Alkatheeri M, Barat M, Moyne T
… +9 more, Pellat A, Dohan A, Nguyen TTL, Bonnin A, Coriat R, Dautry R, Rouquette A, Marchese U, Soyer P
Can Assoc Radiol J
· 2026 Mar · PMID 41852046
·
Publisher ↗
PURPOSE: To identify CT features that may help discriminate between pancreatic adenosquamous carcinoma (PASC) and pancreatic ductal adenocarcinoma (PDAC). METHODS: CT examinations of 42 patients with PASC were analyzed b...PURPOSE: To identify CT features that may help discriminate between pancreatic adenosquamous carcinoma (PASC) and pancreatic ductal adenocarcinoma (PDAC). METHODS: CT examinations of 42 patients with PASC were analyzed by 2 independent readers and compared to those obtained in 42 patients with PDAC. Sensitivity, specificity, and accuracy of each variable for diagnosing PASC versus PDAC were calculated. Associations between variables and PASC were examined using univariable and multivariable analyses. A CT signature was developed to distinguish PASC from PDAC. RESULTS: PASC presented as single (100%), oval (93%), and heterogeneously enhancing (98%) pancreatic mass with a mean largest diameter of 46.2 ± 18.5 mm, vessel encasement (69%), and segmental portal hypertension (64%), in association with hepatic metastases (52%). In univariable analysis, ring enhancement (odds ratio [OR], 25.23; = .002), internal necrosis (OR, 9.48; < .001), heterogeneous tumour enhancement (OR, 25.23; = .002), and segmental portal hypertension (OR, 4.5; = .001), were the most discriminating CT findings for the diagnosis of PASC. In multivariable analysis, internal necrosis (adjusted OR, 5.44; 95% confidence interval [CI]: 1.83-17.34; = .003), heterogeneous tumour enhancement (adjusted OR, 8.80; 95% CI: 1.41-171.47; = .049), and segmental portal hypertension (adjusted OR, 2.96; 95% CI: 1.02-8.97; = .048), were independent variables strongly associated with the diagnosis of PASC. The CT signature yielded 81% sensitivity (95% CI: 66-91), 74% specificity (95% CI: 58-86), and area under the receiver operating characteristic curve of 0.840 (95% CI: 0.756-0.924) for diagnosing PASC. CONCLUSION: CT examination demonstrates several features that help discriminate between PASC and PDAC. A CT signature based on 3 imaging features can help distinguish PASC from PDAC.
Can Assoc Radiol J
· 2026 Feb · PMID 41696877
·
Publisher ↗
Traumatic pancreatic injuries are uncommon but are associated with high rates of morbidity and mortality. Early detection is key for patient prognosis and clinical management, specifically as it relates to injuries to th...Traumatic pancreatic injuries are uncommon but are associated with high rates of morbidity and mortality. Early detection is key for patient prognosis and clinical management, specifically as it relates to injuries to the main pancreatic duct (MPD). The 1990 version of the American Association for the Surgery of Trauma Organ Injury Scale (AAST-OIS) presumed involvement of the MPD for lacerations spanning greater than 50% of pancreatic parenchymal depth on trauma computed tomography (CT) imaging. However, CT lacks specificity and sensitivity for MPD injuries. As such, the 2024 AAST-OIS revision for pancreatic injuries places increased emphasis on MPD evaluation with more sensitive modalities for duct injury, such as endoscopic retrograde cholangiopancreatography and magnetic resonance cholangiopancreatography. The goal of the 2024 revision is to improve concordance between pancreatic injury grade and patient outcomes, as well as to provide a more accurate description of injury to enhance the quality of future pancreatic trauma research. In this review, we will discuss the new 2024 AAST-OIS updates to pancreatic trauma grading, relevant pancreatic anatomy, incidence, mechanisms, imaging appearance and complications of pancreatic trauma, as well as opportunities for future avenues of study.
Canan A, Wiessman M, Aslan ZS
… +1 more, Rajiah PS
Can Assoc Radiol J
· 2026 Feb · PMID 41693176
·
Publisher ↗
Coronary CT angiography (CCTA) offers excellent negative predictive value for ruling out obstructive coronary artery disease (CAD); however, several interpretative pitfalls can lead to diagnostic errors including false-n...Coronary CT angiography (CCTA) offers excellent negative predictive value for ruling out obstructive coronary artery disease (CAD); however, several interpretative pitfalls can lead to diagnostic errors including false-negative, false-positive results or inaccurate estimation of degree of stenosis. These errors may influence patient management, prompt unnecessary or missed downstream testing, and ultimately affect clinical outcomes. This two-part article reviews the most common sources of diagnostic inaccuracy in CCTA through case-based examples. Part I highlights factors that contribute to missed or overdiagnosed coronary lesions while Part II focuses on pitfalls that lead to underestimation or overestimation of stenosis severity and outlines practical strategies to mitigate these errors. Recognizing the inherent limitations of CCTA and employing a systematic, structured interpretive approach are essential for preserving its high diagnostic accuracy and ensuring optimal patient care.
Canan A, Wiessman M, Aslan ZS
… +1 more, Rajiah PS
Can Assoc Radiol J
· 2026 Feb · PMID 41693175
·
Publisher ↗
Accurate quantification of coronary stenosis on coronary CT angiography (CCTA) is essential for appropriate risk stratification and clinical decision-making, yet several technical and interpretative pitfalls can compromi...Accurate quantification of coronary stenosis on coronary CT angiography (CCTA) is essential for appropriate risk stratification and clinical decision-making, yet several technical and interpretative pitfalls can compromise diagnostic accuracy. This second part of a two-part review examines common factors that lead to overestimation or underestimation of stenosis severity, with attention to how these errors influence CAD-RADS categorization, downstream testing, and patient management. Using case-based examples, we describe key contributors to misinterpretation and present practical strategies to mitigate these pitfalls. By recognizing these nuances and employing a structured, standardized interpretive approach, readers can minimize errors in stenosis assessment and enhance the reliability of CCTA as a noninvasive tool for evaluating coronary artery disease.
Can Assoc Radiol J
· 2026 Feb · PMID 41645801
·
Publisher ↗
Radiology is among the most capital-intensive specialities in healthcare, relying on high-cost imaging equipment, complex information technology infrastructure, long-term vendor contracts, and increasingly, artificial in...Radiology is among the most capital-intensive specialities in healthcare, relying on high-cost imaging equipment, complex information technology infrastructure, long-term vendor contracts, and increasingly, artificial intelligence systems. Decisions about these resources shape patient access, diagnostic quality, workforce sustainability, and the long-term resilience of imaging services. Despite this, most radiologists receive little formal training in key financial concepts, and financial decision-making is often perceived as external to clinical practice. This article positions foundational financial reasoning as a core competency for radiologists, introducing key concepts from financial management, including: liquidity, leverage, efficiency, profitability, risk, and capital budgeting, and translating them into clinically meaningful frameworks relevant to radiology. Using practical examples and mini-cases, this article demonstrates how commonly used financial ratios and investment appraisal tools can be interpreted as diagnostic tools for organisational health rather than abstract accounting exercises. Interpreting financial metrics as an integrated system rather than as isolated indicators is important in demonstrating how short-term resilience, long-term commitments, operational efficiency, and sustainability interact in real-world radiology decision-making. Extending this framework to the measurement of value beyond volume and revenue, highlighting the potential role of patient-reported outcome measures (PROMs), as well as the relevance of implementation science and change management, is important in ensuring that financially sound investments deliver meaningful clinical impact. By equipping radiologists with a shared language and conceptual toolkit for engaging with financial decisions, this article aims to strengthen clinical leadership, support transparent resource allocation, and promote resilient, high-value imaging services aligned with patient-centred care.
Thompson J, Silburt J, Schofield S
… +2 more, Costa AF, Rivers-Bowerman M
Can Assoc Radiol J
· 2026 Jan · PMID 41618922
·
Publisher ↗
INTRODUCTION: The carbon footprint of imaging equipment in radiology is high, but the impact of patient travel for imaging is unclear. This study aimed to quantify distances traveled by ambulatory patients for outpatient...INTRODUCTION: The carbon footprint of imaging equipment in radiology is high, but the impact of patient travel for imaging is unclear. This study aimed to quantify distances traveled by ambulatory patients for outpatient MRI, determine the proportion traveling beyond their nearest MRI facility, and estimate the associated excess carbon dioxide equivalent (COe) emissions. METHODS: With research ethics board approval, we retrospectively analyzed provincial MRI data from 2023. Distances from patient home address to the nearest and attended MRI facilities were calculated. COe estimates were derived using an online tool (www.carbonfootprint.com/calculator.aspx) with average vehicle size and emissions. RESULTS: In 2023, 40 062 provincial MRI scans were performed; isolating single visits for adult patients yielded 27 755 data points. Of these, 19.5% (n = 5400) traveled beyond their nearest MRI facility. Mean round-trip travel was 60.4 km for those attending their nearest site versus 295.6 km for those traveling further ( < .0001). The excess travel produced ~288 metric tons of additional COe, equivalent to emissions from 61 large-size gasoline-powered cars driven for 1 year or carbon sequestered by 4762 tree seedlings grown for 10 years. CONCLUSION: Nearly one-fifth of patients traveled farther than necessary for MRI, generating substantial avoidable emissions. Aligning MRI service distribution with population density could lessen the environmental impact of medical imaging.
Cool DW, O'Leary CN, Krishna S
… +1 more, Kachura JR
Can Assoc Radiol J
· 2026 Jan · PMID 41618592
·
Publisher ↗
OBJECTIVES: Local tumor progression (LTP) after percutaneous ablation of small renal cell carcinoma (RCC) is suspected when new enhancing or enlarging soft tissue appears within the ablation zone. Benign post-treatment c...OBJECTIVES: Local tumor progression (LTP) after percutaneous ablation of small renal cell carcinoma (RCC) is suspected when new enhancing or enlarging soft tissue appears within the ablation zone. Benign post-treatment changes can mimic this finding. This study compares the incidence and imaging characteristics of non-malignant changes (NMC) versus LTP after renal ablation. MATERIALS AND METHODS: In this single-center, retrospective study, all patients with RCC treated with radiofrequency ablation (RFA) from February 2004 to May 2016 were identified. Post-ablation imaging reports from through May 2017 were reviewed to detect findings suspicious for LTP. Patients with suspicious findings underwent clinical, imaging, and histopathologic follow-up through May 2025 to determine the reference diagnosis. Imaging features were categorized by morphology, location within the ablation zone, and enhancement pattern. RESULTS: Among 256 patients (mean age 65.6 years ± 10.8, 193 men) with 268 treated tumors, 18 tumors (6.7%) developed suspicious imaging findings. Eight tumors (3.0%) were classified as NMC and 10 tumors (3.7%) as LTP. NMC had significantly lower CT enhancement than LTP (31 vs 152 HU, < .001). Lesions along the renal parenchymal margin were exclusively associated with LTP (9/9), whereas abnormalities at the extrarenal margin or centrally within the ablation zone were predominantly NMC (8/9). Enhancement with washout was seen only in LTP. CONCLUSION: Non-malignant post-ablation changes can mimic LTP and occur with similar frequency. Imaging features can help differentiate benign changes from local tumor progression and reduce unnecessary re-interventions.
Subramonian S, Akhtar A, Borgas P
… +3 more, Byreddy B, Zaman J, Nair M
Can Assoc Radiol J
· 2026 Jan · PMID 41603819
·
Publisher ↗
BACKGROUND: Negative appendicectomies in children can be associated with morbidity. MRI has become a radiation-free alternative to CT to assist in the diagnosis of paediatric appendicitis, particularly when ultrasound is...BACKGROUND: Negative appendicectomies in children can be associated with morbidity. MRI has become a radiation-free alternative to CT to assist in the diagnosis of paediatric appendicitis, particularly when ultrasound is equivocal. A systematic review and meta-analysis were performed to assess the diagnostic accuracy of MRI for paediatric appendicitis and its role in reducing negative appendicectomy rates (NAR). METHODS: Searches were performed across PubMed, Embase, Cochrane Library, Scopus, Web of Science, for studies from 1 January 2000 to 31 July 2025. The inclusion criteria were studies of children (<18 years) with suspected appendicitis undergoing MRI. Bivariate random-effects meta-analyses were performed. Meta-regression explored the impact of covariates for example, DWI, contrast use, image reviewer blinding, and magnetic field strength. RESULTS: Twelve studies (n = 3242) met inclusion. Pooled MRI sensitivity was 96.7% (95% CI: 93.4%-98.9%), specificity 97.9% (95% CI: 95.6%-99.3%). MRI NARs ranged from 0.66% to 11.1%, with 3/12 studies reporting NARs <5%. Meta-regression showed non-significant associations between NAR and DWI use (+3.12%, = .264), MRI contrast use (-5.64%, = .110), and magnetic field strength (-1.63% per Tesla, = .361). No significant publication bias was detected (Deeks' = .152). CONCLUSION: MRI demonstrates high diagnostic accuracy and is associated with low negative appendicectomy rates in children. Its use is particularly effective where ultrasound/clinical findings are inconclusive as MRI overcomes ultrasound limitations, poor appendix visualisation, operator-dependence, and inability to exclude alternate diagnoses. Given its radiation-free nature and CT-like diagnostic performance, wider adoption of MRI within paediatric appendicitis pathways may help avoid surgery and reduce exposure to ionising radiation.