Canadian Association of Radiologists Journal

To assess the quality of screening mammograms performed in daily practice in the Quebec Breast Cancer Screening Program.

Clinical image quality of a random subsample of 197 screening mammograms performed in 2004-2005 was independently evaluated by 2 radiologists based on the criteria by Canadian Association of Radiologists (CAR). When disagreement occurred for overall judgement or positioning score, the mammograms were reviewed by a third radiologist. Cohen's kappas for interrater agreement were computed. Multivariable robust Poisson regression models were used to study associations of overall quality and positioning with body mass index (BMI) and breast density.

The CAR criteria were not satisfied for 49.7% of the mammograms. Positioning was the quality attribute most often deficient, with 37.2% of mammograms failing positioning. Interrater agreement ranged from slight (kappa = 0.02 for compression and sharpness) to fair (kappa = 0.30 for exposure). For overall quality, women with a BMI ≥ 30 kg/m² had a failure proportion of 67.5% compared with 34.9% for women with a BMI<25 kg/m² (risk ratio 2.1 [95% confidence interval, 1.5-3.0]). For positioning, women with a BMI ≥ 30 kg/m² had a failure proportion of 53.8% compared with 27.9% for women with a BMI < 25 kg/m² (risk ratio 1.9 [95% confidence interval, 1.2-3.1]). Effects of breast density on image quality differed among radiologists.

Despite measures to ensure high-quality imaging, including CAR accreditation, approximately half of this random sample of screening mammograms failed the CAR quality standards. It would be important to define quality targets for screening mammograms carried out in daily practice to interpret such observations.

Mycobacterium xenopi is described with upper lobe cavitation (“fibrocavitary” pattern), whereas the Mycobacterium avium complex (MAC) is described with bronchiectasis and centrilobular nodules (“nodular bronchiectasis”). We retrospectively described and compared computed tomography (CT) chest manifestations of disease caused by MAC and M xenopi.

We reviewed patients who had either MAC or M xenopi lung disease and who had CTs between January 2002 and December 2003. Clinical data were recorded, and the patterns on chest CTs were categorized as “fibrocavitary,” “nodular bronchiectatic,” and “unclassified.”

There were 74 patients; 50 with MAC and 24 with M xenopi. The patients with MAC were older (mean 69 vs 58 years; P = .007). Patients with M xenopi more often had emphysema (50% vs 20%; P = .02), cavities (46% vs 16%; P = .01), and nodules ≤5 mm (88% vs 58%; P = .02). M xenopi cases more commonly had a fibrocavitary radiologic pattern (33% vs 18%), with no statistically significant difference (P = .24). MAC was more often associated with a nodular bronchiectatic pattern (68% MAC vs 4% M xenopi; P < .0001). Sixty-three percent of patients with M xenopi had a pattern that was predominantly randomly distributed nodules (11/15 [73%]) or consolidation and/or ground-glass opacities (4/15 [27%]).

Compared with MAC, patients with M xenopi infection develop more cavities and more nodules, and they less often have a predominant nodular bronchiectatic pattern. Although a predominantly cavitary pattern appears to be more common with M xenopi, the majority of patients with M xenopi had CT patterns of random nodules or consolidation and/or ground-glass opacities rather than classically described findings.

To assess ultrasound intrascan variability and the potential error rate of serial ultrasounds in the diagnosis of deep venous thrombosis in children.

A retrospective cohort review of imaging results of children having at least 3 serial ultrasound examinations of the same region within a 2-month period. The results were interpreted as either (1) inadequately visualized or (2) the absence or presence of deep venous thrombosis, and were categorized by location. Serial imaging findings then were further categorized based on results and clinical information.

Sixty-four patients and 157 vessel segments were included in the study. Deep venous thrombosis was documented in 58 patients. Concordant results were observed in 26 patients (40.1%), clot resolution in 17 patients (26.6%), clot formation in 12 patients (18.8%), and discordant results in 9 patients (14%). Twenty-one of 64 patients (32.8%) had at least 1 vessel inadequately imaged.

The inconsistency of serial ultrasound results in up to 25% of patients calls attention to the potential inaccuracy of ultrasound for diagnosis and follow-up of deep venous thrombosis in children. The high proportion of patients with at least 1 inadequately visualized vessel also highlights the limitation of ultrasound in the diagnosis of pediatric deep venous thrombosis.

The objective of this study was to evaluate the diagnostic performance of ultrasound for detecting urinary tract neoplasm in the setting of macroscopic hematuria by using multidetector computed tomography urography (MDCTU) and cystoscopy as the reference standard.

This retrospective study was approved by our institutional review board. Patients with macroscopic hematuria who were investigated with an abdominal or renal ultrasound, an MDCTU, and a cystoscopy between January 2007 and December 2009, were eligible (95 patients). Exclusion criteria were time interval >12 months between index and reference tests or the absence of histopathologic proof of malignancy. Ultrasound results of the remaining 86 patients were collected and compared with the reference standard test, which was the combination of MDCTU for the assessment of upper urinary tract and cystoscopy for assessment of the lower urinary tract. The final diagnosis of neoplasm was based on pathologic findings.

Urinary tract neoplasm was diagnosed in 20% of the patients (17/86). Sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratios of ultrasound for detecting urinary tract neoplasms were 35.3% (6/17), 89.9% (62/69), 46.2% (6/13), 84.9% (62/73), 3.48 (95% confidence interval, 1.34-9.02), and 0.72 (95% confidence interval, 0.5-1.3), respectively.

Sensitivity of ultrasound for the evaluation of macroscopic hematuria in the era of MDCTU is lower than expected. Results of our study suggest that patients with macroscopic hematuria should undergo MDCTU as first-line imaging modality, with little added benefit from ultrasound.