Transformer models have demonstrated the capability to produce highly accurate segmentation of organs and tumors. However, model training requires high-quality curated datasets to ensure robust generalization to unseen datasets. Hence, we developed an artificial intelligence (AI) guided approach to assist with radiologist tumor delineation of partially segmented computed tomography datasets containing primary (adnexa) tumors and metastatic (omental) implants. AI guidance was implemented by training a 2D multiple resolution residual network trained with a dataset of 245 contrast-enhanced CTs with partially segmented examples. The same dataset curated through AI guidance was then used to refine two pretrained transformer models called SMIT and Swin UNETR. The models were independently tested on 71 publicly available multi-institutional 3D CT datasets. Segmentation accuracy was computed using the Dice similarity coefficient metric (DSC), average symmetric surface distance (ASSD), and the relative volume difference (RVD) metrics. Radiomic features reproducibility was assessed using the concordance correlation coefficient (CCC). Training with AI-guided segmentations significantly improved the accuracy of both SMIT (p = 6.2e-5) and Swin UNETR (p = 2e-4) models compared with using a partially delineated training dataset. Furthermore, SMIT-generated segmentations resulted in more reproducible features compared to Swin UNETR under multiple feature categories. Our results show that AI-guided data curation provides a more efficient approach to train AI models and that AI-generated segmentations can provide reproducible radiomics features.

This review provides a practical approach to the imaging evaluation of patients with cervical cancer (CC), from initial diagnosis to restaging of recurrence, focusing on MRI and FDG PET. The primary updates to the International Federation of Gynecology and Obstetrics (FIGO) CC staging system, as well as these updates' relevance to clinical management, are discussed. The recent literature investigating the role of MRI and FDG PET in CC staging and image-guided brachytherapy is summarized. The utility of MRI and FDG PET in response assessment and posttreatment surveillance is described. Important findings on MRI and FDG PET that interpreting radiologists should recognize and report are illustrated. The essential elements of structured reports during various phases of CC management are outlined. Special considerations, including the role of imaging in patients desiring fertility-sparing management, differentiation of CC and endometrial cancer, and unusual CC histologies, are also described. Finally, future research directions including PET/MRI, novel PET tracers, and artificial intelligence applications are highlighted.

Patients with high-grade serous ovarian cancer suffer poor prognosis and variable response to treatment. Known prognostic factors for this disease include homologous recombination deficiency status, age, pathological stage and residual disease status after debulking surgery. Recent work has highlighted important prognostic information captured in computed tomography and histopathological specimens, which can be exploited through machine learning. However, little is known about the capacity of combining features from these disparate sources to improve prediction of treatment response. Here, we assembled a multimodal dataset of 444 patients with primarily late-stage high-grade serous ovarian cancer and discovered quantitative features, such as tumor nuclear size on staining with hematoxylin and eosin and omental texture on contrast-enhanced computed tomography, associated with prognosis. We found that these features contributed complementary prognostic information relative to one another and clinicogenomic features. By fusing histopathological, radiologic and clinicogenomic machine-learning models, we demonstrate a promising path toward improved risk stratification of patients with cancer through multimodal data integration.

A key advantage of cardiac magnetic resonance (CMR) imaging over other cardiac imaging modalities is the ability to perform detailed tissue characterization. CMR techniques continue to evolve, with advanced imaging sequences being developed to provide a reproducible, quantitative method of tissue interrogation. The T-1 mapping technique, a pixel-by-pixel method of quantifying T-1 relaxation time of soft tissues, has been shown to be promising for characterization of diseased myocardium in a wide variety of cardiomyopathies. In this review, we describe the basic principles and common techniques for T-1 mapping and its use for native T-1, postcontrast T-1, and extracellular volume mapping. We will review a wide range of clinical applications of the technique that can be used for identification and quantification of myocardial edema, fibrosis, and infiltrative diseases with illustrative clinical examples. In addition, we will explore the current limitations of the technique and describe some areas of ongoing development. Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2019.

PURPOSE:To investigate the feasibility of accelerating prostate diffusion-weighted imaging (DWI) by reducing the number of acquired averages and denoising the resulting image using a proposed guided denoising convolutional neural network (DnCNN).MATERIALS AND METHODS:Raw data from the prostate DWI scans were retrospectively gathered between July 2018 and July 2019 from six single-vendor MRI scanners. There were 103 datasets used for training (median age, 64 years; interquartile range [IQR], 11), 15 for validation (median age, 68 years; IQR, 12), and 37 for testing (median age, 64 years; IQR, 12). High b-value diffusion-weighted (hb DW) data were reconstructed into noisy images using two averages and reference images using all 16 averages. A conventional DnCNN was modified into a guided DnCNN, which uses the low b-value DW image as a guidance input. Quantitative and qualitative reader evaluations were performed on the denoised hb DW images. A cumulative link mixed regression model was used to compare the readers' scores. The agreement between the apparent diffusion coefficient (ADC) maps (denoised vs reference) was analyzed using Bland-Altman analysis.RESULTS:Compared with the original DnCNN, the guided DnCNN produced denoised hb DW images with higher peak signal-to-noise ratio (32.79 ± 3.64 [standard deviation] vs 33.74 ± 3.64), higher structural similarity index (0.92 ± 0.05 vs 0.93 ± 0.04), and lower normalized mean square error (3.9% ± 10 vs 1.6% ± 1.5) (P < .001 for all). Compared with the reference images, the denoised images received higher image quality scores from the readers (P < .0001). The ADC values based on the denoised hb DW images were in good agreement with the reference ADC values (mean ADC difference ranged from -0.04 to 0.02 × 10-3 mm2/sec).CONCLUSION:Accelerating prostate DWI by reducing the number of acquired averages and denoising the resulting image using the proposed guided DnCNN is technically feasible. Supplemental material is available for this article. © RSNA, 2020.

Objectives: The International Association for the Study of Lung Cancer, American Thoracic Society and European Respiratory Society lung adenocarcinoma classification in 2011 defined three lepidic predominant patterns including adenocarcinoma in situ, minimally invasive adenocarcinoma and lepidic predominant adenocarcinoma. We sought to correlate the radiology and pathology findings and identify any computed tomography (CT) features which can be associated with invasive growth. Materials and methods: An institutional review board approved, retrospective study was conducted evaluating 63 patients with resected, pathologically confirmed, adenocarcinomas with predominant lepidic patterns. Preoperative CT images of the nodules were assessed using quantitative and qualitative radiographic descriptors while blinded to pathologic sub-classification and size. Maximum diameter was measured after evaluation of the axial, sagittal and coronal planes. Radiologic - pathologic associations were examined using Fisher's exact test, the Kruskal-Wallis test and the Spearman correlation coefficient (rho). Results and conclusion: Increasing maximum diameter of the whole lesion (ground glass and solid component) on CT was significantly associated with invasiveness (p = .003), as was the maximum pathologic specimen diameter (p = .008). Larger diameter of the solid component on CT was also found in lepidic predominant adenocarcinoma compared to minimally invasive adenocarcinoma (median 10.5 vs 2 mm, p = .005). More invasive tumors had higher visual estimated percentage solid component compared to whole lesion measurement on CT (p = .014). CT and pathologic measurements were positively correlated, although only moderately (rho = .66) for the maximum whole lesion size and fair (rho = .49) for solid/invasive component maximum measurements. Larger whole lesion size and solid component size of lepidic predominant pattern adenocarcinomas are associated with lesion invasiveness, although radiologic and pathologic lesion measurements are only fair-moderately positively correlated.

On computed tomography (CT), intrahepatic cholangiocarcinomas (ICC) are a visibly heterogeneous group of tumors. The purpose of this study was to investigate the associations between CT imaging phenotypes, patient survival, and known genetic markers.

OBJECTIVEThe purpose of this article is to discuss the role of the radiologist in the treatment of peritoneal cancer, with focus placed on advanced treatment options and selection of patients with resectable disease for whom complete cytoreduction can be achieved.CONCLUSIONPeritoneal cancers traditionally have been associated with significant morbidity and universal mortality; however, the management of such cancers has evolved substantially. Advanced treatment options, including cytoreductive surgery and intraperitoneal chemotherapy, are associated with significantly improved long-term patient survival. To ensure that patients benefit from aggressive multimodality treatments, the radiologist plays a pivotal role in the multidisciplinary team to ensure careful patient selection, identifying individuals with resectable disease for whom complete cytoreduction can be achieved.

A 32-year-old primiparous woman presented with severe abdominal pain at 21 weeks' gestation. Background history of laparoscopy for chronic pelvic pain and a spontaneous miscarriage was noted. On examination, she was peritonitic and tachycardic with low grade fever and anemia. MRI abdomen demonstrated a uterine rupture with a large cap of clotted blood overlying the uterine fundus with the appearance of a "shower cap" and large volume haemoperitoneum, the presumptive diagnosis was uterine rupture with placental extrusion. Emergency laparotomy confirmed a two litre haemoperitoneum due to a 3cm defect at the uterine fundus through which a portion of placenta and membrane were extruding. Hysterotomy and delivery of the non-viable fetus was performed. The defect was repaired. It is important to remember that there are many causes of acute abdominal pain in pregnant patients, obstetric and other. Uterine rupture is a rare but life-threatening cause. An underlying risk factor is usually identified.

In recent years, multidisciplinary meetings (MDMs) have become the standard of patient care in oncologic and other speciality care pathways. The number, complexity, and diverse source of imaging studies presented continue to expand rapidly. True multidisciplinary input requires parallel support from other colleagues and diagnostic services. It is now recognised that this is the appropriate forum for key decision making and education in care algorithms, though service plans make little or no accommodation of their expanding role in addition to existing services.

Patients with inflammatory bowel disease (IBD) have an increased risk of developing malignancy. The use of immunosuppressive therapies and tumour necrosis factor (TNF) inhibitors in these patients may provide a further risk for the development of malignancy. We report the clinical and pathological findings of a high grade osteosarcoma in a patient with Crohns disease receiving TNF inhibitor therapy. In this case, a 32-year old female presented with a painful right knee after receiving maintenance adalimumab for Crohns disease for a period of six years. There is a substantial hypothetical link between TNF inhibitor regimens such as adalimumab and an increased risk of malignancy. TNF inhibitor therapy should be ceased and chemotherapy and surgery is an effective combined modality approach in these patients. The role of TNF inhibitors in patients after cancer diagnosis is uncertain and further research is required to assess efficacy and safety.

Methicillin-resistant Staphylococcus aureus (MRSA) is endemic in many hospitals worldwide and is a common cause of serious infection.1Boucher H.W. Corey G.R. Epidemiology of methicillin-resistant Staphylococcus aureus.Clin Infect Dis. 2008; 46: S344-S349Crossref PubMed Scopus (605) Google Scholar, 2Klevens R.M. Morrison M.A. Nadle J. Petit S. Gerschman K. Ray S. Invasive methicilin-resistant Staphylococcus aureus infections in the United States.JAMA. 2007; 298: 1763-1771Crossref PubMed Scopus (2702) Google Scholar It is associated with significant morbidity and mortality as well as increased health care costs.3Gould I.M. Reilly J. Bunyan D. Walker A. Costs of healthcare-associated methicillin-resistant Staphylococcus aureus and its control.Clin Microbiol Infect. 2010; 16: 1721-1728Crossref PubMed Scopus (62) Google Scholar Interventions used to prevent and control rates of colonization and infection include screening.4Muto C.A. Jernigan J.A. Ostrowsky B.E. Richet H.M. Jarvis W.R. Boyce J.M. et al.SHEA guideline for preventing nosocomial transmission of multidrug-resistant strains of Staphylococcus aureus and Enterococcus.Infect Control Hosp Epidemiol. 2003; 24: 362-386Crossref PubMed Scopus (1098) Google Scholar It is important to identify risk factors for MRSA in order to stratify patients who should be screened. However, the completeness and effectiveness of screening policies themselves also need to be reviewed.We read with interest the recently published articles by Kutlu et al and Gomes et al regarding the prevalence and risk factors for MRSA in a diabetic outpatient population in Turkey and at a tertiary referral center in Philadelphia, respectively.5Kutlu S.S. Cevahir N. Akalin S. Akin F. Caylak S.D. Bastemir M. et al.Prevalence and risk factors for methicillin-resistant Staphylococcus aureus colonization in a diabetic outpatient population: a prospective cohort study.Am J Infect Control. 2012; 40: 365-368Abstract Full Text Full Text PDF PubMed Scopus (21) Google Scholar, 6Gomes S. Altafi S. Garcia K.M. Emery C.L. Hamilton R. Brooks A.D. et al.Occurrence of and risk factors for methicillin-resistant Staphylococcus aureus at a teaching hospital in Philadelphia.Am J Infect Control. 2012; 40: 381-383Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar Both studies attempted to define in their population those patients most at risk for colonization and infection in order to inform targeted screening. Early identification of MRSA-positive patients is a critical component of prevention and control strategies.We previously assessed the impact of rapid testing on compliance with screening and the use of isolation facilities in our own institution.7Creamer E. Dolan A. Sherlock O. Thomas T. Walsh J. Moore J. et al.The effect of rapid screening for methicillin-resistant Staphylococcus aureus (MRSA) on the identification and earlier isolation of MRSA-positive patients.Infect Control Hosp Epidemiol. 2010; 31: 374-381Crossref PubMed Scopus (31) Google Scholar The use of polymerase chain reaction significantly increased the numbers of patients who should be screened from 73% to 90% and reduced the need for pre-emptive isolation pending the results of culture. We recently reviewed what has occurred since that study to determine what proportion of at-risk patients is being screened and how soon after hospital admission the screening is carried out.Our hospital is an 800-bed tertiary referral center where admission screening for MRSA is recommended for at-risk patients including those patients with a previous documented history of MRSA; an overnight admission to an acute hospital within the last 18 months; any chronic skin condition or documented broken skin, including wounds and ulcers; and, finally, patients with any documented long-term external medical devices, such as a urinary catheter. During the first quarter of 2012, 272 admissions on 2 medical and 2 surgical wards were reviewed. Seventy-four percent of all patients admitted had risk factors for MRSA, but only 38% were screened. Of these, 52% were screened 3 days or more after admission. Six percent were colonized with MRSA, but only 56% of these had been pre-emptively isolated largely because of the limited availability of isolation rooms within our hospital. The average time to isolation—from verification of the positive result and verbal notification from the infection prevention and control team—was 39 hours (5-81 hours) for those who were not pre-emptively isolated.Although we have a policy that mandates admission screening, less than half of at-risk patients were screened with delays in the isolation of positive patients. Although we think that it is important to identify risk factors for colonization with MRSA, screening policies and procedures themselves also need to be critically evaluated and complied with in a bid to further reduce our rates of MRSA. Efforts are underway to improve compliance with hospital policies on MRSA screening. The poor compliance may be due in part to the decline in bloodstream infection caused by MRSA in the United Kingdom and Ireland, leading to a perception that MRSA prevention measures may no longer be as important, especially on busy acute hospital wards.Screening detects MRSA-positive patients, thus leading to the opportunity to decolonize, which is effective in certain categories of patients such as those on renal dialysis and those about to undergo certain types of surgery.8Simor A.E. Staphylococcal decolonisation: an effective strategy for prevention of infection?.Lancet Infect Dis. 2011; 11: 952-962Abstract Full Text Full Text PDF PubMed Scopus (75) Google Scholar Consequently, there needs to be more emphasis on whether what should be done is being done, as well as identifying at-risk patients locally, because otherwise poor compliance with best practice undermines MRSA prevention and control measures. Methicillin-resistant Staphylococcus aureus (MRSA) is endemic in many hospitals worldwide and is a common cause of serious infection.1Boucher H.W. Corey G.R. Epidemiology of methicillin-resistant Staphylococcus aureus.Clin Infect Dis. 2008; 46: S344-S349Crossref PubMed Scopus (605) Google Scholar, 2Klevens R.M. Morrison M.A. Nadle J. Petit S. Gerschman K. Ray S. Invasive methicilin-resistant Staphylococcus aureus infections in the United States.JAMA. 2007; 298: 1763-1771Crossref PubMed Scopus (2702) Google Scholar It is associated with significant morbidity and mortality as well as increased health care costs.3Gould I.M. Reilly J. Bunyan D. Walker A. Costs of healthcare-associated methicillin-resistant Staphylococcus aureus and its control.Clin Microbiol Infect. 2010; 16: 1721-1728Crossref PubMed Scopus (62) Google Scholar Interventions used to prevent and control rates of colonization and infection include screening.4Muto C.A. Jernigan J.A. Ostrowsky B.E. Richet H.M. Jarvis W.R. Boyce J.M. et al.SHEA guideline for preventing nosocomial transmission of multidrug-resistant strains of Staphylococcus aureus and Enterococcus.Infect Control Hosp Epidemiol. 2003; 24: 362-386Crossref PubMed Scopus (1098) Google Scholar It is important to identify risk factors for MRSA in order to stratify patients who should be screened. However, the completeness and effectiveness of screening policies themselves also need to be reviewed. We read with interest the recently published articles by Kutlu et al and Gomes et al regarding the prevalence and risk factors for MRSA in a diabetic outpatient population in Turkey and at a tertiary referral center in Philadelphia, respectively.5Kutlu S.S. Cevahir N. Akalin S. Akin F. Caylak S.D. Bastemir M. et al.Prevalence and risk factors for methicillin-resistant Staphylococcus aureus colonization in a diabetic outpatient population: a prospective cohort study.Am J Infect Control. 2012; 40: 365-368Abstract Full Text Full Text PDF PubMed Scopus (21) Google Scholar, 6Gomes S. Altafi S. Garcia K.M. Emery C.L. Hamilton R. Brooks A.D. et al.Occurrence of and risk factors for methicillin-resistant Staphylococcus aureus at a teaching hospital in Philadelphia.Am J Infect Control. 2012; 40: 381-383Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar Both studies attempted to define in their population those patients most at risk for colonization and infection in order to inform targeted screening. Early identification of MRSA-positive patients is a critical component of prevention and control strategies. We previously assessed the impact of rapid testing on compliance with screening and the use of isolation facilities in our own institution.7Creamer E. Dolan A. Sherlock O. Thomas T. Walsh J. Moore J. et al.The effect of rapid screening for methicillin-resistant Staphylococcus aureus (MRSA) on the identification and earlier isolation of MRSA-positive patients.Infect Control Hosp Epidemiol. 2010; 31: 374-381Crossref PubMed Scopus (31) Google Scholar The use of polymerase chain reaction significantly increased the numbers of patients who should be screened from 73% to 90% and reduced the need for pre-emptive isolation pending the results of culture. We recently reviewed what has occurred since that study to determine what proportion of at-risk patients is being screened and how soon after hospital admission the screening is carried out. Our hospital is an 800-bed tertiary referral center where admission screening for MRSA is recommended for at-risk patients including those patients with a previous documented history of MRSA; an overnight admission to an acute hospital within the last 18 months; any chronic skin condition or documented broken skin, including wounds and ulcers; and, finally, patients with any documented long-term external medical devices, such as a urinary catheter. During the first quarter of 2012, 272 admissions on 2 medical and 2 surgical wards were reviewed. Seventy-four percent of all patients admitted had risk factors for MRSA, but only 38% were screened. Of these, 52% were screened 3 days or more after admission. Six percent were colonized with MRSA, but only 56% of these had been pre-emptively isolated largely because of the limited availability of isolation rooms within our hospital. The average time to isolation—from verification of the positive result and verbal notification from the infection prevention and control team—was 39 hours (5-81 hours) for those who were not pre-emptively isolated. Although we have a policy that mandates admission screening, less than half of at-risk patients were screened with delays in the isolation of positive patients. Although we think that it is important to identify risk factors for colonization with MRSA, screening policies and procedures themselves also need to be critically evaluated and complied with in a bid to further reduce our rates of MRSA. Efforts are underway to improve compliance with hospital policies on MRSA screening. The poor compliance may be due in part to the decline in bloodstream infection caused by MRSA in the United Kingdom and Ireland, leading to a perception that MRSA prevention measures may no longer be as important, especially on busy acute hospital wards. Screening detects MRSA-positive patients, thus leading to the opportunity to decolonize, which is effective in certain categories of patients such as those on renal dialysis and those about to undergo certain types of surgery.8Simor A.E. Staphylococcal decolonisation: an effective strategy for prevention of infection?.Lancet Infect Dis. 2011; 11: 952-962Abstract Full Text Full Text PDF PubMed Scopus (75) Google Scholar Consequently, there needs to be more emphasis on whether what should be done is being done, as well as identifying at-risk patients locally, because otherwise poor compliance with best practice undermines MRSA prevention and control measures. Prevalence and risk factors for methicillin-resistant Staphylococcus aureus colonization in a diabetic outpatient population: A prospective cohort studyAmerican Journal of Infection ControlVol. 40Issue 4PreviewDiabetes mellitus is a risk factor for methicillin-resistant Staphylococcus aureus (MRSA) colonization and infection. We attempted to determine the prevalence and risk factors for MRSA colonization in a population of outpatients with diabetes. Full-Text PDF Occurrence of and risk factors for methicillin-resistant Staphylococcus aureus at a teaching hospital in PhiladelphiaAmerican Journal of Infection ControlVol. 40Issue 4PreviewManual medical record mining and data analysis were performed at a tertiary care university teaching hospital to establish the rate of occurrence of and risk factors for infection with methicillin-resistant Staphylococcus aureus (MRSA). Patients with surgical site infections had the highest rate of MRSA infection, representing 59% of the MRSA infections recorded. The mortality rate in patients with relapsed MRSA was 45% (13 of 30), compared with no deaths in 149 new MRSA cases. The majority of deaths in patients with relapsed MRSA occurred in the intensive care unit. Full-Text PDF Institutional MRSA screening practice and policiesAmerican Journal of Infection ControlVol. 40Issue 9PreviewWe thank the authors for their response to the published articles and additional data regarding methicillin-resistant Staphylococcus aureus (MRSA) infections at their institution and referencing our research article.1-4 MRSA is certainly endemic in many hospitals from many countries. Effective screening and treatment measures are advisable for decontamination of hospitalized patients. Often adopting long-term strategies is required for active MRSA surveillance and rapid MRSA disease diagnosis so that health care systems can be alerted to endemic situations. Full-Text PDF