The diagnostic value of abbreviated MRI protocol in the surveillance of Branch-Duct intraductal papillary mucinous neoplasm.

PURPOSE: To assess the diagnostic value of abbreviated protocol (AP) MRI to detect the degeneration signs in branch-duct intraductal papillary mucinous neoplasms (BD-IPMNs) in patients undergoing a routine MRI follow-up. METHODS: This dual-center retrospective study include patients with BD-IPMN diagnosed on initial comprehensive protocol (CP) MRI who underwent routine MRI follow-up. CP included axial and coronal T2-weighted images (T2WI), axial T1-weighted images (T1WI) before and after contrast administration, 3D MR cholangiopancreatography (MRCP) and diffusion-weighted images (DWI). Two APs, eliminating dynamic sequences ± DWI, were extracted from CP. Two radiologists evaluated the APs separately for IPMN degeneration signs according to Fukuoka criteria and compared the results to the follow-up CP. In patients who underwent EUS, imaging findings were correlated with pathological results. Per-patient and per-lesion sensitivity, specificity, PPV, NPV, and accuracy of APs were calculated. Additionally, the acquisition time for different protocols was calculated. RESULTS: One hundred-fourteen patients (56.1 % women, median age: 71 years) with 256 lesions were included. Degeneration signs were observed in 24.6 % and 12.1 % per-patient and per-lesion, respectively. Regarding APs, the per patient sensitivity, specificity, PPV, NPV, and accuracy in the detection of the degeneration signs were 100 %, 93.5 %, 83.3 %, 100 %, and 95.1 %, respectively. No additional role for DWI was detected. AP without DWI economized nearly half of CP acquisition time (388 versus 663 s, respectively). CONCLUSION: AP can confidently replace CP for BD-IPMN follow-up with high sensitivity and PPV while offering benefits such as patient comfort, improved MRI accessibility, and reduced dedicated time for image analysis. DWI necessitates special consideration. CLINICAL RELEVANCE STATEMENT: Our data suggest that APs safely detect all degeneration signs of IPMN. While there is an overestimation of mural nodules due to the lack of contrast injection, this occurs in a negligible number of patients.

Retrograde mesenteric perfusion from the deep femoral artery in a patient with a recurrent anastomotic aneurysm in the groin: a case report.

In patients with atherosclerotic disease in two of the three main vessels in the splanchnic circulation, symptoms of chronic mesenteric ischemia may arise, depending on the disease chronicity and the presence of mesenteric collateral pathways. The most commonly described collateral pathways are between the celiac artery (CA), superior mesenteric artery (SMA), and inferior mesenteric artery (IMA); and between the IMA and the internal iliac artery (IIA). Another collateral network between the deep femoral artery and the IIA can also become important, especially in patients with aorto-iliac occlusion. Here we report a patient with a symptomatic anastomotic aneurysm of the right femoral artery after a previous aorto-bi-femoral bypass. This patient's bowel viability relied on a well-developed collateral network from the ipsilateral deep femoral artery. This unusual anatomy required special surgical considerations and planning, to minimize the risk of perioperative mesenteric ischemia. During open repair, distal femoral debranching with a distal-to-proximal anastomotic sequence allowed minimizing of the ischemic time, and avoidance of potential ischemic complications from the visceral circulation. This case emphasizes the importance and benefit of the deep femoral artery and its collaterals as a reserve network of the splanchnic circulation. Favorable outcomes can be achieved with careful analysis of the preoperative imaging and proper planning, with adaptation of the surgical strategy.

Typical imaging finding of hepatic infections: a pictorial essay.

Hepatic infections are frequent in clinical practice. Although epidemiological, clinical and laboratory data may suggest hepatic infection in certain cases, imaging is nearly always necessary to confirm the diagnosis, assess disease extension and its complications, evaluate the response to treatment, and sometimes to make differential diagnoses such as malignancies. Ultrasound (US) is usually the first-line investigation, while computed tomography (CT) and magnetic resonance imaging (MRI) provide better characterization and a more precise assessment of local extension, especially biliary and vascular. The purpose of this article is to describe the typical features and main complications of common hepatic infections. Familiarity with the radiological features of this entity can help suggest the correct diagnosis and the need for further studies as well as determine appropriate and timely treatment.

Infected Extrahepatic Splanchnic Venous Stent(-Grafts): Clinical Presentation, Imaging, and Treatment in Three Patients.

This brief report describes 3 patients with infected extrahepatic splanchnic venous stents or stent grafts. These devices had been placed to treat prehepatic portal hypertension 4 wk, 3 mo, and 31 mo, respectively, before readmission for fever. Blood cultures and fluorine-18 fludeoxyglucose positron emission tomography/CT were positive in all. With systemic antibiotic treatment, 2 patients showed a clinical recovery. In the third patient, antibiotic treatment failed. Therefore, the infected stent graft was surgically removed and a splenorenal shunt was created. No recurrent splanchnic venous infection was observed in these 3 patients.