Applied Radiology
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Applied Radiology is pleased to offer you a selection of free SA-CME accredited courses to choose from, as part of your free subscription to AR.
SA-CME
Accreditation/Designation Statement
The Institute for Advanced Medical Education (IAME) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.
The Institute for Advanced Medical Education (IAME) designates these Journal-based activities for a maximum of 1 AMA PRA Category 1 Credit™ each. Physicians should only claim credit commensurate with the extent of their participation in the activity.
These credits qualify as SA-CME credits.
Abdominal and Pelvic Imaging of Transgender Patients
Elainea N Smith, MD; Mohammad Ghosheh, MBBS; Kristin K Porter, MD, PhD
Estimated time for completion: 1 hour   •   Date of release and review: July 1, 2022   •   Expiration Date: Junel 30, 2024
The abdominal radiologist plays an important role in providing care for transgender and gender-diverse patients, regardless of whether these patients choose to pursue gender-affirming hormone therapy or surgery. Radiologists must be aware of the various treatment options and associated anatomic and pathologic changes in transgender patients to ensure accurate imaging interpretation. This activity is designed to educate radiologists about caring for transgender patients by reviewing relevant imaging findings of hormonal therapies, nonoperative procedures, and gender-affirming surgeries with a focus on abdominal and pelvic imaging. Creating an inclusive environment for transgender patients is also discussed.
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Trauma Imaging in Pregnancy: A Review of the Evolving Appearance of the Placenta on CT and Mimics of Placental Injury
Kaitlin M Zaki-Metias, MD; Mehrvaan Kaur, MD; Huijuan Wang, MD; Bilal Turfe; Nicholas Mills, MD; Yanruo Lu, MD; Bashir H Hakim, MD; Leslie S Allen, MD
Estimated time for completion: 1 hour   •   Date of release and review: May 1, 2022   •   Expiration Date: April 30, 2024
Pregnant patients infrequently undergo CT given the risk of radiation to the developing fetus. As such, when CT is performed on pregnant patients in emergent situations, radiologists may be unfamiliar with the appearance of the placenta on CT and its normal evolution throughout gestation. This activity is designed to educate radiologists about the normal appearance of the placenta on CT and its evolution throughout pregnancy, as well as differentiation of these ļ¬ndings from placental abruption.
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Imaging Upper Extremity Injuries in Pediatric Athletes
Jonathan R Wood, MD; Ghazal Shadmani, MD; Marilyn J Siegel, MD
Estimated time for completion: 1 hour   •   Date of release and review: March 1, 2022   •   Expiration Date: February 29, 2024
Pediatric upper-extremity sports injuries are common. However, the diagnosis can be challenging for radiologists who have limited experience in imaging children. Increased awareness of the imaging findings is critical in establishing the correct diagnosis and ensuring optimal patient management and outcomes. This activity is designed to educate radiologists about the radiographic findings of common acute and chronic sports injuries of the upper extremities in the pediatric population. Mechanisms of injury are also reviewed, as they impact the type of fracture that occurs. Additionally, the role of magnetic resonance imaging in complementing plain radiography is discussed.
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The Future of Magnetic Resonance Imaging Contrast Agents
Laura E Minton; Renu Pandit; WR Willoughby, PhD; Kristin K Porter, MD, PhD
Estimated time for completion: 1 hour   •   Date of release and review: January 1, 2022   •   Expiration Date: December 31, 2023
Gadolinium (Gd)-based contrast agents (GBCAs) dominate the current contrast-enhanced magnetic resonance imaging (CE-MRI) market and are proven to increase the efficacy of diagnostic magnetic resonance imaging (MRI) scans. However, in the future it is likely that a personalized combination of contrast enhancement and image processing techniques will be used to optimize diagnosis and treatment planning while minimizing risk and cost. This activity is designed to educate radiologists about the future of MRI contrasts agents, including high relaxivity macrocyclic GBCAs, alternatives to GBCAs, and imaging processing techniques.
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Interventional Stroke Management: An Update
Ryan Holland, MD; Steven Benitez, MD; Addison Fortunel, MD; Andrew Brook, BA, MS; Deepak Khatri, MD; Allan Brook, MD
Estimated time for completion: 1 hour   •   Date of release and review: November 1, 2021   •   Expiration Date: October 31, 2023
As thrombectomy has become the standard of care for large vessel/arterial occlusions, the indications are initiated by proper imaging and understanding of the brain blood flow physiology. This two-part series examines the standard of care for acute stroke imaging and the latest techniques. The second part of this activity on stroke intervention will appear in the November-December issue of Applied Radiology.
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Imaging in Stroke Diagnosis and Treatment: An Update
Steven Benitez, MD; Ryan Holland, MD; Richard Zampolin, MD; Andrew Brook, BA, MS; Joshua Hirsch, MD; Allan L Brook, MD, Deepak Khatri, MD
Estimated time for completion: 1 hour   •   Date of release and review: September 1, 2021   •   Expiration Date: August 31, 2023
As thrombectomy has become the standard of care for large vessel/arterial occlusions, the indications are initiated by proper imaging and understanding of the brain blood flow physiology. This two-part series examines the standard of care for acute stroke imaging and the latest techniques. The second part of this activity on stroke intervention will appear in the November-December issue of Applied Radiology.
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Ovarian Masses and O-RADS: A Systematic Approach to Evaluating and Characterizing Adnexal Masses with MRI
Ana Mitchell, MD; Austin Kwong, MD; Simran Sekhon, MD; John P McGahan, MD, FACR
Estimated time for completion: 1 hour   •   Date of release and review: July 1, 2021   •   Expiration Date: June 30, 2023
Given that ovarian and adnexal masses are commonly encountered in daily clinical practice, it is important to be able to recognize worrisome features on MRI. Once these are identified, it is important to accurately classify ovarian masses according to criteria ranging from low-risk to high-risk lesions. Recognizing and categorizing ovarian masses is important for determining that no further treatment or imaging is required for benign or low-risk lesions. Similarly, recognition of a worrisome feature and proper classification of high-risk masses are necessary to permit appropriate referral of these patients to a surgical oncologist.
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Elbow Effusion: Utility and Limitations of Radiography in Pediatric Injuries
Sachin S Kumbhar, MD
Estimated time for completion: 1 hour   •   Date of release and review: May 1, 2021   •   Expiration Date: April 30, 2023
Fractures of the elbow are one of the commonest pediatric injuries. Some of these fractures can be occult on initial radiographs, an elbow effusion being the only initial finding. Elbow effusion can be detected on an adequately obtained lateral radiographic projection of the elbow by identifying the visibility and shape of the anterior and posterior fat pads. To maximize the accuracy of detecting elbow effusions, radiologists should be aware of conditions that can affect the visibility of these fat pads.
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Acquired Pericardial Pathologies: Imaging Features, Clinical Significance, and Management
Pegah Khoshpouri, MD; Mahdie Hosseini, MD; Arya M Iranmanesh, MD; Bahar Mansoori, MD; Arash Bedayat, MD; Holman P McAdams, MD; Hamid Chalian, MD
Estimated time for completion: 1 hour   •   Date of release and review: March 1, 2021   •   Expiration Date: February 28, 2023
There are several acquired diseases involving the pericardium. The clinical signs and symptoms of most of the pericardial disease are similar. This underscores the importance of medical imaging in identification of specific pericardial diseases.
Unfortunately, there are also similarities between the imaging features of several pericardial diseases. Therefore, familiarity with imaging features of different pericardial diseases is very important in the proper management of these patients. It is also of great importance that radiologists understand the clinical significance and management of different pericardial diseases so that they can better communicate with referring clinicians.
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An Overview of Acute Mesenteric Ischemia
Arash Mirrahimi, MD, MSc; Charlotte Gallienne, MD; Hournaz Ghandehari, MD, FRCPC
Estimated time for completion: 1 hour   •   Date of release and review: January 1, 2021   •   Expiration Date: December 31, 2023
Acute mesenteric ischemia (AMI) is a true surgical emergency and a rare life-threatening condition, accounting for 0.01% of hospital admissions, with extremely high mortality rates (up to 69%). Poor outcomes remain prevalent despite advances in both diagnostic and treatment options over the last two decades
Early diagnosis and management are particularly important given that the highest incidence of AMI occurs in the elderly population, who often have multiple comorbidities leading to a worse prognosis. Biphasic contrast enhanced multidetector computed tomography (MDCT) images have become the mainstay and standard of care for investigation and timely diagnosis of AMI.
As such, the importance of recognizing imaging features of AMI and timely communication of findings with the referring physicians is of utmost importance for diagnostic radiologists and always a worthwhile topic for review. We have therefore endeavored to provide a brief summary of the presentation of AMI, its causes, relevant anatomy, and most importantly, illustrated review of CT findings that delineate ischemic changes of the bowel and mesentery.
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Contrast-enhanced Ultrasound of Renal Masses
Jack Bennett, Cynthia Peterson, MPH, RDMS, RVT; Richard G. Barr MD, PhD
Estimated time for completion: 1 hour   •   Date of release and review: November 1, 2020   •   Expiration Date: October 31, 2022
Ultrasound (US) is often the initial imaging modality for evaluation of renal diseases. Non-enhanced US faces limitations in the assessment of focal renal masses and complex cysts. Contrast-enhanced ultrasound (CEUS) on the kidneys can overcome these shortcomings.
There are several advantages of CEUS over contrast-enhanced CT or contrast-enhanced MRI. These include the fact that the narrow US beam allows for improved visualization of vascularity in small structures such as septations or small mural nodules; high temporal resolution with real time assessment of vascularity; lack of radiation; and no renal impairment.
Excluding inflammatory masses, vascular abnormalities and pseudotumors, most solid enhancing renal masses are malignant. Complicated cystic lesions with enhancing soft tissue components, excluding the actual cyst wall, are malignant. Using enhancement pattern, renal masses can be characterized with high sensitivity and specificity
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Pregnancy-associated Breast Cancer and Other Breast Disease: A Radiologic Review
Andrew Ong, MD; Lisa A Mullen, MD; Susan C. Harvey, MD
Estimated time for completion: 1 hour   •   Date of release and review: September 1, 2020   •   Expiration Date: August 31, 2022
Pregnancy associated breast cancer (PABC) is a subset of breast cancer that is typically diagnosed at more advanced stages and carries a worse prognosis. The physiological breast changes that occur during pregnancy and lactation can often make clinical and radiological evaluation difficult.
Ultrasound is the primary imaging modality in the evaluation of pregnancy associated breast lesions with high sensitivity and lack of radiation. Mammography is generally considered safe during pregnancy and lactation and may also be used to assess for PABC. Dynamic contrast enhanced breast MRI is not recommended during pregnancy; however, it may safely be performed in lactating women to evaluate extent of disease or for high risk screening.
This article reviews appropriate imaging evaluation of the pregnant or lactating woman, and showcases the imaging features of benign and malignant lesions occurring during pregnancy and lactation. Many benign lesions, including fibroadenoma and lactating adenoma, can mimic malignancy. New or growing solid masses occurring during pregnancy and lactation should be further evaluated with imaging and biopsy, to avoid a delay in a potential cancer diagnosis.
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