The incidence of neuroendocrine neoplasms (NENs) has gradually increased over the past few decades with the majority of patients presenting with metastases on initial presentation. The liver is the most common site of initial metastatic disease, and the presence of liver metastasis is an independent prognostic factor associated with a negative outcome. Because NENs are heterogenous neoplasms with variable differentiation, grading, and risk of grade transformation over time, accurate diagnosis and management of neuroendocrine liver lesions are both important and challenging. This is particularly so with the multiple liver-directed treatment options available. In this review article, we discuss the diagnosis, treatment, and response evaluation of NEN liver metastases.

Decreasing radiology reimbursement is a major challenge faced by academic radiology practices in the United States. The consequent increased workload from reading more radiological studies can lead to job dissatisfaction, burnout and adverse impact on research, innovation, and education. Thriving successfully in an academic practice despite low reimbursement requires modification of radiology business models and culture of the practice. In this article, we review the financial and operational strategies to mitigate low reimbursement and strategies for thriving in academic radiology without burnout.

This study develops, validates, and deploys deep learning for automated total kidney volume (TKV) measurement (a marker of disease severity) on T2-weighted MRI studies of autosomal dominant polycystic kidney disease (ADPKD). The model was based on the U-Net architecture with an EfficientNet encoder, developed using 213 abdominal MRI studies in 129 patients with ADPKD. Patients were randomly divided into 70% training, 15% validation, and 15% test sets for model development. Model performance was assessed using Dice similarity coefficient (DSC) and Bland-Altman analysis. External validation in 20 patients from outside institutions demonstrated a DSC of 0.98 (IQR, 0.97-0.99) and a Bland-Altman difference of 2.6% (95% CI: 1.0%, 4.1%). Prospective validation in 53 patients demonstrated a DSC of 0.97 (IQR, 0.94-0.98) and a Bland-Altman difference of 3.6% (95% CI: 2.0%, 5.2%). Last, the efficiency of model-assisted annotation was evaluated on the first 50% of prospective cases (n = 28), with a 51% mean reduction in contouring time (P < .001), from 1724 seconds (95% CI: 1373, 2075) to 723 seconds (95% CI: 555, 892). In conclusion, our deployed artificial intelligence pipeline accurately performs automated segmentation for TKV estimation of polycystic kidneys and reduces expert contouring time. Keywords: Convolutional Neural Network (CNN), Segmentation, Kidney ClinicalTrials.gov identification no.: NCT00792155 Supplemental material is available for this article. © RSNA, 2022.

Encephalocele is protrusion of brain parenchyma through a defect in the cranium. It is classified into various types based on the defect location: sincipital (fronto-ethmoidal), basal (trans-sphenoidal, spheno-ethmoidal, trans-ethmoidal, and spheno-orbital), occipital and parietal. Double encephaloceles are very rare with only a handful of cases reported in the literature and most of these cases involved either occipital or sub-occipital region. All, except one, cases of double encephaloceles were diagnosed postnatally. We present a case of double encephalocele with parietal and occipital components diagnosed in utero. To the best of our knowledge, this is the first case of double encephalocele involving the parietal and occipital skull bones diagnosed in-utero.

The prostate imaging reporting and data system (PI-RADS) has revolutionized the use of magnetic resonance imaging (MRI) for the management of prostate cancer (PCa). The most recent version 2.1, PI-RADS v2.1, provides specific refinements in the performance, relaxing some recommendations which were not found to be helpful, while reinforcing and clarifying others. The interpretation of T2-weighted imaging (T2WI) in the transition zone (TZ), and the overall assessment of TZ nodules, now allows for a clearer distinction between those which are clearly benign and those which might warrant tissue sampling. Additional changes also resolve discrepancies in T2WI and diffusion-weighted imaging (DWI) of the peripheral zone (PZ). PI-RADS v2.1 is a simpler, more straightforward, and more reproducible method to better communicate between physicians regarding findings on prostate MRI.

Vascular malformations pose a diagnostic and therapeutic challenge due to the broad differential diagnosis as well as common utilization of inadequate or inaccurate classification systems among healthcare providers. Therapeutic approaches to these lesions vary based on the type, size, and extent of the vascular anomaly, necessitating accurate diagnosis and classification. Magnetic resonance (MR) imaging (MRI) is an effective modality for classifying vascular anomalies due to its ability to delineate the extent and anatomic relationship of the malformation to adjacent structures. In addition to anatomical mapping, the complete evaluation of vascular anomalies includes hemodynamic characterization. Dynamic time-resolved contrast-enhanced MR angiography provides information regarding hemodynamics of vascular anomalies, differentiating high- and low-flow vascular malformations. Radiologists must identify the MRI features of vascular malformations for better diagnosis and classification.

The epiglottis plays an important role in preventing food of different consistencies from entering the airway during swallowing. Calcification of epiglottis can, potentially, alter and limit its movement causing aspiration amongst other swallowing problems. Isolated calcification of the epiglottis and its clinical presentation remains a poorly understood entity for radiologists as well as clinicians. Therefore, it is important to recognize the imaging features of epiglottic calcification, and it's known clinical presentations to help clinicians with early diagnosis and management.

Trauma is one of the leading causes of mortality in the United States. There is a need for effective and efficient delivery of care that can improve survival and reduce morbidity as much as possible. Due to technological advances in interventional radiology (IR); there has been an expanding role for IR in hemodynamically stable and unstable patients. Various tools, such as micro catheters, stent grafts, digital subtraction angiography (DSA), and cone beam angiography have expanded the ability of the IR physician in reducing mortality and morbidity in patients who have suffered traumatic injuries. However, for the best possible patient care to be administered there must be two important resources readily available: the ability to triage before or quickly upon presentation to the hospital and a multidisciplinary trauma team which includes physicians and well trained ancillary staff. Here we describe the critical role IR plays in the trauma setting and its evolution and future growth, given the advances in technology.

With increasing use of pediatric cardiovascular MRI, it is important for all imagers to become familiar with the spectrum of non-cardiovascular imaging findings that can be encountered.

Trauma is one of the leading causes of death in people under the age of 44 years (Rivara et al. 2015). Trauma also has a substantial financial impact on the healthcare system, accounting for over one-third of all emergency department visits and resulting in over $80 billion per year in direct medical care costs in the USA (WISQARS 2016). A significant cause of preventable deaths in trauma is delay in proper surgical care. Significant injuries are overlooked at a high rate in patients with major trauma (Rivara et al. 2015). In particular, the physical examination is unreliable in patients with a reduced level of consciousness (Rivara et al. 2015). With the marked decrease in the use of diagnostic peritoneal lavage, diagnosis of abdominal injuries now relies almost exclusively on the interpretation of computed tomography (CT) examinations (Catre 1995). As a member of the trauma team, the radiologist plays a significant role by contributing to the rapid diagnosis of critical and emergent diagnoses (Clarke et al. 2002; Schueller et al. 2015). Until a few years ago, CT scanning was performed at the end of the clinical evaluation of the patient. However, with the advance of high-speed assessment by multi-detector CT (MDCT), scanning can now be performed immediately upon patient arrival in the trauma bay. As a result, the mortality rate has significantly decreased, especially in cases of severe trauma (Schueller et al. 2015; Jiang et al. 2014).

Primary carcinoma of the vagina is rare, accounting for 1-3% of all gynaecological malignancies. MRI has an increasing role in diagnosis, staging, treatment and assessment of complications in gynaecologic malignancy. In this review, we illustrate the utility of MRI in patients with primary vaginal cancer and highlight key aspects of staging, treatment, recurrence and complications.

In an era of percutaneous stenting for acute myocardial infarction (AMI), a case of thoracic spinal cord ischemia following AMI and cardiac arrest is presented, to highlight and discuss this rare but debilitating condition, well-documented within the neurological literature, but rarely encountered in cardiovascular practice.

(18)Flurodeoxyglucose ((18)F-FDG) positron emission tomography/computed tomography (PET/CT) is nowadays routinely used in management of lymphoma patients. We here present a case of Hodgkin's lymphoma which showed (18)F-FDG avid splenomegaly on PET/CT done for clinically suspected relapse. Further evaluation by peripheral smear examination revealed malaria. The patient was then started on anti-malarial medications and follow-up PET/CT revealed resolution of hypermetabolic splenomegaly. This report highlights that in endemic regions malaria can cause (18)F-FDG avid splenomegaly and might mimic relapse of lymphoma.

1482 Objectives To evaluate the role of 18F-FDG PET/NCCT in staging of intra-hepatic cholangiocarcinoma. Methods Ours was a prospective study done on 16 patients ( age: 55.75yrs +/- 8.1 yrs Male/Female: 7/9 ) who underwent FDG-PET/NCCT study for pre-therapy staging. The physicians interpreting the study were blinded for patient’s clinical history and results of other imaging procedures. A combined visual analysis with semiquantitative analysis was done by PET-CT. Contrast enhanced CT was also evaluated by a separate physician. Histopathology was the gold standard. Results out of 16 patients 12 patients had local infiltrating disease extending into the liver. 15 patients had abdominal lymph node metastases, 5 had distant skeletal metastases, 6 had metastatic lung nodules. One patient had bowel infiltration and one had adrenal metastases. Conclusions PET-CT study is a very useful modality for primary cholangiocarcinoma work-up and staging as it is more sensitive in detecting metastatic disease. Visual analysis is a better predictor than semiquantitative analysis. The pattern of metastases in cholangiocarcinoma is wide spread. Hence, PET/CT is a reasonable investigation of choice for pre-therapy staging of cholangiocarcinoma.

Objective: This study aimed to evaluate the incremental value of I-131-MIBG hybrid SPECT-CT over planar scintigraphy (PS) and SPECT alone in patients with clinical or biochemical suspicion of pheochromocytoma.Methods: A total of 126 adrenals of 63 patients (mean [SD] age, 28.6 [15.7] years; male patients, n = 34; female patients, n = 29) with clinical or biochemical suspicion of pheochromocytoma were retrospectively evaluated. All patients had undergone I-131-MIBG SPECT-CT of adrenal region. The PS, SPECT, and SPECT-CT images were independently evaluated by 2 nuclear medicine physicians with 6 years (R1) and 2 years (R2) experience and in separate sessions 1 week apart. A scoring scale of 1 to 5 was used, in which 1 is definitely abnormal, 2 is probably abnormal, 3 is indeterminate, 4 is probably normal, and 5 is definitely normal. Sensitivity, specificity, predictive values were calculated taking a score 2 or less as abnormal. With receiver operating characteristic (ROC) curve analysis, areas under the curve (AUC) were calculated for each modality and compared. Histopathology and/or clinical/imaging follow-up were taken as reference standard.Results: Of the 126 adrenals evaluated, 29 were indeterminate on PS for R1 and 48 for R2, 39 were indeterminate on SPECT for both, and on SPECT-CT, 1 was indeterminate for R1 and 2 for R2. SPECT-CT correctly characterized 28 of 29 indeterminate adrenals on PS and 37 of 39 indeterminate adrenals on SPECT for R1. Similarly, for R2, SPECT-CT correctly characterized 45 of 48 indeterminate adrenals on PS and 33 of 39 indeterminate adrenals on SPECT. On ROC comparison, PS was inferior to SPECT (P = 0.040 for R1; P < 0.001 for R2) and SPECT-CT (P = 0.001 for R1; P < 0.001 for R2) for both the observers. Moreover, SPECT was inferior to SPECT-CT for both the observers (P = 0.017 for R1 and P = 0.001 for R2). Accuracy of SPECT-CT (R1, 97.6%; R2, 97.6%) was higher than PS (R1, 91.2%; R2, 84.1%) and SPECT (R1, 94.4%; R2, 86.5%). Interobserver agreement was highest for SPECT-CT (kappa = 0.966) as compared with PS (kappa = 0.815) and SPECT (kappa = 0.826).Conclusions: I-131-MIBG hybrid SPECT-CT shows high sensitivity and specificity for characterizing adrenal lesions in patients with clinical or biochemical suspicion of pheochromocytoma and is superior to PS and SPECT alone. It will be especially useful in countries where I-123-MIBG is not available.