Crohn's Disease Is Associated With an Increased Prevalence of Nonalcoholic Fatty Liver Disease: A Cross-Sectional Study Using Magnetic Resonance Proton Density Fat Fraction Mapping.

Nonalcoholic fatty liver disease (NAFLD) commonly coexists with Crohn's disease (CD); however, it remains unclear if it is more prevalent than would be expected as ultrasound surveys of CD patients report a very wide range of prevalence (9%-40%).1-3 To address this uncertainty, we performed a prospective, cross-sectional survey of NAFLD in CD patients by generating magnetic resonance proton density fat fraction (MR-PDFF) maps as compared with 2 control populations. MR-PDFF provides a quantitative, sensitive and specific (97% and 100%, respectively) radiographic surrogate for liver fat.4.

Single-Contrast CT for Detecting Bowel Injuries in Penetrating Abdominopelvic Trauma.

OBJECTIVE: Many centers advocate use of triple-contrast (IV, oral, and rectal) CT for assessing hemodynamically stable patients with penetrating abdominopelvic trauma. Enteric contrast material has several disadvantages, leading our practice to pursue use of single-contrast (IV) CT. We conducted a retrospective review of electronic medical records at our institution to assess the accuracy of single-contrast CT for diagnosing bowel injuries in cases of penetrating abdominopelvic trauma. MATERIALS AND METHODS: We retrospectively reviewed patients who presented to our emergency department between January 1, 2004, and March 1, 2014, with penetrating abdominopelvic trauma, underwent an abdominopelvic CT, and had surgery performed thereafter. We reviewed pertinent emergency department records for details regarding the site of injury, the number of injuries per patient, and the type of weapon used. We correlated CT reports with operative notes for presence and sites of bowel injury. RESULTS: A total of 274 patients (median age, 27 years old) met our inclusion criteria; 77% had sustained gunshot wounds (GSWs). CT showed bowel injury in 173 cases; surgery revealed bowel injury in 162 cases. CT had 142 true-positive, 31 false-positive, 81 true-negative, and 20 false-negative cases, resulting in sensitivity of 88%, specificity of 72%, positive predictive value of 82%, and negative predictive value of 80% for detecting bowel injuries. CT had the highest sensitivity and specificity in patients with multiple GSWs (94% and 79%, respectively) and those with injuries to the stomach and rectum. CONCLUSION: Single-contrast CT can show bowel injuries in patients with penetrating abdominopelvic trauma with accuracy comparable with that reported for triple-contrast CT.

Communication of Incidental Imaging Findings on Inpatient Discharge Summaries After Implementation of Electronic Health Record Notification System.

OBJECTIVES: Inadequate follow-up of incidental imaging findings (IIFs) can result in poor patient outcomes, patient dissatisfaction, and provider malpractice. At our institution, radiologists flag IIFs during report dictation to trigger electronic health record (EHR) notifications to providers and patients. Nurse coordinators directly contact patients or their primary care physicians (PCPs) regarding IIFs if follow-up is not completed within the recommended time frame. Despite these interventions, many patients and their PCPs remain unaware of IIFs. In an effort to improve awareness of IIFs, we aim to investigate communication of IIFs on inpatient discharge summaries after implementation of our EHR notification system. METHODS: Inpatient records with IIFs from 2018 to 2021 were retrospectively reviewed to determine type of IIFs, follow-up recommendations, and mention of IIFs on discharge summaries. Nurse coordinators spoke to patients and providers to determine their awareness of IIFs. RESULTS: Incidental imaging findings were reported in 51% of discharge summaries (711/1383). When nurse coordinators called patients and PCPs regarding IIFs at the time follow-up was due, the patients and PCPs were aware of 79% of IIFs (1096/1383). CONCLUSIONS: With implementation of EHR notifications to providers regarding IIFs, IIFs were included in 51% of discharge summaries. Lack of inclusion of IIFs on discharge summaries could be related to transitions of care within hospitalization, provider alert fatigue, and many diagnostic testing results to distill. These findings demonstrate the need to improve communication of IIFs, possibly via automating mention of IIFs on discharge summaries, and the need for care coordinators to follow up on IIFs.

Pancreatic tail cancer in the setting of pancreatitis with a review of the literature: A case report.

Environmental risk factors for pancreatic cancer include acute and chronic pancreatitis, obesity, and tobacco use. Differentiating a pancreatic neoplasm in a patient with pancreatitis can be challenging due to their similar presentations. A 57-year-old African American man with a history of congestive heart failure, pancreatitis, and incomplete pancreas divisum presented with an epigastric abdominal pain that radiated to his back. Imaging showed necrotizing pancreatitis, a developing splenic infarct, and a mass at the pancreas tail. The patient was discharged with pain medications and was recommended follow-up imaging after resolution of his pancreatitis. He was readmitted to the emergency department 2 weeks later with recurrent acute abdominal pain. Computed tomography scan of abdomen and pelvis followed by magnetic resonance imaging and endoscopic ultrasound revealed an infiltrative pancreatic tail mass. Biopsy of the mass confirmed a locally advanced pancreatic tail adenocarcinoma. Chronic pancreatitis is associated with pancreatic cancer. Practitioners should be aware of the co-existence of chronic pancreatitis and pancreatic cancer, and the initial steps to evaluate a malignancy in chronic pancreatitis.

Accuracy and Variability of Prostate Multiparametric Magnetic Resonance Imaging Interpretation Using the Prostate Imaging Reporting and Data System: A Blinded Comparison of Radiologists.

BACKGROUND: Multiparametric (mp) magnetic resonance imaging (MRI) has become an important tool for the detection of clinically significant prostate cancer. However, diagnostic accuracy is affected by variability between radiologists. OBJECTIVE: To determine the accuracy and variability in prostate mpMRI interpretation among radiologists, both individually and in teams, in a blinded fashion. DESIGN, SETTING, AND PARTICIPANTS: A study cohort (n=32) was created from our prospective registry of patients who received prostate mpMRI with subsequent biopsy. The cohort was then independently reviewed by four radiologists of varying levels of experience, who assigned a Prostate Imaging Reporting and Data System (PI-RADS) classification, blinded to all clinical information. Consensus interpretation by teams of two radiologists was evaluated after a 12-wk wash-out period. Interpretive accuracy was calculated with various cutoffs for PI-RADS classification and Gleason score. Variability among individual radiologists and teams was calculated using the Fleiss kappa and intraclass correlation coefficient (ICC). RESULTS AND LIMITATIONS: Using PI-RADS 3+/Gleason 7+ (p<0.01) and PI-RADS 4+/Gleason 6+ (p=0.02) as cutoffs, significant differences in accuracy among the four radiologists were noted. At no cutoff for PI-RADS classification or Gleason score did a team read achieve higher accuracy than the most accurate radiologist. The kappa and ICC ranged from 0.22 to 0.29 for the individuals and from 0.16 to 0.21 for the teams (poor agreement). A larger sample size may be needed to adequately power differences in accuracy among individual radiologists. CONCLUSIONS: At various cutoffs for PI-RADS classification and Gleason score, we find significant differences in individual radiologist accuracy, as well as a poor agreement among individual radiologists. Consensus interpretations-as teams of two radiologists-did not improve accuracy or reduce variability. PATIENT SUMMARY: This study investigated radiologist variability and differences in accuracy using multiparametric magnetic resonance imaging for the diagnosis of prostate cancer. Despite attempts to standardize interpretation within the field, we found substantial variability and significant differences in accuracy among individual radiologists.

Magnetic resonance enterography features of small bowel Crohn's disease activity: an inter-rater reliability study of small bowel active inflammation in clinical practice setting.

OBJECTIVE: The aim of this study is to determine the interrater agreement in a clinical practice environment for the most commonly used magnetic resonance enterography (MRE) features of Crohn's disease (CD). METHODS: CD patients with MRE's before and after treatment were retrospectively identified using search queries over a 7-year period (May 2017-September 2017). MRE features of CD comprising components of multiple CD scoring indices were scored by radiologists in the same segment of bowel. Agreement for nominal categorical and continuous variables was assessed using a κ and interclass correlation coefficients, respectively. RESULTS: 80 scans comprised the study population. Moderate interrater agreement was seen in both the pre- and post-treatment MRE's for presence of diffusion restriction (к = 0.43, 0.48; pre- and post-treatment), stricturing disease (к = 0.51, 0.52), overall degree of severity (к = 0.49, 0.59). Substantial agreement was seen in pre- and post-treatment scans for length of involvement (interclass correlation coefficient = 0.67, 0.61). The presence of mucosal ulceration had no agreement (к = -0.07, -0.042). CONCLUSION: Many MRE features of active CD comprising the major CD scoring indices are reproducible when interpreted by non-CD focused abdominal radiologists. However, the presence of mucosal ulcerations had no agreement and may need more investigation before including this feature as a driver in therapeutic decision making. ADVANCES IN KNOWLEDGE: Demonstrates the unreliability of mucosal ulceration by non-CD focused abdominal radiologists, targeting a potential area for future education. Key Points The majority of MRE findings incorporated in to many CD scoring indices have fair to moderate inter-rater agreement even when read by non-MRE expert radiologists. Substantial agreement was seen in the length of involved bowel, but this feature is only incorporated in to one of the CD scoring indices. Presence of mucosal ulcerations had no interrater agreement in our study-a feature which is heavily weighted by several CD scoring indices. Research should be focused bridging those features which have poor interrater agreement.

Determination of the Role of Negative Magnetic Resonance Imaging of the Prostate in Clinical Practice: Is Biopsy Still Necessary?

OBJECTIVE: To assess the negative predictive value (NPV) of multiparametric magnetic resonance imaging (mpMRI) for detection of prostate cancer (PCa) in routine clinical practice and to identify characteristics of patients for whom mpMRI fails to detect high-grade (Gleason score ≥7) disease. MATERIALS AND METHODS: We reviewed our prospectively maintained database of consecutive men who received prostate mpMRI at our institution, interpreted by a clinical practice of academic radiologists. Between January 2012 and December 2015, 84 men without any magnetic resonance imaging suspicious regions according to prior institutional classification, or with Prostate Imaging Reporting and Data System (PI-RADS) 1-2 lesions according to the PI-RADS system, underwent standard template transrectal ultrasound (TRUS)-guided prostate biopsy. Using these biopsy results, we calculated the NPV of mpMRI for the detection of PCa and identified patient risk factors for having a Gleason score ≥7 PCa on biopsy. RESULTS: High-grade PCa (Gleason score ≥7) was found on TRUS biopsy in 10.3% of biopsy-naive patients (NPV=89.7%), 16.7% of patients with previous negative biopsy (NPV=83.3%), and 13.3% of patients on active surveillance (NPV=86.6%). On multivariate analysis, the Prostate Cancer Prevention Trial Risk Calculator (PCPTRC) estimated risk for high-grade PCa (as a continuous variable) was a significant predictor for high-grade PCa on biopsy (odds ratio 1.01, P < .01). CONCLUSION: Men with negative mpMRIs interpreted in a routine clinical setting have a significant risk of harboring Gleason score ≥7 PCa on a standard 12-region template biopsy, independent of indication. Standard template TRUS prostate biopsy should still be recommended for patients with negative mpMRI, particularly those with elevated PCPTRC estimated risk of high-grade PCa.