Prevalence, Diagnosis, and Treatment with 3 Different Statins of Non-alcoholic Fatty Liver Disease/Non-alcoholic Steatohepatitis in Military Personnel. Do Genetics Play a Role?

BACKGROUND: Non-alcoholic fatty liver disease (NAFLD) and its severe form, non-alcoholic steatohepatitis (NASH), are major health problems worldwide. Genetics may play a role in the pathogenesis of NAFLD/NASH. AIMS: To investigate the prevalence of NAFLD/NASH in 5,400 military personnel and evaluate the effect of treatment with 3 statins on NAFLD/NASH using 2 non-invasive scores [NAFLD Activity Score (NAS); Fibrosis-4 score (FIB-4)]. METHODS: During the mandatory annual medical check-up, military personnel underwent a clinical and laboratory evaluation. Participants with NAFLD/NASH were randomized into 4 groups (n=151 each): diet-exercise, atorvastatin, rosuvastatin, or pitavastatin for 1 year (i.e., until the next routine evaluation). RESULTS: From all the participants, 613 had NAFLD/NASH (prevalence 11.3 vs 39.8% in the general population, p<0.001), and a total of 604 consented to participate in the study. After a year of treatment, the diet-exercise group showed no significant changes in both scores (NAS 4.98 baseline vs. 5.62, p=0.07; FIB-4 3.42 vs. 3.52, p=0.7). For the atorvastatin group, both scores were reduced (NAS 4.97 vs 1.95, p<0.001, FIB-4 3.56 vs 0.83, p<0.001), for rosuvastatin (NAS 5.55 vs 1.81, p<0.001, FIB-4 3.61 vs 0.79, p<0.001), and for pitavastatin (NAS 4.89 vs 1.99, p<0.001, FIB-4 3.78 vs 0.87, p<0.001). CONCLUSION: Atorvastatin, rosuvastatin, and pitavastatin have a beneficial and safe effect in NAFLD/NASH patients as recorded by the improvement in the NAS (representing NAFLD activity) and FIB-4 (representing liver fibrosis) scores. Since both those with and without NAFLD/- NASH shared several baseline characteristics, genetics may play a role in the pathogenesis of NAFLD/NASH and its treatment with statins.

Intravascular Ultrasound for Evaluation of Left Gonadal Vein Anatomic Variations During Coil Embolization.

We illustrate the intravascular ultrasound (US) findings in the evaluation of left gonadal vein anatomic variations. During a 2-year period, 4 consecutive patients (mean age, 37 years; range, 28-45 years) with left-sided varicocele underwent embolization. Intravascular US examinations and retrograde venography were performed to assess varicocele anatomy. Anatomic variants were recorded and categorized. A comparison between intravascular US and fluoroscopic findings was performed. The Fisher exact test was used for statistical analysis (P < .05). Technical success was achieved in all cases. There was a statistically significant difference in the maximum gonadal vein diameter between venography and intravascular US (P = .0087). Intravascular US showed left gonadal vein anatomic variations and better ability in the evaluation of the vein diameter.

Epithelioid hemangioma of the scapula treated with chemoembolization and microwave ablation: Α case report.

Bone epithelioid hemangiomas are classified within benign vascular tumours but are commonly misdiagnosed as low-grade angiosarcomas or epithelioid hemangioendotheliomas. Current therapeutic interventions include various treatment options but local recurrence or distal lymph node involvement has been reported. We report a rare case of scapular epithelioid hemangioma that was initially treated using a combination of chemoembolization and microwave ablation. This combination has not been previously reported in the literature regarding the management of this tumour. A year after the first course of treatment, the tumour size has been reduced more than 70% and the patient has remarkable clinical improvement. Results reported in this case study demonstrated that combination of chemoembolization and microwave ablation is a feasible, safe and effective technique in the treatment of bone epithelioid hemangiomas. Even if the tumour is still present afterwards, a substantially smaller surgical excision will be needed.

Soft tissue pseudotumours: a pictorial review with emphasis on MRI.

BACKGROUND: Several tumour-like conditions of the soft tissues may be encountered in clinical practice, or when patients undergo radiologic examinations. Al-though advances in cross sectional imaging (ultra-sound, MDCT and MRI) play a pivotal role in the correct evaluation of tumour-like lesions, a systematic approach is needed to achieve a definitive diagnosis or limit the differential diagnosis. Clinical history, physical examination and anatomic location are of paramount importance. METHODS: In this pictorial essay we review some of the most frequent benign soft tissue conditions which may be mistaken for malignancy and thus lead to need-less referrals, unnecessary biopsies and great anxiety to the patients and their carers. LEVEL OF EVIDENCE: IV.

The odontoid process: various configuration types in MR examinations.

PURPOSE: Several developmental anomalies have been described with respect to the odontoid process. The purpose of the study was to describe the MR appearance of the odontoid process and to calculate the prevalence of its morphological variants. METHODS AND MATERIALS: We retrospectively reviewed 133 patients (85 males and 48 females, age range of 19-81 years, mean 39.5), examined within a 7-year period. Patients were divided into two age groups: ≤30 and >30-year-old. The morphology of the odontoid process was classified into type I: pyramidal tip and type II: ovoid or convex tip. The incidence of os odontoideum and os terminale and the presence of longitudinal cleft were also recorded. Fischer's exact test was used for statistical analysis (p < 0.05). RESULTS: Type I was identified in 54 cases (40.6 %) and type II in 79 cases (59.4 %). Os odontoideum was recorded in one case (0.7 %), os terminale in 24 cases (18 %) and the presence of a longitudinal cleft (partial or complete) in 86 cases (64.7 %). Type I showed a higher prevalence in the ≤30 age group (p < 0.05). No differences were shown between sexes. CONCLUSION: The configuration types of odontoid process are reported herein. The clinical relevance of this morphological variation needs to be elucidated with further studies.

MRI characteristics of cysts and "cyst-like" lesions in and around the knee: what the radiologist needs to know.

OBJECTIVES AND METHODS: A variety of benign cystic or "cyst-like" lesions may be encountered during a routine magnetic resonance imaging (MRI) of the knee. These lesions comprise a diverse group of entities from benign cysts to complications of underlying diseases. In addition, normal anatomic bursae and recesses may be misdiagnosed as an intra-articular cystic lesion when they are distended. However, the majority of the aforementioned lesions have characteristic MR appearances that allow a confident diagnosis, thus obviating the need for additional imaging or interventional procedures. RESULTS: This article includes a comprehensive pictorial essay of the characteristic MRI features of common and uncommon benign cysts and "cyst-like" lesions in and around the knee joint. DISCUSSION: For accurate assessment of the "cystic structure", a radiologist should be able to identify typical MRI patterns that contribute in establishing the correct diagnosis and thus guiding specific therapy and avoiding unwarranted interventional procedures such as biopsy or arthroscopy. TEACHING POINTS: • Cystic lesions are common in knee MRI and the commonest, the Baker's cyst, has an incidence of 38 %. • Synovial cysts, meniscal cysts, normal knee bursae and recesses have characteristic MR appearances. • Miscellaneous "cyst-like" lesions may require a more dedicated MR protocol for a correct diagnosis.

MR arthrography of the shoulder: tolerance evaluation of four different injection techniques.

OBJECTIVE: We sought to prospectively evaluate patients' pain perception and technical success of four different arthrographic techniques for shoulder MR arthrography. MATERIALS AND METHODS: A total of 125 consecutive patients were referred for shoulder MR arthrography. The patients were randomly injected under fluoroscopic guidance (n(1) = 37), with CT guidance using an anterior (n(2) = 29) or a posterior approach (n(3) = 32) and with ultrasound guidance (n(4) = 27). For each patient, absolute periprocedural pain on a numerical rating pain scale (0 = "no pain", 10 = "intolerable pain"), technical success of the method used, and reason for referral were recorded. RESULTS: The technical success rate was 100% for all injection methods. The results regarding absolute periprocedural pain were as follows: fluoroscopic guidance showed a mean pain of 4.05 ± 1.24, CT anterior guidance demonstrated a mean pain of 3.87 ± 0.95, CT posterior guidance showed a mean pain of 1.59 ± 0.81, and ultrasound guidance a mean pain of 3.63 ± 1.12. A significant difference (p < .05) was observed for the posterior route under CT guidance. The mean pain level was significantly higher for older (> 51 year) female patients. CONCLUSIONS: No differences were found for the technical success rate of the aforementioned techniques. A CT-guided posterior approach seems to be a more comfortable method for the patient.

MR imaging of anterior knee pain: a pictorial essay.

Anterior knee pathology is a frequent cause of joint pain and limitation of function and mobility among patients presenting to an orthopaedic department. Proper recognition and treatment of pathologic conditions depend on the knowledge of normal anatomy and of the various abnormalities, which affect this area of the knee and may present with anterior knee pain. A broad array of benign and malignant processes may be manifested as anterior knee discomfort, and this common clinical entity is among the most frequent indications for MR imaging of the lower extremities. Clinical history and physical examination are also of paramount importance. The disorders can be categorized and differentiated primarily according to their location. Traumatic or non-traumatic disorders of the patella, patellar retinacula, quadriceps and patellar tendons and supra or infrapatellar fat pad can be the source of symptoms. This article includes a comprehensive pictorial essay of the characteristic MR features of common and uncommon disorders causing anterior knee pain. For accurate assessment of the aforementioned clinical problem, a radiologist should be able to identify typical MR imaging patterns that contribute in establishing the correct diagnosis and thus tailoring the appropriate therapy. Level of evidence IV.

Common and uncommon complications of totally implantable central venous ports: a pictorial essay.

PURPOSE: The purpose of this study is to present the characteristic radiologic features of common and uncommon complications in totally implantable central venous ports. MATERIAL AND METHODS: The authors reviewed 138 implantations of central venous ports in oncologic patients during an 18-month period and present the characteristic imaging features of the complications detected. RESULTS: All chest ports were placed via the internal jugular vein using both fluoroscopic and ultrasound guidance. The technical success rate was 99.3% (137/138). All catheter or port-related complications were retrospectively assessed. Sixteen complications were detected during the follow-up period, and catheter removal was required in 10 patients. CONCLUSIONS: Image-guided central venous port catheter implantation is a very safe procedure with a low rate of complications. The typical imaging features of common and uncommon complications are very helpful in establishing the correct diagnosis and thus tailoring the appropriate therapy.

Comparison of MR-arthrography and MDCT-arthrography for detection of labral and articular cartilage hip pathology.

OBJECTIVE: To compare the diagnostic ability of MR arthrography (MRa) and MDCT arthrography (CTa) in depicting surgically proven hip labral tears and articular cartilage degradation. MATERIALS AND METHODS: Labral pathology and articular cartilage were prospectively evaluated with MRa and CTa in 14 hips of 10 patients. The findings were evaluated by two independent observers (a musculoskeletal fellow and one senior musculoskeletal radiologist). Sensitivity, specificity, accuracy, and positive predictive value were determined using arthroscopic and open surgery findings as the standard of reference. Interobserver agreement was recorded. All images were assessed for the presence of a labral tear (according to Czerny classification) and for cartilage erosion using a 3 point scale for both methods: 1 = complete visualization-sharp edges, 2 = blurred edges fissuring-partial defects, 3 = exposed bone. The same classification was applied surgically. RESULTS: Disagreement between the senior observer and the fellow observer was recorded in three cases of labral tearing with MRa and six with CTa. Disagreement was also found in four cases of cartilage erosion with both MRa and CTa. The percent sensitivity, specificity, accuracy, and positive predictive value for correctly assessing the labral tear were as follows for MRa/CTa, respectively: 100/15, 50/13, 90/14, and 90/13 (P < 0.05). The same values for cartilage assessment were 63/66, 33/40, 50/57 and 55/66 (P > 0.05). CONCLUSION: Interobserver reproducibility with MRa is very good for labral tearing assessment. MRa is better for assessing labral tears. CTa shows better, but not statistically significant, demonstration of the articular cartilage.

Os naviculare: the multi-ossicle configuration of a normal variant.

OBJECTIVE: To describe the multi-ossicle appearance of the os naviculare on MRI and CT examinations and to correlate this appearance with the published classification of this well-known skeletal variant. MATERIALS AND METHODS: We retrospectively reviewed 148 patients, examined within a 2-year period (170 CT and MRI studies of the foot-ankle), for the presence of os naviculare. This variant was classified according to a widely used system (type I, II, III). In addition, each navicular variant was further reclassified according to the presence of one or more ossicles. The presence of bone marrow edema was also recorded. RESULTS: Accessory navicular bone was identified in 34 cases (20%) of the 170 exams. It was detected in 14 male and 14 female patients with the following incidence: 11.15% type I (19 cases), 4.11% type II (7 cases) and 4.74% type III (8 cases). In six cases the location was bilateral. Among patients with os naviculare, a multi-ossicle appearance with a total incidence of 14.7% (8.8% two ossicle configuration and 5.9% three ossicle configuration) was observed. In two type II cases studied with MRI, there was bone marrow edema suggesting a painful pseudarthrosis. CONCLUSION: The presence of multiple accessory navicular bone ossicles, not previously described with cross-sectional imaging, is reported herein. The pathogenesis and clinical relevance of this uncommon variant needs to be elucidated with further studies.

Assessment of a postoperative anastomotic stricture following correction surgery of a type IVa choledochal cyst using Gd-EOB-DTPA-enhanced magnetic resonance cholangiography.

Choledochal cyst is a relatively uncommon disease which is characterized by congenital dilatation of the intra and/or extrahepatic part of the biliary tree. Type IVa choledochal cysts are managed surgically through total excision of the entire extrahepatic part of the abnormal bile ducts and a simultaneous hepaticoenterostomy. Postoperative anastomotic stricture after excision of choledochal cysts and hepaticojejunostomy is a well-known late complication. We report a case of a 17-year-old female in whom gadoxetic acid-enhanced magnetic resonance cholangiography assisted in the evaluation of a biliary stricture following bile duct procedures after choledochal cyst correction surgery.

Diagnosis of periampullary duodenal diverticula: the value of new imaging techniques.

OBJECTIVE: The purpose of this study was to evaluate and demonstrate the clinical and imaging features of symptomatic duodenal diverticula presenting as or mimicking acute abdomen. METHODS: The imaging studies of 10 patients, all presenting with acute abdomen and diagnosed with duodenal diverticula as the possible underlying cause, over a time period of 20 months were retrospectively analyzed. RESULTS: Eleven duodenal diverticula were depicted in 8 Multidetector Computed Tomography (MDCT) exams, 2 MRI-MRCP exams and in one intraoperative cholangiography. Acute abdominal symptomatology resulting from duodenal diverticula was as follows: one patient presented with perforation-diverticulitis, two patients with pancreatitis, one patient with acute acalculous cholecystitis, four patients with biliary dilation and two patients with acute postprandial discomfort-pain. The mean maximal diameter of the diverticula examined was 2.67 cm (range 0.96-4.98 cm). Further image analysis of the MDCT exams revealed that both the axial and the coronal plane demonstrated the presence of the diverticula but the depiction of the diverticular neck was demonstrated in five cases in the axial plane and in all cases in the coronal plane. CONCLUSION: Although duodenal diverticula constitute a rare cause of acute abdomen, careful analysis of imaging studies can aid to the identification of this uncommon factor of abdominal symptomatology.

Pelvic hemangiopericytoma: the role of diffusion weighted imaging in targeting the biopsy site and in monitoring the tumour response to radiotherapy.

BACKGROUND: Despite advances in imaging, the accurate characterization of soft tissue tumours remains a challenging task. Furthermore, the interpretation of post treatment changes and evaluation of tumour response to therapy is another complicating issue regarding soft tissue tumour imaging. CASE REPORT: Herein, a patient with a pelvic hemangiopericytoma, by whom different diagnostic imaging methods were used, is presented. CONCLUSIONS: Diffusion weighted imaging (DWI) might provid useful information in guiding biopsy and enabled monitoring of the radiation therapy results.