Two cases of near-complete regression of focal nodular hyperplasia of the liver: Case reports and review of the literature

AbstractWhile regression of focal nodular hyperplasia of the liver is not uncommon, reports of near-complete involution or regression of these lesions are rare. We report two cases of focal nodular hyperplasia that underwent near-complete regression—one in a 27-year-old female that regressed over a period of 4 years, and one in a 46-year-old female that regressed over a 7-year period. Both patients discontinued use of exogenous estrogens between the diagnosis of focal nodular hyperplasia and its subsequent regression. Although contemporary cross-sectional imaging has improved the ability to detect and follow these lesions, few studies examining the natural history of focal nodular hyperplasia have been conducted. We discuss pertinent imaging findings on magnetic resonance imaging and computed tomography, and review the literature on regression of focal nodular hyperplasia and the effects of endogenous hormones and exogenous hormone therapy

The contemporary role of renal mass biopsy in the management of small renal tumors

The selective use of percutaneous biopsy for diagnosis in renal masses is a relatively uncommon approach when compared to the management of other solid neoplasms. With recent advancements in imaging techniques and their widespread use, the incidental discovery of asymptomatic, small renal masses (SRM) is on the rise and a substantial percentage of these SRM are benign. Recent advances in diagnostics have significantly improved accuracy rates of renal mass biopsy (RMB), making it a potentially powerful tool in the management of SRM. In this review, we will discuss the current management of SRM, problems with the traditional view of RMB, improvements in the diagnostic power of RMB, cost-effectiveness of RMB, and risks associated with RMB. RMB may offer important information enabling treating clinicians to better risk-stratify patients and ultimately provide a more personalized treatment approach for SRM

Segmentations of MRI images of the female pelvic floor: A study of inter- and intra-reader reliability

Purpose: To describe the inter- and intra-operator reliability of segmentations of female pelvic floor structures. Materials and Methods: Three segmentation specialists were asked to segment out the female pelvic structures in 20 MR datasets on three separate occasions. The STAPLE algorithm was used to compute inter- and intra-segmenter agreement of each organ in each dataset. STAPLE computed the sensitivity, specificity, and positive predictive values (PPV) for inter- and intra-segmenter repeatability. These parameters were analyzed using intra-class correlation analysis. Correlation of organ volume to PPV and sensitivity was also computed. Results: Mean PPV of the segmented organs ranged from 0.82 to 0.99, and sensitivity ranged from 33 to 96%. Intra-class correlation ranged from 0.07 to 0.98 across segmenters. Pearson correlation of volume to sensitivity were significant across organs, ranging from 0.54 to 0.91. Organs with significant correlation of PPV to volume were bladder (−0.69), levator ani (−0.68), and coccyx (−0.63). Conclusion: Undirected manual segmentation of the pelvic floor organs are adequate for locating the organs, but poor at defining structural boundaries. J. Magn. Reson. Imaging 2011;33:684–691. © 2011 Wiley-Liss, Inc.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/83166/1/22478_ftp.pd

Imaging in Suspected Renal Colic: Systematic Review of the Literature and Multispecialty Consensus

Background Renal colic is common, and CT is frequently utilized when the diagnosis of kidney stones is suspected. CT is accurate but exposes patients to ionizing radiation and has not been shown to alter either interventional approaches or hospital admission rates. This multi-organizational transdisciplinary collaboration sought evidence-based, multispecialty consensus on optimal imaging across different clinical scenarios in patients with suspected renal colic in the acute setting. Methods In conjunction with the American College of Emergency Physicians (ACEP) eQual network, we formed a nine-member panel with three physician representatives each from ACEP, the ACR, and the American Urology Association. A systematic literature review was used as the basis for a three-step modified Delphi process to seek consensus on optimal imaging in 29 specific clinical scenarios. Results From an initial search yielding 6,337 records, there were 232 relevant articles of acceptable evidence quality to guide the literature summary. At the completion of the Delphi process consensus, agreement was rated as perfect in 15 (52%), excellent in 8 (28%), good in 3 (10%), and moderate in 3 (10%) of the 29 scenarios. There were no scenarios where at least moderate consensus was not reached. CT was recommended in 7 scenarios (24%), with ultrasound in 9 (31%) and no further imaging needed in 12 (45%). Summary Evidence and multispecialty consensus support ultrasound or no further imaging in specific clinical scenarios, with reduced-radiation dose CT to be employed when CT is needed in patients with suspected renal colic

The American Association for the Surgery of Trauma renal injury grading scale: Implications of the 2018 revisions for injury reclassification and predicting bleeding interventions.

BackgroundIn 2018, the American Association for the Surgery of Trauma (AAST) published revisions to the renal injury grading system to reflect the increased reliance on computed tomography scans and non-operative management of high-grade renal trauma (HGRT). We aimed to evaluate how these revisions will change the grading of HGRT and if it outperforms the original 1989 grading in predicting bleeding control interventions.MethodsData on HGRT were collected from 14 Level-1 trauma centers from 2014 to 2017. Patients with initial computed tomography scans were included. Two radiologists reviewed the scans to regrade the injuries according to the 1989 and 2018 AAST grading systems. Descriptive statistics were used to assess grade reclassifications. Mixed-effect multivariable logistic regression was used to measure the predictive ability of each grading system. The areas under the curves were compared.ResultsOf the 322 injuries included, 27.0% were upgraded, 3.4% were downgraded, and 69.5% remained unchanged. Of the injuries graded as III or lower using the 1989 AAST, 33.5% were upgraded to grade IV using the 2018 AAST. Of the grade V injuries, 58.8% were downgraded using the 2018 AAST. There was no statistically significant difference in the overall areas under the curves between the 2018 and 1989 AAST grading system for predicting bleeding interventions (0.72 vs. 0.68, p = 0.34).ConclusionAbout one third of the injuries previously classified as grade III will be upgraded to grade IV using the 2018 AAST, which adds to the heterogeneity of grade IV injuries. Although the 2018 AAST grading provides more anatomic details on injury patterns and includes important radiologic findings, it did not outperform the 1989 AAST grading in predicting bleeding interventions.Level of evidencePrognostic and Epidemiological Study, level III

Teaching Critical Thinking in Graduate Medical Education: Lessons Learned in Diagnostic Radiology

The 2014 Institute of Medicine report, Graduate Medical Education that Meets the Nation’s Health Needs , challenged the current graduate medical training process and encouraged new opportunities to redefine the fundamental skills and abilities of the physician workforce. This workforce should be skilled in critically evaluating the current systems to improve care delivery and health. To meet these goals, current challenges, motivations, and educational models at the medical school and graduate medical education levels related to formal training in nonclinical aspects of medicine, especially critical thinking, are reviewed. Our diagnostic radiology training program is presented as a “case study” to frame the review

Health issues and the practicing radiologist: defining concepts and developing recommendations for leave options and policies

Radiologists today are faced with the challenges of maintaining and balancing individual and family health needs and the demands of the workplace. To provide the highest quality and safest care of our patients, a corresponding ethos of support for a healthy workforce is required. There is a paucity of targeted information describing protections for and maintenance of the health of the practicing radiologist, in both private and academic settings. However, a review of existing family and medical leave policies may be helpful to practice leaders and practicing radiologists as a platform for the development of strategic workforce plans. This writing, by members of the ACR Commission on Human Resources, addresses the following areas: (1) medical leave, (2) maternity and/or paternity leave, and (3) disability