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  • Journal Highlights

    The following are highlights from the current issues of RSNA’s two peer-reviewed journals.

    March 1, 2017

    MR Imaging of Perianal Crohn Disease

    While decisions influence the effectiveness of radiology in patient care on a daily basis, many radiologists struggle to harness the power of cost measurement and cost management as a critical path toward establishing their value in patient care. When radiologists cannot articulate their value, they risk losing control over how imaging is delivered and supported.

    Pelvic MRI plays a key role in successful management of perianal Crohn disease (CD) by enabling accurate detection and characterization of perianal fistulas and associated abscesses or extensions (which may be surgically occult or need drainage prior to immunosuppressive treatment), and its use has been shown to lower rates of recurrence.

    In a review article in the March issue of Radiology (RSNA.org/Radiology), Shannon P. Sheedy, MD, of the Mayo Clinic in Rochester, MN, and colleagues summarize clinically relevant anal sphincter anatomy, imaging methods, classification systems and treatment objectives. Authors also describe the MR appearance of healing perianal fistulas and fistula complications.

    In the illustrative review, authors highlight difficult imaging tasks including the assessment of rectovaginal fistulas and ileoanal anastomoses cases and discuss available, emerging innovative treatments for perianal CD that promise to better control sepsis and maintain fecal continence. Different treatment modalities are selected based on fistula anatomy, patient factors and management goals (closure vs. sepsis control).

    “The importance of a multidisciplinary collaboration between radiologists, gastroenterologists and surgeons cannot be overstated when managing perianal CD. Radiologist familiarity with treatment options, key imaging findings that influence therapeutic choices, and open lines of communication with referring clinicians are necessary for pelvic MRI to have maximal patient benefit,” the authors write.

    This article meets the criteria for AMA PRA Category 1 Credit™. SA-CME is available online only.

    ITMIG Classification of Mediastinal Compartments and Multidisciplinary Approach to Mediastinal Masses

    Accurate identification and characterization of mediastinal masses is necessary for formulating differential diagnoses and developing treatment plans. Therefore, it is important for radiologists to be familiar with the new International Thymic Malignancy Interest Group (ITMIG) classification of mediastinal compartments based on multidetector CT and to understand multidisciplinary algorithms for approaching abnormalities localized to specific compartments.

    In the January-February issue of RadioGraphics (RSNA.org/RadioGraphics) Brett W. Carter, MD, of MD Anderson Cancer Center in Houston, and colleagues describe the new ITMIG mediastinal compartment classification system based on cross-sectional imaging that can be used to accurately localize and characterize mediastinal lesions and assist in the formulation of focused differential diagnoses and management strategies.

    Specific approaches to evaluation of abnormalities in the prevascular, visceral and paravertebral compartments are presented and are primarily based on multidetector CT.

    “The new mediastinal division scheme developed by ITMIG is designed to enable precise identification of mediastinal abnormalities at cross-sectional imaging by radiologists and consistent communication between healthcare providers. It is anticipated that this system will improve lesion localization, help generate a focused differential diagnosis, and assist in tailoring biopsy and treatment plans,” the authors write. This article is accompanied by an Invited Commentary by Paul E. Van Schil, MD, PhD, and Stijn Heyman, MD, both of the University Hospital of Antwerp, Belgium.

    This article meets the criteria for AMA PRA Category 1 Credit™. SA-CME is available online only.

    Radiology Podcasts

    Listen to Radiology Editor Herbert Y. Kressel, MD, deputy editors and authors discuss the following articles in the October issue of Radiology at RSNA.org/Radiology-Podcasts.

    • “Effect of an Institutional Triaging Algorithm on the Use of Multidetector CT for Patients with Blunt Abdominopelvic Trauma over an 8-year Period,” Arthur H. Baghdanian, MD, and colleagues.
    • “Colorectal Findings at Repeat CT Colonography Screening after Initial CT Colonography Screening Negative for Polyps Larger than 5 mm,” Perry J. Pickhardt, MD, and colleagues.
    • “Predictors of CT Radiation Dose and Their Effect on Patient Care: A Comprehensive Analysis Using Automated Data,” Rebecca Smith-Bindman, MD, and colleagues.

    CD proctocilitis
    Image in a 32-year-old man with CD proctocolitis and perianal fistula. Axial T2-weighted fast spin echo image without fat saturation demonstrates a low-lying and unbranching intersphincteric fistula (arrow). The blue dot in the inset image shows the location of the fistula. The patient was treated with an increasing dose of azathioprine and the fistula clinically resolved. (Radiology 2017;282;3:628–645) ©RSNA 2017. All rights reserved. Printed with permission.

    International Thymic Malignancy Interest Group classification of mediastinal compartments shown on an axial multidetector CT image at the level of the left atrium. Note that the prevascular compartment (purple) wraps around the heart and pericardium, which are located in the visceral compartment (blue). Yellow = paravertebral compartment, green line = visceral-paravertebral compartment boundary line. (RadioGraphics 2017;37;2:413–436) ©RSNA 2017. All rights reserved. Printed with permission.