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1.
Abdom Radiol (NY) ; 2024 Jun 18.
Artículo en Inglés | MEDLINE | ID: mdl-38888739

RESUMEN

OBJECTIVE: To retrospectively compare inter- and intra-reader agreement of abbreviated MRCP (aMRCP) with comprehensive MRI (cMRCP) protocol for detection of worrisome features, high-risk stigmata, and concomitant pancreatic cancer in pancreatic cyst surveillance. METHODS: 151 patients (104 women, mean age: 69[10] years) with baseline and follow-up contrast-enhanced MRIs were included. This comprised 138 patients under cyst surveillance with 5-year follow-up showing no pancreatic ductal adenocarcinoma (PDAC), 6 with pancreatic cystic lesion-derived malignancy, and 7 with concomitant PDAC. The aMRCP protocol used four sequences (axial and coronal Half-Fourier Single-shot Turbo-spin-Echo, axial T1 fat-saturated pre-contrast, and 3D-MRCP), while cMRCP included all standard sequences, including post-contrast. Three blinded abdominal radiologists assessed baseline cyst characteristics, worrisome features, high-risk stigmata, and PDAC signs using both aMRCP and cMRCP, with a 2-week washout period. Intra- and inter-reader agreement were calculated using Fleiss' multi-rater kappa and Intra-class Correlation Coefficient (ICC). 95% confidence intervals (CI) were calculated. RESULTS: Cyst size, growth, and abrupt main pancreatic duct transition had strong intra- and inter-reader agreement. Intra-reader agreement was ICC = 0.93-0.99 for cyst size, ICC = 0.71-1.00 for cyst growth, and kappa = 0.83-1.00 for abrupt duct transition. Inter-reader agreement for cyst size was ICC = 0.86 (aMRCP) and ICC = 0.83 (cMRCP), and for abrupt duct transition was kappa = 0.84 (aMRCP) and kappa = 0.69 (cMRCP). Thickened cyst wall, mural nodule and cyst-duct communication demonstrated varying intra-reader agreements and poor inter-reader agreements. CONCLUSION: aMRCP showed high intra- and inter-reader agreement for most pancreatic cyst parameters that highly rely on T2-weighted sequences.

2.
Chest ; 2024 Jun 21.
Artículo en Inglés | MEDLINE | ID: mdl-38909953

RESUMEN

TOPIC IMPORTANCE: Chest computed tomography (CT) holds a major role in the diagnosis of lung disease, many of which affect the peri-bronchovascular (PBV) region. Identification and categorization of PBV abnormalities on CT can assist in formulating a differential diagnosis and directing further diagnostic evaluation. REVIEW FINDINGS: The PBV region of the lung encompasses the pulmonary arteries, airways, and lung interstitium. Understanding disease processes associated with structures of the PBV region and their appearances on CT aids in prompt diagnosis. This manuscript reviews current knowledge in anatomy and pathology of the lung interstitium composed of intercommunicating pre-lymphatic spaces, lymphatics, collagen bundles, lymph nodes, bronchial arteries; diffuse lung diseases that present in a PBV distribution; and an approach to classifying diseases according to patterns of imaging presentations. Lung PBV diseases can appear on CT as diffuse thickening, fibrosis, masses/mass-like consolidation, ground glass or air-space consolidation, and cysts, acknowledging some disease may have multiple presentations.

3.
Artículo en Inglés | MEDLINE | ID: mdl-38722777

RESUMEN

OBJECTIVE: To perform image quality comparison between deep learning-based multiband diffusion-weighted sequence (DL-mb-DWI), accelerated multiband diffusion-weighted sequence (accelerated mb-DWI), and conventional multiband diffusion-weighted sequence (conventional mb-DWI) in patients undergoing clinical liver magnetic resonance imaging (MRI). METHODS: Fifty consecutive patients who underwent clinical MRI of the liver at a 1.5-T scanner, between September 1, 2021, and January 31, 2022, were included in this study. Three radiologists independently reviewed images using a 5-point Likert scale for artifacts and image quality factors, in addition to assessing the presence of liver lesions and lesion conspicuity. RESULTS: DL-mb-DWI acquisition time was 65.0 ± 2.4 seconds, significantly (P < 0.001) shorter than conventional mb-DWI (147.5 ± 19.2 seconds) and accelerated mb-DWI (94.3 ± 1.8 seconds). DL-mb-DWI received significantly higher scores than conventional mb-DWI for conspicuity of the left lobe (P < 0.001), sharpness of intrahepatic vessel margin (P < 0.001), sharpness of the pancreatic contour (P < 0.001), in-plane motion artifact (P = 0.002), and overall image quality (P = 0.005) by reader 2. DL-mb-DWI received significantly higher scores for conspicuity of the left lobe (P = 0.006), sharpness of the pancreatic contour (P = 0.020), and in-plane motion artifact (P = 0.042) by reader 3. DL-mb-DWI received significantly higher scores for strength of fat suppression (P = 0.004) and sharpness of the pancreatic contour (P = 0.038) by reader 1. The remaining quality parameters did not reach statistical significance for reader 1. CONCLUSIONS: Novel diffusion-weighted MRI sequence with deep learning-based image reconstruction demonstrated significantly decreased acquisition times compared with conventional and accelerated mb-DWI sequences, while maintaining or improving image quality for routine abdominal MRI. DL-mb-DWI offers a potential alternative to conventional mb-DWI in routine clinical liver MRI.

4.
Artículo en Inglés | MEDLINE | ID: mdl-38595174

RESUMEN

OBJECTIVE: The aim of this study was to compare portal venous phase photon-counting CT (PCCT) using 20 cc less than weight-based contrast dosing with energy-integrating detector CT (EID-CT) using weight-based dosing by quantitative and qualitative analysis. METHODS: Fifty adult patients who underwent a reduced intravenous contrast dose portal venous phase PCCT from May 1, 2023, to August 10, 2023, and a prior portal-venous EID-CT with weight-based contrast dosing were retrospectively identified. Hounsfield units (HU) and noise (SD of HU) were obtained from region-of-interest measurements on 70-keV PCCT and EID-CT in 4 hepatic segments, the main and right portal vein, and both paraspinal muscles. Signal-to-noise and contrast-to-noise ratios were computed. Three abdominal radiologists qualitatively assessed overall image quality, hepatic enhancement, and confidence for metastasis identification on 5-point Likert scales. Readers also recorded the presence/absence of hepatic metastases. Quantitative variables were compared with paired t tests, and multiple comparisons were accounted for with a Bonferroni-adjusted α level of .0016. Ordinal logistic regression was used to evaluate qualitative assessments. Interreader agreement for hepatic metastases was calculated using Fleiss' κ. RESULTS: Fifty patients (32 women; mean [SD] age, 64 [13] years) were included. There was no significant difference in hepatic HU, portal vein HU, noise, and signal-to-noise or contrast-to-noise ratio between reduced contrast dose portal venous phase PCCT versus EID-CT (all Ps > 0.0016). Image quality, degree of hepatic enhancement, and confidence for metastasis identification were not different for reduced dose PCCT 70-keV images and EID-CT (P = 0.06-0.69). κ Value for metastasis identification was 0.86 (95% confidence interval, 0.70-1.00) with PCCT and 0.78 (95% confidence interval, 0.59-0.98) with EID-CT. CONCLUSION: Reduced intravenous contrast portal venous phase PCCT 70-keV images had similar attenuation and image quality as EID-CT with weight-based dosing. Metastases were identified with near-perfect agreement in reduced dose PCCT 70-keV images.

5.
Radiographics ; 44(4): e230164, 2024 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-38547034

RESUMEN

Severe obstetric hemorrhage is a leading cause of maternal mortality and morbidity worldwide. Major hemorrhage in the antepartum period presents potential risks for both the mother and the fetus. Similarly, postpartum hemorrhage (PPH) accounts for up to a quarter of maternal deaths worldwide. Potential causes of severe antepartum hemorrhage that radiologists should be familiar with include placental abruption, placenta previa, placenta accreta spectrum disorders, and vasa previa. Common causes of PPH that the authors discuss include uterine atony, puerperal genital hematomas, uterine rupture and dehiscence, retained products of conception, and vascular anomalies. Bleeding complications unique to or most frequently encountered after cesarean delivery are also enumerated, including entities such as bladder flap hematomas, rectus sheath and subfascial hemorrhage, and infectious complications of endometritis and uterine dehiscence. ©RSNA, 2024 Test Your Knowledge questions for this article are available in the supplemental material. See the invited commentary by Javitt and Madrazo in this issue.


Asunto(s)
Hemorragia Posparto , Trastornos Puerperales , Embarazo , Femenino , Humanos , Hemorragia Posparto/diagnóstico por imagen , Hemorragia Posparto/etiología , Hemorragia Posparto/cirugía , Placenta , Cesárea , Hematoma
6.
Abdom Radiol (NY) ; 49(3): 868-874, 2024 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-38006415

RESUMEN

PURPOSE: To quantitatively and qualitatively compare the degree of iodine removal in the collecting system from PCCT urographic phase-derived virtual noncontrast (VNC) images obtained at 140 kV versus 120 kV. METHODS: A retrospective PACS search identified adult patients (>18 years) who underwent a PCCT urogram for hematuria from 4/2022 to 4/2023 with available urographic phase-derived VNC images in PACS. Tube voltage (120 kV, 140 kV), body mass index, CTDIvol, dose length product (DLP), and size-specific dose estimate (SSDE) were recorded. Hounsfield Unit (HU) in both renal pelvises and the urinary bladder on urographic-derived VNC were recorded. Three radiologists qualitatively assessed the degree of iodine removal (renal pelvis, urinary bladder) and diagnostic confidence for urinary stone detection. Continuous variables were compared for 140 kV versus 120 kV with the Wilcoxon rank sum test. A p < .05 indicated statistical significance. RESULTS: 63 patients (34 male; median (Q1, Q3) age: 30 (26, 34) years; 140 kV/120 kV: 30 patients/33 patients) were included. BMI, CTDIvol, DLP, and SSDE were not different for 140 kV and 120 kV (all p > .05). Median (Q1, Q3) collecting system HU (renal pelvis and bladder) was 0.9 (- 3.6, 4.4) HU at 140 kV and 10.5 (3.6, 26.7) HU at 120 kV (p = .04). Diagnostic confidence for urinary calculi was 4.6 [1.1] at 140 kV and 4.1 [1.4] at 120 kV (p = .005). Diagnostic confidence was 5/5 (all readers) in 82.2% (74/90) at 140 kV and 59.6% (59/99) at 120 kV (p < .001). CONCLUSION: PCCT urographic phase-derived VNC images obtained at 140 kV had better collecting system iodine removal than 120 kV with similar patient radiation exposure. With excellent PCCT urographic phase iodine removal at 140 kV, consideration can be made to utilize a single-phase CT urogram in young patients.


Asunto(s)
Yodo , Imagen Radiográfica por Emisión de Doble Fotón , Cálculos Urinarios , Adulto , Humanos , Masculino , Estudios Retrospectivos , Imagen Radiográfica por Emisión de Doble Fotón/métodos , Tomografía Computarizada por Rayos X/métodos
7.
Abdom Radiol (NY) ; 48(7): 2284-2291, 2023 07.
Artículo en Inglés | MEDLINE | ID: mdl-37148320

RESUMEN

OBJECTIVE: To analyze the findings of proctitis in patients with laboratory-confirmed Mpox and correlate the patient clinical presentation and laboratory findings. METHODS: 21 patients with PCR-positive Mpox who obtained abdominopelvic CT were retrospectively identified by electronic medical record search. Three radiologists independently evaluated CT images, measuring rectal wall thickness (cm), degree of perirectal fat stranding on a 5-point Likert scale, and size of perirectal lymph nodes (cm, short axis). Mann-Whitney U-test (Wilcoxon rank sum test) was used to assess the association of rectal wall thickness and perirectal fat standing between patients with rectal symptoms and patients without rectal symptoms. RESULTS: 20 of 21 patients presented with perirectal fat stranding, with mean Likert score of 3.0 ± 1.4, indicating moderate perirectal stranding. Mean transverse rectal wall thickness was 1.1 ± 0.5 cm (range 0.3-2.3 cm); it was thicker among patients with HIV (1.2 cm vs 0.7 cm; p = .019). Mean perirectal fat stranding was greater among patients presenting with HIV, and with rectal symptoms, though not significantly so. 17/21 (81%) patients had abnormal mesorectal lymph nodes by at least two of three readers, with mean short-axis measurement 1.0 ± 0.3 cm (range 0.5-1.6 cm). Multiple linear regression showed no significant correlation between rectal thickness and laboratory values or HIV status. CONCLUSION: Nearly all patients with Mpox who presented with additional symptoms warranting a CT demonstrated proctitis. Degree of proctitis varied greatly within the cohort, with greatest thickening among patients with HIV. Physicians should have a high suspicion for proctitis in patients with suspected Mpox.


Asunto(s)
Infecciones por VIH , Mpox , Proctitis , Neoplasias del Recto , Humanos , Neoplasias del Recto/patología , Estudios Retrospectivos , Monkeypox virus , Proctitis/diagnóstico por imagen , Tomografía Computarizada por Rayos X
8.
Abdom Radiol (NY) ; 48(9): 2978-2985, 2023 09.
Artículo en Inglés | MEDLINE | ID: mdl-36871233

RESUMEN

PURPOSE: Given that ileal pouch-anal anastomosis (IPAA) surgery is a technically challenging and high-morbidity procedure, there are numerous pertinent imaging findings that need to be clearly and efficiently communicated to the IBD surgeons for essential patient management and surgical planning. Structured reporting has been increasingly used over the past decade throughout various radiology subspecialties to improve reporting clarity and completeness. We compare structured versus non-structured reporting of pelvic MRI for ileal pouch to evaluate for clarity and effectiveness. METHODS: 164 consecutive pelvic MRI's for ileal pouch evaluation, excluding subsequent exams for the same patient, acquired between 1/1/2019 and 7/31/2021 at one institution were included, before and after implementation (11/15/2020) of a structured reporting template, which was created with institutional IBD surgeons. Reports were assessed for the presence of 18 key features required for complete ileal pouch assessment: anastomosis (IPAA, tip of J, pouch body), cuff (length, cuffitis), pouch body (size, pouchitis, stricture), pouch inlet/pre-pouch ileum (stricture, inflammation, sharp angulation), pouch outlet (stricture), peripouch mesentery (position, mesentery twist), pelvic abscess, peri-anal fistula, pelvic lymph nodes, and skeletal abnormalities. Subgroup analysis was performed based on reader experience and divided into three categories: experienced (n = 2), other intra-institutional (n = 20), or affiliate site (n = 6). RESULTS: 57 (35%) structured and 107 (65%) non-structured pelvic MRI reports were reviewed. Structured reports contained 16.6 [SD:4.0] key features whereas non-structured reports contained 6.3 [SD:2.5] key features (p < .001). The largest improvement following template implementation was for reporting sharp angulation of the pouch inlet (91.2% vs. 0.9%, p < .001), tip of J suture line and pouch body anastomosis (both improved to 91.2% from 3.7%). Structured versus non-structured reports contained mean 17.7 versus 9.1 key features for experienced readers, 17.0 versus 5.9 for other intra-institutional readers, and 8.7 versus 5.3 for affiliate site readers. CONCLUSION: Structured reporting of pelvic MRI guides a systematic search pattern and comprehensive evaluation of ileal pouches, and therefore facilitates surgical planning and clinical management. This standardized reporting template can serve as baseline at other institutions for adaptation based on specific radiology and surgery preferences, fostering a collaborative environment between radiology and surgery, and ultimately improving patient care.


Asunto(s)
Reservorios Cólicos , Enfermedades Inflamatorias del Intestino , Proctocolectomía Restauradora , Humanos , Constricción Patológica/cirugía , Proctocolectomía Restauradora/métodos , Imagen por Resonancia Magnética , Complicaciones Posoperatorias
9.
Radiographics ; 43(2): e220112, 2023 02.
Artículo en Inglés | MEDLINE | ID: mdl-36633971

RESUMEN

Current disparities in the access to diagnostic imaging for Black patients and the underrepresentation of Black physicians in radiology, relative to their representation in the general U.S. population, reflect contemporary consequences of historical anti-Black discrimination. These disparities have existed within the field of radiology and professional medical organizations since their inception. Explicit and implicit racism against Black patients and physicians was institutional policy in the early 20th century when radiology was being developed as a clinical medical field. Early radiology organizations also embraced this structural discrimination, creating strong barriers to professional Black radiologist involvement. Nevertheless, there were numerous pioneering Black radiologists who advanced scholarship, patient care, and diversity within medicine and radiology during the early 20th century. This work remains important in the present day, as race-based health care disparities persist and continue to decrease the quality of radiology-delivered patient care. There are also structural barriers within radiology affecting workforce diversity that negatively impact marginalized groups. Multiple opportunities exist today for antiracism work to improve quality of care and to apply standards of social justice and health equity to the field of radiology. An initial step is to expand education on the disparities in access to imaging and health care among Black patients. Institutional interventions include implementing community-based outreach and applying antibias methodology in artificial intelligence algorithms, while systemic interventions include identifying national race-based quality measures and ensuring imaging guidelines properly address the unique cancer risks in the Black patient population. These approaches reflect some of the strategies that may mutually serve to address health care disparities in radiology. © RSNA, 2023 See the invited commentary by Scott in this issue. Quiz questions for this article are available in the supplemental material.


Asunto(s)
Médicos , Radiología , Humanos , Inteligencia Artificial , Radiografía , Radiólogos
10.
J Magn Reson Imaging ; 58(4): 1055-1064, 2023 10.
Artículo en Inglés | MEDLINE | ID: mdl-36651358

RESUMEN

BACKGROUND: Demand for prostate MRI is increasing, but scan times remain long even in abbreviated biparametric MRIs (bpMRI). Deep learning can be leveraged to accelerate T2-weighted imaging (T2WI). PURPOSE: To compare conventional bpMRIs (CL-bpMRI) with bpMRIs including a deep learning-accelerated T2WI (DL-bpMRI) in diagnosing prostate cancer. STUDY TYPE: Retrospective. POPULATION: Eighty consecutive men, mean age 66 years (47-84) with suspected prostate cancer or prostate cancer on active surveillance who had a prostate MRI from December 28, 2020 to April 28, 2021 were included. Follow-up included prostate biopsy or stability of prostate-specific antigen (PSA) for 1 year. FIELD STRENGTH AND SEQUENCES: A 3 T MRI. Conventional axial and coronal T2 turbo spin echo (CL-T2), 3-fold deep learning-accelerated axial and coronal T2-weighted sequence (DL-T2), diffusion weighted imaging (DWI) with b = 50 sec/mm2 , 1000 sec/mm2 , calculated b = 1500 sec/mm2 . ASSESSMENT: CL-bpMRI and DL-bpMRI including the same conventional diffusion-weighted imaging (DWI) were presented to three radiologists (blinded to acquisition method) and to a deep learning computer-assisted detection algorithm (DL-CAD). The readers evaluated image quality using a 4-point Likert scale (1 = nondiagnostic, 4 = excellent) and graded lesions using Prostate Imaging Reporting and Data System (PI-RADS) v2.1. DL-CAD identified and assigned lesions of PI-RADS 3 or greater. STATISTICAL TESTS: Quality metrics were compared using Wilcoxon signed rank test, and area under the receiver operating characteristic curve (AUC) were compared using Delong's test. SIGNIFICANCE: P = 0.05. RESULTS: Eighty men were included (age: 66 ± 9 years; 17/80 clinically significant prostate cancer). Overall image quality results by the three readers (CL-T2, DL-T2) are reader 1: 3.72 ± 0.53, 3.89 ± 0.39 (P = 0.99); reader 2: 3.33 ± 0.82, 3.31 ± 0.74 (P = 0.49); reader 3: 3.67 ± 0.63, 3.51 ± 0.62. In the patient-based analysis, the reader results of AUC are (CL-bpMRI, DL-bpMRI): reader 1: 0.77, 0.78 (P = 0.98), reader 2: 0.65, 0.66 (P = 0.99), reader 3: 0.57, 0.60 (P = 0.52). Diagnostic statistics from DL-CAD (CL-bpMRI, DL-bpMRI) are sensitivity (0.71, 0.71, P = 1.00), specificity (0.59, 0.44, P = 0.05), positive predictive value (0.23, 0.24, P = 0.25), negative predictive value (0.88, 0.88, P = 0.48). CONCLUSION: Deep learning-accelerated T2-weighted imaging may potentially be used to decrease acquisition time for bpMRI. EVIDENCE LEVEL: 3. TECHNICAL EFFICACY: Stage 2.


Asunto(s)
Aprendizaje Profundo , Neoplasias de la Próstata , Masculino , Humanos , Anciano , Persona de Mediana Edad , Imagen por Resonancia Magnética/métodos , Próstata/diagnóstico por imagen , Próstata/patología , Neoplasias de la Próstata/diagnóstico por imagen , Neoplasias de la Próstata/patología , Estudios Retrospectivos
11.
Abdom Radiol (NY) ; 48(1): 282-290, 2023 01.
Artículo en Inglés | MEDLINE | ID: mdl-36171342

RESUMEN

PURPOSE: Fat-suppressed T2-weighted imaging (T2-FS) requires a long scan time and can be wrought with motion artifacts, urging the development of a shorter and more motion robust sequence. We compare the image quality of a single-shot T2-weighted MRI prototype with deep-learning-based image reconstruction (DL HASTE-FS) with a standard T2-FS sequence for 3 T liver MRI. METHODS: 41 consecutive patients with 3 T abdominal MRI examinations including standard T2-FS and DL HASTE-FS, between 5/6/2020 and 11/23/2020, comprised the study cohort. Three radiologists independently reviewed images using a 5-point Likert scale for artifact and image quality measures, while also assessing for liver lesions. RESULTS: DL HASTE-FS acquisition time was 54.93 ± 16.69, significantly (p < .001) shorter than standard T2-FS (114.00 ± 32.98 s). DL HASTE-FS received significantly higher scores for sharpness of liver margin (4.3 vs 3.3; p < .001), hepatic vessel margin (4.2 vs 3.3; p < .001), pancreatic duct margin (4.0 vs 1.9; p < .001); in-plane (4.0 vs 3.2; p < .001) and through-plane (3.9 vs 3.4; p < .001) motion artifacts; other ghosting artifacts (4.3 vs 2.9; p < .001); and overall image quality (4.0 vs 2.9; p < .001), in addition to receiving a higher score for homogeneity of fat suppression (3.7 vs 3.4; p = .04) and liver-fat contrast (p = .03). For liver lesions, DL HASTE-FS received significantly higher scores for sharpness of lesion margin (4.4 vs 3.7; p = .03). CONCLUSION: Novel single-shot T2-weighted MRI with deep-learning-based image reconstruction demonstrated superior image quality compared with the standard T2-FS sequence for 3 T liver MRI, while being acquired in less than half the time.


Asunto(s)
Aprendizaje Profundo , Neoplasias Hepáticas , Humanos , Imagen por Resonancia Magnética/métodos , Procesamiento de Imagen Asistido por Computador , Artefactos
12.
Abdom Radiol (NY) ; 47(11): 3909-3915, 2022 11.
Artículo en Inglés | MEDLINE | ID: mdl-35918543

RESUMEN

PURPOSE: To determine which patient characteristics influence MRI scan time and how. METHODS: A database search of outpatient MRI liver examinations on 1.5T and 3T scanners from 1/1/2019 to 4/4/2019 was performed using an in-house developed software tool. Mean and median scan times were calculated. Patients who had difficulty following breathing instructions or completing breath-hold sequences were identified. Twenty-one additional patient characteristics were obtained from an Electronic Medical Record (EMR) search. RESULTS: Scan times were significantly increased for patients with breath-holding issues during the exam (N = 43, median = 23.98 min) versus not (N = 179, median = 17.5 min, p < 0.001). Among patients who had difficulty following breathing instructions/completing breath-hold sequences, a significant number were non-native English speakers (23/43, 53%) compared to those whose first language was English (48/179, 27%, p < 0.001). Breath-holding issues were also significantly more frequent for patients requiring a translator during the exam (15/43, 35%) versus those who did not (24/179, 13%, p < 0.001). No other patient characteristics showed a significance difference between those with breathing issues and those without. Patient characteristics that caused a significant number of scan times to be one standard deviation or more above the median were as follows: Breath-holding issues during exam (21/43 ≥ one SD above, 51%, versus 22/189 < one SD above, 12%, p < 0.001); and first language not English (16/71 ≥ one SD above, 23%, versus 55/189 < one SD above, 29%, p = 0.03). CONCLUSION: The ability to follow breathing instructions and complete breath-hold sequences had a significant impact on patient scan time. Patients who were not native English speakers had more frequent breathing issues during scans and significantly longer scans times compared native English speakers.


Asunto(s)
Lenguaje , Imagen por Resonancia Magnética , Contencion de la Respiración , Humanos , Respiración
13.
Abdom Radiol (NY) ; 47(10): 3424-3435, 2022 10.
Artículo en Inglés | MEDLINE | ID: mdl-35916941

RESUMEN

PURPOSE: To retrospectively evaluate which key imaging features described by SAR-AGA on outpatient surveillance MRE correlate with progression to surgery in adults with CD. METHODS: 52 CD patients imaged with outpatient MRE from 10/2015 to 12/2016 and with available clinical information were included. Two abdominal radiologists reviewed the MRE for the presence of active inflammation, intramural edema, restricted diffusion, stricture, probable stricture, ulceration, sacculation, simple fistula, complex fistula, sinus tract, inflammatory mass, abscess, perienteric inflammation, engorged vasa recta, fibrofatty proliferation, and perianal disease. Bowel wall thickness, length of bowel involvement, and degree of upstream dilation in strictures were quantified. Subsequent bowel resection, prior bowel surgery, and available laboratory values were recorded. The association between progression to surgery and imaging features was evaluated using a logistic regression model adjusting for demographics, prior bowel surgery, medication usage, and body mass index. RESULTS: 19.2% (10/52) of patients progressed to surgery. Restricted diffusion, greater degree of upstream dilation from stricture, complex fistula, perienteric inflammation, and fibrofatty proliferation were significantly more common in patients progressing to surgery (all p < 0.05). κ for these significant findings ranged 0.568-0.885. Patients progressing to surgery had longer length bowel involvement (p = 0.03). Platelet count, ESR, and fecal calprotectin were significantly higher, and serum albumin was significantly lower in patients progressing to surgery. Prior bowel surgery, sex, age, and all other parameters were similar. CONCLUSION: Radiologists should carefully describe bowel dilation upstream from strictures, penetrating and perienteric findings on outpatient MRE in CD patients, as these findings may herald progression to surgery.


Asunto(s)
Enfermedad de Crohn , Adulto , Constricción Patológica , Enfermedad de Crohn/diagnóstico por imagen , Enfermedad de Crohn/cirugía , Humanos , Inflamación , Imagen por Resonancia Magnética/métodos , Pacientes Ambulatorios , Estudios Retrospectivos
14.
J Comput Assist Tomogr ; 46(4): 523-529, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-35405714

RESUMEN

OBJECTIVE: The aim of the study was to compare the distribution of Prostate Imaging and Reporting Data System (PI-RADS) scores, interreader agreement, and diagnostic performance of PI-RADS v2.0 and v2.1 for transition zone (TZ) lesions. METHODS: The study included 202 lesions in 202 patients who underwent 3T prostate magnetic resonance imaging showing a TZ lesion that was later biopsied with magnetic resonance imaging/ultrasound fusion. Five abdominal imaging faculty reviewed T2-weighted imaging and high b value/apparent diffusion coefficient images in 2 sessions. Cases were randomized using a crossover design whereby half in the first session were reviewed using v2.0 and the other half using v2.1, and vice versa for the 2nd session. Readers provided T2-weighted imaging and DWI scores, from which PI-RADS scores were derived. RESULTS: Interreader agreement for all PI-RADS scores had κ of 0.37 (v2.0) and 0.26 (v2.1). For 4 readers, the percentage of lesions retrospectively scored PI-RADS 1 increased greater than 5% and PI-RADS 2 score decreased greater than 5% from v2.0 to v2.1. For 2 readers, the percentage scored PI-RADS 3 decreased greater than 5% and, for 2 readers, increased greater than 5%. The percentage of PI-RADS 4 and 5 lesions changed less than 5% for all readers. For the 4 readers with increased frequency of PI-RADS 1 using v2.1, 4% to 16% were Gleason score ≥3 + 4 tumor. Frequency of Gleason score ≥3 + 4 in PI-RADS 3 lesions increased for 2 readers and decreased for 1 reader. Sensitivity of PI-RADS of 3 or greater for Gleason score ≥3 + 4 ranged 76% to 90% (v2.0) and 69% to 96% (v2.1). Specificity ranged 32% to 64% (v2.0) and 25% to 72% (v2.1). Positive predictive value ranged 43% to 55% (v2.0) and 41% to 58% (v2.1). Negative predictive value ranged 82% to 87% (v2.0) and 81% to 91% (v2.1). CONCLUSIONS: Poor interreader agreement and lack of improvement in diagnostic performance indicate an ongoing need to refine evaluation of TZ lesions.


Asunto(s)
Próstata , Neoplasias de la Próstata , Humanos , Imagen por Resonancia Magnética/métodos , Masculino , Clasificación del Tumor , Próstata/diagnóstico por imagen , Próstata/patología , Neoplasias de la Próstata/diagnóstico por imagen , Neoplasias de la Próstata/patología , Estudios Retrospectivos
15.
J Magn Reson Imaging ; 56(1): 184-195, 2022 07.
Artículo en Inglés | MEDLINE | ID: mdl-34877735

RESUMEN

BACKGROUND: Early diagnosis and treatment of prostate cancer (PCa) can be curative; however, prostate-specific antigen is a suboptimal screening test for clinically significant PCa. While prostate magnetic resonance imaging (MRI) has demonstrated value for the diagnosis of PCa, the acquisition time is too long for a first-line screening modality. PURPOSE: To accelerate prostate MRI exams, utilizing a variational network (VN) for image reconstruction. STUDY TYPE: Retrospective. SUBJECTS: One hundred and thirteen subjects (train/val/test: 70/13/30) undergoing prostate MRI. FIELD STRENGTH/SEQUENCE: 3.0 T; a T2 turbo spin echo (TSE) T2-weighted image (T2WI) sequence in axial and coronal planes, and axial echo-planar diffusion-weighted imaging (DWI). ASSESSMENT: Four abdominal radiologists evaluated the image quality of VN reconstructions of retrospectively under-sampled biparametric MRIs (bp-MRI), and standard bp-MRI reconstructions for 20 test subjects (studies). The studies included axial and coronal T2WI, DWI B50 seconds/mm2 and B1000 seconds/mm (4-fold T2WI, 3-fold DWI), all of which were evaluated separately for image quality on a Likert scale (1: non-diagnostic to 5: excellent quality). In another 10 test subjects, three readers graded lesions on bp-MRI-which additionally included calculated B1500 seconds/mm2 , and apparent diffusion coefficient map-according to the Prostate Imaging Reporting and Data System (PI-RADS v2.1), for both VN and standard reconstructions. Accuracy of PI-RADS ≥3 for clinically significant cancer was computed. Projected scan time of the retrospectively under-sampled biparametric exam was also computed. STATISTICAL TESTS: One-sided Wilcoxon signed-rank test was used for comparison of image quality. Sensitivity, specificity, positive predictive value, and negative predictive value were calculated for lesion detection and grading. Generalized estimating equation with cluster effect was used to compare differences between standard and VN bp-MRI. A P-value of <0.05 was considered statistically significant. RESULTS: Three of four readers rated no significant difference for overall quality between the standard and VN axial T2WI (Reader 1: 4.00 ± 0.56 (Standard), 3.90 ± 0.64 (VN) P = 0.33; Reader 2: 4.35 ± 0.74 (Standard), 3.80 ± 0.89 (VN) P = 0.003; Reader 3: 4.60 ± 0.50 (Standard), 4.55 ± 0.60 (VN) P = 0.39; Reader 4: 3.65 ± 0.99 (Standard), 3.60 ± 1.00 (VN) P = 0.38). All four readers rated no significant difference for overall quality between standard and VN DWI B1000 seconds/mm2 (Reader 1: 2.25 ± 0.62 (Standard), 2.45 ± 0.75 (VN) P = 0.96; Reader 2: 3.60 ± 0.92 (Standard), 3.55 ± 0.82 (VN) P = 0.40; Reader 3: 3.85 ± 0.72 (Standard), 3.55 ± 0.89 (VN) P = 0.07; Reader 4: 4.70 ± 0.76 (Standard); 4.60 ± 0.73 (VN) P = 0.17) and three of four readers rated no significant difference for overall quality between standard and VN DWI B50 seconds/mm2 (Reader 1: 3.20 ± 0.70 (Standard), 3.40 ± 0.75 (VN) P = 0.98; Reader 2: 2.85 ± 0.81 (Standard), 3.00 ± 0.79 (VN) P = 0.93; Reader 3: 4.45 ± 0.72 (Standard), 4.05 ± 0.69 (VN) P = 0.02; Reader 4: 4.50 ± 0.69 (Standard), 4.45 ± 0.76 (VN) P = 0.50). In the lesion evaluation study, there was no significant difference in the number of PI-RADS ≥3 lesions identified on standard vs. VN bp-MRI (P = 0.92, 0.59, 0.87) with similar sensitivity and specificity for clinically significant cancer. The average scan time of the standard clinical biparametric exam was 11.8 minutes, and this was projected to be 3.2 minutes for the accelerated exam. DATA CONCLUSION: Diagnostic accelerated biparametric prostate MRI exams can be performed using deep learning methods in <4 minutes, potentially enabling rapid screening prostate MRI. LEVEL OF EVIDENCE: 3 TECHNICAL EFFICACY: Stage 5.


Asunto(s)
Aprendizaje Profundo , Neoplasias de la Próstata , Imagen de Difusión por Resonancia Magnética/métodos , Humanos , Imagen por Resonancia Magnética/métodos , Masculino , Próstata/diagnóstico por imagen , Próstata/patología , Neoplasias de la Próstata/diagnóstico por imagen , Neoplasias de la Próstata/patología , Estudios Retrospectivos
16.
Acad Radiol ; 28(12): 1645-1653, 2021 12.
Artículo en Inglés | MEDLINE | ID: mdl-34740527

RESUMEN

RATIONALE AND OBJECTIVES: Asymptomatic COVID-19 carriers and insufficient testing make containment of the virus difficult. The purpose of this study was to determine if unexpected lung base findings on abdominopelvic CTs concerning for COVID-19 infection could serve as a surrogate for the diagnosis of COVID-19 in the community. MATERIALS AND METHODS: A database search of abdominopelvic CT reports from March 1,2020 to May 2,2020 was performed for keywords suggesting COVID-19 infection by lung base findings. COVID-19 status, respiratory symptoms, laboratory parameters and patient outcomes (hospitalization, ICU admission and/or intubation, and death) were recorded. The trend in cases of unexpected concerning lung base findings on abdominopelvic CT at our institution was compared to the total number of confirmed new cases in NYC over the same time period. RESULTS: The trend in abnormal lung base findings on abdominopelvic CT at our institution correlated with the citywide number of confirmed new cases, including rise and subsequent fall in total cases. The trend was not mediated by COVID-19 testing status or number of tests performed. Patients with respiratory symptoms had significantly higher ferritin (median = 995ng/ml vs 500ng/ml, p = 0.027) and death rate (8/24, 33% vs 4/54, 9%, p = 0.018) compared to those without. CONCLUSION: The rise and fall of unexpected lung base findings suggestive of COVID-19 infection on abdominopelvic CT in patients without COVID-19 symptoms correlated with the number of confirmed new cases throughout NYC from the same time period. A model using abdominopelvic CT lung base findings can serve as a surrogate for future COVID-19 outbreaks.


Asunto(s)
COVID-19 , Prueba de COVID-19 , Brotes de Enfermedades , Humanos , Pulmón , Ciudad de Nueva York/epidemiología , SARS-CoV-2
17.
J Am Coll Radiol ; 18(12): 1635-1642, 2021 12.
Artículo en Inglés | MEDLINE | ID: mdl-34419478

RESUMEN

PURPOSE: To assess the impact of instructional videos in patients' primary language on abdominal MR image quality for whom English is a second language (ESL). METHODS: Twenty-nine ESL patients viewed Spanish or Mandarin Chinese instructional videos (approximately 2.5 min in duration) in the preparation room before abdominal MRI (ESL-video group). Comparison groups included 50 ESL patients who underwent MRI before video implementation (ESL-no video group) and 81 English-speaking patients who were matched for age, sex, magnet strength, and history of prior MRI with patients in the first two groups. Three radiologists independently assessed respiratory motion and image quality on turbo spin-echo T2-weighted images (T2WI) and postcontrast T1-weighted images (T1WI) using 1 to 5 Likert scales. Groups were compared using Kruskal-Wallis tests as well as generalized estimating equations (GEEs) to adjust for possible confounders. RESULTS: For T2WI respiratory motion and T2WI overall image quality, Likert scores of the ESL-no video group (mean score across readers of 2.6 ± 0.1 and 2.6 ± 0.1) were lower (all P < .001) compared with English-speaking (3.3 ± 0.2 and 3.3 ± 0.1) and ESL-video (3.2 ± 0.1 and 3.0 ± 0.2) groups. In the GEE model, mean T2WI respiratory motion (both adjusted P < .001) and T2WI overall quality (adjusted P = .03 and .11) were higher in English and ESL-video groups compared with ESL-no video group. For T1WI respiratory motion and T1WI overall image quality, Likert scores were not different between groups (P > .05), including in the GEE model (adjusted P > .05). CONCLUSION: Providing ESL patients with an instructional video in their primary language before abdominal MRI is an effective intervention to improve imaging quality.


Asunto(s)
Lenguaje , Imagen por Resonancia Magnética , Abdomen/diagnóstico por imagen , Humanos , Estudios Retrospectivos
18.
Eur Radiol ; 31(11): 8447-8457, 2021 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-33961086

RESUMEN

OBJECTIVE: To compare the image quality of an accelerated single-shot T2-weighted fat-suppressed (FS) MRI of the liver with deep learning-based image reconstruction (DL HASTE-FS) with conventional T2-weighted FS sequence (conventional T2 FS) at 1.5 T. METHODS: One hundred consecutive patients who underwent clinical MRI of the liver at 1.5 T including the conventional T2-weighted fat-suppressed sequence (T2 FS) and accelerated single-shot T2-weighted MRI of the liver with deep learning-based image reconstruction (DL HASTE-FS) were included. Images were reviewed independently by three blinded observers who used a 5-point confidence scale for multiple measures regarding the artifacts and image quality. Descriptive statistics and McNemar's test were used to compare image quality scores and percentage of lesions detected by each sequence, respectively. Intra-class correlation coefficient (ICC) was used to assess consistency in reader scores. RESULTS: Acquisition time for DL HASTE-FS was 51.23 +/ 10.1 s, significantly (p < 0.001) shorter than conventional T2-FS (178.9 ± 85.3 s). DL HASTE-FS received significantly higher scores than conventional T2-FS for strength and homogeneity of fat suppression; sharpness of liver margin; sharpness of intra-hepatic vessel margin; in-plane and through-plane respiratory motion; other ghosting artefacts; liver-fat contrast; and overall image quality (all, p < 0.0001). DL HASTE-FS also received higher scores for lesion conspicuity and sharpness of lesion margin (all, p < .001), without significant difference for liver lesion contrast (p > 0.05). CONCLUSIONS: Accelerated single-shot T2-weighted MRI of the liver with deep learning-based image reconstruction showed superior image quality compared to the conventional T2-weighted fat-suppressed sequence despite a 4-fold reduction in acquisition time. KEY POINTS: • Conventional fat-suppressed T2-weighted sequence (conventional T2 FS) can take unacceptably long to acquire and is the most commonly repeated sequence in liver MRI due to motion. • DL HASTE-FS demonstrated superior image quality, improved respiratory motion and other ghosting artefacts, and increased lesion conspicuity with comparable liver-to-lesion contrast compared to conventional T2FS sequence. • DL HASTE- FS has the potential to replace conventional T2 FS sequence in routine clinical MRI of the liver, reducing the scan time, and improving the image quality.


Asunto(s)
Aprendizaje Profundo , Artefactos , Humanos , Procesamiento de Imagen Asistido por Computador , Hígado/diagnóstico por imagen , Imagen por Resonancia Magnética
19.
AJR Am J Roentgenol ; 216(1): 104-105, 2021 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-32603220

RESUMEN

The purpose of this article is to describe arterial and venous thromboembolism in the abdomen, pelvis, and lower extremities in patients with coronavirus disease (COVID-19). Eighty-two patients with COVID-19 who underwent abdominal ultrasound or CT were retrospectively compared with 82 patients without COVID-19 for thromboembolism and solid-organ infarction. Nine (11%) patients with COVID-19 had thromboembolic findings, with medium to large arterial thrombi in five. One patient without COVID-19 had known portal vein thrombus on CT. Thromboembolic findings occurred more frequently in patients with than without COVID-19 (p = 0.02).


Asunto(s)
COVID-19/complicaciones , Tromboembolia/diagnóstico por imagen , Tromboembolia/etiología , Trombofilia , Abdomen/irrigación sanguínea , Anciano , Femenino , Humanos , Extremidad Inferior/irrigación sanguínea , Masculino , Persona de Mediana Edad , New York , Pelvis/irrigación sanguínea , Estudios Retrospectivos , SARS-CoV-2 , Tomografía Computarizada por Rayos X , Ultrasonografía
20.
Clin Imaging ; 69: 63-71, 2021 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-32659682

RESUMEN

Gender-affirming surgery is becoming more accessible, and radiologists must be familiar with both terminology and anatomy following gender-affirming surgical procedures. This essay will review the most common gender-affirming genital surgeries, their post-operative anatomy, and common complications by providing intraoperative photographs, illustrations, and cross-sectional images. Routine radiologic imaging recommendations for transgender patients will also be reviewed.


Asunto(s)
Cirugía de Reasignación de Sexo , Personas Transgénero , Estudios Transversales , Diagnóstico por Imagen , Genitales/diagnóstico por imagen , Genitales/cirugía , Humanos , Cirugía de Reasignación de Sexo/efectos adversos
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