Prostate-Specific Membrane Antigen PET/CT Detection of Prostate Cancer Metastasis to Thyroid and Cricoid Cartilages.

ABSTRACT: Prostate-specific membrane antigen (PSMA) PET/CT has revolutionized the imaging of prostate cancer. Historically, prostate cancer metastasis to thyroid and cricoid cartilages was thought to be exceedingly rare, with only a few reported cases in the literature. Prostate cancer metastasis to the laryngeal cartilages was detected in 4 of 221 patients who underwent imaging with 18 F-PSMA (Pylarify) or 68 Ga-PSMA (Illuccix) PET/CT for initial staging of high-risk prostate cancer or restaging evaluation in the setting of biochemical recurrence from April 2022 through October 2023. The increased sensitivity and specificity of PSMA PET/CT allow for the detection of previously occult metastatic disease.

MRI-based Neuropathy Score Reporting And Data System (NS-RADS): multi-institutional wider-experience usability study of peripheral neuropathy conditions among 32 radiology readers.

OBJECTIVE: To determine the inter-reader reliability and diagnostic performance of classification and severity scales of Neuropathy Score Reporting And Data System (NS-RADS) among readers of differing experience levels after limited teaching of the scoring system. METHODS: This is a multi-institutional, cross-sectional, retrospective study of MRI cases of proven peripheral neuropathy (PN) conditions. Thirty-two radiology readers with varying experience levels were recruited from different institutions. Each reader attended and received a structured presentation that described the NS-RADS classification system containing examples and reviewed published articles on this subject. The readers were then asked to perform NS-RADS scoring with recording of category, subcategory, and most likely diagnosis. Inter-reader agreements were evaluated by Conger's kappa and diagnostic accuracy was calculated for each reader as percent correct diagnosis. A linear mixed model was used to estimate and compare accuracy between trainees and attendings. RESULTS: Across all readers, agreement was good for NS-RADS category and moderate for subcategory. Inter-reader agreement of trainees was comparable to attendings (0.65 vs 0.65). Reader accuracy for attendings was 75% (95% CI 73%, 77%), slightly higher than for trainees (71% (69%, 72%), p = 0.0006) for nerves and comparable for muscles (attendings, 87.5% (95% CI 86.1-88.8%) and trainees, 86.6% (95% CI 85.2-87.9%), p = 0.4). NS-RADS accuracy was also higher than average accuracy for the most plausible diagnosis for attending radiologists at 67% (95% CI 63%, 71%) and for trainees at 65% (95% CI 60%, 69%) (p = 0.036). CONCLUSION: Non-expert radiologists interpreted PN conditions with good accuracy and moderate-to-good inter-reader reliability using the NS-RADS scoring system. CLINICAL RELEVANCE STATEMENT: The Neuropathy Score Reporting And Data System (NS-RADS) is an accurate and reliable MRI-based image scoring system for practical use for the diagnosis and grading of severity of peripheral neuromuscular disorders by both experienced and general radiologists. KEY POINTS: • The Neuropathy Score Reporting And Data System (NS-RADS) can be used effectively by non-expert radiologists to categorize peripheral neuropathy. • Across 32 different experience-level readers, the agreement was good for NS-RADS category and moderate for NS-RADS subcategory. • NS-RADS accuracy was higher than the average accuracy for the most plausible diagnosis for both attending radiologists and trainees (at 75%, 71% and 65%, 65%, respectively).

Establishing an Online Educational Teaching File on Instagram for an Academic Radiology Department: Proof-of-Concept.

Instagram is a powerful social media platform, which can serve as the ideal educational companion app for a visually rich discipline such as Radiology. Instagram facilitates easy content creation allowing for educators to utilize this resource for easy and rapid dissemination of educational content. The authors describe their experience of creating an online publicly available radiology teaching file on Instagram as a proof-of-concept, to help other individuals and institutions in leveraging social media to create and share quality educational content for current and future trainees.

Epidemiology of male breast diseases: A 10-year institutional review.

OBJECTIVE: To review breast imaging utilization and epidemiology of breast diseases in male patients referred to our breast center. MATERIAL AND METHODS: A retrospective analysis of all male patients who underwent breast imaging at our institution over a 10 year period (03/14/2008 to 03/13/2018) was performed. Patient history, imaging findings, biopsy reports, surgical interventions and follow-up data were reviewed. RESULTS: Over the 10 year period, 143 male patients (0.1% of referred breast center patients) underwent breast imaging (versus 139,134 female patients). Mean age was 57.4 years (SD 19.7, median 59, range 21-92 years). The most common indication for referral was a palpable breast mass (98%). The most common diagnosis was gynecomastia (72%). Of the 20 (14%) patients who underwent core biopsy; 1 (0.7%) had breast cancer and the remaining 19 had benign pathologies. Follow-up imaging was recommended for 22 (15.4%) patients, of whom 15 (68%) were lost to follow-up. Two patients under the age of 25 years inadvertently underwent initial mammography instead of ultrasound. CONCLUSION: The epidemiology of breast diseases in our male patient population mirrors that of the general male population worldwide; with an overwhelming 99.3% cases falling into benign category. Two-thirds of our male patients for whom short interval follow up was recommended were lost to follow-up, signifying the need for a more proactive approach in ensuring their compliance. It is important to increase awareness among referring clinicians and general radiologists regarding male breast imaging recommendations so that the appropriate imaging study is performed.

Comprehensive Review of Abdominopelvic Mesenchymal Tumors with Radiologic Pathologic Correlation and Update on Current Treatment Guidelines - Part 1.

Soft-tissue sarcomas are a diverse group of rare mesenchymal malignancies accounting for only 1% of all solid adult malignancies. These have been categorized in 12 broad groups by the World Health Organization (WHO) with their recent update in 2013. Majority of them lack specific imaging features serving as imaging conundrums for a radiologist. These are often large masses at presentation as they are asymptomatic or cause vague clinical symptoms. These tumors are challenging for surgeons as well as they find it difficult to achieve complete resection because of complex intra-abdominal anatomy and their close relationship with critical structures. Often, a multidisciplinary approach is required to decide on the most appropriate management for these complex cases so as to provide optimal patient care. Knowledge of the WHO classification, pathologic features and available treatment options will help the radiologist make a meaningful contribution in multidisciplinary discussions of such cases and overall patient care. Liposarcoma (well-differentiated and dedifferentiated liposarcomas), leiomyosarcoma, and gastrointestinal stromal tumor are the 3 most common primary intra-abdominal sarcomas. In part 1 of this article, general features of soft tissue sarcomas and some of the common tumors from WHO category 1-4 found in abdomen and pelvis are discussed. Part 2 will focus on common tumors from remainder of the WHO categories.

Comparison of outcome after ACL reconstruction in terms of subjective assessment of symptoms and function and clinical assessment of ligament stability.

BACKGROUND: The knee joint is frequently involved in sports and other injuries with Anterior cruciate ligament being a very common ligament to be injured. The Lachman test, pivot-shift test, and instrumented knee laxity examination are frequently used and reported for evaluation of ACL reconstruction. The aim of this study is to examine and evaluate the relationships between the clinical assessment of ligament stability and subjective assessment of symptoms and function after ACL reconstruction. METHODS: A total of 50 young and middle aged patients with unilateral knee ACL injury treated with ACL reconstruction using hamstring graft were evaluated for a minimum period of 1 year. Clinical assessment of ligament stability was done through Lachman and pivot-shift examination. Subjective variables of symptoms at follow-up included pain, swelling, instability and locking of knee. Subjective function at follow up included satisfaction with outcome, squatting, ascending or descending stairs, jumping, twisting and Lysholm score. RESULTS: Lachman Examination at follow-up had no significant (P > .05) relationship with pain, swelling, instability, locking, squatting, ascending or descending stairs, jumping, twisting, satisfaction with outcome and Lysholm score. Pivot-shift examination at follow-up had significant associations with patient satisfaction (P = .04), instability of knee (P = .02), difficulty during twisting (P = .02) and Lysholm score (P = .01). CONCLUSION: Pivot-shift examination is a better measure than Lachman examination or instrumented knee laxity as far as patients' functional outcome and overall satisfaction is concerned.