Advances in Diagnostic Imaging in Pediatric Gastroenterology.

PURPOSE OF REVIEW: The purpose is to provide a review of cross-sectional imaging updates in the assessment of gastrointestinal diseases, relevant to clinical practice and research. RECENT FINDINGS: New magnetic resonance imaging contrast agents (Eovist) are taken up by hepatocytes and excreted via the biliary tree. As such, a lesion will retain contrast only if hepatocytes are present, which aids in refining the differential diagnosis. Magnetic resonance enterography is a method for non-invasively diagnosing and following various GI conditions, predominantly inflammatory bowel disease. Contrast-enhanced ultrasound uses gas-filled microbubbles providing superb temporal resolution most notably in the arterial phase, which aids in differentiating lesions. Elastography is a new technique which assesses stiffness of liver for evaluating fibrosis. These new techniques provide more accurate diagnoses and information, often limiting ionizing radiation exposure from other modalities. While ultrasound will still remain the initial imaging modality, familiarity with these other options is valuable for appropriate pathology workup.

Normal size of the fetal adrenal gland on prenatal magnetic resonance imaging.

BACKGROUND: The adrenal gland plays a vital role in fetal growth. Many disease states such as congenital adrenal hyperplasia, hemorrhage and tumors can lead to morphological changes in the gland. Ultrasound measurements of normal adrenal sizes in the fetus reported in the literature have shown a trend of increasing size with gestational age. There is no literature available on standard fetal adrenal sizes or detailed appearance by fetal MRI. OBJECTIVE: The purpose of this study was to provide MR data on the size and signal characteristics of the fetal adrenal gland throughout the second and third trimesters. MATERIALS AND METHODS: In this retrospective review, we selected 185 prenatal MRIs obtained from Jan. 1, 2014, to May 31, 2017, with normal abdominal findings for inclusion. The adrenal glands were identified in coronal, sagittal or axial T2-W planes and coronal T1-W plane when available. We measured the length and thickness of the medial and lateral limbs of the right and left adrenal glands and recorded signal intensity on T1-W and T2-W sequences, gender and gestational age in each case. RESULTS: The gestational age (GA) ranged 18-37 weeks. Visibility of the adrenal glands on T2-W images was high (90.3-97.2%) up to 30 weeks of GA but declined afterward (47.5-62.2% at 31-37 weeks). Visibility on T1-W images increased with GA, ranging from 21.4% visibility at 18-22 weeks and increasing to 40% at 35-37 weeks. Mean lengths of the adrenal gland limbs steadily increased from 8.2 mm at 18-22 weeks to 11.0 mm at 35-37 weeks. In the second trimester, adrenal glands were low in signal intensity on T2-W images and were surrounded by hyperintense perirenal fatty tissue. In the third trimester, the glands became less distinct, with increasing signal and obliteration of perirenal tissue. The glands were moderately hyperintense on T1-W images throughout pregnancy, with increasing visibility as pregnancy progressed. CONCLUSION: Normal sizes and signal intensities for adrenal glands are reported. Visibility of adrenal glands on T2-W images was 90.3-97.2% up to 30 weeks but declined thereafter. Visibility on T1-W images increased in the third trimester. Adrenal gland sizes increased with gestational age.

Megaconference: a radical approach to radiology resident education with full-day weekly conferences.

PURPOSE: The aim of this study was to assess the value and educational experience of instituting a weekly full-day educational conference format for radiology residents. METHODS: Two independent diagnostic radiology residency programs in a single urban health care network instituted a new teaching model in which residents from both programs participated in a weekly joint conference day. This format replaced independently held, but frequently teleconferenced, 1-hour daily conferences at both programs. Residents' and faculty members' perceptions of the educational experience were assessed using anonymous online surveys. Written board examination scores and number of resident dictations were compared before and after the change. RESULTS: After 6 months, 30% and 53.3% of residents reported positive and neutral overall impressions, respectively. A survey return rate of 63.3% was achieved from 49 residents. Of 34 faculty members who responded, 50% reported increased preparation for conferences. The overall number of resident dictations modestly increased in the year after implementation of the format change, by 3.1%. There was no statistically significant change in the mean written board examination after the change in format compared with 3 years before the change. CONCLUSIONS: Conference interruptions, cancellations, and tardiness were essentially eliminated with the new model. Individual conference quality was reported to have improved as the result of the more formal format and larger audience size. Residents maintained productivity and exposure to case volume despite the loss of a single clinical day. Although residents' perceptions of the new model were predominantly positive or neutral, downsides included fewer cases per resident in case conferences and a less intimate conference setting.