Background:Accurate preoperative imaging is essential in advanced epithelial ovarian cancer, where complete cytoreduction remains the strongest prognostic factor. This study evaluates the CT PAUSE score-a structured, domain-based reporting tool-for its utility in surgical planning and multi-disciplinary team (MDT) decision-making. Methods:In this prospective cross-sectional study between September 2022 to February 2024, 124 patients with FIGO stage III/IV ovarian cancer underwent 175 contrast-enhanced CT scans. PAUSE components-Peritoneal Cancer Index (PCI), Ascites/abdominal wall disease, Unfavourable sites, Small bowel/mesenteric disease, and Extra-peritoneal metastases-were prospectively scored during evaluation. Interobserver agreement was assessed in a subset of 30 cases. Findings:MDT triage using PAUSE resulted in a complete cytoreduction rate of 89.3%. A simplified nomogram based on upper abdominal disease volume showed discriminatory ability (area under the curve (AUC) [95% CI] = 0.820 [0.740-0.880]) and could be an alternative to the full radiological PCI-based nomogram (AUC) [95% CI] = 0.763 [0.677-0.835]), in busy clinical settings. Interobserver agreement was substantial for both nomogram scores, with higher reliability observed for the score derived from the upper abdominal disease-based nomogram (intraclass correlation coefficient (ICC) [95% CI] = 0.710 [0.582-0.825] versus 0.627 [0.460-0.778]; p < 0.001). Interpretation:CT PAUSE provides a structured approach to radiological reporting and may support more consistent MDT discussions and surgical triage in advanced ovarian cancer. Its performance in this cohort might suggest potential for integration into clinical workflows, pending further validation. Funding:There was no funding source for this study.

Groove pancreatitis (GP) is a form of pancreatitis that affects the pancreaticoduodenal groove area, which lies between the head of the pancreas, the second part of the duodenum and the distal bile duct, presenting as abdominal pain and gastric outlet obstruction. In this study, we present the clinical and radiological characteristics of individuals diagnosed with groove pancreatitis at our center and discuss the use of a conservative treatment approach in managing GP. The data of patients with groove pancreatitis treated at our center between January 2012 and December 2021 was analyzed. The clinical, laboratory and radiological features were recorded and patients were followed up for at least six months in the pancreatic clinic by a specialist doctor. Fifty patients were included in the study. Most patients were males (98

To develop and validate a biparametric MRI (bpMRI)-based nomogram for distinguishing malignant or potentially malignant uterine smooth muscle tumors from atypical benign leiomyomas. In this retrospective study, patients who underwent MRI for atypical uterine masses from January 2012 to January 2023 and subsequently underwent surgery were identified. MRI was performed using 1.5 Tesla or 3 Tesla scanners, including T2-weighted, diffusion-weighted sequences, and ADC maps. Two experienced radiologists evaluated lesions for qualitative features (i.e., T1/ T2 signal intensity, margins, presence of haemorrhage, DWI restriction) and quantitative mean ADC values. Histopathology served as the reference standard. Logistic regression identified significant predictors of malignancy, which were incorporated into a point-based nomogram. Receiver Operating Characteristic (ROC) analysis assessed model performance; interobserver agreement was evaluated using Cohen’s kappa. Eighty-nine lesions from 77 patients (median age, 45.6 years) were included. Malignant and potentially malignant lesions were 26 (30

Among cancers, carcinoma gallbladder has one of the most dismal prognosis. Early lesions are difficult to biopsy because of proximity to luminal structures and risk of biliary peritonitis. However, early surgery offers the only chance of a complete cure. Utilizing a risk score would allow characterization of the risk of malignancy and early referral to an oncology centre thereby resulting in better outcomes for patients with carcinoma gallbladder. The aim of this study was to develop a risk score for carcinoma in patients with suspicious gallbladder lesions based on clinical presentation and imaging. All patients with suspicious gallbladder lesions on radiological imaging who underwent surgery were analyzed. Patients were considered for scoring if the ultrasound showed the gallbladder wall thickening (more than 4 mm) and computed tomography scan showed operable disease. Statistical analysis was done to derive a score for malignancy. Total 175 patients underwent an operation for suspicious gallbladder lesions from January 2005 to December 2014. The factors analyzed were clinical biochemical and imaging findings. Of these, 71 were benign on the final histopathology and 104 were malignant. The score was constructed with the following variables: female sex, high total bilirubin (≥ 1 mg/dL), presence of a mass, focal location of the lesion, presence of gallbladder stones and nodal involvement in the hepatoduodenal region on imaging. A model score and modified score were obtained. In this modified score, score of more than 8 out of 20 predicted malignancy with a sensitivity of 78

A variety of tumors involve the anal canal because the anal canal forms the transition between the digestive system and the skin, and this anatomical region is made of a variety of different cells and tissues. Magnetic resonance imaging (MRI) is the modality of choice for diagnosis and local staging of the anal canal and perianal neoplasms. In this pictorial review, we demonstrate the MRI anatomy of the anal canal and perianal region and display the imaging spectrum of tumors in the region along with an overview of its management. Imaging appearances of many tumorlike lesions that can cause diagnostic dilemmas are also demonstrated with pointers to differentiate between them.

To study the prevalence of extramural vascular invasion (EMVI) in patients with gastric adenocarcinoma (GA) and its association with other prognostic factors. In this retrospective study, consecutive patients with GA who underwent staging CT between January 2021 and December 2022 were included. Two radiologists reviewed the staging CT for EMVI and its grade and documented tumor location, thickness, and TNM stage. Grade 3 and 4 EMVI were reported as ct-EMVI positive and the rest as negative. Similar findings were documented on restaging CT following neoadjuvant chemotherapy (NAC) when available. ct-EMVI was compared with imaging findings on staging and restaging CT, staging laparoscopy findings, peritoneal fluid cytology, and surgical histopathology findings. A total of 191 patients (140 males, 51 females) with a mean age of 53 ± 9 years (range 23–93 years) were included. 82.2

Abstract Objectives  The main aim of this study was to compare magnetic resonance imaging (MRI) findings of recurrent and treatment-naïve fistula-in-ano and to correlate imaging findings with anal sphincter morphology in recurrent fistula-in-ano. Methods  This is a retrospective study of adult patients who underwent MRI for suspected fistula-in-ano in 2018. After excluding patients with alternative diagnosis, patients were stratified into recurrent ( n  = 103) and treatment-naïve ( n  = 106) fistula-in-ano groups. Two blinded radiologists reread MRI scans in consensus for fistula characteristics and anal sphincter morphology. We compared imaging features of recurrent and treatment-naïve fistula-in-ano, assessed the incidence of anal sphincter scarring among patients with recurrent fistula-in-ano, and studied its association with fistula features. Results  Two-hundred nine patients (187 males) with mean age of 40.6 (standard deviation: 12.2) years were included. Trans-sphincteric, inter-sphincteric, extra-sphincteric, and supra-sphincteric fistula-in-ano were seen in 63.6, 33, 2.9, and 0.5%, respectively. There were secondary tracts, supralevator extension, and secondary cause for fistula in 49.3, 12.9, and 14.8%, respectively. There was no difference between the fistula features of recurrent and treatment-naïve fistula-in-ano, except for significantly fewer external openings among recurrent fistula-in-ano ( p  = 0.005). Among patients with recurrent fistula-in-ano, MRI detected anal sphincter defect/scarring was seen in 53.4% ( n  = 55) and was significantly associated with posterior fistula-in-ano ( p  = 0.031), collections and/or supralevator extension ( p  = 0.010), and secondary tracts ( p  = 0.015). Conclusion  Fistula features of recurrent and treatment-naïve patients were mostly similar. There was high incidence (53.4%) of MRI-identified anal sphincter scarring/defect among recurrent fistula-in-ano, which was significantly associated with posterior fistula, collections, supra or translevator extension, and secondary tracts. Key Points MRI-identified anal sphincter scarring is very common among patients with recurrent fistula-in-ano and seen in more than half of them. There was significantly higher incidence of sphincter scarring among patients who had posterior fistula, collections, supralevator/translevator extension, and secondary tracts.

Welcome to this special issue of Journal of Gastrointestinal and Abdominal Radiology (JGAR). Our concepts of hepatic pathophysiology have advanced tremendously in the recent times, as for example, with the understanding of the different types of hepatic adenomas or the role of organic anion transporting polypeptides receptor for hepatobiliary contrast uptake. Hepatic imaging concepts and techniques have also made tremendous strides. In fact, a vast majority of hepatic lesions can now be diagnosed on imaging alone, be it cysts, hemangiomas, focal nodular hyperplasia, hepatocellular carcinoma, or cholangiocarcinomas. With the addition of contrast-enhanced ultrasound and hepatobiliary magnetic resonance (MR) contrast to our armory, we have got even better at problem-solving while characterizing hepatic lesions.

Total neoadjuvant therapy (TNT) with pre-operative chemotherapy and chemoradiotherapy results in improved survival and is becoming the new standard of care in locally advanced rectal cancer (LARC). We describe our experience with TNT consisting of induction chemotherapy followed by chemoradiotherapy using full dose 5FU without oxaliplatin. Adults with biopsy-proven, newly diagnosed LARC with high-risk characteristics on pelvic MRI (T4a or T4b, extramural vascular invasion, N2, mesorectal fascia involvement, enlargement/tumor deposits on lateral lymph nodes) were included. The TNT protocol comprised of six biweekly courses of modified FOLFOX6 followed by pelvic RT with four concurrent cycles of biweekly 5-FU 2600 mg/m2 + LV 200 mg/m2 without oxaliplatin to complete 20 uninterrupted weeks of full dose 5FU. Surgery was planned 11–13 weeks after completing chemoradiotherapy. Eighty-four LARC patients, including 26

AimTo study the additional utility of pre-nephrectomy whole and cortical kidney volumes (WKV, CKV) in predicting long-term post-nephrectomy kidney function in Indian living kidney donors (LKDs). MethodsThis retrospective cohort study included all LKDs who underwent nephrectomy between 1 January 2006 and 31 December 2015 at our centre, had pre-nephrectomy height, weight and computed tomography (CT) angiography with arterial and nephrographic phase documented, and 5-year post-nephrectomy creatinine values measured. Correlation between body surface area (BSA) adjusted pre-nephrectomy total CKV, WKV and pre-nephrectomy CKD EPI eGFR; BSA-adjusted remnant pre-nephrectomy CKV (rCKV), WKV (rWKV) and 5-year post-nephrectomy CKD EPI creatinine eGFR (5yeGFR(Cr)); predictors of 5yeGFR(Cr) < 70% of pre-nephrectomy CKD EPI creatinine eGFR (pre-eGFR(Cr)), and an equation to predict 5yeGFR(Cr) from pre-nephrectomy variables were calculated. ResultsA total of 196 LKDs (74% female, mean age 41.7 +/- 11.0 years) were included in the study. Total WKV showed higher correlation with pre-nephrectomy eGFR than CKV, the highest with CKD EPI cystatin eGFR. Remnant WKV showed higher correlation than rCKV with post-nephrectomy eGFR(Cr) and this increased over time. Older age, lower rWKV or rCKV, higher BSA, and higher pre-eGFR(Cr) identified LKDs with 5yeGFR(Cr) < 70% of pre-eGFR(Cr), with rCKV identifying a higher proportion (4.5%) of such LKDs. A model including rWKV or rCKV predicted 5yeGFR(Cr) better than one including age, gender, BSA and pre-eGFR(Cr) alone. ConclusionInclusion of pre-nephrectomy remnant CKV and WKV into models for 5yeGFR(Cr) and sub-optimal post-nephrectomy adaptation in Indian LKDs improves their accuracy. CKD EPI cystatin eGFR correlates better with functional renal mass.

BACKGROUND:Discordant findings are often noted between PET-CT and CT images of 18F-FDG PET-CT scans and cause ambiguity in image interpretation.This study aimed at determining the significance of these findings in the management of oncology patients. CONTEXT:Discordant findings are often noted between PET-CT and CT images of 18F-FDG PET-CT scans and cause ambiguity in image interpretation. AIM:This study aimed at determining the significance of these findings in the management of oncology patients. METHODS:This was an observational, descriptive study. Hence, retrospective analysis of all discordant findings in oncology patients undergoing a PETCT imaging between Jan 2013 and Jan 2016 was done. Those patients who had a follow-up period of minimum 1 year in either of the following forms - repeat PETCT imaging, other radiological imaging, clinical, or histopathological evidence were included. From all the discordant lesions, the sensitivity, specificity, positive predictive, negative predictive value, and accuracy of both PET-CT and CT modalities were determined. RESULTS:Of 348 discordant lesions, 16.7% was noted in soft tissues, 25% in viscera, 28.7% in lungs, 14.1% in lymph nodes, and 15.5% in bones. At the end of follow-up, 15.2% lesions were PET true positive, 57.5% PET true negative, 10.1% CT true positive lesions, 13.8% CT true negative, and 3.4% were inconclusive. CONCLUSION:18F-FDG PET-CT is superior to CT imaging and should be considered as the first-line imaging modality in oncology patients.

Abstract Background The spectrum of placental adhesive disorders (PAD) forms an important cause for emergency cesarean hysterectomy, requiring an accurate prenatal diagnosis for optimal obstetric management. Purpose The aim of this study was to assess the utility of magnetic resonance imaging (MRI) and to identify the individual MRI features that are most useful in the evaluation of PAD. Materials and Methods This was a retrospective review of the MRI of 24 women with abnormal placentation, confirmed using histopathology/intraoperative findings as the reference standard. Patients were categorized as negative or positive for PAD (placenta accreta, increta, and percreta) on MRI and compared with the reference standard. We assessed the diagnostic performance of MRI and the features that best correlated with the presence of PAD. Results Among the 24 women (mean age: 29.8 years) with risk factors, 16 had PAD (6 accreta, 7 increta, and 3 percreta). There was a history of previous lower segment cesarean section and placenta previa in 14 (87.5%). MRI could identify the presence of PAD in all (100% sensitivity) and its absence in three out of eight patients (37.5% specificity). The features with highest sensitivity were intraplacental dark bands (100%), myometrial thinning/loss of interface with myometrium (100%), placental heterogeneity (75%), and uterine contour abnormality (75%). Conclusion MRI is an important modality for the investigation of PAD in suspected cases, with excellent sensitivity and good accuracy. Identifying the presence of risk factors, low-signal-intensity bands, and thinning/loss of placental–myometrial interface will aid in its diagnosis.

Welcome to Part 2 of the Special Issue of Liver Imaging, of Journal of Gastrointestinal and Abdominal Radiology (JGAR). This part is specially dedicated to imaging of primary malignant liver neoplasms. As we know, advances in imaging and a better understanding of liver neoplasms have contributed towardmaking an accurate diagnosis on imaging, often obviating the need for a biopsy. It goes without saying that a good understanding of the pathogenesis of a tumor is crucial to understanding its imaging appearance and thus in making the right diagnosis. In the first article of this issue, Sen et al1 provide a detailed review of etiopathogenesis of hepatocellular carcinoma and how this translates into imaging appearances, supplemented by tables and images that would make easy learning, particularly for the residents. Liver Imaging Reporting And Data System (LIRADS) has been a means of standardized and accurate reporting of liver tumors in individuals at risk. A detailed, meticulous account of LIRADS has been provided by Ganesan et al2,3 with a section on the gray zone in LIRADS that provides clarity on some perceived “gray” areas in LIRADS reporting. There has been a definite increase in locoregional therapies offered to patients with hepatic neoplasms than what was available many years ago. Choudhari et al4 discuss the various treatment strategies, imaging appearances after treatment with special focus on LIRADS treatment response assessment and this is an excellent review of a complex topic. Biliary neoplasms, particularly gallbladder malignancy and cholangiocarcinoma, are tumors with dismal prognosis and not uncommon in the Indian setting. Lee and Rajesh et al5 have a given a detailed review of these tumors with useful structured reporting templates for these neoplasms that would facilitate accurate reporting and help decide operability of these tumors or further management. Lastly, canwe forget the uncommon tumors that often present themselves to remind us of their existence? Vikram et al6 have explicitly presented a spectrum of uncommon neoplasms with varied imaging appearances and have included the pediatric age group neoplasm, hepatoblastoma. We trust that the Part 1 of the Special Issue of Liver Imaging brought you great satisfaction and hope that Part 2 on primary malignant liver neoplasms will also provide a great learning experience. Sincere thanks to all the authors who contributed to the Special Issue of Liver Imaging of JGAR.

AbstractIncrease in portal venous pressure (termed portal hypertension) is seen in a variety of liver diseases. Imaging tests are useful to detect portal hypertension and identify its cause. Noninvasive tests like abdominal ultrasound and Doppler studies are routinely done in clinical practice for this indication. Cross-sectional studies like computed tomography and magnetic resonance imaging are especially useful to delineate morphological abnormalities in the liver. Invasive tests like assessment of hepatic venous pressure gradient are done less frequently for specific indications. Distinctive imaging findings help differentiate the different causes of portal hypertension like cirrhosis and vascular liver disorders like noncirrhotic portal hypertension, extrahepatic portal venous obstruction, and Budd–Chiari syndrome. Radiological interventions are increasingly used to treat complications of portal hypertension like refractory ascites or refractory bleeding from gastroesophageal varices.

Context:Positron emission tomography (PET) using F-18 fluorodeoxyglucose (FDG) for treatment monitoring in patients with lymphoma is one of the most well-developed clinical applications. Deauville five-point score (DS) is recommended for response assessment in international guidelines. DS gives the threshold for adequate or inadequate response to be adapted according to the clinical context or research question. Aims:We aimed to validate DS in Hodgkin's lymphoma (HL) by retrospectively assigning this score to F-18 FDG PET-computed tomography (CT) studies done before 2016 and analyzing its concordance with the line of management. The secondary aim was to assess the reproducibility of DS in the interpretation of PET-CT scans. Subjects and Methods:A total of 100 eligible consecutive patients underwent F-18 FDG PET-CT scans between January 2014 and December 2015. Their interim, end of treatment, and follow-up PET scans were retrospectively visually analyzed and assigned DS by three nuclear medicine physicians. Concordance was defined as agreement between the DS assigned and the line of treatment. Interobserver variability was calculated using weighted Kappa and presented with 95% confidence interval. Results:Among 212 scans assigned DS, 165 scans showed agreement between the DS and line of treatment. Of these, 95.2% of scans scored DS 1-3 were kept on following or the same treatment plan was continued and patients did well. Among the scans that showed discordance, 24 scans scored DS 4/5 were continued on the same treatment regimen and the next assessment showed disease progression. Conclusions:Our study confirmed that DS is a useful tool to aid in reporting F-18 FDG PET-CT in the management of HL with good positive and negative predictive values. This study also demonstrated good interobserver agreement.

Small bowel malignancies are rare, though colorectal cancers are common. This article reviews the current imaging recommendations for small bowel and colorectal malignancies. Contrast-enhanced computed tomography (CT) is the imaging modality of choice for diagnosis/staging/response evaluation/follow-up of the small bowel and colonic tumors. Magnetic resonance imaging of the pelvis with high-resolution T2-weighted images in sagittal, oblique axial, and coronal planes is the imaging modality of choice for staging/response evaluation of anorectal tumors. CT colonography may be utilized as a tumor screening modality, alternative to colonoscopy.