Navin, Patrick

ABSTRACT Chronic liver disease (CLD) is a major cause of global morbidity and mortality, with outcomes closely linked to the severity of liver fibrosis. While liver biopsy has historically been the reference standard for fibrosis staging, its invasiveness, sampling variability and limited suitability for longitudinal monitoring have driven the widespread adoption of non‐invasive tests (NITs). Imaging‐based biomarkers, particularly elastography, now play a central role in the clinical assessment and care pathway design. This review focuses on imaging techniques for non‐invasive assessment of liver fibrosis, with emphasis on elastography techniques: vibration‐controlled transient elastography (VCTE), ultrasound‐based shear wave elastography (SWE) and magnetic resonance elastography (MRE). Technical principles, advantages, limitations and implementation considerations are discussed to support informed selection across clinical contexts. VCTE offers rapid point‐of‐care assessment with extensive validation for identifying advanced fibrosis but is limited by operator dependence, reduced repeatability and lack of anatomical information. SWE provides real‐time, radiologist‐controlled assessment with improved applicability in obesity and ascites, though intervendor variability and operator dependence remain challenges. MRE demonstrates the highest diagnostic accuracy, reproducibility and technical success, with assessment of larger liver volume and strong performance across etiologies, albeit with limited access due to the requirement of an MRI system. Adjunct MRI biomarkers, including proton‐density fat fraction and iron‐corrected T1 mapping, further enhance liver phenotyping by characterising steatosis and fibro‐inflammatory activity. Understanding the strengths and limitations of each technique is essential for radiologists supporting multidisciplinary CLD management and service implementation, particularly in evolving healthcare environments such as Australia.

ABSTRACT Background Gastric emptying (GE) scintigraphy with 4‐h imaging and a radiolabeled chicken egg‐based meal (320 kcal, 30% fat) is the standard test for gastroparesis at Mayo Clinic, with an intraindividual coefficient of variation (COV intra ) of 23.8% for GE half emptying time (T 1/2 ). Alternative meals for patients with dietary restrictions, including egg allergies or vegan diets, are lacking, limiting test accessibility. The study aimed to establish a vegan, lactose‐, nut‐, and gluten‐free meal with similar caloric and fat content to the egg meal and to assess its performance in GE studies. Methods In Vitro: 99m Tc binding to egg meal over 4 h was compared to a calorically and nutritionally similar vegan alternative, JUST Egg, using a validated in vitro model simulating gastric conditions of pH, pepsin, and stirring. In Vivo: 10 healthy participants underwent randomized crossover GE scintigraphy with standard and vegan meals, spaced ≥ 3 days apart to measure GE% at 2 h, 4 h, and GE T 1/2 . Group comparisons and variance analysis included Rank Sum tests and Bland–Altman plots. Key Results In Vitro: A strong correlation ( R = 0.975, p ‐value < 0.01) between 99m Tc binding in the egg and vegan egg models was observed. Minimal variance (< 10%) was recorded at all time points. In Vivo: GE at 4 h and GE T 1/2 showed non‐statistically significant mean differences, < 2% and < 10 min respectively, between both meals. The intra‐individual variability was 18.8%. Conclusions and Inferences The vegan meal demonstrated in vitro stability, in vivo performance comparable to the egg meal, and a COV intra of 18.8%, which was lower than the 23.8% reported in repeat egg meal GE studies. Trial Registration ClinicalTrials.gov number NCT06991036 ( https://clinicaltrials.gov/study/NCT06991036?term=NCT06991036&rank=1 )

Radiologists are integral members of the interdisciplinary team for patients with mucinous appendiceal neoplasms and can directly affect care by suggesting the diagnosis of pseudomyxoma peritonei, optimizing imaging protocols for evaluating peritoneal implants, and reporting the primary tumor and spilled tumor cells thoroughly.

Abstract Adrenal infections are considered clinically important but often go unrecognized, with a significant number of cases only diagnosed post-mortem. The limited evidence regarding imaging findings in the literature emphasizes the need to detect and diagnose these infections early in disease course to improve patient outcomes. A range of microorganisms, including fungi, viruses, parasites, and bacteria, can directly or indirectly affect the morphology and function of the adrenal glands. When evaluating a patient with adrenal infection, several immunological and hormonal factors should be considered, such as the status of the hypothalamic-pituitary-adreno cortical axis and the serum cortisol level. Moreover, certain microorganisms specifically target one of the zones of the adrenal glands or vascular supply, resulting in distinct imaging manifestations. The purpose of this article is to describe the fundamental clinical features and imaging manifestations associated with adrenal infections, enabling radiologists to make informed interpretations and contribute to accurate diagnostic assessments.

Radiologists play a key role in the management of renal masses, and it is important to understand the nonsurgical treatment options for solid renal masses, typical imaging findings after treatment, common complications, and methods to avoid pitfalls.

Abstract Estrogen-secreting adrenocortical carcinoma (ACC) is exceedingly rare, representing 1% to 2% of all ACCs. We present a case of a 65-year-old man diagnosed with an estrogen-secreting, 4.3-cm right adrenal mass discovered during work-up for bilateral gynecomastia. Gynecomastia and hyperestrogenism resolved after laparoscopic adrenalectomy, and pathology was reported as adrenocortical adenoma. However, 5 years later, he again developed bilateral gynecomastia because of recurrent hyperestrogenism. Imaging revealed multiple metastases in the abdomen. Urine steroid profiling demonstrated increased androgen precursors, androgen metabolites, and glucocorticoid precursors. Ultrasound-guided biopsy of one of the metastases confirmed ACC. Initial therapy included debulking surgery with removal of metastatic lesions. Mitotane therapy was initiated 4 weeks later along with hydrocortisone for anticipated mitotane-induced adrenal insufficiency. Histopathology from the adrenalectomy specimen 5 years earlier was rereviewed and confirmed ACC. Estrogen-secreting adrenal tumors are exceedingly rare, and the majority are malignant. This case underlines the importance of making an initial accurate diagnosis of adrenal malignancy that allows better surgical planning and appropriate monitoring. Indeterminate imaging characteristics of the adrenal mass, as well as the presentation with estrogen excess, suggested an elevated risk for ACC. Initial pathology-based misdiagnosis illustrates the need for an expert adrenal pathologist to review these rare tumors.