Purpose
To assess inter-reader agreement of key features from the SAR-AGA recommendations for the interpretation and reporting of MRE in adult patients with CD, focusing on the impact of radiologist ...experience on inter-reader agreement of CD phenotypes.
Methods
Two experienced and two less-experienced radiologists retrospectively evaluated 99 MRE in CD patients (50 initial MRE, 49 follow-up MRE) performed from 1/1/2019 to 3/20/2020 for the presence of active bowel inflammation (stomach, proximal small bowel, ileum, colon), stricture, probable stricture, penetrating disease, and perianal disease. The MRE protocol did not include dedicated perianal sequences. Inter-rater agreement was determined for each imaging feature using prevalence-adjusted bias-adjusted kappa and compared by experience level.
Results
All readers had almost-perfect inter-reader agreement (
κ
> 0.90) for penetrating disease, abscess, and perianal abscess in all 99 CD patients. All readers had strong inter-reader agreement (
κ
: 0.80–0.90) in 99 CD patients for active ileum inflammation, proximal small bowel inflammation, and stricture. Less-experienced readers had significantly lower inter-reader agreement for active ileum inflammation on initial than follow-up MRE (
κ
0.68 versus 0.96,
p
= 0.018) and for strictures on follow-up than initial MRE (
κ
0.76 versus 1.0,
p
= 0.027). Experienced readers had significantly lower agreement for perianal fistula on follow-up than initial MRE (
κ
: 0.55 versus 0.92,
p
= 0.008).
Conclusion
There was strong to almost-perfect inter-reader agreement for key CD phenotypes described in the SAR-AGA consensus recommendations including active ileum and proximal small bowel inflammation, stricture, penetrating disease, abscess, and perianal abscess. Areas of lower inter-reader agreement could be targeted for future education efforts to further standardize CD MRE reporting. Dedicated perianal sequences should be included on follow-up MRE.
Graphic abstract
Purpose
For more than half of Crohn’s disease patients, strictures will cause bowel obstructions that require surgery within 10 years of their initial diagnosis. This study utilizes computed ...tomography imaging and clinical data obtained at the initial emergency room visit to create a prediction model for progression to surgery in Crohn’s disease patients with acute small bowel obstructions.
Methods
A retrospective chart review was performed for patients who presented to the emergency room with an ICD-10 diagnosis for Crohn’s disease and visit diagnosis of small bowel obstruction. Two expert abdominal radiologists evaluated the CT scans for bowel wall thickness, maximal and minimal luminal diameters, length of diseased segment, passage of oral contrast, evidence of penetrating disease, bowel wall hyperenhancement or stratification, presence of a comb sign, fat hypertrophy, and small bowel feces sign. The primary outcome was progression to surgery within 6 months of presentation. The secondary outcome was time to readmission.
Results
Forty patients met the inclusion criteria, with 78% receiving medical treatment alone and 22% undergoing surgery within 6 months of presentation to the emergency room. Multivariable analysis produced a model with an AUC of 92% (95% CI 0.82–1.00), 78% sensitivity, and 97% specificity, using gender, body mass index, and the radiographic features of segment length, penetrating disease, and bowel wall hyperenhancement.
Conclusions
The model demonstrates that routine clinical and radiographic data from an emergency room visit can predict progression to surgery, and has the potential to risk stratify patients, guide management in the acute setting, and predict readmission.
Imaging Genitourinary Trauma Dane, Bari; Baxter, Alexander B; Bernstein, Mark P
The Radiologic clinics of North America,
03/2017, Letnik:
55, Številka:
2
Journal Article
Recenzirano
Contrast-enhanced multidetector computed tomography (MDCT) has become a critical tool in the evaluation of the trauma patient. MDCT can quickly and accurately assess trauma patients for renal, ...ureteral, and bladder injuries. Moreover, CT guides clinical management triaging patients to those requiring discharge, observation, angioembolization, and surgery. Recognition of urinary tract trauma on initial scan acquisition should prompt delayed excretory phase imaging to identify urine leaks. Urethral and testicular trauma are imaged with retrograde urethrography and sonography, respectively.
This study aimed to evaluate the image quality, image artifacts, radiologist confidence, and ability to provide definitive diagnosis for all patients with magnetic resonance imaging (MRI) performed ...after an abdominal fluoroscopic examination and to determine the utility of MRI in this setting.
Thirty-one MRI examinations performed a median of 2 days after fluoroscopic bowel evaluation (barium, n = 13; iodine, n = 18), 20 within 3 days of MRI, were retrospectively reviewed. The image quality, artifact emanating from bowel, inhomogeneity artifact, radiologist confidence, ability to render a definitive diagnosis, and identification of emergent or important findings for all MRI examinations were assessed. These same features were evaluated on 5 computed tomographies performed after fluoroscopy (before the MRI) in the same cohort.
All 31 MRI examinations performed after fluoroscopic studies with concentrated barium or iodine solutions were diagnostic for answering the clinical question according to radiologist and report review, regardless of magnet strength and type of fluoroscopic contrast ingested. Magnetic resonance imaging after fluoroscopy had excellent overall image quality (mean score, 4.74/5), minimal to no artifact emanating from bowel (mean, 4.63/5), minimal inhomogeneity artifact (mean, 4.38/5), and excellent diagnostic confidence (mean, 4.98/5). No additional imaging was necessary for diagnosis after MRI. Computed tomography after fluoroscopy had lower overall image quality, more image artifacts, and lower diagnostic confidence (P < 0.05).
Magnetic resonance imaging is a useful tool for evaluating patients with retained concentrated enteric contrast from recent fluoroscopic examinations. In the absence of contraindication, MRI should be considered in the evaluation of urgent clinical problems in patients who recently underwent a fluoroscopic bowel evaluation.
To evaluate the efficacy of "interleaved carbon minibeams" for ablating a 6.5-mm target in a rabbit brain with little damage to the surrounding brain. The method is based on the well-established ...tissue-sparing effect of arrays of thin planes of radiation.
Broad carbon beams from the National Aeronautics and Space Agency Space Radiation Facility at Brookhaven National Laboratory were segmented into arrays of parallel, horizontal, 0.3-mm-thick planar beams (minibeams). The minibeams' gradual broadening in tissues resulted in 0.525-mm beam thickness at the target's proximal side in the spread-out Bragg peak. Interleaving was therefore implemented by choosing a 1.05 mm beam spacing on-center. The anesthetized rabbit, positioned vertically on a stage capable of rotating about a vertical axis, was exposed to arrays from four 90° angles, with the stage moving up by 0.525 mm in between. This produced a solid radiation field at the target while exposing the nontargeted tissues to single minibeam arrays. The target "physical" absorbed dose was 40.2 Gy.
The rabbit behaved normally during the 6-month observation period. Contrast magnetic resonance imaging and hematoxylin and eosin histology at 6 months showed substantial focal target damage with little damage to the surrounding brain.
We plan to evaluate the method's therapeutic efficacy by comparing it with broad-beam carbon therapy in animal models. The method's merits would combine those of carbon therapy (i.e., tight target dose because of the carbon's Bragg-peak, sharp dose falloff, and high relative biological effectiveness at the target), together with the method's low impact on the nontargeted tissues. The method's smaller impact on the nontargeted brain might allow carbon therapy at higher target doses and/or lower normal tissue impact, thus leading to a more effective treatment of radioresistant tumors. It should also make the method more amenable to administration in either a single dose fraction or in a small number of fractions.
Computed Tomography Enterography Petrocelli, Robert; Dane, Bari
Journal of radiology nursing,
December 2021, 2021-12-00, Letnik:
40, Številka:
4
Journal Article
Recenzirano
Computed tomography enterography (CTE) is an abdominopelvic computed tomography (CT) tailored for evaluation of the small bowel. This multidetector CT examination uses neutral oral contrast to ...optimally distend small bowel. Patients are scanned after the rapid injection of intravenous contrast during peak bowel wall enhancement. CTE is excellent for the evaluation of many small bowel disorders, particularly Crohn's disease. The purpose of this article is to review CTE indications, contraindications, technique, safety considerations, and imaging findings of common small bowel diseases.
•Computed tomography enterography (CTE) is an abdominopelvic computed tomography tailored for evaluation of the small bowel using intravenous and neutral oral contrast to optimally distend small bowel.•Radiology nurses play a critical role in the process of generating high quality CTE images.
•4.9% pancreatic cyst detection rate at photon counting CT and 3% at conventional CT.•Greater pancreatic cyst detection in Photon Counting CTA than conventional CTA.•Greater frequency of newly ...described pancreatic cysts at photon counting CT.
To calculate the prevalence of pancreatic cysts on photon counting CT (PCCT) and compare with that of 128-slice conventional energy-integrating detector CT (EIDCT).
A retrospective single institution database search identified all contrast-enhanced abdominal CT examinations performed at an outpatient facility that has both a PCCT and EIDCT between 4/11/2022 and 7/26/2022. The presence and size of pancreatic cysts were recorded. In patients with PCCT reported pancreatic cysts, prior CT imaging (EIDCT) was reviewed for reported pancreatic cysts. Fisher’s exact test was used to compare the pancreatic cyst detection rate for PCCT and EIDCT. Wilcoxon rank sum test was used to compare cyst size and patient age. A p <.05 indicated statistical significance.
2494 patients were included. Our pancreatic cyst detection rate was 4.9 % (49/1009) with PCCT and 3.0 % (44/1485) for EIDCT (p =.017). For CT angiograms, pancreatic cysts were detected in 6.6 % (21/319) with PCCT and 0.0 % (0/141) with EIDCT (p <.001). Pancreatic cyst detection rate was not statistically different for portal venous, enterography, renal mass, pancreas, 3-phase liver, or venogram protocols (all p >.05). MeanSD pancreatic cyst size was 13.79.7mm for PCCT and 15.314.7 for EIDCT (p =.95). 55.1 % (27/49) of PCCT and 61.4 % (27/44) of EIDCT that described pancreatic cysts had prior contrast-enhanced EIDCTs. Of these, 40.7 % (11/27) of PCCT and 14.8 % (4/27) of EIDCT described pancreatic cysts were not previously reported (p =.027).
Photon-counting CT afforded greater pancreatic cyst detection than conventional energy-integrating detector CT, particularly with CT angiograms.
The purpose of this study is to report unanticipated lung base findings on abdominal CT in 23 patients concerning for coronavirus disease (COVID-19). In these patients, who were not previously ...suspected of having COVID-19, abdominal pain was the most common indication for CT (
= 19), and 11 patients had no extrapulmonary findings. Seventeen patients underwent polymerase chain reaction testing, which returned positive results for all 17.
Unsuspected coronavirus disease may be strongly suggested on the basis of lung findings on abdominopelvic CT.
To develop and test a deep learning approach named Convolutional Neural Network (CNN) for automated screening of T
-weighted (T
WI) liver acquisitions for nondiagnostic images, and compare this ...automated approach to evaluation by two radiologists.
We evaluated 522 liver magnetic resonance imaging (MRI) exams performed at 1.5T and 3T at our institution between November 2014 and May 2016 for CNN training and validation. The CNN consisted of an input layer, convolutional layer, fully connected layer, and output layer. 351 T
WI were anonymized for training. Each case was annotated with a label of being diagnostic or nondiagnostic for detecting lesions and assessing liver morphology. Another independently collected 171 cases were sequestered for a blind test. These 171 T
WI were assessed independently by two radiologists and annotated as being diagnostic or nondiagnostic. These 171 T
WI were presented to the CNN algorithm and image quality (IQ) output of the algorithm was compared to that of two radiologists.
There was concordance in IQ label between Reader 1 and CNN in 79% of cases and between Reader 2 and CNN in 73%. The sensitivity and the specificity of the CNN algorithm in identifying nondiagnostic IQ was 67% and 81% with respect to Reader 1 and 47% and 80% with respect to Reader 2. The negative predictive value of the algorithm for identifying nondiagnostic IQ was 94% and 86% (relative to Readers 1 and 2).
We demonstrate a CNN algorithm that yields a high negative predictive value when screening for nondiagnostic T
WI of the liver.
2 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2018;47:723-728.
