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

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

Position Statements of the Emerging Trends Committee of the Asian Oceanian Society of Radiology on the Adoption and Implementation of Artificial Intelligence for Radiology.

Artificial intelligence (AI) is rapidly gaining recognition in the radiology domain as a greater number of radiologists are becoming AI-literate. However, the adoption and implementation of AI solutions in clinical settings have been slow, with points of contention. A group of AI users comprising mainly clinical radiologists across various Asian countries, including India, Japan, Malaysia, Singapore, Taiwan, Thailand, and Uzbekistan, formed the working group. This study aimed to draft position statements regarding the application and clinical deployment of AI in radiology. The primary aim is to raise awareness among the general public, promote professional interest and discussion, clarify ethical considerations when implementing AI technology, and engage the radiology profession in the ever-changing clinical practice. These position statements highlight pertinent issues that need to be addressed between care providers and care recipients. More importantly, this will help legalize the use of non-human instruments in clinical deployment without compromising ethical considerations, decision-making precision, and clinical professional standards. We base our study on four main principles of medical care-respect for patient autonomy, beneficence, non-maleficence, and justice.

Pancreatic cysts: can surveillance interval for small low-risk lesions be lengthened?

BACKGROUND: Surveillance of pancreatic cysts are necessary due to risk of malignant transformation. However, reported progression rates to advanced neoplasia are variable and the high frequency of surveillance scans may pose a considerable burden on healthcare resources. PURPOSE: To validate the effectiveness of the Fukuoka Guidelines surveillance regime and determine if a longer surveillance interval can be established. MATERIAL AND METHODS: All magnetic resonance imaging (MRI) studies of the pancreas performed at our institution between January 2014 and December 2016 with at least one pancreatic cystic lesion and follow-up MRI or computed tomography (CT) over at least two years were reviewed for size, worrisome feature (WF), and high-risk stigmata (HRS) at diagnosis and follow-up imaging (up to year 6). Reference standards for advanced neoplasia were based on endoscopic ultrasound, fine needle aspiration cytology, or the presence of ≥2 WF or ≥1 HRS on imaging. Comparison of MRI features of progression and outcomes of diagnostic endpoints between lesions <20 mm and ≥20 mm was performed. RESULTS: A total of 270 patients were included (201 cysts <20 mm, 69 cysts ≥20 mm). Compared with cysts <20 mm, cysts ≥20 mm were more likely to be associated with WF or HRS (40.6% vs. 12.4%; P ≤0.00001), demonstrate increase in size of ≥5 mm in two years (20.3% vs. 10.9%; P = 0.049), and develop advanced neoplasia (24.6% vs. 0.5%; P <0.00001). CONCLUSION: Pancreatic cysts <20 mm have a low risk of developing WF and HRS and surveillance interval may be lengthened.

Diffusion-weighted imaging versus dynamic contrast-enhanced imaging for pre-operative diagnosis of deep myometrial invasion in endometrial cancer: A meta-analysis.

PURPOSE: This study investigates the differences in diagnostic performance between diffuse-weighted imaging (DWI) and dynamic contrast-enhanced imaging (DCE), either alone or in combination with T2-weighted imaging (T2WI), for diagnosing deep myometrial invasion (dMI) of endometrial cancers (EC). METHODS: We performed a comprehensive search for published studies comparing DWI and DCE for preoperatively diagnosing dMI of EC. The overall diagnostic accuracy of each test was calculated using the areas under the summary receiver operating characteristic curves (AUCs). The sensitivities and specificities were compared using bivariate meta-regression. RESULTS: Pooled analysis of nineteen studies with 961 patients (main group) showed that DWI had a larger AUC (0.943, 95% confidence interval (CI) = 0.921-0.967) than DCE (0.922, 95% CI = 0.893-0.953). For the subgroup comprising 7 studies, DWI combined with T2WI and DCE combined with T2WI showed AUCs of 0.959 (95% CI, 0.932-0.986) and 0.929 (95% CI, 0.847-1.000), respectively. None of the differences in AUCs were statistically significant. All comparisons of the sensitivities and specificities of the main group and subgroup also showed no significant differences. CONCLUSION: This meta-analysis found no significant difference in diagnostic performance between DWI and DCE for diagnosis of dMI in EC. DWI may be preferred for its ease of use in clinical practice.

Safety of a rapid outpatient hydration protocol for patients with renal impairment requiring intravenous iodinated contrast media for computed tomography.

INTRODUCTION: Patients receiving intravenous iodinated contrast media for computed tomography (CT) are predisposed to contrast-induced nephropathy. Chronic kidney disease is an important risk factor, and hydration is the mainstay of prevention. While inpatients can undergo intravenous hydration, limited knowledge exists regarding regimens for outpatients. We employed a rapid outpatient hydration protocol to reduce postponement of imaging appointments for patients with suboptimal estimated glomerular filtration rate (eGFR). METHODS: From June 2015, we amended our CT preparation protocol to mandate rapid hydration (oral, intravenous or both) for patients with an eGFR of 30-60 mL/min/1.73 m2. Patients receiving this hydration protocol from June to November 2015 were followed up for one month to monitor any admissions for fluid overload, and up to one year to determine the long-term effect on eGFR. RESULTS: 226 outpatients received the hydration protocol, which correlated with a 95% reduction in postponement of imaging appointments. No complications of fluid overload from hydration were encountered. A significant association was observed between age and decrease in eGFR, but this was not significant when stratified by drop in eGFR category. No statistical significance was found between decrease in eGFR and gender or race. Higher baseline eGFR was less likely to be associated with decrease in eGFR after imaging. Type of hydration was not related to a drop in eGFR category for patients with an eGFR of 45-59 mL/min/1.73 m2. CONCLUSION: We defined a shorter hydration regimen that is safe to use in the outpatient setting.

Isolated Systemic Arterial Supply to Normal Lung with Aneurysm Formation: A Rare Entity with An Even Rarer Complication.

BACKGROUND Isolated systemic arterial supply to normal (unsequestered) lung (ISSNL) without associated pulmonary malformation is rare, and lies towards the milder end of the spectrum of congenital lung abnormalities. Aneurysmal dilatation of the anomalous artery is an infrequent complication, with only 5 published cases thus far. CASE REPORT We present the case of a 61-year-old man whose screening chest radiograph showed a retrocardiac mass. Further evaluation with axial imaging demonstrated an ISSNL, complicated by aneurysmal dilatation. The genesis of this condition has been postulated to be due to persistence of primitive aortic branches to the developing lung bud. Initially reported in 1777, this entity is now more accurately classified within the spectrum of pulmonary and bronchovascular abnormalities, with refinement of the latter. The origin of an aberrant artery from the aorta implies that a higher-pressure systemic circulation is being shunted into a lower-pressure pulmonary circulation. While these supplying arteries are known to be large, aneurysmal dilation is exceptionally rare. Here, we review the cases published in the literature and present a case of our own. We aim to describe its pathogenesis, and touch on the classification systems and management. CONCLUSIONS ISSNL is usually first suspected on a screening chest radiograph, as many patients are asymptomatic. Based on contrast-enhanced axial imaging, the diagnosis can be established non-invasively. Definitive management includes surgical and endovascular techniques.