Impact of postoperative baseline MRI on diagnostic confidence and performance in detecting local recurrence of soft-tissue sarcoma of the limb.

OBJECTIVE: To evaluate the impact of a postoperative baseline (PB) MRI on diagnostic confidence and performance in detecting local recurrence (LR) of soft-tissue sarcoma (STS) of the limb. MATERIALS AND METHODS: A total of 72 patients (8 with LR, 64 without LR) with primary STS of the limb were included. Routine follow-up MRI (1.5 T) at 6 and approximately 36 months (meanLR: 39.7 months; meanno LR: 34.9 months) after multimodal therapy or at time of LR were assessed by three independent readers using a 5-point Likert scale. Furthermore, the following imaging parameters were evaluated: presence of a mass, signal characteristics at T2- and T1-weighted imaging, contrast enhancement (CE), and in some of the cases signal intensity on the apparent diffusion coefficient (ADC). U-test, McNemar test, and ROC-analysis were applied. Interobserver reliability was calculated using Fleiss kappa statistics. A p value of 0.05 was considered statistically significant. RESULTS: The presence of a PB MRI significantly improved diagnostic confidence in detecting LR of STS (p < 0.001) and slightly increased specificity (mean specificity without PE 74.1% and with presence of PB MRI 81.2%); however, not to a significant level. The presence of a mass showed highest diagnostic performance and highest interreader agreement (AUC [%]; κ: 73.1-83.6; 0.34) followed by T2-hyperintensity (50.8-66.7; 0.08), CE (52.4-62.5; 0.13), and T1-hypointensity (54.7-77.3; 0.23). ADC showed an AUC of 65.6-96.6% and a κ of 0.55. CONCLUSION: The presence of a PB MRI increases diagnostic confidence in detecting LR of STS of the limb.

Magnetic resonance observation of cartilage repair tissue (MOCART) 2.0 for the evaluation of retropatellar autologous chondrocyte transplantation and correlation to clinical outcome.

BACKGROUND: Matrix-associated chondrocyte transplantation (MACT) has become an established treatment option for cartilage defects. OBJECTIVE: Three objectives were defined: first, to evaluate retropatellar cartilage grafts using Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) 2.0 score; second, to determine whether clinical outcome correlates with specific parameters or overall results; third, to screen those parameters for their ability to predict a clinical outcome of Delta IKDC ≥ 20 as a threshold for good clinical response at 12 months. METHODS: 38 patients were included of whom all underwent retropatellar MACT. MRI was performed 3, 6 and 12 months postoperatively. The clinical status was determined using International Knee Documentation Committee Subjective Form (IKDC). Correlations of MOCART 2.0 parameters and Delta IKDC scores were quantified by nonparametric Spearman's R. Those parameters with significant correlations (p < 0.05) were screened for their ability to predict a clinical outcome of Delta IKDC ≥ 20 at 12 months. RESULTS: Significant correlations were identified for the parameters MOCART total 6 months (p < 0.05), Surface 6 months (p < 0.05), Surface 12 months (p < 0.05), Structure 6 months (p < 0.01), Structure 12 months (p < 0.05), Subchondral changes 3 months (p < 0.0001), Subchondral changes 6 months (p < 0.05) and Subchondral changes 12 months (p < 0.05). Among all MRI score parameters, Subchondral changes 3 months achieved the highest accuracy of 0.76 (0.62-0.86) in predicting Delta IKDC ≥ 20 after 12 months. CONCLUSION: Some of the MOCART 2.0 parameters show significant correlation with Delta IKDC scores in the postoperative course after retropatellar MACT, which seems to depend on the time interval between surgery and MRI acquisition.

Structured Reporting in the Characterization of Renal Cysts by Contrast-Enhanced Ultrasound (CEUS) Using the Bosniak Classification System-Improvement of Report Quality and Interdisciplinary Communication.

BACKGROUND: This study aims to evaluate the potential benefits of structured reporting (SR) compared to conventional free-text reporting (FTR) in contrast-enhanced ultrasound (CEUS) of cystic renal lesions, based on the Bosniak classification. METHODS: Fifty patients with cystic renal lesions who underwent CEUS were included in this single-center study. FTR created in clinical routine were compared to SR retrospectively generated by using a structured reporting template. Two experienced urologists evaluated the reports regarding integrity, effort for information extraction, linguistic quality, and overall quality. RESULTS: The required information could easily be extracted by the reviewers in 100% of SR vs. 82% of FTR (p < 0.001). The reviewers trusted the information given by SR significantly more with a mean of 5.99 vs. 5.52 for FTR (p < 0.001). SR significantly improved the linguistic quality (6.0 for SR vs. 5.68 for FTR (p < 0.001)) and the overall report quality (5.98 for SR vs. 5.58 for FTR (p < 0.001)). CONCLUSIONS: SR significantly increases the quality of radiologic reports in CEUS examinations of cystic renal lesions compared to conventional FTR and represents a promising approach to facilitate interdisciplinary communication in the future.

Structured Reporting Using CEUS LI-RADS for the Diagnosis of Hepatocellular Carcinoma (HCC)-Impact and Advantages on Report Integrity, Quality and Interdisciplinary Communication.

BACKGROUND: Our retrospective single-center study aims to evaluate the impact of structured reporting (SR) using a CEUS LI-RADS template on report quality compared to conventional free-text reporting (FTR) in contrast-enhanced ultrasound (CEUS) for the diagnosis of hepatocellular carcinoma (HCC). METHODS: We included 50 patients who underwent CEUS for HCC staging. FTR created after these examinations were compared to SR retrospectively generated by using template-based online software with clickable decision trees. The reports were evaluated regarding report completeness, information extraction, linguistic quality and overall report quality by two readers specialized in internal medicine and visceral surgery. RESULTS: SR significantly increased report completeness with at least one key feature missing in 31% of FTR vs. 2% of SR (p < 0.001). Information extraction was considered easy in 98% of SR vs. 86% of FTR (p = 0.004). The trust of referring physicians in the report was significantly increased by SR with a mean of 5.68 for SR vs. 4.96 for FTR (p < 0.001). SR received significantly higher ratings regarding linguistic quality (5.79 for SR vs. 4.83 for FTR (p < 0.001)) and overall report quality (5.75 for SR vs. 5.01 for FTR (p < 0.001)). CONCLUSIONS: Using SR instead of conventional FTR increases the overall quality of reports in CEUS examinations of HCC patients and may represent a valuable tool to facilitate clinical decision-making and improve interdisciplinary communication in the future.