Tara A. Morgan

Objectives: Evaluate the value of ultrasound specialist assessment of ovarian masses over 50 mm with sonograms interpreted as possible hemorrhagic ovarian cysts (HOC). Methods: Retrospective review of consecutive endovaginal pelvic US reports of premenopausal women at one organization identified adnexal masses over 50 mm maximum diameter designated as possibly being HOC (large HOC). Four ultrasound specialists reviewed studies, scoring two assessments as true or false: 1) US features are most consistent with either an ovarian hemorrhagic cyst (HOC) or endometrioma; 2) If assessment 1 was true, the mass meets O‐RADS criteria of classic HOC except for size. Results: A total of 457 of 51,305 women (0.9%) had reports indicating possible large HOC. For 366 patients with established outcomes, 225 (61.5%) had a large HOC (87.1% ≤ 70 mm). Assessment 1 was true for 318 patients; outcomes showed 224 (70.4%) HOC, 89 (28.0%) endometriomas, 4 (1.3%) TOAs, and 1 (0.3%) cystadenoma. Assessment 1 was false for 48 patients; outcomes showed 1 (2.1%) HOC, 1 (2.1%) endometrioma, 6 (12.5%) other non‐neoplastic cysts, 33 (68.8%) benign neoplasms, 5 (10.4%) borderline tumors, and 2 (4.2%) high‐grade malignancies. The decrease in neoplasms and malignancies with true assessment 1 was significant ( p < .001). Assessment 2 was true for 190 patients (180 [94.7%] HOC, 9 [4.7%] endometrioma, 1 [0.5%] cystadenoma), false for 128 patients (44 [34.4%] HOC, 80 [62.5%] endometrioma, and 4 [3.1%] TOA) ( p < .001), and not applicable for 48 patients. Conclusions: Ultrasound specialist review of adnexal masses designated as a possible large HOC adds value since over 10% are neoplasms (nearly 2% malignant). Ultrasound specialist assessment can expedite additional imaging or intervention when necessary and obviate follow‐up when HOC features are typical.

The Liver Imaging Reporting and Data System US Surveillance version 2024 update reflects new data accrued since 2017 and is aligned with the 2023 American Association for the Study of Liver Diseases practice guidance on hepatocellular carcinoma.

The Society of Radiologists in Ultrasound First-Trimester US Lexicon recommends well-defined, scientific, and specific terminology to communicate clearly across disciplines, minimize bias and harm, and respect patient preferences.

Amniotic fluid (AF) is an integral part of the fetal environment and is essential for fetal growth and development. Pathways of AF recirculation include the fetal lungs, swallowing, absorption through the fetal gastrointestinal tract, excretion through fetal urine production, and movement. In addition to being a marker for fetal health, adequate AF is necessary for fetal lung development, growth, and movement. The role of diagnostic imaging is to provide a detailed fetal survey, placental evaluation, and clinical correlation with maternal conditions to help identify causes of AF abnormalities and thereby enable specific therapy. Oligohydramnios prompts evaluation for fetal growth restriction as well as genitourinary issues, including renal agenesis, multicystic dysplastic kidneys, ureteropelvic junction obstruction, and bladder outlet obstruction. Premature preterm rupture of membranes should also be clinically excluded as a cause of oligohydramnios. Clinical trials evaluating amnioinfusion are underway as a potential intervention for renal causes of oligohydramnios. Most cases of polyhydramnios are idiopathic, with maternal diabetes being a common cause. Polyhydramnios prompts evaluation for fetal gastrointestinal obstruction and oropharyngeal or thoracic masses, as well as neurologic or musculoskeletal anomalies. Amnioreduction is performed only for maternal indications such as symptomatic polyhydramnios causing maternal respiratory distress. Polyhydramnios with fetal growth restriction is paradoxical and can occur with maternal diabetes and hypertension. When these maternal conditions are absent, this raises concern for aneuploidy. The authors describe the pathways of AF production and circulation, US and MRI assessment of AF, disease-specific disruption of AF pathways, and an algorithmic approach to AF abnormalities. ^©RSNA, 2023 Online supplemental material is available for this article. Quiz questions for this article are available through the Online Learning Center.

Ultrasound guidance is valuable for performing precise joint interventions. Joint interventions may be requested for therapeutic and diagnostic pain injections, joint aspiration in the setting of suspected infection, or contrast injection for arthrography. In practice, interventions of the shoulder girdle, elbow, and hand/wrist joints may be performed without any imaging guidance. However, imaging guidance results in more accurate interventions and better patient outcomes than those performed by palpation alone. When compared to other modalities used for imaging guidance, ultrasound has many potential advantages. Radiologists should be prepared to perform ultrasound-guided upper extremity joint interventions utilizing recommended techniques to optimize clinical practice and patient outcomes.Key points: 1. Ultrasound-guided injections of the glenohumeral, acromioclavicular, sternoclavicular, elbow, and hand/wrist joints have higher accuracy than injections performed without imaging guidance.2. Ultrasound-guided aspirations of upper extremity joints have advantages to fluoroscopic-guided aspirations because of the potential to identify effusions, soft tissue abscess, or bursitis.3. Ultrasound-guided contrast injection prior to MR arthrography is as accurate as fluoroscopic-guided injection for upper extremity joints.

US-guided interventions have an essential role in the diagnosis and treatment of obstetric and gynecologic pathologic conditions, and knowledge of abnormal imaging findings, the limitations of thes... US-guided procedures have an essential role in the diagnosis and treatment of multiple obstetric and gynecologic conditions, can be performed with either transvaginal or transabdominal approaches, ...

Objectives: To assess adequacy of transvaginal ultrasound‐guided fine‐needle aspiration biopsy (TVUS‐FNAB) for pathologic diagnosis of pelvic masses performed using onsite cytopathology consultation.Methods: In this Institutional Review Board approved, Health Insurance Portability and Accountability Act (HIPAA) compliant study, radiology records were retrospectively queried to identify patients who underwent TVUS‐FNAB of a pelvic mass over a 11‐year duration. TVUS‐FNAB adequacy was determined by correlating cytopathology results with transvaginal ultrasound‐guided core‐needle biopsy (TVUS‐CNB) or surgical pathology results when available, and with clinical diagnostic confidence when additional pathology confirmation was not available. Secondary analysis included patient age, history of hysterectomy, or pelvic malignancy. Target‐specific features analyzed included mass size, depth, location, and final pathologic diagnosis.Results: Sixty patients underwent TVUS‐FNAB of pelvic masses, 43 of which underwent FNAB only and 17 underwent both TVUS‐FNAB and TVUS‐CNB during the same procedure. TVUS‐FNAB alone was adequate for diagnosis in 51 (85%) cases and addition of core‐needle biopsy (CNB) achieved a diagnosis in additional 4 patients, increasing overall diagnostic accuracy to 92% (55/60). FNAB inadequacy had statistically significant association with increasing mass depth, occurrence of a minor intraprocedural complication, and decision to perform a CNB (P <.05). Number of FNAB passes, mass size, history of hysterectomy, and final diagnosis were not statistically significant predictors of FNAB adequacy.Conclusion: TVUS‐FNAB has a high specimen adequacy rate when performed with an onsite cytopathologist and can be considered first‐line approach for image‐guided sampling of pelvic lesions with option to add CNB if preliminary cytopathologic review does not confirm sample adequacy.

Purpose To determine the rate of cytologic and diagnostic adequacy and identify features associated with suboptimal tissue sampling in ultrasound‐guided fine‐needle aspiration (US‐FNA) of suspected nodal disease in thyroid cancer patients. Methods A single‐institution pathology database was queried for lymph node FNA reports in thyroid cancer patients from 2014 to 2019. Charts were reviewed for demographics, body mass index (BMI), prior thyroidectomy, cancer type, and subsequent surgery. Ultrasound images were retrospectively reviewed for location, size, depth from skin, cystic components, macrocalcification, echogenic foci, and internal vascularity score. Pathology reports were categorized as cellular and diagnostic, hypocellular/acellular but diagnostic with abnormal cells or thyroglobulin levels, or hypocellular and nondiagnostic. Correlation and multivariate regression analyses were performed. Results Initial query yielded 552 lesions in 343 subjects. Following exclusion, 377 lesions in 255 subjects were included. Mean patient age was 48.5 years (14–90), BMI 28.5, and 66.7% female and 33.3% male. The majority (95.3%) had papillary thyroid carcinoma (PTC); and 65.5% had prior thyroidectomy. 17.7% of lesions were hypocellular/acellular (suboptimal), and 5.6% nondiagnostic. Patient factors had no association (P >.05). Right‐sidedness and hypovascularity were associated with hypocellularity (P <.05). Higher long/short‐axis ratio and cystic foci were weakly associated. On multivariate analysis, right‐sidedness (odds ratio [OR] 1.99; confidence interval [CI] 1.10–3.57) and lower vascularity score (OR 0.54; CI 0.39–0.73) were predictive of suboptimal sampling. Conclusion US‐FNA has high diagnostic yield and cellular sample rate. Lesion size had no effect. Right‐sidedness and lower vascularity scores were predictive of suboptimal tissue. Identifying these features and expected sample adequacy rates can inform management decisions for thyroid cancer patients with cervical lymphadenopathy.

Musculoskeletal ultrasound has grown substantially in use over the past several years as an indispensable companion to magnetic resonance imaging and other imaging modalities. This article reviews 10 integral applications of musculoskeletal ultrasound as a problem‐solving tool with correlative case examples. These applications include the following: (1) accessibility and portability, (2) targeted imaging, (3) dynamic imaging, (4) contralateral comparison, (5) Doppler imaging, (6) increased spatial resolution, (7) solid versus cystic comparison, (8) posttraumatic imaging, (9) postsurgical imaging, and (10) treatment delivery and optimization. The review will help the radiologist recognize the complementary uses of musculoskeletal ultrasound with radiography, computed tomography, and magnetic resonance imaging.

Objectives To assess 3 cm size threshold for follow-up of simple cysts in postmenopausal women. Materials and methods Radiology information system was retrospectively queried for “US pelvis complete” over 8 years in women > 50 years, with keywords ovarian cyst, adnexal cyst, ovarian mass, cystic mass, cystic neoplasm, ovarian neoplasm, and ovarian mass. Premenopausal women were excluded. Cysts, were classified as ≤ 1 cm, 1–3 cm, 3–5 cm, and ≥ 7 cm. Largest cysts on each ovary was recorded. EMR and imaging archives were reviewed for assessing size, stability duration, and surgical records. Descriptive statistics and confidence interval were performed. Results 4388 patients met the initial search criteria. 919 cysts in 896 women (age: 50–91 years, mean: 61.5 years) were identified. We found 162 cysts ≤ 1 cm, 352 1–3 cm, 296 3–7 cm , and 51 ≥ 7 cm cysts. 127 patients with 1–3 cm cysts had no follow-up. Final analysis of 225 1–3 cm cysts included 203 ovarian and 22 paraovarian cysts (average size = 1.95 cm (1.1–3.0 cm)). 103 ovarian cysts had less than 2 years, and 100 cysts had more than 2 years follow-up. All except one ovarian cyst were stable for the entire duration of their follow-up (Mean duration of follow-up 5.4 years) (0.3%, 95% CI 0.0–0.05). 40 cysts resolved. One simple cyst increased in size (followed over 3.25 years) without suspicious imaging features and benign on surgery. Conclusion 1–3 cm cysts represented the most common size range (> 40%) in postmenopausal women, majority of which are stable over follow-up with benign outcome. 3 cm size threshold is appropriate for simple cyst follow-up in postmenopausal women.