Comparing magnetic resonance angiography (MRA) and computed tomography angiography (CTA) with conventional angiography in the detection of distal territory cerebral mycotic and oncotic aneurysms

Background Mycotic and oncotic aneurysms may result in devastating neurologic sequelae if undetected. The objectives of this study were to examine interobserver variability and accuracy of cross-sectional imaging for the detection of distal territory mycotic and oncotic aneurysms. Methods We searched our institutional database for all radiology reports from 2005 to 2015 with an indication or diagnosis of mycotic or oncotic aneurysm. Patients who underwent DSA and either CTA or MRA within 12 weeks of each other were identified. The cross-sectional images from each study were blinded and reviewed by two radiologists. If positive for aneurysm, location and number of aneurysms were reported. Sensitivity, specificity, positive predictive value, negative predictive value, and interobserver variability were determined for MRA and MRA/CTA. Results Twenty-five patients were included in this study. Ten (40%) harbored distal aneurysms. Cross-sectional imaging had a sensitivity of 45.5%, specificity of 90.0%, and kappa value of 0.29 (0.00–0.69) for the detection of cerebral mycotic and oncotic aneurysms. Conclusions Because of the low sensitivity and high interobserver variability of cross-sectional imaging, DSA should remain the gold standard for evaluation of suspected oncotic and mycotic aneurysms. In cases in which cross sectional imaging is negative and there is a high clinical suspicion for mycotic aneurysm, DSA should be strongly considered.

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Poor ‘Real-Life’ Negative Predictive Value of Cross-Sectional Imaging in Obstructive Jaundice

Canadian Journal of Gastroenterology and Hepatology ◽

10.1155/2014/797960 ◽

2014 ◽

Vol 28 (7) ◽

pp. 385-390

Author(s):

Brian A Brunson ◽

Robert Hawes ◽

Brenda Hoffman ◽

Stacie Vela ◽

Joseph Romagnuolo

Keyword(s):

Magnetic Resonance ◽

Obstructive Jaundice ◽

Predictive Value ◽

Resonance Imaging ◽

First Line ◽

Cross Sectional ◽

Post Test ◽

Cross Sectional Imaging ◽

Line Test ◽

Sectional Imaging

BACKGROUND: Cross-sectional imaging remains the first-line test for obstructive jaundice despite high miss rates for pancreatobiliary tumours. Improvements in resolution and slice thickness of spiral computed tomography/magnetic resonance imaging/magnetic resonance cholangiopancreatography promised to increase accuracy.OBJECTIVE: To assess whether the post-test probability of neoplasm is truly altered by the presence or absence of a mass on computed tomography/magnetic resonance imaging in obstructive jaundice.METHODS: The institutional endoscopic ultrasound (EUS) database was retrospectively reviewed to stratify patients presenting to EUS over a two-year period for obstructive jaundice (suspicious for malignancy) according to their pre-EUS imaging results. The primary analysis involved the calculation of the positive predictive value and negative predictive value (NPV) of imaging with 95% binomial CIs. Test performance of EUS/fine-needle aspiration (FNA) was also calculated. Final diagnosis was determined by positive cytology/histology; negative EUS was supplemented by clinical follow-up.RESULTS: The positive predictive value (n=51) and NPV (n=53) of pre-EUS imaging was 98% (95% CI 90% to 100%) and 9% (95% CI 3% to 21%), respectively (accuracy 53%), with post-test suspicion of malignancy similar between imaging-positive and -negative groups. EUS demonstrated a mass in 96% of imaging-positive cases versus 85% in imaging-negative cases (exact P=0.09). Malignant or suspicious FNA cytology was obtained with EUS in 92% of the imaging-positive group, and 62% of the imaging-negative group (75% of subgroup with FNA) (P<0.001).CONCLUSION: Lack of a definite mass on pre-EUS imaging had low NPV, and was clearly not sufficiently accurate or reassuring in this clinical setting. In suspicious obstructive jaundice, EUS with FNA has a high diagnostic yield regardless of the findings of pre-EUS cross-sectional imaging and, as such, EUS may be a more reasonable first-line test in this high-suspicion setting.

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Luminal narrowing alone allows an accurate diagnosis of Crohn’s disease small bowel strictures at cross-sectional imaging

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjaa256 ◽

2020 ◽

Author(s):

Daniel Stocker ◽

Michael J King ◽

Maria El Homsi ◽

Guillermo Carbonell ◽

Octavia Bane ◽

...

Keyword(s):

Crohn’S Disease ◽

Small Bowel ◽

Crohn's Disease ◽

Diagnostic Performance ◽

Mr Enterography ◽

Cross Sectional ◽

Luminal Narrowing ◽

Cross Sectional Imaging ◽

Sectional Imaging ◽

Sensitivity Specificity

Abstract Background and Aims Current consensus recommendations define small bowel strictures (SBS) in Crohn’s disease (CD) on imaging as luminal narrowing with unequivocal upstream bowel dilation. The aim of this study was to 1) evaluate the performance of cross-sectional imaging for SBS diagnosis in CD using luminal narrowing with upstream SB dilation and luminal narrowing with or without upstream dilation, and 2) compare the diagnostic performance of CT and MR enterography (MRE) for SBS diagnosis. Methods One hundred and eleven CD patients (81 with pathologically confirmed SBS, 30 controls) who underwent CT and/or MRE were assessed. Two radiologists (R1, R2) blinded to pathology findings independently assessed the presence of luminal narrowing and upstream SB dilation. Statistical analysis was performed for a) luminal narrowing with or without SB upstream dilation (“possible SBS”), b) luminal narrowing with upstream SB dilation ≥3cm (“definite SBS”). Results Sensitivity for detecting SBS was significantly higher using “possible SBS” (R1, 82.1%; R2, 77.9%) compared to “definite SBS” (R1, 62.1%; R2, 65.3%; p<0.0001) with equivalent specificity (R1, 96.7%; R2, 93.3%; p>0.9). Using criterion “possible SBS”, sensitivity/specificity were equivalent between CT (R1, 87.3%/93.3%; R2, 83.6%/86.7%) and MRE (R1, 75.0%/100%; R2: 70.0%/100%). Using criterion “definite SBS”, CT showed significantly higher sensitivity (78.2%) compared to MRE (40.0%) for R1 but not R2 with similar specificities (CT, 86.7%-93.3%; MRE, 100%). Conclusion SBS can be diagnosed using luminal narrowing alone without the need for upstream dilation. CT and MRE show similar diagnostic performance for SBS diagnosis using luminal narrowing with or without upstream dilation.

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Unexpected Angiography Findings and Effects on Management

Journal of Clinical Imaging Science ◽

10.4103/2156-7514.189727 ◽

2016 ◽

Vol 6 ◽

pp. 33

Author(s):

Matthew Neill ◽

Hearns W Charles ◽

Jonathan S Gross ◽

Sean Farquharson ◽

Amy R Deipolyi

Keyword(s):

Magnetic Resonance Imaging ◽

Computed Tomography ◽

Magnetic Resonance ◽

Interventional Procedures ◽

Diagnostic Workup ◽

Resonance Imaging ◽

Conventional Angiography ◽

Cross Sectional ◽

Cross Sectional Imaging ◽

Sectional Imaging

Despite progress in noninvasive imaging with computed tomography and magnetic resonance imaging, conventional angiography still contributes to the diagnostic workup of oncologic and other diseases. Arteriography can reveal tumors not evident on cross-sectional imaging, in addition to defining aberrant or unexpected arterial supply to targeted lesions. This additional and potentially unanticipated information can alter management decisions during interventional procedures.

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Contrast-enhanced ultrasound (CEUS) reliably rules out neoplasm in developmental renal pseudotumor

Acta Radiologica ◽

10.1177/0284185120939291 ◽

2020 ◽

pp. 028418512093929

Author(s):

Paul Spiesecke ◽

Thomas Fischer ◽

Andreas Maxeiner ◽

Bernd Hamm ◽

Markus H Lerchbaumer

Keyword(s):

Predictive Value ◽

Fast Method ◽

Contrast Enhanced Ultrasound ◽

Cross Sectional ◽

Contrast Enhanced ◽

Cross Sectional Imaging ◽

Renal Pseudotumor ◽

Sectional Imaging ◽

Rule Out

Background Renal pseudotumors appear as benign cortical hypertrophies and are typically assessed by contrast-enhanced computed tomography or magnetic resonance imaging to rule out malignancy. Purpose To investigate whether contrast-enhanced ultrasound (CEUS) can rule out renal neoplasm and thus potentially reduce cross-sectional imaging and further follow-up in these patients. Material and Methods Thirty-two patients with presumption of developmental renal pseudotumor on CEUS between June 2011 and July 2019 were retrospectively analyzed. All patients were examined with a standardized renal US protocol including B-mode, color-coded duplex sonography (CCDS), and CEUS by an experienced radiologist (EFSUMB level 3). Images were retrospectively interpreted in consensus by two highly experienced radiologists. Histopathological reports, cross-sectional imaging findings, and clinical course (treatment response, long-term imaging follow-up) were defined as standard of reference. Results CEUS correctly identified 8/9 neoplastic lesions and missed one oncocytoma within the 32 included patients. Irregular vessel structure (88.9% vs. 13.0%, P = 0.007) and hyperenhancement (66.6% vs. 17.4%, P = 0.031) on CEUS were more common in neoplasm compared to developmental pseudotumors reaching statistical significance. Compared with the standard of reference, CEUS had 89% sensitivity (95% confidence interval [CI] 57–98), 96% specificity (95% CI 80–99), a positive predictive value of 89% (95% CI 57–98), and a negative predictive value of 96% (95% CI 79–99) for ruling out renal malignancy in developmental pseudotumors. Conclusion CEUS is a safe and fast method to rule out neoplasm in the diagnostic work-up of renal pseudotumors. In conjunction with B-mode and CCDS, CEUS has the potential to reduce further (invasive) diagnostic procedures.

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Revealing the most common reporting errors through data mining of the report proofreading process

European Radiology ◽

10.1007/s00330-020-07306-6 ◽

2020 ◽

Author(s):

Jan Vosshenrich ◽

Ivan Nesic ◽

Joshy Cyriac ◽

Daniel T. Boll ◽

Elmar M. Merkle ◽

...

Keyword(s):

Patient Safety ◽

Speech Recognition ◽

Error Rates ◽

Structured Reporting ◽

Cross Sectional ◽

Error Awareness ◽

Radiology Reports ◽

Prose Style ◽

Cross Sectional Imaging ◽

Sectional Imaging

Abstract Objectives To investigate the most common errors in residents’ preliminary reports, if structured reporting impacts error types and frequencies, and to identify possible implications for resident education and patient safety. Material and methods Changes in report content were tracked by a report comparison tool on a word level and extracted for 78,625 radiology reports dictated from September 2017 to December 2018 in our department. Following data aggregation according to word stems and stratification by subspecialty (e.g., neuroradiology) and imaging modality, frequencies of additions/deletions were analyzed for findings and impression report section separately and compared between subgroups. Results Overall modifications per report averaged 4.1 words, with demonstrably higher amounts of changes for cross-sectional imaging (CT: 6.4; MRI: 6.7) than non-cross-sectional imaging (radiographs: 0.2; ultrasound: 2.8). The four most frequently changed words (right, left, one, and none) remained almost similar among all subgroups (range: 0.072–0.117 per report; once every 9–14 reports). Albeit representing only 0.02% of analyzed words, they accounted for up to 9.7% of all observed changes. Subspecialties solely using structured reporting had substantially lower change ratios in the findings report section (mean: 0.2 per report) compared with prose-style reporting subspecialties (mean: 2.0). Relative frequencies of the most changed words remained unchanged. Conclusion Residents’ most common reporting errors in all subspecialties and modalities are laterality discriminator confusions (left/right) and unnoticed descriptor misregistration by speech recognition (one/none). Structured reporting reduces overall error rates, but does not affect occurrence of the most common errors. Increased error awareness and measures improving report correctness and ensuring patient safety are required. Key Points • The two most common reporting errors in residents’ preliminary reports are laterality discriminator confusions (left/right) and unnoticed descriptor misregistration by speech recognition (one/none). • Structured reporting reduces the overall the error frequency in the findings report section by a factor of 10 (structured reporting: mean 0.2 per report; prose-style reporting: 2.0) but does not affect the occurrence of the two major errors. • Staff radiologist review behavior noticeably differs between radiology subspecialties.

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Discordance Rates Between Preliminary and Final Radiology Reports on Cross-sectional Imaging Studies at a Level 1 Trauma Center

Academic Radiology ◽

10.1016/j.acra.2008.03.017 ◽

2008 ◽

Vol 15 (10) ◽

pp. 1217-1226 ◽

Cited By ~ 37

Author(s):

Kathryn J. Stevens ◽

Karen L. Griffiths ◽

Jarrett Rosenberg ◽

Swaminatha Mahadevan ◽

Leslie M. Zatz ◽

...

Keyword(s):

Trauma Center ◽

Imaging Studies ◽

Cross Sectional ◽

Radiology Reports ◽

Cross Sectional Imaging ◽

Sectional Imaging ◽

Level 1 ◽

Level 1 Trauma Center

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State-of-the-art aortic imaging: Part II - applications in transcatheter aortic valve replacement and endovascular aortic aneurysm repair

VASA ◽

10.1024/0301-1526/a000324 ◽

2014 ◽

Vol 43 (1) ◽

pp. 6-26 ◽

Cited By ~ 12

Author(s):

Fabian Rengier ◽

Philipp Geisbüsch ◽

Paul Schoenhagen ◽

Matthias Müller-Eschner ◽

Rolf Vosshenrich ◽

...

Keyword(s):

Aortic Valve ◽

Transcatheter Aortic Valve Replacement ◽

Surgical Repair ◽

Imaging Modality ◽

Open Surgical Repair ◽

Cross Sectional ◽

Transcatheter Aortic Valve ◽

Cross Sectional Imaging ◽

Sectional Imaging

Transcatheter aortic valve replacement (TAVR) as well as thoracic and abdominal endovascular aortic repair (TEVAR and EVAR) rely on accurate pre- and postprocedural imaging. This review article discusses the application of imaging, including preprocedural assessment and measurements as well as postprocedural imaging of complications. Furthermore, the exciting perspective of computational fluid dynamics (CFD) based on cross-sectional imaging is presented. TAVR is a minimally invasive alternative for treatment of aortic valve stenosis in patients with high age and multiple comorbidities who cannot undergo traditional open surgical repair. Given the lack of direct visualization during the procedure, pre- and peri-procedural imaging forms an essential part of the intervention. Computed tomography angiography (CTA) is the imaging modality of choice for preprocedural planning. Routine postprocedural follow-up is performed by echocardiography to confirm treatment success and detect complications. EVAR and TEVAR are minimally invasive alternatives to open surgical repair of aortic pathologies. CTA constitutes the preferred imaging modality for both preoperative planning and postoperative follow-up including detection of endoleaks. Magnetic resonance imaging is an excellent alternative to CT for postoperative follow-up, and is especially beneficial for younger patients given the lack of radiation. Ultrasound is applied in screening and postoperative follow-up of abdominal aortic aneurysms, but cross-sectional imaging is required once abnormalities are detected. Contrast-enhanced ultrasound may be as sensitive as CTA in detecting endoleaks.

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