Initial Radiological Report Research Articles

Efficacy of Ultrasound for the Detection of Possible Fatty Liver Disease in Children.

Pediatric MASLD (previously referred to as NAFLD) incidence has continued to rise along with the obesity pandemic. Pediatric MASLD increases the risk of liver fibrosis and cirrhosis in adulthood. Early detection and intervention can prevent and reduce complications. Liver biopsy remains the gold standard for diagnosis, although imaging modalities are increasingly being used. We performed a retrospective study of 202 children seen in a pediatric gastroenterology clinic with a complaint of abdominal pain, elevated liver enzymes or MASLD, or a combination of the three to evaluate screening methods for MASLD. A total of 134 of the 202 patients included in the study underwent laboratory testing and abdominal ultrasound. Ultrasound images were reviewed with attention to liver size and echotexture by a fellowship-trained pediatric radiologist for liver size and echotexture. Overall, 76.2% of the initial radiology reports correctly identified hepatomegaly based on age and 75.4% of the initial radiology reports correctly described hepatic echogenicity that was consistent with increased hepatic fat deposition. Use of screening ultrasound in concert with other clinical evaluations can be helpful to identify children at risk of MASLD. Utilizing ranges for liver span according to age can help to diagnose hepatomegaly, and understanding how to identify hepatic echogenicity is important for identifying possible hepatic steatosis.

Validation of a commercially available CAD-system for lung nodule detection and characterization using CT-scans.

This study aims to externally validate a commercially available Computer-Aided Detection (CAD)-system for the automatic detection and characterization of solid, part-solid, and ground-glass lung nodules (LN) on CT scans. This retrospective study encompasses 263 chest CT scans performed between January 2020 and December 2021 at a Dutch university hospital. All scans were read by a radiologist (R1) and compared with the initial radiology report. Conflicting scans were assessed by an adjudicating radiologist (R2). All scans were also processed by CAD. The standalone performance of CAD in terms of sensitivity and false-positive (FP)-rate for detection was calculated together with the sensitivity for characterization, including texture, calcification, speculation, and location. The R1's detection sensitivity was also assessed. A total of 183 true nodules were identified in 121 nodule-containing scans (142 non-nodule-containing scans), of which R1 identified 165/183 (90.2%). CAD detected 149 nodules, of which 12 were not identified by R1, achieving a sensitivity of 149/183 (81.4%) with an FP-rate of 49/121 (0.405). CAD's detection sensitivity for solid, part-solid, and ground-glass LNs was 82/94 (87.2%), 42/47 (89.4%), and 25/42 (59.5%), respectively. The classification accuracy for solid, part-solid, and ground-glass LNs was 81/82 (98.8%), 16/42 (38.1%), and 18/25 (72.0%), respectively. Additionally, CAD demonstrated overall classification accuracies of 137/149 (91.9%), 123/149 (82.6%), and 141/149 (94.6%) for calcification, spiculation, and location, respectively. Although the overall detection rate of this system slightly lags behind that of a radiologist, CAD is capable of detecting different LNs and thereby has the potential to enhance a reader's detection rate. While promising characterization performances are obtained, the tool's performance in terms of texture classification remains a subject of concern. Numerous lung nodule computer-aided detection-systems are commercially available, with some of them solely being externally validated based on their detection performance on solid nodules. We encourage researchers to assess performances by incorporating all relevant characteristics, including part-solid and ground-glass nodules. Few computer-aided detection (CAD) systems are externally validated for automatic detection and characterization of lung nodules. A detection sensitivity of 81.4% and an overall texture classification sensitivity of 77.2% were measured utilizing CAD. CAD has the potential to increase single reader detection rate, however, improvement in texture classification is required.

Elastofibroma Dorsi Detected Incidentally on Chest Computed Tomography: The Prevalence and Reporting Rate in Radiology Reports.

Background Elastofibroma dorsi (ED) is an uncommon benign connective-tissue tumor, usually seen in the subscapular region of women after the fifth decade. The study aimed to determine the prevalence, radiological characteristics, and the rates of mentionin the initial radiology reports of ED incidentally detected by chest computed tomography (CT) imaging in a large population. Methodology This study was conducted at Hitit University, Erol Olçok Training and Research Hospital Radiology Department in Çorum, Turkey. A total of 3,299 patients (1,554 females, 1,745 males)who underwent non-contrast chest CT for various reasons were included in this retrospective study. The presence, side, thickness, and density of ED were investigated in these patients. Differences in gender and laterality were assessed statistically. It was also reviewed whether it was stated in the initial radiology report or not. Results ED was detected in 79 (2.4%) of 3,299 patients, in 60 (75.9%) females and 19 (24.1%) males with a median age of 57.5 years (range, 18-99 years). The risk of ED presence was determined to be 3.65-fold in females than in males. In the cases determined with ED, the median age was 75 years (range, 53-96 years), and ED was not determined in any patient aged <50 years. A statistically significant correlation was determined between age and the presence of ED (p < 0.001). No statistically significant correlation was found between age and ED thickness or density (p = 0.602, p = 0.233, respectively). It was noted that none of the patients were diagnosed in the first radiological report. Conclusions ED can be easily overlooked on cross-sectional examinations because of the similar appearance and density to adjacent structures. Knowledge of the characteristic radiological features of these lesions and increased awareness of radiologists will make early diagnosis possible in asymptomatic cases.

Natural language processing to predict isocitrate dehydrogenase genotype in diffuse glioma using MR radiology reports.

To evaluate the performance of natural language processing (NLP) models to predict isocitrate dehydrogenase (IDH) mutation status in diffuse glioma using routine MR radiology reports. This retrospective, multi-center study included consecutive patients with diffuse glioma with known IDH mutation status from May 2009 to November 2021 whose initial MR radiology report was available prior to pathologic diagnosis. Five NLP models (long short-term memory [LSTM], bidirectional LSTM, bidirectional encoder representations from transformers [BERT], BERT graph convolutional network [GCN], BioBERT) were trained, and area under the receiver operating characteristic curve (AUC) was assessed to validate prediction of IDH mutation status in the internal and external validation sets. The performance of the best performing NLP model was compared with that of the human readers. A total of 1427 patients (mean age ± standard deviation, 54 ± 15; 779 men, 54.6%) with 720 patients in the training set, 180 patients in the internal validation set, and 527 patients in the external validation set were included. In the external validation set, BERT GCN showed the highest performance (AUC 0.85, 95% CI 0.81-0.89) in predicting IDH mutation status, which was higher than LSTM (AUC 0.77, 95% CI 0.72-0.81; p = .003) and BioBERT (AUC 0.81, 95% CI 0.76-0.85; p = .03). This was higher than that of a neuroradiologist (AUC 0.80, 95% CI 0.76-0.84; p = .005) and a neurosurgeon (AUC 0.79, 95% CI 0.76-0.84; p = .04). BERT GCN was externally validated to predict IDH mutation status in patients with diffuse glioma using routine MR radiology reports with superior or at least comparable performance to human reader. Natural language processing may be used to extract relevant information from routine radiology reports to predict cancer genotype and provide prognostic information that may aid in guiding treatment strategy and enabling personalized medicine. • A transformer-based natural language processing (NLP) model predicted isocitrate dehydrogenase mutation status in diffuse glioma with an AUC of 0.85 in the external validation set. • The best NLP models were superior or at least comparable to human readers in both internal and external validation sets. • Transformer-based models showed higher performance than conventional NLP model such as long short-term memory.

Isolated thoracic and lumbar transverse process fractures: Do they need spine surgeon evaluation? a high volume level I trauma center experience with cost analysis

BackgroundTransverse process fractures (TPF) of the thoracic and lumbar spine have become increasingly identified due to CT imaging. Spine service consultation is common for further evaluation and management. There are several studies that demonstrate no difference in clinical outcome with or without spine service intervention. However, no study to our knowledge provides an additional cost analysis. We hypothesize that isolated thoracolumbar TPF are stable injuries. Furthermore, spine service consultation and evaluation results in increased health care costs. MethodsPatients were identified using trauma registry data at Saint Louis University (SLU) from January 2012 to August 2018. Chart and imaging review was performed to determine if additional spine fractures were identified by the spine team which were not included in the initial radiology report. TPF associated with other spinal injuries were defined as one or more thoracic and/or lumbar TPF in addition to any other acute fracture or dislocation in the cervical, thoracic, or lumbar spine. A separate cost analysis with institution-specific charges was also performed. ResultsSix hundred eighty-two patients with TPF from January 2012 to August 2018 were identified. Two hundred twenty-eight patients met the criteria to be included in this study. Additional spinal pathology that was not included in the initial radiology report was identified in 5 (2.19%) patients, none of which required surgical intervention. Cost analysis demonstrated additional costs associated with spine service intervention totaled $1,725,360.28. Average cost per patient in our cohort summed to $2,529.85 ConclusionsThese data support that isolated TPF of the thoracic and lumbar spine are stable injuries that likely do not require spine service intervention and in fact may represent unnecessary financial burden. Foregoing unnecessary consultation can alleviate time constraints within spine service practices and reduce health care costs by eliminating costly extraneous interventions from the patient's care.

Using Brain Tumor MRI Structured Reporting to Quantify the Impact of Imaging on Brain Tumor Boards.

Multidisciplinary tumor boards (TB) are an essential part of brain tumor care, but quantifying the impact of imaging on patient management is challenging due to treatment complexity and a lack of quantitative outcome measures. This work uses a structured reporting system for classifying brain tumor MRIs, the brain tumor reporting and data system (BT-RADS), in a TB setting to prospectively assess the impact of imaging review on patient management. Published criteria were used to prospectively assign three separate BT-RADS scores (an initial radiology report, secondary TB presenter review, and TB consensus) to brain MRIs reviewed at an adult brain TB. Clinical recommendations at TB were noted and management changes within 90 days after TB were determined by chart review. In total, 212 MRIs in 130 patients (median age = 57 years) were reviewed. Agreement was 82.2% between report and presenter, 79.0% between report and consensus, and 90.1% between presenter and consensus. Rates of management change increased with increasing BT-RADS scores (0-3.1%, 1a-0%, 1b-66.7%, 2-8.3%, 3a-38.5%, 3b-55.9, 3c-92.0%, and 4-95.6%). Of 184 (86.8%) cases with clinical follow-up within 90 days after the tumor board, 155 (84.2%) of the recommendations were implemented. Structured scoring of MRIs provides a quantitative way to assess rates of agreement interpretation alongside how often management changes are recommended and implemented in a TB setting.

Artificial intelligence vs. radiologist: accuracy of wrist fracture detection on radiographs.

To compare the performances of artificial intelligence (AI) to those of radiologists in wrist fracture detection on radiographs. This retrospective study included 637 patients (1917 radiographs) with wrist trauma between January 2017 and December 2019. The AI software used was a deep neuronal network algorithm. Ground truth was established by three senior musculoskeletal radiologists who compared the initial radiology reports (IRR) made by non-specialized radiologists, the results of AI, and the combination of AI and IRR (IR+AI) RESULTS: A total of 318 fractures were reported by the senior radiologists in 247 patients. Sensitivity of AI (83%; 95% CI: 78-87%) was significantly greater than that of IRR (76%; 95% CI: 70-81%) (p < 0.001). Specificities were similar for AI (96%; 95% CI: 93-97%) and for IRR (96%; 95% CI: 94-98%) (p = 0.80). The combination of AI+IRR had a significantly greater sensitivity (88%; 95% CI: 84-92%) compared to AI and IRR (p < 0.001) and a lower specificity (92%; 95% CI: 89-95%) (p < 0.001). The sensitivity for scaphoid fracture detection was acceptable for AI (84%) and IRR (80%) but poor for the detection of other carpal bones fracture (41% for AI and 26% for IRR). Performance of AI in wrist fracture detection on radiographs is better than that of non-specialized radiologists. The combination of AI and radiologist's analysis yields best performances. • Artificial intelligence has better performances for wrist fracture detection compared to non-expert radiologists in daily practice. • Performance of artificial intelligence greatly differs depending on the anatomical area. • Sensitivity of artificial intelligence for the detection of carpal bones fractures is 56%.

EP-289 Acute gallstone pancreatitis – if a picture is worth a thousand words, how many images do we need?

Abstract Aims Accurate diagnosis and prompt definitive management of choledocholithiasis is vital in acute gallstone pancreatitis (GSP). Sensitivity of detection of choledocholithiasis varies across imaging modalities. Magnetic resonance cholangiopancreatography (MRCP) is most sensitive, but may not be necessary, and may result in delayed implementation of definitive management. We aimed to evaluate the range of radiological investigations patients with acute GSP underwent at our Trust, and the clinical appropriateness of MRCP if performed. Methods An observational study of patients diagnosed with acute GSP between 01/05/2019 and 26/02/2021 was performed. Data were collected from electronic patient records. Results 50 patients were diagnosed with acute GSP (median age 56years). 41 had transabdominal ultrasound (USS), 22 had computed tomography (CT) and 16 patients had MRCP. Median waiting time was 1, 0 and 4 days for respectively. All patients who had MRCP had prior USS and/or CT (Table 1). As definitive management, 14% underwent endoscopic retrograde cholangiopancreatography (ERCP), 28% underwent laparoscopic cholecystectomy and 30% had initial ERCP followed by laparoscopic cholecystectomy. 14% patients were readmitted with pancreatitis prior to definitive management. Conclusions Detailed description of the CBD in initial radiology reports in acute GSP may mitigate the need for unnecessary subsequent imaging, reducing cost and facilitating early definitive management. We recommend establishment of a guideline to streamline imaging in the assessment of acute gallstone pancreatitis.

Thoracic and lumbar spine trauma classification systems fail to predict post-traumatic kyphotic deformity

BackgroundPost-traumatic kyphosis of the thoracic and lumbar spine can lead to pain and decreased function. MRI has been advocated to assess ligament integrity and risk of kyphosis. MethodsAll thoracic and lumbar spine MRI performed for evaluation of trauma over a 3-year period at a single institution were reviewed. Patients were included if there was an MRI showing a vertebral body fracture and follow-up radiographs. Two observers retrospectively reviewed all radiographs, CT and MRI scans, and classified injuries based on the Denis, TLICS, AO and load sharing classification systems. Change in kyphosis between injury and follow-up studies was measured. The initial radiology reports made at time of patient injury were compared to the retrospective interpretations. ResultsThere were 67 separate injuries in 62 patients. Kyphosis measuring ≥ 10° developed despite an intact PLC in 6/14 nonoperative cases, and 3/7 surgically treated cases; when PLC was partially injured, it developed in 6/10 cases (8 treated nonoperatively, 2 treated operatively. Thirty injuries had complete disruption of PLC by MRI, 24 treated with fusion. Kyphosis ≥ 10° developed in 3/6 treated nonoperatively, and 8/24 treated with fusion. Development of kyphosis was independent of degree of vertebral body comminution. It developed equally in patients with Grade 2 and Grade 3 Denis injuries. It developed in patients with intact PLC when multiple vertebrae were involved and/or there was compressive injury to anterior longitudinal ligament (ALL). There was high interobserver variability in assessment of severity of ligamentous injury on MRI. ConclusionsClassification systems of thoracic and lumbar spine injury and integrity of the PLC failed to predict the risk of development of post-traumatic kyphotic deformity.

Clinical impact of a deep learning system for automated detection of missed pulmonary nodules on routine body computed tomography including the chest region.

To evaluate the clinical impact of a deep learning system (DLS) for automated detection of pulmonary nodules on computed tomography (CT) images as a second reader. This single-centre retrospective study screened 21,150 consecutive body CT studies from September 2018 to February 2019. Pulmonary nodules detected by the DLS on axial CT images but not mentioned in initial radiology reports were flagged. Flagged images were scored by four board-certificated radiologists each with at least 5years of experience. Nodules with scores of 2 (understandable miss) or 3 (should not be missed) were then categorised as unlikely to be clinically significant (2a or 3a) or likely to be clinically significant (2b or 3b) according to the 2017 Fleischner guidelines for pulmonary nodules. The miss rate was defined as the total number of studies receiving scores of 2 or 3 divided by total screened studies. Among 172 nodules flagged by the DLS, 60 (35%) missed nodules were confirmed by the radiologists. The nodules were further categorised as 2a, 2b, 3a, and 3b in 24, 14, 10, and 12 studies, respectively, with an overall positive predictive value of 35%. Missed pulmonary nodules were identified in 0.3% of all CT images, and one-third of these lesions were considered clinically significant. Use of DLS-assisted automated detection as a second reader can identify missed pulmonary nodules, some of which may be clinically significant. Use of DLS to help radiologists detect pulmonary lesions may improve patient care. • DLS-assisted automated detection as a second reader is feasible in a large consecutive cohort. • Performance of combined radiologists and DLS was better than DLS or radiologists alone. • Pulmonary nodules were missed more frequently in abdomino-pelvis CT than the thoracic CT.

Role of Dedicated Subspecialized Radiologists in Multidisciplinary Team Discussions on Lower Gastrointestinal Tract Cancers.

ObjectiveTo determine the impact of dedicated subspecialized radiologists in multidisciplinary team (MDT) discussions on the management of lower gastrointestinal (GI) tract malignancies.Materials and MethodsWe retrospectively analyzed the data of 244 patients (mean age ± standard deviation, 61.7 ± 11.9 years) referred to MDT discussions 249 times (i.e., 249 cases, as five patients were discussed twice for different issues) for lower GI tract malignancy including colorectal cancer, small bowel cancer, GI stromal tumor, and GI neuroendocrine tumor between April 2018 and June 2021 in a prospective database. Before the MDT discussions, dedicated GI radiologists reviewed all imaging studies again besides routine clinical reading. The referring clinician’s initial diagnosis, initial treatment plan, change in radiologic interpretation compared with the initial radiology report, and the MDT’s consensus recommendations for treatment were collected and compared. Factors associated with changes in treatment plans and the implementation of MDT decisions were analyzed.ResultsOf the 249 cases, radiologic interpretation was changed in 73 cases (29.3%) after a review by dedicated GI radiologists, with 78.1% (57/73) resulting in changes in the treatment plan. The treatment plan was changed in 92 cases (36.9%), and the rate of change in the treatment plan was significantly higher in cases with changes in radiologic interpretation than in those without (78.1% [57/73] vs. 19.9% [35/176], p < 0.001). Follow-up records of patients showed that 91.2% (227/249) of MDT recommendations for treatment were implemented. Multiple logistic regression analysis revealed that the nonsurgical approach (vs. surgical approach) decided through MDT discussion was a significant factor for patients being managed differently than the MDT recommendations (Odds ratio, 4.48; p = 0.017).ConclusionMDT discussion involving additional review of radiology examinations by dedicated GI radiologists resulted in a change in the treatment plan in 36.9% of cases. Changes in treatment plans were significantly associated with changes in radiologic interpretation.

The adequacy of fluoroscopic upper gastrointestinal studies for suspected intestinal volvulus in a tertiary care centre vs. secondary centres: A regional multicentre study.

Early diagnosis and treatment of intestinal volvulus are important to reduce morbidity. A fluoroscopic upper GI study is the gold standard for diagnosis and may be performed in a secondary or tertiary care centre prior to surgery. It is important the reporting radiologist is confident in the findings. We aim to assess whether there is any difference in confidence and study quality between paediatric and general radiologists who work in secondary or tertiary care centres. Retrospective review of initial radiology reports and blinded review of the study images by paediatric radiologists. A total of 277 children underwent a fluoroscopic study for intestinal volvulus over a four-year period. The majority were performed at a tertiary care centre, by paediatric radiologists. The confidence of initial reporting was higher in paediatric than general radiologists despite whether they worked in a secondary or tertiary care centre (P-value<0.001). On retrospective review, studies performed by paediatric radiologists were rated as having a higher confidence in identifying the location of the duodenojejunal flexure. General radiologists tended to have a slightly higher rate of repeat studies but still low at 2.2%. Despite this, there was no significant difference in the diagnosis rates and secondary centre general radiologists excluded malrotation in 62% of studies likely reducing transfer rates. Confidence in initial reporting and on review of the duodenojejunal flexure location in suspected intestinal volvulus is higher in paediatric radiologists compared with general radiologists, although diagnosis rates are no different.

Comparison of initial and second opinion reads of multiparametric magnetic resonance imaging of the prostate for transperineal template-guided biopsies with MRI-Ultrasound fusion

PurposeTo investigate the value of second-opinion evaluation of multiparametric prostate magnetic resonance imaging (MRI) by subspecialised uroradiologists for the detection of significant cancer in transperineal fusion prostate biopsy. MethodsThe evaluated data included age, PSA (ng/ml), PSA density, Gleason score, digital rectal examination (DRE), prostate volume of 149 patients. Twenty-seven patients (18%) had no previous prostate biopsy, 114 patients (77%) had a previous negative biopsy, and 8 patients (5%) were on active surveillance. Using PI-RADS v2 scores for mpMRI a second report was performed by a specialist uroradiologist. In all cases a subsequent transperineal biopsy was performed with at least 2 cores per target and additional background systemic cores. Initial and second-opinion radiology reports were evaluated for detection of any cancer and Gleason score (GS) 7-10 cancer, including positive predictive value and negative (NPV) and compared by Fisher's exact test. ResultsAt transperineal biopsy, 51 % (76/149) of patients had a GS 6-10 prostate cancer (PCa), 27 % (40/149) of patients had a GS 3 + 3 PCa and 12 % (18/149) a GS 3 + 4 and 12 % (18/149) had a GS ≥4 + 3 PCa. Agreement between initial and second-opinion reads was observed in 57.7% (86/149; kappa value = 0.32). The detection of clinically significant cancers with second-opinion reads was significantly higher (0.61; 17/28) compared to initial reads (0.35; 17/49); P = 0.034. ConclusionsSecond reading of prostate mpMRIs by subspecialised uroradiologists significantly improved the positive predictive value for detection of clinically significant prostate cancer and showed a trend towards improved NPV for MRI-negative cases where biopsy could be safely avoided. Urologists should be aware that the experience of the reporter will affect the report when making decisions if and how to obtain biopsies. Reporter experience may help to reduce overcalling and avoid over-targeting of lesions.

Incidence of Odontogenic Disease in Patients With Pott's Puffy Tumor

Osteomyelitis with subperiosteal abscess of the frontal bone, or Pott's puffy tumor (PPT), is a rare but life-threatening condition. The relationship of concurrent dental disease to PPT has not been well described. This study sought to delineate the incidence of odontogenic disease in PPT, especially in cases where there is no history of facial trauma or prior frontal sinus surgery. A retrospective chart review of patients diagnosed with PPT between 2010 and 2019 was carried out. Demographics, pertinent medical history, surgical procedures performed, and microbial cultures and antibiotics used were extracted for analysis. Maxillofacial computed tomography scans were reviewed for presence of odontogenic disease. A total of 17 patients were identified. Four had documented history of frontal bone trauma; 3 had previous frontal sinus surgery. Seven (41%) had documented odontogenic disease on initial radiology reports; however, upon dentist review, 16 (94%) had various pathology visible on their computed tomography scans. Twelve of these 16 patients had no previous frontal sinus trauma or surgery. Eight patients (47%) had only ipsilateral maxillary or ethmoid inflammation respective to PPT on computed tomography. Seventy-six percent of patients underwent endoscopic sinus surgery. Of 14 patients with cultures collected at the time of surgery, 7 (50%) had polymicrobial growth and 6 (43%) had anaerobic growth. The incidence of odontogenic disease in this population of PPT was 94%. In the absence of a history of frontal bone trauma or frontal sinus surgery, underlying dental origin should be suspected in cases of PPT. Initial radiology reports may not document all identifiable dental pathology. Therefore, patients presenting with PPT should undergo comprehensive evaluation, including an oral cavity and dental examination, and potential referral to dental colleagues.

Expert radiologist review at a hepatobiliary multidisciplinary tumor board: impact on patient management.

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). 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. 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. 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.

Prevalence of elastofibroma dorsi on CT: Is it really an uncommon entity?

ObjectiveThe aim of this study was to determine the prevalence, demographic data of elastofibroma dorsi (ED) in adult population who had undergone chest CT examination and to discuss clinical, and radiological presentations, and treatment options of ED. MethodsWe retrospectively reviewed 4074 chest CT examinations for ED from July 2014 to April 2015. Lesion size, side, and patient demographics were analyzed for positive cases of ED. The initial radiology reports of patients with ED were also reviewed. ResultsOf the 4074 patients, 111 patients (2.73%) (77 women and 34 men; mean age: 68.2 years; range: 35–91 years) had a total of 168 ED. The females had a 1.96 -fold higher prevalence of ED than the males (OR, 1.96; 95% CI, 1.481–2.59). The mean lesion thickness was found to be significantly greater in the female patients compared with the male patients (p = 0.001). The prevalence of the disease was estimated to be 4.98 times higher in patients aged 65 years or older (CI 95%, 3.25–7.36). In 111 ED patients, the lesions were only noted in 9 patients' initial radiology report. ConclusionHere, we present a prevalence study with the largest population in the literature concerning ED. Our study shows that ED is not as uncommon as previously thought and should be especially suspected in females and older age groups. Level of EvidenceLevel IV, Diagnostic Study.

Multivessel Occlusion in Patients Subjected to Thrombectomy: Prevalence, Associated Factors, and Clinical Implications.

Patients with embolic large-vessel occlusion may present with additional coincidental acute occlusions within or distant from the involved territory, referred to as multivessel occlusion (MVO). Purpose of this study was to assess prevalence of MVO, associated factors, and clinical relevance in patients undergoing endovascular stroke treatment. Image data of consecutive endovascular candidates (n=720) with direct access to angiography were extracted from a prospective registry. Prevalence of MVO was assessed with multimodal magnetic resonance imaging/computed tomography and confirmed by intra-arterial angiography. Explorative analysis of associated factors and clinical relevance was evaluated using multivariable logistic regression including variables with P<0.15 in univariate comparison. Good functional outcome was defined as modified Rankin Scale score ≤2 at day 90. MVO was present in 10.7% of patients (95% confidence interval [CI], 6.4%-13.0%). Two, 3, and 4 concomitant occlusions were found in 80.5%, 16.9%, and 2.6% of MVO cases, respectively. Detection rate on initial radiological report was 54.5%. Downstream MVO was present in around one third of MVO (n=27/77, 35.1%), whereas all other MVO (n=50/77, 64.9%) occurred in different territories. Independent factors related to MVO were statin treatment (adjusted odds ratio [aOR], 0.477; 95% CI, 0.276-0.827), higher systolic blood pressure (aOR per mm Hg increase, 1.014; 95% CI, 1.005-1.023), and primary occlusion site M2 (aOR, 1.870; 95% CI, 1.103-3.170). MVO was related to lower rates of successful reperfusion (aOR, 0.549; 95% CI, 0.316-0.953) and lower rates of good functional outcome (aOR, 0.437; 95% CI, 0.207-0.923). Every tenth patient subjected to angiography for endovascular stroke treatment experienced MVO in our series, and only half were prospectively identified on preinterventional diagnostic imaging. Patients with MVO had higher baseline systolic blood pressure and were less often medicated with statins, an observation that warrants external validation and evaluation regarding causality. Occurrence of MVO has implication for treatment decisions, negatively affects endovascular treatment success, and is predictive of worse clinical outcome.

F12. Detecting MRI brain undiagnosed findings – The role of multidisciplinary epilepsy conference

Introduction Every year, more than 1300 patients undergo resections for treatment of medically refractory epilepsy. Outcome studies repeatedly showed that success of epilepsy surgery is partially dependent on finding a lesion on MRI. Frequently, lesions are subtle and missed on initial review. A dedicated epilepsy surgery conference with comprehensive clinical presentation can guide physicians to target a focus for missed subtle lesions. Methods Retrospective data was collected as part of a Quality Improvement (QI) project. We reviewed the last 369 patients presented at the multidisciplinary epilepsy patient management conference (MEPMC) at the University of Pittsburgh Medical Center from January 2013 to November 2017 with available MRI scans. Patients with initial non-lesional MRIs, per radiology reports, who were found to have brain lesions on further MRI review during the conference were the primary focus. These cases were further analyzed based on the pathology of the lesion and surgical outcome. Results Of the 369 patients presented at the conference, 120 patients (32.5%) were deemed non-lesional based on their initial MRI radiology report. Further review revealed that 39 of these 120 patients (32.5% representing 11% of total cohort) had lesions, out of which there were 17 cases of hippocampal sclerosis, 18 cases of malformations of cortical development (7 focal cortical dysplasia (FCD), 3 tumors, 6 abnormal neuronal migration with heterotopia and 2 polymicrogyria-schizencephaly), 3 hypothalamic hamartoma and one region of encephalomalacia. A total of 24 patients (70.58%) had an epilepsy protocol MRI. Out of these 39 patients, 27 (69.23%) had temporal lobe epilepsy and 12 patients had extratemporal (frontal or parietal lobe) epilepsy. 27 patients underwent surgery. Pathology data was collected on all patients with non-laser ablation surgery (23 patients). Hippocampal sclerosis (11 patients, 47.82%) was the most common pathological finding, followed by cortical dysplasia (4), tumors (1 ganglioglioma, 1 DNET and 1 pleomorphic xanthoastrocytoma), polymicrogyria (2) and gliosis (3 patients). At 1 year assessment 15/21 patients had ENGEL I outcome (71.4%). The remaining patients were classified as ENGEL II (5 patients) and III (1 patient). At 2 year assessment 11/15 patients had ENGEL I outcome (73.3%) while 3 patients were classified as ENGEL III and 1 as ENGEL IV. Conclusion Subtle lesions are occasionally missed during MRI examination. This is likely due to multiple factors such as human error and technological inadequacy. The incidence of missed lesions was not significantly different between types of epilepsy (temporal vs extratemporal) or pathologies, after considering expected prevalence of these entities in a major epilepsy center. In addition, this study highlights the importance of a thorough review of all imaging studies during multidisciplinary epilepsy surgery conference in improving outcome.

Comparison of initial and tertiary centre second opinion reads of multiparametric magnetic resonance imaging of the prostate prior to repeat biopsy

ObjectivesTo investigate the value of second-opinion evaluation of multiparametric prostate magnetic resonance imaging (MRI) by subspecialised uroradiologists at a tertiary centre for the detection of significant cancer in transperineal fusion prostate biopsy.MethodsEvaluation of prospectively acquired initial and second-opinion radiology reports of 158 patients who underwent MRI at regional hospitals prior to transperineal MR/untrasound fusion biopsy at a tertiary referral centre over a 3-year period. Gleason score (GS) 7-10 cancer, positive predictive value (PPV) and negative (NPV) predictive value (±95 % confidence intervals) were calculated and compared by Fisher’s exact test.ResultsDisagreement between initial and tertiary centre second-opinion reports was observed in 54 % of cases (86/158). MRIs had a higher NPV for GS 7-10 in tertiary centre reads compared to initial reports (0.89 ± 0.08 vs 0.72 ± 0.16; p = 0.04), and a higher PPV in the target area for all cancer (0.61 ± 0.12 vs 0.28 ± 0.10; p = 0.01) and GS 7-10 cancer (0.43 ± 0.12 vs 0.2 3 ± 0.09; p = 0.02). For equivocal suspicion, the PPV for GS 7-10 was 0.12 ± 0.11 for tertiary centre and 0.11 ± 0.09 for initial reads; p = 1.00.ConclusionsSecond readings of prostate MRI by subspecialised uroradiologists at a tertiary centre significantly improved both NPV and PPV. Reporter experience may help to reduce overcalling and avoid overtargeting of lesions.Key Points• Multiparametric MRIs were more often called negative in subspecialist reads (41 % vs 20 %).• Second readings of prostate mpMRIs by subspecialist uroradiologists significantly improved NPV and PPV.• Reporter experience may reduce overcalling and avoid overtargeting of lesions.• Greater education and training of radiologists in prostate MRI interpretation is advised.

Prospective detection of cortical dysplasia on clinical MRI in pediatric intractable epilepsy.

Cortical dysplasia is the most common cause of pediatric refractory epilepsy. MRI detection of epileptogenic lesion is associated with good postsurgical outcome. Additional electrophysiological information is suggested to be helpful in localization of cortical dysplasia. Educational measures were taken to increase the awareness of cortical dysplasia at our institution in the context of a recent International League Against Epilepsy (ILAE 2011) classification of cortical dysplasia. To determine changes in the rate of prospective identification of cortical dysplasia on an initial radiology report and also evaluate the benefit of MRI review as part of a multidisciplinary epilepsy conference in identifying previously overlooked MRI findings. We retrospectively evaluated surgically treated children with refractory epilepsy from 2007 to 2014 with cortical dysplasia on histopathology. We analyzed the initial radiology report, preoperative MRI interpretation at multidisciplinary epilepsy conference and subsequent retrospective MRI review with knowledge of the resection site. We recorded additional electrophysiological data and the presence of lobar concordance with the MRI findings. Of 78 children (44 MRI lesional) evaluated, 18 had initially overlooked MRI findings. Comparing 2007-2010 to 2011-2014, there was improvement in the rate of overlooked findings on the initial radiology report (54% vs. 13% of lesional cases, respectively; P = 0.008). The majority (72%) were identified at a multidisciplinary conference with lobar concordance of findings with at least one additional electrophysiological investigation in 89%. Awareness of current classification schemes of cortical dysplasia and image review in the context of a multidisciplinary conference can lead to improved MRI detection of cortical dysplasia in children.