Prostate cancer (PCa) is the second most common cancer and cause of cancer death in American men. Existing risk prediction methods have limited accuracy and reproducibility, resulting in difficulty in predicting disease severity. We demonstrate the development and external validation of an automated multimodal artificial intelligence algorithm using biparametric MRI (bpMRI) and clinical covariates for predicting biochemical recurrence (BCR) after radical prostatectomy (RP) in PCa patients. Development cohort included 80% of patients from center 1 (n = 240) who underwent prostate MRI prior to RP between January 2008 and December 2018 with a minimum of two years of follow-up after RP. Test cohort included the remaining 20% of center 1 patients (n = 71), and the external validation cohort from center 2 (n = 168). Center 2 patients included those who underwent prostate MRI and RP between January 2015 and December 2024 with a minimum of two years of follow-up. Clinical comparisons were CAPRA-S (center 1) and ISUP grade group from post-RP biopsy (center 2). Models developed were a clinical model (M0), an automated clinical model (M1), a radiomics model (M2), and a multimodal model (M3). Clinical variables (M0) included PSA, age, primary Gleason, and ISUP grade group. Automated clinical variables (M1 and M3) included PSA and age. Radiomics features (M2 and M3) were extracted from bpMRI using a lesion detection algorithm. Accuracy, sensitivity, specificity, and AUC were calculated, and log-rank tests compared BCR-free survival to assess the models' ability to discriminate relative to clinical standards. Intermediate-risk groups were also assessed. The multimodal model (M3) had the highest AUC across test sets (combined: 0.71; center 1: 0.70; center 2: 0.75) and was the only model to significantly differentiate BCR-free survival outcomes in intermediate-risk groups across both centers (p < 0.05). This automated multimodal model leveraging radiomics and clinical covariates can predict BCR after RP, approaches clinical gold standards, and may enhance imaging-based prognostication following further validation.

The falciform ligament and the ligamentum teres hepatis (LTH) have historically been regarded as embryological remnants with minimal clinical significance. However, their complex anatomical relationships with the liver, diaphragm, retroperitoneum, and abdominal and thoracic walls make them susceptible to various pathological conditions. This review highlights the anatomy of the falciform ligament and the LTH, their significance in surgical procedures, and pathologies of these structures on cross-sectional imaging. We will discuss the normal anatomy, congenital variations, inflammatory and infectious processes, neoplastic conditions, and vascular anomalies affecting these structures. Recognition of the imaging characteristics of the falciform ligament and the LTH pathologies is crucial for accurate diagnosis and management. Recognition of the falciform ligament and the ligamentum teres hepatis pathologies is critical for accurate diagnosis, surgical planning, and avoiding misinterpretation of pseudolesions. Cross-sectional imaging helps identify pathologies of these structures, guide management, and avoid unnecessary interventions.

BACKGROUND:Hepatic steatosis (HS) development and its risk factors in testicular germ cell tumor (TGCT) survivors have not been investigated. METHODS:The study was designed as a retrospective observational study. Patients with existing HS at diagnosis were excluded. Serial imaging was utilized to detect HS. RESULTS:A total of 106 TGCT survivors were included. HS developed in 57% (n = 61) during a median follow-up of 51.8 months (8.5-241.5); 77% (n = 47) of those had persistent HS. Patients who developed HS had a higher baseline body mass index (BMI) (median 26.5 vs. 23.6 kg/m2, p = 0.000). Higher baseline BMI [adjusted odds ratio (aOR): 1.35, (95% CI: 1.10-1.65) p = 0.004] and S0 stage [aOR: 3.87, (95% CI: 1.18-12.67), p = 0.025] were associated with a higher risk of HS development. The median time from the diagnosis of TGCT to the detection of HS was 44.7 months (29.5-59.8). Higher baseline BMI was associated with earlier development of HS both in all patients [hazard ratio (HR): 1.16, (95% CI: 1.04-1.30), p = 0.007] and patients treated with the BEP regimen [HR: 1.21, (95% CI: 1.01-1.47), p = 0.038]. CONCLUSION:HS may be considered a long-term complication in TGCT patients. The risk is associated with baseline BMI. Diagnosis and management of HS should be implemented in the survivorship care plan of TGCT survivors.

PURPOSE: This study investigates the accuracy of multiparametric magnetic resonance imaging (mpMRI), diffusion-weighted imaging (DWI), and magnetic resonance elastography (MRE) in differentiating benign and malignant liver lesions. METHODS: This retrospective study included patients with focal liver lesions who underwent MRI and MRE between 2018 and 2022. Based on histopathologic analyses or follow-up imaging findings, 70 solid liver lesions were retrospectively evaluated as benign (n = 20) or malignant (n = 50). RESULTS: There was no statistically significant difference between the benign and malignant liver lesions in pre-contrast T1 relaxation times (P > 0.05). Malignant liver lesions had a significantly lower T2 value, contrast-enhancement ratio (CER), T1 relaxation time reduction (T1D), T1D percentage [T1D (%)], and apparent diffusion coefficient (ADC), along with a significantly higher stiffness value (P < 0.05). In receiver operating characteristic analysis, the following cut-off values were determined for differentiating malignant from benign lesions: a CER of 1.99 [area under the curve (AUC): 0.828, sensitivity 78.6%, specificity 73.2%], a T1D of 749.5 ms (AUC: 0.817, sensitivity 71.4%, specificity 78%), a T1D (%) reduction of 49.71% (AUC: 0.831, sensitivity 78.6%, specificity 73.2%), a T2 relaxation time of 74 ms (AUC: 0.705, sensitivity 65%, specificity 76.6%), an ADC of 1.275 × 10-3 mm2/s (AUC: 0.861, sensitivity 89.5%, specificity 81.2%), and a stiffness of 3.77 kPa (AUC: 0.848, sensitivity 85%, specificity 75%). CONCLUSION: Combined mpMRI, DWI, and MRE provide high diagnostic accuracy, with ADC and MRE offering superior performance in differentiating malignant from benign liver lesions. CLINICAL SIGNIFICANCE: This article highlights the accuracy of mpMRI, MRE, and DWI in distinguishing between malignant and benign liver lesions. These findings support the integration of mpMRI, DWI, and MRE into clinical practice for non-invasive liver lesion characterization.

ÖZRetroperiton kökenli primer yumuşak doku tümörleri nadir görülmekle birlikte agresif seyir gösterebilir ve klinik belirtiler ortaya çıkana dek büyük boyutlara ulaşabilir.Lezyonların çoğunluğu malindir.Görüntüleme bulguları spesifik olmasa da bazı karakteristik radyolojik özellikler, tümörün tespiti, tanısı, evrelemesi ve preoperatif değerlendirilmesinde önemli rol oynar.Radyolojik olarak; tümörün kökeni, yerleşimi ve boyutu (örneğin; presakral veya paravertebral bölgeler), doku bileşimi (yağ içeriği, fibröz doku, kistik yapılar vb

PURPOSE To evaluate the frequency of abdominal computed tomography (CT) findings in patients with coronavirus disease-2019 (COVID-19) and interrogate the relationship between abdominal CT findings and patient demographic features, clinical findings, and laboratory test results as well as the CT atherosclerosis score in the abdominal aorta. METHODS This study was designed as a multicenter retrospective study. The abdominal CT findings of 1.181 patients with positive abdominal symptoms from 26 tertiary medical centers with a positive polymerase chain-reaction test for severe acute respiratory syndrome coronavirus 2 were reviewed. The frequency of ischemic and non-ischemic CT findings as well as the association between CT findings, clinical features, and abdominal aortic calcific atherosclerosis score (AA-CAS) were recorded. RESULTS Ischemic and non-ischemic abdominal CT findings were detected in 240 (20.3%) and 328 (27.7%) patients, respectively. In 147 patients (12.4%), intra-abdominal malignancy was present. The most frequent ischemic abdominal CT findings were bowel wall thickening (n = 120; 10.2%) and perivascular infiltration (n = 40; 3.4%). As for non-ischemic findings, colitis (n = 91; 7.7%) and small bowel inflammation (n = 73; 6.2%) constituted the most frequent disease processes. The duration of hospital stay was found to be higher in patients with abdominal CT findings than in patients without any positive findings (13.8 ± 13 vs. 10.4 ± 12.8 days, P < 0.001). The frequency of abdominal CT findings was significantly higher in patients who did not survive the infection than in patients who were discharged after recovery (41.7% vs. 27.4%, P < 0.001). Increased AA-CAS was found to be associated with a higher risk of ischemic conditions in abdominal CT examinations. CONCLUSION Abdominal symptoms in patients with COVID-19 are usually associated with positive CT findings. The presence of ischemic findings on CT correlates with poor COVID-19 outcomes. A high AA-CAS is associated with abdominal ischemic findings in patients with COVID-19.

PURPOSE We aim to examine the long-term outcomes of patients who underwent multiparametric prostate magnetic resonance imaging (mp-MRI) for suspected prostate cancer (PCa), specifically based on their initial Prostate Imaging Reporting and Data System (PI-RADS) categories and various clinical factors. Our secondary aim is to evaluate the prognostic value of the PI-RADS through the National Comprehensive Cancer Network (NCCN) risk group distribution. METHODS This research was conducted as a single-center retrospective cohort study in a tertiary care hospital. A total of 1,359 cases having at least one histopathological examination after the initial mp-MRI and/or adequate clinical/radiological follow-up data were included in the clinically significant PCa (cs-PCa) diagnosis-free survival analysis. Initial mp-MRI dates were accepted as the start of follow-up for the time-to-event analysis. The event was defined as cs-PCa diagnosis (International Society of Urological Pathology ≥2). Patients who were not diagnosed with cs-PCa during follow-up were censored according to predefined literature-based criteria at the end of the maximum follow-up duration with no reasonable suspicion of PCa and no biopsy indication. The impact of various factors on survival was assessed using a log-rank test and multivariable Cox regression. Subsequently, 394 cases diagnosed with PCa during follow-up were evaluated, based on initial PI-RADS categories and NCCN risk groups. RESULTS Three main risk factors for cs-PCa diagnosis during follow-up were an initial PI-RADS 5 category, initial PI-RADS 4 category, and high MRI-defined PSA density (mPSAD), with average hazard ratios of 29.52, 14.46, and 3.12, respectively. The PI-RADS 3 category, advanced age group, and biopsy-naïve status were identified as additional risk factors (hazard ratios: 2.03, 1.54-1.98, and 1.79, respectively). In the PI-RADS 1-2 cohort, 1, 3, and 5-year cs-PCa diagnosis-free survival rates were 99.1%, 96.5%, and 93.8%, respectively. For the PI-RADS 3 cohort, 1, 3, and 5-year cs-PCa diagnosis-free survival rates were 94.9%, 90.9%, and 89.1%, respectively. For the PI-RADS 4 cohort, 1, 3, and 5-year cs-PCa diagnosis-free survival rates were 56.6%, 55.1%, and 55.1%, respectively. These rates were found to all be 24.2% in the PI-RADS 5 cohort. Considering the 394 cases diagnosed with PCa during follow-up, PI-RADS ≥4 cases were more likely to harbor unfavorable PCa compared to PI-RADS ≤3 cases (p < 0.001). In the PI-RADS 3 subgroup analysis, a low mPSAD (<0.15 ng/mL2) was found to be a protective prognostic factor against unfavorable PCa (P = 0.005). CONCLUSION The PI-RADS category has a significant impact on patient management and provides important diagnostic and prognostic information. Higher initial PI-RADS categories are associated with decreased follow-up losses, a shorter time to PCa diagnosis, increased biopsy rates, a higher likelihood of developing cs-PCa during follow-up, and a worse PCa prognosis. Combining mPSAD with PI-RADS categories could enhance diagnostic stratification in the identification of cs-PCa.

BACKGROUND:To evaluate the associations between hepatic, pancreatic steatosis, and lumbar spinal bone marrow fat determined by magnetic resonance imaging-proton density fat fraction in patients with no known or suspected liver disease.METHODS:A total of 200 patients who were referred to our radiology department for upper abdominal magnetic resonance imaging between November 2015 and November 2017 were included in this study. All patients underwent a magnetic resonance imaging-proton density fat fraction on a 1.5-T magnetic resonance imaging system.RESULTS:The mean liver, pancreas, and lumbar magnetic resonance imaging-proton density fat fraction were 7.52 ± 4.82%, 5.25 ± 5.44%, and 46.85 ± 10.38% in the study population. There were significant correlations between liver and pancreas (rs = 0.180, P = .036), liver and lumbar (rs = 0.317, P < .001), and pancreas and lumbar magnetic resonance imaging-proton density fat fraction (rs = 0.215, P = .012) in female patients. A weak correlation was observed between liver and lumbar magnetic resonance imaging-proton density fat fraction (rs = 0.174, P = .014) in the total population. The prevalence of hepatic and pancreatic steatosis was 42.5% and 29%, respectively. The prevalence of pancreatic steatosis (42.9% vs. 22.8%, P = .004) was higher in male patients compared to female patients. In subgroup analysis, in patients with hepatic steatosis, there were higher pancreas magnetic resonance imaging-proton density fat fraction (6.07 ± 6.42% vs. 4.66 ± 4.53%, P = .036) and lumbar magnetic resonance imaging-proton density fat fraction (48.81 ± 10.01% vs. 45.40 ± 10.46%, P =.029) compared to patients without hepatic steatosis. In patients with pancreatic steatosis, there were higher liver (9.07 ± 6.08 vs. 6.87 ± 4.06, P = .009) and lumbar magnetic resonance imaging-proton density fat fraction (49.31 ± 9.13% vs.45.83 ± 10.76%, P = .032) in comparison with patients without pancreatic steatosis.CONCLUSION:Based on the results of the present study, fat accumulation in liver, pancreas, and lumbar vertebra have associations with more evident in females.

Infarcts and ischemia of abdominal organs may present with acute abdominal pain, and early diagnosis is crucial to prevent morbidity and mortality. Unfortunately, some of these patients present in poor clinical conditions to the emergency department, and imaging specialists are crucial for optimal outcomes. Although the radiological diagnosis of abdominal infarcts is often straightforward, it is vital to use the appropriate imaging modalities and correct imaging techniques for their detection. Additionally, some non-infarct-related abdominal pathologies may mimic infarcts, cause diagnostic confusion, and result in delayed diagnosis or misdiagnosis. In this article, we aimed to outline the general imaging approach, present cross-sectional imaging findings of infarcts and ischemia in several abdominal organs, including but not limited to, liver, spleen, kidneys, adrenals, omentum, and intestinal segments with relevant vascular anatomy, discuss possible differential diagnoses and emphasize important clinical/radiological clues that may assist radiologists in the diagnostic process.

Magnetic resonance imaging-proton density fat fraction (MRI-PDFF) is an emerging quantitative imaging biomarker that accurately measures the fat fraction of tissue by correcting factors influencing magnetic resonance signal intensity. Beyond fat quantification, it also measures R2* which is a direct measure of iron concentration. The utilization of MRI-PDFF in liver diseases is well established. In the present review, we focused on applications of MRI-PDFF in different body areas including pancreas, bone, muscle, spleen, testis, visceral, and subcutaneous adipose tissue. Future studies can enable tracking of quantitative fat fraction changes in different organs simultaneously, which can be critical in understanding fat metabolism.

Abstract Objective To evaluate the magnetic resonance elastography (MRE)-derived liver stiffness measurement (LSM), T1 and T2 relaxation times, and hepatobiliary phase images in patients, who developed sinusoidal obstruction syndrome (SOS) after oxaliplatin-based chemotherapy. Methods Thirty-four patients (M/F:22/12) who underwent liver MRI-MRE and received oxaliplatin for colorectal, gastric, and pancreas cancer were included in the study. SOS was diagnosed by Gd-EOB-DTPA-enhanced MRI in 18 patients. MRE-LSM and T1–T2 maps were evaluated. Patients with SOS were grouped according to the amount of reticular hypointensity on the hepatobiliary phase images. Results The mean MRE-LSM in the patients with SOS was 3.14 ± 0.45 kPa, and the control group was 2.6 ± 0.5 kPa (p = 0.01). The mean-corrected T1 (cT1) relaxation time was 1181 ± 151 ms in the SOS group and 1032 ± 129 ms in the control group (p = 0.005). The mean T2 relaxation time was 50.29 ± 3.6 ms in the SOS group and 44 ± 3.9 ms in the control group (p = 0.01). Parenchymal stiffness values were 2.8 ± 0.22 kPa, 3 ± 0.33 kPa, and 3.65 ± 0.28 kPa in patients with mild, moderate, and advanced SOS findings, respectively (p = 0.002). Although cT1 and T2 relaxation times increased with increasing SOS severity, no statistical significance was found. Conclusions We observed increased MRE-LSM in patients with SOS after chemotherapy compared to control group. T1 and T2 relaxation times were also useful in diagnosing SOS but were found inadequate in determining SOS severity. MRE is effective in diagnosing SOS and determining SOS severity in patients who cannot receive contrast agents, and it may be useful in the follow-up evaluation of these patients.

Contrary to traumatic and iatrogenic intraabdominal hemorrhages, spontaneous intraabdominal hemorrhage is a challenging clinical situation. A variety of neoplastic and non-neoplastic conditions may cause spontaneous intraabdominal bleeding. Imaging findings vary depending on the source of bleeding and the underlying cause. In this article, we aim to increase the awareness of imagers to the most common causes of spontaneous intraabdominal hemorrhage by using representative cases.

The detection rates of adrenal masses are increasing with the common and widespread use of cross-sectional imaging. Adrenal adenomas, myelolipomas, metastases, pheochromocytomas, and adrenocortical tumors are well-known and relatively common adrenal tumors. However, there are many less-known neoplastic and nonneoplastic adrenal diseases that might affect the adrenal glands in addition to these common lesions. These rare entities include, but are not limited to, hydatid cysts, congenital adrenal hyperplasia, Wolman disease, adrenal tuberculosis, primary adrenal lymphoma. This article aims to present imaging findings of these unusual lesions in accordance with their pathologic characteristics. We think that the simultaneous presentation of the pathological findings with the imaging features may facilitate the learning process and may potentially enhance the recognition of these entities.

PURPOSE:Knowledge of normal anatomy and variations of testicular arteries are critical for planning before minimally invasive surgery. In this article, we aimed to evaluate the morphological characteristics of testicular arteries by MDCT and propose a new classification system. METHOD:A total of 400 adult patients (total of 819 testicular arteries) who underwent abdominal CT angiography examination for several unrelated reasons were enrolled in this study. Testicular arteries (TAs) were evaluated in terms of number, origin, course, and caliber. Based on our findings, we also proposed a novel anatomical classification for the TAs according to their origin (divided into 5 types-type 1-5-) and course (divided into three types-type a-c-). Type 4 origin and type a course are the expected normal origin and course of bilateral TAs. RESULTS:The most common type based on the origin was type 4, with the testicular artery originating from the abdominal aorta, inferior to the level of the renal artery within 5 cm distal to the renal arteries. 70.7% of the right and 75.6% of the left testicular arteries were type 4. The most common type of the vessel course was the normal expected trajectory (type a) with an incidence of 76.3% for the right and 82.6% for the left testicular arteries. CONCLUSION:Normal anatomy and variations of testicular arteries may be effectively evaluated by CT angiography in a non-invasive manner.

The gastrohepatic ligament, a major part of the lesser omentum with hepatoduodenal ligament, is an important anatomic structure connected to several other intraabdominal organs and ligaments. It is at the crossroads of several different anatomic structures and may be affected by different diseases. In this article, we aim to increase the awareness of imagers to this small anatomic structure and provide clues for correct diagnosis and assessment of diseases that may affect this area. We will examine various diseases involving the gastrohepatic ligament in detail and try to address its importance using representative cases.

The spleen plays an important role in the immunological homeostasis of the body. Several neoplastic and non-neoplastic diseases may affect this organ, and imaging is of fundamental importance for diagnosis. Infectious diseases of the spleen can be encountered in daily radiology practice, and differential diagnosis may sometimes be challenging. Infectious involvement of the spleen can be primary or secondary to a different source outside the spleen. Despite the fact that different infectious diseases may cause similar imaging findings, we believe that differential diagnosis between different causes may also be possible in certain patients with imaging. Early diagnosis may potentially enhance patients' treatment and outcome. In this review, we aimed to increase imaging specialists' awareness of splenic infections by describing the multimodality imaging features of common and atypical infections of the spleen with their differential diagnoses.

Introduction: Aneurysm of the communicating vein between the left renal vein and left ascending lumbar vein is extremely rare, with only anecdotal reported cases. Unless detected and recognized promptly, this rare condition may give rise to severe bleeding in patients undergoing retroperitoneal surgery. It may also closely mimic enlarged retroperitoneal lymph nodes, paragangliomas, adrenal masses, or renal artery aneurysms. Case report: In this case study, we reported the imaging findings of this rare entity which was falsely diagnosed as enlarged retroperitoneal lymph node in an outside medical center, reported as to be consistent with metastatic disease, in a patient with newly diagnosed testicular cancer. Conclusion: The aneurysm of the communicating vein should be considered in the differential diagnosis in patients with testicular cancer and other disease processes where lymph nodes are commonly affected.

Since its first introduction in 2003 by Kamisawa et al., IgG4-related disease has gained wide interest in the imaging community, and several manuscripts have been published regarding its imaging features. In addition to initial observations in the pancreaticobiliary system, it is now well known that the disease may involve every organ system in the body. There is not much information in the imaging literature about the involvement of mesentery, omentum, and peritoneum in this disease. This article aims to provide more information about the imaging findings of IgG4-related disease regarding these areas by making radiopathological correlations and discussing the possible differential diagnoses.

Variations in the anatomy of inferior vena cava (IVC) may have important clinical implications. In-depth knowledge of its embryology and variations are of fundamental importance to prevent any potential medical complications related to anatomic variations of the IVC. In this article, we described a previously unreported, to the best of our knowledge, a variation of IVC. In the case we presented, the IVC was seen almost completely encircling the abdominal aorta. We decided to call this anatomic variation as “a sling of a normal right IVC around the abdominal aorta”. Cross-sectional imaging is a prompt and highly reliable method to evaluate IVC anatomy and may have significant clinical importance to prevent any potential complications related to IVC during surgery or interventional radiology procedures.

Tumors of the genital system are common and imaging is of crucial importance for their detection and diagnosis. Several non-neoplastic diseases may mimic these tumors and differential diagnosis may be difficult in certain cases. Misdiagnosing non-neoplastic diseases as tumor may prompt unnecessary medical treatment or surgical interventions. In this article, we aimed to present the imaging characteristics of non-neoplastic diseases of the male and female genital systems that may mimic neoplastic processes. Increasing awareness of the imaging specialists to these entities may have a severe positive impact on the management of these patients.