SAR user guide to the rectal MR synoptic report (primary staging).

Rectal MR is the key diagnostic exam at initial presentation for rectal cancer patients. It is the primary determinant in establishing clinical stage for the patient and greatly impacts the clinical decision-making process. Consequently, structured reporting for MR is critically important to ensure that all required information is provided to the clinical care team. The SAR initial staging reporting template has been constructed to address these important items, including locoregional extent and factors impacting the surgical approach and management of the patient. Potential outputs to each item are defined, requiring the radiologist to commit to a result. This provides essential information to the surgeon or oncologist to make specific treatment deisions for the patient. The SAR Initial Staging MR reporting template has now been officially adopted by the NAPRC (National Accreditation Program for Rectal Cancer) under the American College of Surgery. With the recent revisions to the reporting template, this user guide has been revamped to improve its practicality and support to the radiologist to complete the structured report. Each line item of the report is supplemented with clinical perspectives, images, and illustrations to help the radiologist understand the potential implications for a given finding. Common errors and pitfalls to avoid are highlighted. Ideally, rectal MR interpretation should not occur in a vacuum but in the context of a multi-disciplinary tumor board to ensure that healthcare providers use common terminology and share a solid understanding of the strengths and weaknesses of MR.

Splenic findings in patients with acute babesiosis.

PURPOSE: To identify the imaging manifestations of splenic involvement in babesiosis, a potentially fatal tick-borne zoonosis with multi-organ involvement. METHODS: In our single center HIPAA compliant IRB-approved study, we performed a retrospective search of the electronic medical record at our institution to identify all patients with known or suspected acute babesiosis from 2000 to 2017. We then reviewed all abdominal imaging of patients with confirmed disease to identify incidence and characteristics of splenic involvement. Splenomegaly was determined using a height- and gender-adjusted reference. RESULTS: After exclusions, 63 patients with a confirmed diagnosis of babesiosis and contemporaneous imaging of the spleen were included in the final cohort. Within this cohort, 56 (89%) had splenomegaly at a minimum and 13 had splenic infarcts. Splenic rupture was present in eight patients with three having a pseudoaneurysm. In 14 patients with follow-up imaging, the spleen subsequently diminished in size. One additional patient with ruptured spleen underwent emergency splenectomy prior to imaging. CONCLUSION: Although the literature suggests splenic involvement is a rare finding, acute parasitemia with babesiosis commonly affects the spleen. Recognition of this association can aid radiologists diagnosing splenic involvement in babesiosis and can lead to appropriate intervention in the minority with splenic hemorrhage.

Sickle cell disease and venous thromboembolism: A retrospective comparison of the rate of positive CT pulmonary angiography in the emergency department.

BACKGROUND: Previous authors have reported an increased incidence of acute pulmonary embolism (PE) in patients with sickle cell disease (SCD) based on retrospective analysis of ICD codes. It is unknown whether patients with SCD have higher rates of positive CT pulmonary angiogram (CTPA) in the emergency department (ED). METHODS: The institutional review board (IRB) approved this retrospective study; informed consent was waived. Between January 1, 2005 and May 31, 2015, 28 patients with SCD underwent a total of 78 CTPA studies in the ED. A control group of 75 non-SCD patients matched for age, gender and race underwent 78 consecutive CTPA studies in the emergency department. Modified Wells' (mWells') scores were calculated for each CTPA study performed. The studies for both groups were blind read by two fellowship trained body radiologists. Descriptive statistics were performed, with significance considered if p < 0.05. RESULTS: The rate of positive CT pulmonary angiogram in patients with SCD was 6.4% (5/78), compared with 12.8% (10/78) in non-SCD matched controls. There was no significant difference in the rate of positive CTPA (p = 0.277). There was also no difference in the mean mWells' score between the two groups (2.44 for SCD vs. 1.95 for controls, p = 0.120). CONCLUSION: SCD patients did not have a significantly different rate of acute PE when compared with matched controls undergoing CTPA in the ED.