Part 2: Current Concepts in Radiologic Imaging & Intervention in Acute Biliary Tract Diseases.

Acute cholangitis is encountered commonly in critically ill, often elderly, patients. The most common causes of cholangitis include choledocholithiasis, biliary strictures, and infection from previous endoscopic, percutaneous, or surgical intervention of the biliary tract. Rare causes of acute cholangitis in the United States include sclerosing cholangitis and recurrent pyogenic cholangitis, the latter predominantly occurring in immigrants of Asian descent. Multidisciplinary management of these conditions is essential, with intensivists, surgeons, diagnostic radiologists, interventional radiologists, gastroenterologists, endoscopists, and infectious disease physicians typically involved in the care of these patients. In this paper intended for intensivists predominantly, we will review the imaging findings and radiologic interventional management of critically ill patients with acute cholangitis, primary and secondary sclerosing cholangitis, and recurrent pyogenic cholangitis.

Part 1: Current Concepts in Radiologic Imaging and Intervention in Acute Cholecystitis.

Acute calculous cholecystitis and acute acalculous cholecystitis are encountered commonly among critically ill, often elderly, patients. Multidisciplinary management of these conditions is essential, with intensivists, surgeons, diagnostic radiologists, interventional radiologists, infectious disease physicians, gastroenterologists, and endoscopists able to contribute to patient care. In this article intended predominantly for intensivists, we will review the imaging findings and radiologic treatment of critically ill patients with acute calculous cholecystitis and acute acalculous cholecystitis.

Iatrogenic vascular complications of non-vascular percutaneous abdominal procedures.

PURPOSE: The purpose of this paper is to compile and present all of the reported vascular complications that resulted from common non-vascular abdominal procedures in the literature. Non-vascular procedures include, though are not limited to, percutaneous abscess/fluid collection drainage (PAD), percutaneous nephrostomy (PN), paracentesis, percutaneous transhepatic cholangiography (PTC)/percutaneous biliary drainage (PBD), percutaneous biliary stone removal, and percutaneous radiologic gastrostomy (PG)/percutaneous radiologic gastrojejunostomy (PG-J). By gathering this information, radiologists performing these procedures can be aware of the associated vascular injuries, as well as take steps to minimize risks. METHODS: A literature review was conducted using the PubMed database to catalog relevant articles, published in the year 2000 onward, in which an iatrogenic vascular complication occurred from the following non-vascular abdominal procedures: PAD, PN, paracentesis, PTC/PBD, percutaneous biliary stone removal, and PG/PG-J. Biopsy and tumor ablation were deferred from this article. RESULTS: 214 studies met criteria for analysis. 28 patients died as a result of vascular complications from the analyzed non-vascular abdominal procedures. Vascular complications from paracentesis were responsible for 19 patient deaths, followed by four deaths from PTC/PBD, three from biliary stone removal, and two from PG. CONCLUSION: Despite non-vascular percutaneous abdominal procedures being minimally invasive, vascular complications still can arise and be quite serious, even resulting in death. Through the presentation of vascular complications associated with these procedures, interventionalists can improve patient care by understanding the steps that can be taken to minimize these risks and to reduce complication rates.

The use of ferumoxytol for high-resolution vascular imaging and troubleshooting for abdominal allografts.

Ferumoxytol is an ultrasmall superparamagnetic iron oxide which has been used as an off-label intravenous contrast agent for MRI. Unlike gadolinium-based contrast agents, ferumoxytol remains in the intravascular space with a long half-life of 14-21 h. During the first several hours, it acts as a blood-pool agent and has minimal parenchymal enhancement. Studies have shown adequate intravascular signal for up to 72 h after initial contrast bolus. Ferumoxytol has been shown to be safe, even in patients with renal failure. Ferumoxytol has shown promise in a variety of clinical settings. The exquisite resolution enabled by the long intravascular times and lack of background parenchymal enhancement is of particular interest in the vascular imaging of solid organ allografts. Ferumoxytol magnetic resonance angiography (MRA) may identify clinically actionable findings months before ultrasound, CT angiography, or Gadolinium-enhanced MRA. Ferumoxytol MRA is of particular benefit as a troubleshooting tool in the setting of equivocal ultrasound and CT imaging. In the following review, we highlight the use of ferumoxytol for high-resolution MR vascular imaging for abdominal solid organ allografts, with representative cases.

Academic radiology department subspeciality organization & fellowship offerings: A hodgepodge.

INTRODUCTION: As opportunities for radiologists to subspecialize have increased, many avenues to organize Radiology department subspecialties exist. This study seeks to determine how academic U.S. Radiology departments structure themselves with respect to subspecialty divisions/sections, as there are no current standards for how Radiology departments are subdivided. Additionally, the extent of Radiology fellowships offered are assessed. The websites of academic U.S. Radiology departments, a highly influential source of information, were analyzed to perform this study. MATERIALS & METHODS: Radiology department websites of all allopathic U.S. medical schools (n = 148) were assessed for the following: presence/absence of Radiology department subdivisions, division/section labels, number of divisions/sections, division/section titles, presence/absence of Radiology fellowships, number of fellowships, and fellowships titles. RESULTS: 114/148 (77 %) medical schools had Radiology department websites. According to their respective websites, 66/114 (58 %) academic Radiology departments had subspecialty divisions/sections, whereas 48/114 (42 %) had no divisions/sections listed. Of the departments that had divisions/sections, the median number of divisions/sections per department was nine, and ranged from two to 14. Fellowships were offered at 82/114 (72 %) academic Radiology departments that had websites, and the median number was six, ranging from one to 13. CONCLUSION: There is marked heterogeneity of departmental organization across Radiology departments nationwide, likely due to the lack of current standards for how Radiology departments are subdivided into divisions/sections. Of the 77 % of medical schools that have Radiology department websites, only 58 % of departments listed divisions/sections, and 72 % posted fellowship offerings.

Why Medical Students Pursue Radiology: A Current Longitudinal Survey on Motivations and Controversial Issues in Radiology.

RATIONALE AND OBJECTIVES: Radiology is an increasingly competitive specialty. Various current factors influence medical students' decision to pursue a radiology career, including artificial intelligence (AI), remote reading, and COVID-19. This study seeks to determine the decision-making factors of all alumni from our medical school who matched into a radiology residency, and to gather opinions on emerging radiology topics. MATERIALS AND METHODS: A survey querying decision-making factors and opinions on current radiology topics was distributed to all alumni from our medical school (first graduating class in 2011) who previously matched into a diagnostic or interventional radiology residency program (n = 57). Wilcoxon Rank-Sum and Fisher's Exact tests were used to determine statistical significance. RESULTS: Forty-three of fifty-seven responses were received (75% response rate). The most influential factor that sparked respondents' interest in radiology was a radiology elective (25/43, 58%). Students who will finish radiology training in 2023 or later were more likely to be influenced by a mentor (15/23, 65%) than those who finished radiology training before 2023 (5/20, 25%) (p = 0.04). Respondents reported a 1.6/5 concern about AI negatively impacting their future career in radiology. There was 1.7/5 concern about performing radiology procedures on patients during the COVID-19 pandemic. Respondents predicted that remote reading would have a 3.2/5 positive impact on helping them achieve their preferred lifestyle. Job satisfaction among attending radiologists is rated at 4.3/5. CONCLUSION: Radiology electives had the greatest influence in piquing students' interest in radiology, while mentorship is assuming increasing influence. AI is perceived as a relatively minimal threat to negatively impact radiologists' jobs. Respondents had little concern about performing radiology procedures during the COVID-19 pandemic. Remote reading is viewed as having a moderately positive impact on lifestyle. Responding radiologists enjoy notably high job satisfaction.