Current concepts in the imaging of uterine sarcoma Tirumani, Sree Harsha; Ojili, Vijayanadh; Shanbhogue, Alampady Krishna Prasad ...
Abdominal imaging,
04/2013, Letnik:
38, Številka:
2
Journal Article
Recent advances in genetics and pathology have improved our understanding of diagnosis and staging of uterine sarcomas. The major types of uterine sarcomas include leiomyosarcoma, low-grade ...endometrial stromal sarcoma, undifferentiated endometrial sarcoma, adenosarcoma and carcinosarcoma. The distinctive biological behavior and poor overall survival of uterine sarcoma create challenges in the management of these tumors. We herein present a comprehensive review of taxonomy, epidemiology, pathology, imaging findings and natural history of a wide spectrum of uterine sarcomas.
Diversity, equity, inclusion, and representation in various sectors have garnered increasing attention in the past two decades, including healthcare. In this report we investigate representation of ...females and underrepresented minorities (URM) in the field of radiology and asses for significant growth trends in representation in residency training programs in the United States.
De-identified trainee demographic information for active radiology trainees from 2016 to 2021 was queried using the Accreditation Council for Graduate Medical Education (ACGME), and new radiology trainees using the National Resident Matching Program (NRMP)’s Main Residency Match Data and Reports databooks.
In 2021 females represented 26.7% of DR residency trainees and 22% of IR integrated trainees. In the same year URM trainees represented 11.3% of trainees and 8.7% of IR integrated trainees. From 2017 to 2021, diagnostic radiology had a compound average growth rate (CAGR) 1% (p <0.01) of female representation and 1.12% (p<0.01) of URM representation.
This study quantifies female and underrepresented minority representation among radiology trainees for diagnostic radiology and radiology subspecialities, identifying modest uptrends in representation within both demographics.
Anastomosing hemangioma (AH) is a rare, benign vascular neoplasm with distinctive histopathology and characteristic tumor distribution. AHs show marked proclivity to involve the kidneys, gonads and ...the retroperitoneal soft tissues; kidney is the most common target site often in the context of end stage renal disease. Recent studies have identified activating mutations of
GNA
genes that drive the molecular pathogenesis of AHs. AH appears as a solitary, well-circumscribed, hypervascular tumor that charters a benign course with an excellent prognosis. The purpose of this article is to provide a current update on clinical, pathological and imaging features of anastomotic hemangioma.
Background
Evaluation of prostate MRI relies on diffusion‐weighted imaging (DWI), commonly distorted by susceptibility artifacts, thereby creating a need for approaches to correct such distortion.
...Purpose
To compare geometric distortion on prostate MRI between standard DWI and a geometric distortion correction method for DWI described as static distortion correction DWI (SDC DWI).
Study Type
Retrospective case study.
Population
Thirty patients (ages 31–81 years) undergoing prostate MRI.
Sequence
Geometric distortions from echo planar imaging were corrected with the SDC DWI protocol, which first acquires a B0‐field map to estimate geometric distortions.
Assessment
Contours of the prostate were placed on axial T2‐weighted imaging (T2WI) as an anatomic standard. Pixel shifts and apparent diffusion coefficient (ADC) values were compared between prostate contours applied to the SDC DWI and standard DWI sequences. Detailed characterization of the impact of SDC DWI was performed in three representative patients.
Statistical Tests
One‐way analysis of variance (ANOVA) test, Spearman correlation test, and Bland–Altman plots were calculated.
Results
There was significantly greater overlap of the SDC DWI prostate region of interest (ROI) with T2WI than standard DWI with T2WI (10.56 cm2 ± 3.14, P < 0.05). R2 of ADC values from standard DWI vs. SDC DWI in the 30 patients ranged from 0.02–0.94 (mean 0.60). A patient without susceptibility artifact demonstrated minimal pixel shift ranging from 0.6–1.3 mm and high correlation of ADC values (R2 = 0.89) between SDC DWI and standard DWI. A patient with rectal gas showed greater pixel shift (range: –2.5 to –0.5 mm) and less ADC value correlation (R2 = 0.69). A patient with a pelvic phlebolith adjacent to the prostate showed an even greater pixel shift (range: 10–16 mm) and decreased ADC correlation (R2 = 0.21).
Data Conclusion
SDC DWI appears to correct for susceptibility‐related pixel shifts in the prostate compared with standard DWI, which may have value for assessing prostate lesions obscured by geometric warping.
Level of Evidence 4
Technical Efficacy Stage 1
J. Magn. Reson. Imaging 2019;50:1614–1619.
Hepatocellular carcinoma (HCC) is the most common primary malignant tumor of the liver worldwide. Noninvasive diagnosis of HCC is possible based on imaging features, without the need for tissue ...diagnosis. Liver Imaging Reporting and Data System (LI-RADS) CT/MRI diagnostic algorithm allows for standardized radiological interpretation and reporting of imaging studies for patients at high risk for HCC. Diagnostic categories of LR-1 to LR-5 designate each liver observation to reflect the probability of overall malignancy, HCC, or benignity based on imaging features, where LR-5 category has > 95% probability of HCC. Optimal imaging protocol and scanning technique as described by the technical recommendations for LI-RADS are essential for the depiction of features to accurately characterize liver observations. The LI-RADS MRI technical guidelines recommend the minimum required sequences of T1-weighted out-of-phase and in-phase Imaging, T2-weighted Imaging, and multiphase T1-weighted Imaging. Additional sequences, including diffusion-weighted imaging, subtraction imaging, and the hepatobiliary phase when using gadobenate dimeglumine as contrast, improve diagnostic confidence, but are not required by the guidelines. These optional sequences can help differentiate true lesions from pseudolesions, detect additional observations, identify parenchymal observations when other sequences are suboptimal, and improve observations conspicuity. This manuscript reviews the optional sequences, the advantages they offer, and discusses technical optimization of these sequences to obtain the highest image quality and to avoid common artifacts.
Graphical abstract
Quantitative imaging biomarkers of liver disease measured by using MRI and US are emerging as important clinical tools in the management of patients with chronic liver disease (CLD). Because of their ...high accuracy and noninvasive nature, in many cases, these techniques have replaced liver biopsy for the diagnosis, quantitative staging, and treatment monitoring of patients with CLD. The most commonly evaluated imaging biomarkers are surrogates for liver fibrosis, fat, and iron. MR elastography is now routinely performed to evaluate for liver fibrosis and typically combined with MRI-based liver fat and iron quantification to exclude or grade hepatic steatosis and iron overload, respectively. US elastography is also widely performed to evaluate for liver fibrosis and has the advantage of lower equipment cost and greater availability compared with those of MRI. Emerging US fat quantification methods can be performed along with US elastography. The author group, consisting of members of the Society of Abdominal Radiology (SAR) Liver Fibrosis Disease-Focused Panel (DFP), the SAR Hepatic Iron Overload DFP, and the European Society of Radiology, review the basics of liver fibrosis, fat, and iron quantification with MRI and liver fibrosis and fat quantification with US. The authors cover technical requirements, typical case display, quality control and proper measurement technique and case interpretation guidelines, pitfalls, and confounding factors. The authors aim to provide a practical guide for radiologists interpreting these examinations.
RSNA, 2023 See the invited commentary by Ronot in this issue.
Carcinoma of the rectum is one of the most common malignant tumours in the Western world. Preoperative knowledge of the local spread of rectal cancer is essential in the determination of the ...therapeutic strategy for this disease. Magnetic resonance imaging (MRI) has been described as being accurate in the detection of the extent of rectal cancer for staging. In particular, double-contrast material enhanced MRI of the rectum has been reported to better delineate tumours against the lumen and the normal mucosa I. Tissue characterization is excellent with MRI and can be improved further for staging of rectal cancer by enhancement of the mucosa with intravenously administered gadoliniumbased contrast combined with intraluminal contrast material to distend the bowel. Aqueous gel is a viable, easily accessible, inexpensive, and well-tolerated rectal contrast agent for preoperative evaluation of rectal cancer on MRI. It has high enough viscosity to adequately distend the bowel and signal characteristics that maximize the contrast between the rectal wall and the lumen, both on T2W and enhanced TlW images 6. Endoluminal distension with sonographic gel facilitates visualization of the primary tumour, delineating its extent and local spread. This in turn increases radiologist confidence and decreases the read-out time 7. We would like to advocate the use of aqueous jelly as a distension agent for MRI for rectal cancer. However, the exact accuracy of the distended vs nondistended rectal MRI in T staging and the impact of rectal distension on the distance from the tumour to the mesorectal fascia 8 and its implications for the surgeon are beyond the scope of this article and would be best assessed in a prospective randomized trial.
Cavernous hemangiomas are among the most common liver lesions encountered in abdominal imaging. While classical imaging characteristics usually aid the radiologist in confidently arriving at its ...diagnosis, atypical hemangiomas can prove to be difficult to distinguish from other more worrisome hepatic lesions such as metastases and hepatocellular carcinoma. Furthermore, some malignant lesions can display features that simulate hemangiomas. The radiologist must be aware of these pitfalls to make an accurate diagnosis, when possible.
•A diagnosis of hemangioma is established by classical imaging characteristics.•Hemangiomas with atypical imaging features may present a diagnostic dilemma.•Malignant liver lesions may display imaging features that overlap with hemangiomas.
The Liver Imaging and Reporting Data System (LI-RADS) is a comprehensive system for standardizing the terminology, technique, interpretation, reporting, and data collection of liver imaging with the ...overarching goal of improving communication, clinical care, education, and research relating to patients at risk for or diagnosed with hepatocellular carcinoma (HCC). In 2018, the American Association for the Study of Liver Diseases (AASLD) integrated LI-RADS into its clinical practice guidance for the imaging-based diagnosis of HCC. The harmonization between the AASLD and LI-RADS diagnostic imaging criteria required minor modifications to the recently released LI-RADS v2017 guidelines, necessitating a LI-RADS v2018 update. This article provides an overview of the key changes included in LI-RADS v2018 as well as a look at the LI-RADS v2018 diagnostic algorithm and criteria, technical recommendations, and management suggestions. Substantive changes in LI-RADS v2018 are the removal of the requirement for visibility on antecedent surveillance ultrasound for LI-RADS 5 (LR-5) categorization of 10-19 mm observations with nonrim arterial phase hyper-enhancement and nonperipheral “washout”, and adoption of the Organ Procurement and Transplantation Network definition of threshold growth (≥ 50% size increase of a mass in ≤ 6 months). Nomenclatural changes in LI-RADS v2018 are the removal of -us and -g as LR-5 qualifiers.
