Sarwat Hussain

Focal nodular hyperplasia: Central scar enhancement pattern using gadoxetate disodium

To illustrate the unusual enhancement pattern of the focal nodular hyperplasia central scar using Gadoxetate Disodium.

Dedicated breast CT: geometric design considerations to maximize posterior breast coverage.

An Institutional Review Board-approved protocol was used to quantify breast tissue inclusion in 52 women, under conditions simulating both craniocaudal (CC) and mediolateral oblique (MLO) views in mammography, dedicated breast CT in the upright subject position, and dedicated breast CT in the prone subject position. Using skin as a surrogate for the underlying breast tissue, the posterior aspect of the breast that is aligned with the chest-wall edge of the breast support in a screen-film mammography system was marked with the study participants positioned for CC and MLO views. The union of skin marks with the study participants positioned for CC and MLO views was considered to represent chest-wall tissue available for imaging with mammography and served as the reference standard. For breast CT, a prone stereotactic breast biopsy unit and a custom-fabricated barrier were used to simulate conditions during prone and upright breast CT, respectively. For the same breast marked on the mammography system, skin marks were made along the breast periphery that was just anterior to the apertures of the prone biopsy unit and the upright barrier. The differences in skin marks between subject positioning simulating breast CT (prone, upright) and mammography were quantified at six anatomic locations. For each location, at least one study participant had a skin mark from breast CT (prone, upright) posterior to mammography. However for all study participants, there was at least one anatomic location where the skin mark from mammography was posterior to that from breast CT (prone, upright) positioning. The maximum amount by which the skin mark from mammography was posterior to breast CT (prone and upright) over all six locations was quantified for each study participant and pair-wise comparison did not exhibit statistically significant difference between prone and upright breast CT (paired t- test, p = 0.4). Quantitatively, for 95% of the study participants the skin mark from mammography was posterior to breast CT (prone or upright) by at the most 9 mm over all six locations. Based on the study observations, geometric design considerations targeting chest-wall coverage with breast CT equivalent to mammography, wherein part of the x-ray beam images through the swale during breast CT are provided. Assuming subjects can extend their chest in to a swale, the optimal swale-depth required to achieve equivalent coverage with breast CT images as mammograms for 95% of the subjects varies in the range of ~30-50 mm for clinical prototypes and was dependent on the system geometry.

Alcohol sclerosis of a giant liver cyst following failed deroofings

Percutaneous alcohol sclerotherapy for simple liver cysts is an established and safe procedure. We report alcohol ablation of a very large (5.5 liters) liver cyst that had failed laparoscopic deroofing procedures twice. The cyst responded to multisession alcohol sclerotherapy.

Addenda to the radiology report: what are we trying to convey?

PURPOSE The aims of this paper are to describe addenda to radiology reports and to discuss the communication gaps in radiology addenda reaching referring physicians. The authors examine impediments to compliance with an addendum policy and suggest possible solutions. METHODS A total of 62,500 radiology reports were reviewed to analyze the occurrence of report addenda. Addenda types were separated into clinical, generated by radiologists, and administrative (for billing or regulatory reasons). Two radiologists reviewed all clinical addenda and classified them as significant or not significant. Significant addenda were further analyzed for various aspects. An e-mail survey was also conducted to assess prevailing practices in academic departments of radiology. RESULTS There were 1,069 reports with addenda (1.7%). Of these, 575 were generated by radiologists. Forty-nine (8.5%) were for clinically significant errors and 526 (91.5%) were not. Of the 49 significant addenda, 9 (18%) were fully compliant with departmental addendum policies, 27 (55%) were noncompliant, and 13 (27%) were partially compliant. Of the 49 clinically significant addenda, 17 (55%) were dictated within 1 hour and 40 (82%) within 24 hours of the finalized original reports. CONCLUSIONS Poor compliance with an addendum policy was found. The reasons for noncompliance and possible remedies are discussed, with the hope of beginning a dialogue in the radiology literature on the risks of poor communication processes and the benefits of full implementation of well thought-out addendum policies.

Unusual Complication After Left-Lobe Liver Biopsy for Diffuse Liver Disease: Severe Bleeding From the Superior Epigastric Artery

OBJECTIVE Imaging-guided parenchymal liver biopsy for diffuse liver disease is increasingly performed via an epigastric route from the left lobe, as opposed to the more traditional intercostal right-sided approach. MATERIALS AND METHODS We conducted a retrospective analysis of all liver biopsies performed at our department for 3 years (July 2007 through June 2010). A total of 1028 liver biopsies were performed during this period. Of these, 776 biopsies were performed for diffuse medical liver disease. Electronic medical records were reviewed for any documented complications. RESULTS We identified six cases (0.8%) of documented significant bleeding after 776 biopsies. All bleeding complications were associated with the left-sided epigastric approach. No documented case of major bleeding from the right-sided approach was recorded during the same period. We describe four patients with severe bleeding complications in which classic imaging features were noted on CT, pointing to injury of the superior epigastric artery as the possible cause of the bleeding. CONCLUSION It is important to recognize the subtle CT signs of superior epigastric artery bleeding because the traditional femoral approach with angiography of the hepatic and portal vessels may not reveal active bleeding. The superior epigastric artery, rather than the hepatic arteries, should be evaluated. A brachial approach for the angiogram may be the more optimal technique.

Hepatocellular carcinoma recurrence pattern following liver transplantation and a suggested surveillance algorithm

PURPOSE This study aims to evaluate the recurrence pattern of hepatocellular carcinoma (HCC) following liver transplantation. MATERIALS AND METHODS A total of 54 patients underwent liver transplantation for HCC; 9 patients developed biopsy-proven recurrent HCC (16.6%). The site of HCC recurrence along with other factors was analyzed. RESULTS Seven patients were diagnosed with HCC prior to liver transplantation and 2 patients had incidental HCC in the explanted liver. Two patients had locoregional recurrence, 4 patients had distant metastasis, and 3 patients had synchronous locoregional recurrence and distant metastasis. CONCLUSION A significant proportion of HCC recurrence following liver transplantation is extrahepatic.

Renal biopsy: Comparative yield of cranial versus caudal needle trajectory. An ex vivo analysis

To compare the diagnostic quality of tissue cores obtained using cranial and caudal angulation of the renal biopsy needle. Comparison was made in terms of the number of glomeruli and proportion of renal cortex with medulla on pathological analysis.