Natural History, Clinical Significance, and the Role of Vascular Referral in the Management of Penetrating Ulcers of the Abdominal Aorta.

Background: Penetrating ulcers of the abdominal aorta (PUAA) are an increasingly common finding on abdominal imaging studies; however, their significance and natural history are not well described. This study's objective was to analyze the demographics, presentation, and outcomes of patients with a radiographic diagnosis of PUAA.

Materials And Methods: Patients at our tertiary referral center were identified for inclusion based on a search for the term "penetrating ulcer" in abdominal computed tomography and magnetic resonance imaging reports between January 2014 and December 2017.

Process Improvement for Communication and Follow-up of Incidental Lung Nodules.

Objective: Guideline-concordant follow-up of incidental lung nodules (ILNs) is suboptimal. We aimed to improve communication and tracking for follow-up of these common incidental findings detected on imaging examinations.

Methods: We implemented a process improvement program for reporting and tracking ILNs at a large urban academic health care system.

Natural Language Processing for Identification of Incidental Pulmonary Nodules in Radiology Reports.

Purpose: To develop natural language processing (NLP) to identify incidental lung nodules (ILNs) in radiology reports for assessment of management recommendations.

Methods And Materials: We searched the electronic health records for patients who underwent chest CT during 2014 and 2017, before and after implementation of a department-wide dictation macro of the Fleischner Society recommendations. We randomly selected 950 unstructured chest CT reports and reviewed manually for ILNs.

Informatics Solutions for Driving an Effective and Efficient Radiology Practice.

Radiologists are facing increasing workplace pressures that can lead to decreased job satisfaction and burnout. The increasing complexity and volumes of cases and increasing numbers of noninterpretive tasks, compounded by decreasing reimbursements and visibility in this digital age, have created a critical need to develop innovations that optimize workflow, increase radiologist engagement, and enhance patient care. During their workday, radiologists often must navigate through multiple software programs, including picture archiving and communication systems, electronic health records, and dictation software.

Downstream Costs Associated With Incidental Pancreatic Cysts Detected at MRI.

Objective: The purpose of this study is to assess downstream costs associated with pancreatic cysts incidentally detected at MRI.

Materials And Methods: Two hundred patients with an incidental pancreatic cyst detected at MRI were identified. Downstream events (imaging, office visits, endoscopic ultrasound-guided fine-needle aspiration, or chemotherapy) were identified from the electronic medical record.

Downstream Costs Associated with Incidental Pulmonary Nodules Detected on CT.

Rationale And Objectives: To explore downstream costs associated with incidental pulmonary nodules detected on CT.

Materials And Methods: The cohort comprised 200 patients with an incidental pulmonary nodule on chest CT. Downstream events (chest CT, PET/CT, office visits, percutaneous biopsy, and wedge resection) were identified from the electronic medical record.

Science to Practice: IT Solutions to Drive Standardized Report Recommendations for Abdominal Aortic Aneurysm Surveillance.

Inadequate imaging surveillance has been identified as the most significant contributor to abdominal aortic aneurysm (AAA) rupture. Radiologists can contribute value to patient care and reduce morbidity and mortality related to AAA by incorporating evidence-based management recommendations from the ACR and Society of Vascular Surgery into their report impression. The challenges lie in achieving 100% radiologist compliance to incorporate the recommendations and ensuring that the patient is notified by their provider, the follow-up examination is scheduled, and the patient returns for an imaging test that may be scheduled 3 to 5 years in the future.

Variation in Downstream Relative Costs Associated With Incidental Ovarian Cysts on Ultrasound.

Purpose: To explore variation in downstream relative costs associated with ovarian cysts incidentally detected on ultrasound.

Methods: For 200 consecutive incidental ovarian cysts on ultrasound, ultrasound reports were classified in terms of presence of a radiologist recommendation for additional imaging. All downstream events (imaging, office visits, and surgery) associated with the cysts were identified from the electronic health record.

A Multidisciplinary Approach to Improving Appropriate Follow-Up Imaging of Ovarian Cysts: A Quality Improvement Initiative.

Purpose: Incidental ovarian cysts are frequently detected on imaging. Despite published follow-up consensus statements, there remains variability in radiologist follow-up recommendations and clinician practice patterns. The aim of this study was to evaluate if collaborative ovarian cyst management recommendations and a radiologist decision support tool can improve adherence to follow-up recommendations.

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.

Comparison of nonenhanced MR angiographic subtraction techniques for infragenual arteries at 1.5 T: a preliminary study.

Purpose: To evaluate diagnostic performance of three nonenhanced methods: variable-refocusing-flip angle (FA) fast spin-echo (SE)-based magnetic resonance (MR) angiography (variable FA MR) and constant-refocusing-FA fast SE-based MR angiography (constant-FA MR) and flow-sensitive dephasing (FSD)-prepared steady-state free precession MR angiography (FSD MR) for calf arteries, with dual-injection three-station contrast material-enhanced MR angiography (gadolinium-enhanced MR) as reference.

Materials And Methods: This prospective study was institutional review board approved and HIPAA compliant, with informed consent. Twenty-one patients (13 men, eight women; mean age, 62.

Intraobserver and interobserver variability of renal volume measurements in polycystic kidney disease using a semiautomated MR segmentation algorithm.

Objective: Total renal volume and changes in kidney volume are markers of disease progression in autosomal-dominant polycystic kidney disease (ADPKD) but are not used in clinical practice in part because of the complexity of manual measurements. This study aims to assess the intra- and interobserver reproducibility of a semiautomated renal volumetric algorithm using fluid-sensitive MRI pulse sequences.

Subjects And Methods: Renal volumes of 17 patients with ADPKD were segmented from high-resolution coronal HASTE and true fast imaging with steady-state precession (FISP) MR acquisitions.

CT colonography in senior versus nonsenior patients: extracolonic findings, recommendations for additional imaging, and polyp prevalence.

Purpose: To retrospectively evaluate the frequency of recommendations for additional imaging (RAIs) for important extracolonic findings and polyp prevalence among a cohort of seniors (age ≥ 65 years) and nonseniors (age < 65 years) undergoing low-dose computed tomographic (CT) colonography.

Materials And Methods: Institutional review board approval was obtained for this HIPAA-compliant retrospective study. Four hundred fifty-four patients (204 nonseniors: mean age, 52 years; 250 seniors: mean age, 69 years) underwent CT colonography at an outpatient facility.

Time-resolved lower extremity MRA with temporal interpolation and stochastic spiral trajectories: preliminary clinical experience.

Purpose: To assess added value of a new time-resolved technique with temporal interpolation and stochastic spiral trajectory through k-space and parallel imaging (TR-MRA) to conventional bolus chase MRA (BC-MRA) for infragenual peripheral artery evaluation.

Materials And Methods: An institutional review board-approved retrospective review of peripheral arterial disease patients was performed. Infragenual TR-MRA and BC-MRA were performed in 26 patients over four months.

Evaluation of the mitral and aortic valves with cardiac CT angiography.

Cardiac computed tomographic angiography (CTA) using multidetector computed tomographic scanners has proven to be a reliable technique to image the coronary vessels. CTA also provides excellent visualization of the mitral and aortic valves, and yields useful information regarding valve anatomy and function. Accordingly, an assessment of the valves should be performed whenever possible during CTA interpretation.

Dual-source versus single-source cardiac CT angiography: comparison of diagnostic image quality.

Objective: Dual-source CT improves temporal resolution, and theoretically improves the diagnostic image quality of coronary artery examinations without requiring preexamination beta-blockade. The purpose of our study was to show the improved diagnostic image quality of dual-source CT compared with single-source CT despite the absence of preexamination beta-blockade in the dual-source CT group.

Materials And Methods: We performed a retrospective analysis of consecutive patients who underwent coronary artery evaluation with either single-source CT or dual-source CT at our institution between February 2005 and October 2006.

Angiotensin-converting enzyme inhibitor-enhanced MR renography: repeated measures of GFR and RPF in hypertensive patients.

This study aims to assess the feasibility of a protocol to diagnose renovascular disease using dual MR renography acquisitions: before and after administration of angiotensin-converting enzyme inhibitor (ACEi). Results of our simulation study aimed at testing the reproducibility of glomerular filtration rate (GFR) and renal plasma flow demonstrate that for a fixed overall dose of 12 ml gadolinium-based contrast material (500 mmol/l), the second dose should be approximately twice as large as the first dose. A three-compartment model for analyzing the second-injection data was shown to appropriately handle the tracer residue from the first injection.

Time-resolved dynamic contrast-enhanced MR urography for the evaluation of ureteral peristalsis: initial experience.

Purpose: To determine the feasibility of time-resolved dynamic contrast-enhanced magnetic resonance urography (MRU) for the evaluation of ureteral peristalsis using a data-sharing 3D gradient echo sequence with spiral k-space filling.

Materials And Methods: Eight patients (M=3, F=5, mean 48.1 years) were referred for MRU for the evaluation for renal mass (n=3), hematuria (n=2), urinary tract tuberculosis (n=1), postoperative bladder cancer (n=1), and postoperative ureteric reimplantation (n=1).

Myocardial bridging: evaluation using single- and dual-source multidetector cardiac computed tomographic angiography.

Objective: To evaluate the prevalence and characteristics of myocardial bridging in patients who underwent single- or dual-source multidetector cardiac computed tomographic angiography (MDCTA).

Methods: Retrospective review of the imaging characteristics of 57 myocardial bridges in 53 patients who underwent cardiac MDCTA examinations was performed.

Results: The prevalence of myocardial bridges was 10.

Ventricular diverticula on cardiac CT: more common than previously thought.

Objective: We describe the findings of contrast-enhanced gated cardiac CT in 15 patients with 23 incidentally noted cardiac ventricular diverticula.

Conclusion: Cardiac diverticula most commonly occur in the left ventricle but have been reported to occur in all chambers of the heart. Despite reports of their rare occurrence, cardiac ventricular diverticula are fairly common findings in patients undergoing cardiac MDCT angiography.

Hepatocellular carcinoma in the cirrhotic liver: gadolinium-enhanced 3D T1-weighted MR imaging as a stand-alone sequence for diagnosis.

Purpose: To retrospectively assess the usefulness of contrast material-enhanced T1-weighted magnetic resonance (MR) imaging alone and with T2-weighted MR imaging in the diagnosis of hepatocellular carcinoma (HCC).

Materials And Methods: A waiver of informed consent and institutional review board approval for this retrospective study were granted. The study was HIPAA compliant.

Importance of small (< or = 20-mm) enhancing lesions seen only during the hepatic arterial phase at MR imaging of the cirrhotic liver: evaluation and comparison with whole explanted liver.

Purpose: To retrospectively assess the importance and imaging appearance of small (< or = 20 mm in diameter) hepatic arterial phase-enhancing (HAPE) lesions that are occult during portal and/or equilibrium phases and at unenhanced T1- and T2-weighted magnetic resonance (MR) imaging and to determine the gross pathologic diagnosis with whole-liver explant comparison.

Materials And Methods: This retrospective study was approved by the institutional review board and compliant with HIPPA. Forty-six patients with cirrhosis who underwent MR imaging and transplantation within 90 days were evaluated with breath-hold T2-weighted and volumetric three-dimensional gadolinium-enhanced gradient-echo MR imaging in the hepatic arterial, portal venous, and equilibrium phases at 1.

Renal masses: quantitative analysis of enhancement with signal intensity measurements versus qualitative analysis of enhancement with image subtraction for diagnosing malignancy at MR imaging.

Purpose: To retrospectively compare quantitative and qualitative methods of assessing magnetic resonance (MR) imaging contrast enhancement as the basis for diagnosing renal malignancy.

Materials And Methods: MR imaging was performed by using a gadolinium-enhanced breath-hold fat-suppressed three-dimensional T1-weighted gradient-echo sequence in 71 patients (48 men and 23 women; mean age, 62 years; age range, 26-87 years) with 93 renal lesions for which pathologic correlation was available. For quantitative measurements of enhancement, the relative increase in signal intensity values was measured by one investigator with manually defined regions of interest, and the threshold of an increase of 15% or greater was used to distinguish malignant from benign masses.