Canadian Association of Radiologists Journal-Journal De L Association Canadienne Des Radiologistes最新文献

Background/Objective: We sought to characterize the proportion of peripheral zone lesions "upgraded" within the PI-RADS v2.1 protocol using DCE imaging sequences in a large patient population undergoing multiparametric prostate MRI. Methods: A retrospective review of radiologist reports for 2742 prostate MRI exams at 2 large Alberta teaching hospitals between January 2017 and January 2022 was conducted. Prostate specific antigen (PSA), prostate volume, sequence specific and overall PI-RADS scores, and lesion positivity for DCE were collected if present in the accompanying radiology report. Further, pathology reports of biopsies of the upgraded lesions within upgraded patients were reviewed to see if upgraded lesions were deemed clinically significant by gleason score/grade group. Results: The median age was 63 years, with a median PSA and PSA density of 7.5 ng/mL and 0.13 ng/mL² respectively. A total of 1809 lesions were reported, with 69.4% of all lesions being DCE positive. Of the lesions within the peripheral zone, 548 were overall PI-RADS 4. A total of 87/2742 (3.2%) of patients were upgraded to a PI-RADS 4 by DCE imaging. Within these patients, 65 had pathology reports available, of which 18 had a clinically significant lesion at the upgrade site. Conclusion: Contrast enhancement is only beneficial for a very small portion of patients undergoing prostate MRI. Given the invasive nature of contrast enhanced studies, potential contrast induced side effects, added imaging time, and the cost of contrast agent, routine use of contrast for prostate MRI is questioned. Further studies are necessary to determine if it should be part of routine prostate MRI imaging protocols.

Purpose: Peripartum cardiomyopathy (PPCM) affects women in late pregnancy and postpartum. Cardiovascular magnetic resonance (CMR) can contribute to PPCM diagnosis and management. We explored CMR findings in PPCM, including myocardial strain and late gadolinium enhancement (LGE) patterns. Materials and Methods: This retrospective single-centre study included patients with PPCM who underwent CMR from 2010 to 2018. Exclusions were other cardiomyopathy causes. CMR parameters, including ventricular function, LGE, and myocardial strain, were compared between the PPCM group and healthy controls. Transthoracic echocardiographic data were reviewed to assess functional improvement in PPCM patients. Results: Thirty-two women with PPCM (mean age 42 ± 6 years) and 26 controls (mean age 43 ± 14 years) were included. PPCM patients had significantly lower left ventricular (LV) ejection fractions (median 37.5% vs 60.5%, P < .001), higher LV end-diastolic volumes (median 108 ml/m² vs 76 ml/m², P < .001), and reduced global LV strain compared to controls. Eighteen PPCM patients (58%) had non-ischaemic pattern LGE, with no LGE in controls besides hingepoint LGE (23%). LGE was most prevalent in the basal and mid anteroseptum. LGE patterns included linear mid-wall, subepicardial, and right ventricular side of the septum. Twenty-four patients (92%) showed improvement in LVEF at follow-up echocardiogram (mean LVEF 28% ± 1.9% at diagnosis and 45% ± 3% at follow-up, P < .001). Conclusion: We identified a non-ischaemic pattern LGE that is nonspecific in isolation but could suggest PPCM in the correct clinical context along with abnormal CMR strain values. Future studies should evaluate the clinical application of these findings to facilitate earlier diagnosis and enhance management.

In 2023, the Canadian Society of Abdominal Radiology (CSAR) and Canadian Emergency, Trauma, and Acute Care Radiology Society (CETARS) received Canadian Association of Radiologists (CAR) member feedback that there was an unmet educational need for guidance in the imaging investigation of right lower quadrant (RLQ) pain. Members requested specific guidance on how to handle controversial scenarios including which test to order when, specifics of imaging protocols, and managing pregnant patients who have RLQ pain-all from a Canadian perspective. After conducting an exhaustive literature review, the working group agreed that a Canadian-specific set of guidelines was warranted. The management recommendations presented in this guideline were discussed as a group to achieve expert consensus. As the workup for RLQ pain can vary considerably in the paediatric population, the scope of this paper was restricted to adults (18 years of age or older). Whenever possible, the best evidence was used to inform the clinical guidance, and where gaps existed, the guidelines reflect consensus among experts in the field. The result is a framework to aid in this process of managing patients with RLQ pain across various clinical scenarios while addressing current questions and controversies, particularly those most relevant to the Canadian healthcare system.

Cancer is the second most common cause of death worldwide. Bowel emergencies in patients with cancer are becoming increasingly more prevalent due to advances in cancer therapy and longer overall patient survival. When these patients present acutely, they are often frail and may have pre-existing co-morbidities. This article discusses the imaging features of bowel emergencies commonly encountered in oncological patients in clinical practice. These include chemotherapy related colitis, neutropenia enterocolitis and typhlitis, toxic megacolon, bowel perforation, malignant bowel obstruction and gastrointestinal haemorrhage. The radiologist plays a key role in identifying these oncological emergencies and guiding further management.

Purpose: Vascular Ehlers-Danlos syndrome (vEDS) is a rare and aggressive heritable aortic disease caused by pathogenic variants in COL3A1 gene, characterized by spontaneous arterial dissection and organ rupture. The purpose of this study is to evaluate ventricular size and function and to explore their associations with complications in vEDS. Methods: Adults with genetically confirmed vEDS who underwent clinical cardiac MRI were retrospectively compared with controls matched for age and sex. Cardiac MRI analysis included assessment of ventricular volumetry and arterial vasculature. vEDS-related complications were evaluated including dissection, aneurysm, and pneumothorax. Multivariable logistic regression was performed. Results: We studied 26 individuals with vEDS (38.6 ± 15.6 years, 50.0% female) and 26 healthy controls. Median clinical follow-up was 2.4 (1.1-3.6) years. Left and right ventricular ejection fractions were lower in vEDS compared with controls (LVEF 58 ± 6% vs 61 ± 4%, P = .03; RVEF 54 ± 5% vs 58 ± 4%, P = .03). After controlling for age, sex, and antihypertensive medication, LV end-diastolic volume indexed to body surface area (LVEDVi) predicted dissections (OR 1.1, 95% CI 1.01-1.2, P = .04) and aneurysms (OR 1.1, 95% CI 1.01-1.3, P = .03). Indexed LV end systolic volume (LVESVi) also predicted aneurysms (OR 1.2, 95% CI 1.03-1.5, P = .02). LVEF predicted the presence of any complication (OR 0.71, 95% CI 0.52-0.99, P = .04). Pneumothorax occurred exclusively in vEDS group among those with LVEF <58% (below the mean), 50.0% versus 0.0%, P = .02. Those with LVEF <58% had more frequent dissection and/or aneurysm (75.0% vs 12.5%, P = .04). Conclusion: Lower LVEF and larger cardiac size are associated with complications in vEDS.

Objective: This retrospective study aims to assess the role of pre-contrast sequences of an MRI-guided breast biopsy (MRIB) exam in confident and accurate lesion site localization based on tissue landmarks. Methods: The charts of all consecutives MRIB that were performed between January 2018 and December 2020 were reviewed. The images of the eligible exams were analyzed by 3 breast radiologists. Each radiologist independently attempted to identify lesion site on pre-contrast MRIB sequences, while blinded to the post-contrast MRIB images. Confidence levels (I-confident, II-not confident, and III-unknown) were assigned by each reviewer. A fourth radiologist assessed the accuracy (≤5 mm-accurate, >5 mm-inaccurate) in lesion site localization using the actual biopsied lesion site and the post-contrast MRIB images as reference. Descriptive statistics were used to calculate the percentage of confidence and accuracy categories for each reviewer, with Chi-square tests applied to analyze relationships between categorical variables. Results: There were 174 female patients with 181 lesions eligible for the trial. When the lesion site is confidently identified on the pre-contrast MRIB images (level 1 confidence), mean grade 1 accuracy was 93.8% (P < .001). Accuracy decreased with Level II and III confidence (55.3% and 34.2% respectively). Up to 61.4% improved accuracy was demonstrated when combining the performance of 2 reviewers. No correlation was found between breast density, lesion morphology, or biopsy positioning with confidence level or accuracy grade. Conclusion: Careful review of the pre-contrast MRIB images and familiarization with the surrounding tissue landmarks are important steps in confidently and accurately detecting lesion site.

In the immunocompromised setting, there are distinct radiologic findings of primary central nervous system lymphoma (PCNSL), including necrotic ring-enhancing lesions, increased propensity for intralesional haemorrhage, and multiplicity. In this clinical context, advanced imaging with MR perfusion, spectroscopy, and diffusion-weighted imaging can be used to increase accuracy in the diagnosis of lymphoma over mimics such as high-grade glioma, metastases, or infection. This review summarizes the histology and pathophysiology of PCNSL in immunodeficient hosts, which provide a basis for its imaging appearances, prognosis, and treatment. This discussion is important for the general radiologist as the incidence of immunodeficiency-related PCNSL may be increasing.