Differentiating gallbladder cancer from polyps using non-enhanced magnetic resonance imaging.

Purpose: This retrospective cohort study assessed the efficiency of non-enhanced magnetic resonance imaging (MRI) for differentiating gallbladder cancer (GBC) from gallbladder polyps (GBPs) measuring ≥ 10 mm. Material and methods: Patients diagnosed with GBCs or GBPs ≥ 10 mm and GBC ≤ T2 stage were eligible for inclusion. Two independent blinded readers assessed the continuity of the mucosal and muscular layers (CMML; present or absent) and normalised signal intensity ratio (NIR) on the apparent diffusion coefficient map (NIR-ADC), T1-weighted image (NIR-T1WI), and T2-weighted half-Fourier acquisition single-shot turbo spin-echo image. Univariate and multivariate logistic regression analyses and interobserver agreement analyses were performed to detect predictive variables differentiating GBCs from GBPs. Receiver operating characteristic (ROC) analysis was performed to evaluate diagnostic performance. A reproducibility test was performed to verify the predictive variables. Results: Multivariate analysis showed significant differences in CMML, NIR-ADC, and NIR-T1WI (p < 0.001). The positive predictive value (PPV) and specificity of the absence of CMML were approximately 100%. The CMML showed the best specificity, accuracy, and PPV in the reproducibility study. The sensitivity of CMML alone was approximately 50%, whereas it increased to approximately 70% when combined with NIR-ADC. The diagnostic performance of the combination, including sensitivity, was almost like that of tumour size. The combined tumour size and CMML assessment showed higher diagnostic performance than tumour size alone. Conclusions: The absence of CMML and NIR-ADC ≤ 1.86 helped in differentiating GBCs from GBPs. Evaluation of the absence of CMML and measurement of tumour size could better aid in determining between the two than measurement of tumour size alone.

Evaluation of the Usefulness of Contrast-Enhanced Computed Tomography for the Early Detection of Anastomotic Leakage After Esophagectomy.

OBJECTIVE: Anastomotic leakage is one of the most severe complications after esophagectomy. However, a diagnostic gold standard for anastomotic leakage has not been established yet. This retrospective cohort study aimed to evaluate the potential use of routine postoperative contrast-enhanced computed tomography findings as an early predictor of anastomotic leakage in patients who underwent esophagectomy for esophageal cancer. METHODS: This study included 75 patients who underwent Mckeown esophagectomy, of whom 22 developed anastomotic leakage after surgery. The computed tomography findings for this patient cohort were categorized into 3 grades based on mural enhancement patterns observed at the anastomotic site. Both semiquantitative and quantitative analyses were performed, and the interobserver agreement between the 2 experienced radiologists was assessed. RESULTS: It was found that poor enhancement in both the early and portal venous phases (grade 2) had a robust association with the occurrence of anastomotic leakage. The computed tomography enhancement ratio that is used to estimate wall degeneration and ischemia was significantly higher in patients with anastomotic leakage. CONCLUSIONS: Routine postoperative contrast-enhanced computed tomography could be beneficial for the early detection of anastomotic leakage, even in asymptomatic patients, after esophagectomy.

Efficacy and safety of transcatheter arterial embolization of omental artery aneurysm: A single-center experience.

BACKGROUND: Omental artery aneurysm (OAA) is an extremely rare visceral artery aneurysm. Ruptured OAAs are associated with a high mortality rate. Transcatheter arterial embolization (TAE) has been used to treat OAA in recent years. However, the risk of omental ischemia due to TAE remains unclear. Therefore, this study aimed to investigate the efficacy and safety of TAE of OAA as a first-line treatment. METHODS: Fifteen patients with true aneurysms or pseudoaneurysms who underwent OAA-TAE between 1 April 2010 and 31 December 2022 were included in this study. The technical and clinical outcomes, the incidence of omental infarction after TAE as a major complication, OAA-TAE techniques, radiological findings on computed tomography angiography and angiogram, and patient characteristics were evaluated. RESULTS: Fifteen patients (nine men, six women; age, 69.8 ± 18.59 years) underwent TAE of OAAs (mean aneurysm size of 9.30 ± 6.10 mm) located in the right gastroepiploic (n = 9), left gastroepiploic (n = 1), and epiploic (n = 5) arteries. All patients with ruptured (n = 6) and unruptured (n = 9) OAA successfully underwent TAEs using coils, n-butyl-2-cyanoacrylate, or gelatin sponges. Hepatic artery thrombosis and coil migration were observed during the procedure; however, these adverse events were manageable. Transfusion of red blood cell units (4.66 ± 1.63 units) was required only in cases with ruptured OAAs after TAE. Additional surgery or TAE due to rupture or rerupture of OAA and omental infarction was not required during the postoperative and follow-up periods. CONCLUSION: The OAA-TAE can effectively treat ruptured and unruptured OAAs, and the risk of omental infarction after OAA-TAE may not be high.

Investigating the early diagnosis of pancreatic cancer by surveillance of patients with "K-sign" of the pancreas by computed tomography: A prospective study.

BACKGROUND: We previously conducted a retrospective study investigating pancreatic morphological abnormalities that lead to early diagnosis of pancreatic cancer (PC) using computed tomography (CT). We reviewed 41 of 308 PC patients between 2011 and 2017 who had previously undergone CT to look for morphological changes leading to cancer development. In 24 patients (58.5%), a K-shaped constriction of the pancreas ("K-sign") was observed before the appearance of cancer. This study aimed to investigate whether an early PC diagnosis is possible by prospective CT follow-up of patients with the K-sign. METHODS: We investigated PC development through prospective surveillance of patients exhibiting K-signs identified on CT. RESULTS: Of approximately 87 000 CT scans performed between April 2019 and August 2022, the K-sign was observed in 54 patients. A total of 30 patients provided informed consent and were subsequently monitored using CT. Five patients (16.7%) were diagnosed with PC and underwent surgery after 3-24 months follow-up. Pathologically, four of five patients (80%) were diagnosed with early-stage pancreatic cancer (stage 0-IA). All patients exhibited defects in acinar structure, fibrous tissue, fat replacement, and inflammatory cells, suggesting their potential involvement in PC development. CONCLUSION: The detection and surveillance of the K-sign may be helpful for early PC diagnosis.

Retrospective case-control study examining the relationship between recurrence-free survival and changes in pre- and post-radioiodine therapy serum thyroglobulin levels in patients with differentiated thyroid cancer.

PURPOSE: Thyroglobulin assay is important to assess the residual or recurrence of differentiated thyroid cancer (DTC). Patients with positive serum thyroglobulin levels after radioactive iodine (RAI) adjuvant therapy could achieve long-term recurrence-free survival (RFS). The patient's prognosis could not be confidently estimated based solely on the evaluation of thyroglobulin levels. We investigated the recurrence rate and RFS of patients who received adjuvant RAI therapy after surgery for DTC to clarify the relationship between changes in pre- and post-therapy serum thyroglobulin levels and RFS. MATERIALS AND METHODS: Patients who underwent adjuvant RAI therapy between May 2007 and March 2021 were included in this study, whereas those with positive anti-thyroglobulin antibodies, distant metastases, or gross residual tumors were excluded. The change in pre- and post-treatment serum thyroglobulin levels under thyroid-stimulating hormone stimulation was calculated and classified as follows: group A, thyroglobulin levels decreased by ˃10%; group B, thyroglobulin levels within a range of 10% or less; and group C, thyroglobulin levels increased by ˃10%. RFS outcomes were analyzed using the Kaplan-Meier method. Univariate analysis was performed using the log-rank test, and multivariate analysis was performed using the Cox proportional hazard model. RESULTS: A total of 74 patients were included. Relapse was seen in 13 of 46 patients in group A, 9 of 15 in group B, and 10 of 13 in group C. Median RFS was 129.00 (95% confidence interval CI 77.79-180.21), 113.00 (95% CI 86.83-139.17), and 33 months (95% CI 6.026-59.974) in groups A, B, and C, respectively. Patients in group C exhibited significantly shorter RFS than those in groups A and B (P = 0.001). CONCLUSIONS: Changes in thyroglobulin levels pre- and post-therapy were associated with RFS. Patients with decreased post-therapy thyroglobulin levels had a favorable prognosis, even if their thyroglobulin levels were positive after RAI therapy.

Evaluation of the association between osteoporotic vertebral compression fractures and psoas major/paraspinal muscle mass and ADC measured on MRI.

OBJECTIVE: Evaluate magnetic resonance imaging factors associated with osteoporotic vertebral compression fractures. MATERIALS AND METHODS: We retrospectively reviewed 457 patients' records. Age, sex, and body mass index were recorded. Two blinded readers measured psoas major and paraspinal muscle areas at the L3 vertebral body level on transverse T2-weighted magnetic resonance images and the mean apparent diffusion coefficient values of the non-fractured vertebrae from Th12 to L5. Inter-reader reliability for continuous variables was assessed by intraclass correlation coefficients. RESULTS: We evaluated 210 patients (103 [49.0%] men). The osteoporotic vertebral compression fractures group was older and had lower BMI and smaller psoas major and paraspinal muscle areas than the group without vertebral compression fractures (p < 0.001). The mean apparent diffusion coefficient was weakly correlated with paraspinal muscle area in the osteoporotic vertebral compression fractures group. The intraclass correlation coefficient value was 0.83, and the intraclass correlation coefficients of the psoas major and paraspinal muscles were 0.94 and 0.97, respectively. Multivariate analysis revealed that decreased psoas major and paraspinal muscle areas and increased mean apparent diffusion coefficient values were significantly associated with the presence of osteoporotic vertebral compression fractures (all p < 0.05). Psoas major and paraspinal muscle areas showed relatively high predictive accuracy (57%, 61%). CONCLUSION: Psoas major and paraspinal muscle areas at the L3 level and the mean apparent diffusion coefficient value of non-fractured vertebrae from the Th12 to L5 level were associated with osteoporotic vertebral compression fractures. This may contribute to detecting the potential risk of healthy individuals developing osteoporotic vertebral compression fractures.

Evaluation of the correlation between multiple organ calcification on CT and disease severity in patients with TAFRO syndrome.

PURPOSE: The purpose of this study was to investigate the incidence of multiple organ calcification and the correlation between multiple organ calcification and clinical severity in patients with thrombocytopenia, anasarca, fever, reticulin fibrosis, renal dysfunction, and organomegaly (TAFRO) syndrome. METHODS: We retrospectively identified 13 patients with TAFRO syndrome who were treated at our hospital between February 2019 and March 2021. Computed tomography (CT) images of TAFRO patients, which were acquired at admission and one month after admission, were evaluated. Additionally, clinical and laboratory data related to organ calcification and severity classification of TAFRO syndrome were investigated. The correlation between the presence of organ calcification on CT and TAFRO syndrome-severity classification was evaluated. RESULTS: One month after admission, calcification of the myocardium, adrenal glands, gallbladder wall, pancreas, kidney, skeletal muscle, and skin were observed in 38%, 46%, 15%, 15%, 15%, 23%, and 15% of the thirteen patients, respectively. The occurrence rate of calcifications in the myocardium, adrenal glands, and skeletal muscle was significantly higher in patients with a grade 4 or higher clinical severity than in those with a level up to grade 3 (p = 0.001, p = 0.005, and p = 0.035, respectively). CONCLUSIONS: Our results suggest that the higher the clinical severity in patients with TAFRO syndrome, the higher is the frequency of calcification in the myocardium, adrenal glands, and skeletal muscle; therefore, the assessment of these organ calcifications on CT images may be useful in predicting the severity of TAFRO syndrome.

Optimal threshold score of aortic valve calcification for identification of significant aortic stenosis on non-electrocardiographic-gated computed tomography.

OBJECTIVES: This study evaluated the association between aortic valve calcification (AVC) and aortic stenosis (AS) by scoring the AVC to determine the threshold scores for significant AS on non-electrocardiographic (ECG)-gated computed tomography (CT). METHODS: We retrospectively analyzed the AVC scores of 5385 patients on non-contrast non-ECG-gated CT, who underwent transthoracic echocardiography (TTE) from March 1, 2013, to December 26, 2019, at our institution. Multivariable logistic regression models were used to identify potential risk factors for significant AS. The thresholds for significant AS were computed using receiver operator characteristic (ROC) curves, based on the AVC scores after propensity score matching. RESULTS: A significant association was found between AS and age (p < 0.001; odds ratio [OR], 1.04; 95% confidence interval [CI], 1.02-1.06), female sex (p < 0.001; OR, 4.5; 95% CI, 2.75-7.36), bicuspid aortic valve (p < 0.001; OR, 23.2; 95% CI, 7.35-72.9), and AVC score (AVC score/100) (p < 0.001; OR, 1.82; 95% CI, 1.71-1.95). All sex-specific AVC thresholds for significant AS (moderate and over AS severity, moderate and over AS severity without discordance, discordant severe AS, and concordant severe AS) showed high sensitivity and specificity (AUC, 0.939-0.968; sensitivity, 84.6-96%; specificity, 84.2-97.1%). CONCLUSIONS: We determined the optimal AVC threshold scores for significant AS, which may aid in diagnosing significant asymptomatic AS on incidental detection of AVC through non-ECG-gated CT for non-cardiac indications. KEY POINTS: • Increased frequency of non-electrocardiographic (ECG)-gated computed tomography (CT) for non-cardiac indications has led to the increased incidental identification of aortic valve calcification (AVC). • It is important to identify patients with significant aortic stenosis (AS) who require additional echocardiographic assessment on incidental detection of AVC via non-ECG-gated CT. • We determined the AVC thresholds with high sensitivity and specificity to identify significant AS on non-ECG-gated CT, which could lead to early diagnosis of asymptomatic significant AS and improved prognosis.

Radiomics based on diffusion-weighted imaging for differentiation between focal-type autoimmune pancreatitis and pancreatic carcinoma.

OBJECTIVE: To evaluate the parameters of support vector machine (SVM) using imaging data generated from the apparent diffusion coefficient (ADC) to differentiate between focal-type autoimmune pancreatitis (f-AIP) and pancreatic ductal adenocarcinoma (PDAC) when using SVM based on diffusion-weighted imaging. METHODS: The 2D-ADCmean and texture parameters (16 texture features × [non-filter+17 filters]) were retrospectively segmented by 2 readers in 28 patients with f-AIP and 77 patients with pathologically proven PDAC. The diagnostic accuracy of the SVM model was evaluated by receiver operating characteristic curve analysis and calculation of the area under the curve (AUC). Interreader reliability was assessed by intraclass correlation coefficient (ICC). RESULTS: The 2D-ADCmean and 3D-ADCmean were significantly lower in cases of f-AIP (1.10-1.15 × 10-3 mm2/s and 1.21-1.23× 10-3 mm2/s, respectively) vs PDAC (1.29-1.33 × 10-3 mm2/s and 1.41-1.43 × 10-3 mm2/s, respectively), with excellent and good interreader reliability, respectively (ICC = 0.909 and 0.891, respectively). Among the texture parameters, energy with exponential filtering yielded the highest AUC (Reader 1: 74.7%, Reader 2: 81.5%), with fair interreader reliability (ICC = 0.707). The non-linear SVM, a combination of 2D-ADCmean, object volume and exponential-energy showed an AUC value of 96.2% in the testing cohorts. CONCLUSION: Our results suggest that non-linear SVM using a combination of 2D-ADCmean, object volume, and exponential-energy may assist in differentiating f-AIP from PDAC. ADVANCES IN KNOWLEDGE: The radiomics based on an apparent diffusion coefficient value may assist in differentiating f-AIP from PDAC.

The Utility of Submucosal Linear Enhancement on Dynamic Computed Tomography for Patients With Internal Hemorrhoids.

OBJECTIVE: The purpose of this study was to evaluate the utility of submucosal linear enhancement on dynamic computed tomography (CT) for patients with internal hemorrhoids. METHODS: We retrospectively reviewed patients who were admitted to our institution due to acute lower gastrointestinal bleeding and underwent both dynamic CT and colonoscopy. The presence of submucosal linear enhancement of the intestinal wall from the lower rectum to the anal canal was evaluated using arterial-phase CT images. Based on these images, patients were then classified into 2 groups by 2 blinded radiologists, as follows: group A (absence of submucosal linear enhancement) and group B (presence of submucosal linear enhancement). The relationship between the groups and the risk of bleeding in internal hemorrhoids was evaluated using the size and range of internal hemorrhoids measured during colonoscopy as reference standards. RESULTS: A total of 94 patients were reviewed; of these, 62 patients without submucosal linear enhancement were classified into group A, and 32 patients with submucosal linear enhancement were classified into group B. Group B showed a significantly greater range ( P = 0.017) and size ( P = 0.002) of internal hemorrhoids. The Cohen κ coefficient value for the group classifications between the 2 radiologists was 0.66. CONCLUSIONS: Submucosal linear enhancement on arterial-phase CT images could be a predictive finding suggesting the presence of internal hemorrhoids with a high risk of bleeding.

Clinical significance of chest CT for the exclusion of COVID-19 in pre-admission screening: Is it worthwhile using chest CT with reverse-transcription polymerase chain reaction test?

BACKGROUND: A single reverse-transcription polymerase chain reaction (RT-PCR) test is not sufficient to exclude COVID-19 in hospital pre-admission screening. However, repeated RT-PCR tests are time-consuming. This study investigates the utility of chest computed tomography (CT) for COVID-19 screening in asymptomatic patients. METHODS: Between April 2020 and March 2021, RT-PCR testing and chest CT were performed to screen COVID-19 in 10 823 asymptomatic patients prior to admission. Chest CT findings were retrospectively evaluated using the reporting system of the Radiological Society of North America. Using RT-PCR results as a reference, we assessed the diagnostic efficacy of chest CT during both the low- and high-prevalence periods of the COVID-19 pandemic. RESULTS: Following a positive RT-PCR test, 20 asymptomatic patients (0.18%) were diagnosed with COVID-19; in the low-prevalence period, 5 of 6556 patients (0.076%) were positive; and in the high-prevalence period, 15 of 4267 patients (0.35%) were positive. Of the 20 asymptomatic COVID-19 positive patients, chest CT results were positive for COVID-19 pneumonia in 8 patients. Chest CT results were false-positive in 185 patients (1.7% false-positive rate, and 60% false-negative rate). Pneumonia that was classified as a "typical appearance" of COVID-19 reported as false-positives in 36 of 39 patients (92.3%). Across the study period, the diagnostic efficacy of "typical appearance" on chest CT were characterized by a sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) of 15%, 99.7%, 99.7%, 7.7%, and 99.8%; 20%, 99.6%, 99.6%, 4%, and 99.9%; and 13.3%, 99.7%, 99.7%, 14.3%, and 99.7%, in the entire study, low-, and high-prevalence periods, respectively. CONCLUSIONS: Addition of chest CT to RT-PCR testing provides no benefit to the detection of COVID-19 in asymptomatic patients.

Quantitative Histogram Analysis of T2-Weighted and Diffusion-Weighted Magnetic Resonance Images for Prediction of Malignant Thymic Epithelial Tumors.

PURPOSE: To assess the value of histogram analysis for differentiating a high-risk thymic epithelial tumor (TET) from a low-risk TET using T2-weighted images and the apparent diffusion coefficient (ADC). METHODS: Forty-nine patients with histopathologically proven TET after thymectomy were enrolled in this study and retrospectively classified as having low-risk TET (low-risk thymoma) or high-risk TET (high-risk thymoma or thymic carcinoma). Twelve parameters were obtained from the quantitative histogram analysis. The histogram parameters were compared using the Mann-Whitney U test. Diagnostic efficacy was estimated by receiver-operating characteristic curve analysis. RESULTS: Twenty-five patients were classified as having low-risk TET and 24 as having high-risk TET. The mean ADC value showed diagnostic efficacy for differentiating high-risk TET from low-risk TET, with an area under the curve of 0.7, and was better than when using conventional methods alone. CONCLUSION: The ADC-based histogram analysis could help to differentiate between high-risk and low-risk TETs.

Imaging predictor of ophthalmic involvement in maxillary sinus cancer during super selective intra-arterial cisplatin infusion and concomitant radiotherapy (RADPLAT).

OBJECTIVE: To investigate the predictability of ophthalmic artery involvement in maxillary sinus cancer using preprocedural contrast enhanced CT and MRI. METHODS: We analyzed advanced (T3, T4a, and T4b) primary maxillary sinus squamous cell carcinoma treated with super-selective intra-arterial cisplatin infusion and concomitant radiotherapy (RADPLAT) from Oct 2016 to Mar 2020. Two diagnostic radiologists evaluated the tumor invasion site around the maxillary sinus using preprocedural imaging. These results were compared with the angiographic involvement of the ophthalmic artery using statistical analyses. We also evaluated our RADPLAT quality using complication rate, response to treatment, local progressive free survival (LPFS), and overall survival (OS). RESULTS: Twenty patients were included in this study. There were ten cases of ophthalmic artery tumor stain and there was a correlation between ophthalmic artery involvement and invasion for ethmoid sinus with statistically significant differences. Other imaging findings were not associated with ophthalmic artery involvement. CONCLUSIONS: Ethmoid sinus invasion on preprocedural imaging could suggest ophthalmic artery involvement in maxillary sinus cancer. It may be useful in predicting prognosis and treatment selection.

3D quantitative analysis of diffusion-weighted imaging for predicting the malignant potential of intraductal papillary mucinous neoplasms of the pancreas.

PURPOSE: To investigate the predictors of intraductal papillary mucinous neoplasms of the pancreas (IPMNs) with high-grade dysplasia, using 2-dimensional (2D) analysis and 3-dimensional (3D) volume-of-interest-based apparent diffusion coefficient (ADC) histogram analysis. MATERIAL AND METHODS: The data of 45 patients with histopathologically confirmed IPMNs with high-grade or low-grade dysplasia were retrospectively assessed. The 2D analysis included lesion-to-spinal cord signal intensity ratio (LSR), minimum ADC value (ADCmin), and mean ADC value (ADCmean). The 3D analysis included the overall mean (ADCoverall mean), mean of the bottom 10th percentile (ADCmean0-10), mean of the bottom 10-25th percentile (ADCmean10-25), mean of the bottom 25-50th percentile (ADCmean25-50), skewness (ADCskewness), kurtosis (ADCkurtosis), and entropy (ADCentropy). Diagnostic performance was compared by analysing the area under the receiver operating characteristic curve (AUC). Inter-rater reliability was assessed by blinded evaluation using the intraclass correlation coefficient. RESULTS: There were 16 and 29 IPMNs with high- and low-grade dysplasia, respectively. The LSR, ADCoverall mean, ADCmean0-10, ADCmean10-25, ADCmean25-50, and ADCentropy showed significant between-group differences (AUC = 72-93%; p < 0.05). Inter-rater reliability assessment showed almost perfect agreement for LSR and substantial agreement for ADCoverall mean and ADCentropy. Multivariate logistic regression showed that ADCoverall mean and ADCentropy were significant independent predictors of malignancy (p < 0.05), with diagnostic accuracies of 80% and 73%, respectively. CONCLUSION: ADCoverall mean and ADCentropy from 3D analysis may assist in predicting IPMNs with high-grade dysplasia.

Usefulness of texture analysis for grading pancreatic neuroendocrine tumors on contrast-enhanced computed tomography and apparent diffusion coefficient maps.

PURPOSE: To determine whether texture analysis of contrast-enhanced computed tomography (CECT) and apparent diffusion coefficient (ADC) maps could predict tumor grade (G1 vs G2-3) in patients with pancreatic neuroendocrine tumor (PNET). MATERIALS AND METHODS: Thirty-three PNETs (22 G1 and 11 G2-3) were retrospectively reviewed. Fifty features were individually extracted from the arterial and portal venous phases of CECT and ADC maps by two radiologists. Diagnostic performance was assessed by receiver operating characteristic curves while inter-observer agreement was determined by calculating intraclass correlation coefficients (ICCs). RESULTS: G2-G3 tumors were significantly larger than G1. Seventeen features significantly differed among the two readers on univariate analysis, with ICCs > 0.6; the largest area under the curve (AUC) for features of each CECT phase and ADC map was log-sigma 1.0 joint-energy = 0.855 for the arterial phase, log-sigma 1.5 kurtosis = 0.860 for the portal venous phase, and log-sigma 1.0 correlation = 0.847 for the ADC map. The log-sigma 1.5 kurtosis of the portal venous phase showed the largest AUC in the CECT and ADC map, and its sensitivity, specificity, and accuracy were 95.5%, 72.7%, and 87.9%, respectively. CONCLUSION: Texture analysis may aid in differentiating between G1 and G2-3 PNET.

Relapse-free survival after adjuvant radioactive iodine therapy in patients with differentiated thyroid carcinoma with a microscopically positive tumor margin.

OBJECTIVE: In patients with differentiated thyroid carcinoma (DTC) with a microscopically positive tumor margin, the optimal first dose of I-131 during adjuvant radioactive iodine (RAI) therapy to improve relapse-free survival (RFS) is unclear. Due to the limited number of hospital beds, 1110 MBq of I-131 is administered to such patients in Japan. This study primarily aimed to retrospectively determine the difference in RFS between high-dose (3700 MBq) and low-dose (1110 MBq) adjuvant RAI therapies in DTC patients with a microscopically positive tumor margin. The secondary aim was to investigate the background factors affecting RFS. METHODS: Forty-eight consecutive patients (15 men and 33 women) who underwent total thyroidectomy between April 2007 and December 2017 for DTC without gross residual tumors and distant metastasis, and who were diagnosed with a positive margin histopathologically, followed by RAI therapy, were enrolled. We retrospectively investigated initial I-131 dose, classifying it into high-dose and low-dose groups. The primary endpoint was RFS. Relapse was considered in the following cases: patients with visible recurrent tumor and/or metastasis on neck ultrasound and/or computed tomography, and patients without visible tumor, but with clearly increasing thyroglobulin levels on follow-up every 3-6 months. RFS outcomes were analyzed using the Kaplan-Meier method. Univariate analysis was performed using the log-rank test, and multivariate analysis was undertaken using the Cox proportional hazard model. RESULTS: There were nine cases of recurrence (52.9%) in the low-dose group and seven in the high-dose group (22.5%) during follow-up. The estimated median RFS was 69.4 months in the low-dose group and 120.7 months in the high-dose group. High-dose administration was associated with improved RFS, as demonstrated by Kaplan-Meier survival curves (log-rank test [P = 0.009]). Patient factors associated with worse RFS included low-dose administration (hazard ratio [HR] = 91.9; 95% confidence interval [CI] = 7.66-1102.79); P < 0.001), T4 stage (HR = 1.88; 95% CI = 0.44-8.10; P = 0.015), and presence of central lymph node metastases (HR = 190; 95% CI = 3.80-9496; P = 0.009). The most common type of recurrence was lymph node metastasis. CONCLUSION: Patients with microscopically positive tumor margins could benefit from RAI with high activities.

Differentiating Rheumatoid and Psoriatic Arthritis of the Hand: Multimodality Imaging Characteristics.

Accurate diagnosis and therapeutic intervention at an early stage is paramount for the management of rheumatoid arthritis (RA) and psoriatic arthritis (PsA), which are the two major types of inflammatory arthritis that involve the hand joints. As more disease-specific medications are developed, medication selection according to the correct diagnosis becomes more important. A delay in diagnosis and inappropriate medication selection may result in poor functional prognosis. However, clinical differentiation between RA and PsA can be challenging and may become largely dependent on imaging interpretation results. Although there is substantial overlap in the imaging findings of RA and PsA, there are differences in the affected primary target sites, reflected by the various patterns of joint involvement, and different microanatomic localization of abnormalities within a single joint in each disease. Therefore, appropriate use of various imaging modalities and accurate image interpretation add significant value to the diagnosis and treatment process. The synovio-entheseal complex is an important concept for understanding the imaging features of PsA. The authors review the different features of RA and PsA of the hands seen with various imaging modalities, including radiography, US, MRI, and dual-energy CT, with updates on the contemporary role of imaging in diagnosis and treatment. The radiologist should have sufficient knowledge to interpret imaging findings and understand the strengths and weaknesses of each modality to recommend the appropriate imaging method and differentiate both diseases accurately. ©RSNA, 2020.