Aberrant crypt foci (ACF) are collections of abnormal colonic crypts with heterogeneous molecular and pathologic characteristics. Large and dysplastic ACF are putative precursors of colon cancer with neoplastic risk related to increased proliferation. In this study, we examined the role of epidermal growth factor receptor (EGFR) signaling in regulating ACF proliferation. Using magnification chromoendoscopy, we collected large ACF with endoscopic features of dysplasia and separately biopsied adjacent mucosa. Transcript levels were measured by real-time PCR, proteins were assessed by Western blotting, and levels were expressed as fold changes of adjacent mucosa. K-ras and B-Raf mutations were assessed by PCR and Ras activation by the ratio Ras-GTP / (Ras-GTP + Ras-GDP). At the RNA level, 38% of ACF were hyperproliferative, with proliferating cell nuclear antigen (PCNA) mRNA z2-fold of adjacent mucosa. Hyperproliferative ACF had significantly increased mRNA levels of EGFR (6.0 F 1.7-fold), transforming growth factor-A (14.4 F 5.0-fold), heparin-binding EGF-like growth factor (4.5 F 1.4-fold), cyclin D1 (4.6 F 0.7-fold), and cyclooxygenase-2 (COX-2; 9.3 F 4.2-fold; P < 0.05). At the protein level, 46% of ACF were hyperproliferative (PCNA, 3.2 F 1.2-fold). In hyperproliferative ACF, 44% possessed significant increases in four EGFR signaling components: EGFR (9.5 F 1.3-fold), phosphoactive ErbB2 (2.6 F 0.4-fold), phosphoactive extracellular signal-regulated kinase (3.7 F 1.1-fold), and cyclin D1 (3.4 F 0.8-fold; P < 0.05). Ras was activated in 46% of ACF (3.2 F 0.4-fold; P < 0.05), but K-ras mutations were present in only 7% of ACF. In contrast to COX-2 mRNA, the protein was not increased in hyperproliferative ACF. In summary, we have shown that ACF with up-regulated PCNA possess increased EGFR signaling components that likely contribute to the enhanced proliferative state of

Mesenteric ischemia is an uncommon condition resulting from decreased blood flow to the small or large bowel in an acute or chronic setting. Acute ischemia is associated with high rates of morbidity and mortality; however, it is difficult to diagnose clinically. Therefore, a high degree of suspicion and prompt imaging evaluation are necessary. Chronic mesenteric ischemia is less common and typically caused by atherosclerotic occlusion or severe stenosis of at least two of the main mesenteric vessels. While several imaging examination options are available for the initial evaluation of both acute and chronic mesenteric ischemia, CTA of the abdomen and pelvis is overall the most appropriate choice for both conditions.The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.

We prospectively evaluated the use of combined 18 F-NaF/ 18 F-FDG PET/CT in patients with breast and prostate cancer and compared the results with those for 99m Tc-MDP bone scintigraphy and whole-body MRI. Methods: Thirty patients (15 women with breast cancer and 15 men with prostate cancer) referred for standard-ofcare bone scintigraphy were prospectively enrolled in this study. 18 F-NaF/ 18 F-FDG PET/CT and whole-body MRI were performed after bone scintigraphy. The whole-body MRI protocol consisted of both unenhanced and contrast-enhanced sequences. Lesions detected with each test were tabulated, and the results were compared. Results: For extraskeletal lesions, 18 F-NaF/ 18 F-FDG PET/CT and whole-body MRI had no statistically significant differences in sensitivity (92.9% vs. 92.9%, P 5 1.00), positive predictive value (81.3% vs. 86.7%, P 5 0.68), or accuracy (76.5% vs. 82.4%, P 5 0.56). However, 18 F-NaF/ 18 F-FDG PET/CT showed significantly higher sensitivity and accuracy than whole-body MRI (96.2% vs. 81.4%, P , 0.001, 89.8% vs. 74.7%, P 5 0.01) and bone scintigraphy (96.2% vs. 64.6%, P , 0.001, 89.8% vs. 65.9%, P , 0.001) for the detection of skeletal lesions. Overall, 18 F-NaF/ 18 F-FDG PET/CT showed higher sensitivity and accuracy than whole-body MRI (95.7% vs. 83.3%, P , 0.002, 87.6% vs. 76.0%, P , 0.02) but not statistically significantly so when compared with a combination of whole-body MRI and bone scintigraphy (95.7% vs. 91.6%, P 5 0.17, 87.6% vs. 83.0%, P 5 0.53). 18 F-NaF/ 18 F-FDG PET/CT showed no significant difference from a combination of 18 F-NaF/ 18 F-FDG PET/ CT and whole-body MRI. No statistically significant differences in positive predictive value were noted among the 3 examinations. Conclusion: 18 F-NaF/ 18 F-FDG PET/CT is superior to whole-body MRI and 99m Tc-MDP scintigraphy for evaluation of skeletal disease extent. Further, 18 F-NaF/ 18 F-FDG PET/CT and whole-body MRI detected extraskeletal disease that may change the management of these patients. 18 F-NaF/ 18 F-FDG PET/CT provides diagnostic ability similar to that of a combination of whole-body MRI and bone scintigraphy in patients with breast and prostate cancer. Larger cohorts are needed to confirm these preliminary findings, ideally using the newly introduced simultaneous PET/MRI scanners.

MR enterography is playing an evolving role in the evaluation of small bowel Crohn's disease (CD). Standard MR enterography includes a combination of rapidly acquired T2 sequence, balanced steady-state acquisition, and contrast enhanced T1-weighted gradient echo sequence. The diagnostic performance of these sequences has been shown to be comparable, and in some respects superior, to other small bowel imaging modalities. The findings of CD on MR enterography have been well described in the literature. New and emerging techniques such as diffusion-weighted imaging (DWI), dynamic contrast enhanced MRI (DCE-MRI), cinematography, and magnetization transfer, may lead to improved accuracy in characterizing the disease. These advanced techniques can provide quantitative parameters that may prove to be useful in assessing disease activity, severity, and response to treatment. In the future, MR enterography may play an increasing role in management decisions for patients with small bowel CD; however, larger studies are needed to validate these emerging MRI parameters as imaging biomarkers.

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The clinical history and indication (CHI) provided with a radiological examination are critical components of a quality interpretation by the radiologist. A patient's chronic conditions offer the context in which acute symptoms and findings can be interpreted more accurately. Seven pertinent (potentially diagnosis altering) chronic conditions, which are fairly prevalent at our institution, were selected. We analyze if and how in 140 CHIs there was mention of a patient's previously reported chronic condition and if and how the condition was subsequently described in the radiology report using a four-item scheme (Mention/Specialization, Generalization, Common comorbidity, No mention). In 40.7 % of CHIs, the condition was rated Mention/Specialization. Therefore, we reject our first hypothesis that the CHI is a reliable source for obtaining pertinent chronic conditions (≥90.0 %). Nononcological conditions were significantly more likely rated No mention in the CHI than oncological conditions (58.7 versus 8.3 %, P<0.0001). Stat cases were significantly more frequently No mention than non-stat cases (60.0 versus 31.3 %, P=0.0134). We accept our second hypothesis that the condition's rating in the CHI is significantly correlated with its rating of the final radiology report (χ 2 test, P<0.00001). Our study demonstrates an alarming lack of communication of pertinent medical information to the radiologist, which may negatively impact interpretation quality.Presenting automatically aggregated patient information to the radiologist may be a potential avenue for improving interpretation and adding value of the radiology department to the care chain.

Purpose: Metabolic tumor burden (MTB) measurements including metabolic tumor volume (MTV) and total lesion glycolysis (TLG) have been shown to have prognostic value in non-small cell lung cancer (NSCLC). Calculating MTB typically utilizes software to semi-automatically draw volumes of interest (VOIs) around the tumor, which are subsequently manually adjusted by the radiologist to include the entire tumor. The manual adjustment step can be time-consuming and observer-dependent. We compared the agreement of MTB values obtained from the semi-automatic method with and without manual adjustment in NSCLC patients. Methods: This IRB approved prospective study included 134 patients with histologically proven NSCLC who underwent 18F-FDG-PET/CT. The MTB of the primary tumor was measured with a semi-automatic gradient-based method without manual adjustment (semi-automatic gradient method) and with manual adjustment (manually adjusted semi-automatic gradient method) by two radiologists by using the MIM PETedge tool. The paired t-test, Wilcoxon signed-rank test, and concordance correlation coefficient (CCC) were calculated to evaluate agreement between MTB measures obtained with these two methods, as well as agreement between the two radiologists for each method. Results: SUVmax values were identical between the two methods. No statistically significant difference was present for SUVpeak, MTV and TLG values between the two methods (p=0.23, 0.45 and 0.37, respectively). Excellent agreement between the two methods was found in terms of CCC (CCC > 0.98 for all measures). Inter-observer reliability was excellent for all measures (CCC > 0.90). Conclusion: The semi-automatic gradient-based tumor-segmentation method can be used without the additional manual adjustment step for metabolic tumor burden quantification of primary NSCLC tumors.

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