Incidentally observed posterior transdiaphragmatic hernias are a common finding on multidetector-row computed tomography, occurring in up to 20% of persons by age 70 years.

The aim of the present study was to investigate the significance of appendicoliths as an exacerbating factor of acute appendicitis using multivariate analysis. A total of 254 patients with pathologically proved acute appendicitis were enrolled in this retrospective study (male, 51 %; mean age, 40.1 years; range, 15-91 years). Two radiologists performed a consensus evaluation of preoperative CT images for the presence of appendicoliths in consensus. When there were appendicoliths, they assessed the number and location of appendicoliths, and measured the longest diameter of the largest appendicolith. Pathological diagnosis was used for the reference standard. The relationships of appendicoliths to gangrenous appendicitis and to perforated appendicitis were each assessed with multiple logistic regression models, which were adjusted for demographic and clinical characteristics of patients. Significant relationships were identified between gangrenous appendicitis and the presence of appendicoliths (OR, 2.2; 95 % CI, 1.2-4.0), the largest appendicolith more than 5 mm in the longest (OR, 3.0; 95 % CI, 1.6-5.7), and location of an appendicolith at the root of the appendix (OR, 2.0; 95 % CI, 1.1-3.8). Among the CT characteristics, the location of an appendicolith at the root of the appendix only showed significant relationship with perforated appendicitis (OR, 4.5; 95 % CI, 1.4-15.4). Size of the largest appendicolith and location of appendicoliths at the root of the appendix are exacerbating factors of acute appendicitis.

Recently, primary systemic chemotherapy has been used not only for locally advanced breast cancers but also for operable cases for which adjuvant chemotherapy is necessary. Moreover, various kinds of ablation therapies have been tried to treat early breast cancer non-surgically, such as radiofrequency ablation (RFA), interstitial laser surgery, cryosurgery and focused ultrasound surgery (FUS). If pathological complete remission (pCR) can be correctly assessed by magnetic resonance mammography (MRM) or ultrasonography (US), a non surgical approach can be used for treatment. MRM is now widely used to assess the effect of chemotherapy in the neoadjuvant setting. However, the ability of MRM to estimate pCR is not yet sufficient to allow a non-surgical approach to breast cancer. Conversely, ultrasonography (US) might over-diagnose fibrous change as residual invasive cancer. If both MRM and US reveal no abnormal finding, there might be no residual cancer on pathological examination. However, such circumstances are encountered in only 2-3% of cases given the neoadjuvant treatment. Other cases, such as US showing residual disease in spite of pCR on MRM, have some potential for false positivity. Therefore, US-guided needle biopsy, especially vacuum-assisted breast biopsy, might be suitable to judge whether true pCR was achieved in the targeted lesion.

BackgroundCardiac sarcoidosis is associated with major adverse cardiac events including cardiac arrest, for which anti-inflammatory treatment is indicated. Oral corticosteroid is the mainstay among treatment options; however, adverse effects are a major concern with long-term use. It would be beneficial for providers to predict treatment response and prognosis for proper management strategy of sarcoidosis, though it remains challenging. Fluorine (F)-18 fluorodeoxyglucose (FDG)-positron emission tomography(PET)/computed tomography(CT) has an advantage over anatomical imaging in providing semi-quantitative functional parameters such as standard uptake value (SUV), metabolic volume, and total lesion glycolysis (TLG), which are well-established biomarkers in oncology. However, the relationship between these parameters and treatment response has not been fully investigated in cardiac sarcoidosis. Also, the prognostic value of extracardiac active inflammation noted on FDG-PET/CT in the setting of cardiac sarcoidosis is unclear. The aim of this retrospective study was to investigate the prognostic value of semi-quantitative values of both cardiac and extracardiac disease sites derived from FDG-PET/CT in predicting treatment course in cardiac sarcoidosis.MethodsSixteen consecutive patients with suspected cardiac sarcoidosis, who demonstrated abnormal myocardial activity on cardiac-inflammation FDG-PET/CT encompassing the entire chest/upper abdomen and subsequently underwent corticosteroid therapy for diagnosis of active cardiac sarcoidosis, were included. Semi-quantitative values of hypermetabolic lesions were derived from all visualized organ system and were compared to daily corticosteroid dose at 6 months.Results Of the 16 patients, 81.3% (13/16) of the patients showed extracardiac involvement. The lesion with the greatest SUV was identified in the heart in 11 patients (68.7%), in the liver in 1 patient (6.3%), and in lymph nodes in 4 patients (25%). The maximum SUV across all visualized organ systems including the heart were 8.8 ± 3.1 for the patients with corticosteroid dose ≤ 10 mg and 12.5 ± 3.3 for those with > 10 mg (P = 0.04). Metabolic volume and TLG across all visualized organ systems or any values in the heart alone showed no significant statistical difference between the two groups.ConclusionsMaximum SUV across all involved organ-systems of the chest and upper abdomen, not that of the heart alone, could be a predictor of treatment course of steroid therapy at 6 months in patients with active cardiac sarcoidosis.