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

Prostate cancer (PCa) remains a leading cause of cancer-related morbidity and mortality among men worldwide. Multiparametric MRI (mpMRI) is currently the gold standard for PCa detection, diagnosis, and active surveillance. However, its reliance on dynamic contrast-enhanced (DCE) imaging introduces safety concerns, higher costs, and longer scan times. Biparametric MRI (bpMRI), which omits DCE, has emerged as a streamlined alternative that retains T2-weighted and diffusion-weighted imaging. This review critically examines the technical considerations, diagnostic performance, clinical applications, and limitations of bpMRI compared to mpMRI. We evaluate bpMRI's sensitivity, specificity, and negative predictive value in detecting clinically significant prostate cancer (csPCa), highlighting its advantages in terms of patient safety, accessibility, and cost-effectiveness. Despite promising findings, the widespread clinical adoption of bpMRI is hindered by variability in imaging protocols, limited large-scale validation, and concerns over missed subtle lesions. Future directions include standardizing bpMRI protocols, integrating artificial intelligence and biomarkers, and conducting multi-centre trials to establish its role in PCa management. bpMRI holds significant potential as a reliable and efficient imaging tool that could complement or replace mpMRI in select clinical contexts.

Purpose: A survey to determine the availability of after-hours IR on-call services at Ontario hospitals that have a radiology department. A secondary outcome is to determine potential barriers to the provision of IR after-hours on call services within the province. Methods: A survey was created and distributed to the radiology department heads across Ontario during a 6-week period in 2024. Results: The survey was sent to the department heads at 73 hospitals across the province of Ontario. Survey completion rate was 41% (30/73). Two thirds of the respondents had formal IR divisions (20/30, 66.7%). A total of 14 hospitals with IR departments offered on call services (70%, 14/20) and 2 of the hospitals without IR departments (2/10, 20%) offered on call services for non-vascular IR procedures (eg, abscess drainage). 92.9% of the groups offering IR call services stated year-over-year demand was increasing. The most common barrier to after-hours services were staffing resources. Conclusion: After-hours IR services have limited availability in the province of Ontario, and not all hospitals with IR departments currently provide after-hours access to IR procedures. The main barrier to provision of after-hours services is the lack of health human resources, in particular IR physicians.

The Canadian Association of Radiologists Incidental Findings Working Group (CAR IFWG) has developed new recommendations for the management of incidental findings of the spleen, lymph nodes, peritoneum, and mesentery, tailored to the Canadian healthcare context. This guidance addresses splenomegaly, focal splenic lesions, splenic artery aneurysms, lymphadenopathy, mesenteric panniculitis, and peritoneal nodules. Building on prior American College of Radiology (ACR) guidance and integrating recent evidence, the CAR IFWG offers a pragmatic approach emphasizing radiologic features, clinical context, and patient risk factors to minimize unnecessary follow-up. The recommendations aim to streamline care, reduce patient anxiety, and support radiologists in distinguishing benign from potentially malignant findings in asymptomatic individuals.

Purpose: To develop Choosing Wisely Canada (CWC) recommendations for musculoskeletal (MSK) imaging indications, informed by the 2024 Canadian Association of Radiologists (CAR) Musculoskeletal System Diagnostic Imaging Referral Guideline. Methods: A Steering Committee comprising multidisciplinary MSK experts was convened to guide recommendation development. Using a two-round Delphi method, committee members selected the top 3 scenarios from the CAR MSK referral guidelines deemed most impactful for addressing overuse. Recommendations based on these scenarios were then drafted using the CWC format. Results: The 3 recommendations developed are: (1) Don't order MRI without first considering ultrasound for the assessment of rotator cuff pathology and bursitis; (2) Don't order MRI of the hip or knee when x-ray demonstrates greater than mild osteoarthritis, unless recommended by a musculoskeletal specialist; and (3) Don't order MRI of the hip just based on x-ray features of femoroacetabular impingement unless there are clinical signs and symptoms of joint impingement. Conclusions: This project represents a knowledge translation initiative to disseminate updated MSK imaging guideline recommendations. It strengthens the collaboration between CAR and CWC and establishes a reproducible structured consensus approach that can be applied to developing additional CWC imaging recommendations across the remaining 12 CAR referral guidelines in other subspecialties. This work supports value-based radiology, promoting optimized resource use.

Introduction: This study aims to evaluate the outcomes of breast MRI-guided vacuum assisted biopsies (MVAB) performed on lesions with high T2 signal. Materials and Methods: We retrospectively collected of all MVAB performed at our institution between January 2016 and December 2021 for high T2 lesions. T2 hyperintensity was defined as equal or higher signal than normal lymph node. The correlation between various demographic and imaging characteristics and the binary pathological outcome (benign vs malignant) was evaluated. Results: In total, 174 biopsies from 165 women met the inclusion criteria and were included in the cohort. Malignancy was detected in 35 lesions (20%), most commonly ductal carcinoma in situ (DCIS, 57%), followed by infiltrating ductal carcinoma (IDC, 40%). The most common benign diagnosis was fibrocystic changes (FCC, 38%). In 19 lesions MVAB detected high-risk pathology, 3 of which were upgraded to malignancy. Older age (Mean 61 vs 54 years, P = .04), washout kinetics (29% vs 13%, P = .01), and indication for extent of disease evaluation (53% vs 32%, P = .06) were the strongest predictors of malignancy. Lesion size and morphology were not significantly associated with outcome. Conclusions: Given the considerable cancer rate, T2 hyperintensity should be used with caution as a benign indicator and not as a sole criterion for ruling out malignancy. Additional factors such as patient age, kinetic features, and MRI indication should be considered to improve diagnostic accuracy.

Immunotherapy with checkpoint inhibitors (ICI) has revolutionized oncology by stimulating the immune system to target cancer cells. While effective in treating various malignancies, ICI presents unique challenges in radiological response assessment. Traditional criteria, such as RECIST 1.1, were designed for cytotoxic chemotherapy and fail to account for pseudo-progression-an immune-related phenomenon where tumour size transiently increases due to immune cell infiltration before eventual shrinkage. This occurs in a minority of patients and can lead to misclassification of treatment response. To address this, new assessment criteria have been developed. The immune-related response criteria (irRC) introduced a delayed assessment of new lesions, followed by immune-related RECIST (irRECIST), which sought to align with RECIST 1.1. However, inconsistencies in its application led to the development of iRECIST in 2016, a standardized framework integrating RECIST 1.1 with immunotherapy-specific modifications. Despite its potential to become the gold standard, iRECIST is complex and challenging to implement consistently. This review outlines key differences between RECIST 1.1 and iRECIST, explains their necessity, and provides comprehensive flowcharts and graphical representations to aid interpretation. By addressing common clinical scenarios and frequently asked questions, this article aims to enhance understanding and application of iRECIST in clinical practice.