Objective Surgical staging is the most confidential method for prognosis prediction. However, in which stage the surgery is needed and the treatment management of these patients is controversial. Presentation of new determinant factors with imaging methods for prediction of poor prognosis can provide better disease management. The aim of our study was to demonstrate the ability of metabolic tumor volume and total lesion glycolysis as a prognostic factor to predict the disease-free survival time, necessity of adjuvant radiotherapy–chemotherapy, and the association of these parameters with the clinicopathological features. Methods Forty-four endometrial cancer diagnosed patients whose PET/CT scans were performed for treatment planning were included in our study. Metabolic parameters (SUVmax, metabolic tumor volume, total lesion glycolysis) of the primary tumor were calculated. Abdominal hysterectomy was performed for all patients. Histopathologic findings were noted. Patients were followed for 31.4 ± 14.8 months. Results Metabolic tumor volume and total lesion glycolysis were significant prognostic factors for disease-free survival, whereas SUVmax did not effect disease-free survival. According to regression analysis, only metabolic tumor volume was found significant for radiotherapy planning (cutoff metabolic tumor volume; 26.30 ml). There was significant association between metabolic tumor volume, total lesion glycolysis and early-stage, myometrial invasion, and lymph node positivity. We observed only weak association between SUVmax and myometrial invasion. ROC curve calculated metabolic tumor volume and total lesion glycolysis cutoff values as 19.6 ml and 90 g for early-stage, 14.3 ml and 173.4 g for myometrial invasion, and 29.7 ml and 283.1 g for lymph node positivity, respectively. Conclusion Metabolic tumor volume and total lesion glycolysis may be used as prognostic factors for endometrial cancer. The association between SUVmax and clinical findings, disease-free survival, histopathological features are weak. Further studies are needed for demonstrating the prognostic value of metabolic volumetric parameters.

There are various methods that could be used for small bowel imaging. Although conventional enteroclysis has a high sensitivity in the diagnosis of most of the small bowel diseases, it cannot provide any direct information about the mural-extramural diseases and the other abdominal structures. Besides, enteroclysis-based techniques have risk of additional radiation exposure, and they are poorly tolerated because placement of nasojejunal tube is required. New enterographic methods have been developed, and the number of enterographic techniques increased significantly in the recent years to overcome those limitations. The other modalities including ultrasound, small bowel follow-through, or capsule-endoscopy are often used as complementary methods in evaluation of the small bowel diseases. In this review, technique and clinic details, advantages, and disadvantages of the radiologic techniques that are used in the diagnosis of small bowel diseases, and the imaging findings of common pathologic conditions were discussed in the light of current literature.

SummaryBackgroundAcute appendicitis is an emergent surgically treated disease generally represented by right lower abdominal pain. The most common location of the appendix is descending intraperitoneal. However, it can also show atypical locations such as inguinal canal, femoral canal, subhepatic, retrocecal, intraperitoneal abdominal midline and left side in situs inversus or intestinal malrotation patients. Atypical location can lead to atypical clinical presentations. Ultrasonography is the first choice modality for imaging. However, it can be insufficient for demonstration of the appendix. Therefore, computed tomography (CT) is needed for further examination. We aim to review the CT findings of atypically located acute appendicitis with cases and remind the clinicians and radiologists the importance of the prompt diagnosis.Case ReportWe presented five atypically-located appendix cases, including four with acute appendicitis that presented to our emergency department with acute abdominal pain. Two of the acute appendicitis cases had normal, the other two had elevated white blood cell count, but all of them had elevated CRP. Ultrasonography imaging was performed as a first-line imaging modality. Because of the inconclusive results of both clinical-laboratory findings and ultrasonography, CT imaging was performed. Abdominal CT demonstrated all of the atypically localised appendices successfully, which were left-sided in a malrotated patient, retrocecal, subhepatic, retrocecal ascending, intraperitoneal abdominal midline localised.ConclusıonsAtypically located acute appendicitis can show atypical presentation and result in misdiagnosis. If ultrasonograpgy is inconclusive, we suggest abdominal CT in such confusing, complicated cases, because misdiagnosis or delay in the right diagnosis can result in complications and increased morbidity and mortality rates.

Our new mixture allowed good-quality enterographic images, and this solution was well tolerated by patients. In addition, this mixture is useful for evaluation of small bowels and colonic segments. We suggest the use of it for enterographic examinations.

Background New methods to reduce subjectivity in preoperative magnetic resonance imaging (MRI) staging of endometrial cancer are needed. Purpose To investigate the role of MRI quantitative assessment in staging and risk stratification of endometrial cancer. Material and Methods Preoperative T2-weighted (T2W) images and diffusion-weighted imaging of 42 patients were analyzed retrospectively by two radiologists. Tumor area ratio (TAR) and tumor volume ratio (TVRseg) were calculated by semi-automatic segmentation of the tumor and uterus on T2W imaging and apparent diffusion coefficient (ADC). TVR was also calculated by the 3D metric method (TVRmetric). Mean ADCtumor was calculated. The patients were allocated to risk groups regarding the stage, grade, and lymphovascular invasion (LVI) status. Results TAR, TVRmetric, T2W TVRseg, and ADC TVRseg showed a significant difference between the superficial and deep myometrial invasion groups ( P < 0.001). All of these parameters showed a good diagnostic performance for detecting deep myometrial invasion (AUC>0.82), the highest accuracy rate (85%) was found with T2W TVRseg. LVI was significantly associated with TAR ( P = 0.002) and T2W TVRseg ( P = 0.014), while the cervical invasion was associated with TAR ( P = 0.03). ADCtumor was significantly lower in high-grade tumors ( P = 0.002). There was a significant difference in ADCtumor ( P = 0.002), TAR ( P = 0.004), and T2W TVRseg ( P = 0.038) between the low- and high-risk groups. AUC of TAR and T2W TVRseg for detecting high-risk groups were 0.80 and 0.77, respectively, while AUC of ADCtumor for the low-risk group was 0.75. Conclusion MRI quantitative assessments such as TAR, TVR, and ADCtumor may improve the accuracy of preoperative staging and can help in risk stratification of endometrial cancer.