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Various ectopic lesions occur in the abdomen and pelvis and affect multiple organs including liver, gallbladder, pancreas, spleen, and organs of the genitourinary system. Ectopic organs may be present outside their normal positions, or ectopic tissues may develop while the original organ exists in its normal position. Both benign and malignant lesions can occur in ectopic organs and tissues. Owing to their unusual location, they can often be misdiagnosed as other lesions or even malignant lesions, such as metastasis or seeding. This multimodality pictorial review provides various cases of ectopic lesions in the abdomen and pelvis, which will help narrow the differential diagnosis and guide clinical decision-making. [ABSTRACT FROM AUTHOR]

Endometrial polypoid lesions encompass various conditions from physiologic changes to benign or malignant disease. Differentiating between the various causes of endometrial polypoid lesions remains difficult by transvaginal sonography. Magnetic resonance imaging (MRI) can provide valuable information regarding endometrial polypoid lesions in situations where it is difficult to obtain histologic samples. Multiparametric MRI including T2-weighted images, T1-weighted fat-saturation contrast-enhanced images, and diffusion-weighted images may be helpful for differentiating the various endometrial polypoid lesions and establishing specific diagnoses and appropriate treatment. [ABSTRACT FROM AUTHOR]

We introduce two rare obstetric entities. They show very similar image findings, but the prognosis is different. Prognosis is generally favorable for complete hydatidiform mole with coexisting fetus (CHMCF), but placental mesenchymal dysplasia (PMD) has high fetal and neonatal mortality. Differential diagnosis is essential to management of pregnancy. Twin pregnancies with CHMCF are characterized by the coexistence of complete mole (diploid without fetal parts) and a normal live fetus with a normal placenta. US Findings: 1. Normal fetus and normal placenta with umbilical cord insertion 2. Separated molar placenta, vesicular sonographic pattern Differential Diagnosis: Partial mole (Triploid) Hematoma in placenta (normal β-hCG level) Placental mesenchymal dysplasia Biochemistry: β-hCG concentrations are extremely high • Chorionic villus sampling can be useful to differentiate in early pregnancy between CHMCF and partial hydatidiform mole • Amniocentesis or fetal blood sampling • Genotype of a CHM is entirely of paternal origin • Management of pregnancies with CHMCF has not been standardized • Continuation of CHMCF is an acceptable option: Intensive maternal follow up ultrasonography and β-hCG level monitoring • The chance of a live birth is 7 - 37%. • Complications: Fetal death, vaginal bleeding, preeclampsia, hyperthyroidism, gestational trophoblastic neoplasia Case 1: A 31-year old woman, gravida 2, para 0 CC: IUP at 17 weeks with abnormal placenta. Serum β-hCG levels: 234,358 mIU/mL (elevated) Fetal US: IUP at 17 weeks Twin pregnancy with complete H-mole and coexisting fetus Emergency Cesarian section for fetal distress at 27 wks Delivery: Boy, Apgar score 1'-1, 5'-1 Cytogenetic report: 46, XY, normal Pathological Diagnosis: Complete hydatidiform mole with coexisting fetus Case 2: A 32-year old woman, gravida 1, para 0 CC: IVF pregnancy follow up Serum β-hCG levels: 1,873,485 mIU/mL (elevated) Fetal US: IUP at 8 weeks Twin pregnancy with complete H-mole and coexisting fetus Dilatation and evacuation for vaginal bleeding at 10 weeks Pathological Diagnosis: Complete hydatidiform mole with coexisting fetus Part I: multiple fragments of placental tissue (about 5cc) with variable sized cysts (up to 0.7cm) Part II: multiple fragments of placental tissue (5 × 3cm) without grape like cystic change Developed persistent trophoblastic disease and 18 cycle chemotherapy Case 3: A 34-year old woman, gravida 1, para 0 CC: IVF pregnancy follow up fetus Serum β-hCG levels: 306,645 mIU/mL (elevated) Fetal US: IUP at 17 weeks Twin pregnancy with complete H-mole and coexisting fetus Rare placental lesion estimated to occur in 0.02% of pregnancies. Placental enlargement, dilated and tortuous chorionic vessels, and a focal distribution of cystically enlarged villi. US Findings: Typical large and thickened with multicystic, hypoechoic areas Differential Diagnosis: Partial mole, complete hydatidiform mole with coexisting fetus (CHMCF), chorangioma, intervillous hematoma, infarct or nonspecific hydropic changes • Characteristic morphologic features • Lack of trophoblastic hyperplasia –> maternal serum β-hCG levels are not elevated or only slightly elevated • No known risk of persistent gestational trophoblastic disease • No other specific maternal serum markers • Perinatal demise: not certain, but high as 43% • Cause of fetal death: Massive fetal hemorrhage secondary to rupture of delated periumbilical chorionic vessels Case 4: A 34-year old woman, gravida 1, para 0 CC: IUP at 12 weeks weeks Twin pregnancy with complete H-mole and coexisting fetus Serum β-hCG levels: 39,249 mIU/mL Fetal US: IUP at 12 weeks Twin pregnancy with complete H-mole and coexisting fetus Chorionic Villus Sampling (12 weeks) • Normal appearing placenta: 46, XX Normal • Abnormal appearing placenta: 46, XX Normal QF-PCR: placental mesenchymal dysplasia Pathological Diagnosis: Placental mesenchymal dysplasia Case 5: A 35-year old woman, gravida 2, para 1 CC: IUP 19 weeks, abnormal enlarged and honeycomb shaped placenta Serum β-hCG levels: none Fetal US: IUP at 20 weeks Twin pregnancy with complete H-mole and coexisting fetus R/O Placental mesenchymal dysplasia Amniocenthesis: Mosaicism 47,XY +15[3]/46,XX[31] Pathological Diagnosis: Placental mesenchymal dysplasia Complete Hydatidiform Mole with Coexisting Fetus vs Placental Mesenchymal Dysplasia We proposed two differential diagnosis points 1. Proportion of two patterns of placenta - CHMCF: similar size of two patterns of placenta - PMD: dominant vesicular pattern placenta 2. Umbilical cord insertion - CHMCF: center of normal placenta - PMD: junction of two different patterns of placenta → finally insert into abnormal placenta [ABSTRACT FROM AUTHOR]

Objectives: To investigate ultrasonographic features of focal nodular hyperplasia of the liver with contrast‐enhanced ultrasonography (CEUS) using Sonazoid (perflubutane; GE Healthcare, Oslo, Norway). Methods: Thirty‐one patients with 31 focal nodular hyperplasia nodules who underwent CEUS using Sonazoid between July 2012 and February 2015 were included in this study. After the microbubble contrast agent was injected, intermittent CEUS images were obtained during the following 4 phases: arterial (10–40 seconds), portal venous (60–90 seconds), delayed (3 minutes), and Kupffer (>10 minutes). Three abdominal radiologists retrospectively reviewed the images and achieved consensus for vascular (central artery, stellate vascularity, and centrifugal enhancement) and dynamic enhancement patterns during the late arterial, portal venous, delayed, and Kupffer phases. Results: The patients included 12 men and 19 women (age range, 21–82 years; mean, 47 years). The mean diameter of the lesions ± SD was 2.2 ± 0.9 cm (range, 1.0–4.0 cm). On CEUS, 24 of 31 lesions (77.4%) showed central artery and stellate vascularity in the early arterial phase, and 25 (80.6%) showed centrifugal enhancement. Twenty‐six lesions (83.9%) were hyperechoic during the late arterial phase and showed hyperenhancement or isoenhancement during the serial dynamic phases. Kupffer‐phase images indicated that only 2 lesions (6.5%) were hypoechoic compared with surrounding liver parenchyma, whereas 29 (93.5%) remained either hyperechoic (2 [6.5%]) or isoechoic (27 [87.1%]). Conclusions: Contrast‐enhanced US using Sonazoid for focal nodular hyperplasia showed typical vascular patterns of central artery vascularity, stellate vascularity, and centrifugal enhancement. Most cases were either hyperenhanced or isoenhanced on serial dynamic‐ and Kupffer‐phase imaging. Based on these results, CEUS can provide useful information for noninvasive focal nodular hyperplasia diagnoses. [ABSTRACT FROM AUTHOR]

Purpose: To identify the most reliable imaging features for differentiating hepatocellular carcinoma with paradoxical uptake on the hepatobiliary phase (HCCpara ) from focal nodular hyperplasia (FNH)-like nodules using Gd-EOB-DTPA-enhanced MRI.Materials and Methods: This was a retrospective study. Twenty patients with HCCpara and 21 patients with FNH-like nodules were included. The following MRI features were evaluated using 3.0 Tesla unit by two radiologists: signal intensity (SI) on T1-, T2-, and diffusion-weighted imaging (DWI), arterial enhancement pattern, washout appearance on the portal venous phase (PVP) and/or transitional phase (TP), uptake pattern on the hepatobiliary phase (HBP), "T2 scar," "EOB scar," and chemical shift on in- and out-of-phase images. Multivariate logistic regression analysis was performed to assess MRI features for prediction of HCCpara .Results: Compared with FNH-like nodules, HCCpara had significantly more frequent heterogeneous T1 SI (P < 0.0001), T2 hyperintensity (P = 0.032), heterogeneous arterial enhancement (P < 0.0001), washout appearance on the PVP and/or TP (P < 0.0001), heterogeneous uptake on the HBP (P < 0.0001), absence of "EOB scar" (P < 0.0001), and hyperintensity on DWI (P = 0.004). Multivariate logistic regression analysis revealed washout appearance as the only independent imaging feature associated with HCCpara (odds ratio, 7.019; P = 0.042). Washout appearance also showed the best diagnostic performance with a sensitivity of 90% and a specificity of 100%.Conclusion: Washout appearance on the PVP and/or TP is the most reliable imaging feature for differentiating HCCpara from FNH-like nodules.Level Of Evidence: 3 J. MAGN. RESON. IMAGING 2017;45:1599-1608. [ABSTRACT FROM AUTHOR]

Abstract: Purpose: To compare the in vivo gastric injury observed during radiofrequency (RF) ablation of the liver abutting the stomach before and after the intragastric administration of chilled saline. Materials and methods: Twenty RF ablation zones were created in the livers of 10 pigs with a 1-cm-exposed active tip of an internally cooled electrode under ultrasound guidance for 10min. Ten RF ablation zones were created before (non-saline group) and after (saline group) the intragastric administration of approximately 1000mL of chilled saline, and 20 RF ablation zones were made in the posterior part of the left lobe abutting the stomach. The frequency and severity of the thermal injury observed in the stomach of the two groups were compared histologically. Results: All the resected gastric specimens showed thermal injuries of varying degrees of severity. The largest diameter of the gastric injury was significantly smaller in the saline group (mean 1.5cm; range 1.3–1.8cm) than in the non-saline group (mean 2.1cm; range 1.8–2.4cm) (p =0.000). The saline group showed significantly less thermal injury to the muscular layer of the gastric wall by the histopathology (p =0.033). Conclusions: The intragastric administration of chilled saline might be a useful technique for reducing the severity of gastric injury during RF ablation of the liver abutting the stomach. [Copyright &y& Elsevier]

Abstract: Purpose: The purpose was to describe magnetic resonance imaging (MRI) findings of breast cancer liver metastasis using gadoxetic acid (Gd-EOB-DTPA) with an emphasis on the added value of the hepatobiliary phase (HBP). Material and methods: Nine patients with 13 liver metastases were included in the study after the medical records of 29 breast cancer patients who underwent Gd-EOB-DTPA-enhanced MRI between February 2008 and June 2010 were reviewed. The diagnoses of liver metastasis were established by percutaneous liver biopsy or surgery and on the basis of image findings. Two radiologists retrospectively evaluated signal intensity (SI) and sizes of metastases and patterns of enhancement in an HBP. The SI ratio was calculated as the SI of the central hyperintense portion in “target” lesions divided by the SI of nearby normal liver parenchyma on the HBP. We also measured apparent diffusion coefficient (ADC) values from Diffusion Weighted Image (DWI). Results: Liver metastases were all hypointense [n=13/13 (100%)] on T1-weighted imaging (WI), and many lesions had a “target” appearance with a central high SI and a peripheral low SI rim (47%) on T2WI. Dynamic study showed rim enhancement on the arterial phase (85%) and a “target” appearance, consisting of a central enhancing portion with peripheral washout or hypointense rim, on the HBP (62%). The mean SI ratio was 0.7. The mean ADC value of “target” appearing metastases was 1.25 (×10−3 mm2/s; range 1.3–1.6) compared with a mean value of 0.8 (×10−3 mm2/s; range 0.8–1.4) in homogeneous defect on the HBP. There was statistically significant difference (P<.05). Conclusion: Breast cancer liver metastases commonly demonstrated as a peripheral ring enhancement on arterial dominant phase and a target sign with a central round enhancing portion and a peripheral hypointense rim on the HBP. [Copyright &y& Elsevier]