Faculty Bibliography
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547
Comparison of MRI pulse sequences for prediction of size of hepatocellular carcinoma at explant evaluation
OBJECTIVE. The purpose of this study was to retrospectively compare the size of hepatocellular carcinoma (HCC) on images obtained using different MRI pulse sequences with the tumor size determined at pathologic evaluation of liver explant specimens. MATERIALS AND METHODS. Ninety-two patients with HCC who underwent contrast-enhanced liver MRI within 90 days before liver transplant were included. A single pathologist measured the dominant HCC in each case. In different sessions, two abdominal radiologists (readers 1 and 2) aware only of the location of the dominant HCC independently measured lesion size on images obtained using the following sequences: T2-weighted imaging; b-500 diffusion-weighted imaging; and arterial, portal venous, and equilibrium phases of contrast enhancement. Size measurements on MR images were compared with explant measurements by use of Pearson correlation coefficients, paired t tests, and Bland-Altman plots. RESULTS. Correlation with pathologic findings was highest for reader 1 for portal venous (r = 0.890) and equilibrium (r = 0.828) phase images and for reader 2 for arterial, portal venous, and equilibrium phase images (r = 0.842-0.860). Absolute error relative to pathologic size was lowest for reader 1 using portal venous (4.3 mm) and for reader 2 using portal venous and arterial phase images (both 4.7 mm). Systematic error for both readers was lowest with portal venous and equilibrium phase images (reader 1, systematic under-measurement of 0.5 mm in both sequences; reader 2, systematic over-measurement of 0.1 mm with portal venous phase images and systematic under-measurement of 1.1 mm with equilibrium phase images). Sequences in which reader 1 made systematic over-measurements were diffusion-weighted images, arterial phase images, and T2-weighted images (by 3.5, 2.9, and 1.6 mm). Reader 2 made systematic over-measurements using arterial phase and T2-weighted images (by 1.5 and 0.4 mm). CONCLUSION. The data suggest the arterial phase may be suboptimal for measuring HCC at MRI. Portal venous phase acquisition warrants further investigation as a potential standard approach for such measurements.
PMID: 25055263
ISSN: 0361-803x
CID: 1076082
Guest Editorial: The Figley Fellowship-A Window for Junior Radiologists Into the Inner Workings of the AJR [Editorial]
PMID: 24951189
ISSN: 0361-803x
CID: 1050762
Pilot study of a novel tool for input-free automated identification of transition zone prostate tumors using T2- and diffusion-weighted signal and textural features
PURPOSE: To present results of a pilot study to develop software that identifies regions suspicious for prostate transition zone (TZ) tumor, free of user input. MATERIALS AND METHODS: Eight patients with TZ tumors were used to develop the model by training a Naive Bayes classifier to detect tumors based on selection of most accurate predictors among various signal and textural features on T2-weighted imaging (T2WI) and apparent diffusion coefficient (ADC) maps. Features tested as inputs were: average signal, signal standard deviation, energy, contrast, correlation, homogeneity and entropy (all defined on T2WI); and average ADC. A forward selection scheme was used on the remaining 20% of training set supervoxels to identify important inputs. The trained model was tested on a different set of ten patients, half with TZ tumors. RESULTS: In training cases, the software tiled the TZ with 4 x 4-voxel "supervoxels," 80% of which were used to train the classifier. Each of 100 iterations selected T2WI energy and average ADC, which therefore were deemed the optimal model input. The two-feature model was applied blindly to the separate set of test patients, again without operator input of suspicious foci. The software correctly predicted presence or absence of TZ tumor in all test patients. Furthermore, locations of predicted tumors corresponded spatially with locations of biopsies that had confirmed their presence. CONCLUSION: Preliminary findings suggest that this tool has potential to accurately predict TZ tumor presence and location, without operator input.J. Magn. Reson. Imaging 2013; (c) 2013 Wiley Periodicals, Inc.
PMID: 24924512
ISSN: 1053-1807
CID: 1033862
How "consistent" is "consistent"? A clinician-based assessment of the reliability of expressions used by radiologists to communicate diagnostic confidence
AIM: To evaluate the degree of variability in clinicians' interpretation of expressions used by radiologists to communicate their level of diagnostic confidence within radiological reports. MATERIALS AND METHODS: Clinicians were solicited to complete a prospective survey asking them to select the approximate perceived level of certainty, expressed as a percentage, associated with 20 expressions used by radiologists to communicate their level of diagnostic confidence within radiological reports. The median and inter-decile range (IDR) were computed for each expression, with a smaller IDR indicating greater reproducibility. Clinicians were also asked questions regarding their attitudes about radiologists' communication of diagnostic confidence. RESULTS: Forty-nine surveys were completed. Median confidence associated with the expressions ranged from 10-90%. Reproducibility of the expressions was variable, as IDR ranged from 15-53%, although a median IDR of 40% indicated overall poor reproducibility. Expressions with relatively higher reproducibility included "most likely", "likely", and "unlikely" (IDR 15-20%), whereas expressions with relatively lower reproducibility included "compatible with", "suspicious for", "possibly," and "can be seen in the setting of" (IDR >/=45%). Only 20% of clinicians agreed or strongly agreed that radiologists consistently use such expressions within their reports. Fifty-five percent of clinicians preferred that diagnostic confidence be communicated as a percentage rather than as a textual expression. CONCLUSION: There was poor reproducibility in clinicians' interpretations of many expressions used by radiologists to communicate their level of diagnostic confidence. Use of percentages to convey diagnostic confidence within reports may mitigate this source of ambiguity in radiologists' communication with clinicians.
PMID: 24836524
ISSN: 0009-9260
CID: 1032492
Renal masses measuring under 2cm: Pathologic outcomes and associations with MRI features
PURPOSE: To evaluate pathologic outcomes and associations with MRI features in small renal masses measuring up to 20mm METHODS: 86 patients (61+/-13 years; 45M/41F) with 92 renal masses measuring up to 20mm that underwent MRI prior to tissue diagnosis were included. Two radiologists independently evaluated all masses for microscopic lipid, hemorrhage, T2-hyperintensity, T2-homogeneity, cystic/necrotic areas, hypervascularity, enhancement homogeneity, circumscribed margins, and predominantly exophytic location. These MRI features, as well as patient age, gender, and history of RCC, were compared with pathologic findings using Fisher's exact test, unpaired t-test, and multivariate logistic regression. RESULTS: 26.1% (24/92) of masses under 2cm were benign, only 32.6% (30/92) were clear-cell RCC, and only 7.6% (7/92) were high-grade. Among 16 masses measuring up to 1cm, only 12.5% (2/16) were clear-cell RCC, and none was high-grade. Within the entire cohort, no MRI or clinical feature showed a significant difference between benign and malignant lesions (p>/=0.053). However, for both readers, clear-cell RCC exhibited a significantly higher frequency of T2-hyperintensity, cystic/necrotic areas, and hypervascularity, and a significantly lower frequency of hemorrhage, T2-homogeneity, and enhancement homogeneity (p<0.001-0.036). Hypervascularity was a significant independent predictor of clear-cell RCC for both readers (p=0.002-0.007), as was T2-hyperintensity for reader 2 (p=0.007). CONCLUSION: A substantial fraction of small renal masses were benign, and when malignant, largely exhibited indolent pathologic characteristics, particularly when measuring under 1cm Although small benign and malignant masses could not be differentiated on MRI, hypervascularity showed a significant independent association with clear-cell RCC in comparison with other lesions.
PMID: 24882784
ISSN: 0720-048x
CID: 1030572
Journal of the American College of Radiology : JACR. 2014:11(12 Pt A):1178-81.DOI: 10.1016/j.jacr.2014.03.009
Development and Enterprise-Wide Clinical Implementation of an Enhanced Multimedia Radiology Reporting System
PMID: 24855983
ISSN: 1546-1440
CID: 1013092
Comparison of blood pool and extracellular gadolinium chelate for functional MR evaluation of vascular thoracic outlet syndrome
OBJECTIVE: To compare performance of single-injection blood pool agent (gadofosveset trisodium, BPA) against dual-injection extracellular contrast (gadopentetate dimeglumine, ECA) for MRA/MRV in assessment of suspected vascular TOS. MATERIALS AND METHODS: Thirty-one patients referred for vascular TOS evaluation were assessed with BPA (n=18) or ECA (n=13) MRA/MRV in arm abduction and adduction. Images were retrospectively assessed for: image quality (1=non-diagnostic, 5=excellent), vessel contrast (1=same signal as muscle, 4=much brighter than muscle) and vascular pathology by two independent readers, with a separate experienced reader providing reference assessment of vascular pathology. RESULTS: Median image quality was diagnostic or better (score >/=3) for ECA and BPA at all time points, with BPA image quality superior at abduction late (BPA 4.5, ECA 4, p=0.042) and ECA image quality superior at adduction-early (BPA 4.5; ECA 4.0, p=0.018). High qualitative vessel contrast (mean score >/=3) was observed at all time points with both BPA and ECA, with superior BPA vessel contrast at abduction-late (BPA 3.97+/-0.12; ECA 3.73+/-0.26, p=0.007) and ECA at adduction-early (BPA 3.42+/-0.52; ECA 3.96+/-0.14, p<0.001). Readers readily identified arterial and venous pathology with BPA, similar to ECA examinations. CONCLUSION: Single-injection BPA MRA/MRV for TOS evaluation demonstrated diagnostic image quality and high vessel contrast, similar to dual-injection ECA imaging, enabling identification of fixed and functional arterial and venous pathology.
PMID: 24840478
ISSN: 0720-048x
CID: 1003652
Gleason Score 3 + 4=7 Prostate Cancer With Minimal Quantity of Gleason Pattern 4 on Needle Biopsy Is Associated With Low-risk Tumor in Radical Prostatectomy Specimen
A modified Gleason grading system as proposed in the 2005 International Society of Urological Pathology (ISUP) consensus meeting is the current grading system for prostate cancer. With this modified ISUP Gleason grading system, many Gleason score (GS) 6 cancers by the old grading system are upgraded to GS7 cancers on biopsy diagnosis even with minimal quantity (
PMID: 24832163
ISSN: 0147-5185
CID: 996472
Journal of the American College of Radiology : JACR. 2014:11(10):979-83.DOI: 10.1016/j.jacr.2014.03.017
The Radiologist as Direct Public Educator: Impact of Sessions Demystifying Select Cancer Screening Imaging Examinations
PURPOSE: The aim of this report is to describe our early experience with radiologist-led direct public education about imaging-based cancer screening examinations, with a focus on the level of satisfaction and the educational impact reported by session participants. METHODS: Subspecialty radiologists provided 1-hour educational sessions to small lay public audiences covering breast, prostate, and lung cancer screening, focusing on key radiologic screening tests. Subsequently, session participants completed a survey pertaining to their levels of satisfaction and the perceived impact of the sessions on knowledge of the diseases and relevant screening tests; results from all topic sessions were pooled for analysis. RESULTS: One hundred nineteen participants attended a total of 144 sessions. The large majority of respondents agreed or strongly agreed that the sessions increased their understanding (95.4%), they gained information not obtained from clinic visit (88.1%), seeing radiology images helped their understanding (92.6%), they felt more involved in their own care (85.8%), they felt more prepared to undergo screening tests (87.4%), they were satisfied with the sessions' format (93.3%) and content (96.2%), their main questions were answered (88.3%), they would be interested in similar future radiologist-led sessions (88.5%), and they would recommend the sessions to friends (93.9%). The provided information (43.1%) and images (34.7%) were identified as the most helpful aspects of the sessions. CONCLUSION: Radiologist-led direct public education sessions about imaging-based cancer screening examinations yield high levels of audience satisfaction and add value to the public's understanding of the role of radiology and radiologists. Our experience may provide an encouraging model for other radiology practices in pursuing similar endeavors.
PMID: 24814826
ISSN: 1546-1440
CID: 978462
US of Incidental Adnexal Cysts: Adherence of Radiologists to the 2010 Society of Radiologists in Ultrasound Guidelines
Purpose To retrospectively evaluate the adherence of radiologists to the 2010 Society of Radiologists in Ultrasound (SRU) guidelines for management of adnexal cysts. Materials and Methods One radiologist reviewed the interpreting radiologists' reports for 398 adnexal cysts detected at ultrasonography in 398 patients (mean age +/- standard deviation, 41.1 years +/- 14.3; range, 18-87 years) and classified the management recommendations according to adherence to SRU guidelines. Recommendations that were not adherent were classified as overmanagement, undermanagement, or incomplete. The effects of menopausal status, cyst size and other features, and the individual interpreting radiologist on adherence were assessed by using chi(2) tests, and the association of these factors with over- and undermanagement was identified. Results Overall adherence was 59%; overmanagement, 27%; undermanagement, 9%; and incomplete, 6%. Menopausal status, cyst size, and other cyst features significantly affected adherence (P < .001). For evaluation of premenopausal patients, adherence was 63% (overmanagement, 30%) and of postmenopausal patients, 42% (undermanagement, 26%). For evaluation of cysts 1-3 cm in size, adherence was 65% (overmanagement, 21%); for cysts 3-5 cm, 33% (overmanagement, 49%); for cysts 5-7 cm, 47% (overmanagement, 20%); for cysts larger than 7 cm, 77% (over- and undermanagement, 12% each). Recommendations were adherent in most instances for corpora lutea (88%), simple cysts (56%), and cysts suggestive of benign diagnosis (60%), or with a nodule or multiple thin or thick septations (60%-100%). Cysts with recommentations for overmanagement in most instances were hemorrhagic (59%) and those with a single thin septation (67%); 31% of cysts measuring 1-7 cm in postmenopausal patients were undermanaged. Adherence varied significantly among radiologists (40%-75% adherence among radiologists who interpreted 20 or more examinations; P = .004). Conclusion Adherence to SRU guidelines for management of adnexal cysts at our institution was 59%. Overmanagement generally occurred for physiologic cysts in premenopausal patients; undermanagement was observed for simple cysts in postmenopausal patients. (c) RSNA, 2013.
PMID: 24475836
ISSN: 0033-8419
CID: 931772
