Journal of the American College of Radiology : JACR最新文献

Purpose: The aim of this study was to assess the impact of artificial intelligence (AI) on radiologists' detection of cancer on digital breast tomosynthesis examinations on the basis of density, size, stage, and histopathology.

Methods: A retrospective analysis of mammographic audit data and screening cancers was conducted at four sites during two time periods with nine dedicated breast radiologists. Data were collected from March 1, 2018, to February 29, 2020 (pre-AI) and March 1, 2020, to February 28, 2022, with concurrent use of AI detection (post-AI). Age, density, tumor size, staging, and histopathology were collected for all screen-detected cancers. End points were cancer detection rate (CDR), recall rate, tumor size, stage, and histopathology.

Results: The pre-AI period had 54,440 examinations (339 true positives) and the post-AI had 48,742 examinations (369 true positives). CDR improved from 6.23 to 7.57, an increase of 1.34 (95% confidence interval [CI], 0.33 to 2.36; P < .01). The recall rate was 6.97% pre-AI and 6.96% post-AI, a decrease of 0.01% (95% CI, -0.32% to 0.30%; P = .47). Radiologists detected more cancers in dense breasts post-AI (45.0% vs 37.2% pre-AI, an increase of 7.8% [95% CI, 0.6% to 15.0%; P = .04]). The mean size of invasive cancers pre-AI was 12.16 mm, decreasing to 10.74 mm post-AI (1.42 mm smaller; 95% CI, -2.83 to -0.01 mm; P < .05). More cancers were T1 post-AI (70.7%) than pre-AI (63.1%), an increase of 7.6% (95% CI, 0.68% to 14.53%; P = .03), without a change in detection of ductal carcinoma in situ post-AI (23.0%) versus pre-AI (25.7%) (P = .42). The invasive CDR/ increased from 4.63 pre-AI to 5.83 post-AI, a difference 1.20 (95% CI, 0.31 to 2.08; P < .01). The rate of lobular cancers increased post-AI from 0.44 to 0.98, a difference of 0.54 (95% CI, 0.21 to 0.87; P < .001).

Conclusions: Interpretation of screening digital breast tomosynthesis examinations by dedicated breast radiologists with the concurrent use of AI increased the CDR by 22% and the invasive detection rate by 26%, and the lobular detection rate doubled, with an increase in cancers detected in dense breasts and a decrease in mean invasive size and stage. The use of AI enabled the detection of more invasive cancers without an increase in noninvasive cancers or recall rate.

For asymptomatic patients with saline implants, no imaging is recommended. If there is suspected saline implant rupture, ultrasound is usually appropriate, though saline implant rupture is often clinically evident. For asymptomatic patients with silicone implants, the FDA recommends that patients have an initial ultrasound or MRI examination without contrast 5 to 6 years after initial silicone implant surgery and then every 2 to 3 years thereafter. In a patient with silicone implants and suspected implant complication, MRI without contrast is usually appropriate and ultrasound and/or mammography may be appropriate, depending on age. In a patient with unexplained axillary adenopathy with current or prior silicone breast implants, ultrasound and/or mammography are usually appropriate, depending on age. In the setting of a patient with breast implants of any type and suspected implant-associated malignancy, ultrasound or MRI without and with contrast is usually appropriate as initial imaging test. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.

Nonthrombotic iliac vein lesions (NIVLs), also referred to as a May-Thurner lesion/anatomy or Cockett syndrome, most frequently result from the left common iliac vein being compressed between the right common iliac artery and the spine. Iliac vein compression is often clinically silent, but can be associated with significant symptoms in which case it is referred to as May-Thurner syndrome. It is still unclear why some patients are asymptomatic whereas others can develop severe, debilitating symptoms. Most frequently, this disorder can cause lower extremity edema, deep venous thrombosis, or chronic venous insufficiency. Since NIVL can be clinically silent, a thorough history and physical examination is needed to rule out alternative etiologies. For symptomatic patients, imaging evaluation is warranted to make a definitive diagnosis. The objectives of imaging in a symptomatic patient include confirmation of diagnosis, identifying the location and extent of occlusion, and procedural planning. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.

Liver transplantation is currently the treatment of choice for patients with acute or advanced chronic liver failure. Complications that can lead to liver allograft failure or patient mortality include vascular abnormalities, biliary complications, infection, rejection, and recurrent or posttransplant malignancy. Imaging plays a vital role in detecting these complications. This document summarizes the relevant literature for the selection of imaging after liver transplant for the following clinical scenarios: immediate postoperative period, postoperative complications of suspected vascular etiology, postoperative complications of suspected biliary etiology, and postoperative surveillance. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.

Infertility is defined as the inability to conceive spontaneously after 12 months of routinely unprotected intercourse in patients <35 years of age, and after 6 months in patients ≥35 years of age. Infertility also refers to the inability to achieve a successful pregnancy based on the medical, sexual, and reproductive history; age, physical findings; diagnostic testing; the need for medical intervention; or a combination of these variables for a patient. In the United States, 13% of women 15 to 49 years of age have accessed assisted fertility services and it has been suggested that the rate of infertility has been increasing, without geographic bias. Understanding the initial imaging evaluation is essential to this often complex and/or multifaceted clinical circumstance, which may involve the ovaries, uterus, and fallopian tubes. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.