Imaging features of intra-abdominal and intra-pelvic causes of hirsutism.

Hirsutism is a relatively common disorder which affects approximately 5% to 15% of women. It is defined by excessive growth of terminal hair in women, which primarily affects areas dependent on androgens, such as the face, abdomen, buttocks, and thighs. Hirsutism can be caused by a variety of etiologies, which are most often not lifethreatening. However, in some cases, hirsutism can be an indicator of more serious underlying pathology, such as a neoplasm, which may require further elucidation with imaging. Within the abdomen and pelvis, adrenal and ovarian pathologies are the primary consideration. The goal of this manuscript is to review the etiologies and imaging features of various intra-abdominal and intra-pelvic causes of hirsutism.

Immunotherapy Efficacy in Advanced Hepatocellular Carcinoma in a Diverse and Underserved Population in the United States.

Background :   Incidence of hepatocellular cancer (HCC) in the Bronx is 61% higher than the rest of New York State. Underserved populations are not well represented in clinical trials of immune checkpoint inhibitors (ICI). Methods: Demographics were tabulated for 194 patients treated with ICI at the Montefiore-Einstein Comprehensive Cancer Center (MECCC) between 2017 and 2022. Categorical variables were analyzed by Chi-squared test, and survival was analyzed using Kaplan-Meier (KM) curves. Results: MECCC patients were 40.7% Hispanic and 20.6% Black, compared with 3% and 2%, respectively, in the landmark IMbrave 150 study. Median overall survival (mOS) on ICI was 9.0 months, 25.0 months for the 100 (51.5%) favorable-prognosis Child Pugh A (CPA) patients included in HCC clinical trials. Disease control rate (DCR) was 58.5% among 123 evaluable patients per mRECIST 1.1. Baseline liver function, as defined by CP and the Model for End-Stage Liver Disease-Sodium (MELD-Na), correlated with survival (p < 0.001). Hepatitis C Virus (HCV) and alcoholism were over-represented relative to National Cancer Institute (NCI) data (56.2% vs 4.7% and 38.7% vs 8.2%, respectively). HCV treatment correlated with prolonged survival in infected patients (p = 0.0017). AFP decline correlated with response (p = 0.001). Hispanic patients lived longer when clinical variables were controlled for (mOS 52 vs 23 months; p = 0.011). Conclusion: In an underserved HCC population, ICI yielded a DCR of 58.5% and low rates of severe toxicity. This work highlights ICI efficacy in minority groups, a need for earlier HCC diagnosis and for studies of genetic and environmental factors in Hispanics with HCC.

Abdominopelvic CT in COVID-19 patients with abdominal complaints including both waves and controls: reader agreement and overcalls after consensus review.

BACKGROUND: Since many COVID-19 publications lack consensus reviews or controls, interpretive accuracy is unclear; abdominal processes unique or infrequent during the pandemic remain unknown. The incidence and nature of CT findings accounting for abdominal complaints in COVID patients, reader agreement and overcalling will be determined. METHODS: A retrospective study was performed on COVID patients with abdominal complaints from 3/15/2020-5/31/2020 and 11/1/2020-4/15/2021 including matched controls. Reviewers blinded to initial reads interpreted abdominopelvic CT exams, with discordant cases resolved in consensus. Reader agreement was measured by Cohen's Kappa, differences between cohorts by permutation tests and factors affecting false positive/negative rates by Fisher's Exact Test and logistic regression. RESULTS: 116 first wave (average age 65 years [±15.3], 63 [54%] women) and 194 second wave COVID cases (average age 64 years [±16.3], 103 [53%] women) including 116 wave 1 and 194 wave 2 prepandemic controls were included. Concordance was lower among COVID cases than controls (Cohen's Kappa of 0.58 vs. 0.82 [p ≤ 0.001]) and among wave 1 than wave 2 cases (Cohen's Kappa of 0.45 vs. 0.66 [p = 0.052]). With true positives defined as consensus between the initial reader and study reader, false positive rates were higher among COVID cases than controls (OR = 0.42, p = 0.003) and for initial than study reader (OR = 0.36, p ≤ 0.001), but lower in wave 2 than 1 (OR = 0.5, p = 0.028). CONCLUSION: Greater reader disagreement occurred during COVID than prepandemic with no reader bias as both initial and study readers called more false positives among COVID cases than controls. More overcalling occurred during COVID with colitis and cystitis most common.

CT features of acquired cystic kidney disease-associated renal cell carcinoma.

PURPOSE: Acquired cystic kidney disease-associated renal cell carcinoma (ACKD-RCC) is a relatively recently described entity with scarce literature describing its imaging appearance (1, 2). The purpose of this study was to determine typical and potentially unique features of ACKD-RCC on CT scan that could aid lesion identification. MATERIALS AND METHODS: A retrospective review of the CT scans of 24 patients with 29 histologically proven ACKD-RCC lesions was performed. Imaging features were recorded based on consensus readings of two radiologists. RESULTS: Tumors ranged in size from 1.2 to 5 cm. Nineteen lesions were right-sided and 10 left-sided. Nineteen lesions were exophytic. One patient had bilateral lesions and three patients had multiple lesions in the same kidney. All lesions had well-defined margins with 21 round, 7 lobulated and 1 crescentic in shape. On non-enhanced exam 4 lesions were hypodense, 16 iso-dense and 9 hyperdense; 5 had gross calcifications. Twenty two patients had contrast-enhanced CT exams, with 13 lesions demonstrating homogeneous enhancement (solid pattern) and 14 having inhomogeneous enhancement (cystic or mixed solid and cystic pattern). Only 1 patient had metastatic disease. Eight patients had a history of renal transplants. CONCLUSION: ACKD-RCCs are well-defined lesions of variable size that are almost always rounded and most often exophytic. They occasionally have calcifications and are not uncommonly hyperdense on non-enhanced exam. They are most often iso-dense on non-enhanced exam and can be solid, cystic or mixed in attenuation on enhanced exam.

Efficacy of Multi-Detector Computed Tomography for the Diagnosis of Medullary Sponge Kidney.

OBJECTIVE: To expand the diagnostic armamentarium for medullary sponge kidney (MSK), we evaluate the use of high-resolution multidetector computed tomography (MDCT) for MSK diagnosis and compare to the standard intravenous urography (IVU). Despite a significant prevalence amongst stone formers, diagnosis of this well described condition has declined. IVU, the gold standard in MSK diagnosis, has largely been replaced by CT, which has previously been shown unable to demonstrate signs of MSK. METHODS AND MATERIALS: Patients with known history of MSK based on IVU underwent limited MDCT urogram. Control group patients, without MSK, also had MDCT urograms performed for other clinically indicated conditions. Studies were scored by board-certified radiologists on a 0-2 scale based on the likelihood of MSK. IVU studies, when available, were similarly graded. RESULTS: MDCT was diagnostic of MSK in 9 out of the 10 patients with known history of MSK. No false positives were present in our series. The one case of MSK not detected on MDCT was graded as a "1" on its respective IVU. Sensitivity and specificity were 90 and 100%, respectively, when compared with IVU. CONCLUSION: Concordance with IVU findings, despite a small reduction in sensitivity, indicates MDCT to be a suitable, and more readily available replacement for IVU in the diagnosis of MSK.

Comparison of 0.625-mm source computed tomographic images versus 5-mm thick reconstructed images in the evaluation for renal calculi in at-risk patients.

BACKGROUND AND PURPOSE: CT has become a well-established modality in the evaluation of urinary calculi. The advent of multidetector CT (MDCT) scanners and submillimeter thick slice acquisitions has yielded CT images with even greater resolution. MDCT scanners allow for source data slice acquisition with submillimeter slice thickness. These source images can then be reconstructed to thicker slices for more convenient interpretation of the CT scan. Previous authors have looked at the effect of slice thickness on detection of urinary calculi. We investigated whether the thin slice source images yielded detection of additional stones and the potential significance of detecting these additional stones. PATIENTS AND METHODS: Ninety-five consecutive patients who were referred to our outpatient imaging center for CT, with a clinical history placing them at risk for urinary calculi, were included in the study. RESULTS: In 49 (52%) of the 95 patients, more calculi were visualized using the 0.625-mm thick images than with the 5-mm thick images. In 34 (69%) of these 49 patients, the additional findings were thought to be "clinically significant," while in the remaining 15 (31%) patients, the additional findings were not thought to be clinically significant. In 46 (48%) of the 95 patients, there were no additional urinary calculi identified on the 0.625-mm thick images compared with that observed on 5-mm thick images. CONCLUSION: The results from this study encourage reviewing the thin slice source images of MDCTs in patients at risk for urinary calculi, because important clinical decisions may hinge on the additional findings made on these images.

Feasibility of using single-slice MDCT to evaluate visceral abdominal fat in an urban pediatric population.

OBJECTIVE: Obesity is a growing clinical problem, especially among children of low socioeconomic status. Increased visceral abdominal fat is implicated in the metabolic syndrome and its health consequences. The purpose of this study is to validate measurement of a single MDCT slice as a predictor of total visceral abdominal fat and to correlate over a wide range of body mass indexes (BMIs). MATERIALS AND METHODS: A two-phase retrospective analysis was performed. For validation, MDCTs of 21 consecutive healthy children (8-14 years old) were reviewed. In these cases, visceral abdominal fat and subcutaneous abdominal fat area were calculated using a body fat analysis function from single 0.625-mm MDCT slices at the umbilicus and were compared with total visceral abdominal fat area as measured from T11 to the coccyx. Subsequently, visceral abdominal fat area was obtained from single slices at the umbilicus from abdominal MDCT scans of 146 consecutive healthy children (age range, 6-14 years; 80 boys and 66 girls; 77 Hispanic, 41 African American, 15 white, and 13 multiracial or other race) for whom BMI was available. Associations between visceral abdominal fat area and sex, race, and BMI were determined. Effective radiation dose for a 1.25-mm axial MDCT slice was calculated using a mathematic model that uses derived scaling factors for pediatric patients. RESULTS: Visceral abdominal fat area obtained from a 0.625-mm slice at the umbilicus was highly correlated with total visceral abdominal fat area (r = 0.96; p < 0.0001). Visceral abdominal fat area from single slices at the umbilicus was significantly correlated with BMI (r = 0.72; p < 0.0001). Umbilical visceral abdominal fat area was significantly lower in African American children compared with others (median, 14 vs 22 cm(2); p = 0.02) and was not associated with sex. In our population, the effective radiation dose from the smallest obtainable slice was 0.015-0.019 mSv/37-54 kg of patient weight. CONCLUSION: Visceral abdominal fat area calculated from a single abdominal MDCT slice obtained in children is highly correlated with total visceral abdominal fat and with BMI and involves limited radiation exposure.

Incidentally discovered adrenal schwannoma.

Schwannoma is a rare tumor of neural crest cell origin that is rarely seen arising from the adrenal gland. We report a case of an adrenal mass discovered incidentally in a 70-year-old man as part of a hematuria workup. Metabolic evaluation was unremarkable, and imaging studies did not meet strict imaging criteria for a typical adenoma. Following surgical excision and pathologic evaluation with confirmatory immunohistochemical staining, the mass was reported as a benign nerve sheath neoplasm.

Imaging characteristics of minimal fat renal angiomyolipoma with histologic correlations.

OBJECTIVES: To review our experience with minimal fat angiomyolipomas (AMLs) and correlate the confirmed pathologic diagnosis with preoperative radiologic features to evaluate the feasibility of an accurate diagnosis preoperatively. On rare occasions, renal AMLs contain minimal amounts of fat that are not identified on cross-sectional imaging. METHODS: From November 1998 to August 2003, 6 patients (seven lesions) underwent renal surgery with the preoperative diagnosis of renal cell carcinoma as determined by preoperative imaging studies, and the finding of AML was unexpected. A single pathologist and radiologist reviewed all pathologic specimens and radiologic examinations. The characteristic findings were recorded and compared with those in published reports. RESULTS: Pathologic review of the specimens demonstrated microscopic amounts of mature adipocytes, abnormally thickened blood vessels, and smooth muscle cells in all seven lesions. The mean estimated fat content was 4.1% (range 3% to 10%). Hounsfield unit measurement of the lesions on unenhanced computed tomography images revealed all lesions to be hyperdense relative to the normal kidney parenchyma and enhanced by at least 90 Hounsfield units or more with the administration of intravenous contrast. Enhancement was homogenous throughout each of the seven masses. CONCLUSIONS: Minimal fat renal AML tumors are typically hyperdense relative to the normal kidney parenchyma and demonstrate homogenous enhancement with the administration of intravenous contrast on computed tomography. These results may have important implications when planning partial versus radical nephrectomy by open or minimally invasive techniques.

Renal medullary carcinoma: CT and MRI features.

OBJECTIVE: We review the cross-sectional imaging findings of six cases of pathologically proven renal medullary carcinoma in patients with sickle cell trait. MRI findings were available in three of the patients. To our knowledge, only one previous report has addressed MRI features of this rare disease. CONCLUSION: In young patients with sickle cell trait, an infiltrative renal mass with associated retroperitoneal adenopathy and caliectasis are characteristic findings of renal medullary carcinoma on CT and MRI.