Cross-sectional imaging of acute abdominal conditions in the oncologic patient.

Cross-sectional imaging of acute abdominal conditions encompasses a broad differential diagnosis, including traumatic, inflammatory, and infectious etiologies. In addition, an underappreciated contributor to the acute abdomen is oncologic disease and its treatment. Oncologic patients are at increased risk in the development of numerous acute abdominal conditions due to a combination of tumor invasion, sequelae of treatment, and altered immune response. Cross-sectional imaging of the oncologic patient poses several unique challenges due to the need to be able to evaluate surgically altered anatomy, evaluation of treatment response, and potential untoward effects of neoplasia and its treatment. The radiologist plays a pivotal role in the multidisciplinary approach to cancer diagnosis and management. In addition to diagnosis and follow-up assessment of disease response, the radiologist should be familiar with the imaging findings of acute conditions affecting the oncologic patient to optimize patient care. Recognition of key imaging findings can allow prompt diagnosis and facilitate treatment for potentially lethal abdominal conditions in the complex oncologic patient, thereby reducing morbidity and mortality.

Imaging algorithm for COVID-19: A practical approach.

The global pandemic of COVID-19 pneumonia caused by the novel coronavirus (SARS-CoV-2) has strained healthcare resources across the world with emerging challenges of mass testing, resource allocation and management. While reverse transcriptase-polymerase chain reaction (RT-PCR) test is the most commonly utilized test and considered the current gold standard for diagnosis, the role of chest imaging has been highlighted by several studies demonstrating high sensitivity of computed tomography (CT). Many have suggested using CT chest as a first-line screening tool for the diagnosis of COVID-19. However, with advancement of laboratory testing and challenges in obtaining a CT scan without significant risk to healthcare providers, the role of imaging in diagnosis has been questioned. Several imaging societies have released consensus statements and guidelines on utilizing imaging resources and optimal reporting. In this review, we highlight the current evidence on various modalities in thoracic imaging for the diagnosis of COVID-19 and describe an algorithm on how to use these resources in an optimal fashion in accordance with the guidelines and statements released by major imaging societies.

Myelofibrosis on 18F-FDG-PET/CT in a case suspicious for post-transplant lymphoproliferative disorder.

Recent studies have advocated the utility of fluorine-18 fluorodeoxyglucose-positron emission tomography (18)F-FDG-PET imaging in evaluation of various hematological disorders. We report a case of a 61-year-old man with clinical suspicion of post-transplant lymphoproliferative disorder (PTLD) where (18)F-FDG-PET/CT (computerized tomography) was helpful in identifying myelofibrosis. This paper aims to reveal the potential diagnostic value of PET/CT as an imaging modality in the evaluation of myelofibrosis.

The cyamella, a lost sesamoid: Normal variant or posterolateral corner anomaly?

Cyamella, an accessory sesamoid ossicle of the popliteus in the region of the proximal myotendinous junction, is an extremely unusual finding, with a paucity of current published literature describing its MR appearance. In this case study, we describe MRI findings in a 44-year-old female presenting with pain after a stretching workout. Bone edema in the cyamella, edema in the myotendinous portion of the popliteus, and pericapsular edema at the posterolateral corner were identified. While commonly seen in certain mammalian species, cyamella is rare in humans. The upright walking posture of humans requires posterolateral corner structures to play a greater role in structural support and weight-bearing. We hypothesize that the cyamella, while intrinsic to certain mammalian species, may interfere with these biomechanical functions in upright walking posture, thereby predisposing to isolated injury of the posterolateral corner in humans.

Evaluation of Contrast Extravasation as a Diagnostic Criterion in the Evaluation of Arthroscopically Proven HAGL/pHAGL Lesions.

Purpose. The validity of preoperative MRI in diagnosing HAGL lesions is debated. Various investigations have produced mixed results with regard to the utility of MRI. The purpose of this investigation is to apply a novel method of diagnosing HAGL/pHAGL lesions by looking at contrast extravasation and to evaluate the reliability of such extravasation of contrast into an extra-articular space as a sign of HAGL/pHAGL lesion. Methods. We utilized specific criteria to define contrast extravasation. We evaluated these criteria in 12 patients with arthroscopically proven HAGL/pHAGL lesion. We also evaluated these criteria in a control group. Results. Contrast extravasation occurred in over 83% of arthroscopically positive cases. Contrast extravasation as a diagnostic criterion in the evaluation of HAGL/pHAGL lesions demonstrated a high interobserver degree of agreement. Conclusions. In conclusion, extra-articular contrast extravasation may serve as a valid and reliable sign of HAGL and pHAGL lesions, provided stringent criteria are maintained to assure that the contrast lies in an extra-articular location. In cases where extravasation is not present, the "J" sign, though nonspecific, may be the only evidence of subtle HAGL and pHAGL lesions. Level of Evidence. Level IV, Retrospective Case-Control series.

Lymphatic filariasis disseminating to the upper extremity.

Lymphatic filariasis is the most common cause of acquired lymphedema worldwide (Szuba and Rockson, 1998). It is endemic to tropical and subtropical regions, and its effects are devastating. With over 100 million infected persons, it ranks second only to leprosy as the leading cause of permanent and long-term disability. Wuchereria bancrofti is the etiologic agent in 90% of cases. There is a dearth of published MRI findings with pathologically proven active infections, making this entity even more of a diagnostic dilemma. Imaging may provide the first clue that one is dealing with a parasite and may facilitate proper treatment and containment of this disease. This is the first report of pathologic correlation with MRI findings in the extremity in active filariasis. The magnetic resonance images demonstrate an enhancing, infiltrative, mass-like appearance with partial encasement of vasculature that has not been previously described in filariasis. Low signal strands in T2-hyperintense dilated lymphatic channels are seen and may depict live adult worms. We hypothesize that the low signal strands correspond to the collagen rich acellular cuticle. This, in combination with the surrounding hyperintense T2 signal, corresponding to a dilated lymphatic channel, may provide more specific MRI findings for active nematodal infection, which can prompt early biopsy, pathological correlation, and diagnosis.

Patient-oriented cancer information on the internet: a comparison of wikipedia and a professionally maintained database.

PURPOSE: A wiki is a collaborative Web site, such as Wikipedia, that can be freely edited. Because of a wiki's lack of formal editorial control, we hypothesized that the content would be less complete and accurate than that of a professional peer-reviewed Web site. In this study, the coverage, accuracy, and readability of cancer information on Wikipedia were compared with those of the patient-orientated National Cancer Institute's Physician Data Query (PDQ) comprehensive cancer database. METHODS: For each of 10 cancer types, medically trained personnel scored PDQ and Wikipedia articles for accuracy and presentation of controversies by using an appraisal form. Reliability was assessed by using interobserver variability and test-retest reproducibility. Readability was calculated from word and sentence length. RESULTS: Evaluators were able to rapidly assess articles (18 minutes/article), with a test-retest reliability of 0.71 and interobserver variability of 0.53. For both Web sites, inaccuracies were rare, less than 2% of information examined. PDQ was significantly more readable than Wikipedia: Flesch-Kincaid grade level 9.6 versus 14.1. There was no difference in depth of coverage between PDQ and Wikipedia (29.9, 34.2, respectively; maximum possible score 72). Controversial aspects of cancer care were relatively poorly discussed in both resources (2.9 and 6.1 for PDQ and Wikipedia, respectively, NS; maximum possible score 18). A planned subanalysis comparing common and uncommon cancers demonstrated no difference. CONCLUSION: Although the wiki resource had similar accuracy and depth as the professionally edited database, it was significantly less readable. Further research is required to assess how this influences patients' understanding and retention.