Recommendations for the Management of Incidental Musculoskeletal Findings on MRI and CT

The Canadian Association of Radiologists (CAR) Incidental Findings Working Group consists of both academic subspeciality and general radiologists tasked with either adapting American College of Radiology (ACR) guidelines to meet the needs of Canadian radiologists or authoring new guidelines where appropriate. In this case, entirely new guidelines to deal with incidental musculoskeletal findings that may be encountered on thoracoabdominal computed tomography or magnetic resonance imaging were drafted, focussing on which findings should prompt recommendations for further workup. These recommendations discuss how to deal with incidental marrow changes, focal bone lesions, abnormalities of the pubic symphysis and sacroiliac joints, fatty soft tissue masses, manifestations of renal osteodystrophy and finally discuss opportunistic osteoporosis evaluation.

Multicentre Analysis of Cost, Uptake and Safety of Canadian Multidisciplinary Pancreatic Cyst Guidelines

Background

Pancreatic cystic lesions (PCLs) are common, with several guidelines providing surveillance recommendations. The Canadian Association of Radiologists published surveillance guidelines (CARGs) intended to provide simplified, cost-effective and safe recommendations. This study aimed to evaluate cost savings of CARGs compared to other North American guidelines including American Gastroenterology Association guidelines (AGAG) and American College of Radiology guidelines (ACRG), and to evaluate CARG safety and uptake.

Methods

This is a multicentre retrospective study evaluating adults with PCL from a single health zone. MRIs completed from September 2018–2019, one year after local CARG guideline implementation, were reviewed to identify PCLs. All imaging following 3–4 years of CARG implementation was reviewed to evaluate true costs, missed malignancy and guideline uptake. Modelling, including MRI and consultation, predicted and compared costs associated with surveillance based on CARGs, AGAGs and ACRGs.

Results

6698 abdominal MRIs were reviewed with 1001 (14.9%) identifying PCL. Application of CARGs over 3.1 years demonstrated a >70% cost reduction compared to other guidelines. Similarly, the modelled cost of surveillance for 10-years for each guideline was $516,183, $1,908,425 and $1,924,607 for CARGs, AGAGs and ACRGs respectively. Of patients suggested to not require further surveillance per CARGs, approximately 1% develop malignancy with fewer being candidates for surgical resection. Overall, 44.8% of initial PCL reports provided CARG recommendations while 54.3% of PCLs were followed as per CARGs.

Conclusions

CARGs are safe and offer substantial cost and opportunity savings for PCL surveillance. These findings support Canada-wide implementation with close monitoring of consultation requirements and missed diagnoses.

Recommendations for the Management of Incidental Pancreatic Findings in Adults by the Canadian Association of Radiologists Incidental Findings Working Group

The Canadian Association of Radiologists Incidental Findings Working Group consists of both academic subspecialty and general radiologists and is tasked with adapting and expanding upon the American College of Radiology incidental findings white papers to more closely apply to Canadian practice patterns, particularly more comprehensively dealing with the role of ultrasound and pursuing more cost-effective approaches to the workup of incidental findings without compromising patient care. Presented here are the 2021 Canadian guidelines for the management of pancreatic incidental findings. Topics covered include anatomic variants, fatty atrophy, pancreatic calcifications, ductal ectasia, and management of incidental pancreatic cysts.

COVID-19 outbreak among physicians at a Canadian curling bonspiel: a descriptive observational study

BACKGROUND

Transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is known to occur among individuals who congregate in large groups, especially during indoor activities. Our objective was to provide a detailed clinical description of an outbreak of coronavirus disease 2019 (COVID-19) that occurred after a sporting and social event during the early days of the pandemic.

METHODS

We conducted a descriptive study of a curling bonspiel in Edmonton held on Mar. 11-14, 2020. We used standardized interviews between Apr. 17 and May 5, 2020, to collect demographic data, travel history, symptoms (type, onset and duration), self-reported testing results for SARS-CoV-2 ribonucleic acid (RNA) using reverse transcription polymerase chain reaction (RT-PCR), and clinical outcomes. We also obtained results of convalescent SARS-CoV-2 immunoglobulin G serology.

RESULTS

All 73 curlers (55 active health care workers) who participated in the bonspiel were interviewed for the study. Convalescent SARS-CoV-2 immunoglobulin G serology was completed in 62 (85%) participants. Of the 73 participants (55 [75%] male, median age 51 [range 26-79] yr, 58 [79%] physicians), 40 curlers (55%) tested positive for SARS-CoV-2 RNA by RT-PCR; an additional 16 participants developed symptoms but had negative swabs or were not tested (14 were probable cases), for a 74% attack rate (confirmed or probable cases). Anosmia with ageusia or dysgeusia occurred in 39 of 54 (72%) confirmed or probable cases. The clinical course was mild in most participants (1 emergency visit, no hospital admissions). Transmission likely occurred from multiple individuals with minor nonspecific symptoms during the event, possibly during shared meals.

INTERPRETATION

The 74% attack rate (confirmed or probable cases) highlights the infectivity of SARS-CoV-2 during sporting and social events. This reinforces the need for public health measures (masking, physical distancing and limiting the size of social gatherings) during future waves of COVID-19 in Canada.

Effect of hepatic steatosis on liver FDG uptake measured in mean standard uptake values

PURPOSE

To evaluate the association between diffuse fatty infiltration of the liver and average fluorine 18 fluorodeoxyglucose (FDG) uptake in the liver.

MATERIALS AND METHODS

Institutional review board approval was obtained for this study; the requirement for informed patient consent was waived. Consecutive nonenhanced whole-body hybrid FDG positron emission tomographic (PET)-computed tomographic (CT) scans obtained in 142 patients (mean age, 63.6 years; age range, 19-94 years) from October 1, 2008, to November 28, 2008, were retrospectively reviewed. Mean attenuation (in Hounsfield units) and standardized uptake value (SUV) measurements for the liver and spleen were obtained, with identical regions of interest used for the CT and PET examinations. The patients were assigned to three study groups: a control group-119 patients with a mean liver attenuation value greater than or equal to the mean spleen attenuation value, a diffuse fatty liver disease group-23 patients in whom the mean liver attenuation value was less than the mean spleen attenuation value, and a more strictly defined fatty liver disease group-a subset of 10 patients from the diffuse fatty liver disease group with a mean liver attenuation value minus mean spleen attenuation value difference of less than or equal to -10 HU. Mean SUV (SUV(m)) values were compared between the groups by using a two-sample t test for means. The association between mean liver attenuation and average FDG uptake was assessed with linear regression analysis.

RESULTS

The average SUV(m)for the control group was 2.18 (standard deviation [SD], 0.36; 95% confidence interval [CI]: 2.12, 2.24). No significant difference was identified when the average SUV(m)for the control group was compared with those for the fatty liver disease (SUV(m), 2.03; SD, 0.36; 95% CI: 1.90, 2.16) (P >.05) and more strictly defined fatty liver disease (SUV(m), 2.07; SD, 0.24; 95% CI: 1.92, 2.22) groups (P >.05). Linear regression analysis of liver SUV(m)as a function of mean liver attenuation revealed a mean slope of 0.005 (SD, 0.04; 95% CI: -0.005, 0.015) and a correlation coefficient of 0.02.

CONCLUSION

No association between liver attenuation and FDG uptake measured in terms of SUV(m)was observed. On the basis of these data, it is acceptable to use the liver as a comparator for extrahepatic foci of equivocal increased FDG activity in patients with fatty liver disease. (c) RSNA, 2010.