Beyond the Bowel: Extraintestinal Manifestations of Inflammatory Bowel Disease.

Inflammatory bowel disease (IBD) is a chronic, relapsing immune-mediated inflammation of the gastrointestinal tract. IBD includes two major disease entities: Crohn disease and ulcerative colitis. Imaging plays an important role in the diagnosis and surveillance of these complex disorders. Computed tomographic and magnetic resonance enterographic techniques have been refined in recent years to provide a superb means of evaluating the gastrointestinal tract for suspected IBD. Although the intestinal imaging manifestations of IBD have been extensively discussed in the radiology literature, extraintestinal imaging manifestations of IBD have received less attention. Multiple extraintestinal manifestations may be seen in IBD, including those of gastrointestinal (hepatobiliary and pancreatic), genitourinary, musculoskeletal, pulmonary, cardiac, ocular, and dermatologic disorders. Although many associations between IBD and extraintestinal organ systems have been well established, other associations have not been fully elucidated. Some extraintestinal disorders may share a common pathogenesis with IBD. Other extraintestinal disorders may occur as a result of unintended treatment-related complications of IBD. Although extraintestinal disorders within the abdomen and pelvis may be well depicted with cross-sectional enterography, other musculoskeletal and thoracic disorders may be less evident with such examinations and may warrant further investigation with additional imaging examinations or may be readily apparent from the findings at physical examination. Radiologists involved in the interpretation of IBD imaging examinations must be aware of potential extraintestinal manifestations, to provide referring clinicians with an accurate and comprehensive profile of patients with these complex disorders. © RSNA, 2017.

Smoke: How to Differentiate Flow-related Artifacts From Pathology on Thoracic Computed Tomographic Angiography.

Nonuniform contrast opacification of vasculature is frequently encountered on thoracic computed tomographic angiography. The purpose of this pictorial essay is to discuss the appearance of, and factors underlying mixing artifacts, which we term "smoke." We provide an approach to distinguish it from pathology including pulmonary embolism, aortic dissection, and thrombus. Smoke results from a combination of technical factors, abnormal physiology, or inflow of unopacified blood. Smoke produces ill-defined filling defects that may be confidently diagnosed in many cases if these fundamentals are applied.

ACR appropriateness Criteria® radiographically detected solitary pulmonary nodule.

The solitary pulmonary nodule (SPN) is a common medical problem for which management can be quite complex. Imaging remains at the center of management of SPNs, and computed tomography is the primary modality by which SPNs are characterized and followed up for stability. This manuscript summarizes the American College of Radiology Appropriateness Criteria for radiographically detected solitary pulmonary nodules and briefly reviews the various imaging techniques available. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every 2 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances in which evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.

Association of diabetes with mammographic breast density and breast cancer in the Minnesota breast cancer family study.

Data from the Minnesota Breast Cancer Family Study cohort (n=6,130 women) were used to examine the association of type II diabetes with mammographic percent density and incident breast cancer (BC). Exposures and outcomes were self-reported. The first set of analyses evaluated diabetes (DM) as a risk factor for breast cancer. A total of 403 women (6.6%) reported a diagnosis of type II diabetes and 333 women reported an incident breast cancer. Women who reported type II diabetes had an age-adjusted relative risk (RR) for breast cancer of 1.44 (95% CI 0.89-2.32) compared to those who did not. Adjustment for covariates strengthened the association (RR 1.61, 95% CI 0.98-2.62). Mammograms were retrieved on women over the age of 40 and percent density was estimated with a user-assisted thresholding program. Cross-sectional analyses revealed that mean levels of mammographic density were not statistically significantly different between diabetic and non-diabetic women. Results were similar within strata of menopausal status. Breast cancer cases with diabetes did not have a significantly higher percent density than cases without diabetes. Our findings suggest that breast cancer risk may be increased among women with type II diabetes, but that type II diabetes does not significantly influence mammographic breast density.

The use of population and database resources in outcome-based research.

Many patient management decisions an otolaryngologist makes every day stem from good patient- and population-based evidence. This paper will explore the topic of population/database research and how these studies are useful. We also examine the current literature on this subject, explore the strengths and weaknesses of these studies and provide information on the practical aspects of performing this type of research. Overall, this paper should provide both an understanding of and an incentive for those with an interest in database use and the development of outcome-based projects.