Status of LGBTQ+ inclusion: Multi-institution Assessment of US Radiology Residencies.

INTRODUCTION: An inclusive residency program is crucial to the recruitment and retention of competitive and diverse applicants. The radiology LGBTQ+ inclusion audit was published in 2022, which provided a roadmap for assessing the inclusivity of a program's policies, facilities, culture, and engagement. In this multi-institutional trial, we detail the results of the LGBTQ+ inclusion audit for nine US radiology residency programs. METHODS: A volunteer cohort of academic radiology programs was recruited through the Radiology Residency Education Research Alliance. The LGBTQ+ inclusion audit was modified to apply to a multi-institutional study. Participating programs performed the audit from December 2023-February 2024. A pre- and post-audit survey were distributed to capture participants subjective assessment of inclusivity at their programs. RESULTS: Nine US radiology residency programs completed the audit. Audit scores ranged from 6/10 to 9/10; no program received a perfect 10/10 score. Inclusive facilities and institutional culture scored highly, with 8/9 programs reporting all milestones met in these areas. The lowest performing areas were department culture and community engagement with only 3/9 and 4/9 programs reporting "all milestones met". After the audit, programs overall reported improved self-perceived inclusivity, with post-audit survey scores increasing in areas related to department policy, inclusive facilities, and LGBTQ community outreach. DISCUSSION: Participating radiology residency programs demonstrated an overall high level of LGBTQ+ inclusivity, however all programs identified inclusion shortcomings in department policy and practice. Intentional review of a department can be a helpful tool to promote a welcoming and healthy environment for a diverse radiology practice.

Skeletal Fluorosis.

ABSTRACT: A 27-year-old man with polysubstance abuse including methamphetamine, fentanyl, and 1.5 years of electronics compressed gas duster inhalation presented following an assault. Radiologic imaging performed for suspected fractures revealed periosteal reaction, cortical thickening with increased bone density, and ligament and tendon ossification, which were not present on imaging obtained 3 years before presentation. A bone scan was subsequently performed revealing a metabolic superscan with cortical irregularity. Further investigation revealed skeletal fluorosis from electronics compressed gas duster inhalation. Skeletal fluorosis may be considered when these osseous findings are encountered.

Re: Aducanumab-Related ARIA: Paean or Lament?

ABSTRACT: Høilund-Carlsen and colleagues raise concern regarding the reliability of amyloid PET to exclude Alzheimer disease. We present additional studies of amyloid PET and discuss the diagnostic challenges in Alzheimer disease. We discuss the limitations of amyloid in diagnosis and evaluation of therapy response in AD.

Commentary: Aducanumab-Related ARIA: Paean or Lament?

ABSTRACT: Høilund-Carlsen and colleagues raise important issues related to amyloid PET, diagnosis of Alzheimer disease, and recently approved antiamyloid treatment aducanumab. We discuss new developments that may direct us to methods of presymptomatic detection of Alzheimer disease and development of effective prevention and therapy.

FDG PET/CT in Mixed Langerhans Cell Histiocytosis and Erdheim-Chester Disease.

ABSTRACT: The histiocytoses arise from hematopoietic bone marrow stem cells or monocytes. They range from limited to disseminated disease. We report a 31-year-old woman with multisystem Langerhans cell histiocytosis (LCH). The recognition that pericardial disease was rare in LCH prompted review of the initial limited biopsies, which helped establish a second diagnosis of Erdheim-Chester disease. The increasing recognition of mixed histiocytoses requires searching for Erdheim-Chester disease when a patient is diagnosed with LCH and vice versa. FDG PET/CT can help establish the diagnosis or suggest mixed disease based on the organs involved.

Nuclear Medicine Student Elective at the Keck School of Medicine at LAC-USC Medical Center.

Very few medical schools offer a nuclear medicine elective. I will share our experience with the nuclear medicine elective rotation which has been well received by our fourth-year medical students. This may be of interest to nuclear medicine physicians who work in an academic setting.

Musculoskeletal Pitfalls on Fluorodeoxyglucose F 18 PET-Computed Tomography: Pictorial Review.

A wide range of musculoskeletal processes can demonstrate increased uptake on PET-computed tomography (CT) with fluorodeoxyglucose (FDG) F 18, including reactive, benign neoplastic, inflammatory, traumatic, posttreatment, and arthritic conditions that may mimic malignancy. In addition, physiologic causes of increased FDG uptake such as asymmetric muscle use and presence of brown fat can lead to increased FDG uptake and potential false-positive results. This article presents various case examples of non-malignant musculoskeletal hypermetabolism on 18F-FDG PET-CT and describes useful tools to avoid the potential pitfall of misinterpreting these as malignancy.

Nuclear Medicine Imaging in the Dentomaxillofacial Region.

Nuclear medicine studies evaluate physiology on a molecular level providing earlier detection of lesions before morphologic change is evident. 99mTc-MDP and 18F-fluoride bone scans detect osteomyelitis earlier than radiographs and computed tomography (CT); aid in diagnosis of temporomandibular joint disorder; and evaluate activity of condylar hyperplasia, extent of Paget disease, and viability of bone grafts. 18F-FDG PET/CT distinguish between soft tissue and bone infections and diagnose osteomyelitis complicated by fracture or surgery. FDG PET is more accurate than CT alone and has a major role in staging, restaging, and assessing response to therapy for head and neck malignancies and in detecting sequelae of therapy.

PET/CT in Head-neck Malignancies: The Implications for Personalized Clinical Practice.

PET/CT has been shown to help localize head and neck cancers and provide more accurate staging, post-treatment assessment, and restaging than standard imaging. PET/CT detects synchronous and metachronous cancers and sequelae of therapy and provides prognostic information for each patient. Information provided by PET/CT allows for more individualized therapeutic and surveillance plans for patients with head and neck squamous cell carcinoma.

Prior CT May Improve Diagnostic Confidence in Myocardial Perfusion Imaging.

PURPOSE: Many patients with matching myocardial perfusion imaging defects may have prior CT examinations that include the myocardial region of interest, such as a CT chest or CT abdomen. We correlate these perfusion defects with available prior CT examinations to determine if this will improve diagnostic confidence. METHODS: Myocardial perfusion scans were reviewed to identify cases with myocardial perfusion defects and prior CT imaging that included the myocardium. The CT was reviewed for evidence of myocardial injury that correlated with the perfusion defect. RESULTS: A retrospective review of 732 myocardial perfusion scans was performed, of which 69 cases with perfusion defects were identified that also had prior CT imaging available for review. Of this subset of patients, 19 patients had findings on the CT scan compatible with ischemia or infarction in the expected region of the perfusion defect, which allowed for a more confident diagnosis. CONCLUSIONS: Reviewing a prior CT scan, if available, during the interpretation of a myocardial perfusion scan, can help improve diagnostic confidence in over 25% of cases. This can lead to decreased indeterminate results and can be used to potentially avoid unhelpful further testing.

FDG PET/CT images demonstrating epididymo-orchitis in a patient with HIV, acute kidney injury and known epididymo-orchitis on scrotal ultrasound.

A 52-year-old man with HIV was referred for an F-FDG PET/CT scan for the cause of kidney injury. FDG PET/CT scan revealed increased renal cortical FDG activity, which can be seen in HIV nephropathy or acute interstitial nephritis. Diffuse increased FDG uptake was demonstrated within the right testicle and epididymis, consistent with the patient's known right epididymo-orchitis, as diagnosed on ultrasound 1 week before admission. Multiple enlarged lymph nodes with increased FDG activity were also found within the right inguinal and external iliac nodal chains, which were presumed to be reactive. The patient was treated with ciprofloxacin with symptomatic improvement.

18F-FDG PET/CT appearance of metastatic brachial plexopathy involving epidural space from breast carcinoma.

Patient is a 74-year-old woman with a history of breast carcinoma and known metastatic brachial plexopathy and pulmonary and mediastinal nodal involvement. She had bilateral mastectomies 5 years ago and is currently on chemotherapy. A 6-month follow-up PET/CT study demonstrated no significant interval change in intensity of the previously evident hypermetabolic activity of the brachial plexopathy. However, this activity has extended superiorly and medially involving the right lateral aspect of the epidural space at the C5-6 level, consistent with epidural involvement. In addition, the hypermetabolic activity of the pulmonary and mediastinal metastases has also increased, consistent with interval progression of the disease.

Cosmetic-related changes on 18F-FDG PET/CT.

We present 4 cases of cosmetic-related changes on 18F-FDG PET/CT. These cases represent post-treatment changes from facial juvederm injection, silicone injection in the chest wall and gluteal areas, paraffin injection in the gluteal region, and liposuction. Recognition of cosmetic-related changes and their appearance on PET and CT will help to avoid potential false-positive interpretations.

Malignant transformation of retroperitoneal inflammatory pseudotumor to undifferentiated high-grade pleomorphic sarcoma on FDG PET/CT.

We report FDG PET/CT appearance of malignant transformation of retroperitoneal inflammatory pseudotumor to pleomorphic sarcoma in a 78-year-old woman. The patient was diagnosed with left retroperitoneal pseudotumor in 2007. She subsequently suffered from recurrent disease and chronic osteomyelitis in the L5 vertebral body in July 2008, status post surgical excision. In November 2009, after the patient developed left groin pain, MRI study of lumbosacral spine and whole-body PET/CT study demonstrated 2 hypermetabolic soft-tissue masses originating from the L5 surgical bed. These masses were subsequently resected and were consistent with pleomorphic sarcoma. Malignant transformation of retroperitoneal pseudotumor to pleomorphic sarcoma is extremely rare.

Bilateral ovarian metastases from gastric carcinoma on FDG PET/CT.

We report PET/CT appearance of bilateral ovarian metastases in a 63-year-old female patient with newly diagnosed poorly differentiated adenocarcinoma of the stomach. She was also found to have peritoneal metastasis on an outside CT study. Staging PET/CT demonstrates not only the hypermetabolic gastric primary tumor and peritoneal disease but also bilateral enlarged, moderately active ovaries. The patient subsequently underwent biopsies of bilateral ovaries which revealed metastatic disease from primary gastric carcinoma. It is important to consider this form of neoplasm in the differential diagnosis because the treatment and prognosis will be different from a dyssynchronous primary tumor.

Recurrent ovarian carcinoma presenting as a solitary sternal metastasis on FDG PET/CT.

We report the positron emission tomography/computed tomography appearance of solitary sternal metastasis from primary ovarian carcinoma in a 65-year-old woman who underwent surgery followed by chemoradiation treatment 3 years earlier. Restaging positron emission tomography/computed tomography study demonstrates an intensely active destructive lesion involving the entire sternum (maximum standard uptake value: 4.7) with a photopenic soft tissue mass component in the center of the sternum protruding anteriorly suggestive of necrosis. This sternal lesion was subsequently biopsied and pathology revealed metastatic disease from the primary ovarian tumor for which the patient had received chemoradiation therapy. Bone involvement in ovarian cancer is relatively rare and even rarer in the sternum.

Primary spinal epidural non-Hodgkin lymphoma demonstrated by FDG PET/CT.

We report the F-18 fluorodeoxyglucose positron emission tomography/computed tomography appearance of a biopsy-proven primary epidural non-Hodgkin lymphoma involving the lower cervical and upper thoracic spine with a small hypermetabolic right middle lobe nodule in a 33-year-old man. The HIV-positive patient presented with mid- to low back pain for several days, which progressed to lower extremity weakness and urinary retention. Primary spinal epidural non-Hodgkin lymphoma is a rare form of malignancy, constituting approximately 0.1% to 3.3% of all lymphomas. In our case, the primary tumor appears as an intensely hypermetabolic soft-tissue mass involving the posterior epidural space from C6 through T9 levels.

Renal metastasis from primary colon cancer on FDG PET-CT.

We report the PET-CT appearance of a metastasis from a primary colon cancer to the right kidney in an 84-year-old woman with a history of moderately differentiated adenocarcinoma of the cecum. The patient underwent right hemicolectomy and chemotherapy. Restaging PET-CT study, 4 months after her last chemotherapy, demonstrates a hypermetabolic soft-tissue mass in the inferior pole of the right kidney. The patient subsequently had a right partial nephrectomy. The pathology was consistent with metastatic colonic adenocarcinoma. Renal metastasis from primary colon cancer is very rare.

F-18 FDG PET-CT imaging in recurrent cerebral gliosarcoma.

We report the F-18 FDG PET-CT appearance of recurrent gliosarcoma (GS) with extracranial extension in a 47-year-old man who underwent surgical resection of a right frontal GS 5 months earlier. F-18 FDG PET demonstrated moderate uptake in the recurrent disease. GS is a very rare, biphasic primary neoplasm of the central nervous system, composed of glioblastoma multiforme mixed with a sarcomatous component. It occurs in adults of middle age and carries a poor prognosis. The median survival reported is less than a year. The results suggest that F-18 FDG PET imaging may be useful in detecting recurrent GS.