Corwin, Michael T.

ObjectivesTo evaluate the effectiveness of templated ultrasound reports using transplant renal artery stenosis (TRAS) risk stratification (RS), particularly with regard to utilization of downstream angiographic studies and angiographic presence of TRAS.MethodsUltrasounds with TRAS‐RS templated reports from August 2017 to May 2020 were included. Studies were excluded if performed <28 days posttransplant and where TRAS was not clinically considered. A total of 530 ultrasounds met inclusion/exclusion criteria. TRAS‐RS criteria were recorded (renal artery velocity ≥300 cm/s, spectral broadening in the renal artery, and intraparenchymal acceleration time ≥0.1 second). Depending on the number of criteria present, recipients were stratified into low (0/3), intermediate (1/3), high (2/3), and very high (3/3) risk for TRAS. Student's t‐test was performed to identify whether the TRAS‐RS category was associated with 1) performance of angiography to assess for TRAS and 2) angiographic presence of TRAS.ResultsOf the 530 ultrasounds, 74 (14%) underwent angiography. Of these, 41 (55%) were positive for TRAS (overall positive rate, 8%). Number of ultrasounds, angiograms, and angiograms positive for TRAS, respectively, in each of the TRAS‐RS categories for the 530 cases were: low probability: n = 370 (70% of all studied reports), 7 angiograms (2%), and 0 (0%) positive for TRAS; intermediate: n = 87 (16%), 24 angiograms (28%), and 8 (33%) positive; high: n = 46 (9%), 23 angiograms (50%), and 14 (61%) positive; and very high: n = 27 (5%), 20 angiograms (74%), and 19 (95%) positive. TRAS‐RS score was associated with subsequent performance of angiography and positive rate for TRAS (P < .01).ConclusionImplementing a defined ultrasound screening tool with templated reporting for TRAS allowed for effective selection of those requiring an angiogram.

Objective The aim of the study was to evaluate the prevalence of malignancy on contrast-enhanced computed tomography (CT) of the abdomen and pelvis in patients with unexplained, unintentional weight loss (UUWL). Methods This is a retrospective review of 999 adult outpatient contrast-enhanced CT of the abdomen and pelvis for UUWL. Patients were stratified into 2 groups: (1) weight loss only (WLO, n = 222) and (2) UUWL with additional symptoms (UUWL+, n = 777). χ2 test was performed to compare malignancy detection rate in the WLO and UUWL+ groups. Results Prevalence of malignancy was 5.3% (95% confidence interval [CI], 4.2%–7.1%; 55 of 999). Prevalence of malignancy in the WLO group was 2.3% (95% CI, 0.7%–5.2%; 5 of 222), lower than the prevalence of 6.2% (95% CI, 4.6%–8.1%; 48 of 777) in the UUWL+ group (P = 0.02). Prevalence of malignancy was lower in patients younger than 60 years in all patients and in the UUWL+ subgroup (P < 0.01 in both cases). Conclusions There is low prevalence of malignancy on contrast-enhanced CT of the abdomen and pelvis in patients with UUWL, particularly in younger patients and those without additional symptoms.