Brian C. Allen

Outcomes, complications, and costs of care of Bosniak IIF, III, and IV cystic renal lesions/malignancies: Data from the largest multi-institutional study to date.

344 Background: To evaluate outcomes, complications and costs associated with management of Bosniak IIF, III, and IV cystic renal lesions/malignancies. METHODS An IRB-approved HIPAA-compliant multi-institutional retrospective data registry of prospectively classified Bosniak IIF (N=143), III (N=114), and IV (N=29) cystic renal lesions diagnosed in adults between January 2000 and October 2011 at UMMC, UAB, or WFUBMC was performed. Included patients were managed by surgical excision (N=86), ablation (N=19), or imaging-surveillance >1yr (N=181). De-identified coded data was entered into a web-based REDCap database containing 168 fields/patient. Complication severity was assessed using the Clavien classification system. Inpatient/outpatient technical/professional charges from 6 months prior to 6 months after surgery or ablation were gathered. RESULTS Patient level malignancy on surgical pathology was 38% (3/8) for BIIF, 40% (26/65) for BIII, and 89% (17/19) for BIV lesions. No metastatic BIIF lesions (0/143). One metastatic BIII lesion (1/114) developed after thermal ablation in a patient with a prior history of papillary RCC. One metastatic BIV (1/29) at the time of initial diagnosis (necrotic papillary RCC). Moderate/severe complications in 19%(16/86) of surgical and 5%(1/19) of ablative patients (p = 0.299). 0%(0/181) complications in patients managed by imaging surveillance >1yr. 0%(0/286) deaths for any management strategy. Median charges of

Effect of Altering Automatic Exposure Control Settings and Quality Reference mAs on Radiation Dose, Image Quality, and Diagnostic Efficacy in MDCT Enterography of Active Inflammatory Crohn's Disease

51,902 for partial nephrectomy (N=50),

Hepatocellular carcinoma in a North American population: Does hepatobiliary MR imaging with Gd‐EOB‐DTPA improve sensitivity and confidence for diagnosis?

42,411 for complete nephrectomy (N=36), and

Bosniak Category IIF and III Cystic Renal Lesions: Outcomes and Associations

22,442 for ablation (N=19) were significantly different (p < 0.001). Median charges in surgical patients with moderate/severe complications was

Percutaneous Cryoablation of Renal Tumors: Patient Selection, Technique, and Postprocedural Imaging

80,393 (N=16), significantly higher than

Correlation of intracellular organisms with quantitative endotracheal aspirate.

45,024 (N=70) for no/mild complications (p = 0.002). CONCLUSIONS No deaths from Bosniak IIF or III lesions, irrespective of management approach. Imaging surveillance appears to be a safe primary management strategy for Bosniak III lesions. Moderate/severe complications occurred in 19% of surgery and 5% of ablation patients and nearly doubled the charges for surgery.

Imaging-Guided Radiofrequency Ablation of Cystic Renal Neoplasms

OBJECTIVE The purpose of our study was to determine whether the MDCT enterography dose can be reduced by changing automatic exposure control (AEC) setting and quality reference milliampere-seconds (mAs) without altering subjective image quality or efficacy in active inflammatory Crohns disease. SUBJECTS AND METHODS This is a prospective study of 2,310 MDCT enterography procedures performed using 16- and 64-MDCT in three cohorts (original, intermediate, and final dose levels). For 16-MDCT, the original and intermediate dose level quality reference mAs was 200, and weight-based (1 pound [0.45 kg] = 1 mAs) for the final dose level. For 64-MDCT, the original dose level quality reference mAs was 260; the mAs was 220 for intermediate and weight-based for the final dose level. For the intermediate and final dose levels, AEC was changed from strong to weak increase for obese and weak to strong decrease for slim patients. Demographic data and volume CT dose index (CTDI(vol)) were analyzed. Three readers evaluated the cases for image quality and efficacy differentiating normal from active inflammatory Crohns disease. RESULTS For 16-MDCT, CTDI(vol) decreased from 12.82 to 10.14 mGy and 10.14 to 8.7 mGy between original to intermediate and intermediate to final dose levels. For 64-MDCT, the CTDI(vol) decreased from 15.72 to 11.42 mGy and 11.42 to 9.25 mGy between original to intermediate and intermediate to final dose levels. Images were rated suboptimal or nondiagnostic more often in the intermediate dose level (p < 0.05) but not in the final. There was no reduction in diagnostic efficacy as measured by area under the ROC curve (p > 0.1443 except for one comparison with one reader). CONCLUSION Substantial dose reduction can be achieved using weight-based quality reference mAs and altering AEC settings without affecting diagnostic efficacy in active inflammatory Crohns disease of the terminal ileum. However, subjective image quality can be compromised at these dose settings, depending on radiologist preference.

MR Enterography for Assessment and Management of Small Bowel Crohn Disease

To evaluate the value of hepatobiliary phase imaging for detection and characterization of hepatocellular carcinoma (HCC) in liver MRI with Gd‐EOB‐DTPA, in a North American population.

Characterizing solid renal neoplasms with MRI in adults

PURPOSE To evaluate clinical outcomes, pathologic subtypes, metastatic disease rate, and clinical features associated with malignancy in Bosniak category IIF and III cystic renal lesions. MATERIALS AND METHODS This retrospective study was institutional review board approved and HIPAA compliant. Informed consent was waived. Radiology and hospital information systems were searched for Bosniak IIF and Bosniak III lesions in computed tomographic (CT) reports from January 1, 1994 to August 31, 2009. Patients 18 years and older with unenhanced and contrast material-enhanced CT results and with lesions either surgically resected or with 1 year or more of surveillance were included. Data recorded were history of renal cell carcinoma, number of renal lesions, presence of a coexistent solid renal mass, surgical pathologic findings, and presence of metastatic disease from a renal malignancy. Sixty-two patients with 69 Bosniak IIF lesions and 131 patients with 144 Bosniak III lesions were identified. Proportions from independent groups were compared by using the Fisher exact test; continuous variables were compared by using a two-tailed two-sample t test or a Wilcoxon two-sample test. RESULTS The malignancy rate of resected Bosniak IIF lesions was 25% (four of 16) and that for Bosniak III lesions was 54% (58 of 107) (P = .03). Thirteen percent (nine of 69) of Bosniak IIF lesions progressed at follow-up, and 50% (four of eight) of these resected cysts were malignant. History of primary renal malignancy, coexisting Bosniak category IV lesion and/or solid renal mass, and multiplicity of Bosniak III lesions were each associated with an increased malignancy rate in Bosniak III lesions. No patients developed locally advanced or metastatic disease from a Bosniak IIF or III lesion. CONCLUSION Although the malignancy rate in surgically excised Bosniak IIF and Bosniak III cystic renal lesions was 25% and 54%, respectively, in our study, the malignancy rate was higher in patients with a history of primary renal malignancy or coexisting Bosniak IV lesion and/or solid renal neoplasm.

Intravenous Gadoxetate Disodium Administration Reduces Breath-holding Capacity in the Hepatic Arterial Phase: A Multi-Center Randomized Placebo-controlled Trial

Percutaneous cryoablation of renal tumors requires a number of important steps for success and relies heavily on imaging for treatment planning, intraprocedural guidance and monitoring, detection of untreated tumor, and surveillance for disease progression. Imaging-guided percutaneous cryoablation has several advantages over laparoscopic cryoablation. In particular, computed tomography (CT) and magnetic resonance (MR) imaging allow global evaluation of the ablation zone and an accurate depiction of the treatment margin. Ultrasonography allows real-time guidance of probe placement but cannot help depict ice ball formation as accurately as CT or MR imaging. Multiphasic CT or MR imaging should be performed at structured intervals following ablation. Treated tumors are expected to decrease in size over time, and lesion growth and internal or nodular enhancement are suspicious for tumor recurrence or progression. Complications include probe site pain, hematoma, incomplete ablation, and recurrent tumor. Current limitations of percutaneous cryoablation include the inability to control hemorrhage without intraarterial access and a lack of long-term follow-up data. Nevertheless, percutaneous cryoablation is an effective choice for minimally invasive nephron-sparing treatment of renal tumors.