放射科医师和临床医师对放射科报告的看法:COVER和ROVER的调查结果

目的调查并比较放射科医师、临床医师对放射科报告的意见和期望值,从而找出意见的不一致性、对报告不满意之处、未来报告书写的趋势。材料与方法共3884名临床医     

肾嗜酸细胞腺瘤的影像表现与病理对照分析

肾嗜酸细胞腺瘤是一种非常罕见的良性实质性肿瘤。虽然近年来医师对此病的临床病理特征有所认识，但其影像表现报道甚少，在术前影像诊断中仍常被误诊为肾癌，使患者接受了不必要的根治性手术。笔者回顾性分析了复旦大学附属中山医院2002年至2006年期间资料完整的8例嗜酸细胞腺瘤资料，对其影像表现及病理结果进行了分析，结合文献资料讨论其影像特征及鉴别诊断要点，以提高放射科医师对本病的诊断水平。     

肾透明细胞癌的放射基因学研究:CT影像特征和基因突变的相关性

正目的探讨肾透明细胞癌(RCC)的CT特征和VHL、PBRM1、SETD2、KDM5C和BAP1基因突变的相关性。材料与方法本项回顾性研究经机构审查委员会批准,符合HIPAA     

股骨头的软骨下不全骨折:相关影像表现和临床进展的预测指标

正摘要目的探究股骨头软骨下不全骨折(SIF)的影像特征,并探讨与临床结局相关的影像表现。方法 2名放射科医生记录了51例病人股骨/骨盆MRI的典型SIF表现。其中35例病人有随诊记录,用以评估其临床结局。小组间比较采用     

CT findings of chemotherapy-induced toxicity: what radiologists need to know about the clinical and radiologic manifestations of chemotherapy toxicity

Cancer chemotherapy has evolved from cytotoxic agents and now includes several new agents that target specific molecules responsible for the regulation of cell growth, nutrient supply, and differentiation. These molecularly targeted therapies have a different mechanism of action than do classic cytotoxic agents, which predominantly attack rapidly proliferating cells. Not surprisingly, therefore, the toxicity of targeted and cytotoxic agents may differ in both clinical and radiologic presentation. Many of the toxicities of targeted therapies are not cumulative or dose dependent, some are asymptomatic, and others may first manifest radiologically. It is imperative that radiologists be aware of these toxicities and that they learn to recognize the relevant findings so that they can provide a complete differential diagnosis and thus play an important role in patient care.     

CT colonography: what radiologists need to know

In 2008, CT colonography was approved by the American Cancer Society as a technique for screening for colorectal cancer. This approval should be considered an important step in the recognition of the technique, which although still relatively new is already changing some diagnostic algorithms. This update about CT colonography reports the quality parameters necessary for a CT colonographic study to be diagnostic and reviews the technical innovations and colonic preparation for the study. We provide a brief review of the signs and close with a discussion of the current indications for and controversies about the technique.     

Spontaneous perirenal hemorrhage: what radiologists need to know

Spontaneous perirenal hemorrhage (SPH), also known as Wünderlich’s syndrome, is a rare urological emergency. This article reviews the most common causes of SPH and the role of imaging in establishing the correct diagnosis and in guiding the appropriate therapy. A thorough understanding of underlying etiologies, imaging appearances, optimal imaging techniques, and follow-up protocols are crucial to recognize patients with SPH due to benign disease and avoid unnecessary nephrectomies.     

Musculoskeletal complications of acromegaly: what radiologists should know about early manifestations

The purpose of this article is to summarise the early musculoskeletal complications of acromegaly. Some of the early signs of acromegaly may be evaluated by the musculoskeletal radiologist. In the early stage of disease, peripheral nerve enlargement associated with carpal tunnel syndrome or cubital tunnel syndrome and thickening of retinacula, such as A1 pulley in trigger finger, represent the features that may be seen by radiologists and are worthy of an endocrinological evaluation. Due to the insidious nature of the disease, the diagnosis of acromegaly is significantly delayed. Few and nonspecific symptoms characterise the initial phases of the disease, and therefore, most patients will have generally consulted many specialists (most frequently musculoskeletal radiologists) before an adequate endocrinological assessment is performed. For this reason, initial clinical signs are much more important than symptoms for an early diagnosis of acromegaly. The first and most important therapeutic approach to acromegaly is early diagnosis, whereas the therapeutic goals are to eliminate morbidity and reduce mortality to the expected age- and sex-adjusted rates and prevent the development of systemic complications. Musculoskeletal radiologists should be aware that these features may be early manifestations of acromegaly. When both radiological and clinical abnormalities are present, an endocrinological workup is useful to diagnose the disease in an early phase.     

Exclusive hospital-based service agreements: what radiologists need to know

This article provides radiologists with the information that they need to know to participate meaningfully in negotiating or renegotiating an exclusive hospital-based radiology service agreement. It discusses the contract negotiation process, including how to identify and prioritize contract objectives, and how to assess and create bargaining leverage. Options for achieving contract longevity, for resolving “turf” issues and for achieving financial objectives are also addressed. The article further explains the key regulatory issues that shape exclusive hospital-based radiology service agreements, including antitrust, fraud and abuse, Stark Law, HIPAA, tax, and Medicare reimbursement considerations. The author discusses the contract negotiation process from both the radiology group and hospital perspectives. He suggests that successful negotiation will depend on “fitting” the group’s contracting agenda with the hospital’s priorities, organizational structure, culture and resources.     

Neuroimaging of dementia in 2013: what radiologists need to know

The structural and functional neuroimaging of dementia have substantially evolved over the last few years. The most common forms of dementia, Alzheimer disease (AD), Lewy body dementia (LBD) and fronto-temporal lobar degeneration (FTLD), have distinct patterns of cortical atrophy and hypometabolism that evolve over time, as reviewed in the first part of this article. The second part discusses unspecific white matter alterations on T2-weighted and fluid-attenuated inversion recovery (FLAIR) images as well as cerebral microbleeds, which often occur during normal aging and may affect cognition. The third part summarises molecular neuroimaging biomarkers recently developed to visualise amyloid deposits, tau protein deposits and neurotransmitter systems. The fourth section reviews the utility of advanced image analysis techniques as predictive biomarkers of cognitive decline in individuals with early symptoms compatible with mild cognitive impairment (MCI). As only about half of MCI cases will progress to clinically overt dementia, whereas the other half remain stable or might even improve, the discrimination of stable versus progressive MCI is of paramount importance for both individual patient treatment and patient selection for clinical trials. The fifth and final part discusses the inter-individual variation in the neurocognitive reserve, which is a potential constraint for all proposed methods. Key Points ? Many forms of dementia have spatial atrophy patterns detectable on neuroimaging. ? Early treatment of dementia is beneficial, indicating the need for early diagnosis. ? Advanced image analysis techniques detect subtle anomalies invisible on radiological evaluation. ? Inter-individual variation explains variable cognitive impairment despite the same degree of atrophy.     

Medications as causes of intraluminal hyperdensities: what radiologists need to know

In computed tomography (CT) angiogram or some dedicated CT studies of the abdomen, the use of positive enteric contrast should be avoided as its presence could decrease the sensitivity of the test. There are, however, cases of CT scans with unexpected hyperdense intraluminal contents detected due to the use of certain oral or rectal medications. Reports on medications as causes of intraluminal hyperdensities are sparse in the English literature. We have studied several commonly used medications and revealed that many drugs appear hyperdense in CT scans. The presence of unexpected intraluminal hyperdensities can potentially cause erroneous interpretation of images and in some cases decrease the sensitivity of the test. The hyperdense bowel contents may be mistaken as acute hemorrhage in CT angiogram for detection of GI bleeding. Active GI bleeding, presented as intraluminal extravasation of contrast material, can also be obscured. Certain intra-abdominal pathologies could be masked, for example, in plain CT scan for detection of urinary tract stones or in contrast CT study for suspected bowel ischaemia. It is important for radiologists and clinicians to be aware of this situation in order to prevent misinterpretation of images and to select the most appropriate imaging modality when such unexpected intraluminal hyperdensities are encountered.     

Contrast medium administration and image acquisition parameters in renal CT angiography: what radiologists need to know

Over the last decade, exponential advances in computed tomography (CT) technology have resulted in improved spatial and temporal resolution. Faster image acquisition enabled renal CT angiography to become a viable and effective noninvasive alternative in diagnosing renal vascular pathologies. However, with these advances, new challenges in contrast media administration have emerged. Poor synchronization between scanner and contrast media administration have reduced the consistency in image quality with poor spatial and contrast resolution. Comprehensive understanding of contrast media dynamics is essential in the design and implementation of contrast administration and image acquisition protocols. This review includes an overview of the parameters affecting renal artery opacification and current protocol strategies to achieve optimal image quality during renal CT angiography with iodinated contrast media, with current safety issues highlighted.Personalized medicine is a popular topic in radiology today. Scientists are flooding academic journals, conference proceedings, and book chapters with arguments about radiation reduction strategies with a personalized approach. However, contrast media (CM) dose reduction has been overlooked, which is of great concern. As such, 3% of all patients admitted for renal dialysis are a direct result of excessive CM volume delivered during radiologic imaging in the course of their hospital stay (1).Studies suggest that CM volumes employed during renal computed tomography (CT) angiography (CTA) range from 30–120 mL (2–4). This wide array of CM dose has different effects on scanner parameters. For example, employing 30 mL CM volume with a tube current selection of 80 kVp renders acceptable image quality. However, image quality can either be quantitative or qualitative in nature, which increase the subjectivity of good versus acceptable image quality with desired CM doses. Therefore, judging optimal image quality is determined by the amount of noise and vascular opacification of the renal arteries.Vascular opacification that is too low may compromise the visualization of small renal vasculature and underestimate plaque formation and stenosis (5). Previous studies on contrast-injection protocols for renal CTA suggested that the adequate attenuation value for the arteries is greater than 211 Hounsfield units (HU) (6). However, attenuation values of the renal arteries have reached as high as 435±48 HU, while those of the renal veins have reached 277±29 HU (7).The sensitivity and specificity for diagnosing greater than 50% renal artery stenosis during renal CTA range from 67%–100% and 77%–98%, respectively (8). Renal magnetic resonance angiography (MRA) has sensitivity and specificity of 88%–100% and 70%–100% with low interobserver variability, especially for severe stenosis greater than 70% (9).Renal CTA provides accurate, noninvasive, and time-efficient diagnostic evaluation for medical management of renal arterial disease as well as creating a roadmap prior to surgical intervention. Such clinical questions arise when a hypertensive individual has renal CTA to exclude renal artery stenosis, fibromuscular dysplasia, or dissection. Pathology-specific renal CTA examinations include determining if vasculitis involves the renal arteries or the extent of renal aneurysmal changes. Preoperative renal CTA planning can be useful for nephron-sparing surgery prior to resection of renal masses or as post-procedural follow-up of renal stenting or surgical revascularization. Finally, renal CTA is also employed in the evaluation of the kidney donor and recipient prior to transplantation.Large volumes of CM greater than 100 mL could potentially lead to contrast-induced nephropathy (CIN). CIN is the third leading cause of hospital-acquired acute renal failure, accounting for 11% of all cases, contributing to a prolonged hospital stay and increased medical costs (10). It has raised awareness of the need to optimize CM administration. There is a significant correlation between increased CM volume administration and the risk of CIN, i.e., higher doses of CM increase the risk of CIN (11–13). Additionally, CM doses less than 30 mL can be safely given in patients with chronic renal failure (14).     

What ER radiologists need to know about radiation risks

The annual per capita medical dose in the US is currently 3 mSv, and has increased by about 600% since the early 1980s. Medical doses now account for approximately 50% of the total US population dose, and will likely continue to increase for the foreseeable future. An average patient at a Level 1 trauma center, with an Injury Severity Score of 14, is expected to undergo imaging procedures that will result in an effective dose of approximately 40 mSv. The median age of a trauma patient in the ER setting is about 30 years, and the male cancer incidence from this amount of radiation is estimated to be ~0.3%, with the female risk being ~55% higher. For radiation protection purposes, scientific radiation protection authorities consider that the available evidence shows the linear no threshold (LNT) model to be the most prudent one for radiation protection purposes. Accepting that diagnostic examinations are associated with finite radiation risks requires policies that protect patients from unnecessary radiation. Clinical practice should therefore ensure that: (a) tests should only be ordered when the results are expected to affect patient management; (b) non-ionizing alternatives (i.e., US and MR) be considered, particularly for pediatric patients; (c) only indicated exams should be performed where the patient benefit is judged to exceed any radiation risk; and (d) for indicated examinations, all radiation exposures are kept As Low As Reasonably Achievable (ALARA).