Association of Standardized Radiology Reporting and Management of Abdominal CT and MRI With Diagnosis of Pancreatic Cancer.

BACKGROUND & AIMS: Follow-up of abdominal computed tomography (CT) and magnetic resonance imaging (MRI) findings suspicious for pancreatic cancer may be delayed if documentation is unclear. We evaluated whether standardized reporting and follow-up of imaging results reduced time to diagnosis of pancreatic cancer. METHODS: We used a quasi-experimental stepped-wedge cluster design to evaluate the effectiveness of newly implemented radiology reporting system. The system standardizes the reporting of CT and MRI reports using hashtags that classify pancreatic findings. The system also automates referral of patients with findings suspicious for pancreatic cancer to a multidisciplinary care team for rapid review and follow-up. The study examined 318,331 patients who underwent CT or MRI that included the abdomen from 2016 through 2019 who had not had an eligible CT or MRI in the preceding 24 months. We evaluated the association of the intervention with incidence of pancreatic cancer within 60 days and 120 days after imaging. RESULTS: Thirty-eight percent of patients received the intervention, and 1523 patients (0.48%) were diagnosed with pancreatic cancer. In multivariable analysis accounting for age, race/ethnicity, sex, Charlson comorbidity, history of cancer, diabetes, and 4-month calendar period, the intervention was associated with nearly 50% greater odds of diagnosing pancreatic cancer within 60 days (adjusted odds ratio, 1.47; 95% confidence interval, 1.05-2.06) and 120 days (adjusted odds ratio, 1.46; 95% confidence interval, 1.04-2.06). CONCLUSIONS: In this large quasi-experimental, community-based observational study, implementing standardized reporting of abdominal CT and MRI reports with clinical navigation was effective for increasing the detection and diagnosis of pancreatic cancer.

Implementation of LI-RADS into a radiological practice.

Since its introduction in 2011, Liver Imaging Reporting and Data System (LI-RADS) has become an increasingly utilized method for radiologists to categorize lesions for hepatocellular carcinoma (HCC) in patients at risk (American College of Radiology, www.acr.org/quality-safety/resources/lirads 2016). This overview article presents insight into methods of incorporating LI-RADS into an existing clinical practice, highlighting concrete ways to establish this system as a mainstay in any radiologist's evidence-based armamentarium. We will focus on the importance of standardization to improve the value of our reporting. We will also discuss specific opportunities to favor adoption of LI-RADS including building a community of users composed of radiologists and referring physicians, forming a strategic vision, enlisting a team leader, overcoming barriers to adoption, communicating successes, integrating the system into the departmental culture, and learning from mistakes. The 2017 version of LI-RADS is the most recent update and is based on the most current medical imaging evidence. The details of these updates are described in other articles in this journal's edition. Efforts should be made to increase adherence and to enhance standardized use of LI-RADS internationally. Ultimately, the objective of LI-RADS is to prioritize patient care and optimize medical outcomes.

Ultrasound Monitoring of Extant Adnexal Masses in the Era of Type 1 and Type 2 Ovarian Cancers: Lessons Learned From Ovarian Cancer Screening Trials.

Women that are positive for an ovarian abnormality in a clinical setting can have either a malignancy or a benign tumor with probability favoring the benign alternative. Accelerating the abnormality to surgery will result in a high number of unnecessary procedures that will place cost burdens on the individual and the health delivery system. Surveillance using serial ultrasonography is a reasonable alternative that can be used to discover if changes in the ovarian abnormality will occur that favor either a malignant or benign interpretation. Several ovarian cancer screening trials have had extensive experiences with changes in subclinical ovarian abnormalities in normal women that can define growth, stability or resolution and give some idea of the time frame over which changes occur. The present report examines these experiences and relates them to the current understanding of ovarian cancer ontology, presenting arguments related to the benefits of surveillance.

Ultrasound follow up of an adnexal mass has the potential to save lives.

Ovarian cancer is among the most dreaded cancers since it is often found at a late stage where the opportunity for extended survival is poor. Ultrasound has been utilized in several ovarian cancer screening trials in asymptomatic women in order to detect ovarian cancer at early stages where survival rates are high. Efforts to improve screening for ovarian cancer are ongoing. While ovarian cancer screening in asymptomatic women is not recommended for clinical application currently, the care of women with adnexal masses found by ultrasound in clinical practice can benefit from close evaluation of the evidence obtained from large prospective ovarian cancer screening trials and by relating this evidence to recent advances in the understanding of different types of ovarian cancer. Post-menopausal women who have an adnexal mass discovered by ultrasound have a much higher risk of developing ovarian cancer than women with normal ultrasound. The preponderance of reported evidence indicates that ultrasound monitoring of an adnexal mass is safe, cost effective and can achieve an improved positive predictive value in detecting ovarian cancer when ovarian abnormalities resolve during surveillance. Proposals to arbitrarily discontinue ultrasound monitoring can negatively impact patient care and generate medical-legal actions, especially because there is no evidence to support safe discontinuation. In this review, we outline a rationale for continuing ultrasound surveillance of ovarian abnormalities.

Imaging findings of rhinocerebral mucormycosis.

BACKGROUND AND OBJECTIVES: The purpose of this study was to describe common radiographic patterns that may be useful in predicting the diagnosis of rhinocerebral mucormycosis. METHODS: We retrospectively evaluated the imaging and clinical data of four males and one female, 3 to 72 years old, with rhinocerebral mucormycosis. RESULTS: All the patients presented with sinusitis and ophthalmological symptoms. Most of the patients (80%) had isointense lesions relative to brain in T1-weighted images. The signal intensity in T2-weighted images was more variable, with only one (20%) patient showing hyperintensity. A pattern of anatomic involvement affecting the nasal cavity, maxillary sinus, orbit, and ethmoid cells was consistently observed in all five patients (100%). Our series demonstrated a mortality rate of 60%. CONCLUSION: Progressive and rapid involvement of the cavernous sinus, vascular structures and intracranial contents is the usual evolution of rhinocerebral mucormycosis. In the context of immunosupression, a pattern of nasal cavity, maxillary sinus, ethmoid cells, and orbit inflammatory lesions should prompt the diagnosis of mucormycosis. Multiplanar magnetic resonance imaging shows anatomic involvement, helping in surgery planning. However, the prognosis is grave despite radical surgery and antifungals.

Colonoscopy findings in end-stage liver disease patients with incidental CT colonic wall thickening.

OBJECTIVE: Colonic wall thickening may occur in patients with end-stage liver disease. This study was conducted to correlate colonoscopy with CT-detected colonic wall thickening in this group of patients to assess their radiologic and clinical relevance. CONCLUSION: Our results suggest that CT findings of colonic wall thickening in end-stage liver disease should be considered benign, and colonoscopy is unnecessary for the evaluation of malignancy or colitis unless it is clinically indicated.

The utility of sonography for the triage of blunt abdominal trauma patients to exploratory laparotomy.

OBJECTIVE: The purpose of this study was to assess the utility of focused abdominal sonography for trauma (FAST) in the triage of hypotensive and normotensive blunt abdominal trauma patients to exploratory laparotomy. MATERIALS AND METHODS: Data entered in a trauma registry database were retrospectively reviewed and were correlated with medical records, radiology reports, and surgical laparotomy reports. In the setting of blunt abdominal trauma, hypotensive patients were compared with normotensive patients who underwent FAST. RESULTS: During the 6-year study period, 4,029 patients with blunt abdominal trauma underwent sonography, 122 of whom were hypotensive on arrival and underwent FAST. Of 87 hypotensive patients with positive findings on FAST, 69 (79%) were taken directly to exploratory laparotomy without the need for CT. In predicting the need for therapeutic laparotomy in hypotensive patients, the sensitivity of FAST was 85%, specificity was 60%, and accuracy was 77%. Of the 3,907 normotensive patients, 3,584 had negative FAST findings, whereas 323 had positive FAST findings. In normotensive patients, the sensitivity of FAST was 85%, specificity was 96%, and accuracy was 96%. In the combined patient population (all hypotensive and normotensive patients), 4,029 patients with blunt abdominal trauma underwent sonography: 3,619 had negative and 410 had positive FAST findings. In all patients regardless of blood pressure, the sensitivity of FAST was 85%, specificity was 96%, and accuracy was 95%. CONCLUSION: Hypotensive patients screened in the emergency department with positive FAST findings may be triaged directly to therapeutic laparotomy, depending on the results of the sonography examination, without the need for CT.

Blunt abdominal injury in the pregnant patient: detection with US.

PURPOSE: To determine the accuracy of ultrasonography (US) for the detection of blunt intraabdominal injury in pregnant patients and to compare differences between pregnant and nonpregnant patients of childbearing age. MATERIALS AND METHODS: A retrospective review of results of all consecutive emergency blunt trauma US examinations performed at a level I trauma center from January 1995 to June 2002 was conducted. Data on demographics, free fluid location, and patient outcome were collected. Injuries were determined on the basis of results of computed tomography and/or laparotomy. The Student t test was used to detect differences between continuous variables, and chi(2) analysis was used to evaluate differences between proportions. RESULTS: A total of 2319 US examinations for blunt trauma were performed in girls and women between the ages of 10 and 50 years. There were 328 pregnant patients, 23 of whom had intraabdominal injury. The mean age of the pregnant patients was 24.7 years +/- 6.1 (standard deviation) (age range, 14-42 years). In pregnant patients, the sensitivity of US was 61% (14 of 23 patients), the specificity was 94.4% (288 of 305 patients), and the accuracy was 92.1% (302 of 328 patients). Pregnant patients were significantly more likely to have sustained injuries from assault (odds ratio: 2.6, P < .001). The most common pattern of free fluid accumulation detected at US in pregnant patients was that of fluid in the left and right upper quadrants and pelvis (n = 4, 29%); the second most common pattern was one of isolated pelvic fluid (n = 3, 21%). CONCLUSION: For detection of intraabdominal injury, US was less sensitive in pregnant patients than in nonpregnant patients but was highly specific in both subgroups. The sensitivity of US was highest in pregnant patients during the first trimester.