Abdominal Radiologists Research Articles

Rectal Cancer and Lateral Lymph Node Staging: Interobserver Agreement and Success in Predicting Locoregional Recurrence

Objectives: To evaluate the agreement among radiologists in the evaluation of rectal cancer staging and restaging (after neoadjuvant therapy) and assess whether locoregional recurrence can be predicted with this information. Materials and Methods: Pre-neoadjuvant and after-neoadjuvant therapy magnetic resonance imaging (MRI) examinations of 239 patients diagnosed with locally advanced rectal cancer were retrospectively reviewed by three radiologists. The agreement between the MRI findings (localization of tumor involvement, tumor coverage pattern, external sphincter involvement, mucin content of the mass and lymph node, changes in the peritoneum, MRI T stage, distance between tumor and MRF, submucosal sign, classification of locoregional lymph node, and EMVI) was discussed at the September 2023 meeting of the Society of Abdominal Radiology (SAR) and the interobserver and histopathological findings were examined. The patients were evaluated according to locoregional rectal cancer and lateral lymph node (LLN) staging, and re-staging was performed using MRI images after neoadjuvant treatment. The ability of the locoregional and LLN staging system to predict locoregional recurrence was evaluated. Results: Among the parameters examined, for the MRI T stage and distance between the tumor and the MRF, a moderate agreement (kappa values: 0.61–0.80) was obtained, while for all other parameters, the interobserver agreement was notably high (kappa values 0.81–1.00). LLNs during the restaging with an OR of 2.1 (95% CI = 0.33–4.87, p = 0.004) and a distance between the tumor and the MRF of less than 1 mm with an OR of 2.1 (95% CI = 1.12–3.94, p = 0.023) affected locoregional recurrence. A multivariable Cox regression test revealed that the restaging of lymph nodes among the relevant parameters had an impact on locoregional recurrence, with an OR of 1.6 (95% CI = 0.32–1.82, p = 0.047). With the LLN staging system, an increase in stage was observed in 37 patients (15.5%), and locoregional recurrence was detected in 33 of them (89.2%) (p < 0.001). Conclusions: LLN staging is not only successful in predicting locoregional recurrence among MRI parameters but is also associated with a very high level of interobserver agreement. The presence of positive LLN in the restaging phase is one of the most valuable MRI parameters for poor prognosis.

Heterogeneity of definition of upper gastrointestinal tract in different guidelines of Crohn's disease: A scoping review.

Crohn's Disease (CD) can affect any part of the gastrointestinal (GI) tract, including the upper GI tract (UGIT). However, the definitions and classifications of upper GI CD (UGICD) vary. We conducted a scoping review to explore how UGIT and UGICD are defined and to assess the heterogeneity of these definitions in published CD guidelines, aiming to inform future initiatives for harmonizing definitions. We conducted a search of MEDLINE and Embase for English-language guidelines on CD that mentioned upper GI-related terms in the titles, abstracts, or keywords from inception until 26 July 2024. Definitions of UGIT and UGICD were summarized descriptively. Of 1132 citations, only 19 records met our inclusion criteria. Only eight were identified as CD guidelines. None of them focuses on UGICD. Among these, five diagnostic guidelines explicitly mentioned "upper GI" in their abstracts. Only the joint European Crohn's and Colitis Organisation and European Society of Gastrointestinal and Abdominal Radiology guidelines clearly defined the UGIT. Most guidelines mentioned UGI terms related to upper endoscopy or biopsy only. It was unclear whether these guidelines typically included the esophagus, stomach, and duodenum in the definition of UGICD while excluding the distal small intestine. Although the latest guideline related to pediatric-onset IBD cited the 2011 Paris classification, none of the three guidelines published after that explicitly mentioned the proposed subdivided location of the upper disease. There is a lack of consistent reporting in defining UGICD according to disease location. It is unclear whether there is a consensus on excluding the small intestine beyond the duodenum. Additionally, there is no indication that the subdivided location of UGIT was considered in CD guideline development. Greater consistency in definitions would aid in diagnosis, clinical care, epidemiological research and inclusion into clinical trials. These findings underscore the need for developing a framework to standardize the classification of UGICD, especially for clinical trials.

A Multicenter Study on Hepatocellular Adenomas in Korea: Clinicopathological and Imaging Features With an Emphasis on β-Catenin Mutated Subtype.

The clinicopathologic and imaging features of hepatocellular adenomas (HCAs) in Asian population remain unclear. We aimed to analyse clinicopathologic and imaging features of HCAs in Korea and propose an imaging-based method to differentiate β-catenin mutated HCA (βHCA) from other subtypes. This retrospective multicenter study included pathologically confirmed HCAs from three tertiary institutions in Korea between 2010 and 2023. HCA subtypes were determined according to the current World Health Organization classification using immunohistochemical staining. Two abdominal radiologists reviewed computed tomography and magnetic resonance imaging scans. The clinical characteristics and imaging features of HCA subtypes were compared. A scoring system for βHCA was developed and validated using development (January 2010-April 2021) and validation (May 2021-March 2023) cohorts. 121 patients (47 men; mean age, 39.0 years ±13.5) with 138 HCAs were included. HCAs displayed characteristic clinicopathologic features, including a high proportion of male (38.8%) and obese patients (35.5%), with the inflammatory subtype being the most common (38.4%) and a low percentage of patients using oral contraceptive (5.0%). Each HCA subtype demonstrated distinct clinical and imaging features. The scoring system incorporating tumour heterogeneity and iso to high hepatobiliary phase signal intensity on MRI for differentiating βHCA exhibited high performance in both the development (AUC 0.92, 95% CI: 0.87-0.97) and the validation cohort (AUC 0.91, 95% CI: 0.77-1.00). This comprehensive analysis of clinicopathologic and imaging features of HCAs in Korea contributes to the characterisation of HCAs across different geographical regions. The imaging-based scoring system effectively differentiates βHCA.

Imaging of peritoneal metastases of ovarian and colorectal cancer: joint recommendations of ESGAR, ESUR, PSOGI, and EANM.

Diagnostic imaging of peritoneal metastases in ovarian and colorectal cancer remains pivotal in selecting the most appropriate treatment and balancing clinical benefit with treatment-related morbidity and mortality. To address the challenges related to diagnostic imaging and detecting and reporting peritoneal metastatic spread, a joint guideline was created by the European Society of Gastrointestinal and Abdominal Radiology (ESGAR), European Society of Urogenital Radiology (ESUR), Peritoneal Surface Oncology Group International (PSOGI), and European Association of Nuclear Medicine (EANM). A targeted literature search was performed and consensus recommendations were proposed using Delphi questionnaires and a five-point Likert scale. A total of three Delphi rounds were performed. Consensus was reached on the position of diagnostic imaging for assessment of operability, treatment response monitoring, and follow-up of peritoneal metastases, optimal imaging modality and their technical imaging requirements depending on the indication and how to optimise communication of imaging results by the report and multidisciplinary board discussion. The complete list of recommendations is provided. These expert consensus statements aim to guide appropriate indications, acquisition, interpretation, and reporting of imaging for operability assessment, treatment response monitoring, and follow-up of peritoneal metastases in ovarian and colorectal cancer patients. Question Staging peritoneal metastases (PM) helps toguide clinical decision-making for colorectal and ovarian cancer patients. How can we optimise the use of imaging techniques to assess PM? Findings Imaging plays a crucial role in the detection, operability assessment, treatment response monitoring, and follow-up of peritoneal metastases in colorectal and ovarian cancer patients. Clinical relevance These expert consensus statements aim to guide appropriate indication, acquisition, interpretation, and reporting of imaging for operability assessment, treatment response monitoring, and follow-up of peritoneal metastases in ovarian and colorectal cancer patients.

Gadoxetic acid-enhanced MRI for the detection of liver metastases from melanoma.

We aimed to assess imaging findings and detection sensitivity for melanoma liver metastases on gadoxetic acid-enhanced magnetic resonance imaging (MRI). This retrospective study included patients with melanoma liver metastasis who underwent gadoxetic acid-enhanced MRI. Two abdominal radiologists independently evaluated signal characteristics of liver metastases on morphologic imaging (precontrast T1- and T2-weighted imaging), diffusion-weighted imaging (DWI), dynamic imaging, and hepatobiliary phase (HBP). Imaging findings were compared according to detection on HBP and the primary site of the melanoma using logistic regression with the generalized estimating equation (GEE). Detection sensitivity for metastases was compared among different MR imaging sets using logistic regression with GEE. A total of 67 patients with 254 liver metastases were included (44 women; mean age ± standard deviation, 65.6 ± 13.0 years). On HBP, 76.0% of metastases were detected, and 55.5% (141/254) showed hypointensity. Most of the metastases that were not detected on HBP originated from ocular melanomas (98.4%, 60/61), ≤1 cm (90.2%, 55/61) and showed T1 hyperintensity (98.4%, 60/61). Metastases from non-ocular melanomas more frequently showed T1 hypointensity, T2 hyperintensity, diffusion restriction, arterial enhancement, and HBP hypointensity than those from ocular melanomas (Ps ≤ 0.019). The detection sensitivity of HBP (76.0%) was significantly higher than DWI (65.7%, P = 0.006), but lower than morphologic imaging (98.8%, P < 0.001) and dynamic imaging (97.6%, P < 0.001). The detection sensitivity of HBP for melanoma liver metastasis was 76.0%, which was lower than that of morphologic or dynamic imaging. HBP of gadoxetic acid-enhanced MRI has little advantage in detecting melanoma liver metastases.

Ultrasound innovations in abdominal radiology: techniques and clinical applications in pediatric imaging.

Contrast-enhanced ultrasound, microvascular imaging, elastography, and fat quantification have varying degrees of utility, with some applications in the pediatric setting mirroring that in adults and having unique uses when applied to children in others. This review will present novel ultrasound technologies and the clinical context in which they are applied to the pediatric abdomen. New ultrasound technologies have a broad range of applications in clinical practice and represent a powerful diagnostic tool with the potential to replace other imaging modalities, such as magnetic resonance imaging and computed tomography, in specific cases.

Micro-enema immediately prior to prostate MRI: effects on rectal gas, image quality and PI-QUAL score.

Our aim was to determine whether the administration of a micro-enema immediately prior to prostate MRI is associated with a reduction in rectal gas, gas related artifacts and an improvement in image quality and PI-QUAL score. This retrospective analysis enrolled 171 patients who underwent multiparametric 3T prostate MRI at our institution between January 2021 and September 2022. 86 patients received a micro-enema, and a further 85 patients did not. Two fellowship trained abdominal radiologists were blinded and independently reviewed each prostate MRI, recording scores on a dedicated scoring sheet. The quality of T2 weighted (T2W), diffusion weighted (DWI), and dynamic contrast enhancement (DCE) images were assessed according to standardised scales supported in the literature. In addition, gas related artifacts and rectal gas level were examined. An independent-samples Mann-Whitney U and t-test were performed, comparing both the median and mean score between micro-enema and no micro-enema groups for each reader. Spearman's correlation was used to determine the strength of relationship between variables. A quadratic weighted Cohen's Kappa and percent agreement were used to assess inter-observer agreement. Image quality was improved in those who received the micro-enema compared to those who did not according to the visual grading scale on the DWI sequence for both readers (reader 1: median 4 vs. 4, p < 0.001, mean 4.27 vs. 3.92, p < 0.001; reader 2: median 5 vs. 4, p < 0.001, mean 4.74 vs. 4.14, p < 0.001). PI-QUAL score was significantly improved in the micro-enema group for reader 2 only (reader 1: median 4 vs. 4, p = 0.25, mean 3.99 vs. 4.08, p = 0.21; reader 2: median 5 vs. 5, p = 0.01, mean 4.95 vs. 4.78, p = 0.01). Visual grading score for both the T2W and DCE images was not significantly different. Rectal gas level was lower in patients who received the micro-enema for both readers (reader 1: median 2 vs. 4, p < 0.001, mean 2.12 vs. 3.60, p < 0.001; reader 2: median 1 vs. 2, p < 0.001, mean 1.37 vs. 2.48, p < 0.001), correlating with a lower score for gas-related artifacts (reader 1: median 1 vs. 2, p < 0.001, mean 1.50 vs. 1.92, p < 0.001; reader 2: median 1 vs. 1, p < 0.001, mean 1.16 vs. 1.71, p < 0.001) in this group. Correlation between rectal gas level and gas-related artifacts on DWI regardless of whether a micro-enema was given was strong (rs = 0.71, p < 0.001). Correlation was moderate to strong between rectal gas level and image quality on DWI (rs = -0.63, p < 0.001). There was only 1 (1.2%) borderline diagnostic or non-diagnostic DWI sequence in those who received the micro-enema, compared to 9 (10.6%) in those who did not (p = 0.009). Interobserver agreement was moderate for image quality on DWI, gas related artifacts and rectal gas level (weighted kappa values of 0.52, 0.49 and 0.53 respectively). The administration of a micro-enema immediately prior to prostate MRI is associated with a significant improvement in image quality on the DWI sequence compared to no bowel preparation. This is mediated through a reduction in rectal gas and gas related artifacts. Improvements in PI-QUAL score was mixed between readers.

Whether the Liver-to-Portal Vein Ratio is Applicable for Evaluating the European Society of Gastrointestinal and Abdominal Radiology Hepatobiliary Phase in Gd-EOB-DTPA-Enhanced MRI?

This study aimed to verify whether the Liver-to-portal Ratio (LPR) can assess the adequacy of the Hepatobiliary Phase (HBP) for patients with different liver functions. A total of 125 patients were prospectively enrolled in the study and graded into the non-cirrhosis group (45), Child-Pugh A group (40), and Child- Pugh B/C group (40). The LPR on HBP was calculated after eight HBPs were obtained within 5-40 minutes. The adequate HBP was determined according to the 2016 European Society of Gastrointestinal and Abdominal Radiology (ESGAR) consensus statement. The differences in LPR and lesions' conspicuity between 10-min HBP and adequate HBP were analyzed by paired t-test and Wilcoxon signed-rank test, respectively. The chisquare test was used to test the difference in proportion with LPR larger than 1.462 between 10-min HBP and adequate HBP. The differences in LPR and lesions' conspicuity between 10-min HBP and adequate HBP were significant in Child-Pugh A and Child-Pugh B/C groups (P < 0.05), except for the non-cirrhosis group (P > 0.05). The differences in proportion with LPR larger than 1.462 between 10-min HBP and adequate HBP were not statistically significant in all groups (all P > 0.05). The adequate HBP obtained according to the 2016 ESGAR consensus statement could provide larger LPR and better lesions' conspicuity than 10- min HBP, especially for cirrhotic patients; however, the efficacy of using an LPR cutoff of 1.462 as the standard of the adequate HBP may be compromised in patients with cirrhosis.

MR staging of rectal cancer: Comparison between the 2012 and 2016 European Society of Gastrointestinal and Abdominal Radiology (ESGAR) Guidelines

PurposeTo compare the adherence of the interpretation and reporting staging system, respectively proposed in the 2012 and 2016 European Society of Gastrointestinal and Abdominal Radiology (ESGAR) Guidelines for Magnetic Resonance Imaging (MRI) staging of rectal cancer, focusing on the improvement offered by the criteria introduced by 2016 ESGAR guidelines. MethodFifty-six patients affected by rectal cancer were included; 25/56 patients underwent upfront surgery; 31 underwent to neo-adjuvant chemo-radiotherapy before surgery. All patients underwent 3 T MRI examination for local staging. All MR exams were evaluated by two radiologists with 20- and 4-years’ experience, who were blinded to each other; the T and N stages, the Mesorectal Fascia (MRF) status and the Extramural Vascular Invasion (EMVI) were assessed according to both 2012 and 2016 ESGAR guidelines. The correlation between radiological and pathological findings, as well as the MRI staging were evaluated. ResultsAs to the expert reviewer, no significant differences were found by comparing the MR T and N stages, T and N restaging, MRF status and EMVI according to 2012 and 2016 ESGAR guidelines. As to the 4-years’ experience radiologist the MR staging agreement between 2012 and 2016 guidelines was “moderate” in N-stage evaluation and “fair” in T-restaging evaluation. No significant discrepancies were found for other parameters. ConclusionsMRI is a reliable method in rectal cancer staging/restaging. The assessment of T-restaging is improved by adopting the 2016 ESGAR guidelines, especially for non-expert readers; this result could be justified by the introduction of diffusion-weighted imaging. On the contrary, the newest guidelines do not improve the diagnostic performance in assessing nodal staging and restaging.

Ranking the Relative Importance of Image Quality Features in CT by Consensus Survey

ObjectiveThis study sought to determine consensus opinions from subspecialty radiologists and imaging physicists on the relative importance of image quality features in CT. MethodsA prospective survey of subspecialty radiologists and medical physicists was conducted to collect consensus opinions on the relative importance of ten image quality features: axial sharpness, blooming, contrast, longitudinal sharpness, low contrast axial sharpness, metal artifact, motion, noise magnitude, noise texture, and streaking. The survey was first sent to subspecialty radiologists in volunteer leadership roles in the American College of Radiology and Radiological Society of North America, thereafter relying on snowball sampling. Surveyed subspecialties were abdominal, cardiac, emergency, musculoskeletal, neuro, pediatric, and thoracic radiology, and medical physics. Individual respondents’ ratings were normalized for calculation of mean normalized ratings and priority rankings for each feature within subspecialties. Also calculated were intraclass correlation coefficients across image quality features within subspecialties, and analysis of variance across subspecialties within each feature. ResultsMost subspecialties had moderate to excellent intraclass agreement. For every radiology subspecialty except musculoskeletal, motion was the most important image quality feature. There was agreement across subspecialties that axial sharpness and contrast are only moderately important. There was disagreement across subspecialties on the relative importance of noise magnitude. Blooming was highly important to cardiac radiologists, and noise texture was highly important to musculoskeletal radiologists. ConclusionImage quality preferences differ based on clinical tasks and challenges in each anatomical radiology subspecialty. CT image analysis and development of quantitative measures of quality and protocol optimization—and related policy initiatives—should be specific to radiology subspecialty.

Role of gadoxetic acid-enhanced MRI in the differential diagnosis of chemotherapy-induced focal nodular hyperplasia-like lesions and liver metastases in patients with colorectal cancer.

To describe the gadoxetic acid-enhanced magnetic resonance imaging (MRI) features and follow-up changes of hepatic focal nodular hyperplasia (FNH)-like lesions induced by chemotherapy in patients with colorectal cancer (CRC) and the differential diagnosis of FNH-like lesions and liver metastases. We retrospectively analyzed the data of patients with CRC who received chemotherapy and gadoxetic-enhanced MRI at our hospital. Based on imaging features and pathological findings, the patients were classified into two groups: FNH-like lesions and liver metastases. Two abdominal radiologists reviewed and compared the signal intensities of all images in each phase for both groups. The characteristics of the FNH-like lesions in the hepatobiliary phase were evaluated, and changes in size of lesions were monitored. Thirty patients with 82 FNH-like lesions and 30 with 49 liver metastases following chemotherapy were included in the study. All MRI findings were statistically significantly different between the two groups (p < 0.05). In FNH-like lesions, three enhancement patterns were observed in the hepatobiliary phase: hyperintense/isointense (18.3%), heterogeneous hyperintense (8.5%), and ring-like enhancement (73.2%). The median time from completion of chemotherapy to development of FNH-like lesions was 31 months. During 4-87 months of follow-up, 27 patients with 73 lesions showed the following outcomes: 41 lesions (56.16%) showed stability, 21 lesions (28.77%) growth, and 11 lesions (15.07%) reduction or disappearance. Gadoxetic acid-enhanced MRI can distinguish between chemotherapy-induced FNH-like lesions and liver metastases in patients with CRC. The FNH-like lesions exhibited three enhancement patterns in the hepatobiliary phase, and the changes varied during follow-up.

The added value of MRI in distinguishing malignant and benign ampullary strictures: a multicenter retrospective study.

To investigate the added value of using contrast-enhanced magnetic resonance imaging (MRI) in conjunction with contrast-enhanced computed tomography (CT) for differentiating malignant and benign ampullary strictures. The present retrospective study included 90 patients with ampullary strictures who underwent preoperative contrast-enhanced CT and contrast-enhanced MRI at two tertiary institutions. The image sets (i.e., CT alone vs. combined CT and MRI) were evaluated by three abdominal radiologists, who used a five-point Likert scale to score their confidence for diagnosing malignancy in patients with ampullary strictures. Diagnostic accuracy was calculated using receiver-operating characteristic (ROC) curve analysis, sensitivity, specificity, and accuracy. Additionally, interobserver agreement regarding the scoring of potential malignancies of the ampullary strictures was assessed. The addition of contrast-enhanced MRI to contrast-enhanced CT showed a significant improvement in predicting malignant ampullary strictures in all three observers (p = 0.007, 0.001, and 0.002) using ROC curve analysis, and a significant improvement was observed in diagnostic sensitivity and accuracy for predicting malignancy (p = 0.016 and 0.029 for observer 1; p = 0.023 and 0.010 for observer 2; and p = 0.010 and 0.011 for observer 3). The interobserver agreement for the five-point scale in determining malignancies of the ampullary strictures was 0.86 for CT alone and 0.93 for the combined set of CT and MRI. The addition of contrast-enhanced MRI to CT provided added value for differentiating malignant from benign ampullary strictures.

Diagnostic performance of CT/MRI LI-RADS v2018 in non-cirrhotic hepatitis C virus infection.

To evaluate the diagnostic performance of LI-RADS among patients with non-cirrhotic hepatitis C virus (HCV) infection. This retrospective, IRB-approved, single-center study included 66 observations from 43 adult patients (11 women, 32 men; median age 65 years). All patients received liver protocol CT or MRI from 2010 to 2023, had HCV, and did not have cirrhosis based on histopathology. Three board-certified abdominal radiologists blinded to histopathology and imaging follow-up assessed each observation for major features and final LI-RADS category, and inter-reader agreements with weighted kappa were calculated. The positive predictive value, sensitivity, specificity, and accuracy of in diagnosing HCC and overall malignancy was calculated. Of the 66 observations, 53 (80%) were malignant and 13 (20%) were benign. Positive predictive value for HCC was 0-0% for LR-1, 0-0% for LR-2, 0-33% for LR-3, 57-100% for LR-4, 98-100% for LR-5, 25-50% for LR-M, and 83-100% for LR-TIV. Positive predictive value for overall malignancy was 0-0% for LR-1, 0-0% for LR-2, 0-33% for LR-3, 57-100% for LR-4, 98-100% for LR-5, 100-100% for LR-M, and 100-100% for LR-TIV. For LR-5 in identifying HCC, sensitivity ranged from 74 to 90%, specificity from 94 to 100%, and accuracy from 80 to 91%. For the composite of LR-5, LR-M, or LR-TIV in identifying overall malignancy, sensitivity was 87-98%, specificity was 92-100%, and accuracy was 89-97%. The inter-reader agreement for major features varied from moderate to substantial, with substantial agreement for the final category. CT/MRI LI-RADS v2018 criteria can be applied to non-cirrhotic HCV patients with near-perfect specificity.

DCE-MRI of the liver with sub-second temporal resolution using GRASP-Pro with navi-stack-of-stars sampling.

Respiratory motion-induced image blurring and artifacts can compromise image quality in dynamic contrast-enhanced MRI (DCE-MRI) of the liver. Despite remarkable advances in respiratory motion detection and compensation in past years, these techniques have not yet seen widespread clinical adoption. The accuracy of image-based motion detection can be especially compromised in the presence of contrast enhancement and/or in situations involving deep and/or irregular breathing patterns. This work proposes a framework that combines GRASP-Pro (Golden-angle RAdial Sparse Parallel MRI with imProved performance) MRI with a new radial sampling scheme called navi-stack-of-stars for free-breathing DCE-MRI of the liver without the need for explicit respiratory motion compensation. A prototype 3D golden-angle radial sequence with a navi-stack-of-stars sampling scheme that intermittently acquires a 2D navigator was implemented. Free-breathing DCE-MRI of the liver was conducted in 24 subjects at 3T including 17 volunteers and 7 patients. GRASP-Pro reconstruction was performed with a temporal resolution of 0.34-0.45 s per volume, whereas standard GRASP reconstruction was performed with a temporal resolution of 15 s per volume. Motion compensation was not performed in all image reconstruction tasks. Liver images in different contrast phases from both GRASP and GRASP-Pro reconstructions were visually scored by two experienced abdominal radiologists for comparison. The nonparametric paired two-tailed Wilcoxon signed-rank test was used to compare image quality scores, and the Cohen's kappa coefficient was calculated to evaluate the inter-reader agreement. GRASP-Pro MRI with sub-second temporal resolution consistently received significantly higher image quality scores (P < 0.05) than standard GRASP MRI throughout all contrast enhancement phases and across all assessment categories. There was a substantial inter-reader agreement for all assessment categories (ranging from 0.67 to 0.89). The proposed technique using GRASP-Pro reconstruction with navi-stack-of-stars sampling holds great promise for free-breathing DCE-MRI of the liver without respiratory motion compensation.

Standardizing Multidisciplinary Case Conferences and Improving Communication Between Referring Physicians and Radiologists: A Quality Improvement Initiative.

Purpose: Assess the effectiveness of standardizing multidisciplinary case conferences (MDCs). Methods: Anonymous electronic surveys gauged opinions of abdominal radiologists engaged in recurring MDCs. A standardized Excel template, following Cancer Care Ontario guidelines and relevant literature, was distributed to MDC managers. Physicians were instructed to send cases 36 hours prior to MDC. Template adherence was assessed at 1.5 and 8 months. A follow-up survey at 4 months evaluated the intervention's effectiveness. Results: 27/34 abdominal radiologists provided 47 baseline responses, and 12 delegated radiologists provided 23 follow-up responses. "Often/always" being provided the image's location increased from 36% (17/47) at baseline to 70% (16/23) at follow-up. Non-adherence to the 36-hour cut-off decreased from 36% (16/45) to 17% (4/23). 72% disagreed that uploading remote imaging to hospital servers is easy (33/46), similar to follow-up (18/23, 78%). In assessing the intervention, 41% noted improved standardization (9/22), another 41% considered MDCs already standardized (9/22), and 18% reported no change (4/22). Those reporting no change experienced a higher frequency of non-adherence to the 36-hour cut-off (3/4, 75%) than others (1/18, 6%), and less frequent "often/always" ratings for image location being provided (3/4, 75%) than others (2/18, 11%). 89% (25/28) of MDCs adhered to the template. Issues regarding last-minute add-on cases may be mitigated through EPIC force functions. Artificial intelligence advancements may assist in retrieving external images and patient information. Conclusion: Adherence to MDC standardization was high, allowing for more efficient preparation, potentially reducing radiologist administrative burdens. Future force functions and artificial intelligence integration into electronic patient records may further augment this.

Determinants of decision-making in biopsy of PI-RADS 3 transition zone lesions.

Cancer rates for Prostate Imaging-Reporting and Data System (PI-RADS) 3 lesions are low. We aimed to determine the clinical and magnetic resonance imaging (MRI) parameters that can provide risk stratification for PI-RADS 3 transition zone (TZ) lesions to guide decision for biopsy, which can improve the cost-effectiveness of resource utilisation. The MRI scans of all patients who underwent MRI-ultrasound fusion targeted biopsy from 1 May 2016 to 31 December 2022 were retrospectively assessed by two board-certified abdominal radiologists. The following data were collected and analysed serum prostate-specific antigen, Prostatic Health Index (PHI), prostate volume, histological results, lesion size, location, diffusion-weighted imaging (DWI) parameter scores and overall PI-RADS score. Two hundred and fourteen TZ lesions were included. Among 131 PI-RADS 3 lesions, those with marked restricted diffusion (DWI score ≥4), diameter ≥1 cm, prostrate-specific antigen density (PSAD) ≥0.11 and PHI ≥34 were more likely to contain clinically significant prostate cancer (csPCa; P = 0.04, 0.02, 0.049 and 0.05, respectively), with areas under the receiver operating characteristics curve of 0.9, 0.76, 0.84 and 0.80, respectively. Apical lesions were more likely to contain csPCa compared to midgland or basal lesions (P = 0.01). Clinical parameters (PSAD and PHI) and MRI features (lesion size, DWI score, lesion location) can be used to risk stratify PI-RADS 3 TZ lesions and guide decision for targeted biopsy.

Imaging findings of gastric glomus tumors.

Sparse literature describes the imaging findings of gastric glomus tumors (GGT), focusing on benign tumors. We are not aware of prior radiology reports on malignant GGT. The aim of the study was to determine whether it is possible to differentiate between benign and malignant GGT on CT or MR. Institutional radiology and pathology databases were queried for the diagnosis of GGT between January 2010 to December 2023. Of 22 identified subjects, five were excluded due to non-availability of preoperative CT or MR images and three due to lack of pathological confirmation in our institution. The study cohort comprised of 14 patients (males = 6) with median age of 65 years (range 31 to 79 years). Two abdominal radiologists in consensus reviewed all relevant CT and MR images. There were 10 benign and 4 malignant GGT. Benign tumors were smaller than malignant GGT (median size of 2.0cm vs. 5.3cm, p = 0.03), more likely to exhibit homogeneous hyperenhancement (9/10 vs. 0/4, p < 0.01), and demonstrated intramural rather than exophytic growth. There was no substantial difference in T2 signal or diffusion restriction between benign and malignant GGT. On follow up, benign GGT were essentially stable in size, while malignant GGT grew. A biopsy proven GGT larger than 5cm or showing necrosis is likely to be malignant. This is important since preoperative endoscopic ultrasound-guided fine needle aspiration may be indeterminate for malignancy.

Anatomical and Developmental Abnormalities of Ureters and Renal Pelvis Existing with Accessory Renal Arteries: Cadaveric Study.

Anatomical and developmental variations of ureters and renal pelvis have been observed frequently during routine human cadaveric dissection and surgical practice; however, their coexistence with accessory or aberrant renal arteries is exceptionally rare. Accordingly, this study was designed to evaluate the prevalence of anatomical and developmental abnormalities of ureters and renal pelvis existing with accessory renal arteries in human cadavers. This study was carried out on 50 human cadavers including dissected specimens (25 males and 25 females) the kidneys, renal pelvis, and ureters along with their arteries were exposed and the anomalous abnormalities of the renal pelvis and ureters existing with accessory renal arteries were observed. Photographs of the anomalous and developmental variations were taken for proper documentation. Among the 50 cadavers studied, unilateral double ureters were found in 5 cadavers (10%), rare bilateral "S-"shaped loop of ureter with quadruple uretic constrictors in the abdominal segment of the ureter was observed in one female cadaver (2%), accessory or aberrant renal arteries were found in 15 cadavers (30%), hydronephrosis involving the renal pelvis and ureters was observed in 9 cadavers (18%). Interestingly, this prevalence was higher among males (28%) compared to females (8%). Moreover, the occurrence of bilateral hydronephrosis of the kidneys, renal pelvis, and ureters was identified in a single male cadaver, representing 2% of the sample. Notably, the prevalence of double ureter, hydronephrosis accompanied by congenital double and triple accessory renal arteries was documented in nine cadavers, accounting for 18% of the cohort. Anatomical and developmental variations of the ureters, renal pelvis, and renal vasculature, as well as their relationships to surrounding structures, hold clinical significance due to their impact on various surgical procedures, including kidney transplantation, abdominal aorta reconstruction, interventional radiology, and urologic operations. Therefore, identifying these potential developmental variations is essential for effective surgical management to preserve renal function and ensure optimal patient outcomes.

Gastrointestinal pharmacoradiology, an updated review of medications and gastrointestinal contrasts in abdominal imaging.

The purpose of this article is to review commonly used medications in abdominal radiology including their indications, mechanisms of action, dosages, contraindications, precautions, and adverse reactions. We will clarify common inquiries and address frequently asked questions by patients and clinicians related to their use. In addition, we will explore the indications, advantages and disadvantages, dosages, and contraindications of enteric contrast agents used for CT and fluoroscopic examinations.

Effect of accumulating experience on diagnostic performance of VI-RADS in bladder cancer

PurposeMRI-based VI-RADS score aids in differentiating MIBC and NMIBC, but the experience's impact remains unexplored. We aimed to determine the effect of accumulating experience in the diagnostic performance of VI-RADS. MethodsIn our previously published series 71 primary bladder cancer patients who underwent multiparametric MRI before the transurethral resection were analyzed. The radiologist who assessed the VI-RADS scores at the time the study was performed, re-evaluated all cases after 3 years, in a blinded fashion. During these three years, more than 300 additional bladder MRIs were performed for VI-RADS assessment. The diagnostic performances of the initial and subsequent VI-RADS analyses were compared. Moreover, VIRADS results obtained by a newly trained abdominal radiologist was also compared with experienced radiologist's results. For this study, VI-RADS ≥3 was accepted for predicting MIBC. ResultsOverall 71 patients [62 (87.3 %) males, 67.4 ± 10.2 years] who underwent bladder MRI before TURBT were included. Histopathology revealed MIBC in 16 (26.2 %) cases.The initial MRI analysis revealed VI-RADS score ≥ 3 in 36 (50.7 %) cases. The sensitivity and specificity for depicting MIBC were 75 % and 56.4 % respectively. The subsequent MRI analysis revealed VI-RADS score ≥ 3 in 23 (32.4 %) cases. The sensitivity and specificity were 93.8 % and 85.5 % respectively. The MRI analysis performed by the recently trained abdominal radiologist revealed VI-RADS score ≥ 3 in 24 (33.8 %) cases. The sensitivity and specificity were 87.5 % and 56.4 % respectively. ConclusionThe diagnostic performance of VI-RADS for the interpretation of bladder MRI can improve over time by increasing the experience of the urogenital radiologist.