Target Sign Research Articles

Metaphors to Survive by: Mimicry as Biometaphors, Embodiment of Sign and Cognitive Tools (not only) in Animals?

Abstract Can Cognitive Metaphor Theory (CMT) be applied productively to the study of mimicry in zoosemiotics and ethology? In this theoretical comparison of selected case studies, I would like to propose that biological mimicry is a type of biosemiotic metaphor. At least two major parallels between cognitive metaphors in human cognition and mimicry among animals justify viewing the two phenomena as isomorphic. First—from the semiotic point of view—the argument is that both metaphor and mimicry are cases of semiotic transfer (etymologically: metaphor) of the identity / sign of the source onto the perceived identity / sign of the target. This identity transfer, in turn, triggers appropriate changes in the response (behavior) of the surrounding (human or animal) interpreters (e.g. predators). Semiotically, the mimicry turns the body of its bearer into a sign of something else, resulting in the interpreters’ (e.g. predators’) perception of species X as species Y—hence, a type of embodied sign and cognitive metaphor. Second, ecologically, a species occupying one niche (e.g. a moth: non-venomous, herbivorous primary consumer) is perceived and identified as an occupant of a different niche (e.g. a hornet: venomous, omnivorous predator). Thus, a potential predator’s Umwelt is affected by its perceiving a hornet moth as “a hornet” where there is, in fact, a moth, and its response to this stimulus will not be predation but avoidance. In terms of CMT, we could call this a biosemiotic metaphor (bio-metaphor), e.g. “A MOTH IS A HORNET” or “PREY IS A PREDATOR”. Further correspondences between mimicry and metaphor include the fact that this bio-metaphorical identification by mimicry does not typically require a “perfect” resemblance between the source and the target sign (or species); this seems to correspond to the prototype categorization in CMT where categories are “open-ended” and only a partial similarity is sufficient for metaphorical identification (compare Lakoff, Johnson 1980; Rosch 1983). Such an identification of mimicry as metaphor could be based on Prodi’s argument that “hermeneutics is not a late product of culture, but the same elementary movement of life that is born because something obscurely interprets something else” (Eco 2018: 350; Kull 2018, 352—364). Inasmuch as animal Umwelten are interconnected inter alia by this natural hermeneutics, the trans-disciplinary approach to the study eco-zoosemiotic interpretants on the basis of metaphor-mimicry isomorphism could open new opportunities in comparative studies of semiosis in human and animal cognition and interactions.

Comparison of pathological, radiological, and prognostic features between cellular schwannoma and non-cellular schwannoma

PurposeTo investigate the differences of pathological, radiological, and prognostic features between cellular schwannoma (CS) and non-cellular schwannoma (NCS). MethodsCT and MRI images of 24 patients with CSs and 30 patients with NCSs were reviewed retrospectively. Clinico-pathological characteristics of CSs and NCSs and tumor radiological features including location, shape, size, border, cystic-solid components, hemorrhage, calcification, bone remodeling, pattern of CT/MRI precontrast scan, degree of enhancement, target sign, and tumor vessels were recorded. Statistical analyses were performed with Chi square or Fisher’s exact test, independent sample t test, and logistic regression analysis to compare the differences between CSs and NCSs. ResultsFour CSs showed mitotic activity, which was not found in the NCS group (P = 0.034). The CS group showed higher MIB-1 index than that in the NCS group (P = 0.002). Two patients with CS presented with tumor recurrence. Compared to NCSs, CSs were often located in spinal area (P = 0.028) and irregular (P = 0.013) with larger size (P = 0.005). Target sign, a common finding in NCSs (7/22, 31.8 %), was not seen in CSs (P = 0.014). The tumor vessels were only seen in CS group (4/22, 18.2 %; P = 0.027). Regression analysis revealed that location (P = 0.048) and size (P = 0.012) were independent indicators in differentiating CSs from NCSs. ConclusionsCS is a rare subtype of schwannoma with some significant radiological features including a predilection for the spinal area, irregular shape, large tumor size, absent target sign, tumor vessels, and potential risk of recurrence. Location and size of the schwannomas were the most useful indicators in differentiating CSs from NCSs.

MRI features of symptomatic amputation neuromas.

To demonstrate the magnetic resonance imaging (MRI) features of amputation neuromas in lower extremity amputees and investigate independent predictive MRI features for symptomatic neuromas. This retrospective study included 45 amputation neuromas in 44 lower extremity amputees. Two radiologists assessed the imaging features, including shape, size, type (end-bulb or spindle), signal intensity (SI), heterogeneity, margins, enlarged fascicles, dark outer rim, tail sign, target sign, enhancement, perilesional fibrosis, and muscle denervation. The neuromas were categorized into symptomatic (n = 24) or asymptomatic (n = 21). Symptomatic neuromas were determined based on neuropathic pain characteristics, the presence of Tinel's sign or tenderness, and response to local anesthetic injection. Univariate and multivariate analyses were performed to identify independent predictive MRI features. Of 45 neuromas, 80% (36/45) were end-bulb neuromas and 20% (9/45) were spindle-type neuromas. Eighty percent of the neuromas (36/45) were heterogeneous on T2-weighted images (WIs). Enlarged fascicles were present in 42% (19/45) and dark outer rims in 27% (12/45) of the neuromas. Among the 23 neuromas with enhanced images, 78% (18/23) showed enhancement. Heterogeneity on T2-WIs and enhancement ratios were significantly different between the asymptomatic and symptomatic neuroma groups (p < 0.05). The multivariate analyses indicated that heterogeneity on T2-WIs was an independent factor associated with symptomatic neuromas (p < 0.001). Heterogeneity on T2-WIs could be a predictive indicator for symptomatic neuromas in lower extremity amputees. • Amputation neuromas are classified as either end-bulb or spindle-type. They can show enlarged fascicles, dark outer rims, and enhancement. • Heterogeneity on T2-weighted images could be a predictive indicator for symptomatic neuromas. • Predicting the symptomatic neuroma on MRI would help in effective management of stump pain.

Impact analysis of platform positioning and orientation error on warship weapon target strike

In order to evaluate the weapon strike effect in the joint of ship formation, this paper discusses the influence of platform positioning and orientation error on weapon strike effect. Based on the mathematical model, the damage expectation of platform positioning and orientation error, the long-range strike accuracy of shipboard missile and the target indicating accuracy of cross-platform are analyzed quantitatively. The model includes weapon strike likelihood, the navigation positioning error model and error transfer model of ship platform. The simulation was be perform in MATLAB environment. The larger the positioning and orientation error is, the more cross platform target sign error will increase. And the acquisition probability and weapon strike effect of missile long-range attack will reduce.

Enteritis unravelled with ‘target sign’ of lupus

A 31-year-old woman presented with anasarca developed in the past 2 weeks accompanied by chronic diarrhoea of small bowel, secretory type for 40 days, associated with intermittent, colicky abdominal pain...

Prenatal diagnosis of persistent cloaca accompanied by uterus didelphys: A case report.

Persistent cloaca is a rare abnormality that occurs usually in females and is characterized by direct communication between the gastrointestinal, urinary, and genital structures resulting in a single perineal opening. We report a case of persistent cloaca accompanying uterus didelphys that was diagnosed antenatally with fetal ultrasonography. A gravida 3, para 2, 35-year-old women at 22 weeks of gestation was referred to our hospital with a diagnosis of moderate pyelectasis of the fetal kidneys and fetal diffuse intestinal dilation. Detailed ultrasound scan findings were reported as a small thick-walled septated cystic pelvic mass of 5.2×5.5 cm size seen at the level of the fetal pelvic region. The target sign could not be visualized, it was considered as anal atresia. In the following weeks, the patient, who was evaluated together with meconium on the uterine septum, and monitoring of the neighboring bladder and anal atresia, was diagnosed as having persistent cloaca. Ultrasound findings showed that it could be persistent cloaca accompanying uterus didelphys. The fetus postnatally manifested persistent cloaca. On the first day after vaginal delivery, pelvic ultrasound in the neonatal intensive care unit showed bilateral 2nd-degree hydronephrosis, presacral enlarged bowel loops, uterus didelphis, vaginal septum, direct contact between urethra and vagina, proximal end in the rectum compatible with atresia. On the second day, colostomy was performed. Her renal condition continued to be stable. She is now waiting for definitive surgery for cloaca. Persistent cloaca should be considered in any female fetus presenting with hydronephrosis and a cystic pelvic mass lesion as diagnosed by ultrasound. Prenatal diagnosis allows time for parental counseling and delivery planning at a tertiary hospital for neonatal intensive care and pediatric surgery.

Ювенальное право — комплексная отрасль в системе российского права

The article is devoted to a new complex branch of law — juvenile law. The article identifies the necessity and importance of the complex branch of juvenile law in the system of Russian law, reveals its structuring as a new branch of law. The article analyzes the subject and method of legal regulation of the complex branch of juvenile law. This is a kind of secondary legal formation, in which the original legal regimes and norms re-regulate a group of separate social relations connected by a single subject, and here there is a mixed nature of legal regulation. It is in order to effectively implement, protect, protect the rights and interests of a minor, to regulate legal relations with his participation, that the question is raised about the formation and development of a new branch of law, that is, a complex branch — juvenile law. Through this branch there is a connection of heterogeneous legal material on a subject and target sign, it is carried out.

Successful endoscopic management of adult ileocecal intussusception secondary to a large ileal lipoma.

A 90-year-old man presented to our hospital with abdominal pain, nausea, and loss of appetite that started the day before arrival. Initial CT revealed a target sign with a low-density mass at the center located in the terminal ileum (Fig. 1). Although a severely distended small bowel and ascites were present, physical and serum laboratory findings were not suggestive of peritonitis. From the CT findings, the patient was diagnosed with adult intussusception secondary to a lipoma. Because vital signs were stable and abdominal pain was under control without administration of anesthetics, we attempted endoscopic reduction under fluoroscopic guidance (Video 1, available online at www.VideoGIE.org).

Inverted Meckel's diverticulum associated with heterotopic pancreatic tissue causing intestinal obstruction: a case report

BackgroundMeckel’s diverticulum is the most frequent congenital anomaly of the gastrointestinal tract. It can invert or invaginate into the small intestine lumen. It is usually associated with heterotopic tissue elements.Case presentationWe present a case of inverted Meckel's diverticulum, clinically and radiologically diagnosed as intestinal obstruction due to intussusceptions. The diagnosis was suspected due to target sign shown on radiological examination. Pathologically, it was inverted Meckel's diverticulum obstructing the lumen in parallel plan mimicking the telescoping appearance, with heterotopic pancreatic tissue formed of exocrine and ductal components only.ConclusionsInverted Meckel’s diverticulum may present by vague symptoms and may simulate other causes of intestinal obstruction.

Outcomes of Deep Mural Injury After Endoscopic Resection: An International Cohort of 3717 Large Non-Pedunculated Colorectal Polyps

Although perforation is the most feared adverse event associated with endoscopic mucosal resection (EMR), limited data exists concerning its management. Therefore, we sought to evaluate the short- and long-term outcomes of intra-procedural deep mural injury (DMI) in an international multi-center observational cohort of large (≥20 mm) non-pedunculated colorectal polyps (LNPCPs). Consecutive patients who underwent EMR for a LNPCP ≥20 mm were evaluated. Significant DMI (S-DMI) was defined as Sydney DMI Classification type III (muscularis propria injury, target sign) or type IV/V (perforation without or with contamination, respectively). The primary outcome was successful S-DMI defect closure. Secondary outcomes included technical success (removal of all visible polypoid tissue during index EMR), surgical referral and recurrence at first surveillance colonscopy (SC1). Between July 2008 to May 2020, 3717 LNPCPs underwent EMR. Median lesion size was 35mm (interquartile range (IQR) 25 to 45mm). Significant DMI was identified in 101 cases (2.7%), with successful defect closure in 98 (97.0%) using a median of 4 through-the-scope clips (TTSCs; IQR 3 to 6 TTSCs). Three (3.0%) patients underwent S-DMI-related urgent surgery. Technical success was achieved in 94 (93.1%) patients, with 46 (45.5%) admitted to hospital (median duration 1 day; IQR 1 to 2 days). Comparing LNPCPs with and without S-DMI, no differences in technical success (94 (93.1%) vs 3316 (91.7%); P= .62) or SC1 recurrence (12 (20.0%) vs 363 (13.6%); P= .15) were identified. Significant DMI is readily managed endoscopically and does not appear to affect technical success or recurrence.

Suspecting Intussusception and Recurrence Risk Stratification Using Clinical Data and Plain Abdominal Radiographs.

PurposeAlthough ultrasonography is the gold standard of diagnosing intussusception, plain abdomen radiograph (AXR) is often used to make differential diagnosis for pediatric patients with abdominal pain. In intussusception patients, we aimed to analyze the AXR and clinical data to determine the characteristics of early AXR findings associated with diagnosis of intussusception and recurrence after reduction.MethodsBetween January 2011 and June 2018, 446 patients diagnosed with intussusception based on International Classification of Diseases-10 code of K56.1 were admitted. We retrospectively reviewed medical records of 398 patients who received air reduction; 51 of them have recurred after initial reduction. We evaluated six AXR features including absent ascending colon gas, absent transverse colon gas, target sign, meniscus sign, mass, and ileus. Clinical data and AXR features were compared between single episode and recurrence groups.ResultsTwo groups did not show significant differences regarding clinical data. Mean time to recurrence from air reduction was 3.4±3.2 days. Absent ascending colon gas (63.9%) was the most common feature in intussusception, followed by mass (29.1%). All of six AXR features were observed more frequently in the recurrence group. Absent transverse colon gas was the most closely associated AXR finding for recurrence (odds ratio, 2.964; 95% confidence interval, 1.327–6.618; p=0.008).ConclusionIn our study, absence of ascending colon gas was the most frequently seen AXR factor in intussusception patients. Extended and careful observation after reduction may be beneficial if such finding on AXR is found in intussusception patients.

COVID-19: Chest Computed Tomography Imaging Patterns in Assessment of Disease Progression and Severity

Introduction: Chest Computed Tomography (CT) plays an important role in the diagnosis and management of Corona Virus Disease (COVID-19) infection. A better understanding of the chest CT imaging findings in COVID-19 disease may help in accurate diagnosis and staging of the disease. The temporal changes in the chest CT imaging findings follows a specific pattern which helps in identification of disease progression or recovery from the illness. Aim: To evaluate the chest CT imaging findings of COVID-19 patients during the course of disease. Materials and Methods: This was a retrospective observational study in which 110 hospitalised patients with COVID-19 disease were evaluated for chest CT imaging findings and severity of the infection. Chest CT findings with respect to duration of symptoms onset were divided into early phase disease (&lt;5 days of symptom onset), intermediate phase (5-12 days) and late phase disease (&gt;12 days of symptom onset). Based on visual assessment, CT severity score was given depending on the percentage of each lobe involved in bilateral lung parenchyma. Descriptive statistics were expressed using percentage, range, means and Standard Deviation (mean±SD). Results: A total of 110 COVID-19 positive patients (79 males and 31 females) with mean age of 48.33±9.18 years (range between 22-84 years) were included in the study. CT chest was performed during the different time periods of hospital stay ranging from 2 to 16 days. Early phase disease constituted 53 (48.18%) patients, 21 (19.09%) patients in the intermediate phase and 36 (32.72%) patients were in the late phase. Nineteen (17.27%) patients in the early phase disease (&lt;5 days) had a normal scan. Out of 91 chest CT positive patients, 13 patients (14.28%) were asymptomatic and 78 patients were symptomatic (85.71%). Among the CT positive patients, early phase disease constituted 34 (37.36%) patients, 21 (23.07%) patients were in the intermediate phase and 36 (39.56%) patients in the late phase disease. Early phase disease was predominantly characterised by Ground Glass Opacities (GGOs) which were seen in 27 patients (79.41%), gradual conversion of these GGOs into consolidations during the intermediate phase. Consolidations with fibrotic bands were predominant imaging patterns during the late phase disease seen in 21 patients (58.33%). Mean CT severity score during the early, intermediate and late phase diseases were 4.14±2.12, 14.71±4.80 and 11.08±4.68, respectively. Along with few existing signs described in COVID-19 disease, two signs during the late phase disease were observed such as target sign in 5 patients (13.88%) and centipede sign in 13 patients (36.11%). Splenomegaly was an additional extrapulmonary finding seen in 27 patients (24.5%) which has not been described previously. Conclusion: Specific imaging patterns during the course of COVID- 19 illness provide an information regarding the stage of the illness and disease severity. Ideal timing of chest CT is found to be during the intermediate phase of disease (5-12 days of symptom onset), since most of the lesions evolve in this period and provide accurate disease severity which in turn helps in treatment planning.

Implementation of a multicomponent intervention sign to reduce delirium in orthopaedic inpatients (MIND-ORIENT): a quality improvement project

Delirium is a serious and common condition that leads to significant adverse health outcomes for hospitalised older adults. It occurs in 30%–55% of patients with hip fractures and is one...

Clinical characteristics and management of Petersen hernia after gastrectomy in patients with gastric cancer

Objective: Petersen hernia is a rare but severe complication after gastrectomy, which has been reported by very few studies. This study is dedicated to summarize the clinical characteristics and management of Petersen hernia after gastrectomy in patients with gastric cancer in order to provide reference to clinical practice. Methods: A descriptive case-control study was carried out. All the qualified patients were screened from the database of digestive malignancies in Nanjing Drum Tower Hospital. The inclusion criteria were as follows: Petersen hernia confirmed during operation; previous gastrectomy history due to gastric cancer; complete clinical data. The clinical manifestation, perioperative data and follow-up outcome were summarized. Results: A total of 12 qualified patients were included. They were all male with a mean age of (65.3±8.5) years old, and whose clinical presentation had last for (6~143) hours (median: 21 hours). Common complaints included abdominal pain and bloating. All the patients were admitted to the emergency department. Preoperative CT showed dilatation and effusion of small intestine. Other imaging manifestations included whirlpool sign, target sign, mesenteric retraction or congestion and edema, abdominal and pelvic effusion, etc. Hematological examination showed white blood cell count, ratio of neutrophils, procalcitonin and C-reactive protein were higher than the normal range. The median interval to previous gastrectomy is 20.5 (0.5-55.0) months. The previous gastrectomy of 12 cases included 2 cases of laparoscopic surgery and 10 of laparotomies. Ten cases underwent emergency surgery immediately, and 2 cases underwent surgery after ineffective conservative treatment. Six cases received small bowel restoration without bowel resection, and the other 6 cases received small bowel resection with a mean length of 76 (11~300) cm. Six cases were transferred into ICU with a stay of (2.5±0.8) days. One case deceased at postoperative day 2, due to subtotal small bowel resection, and the other 11 cases survived without grade III or above complication according to Clavien-Dindo classification. The overall postoperative hospitalization was (9.2±3.6) days. During the postoperative follow-up, no acute gastrointestinal symptoms or acute abdomen recurred. Conclusions: Petersen hernia is more common in male, whose onset and progress are rapid and emergent, and prognosis is poor.

A Bayesian approach for diagnostic accuracy of malignant peripheral nerve sheath tumors: a systematic review and meta-analysis.

BackgroundMalignant peripheral nerve sheath tumors (MPNST) carry a dismal prognosis and require early detection and complete resection. However, MPNSTs are prone to sampling errors and biopsies or resections are cumbersome and possibly damaging in benign peripheral nerve sheath tumor (BPNST). This study aimed to systematically review and quantify the diagnostic accuracy of noninvasive tests for distinguishing MPNST from BPNST.MethodsStudies on accuracy of MRI, FDG-PET (fluorodeoxyglucose positron emission tomography), and liquid biopsies were identified in PubMed and Embase from 2000 to 2019. Pooled accuracies were calculated using Bayesian bivariate meta-analyses. Individual level-patient data were analyzed for ideal maximum standardized uptake value (SUVmax) threshold on FDG-PET.ResultsForty-three studies were selected for qualitative synthesis including data on 1875 patients and 2939 lesions. Thirty-five studies were included for meta-analyses. For MRI, the absence of target sign showed highest sensitivity (0.99, 95% CI: 0.94-1.00); ill-defined margins (0.94, 95% CI: 0.88-0.98); and perilesional edema (0.95, 95% CI: 0.83-1.00) showed highest specificity. For FDG-PET, SUVmax and tumor-to-liver ratio show similar accuracy; sensitivity 0.94, 95% CI: 0.91-0.97 and 0.93, 95% CI: 0.87-0.97, respectively, specificity 0.81, 95% CI: 0.76-0.87 and 0.79, 95% CI: 0.70-0.86, respectively. SUVmax ≥3.5 yielded the best accuracy with a sensitivity of 0.99 (95% CI: 0.93-1.00) and specificity of 0.75 (95% CI: 0.56-0.90).ConclusionsBiopsies may be omitted in the presence of a target sign and the absence of ill-defined margins or perilesional edema. Because of diverse radiological characteristics of MPNST, biopsies may still commonly be required. In neurofibromatosis type 1, FDG-PET scans may further reduce biopsies. Ideal SUVmax threshold is ≥3.5.

A polymeric diet rich in transforming growth factor beta 2 does not reduce inflammation in chronic 2,4,6-trinitrobenzene sulfonic acid colitis in pre-pubertal rats

BackgroundPediatric Crohn’s disease is characterized by a higher incidence of complicated phenotypes. Murine models help to better understand the dynamic process of intestinal fibrosis and test therapeutic interventions. Pre-pubertal models are lacking. We aimed to adapt a model of chronic colitis to pre-pubertal rats and test if a polymeric diet rich in TGF-β2 could reduce TNBS-induced intestinal inflammation and fibrosis.MethodsColitis was induced in 20 five-week-old Sprague–Dawley male rats by weekly rectal injections of increasing doses of TNBS (90 mg/kg, 140 mg/kg and 180 mg/kg) for 3 weeks, while 10 controls received phosphate-buffered saline. Rats were anesthetized using ketamine and chlorpromazine. After first administration of TNBS, 10 rats were fed exclusively MODULEN IBD® powder, while remaining rats were fed breeding chow. Colitis was assessed one week after last dose of TNBS by histopathology and magnetic resonance colonography (MRC).ResultsHistological inflammation and fibrosis scores were higher in TNBS group than controls (p < 0.05 for both). MRC showed increased colon wall thickness in TNBS group compared to controls (p < 0.01), and increased prevalence of strictures and target sign (p < 0.05). Colon expression of COL1A1, CTGF, α-SMA and COX-2 did not differ between TNBS rats and controls. TNBS colitis was not associated with growth failure. Treatment with MODULEN IBD® was associated with growth failure, increased colon weight/length ratio (p < 0.01), but did not affect histological scores or MRI characteristics. Colon expression of α-SMA was significantly lower in the MODULEN group versus controls (p = 0.005).ConclusionFeatures of chronic colitis were confirmed in this model, based on MRC and histopathology. Treatment with MODULEN did not reverse inflammation or fibrosis.

A woman with fever and confusion

A 37-year-old HIV-positive woman presented to the emergency department with fever, headache, confusion, and seizures for 3 days. Computed tomography of the head with contrast demonstrated multiple ring-enhancing masses. An eccentric mural nodule in ring-enhanced mass characterizes eccentric target sign, which is pathognomonic for cerebral toxoplasmosis. The patient received anti-toxoplasmic therapy and had marked clinical improvement.

Successful laparoscopic approach for idiopathic adult colo-colonic intussusception: a case report

BackgroundAdult intussusception is recognized as an abdominal emergency. More than 90% of adult patients with intussusception have distinct causes that are related to benign or malignant tumors. In contrast, idiopathic intussusceptions, which are observed in children, are rare conditions in adult. Especially, colo-colonic idiopathic intussusceptions are rare among them. Surgery is traditionally considered the primary treatment option. Recently, laparoscopic surgery has been reported to be safe and feasible. However, laparoscopic surgical reduction, which is a common procedure in pediatric surgery, is not common in adult intussusception.Case presentationWe report a 34-year-old man who presented with sudden abdominal pain. Computed tomography revealed the target sign in the transverse colon. There was no evidence of bowel obstruction, bowel wall edema, or tumor. We diagnosed idiopathic intussusception and selected laparoscopic procedure because of the strong abdominal pain experienced by the patient. There were no signs of perforation, bowel wall ischemia, or tumor in abdominal cavity. We confirmed idiopathic colo-colonic anterograde intussusception. Laparoscopic surgical reduction was achieved by a combination of delicate direct pressure on the anal side of the transverse colon and gentle pulling on the oral side. The patient’s postoperative course was uneventful.ConclusionsWe achieved successful surgical reduction laparoscopically because of an accurate preoperative diagnosis based on characteristic computed tomography features and appropriate surgical technique. Laparoscopic procedure and surgical reduction is considered to be an effective treatment strategy for adult idiopathic intussusceptions with severe symptoms.

Magnetic Resonance Imaging May Be Able to Identify the Origin of Neuroendocrine Tumor Liver Metastases

Objectives: The aim of the study was to discriminate hepatic metastases from pancreatic neuroendocrine tumors (pNET) and hepatic metastases from midgut neuroendocrine tumors (mNET) with magnetic resonance imaging (MRI). Methods: MRI examinations of 24 patients with hepatic metastases from pNET were quantitatively and qualitatively assessed by 2 blinded readers and compared to those obtained in 23 patients with hepatic metastases from mNET. Inter-reader agreement was calculated with kappa and intraclass correlation coefficient (ICC). Sensitivity, specificity, and accuracy of each variable for the diagnosis of hepatic metastasis from pNET were calculated. Associations between variables and primary tumor (i.e., pNET vs. mNET) were assessed by univariate and multivariate analyses. A nomogram was developed and validated using an external cohort of 20 patients with pNET and 20 patients with mNET. Results: Interobserver agreement was strong to perfect (k = 0.893–1) for qualitative criteria and excellent for quantitative variables (ICC: 0.9817–0.9996). At univariate analysis, homogeneity on T1-weighted images was the most discriminating variable for the diagnosis of pNET (OR: 6.417; p = 0.013) with greatest sensitivity (88%; 21/24; 95% CI: 68–97%). At multivariate analysis, tumor homogeneity on T1-weighted images (p = 0.007; OR: 17.607; 95% CI: 2.179–142.295) and target sign on diffusion-weighted images (p = 0.007; OR: 19.869; 95% CI: 2.305–171.276) were independently associated with pNET. Nomogram yielded a corrected AUC of 0.894 (95% CI: 0.796–0.992) for the diagnosis of pNET in the training cohort and 0.805 (95% CI: 0.662–0.948) in the validation cohort. Conclusions: MRI provides qualitative features that can help discriminate between hepatic metastases from pNET and those from mNET.

Target sign on diffusion-weighted MRI in solid and papillary tumor

Target sign on diffusion-weighted MRI in solid and papillary tumor