Faculty Bibliography

Cavernous hemangiomas are among the most common liver lesions encountered in abdominal imaging. While classical imaging characteristics usually aid the radiologist in confidently arriving at its diagnosis, atypical hemangiomas can prove to be difficult to distinguish from other more worrisome hepatic lesions such as metastases and hepatocellular carcinoma. Furthermore, some malignant lesions can display features that simulate hemangiomas. The radiologist must be aware of these pitfalls to make an accurate diagnosis, when possible.

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.

The visceral organs of the male pelvis have complex anatomic relationships with the surrounding extraperitoneal spaces, supplying arteries and adjacent pelvic musculature. Since various neoplastic, vascular, and traumatic pathologies can often involve multiple organs and spread into adjacent pelvic spaces, a keen understanding of this intricate anatomy can help radiologists to accurately characterize findings and improve recognition of the routes in which these conditions can spread. The purpose of this review is to examine the relationships between the anatomic compartments of the pelvic extraperitoneal space, summarize the pelvic arterial anatomy, and identify the pelvic muscles that support normal genitourinary function.

Endometriosis is a common entity causing chronic pain and infertility in women. The gold standard method for diagnosis is diagnostic laparoscopy, which is invasive and costly. MRI has shown promise in its ability to diagnose endometriosis and its efficacy for preoperative planning. The Society of Abdominal Radiology established a Disease-Focused Panel (DFP) to improve patient care for patients with endometriosis. In this article, the DFP performs a literature review and uses its own experience to provide technical recommendations on optimizing MRI Pelvis for the evaluation of endometriosis.

Endometriosis is a chronic, multifocal disease, which can lead to pain or subfertility. Treatments are tailored toward the therapeutic goals of the individual patient; either to improve a specific pain symptom or optimize fertility. Management of endometriosis is complex, and best implemented by a comprehensive, multidisciplinary team of physicians and health care providers. The role of the radiologist in the management of endometriosis is becoming increasingly important as more centers move toward utilizing female pelvic MR studies to diagnose, delineate or follow endometriosis lesions. The radiologist must communicate pertinent, actionable findings from these studies in a manner that is clear and concise. Structured radiologic reports (SRR) add value in that they provide organized, clear, and comprehensive information from imaging studies, ensuring reports include essential items required for decision-making. In this paper, we review our MR imaging protocol and present the structured radiologic report implemented at our institution by our multidisciplinary endometriosis care team. Imaging features of endometriosis at each site specified in the structured report are summarized. The importance of each element included in the structured report from a management perspective is highlighted.

Endometriosis is a common gynecologic disorder characterized by the presence of ectopic endometrial tissue outside the endometrial cavity. Magnetic Resonance Imaging (MRI) has become a mainstay for diagnosis and staging of this disease. In the literature, significant heterogeneity exists in the descriptions of imaging findings and anatomic sites of involvement. The Society of Abdominal Radiology's Endometriosis Disease-Focused Panel presents this consensus document to establish an MRI lexicon for endometriosis MRI evaluation and anatomic localization.

Adverse event (AE) reporting is a key component of patient safety and physicians are known to underreport. The authors hypothesized that integrating AE reporting into a mobile application used in daily physician workflow would increase physician reporting of AEs. After integrating AE reporting into a free-text mobile application used for daily workflow, the change in AE reporting by physicians was analyzed using Mann-Whitney U tests. AE reporting by physicians increased more than 37-fold (21 to 806; U = 7.5, P < .0001). AE reporting by physicians as a proportion of all AE reports received increased 120-fold (from 0.1% to 12% of all reports, U = 10, P < .0001). Integrating AE reporting into a free-text mobile application used in daily physician workflow markedly increased their reporting of AEs. This approach shifted time burden from physicians to quality officers. Implementation should be coupled with physician education about identifying AEs and content to include in reports.

PURPOSE/OBJECTIVE:To evaluate whole-lesion 3D-histogram apparent diffusion coefficient (ADC) metrics for assessment of pancreatic malignancy. METHODS:Forty-two pancreatic malignancies (36 pancreatic adenocarcinoma [PDAC], 6 pancreatic neuroendocrine [PanNET]) underwent abdominal magnetic resonance imaging (MRI) with diffusion-weighted imaging before endoscopic ultrasound biopsy or surgical resection. Two radiologists independently placed 3D volumes of interest to derive whole-lesion histogram ADC metrics. Mann-Whitney tests and receiver operating characteristic analyses were used to assess metrics' diagnostic performance for lesion histology, T-stage, N-stage, and grade. RESULTS:), for reader 1 a threshold <1.17 achieved sensitivity 87% and specificity 67%, and for reader 2 a threshold <1.04 achieved sensitivity 87% and specificity 83%. No metric was associated with T-stage (P > .195) or grade (P > .215). CONCLUSION/CONCLUSIONS:outperformed standard mean for lesion histology and nodal status, supporting the role of histogram analysis.

PURPOSE/OBJECTIVE:To determine the utility of an automated radiology-pathology feedback tool. METHODS:We previously developed a tool that automatically provides radiologists with pathology results related to imaging examinations they interpreted. The tool also allows radiologists to mark the results as concordant or discordant. Five abdominal radiologists prospectively scored their own discordant results related to their previously interpreted abdominal ultrasound, CT, and MR interpretations between August 2017 and June 2018. Radiologists recorded whether they would have followed up on the case if there was no automated alert, reason for the discordance, whether the result required further action, prompted imaging rereview, influenced future interpretations, enhanced teaching files, or inspired a research idea. RESULTS:There were 234 total discordances (range 30-66 per radiologist), and 70.5% (165 of 234) of discordances would not have been manually followed up in the absence of the automated tool. Reasons for discordances included missed findings (10.7%; 25 of 234), misinterpreted findings (29.1%; 68 of 234), possible biopsy sampling error (13.3%; 31 of 234), and limitations of imaging techniques (32.1%; 75/234). In addition, 4.7% (11 of 234) required further radiologist action, including report addenda or discussion with referrer or pathologist, and 93.2% (218 of 234) prompted radiologists to rereview the images. Radiologists reported that they learned from 88% (206 of 234) of discordances, 38.6% (90 of 233) of discordances probably or definitely influenced future interpretations, 55.6% (130 of 234) of discordances prompted the radiologist to add the case to his or her teaching files, and 13.7% (32 of 233) inspired a research idea. CONCLUSION/CONCLUSIONS:Automated pathology feedback provides a valuable opportunity for radiologists across experience levels to learn, increase their skill, and improve patient care.

Pyelonephritis refers to infection involving the renal parenchyma and renal pelvis. In most patients, uncomplicated pyelonephritis is diagnosed clinically and responds quickly to appropriate antibiotic treatment. If treatment is delayed, the patient is immunocompromised, or for other reasons, microabscesses that form during the acute phase of pyelonephritis may coalesce, forming a renal abscess. Patients with underlying diabetes are more vulnerable to complications, including emphysematous pyelonephritis in addition to abscess formation. Additionally, diabetics may not have the typical flank tenderness that helps to differentiate pyelonephritis from a lower urinary tract infection. Additional high-risk populations may include those with anatomic abnormalities of the urinary tract, vesicoureteral reflux, obstruction, pregnancy, nosocomial infection, or infection by treatment-resistant pathogens. Treatment goals include symptom relief, elimination of infection to avoid renal damage, and identification of predisposing factors to avoid future recurrences. The primary imaging modalities used in patients with pyelonephritis are CT, MRI, and ultrasound. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.