Fetal MRI at 3 T: Principles to Optimize Success

Fetal MRI has become an essential tool for prenatal imaging, aiding in the diagnosis of congenital anomalies. In the past decade, 3 T imaging has been introduced to increase signal-to-noise ratio and improve anatomic detail. However, this higher field strength can cause artifacts. A systematic approach to imaging at 3 T, including patient positioning, protocol design, and sequence optimization, can minimize these artifacts and allow for the benefits of increased SNR. The same sequences are used at both field strengths, providing valuable information about fetal anatomy and pathologic conditions. In the authors' experience, fetal imaging at 3 T is superior to 1.5 T when performed optimally. This article provides a guideline for all major aspects of fetal MRI at 3 T.

FDG PET/CT-based Response Assessment in Malignancies

FDG PET/CT is a powerful tool for assessing response to treatment in various malignancies. It can differentiate complete responders from those with residual disease, and detect functional changes before structural changes. Response assessment criteria based on FDG PET/CT findings are continuously being revised to ensure accuracy.

Quality Improvement Report: Adherence to Follow-up Recommendations for Incidental Abdominal Aneurysms

To improve adherence to and consistency with follow-up recommendations for incidental findings, a large academic practice used the Kotter change management framework and developed institution-specific dictation macros. After implementation, there was a significant increase in the number of correct follow-up recommendations for abdominal aortic aneurysms and splenic artery aneurysms (P < .001). Personal feedback to radiologists further improved adherence for rare findings such as renal artery aneurysms. Imaging follow-up also increased (P < .001). These macros can have a significant effect on clinical follow-up.

RadioGraphics Update: Pictorial Guide to CAD-RADS 2.0

This RadioGraphics Update provides an overview of the current state of radiologic imaging in the diagnosis and management of patients with acute appendicitis. It reviews the imaging modalities available, including ultrasound, computed tomography, and magnetic resonance imaging, and discusses the advantages and disadvantages of each. It also provides an update on the latest imaging protocols and clinical guidelines for the diagnosis and management of acute appendicitis. This RadioGraphics Update provides an overview of the current state of radiologic imaging for diagnosing and managing acute appendicitis. It reviews the advantages and disadvantages of ultrasound, computed tomography, and magnetic resonance imaging, and provides an update on the latest imaging protocols and clinical guidelines. With this information, radiologists can make informed decisions when diagnosing and managing patients with acute appendicitis.

Current and Advanced Applications of Gadoxetic Acid-enhanced MRI in Hepatobiliary Disorders

Gadoxetic acid is an MRI contrast agent used to study hepatobiliary disease. It is distributed in the vascular and extravascular spaces, taken up by hepatocytes, and excreted to the bile ducts. MRI sequences, advanced imaging techniques, artificial intelligence, and radiomic and radiogenomic tools based on gadoxetic acid-enhanced MRI findings can help assess liver function, chronic liver disease, and focal liver lesions, as well as biliary pathologic conditions.

Palliative Procedures for Congenital Heart Disease: Imaging Findings and Complications

Palliative procedures are used to treat congenital heart diseases that can't be fixed with surgery. Multimodality imaging, such as echocardiography, CT, and MRI, is used to detect complications and plan future procedures. Common complications of systemic-PA shunts, Glenn shunts, and Fontan shunts include thrombus, stenosis, infection, and cardiac failure. PA banding can lead to stenosis, thrombus, erosion, and subaortic obstruction. Atrial septostomy and atrial switch procedures can cause mechanical, traumatic, embolic, and electrical complications. Multimodality imaging plays an important role in the evaluation of these palliative procedures.

Breast Cancer Screening in Survivors of Childhood Cancer

Survivors of childhood and young adult cancers are at an increased risk of developing breast cancer later in life. This risk is especially high for those treated with radiation therapy, but also extends to those treated with other therapies. Early screening with mammography and MRI is recommended for those exposed to 10 Gy or more of radiation, but there is a lack of guidance for those at high risk without radiation exposure. Survivors have a higher mortality rate and incidence of a second asynchronous breast cancer than the general population, so regular screening is essential. Education and risk prevention strategies are needed to improve long-term outcomes for these patients.

Restaging MRI of Rectal Adenocarcinoma after Neoadjuvant Chemoradiotherapy: Imaging Findings and Potential Pitfalls

Rectal adenocarcinoma is a common form of colorectal cancer, and rectal MRI is essential for diagnosis and treatment. Neoadjuvant chemoradiotherapy can lead to a pathologic complete response in up to 30% of patients, allowing for a watch-and-wait approach. MRI is also used to assess lymph node involvement and guide surgical dissection planes. This article discusses the indications for neoadjuvant therapy, expected imaging appearances, MRI tumor regression grading system, lymphatic compartments of the pelvis, and potential pitfalls of rectal MRI.

Cochlear Implantation: Systematic Approach to Preoperative Radiologic Evaluation

Hearing loss can be caused by a variety of conditions, and cochlear implantation is becoming a popular option for rehabilitation. This article reviews imaging protocols for sensorineural hearing loss, normal inner ear anatomy, and congenital and acquired causes of hearing loss. It also highlights anatomic factors and variations that can affect surgical planning and outcomes.

Gamut of Extratesticular Scrotal Masses: Anatomic Approach to Sonographic Differential Diagnosis

Radiologists must be aware of the complex anatomy of the extratesticular space, as a wide range of pathologic conditions can occur. Many of these lesions have a specific sonographic appearance, allowing accurate diagnosis and minimizing surgical intervention. Malignancies can also occur in the extratesticular space, so proper recognition of findings is critical. This article provides a framework for differential diagnosis and a comprehensive display of pathologic conditions, as well as management of these lesions.

Charcot-Marie-Tooth Disease of the Foot and Ankle: Imaging Features and Pathophysiology

CMT is a common inherited peripheral polyneuropathy that can cause a cavovarus deformity of the foot and ankle. This deformity can be debilitating, limiting mobility and causing instability. Imaging is critical for evaluation and treatment, and multimodality imaging including MRI and US can help diagnose complications. Bracing and surgical correction may be necessary to create a more stable plantigrade foot. This article focuses on CMT, but the information can be applied to other neuromuscular conditions.

Collaborative Privacy-preserving Approaches for Distributed Deep Learning Using Multi-Institutional Data

DL algorithms have the potential to automate medical imaging and reporting tasks. However, models trained on limited data or from one institution may not be generalizable. To improve robustness and generalizability, data from multiple institutions must be used. Pooling data to a central location poses privacy, cost, and regulatory issues. Distributed machine learning techniques and frameworks have been developed to train DL models without sharing private data. This article reviews popular methods, showcases real-world examples, and discusses challenges and future research directions. Clinicians are introduced to the benefits, limitations, and risks of using distributed DL for medical AI.

Editorial Comment: Opportunities for Artificial Intelligence-Aided Radiologic Workflow Optimization

The authors used a deep learning algorithm to reprioritize radiologist worklists and compared the impact on report turnaround times for computed tomography pulmonary angiography (CTPA) examinations positive for acute pulmonary embolism (PE). The authors found that the deep learning algorithm was able to accurately reprioritize the worklist and significantly reduce the report turnaround time for CTPA examinations positive for PE.Discover how a deep learning algorithm can help radiologists reduce report turnaround times for CTPA examinations positive for acute pulmonary embolism! This Editorial Comment discusses an AJR article that used a deep learning algorithm to reprioritize radiologist worklists and found that it significantly improved report turnaround times. Get ready to revolutionize your workflow!

Editorial Comment: Mucinous Degeneration on MRI After Neoadjuvant Therapy

The authors retrospectively evaluated the frequency of mucinous degeneration (MD) on MRI after neoadjuvant therapy (NAT) in patients with rectal adenocarcinoma and its association with clinical outcomes. They found that MD was present in 28.6% of patients and was associated with a higher rate of local recurrence and lower rate of complete pathologic response.Are you curious about the effects of neoadjuvant therapy on rectal adenocarcinoma? This Editorial Comment discusses an AJR article that looked at the frequency of mucinous degeneration on MRI after NAT and its association with clinical outcomes. The results showed that MD was present in nearly 30% of patients and was linked to a higher rate of local recurrence and lower rate of complete pathologic response. Get the full scoop on this fascinating study!

Imaging of Pulmonary Fibrosis: An Update, From the AJR Special Series on Imaging of Fibrosis

Pulmonary fibrosis is a chronic, progressive lung disease that can be associated with a variety of conditions. Idiopathic pulmonary fibrosis (IPF) is the most common form, but progressive pulmonary fibrosis (PPF) can also occur. Interstitial lung abnormalities (ILAs) may be an early sign of pulmonary fibrosis. Traction bronchiectasis and bronchiolectasis are signs of irreversible disease and can predict worse mortality. Radiologists play an essential role in the multidisciplinary approach to understanding and managing pulmonary fibrosis.

Frequency and Outcomes of BI-RADS Category 3 Assessments in Patients With a Personal History of Breast Cancer: Full-Field Digital Mammography Versus Digital Breast Tomosynthesis

This study compared the frequency, outcomes, and additional characteristics of BI-RADS category 3 assessments between FFDM and DBT in patients with a personal history of breast cancer. Results showed that DBT had a lower malignancy rate for category 3 lesions (1.8%) than FFDM (5.0%), and a higher malignancy rate for category 4 lesions (32.0% vs 23.2%). DBT also had a lower PPV3 (13.9% vs 36.1%) and more frequent mammographic finding type of mass (33.2% vs 23.1%). These insights may help reduce benign biopsies and improve early detection of second cancers in patients with PHBC.

Imaging Follow-Up of Nonsurgical Therapies for Lung Cancer: AJR Expert Panel Narrative Review

Lung cancer is the leading cause of cancer-related death worldwide. In the past decade, advances in treatments and imaging have improved survival rates and increased the number of imaging studies for patients. However, many patients are not able to undergo surgery due to comorbidities or advanced stage at diagnosis. This AJR Expert Panel Narrative Review provides guidance to radiologists on imaging assessment after nonsurgical therapies, such as systemic therapy, radiotherapy, and thermal ablation, for nonsmall cell lung cancer.

Radiologist Worklist Reprioritization Using Artificial Intelligence: Impact on Report Turnaround Times for CTPA Examinations Positive for Acute Pulmonary Embolism

This study evaluated the effect of an AI-based radiologist worklist reprioritization tool on report turnaround times for CT pulmonary angiography examinations positive for acute pulmonary embolus. Results showed that the AI tool significantly reduced report turnaround time and wait time for PE-positive examinations, potentially enabling earlier interventions for acute PE.

Diagnosis and Management of Pelvic Venous Disorders: AJR Expert Panel Narrative Review

Pelvic venous disorders (PeVD) have been historically underdiagnosed as a cause of chronic pelvic pain (CPP). However, recent progress in the field has provided clarity on definitions and treatments for PeVD. Endovascular treatments such as ovarian and pelvic vein embolization, as well as endovascular stenting of common iliac venous compression, have been proven safe and effective for CPP of venous origin. Current protocols for PeVD are still evolving, but clinical trials are expected to improve understanding and management of PeVD. This review provides an update on PeVD, including its classification, diagnostic workup, treatments, and future research.

Comparison of Radiation Dose and Image Quality of Pediatric High-Resolution Chest CT Between Photon-Counting Detector CT and Energy-Integrated Detector CT: A Matched Study

This study compared the radiation dose, objective image quality, and subjective image quality of photon-counting detector (PCD) CT and energy-integrating detector (EID) CT in children undergoing high-resolution CT (HRCT) of the chest. Results showed PCD CT had significantly lower radiation dose levels, but no significant difference in objective or subjective image quality compared to EID CT. These findings suggest PCD CT is a viable option for pediatric chest HRCT.

Potential Use Cases for ChatGPT in Radiology Reporting

This review provides an overview of the current state of LLMs in radiology and discusses the potential benefits and risks of their use in clinical practice.LLMs are powerful AI models that can help improve radiology reporting and patient engagement. They can automate the generation of clinical history and impression of a radiology report, create layperson reports, and provide patients with pertinent questions and answers. However, human oversight is needed to reduce the risk of errors and patient harm. This review provides an overview of the current state of LLMs in radiology and their potential benefits and risks.

Technical Adequacy of Fully Automated Artificial Intelligence Body Composition Tools: Assessment in a Heterogeneous Sample of External CT Examinations

This study assessed the technical adequacy of automated AI abdominal CT body composition tools in a heterogeneous sample of external CT examinations. Results showed that all three tools were technically adequate in 97.7% of the 11,699 examinations. Anisometry error was the most common cause of failure, with 97.5% of errors occurring on scanners from a single manufacturer. These findings suggest that AI tools are robust to expected variations and have potential for broad use, but proper acquisition and reconstruction protocols are needed to prevent technical-related failures.

Editorial Comment: Analyzing Causes and Generating Strategies to Mitigate Diagnostic Errors in Radiology Practice

The authors conducted a case-control study to identify factors associated with neuroradiology diagnostic errors at a large tertiary-care academic medical center. The study found that diagnostic errors were associated with increased patient complexity, increased radiologist experience, and increased workload.Are you an expert radiologist? Get ready to learn about the factors associated with neuroradiology diagnostic errors! A case-control study conducted at a large tertiary-care academic medical center found that complexity of the patient, radiologist experience, and workload all play a role in diagnostic errors. So, the more complex the patient, the more experienced the radiologist, and the higher the workload, the higher the risk of diagnostic errors.

Editorial Comment: Value-Added Assessment for Parathyroid Adenomas on Routine CT Examinations

The authors retrospectively reviewed the medical records of patients who underwent CT imaging of the neck and parathyroid glands. They found that the use of a radiologist-recommended biochemical evaluation was associated with a higher rate of diagnosis of primary hyperparathyroidism than when the evaluation was not used.Are you concerned about a possible diagnosis of primary hyperparathyroidism? A recent study has found that using a radiologist-recommended biochemical evaluation can help diagnose this condition more accurately. Don't miss out on this important opportunity to get the answers you need!

Editorial Comment: Meet BERT-The Newest Artificial Intelligence-Based Radiologist Extender

The authors developed and externally validated an artificial intelligence (AI) model to identify radiology reports containing recommendations for additional imaging. The model was trained and tested on a dataset of 8,945 reports from a single institution. The model achieved an area under the receiver operating characteristic curve of 0.945 and a sensitivity of 0.945.This Editorial Comment discusses an AI model developed to identify radiology reports containing recommendations for additional imaging. The model was trained and tested on a dataset of 8,945 reports from a single institution and achieved impressive results, with an area under the receiver operating characteristic curve of 0.945 and a sensitivity of 0.945. This AI model is a promising tool for radiologists to quickly and accurately identify reports with recommendations for additional imaging.

Development and External Validation of an Artificial Intelligence Model for Identifying Radiology Reports Containing Recommendations for Additional Imaging

This study developed and externally validated an AI-based model for identifying radiology reports containing recommendations for additional imaging. The model, based on Bidirectional Encoder Representations from Transformers (BERT), showed high precision, recall, and accuracy in both the test and external validation sets, outperforming a traditional machine-learning model. The model has potential to be applied for real-time EHR monitoring to ensure timely performance of clinically necessary follow-up.

Expanding Role of Dual-Energy CT for Genitourinary Tract Assessment in the Emergency Department, From the AJR Special Series on Emergency Radiology

Dual-energy CT (DECT) is a powerful tool for assessing the genitourinary (GU) tract in the emergency department (ED). It can be used to characterize renal stones, evaluate traumatic injuries and hemorrhage, and characterize incidental renal and adrenal findings. Emerging applications include low-keV virtual monoenergetic images (VMI) to improve image quality and reduce contrast media doses, and high-keV VMI to mitigate renal mass pseudoenhancement. Automatic generation of DECT-derived images with direct PACS transfer can help radiologists adopt DECT in busy EDs with minimal impact on interpretation times. DECT can improve the quality and efficiency of care in the ED.

Career Trajectory Factors Affecting Gender Diversity in Academic Radiology Department Chairs: Results of a Survey of SCARD Members

Women and men in academic radiology departments have similar pathways to becoming a chair, but women more often feel their gender has hindered their career and experienced discrimination. This survey highlights the need for greater gender equity in the field.