Urinary bladder diverticula are common and are frequently incidentally discovered. Many downstream complications can occur due to urinary stasis, such as bladder diverticular stones, infection, and malignancy. Understanding the physiology of bladder diverticula and potential pitfalls and mimics is critical to an accurate description of bladder diverticula and early detection of potential downstream complications. This pictorial review will first review the normal bladder histology and function, bladder diverticular types, and typical imaging features. The paper will then draw attention to technical pitfalls and potential mimics. Finally, we will review the downstream complications, including stones, infection, malignancy, and BCG-related changes.

The slide presentation demonstrates an approach to body MRI for common indications in the abdomen and pelvis, incorporating clinical information, knowledge of imaging patterns, and various scoring paradigms.

HomeRadioGraphicsVol. 44, No. 3 PreviousNext Genitourinary ImagingInvited Commentary: VI-RADS and Routing Patient Care at the Muscularis PropriaMark J. Hoegger Mark J. Hoegger Author AffiliationsFrom the Mallinckrodt Institute of Radiology, Washington University, 510 S Kingshighway Blvd, Box 8131, St Louis, MO 63110.Address correspondence to the author (email: [email protected]).Mark J. Hoegger Published Online:Feb 29 2024https://doi.org/10.1148/rg.230234See also the article by Fávero Prietto dos Santos et al in this issue.MoreSectionsFull textPDF ToolsAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookXLinked In References1. Fávero Prietto dos Santos J, Almeida Ghezzi CL, Pedrollo IM, et al. Practical guide to VI-RADS: MRI protocols, lesion characterization, and pitfalls. RadioGraphics 2024;44(3):e230149. Link, Google Scholar2. Naselli A, Hurle R, Paparella S, et al. Role of Restaging Transurethral Resection for T1 Non-muscle Invasive Bladder Cancer: A Systematic Review and Meta-analysis. Eur Urol Focus 2018;4(4):558–567. Crossref, Medline, Google Scholar3. Panebianco V, Narumi Y, Altun E, et al. Multiparametric Magnetic Resonance Imaging for Bladder Cancer: Development of VI-RADS (Vesical Imaging-Reporting And Data System). Eur Urol 2018;74(3):294–306. Crossref, Medline, Google Scholar4. Wang H, Luo C, Zhang F, et al. Multiparametric MRI for Bladder Cancer: Validation of VI-RADS for the Detection of Detrusor Muscle Invasion. Radiology 2019;291(3):668–674. Link, Google Scholar5. Feng Y, Zhong K, Chen R, Zhou W. Diagnostic accuracy of vesical imaging-reporting and data system (VI-RADS) for the detection of muscle-invasive bladder cancer: a meta-analysis. Abdom Radiol (NY) 2022;47(4):1396–1405. Crossref, Medline, Google Scholar6. Kim SH, Han JH, Jeong S-H, et al. Accuracy of actual stage prediction using Vesical Imaging Reporting and Data System (VI-RADS) before radical cystectomy for urothelial carcinoma in SUPER-UC-Cx. Transl Androl Urol 2023;12(2):168–175. Crossref, Medline, Google Scholar7. Panebianco V, Briganti A, Boellaard TN, et al. Clinical application of bladder MRI and the Vesical Imaging-Reporting And Data System. Nat Rev Urol 2023. https://doi.org/10.1038/s41585-023-00830-2. Published online November 30, 2023. https://doi.org/10.1038/s41585-023-00830-2. Crossref, Medline, Google Scholar8. Davenport MS, Chatfield M, Hoang J, et al. ACR-RADS Programs Current State and Future Opportunities: Defining a Governance Structure to Enable Sustained Success. J Am Coll Radiol 2022;19(6):782–791. Crossref, Medline, Google ScholarArticle HistoryReceived: Dec 3 2023Accepted: Dec 11 2023Published online: Feb 29 2024 FiguresReferencesRelatedDetailsAccompanying This ArticlePractical Guide to VI-RADS: MRI Protocols, Lesion Characterization, and PitfallsFeb 29 2024RadioGraphicsRecommended Articles Multiparametric MRI for Bladder Cancer: Validation of VI-RADS for the Detection of Detrusor Muscle InvasionRadiology2019Volume: 291Issue: 3pp. 668-674Practical Guide to VI-RADS: MRI Protocols, Lesion Characterization, and PitfallsRadioGraphics2024Volume: 44Issue: 3Multiparametric MRI Evaluation of VI-RADS for Bladder Tumors Located at the Ureteral OrificeRadiology2022Volume: 304Issue: 3pp. 593-599Follow the Stream: Imaging of Urinary DiversionsRadioGraphics2016Volume: 36Issue: 3pp. 688-709Squamous Cell Carcinoma of the Bladder Complicating Schistosomiasis: AIRP Best Cases in Radiologic-Pathologic CorrelationRadioGraphics2017Volume: 37Issue: 2pp. 500-504See More RSNA Education Exhibits VIRADS In Bladder Cancer - A Practical ApproachDigital Posters2021Don't Be Outscored - A Practical Guide to VI-RADS, Including DifferentialsDigital Posters2022VI-RADS Made Easy: An Illustrative Practical Guide Digital Posters2020 RSNA Case Collection Carcinoid of the Ileal NeobladderRSNA Case Collection2022Patent vesicourachal diverticulumRSNA Case Collection2022Bilateral UreterolithiasisRSNA Case Collection2021 Vol. 44, No. 3 Abbreviations Abbreviations: RADS reporting and data systems VI-RADS Vesical Imaging Reporting and Data System Metrics Altmetric Score PDF download

Eliciting broad and durable antibody responses against rapidly evolving pathogens like influenza viruses remains a formidable challenge1,2. The germinal center (GC) reaction enables the immune system to generate broad, high-affinity, and durable antibody responses to vaccination3-5. mRNA-based severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccines induce persistent GC B cell responses in humans6-9. Whether an mRNA-based influenza vaccine could induce a superior GC response in humans compared to the conventional inactivated influenza virus vaccine remains unclear. We assessed B cell responses in peripheral blood and draining lymph nodes in cohorts receiving the inactivated or mRNA-based quadrivalent seasonal influenza vaccine. Participants receiving the mRNA-based vaccine produced more robust plasmablast responses and higher antibody titers to H1N1 and H3N2 influenza A viruses and comparable antibody titers against influenza B virus strains. Importantly, mRNA-based vaccination stimulated robust recall B cell responses characterized by sustained GC reactions that lasted at least 26 weeks post-vaccination in three of six participants analyzed. In addition to promoting the maturation of responding B cell clones, these sustained GC reactions resulted in enhanced engagement of low-frequency pre-existing memory B cells, expanding the landscape of vaccine-elicited B cell clones. This translated to expansion of the serological repertoire and increased breadth of serum antibody responses. These findings reveal an important role for the induction of persistent GC responses to influenza vaccination in humans to broaden the repertoire of vaccine-induced antibodies.

Obtaining diagnostic-quality magnetic resonance imaging (MRI) of the abdomen in critically ill patients can be difficult due to challenges with breath-holding and the inability to follow technologist instructions. Protocols that harness advances in commercially available MRI techniques provide a potential solution, particularly using the golden radial angle sparse parallel (GRASP) technique for dynamic post-contrast T1-weighted imaging. The GRASP technique uses a combination of free-breathing, a stack-of-stars radial acquisition, and compressed sensing reconstruction acquired over several minutes to produce motion-free images at time points defined by the user; these include the non-contrast, arterial, venous, and delayed images, which are typical of abdominal MRI protocols. The three cases discussed herein illustrate the use of this technique in providing both exquisite image quality and diagnostic value in the care of critically ill patients with hepatopancreaticobiliary diseases. Our work aims to raise awareness of this technique and its utility in imaging patients who cannot hold their breath for dynamic T1-weighted post-contrast imaging.

Rationale and objectivesThe purpose of this study is to summarize a survey of radiology chief residents focused on 3D printing in radiology.Materials and methodsAn online survey was distributed to chief residents in North American radiology residencies by subgroups of the Association of University Radiologists. The survey included a subset of questions focused on the clinical use of 3D printing and perceptions of the role of 3D printing and radiology. Respondents were asked to define the role of 3D printing at their institution and asked about the potential role of clinical 3D printing in radiology and radiology residencies.Results152 individual responses from 90 programs were provided, with a 46% overall program response rate (n = 90/194 radiology residencies). Most programs had 3D printing at their institution (60%; n = 54/90 programs). Among the institutions that perform 3D printing, 33% (n = 18/54) have structured opportunities for resident contribution. Most residents (60%; n = 91/152 respondents) feel they would benefit from 3D printing exposure or educational material. 56% of residents (n = 84/151) believed clinical 3D printing should be centered in radiology departments. 22% of residents (n = 34/151) believed it would increase communication and improve relationships between radiology and surgery colleagues. A minority (5%; 7/151) believe 3D printing is too costly, time-consuming, or outside a radiologist's scope of practice.ConclusionsA majority of surveyed chief residents in accredited radiology residencies believe they would benefit from exposure to 3D printing in residency. 3D printing education and integration would be a valuable addition to current radiology residency program curricula.

Although immunotherapies that target CD20 on most non-Hodgkin lymphoma (NHL) cells have improved patient outcomes, current therapies are inadequate because many cases are, or become, refractory or undergo relapse. Here, we labelled the third-generation human anti-CD20 antibody ofatumumab with 177Lu, determined the in vitro characteristics of [177Lu]Lu-ofatumumab, estimated human dosimetry, and assayed tumor targeting and therapeutic efficacy in a murine model of disseminated NHL. Methods: CHX-A″-diethylenetriaminepentaacetic acid-[177Lu]Lu-ofatumumab was prepared. We evaluated radiochemical yield, purity, in vitro immunoreactivity, stability, (n = 7), affinity, and killing of CD20-expressing Raji cells (n = 3). Human dosimetry was estimated from biodistribution studies as percentage injected activity per gram using C57BL/6N mice. Tissue and organ biodistribution was determined in R2G2 immunodeficient mice with subcutaneous Raji-cell tumors. Therapy studies used R2G2 mice with disseminated human Raji-luc tumor cells (n = 10 mice/group). Four days after cell injection, the mice were left untreated or were treated with ofatumumab, 8.51 MBq of [177Lu]Lu-IgG, or 0.74 or 8.51 MBq of [177Lu]Lu-ofatumumab. Survival, weight, and bioluminescence were tracked. Results: Radiochemical yield was 93% ± 2%, radiochemical purity was 99% ± 1%, and specific activity was 401 ± 17 MBq/mg. Immunoreactivity was substantially preserved, and more than 75% of 177Lu remained chelated after 7 d in serum. [177Lu]Lu-ofatumumab specifically killed Raji-luc cells in vitro (P < 0.05). Dosimetry estimated that an effective dose for human administration is 0.36 mSv/MBq and that marrow may be the dose-limiting organ. Biodistribution in subcutaneous tumors 1, 3, and 7 d after [177Lu]Lu-ofatumumab injection was 11, 15, and 14 percentage injected activity per gram, respectively. In the therapy study, median survival of untreated mice was 19 d, not statistically different from mice treated with 8.51 MBq of [177Lu]Lu-IgG (25 d). Unlabeled ofatumumab increased survival to 46 d, similar to 0.74 MBq of [177Lu]Lu-ofatumumab (59 d), with both being superior to no treatment (P < 0.0003). Weight loss and increased tumor burden preceded death or killing of the animal for cause. In contrast, treatment with 8.51 MBq of [177Lu]Lu-ofatumumab dramatically increased median survival (>221 d), permitted weight gain, eliminated detectable tumors, and was curative in 9 of 10 mice. Conclusion: [177Lu]Lu-ofatumumab shows favorable in vitro characteristics, localizes to tumor, and demonstrates curative therapeutic efficacy in a disseminated lymphoma model, showing potential for clinical translation to treat NHL.

Small solid renal masses (SRMs) are frequently detected at imaging. Nearly 20% are benign, making careful evaluation with MRI an important consideration before deciding on management. Clear cell renal cell carcinoma (ccRCC) is the most common renal cell carcinoma subtype with potentially aggressive behavior. Thus, confident identification of ccRCC imaging features is a critical task for the radiologist. Imaging features distinguishing ccRCC from other benign and malignant renal masses are based on major features (T2 signal intensity, corticomedullary phase enhancement, and the presence of microscopic fat) and ancillary features (segmental enhancement inversion, arterial-to-delayed enhancement ratio, and diffusion restriction). The clear cell likelihood score (ccLS) system was recently devised to provide a standardized framework for categorizing SRMs, offering a Likert score of the likelihood of ccRCC ranging from 1 (very unlikely) to 5 (very likely). Alternative diagnoses based on imaging appearance are also suggested by the algorithm. Furthermore, the ccLS system aims to stratify which patients may or may not benefit from biopsy. The authors use case examples to guide the reader through the evaluation of major and ancillary MRI features of the ccLS algorithm for assigning a likelihood score to an SRM. The authors also discuss patient selection, imaging parameters, pitfalls, and areas for future development. The goal is for radiologists to be better equipped to guide management and improve shared decision making between the patient and treating physician. © RSNA, 2023 Quiz questions for this article are available in the supplemental material. See the invited commentary by Pedrosa in this issue.

Objective To assess the impact of photoacoustic imaging (PAI) on the assessment of ovarian/adnexal lesion(s) of different risk categories using the sonographic ovarian-adnexal imaging-reporting-data system (O-RADS) in women undergoing planned oophorectomy. Method This prospective study enrolled women with ovarian/adnexal lesion(s) suggestive of malignancy referred for oophorectomy. Participants underwent clinical ultrasound (US) examination followed by coregistered US and PAI prior to oophorectomy. Each ovarian/adnexal lesion was graded by two radiologists using the US O-RADS scale. PAI was used to compute relative total hemoglobin concentration (rHbT) and blood oxygenation saturation (%sO(2)) colormaps in the region of interest. Lesions were categorized by histopathology into malignant ovarian/adnexal lesion, malignant Fallopian tube only and several benign categories, in order to assess the impact of incorporating PAI in the assessment of risk of malignancy with O-RADS. Malignant and benign histologic groups were compared with respect to rHbT and %sO(2) and logistic regression models were developed based on tumor marker CA125 alone, US-based O-RADS alone, PAI-based rHbT with %sO(2), and the combination of CA125, O-RADS, rHbT and %sO(2). Areas under the receiver-operating-characteristics curve (AUC) were used to compare the diagnostic performance of the models. Results There were 93 lesions identified on imaging among 68 women (mean age, 52 (range, 21-79) years). Surgical pathology revealed 14 patients with malignant ovarian/adnexal lesion, two with malignant Fallopian tube only and 52 with benign findings. rHbT was significantly higher in malignant compared with benign lesions. %sO(2) was lower in malignant lesions, but the difference was not statistically significant for all benign categories. Feature analysis revealed that rHbT, CA125, O-RADS and %sO(2) were the most important predictors of malignancy. Logistic regression models revealed an AUC of 0.789 (95% CI, 0.626-0.953) for CA125 alone, AUC of 0.857 (95% CI, 0.733-0.981) for O-RADS only, AUC of 0.883 (95% CI, 0.760-1) for CA125 and O-RADS and an AUC of 0.900 (95% CI, 0.815-0.985) for rHbT and %sO(2) in the prediction of malignancy. A model utilizing all four predictors (CA125, O-RADS, rHbT and%sO(2)) achieved superior performance, with an AUC of 0.970 (95% CI, 0.932-1), sensitivity of 100% and specificity of 82%. Conclusions Incorporating the additional information provided by PAI-derived rHbT and %sO(2) improves significantly the performance of US-based O-RADS in the diagnosis of adnexal lesions. (c) 2023 International Society of Ultrasound in Obstetrics and Gynecology.

Background: To report the evaluation of incentive spirometry (IS)-induced pressure changes in intra-abdominal drainage catheters and consider its use for maintaining catheter patency and enhancing drainage. Methods: Prospective study of patients with indwelling intra-abdominal drainage catheters for abdominal fluid collections who had their intra-abdominal pressures measured while performing incentive spirometry. Patients were instructed in the use of an incentive spirometer. Within a week after initial drainage, pressure changes with IS were evaluated three times at 1500 cc and three times at maximum inspiratory effort. Intra-abdominal pressure (IAP) was measured using a pressure monitor connected to the drainage catheter. Results: Twenty patients (men, 12; women, 8). Fluid collection locations were pelvis, Right-upper quadrant (RUQ), Left-upper quadrant (LUQ), Left-lower quadrant (LLQ), and Right-lower quadrant (RLQ). A total of 16 of 20 patients showed an elevation of IAP with IS. At 1500 cc, the pressure increased by an average of 41.24 mmH(2)O. At maximal inspiratory effort, the pressure increased by an average of 48.26 mmH(2)O. Pressure increase was greater in upper abdomen catheters. Four patients with lower abdominal and pelvic collections showed minimal pressure changes with IS. Conclusion: IS increases IAP and fluid flow through abdominal drainage catheters. Future studies are warranted to determine whether the use of IS enhances catheter performance and facilitates drainage via its effect on IAP.

Rationale and objectives: An annual survey of chief residents in accredited North American radiology programs is conducted by the American Alliance of Academic Chief Residents in Radiology (A3CR2). The purpose of this study is to summarize the 2020 A3CR2 chief resident survey.Materials and methods: An online survey was distributed to chief residents from 194 Accreditation Council on Graduate Medical Education-accredited radiology residencies. Questions were designed to gather information about residency program practices, benefits, fellowship or advanced interventional radiology (IR) training choices, and the integration of IR training. Subsets of questions focused on the perception of corporatization, non-physician providers (NPPs), and artificial intelligence (AI) in radiology and their relationship to the radi-ology job market.Results: 174 individual responses from 94 programs were provided, yielding a 48 % program response rate. Extended emergency department coverage has steadily decreased over the last 5 years (2016-2020), however only 52 % of programs have independent overnight call (without attending coverage). Regarding the impact of new integrated IR residencies on training, 42 % indicated there was no appreciable impact on their DR or IR training, while 20 % indicated DR training for IR residents suffered and 19 % indicated IR training for DR residents suffered. Corporatization in radiology was perceived as the biggest potential threat to the future job market.Conclusions: Integration of IR residency did not detrimentally affect DR or IR training in most programs. Radi-ology resident perception of corporatization, NPPs, and AI may help residency programs shape educational content.

Background: Breast cancer is the most common non-cutaneous malignancy and the second leading cause of cancer mortality in the United States. Breast cancer is a heterogeneous disease; diagnosis at an early stage renders it potentially curable, whereas advanced metastatic disease carries a worse prognosis. Objectives: To investigate whether hepatic steatosis (HS) is associated with liver metastases in patients with newly diagnosed stage IV female breast cancer patients (either de novo metastatic breast cancer or recurrent metastatic breast cancer) using non-contrast computed tomography (CT) as a marker of HS. Design: Retrospective analysis. Methods: We retrospectively identified 168 patients with stage IV breast cancer with suitable imaging from a prospectively maintained oncologic database. Three radiologists manually defined hepatic regions of interest on non-contrast CT images, and attenuation data were extracted. HS was defined as a mean attenuation <48 Hounsfield units. The frequency of hepatic metastatic disease was calculated for patient with and without HS. Relationships between HS and various patient (age, body mass index, race) and tumor (hormone receptor status, HER2 status, tumor grade) characteristics were also analyzed. Results: There were 4 patients with liver metastasis in the HS group (41 patients) versus 20 patients with liver metastases in the non-HS group (127 patients). The difference in frequencies of liver metastases among patients with (9.8%) versus without (15.7%) hepatic steatosis (odds ratio = 1.72 [0.53-7.39]) was not statistically significant (P = .45). Body mass index was significantly higher (P = .01) among patients with hepatic steatosis (32.2 ± 7.3 vs 28.8 ± 7.1 kg/m2). Otherwise, there were no significant differences between patients with versus without HS with respect to regarding age, race, hormone receptor status, HER2 status, or tumor grade. Conclusion: The frequency of hepatic metastatic disease in patients with stage IV breast cancer is similar for steatotic and non-steatotic livers.

Purpose The effect of obesity in penetrating trauma outcomes is poorly understood. The purpose of this study was to determine if there is a protective effect of subcutaneous or visceral fat from stab and gunshot wounds.Methods 443 patients admitted after penetrating traumatic injury of the torso were retrospectively identified from our institution’s trauma registry. CT scans performed at presentation were used to determine cross-sectional area of visceral and subcutaneous fat at the level of the umbilicus via manual segmentation. Obesity-associated parameters including body mass index, visceral and subcutaneous fat were compared with injury severity score, length of hospital/intesive care unit (ICU) stay, and number of operating room (OR) visits. Parameters were compared between patients who sustained stab wounds versus gunshot injuries.Results Comparing all patients with gunshot injuries with those with stab injuries, gunshots resulted in increased hospital and ICU length of stay, and injury severity score (ISS). For patients with gunshot wounds, all obesity-related parameters correlated with increased length of stay and total ICU stay; subcutaneous fat and visceral fat were correlated with increased OR visits, but there was no significant correlation between obesity-related parameters and ISS. In contrast, with stab wounds there were no statistically significant associations between obesity parameters and any of the outcome measures.Conclusion For penetrating trauma in the torso, obesity is correlated with worse outcomes with gunshot injuries but not in stab injuries.Level of evidence Level III, prognostic and epidemiological.

HomeRadioGraphicsVol. 43, No. 2 PreviousNext Gastrointestinal ImagingRadiographics FundamentalsFundamentals of Small Bowel Imaging: What Radiology Residents Should KnowAnup S. Shetty , Anup Bhattacharya, Katerina Konstantinoff, Scott Wilson-Flewelling, David H. Ballard, Mark J. Hoegger, Malak Itani, Vincent M. Mellnick, Mohamed Z. Rajput, Maria Zulfiqar, Dennis BalfeAnup S. Shetty , Anup Bhattacharya, Katerina Konstantinoff, Scott Wilson-Flewelling, David H. Ballard, Mark J. Hoegger, Malak Itani, Vincent M. Mellnick, Mohamed Z. Rajput, Maria Zulfiqar, Dennis BalfeAuthor AffiliationsFrom the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110.Address correspondence to A.S.S. (email: [email protected]).Anup S. Shetty Anup BhattacharyaKaterina KonstantinoffScott Wilson-FlewellingDavid H. BallardMark J. HoeggerMalak ItaniVincent M. MellnickMohamed Z. RajputMaria ZulfiqarDennis BalfePublished Online:Jan 12 2023https://doi.org/10.1148/rg.220094MoreSectionsFull textPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In AbstractA pattern-based approach to small bowel imaging can be useful in potentially narrowing the differential diagnosis and allowing the radiologist to offer a more useful impression.Suggested ReadingsGarzelli L, Nuzzo A, Copin P, et al. Contrast-Enhanced CT for the Diagnosis of Acute Mesenteric Ischemia. AJR Am J Roentgenol 2020;215(1):29–38. Crossref, Medline, Google ScholarGuglielmo FF, Wells ML, Bruining DH, et al. Gastrointestinal Bleeding at CT Angiography and CT Enterography: Imaging Atlas and Glossary of Terms. RadioGraphics 2021;41(6):1632–1656. Link, Google ScholarHa HK, Lee SH, Rha SE, et al. Radiologic features of vasculitis involving the gastrointestinal tract. RadioGraphics 2000;20(3):779–794. Link, Google ScholarJasti R, Carucci LR. Small Bowel Neoplasms: A Pictorial Review. RadioGraphics 2020;40(4):1020–1038. Link, Google ScholarLevine MS, Rubesin SE, Laufer I. Pattern approach for diseases of mesenteric small bowel on barium studies. Radiology 2008;249(2):445–460. Link, Google ScholarMacari M, Megibow AJ, Balthazar EJ. A pattern approach to the abnormal small bowel: observations at MDCT and CT enterography. AJR Am J Roentgenol 2007;188(5):1344–1355. Crossref, Medline, Google ScholarMills A, Mellnick VM, Itani M. Imaging of Bowel Wall Thickening in the Hospitalized Patient. Radiol Clin North Am 2020;58(1):1–17. Crossref, Medline, Google ScholarSugi MD, Menias CO, Lubner MG, et al. CT Findings of Acute Small-Bowel Entities. RadioGraphics 2018;38(5):1352–1369. Link, Google ScholarWells ML, Hansel SL, Bruining DH, et al. CT for Evaluation of Acute Gastrointestinal Bleeding. RadioGraphics 2018;38(4):1089–1107. Link, Google ScholarArticle HistoryReceived: Apr 20 2022Revision requested: Mar 26 2022Revision received: June 2 2022Accepted: June 10 2022Published online: Jan 12 2023 FiguresReferencesRelatedDetailsAccompanying This ArticleFundamentals of Small Bowel Imaging: What Radiology Residents Should KnowJan 12 2023Default Digital Object SeriesRecommended Articles RSNA Education Exhibits RSNA Case Collection Vol. 43, No. 2 Slide PresentationMetrics Altmetric Score PDF download

Abstract Disclosure: S.A. Jacob: None. M. Itani: None. M.J. Hoegger: None. D. Ludwig: None. T. Pandian: None. T.C. Brown: None. L.M. Brunt: None. I. Bancos: None. N. Genere: None. Introduction: Adrenal mass incidence has increased tenfold over the last two decades, with most masses detected in individuals over 40 years of age. The majority of these adrenal masses are benign (>80%), and few are malignant (8%) or hormonally active (4%); most are incidentally detected. Studies suggest higher rates of hormonally active and malignant adrenal masses in younger patients, however, evidence for this age group is scarce. In two recent large cohort studies of adrenal masses, young adults (18-40 years) represented only 0.2-7.1% of individuals studied. This study aimed to characterize clinical, imaging, and biochemical presentation of young adults diagnosed with adrenal masses. Methods: This is a retrospective cohort study of young adults (18-40 years) with adrenal masses detected based on a radiology report text database search between January 2015 and December 2021 at a tertiary medical center. Exclusion criteria included pre-existing adrenal masses before 2015, hyperplasia, or masses <1cm. Images were reviewed by abdominal radiologists, and clinical data were obtained through review of electronic medical records. Results: A total of 255 young adults (56% women, 61% white) were diagnosed with adrenal masses with median age 35 (IQR 30-39) years. Genetic predisposition syndrome was present in 6%. Comorbidities included: BMI >30 kg/m2 in 48%, hypertension in 35%, and diabetes in 10%. Adrenal masses were detected incidentally in 72% and during cancer staging in 16%. Median mass size was 1.9cm (IQR 1.4-2.7cm) and 49% (39/79) were lipid poor (Hounsfield units >10). Only 22% of patients underwent hormonal evaluation. Final diagnoses included 16% malignancy, 9% benign adenoma with overt hormone excess, 40% benign adenoma with incomplete hormonal evaluation and 24% radiographically indeterminate masses. Subgroup analysis showed that adrenal masses in those <30 years old compared to 31-40 year-olds were more frequently associated with tumor predisposition syndrome (15% vs 3%, p<0.01) and more often lipid poor (76% vs 40%, p<0.01); but, no differences in frequency of malignancy or overt hormone excess were identified. Discussion: We found a higher frequency of malignancy and overt hormonal excess in our cohort of young adults compared to previously published studies, though direct comparisons are limited by differences in methodology. These findings, in addition to high frequencies of metabolic disease in our cohort, would suggest the need for hormonal assessment in young adults; yet, this was completed in only a minority of patients. Additional areas of research may include studying hormonal status of adrenal masses in young adults in a multi-center cohort to overcome issues of selection bias and increase the rates of those with complete hormonal evaluation. Presentation: Thursday, June 15, 2023

Urinary bladder masses are commonly encountered in clinical practice, with 95% arising from the epithelial layer and rarer tumors arising from the lamina propria, muscularis propria, serosa, and adventitia. The extent of neoplastic invasion into these bladder layers is assessed with multimodality imaging, and the MRI-based Vesical Imaging Reporting and Data System is increasingly used to aid tumor staging. Given the multiple layers and cell lineages, a diverse array of pathologic entities can arise from the urinary bladder, and distinguishing among benign, malignant, and nonneoplastic entities is not reliably feasible in most cases. Pathologic assessment remains the standard of care for classification of bladder masses. Although urothelial carcinoma accounts for most urinary bladder malignancies in the United States, several histopathologic entities exist, including squamous cell carcinoma, adenocarcinoma, melanoma, and neuroendocrine tumors. Furthermore, there are variant histopathologic subtypes of urothelial carcinoma (eg, the plasmacytoid variant), which are often aggressive. Atypical benign bladder masses are diverse and can have inflammatory or iatrogenic causes and mimic malignancy. © RSNA, 2022 Online supplemental material is available for this article.

HomeRadioGraphicsVol. 43, No. 3 PreviousNext Education CornerRG TEAMNoteworthy: Taking Notes for Radiology Training and BeyondAnna Sophia McKenney , Michail E. Klontzas, Kapil Wattamwar, Mark J. HoeggerAnna Sophia McKenney , Michail E. Klontzas, Kapil Wattamwar, Mark J. HoeggerAuthor AffiliationsFrom the Department of Radiology, New York–Presbyterian Weill Cornell Medical College, 525 E 68th St, New York, NY 10065 (A.S.M.); Department of Radiology, University of Crete School of Medicine, Heraklion, Crete, Greece, and Department of Medical Imaging, University Hospital of Heraklion, Heraklion, Crete, Greece (M.E.K.); Department of Radiology, Montefiore Medical Center, Bronx, NY (K.W.); and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (M.J.H.).Address correspondence to A.S.M. (email: [email protected]).Anna Sophia McKenney Michail E. KlontzasKapil WattamwarMark J. HoeggerPublished Online:Feb 9 2023https://doi.org/10.1148/rg.220184MoreSectionsFull textPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In References1. Stacy EM, Cain J. Note-taking and Handouts in The Digital Age. Am J Pharm Educ 2015;79(7):107. Crossref, Medline, Google Scholar2. Grahame JA. Digital Note-Taking: Discussion of Evidence and Best Practices. J Physician Assist Educ 2016;27(1):47–50. Crossref, Medline, Google Scholar3. Wong SSH, Lim SWH. Take notes, not photos: Mind-wandering mediates the impact of note-taking strategies on video-recorded lecture learning performance. J Exp Psychol Appl 2021. https://doi.org/10.1037/xap0000375. Published online June 24, 2021. Crossref, Medline, Google Scholar4. Mueller PA, Oppenheimer DM. The pen is mightier than the keyboard: advantages of longhand over laptop note taking. Psychol Sci 2014;25(6):1159–1168 [Published correction appears in Psychol Sci 2018;29(9):1565-1568.]. Crossref, Medline, Google ScholarArticle HistoryReceived: Aug 15 2022Accepted: Aug 19 2022Published online: Feb 09 2023 FiguresReferencesRelatedDetailsRecommended Articles Deep Learning: A Primer for RadiologistsRadioGraphics2017Volume: 37Issue: 7pp. 2113-2131Methods for Clinical Evaluation of Artificial Intelligence Algorithms for Medical DiagnosisRadiology2022Volume: 306Issue: 1pp. 20-31RadioGraphics 2023: New BeginningsRadioGraphics2023Volume: 43Issue: 1Hereditary and Sporadic Pancreatic Ductal Adenocarcinoma: Current Update on Genetics and ImagingRadiology: Imaging Cancer2020Volume: 2Issue: 2Deep Learning: An Update for RadiologistsRadioGraphics2021Volume: 41Issue: 5pp. 1427-1445See More RSNA Education Exhibits Uncertainty Estimation in Auto-Segmentation and Image Reconstruction TasksDigital Posters2022Mastering Basic Machine Learning Principles Without Coding Experience: A Tutorial on Googles Teaching MachineDigital Posters2022"Jaws of Life" - Use of Endobronchial Forceps for Complex IVC Filter RetrievalDigital Posters2020 RSNA Case Collection Dysembryoplastic Neuroepithelial Tumors 1RSNA Case Collection2021Papillary Glio-Neuronal Tumor (PGNT) RSNA Case Collection2021Carcinosarcoma of the Ovary RSNA Case Collection2021 Vol. 43, No. 3 Metrics Altmetric Score PDF download

Immunotherapies that target the CD20 protein expressed on most non-Hodgkin lymphoma cells have improved clinical outcomes, but relapse is common. We prepared 225Ac-labeled anti-CD20 ofatumu-mab and evaluated its in vitro characteristics and therapeutic efficacy in a murine model of disseminated human lymphoma. Methods: 225Ac was chelated by DOTA-ofatumumab, and radiochemical yield, purity, immunoreactivity, stability, and chelate number were deter-mined. In vitro cell killing of CD20-positive, human B-cell lymphoma Raji-Luc cells was assayed. Biodistribution was determined as percentage injected activity per gram (%IA/g) in mice with subcutane-ous Raji-cell tumors (n = 4). [225Ac]Ac-ofatumumab biodistribution in C57BL/6N mice was performed to estimate projected human dosime-try. Therapeutic efficacy was tested in mice with systemically dissemi-nated Raji-Luc cells, tracking survival, bioluminescence, and animal weight for a targeted 200 d, with single-dose therapy initiated 8, 12, or 16 d after cell injection, comparing no treatment, ofatumumab, and low (3.7 kBq/mouse) and high (9.25 kBq/mouse) doses of [225Ac]Ac-IgG and [225Ac]Ac-ofatumumab (n = 8-10/cohort). Results: Radio-chemical yield and purity were 32% & PLUSMN; 9% and more than 95%, respectively. Specific activity was more than 5 MBq/mg. Immunoreac-tivity was preserved, and more than 90% of the 225Ac remained che-lated after 10 d in serum. Raji-Luc cell killing in vitro was significant, specific, and dose-dependent. In tumor-bearing mice, [225Ac]Ac-ofa-tumumab displayed low liver (7 %IA/g) and high tumor (28 %IA/g) uptake. Dosimetry estimates indicated that bone marrow is likely the dose-limiting organ. When therapy was initiated 8 d after cell injection, untreated mice and mice treated with cold ofatumumab or low-or high-dose [225Ac]Ac-IgG showed indistinguishable median survivals of 20-24 d, with extensive cancer-cell burden before death. Low-and high-dose [225Ac]Ac-ofatumumab profoundly (P< 0.05) extended median survival to 190 d and more than 200 d (median not determin-able), with 5 and 9 of 10 mice, respectively, surviving at study termina-tion with no detectable cancer cells. Surviving mice treated with high-dose [225Ac]Ac-ofatumumab showed reduced weight gain ver-sus naive mice. When therapy was initiated 12 d, but not 16 d, after cell injection, high-dose [225Ac]Ac-ofatumumab significantly extended median survival to 40 d but was not curative. Conclusion: In an aggressive disseminated tumor model, [225Ac]Ac-ofatumumab was effective at cancer-cell killing and curative when administered 8 d after cell injection. [225Ac]Ac-ofatumumab has substantial potential for clini- cal translation as a next-generation therapeutic for treatment of patients with non-Hodgkin lymphoma.