MRI-based pictorial review of the FIGO classification system for uterine fibroids.

Uterine fibroids are the most common gynecologic neoplasm and contribute to significant morbidity, particularly when submucosal in location or large enough to cause bulk symptoms. Correctly classifying fibroids is essential for treatment planning and prevention of complications. Ultrasound is the first-line imaging modality for characterizing uterine fibroids. However, MRI allows for high-resolution, multiplanar visualization of leiomyomata that affords a more accurate assessment than ultrasound, particularly when fibroids are numerous. The FIGO system was developed in order to more uniformly and consistently describe and classify uterine fibroids. In this article, we review the MRI appearance of each of the FIGO classification types, detailing key features to report. Additionally, we present a proposed template for structured reporting of uterine fibroids based on the FIGO classification system.

Leukemic Ischemia: A Case of Myocardial Infarction Secondary to Leukemic Cardiac Involvement.

We report a case of a 39-year-old male who presented to the emergency department with acute chest pain while being in remission from T-cell acute lymphoblastic leukemia (T-ALL). Cardiac markers were elevated and EKG revealed ischemic changes compatible with acute myocardial ischemia. Coronary computed tomography angiography (CCTA) showed calcium-free coronary arteries and soft tissue myocardial infiltration suggestive of cardiac leukemia. A bone marrow biopsy confirmed recurrence of T-ALL, and patient was successfully treated with chemotherapy. We discuss the prospective diagnosis of myopericardial leukemic involvement and the role of CCTA in diagnosis and perform a literature review.

Abdominal Cocoon Syndrome: a Rare Cause for Recurrent Abdominal Pain.

Abdominal cocoon syndrome, or sclerosing peritonitis, is a rare condition characterized by encasement of small bowel loops by a thick fibrous scar. It most commonly presents as nonspecific vague chronic abdominal pain and weight loss, and is difficult to recognize clinically until the patient develops symptoms of bowel obstruction. We present a case of abdominal cocoon syndrome in a 65-year-old female and describe its clinical, imaging, and pathologic features.

Bariatric CT Imaging: Challenges and Solutions.

The obesity epidemic in the adult and pediatric populations affects all aspects of health care, including diagnostic imaging. With the increasing prevalence of obese and morbidly obese patients, bariatric computed tomographic (CT) imaging is becoming common in day-to-day radiology practice, and a basic understanding of the unique problems that bariatric patients pose to the imaging community is crucial in any setting. Because larger patients may not fit into conventional scanners, having a CT scanner with an adequate table load limit, a large gantry aperture, a large scan field of view, and a high-power generator is a prerequisite for bariatric imaging. Iterative reconstruction methods, high tube current, and high tube voltage can reduce the image noise that is frequently seen in bariatric CT images. Truncation artifacts, cropping artifacts, and ring artifacts frequently complicate the interpretation of CT images of larger patients. If recognized, these artifacts can be easily reduced by using the proper CT equipment, scan acquisition parameters, and postprocessing options. Lastly, because of complex contrast material dynamics, contrast material-enhanced studies of bariatric patients require special attention. Understanding how the rate of injection, the scan timing, and the total mass of iodine affect vascular and parenchymal enhancement will help to optimize contrast-enhanced studies in the bariatric population. This article familiarizes the reader with the challenges that are frequently encountered at CT imaging of bariatric patients, beginning with equipment selection and ending with a review of the most commonly encountered obesity-related artifacts and the technical considerations in the acquisition of contrast-enhanced images. (©)RSNA, 2016.

Solitary Fibrous Tumor of the Kidney: A Case Report and Literature Review.

Solitary fibrous tumors are neoplasms of mesenchymal origin that may occur virtually in any body part, most commonly arising from the pleura. Solitary fibrous tumor of the kidney is exceptionally rare, and limited clinical knowledge regarding its behavior makes prognosis of the neoplasm difficult. We report a case of solitary fibrous tumor of the left kidney and describe its clinical, imaging, and pathological features.

Anomalous Left Circumflex Coronary Artery Arising from the Right Pulmonary Artery: A Rare Cause of Aborted Sudden Cardiac Death.

We report a case of anomalous origin of the left circumflex coronary artery arising from the right pulmonary artery resulting in stress-induced cardiac arrest. The patient collapsed after running a 5K race and was resuscitated. Subsequent workup revealed the culprit anatomy, which was successfully treated with surgical ligation. To the authors' knowledge, this is only the second case of this variant coronary anomaly resulting in aborted sudden cardiac death, subsequent surgical ligation, and recovery in a healthy young adult and is the first case treated by ligation alone without coronary bypass.

Imaging of ankle replacements.

Significant innovations in the field of total ankle replacement surgery have occurred since the early disappointing experiences with first-generation devices. In recent years, total ankle arthroplasties are commonly placed in patients with end-stage ankle osteoarthrosis, supplanting ankle arthrodesis as the procedure of choice at some institutions. Careful clinical and preoperative radiographic evaluation is helpful to plan concomitant ligament release, ligament reconstruction, or osteotomy. Careful attention to radiographic signs of early hardware loosening or subsidence can prompt intervention while bone loss is still minimal, and computed tomography has an adjunct role in the evaluation of periprosthetic lucency and osteolysis.

Ethnicity and insurance status affect health disparities in patients with gallstone disease.

BACKGROUND: Complex gallstone disease is associated with greater risk of morbidity, associated with operative complications and longer hospital stays. The purpose of this study is to evaluate whether ethnicity or insurance status is associated with differences in presentation and outcomes in gallstone disease. MATERIALS AND METHODS: A retrospective analysis was performed for all patients who underwent cholecystectomy between August 1, 2007 and May 31, 2010 at the only teaching hospital in the region. Analysis of Variance, Chi square (χ(2)) and logistical regression analyses were used to evaluate the impact of ethnicity and insurance status on the complexity of gallstone disease and surgical outcomes. RESULTS: A total of 562 patients had a cholecystectomy during the study period, of whom 255 (45.4%) were Latino. Latino patients were significantly younger than any other ethnic group (P < 0.001) and had a significantly higher rate of being uninsured (40%, P = 0.03). Latino patients were significantly more likely to require ERCP (38.6% versus 28.8% for non-Latino, P = 0.01). Latino patients had a significantly higher white blood cell count (P = 0.017). There were no significant differences in liver function tests, bilirubin levels, albumin levels, hospital lengths of stay, operation types, pathology types, or complication rates between ethnic groups. Uninsured patients were significantly younger (P = 0.003) and were more likely to require an ERCP (39.5% versus 26.8% for privately insured and 31.9% for publicly insured, P = 0.04). Patients with no insurance were significantly more likely to have a higher white blood cell count (P = 0.039) and aspartate aminotransferase (AST) level (P = 0.04). Patients with public insurance and no insurance had a significantly longer median length of hospital stay (4.0 d versus 3.0 d for privately insured, P = 0.045). There were no significant differences in operation types, complication rates, or pathologic diagnosis based on insurance status. CONCLUSIONS: In our population, ethnicity and insurance status do play a role in the presentation and care of patients with gallstone disease. Latino and uninsured patients present with a higher complexity of disease and require interventions more frequently.