Current Practice Patterns, Challenges, and Need for Education in Performing and Reporting Advanced Pelvic US and MRI to Investigate Endometriosis: A Survey by the Canadian Association of Radiologists Endometriosis Working Group.

Purpose: The Canadian Association of Radiologists (CAR) Endometriosis Working Group developed a national survey to evaluate current practice patterns associated with imaging endometriosis using advanced pelvic ultrasound and MRI to inform forthcoming clinical practice guidelines for endometriosis imaging. Methods: The anonymous survey consisted of 36 questions and was distributed electronically to CAR members. The survey contained a mix of multiple choice, Likert scale and open-ended questions intended to collect information about training and certification, current practices and protocols associated with imaging endometriosis, opportunities for quality improvement and continuing professional development. Descriptive statistics were used to summarize the results. Results: Canadian radiologists were surveyed about their experience with imaging endometriosis. A total of 89 responses were obtained, mostly from Ontario and Quebec. Most respondents were community radiologists, and almost 33% were in their first five years of practice. Approximately 38% of respondents reported that they or their institution performed advanced pelvic ultrasound for endometriosis, with most having done so for less than 5 years, and most having received training during residency or fellowship. 70% of respondents stated they currently interpret pelvic endometriosis MRI, with most having 1-5 years of experience. Conclusion: Many radiologists in Canada do not perform dedicated imaging for endometriosis. This may be due to a lack of understanding of the benefits and limited access to training. However, dedicated imaging can improve patient outcomes and decrease repeated surgeries. The results highlight the importance of developing guidelines for these imaging techniques and promoting a multidisciplinary approach to endometriosis management.

CETARS/CAR Practice Guideline on Imaging the Pregnant Trauma Patient.

Imaging of pregnant patients who sustained trauma often causes fear and confusion among patients, their families, and health care professionals regarding the potential for detrimental effects from radiation exposure to the fetus. Unnecessary delays or potentially harmful avoidance of the justified imaging studies may result from this understandable anxiety. This guideline was developed by the Canadian Emergency, Trauma and Acute Care Radiology Society (CETARS) and the Canadian Association of Radiologists (CAR) Working Group on Imaging the Pregnant Trauma Patient, informed by a literature review as well as multidisciplinary expert panel opinions and discussions. The working group included academic subspecialty radiologists, a trauma team leader, an emergency physician, and an obstetriciangynaecologist/maternal fetal medicine specialist, who were brought together to provide updated, evidence-based recommendations for the imaging of pregnant trauma patients, including patient safety aspects (eg, radiation and contrast concerns) and counselling, initial imaging in maternal trauma, specific considerations for the use of fluoroscopy, angiography, and magnetic resonance imaging. The guideline strives to achieve clarity and prevent added anxiety in an already stressful situation of injury to a pregnant patient, who should not be imaged differently.

Deep residual network for off-resonance artifact correction with application to pediatric body MRA with 3D cones.

PURPOSE: To enable rapid imaging with a scan time-efficient 3D cones trajectory with a deep-learning off-resonance artifact correction technique. METHODS: A residual convolutional neural network to correct off-resonance artifacts (Off-ResNet) was trained with a prospective study of pediatric MRA exams. Each exam acquired a short readout scan (1.18 ms ± 0.38) and a long readout scan (3.35 ms ± 0.74) at 3 T. Short readout scans, with longer scan times but negligible off-resonance blurring, were used as reference images and augmented with additional off-resonance for supervised training examples. Long readout scans, with greater off-resonance artifacts but shorter scan time, were corrected by autofocus and Off-ResNet and compared with short readout scans by normalized RMS error, structural similarity index, and peak SNR. Scans were also compared by scoring on 8 anatomical features by two radiologists, using analysis of variance with post hoc Tukey's test and two one-sided t-tests. Reader agreement was determined with intraclass correlation. RESULTS: The total scan time for long readout scans was on average 59.3% shorter than short readout scans. Images from Off-ResNet had superior normalized RMS error, structural similarity index, and peak SNR compared with uncorrected images across ±1 kHz off-resonance (P < .01). The proposed method had superior normalized RMS error over -677 Hz to +1 kHz and superior structural similarity index and peak SNR over ±1 kHz compared with autofocus (P < .01). Radiologic scoring demonstrated that long readout scans corrected with Off-ResNet were noninferior to short readout scans (P < .05). CONCLUSION: The proposed method can correct off-resonance artifacts from rapid long-readout 3D cones scans to a noninferior image quality compared with diagnostically standard short readout scans.

MRI evaluation of maternal cardiac displacement in pregnancy: implications for cardiopulmonary resuscitation.

OBJECTIVE: The purpose of this study was to determine, with the use of cardiac magnetic resonance imaging, whether there is vertical displacement of the heart during pregnancy. Cardiopulmonary resuscitation guidelines during pregnancy recommend placing the hands 2-3 cm higher on the sternum than in nonpregnant individuals. This recommendation is based on the presumption that the heart is displaced superiorly by the diaphragm during the third trimester. Whether there is true cardiac displacement because of the expanding uterus in pregnancy remains unknown. STUDY DESIGN: A total of 34 healthy female volunteers 18-35 years old were enrolled prospectively from 2010-2012 at 2 tertiary care centers. The conditions of all participants were evaluated with cardiac magnetic resonance imaging in the one-half left lateral decubitus position during the third trimester of pregnancy and again at a minimum of 3 months after delivery (surrogate for the nonpregnant state). Superior displacement of the heart was determined by measurement of the distance between the inferior aspect of the clavicular heads and the coronary sinus at both time points. RESULTS: The study population included 34 women (mean age, 29 ± 3 years; body mass index, 24 ± 4 kg/m(2)). The mean gestational age at third-trimester imaging was 237 ± 16 days (34 weeks ± 16 days); the mean number of days for postpartum imaging (baseline) was 107 ± 25 days (16 weeks ± 25 days). There was no statistical difference between the cardiac position at baseline (10.1 ± 1.2 cm) and during the third trimester (10.3 ± 1.1 cm; P = .22). CONCLUSION: Contrary to popular assumption, there is no significant vertical displacement of the heart in the third trimester of pregnancy relative to the nonpregnant state. Accordingly, there is no need to alter hand placement for chest compressions during cardiopulmonary resuscitation in pregnancy.

Predicting Hepatocellular Carcinoma Recurrence and Survival.

BACKGROUND/AIMS: Beta blockers can inhibit tumor growth and metastases, while necroinflammation can enhance these tumor properties. The aim of this study was to determine whether beta blockers and necroinflammatory disease predict tumor recurrence and/or overall survival following potentially curative therapeutic interventions for patients with hepatocellular carcinoma (HCC). METHODOLOGY: The medical records of 36 adults with non-metastatic HCC who had undergone surgical resections and/or radiofrequency ablation (RFA) were retrospectively reviewed. In addition to post-intervention beta blocker usage and serum alanine aminotransferase levels greater than 2xULN, other variables commonly associated with recurrences such as number and size of tumors, state of differentiation and vascular invasion were included in univariate and multivariate analyses for recurrence and survival. RESULTS: Vascular invasion (OR 29.3, 95% CI 2.6-33.6) and surgical resection (OR 0.19, 95% CI 0.04-0.90) emerged from univariate (p = 0.003 and 0.03 respectively) and multivariate (p = 0.005 and 0.048 respectively) regression as predictors of tumor recurrence whereas beta blocker usage (OR 0.03, 95% CL 0.04-0.9, p = 0.03) and tumor recurrence (OR 6.7, 95% CI 1.6-28.1, p = 0.026) correlated with overall mortality. CONCLUSIONS: Neither beta blocker usage nor serum ALT levels predict HCC recurrences, but beta blocker usage is associated with improved overall survival following potentially curative therapeutic interventions for HCC in adults.

Hepatic adenomatosis in a young woman with non-familial maturity-onset diabetes of the young type 3.

Hepatic adenomatosis (HA) is a rare condition in which multiple adenomas exist in an otherwise healthy liver. The most common subtype (H-HA) is associated with bi-allelic, somatic hepatic nuclear factor 1-alpha (HNF1A) mutations. Maturity-onset diabetes of the young type 3 (MODY3) is most often seen in young individuals with heterozygous, germline mutations in HNF1A. In this report, we describe a 17-year-old woman with H-HA and non-familial MODY3.

Antihypertensive medications and survival in patients with cancer: a population-based retrospective cohort study.

BACKGROUND: The association between antihypertensive medications and survival in cancer patients remains unclear. OBJECTIVES: To explore the association between classes of antihypertensive drugs and survival in cancer patients. METHODS: Provincial Cancer Registry data was linked with a Provincial Drug Program Information Network (DPIN) for patients with lung (n=4241), colorectal (n=3967), breast (n=4019) or prostate (n=3355) cancer between the years of 2004 and 2008. Cox regression analyses were used to compare survival of patients using beta blockers (BBs), angiotensin-converting enzyme inhibitors/receptor blockers (ACEi/ARB), calcium channel blockers (CCBs) or thiazide diuretics (TDs) to survival of patients who did not use any of these antihypertensive drugs. Survival of patients using only one class of antihypertensive drugs were compared to each other, with BBs as the reference class. RESULTS: Compared to the antihypertensive drug non-user cohort, BBs had no effect on survival for any of the cancers. ACEi/ARBs use was weakly associated with increased deaths for breast cancer (HR: 1.22, 95% CI: 1.04-1.44) and lung cancer (HR: 1.11, 95% CI: 1.03-1.21) patients. Deaths were also increased with CCB use in patients with breast cancer (HR: 1.22, 95% CI: 1.02-1.47) and with TD use in lung cancer patients (HR: 1.1, 95% CI: 1.01-1.19). There was strong evidence (p-value <0.0001) of an increase in deaths with TD use for colorectal (HR: 1.28, 95% CI: 1.15-1.42), and prostate (HR 1.41, 1.2-1.65) cancer patients. When including only antihypertensive drug users prescribed one drug class, lung cancer patients receiving CCBs had improved survival compared to BBs (HR 0.79, 95% CI: 0.64-0.98). CONCLUSIONS: Some classes of antihypertensive agents are associated with a decreased survival in certain cancers. The decrease could be due to more comorbidities in antihypertensive drug users. However, CCB use was associated with improved survival in lung cancer patients.

Global similarity predicts dissociation of classification and recognition: evidence questioning the implicit-explicit learning distinction in amnesia.

Dissociation of classification and recognition in amnesia is widely taken to imply 2 functional systems: an implicit procedural-learning system that is spared in amnesia and an explicit episodic-learning system that is compromised. We argue that both tasks reflect the global similarity of probes to memory. In classification, subjects sort unstudied grammatical exemplars from lures, whereas in recognition, they sort studied grammatical exemplars from lures. Hence, global similarity is necessarily greater in recognition than in classification. Moreover, a grammatical exemplar's similarity to studied exemplars is a nonlinear function of the integrity of the data in memory. Assuming that data integrity is better for control subjects than for subjects with amnesia, the nonlinear relation combined with the advantage for recognition over classification predicts the dissociation of recognition and classification. To illustrate the dissociation of recognition and classification in healthy undergraduates, we manipulated study time to vary the integrity of the data in memory and brought the dissociation under experimental control. We argue that the dissociation reflects a general cost in memory rather than a selective impairment of separate procedural and episodic systems.