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BACKGROUND & AIMS: Perianal fistulizing Crohn's disease (PFCD)-associated anorectal and fistula cancers are rare but often devastating diagnoses. However, given the low incidence and consequent lack of data and clinical trials in the field, there is little to no guidance on screening and management of these cancers. To inform clinical practice, we developed consensus guidelines on PFCD-associated anorectal and fistula cancers by multidisciplinary experts from the international TOpClass consortium. METHODS: We conducted a systematic review by standard methodology, using the Newcastle-Ottawa Scale quality assessment tool. We subsequently developed consensus statements using a Delphi consensus approach. RESULTS: Of 561 articles identified, 110 were eligible, and 76 articles were included. The overall quality of evidence was low. The TOpClass consortium reached consensus on 6 structured statements addressing screening, risk assessment, and management of PFCD-associated anorectal and fistula cancers. Patients with long-standing (>10 years) PFCD should be considered at small but increased risk of developing perianal cancer, including squamous cell carcinoma of the anus and anorectal carcinoma. Risk factors for squamous cell carcinoma of the anus, notably human papilloma virus, should be considered. New, refractory, or progressive perianal symptoms should prompt evaluation for fistula cancer. There was no consensus on timing or frequency of screening in patients with asymptomatic perianal fistula. Multiple modalities may be required for diagnosis, including an examination under anesthesia with biopsy. Multidisciplinary team efforts were deemed central to the management of fistula cancers. CONCLUSIONS: Inflammatory bowel disease clinicians should be aware of the risk of PFCD-associated anorectal and fistula cancers in all patients with PFCD. The TOpClass consortium consensus statements outlined herein offer guidance in managing this challenging scenario.
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PURPOSE: This study evaluates the prognostic value of CT findings, including volumetric measurements, in predicting outcomes for patients with Fournier gangrene (FG), focusing on mortality, ICU admission, hospital stay length, and healthcare costs. METHODS: A retrospective study was conducted on 38 FG patients who underwent CT scans before surgical debridement. We analyzed demographic data, CT volumetric measurements, and clinical outcomes using logistic and linear regression models. RESULTS: No single CT measurement significantly predicted mortality or ICU admission. The best model for mortality prediction included age, air volume, NSTI score, and male sex, with an AUC of 0.911. Intubation likelihood was modeled with an AUC of 0.913 using age, NSTI score, and visceral to subcutaneous fat ratio. The ICU admission model achieved an AUC of 0.677. Hospital stay was predicted by air volume (ß = 0.0002656, p = 0.0505) with an adjusted R-squared of 0.1287. Air volume significantly predicted hospital costs (ß = 2.859, p = 0.00558), resulting in an adjusted R-squared of 0.2165. CONCLUSION: Volumetric CT findings provide valuable prognostic insights for FG patients, suggesting a basis for informed clinical decisions and resource allocation. Further validation in larger, multi-center studies is recommended to develop robust predictive models for FG outcomes.
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Gangrena de Fournier , Tiempo de Internación , Tomografía Computarizada por Rayos X , Humanos , Gangrena de Fournier/diagnóstico por imagen , Masculino , Estudios Retrospectivos , Femenino , Tomografía Computarizada por Rayos X/métodos , Persona de Mediana Edad , Anciano , Pronóstico , Tiempo de Internación/estadística & datos numéricos , Valor Predictivo de las Pruebas , Desbridamiento , Adulto , Anciano de 80 o más AñosRESUMEN
Urinary bladder masses are commonly encountered in clinical practice, with 95% arising from the epithelial layer and rarer tumors arising from the lamina propria, muscularis propria, serosa, and adventitia. The extent of neoplastic invasion into these bladder layers is assessed with multimodality imaging, and the MRI-based Vesical Imaging Reporting and Data System is increasingly used to aid tumor staging. Given the multiple layers and cell lineages, a diverse array of pathologic entities can arise from the urinary bladder, and distinguishing among benign, malignant, and nonneoplastic entities is not reliably feasible in most cases. Pathologic assessment remains the standard of care for classification of bladder masses. Although urothelial carcinoma accounts for most urinary bladder malignancies in the United States, several histopathologic entities exist, including squamous cell carcinoma, adenocarcinoma, melanoma, and neuroendocrine tumors. Furthermore, there are variant histopathologic subtypes of urothelial carcinoma (eg, the plasmacytoid variant), which are often aggressive. Atypical benign bladder masses are diverse and can have inflammatory or iatrogenic causes and mimic malignancy. © RSNA, 2022 Online supplemental material is available for this article.
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Carcinoma de Células Transicionales , Anomalías del Sistema Digestivo , Enfermedades de la Vejiga Urinaria , Neoplasias de la Vejiga Urinaria , Humanos , Carcinoma de Células Transicionales/patología , Neoplasias de la Vejiga Urinaria/diagnóstico por imagen , Neoplasias de la Vejiga Urinaria/patología , Vejiga Urinaria/diagnóstico por imagen , Estadificación de NeoplasiasRESUMEN
Social media is a popular communication and marketing tool in modern society, with the power to reach and engage large audiences. Many members of the medical and radiology communities have embraced social media platforms, particularly X (formerly known as Twitter), as an efficient and economic means for performing patient outreach, disseminating research and educational materials, building networks, and promoting diversity. Editors of medical journals with a clear vision and relevant expertise can leverage social media and other digital tools to advance the journal's mission, further their interests, and directly benefit journal authors and readers. For editors, social media offers a means to increase article visibility and downloads, expand awareness of volunteer opportunities, and use metrics and other feedback to inform future initiatives. Authors benefit from broader dissemination of their work, which aids establishment of a national or international reputation. Readers can receive high-quality high-yield content in a digestible format directly on their devices while actively engaging with journal editors and authors in the online community. The authors highlight the multifaceted benefits of social media engagement and digital tool implementation in the context of medical journalism and summarize the activities of the RadioGraphics Social Media and Digital Innovation Team. By enumerating the social media activities of RadioGraphics and describing the underlying rationale for each activity, the authors present a blueprint for other medical journals considering similar initiatives. ©RSNA, 2023.
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Radiología , Medios de Comunicación Sociales , Humanos , ComunicaciónRESUMEN
Small solid renal masses (SRMs) are frequently detected at imaging. Nearly 20% are benign, making careful evaluation with MRI an important consideration before deciding on management. Clear cell renal cell carcinoma (ccRCC) is the most common renal cell carcinoma subtype with potentially aggressive behavior. Thus, confident identification of ccRCC imaging features is a critical task for the radiologist. Imaging features distinguishing ccRCC from other benign and malignant renal masses are based on major features (T2 signal intensity, corticomedullary phase enhancement, and the presence of microscopic fat) and ancillary features (segmental enhancement inversion, arterial-to-delayed enhancement ratio, and diffusion restriction). The clear cell likelihood score (ccLS) system was recently devised to provide a standardized framework for categorizing SRMs, offering a Likert score of the likelihood of ccRCC ranging from 1 (very unlikely) to 5 (very likely). Alternative diagnoses based on imaging appearance are also suggested by the algorithm. Furthermore, the ccLS system aims to stratify which patients may or may not benefit from biopsy. The authors use case examples to guide the reader through the evaluation of major and ancillary MRI features of the ccLS algorithm for assigning a likelihood score to an SRM. The authors also discuss patient selection, imaging parameters, pitfalls, and areas for future development. The goal is for radiologists to be better equipped to guide management and improve shared decision making between the patient and treating physician. © RSNA, 2023 Quiz questions for this article are available in the supplemental material. See the invited commentary by Pedrosa in this issue.
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Carcinoma de Células Renales , Neoplasias Renales , Humanos , Carcinoma de Células Renales/diagnóstico , Neoplasias Renales/patología , Imagen por Resonancia Magnética/métodos , Diagnóstico Diferencial , Estudios RetrospectivosRESUMEN
Three-dimensional (3D) printing has applications in many fields and has gained substantial traction in medicine as a modality to transform two-dimensional scans into three-dimensional renderings. Patient-specific 3D printed models have direct patient care uses in surgical and procedural specialties, allowing for increased precision and accuracy in developing treatment plans and guiding surgeries. Medical applications include surgical planning, surgical guides, patient and trainee education, and implant fabrication. 3D printing workflow for a laboratory or clinical service that produces anatomic models and guides includes optimizing imaging acquisition and post-processing, segmenting the imaging, and printing the model. Quality assurance considerations include supervising medical imaging expert radiologists' guidance and self-implementing in-house quality control programs. The purpose of this review is to provide a workflow and guide for starting or optimizing laboratories and clinical services that 3D-print anatomic models or guides for clinical use.
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Modelos Anatómicos , Impresión Tridimensional , Diagnóstico por Imagen , Humanos , Planificación de Atención al PacienteRESUMEN
Limited type A aortic dissection (LTAAD) is a rare subtype of dissection that is confined within a well-defined border of the ascending aorta. These dissections may occur in the remaining native portion of the aortic root following aortic root replacement and can be complicated by malperfusion syndrome-a syndrome where dissections compromise the aortic branches and lead to end-organ ischemia. Because LTAAD is confined within the ascending aorta, malperfusion syndrome may preferentially affect the coronary arteries resulting in coronary malperfusion, myocardial infarction, and increased mortality. We report a case of LTAAD and malperfusion syndrome of the left main coronary artery which resulted in inadequate contrast opacification of the aorta and failure of the dissection protocol to trigger on computed tomography (CT). Upon further evaluation of the situation, the radiologist oversaw the manual triggering of CT acquisitions which yielded an actionable CT at 6 minutes post-contrast and real-time visualization of the patient's developing cardiac ischemia.
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Disección Aórtica , Oclusión Coronaria , Humanos , Oclusión Coronaria/complicaciones , Disección Aórtica/complicaciones , Disección Aórtica/diagnóstico por imagen , Disección Aórtica/cirugía , Isquemia , Progresión de la Enfermedad , Resultado del Tratamiento , Enfermedad AgudaRESUMEN
PURPOSE: Fournier's gangrene (FG), a rapidly progressive necrotizing soft tissue infection of the external genitalia and perineum, necessitates urgent surgical debridement. The time to surgery effect of preoperative computed tomography (CT) in managing this condition is yet to be fully explored. The purpose of this study was to assess whether obtaining a preoperative CT in patients with FG impacts the time to surgical intervention. METHODS: This was a single-center retrospective study of patients who underwent CT prior to surgical debridement of FG during a 9-year period vs patients who did not undergo CT. In 76 patients (male = 39, mean age = 51.8), 38 patients with FG received a preoperative CT, and 38 patients with FG did not receive CT prior to surgical debridement. Time to operating room and outcome metrics were compared between CT and non-CT groups. RESULTS: The time from hospital presentation to surgical intervention was not significantly different between patients who underwent CT and those who did not (6.65 ± 3.71 vs 5.73 ± 4.33 h, p = 0.37). There were also no significant differences in cost ($130,000 ± $102,000 vs $142,000 ± $152,000, p = 0.37), mortality (8 vs 7, p = 1), duration of hospital stay (15.5 ± 15 vs 15.7 ± 11.6 days, p = 0.95), average intensive care unit stay (5.82 ± 5.38 days vs 6.97 ± 8.58 days, p = 0.48), and APACHE score (12 ± 4.65 vs 13.9 ± 5.6, p =0.12). CONCLUSION: Obtaining a preoperative CT did not delay surgical intervention in patients with FG.
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Gangrena de Fournier , Humanos , Masculino , Persona de Mediana Edad , Gangrena de Fournier/diagnóstico por imagen , Gangrena de Fournier/cirugía , Estudios Retrospectivos , Desbridamiento/métodos , Perineo , TomografíaRESUMEN
BACKGROUND: Although studies have described factors associated with failed magnetic resonance elastography (MRE), little is known about what factors influence usable elastography data. PURPOSE: To identify factors that have a negative impact on percent measurable liver volume (pMLV), defined as the proportion of usable liver elastography data relative to the volume of imaged liver in patients undergoing MRE. STUDY TYPE: Retrospective. SUBJECTS: A total of 264 patients (n = 132 males, n = 132 females; mean age = 57 years) with suspected or known chronic liver disease underwent MRE paired with a liver protocol MRI. FIELD STRENGTH/SEQUENCE: MRE was performed on a single 1.5 T scanner using a two-dimensional gradient-recalled echo phase-contrast sequence with a passive acoustic driver overlying the right hemiliver. ASSESSMENT: Stiffness maps (usable data at 95% confidence) and liver contours on magnitude images of the MRE acquisition were manually traced and used to assess mean stiffness and pMLV. Hepatic fat fraction and R2 * values were also calculated. The distance from the acoustic wave generator on the skin surface to the liver edge was measured. Two radiologists performed the MR analyses with 50 overlapping cases for inter-reader analysis. STATISTICAL TESTS: Linear regression was performed to identify factors significantly associated with pMLV. Intraclass correlation was performed for inter-reader reliability. RESULTS: pMLV was 31% ± 20% (range 0%-86%). Complete MRE failure (i.e. pMLV = 0%) occurred in 10 patients (4%). Multivariate linear regression identified higher hepatic fat fraction, R2 *, BMI, and driver-to-liver surface distance; male sex; and lower mean liver stiffness was significantly independently associated with lower pMLV. Intraclass correlation for pMLV was 0.96, suggestive of excellent reliability. DATA CONCLUSION: Higher fat fraction, R2 *, BMI, driver-to-liver surface distance, male sex, and lower mean liver stiffness were associated with lower pMLV. Optimization of image acquisition parameters and driver placement may improve MRE quality, and pMLV likely serves as a diagnostic utility quality control metric. LEVEL OF EVIDENCE: 3 TECHNICAL EFFICACY STAGE: 2.
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Diagnóstico por Imagen de Elasticidad , Diagnóstico por Imagen de Elasticidad/métodos , Femenino , Humanos , Hígado/diagnóstico por imagen , Hígado/patología , Cirrosis Hepática/patología , Imagen por Resonancia Magnética/métodos , Masculino , Persona de Mediana Edad , Control de Calidad , Reproducibilidad de los Resultados , Estudios RetrospectivosRESUMEN
Body MRI has evolved from a niche subspecialty to a standard modality in the practice of abdominal radiology. However, the practicing radiologist may feel uncomfortable interpreting body MRI studies owing to a lack of case volume and inconsistent exposure. The authors highlight teaching points and subtleties central to better acquisition and interpretation of body MRI studies. Appropriate contrast agent selection and arterial phase acquisition timing provide greater diagnostic certainty in answering common clinical questions at liver MRI, such as assessing cirrhosis and evaluating focal liver lesions. Clinically relevant artifacts and physiologic phenomena, such as magnetic susceptibility and transient hepatic intensity difference, must be recognized and appropriately used when reading a study. Fat within organs and lesions is commonly encountered at body MRI. The authors discuss the nuances of common and uncommon entities, how to address fat suppression failure, assessment of bone marrow at body MRI, and an organized approach to fat-containing renal and adrenal masses. Motion artifacts are more commonly encountered at body MRI than at MRI of other anatomic regions, and understanding the various techniques, their benefits, and trade-offs will aid the body imager in protocol design and moving beyond "nondiagnostic" examinations. Challenging anatomic sites to evaluate at body MRI are reviewed. Finally, the authors offer tips for accurate interpretation of diffusion-weighted imaging, hepatobiliary phase imaging, and posttreatment imaging studies. By reviewing this article, the abdominal imager will be better prepared to perform and interpret body MRI studies confidently and accurately. An invited commentary by Kalb is available online. Online supplemental material is available for this article. ©RSNA, 2022.
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Artefactos , Imagen por Resonancia Magnética , Humanos , Imagen por Resonancia Magnética/métodos , Medios de Contraste , Imagen de Difusión por Resonancia Magnética , Hígado/patologíaRESUMEN
OBJECTIVE: To test the (1) feasibility of an assistive technology based pillbox intervention on medication adherence; (2) feasibility of trial procedures; and (3) preliminary effectiveness of the pillbox intervention on medication adherence. DESIGN: A single-blinded randomized controlled clinical trial was conducted during 2-4 weeks. SETTING: Researchers recruited a convenience sample to participate in this university laboratory-based study. PARTICIPANTS: English-speaking consumers of 2 or more daily medications (N=15) participated in the study. Individuals with cognitive impairment or who did not manage their own medications were excluded. INTERVENTIONS: Participants were randomized to 1 of 3 pillbox interventions: (1) standard-of-care pillbox; (2) customized off-the-shelf pillbox; or (3) customized 3-dimensional (3D) printed pillbox. MAIN OUTCOME MEASURES: Outcome measures were divided among the 3 goals of the study. In addition to feasibility metrics, the Adherence to Refills and Medications Scale was used to measure the primary outcome measure, medication adherence. The Quebec User Evaluation of Satisfaction with Assistive Technology was used to measure pillbox satisfaction. RESULTS: Researchers successfully administered 6 standard-of-care, 5 custom off-the-shelf, and 4 custom 3D printed pillboxes. Compared with the standard-of-care pillboxes, customized 3D printed pillboxes had large (d=1.04) and customized off-the-shelf pillboxes had medium (d=0.67) effects on medication adherence. CONCLUSIONS: Prescription of customized pillboxes using a manualized and novel assistive technology approach that leverages 3D printing is feasible.
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Cumplimiento de la Medicación , Dispositivos de Autoayuda , Humanos , Estudios de Factibilidad , QuebecRESUMEN
PURPOSE OF REVIEW: Multiple new medications with novel mechanisms of action are now available to treat Crohn's disease (CD). However, they have varying effectiveness in the management of perianal CD. Identifying the most appropriate therapy and optimizing it is essential to maximize effectiveness of therapy. Additionally, the management of perianal CD requires imaging of the perianal area to identify the fistula anatomy and local complications such as abscesses that require surgical drainage. Initial surgical assessment is key to drain abscesses and allow fistula healing with medical therapy. RECENT FINDINGS: Although anti-tumor necrosis factor (TNFs) remain the most effective medications to treat perianal CD, real-world data suggests that ustekinumab may be a 2nd-line option in patients nonresponsive to an anti-TNF or having contraindications. Mesenchymal stem cells are an emerging therapeutic approach that is currently in Phase 3 trials in the United States and poised to play a major role in the treatment algorithm. SUMMARY: The management of perianal CD requires a multidisciplinary approach with a combination of initial imaging and surgical assessment to adequately control local sepsis, optimization of biological therapy with adjunct antibiotics or immunomodulators, and close clinical follow-up with imaging to evaluate response to therapy and guide further surgical management options.
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Enfermedad de Crohn , Fístula Rectal , Enfermedad de Crohn/diagnóstico , Enfermedad de Crohn/terapia , Humanos , Fístula Rectal/etiología , Fístula Rectal/terapia , Resultado del Tratamiento , Inhibidores del Factor de Necrosis Tumoral , Factor de Necrosis Tumoral alfaRESUMEN
OBJECTIVE. The purpose of this article was to assess the reliability and accuracy of hepatic periportal space widening and other qualitative imaging features for the prediction of hepatic fibrosis. MATERIALS AND METHODS. This single-center retrospective study identified consecutive patients who had undergone liver MR elastography. Two abdominal radiologists independently reviewed anatomic images, assessing multiple qualitative features of chronic liver disease (CLD) including periportal space widening. Each reader also measured the periportal space at the main portal vein (MPV) and right portal vein (RPV). Interrater reliability analysis was then performed. Sensitivity and specificity were determined for the detection of any hepatic fibrosis (stage I or higher) and of advanced fibrosis (stage III or higher) using stiffness on MR elastography as the reference standard. RESULTS. Of 229 subjects, 157 (69%) had fibrosis and 78 (34%) had advanced fibrosis. Agreement for periportal space widening was moderate (κ = 0.47), and agreement for remaining features was moderate to substantial (κ = 0.42-0.80). Agreement for the periportal space at the MPV was moderate (ICC, 0.55), and agreement for the periportal space at the RPV was near perfect (ICC, 0.83). Periportal space widening had the highest sensitivity (83.0%) for any fibrosis, with limited specificity (61.3%). Surface nodularity had the highest specificity (94.4%) for any fibrosis, with limited sensitivity (51.6%). Periportal space widening plus one or more additional imaging feature of CLD or the presence of surface nodularity alone had sensitivity of 72.6% and specificity of 76.1%. A periportal space at the MPV greater than 9.5 mm had substantial agreement with qualitative periportal space widening (κ = 0.74). CONCLUSION. Periportal space widening has a high sensitivity for hepatic fibrosis, with moderate specificity when combined with additional anatomic features of CLD.
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Cirrosis Hepática/diagnóstico por imagen , Imagen por Resonancia Magnética/métodos , Adulto , Anciano , Anciano de 80 o más Años , Biomarcadores , Femenino , Humanos , Hígado/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Reproducibilidad de los Resultados , Estudios Retrospectivos , Sensibilidad y Especificidad , Adulto JovenRESUMEN
Penetrating abdominopelvic trauma usually results from abdominal cavity violation from a firearm injury or a stab wound and is a leading cause of morbidity and mortality from traumatic injuries. Penetrating trauma can have subtle or complex imaging findings, posing a diagnostic challenge for radiologists. Contrast-enhanced CT is the modality of choice for evaluating penetrating injuries, with good sensitivity and specificity for solid-organ and hollow viscus injuries. Familiarity with the projectile kinetics of penetrating injuries is an important skill set for radiologists and aids in the diagnosis of both overt and subtle injuries. CT trajectography is a useful tool in CT interpretation that allows the identification of subtle injuries from the transfer of kinetic injury from the projectile to surrounding tissue. In CT trajectography, after the entry and exit wounds are delineated, the two points can be connected by placing cross-cursors and swiveling the cut planes obliquely in orthogonal planes to obtain a double-oblique orientation to visualize the wound track in profile. The path of the projectile and its ensuing damage is not always straight, and the imaging characteristics of free fluid of different attenuation in the abdomen (including hemoperitoneum) can support the diagnosis of visceral and vascular injuries. In addition, CT is increasingly used for evaluation of patients after damage control surgery and helps guide the management of injuries that were overlooked at surgery. An invited commentary by Paes and Munera is available online. Online supplemental material is available for this article. ©RSNA, 2021.
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Traumatismos Abdominales , Armas de Fuego , Heridas por Arma de Fuego , Heridas Penetrantes , Traumatismos Abdominales/diagnóstico por imagen , Humanos , Tomografía Computarizada por Rayos X , Heridas por Arma de Fuego/diagnóstico por imagen , Heridas Penetrantes/diagnóstico por imagenRESUMEN
A granuloma is a compact organization of mature macrophages that forms because of persistent antigenic stimulation. At the microscopic level, granulomas can undergo various morphologic changes, ranging from necrosis to fibrosis, which along with other specialized immune cells define the appearance of the granulomatous process. Accordingly, the imaging features of granulomatous diseases vary and can overlap with those of other diseases, such as malignancy, and lead to surgical excisions and biopsy. However, given the heterogeneity of granulomas as a disease group, it is often hard to make a diagnosis on the basis of the histopathologic features of granulomatous diseases alone owing to overlapping microscopic features. Instead, a multidisciplinary approach is often helpful. Radiologists need to be familiar with the salient clinical manifestations and imaging findings of granulomatous diseases to generate an appropriate differential diagnosis. ©RSNA, 2021.
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Diagnóstico por Imagen , Granuloma , Abdomen , Diagnóstico Diferencial , Granuloma/diagnóstico por imagen , Humanos , Necrosis , Pelvis/diagnóstico por imagenRESUMEN
PURPOSE: To evaluate the safety and image quality of extremity MR examinations performed with two MR conditional external fixators located in the MR bore. MATERIALS AND METHODS: Single-center retrospective study of a prospectively maintained imaging dataset that evaluated MR examinations of extremities in patients managed with external fixations instrumentation and imaged on a single 1.5T MR scanner. The fixation device was one of two MR-conditional instrumentation systems: DuPuy Synthes (aluminum, stainless steel, carbonium and Kevlar) or Dolphix temporary fixation system (PEEK-CA30). Safety events were recorded by the performing MR radiologic technologist. A study musculoskeletal radiologist assessed all sequences to evaluate for image quality, signal- and contrast-to-noise ratios (SNR/CNR), and injury patterns/findings. RESULTS: In the 13 men and 9 women with a mean age of 42 years (range 18 to 72 years), most patients (19/22 patients; 86%) were involved with trauma resulting in extremity injury requiring external fixation. MR examinations included 19 knee, 2 ankle, and 1 elbow examinations. There were no adverse safety events, heating that caused patient discomfort, fixation dislodgement/perturbment, or early termination of MR examinations. All examinations were of diagnostic quality. Fat-suppressed proton density sequences had significantly higher SNR and CNR compared to STIR (p = 0.01 to 0.04). The lower SNR of STIR and increased quality of fat-suppressed proton density during the study period led to the STIR sequence being dropped in standard MR protocol. CONCLUSION: MR of the extremity using the two study MR conditional external fixators within the MR bore is safe and feasible.
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Fijadores Externos , Imagen por Resonancia Magnética , Adolescente , Adulto , Anciano , Extremidades , Femenino , Fijación de Fractura , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Adulto JovenRESUMEN
OBJECTIVES: The aim of this study was to evaluate impact of 3D printed models on decision-making in context of laparoscopic liver resections (LLR) performed with intraoperative ultrasound (IOUS) guidance. METHODS: Nineteen patients with liver malignances (74% were colorectal cancer metastases) were prospectively qualified for LLR or radiofrequency ablation in a single center from April 2017 to December 2018. Models were 3DP in all cases based on CT and facilitated optical visualization of tumors' relationships with portal and hepatic veins. Planned surgical extent and its changes were tracked after CT analysis and 3D model inspection, as well as intraoperatively using IOUS. RESULTS: Nineteen patients were included in the analysis. Information from either 3DP or IOUS led to changes in the planned surgical approach in 13/19 (68%) patients. In 5/19 (26%) patients, the 3DP model altered the plan of the surgery preoperatively. In 4/19 (21%) patients, 3DP independently changed the approach. In one patient, IOUS modified the plan post-3DP. In 8/19 (42%) patients, 3DP model did not change the approach, whereas IOUS did. In total, IOUS altered surgical plans in 9 (47%) cases. Most of those changes (6/9; 67%) were caused by detection of additional lesions not visible on CT and 3DP. CONCLUSIONS: 3DP can be helpful in planning complex and major LLRs and led to changes in surgical approach in 26.3% (5/19 patients) in our series. 3DP may serve as a useful adjunct to IOUS. KEY POINTS: ⢠3D printing can help in decision-making before major and complex resections in patients with liver cancer. ⢠In 5/19 patients, 3D printed model altered surgical plan preoperatively. ⢠Most surgical plan changes based on intraoperative ultrasonography were caused by detection of additional lesions not visible on CT and 3D model.
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Carcinoma Hepatocelular/cirugía , Neoplasias Colorrectales/patología , Hepatectomía/métodos , Laparoscopía/métodos , Neoplasias Hepáticas/cirugía , Impresión Tridimensional , Adulto , Anciano , Anciano de 80 o más Años , Carcinoma Hepatocelular/diagnóstico por imagen , Toma de Decisiones Clínicas , Femenino , Venas Hepáticas/diagnóstico por imagen , Humanos , Imagenología Tridimensional , Cuidados Intraoperatorios/métodos , Neoplasias Hepáticas/diagnóstico por imagen , Neoplasias Hepáticas/secundario , Masculino , Metastasectomía , Persona de Mediana Edad , Modelos Anatómicos , Vena Porta/diagnóstico por imagen , Estudios Prospectivos , Tumores Fibrosos Solitarios/diagnóstico por imagen , Tumores Fibrosos Solitarios/cirugía , Tomografía Computarizada por Rayos X , Ultrasonografía/métodosRESUMEN
OBJECTIVE. Small renal masses (< 4 cm) can be difficult to accurately classify as benign or malignant, particularly when they appear T1 hyperintense on MRI. This intrinsic signal, potentially related to intralesional hemorrhage, may limit evaluation of signal intensity on DWI. The purpose of this study was to test whether apparent diffusion coefficient (ADC) measurements may distinguish malignancy. MATERIALS AND METHODS. This single-center retrospective study identified patients with a T1-hyperintense renal mass less than 4 cm on MRI. Malignant lesions were pathologically proven; a benign mass was established by a predefined hierarchy of pathologic proof, follow-up ultrasound, or follow-up imaging showing more than 5 years of stability. T1 hyperintensity, defined as a signal intensity equivalent to or greater than the adjacent renal cortex, was confirmed by a senior abdominal radiologist. Two additional abdominal radiologists independently measured ADC of the lesion, which was normalized to the ADC of the background ipsilateral kidney and represented as ADCratio. RESULTS. The final cohort included 58 benign and 37 malignant renal lesions in 95 patients. Interrater agreement for ADC measurements was almost perfect (κ = 0.836-0.934). ADCratio was significantly lower in malignant compared with benign lesions (0.65 ± 0.29 vs 1.03 ± 0.32; p < 0.001). Malignant lesions were significantly larger than benign lesions (2.66 ± 0.86 cm vs 1.50 ± 0.65 cm; p < 0.001); however, after controlling for lesion size, ADCratio remained a significant predictor of malignancy (p < 0.001). CONCLUSION. ADCratio was highly reproducible for T1-hyperintense small renal masses and was significantly lower in malignant compared with benign renal masses.
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Imagen de Difusión por Resonancia Magnética , Neoplasias Renales/diagnóstico por imagen , Adulto , Anciano , Anciano de 80 o más Años , Diagnóstico Diferencial , Femenino , Humanos , Neoplasias Renales/patología , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Carga Tumoral , Adulto JovenRESUMEN
The Radiological Society of North America (RSNA) offers educational resources and career development opportunities through many opportunities for trainees. However, trainees frequently lack access to or awareness of these opportunities and requirements. The purpose of this article is to promote access to RSNA trainee opportunities by illustrating their qualifications, advantages, and characteristics. Access to opportunities starts with RSNA membership, which grants access to several educational, research, and career development offerings. One focal point of RSNA opportunities is the RSNA Annual Meeting in Chicago, Ill, which provides several trainee-specific events. RSNA educational opportunities include access to board preparation content and information about emerging radiologic technologies. Research opportunities include mentor pairing, project development workshops, venues for presentation and publication, and the William W. Olmsted Editorial Fellowship for Trainees. Career development opportunities include positions for society involvement, leadership, and job searching. Collectively, the information presented in this article can guide the approach to early radiology career development for interested medical students, residents, fellows, and faculty advisers. ©RSNA, 2020.