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.
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.
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.
Join a global community of leaders in the radiologic sciences.
Continue your education with top-quality learning resources.
With grant applications increasing, the R&E Foundation needs you.