VAT and SAT density provide a unique marker of mortality risk that does not appear to be inflammation related.

Objective-To correlate the presence of major levator ani muscle (LAM) injuries on magnetic resonance imaging (MRI) with fecal incontinence (FI), pelvic organ prolapse (POP) and urinary incontinence (UI) in primiparous women 6-12 months postpartum.Study design-A published scoring system was used to characterize LAM injuries on MRI dichotomously (MRI−, no/mild versus MRI+, major).Results-Major LAM injuries were observed in 17/89(19.1%) women who delivered vaginally with external anal sphincter (EAS) injuries, in 3/88(3.5%) who delivered vaginally without EAS injury, and in 0/29(0%) who delivered by Cesarean before labor (p=0.0005). Among women with EAS injuries, those with major LAM injuries trended towards more FI, 35.3% vs. 16.7% (p=0.10) and POP, 35.3% vs. 15.5% (p=0.09), but not UI (p=1.0).Conclusion-These data support the growing body of literature suggesting that both EAS and LAM are important for fecal continence and that multiple injuries contribute to pelvic floor dysfunction.Keywords fecal incontinence; levator ani muscle; magnetic resonance imaging (MRI); pelvic floor muscle; pelvic organ prolapse; urinary incontinence INTRODUCTIONVaginal birth increases the likelihood that women will have pelvic floor dysfunction. Recent advances in pelvic floor imaging and neuromuscular testing provide evidence to pinpoint the specific anatomical and functional abnormalities caused by vaginal birth that are associated with increased occurrence of fecal incontinence (FI), pelvic organ prolapse (POP) and stress urinary incontinence (SUI).Visible damage to the pubic portion of the levator ani muscle (LAM) is one specific injury associated with vaginal delivery.(1-3) Pelvic imaging using magnetic resonance imaging (MRI) can improve our understanding of anatomic observations and clinical conditions that occur after childbirth. In a case-control study, young women with de novo SUI, nine months after a first vaginal birth, were more than twice as likely to have a LAM defect imaged on MRI compared to women without SUI (28% versus 11%).(1) However, using a different casecontrol mix of middle-aged women with and without stress SUI, the same researchers found similar rates of LAM injury in each group. (4) The relationship of LAM injury to other known injuries is not entirely clear. In a case control study of primiparous women with and without de novo postnatal stress incontinence, LAM injury was more common in those who experienced an anal sphincter rupture at delivery compared to those who did not (62% versus 17%, OR = 8.1).(2) The effect of this injury on fecal incontinence (FI), pelvic organ prolapse (POP) and stress urinary incontinence (SUI) is not fully known.The Childbirth and Pelvic Symptoms (CAPS) study assessed the prevalence and incidence of FI, POP and UI in a population of primiparous women after primary repair of clinically diagnosed 3 rd or 4 th degree sphincter tears, compared to women who underwent vaginal delivery without a tear and those who underwent a Cesarean delivery prior to labor. Two hundred and thirt...

Purpose of the Report The objective was to compare F-18 fluorodeoxyglucose (FDG) and F-18 fluorothymidine (FLT) positron emission tomography (PET) in differentiating radiation necrosis from recurrent glioma. Materials and methods Visual and quantitative analyses were derived from static FDG PET and static and dynamic FLT PET in 15 patients with suspected recurrence of treated ≥ grade II glioma with a new focus of Gd-contrast enhancement on MRI. For FDG PET, SUVmax and the ratio of lesion SUVmax to the SUVmean of contralateral white matter were measured. For FLT PET, SUVmax and Patlak-derived metabolic flux parameter Kimax were measured for the same locus. A 5-point visual confidence scale was applied to FDG PET and FLT PET. ROC analysis was applied to visual and quantitative results. Differences between recurrent tumor and radiation necrosis were tested by Kruskal-Wallis analysis. Based on follow-up Gd-MRI imaging, lesion-specific recurrent tumor was defined as a definitive increase in size of the lesion, and radiation necrosis as stability or regression. Results For FDG SUVmax, FDG ratio lesion:white matter and FLT Kimax, there was a significant difference between mean values for recurrent tumor and radiation necrosis. Recurrent tumor was best identified by FDG ratio of lesion:contralateral normal white matter (AUC 0.98, CI 0.91–1.00, sens. 100%, spec. 75% for an optimized cut-off value of 1.82). Conclusion Both quantitative and visual determinations allow accurate differentiation between recurrent glioma and radiation necrosis by both FDG and FLT PET. In this small series, FLT PET offers no advantage over FDG PET.

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The purpose of this study was to compare optimized whole-body (WB) and dedicated high-resolution contrast-enhanced PET/CT protocols and contrast enhanced CT in the preoperative staging of primary squamous cell carcinoma of the head and neck. Methods: A total of 44 patients with clinically M0 squamous cell carcinoma of the head and neck underwent primary tumor resection and neck dissection within 6 wk of diagnostic imaging. Imaging consisted of a standard WB PET/CT protocol without intravenous contrast enhancement, followed by a high-resolution dedicated head and neck (HN) PET/CT protocol, which included diagnostic-quality contrast-enhanced CT (CECT). Imaging results were compared with histopathology. A 5-point scale was used to designate primary tumor localization and the presence of lymph node metastasis on a per-patient and per-level basis. For cervical nodes, receiver-operating-characteristic curves were generated to determine the differences in performance between the WB and HN PET/CT protocols and CECT. Sensitivity, specificity, positive and negative predictive values, and accuracy were calculated for primary tumor and cervical nodes. Results: No statistical difference was observed between WB and HN PET/CT protocols, both of which significantly outperformed CECT, in the evaluation of the primary tumor. The performance of the HN PET/CT protocol was superior to that of the WB PET/CT in the detection of cervical node metastases, achieving statistical significance on a per-level basis and approaching significance on a per-patient basis, with the greatest advantage in the detection of small positive lymph nodes (,15 mm). No significant difference was observed between the WB PET/CT protocol and CECT in nodal staging, either on a per-patient or on a per-level basis. Conclusion: The primary advantage of the dedicated HN PET/CT protocol over the WB protocol or CECT in the staging of head and neck cancer is in the detection of small lymph node metastases.

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Renal masses are increasingly detected in asymptomatic individuals as incidental findings. CT and MRI with intravenous contrast and a dedicated multiphase protocol are the mainstays of evaluation for indeterminate renal masses. A single-phase postcontrast dual-energy CT can be useful when a dedicated multiphase renal protocol CT is not available. Contrast-enhanced ultrasound with microbubble agents is a useful alternative for characterizing renal masses, especially for patients in whom iodinated CT contrast or gadolinium-based MRI contrast is contraindicated. 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.

In patients with the clinical suspicion of intracranial hypotension, we found that cutoff values of 5.5 mm or less for the mamillopontine distance and 50° or less for the pontomesencephalic angle were sensitive and specific in strengthening the qualitative MRI findings. Therefore, quantitative assessments may provide a more accurate diagnosis.