Clinical impact of molecular breast imaging as adjunct diagnostic modality in evaluation of indeterminate breast abnormalities and unresolved diagnostic concerns.

PURPOSE: Improvements in molecular breast imaging (MBI) have increased the use of MBI as adjunct diagnostic modality and alternative to MRI. We aimed to assess the value of MBI in patients with equivocal breast lesions on conventional imaging, especially in terms of its ability to rule out malignancy. METHODS: We selected patients who underwent MBI in addition to conventional diagnostics due to equivocal breast lesions between 2012 and 2015. All patients underwent digital mammography, target ultrasound and MBI. MBI was performed using a single-head Dilon 6800 gamma camera after administration of 600 MBq 99m Tc-sestamibi. Imaging was reported according to BI-RADS classification and compared with pathology or follow-up of ≥6 months. RESULTS: Of 226 women included, pathology was obtained in 106 (47%) and (pre)malignant lesions were found in 25 (11%). Median follow-up was 5.4 years (IQR 3.9-7.1). Sensitivity was higher for MBI compared to conventional diagnostics (84% vs. 32%; P = 0.002), identifying malignancy in 21 and 6 patients, respectively, but specificity did not differ (86% vs. 81%; P = 0.161). Positive and negative predictive value were 43% and 98% for MBI and 17% and 91% for conventional diagnostics. MBI was discordant with conventional diagnostics in 68 (30%) patients and correctly changed diagnosis in 46 (20%) patients, identifying 15 malignant lesions. In subgroups with nipple discharge ( N = 42) and BI-RADS 3 lesions ( N = 113) MBI detected 7 of 8 occult malignancies. CONCLUSION: MBI correctly adjusted treatment in 20% of patients with diagnostic concerns after conventional work-up, and could rule out malignancy with a high negative predictive value of 98%.

Treating acute colonic diverticulitis with extraluminal pericolic air: An Acute Care Surgery in the Netherlands (ACCSENT) multicenter retrospective cohort study.

BACKGROUND: Owing to improved quality of computed tomography, a new category of complicated acute diverticulitis, including patients with pericolic air but without abscess formation, can be defined (Hinchey 1a). Recent studies question whether this new category of acute diverticulitis could be treated as uncomplicated cases. The aim of our study is to report on the clinical course of acute diverticulitis Hinchey 1a in current clinical practice. METHODS: For this multicenter retrospective cohort study, patients presenting at the emergency department with Hinchey 1a acute diverticulitis as demonstrated by computed tomography scan, were identified. The primary outcome measure was successful conservative treatment with observation alone, antibiotics, and/or hospital admission. Readmissions, percutaneous drainage of abscesses, and emergency operations were considered as failure. RESULTS: Between October 2016 and October 2018, 1,199 patients were clinically suspected for acute diverticulitis, of whom 101 (8.4%) were radiologically diagnosed to have type 1a acute diverticulitis (average age 57 (±13) years, 45% female) and started with conservative treatment. This was successful in 86 (85%) patients. One of the 15 unsuccessfully treated patients (1%) received percutaneous drainage of an abdominal abscess. Surgery was required in 9 cases (9%) after a median time of 6 days (range, 3 to 69 days). Although a difference in the volume of extraluminal air on computed tomography scan was found, this was not shown to be a risk factor for the clinical course. CONCLUSION: Patients with type 1a acute diverticulitis can be treated successfully by conservative therapy in the majority of cases (85%). More research is required to define predictive factors for successful conservative management.

[Gastrografin as a prognostic and therapeutic medium; use for small bowel obstruction, but not for closed loop obstruction]. / Gastrografin als prognostisch en therapeutisch medium.

Timely recognition and treatment of small bowel obstruction is of great importance for the course of the disease. Complete obstruction of the small bowel can lead to serious complications such as bowel ischaemia and perforation. Gastrografin, which is traditionally used as an oral contrast agent in imaging diagnostics, is of prognostic and therapeutic value in patients presenting with adhesive small bowel obstruction. CT is necessary to rule out closed loop obstruction or other than adhesive causes of the bowel obstruction before using Gastrografin. Patients with closed loop obstruction can rapidly develop bowel ischaemia and immediate surgery is indicated once diagnosed. Awaiting clinical resolution of the small bowel obstruction without surgery is justified when closed loop obstruction has been ruled out, there are no signs of bowel ischaemia and an abdominal radiograph within 4-24 hours after administration of Gastrografin shows the oral contrast in the colon.

[A man who is not able to straighten his knee]. / Een man die zijn knie niet kan strekken na een val.

An 86-year-old man presented at the Emergency Department with pain in his right leg and the inability to extend his knee after a fall. An ultrasound of the leg revealed a quadriceps tendon rupture. Surgical repair was performed and we expect complete recovery.

Thoracic causes of acute abdominal pain.

The origin of abdominal pain may be extra-abdominal, caused by a thoracic illness. This article illustrates the various thoracic disorders that may present with acute abdominal pain. An erroneous focus on the abdomen alone can easily lead to misdiagnosis and incorrect treatment. In cases of unexplained acute abdominal pain, radiologists should be aware of also viewing beyond the borders of the abdomen. The key to most of these thoracic diagnoses is detection of pulmonary consolidation, pleural fluid or pericardial fluid.

Diffuse gallbladder wall thickening: differential diagnosis.

OBJECTIVE: The objective of our study was to review and illustrate the various clinical entities that may cause diffuse thickening of the gallbladder wall on diagnostic imaging studies. CONCLUSION: Diffuse gallbladder wall thickening may be caused by a wide range of gallbladder diseases and extracholecystic pathologic conditions. In most cases its cause can be determined by correlation of the clinical presentation and associated imaging findings.

Interobserver agreement on the radiological criteria of the International Panel on the diagnosis of multiple sclerosis.

We assessed the interobserver agreement on the radiological part of the International Panel (IP) criteria for the diagnosis of multiple sclerosis (MS), comprising the assessment of dissemination in space (DIS) and time (DIT) based exclusively on MRI. Four radiologists trained and four radiologists naive in the application of the IP criteria scored the fulfillment for DIS (i.e., > or =3 periventricular, > or =1 infratentorial, > or =1 juxtacortical, > or = 1 enhancing lesion or a total of > or =9 T2-weighted lesions) and DIT (presence of new or enhancing lesions at follow-up) in baseline and two follow-up scans from 20 patients suspected for having MS. The IP-trained radiologists agreed at least moderately on all assessments (kappa>0.40), whereas the IP-naive radiologists showed fair agreement (kappa<0.40) on five of 16 assessments. In the final conclusion on DIS and DIT, the IP-trained radiologists agreed substantially on both items (kappa=0.62 and kappa=0.60, respectively) compared with a fair agreement on DIS (kappa=0.29) and moderate agreement on DIT (kappa=0.52) among the IP-naive radiologists. Given the poor interobserver agreement among IP-naive observers, the new IP criteria for MS require additional training and should perhaps be simplified.