In obese male subjects, visceral adiposity has been associated with obstructive sleep apnoea (OSA), while studies in overweight males and females are limited. Our goal was to examine the association between OSA and visceral fat in a relatively nonobese population and assess the effects of 2 months placebo-controlled continuous positive airway pressure (CPAP) use on abdominal fat.81 subjects, 22 middle-aged males and 20 post-menopausal females with OSA, and 19 male and 20 female controls were studied in the sleep laboratory for four nights. Abdominal (visceral (VAT) and subcutaneous (SAT) adipose tissue) and liver fat were assessed with computed tomography. OSA patients were re-assessed post-CPAP and post sham-CPAP.Apnoeic males had significantly higher VAT than controls, while apnoeic females had higher SAT than controls. In both sexes, OSA was associated with increased liver fat. In males, apnoea was associated with VAT whereas in females it was associated with subcutaneous, visceral and total fat. CPAP did not affect abdominal and liver fat.In overweight males, visceral adiposity is associated with OSA whereas in females it is associated with global adiposity. In overweight males, our therapeutic goal should be the reduction of visceral adiposity and its metabolic correlates, whereas, in females, weight loss may be sufficient. Shortterm CPAP treatment does not affect general, abdominal or intra-hepatic adiposity.

Certain inflammatory pancreatic abnormalities may mimic pancreatic ductal adenocarcinoma at imaging, which precludes accurate preoperative diagnosis and may lead to unnecessary surgery. Inflammatory conditions that may appear masslike include massforming chronic pancreatitis, focal autoimmune pancreatitis, and paraduodenal pancreatitis or "groove pancreatitis." In addition, obstructive chronic pancreatitis can mimic an obstructing ampullary mass or main duct intraductal papillary mucinous neoplasm. Secondary imaging features such as the duct-penetrating sign, biliary or main pancreatic duct skip strictures, a capsulelike rim, the pancreatic duct-to-parenchyma ratio, displaced calcifications in patients with chronic calcific pancreatitis, the "double duct" sign, and vessel encasement or displacement can help to suggest the possibility of an inflammatory mass or a neoplastic process. An awareness of the secondary signs that favor a diagnosis of malignant or inflammatory lesions in the pancreas can help the radiologist to perform the differential diagnosis and determine the degree of suspicion for malignancy. Repeat biopsy or surgical resection may be necessary to achieve an accurate diagnosis and prevent unnecessary surgery for inflammatory conditions.

Background: Crohn's disease (CD) patients are typically underweight; however, a growing cohort of overweight CD patients is emerging. The current study investigates whether body mass index (BMI) or volumetric fat parameters can be used to predict morbidity after ileocolectomy for CD. Methods: One hundred and forty-three CD patients who underwent elective ileocolectomy were identified from our Inflammatory Bowel Disease (IBD) Registry. Patient demographics and operative outcomes were recorded. Visceral (VA) and subcutaneous (SA) adiposity and abdominal circumference (AC) were analyzed on preoperative CT scans using Aquarius iNtuition software. A visceral/subcutaneous ratio (VSR) was calculated. Results: BMI correlated with SA (p = 0.0001), VA (p = 0.0001) and AC (p = 0.0001) but not VSR (p > 0.05). BMI, VA and AC did not predict surgical morbidity (p > 0.05). In multivariate regression analysis, family history of IBD (p = 0.009), high American Society of Anesthesiologists score (p = 0.02) and increased VSR (p = 0.03) were independent predictors of postoperative morbidity. Conclusions: The visceral/subcutaneous fat ratio is a more reliable predictor of postoperative outcomes in CD patients undergoing ileocolectomy than conventional adiposity markers such as BMI. Preoperative calculation of the visceral/subcutaneous fat ratio offers the opportunity to optimize high-risk surgical patients, thus improving outcomes.

Pseudoenhancement of renal cysts significantly correlates with size smaller than 1 cm and central location. Although pseudoenhancement increases with larger numbers of detectors, the correlation was not statistically significant. Cysts in the 1- to 1.5-cm range have a 19% likelihood of pseudoenhancement.

No abstract

The perineal space is often overlooked because of the infrequency of abnormalities. Accurate image interpretation and visualization of extent of pathology is important for proper management. Trauma and infectious diseases occur in the acute setting, whereas tumors are common in the chronic setting. Cross-sectional imaging plays a crucial role in depicting perineal anatomy and evaluating the extent of disease.

ADC values measured on a routine PACS workstation are as accurate as the values obtained on a dedicated specialized workstation. ADC value measurement on the routine PACS will save time and lead to increased utilization, which, in turn, will lead to an improved understanding of the different disease processes and their clinical management.

Radiology 2018; 289:809-813 • https://doi.org/10.1148/radiol.2018180690 • Content code:Academic medical centers have long relied on radiology residents to provide after-hours coverage, which means that they essentially function with autonomy. In this approach, attending radiologist review of resident interpretations occurs the following morning, often by subspecialist faculty. In recent years, however, this traditional coverage model in academic radiology departments has been challenged by an alternative model, the 24-hour attending radiologist coverage. Proponents of this new model seek to improve patient care after hours by increasing report accuracy and the speed with which the report is finalized. In this article, we review the traditional and the 24-hour attending radiologist coverage models. We summarize previous studies that indicate that resident overnight error rates are sufficiently low so that changing to an overnight attending model may not necessarily provide a meaningful increase in report accuracy. Whereas some centers completely replaced overnight residents, we note that most centers use a hybrid model, and overnight residents work alongside supervising attending radiologists, much as they do during the day. Even in this hybrid model, universal double reading and subspecialist final review, typical features of the traditional autonomous resident coverage model, are generally sacrificed. Because of this, changing from resident coverage to coverage by an attending radiologist that is 24 hours/day, 7 days/week may actually have detrimental effects to patient safety and quality of care provided. Changing to an overnight attending radiologist model may also have negative effects on the quality of radiology resident training, and it significantly increases cost.