Routine Radiology Research Articles

The Significance of the Morphological Appearance of Peritoneal Lesions on Imaging in Patients With Peritoneal Malignancies-A Report From Phase 1 of the PRECINCT Study.

This is a report from Phase 1 of the prospective, observational, PRECINCT (Pattern of peritoneal dissemination and REsponse to systemic Chemotherapy IN Common and uncommon peritoneal Tumours) study, in which we studied the incidence of disease at pathological evaluation in different morphological appearances of peritoneal malignancies (PM) on imaging. Radiological findings were captured in a specific format that included a description of the morphological appearance of PM and a correlation performed with pathological findings. In 630 patients enroled at seven centres (September 2022-December 2023), 24 morphological terms were used. Among prespecified terms (N = 8 used in 6350 [92.2%] regions), scalloping was pathologically positive in 93.5%, confluent disease in 78.8%, tumour nodules in 69.6%, thickening in 66.1%, infiltration in 56.3%. Among unspecified appearances (N = 16) for 540 (7.8%) regions, 'enhancement' was positive in 41.5%, micronodules in 65.3% and nodularity in 60.2%. Hierarchal clustering placed gastric cancer and rare tumours together and colorectal cancer, ovarian cancer and peritoneal mesothelioma in one cluster. The incidence of disease at pathological evaluation for most morphological appearances was high (> 50%). Morphological description should be provided in routine radiology reports. A set of standardized terms with their description should be developed by a consensus among experienced radiologists.

Intratumoral calcification on CT assists in distinguishing benign and malignant upper abdomen neoplasm.

The significance of calcification and microcalcification in diagnosing malignant tumors is well established, but their role in the upper abdomen is less explored in routine radiology. To assess the effectiveness of computed tomography (CT) imaging in detecting intratumoral calcification within upper abdominal tumors. This study retrospectively enrolled patients with upper abdominal tumors featuring intratumoral calcifications who underwent plain and contrast-enhanced CT scans between January 2016 and December 2019. We examined the imaging characteristics of calcifications, including location, edges, shape, CT values, and association with necrosis. The diagnostic utility of calcification for distinguishing benign and malignant tumors was assessed using receiver operating characteristic curves. Univariate and multivariate logistic regression analyses were conducted to identify independent predictive factors for the diagnosis of malignancy characterized by intratumoral calcification. This study included 153 patients (median age 49 ± 21years; 83 men) with pathologically confirmed tumors of the upper abdomen (including liver, pancreas, and gastrointestinal tract) with intratumoral calcifications. Significant differences in CT values between benign and malignant tumors were observed (P < .001), with high diagnostic accuracy of calcification in CT imaging (receiver operating characteristic area = 0.884, sensitivity = 0.815, specificity = 0.976). The characteristics of calcification, including its edge and shape, were significantly correlated with tumor differentiation (P < .01). Multivariate logistic regression analysis revealed that the presence of adjacent necrosis around intracalcification is an independent predictor of malignancy (odds ratio = 5.48; 95% confidence interval: 1.55, 19.41; P = .008). Intratumoral calcification in CT imaging is a key marker for distinguishing between benign and malignant epigastric tumors, offering high specificity. Key message • What is already known on this topic - Intratumoral calcification, as a highly sensitive radiological marker, has shown potential in differentiating between benign and malignant tumors in thyroid and breast cancers. However, its discriminatory role in upper abdominal tumors is often overlooked. Therefore, assessing the diagnostic accuracy of intratumoral calcification on CT scans is crucial for improving diagnostic efficiency and avoiding unnecessary examinations. • What this study adds - Intratumoral calcification on CT exhibits high specificity in differentiating between benign and malignant upper abdominal tumors, providing a simple and reliable criterion for improving diagnostic accuracy. • How this study might affect research, practice or policy - This study highlights the significance of intratumoral calcification characteristics observed on CT in determining whether upper abdominal tumors are benign or malignant. The findings could pave the way for the development of a CT-based calcification scoring system, which would facilitate rapid and accurate diagnostics in clinical practice, thereby optimizing treatment strategies and enhancing patient prognosis.

Kista Dentigerus

One of the abnormalities in the mouth that is often found in practice is cysts. Dentigerous cysts are the most common odontogenic cysts and represent approximately 20% of all cysts surrounded by epithelium that can affect the maxillary bone. Local factors causing dentigerous cysts can be related to the development of the crown or permanent tooth and can also arise from residual enamel epithelium. Patients usually show no symptoms or are asymptomatic, so these cysts are discovered accidentally during routine dental radiology examinations. However, pain may be experienced when bone expansion or resorption of adjacent teeth occurs. The goal of treatment for dentigerous cysts is to eliminate pathological abnormalities and preserve the tooth with minimal surgical intervention. The surgical technique in patients with dentigerous cysts is enucleation and marsupialization. Complications after surgery cannot be avoided in the form of paresthesia and the appearance of scars around the incision area. The prognosis after treatment is mostly excellent, and recurrence of dentigerous cysts is very rare. However, if a cystic lesion recurs, it could be the result of incomplete removal of the cyst or incorrect diagnosis of the lesion.

Improving Trainee Doctors' Awareness on How to Refer for Routine Radiological and Cardiac Investigations at a Psychiatric Hospital in South London

Improving Trainee Doctors' Awareness on How to Refer for Routine Radiological and Cardiac Investigations at a Psychiatric Hospital in South London

Osteomyelitis appearing as bone tumor: a case series

Introduction: Focal bone lesions are common and often found on routine radiology examinations. While many lesions are true neoplasms, several bone abnormalities are not tumors. It is essential for radiologists and clinicians to be aware of this possibility and to identify characteristic features that make it possible to differentiate between bone tumors and lesions that resemble bone tumors. This case series will specifically discuss osteomyelitis, which resembles a bone tumor Case Description: There were three cases with features of osteomyelitis that appeared as bone tumors. The first case is a 3-year-old girl with swelling in her right knee. The differential diagnosis based on X-ray examination are chondroblastoma and aneurysmal bone cyst. The second case is a 24-year-old man with left knee swelling. The differential diagnosis based on X-ray examination is chondroblastoma and giant cell tumor (GCT). The third case is a 45-year-old man with swelling and pain in his right thigh. The differential diagnosis based on X-ray examination is periosteal osteosarcoma. All three cases underwent laboratory examination and showed signs of infection, such as leucocytosis, elevated ESR, and elevated CRP. Histopathology examination of all cases shows chronic inflammation. Conclusion: On X-ray examination, it is difficult to differentiate between osteomyelitis and bone tumors. Cases of osteomyelitis that resemble bone tumors emphasize the importance of clinical history, laboratory examination, and radiography because they are generally difficult to detect.

Transient global amnesia and hippocampal diffusion restriction: an overlooked radiological finding.

Transient global amnesia (TGA) is characterized by isolated sudden anterograde amnesia. Diffusion restriction can be observed in the hippocampus on DWI-MRI at varying rates in TGA patients. This study analyzes the prevalence and characteristics of the hippocampal diffusion restriction (HDR), its relationship with vascular risk factors, and the prevalence of lesions overlooked in routine reports. 91 patients diagnosed with TGA at a tertiary hospital between 2011 and 2022 were evaluated retrospectively. The mean age was 64.8 ± 7.3years, and 63.7% of patients were female. 75.8% of the patients had at least one vascular risk factor. Focal diffusion restriction was detected in 17 patients (18.5%) on DWI-MRI, with only one being extra-hippocampal. 81.2% of HDR was detected when DWI-MRI scan was performed between 12 and 96h after the onset of symptoms. HDR was detected most when the imaging was performed in 24 to 48h (p = 0.03). There was no correlation between the duration of symptoms and the detection rates of HDR (p = 0.55). In 9 patients (53% of 17) diffusion restriction was not specified in routine radiology reports. Although focal ischemia, venous flow abnormalities, migraine and epileptic phenomena have been suggested in its etiology, TGA is a clinical condition of which pathophysiology has not been determined clearly. Signal changes observed in DWI-MRI has led to discussions that cerebrovascular etiology may play a role, yet more comprehensive studies are required to prevent and manage TGA. HDRs can be overlooked in routine reports. Therefore, the DWI-MRI images of patients with TGA should be examined vigilantly.

Time to Recurrence of Ameloblastoma and Associated Factors in a Multi-institutional Black Patient Cohort.

Ameloblastoma is a highly recurrent odontogenic neoplasm with variable global distribution. However, impact of race and ethnicity on ameloblastoma recurrence are still unclear. The primary aim of this study was to assess duration of time between primary and recurrent ameloblastomas in a predominantly Black multi-institutional patient cohort and secondarily to determine whether recurrent ameloblastomas are more readily discovered when clinically-symptomatic rather than by radiographic surveillance. A retrospective cross-sectional design was used to evaluate demographic, clinical, and pathological information on recurrent ameloblastomas patients. Outcome variable was time to recurrence, determined as period between the diagnosis of primary and recurrent ameloblastomas. We assessed associations between outcome variable and race, time lapse between primary and recurrent ameloblastomas and clinical symptoms of recurrent ameloblastomas at time of diagnosis. Among 115 recurrent ameloblastomas identified, 90.5% occurred in adults, 91.3% in Blacks, and similarly, 91.3% were conventional ameloblastomas. About 41% affected the posterior mandible. 93.9% were clinically symptomatic at time of presentation while 6.1% non-symptomatic lesions were discovered by routine diagnostic radiology. Median time to presentation of recurrent tumor was significantly longer in females (90months, p = 0.016) and clinically symptomatic group of ameloblastoma patients (75months, p = 0.023). Ameloblastoma recurrence was distinctively high in Black patients, occurred faster in males than females and was located mostly in the posterior mandible. Concomitant with delayed access to healthcare of Black individuals, routine post-surgical follow-up is essential because time lag between primary and recurrence tumors was longer in clinically symptomatic ameloblastomas at the time of diagnosis.

Reporting of Facet Joint Inflammation in Lumbar Spine MRI Studies in Patients With Low Back Pain.

Retrospective. We aimed to assess the frequency of facet joint inflammatory features noted in routine radiology reports of lumbar spine magnetic resonance imaging (MRI) studies among patients with chronic low back pain. Facet joint arthropathy is one of the most common causes of chronic low back pain. It may encompass various inflammatory imaging characteristics, such as facet joint effusion, bone marrow edema, and soft tissue edema. The extent to which radiology reports mention inflammatory features of the lumbar facet joints and the accuracy of these reports have not been investigated. The authors performed a chart review on 49 subjects with previous facet-related interventions ( i.e . medial branch blocks or intra-articular facet joint injection) and MRI available in the medical record. One senior musculoskeletal radiologist and a musculoskeletal radiology fellow graded the inflammatory features using a published facet joint inflammation grading system [Gold Standard (GS)]. The authors identified the inflammatory markers mentioned in the radiology reports and calculated the sensitivity and positive predictive value of the radiology reports compared with GS readings. Compared with the GS, the sensitivity of radiology reports for facet joint effusion, bone marrow, and soft tissue edema ranged from 6% to 22%, and the positive predictive value ranged from 25% to 100%. L4/5 had the highest number of cases with inflammatory features noted on the reports. Inflammatory findings, such as facet joint effusion, bone marrow edema, and soft tissue edema, are not commonly identified in radiology reports. Further investigations are needed to determine the clinical importance of MRI-detected lumbar facet joint inflammatory features as a potential mechanism of nociception and as a predictor of outcomes following injections or other therapies.

Meckel’s diverticulum with varied clinicopathological presentations: A case series at a rural tertiary care center

Meckel’s diverticulum (MD), first documented by Wilhelm Fabricius Hildanus in 1598 as a small bowel diverticulum and later detailed by Johann Friedrich Meckel in 1809, is a remnant of the vitellointestinal duct connecting the fetal gut with the yolk sac. It is a true diverticulum, comprising of all the layers of the bowel wall. The commonly cited “rule of 2s” regarding the diverticulum is: Occurs in 2% of the population, has a 2:1 male-to-female ratio, usually discovered by 2 years of age, located 2 feet from the ileocecal valve, and commonly 2 cm in diameter and 2 inches long. Most Meckel diverticula are benign and are incidentally discovered during autopsy, laparotomy, or barium studies. Vitellointestinal duct lining cell being pluripotent, heterotopic tissues such as gastric, pancreatic followed by others might be found. Common clinical presentation in symptomatic cases is gastrointestinal hemorrhages followed by intestinal obstruction, diverticulitis, cystic abdominal mass, patent umbilical fistula, and neoplasm. Clinical signs and symptoms are non-specific simulating other abdominal emergencies and routine radiology is unable to detect the anomaly in rural peripheral centers. Hence, prompt surgical intervention may be needed in emergency cases. Diverticulectomy or ileal segment resection with end-to-end anastomosis is done. Due to the difficulty of diagnosing a pathologic MD pre-operatively, many surgeons recommend prophylactic diverticulectomy in those found incidentally.

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.

An International Non-Inferiority Study for the Benchmarking of AI for Routine Radiology Cases: Chest X-ray, Fluorography and Mammography.

An international reader study was conducted to gauge an average diagnostic accuracy of radiologists interpreting chest X-ray images, including those from fluorography and mammography, and establish requirements for stand-alone radiological artificial intelligence (AI) models. The retrospective studies in the datasets were labelled as containing or not containing target pathological findings based on a consensus of two experienced radiologists, and the results of a laboratory test and follow-up examination, where applicable. A total of 204 radiologists from 11 countries with various experience performed an assessment of the dataset with a 5-point Likert scale via a web platform. Eight commercial radiological AI models analyzed the same dataset. The AI AUROC was 0.87 (95% CI:0.83-0.9) versus 0.96 (95% CI 0.94-0.97) for radiologists. The sensitivity and specificity of AI versus radiologists were 0.71 (95% CI 0.64-0.78) versus 0.91 (95% CI 0.86-0.95) and 0.93 (95% CI 0.89-0.96) versus 0.9 (95% CI 0.85-0.94) for AI. The overall diagnostic accuracy of radiologists was superior to AI for chest X-ray and mammography. However, the accuracy of AI was noninferior to the least experienced radiologists for mammography and fluorography, and to all radiologists for chest X-ray. Therefore, an AI-based first reading could be recommended to reduce the workload burden of radiologists for the most common radiological studies such as chest X-ray and mammography.

Fast, light, and scalable: harnessing data-mined line annotations for automated tumor segmentation on brain MRI.

While fully supervised learning can yield high-performing segmentation models, the effort required to manually segment large training sets limits practical utility. We investigate whether data mined line annotations can facilitate brain MRI tumor segmentation model development without requiring manually segmented training data. In this retrospective study, a tumor detection model trained using clinical line annotations mined from PACS was leveraged with unsupervised segmentation to generate pseudo-masks of enhancing tumors on T1-weighted post-contrast images (9911 image slices; 3449 adult patients). Baseline segmentation models were trained and employed within a semi-supervised learning (SSL) framework to refine the pseudo-masks. Following each self-refinement cycle, a new model was trained and tested on a held-out set of 319 manually segmented image slices (93 adult patients), with the SSL cycles continuing until Dice score coefficient (DSC) peaked. DSCs were compared using bootstrap resampling. Utilizing the best-performing models, two inference methods were compared: (1) conventional full-image segmentation, and (2) a hybrid method augmenting full-image segmentation with detection plus image patch segmentation. Baseline segmentation models achieved DSC of 0.768 (U-Net), 0.831 (Mask R-CNN), and 0.838 (HRNet), improving with self-refinement to 0.798, 0.871, and 0.873 (each p < 0.001), respectively. Hybrid inference outperformed full image segmentation alone: DSC 0.884 (Mask R-CNN) vs. 0.873 (HRNet), p < 0.001. Line annotations mined from PACS can be harnessed within an automated pipeline to produce accurate brain MRI tumor segmentation models without manually segmented training data, providing a mechanism to rapidly establish tumor segmentation capabilities across radiology modalities. • A brain MRI tumor detection model trained using clinical line measurement annotations mined from PACS was leveraged to automatically generate tumor segmentation pseudo-masks. • An iterative self-refinement process automatically improved pseudo-mask quality, with the best-performing segmentation pipeline achieving a Dice score of 0.884 on a held-out test set. • Tumor line measurement annotations generated in routine clinical radiology practice can be harnessed to develop high-performing segmentation models without manually segmented training data, providing a mechanism to rapidly establish tumor segmentation capabilities across radiology modalities.

Implementation of GAN-Based, Synthetic T2-Weighted Fat Saturated Images in the Routine Radiological Workflow Improves Spinal Pathology Detection.

(1) Background and Purpose: In magnetic resonance imaging (MRI) of the spine, T2-weighted (T2-w) fat-saturated (fs) images improve the diagnostic assessment of pathologies. However, in the daily clinical setting, additional T2-w fs images are frequently missing due to time constraints or motion artifacts. Generative adversarial networks (GANs) can generate synthetic T2-w fs images in a clinically feasible time. Therefore, by simulating the radiological workflow with a heterogenous dataset, this study's purpose was to evaluate the diagnostic value of additional synthetic, GAN-based T2-w fs images in the clinical routine. (2) Methods: 174 patients with MRI of the spine were retrospectively identified. A GAN was trained to synthesize T2-w fs images from T1-w, and non-fs T2-w images of 73 patients scanned in our institution. Subsequently, the GAN was used to create synthetic T2-w fs images for the previously unseen 101 patients from multiple institutions. In this test dataset, the additional diagnostic value of synthetic T2-w fs images was assessed in six pathologies by two neuroradiologists. Pathologies were first graded on T1-w and non-fs T2-w images only, then synthetic T2-w fs images were added, and pathologies were graded again. Evaluation of the additional diagnostic value of the synthetic protocol was performed by calculation of Cohen's ĸ and accuracy in comparison to a ground truth (GT) grading based on real T2-w fs images, pre- or follow-up scans, other imaging modalities, and clinical information. (3) Results: The addition of the synthetic T2-w fs to the imaging protocol led to a more precise grading of abnormalities than when grading was based on T1-w and non-fs T2-w images only (mean ĸ GT versus synthetic protocol = 0.65; mean ĸ GT versus T1/T2 = 0.56; p = 0.043). (4) Conclusions: The implementation of synthetic T2-w fs images in the radiological workflow significantly improves the overall assessment of spine pathologies. Thereby, high-quality, synthetic T2-w fs images can be virtually generated by a GAN from heterogeneous, multicenter T1-w and non-fs T2-w contrasts in a clinically feasible time, which underlines the reproducibility and generalizability of our approach.

Advances in the imaging of gastroenteropancreatic neuroendocrine neoplasms.

Gastroenteropancreatic neuroendocrine neoplasms comprise a heterogeneous group of tumors that differ in their pathogenesis, hormonal syndromes produced, biological behavior and consequently, in their requirement for and/or response to specific chemotherapeutic agents and molecular targeted therapies. Various imaging techniques are available for functional and morphological evaluation of these neoplasms and the selection of investigations performed in each patient should be customized to the clinical question. Also, with the increased availability of cross sectional imaging, these neoplasms are increasingly being detected incidentally in routine radiology practice. This article is a review of the various imaging modalities currently used in the evaluation of neuroendocrine neoplasms, along with a discussion of the role of advanced imaging techniques and a glimpse into the newer imaging horizons, mostly in the research stage.

Novel Radiomic Measurements of Tumor-Associated Vasculature Morphology on Clinical Imaging as a Biomarker of Treatment Response in Multiple Cancers.

The tumor-associated vasculature (TAV) differs from healthy blood vessels by its convolutedness, leakiness, and chaotic architecture, and these attributes facilitate the creation of a treatment-resistant tumor microenvironment. Measurable differences in these attributes might also help stratify patients by likely benefit of systemic therapy (e.g., chemotherapy). In this work, we present a new category of computational image-based biomarkers called quantitative tumor-associated vasculature (QuanTAV) features, and demonstrate their ability to predict response and survival across multiple cancer types, imaging modalities, and treatment regimens involving chemotherapy. We isolated tumor vasculature and extracted mathematical measurements of twistedness and organization from routine pretreatment radiology (CT or contrast-enhanced MRI) of a total of 558 patients, who received one of four first-line chemotherapy-based therapeutic intervention strategies for breast (n = 371) or non-small cell lung cancer (NSCLC, n = 187). Across four chemotherapy-based treatment strategies, classifiers of QuanTAV measurements significantly (P < 0.05) predicted response in held out testing cohorts alone (AUC = 0.63-0.71) and increased AUC by 0.06-0.12 when added to models of significant clinical variables alone. Similarly, we derived QuanTAV risk scores that were prognostic of recurrence-free survival in treatment cohorts who received surgery following chemotherapy for breast cancer [P = 0.0022; HR = 1.25; 95% confidence interval (CI), 1.08-1.44; concordance index (C-index) = 0.66] and chemoradiation for NSCLC (P = 0.039; HR = 1.28; 95% CI, 1.01-1.62; C-index = 0.66). From vessel-based risk scores, we further derived categorical QuanTAV high/low risk groups that were independently prognostic among all treatment groups, including patients with NSCLC who received chemotherapy only (P = 0.034; HR = 2.29; 95% CI, 1.07-4.94; C-index = 0.62). QuanTAV response and risk scores were independent of clinicopathologic risk factors and matched or exceeded models of clinical variables including posttreatment response. Across these domains, we observed an association of vascular morphology on CT and MRI-as captured by metrics of vessel curvature, torsion, and organizational heterogeneity-and treatment outcome. Our findings suggest the potential of shape and structure of the TAV in developing prognostic and predictive biomarkers for multiple cancers and different treatment strategies.

Diagnostic Performance of O-RADS MRI Scoring System for the Assessment of Adnexal Masses in Routine Clinical Radiology Practice- A Single Tertiary Centre Prospective Cohort Study

Introduction: In 2019-20, the American College of Radiology (ACR) introduced Ovarian-Adnexal Reporting and Data System Magnetic Resonance Imaging (O-RADS MRII). Application of the O-RADS MRI in routine clinical practice can increase lesion characterization accuracy, promote better interdisciplinary communication, and help in personalized patient management of adnexal masses. Aim: To assess the diagnostic performance of the ACR O-RADS MRI scoring system for the predicting malignancy in adnexal mass in routine clinical radiology practice by using histology/ imaging findings during a minimum 4 month follow-up as the reference standard. Materials and Methods: In this single- tertiary center prospective cohort study done in Jorhat Medical College, Assam, 42 patients with 46 adnexal masses who underwent MRI between April 2020 and June 2021 were assessed. The ACR O-RADS MR scores were assigned using the MRI protocol with a dynamic study. Sensitivity, specificity, positive and negative predictive values along with the area under the Receiver Operating Characteristic (ROC) curve were calculated (cut-off score ≥4 was considered malignancy,). Histopathologic diagnosis or &gt;4 months followup imaging findings was the reference standard used. Logistic regression analysis of MRI parameters used in identifying malignant masses was assessed. Statistical analysis was done using 95% confidence intervals (CIs). The p-values &lt;0.05 was considered statistically significant. Results: The mean age of subjects in the study was 35.9 (range 10-75 years), and 84.8% of adnexal masses (39) were premenopausal. Malignancy was more common in postmenopausal patients (57.1%). Of 46 lesions, 13 (33.3%) were malignant. The ACR O-RADS-MR scoring system, using a dynamic MRI protocol, showed 92.3% sensitivity and 87.8%specificity in malignancy prediction. The area under the ROC curve for predicting malignancy was 0.962. The positive and negative predictive values were 75% and 89.1%, respectively. Conclusion: In a teaching hospital in assam, the O-RADS MRI scoring system, based on a dynamic MRI protocol demonstrated good sensitivity, specificity and area under the Receiver Operator Characteristic (ROC) curve in identifying malignant adnexal masses. The ACR O-RADS MRI system enables standardized MRI reporting with uniform lexicon and interpretation guide on adnexal masses.This will help to improve communication between radiologists and referring physician and in patient management, particularly in indeterminate masses on ultrasound.

Assessment of the Association between Clinical Examination and Investigations with Outcome in Cases of Abdominal Malignancy

Introduction: Abdominal malignancy is a serious problem in the western world which is presently rising in India due to change in lifestyle. The etiopathogenesis are hereditary, environmental and lifestyle factors. The signs and symptoms vary depending upon the type and stage of cancer. Routine investigations, tumor markers, radiology, endoscopy and biopsy examine patients. There have been advances in chemotherapy, radiotherapy, and palliation but still surgery is curative.&#x0D; Methods: This is a prospective observational study including all cases of abdominal malignancy presenting to Surgery OPD. The sample size is 46 patients.&#x0D; Results: Mean age of presentation is 54.63 years. Preoperative abnormal parameters such as CEA, CA 19-9, preoperative biopsy, lymph nodal metastasis on CT and liver metastasis on CT were correlated with outcome which were found to be significant. Operative findings such as site, area, spread outside serosa, lymph nodal metastasis, and liver metastasis were correlated with same in the radio-pathological findings and were found to be significant. Outcome was assessed. Reasons for delay in presentation, diagnosis and treatment were assessed. &#x0D; Conclusion: Maximum number of patients were in the age group of 41-60 years. There was a definite difference in outcome with reference to preoperative abnormal parameters. There was comparative variation of operative and radio-pathological findings. Study subjects death were due to malignancy as most of them presented to the hospital at advanced stages of malignancy and others dropped out of chemotherapy or radiotherapy and those who took proper treatment had good outcome.

Review of Neonatal and Infant Cranial US.

Review of Neonatal and Infant Cranial US.

Does T2 inversion aid in identifying disc pathologies?

ObjectiveT2 inversion sequence is used in routine radiology practice mainly to heighten contrast resolution within the region to be studied but no evidence exists in current literature to assess it's true efficacy for lumbar disc degeneration. The objective of this study was to analyse T2 inversion and evaluate it's efficacy in assessment of lumbar disc pathology,. Materials and methodsThis retrospective single-centre study included 50 randomly selected patients presenting with back pain and radiculopathy. T2 inversion sequence was obtained in both axial and sagittal planes in addition to routine sequences. All the Magnetic Resonance Imaging (MRI) procedures were performed on 3T. One senior Musculoskeletal (MSK) radiologist, 2 general radiologists and a spinal surgeon blinded to final results reviewed images for the various disc pathologies individually analysing conventional and T2 inversion images. Data was analysed using Fischer's test and Chi2 test with a p value of <0.05 considered as significant. ResultsFifty randomly selected patients (mean age was 47.3 years(range 35–55 years) with back pain and radicular symptoms were included. The spectrum of disc pathologies included protrusions, annular fissures, discal cysts and calcified discs. Based on the above findings, T2 inversion sequence is not proved to be an alternative imaging sequence to routine MR imaging sequences for the depiction of various disc pathologies. ConclusionT2 inversion sequence does not increase the depiction of various lumbar disc pathologies in comparison with conventional sequences when used by experienced MSK radiologists. It may highlight abnormalities better for relatively inexperienced readers such as general radiologists and spinal surgeons.

Rama Co-RADS: Categorical Assessment Scheme of Chest Radiographic Findings for Diagnosing Pneumonia in Patients With Confirmed COVID-19

Due to the rapid spread of COVID-19 during the third wave of infection in Thailand, the number of confirmed COVID-19 cases has increased exponentially since April 2021. As a result, the country’s healthcare facilities and personnel are overwhelmed. Hence, many new intervention strategies have been designed and implemented. In such a resource-constrained condition, multiple alternate care sites, such as converted hotels (the so-called hospitels) and mobile field medical units, have been established for quarantine and taking care of confirmed COVID-19 cases having no or mild symptoms. In this context, it is essential to have clinical and chest radiographic assessment as a baseline screening for an accurate and rapid triage of patients and early detection of COVID-19 pneumonia, which significantly impacts patient outcomes. Therefore, a clear, concise and standardized chest radiographic report is mandatory. To facilitate this process, the authors have introduced Rama Co-RADS for the categorical assessment scheme of pulmonary involvement in COVID-19. After the pilot implementation of Rama Co-RADS in the routine radiology workflow for chest radiography screening in patients with confirmed COVID-19 at the Ramathibodi Hospitels, there is a 24% reduction in the median turnaround radiology reporting time. It also enhances the radiologist’s performance in establishing the diagnosis of COVID-19 pneumonia (especially in the early phase). Furthermore, the categorical assessment scheme in Rama Co-RADS facilitates communication among healthcare personnel, guiding effective management, triage, consultation and treatment of patients with confirmed COVID-19.&#x0D;