Editor’s Choice

Combination of Iterative Metal Artifact Reduction and Virtual Monoenergetic Reconstruction Using Split-Filter Dual-Energy CT in Patients With Dental Artifact on Head and Neck CT
Alexander Marcel Alfred Schmidt, Jan-Peter Grunz, Bernhard Petritsch, Philipp Gruschwitz, Jonas Knarr, Henner Huflage, Thorsten Alexander Bley, Aleksander KosmalaD
Virtual monoenergetic reconstruction and iMAR techniques, using split-filter dual-energy CT, may be combined for clinical head and neck imaging to reduce artifact from dental hardware and improve image quality.

Deep Learning Algorithms for Interpretation of Upper Extremity Radiographs: Laterality and Technologist Initial Labels as Confounding Factors
Paul H. Yi, MD, Patrick Malone, MD, PhD, Cheng Ting Lin, MD, Ross W. Filice, MD
Potential radiographic confounding features should be considered when curating data for radiology CNN development.

Interpretations of Examinations Outside of Radiologists' Fellowship Training: Assessment of Discrepancy Rates Among 5.9 Million Examinations from a National Teleradiology Databank
Suzanne Chong, MD, MS, Tarek Hanna, MD, Christine Lamoureux, MD, MS, Tianwen Ma, MS, Scott Weber, MA, Jamlik-Omari Johnson, MD, Eric Friedberg, MD, Robert S. Pyatt Jr., MD, Catherine J. Everett, MD, MBA, Timothy D. Johnson, PhD
The findings support multispecialty radiologist practice in acute community settings. Efforts to match examination and interpreting radiologist subspecialty may not reduce diagnostic discrepancies.

Cost-Effectiveness of Follow-up Ultrasound for Incidental Thyroid Nodules on CT
Mark M. Hammer, MD, Chung Yin Kong, PhD
Follow-up ultrasound for thyroid nodules incidentally detected on CT is likely not cost-effective in older patients. Follow-up for most thyroid nodules in younger patients may be cost-effective.

Progression Rates of LR-2 and LR-3 Observations on MRI to Higher LI-RADS Categories in Patients at High Risk for Hepatocellular Carcinoma: A Retrospective
Damithri Ranathunga, MBBS, Heba Osman, MD, Nayaar Islam, BHSc, Matthew DF McInnes, MD, PhD, Javeria Munir, MD, Christian B. van der Pol, MD, Mohamed Elfaal, MB Bch, MSc, Cynthia Walsh, MD
Based on progression to LR-4 or LR-5, LR-2 and LR-3 observations showed lower progression rates than reported in studies incorporating pathology in determining progression.

Synthetic Extracellular Volume Fraction Derived Using Virtual Unenhanced Attenuation of Blood on Dual-Energy Contrast-Enhanced Cardiac CT in Nonischemic
Na Young Kim, MD, Dong Jin Im, MD, Jong-Chan Youn, MD, PhD, Yoo Jin Hong, MD, PhD, Byoung Wook Choi, MD, PhD, Seok-Min Kang, MD, PhD, Hye-Jeong Lee, MD, PhD
Synthetic hematocrit calculating using the virtual unenhanced attenuation of blood may provide myocardial extracellular volume measurements from contrast-enhanced dual-energy CT without blood sampling or separate unenhanced CT acquisition.

Image Quality and Diagnostic Performance of Accelerated Shoulder MRI With Deep Learning-Based Reconstruction
Jisook Yi, Seok Hahn, Ho-Joon Lee, Yedaun Lee, Yun-Jung Lim, Jin-Young Bang, Hyunwoong Kim, Joonsung Lee
Accelerated sequences with deep learning reconstruction provide a 67% reduction in scan time with preserved image quality and diagnostic performance compared with standard sequences for shoulder MRI

Consensus Definitions and Interpretation Templates for Magnetic Resonance Imaging of Defecatory Pelvic Floor Disorders: Proceedings of the Consensus Meeting of the Pelvic Floor Disorders Consortium of the American Society of Colon and Rectal Surgeons, the Society of Abdominal Radiology, the International Continence Society, the American Urogynecologic Society, the International Urogynecological Association, and the Society of Gynecologic Surgeons
Brooke H. Gurland, MD, Gaurav Khatri, MD, Roopa Ram, MD, Tracy L. Hull, MD, Ervin Kocjancic, MD, Lieschen H. Quiroz, MD, Rania F. El Sayed, MD, Kedar R. Jambhekar, MD, Victoria Chernyak, MD, MS, Raj Mohan Paspulati, MD, Vipul R. Sheth, MD, PhD, Ari M. Steiner, MD, Amita Kamath, MD, S. Abbas Shobeiri, MD, MBA, Milena M. Weinstein, MD, Liliana Bordeianou, MD, MPH, on behalf of the Members of the Expert Workgroup on Magnetic Resonance Imaging of Pelvic Floor Disorders
The recommendations included in this article represent the work of the Pelvic Floor Disorders Consortium Working Group on Magnetic Resonance Imaging of Pelvic Floor Disorders. The objective was to generate inclusive, rather than prescriptive, guidance for all practitioners, irrespective of discipline, involved in the evaluation and treatment of patients with pelvic floor disorders.

Physician Burnout in Radiology: Perspectives From the Field
Cheri Canon, MD, Jeffrey Forris Beecham Chick, MD, MPH, Ivan Dequesada, MD, Richard B. Gunderman, MD, PhD, Noelle Hoven, MD, Ashley Elizabeth Prosper, MD
Radiologists from a diversity of backgrounds, practice settings, and career stages were asked for their perspectives on burnout.

Prediction of Early Treatment Response in Multiple Myeloma Using MY-RADS Total Burden Score, ADC, and Fat Fraction From Whole-Body MRI: Impact of Anemia on Predictive Performance
Huazheng Dong, Wenyang Huang, Xiaodong Ji, Lixiang Huang, Dehui Zou, Mu Hao, Shuhui Deng, Zhiwei Shen, Xiudi Lu, Jian Wang, Zhiyi Song, Xuening Zhang, Huadan Xue, Shuang Xia
Findings from whole-body MRI, incorporating MY-RADS, may be used to guide early treatment decisions in the subset of patients with multiple myeloma who do not have anemia.

Sporadic Primary Pheochromocytoma: A Prospective Intra-Individual Comparison of Six Imaging Tests (CT, MRI, and PET/CT Using 68Ga-DOTATATE, FDG, 18F-FDOPA, and 18F-FDA)
Abhishek Jha, Mayank Patel, Jorge A. Carrasquillo, Alexander Ling, Corina Millo, Babak Saboury, Clara C. Chen, Paul Wakim, Melissa K. Gonzales, Leah Meuter, Marianne Knue, Sara Talvacchio, Peter Hescovitch, Jaydira Del Rivero, Alice P. Chen, Naris Nilubol, David Taïeb, Frank I. Lin, Ali Cahid Civelek, Karel Pacak
Findings from this small intra-individual comparative study support 18F-FDOPA PET/CT as a preferred first line imaging modality in evaluation of sporadic PHEO.

Learning Curve for CT-Guided Percutaneous Transthoracic Core Needle Biopsy: Retrospective Evaluation Among 17 Thoracic Imaging Fellows at a Tertiary Referral Hospital
Rohee Park, MD, Sang Min Lee, MD, Seonok Kim, MSc, Sohee Park, MD, Jooae Choe, MD, Kyung-Hyun Do, MD, Joon Beom Seo, MD
For CT-guided percutaneous transthoracic needle biopsy, at least 37 and 52 procedures are required to achieve acceptable diagnostic accuracy and false negative rate, respectively. Not all operators achieved acceptable complication rates.

Contrast-Enhanced T1-Weighted Head and Neck MRI: Prospective Intraindividual Image Quality Comparison of Spiral GRE, Cartesian GRE, and Cartesian TSE Sequences
Elisabeth Sartoretti, Sabine Sartoretti-Schefer, MD, Luuk van Smoorenburg, BSc, Christoph A. Binkert, MD, Árpád Schwenk, MD, Andreas Gutzeit, MD, Manoj Mannill, MD, Msc, Michael Wyss, Bsc, Thomas Sartoretti, BMed
3D spiral GRE sequence may help overcome certain challenges of conventional Cartesian sequences for head and neck MRI.

Hepatocellular Carcinoma Staging: Differences Between Radiologic and Pathologic Systems and Relevance to Patient Selection and Outcomes in Liver Transplantation
Guilherme Moura Cunha, MD, Mojgan Hosseini, MD, Alessandro Furlan, MD, Kathryn J. Fowler, MD
Higher congruency between pathology and radiology staging systems for hepatocellular carcinoma may further advance the understanding of radiopathologic phenotypes of disease and their prognostic value.

Mammographic Surveillance After Breast Conserving Therapy: Impact of Digital Breast Tomosynthesis and Artificial Intelligence-Based Computer-Aided Detection
Jung Hyun Yoon, MD, PhD, Eun-Kyung Kim, MD, PhD, Ga Ram Kim, MD, PhD, Kyunghwa Han, PhD, Hee Jung Moon, MD, PhD
AI-CAD is a useful adjunct for reducing false-positive findings when performing surveillance mammography after breast conserving therapy.

Atypical Metastases in the Abdomen and Pelvis From Biochemically Recurrent Prostate Cancer: 11C-Choline PET/CT Imaging With Multimodality
Anurima Patra, MD, Hala Khasawneh, MBBS, Garima Suman, MD, Mark A. Nathan, MD, Annie T. Packard, MD, Geoffrey B. Johnson, MD, PhD, Ajit H. Goenka, MD
Knowledge of atypical metastases’ pathophysiology, imaging features, and relevant pitfalls is necessary given their implications for treatment, prognosis, clinical trial eligibility, and patient counseling.

DUAL-ENERGY CT-DERIVED ELECTRON DENSITY FOR DIAGNOSING METASTATIC MEDIASTINAL LYMPH NODES IN NON-SMALL CELL LUNG CANCER: COMPARISON WITH CONVENTIONAL CT AND FDG PET/CT FINDINGS
Hiroaki Nagano, MD, Koji Takumi, MD, PhD, Masatoyo Nakajo, MD, PhD, Yoshihiko Fukukura, MD, PhD, Yuichi Kumagae, MD, PhD, Megumi Jinguji, MD, PhD, Astushi Tani, MD, PhD, Takashi Yoshiura, MD, PhD
Electron density derived from dual-energy CT may help diagnose metastatic lymph nodes in non-small cell lung cancer given decreased electron density in metastatic nodes.

Feasibility and Safety of Neonatal Brain Contrast-Enhanced Ultrasound: A Prospective Study Using MRI as Reference Standard
Judy H. Squires, MD, Nancy H. Beluk, Vince K. Lee, Toby D. Yanowitz, MD, Serter Gumus, MD, Subramaniam Subramaniam, MD, Ashok Panigrahy, MD
This prospective study in 26 neonates demonstrated that brain contrast-enhanced ultrasound, performed portably in the NICU, is feasible, safe, and more rapid than MRI, with almost perfect inter-reader agreement.

MRI EVALUATION OF PATIENTS BEFORE AND AFTER INTERVENTIONS FOR BENIGN PROSTATIC HYPERPLASIA: AN UPDATE
Teresa Diaz, MD, Benjamin Benson, MD, Alexander Clinkenbeard, MD, Jeremiah Long, MD, Akira Kawashina, MD, PhD, Motoyo Yano, MD,
Radiologists should be familiar with the appearance of the prostate on MRI after these interventions (holmium laser enucleation, photoselecdtive vaporization, water vapor thermal therapy, and permanent metallic device implantation) as well as with postprocedural complications encountered on imaging.

CAR T-CELL THERAPY: AN UPDATE FOR RADIOLOGISTS
Justin G. Yoon, BS, Daniel Smith, MD, Sree H. Tirumani, MD, Paolo F. Caimi, MD, Nikhil Ramaiya, MD
Radiologists should understand the clinical and imaging findings of CAR T-cell related toxicities, including cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS).

CSF-VENOUS FISTULAS: ANATOMY AND DIAGNOSTIC IMAGING
Peter G. Kranz, MD, Linda Gray, MD, Michael D. Malinzak, MD, PhD, Jessica L. Houk, MD, Dong Kun Kim, MD, Timothy J. Amrhein, MD
Specialized imaging tests have been developed to help detect CSF-venous fistulas; selecting an appropriate modality requires an understanding of the advantages and disadvantages of each.

CT ABNORMALITIES OF THE PANCREAS ASSOCIATED WITH THE SUBSEQUENT DIAGNOSIS OF CLINICAL STAGE I PANCREATIC DUCTAL ADENOCARCINOMA
Fumihito Toshima, MD, PhD, Ryosuke Watanabe, MD, Dai Inoue, MD, PhD, Norihide Yoneda, MD, PhD, Tatsuya Yamamoto, MD, PhD, Naoki Sasahira, MD, PhD, Takashi Sasaki, MD, PhD, Masato Matsuyama, MD, PhD, Kaori Minehiro, MD, Ukihide Tateishi, MD, PhD, Toshifumi Gabata, MD, PhD
Focal pancreatic abnormalities predicting subsequent PDAC development, including atrophy, faint enhancement, and MPD change, could allow an earlier diagnosis, thereby improving management and prognosis.

STRUCTURAL HEART 4D FLOW MRI FOR HEMODYNAMIC ASSESSMENT: HOW WE DO IT
Kathleen Jacobs, MD, Lewis Hahn, MD, Michael Horowitz, MD, PhD, Seth Kligerman, MD, Shreyas Vasanawala, MD, PhD, Albert Hsiao, MD, PhD
4D Flow MRI is a highly valuable technique for comprehensive clinical evaluation of structural heart defects, though requires radiologist awareness of various pearls and pitfall.

FEVER: THE FLEXED ELBOW VALGUS EXTERNAL ROTATION VIEW FOR MRI EVALUATION OF THE ULNAR COLLATERAL LIGAMENT IN THROWING ATHLETES— A PILOT STUDY IN MAJOR LEAGUE BASEBALL PITCHERS
Pamela J Lund, Gary Waslewski, Ken Crenshaw, Mari Schenk, Graham Munday, Thomas Knoblauch, Alan Rodriguez, Travis Snyder
FEVER view achieves valgus stress as indicated by joint space widening and improves diagnostic confidence, potentially improving MRI evaluation of the ulnar collateral ligament in throwing athletes.

DEVELOPMENT OF BRAIN METASTASES IN PATIENTS WITH NON-SMALL CELL LUNG CANCER AND NO BRAIN METASTASES AT INITIAL STAGING EVALUATION: CUMULATIVE INCIDENCE AND RISK FACTOR ANALYSIS
Minjae Kim, MD, Chong Hyun Suh, MD, PhD, Sang Min Lee, MD, PhD, Ji Eun Park, MD, PhD, Ho Cheol Kim, MD, Seon-Ok Kim, MSc, Ayal A. Aizer, MD, Ted K. Yanagihara, MD, PhD, Harrison X. Bai, MD, Jeffrey P. Guenette, MD, Raymond Y. Huang, MD, Ho Sung Kim, MD, PhD
Surveillance brain MRI at 12 months after initial evaluation in the identified high risk patient groups may allow earlier targeted therapy for non-small cell lung cancer.

ROLE OF ULTRASOUND AND MRI IN DIAGNOSIS OF SEVERE PLACENTA ACCRETA SPECTRUM DISORDER: AN INTRAINDIVIDUAL ASSESSMENT WITH EMPHASIS ON PLACENTAL BULGE
Shanigarn Thiravit, MD, Kimberly Ma, MD, Inessa Goldman, MD, Pharuhas Chanprapaph, MD, Priyanka Jha, MBBS, Daniel S. Hippe, MS, Manjiri Dighe, MD
Placental bulge sign on either prenatal US or MRI may help diagnose severe placenta accreta spectrum warranting hysterectomy rather than conservative management.

ANALYSIS OF 612 BENIGN PAPILLOMAS DIAGNOSED AT CORE BIOPSY: RATE OF UPGRADE TO MALIGNANCY, FACTORS ASSOCIATED WITH UPGRADE, AND A PROPOSAL FOR SELECTIVE SURGICAL EXCISION
Su-Ju Lee, MD, Rifat A. Wahab, DO, Lawrence D. Sobel, MD, Bin Zhang, PhD, Ann L. Brown, MD, Kyle Lewis, MD, Charmi Vijapura, MD, Mary C. Mahoney, MD
The proposed criteria for selective surgery of benign papillomas on core biopsy would reduce surgeries without delaying diagnosis of malignancy.

SUBLOBAR RESECTION IN STAGE IA NON-SMALL CELL LUNG CANCER: ROLE OF PREOPERATIVE CT FEATURES IN PREDICTING PATHOLOGIC LYMPHOVASCULAR INVASION AND POSTOPERATIVE RECURRENCE
Jooae Choi, Mi Young Kim, Jae Kwang Yun, Geun Dong Lee, Yong-Hee Kim, Sehoon Choi, Dong Kwan Kim
The identified CT features may help identify which patients with stage IA non-small cell lung cancer are optimal candidates for sublobar resection rather than more extensive surgery.

ULTRASOUND-GUIDED OMENTAL BIOPSY: DIAGNOSTIC YIELD AND ASSOCIATION WITH CT FEATURES BASED ON A SINGLE-INSTITUTION 18-YEAR SERIES
Alberto A. Perez, BE, Meghan G. Lubner, MD, Perry J. Pickhardt, MD
US-guided biopsy of suspected omental disease identified on CT provides a safe and effective means for tissue diagnosis and warrants consideration as first line biopsy approach.

CONTRAST-ENHANCED ULTRASOUND IN CHILDREN: IMPLEMENTATION AND KEY DIAGNOSTIC
Judy H. Squires, MD, M. Beth McCarville, MD
This review explores the implementation of contrast-enhanced ultrasound (CEUS) in children, describing basic principles of ultrasound contrast agents and CEUS technique and summarizing current and potential diagnostic applications based on pediatric-specific supporting evidence.

MRI VISUALIZATION OF POLYETHYLENE POST FRACTURES IN POSTERIOR STABILIZED TOTAL KNEE ARTHROPLASTY
Meghan Sahr, MD, Hollis Potter, MD, Yoshimi Endo, MD
We show that MRI can noninvasively detect post fractures, facilitated by an optimized protocol including a metal-artifact reduction technique such as multspectral imaging.

PREOPERATIVE CT FINDINGS FOR PREDICTING ACUTE EXACERBATION OF INTERSTITIAL PNEUMONIA AFTER LUNG CANCER SURGERY: A MULTICENTER CASE-CONTROL STUDY
Yoshiyuki Ozawa, MD, PhD, Yuta Shubamoto, MD, PhD, Marehiko Hiroshima, MD, Motoo Nakagawa, MD, PhD, Asami Ono, MD, PhD, Ryota Hanaoka, MD, PhD, Asako Yamamoto, MD, PhD, Junya Tominaga, MD, PhD, Hiroshi Kawada, MD, PhD, Mitsuhiro Koyama, MD, PhD, Koji Takumi, MD, PhD, Maho Tsubakimoto, MD, PhD, Ryoko Egashira, MD, PhD, Fumiyasu Tsushima, MD, PhD, Yasuka Kikuchi, MD, PhD, Yuchiro Izumi, MD, PhD, Takasuke Ushio, MD, Masatoshi Kimura, MD, Shintaro Ichikawa, MD, PhD, Noriko Kitamura, MD, PhD, Shoichiro Matsushita, PhD, Kenzo Okauchi, MD, PhD, Toshihiro O'uchi, MD, PhD, Hiroyuki Ishikawa, MD, PhD, Manasori Kitase, MD, PhD
Ground glass opacity, consolidation, and pulmonary trunk enlargement on preoperative CT predict acute exacerbation in patients with interstitial pneumonia undergoing lung cancer surgery.

TWO MILLISIEVERT VERSUS CONVENTIONAL-DOSE CT FOR RIGHT COLONIC DIVERTICULITIS AS AN ALTERNATE DIAGNOSIS OF APPENDICITIS: SECONDARY ANALYSIS OF LARGE PRAGMATIC RANDOMIZED TRIAL
Hae Young Kim, MD, PhD, Seungjae Lee, MS, Dong Hwan Kim, MD, Yousun Ko, PhD, Ji Hoon Park, MD, PhD, Ara Ko, MD, Seok Min Jeong, MD, Sung Bin Park, MD, PhD, Kyoung Ho Lee, MD, PhD, for the LOCAT group
By mitigating concern of missed diagnosis of right colonic diverticulitis, the results further support the use of low-dose CT in patients with suspected appendicitis.

ADDING DELAYED PHASE IMAGES TO DUAL-PHASE CONTRAST-ENHANCED CT INCREASES SENSITIVITY FOR SMALL PANCREATIC DUCTAL ADENOCARCINOMA
Yoshihiko Fukukura, MD, PhD, Yuichi Kumagae, MD, PhD, Yosuke Fujisaki, MD, Ryoji Yamagishi, MD, Shinya Nakamura, MD, Junki Kamizono, MD, Masanori Nakajo, MD, PhD, Kiyohisa Kamimura, MD, PhD, Hiroaki Nagano, MD, Koji Takumi, MD, PhD, and Takashi Yoshiura, MD, PhD
Addition of delayed phase to pancreatic and portal venous phase CT increases sensitivity for small PDAC without loss of specificity, partly related to delayed phase hyperattenuation of some small PDACs showing pancreatic phase isoattenuation.

CONTRAST-ENHANCED MAMMOGRAPHY FOR NEWLY DIAGNOSED BREAST CANCER IN WOMEN WITH BREAST AUGMENTATION: PRELIMINARY FINDINGS
Molly Carnahan, MD, Barbara Pockaj, MD, Victor Pizzitola, MD, Marina Giurescu, MD, Roxanne Lorans, MD, William Eversman, MD, Richard Sharpe, MD, Patricia Cronin, MD, Bhavika K. Patel, MD
This preliminary study shows concordance between contrast-enhanced mammography and MRI in women with newly diagnosed breast cancer and breast augmentation.

LATERAL MENISCUS POSTERIOR ROOT INJURY: MRI FINDINGS IN CHILDREN WITH ANTERIOR CRUCIATE LIGAMENT TEAR
Jie C. Nguyen, MD, MS, Soroush Baghdadi, MD, J. Todd R. Lawrence, MD, PhD, Alyssa Sze, BA, Andressa Guariento, MD, Theodore J. Ganley, MD, Ann M. Johnson, MD
Among MRI findings evaluated for preoperative diagnosis of lateral meniscus posterior root tear, tear involving any segment of the root proper had strongest performance; associated findings had high specificity but low sensitivity.

PPV AND DETECTION RATE OF MT-SDNA, FIT, AND CT COLONOGRAPHY FOR ADVANCED NEOPLASIA: A HIERARCHICAL BAYESIAN META-ANALYSIS OF THE NONINVASIVE COLORECTAL SCREENING
Perry J. Pickhardt, MD, Loredana Correale, PhD, Cesare Hassan, MD
Among noninvasive colorectal screening tests, CT colonography with ≥10 mm threshold most effectively targets advanced neoplasia, preserving detection while also decreasing unnecessary colonoscopies compared with mt-sDNA and FIT.

IN-BORE VERSUS FUSION MRI-TARGETED PROSTATE BIOPSY OF PI-RADS CATEGORY 4 OR 5 LESIONS: A RETROSPECTIVE COMPARATIVE ANALYSIS USING PROPENSITY SCORE WEIGHTING
Morgan Prince, MD, Bryan R. Foster, MD, Andy Kaempf, MS, Jen-Jane Liu, MD, Christopher L. Amling, MD, Sudhir Isharwal, MD, Yiyi Chen, PhD, Fergus V. Coakley, MD
In-bore MRI-targeted biopsy may be preferred to fusion biopsy should performing only targeted biopsy of suspicious lesions, without concurrent systematic biopsy, be considered clinically appropriate.

YTTRIUM-90 HEPATIC RADIOEMBOLIZATION FOR ADVANCED CHEMOREFRACTORY METASTATIC COLORECTAL CANCER: SURVIVAL OUTCOMES BASED ON RIGHT-VERSUS LEFT-SIDED PRIMARY TUMOR LOCATION
Vincent Wu, MD, Matthew D. Li, MD, J. Scott Goodwin, MD, Eric P. Wehrenberg-Klee, MD, Omar Zurkiya, MD, PhD, Sanjeeva P. Kalva, MBBS, Suvranu Ganguli, MD
Right-sided primary tumor was independently associated with decreased survival in patients with chemorefractory metastatic colorectal cancer after Y90 radioembolization, despite similar RECIST tumor response, hepatic progression free survival, and extrahepatic disease progression compared to those with left-sided primary tumors.

DISPLACED FLAP TEARS OF THE TRIANGULAR FIBROCARTILAGE COMPLEX: FREQUENCY, FLAP LOCATION, AND THE “COMMA” SIGN ON WRIST MRI
Robert D. Boutin, MD, Russell C. Fritz, MD
Displaced flaps should be considered when MRI shows a triangular fibrocartilage complex tear and an adjacent comma sign.

LIVER FAT QUANTIFICATION BY ULTRASOUND IN CHILDREN: A PROSPECTIVE STUDY
Aurélie D’Hondt, MD, Erika Rubesova, MD, Hua Xie, PhD, Vijay Shamdasani PhD, Richard A. Barth, MD
Quantitative ultrasound parameters may guide NAFLD diagnosis and management in children.

MULTIDISCIPLINARY MANAGEMENT OF COMPLICATED PANCREATITIS: AN UPDATE FOR INTERVENTIONAL RADIOLOGISTS
Amir Ata Rahnemai-Azar, MD, Christopher Sutter, MD, Umar Hayat, MD, Brook R. Glessing, MD, John Ammori, MD, Sidhartha Tavri, MBBS
Management of complicated pancreatitis is most effective in a multidisciplinary team manner. Interventional radiologists are integral in management of these patients and should be familiar with indications, complications, and techniques of procedures performed by gastroenterologists and surgeons.

IMPACT OF PATIENT-REPORTED SYMPTOM INFORMATION ON AGREEMENT IN THE MRI DIAGNOSIS OF PRESUMPTIVE LUMBAR SPINE PAIN GENERATOR
Rene Balza, MD, Sarah F. Mercaldo, PhD, Connie Y. Chang, MD, Ambrose J. Huang, MD, Jad S. Husseini, MD, Arvin B. Kheterpal, MD, F. Joseph Simeone, MD, William E. Palmer
Using patient-reported symptom information from a questionnaire, radiologists interpreting lumbar spine MRI converged on diagnoses of presumptive pain generators and distinguished these from incidental abnormalities.

CLINICAL IMPLEMENTATION OF DUAL-ENERGY CT FOR GASTROINTESTINAL IMAGING
Achille Mileto, MD, Lakshmi Ananthakrishnan, MD, Desiree E. Morgan, MD, Benjamin M. Yeh, MD, Daniele Marin, MD, Avinash R. Kambadakone, MD
This article provides an overview of practical aspects of the DECT technology and acquisition protocols, reviews existing clinical applications, discusses current challenges, and describes future directions, with a focus on gastrointestinal imaging.

MANAGEMENT AND OUTCOMES OF SUSPECTED INFECTIOUS AND INFLAMMATORY LUNG ABNORMALITIES IDENTIFIED ON LUNG CANCER SCREENING CT
Dexter P. Mendoza, MD, Wariya Chintanapakdee, MD, Eric W. Zhang, MD, Matthew D. Gilman, MD, Inga T. Lennes, MD, MPH, MBA, Angela J. Frank, MD, MPH, Jo-Anne O. Shepard, MD, Subba R. Digumarthy, MD
Adopting a conservative management algorithm for suspected infectious or inflammatory lung abnormalities identified on LCS can reduce unnecessary imaging without increasing risk for missing malignancy.

FACIAL FEMINIZATION SURGERY: KEY CT FINDINGS FOR PREOPERATIVE PLANNING AND POSTOPERATIVE EVALUATION
Andrew L. Callen, MD, Ryan K. Badiee, Andrew Phelps, MD, Valeria Potigailo, MD, Eric Wang, MD, Solomon Lee, MD, Jason Talbott, MD, PhD, Christine Glastonbury, MBBS, Jason H. Pomerantz, MD, Jared Narvid, MD
We describe readily identifiable CT features with a key role in FFS planning. Familiarity with these findings will facilitate improved communication between radiologists and surgeons, thereby contributing to the care of transgender women.

DIAGNOSTIC YIELD OF INCREMENTAL BIOPSY CORES AND SECOND LESION SAMPLING FOR INGANTRY MRI-GUIDED PROSTATE BIOPSY
Nicole Seyfried, BS, Amr Mahran, MD, Ananya Panda, MD, Verena C. Obmann, MD, Christina A Buzzy, PhD, Yun Jiang, PhD, Katherine L. Wright, PhD, Dean A. Nakomoto, MD, Indravadan J. Patel, MD, Britt Conroy, MD, PhD, JD, Lee Ponsky, MD, Vikas Gulani, MD, PhD
Obtaining only three cores from the primary lesion during in-gantry MRGB may be sufficient for high diagnostic yield while reducing patient discomfort and procedure times.

BEST PRACTICES: CT-GUIDED PERCUTANEOUS SAMPLING OF VERTEBRAL DISCITIS-OSTEOMYELITIS AND TECHNICAL FACTORS MAXIMIZING BIOPSY YIELD
Jad S. Husseini, MD, Sina Habibollahi, MD, Sandra B. Nelson, MD, Daniel I. Rosenthal, MD, Connie Y. Chang, MD
CT-guided percutaneous sampling of vertebral discitis-osteomyelitis, despite a relatively low microbiologic yield, may be safely performed for detection of causative microorganisms.

FINDINGS ON CHEST CT PERFORMED IN THE EMERGENCY DEPARTMENT IN PATIENTS ON IMMUNE CHECKPOINT INHIBITOR THERAPY: SINGLE-INSTITUTION 8-YEAR EXPERIENCE IN 136 PATIENTS
Daniel A. Smith, MD, Ethan Radzinsky, Sree Harasha Tirumani, MD, Ezgi Guler, MD, Andrew Petraszko, MD, Elias Kikano, MD, Christopher J. Hoimes, DO, Nikhil H. Ramaiya, MD
Most chest CT examinations in the ED in patients on ICI therapy exhibited worsening lung tumor burden, which was associated with worse survival. New consolidation and ICI-associated pneumonitis (most commonly radiation recall pneumonitis) were also commonly detected in the ED setting.

BORDERLINE RESECTABLE AND LOCALLY ADVANCED PANCREAS CANCER: FDG PET/MRI AND CT TUMOR METRICS FOR ASSESSMENT OF NEOADJUVANT THERAPY PATHOLOGIC RESPONSE AND PREDICTION OF SURVIVAL
Ananya Panda, MD, Ishan Garg, MBBS, Mark J. Truty, MD, Timothy M. Kline, PhD, Matthew P. Johnson, MS, Eric C. Ehman, MD, Garima Suman, MD, Deema A. Anaam, MBBS, Bradley J. Kemp, PhD, Geoffrey B. Johnson, MD, PhD, Thorvardur R. Halfdanarson, MD, Sudhakar K. Venkatesh, MD, Jeff L. Fidler, MD, Ajit, H. Goenka, MD
PET/MRI and CT metrics can help guide post-NAT pancreatic cancer treatment decisions. In comparison, serum CA 19-9 was not associated with pathologic response or survival.

IMAGING CHANGES AND CLINICAL COMPLICATIONS AFTER DRUG-ELUTING BEADS VERSUS CONVENTIONAL TRANSARTERIAL CHEMOEMBOLIZATION FOR UNRESECTABLE HEPATOCELLULAR CARCINOMA: MULTICENTER STUDY
Lei Zhang, MD, Jun-Hui Sun, MD PhD, Jian-Song Ji, MD, PhD, Bin-Yan Zhong, MD, PhD, Guan-Hui Zhou, MD, Jing-Jing Song, MD, Zhong-Heng Hou, MD, Peng Huang, MD, Shen Zhang, MD, Zhi Li, Xiao-Li Zhu, MD, PhD, Cai-Fang Ni, MD, PhD
Compared to cTACE, DEB-TACE for treatment-naïve HCC is associated with a higher frequency of hepatobiliary injury, although similar short-term local control.

PATIENT CHARACTERISTICS ASSOCIATED WITH PATIENT-REPORTED DETERRENTS TO ADJUNCT BREAST CANCER SCREENING AMONG PATIENTS WITH DENSE BREASTS
Matthew M. Miller, Kathy Repich, James T. Patrie, Roger T. Anderson, Jennifer A. Harvey
Among 508 women with dense breasts, lower confidence in sensitivity of mammography in dense breasts was associated with lower concern about examination time and additional imaging resulting from adjunct screening, and with higher preference for more sensitive hypothetical screening examinations. Examination cost was the most common adjunct screening deterrent (66.9%).

TOMOSYNTHESIS-GUIDED VACUUM-ASSISTED BREAST BIOPSY OF ARCHITECTURAL DISTORTION WITHOUT A SONOGRAPHIC CORRELATE: A RETROSPECTIVE REVIEW
Emily B. Ambinder, MD, Amy Plotkin, MD, David Euhus, MD, Lisa A. Mullen, MD, Eniola Oluyemi, MD, Philip Di Carlo, MD, Mary Philip, MD, Babita Panigrahi, MD, Ashley Cimino-Matthews, MD, Keely S. Myers, MD
Up to half of architectural distortions without a sonographic correlate represent malignancy or a high-risk lesion, justifying a recommendation for biopsy, using TVAB when available.

EFFECT OF AT LEAST TEN SERIAL GADOBUTROL ADMINISTRATIONS ON BRAIN SIGNAL INTENSITY RATIOS ON T1-WEIGHTED MRI IN CHILDREN: A MATCHED CASE-CONTROL STUDY
Kerem Ozturk, MD, David Nascene, MD
In a matched case-control analysis, 10 or more serial gadobutrol administrations was not associated with increased signal intensity on T1-weighted imaging in the dentate nucleus or globus pallidus using visual and quantitative analyses.

ULTRASOUND-GUIDED PERCUTANEOUS NEEDLE BIOPSY FOR SMALL PLEURAL LESIONS: DIAGNOSTIC YIELD AND IMPACT OF CT AND ULTRASOUND CHARACTERISTICS
Jongmin Park, MD, Byunggeon Park, MD, Jae-Kwang Lim, MD, Kyung Min Shin, MD, Jaehee Lee, MD, PhD, Chang Ho Kim, MD, PhD, Hyewon Seo, MD, Yong Hoon Lee, MD, Jun Heo, MD, PHD, Young Woo Do, MD
US-guided percutaneous pleural needle biopsy may be warranted as an initial or repeat diagnostic test if the pleura is nodular or thicker than 4.5 mm on CT.

UTILITY OF 18F-FLUCICLOVINE PET/MRI FOR STAGING NEWLY DIAGNOSED HIGH-RISK PROSTATE CANCER AND EVALUATING RESPONSE TO INITIAL ANDROGEN DEPRIVATION THERAPY: A PROSPECTIVE SINGLE-ARM PILOT STUDY
Samuel J. Galgano, MD, Andrew McDonald, MD, Soroush Rais-Bahrami, MD, Kristin K. Porter, MD, PhD, Gagandeep Choudhary, MD, Constantine Burgan, MD, Pradeep Bhambhvani, MD, Jeffrey Nix, MD, Desiree E. Morgan, MD, Yufeng Li, PhD, John V. Thomas, MD, Jonathan McConathy, MD, PhD
Fluorine-18-labeled fluciclovine PET/MRI demonstrates potential utility in initial staging of high-risk prostate cancer and in evaluating response to ADT. 

USE OF ENTERIC CONTRAST FOR ABDOMINOPELVIC CT IN PENETRATING TRAUMATIC INJURY IN ADULTS: COMPARISON OF DIAGNOSTIC ACCURACY SYSTEMATIC REVIEW AND META-ANALYSIS
Mostafa Alabousi, MD, Nanxi Zha, Michael N. Patlas, MD
This systematic review and meta-analysis assessed the utility of enteric contrast for CT in the detection of penetrating traumatic abdominopelvic injuries in 1,287 adults and found no additional diagnostic benefit of enteric contrast compared with use of IV contrast alone.

THERMAL ABLATION VERSUS STEREOTACTIC BODY RADIOTHERAPY FOLLOWING TRANSARTERIAL CHEMOEMBOLIZATION FOR INOPERABLE HEPATOCELLULAR CARCINOMA: A PROPENSITY SCORE WEIGHTED
Nima Nabavizadeh, MD, Younes Jahangiri, MD, Ramtin Rahmani, BA, Yuki Tomozawa, MD, PhD, Yindee Geeratikun, MD, Yiyi Chen, PhD, Arthur Hung, MD, Catherine Degnin, PhD, Khashayar Farsad, MD, PhD
TACE with percutaneous thermal ablation may be superior to TACE with stereotactic body radiotherapy for inoperable hepatocellular carcinoma.

MALIGNANT OUTCOMES OF ARCHITECTURAL DISTORTION ON TOMOSYNTHESIS: A SYSTEMATIC REVIEW AND META-ANALYSIS
Sadia Choudhery, MD, Matthew Johnson, MS, Nicholas B. Larson, PhD, Tara Anderson, MD
Pooled PPV for malignancy of architectural distortion without a known cause on DBT is high at 34.6%. Since most malignant distortions have an US finding, US should be performed to look for a correlate, but the absence of a correlate does not obviate the need for a biopsy.

THE PAIN CRISIS: INTERVENTIONAL RADIOLOGY’S ROLE IN PAIN MANAGEMENT
Austin Fletcher, MD, Kelli J. Moore, MD, James D. Stensby, MD, Anna Hulbert, MD, Arash M. Saemi, MD, Ryan M. Davis, MD, Ambarish Bhat, MD
This article reviews a wide range of minimally invasive procedures, including vertebral augmentation, sacroplasty, thermal ablation of osseous metastasis, nerve blocks, and gonadal vein embolization, that interventional radiologists are now using successfully to treat chronic pain.

PREDICTIVE VALUE OF CARDIAC CT ANGIOGRAPHY, CARDIAC MRI, AND TRANSTHORACIC ECHOCARDIOGRAPHY FOR CARDIOEMBOLIC STROKE RECURRENCE
Georg Apfaltrer, MD, Francesco Lavra, Carlo N. De Cecco, Akos Varga-Szemes MD, PhD, Marly van Assen BS, Domenico Mastrodicasa, MD, Marco Scarabello, MD, Marwen H. Eid, MD, L. Parkwood Griffith, MD, John W. Nance, MD, Sheldon E. Litwin, MD, Luca Saba, MD, U. Joseph Schoepf, MD
Given their high negative predictive value, cardiac MRI and cardiac CT angiography are potential alternatives when echocardiography provides equivocal findings for cardioembolic stroke recurrence.

DIFFUSION-WEIGHTED MRI IN THE ASSESSMENT OF SACROILIITIS: IMPROVED IMAGE QUALITY AND DIAGNOSTIC PERFORMANCE WITH READOUT-SEGMENTED ECHO-PLANAR IMAGING COMPARED WITH CONVENTIONAL SINGLE-SHOT ECHO-PLANAR IMAGING
Hua Zhang, MD, Hongjie Huang, MD, Yuyang Zhang, MD, Zhandai Tu, MD, Zebin Xiao, MD, Jummin Chen, MD, PhD, Dairong Cao, MD
Readout-segmented EPI (rs-EPI) significantly improves the image quality and diagnostic confidence for DWI of the sacroiliac joints compared with single-shot-EPI (ss-EPI). ADC values from rs-EPI better differentiated among disease activity states in patients with axial spondyloarthritis than did ADC values from ss-EPI.

BEST PRACTICES FOR POST-TREATMENT SURVEILLANCE IMAGING IN HEAD AND NECK CANCER: APPLICATION OF THE NECK IMAGING REPORTING AND DATA SYSTEM (NI-RADS)
Sara B. Strauss, MD, Ashley H. Aiken, MD, Josua E. Lantos, MD, C. Douglas Phillips, MD
NI-RADS is a practical solution to the inconsistency in surveillance practices, both in terms of modality choice and surveillance schedule, as well as imaging description in post-treatment HNSCC.

TEMPORAL PATTERN OF RADIOGRAPHIC FINDINGS OF COSTOCHONDRAL JUNCTION RIB FRACTURES ON SERIAL SKELETAL SURVEYS IN SUSPECTED INFANT ABUSE
Andy Tsai, MD PhD, Jeannette Perez-Rossello, MD, Susan A. Connolly, MD, Kosuke Kawai, ScD, Paul K. Kleinman, MD
Costochondral junction fractures in suspected infant abuse show primary injury patterns on initial skeletal survey in 59% (most commonly bucket-handle pattern) and on 2-week follow-up in 6%; secondary healing patterns on initial survey in 89% (most commonly growth disturbance) and on 2-week follow-up in 80%.

DIAGNOSTIC ACCURACY OF QUANTITATIVE MULTI-CONTRAST 5-MINUTE KNEE MRI USING PROSPECTIVE ARTIFICIAL INTELLIGENCE IMAGE QUALITY ENHANCEMENT
Akshay S. Chaudhari, PhD, Murray J. Grissom, MD, Zhongman Fang, PhD, Bragi Sveinsson, PhD, Jin Hyung Lee, PhD, Garry E. Gold, MD, Brian A. Hargreaves, PhD, Kathryn J. Stevens, MD
A 5-minute quantitative double-echo steady-state (qDESS) sequence prospectively enhanced with deep learning had high agreement with conventional knee MRI findings and comparable accuracy as conventional knee MRI with respect to surgical findings. Automatic qDESS T2 relaxation time maps improve sensitivity for subtle cartilage lesions compared to conventional knee MRI.

MIXED-METHODS STUDY TO PREDICT UPSTAGING OF DCIS TO INVASIVE DISEASE ON MAMMOGRAPHY
Lars J. Grimm, MD, Benjamin Neely, MS, Rui Hou, MS, Vignesh Selvakumaran, BSE, Jay A. Baker, MD, Sora C. Yoon, MD, Sujata V. Ghate, MD, Ruth Walsh, MD, Tyler P. Litton, MD, Amrita Devalapalli, MD, Connie Kim, MD, Mary Scott Soo, MD, Terry Hyslop, PhD, E. Shelley Hwang, MD, MPH, Joseph Y. Lo, PhD
A mixed-methods two stage observer study demonstrated that radiologists can improve their ability to predict upstaging of DCIS to invasive disease. The performance of radiologists is currently superior to that achieved by deep learning and computer vision algorithms.

VESICLE IMAGING AND DATA REPORTING SYSTEM (VI-RADS): MULTI-INSTITUTIONAL MULTI-READER DIAGNOSTIC ACCURACY AND INTER-OBSERVER AGREEMENT STUDY
Yoshiko Ueno, MD, PhD, Tsutomo Tamada, MD, PhD, Mitsuru Takeuchi, MD, PhD, Keitaro Sofue, MD, PhD, Satoru Takahashi, MD, PhD, Yuki Kamishimi, MD, PhD, Yasuyo Urase, MD, Ayumu Kido, MD, PhD, Nobuyuki Hinata, MD, PhD, Kenichi Harada, MD, PhD, Masato Fujisawa, MD, PhD, Yoshiyuki Miyaji, MD, PhD, Takamichi Murakami, MD, PhD
Among seven radiologists with different levels of experience in bladder MRI interpretation, the Vesical Imaging-Reporting and Data System (VI-RADS) demonstrated moderate to substantial interobserver agreement (κ-value: 0.55-0.80) and a pooled AUC of 0.87 (range: 0.82-0.91) for diagnosing muscle-invasive bladder.

REAL WORLD LUNG CANCER CT SCREENING PERFORMANCE, SMOKING BEHAVIOR, AND ADHERENCE TO RECOMMENDATIONS: LUNG-RADS CATEGORY AND SMOKING STATUS PREDICT ADHERENCE
Eduardo Jose Mortani Barbosa, MD, Rochelle Yang, BA, Michelle Hershman, MD
Patient adherence to lung cancer screening recommendations is low (43.0%). However, adherence is higher in patients with an increased suspicion for lung cancer (i.e., a higher Lung-RADS category) and in former smokers.

DIAGNOSTIC ACCURACY OF 68Ga-PSMA PET/CT FOR INITIAL DETECTION IN PATIENTS WITH SUSPECTED PROSTATE CANCER: A SYSTEMATIC REVIEW AND META-ANALYSIS
Swayamjeet Satapathy, MBBS, Harmandeep Sing, MD, Rajender Kumar, MD, Bhagwant Rai Mittal, MD
68Ga-PSMA-PET/CT had high diagnostic accuracy for initial detection in patients with suspected prostate cancer and has potential application as a ‘rule-out’ test in this setting.

ADVANCED MUSCULOSKELETAL ULTRASOUND TECHNIQUES: WHAT ARE THE APPLICATIONS?
Marnix van Holsbeeck, MD, Steven Soliman, DO, Filip Van Kerkhove, MD, Joseph Craig, MD
This review covers technical advances in musculoskeletal ultrasound from the viewpoint of the user. The authors take a critical look at the recent literature to highlight progress and unsolved questions.

PREDICTORS OF ANESTHETIC EXPOSURE IN PEDIATRIC MRI
Fedel Machado-Rivas, MD, Ellen Leitman, MD, PhD, Camilo Jaimes, MD, John Conklin, MD, Paul A. Caruso, MD, Chang A. Liu, MD, Michael S. Gee, MD, PhD
A direct relationship between pediatric MRI scan time and dose of anesthetic exposure can be modeled using imaging and clinical variables.

PERCUTANEOUS MICROWAVE ABLATION OF STAGE T1A RENAL CELL CARCINOMA: INTERMEDIATE RESULTS ON SAFETY, TECHNICAL FEASIBILITY, AND CLINICAL OUTCOMES OF 119 TUMORS
Jianhai Guo, MD, Ronald S. Arellano, MD
CT-guided percutaneous microwave ablation is associated with high rates of technical success, excellent local progression-free survival and overall survival, and low complication rate for stage T1a renal cell carcinoma.

DIAGNOSTIC PERFORMANCE OF AMERICAN COLLEGE OF RADIOLOGY THYROID IMAGING REPORT AND DATA SYSTEM: A SYSTEMIC REVIEW AND META-ANALYSIS
Wei Li, MS, Yueming Wang, MS, Jing Wen, MS, Lanlan Zhang, MS, Yuan Sun, MS
When compared with ATA guidelines and Korean TI-RADS, ACR TIRADS could avoid a large number of unnecessary biopsies, with acceptable decline in sensitivity..