Beschreibung: Purpose   To assess the utility of magnetic resonance imaging (MRI) in patients with clinically suspected ectopic pregnancy (EP). Methods   We retrospectively reviewed MRIs of 26 consecutive patients who were clinically suspected of having an EP. The diagnostic utility of MRI features of EP was analyzed retrospectively as follows: (1) Direct sign detection of ectopic gestational sac (GS); (2) Indirect signs tubal dilatation with hemosalpinx, adnexal hematoma, and hemorrhagic ascites. The diagnostic accuracy of each sign and their combination was compared to surgical records. The MRI findings of an ectopic GS were reviewed as follows: size, shape, signal intensity, and enhancement pattern. Results   Of 26 patients, 24 had a tubal pregnancy; 22 of these 24 patients (92%) had a direct sign (sensitivity: 91.3%; specificity: 100%; positive predictive value: 100%). The diagnostic accuracy of the direct sign was 92%; this was more accurate than that of any single indirect sign (39%, 54%, and 50%, respectively). However, the diagnostic accuracy of EP increased to 100% when diagnostic criteria required the presence of a direct sign or at least two indirect signs. Conclusions   MRI is an effective modality for diagnosing EP with a high detection rate of extrauterine GSs. The combination of direct and indirect signs is useful for establishing the correct diagnosis. Content Type Journal Article Pages 1-7 DOI 10.1007/s00261-012-9969-0 Authors Aki Takahashi, Department of Radiology, Nara Medical University, 840 Shijo-cho, Kashihara City, Nara 634-8522, Japan Junko Takahama, Department of Radiology, Nara Medical University, 840 Shijo-cho, Kashihara City, Nara 634-8522, Japan Nagaaki Marugami, Department of Radiology, Nara Medical University, 840 Shijo-cho, Kashihara City, Nara 634-8522, Japan Megumi Takewa, Department of Radiology, Heisei Memorial Hospital, 827 Shijo-cho, Kashihara City, Nara 634-0813, Japan Takahiro Itoh, Department of Radiology, Nara Medical University, 840 Shijo-cho, Kashihara City, Nara 634-8522, Japan Satoru Kitano, Department of Radiology, Social Insurance Nara Hospital, 1-62 Asahi-cho, Yamatokoriyama City, Nara 639-1013, Japan Kimihiko Kichikawa, Department of Radiology, Nara Medical University, 840 Shijo-cho, Kashihara City, Nara 634-8522, Japan Journal Abdominal Imaging Online ISSN 1432-0509 Print ISSN 0942-8925

Beschreibung:    Patients, referring physicians, the media, and government agencies have all expressed concern over the risks of medical radiation, particularly as it relates to CT. This concern is particularly paramount when associated with a screening examination such as CT colonography. These theoretical risks must be weighed realistically against the substantial benefits of colon cancer screening as well as against the risks inherent in the major alternative screening option, optical colonoscopy. When put into perspective, the risk–benefit ratio is highly in favor of the performance of CT colonography. Nevertheless, in following the ALARA principle, there is an ever increasing armamentarium of options that can be employed in the pursuit of CT radiation dose reduction, all of which can be used in many synergistic combinations allowing for dose reduction while simultaneously preserving image quality and minimizing image noise. After a brief tutorial on estimating radiation dose, various strategies will be discussed including reductions in tube current and tube voltage as well as the use of automatic dose modulation and iterative reconstruction. Other practical considerations will also be reviewed including proper patient isocentering, optimization of colonic insufflation to minimize additional decubitus scans, proper choice of scan volumes to avoid overranging, and variation of slice thickness and window width to minimize perceived image noise. Finally, a strategy for how to incrementally introduce these methods as well as a way to compare dose reduction efforts across institutions throughout the country will be offered. Content Type Journal Article Pages 1-9 DOI 10.1007/s00261-012-9968-1 Authors Kevin J. Chang, Department of Diagnostic Imaging, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, 593 Eddy St., Providence, RI 02903, USA Judy Yee, Department of Radiology and Biomedical Imaging, School of Medicine, University of California, San Francisco, San Francisco, CA, USA Journal Abdominal Imaging Online ISSN 1432-0509 Print ISSN 0942-8925

Beschreibung: Objective   With major efforts being made to reduce radiation exposure in CT, one area of practice that requires additional improvement is limiting the number of acquisitions for body CT imaging. This review article defines best MDCT practice in terms of tailored abdominal CT protocols, designed to maximize lesion detection while limiting radiation exposure. Conclusions   The literature defines optimal acquisitions for a range of abdominal CT indications, with precontrast and delayed acquisitions being least commonly indicated. Content Type Journal Article Pages 1-9 DOI 10.1007/s00261-012-9964-5 Authors Pamela T. Johnson, Department of Radiology, Johns Hopkins Hospital, 601 N. Caroline Street, Room 3140D, Baltimore, MD 21287, USA Elliot K. Fishman, Department of Radiology, Johns Hopkins Hospital, 601 N. Caroline Street, Room 3140D, Baltimore, MD 21287, USA Journal Abdominal Imaging Online ISSN 1432-0509 Print ISSN 0942-8925

Beschreibung:    The obstructed defecation syndrome is the main functional disorder of the posterior or ano-rectal pelvic floor compartment. Different mechanical and functional rectal disorders may cause this syndrome, including rectocele, rectal invagination, rectal prolapse, and pubo-rectalis muscle dyskinesia. Since pelvic floor muscles and fasciae act as a unique functional entity, dysfunctions of the posterior compartment are usually associated to variable dysfunctions of the anterior and middle urogenital compartments as well. Over 50% of postmenopause women are affected by severe symptoms due to pelvic floor disorders, with frequent need of surgical invasive treatments. Both diagnosis of the specific ano-rectal dysfunction and identification of all possible associated disorders are mandatory for an effective surgical or conservative treatment. Currently, dynamic MRI provides an excellent morphological and functional display of the pelvic floor like no other imaging modality. Pros and cons of posterior pelvic floor MRI, different evaluation techniques, reference lines and grading systems together with the main imaging findings will be discussed and illustrated. Content Type Journal Article Pages 1-22 DOI 10.1007/s00261-012-9955-6 Authors Francesca Maccioni, Department of Radiologic Sciences, Oncology and Pathology, “Sapienza” University of Rome, Policlinico Umberto I Hospital, Viale Regina Elena 324, 00161 Rome, Italy Journal Abdominal Imaging Online ISSN 1432-0509 Print ISSN 0942-8925

Beschreibung: Objective   The objective of this paper is to review the more recent literature on pelvic organ prolapse (POP). A detailed Medline search was performed. Background   An understanding of the published literature is important in deciding, which surgical approach has to be used and how to counsel patients during informed consent. Findings   In the review, we analyze the various interventions for POP and provides also a survey of the current controversies and areas where knowledge is incomplete and need further evaluation for definitive answers regarding optimization of surgical care for POP. While theoretically appealing, the implantation of synthetic mesh in the pelvis may be associated with inherent adverse consequences, such as erosion, extrusion, and infection that further complicate the decision to use synthetic mesh. In addition, the routine use of these materials may carry potential long-term complications, such as dyspareunia, chronic pelvic pain, and vaginal distortion. A final overview on the International Consultation on Incontinence and Cochrane database are reported, as recent warnings by the USA Food and Drug Administration. Content Type Journal Article Pages 1-10 DOI 10.1007/s00261-012-9960-9 Authors Mauro Cervigni, Department of Urogynecology, San Carlo, IDI Hospital, Rome, Italy Franca Natale, Department of Urogynecology, San Carlo, IDI Hospital, Rome, Italy Journal Abdominal Imaging Online ISSN 1432-0509 Print ISSN 0942-8925

Beschreibung:    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

Beschreibung: 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

Beschreibung: Purpose   Our aim was to analyze the value of ultrasound using the twinkling sign in the diagnosis of ureteral stones in patients with renal colic in the emergency setting. Materials and methods   Prospective study of 100 patients with suspected renal colic who underwent an US examination, including color Doppler mode. We analyzed sensitivity, specificity, predictive values, and accuracy. We evaluated whether the stone was observed before or after the twinkling artifact, and whether the use of the Doppler color increased the examination time. Results   US including color Doppler detected 76 of the 84 confirmed lithiasis. The sensitivity and specificity were 90 % and 100 %, respectively. The positive predictive value was 100 % and the negative 67 %. The accuracy was 92 %. A total of 59 calculi (78 %) examined by color Doppler sonography showed the twinkling artifact. Seventy percent of the twinkling-positive calculi showed the artifact before the stone itself was detected. Considering the location of the stones the twinkling sign was seen before the stone in 92 % of lithiasis located in the mid lumbar ureter ( p  = 0.02). The use of the twinkling artifact showed a trend to facilitate the detection of smaller calculi (〈10 mm) ( p  = 0.08). The average examination time was 5.8 min [±4.3] (without differences between the stones detected before or after the twinkling artifact, p  = 0.75). Conclusion   Doppler US examination shows good sensitivity and specificity for the diagnosis of symptomatic ureteral stones. The twinkling artifact is useful for the early detection of the calculi, especially in the middle tract of the ureter, usually the most difficult place in sonographic diagnosis. It also seems helpful for the detection of smaller stones. The use of color Doppler does not increase the exploration time. Content Type Journal Article Pages 1-7 DOI 10.1007/s00261-012-9946-7 Authors Tomás Ripollés, Department of Radiology, Hospital Universitario Dr. Peset, 90 Gaspar Aguilar Avenue, 46017 Valencia, Spain María J. Martínez-Pérez, Department of Radiology, Hospital Universitario Dr. Peset, 90 Gaspar Aguilar Avenue, 46017 Valencia, Spain José Vizuete, Department of Radiology, Hospital Universitario Dr. Peset, 90 Gaspar Aguilar Avenue, 46017 Valencia, Spain Salvador Miralles, Department of Radiology, Hospital Universitario Dr. Peset, 90 Gaspar Aguilar Avenue, 46017 Valencia, Spain Fructuoso Delgado, Department of Radiology, Hospital Universitario Dr. Peset, 90 Gaspar Aguilar Avenue, 46017 Valencia, Spain Teresa Pastor-Navarro, Department of Urology, Hospital Universitario Dr. Peset, 90 Gaspar Aguilar Avenue, 46017 Valencia, Spain Journal Abdominal Imaging Online ISSN 1432-0509 Print ISSN 0942-8925

Beschreibung:    MR and CT techniques optimized for small bowel imaging are playing an increasing role in the evaluation of small bowel disorders. Several studies have shown the advantages of these techniques over traditional barium fluoroscopic examinations due to improvements in spatial and temporal resolution combined with improved bowel distending agents. The preference of MR vs. CT has been geographical and based on expertise and public policy. With the increasing awareness of radiation exposure, there has been a more global interest in implementing techniques that either reduce or eliminate radiation exposure. This is especially important in patients with chronic diseases such as inflammatory bowel disease who may require multiple studies over a lifetime or in studies that require sequential imaging time points such as in assessment of gastrointestinal motility. MRI has many properties that make it well suited to imaging of the small bowel: the lack of ionizing radiation, the improved tissue contrast that can be obtained by using a variety of pulse sequences, and the ability to perform real time functional imaging. Moreover, MR modalities allow visualization of the entire bowel, without overlapping bowel loops, as well as the detection of both intra- and extraluminal abnormalities.The intra- and extraluminal MR findings, combined with contrast enhancement and functional information, help to make an accurate diagnosis and consequently characterize small bowel diseases. Content Type Journal Article Pages 1-11 DOI 10.1007/s00261-012-9961-8 Authors Gabriele Masselli, Radiology Department, Umberto I Hospital. La Sapienza University, Viale del Policlinico 155, 00161 Rome, Italy Gianfranco Gualdi, Radiology Department, Umberto I Hospital. La Sapienza University, Viale del Policlinico 155, 00161 Rome, Italy Journal Abdominal Imaging Online ISSN 1432-0509 Print ISSN 0942-8925

Beschreibung:    The role of FDG PET/CT in anal cancer is becoming increasingly important. At the time of initial staging, FDG PET/CT can detect the primary site of disease more frequently than CT, is sensitive for nodal and metastatic spread and alters staging in a significant number of patients. Indeed, the NCCN guidelines for anal cancer published in April 2012 recommend FDG PET/CT for therapy planning. Metabolic activity of primary anal cancer at presentation is a potential biomarker for predicting prognosis, treatment response and survival. More intensely FDG-avid primary malignancy is associated with a higher incidence of disease spread. Metabolic response following chemoradiotherapy is associated with improved survival. The aim of this paper is to provide an up-to-date pictorial review of FDG PET/CT in anal cancer at the time of staging and to illustrate its utility for determining response to therapy and detecting recurrent disease. Content Type Journal Article Category Pictorial Essay Pages 1-8 DOI 10.1007/s00261-012-9958-3 Authors Sachin S. Saboo, Department of Radiology, Dana-Farber Cancer Institute, Brigham and Women’s Hospital & Harvard Medical School, 450 Brookline Avenue, Boston, MA, 02215, USA Katherine Zukotynski, Department of Radiology, Dana-Farber Cancer Institute, Brigham and Women’s Hospital & Harvard Medical School, 450 Brookline Avenue, Boston, MA, 02215, USA Atul B. Shinagare, Department of Radiology, Dana-Farber Cancer Institute, Brigham and Women’s Hospital & Harvard Medical School, 450 Brookline Avenue, Boston, MA, 02215, USA Katherine M. Krajewski, Department of Radiology, Dana-Farber Cancer Institute, Brigham and Women’s Hospital & Harvard Medical School, 450 Brookline Avenue, Boston, MA, 02215, USA Nikhil Ramaiya, Department of Radiology, Dana-Farber Cancer Institute, Brigham and Women’s Hospital & Harvard Medical School, 450 Brookline Avenue, Boston, MA, 02215, USA Journal Abdominal Imaging Online ISSN 1432-0509 Print ISSN 0942-8925