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MYSIR’s Abstracts 2 1. EP01: A RARE CASE OF POST MVA CERVICAL LIGAMENTOUS TEAR COMPLICATED WITH VERTEBRAL ARTERIOVENOUS FISTULA (VAVF) WITH SUCCESSFUL ENDOVASCULAR TREATMENT 2. EP02: SIGNIFICANTLY LESS BLEEDING INTRAOPERATIVELY WITH FAVORABLE POST-SURGICAL OUTCOMES FOLLOWING ENDOVASCULAR COILING AND AMPLATZER VASCULAR PLUG FOR AURICULAR ARTERIO-VENOUS MALFORMATION 3. EP03: POSTERIOR TRANSGLUTEAL CT FLUOROSCOPY GUIDED PERCUTANEOUS DRAINAGE OF DEEP PELVIC ABSCESS IN SULTAN HAJI AHMAD SHAH MEDICAL CENTRE @IIUM (SASMEC @IIUM): A CASE SERIES 4. EP04: PERCUTANEOUS TRANSHEPATIC BILIARY DRAINAGE IN ADULT BILIARY ATRESIA WITH NATIVE LIVER: A CASE SERIES 5. EP05: MAY-THURNER SYNDROME CONUNDRUM: MASSIVE SUBCAPSULAR LIVER HEMATOMA FOLLOWING INTRAVENOUS THROMBOLYSIS FOR DEEP VEIN THROMBOSIS 6. EP06: FIRST SUCCESSFUL TRANSCHOLECYSTO-CYSTIC DUCT COMMON BILE DUCT STENTING IN A CASE OF MALIGNANT OBSTRUCTIVE JAUNDICE

MYSIR’s Abstracts 11. OP01: COMPARING EFFECTS OF C-ARM CONE BEAM CT AND HYBRID-CT/C-ARM SYSTEMS ON PATIENT RADIATION DOSE IN TRANSARTERIAL CHEMOEMBOLISATION PROCEDURES 2. OP02: EXTRAHEPATIC SUPPLY IN A LARGE HEPATOCELLULAR CARCINOMA. THE MULTIPLE ORIGINS OF RIGHT INFERIOR PHRENIC ARTERY: A CASE SERIES 3. OP03: TREATMENT OUTCOMES OF SCLEROTHERAPY FOR LOW-FLOW VASCULAR MALFORMATIONS AT SOUTHERN PHILIPPINES MEDICAL CENTER 4. OP04: EFFECTIVENESS OF AN INSTITUTIONAL ANTIBIOTIC PROPHYLAXIS GUIDELINE IN PATIENTS UNDERGOING RADIOFREQUENCY AND MICROWAVE ABLATION OF LIVER TUMORS: A RETROSPECTIVE COHORT STUDY 5. OP05: PERCUTANEOUS MICROWAVE ABLATION OF BENIGN BREAST LESION: A REPORT OF TWO PIONEER CASES IN MALAYSIA 6. OP06: ADRENAL VENOUS SAMPLING (AVS) PROCEDURE USING CONE BEAM CT; NATIONAL CANCER INSTITUTE’S EXPERIENCE

MYSIR's Abstracts 4 1. EP13: PULMONARY ARTERY ANEURYSM – TO GLUE OR TO COIL? 2. EP14: ENDOVASCULAR MANAGEMENT OF A MURAL TYPE OF VEIN OF GALEN MALFORMATION IN A 5 YEAR OLD, FILIPINO CHILD WITH DEVELOPMENTAL DELAY AND SEIZURES: A CASE REPORT 3. EP15: PERCUTANEOUS COIL EMBOLISATION OF HEPATIC ARTERY MYCOTIC ANEURYSM 4. EP16: HEPATIC FALCIFORM ARTERY AS AN ANATOMICAL VARIANT AND ITS CLINICAL SIGNIFICANCE IN CHEMOEMBOLISATION 5. EP17: PERCUTANEOUS TRANSHEPATICCHOLECYSTIC PLACEMENT OF UNCOVERED STENT IN THE COMMON BILE DUCT AND PERCUTANEOUS CHOLECYSTOMY TUBE INSERTION 6. EP18: CRYOABLATION AS AN EFFECTIVE TREATMENT FOR LUNG METASTASES SECONDARY TO UNDIFFERENTIATED SOFT TISSUE SARCOMA 7. EP19: SUPER-SELECTIVE TRANSARTERIAL GLUE EMBOLIZATION (TAGE) OF ACQUIRED UTERINE ARTERIOVENOUS MALFORMATIONS (AVMS) - A CASE REPORT

MYSIR's Abstracts 3 1. EP07: CASE OF REFRACTORY AND RECURRENT RADIAL ANEURYSMAL BONE CYST TREATED WITH TRANS-ARTERIAL EMBOLISATION AND PERCUTANEOUS SCLEROTHERAPY – OUR EXPERIENCE 2. EP08: ANGIOEMBOLISATION OF CREMASTERIC ARTERY FOR SCROTAL HAEMATOMA FOLLOWING HERNIAL REPAIR 3. EP09: EMBOLIZATION OF A HIGHLY VASCULAR CERVICAL SPINE TUMOUR AND IMAGING ASSESMENT PRIOR TO SURGERY 4. EP10: PRE-OPERATIVE EMBOLIZATION OF ANGIOSARCOMA OF THE HEAD: A CASE REPORT 5. EP11: PSEUDOMYXOMA PERITONEI MIMICKING RUPTURED LIVER ARTERIOVENOUS MALFORMATION – AN UNCOMMON PRESENTATION OF A HIGH GRADE LIVER SARCOMA 6. EP12: RUPTURED CYSTIC ARTERY PSEUDOANEURYSM AS A COMPLICATION OF ACUTE CALCULOUS CHOLECYSTITIS – A CASE REPORT

Diffuse malignant peritoneal mesothelioma (DMPM) and peritoneal carcinomatosis have similar computed tomography imaging features. Peritoneal carcinomatosis is a known metastatic site for many malignancies and particularly gastrointestinal tract and ovarian cancers. Also, DMPM can masquerade as an ovarian epithelial neoplasm, with very similar clinical presentation and an overlap in imaging findings. When no evident primary tumor is detected other than the peritoneal disease, primary malignant mesothelioma should be considered. Since accurate diagnosis is essential for treatment management, the gold standard in differentiating between these two entities lies in histological analysis. We report a case of DMPM that was initially misdiagnosed as an ovarian cancer, where the biopsy of a peritoneal nodule was able to correct and confirm the diagnosis of DMPM.

The diagnosis and follow-up of patients with Crohn's disease are undergoing rapid development and innovation. In recent decades, significant diagnostic advances have been observed in diagnostic imaging. In recent years, the rapid development of new computer technologies and the introduction of new software have increased the informativeness and accuracy of CT, MRI, and ultrasound examinations of the abdomen. The quality of the CT scan is optimized, and at the same time, the ionizing dose to the patient is reduced. One of the ways to reduce the ionizing dose while scanning patients with Crohn's disease is to use a low-dose scanning protocol. With this scanning method, patients receive a much lower ionizing dose than the standard protocol without significantly losing quality. Dual-energy and dual-layer spectral detectors are two other scan protocols and image post-processing techniques that significantly improve image informativeness. New ultrasound machines and the development of the software have greatly improved the informativeness of this harmless study. Shear wave elastography and strain elastography are new research techniques through which we can obtain information about changes in the mesenteric of the affected areas. Development in magnetic resonance techniques is also observed. New magnetic resonance methods such as MR fluoroscopy, dynamic contrast-enhanced MR perfusion (DCE MR), magnetization transfer, and others are examples of this. Thus, new diagnostic methods give a key role to diagnostic imaging in the detection and follow-up of Crohn's disease.

Neuroendocrine tumors (NETs) are a heterogeneous group of rare malignancies. Rectal neuroendocrine tumors (pHET) are rare, with a frequency of 0.17%, but represent 12% to 27% of all NETs). The World Health Organization classifies NETs into low-grade (G1), medium (G2) tumors (NETs), and high-grade carcinomas (G3) [neuroendocrine carcinomas (NECs)]. The classification is based on the Ki67 proliferation index and the mitotic number. There are a variety of diagnostic imaging techniques. Metastatic lymph nodes are found in nearly 10% of cases of rectal neuroendocrine tumors, which in turn is a poor prognostic sign.We present a case of a positive finding from a PET/CT scan performed with 18F-FDG in the lower and middle thirds of the rectum with increased glucose metabolism and metastatic regional lymph nodes.

1. ABERRATION IN VARIATION: DECEPTION BY A CTA OCCULT BLEEDING VARIANT 2. ATYPICAL MULTICENTRIC EXTRA COMPARTMENTAL AND METACHRONOUS GIANT CELL TUMOR RECURRENCE 3. A RARE CASE OF PARARENAL MALAKOPLAKIA 4. A CASE OF ERDHEIM CHESTER DISEASE WITH MULTISYSTEM INVOLVEMENT 5. EXTRAOSSEOUS EWING’S SARCOMA INVOLVING VAS DEFERENS: A CASE REPORT

1. A RED HERRING OF MEDIASTINAL LYMPHOMA 2. ACUTE SUBMANDIBULAR SIALADENITIS; A RARE COMPLICATION POST POSTERIOR FOSSA SURGERY 3. A COST ANALYSIS OF INTERVENTION RADIOLOGY RELATED PROCEDURES IN VASCULAR ACCESS FOR HEMODIALYSIS 4. A CASE SERIES OF SPONTANEOUS EXTRAPERITONEAL HEMORRHAGE IN COVID-19 PATIENTS IN MALAYSIA 5. CONCURRENT STENTING OF MALIGNANCY-RELATED SVC & PULMONARY ARTERY STENOSES : A CASE REPORT

1. HOW TO GET OUT OF JAIL: AN ENDOVASCULAR APPROACH TO A MAL-POSITIONED CENTRAL VENOUS DIALYSIS CATHETER FROM LEFT SUBCLAVIAN ARTERY TO LEFT VENTRICLE 2. HOW TO GET OUT OF JAIL: AN ENDOVASCULAR APPROACH TO A MAL-POSITIONED CENTRAL VENOUS DIALYSIS CATHETER FROM LEFT SUBCLAVIAN ARTERY TO LEFT VENTRICLE 3. TUNNELED ADULT PERIPHERALLY INSERTED CENTRAL CATHETER (PICC) FOR CENTRAL VENOUS ACCESS IN PEDIATRICS: A SINGLE CENTRE EXPERIENCE 4. POST TRAUMATIC FACIAL PAIN; MULTIFACTORIAL CAUSES AND ROLE OF MINIMALLY INVASIVE PAIN INTERVENTION TREATMENT OPTIONS 5. A RARE CASE OF MECKEL’S DIVERTICULUM IN ELDERLY PRESENTED WITH GASTROINTESTINAL BLEED WITH MULTIPLE INTRAABDOMINAL SMALL VESSELS PSEUDOANEYRYSM

Introduction/Purpose: Multiple myeloma (MM) is a malignant disease of plasma cells, characterized by their uncontrolled proliferation in the bone marrow, leading to bone destruction. In MM, the interaction between malignant plasma cells and the bone microenvironment leads to osteoclast bone destruction, reduced osteoblast function, and blockage of bone regeneration. This imbalance, together with decreased bone mineral density and treatment-related factors such as glucocorticoid therapy, can lead to MM fractures. The aim of our study was to evaluate the characteristics, distribution, and frequency of pathological fractures in patients diagnosed with multiple myeloma.Materials and methods: We retrospectively analyzed the laboratory tests and the results of 29 patients with a total of 45 PET/CT tests, which revealed pathological fractures in 16 (55.18%) men and 13 (44.82%) women. Based on the mean values of SUVmax, the correlation with both laboratory results and clinical stage was examined.Results and discussion: The distribution of pathological fractures by location was as follows: vertebrae: 12 (41.37%), ribs: 9 (31.03%), clavicles: 2 (6.9%), humerus: 2 (6.9%), femurs: 2 (6.9%), pubic bones: 2 (6.9%). In 14 (48.28%) patients, one pathological fracture was found, and in 15 (51.72%), two or more were found as well. In the comparison, no significant correlation was found between laboratory values (hemoglobin, lactate dehydrogenase, creatinine, and alkaline phosphatase) and the value of SUVmax in pathological fractures in patients referred for staging (p-value = 0.9932). In the comparison, no significant correlation was found between the clinical stage and the value of SUVmax in pathological fractures (p-value = 0.9840).Conclusion: The study found that the most common pathological fractures are in the vertebrae. No correlation was found between the clinical stage, laboratory results (hemoglobin, lactate dehydrogenase, creatinine, and alkaline phosphatase), and SUVmax values in pathological fractures. The study was retrospective and based on a small cohort of patients. We cannot be sure whether our conclusions are applicable to other or larger cohorts. More research is needed to confirm our findings.

Introduction/ Aim: The aim of our study was to assess the parameters of the hybrid imaging method 68Ga-prostate-specific membrane antigen (PSMA) positron emission tomography (PET/CT): detection rate, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy in different diagnostic groups of patients.Materials and Methods: We analyzed retrospectively and included in the study a total of 386 patients diagnosed with prostate cancer (PC) in the period 07.2019–01.2021, based on defined inclusion criteria. The patients were divided into four groups: 133 with biochemical recurrence (BHR) after radical therapy (group I); 144 with biochemical progression after radical prostatectomy (RP) (group II); 109 referred for staging of primary PC (group III); and 61 with high-risk PC (group IV).Results and discussion: We reported high specificity (from 97.7% to 100.0%) and PPV (from 98.9% to 100.0%) in all studied diagnostic groups of patients. We reported high values for the sensitivity of the hybrid imaging method in all diagnostic groups of patients (from 92.3% to 98.9%), with lower values found in patients with ISUP grade 5 (group IV) (92.3%) compared to other groups (from 95.3% to 98.9%). NPV was reported from 69.2% to 97.7%, with lower values shown by patients in group IV (69.2%) compared to the first three groups of patients (from 97.1% to 98.8%). The accuracy of the method in all studied groups of patients was reported as high: from 93.4% to 99.3%. Patients with ISUP grade 5 had relatively lower values (93.4%) when compared to other groups (98.2%–99.3%).Conclusion: 68Ga-PSMA PET/CCT is a highly promising imaging modality for PC detection in BHR and staging of primary PC, demonstrating high parametric data in all studied groups of patients. Patients with ISUP grade 5 have the highest detection rate, while other parameters in the same group (NPV, sensitivity, and accuracy) have relatively lower values.

Proliferating trichilemmal cyst, also known as proliferating pilar scalp tumor, is a rare benign tumor of the hair follicle. While trichilemmal cysts are common intradermal or subcutaneous cysts, occuring in 5–10% of the population, only 2% will develop into proliferative trichilemmal cyst. The differential diagnosis should include lesions such as malignant proliferating trichilemmal tumor and squamous cell carcinoma. Surgical treatment is the only effective method for treating these rare cysts. We present a case report of a 78-years-old female patient who hasentered the Neurosurgery clinic of “St. Marina” University Hospital with clinical manifestation of rapidly growing from several months subcutaneous formation on the head and the presence of two smaller ones. MRI scan discovered three subcutaneous tumor formations suspicious for trichilem cysts, one of which was gigantic in size. After clinical discussion, under general anesthesia an operative treatment was performed with total extirpation of the cysts. Postoperatively, surgery-related complications were not observed. The patient was mobilized and verticalized on the day after intervention and discharged on the 5th day. As a result, a good cosmetic effect was obtained. Proliferating trichilemmal cyst is an uncommon neoplasm, and reporting of these lesions are important due to the good clinical evolution compared to the malignant macroscopic and microscopic feature of these tumor formations.

Endometrial hyperplasia is defined as the pathological condition caused by hyper plastic changes at the level of the glandular and stromal structures of the endometrium that are part of the lining of the endometrial cavity. Atypical endometrial hyperplasia can cause an essential problem because it is considered a precursor of endometrial cancer. The early diagnosis of precancerous endometrial lesions and the exclusion of pre-existing endometrial carcinomas are necessary for patients’ optimal management. The following is a case of a 50-year-old Guatemalan patient with a three-day history of vaginal bleeding. The transvaginal ultrasound reports endometrial thickening suggestive of endometrial hyperplasia. The diagnosis was confirmed with histology. The treatment offered was surgery without indicating any medication.

Non-variceal upper gastrointestinal bleeding (NVUGIB) refers to bleeding that develops in the gastrointestinal tract proximal to the ligament of Treitz. NVUGIB is an important cause for visiting the hospital and is associated with significant morbidity and mortality. Although European and Asian-Pacific guidelines have been published, there has been no previous guidelines regarding management of NVUGIB in Korea. Korea is a country with a high prevalence of Helicobacter pylori infection and patients have easy accessibility to receive endoscopy. Therefore, we believe that guidelines regarding management of NVUGIB are mandatory. The Korean Society of Gastroenterology reviewed recent evidence and recommends practical management guidelines on NVUGIB in Korea.

Objective: Imaging of anterior male urethra is usually done using retrograde urethrogram, which utilises radiation. This study utilises high resolution ultrasound which is radiation free and helps to understand urethral pathologies like strictures, chronic urethritis etc. This study also compares the utility of sonourethrogram with retrograde urethrogram and provides the advantages of using sonourethrogram. Also establishes the drawbacks of using sonourethrogram over retrograde urethrogram. Material & Methods: This study was done on 60 patients, came with different complaints like difficulty in micturition, obstructed urinary stream, pain in penis, increasing frequency of micturition and referred to us for retrograde urethrogram. Patients were examined with high resolution ultrasound with due permissions. Results are compared with findings of retrograde urerthrogram. Results: Out of 60 patients, 59 had strictures shown in retrograde urethrogram either in penile, bulbar or membranous parts. Only one patient had membranous urethral stricture in retrograde urethrogram which was not shown in sonourethrogram. All other patients have shown strictures in sonourethrogram. One patient had penile urethral calculus shown in both sonourethrogram and retrograde urethrogram. Conclusion: Sonourethrogram is equally effective as that of retrograde urethrogram especially in anterior urethral strictures. However, it underestimates or less useful in evaluation of posterior male urethral pathologies. Sonourethrogram is easily available, cost effective technique that uses no radiation in the evaluation of male urethra. It is equally effective compared to retrograde urethrogram in the evaluation of male anterior urethral strictures. Periurethral pathologies like fibrosis are better evaluated with sonourethrogram than with retrograde urethrogram. It is also important in the surgical planning and approach.

A 72-year-old man was admitted to the hospital with fatigue. Colonoscopy revealed a 50 × 50 mm rectal tumor with bleeding. Based on close inspection, he was diagnosed with unresectable advanced rectal cancer with multiple liver metastases. Chemotherapy was administered as 10 cycles of bevacizumab + mFOLFOX6 and 7 cycles of bevacizumab + FOLFIRI. Nine months later, he presented with hematochezia and progression of anemia. It was difficult to stop the bleeding via endoscopy. He underwent radiation therapy (39 Gy in 13 fractions), and hemostasis was confirmed. Then, further chemotherapy was performed with 3 cycles of bevacizumab + FOLFIRI and 2 cycles of TAS102. However 14 months after the initial visit, he presented with right hypochondralgia and abdominal fullness due to the progression of multiple liver metastases. Palliative low-dose whole-liver radiation therapy (WLRT) (30 Gy in 10 fractions) was performed. He developed Grade 2 nausea, but his right hypochondralgia reduced, liver dysfunction improved, and he successfully completed radiotherapy. At approximately the same time his anemia progressed, and colonoscopy revealed recurrent bleeding from the tumor. Re-irradiation (15 Gy in 5 fractions) of the rectal tumor was carried out and a blood transfusion was performed for the bleeding. He was discharged after confirmation the anemia had not progressed. Few reports have been published on the use of both palliative re-irradiation to stop bleeding from rectal cancer and palliative low-dose WLRT. Based on our experience with this case, we believe that palliative radiotherapy can be useful in treating patients with a poor prognosis.

PURPOSE: We aimed to evaluate the benefit of adding CT texture analysis on conventional CT features of benign adnexal cystic lesions, especially in identifying mucinous cystadenoma. METHODS: This retrospective study included patients who underwent surgical removal of benign ovarian cysts (44 mucinous cystadenomas, 32 serous cystadenomas, 16 follicular/simple cysts and 43 endometriotic cysts) at our institution between January 2015 and November 2017. The CT images were independently reviewed by an abdominal radiologist (reviewer 1) and a resident (reviewer 2). Both reviewers recorded the conventional characteristics and performed texture analysis. Based on reviewer 1’s results, two decision trees for differential diagnosis were developed. Reviewer 2’s results were then applied to the decision trees. The diagnostic performances of each reviewer with and without the decision trees were compared. RESULTS: Several conventional features and texture analysis parameters showed significant differences between mucinous cystadenomas and other benign adnexal cysts. The first decision tree selected septum number and thickness as significant features, whereas the second decision tree selected septum number and the mean values at spatial scaling factor (SSF) 0. Reviewer 1’s performance did not change significantly with or without the use of the decision trees. Reviewer 2’s interpretations were significantly less sensitive than reviewer 1’s interpretations (p = 0.001). However, when aided by the first and second decision trees, Reviewer 2’s interpretations were significantly more sensitive than reviewer 1’s interpretations (86.4%, p < 0.001; 72.7%, p = 0.001). CONCLUSION: This study suggests the benefit of CT texture analysis on conventional images to differentiate mucinous cystadenoma from other benign adnexal cysts, particularly for less experienced radiologists.

Metabolic abnormalities affect the adolescent brain. For equivalent abnormalities in metabolism young people exhibit deficits in more cognitive domains than adults. We examine sex differences performance for adolescents with obesity/insulin resistance (IR) and evaluated how sex and IR effected frontal lobe structures and executive functioning. 125 adolescents underwent medical, cognitive, and brain-imaging assessments. Participants were categorized as insulin sensitive (IS) (QUICKI ≧ 0.350) or IR (QUICKI < 0.350). Degree of IR may affect brain and cognition differentially by sex. Females had positive associations between QUICKI and anterior cingulate cortex (ACC) volume, medial orbito-frontal cortex (OFC) thickness, and scores on the Stroop and Digit Symbol Substitution (DSST) tests. Females with IR tended to have thinner insular cortices. No such associations were found in males. In female adolescents, IR may negatively affect brain structure and function. No such effects were found for males. Although needing more development, hormonal effects and inflammation are potential contributors.

T2* relaxometry mapping has found diverse applications in neuroradiology but was insufficiently evaluated in pelvis MRI. Further, staging of the uterine-related cancers may be sometimes a cumbersome. Our aim is to present the T2* relaxometry maps respectively relaxometry and proton density values in patients with endometrial and cervical cancer, together with their postoperative outcomes. Three patients with uterine-related cancers underwent a 3T pelvic MRI examination. The protocol included a large field-of-view (FOV = 28 cm), a short (TE=30 ms) and a long (TE = 200 ms) echo time sequences. T2* maps were obtained by the means of post-processing methods. Parametric maps showed same Relaxation Time (RT) between endometrial cancer and adjacent metastatic lymphadenopathy, respectively different RT between endometrial and cervical cancer. In conclusion, we presented the T2* relaxometry values of endometrial and cervical cancer, and discuss their possible implications in FIGO staging and patient management. Keywords: T2 relaxometry; T2 mapping; MRI; Endometrial cancer; Cervical cancer; FIGO staging.

Antineutrophil cytoplasmic antibody (ANCA) - associated vasculitis is a severe autoimmune disorder. Its prognosis has been markedly improved by the introduction of immunosuppressive treatments. Nevertheless, this has been associated with an increased incidence of malignancy. We report the case of a 60-year-old woman who presented C-ANCA vasculitis with renal failure and pulmonary involvement requiring immunosuppressive therapy. A complete remission was achieved. After a follow-up of 22 months, she presented asthenia with fever and jaundice. The diagnosis of locally advanced peri-hilar cholangiocarcinoma was made. The outcome was unfavorable and the patient died. The incidence of malignancies is increased in ANCA vasculitis. Biliary tumors are uncommon compared to other cancers. The risk is mainly related to exposure to cyclophosphamide.

This article introduces the European Society of Radiology’s EuroSafe Imaging initiative in the year of its 6th anniversary. The European and global radiation protection frameworks are outlined and the role of the EuroSafe Imaging initiative’s Call for Action in successfully achieving international radiation protection goals as set out by those frameworks is detailed.

High levels of lipoprotein(a) [Lp(a)], an apoB100-containing lipoprotein, are an independent and causal risk factor for atherosclerotic cardiovascular diseases through mechanisms associated with increased atherogenesis, inflammation, and thrombosis. Lp(a) is predominantly a monogenic cardiovascular risk determinant, with ���70% to ���90% of interindividual heterogeneity in levels being genetically determined. The 2 major protein components of Lp(a) particles are apoB100 and apolipoprotein(a). Lp(a) remains a risk factor for cardiovascular disease development even in the setting of effective reduction of plasma low-density lipoprotein cholesterol and apoB100. Despite its demonstrated contribution to atherosclerotic cardiovascular disease burden, we presently lack standardization and harmonization of assays, universal guidelines for diagnosing and providing risk assessment, and targeted treatments to lower Lp(a). There is a clinical need to understand the genetic and biological basis for variation in Lp(a) levels and its relationship to disease in different ancestry groups. This scientific statement capitalizes on the expertise of a diverse basic science and clinical workgroup to highlight the history, biology, pathophysiology, and emerging clinical evidence in the Lp(a) field. Herein, we address key knowledge gaps and future directions required to mitigate the atherosclerotic cardiovascular disease risk attributable to elevated Lp(a) levels.