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Abstract: Manganese-based contrast agents (MBCAs) show promise to complement gadolinium-based contrast agents (GBCAs) in magnetic resonance imaging (MRI) of the liver. Management of patients with focal liver lesions and severely impaired renal function uses unenhanced liver MRI or GBCA-enhanced MRI. However, unenhanced MRI risks reducing patient's survival.Gadolinium-based contrast agents, which help to detect and visualize liver lesions, are associated with increased risk of nephrogenic systemic fibrosis in renally impaired patients, a severe adverse event (AE) with potentially fatal outcome. Therefore, use of GBCA in patients with impaired renal function requires careful consideration. Other concerns are related to tissue deposition in the brain and other organs due to lack of gadolinium clearance, which could lead to concerns also for other patient populations, for example, those exposed to multiple procedures with GBCA. Of particular concern are the linear chelates that remain available for liver MRI, where there is no replacement technology. This has highlighted the urgency for safer alternatives.An alternative may be the drug candidate Ascelia-MBCA (ACE-MBCA, Orviglance), oral manganese chloride tetrahydrate. This candidate effectively visualizes and detects focal liver lesions, as demonstrated in 8 clinical studies on 201 adults (healthy or with known or suspected focal liver lesions). ACE-MBCA has a low and transient systemic exposure, which is likely the reason for its beneficial safety profile. The AEs were primarily mild and transient, and related to the gastrointestinal tract. This new, orally administered product may offer a simple imaging approach, allowing appropriate patient management in renally impaired patients when use of GBCA requires careful consideration.In this review, we highlight the clinical development of ACE-MBCA-a novel, liver-specific contrast agent. We begin with a brief overview of manganese properties, addressing the need for MBCAs and describing their optimal properties. We then review key findings on the novel agent and how this allows high-quality MRIs that are comparable to GBCA and superior to unenhanced MRI. Lastly, we provide our view of future perspectives that could advance the field of liver imaging, addressing the medical needs of patients with focal liver lesions and severe renal impairment.Our review suggests that ACE-MBCA is a promising, effective, and well-tolerated new tool in the radiologist's toolbox., Competing Interests: Conflicts of interest and sources of funding: T.B.B. and N.K. accepted paid consultancy from Bayer. H.P.H. and A.N. are employed at Ascelia Pharma. H.P.H. and A.N. also have shares in Ascelia Pharma. Ascelia Pharma funded editorial and writing services from Aixial Group. There were no other sources of funding or conflicts of interest., (Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc.)

We reviewed the CT of 20 patients with peripheral lung malignancies in which CT appearance suggested chest wall invasion on the basis of extension of mass around ribs into fat or muscle of the chest wall, or definite bone destruction. We correlated these findings with other radiographic studies and surgical and autopsy results. All 11 cases in which CT indicated chest wall involvement on the basis of definite bone destruction were confirmed. Tumor extension into the chest wall was disproven in six of the remaining nine cases in which invasion was suggested on the basis of tumor infiltration between ribs or extension of tumor into fat or soft tissue planes. Our findings confirm the lack of reliability of CT findings in determining the extension of malignancy into the chest wall, except when definite bone destruction is present.

Complete unilateral ligation of the renal vein was done in five adult mongrel dogs. An initial ultrasound examination was performed at 6 hours with serial scans every 12 hours until the animals died or were sacrificed. There were a number of sonographic findings, consisting of immediate renal enlargement, increased cortical thickness, sparsely distributed cortical echoes with increased transonance, indistinct cortico-medullary boundary, parenchymal anechoic areas due to hemorrhage and hemorrhagic infarct, compressed renal parenchyma appearing as echogenic clusters, dilated renal veins, and renal rupture. These findings corresponded to changes in the pathologic specimens and were dependent upon the duration of the venous occlusion. In patients clinically suspected to have renal vein thrombosis, the combination of the above-described sonographic findings supplemented with findings on excretory urography should be sufficient for the diagnosis of renal vein thrombosis, eliminating the need for invasive procedures.