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The Canadian Association of Radiologists Incidental Findings Working Group consists of both academic subspecialty and general radiologists and is tasked with adapting and expanding upon the American College of Radiology incidental findings white papers to more closely apply to Canadian practice patterns, particularly more comprehensively dealing with the role of ultrasound and pursuing more cost-effective approaches to the workup of incidental findings without compromising patient care. Presented here are the 2020 Canadian guidelines for the management of hepatobiliary incidental findings. Topics covered include initial assessment of hepatic steatosis and cirrhosis, the workup of incidental liver masses identified on ultrasound and computed tomography (with algorithms presented), incidental gallbladder findings (wall thickening, calcification, and polyps), and management of incidental biliary dilatation.

Congenital abnormalities of the liver are rare with prior descriptions of lobar or segmental agenesis, Reidel's lobe, and ectopic hepatic lobes. Intrathoracic ectopic hepatic lobes have been reported in many instances; however, there is only one documented case of abnormally positioned liver tissue within the inferior vena cava (J Chapman-Fredricks, R Birusingh, M Ricci, M Rodriguez, Intracaval liver with cardiac extension. A new developmental anomaly? Fetal and Pediatric Pathology. 2010; 29:401-406). We report a second case of an ectopic intracaval liver defined as a mass in an adult who presented for abdominal pain and review the radiological findings.

Regorafenib (Stivarga, BAY 73-4506; Bayer Pharma AG, Berlin, Germany) is an oral multikinase inhibitor that targets the angiogenic tumor microenvironment and oncogenic kinases including vascular endothelial growth factor receptor 2 (VEGFR2), VEGFR1, VEGFR3, fibroblast growth factor receptor 1 (FGFR1), RAF, KIT, RET and BRAF. Its antiangiogenic effect is greater than that of its related drug, sorafenib. Regorafenib has been approved by the US Food and Drug Administration (FDA) for the treatment of metastatic colorectal cancer (mCRC) in patients who have failed treatment with fluoropyrimidine, oxaliplatin and irinotecan based chemotherapy, an anti-VEGF therapy and, if KRAS wild type, an anti-EGFR therapy. The FDA based this approval on data from the CORRECT trial, which showed the efficacy of regorafenib compared with placebo. The most common grade 3–4 adverse reactions with the drug are hand foot skin reactions (HFSR), diarrhea, hypertension and fatigue. This review discusses the efficacy data, and the incidence and management of regorafenib’s toxicities.

Objective To analyze female breast cancer data for Mississippi from 2005 to 2009 to test whether race and/or geography had an impact on the stage of breast cancer at the time of diagnosis. Methods A cross-sectional design for data was developed and collected by the Mississippi Cancer Registry (MCR). The MCR dataset contained female breast cancer cases diagnosed between 2005 and 2009. Of the 9699 cases used, 2925 were white patients living in urban counties and 3584 were white patients residing in a rural county. Among African American patients, 1247 lived in urban areas, and 1943 resided in rural counties. Results Geography had a significant impact on the stage of breast cancer at which the patient was diagnosed. Women living in rural Mississippi had a greater chance (white 4% and African American 19%) of presenting with advanced regional/distant breast cancer rather than in situ/localized breast cancer. The number of white patients was similar to the number of African American patients who presented at the time of diagnosis with advanced regional/distant breast cancer. African American women had greater odds than white women (urban 25%, rural 47%) of presenting with advanced regional/distant breast cancer. Conclusions This study provides important new information about two specific factors that may affect the stage of breast cancer diagnosis: race (whites vs African Americans) and geography (urban vs rural county). The implications of this study will aid the Mississippi State Department of Health in targeting screening programs throughout the state. The results also may affect medical and allied health care.

This white paper describes gallbladder and biliary incidental findings found on CT and MRI. Recommendations for management are included. This represents the fourth of 4 such papers from the ACR Incidental Findings Committee II, which used a consensus method based on repeated reviews and revisions and a collective review and interpretation of relevant literature. Topics include the management of a variety of gallbladder abnormalities and biliary dilation. A table is provided for reference.

We report the case of a 52-year-old female with multiple medical complaints and extensive prior clinical and imaging workup who presented to the emergency department with weakness and recurrent episodes of abdominal pain. She had had multiple inconclusive routine computed tomographic (CT) examinations. A 7-mm small bowel tumor was diagnosed on CT enterography and subsequently confirmed to be a carcinoid tumor of the ileum by enteroscopy and at surgery. The diagnosis was suggested prospectively utilizing CT enterography performed in the emergency radiology suite.

Imaging has an important role in the diagnosis and staging of patients with lymphoma, with a major influence on both patient management and outcome. CT is probably the most widely used modality in patients with lymphoma bur MRI is probably as useful as CT in the initial work-up of the patient. Finally, PET/CT can detect residual disease in patients post-treatment better than both CT and MRI and is playing an increasing role in the imaging of patients with lymphoma.

Imaging has an important role in the diagnosis and staging of patients with lymphoma, with a major influence on both patient management and outcome. CT is probably the most widely used modality in patients with lymphoma bur MRI is probably as useful as CT in the initial work-up of the patient. Finally, PET/CT can detect residual disease in patients post-treatment better than both CT and MRI and is playing an increasing role in the imaging of patients with lymphoma.

To assess whether independent evaluation of coronal and sagittal reformatted images can replace axial images for primary interpretation of multidetector row computed tomography (MDCT) images in patients with thoraco-abdominal trauma. 111 (M/F 69:42) patients with acute chest or abdominal trauma underwent 16-channel MDCT. Coronal and sagittal multiplanar reformatted (MPR) images were generated from thin-section axial images. Two radiologists independently interpreted the MPR images first followed by axial images for both imaging findings as well as adequacy of image quality. Differences between independent reader review of axial and MPR images were assessed using the Wilcoxon signed rank test. There was no significant difference in soft tissue findings identified on MPR vs axial images for either reader, p = 0.91 and 0.34, respectively. However, both readers identified more skeletal findings on the MPR as compared to the axial images, p = 0.026 and 0.040, respectively. There was no significant difference between the readers in their interpretation of axial (soft tissue, p = 0.56; skeletal, p = 0.65) or MPR (soft tissue, p = 0.32; skeletal, p = 0.65) findings. More skeletal findings were identified during the isolated review of MPR as compared to axial images alone. However, the use of MPR images alone still resulted in an unacceptably high number of missed soft tissue and even skeletal findings. A combined approach where both data sets are simultaneously available is therefore preferred.

To compare fusion, positron emission tomography–computed tomography (PET–CT) with CT alone in detecting ovarian carcinoma recurrence. Fifty-one consecutive patients underwent 53 restaging PET–CT scans with a concurrent diagnostic quality CT scan. Two body imaging radiologists independently assessed the CT’s; each then teamed with a nuclear medicine specialist to review the PET–CT’s. Two teams conferred for consensus on the presence of disease in the chest, abdomen, and body overall with CT alone and with PET–CT, using a six-point reader confidence metric to determine accuracy and receiver operating characteristic (ROC) curves. Reader agreement was compared using kappa. Recurrence was determined by two gynecologic oncologists reviewing clinical records from time of presentation to at least 13 months (mean 22.7) after imaging. Recurrence was based on histopathology in 17% (9/53). Seventy-two percent (38/53) cases had recurrence, with two cases showing isolated chest recurrence. PET–CT accuracy exceeded CT for body 92% (49/53) vs. 83% (44/53), chest 96% (51/53) vs. 89% (47/53), and abdomen 91% (48/53) vs. 79% (42/53). ROC curves for PET–CT dominated that for CT alone; this difference was statistically significant for abdomen and for body overall (P

Technical advances in the past decade have made computed tomography (CT) increasingly valuable in the early clinical management of patients with polytrauma. The development of multidetector CT (MDCT) has transformed CT from a simple, crosssectional imaging technique to an advanced, three-dimensional (3-D) imaging modality, enabling excellent 3-D displays [1]. Multislice CT scanning is associated with a substantial gain in performance, decreased scan timers, reduced section collimation, and reduction in scan length. The combined value of MDCT and 3-D reformations in assessment of the musculoskeletal system has been documented in the literature. The high contrast interface between bone and adjacent tissues in the musculoskeletal system makes it ideal for 3-D evaluation. The increased acquisition speed of MDCT with superior image resolution enables rapid diagnostic work up and institution of therapy in the setting of musculoskeletal trauma.

Malakoplakia is an uncommon chronic inflammatory condition with distinct histopathologic features. Herein, we report a 64-year-old Caucasian female with anemia and renal failure, who presented with 4 weeks of hematuria, vaginal bleeding, and left hip pain. Magnetic resonance imaging demonstrated a 10-cm soft tissue mass in the pelvis, which involved the left pelvic sidewall, the left external iliac vein …

To evaluate if coronal reformatted images can be used for primary interpretation of MDCT of the abdomen and pelvis using 64-slice MDCT.IRB approval was obtained. We reviewed MDCT studies of the abdomen and pelvis of 220 consecutive patients performed with 64 row MDCT with constant scanning parameters. Based on a 0.625mm raw data set, transverse images were reconstructed at 5mm and coronal images at 3mm using standard reconstruction algorithms. Reader familiarity was achieved by simultaneous evaluation of transverse and coronal reformats in an initial group of 20 separate cases for findings in consensus. Two subsequent phases of image analysis were then performed in two groups of 100 patients each. In the first phase two radiologists evaluated the added utility of simultaneous review of MDCT of transverse and coronal reformatted images over transverse images alone in 100 consecutive patients referred for MDCT of the abdomen and pelvis. In the second phase, the same radiologists evaluated whether coronal multiplanar reformats could be used for primary interpretation of MDCT of the abdomen and pelvis in a separate but similar cohort of 100 consecutive abdominopelvic MDCT studies. The number of lesion(s), their location, size of smallest lesion, presence of artifacts and likely diagnosis were noted at each image interpretation. Image quality and confidence for interpretation was evaluated using five-point and three-point scale, respectively. The time required for primary interpretation of coronal reformats and transverse images were recorded. Statistical analysis was performed using Wilcoxon signed rank test.Both readers detected additional findings (n=37, 35), respectively, on simultaneous review of transverse and coronal reformats as compared with transverse images alone (p0.001). Excellent interobserver agreement was noted (r=0.94-0.96). Both readers detected additional findings (n=62, 53), respectively, on independent review of coronal reformats as compared with transverse images alone (p0.001). Readers' confidence was also found to be higher on coronal evaluations as compared to axial images (p0.01). There was good interobserver agreement between the two readers.Independent coronal multiplanar reformatted images obtained using state-of-the-art MDCT scanners show promise as the preferred orientation and can be useful for primary interpretation of MDCT of the abdomen and pelvis.