Faculty Bibliography

Three-dimensional (3D) US is an invaluable, rapidly evolving tool in gynecologic imaging. This examination, comparable to CT and MRI, enables volumetric data to be obtained, reconstructed, and displayed in multiple planes. It also enables the sonologist to better understand the spatial and anatomic relationships of uterine and adnexal abnormalities, thereby improving diagnostic accuracy. Three-dimensional US can be performed routinely following a two-dimensional (2D) transabdominal and/or transvaginal US examination or as an adjunctive troubleshooting technique, since no additional patient preparation is necessary. Performing additional 3D imaging adds only a few minutes to the original examination time while yielding information that is useful for reaching a diagnosis. Multiplanar reconstruction of volumetric data in the midcoronal plane is the cornerstone for diagnosing congenital uterine anomalies, as it allows visualization of the external uterine contour and shape of the endometrial cavity. It also enables early detection of endomyometrial junction abnormalities such as adenomyosis and focal adenomyomas. Combined with 3D power Doppler imaging, 3D US may help differentiate endometrial polyps, submucosal fibroids, endometrial hyperplasia, and endometrial carcinoma, aiding in clinical decision making. This examination also facilitates accurate localization of fibroids relative to the endometrial cavity and serosal surface of the uterus. The authors review the technique for acquisition of 3D volume datasets, image reconstruction, and new software techniques for data postprocessing that are applicable to gynecologic imaging. In addition, scenarios in which the addition of 3D US provides an advantage over routine 2D US, including imaging of congenital uterine anomalies, fibroid localization, and differentiation of endometrial diseases, are highlighted. ^©RSNA, 2025 Supplemental material is available for this article.

BACKGROUND:For many common malignancies, including breast cancer, evaluation for metastatic disease using multiphase computed tomography (CT) has fallen out of favor and been replaced by studies performed only in the portal venous phase. However, differences in tumor vascularity could produce differences in appearance on post-contrast imaging. PURPOSE/OBJECTIVE:To assess non-contrast phase and portal venous phase computed tomography in detection and measurement of hepatic metastases from breast carcinoma. MATERIALS AND METHODS/METHODS:A total of 75 CT scans from 52 breast cancer patients were independently assessed by three body imagers for lesion presence, number and size. Readers randomly assessed portal venous phase or combined phase images at one session with cross-over reads performed four to six weeks later. RESULTS:In the 58% of cases where index lesions measured larger on combined phase, the mean difference in lesion size was 5.7 mm. In this group, combined phase reads demonstrated an 8.4 mm increase in sum of largest diameters, and a mean percentage sum of largest diameters increase of 19% compared to portal venous phase-only reads. CONCLUSION/CONCLUSIONS:Addition of non-contrast phase images results in increased index lesion size in most patients with hepatic metastases from breast cancer. If only the portal venous phase is utilized, there is potential for incorrectly diagnosing disease progression on follow-up due to underestimation of lesion size.

OBJECTIVE:The objective of this study was to assess renal lesions measuring less than 20 Hounsfield units (HU) on noncontrast computed tomography (NCT). METHODS:Twenty-one (18.1%) of 116 consecutive pathologically proven renal cell carcinomas measured less than 20 HU on NCT and were compared with 40 confirmed benign cysts also measuring less than 20 HU. All lesions were assessed qualitatively (heterogeneous or homogenous) by 3 blinded readers and quantitatively with commercially available textural analysis software. Finally, a combined assessment was performed. RESULTS:Qualitative assessment performed well (sensitivity, 76%-90%; specificity, 70%-88%). Quantitative assessment revealed mean positive pixels as having the highest performance (area under the curve, 0.912; sensitivity, 90%; specificity, 80% at a cutoff value of 21). The combined assessment, using the mean positive pixel cutoff, improved the sensitivity (reader 1, 100%; reader 2, 95%; and reader 3, 95%). CONCLUSION/CONCLUSIONS:Qualitative and quantitative assessments have relatively good performance, but the combination can nearly eliminate renal cell carcinomas being missed on NCT.

PURPOSE/OBJECTIVE:To assess quantitative and qualitative effects of kVp on oral contrast density. MATERIALS AND METHODS/METHODS:Three readers retrospectively reviewed 100 CT scans performed at a range of high- and low-energy settings, independently determining their preferred window and level settings for evaluation of the oral-contrast-opacified bowel. Contrast density was also assessed quantitatively in the stomach, jejunum, and ileum. Subsequently, a range of oral contrast dilutions were imaged at varying kVp's in a commercially available CIRS tissue equivalent phantom model. RESULTS:In the retrospective patient study, mean oral contrast density increased significantly in the ileum compared to the jejunum (455.2 and 308.8 HU, respectively, p < 0.01). Similar findings were seen in patients regardless of patients' weight. Mean oral contrast density was higher on lower-energy scans, requiring more window/level adjustment. An oral contrast iodine concentration of 5.82-7.77 mg I/mL most closely approximated a target oral contrast density of 200 HU. CONCLUSIONS:Oral contrast density is strongly influenced by kVp, supporting use of more dilute oral contrast when using lower-kVp techniques.

OBJECTIVE:To identify performance of imaging features in differentiating hepatic cysts from biliary cystadenomas of the liver. METHODS:25 pathologically confirmed hepatic cystic lesions (hepatic cysts or biliary cystadenomas) were evaluated retrospectively and predetermined imaging features assessed for performance in differentiation. RESULTS:Any septation which arose from a cyst wall without external indentation had a very high association with biliary cystadenoma, while the presence of a thick septation had only a moderate association. CONCLUSIONS:The relationship between septations and the wall of the cystic lesion performed better than previously reported features including thick septations.

We present a case of appendicitis within a De Garengeot hernia. The patient presented to the emergency department with 4 days of worsening abdominal pain. Computed tomography examination revealed an inflamed appendix within a femoral hernia. The patient underwent appendectomy and repair of the femoral defect. Pathological examination was consistent with acute appendicitis. De Garengeot hernia is a rare phenomenon, with less than 5% of femoral hernias containing the appendix and 0.08% to 0.13% containing an incarcerated acute appendicitis.

PURPOSE/OBJECTIVE:To determine the benefit of the addition of low-fidelity simulation-based training to the standard didactic-based training in teaching radiology residents common CT-guided procedures. METHODS:This was a prospective study involving 24 radiology residents across all years in a university program. All residents underwent standard didactic lecture followed by low-fidelity simulation-based training on three common CT-guided procedures: random liver biopsy, lung nodule biopsy, and drain placement. Baseline knowledge, confidence, and performance assessments were obtained after the didactic session and before the simulation training session. Approximately 2 months later, all residents participated in a simulation-based training session covering all three of these procedures. Knowledge, confidence, and performance data were obtained afterward. These assessments covered topics related to preprocedure workup, intraprocedure steps, and postprocedure management. Knowledge data were collected based on a 15-question assessment. Confidence data were obtained based on a 5-point Likert-like scale. Performance data were obtained based on successful completion of predefined critical steps. RESULTS:There was significant improvement in knowledge (P = .005), confidence (P < .008), and tested performance (P < .043) after the addition of simulation-based training to the standard didactic curriculum for all procedures. CONCLUSIONS:This study suggests that the addition of low-fidelity simulation-based training to a standard didactic-based curriculum is beneficial in improving resident knowledge, confidence, and tested performance of common CT-guided procedures.

PURPOSE/OBJECTIVE:The aim of this study was to determine whether a self-referred population screened by an interventional radiology (IR) clinic and a non-IR, physician-referred population differed with regard to suitability for uterine artery embolization (UAE) for symptomatic leiomyomas on the basis of preprocedure MRI. METHODS:This was an institutional review board-approved, HIPAA-compliant retrospective study of 301 women evaluated in an IR clinic for possible UAE from January 2009 to September 2012. Subjects were retrospectively divided into two groups: self-referred via direct marketing (group A, n = 203; mean age, 41.8 years; range, 22-58 years) and physician referred (group B, n = 98; mean age, 42.9 years; range, 30-65 years). RESULTS:There was no significant difference between groups in presenting symptoms (multiple symptoms, bleeding, bulk-related symptoms, pain). After initial screening, 73.4% of group A (149 of 203) and 79.6% of group B (78 of 98) underwent MRI (P = .242). On the basis of MRI findings, 91.3% of group A (136 of 149) and 94.9% of group B (74 of 78) had uterine leiomyomas (P = .328). Adenomyosis without leiomyoma was present in 4.0% of group A (6 of 149) and 3.8% of group B (3 of 78) (P = .947). Incidental findings requiring further clinical or imaging evaluation were found in 20.8% of group A (31 of 149) and 24.4% of group B (19 of 78) (P = .539). After MRI, 41.6% of group A (62 of 149) and 48.7% of group B (38 of 78) proceeded to UAE (P = .306). CONCLUSIONS:After initial screening, similar proportions of self-referred and physician-referred patients were candidates for UAE. The rates of confirmed leiomyomas and incidental findings on MRI were similar between groups.

OBJECTIVES/OBJECTIVE:To evaluate optimal window settings for display of virtual monoenergetic reconstructions in third-generation dual-source, dual-energy computed tomography (DECT) of the liver. METHODS:Twenty-nine subjects were prospectively evaluated with DECT in arterial (AP) and portal venous (PVP) phases. Three reconstructed datasets were calculated: standard linearly-blended (LB120), 70-keV standard virtual monoenergetic (M70), and 50-keV advanced image-based virtual monoenergetic (M50+). Two readers assessed optimal window settings (width and level, W/L), establishing a mean for each reconstruction which was used for a blinded assessment of liver lesions. RESULTS:The optimal W/L for M50+ were significantly higher for both AP (W=429.3 ± 44.6 HU, L=129.4 ± 9.7 HU) and PVP (W=376.1 ± 14.2HU, L=146.6 ± 7.0 HU) than for LB120 (AP, W=215.9 ± 16.9 HU, L=82.3 ± 9.4 HU) (PVP, W=173.4 ± 8.9 HU, L=69.3 ± 6.0 HU) and M70 (AP, W=247.1 ± 22.2 HU, L=72.9 ± 6.8 HU) (PVP, W=232.0 ± 27.9 HU, L=91.6 ± 14.4 HU). Use of the optimal window setting for M50+ vs. LB120 resulted in higher sensitivity (AP, 100% vs. 86%; PVP, 96% vs. 63%). CONCLUSIONS:Application of dedicated window settings results in improved liver lesion detection rates in advanced image-based virtual monoenergetic DECT when customized for arterial and portal venous phases.