Complications of lymphoma in the abdomen and pelvis: clinical and imaging review.

Involvement of the abdomen and pelvis is common in lymphoma. Nodal and extranodal abdominal and pelvic lymphoma may present with various complications. Complications are most common in high-grade lymphomas, especially diffuse large B-cell lymphoma. Complications may occur as the initial manifestation of lymphoma, during treatment course, or late following complete disease remission. Most complications are associated with worse prognosis and increased mortality. Imaging is essential in evaluation of disease extent and diagnosis of complications. Therefore, radiologists should be familiar with the clinical context and imaging features of abdominal and pelvic lymphoma complications. We provide a comprehensive, organ system-based approach, and clinical and imaging review of complications of abdominal and pelvic lymphoma along with radiologic images of illustrated cases of the most commonly encountered complications.

Developing a Cancer Digital Twin: Supervised Metastases Detection From Consecutive Structured Radiology Reports.

The development of digital cancer twins relies on the capture of high-resolution representations of individual cancer patients throughout the course of their treatment. Our research aims to improve the detection of metastatic disease over time from structured radiology reports by exposing prediction models to historical information. We demonstrate that Natural language processing (NLP) can generate better weak labels for semi-supervised classification of computed tomography (CT) reports when it is exposed to consecutive reports through a patient's treatment history. Around 714,454 structured radiology reports from Memorial Sloan Kettering Cancer Center adhering to a standardized departmental structured template were used for model development with a subset of the reports included for validation. To develop the models, a subset of the reports was curated for ground-truth: 7,732 total reports in the lung metastases dataset from 867 individual patients; 2,777 reports in the liver metastases dataset from 315 patients; and 4,107 reports in the adrenal metastases dataset from 404 patients. We use NLP to extract and encode important features from the structured text reports, which are then used to develop, train, and validate models. Three models-a simple convolutional neural network (CNN), a CNN augmented with an attention layer, and a recurrent neural network (RNN)-were developed to classify the type of metastatic disease and validated against the ground truth labels. The models use features from consecutive structured text radiology reports of a patient to predict the presence of metastatic disease in the reports. A single-report model, previously developed to analyze one report instead of multiple past reports, is included and the results from all four models are compared based on accuracy, precision, recall, and F1-score. The best model is used to label all 714,454 reports to generate metastases maps. Our results suggest that NLP models can extract cancer progression patterns from multiple consecutive reports and predict the presence of metastatic disease in multiple organs with higher performance when compared with a single-report-based prediction. It demonstrates a promising automated approach to label large numbers of radiology reports without involving human experts in a time- and cost-effective manner and enables tracking of cancer progression over time.

Chest computed tomography and chest X-ray in the diagnosis of community-acquired pneumonia: a retrospective observational study.

OBJECTIVES: To compare the yield of early combined use of chest X-ray (CXR) and chest computed tomography (CT) in patients diagnosed with community-acquired pneumonia (CAP) presenting to the emergency department (ED) and assess the impact of chest CT on the initial diagnosis. METHODS: The medical records of 900 patients who presented to the ED and were diagnosed with CAP over a 1-year period were reviewed, and 130 patients who underwent CXR and chest CT within 48 hours were selected. CXR findings were classified as positive, negative, or inconclusive for CAP. Chest CT findings were defined as positive, negative, inconclusive, or positive with add-on to the CXR findings. CT was classified as having no benefit, large benefit, or moderate benefit based on the chest CT and CXR findings. RESULTS: Chest CT results were positive in 90.7% of patients, with 41.5% being newly diagnosed after negative or inconclusive CXR and 21.5% being diagnosed with add-on to the CXR findings. CT had large, moderate, and no benefit over CXR in diagnosing or excluding CAP in 45.3%, 21.5%, and 33.1% of patients, respectively. CONCLUSION: Early chest CT may be used to compliment CXR in the early diagnosis of CAP among patients in the ED.

Emergency room imaging in pediatric patients with cancer: analysis of the spectrum and frequency of imaging modalities and findings in a tertiary cancer center and their relationship with survival.

BACKGROUND: To assess the spectrum and frequency of modalities used for emergency room (ER) imaging and their findings in pediatric cancer patients and assess their relationship with survival. METHODS: Consecutive pediatric cancer patients that underwent imaging during an ER visit at our tertiary cancer center over a 5-year period were retrospectively analyzed. Imaging findings were considered positive when they were relevant to the ER presenting complaint. Imaging positivity was correlated with inpatient admission. Overall survival (OS) was assessed with Kaplan-Meier curves and uni- and multi-variate Cox proportional hazards model was used to identify significant factors associated with OS. RESULTS: Two hundred sixty-one patients (135 males and 126 females; median age 11 years [interquartile range 5-16 years] with 348 visits and a total of 406 imaging studies were included. Common chief complaints were related to the chest (100 [28.7 %]) and fever (99 [28.4 %]). ER imaging was positive in 207 visits (59.5 %), commonly revealing increased metastases (50 [14.4 %]), pneumonia (47 [13.5 %]), and other lung problems (12 [2.9 %]). Positive ER imaging was associated with inpatient admission (69.3 % [133/192] vs. 40.4 % [63/156], p < 0.01). Multivariate survival analysis showed that positive ER imaging (hazard ratio [HR] = 2.35 [95% CI 1.44-3.83, p < 0.01), admission (HR = 1.86 [95% CI 1.17-3.00], p < 0.01), number of ER visits (HR = 3.08 [95% CI 1.62-5.83], p < 0.01 for ≥ 3 visits) were associated with poorer survival. CONCLUSIONS: Imaging was able to delineate the cause for ER visits in children with cancer in over half of the cases. Positive ER imaging was associated with admission and worse survival.

Factors influencing incidental 18F-FDG uptake in the gallbladder in a large cohort of patients: A retrospective study.

OBJECTIVES: This study aims to assess the incidence of incidental activity in the gallbladder and the factors that may contribute to it in a large cohort of patients undergoing 18F-fluorodeoxyglucose-PET/CT for cancer evaluation. METHODS: 8096 PET/CTs were retrospectively reviewed. Data pertaining to patient demographics and PET/CT parameters were collected. Patients' records were reviewed for gallbladder disorders for up to 3 years after the exam. The presence/absence of gallbladder uptake was visually assessed. Findings were classified as focal, diffuse increased and diffuse increased wall uptake, or no uptake. Volumetric measurements of the gallbladder and SUVmax of the gallbladder, liver and blood pool were measured. Chi-square and Student's t-test were used for statistical analysis. RESULTS: 54 cases (0.67%) of incidental gallbladder uptake were detected (uptake group). 162 exams without uptake were selected as control (no uptake group). The injection-to-scan interval, SUVmax of the liver and blood pool, and the gallbladder volume did not differ significantly between both groups. Higher blood glucose levels were observed in the uptake (109.9 ± 32.5) vs. no uptake group (97.4 ± 18) (p = 0.01), with levels >150 mg/dL more common in the uptake group (p = 0.004). The incidence of gallbladder disease within 3 years after imaging was higher for the uptake group (12/36) compared to the no uptake group (15/115) (p = 0.02). Diffuse increased wall uptake was more likely in the group who later developed a pathology (4/12) (p = 0.03). CONCLUSION: Incidental gallbladder uptake in patients is independent of the injected FDG dose, injection-to-scan interval or gallbladder volume, but may be related to blood glucose level. There's a higher incidence of gallbladder pathology three years after the exam particularly in cases of diffuse increased wall uptake.

Functioning metastatic paraganglioma of the urinary bladder in a 10-year-old child.

Paragangliomas of the urinary bladder are very rare tumours representing less than 1% of bladder tumours. Preoperative diagnosis is essential to avoid perioperative complications related to catecholamine release. A high index of suspicion should be maintained when the classical symptoms of voiding-related paroxysms of headache, palpitation and dizziness are present. We present a rare case of malignant paraganglioma of the urinary bladder in a 10-year-old boy. The patient had the classic presentation. We review the radiological diagnostic tools and findings of this rare entity.