Search

The article presents a case study of a 31-year-old female patient that presented postpartum abdominal pain with fever and was diagnosed with hepatic adenoma. Topics discussed include brief details about the medical history and pregnancy of the patient prior to hospital admission, the results of the physical and laboratory examinations performed such as blood tests and urinalysis, and the patient outcomes recorded following treatment.

The article presents a case study of a 41-year-old woman who had undergone renal transplantation was admitted to this hospital because of bloody stools and thrombocytopenia. Topics include the patient had been in her usual state of health until 3 weeks before this admission, the episodes of diarrhea occurred several times a day and were not associated with fever, chills, abdominal pain, nausea, or vomiting, and the abdominal and rectal examinations were normal.

Imaging plays an important role in the diagnosis and treatment of women with uterine cervical and endometrial cancers. Quantitative imaging, through MRI, PET/CT, and hybrid PET/MRI, allows for characterization of primary tumors beyond anatomic and qualitative descriptors. MRI diffusion-weighted imaging (DWI) yields an apparent diffusion coefficient (ADC), which can be applied in both the pre-and post-treatment assessment of uterine tumors. PET/CT assesses metabolic activity, and measurement of tumor standardized uptake value (SUV) is a useful metric in the staging of uterine malignancies. Hybrid PET/MRI is an emerging modality that combines the soft tissue contrast of MRI with the molecular imaging capability of PET. This review provides an overview of these quantitative imaging modalities, and their current and potential roles in the assessment of uterine cervical and cancer. [ABSTRACT FROM AUTHOR]

Purpose: To externally validate an algorithm for non-invasive differentiation of hepatic mucinous cystic neoplasms (MCN) from benign hepatic cysts (BHC), which differ in management. Methods: Patients with cystic liver lesions pathologically confirmed as MCN or BHC between January 2005 and March 2022 from multiple institutions were retrospectively included. Five readers (2 radiologists, 3 non-radiologist physicians) independently reviewed contrast-enhanced CT or MRI examinations before tissue sampling and applied the 3-feature classification algorithm described by Hardie et al. to differentiate between MCN and BHC, which had a reported accuracy of 93.5%. The classification was then compared to the pathology results. Interreader agreement between readers across different levels of experience was evaluated with Fleiss' Kappa. Results: The final cohort included 159 patients, median age of 62 years (IQR [52.0, 70.0]), 66.7% female (106). Of all patients, 89.3% (142) had BHC, and the remaining 10.7% (17) had MCN on pathology. Agreement for class designation between the radiologists was almost perfect (Fleiss' Kappa 0.840, p < 0.001). The algorithm had an accuracy of 98.1% (95% CI [94.6%, 99.6%]), a positive predictive value of 100.0% (95% CI [76.8%, 100.0%]), a negative predictive value of 97.9% (95% CI [94.1%, 99.6%]), and an area under the receiver operator characteristic curve (AUC) of 0.911 (95% CI [0.818, 1.000]). Conclusion: The evaluated algorithm showed similarly high diagnostic accuracy in our external, multi-institutional validation cohort. This 3-feature algorithm is easily and rapidly applied and its features are reproducible among radiologists, showing promise as a clinical decision support tool. [ABSTRACT FROM AUTHOR]

Purpose: New generation of receptor tyrosine kinase inhibitors (RTKIs) have shown to improve survival in many solid tumors. However, an imaging biomarker is needed for patient selection and prediction of treatment response. This study evaluates the use of quantitative changes of HER3 on 68 Ga-NOTA-HER3P1 PET/MRI for prediction of early response to pan-RTKIs in gastric cancer (GCa).Procedures: GCa cell lines were evaluated for expression of RTKs, and downstream signaling pathways (AKT and MAPK). Cell viability was assessed following 24-72 h of treatment with 0.01-1 µmol/L of afatinib, a pan-RTKI. HER3-expressing afatinib-sensitive (NCI-N87) and resistant cells (SNU16) were selected for evaluation of changes in RTKs expression and downstream pathways, with 24-72 h of 0.1 µmol/L afatinib treatment. 68 Ga-NOTA-HER3P1 PET/MRI was performed in subcutaneous NCI-N87 and SNU16 xenografts (nu:nu, n = 12/group) at baseline and 4 days after afatinib treatment (10 mg/kg, PO, daily). Temporal changes in PET measures were correlated to HER3 expression in tumors, tumor growth rate, and treatment response.Results: With afatinib therapy, NCI-N87 cells showed increased total HER3 expression, and reduction of other RTKs and downstream nodes within 72 h, while SNU16 cells showed no significant change in total HER3 and downstream nodes. 68 Ga-HER3P1 PET/MRI showed increased uptake in NCI-N87 and no significant change in SNU16 tumors (day 4 vs. baseline SUVmean: 3.8 ± 0.7 vs. 1.6 ± 0.6, p < 0.05 in NCI-N87, and 1.5 ± 0.7 vs. 1.7 ± 0.7, p > 0.05 in SNU16). These findings were in concordance with HER3 expression in histopathological analyses and tumor growth over 3 weeks of treatment (mean tumor volume in treated vs. control: 11 ± 17 mm3 vs. 293 ± 79 mm3, p < 0.001 in NCI-N87, and 238 ± 91 mm3 vs. 282 ± 35 mm3, p > 0.05 in SNU16).Conclusions: Quantitative changes in HER3 PET could be used to predict response to pan-RTKI within few days after initiation of treatment and can help with personalizing GCa management. [ABSTRACT FROM AUTHOR]

Objective: To compare standard (STD-DWI) single-shot echo-planar imaging DWI and simultaneous multislice (SMS) DWI during whole-body positron emission tomography (PET)/MRI regarding acquisition time, image quality, and lesion detection. Methods: Eighty-three adults (47 females, 57%), median age of 64 years (IQR 52–71), were prospectively enrolled from August 2018 to March 2020. Inclusion criteria were (a) abdominal or pelvic tumors and (b) PET/MRI referral from a clinician. Patients were excluded if whole-body acquisition of STD-DWI and SMS-DWI sequences was not completed. The evaluated sequences were axial STD-DWI at b-values 50–400–800 s/mm2 and the apparent diffusion coefficient (ADC), and axial SMS-DWI at b-values 50–300–800 s/mm2 and ADC, acquired with a 3-T PET/MRI scanner. Three radiologists rated each sequence's quality on a five-point scale. Lesion detection was quantified using the anatomic MRI sequences and PET as the reference standard. Regression models were constructed to quantify the association between all imaging outcomes/scores and sequence type. Results: The median whole-body STD-DWI acquisition time was 14.8 min (IQR 14.1–16.0) versus 7.0 min (IQR 6.7–7.2) for whole-body SMS-DWI, p < 0.001. SMS-DWI image quality scores were higher than STD-DWI in the abdomen (OR 5.31, 95% CI 2.76–10.22, p < 0.001), but lower in the cervicothoracic junction (OR 0.21, 95% CI 0.10–0.43, p < 0.001). There was no significant difference in the chest, mediastinum, pelvis, and rectum. STD-DWI detected 276/352 (78%) lesions while SMS-DWI located 296/352 (84%, OR 1.46, 95% CI 1.02–2.07, p = 0.038). Conclusions: In cancer staging and restaging, SMS-DWI abbreviates acquisition while maintaining or improving the diagnostic yield in most anatomic regions. Key Points: • Simultaneous multislice diffusion-weighted imaging enables faster whole-body image acquisition. • Simultaneous multislice diffusion-weighted imaging maintains or improves image quality when compared to single-shot echo-planar diffusion-weighted imaging in most anatomical regions. • Simultaneous multislice diffusion-weighted imaging leads to superior lesion detection. [ABSTRACT FROM AUTHOR]

To implement a new daily peer learning (PL) conference which incorporates faculty and trainees within the abdominal imaging division of a large academic medical center, and to determine participants' level of satisfaction and preference over the pre-existing peer review (PR) model. We replaced our pre-existing PR-based tool with a daily hour-long case-based PL teaching conference over a 3-month pilot period. Faculty and trainees were surveyed about their experience at the end of the pilot period. A total of 711 cases were logged during the pilot period (median 9 cases per day). We received 30 survey responses from a total of 48 eligible participants. Survey responses from both faculty and trainees on the new PL conference were overwhelmingly favorable, including unanimous support for permanently replacing the existing PR tool with the new PL conference. Our successful pilot of a daily PL conference replacing an existing PR tool adds to the growing body of evidence of radiologists strongly supporting PL based processes over PR. Our paradigm of actively involving trainees within the process can serve as a model for other institutions. • Peer learning is rapidly increasing in popularity as an alternative to traditional peer review. • Surveyed radiologists unanimously preferred participating in peer learning rather than peer review. • Trainees enjoyed participating in peer learning conferences and found the experience to be educational. [ABSTRACT FROM AUTHOR]

Purpose: Prior case reports have noted an increase in renal size and perinephric stranding accompanying immunotherapy-related renal toxicity due to checkpoint-inhibitor therapy. The purpose of this investigation was to systematically evaluate if immunotherapy-related renal toxicity affects renal size and possible associated imaging findings. Methods: This retrospective multi-hospital study included 25 patients (13 men), mean age 67 years (range 46–83) who received immune-checkpoint inhibitors for cancer treatment, developed biopsy-proven immunotherapy-related nephritis, and who also had abdominal imaging before, during, and after nephritis was diagnosed. Long axis renal diameter, renal corticomedullary differentiation/enhancement and perinephric stranding were evaluated by two readers at three timepoints: (1) prior to checkpoint inhibitor therapy (baseline), (2) after biopsy-proven immunotherapy-related nephritis (post-treatment), and (3) following renal function recovery (follow-up). Intraclass correlation coefficient and Cohen's Kappa were calculated to quantify agreement. Logistic regression analysis was implemented to measure the association between each timepoint and imaging features. Results: Reader agreement on kidney measurements was excellent (ICC = 0.87). There was an increase in renal size between baseline and post-treatment (p = 0.001), followed by a decrease between post-treatment to follow-up (p < 0.001). Agreement was perfect for abnormal renal corticomedullary differentiation/enhancement (Kappa = 1, p < 0.001) and almost perfect for perinephric stranding (Kappa = 0.97, p < 0.001). Neither post-treatment nor follow-up imaging findings were significantly associated with these findings compared to the baseline (p = 0.2–0.6). Conclusion: Immunotherapy-related renal toxicity was associated with an increase in renal size coincident with acute renal dysfunction. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate if radiomics with machine learning can differentiate between F-18-fluorodeoxyglucose (FDG)-avid breast cancer metastatic lymphadenopathy and FDG-avid COVID-19 mRNA vaccine–related axillary lymphadenopathy. Materials and methods: We retrospectively analyzed FDG-positive, pathology-proven, metastatic axillary lymph nodes in 53 breast cancer patients who had PET/CT for follow-up or staging, and FDG-positive axillary lymph nodes in 46 patients who were vaccinated with the COVID-19 mRNA vaccine. Radiomics features (110 features classified into 7 groups) were extracted from all segmented lymph nodes. Analysis was performed on PET, CT, and combined PET/CT inputs. Lymph nodes were randomly assigned to a training (n = 132) and validation cohort (n = 33) by 5-fold cross-validation. K-nearest neighbors (KNN) and random forest (RF) machine learning models were used. Performance was evaluated using an area under the receiver-operator characteristic curve (AUC-ROC) score. Results: Axillary lymph nodes from breast cancer patients (n = 85) and COVID-19-vaccinated individuals (n = 80) were analyzed. Analysis of first-order features showed statistically significant differences (p < 0.05) in all combined PET/CT features, most PET features, and half of the CT features. The KNN model showed the best performance score for combined PET/CT and PET input with 0.98 (± 0.03) and 0.88 (± 0.07) validation AUC, and 96% (± 4%) and 85% (± 9%) validation accuracy, respectively. The RF model showed the best result for CT input with 0.96 (± 0.04) validation AUC and 90% (± 6%) validation accuracy. Conclusion: Radiomics features can differentiate between FDG-avid breast cancer metastatic and FDG-avid COVID-19 vaccine–related axillary lymphadenopathy. Such a model may have a role in differentiating benign nodes from malignant ones. Key Points: • Patients who were vaccinated with the COVID-19 mRNA vaccine have shown FDG-avid reactive axillary lymph nodes in PET-CT scans. • We evaluated if radiomics and machine learning can distinguish between FDG-avid metastatic axillary lymphadenopathy in breast cancer patients and FDG-avid reactive axillary lymph nodes. • Combined PET and CT radiomics data showed good test AUC (0.98) for distinguishing between metastatic axillary lymphadenopathy and post-COVID-19 vaccine–associated axillary lymphadenopathy. Therefore, the use of radiomics may have a role in differentiating between benign from malignant FDG-avid nodes. [ABSTRACT FROM AUTHOR]

Purpose: This review aims to provide a comprehensive summary of DECT techniques, acquisition workflows, and post-processing methods. By doing so, we aim to elucidate the advantages and disadvantages of DECT compared to conventional single-energy CT imaging.A systematic search was conducted on MEDLINE/EMBASE for DECT studies in liver imaging published between 1980 and 2024. Information regarding study design and endpoints, patient characteristics, DECT technical parameters, radiation dose, iodinated contrast agent (ICA) administration and postprocessing methods were extracted. Technical parameters, including DECT phase, field of view, pitch, collimation, rotation time, arterial phase timing (from injection), and venous timing (from injection) from the included studies were reported, along with formal narrative synthesis of main DECT applications for liver imaging.Out of the initially identified 234 articles, 153 met the inclusion criteria. Extensive variability in acquisition parameters was observed, except for tube voltage (80/140 kVp combination reported in 50% of articles) and ICA administration (1.5 mL/kg at 3–4 mL/s, reported in 91% of articles). Radiation dose information was provided in only 40% of articles (range: 6–80 mGy), and virtual non-contrast imaging (VNC) emerged as a common strategy to reduce the radiation dose. The primary application of DECT post-processed images was in detecting focal liver lesions (47% of articles), with predominance of study focusing on hepatocellular carcinoma (HCC) (27%). Furthermore, a significant proportion of the articles (16%) focused on enhancing DECT protocols, while 15% explored metastasis detection.Our review recommends using 80/140 kVp tube voltage with 1.5 mL/kg ICA at 3–4 mL/s flow rate. Post-processing should include low keV-VMI for enhanced lesion detection, IMs for tumor iodine content evaluation, and VNC for dose reduction. However, heterogeneous literature hinders protocol standardization.Methods: This review aims to provide a comprehensive summary of DECT techniques, acquisition workflows, and post-processing methods. By doing so, we aim to elucidate the advantages and disadvantages of DECT compared to conventional single-energy CT imaging.A systematic search was conducted on MEDLINE/EMBASE for DECT studies in liver imaging published between 1980 and 2024. Information regarding study design and endpoints, patient characteristics, DECT technical parameters, radiation dose, iodinated contrast agent (ICA) administration and postprocessing methods were extracted. Technical parameters, including DECT phase, field of view, pitch, collimation, rotation time, arterial phase timing (from injection), and venous timing (from injection) from the included studies were reported, along with formal narrative synthesis of main DECT applications for liver imaging.Out of the initially identified 234 articles, 153 met the inclusion criteria. Extensive variability in acquisition parameters was observed, except for tube voltage (80/140 kVp combination reported in 50% of articles) and ICA administration (1.5 mL/kg at 3–4 mL/s, reported in 91% of articles). Radiation dose information was provided in only 40% of articles (range: 6–80 mGy), and virtual non-contrast imaging (VNC) emerged as a common strategy to reduce the radiation dose. The primary application of DECT post-processed images was in detecting focal liver lesions (47% of articles), with predominance of study focusing on hepatocellular carcinoma (HCC) (27%). Furthermore, a significant proportion of the articles (16%) focused on enhancing DECT protocols, while 15% explored metastasis detection.Our review recommends using 80/140 kVp tube voltage with 1.5 mL/kg ICA at 3–4 mL/s flow rate. Post-processing should include low keV-VMI for enhanced lesion detection, IMs for tumor iodine content evaluation, and VNC for dose reduction. However, heterogeneous literature hinders protocol standardization.Results: This review aims to provide a comprehensive summary of DECT techniques, acquisition workflows, and post-processing methods. By doing so, we aim to elucidate the advantages and disadvantages of DECT compared to conventional single-energy CT imaging.A systematic search was conducted on MEDLINE/EMBASE for DECT studies in liver imaging published between 1980 and 2024. Information regarding study design and endpoints, patient characteristics, DECT technical parameters, radiation dose, iodinated contrast agent (ICA) administration and postprocessing methods were extracted. Technical parameters, including DECT phase, field of view, pitch, collimation, rotation time, arterial phase timing (from injection), and venous timing (from injection) from the included studies were reported, along with formal narrative synthesis of main DECT applications for liver imaging.Out of the initially identified 234 articles, 153 met the inclusion criteria. Extensive variability in acquisition parameters was observed, except for tube voltage (80/140 kVp combination reported in 50% of articles) and ICA administration (1.5 mL/kg at 3–4 mL/s, reported in 91% of articles). Radiation dose information was provided in only 40% of articles (range: 6–80 mGy), and virtual non-contrast imaging (VNC) emerged as a common strategy to reduce the radiation dose. The primary application of DECT post-processed images was in detecting focal liver lesions (47% of articles), with predominance of study focusing on hepatocellular carcinoma (HCC) (27%). Furthermore, a significant proportion of the articles (16%) focused on enhancing DECT protocols, while 15% explored metastasis detection.Our review recommends using 80/140 kVp tube voltage with 1.5 mL/kg ICA at 3–4 mL/s flow rate. Post-processing should include low keV-VMI for enhanced lesion detection, IMs for tumor iodine content evaluation, and VNC for dose reduction. However, heterogeneous literature hinders protocol standardization.Conclusion: This review aims to provide a comprehensive summary of DECT techniques, acquisition workflows, and post-processing methods. By doing so, we aim to elucidate the advantages and disadvantages of DECT compared to conventional single-energy CT imaging.A systematic search was conducted on MEDLINE/EMBASE for DECT studies in liver imaging published between 1980 and 2024. Information regarding study design and endpoints, patient characteristics, DECT technical parameters, radiation dose, iodinated contrast agent (ICA) administration and postprocessing methods were extracted. Technical parameters, including DECT phase, field of view, pitch, collimation, rotation time, arterial phase timing (from injection), and venous timing (from injection) from the included studies were reported, along with formal narrative synthesis of main DECT applications for liver imaging.Out of the initially identified 234 articles, 153 met the inclusion criteria. Extensive variability in acquisition parameters was observed, except for tube voltage (80/140 kVp combination reported in 50% of articles) and ICA administration (1.5 mL/kg at 3–4 mL/s, reported in 91% of articles). Radiation dose information was provided in only 40% of articles (range: 6–80 mGy), and virtual non-contrast imaging (VNC) emerged as a common strategy to reduce the radiation dose. The primary application of DECT post-processed images was in detecting focal liver lesions (47% of articles), with predominance of study focusing on hepatocellular carcinoma (HCC) (27%). Furthermore, a significant proportion of the articles (16%) focused on enhancing DECT protocols, while 15% explored metastasis detection.Our review recommends using 80/140 kVp tube voltage with 1.5 mL/kg ICA at 3–4 mL/s flow rate. Post-processing should include low keV-VMI for enhanced lesion detection, IMs for tumor iodine content evaluation, and VNC for dose reduction. However, heterogeneous literature hinders protocol standardization.Graphical abstract: This review aims to provide a comprehensive summary of DECT techniques, acquisition workflows, and post-processing methods. By doing so, we aim to elucidate the advantages and disadvantages of DECT compared to conventional single-energy CT imaging.A systematic search was conducted on MEDLINE/EMBASE for DECT studies in liver imaging published between 1980 and 2024. Information regarding study design and endpoints, patient characteristics, DECT technical parameters, radiation dose, iodinated contrast agent (ICA) administration and postprocessing methods were extracted. Technical parameters, including DECT phase, field of view, pitch, collimation, rotation time, arterial phase timing (from injection), and venous timing (from injection) from the included studies were reported, along with formal narrative synthesis of main DECT applications for liver imaging.Out of the initially identified 234 articles, 153 met the inclusion criteria. Extensive variability in acquisition parameters was observed, except for tube voltage (80/140 kVp combination reported in 50% of articles) and ICA administration (1.5 mL/kg at 3–4 mL/s, reported in 91% of articles). Radiation dose information was provided in only 40% of articles (range: 6–80 mGy), and virtual non-contrast imaging (VNC) emerged as a common strategy to reduce the radiation dose. The primary application of DECT post-processed images was in detecting focal liver lesions (47% of articles), with predominance of study focusing on hepatocellular carcinoma (HCC) (27%). Furthermore, a significant proportion of the articles (16%) focused on enhancing DECT protocols, while 15% explored metastasis detection.Our review recommends using 80/140 kVp tube voltage with 1.5 mL/kg ICA at 3–4 mL/s flow rate. Post-processing should include low keV-VMI for enhanced lesion detection, IMs for tumor iodine content evaluation, and VNC for dose reduction. However, heterogeneous literature hinders protocol standardization. [ABSTRACT FROM AUTHOR]

Background: The clinical value of FDG-PET/CT for staging and monitoring treatment response in patients with aggressive lymphoma is well established. Conversely, its role in the assessment and management of marginal zone lymphoma (MZL) is less conclusive. We aimed to assess clinical, laboratory, and pathological predictors for FDG uptake in these patients, in an attempt to identify MZL patients whose management will benefit from this imaging modality. Methods: In this single-center, retrospective cohort study, we included all adult patients diagnosed with MZL at the Rabin Medical Center between January 2006 and December 2020 who underwent FDG-PET/CT at the time of diagnosis. Primary outcomes were FDG avidity (defined as a visual assessment of at least moderate intensity), SUVmax, and SUVliver. Variables such as advanced clinical stage, primary disease site, hemoglobin level (Hb), platelet count (Plt), serum albumin, LDH level, β-2 microglobulin, and Ki 67 index were evaluated univariate and multivariate analysis using logistic and linear regression models. Association between FDG avidity and progression-free and overall survival was evaluated using Kaplan–Meier curves and Cox regression analysis. Results: A total of 207 MZL patients were included in this study, 76 of whom (36.7%) had FDG-avid disease. Baseline patients' characteristics such as age, gender, and comorbid conditions were similar between patients with and without significant FDG uptake. In a multivariate logistic regression model, non-gastric MALT (OR 4.2, 95% CI 1.78–10), Ki 67 index ≥ 15% (OR 3.64, 95% CI 1.36–9.76), and elevated LDH level (OR 8.6, 95% CI 3.2–22.8) were all associated with positive FDG avidity. In a multivariate linear regression model, a combination of advanced clinical stage, specific disease subtypes, LDH level, and Ki 67 index predicted the value of SUVmax (P value < 0.001; adjusted R2 = 33.8%) and SUVmax/SUVliver (P value < 0.001; adjusted R2 = 27%). Baseline FDG avidity was associated to PFS and OS only in univariate analyses. Conclusions: In this retrospective cohort study, we present prediction models for positive FDG uptake and SUVmax in MZL patients. These models aim to help clinicians choose patients suitable for incorporation of FDG-PET/CT for staging and monitoring disease and reduce the costs of redundant tests. [ABSTRACT FROM AUTHOR]

Simple Summary: In breast cancer, the leading cancer type and the main cause of cancer death in women, achieving pathological complete response after neoadjuvant chemotherapy has been shown to be associated with prolonged overall survival. Hence, the correct assessment and the potential prediction of therapy response have recently become the focus of research. In this study, we predicted pathological complete response prior to neoadjuvant system therapy using 18F-FDG PET/MRI radiomics analysis of the breast. Hence, simultaneous 18F-FDG PET/MRI may enable a more individualized and targeted approach to treatment as well as pretherapeutic patient stratification. Background: The aim of this study was to assess whether multiparametric 18F-FDG PET/MRI-based radiomics analysis is able to predict pathological complete response in breast cancer patients and hence potentially enhance pretherapeutic patient stratification. Methods: A total of 73 female patients (mean age 49 years; range 27–77 years) with newly diagnosed, therapy-naive breast cancer underwent simultaneous 18F-FDG PET/MRI and were included in this retrospective study. All PET/MRI datasets were imported to dedicated software (ITK-SNAP v. 3.6.0) for lesion annotation using a semi-automated method. Pretreatment biopsy specimens were used to determine tumor histology, tumor and nuclear grades, and immunohistochemical status. Histopathological results from surgical tumor specimens were used as the reference standard to distinguish between complete pathological response (pCR) and noncomplete pathological response. An elastic net was employed to select the most important radiomic features prior to model development. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were calculated for each model. Results: The best results in terms of AUCs and NPV for predicting complete pathological response in the entire cohort were obtained by the combination of all MR sequences and PET (0.8 and 79.5%, respectively), and no significant differences from the other models were observed. In further subgroup analyses, combining all MR and PET data, the best AUC (0.94) for predicting complete pathologic response was obtained in the HR+/HER2− group. No difference between results with/without the inclusion of PET characteristics was observed in the TN/HER2+ group, each leading to an AUC of 0.92 for all MR and all MR + PET datasets. Conclusion: 18F-FDG PET/MRI enables comprehensive high-quality radiomics analysis for the prediction of pCR in breast cancer patients, especially in those with HR+/HER2− receptor status. [ABSTRACT FROM AUTHOR]

Purpose : To evaluate the correlation of radiomic features in pelvic [2-deoxy-2-18F]fluoro-d-glucose positron emission tomography/magnetic resonance imaging and computed tomography ([18F]FDG PET/MRI and [18F]FDG PET/CT) in patients with primary cervical cancer (CCa). Procedures: Nineteen patients with histologically confirmed primary squamous cell carcinoma of the cervix underwent same-day [18F]FDG PET/MRI and PET/CT. Two nuclear medicine physicians performed a consensus reading in random order. Free-hand regions of interest covering the primary cervical tumors were drawn on PET, contrast-enhanced pelvic CT, and pelvic MR (T2 weighted and ADC) images. Several basic imaging features, standard uptake values (SUVmean, SUVmax, and SUVpeak), total lesion glycolysis (TLG), metabolic tumor volume (MTV), and more advanced texture analysis features were calculated. Pearson's correlation test was used to assess the correlation between each pair of features. Features were compared between local and metastatic tumors, and their role in predicting metastasis was evaluated by receiver operating characteristic curves. Results: For a total of 101 extracted features, 1104/5050 pairs of features showed a significant correlation (ρ ≥ 0.70, p < 0.05). There was a strong correlation between 190/484 PET pairs of features from PET/MRI and PET/CT, 91/418 pairs of CT and PET from PET/CT, 79/418 pairs of T2 and PET from PET/MRI, and 50/418 pairs of ADC and PET from PET/MRI. Significant difference was seen between eight features in local and metastatic tumors including MTV, TLG, and entropy on PET from PET/CT; MTV and TLG on PET from PET/MRI; compactness and entropy on T2; and entropy on ADC images. Conclusions: We demonstrated strong correlation of many extracted radiomic features between PET/MRI and PET/CT. Eight radiomic features calculated on PET/CT and PET/MRI were significantly different between local and metastatic CCa. This study paves the way for future studies to evaluate the diagnostic and predictive potential of radiomics that could guide clinicians toward personalized patients care. [ABSTRACT FROM AUTHOR]

Background: Dynamic survival data based on time already survived are lacking for resected borderline resectable/locally advanced (BR/LA) pancreatic ductal adenocarcinoma (PDAC) patients who received total neoadjuvant therapy (TNT) with FOLFIRINOX followed by chemoradiation. Conditional survival, i.e., the probability of surviving an additional length of time after having already survived an amount of time, offers such information. We aimed to determine actuarial and conditional overall (OS, COS) and disease-free survival (DFS, CDFS) among this cohort. Methods: Clinicopathologic data were retrospectively collected for resected BR/LA PDAC patients who received TNT (2011–2019). COS and CDFS rates were calculated for patients being event (death/recurrence)-free at multiple intervals and by recurrence status. Results: After a median follow-up of 32.1 months, the 183 patients had a median OS and DFS of 39.1 months and 16.8 months, respectively. COS and CDFS increased as a function of time already survived. The probability of surviving an additional 24 months if a patient survived 2 years post-operatively was 70%, whereas the 4-year actuarial OS was 47%. Similarly, the probability of surviving disease-free an additional 24 months after 2 years was 66%, while actuarial 48-month DFS was 27%. COS for disease-free patients increased further over time. For patients remaining disease-free 12 months post-operatively, BR vs. LA status at diagnosis, tumor ≤ 4 cm at diagnosis, and R0 resection were independent predictors of favorable additional OS and DFS. Conclusions: For resected TNT-treated BR/LA PDAC patients, the probability of surviving an additional length of time increases as a function of survival already accrued. Dynamic survival estimates may allow personalized follow-up and counseling. [ABSTRACT FROM AUTHOR]

Purpose: To assess the incidence of erroneous diagnosis of pneumatosis (pseudo-pneumatosis) in patients who underwent an emergency abdominal CT and to verify the performance of imaging features, supported by artificial intelligence (AI) techniques, to reduce this misinterpretation. Methods: We selected 71 radiological reports where the presence of pneumatosis was considered definitive or suspected. Surgical findings, clinical outcomes, and reevaluation of the CT scans were used to assess the correct diagnosis of pneumatosis. We identified four imaging signs from literature, to differentiate pneumatosis from pseudo-pneumatosis: gas location, dissecting gas in the bowel wall, a circumferential gas pattern, and intramural gas beyond a gas-fluid/faecal level. Two radiologists reevaluated in consensus all the CT scans, assessing the four above-mentioned variables. Variable discriminative importance was assessed using the Fisher exact test. Accurate and statistically significant variables (p-value < 0.05, accuracy > 75%) were pooled using boosted Random Forests (RFs) executed using a Leave-One-Out cross-validation (LOO cv) strategy to obtain unbiased estimates of individual variable importance by permutation analysis. After the LOO cv, the comparison of the variable importance distribution was validated by one-sided Wilcoxon test. Results: Twenty-seven patients proved to have pseudo-pneumatosis (error: 38%). The most significant features to diagnose pneumatosis were presence of dissecting gas in the bowel wall (accuracy: 94%), presence of intramural gas beyond a gas-fluid/faecal level (accuracy: 86%), and a circumferential gas pattern (accuracy: 78%). Conclusion: The incidence of pseudo-pneumatosis can be high. The use of a checklist which includes three imaging signs can be useful to reduce this overestimation. [ABSTRACT FROM AUTHOR]

Background: Oligometastatic colorectal cancer (CRC) is potentially curable and demands individualised strategies. Methods: This single-centre retrospective study investigated if positron emission tomography (PET)/magnetic resonance imaging (MR) had a clinical impact on oligometastatic CRC relative to the standard of care imaging (SCI). Adult patients with oligometastatic CRC on SCI who also underwent PET/MR between 3/2016 and 3/2019 were included. The exclusion criterion was lack of confirmatory standard of reference, either surgical pathology, intraoperative gross confirmation or imaging follow-up. SCI consisted of contrast-enhanced (CE) computed tomography (CT) of the chest/abdomen/pelvis, abdominal/pelvic CE-MR, and/or CE whole-body PET/CT with diagnostic quality (i.e. standard radiation dose) CT. Follow-up was evaluated until 3/2020. Results: Thirty-one patients constituted the cohort, 16 (52%) male, median patient age was 53 years (interquartile range: 49–65 years). PET/MR and SCI results were divergent in 19% (95% CI 9–37%) of the cases, with PET/MR leading to management changes in all of them. The diagnostic accuracy of PET/MR was 90 ± 5%, versus 71 ± 8% for SCI. In a pairwise analysis, PET/MR outperformed SCI when compared to the reference standard (p = 0.0412). Conclusions: These findings suggest the potential usefulness of PET/MR in the management of oligometastatic CRC. [ABSTRACT FROM AUTHOR]

Background: Oligometastatic colorectal cancer (CRC) is potentially curable and demands individualised strategies.Methods: This single-centre retrospective study investigated if positron emission tomography (PET)/magnetic resonance imaging (MR) had a clinical impact on oligometastatic CRC relative to the standard of care imaging (SCI). Adult patients with oligometastatic CRC on SCI who also underwent PET/MR between 3/2016 and 3/2019 were included. The exclusion criterion was lack of confirmatory standard of reference, either surgical pathology, intraoperative gross confirmation or imaging follow-up. SCI consisted of contrast-enhanced (CE) computed tomography (CT) of the chest/abdomen/pelvis, abdominal/pelvic CE-MR, and/or CE whole-body PET/CT with diagnostic quality (i.e. standard radiation dose) CT. Follow-up was evaluated until 3/2020.Results: Thirty-one patients constituted the cohort, 16 (52%) male, median patient age was 53 years (interquartile range: 49-65 years). PET/MR and SCI results were divergent in 19% (95% CI 9-37%) of the cases, with PET/MR leading to management changes in all of them. The diagnostic accuracy of PET/MR was 90 ± 5%, versus 71 ± 8% for SCI. In a pairwise analysis, PET/MR outperformed SCI when compared to the reference standard (p = 0.0412).Conclusions: These findings suggest the potential usefulness of PET/MR in the management of oligometastatic CRC. [ABSTRACT FROM AUTHOR]

Purpose: Radiation therapy (RT) is an effective treatment for unresectable cholangiocarcinoma (CC). Accurate tumor volume delineation is critical in achieving high rates of local control while minimizing treatment-related toxicity. This study compares 18F-FDG PET/MR to MR and CT for target volume delineation for RT planning. Methods: We retrospectively included 22 patients with newly diagnosed unresectable primary CC who underwent 18F-FDG PET/MR for initial staging. Gross tumor volume (GTV) of the primary mass (GTVM) and lymph nodes (GTVLN) were contoured on CT images, MR images, and PET/MR fused images and compared among modalities. The dice similarity coefficient (DSC) was calculated to assess spatial coverage between different modalities. Results: GTVMPET/MR (median: 94 ml, range 16–655 ml) was significantly greater than GTVMMR (69 ml, 11–635 ml) (p = 0.0001) and GTVMCT (96 ml, 4–564 ml) (p = 0.035). There was no significant difference between GTVMCT and GTVMMR (p = 0.078). Subgroup analysis of intrahepatic and extrahepatic tumors showed that the median GTVMPET/MR was significantly greater than GTVMMR in both groups (117.5 ml, 22–655 ml vs. 102.5 ml, 22–635 ml, p = 0.004 and 37 ml, 16–303 ml vs. 34 ml, 11–207 ml, p = 0.042, respectively). The GTVLNPET/MR (8.5 ml, 1–27 ml) was significantly higher than GTVLNCT (5 ml, 4–16 ml) (p = 0.026). GTVPET/MR had the highest similarity to the GTVMR, i.e., DSCPET/MR-MR (0.82, 0.25–1.00), compared to DSC PET/MR-CT of 0.58 (0.22–0.87) and DSCMR-CT of 0.58 (0.03–0.83). Conclusion: 18F-FDG PET/MR-based CC delineation yields greater GTVs and detected a higher number of positive lymph nodes compared to CT or MR, potentially improving RT planning by reducing the risk of geographic misses. [ABSTRACT FROM AUTHOR]

The purpose of this study was to determine if CT and MRI features can accurately differentiate mucinous cystic neoplasms (MCNs) from simple liver cysts and to compare accuracy of CT and MRI in detecting these features. Eighty-four surgically treated lesions with pre-operative CT or MRI were evaluated by two abdominal radiologists for upstream biliary dilatation, perfusional change, internal hemorrhage, thin septations, thick septations/nodularity, lobar location, and number of coexistent liver cysts. Odds ratios, sensitivities, specificities, and positive and negative predictive values were calculated for association of each feature with MCNs. Of 84 liver lesions, 13 (15%) were MCNs, all in women, and 71 (85%) were simple cysts, in 59 women and 12 men. Thick septations/nodularity, upstream biliary dilation, thin septations, internal hemorrhage, perfusional change, and fewer than 3 coexistent liver cysts were more frequent in MCNs than in simple cysts. The combination of thick septations/nodularity and at least one additional associated feature showed high specificity for MCNs (94–98%). MRI detected significant associations of biliary dilation, thin septations, and hemorrhage/debris with MCNs which CT did not. Surgically treated MCNs of the liver with preoperative imaging occurred at our institution only in women. Thick septations or nodularity, biliary dilation, thin septations, internal hemorrhage or debris, perfusional change, and fewer than 3 coexistent liver cysts are features that help differentiate MCNs from simple cysts. MRI has advantages over CT in detecting these features. • Mucinous cystic neoplasms of the liver and bile ducts are rare. • Imaging can differentiate mucinous cystic neoplasms from simple liver cysts. • MRI has advantages over CT in detecting differentiating features. [ABSTRACT FROM AUTHOR]

Background: The survival benefit of negative margins for hepatocellular carcinoma (HCC) has been demonstrated. However, there is no consensus regarding the optimal resection margin width. We assessed the impact of hepatic resection margin width for solitary HCC on overall (OS), recurrence-free (RFS), and liver-specific recurrence-free survival (LSRFS). Methods: Clinicopathologic data were retrospectively collected for solitary HCC patients who underwent a negative margin hepatectomy (1992–2015). Margin width was categorized in tertiles as "narrow" (≤ 0.3 cm), "intermediate" (0.31–1.0 cm), or "wide" (> 1.0 cm). Survival was compared among groups. Results: Of the 178 included patients, most were male (76%); median age, MELD score, and tumor size were 63 years, 8, and 5.2 cm, respectively; 93% were Child-Pugh class A. Median margin width was 0.5 cm. Median follow-up and OS were 47.8 months and 76.7 months, respectively. There was no significant survival difference among narrow, intermediate, and wide margin groups with a median OS of 53 months (IQR 21–not reached [NR]), 74 months (IQR 14–138), and 97 months (IQR 37–142) (p = 0.87), respectively. Median RFS was 33.0 months; again, there was no difference among narrow, intermediate, and wide margin groups with a median of 31 months (IQR 18–NR), 45 months (IQR 14–NR), and 27 months (IQR 11–NR), respectively (p = 0.66). Median LSRFS was 63.0 months (IQR 14–NR) with no difference among groups (p = 0.87). In multivariate analyses, margin width was not associated with OS (p = 0.77), RFS (p = 0.74), or LSRFS (p = 0.92). Findings were similar in all subgroups analyzed (≤ 5 cm, > 5 cm, microvascular invasion, T1, T2/T3, anatomical or non-anatomical resection, major or minor hepatectomy). Conclusions: Narrow margins appear to be oncologically safe and the feasibility of achieving wide margins should not determine resectability. [ABSTRACT FROM AUTHOR]

• Hybrid PET/MR imaging may be superior to conventional MR or PET/CT imaging in visualizing disease activity in inflammatory bowel diseases. • Standardization of technical aspects of imaging is of paramount importance in ensuring the reproducibility of imaging outputs. • PET/MR imaging could contribute to follow up of patients with IBD, with determining probability of response to treatment and providing prognostication about long term clinical outcome. Positron emission tomography (PET) magnetic resonance (MR) enterography is a novel hybrid imaging technique that is gaining popularity in the study of complex inflammatory disorders of the gastrointestinal system, such as inflammatory bowel disease (IBD). This imaging technique combines the metabolic information of PET imaging with the spatial resolution and soft tissue contrast of MR imaging. Several studies have suggested potential roles for PET/MR imaging in determining the activity status of IBD, evaluating treatment response, stratifying risk, and predicting long-term clinical outcomes. However, there are challenges in generalizing findings due to limited studies, technical aspects of hybrid MR/PET imaging, and clinical indications of this imaging modality. This review aims to further elucidate the possible role of PET/MR in IBD, highlight important technical aspects of imaging, and address potential pitfalls and prospects of this modality in IBDs. [ABSTRACT FROM AUTHOR]

Publisher Correction to: PET/MRI and PET/CT Radiomics in Primary Cervical Cancer: A Pilot Study on the Correlation of Pelvic PET, MRI, and CT Derived Image Features B Correction to: Molecular Imaging and Biology b https://doi.org/10.1007/s11307-021-01658-1 This article was updated to include the statement "Shadi A. Esfahani and Angel Torrado-Carvajal contributed equally to this manuscript." Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. [Extracted from the article]

Simple Summary: Over the past few years, radiomics-based tissue characterization has demonstrated its potential for non-invasive prediction of the genetic profile and grading in cerebral gliomas using multiparametric MRI. The aim of our study was to investigate the feasibility and diagnostic accuracy of a fully automated radiomics analysis based on a simplified MR protocol derived from various scanner systems to prospectively ease the transition of radiomics-based non-invasive tissue sampling into clinical practice. Using an MRI with non-contrast and post-contrast T1-weighted sequences and FLAIR, our workflow automatically predicts the IDH1/2 mutation, the ATRX expression loss, the 1p19q co-deletion and the MGMT methylation status. It also effectively differentiates low-grade from high-grade gliomas. In summary, the present study demonstrated that a fully automated prediction of grading and the genetic profile of cerebral gliomas could be performed with our proposed method using a simplified MRI protocol that is robust to variations in scanner systems, imaging parameters and field strength. Objective: The aim of this study was to investigate the diagnostic accuracy of a radiomics analysis based on a fully automated segmentation and a simplified and robust MR imaging protocol to provide a comprehensive analysis of the genetic profile and grading of cerebral gliomas for everyday clinical use. Methods: MRI examinations of 217 therapy-naïve patients with cerebral gliomas, each comprising a non-contrast T1-weighted, FLAIR and contrast-enhanced T1-weighted sequence, were included in the study. In addition, clinical and laboratory parameters were incorporated into the analysis. The BraTS 2019 pretrained DeepMedic network was used for automated segmentation. The segmentations generated by DeepMedic were evaluated with 200 manual segmentations with a DICE score of 0.8082 ± 0.1321. Subsequently, the radiomics signatures were utilized to predict the genetic profile of ATRX, IDH1/2, MGMT and 1p19q co-deletion, as well as differentiating low-grade glioma from high-grade glioma. Results: The network provided an AUC (validation/test) for the differentiation between low-grade gliomas vs. high-grade gliomas of 0.981 ± 0.015/0.885 ± 0.02. The best results were achieved for the prediction of the ATRX expression loss with AUCs of 0.979 ± 0.028/0.923 ± 0.045, followed by 0.929 ± 0.042/0.861 ± 0.023 for the prediction of IDH1/2. The prediction of 1p19q and MGMT achieved moderate results, with AUCs of 0.999 ± 0.005/0.711 ± 0.128 for 1p19q and 0.854 ± 0.046/0.742 ± 0.050 for MGMT. Conclusion: This fully automated approach utilizing simplified MR protocols to predict the genetic profile and grading of cerebral gliomas provides an easy and efficient method for non-invasive tumor decoding. [ABSTRACT FROM AUTHOR]