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Objectives: To evaluate a CT-based radiomics model for identifying malignant pancreatic intraductal papillary mucinous neoplasms (IPMNs) and compare its performance with the 2017 international consensus guidelines (ICGs). Materials and methods: We retrospectively included 194 consecutive patients who underwent surgical resection of pancreatic IPMNs between January 2008 and December 2020. Surgical histopathology was the reference standard for diagnosing malignancy. Using radiomics features from preoperative contrast-enhanced CT, a radiomics model was built with the least absolute shrinkage and selection operator by a five-fold cross-validation. CT and MR images were independently reviewed based on the 2017 ICGs by two abdominal radiologists, and the performances of the 2017 ICGs and radiomics model were compared. The areas under the curve (AUCs) were compared using the DeLong method. Results: A total of 194 patients with pancreatic IPMNs (benign, 83 [43%]; malignant, 111 [57%]) were chronologically divided into training (n = 141; age, 65 ± 8.6 years; 88 males) and validation sets (n = 53; age, 66 ± 9.7 years; 31 males). There was no statistically significant difference in the diagnostic performance of the 2017 ICGs between CT and MRI (AUC, 0.71 vs. 0.71; p = 0.93) with excellent intermodality agreement (k = 0.86). In the validation set, the CT radiomics model had higher AUC (0.85 vs. 0.71; p = 0.038), specificity (84.6% vs. 61.5%; p = 0.041), and positive predictive value (84.0% vs. 66.7%; p = 0.044) than the 2017 ICGs. Conclusion: The CT radiomics model exhibited better diagnostic performance than the 2017 ICGs in classifying malignant IPMNs. Clinical relevance statement: Compared with the radiologists' evaluation based on the 2017 international consensus guidelines, the CT radiomics model exhibited better diagnostic performance in classifying malignant intraductal papillary mucinous neoplasms. Key Points: • There is a paucity of comparisons between the 2017 international consensus guidelines (ICGs) and radiomics models for malignant intraductal papillary mucinous neoplasms (IPMNs). • The CT radiomics model developed in this study exhibited better diagnostic performance than the 2017 ICGs in classifying malignant IPMNs. • The radiomics model may serve as a valuable complementary tool to the 2017 ICGs, potentially allowing a more quantitative assessment of IPMNs. [ABSTRACT FROM AUTHOR]

Aim: To compare clinical and radiological findings of newly diagnosed hepatocellular carcinomas (HCCs) in patients with chronic hepatitis B virus (HBV) and chronic hepatitis C virus (HCV) infections. Materials and Methods: Dynamic contrast-enhanced CT images in 532 patients with newly diagnosed HCC were retrospectively reviewed. Of these patients, 418 had chronic HBV infections and 114 had chronic HCV infections. The number, size, shape (nodular vs. non-nodular) and enhancement pattern (typical vs. atypical) of hepatic lesions were assessed. The presence of portal vein thrombosis and bile duct invasion were determined. Results: The mean age of the HBV group (54.31 [range 27-85], median 54) was younger than that of the HCV group (64.21 [range 30-86], median 64) ( P < 0.001). Lesions in patients with HBV were more likely to be multifocal (>5; P < 0.001); larger than 5 cm ( P = 0.023); non-nodular shape ( P < 0.001); atypical enhancement pattern ( P = 0.047), association with portal vein thrombosis ( P = 0.004); association with bile duct invasion ( P < 0.001). Conclusions: Clinical and radiological findings of HCC differ between patients with HBV and HCV infections. [ABSTRACT FROM AUTHOR]

BACKGROUND. When coronary CTA is performed in the emergency department (ED), the use of a contemporary scanner with improved temporal resolution may eliminate the need to administer β-blockers for heart rate (HR) control, thereby expediting workup. OBJECTIVE. The purpose of this study was to compare ED length of stay (LOS), image quality, frequency of nondiagnostic examinations, and other clinical outcomes between patients undergoing coronary CTA in the ED on a single-source CT (SSCT) scanner with HR control versus on a dual-source CT (DSCT) scanner without HR control. METHODS. This retrospective study included 509 patients (283 men, 226 women; mean age, 52.1 ± 15.1 [SD] years) at low to intermediate risk for acute coronary syndrome who underwent coronary CTA for acute chest pain during off-hours in a single ED from March 1, 2020, to April 25, 2022. A total of 205 patients initially underwent CTA using a 64-detector-row SSCT scanner with HR control (oral β-blocker administration if HR was > 65 beats/min); after scanner replacement on April 26, 2021, 304 patients underwent CTA using a third-generation DSCT without HR control. Groups were compared in terms of ED LOS and CT completion time (defined as time from ordering CTA to completion of acquisition) using propensity score matching and additional endpoints including image quality and nondiagnostic examinations based on radiology reports. RESULTS. The DSCT group, compared with the SSCT group, showed no significant difference in median ED LOS (505 vs 457 minutes, respectively; p = .37) but showed shorter median CT completion time (95 vs 117 minutes, p < .001); on the basis of a mediation analysis, 89% of the reduction in CT completion time for DSCT was attributed to the absence of HR control. The DSCT group, compared with the SSCT group, showed higher frequency of examinations with good or excellent image quality (87.8% vs 60.0%, p < .001) and lower frequency of nondiagnostic examinations (1.6% vs 6.3%, p = .01) but showed no significant difference in frequencies of emergent cardiology consultation, invasive angiography, ED disposition, or coronary revascularization (all p > .05). No patient in either group experienced 30-day all-cause mortality or a major adverse cardiovascular event. CONCLUSION. The use of a DSCT scanner for coronary CTA can eliminate the need for β-blocker administration for HR control while decreasing nondiagnostic examinations. CLINICAL IMPACT. A DSCT scanner can expedite clinical processes in the ED.

Objective: Our retrospective study compared Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1 with modified CT criteria to determine their respective utilities as a prognostic indicator. Using both sets of criteria, we compared treatment responses of patients with colorectal liver metastases treated with bevacizumab-containing chemotherapy with those of patients treated with chemotherapy alone., Materials and Methods: Fifty-nine patients who received bevacizumab-containing chemotherapy (n=30, group 1) or chemotherapy alone (n=29, group 2) for the treatment of colorectal carcinoma underwent contrast-enhanced CT before treatment and 2 months after treatment. Two radiologists determined changes in tumor size and density between the pretreatment and 2-month follow-up CT images. RECIST 1.1 assesses responses on the basis of changes in tumor size, and the modified CT criteria assesses responses on the basis of changes in tumor density and size. Responses were correlated with time to tumor progression by log rank test., Results: According to RECIST 1.1, nine of 30 patients (30%) in group 1 and 12 of 29 patients (41%) in group 2 were good responders. According to the modified CT criteria, 23 of 30 patients in group 1 (77%) and 23 of 29 patients in group 2 (79%) were good responders. As assessed by the modified CT criteria, good responders in both groups had significantly longer time to tumor progression than poor responders (p<0.05). As assessed by RECIST 1.1, good responders in group 1 had significantly longer time to tumor progression than poor responders (p=0.0154), but there was no difference in group 2., Conclusion: Evaluating treatment response with tumor size and density changes on CT was a better predictor of time to tumor progression than changes in tumor size alone in both groups.

Objective: The purpose of this article is to assess CT enhancement patterns of hepatocellular carcinoma (HCC) within 1 month after transarterial chemoembolization (TACE) using drug-eluting beads and to determine whether enhancement patterns may be useful for predicting local tumor progression., Materials and Methods: Forty-one patients with 50 HCCs underwent CT within 1 month after TACE with drug-eluting beads. Two blinded readers independently reviewed the arterial phase images and classified enhancement patterns as follows: no enhancement, peripheral ring enhancement, and peripheral nodulelike enhancement. Enhancement patterns were correlated with time to tumor progression of enhancing tissue by log-rank test., Results: In the group with no enhancement, 92.3% (24/26) had not progressed and 7.7% (2/26) showed progression; for peripheral ring enhancement, 83.3% (10/12) had not progressed and 16.7% (2/12) showed progression; and for peripheral nodulelike enhancement, 16.7% (2/12) had not progressed and 83.3% (10/12) showed progression. The time to progression of enhancing tissue was significantly different between the group with no enhancement plus peripheral ring enhancement and the group with peripheral nodulelike enhancement (p < 0.001)., Conclusion: Analysis of enhancement patterns at the arterial phase of the first follow-up CT after TACE with drug-eluting beads is helpful for predicting progression of treated HCC.