the histopathologic findings. Methods: Six patients with histopathologically proven placental transmogrification of the lung from 2004 to 2021 were included. Their CT findings were analyzed and their imaging features were compared with pathology specimens. Results: In four of six cases, CT showed variable sized cystic lesions confined to a unilateral lung. One case presented nodule and cystic lesion together. The other case showed solitary pulmonary nodule without cystic lesion. Moreover, nodular interlobular septal thickening and clustered interstitial nodules were observed in all six cases. In four of the six cases, these nodules merged into dense nodular consolidation. Three cases showed dilated pulmonary vasculatures of the involved lung. Conclusions: On CT, placental transmogrification of the lung typically presents as cystic lesion confined to a unilateral lung. Pulmonary nodule with or without associated cystic lesion can also be seen. Nodular interlobular septal thickening and clustered interstitial nodules were observed in all cases. This might be attributable to the proliferation of chorionic villi-like structures in interstitium which are found in histopathologic specimens.

Ultrasound findings of subpial hemorrhage in neonates.

PURPOSE: Subpial hemorrhage (SPH) is a subtype of intracranial hemorrhage characterized by damage to the adjacent brain parenchyma. The aim of this study was to describe the sonographic features of SPH in neonates. METHODS: The cranial ultrasound (US) findings of neonates with SPH confirmed by brain magnetic resonance imaging (MRI) were analyzed retrospectively. Initial and follow-up US and MRI scans were reviewed by two pediatric radiologists who were blinded to both clinical history and outcomes. The US features were compared with the MRI findings. RESULTS: Sixteen patients were included (median gestational age, 38 weeks; range, 26 to 40 weeks; 69% term). SPH was detected most often in the temporal lobe (63%), and multiple SPHs were found in seven of 16 neonates, based on MRI. Acute SPH with an underlying venous infarct (UVI) was detected on US in 15 of 16 patients: small or large fan-shaped hyperechoic lesions (n=7 and 4, respectively) and gyriform hyperechoic lesions (n=4). The sonographic yin-yang sign was observed in three of the four large fan-shaped SPH cases. The accompanying findings on US were intraventricular hemorrhage (four out of six MRI-confirmed cases), and concurrent periventricular venous infarcts (five out of nine MRI-confirmed cases). In five patients, subpial cysts were observed on follow-up US or MRI (n=4 and n=4, respectively). CONCLUSION: Acute SPH with UVI can appear as a peripheral fan-shaped or gyriform hyperechoic lesion on cranial US. SPH can be detected and suspected based on the US features of SPH with the accompanying findings.

[Development of Entrustable Professional Activity, Core Competencies, and Guidelines in 2021 Radiology Competency Education Project]. / 2021ë „ 대한영상의학회 ì „ê³µì˜ 연차별 ìˆ˜ë ¨êµê³¼ê³¼ì • 체계화 구축 ì‚¬ì— ì—ì„œ 개발한 위임가능 ì „ë¬¸ì§ë¬´(Entrustable Professional Activity)와 필수 핵심역량 평가항목 및 평가 가이드라인.

To provide high-quality training to residents in a rapidly changing medical environment, it is very important to improve the annual training curriculum centered on competency and ensure that training hospitals maintain an environment suitable for training. The Korean Society of Radiology (KSR) has been steadily improving the training system and has suggested the improvement of the training system by strengthening the competency-based evaluation and faculty development. Currently, KSR was selected for the second annual training curriculum systematization construction project in July 2021, and developed entrustable professional activities, core competencies, and assessment guidelines required by the construction project. Therefore, the development process and assessment guidelines will be introduced to residents and the faculty.

Sonographic Features of Palpable Breast and Axillary Lesions in Adult Male Patients: A Pictorial Essay.

The male breast is a non-functional and rudimentary organ, but similarly to the female breast, it can be affected by various diseases. In contrast to female breast cancer, male breast cancer has a low incidence, and there is no established breast cancer screening program for male patients. Therefore, the diagnostic evaluation is usually performed in male patients with symptoms such as palpability or pain in the breasts. Furthermore, most adult male patients who visit breast clinics sometimes present with not only breast symptoms but also axillary symptoms, and both the breast and axilla are usually examined during breast ultrasonography in daily clinical practice. The purpose of this pictorial essay was to present the sonographic features of various palpable breast and axillary lesions in adult male patients.

Comparison of Computed Diffusion-Weighted Imaging b2000 and Acquired Diffusion-Weighted Imaging b2000 for Detection of Prostate Cancer.

Purpose: To compare the sensitivity of tumor detection and inter-observer agreement between acquired diffusion-weighted imaging (aDWI) b2000 and computed DWI (cDWI) b2000 in patients with prostate cancer (PCa). Materials and Methods: Eighty-eight patients diagnosed with PCa by radical prostatectomy and having undergone pre-operative 3 Tesla-MRI, including DWI (b, 0, 100, 1000, 2000 s/mm2), were included in the study. cDWI b2000 was obtained from aDWI b0, b100, and b1000. Two independent reviewers performed a review of the aDWI b2000 and cDWI b2000 images in random order at 4-week intervals. A region of interest was drawn for the largest tumor on each dataset, and a Prostate Imaging-Reporting and Data System (PI-RADS) score based on PI-RADS v2.1 was recorded. Histologic topographic maps served as the reference standard. Results: The study population's Gleason scores were 6 (n = 16), 7 (n = 53), 8 (n = 9), and 9 (n = 10). According to the reviewers, the sensitivities of cDWI b2000 and aDWI b2000 showed no significant differences (for reviewer 1, both 94% [83/88]; for reviewer 2, both 90% [79/88]; p = 1.000, respectively). The kappa values of cDWI b2000 and aDWI b2000 for the PI-RADS score were 0.422 (95% confidence interval [CI], 0.240-0.603) and 0.495 (95% CI, 0.308-0.683), respectively. Conclusion: cDWI b2000 showed comparable sensitivity with aDWI b2000, in addition to sustained moderate inter-observer agreement, in the detection of PCa.

Portal Vein Gas in Neonates: Predicting Clinical Treatment Outcomes From Ultrasound Findings.

OBJECTIVES: To identify sonographic findings that predict clinical outcomes in neonates with portal vein gas. METHODS: This retrospective study included neonates with portal vein gas detected using ultrasound (US). The US images were reviewed by a pediatric radiologist. US findings included the extent and amount of portal vein gas, mesenteric vein gas, intramural gas, bowel wall thickening or thinning, focal discontinuity of the bowel wall, ascites, free intra-abdominal gas, pseudocyst, gas in the other solid organs, and bowel distension. The imaging findings and demographic factors between survivors and non-survivors were statistically compared. RESULTS: The mortality rate was 26% (39 survivors, 14 non-survivors) when iatrogenic and idiopathic causes were excluded. The causes of portal vein gas were determined to be necrotizing enterocolitis (n = 33), bowel distension or obstruction (n = 12), fetal hydrops (n = 4), pneumothorax (n = 3), immediate postoperative state for bowel perforation (n = 1), and umbilical vein catheterization (n = 9) based on surgical findings (n = 20) and clinical information (n = 46). Gas within the mesenteric vein and the other solid organs, gestational age, and birth weight were significantly different between survivors and those who succumbed (P < .05). CONCLUSION: Gas within the mesenteric vein and other solid organs is a US finding that may predict poor outcomes in neonates with portal vein gas.

Sonographic findings of total colonic aganglionosis in a neonate with Haddad syndrome: A case report.

Haddad syndrome is a rare congenital disorder characterized by congenital central hypoventilation syndrome and Hirschsprung disease. Total colonic aganglionosis is a rare and long-segment form of Hirschsprung disease, which is primarily diagnosed using contrast enemas. However, the diagnostic performance of contrast enemas is relatively low, making the diagnosis of total colonic aganglionosis challenging. In neonates, ultrasound may be used as an additional imaging modality for the diagnosis of Hirschsprung disease. We describe the unique sonographic findings of total colonic aganglionosis in a term neonate with failure to pass meconium and respiratory distress, who was subsequently diagnosed with Haddad syndrome.

Image Quality and Diagnostic Performance of Accelerated Shoulder MRI With Deep Learning-Based Reconstruction.

BACKGROUND. Shoulder MRI using standard multiplanar sequences requires long scan times. Accelerated sequences have tradeoffs in noise and resolution. Deep learning-based reconstruction (DLR) may allow reduced scan time with preserved image quality. OBJECTIVE. The purpose of this study was to compare standard shoulder MRI sequences and accelerated sequences without and with DLR in terms of image quality and diagnostic performance. METHODS. This retrospective study included 105 patients (45 men, 60 women; mean age, 57.6 ± 10.9 [SD] years) who underwent a total of 110 3-T shoulder MRI examinations. Examinations included standard sequences (scan time, 9 minutes 23 seconds) and accelerated sequences (3 minutes 5 seconds; 67% reduction), both including fast spin-echo sequences in three planes. Standard sequences were reconstructed using the conventional pipeline; accelerated sequences were reconstructed using both the conventional pipeline and a commercially available DLR pipeline. Two radiologists independently assessed three image sets (standard sequence, accelerated sequence without DLR, and accelerated sequence with DLR) for subjective image quality and artifacts using 4-point scales (4 = highest quality) and identified pathologies of the subscapularis tendon, supraspinatus-infraspinatus tendon, long head of the biceps brachii tendon, and glenoid labrum. Interobserver agreement and agreement between image sets for the evaluated pathologies were assessed using weighted kappa statistics. In 27 patients who underwent arthroscopy, diagnostic performance was calculated using arthroscopic findings as a reference standard. RESULTS. Mean subjective image quality scores for readers 1 and 2 were 10.6 ± 1.2 and 10.5 ± 1.4 for the standard sequence, 8.1 ± 1.3 and 7.2 ± 1.1 for the accelerated sequence without DLR, and 10.7 ± 1.2 and 10.5 ± 1.6 for the accelerated sequence with DLR. Mean artifact scores for readers 1 and 2 were 9.3 ± 1.2 and 10.0 ± 1.0 for the standard sequence, 7.3 ± 1.3 and 9.1 ± 0.8 for the accelerated sequence without DLR, and 9.4 ± 1.2 and 9.8 ± 0.8 for the accelerated sequence with DLR. Interobserver agreement ranged from kappa of 0.813-0.951 except for accelerated sequence without DLR for the supraspinatus-infraspinatus tendon (κ = 0.673). Agreement between image sets ranged from kappa of 0.809-0.957 except for reader 1 for supraspinatus-infraspinatus tendon (κ = 0.663-0.700). Accuracy, sensitivity, and specificity for tears of the four structures were not different (p > .05) among image sets. CONCLUSION. Accelerated sequences with DLR provide 67% scan time reduction with similar subjective image quality, artifacts, and diagnostic performance to standard sequences. CLINICAL IMPACT. Accelerated sequences with DLR may provide an alternative to standard sequences for clinical shoulder MRI.

Breast Cancer Metastasis to the Parotid: A Case Report with Imaging Findings.

BACKGROUND Metastasis to the salivary gland is rare, with the parotid being the most commonly involved site among the salivary glands. Breast cancer metastasis to the parotid gland has been rarely reported in the literature, and relatively few case reports have described the imaging findings. CASE REPORT A 59-year-old woman presented with a recently growing mass in the left parotid gland. She had a past history of left breast cancer 6 years ago, treated by left modified radical mastectomy with axillary lymph node dissection followed by adjuvant chemotherapy, radiation therapy, and trastuzumab. During follow-up, multiple metastases developed and the patient was subsequently treated with palliative chemotherapy. Neck ultrasonography revealed a heterogeneous echoic mass with indistinct margins, irregular shape, and weak rim vascularity in the left parotid gland. Contrast-enhanced neck computed tomography revealed an irregular mass with heterogeneous enhancement in the inferior pole of the left parotid gland. Ultrasonography-guided 18-gauge core needle biopsy was performed, and the histopathology report was metastasis from ductal carcinoma of breast with positive expression of human epidermal growth factor receptor 2 and negative expression of estrogen receptor, progesterone receptor, and androgen receptor. Despite palliative chemotherapy and trastuzumab, the patient died 2 months after the diagnosis of metastasis to the parotid gland. CONCLUSIONS We report a rare case of metastasis from breast cancer to the parotid gland, with imaging findings including neck ultrasonography and contrast-enhanced neck computed tomography. Breast cancer rarely metastasizes to the parotid gland, but radiologists should be aware of this possibility, especially in patients with a prior history of breast cancer.

High-Resolution Diffusion-Weighted Imaging for Evaluation of Extramural Tumor Invasion in Primary Rectal Cancer.

OBJECTIVE: The aim of this study was to determine the added value of high-resolution diffusion-weighted imaging (DWI) to T2-weighted imaging (T2WI) for evaluation of extramural tumor invasion (EMTI) in patients with primary rectal cancer. METHODS: Seventy-eight patients who had undergone 3.0-T magnetic resonance imaging including DWI (b = 0, 1000 s/mm2, 2 mm iso-voxel) and subsequent surgery were included. Two blinded radiologists independently read the T2WI first and then the combined DWI set. They recorded their confidence level using a 5-point scale. The diagnostic accuracy was calculated by receiver operating characteristic curve analysis based on the histopathological results as the reference. RESULTS: The study population consisted of EMTI positive (n = 44) and negative (n = 34). The area under the curve was not significantly increased after adding DWI to T2WI (reader 1, 0.868-0.856, P = 0.5618; reader 2, 0.848-0.865, P = 0.4539). CONCLUSION: Adding DWI to T2WI showed no additional diagnostic value for the evaluation of EMTI in patients with primary rectal cancer.

Clinical applicability of shear wave elastography for the evaluation of medial epicondylitis.

OBJECTIVES: To evaluate the ability of shear wave elastography (SWE) in diagnosing medial epicondylitis and to compare the diagnostic performance of SWE with that of grey-scale ultrasound (GSU) and strain elastography (SE). METHODS: GSU, SE, and SWE were performed on 61 elbows of 54 patients from March 2018 to April 2019. An experienced radiologist evaluated the GSU findings (swelling, cortical irregularity, hypoechogenicity, calcification, and tear), colour Doppler findings (hyperaemia), SE findings (strain ratio [SR]), and SWE findings (stiffness and shear wave velocity [SWV]). Participants were divided in two groups: patients with clinically diagnosed medial epicondylitis and patients without medial elbow pain. Findings from the two groups were compared, and the receiver operating characteristic (ROC) curves were calculated for significant features. RESULTS: Of the 54 patients, 25 patients with 28 imaged elbows were clinically diagnosed with medial epicondylitis and 29 patients with 33 imaged elbows had no medial elbow pain. Cortical irregularity, hypoechogenicity, calcification, hyperaemia, SR, stiffness, and SWV were significantly different between the two groups. The areas under the ROC curves were 0.838 for hypoechogenicity, 0.948 for SR, 0.999 for stiffness, and 0.999 for SWV. The diagnostic performances of SR, stiffness, and SWV were significantly superior compared to that of hypoechogenicity. However, there were no significant differences among SR, stiffness, and SWV. CONCLUSIONS: SWE can obtain both stiffness and SWV, which are valuable diagnostic tools in the diagnosis of medial epicondylitis. The diagnostic performance of SWE and SE is similar in detecting medial epicondylitis. KEY POINTS: • Shear wave elastography providing stiffness and shear wave velocity showed excellent performance in the diagnosis of medial epicondylitis. • There was no significant difference in the ability of SE and SWE for diagnosing medial epicondylitis.

Non-strangulated adhesive small bowel obstruction: CT findings predicting outcome of conservative treatment.

OBJECTIVES: To clarify CT findings that predict outcome of conservative treatment in patients with non-strangulated adhesive small bowel obstruction (SBO). METHODS: Unenhanced and contrast-enhanced abdominopelvic CT studies in 189 patients with adhesive SBO who had initial conservative treatment were reviewed. The CT findings included transition zone, beak signs, maximum bowel diameter, bowel diameter ratio, decreased bowel wall enhancement, increased unenhanced bowel wall attenuation, anterior parietal adhesion, bowel wall thickening, closed-loop obstruction, small bowel feces sign, whirl sign, mesenteric haziness, mesenteric, peritoneal fluid, and submucosal edema. These findings were statistically compared according to the success or failure of treatment. RESULTS: Conservative treatment succeeded in 144 patients (76.2%) and failed in 45 patients (23.8%). At multivariate analysis, the lack of small bowel feces sign, focal, diffuse mesenteric haziness, and moderate amount of mesenteric fluid were independent findings predicting failure of conservative treatment, with odds ratios of 5.23, 5.5, 13.55, and 4.89, respectively. The presence of all significant findings showed a high specificity of 97.2% with positive likelihood ratio of 8.8. If CT scans showed none of the three significant findings, the negative predictive value was 97.6% and negative likelihood ratio was 0.08. CONCLUSIONS: The lack of small bowel feces sign, focal, diffuse mesenteric haziness, and moderate amount of mesenteric fluid are independent CT findings predicting the failure of conservative treatment in patients with non-strangulated adhesive SBO. The combination of all CT findings suggests the need for surgery; absence of two or all CT findings should suggest an attempt for conservative treatment. KEY POINTS: • To minimize delayed operation, it is important to identify non-strangulated adhesive small bowel obstruction patients in whom initial conservative treatment is likely to fail. • The lack of small bowel feces sign, the presence of mesenteric haziness, and a moderate amount of mesenteric fluid are independent factors predicting the failure of conservative treatment in patients with non-strangulated adhesive small bowel obstruction. • The combination of all three CT findings suggests the need for surgery; absence of two or all three CT findings should suggest an attempt for conservative treatment.

Rare Occurrence of Internal Auditory Canal Stenosis Accompanied With Congenital Facial Palsy in a 3-Month-Old Infant: A Case Report.

Internal auditory canal (IAC) stenosis with hypoplasia of the facial and vestibulocochlear nerves is a rare cause of congenital facial palsy. In this case report, a 3-month-old female infant was referred for a neurological developmental assessment for developmental delay and congenital facial palsy. Upon evaluation of developmental delay, hearing loss was detected. Following a magnetic resonance imaging scan of the brain and a computed tomography scan of the temporal bone, IAC stenosis with hypoplasia of facial and vestibular nerves was diagnosed. This is a rare case of IAC stenosis in an infant with initial presentations of left facial palsy and developmental delay associated with hearing loss in the left ear. We strongly suggest that IAC stenosis be considered a cause of congenital facial palsy in infants, especially in patients with developmental delay. In infants with congenital facial palsy, a thorough physical examination and neurological developmental assessment should be performed.

Incidence and risk factors of subclinical umbilical catheter-related thrombosis in neonates.

INTRODUCTION: This study aimed to determine the risk factors for subclinical umbilical catheter-related thrombosis (UCRT) and its association with clinical morbidities. MATERIALS AND METHODS: In infants without any symptoms associated with umbilical catheterization, the presence of thrombosis was monitored using abdominal ultrasonography within 1 week after umbilical catheter removal. The association between UCRT and the clinical variables was analyzed by comparing the groups with and without UCRT. RESULTS: UCRT occurred in 26 (19.0%) of 137 infants. The relative incidence rate of thrombosis was 12.3% at the umbilical artery and 21.7% at the umbilical vein. However, the type of umbilical vessels with a catheter was not associated with thrombosis (P = 0.095). Subclinical UCRT was associated with high serum calcium concentration in the multivariate analysis (95% confidence interval, 1.26-15.32; P = 0.020). UCRT was resolved within 3 weeks in 13 infants (50.0%), although the thrombosis persisted for up to 2 months in 2 infants (7.7%). We found no significant association between the subclinical UCRT and the neonatal morbidities in preterm infants. CONCLUSIONS: Though a rare cause of thrombosis, hypercalcemia should be considered in the assessment of infants with subclinical UCRT, and calcium levels should be routinely checked in infants with umbilical catheters.

Ultrasound Features and Rate of Upgrade to Malignancy in Atypical Apocrine Lesions of the Breast.

OBJECTIVES: To evaluate the ultrasound (US) features and rate of upgrade to malignancy in atypical apocrine lesions (AALs) of the breast, diagnosed on percutaneous needle biopsy. METHODS: This retrospective study included 17 AALs diagnosed by needle biopsy in 15 patients. For 16 of the 17 AALs, subsequent surgical excision (n = 14) or 8-gauge vacuum-assisted biopsy (n = 2) was performed. Ultrasound features were retrospectively analyzed according to the American College of Radiology Breast Imaging Reporting and Data System lexicon. RESULTS: Of 17 AALs, 13 (76.5%) were atypical apocrine hyperplasia; 3 (17.6%) were atypical apocrine adenosis; and 1 (5.9%) was combined atypical apocrine hyperplasia and atypical apocrine adenosis on needle biopsy. Subsequently, 4 of 16 AALs (25%) were upgraded to malignancy at surgical excision. On US imaging, all 17 lesions presented as masses, which were mainly irregular and noncircumscribed (n = 8) or oval/round and noncircumscribed (n = 7) with isoechogenicity or hypoechogenicity. Rarely, an AAL would show complex cystic and solid echogenicity (n = 1) or appear as a hypoechoic mass with oval shape and a circumscribed margin (n = 1). CONCLUSIONS: Atypical apocrine lesions of the breast often showed suspicious malignant features on US imaging. Given the high upgrade rate (25%), the diagnosis of an AAL by needle biopsy warrants subsequent surgical excision.

Prospective Multicenter Study of the Safety of Gadoteridol in 6163 Patients.

BACKGROUND: The safety of gadolinium-based contrast agents is of fundamental importance. PURPOSE: To determine the frequency and severity of immediate-type adverse reactions to approved doses of gadoteridol in patients referred for routine gadoteridol-enhanced MRI in actual clinical practice settings. STUDY TYPE: Prospective, observational. POPULATION: In all, 6163 subjects were enrolled (mean age: 56.7 ± 15.4 years; range: 6-93 years). FIELD STRENGTH/SEQUENCE: 1.5T and 3.0T. ASSESSMENT: Assessment was of immediate adverse reactions by the investigating radiologist using the MedDRA System Organ Class and preferred term. STATISTICAL TESTS: Summary statistics for continuous variables, descriptive statistics for demographic characteristics. RESULTS: Overall, 19 adverse events occurred in 13 (0.21%) patients, of which 15 in 10 (0.16%) patients were considered related to gadoteridol administration. These events were evenly distributed between male and female subjects and all occurred in adults. Twelve of the 15 related events in eight (0.13%) patients were considered mild in intensity (rapidly self-resolving), while the remaining three events in two patients (0.03%) were considered moderate in intensity. None were of severe intensity and no serious adverse events occurred. DATA CONCLUSION: The rate of immediate-type adverse events following exposure to approved doses of gadoteridol is extremely low, and mostly limited to transient and self-resolving symptoms. LEVEL OF EVIDENCE: 2 Technical Efficacy Stage: 5 J. Magn. Reson. Imaging 2020;51:861-868.

The most-cited articles in pediatric imaging: a bibliometric analysis.

INTRODUCTION: The number of citations that an article has received reflects its impact on the scientific community. The purpose of our study was to identify and characterize the 51 most-cited articles in pediatric imaging. EVIDENCE ACQUISITION: Based on the database of Journal Citation Reports, we selected 350 journals that were considered as potential outlets for pediatric imaging articles. The Web of Science search tools were used to identify the most-cited articles relevant to pediatric imaging within the selected journals. EVIDENCE SYNTHESIS: The 51 most-cited articles in pediatric imaging were published between 1952 and 2011, with 1980-1989 and 2000-2009 producing 15 articles, each. The number of citations ranged from 576-124 and the number of annual citations ranged from 49.05-2.56. The majority of articles were published in pediatric and related journals (N.=26), originated in the USA (N.=23), were original articles (N.=45), used MRI as imaging modality (N.=27), and were concerned with the subspecialty of brain (N.=34). University College London School of Medicine (N.=6) and School of Medicine University of California (N.=4) were the leading institutions and Reynolds EO (N.=7) was the most voluminous author. CONCLUSIONS: Our study presents a detailed list and an analysis of the most-cited articles in the field of pediatric imaging, which provides an insight into historical developments and allows for recognition of the important advances in this field.

Clinical Application of Real-Time Sonoelastography for Evaluation of Medial Epicondylitis: A Pilot Study.

The aim of this study was to evaluate the diagnostic potential of real-time sonoelastography (RSE) in medial epicondylitis by comparing clinically diagnosed patients and patients without medial elbow pain. From July 2016 to December 2017, gray-scale sonographic findings (swelling, cortical irregularity, hypo-echogenicity, calcification and tear), color Doppler findings (hyperemia) and sonoelastographic findings (elastographic grade on a 3-point visual scale and strain ratio from two regions of interest) for 63 elbows of 56 patients were compared. Twenty-four patients with 29 imaged elbows were clinically diagnosed with medial epicondylitis, and 32 patients with 34 imaged elbows had no medial elbow pain. Cortical irregularity, hypo-echogenicity, calcification, elastographic grade and strain ratio revealed significant differences (p < 0.05). Among these, strain ratio had the highest diagnostic performance (area under the curve: 0.985). Real-time sonoelastography, which can obtain both elastographic grade and strain ratio, is valuable as a supplementary tool in the diagnosis of medial epicondylitis.

Omental calcification, necrotizing enterocolitis, and undescended testes after fetal abdomino-amniotic shunting performed for the management of meconium peritonitis: A case report.

Prenatal ultrasonography (US) in a 39 year-old woman revealed massive fetal ascites. A fetal abdomino-amniotic shunting procedure was performed. Subsequently, plain radiographs demonstrated diffuse gaseous distention of the bowel and multiple punctate calcifications in the left upper abdomen. Postnatal US examination showed multiple echogenic foci in the liver and the left upper abdomen, bowel wall thickening in the right-sided abdomen, and undescended testes. There was no intra-abdominal free air or loculated fluid collections. Medical management was instituted secondary to the clinical suspicion of omental calcification, necrotizing enterocolitis, and undescended testes. Follow-up US examination showed resolution of portal vein gas and bowel wall thickening. The neonate recovered fully.