Percutaneous creation of new bilioenteric anastomosis in a patient with accidentally failed hepaticojejunostomy.

ABSTRACT: If the cause of the bile leakage after hepaticojejunostomy is accidental non-anastomosis of one bile duct, it is unlikely that the leakage will resolve spontaneously, and reoperation may be necessary. However, if the patient has contraindications to surgery, other treatments should be considered. In this case report, we describe a new percutaneous tract creation between the isolated right bile duct and Roux-en-Y afferent jejunal loop in a patient who underwent hepaticojejunostomy, and the right bile duct was accidentally not anastomosed with the jejunal loop.

Artificial intelligence-based iliofemoral deep venous thrombosis detection using a clinical approach.

Early diagnosis of deep venous thrombosis is essential for reducing complications, such as recurrent pulmonary embolism and venous thromboembolism. There are numerous studies on enhancing efficiency of computer-aided diagnosis, but clinical diagnostic approaches have never been considered. In this study, we evaluated the performance of an artificial intelligence (AI) algorithm in the detection of iliofemoral deep venous thrombosis on computed tomography angiography of the lower extremities to investigate the effectiveness of using the clinical approach during the feature extraction process of the AI algorithm. To investigate the effectiveness of the proposed method, we created synthesized images to consider practical diagnostic procedures and applied them to the convolutional neural network-based RetinaNet model. We compared and analyzed the performances based on the model's backbone and data. The performance of the model was as follows: ResNet50: sensitivity = 0.843 (± 0.037), false positives per image = 0.608 (± 0.139); ResNet152 backbone: sensitivity = 0.839 (± 0.031), false positives per image = 0.503 (± 0.079). The results demonstrated the effectiveness of the suggested method in using computed tomography angiography of the lower extremities, and improving the reporting efficiency of the critical iliofemoral deep venous thrombosis cases.

MRI Findings of Renal Myxoma: A Case Report and Literature Review.

Renal myxomas are very rare benign tumors. To date, a few cases have been reported in English literature, mostly in pathology and urology journals. Thus, there are few reports on the radiological findings associated with renal myxomas. We report on the imaging findings in a case of renal myxoma in a 62-year-old male. MRI demonstrated a well-defined mass in the left renal sinus, with intermediate high signal intensity on T2-weighted images and low signal intensity on T1-weighted images. The tumor showed gradual enhancement on contrast-enhanced T1-weighted images.

Revisiting Kümmell's disease: MRI findings beyond the intraosseous cavity for improved diagnosis.

PURPOSE: The diagnostic tool for Kümmell's disease (KD), including the intravertebral vacuum cavity on imaging, is still limited. The purpose of this study was to find other magnetic resonance imaging (MRI) findings that could help the diagnosis of KD. METHODS: A total of 289 patients (103 males and 186 females with a mean age of 69 ± 15 years) with thoracolumbar compression fracture were included. Medical records were reviewed to note symptom duration. MRIs were analyzed for intraosseous cavities (IOC), prevertebral soft-tissue changes (PreSC), posterior wall fracture (PoF), and posterior ligamentous complex tear (PLCT). KD was diagnosed based on surgical findings or clinical report. MRI findings and symptom duration in the presence or absence of KD were compared with chi-squared test, logistic regression, and Student's t-test and area under the curve (AUC) analyses. RESULTS: KD was diagnosed in 55 cases. IOC was noted in 33 (60%) cases in the KD group and 82 (35%) cases in non-KD group. Definite PreSC was noted in 44 (80%) cases in the KD group and 94 (40%) cases in the non-KD group. PoF was seen in 36 (65%) and 140 (60%) cases, and PLCT was seen in 7 (13%) and 26 (11%) cases in KD and non-KD groups, respectively. The IOC and PreSC MRI findings were significantly correlated with KD (p < 0.001), but not with PoF (p = 0.539) or PLCT (p = 0.814). AUC of combined IOC and PreSC was 0.72, higher than that of IOC alone (0.63) or PreSC alone (0.69) (both p < 0.001). The average duration of symptom was 64 days in the KD group and 14 days in the non-KD group (p < 0.001). Positive IOC and PreSC findings were associated with longer symptom duration (p < 0.001). CONCLUSIONS: Prevertebral soft-tissue changes and intraosseous cavity are associated with KD. Combined findings of prevertebral soft-tissue changes and intraosseous cavity can help the diagnosis of KD.

Percutaneous Internal Drainage in Symptomatic Renal Parapelvic Cyst Refractory to Sclerotherapy: A Case Report.

Percutaneous sclerotherapy is a safe and effective treatment for renal parapelvic cysts. However, if the cyst is in communication with the adjacent renal pelvocalyceal system, sclerotherapy is contraindicated and alternative treatment should be considered. Here, we report a case of a patient with a symptomatic renal parapelvic cyst that was treated using a novel technique involving percutaneous new tract formation between the cyst and renal pelvis.

Imaging Features and Interventional Treatment for Liver Injuries and Their Complications.

Liver injury is a common consequence of blunt abdominopelvic trauma. Contrast-enhanced CT allows for the rapid detection and evaluation of liver injury. The treatment strategy for blunt liver injury has shifted from surgical to nonoperative management, which has been widely complemented by interventional management to treat both liver injury and its complications. In this article, we review the major imaging features of liver injury and the role of interventional management for the treatment of liver injury.

Comparison of CT Volumetry and RECIST to Predict the Treatment Response and Overall Survival in Gastric Cancer Liver Metastases.

Purpose: The aim of this study was to compare the diameter and volume of liver metastases on CT images in relation to overall survival and tumor response in patients with gastric cancer liver metastases (GCLM) treated with chemotherapy. Materials and Methods: We recruited 43 patients with GCLM who underwent chemotherapy as a first-line treatment. We performed a three-dimensional quantification of the metastases for each patient. An independent survival analysis using the Response Evaluation Criteria in Solid Tumors (RECIST) was performed and compared to volumetric measurements. Overall survival was evaluated using Kaplan-Meier analysis and compared using Cox proportional hazard ratios following univariate analyses. Results: When patients were classified as responders or non-responders based on volumetric criteria, the median overall survival was 23.6 months [95% confidence interval (CI), 8.63-38.57] and 7.6 months (95% CI, 3.78-11.42), respectively (p = 0.039). The volumetric analysis and RECIST of the non-progressing and progressing groups showed similar results based on the Kaplan-Meier method (p = 0.006) and the Cox proportional hazard model (p = 0.008). Conclusion: Volumetric assessment of liver metastases could be an alternative predictor of overall survival for patients with GCLM treated with chemotherapy.

Duplication of superficial femoral artery: imaging findings and literature review.

BACKGROUND: Duplication of the superficial femoral artery (SFA) is an extremely rare anatomic variation, with few case studies reported. We report one case of the duplicated SFA, discovered by both ultrasonography (US) and computed tomography angiography (CTA). We also reviewed literatures concerning 6 cases of the duplicated SFA (including our present case), and summarized the clinical and imaging features of the anatomic variation. CASE PRESENTATION: A 55-year-old woman presented to our hospital with an intermittent cramp in the lateral aspect of the right leg. The patient underwent Doppler US examination on bilateral lower extremity arteries and veins to examine potential vascular abnormality. Incidentally, US discovered the duplicated left SFA and CTA of bilateral lower extremities revealed the anatomic orientation, course, length, diameter and distance of the duplicated left SFA. It was revealed to be divided into two trunks with similar luminal diameter and courses parallel. They reunited at distal thigh level. The findings of US and CTA examination did not correspond with the symptom of the patient, and the patient was discharged. CONCLUSION: We report a rare case of the duplicated SFA diagnosed with the combinations of US and CTA examination, which served as valuable imaging methods to detect and diagnose the vascular anatomic variation in lower extremities.