Rupan Sanyal

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

Secretin-enhanced MR Cholangiopancreatography: Spectrum of Findings

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

Outcomes and Complications Related to the Management of Bosniak Cystic Renal Lesions

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

Postoperative doppler evaluation of liver transplants

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

Surgical Techniques and Imaging Complications of Liver Transplant

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

A Guide to Writing Academic Portfolios for Radiologists

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.

Recent advances in cross-sectional renal imaging -an oncologic perspective: The current concepts and the future challenges

Magnetic resonance cholangiopancreatography (MRCP) is the most effective, safe, noninvasive magnetic resonance (MR) imaging technique for the evaluation of the pancreaticobiliary ductal system. The MRCP imaging technique has substantially improved during the past 2 decades and is based mainly on the acquisition of heavily T2-weighted MR images, with variants of fast spin-echo sequences. MRCP can also be performed by utilizing the hormone secretin, which stimulates a normal pancreas to secrete a significant amount of fluid while transiently increasing the tone of the sphincter of Oddi. The transient increase in the diameter of the pancreatic duct improves the depiction of the ductal anatomy, which can be useful in patients in whom detailed evaluation of the pancreatic duct is most desired because of a suspicion of pancreatic disease. Improved depiction of the ductal anatomy can be important in (a) the differentiation of side-branch intraductal papillary mucinous neoplasms from other cystic neoplasms and (b) the diagnosis and classification of chronic pancreatitis, the disconnected pancreatic duct syndrome, and ductal anomalies such as anomalous pancreaticobiliary junction and pancreas divisum. In patients examined after pancreatectomy, stimulation with secretin can give information about the patency of the pancreaticoenteric anastomosis. Duodenal filling during the secretin-enhanced phase of the MRCP examination can be used to estimate the excretory reserve of the pancreas. Secretin is well tolerated, and complications are rarely seen. Secretin-enhanced MRCP is most useful in (a) the evaluation of acute and chronic pancreatitis, congenital variants of the pancreaticoduodenal junction, and intraductal papillary mucinous neoplasms and (b) follow-up of patients after pancreatectomy.

Thoracic Imaging After Bariatric Surgery

OBJECTIVE The objective of our study was to evaluate outcomes and complications related to the management of Bosniak category IIF, III, and IV renal cysts. MATERIALS AND METHODS For this multiinstitutional retrospective study, a Web-based Research Electronic Data Capture (REDCap) data registry was used to record data of 286 adult patients with 312 prospectively classified Bosniak IIF, III, and IV renal cysts diagnosed between January 2000 and October 2011. Included patients were managed by surgery (n = 86), percutaneous ablation (n = 19), or imaging surveillance of 1 year or more (n = 181). The median number of years of clinical surveillance was 2.4 years (range, 0-11.7 years), 2.6 years (range, 0.4-11.4 years), and 3.2 years (range, 1.1-11.6 years) for patients managed by surgery, ablation, and imaging surveillance, respectively. Pathologic and survival outcomes and complications related to management were evaluated. RESULTS The malignancy rate at surgical pathology was 38% (3/8) for Bosniak IIF, 40% (29/72) for Bosniak III, and 90% (18/20) for Bosniak IV renal cysts. There were no metastases or deaths (0/144) directly related to Bosniak IIF renal cysts. There were no deaths (0/113) directly related to Bosniak III renal cysts, although one patient (1/113) developed local progression and lung metastases after thermal ablation. One patient with a Bosniak IV renal cyst (1/29) presented with and died of metastatic disease. Moderate to severe complications occurred in 19% (16/86), 5% (1/19), and 0% (0/181) of patients managed by surgery, ablation, and imaging surveillance, respectively (p < 0.0001). Severe complications occurred in 7% (6/86) of surgical patients and included multiorgan failure (n = 2), acute myocardial infarction (n = 1), acute ischemic stroke (n = 1), conversion to hemodialysis-dependent chronic kidney disease (n = 1), and postoperative severe hemorrhage (n = 1). CONCLUSION There were no deaths from Bosniak IIF or III renal cysts regardless of management approach. Moderate to severe complications are frequent in patients managed by surgery.

Optimizing renal transplant Doppler ultrasound

Doppler ultrasound plays an important role in the postoperative management of hepatic transplantation, by enabling early detection and treatment of various vascular complications. This article describes the normal Doppler findings following liver transplantation and reviews the imaging appearances of various vascular complications associated with it. The article also discusses transient waveform abnormalities, often seen on a post-transplant Doppler examination, and the importance of differentiating them from findings suggestive of ominous vascular complications.

Incidental Bladder Cancer Detected on Multiparametric Magnetic Resonance Imaging of the Prostate Gland

Liver transplant is the treatment of choice for end-stage liver disease. Management of transplant patients requires a multidisciplinary approach, with radiologists playing a key role in identifying complications in both symptomatic and asymptomatic patients. Ultrasonography remains the investigation of choice for the initial evaluation of symptomatic patients. Depending on the clinical situation, further evaluation with CT, MRI, or biopsy may be performed or clinical and imaging surveillance may be continued. This article discusses the various normal and abnormal imaging presentations of liver transplant patients, including various acute and chronic complications, and their management.