Pelvic Lesions Research Articles

Ovarian serous carcinoma with stomach metastasis: a rare case report and literature review.

Ovarian cancer is a common tumor among women. It is often asymptomatic in the early stages, with most cases already at stage III to IVE at the time of diagnosis. Direct spread and lymphatic metastasis are the primary modes of metastasis, whereas hematogenous spread is rare. An initial diagnosis of ovarian cancer that has metastasized to the stomach is also uncommon. Therefore, clear treatment methods and prognostic data for such metastasis are lacking. In our hospital, we encountered a patient with an initial imaging diagnosis of a gastric tumor and a history of an ovarian tumor with endoscopic abdominal metastasis. Based on the characteristics of the case, the two tumors were considered to be the same. After chemotherapy, a partial response was observed in the stomach and pelvic lesions, suggesting the effectiveness of the treatment. Through three treatments of recurrence, gastroscopy confirmed the stomach to be a metastatic site. Therefore, determining the primary source of advanced tumors is crucial in guiding treatment decisions. Clinicians must approach this comprehensively, relying on thorough evaluation and personal experience.

Comparison of Ga-68 PSMA PET/CT and Multiparametric MRI for Initial Detection and Staging of Prostate Cancer

Abstract Background Multiparametric magnetic resonance imaging (mpMRI) is widely used for the evaluation of prostate cancer and is known to have better accuracy. Gallium-68 prostate-specific membrane antigen (Ga-68 PSMA) is a radiotracer that shows high localization in prostate cancer cells. Purpose The purpose of this study was to assess the sensitivity and utility of Ga-68 PSMA positron emission tomography/computed tomography (PET/CT) in comparison with mpMRI as a noninvasive imaging technique for the initial diagnosis and locoregional staging of prostate cancer using transrectal ultrasound (TRUS)-guided biopsy as gold standard. Materials and Methods This prospective observational study conducted from August 2017 to April 2020 evaluated 60 men (n = 60) with biopsy-proven prostate carcinoma. They underwent mpMRI and Ga-68 PSMA PET/CT scans within 14 days with TRUS biopsy being gold standard. T staging of disease, N staging of lymph nodes within the pelvis, and M staging of lesions in pelvic bones (within the imaging field of mpMRI) were compared using PSPP version 1.0.1 statistical software. Results All 60 men with a mean age of 69.9 ± 9.35 years showed Ga-68 PSMA avid disease, whereas 55 were detected by mpMRI. The sensitivity in detection of prostate lesions (with 95% confidence interval) was 99.08% for Ga-68 PSMA PET/CT and 84.40% for mpMRI. Ga-68 PSMA PET/CT detected greater number of patients with regional lymph nodal involvement (19/60) as compared with mpMRI (12/60). Ga-68 PSMA PET/CT showed PSMA avid pelvic skeletal lesions in nine patients, whereas mpMRI detected pelvic lesions in six patients. In addition, four other patients showed extrapelvic skeletal lesions on Ga-68 PSMA PET/CT. Conclusion Ga-68 PSMA PET/CT has superior sensitivity in detection of primary prostate tumor, as compared with mpMRI. Both modalities correlate well in detection of seminal vesicle involvement. Ga-68 PSMA PET/CT outperformed mpMRI in detection of lymph nodal and skeletal metastases. Hence, Ga-68 PSMA PET/CT should be considered as first-line diagnostic modality for carcinoma prostate. Summary Statement: Ga-68 PSMA PET/CT shows superior diagnostic performance than mpMRI in the evaluation of prostate cancer.

Ileal Chylolymphatic Mesenteric Cyst in a 4-year-old Child

Abstract Mesenteric cysts are rare, usually asymptomatic intra-abdominal benign cystic lesions, located in gastrointestinal tract mesentery. Their incidence is estimated about 1/20,000 in the pediatric age group with a male-to-female ratio of 1:2. Here, we report a case of ileal chylolymphatic mesenteric cyst in a 4-year-old male child. A 4-year-old male child presented to the outpatient department with a history of on-and-off abdominal pain and vomiting for the last 2 years. Ultrasound revealed a well-defined anechoic area measuring approximately 68 mm × 52 mm in the lower abdomen and pelvis. Exploratory laparotomy was performed and excised cyst with an attached part of the ileum was sent for histopathology. Correlating histology with immunohistochemical findings, the final diagnosis of ileal chylolymphatic type mesenteric cyst was considered. Mesenteric cysts should be kept as a differential diagnosis of intra-abdominal and pelvic cystic lesions. Although rare, awareness of this entity is necessary for early and prompt diagnosis as well as management, particularly in patients of the pediatric age group.

El análisis cuantitativo de las imágenes potenciadas en difusión (DWI) mejora la precisión diagnóstica del sistema de puntuación O-RADS RM en lesiones anexiales indeterminadas

IntroductionDespite the overall high accuracy of the O-RADS MRI scoring system for characterization of indeterminate adnexal lesions, a non-negligible percentage of adnexal lesions remains indeterminate. Given this, the main objective of this study was to evaluate the value of adding quantitative diffusion-weighted imaging (DWI) to Ovarian-Adnexal Reporting and Data System (O-RADS) MRI to improve the diagnostic accuracy of the scoring system in a cohort of indeterminate adnexal lesions according to International Ovarian Tumor Analysis Group Simple Rules (IOTA-SR). Methods and materialSeventy-nine women with 81 pelvic lesions classified as indeterminate according to IOTA-SR underwent 3-Tesla MRI with a conventional multiparametric protocol. DWI was quantitatively analyzed. Lesions were surgically removed or followed-up, according to a local protocol. Sensitivity, specificity, positive and negative predictive values and accuracy were determined for conventional multiparametric MRI and quantitative DWI-derived data. ResultsTwenty masses in 72 patients (27.8%) were malignant. An apparent diffusion coefficient (ADC) cut-off value of 1.30×10-3mm2/s had 89% sensitivity and 80% specificity for malignancy. Overall, adding quantitative DWI to O-RADS MRI increased the specificity (98.08%, P<.001), positive predictive value (94.12%, P<.001), and accuracy (93.06%, P=.05). In the specific O-RADS MRI score 4 subgroup, an ADC cut-off value of 1.22×10-3 mm2/s had 86% sensitivity and 67% specificity for distinguishing benign from malignant lesions. ConclusionIn IOTA-SR indeterminate adnexal lesions, quantitative DWI significantly improves the diagnostic performance of conventional multiparametric MRI in all O-RADS MRI score groups.

UMBILICAL ENDOMETRIOSIS: A CASE REPORT

Introduction: We report a recently observed case of secondary umbilical endometriosis (UE), with the main aim to discuss diagnosis and the management of this rare condition. Observation: A 41-year-old woman admitted to our facility with a nodular, bluish umbilical swelling, non- painful, gradually increasing in size, bleeding with her menstrual cycle. Ultrasonography did not reveal any images indicative of pelvic endometriotic lesions. A pelvic MRI was performed wich showed an ovoid formation at the umbilical level, suggestive of a UE implant. A biopsy of the lesion was also carried out, showing a morphological appearance compatible with parietal endometriosis. Histopathological analysis confirmed the diagnosis of UE. Neither symptoms or signs of local recurrence have been observed after 6 months. Discussion: Extra-pelvic endometriosis sites are not common, especially the umbilicus. It usually occurs secondary to surgical scars, specifically after laparoscopy or open abdominal surgery. UE should be taken into accounting differential diagnosis of umbilical disorders even in young nulliparous women with no typical symptoms of pelvic endometriosis. UE can be treated medically or surgically. Surgical treatment options are either local excision of the lesion or removal of the whole umbilicus with or without laparoscopic exploration of the peritoneal cavity. The decision should be tailored for the individual patient, taking into consideration the size of the lesion, the duration of symptoms and the presence of possible pelvic endometriosis. Conclusion: Local excision saving the umbilicus may be the treatment of choice in patients with small UE lesions.

The Cellular Respiration of Endometrial Biopsies from Patients with Various Forms of Endometriosis.

Endometriosis is one of the leading pathologies of the reproductive system of women of fertile age, which shows changes in cell metabolism in the lesions. We conducted a study of the cellular respiration according to the polarography and the mRNA content of the main metabolic proteins using qRT-PCR of intraoperative endometrial biopsies from patients in the control group and with different localizations of endometriosis (adenomyosis, endometrioma, pelvic peritoneum). In biopsy samples of patients with endometriomas and pelvic peritoneum endometriotic lesions, the rate of oxygen absorption was significantly reduced, and, moreover, in the extragenital case, there was a shift to succinate utilization. The mRNA content of the cytochrome c, cytochrome c oxidase, and ATP synthase was also reduced, but hexokinase HK2 as well as pyruvate kinase were significantly higher than in the control. These oxidative phosphorylation and gene expression profiles suggest the Warburg effect and a shift in metabolism toward glycolysis. For adenomyosis, on the contrary, cellular respiration was significantly higher than in the control group due to the terminal region of the respiratory chain, ATP synthase, and its mRNA was increased as well. These data allow us to suggest that the therapeutic strategies of endometriosis based on modulation energy metabolism should take lesion localization into account.

The Role of Endoscopic Ultrasound-guided Fine-needle Aspiration of Pelvic Lesions: A Meta-analysis.

Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is a potentially valuable tool for the diagnosis of pelvic lesions. The aim of this meta‑analysis was to evaluate the efficacy and feasibility of EUS-FNA in the diagnosis of pelvic lesions. We performed a computerized search of PubMed, EMBASE, Cochrane Library, and Science Citation Index, through March 2023. The main outcome measures examined in the meta-analysis were sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy. We evaluated 22 trials that used surgical pathology or imaging follow-up results as the reference standard. The studies comprised 844 patients. The cumulative sensitivity, specificity, PPV, NPV, and accuracy were 94%, 100%, 100%, 89%, and 96%, respectively. In the subgroup analysis, the prospective studies revealed the cumulative sensitivity, specificity, PPV, NPV, and accuracy were 91%, 100%, 100%, 85%, and 93%, respectively. In conclusion, we provide evidence that EUS-FNA is a qualitative diagnostic technique with high sensitivity, specificity, PPV, and accuracy. However, its NPV is slightly low, which does not exclude the risk of a missed diagnosis, and more randomized controlled trials or prospective studies are still needed in the future. EUS-FNA is effective and feasible for pelvic space-occupying lesions. This technique has high clinical application value for pelvic lesions.

Management of Pelvic Trauma Orthopedic Management of Pelvic Trauma

Patients with a suspected pelvic fracture should be managed according to the principles of Advanced Trauma Life Support. The mechanism of trauma determines the pattern of pelvic lesions and the likelihood of associated injuries. The most common classification to describe pelvic lesions is the Young–Burgess system. This classification describes the radiographic images by analyzing the mechanism of injury that leads to predictable patterns of injury and displacement. It is useful in describing injuries and in helping guide both initial treatment and definitive fixation. The initial treatment in case of pelvic lesion is the application of a pelvic binder. An external fixator is recommended in hemodynamically unstable patients with unstable pelvic lesions to prevent further bleeding and to support measures of hemorrhage control. Definitive treatment of pelvic ring lesions requires anterior stabilization or a posterior fixation, or both, depending on the type of injury.

Triangular osteosynthesis and lumbopelvic fixation as a valid surgical treatment in posterior pelvic ring lesions: a systematic review.

Unstable fractures of the sacrum often occur in patients with pelvic fractures and represent a real challenge for the orthopedic surgeon. Triangular osteosynthesis (TOS) and lumbopelvic fixation (LP) may represent a valid management option for the treatment of this condition. We present a systematic literature review about lumbopelvic fixation and triangular fixation as treatment option for unstable sacral fractures, to assess clinical and radiological outcomes after surgery and to evaluate appropriate indications and impact on the natural history of sacral fractures. The review is reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. 50 articles out of 108 titles, were considered eligible for the full-text analysis. Finally, 16 studies that met inclusion criteria were included in this review. Overall, 212 patients (87 males, 58 females) with sacral fractures treated with TOS triangular fixation or LP lumbopelvic fixation were collected. The mean age was 37.6 years. Mean follow-up reported in all studies was 24.14 months. The results presented by the different authors, highlight the effectiveness of TOS triangular fixation and LP lumbopelvic fixation for the treatment of unstable sacral fractures associated with other pelvic fractures, in terms of function, stability, cost-effectiveness, and quality of life postoperatively.

Dramatic response of synovitis, acne, pustulosis, hyperostosis, and osteitis syndrome to tofacitinib monotherapy: a case report

IntroductionThe synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome is a rare condition. Its treatment remains a challenge for clinicians, and often yields mixed results.CaseWe report the case of a 51-year-old Caucasian woman who presented with SAPHO syndrome with mainly axial involvement. She had been treated with sulfasalazine and anti-inflammatory drugs for many years without any success. A few weeks after starting treatment with tofacitinib, both clinical and biological parameters dramatically improved. Imaging also showed considerable regression of the vertebral and pelvic lesions. However, tofacitinib had to be discontinued due to the occurrence of pulmonary embolism. Consequently, recurrence of bone pain and biologic inflammation was rapidly observed.ConclusionsAnti-JAKs are an interesting treatment option in the management of SAPHO syndrome that need further clinical trials and assessment for validating response.

Applications of PET/MRI in prostate cancer

The advantages of both PET and MRI are combined with PET/MRI to provide near-perfect picture co-registration and simultaneous image capture. Prostate cancer and other pelvic oncologic lesions are increasingly being staged and restaged using magnetic resonance imaging (MRI). Long regarded as the cornerstone of oncologic imaging, fluorine 18-fluorodeoxyglucose PET/CT is now being studied and used in clinical practice more often due to the emergence of several tailored radiotracers. Therefore, PET/MRI performed concurrently offers a number of advantages over PET/CT and MR image collections, including the ability to obtain complementary imaging data. An overview of PET/MRI is given by the author, along with a discussion of the key distinctions between PET/MRI and PET/CT, case studies, and treatment guidelines for patients with common prostate cancers.

Leveraging GAN-based CBCT-to-CT translation models for enhanced image quality and accurate photon and proton dose calculation in adaptive radiotherapy

PurposeTo develop a deep learning-based network for CBCT-to-CT translation. This approach aims to enhance CBCT image quality and enable more accurate photon and proton dose calculation in adaptive radiotherapy. MethodsThe proposed network is based on a simple generative adversarial network (GAN) and task-specific loss functions. The CBCT images were input into the network for synthetic CT (sCT) generation with regularization loss in the form of gradient loss (between CBCT and sCT) and style loss (between registered planning CT and sCT) to preserve the CBCT structural information and obtain accurate HU values through CT style transfer, respectively. CBCT and planning CT images collected from 58 patients with pelvic lesions were used for training. The model performance was quantitatively and qualitatively evaluated and compared to that of three other models (Res-G, CycleGAN and CUT). Quantitative analysis was performed to assess the noise reduction and dosimetric improvement achieved by the proposed network. The performance of the model was evaluated in an additional 6 pelvic patients. ResultsThe best visual effects on the test data were achieved using our model, which showed detailed information preservation and artifact removal ability. Quantitative values of 13.02 ± 4.40 HU, 56.59 ± 20.58 HU, 37.53 ± 3.06 dB and 93.43 ± 1.23% were obtained for the MAE, RSME, PSNR and SSIM, respectively. Our sCT also showed CT-like noise levels, with a mean global noise level (GNL) of 3.31 ± 0.32 HU. The dosimetric evaluation revealed a gamma pass rate higher than 99% under all criteria for photon treatment and high pass rates of 95.77 ± 1.21% (2%/2 mm) and 98.07 ± 0.45% (3%/3 mm)) for proton treatment. ConclusionWe introduce novel task-specific loss functions into a GAN-based network for generating high-quality sCT images. The model also has an excellent ability to remove artifacts and suppress noise. Dosimetric results show the potential for integration into the clinical ART workflow.

Polytrauma: pelvic fractures and lesions to the urinary system

Purpose. Determination of the management particularities in polytrauma patients with pelvic fractures and the urinary organs injuries. Material and methods. A retrospective study was carried out, 61 medical records of the patients with polytrauma: injuries of the pelvic ring and urinary system were analyzed. Results. Based on the study, the main tactical aspects in the conduct of patients were identified: stabilization of the general condition of patients, early fixation of the pelvic ring with external device, restoration of the integrity of the urinary bladder, drainage of the urinary bladder and pathological accumulation of urine in the pelvic cavity. Conclusions. The preventive results of the treatment of polytraumapatients with lesions of the pelvic bones and urinary system indicates that early surgical correction of the pelvic ring with an external fixation device and the restoration of the integrity of the urinary bladder is possible in almost all cases. This requires special equipment, qualified and trained personnel

A A retrospective observational study in assesment of role of sonography in adnexal masses and its histopathological correlation in tertiary care centre.

Background- Adnexal masses (masses of the ovary, fallopian tube, or surrounding tissues) commonly are encountered by obstetrician–gynaecologist and often present diagnostic and management dilemmas. Types of adnexal mass ranges from benign ovarian and non-ovarian to primary and secondary malignant ovarian masses. Although most adnexal masses are benign, the main goal of the diagnostic evaluation is to exclude malignancy. Transvaginal ultrasonography remains the gold standard for evaluation of adnexal masses. The management of the adnexal masses varies according to age at presentation, whether benign or malignant, acute emergency or chronic presentation. Aim- The study aimed to determine the causes of adnexal masses and correlation of ultrasonographic and histopathologic findings of the adnexal masses. Methods- This is a retrospective observational study, performed in the Department of Obstetrics and Gynaecology, in tertiary care hospital. Operative and demographic details of patients operated for adnexal masses over a period of one year was obtained from case records of patient. Results- Among 90 cases studied, 86.66%(78) cases of adnexal masses was of ovarian origin followed by 11.66%(7) was of tubal origin. Among 90 cases of adnexal masses, 91.11%(82) cases were benign , 4.44%(4) were of borderline and malignant. Most common ovarian cause of adnexal mass was endometriotic cyst(22.22%) followed by serous cyst adenoma(20%) The highest sensitivity was found for follicular cyst (87.5%) followed by dermoid and serous cyst adenoma (83.33%). Malignancy was found in 8 cases among which 6 were correctly reported by USG resulting in sensitivity of 75%. Conclusion- It was concluded from the current study findings that sonography was primary modality and best screening tool for evaluation of pelvic masses. Ultrasound has high sensitivity for correctly diagnosing benign versus malignant pelvic lesions. Sonography was observed to be best modality to differentiate between solid and cystic pelvic masses.

Problems of preoperative diagnosis of pelvic lymph node lesions in rectal cancer (review)

Background: metastasis in lateral pelvic lymph nodes (LPLN) occurred in 6–15% of patients with middle or low rectal cancer. Currently there are still no criteria of diagnosis of this. There is no generally accepted management this group of the patients.Aim: to systematize the available literature data about lateral pelvic lymph node dissection in patients with rectal cancer.Materials and Methods: literature search was performed in the PubMed and e-Library databases using the keywords: LLND, lateral lymph node, rectal cancer, lymphodissection. The search date: July 2023.Results: preoperative CRT with total mesorectumectomy supplemented with selective LTLD for suspected metastases seems to be a rational strategy to achieve a favorable oncological treatment outcome.Conclusion: Additional studies are required.

Prevalence of bilateral loco-regional spread in unilateral pelvic PSMA PET positive recurrent prostate cancer.

Defining the best surgical template for salvage lymph node dissection (SLND) in patients exhibiting unilateral prostate cancer (PCa) recurrence in pelvic lymph nodes (LNs) is an unmet need. We assessed the risk of missing contralateral nodal recurrence in patients with unilateral positive PSMA-PET who were treated with bilateral PSMA-radioguided (RGS) SLND. Patients who consecutively underwent bilateral PSMA-radioguided SLND for PCa recurrence between April 2014 and January 2023 were identified. We compared PSMA PET findings with the number and the location of PCa LN metastases of the final pathological report. Univariable logistic regression models to try to predict contralateral missed disease were performed. Sixty patients were identified. At PSMA-RGS, the median PSA level was 0.71 ng/mL (IQR: 0.38-2.28). At PSMA-PET pre-SLND, 49 (82%) patients had unilateral exclusively pelvic lesions, 2 (3%) had unilateral positive nodes at the level of the common iliac arteries, and 9 (15%) had unilateral positive nodes in both levels. Final pathology revealed unilateral LN involvement in 43 (72%), a negative report in 3 (5%), and bilateral positive lesions in 14 (23%) patients. In the univariable logistic regression models, none of the tested factors showed influence on missing contralateral lesions. Four patients out of 35 (11%) with one positive LN at PSMA-PET had bilateral PCa recurrence. Patients with one-sided positive LNs on PSMA PET can be considered for a unilateral PSMA-radioguided SLND template with the caveat that about a quarter of patients ultimately have bilateral positive LNs. Larger prospective randomized trials are needed to confirm our findings.

An Unusual Presentation: High-Grade Serous Carcinoma of the Fallopian Tube Manifesting With Altered Mental Status Secondary to a Single Brain Metastasis—A Case Report and Review of the Literature

Epithelial ovarian and fallopian cancers are aggressive lesions that rarely metastasize to the central nervous system. Brain metastases usually occur in the setting of known primary disease or widespread metastatic disease. However, in extremely rare cases, an isolated intracranial neoplasm may be the first presentation of fallopian cancer. To the best of our knowledge, only one such case has been reported previously. We present an illustrative case with multimodality imaging and histopathologic correlation of a fallopian tube carcinoma first presenting with altered mental status secondary to an isolated brain metastasis. A 64-year-old female with no pertinent medical history presented with altered mentation. Initial workup identified a 1.6 cm avidly enhancing, solitary brain lesion at the gray-white junction with associated vasogenic edema concerning for either central nervous system lymphoma or metastatic disease. Additional imaging identified a 7.5×3 cm left adnexal lesion, initially thought to be a hydrosalpinx with hemorrhage, but magnetic resonance imaging suggested gynecologic malignancy. No lesions elsewhere in the body were identified. Given the lack of locoregional or systemic disease, the intracranial and pelvic lesions were assumed to represent synchronous but distinct processes. The intracranial lesion was biopsied. Preliminary results were suggestive of lymphoma, but further analysis was consistent with high-grade serous carcinoma of müllerian origin. Positron emission tomography/computed tomography was performed to evaluate for other neoplastic lesions, only highlighting the intracranial and pelvic lesions. At this point, a diagnosis of metastatic fallopian cancer was made. The patient was taken for robot-assisted laparoscopy with surgical debulking of the pelvic neoplasm, pathology demonstrating high-grade serous carcinoma of the fallopian tube, matching that of the intracranial lesion. Even though rare, metastatic fallopian cancer should be considered in patients with isolated brain lesions and adnexal lesions, even in the absence of locoregional or systemic disease.

Image-guided core biopsy for pelvic lesions of unknown origin.

Image-guided core biopsy for pelvic lesions of unknown origin.

Idiopathic Thrombocytopenia Purpura After Pembrolizumab Treatment Against Locally Recurrent Bladder Cancer : A Case Report

A man in his 70s visited our hospital for gross hematuria. He was diagnosed with invasive urothelial carcinoma (cT3N2M0) and underwent total cystectomy and ileum conduit construction after three courses of neoadjuvant chemotherapy. Eight months after the operation, the disease reoccurred in the pelvic lesion. He received pembrolizumab therapy but developed idiopathic thrombocytopenic purpura (ITP) immediately before the ninth course of administration; and, treatment was discontinued. Recovery of symptoms and normalization of blood test data were achieved 3.5months after starting steroid treatment. Reduction of recurrent disease has been maintained for 2 years.

Value of deep-learning image reconstruction at submillisievert CT for evaluation of the female pelvis

To assess the value of deep-learning reconstruction (DLR) at submillisievert computed tomography (CT) for the evaluation of the female pelvis, with standard dose (SD) hybrid iterative reconstruction (IR) images as reference. The present study enrolled 50 female patients consecutively who underwent contrast-enhanced abdominopelvic CT for clinically indicated reasons. Submillisievert pelvic images were acquired using a noise index of 15 for low-dose (LD) scans, which were reconstructed with DLR (body and body sharp), hybrid-IR, and model-based IR (MBIR). Additionally, SD scans were reconstructed with a noise index of 7.5 using hybrid-IR. Radiation dose, quantitative image quality, overall image quality, image appearance using a five-point Likert scale (1-5: worst to best), and lesion evaluation in both SD and LD images were analysed and compared. The submillisievert pelvic CT examinations showed a 61.09±4.13% reduction in the CT dose index volume compared to SD examinations. Among the LD images, DLR (body sharp) had the highest quantitative quality, followed by DLR (body), MBIR, and hybrid-IR. LD DLR (body) had overall image quality comparable to the reference (p=0.084) and favourable image appearance (p=0.209). In total, 40 pelvic lesions were detected in both SD and LD images. LD DLR (body and body sharp) exhibited similar diagnostic confidence (p=0.317 and 0.096) compared with SD hybrid-IR. DLR algorithms, providing comparable image quality and diagnostic confidence, are feasible in submillisievert abdominopelvic CT. The DLR (body) algorithm with favourable image appearance is recommended in clinical settings.