Cerebral venous thrombosis is a relatively uncommon but serious neurologic disorder that is potentially reversible with prompt diagnosis and appropriate medical care. Because the possible causal factors and clinical manifestations of this disorder are many and varied, imaging plays a primary role in the diagnosis. Magnetic resonance (MR) imaging, unenhanced computed tomography (CT), unenhanced time-of-flight MR venography, and contrast material-enhanced MR venography and CT venography are particularly useful techniques for detecting cerebral venous and brain parenchymal changes that may be related to thrombosis. To achieve an accurate diagnosis, it is important to have a detailed knowledge of the normal venous anatomy and variants, the spectrum of findings (venous sinus thrombi and recanalization, parenchymal diffusion or perfusion changes or hemorrhage), other potentially relevant conditions (deep venous occlusion, isolated cortical venous thrombosis, idiopathic intracranial hypertension), and potential pitfalls in image interpretation.

Imaging of cerebral venous thrombosis : Current techniques, spectrum of findings, and diagnostic pitfalls. Commentary and Authors' reply

The Contrast Media Safety Committee (CMSC) of the European Society of Urogenital Radiology (ESUR) has updated its 2011 guidelines on the prevention of post-contrast acute kidney injury (PC-AKI). The results of the literature review and the recommendations based on it, which were used to prepare the new guidelines, are presented in two papers. Topics reviewed include the terminology used, the best way to measure eGFR, the definition of PC-AKI, and the risk factors for PC-AKI, including whether the risk with intravenous and intra-arterial contrast medium differs. • PC-AKI is the preferred term for renal function deterioration after contrast medium. • PC-AKI has many possible causes. • The risk of AKI caused by intravascular contrast medium has been overstated. • Important patient risk factors for PC-AKI are CKD and dehydration.

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Post-contrast acute kidney injury - Part 1: Definition, clinical features, incidence, role of contrast medium and risk factors : Recommendations for updated ESUR Contrast Medium Safety Committee guidelines.

The Breast Imaging Reporting and Data System (BI-RADS®) is a standardized system of reporting breast pathology as seen on mammogram, ultrasound, and magnetic resonance imaging. It encourages consistency between reports and facilitates clear communication between the radiologist and other physicians by providing a lexicon of descriptors, a reporting structure that relates assessment categories to management recommendations, and a framework for data collection and auditing. This article highlights the changes made to the BI-RADS® atlas 5th edition by comparison with its predecessor, provide a useful resource for a radiologist attempting to review the recent changes to the new edition, and serve as a quick reference to those who have previously become familiar with the material.

BI-RADS(®) fifth edition: A summary of changes.

The standardized Breast Imaging Reporting and Data System lexicon for breast MR imaging provides descriptors and assessment categories that can be used to predict the likelihood of malignancy at MR imaging.

/pdf/positive-predictive-value-of-bi-rads-mr-imaging-jhhqbsxqob.pdf

Positive predictive value of BI-RADS MR imaging.

Monitoring response to treatment is a key element in the management of breast cancer that involves several different viewpoints from surgery, radiology, and medical oncology. In the adjuvant setting, appropriate surgical and pathological evaluation guides adjuvant treatment and follow up care focuses on detecting recurrent disease with the intention of improving long term survival. In the neoadjuvant setting, assessing response to chemotherapy prior to surgery to include evaluation for pathologic response can provide prognostic information to help guide follow up care. In the metastatic setting, for those undergoing treatment, it is crucial to determine responders versus non-responders in order to help guide treatment decisions. In this review, we present the current guidelines for monitoring treatment response in the adjuvant, neoadjuvant, and metastatic setting. In addition, we also discuss challenges that are faced in each setting.

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Current approaches and challenges in monitoring treatment responses in breast cancer.

OBJECTIVE. The purpose of this article is to retrospectively assess the likelihood of malignancy of microcalcifications according to the BI-RADS descriptors in a digital mammography environment.MATERIALS AND METHODS. The study included 146 women with calcifications who underwent imaging-guided biopsy between April 2005 and July 2006. Digital mammograms procured before biopsy were analyzed independently by two breast imaging subspecialists blinded to biopsy results. Lesions described discordantly were settled by consensus. One of the radiologists provided a BI-RADS final assessment score.RESULTS. The overall positive predictive value of biopsies was 28.8%. The individual morphologic descriptors predicted the risk of malignancy as follows: fine linear/branching, 16 (70%) of 23 cases; fine pleomorphic, 14 (28%) of 50 cases; coarse heterogeneous, two (20%) of 10 cases; amorphous, 10 (20%) of 51 cases; and typically benign, zero (0%) of 12 cases. Fisher-Freeman-Halton exact testing showed statistical significa...

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The positive predictive value of BI-RADS microcalcification descriptors and final assessment categories.

The positive rate of head CT in non-trauma patients presenting to the emergency department (ED) is low. Currently, indications for imaging are based on the individual experience of the treating physician, which contributes to overutilization and variability in imaging utilization. The goals of this study are to ascertain the predictors of positive head CT in non-trauma patients and demonstrate feasibility of a clinical scoring algorithm to improve yield. We retrospectively reviewed 500 consecutive ED non-trauma patients evaluated with non-contrast head CT after presenting with headache, altered mentation, syncope, dizziness, or focal neurologic deficit. Medical records were assessed for clinical risk factors: focal neurologic deficit, altered mental status, nausea/vomiting, known malignancy, coagulopathy, and age. Data was analyzed using logistic regression and receiver operator characteristic (ROC) curves and three derived algorithms. Positive CTs were found in 51 of 500 patients (10.2 %). Only two clinical factors were significant: focal neurologic deficit (adjusted odds ratio (OR) 20.7; 95 % confidence interval (CI) 9.4–45.7) and age >55 (adjusted OR 3.08; CI 1.44–6.56). Area under the ROC curve for all three algorithms was 0.73–0.83. In proposed algorithm C, only patients with focal neurologic deficit (major risk factor) or ≥2 of the five minor risk factors (altered mental status, nausea/vomiting, known malignancy, coagulopathy, and age) would undergo CT imaging. This may reduce utilization by 34 % with only a small decrease in sensitivity (98 %). Our simple scoring algorithm utilizing multiple clinical risk factors could help to predict the non-trauma patients who will benefit from CT imaging, resulting in reduced radiation exposure without sacrificing sensitivity.

/pdf/clinical-scoring-system-may-improve-yield-of-head-ct-of-non-2k16gywxwf.pdf

Clinical scoring system may improve yield of head CT of non-trauma emergency department patients.

Purpose To examine, in a retrospective study, whether the initial posttreatment mammogram offers any benefit to patients. Methods and Materials Patients were selected who had radiation after breast-conservation therapy from 1995 through 2005 and had follow-up mammography at the University of California-Los Angeles (UCLA) within 1 year of completing radiotherapy. Results of the initial follow-up mammogram were analyzed to determine the yield of this initial mammogram. Results Between 1995 and 2005, 408 patients treated with breast-conserving therapy and radiation had follow-up mammograms at UCLA within 1 year of completion of radiation. Median age at radiation completion was 56.9 years. Median interval between radiation and the initial mammogram was 3.1 months. Ten patients were found to have suspicious findings on the initial postradiation mammogram, prompting biopsy, but only 2 were found to have recurrent cancer. None of those lesions were palpable. In both cases the recurrences were ductal carcinoma in situ . Thus, the yield of the initial postoperative mammogram as compared with physical examination findings is estimated at 0.49 recurrences detected per 100 mammograms performed (95% confidence interval 0.059–1.759). Conclusions The yield of the initial postradiation mammography at UCLA seems to be low, and only noninvasive carcinomas were found. Our data support the rationale to avoid the initial short-interval postradiation mammography and evaluate patients at 12 months.

Is a Short-Interval Postradiation Mammogram Necessary After Conservative Surgery and Radiation in Breast Cancer?

https://www.onlinelibrary.wiley.com/doi/pdf/10.1111/ajt.13365

Graft arterial stenosis in kidney en bloc grafts from very small pediatric donors: incidence, timing, and role of ultrasound in screening.

OBJECTIVE. The purpose of this study was to investigate the training and attitudes of senior residents regarding breast imaging. MATERIALS AND METHODS. In 2008 a follow-up survey was completed by a chief or senior resident at 201 radiology training programs in North America. Questions included organization of breast imaging rotation, resident responsibilities, clinical practice protocols at the institution, resident impressions regarding breast imaging, and resident interest in performing breast imaging after residency. Results were compared with those of a survey completed in 2000. RESULTS. Of 201 training programs, 200 (99.5%) had dedicated breast imaging rotations; 190 (95%), 12 weeks or longer; and 39 (19%), 16 weeks or longer. Residents regularly performed real-time ultrasound imaging in 138 programs (69%), needle localization in 159 (79%), ultrasound-guided biopsy in 154 (77%), and stereotactically guided biopsy in 145 programs (72%). One hundred sixty-two residents (81%) reported that interpreting ...

https://www.ajronline.org/doi/pdf/10.2214/AJR.10.5834

Chris Bent

Papers

The positive predictive value of BI-RADS microcalcification descriptors and final assessment categories.

Clinical scoring system may improve yield of head CT of non-trauma emergency department patients.

Is a Short-Interval Postradiation Mammogram Necessary After Conservative Surgery and Radiation in Breast Cancer?

Graft arterial stenosis in kidney en bloc grafts from very small pediatric donors: incidence, timing, and role of ultrasound in screening.

Breast imaging training and attitudes: update survey of senior radiology residents.