Faculty Bibliography

PURPOSE/OBJECTIVE:While pelvic congestion syndrome and chronic pelvic pain are relatively common in women, no large- or medium-sized studies have been conducted to our knowledge to evaluate the frequency and severity of ovarian vein dilatation (OVD) on computed tomography (CT). The purpose of our study was therefore to analyze a large number of consecutive abdominal and pelvic CT scans in adult women to determine OVD frequency and severity. METHODS:An IRB-approved, single-institution retrospective analysis of 1042 consecutive abdominal and pelvic CT scans in women ages 25-65 was performed. Scans were evaluated for the presence and severity of OVD and association with "nutcracker anatomy." A gradation scheme was developed based on quartile analysis. RESULTS:143 of the CT scans had OVD (13.7%). Of the positive scans, 96 were bilateral, 29 were left-side only, 18 were right-side only, and 18 had nutcracker-type compression of the left renal vein (14.4% of scans with left or bilateral OVD). In positive scans, the mean and median left OVD were 7.5 and 7 mm, respectively, and right-side were 7.2 and 7 mm, respectively. Based on quartile analysis, OVD grading was mild (< 6 mm), moderate (6-8 mm), or severe (> 8 mm), with moderate including the middle 50% of patients. CONCLUSIONS:OVD was found on 13.7% of 1042 consecutive female abdominal and pelvic CT scans, with "nutcracker anatomy" present in 14.4% of the scans with left OVD. Moderate dilatation was defined as an OVD of 6-8 mm at the iliac crests.

Obesity is a growing problem around the world, and radiology departments frequently encounter difficulties related to large patient size. Diagnosis and management of suspected venous thromboembolism, in particular deep venous thrombosis (DVT) and pulmonary embolism (PE), are challenging even in some lean patients, and can become even more complicated in the setting of obesity. Many obstacles must be overcome to obtain imaging examinations in obese patients with suspected PE and/or DVT, and to ensure that these examinations are of sufficient quality to diagnose or exclude thromboembolic disease, or to establish an alternative diagnosis. Equipment limitations and technical issues both need to be acknowledged and addressed. Table weight limits and scanner sizes that readily accommodate obese and even morbidly obese patients are not in place at many clinical sites. There are also issues with image quality, which can be substantially compromised. We discuss current understanding of the effects of patient size on imaging in general and, more specifically, on the imaging modalities used for the diagnosis and treatment of DVT and PE. Emphasis will be placed on the technical parameters and protocol nuances, including contrast dosing, which are necessary to refine and optimize images for the diagnosis of DVT and PE in obese patients, while remaining cognizant of radiation exposure. More research is necessary to develop consistent high-level evidence regarding protocols to guide radiologists, and to help them effectively utilize emerging technology.

Although a broad spectrum of entities can induce acute pathologic changes in the small bowel, there are relatively few imaging features that are characteristic of a specific diagnosis on the basis of CT findings. Specific clinical information, including time course and onset of disease, patient risk factors, and any recent pharmacologic or radiation therapy, is often instrumental in refining the differential diagnosis. A wide spectrum of disorders is reviewed in this article; however, given the breadth of disorders associated with the small bowel, neoplastic and infectious conditions affecting the small bowel that can manifest acutely are not specifically discussed. Vascular diseases that can affect the small bowel regionally or diffusely, including thromboembolic and hypoperfusion phenomena, as well as a spectrum of vasculitides, are reviewed. Iatrogenic causes of small bowel disorders are discussed, including angiotensin-converting enzyme inhibitor-induced angioedema, and chemotherapy- and radiation therapy-associated patterns of disease. Autoimmune and hereditary conditions that can affect the small bowel, including systemic lupus erythematosus and genetic C1 esterase inhibitor deficiency, respectively, are reviewed. ^©RSNA, 2018.

OBJECTIVE:Common fetal anomalies of the kidneys and urinary tract encompass a complex spectrum of abnormalities that can be detected prenatally by ultrasound. Common fetal anomalies of the kidneys and urinary tract can affect amniotic fluid volume production with the development of oligohydramnios or anhydramnios, resulting in fetal pulmonary hypoplasia and, potentially, abnormal development of other fetal structures. CONCLUSION/CONCLUSIONS:We provide an overview of common fetal anomalies of the kidneys and urinary tract with an emphasis on sonographic patterns as well as pathologic and postnatal correlation, along with brief recommendations for postnatal management. Of note, we render an updated classification of fetal abnormalities of the kidneys and urinary tract based on the presence or absence of associated urinary tract dilation. In addition, we review the 2014 classification of urinary tract dilation based on the Linthicum multidisciplinary consensus panel.

PURPOSE/OBJECTIVE:To examine trends in female authorship in the journal Emergency Radiology from January 1994 to December 2014. METHODS:We obtained institutional review board approval for our study. We retrospectively reviewed a total of 1617 articles published in the journal Emergency Radiology over a 20-year period. Original articles, case reports, review articles, and pictorial essays were included. The first and last position author's gender was categorized as female or male. We analyzed trends by comparing the first and last position authors of original articles from the first and last year reviewed. We utilized Chi-square test for statistical analysis, with a p value <0.05 noted as significant. RESULTS:One thousand four hundred twenty articles met our inclusion criteria. There were 1420 first position authors and 1295 last position authors. There were 125 articles that had a sole author-these authors were considered as first position authors only. We determined, as best as possible, the gender of 96% of the authors. Overall, female authors were 21% of first position authors (290 of 1368) and 15% of last position authors (183 of 1246). Thirty-two percent of articles with female last position authors also had female first position authors (58 of 183). There was a statistically significant increase in female last position authors, from 12.9% in 1994 to 21.3% in 2014 (p = 0.026), a non-significant increase in female first position authors, from 17.5% in 1994 to 20.9% in 2014 (p = 0.514), and a non-significant increase in articles with both a first and last female author, from 25% in 1994 to 35% in 2014 (p = 0.593). CONCLUSION/CONCLUSIONS:Over the last 20 years, there has been a statistically significant upward trend in female last position authors publishing in the journal Emergency Radiology.

Ureteral injuries are uncommon in trauma patients, accounting for fewer than 1% of all injuries to the urinary tract. These uncommon, yet problematic, injuries can often be overlooked in the standard search pattern on abdominal and pelvic multi-detector CT (MDCT) images, as radiologists focus on more immediate life-threatening injuries. However, early diagnosis and management are vital to reduce potential morbidity. If there is a high clinical index of suspicion for ureteral injuries with penetrating or blunt trauma, or if there is suspected iatrogenic ureteral injury, delayed-phase/urographic-phase MDCT images are essential for confirming the diagnosis. Moreover, making the distinction between partial and complete ureteral transection is critical, as it will guide management. The aim of this pictorial review is to overview the key imaging findings in blunt and penetrating traumatic and iatrogenic injuries of the ureter, as well as to discuss the advantages and disadvantages of different imaging modalities for accurately and rapidly establishing or excluding the diagnosis of ureteral injuries, with an emphasis on MDCT. The potential causes of missed ureteral injuries will also be discussed.

The failure to diagnose acute appendicitis (AA) is the third most common medical malpractice allegation related to gastrointestinal disease. There is a paucity of detailed data on this topic; however, publications by Whang et al and by Berlin and Berlin, which analyzed all types of malpractice suits against radiologists, have shown that the incidence of litigation has increased over time in the United States. This is likely true for cases of AA as well. The misinterpretation of cross-sectional imaging in patients with suspected appendicitis may be caused by suboptimal technique, errors of omission, i.e, missing key findings, failure to review a portion of the examination, and satisfaction of search error. This article summarizes the published legal, clinical, and imaging literature regarding litigation in cases of missed AA, and reviews optimized multidetector computed tomography and magnetic resonance imaging protocols for the diagnosis of AA, with examples shown of challenging cases.