Inter- and intraobserver variation between radiologists in the detection of abnormal parenchymal lung changes on high-resolution computed tomography

Radiological and histological evaluations are affected by subjective interpretation. This study determined the level of inter- and intraobserver variation among radiologists for detection of abnormal parenchymal lung changes on high resolution computed tomography [HRCT]. HRCT images of 65 patients known to have systemic lupus erythematosus [with clinical pulmonary involvement] were retrospectively reviewed by four nonthoracic radiologists [two with expertise in magnetic resonance [MR] and two general radiologists]. Each radiologist read the scans twice, with an interval between readings of at least 6 months. The interobserver variation among the first and second readings of the four radiologists and the intraobserver variation of each radiologist's two readings were assessed by the kappa statistic. There was good agreement between the first and second readings of each radiologist. There was moderate agreement between the two readings of one MR radiologist [kappa=0.482]; the other three radiologists had kappa values that were good to excellent [0.716, 0.691, and 0.829]. There was a clinically acceptable level of interobserver variability between all radiologists. The agreement was fair to moderate between the MR radiologist and the other observers [kappa range: 0.362-0.519] and moderate to good between the other three radiologists [0.508-0.730]. The interpretation of imaging findings of abnormal parenchymal lung changes on HRCT is reproducible and the agreement between general radiologists is clinically acceptable. There is reduced agreement when the radiologist is not involved on a regular basis with thoracic imaging. Difficult or indeterminate cases may benefit from review by a chest radiologist

Accuracy of the fischer scoring system and the breast imaging reporting and data system in identification of malignant breast lesions

Fischer developed a scoring system in 1999 that made identifying malignant lesions much easier for inexperienced radiologists. Our study was performed to assess whether this scoring system would help beginners to accurately diagnose breast lesions on magnetic resonance [MR] imaging and to assess the correlation between the magnetic resonance mammography Breast Imaging Reporting and Data System [MRM BI-RADS] grade and the final diagnosis. The lesion morphology and contrast kinetics of 63 masses in 41 patients were evaluated on MRI and accorded a MRM BI-RADS final assessment category using the Fischer scoring system. The accuracy was evaluated after the final diagnosis was obtained by tissue sampling and follow-up imaging. There were 25 malignant and 30 benign lesions. Eight lesions were seen by MRI only and we could not verify their pathology since we did not have MR-guided biopsy facilities at the time of the study. On MR mammography, the proven carcinomatous lesions were characterized as BI-RADS category V in 16 [64%], category IV in 7 [28%], and category III in 2 [8%] lesions. Benign lesions were graded as category V in 3 [10%], category IV in 6 [20%], and category III in 3 [10%], category II in 10 [33%] and category I in 8 [27%] lesions. The MRM BI-RADS category accurately predicted malignancy in 92% and a benign pathology in 70% of the lesions. The overlap between the MRM features of chronic inflammatory lesions and carcinomas resulted in a lower accuracy in diagnosing benign as compared to malignant lesions. The MRM BI-RADS lexicon using the Fischer scoring system is useful and has a high predictive value, especially for malignant breast lesions, and is easy to apply. Overlapping features between benign inflammatory and malignant lesions might yield a reduced accuracy in inflammatory pathologies

Accuracy of the Fischer scoring system and the Breast Imaging Reporting and Data System in identification of malignant breast lesions

Fischer developed a scoring system in 1999 that made identifying malignant lesions much easier for inexperienced radiologists. Our study was performed to assess whether this scoring system would help beginners to accurately diagnose breast lesions on magnetic resonance [MR] imaging and to assess the correlation between the magnetic resonance mammography Breast Imaging Reporting and Data System [MRM BI-RADS] grade and the final diagnosis. The lesion morphology and contrast kinetics of 63 masses in 41 patients were evaluated on MRI and accorded a MRM BI-RADS final assessment category using the Fischer scoring system. The accuracy was evaluated after the final diagnosis was obtained by tissue sampling and follow-up imaging. There were 25 malignant and 30 benign lesions. Eight lesions were seen by MRI only and we could not verify their pathology since we did not have MR-guided biopsy facilities at the time of the study. On MR mammography, the proven carcinomatous lesions were characterized as BI-RADS category V in 16 [64%], category IV in 7 [28%], and category III in 2 [8%] lesions. Benign lesions were graded as category V in 3 [10%], category IV in 6 [20%], and category III in 3 [10%], category II in 10 [33%] and category I in 8 [27%] lesions. The MRM BI-RADS category accurately predicted malignancy in 92% and a benign pathology in 70% of the lesions. The overlap between the MRM features of chronic inflammatory lesions and carcinomas resulted in a lower accuracy in diagnosing benign as compared to malignant lesions. The MRM BI-RADS lexicon using the Fischer scoring system is useful and has a high predictive value, especially for malignant breast lesions, and is easy to apply. Overlapping features between benign inflammatory and malignant lesions might yield a reduced accuracy in inflammatory pathologies

Contrast media extravasation: manual versus power injector

To compare the incidence and complications of extravasation of low-osmolar nonionic contrast media, injected manually and by the automatic power injector [API]. Subjects and Three thousand five hundred and sixty patients underwent contrast-enhanced abdominal and thoracic computerized tomography scan in the Department of Clinical Radiology, Al-Amiri Hospital, Kuwait, between June 1998 and De cember 2002. These patients were prospectively analyzed for contrast media extravasation, its relation to injection rate, cannula insertion and gauge and its complications. 920 patients were administered low-osmolar nonionic contrast media [Ultravist 300, Omni Paque 240 or 300] intravenously by manual injection and 2,640 patients by automatic power injector. Of the 3,560 patients contrast media extravasation occurred in 11 [0.3%]. The symptoms were observed in 9 patients [0.3%] in the API group and 2 patients [0.2%] in the manual injection group, respectively. None of the patients had any soft tissue injury. The incidence of contrast media extravasation is not significantly increased by the use of the API. Low-osmolar nonionic contrast media extravasation resulting from the use of API does not cause any morbidity