Faculty Bibliography

PURPOSE/OBJECTIVE:The present study aimed to examine the molecular profiles of cytologically indeterminate thyroid nodules stratified by American College of Radiology Thyroid Imaging Reporting and Data System (TI-RADS) categories and to determine whether certain ultrasonographic features display particular molecular alterations. METHODS:A retrospective review was conducted of cases from January 1, 2016 to April 1, 2018. Cases with in-house ultrasonography, fine-needle aspiration Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) diagnoses, molecular testing, and surgery were included. All cases were diagnosed as TBSRTC indeterminate categories. The ultrasound studies were retrospectively reviewed and assigned TI-RADS scores (TR1-TR5) by board-certified radiologists. The final diagnoses were determined based on the surgical resection pathology. Binary logistic regression analysis was used to study whether demographic characteristics, TI-RADS levels, and TBSRTC diagnoses were associated with ThyroSeq molecular results. RESULTS:Eighty-one cases met the inclusion criteria. RAS mutations were the most common alteration across all TI-RADS categories (TR2 2/2; TR3 10/19, TR4 13/44, and TR5 8/16), and did not stratify with any particular TI-RADS category. Only TR4 and TR5 categories displayed more aggressive mutations such as BRAFV600E and TERT. ThyroSeq results were positively correlated with thyroid malignancy when non-invasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) was categorized in the malignant category (odds ratio [OR], 6.859; P<0.01), but not when NIFTP was removed from the malignancy category. Echogenicity scores were found to be negatively correlated with ThyroSeq results in thyroid nodules (OR, 0.162; P<0.01). CONCLUSION/CONCLUSIONS:Higher-risk molecular alterations tended to stratify with the higher TI-RADS categories.

OBJECTIVE. The objective of this article is to assess radiologist concordance in characterizing thyroid nodules using the American College of Radiology Thyroid Imaging Reporting and Data System (TI-RADS), focusing on the effect of radiologist experience on reader concordance. MATERIALS AND METHODS. Three experienced and three less experienced radiologists assessed 150 thyroid nodules using the TI-RADS lexicon. Percent concordance was determined for various endpoints. RESULTS. Interreader concordance for the five TI-RADS categories was 87.2% for shape, 81.2% for composition, 76.1% for echogenicity, 72.9% for margins, and 69.8% for echogenic foci. Concordance for individual features was 96.3% for rim calcifications, 90.8% for macrocalcifications, 90.1% for spongiform, 83.5% for comet tail artifact, and 77.7% for punctate echogenic foci. Concordance for the TI-RADS level and recommendation for fine-needle aspiration (FNA) were 50.4% and 78.9%, respectively. Concordance was significantly (p < 0.05) higher for less experienced readers in identifying margins (84.3% vs 67.4%), echogenic foci (76.9% vs 69.3%), comet tail artifact (89.6% vs 79.2%), and punctate echogenic foci (85.3% vs 75.5%), and lower for peripheral rim calcifications (95.0% vs 97.8 %), but was not different (p > 0.05) for the remaining categories and features. CONCLUSION. A range of TI-RADS categories, features, and recommendations for FNA had generally moderate interreader agreement among six radiologists. Our results show that concordance for numerous characteristics was significantly higher for the less experienced versus the more experienced readers. These results suggest that less experienced readers relied more on the explicit TI-RADS criteria, whereas the experienced radiologists partially relied on their accumulated experience when forming impressions. However, the overall TI-RADS level and recommendation for FNA were unaffected, supporting the robustness of the TI-RADS lexicon and its continued use in practice.

Women of reproductive age with pelvic pain, vaginal bleeding, and a positive pregnancy test often require evaluation with pelvic ultrasound. In these situations, the primary role of pelvic ultrasound is to differentiate an ectopic pregnancy from either a normal or abnormal intrauterine pregnancy. While an accurately performed and interpreted pelvic ultrasound results in rapid diagnosis and management, numerous diagnostic pitfalls can lead to negative outcomes. Therefore, familiarity with the appropriate laboratory tests, sonographic technique, and imaging features of ectopic pregnancy is essential for all radiologists. We present a review of ectopic pregnancy cases from our institution with attention to common pitfalls and troubleshooting tips for physicians who perform and interpret pelvic ultrasounds. We also present recently published literature to aid in the management of first trimester pregnancy.

OBJECTIVE: The objective of this article is to illustrate the MDCT appearances of several commonly encountered foreign bodies and devices in the female pelvis. CONCLUSION: The presence of a foreign body or device in the female pelvis can be a potential source of confusion to radiologists, particularly to the inexperienced reader. Familiarity with the normal appearances and locations of these devices on MDCT allows their accurate identification and detection of associated complications

The educational objectives for this self-assessment module are for the participant to exercise, self-assess, and improve his or her understanding of the imaging spectrum of endometriosis

Although computed tomography (CT) is generally not the first-line imaging test of choice for the evaluation of female pelvic disorders, it is often the initial diagnostic examination performed in the emergency setting in patients who present with abdominal pain and nonspecific clinical symptoms. Multidetector CT coupled with reconstruction software permits isotropic voxel acquisition that can be used to generate two-dimensional multiplanar reformatted (MPR) images for evaluation of the female pelvis with no additional radiation exposure. Multidetector CT with MPR allows improved visualization of the normal anatomy and anatomic variants as well as greater diagnostic accuracy in the evaluation of the female pelvis. Although ultrasonography and magnetic resonance imaging remain the primary imaging modalities for the assessment of most female pelvic disorders, more accurate diagnosis of these disorders at multidetector CT may obviate additional imaging tests and allow more appropriate management

OBJECTIVE: The purpose of our study was to describe the imaging findings and CT characteristics that lead to accurate distinction of large exophytic renal angiomyolipomas from retroperitoneal perirenal liposarcomas, which at times can be confused on imaging studies and even at pathologic examination. MATERIALS AND METHODS: We retrospectively analyzed CT images of 15 large exophytic renal angiomyolipomas and 12 well-differentiated perirenal liposarcomas. Pathologic correlation was available for six of 15 angiomyolipomas and all of the liposarcomas. All examinations were evaluated for lesion size, renal parenchymal defect, enlarged vessels, kidney displacement, lesion encapsulation or margination, associated hemorrhage, and additional angiomyolipomas. The records of patients with tuberous sclerosis or the forme fruste of that condition were excluded from the study. RESULTS: The average size of the angiomyolipomas was 14 x 10 cm. They showed a renal parenchymal defect (n = 15), enlarged vessels (n = 12), renal displacement (n = 14), good margination without a distinct capsule (n = 14), hemorrhage (n = 1), and additional (one or two) angiomyolipomas (n = 4). The average size of the liposarcomas was 18 x 11.6 cm. They showed enlarged vessels (n = 3), renal displacement (n = 11), and encapsulation (n = 4); none showed a renal parenchymal defect, hemorrhage, or associated angiomyolipomas. CONCLUSION: Although large exophytic angiomyolipomas and well-differentiated retroperitoneal liposarcomas may have similar appearances on imaging, careful evaluation for a defect in the renal parenchyma combined with the presence of enlarged vessels in angiomyolipomas should enable accurate differentiation in almost all cases. Achieving an accurate diagnosis can have a significant impact on patient treatment