Tara M. Catanzano

Primary Liver Tumors in Pediatric Patients: Proper Imaging Technique for Diagnosis and Staging

Liver tumors in children are rare and comprise a diverse set of both benign and malignant lesions, most of which are not clinically detected until they are large and often difficult to resect. Technological advances in diagnostic imaging have greatly influenced the surgical planning of these lesions and ultimately the clinical outcome. The intent of this article is to present an imaging algorithm for the effective and efficient workup of liver tumors in pediatric patients. This includes the appropriate timing and use of various imaging modalities, such as conventional radiographs, ultrasound, computed tomography, and magnetic resonance imaging. This article also addresses the use of sedation, intravenous contrast agents, and the benefits and limitations of specific imaging modalities. An overview of the radiologic and pathologic findings in common liver lesions in pediatric patients, as well as individual case examples demonstrating the use of the proposed workup algorithm, is provided.

Imaging of Nontraumatic Acute Hip Pain in Children: Multimodality Approach With Attention to the Reduction of Medical Radiation Exposure

Nontraumatic acute hip pain in children is common. However, the presentation and etiology is variable, including difficulty with weight bearing and abnormal gait. Barriers in communication, multiple possible etiologies, and age-specific anatomical variations of the pediatric hip make the evaluation of hip pain in children a difficult clinical diagnosis. Multimodality radiologic approach plays an important role for the evaluation of these children. However, owing to the complexity of pediatric hip disease, children sometimes undergo multiple radiologic examinations, resulting in delay in diagnosis and increased radiation dose. This article focuses on the illustration and discussion of common causes of acute hip pain or limp in children. Current recommendations for the imaging of these patients with specific attention to the ALARA (as low radiation as reasonably achievable) principle of radiation exposure are considered. Examples of the entities discussed are provided.

Nontraumatic Abdominal Pain in Pregnancy: Imaging Considerations for a Multiorgan System Problem

Nontraumatic abdominal pain in the pregnant patient can present a clinician with a variety of diagnostic possibilities. The overlap between signs and symptoms expected in normal pregnancy and these many pathologic possibilities does little to help focus the clinicians diagnostic efforts. Fear of ionizing radiations effects on the fetus has driven efforts to refine medical imaging algorithms in such a way as to attempt to eliminate its use at all cost. In todays world, we are nearly there. In this review the differential diagnosis of nontraumatic abdominal pain in the pregnant patient will be explored. Of note is the recurring theme that much of what can be done today with regard to diagnostic imaging, both in general and with regard to this specific subset of patients, centers on the use of the non-ionizing modalities of ultrasound and magnetic resonance imaging.

Practice patterns in imaging of the abdomen and pelvis of the pregnant patient: a survey from the 2012 Radiological Society Of North America Annual Meeting controversies session.

Imaging in pregnancy is a complex topic, as imaging is typically individualized based on clinical presentation and gestational age. Modalities that do not use ionizing radiation, particularly ultrasound (US) and magnetic resonance imaging (MRI), are preferred to radiography and computed tomography (CT), which use ionizing radiation, and the use of CT in particular in pregnancy is somewhat controversial. The fetal dose from a single abdominal and pelvic CT has been reported as ranging from 7 to 56 mGy, and it is generally accepted at present that exposure during pregnancy under 100 mGy carries only a very small risk of fetal effects. At our primary institution, the dose for a single-phase CT of the abdomen and pelvis ranges between 12 and 15 mGy. Nearly all institutions routinely inquire about pregnancy in women of child-bearing age, and based on the American College of Radiology guidelines for imaging pregnant patients, institutions may benefit from algorithms to decrease maternal/fetal radiation exposure as part of their standard practice. A 16-question survey was administered to 45 radiologists during the 2012 Radiological Society of North America (RSNA) annual meeting at a session discussing controversies in abdominal and pelvic imaging of pregnant women to evaluate current practices based on simple clinical scenarios and/or respective practice/institutional guidelines for imaging during pregnancy. The number of responses varied for each question, ranging from 22 to 41. The purpose of this article is to discuss the more recent imaging practice trends and to compare them to a prior survey by Jaffe et al published in 2007 in the American Journal of Roentgenology from the Duke University Medical Center, which presented the results of a national survey of academic resident teaching institutions regarding imaging of the pregnant patient with abdominal pain. The audience polled at the RSNA session was more diverse compared with the radiologists/institutions included in the survey by Jaffe et al, with 48% (n = 15) of responding radiologists practicing at an academic institution, 19% (n = 6) in community hospitals with residents, 26% (n = 8) in a nonspecialty private practice, and 6% (n = 2) in subspecialty private practice. Only 43% (n = 17) had a formal written policy for imaging in pregnancy, and 13% (n = 5) were unsure if their departments had such a policy. Over 90% (n = 35) responded that they optimized the parameters of CT examinations for pregnant patients. Although fewer COMMENTARY

Ovarian Torsion: Multimodality Review of Imaging Characteristics.

Abstract We present a case of ovarian torsion in pregnancy with demonstration of vascular flow on sequential Doppler ultrasonography. Magnetic resonance imaging demonstrated ovarian enlargement and edema. Mild symptoms and low clinical suspicion, in addition to risks associated with pregnancy prevented early laparoscopic examination, though torsion was considered. Progressive ovarian enlargement supported surgical intervention, which confirmed the presence of torsion. This case report reviews multimodality imaging characteristics of ovarian torsion, re-emphasizing the significance of ovarian morphology.

Running a Radiology Residency Program: Strategies for Success.

Running a successful radiology residency program requires departments to navigate the evolving educational landscape at the departmental, institutional, and national levels. To attract the best applicants, departments must invest time and money to support the leadership of the program and its faculty to provide innovative educational opportunities in a positive learning environment while simultaneously complying with all of the requirements of the Accreditation Council for Graduate Medical Education. The key administrative requirements of a successful radiology residency program are described and can be grouped into (a) essential administrative components, (b) the clinical learning environment review and self-study process, and (c) resident recruitment. Ten specific strategies for running a successful residency program are also presented. The goal is for this article to serve as a guide for not only existing diagnostic and interventional radiology residency programs but also newly formed programs that are in the process of seeking accreditation. ©RSNA, 2018.

Ultrasound Emergencies of the Male Pelvis

Male pelvic emergencies are uncommon, and symptoms typically include scrotal pain, scrotal enlargement, or a palpable scrotal mass or all of these. Ultrasound is often the first-line modality for evaluation of male pelvic emergencies, which may be stratified into vascular, infectious, or traumatic causes. Entities such as testicular torsion, Fournier gangrene, and testicular dislocation are surgical emergencies and should not be missed or misdiagnosed, as this may cause a significant delay in urgently necessary treatment. Radiologists need to be familiar with the role of imaging as well as the key characteristic imaging findings of these injuries to direct the appropriate management.

Emergency Computed Tomography Angiogram of the Chest, Abdomen, and Pelvis

In the setting of blunt trauma, the rapid assessment of internal injuries is essential to prevent potentially fatal outcomes. Computed tomography is a useful diagnostic tool for both screening and diagnosis. In addition to trauma, acute chest syndromes often warrant emergent computed tomographic angiography, looking for etiologies such as aortic aneurysms or complications of aortic aneurysms, or both, pulmonary emboli, as well as other acute vascular process like aortic dissection and Takayasu aortitis. With continued improvements in diagnostic imaging, computed tomographic angiography of the chest, abdominal and pelvis proves to be an effective modality to image the aorta and other major vascular structures.

Acute Bowel Computed Tomography

Acute abdominal pain is a common presenting complaint in the emergency department. Increasingly, computed tomography is utilized for evaluating these patients. Radiologists are therefore expected to be familiar with the pertinent clinical and radiologic information related to acute bowel pathology. This primer will review the need-to-know and latest updates related to computed tomography evaluation of acute bowel pathology.

Letter From the Guest Editors: Multimodality Imaging of the Pregnant Patient

It is well recognized that radiation exposure during pregnancy carries significant risk to the fetus. Many factors must be taken into consideration when faced with a pregnant patient who requires medical imaging. The risk/benefit ratio to the mother must always outweigh the risk of radiation exposure to the fetus. Once the benefit of imaging has been determined to outweigh fetal risk, careful thought must be given to the appropriate imaging modality to be used, as well as to the mandatory employment of radiation dose reduction techniques. Where possible, ultrasound and magnetic resonance imaging (MRI) should be the primary imaging modalities used to evaluate the pregnant patient. There are several benefits of both of these imaging technologies, the most important of which is the lack of ionizing radiation. Ultrasound is readily available, cost-effective, and portable. It may be performed at the bedside for unstable or immobile patients and is a rapid screening and diagnostic tool in this patient population. Ultrasound plays a significant role in the evaluation of the newly confirmed pregnancy, particularly when there is concern for ectopic gestation or missed/threatened abortion. In secondand third-trimester pregnancy, ultrasound is the imaging modality of choice for evaluation of fetal anomalies and dating, as well as for assessment of placental abruption in symptomatic women. Beyond its obstetrical role, ultrasound is a valuable tool in the assessment of the pregnant patient presenting with abdominal or pelvic pain. Evaluation or surveillance of adnexal masses is typically performed with ultrasound imaging; MRI may be required if a confident diagnosis cannot be made with ultrasound. Imaging is often requested to evaluate the etiology of acute right lower quadrant pain, with the main diagnostic considerations including appendicitis and ovarian torsion. Ultrasound has a very high sensitivity and specificity for the identification of ovarian torsion; however, it is less reliable and reproducible in the identification of appendiceal pathology. This is typically because of the variable location of the appendix in pregnancy due to displacement of viscera by the gravid uterus. The role of ultrasound in the evaluation of abdominal pain is well established, particularly for cholelithiasis, cholecystitis, and renal obstruction. Conventional ultrasound imaging techniques are used for the evaluation of abdominal pain in