Magnetic resonance imaging of the upper tract (pyelocalyces and ureters) or MR Urography (MRU) is technically possible and when performed correctly offers similar visualization of the upper tracts ...and for detection of non-calculous diseases of the collecting system similar specificity but with lower sensitivity compared to CTU. MRU provides the ability to simultaneously image the kidneys and urinary bladder with improved soft tissue resolution, better tissue characterization and when combined with assessment of the upper tract, a comprehensive examination of the urinary system. MRU requires meticulous attention to technical details and is a longer more demanding examination compared to CTU. Advances in MR imaging techniques including: parallel imaging, free-breathing motion compensation techniques and compressed sensing can dramatically shorten examination times and improve image quality and patient tolerance for the exam. This review article discusses updates in the MRU technique, summarizes clinical indications and opportunities for MRU in clinical practice and reviews advantages and disadvantages of MRU compared to CTU.
Purpose
To identify the frequency, source, and management impact of discrepancies between the initial radiology report and expert reinterpretation occurring in the context of a hepatobiliary ...multidisciplinary tumor board (MTB).
Methods
This retrospective study included 974 consecutive patients discussed at a weekly MTB at a large tertiary care academic medical center over a 2-year period. A single radiologist with dedicated hepatobiliary imaging expertise attended all conferences to review and discuss the relevant liver imaging and rated the concordance between original and re-reads based on RADPEER scoring criteria. Impact on management was based on the conference discussion and reflected changes in follow-up imaging, recommendations for biopsy/surgery, or liver transplant eligibility.
Results
Image reinterpretation was discordant with the initial report in 19.9% (194/974) of cases (59.8%, 34.5%, 5.7% RADPEER 2/3/4 discrepancies, respectively). A change in LI-RADS category occurred in 59.8% of discrepancies. Most common causes of discordance included re-classification of a lesion as benign rather than malignant (16.0%) and missed tumor recurrence (13.9%). Impact on management occurred in 99.0% of discordant cases and included loco-regional therapy instead of follow-up imaging (19.1%), follow-up imaging instead of treatment (17.5%), and avoidance of biopsy (12.4%). 11.3% received OPTN exception scores due to the revised interpretation, and 8.8% were excluded from listing for orthotopic liver transplant.
Conclusion
Even in a sub-specialized abdominal imaging academic practice, expert radiologist review in the MTB setting identified discordant interpretations and impacted management in a substantial fraction of patients, potentially impacting transplant allocation. The findings may impact how abdominal imaging sections best staff advanced MTBs.
Renal Neoplasms in Young Adults Gopee-Ramanan, Prasaanthan; Chin, Sook Suzy; Lim, Chris ...
Radiographics,
2022 Mar-Apr, Letnik:
42, Številka:
2
Journal Article
Recenzirano
Renal cell carcinoma (RCC) is usually diagnosed in older adults (the median age of diagnosis is 64 years). Although less common in patients younger than 45 years, RCCs in young adults differ in ...clinical manifestation, pathologic diagnosis, and prognosis. RCCs in young adults are typically smaller, are more organ confined, and manifest at lower stages of disease. The proportion of clear cell RCC is lower in young adults, while the prevalence of familial renal neoplastic syndromes is much higher, and genetic testing is routinely recommended. In such syndromic manifestations, benign-appearing renal cysts can harbor malignancy. Radiologists need to be familiar with the differences of RCCs in young adults and apply an altered approach to diagnosis, treatment, and surveillance. For sporadic renal neoplasms, biopsy and active surveillance are less often used in young adults than in older adults. RCCs in young adults are overall associated with better disease-specific survival after surgical treatment, and minimally invasive nephron-sparing treatment options are preferred. However, surveillance schedules, need for biopsy, decision for an initial period of active surveillance, type of surgery (enucleation or wide-margin partial nephrectomy), and utilization of ablative therapy depend on the presence and type of underlying familial renal neoplastic syndrome. In this pictorial review, syndromic, nonsyndromic, and newer RCC entities that are common in young adults are presented. Their associated unique epidemiology, characteristic imaging and pathologic traits, and key aspects of surveillance and management of renal neoplasms in young adults are discussed. The vital role of the informed radiologist in the multidisciplinary management of RCCs in young adults is highlighted.
RSNA, 2022.
There is a diverse group of non-gastrointestinal stromal tumor (GIST), mesenchymal neoplasms of the gastrointestinal (GI) tract that demonstrate characteristic pathology and histogenesis as well as ...variable imaging findings and biological behavior. Recent advancements in tumor genetics have unveiled specific abnormalities associated with certain tumors, influencing their molecular pathogenesis, biology, response to treatment, and prognosis. Notably, giant fibrovascular polyps of the esophagus, identified through
MDM2
gene amplifications, are now classified as liposarcomas. Some tumors exhibit distinctive patterns of disease distribution. Glomus tumors and plexiform fibromyxomas exhibit a pronounced affinity for the gastric antrum. In contrast, smooth muscle tumors within the GI tract are predominantly found in the esophagus and colorectum, surpassing the incidence of GISTs in these locations. Surgical resection suffices for symptomatic benign tumors; multimodality treatment may be necessary for frank sarcomas. This article aims to elucidate the cross-sectional imaging findings associated with a wide spectrum of these tumors, providing insights that align with their histopathological features.
Graphical abstract
Purpose
Fat-suppressed T2-weighted imaging (T2-FS) requires a long scan time and can be wrought with motion artifacts, urging the development of a shorter and more motion robust sequence. We compare ...the image quality of a single-shot T2-weighted MRI prototype with deep-learning-based image reconstruction (DL HASTE-FS) with a standard T2-FS sequence for 3 T liver MRI.
Methods
41 consecutive patients with 3 T abdominal MRI examinations including standard T2-FS and DL HASTE-FS, between 5/6/2020 and 11/23/2020, comprised the study cohort. Three radiologists independently reviewed images using a 5-point Likert scale for artifact and image quality measures, while also assessing for liver lesions.
Results
DL HASTE-FS acquisition time was 54.93 ± 16.69, significantly (
p
< .001) shorter than standard T2-FS (114.00 ± 32.98 s). DL HASTE-FS received significantly higher scores for sharpness of liver margin (4.3 vs 3.3;
p
< .001), hepatic vessel margin (4.2 vs 3.3;
p
< .001), pancreatic duct margin (4.0 vs 1.9;
p
< .001); in-plane (4.0 vs 3.2;
p
< .001) and through-plane (3.9 vs 3.4;
p
< .001) motion artifacts; other ghosting artifacts (4.3 vs 2.9;
p
< .001); and overall image quality (4.0 vs 2.9;
p
< .001), in addition to receiving a higher score for homogeneity of fat suppression (3.7 vs 3.4;
p
= .04) and liver-fat contrast (
p
= .03). For liver lesions, DL HASTE-FS received significantly higher scores for sharpness of lesion margin (4.4 vs 3.7;
p
= .03).
Conclusion
Novel single-shot T2-weighted MRI with deep-learning-based image reconstruction demonstrated superior image quality compared with the standard T2-FS sequence for 3 T liver MRI, while being acquired in less than half the time.
Graphical abstract
Survival Guide for Foreign-Born Faculty Members Lalwani, Neeraj; Shanbhogue, Krishna P; Tappouni, Rafel
Journal of the American College of Radiology,
04/2019, Letnik:
16, Številka:
4 Pt A
Journal Article
A wide spectrum of benign and malignant primary mesenchymal tumors and tumor-like lesions of the spleen has been recently included under the umbrella term 'stroma-derived' neoplasms and tumor-like ...lesions. These include dendritic cell neoplasms such as follicular dendritic cell sarcoma, EBV-positive inflammatory follicular dendritic cell sarcoma, and fibroblastic reticular cell tumor; smooth muscle and myofibroblastic lesions such as inflammatory pseudotumor, EBV-associated smooth muscle tumor and undifferentiated pleomorphic sarcoma as well as a diverse spectrum of vascular and vascular-stromal tumors and tumor-like lesions. While some tumor and tumor-like lesions are unique to the spleen, others may also occur in diverse extra-splenic viscera. These tumors and tumor-like lesions demonstrate characteristic histopathology, immunocytochemistry and biological behavior. While cross-sectional imaging studies allow detection, staging and limited characterization of these splenic lesions, histopathological confirmation permits optimal management and surveillance strategies.A wide spectrum of benign and malignant primary mesenchymal tumors and tumor-like lesions of the spleen has been recently included under the umbrella term 'stroma-derived' neoplasms and tumor-like lesions. These include dendritic cell neoplasms such as follicular dendritic cell sarcoma, EBV-positive inflammatory follicular dendritic cell sarcoma, and fibroblastic reticular cell tumor; smooth muscle and myofibroblastic lesions such as inflammatory pseudotumor, EBV-associated smooth muscle tumor and undifferentiated pleomorphic sarcoma as well as a diverse spectrum of vascular and vascular-stromal tumors and tumor-like lesions. While some tumor and tumor-like lesions are unique to the spleen, others may also occur in diverse extra-splenic viscera. These tumors and tumor-like lesions demonstrate characteristic histopathology, immunocytochemistry and biological behavior. While cross-sectional imaging studies allow detection, staging and limited characterization of these splenic lesions, histopathological confirmation permits optimal management and surveillance strategies.
Beginning a new job after radiology training is exciting but can also be nerve-racking. The key challenge remains making the strange familiar and assimilating with the new practice as soon as ...possible. This process is complicated and may require learning new policies, getting to know new colleagues, adapting to new surroundings, and learning new skills.
This article provides strategies to navigate professionally and adapt to a new environment.
The purpose of this study was to apply a visual assessment of the intensity and pattern of T1 hyperintensity at MRI to differentiate hemorrhagic renal cysts from renal cell carcinoma (RCC).
A total ...of 144 T1-hyperintense renal lesions (62 cysts, all showing no enhancement on subtracted contrast-enhanced images and either 2-year stability or unenhanced CT density > 70 HU, and 82 histologically confirmed RCCs) in 144 patients were included. Two radiologists independently characterized qualitative features of the T1 hyperintensity in each lesion on unenhanced T1-weighted images. An additional radiologist placed ROIs to measure lesions' T1 signal intensity normalized to that of the psoas muscle. Chi-square and unpaired t tests were performed to compare the pattern of T1 hyperintensity between groups.
The T1 hyperintensity was considered marked in 62.9% of cysts and 17.1% of RCCs for reader 1 and in 46.8% of cysts and 8.5% of RCCs for reader 2 (p < 0.001). The T1 hyperintensity exhibited a diffusely homogeneous distribution in 88.7% of cysts and 7.3% of RCCs for reader 1 and in 72.6% of cysts and 4.9% of RCCs for reader 2 (p < 0.001). The combination of both diffusely homogeneous distribution and marked degree of T1 hyperintensity achieved sensitivities of 40.3-56.5%, specificities of 97.6-98.8%, and accuracies of 73.6-79.9% for the diagnosis of T1-hyperintense cysts. The two cases of RCC exhibiting this imaging pattern for at least one reader were both papillary RCCs. Normalized signal intensity was 2.39 ± 0.99 in T1-hyperintense cysts versus 2.12 ± 0.84 in T1-hyperintense RCCs (p = 0.088).
Diffuse T1 hyperintensity, particularly when marked, strongly indicates a hemorrhagic cyst rather than an RCC. Deferral of follow-up imaging may be considered when this imaging appearance is encountered at unenhanced MRI.
Purpose
To assess subspecialty mix and case volumes of general and abdominal subspecialty radiologists interpreting abdominal MRI.
Methods
The 2016 CMS Physician/Supplier Procedure Summary Master ...File was used to obtain billed counts of radiologist-interpreted abdominal fluoroscopy, US, CT, and MRI examinations. The CMS Physician and Other Supplier Public Use File was used to assess the subspecialty mix and case volume of the radiologists interpreting those examinations.
Results
The fraction of all abdominal imaging examinations interpreted by generalists and abdominal subspecialty radiologists was 70.7% and 16.5% for fluoroscopy; 68.7% and 21.0% for US; 71.4% and 19.2% for CT; and 41.9% and 52.5% for MRI. In 2016, the fraction of general and abdominal radiologists interpreting > 50 fluoroscopy examinations on Medicare fee-for-service beneficiaries was 15.1% and 16.2%. For > 50 US examinations, the fraction was 61.5% and 60.5%; for > 50 CT examinations, 91.2% and 79.6%; and for > 50 MRI examinations, 4.0% and 28.5%. The fraction of abdominal imaging examinations interpreted overall by low-volume providers (those interpreting ≤ 50 examinations in 2016) was 59.5% for fluoroscopy, 17.5% for US, 6.3% for CT, and 50.6% for MRI.
Conclusion
Nationally, most abdominal fluoroscopy, US, and CT examinations are interpreted by general radiologists, who have similar annual volumes of these examinations as abdominal subspecialty radiologists. In contrast, most abdominal MRI examinations are interpreted by abdominal subspecialty radiologists, who attain considerably higher volumes. These findings have implications for workforce planning and abdominal imaging fellowship design to ensure their graduates are optimally prepared to contribute to their future practices.
