Society Of Radiologists In Ultrasound Research Articles

Carotid Disease Classification: Impact of the 2021 Intersocietal Accreditation Commission Updated Recommendations vs 2003 Society of Radiologists in Ultrasound Consensus Conference Criteria

Introduction: In 2021, the Intersocietal Accreditation Commission (IAC) introduced modified criteria for carotid duplex interpretation based on peak systolic velocity (PSV) and PSV ratio. The most significant change compared to the 2003 Society of Radiologists in Ultrasound (SRU) criteria involved re-defining the thresholds for <50 and 50% to 69% stenosis ranges. Patients identified in <50% vs 50% to 69% ranges may face different disease severity assignments, variable surveillance protocols, medical management approaches, and recommendations for intervention. Facilities may experience altered payment coverage, issues of staff re-training, and questions from referring physicians regarding patient treatment and disease management expectations. The objective of this study was to assess the impact of re-defining these stenosis ranges using the 2021 IAC criteria vs the SRU criteria. Methods: Anonymized patient data from carotid duplex examinations were collected as part of an internal laboratory quality improvement strategy. These data were analyzed in an electronic database using the IAC and SRU threshold criteria to determine the degree of carotid stenosis. Patients with normal arteries, unilateral studies, or complete occlusions were excluded. Results: Of the 1000 patients considered, 850 met the eligibility criteria. Using PSV: for the right carotid, 242 (28.5%) showed a change and 608 (71.5%) showed no change in stenosis classification; for the left carotid, 228 (27%) showed a change and 622 (73%) showed no change. All changes were a downgrading of disease to <50% stenosis. Using PSV ratio: for the right carotid, re-assignment of 53 (22% of changed, 6% of total cohort); for the left carotid, re-assignment of 48 (21% of changed, 5.6% of total cohort). All changes resulted in re-assignment to the 50% to 69% stenosis category. Conclusions: Implementation of the IAC criteria resulted in patients being re-assigned to lower stenosis categories (27% for PSV and 21% for PSV ratio). The impact of these changes on patient care and facility logistics needs careful consideration.

Management of incidentally detected gallbladder polyps: a review of clinical scenarios using the 2022 SRU gallbladder polyp consensus guidelines.

Gallbladder (GB) polyps are a common incidental finding on sonography, but only a small fraction of polyps become GB cancer. The Society of Radiologists in Ultrasound (SRU) consensus committee recently performed an extensive literature review and published guidelines for GB polyp follow-up/management to provide clarity among the many heterogeneous recommendations that are available to clinicians. As these guidelines have become adopted into clinical practice, challenging clinical scenarios have arisen including GB polyps in primary sclerosing cholangitis (PSC), high risk geographic/genetic patient populations, shrinking polyps, pedunculated vs sessile polyps, thin vs thick stalked polyps, vascular polyps and multiple polyps. According to the SRU guidelines, clinicians should refer to gastroenterology guidelines when managing GB polyps in patients with known PSC. If patients at high geographic/genetic risk develop GB polyps, 'extremely low risk' polyps may be managed as 'low risk' and 10-14mm 'extremely low risk' or '7-14mm' low risk polyps that decrease in size by ≥ 4mm require no follow-up. Thin-stalked or pedunculated polyps are 'extremely low risk' and thick-stalked pedunculated polyps are 'low risk'. Sessile polyps are 'low risk' but should receive immediate specialist referral if features suggestive of GB cancer are present. Neither polyp multiplicity nor vascularity impact risk of GB cancer and follow up should be based on morphology alone.

Society of Radiologists in Ultrasound Consensus Conference Recommendations for Incidental Gallbladder Polyp Management: Interreader Agreement Among Ten Radiologists.

Background: The 2022 Society of Radiologists in Ultrasound (SRU) consensus conference recommendations support less-aggressive management of small gallbladder polyps on ultrasound versus earlier approaches and may help standardize polyp evaluation by radiologists. Objective: To assess radiologists' interreader agreement in applying the SRU recommendations for management of incidental gallbladder polyps on ultrasound. Methods: This retrospective study included 105 patients (median age, 52 years; 75 women, 27 men) with a gallbladder polyp on ultrasound (without features highly suspicious for invasive or malignant tumor) who underwent cholecystectomy between January 1, 2003 and January 1, 2021. Ten abdominal radiologists independently reviewed ultrasound examinations and, using SRU recommendations, assessed one polyp per patient for risk category (extremely low-risk, low-risk, or indeterminate risk) and possible recommendation for surgical consultation. Five radiologists were considered less-experienced (<5 years), and five more-experienced (≥5 years). Interreader agreement was evaluated. Polyps were classified pathologically as nonneoplastic or neoplastic. Results: For risk category assignments, interreader agreement was substantial among all readers (k=0.710), less-experienced readers (k=0.705), and more-experienced readers (k=0.692). For surgical consultation recommendations, interreader agreement was substantial among all readers (k=0.795) and more-experienced readers (kappa=0.740), and almost perfect among less-experienced readers (k=0.811). Of ten readers, a median of 5 (IQR, 2-8), 4 (IQR, 2-7), and 0 (IQR, 0-0) classified polyps as extremely low risk, low risk, and indeterminate risk, respectively. Across readers, the fraction of polyps classified as extremely low risk ranged from 32-72%, as low risk from 24-65%, and as indeterminate risk from 0-8%. Of ten readers, a median of 0 (IQR, 0-1) recommended surgical consultation; the fraction of polyps receiving a surgical consultation recommendation ranged from 4-22%. A total of 102/105 polyps were nonneoplastic; 3/105 were neoplastic (all benign). Based on readers' most-common assessments for the nonneoplastic polyps, the risk category was extremely low risk in 53, low risk in 48, and indeterminate risk in 1; surgical consultation was recommended in 16. Conclusion: Ten abdominal radiologists showed substantial agreement for polyp risk categorizations and surgical consultation recommendations, although areas of reader variability were identified. Clinical Impact: The findings support overall reproducibility of the SRU recommendations, while indicating opportunity for improvement.

Use of cine images in standard ultrasound imaging: a survey of sonologists.

The aim of this study was to explore how sonologists utilize cine images in their routine practice. A 10-question, multiple choice survey was distributed to members of the Society of Radiologists in Ultrasound. The survey queried respondent's routine inclusion of cines for ultrasound examinations in normal and abnormal studies in addition to questions related to respondent's practice type, geographic location, number of radiologists interpreting ultrasound examinations, and ultrasound imaging workflow. Sixty-five percent of respondents are in academic practice. Geographic location of practice, number of radiologists in the practice who interpret ultrasound, and whether the sonologist was on site where the examinations were performed was variable. Of respondents, 97% of used both static and cine images for abnormal/positive examinations and 82% used both for normal/negative studies. Nearly all respondents, who are mostly in academic practice, report using both static and cine images for all ultrasound examinations in their practice.

AIUM Practice Parameter for the Performance and Interpretation of Diagnostic Ultrasound of the Thyroid and Extracranial Head and Neck.

AIUM Practice Parameter for the Performance and Interpretation of Diagnostic Ultrasound of the Thyroid and Extracranial Head and Neck.

Assessment of the Adherence of Radiologists in Reporting the Ovarian Cysts to the 2010 Society of Radiologists in Ultrasound Guidelines.

The objective of this study was to determine the adherence of radiologists to the guideline of the Society of Radiologists in Ultrasound (SRU)-2010 for the follow-up of ovarian cysts in patients during 2015-2016. The patients' data, referring for transvaginal and pelvic ultrasonography, suffering from ovarian cyst were assessed in terms of menopause status, cyst size, and type, as well as follow-ups recommended by radiologist to assess the adherence of reports to SRU-2010. Three hundred and sixty-four sonography reports were investigated. Seventy-seven percent of the reports had adhered to SRU-2010, 9.9% and 9.1% had under/overmanagement, and 4.1% was incomplete. 94.2% and 5.8% of cases were in pre/postmenopause status, respectively. The highest adherence belonged to cysts in size <1 cm, 1-3 cm, 5-7 cm. The highest adherence, over/undermanagement, and incomplete reports belonged to corpus luteum, hemorrhagic, dermoid cysts, and nodules without flow. The adherence of sonography reports to SRU-2010 for accidental ovarian cysts was 76.9%. The tendency for overmanagement of simple cysts in premenopausal women and the tendency for undermanagement in simple cysts and in postmenopausal women were higher, respectively. It is expected that more training of the guideline to radiologists will lead to the reduction of unnecessary follow-up, which in turn leads to reduced patient's anxiety and cost of treatment.

Accuracy of the Society of Radiologists in Ultrasound (SRU) Carotid Doppler Velocity Criteria for Grading North American Symptomatic Carotid Endarterectomy Trial (NASCET) Stenosis: A Meta-Analysis.

The Society of Radiologists in Ultrasound (SRU) consensus panel proposed six Doppler velocity cut points for classifying internal carotid artery (ICA) stenosis of 50% and 70% according to the North American Symptomatic Carotid Endarterectomy Trial (NASCET) method. Their relative accuracies have not been compared. Meta-analysis performed following comprehensive literature review and identification of manuscripts with graphs of individual patient NASCET ICA stenosis measured by arteriography versus ICA peak-systolic velocity (PSV), end-diastolic velocity (EDV) and ICA PSV to common carotid artery (CCA) PSV. True positives, true negatives, false positives, and false negatives were calculated and used in two-level mixed effects models. Hierarchical summary receiver operating characteristic (ROC) curves were generated. Areas under the ROC curves were estimated. Nine studies performed between 1993 and 2016 were identified after review of 337 manuscripts. There were 1738 bifurcation data points extracted for PSV, 1026 for EDV, and 775 for ICA/CCA ratio. The highest sensitivity was 96% (95% CI: 93%, 98%) for PSV of 125 cm/s (50% stenosis) and highest specificity 86% (95% CI: 71%, 93%) for PSV of 230 cm/s (70% stenosis). Areas under the ROC curves ranged from a high of 0.93 (95% CI: 0.92, 0.95) for PSV (50% stenosis) to a low of 0.86 (95% CI: 0.84, 0.88) for EDV (70% stenosis). The SRU consensus Doppler cut points vary in their accuracies for predicting ICA stenosis. The PSV cut points have tradeoffs: high sensitivity/low specificity for 50% stenosis and high specificity/moderate sensitivity for 70% stenosis.

Impact of Use of Intersocietal Accreditation Commission Versus Society of Radiologists in Ultrasound Carotid Interpretation Criteria on Patient Management

The Intersocietal Accreditation Commission (IAC) recently introduced modified criteria for carotid duplex ultrasound interpretation. The most significant change, compared with the Society of Radiologists in Ultrasound (SRU) criteria, involved redefining the ranges of <50% and 50% to 69%. The definitions of 70% to 99%, near occlusion, and occlusion remained unchanged. Patients identified in the <50% vs 50% to 69% ranges could experience different disease severity assignments, surveillance protocols, medical management approaches, and access to intervention (if symptomatic).

Shear wave elastography using sound touch elastography and supersonic shear imaging for liver measurements: a comparative study.

Measurements of liver stiffness obtained with 2-dimensional shear wave elastography (2D-SWE) have been widely used to clinically assess liver fibrosis. However, differences between different 2D-SWE systems can lead to confusion when interpreting measurements. This study investigated the variability between a recently released sound touch elastography (STE) system and a supersonic shear imaging (SSI) system and assessed the degree of intersystem discrepancy using the different liver stiffness value (LSV) thresholds recommended by the Society of Radiologists in Ultrasound (SRU) for assessing liver fibrosis. A total of 4,152 patients who had undergone STE and SSI on the same day were enrolled in this retrospective study. First, intrasystem agreement for STE and SSI was assessed. Then, intraclass correlation coefficients (ICCs) and the Bland-Altman method were used to assess intersystem variability for all cases, classified according to the thresholds recommended by the SRU. The effects of age, gender, and body-mass index (BMI) were evaluated using multivariate linear regression analysis and attributive intervals were computed for STE and SSI at each of the different thresholds. The ICCs for STE and SSI intrasystem agreement were 0.94 [95% confidence interval (CI): 0.937-0.943; P<0.001] and 0.984 (95% CI: 0.984-0.985; P<0.001), respectively. The 95% limit of agreement (LOA) for all cases ranged from -6.96 to 7.44 kPa. The 95% LOA increased as the threshold values rose, and intersystem variability was obvious, even at the smallest threshold (the 95% LOA at values ≤5 kPa was -0.85 to 2.08 kPa, while that at values >17 kPa was -20.81 to 14.71 kPa). The adjusted R2 for age, gender, and BMI was only 0.018 (all P value <0.05). There was clear variability between STE and SSI, in contrast with some previous studies with small sample sizes, and consistent with others. Intersystem variability increased with the elevation of the LSV thresholds recommended by the SRU. Gender and BMI had little effect on intersystem variability. Future research could compare STE and SSI in different liver diseases, assessing the feasibility of the SRU-recommended thresholds in proven pathologies and evaluating the test-retest repeatability.

Survey Study on the Experience, Practice Patterns, and Preferences of the Fellows of the Society of Radiologists in Ultrasound for Evaluation and Management of Gallbladder Polyps Detected With Ultrasound.

Gallbladder polyps (GPs) are a common incidental finding on ultrasound; however, important differences in recommended management exist among professional society guidelines.An electronic survey was sent to 189 fellows of the Society of Radiologists in Ultrasound. Main outcomes included preferences and current practice patterns for evaluation, management, and surveillance of GPs as well as personal lifetime experience with gallbladder sonography and GPs.A total of 64 subjects (34%) with experience in gallbladder sonography completed the study. The estimated combined total number of gallbladder scans seen by the responders was 3,071,880. None of fellows had ever seen a pedunculated GP <1 cm detected on ultrasound that was proven to be malignant at the time of detection or during subsequent follow-up. All of the fellows used size as a feature to stratify recommendations. The median size threshold currently used by Society of Radiologists in Ultrasound fellows for recommending ultrasound follow-up was 6 mm, and their preferred threshold was 7 mm. The median size threshold for recommending surgical consultation was 10 mm, and the preferred threshold was 10 mm. Wall thickening and shape were considered important factors by 76% and 67% of respondents, respectively.Society of Radiologists in Ultrasound fellows tend to provide recommendations most similar to the American College of Radiology and Canadian Association of Radiology guidelines for management of GPs. Many would prefer guidelines that result in fewer recommendations for follow-up and surgical consultation. Despite a substantial combined experience, this survey did not uncover any case of a small GP that was malignant.

Benign-appearing Incidental Adnexal Cysts at US, CT, and MRI: Putting the ACR, O-RADS, and SRU Guidelines All Together

Adnexal cysts are a common incidental finding at US, CT, and MRI but have historically caused a diagnostic dilemma for determining when to follow up and how to manage them. Characteristic imaging features of simple adnexal cysts include a simple fluid collection with smooth walls and no solid or vascular components. Day-to-day practice guidelines were recently updated to reflect the overwhelming evidence that incidental cystic adnexal masses are almost always benign. Three major consensus articles on adnexal cystic masses were published between 2019 and 2020: the Society of Radiologists in Ultrasound (SRU) consensus update on adnexal cysts, the Ovarian-Adnexal Reporting and Data System (O-RADS) US consensus guideline, and the American College of Radiology (ACR) white paper on the management for incidental adnexal findings at CT and MRI. All three standardize reporting terminology, are based on evidence-based data and institutional practice patterns, and apply to nonpregnant women of average risk for ovarian cancer. While there are small differences in follow-up recommendations based on size thresholds, the goal of each is the same-to limit unnecessary imaging follow-up and, by doing so, save the patient time, money, and anxiety. For the diagnostic radiologist to use these guidelines, it is essential that the entire mass is visualized well. Without adequate visualization, further characterization of the mass may be necessary. To put it all together, the SRU consensus guideline and ACR white paper are easily applied in day-to-day practice for masses that are O-RADS 2 and below. An invited commentary by Patel is available online.The online slide presentation from the RSNA Annual Meeting is available for this article.©RSNA, 2022.

The AIUM Practice Parameter for the Performance of an Ultrasound Examination of the Extracranial Cerebrovascular System.

The AIUM Practice Parameter for the Performance of an Ultrasound Examination of the Extracranial Cerebrovascular System.

The AIUM Practice Parameter for the Performance of an Ultrasound Examination of the Abdomen and/or Retroperitoneum.

The AIUM Practice Parameter for the Performance of an Ultrasound Examination of the Abdomen and/or Retroperitoneum.

The AIUM Practice Parameter for the Performance of an Ultrasound Examination of the Neonatal and Infant Spine.

The AIUM Practice Parameter for the Performance of an Ultrasound Examination of the Neonatal and Infant Spine.

Review of Neonatal and Infant Cranial US.

Review of Neonatal and Infant Cranial US.

AIUM Practice Parameter for the Performance of Sonohysterography and Hysterosalpingo-Contrast Sonography.

AIUM Practice Parameter for the Performance of Sonohysterography and Hysterosalpingo-Contrast Sonography.

AIUM Practice Parameter for the Performance of Ultrasound Evaluations of the Prostate (and Surrounding Structures).

AIUM Practice Parameter for the Performance of Ultrasound Evaluations of the Prostate (and Surrounding Structures).

Why are we still debating criteria for carotid artery stenosis?

The risk of new or recurrent stroke is high among patients with extracranial carotid artery stenosis and the benefit of carotid revascularization is associated to the degree of luminal stenosis. Catheter-based digital subtraction angiography (DSA) as the diagnostic gold-standard for carotid stenosis (CS) has been replaced by non-invasive techniques including duplex ultrasound, computed-tomography angiography, and magnetic resonance angiography (MRA). Duplex ultrasound is the primary noninvasive diagnostic tool for detecting, grading and monitoring of carotid artery stenosis due to its low cost, high resolution, and widespread availability. However, as discussed in this review, there is a wide range of practice patterns in use of ultrasound diagnostic criteria for carotid artery stenosis. To date, there is no internationally accepted standard for the gradation of CS. Discrepancies in ultrasound criteria may result in clinically relevant misclassification of disease severity leading to inappropriate referral, or lack of it, to revascularization procedures, and potential for consequential adverse outcome. The Society of Radiologists in Ultrasound (SRU), either as originally outlined or in a modified form, are the most common criteria applied. However, such criteria have received criticism for relying primarily on peak systolic velocities, a parameter that when used in isolation could be misleading. Recent proposals rely on a multiparametric approach in which the hemodynamic consequences of carotid narrowing beyond velocity augmentation are considered for an accurate stenosis classification. Consensus criteria would provide standardized parameters for the diagnosis of CS and considerably improve quality of care. Accrediting bodies around the world have called for consensus on unified criteria for diagnosis of CS. A healthy debate between professionals caring for patients with CS regarding optimal CS criteria still continues.

AIUM Practice Parameter for the Performance of Duplex Sonography of Native Renal Vessels

AIUM Practice Parameter for the Performance of Duplex Sonography of Native Renal Vessels

AIUM Practice Parameter for the Performance of an Ultrasound Examination of Solid-Organ Transplants.

AIUM Practice Parameter for the Performance of an Ultrasound Examination of Solid-Organ Transplants.