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Intracholecystic papillary neoplasm (ICPN) is a rare preinvasive neoplasm of the gallbladder. The lesion typically appears as a polypoid lesion or gallbladder wall thickening. We report a case involving a 40-year-old man with an ICPN that lacked typical polypoid lesions and was difficult to differentiate from adenomyomatosis because of the presence of intramural cysts. Initial contrast-enhanced computed tomography and magnetic resonance imaging showed edematous gallbladder wall thickening. The lumen was constricted and surrounded by a cluster of small cysts that were suspected to be Rokitansky-Aschoff sinuses (RAS). There were also large cysts within the gallbladder wall. No mucosal irregularities or polypoid lesions were observed, and the mucosal continuity was preserved. After antimicrobial therapy, follow-up computed tomography revealed improvement in the thickening of the gallbladder wall; however, the cysts persisted and some had enlarged. The patient underwent laparoscopic cholecystectomy. Pathologically, a tubulopapillary lesion with atypical epithelial cells was observed in the lumen of the gallbladder, extending continuously into the RAS and cysts within the gallbladder wall. High-grade dysplasia was occasionally found, and microscopic foci of invasion were present. ICPN with associated invasive carcinoma was diagnosed. In conclusion, ICPN may not exhibit polypoid lesions or significant wall thickening on imaging. ICPN may present with secondary RAS dilatation, and the presence of large intramural cysts may be helpful in the diagnosis.

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The purpose of this report was to evaluate the usefulness of hyperdense whirl sign on unenhanced computed tomography (CT) for diagnosing gallbladder torsion. The CT scans of seven patients with gallbladder torsion were independently reviewed by two board-certified radiologists for locating the high-density core with twisting between the gallbladder neck and liver bed, termed hyperdense whirl sign. The sign was observed in six cases. The detection of a hyperdense whirl sign on unenhanced CT appears useful for diagnosing gallbladder torsion.

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This is a case report of fascioliasis that progressed from the hepatic to the biliary phases over 2 years. A woman in her late 60s ate Zingiber mioga from the field, which was followed by abdominal pain that occurred 1 month later. Although CT and MRI studies revealed an increase in blood eosinophils as well as multiple hepatic nodules, they vanished quickly. After 2 years, an MRCP study revealed multiple flat lesions, which were diagnosed as adult fascioliasis. Definitive diagnosis was provided by enzyme-labeled antibody method using fasciola-specific antigen. Triclabendazole was administered once to complete the treatment.

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PURPOSE: To evaluate the time-course changes of multiparametric MRI findings following focal cryotherapy for localized prostate cancer. METHODS: Sixteen patients who underwent focal cryotherapy as an initial curative treatment for localized prostate cancer during March 2017-April 2021 were included. Before the treatment, the patients underwent targeted prostate biopsy using MRI-transrectal ultrasound fusion. Overall, 64 MRIs were conducted after focal cryotherapy and the temporal post-treatment MR signal changes of the ablated area in T2WI, T1WI, DWI, and DCE-MRI were analyzed. RESULTS: Technical success was achieved in all patients. The median follow-up period was 22 months. The initial post-treatment MRI revealed significant signal changes in the target lesions for all patients, including the disappearance of findings suggestive of cancer. At 3 months post-treatment, most lesions were hyperintense with a hypointense rim on T2WI, T1WI, and DWI (83.3 %). After 6 months, hyperintensity reduced, and after 17 months, all lesions showed hypointensity in these sequences. DCE-MRI of most patients showed loss of internal enhancement; however, one patient exhibited residual nodular enhancement in the ablated area at 3 months, which disappeared after 6 months. Peripheral enhancement was common at 3 months, disappearing after 23 months. Two patients showed biopsy-evidenced local recurrence. The recurrent lesions showed hypointensity on T2WI with diffusion restriction and early contrast enhancement in the ventral transition zone. CONCLUSION: MRI findings of the ablated sites following focal cryotherapy for localized prostate cancer show dynamic signal changes, especially within the first 6 months.

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METHODS:: The cases of eight patients who underwent MRI and surgery for acute scrotum between January 2010 and January 2017 were evaluated. We recorded whether hyperintense fluid on T2 weighted images existed between the posterior aspect of the epididymis and the scrotal wall ("split sign") and investigated if it correlated with BCD in surgical findings. RESULTS:: In one patient without hydrocele, readers were unable to evaluate the anatomy of the tunica vaginalis. Among seven patients with hydrocele, five had the split sign and all were surgically confirmed as BCD. In two patients with hydrocele but no split sign, one had normal scrotal anatomy and the other had a BCD with a necrotic testis adherent to the scrotal wall. CONCLUSION:: The split sign on MRI corresponded well to the lack of fixation of the epididymis to the scrotal wall and detected BCD with high sensitivity (5/6). ADVANCES IN KNOWLEDGE:: A hyperintense area on T2 weighted image between the posterior aspect of the epididymis and scrotal wall ("split sign") is a useful MRI finding for diagnosing BCD.

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