http://radiology.rsnajnls.org/cgi/content/full/250/3/897//DC1.

onventional autopsy is a valuable tool, particularly for quality control in health care (1-3). Nevertheless, autopsy rates have been rapidly decreasing for various reasons, such as lack of interest of clinicians and next of kin due to overconfidence in premortem diagnostics, reluctance of family members to provide consent to autopsy because of the invasiveness of the procedure, reluctance of pathologists to perform autopsies, budgetary issues, and ideological opposition to postmortem investigation (4-11). Hence, noninvasive or minimally invasive alternative autopsy methods are being developed (12). The entire body can be visualized with postmortem CT and MRI (13-15), and imaging-guided biopsy can be performed to obtain tissue for histologic examination (16). In addition, CT angiography can be performed (17-23). Some of these methods are already used to support or even substitute for the forensic autopsy (24-26). In the clinical setting, noninvasive or minimally invasive autopsies of fetuses, newborns, and infants (27) have gained acceptance with parents and physicians along with political and public interest (28). However, they are still rarely applied in adult patients.

ObjectivesTo evaluate the frequency of total-body CT and MR features of postmortem change in in-hospital deaths.Materials and methodsIn this prospective blinded cross-sectional study, in-hospital deceased adult patients underwent total-body postmortem CT and MR followed by image-guided biopsies. The presence of PMCT and PMMR features related to postmortem change was scored retrospectively and correlated with postmortem time interval, post-resuscitation status and intensive care unit (ICU) admittance.ResultsIntravascular air, pleural effusion, periportal edema, and distended intestines occurred more frequently in patients who were resuscitated compared to those who were not. Postmortem clotting was seen less often in resuscitated patients (p = 0.002). Distended intestines and loss of grey-white matter differentiation in the brain showed a significant correlation with postmortem time interval (p = 0.001, p<0.001). Hyperdense cerebral vessels, intravenous clotting, subcutaneous edema, fluid in the abdomen and internal livores of the liver were seen more in ICU patients. Longer postmortem time interval led to a significant increase in decomposition related changes (p = 0.026).ConclusionsThere is a wide variety of imaging features of postmortem change in in-hospital deaths. These imaging features vary among clinical conditions, increase with longer postmortem time interval and must be distinguished from pathologic changes.

The purpose of this phase III clinical trial was to compare two different extracellular contrast agents, 1.0 M gadobutrol and 0.5 M gadopentate dimeglumine, for magnetic resonance imaging (MRI) in patients with known or suspected focal renal lesions. Using a multicenter, single-blind, interindividual, randomized study design, both contrast agents were compared in a total of 471 patients regarding their diagnostic accuracy, sensitivity, and specificity to correctly classify focal lesions of the kidney. To test for noninferiority the diagnostic accuracy rates for both contrast agents were compared with CT results based on a blinded reading. The average diagnostic accuracy across the three blinded readers ('average reader') was 83.7% for gadobutrol and 87.3% for gadopentate dimeglumine. The increase in accuracy from precontrast to combined precontrast and postcontrast MRI was 8.0% for gadobutrol and 6.9% for gadopentate dimeglumine. Sensitivity of the average reader was 85.2% for gadobutrol and 88.7% for gadopentate dimeglumine. Specificity of the average reader was 82.1% for gadobutrol and 86.1% for gadopentate dimeglumine. In conclusion, this study documents evidence for the noninferiority of a single i.v. bolus injection of 1.0 M gadobutrol compared with 0.5 M gadopentate dimeglumine in the diagnostic assessment of renal lesions with CE-MRI.

Introduction: Since current studies on locally advanced pancreatic cancer (LAPC) mainly report from single, high-volume centers, it is unclear if outcomes can be translated to daily clinical practice. This study provides treatment strategies and clinical outcomes within a multicenter cohort of unselected patients with LAPC. Materials and methods: Consecutive patients with LAPC according to Dutch Pancreatic Cancer Group criteria, were prospectively included in 14 centers from April 2015 until December 2017. A centralized expert panel reviewed response according to RECIST v1.1 and potential surgical resectability. Primary outcome was median overall survival (mOS), stratified for primary treatment strategy. Results: Overall, 422 patients were included, of whom 77% (n ¼ 326) received chemotherapy. The majority started with FOLFIRINOX (77%, 252/326) with a median of six cycles (IQR 4e10). Gemcitabine monotherapy was given to 13% (41/326) of patients and nab-paclitaxel/gemcitabine to 10% (33/326), with a median of two (IQR 3e5) and three (IQR 3e5) cycles respectively. The mOS of the entire cohort was 10 months (95%CI 9e11). In patients treated with FOLFIRINOX, gemcitabine monotherapy, or nab-paclitaxel/ gemcitabine, mOS was 14 (95%CI 13e15), 9 (95%CI 8e10), and 9 months (95%CI 8e10), respectively. A resection was performed in 13% (32/252) of patients after FOLFIRINOX, resulting in a mOS of 23 months (95%CI 12e34). Conclusion: This multicenter unselected cohort of patients with LAPC resulted in a 14 month mOS and a 13% resection rate after FOLFIRINOX. These data put previous results in perspective, enable us to inform patients with more accurate survival numbers and will support decision-making in clinical practice.