Interobserver variability of selective region-of-interest measurement protocols for quantitative diffusion weighted imaging in soft tissue masses: Comparison with whole tumor volume measurements.

BACKGROUND: To assess the interobserver reliability of three selective region-of-interest (ROI) measurement protocols for apparent diffusion coefficient (ADC) quantifications in soft tissue masses (STMs) compared with whole tumor volume (WTV) ADC measurements. METHODS: Institutional review board approval was obtained and informed consent was waived. Three observers independently measured minimum and mean ADCs of 73 benign and malignant musculoskeletal STMs using three selective methods (single-slice [SS], predefined three slices [PD], observer-based [OB]) and WTV measurements at 3.0 Tesla. Minimum and mean ADC values derived from each method were compared with WTV measurements, and inter-reader variation was assessed using the intraclass correlation coefficient (ICC). The time required for each method of ADC measurement was recorded. RESULTS: For the SS, PD, OB, and WTV methods, minimum ADC values ((×10(-3) mm2 /s)) were 0.97, 0.78, 0.73, and 0.67, respectively, and mean ADC values ((×10(-3) mm2 /s)) were 1.49, 1.49, 1.51, and 1.49, respectively. Interobserver agreement was good to excellent for the minimum and mean ADC values for the three readers using the SS, PD, OB, and WTV (ICC range 0.78-0.90). The SS, PD and OB methods required the least amount of measurement time (14 ± 5, 40 ± 17, and 38 ± 15 s, respectively) while the reference WTV method required the longest measurement time (111 ± 54 s) (P < 0.01). CONCLUSION: While all selective and WTV measurements offer good to excellent interobserver agreement, the selective OB method of ADC measurement results in the closest values to WTV measurements and requires significantly less measurement time than that required for the WTV method.

Meaningful Peer Review in Radiology: A Review of Current Practices and Potential Future Directions.

The current practice of peer review within radiology is well developed and widely implemented compared with other medical specialties. However, there are many factors that limit current peer review practices from reducing diagnostic errors and improving patient care. The development of "meaningful peer review" requires a transition away from compliance toward quality improvement, whereby the information and insights gained facilitate education and drive systematic improvements that reduce the frequency and impact of diagnostic error. The next generation of peer review requires significant improvements in IT functionality and integration, enabling features such as anonymization, adjudication by multiple specialists, categorization and analysis of errors, tracking, feedback, and easy export into teaching files and other media that require strong partnerships with vendors. In this article, the authors assess various peer review practices, with focused discussion on current limitations and future needs for meaningful peer review in radiology.

Differentiation of benign and malignant skeletal lesions with quantitative diffusion weighted MRI at 3T.

OBJECTIVES: To investigate the accuracy of quantitative diffusion-weighted imaging with apparent diffusion coefficient (ADC) mapping for characterizing bone lesions as benign or malignant. METHODS: At 3T, 31 subjects with intramedullary lesions imaged by DWI (b-values 50, 400, 800s/mm(2)) were included. ADC values (minimum, mean, maximum) were recorded by three observers independently. Interobserver variability and differences between ADC values in benign and malignant lesions were assessed (unpaired t-test, receiver operating characteristic (ROC) analysis). RESULTS: Of 31 lesions, 18 were benign (osteoblastic (n=1), chondroid (n=6), cysts (n=4), hemangiomatosis (n=1), fibrous (n=3), eosinophilic granuloma (n=1), giant cell tumor (n=1), osteomyelitis (n=1)) and 13 were malignant (primary (n=5), metastases (n=8)). Overall, there were higher minimum (1.27 × 10(-3)mm(2)/s vs 0.68 × 10(-3)mm(2)/s, p<0.001), mean (1.68 × 10(-3)mm(2)/s vs 1.13 × 10(-3)mm(2)/s, p<0.001), and maximum (2.09 × 10(-3)mm(2)/s vs 1. 7 × 10(-3)mm(2)/s, p=0.03). ADC values in benign lesions compared with those in malignancies. ROC analysis revealed areas under the curve for minimum, mean, and maximum ADC values of 0.91, 0.85, and 0.71, respectively. ADC measurements were made with high inter-observer concordance (ρ=0.83-0.96). CONCLUSION: Quantitative ADC maps may have predictive value for the characterization of bone lesions. Benign lesions generally have higher minimum, mean, and maximum ADC values than malignancies, with the minimum value offering the highest accuracy for characterization.

Reengineering the radiology enterprise: a summary of the 2014 Intersociety Committee Summer Conference.

The current initiative to reform health care from both a quality and a cost perspective has already had a profound impact on the radiology enterprise. We have seen a decrease in the utilization of imaging studies, a reduction in reimbursement, a declining payer mix, shrinking incomes, a proliferation of performance indices, creation of radiology mega-groups, growth of national radiology companies, and increasing turf incursions. Our cheese is clearly on the move, and we must take action to reengineer the radiology enterprise. In keeping with general health care reform, we must be patient-centric, data driven, and outcome based. We must create a radiology enterprise that adheres to the value equation of providing the highest quality health care, for the lowest possible cost, for all citizens.

Ischemic stroke occurring during intercourse in young women on oral contraceptives.

Ischemic stroke occurring during intercourse in young patients is exceedingly rare. We present 2 cases of young women taking oral contraceptives, each presenting with an ischemic stroke. Transthoracic echocardiography revealed a patent foramen ovale in one patient and an atrial septal defect in the other. The most likely cause of stroke in both patients is embolic. Despite conflicting evidence, young patients presenting with ischemic stroke and found to have a patent foramen ovale or atrial septal defect should be considered for possible device-based closure.