Winnie Mar

Update on imaging and treatment of Ewing sarcoma family tumors: What the radiologist needs to know

This review article provides an update on multimodality imaging characteristics of Ewing sarcoma family tumors. Pathology of this tumor and current trends in medical and surgical treatment are briefly discussed.

Measuring Abdominal Circumference and Skeletal Muscle From a Single Cross-Sectional Computed Tomography Image: A Step-by-Step Guide for Clinicians Using National Institutes of Health ImageJ.

Diagnostic computed tomography (CT) scans provide numerous opportunities for body composition analysis, including quantification of abdominal circumference, abdominal adipose tissues (subcutaneous, visceral, and intermuscular), and skeletal muscle (SM). CT scans are commonly performed for diagnostic purposes in clinical settings, and methods for estimating abdominal circumference and whole-body SM mass from them have been reported. A supine abdominal circumference is a valid measure of waist circumference (WC). The valid correlation between a single cross-sectional CT image (slice) at third lumbar (L3) for abdominal SM and whole-body SM is also well established. Sarcopenia refers to the age-associated decreased in muscle mass and function. A single dimensional definition of sarcopenia using CT images that includes only assessment of low whole-body SM has been validated in clinical populations and significantly associated with negative outcomes. However, despite the availability and precision of SM data from CT scans and the relationship between these measurements and clinical outcomes, they have not become a routine component of clinical nutrition assessment. Lack of time, training, and expense are potential barriers that prevent clinicians from fully embracing this technique. This tutorial presents a systematic, step-by-step guide to quickly quantify abdominal circumference as a proxy for WC and SM using a cross-sectional CT image from a regional diagnostic CT scan for clinical identification of sarcopenia. Multiple software options are available, but this tutorial uses ImageJ, a free public-domain software developed by the National Institutes of Health.

Pelvic Venous Insufficiency: Imaging Diagnosis, Treatment Approaches, and Therapeutic Issues

OBJECTIVE. The purposes of this article are to review the causes of pelvic congestion syndrome and the imaging used to make the diagnosis and to summarize the treatment options. CONCLUSION. Pelvic congestion syndrome is one of many causes of chronic pelvic pain. It is thought to arise from ovarian and pelvic venous incompetence. Findings from various noninvasive imaging studies, such as Doppler ultrasound and MRI, in association with the clinical symptoms are critical in establishing the diagnosis.

Diagnostic imaging in the evaluation of leg pain in athletes.

The causes of leg pain in the athlete are diverse. Pain can relate to more common etiologies, such as musculotendinous injury to the hamstrings and Achilles tendon as well as stress injury to bone, with tibial stress injuries comprising the most common cause for lower leg pain in athletes. Less-common causes include chronic exertional compartment syndrome and popliteal artery entrapment syndrome, both of which cause pain as a result of muscle ischemia. Radiologic evaluation plays an important role in differentiating among the many possible causes of leg pain and is often essential in determining degree of injury as well as in documenting healing before patient return to athletic activity. With PAES and hamstring and Achilles injuries, imaging may be helpful in surgical planning as well as in determining an underlying anatomic cause for injury. Several of these conditions can be evaluated with multiple different imaging modalities. The imaging modality of choice should be selected based on the sensitivity and specificity of the imaging examination but should also be tailored to each individual patient after determining comorbidities that may preclude certain types of imaging as well as assessing the patients ability to undergo such testing.

Imaging spectrum of cholangiocarcinoma: role in diagnosis, staging, and posttreatment evaluation

Cholangiocarcinoma, a tumor of biliary epithelium, is increasing in incidence. The imaging appearance, behavior, and treatment of cholangiocarcinoma differ according to its location and morphology. Cholangiocarcinoma is usually classified as intrahepatic, perihilar, or distal. The three morphologies are mass-forming, periductal sclerosing, and intraductal growing. As surgical resection is the only cure, prompt diagnosis and accurate staging is crucial. In staging, vascular involvement, longitudinal spread, and lymphadenopathy are important to assess. The role of liver transplantation for unresectable peripheral cholangiocarcinoma will be discussed. Locoregional therapy can extend survival for those with unresectable intrahepatic tumors. The main risk factors predisposing to cholangiocarcinoma are parasitic infections, primary sclerosing cholangitis, choledochal cysts, and viral hepatitis. Several inflammatory conditions can mimic cholangiocarcinoma, including IgG4 disease, sclerosing cholangitis, Mirizzi’s syndrome, and recurrent pyogenic cholangitis. The role of PET in diagnosis and staging will also be discussed. Radiologists play a crucial role in diagnosis, staging, and treatment of this disease.

Ultrasound Imaging of Placenta Accreta with MR Correlation

Abstract Placenta accreta is abnormal placental adherence or invasion of the myometrium or extrauterine structures. It is increasing in incidence because of increasing number of cesarean sections and is one of the main causes of excessive postpartum hemorrhage. Recognition of this entity is crucial because improved outcomes have been shown when the antenatal diagnosis of placenta accreta is made. Ultrasound is the first-line tool; magnetic resonance imaging (MRI) is complementary. Ultrasound and MRI features and MRI protocols will be reviewed.

Misplaced Devices in the Chest, Abdomen, and Pelvis: Part II

Numerous medical devices are used in the chest and fewer in the abdomen and pelvis. They are frequently seen on various radiological studies in daily practice. Knowing the specific name of the device is not important. However, knowing the proper positioning and function of the device is necessary. It is a duty of the reporting radiologist to recognize the malpositioning or breakage of a medical device and to inform the responsible physician promptly, since these complications can have undesirable consequences and sometimes a fatal outcome.

Improved Image Quality of Low-Dose CT Pulmonary Angiograms

OBJECTIVE The use of CT pulmonary angiography (CTPA) to evaluate for pulmonary embolism has been increasing, and carries a significant radiation dose. We evaluate image quality of lower-dose images, taking into account patient size as well as the effects of image postprocessing. METHODS A total of 250 CTPAs were retrospectively reviewed. The following parameters were obtained: kVp, mA, dose length product, Hounsfield units (HU) with standard deviation in the main pulmonary artery, transverse scout measurement, and subjective image quality. RESULTS Radiation dose decreased 55% by reducing kVp from 120 to 100, and 60% from 100 to 80 kVp. Radiation dose decreased 82% from 120 to 80 kVp. Noise increased 38% from 120 kVp to 100 kVp, and increased 23% from 100 kVp to 80 kVp. Adding an overlapped reconstructed image decreased noise by 16% to 21%. Despite the increase in image noise, diagnostic quality was significantly improved at 80 and 100 kVp, compared with 120 kVp, with an average subjective quality rating of 3.8, 4.0, and 3.2, respectively, and an average pulmonary artery density of 536, 423, and 278 HU. Even in larger patients, qualitative image quality was better at 100 kVp compared with 120 kVp, with an average quality rating of 3.6 versus 2.9, respectively. CONCLUSIONS Radiation dose exposure can be easily reduced on CTPA by lowering kVp, which at the same time improves image quality. Studies using a lower kVp were of significantly higher diagnostic quality. This held true even in larger patients.

Promoting Collaborations Between Radiologists and Scientists

Radiology as a discipline thrives on the dynamic interplay between technological and clinical advances. Progress in almost all facets of the imaging sciences is highly dependent on complex tools sourced from physics, engineering, biology, and the clinical sciences to obtain, process, and view imaging studies. The application of these tools, however, requires broad and deep medical knowledge about disease pathophysiology and its relationship with medical imaging. This relationship between clinical medicine and imaging technology, nurtured and fostered over the past 75 years, has cultivated extraordinarily rich collaborative opportunities between basic scientists, engineers, and physicians. In this review, we attempt to provide a framework to identify both currently successful collaborative ventures and future opportunities for scientific partnership. This invited review is a product of a special working group within the Association of University Radiologists-Radiology Research Alliance.

Rosai-Dorfman Disease: Manifestations Outside of the Head and Neck

OBJECTIVE Rosai-Dorfman disease (RDD) is an uncommon benign histiocytic disorder. Extranodal involvement occurs in 43% and most commonly involves the head and neck, skin, and bones. We review less common imaging findings outside the head and neck. CONCLUSION The imaging manifestations of RDD overlap with a variety of neoplastic and nonneoplastic conditions. Confirmation of an RDD diagnosis is based on specific histologic features. Radiologic assessment is used to rule out multifocality on initial workup and to evaluate treatment response.