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BACKGROUND. Treatment recommendations of penile cancers are determined primarily by the local extent of the primary tumor. Clinical palpation is used for local staging. OBJECTIVE. We reviewed diagnostic performance of MRI in local staging of penile cancer in three clinical scenarios (questions [Qs] 1 through 3, Q1-Q3) and one imaging scenario (Q4). Q1 asked whether MRI reliably distinguishes ≤ T1 from ≥ T2 disease. Q2 asked whether clinical staging reliably identifies ≤ T1 versus ≥ T2 disease and how clinical staging compares to MRI. Q3 asked if MRI is accurate for diagnosis of T3 disease. Q4 asked if artificial erection (by intracavernosal injection of prostaglandin E 1 ) improved accuracy of MRI in T categorization. EVIDENCE ACQUISITION. MEDLINE, EMBASE, and Cochrane Library databases were searched through September 13, 2021, for studies evaluating local staging of penile cancer using MRI with surgical pathology as the reference standard. Diagnostic accuracy was calculated using a bivariate random-effects model and hierarchic summary ROC mode Meta-regression was performed to test for covariate effects of MRI and artificial erection in Q3 and Q4, respectively. EVIDENCE SYNTHESIS. Eight studies and 481 patients were included. The sensitivity and specificity of MRI for Q1 were 86% (95% CI, 73-94%) and 89% (95% CI, 77-95%), respectively. AUC for MRI (0.94; 95% CI, 0.92-0.96) did not differ from clinical staging (0.87; 95% CI, 0.84-0.90; p = .83). For Q3, MRI had sensitivity and specificity of 80% (95% CI, 70-87%) and 96% (95% CI, 85-99%), respectively. For Q4, sensitivity and specificity for MRI with versus without artificial erection were 85% (95% CI, 71-92%) and 93% (95% CI, 77-98%) versus 86% (95% CI, 68-95%) and 84% (95% CI, 70-93%), respectively ( p = .50). CONCLUSION. MRI staging of penile cancer may be considered for ≤ T1 versus ≥ T2 disease but did not appear more accurate than clinical staging. High specificity of MRI for diagnosis of ≥ T3 disease suggests that MRI may be useful when organ-sparing approaches are planned. MRI with and without artificial erection showed similar accuracy in local staging. CLINICAL IMPACT. MRI, with or without artificial erection, may be valuable in routine preoperative evaluation of local staging of penile cancer, particularly when organ-sparing options are considered.

OBJECTIVE. The purposes of this study were to evaluate the outcome of new arterial phase enhancing nodules at MRI of cirrhotic livers, including clinical and imaging factors that affect progression to hepatocellular carcinoma (HCC), and to assess the diagnostic performance of Liver Imaging Reporting and Data System version 2018 (LI-RADSv2018) versus version 2017 (LI-RADSv2017) in categorizing these nodules. MATERIALS AND METHODS. A database search identified 129 new arterial phase enhancing, round, solid, space-occupying nodules in 79 patients with cirrhosis who underwent surveillance MRI. Three readers assessed the nodules for LI-RADS findings and made assessments based on the 2017 and 2018 criteria. Clinical information and laboratory values were collected. Outcome data were assessed on the basis of follow-up imaging and pathology results. Interreader agreement was assessed. Logistic regression and ROC curve analyses were used to assess the utility of the features for prediction of progression to HCC. RESULTS. Of the 129 nodules, 71 (55%) progressed to HCC. LI-RADSv2017 score, LIRADSv2018 score, and mild-to-moderate T2 hyperintensity were significant independent predictors of progression to HCC in univariate analyses. Serum α-fetoprotein level, hepatitis B or C virus infection as the cause of liver disease, and presence of other HCCs were significant predictors of progression to HCC in multivariate analyses. The rates of progression of LI-RADS category 3 and 4 observations were 38.1% and 57.6%, respectively, for LI-RADSv2017 and 44.4% and 69.9%, respectively, for LI-RADSv2018. CONCLUSION. New arterial phase enhancing nodules in patients with cirrhosis frequently progress to HCC. Factors such as serum α-fetoprotein level and presence of other HCCs are strong predictors of progression to HCC.

Objective: Beginning a new job after radiology training is exciting but can also be nerve-racking. The key challenge remains making the strange familiar and assimilating with the new practice as soon as possible. This process is complicated and may require learning new policies, getting to know new colleagues, adapting to new surroundings, and learning new skills., Conclusion: This article provides strategies to navigate professionally and adapt to a new environment.

Objective: The purpose of this study was to apply a visual assessment of the intensity and pattern of T1 hyperintensity at MRI to differentiate hemorrhagic renal cysts from renal cell carcinoma (RCC)., Materials and Methods: A total of 144 T1-hyperintense renal lesions (62 cysts, all showing no enhancement on subtracted contrast-enhanced images and either 2-year stability or unenhanced CT density > 70 HU, and 82 histologically confirmed RCCs) in 144 patients were included. Two radiologists independently characterized qualitative features of the T1 hyperintensity in each lesion on unenhanced T1-weighted images. An additional radiologist placed ROIs to measure lesions' T1 signal intensity normalized to that of the psoas muscle. Chi-square and unpaired t tests were performed to compare the pattern of T1 hyperintensity between groups., Results: The T1 hyperintensity was considered marked in 62.9% of cysts and 17.1% of RCCs for reader 1 and in 46.8% of cysts and 8.5% of RCCs for reader 2 (p < 0.001). The T1 hyperintensity exhibited a diffusely homogeneous distribution in 88.7% of cysts and 7.3% of RCCs for reader 1 and in 72.6% of cysts and 4.9% of RCCs for reader 2 (p < 0.001). The combination of both diffusely homogeneous distribution and marked degree of T1 hyperintensity achieved sensitivities of 40.3-56.5%, specificities of 97.6-98.8%, and accuracies of 73.6-79.9% for the diagnosis of T1-hyperintense cysts. The two cases of RCC exhibiting this imaging pattern for at least one reader were both papillary RCCs. Normalized signal intensity was 2.39 ± 0.99 in T1-hyperintense cysts versus 2.12 ± 0.84 in T1-hyperintense RCCs (p = 0.088)., Conclusion: Diffuse T1 hyperintensity, particularly when marked, strongly indicates a hemorrhagic cyst rather than an RCC. Deferral of follow-up imaging may be considered when this imaging appearance is encountered at unenhanced MRI.