Percutaneous cryoablation of renal tumors requires a number of important steps for success and relies heavily on imaging for treatment planning, intraprocedural guidance and monitoring, detection of untreated tumor, and surveillance for disease progression. Imaging-guided percutaneous cryoablation has several advantages over laparoscopic cryoablation. In particular, computed tomography (CT) and magnetic resonance (MR) imaging allow global evaluation of the ablation zone and an accurate depiction of the treatment margin. Ultrasonography allows real-time guidance of probe placement but cannot help depict ice ball formation as accurately as CT or MR imaging. Multiphasic CT or MR imaging should be performed at structured intervals following ablation. Treated tumors are expected to decrease in size over time, and lesion growth and internal or nodular enhancement are suspicious for tumor recurrence or progression. Complications include probe site pain, hematoma, incomplete ablation, and recurrent tumor. Current limitations of percutaneous cryoablation include the inability to control hemorrhage without intraarterial access and a lack of long-term follow-up data. Nevertheless, percutaneous cryoablation is an effective choice for minimally invasive nephron-sparing treatment of renal tumors.

Although the malignancy rate in surgically excised Bosniak IIF and Bosniak III cystic renal lesions was 25% and 54%, respectively, in our study, the malignancy rate was higher in patients with a history of primary renal malignancy or coexisting Bosniak IV lesion and/or solid renal neoplasm.

Gastrointestinal (GI) tract perforation is a life-threatening condition that can occur at any site along the alimentary tract. Early perforation detection and intervention significantly improves patient outcome. With a high sensitivity for pneumoperitoneum, computed tomography (CT) is widely accepted as the diagnostic modality of choice when a perforated hollow viscus is suspected. While confirming the presence of a perforation is critical, clinical management and surgical technique also depend on localizing the perforation site. CT is accurate in detecting the site of perforation, with segmental bowel wall thickening, focal bowel wall defect, or bubbles of extraluminal gas concentrated in close proximity to the bowel wall shown to be the most specific findings. In this article, we will present the causes for perforation at each site throughout the GI tract and review the patterns that can lead to prospective diagnosis and perforation site localization utilizing CT images of surgically proven cases.

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epatocellular carcinoma (HCC) is the most common primary liver malignancy and the second-most common cause of cancer-related death worldwide (1,2). For patients with stage T2 HCC who are not candidates for surgical resection, liver transplantation offers the best chance for disease-free survival (3). The limited availability of donor organs and increasing demand for these organs result in long waiting-list times, during which many patients become ineligible for transplantation because of tumor progression beyond stage T2 (4). This has prompted the widespread use of local-regional bridging therapies such as percutaneous ablation, transcatheter bland arterial embolization, chemoembolization, radioembolization, and radiation therapy to maintain a patient's eligibility for transplantation (5,6). The Liver Imaging Reporting and Data System (LI-RADS) is a system of standardized imaging criteria developed for the evaluation of patients at risk of developing HCC. The 2017 version of LI-RADS introduced a Treatment Response (LI-RADS Treatment Response [LR-TR]) algorithm for the assessment of lesions that have been previously treated with local-regional therapies (7,8). These lesions are categorized as LR-TR Nonviable, Equivocal, or Viable according to their imaging features, including focal arterial phase hyperenhancement (APHE), washout, and enhancement similar to pretreatment enhancement (9). While similar to the modified Response Evaluation Criteria in Solid Tumors (mRECIST) (10), the LR-TR algorithm clarifies tumor status at the level of individual lesions, rather than making an overall categorization of disease burden (11). However, there are currently no published data that evaluate the performance of the Treatment Response algorithm for predicting the degree of local-regional

Hepatobiliary phase imaging may improve small lesion detection (<1 cm) and characterization of lesions in general, in MRI of the cirrhotic liver with Gd-EOB-DTPA.

Conservative management for the majority of patients with severe chest injuries has produced a reduction in mortality, complications, and hospital length of stay. More recently, operative stabilization of rib fractures has been used with the implication of improved outcome. We assessed the impact of operative rib fracture stabilization on outcome among trauma patients. A matched case-control study of patients undergoing operative rib fracture stabilization was performed. Thirty patients undergoing rib stabilization were matched with 30 controls. Length of intensive care unit (controls, 14.1 ± 2.7 vs cases, 12.1 ± 1.2, P = 0.51) and total hospital (controls, 21.1 ± 3.9 vs cases, 18.8 ± 1.8, P = 0.59) stay were similar for both groups. There was a trend toward fewer total ventilator days for operative patients (6.5 ± 1.3 days vs 11.2 ± 2.6 days, P = 0.12). Ventilator days for operative patients from the time of stabilization was 2.9 ± 0.6 days compared with 9.4 ± 2.7 days in controls (P = 0.02). Rib fracture fixation may reduce ventilator requirements in trauma patients with severe thoracic injuries. Long-term functional outcomes need to be assessed to ascertain the impact of this procedure.

There were no deaths from Bosniak IIF or III renal cysts regardless of management approach. Moderate to severe complications are frequent in patients managed by surgery.