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Objective The American College of Radiology (ACR) recently published the ovarian-adnexal reporting and data system (O-RADS) to provide guidelines to physicians who interpret ultrasound (US) examinations of adnexal masses (AM). This study aimed to compare the O-RADS with two other well-established US classification systems for diagnosis of AM. Methods This retrospective multicenter study between May 2016 and December 2019 assessed consecutive women with AM detected by the US. Five experienced consultant radiologists independently categorized each AM according to O-RADS, gynecologic imaging reporting and data system (GI-RADS), and international ovarian tumor analysis (IOTA) simple rules. Pathology and adequate follow-up were used as reference standards for calculating the validity of three US classification systems for diagnosis of AM. Kappa statistics were used to assess the inter-reviewer agreement (IRA). Results A total of 609 women (mean age, 48 ± 13.7 years; range, 18–72 years) with 647 AM were included. Of the 647 AM, 178 were malignant and 469 were benign. Malignancy rates were comparable to recommended rates by previous literature in O-RADS and IOTA, but higher in GI-RADS. O-RADS had significantly higher sensitivity for malignancy than GI-RAD and IOTA ( p = 0.003 and 0.0007, respectively), but non-significant slightly lower specificity ( p > 0.05). O-RADS, GI-RADS, and IOTA showed similar overall IRA ( κ = 0.77, 0.69, and 0.63, respectively) with a tendency toward higher IRA with O-RADS than with GI-RADS and IOTA. Conclusions O-RADS compares favorably with GI-RADS and IOTA. O-RADS had higher sensitivity than GI-RADS and IOTA simple rules with relatively similar specificity and reliability. Key Points • The malignancy rates were comparable to recommended rates by previous literature in O-RADS and IOTA, but higher in GI-RADS. • The O-RADS had significantly higher sensitivity for malignancy than GI-RADS and IOTA (96.8% vs 92.7% and 92.1%; p = 0.003 and 0.0007, respectively), but non-significant slightly lower specificity (92.8% vs 93.6% and 93.2%, respectively; p > 0.05). • The O-RADS, GI-RADS, and IOTA showed similar overall inter-reviewer agreement (IRA) (κ = 0.77, 0.69, and 0.63, respectively), with a tendency toward higher IRA with O-RADS than with GI-RADS and IOTA.

This prospective study was conducted between January 2015 and June 2018 and included 50 patients (mean age of 52.12 ± 2.0 years), all presented with acute pancreatitis and admitted to the ICU 1-3 days after the onset. All patients underwent contrast-enhanced CT, and images are evaluated by 2 independent radiologists for the modified CTSI parameters and retroperitoneal extension parameters to detect the severity of pancreatitis. The aim of this study is to compare the results of the modified CT severity index and retroperitoneal interfascial extension CT grading system in the grading of the severity of acute pancreatitis and compare both grading systems to the clinical course of the disease and its complications. Both grading systems show a statistical significant correlation in terms of the length of hospital stay, the need for interventions, and the development of organ failure. In conclusion, a good correlation was observed between the modified CTSI and retroperitoneal extension grading systems in grading the severity of acute pancreatitis. We think that we can apply Ishikawa et al. grading system as a prognostic indicator if there is a contraindication to contrast administration.

Causes of encephalopathy in neonates/pediatrics include hypoxic-ischemic injury (which is the most frequent cause and is defined as any impairment to the brain caused by insufficient blood flow and oxygenation), trauma, metabolic disorders, and congenital and infectious diseases. The aim of this study is to evaluate the value of MRI in detection and possible differentiation of different non-traumatic, non-infectious causes of acute neonatal/pediatric encephalopathy among NICU/PICU patients. This retrospective study included 60 selected patients according to the study inclusion and exclusion criteria; all presented with positive MRI findings for non-traumatic, non-infectious acute brain injury. Females (32, 53.3%) were affected more than males (28, 46.7%) with a mean age of 1.1 ± 1.02 years; all presented with variable neurological symptoms and signs that necessitate neonatal intensive care unit/pediatric intensive care unit (NICU/PICU) admission. The final diagnosis of the study group patients were hypoxic ischemia injury (HII) in 39 patients (65%), metachromatic leukodystrophy in 6 patients (10%), biotin-thiamine-responsive basal ganglia disease (BTBGD) and Leigh disease each in 4 patients (6.7%), periventricular leukomalacia (PVL) in 3 patients (5%), and mitochondrial encephalopathy with lactic acidosis and stroke-like episodes syndrome (MELAS) and non-ketotic hyperglycinemia (NKH) each in 2 patients (3.3%). Much attention should be paid to pediatric non-traumatic brain injuries. MRI is a safe modality and should be the first radiological investigation if neurological causes are suggested but should be aided by meticulous clinical evaluation and dedicated laboratory investigations for better characterization and differentiation of various causes of non-traumatic, non-infective brain encephalopathy among NICU/PICU patients. When interpreting MRI, it is essential to have thorough relevant clinical data, gestational age at birth which is prognostic of the pattern of hypoxic-ischemic injury, and the time lag between the onset of HII and the time of performing the MR study.

Classifications of intra-articular masses are infectious granulomatous diseases, non-infectious synovial proliferative processes (synovial chondromatosis, lipoma arborescens, rheumatoid arthritis, pigmented villonodular synovitis [PVNS]), vascular malformations, deposition disorders, neoplastic, and miscellaneous conditions. The aim of this study is to correlate the results of MRI with arthroscopy in characterization of different varieties of intra-articular synovial masses and mass-like lesions. This observational prospective study was conducted between February 2018 and August 2019. We screened 1000 routine musculoskeletal MRI examination during this period, 32 of which showed intra-articular synovial masses/mass-like lesions. The selected 32 patients (20 males and 12 females) have a mean age of 49.20 ± 2.0 years; all presented with joint swelling, pain, or difficulty of movement according to the joint affected. All patients underwent arthroscopy for histopathological correlation. The final diagnosis was synovial chondromatosis in 14 patients (43.8%), PVNS in ten patients (31.3%), and lipoma arborescens in five patients (15.6%). Synovial chondrosarcoma, synovial hematoma, and synovial ganglion cyst each in one patient (3.1%). The concordance of MRI to arthroscopy was 96.6% accuracy, 91.7% sensitivity, 99% specificity, 52.3% PPV, and 99.9% NPV. Good correlation was observed between MRI and arthroscopy in diagnosis of intra-articular synovial masses/mass-like lesions.

Follicular dendritic cells (FDCs) fundamentally contribute to the formation of synovial ectopic lymphoid-like structures in rheumatoid arthritis (RA) which is associated with poor clinical prognosis. Despite this critical role, regulation of FDC development in the RA synovium and its correlation with synovial pathotype differentiation remained largely unknown. Here, we demonstrate that CNA.42 + FDCs distinctively express the pericyte/fibroblast-associated markers PDGFR-β, NG2, and Thy-1 in the synovial perivascular space but not in established follicles. In addition, synovial RNA-Seq analysis revealed that expression of the perivascular FDC markers was strongly correlated with PDGF-BB and fibroid synovitis, whereas TNF-α/LT-β was significantly associated with lymphoid synovitis and expression of CR1, CR2, and FcγRIIB characteristic of mature FDCs in lymphoid follicles. Moreover, PDGF-BB induced CNA.42 + FDC differentiation and CXCL13 secretion from NG2 + synovial pericytes, and together with TNF-α/LT-β conversely regulated early and late FDC differentiation genes in unsorted RA synovial fibroblasts (RASF) and this was confirmed in flow sorted stromal cell subsets. Furthermore, RASF TNF-αR expression was upregulated by TNF-α/LT-β and PDGF-BB; and TNF-α/LT-β-activated RASF retained ICs and induced B cell activation in in vitro germinal center reactions typical of FDCs. Additionally, FDCs trapped peptidyl citrulline, and strongly correlated with IL-6 expression, and plasma cell, B cell, and T cell infiltration of the RA synovium. Moreover, synovial FDCs were significantly associated with RA disease activity and radiographic features of tissue damage. To the best of our knowledge, this is the first report describing the reciprocal interaction between PDGF-BB and TNF-α/LT-β in synovial FDC development and evolution of RA histological pathotypes. Selective targeting of this interplay could inhibit FDC differentiation and potentially ameliorate RA in clinically severe and drug-resistant patients.