Elizabeth Kagan Arleo

Emergent Complications of Assisted Reproduction: Expecting the Unexpected

With the increasing popularity of assisted reproductive technology (ART), radiologists are more likely to encounter associated complications, especially in an emergency setting. These complications include ovarian hyperstimulation syndrome (OHSS), ovarian torsion, and ectopic and heterotopic pregnancy. OHSS occurs following ovulation induction or ovarian stimulation and manifests with bilateral ovarian enlargement by multiple cysts, third-spacing of fluids, and clinical findings ranging from gastrointestinal discomfort to life-threatening renal failure and coagulopathy. Enlarged hyperstimulated ovaries are at risk for torsion. Clinical symptoms are often nonspecific, and ovarian torsion should be suspected and excluded in any female patient undergoing infertility treatment who presents with severe abdominal pain. The most consistent imaging finding is asymmetric enlargement of the twisted ovary. There is also an increased risk for ectopic pregnancy following ART, with a relative increased risk for rarer and more lethal forms, including interstitial and cervical ectopic pregnancies. Heterotopic pregnancy refers to simultaneous intrauterine and ectopic pregnancies and has an incidence of 1%-3% in ART patients. Careful evaluation of the adnexa is critical in this patient population, even when an intrauterine pregnancy has been confirmed. Ultrasonography is the first-line imaging modality for the evaluation of complications of ART, although nonspecific symptoms may sometimes lead to cross-sectional imaging being performed. Familiarity with the multimodality imaging appearance of these entities will allow accurate and timely diagnosis and help avert potentially fatal consequences.

Comparison of recommendations for screening mammography using CISNET models

Currently, there are several different recommendations for screening mammography from major national health care organizations, including: 1) annual screening at ages 40 to 84 years; 2) screening annually at ages 45 to 54 years, then biennially at ages 55 to 79 years; and 3) biennial screening at ages 50 to 74 years.

Review of Leiomyoma Variants

OBJECTIVE The purpose of this article is to review the clinical, imaging, and pathologic features of leiomyoma variants. CONCLUSION Fortunately, most of these variants are rare and have a benign natural history, given currently there are no significant series to establish definitive clinical or imaging findings that can reliably distinguish among them. Although there are some suggestive features, the diagnosis of a leiomyoma variant is usually made postoperatively at pathologic examination.

Screening Mammography for Women in Their 40s: A Retrospective Study of the Potential Impact of the U.S. Preventive Service Task Force's 2009 Breast Cancer Screening Recommendations

OBJECTIVE The objective of our study was to review screening mammography examinations performed at our institution from 2007 through 2010 with the primary endpoint of determining the incidence of breast cancer and associated histologic and prognostic features in women in their 40s. MATERIALS AND METHODS Patients who presented for screening mammography who ultimately (i.e., after additional imaging, including diagnostic mammographic views and ultrasound) received a BI-RADS assessment of a category 4 or 5 for a suspicious abnormality were followed retrospectively through completion of care and were analyzed with respect to pathology results after biopsy, treatment, and family history. RESULTS During the study period, 43,351 screening mammography examinations were performed; 1227 biopsies were recommended on the basis of those studies and yielded 205 breast cancers (cancer detection rate of 4.7 per 1000 screening examinations). These screening examinations included 14,528 (33.5%) screening examinations of patients in their 40s; 413 biopsies were recommended and yielded 39 breast cancers (39/205 = 19%) (cancer detection rate of 2.7 per 1000 screening examinations). More than 50% (21/39) of the cancers in women in their 40s were invasive. Only 8% (3/39) of the women in their 40s with screening-detected breast cancer had a first-degree relative with breast cancer. CONCLUSION From 2007 through 2010, patients in their 40s accounted for one third of the population undergoing screening mammography and for nearly 20% of the screening-detected breast cancers--more than half of which were invasive. This information should be a useful contribution to counseling women in this age group when discussing whether or not to pursue regular screening mammography.

Utilizing two-dimensional ultrasound to develop normative curves for estimated placental volume.

OBJECTIVE The objective of this study was to use two-dimensional (2D) ultrasound (US) during routine prenatal surveillance to develop normative estimated placental volume (EPV) growth curves. STUDY DESIGN Patients ≥ 18 years old with singleton pregnancies were prospectively followed from 11 weeks gestational age (GA) until delivery. At routine US visits, placental width, height, and thickness were measured and EPV calculated using a validated mathematical model. RESULTS In this study, 423 patients were scanned between 9.7 and 39.3 weeks GA to generate a total of 627 EPV calculations. Readings were clustered at 12 and 20 weeks, times of routine scanning. The mean EPV was 73 ± 47 cc at 12.5 ± 1.5 weeks (n = 444) and 276 ± 106 cc at 20 ± 2 weeks (n = 151). The data best fit a parabolic function as follows: EPV = (0.384GA - 0.00366GA(2))(3). Tenth and 90th percentile lines were generated with ± 1.28 SE offset. EPV readings below the 10th or above the 90th percentiles tended to be associated with either small or large newborns, respectively. CONCLUSION Routine 2D US created EPV growth curves, which may be useful for stratifying patients into prenatal risk groups.

2D mammography, digital breast tomosynthesis, and ultrasound: which should be used for the different breast densities in breast cancer screening?

PURPOSE To determine which modalities [2D mammography (2D), digital breast tomosynthesis (DBT), whole breast sonography (WBS)] are optimal for screening depending on breast density. METHODS Institutional retrospective cohort study of 2013 screening mammograms (16,789), sorted by modalities and density. RESULTS Cancer detection is increased by adding WBS to 2D (P=.02) for the overall study population. Recall rate was lowest with 2D+DBT (10.2%, P<.001) and highest with 2D+DBT+WBS (23.6%, P<.001) for the overall study population as well. CONCLUSION Women with dense and nondense breasts benefit from reduced recall rate with the addition of DBT; however, this benefit is negated with the addition of WBS.

Chorionic Bump on First-Trimester Sonography Not Necessarily a Poor Prognostic Indicator for Pregnancy

The purpose of this study was to determine the live birth rate of pregnancies with a diagnosis of a chorionic bump, a convex bulge from the choriodecidual surface into the first‐trimester gestational sac.

Annual Screening Mammography for Breast Cancer in Women 75 Years Old or Older: To Screen or Not to Screen

OBJECTIVE The purpose of the study was to review screening mammography examinations at our institution from 2007 through 2013 with the primary endpoint of determining the incidence of breast cancer and the associated histologic and prognostic features in women 75 years old or older. MATERIALS AND METHODS Patients who presented for screening mammography who ultimately received a BI-RADS assessment of category 4 or 5 for a suspicious abnormality were followed retrospectively through completion of care and were analyzed with respect to pathology results, treatment, and family history. RESULTS From 2007 through 2013, 68,694 screening mammography examinations were performed. Of these screening examinations, 4424 (6.4%) were performed of patients 75 years old or older. On the basis of these examinations, 64 biopsies were recommended. Sixty biopsies were performed, and these biopsies detected 26 breast cancers. These results correspond to a breast cancer detection rate of 5.9 per 1000 screening examinations and a positive predictive value 2 (PPV2), defined as the probability of breast cancer after a BI-RADS assessment category of 4 (suspicious abnormality) or 5 (highly suggestive of malignancy), of 40.6%. Approximately 85% (22/26) of the screening-detected cancers in the women in this age group were invasive. For those with known genetic status (18 of 26), 33% had a first-degree relative with breast cancer. CONCLUSION Although women 75 years or older accounted for less than 10% of the total screening population during the study time period, the breast cancer detection rate in this cohort was 5.9 per 1000 screening examinations, which is compatible with the American College of Radiologys recommendations, and most of these breast cancers were invasive. These results are relevant when considering appropriate age ranges for annual screening mammography.

Surveying Academic Radiology Department Chairs Regarding New and Effective Strategies for Medical Student Recruitment

OBJECTIVE The number of 4th-year medical student applications to the field of diagnostic radiology has decreased from 2009 to 2015. The purpose of this study was to learn how radiology departments are recruiting medical students. MATERIALS AND METHODS An anonymous online survey hyperlink was distributed to the members of the Society of Chairs of Academic Radiology Departments regarding both innovative and proven recruitment strategies. The results were synthesized with a recently published survey of medical students about factors influencing them to go into radiology. RESULTS Forty of 126 radiology departments completed the survey. Most felt that radiology exposure and curricula require alteration given recent downward trends in medical student applications. A majority (79%) had changed their outreach to medical students in response to these trends. The responding department chairs felt that interactive learning while on rotation was the most important strategy for recruitment. The presence of a diversity program, dedicated medical school educator, or rotating daily assignment for students did not affect the likelihood of filling residency spots in the main match. CONCLUSION Many radiology departments are changing their outreach to medical students to improve recruitment. Effective strategies to focus on include early active outreach by involving students in the radiology department, thereby framing radiologists as clinicians.

New diagnosis of sarcoidosis during treatment for breast cancer, with radiologic–pathologic correlation

A 63-year old female with right breast cancer underwent lumpectomy, with axillary lymph nodes negative for metastatic carcinoma but demonstrating noncaseating granulomatous lymphadenitis. These histopathologic findings, in conjunction with thoracic lymphadenopathy and diffuse splenic nodules on computed tomography, were consistent with sarcoidosis. This unusually novel case of concomitant diagnosis of breast cancer and sarcoidosis case reminds both the radiologist and pathologist to keep in mind the possibility of alternate or new diagnoses when reading their respective studies.