Describe the typical MRI imaging findings in cases of SSS+ and SSS-. Demonstrate the applicability of MRI in the context of neoadjuvant radiotherapy in rectal cancer and its potential limitations. Propose a structured report for local re-staging purposes.

Radical mesorectal excision surgery contributes substantially to patient morbidity in the context of rectal cancer. A number of clinical trials support the use of neoadjuvant radiation as a form of initial approach in an attempt at more conservative treatment, and responders to this modality have a favorable prognosis and similar outcomes to those who underwent radical surgery. In this context, MRI is the imaging modality of choice in response assessment to predict fibrosis or suspicious areas of viable neoplastic tissue. The split scar sign (SSS) is assessed on high-resolution T2-WI, positive or present when a thin regular 1-2 mm layer of hypointense "fibrosis" is well defined on the endoluminal aspect of the tumor site (corresponding to fibrous submucosa). Whenever the tumor site is not "organized" and this T2WI hypointensity layer is broken focally, the signal should be considered absent or negative. The positive or present SSS (+) has a very high specificity (97%) and positive predictive value (93/94%) for sustained complete response in case of neoadjuvant radiotherapy in rectal cancer. A good quality examination with the appropriate technique is necessary as well as the recognition of the imaging findings related to the presence or absence of this sign (SSS) and potential limitations of MRI.

Incidental gallbladder (GB) polyps are common, seen in 3-6% of the general population, often benign cholesterol polyps. Few GB polyps (6%) are neoplastic (intracholecystic papillary neoplasm, ICPN). While ICPNs have malignant potential, malignant transformation is believed rare. GB cancers also typically arise from flat dysplastic epithelium, not polyps. Yet the concern a small polyp may harbor a future or early neoplasm has led past guidelines to suggest relatively aggressive management; recent studies show significant overtreatment of predominantly benign GB lesions.In 2021 the Society of Radiologists in Ultrasound (SRU) convened a multidisciplinary committee to review current literature and construct updated guidelines for the management of incidentally detected GB polyps. The SRU Guidelines, to be published in 2022 (Radiology), stratify risk into three categories: Extremely Low, Low, and Indeterminate Risk. Clinical examples and common questions will be addressed.

1. Background and review of prior guidelines a. Overview of gallbladder polyps and underlying pathology b. Discussion of current literature and recommendations2. 2021 SRU Gallbladder Polyp Consensus Recommendations a. Applicable and excluded patient populationsb. Risk Categories: Extremely Low Risk, Low Risk, Indeterminate Risk3. Common and uncommon clinical scenarios a. Polyp measurement b. Sessile versus pedunculated c. Determination of growth d. Doppler assessment e. Multiple versus single gallbladder polyps f. The role of alternative modalities such as contrast-enhanced ultrasound and MRI g. Other risk factors: primary sclerosing cholangitis, age, ethnicity, geographic location

To describe the comprehensive categorization system between well-differentiated neuroendocrine tumors (NETs), poorly differentiated neuroendocrine carcinomas (NECs), and mixed neuroendocrine-non-neuroendocrine neoplasms (MiNENs) on the basis of the WHO 2019 classification for gastrointestinal neuroendocrine neoplasms (GI-NENs). To review multimodality imaging of endoscopy, enteroscopy, endoscopic ultrasound, and cross-sectional images (CT, MRI, SPECT, and PET) in this case-based review presentation correlated with pathology.

1.Introduction including definition, epidemiology, genetic evidence, clinical features, and TNM staging in GI-NENs.2.Pathology of the WHO 2019 classification for grading and differentiation of GI-NENs to discuss differentiation, mitosis index, Ki-67 index and immunostaining. 3.Case-based review presentations with multimodality imaging for esophageal NEC, gastric NET, NEC and MiNEN, ampullary NET, duodenal NET, duodenal gastrinomas with MEN 1, small bowel NET, metastases of

Know the epidemiology, increasing number of cases, and risk factors of anal squamous cell carcinoma (SCC)Recognize the imaging differences between rectal adenocarcinoma and anal SCCBe familiar with future directions in anal SCC staging

INTRODUCTIONEpidemiologyRisk factorsRECTAL ADENOCARCINOMA X ANAL SQUAMOUS CELL CARCINOMA ANAL SCC TREATMENTChemoradiation therapy (CRT) and how to prevent sequelaeSurgeryTumor recurrence/persistenceAnal margin tumor approachROLE OF IMAGINGStaging scenarioRestaging scenarioTHE MOST RECENT CONSENSUSHow to stagingHow to restaging post CRTWHAT’S ON THE HORIZONINTERACTIVE CHALLENGING SCENARIOS

Review of AJCC for radiological staging of hepatobiliary and pancreatic tumors. Review of NCCN guidelines for stage-based treatment planning of hepatobiliary and pancreatic tumors. Review of NCCN guidelines for follow up of post treatment hepato-bilio pancreatic tumors. Radiological implication of AJCC and NCCN guidelines in tumor boards for determining the further diagnostic steps and making decisions about the appropriate treatment. Pitfalls in imaging.

Tumor staging and stage-based treatment planning is a crucial step in appropriate cancer treatment and being a part of multidisciplinary team in tumor boards, radiologists play a critical role in diagnosing, characterizing, initial staging, determining resectability, and surveillance of cancer patients. This helps the rest of the team to choose the appropriate treatment therapies and determine the follow up interval for post treatment cases. We will provide a comprehensive review of the AJCC staging and NCCN guidelines for hepato bilio pancreatic tumors using multiple imaging modalities, which will help the radiologists in day-to-day tumor boards to solve the staging and decision dilemmas.

TEACHING POINTS:Initial malignant lesions may be an incidental finding.We must pay special attention to small findings in patients with a background that favors malignancy, such as neoplastic syndromes and a known primary tumor.Understand how we can and should improve our imaging protocol according to each patients background.Review when we should consider complementation with different methods and how to choose the best protocol.Understand which characteristics of small lesions may favour malignancy.Protocol pearls for certain tumor types.

Epidemiological considerations that may change our interpretation and pretest probability of a disease when characterizing a small lesion.Imaging examples of small lesions that were confirmed as malignant on follow up, biopsy or surgery: Neuroendocrine tumors; Initial metastasis; Small cholangiocarcinoma; Early CHCImaging protocol and imaging methods discussion regarding small lesions: When to include additional phases in our protocol; When to consider MRI evaluation; Hepatocyte-specific contrast indications; PET scan evaluation considerations.

To review the usual anatomy and the most common congenital variants of the inferior vena cava (IVC).To describe the most used IVC imaging techniques, its relevance and usefulness.To highlight the pathologies that may affect the IVC and the associated radiological findings.To describe the most frequent IVC pitfalls.

Brief review of the anatomy and embryology of the inferior vena cavaImaging techniques and its relevance.Most common IVC congenital variants.Pathologies that can involve IVC ( primary and secondary involvement)Pitfalls at IVC imaging and miscellaneous imaging.

Understand the different etiologies of acute mesenteric ischemiaRecall the CT protocol used in the evaluation of acute mesenteric ischemiaEvaluate for the radiological features associated with each etiology of acute mesenteric ischemia

A. BackgroundB. Etiology and pathophysiologyC. Clinical presentationD. EvaluationImaging- ACR appropriateness guidelines- CT protocol- Imaging findings for different etiologies2. Non-imagingE. Treatment and managementF. Summary

- Review anatomy of the mesentery with illustrations - Review common and rare, focal and diffuse mesenteric pathologies with imaging examples - Present an imaging-based approach to various mesenteric pathology

1. Mesenteric anatomy 2. Differential diagnoses for mesenteric infiltration a. Edema i. Hepatic failure, hypoproteinemia ii. Venous thrombosis iii. Angioedema (angiotensin converting enzyme inhibitor-associated angioedema) b. Hemorrhage i. Trauma c. Inflammation i. Pancreatitis ii. Crohn’s disease iii. Post-operative iv. Sclerosing encapsulating peritonitis v. COVID-19 d. Neoplasm i. Peritoneal carcinomatosis ii. Lymphoma iii. Carcinoid iv. Mesothelioma v. Primary peritoneal serous neoplasm vi. Pseudomyxoma peritonei vii. Desmoid viii. Lymphangioma e. Sclerosing mesenteritis i. Mesenteric panniculitis ii. Retractile mesenteritis f. Idiopathic 3. Conclusion a. Mesenteric infiltration is often nonspecific and can pose diagnostic challenges to the radiologist. Knowledge of key imaging features associated with various mesenteric pathologies can help narrow the differential diagnosis in appropriate clinical setting.

Mesenteric lesions are frequently encountered incidentally on abdominal imaging. As many of the underlying etiologies appear similar on CT and/or MRI, they often pose a diagnostic dilemma. The broad differential diagnosis for these lesions ranges from benign etiologies including infection, inflammation, and benign neoplasia to malignant etiologies such as carcinoid, lymphoma and metastatic disease. Via a multiple-choice case-based approach, this presentation will provide a framework for approaching solid mesenteric lesions, while providing pathologic correlation to highlight their similarities and differences, as well as how the histology influences their imaging appearance.

I. Review of normal peritoneal anatomy and histology. II. Quiz-style case-based review of solid mesenteric masses. IIa. Discussion of sclerosing mesenteritis with cases of mesenteric panniculitis and retractile mesenteritis showing radiologic-pathologic correlation. IIb. Case of multiple mesenteric masses highlighting the differential and pertinent imaging findings. IIc. Case of mesenteric mass with associated small bowel masses. IId. Case of a 68Ga-DOTATATE-avid mass with potential pitfalls to avoid with this imaging modality. III. Summary with our method for approaching and differentiating between commonly encountered incidental mesenteric lesions.

- The perihepatic space is often involved in a spectrum of diseases, including intrahepatic lesions that extend into the capsule and conditions arising from adjacent or pelvic organs. It is covered by the peritoneum, and it includes the right subphrenic space, the subhepatic space, the lesser sac, and the left perihepatic space.- The distribution and dynamics of the peritoneal fluid influence the spread of inflammatory and tumor processes to the perihepatic space. The correct evaluation of this space is part of abdominal radiology workup and the knowledge of the main abnormalities is crucial for the best report.- The objectives of this exhibit are to highlight different etiologies of perihepatic involvement, from inflammatory/infectious diseases (stone-related abscesses, Fitz-Hugh-Curtis Syndrome, peritoneal tuberculosis, echinococcosis), endometriotic and metastatic lesions, to rare primary peritoneal tumors (peritoneal malignant mesothelioma, desmoplastic small round cell tumor, peritoneal serous papillary carcinoma, periportal plexiform neurofibroma, and hepatic hilum lymphoma), with illustrative cases (CT and MRI).

Background of the perihepatic space. Evaluation of the anatomy and physiology of the perihepatic space and its peritoneal fluid dynamic. Case-based review of a range of cases including the main and rarer abnormalities of the perihepatic space with respective MRI and CT findings. Radiological correlation with the peritoneal fluid flow distribution.

To identify typical and atypical radiological findings of gastrointestinal stromal tumors (GIST).To know the radiological criteria used in GIST for the evaluation of tumor response.To review what factors have been proposed as relevant when predicting prognosis and response to treatment.

Relevant information towards the diagnosis of GIST will be clearly exposed using examples of different cases seen in our center.We will review the main radiological characteristics of GIST in order to suggest a correct differential diagnosis and adequately suggest this pathology.GIST complications and their different responses to treatment are not rare, especially in the emergency room. That is why we will display some key points to identify those situations and ensure a rapid diagnosis and treatment.Likewise, it is interesting to know the different response criteria to treatment so as not to confuse a favorable evolution with a progression of the disease.

1. Ultrasound is typically the first-line option for post-surgical evaluation in the setting of kidney, liver, and pancreas transplantation. A focused review of vascular complications across these organ transplantations can enable a comparative and more conceptual-based approach toward this topic.2. Kidney, liver, and pancreas transplantation can be performed using different surgical techniques leading to variable post-surgical vascular configurations.3. Post-transplant vascular complications differ across etiology, timing, and clinical presentations, largely falling into categories of thrombosis, stenosis, and post-biopsy complications, with early and accurate detection being essential to preventing graft failure.

I. Kidney transplantation A. Post-transplant vascular anatomy and variations B. Common indications for ultrasound C. Vascular complications 1. Renal artery thrombosis, stenosis 2. Renal vein thrombosis, stenosis 3. Post-biopsy vascular complications (arteriovenous fistula, pseudoaneurysm) II. Liver transplantation A. Post-transplant vascular anatomy and variations B. Common indications for ultrasound C. Vascular complications 1. Hepatic artery thrombosis, stenosis 2. Portal vein thrombosis, stenosis 3. Hepatic vein stenosis 4. IVC thrombosis, stenosis III. Pancreas transplantation A. Post-transplant vascular anatomy and variations B. Common indications for ultrasound C. Vascular complications 1. Thrombosis, stenosis 2. Post-biopsy vascular complications

-Review how contrast agent distribution reflects physiology and provides a foundation for diagnosis, problem-solving, and avoiding imaging pitfalls.-Discuss diagnostic advantages and pitfalls related to iodinated contrast distribution, altered hemodynamics, x-ray interaction, and contrast timing.-Collaborative use of gained knowledge to focus on problem solving complex post-surgical cases

The goal of this education exhibit is to review how contrast agent distribution reflects physiology in normal and diseased states which provides the foundation for understanding how CT contrast agent enhancement patterns can be used for diagnosis, problem-solving, and avoiding imaging pitfalls. We will first discuss the physiologic redistribution effect of typical iodinated contrast agent from the intravascular to interstitial space. Next, we will discuss the effects of altered vascular hemodynamics, for example, in the setting of VA-ECMO and inhomogeneous venous return. Following, the physics of x-ray interaction with iodinated contrast will be discussed accompanied with its diagnostic challenges and exploitation with dual energy CT. Additionally, we will discuss the diagnostic sensitivity of various pathologies related to CT technique/contrast timing and explore the utility of bowel contrast agents. Throughout the presentation, we will use these main ideas to problem solve complex postsurgical patients. In conclusion, the audience will gain a higher level of understanding of CT contrast agents and apply these concepts to improve diagnostic confidence at daily practice.

1.Learning the anatomical structures involving the porta hepatis and their importance.2.To classify various periportal pathologies based upon the structure of origin.3.To study the radiological features of the individual pathologies, the unique patterns and differentiating points from other pathologies.

BACKGROUND:ANATOMY OF THE PORTA HEPATIS: ROLE OF IMAGING MODALITIES:CLASSIFICATION OF PERIPORTAL PATHOLOGIES BASED ON THE STRUCTURE OF ORIGIN1) DUCTAL AND PERI-DUCTAL PATHOLOGIES: • Cholangiocarcinoma (large duct carcinoma)- periductal and infiltrating, hilar types, advanced locally aggressive spread • Intraductal papillary neoplasm of the bile duct (IPNB)/ biliary papillomatosis • Primary neuroendocrine tumors of the bile ducts Cholangitis • IgG4 related sclerosing cholangitis • Langerhans cell histiocytosis - proliferative and fibrotic phase 2) LYMPH NODAL PATHOLOGIES: • Benign reactive hyperplasia of periportal nodes. • Infective nodes • Peritoneal carcinomatosis / Loco-regional spread of tumor 3) NERVES AND CONNECTIVE TISSUE:• Schwannoma, Neurofibroma • Sarcomas 4) POST SURGICAL OR POST TRANSPLANT CASES: • Periportal inflammatory soft tissue • Tumor recurrence • Post Transplant lymphoproliferative disorder.IMPORTANCE OF PREVIOUS IMAGES/ FOLLOW UP.ROLE OF TUMOUR MARKERS.CONCLUSION: Primary step in the diagnostic approach would be identification of the structure or epicenter of origin and then considering the relevant differentials.

The purposes of this quiz are:1. Recognize some classic radiologic signs (a way that makes easier to achieve diferent diagnosis).2. To discuss the pathophysiologic characteristics associated with these radiologic findings.3. Improve the memorize process making associations, since many signs use metaphorical language, such as comparision with objects.4. At the end of the quiz, the reader must be able to recognize these signs and associated pathologies, consolidating the acquired knowledge.

1. The presentation describes classic signs associated with hepatobiliary diseases through Computed Tomography (CT) and Magnetic Resonance (MR) images, in a cased-based quiz format.2. Illustrative key points: improve understanding of the correlation between the sign and pathophysiologic process involved.3. Pictorial review of most frequent hepatobiliary signs and associated disease, for example: adenomyomatosis (pearl neklace/rosary sign; hourglass gallbladder), inflamatory hepatic adenoma (atoll sign), hepatic hydatid disease (water-lily sign ) and more.4. Key images that the radiologist must actively look to recognize the sign.

The purpose of this presentation is:1) To demonstrate epidemiology of small bowel tumors and the characteristic imaging findings of ultrasound, endoscopy, computed tomography and magnetic resonance imaging including the radiologic-pathologic correlation.2) To learn about the differentiation between benign and malignant small bowel tumors by imaging of various modalities.

CONTENTS ORGANIZATIONDECISION TREE FOR SMALL BOWEL TUMORS BENIGN BOWEL TUMORS - Polyp/Polyposis syndromes- Lipoma - Ectopic endometriosis- HemangiomaMALIGNANT SMALL BOWEL TUMORS- Adenocarcinoma- Neuroendocrine tumor: NET- Gastrointestinal stromal tumor: GIST- Malignant lymphoma - Metastatic disease- Sarcoma

•What constitute LPLN compartments in the pelvisWhat are the boundaries of LPLN compartments on CT/MR •What are the pathways of lymphatic rectum and why are these important •What the most commonly involved LPLN compartments in rectal cancer What are the currently proposed size criteria for LPLN involvement?What are the circumstances in which these criteria should be applied?

Definition of LPLN compartments based on exisiting surgical literatureDefintion of boundaries of LPLN compartments on CT/MRSimplfied imaging criteria to define LPLN on cross sectional imagingClarification of pathways of lymphatic spread in the pelvis and how this impacts nodal invovlmentSurvey of the current criteria of LPLN involvment in the literature implcation for radiologistsSize crtiera for LPLN what do these really mean?

The purpose of the exhibit is to update knowledge of hyperintense HCC on the hepatobiliary phase (HBP) of EOB-MRI, not only for diagnosis but also for early prediction of treatment effect, leading to personalized therapy in the future, and to recognize various cases of HCC with atypical imaging features on multimodality imaging.

With recent advances in systemic therapy for HCC, treatment strategies for HCC are changing. Now radiologists are required not only to diagnose but also to predict early treatment effects and contribute to appropriate treatment selection. As an imaging finding linked to predicting treatment effects, the signal intensity of HCC on HBP of EOB-MRI has recently attracted attention. Hyperintense HCC on HBP of EOB-MRI showed a correlation with the therapeutic effects of various treatments, such as immunotherapy, TACE, and hepatic arterial infusion chemotherapy (HAIC). HCC is also a genetically and molecularly diverse group. Actually, approximately 40% of HCCs do not show typical imaging features, such as Li-RADS major imaging feature of HCC, including hyperenhancement (APHE), portal venous phase, delayed phase washout, and capsule appearance. The atypical imaging features of HCC are generally associated with pathological type and molecular phenotype. Understanding HCC with atypical imaging features can improve diagnostic accuracy and help clinicians plan strategies for better treatment.1) Hyperintense HCC on HBP of EOB-MRIa) Etiology and Imaging findingsb) Treatment prediction: TACE, HAIC, and systemic therapy c) Differential diagnosis: the hepatic tumor with hyperintensity on HBP 2) Multimodality imaging of HCC with atypical imaging features

The purpose of this exhibit is to:Review anatomy of the anorectal region and MR imaging landmarks relative to anorectal fistula classification.Demonstrate the role of MR in presurgical planning for anorectal fistulas, including anatomic mapping, fistula track relation to the sphincters and pelvic organs, detecting internal and external fistula openings, assessing the degree of fistula complexity, and associate fluid collections.Discuss current and evolving concepts of anorectal fistula management and imaging features predicting prognosis.Validate with sample cases MR contribution to diagnosis and decision-making.

The present role of MR in diagnosis and management of anorectal fistula:-Anatomy of the anorectal regions and anal sphincters.MR protocols and optimizing imaging techniques in detecting anorectal fistulas.-Anorectal fistula classifications.Imaging manifestation and diagnostic pearls for each fistula subtype.Surgical approach and treatment options.Radiologic appearance of postsurgical devices.Example cases and illustrations of the above contents.

Opportunistic screening (1) with abdominal CT examinations, capturing anatomic structures beyond the main clinical indication for performing the exam, may provide the opportunity for more comprehensive analyses of the entire abdomen and pelvis (2). It provides additional value to both patients, by uncovering incidental findings without additional scans, and providers, by improving both quality and service offerings, potentially mitigating risk and improving revenue without additional scan costs (3). The challenge, however, is that opportunistic screening has the potential to increase the burden of unnecessary work for providers. Artificial Intelligence (AI) based machine learning (ML) approaches can help reduce some of this burden particularly in the automation of tedious tasks like image segmentation (4). We present a comprehensive approach to evaluating the performance of an AI algorithm for fully automated CT-based body composition measurements (5) with automated reporting to PACS prior to deployment in routine clinical workflow.References Cited 1. P. J. Pickhardt, Radiology, 211561 (2022). 2. L. L. Berland et al., J Am Coll Radiol 7, 754-773 (2010). 3. P. J. Pickhardt et al., Radiology 249, 151-159 (2008). 4. J. Mongan, A. Vagal, C. C. Wu, Radiol Artif Intell 4, e220039 (2022). 5. M. T. MacLean et al., J Am Med Inform Assoc 28, 1178-1187 (2021).

A. Clinical need for an AI solution a. Current approaches to body organ segmentation b. Our solution i. Automated phenotyping ii. Structured reporting c. Impact on patient care d. Cost implicationsB. Evaluating the value of the output for radiologists a. Reader studies b. Analyses of Concordance

Biliopancreatic anatomic variants are common and they are more frequently diagnosed nowadays due to the increasing number of patients submitted to radiology exams. Recognizing these variants is essential to avoid misdiagnosis of pathologies and in the preoperative of biliopancreatic surgeries. The purpose of this exhibit is to make a brief review of pancreatic and biliary tract embryology and review the main biliopancreatic anatomic variants and their clinical relevance.

Introduction with a schematic review of the embryology of the pancreas and biliary tract. Present with images from CT, MR, ERCP, and USG illustrative cases of biliopancreatic anatomic variants and anomalies including annular pancreas, pancreas divisum, ectopic pancreas, ansa pancreatica, pancreatic hypoplasia, circumportal pancreas, dorsal pancreatic agenesis, anomalous biliopancreatic junction, low cystic duct insertion, gallbladder duplication, Caroli disease, intrahepatic bile ducts variations, among others. Correlate each one of these cases with its clinical/surgical relevance. Summary and take-home notes.

When radiologists inspect computed tomography (CT) images, small bowel malignancies are often easy to miss because of the small size, which can lead to mistake for normal small bowel due to their similar enhancement to small bowel or non-specific enhancement. In addition, small bowel malignancies are sometimes mistaken for masses from other origins, such as the uterus, rectum, or omentum. In this article, we illustrate various small bowel malignancies and their mimicking lesions with typical and atypical features on CT imaging as well as their clinical manifestations.

1. Introduction 2. Small bowel gastrointestinal stromal tumor (GIST) 3. Small bowel adenocarcinoma 4. Small bowel lymphoma 5. Small bowel sarcoma 6. Small bowel plasmacytoma (Extramedullary plasmacytoma) 7. Small bowel neuroendocrine tumor (NET) 8. Mass-like small bowel lesions mimicking small bowel malignancies 9. Clinical history of small bowel malignancy: anemia, weight loss, vomiting, nonspecific abdominal pain Small bowel malignancies can be easily missed or misdiagnosed by radiologists because of their rarity, nonspecific symptoms, and overlapping imaging features, especially when manifesting with small sizes. However, if radiologists know some characteristic imaging features of small bowel malignancies and their mimicking lesions, and perform a careful inspection of the entire small bowel loops, especially when patients present with gastrointestinal bleeding symptoms, optimal detection and diagnosis of small bowel malignancies can be achieved.Please visit the Learning Center to also view this presentation in hardcopy format.

1. Understand the benefits and limitations of using a high frequency linear transducer (= 12 MHz) for adult hepatobiliary imaging and how it can improve confidence in ultrasound interpretations.2. Compare routine and high frequency imaging of liver parenchyma and surface contour in patients on a spectrum including normal, steatosis, fibrosis, and cirrhosis.3. Demonstrate the usefulness of high frequency liver imaging for focal hepatic lesions.4. Understand the advantage of high frequency imaging for biliary pathology including dilatation, sludge, and calculi.5. Compare low and high frequency imaging for the evaluation of gallbladder wall thickening, integrity, focal lesions, and calculi.

1. General- how technique affects high frequency imaginga. Variable transducer frequenciesb. Different machine settingsc. Patient habitus2. Livera. Diffuse parenchymal liver diseasei. Steatosis1. Homogeneous increased echogenicity2. Focal fatii. Fibrosis1. Coarse echotexture2. Correlate with shear wave elastographyiii. Cirrhosis1. Nodular surface2. Regenerative nodules3. Parenchymal atrophyb. Focal liver lesionsi. Hepatocellular carcinomaii. Metastasesiii. Cystsc. Otheri. Fulminant liver failureii. Periportal edemaiii. Portal thrombosis- benign and malignantiv. Varices3. Biliary Ductsa. Choledocholithiasisb. Biliary duct dilationc. Biliary castsd. Von Meyenburg Complexes4. Gallbladdera. Wall thickeningb. Integrity of walla. Adenomyomatosisb. Focal lesions: polyps, masses

External hernias of the abdomen are clinically common problems and frequently require imaging evaluation preoperatively. Various kinds of external hernias can occur in the abdominal wall. In the era of three-dimensional imaging using CT and MRI, a more precise evaluation of the structure of each hernia (hernia orifice, hernia sac, its content, and its covering) and complications such as inflammation, bowel obstruction/incarceration, and strangulation can be analyzed than before. In this presentation, we review various kinds of external hernias of the abdomen and show radiological anatomy using three-dimensional images with representative cases as well as their rare types. Understanding the membranous structures of the abdominal wall related to external hernias will be essential for GI radiologists to provide more critical information to surgeons in patient management and surgical planning.

1. General consideration of external hernias of the abdomen2. Classification of external abdominal hernias and their imaging findings: case presentations a. groin (inguinal): indirect (external), direct (internal), femoral, b. umbilical/periumbilical: cf. omphalocele, c. ventral (anterior): epigastric/hypogastric (linea alba), suprapubic, Spigelian (linea semilunaris), d. lumbar (lateral): superior lumbar (Grynfeltt-Lesshaft), inferior lumbar (Petit), e. pelvic floor (inferior): obturator foramen, sciatic foramen, perineal, f. cicatricial: traumatic, incisional, parastomal, trocar site3. Conclusions

MR Enterography is the gold-standard method for studying the small-bowel in patients with Chron's Disease, not only to depict active inflammatory disease, but to exclude complications, as the presence of fibrostenosing and/or penetrating disease alters medical treatment and may imply surgical intervention.The aim of this work is to depict the imaging findings of complicated Crohn's disease on MR Enterography and discuss the correct terminology and potential differential diagnoses of such findings.

Through pictorial review we illustrate the different aspects of penetrating disease such as such as sinuses, simple and complex fistulas, inflammatory masses and abscesses, concentrating on what defines and differentiates them from pseudo-sacculations or deep ulcers and from adhesions, that can be misinterpreted on imaging studies as sinuses and fistulas, respectively. In regards to stenosing disease, we explain the criteria for defining a stricture and provide examples of strictures with and without active inflammation as the distinction is important for determining the treatment plan. We will also clarify the circumstances in which you can consider a probable stricture even when there is no upstream dilation. We will discuss how to potentially differentiate occlusion due to peritoneal adhesions from fibrotic strictures; and from functional abnormalities sometimes seen in these patients who demonstrate dilated small bowel loops without mechanical obstruction.

The purpose of this exhibit is: 1. To describe Meckel diverticulum´s characteristics 2. To review imaging findings of Meckel's diverticulum on computer tomography 3. To describe the radiologic features of complications of Meckel diverticulum 4. To correlate the histological findings with the radiological perspective

1. Embriology of Meckel diverticulum 2. Pathology of Meckel diverticulum 3. Review of imaging findings on CT and pathological correlation (sample cases) - Non complicated Meckel diverticulum - Complicated Mecel diverticulum Hemorrhage Bezoar Intestinal obstruction Diverticulitis Neoplasms Volvulation Intususpection 4. Conclussions and taking-home messages

- Become familiar with the radiological findings of anisakiasis, because it is an underdiagnosed parasitosis with an increasing incidence worldwide.- Initial clinical suspicion is sometimes difficult as the symptoms are non-specific, and a multidisciplinary approach in important to make an accurate diagnosis.

Objectives: Review and describe the main clinical, radiological and epidemiological features of the different forms of Anisakiasis. Background: Anisakiasis is a zoonosis caused by accidental infection by Anisakis simplex due to the ingestion of raw or undercooked fish that affects mainly the gastrointestinal tract. Although the highest prevalence of anisakiasis is found in Asia and it is rare in the United States and Europe, the incidence is expected to increase worldwide as cultural globalization of food habits increases opportunities to eat raw or undercooked seafood. Imaging findings: Severe submucosal edema, ascites, fluid collection and mesenteric fat infiltration. Diagnosis: Clinical suspicion is helpful but difficult in some cases, especially in intestinal anisakiasis, and CT findings may suggest the possibility of anisakiasis when characteristic imaging features are present. Laboratory tests or endoscopic direct visualization give a definite diagnosis. Treatment: Generally symptomatic and in some cases endoscopic larvae removal. Conclusions: Anisakiasis is a rare and underdiagnosed parasitosis that affects the gastrointestinal tract. As its incidence is increasing worldwide, it is important that we are familiar with the characteristic clinical and radiological manifestations.

To describe the normal appearance of the colon in the different imaging modalities.To explain the appearances, pathogenesis and differential diagnosis of CT colonic enhancement patterns.To discuss the differential diagnosis of colitis based on imaging findings, epidemiology and clinical history.

IntroductionNormal anatomy of the colon in the different imaging modalitiesClassification of CT colonic enhancement patternsInfectious colitisPseudomembranous colitisNeutropenic colitis (Typhlitis)Radiation colitisInflammatory bowel diseaseIschemic colitisTake home points

1) To illustrate the spectrum of early post-operative complications, emphasizing the importance of the timing of surgery.2) To distinguish expected post-operative CT appearances versus a complication, highlighting useful tips and potential pitfalls.3) To relate the type of surgery to key review areas on post operative imaging (including recent advances in endoluminal and robotic surgery).4) To discuss the utility of positive luminal contrast in problem solving.

The post-operative abdomen is challenging. Knowledge of the potential complications is important to every radiologist so that life-threatening conditions can be quickly diagnosed and treated.Post-operative GI complications covered will be broadly categorised into the following headings. A range of examples with key learning points will be illustrated and where relevant correlate with any pre-operative imaging.• Abnormal gas patternso Location and volume of free gas.o Retained surgical swabso Haemostatic agents.• Fluid collectionso Anastomotic leako Urinoma• Vascular complicationso Bowel ischemiao Arterio-venous fistulao Pseudo-aneurysm

Discuss various standards to maximize the quality of CT colonography.

Background: There is an increasing incidence of colorectal cancer which is a largely preventable disease if identified at precursor polyp stage and removed.CTC Performance standards: a. Patient Information and experience. b. Bowel Preparation: 1. Diet. 2. Catharsis: Dry versus wet agents and 3.Tagging of residual stool and fluid. Bowel preparation for same-day CTC after incomplete colonoscopy. c. Imaging: A. CT technique/ Scanning parameters and radiation risk. B. Colonic distension with carbon dioxide, using an automated insufflator. C. Scout to assess for adequate bowel distension. D. Dual-position scanning in Supine and prone positions versus decubitus position. d. Interpretation: A. Colonic and extracolonic findings are reported in a standard examination as per CT Colonography Reporting and Data System (C-RADS). B. Colonic interpretation involving primary 2-D and primary 3-D reviews. Flat lesions measuring 3 mm or less in height are better depicted with contrast tagging at 2D while 3D reviews are better at smaller polyp detection and greater conspicuity of polyps at or near the folds. C. CTC descriptors including polyp morphology, location and measurements. D. Pitfalls in CTC interpretation. e. Management decisions and interval surveillance: Follow-up recommendations on polyp management and role of surveillance CTC. f. CTC outcome measures: Audits and ACR’s CTC registry.

- Review the Roux-en-Y gastric bypass surgical technique and understand the normal post-surgical anatomy and radiological findings. - Describe and explain the most frequent complications and their imaging manifestations using a series of cases from our institution as examples.

Background Obesity is a disease of epidemic proportions. Non-surgical treatment fails in 95% of the patients, and therefore bariatric surgery is the most effective, yet invasive, treatment. There are two surgical approaches for achieving weight loss: bypass procedures and restrictive procedures. Roux-en-Y gastric bypass is the most popular technique and obtains greater sustained weight loss and higher sustained long-term success than other techniques. Findings: As radiologists, we should be familiar with the anatomic changes caused by this surgery, in order to be able to recognize them and identify possible complications. Complications In this presentation, we describe the most common complications of gastric bypass surgery (mainly post-operative leaks, small bowel obstruction, gastro-gastric fistula and ulceration) and their imaging features based on cases of our centre. We revise the imaging techniques recommended to examine each type of complication and key findings to identify them. Conclusions Bariatric surgery is increasing dramatically, especially Roux-en-Y gastric bypass and radiologists should be able to recognize the anatomic changes that this surgery involves and the most frequent complications it may have.

- Explain the anatomy thorough diagrams as well as the typical imaging findings.- Review the different types of hernia and much more frequently observed in radiological practice.- Simplify the correct technique for the execution of the esophagogram.- Present through real clinical cases usual findings during an esophagram.

1. Introduction.2. Anatomy3. Technique4. Hiatal hernias- Definitions.- Pearls and pitfalls.- Key terms of the radiographic lexicon terms.- Categories.5. Other common findings in Barium Esophagogram.6. Conclusions.

Despite the adoption of rectal MRI as a mandatory staging tool for rectal cancer, inconsistencies still exist in defining anatomic landmarks even among experts (Lambregts DMJ et al. 2022).

This exhibit aims to review controversies in anatomic issues, propose the best opinion based on the evolving literature, and discuss impact on management.Anatomic landmarks to be discussed include:Re-definition of the rectum and its upper/lower boundaries.-The anatomy of the anal sphincter and staging of tumors involving this structure.-The definition of circumferential resection margin (CRM) will vary depending on surgical procedure and does not equate to mesorectal fascia (MRF). -Clarify the difference between peritoneal involvement and mesorectal fascia involvement in the upper rectum.-Clarify the anatomic boundaries of lateral pelvic nodes and their clinical significance.

1.) Percutaneous diagnostic and therapeutic liver procedures are commonly performed and range from biopsy to more invasive treatments such as ablation and biliary interventions. 2.) While these procedures are generally safe, major complications do occur usually at a rate of 0.1-5%. Bleeding is one of the most common complications and various manifestations of bleeding are important to recognize as they may require different treatment approaches. 3.) Non-hemorrhagic complications are diagnosed primarily by imaging and the radiologist should be aware of the range of complications so that timely treatment can be instituted.

1.) Brief overview of literature regarding complications of percutaneous liver procedures a.) Definition of minor vs. major complications 2.) Multimodality case-based review of complications with teaching points and discussion of treatment implications. a.) Hemorrhagic and Vascular i.) Subcapsular hematoma, hemoperitoneum ii.) Pseudoaneurysm, active bleeding, AVF iii.) Arterial vs. Venous bleeding iv.) Thrombosis b.) Biliary i.) Bile leak/biloma ii.) Stricture iii.) Hemobilia c.) Infectious i.) Liver abscess ii.) Biliary sepsis d.) Local i.) Organ injury (diaphragm, GB, stomach, colon) ii.) Residual/recurrent tumor iii.) Liver infarction iv.) Tumor seeding e.) Thoracic i.) Pneumothorax, hemothorax Hemopericardium

• To review and illustrate the vascular involvement in hepatocellular carcinoma (HCC) on ultrasound, computerized tomography (CT), and magnetic resonance imaging (MRI).• To prepare abdominal radiologists to identify the most common hepatic venous thrombosis sites on imaging in HCC, with emphasis on portal vein. • To present imaging features of tumor thrombosis according to LI-RADS v2018. • To present clinical cases from our institution with a multidisciplinary approach, some correlated with pathology results and individualized treatment. • To recognize potential pitfalls in image interpretation and differential diagnosis of tumor thrombus.

• Background: the importance of a multimodality assessment of vascular involvement in HCC, which can be subtle. • The impact of tumor thrombus on management in patient care. • Categorization according to LI-RADS v2018. • Illustrative cases of our institution with the main hepatic tumor thrombus sites with imaging features and interpretation on: o Ultrasound. o CT. o MRI. • Challenging cases of tumor thrombosis in HCC (as infiltrative carcinoma). • Differential diagnosis with hematic thrombosis. • Tips and tricks.

1. Understanding the characteristics of advanced techniques such as 1024-matrix ultra-high resolution (UHR) CT, dual-energy CT, contrast enhancement boost (CE boost) technique, and radiomics. 2. Understanding how radiologists can use advanced techniques to detect and characterize hepatocellular carcinoma (HCC). 3. Understanding the prospects for advanced techniques to improve the management of patients with HCC.

A. Introduction B. Ultra-high-resolution (UHR) CT with a 1024 matrix B-1. Spatial resolution, image noise, and deep learning reconstruction B-2. Tumor margin can be better delineated, potentially resulting in improved assessment of microvascular invasion C. Dual-energy CT (DECT) C-1. Material decomposition C-2. Virtual monochromatic imaging (VMI) can enhance tumor-to-liver contrast C-3. Beyond the dual-energy CT: Hope for photon counting CT D. Contrast enhancement boost (CE boost) technique: a postprocessing technique for increasing the degree of contrast enhancement D-1. Principles: Roles of image subtraction, non-rigid registration, and denoising D-2. CE boost combined with multiphasic CT can improve the detection of small HCC D-3. CE boost can be combined with low-keV VMI in DECT to further increase the conspicuity of HCC E. Radiomics F. Clinical roles of the advanced techniques in evaluating HCC G. Conclusion

1. Understand the etiopathogenesis of hydatid disease 2. Highlight hepatic and extrahepatic hydatidosis imaging features (cardiac, brain, spine, muscular, subcutaneous, and adrenal) 3. Highlight different IR management for hepatic hydatid cysts

1. Etiopathogenesis of hydatid disease:• Historical overview• Echinococci types, lifecycle, infection sources, and clinical relevance• Hydatid cyst composition and imaging features 2. Imaging features of different stages:• WHO IWG 2001 management classification and radiological classification (Active vs transient vs inactive)• Extrahepatic lesions (brain, spleen, pulmonary, spine, pyriformis muscle, subcutaneous and adrenal) • CT vs MRI, which is better? 3. Management; indications, contraindications, procedural steps, and imaging follow-up• Surgical: conservative (partial cystectomy, and deroofing) vs radical (pericystectomy vs hepatic resection)• IR options. Discussing PAIR cases and highlighting why it is better i. PAIR “Percutaneous puncture under sonographic guidance, Aspiration of a substantial amount, Injection of scolicidal agent, Re-aspiration) ii. D-PAI: Double puncture-aspiration-injection iii. PEVAC: Percutaneous evacuate on of cyst content

To show the wide spectrum of unusual primary liver tumors that can arise from the different progenitor cells in the liver, and review the imaging findings of these uncommon lesions.To assess features that may help in the diagnosis of rare hepatic tumors.

Introduction to unusual hepatic tumorsDescription of hepatocellular tumors:- Fibrolamellar hepatocarcinoma- Hepatocoangiocarcinoma- HepatoblastomaReview of epithelial/cholangiocellular tumors:- Intraductal papillary tumor of the bile ducts- Cystic mucinous tumorMesenchymal tumors:- Angiomyolipoma- Angiosarcoma- Hepatic epithelioid hemangioendothelioma- Inflammatory myofibroblastic tumor- Solitary fibrous tumorPrimary hepatic neuroendrocrine carcinoma.Primary hepatic lymphoma.Others:- Necrotic nodule of the liver- Brucellar liver abscess ( brucelloma).Conclusions

1. Recognizing the types of disease spread in the abdominal cavity (interfascial, intraperitoneal, subperitoneal and transperitoneal). 2. Understanding the anatomy of the peritoneum and retroperitoneum and its correlation with disease spread. 3. Expected findings on disease spread in the abdominal cavity, from tumoral dissemination to inflamatory disease and trauma.

Introduction: general aspects of the disease spread in the peritoneum and retroperitoneum. Anatomy of the retroperitoneum as it relates to interfascial spread of diseases. Peritoneal cavity and the circulation of ascitic fluid as it relates to intraperitoneal disease spread. Anatomy of peritoneal ligaments and omental sacs as it relates to subperitoneal spread of diseases. Understanding the relation of retroperitoneal and peritoneal organs with the peritoneal membrane as it relates to transperitoneal spread of disease. Take home messages.

-To know the MRI sequences to be performed and the order of execution-To understand usefulness of each sequence for the detection of peritoneal malignancies-To know how to adapt patient preparation and sequence parameters in case of MRI artifacts

Magnetic Resonance Imaging (MRI) has an emerging role in the exploration of peritoneal malignancy. The knowledge and the management of peritoneal pathologies have considerably evolved over the last decade, especially with the possibility of curative treatment of peritoneal metastatic disease. Peritoneal MRI is routinely performed in referral centers and play essential role at different stages of the management: for the selection of patients for curative surgery, in the preoperative phase to optimize mapping of lesions, and in surveillance for early detection of recurrence. A dedicated and detailed protocol is proposed to perform a peritoneal MRI. Each step are explained including the preparation of the patient, oral and intravenous contrast agent and drugs used. Then each sequences (recommended and optional) with their parameters and the optimized order of realization are detailed, as well as their usefulness to detect peritoneal lesions and their limits. Finally, tips and tricks to limit artifacts are given, in particular to reduce artifacts related to the MR technique like susceptibility artifact and related to the patient condition (for exemple the black hole artifact caused by the presence of ascites).

1. Demonstrate the wide array of acute pancreatitis encountered on imaging.2. Discuss the utility of imaging.3. Evolution of interstitial edematous pancreatitis and necrotizing pancreatitis.4. Summarize the nomenclature of the 2012 Revised Atlanta Classification for acute pancreatitis.5. Review of common complications of acute pancreatitis through illustrative cases.

Utility of imaging in acute pancreatitis and complications:Limited in the early phase of the disease processClinical diagnosis: epigastric pain and elevated pancreatic enzymes three times the normal levelDiagnostic in cases where elevated pancreatic enzymes do not meet the threshold criteria. Typically, in late presentation of acute pancreatitisDetermining unclear etiologyGallstone pancreatitisObstructive neoplastic processPredictor of mortality in the late phase of disease processExtent of necrosisInfectionLocal complications: pseudoaneurysm/bleeding, venous thrombosis, CBD stricture, pancreatic duct strictureDiscuss Case Examples with Imaging Findings:Acute interstitial edematous pancreatitisAcute necrotizing pancreatitis Acute pancreatic fluid collectionAcute necrotic collectionPseudocystWalled-off necrosisInfected walled-off necrosisBleeding splenic artery pseudoaneurysmLarge gastroduodenal artery pseudoaneurysmInteresting case of splenic vein thrombosis

Pancreatic ductal adenocarcinoma (PDAC) still has a dismal prognosis because of the difficulty in early diagnosis, although small PDAC has a good prognosis with a 5-year survival rate of 68.7% for stage IA disease. CT and MR are the most frequent imaging modalities used for evaluating patients with clinically suspected PDAC. However, these modalities often fail to demonstrate small PDAC. The possibility of diagnosing precursor lesions of the pancreas (pancreatic intraepithelial neoplasia [PanIN-3]) and small PDAC may greatly improve the prognosis of PDAC. The purpose of this exhibit is 1. To illustrate CT and MR imaging findings of PanIN and small PDAC 2. To discuss how to improve the detection of PDAC.

1. Summarize the definition, etiology, and clinical and histological features of PanIN and small PDAC (<20 mm) 2. Describe the characteristic CT and MR imaging findings of PanIN and small PDAC (<20 mm) with histopathological correlation 3. Highlight how to improve the detection of PDAC (tumor delineation and important secondary signs) 4. Discuss the diagnostic approach to potentially achieve earlier detection of PDAC 5. Summary: Knowledge of characteristic CT and MRI features and how to improve tumor delineation is important to improve the prognosis of patients with PDAC.

Imaging characteristics of cystic and solid lesions of the pancreas are well studied. However, with ongoing research in management and prognosis of these pancreatic lesions, it can be confusing for practicing radiologists and trainees to form recommendations for patients and clinicians. In this education exhibit, we will describe classic imaging findings of pancreatic lesions, review their clinical features, and discuss the latest recommendations on treatment options and management of these lesions. We present a pictorial review of cystic and solid lesions of the pancreas to guide radiologists on the management of these lesions.

Solid pancreatic lesions:? Ductal adenocarcinoma,? Neuroendocrine tumors, Metastasis, ? Lymphoma.Cystic pancreatic lesions:? Intrapancreatic Mucinous N?eoplasms (IPMN), Serous Cystadenoma, Mucinous cystadenoma?, Solid Pseudopapillary Neoplasm?. Mimickers?: Pseudocyst,? Duodenal diverticulum?.

The role of small bowel imaging is most important in patients with nonresponsive celiac disease and to exclude celiac disease related complications.The most specific imaging finding of celiac disease is the jejunoileal fold reversal pattern, but other findings are those of a nonspecific malabsorptive pattern.Ulcerative jejunitis, small bowel wall thickening, and small bowel dilation are more commonly seen in patients with refractory celiac disease.Ascites, pleural effusion and/or subcutaneous edema are related to severe malnutrition secondary to refractory celiac disease.

1) Introduction 2) Imaging protocolsCT enterography MR enterography3) Imaging analysis: Systemic approach4) Intestinal findingsIleal jejunizationJejunal fold flatteningFold pattern reversalIntestine wall thickeningBowel dilatationStrictureIntussusception5) Extra-intestinal findingsMesenteric adenopathyMesenteric vascular engorgementHyposplenismAscites6) ComplicationsUlcerative jejunoileitisMalignancyCavitary mesenteric lymph node syndrome7) Take home messages

Neoplastic and non-neoplastic pancreatic conditions can mimic pancreatic ductal adenocarcinoma (PDAC) on cross-sectional imaging. Our purpose is to: • Highlight distinguishing clinical and radiologic features that provide a clue to the correct (non-PDAC) diagnosis • Understand treatment and outcome implications for these mimics

Around 90% of pancreatic cancers are pancreatic adenocarcinoma while other pancreatic tumors are infrequently seen. This exhibit will highlight distinguishing radiologic and clinical features of PDAC mimics. 1. Uncommon exocrine pancreatic neoplasms.*Acinar cell carcinoma *Pancreatoblastoma *Squamous and Adenosquamous Ca *Colloid Carcinoma *Invasive IPMN *Mucinous cystadenocarcinoma 2. Non-exocrine pancreatic neoplasms that can mimic pancreatic cancer. *Pancreatic neuroendocrine neoplasms *Metastasis 3. Benign mimics of pancreatic cancer: “groove pancreatitis”, focal autoimmune pancreatitis, mass forming chronic pancreatitis, obstructive chronic pancreatitis, and focal steatosis 4. Key imaging features that can distinguish these entities from PDAC: multifocality, multiple ductal strictures, hemorrhage, duct-penetrating sign, low duct-to-parenchyma ratio, collateral duct dilatation, “sandwich sign”, hyperenhancement, calcifications, and capsule like rim or loss of lobulations. 5. Clinical features that can support the differential diagnosis are the history of a primary tumor, sex, age, predisposing genetic syndromes, and serum markers (IgG4, tryptase).

Diagnostic errors are common and can affect overall patient care, none more so than in the setting of pancreatic ductal adenocarcinoma (PDAC). In the absence of a PDAC screening program for the general population, the onus of early diagnosis is primarily placed on radiologists which largely determine patient outcomes and is an understandable source of anxiety to radiologists. Diagnostic errors can occur at any time in the process, from initial perception to final image interpretation. Cognitive errors include perceptual challenges and a myriad of cognitive biases which are particularly common and impactful in pancreatic imaging. Becoming aware of perceptual challenges specifically related to PDAC as well as understanding the various biases, related to internal and external pressures, can allow radiologists to minimize diagnostic errors and thereby help improve patient outcomes. In this exhibit we will provide explanations, insight and a framework for understanding the basis of these diagnostic errors and potential avenues to minimize them.

What contributes to diagnostic errors in the setting of PDAC? What’s the unique perceptual challenges of PDAC? Direct vs indirect signs of PDAC. Which cognitive biases are in play in pancreatic imaging? Internal and external factors contributing to bias. Common vs newly described biases as it pertains to pancreatic imaging. How to overcome biases with guidelines to create an environment of peer learning which enables systematic improvement, rather than viewing it as individual failures.

1. Ultrasound is a low cost, low risk, widely accessible imaging tool that can serve as a first line imaging modality in characterizing superficial lesions.2. A thorough understanding of abdominal wall anatomy and scanning techniques will allow the radiologist to confidently identify common abdominal wall pathologies.? 3. By combining scanning technique, anatomic knowledge and patient history, the radiologist can troubleshoot challenging cases and confidently arrive at the correct diagnosis.

1. A brief overview of the advantages and disadvantages of ultrasound in the assessment of superficial lumps and bumps in the abdominal wall. ?2. Review the anatomy of the abdominal wall and its ultrasonographic appearance. ?3. Review use and limitations of ultrasound and key ultrasound scanning techniques.4. Case based presentation of common lumps and bumps, describing key ultrasound findings, scanning tips and tricks, common mimics and/or complications, clinical presentation and management of these pathologies including but not limited to: Subcutaneous lesions: lipoma and epidermal inclusion cyst; Hernias: direct versus indirect inguinal hernia, femoral hernia, incisional hernia; Sequelae of trauma and infection: hematoma, abscess, Moral Lavallee lesion; Neoplasms: desmoid tumor, liposarcoma, melanoma; Miscellaneous lesions: adenopathy, endometriosis.

1. Understand normal ultrasound appearance of portal veins in grayscale, color and spectral Doppler 2. Recognize abnormalities of the portal vein including thrombus (bland and tumor), cavernous transformation and portal venous gas 3. Identify abnormal waveforms and abnormal direction of flow in the portal veins and formulate a differential diagnosis 4. Understand the normal ultrasound appearance of a TIPS and recognize complications

1. Normal ultrasound of portal vein a. Anatomy i. 3D rendering of portal venous system b. Grayscale c. Doppler i. Color ii. Waveforms iii. Velocities 2. Abnormalities of flow a. Slow flow b. Helical flow c. Abnormal flow due to portal hypertension i. Alterations of velocity and direction 1. Hepatofugal flow: partial and complete 2. Perihepatic varices: paraumbilical, coronary, gallbladder 3. Portal Vein Thrombosis a. Bland thrombus 1. Causes 2. Acute versus chronic 3. Differentiating occlusive from non-occlusive b. Tumor thrombus 1. Hepatocellular carcinoma and other tumors 2. Grayscale, cine clips 3. Doppler: arterial flow within thrombus c. Chronic occlusion/Cavernous Transformation 4. Portal venous gas a. Causes b. Differentiate from pneumobilia c. Gray scale and Doppler appearance 5. Other a. Effect of cardiac disease on portal system b. Portal fistula i. Portal-hepatic venous ii. Portal-hepatic arterial 6. TIPS a. Normal appearance on Grayscale and Doppler i. when to image a TIPS after insertion ii. protocol for imaging a TIPS iii. effect on other vessels b. Complications i. Thrombus ii. Stenosis

1. Review of the adult presentation of pediatric acute abdominal pathology with discussion of imaging findings. 2. Illustrated conditions include Meckel’s diverticulum, intussusception, anatomical variants, intestinal malrotation, mesenteric adenitis. 3. Highlight important review areas and implications. 4. Insight into their clinical management.

Pediatric pathology is often not a primary focus for adult GI radiologists and clinicians. Whilst uncommon, pediatric abdominal pathologies can also present later in life. It is therefore crucial that the radiologist on call considers pediatric illnesses and underlying congenital structural abnormalities within their differential diagnosis. We present a case-based educational exhibit to familiarize radiologists with the key imaging findings.

Teaching Points • Review different etiologies of sclerosing cholangitis • Discuss specific SC manifestations, including: background, clinical presentation, mechanism, treatment • Emphasize sonographic features of each, to allow an educated query of appropriate diagnosis

Sclerosing cholangitis is a progressive cholestatic disease, characterized by inflammation, fibrosis strictures. It is divided into primary sclerosing cholangitis (PSC) secondary sclerosing cholangitis (SSC). PSC is idiopathic, often seen in young males with concomitant ulcerative colitis, while SSC denotes a spectrum of progressive cholestatic diseases which have an identifiable, even treatable cause. SSC etiologies are divided into five mechanistic categories: immune-mediated, drug-induced, infectious, obstructive, or ischemic. Differentiation between the various causes of sclerosing cholangitis is imperative for appropriate patient management. Ultrasound (U/S) is the primary imaging of choice for evaluation of the biliary tree, being accurate, available, cost-effective, impervious to motion, safe. U/S is underrecognized as a diagnostic and problem-solving tool in assessment of PSC SSC. U/S’s high spatial resolution allows detection of fine ductal features not often seen by MRCP. Subcapular ducts are often only visible on U/S. As well, it has the highest sensitivity for detection of intrahepatic stones bile duct casts. However, lack of familiarity means that many diagnostic features of biliary diseases are often missed. In this review we will describe the typical U/S features of PSC SSC.

1)Learn embryological basis of anomalies of hepatic, biliary and pancreatic ducts 2) Optimal MRCP protocol/Physics 3) Know classification of anatomical variants in configuration of intra/extrahepatic biliary ducts(BD) with clinical relevance 4) Appreciate classification of cystic duct pancreatic duct (PD) variations based on course insertion 5) Classification MRI features of Gall bladder(GB) variations such as duplication, intrahepatic GB. 6) Learn incidence of variations with literature comparison 7)Learn clinical significance (eg longterm effects, Surgeon's needs) of identified hepato-biliary-pancreatic duct variations and how to document them accurately on pre-op MRCP report to answer clinical needs 8) Learn to avoid diagnostic pitfalls and mimics causing misinterpretation on MRI/MRCP

1) Introduction to spectrum of BD, PD,Cystic duct GB anatomical variants, aberrant anatomy embryological basis with illustrations 2)Optimised MRCP protocol 3) Huang classification of Right Left intra hepatic BD illustrated with our MRCP images -Demography incidence 4) Classification of extrahepatic BD, PD and cystic duct variants with our sample cases 5) MRCP of Intrahepatic GB, double GB and classification 6) Pictorial depiction of concomitant BD,PD,GB variants and choledochal cysts with sample MRI cases 7) Diagnostic Mimics pitfalls, clues to avoid them 8) Potential longterm complications of variants such as pancreatitis 9)Challenges to Hepatobiliary surgery and value of pre operative documenting of anatomical variants 10) Guidance for systematic MRI/MRCP reporting focused specially for hepatic transplantation, hepatic resection, ERCP, laparoscopic surgery etc.

Gallbladder Malignancy and its Many Mimics Teaching Points: 1. Gallbladder malignancy tends to predominantly present in several different ways on imaging as an: intraluminal mass lesion, asymmetric wall thickening, or polyp. 2: Many potential mimics of gallbladder malignancy exist. Use the clinical history, all available views, and all modalities to create a more informed differential. 3: How the lesion evolves (or doesn’t evolve) over time can help narrow or change the differential. 4: Sometimes you don’t know if it is malignancy or a benign process. When in doubt take it out! (Or biopsy).

Table of Contents: - 1. Different gall bladder malignancies and their presentations (some with rad-path correlation). - 2. Metastatic diseases to the gallbladder (including lung and melanoma).- 3. The different potential mimics of gall bladder cancer (cholecystitis, adenomyomatosis, etc) - 4. Multiple case-based examples where specifics of the patient presentation help aid the differential diagnosis. - 5. Multiple case-based examples where the temporal course of the lesion changes the differential. - 6. Xanthogranlmatous cholecystitis cases (the great mimicker) with rad path correlation.

• Recognize hepatobiliopancreatic (HBP) anatomy and anatomical variations. • Understand most common types of HBP surgeries. • Know radiologists role in the pre- and postoperative settings. • Recognize HBP postoperative complications through multimodality imagings.

INTRODUCTION: o Overview of frequency, relevance, and cost of HBP surgeries. o HBP anatomy including key anatomical variations as they relate to surgical complications. o Summary of most common types of HBP surgeries. 2. IMAGING ON THE PREOPERATIVE SETTING: o Presurgical roadmap to optimize the surgery and avoid complications. o Pros and cons of each imaging modality. 3. IMAGING ON THE POSTOPERATIVE SETTING: o Step by step didactic approach in assessing patients after HBP surgery: § Surgical notes; § What to ask to the multidisciplinary team; § Clinical notes and laboratory tests; § How to decide which imaging modality; § Best protocol; § Ultrasound approach; § CT approach; § MRI approach; § How to report and communicate; o Surgical complications: § Acute versus chronic; § Main groups: vascular, biliary, GI tract, infectious, other. 4. WHAT IS THE ROLE OF INTERVENTIONAL RADIOLOGY. 5. WHAT’S ON THE HORIZON. 6. INTERACTIVE CHALLENGING SCENARIOS.

To show normal anatomy, pathology and its variants.-To identify in a simpler way the ultrasonographic characteristics of acute cholecystitis, in special for new residents.-To recognize different clinical characteristics that help to recognize acute cholecystitis.-To give advice for new residents when performing an ultrasound, to help base the most accurate diagnosis and thus decide on interdisciplinary management.-To be familiar with the sonographic technique, tips, pitfalls, limitations and troubleshooting for the right upper quadrant pain.-This discussion will help residents to reinforce the radiological and clinical features of acute cholecystitis, keeping in mind that interdisciplinary consensus remains the gold standard for diagnosis

1.Objectives.2.Review the anatomy of the gallbladder and its variants. 3.Discuss the global panorama about the importance of acute cholecystitis. 4.Explain the clinical characteristics based on Tokyo’s criteria for acute cholecystitis as a multidisciplinary approach. 5.Discuss the algorithm of the ultrasound technique used to evaluate the right upper quadrant pain. 6.Recognize and illustrate the main ultrasonographic findings in this pathology. 7.Present a series of cases to exemplify the most important ultrasonographic findings of acute cholecystitis, as well tips for the correct approach. 8.Recognize differential diagnoses of right upper quadrant pain. 9.Conclusions. 10.References

Conventional CT uses energy integrating detectors (EID), in which x-rays create visible light that is converted to electrical pulses to create images. Photon counting CT (PCCT) detectors directly convert photons into electrical pulses, allowing electronic noise elimination and leading to significant dose reduction. Unlike EID, PCCT counts the energy of each photon, including low energy photons. This improves image contrast, makes every CT multienergy, and permits electronic baseline noise removal. Downsides include K-escape and charge sharing in PCCT can reduce spectral separation.

1. PCCT versus EID physics2. Clinical benefits a. Improved spatial and contrast resolution, without dose penalty - Small vessel visualization - Small lesion visibility and characterization in low contrast areas (pancreas, liver, peritoneum) - Better iodine contrast to noise ratio, lower intravenous contrast dose b. Multienergy every scan - Simultaneous high pitch and multienergy - Incidental finding characterization c. Remove electronic noise - Better image quality in obese patients - Lower dose CT - Better virtual noncontrast (VNC) image quality3. Current Version Pitfalls a. Cross-scatter artifact with dual-source mode b. Urographic phase derived VNC artifact c. Slower reconstruction time

Learning objectiveIdentify the anatomy of the anal canal by MRI to achieve an adequate classification of anal fistula.IntroductionThe anal fistula corresponds to an anomalous path that connects the anal canal with the skin. MRI is the imaging modality of choice due to its high resolution, allowing an adequate characterization of the anatomy and also greater precision in the classification of the anal fistula.Teaching pointsThe anal canal is limited between the dentate line and the anal verge. The layers of this wall are mucosa, submucosa and muscularis. The muscularis layer is composed from the innermost to the outermost layer, by the internal anal sphincter(IAS), the intersphincteric liner and the external anal sphincter(EAS). The IAS is a continuation of the muscular layer of the rectum, and the EAS is composed of skeletal muscle.The MRI is the imaging modality recommended in ESGAR consensus.The protocol used in our institution is performed in 1.5 T and 3 T, the MRI sequences and the planes are axial, coronal and sagittal T2-weighted, and post-contrast T1-weighted sequences are performed. The axial acquisition performed align with respect to anal canal axis.By magnetic resonance imaging in axial T2-weighted sequences, the anal canal is a circumference of 5 layers: the innermost layer mucosa (hyperintense),submucosa (hypointense), IAS (hyperintense), intersphincteric liner (hyperintense) and the outermost layer EAS (hypointense). The Parks classification is used for anal fistula: intersphincteric, transsphincteric, suprasphincteric and extrasphincteric.

1. Learning objective2. Introduction3. Teaching points

Review the relevant anatomy of the structures participating in formation of the anterior extraperitoneal space Review characteristic imaging findings of common and uncommon pathologies involving this region

Normal embryology and anatomy of the anterior extraperitoneal space Development Transversalis fascia Umbilical prevesical fascia Umbilicovesical fascia Fascia around the round ligament Imaging characteristics with cadaveric correlation Abdominal above the umbilicus Retropubic or prevesical space of Retzius Prevesical, perivesical, and paravesical spaces The retroinguinal space of Bogros Connections to Subperitoneal pelvic space, presacral space and retoperitoneum Relationship to the vessels, median and medial umbilical ligaments Anatomical variations Abnormalities of the anterior extraperitoneal space Infection and abscess Post trauma changes Malignancies Relevance for extraperitoneal laparoscopic surgery Relevant considerations for percutaneous interventions

1. Review the most common bowel pathology and gas appearances on abdominal radiographs and understand clinical relevance.2. Discuss common and uncommon calcifications that can be seen on the abdominal radiograph.3. Highlight most common "corner" pitfalls to increase sensitivity for these commonly missed pathologies.

IntroductionBowel- Small bowel obstruction- Large bowel obstruction- Ileus- Enteritis/colitis- PneumatosisAir- Free intraperitoneal air- Portal venous gas- Retroperitoneal gas- Emphysematous cholecystitis- Emphysematous cystitisCalcifications- Renal stones- Gallstones- Calcified mass(es)- VascularCorners- Lung bases- Cardiac- Proximal thighsConclusion

For abdominal radiologists, cognitive biases impact our interpretive and perceptual skills predisposing to diagnostic errors. Published data suggests that such biases are particularly common and impactful in abdominal radiology. A broad spectrum of recognized (common and less common) as well as newly emerging biases occur in abdominal radiology. Being aware of one’s personal diagnostic biases, as well as strategies for mitigating their occurrence, is likely to improve our diagnostic performance. Familiarity with the spectrum of biases enables cases to be categorized in the peer learning and improvement meeting.

What are cognitive biases? How do biases impact abdominal radiologists? How to construct your Personal Bias Profile? Brief explanations, clinical examples and strategies for mitigating the following biases: Common biases: anchoring, confirmation, availability, automation, bandwagon, satisfaction of search and of report, premature closure, zebra retreat, representative, outcomes, framing, attribution, context, authority, premature closure, provider, hindsight, alliterative, blind spot, regret, scout neglect and inattention biases. Newly recognized biases: hanging protocol, risk averse, clinical trial, demographic, productivity, follow up, trainee assumption, provisional report, structured report and remote reader biases.

Various disorders of the hepatobiliary system and pancreas are caused by several drugs, and imaging diagnosis is often challenging. Familiarity with these conditions may improve diagnostic accuracy and patient management. The purpose of this presentation is to describe the imaging findings of drug-associated hepatobiliary and pancreatic disorders and to identify tips for correct diagnosis.

The following drug-associated hepatobiliary and pancreatic disorders are discussed along with their key imaging findings: 1. Drug-induced acute liver failure Imaging findings are non-specific and include hepatomegaly with heterogeneous parenchymal enhancement, periportal edema, gallbladder wall thickening, and ascites. 2. Sinusoidal obstruction syndrome (SOS) A diffuse hypointense reticular pattern in the hepatobiliary phase is a highly specific sign for the diagnosis. 3. Pseudocirrhosis Imaging manifestations may be identical to those of liver cirrhosis. 4. Immune-related adverse events (irAEs) Cholangitis and pancreatitis may develop after immune checkpoint inhibitors therapy. 5. Methotrexate-associated lymphoproliferative disorders It is visible as a periportal infiltrating hypodense mass on computed tomography and is weakly enhanced. 6. Amiodarone deposition in the liver 7. Ceftriaxone-associated gallbladder pseudolithiasis 8. Secondary iron overload

Know the normal anatomy of the spleenIdentify congenital anomalies of the spleen and their associated systemic pathologiesUnderstand the multiple imaging modalities used in the assessment of splenic pathologies and the pitfallsKnow and accurately diagnose focal and diffuse pathologies in the spleen on imaging

A. AnatomyB. Multimodality imaging of the spleen and associated pitfallsC. Splenic pathologies1. Congenital including asplenia and polysplenia and their associated imaging findings in other systems2. Focal massesi. Benignii. Indeterminantiii. Malignant3. Diffuse processes (Splenomegaly/granulomas)4. Otheri. Ruptureii. Infarctiii. Splenosisiv. PeliosisD. Summary

Stereotactic body radiotherapy (SBRT) and transarterial radioembolization (TARE) with Yttrium-90 are the two commonly used treatment options for primary liver cancer and liver metastasis in patients unsuitable for surgery. Patients receiving such treatments require to undergo imaging surveillance with CT or MRI as there is possibility of incomplete tumor response. Careful assessment of these follow-up studies is essential to proper patient management. It is also crucial for radiologist to be aware of expected treatment-specific changes within the treatment zone as well as non-treated liver parenchyma following each type of treatment.The purposes of this exhibit are1. To discuss the concept of tumor response assessment after radiation-based therapies2. Demonstrate expected posttreatment changes within the targeted as well as surrounding non-targeted liver parenchyma following SBRT and TARE3. To review potential complications of radiation-based therapies

Table of contents/outline1. What are the optimal imaging follow-up strategies after radiation-based therapies for liver cancer?2. How should we assess response after SBRT?• Imaging features of non-viable tumor• Imaging features of viable tumor3. How should we assess response after TARE?• Imaging features of non-viable tumor• Imaging features of viable tumor4. What are the expected posttreatment findings within targeted region as well as surrounding off-target liver following TARE and SBRT?5. Potential complications of radiation-based therapies6. Summary

-Focal nodular hyperplasia (FNH) is a benign hepatic lesion with a typical imaging presentation at CT and MR imaging.-Rarely, FNH may show histological components that lead to an atypical imaging presentation mimicking other benign and malignant lesions. Atypical features include intralesional fat, iron, calcifications, sinusoidal dilatation, and significant growth. FNH occurring in an abnormal liver, defined as FNH-like lesions, may present a diagnostic challenge.-Illustrated overview of typical and atypical presentations of FNH and FNH-like lesions with representative rad-path correlation cases, along with key diagnostic clues for an accurate diagnosis of FNH and FNH-like lesions based on a constellation of multiple imaging features to include iso-to-hyperintensity on hepatobiliary phase imaging.

-Epidemiology, pathology of FNH-Typical features of FNH on CT and MR imaging (with extra-cellular and hepatobiliary Gd-based contrast agents).-Atypical imaging presentation of FNH to include steatotic and steatohepatitic FNHs, calcification, intralesional sinusoidal dilatation, abnormal growth and intralesional iron-Definition and pathology of FNH-like lesions.-Imaging presentation of FNH-like lesions.-Key clues for accurate diagnosis of FNH and FNH-like lesions and differential diagnosis with other hepatic lesions (e.g hepatocellular adenoma).

1) Review the typical imaging appearance of HCC on CT and MRI 2) Learn about the various patterns of HCC presentation 3) Review the recognized histologic subtypes of HCC with an emphasis on characteristic differentiating imaging features 4) Understand HCC imaging features that correlate with favorable versus poor outcome 5) Review LIRADS categorization with some examples

1. HCC overview a. Typical HCC appearance on imaging b. Patterns of presentation on imaging i. Nodular (expansive) - single, dominant nodule, with or without satellite nodules ii. Multifocal nodules iii. Infiltrative (massive) iv. Cirrhotomimetic v. Pedunculated c. Histologic growth patterns of HCC 2. Histologic subtypes of HCC a. Frequency b. Characteristic and “buzzword” imaging features 3. Favorable and poor prognostic features of HCCs a. Favorable imaging signs include single, small nodule with smooth margins, no necrosis, and homogenous enhancement. Other favorable features include low tumor stiffness on elastography, uptake of hepatobiliary contrast suggestive of beta-catenin activation, and occurrence in a normal or non-cirrhotic liver b. Poor prognostic imaging signs include large size at presentation, multifocality, evidence of necrosis, heterogeneous enhancement, ill-defined margins, and macroscopic vascular invasion. 4. LIRADS characterization overview a. Explanation of LIRADS categorization with examples

Cystic hepatic lesions are very common in daily practice. The differential diagnosis ranges from benign lesions with no clinical significance to malignant neoplasms and potentially lethal conditions. Some cystic hepatic lesions have classical findings, allowing a correct diagnosis based on imaging findings only. On the other hand, some presentations may be challenging. In most cases, familiarity with the most relevant radiologic key features in combination with critical clinical and laboratory information is enough for adequate lesion characterization. The purpose of this presentation is to review the main cystic liver lesions, recalling imaging features from typical to challenging cases; a series of diagnostic tips will be presented, as well as a practical guide on how to develop objective reasoning in face of such cases.

1) Review the most common liver cystic lesions and their imaging features with didactical cases.2) Provide a didactic approach to differential diagnoses.3) Tips that can be helpful in face of challenging cases.4) Surviving guide that can be useful for a quick consultation.

1. Imaging features of FNH including typical findings and rarer features2. Multiple imaging modalities presented3. A unique method of presenting the findings using letters of the alphabet as an aide memoir

FNH is a common benign lesion, encountered on multiple imaging modalities. It is therefore important to recognise the key features of both typical and atypical lesions for accurate diagnosis in order to prevent unnecessary intervention. This display will include ultrasound examples, using both colour doppler and contrast enhanced techniques. All MRI sequences will be demonstrated with key learning points illustrated. The importance of liver specific contrast agents is highlighted, along with the pathology and aetiology of the lesion. The unique selling point for this presentation is the format which should be easy to remember and help in consolidating knowledge. The points to be covered using an A to Z format are as follows:Arterialisation, Biopsy, Contrast enhanced ultrasound, Doppler, Exophytic lesion, Fat, Glutamine synthetase, Hepatobiliary phase, Isointensity, Juicy orange, Kuppfer cells, Lobulated, MRI, Nodules, OATP receptors, Pathology, Question, Ring on hepatobiliary phase, Scar, Telangiectatic, Ultrasound, Vascular malformation, Washout, Xtra fun fact, Young, Zero malignant.

Iron is an essential mineral critical to oxygen transport but it can have a toxic effect at high concentration. Absorption is regulated, but primary hemochromatosis and hemosiderosis lead to toxicity. The liver stores and regulates iron. Primary hemochromatosis and hemosiderosis cause toxic buildup of iron in the liver which has characteristic imaging appearances. Primary hemochromatosis typically affects the liver and pancreas on MRI. Hemosiderosis, which is usually due to frequent blood transfusions secondary to various anemias, typically affects the liver, spleen, and bone marrow. Intravascular hemolysis can affect the kidneys. MRI can qualitatively and quantitatively assess iron overload and assists in diagnosing and managing hemochromatosis and hemosiderosis.

Intro Iron absorption, transport, and regulation Iron overload causes and clinical impact Diagnosis, treatment, and management of iron overload Imaging Noncontrast CT Typical appearance Confounding factors and differential with cases Dual energy CT Methodology and typical appearanceIron content quantification MRI Basic physics Qualitative assessment In/out of phase imaging analysisImaging patterns with case examples Quantitative assessment Methodology - Benefits and drawbacks Signal Intensity ratios T2/R2 relaxometry (FerriScan) T2* and R2* relaxometry Quantitative Susceptibility Mapping Example cases with effects of treatmentSQUID Biomagnetometry - Advantages, disadvantages, and relevance Conclusion

1) To review the pathophysiology of common imaging findings seen in inflammatory bowel disease. 2) To demonstrate barium enema, CT, and MRI findings of acute and chronic inflammatory bowel disease, associated findings, and diverse complications. 3) To discuss the advantages and disadvantages of currently available imaging modalities for inflammatory bowel disease.

Inflammatory bowel disease (IBD) most commonly occurs in North America and Europe, with an estimated combined patient population of 4-5 million in both regions. Incidence of IBD has been gradually rising since the mid-20th century, likely due to widespread changes in dietary patterns along with environmental factors. Cross-sectional imaging modalities such as computed tomography (CT) and magnetic resonance (MR) enterography are now more commonly utilized because of their ability to detect subtle changes in inflammation, high clinical sensitivity, and ability to detect complications such as a) fistulae, b) bowel obstruction, c) intussusception, and d) abscesses outside the bowel lumen. Though resolution for both CT and MR are comparable, MR has the added benefit of zero radiation exposure.

* Describe the clinical states of cirrhosis according to the development of disease complications (varices and decompensation events) with the progression of pathophysiological mechanisms and hemodynamic. * Discuss the clinical importance of noninvasive prediction of these complications in cirrhosis. * Discuss how and whether routine dual-energy CT (DECT) and MRI can predict future complications in cirrhosis based on the recent quantitative studies.

EpidemiologyClinical states in cirrhosis Management implications of clinical states of cirrhosisDECT and MRI-based techniques for prediction of cirrhosis-related complications- DECT- T1 mapping- T2 mappingFuture directionsSummary

-MAFLD, aprendendo mais sobre a nova 'epidemia'- Learn and review basic protocol sequences for a complete liver assessment- Execution and preparation tips- Limitations for measures of steatosis and iron overload- Illustrate the findings and correlate them with clinic application- Learn how to make illustrative radiology reports- Attention to the most common pitfalls

- Imaging protocols- Imaging aspects that may be mistaken- Pitfalls- Practical examples- Impact the liver evaluation and clinical application in everyday life- Ilustrated and structured report

Since significant differences are found in the prognosis of NAFLD depending on histological findings including fibrosis and steatosis, exact diagnosis of these conditions is clinically crucial. Many studies for non-invasive methods to estimate the histological severity of NAFLD instead of liver biopsy have been undertaken, mainly in the field of radiological and biochemical examinations. The purposes of this review are 1) to explain the principal, clinical application, pros/cons and limitations of imaging techniques for hepatic steatosis, fibrosis and hepatitis 2) to review the recently developed machine-learning based evaluations (computer aided diagnosis and radiomics) of conventional US, CT and MR images for the measurement of intrahepatic fat and fibrosis, 3) to discuss the future of these techniques, the possibility for wider clinical applications and roles in clinical trials for the treatment of diffuse liver disease

• Background• Hepatic steatosis1. US based techniques 1) Gray scale imaging 2) Controlled attenuation parameter 3) Attenuation imaging2. Unenhanced CT 3. MRI based techniques 1) Two point DIXON 2) MR spectroscopy 3) MRI-PDFF• Differentiation of NASH from simple steatosis• Hepatic fibrosis1. US based techniques 1) Transient elastography 2) Shear wave-based elastography: Point SWE, ARFI, Supersonic shearwave2. MRI based techniques 1) Diffusion weighted imaging 2) Hepatocyte-specific contrast agent enhanced imaging 3) MR elastography• Machine learning based evaluation of hepatic steatosis and fibrosis with US, CT, MR images• Can we replace liver biopsy by imaging studies for hepatic steatosis or fibrosis?• Conclusion

Gastric wall thickening can present a diagnostic challenge due the overlapping features of normal rugal folds, inflammation, and neoplasm. Features that suggest true gastric wall thickening include altered wall enhancement, asymmetric thickening, adjacent stranding, or local adenopathy Lower attenuation (edema) or mural stratification favors a benign process related to infection or inflammation. Intermediate/soft tissue attenuation favors neoplastic processes such as lymphoma or adenocarcinoma. Additional diagnostic work-up will frequently include further evaluation with endoscopy and endoscopic biopsy

1. Basics of gastric wall evaluation 2. Tips and tricks a. Differentiating true versus pseudo-thickening b. Differentiating malignant versus benign thickening3. Malignant causes (e.g., linitis plastic, lymphoma, gastric adenocarcinoma)4. Benign causes - common (e.g., gastritis) and uncommon (e.g., Ménétrier’s disease) a. Inflammatory/infiltrative b. Infectious

Teaching PointsThe peritoneum and retroperitoneum, with their myriad spaces, pouches, and ligaments, are difficult to comprehend, let alone identify on imaging. However, understanding how the peritoneal reflections limit, circulate, and react to disease can facilitate the correct diagnosis and proper care.After reviewing this education exhibit, the learner will be able to: Understand and identify structures and spaces of the peritoneum and retroperitoneum. Appreciate the significance of the peritoneum and retroperitoneum, with respect to the spread of and response to infection, the staging of cancers, and the severity and localization of traumatic injuries. Recognize how medical and surgical management changes when peritoneal borders are violated.

Outline1.) Overview of the anatomy, spaces, and pouches of the peritoneum and retroperitoneum.2.) Differences regarding the peritoneum of males and females.3.) Case-based demonstration of the significance of the peritoneum, with regards to management and outcomes in cancer, trauma. and infection.

1. Hernias are a very common pathology found on imaging with a large variety of presentation types. We provide multiple examples of hernias, both superficial and internal. 2. Superficial hernias can occur anywhere along the anterior, lateral, or posterior abdominal wall and can be simple containing only fat, or complex containing organs. We have cases of these simple and complex hernias, and hernias which contain pathology in the hernia sac. 3. Internal hernias can be intimidating to radiologists who are unfamiliar with the specific imaging patterns, our goal is to provide examples of these hernias along with the etiologies to help improve diagnostic acumen and accuracy. 4. The important goal of reporting pertinent information of type of hernias to clinicians to ensure that patients receive the best treatment possible.

Discussion of superficial hernias, which include inguinal, umbilical, Spigelian, amyand, Richter, incisional and others.Elucidate internal hernias, which include paraduodenal, Foramen of Winslow, Petersen and others.Highlight features of complex hernias.Imaging tips on recognizing specific hernia types.Report pertinent information that the clinicians want to know.Conclusion.

1. To understand the mechanisms and application of molecular targeted therapy and immuno-therapy for HCC2. To know the role of imaging in evaluation and prediction of treatment response of HCC3. To learn the adverse events of these systemic therapies for HCC that can be assessed by imaging

1. History and treatment mechanisms-Molecular targeted therapy-Immunotherapy2. Application-Clinical and imaging criteria-Roles in multidisciplinary therapy3. Evaluation of treatment response-Guidelines, especially in modified response evaluation criteria in solid tumors (RECIST)-Imaging modalities and techniques: dynamic CT, dynamic MRI, contrast enhanced US and radiomics-Pitfalls4. Prediction of treatment response based on molecular subclassification of HCC-Molecular targeted therapy: dynamic CT, intravoxel incoherent motion (IVIM) and 18F-FDG PET/CT-Immunotherapy: gadoxetate-enhanced MRI5. Adverse reactions of molecular targeted therapy and immunotherapy-Tumor related reactions-Systemic reactionsSummaryThe radiologists should know the imaging features related to molecular targeted therapy and immunotherapy for HCC in the era of personalized medicine.

1) To understand the anatomical basis of common and uncommon surgical procedures2) To elaborate on the salient features of various pathologies encountered in cross-sectional imaging of the post-operative abdomen3) To illustrate the distinguishing imaging features of complications of laparotomy4) To propose an algorithmic approach to the differential diagnosis of various pathologies5) To highlight red flag imaging biomarkers with implications on management strategies

1) Introduction2) Radiological anatomy of common and uncommon abdominal surgeries3) Imaging of complications of Hepatobiliary surgeries including Whipple, Extended hepatectomy, Roux en Y jejunostomy, resection and anastomosis, rectal surgeries and Cholecystectomy4) Imaging of complications of Genitourinary surgeries including nephrectomy, hysterectomy and caesarean section5) Understanding the chronology and pathophysiology of early and late complications6) Tailored regimens of cross sectional imaging to optimise image acquisition7) Diagnostic challenges posed by sequelae of laparotomy including structures, adhesions and scar8) Endovascular management of Vascular complications of Abdominal surgery9) Conclusion

1.) Understand basic principles of ultrasound and how to acquire ultrasound images of the right upper quadrant. 2.) Review anatomy of the RUQ on cine ultrasound images including hepatobiliary, pancreatic and regional anatomy. 3.) Identify common pathology seen in the right upper quadrant, with a focus on high yield on-call ultrasound findings and diagnoses for trainees.

1.) Basic principles of ultrasound imaging. a.) Ultrasound probe selection and sonographic windows to assess the liver, gallbladder, and pancreas illustrated with images/movies. b.) Knobology basics: Image optimization for best image quality. 2.) Imaging review of labelled cine images of right upper quadrant anatomy. a.) Hepatobiliary - hepatic segments, vasculature, biliary system. b.) Pancreas and upper abdominal vasculature. c.) Regional anatomy - Bowel, right kidney, thorax. 3.) Review imaging of RUQ pathology. a.) Hepatic - diffuse liver disease, mass, abscess, TIPS, portal vein thrombus, portal vein gas. b.) Biliary - Cholecystitis, cholelithiasis, obstruction, choledocholithiasis, adenomyomatosis, gallbladder cancer, pneumobilia. c.) Pancreatic - pancreatic mass, pancreatitis. d.) Peritoneum.

Discuss anatomy, embryology, arterial, portal venous supply hepatic venous drainage biliary drainage of segment 4 (S4)Review select pseudotumors, developmental, inflammatory, and neoplastic pathologies specific to S4Discuss the clinical significance of S4 vasculature, bile ducts in living donor liver transplant viability complications

IntroductionAnatomy: Couinaud, International Hepato-Pancreatico-Biliary Association New World Terminology ClassificationsEmbryologyHepatic arteriesPortal veinsHepatic veinsBile ductsImaging Modalities: US, CT MRIImplications of living donor transplant hepatic resection surgeries: Hepatic artery thrombosis, venous congestion post-operative bile leakPseudotumors: Focal fat deposition, sparing perfusion abnormalities due to aberrant vesselsHot quadrant lobe sign in superior vena cava syndromeTarget-like lesions in S4Ciliary Hepatic Foregut cystIngested gastric foreign bodies perforating S4: Toothpicks, fish bones wires bristles from grill cleaning brush Mucinous cystic neoplasm of the liver (MCN)Direct tumor extension from stomach gastrohepatic ligamentConclusion Clinical Implications Knowledge of arterial, portal venous, hepatic venous, bile duct anatomy of S4 vascular variations is crucial in successful liver donor liver transplant other left lobe resections. Focal fat sparing, deposition are more common in S4 due to peculiar venous drainage. Given embryologic origin in close proximity to esophagus stomach, MCN ciliated foregut cyst develop exclusively in S4.

a. In well-to-moderately differentiated hepatocellular carcinoma (HCC), the 18F-flurodeoxy-glucose (FDG) uptake tends to be poor. A high FDG uptake is associated with histologically poor differentiation, microvascular invasion, and a poor prognosis. Therefore, 18F-FDG-PET is useful for estimating the malignancy grade of HCC. b. Although most intrahepatic cholangiocellular carcinomas (ICC) show elevated FDG uptake, in some the uptake may be poor. c. A marked FDG uptake may identify rare malignant hepatic tumors such as malignant lymphoma and leiomyosarcoma. d. As it is difficult to differentiate malignant hepatic tumors from inflammation with only the degree of FDG uptake, findings of other imaging modalities should be considered.

1. Molecular background of 18F-FDG 2. Technical and physiological pitfalls of 18F-FDG PET/CT 3. Imaging findings of various hepatic lesions on 18F-FDG-PET/CT scans 4. The advantages and limitations of 18F-FDG-PET/CT vis-à-vis other imaging modalities for the diagnosis of hepatic lesions 5. The future prospects of nuclear imaging for the diagnosis of hepatic lesions

Hepatic vascular lesions have a wide spectrum of clinical presentations and varying degrees of malignancies. They range from benign tumors such as hepatic hemangiomas, benign/low-grade malignancies such as hepatic small vessel neoplasia, tumors with high malignant potential such as hepatic perivascular epithelioid cell tumors, and hepatic hemangiopericytomas, other tumors with intermediate degrees of malignancy such as hepatic epithelioid hemangioendothelioma, up to malignancies developed more often in the context of immunodeficiency syndrome-Kaposi sarcomas, and high-grade malignancies with a poor outcome such as hepatic angiosarcomas. On Imaging, differentiation of primary malignant vascular tumors of the liver from benign neoplasms or vascular abnormalities is often difficult. After reviewing this exhibit, the learner will be able to:1. Understand the epidemiology, pathology, and imaging appearance of common and uncommon benign and malignant hepatic vascular lesions or neoplasms 2. Imaging tips to differentiate vascular lesions from other non-vascular abnormalities.

A. WHO Classification of hepatic vascular neoplasms B. Epidemiology and pathophysiology. C. Multimodality imaging of benign and vascular lesions with imaging tips and pitfalls

1) Orthotopic liver transplantation (OLT) is the definitive treatment for patients with end-stage liver disease accounting for 22.8% of all organ transplantations in the United States (OPTN).2) Although the advances in OLT have led to reduced morbidity and mortality, the procedure continues to be associated with a high rate of complications occurring in 25-30% of cases (NG 2015).3) We will highlight the surgical technique and anatomy of OLT with a brief overview of different anastomosis techniques.4) We will review the imaging techniques for peri- and post-operative evaluation of transplanted grafts including normal imaging appearance post-transplantation.5) We will summarize the most common post-operative complications following OLT with their associated radiologic findings and discuss possible interventional solutions.

Summary of OLT surgical approach Surgical anatomy with location of anastomoses for the hepatic artery, portal vein, inferior vena cava, and biliary duct system accompanied with illustrations.Imaging of transplanted grafts Grayscale and Doppler ultrasound for routine surveillance post-transplantation. Describe common waveform characteristics seen with specific complications.The use of CT and MRI to further explore suspected abnormalities followed by angiography.Common OLT complications with associated radiologic findings i. Biliary complications including biliary strictures and bilomas. ii. Vascular complications including arterial and venous stenosis, thrombosis, and pseudoaneurysm formation.Brief imaging review of OLT complications pre- and post- treatment with interventional radiology procedures.

Use of chemotherapy has revolutionized management of cancer in past decades. Liver toxicity is commonly observed among different types of chemotherapy drugs. The aim of this exhibit is to illustrate radiological features of various chemotherapy-associated hepatic parenchymal changes, with examples in different imaging modalities, and to demonstrate potential complications of these liver injury patterns with representative cases. Early recognition of these liver conditions allow prompt clinical action to be taken, thus optimizing management and avoiding severe complications.

1. Introduction 2. To illustrate cases and radiological features of: a. Pseudocirrhosis in breast cancer and non breast cancer patients with liver metastasis, as well as its potential complications b. Chemotherapy-related hepatic steatosis c. Chemotherapy-related hepatitis d. Chemotherapy-related cholangiopathy 3. Summary of key teaching points

Non-alcoholic fatty liver disease (NAFLD) is a growing cause of cirrhosis, hepatocellular carcinoma and liver transplant.Currently, steatosis is graded by subjective assessment of liver echogenicity and attenuation, with significant interobserver variability and sub-optimal detection of mild or greater steatosis (S>0).Controlled Attenuation Parameter is widely used (found in the Fibroscan® system, Echosens). Different disease states and probes impact measurement and for S>0 steatosis, it has a high false negative rate and low sensitivity.Quantitative metrics are now offered by various vendors, relying on changes in backscatter, attenuation and the speed of sound found in steatotic livers.Attenuation Imaging (Canon) and Ultrasound Guided Attenuation Parameter (General Electric) show excellent S>0 performance in NAFLD and other aetiologies of hepatic steatosis compared to both MRI and histology. Fatty Liver Attenuation Index (Samsung) shows moderate performance at the S>0 task in 351 patients with mixed aetiologies of chronic liver disease at histologyUltrasound Derived Fat Fraction (Siemens Healthineers) obtains 15 point shear wave and a steatosis percentage from a single large region of interest, also showing excellent S>0 performanceThese technologies are in their early stages. Larger clinical trials are needed to determine optimal steatosis grade cut-off values and compare results across vendors.

IntroductionQualitative AssessmentQuantitative AssessmentConclusion

• NAFLD is the most common chronic liver disease worldwide. It has increasing prevalence among adults and children.• Iron overload may lead to liver cirrhosis, hepatocellular carcinoma, and cardiac and endocrine complications.• Fibrosis is the final stage of diffuse liver disease, with its complications and which we want to anticipate.• Measurement of fat, iron overload and liver stiffness by MRI is a noninvasive and accurate approach.• Knowledge of the protocol and the post-process will lead more hospitals worldwide to diagnose and quantify these pathologies, being of great help to the patient and other specialties. For example, we observe two similar liver parenchyma in images A and B. Still, we identify greater hardness in image B when quantifying liver stiffness, which alerts us about an inflammatory process.

1. Introduction.2. FatFrac.3. Iron quantification.4. Elastography.5. Conclusions.

The falciform ligament and the ligamentum teres hepatis have been considered as insignificant embryological remnants that include umbilical artery and vein. The purpose of this educational exhibit is to spotlight the clinical importance of the falciform ligament and the ligamentum teres hepatis in the radiological perspective.

This education exhibit includes 4 categories;(i) clinical embryology;(ii) clinical anatomy;(iii) clinical use for packing material; (iv) pathological conditions and disease process. Schematic illustrations of the embryology and anatomy and case based-presentations using CT images, macroscopic specimens and operative findings will be presented.

• Recognize the most common mimickers of liver malignancies. • Illustrate key clinical and imaging findings that may help distinguishing benign from malignant liver lesions. • Discuss relevant tips including clinical information, and diagnostic workup which could help in making precise diagnosis • Discuss appropriate management options including, tissue sampling or follow-up.

1.Overview of liver findings on imaging modalities -Prevalence, relevance, costs -Cancer facts and statistics 2022 -ACR white paper recommendations for management of incidental liver lesions 2.Clinical and Pathological Background -Symptoms -Key pathological and laboratorial findings 3.Imaging-based approach to assess mimickers of liver malignancies on imaging -Background liver -Pattern of the liver findings -Combined clinical and imaging algorithm 4.Illustrate a spectrum of imaging findings, differentiation with pathological correlation -Benign nodules: e.g. atypical hemangiomas, inflammatory pseudotumor, FNH-like lesions. -Inflammatory: IgG4-related disease, eosinophilic hepatitis, confluent fibrosis.-Infectious: ex. parasitic infections, pseudotumoral granulomatosis, abscess.-Precancerous: ex. dysplastic nodules, bile duct adenoma. -Miscellaneous: ex. vascular shunts, infarction.5.Multidisciplinary liver tumor board -What do non-radiologist liver physicians and surgeons need to know -What do radiologists need to ask. 6. Interactive case examples -Sample cases to illustrate challenging scenarios and provide tips to reach a specific diagnoses

Explain the anatomy and contents of the mesentery Describe ultrasound (USG) and computed tomographic (CT) features of primary and secondary solid mesenteric lesions, mesenteric cystic lesions, secondary mesenteric involvement in inflammatory/ infectious conditions like tuberculosis and inflammatory bowel disease and vascular lesions affecting mesentery. Highlight the importance of cross sectional imaging in diagnosis, detection of complications and management of mesenteric lesions Discuss a stepwise algorithm to approach mesenteric lesions for providing thoughtful differentials

Anatomy and contents of the small bowel mesentery USG and computed tomographic (CT) features of - Primary mesenteric solid neoplasms Mesenteric cystic lesions Unilocular cysts Multilocular cysts Secondary mesenteric solid lesions and their routes of spread Deposits Lymphadenopathy Stellate mesentery Mesenteric involvement in tuberculosis and inflammatory bowel disease Vascular anomalies of mesentery SMA thrombosis with acute mesenteric ischemia SMA-SMV arteriovenous fistula Complications due to mesenteric lesions Bowel Urological Vascular Management of mesenteric lesions Image guided biopsy Planning surgical strategy Stepwise algorithm for imaging evaluation of mesenteric lesions

A wide spectrum of abnormalities affect the peritoneum; including neoplastic, infectious, and inflammatory etiologies as well as spread of ectopic tissues. Anatomy of the peritoneal cavity and its ligaments determine the patterns of disease spread. In this educational exhibit, we provide a comprehensive radiologic diagnostic approach to peritoneal lesions based of the predominant composition (solid, cystic, hemorrhagic, calcific, lipomatous, and gas containing). Each entity will be discussed briefly along with illustrated images of various cases.

Peritoneal Anatomy; Outline of Diagnostic Approach to Peritoneal Lesions; Solid Lesions; Cystic Lesions; Hemorrhagic Lesions; Calcific Lesions; Lipomatous Lesions; Gas Containing Lesions

To depict the most frequent and the not so common sites and imaging features of peritoneal carcinomatosis on CT and MR. To propose how to systematically look for peritoneal implants on CT and MR,acknowledging the technical limitations.To describe the differential diagnosis and pitfalls

IntroductionThe peritoneum is the second most common metastatic localization for abdominal tumors, only surpassed by the liver. Peritoneal metastases in tumors of an extraabdominal origin occur less frequently.Early diagnosis of peritoneal carcinomatosis based on imaging findings is not always easy but it is essential in staging and managing primary tumors.CT is usually the first diagnostic tool but its performance is poor when it comes to detecting subcentimetric implants and those in anatomically difficult sites. MR has proved to have a better performance due to its better contrast resolution. Material and methodsThe revision of 300 peritoneal carcinomatosis cases from our database (comprising tumors of digestive origin, breast, gynecologic, testicular, renal, neuroendocrine, melanoma, lung, head and neck and soft tissue) has allowed us to establish a systematic diagnostic approach.Examples of the how and where to look for peritoneal implants, bearing in mind the anatomical sites and the major pathways of spread will be described, enhancing the added value of multiplanar reconstructions.Typical and less common presentations will be described using a case-based approach.Despite the non-specificity of the imaging findings,in some cases there are helpful hints to suggest the origin of the primary tumor.Examples of pitfalls and differential diagnosis will also be discussed.

Among the worldwide women, pelvic floor disoreder is common health problem which is hard to say other people. and it is significant problem lowering their quality of life and causing to morbidity. Pelvic floor disorder means overall pelvic floor functional disorders caused by impairment of the ligament, fasiae, muscles supporting the pelvic organs.Conventional defecography is performed with fluoroscopy after injection of barium contrast to rectum. But it can evaluate pelvic floor disorder concentrating posterior compartment of pelvic floor and has risk of exposure to ionizing radiation to patient and doctor. MR defecography is dynamic study to evaluate pelvic floor disorder during defecation using US gel in real time and has been proven accurate and reliable for checking multiple compartments of pelvic floor. It is used to diagnosis of rectocele, intussusception, and anismus. we review normal female pelvic floor anatomy and MR defecography which can accurate diagnosis of pelvic floor disorder involving all three compartments of pelvic floor and improve the postoperative results. Our teaching points are as follows. To review normal anatomy of the pelvic floor, To compare MR defecography to fluor defecography, To ntroduce the concepts of the integral theory ; anatomically-based diagnostic methods locate damaged structure.

1) Subdivisions of female pelvic anatomy (three compartment) : anterior compartment -middle compartment -posterior compartment 2) Defecation function evaluation 3) Comparison of fluoro defecography and MR defecography. 4) Introduce the concepts of the integral theoryPlease visit the Learning Center to also view this presentation in hardcopy format.

1. Using ultrafast technique (RARE< HASTE< SSFSE) reduces artifacts and improves acquisition time2. Use breathing independent sequences

1. Applications of MRCP (Congenital anomalies, choledocholithiases, biliary strictures, cystic pancreatic tumors, biliary injuries).2. Common indications (Failed MRCP, contraindication to MRCP and post biliary-enteric anastamosis case).3. Advantages and disadvantages of MRCP over ERCP4. Techniques (2D Vs. 3D).5. Factors affecting image quality.6. Artifacts (Susceptibility, motion and other artifacts).7. Image optimization techniques.

Gastric carcinoma is one of the most common malignancies worldwide and is currently the fourth leading cause of cancer-related deaths. While early gastric cancers are limited to the mucosa and submucosa and usually manifest as focal wall thickening with possible ulceration, advanced cancers involve the muscularis propria or even deeper, manifesting as diffuse, infiltrative thickening with ulceration and possible linitis plastica. Upper gastrointestinal endoscopy is currently accepted as the gold standard for detection of gastric cancer, while Multidetector Computed Tomography (MDCT) is preferred for staging of the tumor. MDCT allows for assessment of tumor depth, lymph node involvement, and disease spread which may be through subperitoneal dissemination, direct invasion, transperitoneal dissemination, or hematogenous spread. Careful preoperative staging is essential for proper surgical treatment, as complete resection of the tumor and surrounding lymph nodes is the only cure. In this exhibit we will discuss the MDCT technique and imaging features of gastric cancer with treatment approaches and various pearls and pitfalls learned during our experience at gastric cancer tumor board.

Introduction; Staging of gastric cancer; Imaging modalities; Treatment algorithm; Medical management; Surgical management; Imaging; Pearls and Pitfalls

- Describe the surgical anatomy and normal imaging findings of the main upper gastrointestinal surgeries in fluoroscopy. - Evaluate the main imaging findings of the routine use of postoperative contrast swallow. - Illustrate the major complications of upper gastrointestinal surgeries.

- Describe major headings (e.g., anatomy, physiology, imaging techniques, etc.) - Describe the following surgeries and identify the major complications of these: Bariatric Surgery (Sleeve and Y-Roux), gastrectomy, Nissen fundoplication, hiatus hernia repair, Peroral endoscopic myotomy (POEM)- Imaging in postoperative barium or iodine contrast to diagnose the main postoperative complications.

1. To clarify the role of MRCP in preoperative evaluation of acute or chronic cholecystitis. 2. To understand the normal variations of bile duct anatomy to avoid surgical injury in laparoscopic cholecystectomy. 3. To describe the useful MRCP findings for differential diagnosis of various wall thickening gallbladder lesions.

1. Review of various MRCP techniques 2. Classification of bile duct anatomy using MRCP of a total of 879 patients were examined before laparoscopic cholecystectomy.Cases of bile duct injury during cholecystectomy were added. 3. Representative cases of gallbladder diseases, such as acute cholecystitis, chronic cholecystitis, gallstones, adenomyomatosis, xanthogranulomatous cholecystitis, Mirizzi syndrome, cholangitis with common bile duct stones, and wall thickening type gallbladder carcinoma, were included, and their imaging findings with literature review were illustrated.Conclusion: MRCP is a useful method for preoperative evaluation of biliary anatomy to prevent surgical complications. In various cases such as inflammatory and malignant diseases, accurate diagnosis is possible through preoperative MRCP.Please visit the Learning Center to also view this presentation in hardcopy format.

1. Understand how to use multiphase CT with CT angiography and 3D mapping with Cinematic Rendering to optimize detection of pancreatic neuroendocrine tumors2. understand the range of appearance of pancreatic neuroendocrine tumors and how to distinguish them from other pancreatic tumors3. learn how to optimize staging of pancreatic neuroendocrine tumors by creating vascular 3D maps for staging of vascular involvement and for pre-op surgical planning4. understand the challenges and pitfalls in the diagnosis of pancreatic neuroendocrine tumors5. understand how cinematic rendering can be valuable in small tumor detection and staging of larger tumors

1. CT scan protocols and role of dual phase imaging and CTA2. role of Cinematic Rendering and how to optimize cinematic rendering for lesion detection and staging.3. learn how to geerate and interpret the images created by Cnematic rendering4. case studies and examples showing typical and atypical appearances5. potential pitfalls and challenges6. role of CT and AI in the near time to help build on cinematic rendering over tme.

• Prolonged cholestasis in critically ill patients after severe COVID-19 infection may indicate the presence of secondary sclerosing cholangitis (SSC).• Affected patients are at high risk of progression to biliary cirrhosis requiring liver transplantation.• Since differential diagnosis to other causes of cholestatic liver injury can be difficult based on clinical and laboratory findings alone, imaging with MRI and MRCP can be crucial to help confirm the diagnosis.• COVID 19-associated SSC mostly affects intrahepatic bile ducts showing strictures with or without upstream dilatation, bile duct beading, vanishing ducts and periductal edema.• The extrahepatic bile ducts are typically spared.• Changes of the liver parenchyma are commonly observed including patchy arterial enhancement, reduced uptake of hepatobiliary contrast agent and signal changes on T2- and diffusion weighted-images.• Hepatic macrovascular changes and periportal lymphadenopathy are not typically seen.

1) Background a. Epidemiology b. Pathogenesis c. Clinical presentation d. Diagnosis 2) Imaging findings a. Biliary tree b. Liver parenchyma c. Hepatic vessels d. Other findings 3) Clinical implication and prognosis 4) Conclusion

• Therapeutic response is assessed by tumour diameter measurements (WHO, RECIST 1.1, and iRECIST), tumour enhancement (mRECIST, EASL, RECICL) or CT density (CHOI). Metabolic response is measured on PET by the standardized uptake value (SUV) normalized to the lean body weight (PERCIST).• Novel therapeutics and therapy-induced non-tumoral changes can lead to interpretation pitfalls. • In rectal cancer, MRI-derived tumour regression grade (TRG) infers pathological response to guide treatment and disease prognosis.• Functional imaging, radiomics, artificial intelligence and machine learning provide new and early biomarkers of response but require further qualification.

• GI Cancer therapies: 1) FDA-approved chemotherapies, targeted therapies and immunotherapies 2) external/internal radiotherapy • Imaging response criteria: when, where and how?• Patterns of response, stable disease and progression.• Atypical response patterns: pseudo-progression, hyper-progression, dissociated response, abscopal effect.• Potential pitfalls from non-tumoral effects of treatment: Hepatic steatosis, Sinusoidal obstruction syndrome, Others.• MRI-TRG [after Mandard/Rodel] applied to rectal cancer after neoadjuvant treatment.• LI-RADS, a structured reporting system, for treatment response of hepatocellular carcinoma.• Imaging response evaluation after neoadjuvant treatments of pancreatic cancer.• Functional imaging: DCE-MRI, DWI and others; myth or reality?• Radiomics: summary of current evidence.• AI and machine learning: potential applications

- The treatment of peritoneal carcinomatosis has been revolutionised by cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (HIPEC).- HIPEC is used in a combined approach immediately following surgery and involves heated chemotherapy agents being temporarily instilled into the abdominopelvic cavity.- The associated high morbidity means an optimised patient selection process is vital.- We review key patterns of peritoneal disease and their prognostic implications.- We summarise common and important HIPEC complications.

- Background into the clinical indications and outcomes for HIPEC.- Review of common sites of peritoneal disease and types (nodular, mass or plaque-like).- Review of prognostic imaging features, including, gastrointestinal involvement, mesenteric and retroperitoneal lymphadenopathy, ureteric obstruction, psoas or pelvic sidewall involvement and gastrohepatic ligament disease.- Review of radiological contraindications to HIPEC, including extra-abdominal metastases and massive retroperitoneal lymphadenopathy.- Review of post-HIPEC complications, including ascites, splenic/ovarian venous thrombosis, pseudoaneurysm, haemoperitoneum, lymphocyte, perihepatic hematoma, pancreatic fistula and ureteric injury.- Importance of radiological assessment in the selection and management of HIPEC patients.

1- To review splenic and vascular anatomy. 2- To discuss the differences in Strain and Shear Wave Elastography. 3- To identify the different techniques of Shear Wave Elastography. 4- To learn the indications and adequate protocol of splenic Doppler and Elastography. 5- To teach how to interpret and report findings.

1. Introduction2. Splenic anatomy: A) Parenchyma B) Circulation3. Elastography: A) Strain vs Shear Wave4. Shear Wave Techniques: A) 1D Transient Elastography B) Point Shear Wave Elastography C) 2D Shear Wave Elastography5. Indications6. Protocol: A) Technique B) Errors C) Artifacts7. Report: A) Interpretation B) Suggested Reporting

- Recently, a global online survey was carried out among 321 experts from 32 countries to identify points of controversy in the applicability of the TNM system (8th ed.) for the radiological staging of rectal cancer. A total of 16 problem areas were identified, grouped in topics related to clinical tumor staging in low-rectal cancers, definitions for cT4b and cM1a disease, definitions for mesorectal fascia involvement, evaluation of lymph nodes versus tumor deposits, and staging of lateral lymph nodes.- These critical areas remain considerable points of dissensus even among experts in rectal cancer imaging, and their awareness by residents, general radiologists, and even abdominal radiologists is paramount for better and more consistent use of the TNM system in the everyday radiological practice.- An illustrated case-based review with schematic drawings may be a didactical and straightforward way of exhibiting such a range of controversies, facilitating their comprehension by a general audience. Secondarily, it may also help make more understandable the points of consensus proposed and published by the international multidisciplinary panel of specialists.

1) Presentation of the 16 problem areas identified, illustrating them with schematical drawings. 2) Imaging-based review with didactical clinical cases exhibiting such critical points of controversies. 3) Tips on how to report the radiological findings in such cases in the light of the consensus proposed by the panel of experts.

Highlight the emerging concepts and recent advances in the domain of early detection of pancreas ductal adenocarcinoma (PDA): 1. Dire prognosis of PDA: Early detection is the only intervention with the highest potential to improve outcomes 2. Rationale for early detection: Substantial differences in the 5-year survival between stage I (26-months) versus stage IV disease (4.8-months) 3. Challenges of early detection including inability of imaging to identify early PDA 4. Emerging evidence supporting the role of Artificial Intelligence (AI) to augment imaging-based screening efforts for early detection of PDA in high-risk cohorts

1. PDA as an almost uniformly fatal disease2. Rationale for early PDA detection: What is “early” PDA and why is it critical to detect PDA at a stage when surgical cure is a possibility? 3. Challenges and opportunities for population-based screening for PDA a) The Define (D)-Enrich (E)-Find (F) protocol as an emerging paradigm 4. High-risk cohorts: a) Familial PDA and subjects with germline mutations b) New-onset diabetes (NOD) with high Enriching New-Onset Diabetes for Pancreas Cancer model (END-PAC) score c) Potential precursor lesions such as intraductal papillary mucinous neoplasms 5. Limitations of imaging to detect early or incidental PDA: a) Imaging findings of early PDA b) Factors contributing to missed PDA on imaging 6. AI tools being developed to augment screening efforts for PDA: a) Pancreas segmentation tools b) Imaging signature of pancreatic carcinogenesis at the prediagnostic stage c) AI-augmented detection of PDA on CTs 7. Potential utility of molecular imaging for early detection of PDA

Young onset colorectal cancer is defined as a colorectal tumour diagnosed at < 50 years. The incidence of young-onset colorectal cancer is on the rise, currently constituting approximately 10% of all cases. As such, reporting radiologists should have a good understanding of the imaging features and considerations associated with such patients including: • The risk factors and pre-disposing conditions associated with young-onset colorectal cancer. • The imaging manifestations frequently encountered on CT and MRI with correlation to histopathology and genetic markers. • Imaging appearances during the disease course including complex surgical management.

A case based educational exhibit including multiple examples of young-onset colorectal cancer with referenced teaching points. To include: • Demographics and epidemiology • Risk factors associated with young-onset colorectal cancer and associated imaging features. Including Hereditary syndromes (e.g. Lynch syndrome), genetic mutations and inflammatory bowel disease • Imaging presentations on MRI and CT with histopathological and genetic correlation, including synchronous or metasynchronous cancers. • Staging imaging and imaging during the disease course. • Post-treatment appearances, including complex surgical management e.g. exenteration, pelvic side wall clearance and peritoneal therapies. • Risk stratification and follow-up imaging surveillance.

• Understanding the critical role that MRI plays in rectal cancer staging and restaging. • Comprehend that several histopathologic changes may occur within rectal tumors after chemoradiation treatment, such as fibrosis or increased mucin production. • Radiologists play a crucial role in “watch-and-wait” programs for select patients with rectal cancer and should understand how to differentiate the several types of response, as well as how these posttreatment changes may be evaluated with high-spatial-resolution MRI.

• INTRODUCTION: o Rectal cancer treatment guidelines overview: § Selecting whether primary surgery or neoadjuvant treatment is an optimal approach; § Neoadjuvant treatment options: chemoradiotherapy versus total neoadjuvant therapy (TNT). o Primary tumor and nodal assessment with MRI. • ASSESSMENT OF TREATMENT RESPONSE: A SYSTEMATIC APPROACH. o Posttreatment changes in the primary tumor o Tumor Restaging: Histopathologic and MRI regression grades: § Identifying incomplete/poor responders, as well as “near-complete” and complete responders. o Patterns of tumor response: shrinking versus fragmentation; fibrosis and increased mucin production. • “WATCH-AND-WAIT”: PATIENT SELECTION AND CURRENT CONTROVERSIES. • FUTURE DIRECTIONS IN RECTAL CANCER TREATMENT AND IMAGING. • TAKE HOME MESSAGES.

> To demonstrate the importance of the radiologist in the context of rectal cancer, with a special interest in post-neoadjuvant evaluation.> To familiarize radiologists with the tumor regression grade (TRG) and its importance.> To demonstrate a simple way to minimize possible errors in the tumor regression grade (TRG).> To train the correct characterization of the tumor regression grade (TRG) based on recent cases using a simple way.

IntroductionRectal neoplasm is the third most common type of tumor in men and the second in women. Surgical treatment with total mesorectal excision is the gold standard, however, in cases of locally advanced tumors at diagnosis, neoadjuvant chemotherapy and radiotherapy are required. Magnetic resonance imaging is one of the mainstays in the management of patients with rectal tumors, providing primary staging and re-staging after neoadjuvant therapy. In the latter context, the response to treatment is evaluated by MRI, which provides the tumor regression grade (TRG) and re-staging, fundamental factors directly related to patient survival, which is again managed according to the imaging findings.We evaluated several MRI scans of post-neoadjuvant rectal tumors, with emphasis on the adequate qualification of the TRG, and we also developed a simple sequence of questions with a mnemonic (PRO TuMor) to assist in the proper characterization of the TRG, reducing possible errors.At the end of the presentation, we selected some MRI images in a quiz format for training purposes, using PRO TuMor.

• Review indications of pancreatic surgeries • Illustrate types of pancreatic surgeries • Discuss complications of pancreatic surgeries and their imaging features, including pancreas transplant • Highlight management options of these complications

1. Introduction a. Normal anatomy b. Indications for pancreatic surgery 2. Approaches to pancreatic surgeries: a. Endoscopic b. Minimally invasive- laparoscopic and robotic c. Open pancreatectomy 3. Types of pancreatic surgeries: a. Necrosectomy and abscess drainage b. Lateral pancreaticojejunostomy (Puestow) c. Beger procedure d. Frey procedure e. Pancreaticoduodenectomy (Whipple’s procedure) f. Distal/central pancreatectomy g. Total pancreatectomy h. Pancreatic transplant surgery 4. Normal postoperative imaging findings 5. Multimodality Imaging features of post-surgical complications: a. Pancreatico-biliary complications i. Transient fluid collection ii. Biliary leaks/bilomas iii. Pseudocysts iv. Pancreatitis v. Pancreatic fistulas 1. Pancreatic-enteric fistulas 2. Pancreatic-cutaneous fistulas vi. Anastomotic stenosis vii. Infections (abscess and peritonitis) viii. Local disease recurrence b. Vascular complications i. Arterial injuries ii. Hematomas iii. Arteriovenous fistulas iv. Vascular thrombosis c. Bowel complications i. Delayed gastric emptying ii. Bowel ischemia iii. Bowel injury iv. Anastomotic leak v. Anastomotic stenosis vi. Afferent loop syndrome d. Solid-organ complications: (e.g., liver infarction, splenic injury, etc.) e. Abdominal compartment syndrome f. Pancreatic transplantation i. Rejection ii. Vascular complications Inflammation, infection, necrosis

* Review indications for various pancreatic surgeries and circumstances under which they are done.* Understand the postoperative anatomy after common and uncommon pancreatic surgeries, as seen on radiologic studies including CT, MRI, Ultrasound, fluoroscopy and nuclear medicine.* Be aware of the complications of the postoperative pancreas, and their imaging appearance. * After reviewing this material, the radiologist will more easily and accurately identify normal postoperative anatomy after pancreatic surgeries (both common and uncommon), leading to improved diagnosis of potential complications and avoiding pitfalls such as misinterpreting postoperative anatomy as pathology.

* Indications, anatomy and radiologic appearance of common pancreatic procedures: Whipple procedure (Classic, Pylorus-sparing), Distal pancreatectomy, Total pancreatectomy, Puestow procedure. Devices (CIVA sheet, Cystgastrostomy device).* Complications of common pancreatic procedures and their radiologic appearance: Leaks (Anastomotic leak, Pancreatic fistula, Bile leak), Other collections (Abscess, Hematoma), Strictures (Gastrojejunal anastomotic stricture, Bile duct stricture, Pancreatic duct stricture), Delayed gastric emptying, Vascular complications (Portomesenteric venous thrombosis, Portomesenteric venous stenosis, Aneurysms and pseudoaneurysms), Tumor recurrence.

The purposes of this exhibit are:1) Review the most relevant imaging findings of ectopic and accessory tissue types, using a didactic approach by illustrations and cased-based imaging.2) Review the pathophysiology and embryology that are related to ectopic tissues, helping to understand the imaging findings in Computed Tomography (CT) and Magnetic Resonance (MR) imaging.3) Discuss the relevance of different ectopic tissue imaging presentations correlating with possible clinical complications.4) Improve knowledge about the main differential diagnoses and the main patterns of image appearance that are the key points to clarify diagnostic challenges.

1) Pictorial review of most frequent image findings of different ectopic and accessory tissue types.2) Cased-based review of ectopic tissue clinical presentation, frequent location, imaging findings, possible complications and differential diagnosis: pancreas, spleen, liver, gallbladder, leiomyomatosis, genitourinary system and endometriosis.3) Illustrative key points: improve understanding of the correlation between embryology and ectopic tissue imaging findings.4) Highlight the relevant imaging findings that aid surgical decisions.5) Conclusions and “take home messages”: consolidate the acquired knowledge.

Revisit the surgical techniques involving the pancreas, liver, and bile ducts for the various pathologies that involve these organs. To review the most relevant complications of hepatobiliopancreatic surgeries and correlate with the imaging findings of computed tomography (CT), magnetic resonance imaging (MRI), and cholangiopancreatography (MRCP). Illustrate the cases of complications and demonstrate the therapeutical options.

Surgical techniques of hepatobioliopancreatic surgeries. Imaging protocols. Advantages and disadvantages of CT, MRI, and MRCP. Expected findings on postoperative imaging evaluation. Key sites where the radiologist should actively look for complications. Illustrate with cases the imaging findings of complications that must be described in the report. Demonstrate surgical and non-surgical treatment options.

1. To recognize the MRI pitfalls in restaging rectal cancer after neoadjuvant treatment with chemotherapy and/or radiotherapy. 2. Test the limits of MRI rectal cancer re-staging emphasizing the difference between the misdiagnosis that is a limitation of the MRI and those that can be avoided thru a careful analysis by the radiologist

Introduction: Basic concepts of image analysis in rectal carcinoma after neoadjuvant treatment.Discussion- Correlation between MRI TRG scoring and histopathological TRG in selected cases. - Is that fibrosis or tumor cells? Follow-up results for patients eligible for watch and wait; - Mesorectal e pelvic nodes: the assessment of response comparing MRI and histopathologic or MRI follow-up;- Detecting complete clinical response after neoadjuvant therapy.ConclusionSummary with pearls and best tips of the analysis of MR rectal carcinoma after neoadjuvant treatment.

1. Fluoroscopy is a cost-effective method of postoperatively distending the esophagus, stomach, and bowel to assess for postoperative anastomotic leak and other complications. Learning fluoroscopy requires exposure to high volume of cases including those performed in the postoperative setting.2. Identify common postoperative settings in which fluoroscopy is performed for anatomic evaluation.3. Review normal postoperative luminal anatomy and the fluoroscopic appearance of postoperative complications.4. Review fluoroscopic techniques that are helpful in diagnosing postoperative complications.

1. Introduction - commonly encountered postprocedural scenarios in the fluoroscopy suite2. Postoperative scenarios including explanation of surgery, expected postoperative appearance, possible complications, and corresponding normal and abnormal fluoroscopic cases. Technique and important views will be emphasized for each case. Case selection includes -- a) Zenker’s diverticulotomy/diverticulectomy; b) evaluation for iatrogenic esophageal perforation; c) transhiatal esophagectomy; d) hiatal hernia repair; e) bariatric surgery (gastric sleeve surgery roux-en-y gastric bypass); f) percutaneous gastrostomy evaluation and g) colorectal surgeries (low anterior resection, ileoanal J-pouch creation, ileocolonic anastomosis).

The diagnosis of intraductal papillary mucinous neoplasms (IPMNs) is complex because adherence to the clinical guidelines depends on numerous imaging features and clinician opinions. The rate of accuracy of diagnostic guidelines for the presence of advanced dysplasia or cancer is 50-80%. Therefore, a small percentage of patients will be overtreated and some patients with IPMNs with high-grade dysplasia or cancer will be overlooked. This educational exhibit explains the key diagnostic imaging aspects of IPMNs and suggests methods to solve this dilemma in real-world clinical practice.

1. Why do IPMNs matter? 2. Algorithm for the management of suspected IPMNs 3. Solving the imaging dilemma of IPMN 4. Pancreatic cystic disease vs. IPMN

1. Review the differential for a diffuse infiltrative small bowel disease process. 2. Present the clinical presentation and imaging findings of several diffusely infiltrative diseases within the small bowel, in order to delineate the unique features of each entity. 3. Review entities that may mimic infiltrative bowel disease on imaging.

The presentation will present the following disease categories and examples of infiltrative bowel disease within them. A non-exhaustive list of example cases by category is provided. 1. Infectious: Mycobacterium avium intracellulare (MAI), Whipple disease, Histoplasmosis, Coccidiomycosis 2. Inflammatory: IgA vasculitis, graft-vs-host disease, radiation enteritis 3. Neoplastic: Metastatic lobular breast carcinoma, acute myelogenous leukemia, diffuse large B-cell lymphoma, post-transplant lymphoproliferative disorder 4. Other: Amyloidosis, endometriosis, hemorrhage, lymphangiectasia Summary: An infiltrative small bowel disease will manifest as a segmental or diffuse degree of small bowel wall thickening. Although these disease processes may share many characteristics, there are key clinical and imaging attributes of each that can be examined. This education exhibit aims to present several cases demonstrating disease processes in which the small bowel is diffusely infiltrated. The unique features of each disease entity will be examined in order to best differentiate them, with additional cases presented as potential mimics.

Review indications and techniques of the common colonic surgical procedures with diagrammatic depiction. Multimodality imaging review of the normal post-surgical anatomy and associated complications with diagrammatic correlation. Summarize the appropriate imaging workup of patients suspected of postoperative gastrointestinal complications.

1. Review indications for colon surgeries and relevant variants that would alter surgical approach (robotic vs. other). 2. Review post-surgical anatomy of ileal-anal anastomosis, Hartmann pouch and its reversal, APR, colostomy complications and reversal, rectopexy, etc. 3. Imaging of post-operative complications such as anastomotic leaks, afferent loop syndrome, and parastomal hernias, lower abdominal resection, etc. 4. Review multimodality imaging evaluation including the role of barium studies, CT, MRI, and relevant endoscopic correlation. 5. Algorithmic approach in the setting of unknown surgical anatomy.

1. Advanced CT techniques and novel CT-based software are increasingly used in daily clinical practice. These new approaches can improve accuracy of CT in detection and characterization of focal liver lesions while ensuring optimized radiation dose and image quality. 2. The appropriate use of these new techniques can improve characterization of focal hepatic lesions in at-risk population.

Current Status of CT in Liver Imaging • Overview of techniques and protocols • Dosage and timing of iodinated contrast o Effect on detection and conspicuity of hepatic lesions • ACR LI-RADS CT technical recommendations Spectral CT: Dual-energy and Multi-energy CT • Overview of basic principles of spectral CT • Review of current acquisition techniques • Advantages of spectral CT for LI-RADS classification • Suggested protocols and workflow Low kVp CT • Overview of physical principles of mass attenuation coefficient • Advantages and disadvantages of low kVp CT imaging • Added value of low kVp CT technique for LI-RADS classification Deep Learning (DL) Techniques • Background • Novel DL-based noise reduction and image reconstruction techniques • Role in detection and characterization of focal hepatic lesions o Computer-assisted detection (CAD) Novel Post-Processing Techniques • Background • Image subtraction o Value in assessment of focal hepatic lesions and classification

Understand the pathophysiology of congestive hepatopathy and its effects on the liver parenchyma Recognize the imaging findings of congestive hepatopathy Know the benign and malignant lesions that develop in congested livers and how to use imaging features and techniques to distinguish them

1. Liver vascular anatomy and sinusoidal architecture2. Pathophysiology of congestive hepatopathy3. Etiologies of congestive hepatopathy4. Imaging findings of congestive hepatopathy a. Diffuse liver abnormalities b. Focal lesions associated with congestive hepatopathy5. Challenges and pitfalls in imaging of congestive hepatopathy a. Assessment of hepatic fibrosis b. Differentiation of benign hypervasular lesions from hepatocellular carcinoma c. Proposed algorithm for workup of focal hepatic lesions in setting of congestive hepatopathy?

1) Review normal postsurgical CT and fluoroscopic imaging appearance after gastric surgical interventions for weight loss, reflux management, and gastroparesis treatment.2) Discuss normal postprocedural CT and fluoroscopic imaging appearance after endoscopic sleeve gastroplasty, transoral incisionless fundoplication (TIF), gastric peroral endoscopic myotomy (G-POEM), and other specialized endoscopic procedures.3) Recognize the normal CT and fluoroscopic appearance of various gastric devices, including those used for weight loss, reflux management, and pancreatitis.4) Understand the CT and fluoroscopic imaging appearance of the complications associated with these gastric surgeries, procedures, and devices.

1) Postsurgical Stomach:a) Roux-en-Y gastric bypassb) Laparoscopic sleeve gastrectomyc) Laparoscopic bandingd) Nissen/complete fundoplicatione) Toupet/partial fundoplicationf) Gastric pacemaker placement.2) Postprocedural Stomach:a) Endoscopic sleeve gastroplastyb) Transoral incisionless fundoplication (TIF)c) Transgastric Rendezvous techniqued) Endoscopic Ultrasound Directed Transgastric ERCP (EDGE)e) Gastric Peroral Endoscopic Myotomy (G-POEM).3) Unusual Devices:a) LINX Reflux Management Systemb) Intragastric balloonc) AspireAssist Deviced) Axios stent and drainagee) Metallic gastric stent for cancer

1. Different treatment options exist for hepatocellular carcinoma (HCC) including surgical, locoregional and systemic therapies. Appropriate choice of therapy is crucial to improve clinical outcomes. 2. HCC treatment guidelines incorporate different clinical and imaging variables to guide treatment options. 3. Radiologists need to be familiar with how imaging findings can change treatment planning for HCC and what is the crucial information that the multidisciplinary liver team (MDLT) wants to know.

1. Brief overview of HCC management: a. Surveillance. b. Overview of HCC staging and treatment options. i. Describe various treatment options. ii. Status of stereotactic body radiation therapy (SBRT). iii. Goals of noncurative treatments. c. HCC imaging features and role of biopsy in diagnosis and management. 2. Tumor burden and treatment considerations: a. Single vs. Multipleb. Size. c. Location in relation to other structures. 3. Liver status and treatment considerations: a. Background liver disease. b. Liver volume. c. Signs and symptoms of Portal hypertension. d. Portal vein thrombosis. e. Arterial anatomy. f. Metastasis. g. Liver transplant candidacy. h. Performance status. 4. Treatment response: a. Size vs. viability. b. LI-RADS treatment response criteria. c. Specific challenges for TARE and SBRT. 5. Common questions for radiologists during MDLTs.

Peritumoral area of focal liver lesions is the liver parenchyma adjacent to focal hepatic lesions, which is often altered due to compression of the tumors, drainage of blood flow of the lesion, vascular or bile duct invasion as well as due to malignant infiltration in some cases. These histological findings are plainly reflected in the imaging findings. In some tumors, the imaging findings of peritumoral area could be helpful for an accurate diagnosis and could be biomarkers of malignant grades or prognosis. The radiologist should pay attention to not only the tumor itself but also peritumoral area.

1. Introduction. 2. The definition of “peritumoral area,” and several imaging findings of peritumoral area. 3. Imaging-pathological correlation of peritumoral area of each lesion as follows; peritumoral arterial enhancement (corona enhancement) of hepatocellular carcinoma, peritumoral hyper- or hypointensity on hepatobiliary phase of hepatocellular carcinoma, peritumoral arterial enhancement and peritumoral hypointensity on hepatobiliary phase of colorectal liver metastases, peritumoral hyperintensity on hepatobiliary phase of liver metastases from neuroendocrine tumor, and peritumoral arterial enhancement (arterioportal shunt) of cavernous hemangioma. 4. Non-existence of peritumoral changes of simple cysts or focal nodular hyperplasia 5. Clinical significance of peritumoral area of each lesions such as microvascular invasion, prognosis, the effect of chemotherapy, and the influence on the results of radiomics analyses. 6. Summary of the clinical significance of peritumoral area of focal liver lesions. 7. Conclusion.

This exhibit intends to: (1)To clarify and to compare the old and the new nomenclature of mucin-producing cystic neoplasms of the liver.(2)To summarize the characteristic features of hepatic mucinous cystic neoplasms (MCN) and intraductal papillary neoplasms of the bile duct (IPNB). (3)To highlight the key differences between MCN and IPNB and to present the main differential diagnoses. (4)To understand the impact of an adequate differential diagnosis.The main teaching points are: Mucinous cystic neoplasms of the liver are rare neoplasms that include hepatic mucinous cystic neoplasms (MCN), previously known as cystadenoma and cystadenocarcinoma, and intraductal papillary neoplasms of the bile duct (IPNB). The keys for distinguishing MCN and IPNB are based on the presence of bile ductal communication (only in the case of IPNB) and the presence of sub-epithelial ovarian stroma (only in the case of MCN). The differential diagnosis encompasses non-neoplastic cystic lesions and cystic metastases. The five top tips to the radiologist are: (1) to look for ductal communication, (2) to assess for bile duct dilation, (3) to look for thickened enhancing septa, mural solid nodules and calcifications, (4) to take into account location and number of lesion(s), and (5) to review the clinical data (namely primary extra-hepatic malignancy).

- Mucin-producing cystic neoplasms of the liver: the old and the new nomenclature- Hepatic mucinous cystic neoplasms (MCN) and intraductal papillary neoplasms of the bile duct (IPNB): epidemiologic, clinical, histological, and imaging features- MCN versus IPNB: top tips to the radiologist- Therapeutic insights- Diagnostic flowchart

1- In the last two decades there has been an increase in the number of hepatic surgeries performed, together with an improvement in surgical techniques and new dissection devices. 2- Radiologists play a key role in the process of surgical planning and post surgical evaluation. Knowledge of types of resection is important to interprete postsurgical liver appearence. 3- In the acute post surgical period, imaging helps to identify complications and contribuites to define treatment.

1) Introduction. 2) Type of hepatectomies and technique- left hepatectomy, right hepatectomy, trisegmentectomy, segmentectomy, atypical segmentectomy, alpps, mini alpps.- liver hanging maneuver- Pringle Maneuver- liver transection methods: clamp crushing, electric scalpel, CUSA, water jet, tissue link. When and why?. 3)- Imaging findings after hepatectomies.- Normal findings: fluid collection, hypodense line, hepatic perfusion abnormalities, air bubbles, omentun adipose tissue, extraluminal gas.- Pathologic findings: biloma, hematoma, abscess, pulmonary complications. Tips for the correct diagnosis and differentiation. Example cases and evaluation test. Conclusion

• Review the basic principles of elastography, focusing on the liver • Summarize the liver magnetic resonance elastography technique • Describe the steps in the evaluation and quality control of elastography images • Recognize the main causes of low-quality and nondiagnostic elastograms • Illustrate with didactic cases some technical failures of liver MR elastography and how to potentially correct them

? INTRODUCTION - Important concepts - Basic principles of elastography ? LIVER MR ELASTOGRAPHY TECHNIQUE - Typical liver MR elastography configuration - Raw data and post-processed images ? IMAGES QUALITY CONTROL - How to evaluate elastography images and ensure their quality ? LOW-QUALITY AND NONDIAGNOSTIC ELASTOGRAMS - Main causes of technical failures during the liver MR elastography ? INTERACTIVE CASE-BASED DIDACTICS - Sample cases to illustrate and solidify the concepts - How to potentially correct low-quality and nondiagnostic elastograms ? TAKE HOME MESSAGES

• Review normal liver segmentation, vascular, biliary anatomy, and variants • Recognize the normal appearance of the postoperative liver • Recognize early complications such as abscess, parenchymal necrosis, and bile leak • Describe pertinent vascular findings such as active bleeding, pseudoaneurysm, stenoses, and thrombosis • Understand the post ablation appearance of the liver and potential complications • Many of our cases will contain a QR code that will allow the reader to open a fully functional PACS interface on their mobile device

• Background: Liver surgery is a common procedure and complication rates can be as high as 50%. With the high-risk nature, radiologists can play an important role in the early detection and management of potential complications. • Review normal hepatic anatomy including the conventional segmental divisions, vasculature, and biliary system. • Terminology including wedge resections, segmentectomy, and hepatectomy to assist the radiologist in reviewing operative reports and accurately describing imaging findings. • Normal/expected post operative appearances • Case based examples illustrated utilizing multiple modalities to demonstrate common complications that radiologists may encounter: o CT and MR examples of early complications requiring hospital admission o Vascular and biliary complications and interventions o Utility of nuclear medicine studies o Evaluation of long-term complications. o Post ablation appearance and potential complications.

1. To review cancer drugs that are primarily responsible for causing colitis 2. Review the different etiologies of colitis and imaging findings that help differentiate them from cancer-therapy associated colitis 3. To discuss the CT imaging patterns of colitis of different etiologies 4. To discuss the crucial role of the radiologist in monitoring/management of treatment-related colitis. 5. Review established grading and management guidelines for treatment related colitis

1. Discuss common anti-neoplastic agents that cause colitis 2. Enumerate etiologies of colitis, along with their typical imaging findingsi) Immune checkpoint inhibitor associated colitisii) Drug-induced colitisiii) Infectious colitis -a. Neutropenic colitisb. Pseudomembranous colitisiv) Radiation induced colitis v) Inflammatory - Ulcerative colitis/Crohn disease vi) Ischemic colitis 3. Discuss clinical findings, history and risk factors for developing colitis 4. Discuss mimics of colitis a. Diverticulitis b. Appendicitis c. Epiploic appendagitis 5. Discuss presenting clinical symptoms and grading system for drug-induced colitis6. Management guidelines for drug-induced colitis with special focus on checkpoint inhibitors (ICI), targeted therapy, Car-T cell therapy 7. How a Radiologist plays an important role in monitoring and management 8. Prognosis and clinical outcome of patients developing drug-induced colitis 9. Real-world cases showing management and clinical course of drug-induced colitis in cancer therapies from to combination ICI and CAR-T cells as well as additional causes of colitis in cancer patients

? Overview of the application of tumor response criteria and quantitative imaging and its benefits for clinical trials and novel oncology therapeutics. ? The role of radiologists in the standardization of tumor evaluation for clinical trials. ? Basics on response assessment and quantitative analysis of the most prevalent abdominopelvic tumors. ? Updates in imaging management and surveillance strategies for abdominal tumors. ? The role of imaging and genetic/molecular evaluation

Based on extensive imaging experience from a leading cancer center: ? A brief review of abdominopelvic tumors, highlighting the clinical and laboratory features that can be helpful in diagnosis and management. ? Review of the main criteria for clinical trials and clinical decision support employed to evaluate abdominopelvic tumors, for instance, RECIST 1.1, irRECIST, iRECIST, irRC, Lugano, Cheson, EASL, imRECIST, itRECIST, PERCIST, RECIL, and Choi. ? Tumor metrics criteria evaluation for abdominal tumors response compared to radiomics and imaging genomics role. ? Evaluation of immunotherapy: main concepts and practical application of tumor response evaluation. ? Interactive imaging-based approach with teaching points for response evaluation, work-up and recurrence of abdominopelvic tumors, challenges of immunotherapy evaluation, and equivocal cases on anatomic (CT/MRI) and functional (PET/CT and PET MRI) cross-sectional imaging. ? Current guidelines. ? Limitations of current imaging methods and new directions. ? Take-home messages.

1. Case-based review on imaging pitfalls and pearls of focal liver lesions in cirrhosis.2. The distortion of normal liver parenchyma by fibrous and regenerative tissue can change the typical appearance of many benign lesions, causing misdiagnosis as malignancy.3. As the most common primary malignancy arising from cirrhotic liver, hepatocellular carcinomas (HCC) can have atypical imaging appearance.4. Contrast enhanced ultrasound (CEUS) can provide characterization of focal liver lesions in additional to CT and MRI to achieve accurate diagnosis.

Technical pitfalls in cirrhotic liver imaging: 1) HCC may be nearly isointense to background liver on heavily T2 weighted MR images. 2) CT and MRI can miss early enhancement pattern of HCC due to mistiming. 3) Replacement of liver parenchyma by fibrous and regenerative tissue in cirrhosis can lead to decreased penetration by ultrasound.Benign lesions mimicking malignancy: 1) Regenerative nodules. 2) Siderotic nodules. 3) Confluent fibrosis. 4) Hemangioma with pseudo washout.Atypical appearance of HCC 1) Hypovascular. 2) Cystic. 3) Fat containing HCC. 4) Nodule in nodule HCC.Other malignancies mimicking HCC 1) Intrahepatic cholangiocarcinoma. 2) Metastases.CEUS providing added value to CT and MRI, for differentiation of benign versus malignant lesions 1) HCC washout not shown on CT or MRI, but demonstrated by CEUS, due to the purely intravascular nature. 2) More sensitive detection of arterial hyperenhancement, due to its real-time nature.

Teaching Points Although many hepatocellular carcinoma staging systems exist, the Barcelona Clinic Liver Cancer (BCLC) staging system is the most widely validated system which provides guidelines for therapy based on tumor stage and underlying liver function. Following the BCLC treatment guidelines has survival benefits for HCC patients, and the 2022 expanded upon its previous iteration for a more personalized and individualized approach, taking into consideration local technical and expertise availability in conjunction with the tumor profile. Knowledge of the imaging findings for each BCLC stage and understanding the updated treatment recommendations for each stage are required to ensure appropriate clinical decisions and management for each patient This exhibit aims to highlight the imaging appearance of HCC for various BCLC stages while highlighting the key differences in the 2022 version

OutlineBrief background on HCC and the BCLC staging systemHighlight key updates of the BCLC 2022 staging systemCase based review illustrating the key imaging features of each stageBCLC-0, very early stageBCLC-A, early stageBCLC-B, intermediate stageBCLC-C, advanced stageBCLC-D, terminal stageCase-based review highlighting the various treatment options recommended by the updated BCLC system for each stage, with an emphasis on locoregional interventional treatments

Describe the imaging modalities of choice for the detection of early gastrointestinal and hepatobiliary cancers; Understand MRI technique and protocols, common challenges, and how to overcome them; Highlight imaging pearls and pitfalls for the characterization of early lesions on each modality; Underscore imaging characteristics that help in the differential diagnosis; Recognize key anatomical landmarks for surgical planning; Know what to include in the radiology report; Discuss future directions in the image analysis of early gastrointestinal and hepatobiliary cancers.

INTRODUCTION: General overview and definitions; Common gastrointestinal and hepatobiliary cancers. IMAGING TECHNIQUE: Modalities of choice; Sensitivity, specificity, and accuracy across methods; Protocols; Difficulties and how to overcome them to obtain high-quality images. IMAGING INTERPRETATION: Structured imaging analysis; Piftalls and pearls; Anatomic Landmarks: What the Surgeon whants to know?; What should be included in the tadiology report. STRATEGIES TO OVERCOME THE CHALLENGING CASES: Imaging characteristics that help in the differential diagnosis; WHAT’S ON THE HORIZON TO ASSESS EARLY GASTROINTESTINAL AND HEPATOBILIARY CANCER: Dual-energy CT; Digital Subtraction Angiography; DWI; Radiomics; Artificial Intelligence applied to image acquisition, reconstruction; Quantitative Imaging Analysis; PET/MRI; New nuclear medicine radionuclides; Nanoparticles.

• The kidney is the most commonly transplanted solid organ and therefore it is imperative that the radiologist be familiar with the surgical procedure, as well as the post operative complications. • Understanding the general timeline of specific complications in order to narrow the differential of imaging findings. • Recognize the imaging findings of the most common and the rare postoperative complications related to renal transplantation.

• Review of the renal transplant surgical procedure and normal post-operative anatomy • Imaging modalities used to assess the allograft • Complication timeline • Perinephric fluid collections • Vascular complications • Collecting system complications • Parenchymal abnormalities • Abdominopelvic complications • Conclusion

· Review of characteristic and atypical pancreatic ductal adenocarcinoma imaging and clinical findings · Review of imaging and clinical features that allow differentiation between pancreatic ductal adenocarcinoma and its mimickers

Pancreatic ductal adenocarcinoma is the most common primary tumor of the pancreas. Several pancreatic conditions can mimic the appearance of pancreatic ductal adenocarcinoma, including inflammatory conditions, uncommon primary pancreatic tumors, and metastases to the pancreas. Imaging differentiation between these lesions and pancreatic ductal adenocarcinoma can be difficult because of overlapping features; however, knowledge of their typical imaging characteristics and clinical presentation may assist in their differentiation. 1. Introduction 2. What key imaging and clinical features of pancreatic ductal adenocarcinoma suggest this diagnosis and what are the atypical findings? 3. What clinical and imaging features differentiate mimickers (acute and chronic pancreatitis, groove pancreatitis, autoimmune pancreatitis, high-grade neuroendocrine tumors, metastases, other less common benign and malignant tumors) from pancreatic ductal adenocarcinoma? 4. Take home points

1) Review principles of MR elastography (MRE) for noninvasive assessment of liver fibrosis. 2) Summarize the literature on diagnostic accuracy of MRE in different liver disease etiologies. 3) Review pitfalls and confounders. 4) Provide guidance on liver MRE reporting and interpretation. 5) Discuss future directions.

1) Introduction: Stiffness as a biomarker of liver fibrosis and clinical significance. 2) Basic principles of MRE. 3) Clinical application detection and staging of liver fibrosis, liver stiffness and histology fibrosis stages, contexts of use and populations. 4) Diagnostic performance: overview of meta-analyses, MRE sequence, disease-specific MRE-determined liver stiffness thresholds. 5) Pitfalls and confounders a. Technical: improper hardware setup, left lobe vs right lobe, wave frequency dependencies, region of interest (ROI) placement. b. Biological: steatosis, iron overload, inflammation, cholestasis and venous congestion, expiration vs inspiration, fasting vs postprandial state. 6) Image interpretation Image analysis and interpretation (wave and elastograms), ROI approaches, stiffness thresholds and disease-specific interpretation. 7) Reporting: what to report, how to report it, QIBA recommendations. 8) Future directions: new contexts of use and applications, technical innovations.

(1) Iron overload could be due to primary hemochromatosis (hereditary) or secondary hemochromatosis (acquired by blood transfusions) and can cause serious complications including liver cirrhosis and heart failure. (2) MRI based iron quantification is increasingly being preferred to biopsy which is invasive, and not representative in inhomogenous distribution and serum ferritin which can be inaccurate in inflammatory states. (3) MRI based liver iron quantification is the recommended technique for estimating liver iron concentration in patients with increased serum Ferritin levels and assessing its trend in patients with repeated blood transfusions. (4) Superparamagnetic property of iron is the basis of quantification by MRI as it creates magnetic field inhomogeneity (estimated by QSM), which leads to signal drop of liver (measured by SIR method) and shortening of T2 and T2* times (measured by relaxometry). (5) The choice of method of iron quantification is made according to the availability of resources, and level of iron overload. (6) In cases with very high iron overload, R2* based relaxometry mapping gives error and use of signal intensity ratio method is preferred.

(1) Iron metabolism (2) Iron Overload and its clinical implications (3) Monitoring of Iron Overload (4) Clinical Indication for liver iron quantification (5) Principle of MRI based Iron Quantification (a) Principles (b) Relaxometry: T2 and T2* (c) Signal Intensity Ratio (SIR) Method (d) Quantum Susceptibility Mapping (QSM) Method (6) Merits and Demerits of MRI based Iron Quantification methods in practical usage (a) T2 Relaxometry (b) T2* Relaxometry (c) SIR (d) QSM (7) How to practically use different tools and methods

-Recognize normal anatomy of the abdominal wall-Know and identify the types of hernias that occur in the abdominal wall-Identify normal and pathologic conditions that may clinically mimic hernias

1. Introductiona. Hernia general terms and definitionsb. Hernia ultrasound protocolc. Normal abdominal wall anatomy2. Abdominal wall hernia casesa. Umbilical herniab. Indirect inguinal herniac. Direct inguinal herniad. Spigelian herniae. Lumbar herniaf. Incisional hernia3. Abdominal wall pathology mimicking herniaa. Lipomab. Cellulitisc. Post op fat necrosisd. Rectus sheath hematomae. Endometrioma in C-section scarf. Lung cancer metastasis4. Inguinal pathology mimicking herniaa. Metastatic lymph nodeb. Hydrocelec. Rhabdomyosarcomad. Spermatic cord lipomae. Encysted hydrocelef. Undescended testicle5. Vascular pathology mimicking herniaa. Varicose veinsb. Pseudoaneurysmc. Thrombosed veins6. Conclusion and summary

Combining radiological case examples with succinct explanation and illustrations this exhibit will provide a comprehensive summary of the portal vein (PV). This will:• Guide the radiologist in successful description of PV anatomy and branching patterns leading to optimal surgical approach. • Teach recognition and correct interpretation of rare topographic portal vein variations such as circumportal pancreas and preduodenal PV. • Provide an understanding of the appearances, associations and complications of PV shunts including congenital (E.g., Abernethy malformations, hereditary hemorrhagic telangiectasia) and acquired shunts (E.g., cirrhosis, traumatic). • Examine all pathology of the PV, including tips to differentiate between bland and tumour thrombus and explain sequelae with case examples (E.g., cavernous transformation, THAD/hepatic artery buffer response and portal bilopathy) • Deliver an overview of the newly described disease entity “porto-sinusoidal vascular disorder” clarifying the nomenclature associated with it and distinguishing it from cirrhosis and non-cirrhotic portal hypertension

Portal vein anatomy: branching pattern variations and extrahepatic topographyMalformations of the portal vein: associations and sequelaeDisease processes affecting the portal veinPortal vein interventionSummary and recommendations

This exhibit aims to provide an overview of the different benign and neoplastic mimickers of rectal cancer that can be encountered and provide an evidence-based framework for how to approach the differential diagnoses for rectal masses.

Different categories of rectal masses/rectal cancer mimickers to be discussed include: -Large rectal masses: In addition to advanced stage or poorly differentiated adenocarcinoma, high grade neoplasms such as poorly differentiated squamous cell carcinoma, high-grade neuroendocrine tumor, adenosquamous carcinoma, or lymphoma may be considered. If the tumor is eccentrically located, non-epithelial/mesenchymal tumors such as gastrointestinal stromal tumor or tumor of adjacent organ origin should be in the differential. -Anorectal junction masses of unknown histology: These lesions present a dilemma, as staging and treatment of anal cancer differ from rectal adenocarcinoma. -Precancerous/early-stage rectal cancer: These lesions have differing morphological and enhancement patterns compared to more locally advanced disease. -Benign rectal masses: Differentials include vascular malformations/hemangiomas, solitary rectal ulcer syndrome, and endometriosis implants. -Metastasis, including direct invasion of adjacent organs and commonly confused non-rectal cancer origin metastasis.

The purpose of this exhibit is to: Identify imaging patterns of wall thickening in the stomach, small bowel, and colon.Discuss the differential diagnosis of bowel wall thickening based on imaging characteristics, morphology, distribution, secondary signs, and clinical presentation. Present correlative endoscopic gross images when available.

The presentation will include Anatomic layers of the bowel wall. Pathophysiology of bowel wall thickening including wall layers involvement with edema, hemorrhage, inflammatory and neoplastic cells, fatty deposits, and fibrotic replacement. Differential diagnosis, example cases, and concurrent endoscopic images of gastric wall thickening are classified into diffuse, segmental, focal, and multifocal wall thickening. Differential diagnosis, example cases, and concurrent capsule endoscopic images of bowel wall thickening are classified into diffuse, segmental, and nodular fold thickening. Differential diagnosis, example cases, and concurrent colonoscopy images of bowel wall thickening are classified into diffuse, segmental, and nodular fold thickening. Address secondary signs favoring one diagnosis over others.

• To review the general anatomy of the ampullary region and its variants with schematic drawings correlated with CT and MRI. • Expose the possible periampullary disorders categorized into four large groups (anatomical variations, tumoral, inflammatory, and miscellaneous). To unravel the main differential diagnoses of periampullary involvement with didactic cases, literature review, and main imaging aspects.

Diagram and educational schematic drawings for diagnostic of the ampullary and periampullary lesions, dividing them as:- Anatomical variations: including cases of pancreas divisum, annular pancreas, and independent drainage of the common bile duct and pancreatic duct. - Tumoral disorders: including cases of a duodenum GIST, a papilla tumor, and a Frantz Tumor - Inflammatory disorders: such as paraduodenal pancreatitis, bulging duodenal papilla, and HIV papillitis. - Miscellaneous disorders: presenting other kinds of periampullary involvement, including a case of collateral circulation mimicking a neoplastic pathology, ischemic cholangiopathy, and intradiverticular papilla.

Body MRI protocols can be daunting for the new trainee or novice reader, with a multitude of pulse sequences and a wide variety of acronyms. Understanding of basic MRI physics provides a framework for how to optimally use these sequences in clinical practice. Knowledge of the sequences as building blocks also informs efficient protocol design. This exhibit will:1) Highlight basic MRI physics principles that underpin core body MRI sequences2) Provide a framework of the families of sequences used in body MRI protocols, including individual vendors sequence names and key parameters3) Illustrate technical considerations and clinical utility of each sequence through case examples4) Describe how to build efficient protocols for indications such as liver masses, pancreaticobiliary imaging, renal/adrenal imaging, pelvic imaging, and imaging the moving patient

- relevant body MRI physics: single-shot, free-breathing, respiratory navigation, chemical shift, hepatobiliary contrast- sequence families: single-shot fast-spin echo, balanced steady-state free-precession, diffusion-weighted, spoiled gradient echo (chemical shift, quantitative multi-echo imaging, dynamic imaging), high resolution/small field of view imaging- for each sequence: vendor names/acronyms, key sequence parameters (TR, TE, flip angle, acquisition time, breath-holding strategy), technical considerations (SNR, artifacts, sensitivity to motion and susceptibility, need for fat suppression), and clinical applications- body MRI protocols: what sequences to include and why, using examples such as liver mass, pancreaticobiliary, renal/adrenal, and pelvic imaging, and how to image the moving patient

? To review the role of MRI in restaging rectal cancer, emphasizing the use of T2 weighted images and diffusion weighted images. ? To describe the basis of neoadjuvant treatment in rectal cancer, making a brief analysis of the Prodige, Opra and Rapido Trial. ? To accomplish a description of the tumor regression grade system (TRG) using cases from our database as examples. ? To highlight the importance of multidisciplinary approach between imaging findings, endoscopy and histopathologic results.

? Introduction. ? Rectal MRI basis. ? Neoadjuvant chemoradiotherapy in rectal cancer. ? TRG review. ? Conclusion.

This educational exhibit will aim to: Describe and define Nodular Regenerative Hyperplasia (NRH) from a clinical, radiological and histopathological perspective with the use of CT and MRI imaging. Compare and contrast NRH from other liver pathology. Distinguish NRH from other adaptive liver reactions that precede non-cirrhotic portal hypertension. Describe the causes and associations of NRH.

• NRH Background o NRH and other liver adaptive reactions causing non-cirrhotic intrahepatic portal hypertension o Epidemiology o Aetiology and pathogenesis • Histopathological-Radiological correlation with CT and MRI Imaging o Molecular background o Imaging features • Imaging pearls and pitfalls o Mimics of NRH o Appearance with hepatobiliary phase Gadoxetic Acid- enhanced MR imaging • Summary

1. Review the importance of identifying liver fat and iron in the general population and in patients with liver disease. 2. Discuss ultrasound and MR imaging techniques for detection and quantification of liver fat and iron. 3. Illustrate these imaging techniques with clinical vignettes, including pearls and pitfalls.

1. Background and clinical importance of identifying abnormal accumulation of liver fat and iron. 2. Risks, clinical implications, impact on health care costs and mortality in patients with abnormal liver fat or iron. 3. Benefits of early detection and intervention in patients with abnormal fat and/or iron in the liver. 4. Ultrasound and MR imaging techniques for detection and quantification of liver fat and iron, including physical concepts, technique, interpretation, limitations, and future trends. 5. Multimodality case-based examples and appropriate clinical indications. 6. How to calculate and report fat and iron content.

- Going over current abdominal X-ray purposes and indications. - Optimal technique review and basic projections. - Learning basic radiological anatomy. - Knowing most common abnormalities and underlying disease.

Indications Technique Basic projections 1) AP supine view 2) AP erect view 3) Lateral decubitus view 4) PA erect view Regional anatomy - Air (luminogram) - Organ silhouettes - Fat stripes - Bone Abdominal X-Ray semiology - Hepatobiliary Hepatomegaly, Splenomegaly, Cholelithiasis, Calcified cysts - Genitourinary Urolithiasis and other calcified structures - Gastrointestinal Bowel obstruction (Small bowel obstruction, large bowel obstruction and volvulus), and pneumoperitoneum - Foreign bodies - Medical devices

The purpose of this educational exhibit is:- To analyze the different pathological processes that can be found in the imaging modalities intended for the characterization and staging of rectoanal or perirectal pathology, beyond the adenocarcinoma and squamous neoplasia.- To illustrate the characteristic image features of these processes, especially on MRI, emphasizing those aspects that can be clues to orientate the diagnosis.

We have realized a retrospective review of patients in whom an imaging study, mostly MRI, has been requested to evaluate recto-anal or perirectal diseases in the last 12 years and whose definitive diagnosis has been other than primary neoplasia (adenocarcinoma or squamous neoplasia) or perianal fistula extension study. The final diagnosis was histologically confirmed. In this way, we present 44 patients and we have classified them into six groups:- Inflammatory/infectious pathology. - Endometriosis.- Neoplastic pathology Benign: schwannoma, leiomyoma, myelolipoma, hemangioma, diffuse rectal hemangiomatosis. Malign: neuroendocrine tumor, melanoma, plasmablastic lymphoma, undifferentiated pleomorphic sarcoma.- Secondary neoplastic involvement ? highlights a rare and specific form of involvement such as rectal linitis.- Congenital and developmental lesions.- Other benign processes.

To better understand pancreas-kidney transplant, its technique and complications using a didactic approach using images and illustrations.To show the different imaging methods for evaluating transplant complications, such as Computed Tomography (CT) and Ultrasound (US).To highlight the surgical complications using cases from our database and the importance of their detection.To highlight the importance of a structured report.

1. Review of the pancreas-kidney transplant and its technique through illustrations and images.2. Explore pancreas-kidney complications supported by cross-sectional imaging cases, such as CT and US.3. Preoperative and postoperative knowledge of pancreas-kidney transplant is mandatory for surgical planning and thus helping to identify postoperative complications. This information must be a part of the structured report.4. Summary and take home messages.

1. Review the most common gastrointestinal surgical procedures performed and common indications - from pharynx to anus.2. Discuss case examples of the expected postoperative appearance of these procedures.3. Highlight the most common post operative complications and their fluoroscopic appearance.

IntroductionPharynx- LaryngectomyEsophagus- Zenker's diverticulectomy and diverticuolotomy- Reflux management devices (such as Linx device)- POEM- Esophagectomy- Hiatal hernia repair- Heller myomotomyStomach- Fundoplication- Sleeve gastrectomy- Roux-en-Y gastric bypass- Total gastrectomySmall bowel - Gastrostomy or gastrojejunostomy catheters- Whipple procedure- Pylorus sparing whippleLarge bowel- Partial colectomy- LAR versus APRSummary

- Illustrate how to recognize bowel stenosis in Patients with Crohn's disease (CD), show the differences between inflammatory and fibrotic strictures, and explain their implication on the treatment choice. - How to describe intestinal stenosis in CD patients and which information should be included in the report to guide the management. - Exclude other potential differential diagnosis, including adhesive disease and bowel cancer.

Stricture is a frequent complication in CD. The precise definition of stricture has not been defined yet, and varies across studies, comprising either luminal stenosis with intestinal wall thickening with or without pre-stenotic dilatation, and lesion-causing stenosis lower than 1 cm. The site of strictures usually follows the distribution of inflammation, frequently involving the ileum. Even though CT- and MR-enterography offer great visualization of the intestinal tract, defining strictures remains challenging. Assessing strictures, the transition point should be carefully evaluated to establish the cause of bowel obstruction and exclude other potential differential diagnosis, including adhesive disease and bowel cancer. In addition, in CD inflammation and fibrosis are strictly connected mechanisms, which usually coexist in the same Patient and even in the same intestinal tract in varying degrees, making the diagnosis even more complex. MR exams can accurately differentiate between inflammatory and fibrotic strictures, guiding the correct treatment choice. Inflammatory strictures are treated with anti-inflammatory drugs; on the other hand, fibrotic strictures are treated mechanically with intestinal resection or endoscopic dilatation.

1-To familiarize radiologists with activity indices of Crohn’s disease (CD) used by gastroenterologists including clinical and endoscopic scores2-To describe the main validated activity scores and other imaging biomarkers for assessing inflammation in patients with CD3-To provide a practical guide on the correct use and interpretation of imaging biomarkers in CD4-To discuss the potential contribution of imaging biomarkers in assessing therapeutic efficacy and to applied as endpoints in clinical research

1- Limitation of endoscopy as reference standard to assess inflammation and therapeutic response in patients with CDCross-sectional imaging may overcome these limitations and offers additional advantages2- Description of Magnetic Resonance Enterography (MRE) and intestinal ultrasound (IUS) activity scores have been developed and validatedDetailed list of MRE and IUS activity scores and other imaging biomarkers (e.g.motility) in CDEvidence supporting their satisfactory inter- and intra-reader reproducibility, and validity against a range of reference standardsOptimal use and interpretation. Not forget ulcerative colitis3- Rational and limitations to consider activity scores as endpoints in clinical research in CD.

1. The ‘anorectal junction to tumor’ distance can estimate potential distal surgical margin and thus helps to determine the surgical approach. 2. MRF involvement at the pelvic floor can be inferred by the T category status for low cancers. 3. Cancer involvement of the anal sphincter in the context of T staging is remains undefined by AJCC. The recommendation is to be descriptive. It is important to have a strong grasp of anal sphincter anatomy to accurately describe tumor involvement with particular emphasis regarding the tumor relationship to the intersphincteric space. 4. External iliac and inguinal lymph nodes are regional (N+) not M disease when there is cancer involvement of the anal sphincter. 5. The histology of the tumor must be confirmed as adenocarcinoma. If squamous in histology, a low cancer is staged and treated as an anal cancer.

Background • Rectal MR and clinical staging • Classification (high/mid/low) Low rectal cancers (special considerations) • Anatomy of the anal sphincter • Treatment approaches • Staging issues and areas of controversy • Histology Summary

1 - Review the imaging findings for inflammatory bowel disease when using enterography protocols in CT and MR.2 - Illustrate these findings and correlate them with the correct terms to use on radiology reports.3 - Showcase the most common pitfalls that can be mistaken for active inflammatory disease and what to look for besides the bowel.

1 - Advantages and disadvantages of CT and MR.2 - Exam protocols.3 - Imaging findings in Crohn's disease and their descriptors.4 - Imaging findings in non-specific intestinal inflammatory conditions.5 - Pitfalls that may be mistaken for active inflammation.6 - Other sites of interest for when analyzing a patient with Crohn's disease.

- Review literature in appendiceal malignancies and benign disease.- Demonstrate images patterns of the different diseases of the appendix- Postulate a flowchart to investigate appendiceal disease

Appendicitis is one of the most common acute abdominal inflammatory disease and demands surgical treatment. Other appendix afflictions are rare in comparison and frequently overlooked. Radiologists must know the different diagnosis, to recognize when it’s not appendicitis and impact the surgical or clinical management.

1. Understand basic technique of dual energy CT (DECT) imaging.2. Describe the role of DECT in complex biliary pathologies.3. Show how DECT aids appropriate management of challenging biliary cases.

1. Background: DECT has a variety of emerging clinical applications. By acquiring images at both high and low x-ray energies, computer software analysis can estimate chemical composition of materials. Images are reconstructed to enhance or suppress appearance of different materials. CT is often first choice of cross-sectional imaging in outpatient and acute care settings due its relative ease of acquisition and lower cost compared to MRI. DECT is a particularly useful tool in imaging biliary pathologies to add greater information and value from a single imaging encounter.2. Gallstone disease: Noncalcified cholesterol stones are less apparent on single-energy contrast enhanced CT, but attenuate differently at various energies and are better visualized on monoenergetic images.3. Postoperative cases: Iodine map and virtual non-contrast (VNC) images distinguish true postoperative abscesses.4. Biliary malignancy: Iodine map and VNC images distinguish enhancing tissue versus biliary hematoma.5. Other pathology: In unusual cases such as gallbladder volvulus, iodine map and VNC images identify gallbladder ischemia and expedite management.VI. Conclusions: DECT has an exciting range of applications for biliary pathology, aiding in appropriate management and minimizing additional studies and delayed care.

• Recognize early focal pancreatic abnormalities on CT associated with subsequent diagnosis of early-stage pancreatic ductal adenocarcinoma (PDAC).• Understand the role and limitations of radiology on primary staging and restaging.• Comprehend common imaging pitfalls and benign mimickers of PDAC.• Recognize post-surgical complications.• Recognize different patterns of recurrence on imaging.• Understand imaging response to CRT and current limitations. • Be familiar with future directions on PDAC.

1.INTRODUCTION oWorld prevalence and cancer Facts and statistics 2022. oRelevance, costs. 2.TREATMENT SUMMARY 3.ROLE OF IMAGING oEarly detection oInitial staging oCommon pitfalls •Vascular involvement from surgical perspective •Peritoneal carcinomatosis versus inflammatory changes or congestion. •Regional and extra-regional nodal metastasis. •Perineural invasion: myth or fact? oMimickers •Pancreatitis. •Duodenal diverticulitis. •Prominent pancreatic lobulations. •Uneven fat deposition oRestaging •Imaging criteria and limitations. oTumor recurrence •Common locations. •Imaging patterns. •Role of follow up comparison 4.RADIOSURGICAL CORRELATION oWhen we were wrong 5.POST-OPERATIVE COMPLICATIONS oPre-surgical red flags. oConcerning imaging findings. 6.MULTIDISCIPLINARY TUMOR BOARD oWhat they need to know and what we need to ask 7.WHAT’S ON THE HORIZON

* Demonstrating a radiologist’s role in the clinical management of GI tumors.* Reviewing NCCN guidelines for GI tumors.* Highlighting the use of different imaging modalities in management decisions.* Identifying possible pitfalls in multidisciplinary tumor board discussions from a radiology standpoint.

GI tract cancers are one of the most common malignancies discussed during multidisciplinary tumor board meetings. The National Cancer Committee Network (NCCN) publishes guidelines that are considered the gold standard for management of malignancies. This exhibit is a pictorial review of cancers of the stomach, small bowel, colon and rectum with emphasis on the NCCN guidelines.Key points:* Description of the role of imaging in cancer staging.* Multimodality imaging for initial workup.* Outline of impact of radiology on the surgical management and medical treatment of GI cancers.* Highlight of potential conflicts and pitfalls in tumor boards discussions.* Imaging principles for active surveillance.

Acute and chronic pancreatitis may lead to a wide array of complications which can be visualized on imaging. Our exhibit will focus on understanding the use and unique advantages of ultrasound, CT, and MRI including secretin enhanced MRI to better characterize complications of acute and chronic pancreatitis to aid in management decisions. Acute pancreatitis may lead to numerous local complications including acute peripancreatic fluid collections, necrosis with or without superimposed infection, fistula formation, and vascular complications such as hemorrhage from erosion of nearby vessels, pseudoaneurysm formation, and adjacent venous thrombosis. Chronic pancreatitis may lead to pseudocyst formation with possible dissection into the mediastinum or adjacent peritoneal compartments, parenchymal atrophy or enlargement with or without calcifications, and decreased exocrine reserve which may be evaluated on secretin enhanced MRI. This exhibit will also focus on effective reporting for management and clinical decision making.

Peripancreatic fluid collections, pancreatic and peripancreatic necrosis, emphysematous pancreatitis, fistula formation, vascular complications, chronic pancreatitis pseudocyst formation, ductal stenosis

1. To explain congenital cystic lesions of the biliary tree: congenital hepatic fibrosis, biliary hamartomas (von Meyenburg complexes), autosomal dominant polycystic disease, Caroli disease and choledochal cysts. 2. To review the embryology, physiology and pathogenesis. 3. To illustrate the imaging findings. 4. To discuss their differential diagnosis illustrated by sample cases.

1. Introduction. 2. Embryopathogenesis. 3. Anomalies of the intrahepatic bile ducts. - Congenital hepatic fibrosis: Etiopathogenesis, Imaging findings. - Biliary hamartomas (von Meyenburg complexes): Etiopathogenesis, Imaging findings (Ultrasound, CT, MR), Differential diagnosis. - Caroli disease: Etiopathogenesis, Types (Caroli disease proper, Caroli Syndrome), Imaging findings (Ultrasound, CT, MR), Complications, Differential diagnosis. - Autosomal dominant polycystic disease: Etiopathogenesis, Imaging findings (Ultrasound, CT, MR), Complications, Extrahepatic associations. 4. Anomalies of the extrahepatic bile ducts. - Choledochal cysts: Etiopathogenesis, Imaging findings, Classification, Complications. 5. Summary.

- To review the origin, pathophysiology and classification of gastroenteropancreatic neuroendocrine neoplasms.- To recognize the utility of anatomical and somatostatine receptor functional imaging in the diagnosis, staging, prognosis and selection of treatment.- To identify, in a case- based review, the main challenges and pitfalls of functional imaging in the diagnosis and follow- up of GEP NETs.- To understand the radiologists role in the selection of treatment with theranostic agents.

- Introduction to gastroenteropancreatic neuroendocrine neoplasms (GEP NENs): origin, pathophysiology and clinical syndromes- The WHO 2019 classification of GEP NENs: well- differentiated neuroendocrine tumor versus poorly differentiated neuroendocrine carcinoma- Multimodality anatomical and somatostatine receptor imaging criteria in diagnosis and staging- Pitfalls in interpretation of somatostatine receptor imaging- Prognostic value of dual positron emission tomography imaging with 18F-FDG and 18F-OC for NENs- Overview of theranostic agents for treatment of NENs

· Review of biliary tract imaging technique · Identify the multimodality imaging features of benign and malignant conditions of the biliary tract · Discuss pitfalls in the interpretation of MR imaging and CT findings in the biliary tract

The biliary tract may be affected by a wide variety of pathologic conditions, some with similar clinical presentations. Biliary tract imaging plays a key role in determining the etiology, location, and severity of the condition and any complications. Imaging also guides management of biliary tract diseases including the most appropriate intervention when required. 1. Introduction 2. Imaging technique: what are the uses and how are standard MR cholangiopancreatography, 3D isotropic MR cholangiopancreatography and contrast-enhanced MR cholangiography and DECT performed? 3. What features characterize, on multimodality imaging including but not malignant to benign biliary (choledochal cysts including Caroli disease, cholangitis, recurrent pyogenic cholangitis, primary sclerosing cholangitis, ischemic cholangiopathy) and pre-malignant and malignant conditions (intraductal papillary neoplasm of the bile duct-IPNB-, cholangiocarcinoma and metastases)? 4. Review imaging pitfalls in the biliary tract imaging: blooming artifact, physiologic variants of the biliary system and pulsation/compression artifact 5. Take home points

Extramural venous invasion (EMVI) is a well-investigated prognostic factor predicting poor survival in rectal cancer despite no statement in American Joint Committee on Cancer TNM staging system. EMVI was described as an expanded, irregular vessel with intermediate tumor-signal intensity; however, detailed characteristics such as the number, diameter, and location of the involved vessel, and treatment response are gathering attention, aiming to predict precise patient outcomes and stratify risk. Tumor deposits (TDs), defined as cancer nodules located in the mesorectum without evidence of underlying lymph node architecture on histopathology, are recently reported as irregular nodules in the mesorectum directly interrupting the course of the vein with tapering into the vein on MRI. MR-detected TDs are reported to be a prognostic factor as well as pathological TDs. The purposes of this exhibit are:1. To review imaging findings of EMVI and TDs in rectal cancer2. To discuss the clinical significance of EMVI and TDs in contemporary therapeutic strategy in rectal cancer.

1. Detection of EMVI and imaging pitfalls 2. What are TDs? Imaging findings and cutting-edge knowledge. 3. Detailed characteristics of EMVI and difference between EMVI and TDs 4. Assessing response of EMVI and TDs after neoadjuvant therapy 5. Summary

1. Complex small bowel obstructions often bring both diagnostic and management dilemmas to the radiology and surgical teams.2. The radiologist plays a major role in providing a confident interpretation of the baseline CT exam that influences management and follow-up.3. Complex small bowel obstructions can be divided up into mechanical, neoplastic, and closed-loop categories.The key findings that raise the concern of closed-loop physiology include the beak sign, asymmetric edema, clustered loops with radial vessels, dilated C or U-shaped loops, and swirling narrowed vasculature. 4. Important mimics and pitfalls to consider when evaluating a complex bowel case include ischemia, angioedema, inflammatory enteritides, and graft versus host disease.

A. Defining simple versus complex small bowel obstruction- Mechanical- Abdominal and pelvic external hernias- Gallstone ileus - Afferent loop syndrome- EndometriosisB. Neoplastic- Benign- Primary tumors- Secondary tumorsC. Closed-loop- Key signs of CLO- Adhesive disease- Internal hernia- Gastric bypass related- VolvulusD. Mimics and pitfalls- Non-obstructive ischemia- Angioedema- Inflammatory enteritides (vasculitis, eosinophilic, IBD)- Radiation and GVHDE. A practical approach to reporting challenging cases

The goal of this exhibit is to familiarize the participants with the surgical anatomy of the most common forms of bariatric surgery. Participants can then use that knowledge as a basis to identify complications of bariatric surgery and corresponding CT and fluoroscopic imaging features.Upon completion of this educational exhibit, participants will be familiar with the normal CT and fluoroscopic imaging appearance as well as the CT and fluoroscopic appearance of postoperative complications for the most commonly performed bariatric procedures. Familiarity with this subject will allow for prompt diagnosis and management for bariatric patients.

CT and GI fluoroscopic appearance of:-Gastric bypass-Gastric band-Sleeve gastrectomyThis exhibit will highlight the CT and fluoroscopic appearance for the gamut of postoperative complications including but not limited to: -leaks-strictures-marginal ulcers-hernias-small bowel obstruction-intussusception-gastroesophageal reflux

1) Review the indications, contraindications, and technique for the small bowel follow-through2) Review the normal fluoroscopic appearance of small bowel anatomy3) Provide a practical algorithmic approach to small bowel pathologies on fluoroscopy with an emphasis on clinical significance4) Discuss the role of the small bowel follow-through in small bowel motility assessment5) Fluoroscopic - cross-sectional imaging correlation

Introduction. Indications, contraindications, and technique. Discussion of the following entities with case examples and an approach for diagnosis and further managementMotility Assessment:• Normal small bowel transit times• Bedside SBFT for assessment of small bowel obstruction.Congenital: • Duplication cyst communicating with ileum• Cystic fibrosis• Meckel’s diverticulum• Malrotation.Infectious:• Ascariasis• Giardiasis• Mononucleosis• Strongyloides• Tuberculous enteritis• Typhoid ileitis• Whipple’s disease.Inflammatory: • Crohn disease (stenosis, diffuse mucosal thickening, colonic fistulae, enteroenteric fistula, sacculation, polyp, cobble stone)• Eosinophilic enterocolitis• Radiation enteritis• Scleroderma• Celiac Sprue• Amyloidosis• Henoch-Schoenlein Purpura• GVHD• Sclerosing mesenteritis. Neoplastic: • Adenocarcinoma• Carcinoid• Gastrointestinal stromal tumors• Lymphoma• Zollinger-Ellison syndrome• Metastasis. Miscellaneous: • Ischemia• Intestinal neuropathy• Small bowel - small bowel intussusception• Diverticulosis• Hypoalbuminemia

Ulcerative colitis (UC) is a chronic inflammatory disease that can present at various stages of disease activity. Ileocolonoscopy and biopsy are the tests of choice to diagnose ulcerative colitis and assess disease severity. The value of MR enterography (MRE) is its usefulness in transmural/extramural assessment and identification of disease complications and extraintestinal manifestations. On the other hand, a complete colonoscopy might be unachievable in some patients, even in the expert hands, due to anatomical limitations or disease severity. However, this role is less emphasized compared to Crohn’s disease due to the gradual course of UC, which is confined to the mucosa/submucosal layers of the colon. Beyond describing UC extension and severity, after completing this educational material, the readers will be able to recognize the value of MRE in: 1. Assessment of GI tract abnormalities beyond the colon in UC. 2. Identifying acute complications related to UC. 3. Describing benign and malignant disorders superimposed on UC. 4. Diagnosis of post-surgical complications in UC.

Ø Background Ø Technical considerations Ø Imaging features of UC variants in MRE Ø Acute complications Ø Extra-colonic manifestations Ø Benign disorders superimposed on UC Ø Malignant disorders superimposed on UC Ø Post-surgical imaging findings and complications Ø Mimickers Ø A practical algorithm for interpretation of MRE in UC Ø Conclusion Ø References

1. Familiarity with surgical techniques for deceased-donor and living-donor liver transplantation and postoperative anatomy 2. Familiarity with pertinent variant anatomies affecting the future transplant and role of imaging for their pre-operative assessment 3. Familiarity with role of imaging in early post-operative assessment of liver allograft 4. Familiarity with the common post-transplant complications and their imaging findings

[All information will be presented and highlighted in an interactive questions-based and case-based format.]Indications• Current and expanding indications for liver transplantation• The issues with organ availability and organ allocationSurgical Techniques• Surgical techniques for deceased liver transplant• Surgical techniques for living donor liver transplant• Postsurgical anatomyPretransplant evaluation• Imaging assessment of recipient for surgical candidacy• Imaging assessment of living donor candidate o Overview of different imaging techniques and protocols o Pertinent variant biliary and vascular anatomy that may affect surgical planning o Segmentation and calculation of liver volumesPostoperative complications• Early post-operative complications• Delayed post-operative complications o Post-Transplant Lymphoproliferative Disorder (PTLD) and other malignancies

o To provide a comprehensive review of bile pathway anatomy and a basic approach to Its histology o To be able to identify abnormal appearance of the biliary tree on radiologic images, image patterns and the most common causes of diffuse biliary tree diseases o To include anatomopathological correlation for the pathologies reviewed so the radiologic signs associated to each entity can be better understood. o Key signs to be considered to differentiate malignance from other diseases

1. Overview 2. Possible etiologies3. Case based - review with histopathologic correlation4. Pearls5. Conclusions

1 - To demonstrate the vascular reconstructions techniques in hepatopancreatobiliary surgeries, including the liver transplant scenario.2 - To recognize the vascular surgical complications and how to elaborate a structured report that may help the clinical management.3 - To Illustrate the different imaging methods for evaluating vascular complications, such as Computed Tomography (CT) and ultrasonography (US).

1 - Illustration of typical imaging features of vascular complications supported by the use of graphics and cross-sectional imaging cases, such as arterial and venous stenosis and thrombosis.2 - Knowledge of hepatic vascular reconstruction is mandatory for early recognition of postoperative complications. 3 - Summary and take home messages.

- Recognize the importance of swallow mechanism in the diagnostic algorithm of dysphagia- Learn the indications and technique used in the performance of a swallow mechanism- Review the normal anatomy of the oral cavity, oropharynx, hypopharynx, and esophagus- Understand the physiology and different phases involved in deglutition- Case-based review of the main radiologic signs and features observed in deglutition alterations leading to dysphagia

1. Normal anatomy - Oral cavity - Oropharynx - Hypopharynx - Esophagus - Anatomic variants2. Indications and technique of swallow mechanism - Useful projections - Oral contrast consistencies3. Deglutition physiology - Oral phase - Pharyngeal phase - Esophageal phase4. Deglutition pathology a) Oral phase: - Lip incompetence - Leakage to the oropharynx - Nasopharyngeal refluxb) Pharyngeal phase: - Functional alterations: penetration, aspiration, asymmetry, stasis, cricopharyngeal disfunction- Structural alterations: esophageal web, Killian Jamieson`s diverticulum, Zenker`s diverticulumc) Esophageal phase: - Functional: achalasia, diffuse esophageal spasm - Structural: epiphrenic diverticulum

• Review surgical techniques of liver transplant with a focus on vascular anatomy.• Discuss imaging findings of common vascular complications after liver transplant.• Understand and recognize unique imaging findings of uncommon vascular findings and complications of liver transplant.

1. Liver transplant surgical techniques a. Review of liver transplant anatomy, including that of conventional, piggyback, deceased donor, and split liver techniques 2. Imaging work-up of liver transplant complications 3. Hepatic artery complications a. Hepatic artery thrombosis b. Hepatic artery stenosis c. Hepatic artery kinking d. Reversal of hepatic arterial flow e. Hepatic arterial-portal venous fistula f. Hepatic artery pseudoaneurysm 4. Portal vein complications a. Portal vein thrombosis b. Portal vein stenosis c. Portal vein compression d. Portal vein size discrepancy e. Portal steal f. Primary nonfunction 5. Hepatic vein/IVC complications a. IVC thrombosis b. IVC stenosis c. Venocaval anastomotic stricture

Illustrate the malignant tumor (non-HCC malignancies and atypical HCC), which are classified as LR-M in the LI-RADS v2018 as follows: 1. The definition of LR-M criteria including “targetoid” and “nontargetoid” imaging appearance on EOB-enhanced MRI. 2. The relationship between the targetoid/nontargetoid imaging appearances and pathological findings (i.e., fibrosis, peliotic change, mucin, cell density/ ischemia, necrosis). 3. The relationship between delayed (or persistent) extracellular contrast enhancement effects and targetoid imaging appearances. 4. Exhibit of non-HCC malignancies with targetoid or nontargetoid imaging appearance (i.e., intrahepatic cholangiocarcinoma, cholangiolocellular carcinoma, sarcomatous HCC, neuroendocrine tumors, mucinous carcinoma, intraductal papillary neoplasm of the bile duct and primary hepatic lymphoma). 5. New knowledge about the atypical HCCs with targetoid or nontargetoid imaging appearance favoring non-HCC malignancies.

LI-RADS v2017 introduced an important update to the LI-RADS-M (LR-M; probably or definitely malignant but not HCC specific) category to clarify appropriate use. Specifically, LR-M was modified as follows: “targetoid mass” including peripheral hypercellularity and central stromal fibrosis or “nontargetoid mass” including an infiltrative appearance, marked diffusion restriction, necrosis or severe ischemia, in addition to features that suggest a non-HCC malignancy in radiologist’s judgment. While these imaging findings are not specific finding, to understand these imaging findings are helpful in the diagnosis of hepatic tumors, and is important in assignment of the LI-RADS.

1) Identify components of post-operative anatomy for a) Standard Whipple b) Pylorus-sparing Whipple2) Identify normal post-operative findings and distinguish them from complications

1) Conventional Whipple consists ofa) Partial pancreatectomy and pancreaticojejunostomyb) Duodenectomyc) Distal gastrectomy and gastrojejunostomyd) Cholecystectomy and hepaticojejunostomy2) Pylorus-sparing Whipple consists ofa) Partial pancreatectomy and pancreaticojejunostomyb) Partial duodenectomy and duodenojejunostomyc) Cholecystectomy and hepaticojejunostomy3) Common normal post-operative findingsa) Post-operative anatomy: 1) Hepaticojejunostomy 2) Pancreaticojejunostomy 3) Gastrojejunostomyb) Vascular reconstructionsc) Jejunal limb edema4) CT appearance of post-operative complicationsa) Delayed gastric emptying (a clinical diagnosis)b) Pancreatic fistulac) Biliary leakd) Hemorrhagee) Acute pancreatitisf) Vascular thrombus

Intralesional fat within the abdominopelvic viscera narrows differential diagnosis for benign and malignant disease processes. Abdominal and pelvic fat distribution can help diagnose co-existent and unrecognized disease. The presence of fat within a lesion does not automatically suggest a benign diagnosis. It is critical for radiologists to identify when a fat-containing lesion is most likely malignant.

1. Introduction of fat-containing lesions and typical appearance on ultrasound, CT, and MRI2. Case-based review of benign and malignant fatty lesions in the following locations: a. Right upper abdomenb. GI tractc. Renal and adrenal glandsd. Reproductive systeme. Retroperitoneum f. Mesentery/peritoneum

GIST is the most common single type of sarcoma and the most common mesenchymal tumor in the GI tract. Teaching points include 1) Approximately 25% of GIST are discovered incidentally. GISTs have 3 morphologic patterns: spindle, epithelioid, and Wild-Type which can be associated with genetic syndromes and worse prognosis. 2) The diagnostic workup of GIST consists of the initial imaging with contrast-enhanced CT(CECT), detection of metastasis with CECT or PET/MRI, and definitive diagnosis by histopathology. Given its propensity for the stomach, CT protocols for GIST can be optimized with changes in patient position, use of oral water, CO2 crystals or positive enteric contrast. Multiphase CECT is useful in differentiating enhancement patterns of GIST vs other tumors. 3) Surgery remains the standard of care for localized tumors, but systemic therapy may be indicated based off unfavorable tumor locations, metastases, and genetic mutations. New biologic treatments (Imatinib, Sunitinib) have changed the clinical management of GIST and radiomic response evaluation continues to evolve to better assess disease progression. RECIST focuses on unidimensional, anatomic measurements, CHOI evaluates both anatomic and functional measurements, while PERCIST measures the metabolic response of tumors. We will discuss the strengths and weaknesses of these different criteria and how they impact patient management.

GIST Outline:- Pathophysiology- Clinical manifestations- Diagnostic imaging modalities/imaging features- Optimizing imaging protocols - Differential diagnoses on imaging- Treatment options, new biologic drugs- Radiomics (RECIST, PERCIST, CHOI) strengths and weaknesses

* To review the indications, limitations, and benefits of plain abdominal radiographs.* To discuss the basic projections in the abdominal radiograph.* To show normal anatomy and its variants.* To analyze the systematic approach for interpretation of abdominal radiographs and provide a guide for residents.* To recognize normal bowel from the abnormal small and large bowel. * To be familiarize with descriptive terms for common bone and soft tissue abnormalities seen on abdominal radiographs.* To review abnormal calcification on an abdominal radiograph. * To review the lines, tubes, and other devices commonly seen on AXR including their purposes and proper positions.

1. Review of indications, advantages, and disadvantages of plain abdominal radiographs. 2.Discuss the basic projections in the abdominal radiograph. 3.Explain the normal anatomy and its variants. 4.Discuss the algorithm for the evaluation of abdominal x-ray. 5. Present a series of cases to exemplify the most important diseases presented in AXR: - Abnormal calcifications: solid organs, hollow organs, and others. -Classification of bowel gas patterns: intraluminal and extraluminal. -Fluid/Soft Tissue Density: intraluminal and extraluminal. - Displacement of Structures: splenomegaly and hepatomegaly. - Bone and soft tissue abnormalities: osteophytes, neoplasms, post traumatic, and metabolic. 6. Recognize and illustrate devices commonly seen on AXR, the lines, tubes, and drains with demonstrative cases. 7. Conclusions and a complete section of key points of what residents need to know of abdominal X-rays. 8. References.

Since the turn of the 21st century, there has been a significant increase in the number of Cosmetic Surgeries performed. In 2020 alone, there were more than 2 million cosmetic procedures in the United States, including over 200,000 liposuction procedures, over 90,000 abdominoplasties, and more than 20,000 gluteal augmentation surgeries. While most of these cases do not undergo routine pre- or post-operative imaging, the increased incidence of these surgeries has led to an increased number of post-op patients who are imaged for other reasons. It is important to understand the expected post-operative appearances of these procedures so as to not misdiagnose pathology, and to correctly identify complications, if present.The expected post-surgical appearances and possible complications vary depending on the specific surgery. Gluteal injections and implants can be complicated by silicone granuloma formation or implant rupture. Abdominoplasty with gluteal fat transfer (i.e. “Brazilian Butt Lift”) can be complicated by fat embolism; the risk varies with the surgical technique used. Complications for most procedures include infection, hematoma, and dehiscence.

Background on Cosmetic SurgeryAbdominal Wall Augmentationo Liposuctiono Abdominoplasty§ Abdominoplasty with Gluteal Fat TransferGluteal Augmentationo Implantso InjectionsPelvic Augmentationo Cosmetic Phalloplastyo Cosmetic LabiaplastyComplicationso Hematomao Infectiono Dehiscenceo Fat Embolismo Granuloma Formationo Implant Rupture

The accuracy improvement of diagnostic imaging of pancreatic cancer including the early lesion is necessary. Functional information obtained by perfusion CT (PCT) would be able to address unmet clinical needs in conventional diagnostic imaging based on morphological images. We have developed a novel protocol that incorporates volumetric PCT into multiphasic contrast-enhanced CT, enabling broad clinical use. Besides reducing radiation exposure, this method provides high-resolution perfusion information through parametric map fused with morphological images. In general, pancreatic cancer is depicted as a decreased area of blood flow and blood volume and a prolonged area of mean transit time compared with the background pancreatic parenchyma. Imaging assessment using PCT increased the diagnostic accuracy of small pancreatic cancers and helped detect minute lesion that was not visible as a mass. Perfusion information is associated with histopathological features, and its detailed examination may be useful in the management of pancreatic cancer.

1. Clinical issues in imaging diagnosis of pancreatic cancer. 2. Development of PCT imaging protocol. 3. High-resolution perfusion imaging: Parametric map analysis. 4. Reduction of exposure dose. 5. Imaging evaluation of pancreatic cancer using PCT. 6. Clinical usefulness and research applications.

• To assess the role of contrast enhanced ultrasound (CEUS) in the characterization of non-traumatic splenic focal lesions. • To review the technique used and the main fundamentals of CEUS as well as the main indications. • To analyze the different focal splenic lesions through representative cases with special emphasis on the semiology of the lesions and their behavior after the injection of ultrasound contrast material.

Focal splenic lesions (FSL) are rare compared to those of other organs such as the liver and are often discovered incidentally. Conventional ultrasound and Doppler ultrasound have a limited role in the characterization of FSL, many of them being non-specific due to the wide spectrum of radiological manifestations they may present. CEUS is an accessible, inexpensive and safe technique that can help in the characterization of FSL. We analyzed the main imaging findings supporting us in the anatomopathological diagnosis, through representative cases performed in our center of both benign (simple cyst, abscesses, cystic lymphangioma, hemangioma, hamartoma) and malignant (lymphoma, metastasis) lesions.CEUS has an added role in the characterization of FSL allowing to see the enhancement of lesions in real time. Therefore, the spleen presents a special appetite for contrast due to the unique histological characteristics of this organ. CEUS may become a good alternative when other diagnostic techniques such as computed tomography (CT) and magnetic resonance imaging (MRI) are not available.

1. Conventional grayscale ultrasound (US) is useful in evaluating various gallbladder diseases; however, assessment of microvascularity is often needed for detailed wall assessment and to distinguish many benign from malignant processes. 2. Contrast-enhanced ultrasound (CEUS) is an easy and effective modality to differentiate conditions such as tumefactive sludge from gallbladder cancer. 3. CEUS may be useful in differentiating benign wall thickening from adenomyomatosis and chronic cholecystitis and gallbladder cancer. 4. CEUS can accurately demonstrate the microvascularity used to differentiate adherent biliary precipitate from polyps, and can help identify features of malignancy. 5. Cholecystectomy tube injection of ultrasound contrast can be used to determine cystic duct patency and identify leak.

1. Introduction:a. Briefly review microbubble formulation and pharmacokineticsb. Discuss imaging techniques with CEUS to optimize image quality 2. Case guided review of various gallbladder pathologies a. Benign i. Stones ii. Adenomyomatosis iii. Polyps iv. Chronic cholecystitis v. Tumefactive sludge b. Malignant i. Gallbladder carcinoma ii. Malignant polyps 3. Role of CEUS in interventions a. Image guided biopsy b. Evaluation of cholecystostomy tube for cystic duct patency and leaks 4. Pitfalls

- The retrorectal cystic lesions include a wide spectrum of etiologies.- The magnetic resonance imaging (MRI) allows approximate the diagnosis and to determine complications.- Diffusion weighted imaging (DWI) sequence is a cornerstone to suggest the presence of a solid component within the cyst.- Surgical management is mainly influenced by the MRI findings. The third sacral vertebra (S3) level is the key point for surgical approach selection.

1) Introduction and anatomy2) Differential diagnosis. Definition and imaging characteristics a) Developmental cysts - Dermoid cysts - Epidermoid cysts - Retrorectal cystic hamartomas (tailgut cysts) b) Malignancy - Rectal carcinomas with atypical presentations - Metastases c) Abscess d) Others - Vascular malformations - Granulomas3) MRI advantagesa) Intracystic content characterization - What to look for? (Size, lobulations, septum, walls, dense, fat and/or solid component) - Malignancy signs - Complications: infection and fistula. b) Malignant transformation - Why does it matter? Prognosis and management implications. - How to diagnose? DWI/ADC utility. Avoiding pitfalls: teratomas and dense-content lesions. c) Surgical planning. What radiologist apports to the surgeon? - Surgical approach selection. The S3 level. - Non-surgical treatment. The MRI role

To review the expected imaging appearance after hepatobiliary surgeries. To list radiologic features of early and late usual biliary postsurgical complications to provide a practical resource for radiologists to standardize examination. To illustrate cases of unusual complications after biliary procedures to improve the clarity and clinical impact of radiology reports.

Anatomy of the normal biliary tract. Most common variants of the biliary tree and their surgical relevance. Role of imaging in surgical planning and relevant report information. List of most common biliary surgeries and procedures. Epidemiological background of biliary procedures and associated complications. Usual complications after biliary procedures (biliary and nonbiliary, early and late ones), including key patient history, risk factors, imaging findings, and pitfalls. Unusual postsurgical biliary complications, including right hepatic artery pseudoaneurysm, post-cholecystectomy Mirizzi syndrome, late cholangitis after Kasai procedure, lung abscess due to retained gallstones, subcapsular liver hematoma after cholecystectomy, foreign-body granuloma caused by dropped gallstones simulating abdominal wall tumor, and others. Diagnostic tools, including magnetic resonance cholangiopancreatography (MRCP). Optimal imaging protocols.

Pancreatic adenocarcinomas are highly lethal and timely detection is key to improving patient prognosis. While most cases present with typical features of pancreatic ductal dilatation, hypo enhancing mass and mass with restricted diffusion, some cases can present a diagnostic dilemma and are frequently misdiagnosed. Recognizing the atypical features helps in early diagnosis. We present atypical cross-sectional imaging findings of pancreatic adenocarcinoma.To review the epidemiology, pathology, and prognosis of pancreatic ductal adenocarcinomaTo describe typical imaging characteristics of PDAC along with atypical features to improve diagnostic accuracyTo discuss optimization of imaging techniques with the goal of preventing diagnostic delays and improving prognosis

Introduction, epidemiology, clinical manifestations, histopathology, typical CT/MRI findings, atypical CT/ MRI findings including lesions without pancreatic ductal dilatation, lesions without restricted diffusion, lesions masquerading as cystic lesions, lesions presenting as acute pancreatitis, groove pancreatitis. Discussion on optimization of CT technique including use of dual energy, optimization of MRI techniques including use of MRCP, and T1 weighted sequences. Conclusion.

1. Revisiting fluoroscopic findings in inflammatory bowel disease (IBD) with cross sectional correlation. 2. Outline possible surgical interventions for IBD. 3. Steps to successful fluoroscopic evaluation prior to ileostomy reversal 4. Fluoroscopic assessment of postoperative surgical complications.

1. Introduction a. Definition of IBD b. Epidemiology 2. Multimodality imaging of IBD a. Small bowel follow-through and barium enema examination. i. Technique ii. Imaging findings b. Cross sectional imaging findings 3. Fluoroscopic evaluation prior to ileostomy reversal a. Evaluate records to determine anatomy and surgical anastomoses b. Scout images in multiple obliquities c. Water-soluble fluoroscopic LGI steps to success d. Troubleshooting common complications during LGI: how to navigate enterocutaneous fistulas, severe anastomotic strictures, no contrast progression into the ostomy bag, multiple anastomoses. 4. Common surgical procedures (Fluoroscopic assessment of the altered anatomy) a. Small bowel resection b. Small bowel strictureplasty c. Total abdominal colectomy with ileorectal anastomosis d. Total abdominal colectomy with end ileostomy e. Colectomy (segmental/total) f. Proctectomy g. Restorative proctocolectomy with ileal pouch anal anastomosis h. Balloon dilatation 5. Postoperative complications: Fluoroscopic assessment with cross sectional correlation a. Strictures b. Pelvic infections c. Anastomotic site leakage d. Pouch failure e. Pouch cancer f. Fecal incontinence 6. Conclusion and take-home messages

1. Distinguishing frequent and expected postoperative image findings after gastrointestinal tract surgical procedures from complications is essential in the early postoperative period, as well as detecting signs of possible complications that require further investigation.2. Intraperitoneal free air and fluid, fat stranding and bowel dilatation are extremely common findings in the early postoperative image and, although are expected, they can sometimes represent signs of complications. The imaging characteristics and evolution are key for this differentiation.3. Contrast-enhanced CT is the imaging method of choice for the evaluation of patients in the early postoperative period, with good characterization of gas and free fluid and the possibility of using positive oral contrast in patients with suspected anastomotic leakage or bowel perforation.

a. Introduction. b. CT protocol for early postoperative evaluation. c. Evaluation of intraperitoneal air: residual postoperative pneumoperitoneum or complication? d. Evaluation of intraabdominal fluids: sterile postoperative content or infected collections - imaging features and score systems. e. Fat stranding patterns of the mesentery that may suggest postoperative complications. f. Identification of dilated bowel and differentiation between metabolic, obstructive or ischemic conditions. g. Other expected postoperative findings and major early complications. h. Take home messages.

The purpose of this exhibit is:- To review usual and unusual cases of perianal fistulas.- To correlate important findings with the anatomy and pathophysiology.- To discuss image findings according to Parks and St James's University Hospital classifications, in order to enhance surgeons and radiologists’ skills.- To review MRI protocols in the evaluation of patients with perianal fistulas.- To highlight their characteristics in order to familiarize surgeons and radiologists with these conditions, preventing unfavorable patient outcome.

Applied anatomy of the anal sphincter complex.MRI protocols in the evaluation of patients with perianal fistula.Parks classification with sample cases of:- Intersphincteric Suprasphincteric- Transsphincteric- Extrasphincteric.St James's University Hospital classification with sample cases of:- Grade 1: simple linear intersphincteric fistula- Grade 2: intersphincteric fistula with an abscess or secondary track- Grade 3: transsphincteric fistula- Grade 4: transsphincteric fistula with an abscess or secondary track in the ischiorectal or ischioanal fossa- Grade 5: supralevator and translevator disease.Correlation between Parks and St James's University Hospital classifications.Submucosal fistula.How do I report?- Location- Track o Relationship to sphincters o Simple or complex?Sample cases of pearls, pitfalls, diagnostic difficulties, and mimics.Summary and take-home messages.

1. Radiological evaluation of the post-operative abdomen can be challenging and knowledge of normal post-operative anatomy is important to identify possible complications. 2. The intention of this pictorial review is to describe the most important gastrointestinal surgical techniques, their clinical indications and show their normal post-operative appearance on computed tomography (CT). 3. Besides that, this essay provides some signs to identifying the procedure, which can be helpful particularly when surgical history is missing, with recognition of the organ(s) involved, determination of what was resected and familiarity with the type of anastomoses used.

a. Introduction b. Imaging methods and protocols for postoperative evaluation. c. Identification of mechanical stapling patterns and radio-opaque markers from the anastomosis. d. Evaluation of gastric surgical techniques, including bariatric procedures and expected results. e. Evaluation of small bowel surgical techniques. f. Evaluation of the most common colorectal surgical techniques, including Hartmann procedure and restoration of intestinal continuity. g. Take-home messages.

1. Gallstone ileus represents a rare cause of small bowel obstruction. 2. Sensitivity of CT in the diagnosis of gallstone ileus is > 90%. 3. CT diagnosis of gallstone ileus is dependent on establishing the features of Rigler’s triad - small bowel obstruction, pneumobilia, and an ectopic calcified gallstone. 4. 15% - 20% of gallstones are radio-opaque. This fact limits the Radiologist’s ability to definitively establish the presence of an ectopic gallstone, although this presence is usually inferred based on associated features. 5. Spectral CT offers numerous advantages over standard CT. Spectral CT utilises the principle that elements and by extension mixed-composition materials cause differing attenuation of photons (via photo-electric absorption) at energy levels near the k-edge of the element in question, as compared to the remainder of the energy spectrum. The differing behaviour of elements across the energy spectrum allows material differentiation and the determination of material composition. 6. Effective atomic number (Z effective), mono-energetic (mono keV), and iodine density spectral reformats all aide in material differentiation. Z effective reformats provide the most reliable and reproducible results in relation to the detection of radio-lucent gallstones.

1. Introduction. 2. Role of conventional CT. 3. Conventional CT vs Spectral CT. 4. Spectral CT - options for diagnosis.

1 - Describe the anatomy of the main pancreatic transplantation technique.??2 - Discuss the Pancreas graft biopsy and Percutaneous needle biopsy technique guided by Ultrasound (US) and Computed Tomography (CT).3 - Discuss the sample of the pancreas considered adequate for evaluation.

1 - Review indications for pancreas transplantation and causes of graft injury.2 - Illustrate anatomy and surgical techniques supported by the use of graphics and cross-sectional imaging cases. 3 - Discuss the indication for pancreas graft biopsy and biopsy access routes.4 - Discuss what constitutes a satisfactory graft sample and what are the histopathological findings.5 - Summary and take home messages.

The purpose of this exhibit is: 1)To review imaging features on contrast enhanced CT, MRI of hepatocellular nodules found in vascular liver diseases with histopathological correlations. 2) To discuss the point of differential diagnosis.

Hepatocellular nodules have been recognized in vascular liver diseases (Budd-Chiari syndrome, congenital portosystemic shunt, hereditary hemorrhagic telangiectasia, extrahepatic portal vein obstruction and congenital heart disease etc.). They may be related to portal venous deprivation, venous outflow obstruction, or arterial diseases, imbalances in arterial, portal, and venous blood flow have been reported to cause nodule formation. These nodules include nodular regenerative hyperplasia, large regenerative nodule, partial nodular transformation, focal nodular hyperplasia, and others, as well as hepatocellular adenoma and hepatocellular carcinoma, which are true neoplastic lesions. Some confusions in their identification and overlap in their definitions exist. This exhibit will describe the imaging appearances of each type of hepatocellular nodules found in the vascular liver diseases, by correlating with histology, and provide some clues for their differential diagnosis.

Deep learning reconstruction (DLR) has been introduced by several vendors to improve MR image quality. DLR has various benefits such as effective noise reduction in the diagnosis with MR imaging. The purpose of this presentation is: 1. To illustrate technical features of DLR compared with conventional reconstruction, 2. To discuss image quality of MR imaging using DLR, and 3. To discuss clinical impact on MR study in the diagnosis of abdominal diseases.

1. Overview 2. Principle of DLR 3. Difference from the conventional reconstruction technique 4. Sequences applicable to DLR: fast spin echo T2WI, single-shot fast spin echo T2WI, DWI, small field-of-view DWI, fast imaging employing steady-state acquisition (FIESTA), etc. 5. Effective reduction of image noise with DLR 6. Improved spatial resolution with DLR 7. Reduction of truncation artifacts with DLR 8. What purpose can DLR be used for in clinical practice? To improve image quality, to increase the spatial resolution of the images, to save acquisition time, or combination of them 9. Clinical impact on the diagnosis of liver diseases 10. Clinical impact on the diagnosis of pancreatic diseases 11. Summary