ADPKD is marked by gradual renal cyst and kidney enlargement and ultimately renal failure. Magnetic resonance-based, height-adjusted total kidney volume (htTKV) over 600 ml/m predicts the development of CKD Stage 3 within 8 years in the Consortium for Radiologic Imaging in Polycystic Kidney Disease cohort. Here we compared simultaneous ultrasound and magnetic resonance imaging to determine if ultrasound and kidney length (KL) predict future CKD Stage 3 over longer periods of follow-up. A total of 241 ADPKD patients, 15–46 years, with creatinine clearance of 70 ml/min and above had iothalamate clearance, magnetic resonance and ultrasound evaluations. Participants underwent an average of five repeat clearance measurements over a mean follow-up of 9.3 years. Ultrasound and magnetic resonance-based TKV and KL were compared using Bland-Altman plots and intra-class correlations. Each measure was tested to predict future CKD Stage 3. Relatively strong intra-class correlations between ultrasound and magnetic resonance were found for both htTKV and KL (0.81 and 0.85, respectively). Ultrasound and magnetic resonance-based htTKV and KL predicted future CKD Stage 3 similarly (AUC of 0.87, 0.88, 0.87 and 0.88 respectively). An ultrasound kidney length over 16.5 cm and htTKV over 650 ml/m had the best cut-point for predicting the development of CKD Stage 3. Thus, kidney length alone is sufficient to stratify the risk of progression to renal insufficiency early in ADPKD using either ultrasound or magnetic resonance imaging.

SummaryAutosomal-dominant polycystic kidney disease is a systemic disorder and the most common hereditary renal disease, which is characterized by cyst growth, progressive renal enlargement, and development of renal failure. The cystic nature of autosomal dominant polycystic kidney disease and its renal and extrarenal complications (kidney stones, cyst hemorrhage, intracerebral aneurysm, liver cysts, cardiac valve abnormalities, etc.) give radiologic imaging studies a central role in the management of these patients. This article reviews the indications, comparative use, and limitation of various imaging modalities (ultrasonography, magnetic resonance imaging, computerized tomography scan, Positron emission tomography scan, and renal scintigraphy) for the diagnosis and management of complications in autosomal dominant polycystic kidney disease. Finally, this work provides evidence for the value of total kidney volume to predict disease progression in autosomal dominant polycystic kidney disease.

Background and objectiveThe coronavirus disease 2019 (COVID-19) pandemic has accelerated the shift towards remote consultations in the medical field, including musculoskeletal (MSK) appointments. General practitioner (GP) registrars are now routinely conducting many MSK consultations remotely; however, very little is known of their level of confidence and satisfaction regarding this new and evolving scenario, or how this may impact patient management of patients. In this study, we aimed to understand GP registrars' level of confidence and satisfaction with respect to remote MSK consultations, and the perceived impact on patient management. Study designThis study involved a cross-sectional online survey of GP registrars in the West Midlands, which was conducted in January 2021. MethodsThe survey asked for ranked responses to questions comparing face-to-face consulting methods with remote consulting, focusing on confidence, satisfaction, onward investigations, and referral activity. Statistical analysis was performed using the R software version 4.0.3. ResultsThe overall survey response was 21.2% (n=312/1,471). Of the respondents, 85.9% of GP registrars had not received any training to prepare them for remote MSK consultations. GP registrars generally felt that they were more confident when treating patients face-to-face compared to remote consultations (p<0.001). This was true for general MSK complaints as well as specific assessments of the hand, shoulder, spine, hip, knee, and ankle; 36.2% of GP registrars were not satisfied and 51.0% thought that their patients were not satisfied with the current quality of remote MSK consultations. Of note, 77.6% of GP registrars said that they were more likely to request additional investigations, and 75.6% stated that they were more likely to refer patients to a specialist after a remote MSK consultation. ConclusionThis study highlights the need for further training to better equip primary care doctors for remote MSK consultations. With tailored training, GP registrars could offer more streamlined remote patient care for MSK complaints.

Of the total 125 subjects enrolled in our present study, 25 cases were of PCa and 100 were healthy controls. The mean value of fasting plasma glucose was 95.5 mg/dl in cases of prostatic carcinoma and the mean value of fasting plasma insulin was 5.78 µU/ml (p value: 0.0001*). The fasting insulin levels µU/ml were categorized into the different ranges starting from ≤2.75, >2.75 to ≤4.10, >4.10 to ≤6.10, >6.10µU/ml. The maximum number of cases of prostatic carcinoma of fasting insulin levels falls in range of >6.10µU/ml. The highest insulin levels (>6.10µU/ml) were seen to be associated with an 2.55 fold risk of prostatic carcinoma when compared with fasting insulin levels of (<2.75 µU/ml). Conclusions: Elevated fasting levels of serum insulin appear to be associated with a higher risk of prostate cancer.

Contrast-enhanced magnetic resonance imaging and magnetic resonance cholangiopancreatography (MRCP), due to their excellent soft tissue contrasts, have become first-line noninvasive tests in the characterization and detection of both hepatic and pancreaticobiliary pathologies. MRCP is also helpful in detecting the level and cause of obstruction in patients presenting with jaundice. Cholangiocarcinoma (CCA) is the most common primary malignant tumor arising from the bile duct epithelium, with extrahepatic tumors presenting more often than with intrahepatic ones. However, the diagnosis and management of CCA is made more complex by a variety of malignant and benign conditions that resemble CCA, including hepatocellular carcinoma variants such as the fibrolamellar variant of hepatocellular carcinoma, cholangiocellular carcinoma, biliary metastases, hepatic inflammatory pseudotumor, lymphoepithelioma-like carcinoma, confluent fibrosis, primary sclerosis cholangitis, and the secondary sclerosing cholangitis complex. Consequently, knowledge of the underlying risk factors and imaging characteristics of these conditions is important in differentiating between neoplastic and non-neoplastic conditions in order to reach a definite diagnosis. Endoscopic retrograde cholangiopancreatography should be reserved for those patients who require intervention or biopsy for histopathological diagnosis.