Radiology of pancreatic neoplasms: An update.

Diagnostic imaging is an important tool to evaluate pancreatic neoplasms. We describe the imaging features of pancreatic malignancies and their benign mimics. Accurate detection and staging are essential for ensuring appropriate selection of patients who will benefit from surgery and for preventing unnecessary surgeries in patients with unresectable disease. Ultrasound, multidetector computed tomography with multiplanar reconstruction and magnetic resonance imaging can help to do a correct diagnosis. Radiologists should be aware of the wide variety of anatomic variants and pathologic conditions that may mimic pancreatic neoplasms. The knowledge of the most important characteristic key findings may facilitate the right diagnosis.

Optimising the preoperative planning of deep inferior epigastric perforator flaps for breast reconstruction.

OBJECTIVES: Preoperative planning of deep inferior epigastric perforator (DIEP) flaps has become increasingly important in radiology services as multidetector CT angiography (CTA) has been proven to be the technique of choice. We aim to optimise the process, checking the value of the "Navarra criteria," assessing radiological and surgical concordance. METHODS: Preoperative CTA was obtained in 105 DIEP flaps involving 101 women (mean age 49.1 years). A main perforator pedicle and an alternative were chosen, applying a modification of the "Navarra criteria," assessing the correlation between the main perforator chosen by the radiologist and the one that was ultimately used to perform the flap using the Kappa index. RESULTS: In 100 of the 105 DIEP flaps (95.2%), the perforator pedicles chosen were ultimately used to raise the flap. Four of the perforator pedicles that were not used were dismissed due to avoidable errors in the radiological approach. Concordance was very high, with a Kappa index of 0.93 (95% CI: 0.87-0.99). CT room time was less than 12 minutes, and reading time was 10 minutes. CONCLUSIONS: The application of the "Navarra criteria" in preoperative planning of DIEP flaps improves radiological and surgical concordance as well as the reading process. KEY POINTS: DIEP flap is one of the best techniques for breast reconstruction. Preoperative planning is essential in DIEP flaps. CTA is the best option for the preoperative planning of DIEP flaps. "Navarra criteria" allow radiologists to choose the best perforator to form flaps. Modified "Navarra criteria" improves radiological and surgical concordance.