Faculty Bibliography

Pancreatic cystic lesions are frequently identified on cross-sectional imaging. As many of these are presumed branch-duct intraductal papillary mucinous neoplasms, these lesions generate much anxiety for the patients and clinicians, often necessitating long-term follow-up imaging and even unnecessary surgical resections. However, the incidence of pancreatic cancer is overall low for patients with incidental pancreatic cystic lesions. Radiomics and deep learning are advanced tools of imaging analysis that have attracted much attention in addressing this unmet need, however, current publications on this topic show limited success and large-scale research is needed.

PURPOSE/OBJECTIVE:The purpose of this study is to assess the utility of dual reader interpretation of prostate MRI in the evaluation/detection of prostate cancer, using the PI-RADS v2.1 scoring system. METHODS:We performed a retrospective study to assess the utility of dual reader interpretation for prostate MRI. All MRI cases compiled for analysis were accompanied with prostate biopsy pathology reports that included Gleason scores to correlate to the MRI PI-RADS v2.1 score, tissue findings and location of pathology within the prostate gland. To assess for dual reader utility, two fellowship trained abdominal imagers (each with > 5 years of experience) provided independent and concurrent PI-RADS v2.1 scores on all included MRI examinations, which were then compared to the biopsy proven Gleason scores. RESULTS:After application of inclusion criteria, 131 cases were used for analysis. The mean age of the cohort was 63.6 years. Sensitivity, specificity and positive/negative predictive values were calculated for each reader and concurrent scores. Reader 1 demonstrated 71.43% sensitivity, 85.39% specificity, 69.77% PPV and 86.36% NPV. Reader 2 demonstrated 83.33% sensitivity, 78.65% specificity, 64.81% PPV and 90.91% NPV. Concurrent reads demonstrated 78.57% sensitivity, 80.9% specificity, 66% PPV and 88.89% NPV. There was no statistically significant difference between the individual readers or concurrent reads (p = 0.79). CONCLUSION/CONCLUSIONS:Our results highlight that dual reader interpretation in prostate MRI is not needed to detect clinically relevant tumor and that radiologists with experience and training in prostate MRI interpretation establish acceptable sensitivity and specificity marks on PI-RADS v2.1 assessment.

BACKGROUND:Acquired arteriovenous fistulas (AVFs) are most commonly caused by direct arterial trauma, with 90% of traumatic AVFs due to penetrating trauma. Post-traumatic common carotid artery-internal jugular vein fistulae are rare, with an incidence of 4% to 7% of all traumatic AVFs. CASE REPORT:We present a case of delayed presentation of a patient with shortness of breath, neck pain, and worsening right upper extremity paresthesias 10 days after a blunt injury to the neck by an arrow. He was subsequently found to have a common carotid artery-internal jugular vein fistula and a common carotid pseudoaneurysm on computed tomography angiography. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Post-traumatic common carotid-jugular AVFs are uncommon, especially in patients with delayed presentations and a blunt injury mechanism. If left untreated, AVFs may progress to high-output cardiac failure, atrial fibrillation, and embolization. Clinicians must be aware of this finding, given the potential for significant morbidity.

PURPOSE/OBJECTIVE:To highlight perspectives about differing medical degrees and graduate medical education amongst current allopathic (MD) and osteopathic (DO) radiology residents. MATERIALS AND METHOD/METHODS:Two hundred sixty-eight radiology residents were interviewed using an approved Association of Program Coordinators in Radiology (APCR) survey designed to evaluate perceptions of allopathic and osteopathic radiology residents regarding type of medical degree and their career development. The surveys were kept anonymous with no identifiable information. Residents in their first through fourth years of training replied with an approximate equal distribution amongst the different years. RESULTS:Based on the 268 respondents, DOs' more so than MDs', reported that their degree type altered their medical careers (P < 0.0001) and that they were advised to not pursue a radiology residency based on degree type (P< 0.0001). In addition, a large majority of both DOs' and MDs' felt that residency selection is favored towards the allopathic degree (P= 0.0451). CONCLUSION/CONCLUSIONS:This survey-based study does reveal perceived differences in the residency recruitment process based on degree type. Future discussions to bridge this perceived gap will be important, especially in light of the recent ACGME merger between the 2 educational pathways.

PURPOSE:The aim of this study was to determine if contrast-enhanced CT can safely exclude obstructive urolithiasis in patients with flank plain. We performed a retrospective cohort analysis to compare the negative predictive values of contrast-enhanced and non-contrast CTs for the detection of obstructing urolithiasis. METHODS:Through report analysis, we identified all non-contrast and contrast-enhanced CT examinations of the abdomen and pelvis performed on adult patients in the emergency department at a single, multi-site academic medical institution in 2017 with an indication of flank pain. The prevalence of obstructive urolithiasis in each group was calculated. We subsequently analyzed 200 consecutive studies from each of these groups (reported negative for obstructive urolithiasis) for negative predictive value calculation. Follow up abdominal imaging within 7 days from original presentation was used as a reference standard for analysis. RESULTS:In the noncontrast group, 1 study out of 200 was false negative (negative predictive value = 99.5%). In the contrast-enhanced group, there were no false negatives (negative predictive value = 100%). The prevalence of obstructive urolithiasis was 44.0% (351/797) in the noncontrast group and 18.7% (86/459) in the contrast-enhanced group. CONCLUSION:Our results suggest that contrast-enhanced CT can safely exclude obstructing ureteral calculi in the setting of acute flank pain. This finding is of clinical relevance given the inherent benefit of IV contrast in diagnosing abdominopelvic pathology.

PURPOSE/OBJECTIVE:The purpose of this study is to assess the utility of an abdominal and/or pelvic ultrasound (US) performed within 24 h after a negative CT of the abdomen and pelvis (CTAP) in the emergency department (ED). The secondary endpoint is to assess whether there is a significant increase in length of stay (LOS) in the ED due to immediate US reimaging. METHOD/METHODS:We reviewed the imaging reports of 335 patients over the course of 3 years in our ED who had an US within 24 h after a negative CTAP. We then assessed type of US and whether the US showed any acute findings. We also evaluated LOS in the ED. RESULTS:Out of 335 patients, there were only three US cases suspicious for acute surgical pathology (3/335 or 0.9%). On 30-day clinical follow-up, only one of the three cases was confirmed as cholecystitis on pathology. The most common non-surgical findings on US not initially reported on CTAP were ovarian cysts (29/83) and gallstones (9/83). Additionally, the LOS for patients who received both a CTAP and US was 119 min longer than patients who only received a CTAP. CONCLUSION/CONCLUSIONS:US abdomen and/or pelvis reimaging within 24 h following a negative CTAP is unlikely to change surgical management in the acute setting. US reimaging can still be useful in diagnosing non-surgical pathology, which could serve to explain the patient's pain. US reimaging after negative CTAP is associated with an average increase in the ED LOS.

Olivopontocerebellar atrophy is a rare neurodegenerative syndrome associated with 2 distinct disorders: multiple system atrophy and spinocerebellar ataxia. We present a case involving a 66-year-old man with adult-onset progressing cerebellar signs reflective of a cerebellar syndrome with no significant family history and unremarkable genetic testing for spinocerebellar ataxia. This case was found to be most consistent with sporadic olivopontocerebellar atrophy, which falls under the multiple system atrophy category. This diagnosis can be made using F-FDG PET/CT scanning and with MRI in some cases. However, in this case, relatively new PET/CT quantification and parametric imaging software was used for analysis, CortexID Suite.