Optimized definition of right ventricular dysfunction on computed tomography for risk stratification of pulmonary embolism.

Objectives: There is an ongoing discussion on the optimal right to left (RV/LV) diameter ratio threshold and the best definition of RV dysfunction on computed tomography pulmonary angiography (CTPA) for risk assessment of pulmonary embolism (PE).

Methods: On routine diagnostic CTPA, volumetric and diameter measurements (axial and reconstructed views) of the ventricles and reflux of contrast medium into the inferior vena cava (IVC) and hepatic veins were assessed in consecutive PE patients enrolled in a prospective single-center registry. In-hospital adverse outcome was defined as PE-related death, cardiopulmonary resuscitation, mechanical ventilation or catecholamine administration.

Spectral CT of the abdomen: Where are we now?

Spectral CT adds a new dimension to radiological evaluation, beyond assessment of anatomical abnormalities. Spectral data allows for detection of specific materials, improves image quality while at the same time reducing radiation doses and contrast media doses, and decreases the need for follow up evaluation of indeterminate lesions. We review the different acquisition techniques of spectral images, mainly dual-source, rapid kV switching and dual-layer detector, and discuss the main spectral results available.

Detection of severe pulmonary hypertension based on computed tomography pulmonary angiography.

Pulmonary hypertension (PH) is often diagnosed late in the disease course. As many patients may undergo computed tomography pulmonary angiography (CTPA) for exclusion of pulmonary embolism (PE), we aimed to create a model that can detect the existence of PH and grade its severity. Consecutive patients who underwent CTPA which was negative for PE, and echocardiography study within 24 h, were included.

Re-Appraisal of Echocardiographic Assessment in Patients with Pulmonary Embolism: Prospective Blinded Long-Term Follow-Up.

Background: Acute pulmonary embolism (PE) is considered to be one of the most common cardiovascular diseases with considerable mortality. Conflicting data imply possible role for echocardiography in assessing this disease.

Objectives: To determine which of the echo parameters best predicts short-term and long-term mortality in patients with PE.

CT findings are highly predictive for perforation in patients with diffuse large B-cell lymphoma involving the intestines.

Patients with diffuse large B-cell lymphoma (DLBCL) presenting with intestinal involvement are prone to develop perforation. Identification of those who are at high risk for this complication would enable a rational-based decision regarding preemptive surgery. Although computed tomography (CT) is widely used at diagnosis, data regarding its ability to predict intestinal perforation are scanty.

Imaging of the Urachus: Anomalies, Complications, and Mimics.

Urachal anomalies are more common than previously thought, with more cases discovered incidentally, because of the increased use of cross-sectional imaging. Although an abnormal persistence of an embryologic communication between the bladder and the umbilicus is often recognized and managed in childhood, it may persist into adulthood, with a greater risk of morbidity. Congenital urachal anomalies that are detected early can benefit from an optimized management including surgical approach with a complete resection of the urachal remnant in cases when spontaneous resolution or medical management has failed.

Loss of intratumoral macroscopic fat in renal angiomyolipoma following chemoradiation therapy for pancreatic cancer.

Angiomyolipoma (AML) is the most common benign mesenchymal tumour of the kidney. Classically, AML can readily be diagnosed by identifying the negatively attenuating intratumoral macroscopic fat component on non-enhanced CT scans. However, intratumoral macroscopic fat may not be visible on CT scans, mimicking renal cell carcinoma.

Diagnostic accuracy of magnetic resonance elastography in liver transplant recipients: A pooled analysis.

Background And Aims: We conducted an individual participant data (IPD) pooled analysis on the diagnostic accuracy of magnetic resonance elastography (MRE) to detect fibrosis stage in liver transplant recipients.

Material And Methods: Through a systematic literature search, we identified studies on diagnostic performance of MRE for staging liver fibrosis, using liver biopsy as gold standard. We contacted study authors for published and unpublished IPD on age, sex, body mass index, liver stiffness, fibrosis stage, degree of inflammation and interval between MRE and biopsy; from these we limited analysis to patients who had undergone liver transplantation.

Magnetic resonance imaging of pancreatic metastases from renal cell carcinoma.

Pancreatic metastases are rare but are thought to be most commonly from renal cell carcinoma (RCC). These metastases can present many years after the initial tumor is resected, and accordingly, these patients require prolonged imaging follow-up. Although the computed tomographic findings of these metastases have been extensively reviewed in the literature, little has been written about the magnetic resonance imaging appearance of these metastases.

Imaging of the Liver Following Interventional Therapy for Hepatic Neoplasms.

Locoregional therapies for hepatic neoplasms have distinctive imaging features after treatment, different from those observed after systemic therapy. As these therapies are becoming more common, it is important that radiologists be aware of the imaging appearance of tumors after locoregional therapies to correctly diagnose treatment response or failure and potential complications. This article reviews the imaging recommendations and findings after intra-arterial therapies (chemoembolization and radioembolization) and ablative therapies.

Beyond hepatic hemangiomas: the diverse appearances of gastrointestinal and genitourinary hemangiomas.

Hemangiomas are common lesions, best known for their appearance in the liver. Their appearance in less common locations, such as the gastrointestinal and genitourinary tracts, is less well known. We will review the typical and atypical appearance of hemangiomas in these locations on sonography, CT, and MRI.

Acute Pancreatitis: Revised Atlanta Classification and the Role of Cross-Sectional Imaging.

Objective: The 2012 revision of the Atlanta Classification emphasizes accurate characterization of collections that complicate acute pancreatitis: acute peripancreatic fluid collections, pseudocysts, acute necrotic collections, and walled-off necroses. As a result, the role of imaging in the management of acute pancreatitis has substantially increased.

Conclusion: This article reviews the imaging findings associated with acute pancreatitis and its complications on cross-sectional imaging and discusses the role of imaging in light of this revision.

Intrahepatic cholangiocarcinomas mimicking other lesions.

Background: While the typical features of large cholangiocarcinomas have been described extensively and are known to radiologists, atypical cholangiocarcinomas are not as well known and radiologists should be more aware of their features. Due to the increasing numbers of cross-sectional imaging studies performed for various reasons, cholangiocarcinomas may be more frequently detected incidentally when small, before they become symptomatic, and might be mistaken for other liver lesions. We studied the appearance of misdiagnosed cholangiocarcinomas.

Imaging of adrenal and renal hemorrhage.

Hemorrhage of the kidneys and adrenal glands has many etiologies. In the adrenal glands, trauma, anticoagulation, stress, sepsis, surgery, and neoplasms are common causes of hemorrhage. In the kidneys, reasons for hemorrhage include trauma, bleeding diathesis, vascular diseases, infection, infarction, hemorrhagic cyst rupture, the Antopol-Goldman lesion, and neoplasms.

Pulmonary Hypertension: A Nomogram Based on CT Pulmonary Angiographic Data for Prediction in Patients without Pulmonary Embolism.

Purpose: To use cardiovascular data from computerized tomographic (CT) pulmonary angiography for facilitating the identification of pulmonary hypertension (PH) in patients without acute pulmonary embolism.

Materials And Methods: The institutional human research committee approved this retrospective study; informed consent was waived. Patients without pulmonary embolism who underwent CT pulmonary angiography and echocardiography within 24 hours of each other between December 2008 and October 2012 were retrospectively identified.

Imaging of choledochal cysts.

Choledochal cysts are rare cystic dilatations of the intrahepatic and/or extrahepatic biliary tree, which may be mistaken for other cystic lesions if their characteristic features are not recognized. The etiology is unknown, and likely multifactorial, and it is uncertain whether they are congenital or acquired. Multiple imaging modalities can be used to diagnose choledochal cysts, including ultrasound, computed tomography, magnetic resonance (MR) cholangiopancreatography (MRCP), endoscopic retrograde cholangiopancreatography, and percutaneous transhepatic cholangiography.

Radiologists' performance in the diagnosis of acute intestinal ischemia, using MDCT and specific CT findings, using a variety of CT protocols.

The aim of this study was to evaluate the performance of radiologists in the diagnosis of acute intestinal ischemia using specific multi-detector CT findings. The abdominal CT scans of 90 patients were retrospectively reviewed by three radiologists: an abdominal imaging specialist, an experienced general radiologist, and a senior resident. Forty-seven patients had surgically proven intestinal ischemia and comprised the case group, while 43 patients had no evidence of intestinal ischemia at surgery and comprised the control group.

Revascularization of the left anterior descending artery with drug-eluting stents: comparison with arterial off-pump surgery.

Background: This study compared early results of left anterior descending artery (LAD) stenting using drug-eluting stents (Cypher) with off-pump bilateral internal thoracic arterial (BITA) grafting.

Methods: From June 2002 to June 2003, 200 consecutive patients underwent myocardial revascularization of the LAD territory, 100 by Cypher and 100 by BITA. The 2 groups were similar; however, left main disease and triple-vessel disease (20% and 75% versus 2% and 28%), age >70 (36% versus 17%) and intraaortic balloon pump (7% versus 0%) were more prevalent in the BITA group, and prior percutaneous coronary angiogplasty to the LAD was more prevalent in the Cypher group (28% versus 16%).

Revascularization of left anterior descending artery with drug-eluting stents: comparison with off-pump surgery.

Background: This study compares early results of left anterior descending coronary artery stenting using drug-eluting stents (Cypher) with off-pump coronary artery bypass grafting (OPCAB).

Methods: From June 2002 to June 2003, 386 consecutive patients underwent myocardial revascularization of the left anterior descending coronary artery territory, 130 by Cypher and 256 by OPCAB. After matching for age, sex, and extent of coronary artery disease, two groups (each with 94 patients) were used to compare the two revascularization modalities.