Christian B Van der Pol

• BEng, MD
• Fellow at Brigham and Women's Hospital

Background: A number of patients with periampullary carcinoma deemed resectable on preoperative CT have their curative-intent surgery aborted on the basis of intraoperative findings. Objective: This study sought to identify imaging and clinical factors associated with aborted curative-intent Whipple procedures for periampullary adenocarcinoma. Meth...

The American College of Radiology Liver Imaging Reporting and Data System (LI‐RADS) is the preeminent framework for classification and risk stratification of liver observations on imaging in patients at high risk for hepatocellular carcinoma. In this review, the pathogenesis of hepatocellular carcinoma and the use of MRI in LI‐RADS is discussed, in...

Background: Guidelines suggest the Liver Imaging Reporting and Data System (LI-RADS) may not be applicable for some populations at risk for hepatocellular carcinoma (HCC). However, data assessing the association of HCC risk factors with LI-RADS major features are lacking. Purpose: To evaluate whether the association between HCC risk factors and eac...

Purpose: Use a tailored version of the Quality Assessment of Diagnostic Accuracy Studies tool to evaluate risk of bias and applicability across LIRADS related publications. Method: A tailored QUADAS-2 tool was created through consensus approach to assess risk of bias and applicability across 37 LI-RADS related publications. Studies were selected fr...

Impact of Wait Time From Preoperative CT to Pancreatectomy on Overall Survival for Patients With Pancreatic Carcinoma

Objective This study aims to determine which qualitative and quantitative US features are independently associated with malignancy, including those derived from grayscale imaging morphology, shear wave elastography (SWE), and texture analysis. Methods This single-center retrospective study was approved by the institutional research ethics board. C...

Background This study determined the impact of pre-operative abdominal MRI on all-cause mortality for patients with resected PDAC. Methods All adult (≥18 years) PDAC patients who underwent pancreatectomy between January 2011 and December 2022 in Ontario, Canada, were identified for this population-based cohort study (ICD-O-3 codes: C250, C251, C252...

Purpose: To evaluate factors impacting the Segment Anything Model (SAM) and variant MedSAM performance for segmenting liver observations on contrast-enhanced (CE) magnetic resonance imaging (MRI) in high-risk patients with probable hepatocellular carcinoma (HCC) (LR-4) and definite HCC (LR-5). Methods: A retrospective cohort of liver observations (...

Background The independent contribution of each Liver Imaging Reporting and Data System (LI-RADS) CT or MRI ancillary feature (AF) has not been established. Purpose To evaluate the association of LI-RADS AFs with hepatocellular carcinoma (HCC) and malignancy while adjusting for LI-RADS major features through an individual participant data (IPD) met...

Purpose Patients may seek online information to better understand medical imaging procedures. The purpose of this study was to assess the accuracy of information provided by 2 popular artificial intelligence (AI) chatbots pertaining to common imaging scenarios’ risks, benefits, and alternatives. Methods Fourteen imaging-related scenarios pertainin...

Background Pancreatic cystic lesions (PCLs) are frequent on MRI and are thought to be associated with pancreatic adenocarcinoma (PDAC) necessitating long‐term surveillance based on older studies suffering from selection bias. Purpose To establish the percentage of patients with PCLs on MRI with a present or future PDAC. Study Type Systematic revi...

Background A simplification of the Liver Imaging Reporting and Data System (LI-RADS) version 2018 (v2018), revised LI-RADS (rLI-RADS), has been proposed for imaging-based diagnosis of hepatocellular carcinoma (HCC). Single-site data suggest that rLI-RADS category 5 (rLR-5) improves sensitivity while maintaining positive predictive value (PPV) of th...

CT, MRI, and Medical Radiation Technologist Trends in Ontario

Medical imaging diagnostic test accuracy research is strengthened by adhering to best practices for study design, data collection, data documentation, and study reporting. In this review, key elements of such research are discussed, and specific recommendations provided for optimizing diagnostic accuracy study execution to improve uniformity, minim...

Purpose: Bard by Google, a direct competitor to ChatGPT, was recently released. Understanding the relative performance of these different chatbots can provide important insight into their strengths and weaknesses as well as which roles they are most suited to fill. In this project, we aimed to compare the most recent version of ChatGPT, ChatGPT-4,...

Objectives: To perform a systematic review comparing the diagnostic accuracy of MRI vs. CT for assessing pancreatic ductal adenocarcinoma (PDAC) vascular invasion. Methods: MEDLINE, EMBASE, Cochrane Central, and Scopus were searched until December 2021 for diagnostic accuracy studies comparing MRI vs. CT to evaluate vascular invasion of patholog...

Objective: To determine the accuracy of qualitative and quantitative MRI features for the diagnosis of pathologic regional lymph nodes at standard lymphadenectomy in patients with pancreatic ductal adenocarcinoma (PDAC). Methods: All adult patients with pancreatic MRI performed from 2011 to 2021 within 3 months of a pancreaticoduodenectomy were...

Overcrowding is a well-known problem in hospitals and emergency departments (ED) that can negatively impact patients and staff. This study aims to present a machine learning model to detect a patient’s need for a Computed Tomography (CT) exam in the emergency department at the earliest possible time. The data for this work was collected from ED at...

Purpose: To establish reporting adherence to the Checklist for Artificial Intelligence in Medical Imaging (CLAIM) in diagnostic accuracy AI studies with the highest Altmetric Attention Scores (AAS), and to compare completeness of reporting between peer-reviewed manuscripts and preprints. Methods: MEDLINE, EMBASE, arXiv, bioRxiv, and medRxiv were re...

Pancreatic cystic lesions (PCLs) are both common and often incidental. These encompass a range of pathologies with varying degrees of concern for malignancy. Although establishing a diagnosis is helpful for determining malignant potential, many PCLs are either too small to characterize or demonstrate nonspecific morphologic features. The most salie...

Structured reporting for pancreatic ductal adenocarcinoma (PDAC) staging should describe vascular involvement as absent, abutment, or encasement based on solid tumor contact rather than perivascular stranding. Liver MRI is mandatory before PDAC curative surgical resection as computed tomography (CT) is more likely to miss liver metastases, which ar...

Background: Pancreatic cystic lesions (PCLs) are followed for years due to older and likely biased works demonstrating a strong association with pancreatic carcinoma; more recent data are needed clarifying this relationship. Purpose: To determine the association between PCLs on MRI and a synchronous or future diagnosis of pancreatic carcinoma....

The Coronavirus Disease of 2019 (COVID-19) pandemic has caused significant delays in the delivery of cancer treatments in Canada. As cancer treatment and imaging volumes return to normal, radiologists will encounter more cases of chemotherapy-induced toxicities. These toxicities have varied appearances on imaging, and can affect multiple organ syst...

Artificial intelligence (AI) applications in radiology have been rising exponentially in the last decade. Although AI has found usage in various areas of healthcare, its utilization in the emergency department (ED) as a tool for emergency radiologists shows great promise towards easing some of the challenges faced daily. There have been numerous re...

Purpose To assess the diagnostic performance of quantitative and qualitative imaging features of hepatic cirrhosis on CT. Methods A single-center retrospective cohort study was performed on all patients who had undergone non-targeted liver biopsy < 3 months following abdominal CT imaging between 2007 and 2020. Histopathology was required as a refe...

Background: Our March 2021 edition of this review showed thoracic imaging computed tomography (CT) to be sensitive and moderately specific in diagnosing COVID-19 pneumonia. This new edition is an update of the review. Objectives: Our objectives were to evaluate the diagnostic accuracy of thoracic imaging in people with suspected COVID-19; assess...

See also the editorial by Ronot in this issue. Online supplemental material is available for this article.

The purpose is to determine factors impacting radiologist abdominal pelvic CT exam reporting time. This study was Research Ethics Board approved. Between January 2019 and March 2020, consecutive abdominal pelvic CT exams were documented as structured or unstructured based on application of templates with separate sections for different organs or or...

Background The Liver Imaging Reporting and Data System (LI-RADS) assigns a risk category for hepatocellular carcinoma (HCC) to imaging observations. Establishing the contributions of major features can inform the diagnostic algorithm. Purpose To perform a systematic review and individual patient data meta-analysis to establish the probability of HC...

Background: Reported rates of hepatocellular carcinoma (HCC) for LR-2 and LR-3 observations are generally greater than what may be expected based on clinical experience, possibly reflecting some studies' requirement for pathologic reference. Objective: To determine progression rates to higher LI-RADS categories of LR-2 and LR-3 observations in pati...

Background For patients undergoing rectal cancer surgery, we evaluated whether suboptimal preoperative surgeon evaluation of resection margins is a latent condition factor—a factor that is common, unrecognized, and may increase the risk of certain adverse events, including local tumour recurrence, positive surgical margin, nontherapeutic surgery, a...

Optimizing the Radiologist Work Environment

Background Differentiation of benign and malignant pancreatic cystic lesions on MRI, computed tomography (CT), and endoscopic ultrasound (EUS) is critical for determining management. Purpose To perform a systematic review evaluating the diagnostic accuracy of MRI for diagnosing malignant pancreatic cystic lesions, and to compare the accuracy of MR...

Purpose: To determine equivalency of multi-slice 3D CTTA and single slice 2D CTTA of pancreas adenocarcinoma. Methods: This retrospective study was research ethics board approved. Untreated pancreas adenocarcinomas were segmented on CT in 128 consecutive patients. Tumor segmentation was compared using two techniques: 3D segmentation by contourin...

A 79‐year old male was admitted to hospital for weight loss and polyarthritis. Examination revealed warmth, erythema and swelling of the left metacarpophalangeal joints, wrist, right shoulder and ankle. The CRP was elevated at 109 mg/L (ULN <5 mg/L) however other rheumatoid markers were within normal limits (ANA, RF, anti‐CCP, ANCAs). Radiographs d...

Background: The respiratory illness caused by SARS-CoV-2 infection continues to present diagnostic challenges. Our 2020 edition of this review showed thoracic (chest) imaging to be sensitive and moderately specific in the diagnosis of coronavirus disease 2019 (COVID-19). In this update, we include new relevant studies, and have removed studies wit...

OBJECTIVE. The purpose of this study is to determine the impact of LI-RADS ancillary features on MRI and to ascertain whether the number of ancillary features can be reduced without compromising LI-RADS accuracy. MATERIALS AND METHODS. A total of 222 liver observations in 81 consecutive patients were identified on MRI between August 2013 and Decemb...

Background: The respiratory illness caused by SARS-CoV-2 infection continues to present diagnostic challenges. Early research showed thoracic (chest) imaging to be sensitive but not specific in the diagnosis of coronavirus disease 2019 (COVID-19). However, this is a rapidly developing field and these findings need to be re-evaluated in the light o...

Purpose: To determine the impact of the Coronavirus disease-2019 (COVID-19) pandemic on the volume, indications, and results of CT heads performed in the emergency department (ED) at Canadian tertiary academic centers in Ontario. Methods: A retrospective review of consecutive CT head examinations ordered through the ED during the early stages of...

Objective: To evaluateProstate Imaging Reporting and Data System (PI-RADS) category three lesions impact on diagnostic test accuracy (DTA) of MRI for prostate cancer (PC) and to derive prevalence of PC within each PI-RADS category. Methods: MEDLINE and Embase were searched for studies reporting on the DTA of MRI by PI-RADS category. Accuracy metri...

Background: The diagnosis of infection by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) presents major challenges. Reverse transcriptase polymerase chain reaction (RT-PCR) testing is used to diagnose a current infection, but its utility as a reference standard is constrained by sampling errors, limited sensitivity (71% to 98%),...

Background Gadoxetic acid is classified by the American College of Radiology as a group III gadolinium-based contrast agent (GBCA), which indicates that there are limited data regarding nephrogenic systemic fibrosis (NSF) risk, but there are few if any unconfounded cases of NSF. Purpose To perform a systematic review and meta-analysis of gadoxetic...

Objective: The aim of this study was to determine if texture analysis can classify liver observations likely to be hepatocellular carcinoma based on the Liver Imaging Reporting and Data System (LI-RADS) using single portal venous phase computed tomography. Methods: This research ethics board-approved retrospective cohort study included 64 consec...

Objectives To determine if CT texture analysis features are associated with hypovascular pancreas head adenocarcinoma (PHA) postoperative margin status, nodal status, grade, lymphovascular invasion (LVI), and perineural invasion (PNI). Methods This Research Ethics Board–approved retrospective cohort study included 131 consecutive patients with res...

Background: The detection of liver metastases is important for pancreatic cancer curative treatment eligibility. The data suggest that magnetic resonance imaging (MRI) is more sensitive than computed tomography (CT) for the diagnosis of pancreatic cancer liver metastases. However, MRI is not currently recommended in multiple published guidelines....

OBJECTIVE. The purpose of this study was to determine whether quantitative T2-weighted imaging and apparent diffusion coefficient (ADC) texture features of bladder cancer and extravesical fat are predictive of muscle invasive bladder cancer (category ≥ T2) and extravesical (category ≥ T3) disease after transurethral resection of a bladder tumor (TU...

Purpose To assess qualitative and quantitative imaging features on enhanced CT that may differentiate pancreatic neuroendocrine tumors (PNETs) from pancreatic renal cell carcinoma (RCC) metastases. Methods This IRB-approved multi-center retrospective case–control study compared 43 resected PNETs and 28 resected RCC metastases with pre-operative en...

Suboptimal reporting in the publication of imaging research studies is a growing concern. Deficient and incomplete reporting prevents the evaluation of the validity, replicability, and the overall quality of the research. Reporting guidelines are checklists designed to guide researchers about the minimum information to be provided in research studi...

Background & Aims The Liver Imaging Reporting and Data System (LI-RADS) categorizes observations from imaging analyses of high-risk patients based on the level of suspicion for hepatocellular carcinoma (HCC) and overall malignancy. The categories range from definitely benign (LR-1) to definitely HCC (LR-5), malignancy (LR-M), or tumor in vein (LR-T...

While many institutions perform MRI during the work‐up of urinary bladder cancer, others use MRI rarely if at all, possibly due to a variation in the reported staging accuracy and unfamiliarity with the potential benefits of performing MRI. Through increased application of functional imaging techniques including diffusion‐weighted imaging (DWI) and...

Emerging evidence has confirmed that, following administration of a gadolinium-based contrast agent (GBCA), very small amounts of gadolinium will deposit in the brain of humans with intact blood-brain barriers. The literature is evolving rapidly and the degree to which gadolinium will deposit for a particular GBCA or class of GBCAs remains undeterm...

Objective: The objective of the present study is to determine whether hemorrhage within papillary renal cell carcinoma (RCC) can be detected using T1-weighted MRI and to ascertain whether it can be used to differentiate papillary RCC from angiomyolipoma (AML) without visible fat. Materials and methods: A retrospective case-control study compared...

Purpose To determine if adherence to the Standards for Reporting of Diagnostic Accuracy (STARD) is associated with postpublication citation rates. Materials and Methods A comprehensive search of PubMed, EMBASE, and Cochrane Library databases was performed to identify published articles that have evaluated adherence of diagnostic accuracy studies to...

History A 24-year-old woman presented to the emergency department with a history of acute urinary retention, gross hematuria, and left flank pain for 2 days. Past history was unrevealing. Her last menstrual period occurred 2 weeks prior to presentation. At physical examination, she had a temperature of 38.4°C. A palpable mass was noted in the supra...

The objective of our study was to determine whether CT findings, including texture analysis, can differentiate sarcomatoid renal cell carcinoma (RCC) from clear cell RCC. A retrospective case-control study was performed of consecutive patients with a histologic diagnosis of sarcomatoid RCC (n = 20) and clear cell RCC (n = 25) who underwent preopera...

History A 58-year-old woman presented for evaluation of gradually progressive lower extremity pain and paresthesia. She initially experienced interscapular pain that developed while gardening. After 1 month, she started to feel numbness in her feet. This numbness ascended over the next few days to involve her lower breast margin. There were no exac...

The purpose of this study is to determine whether study quality and completeness of reporting of systematic reviews (SR) and meta-analyses (MA) published in high impact factor (IF) radiology journals is associated with citation rates. All SR and MA published in English between Jan 2007-Dec 2011, in radiology journals with an IF >2.75, were identifi...

To evaluate if pRCCs demonstrate intracellular lipid (i-lipid) at chemical-shift (CS) MRI, and assess T2W-MRI and pathologic characteristics. Sixty-two patients with a pRCC diagnosis underwent MRI over 11 years (IRB-approved). Two radiologists independently assessed for presence of i-lipid on CS-MRI and homogeneity on T2W-MRI. Inter-observer agreem...

Clear cell renal cell carcinoma (RRC) characteristically contain intracellular lipid which is also detectable in tumor thrombus and metastases. To assess the incidence of intracellular lipid in clear cell RCC metastases and tumor thrombus using chemical shift MRI. With REB approval, 33 consecutive patients with clear cell RCC and tumor thrombus/met...

The purpose of this study was to determine the frequency/significance of incorrectly planned oblique T2-weighted (T2W) MRI of rectal adenocarcinoma. Eighty-six consecutive patients underwent MRI for rectal cancer staging. Two radiologists evaluated oblique T2W imaging and tumor stage. A total of 71% of middle/high tumors had correctly planned obliq...

The extraocular muscles (EOM) are involved in a variety of disease processes with characteristic findings on imaging. EOM anatomy is described, followed by a review of adult EOM pathology. The imaging characteristics are explained with examples. The pattern of EOM disease on imaging, in corroboration with clinical findings, can often lead the radio...

The purpose of this study was to determine if bone metastasis characteristics on axial skeleton MRI are associated with either skeletal-related events (SREs) or survival in breast cancer patients. A retrospective review was performed on 247 breast cancer patients with bone metastases identified on axial skeleton MRI. MRI studies were reviewed for m...

PURPOSE Bone metastases from breast cancer are associated with significant morbidity and mortality. Skeletal related events (SREs) are defined as radiation/surgery to bone, pathologic fractures, malignant spinal cord compression and hypercalcemia. We hypothesized that certain skeleton MRI characteristics were associated with developing an SRE. MET...