Shannon P. Sheedy

The SAR Colorectal and Anal Cancer Disease-focused Panel rectal cancer MRI restaging report template can be used to clarify common areas of confusion and deliver essential insights to ensure that clinically relevant information is effectively communicated to the treatment team.

Objectives Radiologist participation in multidisciplinary tumor board can be time-consuming and demanding, requiring substantial preparation. Anecdotally radiologist participation is felt to help identify discrepancies in previous interpretations; however, there are limited data assessing the actual impact of their tumor board review on patient management. This prospective study aims to evaluate how the reinterpretation of outside imaging and review at hepatobiliary tumor board (HBTB) affects the diagnosis and management of patients with hepatobiliary neoplasms. Methods This prospective analysis included all patients presented at the weekly HBTB between 6/13/2023—6/25/2024. One radiologist reviewed the available reports of outside imaging, the local reinterpretation of outside imaging, the updated local imaging, and documented conclusions from discussion of the case at HBTB. HBTB included 4 radiologists who had reviewed each case. Discrepancies (presence/absence, number, and reasons for) were recorded. When discrepancies occurred, the impact on patient management (5-point Likert scale) was determined by two of the radiologists present at the HBTB in consensus, with input from clinicians if needed. A six-month follow-up was performed to confirm suspected diagnoses. Results 208 cases (128 males, 104 chronic liver disease patients) were presented at HBTB. Disagreements in the detection or characterization of lesions were found in 59/208 (28.4%) of cases. A change in management occurred in 38/59 (64.6%) of these discrepant cases. In cases with recorded discrepancies in which follow-up confirmation was available, the final interpretation was confirmed in 34/41 (82.9%) of cases. Conclusion Our study found a discrepant interpretation in nearly one-third of cases presented at a weekly HBTB and a resultant change in management in 65% of those cases. These findings highlight the importance of reinterpretation of prior imaging studies and the presence of radiologists at HBTB to guide optimal patient management. Key message Patient care is substantially impacted by reinterpretation of prior imaging and participation of radiologists at hepatobiliary tumor board. Graphical abstract

Alcohol use disorder is linked to a multitude of diseases and disorders, many of which can be diagnosed with imaging techniques such as US, CT, and MRI, enabling early detection and potentially preventing further damage and improving outcomes.

Radiologists are integral members of the interdisciplinary team for patients with mucinous appendiceal neoplasms and can directly affect care by suggesting the diagnosis of pseudomyxoma peritonei, optimizing imaging protocols for evaluating peritoneal implants, and reporting the primary tumor and spilled tumor cells thoroughly.

Background Rectosigmoid endometriosis (RSE) presents with a diverse array of MRI findings that impact surgical planning. No standardized reporting and data system has been established for RSE. Purpose We propose a novel MRI scoring system designed to predict the likelihood of muscularis propria (MP) involvement in RSE, which would, in turn, influence surgical planning. Materials and methods The records of patients with bowel endometriosis treated surgically from May 2018 to June 2022 were retrieved. Surgery was classified as partial thickness discoid, full thickness discoid, or segmental resection. Each pre-treatment MRI was scored based on the mutual agreement of two abdominal radiologists (reference score). The MRI score was defined as (1) score 0: no evidence of RSE, (2) score 1: minimal tethering involving the serosal surface without MP involvement, (3) score 2: intermediate soft tissue thickening involving the rectosigmoid colon with indeterminate MP involvement, or (4) score 3: definite mushroom cap sign or definite MP involvement. In the reader study, two radiologists independently scored each exam. The area under the curve (AUC) was evaluated for predicting the need for segmental or full thickness discoid resection. Results The cohort consisted of 95 patients (median age: 36 years); 16, 14, 30, and 35 patients had MRI score 0, 1, 2, and 3, respectively. Patients with MRI scores 3 and 2 underwent partial thickness discoid (6% vs. 50%), full thickness discoid (6% vs. 17%), and segmental resection (89% vs. 33%), respectively. All patients with MRI scores 1 or 0 either underwent partial thickness discoid resection or did not undergo rectosigmoid surgery. The AUCs were 92.2%, 84.5% and 93.9% for MRI scores of the reference, reader 1, and 2, respectively. Conclusion Our MRI scoring system based on suspected depth of bowel invasion showed good diagnostic performance to predict the type of surgical intervention needed.

Background and purpose Endometriosis affects 5–10% of women of reproductive age. Despite its prevalence, diagnosing endometriosis through imaging remains challenging. Advances in deep learning (DL) are revolutionizing the diagnosis and management of complex medical conditions. This study aims to evaluate DL tools in enhancing the accuracy of multi-sequence MRI-based detection of endometriosis. Method We gathered a patient cohort from our institutional database, composed of patients with pathologically confirmed endometriosis from 2015 to 2024. We created an age-matched control group that underwent a similar MR protocol without an endometriosis diagnosis. We used sagittal fat-saturated T1-weighted (T1W FS) pre- and post-contrast and T2-weighted (T2W) MRIs. Our dataset was split at the patient level, allocating 12.5% for testing and conducting seven-fold cross-validation on the remainder. Seven abdominal radiologists with experience in endometriosis MRI and complex surgical planning and one women’s imaging fellow with specific training in endometriosis MRI reviewed a random selection of images and documented their endometriosis detection. Results 395 and 356 patients were included in the case and control groups respectively. The final 3D-DenseNet-121 classifier model demonstrated robust performance. Our findings indicated the most accurate predictions were obtained using T2W, T1W FS pre-, and post-contrast images. Using an ensemble technique on the test set resulted in an F1 Score of 0.881, AUROCC of 0.911, sensitivity of 0.976, and specificity of 0.720. Radiologists achieved 84.48% and 87.93% sensitivity without and with AI assistance in detecting endometriosis. The agreement among radiologists in predicting labels for endometriosis was measured as a Fleiss’ kappa of 0.5718 without AI assistance and 0.6839 with AI assistance. Conclusion This study introduced the first DL model to use multi-sequence MRI on a large cohort, showing results equivalent to human detection by trained readers in identifying endometriosis.

Multiple infiltrative disorders can affect the small bowel, often resulting in diffuse small bowel wall thickening. These infiltrative disorders can manifest owing to various factors such as an influx of immunologic or neoplastic cells or the accumulation of substances within one or more layers of the intestinal wall. Although there can be considerable overlap in the appearances of infiltrative diseases on cross-sectional images, a comprehensive understanding of more specific ancillary imaging features and clinicopathologic correlation can substantially narrow the differential diagnosis. The radiologist can be instrumental in synthesizing the clinical and imaging information and guiding subsequent workup. The authors present a comprehensive review of the infiltrative disorders that commonly involve the small bowel. These disorders are organized on the basis of their pathophysiologic features, with multiple illustrative case examples to enhance understanding of these entities. CT and MRI are currently the most commonly used imaging modalities for evaluating small bowel disorders, and this review is focused on these two modalities. Detailed information regarding the pathologic features, clinical presentation, and imaging findings of these infiltrative disorders is provided to aid radiologists in recognizing and differentiating these conditions. ^©RSNA, 2024.