MRI features of intraductal papillary mucinous neoplasm of the bile ducts, "The myth about the cyst": A systematic review.

Rationale and objectives: Intraductal papillary mucinous neoplasm of the bile ducts (IPMN-B) is a true pre-cancerous lesion, which shares common features with pancreatic IPMN (IPMN-P). While IPMN-P is a well described entity for which guidelines were formulated and revised, IPMN-B is a poorly described entity.We carried out a systematic review to evaluate the existing literature, emphasizing the role of MRI in IPMN-B depiction. Materials and methods: PubMed database was used to identify original studies and case series that reported MR Imaging features of IPMN-B. The search keywords were "IPMN OR intraductal papillary mucinous neoplasm OR IPNB OR intraductal papillary neoplasm of the bile duct AND Biliary OR biliary cancer OR hepatic cystic lesions". Risk of bias and applicability were evaluated using the QUADAS-2 tool. Results: 884 Records were Identified through database searching. 12 studies satisfied the inclusion criteria, resulting in MR features of 288 patients. All the studies were retrospective. Classic features of IPMN-B are under-described. Few studies note worrisome features, concerning for an underlying malignancy. 50 % of the studies had a high risk of bias and concerns regarding applicability. Conclusions: The MRI features of IPMN-B are not well elaborated and need to be further studied. Worrisome features and guidelines regarding reporting the imaging findings should be established and published. Radiologists should be aware of IPMN-B, since malignancy diagnosis in an early stage will yield improved prognosis.

Diffusion-weighted MRI for predicting and assessing treatment response of liver metastases from CRC - A systematic review and meta-analysis.

The evaluation of response to chemotherapy and targeted therapies in colorectal liver metastases has traditionally been based on size changes, as per the RECIST criteria. However, therapy may alter tissue composition and not only tumor size, therefore, functional imaging techniques such as diffusion-weighted magnetic resonance imaging (DWI) may offer a more comprehensive assessment of treatment response. The aim of this systematic review and meta-analysis was to evaluate the use of DWI in the prediction and assessment of response to treatment in colorectal liver metastases and to determine if there is a baseline apparent diffusion coefficient (ADC) cut-off value that can predict a favorable response. A literature search was conducted using the MEDLINE/PubMed database, and risk of bias was evaluated using the QUADAS-2 tool. The mean differences between responders and non-responders were pooled. A total of 16 studies met the inclusion criteria, and various diffusion-derived techniques and coefficients were found to have potential for predicting and assessing treatment response. However, discrepancies were noted between studies. The most consistent predictor of response was a lower baseline ADC value calculated using traditional mono-exponential methods. Non-mono-exponential techniques for calculating DWI-derived parameters were also reported. A meta-analysis of a subset of studies failed to establish a cut-off value of ADC due to heterogeneity, but revealed a pooled mean difference of -0.12 × 10-3 mm2/s between responders and non-responders. The results of this systematic review suggest that diffusion-derived techniques and coefficients may contribute to the evaluation and prediction of treatment response in colorectal liver metastases. Further controlled prospective studies are needed to confirm these findings and to guide clinical and radiological decision-making in the management of patients with CRC liver metastases.

Susac syndrome following COVID-19 vaccination: a case-based review.

COVID-19 vaccine circulation approval was a turning point for the coronavirus pandemic. The current approved COVID-19 vaccines, including messenger ribonucleic acid (mRNA)-based and adenovirus vector-based vaccines, were shown to significantly reduce the disease mortality and severity, and its adverse reactions are mainly mild ones. However, few cases of autoimmune conditions, both flare-ups and new-onset, were described in association with these vaccines. Susac vasculitis (SaS) is a rare autoimmune disease characterized by the clinical triad of encephalopathy, visual disturbances, and sensorineural hearing loss. Its pathogenesis is still not fully understood but is believed to be related to autoimmune processes, including autoantibodies to anti-endothelial cells and cellular immune processes that lead to microvascular damage and, consequently, micro-occlusions of the cerebral, inner ear, and retinal vessels. It has been previously described following vaccination and, most recently, few cases following coronavirus vaccines. We here describe a case of a previously healthy 49-year-old man diagnosed with SaS 5 days following the first dose of the BNT162b2 COVID-19 vaccine.

Assessing the results of anophthalmic prostheses.

Purpose: Anophthalmic sockets cause disfigurement that may result in emotional and social distress. The choice of procedure and implant is based upon the surgeon's experience. There remains no standardization of cosmetic result. We sought to identify quantifiable anatomical features and functional properties related to a successful cosmetic result in patients with ocular prosthesis and to determine correlations between self-reported and third-party assessment of cosmetic success. Methods: This was a prospective observational study, which included 107 adult patients (50.1% female; age 53.08 ± 18.64 years, range 18-89) with acquired anophthalmia following prosthesis fitting. Patients completed a self-assessment questionnaire on self-perception of body image and ocular properties. Three independent examiners assessed cosmetic score. Assessed variables included prosthesis movement, eyelid symmetry, prosthesis stability, and socket fullness. Results: The general cosmetic result was 8.1 ± 2.19 (on a predetermined scale of 1-10) as perceived by the patients and 7.2 ± 0.19 by the examiners. Interexaminer correlation was high for all variables (P < 0.05). A good cosmetic result was correlated with prosthesis movement (P = 0.02), eyelid symmetry (P = 0.001), and prosthesis stability (P = 0.01). Factors that correlated with a good cosmetic result on multivariate analysis were prosthesis movement (odds ratio [OR] 4.95, P = 0.004), eyelid symmetry (OR 4.51, P = 0.006), and socket fullness (OR 3.56, P = 0.005). No correlation was observed between patients' perceptions of the overall cosmetic result and those of the examiners. Conclusion: The cosmetic result of prosthesis use among anophthalmic patients is generally good, as perceived by both patients and examiners. Good eyelid position and symmetry, orbital fullness, and prosthesis motility were associated with a better cosmetic result.

Post hemorrhoidectomy complications: CT imaging findings.

INTRODUCTION: We aimed to describe computed tomography (CT) findings of early complications after interventional hemorrhoid treatments in emergency department (ED) patients. MATERIALS AND METHODS: We identified all ED patients requiring abdominal and/or pelvic CT between February 2012 and February 2019, and included only patients who underwent CT for suspected early (up to 30 days) post hemorrhoidectomy procedure complications. Presenting symptoms, salient CT findings and clinical outcomes were collected. RESULTS: Overall, 48,425 abdominal and/or pelvic CTs were performed. Of these, we identified 12 patients (8 male, 4 female) who underwent CT in our ED following hemorrhoidectomy procedures. At presentation, peri-anal or abdominal pain was the most common symptom. One patient presented with hemodynamic instability. CT findings included proctitis (4/12), rectal perforation (2/12), peri-anal abscess (1/12) and peri-anal fistula (1/12). Two of the patients with proctitis presented with significant submucosal edema. On follow-up, three patients required intensive care hospitalization, and two of those underwent emergent laparotomy. The third patient died due to secondary infection during his hospitalization. CONCLUSION: Hemorrhoidectomy procedures may result in severe complications which should be recognized by ED radiologists. These complications carry a potential risk for significant clinical consequences. Both clinicians and radiologists should be aware of the possibility of such complications when patients present to the ED early after hemorrhoid procedures.