Pancreatic Cystic Lesions and Malignancy: Assessment, Guidelines, and the Field Defect.

The widespread use of high-spatial-resolution cross-sectional imaging has led to an increase in detection of incidental pancreatic cystic lesions. These lesions are a diverse group, ranging from indolent and premalignant lesions to invasive cancers. The diagnosis of several of these lesions can be suggested on the basis of their imaging appearance, while many other lesions require follow-up imaging and/or aspiration. The smaller cystic lesions, often branch-duct intraductal papillary mucinous neoplasms, have overlapping imaging characteristics that make diagnostic assessment of the natural history and malignancy risk confusing. Expert panels have developed societal guidelines, based on a consensus, for surveillance of these lesions. However, these guidelines are often inconsistent and are constantly evolving as additional scientific data are accumulated. Identification of features associated with increased risk of malignancy is important for proper management. The concept of field defect, whereby pancreatic adenocarcinoma develops at a site different from the site of the pancreatic cyst, adds to the complexity of screening guidelines. As a result of the differences in guidelines, key stakeholders (eg, radiologists, gastroenterologists, and surgeons) must review and come to a consensus regarding which guideline, or combination of guidelines, to follow at their individual institutions. Standardized reporting and macros are helpful for ensuring the uniformity of interpretations. Radiologists play a critical role in the detection and characterization of pancreatic cystic lesions, in the follow-up recommendations for these lesions, and in the detection of associated cancer. An invited commentary by Zaheer is available online. Online supplemental material is available for this article. ©RSNA, 2021.

The reformatted sagittal spine on abdominal CT: structured approach to non-traumatic pathology.

Non-traumatic spinal pathology is often missed on routine axial imaging of the abdomen and pelvis, particularly when obtained in the acute setting, and is much more readily evaluated on sagittal reformats. The purpose of this pictorial essay is to reinforce the diagnostic utility of reviewing sagittal reformats of the thoracolumbar spine on routine abdominal imaging. We present a structured approach to non-traumatic pathology of the lumbar spine using seven categories of pathology that can be identified on sagittal reformats of the spine on abdomen and pelvis CT.

Cinematic Rendering of a Perforated Benign Gastric Ulcer.

Online supplemental material is available for this article.

A Virion-Based Assay for Glycoprotein Thermostability Reveals Key Determinants of Filovirus Entry and Its Inhibition.

Ebola virus (EBOV) entry into cells is mediated by its spike glycoprotein (GP). Following attachment and internalization, virions traffic to late endosomes where GP is cleaved by host cysteine proteases. Cleaved GP then binds its cellular receptor, Niemann-Pick C1. In response to an unknown cellular trigger, GP undergoes conformational rearrangements that drive fusion of viral and endosomal membranes. The temperature-dependent stability (thermostability) of the prefusion conformers of class I viral fusion glycoproteins, including those of filovirus GPs, has provided insights into their propensity to undergo fusion-related rearrangements. However, previously described assays have relied on soluble glycoprotein ectodomains. Here, we developed a simple enzyme-linked immunosorbent assay (ELISA)-based assay that uses the temperature-dependent loss of conformational epitopes to measure thermostability of GP embedded in viral membranes. The base and glycan cap subdomains of all filovirus GPs tested suffered a concerted loss of prefusion conformation at elevated temperatures but did so at different temperature ranges, indicating virus-specific differences in thermostability. Despite these differences, all of these GPs displayed reduced thermostability upon cleavage to GP conformers (GPCL). Surprisingly, acid pH enhanced, rather than decreased, GP thermostability, suggesting it could enhance viral survival in hostile endo/lysosomal compartments. Finally, we confirmed and extended previous findings that some small-molecule inhibitors of filovirus entry destabilize EBOV GP and uncovered evidence that the most potent inhibitors act through multiple mechanisms. We establish the epitope-loss ELISA as a useful tool for studies of filovirus entry, engineering of GP variants with enhanced stability for use in vaccine development, and discovery of new stability-modulating antivirals.IMPORTANCE The development of Ebola virus countermeasures is challenged by our limited understanding of cell entry, especially at the step of membrane fusion. The surface-exposed viral protein, GP, mediates membrane fusion and undergoes major structural rearrangements during this process. The stability of GP at elevated temperatures (thermostability) can provide insights into its capacity to undergo these rearrangements. Here, we describe a new assay that uses GP-specific antibodies to measure GP thermostability under a variety of conditions relevant to viral entry. We show that proteolytic cleavage and acid pH have significant effects on GP thermostability that shed light on their respective roles in viral entry. We also show that the assay can be used to study how small-molecule entry inhibitors affect GP stability. This work provides a simple and readily accessible assay to engineer stabilized GP variants for antiviral vaccines and to discover and improve drugs that act by modulating GP stability.

Cinematic rendering enhancements to virtual bronchoscopy: assessment of emergent tracheal pathology.

Utilizing complex lighting models, cinematic rendering is a novel technique for demonstrating computed tomography data with exquisite 3D anatomic detail. The tracheal lumen, tracheal wall, and adjacent soft tissue structures are represented with photorealistic detail exceeding that of conventional volume rendering or virtual bronchoscopy techniques. We applied cinematic rendering to a spectrum of emergent tracheal pathologies: traumatic tracheal tears, tracheoesophageal fistulas, tracheal foreign bodies, tracheal stenosis (intrinsic and extrinsic causes), tracheal neoplasms, and tracheomalacia. Cinematic rendering images enable visually accessible evaluation and comprehensive understanding of acute tracheal pathology, which is likely to be of value to both interventional pulmonologists and thoracic surgeons who are determining patient treatment plans.

Cinematic Rendering of an Atrial Septal Occluder Device.

Online supplemental material is available for this article.

The association between subjective assessment of menstrual bleeding and measures of iron deficiency anemia in premenopausal African-American women: a cross-sectional study.

BACKGROUND: Both iron deficiency and iron deficiency anemia are common in the United States with a prevalence amongst women of 12 % and 4 % respectively. These numbers are even higher in African-American women (AAW) and are often a result of heavy menstrual bleeding (HMB). The primary objective of this study was to determine if perceived assessment of menstrual bleeding was associated with objective and subjective measures of anemia in AAW. METHODS: Quantitative cross-sectional pilot study with surveys and venipuncture. RESULTS: 44 premenopausal AAW (mean age 37.9 years ± 9. 4) participated in the study. Iron deficiency was present in 68.2 % of the participants and 18.2 % were anemic. Almost half of the participants reported that their menses were heavy or very heavy, and there was a relationship between perceived heaviness of menstrual flow and anemia (P = 0.021). Of the individuals who reported that their menses were heavy or very heavy, 35.0 % were anemic. AAW who reported heavy or very heavy menses had significantly lower hemoglobin (P = 0.015), hematocrit (P = 0.003), and ferritin (P = 0.012) levels, as well as more general (P = 0.006) and menses-associated symptoms of anemia (P = 0.015) than those who reported normal or light menses. CONCLUSIONS: This pilot study of premenopausal AAW found that a significant percentage of women who report HMB are not only iron deficient, but also anemic. AAW should be educated on the consequences of HMB and counseled to seek care with a women's health provider when they perceive HMB. More importantly, providers should be aware that when AAW report HMB, evaluation for iron deficiency and anemia are essential.

Knowledge of uterine fibroid symptoms and presentation among African-American women: a pilot study.

OBJECTIVE: To assess awareness and knowledge of fibroid symptoms and presentation among African-American women. STUDY DESIGN: This was a cross-sectional survey study completed by a convenience sample of African-American women attending a community fair. Questions covered demographics, medical history, technology use, and fibroid knowledge. A total of437 surveys were distributed, 320 were returned, and 199 met eligibility criteria. RESULTS: Participants' mean age was 48.8 +/- 12.9 years. Of them, 65.8% lacked college degrees and 43.2% had annual household incomes of < $25,000. The prevalence of inadequate health literacy was 14.1%. Most knew that fibroids are more common in African-American women (74.9%), can cause menorrhagia (80.9%), and can increase odds of miscarriage (74.4%). Many thought that fibroids are cancerous (47.2%), increase the risk of heart disease (32.7%), or are diagnosable via blood test (46.2%). Internet usage and education had highest correlations with fibroid awareness. Health literacy status showed no significant correlation with cumulative fibroid knowledge. CONCLUSION: African-American women's knowledge of the symptoms of fibroids is intact; however, they are less familiar with the systemic impact of the tumors. Additional research is needed to further assess women's knowledge offibroids and to develop interventions for patient education.

3D CT cinematic rendering of pediatric thoracic vascular anomalies.

Thoracic vascular anomalies in the pediatric population are a heterogeneous group of diseases, with varied clinical presentations and imaging findings. High-resolution computed tomography is widely available and has become a standard part of the workup of these patients, often with three dimensional images. Cinematic rendering is a novel 3D visualization technique that utilizes a new, complex global lighting model to create photorealistic images with enhanced anatomic detail. The purpose of this pictorial review is to highlight the advantages of cinematic rendering compared to standard 2D computed tomography and traditional volume-rendered 3D images in the evaluation of thoracic vascular anomalies. Although cinematic rendering remains a new visualization technique under continued study, the improved anatomic detail and photorealistic quality of these images may be advantageous for surgical planning in cases of complex vascular abnormalities. Cinematic rendering may also help improve communication among clinicians, trainees, and patients and their families.

Evaluation and Comparison of Two Media-Rich Radiology Apps Regarding Pathology of the Lumbar Spine: Lessons for Medical Education App Developers and Content Creators.

BACKGROUND: Mobile applications have become an increasingly popular component of medical education over the past 2 decades. Visual layout and aesthetics are important considerations in app design given Generation Z's strong preference for visually appealing digital content. In this study, we evaluate students' perceptions of an educational app related to pathology of the lumbar spine before and after a redesign of its workflow and illustrations. OBJECTIVE, MATERIAL AND METHODS: A professional user experience and interface designer was recruited for the revision of an iOS app focused on anatomy and pathology of the lumbar spine on abdominal computed tomography (CT). Revisions focused on developing the app to make it more visually appealing, increasing ease of use, and fixing bugs. An IRB-approved study was conducted in which participants were asked to interact with the original and revised versions of the app prior to completing a survey regarding their perception of the graphics, animation style, overall app design, and content. RESULTS: Overall impressions of the revised app were more positive than the original app, with 89% of respondents finding the revised app's graphics to be visually appealing compared to 39% regarding the original app. Further, 95% of respondents indicated that the revised app's layout was organized and user-friendly compared to 73% regarding the original. Both apps received similarly positive ratings for participants' understanding of the presented materials. CONCLUSION: User feedback is key when designing mobile health and educational applications. Feedback may be sought via formal usability testing or app-specific surveys. The aesthetics, layout, and ease of use of mobile apps are important considerations and, in the absence of content alteration, may influence user engagement. Knowledge regarding these factors may guide content creators when developing and deploying mobile health applications.

Interrater Reliability of Cervical Neural Foraminal Stenosis Using Traditional and Splayed Reconstructions: Analysis of One Hundred Scans.

OBJECTIVE: The oblique sagittal orientation of the cervical neural foramina hinders the evaluation of cervical neural foraminal stenosis (CNFS) on traditional axial and sagittal slices. Traditional image reconstruction techniques to generate oblique slices provide only a view of the foramina unilaterally. We present a simple technique for generating splayed slices that show the bilateral neuroforamina simultaneously and assess its reliability compared with traditional axial windows. METHODS: Cervical computed tomography (CT) scans from 100 patients were retrospectively collected and de-identified. The axial slices were reformatted into a curved reformat with the plane of the reformat extending across the bilateral neuroforamina. The foramina along the C2-T1 vertebral levels were assessed by 4 neuroradiologists using the axial and splayed slices. The intrarater agreement across the axial and splayed slices for a given foramen and the interrater agreement for the axial and splayed slices individually were calculated using the Cohen κ statistic. RESULTS: Interrater agreement was overall higher for the splayed slices (κ = 0.25) compared with the axial slices (κ = 0.20). The splayed slices were more likely to have fair agreement across raters compared with the axial slices. Intrarater agreement between the axial and splayed slices was poorer for residents compared with fellows. CONCLUSIONS: Splayed reconstructions showing the bilateral neuroforamina en face can be readily generated from axial CT imaging. These splayed reconstructions can improve the consistency of CNFS evaluation compared with traditional CT slices and should be considered in the workup of CNFS, particularly for less experienced readers.

Gynecologic oncology tumor board: the central role of the radiologist.

This manuscript is a collaborative, multi-institutional effort by members of the Society of Abdominal Radiology Uterine and Ovarian Cancer Disease Focus Panel and the European Society of Urogenital Radiology Women Pelvic Imaging working group. The manuscript reviews the key role radiologists play at tumor board and highlights key imaging findings that guide management decisions in patients with the most common gynecologic malignancies including ovarian cancer, cervical cancer, and endometrial cancer.

Carney-Stratakis syndrome: A dyad of familial paraganglioma and gastrointestinal stromal tumor.

Carney-Stratakis syndrome is a rare, distinct dyad of familial paraganglioma and gastrointestinal stromal tumor, and is associated with germline mutations in the succinate dehydrogenase genes SDHB, SDHC, and SDHD. We present a unique case of a 45-year-old woman with Carney-Stratakis syndrome who initially presented with a palpable left neck mass. Further workup demonstrated 2 paragangliomas in the neck and multiple SDHB deficient gastrointestinal stromal tumors of the stomach. We describe the imaging findings and clinical course of this rare syndrome.

Black-blood cinematic rendering: A new method for cardiac CT intraluminal visualization.

BACKGROUND: Cinematic rendering (CR) is a method of generating photorealistic 3D images from volumetric computed tomography (CT) data. In this manuscript, we describe a CR preset we have termed black-blood cinematic rendering (BBCR) that allows for detailed endoluminal views of the heart. METHODS: Three recent chest CT scans were retrospectively selected as representative examples for BBCR visualization. All scans had been performed with our institution's clinical standard, post-contrast, cardiac-gated chest CT. The BBCR images were created from isotropic-voxel reconstructed volumetric data on a stand-alone workstation. RESULTS: The BBCR technique was successfully utilized to demonstrate intraluminal cardiac findings in a patient with a normal left ventricle, a patient with a left ventricular mural thrombus, and a patient status-post transcatheter aortic valve replacement. CONCLUSIONS: BBCR is a new method of utilizing volumetric chest CT data in order to provide detailed images of intraluminal anatomy and pathology of the heart. Further study of this promising method is warranted.

Selective atrophy of the abductor digiti quinti: an MRI study.

OBJECTIVE: Entrapment of the first branch of the lateral plantar nerve is a well-recognized but diagnostically elusive cause of heel pain. The MR finding of selective atrophy of the abductor digiti quinti (ADQ) muscle has been reported as a marker of such entrapment. We performed a prospective study of consecutive patients undergoing foot and ankle MRI to determine the prevalence of ADQ atrophy and to examine the clinical symptoms of patients found to have ADQ atrophy. SUBJECTS AND METHODS: A prospective study of all patients referred for ankle and foot MRI examinations was performed. Six hundred two patients were included in the study: 387 females and 215 males. All images were evaluated for the presence of selective fatty atrophy of the ADQ muscle. The clinical notes on all patients with findings of ADQ atrophy were analyzed for descriptions of symptoms leading to the MR examination, the presence of symptoms that might be related to nerve entrapment, and the influence on clinical management related to the MR finding of ADQ atrophy. RESULTS: Thirty-eight of the 602 patients had selective fatty atrophy of the ADQ, 29 females and nine males. Only one patient had a clinical diagnosis of possible nerve entrapment before MR examination. MRI findings of ADQ atrophy altered clinical management in only one patient. CONCLUSION: Selective fatty atrophy of the ADQ is not a rare finding on MR examination of the foot and ankle, being seen in 6.3% of all studies and in 7.5% of all studies in females. The clinical relevance of selective ADQ atrophy seen on MRI is uncertain.

Beyond the physical: a qualitative assessment of the burden of symptomatic uterine fibroids on women's emotional and psychosocial health.

OBJECTIVE: To qualitatively assess the burden of uterine fibroids on women's emotional health. METHODS: Sixty women (n = 60) with symptomatic uterine fibroids were recruited from an urban academic medical center and community-based organizations. Women completed qualitative, semi-structured interviews and demographic surveys. Interviews were recorded and transcribed verbatim. Using a grounded theory approach, three coders independently identified major themes and subthemes that emerged from the interviews. RESULTS: The kappa among coders was 0.94. The mean age of participants was 43.0 ± 6.8. 61.7% of participants self-identified as African-American, 25.0% as Caucasian, 8.3% as Hispanic and 5.0% as Asian. Most participants exhibited a significant emotional response to their fibroids, including fear, anxiety, anger, and depression. Half of the women felt helpless and believed that they had no control over their fibroids. Many women possessed a negative self-image and cited concern over appearing less attractive, which led to difficulties becoming intimate. Several women felt that they lacked substantial support to help them deal with these issues. CONCLUSION: In addition to the known high prevalence and severe physical impact of uterine fibroids, there is a significant psychological impact on women. Many women lack support to help them deal with these issues and very few seek help from a mental health professional. There is an opportunity and a need for the mental health community to address the concerns in this population, in order to improve psychological health and quality of life in patients living with this chronic condition.

Prevalence and knowledge of heavy menstrual bleeding among African American women.

OBJECTIVE: To assess self-reported prevalence, knowledge, and health literacy regarding heavy menstrual bleeding (HMB) among African American women. METHODS: A quantitative cross-sectional survey study was conducted. An original survey was developed and distributed to a convenience sample of African American women aged 18-60 years at a community fair in a large city in the Midwestern region of the USA. RESULTS: Of the 274 surveys distributed, 247 were returned, 193 of which met the inclusion criteria. Overall, 163 (84.5%) participants demonstrated adequate health literacy; however, 168 (87.0%) answered fewer than 8 of 15 knowledge questions correctly. Although 75 (38.9%) women reported seeing a clinician for HMB, 89 (46.1%) believed that there was nothing that they could do to prevent it from occurring. CONCLUSION: The present study found that the proportion of HMB among participants was higher than the nationwide prevalence. However, a gap existed in knowledge of HMB among the women surveyed. The study findings indicate an opportunity for community-based education to raise awareness of HMB, its associated clinical presentations, and available treatment modalities.