Expanded experience with cardiovascular black blood cinematic rendering.

Black blood cinematic rendering (BBCR) is a newly described preset for cinematic rendering, which creates photorealistic displays from volumetric data sets with the contrast-enhanced blood pool displayed as dark and transparent. That set of features potentially provides for enhanced visualization of endomyocardial and intraluminal pathology, as well as cardiac devices. The similarity of the images to black-blood magnetic resonance imaging (MRI) may allow for expansion of the evaluation of certain types of pathology into patient populations unable to undergo MRI. In the emergency setting, the rapid acquisition time and reasonable post-processing time make this technique clinically feasible. In this expanded experience, we demonstrate an expanded clinical experience with the BBCR technique, highlighting the applications for intraluminal cardiovascular evaluation, especially focused on current and potential emergency radiology applications.

Emergent and unusual presentations of endometriosis: pearls and pitfalls.

The purpose of this pictorial essay is to highlight atypical and unusual presentations of endometriosis that can be missed or misinterpreted in the emergency setting. Although endometriosis is a chronic disease, it can present acutely with symptoms and imaging mimicking more common acute gynecologic, gastrointestinal, or urinary conditions as well as neoplasms. Furthermore, patients may present emergently prior to an established diagnosis of endometriosis. Here, we present a range of cases including endometrioma rupture and infection, urinary tract involvement and obstruction, bowel obstruction, appendicitis, gastrointestinal infiltration, abdominal masses, and thoracic involvement. Pelvic ultrasound and MRI are the most valuable imaging modalities in the assessment of endometriosis. CT findings are non-specific, but given the widespread use of CT in emergency settings, it is important to recognize CT findings suggestive of the diagnosis in the right clinical setting.

Multimodality Imaging after Liver Transplant: Top 10 Important Complications.

Patients who have undergone liver transplant are now regularly seen in day-to-day radiology practice. All surgical techniques for liver transplant require arterial, portal venous, hepatic venous and caval, and biliary anastomoses. This review is focused on the 10 "not to be missed" complications of liver transplant that affect the health and life of the graft and graft recipient. Arterial complications are the most common and devastating. Early hepatic artery thrombosis may be catastrophic because the biliary tree is solely dependent on the hepatic artery after transplant and collateral vessels have not yet formed. In contrast, delayed hepatic artery thrombosis may be more insidious as collateral arteries develop. US findings of delayed hepatic artery thrombosis may be similar to those of hepatic artery stenosis and celiac artery stenosis. Splenic artery steal syndrome is an increasingly recognized cause of graft ischemia. Venous complications are much less common. Hepatic venous and caval complications are notable for their increased incidence in living-donor and pediatric transplants. Biliary complications often result from arterial ischemia. Biliary cast syndrome is a notable example in which ischemic biliary mucosa sloughs into and obstructs the duct lumens. Neoplasms also may occur within the hepatic graft and may be due to recurrent malignancy, posttransplant lymphoproliferative disorder, or metastases. US is the initial imaging modality of choice, particularly in the acute postoperative setting. Further evaluation with contrast-enhanced US, CT, or MRI; catheter angiography; endoscopic retrograde cholangiopancreatography; and/or nuclear medicine studies is performed as needed. An invited commentary by Bhargava is available online. Online supplemental material is available for this article. ©RSNA, 2022.

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.

Challenging diagnosis of Kaposiform lymphangiomatosis: Unveiling a rare primary lymphatic disorder.

Kaposiform lymphangiomatosis (KLA) is a rare and complex lymphatic anomaly associated with substantial morbidity and mortality. It features diffuse and multifocal malformed lymphatic channels, often leading to diagnostic difficulties due to its uncommon occurrence and non-specific clinical presentation. This case report emphasizes the crucial role of expert radiologists in accurately diagnosing a challenging KLA case initially mistaken for a neoplasm.

Don't be thrown for a loop: a review of internal hernias for the abdominal imager.

Internal hernias are herniations of abdominal viscera, usually small bowel, through congenital or acquired openings of the peritoneum or mesentery. Congenital hernias may involve anatomic fossae such as the epiploic foramen as well as those related to abnormal peritoneal or mesenteric defects; these include left and right paraduodenal, transomental, transmesenteric, pericecal and broad ligament hernias. Acquired hernias are due to defects in the mesentery or peritoneum, usually resulting from prior surgeries, and include those associated with Roux-en-Y surgery as well as colorectal cancer resections. Internal hernias account for 5.8% of small obstructions. Obstructed internal hernias are considered surgical emergencies due to the high risk of bowel strangulation. This review summarizes the various types of congenital and acquired internal hernias, their relevant anatomy, embryology, associated surgical history and imaging appearance. We will also discuss a location-based approach to identifying internal hernias on CT, as well as complications and relevant signs, of which abdominal imagers should be vigilant.

Clinical implementation of cinematic rendering.

Cinematic rendering is a recently developed photorealistic display technique for standard volumetric data sets. It has broad-reaching applications in cardiovascular, musculoskeletal, abdominopelvic, and thoracic imaging. It has been used for surgical planning and has emerging use in educational settings. We review the logistics of performing this post-processing step and its integration into existing workflow.

'That's just the Ovary!' and other cases of mistaken identity on CT of the female pelvis.

CT is often the first imaging test in female patients with lower abdominal and pelvic pain because of the wide availability of CT and differential diagnoses that span both gynecologic and gastrointestinal disease. Pathology within the female pelvis may be difficult to diagnose on CT owing to suboptimal delineation of anatomy in comparison to MRI and ultrasound. These challenges are confounded by overlapping imaging features of a wide range of gynecologic entities and can lead to diagnostic dilemmas. High value CT interpretation will direct the clinician to the best next diagnostic step as ultrasound and MRI provide superior soft tissue delineation. Other imaging modalities, laboratory investigations, or tissue sampling may be necessary to definitively characterize indeterminate lesions. In this review, we illustrate various cases of mistaken identity on CT of the female pelvis involving the ovaries, uterus, and peritoneal cavity while highlighting clinical pearls that may aid the radiologist in arriving at the correct diagnosis and avoiding potential pitfalls.

High throughput liquid and gas chromatography-tandem mass spectrometry assays for tobacco-specific nitrosamine and polycyclic aromatic hydrocarbon metabolites associated with lung cancer in smokers.

We developed and applied high throughput liquid and gas chromatography-tandem mass spectrometry (LC-MS/MS and GC-MS/MS) methods for the cigarette smoking-associated biomarkers 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL) and r-1,t-2,3,c-4-tetrahydroxy-1,2,3,4-tetrahydrophenanthrene (PheT), which are urinary metabolites of the carcinogenic tobacco-specific nitrosamine 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK) and the polycyclic aromatic hydrocarbon phenanthrene. NNAL and PheT levels have been linked to lung cancer in previous studies of smokers. Confirmation of these relationships will require further molecular epidemiology studies, necessitating improved methodology applicable to large numbers of small urine samples. Furthermore, NNAL is excreted in urine either unconjugated or as an N- or O-glucuronide, but little data are available on the amounts of each in urine. For the high throughput analysis of NNAL, 3 aliquots were processed from each urine sample, one for the analysis of free NNAL, one for free NNAL plus NNAL-N-Gluc, and one for total NNAL (the sum of free NNAL, NNAL-N-Gluc, and NNAL-O-Gluc). Ninety-six well plate technology was used for sample enrichment by supported liquid extraction plates, mixed mode reverse-phase/cation exchange solid-phase extraction, and LC-MS/MS analysis. For the analysis of PheT, the urine samples were cleaned up by solid-phase extraction on styrene-divinylbenzene sorbent, silylated, and analyzed by GC-MS/MS, both in 96-well format. The methods were validated analytically with respect to accuracy and precision, and applied in an ongoing molecular epidemiology study of smokers. The amount of total NNAL in smokers' urine was (mean ± SD) 1.65 ± 2.13 pmol/mL (N = 2641). Free NNAL, NNAL-N-Gluc, and NNAL-O-Gluc represented (mean ± SD) 31 ± 11%, 22 ± 14%, and 48 ± 15% of total NNAL, respectively. The amount of PheT in smokers' urine was (mean ± SD) 1.43 ± 2.16 pmol/mL (N = 2613). The methodology described here should be widely applicable in future studies of tobacco use and cancer.

Development of unilateral renal peripelvic lymphangiectasia after renal vein thrombosis.

Renal peripelvic lymphangiectasia is a rare entity that can mimic hydronephrosis on routine contrast-enhanced computer tomography (CT). While it may remain asymptomatic, symptomatic cases can exhibit refractory hypertension (HTN) and recurrent abdominal pain. Diagnostic challenges stem from its nonspecific symptoms and imaging characteristics, which can overlap with other renal disorders. Thereby, adequate protocolling of CT or magnetic resonance (MR) imaging is important for accurate diagnosis. In this report, we present a case of renal lymphangiectasia that developed in a medically complex patient following renal vein thrombosis.

Thymic hyperplasia due to excess growth hormone stimulation: A case report.

Growth hormone has a strong role in stimulation of the thymus. We report a case of thymic hyperplasia due to excess endogenous growth hormone in the setting of acromegaly. Acromegaly often presents with systemic manifestations that may be confused with a systemic hematologic malignancy or infection, especially if an anterior mediastinal mass is present but unrecognized as a benign thymic hyperplasia. It is important for radiologists to be aware of this association between growth hormone and thymic stimulation because it may increase confidence diagnosing thymic hyperplasia in this setting, and avoid unnecessary mediastinal biopsy or surgery.

Conference Attendance Tracking and Evaluation in the Era of Virtual Conferences.

RATIONALE AND OBJECTIVES: The coronavirus pandemic upended in-person radiology education and led to a transition to virtual platforms. We needed a new method to monitor lecture attendance, previously relying on a physical badge system. Our goal was to develop and implement a virtual conference attendance system that is user-friendly, automated, useable in any virtual conference environment, and accurate. MATERIALS AND METHODS: We developed a web-based platform to serve as a virtual conference attendance tracking and evaluation platform. Daily, the application synchronizes with our lecture calendar to identify scheduled conferences and generates a unique attendance link for each event. The link is automatically posted in the conference chat and attendees must be logged in by the time it is posted to click the link, prompting single sign-on authentication. We integrated the system with resident schedules to excuse residents when appropriate. Real-time attendance reports are accessible in a user-friendly dashboard with a 5-star lecture review and comment system. We surveyed residents on satisfaction with the application after 1-year of use. RESULTS: Over the 2020-2021 academic year, we registered 376 conferences with 5,040 virtual swipes from 65 users. Once set up, virtual swipes take seconds to perform with minimal disruption to the conference. Average satisfaction for the platform was rated as 4.69 on a scale of 1 to 5. All respondents agreed or strongly agreed that use of the platform should be continued for future years, with 85% strongly agreeing. CONCLUSION: We developed an online platform for radiology conference attendance logging and evaluation, designed for virtual conferences.

Implementation of cinematic rendering of gastric masses into clinical practice: a pictorial review.

High-resolution CT is the gold standard diagnostic imaging study for staging of gastric malignancies. Cinematic rendering creates a photorealistic evaluation using the standard high-resolution CT volumetric data set. This novel display method offers unique possibilities for the evaluation of gastric masses. Here we present further observations of the role of cinematic rendering in the evaluation of gastric masses at a large tertiary care center. We offer three valuable teaching points for the application of the cinematic rendering for gastric masses with several case examples for each teaching point, discuss potential limitations of cinematic rendering, and review future directions for cinematic rendering in this setting.