Description:    This is the introduction to the feature section of functional imaging of the pelvic floor, which includes 6 articles, two focused on clinical issues, while four on radiological aspects, mostly on dynamic pelvic floor MRI. Content Type Journal Article Pages 1-3 DOI 10.1007/s00261-012-9948-5 Authors Francesca Maccioni, Department of Radiological Sciences, Oncology and Pathology, Sapienza University Rome, Rome, Italy Journal Abdominal Imaging Online ISSN 1432-0509 Print ISSN 0942-8925

Description:    Obesity is an epidemic in the United States and Western World with an associated increasing impact on radiology departments. The increased prevalence of obesity in conjunction with the growing use and success of bariatric surgery results in an influx of obese patients into the health system in need of hospital services and care. Imaging services in particular are in demand in this patient population. Obese patients place special needs upon facilities and imaging equipment and also create technical challenges. This manuscript will address problems and potential solutions for imaging obese patients, specifically with regards to the modalities of radiography, fluoroscopy, computed tomography, and magnetic resonance imaging. Content Type Journal Article Pages 1-17 DOI 10.1007/s00261-012-9959-2 Authors Laura R. Carucci, Department of Radiology, Magnetic Resonance Imaging, Computed Tomography, Virginia Commonwealth University Health System, 1250 East Marshall Street, Richmond, VA 23298, USA Journal Abdominal Imaging Online ISSN 1432-0509 Print ISSN 0942-8925

Description: Purpose   To analyze Gd-EOB-DTPA-enhanced magnetic resonance (MR) findings of nodules (low-grade dysplastic nodules—LGDNs; high-grade dysplastic nodules—HGDN, and hepatocellular carcinoma—HCC), histologically identified on cirrhotic, explanted livers. Methods   IRB approval was obtained for this study. Thirty-four patients underwent Gd-EOB-DTPA-enhanced MR examinations (1.5T system), that included 20-min delayed hepatobiliary (HB) phase imaging, before undergoing orthotopic liver transplantation (OLT; mean time MR-OLT: 2.7 months). A total of 102 hepatic nodules were identified and analyzed at histopathological examination, and classified as LGDN, HGDN, and HCC. Two radiologists by consensus performed a quantitative (enhancement ratios, ERs) and a qualitative analyses of signal intensities of identified nodules on vascular dynamic phases (30–35 s after injection–arterial phase; 180–190 s after injection late phase) and on HB phases. Correlation between nodules MR patterns and histological classification was analyzed by means of dedicated statistical software. Results   No differences were appreciable among ERs of HGDN and HCCs on HB phase ( P  〉 0.001). Lesions’ enhancement on vascular dynamic and on HB phases significantly correlated to histological classification of nodules ( P  〈 0.0001). Nodular hyperintensity on arterial phase and hypointensity on late phase were highly predictive for HCC (PPV 100%), with a moderate sensitivity (72.5%). Nodular hypointensity on HB phase was detected on 39/40 HCCs (sensitivity 97.5%) and in 21/30 HGDNs, whereas no LGDN showed it. Conclusions   Hyperenhancement on arterial phase and hypointensity on late phase are the most specific clues for the diagnosis of HCC. Hypointensity on HB phase shows a PPV of 100% in suggesting nodular premalignancy/malignancy, independently from nodular dynamic vascular enhancement. Content Type Journal Article Pages 1-7 DOI 10.1007/s00261-012-9952-9 Authors Carlo Bartolozzi, Department of Diagnostic and Interventional Radiology, University Hospital of Pisa, Via Paradisa 2, 56100 Pisa, Italy Valentina Battaglia, Department of Diagnostic and Interventional Radiology, University Hospital of Pisa, Via Paradisa 2, 56100 Pisa, Italy Irene Bargellini, Department of Diagnostic and Interventional Radiology, University Hospital of Pisa, Via Paradisa 2, 56100 Pisa, Italy Elena Bozzi, Department of Diagnostic and Interventional Radiology, University Hospital of Pisa, Via Paradisa 2, 56100 Pisa, Italy Daniela Campani, Unit of Hepatic Pathology, University Hospital of Pisa, Via Paradisa 2, 56100 Pisa, Italy Luca Emanuele Pollina, Unit of Hepatic Pathology, University Hospital of Pisa, Via Paradisa 2, 56100 Pisa, Italy Franco Filipponi, Department of Liver Transplantation, University Hospital of Pisa, Via Paradisa 2, 56124 Pisa, Italy Journal Abdominal Imaging Online ISSN 1432-0509 Print ISSN 0942-8925

Description:    Transcatheter arterial chemoembolization with drug-eluting beads (TACE-DC-beads) is a new local treatment for primary or metastatic liver tumors. Despite technical efforts to achieve highly selective embolization of the tumor-supplying vessels, small, or large insults to the non-tumorous parenchyma are inevitably induced by the embolic materials or procedure itself. Parenchymal changes following TACE-DC-beads include bile duct injuries (bile duct dilatation, periportal edema, and bilomas), obliteration of intrahepatic portal vein branches, hypodense ill-defined areas, and perilesional parenchymal enhancement. The radiologist must be familiar with the changes induced by this treatment in order to distinguish therapeutic effect and collateral findings from complications and residual or recurrent tumor. Content Type Journal Article Category Pictorial Essay Pages 1-7 DOI 10.1007/s00261-012-9963-6 Authors Juan Carlos Spina, Department of Radiology, Hospital Italiano, Universidad de Buenos Aires, Gascón 450, Buenos Aires, Argentina Marina Ulla, Department of Radiology, Hospital Italiano, Universidad de Buenos Aires, Gascón 450, Buenos Aires, Argentina Ezequiel Levy Yeyati, Department of Radiology, Hospital Italiano, Universidad de Buenos Aires, Gascón 450, Buenos Aires, Argentina Mariana Cecilia Kucharczyk, Department of Radiology, Hospital Italiano, Universidad de Buenos Aires, Gascón 450, Buenos Aires, Argentina Hernan Irusta, Department of Radiology, Hospital Italiano, Universidad de Buenos Aires, Gascón 450, Buenos Aires, Argentina Jesica Lorena Savluk, Department of Radiology, Hospital Italiano, Universidad de Buenos Aires, Gascón 450, Buenos Aires, Argentina Ricardo García-Mónaco, Department of Radiology, Hospital Italiano, Universidad de Buenos Aires, Gascón 450, Buenos Aires, Argentina Journal Abdominal Imaging Online ISSN 1432-0509 Print ISSN 0942-8925

Description: Purpose   To investigate the presentation of splenic hamartomas (SHs) on ultrasonography (US), CT and MRI. Methods   Nine patients (5 males and 4 females, mean age, 52.8 years) with pathologically proven SHs were included in this study. US, CT and MRI images were analyzed retrospectively, and imaging features were correlated with pathological findings. Results   SHs appeared solitary lesion ( n  = 8) and multiple lesions ( n  = 1) in the present study. (1) In 8 cases of solitary lesion, the lesions appeared as solid nodules or masses with well-defined margins and varying echogenicity (hyperecho = 5, hypoecho = 2, strong echo = 1) on ultrasound. The lesions showed iso-attenuation ( n  = 3) or slightly hypo-attenuation ( n  = 4) on unenhanced CT, and calcification were revealed in 3 lesions. MRI showed isointensity ( n  = 3) or hypointensity ( n  = 2) on the T1-weighted image, and heterogeneous hypointensity ( n  = 2), slightly hyperintensity ( n  = 2) and hyperintensity ( n  = 1) on the T2-weighted image. The enhanced patterns of SHs showed mild diffuse heterogeneous enhancement ( n  = 6) and prominent enhancement ( n  = 1) during arterial phase and above 7 lesions were demonstrated progressive enhancement at delayed phase on enhanced CT. One lesion without any enhancement was revealed in another patient. (2) One case of multiple lesions included 1 cystic lesion with irregular calcification and 7 solid lesions with progressive enhancement on CT images. Conclusions   Combination of a variety of imaging modalities could more fully reflect the pathological characteristics and contribute to the diagnosis of SH. Content Type Journal Article Pages 1-9 DOI 10.1007/s00261-012-9880-8 Authors Jian-hua Wang, Department of Radiology, The Affiliated Hospital of Ningbo University School of Medicine, Ningbo No. 2 Hospital, Ningbo, 315010 Zhejiang, China Xiao-long Ma, Department of Radiology, Changhai Hospital, Second Military Medical University, Shanghai, 200433 China Fang-yuan Ren, Department of Radiology, Lanzhou General Hospital of Lanzhou Military Region, Lanzhou, 730050 Gansu, China Chang-jing Zuo, Department of Nuclear Medicine and Department of Radiology, Changhai Hospital, Second Military Medical University, Shanghai, 200433 China Jian-ming Tian, Department of Radiology, Changhai Hospital, Second Military Medical University, Shanghai, 200433 China Zhi-feng Wang, Department of Radiology, The Affiliated Hospital of Ningbo University School of Medicine, Ningbo No. 2 Hospital, Ningbo, 315010 Zhejiang, China Jian-ming Zheng, Department of Pathology, Changhai Hospital, Second Military Medical University, Shanghai, 200433 China Journal Abdominal Imaging Online ISSN 1432-0509 Print ISSN 0942-8925

Description:    Misinterpretation at CT colonography (CTC) can result in either a colorectal lesion being missed (false-negative) or a false-positive diagnosis. This review will largely focus on potential missed lesions—and ways to avoid such misses. The general causes of false-negative interpretation at CTC can be broadly characterized and grouped into discrete categories related to suboptimal study technique, specific lesion characteristics, anatomic location, and imaging artifacts. Overlapping causes further increase the likelihood of missing a clinically relevant lesion. In the end, if the technical factors of bowel preparation, colonic distention, and robust CTC software are adequately addressed on a consistent basis, and the reader is aware of all the potential pitfalls at CTC, important lesions will seldom be missed. Content Type Journal Article Pages 1-16 DOI 10.1007/s00261-012-9897-z Authors Perry J. Pickhardt, Department of Radiology, University of Wisconsin School of Medicine & Public Health, E3/311 Clinical Science Center, 600 Highland Ave., Madison, WI 53792-3252, USA Journal Abdominal Imaging Online ISSN 1432-0509 Print ISSN 0942-8925

Description: Purpose   To facilitate a better understanding of incidentally noted cystic pancreatic lesions, since these lesions often pose a challenge regarding appropriate management. Methods   This article reviews pathophysiology, prevalence, significance, and recommendations for management of the various pancreatic cystic lesions. Illustrative cases are demonstrated. Results   Diagnostic benign lesions can be left alone. Cross-sectional imaging can be used to follow-up benign appearing lesions and to stage more aggressive ones. Endoscopic ultrasound with fine needle aspiration and cyst fluid analysis can be performed on certain indeterminate lesions. Lesions with high malignant potential should undergo resection. Conclusions   A better understanding of the variety of incidentally detected pancreatic cystic lesions can help direct appropriate management. Content Type Journal Article Pages 1-11 DOI 10.1007/s00261-012-9898-y Authors Atif Zaheer, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institutions, 601 N. Caroline Street, JHOC 3235 A, Baltimore, MD 21231, USA Sajal S. Pokharel, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institutions, 601 N. Caroline Street, JHOC 3235 A, Baltimore, MD 21231, USA Christopher Wolfgang, Department of Surgery, Johns Hopkins Medical Institutions, Baltimore, MD 21287, USA Elliot K. Fishman, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institutions, 601 N. Caroline Street, JHOC 3235 A, Baltimore, MD 21231, USA Karen M. Horton, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institutions, 601 N. Caroline Street, JHOC 3235 A, Baltimore, MD 21231, USA Journal Abdominal Imaging Online ISSN 1432-0509 Print ISSN 0942-8925

Description: Objective   We describe the use of imaging in the management of adjustable gastric-banding patients, and describe complications of banding that are diagnosed by imaging. Materials & Methods   Using a four-year period as an example of complications of this type of laparoscopic approach, we have retrospectively identified all patients with laparoscopic bands who were imaged in the radiology department at our large multispecialty hospital. Included are patients who had their bands placed by the hospital’s surgeons as well as patients referred for consultation from other practices. Results   Twenty-two of 165 patients who had banding as their sole weight loss surgery had 23 complications diagnosed by imaging. Complications included band slip (3), device issues (4), esophageal dilation (8), esophageal dysmotility (5), symptomatic gallstones (2) and a gastroesphageal diverticulum (1). Complications were detected by fluoroscopy (17), CT (4) or ultrasound (2). 17 patients had banding as one of multiple bariatric surgeries, with 13 complications: band slip (4), port infection (1), esophageal dilation (1), esophageal dysmotility (5), anastomotic leak (1) and internal hernia (2). Complications were detected with fluoroscopy (12) and CT (1). Conclusions   Fluoroscopy is generally the primary imaging modality used to diagnose complications of gastric banding. Esophageal dilation and dysmotility, which appear to be long-term sequelae of banding, were the most common complications identified by imaging. Content Type Journal Article Pages 1-7 DOI 10.1007/s00261-012-9859-5 Authors Thomas Keane, 2602 Prendergast Place, Reynoldsburg, OH 43068, USA Alexander R. Margulis, Weill Cornell Medical College, 525 East 68th Street, New York, NY 10065, USA Gregory F. Dakin, Department of Surgery, Section of Laparoscopic and Bariatric Surgery, Weill Cornell Medical College, New York Presbyterian Hospital, 525 East 68th Street, New York, NY, USA Alfons Pomp, Department of Surgery, Section of Laparoscopic and Bariatric Surgery, Weill Cornell Medical College, New York Presbyterian Hospital, 525 East 68th Street, New York, NY, USA Journal Abdominal Imaging Online ISSN 1432-0509 Print ISSN 0942-8925

Description:    Morbid obesity remains as a common and increasing health problem. Due to limited long-term success with nonsurgical weight loss measures for morbid obesity, bariatric surgery is being performed more and more often in both academic and private practice settings and has proven to be an effective treatment option with sustained weight loss, decreased morbidity, reversal of comorbidities, and prolonged life expectancies [Am J Clin Nutr 55:615S–619S, 1992 ; Brolin, Nutrition 12:403–404, 1996 ; Fisher and Schauer, Am J Surg 184:9S–16S 2002 ]. The Roux-en-Y gastric bypass, biliopancreatic diversion, and gastric sleeve will be discussed in terms of their expected imaging appearance and potential complications. Content Type Journal Article Pages 1-15 DOI 10.1007/s00261-012-9860-z Authors Laura R. Carucci, Virginia Commonwealth University Health System, 1250 East Marshall Street, Richmond, VA 23298, USA Mary Ann Turner, Virginia Commonwealth University Health System, 1250 East Marshall Street, Richmond, VA 23298, USA Journal Abdominal Imaging Online ISSN 1432-0509 Print ISSN 0942-8925

Description: Lower gastrointestinal bleeding due to primary ilioenteric fistula Content Type Journal Article Pages 1-3 DOI 10.1007/s00261-012-9893-3 Authors Mathurin Fumery, Service d’hépato-gastroentérologie, Centre Hospitalier Universitaire d’Amiens, Place Victor Pauchet, 80000 Amiens, France Jean Christophe Duchmann, Gastroenterology Department, Compiègne General Hospital, 60200 Compiègne, France Raymond Andary, Urology Department, Compiègne General Hospital, 60200 Compiègne, France Matthieu Eoche, Service d’hépato-gastroentérologie, Centre Hospitalier Universitaire d’Amiens, Place Victor Pauchet, 80000 Amiens, France Marthe Chavance, Gastroenterology Department, Compiègne General Hospital, 60200 Compiègne, France Morgane Bourgeois, Gastroenterology Department, Compiègne General Hospital, 60200 Compiègne, France Jean Louis Dupas, Service d’hépato-gastroentérologie, Centre Hospitalier Universitaire d’Amiens, Place Victor Pauchet, 80000 Amiens, France Journal Abdominal Imaging Online ISSN 1432-0509 Print ISSN 0942-8925