Magnetic resonance imaging (MRI) is considered the gold standard for staging penile squamous cell carcinoma and assessing its extent. However, due to the rarity of this pathology, few medical centers have regular experience with penis carcinoma imaging. The purpose of this article is to provide a comprehensive update on the role of MRI in penile cancer by reviewing the MRI anatomy of a normal penis, outlining the recommended MRI techniques for penis assessment, and discussing the benefits and drawbacks of artificial erection. We will also highlight how MRI can serve the purpose of tumor staging and its therapeutic consequences. To provide a comprehensive and practical review of penile cancer based on imaging, including epidemiology, prognosis, treatment, penile MRI protocol, anatomy, and key points for accurate analysis.

OBJECTIVES:To assess the diagnostic yield of thoraco-abdominal-pelvic computed tomography (TAP-CT) in suspected infection of unclear origin in the emergency department (ED) and identify predictive factors for normal TAP-CT to optimize its use. METHODS:We retrospectively categorized 517 TAP-CT studies of adult patients with non-severe infection of unclear origin based on the presence of an infectious focus or significant findings, such as neoplasia or thrombosis. Descriptive analysis, correspondence assessment between CT results and final diagnosis, and statistical modelling were performed to identify predictors of normal TAP-CT. RESULTS:An infectious focus was identified in 55% TAP-CT scans, mainly pulmonary (46%), bilio-digestive (25%), and genitourinary (23%). Significant non-infectious findings were detected in 20%, including thrombosis (7%) and neoplasia (12%). TAP-CT showed a sensitivity of 73%, specificity of 88%, positive predictive value of 94%, and negative predictive value of 57%, with moderate agreement (Kappa = 0.53) between TAP-CT findings and final diagnosis. Overall, 67% of patients had an identifiable cause for infection-like symptoms. Although C-reactive protein <128 mg/L was associated with normal TAP-CT, no model reliably predicted a normal scan. CONCLUSIONS:TAP-CT identified a relevant finding in over two-thirds of cases, reinforcing its role in diagnosing both infectious and mimicking conditions. No specific criteria could safely exclude TAP-CT, making it a valuable tool for managing patients with suspected infections of unclear origin. ADVANCES IN KNOWLEDGE:This study is the first to assess TAP-CT's value in suspected non-severe infections of unclear origin in the ED, highlighting its role in detecting infectious and non-infectious conditions and optimizing diagnostic strategies.

Abdominal disorders represent 10 to 15

To assess the noninferiority of MRI diagnostic accuracy to CT scan as a second-line examination of acute/subacute abdominopelvic pain in a population of young women after an inconclusive ultrasound (US). This prospective, multicenter non-inferiority study included 18–40-year-old non-pregnant women with non-traumatic acute/subacute abdominal pain. They had an inconclusive US warranting the prescription of an additional CT scan. Within 6 h of the CT, all these women underwent abdomino-pelvic MRI. A retrospective reading of the CT and MR provided a diagnosis using a standardized list. The gold standard diagnosis, based on a 3-month follow-up, was done by a panel of experts. Statistical analysis was conducted to assess the noninferiority of the diagnostic accuracy of MRI compared to that of CT. The noninferiority margin was set at 10

IntroductionLa colite ischémique est une atteinte aiguë de la paroi colique d’origine vasculaire, liée à une séquence ischémie-reperfusion, le plus souvent en lien avec un bas débit hémodynamique aigu et transitoire.Données récentesLes colites ischémiques peuvent survenir dans des contextes cliniques variables : troubles du rythme, état de choc, contexte postopératoire de chirurgie aortique. Il est important de distinguer les formes « spontanées » des formes postopératoires, ces dernières étant généralement plus sévères. La symptomatologie associe le plus souvent des douleurs abdominales et des rectorragies, mais le grand polymorphisme clinique de cette affection rend son diagnostic difficile. La durée, l’intensité de l’hypoxie tissulaire et le stress induit par la séquence ischémie-reperfusion conditionnent la sévérité de l’atteinte, et distinguent deux formes de pronostic différent : la colite ischémique bénigne, la plus fréquente, d’évolution habituellement favorable après rétablissement volémique, et la colite ischémique sévère gangréneuse, en l’absence de reperfusion colique efficace, nécessitant une résection du segment digestif nécrosé. La tomodensitométrie abdominopelvienne avec injection est un examen clé tant pour le diagnostic que pour le pronostic de l’affection. L’atteinte préférentielle de zones de faiblesse vasculaires telles que l’angle colique gauche et la jonction rectosigmoïdienne doit faire évoquer le diagnostic. En outre, un épaississement pariétal colique avec rehaussement stratifié en cible est en faveur d’une forme bénigne nécessitant un traitement conservateur, alors qu’un côlon d’aspect atone, avec une paroi virtuelle et un défaut de rehaussement pariétal, doit orienter vers une forme sévère gangréneuse qui nécessite une prise en charge chirurgicale en urgence.ConclusionLa colite ischémique est une pathologie le plus souvent bénigne et transitoire. La tomodensitométrie est un examen indispensable pour rechercher des signes évocateurs d’une évolution péjorative et pour orienter rapidement la prise en charge du patient.

Background: The present study investigated an institutional multidisciplinary strategy for managing traumatic haemorrhagic shock by integrating the placement of REBOA (resuscitative endovascular balloon occlusion of the aorta) by anaesthesiologist-intensivists. Methods: All severe trauma patients who received percutaneous REBOA placement between January 2013 and December 2022 in our level 1 trauma centre were retrospectively analysed. The data collected included the clinical context, indications and location of REBOA, durations of aortic occlusion (AO), choice of haemostatic procedures and surgical teams, and specific complications. Results: In total, 38 trauma patients were included in the present study (mean age = 41 years [standard deviation = 21 years], 31 [82 %] were male, and median injury severity score was 62.5 [inter-quartile range (IQR) = 45-75]). REBOA was always placed by anaesthesiologist-intensivists, who comprised 68 % of the senior physicians (13/19) in our trauma team over the period. Twenty-eight AOs (74 %) were performed in zone 1 and 10 (26 %) in zone 3. Twelve patients (32 %) received REBOA upon circulatory arrest. Routes following REBOA placement comprised: computed tomography scan = 47 %, operating room = 34 %, angiography = 3 %, emergency room thoracotomy = 5 %, and prematurely died = 11 %. Duration of AO was 38 min (IQR = 32-44 min) in zone 1 and 78 min (IQR = 48-112 min) in zone 3. Mortality rate was 66 % (95 % CI 51-81 %) and higher in cases of AO in zone 1 (79 % versus 30 %, p = 0.018) or concomitant with circulatory arrest (92 % versus 54 %, p = 0.047). No ischemic limb needed an intervention and three endothelial injuries required delayed endovascular stenting. Conclusions: Percutaneous REBOA placement by anaesthesiologist-intensivists included in the multidisciplinary management of traumatic haemorrhagic shock was associated with acceptable time of AO and local complications similar to those observed in other series.

IntroductionLes tumeurs rétropéritonéales primitives sont un groupe hétérogène de lésions développées indépendamment des organes rétropéritonéaux. Les tumeurs solides peuvent être divisées en quatre groupes : tumeurs mésenchymateuses, lymphoïdes, neurogènes et germinales. Les lésions kystiques du rétropéritoine ont une gamme diagnostique propre, et sont dans la grande majorité des cas bénignes.Messages principauxLes tumeurs solides primitives du rétropéritoine sont majoritairement malignes, dominées par les sarcomes. Les liposarcomes, les plus fréquents, sont composés de tissu et de graisse en proportion variable, la quantité de graisse étant inversement proportionnelle à la différenciation du sarcome. Les lymphomes représentent environ un tiers des tumeurs solides primitives du rétropéritoine, et se présentent sous la forme d’adénomégalies multiples ou de masses confluentes. Les tumeurs neurogènes sont majoritairement bénignes, et rencontrées chez les sujets plus jeunes. Alors que les schwannomes et les ganglioneuromes présentent volontiers une composante myxoïde, les paragangliomes sont des lésions habituellement hypervasculaires. Les lésions germinales du rétropéritoine sont le plus souvent secondaires à une néoplasie ovarienne ou testiculaire, mais il existe des masses germinales rétropéritonéales d’origine extragonadique. Les lésions kystiques du rétropéritoine sont de nature diverse, les plus fréquentes étant les malformations rétropéritonéales lymphatiques, qui franchissent les différents espaces sans effet de masse sur les organes adjacents. Les lésions présacrées ont quant à elle une gamme diagnostique spécifique, les plus fréquentes étant les tératomes, les myélolipomes extrasurrénaliens et les kystes de Tailgut.ConclusionLa TDM en première intention et l’IRM permettent une orientation diagnostique fiable devant une lésion rétropéritonéale. Une biopsie est nécessaire pour les lésions d’allure maligne ou indéterminée, en centre expert en cas de suspicion de sarcome, afin de planifier la prise en charge.

To assess the role of CT venography (CTV) in the diagnosis of venous thromboembolism (VTE) during the postpartum period. This multicenter prospective cohort study was conducted between April 2016 and April 2020 in 14 university hospitals. All women referred for CT pulmonary angiography (CTPA) for suspected pulmonary embolism (PE) within the first 6 weeks postpartum were eligible. All CTPAs were performed on multidetector CT machines with the usual parameters and followed by CTV of the abdomen, pelvis, and proximal lower limbs. On-site reports were compared to expert consensus reading, and the added value of CTV was assessed for both. The final study population consisted of 123 women. On-site CTPA reports mentioned PE in seven women (7/123, 5.7

Introduction Le syndrome du compartiment abdominal est une pathologie mal connue, d’évolution souvent fatale, définie par une augmentation rapide et persistante de la pression abdominale (>20mmHg) associée à une défaillance d’organe. L’objectif de cet article est de présenter les principales situations cliniques à risque, ainsi que les signes tomodensitométriques devant faire évoquer ce syndrome. Messages principaux Le syndrome du compartiment abdominal survient dans un contexte d’augmentation rapide de la pression intra-abdominale, notamment en cas de polytraumatisme, de syndrome occlusif ou de pancréatite aiguë, ou dans un contexte de diminution de la compliance abdominale. Chez un patient présentant des signes de défaillance d’organe, la présence d’une distension abdominale anormale doit être recherchée en tomodensitométrie par la mesure du « ratio des hauteurs » (pathologique si>0,52) et du « signe du ventre rond » (round belly sign, pathologique si>0,80). La mesure directe de la pression intravésicale permet de confirmer le diagnostic. Le traitement de référence est la chirurgie de décompression abdominale en urgence. Conclusion Le syndrome du compartiment abdominal est une pathologie grave, principalement rencontrée chez des patients de réanimation. La connaissance des signes tomodensitométriques spécifiques permet une prise en charge précoce et une amélioration du pronostic.

Although endometriosis is a common gynecological condition in women of reproductive age, a complication of endometriosis is rarely considered as the differential diagnosis of acute abdominal pain in that context. However, acute events in women with endometriosis can represent life-threatening conditions, which require emergent treatment and often surgical management. Mass effect of endometriotic implants can give rise to obstructive complications, specifically occurring in the bowel or in the urinary tract, while inflammatory mediators released by ectopic endometrial tissue can lead to inflammation of the surrounding tissues or to superinfection of the endometriotic implants. Magnetic resonance imaging is the best imaging modality to reach the diagnosis of endometriosis, but an accurate diagnosis is possible on computed tomography, especially in the presence of stellar, mildly enhanced, infiltrative lesions in suggestive areas. The aim of this pictorial review is to provide an image-based overview of key findings for the diagnosis of acute abdominal complications of endometriosis.

PURPOSE:Isolated Fallopian tube torsion (IFTT) is a rare cause of acute pelvic pain in women of reproductive age. Preoperative diagnosis is rarely made, even though an early surgery is necessary to preserve women's fertility. This study aims to identify simple and reproductible imaging features for the diagnosis of IFTT on sectional imaging. METHODS:We conducted a retrospective, cross-sectional study on patients diagnosed with IFTT in our center between January 2008 and December 2021. The CTs and MRIs of 16 patients with surgically proven IFTT were retrospectively and independently reviewed by two radiologists to identify the relevant findings for the diagnosis. RESULTS:The median patient age was 29 years (range: 13-63 years). Only four patients (25 %) had a conservatory treatment. Two patterns of IFTT were identified on CT and MRI. The first pattern (n = 6, 37 %) consisted of a thin-walled hydrosalpinx, U- or C-shaped, with a median diameter of 3 cm. The second pattern (n = 10, 63 %) consisted of an extra-ovarian cyst adjacent to a soft tissue mass containing the twisted tube and vessels. In 15 patients (94 %), the ipsilateral ovary was of normal size. Hematosalpinx was observed in 3 patients with necrosis of the tube on pathological reports (19 %). Interobserver agreement was substantial or good for all criteria. CONCLUSIONS:An association of simple and reproductible features can support the diagnosis of IFTT on sectional imaging in an emergency context: the identification of these features may avoid a delayed surgical treatment, which could otherwise compromise women's fertility.

To test the performance of the Ovarian-Adnexal Reporting Data System (O-RADS) MRI in characterizing adnexal masses with cystic components and to test new specific MRI features related to cystic components to improve the ability of the O-RADS MRI score to stratify lesions according to their risk of malignancy. The EURopean ADnexal study (EURAD) database was retrospectively queried to identify adnexal masses with a cystic component. One junior and 13 radiologists independently reviewed cases blinded to the pathological diagnosis. For each lesion, the size of the whole lesion, morphological appearance, number of loculi, presence of a thickened wall, thickened septae, signal intensity of the cystic components on T1-weighted/T2-weighted/diffusion weighted, mean value of the apparent diffusion coefficient, and O-RADS MRI score were reported. Univariate and multivariate logistic regression analysis was performed to determine significant features to predict malignancy. The final cohort consisted of 585 patients with 779 pelvic masses who underwent pelvic MRI to characterize an adnexal mass(es). Histology served as the standard of reference. The diagnostic performance of the O-RADS MRI score was 0.944, 95%CI [0.922–0.961]. Significant criteria associated with malignancy included an O-RADS MRI score ≥ 4, ADCmean of cystic component > 1.69, number of loculi > 3, lesion size > 75 mm, the presence of a thick wall, and a low T1-weighted, a high T2-weighted, and a low diffusion-weighted signal intensity of the cystic component. Multivariate analysis demonstrated that an O-RADS MRI score ≥ combined with an ADC mean of the cystic component > 1.69, size > 75 mm, and low diffusion-weighted signal of the cystic component significantly improved the diagnostic performance up to 0.958, 95%CI [0.938–0.973]. Cystic component analysis may improve the diagnosis performance of the O-RADS MRI score in adnexal cystic masses. • O-RADS MRI score combined with specific cystic features (area under the receiving operating curve, AUROC = 0.958) improves the diagnostic performance of the O-RADS MRI score (AUROC = 0.944) for predicting malignancy in this cohort. • Cystic features that improve the prediction of malignancy are ADC mean > 1.69 (OR = 7); number of loculi ≥ 3 (OR = 5.16); lesion size > 75 mm (OR = 4.40); the presence of a thick wall (OR = 3.59); a high T2-weighted signal intensity score 4 or 5 (OR = 3.30); a low T1-weighted signal intensity score 1, 2, or 3 (OR = 3.45); and a low diffusion-weighted signal intensity (OR = 2.12). • An adnexal lesion with a cystic component rated O-RADS MRI score 4 and an ADC value of the cystic component < 1.69 associated with a low diffusion-weighted signal, has virtually a 0% risk of malignancy.

A groin lump is not an uncommon condition in girls and female infants, and US plays a fundamental role in its exploration. The main pathologic conditions are related to the failure of obliteration of the canal of Nuck. Radiologists should gain a full understanding of the embryology and US anatomy of the inguinal canal before assessing this entity for the first time. An optimal age-adjusted US technique-including examinations at rest and during straining-is essential to help assess the canal of Nuck, diagnose a hernia, and analyze its content. The radiologist must be aware of the various types of hernial content depending on the patient's age, including intestinal, omental, ovarian, or tubouterine hernia, and the US features of each. Incarcerated hernias are common in girls and mostly contain an ovary. In such cases, it is crucial to screen for US signs suggestive of ovarian ischemic damage, thereby calling for urgent surgery. US can also depict a cyst or hydrocele of the canal of Nuck and its complications. Moreover, other rare pathologic conditions involving the inguinal area may be depicted at US, which helps guide appropriate treatment. US is the ideal modality for evaluating an inguinal lump in girls and female infants. Online supplemental material is available for this article. ©RSNA, 2022.

To develop a simple scoring system in order to predict the risk of severe (death and/or surgery) ischemic colitis In this retrospective study, 205 patients diagnosed with ischemic colitis in a tertiary hospital were consecutively included over a 6-year period. The study sample was sequentially divided into a training cohort (n = 103) and a validation cohort (n = 102). In the training cohort, multivariable analysis was used to identify clinical, biological, and CT variables associated with poor outcome and to build a risk scoring system. The discriminative ability of the score (sensitivity, specificity, positive predictive value, negative predictive value) was estimated in the two cohorts to externally validate the score, and a receiver operating characteristic curve was established to estimate the area under the curve of the score. Bootstrapping was used to validate the score internally. In the training cohort, four independent variables were associated with unfavorable outcome: hemodynamic instability (2 pts), involvement of the small bowel (1 pt), paper-thin wall pattern (3 pts), no stratified enhancement pattern (1 pt). The score was used to categorize patients into low risk (score: 0, 1), high risk (score: 2–3), and very high risk (score: 4–7) groups with sensitivity and specificity of 97% and 67%, respectively, and a good discriminating capability, with a C-statistic of 0.94. Internal and external validation showed good discrimination capability (C-statistics of 0.9 and 0.84, respectively). A simple risk score can stratify patients into three distinct prognosis groups, which can optimize patient management. NCT04662268 • Simple scoring system predicting the risk of severe ischemic colitis • First study to include CT findings to the clinical and biological data used to determine a severity score.

Introduction. - Our aim was to evaluate electromagnetic extracorporeal shockwave lithotripsy (SWL) in treating high-density radiopaque ureteral stones on non-contrast computed tomogra-phy (NCCT).Patients and methods. - Adult patients with radiopaque stones in the ureter who underwent SWL in a high volume center between 2016 and 2017 were retrospectively included. NCCT characteristics such as mean stone density (MSD), stone size, skin to stone distance (SSD) were recorded before treatment. Treatment success was defined as complete stone clearance (SF).Results. - 108 patients were included. Global stones MSD was 1119 HU. 55% and 62% of patients were SF respectively after 1 and 2 sessions of SWL. There was no difference of success rates between the treatment of low MSD (< 1000 HU, n = 33) and high MSD (>= 1000 HU, n = 75) (P = 0.57, OR = 0.79, 95% CI [0.35-1.80]). The SF rate dropped to 31.6% for 19 patients with ureteral stenting before treatment (P = 0.02, OR = 3.34, 95% CI [1.16-9.62]). Mean stone size was 7.2 mm, SF rate for stones over 7 mm were statistically lower (P = 0.04, OR = 2.18, 95% CI [1.00-4.73]). 4 patients needed ureteral stenting in emergency after SWL (3.7%).

Background: The aim of present study was to assess the association between acute post-traumatic atrophy (APTMA) determined on psoas computed tomography [CT] scan and the duration of mechanical ventilation and outcomes in severe trauma patients. Methods: A retrospective analysis of severe trauma patients (Injury Severity Score [ISS], > 15) hospitalized in the intensive care unit (ICU) for more than 7 days between January 2010 and December 2015 was performed. The psoas muscle index (PMI) was measured on admission and at delayed CT scan. delta PMI was calculated as the percentage PMI loss between these two scans. Three groups were defined and compared a posteriori using the quartiles of the delta PMI values: low (lower quartile), moderate, and severe (higher quartile) APTMA groups. Linear regression analysis was performed to predict the duration of mechanical ventilation, of catecholamines, length of stay (LOS) in the ICU and hospital, and complications were assessed. Results: A total of 114 trauma patients were included (median age, 40 years; [IQR, 25-54 years]; ISS, 33 [IQR, 25-41]). Based on the delta PMI determination, 29 patients were allocated in the low APTMA group (range delta PMI, 0%-6%), 56 in the moderate APTMA group (range delta PMI, 6%-18%), and 29 in the APTMA group (range delta PMI, & GE;19%). Severity of APTMA was significantly associated with the duration of mechanical ventilation and catecholamines, ICU and hospital LOS (P < 0.001). Delayed pneumonia (P=0.006) and other delayed infections (P=0.014), as well as thromboembolic events (P=0.04) were statistically associated with the severity of APTMA, whereas mortality did not differ between the three groups (P=0.20). Using linear regression analysis, each delta PMI increase of 1% was significantly associated with 0.90 supplementary days of mechanical ventilation (P < 0.001), 0.29 supplementary days of catecholamines (P < 0.001) and 0.82 supplementary days of hospitalization (P < 0.001). All these statistical associations were confirmed in multivariate analysis (P < 0.001). Conclusion: Acute muscle atrophy diagnosed on CT scan by psoas area measurement (delta PMI) was strongly associated with poor outcomes in severe trauma patients. (c) 2022 Published by Elsevier Ltd.

Purpose: To compare the performance in breast lesion characterization of one-view mediolateral (MLO) digital mammography plus digital breast tomosynthesis (DM-DBT) versus one-view craniocaudal (CC) DM-DBT versus two-view DM-DBT. Materials and methods: The institutional review board approved this retrospective study conducted on 138 women from the population of a previous prospective multicenter study, with 69 consecutive patients with benign or high-risk lesions and 69 randomized patients with breast cancer, all confirmed at pathology. Four radiologists (two senior and two junior) blinded to the clinical, mammographic and pathological data independently reviewed the MLO DM-DBT views, the CC DM-DBT views and the MLO + CC DM-DBT views using the American College of Radiology Breast Imaging-Reporting and Data System criteria for index lesion characterization. Areas under the receiver were calculated and compared for each reader and imaging protocol. Results: No significant differences in breast cancer characterization were observed between single MLO and CC views for all the readers. The added value of a second view was statistically significant for characterization in pooled data and for junior readers but not for senior readers (p ranging from 0.15 to 0.57 depending on the view and the senior reader). Finally, in 4 breast cancer cases, lesions were only detectable on the CC DM-DBT view in two cases and on the MLO DM-DBT view in the two other cases. Conclusion: Our results support the use of two-view DM-DBT for breast lesion characterization when the readers are inexperienced. There is no significant difference between CC and MLO views when diagnosis is performed with one view.