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Background/Purpose: Breast masses in the pediatric population cause patient and family concern, partially driven by public awareness of adult breast cancer. However, the spectrum of breast masses in children differs greatly from that in adults, and malignancy is exceedingly rare. The American College of Radiology Breast Imaging Reporting and Data System (BI-RADS) ultrasound-based classification system is the diagnostic standard, yet no study has validated BI-RADS in pediatric patients. This study compares BI-RADS classification with histologic diagnoses to evaluate BI-RADS validity in pediatric patients. Methods: Multicenter retrospective evaluation of breast masses in patients under 21 years. Ultrasound reports were compared with histologic diagnoses. Results: There were 283 patients with breast pathology results after excluding clinical diagnoses of gynecomastia. Mean age was 16.9 (SD 2.3), ranging 10–20 years. 227 had pre-operative ultrasounds, and 84% (191/227) were assigned a BI-RADS category. BI-RADS 4 was the most frequent category (55%, n = 124), by definition predicting 2 – 95% likelihood of malignancy. However, pathology was benign in all patients. Conclusions: The current BI-RADS categorization system overestimates cancer risk when applied to pediatric patients. BI-RADS scores should not be assigned to pediatric patients, and BIRADS-defined recommendations for biopsy should be disregarded. A pediatric-specific classification system could be useful.

The purpose of this study was to compare respiratory motion artifact and diagnostic image quality between end-inspiration and end-expiration breath-holding techniques on unenhanced and contrast-enhanced axial T1-weighted MRI of the liver.This retrospective observational study included 50 consecutive subjects undergoing axial T1-weighted liver MRI, with unenhanced images acquired with both end-inspiration and end-expiration breath-holding techniques, and with contrast-enhanced images acquired for 47 of the subjects with either the end-inspiration or the end-expiration breath-holding technique. Three radiologists performed blinded independent evaluations of each unenhanced sequence, contrast-enhanced sequence, and subtraction (contrast-enhanced minus unenhanced) image, using a scale ranging from 1 point (denoting nondiagnostic imaging) to 5 points (denoting no artifacts). Blinded side-by-side assessment of each pair of unenhanced sequences was also performed. Two-tailed Wilcoxon signed rank and Wilcoxon rank sum tests were used to assess statistical significance.A significant improvement in motion scores was noted for sequences acquired in end-expiration, compared with those acquired in end-inspiration, for unenhanced sequences (mean, 3.35 vs 2.80; p0.00001), contrast-enhanced sequences (mean, 4.02 vs 3.46; p = 0.0003), and subtraction images (mean, 3.67 vs 2.41; p0.00001). Severe degradation of image quality or nondiagnostic image quality was noted for 15% of unenhanced images (23/150), 0% of contrast-enhanced images, and 8% (5/63) of subtraction images acquired on end-expiration, whereas it was noted for 36% (54/150) of unenhanced images, 13% (10/78) of contrast-enhanced images, and 59% (46/78) of subtraction images acquired on end-inspiration. When side-by-side assessment of paired unenhanced sequences was performed, images acquired in end-expiration were significantly favored in 59% of paired sequences (88/150) (p0.00001), and no difference between images acquired with both breath-hold techniques was noted for 21% (32/150) of paired sequences.The end-expiration breath-holding technique leads to significant decreases in respiratory motion artifacts, compared with the end-inspiration technique, on unenhanced and contrast-enhanced T1-weighted liver MRI.

Background Prostate imaging reporting and data system version 2 (PI-RADS v2) relegates dynamic contrast enhanced (DCE) imaging to a minor role. We sought to determine how often DCE is used in PI-RADS v2 scoring. Materials and Methods We retrospectively reviewed data from 388 patients who underwent prostate magnetic resonance imaging and subsequent biopsy from January 2016 through December 2017. In accordance with PI-RADS v2, DCE was deemed necessary if a peripheral-zone lesion had a diffusion-weighted imaging score of 3, or if a transition-zone lesion had a T2 score of 3 and diffusion-weighted imaging experienced technical failure. Receiver operating characteristic curve analysis assessed the accuracy of prostate-specific antigen density (PSAD) at different threshold values for differentiating lesions that would be equivocal with noncontrast technique. Accuracy of PSAD was compared to DCE using McNemar's test. Results Sixty-nine lesions in 62 patients (16%) required DCE for PI-RADS scoring. Biopsy of 10 (14%) of these lesions showed clinically significant cancer (Gleason score ≥7). In the subgroup of patients with equivocal lesions, those with clinically significant cancer had significantly higher PSADs than those with clinically insignificant lesions (means of 0.18 and 0.13 ng/mL/mL, respectively; P= 0.038). In this subgroup, there was no statistical difference in accuracy in determining clinically significant cancer between a PSAD threshold value of 0.13 and DCE (P= 0.25). Conclusions Only 16% of our patients needed DCE to generate the PI-RADS version 2 score, raising the possibility of limiting the initial screening prostate MRI to a noncontrast exam. PSAD may also be used to further decrease the need for or to replace DCE altogether.

PURPOSE: Magnetic resonance imaging (MRI) sequences with conical k-space trajectories are able to decrease motion artifacts while achieving ultrashort echo times (UTE). We assessed the performance of free-breathing conical UTE MRI in the evaluation of the pediatric pelvis for suspected appendicitis. METHODS: Our retrospective review of 84 pediatric patients who underwent MRI for suspected appendicitis compared three contrast-enhanced sequences: free-breathing conical UTE, breath-hold three-dimensional (3D) spoiled gradient echo (BH-SPGR), and free-breathing high-resolution 3D SPGR (FB-SPGR). Two radiologists performed blinded and independent evaluations of each sequence for image quality (four point scale), anatomic delineation (four point scale), and diagnostic confidence (five point scale). Subsequently, the three sequences were directly compared for overall image quality (− 3 to + 3 scale). Scores were compared using Kruskal–Wallis and Wilcoxon signed-rank tests. RESULTS: UTE demonstrated significantly better perceived signal-to-noise ratio (SNR) and fewer artifacts than BH-SPGR and FB-SPGR (means of 3.6 and 3.4, 3.4 and 3.2, 3.1 and 2.7, respectively; p < 0.0006). BH-SPGR and FB-SPGR demonstrated significantly better contrast than UTE (means of 3.6, 3.4, and 3.2, respectively; p < 0.03). In the remaining categories, UTE performed significantly better than FB-SPGR (p < 0.00001), while there was no statistical difference between UTE and BH-SPGR. Direct paired comparisons of overall image quality demonstrated the readers significantly preferred UTE over both BH-SPGR (mean + 0.5, p < 0.00001) and FB-SPGR (mean + 1.2, p < 0.00001). CONCLUSIONS: In the evaluation of suspected appendicitis, free-breathing conical UTE MRI performed better in the assessed metrics than FB-SPGR. When compared to BH-SPGR, UTE demonstrated superior perceived SNR and fewer artifacts.

BACKGROUND View-sharing (VS) increases spatiotemporal resolution in dynamic contrast-enhanced (DCE) MRI by sharing high-frequency k-space data across temporal phases. This temporal sharing results in respiratory motion within any phase to propagate artifacts across all shared phases. Compressed sensing (CS) eliminates the need for VS by recovering missing k-space data from pseudorandom undersampling, reducing temporal blurring while maintaining spatial resolution. PURPOSE To evaluate a CS reconstruction algorithm on undersampled DCE-MRI data for image quality and hepatocellular carcinoma (HCC) detection. STUDY TYPE Retrospective. SUBJECTS Fifty consecutive patients undergoing MRI for HCC screening (29 males, 21 females, 52-72 years). FIELD STRENGTH/SEQUENCE 3.0T MRI. Multiphase 3D-SPGR T1 -weighted sequence undersampled in arterial phases with a complementary Poisson disc sampling pattern reconstructed with VS and CS algorithms. ASSESSMENT VS and CS reconstructions evaluated by blinded assessments of image quality and anatomic delineation on Likert scales (1-4 and 1-5, respectively), and HCC detection by OPTN/UNOS criteria including a diagnostic confidence score (1-5). Blinded side-by-side reconstruction comparisons for lesion depiction and overall series preference (-3-3). STATISTICAL ANALYSIS Two-tailed Wilcoxon signed rank tests for paired nonparametric analyses with Bonferroni-Holm multiple-comparison corrections. McNemar's test for differences in lesion detection frequency and transplantation eligibility. RESULTS CS compared with VS demonstrated significantly improved contrast (mean 3.6 vs. 2.9, P

To determine if a physician-patient language barrier impacts the diagnostic accuracy of pulmonary embolism (PE) evaluation.A retrospective chart review, conducted between June 2015 and December 2016, of a consecutive sample of diagnostic computed tomography pulmonary angiogram (CTPA) studies performed on adult patients. Positive and negative CTPA scans were further categorized by patient language and the positive diagnostic yield was determined for each language group. A post collection sub-analysis was performed to determine the yield when interpreter services were identified as necessary.The yield for English speaking patients was 10.24% (92/898, 95% CI 8.39% to 12.36%), similar to the yield in Spanish speaking patients of 9.40% (25/266, 95% CI 6.31% to 13.37%, P=0.69). This contrasted with the yield in patients who identified as bilingual, which was significantly lower at 1.41% (1/71, 95% CI 0.07% to 6.75%) compared to both English-(P0.02) and Spanish-only speakers (P0.03). The yield for non-English speaking patients who requested an interpreter was 7.37% (14/190, 95% CI 4.26% to 11.77%) versus 3.23% (2/62, 95% CI 0.54% to 10.25%, P=0.25) in those who did not.The diagnostic yield in English- and Spanish-only speaking patients was similar, however, the yield in those that self-identified as bilingual was significantly lower. In patient groups in which a language barrier existed and an interpreter was not utilized, there was a trend toward a lower diagnostic yield. This suggests an increased propensity to order diagnostic imaging when potential communication barriers exist.

Computed tomography (CT) is commonly used to evaluate suspected acute appendicitis. Although very effective, CT uses ionizing radiation, exposing patients to an increased risk of cancer. This study assessed the potential for decreasing the field of view of the CT (and therefore the dose to the patient) in the evaluation of suspected acute appendicitis in children. This study was a retrospective review of prospectively collected data from 212 consecutive patients who underwent CT for suspected acute appendicitis. The most superior aspect of the appendix with respect to vertebral bodies was recorded. Age, gender and diagnosis (negative, acute appendicitis or alternative diagnosis) were noted. The appendix was visualized in 190 of 212 subjects (89.6%). Overall, all visualized appendixes were located at or below the level of L1. Sixty-three of the subjects (29.7%) were diagnosed with acute appendicitis via CT imaging. All appendixes in patients with acute appendicitis were located at or below the level of the L3 vertebral body, predominating at the level of L5. Six subjects (3.1%) received alternative diagnoses, including pneumonia, pyelonephritis, small bowel obstruction and infected urachal cyst. There were no differences in appendix location with regard to diagnosis, gender, or age (P=0.664, 0.748 and 0.705, respectively). CT field of view may be decreased to the level of L1 or L3 superiorly, decreasing radiation dose without affecting the rate of appendix visualization.