Diagnostic accuracy and inter-observer reliability of the O-RADS scoring system among staff radiologists in a North American academic clinical setting.

PURPOSE: The objective of this study is to evaluate the diagnostic accuracy, interobserver variability, and common lexicon pitfalls of the ACR O-RADS scoring system among staff radiologists without prior experience to O-RADS. MATERIALS AND METHODS: After independent review of the ACR O-RADS publications and 30 training cases, three fellowship-trained, board-certified staff radiologists scored 50 pelvic ultrasound exams using the O-RADS system. The diagnostic accuracy and area under receiver operating characteristic were analyzed for each reader. Overall agreement and pair-wise agreement between readers were also analyzed. RESULTS: Excellent specificities (92 to 100%), NPVs (92 to 100%), and variable sensitivities (72 to 100%), PPVs (66 to 100%) were observed. Considering O-RADS 4 and O-RADS 5 as predictors of malignancy, individual reader AUC values range from 0.94 to 0.98 (p < 0.001). Overall inter-reader agreement for all 3 readers was "very good," k = 0.82 (0.73 to 0.90, 95% CI, p < 0.001). Pair-wise agreement between readers were also "very good," k = 0.86-0.92. 14 out of 150 lesions were misclassified, with the most common error being down-scoring of a solid lesion with irregular outer contours. CONCLUSION: Even without specific training, experienced ultrasound readers can achieve excellent diagnostic performance and high inter-reader reliability with self-directed review of guidelines and cases. The study highlights the effectiveness of ACR O-RADS as a stratification tool for radiologists and supports its continued use in practice.

Evaluation of the efficacy and safety of topical imiquimod 5% for plaque-type morphea: a multicenter, prospective, vehicle-controlled trial.

BACKGROUND: There is currently a lack of evidence-based therapies that are safe and effective for plaque-type morphea. We aimed to evaluate the therapeutic potential and safety profile of imiquimod 5% cream in plaque-type morphea. METHODS: We enrolled 25 adult patients from two Canadian centers with histologically confirmed plaque-type morphea. Imiquimod 5% was applied to a representative plaque, and vehicle was applied to a control plaque for 9 months. Treatment efficacy was assessed with the Dyspigmentation, Induration, Erythema, and Telangiectasias (DIET) score, histology, and ultrasound evaluation. RESULTS AND CONCLUSIONS: Twenty-two patients completed the entire length of the study. Imiquimod 5% was superior to vehicle in reducing DIET scores at 3, 6, 9, and 12 months (p < .05). Induration demonstrated the greatest response. Histologic evaluation showed significant improvement or resolution of disease. However, no ultrasonographic differences were found in dermal and hypodermal thicknesses between the treatment and vehicle groups (p > .05). Adverse effects were minimal and well tolerated.

Long-term follow-up of hepatic ultrasound findings in subjects with magnetic resonance imaging defined hepatic steatosis following clinical islet transplantation: a case-control study.

Hepatic steatosis is one complication patients may experience following clinical islet transplantation (CIT), yet the cause and consequences of this are poorly understood. The purpose of this case-control study was to examine the relationship between hepatic steatosis, metabolic parameters and graft function in an Albertan cohort of CIT recipients. Hepatic steatosis was detected by magnetic resonance imaging (MRI) in n = 10 cases age-matched with n=10 MRI-negative controls. Progression/regression of steatosis was determined by ultrasound (US) in cases. Hepatic steatosis first appeared 2.8 ± 2.2 (mean ± SD) years post-CIT, and lasted approximately 4.6 ± 2.0 years. In five cases steatosis resolved, with recurrence in two cases during the follow-up period (8.5 ± 3.2 years). No evidence of CIT causing deleterious effects on long-term liver function or graft outcome was observed.

High prevalence of ovarian cysts in premenopausal women receiving sirolimus and tacrolimus after clinical islet transplantation.

We encountered an unexpectedly high rate of ovarian cysts in premenopausal women receiving sirolimus and tacrolimus following islet transplantation. The goal of this retrospective chart review was to determine the frequency of ovarian cysts found on pelvic ultrasound examinations of female islet transplant recipients and to look for potential causal factors. Fifty-seven women with a median age of 42.5 years underwent islet transplantation at the University of Alberta. Ovarian cysts were found in 31 out of 44 (70.5%) premenopausal and two out of 13 (15.4%) postmenopausal women (P = 0.001). No women using combined oral contraception developed ovarian cysts. Eight women required surgery; in four women undergoing cystectomy or unilateral oophorectomy, ovarian cysts recurred. Sirolimus withdrawal was associated with a reduction in cyst size and resolution of cysts in 80% of subjects. The risk of ovarian cysts should be discussed with female islet transplant candidates and pelvic ultrasounds performed routinely post-transplant.

Magnetic resonance-defined perinephric edema after clinical islet transplantation: a benign finding associated with mild renal impairment.

Immunosuppression with sirolimus and low-dose tacrolimus has facilitated successful clinical islet transplantation (CIT). Because the long-term effects on the kidney are unknown and immunosuppressant drugs can be nephrotoxic, CIT is currently restricted to patients with preserved renal function or a functioning renal transplant. The impact of CIT on the native kidney of islet-alone recipients was assessed with magnetic resonance imaging (MRI). After successful CIT, MRI revealed perinephric edema (PNE) in 10 of 30 recipients. PNE was associated with a mild degree of renal impairment but was not associated with preexisting diabetic nephropathy, albuminuria, microscopic hematuria, graft function, or other clinical and metabolic parameters. The presence of PNE on MRI after CIT seems to be a common but benign finding, most likely an adverse effect of sirolimus. Although this novel observation does not seem to be of concern, further studies are required to examine the long-term impact of CIT and immunosuppression on renal function.

Prevalence of hepatic steatosis after islet transplantation and its relation to graft function.

Islet allotransplantation can provide insulin independence in selected individuals with type 1 diabetes. The long-term effects of these transplants on the liver are unknown. Recently, two cases of periportal steatosis after islet transplantation have been described. In this study, we performed ultrasound and magnetic resonance imaging (MRI) in 30 C-peptide-positive islet transplant recipients to detect steatosis and to explore the association of the radiological findings with clinical and metabolic factors. Steatosis was observed on MRI in six (20%) subjects. Histological findings of hepatic steatosis concurred with the imaging findings. Steatosis completely resolved in one subject whose graft failed. More subjects with steatosis required supplementary exogenous insulin than not (67 vs. 21%; P < 0.05). The clinical features of subjects with and without steatosis were otherwise similar, although C-peptide levels were higher in insulin-independent subjects with steatosis (0.98 +/- 0.12 vs. 0.70 +/- 0.18 nmol/l; P = 0.05), despite similar blood glucose levels. Serum triglycerides and the use of exogenous insulin were associated with increased odds of steatosis in a logistic regression model (chi(2) [degrees freedom] = 13.6 [2]); P = 0.001). MRI-detected steatosis is a common finding; the steatosis appears to be due to a paracrine action of insulin secreted from intrahepatic islets. Hepatic steatosis may be associated with insulin resistance or graft dysfunction.