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Editor's Note.-RadioGraphics continues to publish radiologic-pathologic case material selected from the American Institute for Radiologic Pathology (AIRP) "best case" presentations. The AIRP conducts a 4-week Radiologic Pathology Correlation Course, which is offered five times per year. On the penultimate day of the course, the best case presentation is held at the American Film Institute Silver Theater and Cultural Center in Silver Spring, Md. The AIRP faculty identifies the best cases from each organ system, brought by the resident attendees. One or more of the best cases from each of the five courses are then solicited for publication in RadioGraphics. These cases emphasize the importance of radiologic-pathologic correlation in the imaging evaluation and diagnosis of diseases encountered at the institute and its predecessor, the Armed Forces Institute of Pathology (AFIP).

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OBJECTIVE: Accuracy of ultrasound in diagnosis of ovarian torsion remains controversial, with some studies reporting correct diagnosis in only 23% to 66% of cases. Normal Doppler flow does not necessarily exclude an ovarian torsion; in fact, it may lead to missing the diagnosis and has been show to delay management. The objective of our study was to assess sensitivity and specificity of ultrasound diagnosis of ovarian torsion and to analyze the factors contributing to correct and incorrect diagnosis. METHODS: All women presenting with abdominal pain and admitted for urgent/emergent surgery to the gynaecology service at a major teaching hospital between September 2010 and August 2015 were reviewed. Of those, 55 cases of surgically proven ovarian torsion and 48 control cases were selected. Ultrasound reports were reviewed and analyzed. RESULTS: Sixty-one percent of right ovarian torsion case and 27% of left ovarian torsion cases had normal Doppler flow. Presence of ovarian cysts was significantly associated with torsion. Sensitivity of ultrasound was 70% and specificity was 87%. CONCLUSION: While ultrasound can be used to support a diagnosis of ovarian torsion, it is a clinical diagnosis that requires integration of many factors, especially patient presentation and exclusion of other non-gynaecological pathologies. Doppler flow is not a useful variable to diagnose or exclude ovarian torsion and we recommend it should not be used to exclude a diagnosis of ovarian torsion.

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BACKGROUND: Estimates of lifetime cancer risk are commonly used in the clinical setting and in health-care evaluations. These measures are based on lifetime cancer risk estimates and may create an unrealistically frightening perception of cancer risk for an individual. We suggest using two new measures of cancer risk to complement the cancer lifetime risk measure, namely estimates of cancer risk from birth to a specific age or from a specific age to life expectancy. METHODS: We calculated risks using incidence density data from the Israel National Cancer Registry of 2013, applying a well-known formula for calculating risk, for a follow-up time. The joint disease-free survival probability is calculated for several age intervals, and hence the risk (i.e. 1-survival) for the intervals. RESULTS: The risk of cancer to age 80 in Jewish men and women, respectively, ranged from about 0.336 and 0.329 at age 0, to 0.279 and 0.237 at age 60. The risk of cancer from birth up to an age in Jewish men and women, respectively, ranged from 0 and 0 at birth to 0.088 and 0.129 at age 60. The risk of cancer to age 80 in Arab men and women, respectively, ranged from 0.298 and 0.235 at age 0 to 0.249 and 0.161 at age 60. The risk of cancer from birth up to an age in Arab men and women, respectively, ranged from 0 and 0 at age 0 to 0.074 and 0.095 at age 60. In Jewish and Arab women, breast cancer risk to age 80 decreased from about 0.127 in Jewish women at age 40 to 0.079 at age 60 and from 0.080 to 0.043 in Arab women; the risk from birth up to a specific age ranged between 0 and 0.056, and 0 and 0.040, respectively. CONCLUSION: The two proposed new estimates convey important additional information to patients and physicians. These estimates are considerably lower than the frequently quoted 33% lifetime cancer risk and are more relevant to patients and physicians. Similarly, breast cancer risk estimates up to or from a specific age differ considerably from the frequently quoted lifetime risk estimates of 1 in 8 women.

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Burkitt's lymphoma is a highly aggressive non-Hodgkin's B-cell lymphoma, which often presents with intra-abdominal involvement. The purpose of this pictorial review is to illustrate the various intra-abdominal imaging findings of Burkitt's lymphoma. Extranodal disease at presentation is common, including involvement of the bowel, stomach, pancreas, spleen, and mesentery.

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PURPOSE: The objective of this study was to assess whether sex differences exist in plaque burden and plaque subtype as assessed by coronary computed tomography angiography (CCTA). METHODS: The study cohort included 937 consecutive patients who underwent CCTA between 2008 and 2010. Stenosis was quantified using the Society of Cardiovascular Computed Tomography stenosis grading scale and a total stenosis score (TSS) was generated. Plaque morphology (PM) was reported as predominantly calcified (CP), noncalcified (NCP), or mixed (MP) plaque, and CP, NCP, and MP percentages were calculated. RESULTS: On multivariate analysis, men were significantly more likely to have plaque (65.9% of men vs. 44.6% of women, p<0.001), at least one segment with ≥50% stenosis (22.7% of men vs. 10.3% of women, p<0.001) and higher TSS (mean score=2.81 for men vs. 1.58 for women, p<0.001). Sex was the strongest predictor in all models (odds ratio [OR]=2.55, 95% confidence interval [CI] 1.78-3.67, p<0.001 for any plaque; OR=2.48, 95% CI 1.48-4.16, p<0.01 for segments with ≥50% stenosis; ß=1.46, 95% CI 0.69-2.22, p<0.001 for TSS). Among patients with coronary plaque present, no significant sex differences in PM were found. CONCLUSIONS: Sex was the strongest risk factor for the presence and extent of plaque. Significant sex differences in PM did not exist.

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Fractional flow reserve (FFR) at the time of invasive coronary angiography is the current gold standard for determination of ischemia. Coronary CT angiography (coronary CTA) has emerged as an effective noninvasive method for direct visualization of coronary artery disease. However, severe stenosis by coronary CTA are only modestly predictive of ischemia. Recent technological innovations enable non-invasive calculation of FFR from CT. FFRCT is superior to anatomic assessment of stenoses in coronary CTA for the diagnosis of ischemia-causing lesions on both a per-patient and a per-vessel basis. FFRCT improves the diagnostic accuracy mostly by reducing the false positive rate of stenosis assessment alone. Furthermore, in patients where CT demonstrates an intermediate stenosis, FFRCT demonstrates significantly higher diagnostic performance than anatomic assessment alone.

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OBJECTIVE: To investigate whether there are gender and ethnic disparities in the patient education provided by primary healthcare providers about heart disease (HD) risk and prevention. METHODS: A telephone survey, conducted in four languages, was completed by 976 people, 40+ years of age, in Metro Vancouver, Canada. Questions assessing communication with healthcare providers' provision of HD risk and management education were the focus. RESULTS: Statistically significant gender and ethnic differences were found. Women were less likely to report discussing HD risk and management with their healthcare providers. Chinese-Canadian participants had less likelihood of receiving HD education compared with participants of other ethnic origins. These differences persisted after multivariate adjustment with income, highest level of education attained, age, and other factors. CONCLUSION: Primary healthcare providers should make improved efforts towards education about HD and its risk factors for women in general, and for postmenopausal women especially. PRACTICE IMPLICATIONS: Healthcare providers should be aware that some ethnic populations may not be receiving patient education similar to that received by people of other communities, as found for Chinese-Canadian members of this study community. Further understanding of the barriers faced by ethnic groups must be gained to develop solutions.

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BACKGROUND: Women reportedly do not perceive heart disease (HD) as a major threat to their health; however, men's perceptions are rarely studied. PURPOSE: We explored gender and ethnic differences in risk perception of HD mortality. METHODS: The survey was completed by 976 people 40+ years of age, in metropolitan Vancouver, Canada. RESULTS: Men, compared with women, were more likely not to know the answer to a question about whether HD is the most common cause of death for women; however, women were more likely not to know the answer to a question about whether HD is the most common cause of death for men. Chinese-Canadian and South Asian-Canadian participants were more likely than participants of other ethnic groups not to know the answer to either question, and the Chinese-Canadian participants were more likely to disagree that HD is the most common cause of death for women. CONCLUSION: There is a need to educate the Chinese-Canadian and South Asian-Canadian communities about HD as a first step in promoting health behavior change. Men and women must be educated about the other gender's risk of HD because all adults play integral roles in making decisions about the prevention of and early intervention for HD.

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BACKGROUND: Early-onset depression after acute myocardial infarction (AMI) affects short-term survival in clinical samples of patients. There is no information on the impact of early-onset depression or late-onset depression on long-term survival. OBJECTIVE: To investigate the impact of early- and late-onset depression on survival using administrative data. METHODS: A historical inception cohort design was used, commencing in 1994 with up to eight years of follow-up. A province-wide administrative data set from British Columbia was used to select the cohort and construct the variables. Data regarding hospitalizations, physician visits and prescription drugs were available. All individuals 66 years of age and older who had an AMI in 1994 or 1995 were selected (n=4874). Individuals were categorized as depressed, possibly depressed or not depressed based on physician or hospital visits indicating depression as a diagnosis and/or prescriptions for antidepressants. Early-onset depression was assessed during the first six months post-AMI, and late-onset depression was assessed between six months and five years post-AMI. All-cause mortality up to eight years post-AMI was the outcome. RESULTS: Both early- and late-onset depression were associated with long-term mortality. The hazard ratio was 1.34 (95% CI 1.04 to 1.73) for early-onset depression and 1.79 (95% CI 1.38 to 2.35) for late-onset depression. CONCLUSIONS: Both early- and late-onset depression post-AMI were significantly associated with mortality up to eight years post-AMI. Depression is a strong independent predictor of post-AMI mortality in older adults.

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OBJECTIVE: To compare methods of risk adjustment in a population of individuals with acute myocardial infarction (AMI), in order to assist clinicians in assessing patient prognosis. STUDY DESIGN AND SETTING: A historical inception cohort design was established, with follow-up of or=66 years who had an AMI in 1994 or 1995 were selected (n = 4,874). The three risk-adjustment methods were the Ontario AMI prediction rule (OAMIPR), the D'Hoore adaptation of the Charlson Index, and the total number of distinct comorbidities. Logistic regression models were built including each of the adjustment methods, age, sex, socioeconomic status, previous AMI, and cardiac procedures at time of AMI. RESULTS: The OAMIPR had the highest C-statistic and R(2). CONCLUSION: Clinicians are advised to consider the specific comorbidities that are present, not merely their number, and those that emerge over time, not merely those present at the time of the infarct.

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