Background/Objectives: To systematically review computed tomography (CT)-derived body composition and morphological predictors of incisional hernia (IH) following colorectal cancer (CRC) resection. Methods: PubMed/MEDLINE, Embase, Scopus, Web of Science, Cochrane Library, and CINAHL were searched from inception to May 2026, supplemented by grey literature searching. Studies reporting CT-derived predictors of IH after CRC resection were eligible. Two independent reviewers screened records, extracted data, and assessed risk of bias using the Newcastle–Ottawa Scale. Given heterogeneity in CT metrics, exposure definitions, and statistical models, findings were synthesised narratively, and certainty of evidence was assessed using GRADE. Results: Nine retrospective cohort studies including 2392 patients met the inclusion criteria. IH incidence ranged from 4.5% to 33.6%. Visceral adiposity was the most frequently evaluated predictor, although only two studies reported standalone adjusted odds ratios for the elevated visceral fat area. Subcutaneous adiposity, sarcobesity, and novel umbilical morphological metrics, including umbilical fat, intraperitoneal thickness, and enlargement of the umbilical orifice, were independently associated with IHs in individual studies. Umbilical fat showed the largest adjusted effect estimate (hazard ratio 6.56; 95% CI 2.73–15.70). Quantitative pooling was not performed as fewer than three studies reported comparable adjusted estimates for any predictor. Certainty of evidence was low to very low across all predictor categories. Conclusions: Preoperative CT may provide clinically useful, but currently low-certainty, body composition data for IH risk stratification after CRC resection. Prospective multicentre validation using standardised CT protocols is required before routine clinical implementation.

OBJECTIVES:Treatment response to definitive chemoradiation (dCRT) in patients with anal cancer varies significantly, with a subset experiencing persistent or progressive disease despite therapy. Radiomics extracts quantitative features from radiological images, with the potential to develop predictive tools to assess treatment response. We aim to develop and validate an MRI-based radiomics nomogram to predict response to dCRT in patients with anal cancer. METHODS:A single-institutional retrospective analysis of 45 patients with anal cancer treated with dCRT was performed. Radiomic features were extracted from pre-treatment T2-weighted MRI scans, and predictive models were constructed. Clinical and radiomic features were analysed to develop the nomogram. Internal validation with 1000 bootstrap samples was performed to calculate optimism-corrected performance measures. RESULTS:Overall, 30/45(66.7%) achieved a complete treatment response. Male gender was found to be an independent predictor of incomplete response to dCRT (OR 4.763,95% CI: 1.170-19.384,*P = .029). Two radiomic signatures emerged as strong predictors of treatment response to dCRT. The combined model outperformed the clinical and radiomic models. The combined model showed the highest predictive accuracy, achieving an apparent area under the receiver operating characteristic curve (AUC): 0.87 (0.75-0.99) and an optimism-corrected AUC: 0.85, mean absolute error: 0.029, positive predictive value (0.68) and negative predictive value (0.92), indicating excellent discriminative performance. It demonstrated a positive net benefit in decision analysis. The optimism-corrected calibration curves demonstrate that the radiomic and combined model provide well-calibrated predictions. CONCLUSION:This MRI-based radiomics nomogram offers a promising approach to predict response to dCRT in patients with anal cancer. ADVANCES IN KNOWLEDGE:This study is the first to integrate radiomics and clinical features into a validated predictive model for anal cancer.

Pulmonary Pleomorphic Carcinomas (PPCs) represent a rare and aggressive subtype of Non-Small Cell Lung Cancer (NSCLC) that can only be definitively diagnosed on a surgical specimen. This study utilised PET-CT to evaluate radiological characteristics of PPCs. This study retrospectively evaluated the radiological characteristics of PCCs diagnosed in St James’s Hospital Dublin between 2012-2023. Computed Tomography (CT) and Positron Emission Tomography (FDG-PET) imaging features (size, location, density, shape, invasion, and growth kinetics) and standard uptake value for each lesion were evaluated. 39 PCCs were identified with a mean age of 66.5 years (range: 49-82 years). FDG-PET was performed in all 39 cases. Tumours demonstrated a high FDG uptake at baseline with a mean (SUV) of 12.6 (range: 1.4 - 36.9). A second interval PET-CT on average 3.3 months after the first in 3 cases demonstrated over 120% increase in SUV. The mean tumour size was 4.3 cm (range: 1.0 - 14.5 cm). Tumours developed rapid interval growth, reaching a mean maximum diameter of 6.6 cm (53.4%) within a mean of 2.1 months. Tumours were predominantly located in the upper lobe (71.8 %) and displayed necrotic features in 53.8 % of cases. 82.1% of tumours invaded the mediastinum. This study describes the largest cohort of Pulmonary Pleomorphic Carcinoma in the literature. Tumours demonstrate a high SUV on baseline imaging and demonstrate rapid growth on interval imaging and central necrosis. Please click on the 'PDF' for the full abstract!

Demand for inpatient MRI outstrips capacity which results in long waiting lists. The hospital commenced a routine weekend MRI service in January 2023. The aim of this study was to investigate the effect of a limited routine weekend MRI service on MRI turnaround times. Waiting times for inpatient MRI scans performed before and after the introduction of weekend MRI from January 1 to August 31, 2022, and January 1 to August 31, 2023, were obtained. The turnaround time (TAT) and request category for each study were calculated. Category 1 requests were required immediately, category 2 requests were urgent and category 3 requests were routine. There was a 6

A 77-year-old male smoker was scheduled to undergo computed tomography (CT)–guided percutaneous transthoracic lung biopsy of a fluorodeoxyglucose-avid cystic mass in the anterior segment of the right upper lobe (Fig 1a). The wall of the mass was irregular, with a maximal wall thickness of 5 mm.

Visceral obesity (VO) and metabolic syndrome (MetS) are risk factors for esophageal adenocarcinoma (EAC); however, their impact on operative and oncological outcomes is unclear. The aim of this study was to determine the incidence of VO and MetS among patients with EAC, and to assess their independent impact on operative and oncological outcomes. A total of 454 consecutive patients undergoing treatment with curative intent were studied. Total, subcutaneous, visceral fat area (VFA), and lean body mass (LBM) were measured by computed tomography pretreatment, with VO defined as VFA >163.8cm(2) for men and 80.1cm(2) for women. MetS was defined per the ATPIII definition. Multivariable logistic and Cox proportional hazards regression were utilized to determine independent predictors of oncologic and operative outcomes. A total of 227 patients (50.0%) had VO. A total of 134 (30%) overall had MetS, 44% in the VO cohort. VO was associated with Barrett's esophagus (P = 0.002) and lower cT (P = 0.006) and cN stage (P = 0.011), and improved disease-specific (P = 0.021) and overall survival (P = 0.012). No survival benefit existed for patients with VO who also had MetS. For operative complications, neither VO nor MetS increased the severity of complications, or mortality. However, VO was significantly (P = 0.035) associated with anastomotic leak and pneumonia (P = 0.037). MetS alone did not increase complication risk. VO increases specific major operative complications with no increase in mortality. VO improved survival, mainly relating to earlier stage disease; however, co-existent MetS abrogated this benefit. These seemingly paradoxical outcomes highlight manageable and potentially targetable perioperative challenges in the context of an overall favorable oncologic vista.

Background: Mucosal-associated invariant T (MAIT) cells promote inflammation in obesity and are implicated in the progression of non-alcoholic fatty liver disease (NAFLD). However, as the intrahepatic MAIT cell response to lifestyle intervention in NAFLD has not been investigated, this work aimed to examine circulating and intrahepatic MAIT cell populations in patients with NAFLD, after either 12 weeks of dietary intervention (DI) or aerobic exercise intervention (EI). Methods: Multicolour flow cytometry was used to immunophenotype circulating and intrahepatic MAIT cells and measure MAIT cell expression (median fluorescence intensity, MFI) of the activation marker CD69 and apoptotic marker CD95. Liver histology, clinical parameters, and MAIT cell populations were assessed at baseline (T0) and following completion (T1) of DI or EI. Results: Forty-five patients completed the study. DI participants showed decreased median (interquartile range) expression of the activation marker CD69 on circulating MAIT cells (T0: 104 (134) versus T1 27 (114) MFI; p = 0.0353) and improvements in histological steatosis grade post-intervention. EI participants showed increased expression of the apoptotic marker CD95, both in circulating (T0: 1549 (888) versus T1: 2563 (1371) MFI; p = 0.0043) and intrahepatic MAIT cells (T0: 2724 (862) versus T1: 3117 (1622) MFI; p = 0.0269). Moreover, the percentage of intrahepatic MAIT cells significantly decreased after EI (T0: 11.1 (14.4) versus T1: 5.3 (9.3)%; p = 0.0029), in conjunction with significant improvements in fibrosis stage and hepatocyte ballooning. Conclusions: These data demonstrate independent benefits from dietary and exercise intervention and suggest a role for intrahepatic MAIT cells in the observed histological improvements in NAFLD.

Background and Objectives: Women with gynecological cancers constitute a high-risk cohort for loss of bone density. International guidance stipulates women undergoing cancer treatments associated with bone loss should have a quantitative assessment of bone density. Access to Dual-energy X-ray Absorptiometry (DXA) is limited. This study aimed to assess the accuracy of opportunistic bone density measurement on staging computed tomography (CT) scans for gynaecological malignancies, in comparison to the gold standard DXA. Materials and Methods: Women with a staging CT scan of the abdomen and pelvis for a new diagnosis of gynecological cancer were recruited. DXA was performed within 6 weeks of treatment for gynaecological cancer. Lumbar bone density was measured by CT attenuation values, in Hounsfield units (HU), of the anterior trabecular region. Correlations between CT and DXA parameters were analysed. Receiver Operating Characteristic(ROC) curves for diagnosis of low bone density and osteoporosis were analysed. Results: Final cohort included 48 of 50 women recruited. There was good diagnostic accuracy for abnormal bone density and osteoporosis, with areas under the ROC curve at L1 of 0.77 (p = 0.002) and 0.80 (p = 0.020) respectively. CT-HU of 170–190 yielded sensitivities of 87–90%, positive predictive values of 75–84% and negative predictive values of 71–75% for the diagnosis of low bone mineral density. CT-HU of 90–110 yielded specificities of 85–93% for the diagnosis of osteoporosis. Moderate correlations were found between CT-HU and both DXA T-scores and diagnostic categories. Conclusions: This is the first study to assess the opportunistic application of CT in the assessment of bone health in women with gynaecological cancer, a cohort at high-risk of osteoporosis. The correlation between bone density assessment in CT-HU and DXA, and strong AUC values for the diagnosis of low bone density (0.77) and osteoporosis (0.80) support this pragmatic solution in resolving the care-gap in cancer treatment-induced bone loss, often associated with poor access to DXA.

Abstract Visceral obesity, metabolic syndrome and non-alcoholic fatty liver disease (NAFLD) represent risk factors for esophageal adenocarcinoma (EAC). The prevalence of NAFLD, and its impact on the hepatic response to esophageal cancer surgery, has never been systematically evaluated, and was the focus of this study. Methods Consecutive patients (n = 547) treated with curative intent for esophageal cancer from 2007–2017 were studied. In an unselected subgroup (n = 138), liver biopsies were collected intraoperatively and assessed for NAFLD, defined as ≥5% macrovesicular steatosis. Postoperative complications were recorded prospectively, including Clavien-Dindo grade (CD) and comprehensive complications index (CCI). Liver function tests were monitored in the first postoperative week, with hepatocellular dysfunction defined as a transaminase rise ≥3-times the upper limit of normal. Multivariable logistic and Cox proportional hazards regression were utilised to determine independent predictors of operative and oncologic outcome. The study was registered on clinicaltrials.gov (NCT04152044). Results NAFLD was evident in 62 patients (47.7%) who had biopsies, with a mean (SD) score of 10.1(9.3)%. NAFLD was associated with metabolic syndrome (41.9 vs 25%, P = 0.04), obesity (44.1 vs 11.9%, P < 0.001) and visceral adiposity (172.8 vs 136.5 cm2, P = 0.008), but not clinical or pathologic disease stage. Postoperative hepatocellular dysfunction was observed in 287 (54.8%) patients, associated with NAFLD (P = 0.006), but not visceral obesity (P = 0.396), and normalized in a median (range) of 9 (1–76) days. NAFLD did not impact oncologic outcome, but postoperative hepatocellular dysfunction was independently associated with reduced overall survival (HR 1.87 (1.16–2.29), P = 0.002) on multivariable analysis. Conclusion A marker of metabolic dysregulation in obesity-associated carcinogenesis, NAFLD is prevalent among patients with esophageal cancer. Liver dysfunction post esophagectomy is common, and although temporary, is associated with worse oncologic outcomes. Baseline NAFLD did not incur an adverse long-term oncologic outcome.

Abstract Obesity, in particular visceral obesity, is a risk factor for esophageal cancer, but its prevalence and impact on operative and oncologic outcomes is unclear. The aim of this study was to study adipose distribution in esophageal cancer (EC), and to assess its independent impact. Methods 11 consecutive patients undergoing treatment with curative intent for esophageal cancer were studied. Total (TFA), subcutaneous (SFA) and visceral fat areas (VFA), and fat mass (FM), were determined pre-treatment, preoperatively, and 1 year postoperatively. Visceral obesity was defined by CT at L3 as VFA greater than 163.8 cm2 for men and 80.1 cm2 for women. All complications were recorded prospectively, including comprehensive complications index, Clavien-Dindo, and pulmonary complications (PPC). Multivariable logistic and Cox proportional hazards regression were utilized to determine independent predictors of operative and oncologic outcome. Results Visceral obesity (VO) was evident in 290 patients (47.5%), and was associated with BMI-defined obesity, diabetes, metabolic syndrome, Barrett’s esophagus (P = 0.001), well-differentiated tumors (P = 0.027), and lower cN stage (P = 0.012). VO did not impact tumor regression grade (TRG) after neoadjuvant therapy. Postoperatively, VO independently predicted anastomotic leak (P = 0.033, OR2.42 [1.07-5.45]) and pneumonia (P = 0.046, OR1.53 [1.01–2.32]), but not in-hospital mortality (P = 0.466), which was 1% overall. VO was associated with significantly improved overall and disease-specific survival on univariable (P = 0.005, Figure), and multivariable analysis (P = 0.026, 0.74 [0.57–0.97]). In survivorship, VO significantly declined, and was evident in just 15.3% at one year postoperatively. Conclusion VO is linked with Barrett’s associated EC, and less aggressive tumour biology. Although it negatively impacted operative outcomes, VO was associated with improved oncologic outcomes, independent of BMI or fat mass, indicating a distinct biologic phenotype, and highlighting the importance of research elucidating the interaction between the visceral fat microenvironment, metabolic dysfunction, and the tumor microenvironment.

Summary Background Lifestyle interventions are the primary treatment for metabolic (dysfunction) associated fatty liver disease (MAFLD). However, the histological and cardiometabolic effects of aerobic exercise in MAFLD remain unclear. Aims To assess the effects of a 12‐week aerobic exercise intervention on histological and cardiometabolic endpoints in MAFLD. Methods Patients with biopsy‐confirmed MAFLD participated in a 12‐week aerobic exercise intervention. Liver histology, cardiorespiratory fitness (estimated V̇O 2max ), physical activity, anthropometry and biochemical markers were assessed at baseline, intervention completion, and 12 and 52 weeks after intervention completion. Results Twenty‐four patients completed the exercise intervention (exercise group n = 16, control group n = 8). In the exercise group, 12 weeks of aerobic exercise reduced fibrosis and hepatocyte ballooning by one stage in 58% ( P = 0.034) and 67% ( P = 0.020) of patients, with no changes in steatosis ( P = 1.000), lobular inflammation ( P = 0.739) or NAFLD activity score ( P = 0.172). Estimated V̇O 2max increased by 17% compared to the control group ( P = 0.027) but this level of improvement was not maintained at 12 or 52 weeks after the intervention. Patients with fibrosis and ballooning improvement increased estimated V̇O 2max by 25% ( P = 0.020) and 26% ( P = 0.010), respectively. Anthropometric reductions including body mass ( P = 0.038), waist circumference ( P = 0.015) and fat mass ( P = 0.007) were also observed, but no patient achieved 7%‐10% weight loss. Conclusion This study highlights the potential benefits of a 12‐week aerobic exercise intervention in improving histological endpoints of MAFLD. The development of strategies to ensure continued engagement in aerobic exercise in MAFLD are needed.

Results We collected 24 cases of cervical cancer, which rep-resented 25.26% of the cancers recorded. The average age at diagnosis was 49.23 years. Squamous cell carcinoma rep-resented 96% of the histological type. The diagnostic time was 2 years on average; The disease is diagnosed in the advanced stage in 87.49% of cases. Risk factors are repre-sented by the precocity of sexual intercourse at 53.17%, by the relationship of multiple sexual partners in 62.50%, the history of non-specific sexually transmitted infection was found in 45.83% and multiparity predominated at 59%. Conclusion Compared to hospital data from other cancer cen-ters, cervical cancer seen in the Oncology Department of Toa-masina has the same epidemiological and clinical characteristics as those in other provinces. This disease is ranked second among registered cancers, but is the first gyne-cological cancer. However, access to DXA is variable. This study explores the utility of assessment of BMD on CTs per-formed for cancer-staging in the gynaecologic oncology setting. Methods Prospective, cross-sectional, validation study com-paring quantitative BMD assessment on CT(performed at 120kV) to the gold standard, DXA. CT assessment was per-formed using simple region of interest placement on lumbar vertebral trabecular bone and recording of resultant Houns-field units(HU). Forty-eight women were included in this study. Results CT BMD measurement showed significant correlation with DXA diagnostic categories and BMD. AUC for differentiation of normal from abnormally low BMD on CT ranged from 0.75 – 0.81. Threshold analysis (Youdon ’ s J-statistic) iden-tified the optimal threshold for differentiation of normal from abnormal BMD as 148HU at L3 (sensitivity 82.4%,specificity 83.9%). Conclusion Assessment of BMD on CT at diagnosis of a gynaecological cancer is simple, differentiates normal from abnormally low BMD with a high degree of accuracy, and requires a negligible increase in reporting time. For this high-risk cohort, it can facilitate early identification of patients with low BMD and optimisation of their bone health prior to deleterious effects of therapy. It can improve prioritisation of DXA referrals and commencement of either therapeutic or prophylactic bone modifying agents as clini-cally appropriate. The sensitivity and specificity of thresholds should be con-sidered in determining the appropriate threshold for the chosen clinical application.

Background Supine or prone positioning of the patient on the gantry table is the current standard of care for CT-guided lung biopsy; positioning biopsy side down was hypothesized to be associated with lower pneumothorax rate. Purpose To assess the effect of positioning patients biopsy side down during CT-guided lung biopsy on the incidence of pneumothorax, chest drain placement, and hemoptysis. Materials and Methods This retrospective study was performed between January 2013 and December 2016 in a tertiary referral oncology center. Patients undergoing CT-guided lung biopsy were either positioned in (a) the standard prone or supine position or (b) the lateral decubitus position with the biopsy side down. The relationship between patient position and pneumothorax, drain placement, and hemoptysis was assessed by using multivariable logistic regression models. Results A total of 373 consecutive patients (mean age ± standard deviation, 68 years ± 10), including 196 women and 177 men, were included in the study. Among these patients, 184 were positioned either prone or supine depending on the most direct path to the lesion and 189 were positioned biopsy side down. Pneumothorax occurred in 50 of 184 (27.2%) patients who were positioned either prone or supine and in 20 of 189 (10.6%) patients who were positioned biopsy side down (P < .001). Drain placement was required in 10 of 184 (5.4%) patients who were positioned either prone or supine and in eight of 189 (4.2%) patients who were positioned biopsy side down (P = .54). Hemoptysis occurred in 19 of 184 (10.3%) patients who were positioned prone or supine and in 10 of 189 (5.3%) patients who were positioned biopsy side down (P = .07). Prone or supine patient position (P = .001, odds ratio [OR] = 2.7 [95% confidence interval {CI}: 1.4, 4.9]), emphysema along the needle path (P = .02, OR = 2.1 [95% CI: 1.1, 4.0]), and lesion size (P = .02, OR = 1.0 [95% CI: 0.9, 1.0]) were independent risk factors for developing pneumothorax. Conclusion Positioning a patient biopsy side down for percutaneous CT-guided lung biopsy reduced the incidence of pneumothorax compared with the supine or prone position. © RSNA, 2019.

Micronutrient and fat malabsorption and altered enteroendocrine signaling occur after esophagectomy for cancer; however, the impact of malnutrition on bone health in this cohort has not been previously investigated. In this study, the prevalence of osteoporosis increased after curative surgery, associated with disease-specific, treatment-related, and population risk factors.

Background: Acute mesenteric ischaemia can be caused by various conditions such as arterial occlusion, strangulating obstruction, and hypoperfusion. The CT findings of acute mesenteric ischaemia can vary widely depending on the cause and location. Many of these features are non-specific and can therefore mimic other intestinal pathologies. Methods: Using cases from our institution, we will provide a pictorial description of the CT findings associated with mesenteric ischaemia in order to improve detection of this condition at a potentially reversible stage. Results: The rapid diagnosis of acute mesenteric ischaemia requires a strong clinical suspicion, usually combined with a CT. This pictorial review will illustrate the various imaging features of bowel ischaemia from early to late stage disease. We will correlate the imaging findings with pathological specimens and clinical outcome. In early mesenteric ischaemia, non-specific findings such as bowel wall thickening, dilatation, abnormal bowel enhancement and mesenteric stranding can only be attributed to ischaemia in the context of clinical suspicion. Bowel wall thickening is most frequently identified however is the least specific finding. Pneumatosis intestinalis and portal venous gas are more well recognised features, however these indicate necrosis for which urgent surgical resection is the only option. The cases in this exhibit will review each of the salient findings of mesenteric ischaemia with a number of examples. We will also highlight the tips and tricks we find helpful in diagnosis. Conclusions: A strong clinical suspicion followed by a methodical search for both intra and extraintestinal features of mesenteric ischaemia are essential for its prompt diagnosis.