Postmortem computed tomography (CT) is currently a well-known procedure and helps in postmortem investigations. In this case report, we report a unique postmortem CT finding: delayed cerebral enhancement associated with the antemortem infusion of contrast medium. A 72-year-old female lost consciousness at a restaurant and was taken to a hospital in an ambulance. Despite resuscitation efforts, she died of hypoxic–ischemic encephalopathy caused by cardiac arrest. About 6 h before her death, she underwent enhanced antemortem CT of the head. No abnormal enhancement was observed in the cerebral parenchyma. Then, 11 h after her death, she underwent unenhanced postmortem CT, which showed bilateral hyperdense caudate nucleus and putamina, due to residual iodinated contrast medium, in addition to other characteristic findings of hypoxic–ischemic encephalopathy. The mechanism underlying this phenomenon could be the destruction of the blood–brain barrier, and/or selective vulnerability, due to hypoxic–ischemic changes in the gray matter. Enhancement of basal ganglia on postmortem CT due to antemortem infusion of iodinated contrast medium might suggest hypoxic–ischemic encephalopathy, which should be noted in postmortem CT interpretations.

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Purpose This study aimed to compare the hepatocellular carcinoma (HCC) detection performance, interobserver agreement for Liver Imaging Reporting and Data System (LI-RADS) categories, and image quality between deep learning reconstruction (DLR) and conventional hybrid iterative reconstruction (Hybrid IR) in CT. Methods This retrospective study included patients who underwent abdominal dynamic contrast-enhanced CT between October 2021 and March 2022. Arterial, portal, and delayed phase images were reconstructed using DLR and Hybrid IR. Two blinded readers independently read the image sets with detecting HCCs, scoring LI-RADS, and evaluating image quality. Results A total of 26 patients with HCC (mean age, 73 years ± 12.3) and 23 patients without HCC (mean age, 66 years ± 14.7) were included. The figures of merit (FOM) for the jackknife alternative free-response receiver operating characteristic analysis in detecting HCC averaged for the readers were 0.925 (reader 1, 0.937; reader 2, 0.913) in DLR and 0.878 (reader 1, 0.904; reader 2, 0.851) in Hybrid IR, and the FOM in DLR were significantly higher than that in Hybrid IR (p = 0.038). The interobserver agreement (Cohen’s weighted kappa statistics) for LI-RADS categories was moderate for DLR (0.595; 95% CI, 0.585–0.605) and significantly superior to Hybrid IR (0.568; 95% CI, 0.553–0.582). According to both readers, DLR was significantly superior to Hybrid IR in terms of image quality (p ≤ 0.021). Conclusion DLR improved HCC detection, interobserver agreement for LI-RADS categories, and image quality in evaluations of HCC compared to Hybrid IR in abdominal dynamic contrast-enhanced CT. Graphical Abstract

Purpose Biliary adenofibroma is a solid microcystic epithelial neoplasm in the liver, comprising microcystic and tubuloacinar glandular tissues lined by a non-mucin secreting biliary epithelium and supported by a fibrous stroma. It is an extremely rare benign tumor with potential for malignant transformation. Herein, we report the case of a 64-year-old woman diagnosed with intrahepatic cholangiocarcinoma arising from biliary adenofibroma. Methods Imaging studies revealed a tumor of 50 mm diameter, consisting of two components in S1 of the liver. The ventral portion of the tumor showed an ill-defined mass with early peripheral and gradual centripetal enhancement invading to the middle hepatic vein on computed tomography (CT), diffusion restriction on magnetic resonance images, and high fluorine-18-2-deoxy-d-glucose (FDG) uptake on positron emission tomography, like conventional intrahepatic cholangiocarcinoma. The dorsal portion showed a well-defined and low-attenuated mass with heterogeneous early enhancement and partial wash-out on CT, marked hyperintensity on heavily T2-weighted images, and low FDG uptake. The patient subsequently underwent extended left hepatectomy. Results Pathologically, the former was diagnosed as cholangiocarcinoma and the latter as biliary adenofibroma. We discuss the radiological-pathological correlation of the tumor with a literature review. Conclusion Preoperative diagnosis of biliary adenofibroma is extremely challenging; however, clinically, it is crucial not to miss the presence of malignant findings. Graphical abstract

Objective: This study aimed to test the usefulness of computer-aided detection (CAD) for the detection of brain metastasis (BM) on contrast-enhanced computed tomography. Methods:The test data set included whole-brain axial contrast-enhanced computed tomography images of 25 cases with 62 BMs and 5 cases without BM. Six radiologists from 3 institutions with 2 to 4 years of experience independently reviewed the cases, both in conditions with and without CAD assistance. Sensitivity, positive predictive value, number of false positives, and reading time were compared between the conditions using paired t tests. Subanalysis was also performed for groups of lesions divided according to size. A P value <0.05 was considered statistically significant.Results: With CAD, sensitivity significantly increased from 80.4% to 83.9% (P = 0.04), whereas positive predictive value significantly decreased from 88.7% to 84.8% (P = 0.03). Reading time with and without CAD was 112 and 107 seconds, respectively (P = 0.38), and the number of false positives was 10.5 with CAD and 7.0 without CAD (P = 0.053). Sensitivity significantly improved for 6-to 12-mm lesions, from 71.2% without CAD to 80.3% with CAD (P = 0.02). The sensitivity of the CAD (95.2%) was significantly higher than that of any reader (with CAD: P = 0.01; without CAD: P = 0.005). Conclusions:Computer-aided detection significantly improved BM detection sensitivity without prolonging reading time while marginally increased the false positives.