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

Objective: To assess the operational and environmental benefits of using an abbreviated protocol for hepatocellular carcinoma (HCC) surveillance.

Methods: This IRB-approved retrospective single-center quality improvement study evaluated time, energy use, and appointment access. Inclusion criteria were HCC surveillance MRIs with either a full or abbreviated imaging protocol. Exclusion criteria were other abdominopelvic MR protocols or incomplete studies. DICOM time data were extracted via Quantivly and validated with 10 prospective time studies. Exam times from PACS images were cross-referenced with DICOM data to identify and resolve extraction outliers. Power logs from 10 exams per protocol were used to quantify energy and greenhouse gas emissions. Schedule logs assessed appointment volume changes. Mean times (±SD) and energy (±SD) were reported, and Welch's t-test determined statistical significance (P < .05).

Results: Exam times for 487 MRIs (318 abbreviated, 169 full protocol) were analyzed, with 67 excluded. The mean duration of exam time for the abbreviated protocol was 12.0 minutes (SD: 4.3), compared with 29.7 minutes (SD: 8.8) for the full protocol (mean difference, 17.7 minutes; P < .0001). The mean energy for the abbreviated protocol was 4.7 kWh (SD: 0.6), compared with 11.7 kWh (SD: 1.3) for the full protocol (mean difference, 7.0 kWh; P < .0001). Across 318 abbreviated exams, estimated savings totaled 2226 kWh and 1494.6 kg CO2eq. Despite time savings, MRI appointment volume and scanner access remained unchanged.

Conclusion: Abbreviated HCC surveillance MRIs cut scan time, energy use, and carbon emissions by 60%, but scheduling complexities precluded increased MRI appointments.

Purpose: To identify CT features that may help discriminate between pancreatic adenosquamous carcinoma (PASC) and pancreatic ductal adenocarcinoma (PDAC).

Methods: CT examinations of 42 patients with PASC were analyzed by 2 independent readers and compared to those obtained in 42 patients with PDAC. Sensitivity, specificity, and accuracy of each variable for diagnosing PASC versus PDAC were calculated. Associations between variables and PASC were examined using univariable and multivariable analyses. A CT signature was developed to distinguish PASC from PDAC.

Results: PASC presented as single (100%), oval (93%), and heterogeneously enhancing (98%) pancreatic mass with a mean largest diameter of 46.2 ± 18.5 mm, vessel encasement (69%), and segmental portal hypertension (64%), in association with hepatic metastases (52%). In univariable analysis, ring enhancement (odds ratio [OR], 25.23; P = .002), internal necrosis (OR, 9.48; P < .001), heterogeneous tumour enhancement (OR, 25.23; P = .002), and segmental portal hypertension (OR, 4.5; P = .001), were the most discriminating CT findings for the diagnosis of PASC. In multivariable analysis, internal necrosis (adjusted OR, 5.44; 95% confidence interval [CI]: 1.83-17.34; P = .003), heterogeneous tumour enhancement (adjusted OR, 8.80; 95% CI: 1.41-171.47; P = .049), and segmental portal hypertension (adjusted OR, 2.96; 95% CI: 1.02-8.97; P = .048), were independent variables strongly associated with the diagnosis of PASC. The CT signature yielded 81% sensitivity (95% CI: 66-91), 74% specificity (95% CI: 58-86), and area under the receiver operating characteristic curve of 0.840 (95% CI: 0.756-0.924) for diagnosing PASC.

Conclusion: CT examination demonstrates several features that help discriminate between PASC and PDAC. A CT signature based on 3 imaging features can help distinguish PASC from PDAC.

Traumatic pancreatic injuries are uncommon but are associated with high rates of morbidity and mortality. Early detection is key for patient prognosis and clinical management, specifically as it relates to injuries to the main pancreatic duct (MPD). The 1990 version of the American Association for the Surgery of Trauma Organ Injury Scale (AAST-OIS) presumed involvement of the MPD for lacerations spanning greater than 50% of pancreatic parenchymal depth on trauma computed tomography (CT) imaging. However, CT lacks specificity and sensitivity for MPD injuries. As such, the 2024 AAST-OIS revision for pancreatic injuries places increased emphasis on MPD evaluation with more sensitive modalities for duct injury, such as endoscopic retrograde cholangiopancreatography and magnetic resonance cholangiopancreatography. The goal of the 2024 revision is to improve concordance between pancreatic injury grade and patient outcomes, as well as to provide a more accurate description of injury to enhance the quality of future pancreatic trauma research. In this review, we will discuss the new 2024 AAST-OIS updates to pancreatic trauma grading, relevant pancreatic anatomy, incidence, mechanisms, imaging appearance and complications of pancreatic trauma, as well as opportunities for future avenues of study.