Radiological Reporting of Urgencies Related to Medical Devices: Commentary on a Possible Systematic Approach

Most medical devices are routinely recognized on radiological images and described as normal findings in the radiological report, but sometimes they can cause patient access to the emergency department. Multiple possible complications have been described and most of them require prompt recognition by radiologists for proper clinical management. This commentary proposes a systematic approach to radiological reporting of the most common emergent complications related to medical devices with the intent to avoid the omission of important findings in the final radiological report.

Impact of Multiparametric Stone Measurement in Noncontrast Computer Tomography on Ureterorenoscopic Stone Removal

<b><i>Purpose:</i></b> Low-dose computer tomography (NCCT) is the standard imaging modality for patients with acute flank pain with a suspicion of urolithiasis. The stone size is usually measured 2D by a radiologist. We compared 3D stone measurement using different windows to the 2D measurement and evaluated the clinical impact on ureterorenoscopic stone removal (URS). <b><i>Methods:</i></b> One hundred sixty-four patients (201 stones) with a preoperative NCCT, following a URS within 4 weeks, were included in this study. Stone location, number and size of stones, operating time, and laser lithotripsy were documented. Stones were measured in 3D using bone and soft tissue window. The maximum diameter was compared to the radiological report. The U test, Kruskal-Wallis, and regression were used for statistical analyses. <b><i>Results:</i></b> Almost two-thirds (64.68%; 130 stones) of stone measurements in 3D with the bone window were lower than the radiologist reports in 2D. One-third (34.83%; 70 stones) of stone measurements were higher and 0.5% (1 stone) reported the same size. Using the 3D soft tissue window, 81.09% (163 stones), 17.91% (37 stones), and 1% (2 stones) of stones were measured bigger, smaller, or had the same measurement results, respectively. In the clinical setting, we could calculate a cutoff for laser lithotripsy at a maximum stone diameter of 5.70 mm (<i>p</i> &#x3c; 0.01) with the 3D and 6.01 mm with the 2D measurements, respectively, and found a significant correlation between maximum stone diameter and operating time (<i>p</i> &#x3c; 0.01) and number of stones and operating time (<i>p</i> &#x3c; 0.01 with and <i>p</i> = 0.02 without laser). <b><i>Conclusion:</i></b> 3D stone measurement with bone window seems to be more accurate than 2D measurement, but 2D is sufficient for planning stone treatment.

Impact of Chronic Prostatitis on the PI-RADS Score 3: Proposal for the Addition of a Novel Binary Suffix

We examined the impact of chronic prostatitis on the diagnostic performance of multiparametric magnetic resonance imaging (mpMRI). In this retrospective study, 63 men underwent 3T mpMRI followed by MRI/ultrasound fusion biopsy to exclude/confirm clinically significant prostate cancer (csPCa). A total of 93 lesions were included for evaluation. Images were assessed by two radiologists. Prostatitis was graded visually on T2-weighted and contrast-enhanced sequences. The correlation of prostatitis features with the assigned Prostate Imaging Reporting and Data System (PI-RADS) and the presence of csPCa were assessed, and the clinical and functional imaging parameters for differentiating between prostatitis and significant tumors were examined. Histopathological analysis was used as the reference standard. The rate of PI-RADS 3 scores tended to be higher in the presence of radiologically severe prostatitis compared with no/discrete prostatitis (n = 52 vs. n = 9; p = 0.225). In severe prostatitis, csPCa was determined in only 7.7% (4/52) of PI-RADS 3 lesions. In severe chronic prostatitis, a binary prostatitis suffix (e.g., PI-RADS 3 i+ versus i−) within the radiological report may help assess the limitations of mpMRI interpretability because of severe prostatitis and avoid unnecessary biopsies. Mean apparent diffusion coefficient (ADCmean) was the best marker (cutoff 0.93 × 10−3 mm2/s) to differentiate between csPCa/non csPCa in severe prostatitis.

Evaluation of equivocal small cystic pancreatic lesions with spectral-detector computed tomography

Background Evaluation of small cystic lesions of the pancreas remains a challenging task, as due to their size appearance can be rather hypodense than clearly fluid-filled. Purpose To evaluate whether additional information provided by novel dual-layer spectral-detector computed tomography (SDCT) imaging can improve assessment of these lesions. Material and Methods For this retrospective study, we reviewed reports of 1192 contrast-enhanced portal-venous phase SDCT scans of the abdomen conducted between May 2017 and January 2019. On basis of the radiological report 25 small (≤1.5 cm) cystic pancreatic lesions in 22 patients were identified, in which additional short-term follow-up imaging was recommended to confirm/clarify cystic nature. Conventional images (CI) and spectral images (SI) including virtual-monoenergetic images at 40 keV (VMI), iodine-density and iodine-overlay images were reconstructed. Two readers indicated lesion conspicuity and confidence for presence of cystic nature on three-point scales. First, solely CI were evaluated, while in a second reading after a four-week interval, the combination of CI and corresponding SI were reviewed. Quantitatively, ROI-based mean attenuation was measured in CI and VMI. Results In the subjective reading, SI significantly improved lesion conspicuity (CI 2 [1–2], SI 3 [2–3], P < 0.001) and confidence regarding presence of cystic nature (CI 2 [1–2], SI 3 [3–3], P < 0.001). Inter-observer agreement depicted by intraclass correlation coefficient improved considerably from 0.51 with only CI to 0.85 when the combination with SI was used. Further, VMI displayed significantly higher signal-to-noise (CI 1.2 ± 0.8, VMI 3.2 ± 1.8, P < 0.001) and contrast-to-noise ratios (CI 2.6 ± 0.8, VMI 4.7 ± 1.9). Conclusion Compared to CI alone, combination with SI significantly improves visualization and confidence in evaluation of small equivocal cystic pancreatic lesions.

Spontaneous rupture of giant hepatic hemangioma: misdiagnosis as gastrointestinal perforation

Hepatic hemangioma is a frequent nonmalignant tumor in the human liver. Although rupture of hepatic hemangioma is a rare complication, it may have serious consequences. In this report, we describe a 56-year-old woman who underwent laparoscopic surgery and open surgery for sudden abdominal pain and peritonitis. Gastrointestinal perforation was prioritized before surgery according to the patient’s symptoms, signs, and radiological report. A giant dark red mass connected to the left liver by a pedicle was unexpectedly found during intraoperative exploration. Hemoperitoneum was also found. Conversely, no gastrointestinal perforation was found during intraoperative exploration. The mass was successfully removed, and the hemoperitoneum was resolved. Postoperative pathological examination showed that the mass was a hepatic hemangioma. Ultimately, the patient was diagnosed with spontaneous rupture of a giant hepatic hemangioma.

Neuroradiology in Azerbaijan and in the Netherlands: A healthcare assessment from the neurologist’s perspective

Background. Referring physicians are valuable sources of information for radiologist to improve quality in radiology. In differenthealthcare systems neuroradiology has developed differently. Healthcare in Azerbaijan is developing and investmentstake place both in infrastructure and knowledge. Tools to compare healthcare in Azerbaijan and western countries can help toguide these improvements by providing detailed information about a specific field resulting in a more focused approach.Methods. A survey covering the field of neuroradiology was developed, with a variety of items including the availability ofequipment, the contentment with the radiological report, the experience of the neurologist, and factors omitting neurologicalimaging. Data was collected both in Azerbaijan and the Netherlands.Results. In both countries most neurologist do not receive formal neuroradiology training. The data demonstrate a higher availabilityof advanced computed tomography (CT) and magnetic resonance imaging (MRI) machines in the Netherlands comparedwith Azerbaijan, and a higher experience with requesting imaging and case reading for the Dutch respondents. The financialsituation of the patient can be a reason for Azerbaijan neurologists to omit imaging (due to the establishment of CT and MRIin most cases in specialized and private centers).Conclusion. The presented survey allows comparison of neuroradiological healthcare between countries in general, and identificationof required preconditions to improve collaboration between neurologists and radiologists. A future lower financialthreshold for imaging and a future increase in availability of PACS (picture archiving and communication system) will facilitatethe improvement of neuroradiological skills of Azerbaijan neurologists. Both Dutch and Azerbaijan neurologists considerweekly clinical neuroradiological conferences together with radiologists useful to improve their skills.