Impact of a content-based image retrieval system on the interpretation of chest CTs of patients with diffuse parenchymal lung disease.

OBJECTIVES: Content-based image retrieval systems (CBIRS) are a new and potentially impactful tool for radiological reporting, but their clinical evaluation is largely missing. This study aimed at assessing the effect of CBIRS on the interpretation of chest CT scans from patients with suspected diffuse parenchymal lung disease (DPLD). MATERIALS AND METHODS: A total of 108 retrospectively included chest CT scans with 22 unique, clinically and/or histopathologically verified diagnoses were read by eight radiologists (four residents, four attending, median years reading chest CT scans 2.1± 0.7 and 12 ± 1.8, respectively). The radiologists read and provided the suspected diagnosis at a certified radiological workstation to simulate clinical routine. Half of the readings were done without CBIRS and half with the additional support of the CBIRS. The CBIRS retrieved the most likely of 19 lung-specific patterns from a large database of 6542 thin-section CT scans and provided relevant information (e.g., a list of potential differential diagnoses). RESULTS: Reading time decreased by 31.3% (p < 0.001) despite the radiologists searching for additional information more frequently when the CBIRS was available (154 [72%] vs. 95 [43%], p < 0.001). There was a trend towards higher overall diagnostic accuracy (42.2% vs 34.7%, p = 0.083) when the CBIRS was available. CONCLUSION: The use of the CBIRS had a beneficial impact on the reading time of chest CT scans in cases with DPLD. In addition, both resident and attending radiologists were more likely to consult informational resources if they had access to the CBIRS. Further studies are needed to confirm the observed trend towards increased diagnostic accuracy with the use of a CBIRS in practice. KEY POINTS: • A content-based image retrieval system for supporting the diagnostic process of reading chest CT scans can decrease reading time by 31.3% (p < 0.001). • The decrease in reading time was present despite frequent usage of the content-based image retrieval system. • Additionally, a trend towards higher diagnostic accuracy was observed when using the content-based image retrieval system (42.2% vs 34.7%, p = 0.083).

The epidemiology of and management of pediatric patients with head trauma: a hospital-based study from Southern Sweden.

BACKGROUND: Traumatic brain injury (TBI) is a common cause of morbidity and mortality in children worldwide. In Scandinavia, the epidemiology of pediatric head trauma is poorly documented. This study aimed to investigate and compare the epidemiology and management of pediatric patients with isolated head trauma (IHT) and head trauma in connection with multitrauma (MHT). METHODS: We conducted a retrospective review of medical records of patients < 18 years of age who attended any of the five emergency departments (ED) in Scania County in Sweden in 2016 due to head trauma. Clinical data of patients with IHT were analyzed and compared with those of patients with MHT. RESULTS: We identified 5046 pediatric patients with head trauma, 4874 with IHT and 186 with MHT, yielding an incidence of ED visits due to head trauma of 1815/100,000 children/year. There was male predominance, and the median age was four years. Falls were the dominating trauma mechanism in IHT patients, while motor vehicle accidents dominated in MHT patients. The frequencies of CT head-scans, ward admissions and intracranial injuries (ICI) were 5.4%, 11.1% and 0.7%, respectively. Four patients (0.08%) required neurosurgical intervention. The relative risks for CT-scans and admissions to a hospital ward and ICI were 10, 4.5 and 19 times higher for MHT compared with IHT patients. CONCLUSION: Head trauma is a common cause of ED visits in our study. Head-CTs and ICIs were less frequent than in previous studies. MHT patients had higher rates of CT-scans, admissions, and ICIs than IHT patients, suggesting that they are separate entities that should ideally be managed using different guidelines to optimize the use of CT-scans of the head.

CT colonography: size reduction of submerged colorectal polyps due to electronic cleansing and CT-window settings.

OBJECTIVES: To assess whether electronic cleansing (EC) of tagged residue and different computed tomography (CT) windows influence the size of colorectal polyps in CT colonography (CTC). METHODS: A database of 894 colonoscopy-validated CTC datasets of a low-prevalence cohort was retrospectively reviewed to identify patients with polyps ≥6 mm that were entirely submerged in tagged residue. Ten radiologists independently measured the largest diameter of each polyp, two-dimensionally, before and after EC in colon, bone, and soft-tissue-windows, in randomised order. Differences in size and polyp count before and after EC were calculated for size categories ≥6 mm and ≥10 mm. Statistical testing involved 95% confidence interval, intraclass correlation and mixed-model ANOVA. RESULTS: Thirty-seven patients with 48 polyps were included. Mean polyp size before EC was 9.8 mm in colon, 9.9 mm in bone and 8.2 mm in soft-tissue windows. After EC, the mean polyp size decreased significantly to 9.4 mm in colon, 9.1 mm in bone and 7.1 mm in soft-tissue windows. Compared to unsubtracted colon windows, EC, performed in colon, bone and soft-tissue windows, led to a shift of 6 (12,5%), 10 (20.8%) and 25 (52.1%) polyps ≥6 mm into the next smaller size category, thus affecting patient risk stratification. CONCLUSIONS: EC and narrow CT windows significantly reduce the size of polyps submerged in tagged residue. Polyp measurements should be performed in unsubtracted colon windows. KEY POINTS: • EC significantly reduces the size of polyps submerged in tagged residue. • Abdominal CT-window settings significantly underestimate 2D sizes of submerged polyps. • Size reduction in EC is significantly greater in narrow than wide windows. • Underestimation of polyp size due to EC may lead to inadequate treatment. • Polyp measurements should be performed in unsubtracted images using a colon window.

Case report: impressive response to pembrolizumab in a patient with mismatch-repair deficient metastasized colorectal cancer and bulky disease.

Here, we report the history of a 42-year-old female patient with sporadic mismatch-repair-deficient metastatic colorectal cancer and abdominal bulky disease, who received pembrolizumab (200 mg every 3 weeks) after the failure of third-line treatment. Restaging 3 months after initiation of treatment revealed a striking response with shrinkage of the bulky peritoneal tumour mass (baseline size 11×11×14 cm) to nearly 25% of the original tumour volume (6.2×7.1×10.4 cm). Restaging 8 months after initiation showed further downsizing of the tumour mass (5.5×7.0×8.0 cm). Tumour markers CEA and CA 19-9 decreased to normal levels, haemoglobin level increased from 8 to 13 mg/dL and her overall clinical performance status increased from ECOG 3 to 1 within 3 months. Therapy with pembrolizumab was continued and is still ongoing. We emphasise the importance of testing for mismatch-repair status in metastatic disease.

Diagnostic pitfalls in fetal brain MRI.

Recent technological advances in fetal magnetic resonance imaging (MRI) and increased reliability of MRI in depicting abnormalities and lesions, especially in the central nervous system, are increasingly bringing up challenging issues with regard to accurate diagnosis. There are also pitfalls not only attributable to image acquisition but also in clinical interpretation. The misinterpretation of findings because of insufficient knowledge about fetal brain development as visualized by MRI may also be regarded as an important limitation of fetal MRI. We provide an overview of the most common pitfalls experienced in fetal MRI in routine practice, demonstrate how to identify some of the factors that lead to imaging misinterpretation, and suggest ways to tackle these problems, with an emphasis on MR techniques and image calibration.