Faculty Bibliography

AIM: To retrospectively evaluate the prevalence of pelvic organ prolapse as an incidental finding on dynamic magnetic resonance imaging (MRI) using two different references lines. MATERIALS AND METHODS: Sixty women with symptoms unrelated to pelvic floor dysfunction who underwent MRI including a dynamic sagittal true fast imaging with steady-state free precession (TrueFISP) sequence during straining were identified. Two radiologists in consensus used the pubococcygeal line (PCL) and mid-pubic line (MPL) to diagnose and grade prolapse in all three pelvic compartments. RESULTS: Cystocele was absent, mild, moderate, and severe in 88% (53/60), 7% (4/60), 5% (3/60), and 0% (0/60) of patients, respectively, using PCL, versus 78% (47/60), 13% (8/60), 5% (3/60), and 3% (2/60) of patients, respectively, using MPL. Vaginal prolapse was absent, mild, moderate, and severe in 95% (57/60), 5% (3/60), 0% (0/60), and 0% (0/60) of patients, respectively, using PCL, versus 80% (48/60), 17% (10/60), 3% (2/60), and 0% (0/60) of patients, respectively, using MPL. Rectal descent was absent, mild, moderate, and severe in 63% (38/60), 10% (6/60), 23% (14/60), and 3% (2/60) of patients, respectively, using PCL, versus 43% (26/60), 27% (16/60), 27% (16/60), and 3% (2/60) of patients, respectively, using MPL. No enterocele, peritoneocele, or muscular defect was identified. Two percent (1/60) of patients had mild rectocele, 8% (5/60) had abnormal vesico-urethral angle, and 25% (15/60) had abnormal levator plate angle. CONCLUSION: In asymptomatic women, dynamic MRI identified the greatest degrees of prolapse in the posterior compartment. The MPL consistently yielded greater frequency of prolapse than the PCL. Findings of pelvic organ prolapse may be observed in asymptomatic patients and are of uncertain significance, requiring correlation with clinical and physical examination findings.

PURPOSE: A 2008 federal report expressed concern regarding substantial regional variation in imaging expenditures. The aims of this study were to evaluate trends in regional variation in Medicare imaging utilization and expenditures from 2007 to 2011 and to compare these trends with regional variation in other health service categories. METHODS: Data were based on CMS's Chronic Condition Data Warehouse and organized on the basis of 306 US health referral regions (HRRs). Imaging costs per beneficiary, standardized for regional differences in reimbursement rates, and imaging utilization per beneficiary were recorded per HRR from 2007 through 2011. Costs and utilization were also recorded for other service categories in 2011. Regional variation was assessed via relative risk (RR; the ratio between the highest and lowest HRRs) and coefficient of variation (CV; the standard deviation divided by the mean among all HRRs). Correlations between imaging and other service categories were assessed using Pearson's correlation coefficient. RESULTS: There was minimal change in regional variation in imaging costs or utilization between 2007 and 2011. Regional variation in imaging costs (RR, 5.70-5.88; CV, 33.0%-33.3%) was considerably greater than variation in imaging utilization (RR, 2.11%-2.25%; CV, 14.2%-14.6%). Imaging costs and utilization showed moderate to strong correlations with those of other service categories (r = 0.572-0.869). In 2011, regional variation in imaging utilization (RR, 2.25; CV, 14.2%) was considerably lower than variation in utilization of other service categories (RR, 2.80-10.78; CV, 20.9%-33.3%). CONCLUSIONS: Regional variation in imaging utilization is considerably lower than both variation in imaging costs and variation in utilization of other major service categories. It is unclear whether variation in imaging utilization provides an optimal individual target for major policy decisions.

OBJECTIVE. In this article, we describe 10 diagnostic challenges that may confound the interpretation of multiparametric prostate MRI for tumor, grouped into three categories on the basis of our experience: normal anatomic structures that may be misinterpreted as suspicious lesions if their normal appearance is not recognized, benign processes that may mimic tumor, and technical issues relating to acquisition and interpretation of diffusion-weighted imaging that may decrease sensitivity for tumor. Strategies for addressing these challenges are suggested. CONCLUSION. It is important that the radiologist involved in the interpretation of prostate MRI be aware of these pitfalls that will be encountered during routine clinical practice. This awareness can contribute to improved diagnostic performance in MRI interpretation.

OBJECTIVE. In this article, we provide our perspective on current multiinstitutional efforts to improve standardization of interpretation and reporting of multiparametric prostate MRI, emphasizing their strengths and limitations based on our experiences, and provide several suggestions for guiding continued initiatives for standardizing multiparametric prostate MRI reporting. CONCLUSION. Significant steps are being taken to facilitate the adoption of prostate MRI by urologists and other physicians in the community. Ultimately, however, prospective multicenter validation studies assessing the various aspects of a diagnostic test will be required.