Radiographics最新文献

The majority of radiologists will face litigation in their careers, yet it remains an uncommon topic for training programs and educational conferences. The authors explore the landscape of radiology malpractice litigation to equip radiologists with essential knowledge before and in the event of a lawsuit. Radiologists should understand the four components necessary to be found liable for medical negligence: patient duty, breach of standard of care, injury, and proximate causality between the breach of standard of care and the injury. The authors introduce the mechanics of a lawsuit, common causes of lawsuits, and factors affecting risk. Many current radiologic norms and standards derive from legal precedent; examining these precedents and their effects on current practice through the context of prior litigated cases can help radiologists understand their evolving roles and responsibilities. Ultimately, 63% of malpractice claims are dismissed or dropped, 28% reach settlement agreements, and the remaining claims proceed to trial, where most result in defense wins. Radiologists should be familiar with common practices that may affect their legal risk, as well as potential misunderstandings regarding the discoverability of morbidity and mortality conferences, tumor boards, and other interdisciplinary conferences. Although litigation may not always be preventable, radiologists who understand the U.S. malpractice and medicolegal environment will be better positioned to mitigate unfavorable patient and legal outcomes. ^©RSNA, 2025.

Sternotomy is a widely used incision technique in cardiac and thoracic surgeries. Multiple sternotomy techniques exist, such as the Robicsek technique for redo sternotomy and transverse (clamshell) thoracosternotomy for bilateral lung transplantation. Various complications after sternotomy can occur, and imaging plays a key role in their identification. Complications may involve the hardware, sternum, and peristernal soft tissues and are divided into acute, subacute, and late. Acute complications primarily involve hemorrhage and dehiscence, while subacute complications include superficial or deep sternal wound infections and late complications are typically osseous or hardware related. Imaging also plays a critical role in assessment of cardiovascular structures and their relations to the sternum in those undergoing redo sternotomy, which has become increasingly performed. CT allows radiologists to identify the relationship of vascular anatomy to the sternum as well as other factors that may complicate repeat surgery, allowing surgeons to strategize safe surgical approaches. ^©RSNA, 2025 Supplemental material is available for this article.

The urachus is a remnant fibrous cord of the allantois and the ventral aspect of the cloaca that connects the urinary bladder to the anterior abdominal wall at the level of the umbilicus. The authors explore the embryologic origins of the urachus and delineate its normal anatomy, followed by a discussion of urachal pathologic conditions seen with different imaging modalities-including US, CT, and MRI-using a case-based approach. Although it is a vestigial structure, the urachus can harbor significant disease, including congenital anomalies arising secondary to varying degrees of incomplete involution of the urachus and ranging from focal patency (urachal cyst, diverticulum, and sinus) to complete patency (patent urachus). The spectrum of congenital abnormalities can manifest with various clinical findings and is often discovered at imaging when infected. Understanding the embryogenesis of the urachus is therefore crucial for understanding the imaging manifestations of urachal abnormalities. Nonneoplastic urachal masses can be inflammatory and sometimes difficult to differentiate from malignancy. In women, the urachus can be involved by endometriosis. Neoplastic urachal entities can include mucinous cystadenoma, which can rupture with associated mucinous ascites. Adenocarcinoma is the most common urachal malignancy and frequently can extend to involve the urinary bladder. Other malignant urachal entities include urothelial carcinoma and metastasis. Mimics of urachal pathologic conditions can cause diagnostic misperception and include primary bladder malignancy, infections, and dropped gallstones or appendicoliths. This comprehensive overview aims to enhance radiologists' proficiency in recognizing and interpreting urachal abnormalities, thus contributing to improved patient outcomes. ^©RSNA, 2025 Supplemental material is available for this article.

Hyperthermic intraperitoneal chemotherapy (HIPEC) combined with cytoreductive surgery (CRS) (CRS-HIPEC) has revolutionized the management of peritoneal malignancies, pivoting from a palliative care approach to a treatment strategy tailored to improve overall survival. This procedure is based on the principle that local instillation of heated chemotherapeutic agents augments their cytotoxic effects, which target and eradicate microscopic disease. Imaging is integral to the management of patients undergoing HIPEC, having multiple roles that range from patient selection, preoperative assessment, and determining treatment effectiveness to postprocedural surveillance. Various imaging modalities can be used for radiologic assessment and include CT, dual-energy CT, MRI, fluorine 18-fluorodeoxyglucose PET/CT, and PET/MRI. A crucial step in assessing the feasibility of CRS-HIPEC is estimation of the peritoneal carcinomatosis index, which enables one to determine the total peritoneal disease burden and is essential for effective multidisciplinary management. Following HIPEC, the completeness of cytoreduction score and residual disease score provide a robust framework for assessing treatment efficacy and strategically guiding subsequent management and surveillance protocols. Imaging facilitates accurate evaluation of complications, as well as early recognition of residual or recurrent peritoneal disease. The authors provide a comprehensive overview of HIPEC therapy, focusing on the role of imaging in the management of patients with peritoneal malignancies, delving into the nuances of this procedure, and discussing crucial aspects related to patient selection, surgical complexity, and prediction of outcomes. ^©RSNA, 2025 See the invited commentary by Wasif in this issue.

Most muscle tears occur in the lower extremities, especially in the hamstrings. The hamstring muscle complex consists of the semimembranosus (SM), semitendinosus (ST), and biceps femoris (BF) muscles. They originate from the ischial tuberosity, and while the BF inserts into the head of the fibula, the ST and SM muscles attach to the medial aspect of the tibia. The hamstrings are primarily hip extensors and knee flexors. Tears mostly occur during sport practice, particularly during forceful stretching or high-speed running, and typical sites are grouped and classified according to their location within the muscle anatomy. Sprint and stretching injuries typically affect the BF and SM, respectively. MRI and US are key complementary modalities for the diagnosis, treatment, and prognosis of hamstring injuries, as injury length, connective tissue involvement, and tear location determine evolution, recovery strategies, and return to play. ^©RSNA, 2025.