Utility of Prostate Health Index Density for Biopsy Strategy in Biopsy-Naïve Patients With PI-RADS v2.1 Category 3 Lesions.

BACKGROUND: Category 3 lesions in PI-RADSv2.1 pose diagnostic challenges, complicating biopsy decisions. Recent biomarkers like prostate health index (PHI) have shown higher specificity in detecting clinically significant prostate cancer (csPCa) than prostate-specific antigen (PSA). Yet their integration with MRI remains understudied. PURPOSE: To evaluate the utility of PSA and PHI with its derivatives for detecting csPCa in biopsy-naïve patients with category 3 lesion on initial prostate MRI scan. STUDY TYPE: Retrospective. POPULATION: One hundred ninety-three biopsy-naïve patients who underwent MRI, PSA, and PHI testing, followed by both targeted and systematic biopsies. FIELD STRENGTH/SEQUENCE: Turbo spin-echo T2-weighted imaging, diffusion-weighted single-shot echo-planar imaging, and dynamic contrast-enhanced T1-weighted fast field echo sequence imaging in 3 T. ASSESSMENT: PHI density (PHID) and PSA density (PSAD) derived by dividing serum PHI and PSA with prostate volume (MRI based methodology suggested by PI-RADSv2.1). Risk-stratified models to evaluate the utility of markers in triaging patients for biopsy, including low-, intermediate-, and high-risk groups. STATISTICAL TESTS: Independent t-test, Mann-Whitney U test, Mantel-Haenszel test, generalized estimating equation, and receiver operating characteristic (ROC) curve analysis were used. Statistical significance defined as P < 0.05. RESULTS: CsPCa was found in 16.6% (32/193) of patients. PHID had the highest area under the ROC curve (AUROC) of 0.793, followed by PHI of 0.752, PSAD of 0.750, and PSA of 0.654. PHID with two cut-off points (0.88/mL and 1.82/mL) showed the highest potential biopsy avoidance of 47.7% (92/193) with 5% missing csPCa, and the lowest intermediate-risk group (borderline decision group) at 38.9% (75/193), compared to PSA and PHI. DATA CONCLUSION: PHID demonstrated better potential in triaging patients with category 3 lesions, possibly aiding more selective and confident biopsy decisions for csPCa detection, than traditional markers. EVIDENCE LEVEL: 4 TECHNICAL EFFICACY: Stage 5.

Validation of the modified CT criteria for identifying non-adenomas.

PURPOSE: Although adrenal computed tomography (CT) percentage washout is a potentially powerful imaging technique for differentiating adrenal adenomas from non-adenomas, its application to non-adenomas can be problematic. Recently, modified criteria for diagnosing pheochromocytomas using adrenal CT were developed based on data from 199 patients with surgically proven pheochromocytomas and adenomas. However, these criteria have not been thoroughly validated. The purpose of this study was to validate the performance of the modified criteria for diagnosing non-adenomas including pheochromocytomas. METHODS: The conventional and modified criteria were applied to 266 patients from two cohorts who had surgically proven lipid-poor adenomas (155/266, 58.3%) and non-adenomas (111/266, 41.7%) and underwent adrenal CT. Two radiologists calculated the attenuation on each dynamic phase and percentage washout of adrenal masses. The final assessments based on the conventional and modified criteria were categorized into adenomas or non-adenomas. The diagnostic performance of each criterion for diagnosing non-adenomas was evaluated using the area under the receiver operating characteristic curve (AUC). False negatives and positives were also compared. RESULTS: The AUC for the diagnosis of non-adenomas was 0.806 for conventional criteria and 0.858 for modified criteria (p = 0.047). The false-negative rate of conventional criteria for the diagnosis of non-adenomas was 29.7%. Use of modified criteria could have reduced the false-negative rate by to 7.2%. The false-positive rate increased from 9% to 21.3% when using the modified criteria. CONCLUSION: The utilization of modified criteria has the potential to identify additional non-adenomas that would otherwise be misdiagnosed as adenomas using conventional criteria alone.

Computed tomography-based prediction model for identifying patients with high probability of non-muscle-invasive bladder cancer.

PURPOSE: To investigate computed tomography (CT)-based prediction model for identifying patients with high probability of non-muscle-invasive bladder cancer (NMIBC). METHODS: This retrospective study evaluated 147 consecutive patients who underwent contrast-enhanced CT and surgery for bladder cancer. Using corticomedullary-to-portal venous phase images, two independent readers analyzed bladder muscle invasion, tumor stalk, and tumor size, respectively. Three-point scale (i.e., from 0 to 2) was applied for assessing the suspicion degree of muscle invasion or tumor stalk. A multivariate prediction model using the CT parameters for achieving high positive predictive value (PPV) for NMIBC was investigated. The PPVs from raw data or 1000 bootstrap resampling and inter-reader agreement using Gwet's AC1 were analyzed, respectively. RESULTS: Proportion of patients with NMIBC was 81.0% (119/147). The CT criteria of the prediction model were as follows: (a) muscle invasion score < 2; (b) tumor stalk score > 0; and (c) tumor size < 3 cm. From the raw data, PPV of the model for NMIBC was 92.7% (51/55; 95% confidence interval [CI] 82.4-98.0) in reader 1 and 93.3% (42/45; 95% CI 81.7-98.6) in reader 2. From the bootstrap data, PPV was 92.8% (95% CI 85.2-98.3) in reader 1 and 93.4% (95% CI 84.9-99.9) in reader 2. The model's AC1 was 0.753 (95% CI 0.647-0.859). CONCLUSION: The current CT-derived prediction model demonstrated high PPV for identifying patients with NMIBC. Depending on CT findings, approximately 30% of patients with bladder cancer may have a low need for additional MRI for interpreting vesical imaging-reporting and data system.

Role of computed tomography in predicting adrenal adenomas with cortisol hypersecretion.

OBJECTIVES: To investigate performance of adrenal CT-derived multivariate prediction models in differentiating adenomas with cortisol hypersecretion from the other subtypes. METHODS: This retrospective study included 127 patients who underwent adrenal CT and had a surgically proven adrenal adenoma. Adenoma subtypes were defined according to biochemical test results: Group A, overt cortisol hypersecretion; Group B, mild cortisol hypersecretion; Group C, aldosterone hypersecretion; and Group D, non-function. Two independent readers analyzed size, attenuation, and washout properties of adenomas, and performed quantitative and qualitative analyses for assessing contralateral adrenal atrophy. Actual and internally validated areas under the curves (AUCs) of adrenal CT-derived multivariate prediction models for differentiating adenomas with cortisol hypersecretion from the other subtypes were assessed. RESULTS: In differentiating Group A from the other groups, the actual and internally validated AUCs of the prediction model were 0.856 (95% confidence interval [CI]: 0.786, 0.926) and 0.847 (95% CI: 0.695, 0.999) for Reader 1, respectively, and 0.901 (95% CI: 0.845, 0.956) and 0.897 (95% CI: 0.783, 1.000) for Reader 2, respectively. In differentiating Group B from groups C and D, the actual and internally validated AUCs of the prediction model were 0.777 (95% CI: 0.687, 0.866) and 0.760 (95% CI: 0.552, 0.969) for Reader 1, respectively, and 0.783 (95% CI: 0.690, 0.875) and 0.765 (95% CI: 0.553, 0.977) for Reader 2, respectively. CONCLUSION: Adrenal CT may be useful in differentiating adenomas with cortisol hypersecretion from the other subtypes. ADVANCES IN KNOWLEDGE: Adrenal CT may benefit in adrenal adenoma subtyping.

Prostate imaging-reporting and data system version 2 has improved biopsy tumor grade accuracy: a single, tertiary institutional experience.

PURPOSE: To investigate change in prostate biopsy accuracy regarding tumor grade before and after the release of Prostate Imaging-Reporting and Data System version 2 (PI-RADSv2) in a single tertiary institution. METHODS: We retrospectively evaluated 1191 patients with biopsy-proven prostate cancer (PCa) who had undergone prostate magnetic resonance imaging (MRI) and surgery before (2013 cohort, n = 394) and 5 years after PI-RADSv2 release (2020 cohort, n = 797). The highest tumor grade of each biopsy and surgical specimen was recorded, respectively. We compared concordant, underestimated, and overestimated biopsy rates regarding tumor grade to surgery between two cohorts, respectively. For patients who underwent both prostate MRI and biopsy at our institution, we investigated proportion of pre-biopsy MRI, age, and prostate-specific antigen of patients, and performed logistic regression to analyze which parameters are associated with concordant biopsy. RESULTS: Concordant and underestimated biopsy rates were significantly different between two cohorts: Concordance and underestimation rates were 47.2% and 46.3% in 2013 and 54.5% and 36.4% in 2020 (p = .019; p = .003), respectively. Overestimated biopsy rates were similar (p = .993). Proportion of pre-biopsy MRI was significantly higher in 2020 than in 2013 (80.9% versus 4.9%; p < .001), and was independently associated with concordant biopsy results in multivariate analysis (odds ratio = 1.486; 95% confidence interval, 1.057-2.089; p = .022). CONCLUSIONS: There was a significant change in proportion of pre-biopsy MRI before and after the release of PI-RADSv2 in patients who underwent surgery for PCa. This change appears to have improved biopsy accuracy regarding tumor grade by reducing underestimation.

Diagnostic performance of a novel ultrasound-based quantitative method to assess liver steatosis in histologically identified nonalcoholic fatty liver disease.

AIMS: To investigate the diagnostic performance of ultrasound-guided attenuation parameter (UGAP) for the detection of hepatic steatosis in nonalcoholic fatty liver disease (NAFLD) cohorts using histopathology as the reference standard andcomparing it with that of various imaging modalities. MATERIALS AND METHODS: A total of 87 subjects who underwent UGAP, controlled attenuation parameter (CAP), and magnetic resonance imaging-based proton density fat fraction (MRI-PDFF) between December, 2020 and January, 2022 were enrolled. Of these patients, 38 patients had NAFLD. The association between UGAP and clinical and imaging parameters was assessed using Pearson's or Spearman's correlations. The area under the receiver operating characteristic curve (AUROC) was used to evaluate the diagnostic performance. RESULTS: The UGAP and MRI-logPDFF demonstrated strong positive correlations (correlation coefficient= 0.704, P <0.0001). UGAP showed excellent diagnostic performance for distinguishing steatosis grade ≥1 with an AUROC of 0.821 (95% confidence interval [CI], 0.729-0.913), which was comparable to that of MRI-PDFF (0.829, 95%CI, 0.723-0.936). The AUROCs of BUSG (B-mode ultrasonography) (0.766, 95% CI, 0.767-0.856) and CAP (0.788, 95% CI, 0.684-0.891) were slightly lower than those of UGAP. The AUROCs of UGAP, MRI-PDFF, CAP, and BUSG for detecting steatosis grade ≥2 were 0.796 (95% CI, 0.616-0.975), 0.971 (95% CI, 0.936-1.000), 0.726 (95% CI, 0.561-0.891) and 0.774 (95% CI, 0.612-0.936), respectively. CONCLUSION: UGAP may be a valuable potential screening tool as a first-line assessment of liver steatosis in patients with NAFLD.

Inter-method agreement between wash-in and wash-out computed tomography for characterizing hyperattenuating adrenal lesions as adenomas or non-adenomas.

OBJECTIVES: To investigate inter-method agreement between wash-out and wash-in computed tomography (CT) to determine whether hyperattenuating adrenal lesions are characterized as adenomas or non-adenomas. METHODS: We evaluated 243 patients who underwent wash-out CT for a solid enhancing hyperattenuating (i.e., > 10 Hounsfield unit [HU]) adrenal mass of ≥ 1 to < 4 cm. Wash-out (absolute percentage wash-out [APW]; relative percentage wash-out [RPW]) and wash-in values (enhancement ratio [ER]; relative enhancement ratio [RER]) were analyzed by two independent readers. Diagnostic criteria of wash-out CT for adenoma were APW ≥ 60% or RPW ≥ 40% (conventional method). Three different criteria for wash-in CT were set: ER ≥ 3.0; RER ≥ 200%; and RER ≥ 210%. Concordance rate and inter-method agreement between wash-out and wash-in CT were investigated using Gwet's AC1. RESULTS: For all lesions, concordance rates between wash-out and wash-in CT were > 83%. AC1 between conventional method and ER ≥ 3.0 or between conventional method and RER ≥ 200% were identically 0.843 for reader 1 and 0.776 for reader 2. AC1 between conventional method and RER ≥ 210% were 0.780 for reader 1 and 0.737 for reader 2. For lesions of > 10 to ≤ 30 HU, concordance rates between wash-out and wash-in CT were > 89%. AC1 between conventional method and ER ≥ 3.0 or between conventional method and RER ≥ 200% were identically 0.914 for reader 1 and 0.866 for reader 2. AC1 between conventional method and RER ≥ 210% were 0.888 for reader 1 and 0.874 for reader 2. CONCLUSION: In approximately 90% of patients with a hyperattenuating adrenal lesion of ≥ 1 to < 4 cm and >10 to ≤ 30 HU, wash-out CT with 15-min contrast-enhanced images may be replaced by wash-in CT. KEY POINTS: • An enhancement ratio of ≥ 3.0 or a relative enhancement ratio of ≥ 200% appears to be appropriate as the threshold of wash-in computed tomography (CT) comprising unenhanced and 1-min contrast-enhanced CT. • Measurement of enhancement ratio or relative enhancement ratio was reproducible. • We found good agreement between wash-in and wash-out CT for determining whether hyperattenuating adrenal lesions of ≥ 1 to < 4 cm and >10 to ≤ 30 Hounsfield unit would be characterized as adenomas.

Oral effervescent agent improving magnetic resonance cholangiopancreatography.

Background: The purpose of our study was to validate the oral effervescent agent improving magnetic resonance cholangiopancreatography (MRCP) in patients with suspicious pancreatobiliary disease. Methods: One hundred and eleven consecutive patients with alleged or suspected pancreatobiliary tree problems who had undergone two-dimensional (2D) MRCP imaging both before and after oral effervescent enhancement (conventional-MRCP and enhanced-MRCP) were included. Two radiologists independently scored overall image quality, visualization of ten ductal segments, and gastroduodenal fluid signal intensity score. In consensus, they assessed the presence of gastroduodenal fluids and pancreatobiliary tree overlapping. The data were analyzed using Wilcoxon's signed-rank test, McNemar test, and paired t-test. Results: The grades of overall image quality and individual biliary duct visualization for ten targeted ductal segments, and gastroduodenal fluid signal intensity scores increased significantly on enhanced-MRCP by both readers (P≤0.02), but there was no significant increase for pancreatic duct (PD) at head and tail. On enhanced-MRCP, gastroduodenal fluids except for gastric fundus were less detected rather than those on conventional-MRCP. Anatomic structures of gastroduodenal fluids overlapping extrahepatic bile duct were mainly gastric antrum, duodenal bulb, and 2nd portion on conventional-MRCP. However, these fluids were less overlapped on enhanced-MRCP (P<0.001). Gastric body and antrum were main anatomic structures of gastroduodenal fluids overlapping PD on conventional-MRCP, and fluid in these locations significantly less overlapped PD on enhanced-MRCP (P≤0.02). Conclusions: Oral administration of effervescent agent provided effective elimination of gastroduodenal fluid overlapping pancreatobiliary ductal system at MRCP and can improve the quality of the examination in the patients with known or suspected pancreatobiliary disease.

A Retrospective Study of First-Line Therapy Involving Immune Checkpoint Inhibitors in Patients With Poor Risk Metastatic Renal Cell Carcinoma.

Purpose: Patients with International Metastatic RCC Database Consortium (IMDC) poor risk metastatic renal cell carcinoma (mRCC) rarely respond to first-line tyrosine kinase inhibitors (TKIs) including sunitinib, and carries a very poor prognosis. In recent years, combination therapy involving immune checkpoint inhibitors (ICIs) have demonstrated superior efficacy to sunitinib in poor risk disease. Materials and Methods: In a retrospective study using a cancer chemotherapy registry, 206 consecutive patients with mRCC in the first-line setting were identified between Oct 2019 and Dec 2020. Sixty-one patients had a poor risk mRCC, and were treated with TKI monotherapy (n=36), nivolumab plus ipilimumab (n=16), or pembrolizumab plus axitinib (n=9). Endpoints included overall survival (OS), progression-free survival (PFS), response rate (RR), and safety. Results: Patients' median age was 61 years and the median number of risk factors was 3 (range, 3-5). During a median 23.0 months of follow-up, the median OS was 24.3 months with ICI-based combinations and 14.8 months with TKI monotherapy, and the median PFS periods were 9.3 months and 3.4 months, respectively. An objective response occurred in 60% of the patients receiving ICI-based combinations and in 19% of those receiving TKI monotherapy (P=0.001). In the multivariate regression model, number of IMDC risk factors and the ICI-based combination therapy were independent prognostic factors for PFS. All-causality grade 3 or 4 adverse events were 44% for ICI-based combinations and 50% for TKI monotherapy. Conclusions: Among patients with poor risk mRCC, first-line ICI-based therapy showed significantly longer OS and PFS, as well as a higher RR, than TKI monotherapy.

Ovarian Masses in Patients With Breast Cancer.

PURPOSE: The aim of the study was to investigate the characteristic findings of computed tomography (CT) or magnetic resonance imaging (MRI) to discriminate metastasis from primary ovarian tumors in patients with a history of breast cancer. METHODS: This retrospective study enrolled consecutive 72 patients with a history of breast cancer who underwent surgical confirmation of an ovarian mass detected on CT or MRI (primary ovarian tumors, n = 66; metastases, n = 6). Two independent readers analyzed the grade of solid portions of the ovarian mass using a 5-point scale on CT or MRI. A predominantly cystic mass was defined as a solid grade of 1 to 2. Cancer antigen 125 (CA 125) and the initial stage of breast cancer were also investigated. RESULTS: The proportions of predominantly cystic masses were significantly different between metastases (0% for both readers) and primary ovarian tumors (59% for reader 1 and 53% for reader 2, P < 0.05). For masses of solid portion grades 3 to 5, CA 125 was significantly higher for malignant epithelial tumors than for the other tumors ( P < 0.001), and the initial stage of breast cancer was significantly higher for metastases than for the other tumors ( P < 0.001), respectively. CONCLUSIONS: In patients with a history of breast cancer, predominantly cystic masses detected on CT or MRI seem to be primary ovarian tumors. For the other masses, knowledge of CA 125 and initial breast cancer stage may help in the differential diagnosis.

Clinical significance of a 10-mm cutoff size for adrenal lesions: a retrospective study with 547 non-oncologic patients undergoing adrenal computed tomography.

PURPOSE: To investigate the proportion of clinically significant adrenal lesions in patients with a subcentimeter adrenal lesion, and the sensitivity of a cutoff size of 10 mm on computed tomography (CT). METHODS: This retrospective study included consecutive 547 non-oncologic patients who underwent adrenal CT. Clinically significant adrenal lesions were defined as those that were biochemically abnormal (n = 99) or surgically resected according to the clinician's decision (n = 23). Long-axis diameters (LDs) and short-axis diameters (SDs) of the lesions were measured on CT by two independent readers. Likelihood of the focal lesion was analyzed using a five-point scale (1 = very low; 5 = very high). 66 Sensitivities for clinically significant lesions were analyzed according to cutoff size. Proportions of the clinically significant lesions for subcentimeter lesions were analyzed according to the visual score. RESULTS: Sensitivities for clinically significant lesions for cutoffs of 10, 15, and 20 mm were 93%, 79%, and 63% for LD and 85%, 61%, and 49% for SD for Reader 1 and 89%, 78%, and 65% for LD and 80%, 65%, and 48% for SD for Reader 2, respectively (p < 0.001 for 10 mm versus the other cutoffs). In subcentimeter lesions with visual scores of 1-3, the proportions of clinically significant lesions were 5.4% for LD or SD for Reader 1 and 6.6% for LD and 7.7% for SD for Reader 2, respectively. CONCLUSION: A lesion LD of ≥ 10 mm was a reasonable cutoff for determining adrenal abnormality. Subcentimeter lesions without visually high suspicion had a low risk of clinical significant lesions in our study cohort. Higher cutoffs significantly decreased sensitivity.

Radiofrequency ablation of subcapsular lesions with internally cooled perfusion electrode: ex vivo study.

PURPOSE: To compare the ex vivo efficiency of an internally cooled perfusion (ICP) electrode and an internally cooled (IC) electrode for radiofrequency ablation (RFA) of subscapular lesions. MATERIAL AND METHODS: Using 200 W generator and ICP electrode (group A, n = 10) or 15 gauge or 17 gauge IC electrode (group B, n = 10 and group C, n = 10), RFA was applied to the bovine liver for 12 min. Each electrode was inserted at a 3 cm depth into the liver block, and the proximal end of the active exposure portion of each electrode was located at a capsule of the liver block. During RFA, normal saline was pumped through the side hole of the ICP electrode into the tissue at an injection rate of 0.5 mL/min. RESULTS: The ICP electrode achieved larger capsular ablative area and ablative volume than the IC electrode: 7.29 ± 1.59 cm2 and 44.56 ± 10.08 cm3 in group A; 4.36 ± 1.29cm2 and 30.15 ± 5.97 cm3 in group B; and 3.57 ± 0.99cm2 and 24.52 ± 4.21 cm3 in group C (p < .05), respectively. Mean impedance of ICP RFA was lower than IC RFA: 41.5 ± 3.75Ω in group A; 52.4 ± 5.64Ω in group B; and 58.1 ± 10.98Ω in group C (p < .05). CONCLUSION: RFA using the ICP electrode more efficiently created a larger capsular ablative area and ablative volume of ablation than IC RFA for subcapsular lesions. The results were obtained in an ex vivo liver model without tumor simulation inside.

Determining the Target Population That Would Most Benefit from Screening for Hepatic Fibrosis in a Primary Care Setting.

Due to its high prevalence, screening for hepatic fibrosis in the low-risk population is called for action in the primary care clinic. However, current guidelines provide conflicting recommendations on populations to be screened. We aimed to identify the target populations that would most benefit from screening for hepatic fibrosis in clinical practice. This study examined 1288 subjects who underwent magnetic resonance elastography. The diagnostic performance of the Fibrosis-4 (FIB-4) index and NAFLD fibrosis score was compared in the following groups: (1) ultrasonography (USG)-diagnosed NAFLD, (2) elevated liver enzyme, (3) metabolic syndrome, (4) impaired fasting glucose, and (5) type 2 diabetes regardless of fatty liver. Decision curve analysis was performed to express the net benefit of groups over a range of probability thresholds (Pts). The diabetes group showed a better area under the receiver operating characteristic curve (AUROC: 0.69) compared with subjects in the USG-diagnosed NAFLD (AUROC: 0.57) and elevated liver enzyme (AUROC: 0.55) groups based on the FIB-4 index. In decision curve analysis, the diabetes group showed the highest net benefit for the detection of significant fibrosis across a wide range of Pts. Patients with diabetes, even in the absence of fatty liver, would be preferable for hepatic fibrosis screening in low-risk populations.

Superselective vesical artery embolization for intractable bladder hemorrhage related to pelvic malignancy.

BACKGROUND: Intractable bladder hemorrhage from pelvic malignancy can be potentially life-threatening and its management can be a challenging clinical problem. PURPOSE: To evaluate safety, efficacy, and clinical outcome of superselective vesical artery embolization for the control of intractable bladder hemorrhage from pelvic malignancy. MATERIAL AND METHODS: Between January 2010 and September 2018, 20 patients underwent superselective vesical artery embolization for intractable hematuria secondary to pelvic malignancy arising from or invading the bladder. Treatment details and clinical outcomes were obtained. RESULTS: There were 12 men and 8 women (mean age = 77 years). Bilateral embolization was performed in 10 patients and unilateral approach in 10 patients. Two patients died within four days after embolization due to underlying heart failure and systemic metastasis, respectively. The remaining 18 patients had a follow-up of >30 days. Bleeding was controlled after the first embolization in 17/18 patients and after a repeat embolization in the remaining one patient. The mean follow-up period of 18 patients was 10.6 months (range = 1-77 months). Late recurrent hemorrhage (≥ 30 days after embolization) was reported in 6 (33.3%) patients. Five of these six patients underwent repeat embolization. There were no major complications related to embolization. CONCLUSION: Palliative superselective vesical artery embolization is a feasible, effective, and safe procedure to control intractable hematuria in patients with pelvic malignancy.

Impacts on outcomes and management of preoperative magnetic resonance cholangiopancreatography in patients scheduled for laparoscopic cholecystectomy: for whom it should be considered?

PURPOSE: We evaluated the impact of preoperative magnetic resonance cholangiopancreatography (MRCP) on patient outcomes, and found which patients should be considered for MRCP before cholecystectomy. METHODS: We performed retrospective analysis of 2,072 patients that underwent cholecystectomy for benign gallbladder disease from January 2014 to June 2017. Patients were grouped as CT only group (n = 737) and MRCP group (n = 1,335), including both CT and MRCP (n = 1,292) or MRCP only (n = 43). The main outcome measure was associated with complications after cholecystectomy, and the secondary outcomes were hospital stay, readmission, and events that could impact patient management due to addition of MRCP. RESULTS: There were no statistical differences in occurrence of intraoperative or postoperative complications or readmission rate between the 2 groups. Hospital stay was about 0.6 days longer in the MRCP group. However, MRCP group was more susceptible to complications due to underlying patient demographics (older age, higher frequency of diabetes, and higher level of the inflammatory markers). MRCP diagnosed common bile duct (CBD) stones in 6.5% of patients (84/1,292) without CBD stones in CT, and bile duct anomalies were identified in 41 patients (3.2%). Elevated γ-GT was the only independent factor for additional detection of CBD stones (adjusted odds ratio [OR], 2.89; P = 0.029) and subsequent biliary procedures (adjusted OR, 3.34; P = 0.018) when additional MRCP was performed. CONCLUSION: MRCP is valuable for identification of bile duct variation and CBD stones. Preoperative MRCP can be considered, particularly in patients with elevated γ-GT, for proper preoperative management and avoidance of complications.

Comparative Assessment and External Validation of Hepatic Steatosis Formulae in a Community-Based Setting.

Several hepatic steatosis formulae have been validated in various cohorts using ultrasonography. However, none of these studies has been validated in a community-based setting using the gold standard method. Thus, the aim of this study was to externally validate hepatic steatosis formulae in community-based settings using magnetic resonance imaging (MRI). A total of 1301 community-based health checkup subjects who underwent liver fat quantification with MRI were enrolled in this study. Diagnostic performance was assessed using the area under the receiver operating characteristic curve (AUROC). Non-alcoholic fatty liver disease (NAFLD) liver fat score showed the highest diagnostic performance with an AUROC of 0.72, followed by Framingham steatosis index (0.70), hepatic steatosis index (HSI, 0.69), ZJU index (0.69), and fatty liver index (FLI, 0.68). There were considerable gray zones in three fatty liver prediction models using two cutoffs (FLI, 28.9%; HSI, 48.9%; and ZJU index, 53.6%). The diagnostic performance of NAFLD liver fat score for detecting steatosis was comparable to that of ultrasonography. The diagnostic agreement was 72.7% between NAFLD liver fat score and 70.9% between ultrasound and MRI. In conclusion, the NAFLD liver fat score showed the best diagnostic performance for detecting hepatic steatosis. Its diagnostic performance was comparable to that of ultrasonography in a community-based setting.

Prevalence of significant hepatic fibrosis using magnetic resonance elastography in a health check-up clinic population.

BACKGROUND: Significant hepatic fibrosis is associated with higher mortality. However, data on the estimated prevalence of liver fibrosis in the general population are scarce. AIM: To use magnetic resonance elastography (MRE) to investigate the prevalence of hepatic fibrosis in a Korean health check-up clinic cohort. METHODS: We enrolled 2170 participants at our health check-up clinic between January 2015 and May 2018, all of whom had MR with chemical shift technique and MRE. The primary objective was to estimate the prevalence of liver fibrosis. For generalisation, sex- and age-standardised prevalence was calculated based on the Korean Statistical Information Service (KOSIS) during the period 2015-2018. RESULTS: The prevalence of F2 (≥3.0 kPa) and F3 (≥3.6 kPa) in the overall cohort was 5.1% and 1.3% respectively (sex- and age-adjusted prevalence of 3.8% and 1.3%). Non-alcoholic fatty liver disease (NAFLD) prevalence (>5% fat fraction) was 27.7% in the average risk population (after excluding alcohol use and viral hepatitis), and the prevalence of significant and advanced fibrosis in NAFLD participants was 8.0% and 1.5% respectively. In participants with diabetes, 12.5% had ≥F2 and 4.3% ≥F3. In participants with NAFLD plus diabetes, 24.1% had ≥F2 and 6.0% ≥F3. On multivariate analysis, only age, insulin, diabetes and fatty liver on MR were independently associated with significant fibrosis. CONCLUSIONS: In a Korean health check-up clinic setting, the prevalence of significant and advanced liver fibrosis was 5.1% and 1.3% (sex- and age-adjusted prevalence of 3.8% and 1.3%). The prevalence of advanced liver fibrosis was five times higher for diabetic participants with NAFLD.

[Malignant Pancreatic Serous Cystic Neoplasm: A Case of Local Recurrence and Liver Metastasis that Occurred During Follow-Up]. / 췌장의 ì• ì„± 장액성 낭성 ì¢ ì–‘: ì¶”ì  관찰 중 국소 재발과 함께 간 ì „ì´ë¥¼ 보인 증례 ë³´ê³ .

Serous cystic neoplasms of the pancreas are usually benign, with a low malignant potential. Herein, we report a case of malignant serous cystic neoplasm of the pancreas treated with subtotal pancreatectomy, which progressed to local recurrence and metachronous hepatic metastasis during the regular follow-up period.

[Ischemic Colitis due to Fibromuscular Dysplasia Limited to the Inferior Mesenteric Artery: A Case Report]. / 하장간막동맥을 ë‹¨ë ìœ¼ë¡œ 침범한 ì„¬ìœ ê·¼í˜•ì„±ì´ìƒìœ¼ë¡œì¸í•œ 허혈성 대장염: 증례 ë³´ê³ .

Fibromuscular dysplasia is a nonatheromatous, noninflammatory arterial disorder that results in stenosis and/or aneurysm formation and rarely involves the mesenteric arteries. Herein, we report a case of fibromuscular dysplasia limited to the inferior mesenteric artery, which manifested with arterial aneurysms and ischemic colitis.