Description: Purpose Papillary renal cell carcinoma (P-RCC) typically exhibits a homogeneous, solid hypovascular mass; P-RCC with a cystic appearance is atypical. Tubulocystic RCC (TC-RCC), a newly proposed entity for renal tumors in the 2016 WHO classification, and cystic papillary RCC, may yield similar imaging findings. Therefore, we investigated the incidence of papillary RCC with cystic changes and compared its CT and pathologic features to differentiate between two entities. Methods We retrospectively evaluated 26 consecutive patients diagnosed with P-RCC. Two radiologists consensually identified dominant masses indicative of cystic changes on CT scans and recorded their Bosniak classification. In addition, two pathologists inspected the whole area of tumors macroscopically, labeled them as solid- or cystic change-dominant tumors, determined the pathogenesis of the cystic components (necrosis or hemorrhage), and recorded their inherent cystic characteristics (with/without TC-RCC components). We defined masses with cystic changes involving more than 50% of the entire tumor as cystic change-dominant tumors. Results Of the 26 tumors, 7 (27%) were diagnosed cystic change-dominant based on imaging and pathologic findings, of these, 2 were classified as Bosniak type III and 5 as Bosniak type IV. The pathologists confirmed that two type IV tumors demonstrated extensive necrosis and one type IV tumor revealed extensive hemorrhage. Four P-RCCs (type III and IV, 2 each) were of a mixed type harboring both solid and cystic components. Only one tumor exhibited a multilocular cystic appearance. All 7 cystic change-dominant P-RCCs were pathologically diagnosed as a pure P-RCC without TC-RCC components. Conclusion While P-RCCs may contain cystic features, the multilocular type of cystic P-RCC is rare.

Description: Historically, cancer treatment has emphasized measures for the “cure” regardless of the long-term consequences. Advances in cancer detection and treatment have resulted in improved outcomes bringing to the fore various quality of life considerations including future fertility. For many young cancer patients, fertility preservation is now an integral component of clinical decision-making and treatment design. Optimal fertility-sparing options for young patients with gynecologic cancer are influenced by patient age, primary cancer, treatment regimens, and patient preferences. Possible approaches include embryo or oocyte cryopreservation, ovarian transposition, conservative surgery, and conservative medical treatment to delay radical surgery. These may be used alone or in combination to maximize fertility preservation. Awareness of the various fertility-sparing options, eligibility criteria, and the central role of magnetic resonance imaging in the proper selection of patients will enable radiologists to produce complete clinically relevant imaging reports and serve as effective consultants to referring clinicians. Knowledge of the potential imaging pitfalls is essential to avoid misinterpretation and guide appropriate management.

Description: Purpose To investigate the diagnostic usefulness of real-time elastography (RTE) for liver fibrosis in chronic hepatitis B (CHB). Methods 89 CHB patients were enrolled in the cross-sectional study. Ultrasound-guided percutaneous liver biopsies, RTE, and blood testing were performed in all patients. Areas under receiver operating characteristic curves (AUROC) were used to examine the diagnostic performance of liver fibrosis index (LFI) for the assessment of liver fibrosis. Results LFI differed significantly across histologic fibrosis stages ( P  〈 0.05), except the comparison between S 0 and S 1 ( P  = 0.298). There was a strong positive correlation between LFI and histologic liver fibrosis stage (Spearman r  = 0.831, P  〈 0.001). The cutoff LFI value of 〉2.74 indicated a sensitivity of 0.766 and a specificity of 0.872 for predicting significant liver fibrosis ( S  ≥ 2), and the cutoff LFI value of 〉3.61 indicated a sensitivity of 0.833 and a specificity of 0.878 for predicting early liver cirrhosis ( S  = 4). LFI showed higher AUROC for discriminating significant liver fibrosis (0.873 vs. 0.614) and early liver cirrhosis (0.923 vs. 0.769) than aspartate aminotransferase-to-platelet ratio index (APRI). Conclusions RTE is a valuable sonography-based non-invasive method for assessment of liver fibrosis and has better discrimination power for significant liver fibrosis and early liver cirrhosis than APRI in CHB.

Description: Purpose To compare studies with and without oral contrast on performance of multidetector computed tomography (CT) and the order to CT examination turnaround time in cancer patients presenting to the emergency department (ED). To the best of our knowledge, oral contrast utility has not previously been specifically assessed in cancer patients presenting to the emergency department. Materials & methods Retrospective review of CT abdomen examinations performed in oncology patients presenting to the emergency department during one month. CT examinations performed with and without oral contrast were rated by two consensus readers for degree of confidence and diagnostic ability. Correlations were assessed for primary cancer type, age, sex, chief complaint/examination indication, body mass index, intravenous contrast status, repeat CT examination within 4 weeks, and disposition. Turnaround times from order to the start of the CT examination were calculated. Results The studied group consisted of 267 patients (127 men and 140 women) with a mean age of 56 years and a mean body mass index of 27.8 kg/m 2 . One hundred sixty CT examinations were performed without oral contrast, and 107 CT examinations were performed with oral contrast. There was no significant difference between cases with oral contrast and cases without oral contrast in the number of cases rated as “improved confidence” (odds ratio [OR] 0.54, 95% confidence interval [CI] 0.23–1.31, P  = 0.17), “improved diagnosis” (OR 0.58, 95% CI 0.20–1.64, P  = 0.3), “impaired confidence” (OR 3.92, 95% CI 0.46–33.06, P  = 0.21), or “impaired diagnosis” (OR 2.63, 95% CI 0.29–23.89, P  = 0.39). The turnaround time in the group receiving oral contrast (mean, 141 min; standard deviation, 49.8 min) was significantly longer than that in the group not receiving oral contrast (mean, 109.2 min; standard deviation, 64.8 min) with a mean difference of 31.8 min ( P  〈 0.0001). Conclusion On the basis of our findings and prior studies, targeted rather than default use of oral contrast shows acceptable diagnostic ability in the emergency setting for oncology patients. Benefit from oral contrast use is suggested in scenarios such as suspected fistula/bowel leak/abscess, hypoattenuating peritoneal disease, prior bowel surgery such as gastric bypass, and the absence of intravenous contrast administration. Improvement through the use of targeted oral contrast administration also supports the emergency department need for prompt diagnosis and disposition.

Description: Purpose To review borderline resectability criteria for pancreatic malignancies, show examples of few surgically treated minimally advanced pancreatic malignancies, discuss various complex vascular reconstructions, and highlight the imaging appearances. Background Often aggressive surgical approaches are used to treat borderline to minimally advanced pancreatic malignancies in specialist centers. As abdominal radiologists it is essential to have up-to-date knowledge to distinguish such tumors with accuracy and also be well versed with the various vascular reconstructions used in such surgeries. Imaging findings We will show various examples of resected borderline resectable and minimally advanced pancreatic malignancies, highlight crucial vascular involvements, describe various types of advanced vascular reconstructions, and review their standard imaging appearances. We will also briefly describe the vascular complications and highlight the importance of imaging surveillance in early post-operative period. Conclusions It is essential for abdominal radiologists in specialist centers where aggressive surgical approaches are used to have accurate knowledge to assess vascular involvement in pancreatic malignancies and equally to recognize and assess vascular reconstructions on imaging after complex surgeries.

Description: Purpose To demonstrate that fully navigated magnetic resonance spectroscopy (MRS) with inner-volume saturation (IVS) at 3 T results in high-quality spectra that permit evaluating metabolic changes in hepatic metastases without the need for patient compliance. Methods Nine patients with untreated, biopsy-proven large hepatic metastases (minimum diameter of 3 cm) were included. In each patient, localized proton MRS was performed in the metastatic lesion and in uninvolved liver parenchyma. To improve quality and consistency of proton MRS, navigator gating was thereby performed not only during acquisition of the spectroscopic data but also during localization imaging and throughout the preparation phases. IVS was utilized to reduce chemical shift displacement between different metabolites and to diminish flow artifacts. Metabolite quantities were normalized relative to the unsuppressed water peak and choline-containing compounds (CCC) to lipid ratios were determined. Wilcoxon signed-rank tests were used to assess differences in the amounts of lipids and CCC as well as the CCC-to-lipid ratios between liver metastases and normal-appearing liver parenchyma. Results Fully navigated point-resolved spectroscopy with IVS resulted in high-quality spectra in all patients. Navigator gating during localization imaging and spectroscopic acquisition thereby ensured a precise localization of the spectroscopic voxel. Decreased quantities of lipid and CCC were observed in metastatic tissue compared with uninvolved liver parenchyma. However, the latter trend fell short of statistical significance. Moreover, elevated levels of the CCC-to-lipid ratios were detected in metastatic tissue relative to normal-appearing liver parenchyma. Conclusions The present study demonstrates that fully navigated MRS of the liver with IVS at 3 T allows for a precise localization of the spectroscopic voxel and results in high-quality spectra that permit evaluating liver metabolism without the need for patient compliance.