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OBJECTIVE: Determine the multiparametric magnetic resonance imaging (mpMRI) appearance of the prostate following focal laser ablation (FLA) for PCa and to identify imaging characteristics associated with recurrent disease. METHODS: Retrospective analysis of patients who underwent FLA for low-intermediate risk PCa between 2010 and 2014 was performed. Early (median 4 months) and late mpMRI (median 49 months) follow-up were qualitatively assessed for T2-weighted, dynamic contrast enhanced (DCE) and diffusion weighted imaging (DWI) appearances and also compared to corresponding PSA values and biopsy results. RESULTS: 55 cancers were treated in 54 men (mean age 61.0 years). Early mpMRI was performed in 30 (54.5%) patients while late follow-up mpMRI in 42 (84%). Ill-defined scarring with and without atrophy at the treatment site were the most common appearances. In patients with paired MRI and biopsy, one of four patients with clinically significant PCa on biopsy (≥GG2 or≥6 mm GG1) showed hyperenhancement or restricted diffusion at early follow-up. At late follow-up, positive biopsies were seen in 5/8 (63%) cases with hyperenhancement and 5/6 (83%) cases with restricted diffusion at the treatment site. PSA change was not associated with biopsy results at either time point. CONCLUSION: mpMRI is able to document the morphological and temporal changes following focal therapy. It has limited ability to detect recurrent disease in early months following treatment. Late-term mpMRI is sensitive at identifying patients with recurrent disease. Small sample size is, however, a limitation of the study. ADVANCES IN KNOWLEDGE: Implementing MRI in follow-up after FT may be useful in predicting residual or recurrent PCa and therefore provide reliable outcome data.
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Terapia por Láser/métodos , Imágenes de Resonancia Magnética Multiparamétrica , Neoplasias de la Próstata/diagnóstico por imagen , Neoplasias de la Próstata/cirugía , Biopsia , Medios de Contraste , Humanos , Masculino , Persona de Mediana Edad , Neoplasias de la Próstata/patología , Estudios RetrospectivosRESUMEN
PURPOSE: To evaluate the performance of a multiparametric (mp) MRI scoring system for assessment of tumour response in patients with locally advanced rectal cancer (LARC) after neoadjuvant chemoradiotherapy (CRT). METHOD: Fifty-nine consecutive patients with LARC who had rectal MRI before and after CRT followed by surgery were included. Two radiologists retrospectively assessed tumour response using a proposed mpMRI scoring system. Treatment response was classified as complete, near complete, partial or poor. Accuracy, sensitivity, specificity, positive predictive value and negative predictive values were calculated and inter-reader agreements were assessed. Pathologic tumour regression grade (pTRG) was the reference standard. RESULTS: Treatment response was correctly predicted by both readers in 32.2%-40.7% of patients. Overestimation was more common than underestimation. Sensitivity, specificity, PPV and NPV for pathologic complete response (pCR) among both readers was 16.7-33.0 %, 88.7-94.2 %, 14.3-40.0 % and 92.5-94.2 % respectively. Sensitivity and PPV for both readers improved to 56.0-60.0 % and 53.6-66.7 % respectively when complete response and near complete response categories (good responders) were combined. Inter-reader agreement using the scoring system was fair (κâ¯=â¯0.383). Agreement between mpMRI score and pathological tumour response was poor to fair for both readers (κâ¯=â¯0.050 to 0.258) but improved when complete and near complete response categories (good responders) were combined (κâ¯=â¯0.214 to 0.362). CONCLUSIONS: Despite low agreement between radiological tumour response and pTRG, the proposed mpMRI-based scoring system appears useful in identifying good responders who may benefit from nonoperative management strategies.
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Imágenes de Resonancia Magnética Multiparamétrica , Neoplasias del Recto , Quimioradioterapia , Humanos , Imagen por Resonancia Magnética , Terapia Neoadyuvante , Estadificación de Neoplasias , Neoplasias del Recto/diagnóstico por imagen , Neoplasias del Recto/patología , Neoplasias del Recto/terapia , Estudios Retrospectivos , Sensibilidad y Especificidad , Resultado del TratamientoRESUMEN
PURPOSE: To assess the role of multi-parametric MRI (mpMRI) in assessment of tumor response to fluvastatin administered prior to radical prostatectomy. METHODS: Men with MRI-visible, clinically significant prostate cancer and due to be treated with radical prostatectomy were prospectively enrolled. mpMRI was performed at baseline and following 6-7 week of neoadjuvant oral statin therapy (40 mg fluvastatin, twice daily), prior to prostatectomy. MRI assessment included tumor size, T2 relaxation time, ADC value, K-trans (volume transfer constant), Kep (reflux constant), and Ve (fractional volume) parameters at the 2 time points. Initial prostate needle biopsy cores, prior to starting oral statin therapy, corresponding to site of tumor on radical prostatectomy specimens were selected for analysis. The effect of fluvastatin on tumor proliferation (marker Ki67) and on tumor cell apoptosis (marker cleaved Caspase-3, CC3) were analyzed and correlated with MRI findings. RESULTS: Nine men with paired MRI studies were included in the study. Binary histopathological data was available for 6 of the participants. No significant change in tumor size (P = 0.898), T2 relaxation time (P = 0.213), ADC value (P = 0.455), K-trans (P = 0.613), Kep (P = 0.547) or Ve (P = 0.883) between the time of biopsy and prostatectomy were observed. No significant change in tumor proliferation (%Ki67-positive cells, P = 0.766) was observed by immunohistochemistry analysis. However, there was a significant increase in tumor cell apoptosis (%CC3-positive cells, P = 0.047). CONCLUSION: mpMRI techniques may not be sufficiently sensitive to detect the types (or magnitude) of tumor cell changes observed following 6-7 weeks of fluvastatin therapy for prostate cancer.
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Fluvastatina/uso terapéutico , Imagen por Resonancia Magnética/métodos , Neoplasias de la Próstata/diagnóstico por imagen , Neoplasias de la Próstata/tratamiento farmacológico , Administración Oral , Anciano , Estudios de Evaluación como Asunto , Fluvastatina/administración & dosificación , Humanos , Masculino , Persona de Mediana Edad , Proyectos Piloto , Estudios Prospectivos , Próstata/diagnóstico por imagen , Resultado del TratamientoRESUMEN
OBJECTIVES: The Medical Imaging Call Centre (MICC) was an initiative carried out by a hospital-based academic imaging department with the aim to provide navigational services and radiologist consultations to community-based primary care physicians (PCPs). The strategies used to expand and sustain the initiative over a 3.5-year period after an initial pilot are described. METHODS: The strategy to evolve the MICC had internal and external components. Internally, processes were refined to ensure satisfaction of stakeholders. Externally, a robust engagement strategy focused on recruiting and engaging callers was implemented. Metrics including call volumes, unique callers, and call type were monitored to track utilization and further inform the engagement strategy. A reduction in avoidable use of the emergency department (ED) was determined by tracking pre- and post radiologist consultation decisions reported by callers. RESULTS: During the evaluation period, 2,297 calls were made. There was a 39% increase in the average number of monthly calls in the last 6-month period (61) compared with the first 6 months (44). Call types that involved PCP-to-radiologist communication for patient management consultation also increased over time. A 98% ED avoidance rate (215 of 220) was reported for calls in which PCPs initially indicated that they would be sending their patients to the ED for urgent imaging if the MICC were unavailable. DISCUSSION: The MICC was successful in connecting community-based PCPs with hospital-based subspecialized radiologists. Results indicate that an active engagement strategy is necessary and can lead to changes in patient management that will decrease the burden on other specialists.
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Centrales de Llamados , Médicos de Atención Primaria , Radiología , Servicio de Urgencia en Hospital , Humanos , Atención Primaria de SaludRESUMEN
OBJECTIVE: To assess consistency and long-term progress in thyroid biopsy performed by trained sonographers under supervision of a radiologist. METHODS: Trained sonographers started performing thyroid biopsy at our institute in August 2011. The data for this study were extracted from a prospectively maintained database for ultrasound guided thyroid biopsy and included the number of thyroid fine needle aspiration biopsy procedures performed between August 2011 and 2016 and the final cytopathology report as per the Bethesda Classification. For the analysis, the study was divided into two time periods: initial postimplementation period (August 2011 to 2013) and late postimplementation period (2014-2016). RESULTS: In all, 5,538 thyroid biopsies were performed by trained sonographers in the period, 2,561 in the initial implementation period and 2,977 between 2014 and 2016. The unsatisfactory rates dropped from 21% to 10% in the two periods (P < .001), and the proportion of malignant nodules on cytopathology increased from 6% to 7% in the two periods (P = .010). Wait times for thyroid biopsies remained low during the period. CONCLUSION: Sonographers trained to perform ultrasound guided thyroid biopsies provide persistent improved patient care over a long-term period. This reinforces the role of physician extenders in targeted scopes of practice.
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Neoplasias de la Tiroides , Nódulo Tiroideo , Biopsia con Aguja Fina , Humanos , Estudios Retrospectivos , Especialización , UltrasonografíaRESUMEN
Ordering and protocolling CT scans after-hours from the emergency department (ED) at our institution previously required discussion between the ED physician and radiology resident, which led to workflow inefficiency. Our intervention consisted of creating an electronic list of CT requests that radiology residents would monitor. Radiology protocolled straightforward requests and contacted the ordering physician for more details when required. We aimed to improve workflow efficiency, increase provider satisfaction and reduce CT turnaround time without significantly affecting CT utilisation. Plan-do-study-act cycles were used to plan and evaluate the intervention. The intervention was initiated on weekday evenings and then expanded to weekend hours after an interim analysis. Qualitative outcomes were measured via electronic survey, and quantitative outcomes were collected from administrative data and analysed via control charts and other statistical methods. Survey response was high from ED physicians (76%, n=82/108) and radiology residents (79%, n=30/38). After the intervention, the majority of ED staff and radiology residents perceived improved workflow efficiency (96.3%, 73.3%), radiology residents noted a subjective decrease in disruptions (83.3%) and most ED staff felt that scans were performed more quickly (84.1%). Radiology residents received fewer pages per shift, adjusted for scan volume. There was a reduction in time from order entry to protocol on weekday shifts only, with no statistically significant effect on time from order entry to scan. Segmented regression analysis demonstrated a background increase in utilisation over time (0.7-2.0 CT/100 ED visits/year, p<0.0005), but the intervention itself did not contribute to an overall increase in CT utilisation. In conclusion, our intervention led to improved perceived workflow efficiency and reduced pages. Scans were protocoled more quickly on weekdays, but turnaround times were otherwise not significantly affected by the intervention. Background CT utilisation increased over time, but this increase was not attributable to our intervention.
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Atención Posterior/métodos , Servicio de Radiología en Hospital/normas , Tomografía Computarizada por Rayos X/instrumentación , Flujo de Trabajo , Atención Posterior/normas , Atención Posterior/estadística & datos numéricos , Servicio de Urgencia en Hospital/organización & administración , Servicio de Urgencia en Hospital/estadística & datos numéricos , Humanos , Investigación Cualitativa , Servicio de Radiología en Hospital/organización & administración , Servicio de Radiología en Hospital/estadística & datos numéricos , Estudios Retrospectivos , Encuestas y Cuestionarios , Factores de Tiempo , Tomografía Computarizada por Rayos X/métodos , Tomografía Computarizada por Rayos X/estadística & datos numéricosRESUMEN
OBJECTIVE: The purpose of this study is to determine the role of clinico-sonographic features of breast cellular fibroepithelial lesions (CFELs) diagnosed on core needle biopsy (CNB) in the differentiation between fibroadenoma (FA) and phyllodes. MATERIALS AND METHODS: Results of consecutive women with a CNB showing CFEL from 2005 to 2010 were retrospectively reviewed. Clinical and sonographic findings were compared with surgical outcomes. Chi-square and Fisher's exact tests were used followed by a regression model for statistical analysis. RESULTS: A total of 131 women with 134 CFEL were included in the study; 89 (66%) were FAs and 45 (34%) were phyllodes (32 benign; 13 malignant). Significant predictors of increased risk of phyllodes tumor were patient age equal to or greater than 50 years (P = .021) and lesion size less than 2 cm at sonography (P = .043). No other imaging or clinical features were able to differentiate FA from phyllodes tumors. CONCLUSION: CFEL with a larger size in older women is associated with the surgical pathological result of phyllodes tumor and management should be tailored accordingly. Younger patients with small size nodules might be approached less aggressively, depending on a personalized discussion with the surgeons, taking into account the results obtained in this study.
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Neoplasias de la Mama/diagnóstico por imagen , Fibroadenoma/diagnóstico por imagen , Tumor Filoide/diagnóstico por imagen , Biopsia con Aguja Gruesa/métodos , Neoplasias de la Mama/patología , Diagnóstico Diferencial , Femenino , Fibroadenoma/patología , Humanos , Biopsia Guiada por Imagen/métodos , Persona de Mediana Edad , Tumor Filoide/patología , Estudios Retrospectivos , Ultrasonografía/métodosRESUMEN
OBJECTIVES: To compare biliary stricture severity on magnetic resonance cholangiopancreatography (MRCP), magnetic resonance elastography (MRE), and vibration-controlled transient elastography (VCTE) liver stiffness (LS) for evaluation of risk stratification and prognostication in primary sclerosing cholangitis (PSC). MATERIALS AND METHODS: Eighty-seven patients (31-61 years; 34 female/53 male) prospectively underwent biochemical testing, VCTE, MRCP, and MRE between January 2014 and July 2016. Correlation between the MRCP grading of PSC based on biliary stricture severity, LS on MRE and VCTE, and the Mayo Risk Score as well as the Amsterdam Oxford Prognostic Index (AOPI) were evaluated and compared. Stricture severity was classified according to previous classification systems based on ERCP. Spearman's correlation and Kruskal-Wallis tests were performed. RESULTS: MRE-LS and intrahepatic stricture severity combined demonstrated higher discriminatory ability among risk categories based on Mayo Risk Score (AUROC = 0.8). MRE-LS alone demonstrated excellent discriminatory ability among risk categories based on AOPI using cutoffs of 1 and 2.7 and was superior to intrahepatic stricture severity (AUROC = 0.9, AUROC = 0.6-0.7). There was a weak correlation between intrahepatic stricture severity and MRE-LS (rho = 0.3; p = 0.011). VCTE-LS values were not correlated with stricture severity and were noncontributory to differentiate patients across risk groups. Intrahepatic stricture severity alone was a poor discriminator of advanced liver fibrosis on MRE (AUROC = 0.7); however, combining intra- and extrahepatic stricture severity and controlling for cholestasis and disease duration improved results (AUROC = 0.9). CONCLUSION: This study demonstrates a significant discriminatory ability of LS values on MRE to distinguish between early to moderate and advanced liver fibrosis. LS values on MRE may add value to risk prognostication and further studies including clinical outcomes are needed. KEY POINTS: ⢠Risk stratification was excellent for liver stiffness measurements on MRE and poor for VCTE and biliary stricture severity. ⢠Risk stratification was further improved when liver stiffness measured on MRE was combined with intrahepatic and extrahepatic stricture severity and indicators of cholestasis were controlled for. ⢠Liver stiffness measurements on MRE correlated with prognostic scores better than measurements performed on VCTE.
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Pancreatocolangiografía por Resonancia Magnética/métodos , Colangitis Esclerosante/diagnóstico , Diagnóstico por Imagen de Elasticidad/métodos , Hígado/diagnóstico por imagen , Adulto , Elasticidad , Femenino , Humanos , Hígado/fisiopatología , Masculino , Persona de Mediana Edad , Pronóstico , Índice de Severidad de la EnfermedadRESUMEN
OBJECTIVE: To determine the interobserver variability of the 2015 American Thyroid Association (ATA) thyroid guidelines and to evaluate the diagnostic accuracy of the guidelines in detecting thyroid cancer. MATERIALS AND METHODS: Sonographic patterns of 189 thyroid lesions were retrospectively analyzed by two radiologists according to the 2015 guidelines. The risk of malignancy was calculated for each pattern and compared with the published expected risk of malignancy. RESULTS: The observed risk of malignancy for very low suspicion, low suspicion, intermediate suspicion and high suspicion patterns were 2%, 12.7%, 26.3% and 29.8% respectively. Interobserver agreement for final category assignment was moderate (κ 0.518). CONCLUSION: The estimated risk of malignancy in the high suspicion pattern of the 2015 ATA thyroid biopsy guidelines appears to be less than stated. However, this needs further validation in a larger cohort study.
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OBJECTIVE: To determine the accuracy of shear-wave elastography (SWE) to differentiate low from advanced degrees of liver fibrosis in hepatitis C patients. MATERIAL & METHOD: Consented native/transplant hepatitis C patients underwent SWE using a C1-6 MHz transducer before ultrasound (US)-guided liver biopsy. Five interpretable SWE samples were obtained from the right lobe of the liver immediately before US-guided random biopsy of the right lobe. Average kilopascal (kPa) values were compared to the meta-analysis of histological data in viral hepatitis (METAVIR) fibrosis grading. SWE values were correlated with the degree of inflammation and fatty infiltration. RESULTS: Study population consisted of 115 patients (63 with transplant, and 52 with native liver) including 29 women and 86 men, with a mean ± SD age of 56 ± 8.7 years. Mean ± SD SWE values were 7.9 ± 3 kPa in 83 patients with METAVIR scores of 0-2 and 13.2 ± 5.9 kPa in 32 patients with METAVIR scores of 3 or 4 (P < .001). Area under curve (AUC) of a Receiver Operating Characteristics curve for advanced degrees of fibrosis was 0.81 (95% CI: 0.71, 0.90) (P < .001). AUCs of transplant versus native livers (0.78 [CI:0.62, 0.94] versus 0.85 [CI: 0.73, 0.96]), degree of inflammation (0.81 [CI: 0.65, 0.97] versus 0.72 [0.56, 0.88]), or degree of fat deposition (0.81 [CI:0.70, 0.92] versus 0.80 [CI:0.61, 1]) were not statistically different (P > .05). for kPa threshold of SWE value of 10.67 kPa to differentiate advanced from low degree of fibrosis had a sensitivity of 59% (CI: 41%-76%) and specificity of 90% (CI: 82%-96%). CONCLUSION: Liver stiffness evaluated by SWE can differentiate low from advanced liver fibrosis.
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Diagnóstico por Imagen de Elasticidad/métodos , Hepatitis C/complicaciones , Hepatitis C/diagnóstico por imagen , Cirrosis Hepática/complicaciones , Cirrosis Hepática/diagnóstico por imagen , Trasplante de Hígado , Diagnóstico Diferencial , Femenino , Hepatitis C/patología , Humanos , Hígado/diagnóstico por imagen , Hígado/microbiología , Cirrosis Hepática/patología , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Reproducibilidad de los Resultados , Sensibilidad y Especificidad , Índice de Severidad de la EnfermedadRESUMEN
OBJECTIVE: To prospectively compare the diagnostic performance of gadoxetic acid-enhanced MRI (EOB-MRI) and contrast-enhanced CT (CECT) for preoperative detection of colorectal liver metastases (CRLM) following chemotherapy and to evaluate the potential change in the hepatic resection plan. METHODS: 51 patients with CRLM treated with preoperative chemotherapy underwent liver imaging by EOB-MRI and CECT prospectively. Two independent blinded readers characterized hepatic lesions on each imaging modality using a 5-point scoring system. 41 patients underwent hepatic resection and histopathological evaluation. RESULTS: 151 CRLM were confirmed by histology. EOB-MRI, compared to CECT, had significantly higher sensitivity in detection of CRLM ≤1.0 cm (86% vs. 45.5%; p < 0.001), significantly lower indeterminate lesions diagnosis (7% vs. 33%; p < 0.001) and significantly higher interobserver concordance rate in characterizing the lesions ≤1.0 cm (72% vs. 51%; p = 0.041). The higher yield of EOB-MRI could have changed the surgical plan in 45% of patients. CONCLUSION: Following preoperative chemotherapy, EOB-MRI is superior to CECT in detection of small CRLM (≤1 cm) with significantly higher sensitivity and diagnostic confidence and interobserver concordance in lesion characterization. This improved diagnostic performance can alter the surgical plan in almost half of patients scheduled for liver resection.
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Neoplasias Colorrectales/patología , Medios de Contraste/administración & dosificación , Hepatectomía , Ácido Yotalámico/análogos & derivados , Neoplasias Hepáticas/diagnóstico por imagen , Neoplasias Hepáticas/terapia , Imagen por Resonancia Magnética , Tomografía Computarizada Multidetector , Terapia Neoadyuvante , Ácidos Triyodobenzoicos/administración & dosificación , Adulto , Anciano , Anciano de 80 o más Años , Biopsia , Quimioterapia Adyuvante , Toma de Decisiones Clínicas , Femenino , Gadolinio DTPA , Humanos , Ácido Yotalámico/administración & dosificación , Neoplasias Hepáticas/secundario , Masculino , Persona de Mediana Edad , Variaciones Dependientes del Observador , Valor Predictivo de las Pruebas , Estudios Prospectivos , Factores de Tiempo , Resultado del Tratamiento , Carga TumoralRESUMEN
PURPOSE: The aim of this study was to evaluate diagnostic performance of non-contrast-enhanced 2D quiescent-interval single-shot (QISS) and 3D turbo spin-echo (TSE)-based subtraction magnetic resonance angiography (MRA) in the assessment of peripheral arteries in patients with critical limb ischemia (CLI). MATERIALS AND METHODS: Nineteen consecutive patients (74 % male, 72.8 ± 9.9 years) with CLI underwent 2D QISS and 3D TSE-based subtraction MRA at 1.5 T. Axial-overlapping QISS MRA (3 mm/2 mm; 1 × 1 mm2) covered from the toes to the aortic bifurcation while coronal 3D TSE-based subtraction MRA (1.3 × 1.2 × 1.3 mm3) was restricted to the calf only. MRA data sets (two readers) were evaluated for stenosis (≥50 %) and image quality. Results were compared with digital subtraction angiography (DSA). RESULTS: Two hundred and sixty-seven (267) segments were available for MRA-DSA comparison, with a prevalence of stenosis ≥50 % of 41.9 %. QISS MRA was rated as good to excellent in 79.5-96.0 % of segments without any nondiagnostic segments; 89.8-96.1 % of segments in 3D TSE-based subtraction MRA were rated as nondiagnostic or poor. QISS MRA sensitivities and specificities (segmental) were 92 % and 95 %, respectively, for reader one and 81-97 % for reader two. Due to poor image quality of 3D TSE-based subtraction MRA, diagnostic performance measures were not calculated. CONCLUSION: QISS MRA demonstrates excellent diagnostic performance and higher robustness than 3D TSE-based subtraction MRA in the challenging patient population with CLI. KEY POINTS: ⢠QISS MRA allows reliable diagnosis of peripheral artery stenosis in critical limb ischemia. ⢠Robustness of TSE-based subtraction MRA is limited in critical limb ischemia. ⢠QISS MRA allows robust therapy planning in PAD patients with resting leg pain.
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Angiografía de Substracción Digital/métodos , Isquemia/diagnóstico por imagen , Pierna/irrigación sanguínea , Pierna/diagnóstico por imagen , Angiografía por Resonancia Magnética/métodos , Enfermedad Arterial Periférica/diagnóstico por imagen , Anciano , Femenino , Humanos , Imagenología Tridimensional/métodos , Isquemia/patología , Pierna/patología , Masculino , Enfermedad Arterial Periférica/patología , Reproducibilidad de los Resultados , Sensibilidad y EspecificidadAsunto(s)
Instituciones de Atención Ambulatoria/organización & administración , Relaciones Interinstitucionales , Colaboración Intersectorial , Atención Primaria de Salud/organización & administración , Servicio de Radiología en Hospital/organización & administración , Telerradiología/organización & administración , Modelos Organizacionales , OntarioRESUMEN
PURPOSE: To investigate the relationship of pre-treatment volumetric apparent diffusion coefficient (ADC) histogram parameters with post-operative histopathologic treatment response and clinical outcomes following pre-operative chemoradiation treatment (CRT) in rectal cancer. MATERIALS AND METHODS: In a Health Insurance Portability and Accountability Act compliant retrospective study, 78 rectal cancer patients treated with pre-operative CRT and rectal MRI were included. MR imaging analysis was performed using OncoTREAT (software tool). Multiple volumetric ADC histogram parameters (voxel distribution across ADC ranges, kurtosis, and skewness) were assessed. Correlation was made to post-operative pathological complete response, clinical, or radiological evidence of disease progression using the Mann-Whitney test. RESULTS: Post CRT, 8 patients showed pathologic complete response and 13 patients showed distant disease progression. Pre-treatment mean ADC was 1.2 × 10-3 mm2/s (range 0.3-1.99 × 10-3 mm2/s). Mean kurtosis measured was 0.56 (range -1 to 6; SD 1.36). Mean skewness was 0.3 (range -1 to 2; SD 0.69). Skewness had significant correlation (p value = 0.006) with disease progression. The mean rectal tumor volume was 24cc (range 1cc-134cc). Pre-treatment MRI tumor volume showed significant correlation (p value = 0.013) with pathologic complete response. Mean ADC and percentage voxels distribution against ADC ranges had no significant correlation with treatment response or disease outcomes. CONCLUSION: Volumetric ADC histogram analysis of pre-CRT rectal cancer MRI appears promising for prediction of post-CRT complete response and disease progression.
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Adenocarcinoma/diagnóstico por imagen , Adenocarcinoma/terapia , Quimioradioterapia/métodos , Imagen de Difusión por Resonancia Magnética/métodos , Neoplasias del Recto/diagnóstico por imagen , Neoplasias del Recto/terapia , Adenocarcinoma/patología , Adulto , Anciano , Progresión de la Enfermedad , Femenino , Humanos , Interpretación de Imagen Asistida por Computador , Escisión del Ganglio Linfático , Masculino , Persona de Mediana Edad , Clasificación del Tumor , Estadificación de Neoplasias , Neoplasias del Recto/patología , Estudios Retrospectivos , Programas Informáticos , Resultado del Tratamiento , Carga TumoralRESUMEN
OBJECTIVE: The purpose of this article is to evaluate the diagnostic performance of MRI for detection of extramural venous invasion (EMVI) compared with histopathologic analysis using elastin stain. MATERIALS AND METHODS: Forty-nine patients with rectal cancer who had undergone surgical resection with preoperative MRI were identified. Thirty-seven patients had received preoperative chemoradiation therapy (CRT). Sixty-nine MRI studies were independently reviewed by two blinded radiologists for EMVI using a score of 0-4. Comparison was made with histopathologic results obtained by two pathologists reviewing the elastin-stained slides in consensus. EMVI status was also correlated with other tumoral and prognostic features on imaging and pathologic analysis. Statistical analysis was performed using Fisher exact and McNemar tests. RESULTS: EMVI was present in 31% of the pathology specimens. An MRI EMVI score of 3-4 was 54% sensitive and 96% specific in detecting EMVI in veins 3 mm in diameter or larger. Inclusion of a score of 2 as positive for EMVI increased the sensitivity to 79% but decreased the specificity to 74%, with poor positive predictive value. Preoperative CRT had no significant effect on the diagnostic performance of MRI. Contrast-enhanced MRI increased reader confidence for diagnosis or exclusion of EMVI compared with T2-weighted imaging. EMVI status correlated with depth of extramural invasion and proximity to mesorectal fascia. CONCLUSION: Despite an anticipated increase in sensitivity for EMVI detection by histopathologic analysis using elastin compared with H and E staining, MRI maintains a high specificity and moderate sensitivity for the detection of EMVI.
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Imagen por Resonancia Magnética/métodos , Invasividad Neoplásica/patología , Neoplasias del Recto/patología , Neoplasias Vasculares/patología , Adulto , Anciano , Anciano de 80 o más Años , Quimioradioterapia , Medios de Contraste , Elastina , Femenino , Humanos , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Neoplasias del Recto/terapia , Estudios Retrospectivos , Sensibilidad y Especificidad , Coloración y EtiquetadoAsunto(s)
Neoplasias de la Mama/patología , Mama/patología , Biopsia Guiada por Imagen/efectos adversos , Dolor/etiología , Centros Médicos Académicos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Ansiedad/psicología , Biopsia con Aguja Fina/efectos adversos , Biopsia con Aguja Fina/métodos , Biopsia con Aguja Gruesa/efectos adversos , Biopsia con Aguja Gruesa/métodos , Mama/diagnóstico por imagen , Neoplasias de la Mama/diagnóstico por imagen , Competencia Clínica , Femenino , Humanos , Biopsia Guiada por Imagen/instrumentación , Biopsia Guiada por Imagen/métodos , Imagen por Resonancia Magnética Intervencional , Mamografía , Auditoría Médica , Persona de Mediana Edad , Agujas , Dimensión del Dolor , Radiología Intervencionista , Ultrasonografía Intervencional , Adulto JovenRESUMEN
PURPOSE: To evaluate the diagnostic performance of diffusion-weighted imaging (DWI) and gadoxetic acid-enhanced magnetic resonance imaging (MRI) to differentiate colorectal liver metastasis (CRLM) with complete pathologic response from those with incomplete response in patients treated with preoperative chemotherapy. METHODS: Gadoxetic acid-enhanced liver MRI and DWI were performed after completion of preoperative chemotherapy in patients with CRLM scheduled for liver resection. Metastases were classified as those with complete pathologic response (CR-CRLM) or incomplete response (IR-CRLM) according to postsurgical histopathology. Quantitative analysis was performed on non-contrast-enhanced images and hepatobiliary phase images following gadoxetic acid administration. Apparent diffusion coefficient values (ADC), normalized relative enhancement (NRE), and relative signal intensity difference (RSID) along with their diagnostic measures for detection of CR-CRLM were calculated for all lesions. RESULTS: In 23 patients, 10 CR-CRLM and 35 IR-CRLM (mean diameter, 21.2 mm) were evaluated. In CR-CRLM, ADC was significantly higher after exclusion of the outliers (p = 0.030); and RSID was significantly lower (p = 0.008). Combined indices range of ADC = 1.25-1.9 × 10(-3) mm(2)/s, NRE = 0-35% and RSID <120 had 60% sensitivity and 100% specificity for detection of CR-CRLM. CONCLUSION: DWI and gadoxetic acid-enhanced MRI appear promising for the detection of CRLM with complete response to preoperative chemotherapy. This could have significant implications for liver resection planning after preoperative chemotherapy.
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Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Neoplasias Colorrectales/tratamiento farmacológico , Neoplasias Colorrectales/patología , Imagen de Difusión por Resonancia Magnética/métodos , Neoplasias Hepáticas/diagnóstico por imagen , Neoplasias Hepáticas/secundario , Neoplasias Hepáticas/terapia , Medios de Contraste , Femenino , Gadolinio DTPA , Hepatectomía , Humanos , Masculino , Persona de Mediana Edad , Neoplasia Residual/diagnóstico por imagen , Estudios Prospectivos , Sensibilidad y Especificidad , Resultado del TratamientoRESUMEN
OBJECTIVES: To evaluate the heart rate lowering effect of relaxation music in patients undergoing coronary CT angiography (CCTA), pulmonary vein CT (PVCT) and coronary calcium score CT (CCS). METHODS: Patients were randomised to a control group (i.e. standard of care protocol) or to a relaxation music group (ie. standard of care protocol with music). The groups were compared for heart rate, radiation dose, image quality and dose of IV metoprolol. Both groups completed State-Trait Anxiety Inventory anxiety questionnaires to assess patient experience. RESULTS: One hundred and ninety-seven patients were recruited (61.9 % males); mean age 56y (19-86 y); 127 CCTA, 17 PVCT, 53 CCS. No significant difference in heart rate, radiation dose, image quality, metoprolol dose and anxiety scores. 86 % of patients enjoyed the music. 90 % of patients in the music group expressed a strong preference to have music for future examinations. The patient cohort demonstrated low anxiety levels prior to CT. CONCLUSION: Relaxation music in CCTA, PVCT and CCS does not reduce heart rate or IV metoprolol use. Patients showed low levels of anxiety indicating that anxiolytics may not have a significant role in lowering heart rate. Music can be used in cardiac CT to improve patient experience. KEY POINTS: ⢠Relaxation music does not reduce heart rate in cardiac CT ⢠Relaxation music does not reduce beta-blocker use in cardiac CT ⢠Relaxation music has no effect on cardiac CT image quality ⢠Low levels of anxiety are present in patients prior to cardiac CT ⢠Patients enjoyed the relaxation music and this results in improved patient experience.
Asunto(s)
Angiografía Coronaria/métodos , Frecuencia Cardíaca/fisiología , Musicoterapia/métodos , Tomografía Computarizada por Rayos X/métodos , Antagonistas de Receptores Adrenérgicos beta 1/administración & dosificación , Adulto , Anciano , Anciano de 80 o más Años , Ansiedad/etiología , Angiografía Coronaria/psicología , Esquema de Medicación , Femenino , Humanos , Masculino , Metoprolol/administración & dosificación , Persona de Mediana Edad , Venas Pulmonares/diagnóstico por imagen , Dosis de Radiación , Tomografía Computarizada por Rayos X/psicología , Adulto JovenRESUMEN
PURPOSE: To develop and implement a program where selected sonographers would be trained to perform thyroid biopsies independently under the supervision of a radiologist, with the goal of improving efficiency and quality. MATERIALS AND METHODS: Institutional research ethics board approval was obtained for this retrospective study, with waiver of informed consent. After approval from the relevant regulatory bodies, four sonographers successfully completed a training program and began to perform all thyroid biopsies (with informed consent) in a room adjacent to the main radiologist-run biopsy room, where the radiologist was available for backup as needed. In the preimplementation period (January 2010 to April 2011), 1321 nodules were biopsied, 29 of which included on-site cytopathology assessment. In the postimplementation period (August 2011 to July 2012), 1347 nodules were biopsied, 103 of which underwent on-site cytopathology assessment. Wait times and adequacy rates were calculated for both periods. RESULTS: Patient wait times decreased from a mean of 80-90 days before implementation of the thyroid biopsy specialist program to 20-30 days afterward. The percentage of adequate samples improved from 74.6% (985 of 1321 nodules) to 78.6% (1059 of 1347 nodules), with a P value of .015 (74.1% [957 of 1292 nodules] to 77.5% [964 of 1244 nodules] when excluding nodules with on-site cytopathology assessment, P = .0497). The percentage of malignant samples showed no significant change in the two time periods, 5.1% (68 of 1321 nodules) before implementation of the program versus 5.4% (73 of 1347 nodules) after implementation, P = .823 (5.1% [66 of 1292 nodules] vs 5.3% [66 of 1244 nodules] in the respective time periods when excluding nodules with on-site cytopathology assessment, P = .888). No major procedural complications occurred. CONCLUSION: Sonographers can be successfully trained to perform ultrasonography-guided thyroid biopsies safely under the supervision of a radiologist, which can improve wait times and adequacy rates.
Asunto(s)
Glándula Tiroides/diagnóstico por imagen , Glándula Tiroides/patología , Humanos , Biopsia Guiada por Imagen , Mejoramiento de la Calidad , Estudios Retrospectivos , Especialización , Factores de Tiempo , Ultrasonografía Intervencional/normasRESUMEN
OBJECTIVES: To evaluate the ability of sonographers to prospectively identify intracranial translucency and posterior brain structures at 11 to 13 weeks and to evaluate measurement reproducibility of brain stem and brain stem-occipital bone diameters on stored images. METHODS: After specific training for intracranial translucency visualization, 10 nonphysician sonographers prospectively identified intracranial translucency at the 11- to 13-week scan, noting whether intracranial translucency was present, absent, or uncertain. If absent/uncertain, they documented the reason as spina bifida or an inadequate image (with reasons for the inadequate image). Measurements of brain stem and brain stem-occipital bone diameters were performed on stored images. Fifty randomly selected cases were reviewed for intraobserver and interobserver variability. RESULTS: In 313 singleton pregnancies, the posterior brain including intracranial translucency was evaluated; 293 (93.6%) had known pregnancy outcomes. None had open spina bifida, but 7 had chromosomal or congenital abnormalities. In the remaining 286 normal fetuses, intracranial translucency was seen in 275 (96%) and uncertain in 11 (4%), due to inadequate images (top 3 reasons were fetal position [n = 8], obesity [n = 5], and retroverted uterus [n = 4]). Fetal position and gestational age were significantly associated with intracranial translucency visualization (P < .05). Intraobserver and interobserver agreement rates were moderate for measurements of brain stem diameter (intraclass correlation coefficients, 0.59 and 0.57) and substantial for brain stem-occipital bone diameter (intraclass correlation coefficients, 0.76 and 0.61). Bland-Altman analysis revealed negligible intraobserver and interobserver differences in brain stem and brain stem-occipital bone diameter measurements. CONCLUSIONS: Intracranial translucency can be prospectively identified by trained sonographers in 96% of normal fetuses at 11 to 13 weeks. Measurements of brain stem and brain stem-occipital bone diameters are reproducible.