Faculty Bibliography

OBJECTIVE:Whole-body MRI (WB-MRI) has gained popularity as a direct-to-consumer, comprehensive screening exam. Although the American College of Radiology does not recommend WB-MRI for asymptomatic individuals due to concerns about overdiagnosis, public interest continues to grow. This study evaluates public opinions and sentiments toward WB-MRI by analyzing discussions on Reddit, a social media platform rich in health-related discourse. METHODS:Using the Reddit API, we collected posts containing the terms "whole body mri," "ezra mri," and "prenuvo mri." One reviewer screened posts for relevance, and two reviewers independently applied an a priori coding framework to classify user type, sentiment, and thematic content. Posts were evaluated for stance toward WB-MRI and whether the user reported undergoing WB-MRI screening. Descriptive statistics were calculated. RESULTS:Of 17,177 posts collected, 3077 relevant posts were written by 1932 unique users from 2013 to 2024. Posting peaked in August 2023, accounting for 38% of posts following a viral influencer endorsement. Most users were from the general public (89%); 5% were non-physician healthcare professionals, 3% were non radiologist physicians, 2% were radiologists, and 1% were researchers. Overall, 47% opposed WB-MRI, 25% favored it, 20% were neutral, and 7% expressed mixed views. Only 4% reported undergoing WB-MRI, with most describing positive experiences. Common themes included early detection and preventive health (11%), information exchange (10%), cost (9%), ethical and health equity concerns (7%), and advertising practices (7%). CONCLUSION/CONCLUSIONS:Reddit discussions demonstrate strong interest but substantial uncertainty regarding WB-MRI, highlighting opportunities for radiologists to engage online and support evidence-based public discussions about preventive imaging.

The retroperitoneum, a complex abdominal compartment encompassing the anterior and posterior pararenal spaces, perirenal spaces, and great vessel space, is involved by both organ-based and non-organ-based pathologies. Imaging characteristics are invaluable in localizing pathologies to the either the retroperitoneum or one of its organs. A wide array of primary and metastatic neoplasms, including those of mesodermal, neurogenic, germ cell, sex cord-stromal, and lymphoid origin, may arise in this region. Frequently encountered non-neoplastic entities include fluid collections and retroperitoneal fibrosis. Integrating key clinical and imaging features is essential for the nuanced differentiation of this heterogeneous spectrum of pathologies.

PURPOSE/OBJECTIVE:Though prior studies have proven CTC's efficacy in outpatients, its utility in the inpatient setting has not been studied. We evaluated the efficacy of a modified CTC protocol in the inpatient setting, primarily for patients awaiting organ transplantation. METHODS:This retrospective study compared a group of inpatient CTCs from 2019 to 2021 and a randomly selected, age-matched 2:1 control group of outpatient CTCs. Both groups were assessed based on established criteria from literature. RESULTS:10 % (63/652) of CTCs were performed in the inpatient setting, of which 29 were excluded, yielding 34 inpatient cases. 90 % (589/652) of CTCs were performed in the outpatient setting, from which 68 randomly selected, age-matched patients were selected as controls. Significantly more (24 %, 8/34) inpatients expired due to extracolonic causes (vs. 1 %, 1/68 outpatients, p < 0.05). 62 % (21/34) of inpatient CTCs were reported as diagnostic (vs. 74 %, 50/68 outpatient, p = 0.22). Significantly more inpatients (12 %, 4/34) than outpatients (1 %, 1/68) were unable to tolerate two imaging positions (p = 0.02). Subsequent colonoscopy was performed in 24 % (8/34) of inpatients, revealing pathologies including colonic polyps and non-bleeding ulcers. Inpatient CTCs had lower average quality scores, significant for one reviewer (p = 0.009-0.054). Inpatients had a larger number of segments with: >25 % residual fluid (1.22-1.28 inpatients vs. 0.60-0.73 outpatients, p = 0.003-0.026) and inadequate fluid tagging (1.10 inpatients vs. 0.49 outpatients, p = 0.046-0.0501). Distention was not significantly different between groups (p = 0.317-0.410). CONCLUSION/CONCLUSIONS:Quality of inpatient CTC was inferior to outpatient CTCs across several metrics. 24 % undergoing inpatient CTC died of extracolonic causes within 22 months, and most did not have findings warranting intervention, questioning the value of this difficult exam in this patient population. Routine CT may be sufficient to exclude large or metastatic colonic lesions precluding transplant.

BACKGROUND:Minimally invasive focal therapy of low- to intermediate-risk prostate cancer is becoming more common and has demonstrated lower morbidity compared to other treatments. Multiparametric prostate magnetic resonance imaging (mpMRI) has the potential to be an effective posttreatment evaluation method for residual/recurrent neoplasm. OBJECTIVE:This study aimed to evaluate the ability of mpMRI to detect residual/recurrent neoplasm after focal therapy treatment of prostate cancer using a 3-point Likert scale. METHODS:This retrospective study included patients who underwent focal therapy utilizing cryoablation, high-frequency ultrasound, and radiofrequency ablation for low- to intermediate-risk prostate cancer with baseline mpMRI and biopsy and a 6- to 12-month follow-up mpMRI and biopsy. Three abdominal fellowship-trained readers were asked to evaluate the follow-up mpMRI utilizing a 3-point Likert scale based on the level of suspicion as "nonviable," "equivocal," or "viable." Diagnostic statistics and Light's κ for interreader variability were calculated. RESULTS:A total of 142 patients were included (mean age, 65 ± 7 years). When considering "equivocal" or "viable" as positive, the overall sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and area under the receiver operating characteristic curve (AUC) for detecting recurrent grade group (GG) 2 or greater disease for Reader 1 were 0.47, 0.83, 0.24, 0.93, and 0.65; for Reader 2, 0.73, 0.75, 0.26, 0.96, and 0.74; and for Reader 3, 0.73, 0.57, 0.17, 0.95, and 0.65. When considering "viable" as positive, the overall sensitivity, specificity, PPV, NPV, and AUC for Reader 1 were 0.47, 0.92, 0.41, 0.94, and 0.69; for Reader 2, 0.33, 0.97, 0.56, 0.93, and 0.65; and for Reader 3, 0.53, 0.84, 0.29, 0.94, and 0.69. κ was 0.39. CONCLUSIONS:This study suggests that DCE and DWI are the most important sequences in mpMRI and demonstrates the efficacy of utilizing a 3-point grading system in detecting and diagnosing prostate cancer after focal therapy. CLINICAL IMPACT/CONCLUSIONS:mpMRI can be used to monitor for residual/recurrent disease after focal therapy.

OBJECTIVE:To retrospectively compare inter- and intra-reader agreement of abbreviated MRCP (aMRCP) with comprehensive MRI (cMRCP) protocol for detection of worrisome features, high-risk stigmata, and concomitant pancreatic cancer in pancreatic cyst surveillance. METHODS:151 patients (104 women, mean age: 69[10] years) with baseline and follow-up contrast-enhanced MRIs were included. This comprised 138 patients under cyst surveillance with 5-year follow-up showing no pancreatic ductal adenocarcinoma (PDAC), 6 with pancreatic cystic lesion-derived malignancy, and 7 with concomitant PDAC. The aMRCP protocol used four sequences (axial and coronal Half-Fourier Single-shot Turbo-spin-Echo, axial T1 fat-saturated pre-contrast, and 3D-MRCP), while cMRCP included all standard sequences, including post-contrast. Three blinded abdominal radiologists assessed baseline cyst characteristics, worrisome features, high-risk stigmata, and PDAC signs using both aMRCP and cMRCP, with a 2-week washout period. Intra- and inter-reader agreement were calculated using Fleiss' multi-rater kappa and Intra-class Correlation Coefficient (ICC). 95% confidence intervals (CI) were calculated. RESULTS:Cyst size, growth, and abrupt main pancreatic duct transition had strong intra- and inter-reader agreement. Intra-reader agreement was ICC = 0.93-0.99 for cyst size, ICC = 0.71-1.00 for cyst growth, and kappa = 0.83-1.00 for abrupt duct transition. Inter-reader agreement for cyst size was ICC = 0.86 (aMRCP) and ICC = 0.83 (cMRCP), and for abrupt duct transition was kappa = 0.84 (aMRCP) and kappa = 0.69 (cMRCP). Thickened cyst wall, mural nodule and cyst-duct communication demonstrated varying intra-reader agreements and poor inter-reader agreements. CONCLUSION/CONCLUSIONS:aMRCP showed high intra- and inter-reader agreement for most pancreatic cyst parameters that highly rely on T2-weighted sequences.

The visceral vasculature is inextricably intertwined with abdominopelvic disease staging, spread, and management in routine and emergent cases. Comprehensive evaluation requires specialized imaging techniques for abnormality detection and characterization. Vascular pathology is often encountered on nondedicated routine imaging examinations, which may obscure, mimic, or confound many vascular diagnoses. This review highlights normal arterial, portal venous, and systemic venous anatomy and clinically relevant variants; diagnostic pitfalls related to image-acquisition technique and disease mimics; and characteristics of common and rare vascular diseases to empower radiologists to confidently interpret the vascular findings and avoid misdiagnosis.

BACKGROUND:Chronic kidney disease (CKD) is highly prevalent, affecting approximately 11% of U.S. adults. Multiple studies have evaluated a potential association between CKD and urinary tract malignancies. Summary estimates of urinary tract malignancy risk in CKD patients with and without common co-existing conditions may guide clinical practice recommendations. METHODS:Four electronic databases were searched for original cohort studies evaluating the association between CKD and urinary tract cancers (kidney cancer and urothelial carcinoma) through May 25, 2023, in persons with at least moderate CKD and no dialysis or kidney transplantation. Quality assessment was performed for studies meeting inclusion criteria using the Newcastle-Ottawa Scale. Meta-analysis with a random-effects model was performed for unadjusted incidence rate ratios (IRR) as well as adjusted hazard ratios (aHR) for confounding conditions (diabetes, hypertension, and/or tobacco use), shown to have association with kidney cancer and urothelial carcinoma. Sub-analysis was conducted for estimates associated with CKD stages separately. RESULTS:Six cohort studies with 8 617 563 persons were included. Overall, methodological quality of the studies was good. CKD was associated with both higher unadjusted incidence and adjusted hazard of kidney cancer (IRR, 3.36; 95% confidence interval [CI], 2.32-4.88; aHR, 2.04; 95% CI, 1.77-2.36) and urothelial cancer (IRR, 3.96; 95% CI, 2.44-6.40; aHR, 1.40; 95% CI, 1.22-1.68) compared with persons without CKD. Examining incident urinary tract cancers by CKD severity, risks were elevated in stage 3 CKD (kidney aHR, 1.89; 95% CI, 1.56-2.30; urothelial carcinoma aHR, 1.40; 95% CI, 1.18-1.65) as well as in stages 4/5 CKD (kidney cancer aHR, 2.30; 95% CI, 2.00-2.66, UC aHR, 1.24; 95% CI, 1.04-1.49). CONCLUSIONS:Even moderate CKD is associated with elevated risk of kidney cancer and UC. Providers should consider these elevated risks when managing individuals with CKD, particularly when considering evaluation for the presence and etiology of hematuria.