Efficient Collaboration Between Radiologists Using the PACS-Integrated Refer Function to Reduce Communication Times.

The purpose of this study was to assess the utility of a picture archiving and communication systems (PACS)-integrated refer function for improving collaboration between radiologists and radiographers during daily reading sessions. Retrospective analysis was conducted on refers sent by radiologists using a PACS-integrated refer system from March 2020 to December 2021. Refers were categorized according to receiver: radiologists in the same division (intra-division), radiologists in a different division (inter-division), and radiographers. The proportions of answered refers, content of refers, and timing of refer posts were evaluated. Additionally, time intervals in minutes from initial refer post to refer response were assessed to assess the efficiency of the refer system and compared according to receivers using the Mann-Whitney U test. Among a total of 691 refers posted by radiologists, 579 (83.8%) were answered directly using the refer function in PACS. Of the answered refers, 346 refers (59.8%) were made between radiologists, and 173 (50%) were intra-division refers. About the content of refers, about 82.6% of radiologists' refers were about imaging interpretation consultation, and about 98.9% of refers from radiologists to radiographers were for image quality control. The median time interval until refer response was 9 min, and this response time did not differ between intra-division and inter-division refers (p = 0.998). Of the refers that got responses, 74.3% (257/346) were sent among radiologists before official reports were made, and the median time until refer response was 9-10 min. The proportion of refers answered by radiographers was 85.7% (233/272). The median time interval until refer response by radiographers was 87 min for all refers, and 63% were made within 6 h. Therefore, the PACS-integrated refer function can facilitate communication between radiologists for image interpretation and quality control.

Severity of nonalcoholic fatty liver disease is associated with subclinical cerebro-cardiovascular atherosclerosis risk in Korean men.

BACKGROUND: No studies have reported the relationship between nonalcoholic fatty liver disease (NAFLD) and concurrent cerebral artery and coronary artery atherosclerosis simultaneously. We aimed at determining whether NAFLD, as assessed by ultrasound, is associated with subclinical cerebro-cardio vascular atherosclerosis (CCVA) by multidetector-row computed tomography (MDCT), and high resolution-magnetic resonance angiography (HR-MRA). This cross-sectional study included men in the general Korean population aged 20-70 years. RESULTS: A total of 1,652 men participated in the study (normal, n = 835; mild-to-moderate NAFLD, n = 512; severe NAFLD, n = 305). The risk of subclinical CCVA was positively associated with age (odds ratio [OR] 1.068; 1.054-1.081, p < 0.001), body mass index (OR 1.120; 1.08 0-1.162, p < 0.001), hepatic enzyme levels (OR 1.012; 1.001-1.023, p = 0.027; OR 1.006; 1.001-1.012, p = 0.036), fasting glucose (OR 1.021; 1.015-1.027, p < 0.001), triglycerides (OR 1.002; 1.000-1.003, p = 0.016), hypertension (OR 2.836; 2.268-3.546, p < 0.001), and diabetes (OR 2.911; 2.137-3.964, p < 0.001). Also, high-density lipoprotein cholesterol was inversely associated with subclinical CCVA (OR 0.974; 0.965-0.982, p < 0.001). Compared with normal controls, the OR for subclinical CCVA after full adjustment was 1.46 in the mild-to-moderate NAFLD group (95% confidence interval [CI]: 1.10 to 1.93) and 2.04 in the severe NAFLD group (95% CI: 1.44 to 2.89). CONCLUSIONS: Our data show that NAFLD is common among Korean men, and NAFLD severity on ultrasonography is associated with subclinical CCVA, as assessed by MDCT, and HR-MRA.

Three-Dimensional Fast Spin-Echo Imaging without Fat Suppression of the Knee: Diagnostic Accuracy Comparison to Fat-Suppressed Imaging on 1.5T MRI.

PURPOSE: To evaluate the diagnostic performance of three-dimensional fast spin-echo (3D FSE-Cube) without fat suppression (NFS) for detecting knee lesions, using comparison to 3D FSE-Cube with fat suppression (FS). MATERIALS AND METHODS: One hundred twenty-four patients who underwent 1.5T knee magnetic resonance imaging (MRI) scans and 25 subsequent arthroscopic surgeries were retrospectively reviewed. Using arthroscopic results and two-dimensional images as reference standards, diagnostic performances of 3D FSE-Cube-NFS and FS imaging about lesions of ligament, meniscus, subchondral bone marrow edema (BME), and cartilage were compared. Scan parameters of 3D FSE-Cube imaging were previously optimized by a porcine knee phantom. RESULTS: No significant differences were observed between detection rates of NFS and FS imaging for detecting lesions of meniscus and cartilage (p>0.05). However, NFS imaging had lower sensitivity for detection of medial collateral ligament (MCL) tears, and lower sensitivity and specificity for detection of BME lesions, compared to FS imaging (p<0.05). CONCLUSION: 3D FSE-Cube-NFS imaging showed similar diagnostic performance for detecting lesions of meniscus or cartilage compared to FS imaging, unlike MCL or BME lesions.

How reliable is routine lumbar spine MRI for detection of renal cysts? Correlation with abdominal CT.

BACKGROUND: Incidental renal cysts are a very common finding in routine lumbar spine magnetic resonance imaging (MRI). However, there is no report of the renal cyst detection rate on routine lumbar spine MRI. PURPOSE: To determine the renal cyst detection rate in routine lumbar spine MRI based on findings of abdominal computed tomography (CT), and to investigate if the largest renal cyst seen by abdominal CT could be also detected by routine lumbar spine MRI. MATERIAL AND METHODS: A retrospective study was conducted of 70 patients who underwent both routine lumbar spine MRI and abdominal CT between December 2011 and January 2014. The detection rate of all renal cysts>5 mm as well as the largest renal cyst seen by abdominal CT were assessed in routine lumbar spine MRI. RESULTS: On routine lumbar spine MRI, the detection rate of renal cysts was 46.5% (73/157) for>5-mm renal cysts and 68.0% (34/50) for>10-mm renal cysts, correlating with abdominal CT. The detection rate of the largest renal cyst seen by abdominal CT was 60.0% (27/45). Non-detection of the largest renal cyst could be caused by upper positioning (n = 7), lateral positioning (n = 6), or relatively small cyst size (n = 5). CONCLUSION: Approximately half of renal cysts>5 mm and two-thirds of renal cysts>10 mm were detected on routine lumbar spine MRI. However, radiologists should be aware that kidney lesions may not be included in the scan coverage of routine lumbar spine MRI.

Effects of post biopsy digital rectal compression on improving prostate cancer staging using magnetic resonance imaging in localized prostate cancer.

PURPOSE: To evaluate the effectiveness of digital rectal-compression immediately after transrectal prostate biopsy (P-bx) for improving the accuracy of prostate cancer (PCa) staging. MATERIALS AND METHODS: Between July 2008 and June 2010, 94 consecutive patients who had a radical prostatectomy were included in our retrospective analysis. The exclusion criteria included a history of previous P-bx and surgery, a biopsy performed in another hospital, a number of biopsy cores different from 12, or a condition interfering with bleeding assessment. The subjects were divided into two groups, compression and non-compression. All enrolled patients took magnetic resonance imaging (MRI) for PCa staging. RESULTS: The compression and non-compression groups were comparable with respect to several baseline characteristics. However, the total hemorrhage score of intraprostatic bleeding was significantly different between the groups, even with adjustment for the time from biopsy to MRI (compression:15.4 ± 2.32, non-compression: 24.9 ± 2.43, p<0.001). The intra-prostatic cancer location matching rate was higher in the compression group (78.0%) than in the non-compression group (70.2%) (p = 0.011). Overall accuracy of staging in compression and non-compression groups was 84.7% and 77.3%, respectively. CONCLUSION: Our results demonstrate that digital rectal compression performed immediately after prostate biopsy to reduce intraprostatic hemorrhage improves the accuracy for detection of PCa using MRI.

18F-FDG PET imaging of progressive massive fibrosis.

PURPOSE: This study was to evaluate (18)F-FDG PET features of progressive massive fibrosis (PMF) and to determine the ability of FDG PET to differentiate pure PMF from PMF-associated lung cancer. METHODS: (18)F-FDG PET and chest computed tomography (CT) scans were performed in 9 patients with pneumoconiosis and PMF. Patients who showed active pulmonary tuberculosis on CT scan were excluded. Pure PMF was confirmed via either fine needle aspiration biopsy (n = 6) or 12 months follow-up CT scan (n = 3). CT features and PET findings were evaluated for distribution of fibrotic masses, consolidations, and nodules on CT scan and mean and maximum standardized uptake values (SUVs) of abnormalities depicted on PET scan. RESULTS: 14 masses were detected from nine patients. On chest CT scan, PMF masses were noted with surrounding small nodules and distortion of parenchyma. The size of the lesions ranged from 1.2 to 6.4 cm in maximum diameter. FDG PET scans identified metabolically active lesions in all patients. Maximal SUV ranged from 3.1 to 14.6 and mean SUV ranged from 1.4 to 8.5. CONCLUSION: FDG PET can identify PMF lesions as hypermetabolic lesions even without associated malignancy or tuberculosis. Therefore, it might have a limited role in the diagnosis of PMF with possible concurrent granulomatous inflammation or lung cancer.

F-18 FDG PET scan findings in patients with Loeffler's syndrome.

PURPOSE: : This study aimed to evaluate the F-2-fluoro-2-deoxyglucose positron emission tomography (F-18 FDG PET) findings of Loeffler's syndrome and to determine differential features between lung malignancy and Loeffler's syndrome. MATERIALS AND METHODS: : F-18 FDG PET and low-dose chest CT scans were performed to screen for lung cancer. Eleven patients who showed pulmonary lesions on CT scan with peripheral blood eosinophilia were included. PET scans were evaluated by mean and maximum standardized uptake values (SUVs) of abnormalities. CT findings were reviewed and correlated with the PET findings. In all patients, follow-up CT scans and PET scans were done from 1 to 4 weeks after the initial study. RESULTS: : F-18 FDG PET scans identified metabolically active lesions in 9 of 11 patients. Maximum SUVs ranged from 2.8 to 10.6, and mean SUVs ranged from 2.2 to 7.2. The other 2 patients had maximum SUVs of 1.3 and 2.2. Follow-up PET scans showed a decreased degree of initially noted FDG uptakes or migration of the lesion. The CT scan showed nodular lesions with a peripheral halo (n = 6), ground-glass attenuation (n = 4), and consolidation (n = 1). Follow-up CT scans revealed decreased size and extent of the initial lesions in 7 patients and migration in 2 patients. The other 2, who had relatively mild F-18 FDG uptakes, showed complete radiographic resolution of the lesions. CONCLUSIONS: : A single F-18 FDG PET study is not useful in differentiating benign and malignancy in patients with Loeffler's syndrome. Correlation and follow-up of PET and CT scan for the identification of abnormalities and their changes can be helpful for the differentiation between lung malignancy and Loeffler's syndrome.

Differential CT features of infectious pneumonia versus bronchioloalveolar carcinoma (BAC) mimicking pneumonia.

The purpose of this study was to evaluate retrospectively the differential CT features of bronchioloalveolar carcinoma (BAC) mimicking pneumonia and infectious pneumonia at the lung periphery. CT images were reviewed in 47 patients with focal areas of parenchymal opacification at the lung periphery. We evaluated the presence of ground-glass attenuation, marginal conspicuity of the lesion, CT angiogram sign, air-bronchogram sign, a bubble-like low-attenuation area within the lesion, presence of pleural thickening and retraction associated with the lesion, presence of pleural effusion and extra-pleural fatty hypertrophy, presence of bronchial wall thickening proximal to the lesion, and air-trapping in the normal lung near the lesion. BAC (n=18) depicted the presence of a bubble-like low-attenuation area within the lesion, whereas infectious pneumonia (n=29) represented the pleural thickening associated with the lesion and bronchial wall thickening proximal to the lesion (P<0.05). The other CT findings showed no significant differences (P>0.05). The focal areas of the parenchymal opacification on the CT images may suggest infectious pneumonia rather than BAC when they show bronchial wall thickening proximal to the lesion and pleural thickening associated with the lesion, whereas BAC is characterized as the presence of a bubble-like low attenuation area within the tumor.

Computed tomography findings of pathologically confirmed pulmonary parenchymal endometriosis.

OBJECTIVE: To evaluate the usefulness of computed tomography (CT) in the localization of parenchymal pulmonary endometriosis and to correlate the CT findings with fiberoptic bronchoscopic and pathologic findings. METHODS: A prospective study of 5 patients presenting with catamenial hemoptysis was conducted. The CT scans and fiberoptic bronchoscopy were performed twice during and 2 weeks after menstruation. After the localization of the presumed bleeding focus, surgical resection was performed. RESULTS: The CT scans obtained during menstruation revealed a well-demarcated area of consolidation (n = 4) and ground-glass opacity (n = 5), whereas CT scans obtained after menstruation demonstrated ground-glass opacity (n = 4) or complete resolution of the previously noted lesion (n = 1). Fiberoptic bronchoscopy exhibited trails of blood clot at the orifice of the involved bronchi unilaterally (n = 4) or a thin bloody secretion in the bronchi bilaterally. Histopathologic examination of the resected specimens showed typical findings of pulmonary endometriosis. CONCLUSION: Computed tomography scans during and after menstruation were useful for the precise preoperative localization of parenchymal pulmonary endometriosis.