Systematic approach to the post-Whipple CT: clinical cases and problem-solving strategies.

Pancreaticoduodenectomy, also known as the classic Whipple procedure, is the most common surgical treatment for pancreatic adenocarcinoma. Postoperative complications are common and occur in approximately 50% of patients. Prompt detection and management of these complications is vital for improving patient outcomes.

Proposed new MRI scoring system of rectosigmoid endometriosis to guide operative planning.

Background: Rectosigmoid endometriosis (RSE) presents with a diverse array of MRI findings that impact surgical planning. No standardized reporting and data system has been established for RSE.

Purpose: We propose a novel MRI scoring system designed to predict the likelihood of muscularis propria (MP) involvement in RSE, which would, in turn, influence surgical planning.

MRI directed US for rectosigmoid endometriosis provides added value for preoperative planning.

Endometriosis is a multifocal disease of pelvis affecting mostly reproductive age women. It can involve genital and extra genital organs. The gastrointestinal tract including rectum and sigmoid colon is the most affected extragenital site.

Advancing endometriosis detection in daily practice: a deep learning-enhanced multi-sequence MRI analytical model.

Background And Purpose: Endometriosis affects 5-10% of women of reproductive age. Despite its prevalence, diagnosing endometriosis through imaging remains challenging. Advances in deep learning (DL) are revolutionizing the diagnosis and management of complex medical conditions.

Differentiation between renal cell carcinoma metastases to the pancreas and pancreatic neuroendocrine tumors in patients with renal cell carcinoma on CT or MRI.

Purpose: To determine whether renal cell carcinoma metastases (RCC-Mets) to the pancreas can be differentiated from pancreatic neuroendocrine tumors (PNETs) in patients with RCC on CT or MRI at presentation.

Methods: This retrospective study included patients with biopsy-proven RCC-Mets (n = 102) or PNETs (n = 32) at diagnosis or after nephrectomy for RCC. Inter-observer agreement (Cohen kappa) was assessed in 95 patients with independent reads by two radiologists, with discrepancies resolved by consensus for final analysis.

A practical approach to the post esophagectomy CT: expected postoperative anatomy and anatomical approach to associated complication.

This pictorial review aims to provide a structured approach to the interpretation of post esophagectomy CT by reviewing the major esophagectomy surgeries and conduit reconstructions, along with their associated complications at key anatomical landmarks. This paper combines an image rich experience and evidence-based approach to common and rare complications. The paper begins with an overview of the conventional Ivor Lewis esophagectomy and the expected postoperative imaging appearance (with separate detailed tables on additional surgical reconstructions), followed by a focused review of various complications at specific anatomical sites in a systematic fashion.

Nuclear Imaging in Orthopaedic Practice: A Critical Analysis Review.

» Nuclear imaging techniques, including bone scintigraphy, labeled leukocyte scintigraphy, positron emission tomography (PET), and single-photon emission computed tomography (SPECT) combined with computed tomography (CT), have wide applications in orthopaedics for evaluating trauma, painful total joint arthroplasty, musculoskeletal infection, and orthopaedic oncology.» Three-phase bone scintigraphy is a first-line, highly sensitive nuclear medicine study for evaluating orthopaedic pathology when initial studies are inconclusive. However, its specificity is limited, and findings may be falsely positive for up to 2 years after total joint arthroplasty because of physiologic bone remodeling.

Deciphering ovarian torsion: insights from CT imaging analysis.

Purpose: In the milieu of emergency medicine, pelvic and lower abdominal pain present recurrently, with ovarian torsion posing a formidable diagnostic quandary amid multifarious etiologies. Given the burgeoning reliance on CT in acute care settings, it invariably assumes primacy as the principal imaging modality. This study endeavors to elucidate the CT imaging manifestations encountered by surgically confirmed ovarian torsion patients and utilizing CT to differentiate necrosis.

Paroxysmal nocturnal hemoglobinuria-related thrombosis in the era of novel therapies: a 2043-patient-year analysis.

Thrombophilia is one of the principal features of paroxysmal nocturnal hemoglobinuria (PNH) and constitutes the main cause of disease morbidity/mortality. Anticomplement treatment has revolutionized the natural history of PNH, with control of the hemolytic process and abolition of thrombotic events (TEs). However, no guidelines exist for the management of thromboembolic complications in this setting, with type and duration of anticoagulation depending on individual practices.

Posteromedial Tibial Bone Bruise After Anterior Cruciate Ligament Injury: An MRI Study of Bone Bruise Patterns in 208 Patients.

Background: Bone bruise patterns after anterior cruciate ligament (ACL) rupture may predict the presence of intra-articular pathology and help explain the mechanism of injury. Lateral femoral condyle (LFC) and lateral tibial plateau (LTP) bone bruises are pathognomic to ACL rupture. There is a lack of information regarding medial tibial plateau (MTP) and medial femoral condyle (MFC) bone bruises.

Incidental Adrenal Nodules in Patients Without Known Malignancy: Prevalence of Malignancy and Utility of Washout CT for Characterization-A Multiinstitutional Study.

Washout CT is commonly used to evaluate indeterminate adrenal nodules, although its diagnostic performance is poorly established in true adrenal incidentalomas. The purpose of this study was to compare, in patients without a known malignancy history, the prevalence of malignancy for incidental adrenal nodules with unenhanced attenuation more than 10 HU that do and do not show absolute washout of 60% or more, thereby determining the diagnostic performance of washout CT for differentiating benign from malignant incidental adrenal nodules. This retrospective six-institution study included 299 patients (mean age, 57.

Extra-abdominal desmoid fibromatosis: Cryoablation versus traditional therapies.

Purpose: To retrospectively review the various methods used to treat extra-abdominal desmoid fibromatosis (EDF) at our institution to compare treatment response and complications with those for the emerging option of percutaneous cryoablation therapy.

Methods: A single-center retrospective review was conducted to identify patients with EDF who underwent some form of treatment for EDF in any combination (including medical therapy, surgery, percutaneous ablation and radiation therapy) at our institution between January 2007 and January 2020. Patients with pathological evidence of EDF and pretreatment and posttreatment images were included.

Preoperative and Postoperative Magnetic Resonance Imaging of the Cruciate Ligaments.

The anterior cruciate ligament and posterior cruciate ligament are key stabilizers of the knee. Magnetic resonance (MR) imaging excels at depiction of injury in both the native and reconstructed cruciate ligaments as well as associated injuries. This article reviews the anatomy, injury patterns, and relevant surgical techniques crucial to making accurate interpretation of MR imaging of the cruciate ligaments.

Automated knee cartilage segmentation for heterogeneous clinical MRI using generative adversarial networks with transfer learning.

Background: This study aimed to build a deep learning model to automatically segment heterogeneous clinical MRI scans by optimizing a pre-trained model built from a homogeneous research dataset with transfer learning.

Methods: Conditional generative adversarial networks pretrained on the Osteoarthritis Initiative MR images was transferred to 30 sets of heterogenous MR images collected from clinical routines. Two trained radiologists manually segmented the 30 sets of clinical MR images for model training, validation and test.

Preoperative cryoablation of a hypervascular bone metastasis: A case of effective devascularization before preoperative embolization.

Image-guided cryoablation has become a common approach for the palliative treatment of painful metastatic bone lesions, and indications for this procedure have expanded to include local control of bone metastases. We report a case in which cryoablation was performed on a large hypervascular renal cell carcinoma bone metastasis before surgical fixation of an impending fracture. In this case, cryoablation reduced the patient's pain but also appeared to result in devascularization of the tumor, thus obviating the need for preoperative embolization.

Magnetic resonance imaging of deltoid muscle/tendon tears: a descriptive study.

Objective: To describe the MRI features of deltoid tears and to evaluate tear characteristics in patient groups based on history of trauma and rotator cuff tear (RCT).

Materials And Methods: The records of patients who underwent shoulder MRI at our institution between July 2007 and June 2018 were retrospectively reviewed to identify deltoid tears, and patients were divided into groups based on history of recent trauma and presence of RCT. Images were reviewed to identify the location and size of the deltoid tear; the presence or absence of RCT, muscle atrophy, tendon retraction, humeral head subluxation, soft tissue edema, and additional pathologies were also noted.

Specimen specific imaging and joint mechanical testing data for next generation virtual knees.

Virtual knees, with specimen-specific anatomy and mechanics, require heterogeneous data collected on the same knee. Specimen-specific data such as the specimen geometry, physiological joint kinematics-kinetics and contact mechanics are necessary in the development of virtual knee specimens for clinical and scientific simulations. These data are also required to capture or evaluate the predictive capacity of the model to represent joint and tissue mechanical response.

Radiographic evaluation of knee osteoarthritis in predicting outcomes after arthroscopic partial meniscectomy.

Background: Knee osteoarthritis (OA) severity is a predictor of outcomes after arthroscopic partial meniscectomy (APM). Magnetic resonance imaging (MRI) grading of OA is predictive of postoperative outcomes; this prospective study assessed whether radiographic grading is also predictive of outcomes.

Methods: Patients who underwent APM between February 2015 and January 2016, underwent radiography and MRI ≤6 months before surgery, and had outcomes from the surgery date and one year later were included.

Comparison of Clinical and Semiquantitative Cartilage Grading Systems in Predicting Outcomes After Arthroscopic Partial Meniscectomy.

Cartilage loss on preoperative knee MRI is a predictor of poor outcomes after arthroscopic partial meniscectomy. The purpose of this study was to compare the ability to predict outcomes after arthroscopic partial meniscectomy with a clinically used modified Outerbridge system versus a semiquantitative MRI Osteoarthritis Knee Score system for grading cartilage loss. Patients who underwent preoperative knee MRI within 6 months of arthroscopic partial meniscectomy and who had outcomes available from the time of surgery and 1 year later were eligible for inclusion.

Combined Dual-Energy and Single-Energy Metal Artifact Reduction Techniques Versus Single-Energy Techniques Alone for Lesion Detection Near an Arthroplasty.

The purpose of this study was to compare a combined dual-energy CT (DECT) and single-energy CT (SECT) metal artifact reduction technique with a SECT metal artifact reduction technique for detecting lesions near an arthroplasty in a phantom model. Two CT phantoms with a cobalt chromium sphere attached to a titanium rod, simulating an arthroplasty, within a background of soft-tissue attenuation containing spherical lesions (range, 10-20 mm) around the head and stem of different attenuations from the background (range of attenuation, 10-70 HU) were scanned with a single CT scanner individually (unilateral) and together (bilateral) with the following three dose-equivalent techniques: the currently used clinical protocol (140 kVp, 300 Reference mAs); 100 kVp; and DECT (100 kVp and 150 kVp with a tin filter). Three radiologists reviewed the datasets to identify lesions.

Bioabsorbable Versus Titanium Screws in Anterior Cruciate Ligament Reconstruction Using Hamstring Autograft: A Prospective, Randomized Controlled Trial With 13-Year Follow-up.

Background: Bioabsorbable screws for anterior cruciate ligament reconstruction (ACLR) have been a popular choice, with theoretical advantages in imaging and surgery. Titanium and poly-L-lactic acid with hydroxyapatite (PLLA-HA) screws have been compared, but with less than a decade of follow-up.

Purpose/hypothesis: The purpose was to compare long-term outcomes of hamstring autograft ACLR using either PLLA-HA screws or titanium screws.