Search Results (126)

Cholecystohepatic communication is a rare complication of gallbladder rupture in dogs, and its imaging features are not well described. A 10-year-old Pomeranian showed a gallbladder wall defect, a tortuous tubular structure extending into an adjacent ill-defined hepatic lesion. Contrast-enhanced ultrasonography revealed marked enhancement of the tubular structure and weaker heterogeneous enhancement of the hepatic lesion. Laparotomy confirmed gallbladder rupture with severe adhesion at the suspected communication site. Contrast-enhanced ultrasonography enabled delineation of the enhancing tubular structure and improved characterization of the adjacent hepatic inflammation, increasing diagnostic confidence in cholecystohepatic communication secondary to gallbladder rupture. Full article

Background/Objectives: Acute pelvic pain in pediatric female patients is a common presentation in the emergency setting and poses significant diagnostic challenges. Ultrasonography is the first-line imaging modality, but a substantial proportion of examinations remain inconclusive. Magnetic resonance imaging (MRI) is increasingly used as a second-line modality in this context; however, evidence comparing the diagnostic performance of non-contrast-enhanced and contrast-enhanced MRI protocols in pediatric patients remains limited. The aim of this study was to assess the diagnostic accuracy of MRI in pediatric females with acute pelvic pain after inconclusive ultrasonography and to compare non-contrast-enhanced and contrast-enhanced MRI protocols. Methods: This single-center observational study included pediatric female patients presenting with acute pelvic pain who underwent MRI after inconclusive ultrasonography. MRI examinations were performed using a standardized protocol including non-contrast-enhanced sequences and diffusion-weighted imaging. Administration of contrast material was determined by the attending radiologist according to clinical indications. Three radiologists with different levels of experience independently reviewed all examinations in two separate reading sessions (without and with contrast). Diagnostic performance, interobserver and intraobserver agreement, diagnostic confidence, and examination duration were assessed using a composite clinical reference standard. Results: Eighty-eight patients (mean age, 13.5 years; range, 7–17 years) were included. MRI identified a specific cause of acute pelvic pain in 60 patients (68.2%), with gynecological conditions accounting for 75.0% of positive findings. Hemorrhagic ovarian cysts and adnexal torsion were the most frequent diagnoses. Both non-contrast-enhanced and contrast-enhanced MRI demonstrated high diagnostic accuracy across all readers, with no statistically significant differences in sensitivity or specificity between protocols (p > 0.05). Contrast-enhanced MRI was associated with higher diagnostic confidence for all readers (p < 0.001) but longer examination times. Conclusions: MRI is a reliable second-line imaging modality for evaluating acute pelvic pain in pediatric female patients after inconclusive ultrasonography. Non-contrast-enhanced MRI combined with diffusion-weighted imaging provides robust diagnostic performance in most cases, while contrast-enhanced MRI may be reserved for selected equivocal cases. Full article

Background: Gallbladder cancer (GBC) is a highly lethal malignancy that is often asymptomatic in its early stages and difficult to treat once clinical symptoms appear. Although established risk factors include female sex, gallstones, and chronic biliary inflammation, other clinical contexts associated with GBC remain insufficiently characterized. Multiple primary malignancies (MPMs), in which more than one primary cancer develops in the same individual, have recently attracted attention; however, their relationship with GBC has only rarely been examined. In this study, we aimed to clarify the clinical features of MPM-related GBC and explore its implications for early detection. Methods: We retrospectively compared 22 patients with GBC associated with other malignancies (MPM-positive GBC) and 16 patients with GBC alone (MPM-negative GBC). Clinical characteristics, major risk factors, tumor presentation, and imaging findings were evaluated. Special attention was paid to the sequence of cancer development and the diagnostic utility of contrast-enhanced ultrasonography (CEUS). Results: In all MPM-positive cases, GBC occurred as a second primary malignancy, most commonly following gastrointestinal cancers (12/22). Gallstones were significantly less frequent in the MPM-positive group than in the MPM-negative group (2/22 vs. 6/16). The MPM-positive group showed a slight male predominance (12 males and 10 females). Neither pancreaticobiliary maljunction nor porcelain gallbladder was identified in either group. CEUS was useful for both the detection and qualitative diagnosis of GBC in all patients. Conclusions: MPM-related GBC frequently develops as a second primary malignancy in patients with prior gastrointestinal cancer and may arise in the absence of classical risk factors. Careful long-term surveillance after cancer treatment is therefore essential for identifying second primary GBC at a potentially resectable stage. The combined use of ultrasonography and CEUS may facilitate earlier and more accurate diagnosis in this clinical setting. Full article

Background: Focal nodular hyperplasia (FNH) and hepatocellular adenoma (HA) are benign hepatic tumors that predominantly affect women of reproductive age and are associated with hormonal and metabolic factors. While FNH is a non-progressive lesion without malignant potential, HA carries a relevant risk of hemorrhage and malignant transformation. Differentiation between these entities remains challenging due to overlapping imaging features. Although contrast-enhanced magnetic resonance imaging (MRI) is considered the diagnostic reference standard, its cost, limited availability, and contraindications restrict routine long-term use. Therefore, contrast-enhanced ultrasound (CEUS) has emerged as an alternative modality for follow-up. This study evaluated the effectiveness of CEUS in long-term monitoring of FNH and HA compared with MRI. Methods: Patients with imaging-confirmed FNH or HA underwent paired CEUS and MRI examinations within 48 h at baseline and follow-up. Lesion size was assessed using maximal and minimal diameters, and longitudinal changes were classified according to RECIST-like criteria. Paired non-parametric statistical tests were applied. Results: 41 benign liver lesions (28 FNH and 13 HA) were analyzed across 92 paired examinations. Baseline lesion measurements were comparable between CEUS and MRI. A statistically significant difference was observed in the assessment of the largest lesion diameter, while no significant differences were detected for the shortest diameter. Longitudinal evaluation showed no significant differences between modalities in detecting lesion size changes. Response classification was concordant in 42 of 51 follow-up assessments, with stable disease as the most frequent outcome. Conclusions: After definitive diagnosis, CEUS may serve as a reliable standalone modality for routine long-term surveillance of FNH and HA in clinically stable patients. Its performance in lesion measurement and response assessment is comparable to MRI, while offering advantages in cost, accessibility, and patient tolerability. MRI may be reserved for cases with suspicious changes on CEUS. Full article

Background and Clinical Significance: CEUS enhances the visualization of vascular patterns within liver lesions, enabling differentiation between benign and malignant lesions, including hemangiomas, focal nodular hyperplasia, and hepatocellular carcinoma, with high accuracy. Lymphangiomas are rare benign lymphatic-system tumors, with intra-abdominal lymphangiomas accounting for approximately 5% of cases, most of which occur in the pediatric population. Intra-abdominal lymphangiomas commonly occur in multiple localizations due to lymphangiomatosis, but solitary lymphangiomas in adults are rare and easy to be misdiagnosed due to asymptomatic cases or non-specific symptoms. Case Presentation: A 65-year-old male with a history of left nephroadrenalectomy due to clear renal-cell carcinoma and paraaortic lymphadenectomy (staging pT3bN0M0V1R0) presented for a routine contrast-enhanced abdominal computer tomography examination. The scan showed several hypervascular structures that accumulate contrast in the arterial phase in the right liver lobe. Three years later, the patient developed complaints of abdominal pain and night sweats. Multiple MRI and CT examinations were performed, followed by a CEUS and a liver-core biopsy, which supported the diagnosis of hepatic lymphangioma. Conclusions: CEUS may be a more valuable evaluation method for follow-up examination than repeating CT and MRI scans. The real-time diagnostic possibility and tissue-perfusion data provide more profound information about the lesion of interest. Thus, it can be used as a primary diagnostic tool when a biopsy is performed. Although this method is relatively new, it can be applied in clinical settings with great value, and it saves time and resources. Full article

Uriniferous perinephric pseudocysts (PNPs) are a rare condition in cats, primarily managed by nephrectomy to eliminate persistent urinary leakage. Organ preservation is critical in cases with solitary kidneys. This report describes a cat with congenital absence of the right kidney that developed a uriniferous PNP secondary to abnormal communication between the calyceal diverticulum and subcapsular space. A 6-year-and-11-month-old neutered male Ragdoll cat presented with abdominal distension and lethargy. Ultrasonography revealed an extensive subcapsular perinephric fluid and a cystic lesion adjacent to the renal pelvis. Contrast-enhanced computed tomography with excretory urography directly demonstrated the time-dependent passage of contrast medium from the renal pelvis into the calyceal diverticulum and subsequent leakage into the subcapsular space, allowing precise identification of the renal leakage pathway. Based on these findings, an operation was performed using a non-vascularized free omental plug inserted into the diverticular opening and secured using capsular sutures. Postoperative drainage resolved rapidly, renal function normalized, and no recurrence was detected during long-term follow-up of up to 465 days. To the best of our knowledge, this is the first report to describe an organ-sparing surgical approach that directly addresses the renal leakage pathway in feline uriniferous PNPs. Full article

Background and Clinical Significance: Hepatic sarcoidosis is a benign lesion of unknown etiology. The gold standard for diagnosing hepatic sarcoidosis is histopathological examination. The symptoms and imaging findings of patients with hepatic sarcoidosis are often atypical, leading to misdiagnosis as hepatocellular carcinoma (HCC). Ultrasound resolution microscopy (URM) can overcome the diffraction limit, enabling fine visualization and quantitative analysis of the microvascular networks. This study aimed to provide new evidence for the differential diagnosis of these two diseases by comparing the URM parameters of hepatic sarcoidosis initially misdiagnosed as HCC with those of HCC. Case Presentation: A 67-year-old woman was admitted to the hospital due to upper abdominal pain for two weeks. Ultrasonography revealed a liver mass. The lesion was located in segment IV of the left hepatic lobe, was approximately 18 × 10 mm in size, and appeared hypoechoic. Contrast-enhanced ultrasound and enhanced magnetic resonance imaging both showed a “fast-in, fast-out” pattern, strongly suggesting HCC. The tumor markers were within the normal range. The patient underwent a laparoscopic left hepatic lobectomy. The histopathological diagnosis of the resected specimen was “hepatic sarcoidosis”. URM examination was performed during the preoperative diagnostic process. Subsequently, the URM parameters of the patient’s lesion were analyzed and compared with those of HCC. The results showed differences in multiple URM parameters, including microvascular flow velocity, diameter, microvascular density ratio, and vascular distribution, between this case of hepatic sarcoidosis and HCC. Conclusions: URM can quantitatively and multidimensionally evaluate the microvasculature of liver lesions, providing new reference data for the diagnosis and differential diagnosis of hepatic sarcoidosis. Full article

Background/Objectives: Contrast-enhanced harmonic endoscopic ultrasonography (CH-EUS) is a promising tool for differentiating gastric subepithelial tumors (SETs). However, most published studies have mainly included gastrointestinal stromal tumors (GIST) and leiomyomas in the gastrointestinal tract, not limited to gastric SETs. This study evaluated the diagnostic performance of CH-EUS in gastric SETs encountered in clinical practice. Methods: We retrospectively analyzed 68 patients who underwent CH-EUS for gastric SETs between March 2021 and July 2025 at our institution. Gastric SETs were classified into benign (n = 27: ectopic pancreas, leiomyoma, schwannoma, glomus tumor, plexiform fibromyxoma, desmoid tumor, solitary fibrous tumor, and abscess) and GIST groups (n = 41). CH-EUS features, including arterial enhancement, irregular vessels, and diffuse enhancement, were assessed. Histopathological confirmation was obtained through EUS-guided fine-needle biopsy or endoscopic/surgical resection. Results: The GIST group showed significantly higher rates of arterial enhancement (95.1% vs. 74.1%, p = 0.024), irregular vessels (51.2% vs. 22.2%, p = 0.017), and diffuse enhancement (87.8% vs. 66.7%, p = 0.035) than the benign SETs. The diagnostic performance of arterial enhancement showed a sensitivity of 95.1% and specificity of 25.9%, while irregular vessels demonstrated a sensitivity of 51.2% and specificity of 77.8%, and diffuse enhancement showed a sensitivity of 87.8% and specificity of 33.3%. When combining ≥2 CH-EUS features, the sensitivity and specificity were 92.7% and 33.3%, respectively, with an overall accuracy of 69.1%. The presence of all three features yielded a specificity of 81.5% but a lower sensitivity (46.3%). Conclusions: CH-EUS exhibited a high sensitivity but low specificity in differentiating GISTs from various benign gastric SETs when using a combination of at least two CE-EUS features, including arterial enhancement, irregular vessels, and diffuse enhancement. Full article

Background and Clinical Significance: We present an 85-year-old male case of primary hepatic SCC manifesting as multiple liver nodules with atypical imaging findings. Case Presentation: The patient was negative for hepatitis B surface antigen and hepatitis C virus antibody. Serum tumor markers were all within normal limits. Contrast-enhanced ultrasonography with perflubutane demonstrated hypervascular nodules in the early vascular phase, early washout in the portal phase, and a defect in the postvascular phase (10 mm in S5 and 25 mm in S6). Histopathological examination revealed irregularly shaped tumor cells with large hyperchromatic nuclei and basophilic cytoplasm, surrounded by dense fibrous stroma forming cords, solid nests, and sheet-like structures. Immunohistochemical analysis showed positivity for AE1/AE3, p40, CK5/6, c-kit, and NCAM. Conclusions: The lesions were diagnosed as primary hepatic squamous cell carcinoma and suggested the possible involvement of hepatic progenitor cells, supporting the hypothesis of de novo carcinogenesis. Full article

Background: Fontan-associated liver disease (FALD) is a progressive condition resulting from chronic hepatic venous congestion following the Fontan procedure for univentricular heart defects. As survival improves in these patients, recognition and management of FALD have become increasingly important. Objective: To describe the pathophysiological mechanisms, imaging findings, and diagnostic approach to FALD, with a focus on the role of ultrasonography, including contrast-enhanced ultrasound (CEUS). Methods: This narrative review explores the evolution of FALD through a multidisciplinary lens, integrating cardiovascular and hepatic imaging data. Particular attention is paid to Doppler ultrasound and CEUS, both in early parenchymal changes and in the differential diagnosis of potential complications such as hepatic nodules. Results: FALD is characterized by progressive fibrosis due to long-standing passive congestion, resulting in a wide spectrum of imaging findings. B-mode ultrasound reveals hepatomegaly, heterogeneous parenchyma, and gallbladder wall thickening. Doppler studies show altered hepatic venous flow patterns, while CEUS provides dynamic vascular evaluation, highlighting areas of altered perfusion. In advanced stages, hypo-vascular areas in the late phase may simulate malignant lesions, emphasizing the need for careful interpretation. The role of liver biopsy, though limited by invasiveness, remains crucial in selected cases. Surveillance strategies are not standardized but require close multidisciplinary follow-up. Conclusions: FALD presents complex diagnostic challenges requiring integrated imaging and clinical assessment. CEUS emerges as a valuable, non-invasive tool in characterizing hepatic congestion and guiding management. Increased awareness and standardized protocols are essential for early detection and tailored care in this growing patient population. Full article

Background: Magnetic resonance imaging (MRI) plays an increasingly important role in the evaluation of scrotal and penile disorders, complementing ultrasonography in cases where findings are equivocal or complex. With its superior soft-tissue contrast, multiplanar capability, and advanced functional sequences, MRI provides unparalleled anatomic and tissue characterization across a wide range of male genital pathologies. Summary: This review summarizes current clinical applications of MRI in scrotal and penile imaging and discusses its diagnostic value, protocol optimization, and interpretive features. In scrotal pathology, MRI accurately differentiates torsion, trauma, infection, and neoplasms, aiding in the distinction between benign and malignant testicular lesions and supporting testis-sparing management. Quantitative diffusion and perfusion metrics further refine lesion characterization. In andrology, MRI biomarkers such as apparent diffusion coefficient (ADC), magnetization transfer ratio (MTR), and proton spectroscopy serve as promising non-invasive indicators of spermatogenic activity in male infertility. In penile imaging, MRI enables precise local staging of carcinoma, assessment of plaque morphology and activity in Peyronie’s disease, evaluation of tissue viability in priapism, and detection of prosthesis-related complications. Conclusions: MRI has become an essential problem-solving tool in the assessment of scrotal and penile diseases, enhancing diagnostic confidence and surgical planning. Future directions include protocol standardization, quantitative parameter validation, and the integration of radiomics and artificial intelligence to improve reproducibility and clinical impact. Full article

Mammary gland tumors (MGT) are the most common neoplasms in intact female dogs and represent the third most frequent tumor type in female cats. Imaging plays a central role in the diagnosis, staging, and follow-up of these neoplasms. This review summarizes the diagnostic imaging features of canine and feline MGT and the advantages and limitations of each modality. Radiography and computed tomography (CT) are mainly used to detect pulmonary and abdominal metastases, while ultrasonography provides key information about primary tumor size, margins, echogenicity, vascularization, and elasticity. Advanced ultrasound techniques, such as Doppler, contrast-enhanced ultrasonography (CEUS), and elastography, improve differentiation between benign and malignant lesions. Magnetic resonance imaging (MRI) offers excellent soft-tissue detail and can assist in preoperative planning, whereas nuclear medicine techniques, including scintigraphy and positron emission tomography (PET), allow functional assessment and the early detection of micrometastases. Although histopathology remains the diagnostic gold standard, imaging is indispensable for characterizing primary lesions, evaluating metastatic spread, guiding sampling, and monitoring therapeutic outcomes in small animal oncology. By integrating and comparing the main imaging modalities applied to canine and feline mammary tumors, this review underscores their complementary roles in improving diagnosis, staging, and therapeutic decision-making in small animal oncology. Full article

Contrast-enhanced ultrasound (CEUS) is increasingly applied in veterinary medicine as a safe, rapid, and non-invasive imaging technique for assessing renal disorders. Despite its expanding use, the literature on its application in feline renal trauma remains scarce. This retrospective study aimed to describe CEUS findings in cats with suspected traumatic renal injuries. Medical records were reviewed for cats that underwent both B-mode ultrasonography and CEUS, with findings confirmed by follow-up, surgery, or cytology. Three cats met the inclusion criteria. Two presented focal or multifocal renal lesions ranging from 10 to 20 mm in diameter, with heterogeneous echotexture, distortion of renal contours, and non-enhancing areas on CEUS consistent with hematomas or lacerations. The third cat showed a circumferential subcapsular halo (approximately 3–5 mm thick) with evidence of contrast leakage, compatible with limited active hemorrhage. CEUS appeared effective in identifying and characterizing renal injuries, offering valuable information to support clinical decision-making and guide both conservative and surgical management. Nevertheless, due to the limited sample size and the absence of quantitative data, these results should be considered preliminary. Further prospective studies are warranted to confirm the diagnostic performance and clinical utility of CEUS in feline renal trauma. Full article

Early diagnosis of pancreatic cancer, particularly in intraductal papillary mucinous neoplasm (IPMN), remains challenging despite advances in imaging and biomarkers. Pancreatic adenocarcinoma (PDAC) has a high mortality rate; therefore, its early detection and adequate interventions are necessary to improve the disease outcome. Most IPMNs are asymptomatic and discovered incidentally. Magnetic resonance imaging (MRI) is a preferred tool for diagnosing malignant IPMNs, with a sensitivity of 90.7–94.1% and a specificity of 84.7–87.2% in detecting mural nodules > 5 mm, a strong predictor of high-risk lesions. Radiomics further enhances diagnostic accuracy (sensitivity 91–96%, specificity 78–81%), especially when combined with CA 19-9, which has lower sensitivity (73–90%) but higher specificity (79–95%). Computed tomography (CT), though less effective for small mural nodules, remains widely used; its accuracy improves with radiomics and clinical variables (sensitivity 90.4%, specificity 74%). Conventional endoscopic ultrasonography (EUS) shows lower performance (sensitivity 60%, specificity 80%), but its advanced variations have improved outcomes. Contrast-enhanced EUS (CE-EUS) visualizes mural nodules with more than 90% sensitivity and involvement of the main pancreatic duct, with a sensitivity of 83.5% and a specificity of 87%. EUS–fine-needle aspiration (EUS-FNA) allows cyst fluid analysis; however, CEA, glucose, and KRAS/GNAS mutations show poor value for malignancy risk. Cytology has low sensitivity (28.7–64.8%) but high specificity (84–94%) in diagnostic malignant changes and strongly affects further management. EUS–through-the-needle biopsy (EUS-TTNB) yields high diagnostic accuracy (sensitivity 90%, specificity 95%) but carries a range of 2–23% adverse events, which limits its wide use. EUS–confocal laser endomicroscopy (EUS-nCLE) provides real-time microscopic evaluation, detecting malignant IPMN with a sensitivity of 90% and a specificity of 73%, though its availability is limited. New emerging biomarkers available in cyst fluid or blood include mucins, miRNA panels (sensitivity 66.7–89%, specificity 89.7–100%), lipidomics, and cancer metabolite profiling, with diagnostic accuracy approaching 89–91%. Pancreatoscopy (POP) enables direct main pancreatic duct (MPD) visualization and biopsy with a sensitivity of 64–100% and a specificity of 75–100%, though adverse events occur in around 12% cases. Combining advanced imaging, EUS-based tissue acquisition, and novel biomarkers holds promise for earlier and more accurate detection of malignant IPMN, potentially improving PDAC outcomes. Full article

Background and Clinical Significance: Neuroendocrine neoplasms (NENs) are a group of malignancies that may remain clinically silent for many years. The presence of hepatic metastases can be the first clue leading to diagnosis. Case Presentation: We report the case of a 67-year-old man with intermittent tiredness and suspicious hepatic nodules detected on routine abdominal ultrasound. Contrast-enhanced ultrasonography showed arterial hyperenhancement with early washout, suggestive of metastases. Synchronous high-grade neuroendocrine carcinomas (NECs) of the lung and cecum were identified. Although the liver lesions were initially presumed to arise from the cecal tumor, liver biopsy immunohistochemistry was TTF-1 positive/CDX2 negative, whereas the cecal lesion was TTF-1 negative/CDX2 positive. This mutually exclusive immunophenotype confirmed two separate primary carcinomas. Given the high-grade histology, the patient received platinum-based chemotherapy and achieved a partial response. Conclusions: This case illustrates the diagnostic complexity of synchronous lesions and highlights the “mirage of the first lesion” phenomenon, in which the initially detected tumor may not represent the true primary site. A comprehensive, multidisciplinary strategy is crucial for establishing the correct diagnosis and guiding optimal management. Full article