American Journal of Roentgenology

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ISSN / EISSN : 0361-803X / 1546-3141
Published by: American Roentgen Ray Society (10.2214)
Total articles ≅ 34,086
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Júlio B. Guimarães, Renan N. Chemin, Flavia F. Araujo, Thomas M. Link, Flávio D. Silva, Alexandre Bitar, Marcelo A. C. Nico, Alípio G. O. Filho
American Journal of Roentgenology pp 1-10; https://doi.org/10.2214/ajr.22.27338

Abstract:
Meniscal root tears represent radial tears or avulsions of the meniscal cartilage at the tibial attachment site that profoundly affect meniscal biomechanics and kinematics. Meniscal root tears have the functional effect of a total meniscectomy and can lead to rapid degenerative change with development of early knee osteoarthritis (OA). A growing range of arthroscopic surgical techniques have been developed to repair meniscal root tears with the aim of restoring joint kinematics and contact pressures and delaying the development of OA. Following increased understanding of the anatomy and biomechanics of the meniscal root, meniscal root injury repair has become the treatment of choice in knees with nonadvanced OA. This article reviews the anatomy and biomechanics of the meniscal roots, clinical and imaging diagnostic criteria of meniscal root tears, correlation between arthroscopy and MRI in the diagnosis and classification of meniscal root tears, and expected and abnormal MRI findings after meniscal root repair. Familiarity with MRI signs and classifications of meniscal root tears, as well as with root repair surgical techniques, can aid radiologists in correctly reporting preoperative and postoperative MRI findings.
Sara Dastmalchian, Hamed Aryafar, Sidhartha Tavri
American Journal of Roentgenology; https://doi.org/10.2214/ajr.22.27626

Abstract:
The most challenging and time-consuming step of transjugular intrahepatic portosystemic shunt (TIPS) procedures is obtaining appropriate portal vein access. Given the lack of real-time direct target visualization, conventional fluoroscopic guidance requires multiple passes, contributing to complications. In comparison, intravascular ultrasound (IVUS) guidance during TIPS procedures provides direct visualization of hepatic structures and real-time guidance for portal vein puncture. IVUS guidance during TIPS creation improves procedural metrics such as radiation dose, contrast agent volume, procedure time, and technical success rate, and is particularly beneficial in technically challenging cases (e.g., in patients portal vein thrombosis, small or variant portal vein anatomy, Budd-Chiari syndrome, or liver masses). The purpose of this review is to summarize current IVUS technology, describe technical aspects of IVUS-guided TIPS creation, and discuss clinical indications for and benefits of using IVUS for TIPS creation, while presenting available evidence supporting the technique's use. Given the improved safety profile and overall success rate in comparison with conventional guidance methods, IVUS guidance has the future potential to become the standard practice for TIPS placement.
Nathan C. Hull
American Journal of Roentgenology; https://doi.org/10.2214/ajr.22.27975

Abstract:
This Editorial Comment discusses the following AJR article: Imaging Features of Hepatocellular Carcinoma in Children With and Without Underlying Risk Factors.
Elizabeth G. Lane, Carolyn S. Eisen, Michele B. Drotman, Katerina Dodelzon, Eralda Mema, Charlene Thomas, Martin R. Prince
American Journal of Roentgenology; https://doi.org/10.2214/ajr.22.27687

Abstract:
Background. The variable clinical course of subclinical lymphadenopathy detected on breast imaging after COVID-19 vaccination creates management challenges and has led to evolving practice recommendations. Objective. To assess the duration of axillary lymphadenopathy ipsilateral to COVID-19 vaccination detected by breast imaging and to assess factors associated with the time until resolution. Methods. This retrospective single-center study included 111 patients (mean, 52±12 years) with unilateral axillary lymphadenopathy ipsilateral to Pfizer or Moderna COVID-19 vaccine administration performed within the prior 8 weeks that was detected on breast ultrasound performed between January 1st, 2021, and October 1st, 2021 and that underwent follow-up ultrasound examinations at 4-12 week intervals until resolution of the lymphadenopathy. Patient information was extracted from medical records. Cortical thickness of the largest axillary lymph node on ultrasound was retrospectively measured and was considered enlarged when greater than 3 mm. Multivariable linear regression analysis was used to identify independent predictors of the time until resolution. Results. The mean cortical thickness on the initial ultrasound was 4.7±1.2 mm. The lymphadenopathy resolved a mean of 97±44 days after the initial ultrasound and 127±43 days after the first vaccine dose, as well as after a mean of 2.4±0.6 follow-up ultrasound examinations. Significant independent predictor of shorter time to resolution was Pfizer (rather than Moderna) vaccination [coefficient=-18.0 (95% CI: -34.3, -1.7); p=.03], and significant independent predictors of longer time to resolution were receipt of the second dose after the initial ultrasound [coefficient=19.2 (95% CI: 3.1, 35.2); p=.02] and greater cortical thickness on the initial ultrasound [coefficient=8.0 (95% CI: 1.5, 14.5); p=.02]. Patient age, prior history of breast cancer, and axillary symptoms were not significantly associated with time to resolution (all p>.05). Conclusion. Axillary lymphadenopathy detected by breast ultrasound after COVID-19 mRNA vaccination lasts longer than reported in initial vaccine clinical trials. Clinical Impact. The prolonged time for resolution supports not delaying screening mammography due to recent COVID-19 vaccination as well as the recent professional society recommendation of a follow-up interval of at least 12 weeks for suspected vaccine-related lymphadenopathy.
Tae Jung Kim, Brent P. Little, Daria Manos, Nicola Sverzellati
American Journal of Roentgenology; https://doi.org/10.2214/ajr.22.27984

Chansik An, Markus M. Obmann, Yuxin Sun, Zhen J. Wang, Mark D. Sugi, Spencer C. Behr, Ronald J. Zagoria, Sean A. Woolen, Benjamin M. Yeh
American Journal of Roentgenology pp 1-11; https://doi.org/10.2214/ajr.21.27319

Abstract:
Background: Data are limited regarding utility of positive oral contrast material for peritoneal tumor detection on CT. Objective: To compare positive versus neutral oral contrast material for detection of malignant deposits in nonsolid intraabdominal organs on CT. Methods: This retrospective study included 265 patients (133 men, 132 women; median age, 61 years) who underwent an abdominopelvic CT examination where the report did not suggest presence of malignant deposits and subsequent CT examination within 6 months where the report indicated at least one unequivocal malignant deposit. Examinations used positive (iohexol; n=100) or neutral (water; n=165) oral agents. A radiologist reviewed images to assess whether the deposits were visible (despite clinical reports indicating no deposits) on unblinded comparison with the follow-up examinations; identified deposits were assigned to one of seven intraabdominal compartments. The radiologist also assessed adequacy of bowel filling with oral contrast material. Two additional radiologists independently reviewed examinations in blinded fashion for malignant deposits. NPV was assessed of clinical CT reports and blinded retrospective readings for detection of malignant deposits visible on unblinded comparison with follow-up examinations. Results: Unblinded review identified malignant deposits in 58.1% (154/265) of examinations. In per-patient analysis of clinical reports, NPV for malignant deposits was higher for examinations with adequate bowel filling with positive oral contrast material [65.8% (25/38)] than for examinations with inadequate bowel filling with positive oral contrast material [45.2% (28/62]], p=.07) or with neutral oral contrast material regardless of bowel filling adequacy [35.2% (58/165), p=.002]. In per-compartment analysis of blinded interpretations, NPV was higher for examinations with adequate and inadequate bowel filling with positive oral contrast material than for examinations with neutral oral contrast regardless of bowel filling adequacy [reader 1: 94.7% (234/247) and 92.5% (382/413) vs 88.3% (947/1072), both p=.045; reader 2: 93.1% (228/245) and 91.6% (361/394) vs 85.9% (939/1093), both p=.01]. Conclusion: CT has suboptimal NPV for malignant deposits in intraabdominal nonsolid organs. Compared to neutral material, positive oral contrast material improves detection, particularly with adequate bowel filling. Clinical Impact: Optimization of bowel preparation for oncologic CT may help avoid potentially severe clinical consequences of missed malignant deposits.
Fumiko Hamabe, Ayako Mikoshi, Hiromi Edo, Hiroaki Sugiura, Kousuke Okano, Yoshitake Yamada, Masahiro Jinzaki, Hiroshi Shinmoto
American Journal of Roentgenology; https://doi.org/10.2214/ajr.22.27354

Abstract:
Background: Ultra-high resolution CT (U-HRCT) allows acquisition using a small detector element size, in turn allowing very high spatial resolutions. The high resolution may reduce partial-volume averaging and thereby renal cyst pseudoenhancement. Objective: To assess the impact of U-HRCT on renal cyst pseudoenhancement. Methods: A phantom was constructed that contained 7-, 15-, and 25-mm simulated cysts within compartments simulating unenhanced and nephrographic-phase renal parenchyma. The phantom underwent two U-HRCT acquisitions using 0.25- and 0.5-mm detector elements, with reconstruction at varying matrices and slice thicknesses. A retrospective study was performed of 36 patients (24 men, 12 women; mean age, 75.7±9.4 years) with 118 renal cysts who underwent renal-mass protocol CT using U-HRCT and the 0.25-mm detector element, with reconstruction at varying matrices and slice thicknesses; detector element size could not be retrospectively adjusted. ROIs were placed to measure cysts' attenuation increase from unenhanced to nephrographic phases (to reflect pseudoenhancement), and SD of unenhanced-phase attenuation (to reflect image noise). Results: In the phantom, attenuation increase was lower for the 0.25 mm than 0.5 mm detector element for the 15-mm cyst (4.6±2.7 HU vs 6.8±2.9 HU, p=.03) and 25-mm cyst (2.3±1.4 HU vs 3.8±1.2 HU, p=.02), but not the 7-mm cyst (p=.72). Attenuation increase was not different between 512×512 and 1024×1024 matrices for any cyst size in the phantom or patients (p>.05). Attenuation increase was not associated with slice thickness for any cyst size in the phantom or for ≥5-to-.05). For cysts <5 mm in patients, attenuation increase showed decreases with thinner slices (3 mm: 23.7±22.5, 2 mm: 20.2±22.7 HU, 0.5 mm: 11.6±17.5 HU, 0.25 mm: 12.6±19.7 HU; p<.001). Smaller detector element size, increased matrix size, and thinner slices all increased image noise for cysts of all sizes in the phantom and patients (p<.05). Conclusion: U-HRCT may reduce renal cyst pseudoenhancement through a smaller detector element size and, for <5 mm cysts, very thin slices; however, these adjustments result in increased noise. Clinical Impact: Although requiring further clinical evaluation, U-HRCT may facilitate characterization of small cystic renal lesions, thereby reducing equivocal interpretations and follow-up recommendations.
Maxime Ronot
American Journal of Roentgenology; https://doi.org/10.2214/ajr.22.27985

Abstract:
This Editorial Comment discusses the following AJR article: Liver Stiffness Measurements by 2D Shear-Wave Elastography: Effect of Steatosis on Fibrosis Evaluation.
Patrick J. Peller
American Journal of Roentgenology; https://doi.org/10.2214/ajr.22.27925

Abstract:
This Editorial Comment discusses the following AJR article: Multimodal Presurgical Evaluation of Medically Refractory Focal Epilepsy in Adults: An Update for Radiologists.
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