Prostate Multiparametric Magnetic Resonance Imaging Program Implementation and Impact: Initial Clinical Experience in a Community Based Health System.

Introduction: Magnetic resonance imaging of the prostate is increasingly being performed at academic centers but implementation in community based health systems has lagged and literature regarding clinical impact in this setting is limited. We describe our experience developing a community based prostate magnetic resonance imaging program, including the evolution of interpretation and reporting methods, and the resulting clinical impact during a period of more than 5 years (August 2010 to December 2015).

Methods: Data collected for prostate magnetic resonance imaging included demographic, clinical, scanning, pathology and treatment/management information.

Regression of massive cardiac rhabdomyoma on everolimus therapy.

Cardiac rhabdomyoma is the primary feature of the genetic disease, tuberous sclerosis complex, the most common cardiac tumor diagnosed in neonates and infants. Spontaneous regression is observed in most cases, but these tumors may cause hemodynamic instability, arrhythmias or other complications. We describe the case of a critically ill neonate, resuscitated after cardiac arrest secondary to massive locally invasive cardiac rhabdomyoma, who was successfully treated with everolimus (mammalian target of rapamycin [mTOR] inhibitor).

ACR appropriateness criteria® nonischemic myocardial disease with clinical manifestations (ischemic cardiomyopathy already excluded).

Nonischemic myocardial disease or cardiomyopathy can present as arrhythmia, palpitations, heart failure, dyspnea, lower extremity edema, ascites, syncope, and/or chest discomfort and can be classified as either systolic, diastolic, or a combination of both. Echocardiography is the mainstay of evaluating left ventricular function. However, cardiac magnetic resonance imaging (MRI) is now considered the reference standard imaging technique to assess myocardial anatomy, function, and viability.

Surgeon assessment of renal preservation with partial nephrectomy provides information comparable to measurement of volume preservation with 3-dimensional image analysis.

Purpose: The strongest predictors of renal function after partial nephrectomy are the preoperative glomerular filtration rate and the amount of preserved parenchyma. Measuring volume preservation by 3-dimensional imaging is accurate but time-consuming. Percent functional volume preservation was designed to replace surgeon assessment of volume preservation with a less labor intensive, objective assessment.

ACR Appropriateness Criteria chronic chest pain-low to intermediate probability of coronary artery disease.

Chronic chest pain can arise from a variety of etiologies. However, of those potential causes, the most life-threatening include cardiac disease. Chronic cardiac chest pain may be caused either by ischemia or atherosclerotic coronary artery disease or by other cardiac-related etiologies, such as pericardial disease.

ACR Appropriateness Criteria(®) acute nonspecific chest pain-low probability of coronary artery disease.

This document outlines the usefulness of available diagnostic imaging for patients without known coronary artery disease and at low probability for having coronary artery disease who do not present with classic signs, symptoms, or electrocardiographic abnormalities indicating acute coronary syndrome but rather with nonspecific chest pain leading to a differential diagnosis, including pulmonary, gastrointestinal, or musculoskeletal pathologies. A number of imaging modalities are available to evaluate the broad spectrum of possible pathologies in these patients, such as chest radiography, multidetector CT, MRI, ventilation-perfusion scans, cardiac perfusion scintigraphy, transesophageal and transthoracic echocardiography, PET, spine and rib radiography, barium esophageal and upper gastrointestinal studies, and abdominal ultrasound. It is considered appropriate to start the assessment of these patients with a low-cost, low-risk diagnostic test such as a chest x-ray.

ACR Appropriateness Criteria® chronic chest pain--high probability of coronary artery disease.

Imaging is valuable in determining the presence, extent, and severity of myocardial ischemia and the severity of obstructive coronary lesions in patients with chronic chest pain in the setting of high probability of coronary artery disease. Imaging is critical for defining patients best suited for medical therapy or intervention, and findings can be used to predict long-term prognosis and the likely benefit from various therapeutic options. Chest radiography, radionuclide single photon-emission CT, radionuclide ventriculography, and conventional coronary angiography are the imaging modalities historically used in evaluating suspected chronic myocardial ischemia.

ACR Appropriateness Criteria(®) on suspected lower extremity deep vein thrombosis.

Lower extremity deep vein thrombosis (DVT) is a common clinical concern, with an incidence that increases with advanced age. DVT typically begins below the knee but may extend proximally and result in pulmonary embolism. Pulmonary embolism can occur in 50% to 60% of patients with untreated DVT and can be fatal.

ACR Appropriateness Criteria® on chest pain, suggestive of acute coronary syndrome.

Acute chest pain suggestive of acute coronary syndrome is a frequent complaint in the emergency department. Acute coronary syndromes include myocardial infarction and unstable angina. Being able to establish the diagnosis rapidly and accurately may be lifesaving.

Coronary artery fistulas: CT findings.

Coronary artery fistulas are anomalous terminations of the coronary arteries. Most often, these fistulas are incidentally identified in the adult and pediatric populations. Many patients are asymptomatic; however, an awareness of these fistulas is important because they have been associated with various clinical features, including chest pain or heart failure in young patients.

ACR appropriateness criteria on recurrent symptoms following lower-extremity angioplasty.

Lower-extremity arteriopathy patients can be managed nonsurgically, but there is no standard algorithm for follow-up. The authors present a consensus on appropriate postangioplasty studies in the setting of claudication or a threatened limb. Physical examination with measurements of the ankle-brachial index should be the first step in patients with recurrent symptoms.

Descending tumor thrombus from renal cell carcinoma metastases with SVC syndrome.

We describe a case of renal cell carcinoma metastases to the thyroid gland invading local veins and extending to the neck veins causing superior vena cava (SVC) syndrome.

Outcome of fetuses with clubfeet diagnosed by prenatal sonography.

Objective: To determine the outcome of fetuses with clubfoot diagnosed by prenatal sonography.

Methods: We identified all fetuses scanned at our institution from May 1989 to May 2002 in whom clubfoot was suspected or diagnosed on prenatal sonography. From maternal and neonatal medical records, we collected the following information when available: unilateral or bilateral clubfoot, gestational age at diagnosis, other sonographic findings, and pregnancy outcome, including pathologic reports and neonatal findings at birth.