Abdominal Tomography Examination Research Articles

Correlation between the mutation spectrum of the UGT1A1 gene and clinical phenotype in patients with inherited hyperunconjugated bilirubinemia

Objective: To analyze the distribution characteristics of UGT1A1 mutant genes (including enhancers, promoters, and exons 1-5) and further explore the correlation between UGT1A1 genotype and clinical phenotypes in patients with inherited hyperunconjugated bilirubinemia. Methods: Patients diagnosed with hereditary hyperunconjugated bilirubinemia at Nanjing Second Hospital from June 2015 to December 2022 were retrospectively analyzed. The UGT1A1 gene was examined using Sanger sequencing in all patients. Complete blood count, liver function, and abdominal imaging examinations were performed. Comparison of categorical variable data using χ(2) testor Fisher percision tests. Comparison of continaous veriable data with normal distribution using t-test. Results: 112 cases (male:female ratio 81:31, aged 9-70 years) had inherited hyperunconjugated bilirubinemia, with a total of 14 mutation sites identified, of which seven were confirmed mutations, and the frequency ranged from high to low: (TA)n accounted for 50%, c.211G>A (p.G71R) accounted for 49.10%, 1456T>G (p.Y486D) accounted for 16.96%, c.686C>A (p.R229W) accounted for 12.5%, 1091C>T (p.P364L) accounted for 8.04%, and c- 3279T>G accounted for 0.982%. Simultaneously, all patients had one to four mutations, of which only one mutation was the most common (55.36%), followed by two mutations (37.5%), and rare three and four mutations (5.36% and 1.78%). There was no statistical significance in total bilirubin (TBil) levels among the four groups (F=0.652, P=0.583). One mutation was most common in (TA)n and c.211G>A (p.G71R), among which TA6/TA7 (n=10) and TA7/TA7 (n=14) mutations were statistically significant in TBil (t=2.143, P=0.043). The c.211G>A (p.G71R) heterozygous (n=9) and isolated (n=15) mutation had no statistical significance in TBil (t=0.382, P=0.706). The GS group accounted for 75%, the intermediate group accounted for 16.9%, and the CNS-Ⅱ group accounted for 8%. TBil was statistically significant among the three groups (F=270.992, P<0.001). There was no statistically significant difference (χ(2)=3.317, P=0.19) between mutation 1 (44 cases, 14 cases, and 4 cases, respectively) and mutations ≥ 2 (40 cases, 5 cases, and 5 cases, respectively) in the GS group, intermediate group, and CNS-II group. Conclusion: The number of UGT1A1 gene mutation sites may have no synergistic effect on TBil levels in patients with inherited hyperunconjugated bilirubinemia. TA7/TA7 mutations are not uncommon, and TBil levels are relatively high.

ESR Essentials: Imaging in colorectal cancer-practice recommendations by ESGAR.

Colorectal cancer (CRC) is a significant global health concern. Diagnostic imaging, using different modalities, has a pivotal role in CRC, from early detection (i.e., screening) to follow-up. The role of imaging in CRC screening depends on each country's approach: if an organized screening program is in place, the role of CT colonography (CTC) is limited to the study of either individuals with a positive stool test unwilling/unable to undergo colonoscopy (CC) or in patients with incomplete CC. Although CC is the most common modality to diagnose CRC, CRC can be also incidentally detected during a routine abdominal imaging examination or at the emergency room in patients presenting with intestinal occlusion/subocclusion or perforation. Staging is a crucial aspect of CRC management, guiding treatment decisions and providing valuable prognostic information. An accurate local staging is mandatory in both rectal and colon cancer to drive the appropriate therapeutic workflow. Important limitations of US, CT, and MR in N-staging can be partially solved by FDG PET/CT. Distant staging is usually managed by CT, with MR and FDG PET/CT which can be used as problem-solving techniques. Follow-up is performed according to the general recommendations of the oncological societies. CLINICAL RELEVANCE STATEMENT: It is essential to summarize each phase of colorectal cancer workup, differentiating the management for colon and rectal cancer supported by the main international guidelines and literature data, with the aim to inform the community on the best practice imaging in colorectal cancer. KEY POINTS: • Colorectal cancer is a prevalent disease that lends itself to imaging at each stage of detection and management. • Various imaging modalities can be used as adjuncts to, or in place of, direct visualization methods of screening and are necessary for evaluating metastatic disease. • Reevaluation of follow-up strategies should be considered depending on patients' individual risk of recurrence.

Selinexor in Combination with Azacitidine (AZA) in Patients with Myelodysplastic Syndrome (MDS): A Real-World Retrospective Study

Background: Patients with higher-risk MDS face limited treatment options and poor outcomes. While HMAs are approved as frontline therapy for higher-risk MDS, primary failure occurs in 50% of HMA-treated patients, and most responders progress within 2 years. There is an unmet need to improve the efficacy of AZA frontline therapy while maintaining a tolerable safety profile. Preclinical studies have demonstrated that the combination of selinexor and azacitidine synergistically inhibits MDS cell proliferation and arrests the cell cycle at the G2/M phase (Yixuan Guo, 2022). The combination of selinexor and azacitidine may be a promising approach for treating MDS. Here, we present this single-center, real-world evidence supporting the use of selinexor in combination with AZA in MDS patients. Methods: Medical records of 19 patients with MDS receiving selinexor in combination with AZA at the First Affiliated Hospital of Soochow University between Jan 2022 and March 2023 were reviewed. Inclusion criteria were a pathologically confirmed diagnosis of MDS, and receipt of ≥1 cycle of azacitidine in combination with selinexor. HMA-naïve patients and those previously treated with HMAs were included. Patients with a diagnosis other than MDS or progression to AML before treatment with selinexor + AZA were excluded. Patients received selinexor 40-60 mg QW orally and AZA 75 mg/m 2 intravenously or subcutaneously on days 1-5 or 7 of each 28-day cycle. Responses were evaluated per the International Working Group criteria. Results: A total of 19 pts (median age, 54 y [range, 13-68 y]) were treated (Table 1). IPSS-R risk was high or very high in 15.8% and 68.4% of pts, respectively. IPSS-M risk was high or very high in 10.5% and 78.9% of pts, respectively. 57.9% of pts were previously treated with HMA. 63.2% had myelofibrosis, 42.1% had hepatosplenomegaly, 31.6% had a TP53 mutation, and 63.2% had poor or very poor-risk cytogenetics. As of Jun 10, 2023 at a median follow-up of 5.9 months (range 1.5-17.4 months), eight pts died (42.1%) due to disease progression. For the total cohort, the overall response rate (ORR) was 73%. In pts with worse survival prognosis, such as relapse and refractory, high and very high in IPSS-R, high and very high in IPSS-M, myelofibrosis and TP53 mut, the ORR was 64%, 81%, 76%, 75% and 83%, respectively (Figure 1). In seven pts with splenomegaly, six pts had reduced spleen volume, and one pt had no significant change by abdominal palpation or imaging examination. The 6-month overall survival (OS) was 74.7% in total pts, and 70.0% in pts previously exposed to HMA (Figure 2a, 2b). Selinexor + AZA therapy improved survival of patients with poor prognosis, such as TP53 mut (0.099), MF (+) (0.613), ≥high in IPSS-R (0.938) (Figure 2c, 2d, 2e). The survival of six pts who received transplantation after combination therapy was significantly prolonged, with 6-month OS was 83.3% (Figure 2f). Conclusion: Selinexor + AZA combination therapy was well tolerated with promising efficacy in patients with untreated or relapse/refractory MDS, including those with TP53 mutation, myelofibrosis, and higher risk in IPSS-R.

A Case of Hepatocellular Carcinoma Treated with Mid-Infrared Rays

A 61-year-old man suffering from hepatocellular carcinoma was treated with Mid-Infrared rays (MIFR) irradiation. The patient was diagnosed with hepatocellular carcinoma at a hospital referred by his primary doctor, with markedly elevated values of tumor markers, and started oral administration of molecular target drugs. Initially, the tumor marker decreased once, but increased again 6 months after the start of therapy. Following the increase, the patient started MIFR irradiation therapy at our institution. After that, according to our instructions, the molecular target drug was tapered off (1/2, then 1/4), and finally oral administration was discontinued, and only MIFR irradiation therapy was performed. From the 12th month after the start of MIFR irradiation therapy, the tumor marker has maintained the reference value, and the growth of the tumor has disappeared in the abdominal CT imaging examination.

Perirenal fat thickness and liver fat fraction are independent predictors of MetS in adults with overweight and obesity suspected with NAFLD: a retrospective study

BackgroundNonalcoholic fatty liver disease (NAFLD) has a multidirectional relationship with metabolic syndrome (MetS) and used to be considered a hepatic manifestation of MetS. Perirenal fat, as a part of visceral adipose tissue (VAT), was reported to be correlated with MetS components, but data for intraorgan fat are lacking. This study was undertaken to assess the value of peripheral and intraorgan fat to predict MetS in adults with overweight and obesity with suspected NAFLD.MethodsWe studied 134 sequential adults (mean age, 31.5 years; 47% female) with overweight and obesity with suspected NAFLD. All participants underwent abdominal magnetic resonance imaging (MRI) examination. Anthropometric and metabolic parameters and perirenal fat thickness (PRFT), subcutaneous adipose tissue thickness (SATT), liver fat fraction (LFF), pancreas fat fraction (PFF), and lumbar spine fat fraction (LSFF) were collected. MetS was defined according to the International Diabetes Federation (IDF) criteria. Statistical analyses included basic statistics, linear correlation and logistic regression analysis.ResultsA total of 63 adults with MetS and 71 adults with advanced liver steatosis (grades 2 and 3) were included in our study. Patients with MetS had greater PRFT (p = 0.026) and LFF (p < 0.001), as well as greater homeostasis model assessment of insulin resistance (HOMA-IR), alanine transaminase (ALT), aspartate transaminase (AST), and decreased SATT. MetS patients had a higher proportion of advanced steatosis than those without MetS (P < 0.001). The MetS score was associated with PRFT and LFF. Logistic regression analysis showed that the PRFT and LFF were independent predictors of MetS after adjusting for age and sex. A cutoff of 9.15 mm for PRFT and 14.68% for LFF could be predictive of MetS.ConclusionsThis study shows that the absolute cutoff level of 9.15 mm for PRFT and 14.68% for LFF may be clinically important markers for identifying patients who are at high risk of MetS among adults with overweight and obesity with suspected NAFLD, irrespective of sex and age. Moreover, ectopic fat levels in pancreas and lumbar spine are positively associated with PRFT.Trial registrationNot applicable.

Risk Factors and the Character of Clinical Course of the Echinococcus multilocularis Infection in Patients in Poland.

Alveolar echinococcosis (AE) is a chronic zoonotic disease caused by the larval form of Echinococcus multilocularis. In humans, it may become a serious chronic infection of the liver which resembles a slow malignant process leading to death when untreated. The aim of the study was an assessment of the risk factors of the E. multilocularis infections and the description of AE clinical course in the group of 36 patients with confirmed AE, hospitalized at the Department and Clinic of Tropical and Parasitic Diseases, Poznan University of Medical Sciences between 2013 and 2022. Among the study participants, most patients cultivated land, bred livestock, worked in the forest, or were employed in animal shelters. The E. multilocularis infection was diagnosed based on imaging and immunoassay techniques within 6 months in the majority of patients hospitalized in the Department. All patients hospitalized in the Department initiated anti-parasitic therapy at the moment of the diagnosis. Pharmacological treatment combined with surgery was applied in most of the study participants, who were presented with more advanced stages of infection. We conclude the following: 1. For humans in the risk group, regular abdominal imaging examinations and the detection of specific antibodies against E. multilocularis are recommended. 2. Regular screening tests in the hyperendemic areas of AE would increase the early detection of the disease and to improve the clinical prognosis in this extremely life-threatening parasitic disease.

An Impressive Case of Compulsive Chicken Bones Ingestion.

CASE REPORT A 53-year-old woman with a medical history of depression and anxiety was admitted because of idiopathic anaphylaxis. Owing to acute respiratory failure, she underwent a thoracic computed tomography scan, which revealed a large number of bone fragments inside the stomach and duodenum (Figure 1). The patient was evaluated by psychiatry and admitted because she had ingested numerous chicken legs in the context of acute alcohol intoxication. We had some concerns about the efficacy and safety of performing an upper gastrointestinal endoscopy in this scenario. Indeed, there were already some bone fragments beyond the proximal duodenum and the objects were numerous and sharp. Thus, there was a high risk of complications (e.g., perforation and aspiration) during the procedure, with the probability of successful removal of all the fragments being very low. Therefore, we chose to start treatment with metoclopramide. During hospitalization, she underwent daily abdominal imaging examinations, which showed progression of the bone fragments through the small bowel and colon (Figure 2), with no evidence of obstruction or perforation. Later, the patient started oral feeding, with good tolerance. Because she maintained abdominal pain, and to exclude local complications, a colonoscopy was performed 10 days after admission. No foreign bodies or mucosal changes were identified. Given the progressive improvement in her clinical condition, the patient was discharged and oriented to immunoallergy and psychiatry consultation.Figure 1.: Computed tomography scan showing multiple chicken legs inside (A) the stomach and (B) the duodenum, with no evidence of obstruction or perforation.Figure 2.: Computed tomography scan showing the progression of the bone fragments through the small bowel and colon, without complications.We report an impressive case of ingestion of large amounts of chicken bones, which crossed the entire gastrointestinal tract without complications and only minor symptoms. Foreign body ingestion remains a common problem both in pediatric and adult populations.1,2 The associated morbidity and mortality are significant, with some reports estimating that nearly 1,500 deaths occur annually in the United States due to foreign body ingestion.3 In fact, sharp foreign bodies such as chicken bones can lead to acute and life-threatening complications, such as obstruction, hemorrhage, perforation, and associated infection, including peritonitis and sepsis.4 Complications and their severity are usually related to the object ingested, its location, and the amount of time that has passed since the ingestion.5 Gastrointestinal tract obstruction and perforations have been reported in all segments but tend to occur at sites of acute angulation. DISCLOSURES Authors contributions: I. Garrido drafted the manuscript and is the guarantor of the article. I. Garrido, P. Moutinho-Ribeiro, and G. Macedo critically revised and finalized the manuscript. All authors approved the final version of the manuscript. Financial disclosure: None to report. Informed consent was obtained for this case report.

A Randomized Study of b3 Agonists versus Anticholinergics Administration in Patients with Multiple Sclerosis and Lower Urinary Tract Dysfunction

Abstract Introduction and Objective: Multiple sclerosis (MS) is the most frequent autoimmune demyelinating disease of the central nervous system usually affecting lower urinary tract function. In the present study, we compare the efficacy and safety of either a b3 agonist (mirabegron) or anticholinergics in treating MS patients with lower urinary tract dysfunction (LUTD) and assess the LUTD symptom improvement. Evidence Acquisition: A multi-center, single-blinded, comparative study was designed, including MS patients with LUTD. Patients were administered either mirabegron or anticholinergics in combination with standard MS treatment. All cases underwent clinical examination and completed urination diaries and validated questionnaires (Neurogenic Bladder Symptom Score and MS International Quality of Life). Furthermore, urine test analysis, as well as abdominal ultrasound imaging examination, was performed. Data on several clinical and imaging parameters were collected between the two groups at the first visit and after 3 months of treatment. Evidence Synthesis: A total of 61 patients with LUTD participated in the survey. An improvement regarding LUTD was noted in all patients. However, no statistical difference was recorded between the mirabegron and the anticholinergic group. Medical treatment was well tolerated, and no patient discontinued medication due to side effects. Conclusions: Both mirabegron and anticholinergic therapy can be administered for LUTD in MS patients. In terms of drug efficacy, no statistical difference was noted between the two cohorts at 3 months.

Hepatic Paragonimiasis: A Case Report and Literature Review

Paragonimiasis is a parasitic disease caused by paragnonimus, which primarily caused infection in the lung, and ectopic infection was less common. Ectopic paragonimiasis are more likely to be misdiagnosed as malignancy or other inflammatory diseases. Here, we report an ectopic paragonimiasis case initially presented with recurrent fever and abdominal pain. Blood tests suggestive of elevated eosinophil count and the positivity of hydatid immunoglobulin G (IgG) antibodies, additionally, abdominal imaging examination revealed liver space-occupying lesion. A final diagnosis of paragonimiasis was demonstrated through liver puncture biopsy histopathology. This case report reminds clinicians to be aware of ectopic paragonimiasis presented with liver space-occupying lesion. At the same time, we should also pay attention to the mutual identification between parasitic infections.

Abdominal Imaging Utilization during the First COVID-19 Surge and Utility of Abdominal MRI.

We sought to determine relative utilization of abdominal imaging modalities in coronavirus disease 2019 (COVID-19) patients at a single institution during the first surge and evaluate whether abdominal magnetic resonance imaging (MRI) changed diagnosis and management. 1107 COVID-19 patients who had abdominal imaging were analyzed for modality and imaging setting. Patients who underwent abdominal MRI were reviewed to determine impact on management. Of 2259 examinations, 80% were inpatient, 14% were emergency, and 6% were outpatient consisting of 55% radiograph (XR), 31% computed tomography (CT), 13% ultrasound (US), and 0.6% MRI. Among 1107 patients, abdominal MRI was performed in 12 within 100 days of positive SARS-CoV-2 PCR. Indications were unrelated to COVID-19 in 75% while MRI was performed for workup of acute liver dysfunction in 25%. In 1 of 12 patients, MRI resulted in change to management unrelated to COVID-19 diagnosis. During the first surge of COVID-19 at one institution, the most common abdominal imaging examinations were radiographs and CT followed by ultrasound with the majority being performed as inpatients. Future COVID-19 surges may place disproportionate demands on inpatient abdominal radiography and CT resources. Abdominal MRI was rarely performed and did not lead to change in diagnosis or management related to COVID-19 but needs higher patient numbers for accurate assessment of utility.

Efficacy of endoscopic surveillance in the detection of local recurrence after radical rectal cancer surgery is limited? A retrospective study

BackgroundRectal cancer, one of most common neoplasms, is characterized by an overall survival rate exceeding 60%. Nonetheless, local recurrence (LR) following surgery for rectal cancer remains a formidable clinical problem. The aim of this study was to assess the value of postoperative endoscopic surveillance (PES) for the early detection of LR in rectal cancer after radical anterior resection with sigmoid-rectal anastomosis.MethodsWe performed an anterior resection in 228 patients with stages I‑III rectal cancer who had undergone surgery from 2001 to 2008 in the Oncology Center in Bydgoszcz, Poland. Of these patients, 169 had perioperative radiotherapy or radiochemotherapy. All patients underwent PES with abdominal and pelvic imaging (abdominal ultrasound, computed tomography, magnetic resonance) and clinical examination. Sensitivities, specificities, positive likelihood ratios, negative likelihood ratios, and receiver operating characteristic curves were calculated to compare the value of colonoscopy versus imaging techniques for the diagnosis of LR.ResultsDuring the 5-year follow-up, recurrences occurred in 49 (21%) patients; of these, 15 (6%) had LR, which was most often located outside the intestinal lumen (n = 10, 4%). Anastomotic LR occurred in 5 (2%) patients. The mean time to anastomotic LR was 30 months after initial surgery, similar to that of other locations (29 months). Both imaging and endoscopy were shown to be efficient techniques for the diagnosis of LR in anastomotic sites. In the study group, endoscopy did not provide any additional benefit in patients who were receiving radiation therapy.ConclusionsThe benefit of PES for the detection of LR after curative treatment of rectal cancer is limited and not superior to imaging techniques. It remains a useful method, however, for the histopathological confirmation of suspected or confirmed recurrence.

Opinions on Computer Audition for Bowel Sounds Analysis in Intestinal Obstruction: Opportunities and Challenges From a Clinical Point of View.

Intestinal obstruction (IO) is a common acute abdominal disease with abdominal pain, distension, vomiting, and constipation. It may need emergency surgery, since it possibly has high morbidity and mortality in cases of perforation, intestinal fistula, peritonitis, etc. At present, the diagnosis of IO has still depended on traditional bowel sounds(BS) auscultation, abdominal imaging examination (computerized tomography, X-ray). But in a certain situation, it is still difficult to identify the cause of IO, judge the severity and location of IO, and monitor the intestinal motility by those traditional methods. Computer audition, including machine learning and deep learning has greatly facilitated BS analysis. That might provide a new way to solve the above problems.

Cyst of the gallbladder

A 52-year-old man was found to have a cystic lesion of the gallbladder during an ultrasonography examination performed as part of a medical examination. He had no symptoms, and his laboratory data were within the normal limits upon admission. A contrast-enhanced abdominal magnetic resonance imaging examination revealed a well-defined, unilocular cystic lesion that was approximately 58 mm in diameter and was compressing the gallbladder to the right (Fig 1). What is the diagnosis: (1) foregut ciliated cyst of the gallbladder, (2) hydatid cyst of the gallbladder, (3) acquired cyst of the gallbladder associated with Rokitansky-Aschoff sinuses, or (4) cystadenocarcinomas of the gallbladder?

Intestinal malrotation in adults: prevalence and findings based on CT colonography.

Intestinal malrotation is largely a pediatric diagnosis, but initial detection can be made in adulthood. CT colonography (CTC) provides an ideal means for estimating prevalence. Our purpose was to evaluate the prevalence and imaging findings of intestinal malrotation in asymptomatic adults at CTC screening, as well as incomplete optical colonoscopy (OC) referral. The CTC database of a single academic institution was searched for cases of intestinal malrotation (developmental nonrotation). Prevalence was estimated from 11,176 adults undergoing CTC. Demographic, clinical, imaging (CTC and other abdominal exams), and surgical data were reviewed. 27 cases of malrotation were confirmed (mean age 62 ± 9years; 15M/12F), including 17 from the CTC screening cohort (0.17% prevalence) and 10 from incomplete OC (0.75% prevalence; p < 0.001). Most cases (59%; 16/27) were initially diagnosed at CTC. In 67% (12/18); the presence of malrotation was missed on at least one relevant abdominal imaging examination. At least 22% (6/27) had a history of unexplained, chronic intermittent abdominal pain. At CTC, the SMA-SMV relationship was normal in only 11% (3/27). The ileocecal valve was located in the RLQ in only 22% (6/27). Two patients (7%) had associated findings of heterotaxy (polysplenia). The prevalence of intestinal malrotation was four times greater for patients referred from incomplete OC compared with primary screening CTC, likely related to anatomic challenges at endoscopy. Malrotation was frequently missed at other abdominal imaging examinations. CTC can uncover unexpected cases of malrotation in adults, which may be relevant in terms of potential for future complications.

Primary Splenic Diffuse Large B Cell Lymphoma. Case Report and Literature Review

We report a case of a localized, massive, diffuse large B cell splenic lymphoma diagnosed by splenectomy. A 61-year-old man complaining of abdominal pain was admitted to our hospital. On abdominal tomography examination, there was seen to be a significant increase in the spleen dimensions and a lesion of heterogenous density was observed to be covering almost all of the spleen parenchyma. Intraoperatively, a massive hematoma involving approximately 95% of the spleen and ischemic areas were observed, so it was decided to perform splenectomy. With an improvement in general condition and no active complaints, the patient was discharged, but then failed to attend for follow-up examinations. At 7 months after the splenectomy, the patient again presented at the Emergency Department with complaints of abdominal pain, nausea, and vomiting. On abdominal tomography, a solid mass was observed, approximately 12 × 9 cm in size with irregular contours in the margins of the splenectomy location. The diagnosis was reported as non-germinal center diffuse large B cell lymphoma showing involvement with the colon and small intestine segments. It was learned that the patient had not attended follow-up examinations and when the splenectomy material of 17.5 × 13.5 × 6 cm was examined, it was reported as non-germinal center diffuse large B cell lymphoma. This case is of importance in respect of the development of recurrence in less than a year as splenectomy only without systemic chemotherapy was insufficient in the treatment of diffuse large B cell lymphoma with isolated spleen involvement.

Abdominal magnetic resonance imaging examination of Tibetan patients with abnormal iron metabolism and a preliminary study of correlations with blood cell analysis.

ObjectiveThe objective was to investigate factors influencing the high incidence of abnormal iron metabolism in a Tibetan population.MethodsThis was a retrospective observational study. Magnetic resonance imaging and blood analysis of 363 Tibetan patients were performed and patients divided into normal and abnormal groups based on the clinical diagnostic standard. The upper limit of normal liver iron content was 50 μmol/g. We analyzed the association between abnormal iron metabolism and blood cell indicators using the Spearman rank correlation test.ResultsIn male patients, differences in mean corpuscular hemoglobin (MCH) and MCH concentration in blood between the normal and abnormal groups were significant. Abnormal iron metabolism in male patients was positively correlated with MCH and MCH concentration. In female patients, differences in erythrocytes, hemoglobin, and hematocrit levels between the two groups were significant. Erythrocyte counts and hemoglobin and hematocrit levels of female patients were positively correlated.ConclusionIron overload in male patients was correlated with an increase in MCH and MCH concentration, and that in female patients was correlated with levels of erythrocytes, hemoglobin, and hematocrit. The incidence rate of iron overload was higher in males than in females and was correlated with age in this Tibetan population.

A New Health Care Policy in Korea Part 2: Expansion of Coverage by National Health Insurance on the Abdominal Ultrasound and MRI

복부 영상 영역에서는 새로운 건강보험 보장성 강화 대책으로 인하여 2018년 4월 1일 상복부초음파, 2019년 2월 1일 하복부 초음파와 2019년 11월 1일 복부 MRI가 순서대로 급여 확대되었다. 많은 환자들이 건강보험 급여 혜택을 보게 되었으며 간경화, 담낭용종, 간선종, 이형성 결절, 췌장 낭종과 자가면역성 췌장염, 담석 등이 건강보험에 포함되었다. 그러나 급여화로 인해 각 검사의 적응증, 추적검사 가능 질환과 적용 횟수 등이 보다 복잡해졌으며 획득하여야 할 표준영상과 판독소견서의 양식이 지정되었으며, 따라서 외래나 병실에서 검사를 처방하고 검사실에서 검사를 시행할 때 주의해야 할 필요가 있다.

Recommendations in Second Opinion Radiology Reports of Abdominal Imaging Examinations: Referring Clinicians' Compliance and Diagnostic Outcome.

OBJECTIVE. The purpose of this study was to investigate how often referring clinicians comply with recommendations in second opinion radiology reports of abdominal imaging examinations, determinants of their compliance, and diagnostic outcome of recommendations. MATERIALS AND METHODS. This retrospective study included 2225 consecutive tertiary center second opinion radiology reports of abdominal imaging examinations performed at outside institutions. RESULTS. Referring clinicians followed 163 of 307 recommendations, corresponding to a frequency of 53.1% (95% CI, 47.5-58.6%). Logistic regression analysis showed no significant association between referring clinicians' compliance and any of the investigated variables, which included patient age, sex, hospitalization status, indication for reinterpretation, strength and clarity of the recommendation, whether the recommendation was made because of perceived insufficient quality of the original imaging examination, and experience of the radiologist who performed the reinterpretation. Of the 275 recommendations that were eligible for a subanalysis on diagnostic outcome, 147 (53.5%) were followed by the referring clinicians and yielded a malignant diagnosis in 30 cases (20.4%). Of the 128 recommendations that were not followed, the advice would have yielded a malignant diagnosis in four cases (3.1%) if it had been followed. The proportions of malignant diagnoses were significantly different between the recommendations that were followed and those that were not (p < 0.001), favoring a higher proportion of the former. CONCLUSION. Recommendations in second opinion reports of abdominal imaging examinations are frequently followed by referring clinicians, but it remains unclear as to which factors influence their compliance. These recommendations lead to a malignant diagnosis in a considerable number of cases.

Recommendations for additional imaging of abdominal imaging examinations: frequency, benefit, and cost

ObjectivesTo investigate the frequency, determinants, clinical implications, and costs of recommendations for additional imaging (RAIs) in secondary interpretations of abdominal imaging examinations.MethodsThis retrospective study included 2225 abdominal imaging examinations from outside institutions that were reinterpreted as part of standard clinical care at a tertiary care center in a one-year time frame.ResultsTwo hundred forty-six RAIs were present in 231 of 2225 reports (10.4%) of secondary abdominal imaging interpretations. Patient age and experience of the radiologist who performed the secondary interpretation were independently significantly associated with the presence of an RAI (both p = 0.002), with odds ratios of 0.99 per year increase in patient age (95% confidence interval [CI], 0.98–1.00) and 1.06 per year increase in experience of the radiologist (95% CI, 1.02–1.10). If followed, RAIs changed clinical management in 31.2%. Total costs of all 246 RAIs, whether performed or not by the referring physicians, amounted to €71,032.21, thus resulting in €31.92 per secondary abdominal imaging interpretation. Total costs of the 140 RAIs that were actually performed by the referring physicians amounted to €42,683.08, resulting in €19.18 per secondary abdominal imaging interpretation.ConclusionsThe frequency of RAIs in reports of secondary interpretations of abdominal imaging examinations (which appear to be affected by patients’ age and radiologists’ experience) and associated costs are non-negligible. However, RAIs not infrequently change clinical management. The presented data may be helpful to radiology departments and healthcare policy makers to make well-informed decisions on the value and facilitation of the practice of secondary interpretations.Key Points• Frequency of recommendations for additional imaging (RAIs) in secondary interpretations of abdominal imaging examinations at a tertiary care center is approximately 10.4%.• RAIs appear to be more frequently issued in younger patients and by more experienced radiologists, and if followed by referring clinicians, change clinical management in about one third of cases.• RAI costs per secondary interpretation in the Dutch Healthcare system are €31.92 (considering all RAIs) or €19.18 (considering only those RAIs that are actually performed).

Feasibility of measuring spleen stiffness with MR elastography and splenic volume to predict hepatic fibrosis stage.

AimThe aim of this study was to investigate the relationship between spleen stiffness value, splenic volume and the liver fibrosis stages.Materials and methodsThis retrospective study was approved by the institutional review board of our institute. We enrolled 109 patients that had undergone abdominal MR imaging and histopathological examination. The preoperative MR imaging, MR elastography and laboratory data were reviewed. Liver stiffness and spleen stiffness were determined with MR elastography, and splenic volume was calculated. Liver fibrosis stage was determined using surgical pathology.ResultsThe correlation coefficient between the liver stiffness and the fibrosis stage was r = 0.72 and r = 0.62 when the passive driver was on right chest wall and the left chest wall, respectively. The correlation coefficient between the spleen stiffness and the fibrosis stage was r = 0.63 and r = 0.18 when the passive driver was on the left chest wall and the right chest wall, respectively. The correlation coefficient between the splenic volume and the fibrosis stage was r = 0.31. The diagnostic performance of spleen stiffness was similar to liver stiffness in prediction of advanced liver fibrosis. The combination of spleen stiffness and liver stiffness provided greater sensitivity in prediction of advanced fibrosis than spleen or liver stiffness alone, but no significant difference was found.ConclusionAccording to our study, the spleen stiffness value was useful in staging liver fibrosis. The combination of spleen stiffness and liver stiffness could provide higher diagnostic sensitivity than liver stiffness alone in prediction of advanced fibrosis.