Photon-counting CT (PCCT) is an emerging imaging modality that offers improved spatial resolution, soft tissue contrast, material decomposition, and dose efficiency over conventional CT with energy-integrating detectors (EID-CT). For patients with abdominal malignancies, who routinely undergo cross-sectional imaging for diagnosis, staging, response assessment, and surveillance, PCCT has the potential to enhance the detection and characterization of contrast-enhanced tumors and improve treatment response assessment. The objectives of this review are to provide a comprehensive overview of the technical principles of PCCT, optimization strategies, advantages in abdominal oncologic imaging, and current clinical applications geared towards clinical radiologists. We also address implementation challenges and discuss future directions for integrating PCCT into routine oncologic care. As PCCT utilization increases, its impact on abdominal cancer diagnosis and management is expected to grow, offering new opportunities for precision medicine and personalized imaging strategies. Not applicable.

To determine the performance of MRI features alone and combined in a model for the diagnosis of placenta accreta spectrum (PAS) disorders in pregnant women. This single health system IRB-approved retrospective study included 131 pregnant women who underwent MRI for placental (n = 122) or fetal (n = 9, controls) indications (2016–2021). Three independent observers assessed 11 PAS features on MRI, endorsed in prior studies, with consensus adjudication of discordances by 2 separate expert observers. The reference standard was established by intra-operative findings and/or pathology. Univariable and multivariable logistic regression and ROC analysis evaluated MRI feature performance for PAS diagnosis alone and combined in a model. 131 pregnant patients (mean age 36 years, range 21–54 years; mean gestational age 28 weeks) were included. PAS was present in 54/131 (41.2

MRI findings have limited reproducibility across different readers, necessitating more training and education on the subject, clarification on feature definitions, and consideration of double reading, expert consensus, or multidisciplinary interpretation.

Purpose Interactions between radiologists and emergency physicians are often diminished as imaging volume increases and more radiologists read off site. We explore how several commonly used phrasings are perceived by radiologists and emergency physicians to decrease ambiguity in reporting. Methods An anonymous survey was distributed to attendings and residents at seven academic radiology and emergency departments across the USA via a digital platform as well as to an email group consisting of radiologists across the country with an interest in quality assurance. Physicians were asked to assign a percent score to probabilistic phrases such as, “suspicious of,” or “concerned for.” Additional questions including, “how often the report findings are reviewed,” “what makes a good radiology report,” and “when is it useful to use the phrase ‘clinical correlation are recommended.’” Median scores and confidence intervals were compared using an independent Student’s T -test. Results Generally, there was agreement between radiologists and emergency room physicians in how they interpret probabilistic phrases except for the phrases, “compatible with,” and “subcentimeter liver lesions too small to characterize.” Radiologists consider a useful report to answer the clinical question, be concise, and well organized. Emergency physicians consider a useful report to be concise, definitive or include a differential diagnosis, answer the clinical question, and recommend a next step. Radiologists and emergency physicians did not agree on the usefulness of the phrase, “clinical correlation recommended,” in which radiologists found the phrase more helpful under particular circumstances. Conclusion The survey demonstrated a wide range of answers for probabilistic phrases for both radiologists and emergency physicians. While the medians and means of the two groups were often different by statistical significance, the actual percent difference was minor. These wide range of answers suggest that use of probabilistic phrases may sometimes lead to misinterpretation between radiologist and emergency room physician and should be avoided or defined if possible.

Background: Reports have indicated an association of large vessel peripheral arterial occlusion in the setting of Coronavirus Disease 2019 (COVID-19). While prior investigations have mostly focused on venous or cerebral arterial occlusions, we examined patients presenting exclusively with peripheral arterial extremity occlusions to investigate for any predisposing factors in this subset of COVID-19 patients. Materials and methods: This is a retrospective study of COVID-19 patients with peripheral arterial occlusions presenting to a multi-hospital health care system in New York City between February 1st, 2020 and April 30th, 2020. Patient data and computed tomography angiography (CTA) exams in this subset were then collected and analyzed. Results: For the months of February, March, and April 2020, we identified 9 patients (ages 37-93 yrs) at our health care system who underwent extremity CTA for large vessel upper or lower extremity arterial occlusion and were diagnosed with COVID-19. Patient medical histories and clinical parameters were evaluated to identify common risk factors including obesity, hypertension, hyperlipidemia, and diabetes. Patients presented with increased inflammatory markers including ferritin, erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) as well as increased D-dimer. Conclusion: Our findings suggest patients with COVID-19 and comorbidities presenting with elevated inflammatory markers and D-dimer may be at increased risk of large vessel peripheral arterial occlusion.

Autosomal dominant polycystic kidney disease (ADPKD) eventually leads to end stage renal disease (ESRD) with an increase in size and number of cysts over time. Progression to ESRD has previously been shown to correlate with total kidney volume (TKV). An accurate and relatively simple method to perform measurement of TKV has been difficult to develop. We propose a semi-automated approach of calculating TKV inclusive of all cysts in ADPKD patients based on b0 images relatively quickly without requiring any calculations or additional MRI time. Our purpose is to evaluate the reliability and reproducibility of our method by raters of various training levels within the environment of an advanced 3D viewer. Thirty patients were retrospectively identified who had DWI performed as part of 1.5T MRI renal examination. Right and left TKVs were calculated by five radiologists of various training levels. Interrater reliability (IRR) was estimated by computing the intraclass correlation (ICC) for all raters. ICC values calculated for TKV measurements between the five raters were 0.989 (95% CI = (0.981, 0.994), p < 0.01) for the right and 0.961 (95% CI = (0.936, 0.979), p < 0.01) for the left. Our method shows excellent intraclass correlation between raters, allowing for excellent interrater reliability.

•Uterine artery embolization as management of uterine rupture due to invasive GTN.•Fertility preservation for select cases of uterine rupture due to invasive GTN.•Conservative surgery and chemotherapy for invasive GTN with uterine rupture.

Pregnant women with abdominal pain can pose a diagnostic dilemma due to the nonspecific nature of symptoms and the desire to avoid radiation to the conceptus. Many algorithms will suggest ultrasound (US) or Magnetic Resonance Imaging (MRI) as the first-line imaging choice in pregnant women with abdominal pain due to the lack of ionizing radiation. However, these studies can have limitations as well. Abdominopelvic MRI is susceptible to respiratory motion that could cause a study to be nondiagnostic (Zaitsev et al., 2015 [1]). In the current case series, we present 8 pregnant patients with abdominal pain who underwent CT abdomen and pelvis after negative or inconclusive abdominal MRI exams. To our knowledge, this is the only case series that describes CT findings in the pregnant population after negative or inconclusive MRI.

Pancreatic neuroendocrine tumors (PNETs) are uncommon pancreatic masses which arise from amine precursor and uptake decarboxylation cells. They are classified as functional or nonfunctional based on the associated clinical symptoms. Insulinomas and gastrinomas are the most common functional tumors. PNETs are also classified based on their biologic behavior as benign or malignant. While most PNETs are sporadic, a small percentage are associated with syndromes such as multiple endocrine neoplasia type 1, von Hippel-Lindau syndrome, and are usually multiple in those cases. On imaging, most PNETs are circumscribed and hypervascular masses; however, larger tumors are often heterogeneous. The presence of calcification, cystic degeneration, and necrosis increases the likelihood of malignancy and carries a poor prognosis. Metastases have similar imaging appearance to the primary lesion and are most commonly seen in the liver, locoregional lymph nodes, and bone. This article reviews the pathologic and radiologic features of pancreatic neuroendocrine tumors as well as imaging mimics and their distinguishing features. (C) 2019 Published by Elsevier Inc.

Here we report the case of a pregnant 28-year-old who presented with acute upper abdominal pain. CT demonstrated midgut volvulus with short segment occlusion of the superior mesenteric artery (SMA). Emergent detorsion of the small bowel was performed, at which time underlying intestinal malrotation was discovered. Following detorsion, the SMA had a bounding pulse and did not require thrombectomy or revascularization. Fewer than 25 cases of midgut volvulus during pregnancy have been reported over the past 20years. To our knowledge, this is the first report of maternal midgut volvulus in which imaging captures the resultant occlusion of the SMA.

Introduction: Nutritional support is associated with better patient outcomes in acute pancreatitis (AP). However current tools to assess nutritial status including NSR-2002, SNAQ, BMI, and weight have inherent limitations in certain populations and their interpretation can be subjective. Previous literature has demonstrated that the L3 skeletal muscle index (L3-SMI) provides a more accurate, faster, and objective way to assess nutritional status. This study explored the relationship between diminished nutritional status using L3-SMI and the severity and outcomes of acute pancreatitis. Methods: This retrospective cohort study was conducted at Long Island Jewish Medical Center (LIJ) and North Shore University Hospital (NSUH). Patients met the criteria for AP on having two out of three criteria: (1) lipase or amylase > 3 times the upper limit of normal, (2) radiological findings of AP, (3) presence of epigastric pain. The L3 skeletal muscle index was obtained for 166 patients with AP by normalizing the calculated L3 skeletal muscle area with the patient height. These values divided patients into undernourished and adequately nourished groups based on sex-specific cutoffs. The indices along with the clinical data were used to determine the correlation between nutritional status and outcomes including length of hospital stay, admission to the ICU, incidence of organ failure, and BISAP classification. Results: Results showed that undernourished patients are more likely to be associated with worse outcomes and more severe AP. However, results were not statistically significant. Organ failure appeared to be the most closely associated with nutritional status (p = .0513). Further, hypertension was shown to be a confounding variable between nutritional status and organ failure. Conclusion: The relationship between nutritional status and outcomes as well as severity of acute pancreatitis is not statistically significant, however it is possible that the study population size was not adequate to power this study, and further studies should be done to explore this relationship.

Large bowel perforation is an abdominal emergency that results from a wide range of etiologies. Computed tomography is the most reliable modality in detecting the site of large bowel perforation. The diagnosis is made by identifying direct CT findings such as extraluminal gas or contrast and discontinuity along the bowel wall. Indirect CT findings can help support the diagnosis, and include bowel wall thickening, pericolic fat stranding, abnormal bowel wall enhancement, abscess, and a feculent collection adjacent to the bowel. Common etiologies that cause large bowel perforation are colon cancer, foreign body aspiration, stercoral colitis, diverticulitis, ischemia, inflammatory and infectious colitides, and various iatrogenic causes. Recognizing a large bowel perforation on CT can be difficult at times, and there are various entities that may be misinterpreted as a colonic perforation. The purpose of this article is to outline the MDCT technique used for evaluation of suspected colorectal perforation, discuss relevant imaging findings, review common etiologies, and point out potential pitfalls in making the diagnosis of large bowel perforation.

Introduction: Duodenal diverticula are weakened mucosal outpouchings that are most frequently located in the second portion of the duodenum, neighboring the ampulla of Vater. Most diverticula are acquired and asymptomatic. Presentation of case: A 46-year-old female presented with complaints of recurrent intermittent epigastric pain associated with nausea and vomiting for duration of one year, and was incidentally found to have a hemoglobin level of 5.0 g/dL. She was worked up by a gastroenterologist and an upper endoscopy revealed a dilated duodenum. A CT scan confirmed the diagnosis of a duodenal diverticulum and the patient successfully underwent duodenal resection. Discussion: Duodenal diverticula are common and are usually discovered incidentally. Here, we present a case report and a review of the literature in an effort to increase the awareness of signs, symptoms, demographics, and possible complications of small bowel diverticula. Signs and symptoms of a duodenal diverticulum are highly variable, and depend on the associated complications. Conclusion: Duodenal diverticula are common, but are often missed by clinicians. Signs, symptoms and complications vary. Familiarity with the various modes of presentation will help clinicians diagnose and manage diverticula, as well as prevent further complications.

Non-contrast chest CT scans are commonly performed while CT scans of the abdomen and pelvis are performed in a select subset of patients; those with limited renal function, an allergy to iodinated contrast, in the setting of suspected renal calculus, retroperitoneal hematoma, common duct calculus, abdominal aortic aneurysm with or without rupture, and in patients undergoing a PET-CT scan. In the absence of intravenous contrast, vascular structures may prove challenging to evaluate, yet their assessment is an important component of every non-contrast CT examination. We describe the key imaging features of both arterial and venous pathology, and review clues and common associated non-vascular findings, which can help the radiologist identify vascular disorders at non-contrast CT. Briefly, alternative imaging options are discussed.

Most men with hematospermia or hemospermia (HS) are young (<40 years of age), presenting with transient or episodic HS without other signs or symptoms of disease. The condition is self-limiting in most cases and idiopathic in nature. When a cause can be identified, infections of the urogenital tract are the most common. Imaging does not play a role in this patient population. In older men (>40 years of age), clinical screening for prostate cancer is advised. Furthermore, when HS is persistent or has symptoms, causes include obstruction or stricture at the level of the verumontanum, calcifications or calculi in the prostate, ejaculatory ducts or seminal vesicles, and cysts arising within these structures. Noninvasive imaging, predominantly transrectal ultrasound (TRUS) and MRI, can be used in men of any age with persistent or refractory HS, or other associated symptoms or signs. TRUS is considered as the first-line imaging with MRI used when TRUS is inconclusive or negative.The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer-reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.

Body packing refers to the intracorporeal concealment of illicit drugs. Here we report the case of a 55-year-old body packer who presented with palpitations, visual hallucinations, and a sense of impending death. Abdominal radiography demonstrated five ovoid foreign bodies overlying the rectum. At subsequent gastrotomy and cecotomy, thirty-eight cocaine-containing packets were retrieved from the stomach and ascending colon as well as from the rectum. As the contraband market evolves new techniques to evade detection, evaluation of the burden of body packer ingestion has become increasingly challenging. As demonstrated in this case, plain radiography can grossly underestimate the burden of ingestion.

Rosai-Dorfman disease is a rare disorder of unknown etiology caused by the proliferation of histiocytes within lymph nodes, predominantly in the cervical chain. Extranodal sites may be involved as well, with involvement of nearly every organ system described in the literature. Abdominal and pelvic manifestations of Rosai-Dorfman disease are extremely rare. We present four cases of abdominal and pelvic involvement by Rosai-Dorfman disease, specifically within the biliary tract, pancreas, spleen, and presacral space. Of note, a presacral mass was present in three of the four patients, and although not previously reported in Rosai-Dorfman disease, may suggest the diagnosis in the proper clinical scenario.

* See Last Page for Key 2016 Review Yacoub/Oto Page 1 Reference Study Type Patients/ Events Study Objective (Purpose of Study) Study Results Study Quality 1. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2015. CA Cancer J Clin. 2015;65(1):5-29. Review/OtherTx N/A To provide the expected numbers of new cancer cases and deaths in 2015 nationally and for each state, as well as a comprehensive overview of cancer incidence, mortality, and survival rates and trends using the most current population-based data. The article also estimates the total number of deaths averted nationally during the past 2 decades and by state in 2011 as a result of the continual decline in cancer death rates and present actual number of deaths reported in 2011 by age for the 10 leading causes of death and for the 5 leading causes of cancer death. Cancer death rates have been continuously declining for the past 2 decades. Overall, the risk of dying from cancer decreased by 22% between 1991 and 2011. Regionally, progress has been most rapid for residents of the Northeast, among whom death rates have declined by 25% to 30%, and slowest in the South, where rates declined by about 15%. Further reductions in cancer death rates can be accelerated by applying existing cancer control knowledge across all segments of the population, with an emphasis on those in the lowest socioeconomic bracket and other disadvantaged populations. 4

Testicular cancer represents only 1% of all malignancies occurring in men. However, it is the most frequent malignancy in men between the ages of 20 and 34 years, accounting for 10% to 14% of cancer incidence in that age group. In most instances, the diagnosis of testicular tumors is established with a carefully performed physical examination and scrotal ultrasonography. Tumor markers are useful for determining the presence of residual disease. Cross-sectional imaging studies (CT, MRI) are useful in determining the location of metastases. Chest radiography and CT are used to assess pulmonary disease. Fluorine-18-2-fluoro-2-deoxy-d-glucose (FDG) PET scans have slightly higher sensitivity than CT, but their role in staging testicular cancer has not been determined in a large study. FDG PET may play a role in the follow-up of higher stage seminoma after chemotherapy. Bone scans are useful in the absence of FDG PET scans and should be used when bone metastases are suspected. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (the RAND/UCLA Appropriateness Method and the Grading of Recommendations Assessment, Development, and Evaluation) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances in which evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.