Search
CTisus CT Scanning CTisus CT Scanning CTisus CT Scanning CTisus CT Scanning CTisus CT Scanning CTisus CT Scanning CTisus CT Scanning Ask the Fish

Everything you need to know about Computed Tomography (CT) & CT Scanning

September 2017 Imaging Pearls - Learning Modules | CT Scanning | CT Imaging | CT Scan Protocols - CTisus
Imaging Pearls ❯ September 2017

-- OR --

3D and Workflow

    • “For comprehensive improvements to health care delivery, other failures in the cycle besides diagnostic interpretive error—such as ordering inappropriate studies, PACS failures, and a lack of accurate clinician contact information (with resultant communication failure)—should be recognized as contributors to patient harm because they lead to wasted resources and delayed care. By taking ownership of the entire imaging cycle, radiologists can increase their net worth to patient care and cement their roles as experts in the effective, evidence-based use of imaging technologies.”


      Systemic Error in Radiology.
Waite S, Scott JM, Legasto A et al.
AJR Am J Roentgenol. 2017 Sep;209(3):629-639
    • “Although interpretative errors related to faulty visual detection, pattern recognition, or cognitive reasoning are the most common cause of malpractice litigation against radiologists , Jones et al. found that more than 62% of errors, incidents (defined as an event or circumstance that may have resulted in unnecessary patient harm), and process failures occur in other phases of the cycle.”


      Systemic Error in Radiology.
Waite S, Scott JM, Legasto A et al.
AJR Am J Roentgenol. 2017 Sep;209(3):629-639
    • “Communication errors are the third most common cause of malpractice against radiol- ogists after diagnostic errors and procedural complications. Although most studies of communication failures in radiology focus on results communication, 52.4% of communica- tion errors occur during the ordering, sched- uling, and performance of an imaging ex- amination.”


      Systemic Error in Radiology.
Waite S, Scott JM, Legasto A et al.
AJR Am J Roentgenol. 2017 Sep;209(3):629-639
    • “For comprehensive improvements to health care delivery, other failures in the cycle besides diagnostic interpretive error— such as inappropriate imaging, PACS failures, and a lack of accurate clinician contact information (with resultant communication failure)—should be recognized as contributors to patient harm because they lead to wasted resources and delayed care. By taking ownership of the entire imaging cycle, radiologists can increase their net worth to patient care and cement their roles as experts in the effective, evidence-based use of imaging technologies.”


      Systemic Error in Radiology.
Waite S, Scott JM, Legasto A et al.
AJR Am J Roentgenol. 2017 Sep;209(3):629-639
    • “By taking ownership of the entire imaging cycle, radiologists can increase their net worth to patient care and cement their roles as experts in the effective, evidence-based use of imaging technologies.”


      Systemic Error in Radiology.
Waite S, Scott JM, Legasto A et al.
AJR Am J Roentgenol. 2017 Sep;209(3):629-639
    • “ The common theme from attendees was that everyone participating in medical image evaluation with machine learning is data starved. There is an urgent need to find better ways to collect, annotate, and reuse medical imaging data. Unique domain issues with medical image datasets require further study, development, and dissemination of best practices and standards, and a coordinated effort among medical imaging domain experts, medical imaging informaticists, government and industry data scientists, and interested commercial, academic, and government entities.”


      Medical Image Data and Datasets in the Era of Machine Learning—Whitepaper from the 2016 C-MIMI Meeting Dataset Session 
Marc D. Kohli & Ronald M. Summers & J. Raymond Geis
J Digit Imaging (2017) 30:392–399 

    • “The amount and quality of training data are dominant influencers on a machine learning (ML) model’s performance. The common theme from all attendees was that everyone participating in medical image evaluation with machine learning is data starved. This is a particularly pressing problem in the new era of deep learning.”


      Medical Image Data and Datasets in the Era of Machine Learning—Whitepaper from the 2016 C-MIMI Meeting Dataset Session 
Marc D. Kohli & Ronald M. Summers & J. Raymond Geis
J Digit Imaging (2017) 30:392–399 

    • “Radiologists’ reports are not definitive expressions of ground truth. A retrospective 20-year literature re- view in 2001 suggested that the level of significant radiology error ranged between 2 and 20% . This is not limited to radiology; a Mayo clinic study comparing clinical diagnoses with postmortem autopsies reported that a major diagnosis was missed clinically in 26% of patients.”

      
Medical Image Data and Datasets in the Era of Machine Learning—Whitepaper from the 2016 C-MIMI Meeting Dataset Session 
Marc D. Kohli & Ronald M. Summers & J. Raymond Geis
J Digit Imaging (2017) 30:392–399 

    • “In contrast, most publically available medical image datasets have tens or hundreds of cases, and datasets with more than 5000 well-annotated cases are rare. In the USA, individual healthcare institutions may have 103 up to rarely 107 of an exam type. These common radiology exam types, for example, chest radiographs, unenhanced brain CTs, mammograms, and abdominal CTs, are often high-dimensional data due to variations in pathology, technique, radiology interpretation, patient population, and clinical setting.”

      
Medical Image Data and Datasets in the Era of Machine Learning—Whitepaper from the 2016 C-MIMI Meeting Dataset Session 
Marc D. Kohli & Ronald M. Summers & J. Raymond Geis
J Digit Imaging (2017) 30:392–399 

    • “Action items, and priority research topics, for this field of study include the following: 
Describe, via a whitepaper, the high-level attributes of reusable medical image datasets suitable to train, test, validate, verify, and regulate ML products 
& Describe common categories of use cases for medical image datasets, and understand unique dataset attributes applicable to each 
& Describe the metadata, framework, and standards needed to catalog and discover datasets of medical images appropriate for ML. 
& Understand and describe business cases and models for medical image datasets.”


      Medical Image Data and Datasets in the Era of Machine Learning—Whitepaper from the 2016 C-MIMI Meeting Dataset Session 
Marc D. Kohli & Ronald M. Summers & J. Raymond Geis
J Digit Imaging (2017) 30:392–399 

    • “Deep learning is an important new area of machine learning which encompasses a wide range of neural network architectures designed to complete various tasks. In the medical imaging domain, example tasks include organ segmentation, lesion detection, and tumor classification. The most popular network architecture for deep learning for images is the convolutional neural network (CNN). Whereas traditional machine learning requires determination and calculation of features from which the algorithm learns, deep learning approaches learn the important features as well as the proper weighting of those features to make predictions for new data.”

      
Toolkits and Libraries for Deep Learning 
Bradley J. Erickson et al. 
J Digit Imaging (2017) 30:400–405
    • “As the organ shortage continues to grow, the creation of social media communities by transplant centers and the public is rapidly expanding to increase the number of living donors. Social media communities are arranged in myriad ways, and without standardization, raising concerns about potential recipients' and potential donors' autonomy and quality of care. Social media communities magnify and modify extant ethical issues in deceased and living donation related to privacy, confidentiality, professionalism, and informed consent, and increase the potential for undue influence and coercion for potential living donors and transplant candidates. Currently, no national ethical guidelines have been developed in the U.S. regarding the use of social media to foster organ transplantation. We provide an ethical framework to guide transplant stakeholders in using social media for public and patient communication about transplantation and living donation, and offer recommendations for transplant clinical practice and future research.”


      Social Media and Organ Donation: Ethically Navigating the Next Frontier.
Henderson ML et al.
Am J Transplant. 2017 Jul 25. doi: 10.1111/ajt.14444. [Epub ahead of print]
    • “As the organ shortage continues to grow, the creation of social media communities by transplant centers and the public is rapidly expanding to increase the number of living donors. Social media communities are arranged in myriad ways, and without standardization, raising concerns about potential recipients' and potential donors' autonomy and quality of care. Social media communities magnify and modify extant ethical issues in deceased and living donation related to privacy, confidentiality, professionalism, and informed consent, and increase the potential for undue influence and coercion for potential living donors and transplant candidates. Currently, no national ethical guidelines have been developed in the U.S. regarding the use of social media to foster organ transplantation.”


      Social Media and Organ Donation: Ethically Navigating the Next Frontier.
Henderson ML et al.
Am J Transplant. 2017 Jul 25. doi: 10.1111/ajt.14444. [Epub ahead of print]
    • “Cancer patients and their caregivers are increasingly using social media as a platform to share cancer experiences, connect with support, and exchange cancer-related information. Yet, little is known about the nature and scientific accuracy of cancer-related information exchanged on social media. We conducted a content analysis of 12 months of data from 18 publically available Facebook Pages hosted by parents of children with acute lymphoblastic leukemia (N = 15,852 posts) and extracted all exchanges of medically-oriented cancer information. We systematically coded for themes in the nature of cancer-related information exchanged on personal Facebook Pages and two oncology experts independently evaluated the scientific accuracy of each post.” 

      
Is Cancer Information Exchanged on Social Media Scientifically Accurate?
Gage-Bouchard EA et al.
J Cancer Educ. 2017 Jul 19. doi: 10.1007/s13187-017-1254-z. [Epub ahead of print
    • “Of the 15,852 total posts, 171 posts contained medically-oriented cancer information. The most frequent type of cancer information exchanged was information related to treatment protocols and health services use (35%) followed by information related to side effects and late effects (26%), medication (16%), medical caregiving strategies (13%), alternative and complementary therapies (8%), and other (2%). Overall, 67% of all cancer information exchanged was deemed medically/scientifically accurate, 19% was not medically/scientifically accurate, and 14% described unproven treatment modalities. These findings highlight the potential utility of social media as a cancer-related resource, but also indicate that providers should focus on recommending reliable, evidence-based sources to patients and caregivers.” 


      Is Cancer Information Exchanged on Social Media Scientifically Accurate?
Gage-Bouchard EA et al.
J Cancer Educ. 2017 Jul 19. doi: 10.1007/s13187-017-1254-z. [Epub ahead of print
    • “The success of gender-diverse teams isn’t true just in companies but also on boards. When there is a higher representation of women on boards, companies have more meetings, have higher attendance rates, experience greater participation in decision making, engage in tougher monitoring, and are more likely to replace CEOs when stock performs poorly.”


      The Cost of Unconscious Bias and Pattern Recognition
Jenny Abramson, Elliot K. Fishman, Karen M. Horton, Sheila Sheth 
Journal of the American College of Radiology , Volume 14 , Issue 8 , 1119 - 1121
    • “When you combine this concept of pattern recognition with the fact that fewer than 6% of people making investment decisions at venture capital firms are women, it’s not surprising that venture capitalists might often overlook female entrepreneurs in their attempt to unearth the “next big thing”.


      The Cost of Unconscious Bias and Pattern Recognition
Jenny Abramson, Elliot K. Fishman, Karen M. Horton, Sheila Sheth 
.Journal of the American College of Radiology , Volume 14 , Issue 8 , 1119 - 1121
    • “With 70% of consumer spending decisions being made by women (and an even higher percentage when it comes to health care decisions) and two-thirds of all the wealth in the United States being controlled by women by 2030, if you don’t have women participating in strategy and product decision making, one could argue that you are leaving money on the table”.


      The Cost of Unconscious Bias and Pattern Recognition
Jenny Abramson, Elliot K. Fishman, Karen M. Horton, Sheila Sheth 
.Journal of the American College of Radiology , Volume 14 , Issue 8 , 1119 - 1121
    • “Although these data and experience are clearly focused on venture capital and business, many of these findings and lessons may apply equally to other sectors, including health care and radiology, where, as in venture capital, pattern recognition may be both the key to success and a significant risk.”


      The Cost of Unconscious Bias and Pattern Recognition
Jenny Abramson, Elliot K. Fishman, Karen M. Horton, Sheila Sheth 
.Journal of the American College of Radiology , Volume 14 , Issue 8 , 1119 - 1121
    • “In terms of diversity, specifically gender diversity, our profession lags significantly behind other medical specialties. A survey by the ACR found that in 2014, women consti- tuted 22% of radiologists, a figure that had not changed significantly since 2007, even though women now account for about half of all medical students. The numbers of women in private practice and at the highest level of radiology leadership are even lower.”


      The Cost of Unconscious Bias and Pattern Recognition
Jenny Abramson, Elliot K. Fishman, Karen M. Horton, Sheila Sheth 
.Journal of the American College of Radiology , Volume 14 , Issue 8 , 1119 - 1121
    • “Creating a radiology workplace that is attractive to women will be a major step forward in the recruitment process. As Ms Abramson states, if we can recruit and retain a more diverse workforce, we will be rewarded with more successful departments with greater ability to realize our full potential.”


      The Cost of Unconscious Bias and Pattern Recognition
Jenny Abramson, Elliot K. Fishman, Karen M. Horton, Sheila Sheth 
.Journal of the American College of Radiology , Volume 14 , Issue 8 , 1119 - 1121
    • “However, instead of ray casting methods, in which each pixel is formed by one light ray, the algorithm used in cinematic rendering is based on path-tracing methods and the global illumination model which simulate the different paths of billions of photons traveling from all possible directions through a volumetric dataset and their interaction with the volume to form one pixel. As a result, the technique models the real-life physical propagation of light and generates a highly photorealistic 3D image based on the acquired data.”

      
Cinematic Rendering in CT: A Novel, Lifelike 3D Visualization Technique 
Eid M et al.
AJR 2017; 209:370–379
    • “To attain photorealistic quality, high dynamic range rendering light maps are used to create a natural lighting en- vironment by simulating realistic lighting effects from real-world environments, which are then applied to the rendering scene.”

      
Cinematic Rendering in CT: A Novel, Lifelike 3D Visualization Technique 
Eid M et al.
AJR 2017; 209:370–379
    • “Compared with the results of volume rendering, the more realistic light me- ulation of cinematic rendering although it does not affect spatial resolution enhances evaluation of spatial relations, particularly in the through plane. .”


      Cinematic Rendering in CT: A Novel, Lifelike 3D Visualization Technique 
Eid M et al.
AJR 2017; 209:370–379
    • “Cinematic rendering entails the use of complex high dynamic range rendering maps to create a natural lighting environment, as opposed to the synthetic light source of vol- ume rendering. The result of this difference in lighting functions available in cinematic rendering is an overall more lifelike and vi- sually appealing 3D image, compared with a volume-rendered image, that has a focus on improving depth and shape perception .”

      
Cinematic Rendering in CT: A Novel, Lifelike 3D Visualization Technique 
Eid M et al.
AJR 2017; 209:370–379
    • “Although surgical planning is classically done by mentally integrating multiple images, possibly obtained with different modalities, cinematic rendering generates an all-in one highly realistic 3D representation of the structures of interest with a single modality. Image manipulation allows visualization of anatomic details from different perspectives.”


      Cinematic Rendering in CT: A Novel, Lifelike 3D Visualization Technique 
Eid M et al.
AJR 2017; 209:370–379
    • “Moreover, 3D imaging can be a helpful tool for preoperative and postoperative assessment of renal and liver grafts, paricularly in establishing vascular anatomy. The complexity of gastrointestinal anatomy also lends itself to 3D visualization techniques, as already evidenced in virtual colonoscopy. Cinematic rendering may have an adjunct role in detecting gastrointestinal diseases such as occlusions, strictures, herniation, and tumors and aid physicians and surgeons in treatment planning.”

      
Cinematic Rendering in CT: A Novel, Lifelike 3D Visualization Technique 
Eid M et al.
AJR 2017; 209:370–379
Kidney

    • “The most common abdominal manifestation of ECD is retroperitoneal xanthogranulomatosis, with involvement of the kidneys, ureters, and aorta. Perirenal and periureteral manifestations of ECD include a thick rind-like soft-tissue lesion encasing the renal parenchyma and ureters leading to obstruction. This perirenal soft-tissue infiltration has a characteristic, so-called hairy kidney appearance, which is pathognomonic for ECD.”


      Spectrum of Xanthogranulomatous Processes in the Abdomen and Pelvis: A Pictorial Review of Infectious, 
Inflammatory, and Proliferative Responses 
Kelsey S. Bourm et al.
AJR 2017; 208:475–484
    • “ECD is a rare multisystem non–Langerhans cell histiocytotic disorder primarily affecting middle-aged to older adults, with a slight male predominance. Histologically, ECD shows focal fibrosis with foamy histiocyte infiltration. The histiocyte cells are positive for cluster of differentiation (CD) 68 and negative for S-100, CD1a, or Birbeck granules, which differentiates ECD from Langerhans type histiocytosis.”


      Spectrum of Xanthogranulomatous Processes in the Abdomen and Pelvis: A Pictorial Review of Infectious, In ammatory, and Proliferative Responses 
Kelsey S. Bourm et al.
AJR 2017; 208:475–484
    • “FDG PET allows accurate evaluation of the extent of the disease; it also helps in assessing the degree of visceral and vascular involvement. As with all XG processes, ECD exhibits GLUT receptors, and FDG uptake is seen in the organs affected. Retroperitoneal xanthogranulomatosis usually exhibits intense FDG avidity.”


      Spectrum of Xanthogranulomatous Processes in the Abdomen and Pelvis: A Pictorial Review of Infectious, In ammatory, and Proliferative Responses 
Kelsey S. Bourm et al.
AJR 2017; 208:475–484
    • “Another important retroperitoneal structure involved is the aorta, which presents with circumferential soft-tissue-like sheathing, giving a so-called coated aorta appearance. The infiltration may extend into the branching vessels, such as the mesenteric and renal arteries.”


      Spectrum of Xanthogranulomatous Processes in the Abdomen and Pelvis: A Pictorial Review of Infectious, In ammatory, and Proliferative Responses 
Kelsey S. Bourm et al.
AJR 2017; 208:475–484
    • “Xanthogranulomatous processes are un- common. However, they should be considered when an aggressive process is present on abdominal imaging. Although XG processes are nonspecific, recognizing features of XG processes may have a significant impact on patient management, surgical planning, and patient morbidity. Imaging also plays a significant role in assessing disease extension and commonly occurring associated complications. Knowledge of the histopathologic behavior of these processes may aid in consideration of xanthogranulomatous entities in a differential diagnosis.”


      Spectrum of Xanthogranulomatous Processes in the Abdomen and Pelvis: A Pictorial Review of Infectious, Inflammatory, and Proliferative Responses 
Kelsey S. Bourm et al.
AJR 2017; 208:475–484
    • ”XG pyelonephritis is an unusual variant of chronic pyelonephritis or recurrent bacterial tract infections. It occurs in the setting of chronic obstruction from an infected renal stone and altered immune response. These infections produce a chronic granulomatous 
inflammatory response and eventual destruction of the renal parenchyma, with the renal parenchyma eventually being replaced by lipid-laden (foamy) macrophages.” 


      Spectrum of Xanthogranulomatous Processes in the Abdomen and Pelvis: A Pictorial Review of Infectious, Inflammatory, and Proliferative Responses 
Kelsey S. Bourm et al.
AJR 2017; 208:475–484
    • “Typically, a large staghorn calculus and hydronephrosis are seen. Other associations with XG pyelonephritis include ureteropelvic junction obstruction, ureteropelvic duplication, bladder tumor, chronic interstitial nephritis, and calyceal stones.”


      Spectrum of Xanthogranulomatous Processes in the Abdomen and Pelvis: A Pictorial Review of Infectious, Inflammatory, and Proliferative Responses 
Kelsey S. Bourm et al.
AJR 2017; 208:475–484
    • “XG pyelonephritis typically presents in middle-aged women with a history of recur- rent urinary tract infections, diabetes mellitus, or obstructing renal calculi. Cases in children and in the elderly are also reported. The patient may present with nonspecific complaints such as malaise, fatigue, lethargy, recurrent low-grade fever, and flank pain.”

      Spectrum of Xanthogranulomatous Processes in the Abdomen and Pelvis: A Pictorial Review of Infectious, Inflammatory, and Proliferative Responses 
Kelsey S. Bourm et al.
AJR 2017; 208:475–484
    • “Clinically, patients may present with a palpa- ble abdominal mass, urinary tract infections, or fistulous tracts. Laboratory studies often show leukocytosis, anemia, elevated C-reactive protein, and erythrocyte sedimentation rate. Positive urine cultures with Proteus mirabillis and Escherichia coli are most frequently seen with XG pyelonephritis, although other pathogens may be found.”

      Spectrum of Xanthogranulomatous Processes in the Abdomen and Pelvis: A Pictorial Review of Infectious, Inflammatory, and Proliferative Responses 
Kelsey S. Bourm et al.
AJR 2017; 208:475–484
    • “Contrast-enhanced CT shows low-attenuation blown-out calyces replacing the renal parenchyma and cortical thinning, representing the classic “bear paw sign”. These blown-out calyces either signify dilated calyces or renal parenchyma filled with pus, debris, or hemorrhage.” 


      Spectrum of Xanthogranulomatous Processes in the Abdomen and Pelvis: A Pictorial Review of Infectious, Inflammatory, and Proliferative Responses 
Kelsey S. Bourm et al.
AJR 2017; 208:475–484
    • “Peripheral enhancement of the masses is also seen. The remainder of the kidney often shows nonenhancement or lack of excretion, indicating a nonfunctioning kidney. A large staghorn calculus with contraction of the renal pelvis can be seen. Associated hypoattenuation is often seen in the renal pelvis mimicking hydronephrosis, but in most cases this region of hypoattenuation rep- resents an extensive inflammatory process.” 


      Spectrum of Xanthogranulomatous Processes in the Abdomen and Pelvis: A Pictorial Review of Infectious, Inflammatory, and Proliferative Responses 
Kelsey S. Bourm et al.
AJR 2017; 208:475–484
    • “Surrounding perinephric inflammatory changes are common with extrarenal exten- sion. A high rate of complications is reported with diffuse XG pyelonephritis, including perforation with abscess formation involving the spleen, paraspinal muscles, or psoas muscles. Fistula tracts are also common, with case reports of renocutaneous, renocolic, or nephrobronchial fistula tracts.” 


      Spectrum of Xanthogranulomatous Processes in the Abdomen and Pelvis: A Pictorial Review of Infectious, Inflammatory, and Proliferative Responses 
Kelsey S. Bourm et al.
AJR 2017; 208:475–484
    • “Xanthogranulomatous (XG) processes are rare inflammatory conditions with the characteristic pathologic feature of lipid-laden macrophages or histiocyte cells. Imaging findings are nonspecific and can simulate aggressive neoplastic processes. XG processes can be caused by infection, inflammation, histolytic process, or an inherited lysosomal disorder. XG infectious processes are mainly seen in cholecystitis and pyelonephritis, but several other organs can also be involved. Histiocytic processes can be divided into Langerhans and non–Langerhans cell histiocytosis. The non–Langerhans cell histiocytosis entities include Erdheim-Chester disease, Rosai-Dorfman disease, juvenile xanthogranuloma, and he- mophagocytic lymphohistiocytosis. The inherited lysosomal disorders resulting in XG processes include Nieman-Pick, Gaucher, and other lysosomal storage disorders.” 


      Spectrum of Xanthogranulomatous Processes in the Abdomen and Pelvis: A Pictorial Review of Infectious, Inflammatory, and Proliferative Responses 
Kelsey S. Bourm et al.
AJR 2017; 208:475–484
Liver

    • “ICC (Intrahepatic cholangiocarcinoma) 
can be classified on the basis of the macroscopic tumor growth pattern as mass- forming type, periductal infiltrating type, or intraductal growing type according to the classification of the Liver Cancer Study Group of Japan. The mass-forming type is the most common, accounting for 78% of all cases of ICC.”


      Cross-Sectional Imaging of Intrahepatic Cholangiocarcinoma: Development, Growth, Spread, and Prognosis 
Seo N et al.
AJR 2017; 209:W64–W75
    • “The mass-forming type is the most common, accounting for 78% of all cases of ICC. Tumors of this type are usually large, up to 15 cm in diameter. The majority manifest as well-defined lobulated masses with varying degrees of central sclerotic changes. Multicentricity around the main tumor is common, probably because mass-forming ICC commonly invades the adjacent portal vein branches.”


      Cross-Sectional Imaging of Intrahepatic Cholangiocarcinoma: Development, Growth, Spread, and Prognosis 
Seo N et al.
AJR 2017; 209:W64–W75
    • “Periductal infiltrating tumors extend lon- 
gitudinally along the bile ducts and cause bile duct wall thickening. Progressive periductal invasion causes luminal stenosis and proximal biliary dilatation. Although periductal infiltrating type is the most common type of hilar cholangiocarcinoma, it is much less common in ICC, constituting approximately 16% of ICCs.”


      Cross-Sectional Imaging of Intrahepatic Cholangiocarcinoma: Development, Growth, Spread, and Prognosis 
Seo N et al.
AJR 2017; 209:W64–W75
    • “Intraductal growing ICC is the rarest type of ICC (approximately 6%) and presents as a papillary tumor within the dilated bile duct lumen; this type shares morphologic features with intra- ductal papillary neoplasm of the bile duct (IPNB). Intraductal growing ICCs are usually small, sessile, or polypoid and spread along the mucosa with multiplicity.”


      Cross-Sectional Imaging of Intrahepatic Cholangiocarcinoma: Development, Growth, Spread, and Prognosis 
Seo N et al.
AJR 2017; 209:W64–W75
Pancreas

    • “ A study led by Gangi and colleagues28 was conducted to test the value of imaging in early diagnosis of pancreatic cancer. For the study, 2 radiologists blindly interpreted 62 CT scans performed before a pancreatic cancer clinical diagnosis was made, and both radiologists agreed that suspicious findings were present in 50% of CT scans performed within 18 months prior to pancreatic cancer diagnosis.”


      Current Status and Future Directions 
for Screening Patients at High Risk for Pancreatic Cancer 
Florencia McAllister et al.
Gastroenterology & Hepatology Volume 13, Issue 5 May 2017;268-275
    • “However, only 7% of CT scans performed more than 18 months prior to diagnosis showed suspicious lesions.28 e main early signs detected in the CT scans are pancreatic ductal dilation and cutoff. However, it should be noted that many patients had normal CT scans even 6 months before diagnosis, highlighting the importance of further developing novel imaging methods to detect smaller lesions. CT has a threshold for lesion detection of 0.3 to 0.5 cm.”


    • Current Status and Future Directions 
for Screening Patients at High Risk for Pancreatic Cancer 
Florencia McAllister et al.
Gastroenterology & Hepatology Volume 13, Issue 5 May 2017;268-275

    • Current Status and Future Directions 
for Screening Patients at High Risk for Pancreatic Cancer 
Florencia McAllister et al.
Gastroenterology & Hepatology Volume 13, Issue 5 May 2017;268-275
      
Current Status and Future Directions 
for Screening Patients at High Risk for Pancreatic Cancer 
Florencia McAllister et al.
Gastroenterology & Hepatology Volume 13, Issue 5 May 2017;268-275
    • “Multidetector computed tomography now offers a powerful tool for the evaluation, diagnosis, and risk stratification of pancreatic cystic neoplasms. Improvements in image quality and spatial reso- lution, as well as sophisticated 3-D reconstruction techniques, allow exquisite assessment of the internal architecture of these lesions that not only may allow the radiologist to provide a specific diagnosis but also to assess features that might predict the risk of malignancy.”

      
Multidetector Computed Tomography in the Evaluation
of Cystic Tumors of the Pancreas 
Siva P. Raman, Elliot K. Fishman 
(in) Cystic Tumors of the Pancreas: Diagnosis and Treatment 
Marco Del Chiaro, StephanL.Haas, RichardD.Schulick Editors
© Springer International Publishing Switzerland 2016
    • “Cystic neuroendocrine tumors almost always demonstrate the presence of either a peripheral “rind” of hypervascular enhancing solid tissue or, alternatively, hyperenhancing mural nodularity along the margins of the cyst. This diagnosis is one of the primary reasons for the inclusion of arterial phase images in the evaluation of a suspected pancreatic cystic neoplasm, as both the solid rim and mural nodularity associated with these lesions are almost always most conspicuous on the arterial phase and may be more difficult to appreciate on venous phase imaging.”

      
Multidetector Computed Tomography in the Evaluation
of Cystic Tumors of the Pancreas 
Siva P. Raman, Elliot K. Fishman 
(in) Cystic Tumors of the Pancreas: Diagnosis and Treatment 
Marco Del Chiaro, StephanL.Haas, RichardD.Schulick Editors
© Springer International Publishing Switzerland 2016
    • “Unfortunately, given that the hypervascular components may be less conspicuous on the venous phase, these lesions are not infre- quently incorrectly diagnosed as IPMN when only a venous phase is acquired. In addition, the presence of other signs of metastatic dis- semination can also be a strong clue to the correct diagnosis, including hyperenhancing liver or lymph node metastases.”


      Multidetector Computed Tomography in the Evaluation
of Cystic Tumors of the Pancreas 
Siva P. Raman, Elliot K. Fishman 
(in) Cystic Tumors of the Pancreas: Diagnosis and Treatment 
Marco Del Chiaro, StephanL.Haas, RichardD.Schulick Editors
© Springer International Publishing Switzerland 2016
    • “Solid pseudopapillary neoplasms (SPEN), also known Hamoudi tumors or Franz tumors, are rare pancreatic neoplasms which are almost always seen in young women (usually under 35 years of age), with only a small minority of cases diagnosed in men (~12 %). As a result of this age and gender predisposition, these tumors are frequently referred to as “daughter” tumors. Although less certain, some studies have suggested a slightly higher incidence in patients of African or Asian ethnicities.”


      Multidetector Computed Tomography in the Evaluation
of Cystic Tumors of the Pancreas 
Siva P. Raman, Elliot K. Fishman 
(in) Cystic Tumors of the Pancreas: Diagnosis and Treatment 
Marco Del Chiaro, StephanL.Haas, RichardD.Schulick Editors
© Springer International Publishing Switzerland 2016
    • “While these lesions are classified as low-grade malignancies, they have an excellent prognosis after surgical resection, with fewer than 10% of patients demonstrating distant metastases (usually to the liver) or locoregional lymphadenopathy and reported 5-year survival rates as high as 94–97 %. In fact, given the relative indolence of these lesions, it is not surprising that these tumors are increasingly being identified incidentally on imaging, with over 40% of all cases found in patients undergoing imaging for unrelated reasons.”

      
Multidetector Computed Tomography in the Evaluation
of Cystic Tumors of the Pancreas 
Siva P. Raman, Elliot K. Fishman 
(in) Cystic Tumors of the Pancreas: Diagnosis and Treatment 
Marco Del Chiaro, StephanL.Haas, RichardD.Schulick Editors
© Springer International Publishing Switzerland 2016
    • “In some cases, the presence of gross intratumoral or peritumoral hemorrhage may be present and is very strongly suggestive of SPEN, although blood within the lesion is often easier to perceive on MRI compared to CT . In rare instances, SPEN can be associated with large retroperitoneal hemorrhage that may result in the patient’s presentation. Calcification is very frequent and may be seen either within the center of the lesion or peripherally.”


      Multidetector Computed Tomography in the Evaluation
of Cystic Tumors of the Pancreas 
Siva P. Raman, Elliot K. Fishman 
(in) Cystic Tumors of the Pancreas: Diagnosis and Treatment 
Marco Del Chiaro, StephanL.Haas, RichardD.Schulick Editors
© Springer International Publishing Switzerland 2016
    • “All lesions were well-defined and were exophytic off the pancreatic parenchyma. The lesion in Patient #2 had a unilocular cystic appearance, whereas the lesions in the other patients had a multilocular cystic appearance. The wall and septum of the cysts were enhanced. The contents of the cysts seemed homogeneous low density without enhancement. There were no solid portions within the cysts, calcification of the wall of the cyst, or dilatation of the main pancreatic duct, in any of the patients.”

      
Clinical and radiological feature of lymphoepithelial cyst of the pancreas
Hirofumi Terakawa et al.
World J Gastroenterol. Dec 7, 2014; 20(45): 17247-17253

    • “A LEC is a rare benign lesion, which is lined with mature keratinizing squamous epithelium and surrounded by lymphoid tissue. It typically develops in middle-aged and elderly men, and it is localized to all parts of the pancreas with equal frequency. The mean size of these cysts is 47 mm. The cyst may be multilocular (60% of patients) or unilocular (40% of patients. Many patients with LEC have elevated serum levels of CA19-9. The cyst contents may vary from serous to caseous-like, depending on the degree of keratin formation.”

      
Clinical and radiological feature of lymphoepithelial cyst of the pancreas
Hirofumi Terakawa et al.
World J Gastroenterol. Dec 7, 2014; 20(45): 17247-17253

    • “Because LEC is a benign lesion, it is often possible to select conservative treatment for ones without any significant symptoms if they can be diagnosed correctly. However, surgical resection is still commonly performed because it is difficult to distinguish them from other cystic lesions that require surgical intervention on account of their malignant potential. EUS-guided biopsy coupled with biochemical/tumor marker studies have recently helped to improve the diagnostic accuracy of pancreatic cysts. However, EUS-guided biopsy for cystic lesions of the pancreas is not generally performed in Japan because of the risk of the dissemination of tumor cells or the development of pseudomyxoma.”


      Clinical and radiological feature of lymphoepithelial cyst of the pancreas
Hirofumi Terakawa et al.
World J Gastroenterol. Dec 7, 2014; 20(45): 17247-17253
    • “Lymphoepithelial cysts (LECs) are very rare, non-malignant lesions which were first described by Lüchtrath and Schriefers in 1985. LECs are true pancreatic cysts that are lined by squamous epithelium and surrounded by mature lymphoid tissue. Kavuturu et al. reported that in the 28 years since the first report of an LEC, 109 cases have so far been documented in the literature.”


      Lymphoepithelial Cyst of the Pancreas
Arumugam P et al.
Case Rep Gastroenterol. 2016 Jan-Apr; 10(1): 181–192.
    • “Recent reviews documenting the demographic features of LECs indicate a strong male preponderance, with lesions of variable size distributed throughout the head, body, and tail of the pancreas. Approximately half of the patients present incidentally, with the remaining patients being associated with non-specific symptoms such as nausea, vomiting, diarrhea, abdominal pain, weight loss, and fatigue.”


      Lymphoepithelial Cyst of the Pancreas
Arumugam P et al.
Case Rep Gastroenterol. 2016 Jan-Apr; 10(1): 181–192.
    • “It has been thought to be difficult to differentiate LECs from other pancreatic lesions, such as serous cystic neoplasms, mucinous cystic neoplasms, and intraductal papillary mucinous neoplasms, because the appearance of the LEC on imaging varies from patient to patient and sometimes is similar to other pancreatic lesions.LECs are benign and do not possess malignant potential, and, thus, an accurate identification of these lesions is important to avoid unnecessary intervention.”


      Lymphoepithelial Cyst of the Pancreas
Arumugam P et al.
Case Rep Gastroenterol. 2016 Jan-Apr; 10(1): 181–192.
    • “LECs tend to be well demarcated from surrounding pancreatic and adipose tissue and are commonly spherical with a well-defined wall . Cases are often peripancreatic rather than intrapancreatic, and the cysts can be multilocular (60%) or unilocular (40%). LECs can range in size from 0.5 to 17 cm, although the mean size is usually around 4 cm .”
Lymphoepithelial Cyst of the Pancreas
Arumugam P et al.
Case Rep Gastroenterol. 2016 Jan-Apr; 10(1): 181–192.
    • “Lymphoepithelial cysts are rare (<0.5% of all pancreatic cystic lesions) benign pancreatic cystic neoplasms that are most commonly seen in elderly men between 50 and 70 years old. These lesions have no malignant potential and are usually an incidental finding seen on imaging studies performed for totally unrelated reasons, although patients can rarely present with non- specific symptoms of abdominal pain.”


      Multidetector Computed Tomography in the Evaluation
of Cystic Tumors of the Pancreas 
Siva P. Raman, Elliot K. Fishman 
(in) Cystic Tumors of the Pancreas: Diagnosis and Treatment 
Marco Del Chiaro, StephanL.Haas, RichardD.Schulick Editors
© Springer International Publishing Switzerland 2016
    • “Prospective diagnosis can be extraordinarily difficult, although these lesions do tend to be peripancreatic (abutting and invaginating into the pancreas) rather than being truly of pancreatic origin. If a lesion is suspected to be extrapancreatic, rather than arising from the pancreas itself, lymphoepithelial cyst (along with lymphangioma and pseudocyst) should be considered.”


      Multidetector Computed Tomography in the Evaluation
of Cystic Tumors of the Pancreas 
Siva P. Raman, Elliot K. Fishman 
(in) Cystic Tumors of the Pancreas: Diagnosis and Treatment 
Marco Del Chiaro, StephanL.Haas, RichardD.Schulick Editors
© Springer International Publishing Switzerland 2016
    • “Mucous producing neoplasms are classified into intraductal papillary mucinous neoplasms (IPMNs) and mucinous cystic neoplasms (MCNs), which have distinct biological characteristics. IPMNs arise in the main pancreatic duct or its major branches, whereas MCNs are large cysts with a thick, peripheral rim of calcifications that do not communicate with the pancreatic ductal system.”

      
Pancreatic mucinous cystadenocarcinoma: Epidemiology and outcomes
Doulamis, Ilias P. et al.
International Journal of Surgery , Volume 35 , 76 - 82

    • “MCACs are usually symptomatic at the time of diagnosis, with obstructive jaundice and palpable abdominal mass being commonly present (>25%). Notably, portal hypertension, hemobilia and diabetes mellitus constitute signs of aggressive malignancy. Apart from clinical presentation and imaging techniques, cyst fluid analysis may be useful in the preoperative differential diagnosis of these patients, since detecting K-RAS mutations, carcinoembryonic antigen levels >400 ng/ml and CA19-9 >50,000 U/ml may indicate malignancy over a benign lesion, such as a pseudocyst.”

      
Pancreatic mucinous cystadenocarcinoma: Epidemiology and outcomes
Doulamis, Ilias P. et al.
International Journal of Surgery , Volume 35 , 76 - 82
    • ” In the present study, median patient age at diagnosis was 67 years and the majority was white females. Findings from literature review indicated a similar age range (29–89 years), but over a decade younger with a mean age of 54.3 years. Only two studies reported data regarding patient race; in both studies white race dominated (87.6%). It should be noted that, before 2000, small case-series advocated that female predominance is less common in pancreatic mucinous cystadenocarcinoma compared with benign cystic tumors and some studies even found higher prevalence in males.”

      
Pancreatic mucinous cystadenocarcinoma: Epidemiology and outcomes
Doulamis, Ilias P. et al.
International Journal of Surgery , Volume 35 , 76 - 82
    • ” In the present study, median patient age at diagnosis was 67 years and the majority was white females. Findings from literature review indicated a similar age range (29–89 years), but over a decade younger with a mean age of 54.3 years. Only two studies reported data regarding patient race; in both studies white race dominated (87.6%). It should be noted that, before 2000, small case-series advocated that female predominance is less common in pancreatic mucinous cystadenocarcinoma compared with benign cystic tumors and some studies even found higher prevalence in males .With regard to tumor location, body/tail were the most frequently affected sites both in the SEER analysis (45.6%) and in accordance to literature, despite outdated reports implicating the head of the pancreas as the most common MCAC site.”


      Pancreatic mucinous cystadenocarcinoma: Epidemiology and outcomes
Doulamis, Ilias P. et al.
International Journal of Surgery , Volume 35 , 76 - 82
    • ” All in all, the prognosis of resectable MCAC seems to be significantly more favorable compared to pancreatic ductal adenocarcinoma, and inoperability is associated with very poor outcomes. To the best of our knowledge this is the largest population-based study specifically dedicated to the epidemiology and outcomes of patients with pancreatic mucinous cystadenocarcinomas. The major strength of our study is that it limits publication bias, which traditionally hinders the applicability of results generated by secondary research papers. It should be noted that 66.7% of the SEER cases were diagnosed after 2000, whereas most of the studies identified were published before 2000 and mainly consisted of small case series (11–78 patients).”

      
Pancreatic mucinous cystadenocarcinoma: Epidemiology and outcomes
Doulamis, Ilias P. et al.
International Journal of Surgery , Volume 35 , 76 - 82
© 1999-2017 Elliot K. Fishman, MD, FACR. All rights reserved.