Background and Aims Pancreatic neuroendocrine neoplasms (PanNENs), including Grade 1 (G1) or G2 tumors, can have a poor prognosis. This study investigated the value of contrast‐enhanced harmonic endoscopic ultrasonography (CH‐EUS) for predicting the prognosis of PanNENs. Methods This single‐center, retrospective study included 47 consecutive patients who underwent CH‐EUS and were diagnosed with PanNEN by surgical resection or EUS‐guided fine needle aspiration between December 2011 and February 2016. Patients were divided into aggressive and non‐aggressive groups according to the degree of clinical malignancy. CH‐EUS was assessed regarding its capacity for diagnosing aggressive PanNEN, the correspondence between contrast patterns and pathological features, and its ability to predict the prognosis of PanNEN. Results There were 19 cases of aggressive PanNEN and 28 cases of non‐aggressive PanNEN. The aggressive group included three G1, four G2, three G3 tumors, three mixed neuroendocrine non‐neuroendocrine neoplasms, and six neuroendocrine carcinomas. CH‐EUS was superior to contrast‐enhanced computed tomography for the diagnosis of aggressive PanNEN (P < 0.001): hypo‐enhancement on CH‐EUS was an indicator of aggressive PanNEN, with sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of 94.7%, 100%, 100%, 96.6%, and 97.9%, respectively. Among G1/G2 PanNENs, cases with hypo‐enhancement on CH‐EUS had a poorer prognosis than those with hyper/iso‐enhancement (P = 0.0009). Assessment of 36 resected specimens showed that hypo‐enhancement on CH‐EUS was associated with smaller and fewer vessels and greater degree of fibrosis. Conclusion Contrast‐enhanced harmonic endoscopic ultrasonography may be useful for predicting the prognosis of PanNENs.

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IVPs of the cervical spine are a common incidental finding, increasing in prevalence with age and more common than IDV in all age groups.

Objective The aim of the study was to characterize magnetic resonance imaging findings in patients with recurrent ovarian adult granulosa cell tumors (AGCTs). Methods Clinical and magnetic resonance imaging manifestations of recurrent AGCTs were evaluated in 11 patients. Results Initial recurrences of AGCT were diagnosed between 13 months and 30 years (mean, 11.3 years). Recurrent tumors were located in the pelvic peritoneum, the abdominal peritoneum, the retroperitoneum, and bone. The number of recurrent tumors varied from 1 to 5. Tumors varied in morphology and all margins were well circumscribed. The internal structures noted were as follows: multilocular cystic and solid and cystic. Furthermore, internal hemorrhage and sponge-like multicystic components were identified. Conclusions Ovarian AGCTs recurred in the pelvic peritoneum, abdominal peritoneum, and the retroperitoneal lymph nodes. Large recurrent AGCTs were commonly well circumscribed, round or lobulated, and multilocular cystic or solid and cystic. Moreover, they frequently included internal hemorrhage and sponge-like multicystic components.

Objective: This study aimed to assess and compare the diagnostic performance of the coronary artery to aortic luminal attenuation ratio (CAR), transluminal attenuation gradient (TAG), and corrected coronary opacification (CCO) difference on coronary CT angiography (cCTA) for detecting haemodynamically significant coronary artery stenosis. Methods: 33 patients who underwent cCTA, gated SPECT myocardial perfusion imaging (MPI), and invasive coronary angiography within 3 months were included in this retrospective study. The degree of coronary stenosis on cCTA was visually assessed in all patients. Additionally, CAR, TAG, and CCO difference were analyzed and calculated in all patients. Haemodynamically significant coronary stenosis was defined as a vessel with ≥50% luminal stenosis on invasive coronary angiography and an associated abnormal perfusion defect on MPI in the same territory. Diagnostic performance was assessed on a per-vessel basis by the area under the receiver operating characteristic (ROC) curve (AUC). Results: Among 99 vessels, 12 were excluded and the remaining 87 were analyzed. 17 (19.5%) vessels were determined as haemodynamically significant coronary artery stenosis. On ROC analysis, the AUC was 0.71 for cCTA, 0.80 for CAR, 0.61 for TAG, 0.74 for CCO, 0.87 for combined CAR and cCTA, 0.77 for combined TAG and cCTA, and 0.75 for combined CCO and cCTA. The AUC for combined CAR and cCTA was significantly greater compared with cCTA alone (p < 0.01). Conclusion: Non-invasive CAR derived from 64-detector row CT was feasible and might be helpful for the detection of haemodynamically significant coronary artery stenosis. Still, further investigations such as intra- and inter-reader correlation, evaluation of larger numbers in different settings, and time efficiency are required for applying CAR in various situations. Advances in knowledge: CAR could be used as novel noninvasive technique to detect haemodynamically significant coronary artery stenosis.