Correction: Interventional Radiology Awareness Among Family Physicians and General Practitioners in the Qassim Region, Saudi Arabia.

[This corrects the article DOI: 10.7759/cureus.51751.].

Advanced strain elastography is a reliable approach for prostate cancer detection in patients with elevated PSA levels.

This study aimed to examine the validity and reproducibility of strain elastography (SE) for detecting prostate cancer (PCa) in patients with elevated prostate-specific antigen (PSA) levels. The study included 107 patients with elevated PSA levels. All eligible patients underwent transrectal ultrasound (TRUS) with real-time elastography (RTE) to detect suspicious lesions. Two readers independently evaluated the lesions and assigned a strain ratio and elastography score to each lesion. Histopathology was used as a reference standard to estimate the validity of RTE in predicting malignant lesions. An intraclass correlation (ICC) was performed to detect reliability of the strain ratios and elastography scores. TRUS-guided biopsy detected malignancies in 64 (59.8%) patients. TRUS with RTE revealed 122 lesions. The strain ratio index (SRI) cut-off values to diagnose malignancy were 4.05 and 4.35, with sensitivity, specificity, and accuracy of 94.7%, 91.3%, and 93.4%, respectively. An elastography score > 3 was the best cut-off value for detecting malignancy. According to readers, the sensitivity, specificity, and accuracy were 91.3-94.7%, 89.5-93.4%, and 91.3-90.9%, respectively. Excellent inter-reader agreement was recorded for SRI and elastography scores, with ICC of 0.937 and 0.800, respectively. SE proves to be an efficient tool for detecting PCa with high accuracy in patients with elevated PSA levels.

Interventional Radiology Awareness Among Family Physicians and General Practitioners in the Qassim Region, Saudi Arabia.

Interventional radiology (IR) is a rapidly growing specialty and is increasingly developing new procedures and minimally invasive interventions; thus, it might be challenging for non-specialists to keep up with all the new findings of IR. In this study, we tried to determine the level of awareness of family physicians and general practitioners about IR in the Qassim Region, Saudi Arabia. A self-completed online questionnaire was distributed among family physicians in the Qassim Region, with a total of 197 respondents. We found that the overall awareness level of family physicians and general practitioners about IR in the Qassim Region was low, with only 56 (28.4%) having an overall good knowledge level regarding IR, while 141 (74.6%) had poor knowledge. A total of 85 (43.1%) of the study participants reported that they would greatly benefit from more education about IR. The results demonstrate that there is a significant knowledge gap among family and general physicians about IR. Therefore, we suggest that there needs to be more education about IR and its developing procedures to promote collaboration among family medicine physicians, general physicians, and interventional radiologists.

Inter-observer Variability in the Analysis of CO-RADS Classification for COVID-19 Patients.

During the early stages of the pandemic, computed tomography (CT) of the chest, along with serological and clinical data, was frequently utilized in diagnosing COVID-19, particularly in regions facing challenges such as shortages of PCR kits. In these circumstances, CT scans played a crucial role in diagnosing COVID-19 and guiding patient management. The COVID-19 Reporting and Data System (CO-RADS) was established as a standardized reporting system for cases of COVID-19 pneumonia. Its implementation necessitates a high level of agreement among observers to prevent any potential confusion. This study aimed to assess the inter-observer agreement between physicians from different specialties with variable levels of experience in their CO-RADS scoring of CT chests for confirmed COVID-19 patients, and to assess the feasibility of applying this reporting system to those having little experience with it. All chest CT images of patients with positive RT-PCR tests for COVID-19 were retrospectively reviewed by seven observers. The observers were divided into three groups according to their type of specialty (three radiologists, three house officers, and one pulmonologist). The observers assessed each image and categorized the patients into five CO-RADS groups. A total of 630 participants were included in this study. The inter-observer agreement was almost perfect among the radiologists, substantial among a pulmonologist and the house officers, and moderate-to-substantial among the radiologists, the pulmonologist, and the house officers. There was substantial to almost perfect inter-observer agreement when reporting using the CO-RADS among observers with different experience levels. Although the inter-observer variability among the radiologists was high, it decreased compared to the pulmonologist and house officers. Radiologists, house officers, and pulmonologists applying the CO-RADS can accurately and promptly identify typical CT imaging features of lung involvement in COVID-19.

MRI-Based Classification for Tibial Spine Fracture: Detection Efficacy, Classification Accuracy, and Reliability.

RATIONALE AND OBJECTIVES: Recently, a new MRI-based classification for evaluating tibial spine fractures (TSFs) was developed to aid in treating these injuries. Our objective was to assess the detection efficacy, classification accuracy, and reliability of this classification in detecting and grading TSFs, as well as its impact on treatment strategy, compared to the Meyers and McKeever (MM) classification. MATERIALS AND METHODS: A retrospective study included 68 patients with arthroscopically confirmed TSFs. All patients had plain radiography and conventional MRI of the affected knee before arthroscopy. Three experienced radiologists independently reviewed all plain radiographs and MRI data and graded each patient according to MM and MRI-based classifications. The detection efficacy, classification accuracy, and inter-rater agreement of both classifications were evaluated and compared, using arthroscopic findings as the gold standard. RESULTS: The final analysis included 68 affected knees. Compared to the MM classification, the MRI-based classification produced 22.0% upgrade of TSFs and 11.8% downgrade of TSFs. According to the reviewers, the fracture classification accuracy of the MRI-based classification (91.2-95.6%) was significantly higher than that of the MM classification (73.5-76.5%, p = 0.002-0.01). The fracture detection rate of MRI-based classification (94.1-98.5%) was non-significantly higher than that of the MM classification (83.8-89.7%, p = 0.07-0.4). The soft tissue injury detection accuracy for MRI-based classification was 91.2-94.1%. The inter-rater reliability for grading TSFs was substantial for both the MM classification (κ = 0.69) and MRI-based classification (κ = 0.79). CONCLUSION: MRI-based classification demonstrates greater accuracy and reliability compared to MM classification for detecting and grading TSFs and associated soft tissue injuries.

Magnetic Resonance Imaging Features of Rhino-Orbito-Cerebral Mucormycosis in Post-COVID-19 Patients: Radio-Pathological Correlation.

There has been a notable increase in rhino-orbito-cerebral mucormycosis (ROCM) post-coronavirus disease 2019 (COVID-19), which is an invasive fungal infection with a fatal outcome. Magnetic resonance imaging (MRI) is a valuable tool for early diagnosis of ROCM and assists in the proper management of these cases. This study aimed to describe the characteristic MRI findings of ROCM in post-COVID-19 patients to help in the early diagnosis and management of these patients. This retrospective descriptive study was conducted at a single hospital and included 52 patients with COVID-19 and a histopathologically proven ROCM infection who were referred for an MRI of the paranasal sinuses (PNS) due to sino-orbital manifestations. Two radiologists reviewed all the MR images in consensus. The diagnosis was confirmed by histopathological examination. The maxillary sinus was the most commonly affected PNS (96.2%). In most patients (57.7%), multiple sinuses were involved with the black turbinate sign on postcontrast images. Extrasinus was evident in 43 patients with orbital involvement. The pterygopalatine fossa was involved in four patients. Three patients had cavernous sinus extension, two had pachymeningeal enhancement, and one had epidural collection. The alveolar margin was affected in two patients, and five patients had an extension to the cheek. The awareness of radiologists by the characteristic MRI features of ROCM in post-COVID-19 patients helps in early detection, early proper management, and prevention of morbid complications.

The Impact of Adding Digital Breast Tomosynthesis to BI-RADS Categorization of Mammographically Equivocal Breast Lesions.

Digital mammography (DM) is the cornerstone of breast cancer detection. Digital breast tomosynthesis (DBT) is an advanced imaging technique used for diagnosing and screening breast lesions, particularly in dense breasts. This study aimed to evaluate the impact of combining DBT with DM on the BI-RADS categorization of equivocal breast lesions. We prospectively evaluated 148 females with equivocal BI-RADS breast lesions (BI-RADS 0, 3, and 4) with DM. All patients underwent DBT. Two experienced radiologists analyzed the lesions. They then assigned a BI-RADS category for each lesion according to the BI-RADS 2013 lexicon, using DM, DBT, and integrated DM and DBT. We compared the results based on major radiological characteristics, BI-RADS classification, and diagnostic accuracy, using the histopathological examination of the lesions as a reference standard. The total number of lesions was 178 on DBT and 159 on DM. Nineteen lesions were discovered using DBT and were missed by DM. The final diagnoses of 178 lesions were malignant (41.6%) and benign (58.4%). Compared to DM, DBT produced 34.8% downgrading and 32% upgrading of breast lesions. Compared with DM, DBT decreased the number of BI-RADS 4 and 3. All the upgraded BI-RADS 4 lesions were confirmed to be malignant. The combination of DM and DBT improves the diagnostic accuracy of BI-RADS for evaluating and characterizing mammographic equivocal breast lesions and allows for proper BI-RADS categorization.

Precision Mapping of Intrahepatic Biliary Anatomy and Its Anatomical Variants Having a Normal Liver Using 2D and 3D MRCP.

Despite significant advances in hepatobiliary surgery, biliary injury and leakage remain typical postoperative complications. Thus, a precise depiction of the intrahepatic biliary anatomy and anatomical variant is crucial in preoperative evaluation. This study aimed to evaluate the precision of 2D and 3D magnetic resonance cholangiopancreatography (MRCP) in exact mapping of intrahepatic biliary anatomy and its variants anatomically in subjects with normal liver using intraoperative cholangiography (IOC) as a reference standard. Thirty-five subjects with normal liver activity were imaged via IOC and 3D MRCP. The findings were compared and statistically analyzed. Type I was observed in 23 subjects using IOC and 22 using MRCP. Type II was evident in 4 subjects via IOC and 6 via MRCP. Type III was observed equally by both modalities (4 subjects). Both modalities observed type IV in 3 subjects. The unclassified type was observed in a single subject via IOC and was missed in 3D MRCP. Accurate detection by MRCP of intrahepatic biliary anatomy and its anatomical variants was made in 33 subjects out of 35, with an accuracy of 94.3% and a sensitivity of 100%. In the remaining two subjects, MRCP results provided a false-positive pattern of trifurcation. MRCP competently maps the standard biliary anatomy.

Prevalence of Transient Osteoporosis of the Hip Among Patients Presenting With Hip Pain in a Major Tertiary Hospital in Saudi Arabia.

BACKGROUND: Transient osteoporosis of the hip, or acute bone marrow edema syndrome, is a rare condition characterized by a decrease in bone mineral density of the proximal femur, which resolves with conservative management over 6-24 months. At presentation, the patient complains of sudden onset of localized pain in the hip, which is aggravated by weight-bearing. However, the prevalence and risk factors for this condition are still unclear. Objective: This study aims to identify the prevalence of transient osteoporosis of the hip among patients who present with hip pain and underwent magnetic resonance imaging of the hip. METHOD: This is a retrospective investigation that involved collecting data from patients' records in a tertiary hospital in Saudi Arabia. Included candidates were patients who presented with hip pain, had an MRI done between 2016 and 2019 inclusive, and were older than 14 years. The collected data involved the age and gender of patients, the hip's affected side, and the diagnosis. Data analysis was executed through SPSS version 26 (IBM Corp., Armonk, NY). RESULTS: Three hundred and fourteen patients matched our inclusion criteria. The prevalence of transient osteoporosis of the hip was 2.5%. All of them were males and half were above 40 years, 50% had pain in the left side, and 75% had a small joint effusion. The femoral head was the most affected part of the joint in patients with transient osteoporosis of the hip. Among our patients, the most common cause of hip pain was gluteus medius tendonitis (12.9%), where 33.1% of patients with hip pain had normal examination and investigations, and 15.2% had more than one condition. Risk factors for transient osteoporosis of the hip are pain in the left hip joint (p-value=0.023) and an age between 41 and 50 years (p-value=0.012). CONCLUSION: The prevalence of transient osteoporosis of the hip is low, yet it requires confirmation by studies with a more robust design. Males older than 40 years and left-side hip pain are at higher risk.