Publications

PURPOSE: To assess the safety and efficacy of CyberKnife® radiotherapy (CKRT) for the treatment of olfactory groove meningiomas (OGMs).

METHODS: A retrospective review was performed of 13 patients with OGM treated with CKRT from September 2005 to May 2018 at our institution. Nine patients were treated primarily with CKRT, 3 for residual disease following resection, and 1 for disease recurrence.

RESULTS: Five patients were treated with stereotactic radiosurgery (SRS), 6 with hypofractionated stereotactic radiotherapy (HSRT), and 2 with fractionated stereotactic radiotherapy (FSRT). The median tumor volume was 8.12 cm3. The median prescribed dose was 14.8 Gy for SRS, 27.3 Gy for HSRT, and 50.2 Gy for FSRT. The median maximal dose delivered was 32.27 Gy. Median post treatment follow-up was 48 months. Twelve of 13 patients yielded a 100% regional control rate with a median tumor volume reduction of 31.7%. Six of the 12 patients had reduced tumor volumes while the other 6 had no changes. The thirteenth patient had significant radiation-induced edema requiring surgical decompression. Twelve patients were alive and neurologically stable at the time of the review. One patient died from pneumonia unrelated to his CKRT treatment.

CONCLUSIONS: CKRT appears to be safe and effective for the treatment of OGMs.

OBJECTIVE: To assess impact of single-energy metal artifact reduction (SEMAR) algorithm utilizing retrospective adaptive thresholding in reducing metal artifacts in the abdomen and pelvis.

METHODS: In this prospective institutional review board-approved, Health Insurance Portability and Accountability Act-compliant study, 90 patients with various metals (n = 97) on computed tomography of abdomen and pelvis (Canon Medical, Aquilion ONE and PRIME) scanned 07/2017-09/2018 with SEMAR retrospectively applied were included. Density was measured in the near and far field to the metals. Density standard deviation (SD), representing artifact severity, was compared with and without SEMAR applied. Two trained human observers independently evaluated severity of artifacts on a five-point scale (0, no artifact; 5, severe artifact).

RESULTS: The SEMAR significantly decreased artifact severity in the near field of high-density metal implants (SD of 204 ± 101HU without vs. 66 ± 40HU with SEMAR, P < 0.001). In the far field, the artifact severity was similar (40 ± 31HU without vs. 36 ± 27HU with SEMAR, P = 0.41). Artifact severity was decreased adjacent to low-density metal in the near field (SD of 86 ± 56HU without vs 49 ± 30HU with SEMAR, P < 0.001). In the far field to the low-density metals artifact severity was similar (33 ± 29HU without vs. 31 ± 27HU with SEMAR, P = 0.79). Subjectively, artifacts severity decreased for high-density metals in near field by 1.3 ± 1.0, and in far field by 0.7 ± 0.7 and for low-density metals in the near field by 0.7 ± 1.0, far field 0.4 ± 0.5, all P < 0.05.

CONCLUSIONS: The SEMAR retrospective algorithm with adaptive thresholding subjectively and objectively reduced near-field artifacts generated by high- and low-density metals.

INTRODUCTION: Short bowel syndrome (SBS) has traditionally been regarded as a rapidly fatal medical catastrophe. The advent of pharmacological options directly targeting disease pathophysiology justified this review.

AREAS COVERED: Since the 1970s, home parenteral nutrition has reduced mortality, converting SBS into a chronic and disabling compensated and occasionally curable illness. Off-label antidiarrheal drugs and related products, though having minimal scientific evidence of efficacy, represent the standard-of-care and are here reviewed. Trophic intestinal hormones, including GLP-2 and its analogs, have great promise for alleviating malabsorption, the most important symptom within a nonsurgical, routine outpatient framework. Current indications involve adults with massive intestinal losses (fecal wet weight >1500 g/day). Surgical options such as intestinal lengthening or transplantation are also addressed although these options are considerably more aggressive and have stricter indications.

EXPERT OPINION: GLP-2 analogs are the first candidates from a pioneering pharmacotherapic family within the SBS framework, namely disease-modifying, absorption-restoring agents. This family of drugs, potentially applicable in all contexts of severe intestinal loss, could become the therapeutic benchmark of the near future.

OBJECTIVE. The purpose of this article is to present strategies and guidelines that can be implemented in the performance of cross-sectional interventional procedures during the coronavirus disease (COVID-19) pandemic. CONCLUSION. Radiologists who perform cross-sectional interventional procedures can take several steps to minimize the risks to patients and radiology personnel, including screening referred patients to decide which procedures can be postponed, using appropriate personal protective equipment (PPE), minimizing the number of people involved in procedures, preserving PPE when possible, and applying proper room and equipment cleaning measures.

The most common known causes of female infertility are male factor (26%), ovulatory failure (21%), and tubal damage (14%), while in 28% a couple's infertility remains unexplained. Female-specific causes of infertility include deterioration of oocyte quality with increasing maternal age; ovulatory disorders, most notably polycystic ovarian syndrome; history of salpingitis such as that caused by chlamydia infection; endometriosis; and uterine cavity abnormalities interfering with implantation causing inability to become pregnant or causing recurrent pregnancy loss. These potential causes of female infertility are discussed in this document and the appropriate imaging recommendations for each variant are provided. 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 include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.

PURPOSE: Cough-associated headache (CAH) is the most distinctive symptom of patients with Chiari I malformation (CMI) and indicates clinically significant disease. We determined the clinical utility of simple 2D anatomic measurements performed on a PACS workstation by assessing their diagnostic accuracy in predicting CAH in CMI patients.

METHODS: Seventy-two consecutive CMI patients (cerebellar tonsillar herniation > 5 mm) with headache seen by neurosurgeons over 6 years were included. Sagittal T1 images were used by two readers to measure: extent of tonsillar herniation, lengths of the clivus and supra-occiput, McRae and pB-C2 lines, as well as clivus-canal, odontoid retroversion, and skull base angles. Neurosurgery notes were reviewed to determine presence of CAH. Mann-Whitney test was used to compare measurements between patients with and without CAH. Predictive accuracy was assessed by receiver operating characteristic (ROC) curve.

RESULTS: 47/72 (65.3%) CMI patients reported CAH. Tonsillar herniation with CAH (10.2 mm, 7-14 mm; median, interquartile range) was significantly greater than those without CAH (7.9 mm, 6.3-10.9 mm; p = 0.02). Tonsillar herniation ≥ 10 mm showed sensitivity and specificity of 51% and 68%, and tonsillar herniation > 14 mm showed sensitivity and specificity of 30% and 100%, respectively, for predicting CAH. Other 2D measurements showed no statistically significant differences.

CONCLUSIONS: Among the 2D measurements used, only the extent of tonsillar herniation is different between CMI patients with and without CAH. Although CMI is diagnosed with tonsillar herniation of only 5 mm, we found that a much higher extent of herniation is needed to be predictive of CAH.

The purpose of this study is to review the clinical presentation, multi-modality appearance, and management of the most common benign and malignant fibroepithelial lesions of the breast. Fibroepithelial lesions of the breast may exhibit characteristic features on mammography, ultrasound, and MRI, although definitive diagnosis most often requires biopsy and at times, surgical excision. Knowledge of the imaging features can assist in refining the differential diagnosis and guiding appropriate management.