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Chimeric antigen receptor (CAR) T cell therapy is a revolutionary form of immunotherapy that has proven to be efficacious in the treatment of many hematologic cancers. CARs are modified T lymphocytes that express an artificial receptor specific to a tumor-associated antigen. These engineered cells are then reintroduced to upregulate the host immune responses and eradicate malignant cells. While the use of CAR T cell therapy is rapidly expanding, little is known about how common side effects such as cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity (ICANS) present radiographically. Here we provide a comprehensive review of how side effects present in different organ systems and how they can be optimally imaged. Early and accurate recognition of the radiographic presentation of these side effects is critical to the practicing radiologist and their patients so that these side effects can be promptly identified and treated. [ABSTRACT FROM AUTHOR]

Objective: To assess current practice patterns with respect to protocols used for incidental pancreatic cyst follow-up, management guidelines, and template reporting.Methods: The Society of Abdominal Radiology Disease Focused Panel on intraductal pancreatic neoplasms distributed an anonymous 14-question survey to its members in June 2018 that focused on current utilization of incidental pancreatic cyst guidelines, protocols, and template reporting.Results: Among the 1,390 email invitations, 323 responded, and 94.7% (306 of 323) completed all questions. Respondents were mainly radiologists (93.8%, 303 of 323) from academic institutions (74.7%, 227 of 304) in North America (93.7%, 286 of 305). Of respondents, 42.5% (136 of 320) preferred 2017 ACR recommendations, 17.8% (57 of 320) homegrown systems, 15.0% (48 of 320) Fukuoka guidelines, and 7.8% (25 of 320) American Gastroenterological Association guidelines. The majority (68.7%, 222 of 323) agreed or strongly agreed that developing a single international consensus recommendation for management was important, and most radiologists preferred to include them in reports (231 of 322, 71.7%); yet only half included recommendations in >75% of reports (161 of 321). MR cholangiopancreatography was the modality of choice for follow-up of <2.5 cm cysts. Intravenous contrast was routinely used by 69.7% (212 of 304). Standardized reporting templates were rarely used in practice (12.8% 39 of 306).Conclusions: Nearly 7 of 10 radiologists desire a unified international consensus recommendation for management of incidental cystic pancreatic lesions; ACR 2017 recommendations are most commonly used, followed by homegrown systems and Fukuoka guidelines. The majority of radiologists routinely use MR cholangiopancreatography with intravenous contrast for follow-up of incidental cystic lesions, but template reporting is rarely used. [ABSTRACT FROM AUTHOR]

Rationale and Objectives: Recent changes in radiology curriculum and access to residency program information, including the introduction of various online resources and the Interventional Radiology integrated pathway, may influence the rank list order of medical student applicants. The purpose of this study is to assess factors that affect the rank lists of medical students applying to our radiology residency program in the 2016-2017 academic year.Materials and Methods: After IRB approval, an anonymous online 19 question survey was emailed to 622 applicants to our diagnostic radiology and/or interventional radiology integrated pathway. Applicants ranked 35 unique factors that may influence their residency rank list order from 1 (not important at all) to 5 (very important), listed their top five 'very important' factors, and ranked various sources of information used to learn about residency programs. General applicant demographic questions were also included.Results: Response rate was 18.8% (117/622). The 5 most important factors affecting applicant ranking of programs are perceived happiness of the residents and faculty (4.69), fellowship and job placement of recent graduates (4.34), interactions with programs' current residents (4.33), stability of the department and program (4.29), and geographic location of the program (4.27). The top 5 resources for learning about residency programs were interactions with current residents at the program (4.47), program director (3.87), and interviewing faculty (3.87). Individual program websites were ranked more highly than internet message boards and forums as an information source.Conclusion: Medical students consider a large number of factors and resources in determining their rank lists, with factors encountered during the interview day playing a significant role in shaping the applicants' view of a residency program. [ABSTRACT FROM AUTHOR]

The purpose of this study is to compare diagnostic quality, inter-observer variability and agreement of non-contrast enhanced MRA (NC-MRA) with contrast-enhanced MRA (CE-MRA) in the evaluation of hepatic arterial anatomy. 20 potential liver donors were included in this retrospective study. NC-MRA, CE-MRA and combined data sets were randomized and reviewed by two readers. Reference standard was consensus by two senior radiologists using all data including CTA. There was no difference in IQ or diagnostic confidence between NC-MRA, CE-MRA or combined data for either reader but the arterial origin of segment IV was successfully identified on NC-MRA when CE-MRA was suboptimal. [ABSTRACT FROM AUTHOR]

Abdominal CT is often the first imaging modality used to characterize the primary tumor (including invasion of vasculature) and identify metastatic lesions. Finally, functional imaging with somatostatin receptor scintigraphy or SP 68 sp Ga-DOTATATE PET/CT can identify lesions not seen on either CT or MRI and help differentiate pNET from neuroendocrine carcinoma. In this case, SP 68 sp Ga-DOTATATE PET/CT was not necessary since the tumor was localized by CT and confirmed by endoscopic ultrasound without findings suggestive of occult metastatic disease. [Extracted from the article]

Rationale and Objective: The modification of the initial radiology board exam series has as a concerted aim the promotion of subspecialization. Yet, in practice, fellowship-trained radiologists may be assigned to off-hours work in other diagnostic areas. The purpose of this study is to chart the prevalence of after-hour work among the various subspecialties in radiology and to relate those findings to the pertinence of a fourth-year training curriculum devoted to only one imaging discipline. Materials and Methods: A questionnaire was sent to members of Society of Chairs of Academic Radiology Departments and to directors of the 50 largest American private radiology practices requesting that they list after-hours coverage obligations of their various subspecialists. Results: Academic and private practice response rates were 40.8% (42 of 103) and 42% (21 of 50), respectively. In academic practice, 80% of neuroradiologists, 93% of interventional radiologists, and 84% of pediatric radiologists were not assigned after-hour coverage in other subspecialties. In private practice groups, only 24% of neuroradiologists, 48% of interventional radiologists, and 33% of pediatric radiologists were free of these duties. For other subspecialists, the likelihood of after-hours assignments to other disciplines was not so discrepant between academic and private practices. Conclusion: Residents pursuing an academic career in neuroradiology, interventional radiology, or pediatric radiology could benefit from a full fourth-year experience in their area of subspecialty, whereas a more variegated curriculum would be more suitable for other specialists independent of practice type. [ABSTRACT FROM AUTHOR]

The fellowship year is now chosen by more than 90% of radiology residents. However, oversight of training programs is not uniform, with the number of occupied positions in non-ACGME programs now exceeding that of programs under periodic ACGME review. Lacking surveillance by a national regulatory body, non-ACGME programs are free to determine curricular content and the terms of employment, leaving trainees to function at program directors'' behest, without guaranteed, codified appellate rights. Another area for concern is in ACGME-related fellowship programs, in which the record of citations, particularly in interventional radiology, is worse than for the core residencies. Moreover, the abandonment of the abortive fellowship match has recently led to the establishment of earlier deadlines for interviews and acceptance notification in many programs, in which such choices are now being made early in the third year of residency. These are troubling developments requiring increased attention by leaders in radiology education. [Copyright &y& Elsevier]

While masses of thymic origin are commonly located within the anterior mediastinum, abnormal migration of thymic tissue during development can result in thymic lesions in other intrathoracic locations. Ectopic thymic lesions in the middle mediastinum are extremely rare. We present a case of a calcified thymic cyst located posterior to the left atrium entirely within the caudal aspect of the middle mediastinum, a location not previously reported. [ABSTRACT FROM AUTHOR]

Pancreatic cancer is the fourth leading cause of cancer-related death. Early detection is challenging because symptoms are relatively nonspecific. Imaging is vital in detecting and staging pancreatic tumors, and management depends on imaging findings. Radiologists should be aware of current surgical treatments for pancreatic neoplasms, as surgeons rely on interpretation of cross-sectional imaging for presurgical planning. Understanding postsurgical anatomy is critical to assess for complications and recurrence. This review will emphasize the role of the radiologist in planning for surgery and will review postoperative changes based on surgical intervention and common complications. [ABSTRACT FROM AUTHOR]

Pneumonitis has been described as a side effect of immunotherapy as well as traditional chemotherapy. Although immune-related adverse event (IRAE) pneumonitis has been extensively characterized, the relationship between IRAE pneumonitis and pneumonitis secondary to chemotherapy is less clear. Here, we present the first analysis of radiographic features of pneumonitis secondary to immunotherapy compared to chemotherapy. Using our radiology records system, we searched chest computed tomography (CT) reports for the term "pneumonitis". We evaluated medical records to establish chronicity of pneumonitis occurring after medication administration and excluded cases where radiation therapy appeared to be the cause of pneumonitis. We also obtained information regarding demographic, clinical, and treatment characteristics for comparison. Patients treated with immunotherapy demonstrated more specific features of pneumonitis including consolidation, ground glass opacities, septal thickening, traction bronchiectasis, and pulmonary nodules compared to those treated with chemotherapy. Immunotherapy treatment correlated with the development of pulmonary nodules (p = 0.048), and administration of more than one immunotherapy agent correlated with a greater incidence of development of nodules (p = 0.050). Radiographic features in patients treated with immunotherapy all decreased over time. Conversely, in patients treated with chemotherapy the incidence of ground glass opacities, traction bronchiectasis, pulmonary nodules, and mediastinal/hilar adenopathy increased over time. IRAE-pneumonitis has distinct features and a distinct clinical course compared to pneumonitis secondary to chemotherapy. Importantly, IRAE-pneumonitis features decreased over time, suggesting that careful consideration of the benefit-risk ratio may allow for continuation of immunotherapy in some patients who develop pneumonitis. • Here we present the first analysis of radiographic findings of IRAE pneumonitis versus pneumonitis caused by chemotherapy • Immunotherapy was associated pulmonary nodules and the number of immunotherapy agents correlated with incidence of pulmonary nodules • Features of IRAE pneumonitis improved over time while those of chemotherapy pneumonitis worsened [ABSTRACT FROM AUTHOR]

Acute abdominal pain is a common cause of ED visits and often requires imaging to identify a specific diagnosis. Prompt and appropriate imaging plays a crucial role in patient management and leads to improved patient outcomes, decreased hospital stay, and improved ED workflow. There are many cases of abdominal pain in the ED with delayed diagnosis and management secondary to a combination of institutional policies and knowledge deficits in current imaging guidelines. Inappropriate use of abdominal radiographs, use of oral contrast for CT abdomen and pelvis, and concern for iodinated contrast-induced acute kidney injury are three of the more commonly encountered roadblocks to prompt imaging diagnosis of abdominal pain. The purpose of this review is to discuss why these potential causes of delayed diagnosis occur and how radiologists can help improve both imaging and ED workflow by utilizing the most up-to-date imaging guidelines such the American College of Radiology (ACR) Appropriateness Criteria and ACR Manual on Contrast Media to assist clinicians working in the emergency setting. • Prompt radiology evaluation of acute nontraumatic abdominal pain leads to improved patient outcomes • Abdominal radiographs are less accurate than CT in diagnosing common causes of acute abdominal pain • Oral contrast does not provide significant diagnostic benefit to CT abdomen and pelvis but takes longer to perform • Contrast-induced acute kidney injury risk is overestimated due to results from outdated research studies • Reviewing up to date imaging and contrast guidelines can help limit delays in ordering the proper imaging study [ABSTRACT FROM AUTHOR]

Objective: To investigate specific imaging and patient-related factors associated with a false negative (FN) MRI-targeted prostate fusion biopsies (TBx) of suspicious MRI lesions.Methods: Retrospective study of men with PI-RADS 4 or 5 lesions November, 2015-December 2020 with TBx and systematic biopsy (SBx) performed. Only FN and true positive (TP) targeted lesions were included. FN biopsy was defined as a negative TBx with a positive systematic core in the ROI or perilesional sextant. Logistic regression was used to determine the association of patient and imaging-specific factors with the probability of a FN TBx.Results: 361 PI-RADS 4 or 5 lesions in 304 patients, including 67 FN (19%) and 294 TP (81%) were included. There was a significant inverse association between lesion size (OR: 0.94, P-value: .02), presence of a suspicious DRE (OR: 0.36, P-value: .02) and PSA density (OR: 0.01, P-value: .004) on the probability of obtaining a FN TBx. There was no association between age, biopsy indication, use of an enema before MRI, prostate size, or discrepant US and MRI segmentation volumes on the probability of a FN TBx.Conclusion: In this cohort, SBx detected 19% of csPCa missed on TBx. Smaller PI-RADS 4/5 lesions, lower PSAD values, and a normal DRE were all associated with an increased probability of a FN TBx. [ABSTRACT FROM AUTHOR]

Accurate and prompt diagnosis of the different patterns for pulmonary fibrosis is essential for patient management. However, accurate diagnosis of the specific pattern is challenging due to overlapping radiographic characteristics. We conducted a retrospective chart review utilizing two machine learning methods, classification and regression tree and Bayesian additive regression tree, to select the most important radiographic features for diagnosing the three most common fibrosis patterns and created an online diagnostic app for convenient implementation. Four hundred patients (median age of 67 with inter quartile range 58–73; 200 males) were included in the study. Peripheral distribution, homogeneity, lower lobe predominance and mosaic attenuation of fibrosis are the four most important features identified. Bayesian additive regression tree demonstrates better performance than classification and regression tree in diagnosis prediction and provides the predicted probability of each diagnosis with uncertainty intervals for each combination of features. The model and app built with Bayesian additive regression tree can be used as an effective tool in assisting radiologists in the diagnostic process of pulmonary fibrosis pattern recognition. • Classification and regression tree and Bayesian additive regression tree build diagnostic tools for fibrosis patterns • Peripheral, lower lobe predominant, homogeneous and mosaic attenuation are most important in differentiating common fibrosis • An online interactive diagnostic tool is developed to assist physicians in making more accurate diagnosis [ABSTRACT FROM AUTHOR]

Purpose: The clinical adoption of quantitative imaging biomarkers (radiomics) has established the need for high quality contrast-enhancement in medical images. We aimed to develop a machine-learning algorithm for Quality Control of Contrast-Enhancement on CT-scan (CECT-QC).Method: Multicenter data from four independent cohorts [A, B, C, D] of patients with measurable liver lesions were analyzed retrospectively (patients:time-points; 503:3397): [A] dynamic CTs from primary liver cancer (60:2359); [B] triphasic CTs from primary liver cancer (31:93); [C] triphasic CTs from hepatocellular carcinoma (121:363); [D] portal venous phase CTs of liver metastasis from colorectal cancer (291:582). Patients from cohort A were randomized to training-set (48:1884) and test-set (12:475). A random forest classifier was trained and tested to identify five contrast-enhancement phases. The input was the mean intensity of the abdominal aorta and the portal vein measured on a single abdominal CT scan image at a single time-point. The output to be predicted was: non-contrast [NCP], early-arterial [E-AP], optimal-arterial [O-AP], optimal-portal [O-PVP], and late-portal [L-PVP]. Clinical utility was assessed in cohorts B, C, and D.Results: The CECT-QC algorithm showed performances of 98 %, 90 %, and 84 % for predicting NCP, O-AP, and O-PVP, respectively. O-PVP was reached in half of patients and was associated with a peak in liver malignancy density. Contrast-enhancement quality significantly influenced radiomics features deciphering the phenotype of liver neoplasms.Conclusions: A single CT-image can be used to differentiate five contrast-enhancement phases for radiomics-based precision medicine in the most common liver neoplasms occurring in patients with or without liver cirrhosis. [ABSTRACT FROM AUTHOR]