Faculty Bibliography

PURPOSE/OBJECTIVE:To assess the impact of instructional videos in patients' primary language on abdominal MR image quality for whom English is a second language (ESL). METHODS:Twenty-nine ESL patients viewed Spanish or Mandarin Chinese instructional videos (approximately 2.5 min in duration) in the preparation room before abdominal MRI (ESL-video group). Comparison groups included 50 ESL patients who underwent MRI before video implementation (ESL-no video group) and 81 English-speaking patients who were matched for age, sex, magnet strength, and history of prior MRI with patients in the first two groups. Three radiologists independently assessed respiratory motion and image quality on turbo spin-echo T2-weighted images (T2WI) and postcontrast T1-weighted images (T1WI) using 1 to 5 Likert scales. Groups were compared using Kruskal-Wallis tests as well as generalized estimating equations (GEEs) to adjust for possible confounders. RESULTS:For T2WI respiratory motion and T2WI overall image quality, Likert scores of the ESL-no video group (mean score across readers of 2.6 ± 0.1 and 2.6 ± 0.1) were lower (all P < .001) compared with English-speaking (3.3 ± 0.2 and 3.3 ± 0.1) and ESL-video (3.2 ± 0.1 and 3.0 ± 0.2) groups. In the GEE model, mean T2WI respiratory motion (both adjusted P < .001) and T2WI overall quality (adjusted P = .03 and .11) were higher in English and ESL-video groups compared with ESL-no video group. For T1WI respiratory motion and T1WI overall image quality, Likert scores were not different between groups (P > .05), including in the GEE model (adjusted P > .05). CONCLUSION/CONCLUSIONS:Providing ESL patients with an instructional video in their primary language before abdominal MRI is an effective intervention to improve imaging quality.

PURPOSE/OBJECTIVE:To assess inter-reader agreement of key features from the SAR-AGA recommendations for the interpretation and reporting of MRE in adult patients with CD, focusing on the impact of radiologist experience on inter-reader agreement of CD phenotypes. METHODS:Two experienced and two less-experienced radiologists retrospectively evaluated 99 MRE in CD patients (50 initial MRE, 49 follow-up MRE) performed from 1/1/2019 to 3/20/2020 for the presence of active bowel inflammation (stomach, proximal small bowel, ileum, colon), stricture, probable stricture, penetrating disease, and perianal disease. The MRE protocol did not include dedicated perianal sequences. Inter-rater agreement was determined for each imaging feature using prevalence-adjusted bias-adjusted kappa and compared by experience level. RESULTS:All readers had almost-perfect inter-reader agreement (κ > 0.90) for penetrating disease, abscess, and perianal abscess in all 99 CD patients. All readers had strong inter-reader agreement (κ: 0.80-0.90) in 99 CD patients for active ileum inflammation, proximal small bowel inflammation, and stricture. Less-experienced readers had significantly lower inter-reader agreement for active ileum inflammation on initial than follow-up MRE (κ 0.68 versus 0.96, p = 0.018) and for strictures on follow-up than initial MRE (κ 0.76 versus 1.0, p = 0.027). Experienced readers had significantly lower agreement for perianal fistula on follow-up than initial MRE (κ: 0.55 versus 0.92, p = 0.008). CONCLUSION/CONCLUSIONS:There was strong to almost-perfect inter-reader agreement for key CD phenotypes described in the SAR-AGA consensus recommendations including active ileum and proximal small bowel inflammation, stricture, penetrating disease, abscess, and perianal abscess. Areas of lower inter-reader agreement could be targeted for future education efforts to further standardize CD MRE reporting. Dedicated perianal sequences should be included on follow-up MRE.

PURPOSE/OBJECTIVE:To evaluate the effect of English proficiency on abdominal MRI imaging quality. METHODS:Three equal-sized cohorts of patients undergoing 3T abdominal MRI were identified based on English proficiency as documented in the EMR: Primary language of English; English as a second language (ESL)/no translator needed; or ESL, translator needed (42 patients per cohort for total study size of 126 patients). Three radiologists independently used a 1-5 Likert scale to assess respiratory motion and image quality on turbo spin-echo T2WI and post-contrast T1WI. Groups were compared using Kruskal-Wallis tests. RESULTS:For T2WI respiratory motion, all three readers scored the Translator group significantly worse than the English and ESL/no-Translator groups (mean scores across readers of 2.98 vs. 3.58 and 3.51; p values < 0.001-0.008). For T2WI overall image quality, all three readers also scored the Translator group significantly worse than the English and ESL/no-Translator groups (2.77 vs. 3.28 and 3.31; p values 0.002-0.005). For T1WI respiratory motion, mean scores were not significantly different between groups (English: 4.14, ESL/no-Translator: 4.02, Translator: 3.94; p values 0.398-0.597). For T1WI overall image quality, mean scores also were not significantly different (4.09, 3.99, and 3.95, respectively; p values 0.369-0.831). CONCLUSION/CONCLUSIONS:Abdominal MR examinations show significantly worse T2WI respiratory motion and overall image quality when requiring a translator, even compared with non-translator exams in non-English primary language patients. Strategies are warranted to improve coordination among MR technologists, translators, and non-English speaking patients undergoing abdominal MR, to ensure robust image quality in this vulnerable patient population.

OBJECTIVE. The purpose of this study was to evaluate the utility of T1- and T2-weighted MRI signal-intensity ratios and signal-intensity SDs of renal lesions to determine the feasibility of distinguishing between simple cysts, hemorrhagic renal cysts, clear cell renal cell carcinoma (RCC), and papillary RCC. MATERIALS AND METHODS. Pathology records of 53 cases of papillary RCCs between 1 and 5 cm in size were included. Thirty-eight pathology-proven clear cell RCCs, 54 simple renal cysts seen on abdominal MRI, and 59 hemorrhagic renal cysts seen on abdominal MRI were identified. Lesion location and size, T1- and T2-weighted signal intensity, and corresponding SD values for each renal lesion and psoas muscle (from which lesion-to-muscle ratios were calculated) were collected. RESULTS. Analysis revealed a statistically significant difference (p < 0.001) in T1-weighted lesion-to-muscle signal-intensity ratios between simple cysts (mean ± standard error, 0.54 ± 0.05), clear cell RCCs (0.86 ± 0.06), papillary RCCs (1.17 ± 0.05), and hemorrhagic renal cysts (1.95 ± 0.04). The T2-weighted lesion-to-muscle signal-intensity ratios showed a statistically significant difference between all lesion types (p < 0.02) except between hemorrhagic renal cysts and papillary RCCs, where the difference approached significance (p = 0.075). ROC analysis showed an optimal cutoff of T1-weighted lesion-to-muscle signal-intensity ratio of 1.39 to differentiate hemorrhagic cysts (above this value) from RCCs (below this value). Corresponding sensitivity and specificity were 91.2% and 74.6%, respectively. CONCLUSION. T1-weighted lesion-to-muscle signal-intensity ratio is a useful measure to discriminate mildly hyperintense RCCs from more hyperintense hemorrhagic cysts when contrast enhancement is unavailable.

We report a case of a 29-year-old woman with a pancreatic lymphangioma who presented clinically as a case of acute pancreatitis. Lymphangiomas are benign tumors of vascular origin with lymphatic differentiation, most commonly found in the head and neck. Pancreatic lymphangiomas are extremely rare, accounting for only 1% of abdominal lymphangiomas, with approximately 60 cases reported in the literature. Although imaging findings are characteristic and can point to the diagnosis, confirmation with fine needle aspiration and histopathologic correlation is necessary. Although these lesions are benign, they can often present a diagnostic dilemma and can be mistaken for other cystic pancreatic lesions, namely, pseudocysts, cysts, cystadenomas, and cystadenocarcinomas.

As the incidence of hepatocellular carcinoma (HCC) continues to increase worldwide, the role imaging plays in management continues to gain clinical importance. Multiple entry points exist for patients in the scheme of diagnosis and treatment of HCC and non-HCC malignancies. Further complicating this scheme is the lack of standardization in the language used for diagnostic imaging and management recommendations. The Liver Imaging Reporting and Data System (LI-RADS) was created to improve communication between clinicians and management teams. LI-RADS serves to standardize reports, improving physician satisfaction and aiding in management decisions across the continuum of care of these patients. Furthermore, LI-RADS provides technical specifications across multiple imaging modalities for screening and follow-up examinations, with the end goal of curing the disease or prolonging survival. In this review, the LI-RADS algorithm will be expanded upon, as well as its utility for various treatment options using the standardized LI-RADS lexicon. Additionally, pitfalls and non-HCC malignancies will also be addressed with resultant improvement in reproducibility of radiology reports that guide therapeutic management

Rosai-Dorfman disease is a rare disorder of unknown etiology caused by the proliferation of histiocytes within lymph nodes, predominantly in the cervical chain. Extranodal sites may be involved as well, with involvement of nearly every organ system described in the literature. Abdominal and pelvic manifestations of Rosai-Dorfman disease are extremely rare. We present four cases of abdominal and pelvic involvement by Rosai-Dorfman disease, specifically within the biliary tract, pancreas, spleen, and presacral space. Of note, a presacral mass was present in three of the four patients, and although not previously reported in Rosai-Dorfman disease, may suggest the diagnosis in the proper clinical scenario.

Since the recognition of the anaplastic large-cell lymphomas in the 1980s, much has been learned about the diagnosis, clinical presentation, and treatment of these malignant conditions. The systemic and primary cutaneous types of anaplastic large cell lymphomas have been differentiated on clinical and immunophenotypical findings, but further research is required to elucidate their exact etiologies and pathogeneses. Primary cutaneous anaplastic large-cell lymphoma has a 95% disease-specific 5-year survival, owing partly to the relatively benign course of the disease and partly to the variety of effective treatments that are available. As with many other oncological diseases, new drugs are continually being tested and developed, with immunotherapy and biological response modifiers showing promise.