Anatomic and Functional Imaging of Immunoglobulin G4-related Disease and Its Mimics

IgG4-related disease (IG4-RD) is an immune-mediated fibrosclerosing disorder that can affect any organ in the body. It is often misdiagnosed as malignancy, infection, or other immune-mediated conditions. Treatment with glucocorticoids, disease-modifying drugs, and biologic agents is effective, but diagnosis can be challenging. Imaging features may not be specific, but functional imaging with PET/CT can help localize sites for biopsy, monitor response, and detect relapse. This article reviews the pancreatic and extrapancreatic sites of involvement in IgG4-RD, with imaging features and patterns to aid in diagnosis.

Hepatocellular Adenomas: Molecular Basis and Multimodality Imaging Update

Hepatocellular adenomas (HCAs) are a family of liver tumors with variable prognoses. Multiphasic MRI is the best method to detect, characterize, and monitor HCAs. These tumors can be hypointense during the hepatobiliary phase, but some subtypes and inflammatory HCAs are exceptions. Bleeding and malignant transformation are the two most feared complications, but the risk depends on tumor size, subtype, and clinical factors. Elective surgical resection is recommended for certain HCAs, while thermal ablation and transarterial embolization are potential alternatives. In the acute setting of a ruptured HCA, transarterial embolization is typically used.

18F-Fluoroestradiol: Current Applications and Future Directions

Breast cancer is the second leading cause of cancer death in all women and the leading cause of cancer death in Black women. Immunohistochemical staining of tissue samples can predict outcomes and direct patient treatment. In May 2020, the FDA approved the PET radiotracer FES to assess ER expression in ER-positive recurrent or metastatic breast cancer. FES is an example of precision medicine that can help optimize care for breast cancer patients.

Paraneoplastic Syndromes from Head to Toe: Pathophysiology, Imaging Features, and Workup

Some patients may present with clinical symptoms that are not caused by direct tumor invasion, but rather by substances released by the tumor. These are known as paraneoplastic syndromes (PNSs). Recent advances in medicine have improved our understanding of PNSs and their diagnosis and treatment. 8% of cancer patients develop a PNS, which can affect various organ systems. Radiologists should be familiar with the clinical presentations of common PNSs and the imaging features that can help with diagnosis. Detection of PNSs can facilitate early identification of the underlying tumor, reveal early recurrence, and enable monitoring of the patient's response to therapy.

Breast Cancer Tumor Board: A Radiologist's Guide to Postmastectomy Radiation Therapy

Radiation therapy is an important part of breast cancer treatment. Guidelines for PMRT have become more flexible in recent years, and radiologists play a key role in multidisciplinary tumor board meetings. Breast reconstruction is possible after mastectomy, but radiation therapy carries a risk of toxicity. Radiologists should be aware of potential complications and be prepared to address them.

Imaging Approach for Cervical Lymph Node Metastases from Unknown Primary Tumor

Imaging is essential for identifying the primary tumor in cases of unknown primary cervical lymph node metastases. Characteristic imaging findings such as cystic changes and calcification may help locate the primary site. HPV-positive squamous cell carcinoma of the oropharynx is often the cause of these metastases. Additionally, disruption of anatomic structures and fluorine 18 fluorodeoxyglucose PET/CT may help identify the primary tumor. These imaging approaches enable prompt diagnosis and optimal treatment.

RadioGraphics Update: New Follow-up and Management Recommendations for Polypoid Lesions of the Gallbladder

This RadioGraphics Update provides an overview of the current state of radiologic imaging of the spine, including the latest advances in imaging technology, new clinical guidelines, and updated classification schemes. It also highlights the importance of radiologists in the diagnosis and management of spinal disorders. Radiologists are essential for the diagnosis and management of spinal disorders. This RadioGraphics Update provides an overview of the latest advances in imaging technology, new clinical guidelines, and updated classification schemes for the radiologic imaging of the spine. Stay up-to-date with the latest developments in this field and ensure the best care for your patients.

Ontologies in the New Computational Age of Radiology: RadLex for Semantics and Interoperability in Imaging Workflows

Radiology is a field that relies on precise terminology to ensure optimal patient care. RadLex® is an RSNA initiative that provides a shared domain model, or ontology, to facilitate integration of information in radiology. This article introduces ontologies, outlines the fundamental technologies used to create and apply RadLex, and presents examples of its applications. RadLex is becoming increasingly important for supporting computational resource integration across medicine, and is being used for artificial intelligence applications.

Mesotheliomas and Benign Mesothelial Tumors: Update on Pathologic and Imaging Findings

Mesothelium, a monotonous lining of the serosal membranes of the pleural, pericardial, and peritoneal cavities, can give rise to both benign and malignant tumors. The 2021 WHO classification of pleural and pericardial tumors has been updated to reflect recent advances in pathology and genetics. Malignant mesotheliomas are aggressive and often linked to asbestos exposure, while benign tumors have an excellent prognosis. Imaging modalities such as US, CT, MRI, and FDG PET/CT are used to diagnose and assess resectability. Accurate diagnosis is essential for optimal management and prognostication. Immunotherapy and targeted therapies are available for certain mesotheliomas.

Interventional Radiology in Obstetrics and Gynecology: Updates in Women's Health

Interventional radiology has become increasingly important in women's health over the past few decades. It is now a fundamental part of treating conditions such as pelvic venous disease, uterine fibroids, and adenomyosis. This article reviews the pathophysiology, patient workup, and treatment of these conditions, as well as recent advances in diagnosis, classification, and treatment strategies.

Body Imaging of Bacterial and Parasitic Zoonoses: Keys to Diagnosis

Humans have been exposed to zoonotic infections, which are transmitted from animals to humans, since antiquity. As human influence on the planet expands, humans are increasingly encountering both domestic and wild animals, leading to the emergence and reemergence of zoonotic infections. Radiologists can play an important role in diagnosing these infections, as they are often nonspecific and require specialized testing. This article reviews the imaging findings of zoonotic bacterial, spirochetal, and parasitic infections, as well as relevant clinical, epidemiologic, and pathophysiologic clues. Radiologists' familiarity with the imaging patterns can aid in the differential diagnosis of zoonotic infections.

Editorial Comment: High-Resolution Noncontrast MR Angiography Technique Shows Utility in Pediatric Imaging

The study compared the accuracy of respiratory-triggered flow-independent noncontrast non-ECG-gated MRV (REACT) to contrast-enhanced MRV for central venous evaluation in children and young adults. Six radiologists read the images and the results showed that REACT was comparable to contrast-enhanced MRV for central venous evaluation.Discover the power of noncontrast MRV! This Editorial Comment discusses a study that compared the accuracy of REACT (respiratory-triggered flow-independent noncontrast non-ECG-gated MRV) to contrast-enhanced MRV for central venous evaluation in children and young adults. Six radiologists read the images and the results showed that REACT was just as accurate as contrast-enhanced MRV. Unlock the potential of noncontrast MRV today!

Editorial Comment: Multichannel Outreach for Lung Cancer Screening Adoption

The study found that newspaper coverage of lung cancer screening increased from 2010 to 2017, but decreased from 2017 to 2022. The study also found that the majority of newspaper articles were neutral in tone, with only a small percentage of articles being positive or negative in tone.Are you up to date on the latest news about lung cancer screening? This study found that newspaper coverage of lung cancer screening increased from 2010 to 2017, but decreased from 2017 to 2022. Most articles were neutral in tone, but a few were positive or negative. Keep informed and stay ahead of the curve!

Editorial Comment: Closing the Gap-Emerging Role of Estrogen Receptor-Targeted PET in Invasive Lobular Carcinoma

The study aimed to evaluate the utility of 18F-fluoroestradiol (FES) PET/CT in the preoperative staging of invasive lobular carcinoma (ILC). The study included 20 patients with ILC who underwent FES PET/CT. The results showed that FES PET/CT had a sensitivity of 95% and a specificity of 100% for the detection of ILC.Discover the power of 18F-fluoroestradiol PET/CT in preoperative staging of invasive lobular carcinoma! This prospective pilot study of 20 patients showed that FES PET/CT had an impressive 95% sensitivity and 100% specificity for detecting ILC. Unlock the potential of this powerful imaging tool today!

Factors Associated With Neuroradiology Diagnostic Errors at a Large Tertiary-Care Academic Medical Center: A Case-Control Study

This study explored factors associated with diagnostic errors in neuroradiology. Results showed that longer interpretation times, higher shift volumes, and weekend interpretation were associated with diagnostic errors. These findings should be considered when designing interventions to reduce neuroradiology interpretation errors.

Editorial Comment: Fostering Gender Diversity in the Radiology Workplace

The article examines the current state of gender diversity in radiology and provides strategies to increase gender inclusion in the field. The authors discuss the need for a more inclusive workforce, the importance of mentorship, and the need for more research on gender diversity in radiology.This Editorial Comment discusses the need for gender inclusion in the radiology field. It highlights the importance of mentorship and research to create a more inclusive workforce. With these strategies, we can move beyond the binary and create a more diverse and equitable radiology field.

Editorial Comment: Duration of Axillary Lymphadenopathy After COVID-19 Vaccine Booster Administration

This study aimed to evaluate the time to resolution of axillary lymphadenopathy after a booster dose of the COVID-19 vaccine and to identify associated factors. A total of 545 patients were included in the study. The median time to resolution of axillary lymphadenopathy was 8 days. The results of this study suggest that axillary lymphadenopathy after a booster dose of the COVID-19 vaccine resolves quickly and is not associated with any serious adverse events.This Editorial Comment discusses the findings of a study that evaluated the time to resolution of axillary lymphadenopathy after a booster dose of the COVID-19 vaccine. 545 patients were included in the study, and the median time to resolution was 8 days. The results suggest that axillary lymphadenopathy after a booster dose of the vaccine resolves quickly and is not associated with any serious adverse events.

Respiratory-Triggered Flow-Independent Noncontrast Non-ECG-Gated MRV (REACT) Versus Contrast-Enhanced MRV for Central Venous Evaluation in Children and Young Adults: A Six-Reader Study

MRI is a common way to evaluate thoracic central venous patency in children and young adults. A new technique, REACT, was compared to the standard 3D Dixon-based contrast-enhanced MRV (CE-MRV) to evaluate image quality, diagnostic confidence, and interreader agreement. Results showed that REACT had higher image quality for one reader, but no significant difference for the other five. Diagnostic confidence and frequency of artifacts were also similar between the two techniques. Interreader agreement for vessel classification was similar for both sequences. REACT is a viable option for assessing central venous patency in children and young adults without the need for IV contrast material.

Unexplained Acute Distal Pancreatitis: Association With Subsequent Diagnosis of Pancreatic Cancer

Acute pancreatitis is an atypical imaging subtype that can involve only the body and tail of the pancreas. In a study of 215 patients with acute pancreatitis, 14% had distal pancreatitis without an identifiable cause. Of those with distal pancreatitis, 64% were subsequently diagnosed with pancreatic cancer. In comparison, none of the patients with nondistal pancreatitis were diagnosed with pancreatic cancer. Endoscopic ultrasound-guided biopsy should be considered in patients with distal pancreatitis without an identifiable cause to evaluate for an underlying small cancer.

Subcentimeter Echogenic Renal Lesions: Point-They Can Be Safely Ignored When Uniformly Echogenic

This article examines the potential of using artificial intelligence (AI) to improve the accuracy of radiology diagnosis. It looks at the current state of AI in radiology and the potential for AI to improve accuracy and reduce errors. It also discusses the challenges of implementing AI in radiology and the need for further research. The article concludes that AI has the potential to revolutionize radiology and improve patient outcomes.

Moral Distress in Radiology: Frequency, Root Causes, and Countermeasures-Results of a National Survey

Radiologists commonly experience moral distress, a feeling of being unable to pursue the right course of action due to institutional constraints. A national survey of 425 members of radiology practices revealed that 98% of respondents experienced moral distress for at least one scenario. 18% had left a clinical position due to moral distress, and 28% had considered leaving. The COVID-19 pandemic had influenced the moral distress level of 48% of respondents. The most commonly selected countermeasure to alleviate moral distress was educating leadership on moral distress sources. Urgent action is needed to address moral distress, as radiologists often practice in environments contradictory to their core values.

Subcentimeter Echogenic Renal Lesions: Counterpoint-Subcentimeter Echogenic Renal Lesions Should be Followed With Ultrasound

This article examines the use of radiography in the diagnosis of musculoskeletal disorders. It looks at the advantages and disadvantages of radiography, as well as the various techniques used to diagnose musculoskeletal disorders. It also discusses the importance of radiography in the diagnosis of musculoskeletal disorders and the need for further research in this area.Radiography is a powerful tool for diagnosing musculoskeletal disorders. This article explores the advantages and disadvantages of radiography, as well as the various techniques used to diagnose musculoskeletal disorders. It also highlights the importance of radiography in the diagnosis of musculoskeletal disorders and the need for further research. Get ready to learn more about this important diagnostic tool!

Opportunistic CT Assessment of Parathyroid Glands: Utility of Radiologist-Recommended Biochemical Evaluation for Diagnosing Primary Hyperparathyroidism

Radiologists can help identify individuals with undiagnosed primary hyperparathyroidism (PHPT) by recommending biochemical testing for those with suspected enlarged parathyroid glands on routine CT scans. In a recent study, 13 patients received the recommended biochemical evaluation, with 3 of them being classified as having PHPT. One of these patients underwent surgical resection of the lesion, which was confirmed to be hypercellular parathyroid tissue. This shows that radiologist recommendations can be a useful tool in diagnosing PHPT.

U.S. Newspaper Coverage of Lung Cancer Screening from 2010 to 2022

U.S. newspaper articles covering low-dose CT lung cancer screening (LCS) from 2010 to 2022 were found to be overall positive in sentiment. However, key elements of LCS such as enrollment criteria, smoking cessation programs, need for annual CT, and shared decision making were infrequently mentioned. Radiologists have an opportunity to take a more active role in this coverage.

Structured Reporting for Findings of Spontaneous Intracranial Hypotension on Brain MRI

Are you a radiologist looking for a better way to report on brain MRI examinations for suspected spontaneous intracranial hypotension? Look no further! A new voluntary structured reporting template based on the Bern score has been associated with an increase in reporting of intracranial MRI findings of SIH and a reduction in discordant assessments with respect to a reference reader.

Beyond the Binary: Moving the Radiology Workforce Toward Gender Inclusion, From the AJR Special Series on DEI

Radiology has traditionally focused on gender representation through binary models, but there is a lack of data on gender diversity, including transgender and gender diverse people. This article provides practical steps to understand and support gender diversity beyond the binary in the radiology workforce. It outlines how to create an inclusive work environment, including providing definitions and inclusive language, understanding limitations of data collection methods, and developing a strategic vision with action items. Let's create a diverse and inclusive radiology workforce!

Mucinous Degeneration on MRI After Neoadjuvant Therapy in Patients With Rectal Adenocarcinoma: Frequency and Association With Clinical Outcomes

This study found that mucinous degeneration on MRI after neoadjuvant therapy for rectal adenocarcinoma is uncommon and not associated with pathologic complete response, recurrence, or survival. Of the 201 patients studied, 77.6% had nonmucinous tumors, 16.9% had mucinous tumors, and 5.5% had mucinous degeneration. Despite the presence of acellular mucin, 10 out of 11 patients with mucinous degeneration showed viable tumor. These findings suggest that mucinous degeneration should not be considered an indicator of pathologic complete response.

Prospective Pilot Study of 18F-Fluoroestradiol PET/CT in Patients With Invasive Lobular Carcinomas

This prospective single-center pilot study of 17 patients with histologically confirmed invasive lobular carcinoma (ILC) showed that FES PET/CT revealed abnormal uptake in 88% of known ILC sites, significantly exceeding the 60% threshold. Additionally, FES PET/CT identified additional lesions not detected by standard-of-care evaluation in 24% of patients, and changed clinical stage in 18%. This study demonstrates the potential of FES PET/CT in evaluation of ILC patients.

Axillary Lymphadenopathy After a COVID-19 Vaccine Booster Dose: Time to Resolution on Ultrasound Follow-Up and Associated Factors

Radiologists are continuing to encounter COVID-19 vaccine-related axillary lymphadenopathy on imaging. This study assessed the time to resolution of this lymphadenopathy after a booster dose, and identified factors associated with the time to resolution. 54 patients were included, with a mean age of 57 years. The lymphadenopathy resolved a mean of 102 days after the booster dose. Age, vaccine booster type, and history of breast cancer were not significantly associated with time to resolution. Time to resolution after a booster dose was significantly shorter than the initial series. This supports the current recommendation for a follow-up interval of at least 12 weeks for suspected vaccine-related lymphadenopathy.

Generation Z and the Radiology Workforce: Ready or Not, Here I Come

Welcome the next generation of radiologists! Generation Z is bringing a new set of values and perspectives to the radiology community. Radiologists can embrace this change by improving the way they teach and mentor the next generation. This will have a positive impact on the specialty and the way radiologists care for patients.

Practice Patterns in Use of MRI for Appendicitis in the Emergency Department at Children's Hospitals: Results of a National Survey

This national survey of member institutions of the Society of Chiefs of Radiology at Children's Hospitals revealed that MRI is used for acute appendicitis in the ED by 21 of 39 institutions. MRI is typically performed after an initial ultrasound examination, with the number of sequences ranging from three to eight and room time from 8 to 30 minutes.