Jessica G. Zarzour

The modified barium swallow study (MBSS) is a diagnostic examination that visualizes the functional anatomy and physiology of the oral pharyngeal swallowing mechanism in real time. The MBSS, a videofluoroscopic imaging method, is indicated for patients with known or suspected oropharyngeal dysphagia and ideally involves the combined expertise of a radiologist and speech pathologist. The MBSS provides critical diagnostic insights that help in identifying and assessing the type and severity of physiological swallowing impairments, evaluating the safety of oral intake, testing the effectiveness of evidence-based interventions, and developing treatment plans. This manuscript aims to present an overview of MBSS standards from an interdisciplinary perspective, emphasizes key areas of best practices, and reviews the common morphologic abnormalities seen on MBSS exams.

Barium enema studies continue to provide important and unique information to clinicians in an era of more advanced cross-sectional imaging.

Liver lesions are often incidentally detected on ultrasound examination and may be incompletely characterized, requiring further imaging. Contrast-enhanced ultrasound (CEUS) was recently approved by the Food and Drug Administration in the United States for liver lesion characterization. CEUS has the ability to characterize focal liver lesions and has been shown to be superior to color Doppler and power Doppler ultrasound in the detection of tumor vascularity. Differentiating benign from malignant liver lesions is essential to characterizing liver lesions. The CEUS imaging characteristics of benign liver lesions are reviewed, including hepatic cysts, hemangiomas, focal fat, focal nodular hyperplasia, hepatocellular adenomas, abscesses, and traumatic lesions.

Lymph node imaging in initial staging of prostate cancer: An overview and update

Objectives: To determine the utility of contrast‐enhanced ultrasound (US) for characterizing renal lesions that were indeterminate on prior imaging.Methods: This Institutional Review Board–approved retrospective diagnostic accuracy study evaluated all patients who underwent renal contrast‐enhanced US examinations from 2006 to 2015 at our tertiary care hospital. We compared the number of lesions definitively characterized by contrast‐enhanced US with the indeterminate lesions by prior imaging. The accuracy of contrast‐enhanced US was compared with the final diagnosis by histologic examination and follow‐up (mean, 3.63 years). Accuracy and agreement estimates were compared with the exact binomial distribution to assess statistical significance.Results: A total of 134 lesions were evaluated with contrast‐enhanced US, and 106 were indeterminate by preceding computed tomography, magnetic resonance imaging, or US. Only the largest lesion per patient was included in analysis. A total of 95.7% (90 of 94) of the previously indeterminate lesions were successfully classified with contrast‐enhanced US. The sensitivity was 100% (20 of 20; 95% confidence interval [CI], 83%–100%; P < .0001); specificity was 85.7% (18 of 21; 95% CI, 62%–97%; P = .0026); positive predictive value was 87.0% (20 of 23; 95% CI, 66%–97%; P = .0005); negative predictive value was 100% (18 of 18; 95% CI, 81%–100%; P < .001); and accuracy was 90.2% (37 of 41; 95% CI, 80%–98%; P < .0001).Conclusions: Contrast‐enhanced US has a high likelihood of definitively classifying a renal lesion that is indeterminate by computed tomography, magnetic resonance imaging, or conventional US.

Purpose Determine iodine content threshold discriminating papillary renal cell carcinomas (pRCC) from complex cysts (CCs) using rapid kV-switching dual-energy CT (rsDECT). Materials and methods IRB-approved retrospective study of 72 consecutive patients with pathologic diagnosis of renal cell carcinoma, who underwent rsDECT from 2011 to 2015. Controls included consecutive patients with CC during same period. Iodine content of each pRCC (n = 27) was measured on rsDECT workstation for arterial (n = 15) or nephrographic phase (n = 12), and compared to iodine content for clear cell renal cell carcinomas (ccRCC, n = 46) and complex cysts (n = 54). An optimal iodine content threshold was estimated using logistic regressions and Youden’s J based on maximum specificity and sensitivity. Results Iodine threshold of 1.28 mg/cc was optimal to discriminate between pRCCs and CCs for nephrographic phase (sens 1.0, spec 0.96, PPV 0.92, and NPV 1.0, AUC 0.997, acc 0.97, p < 0.0001). Iodine threshold of 1.22 mg/cc was the optimal cutoff value to discriminate between pRCCs and CCs in the arterial phase (sens 0.67, spec 0.97, PPV 0.91, NPV 0.85, AUC 0.76, and acc 0.84, p = 0.006). The optimal threshold to discriminate between ccRCCs and pRCCs was 1.85 mg/cc in the arterial phase (sens 0.87, spec 0.92, PPV 0.87, NPV 0.92, p < 0001) and 2.71 mg/cc in the nephrographic phase (sens 1.0, spec 1.0, PPV 1.0, NPV 1.0, p < 0.0001). Conclusions Quantitative iodine values on rsDECT discriminate between papillary RCC and complex cysts, and between papillary RCC and clear cell RCC, the former addressing an important clinical challenge particularly when an unenhanced series has not been performed. These rsDECT thresholds differ from values derived from dual-source DECT technology.

Acrokeratosis paraneoplastic (Bazex syndrome) is a rare, but distinctive paraneoplastic dermatosis characterized by erythematosquamous lesions located at the acral sites and is most commonly associated with carcinomas of the upper aerodigestive tract. We report a 58-year-old female with a history of a pigmented rash on her extremities, thick keratotic plaques on her hands, and brittle nails. Chest imaging revealed a right upper lobe mass that was proven to be small cell lung carcinoma. While Bazex syndrome has been described in the dermatology literature, it is also important for the radiologist to be aware of this entity and its common presentations.