Overview of F18-FDG uptake patterns in retroperitoneal pathologies: imaging findings, pitfalls, and artifacts.

INTRODUCTION: Retroperitoneum can be the origin of a wide variety of pathologic conditions and potential space for disease spread to other compartments of the abdomen and pelvis. Computed tomography (CT) and magnetic resonance imaging (MRI) are often the initial imaging modalities to evaluate the retroperitoneal pathologies, however given the intrinsic limitations, F18-FDG PET/CT provides additional valuable metabolic information which can change the patient management and clinical outcomes. We highlight the features of retroperitoneal pathologies on F18-FDG PET/CT and the commonly encountered imaging artifacts and pitfalls. The aim of this review is to characterize primary and secondary retroperitoneal pathologies based on their metabolic features, and correlate PET findings with anatomic imaging. CONCLUSION: Retroperitoneal pathologies can be complex, ranging from oncologic to a spectrum of non-oncologic disorders. While crosse-sectional imaging (CT and MRI) are often the initial imaging modalities to localize and characterize pathologies, metabolic information provided by F18-FDG PET/CT can change the management and clinical outcome in many cases.

Imaging of abdominopelvic oncologic emergencies.

With advancements in cancer treatment, the survival rates for many malignancies have increased. However, both the primary tumors and the treatments themselves can give rise to various complications. Acute symptoms in oncology patients require prompt attention. Abdominopelvic oncologic emergencies can be classified into four distinct categories: vascular, bowel, hepatopancreatobiliary, and bone-related complications. Radiologists need to be familiar with these complications to ensure timely diagnosis, which ultimately enhances patient outcomes.

Skin Malignancies: Imaging Review with Radiologic-Histopathologic Correlation.

Skin malignancies are commonly encountered as primary or incidental findings. Neoplasms that affect the skin include primary (basal cell carcinoma, squamous cell carcinoma, melanoma, and Merkel cell carcinoma) and secondary (mesenchymal neoplasms, lymphoma, and metastases) tumors. Imaging provides valuable anatomic information (tumor size, depth of involvement, presence of distant metastasis, and data for guiding biopsy) and functional information (metabolic activity and sentinel node mapping data). This information, in addition to biopsy results, improves the histopathologic characterization of tumors and treatment planning. Various histopathologic types of the same entity exhibit different biologic behavior and have different imaging features. Familiarity with the multimodality imaging features, histopathologic characteristics, and various modes of dissemination (direct invasion; perineural, lymphatic, and hematogenous spread) of the most common skin malignancies helps radiologists narrow the differential diagnosis in clinical practice. ©RSNA, 2023 Supplemental material is available for this article. Quiz questions for this article are available through the Online Learning Center.

Fibroblastic and Myofibroblastic Soft-Tissue Tumors: Imaging Spectrum and Radiologic-Pathologic Correlation.

Fibroblastic and myofibroblastic tumors are a variable group of neoplasms ranging from benign to malignant. These lesions may affect patients of any age group but are more frequently encountered in the pediatric population. Patient clinical presentation depends on the location, growth pattern, adjacent soft-tissue involvement, and pathologic behavior of these neoplasms. In the 2020 update to the World Health Organization (WHO) classification system, these tumors are classified on the basis of their distinct biologic behavior, histomorphologic characteristics, and molecular profiles into four tumor categories: (a) benign (eg, fibrous hamartoma of infancy, nodular fasciitis, proliferative fasciitis, fibroma of the tendon sheath, calcifying aponeurotic fibroma); (b) intermediate, locally aggressive (eg, desmoid fibromatosis); (c) intermediate, rarely metastasizing (eg, dermatofibrosarcoma protuberans, myxoinflammatory fibroblastic sarcoma, low-grade myofibroblastic sarcoma, infantile fibrosarcoma); and (d) malignant (eg, sclerosing epithelioid fibrosarcomas; low-grade fibromyxoid sarcoma; myxofibrosarcoma; fibrosarcoma, not otherwise specified). Detection of various components of solid tumors at imaging can help in prediction of the presence of corresponding histopathologic variations, thus influencing diagnosis, prognosis, and treatment planning. For example, lesions with a greater myxoid matrix or necrotic components tend to show higher signal intensity on T2-weighted MR images, whereas lesions with hypercellularity and dense internal collagen content display low signal intensity. In addition, understanding the radiologic-pathologic correlation of soft-tissue tumors can help to increase the accuracy of percutaneous biopsy and allow unnecessary interventions to be avoided. ©RSNA, 2023 Quiz questions for this article are available in the supplemental material.

MR Defecating Proctography with Emphasis on Posterior Compartment Disorders.

MR defecating proctography (MRDP) is a noninvasive examination that can be used for evaluating posterior compartment disorders. MRDP has several advantages over conventional fluoroscopic defecography. These benefits include high-contrast resolution evaluation of the deep pelvic organs, simultaneous multicompartmental assessment that is performed statically and dynamically during defecation, and lack of ionizing radiation. MRDP also provides a highly detailed anatomic evaluation of the pelvic floor supportive structures, including direct assessment of the pelvic floor musculature and indirect assessment of the endopelvic fascia. As the breadth of knowledge regarding anatomic and functional posterior compartment disorders expands, so too does the advancement of noninvasive and surgical treatment options for these conditions. High-quality MRDP examinations, with key anatomic and functional features reported, guide treatment planning. Reporting of MRDP examination findings with use of standardized terminology that emphasizes objective measurements rather than subjective grading aids consistent communication among radiologists, clinicians, and surgeons. Familiarity with commonly encountered posterior compartment pelvic floor pathologic entities that contribute to posterior compartment disorders and awareness of the essential information needed by surgeons are key to providing an optimal multidisciplinary discussion for planning pelvic floor dysfunction treatment. The authors provide an overview of the basic concepts of the MRDP acquisition technique, the anatomic abnormalities of posterior compartment pelvic floor pathologic entities associated with defecatory disorders, and recently developed interdisciplinary MRDP reporting templates and lexicons. In addition, the associated imaging findings that are key for surgical treatment guidance are highlighted. © RSNA, 2022 Online supplemental material is available for this article.

Approaches to Greening Radiology.

The health care sector is a resource-intensive industry, consuming significant amounts of water and energy, and producing a multitude of waste. Health care providers are increasingly implementing strategies to reduce energy use and waste. Little is currently known about existing sustainability strategies and how they may be supported by radiology practices. Here, we review concepts and ideas that minimize energy use and waste, and that can be supported or implemented by radiologists.

Diffusion-weighted imaging (DWI) in diagnosis, staging, and treatment response assessment of multiple myeloma: a systematic review and meta-analysis.

OBJECTIVE: To evaluate the role of diffusion-weighted imaging (DWI) in the initial diagnosis, staging, and assessment of treatment response in patients with multiple myeloma (MM). MATERIALS AND METHODS: A systematic literature review was conducted in PubMed, the Cochrane Library, EMBASE, Scopus, and Web of Science databases. The primary endpoints were defined as the diagnostic performance of DWI for disease detection, staging of MM, and assessing response to treatment in these patients. RESULTS: Of 5881 initially reviewed publications, 33 were included in the final qualitative and quantitative meta-analysis. The diagnostic performance of DWI in the detection of patients with MM revealed pooled sensitivity and specificity of 86% (95% CI: 84-89) and 63% (95% CI: 56-70), respectively, with a diagnostic odds ratio (OR) of 14.98 (95% CI: 4.24-52.91). The pooled risk difference of 0.19 (95% CI: - 0.04-0.42) was reported in favor of upstaging with DWI compared to conventional MRI (P value = 0.1). Treatment response evaluation and ADCmean value changes across different studies showed sensitivity and specificity of approximately 78% (95% CI: 72-83) and 73% (95% CI: 61-83), respectively, with a diagnostic OR of 7.21 in distinguishing responders from non-responders. CONCLUSIONS: DWI is not only a promising tool for the diagnosis of MM, but it is also useful in the initial staging and re-staging of the disease and treatment response assessment. This can aid clinicians with earlier initiation or change in treatment strategy, which could have prognostic significance for patients.

Articular Findings on Chest Computed Tomography: An Algorithmic Approach for Radiologists.

ABSTRACT: Chest computed tomography (CT) is one of the most frequently performed imaging studies. Incidental osseous and articular findings are commonly encountered in chest CTs in daily practice. The spectrum of findings is broad, varying from benign to malignant, and interpretation of these incidental musculoskeletal findings could be challenging for radiologists. In this review, we provide a systematic algorithmic approach for the diagnosis of common articular findings seen on chest CT with recommendations for appropriate follow-up evaluation.

Incidental osseous lesions on chest CT: an algorithmic approach for radiologists.

Numerous osseous findings are commonly discovered incidentally at chest CTs in daily practice. A broad spectrum of these findings ranges from benign and do not touch lesions to ominous conditions requiring further imaging evaluation and/or intervention. Interpretation of these incidental musculoskeletal findings may constitute a diagnostic challenge to radiologists. This review provides a systematic, algorithmic approach to common osseous lesions on chest CT based on imaging findings with recommendations for proper next step management.

Imaging More than Skin-Deep: Radiologic and Dermatologic Presentations of Systemic Disorders.

BACKGROUND: Cutaneous manifestations of systemic diseases are diverse and sometimes precede more serious diseases and symptomatology. Similarly, radiologic imaging plays a key role in early diagnosis and determination of the extent of systemic involvement. Simultaneous awareness of skin and imaging manifestations can help the radiologist to narrow down differential diagnosis even if imaging findings are nonspecific. AIMS: To improve diagnostic accuracy and patient care, it is important that clinicians and radiologists be familiar with both cutaneous and radiologic features of various systemic disorders. This article reviews cutaneous manifestations and imaging findings of commonly encountered systemic diseases. CONCLUSIONS: Familiarity with the most disease-specific skin lesions help the radiologist pinpoint a specific diagnosis and consequently, in preventing unnecessary invasive workups and contributing to improved patient care.

A Review of Posteromedial Lesions of the Chest Wall: What Should a Chest Radiologist Know?

A heterogeneous group of tumors can affect the posteromedial chest wall. They form diverse groups of benign and malignant (primary or secondary) pathologies that can arise from different chest wall structures, i.e., fat, muscular, vascular, osseous, or neurogenic tissues. Chest radiography is very nonspecific for the characterization of chest wall lesions. The modality of choice for the initial assessment of the chest wall lesions is computed tomography (CT). More advanced cross-sectional modalities such as magnetic resonance imaging (MRI) and positron emission tomography (PET) with fluorodeoxyglucose are usually used for further characterization, staging, treatment response, and assessment of recurrence. A systematic approach based on age, clinical history, and radiologic findings is required for correct diagnosis. It is essential for radiologists to be familiar with the spectrum of lesions that might affect the posteromedial chest wall and their characteristic imaging features. Although the imaging findings of these tumors can be nonspecific, cross-sectional imaging helps to limit the differential diagnosis and determine the further diagnostic investigation (e.g., image-guided biopsy). Specific imaging findings, e.g., location, mineralization, enhancement pattern, and local invasion, occasionally allow a particular diagnosis. This article reviews the posteromedial chest wall anatomy and different pathologies. We provide a combination of location and imaging features of each pathology. We will also explore the role of imaging and its strengths and limitations for diagnosing posteromedial chest wall lesions.

Fluoroscopic Evaluation of Duodenal Diseases.

The duodenum can be affected by a variety of abnormalities because of its development during embryogenesis and its dual intra- and retroperitoneal location. If small bowel embryogenesis is disturbed, congenital errors occur. Although some congenital variants may be asymptomatic and inconsequential to the patient, other anomalies can result in life-threatening emergencies such as malrotation, leading to midgut volvulus. Many infectious processes affect the duodenum, including duodenal ulcers and opportunistic infection in patients with HIV/AIDS or Crohn disease. Small bowel malignancies are uncommon but important to recognize, because the duodenum can be involved in polyposis syndromes or the development of primary adenocarcinoma, neuroendocrine tumors, lymphoma, and metastasis. Although endoscopy is currently the most used diagnostic method to assess the lumen of the upper gastrointestinal tract, fluoroscopy is a valuable adjunct technique and the study of choice for many diseases, specifically those for which anatomic and functional information is required. Fluoroscopy is also commonly used postoperatively to assess for complications such as obstruction and extraluminal leaks. Compared with endoscopy, fluoroscopy is an inexpensive and noninvasive technique that provides salient anatomic information and allows delineation of the duodenal mucosa and assessment of real-time duodenal motility. The authors examine the broad spectrum of conditions that can involve the duodenum, including congenital, infectious, inflammatory, and neoplastic abnormalities, and review their typical appearances at fluoroscopy. Online supplemental material is available for this article. ©RSNA, 2022.

Geographic Trends in Publications and Submissions in Radiology Journals: Decade Report (2010 - 2020).

RATIONALE AND OBJECTIVE: The Radiology Research Alliance (RRA) of the Association of University Radiologists (AUR) organized a task force to quantify geographic changes in submissions to and publications within radiology journals over time. MATERIALS AND METHODS: Twenty journals were selected: 7 US-based general, 4 European-based general, and 9 subspecialty radiology journals. Journals were solicited for submissions and publications based on country of origin from 2010 -2020. Regression models assessed changes over time across countries, and by continent, with an emphasis on the US and China, for each journal category. RESULTS: There were 104,679 publications and 92,446 submissions from 149 countries. Overall, there were significant increases in numbers of publications from Asia (R2 = 0.66, p <0.01), and specifically, China (R2 = 0.87, p <0.01). For US journals, there were increased numbers of publications from Asia (R2 = 0.72, p <0.01) and China (R2 = 0.98, p <0.01), but decreased numbers from North America (R2 = 0.41, p = 0.03). For European journals, there were increased numbers of publications from Asia (R2 = 0.79, p <0.01), North America (R2 = 0.75, p <0.01), and China (R2 = 0.82, p <0.01). For subspecialty journals, there were increased numbers of publications from North America (R2 = 0.38, p = 0.04) and China (R2 = 0.73, p <0.01). There was an acute COVID spike in submissions during 2020, with a continuous increase most notable in China (R2 = 0.96, p <0.01). CONCLUSION: In the last decade, the numbers of submissions to and publications within general and subspecialty US and European radiology journals have generally increased around the world, with the largest growth in Asia and in particular China.

Management of locally advanced mesonephric carcinoma of the cervix in the setting of Mullerian Duct anomaly spectrum and unilateral renal agenesis: A case report and review of the literature.

Cervical mesonephric adenocarcinoma is a rare histologic cervical carcinoma variant arising from remnants of the mesonephric duct. Few clinical cases have been reported in the literature, and given the low rate of occurrence, the optimal management strategy is unknown. Most reported cases involve patients with either early stage (FIGO I) or metastatic disease. Herein, we report the only known case of locally advanced, node-positive cervical mesonephric carcinoma in a 55-year old woman with Mullerian duct anomaly of the uterus, obstructed hemivagina, and ipsilateral renal agenesis. To our knowledge, this would be the first case report with the concurrence of both rare entities. We review the treatment paradigm in this patient, and the literature, including radiotherapy and brachytherapy techniques.

Phleboliths mistaken for intraperitoneal copper-containing intrauterine device in the presence of missing strings.

Although rare, pelvic phleboliths may confound the diagnosis of an intraperitoneal or malpositioned intrauterine device (IUD). Pelvic phleboliths are focal calcifications in pelvic veins, often in multiples near the ureters, occurring in about 40% of adult patients. We treated a 35-year-old woman requesting removal of her copper-containing IUD (TCu380A IUD). She had missing IUD strings on clinical examination. A clinic-based transvaginal ultrasound and anteroposterior abdominal radiograph that followed suggested prior TCu380A IUD expulsion. A radiologist later interpreted several ambiguous radiodensities in the abdominal radiograph as a possible intraperitoneal or malpositioned IUD. In collaboration with radiologists and family planning specialists, it was suggested that the patient further undergo a three-dimensional ultrasonography and a CT of the pelvis. The radiodensities first noted on the radiograph were revealed to be phleboliths, a diagnostic possibility not initially considered by any of the primary clinical care team, radiologists or family planning specialists.

A novel imaging based Nomogram for predicting post-surgical biochemical recurrence and adverse pathology of prostate cancer from pre-operative bi-parametric MRI.

BACKGROUND: We developed and validated an integrated radiomic-clinicopathologic nomogram (RadClip) for post-surgical biochemical recurrence free survival (bRFS) and adverse pathology (AP) prediction in men with prostate cancer (PCa). RadClip was further compared against extant prognostics tools like CAPRA and Decipher. METHODS: A retrospective study of 198 patients with PCa from four institutions who underwent pre-operative 3 Tesla MRI followed by radical prostatectomy, between 2009 and 2017 with a median 35-month follow-up was performed. Radiomic features were extracted from prostate cancer regions on bi-parametric magnetic resonance imaging (bpMRI). Cox Proportional-Hazards (CPH) model warped with minimum redundancy maximum relevance (MRMR) feature selection was employed to select bpMRI radiomic features for bRFS prediction in the training set (D1, N = 71). In addition, a bpMRI radiomic risk score (RadS) and associated nomogram, RadClip, were constructed in D1 and then compared against the Decipher, pre-operative (CAPRA), and post-operative (CAPRA-S) nomograms for bRFS and AP prediction in the testing set (D2, N = 127). FINDINGS: "RadClip yielded a higher C-index (0.77, 95% CI 0.65-0.88) compared to CAPRA (0.68, 95% CI 0.57-0.8) and Decipher (0.51, 95% CI 0.33-0.69) and was found to be comparable to CAPRA-S (0.75, 95% CI 0.65-0.85). RadClip resulted in a higher AUC (0.71, 95% CI 0.62-0.81) for predicting AP compared to Decipher (0.66, 95% CI 0.56-0.77) and CAPRA (0.69, 95% CI 0.59-0.79)." INTERPRETATION: RadClip was more prognostic of bRFS and AP compared to Decipher and CAPRA. It could help pre-operatively identify PCa patients at low risk of biochemical recurrence and AP and who therefore might defer additional therapy. FUNDING: The National Institutes of Health, the U.S. Department of Veterans Affairs, and the Department of Defense.

Ultrasound Training in Radiology Residency Programs: A National Survey.

OBJECTIVES: Comprehensive training in ultrasound (US) imaging during radiology residency is crucial if radiologists are expected to maintain a substantial role in this widely used imaging modality. This study aimed to evaluate the current curriculum of US training among radiology residency programs across the country via a nationwide survey. METHODS: A 28-question survey was distributed among all academic radiology departments in the United States and their radiology residents. The survey consisted of 4 sections: general demographic information, training information, clinical competency, and adequacy of training (perspective). The Student t test and 1-way analyses of variance were performed to assess statistical significance. RESULTS: Overall, 256 residents from 32 states completed the questionnaire. Only 114 (45%) residents reported having a dedicated rotation for performing US studies. Although 228 (89%) of trainees believed they received adequate experience for interpreting US studies, only 66 (26%) of them had the same belief about performing them. Only 116 (45%) of the residents were comfortable operating the US machines in their departments. Higher years of residency training, having a dedicated rotation for performing US studies, and having more than 10 hours per year of didactic lectures and/or more than 5 hours per year of case conferences dedicated to US had a positive impact on the residents' clinical competency and perspective (all P < .05). CONCLUSIONS: Most radiology residents do not feel confident in performing US examinations by themselves. However, higher clinical competency was reported in the residents who had dedicated rotations for performing US studies and received more hours of US lectures and case conferences throughout their residency.

Simulation-based learning for enhanced gynecologic brachytherapy training among radiation oncology residents.

PURPOSE: Brachytherapy is an irreplaceable component of gynecologic cancer treatment. Resident training has declined, and procedural exposure is variable. We evaluated whether simulation-based gynecologic brachytherapy training among radiation oncology residents could improve knowledge, confidence, and interest. METHODS AND MATERIALS: Before a brachytherapy workshop, radiation oncology residents without prior gynecologic brachytherapy experience completed a survey on brachytherapy knowledge, procedural confidence, plan evaluation, and quality/safety. Residents then participated in a gynecologic brachytherapy workshop. Lectures covered brachytherapy imaging and physics principles/quality assurance, followed by hands-on and individualized feedback regarding applicator selection and placement, target segmentation, and physics quality assurance. Afterward, preworkshop questions were recollected. Descriptive statistics and Fisher's exact tests were used for data analysis. RESULTS: After the workshop, resident responses regarding the learning environment and baseline knowledge questions improved overall. There was a 30% improvement in favorable responses to the learning environment statement "My residency has a formal process/curriculum to teach brachytherapy" and for baseline knowledge the greatest improvement was seen for "I am familiar with the anatomy and placement of the applicators in relation to the anatomy". "Lack of didactic or procedural training exposure" was identified as the main reason for declining brachytherapy use. Initially, 1/8 residents correctly completed the knowledge questions, and after the workshop, 6/7 (p < 0.001) residents correctly completed the questions. CONCLUSIONS: Domain-specific knowledge, procedural confidence, and brachytherapy interest improved after a gynecologic brachytherapy workshop. Integrated didactic and simulation-based brachytherapy training may serve as a valuable learning tool to augment resident knowledge, introduce practical skills, and spark resident interest in brachytherapy.