Ovarian cancer reporting lexicon for computed tomography (CT) and magnetic resonance (MR) imaging developed by the SAR Uterine and Ovarian Cancer Disease-Focused Panel and the ESUR Female Pelvic Imaging Working Group.

OBJECTIVES: Imaging evaluation is an essential part of treatment planning for patients with ovarian cancer. Variation in the terminology used for describing ovarian cancer on computed tomography (CT) and magnetic resonance (MR) imaging can lead to ambiguity and inconsistency in clinical radiology reports. The aim of this collaborative project between Society of Abdominal Radiology (SAR) Uterine and Ovarian Cancer (UOC) Disease-focused Panel (DFP) and the European Society of Uroradiology (ESUR) Female Pelvic Imaging (FPI) Working Group was to develop an ovarian cancer reporting lexicon for CT and MR imaging. METHODS: Twenty-one members of the SAR UOC DFP and ESUR FPI working group, one radiology clinical fellow, and two gynecologic oncology surgeons formed the Ovarian Cancer Reporting Lexicon Committee. Two attending radiologist members of the committee prepared a preliminary list of imaging terms that was sent as an online survey to 173 radiologists and gynecologic oncologic physicians, of whom 67 responded to the survey. The committee reviewed these responses to create a final consensus list of lexicon terms. RESULTS: An ovarian cancer reporting lexicon was created for CT and MR Imaging. This consensus-based lexicon has 6 major categories of terms: general, adnexal lesion-specific, peritoneal carcinomatosis-specific, lymph node-specific, metastatic disease -specific, and fluid-specific. CONCLUSIONS: This lexicon for CT and MR imaging evaluation of ovarian cancer patients has the capacity to improve the clarity and consistency of reporting disease sites seen on imaging. KEY POINTS: • This reporting lexicon for CT and MR imaging provides a list of consensus-based, standardized terms and definitions for reporting sites of ovarian cancer on imaging at initial diagnosis or follow-up. • Use of standardized terms and morphologic imaging descriptors can help improve interdisciplinary communication of disease extent and facilitate optimal patient management. • The radiologists should identify and communicate areas of disease, including difficult to resect or potentially unresectable disease that may limit the ability to achieve optimal resection.

Imaging Cancer in Pregnancy.

Pregnancy-associated cancer (PAC) is defined as cancer that is detected during pregnancy and up to 1 year postpartum. Although rare (~1:1000 pregnancies), PAC is increasing owing to postponed childbearing and advanced maternal age at conception. Cancer-related symptoms masked by physiologic gestational changes may delay diagnosis. Imaging, clinical management, and treatment require a carefully choreographed multidisciplinary team approach. The risk-benefit of every imaging modality, the strategies to balance the safety of mother and fetus, and the support of the patient and family at every step are crucial. US and MRI are preferred imaging modalities that lack ionizing radiation. Radiation dose concerns should be addressed, noting that most imaging examinations (including mammography, radiography, CT, and technetium 99m-labeled sulfur colloid sentinel lymph node staging) are performed at radiation levels below thresholds at which deterministic side effects are seen. Dose estimates should be provided after each examination. The use of iodinated intravenous contrast material is safe during pregnancy, but gadolinium-based contrast material should be avoided. Accurate diagnosis and staging combined with gestational age affect decisions about surgery and chemotherapy. Whole-body MRI with diffusion-weighted sequences is ideal to screen for primary and metastatic sites, determine disease stage, identify biopsy targets, and guide further cancer site-specific imaging. The authors provide an update of the imaging triage, safety considerations, cancer-specific imaging, and treatment options for cancer in pregnancy. An invited commentary by Silverstein and Van Loon is available online. Online supplemental material is available for this article. ©RSNA, 2022.

CT-Ultrasound Fusion for Abdominal Aortic Aneurysm Measurement.

OBJECTIVE. To evaluate the potential for surveillance of abdominal aortic aneurysms without ionizing radiation exposure and without the risks of iodinated contrast administration, the accuracy of fusion of CT angiography (CTA) with ultrasound (US) was compared with conventional US in 14 patients. CONCLUSION. The mean measurement difference between conventional US and CTA was 0.50 cm, compared with 0.13 cm between CT-US fusion and CTA (p < 0.0005). CT-US fusion was more accurate than conventional US, reduces operator dependence, and is promising for accurate measurement of aortic aneurysms.

Transthoracic parametric Doppler for bedside diagnosis of pulmonary embolism: A pilot study.

Transthoracic parametric Doppler (TPD), unlike conventional ultrasonography, measures signals originating from movements of pulmonary blood vessel walls. In this pilot study, we tested TPD in 15 patients diagnosed with pulmonary embolism on computed tomography pulmonary angiography. Results were mapped to the upper, middle, and lower thirds of the right lung. In the lower third, TPD yielded 100% specificity and positive predictive value for acute pulmonary embolism. If validated in a larger series, this rapid bedside technique might obviate the need for computed tomography in specific cases. This could be advantageous in patients who are unstable, in intensive care, or have allergies to iodinated contrast material.

Ultrasound-Unenhanced CT Fusion for Detection and Localization of Ureteral Stones.

OBJECTIVE: The standard of care for the diagnosis and follow-up of urolithiasis is unenhanced CT. The hypothesis of this study was that that by using image fusion of subsequent ultrasound (US) with the initial unenhanced CT, ureteral stones can be precisely localized. CONCLUSION: Of the 25 stones founds on unenhanced CT studies, 22 (88%) were confidently identified using US-unenhanced CT fusion within 72 hours after the initial CT scan was obtained. US-unenhanced CT fusion might obviate the need for repeated CT scans for monitoring urolithiasis.

Automatic Estimation of Optimal Deployment of Transcatheter Aortic Valve Implantation Using Computed Tomography.

BACKGROUND: A comparison was made between the accuracy of and time saved by using novel automated software for pre-procedural computed tomography (CT) planning before transcatheter aortic valve implantation (TAVI) and manual methods. Preprocedural CT to assess aortic annulus dimensions and predict the optimal C-arm implant angle before TAVI can reduce complications related to incorrect prosthesis sizing and positioning. METHODS: A total of 61 consecutive patients underwent TAVI using either the SAPIEN XT or CoreValve prosthesis. Pre-procedural CT scans were analysed using three methods: automatic; semi-automatic; and manual. For each method, annular dimensions were measured and the optimal implantation angle was predicted. After TAVI the actual post-deployment angle orthogonal to the prosthesis was determined using aortic fluoroscopy. The difference between the predicted angle by CT and the measured post-deployment angle was calculated for each method. RESULTS: For all methods the mean angular difference with the actual post-deployment angle was similar at ~9 ± 7°. There was a significant difference between the SAPIEN XT (6.6 ± 5.8°) and CoreValve (11.5 ± 6.9°, p <0.001) prostheses due to a consistently greater left anterior oblique and caudal angulation for the CoreValve. Although the annular area correlated well among all methods, 'automatic' results were consistently larger than 'manual' results. Interobserver variability was low for all measures. The fully automatic method saved 98 s, and the semiautomatic method 40 s per case. CONCLUSIONS: The use of automatic software enabled a rapid and accurate prediction of implantation angles, though results differed for specific manufacturers. Annular areas were overestimated by the automatic method, and thus required manual adjustments.

Clinical performance metrics of 3D digital breast tomosynthesis compared with 2D digital mammography for breast cancer screening in community practice.

OBJECTIVE: The objective of our study was to assess the clinical performance of combined 2D-3D digital breast tomosynthesis (DBT), referred to as "3D DBT," compared with 2D digital mammography (DM) alone for screening mammography in a community-based radiology practice. MATERIALS AND METHODS: Performance outcomes measures were assessed for 14 radiologists who interpreted more than 500 screening mammography 3D DBT studies after the initiation of tomosynthesis. Outcomes from screening mammography during the study period between August 9, 2011, and November 30, 2012, using 3D DBT (n = 23,149 patients) versus 2D DM (n = 54,684 patients) were compared. RESULTS: For patients screened with 3D DBT, the relative change in recall rate was 16.1% lower than for patients screened with 2D DM (p > 0.0001). The overall cancer detection rate (CDR), expressed as number of cancers per 1000 patients screened, was 28.6% greater (p = 0.035) for 3D DBT (6.3/1000) compared with 2D DM (4.9/1000). The CDR for invasive cancers with 3D DBT (4.6/1000) was 43.8% higher (p = 0.0056) than with 2D DM (3.2/1000). The positive predictive value for recalls from screening (PPV1) was 53.3% greater (p = 0.0003) for 3D DBT (4.6%) compared with 2D DM (3.0%). No significant difference in the positive predictive value for biopsy (PPV3) was found for 3D DBT versus 2D DM (22.8% and 23.8%, respectively) (p = 0.696). CONCLUSION: In community-based radiology practice, mammography screening with 3D DBT yielded lower recall rates, an increased CDR for cancer overall, and an increased CDR for invasive cancer compared with 2D DM. The PPV1 was significantly greater in the group screened using 3D DBT.

Cancer in pregnancy: overview and epidemiology.

Cancer in pregnancy, one of the most distressing and demanding conditions in all of women's health care, occurs about 1:1000 pregnancies with an increasing incidence due to delayed childbearing. Diagnosis of pregnancy associated cancer is especially challenging because tumor symptoms may be masked by normal physiologic changes of pregnancy. The burden of care for both mother and child goes well beyond factual medical information. Balancing the potential risks and benefits to the mother and fetus necessitates a superior level of knowledge and expertise that includes epidemiology, pathophysiology, ionizing radiation and teratogenesis, risks and benefits of various imaging modalities, oncology, and radiotherapy, and other areas. Radiologists are an integral part of a multidisciplinary team that shares responsibility for selection of safe and effective diagnosis and management. Throughout the course of treatment, counseling and support are of paramount importance to the patient and her family. A compassionate culture of care bolsters the effectiveness of the care team to inform, counsel, and engage with the patient to achieve optimal outcomes. This special section of Abdominal Radiology is meant to offer insights for diagnostic imaging and its role in personalized management of this most serious and challenging condition. This article will provide an overview of imaging cancer in pregnancy and detail the relevant epidemiology.

Intraoral and transcutaneous point-of-care-ultrasound: an adjunct bedside tool for oral and maxillofacial clinicians.

Point-of-care-ultrasound (PoCUS) is performed by the clinician at the patient's bedside and is an essential diagnostic tool in many medical subspecialties, in hospital-based care, emergencies, trauma, and in general practice. A simple, novel approach for implementation of PoCUS of the oral cavity and maxillofacial complex is introduced. Relevant indications include differentiating abscess from cellulitis, detecting jaw and facial fractures, assessment of surgical complications, removing foreign bodies, and evaluating soft tissue masses. Intraoral and transcutaneous approaches may be used alone or in combination. This pilot series shows the capability of PoCUS to improve diagnostic accuracy, speed diagnosis, guide procedures, and improve management. Prospective studies are underway to determine the strengths and weaknesses of the method and its impact on patient outcomes.

Radiation risks from exposure to chest computed tomography.

Since 1972, when the first clinical computed tomography (CT) scanner was installed, amazing advances in CT technology have spurned its rapid growth and increasing utilization. Although CT scans are often performed for clinically valid indications that enable proper medical decision-making, the introduction of some protocols has outpaced the scientific data supporting their appropriateness. Considering the growing volume of CT scans performed and the appurtenant risks of radiation exposure, any exposure of patients to radiation for unnecessary or undocumented indications is worrisome. In this paper, the radiation risks associated with chest CT in 3 specific scenarios are discussed: (1) lung cancer screening, for which scientific data demonstrating a reduction in lung cancer mortality is lacking; (2) CT coronary artery angiography, for which the peer reviewed scientific literature is in evolution as its clinical utility is defined and expanded; and (3) CT pulmonary angiography, which is now widely utilized as the imaging modality of choice in the diagnosis of pulmonary emboli. The risks and benefits of these studies will be reviewed in light of the population radiation burden and the appropriateness of each examination.