With greater sensitivity of modern CT scans, PI and PVG are being detected in patients with a wide range of surgical and non-surgical conditions. This clinical algorithm can identify subgroups to direct surgical intervention for acute ischemic insults and prevent non-therapeutic laparotomies for benign idiopathic PI and PVG.

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Purpose:To evaluate the performance of T2-and diffusionweighted magnetic resonance imaging (MRI) with image fusion for detection of locally recurrent pelvic malignancy. Materials and Methods:The study group consisted of 28 patients (27 female, 1 male) who underwent pelvic MRI at 1.5 T after treatment of pelvic malignancy. MR images were reviewed independently by three blinded readers. The performance of the four sequences for detecting local recurrence was evaluated using receiver operating characteristic analysis: T2-weighted fast spin-echo (FSE), diffusionweighted echo-planar imaging (DWI), dynamic contrast-enhanced (DCE) fat-suppressed T1-weighted spoiled gradient echo (SPGR), and T2-DWI with image fusion, the latter created using OsiriX Medical Imaging Software.Results: Local recurrence was confirmed at biopsy in 16 patients. Twelve patients showed no evidence of recurrence on two consecutive MRI studies. The Az value for T2-DWI with image fusion (0.949) was statistically greater than that for T2-weighted FSE (0.849) (P Ͻ 0.05). The sensitivity and specificity was 87.5% and 47.2%, respectively, for T2-weighted FSE, 100.0% and 50.0% for DWI, 95.8% and 58.3% for DCE fat-suppressed T1-weighted SPGR, and 93.8% and 72.2% for T2-DWI with image fusion. Conclusion:For depicting locally recurrent pelvic malignancy, T2-DWI with image fusion outperforms standard T2-weighted FSE and DWI and is comparable to DCE fatsuppressed T1-weighted SPGR.

The purpose of this study was to clarify the association between CT findings and Fuhrman grade of clear cell renal cell carcinoma (ccRCC). The study group consisted of 214 surgically proven ccRCC in 214 patients. Contrast-enhanced CT studies were retrospectively assessed for tumor size, cystic versus solid, calcification, heterogeneity of lesions, percentage of non-enhancing (necrotic) areas, and growth pattern. CT findings and Fuhrman grade were compared. Nineteen of 22 (86.4%) cystic ccRCC were low grade (Fuhrman grades 1-2). There was no significant correlation between tumor size and grade in cystic ccRCC (P = 0.43). In predominantly solid ccRCC, there was significant correlation between tumor size and grade (P < 0.0001). Thirty-eight of 43 (88.4%) infiltrative ccRCC were high grade (Fuhrman grades 3-4). Logistic regression showed tumor size and infiltrative growth were significantly associated with grades 3-4 (P = 0.00083 and P = 0.0059). Cystic ccRCC tends to be low grade. Infiltrative growth and larger tumor size may increase the likelihood of high grade ccRCC.

Background: The authors investigated whether there is any correlation between gastric pouch size measured by routine upper gastrointestinal contrast study (UGI) after laparoscopic Roux-en-Y gastric bypass (LRYGBP) and short-term weight loss.Methods: The study group consisted of 82 patients (66F, 16M) who underwent LRYGBP. Body mass index before surgery ranged from 35.4 to 71.7 kg/m 2, with a mean of 47.4 kg/m 2. UGI was performed 1 day after LRYGBP in all patients. Proximal gastric pouch size was estimated by multiplying maximal transverse and longitudinal diameters on AP spot image or film. Percent excess weight loss (%EWL) obtained at 3, 6, 12 and 24 months after surgery was used as an indicator of short-term results. According to the presence of contrast passage through the gastrojejunostomy, each patient was classified into 2 groups: Group A, negative; Group B, positive.Results: There was no correlation between proximal gastric pouch size and %EWL at any point of time (P>0.05). The correlation coefficients calculated for 3, 6, 12 and 24 months after surgery were 0.038, 0.110, 0.015 and 0.042, respectively (Pearson correlation test). The gastric pouch size of Group A was larger than that of Group B (Student t-test, P<0.001). There was no difference in %EWL between Groups A and B at 3 and 6 months after surgery (P>O.05).Conclusion: Pouch size area, measured by routine UGI study on the first postoperative day, does not influence short-term postoperative weight loss.

The purpose of this study was to retrospectively assess the diagnostic performance of multi-detector row computed tomography (MDCT) in an evaluation of pancreas divisum using endoscopic retrograde pancreatography (ERP) as the reference standard. We analyzed 41 consecutive patients (14 cases of pancreas divisum and 27 cases of standard anatomy) who had undergone both MDCT and ERP for the evaluation of clinically diagnosed acute pancreatitis between November 2004 and June 2007. The CT reconstruction thickness and interval were both 3 mm. Two radiologists independently reviewed CT data, and the diagnostic confidence in determining the pancreatic ductal anatomy was scored using a five-point scale. CT detectability was correlated with the severity of pancreatitis and the degree of pancreatic necrosis based on the Balthazar index. With consensus, 16 of 41 cases (39.0%) were evaluated as indeterminate. Ductal anatomy was correctly diagnosed in 23 of 41 cases (56.1%). Eight of 14 cases (57.1%) were correctly diagnosed as pancreas divisum. Standard anatomy was identified in 15 of 27 cases (55.6%). The inter-observer agreement was substantial (κ = 0.71). Grade B or more pancreatitis and the presence of pancreatic necrosis significantly influenced the evaluation of ductal anatomy (p = 0.01 and p < 0.01, respectively). Pancreas divisum was correctly diagnosed in the case of grade A acute pancreatitis. The CT detectability of pancreas divisum in patients with grade B or more pancreatitis is still relatively low even in the MDCT era.