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The new 2023 update of the International Federation of Gynecology and Obstetrics (FIGO) staging system for endometrial cancer incorporates the advances made in the understanding of the pathology and molecular classifications into the staging system. While the new staging system aids in precision medicine and may lead to better documentation of prognostic risk categories of endometrial cancer, it is complex and calls for an integrated approach and better communication between multiple disciplines involved in the management of endometrial cancer. In this review article, we address how the referral patterns to imaging services might change considering the updated staging system for endometrial cancer. We also discuss the practical aspects and nuances involved in the radiology service delivery and reporting practices as we adopt the new FIGO staging system for managing endometrial cancer patients.

Abstract Background Incidence of malignancy in architectural distortion (AD) is variable, and as a standard of care, all the architectural distortions are biopsied. It is important to identify benign and malignant characteristics of ADs on imaging to predict the probability of malignancies as well as to establish radiological–pathological concordance. The aim of our study was to analyse the utility of contrast-enhanced mammography (CEM) in primary AD, to describe and evaluate the accuracy of CEM parameters and derive a novel scoring system to differentiate benign and malignant AD. Results Forty-six patients with 49 ADs were evaluated with a median age, 51 years (age range—34–72 years) and all were women. Of the 49 ADs, 65.3% (32/49) were benign, and 34.69% (17/49) were malignant. The CEM parameters which predicted malignancy were moderate or marked density, size > 0.95 cm, CT ratio > 1.31, mass morphology and washout kinetics. The absence of enhancement and enhancing AD with AD score of 0 had a 100% NPV for malignancy. Enhancing architectural distortion with a score of 3 or more had 100% PPV for malignancy. A score of 1 or 2 was indeterminate, and an individualised decision was recommended. Conclusions In primary AD, several CEM features have significantly predicted malignancy when the score is 3 and above. A biopsy may be avoided in non-enhancing AD and enhancing AD with a score of 0 due to high NPV.

Abstract Background Contrast-enhanced MRI (CE MRI) of the breast is currently the most sensitive imaging technique for detecting invasive breast cancer, and it provides both morphologic and functional information through kinetics for characterizing breast masses. Contrast-enhanced mammography (CEM) uses the same principle of neo-angiogenesis to detect early cancers similar to MRI with comparable diagnostic performance. However, there is an important limitation in CEM in characterizing the breast lesions because of the non-availability of kinetic information. To the best of our knowledge, very few studies have assessed the CEM kinetics. In this study, we have evaluated the accuracy of subjective assessment of contrast kinetics in CEM and compared it with the subjective and quantitative kinetic assessment in CE MRI. If the performance of CEM is comparable to MRI, it may add an additional dimension to CEM in characterizing the breast masses in addition to detection. Results Kinetic information of 123 lesions in 90 patients was analyzed in CEM and MRI. Of these, 26 (21.1%) were benign, 4 (3.3%) were high risk lesions, and 93 (75.6%) were malignant breast lesions. Comparison of subjective and quantitative assessment in CE MRI had almost perfect agreement with a kappa value of 0.816, and both were used as reference standards for comparing CEM kinetics. Comparison of subjective assessment of kinetic patterns in CEM using only CC and MLO views showed moderate agreement with both quantitative (kappa − 0.483) and subjective (0.547) CE MRI kinetics. When the delayed image obtained at 8 min was included for kinetic analysis, CEM kinetics showed substantial to almost perfect agreement with quantitative (kappa − 0.673) and subjective (kappa − 0.855) CE MRI kinetics, respectively. Conclusion We hope that this study results would encourage the breast radiologist to assess the kinetic information from CEM and use CEM as a single, simple and cost-effective imaging modality in detecting and characterizing breast masses.

Background and Objectives The purpose of this study is to evaluate and establish the accuracy of noninvasive methods, including third-generation dual-source dual-energy computed tomography (DECT) and proton density fat (PDF) fraction on magnetic resonance imaging (MRI) using three-dimensional multiecho multipoint chemical shift-encoded spoiled gradient echo (q-Dixon) sequence in the quantification of hepatic steatosis; with H1-MR spectroscopy (MRS) as the reference standard. Materials and Methods A total of 47 patients were included in this prospective study. We studied the accuracy of fatty liver detection using third-generation DECT using mixed set images (MSIs), virtual monochromatic images (VMIs), and MRI q-Dixon. The results were compared with H1-MRS. Data were analyzed using linear regression for each technique compared with MRS. Results Our study's correlation and linear regression analysis showed a good correlation between PDF values obtained by H1-MRS and MR q-Dixon methods (r = 0.821, r 2 = 0.674, p

Pseudoangiomatous stromal hyperplasia (PASH) is a benign mesenchymal tumor-like lesion of the breast. It is commonly seen as incidental background changes of the intralobular stroma in biopsy specimens performed for other breast lesions. Less frequently, it presents as a nodular form that has a benign morphology on imaging, mimicking fibroadenoma or as a diffuse form causing progressive massive gigantomastia. Diagnosis is established by biopsy. Knowledge of the imaging appearance of PASH not only facilitates proper assessment of radiopathological correlation but also helps in deciding further management of these lesions. Occasionally, nodular PASH may have a suspicious appearance on imaging wherein excision biopsy is indicated to exclude a coexisting carcinoma.

Abstract Background The purpose of the study was to assess the correlation between peritumoral edema (PE) seen on magnetic resonance imaging (MRI) in breast cancer and the established pathological prognostic factors like tumor histology and molecular subtype, grade, Ki67 index, lymphovascular invasion (LVI) and nodal stage. The breast MRI and pathological data of post-surgery specimen of 126 breast cancer patients over a period of 18 months were retrospectively studied. Those who received neoadjuvant therapy, had non-invasive, locally advanced, inflammatory and bilateral breast cancers were excluded. Patients were divided into two groups based on finding of peritumoral edema on T2w MRI images: Group A with PE (n = 88) and Group B without PE (n = 38). Pathological results for the two groups were analyzed and compared using Chi square test. p values of

Abstract Background The purpose of this study was to compare the Image Quality, Contrast Medium Volume, and Radiation dose in renal angiography performed using Turbo Flash mode and dual-energy (DE) mode in the third-generation dual-source dual-energy CT. This prospective observational study was performed on renal donors who underwent CTA imaging as a pre-transplant workup. The study population was divided into two groups. Group A underwent DECT renal angiography. Group B underwent Turbo Flash Mode CT renal angiography. For group A, a contrast volume of 1 ml/kg and for group B at 0.5 ml/kg was administered. Image Quality was evaluated objectively by calculating CNR and SNR and subjectively by a 5-point scale. Radiation Dose analysis was done by noting CTDIvol and DLP on the scanner system and calculating effective radiation dose (ED). Results The subjective image quality scores for the Turbo Flash group were comparable with the DE group in qualitative image analysis. Additionally, in the Turbo Flash group, there was a reduction in contrast media and effective radiation dose by 47.5% and 32.7%, respectively. Nevertheless, mean attenuation of the abdominal arteries, CNR, SNR, and Noise (S.D) showed statistical significance between the two groups (p value

Objectives The purpose of our study was to evaluate the virtual monochromatic imaging in detecting hypervascular focal liver lesions in the late arterial phase with third-generation dual-source dual-energy computed tomography and to assess its image quality. Materials and Methods In our study, 80 patients were included. Contrast-enhanced images in the late arterial phase (in the dual-energy mode) were acquired and were post-processed in Syngo, via workstation, using Monoenergetic + software. Five sets of images, one polychromatic energy image (corresponding to 120 kVp single-energy image) and four virtual monoenergetic image (VMI) sets at 40, 50, 60, and 70 keV levels, were generated. All these images were analyzed both objectively and subjectively. The attenuation values were measured, and the contrast-to-noise ratio (CNR) of liver and tumor were measured and compared objectively in each dataset. Image noise, image contrast, and diagnostic confidence for liver lesion detection were analyzed subjectively using a five-point scale system. Statistical analysis was performed using Kolmogorov–Smirnov, analysis of variance, and Kruskal–Wallis tests. Results Among the VMI, maximum image noise was observed in the 40 keV image, with a gradual reduction in the image noise being noted with an increase in the VMI energy. The CNR of the hepatic parenchyma and the tumor gradually increased with a reduction in VMI energy from 70 to 40 keV. On subjective analysis, image contrast and image noise were observed to be more in low VMI datasets. In lesion detection, diagnostic confidence with an excellent confidence level was observed with a decrease in VMI energy. Conclusion VMI datasets of 40 to 70 keV from third-generation dual-source DECT provide superior diagnostic accuracy for detecting hypervascular liver lesions. Considering the image noise and lesion detection rate among the VMI datasets, 60 keV VMI is the most helpful dataset for increased liver lesion detection with good image quality.

Objectives The aims of our study were to assess the comparability of conventional unenhanced images (CUIs) of hepatopancreaticobiliary system with virtual unenhanced images (VUIs) derived from arterial and portal venous phases acquired in a third-generation, dual-source, dual-energy CT (DECT), and also to assess the best dataset among these VUIs. We also calculated the radiation effective dose (ED) reduction by eliminating noncontrast acquisition. Materials and Methods 60 patients were included in our study. Unenhanced images in single energy and contrast-enhanced images in dual-energy mode were acquired. Arterial virtual unenhanced (AVU) and portal virtual unenhanced (PVU) images were generated and compared with CUI, using both objective and subjective methods. The ED was calculated separately for each phase. Statistical significance between difference in mean attenuation values were analyzed using ANOVA and unpaired student t-test. Results In our study, the difference in mean attenuation of liver, spleen, and pancreas between the three phases—CU, AVU, and PVU—were insignificant with p-value > 0.05. This indicates that the values were comparable. Among the VUI, AVU images were statistically superior in image quality. Elimination of noncontrast CT from triple phase abdominal imaging can achieve an average ED reduction of 39%. Conclusions We conclude that VUI generated in third-generation, dual-source DECT has diagnostic image quality and can replace the CUI in triple-phase studies, with a mean ED reduction by 39%. The VUI obtained from arterial phase is superior to those obtained from portal venous phase.

Urinoma is defined as the extravasation of urine from any part of the urinary collecting system, which causes lipolysis of the surrounding fat, resulting in an encapsulated collection. The most common cause of urinoma is the direct obstruction of the urinary system. The other etiologies include trauma and postinstrumentation/surgery. Parenchymal cause for spontaneous urinoma is exceedingly rare. We present a case of a 30-year-old gentleman who presented with lower abdominal pain and was treated with a Diclofenac injection. The pain got better temporarily, but he presented again with right loin pain after 3 days. His computed tomography scan images revealed bilateral perinephric urinoma. As there was significant deterioration of renal function, he underwent a renal biopsy. The histopathology was reported as acute interstitial nephritis (AIN). Drug-induced AIN is very rarely presented with acute loin or abdominal pain due to spontaneous perinephric urinoma, as it was seen in our case.

Background Acute necrotizing pancreatitis (ANP) is associated with higher mortality and morbidity. We need a method which is accurate in predicting the prognosis, and when applied early in the disease process, can help in closer monitoring and early initiation of treatment for at-risk patients. Objectives The aim of this prospective study was to assess the extra pancreatic necrosis (EPN) volume in patients with ANP and compare it with outcome variables such as organ failure, death and need for intervention as well as to compare the predictive power of EPN volume with modified CT severity index (CTSI). Materials and Methods The study had 48 patients with clinical diagnosis of acute pancreatitis, who underwent Contrast enhanced CT (CECT) between 3–6 days of onset. In all these patients, EPN volume (in cubic centimetre) and modified CTSI score were calculated and compared with the patient outcome parameters such as duration of hospital/ICU stay, need for percutaneous/surgical intervention, evidence of infection and organ failure. The results were compared with assess the predictive power of EPN volume. Statistical analysis The analysis was done in SPSS version 16.0 for windows. Pearson Correlation was used to assess the significant relationship between selected objective variables. Results EPN volume (>/= to 360 cc) had a statistically significant correlation with outcome parameters as well as in predicting overall organ failure. In our study, Modified CTSI had no significant correlation with the above mentioned factors. Conclusions The volume of EPN calculated between 3rd and 6th day of onset of symptoms showed a significant correlation with the outcome in patients with ANP.