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Publisher: Elsevier   (Total: 3043 journals)

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Showing 1 - 200 of 3043 Journals sorted alphabetically
AASRI Procedia     Open Access   (Followers: 15)
Academic Pediatrics     Hybrid Journal   (Followers: 20, SJR: 1.402, h-index: 51)
Academic Radiology     Hybrid Journal   (Followers: 18, SJR: 1.008, h-index: 75)
Accident Analysis & Prevention     Partially Free   (Followers: 83, SJR: 1.109, h-index: 94)
Accounting Forum     Hybrid Journal   (Followers: 23, SJR: 0.612, h-index: 27)
Accounting, Organizations and Society     Hybrid Journal   (Followers: 27, SJR: 2.515, h-index: 90)
Achievements in the Life Sciences     Open Access   (Followers: 4)
Acta Anaesthesiologica Taiwanica     Open Access   (Followers: 5, SJR: 0.338, h-index: 19)
Acta Astronautica     Hybrid Journal   (Followers: 333, SJR: 0.726, h-index: 43)
Acta Automatica Sinica     Full-text available via subscription   (Followers: 3)
Acta Biomaterialia     Hybrid Journal   (Followers: 25, SJR: 2.02, h-index: 104)
Acta Colombiana de Cuidado Intensivo     Full-text available via subscription   (Followers: 1)
Acta de Investigación Psicológica     Open Access   (Followers: 2)
Acta Ecologica Sinica     Open Access   (Followers: 8, SJR: 0.172, h-index: 29)
Acta Haematologica Polonica     Free   (SJR: 0.123, h-index: 8)
Acta Histochemica     Hybrid Journal   (Followers: 3, SJR: 0.604, h-index: 38)
Acta Materialia     Hybrid Journal   (Followers: 225, SJR: 3.683, h-index: 202)
Acta Mathematica Scientia     Full-text available via subscription   (Followers: 5, SJR: 0.615, h-index: 21)
Acta Mechanica Solida Sinica     Full-text available via subscription   (Followers: 9, SJR: 0.442, h-index: 21)
Acta Oecologica     Hybrid Journal   (Followers: 9, SJR: 0.915, h-index: 53)
Acta Otorrinolaringologica (English Edition)     Full-text available via subscription   (Followers: 1)
Acta Otorrinolaringológica Española     Full-text available via subscription   (Followers: 3, SJR: 0.311, h-index: 16)
Acta Pharmaceutica Sinica B     Open Access   (Followers: 2)
Acta Poética     Open Access   (Followers: 4)
Acta Psychologica     Hybrid Journal   (Followers: 23, SJR: 1.365, h-index: 73)
Acta Sociológica     Open Access  
Acta Tropica     Hybrid Journal   (Followers: 6, SJR: 1.059, h-index: 77)
Acta Urológica Portuguesa     Open Access  
Actas Dermo-Sifiliograficas     Full-text available via subscription   (Followers: 4)
Actas Dermo-Sifiliográficas (English Edition)     Full-text available via subscription   (Followers: 3)
Actas Urológicas Españolas     Full-text available via subscription   (Followers: 4, SJR: 0.383, h-index: 19)
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Actualites Pharmaceutiques     Full-text available via subscription   (Followers: 5, SJR: 0.141, h-index: 3)
Actualites Pharmaceutiques Hospitalieres     Full-text available via subscription   (Followers: 4, SJR: 0.112, h-index: 2)
Acupuncture and Related Therapies     Hybrid Journal   (Followers: 3)
Ad Hoc Networks     Hybrid Journal   (Followers: 11, SJR: 0.967, h-index: 57)
Addictive Behaviors     Hybrid Journal   (Followers: 15, SJR: 1.514, h-index: 92)
Addictive Behaviors Reports     Open Access   (Followers: 5)
Additive Manufacturing     Hybrid Journal   (Followers: 8, SJR: 1.039, h-index: 5)
Additives for Polymers     Full-text available via subscription   (Followers: 20)
Advanced Drug Delivery Reviews     Hybrid Journal   (Followers: 134, SJR: 5.2, h-index: 222)
Advanced Engineering Informatics     Hybrid Journal   (Followers: 11, SJR: 1.265, h-index: 53)
Advanced Powder Technology     Hybrid Journal   (Followers: 16, SJR: 0.739, h-index: 33)
Advances in Accounting     Hybrid Journal   (Followers: 9, SJR: 0.299, h-index: 15)
Advances in Agronomy     Full-text available via subscription   (Followers: 15, SJR: 2.071, h-index: 82)
Advances in Anesthesia     Full-text available via subscription   (Followers: 25, SJR: 0.169, h-index: 4)
Advances in Antiviral Drug Design     Full-text available via subscription   (Followers: 3)
Advances in Applied Mathematics     Full-text available via subscription   (Followers: 6, SJR: 1.054, h-index: 35)
Advances in Applied Mechanics     Full-text available via subscription   (Followers: 10, SJR: 0.801, h-index: 26)
Advances in Applied Microbiology     Full-text available via subscription   (Followers: 22, SJR: 1.286, h-index: 49)
Advances In Atomic, Molecular, and Optical Physics     Full-text available via subscription   (Followers: 16, SJR: 3.31, h-index: 42)
Advances in Biological Regulation     Hybrid Journal   (Followers: 4, SJR: 2.277, h-index: 43)
Advances in Botanical Research     Full-text available via subscription   (Followers: 3, SJR: 0.619, h-index: 48)
Advances in Cancer Research     Full-text available via subscription   (Followers: 25, SJR: 2.215, h-index: 78)
Advances in Carbohydrate Chemistry and Biochemistry     Full-text available via subscription   (Followers: 9, SJR: 0.9, h-index: 30)
Advances in Catalysis     Full-text available via subscription   (Followers: 5, SJR: 2.139, h-index: 42)
Advances in Cellular and Molecular Biology of Membranes and Organelles     Full-text available via subscription   (Followers: 12)
Advances in Chemical Engineering     Full-text available via subscription   (Followers: 24, SJR: 0.183, h-index: 23)
Advances in Child Development and Behavior     Full-text available via subscription   (Followers: 10, SJR: 0.665, h-index: 29)
Advances in Chronic Kidney Disease     Full-text available via subscription   (Followers: 10, SJR: 1.268, h-index: 45)
Advances in Clinical Chemistry     Full-text available via subscription   (Followers: 28, SJR: 0.938, h-index: 33)
Advances in Colloid and Interface Science     Full-text available via subscription   (Followers: 18, SJR: 2.314, h-index: 130)
Advances in Computers     Full-text available via subscription   (Followers: 16, SJR: 0.223, h-index: 22)
Advances in Developmental Biology     Full-text available via subscription   (Followers: 11)
Advances in Digestive Medicine     Open Access   (Followers: 4)
Advances in DNA Sequence-Specific Agents     Full-text available via subscription   (Followers: 5)
Advances in Drug Research     Full-text available via subscription   (Followers: 22)
Advances in Ecological Research     Full-text available via subscription   (Followers: 42, SJR: 3.25, h-index: 43)
Advances in Engineering Software     Hybrid Journal   (Followers: 25, SJR: 0.486, h-index: 10)
Advances in Experimental Biology     Full-text available via subscription   (Followers: 7)
Advances in Experimental Social Psychology     Full-text available via subscription   (Followers: 40, SJR: 5.465, h-index: 64)
Advances in Exploration Geophysics     Full-text available via subscription   (Followers: 3)
Advances in Fluorine Science     Full-text available via subscription   (Followers: 8)
Advances in Food and Nutrition Research     Full-text available via subscription   (Followers: 47, SJR: 0.674, h-index: 38)
Advances in Fuel Cells     Full-text available via subscription   (Followers: 15)
Advances in Genetics     Full-text available via subscription   (Followers: 15, SJR: 2.558, h-index: 54)
Advances in Genome Biology     Full-text available via subscription   (Followers: 11)
Advances in Geophysics     Full-text available via subscription   (Followers: 6, SJR: 2.325, h-index: 20)
Advances in Heat Transfer     Full-text available via subscription   (Followers: 21, SJR: 0.906, h-index: 24)
Advances in Heterocyclic Chemistry     Full-text available via subscription   (Followers: 8, SJR: 0.497, h-index: 31)
Advances in Human Factors/Ergonomics     Full-text available via subscription   (Followers: 26)
Advances in Imaging and Electron Physics     Full-text available via subscription   (Followers: 2, SJR: 0.396, h-index: 27)
Advances in Immunology     Full-text available via subscription   (Followers: 35, SJR: 4.152, h-index: 85)
Advances in Inorganic Chemistry     Full-text available via subscription   (Followers: 9, SJR: 1.132, h-index: 42)
Advances in Insect Physiology     Full-text available via subscription   (Followers: 3, SJR: 1.274, h-index: 27)
Advances in Integrative Medicine     Hybrid Journal   (Followers: 5)
Advances in Intl. Accounting     Full-text available via subscription   (Followers: 4)
Advances in Life Course Research     Hybrid Journal   (Followers: 8, SJR: 0.764, h-index: 15)
Advances in Lipobiology     Full-text available via subscription   (Followers: 2)
Advances in Magnetic and Optical Resonance     Full-text available via subscription   (Followers: 9)
Advances in Marine Biology     Full-text available via subscription   (Followers: 16, SJR: 1.645, h-index: 45)
Advances in Mathematics     Full-text available via subscription   (Followers: 10, SJR: 3.261, h-index: 65)
Advances in Medical Sciences     Hybrid Journal   (Followers: 6, SJR: 0.489, h-index: 25)
Advances in Medicinal Chemistry     Full-text available via subscription   (Followers: 5)
Advances in Microbial Physiology     Full-text available via subscription   (Followers: 4, SJR: 1.44, h-index: 51)
Advances in Molecular and Cell Biology     Full-text available via subscription   (Followers: 22)
Advances in Molecular and Cellular Endocrinology     Full-text available via subscription   (Followers: 10)
Advances in Molecular Toxicology     Full-text available via subscription   (Followers: 7, SJR: 0.324, h-index: 8)
Advances in Nanoporous Materials     Full-text available via subscription   (Followers: 4)
Advances in Oncobiology     Full-text available via subscription   (Followers: 3)
Advances in Organometallic Chemistry     Full-text available via subscription   (Followers: 15, SJR: 2.885, h-index: 45)
Advances in Parallel Computing     Full-text available via subscription   (Followers: 7, SJR: 0.148, h-index: 11)
Advances in Parasitology     Full-text available via subscription   (Followers: 7, SJR: 2.37, h-index: 73)
Advances in Pediatrics     Full-text available via subscription   (Followers: 24, SJR: 0.4, h-index: 28)
Advances in Pharmaceutical Sciences     Full-text available via subscription   (Followers: 13)
Advances in Pharmacology     Full-text available via subscription   (Followers: 15, SJR: 1.718, h-index: 58)
Advances in Physical Organic Chemistry     Full-text available via subscription   (Followers: 7, SJR: 0.384, h-index: 26)
Advances in Phytomedicine     Full-text available via subscription  
Advances in Planar Lipid Bilayers and Liposomes     Full-text available via subscription   (Followers: 3, SJR: 0.248, h-index: 11)
Advances in Plant Biochemistry and Molecular Biology     Full-text available via subscription   (Followers: 8)
Advances in Plant Pathology     Full-text available via subscription   (Followers: 5)
Advances in Porous Media     Full-text available via subscription   (Followers: 4)
Advances in Protein Chemistry     Full-text available via subscription   (Followers: 18)
Advances in Protein Chemistry and Structural Biology     Full-text available via subscription   (Followers: 19, SJR: 1.5, h-index: 62)
Advances in Psychology     Full-text available via subscription   (Followers: 60)
Advances in Quantum Chemistry     Full-text available via subscription   (Followers: 5, SJR: 0.478, h-index: 32)
Advances in Radiation Oncology     Open Access  
Advances in Small Animal Medicine and Surgery     Hybrid Journal   (Followers: 2, SJR: 0.1, h-index: 2)
Advances in Space Research     Full-text available via subscription   (Followers: 345, SJR: 0.606, h-index: 65)
Advances in Structural Biology     Full-text available via subscription   (Followers: 8)
Advances in Surgery     Full-text available via subscription   (Followers: 7, SJR: 0.823, h-index: 27)
Advances in the Study of Behavior     Full-text available via subscription   (Followers: 30, SJR: 1.321, h-index: 56)
Advances in Veterinary Medicine     Full-text available via subscription   (Followers: 16)
Advances in Veterinary Science and Comparative Medicine     Full-text available via subscription   (Followers: 13)
Advances in Virus Research     Full-text available via subscription   (Followers: 5, SJR: 1.878, h-index: 68)
Advances in Water Resources     Hybrid Journal   (Followers: 43, SJR: 2.408, h-index: 94)
Aeolian Research     Hybrid Journal   (Followers: 5, SJR: 0.973, h-index: 22)
Aerospace Science and Technology     Hybrid Journal   (Followers: 310, SJR: 0.816, h-index: 49)
AEU - Intl. J. of Electronics and Communications     Hybrid Journal   (Followers: 8, SJR: 0.318, h-index: 36)
African J. of Emergency Medicine     Open Access   (Followers: 5, SJR: 0.344, h-index: 6)
Ageing Research Reviews     Hybrid Journal   (Followers: 8, SJR: 3.289, h-index: 78)
Aggression and Violent Behavior     Hybrid Journal   (Followers: 408, SJR: 1.385, h-index: 72)
Agri Gene     Hybrid Journal  
Agricultural and Forest Meteorology     Hybrid Journal   (Followers: 15, SJR: 2.18, h-index: 116)
Agricultural Systems     Hybrid Journal   (Followers: 30, SJR: 1.275, h-index: 74)
Agricultural Water Management     Hybrid Journal   (Followers: 38, SJR: 1.546, h-index: 79)
Agriculture and Agricultural Science Procedia     Open Access  
Agriculture and Natural Resources     Open Access   (Followers: 1)
Agriculture, Ecosystems & Environment     Hybrid Journal   (Followers: 53, SJR: 1.879, h-index: 120)
Ain Shams Engineering J.     Open Access   (Followers: 5, SJR: 0.434, h-index: 14)
Air Medical J.     Hybrid Journal   (Followers: 5, SJR: 0.234, h-index: 18)
AKCE Intl. J. of Graphs and Combinatorics     Open Access   (SJR: 0.285, h-index: 3)
Alcohol     Hybrid Journal   (Followers: 9, SJR: 0.922, h-index: 66)
Alcoholism and Drug Addiction     Open Access   (Followers: 6)
Alergologia Polska : Polish J. of Allergology     Full-text available via subscription   (Followers: 1)
Alexandria Engineering J.     Open Access   (Followers: 1, SJR: 0.436, h-index: 12)
Alexandria J. of Medicine     Open Access  
Algal Research     Partially Free   (Followers: 8, SJR: 2.05, h-index: 20)
Alkaloids: Chemical and Biological Perspectives     Full-text available via subscription   (Followers: 3)
Allergologia et Immunopathologia     Full-text available via subscription   (Followers: 1, SJR: 0.46, h-index: 29)
Allergology Intl.     Open Access   (Followers: 4, SJR: 0.776, h-index: 35)
ALTER - European J. of Disability Research / Revue Européenne de Recherche sur le Handicap     Full-text available via subscription   (Followers: 7, SJR: 0.158, h-index: 9)
Alzheimer's & Dementia     Hybrid Journal   (Followers: 48, SJR: 4.289, h-index: 64)
Alzheimer's & Dementia: Diagnosis, Assessment & Disease Monitoring     Open Access   (Followers: 5)
Alzheimer's & Dementia: Translational Research & Clinical Interventions     Open Access   (Followers: 3)
American Heart J.     Hybrid Journal   (Followers: 48, SJR: 3.157, h-index: 153)
American J. of Cardiology     Hybrid Journal   (Followers: 45, SJR: 2.063, h-index: 186)
American J. of Emergency Medicine     Hybrid Journal   (Followers: 38, SJR: 0.574, h-index: 65)
American J. of Geriatric Pharmacotherapy     Full-text available via subscription   (Followers: 6, SJR: 1.091, h-index: 45)
American J. of Geriatric Psychiatry     Hybrid Journal   (Followers: 16, SJR: 1.653, h-index: 93)
American J. of Human Genetics     Hybrid Journal   (Followers: 31, SJR: 8.769, h-index: 256)
American J. of Infection Control     Hybrid Journal   (Followers: 24, SJR: 1.259, h-index: 81)
American J. of Kidney Diseases     Hybrid Journal   (Followers: 33, SJR: 2.313, h-index: 172)
American J. of Medicine     Hybrid Journal   (Followers: 46, SJR: 2.023, h-index: 189)
American J. of Medicine Supplements     Full-text available via subscription   (Followers: 3)
American J. of Obstetrics and Gynecology     Hybrid Journal   (Followers: 187, SJR: 2.255, h-index: 171)
American J. of Ophthalmology     Hybrid Journal   (Followers: 54, SJR: 2.803, h-index: 148)
American J. of Ophthalmology Case Reports     Open Access   (Followers: 3)
American J. of Orthodontics and Dentofacial Orthopedics     Full-text available via subscription   (Followers: 6, SJR: 1.249, h-index: 88)
American J. of Otolaryngology     Hybrid Journal   (Followers: 23, SJR: 0.59, h-index: 45)
American J. of Pathology     Hybrid Journal   (Followers: 26, SJR: 2.653, h-index: 228)
American J. of Preventive Medicine     Hybrid Journal   (Followers: 21, SJR: 2.764, h-index: 154)
American J. of Surgery     Hybrid Journal   (Followers: 34, SJR: 1.286, h-index: 125)
American J. of the Medical Sciences     Hybrid Journal   (Followers: 12, SJR: 0.653, h-index: 70)
Ampersand : An Intl. J. of General and Applied Linguistics     Open Access   (Followers: 5)
Anaerobe     Hybrid Journal   (Followers: 4, SJR: 1.066, h-index: 51)
Anaesthesia & Intensive Care Medicine     Full-text available via subscription   (Followers: 55, SJR: 0.124, h-index: 9)
Anaesthesia Critical Care & Pain Medicine     Full-text available via subscription   (Followers: 9)
Anales de Cirugia Vascular     Full-text available via subscription  
Anales de Pediatría     Full-text available via subscription   (Followers: 2, SJR: 0.209, h-index: 27)
Anales de Pediatría (English Edition)     Full-text available via subscription  
Anales de Pediatría Continuada     Full-text available via subscription   (SJR: 0.104, h-index: 3)
Analytic Methods in Accident Research     Hybrid Journal   (Followers: 2, SJR: 2.577, h-index: 7)
Analytica Chimica Acta     Hybrid Journal   (Followers: 38, SJR: 1.548, h-index: 152)
Analytical Biochemistry     Hybrid Journal   (Followers: 164, SJR: 0.725, h-index: 154)
Analytical Chemistry Research     Open Access   (Followers: 8, SJR: 0.18, h-index: 2)
Analytical Spectroscopy Library     Full-text available via subscription   (Followers: 11)
Anesthésie & Réanimation     Full-text available via subscription   (Followers: 1)
Anesthesiology Clinics     Full-text available via subscription   (Followers: 22, SJR: 0.421, h-index: 40)
Angiología     Full-text available via subscription   (SJR: 0.124, h-index: 9)
Angiologia e Cirurgia Vascular     Open Access  
Animal Behaviour     Hybrid Journal   (Followers: 158, SJR: 1.907, h-index: 126)
Animal Feed Science and Technology     Hybrid Journal   (Followers: 5, SJR: 1.151, h-index: 83)
Animal Reproduction Science     Hybrid Journal   (Followers: 5, SJR: 0.711, h-index: 78)
Annales d'Endocrinologie     Full-text available via subscription   (Followers: 1, SJR: 0.394, h-index: 30)
Annales d'Urologie     Full-text available via subscription  
Annales de Cardiologie et d'Angéiologie     Full-text available via subscription   (SJR: 0.177, h-index: 13)
Annales de Chirurgie de la Main et du Membre Supérieur     Full-text available via subscription  
Annales de Chirurgie Plastique Esthétique     Full-text available via subscription   (Followers: 2, SJR: 0.354, h-index: 22)
Annales de Chirurgie Vasculaire     Full-text available via subscription   (Followers: 1)

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Journal Cover Academic Radiology
  [SJR: 1.008]   [H-I: 75]   [18 followers]  Follow
    
   Hybrid Journal Hybrid journal (It can contain Open Access articles)
   ISSN (Print) 1076-6332
   Published by Elsevier Homepage  [3043 journals]
  • The Impact of Fatigue on Satisfaction of Search in Chest Radiography
    • Authors: Elizabeth A. Krupinski; Kevin S. Berbaum; Kevin M. Schartz; Robert T. Caldwell; Mark T. Madsen
      Pages: 1058 - 1063
      Abstract: Publication date: September 2017
      Source:Academic Radiology, Volume 24, Issue 9
      Author(s): Elizabeth A. Krupinski, Kevin S. Berbaum, Kevin M. Schartz, Robert T. Caldwell, Mark T. Madsen
      Rationale and Objectives To assess the nature of the satisfaction of search (SOS) effect in chest radiography when observers are fatigued; determine if we could replicate recent findings that have documented the nature of the SOS effect to be due to a threshold shift rather than a change in diagnostic accuracy as in earlier film-based studies. Materials and Methods Nearing or at the end of a clinical workday, 20 radiologists read 64 chest images twice, once with and once without the addition of a simulated pulmonary nodule. Half of the images had different types of “test” abnormalities. Decision thresholds were analyzed using the center of the range of false-positive (FP) and true-positive (TP) fractions associated with each receiver operating characteristic (ROC) point for reporting test abnormalities. Detection accuracy was assessed with ROC technique and inspection time was recorded. Results The SOS effect was confirmed to be a reduction in willingness to respond (threshold shift). The center of the FP range was significantly reduced (FP = 0.10 without added nodules, FP = 0.05 with added nodules, F(1,18) = 19.85, P = 0.0003). The center of the TP range was significantly reduced (TP = 0.39 without added nodules, TP = 0.33 with added nodules, F(1,18) = 10.81, P = 0.004). Conclusions This study suggests that fatigue does not change the nature of the SOS effect, but rather may be additive with the SOS effect. SOS reduces both TP and FP responses, whereas fatigue reduces TPs more than FPs.

      PubDate: 2017-08-20T19:30:13Z
      DOI: 10.1016/j.acra.2017.03.021
       
  • Maximum Aortic Valve Opening Phase for Annulus Sizing in Pre-TAVR CTA
    • Authors: Nam Ju Lee; Saurabh Jha; Bong Ju Lee; Harold Litt
      Pages: 1064 - 1069
      Abstract: Publication date: September 2017
      Source:Academic Radiology, Volume 24, Issue 9
      Author(s): Nam Ju Lee, Saurabh Jha, Bong Ju Lee, Harold Litt
      Rationale and Objectives The optimal phase for the measurement of the aortic annular area for transcatheter aortic valve replacement (TAVR) is not standardized, although most agree that systolic measurements are preferred, when the annulus is larger. We hypothesized that the maximum annular area occurs at the cardiac phase of the maximum aortic valve opening (MAVO) and that this phase can be accurately and reproducibly assessed by visual inspection only. Materials and Methods The aortic valve opening area was inspected visually by two readers to determine the MAVO phase. The annular area was measured at the MAVO phase and the typical systolic phase (35% of the R-R interval). Differences in the annular area that would change valve sizing for prostheses were noted. Results Fifty patients (mean age 81) were studied. Ninety percent had the MAVO at the 15%–25% R-R interval. There was high interobserver correlation (0.89) for determining the MAVO phase by visual inspection. For 49 out of 50 patients, the annular area was maximal at the MAVO phase. The mean difference in the annular area between the MAVO phase and 35% was 22.3 (±4.57) mm2. In 12% of the patients, the difference in the annular area changed the recommended size of a self-expanding prosthesis and would have altered the procedure in 32% for balloon-expandable prostheses. Conclusions Visually assessed MAVO occurs in early systole for most patients and is almost always the cardiac phase of the maximal aortic annular area. This method allows rapid and reproducible determination of the appropriate phase for TAVR planning measurements. Consideration should be given to optimizing pre-TAVR computed tomography acquisitions for early systolic reconstruction and visual determination of the MAVO.

      PubDate: 2017-08-20T19:30:13Z
      DOI: 10.1016/j.acra.2017.03.011
       
  • Improved Estimation of Coronary Plaque and Luminal Attenuation Using a
           Vendor-specific Model-based Iterative Reconstruction Algorithm in
           Contrast-enhanced CT Coronary Angiography
    • Authors: Yoshinori Funama; Daisuke Utsunomiya; Kenichiro Hirata; Katsuyuki Taguchi; Takeshi Nakaura; Seitaro Oda; Masafumi Kidoh; Hideaki Yuki; Yasuyuki Yamashita
      Pages: 1070 - 1078
      Abstract: Publication date: September 2017
      Source:Academic Radiology, Volume 24, Issue 9
      Author(s): Yoshinori Funama, Daisuke Utsunomiya, Kenichiro Hirata, Katsuyuki Taguchi, Takeshi Nakaura, Seitaro Oda, Masafumi Kidoh, Hideaki Yuki, Yasuyuki Yamashita
      Rationale and Objectives To investigate the stabilities of plaque attenuation and coronary lumen for different plaque types, stenotic degrees, lumen densities, and reconstruction methods using coronary vessel phantoms and the visualization of coronary plaques in clinical patients through coronary computed tomography (CT) angiography. Materials and Methods We performed 320-detector volume scanning of vessel tubes with stenosis and a tube without stenosis using three types of plaque CT numbers. The stenotic degrees were 50% and 75%. Images were reconstructed with filtered back projection (FBP) and two types of iterative reconstructions (AIDR3D and FIRST [forward-projected model-based iterative reconstruction solution]), with stenotic CT number of approximately 40, 80, and 150 HU (Hounsfield unit), respectively. In each case, the tubing of the coronary vessel was filled with diluted contrast material and distilled water to reach the target lumen CT numbers of approximately 350 HU and 450 HU, and 0 HU, respectively. Peak lumen and plaque CT numbers were measured to calculate the lumen–plaque contrast. In addition, we retrospectively evaluated the image quality with regard to coronary arterial lumen and the plaque in 10 clinical patients on a 4-point scale. Results At 50% stenosis, the plaque CT number with contrast enhancement increased for FBP and AIDR3D, and the difference in the plaque CT number with and without contrast enhancement was 15–44 HU for FBP and 10–31 HU for AIDR3D. However, the plaque CT number for FIRST had a smaller variation and the difference with and without contrast enhancement was −12 to 8 HU. The visual evaluation score for the vessel lumen was 2.8 ± 0.6, 3.5 ± 0.5, and 3.7 ± 0.5 for FBP, AIDR3D, and FIRST, respectively. Conclusions The FIRST method controls the increase in plaque density and the lumen–plaque contrast. Consequently, it improves the visualization of coronary plaques in coronary CT angiography.

      PubDate: 2017-08-20T19:30:13Z
      DOI: 10.1016/j.acra.2017.02.006
       
  • Quantification of Mouse Renal Perfusion Using Arterial Spin Labeled MRI at
           1 T
    • Authors: Quyen N. Do; Ananth J. Madhuranthakam; Peter Bendel; Robert E. Lenkinski
      Pages: 1079 - 1085
      Abstract: Publication date: September 2017
      Source:Academic Radiology, Volume 24, Issue 9
      Author(s): Quyen N. Do, Ananth J. Madhuranthakam, Peter Bendel, Robert E. Lenkinski
      Rationale and Objectives Quantitative measurement of renal perfusion in murine models provides important information on the organ physiology and disease states. The 1-T desktop magnetic resonance imaging has a small footprint and a self-contained fringe field. This resultant flexibility in siting makes the system ideal for preclinical imaging research. Our objective was to evaluate the capability of the 1-T desktop magnetic resonance imaging to measure mouse renal perfusion without the administration of exogenous contrast agents. Materials and Methods We implemented a flow-sensitive alternating inversion recovery (FAIR)-based arterial spin labeling sequence with a mouse volume coil on a 1-T desktop magnetic resonance scanner. The validity of the implementation was tested by comparing obtained renal perfusion results with literature values for normal mice and challenging the technique with mice treated with furosemide, a blood vessel vasoconstrictor drug. Results The measured cortical and medullary perfusions were quantified to be 402 ± 95 and 184 ± 52 mL/100 g/min, respectively, in agreement with literature values. The ratio of cortical to medullary renal blood flow was between 2 and 3 and was independent of the mouse weight. As expected, upon furosemide injection, a decrease (~50%) in cortical perfusion was observed in the mice population, at 1 hour post injection compared to baseline (P < 0.0001), which returned to baseline after 24 hours (P = 0.68). Conclusions We reported the successful application of FAIR-based arterial spin labeling for noncontrast perfusion measurement of mouse kidneys using a 1-T desktop scanner. The easy implementation of FAIR sequence on a 1-T desktop scanner offers the potential for longitudinal perfusion studies in limited access areas such as behind the barrier in mouse facilities and in multimodality preclinical imaging laboratories without the administration of exogenous contrast agents.

      PubDate: 2017-08-20T19:30:13Z
      DOI: 10.1016/j.acra.2017.04.001
       
  • 3 Tesla 23Na Magnetic Resonance Imaging During Acute Kidney Injury
    • Authors: Matthias Hammon; Susan Grossmann; Peter Linz; Hannes Seuss; Rebecca Hammon; Daniela Rosenhauer; Rolf Janka; Alexander Cavallaro; Friedrich C. Luft; Jens Titze; Michael Uder; Anke Dahlmann
      Pages: 1086 - 1093
      Abstract: Publication date: September 2017
      Source:Academic Radiology, Volume 24, Issue 9
      Author(s): Matthias Hammon, Susan Grossmann, Peter Linz, Hannes Seuss, Rebecca Hammon, Daniela Rosenhauer, Rolf Janka, Alexander Cavallaro, Friedrich C. Luft, Jens Titze, Michael Uder, Anke Dahlmann
      Rationale and Objectives Sodium and proton magnetic resonance imaging (23Na/1H-MRI) have shown that muscle and skin can store Na+ without water. In chronic renal failure and in heart failure, Na+ mobilization occurs, but is variable depending on age, dialysis vintage, and other features. Na+ storage depots have not been studied in patients with acute kidney injury (AKI). Materials and Methods We studied 7 patients with AKI (mean age: 51.7 years; range: 25–84) and 14 age-matched and gender-matched healthy controls. All underwent 23Na/1H-MRI at the calf. Patients were studied before and after acute hemodialysis therapy within 5–6 days. The 23Na-MRI produced grayscale images containing Na+ phantoms, which served to quantify Na+ contents. A fat-suppressed inversion recovery sequence was used to quantify H2O content. Results Plasma Na+ levels did not change. Mean Na+ contents in muscle and skin did not significantly change following four to five cycles of hemodialysis treatment (before therapy: 32.7 ± 6.9 and 44.2 ± 13.5 mmol/L, respectively; after dialysis: 31.7 ± 10.2 and 42.8 ± 11.8 mmol/L, respectively; P > .05). Water content measurements did not differ significantly before and after hemodialysis in muscle and skin (P > .05). Na+ contents in calf muscle and skin of patients before hemodialysis were significantly higher than in healthy subjects (16.6 ± 2.1 and 17.9 ± 3.2) and remained significantly elevated after hemodialysis. Conclusions Na+ in muscle and skin accumulates in patients with AKI and, in contrast to patients receiving chronic hemodialysis and those with acute heart failure, is not mobilized with hemodialysis within 5–6 days.

      PubDate: 2017-08-20T19:30:13Z
      DOI: 10.1016/j.acra.2017.03.012
       
  • Dorsal Muscle Attenuation May Predict Failure to Respond to Interleukin-2
           Therapy in Metastatic Renal Cell Carcinoma
    • Authors: Bamidele Otemuyiwa; Brian A. Derstine; Peng Zhang; Sandra L. Wong; Michael S. Sabel; Bruce G. Redman; Stewart C. Wang; Ajjai S. Alva; Matthew S. Davenport
      Pages: 1094 - 1100
      Abstract: Publication date: September 2017
      Source:Academic Radiology, Volume 24, Issue 9
      Author(s): Bamidele Otemuyiwa, Brian A. Derstine, Peng Zhang, Sandra L. Wong, Michael S. Sabel, Bruce G. Redman, Stewart C. Wang, Ajjai S. Alva, Matthew S. Davenport
      Rationale and Objectives To explore whether the sarcopenia body type can help predict response to interleukin-2 (IL-2) therapy in metastatic renal cell carcinoma (RCC). Materials and Methods Institutional review board approval was obtained for this Health Insurance Portability and Accountability Act-compliant retrospective cohort study of 75 subjects with metastatic RCC who underwent pretreatment contrast-enhanced computed tomography within 1 year of initiating IL-2 therapy. Cross-sectional area and attenuation of normal-density (31–100 Hounsfield units [HU]) and low-density (0–30 HU) dorsal muscles were obtained at the T11 vertebral level. The primary outcome was partial or complete response to IL-2 using RECIST 1.1 criteria at 6 weeks. A conditional inference tree was used to determine an optimal HU cutoff for predicting outcome. Bonferroni-adjusted multivariate logistic regression was conducted to investigate the independent associations between imaging features and response after controlling for demographics, doses of IL-2, and RCC prognostic scales (eg, Heng and the Memorial Sloan Kettering Cancer Center [MSKCC]). Results Most subjects had intermediate prognosis by Heng (65% [49 of 75]) and the MSKCC (63% [47 of 75]) criteria; 7% had complete response and 12% had partial response. Mean attenuation of low-density dorsal muscles was a significant univariate predictor of IL-2 response after Bonferroni correction (P = 0.03). The odds of responding to treatment were 5.8 times higher for subjects with higher-attenuation low-density dorsal muscles (optimal cutoff: 18.1 HU). This persisted in multivariate analysis (P = 0.02). Body mass index (P = 0.67) and the Heng (P = 0.22) and MSKCC (P = 0.08) clinical prognostic scales were not significant predictors of response. Conclusions Mean cross-sectional attenuation of low-density dorsal muscles (ie, sarcopenia) may predict IL-2 response in metastatic RCC. Clinical variables are poor predictors of response.

      PubDate: 2017-08-20T19:30:13Z
      DOI: 10.1016/j.acra.2017.03.003
       
  • Application of Prostate Imaging Reporting and Data System Version 2
           (PI-RADS v2)
    • Authors: Frank Chen; Steven Cen; Suzanne Palmer
      Pages: 1101 - 1106
      Abstract: Publication date: September 2017
      Source:Academic Radiology, Volume 24, Issue 9
      Author(s): Frank Chen, Steven Cen, Suzanne Palmer
      Rationale and Objectives To evaluate interobserver agreement with the use of and the positive predictive value (PPV) of Prostate Imaging Reporting and Data System version 2 (PI-RADS v2) for the localization of intermediate- and high-grade prostate cancers on multiparametric magnetic resonance imaging (mpMRI). Materials and Methods In this retrospective, institutional review board-approved study, 131 consecutive patients who had mpMRI followed by transrectal ultrasound-MR imaging fusion-guided biopsy of the prostate were included. Two readers who were blinded to initial mpMRI reports, clinical data, and pathologic outcomes reviewed the MR images, identified all prostate lesions, and scored each lesion based on the PI-RADS v2. Interobserver agreement was assessed by intraclass correlation coefficient (ICC), and PPV was calculated for each PI-RADS category. Results PI-RADS v2 was found to have a moderate level of interobserver agreement between two readers of varying experience, with ICC of 0.74, 0.72, and 0.67 for all lesions, peripheral zone lesions, and transitional zone lesions, respectively. Despite only moderate interobserver agreement, the calculated PPV in the detection of intermediate- and high-grade prostate cancers for each PI-RADS category was very similar between the two readers, with approximate PPV of 0%, 12%, 64%, and 87% for PI-RADS categories 2, 3, 4, and 5, respectively. Conclusions In our study, PI-RADS v2 has only moderate interobserver agreement, a similar finding in studies of the original PI-RADS and in initial studies of PI-RADS v2. Despite this, PI-RADS v2 appears to be a useful system to predict significant prostate cancer, with PI-RADS scores correlating well with the likelihood of intermediate- and high-grade cancers.

      PubDate: 2017-08-20T19:30:13Z
      DOI: 10.1016/j.acra.2017.03.019
       
  • Incidental Findings on Pediatric Abdominal Magnetic Resonance Angiography
    • Authors: Nattinee Leelakanok; Matthew A. Zapala; Emily A. Edwards; Andrew S. Phelps; John D. Mackenzie; Jesse Courtier
      Pages: 1107 - 1113
      Abstract: Publication date: September 2017
      Source:Academic Radiology, Volume 24, Issue 9
      Author(s): Nattinee Leelakanok, Matthew A. Zapala, Emily A. Edwards, Andrew S. Phelps, John D. Mackenzie, Jesse Courtier
      Rationale and Objectives Abdominal magnetic resonance angiography (MRA) has gained favor in pediatric patients owing to its lack of ionizing radiation and noninvasive nature. Reports exist regarding incidental findings on body MRA in adult patients. However, the incidental findings in pediatric abdominal MRA have not been previously reported. Our study aims to determine the frequencies, characteristics, and categories of incidental findings in pediatric patients undergoing abdominal MRA. Materials and Methods Retrospective study was performed in 78 consecutive contrast-enhanced abdominal MRA of patients between ages 0 and 20 years over a 7-year time period. The presence of incidental vascular and extravascular findings was noted. Reports were categorized in consensus by two radiologists as no incidental finding (group A), normal or normal variants or nonsignificant incidental common findings (group B), or abnormal incidental findings (group C). Group C was reviewed to determine whether additional management was performed. Results A total of 40 boys and 38 girls (51%:49%) were reported, with a mean age of 12.3 years (standard deviation ±5.6 years, range 7 days to 20 years). Three most common indications for MRA were renal artery stenosis (24.4%), vasculitis (21.8%), and suspected intra-abdominal venous thrombosis (14.1%). We identified a total of 92 incidental findings in 50 of 78 patients; 60 findings in 29 patients in group B, and 32 findings in 21 patients in group C. Atelectasis at the lung bases was the most common incidental finding in group B (14 of 78 patients). The most common findings in group C were ascites, scoliosis, and splenomegaly. There were three abnormal incidental findings that led to causative workup and/or further management (moderate ascites, pericardial and pleural effusion, and venous malformation). The remaining cases with abnormal findings received treatment of their primary conditions only. Conclusions Pediatric abdominal MRA revealed a large number of incidental findings. The large majority were findings without clinical significance. Basal lung atelectasis was the most common overall incidental and nonsignificant finding, whereas ascites was the most common abnormal incidental finding. Although not all abnormal incidental findings affected management, appropriate identification and communication of relevant findings would improve patient care.

      PubDate: 2017-08-20T19:30:13Z
      DOI: 10.1016/j.acra.2017.01.019
       
  • Iterative Reconstructions in Reduced-Dose CT
    • Authors: Bastien Pauchard; Kai Higashigaito; Aicha Lamri-Senouci; Jean-Francois Knebel; Dominik Berthold; Francis Robert Verdun; Hatem Alkadhi; Sabine Schmidt
      Pages: 1114 - 1124
      Abstract: Publication date: September 2017
      Source:Academic Radiology, Volume 24, Issue 9
      Author(s): Bastien Pauchard, Kai Higashigaito, Aicha Lamri-Senouci, Jean-Francois Knebel, Dominik Berthold, Francis Robert Verdun, Hatem Alkadhi, Sabine Schmidt
      Rationale and Objectives To compare adaptive statistical iterative reconstruction (ASIR) and model-based iterative reconstruction (MBIR) algorithms for reduced-dose computed tomography (CT). Materials and Methods Forty-four young oncology patients (mean age 30 ± 9 years) were included. After routine thoraco-abdominal CT (dose 100%, average CTDIvol 9.1 ± 2.4 mGy, range 4.4–16.9 mGy), follow-up CT was acquired at 50% (average CTDIvol 4.5 ± 1.2 mGy, range 2.2–8.4 mGy) in 29 patients additionally at 20% dose (average CTDIvol 1.9 ± 0.5 mGy, range 0.9–3.4 mGy). Each reduced-dose CT was reconstructed using both ASIR and MBIR. Four radiologists (two juniors and two seniors) blinded to dose and technique read each set of CT images regarding objective and subjective image qualities (high- or low-contrast structures), subjective noise or pixilated appearance, diagnostic confidence, and lesion detection. Results At all dose levels, objective image noise was significantly lower with MBIR than with ASIR (P < 0.001). The subjective image quality for low-contrast structures was significantly higher with MBIR than with ASIR (P < 0.001). Reduced-dose abdominal CT images of patients with higher body mass index (BMI) were read with significantly higher diagnostic confidence than images of slimmer patients (P < 0.001) and had higher subjective image quality, regardless of technique. Although MBIR images appeared significantly more pixilated than ASIR images, they were read with higher diagnostic confidence, especially by juniors (P < 0.001). Conclusions Reduced-dose CT during the follow-up of young oncology patients should be reconstructed with MBIR to ensure diagnostic quality. Elevated body mass index does not hamper the quality of reduced-dose CT.

      PubDate: 2017-08-20T19:30:13Z
      DOI: 10.1016/j.acra.2017.02.012
       
  • Travel Times for Screening Mammography
    • Authors: Andrew B. Rosenkrantz; Yu Liang; Richard Duszak; Michael P. Recht
      Pages: 1125 - 1131
      Abstract: Publication date: September 2017
      Source:Academic Radiology, Volume 24, Issue 9
      Author(s): Andrew B. Rosenkrantz, Yu Liang, Richard Duszak, Michael P. Recht
      Rationale and Objectives This study aims to assess the impact of off-campus facility expansion by a large academic health system on patient travel times for screening mammography. Materials and Methods Screening mammograms performed from 2013 to 2015 and associated patient demographics were identified using the NYU Langone Medical Center Enterprise Data Warehouse. During this time, the system's number of mammography facilities increased from 6 to 19, reflecting expansion beyond Manhattan throughout the New York metropolitan region. Geocoding software was used to estimate driving times from patients' homes to imaging facilities. Results For 147,566 screening mammograms, the mean estimated patient travel time was 19.9 ± 15.2 minutes. With facility expansion, travel times declined significantly (P < 0.001) from 26.8 ± 18.9 to 18.5 ± 13.3 minutes (non-Manhattan residents: from 31.4 ± 20.3 to 18.7 ± 13.6). This decline occurred consistently across subgroups of patient age, race, ethnicity, payer status, and rurality, leading to decreased variation in travel times between such subgroups. However, travel times to pre-expansion facilities remained stable (initial: 26.8 ± 18.9 minutes, final: 26.7 ± 18.6 minutes). Among women undergoing mammography before and after expansion, travel times were shorter for the postexpansion mammogram in only 6.3%, but this rate varied significantly (all P < 0.05) by certain demographic factors (higher in younger and non-Hispanic patients) and was as high as 18.2%–18.9% of patients residing in regions with the most active expansion. Conclusions Health system mammography facility geographic expansion can improve average patient travel burden and reduce travel time variation among sociodemographic populations. Nonetheless, existing patients strongly tend to return to established facilities despite potentially shorter travel time locations, suggesting strong site loyalty. Variation in travel times likely relates to various factors other than facility proximity.

      PubDate: 2017-08-20T19:30:13Z
      DOI: 10.1016/j.acra.2017.03.010
       
  • An Abbreviated Protocol for High-risk Screening Breast Magnetic Resonance
           Imaging
    • Authors: Babita Panigrahi; Lisa Mullen; Eniola Falomo; Benita Panigrahi; Susan Harvey
      Pages: 1132 - 1138
      Abstract: Publication date: September 2017
      Source:Academic Radiology, Volume 24, Issue 9
      Author(s): Babita Panigrahi, Lisa Mullen, Eniola Falomo, Benita Panigrahi, Susan Harvey
      Rationale and Objectives Annual breast magnetic resonance imaging (MRI) is recommended to screen high-risk populations for breast cancer, although costs are significant. This study assesses the performance of an abbreviated MRI protocol as a resource-efficient approach for screening patients at high-risk of breast cancer, and assesses whether the abbreviated protocol alters the assigned Breast Imaging Reporting and Data System (BI-RADS) category. Materials and Methods This is a prospective paired cohort study performed in an academic ambulatory setting. MRI images of women at high risk of breast cancer were reviewed using an abbreviated MRI protocol, followed by an immediate review of additional sequences included in a full diagnostic protocol. BI-RADS assessments, including all changes and interpretation times, were recorded for both the abbreviated and full protocol reviews. Cancer detection rate, positive predictive value 3 (PPV3), sensitivity, and specificity were calculated. Results A total of 1052 MRI cases were reviewed. The cancer detection rate was 13.3 per 1000 with a PPV3 of 30.4% based on the full protocol. Review of sequences included in the full protocol resulted in a change in the final BI-RADS assessments in 3.4% of the cases, the majority of which did not change clinical management with respect to biopsy. The sensitivity and specificity of the abbreviated and full protocols were not significantly different. Conclusions This pilot study of an abbreviated MRI protocol demonstrates effective performance in cancer detection. BI-RADS assessments were rarely altered with the additional information afforded by the full protocol. The abbreviated protocol holds promise for resource-efficient breast cancer screening in high-risk women.

      PubDate: 2017-08-20T19:30:13Z
      DOI: 10.1016/j.acra.2017.03.014
       
  • Can Occult Invasive Disease in Ductal Carcinoma In Situ Be Predicted Using
           Computer-extracted Mammographic Features'
    • Authors: Bibo Shi; Lars J. Grimm; Maciej A. Mazurowski; Jay A. Baker; Jeffrey R. Marks; Lorraine M. King; Carlo C. Maley; E. Shelley Hwang; Joseph Y. Lo
      Pages: 1139 - 1147
      Abstract: Publication date: September 2017
      Source:Academic Radiology, Volume 24, Issue 9
      Author(s): Bibo Shi, Lars J. Grimm, Maciej A. Mazurowski, Jay A. Baker, Jeffrey R. Marks, Lorraine M. King, Carlo C. Maley, E. Shelley Hwang, Joseph Y. Lo
      Rationale and Objectives This study aimed to determine whether mammographic features assessed by radiologists and using computer algorithms are prognostic of occult invasive disease for patients showing ductal carcinoma in situ (DCIS) only in core biopsy. Materials and Methods In this retrospective study, we analyzed data from 99 subjects with DCIS (74 pure DCIS, 25 DCIS with occult invasion). We developed a computer-vision algorithm capable of extracting 113 features from magnification views in mammograms and combining these features to predict whether a DCIS case will be upstaged to invasive cancer at the time of definitive surgery. In comparison, we also built predictive models based on physician-interpreted features, which included histologic features extracted from biopsy reports and Breast Imaging Reporting and Data System-related mammographic features assessed by two radiologists. The generalization performance was assessed using leave-one-out cross validation with the receiver operating characteristic curve analysis. Results Using the computer-extracted mammographic features, the multivariate classifier was able to distinguish DCIS with occult invasion from pure DCIS, with an area under the curve for receiver operating characteristic equal to 0.70 (95% confidence interval: 0.59–0.81). The physician-interpreted features including histologic features and Breast Imaging Reporting and Data System-related mammographic features assessed by two radiologists showed mixed results, and only one radiologist's subjective assessment was predictive, with an area under the curve for receiver operating characteristic equal to 0.68 (95% confidence interval: 0.57–0.81). Conclusions Predicting upstaging for DCIS based upon mammograms is challenging, and there exists significant interobserver variability among radiologists. However, the proposed computer-extracted mammographic features are promising for the prediction of occult invasion in DCIS.

      PubDate: 2017-08-20T19:30:13Z
      DOI: 10.1016/j.acra.2017.03.013
       
  • Accuracy of Cyst Versus Solid Diagnosis in the Breast Using Quantitative
           Transmission (QT) Ultrasound
    • Authors: Elaine Iuanow; Kathleen Smith; Nancy A. Obuchowski; Jennifer Bullen; John C. Klock
      Pages: 1148 - 1153
      Abstract: Publication date: September 2017
      Source:Academic Radiology, Volume 24, Issue 9
      Author(s): Elaine Iuanow, Kathleen Smith, Nancy A. Obuchowski, Jennifer Bullen, John C. Klock
      Rational and Objectives This study aims to evaluate the diagnostic utility of breast imaging using transmission ultrasound. We present readers' accuracy in determining whether a breast lesion is a cyst versus a solid using transmission ultrasound as an adjunct to mammography. Materials and Methods This retrospective multi-reader, multi-case receiver operating characteristic study included 37 lesions seen on mammography and transmission ultrasound. Cyst cases were confirmed as cysts using their appearance on handheld ultrasound. Solid cases were confirmed as solids with pathology results. Fourteen readers performed blinded, randomized reads with mammography + quantitative transmission scan images, assigning both a confidence score (0–100) and a binary classification of cyst or solid. A 95% percentile bootstrap confidence interval (CI) was computed for the readers' mean receiver operating characteristic area, sensitivity, and specificity. Results Using the readers' binary classification of cyst or solid lesions, the mean sensitivity and specificity were 0.933 [95% CI: 0.837, 0.995] and 0.858 [95% CI: 0.701, 0.985], respectively. When the readers' confidence scores were used to distinguish a cyst versus solid, the mean receiver operating characteristic area was 0.920 [95% CI: 0.827, 0.985]. Conclusions Transmission ultrasound can provide an accurate assessment of a cyst versus a solid lesion in the breast. Prospective clinical trials will further delineate the role of transmission ultrasound as an adjunct to mammography to increase specificity in breast evaluation.

      PubDate: 2017-08-20T19:30:13Z
      DOI: 10.1016/j.acra.2017.03.024
       
  • Diagnosing Sarcopenia on Thoracic Computed Tomography
    • Authors: Ursula Nemec; Benedikt Heidinger; Claire Sokas; Louis Chu; Ronald L. Eisenberg
      Pages: 1154 - 1161
      Abstract: Publication date: September 2017
      Source:Academic Radiology, Volume 24, Issue 9
      Author(s): Ursula Nemec, Benedikt Heidinger, Claire Sokas, Louis Chu, Ronald L. Eisenberg
      Rationale and Objectives This study aims to assess the use of skeletal muscle mass measurements at two thoracic levels to diagnose sarcopenia on computed tomography (CT) chest examinations and to analyze the impact of these measurements on clinical outcome parameters following transcatheter aortic valve replacement. Materials and Methods This study retrospectively included 157 patients who underwent preoperative CT examinations. The total muscle area was measured on transverse CT images at the 3rd lumbar and 7th and 12th thoracic levels with skeletal muscle indices (SMIs) calculated at each level. SMIs were then compared to clinical outcome parameters, and thoracic cutoff values for sarcopenia at the 7th and 12th thoracic levels were calculated. Results Correlation between SMIs at the third lumbar vertebra (L3) and the 12th thoracic vertebra (T12) was stronger (r = 0.724, P < 0.001) than that between L3 and the seventh thoracic vertebra (T7) (r = 0.594, P < 0.001). SMIs at L3 and T12 significantly correlated with prolonged length of stay. Thoracic cutoff values for the 12th thoracic level were 42.6 cm2/m2 (men) and 30.6 cm2/m2 (women), and those for the 7th thoracic level were 46.5 cm2/m2 (men) and 32.3 cm2/m2 (women). Conclusions Skeletal muscle measurements at the T12 level could permit the diagnosis of sarcopenia and could be used to correlate sarcopenia with outcome parameters in patients undergoing CT limited to the chest.

      PubDate: 2017-08-20T19:30:13Z
      DOI: 10.1016/j.acra.2017.02.008
       
  • Patterns of Recent National Institutes of Health (NIH) Funding to
           Diagnostic Radiology Departments
    • Authors: Ana M. Franceschi; Andrew B. Rosenkrantz
      Pages: 1162 - 1168
      Abstract: Publication date: September 2017
      Source:Academic Radiology, Volume 24, Issue 9
      Author(s): Ana M. Franceschi, Andrew B. Rosenkrantz
      Rationale and Objectives This study aimed to characterize recent National Institutes of Health (NIH) funding for diagnostic radiology departments at US medical schools. Materials and Methods This retrospective study did not use private identifiable information and thus did not constitute human subjects research. The public NIH Research Portfolio Online Reporting Tools Expenditure and Results system was used to extract information regarding 887 NIH awards in 2015 to departments of “Radiation-Diagnostic/Oncology.” Internet searches were conducted to identify each primary investigator (PI)'s university web page, which was used to identify the PI's departmental affiliation, gender, degree, and academic rank. A total of 649 awards to diagnostic radiology departments, based on these web searches, were included; awards to radiation oncology departments were excluded. Characteristics were summarized descriptively. Results A total of 61 unique institutions received awards. The top five funded institutions represented 33.6% of all funding. The most common institutes administering these awards were the National Cancer Institute (29.0%) and the National Institute of Biomedical Imaging and Bioengineering (21.6%). Women received 15.9% of awards and 13.3% of funding, with average funding per award of $353,512 compared to $434,572 for men. PhDs received 77.7% of all awards, with average funding per award of $457,413 compared to $505,516 for MDs. Full professors received 51.2% of awards (average funding per award of $532,668), compared to assistant professors who received 18.4% of awards ($260,177). Average funding was $499,859 for multiple-PI awards vs. $397,932 for single-PI awards. Common spending categories included “neurosciences,” “cancer,” “prevention,” and “aging.” Conclusions NIH funding for diagnostic radiology departments has largely been awarded to senior-ranking male PhD investigators, commonly at large major academic medical centers. Initiatives are warranted to address such disparities and promote greater diversity in NIH funding among diagnostic radiology investigators.

      PubDate: 2017-08-20T19:30:13Z
      DOI: 10.1016/j.acra.2017.02.018
       
  • Patients' Use and Evaluation of an Online System to Annotate Radiology
           Reports with Lay Language Definitions
    • Authors: Tessa S. Cook; Seong Cheol Oh; Charles E. Kahn
      Pages: 1169 - 1174
      Abstract: Publication date: September 2017
      Source:Academic Radiology, Volume 24, Issue 9
      Author(s): Tessa S. Cook, Seong Cheol Oh, Charles E. Kahn
      Rationale and Objectives The increasing availability of personal health portals has made it easier for patients to obtain their imaging results online. However, the radiology report typically is designed to communicate findings and recommendations to the referring clinician, and may contain many terms unfamiliar to lay readers. We sought to evaluate a web-based interface that presented reports of knee MRI (magnetic resonance imaging) examinations with annotations that included patient-oriented definitions, anatomic illustrations, and hyperlinks to additional information. Materials and Methods During a 7-month observational trial, a statement added to all knee MRI reports invited patients to view their annotated report online. We tracked the number of patients who opened their reports, the terms they hovered over to view definitions, and the time hovering over each term. Patients who accessed their annotated reports were invited to complete a survey. Results Of 1138 knee MRI examinations during the trial period, 185 patients (16.3%) opened their report in the viewing portal. Of those, 141 (76%) hovered over at least one term to view its definition, and 121 patients (65%) viewed a mean of 27.5 terms per examination and spent an average of 3.5 minutes viewing those terms. Of the 22 patients who completed the survey, 77% agreed that the definitions helped them understand the report and 91% stated that the illustrations were helpful. Conclusions A system that provided definitions and illustrations of the medical and technical terms in radiology reports has potential to improve patients' understanding of their reports and their diagnoses.

      PubDate: 2017-08-20T19:30:13Z
      DOI: 10.1016/j.acra.2017.03.005
       
  • Improving Care and Education Through a Radiology Resident-driven Clinical
           Consultation Service
    • Authors: Gayle R. Salama; Courtney Sullivan; Daniel Holzwanger; Ashley E. Giambrone; Robert J. Min; Keith D. Hentel
      Pages: 1175 - 1181
      Abstract: Publication date: September 2017
      Source:Academic Radiology, Volume 24, Issue 9
      Author(s): Gayle R. Salama, Courtney Sullivan, Daniel Holzwanger, Ashley E. Giambrone, Robert J. Min, Keith D. Hentel
      Rationale and Objective As health care moves toward bundled payment systems and merit-based incentive models, increasing awareness of the value of the radiologist is essential. A resident-driven clinical imaging rounds (CIR) program initiated at our institution allows radiologists to actively and directly participate in the team-based medical model. A retrospective review of survey data evaluated the qualitative and quantitative effects of CIR on clinical management, communication, and education of referring providers and radiology residents. Materials and Methods The initial 10 months of a resident-organized CIR were evaluated in a retrospective study. Twenty radiology residents and 150 internal medicine physicians and medical students participated in imaging rounds. An anonymous survey of participants was performed and results were analyzed. Results Eighty-five percent of radiology resident participants completed the survey (N = 17). Approximately 30% of internal medicine participants completed the survey (N = 45). There was an overwhelming positive review of imaging rounds, with a large majority of all groups agreeing that imaging rounds improve education, communication, and patient care. Conclusions Resident-driven imaging rounds provide a valuable opportunity to improve communication, education, and patient care. We have created a CIR with a sustainable workflow that allows direct and regularly scheduled imaging-medicine consultation valued by both radiologists and internal medicine physicians, improving the quality of patient care and providing education to our radiology residents in value-based care.

      PubDate: 2017-08-20T19:30:13Z
      DOI: 10.1016/j.acra.2017.01.023
       
  • High-ability Learners
    • Authors: Richard B. Gunderman
      Pages: 1182 - 1183
      Abstract: Publication date: September 2017
      Source:Academic Radiology, Volume 24, Issue 9
      Author(s): Richard B. Gunderman


      PubDate: 2017-08-20T19:30:13Z
      DOI: 10.1016/j.acra.2017.05.016
       
  • Bacterial Contamination of CT Equipment
    • Authors: Brett W. Carter
      Pages: 921 - 922
      Abstract: Publication date: August 2017
      Source:Academic Radiology, Volume 24, Issue 8
      Author(s): Brett W. Carter


      PubDate: 2017-07-24T12:51:02Z
      DOI: 10.1016/j.acra.2017.04.005
       
  • Bacterial Contamination of CT Equipment
    • Authors: John Childress; Debborah Burch; Cheryl Kucharski; Carol Young; Ella A. Kazerooni; Matthew S. Davenport
      Pages: 923 - 929
      Abstract: Publication date: August 2017
      Source:Academic Radiology, Volume 24, Issue 8
      Author(s): John Childress, Debborah Burch, Cheryl Kucharski, Carol Young, Ella A. Kazerooni, Matthew S. Davenport
      Rationale and Objective This study aimed to evaluate the use of an adenosine triphosphate (ATP) monitoring system to minimize surface contamination on inpatient computed tomography (CT) scanners. Methods The bore, table, and wrap of two quaternary care inpatient CT scanners (load/scanner: ~ 30–40 CT examinations/day) were assayed with bacterial cultures and an ATP detection system during six prospective iterative plan–do–check–act improvement cycles from January 6, 2016 to October 12, 2016. Per-cycle sampling was for eight consecutive weekdays. ATP detection was expressed as relative light units (RLUs) through a luciferase reaction, with >350 RLU considered contaminated per manufacturer recommendations. Culture swabs were placed into 6.5% NaCl broth, a Staphylococcus enrichment broth, and incubated aerobically at 37°C for 48 hours. Positive broths were plated to chromogenic Staphylococcus media. Culture rates (Fisher exact test) and RLU values (Mann-Whitney U test) were compared. Results In Cycle 1, both culture results and median RLU values indicated the wrap was the most contaminated item (positive culture rate: 63% [10/16], median RLU interquartile range: 173 [IQR: 56–640]); however, RLU values were not predictive of per-sample culture results (P = .36). Following iterative improvements, RLU values at Cycle 6 were significantly lower than at peak (P = .02–.04) and within manufacturer's recommendations: all samples: 45 (IQR: 16–87), bore: 26 (IQR: 0–51), table: 68 (IQR: 21–89), wrap: 47 (IQR: 38–121). Conclusion The Velcro wrap is the most contaminated item on a CT scanner, and special processes may be needed to ensure adequate cleansing. ATP detection is a crude surrogate for bacterial culture results but benefits from speed, reduced cost, and greater statistical power.

      PubDate: 2017-08-01T13:03:12Z
      DOI: 10.1016/j.acra.2017.01.022
       
  • A Study of the Feasibility of FDG-PET/CT to Systematically Detect and
           Quantify Differential Metabolic Effects of Chronic Tobacco Use in Organs
           of the Whole Body—A Prospective Pilot Study
    • Authors: Drew A. Torigian; Judith Green-McKenzie; Xianling Liu; Frances S. Shofer; Thomas Werner; Catherine E. Smith; Andrew A. Strasser; Mateen C. Moghbel; Ami H. Parekh; Grace Choi; Marcus D. Goncalves; Natalie Spaccarelli; Saied Gholami; Prithvi S. Kumar; Yubing Tong; Jayaram K. Udupa; Clementina Mesaros; Abass Alavi
      Pages: 930 - 940
      Abstract: Publication date: August 2017
      Source:Academic Radiology, Volume 24, Issue 8
      Author(s): Drew A. Torigian, Judith Green-McKenzie, Xianling Liu, Frances S. Shofer, Thomas Werner, Catherine E. Smith, Andrew A. Strasser, Mateen C. Moghbel, Ami H. Parekh, Grace Choi, Marcus D. Goncalves, Natalie Spaccarelli, Saied Gholami, Prithvi S. Kumar, Yubing Tong, Jayaram K. Udupa, Clementina Mesaros, Abass Alavi
      Rationale and Objectives The aim of this study was to assess the feasibility of 18F-fluorodeoxyglucose (FDG)-positron emission tomography/computed tomography (PET/CT) to systematically detect and quantify differential effects of chronic tobacco use in organs of the whole body. Materials and Methods Twenty healthy male subjects (10 nonsmokers and 10 chronic heavy smokers) were enrolled. Subjects underwent whole-body FDG-PET/CT, diagnostic unenhanced chest CT, mini-mental state examination, urine testing for oxidative stress, and serum testing. The organs of interest (thyroid, skin, skeletal muscle, aorta, heart, lung, adipose tissue, liver, spleen, brain, lumbar spinal bone marrow, and testis) were analyzed on FDG-PET/CT images to determine their metabolic activities using standardized uptake value (SUV) or metabolic volumetric product (MVP). Measurements were compared between subject groups using two-sample t tests or Wilcoxon rank-sum tests as determined by tests for normality. Correlational analyses were also performed. Results FDG-PET/CT revealed significantly decreased metabolic activity of lumbar spinal bone marrow (MVPmean: 29.8 ± 9.7 cc vs 40.8 ± 11.6 cc, P = 0.03) and liver (SUVmean: 1.8 ± 0.2 vs 2.0 ± 0.2, P = 0.049) and increased metabolic activity of visceral adipose tissue (SUVmean: 0.35 ± 0.10 vs 0.26 ± 0.06, P = 0.02) in chronic smokers compared to nonsmokers. Normalized visceral adipose tissue volume was also significantly decreased (P = 0.04) in chronic smokers. There were no statistically significant differences in the metabolic activity of other assessed organs. Conclusions Subclinical organ effects of chronic tobacco use are detectable and quantifiable on FDG-PET/CT. FDG-PET/CT may, therefore, play a major role in the study of systemic toxic effects of tobacco use in organs of the whole body for clinical or research purposes.

      PubDate: 2017-07-24T12:51:02Z
      DOI: 10.1016/j.acra.2016.09.003
       
  • The Objective Identification and Quantification of Interstitial Lung
           Abnormalities in Smokers
    • Authors: Samuel Y. Ash; Rola Harmouche; James C. Ross; Alejandro A. Diaz; Gary M. Hunninghake; Rachel K. Putman; Jorge Onieva; Fernando J. Martinez; Augustine M. Choi; David A. Lynch; Hiroto Hatabu; Ivan O. Rosas; Raul San Jose Estepar; George R. Washko
      Pages: 941 - 946
      Abstract: Publication date: August 2017
      Source:Academic Radiology, Volume 24, Issue 8
      Author(s): Samuel Y. Ash, Rola Harmouche, James C. Ross, Alejandro A. Diaz, Gary M. Hunninghake, Rachel K. Putman, Jorge Onieva, Fernando J. Martinez, Augustine M. Choi, David A. Lynch, Hiroto Hatabu, Ivan O. Rosas, Raul San Jose Estepar, George R. Washko
      Rationale and Objectives Previous investigation suggests that visually detected interstitial changes in the lung parenchyma of smokers are highly clinically relevant and predict outcomes, including death. Visual subjective analysis to detect these changes is time-consuming, insensitive to subtle changes, and requires training to enhance reproducibility. Objective detection of such changes could provide a method of disease identification without these limitations. The goal of this study was to develop and test a fully automated image processing tool to objectively identify radiographic features associated with interstitial abnormalities in the computed tomography scans of a large cohort of smokers. Materials and Methods An automated tool that uses local histogram analysis combined with distance from the pleural surface was used to detect radiographic features consistent with interstitial lung abnormalities in computed tomography scans from 2257 individuals from the Genetic Epidemiology of COPD study, a longitudinal observational study of smokers. The sensitivity and specificity of this tool was determined based on its ability to detect the visually identified presence of these abnormalities. Results The tool had a sensitivity of 87.8% and a specificity of 57.5% for the detection of interstitial lung abnormalities, with a c-statistic of 0.82, and was 100% sensitive and 56.7% specific for the detection of the visual subtype of interstitial abnormalities called fibrotic parenchymal abnormalities, with a c-statistic of 0.89. Conclusions In smokers, a fully automated image processing tool is able to identify those individuals who have interstitial lung abnormalities with moderate sensitivity and specificity.

      PubDate: 2017-07-24T12:51:02Z
      DOI: 10.1016/j.acra.2016.08.023
       
  • Digital Breast Tomosynthesis Practice Patterns Following 2011 FDA Approval
    • Authors: Yiming Gao; James S. Babb; Hildegard K. Toth; Linda Moy; Samantha L. Heller
      Pages: 947 - 953
      Abstract: Publication date: August 2017
      Source:Academic Radiology, Volume 24, Issue 8
      Author(s): Yiming Gao, James S. Babb, Hildegard K. Toth, Linda Moy, Samantha L. Heller
      Rationale and Objectives To evaluate uptake, patterns of use, and perception of digital breast tomosynthesis (DBT) among practicing breast radiologists. Materials and Methods Institutional Review Board exemption was obtained for this Health Insurance Portability and Accountability Act-compliant electronic survey, sent to 7023 breast radiologists identified via the Radiological Society of North America database. Respondents were asked of their geographic location and practice type. DBT users reported length of use, selection criteria, interpretive sequences, recall rate, and reading time. Radiologist satisfaction with DBT as a diagnostic tool was assessed (1–5 scale). Results There were 1156 (16.5%) responders, 65.8% from the United States and 34.2% from abroad. Of these, 749 (68.6%) use DBT; 22.6% in academia, 56.5% private, and 21% other. Participants are equally likely to report use of DBT if they worked in academics versus in private practice (78.2% [169 of 216] vs 71% [423 of 596]) (odds ratio, 1.10; 95% confidence interval: 0.87–1.40; P = 1.000). Of nonusers, 43% (147 of 343) plan to adopt DBT. No US regional differences in uptake were observed (P = 1.000). Although 59.3% (416 of 702) of DBT users include synthetic 2D (s2D) for interpretation, only 24.2% (170 of 702) use s2D alone. Majority (66%; 441 of 672) do not perform DBT-guided procedures. Radiologist (76.6%) (544 of 710) satisfaction with DBT as a diagnostic tool is high (score ≥ 4/5). Conclusions DBT is being adopted worldwide across all practice types, yet variations in examination indication, patient selection, utilization of s2D images, and access to DBT-guided procedures persist, highlighting the need for consensus and standardization.

      PubDate: 2017-07-24T12:51:02Z
      DOI: 10.1016/j.acra.2016.12.011
       
  • Diagnostic Performance of Automated Breast Volume Scanning (ABVS) Compared
           to Handheld Ultrasonography With Breast MRI as the Gold Standard
    • Authors: Constanze Schmachtenberg; Thomas Fischer; Bernd Hamm; Ulrich Bick
      Pages: 954 - 961
      Abstract: Publication date: August 2017
      Source:Academic Radiology, Volume 24, Issue 8
      Author(s): Constanze Schmachtenberg, Thomas Fischer, Bernd Hamm, Ulrich Bick
      Rationale and Objectives This study aimed to compare the diagnostic value of automated breast volume scanning (ABVS) to that of handheld ultrasonography (HHUS) using breast magnetic resonance imaging (MRI) as the gold standard. Materials and Methods Twenty-eight patients with 39 examined breasts with at least one lesion visible in breast MRI underwent HHUS and ABVS. Detection rate, localization, maximum diameter, and Breast Imaging Reporting and Data System classification were compared. Sensitivity, specificity, diagnostic accuracy, positive predictive value, and negative predictive value were calculated for HHUS and ABVS. Lesion localization and maximum diameters based on HHUS and ABVS were compared to size measurement in MRI. Breast Imaging Reporting and Data System categories based on each method were compared to the MRI diagnosis (malignant or benign) or, if available (21 cases), with the histologic diagnosis. Results MRI detected 72 lesions, ABVS 59 lesions, and HHUS 54 lesions. Malignancy was proven histopathologically in 15 cases. There was no significant difference between ABVS and HHUS in terms of sensitivity (93.3% vs. 100%), specificity (83.3% vs. 83.3%), diagnostic accuracy (87.2% vs. 89.7%), positive predictive value (77.8% vs. 78.9%), and negative predictive value (95.2% vs. 100%). Agreement regarding lesion localization (same quadrant) was 94.3% for ABVS and MRI and 91.2% for HHUS and MRI. Lesion size compared to MRI lesion size was assessed correctly (+/− 3 mm) in 79.4% (HHUS) and 80% (ABVS). The correlation of size measurement was slightly higher for ABVS-MRI (r = 0.89) than for HHUS-MRI (r = 0.82) with P < .001. Conclusions ABVS can be used as an alternative to HHUS. ABVS has the advantage of operator independence and better reproducibility although it is limited in evaluating axillary lymph nodes and lacks Doppler or elastrography capabilities, which sometimes provide important supplementary information in HHUS.

      PubDate: 2017-07-24T12:51:02Z
      DOI: 10.1016/j.acra.2017.01.021
       
  • An Interprofessional Learning Workshop for Mammography and Sonography
           Students Focusing on Breast Cancer Care and Management Via Simulation
    • Authors: Eileen M. Giles; Nayana Parange; Bronwyn Knight
      Pages: 962 - 967
      Abstract: Publication date: August 2017
      Source:Academic Radiology, Volume 24, Issue 8
      Author(s): Eileen M. Giles, Nayana Parange, Bronwyn Knight
      Rationale and Objectives The literature surrounding interprofessional education claims that students who learn with, from, and about one another in well-designed interprofessional programs will practice together collaboratively upon graduation, given the skills to do so. The objective of this study was to examine attitudes to interprofessional practice before and after an interprofessional learning (IPL) activity. Materials and Methods A total of 35 postgraduate medical imaging students attended a week-long mammography workshop. The sessions provided a range of didactic sessions related to diagnosis and management of breast cancer. An IPL session was incorporated on completion of the workshop to consolidate learning. Props and authentic resources were used to increase the fidelity of the simulation. Participants completed pre- and post-workshop questionnaires comprising an interprofessional education and collaboration scale and a quiz to gauge knowledge of specific content related to professional roles. Responses to each statement in the scale and quiz score, pre or post workshop, were compared, whereas responses to open-ended questions in post-workshop survey were thematically analyzed. Results Seventeen paired surveys were received. There was a significant total improvement of 10.66% (P = .036). After simulation, there was a statistically significant improvement in participants' understanding (P < .05) that IPL offers holistic care to the patient and that teamwork is useful for reducing errors in patient care. Simulation helped participants develop more awareness of their role within the profession, improve their understanding of other professionals, and gain more realistic expectations of team members. Conclusion This pilot study confirmed learning within an IPL simulation improved attitudes toward shared learning, teamwork, and communication. Simulation provides opportunities for learning in a safe environment, and technology can be used in diverse ways to provide authentic learning.

      PubDate: 2017-07-24T12:51:02Z
      DOI: 10.1016/j.acra.2017.02.015
       
  • Evaluation of Plaque Morphology by 64-Slice Coronary Computed Tomographic
           Angiography Compared to Intravascular Ultrasound in Nonocclusive Segments
           of Coronary Arteries
    • Authors: Manoj Kesarwani; Rine Nakanishi; Tae-Young Choi; David M. Shavelle; Matthew J. Budoff
      Pages: 968 - 974
      Abstract: Publication date: August 2017
      Source:Academic Radiology, Volume 24, Issue 8
      Author(s): Manoj Kesarwani, Rine Nakanishi, Tae-Young Choi, David M. Shavelle, Matthew J. Budoff
      Rationale and Objectives Although intravascular ultrasound (IVUS) is the current gold standard for plaque characterization, noninvasive coronary computed tomographic angiography (CCTA) requires further evaluation. The ability to detect plaque morphology by CCTA remains unclear. The purpose of this study was to evaluate the diagnostic accuracy of CCTA for plaque detection and morphology. Materials and Methods Thirty-one patients underwent cardiac catheterization with IVUS and CCTA. The presence of plaque was evaluated by both modalities in nonocclusive segments (<50% stenosis) of the left anterior descending artery, left circumflex artery, and right coronary artery. Plaque morphology was classified as (1) normal, (2) soft or fibrous, (3) fibrocalcific, or (4) calcific. Results by IVUS and CCTA were compared blindly on a segment-to-segment basis with subgroup analysis based on CCTA tube voltage. Results Among the 31 patients (mean age 56.2 ± 8.6 years, 27% female), 152 segments were analyzed. Of these segments, 42% were in the left anterior descending artery, 32% were in the left circumflex artery, and 26% were in the right coronary artery. Plaque morphology by IVUS identified 103 segments as fibrous (68%), 31 as fibrocalcific (20%), and 6 as calcific (4.0%); 12 segments were normal (8.0%). To evaluate for the presence of plaque, CCTA had an overall sensitivity and specificity of 99% and 75%, respectively. In patients who underwent CCTA with a tube voltage of 100 kV, both sensitivity and specificity were 100%. The sensitivity and specificity of CCTA to identify plaque as calcified (fibrocalcific or calcific) vs noncalcified (soft or fibrous) were 87% and 96%, respectively. Overall, the accuracy of CCTA to detect the presence of plaque was 97%; the accuracy to detect plaque calcification was 94%. Conclusions CCTA offers excellent sensitivity and accuracy for plaque detection and morphology characterization in nonocclusive coronary segments. In addition, diagnostic accuracy is preserved with a reduced tube voltage protocol.

      PubDate: 2017-07-24T12:51:02Z
      DOI: 10.1016/j.acra.2017.03.001
       
  • Coronary Artery Stent Evaluation with Model-based Iterative Reconstruction
           at Coronary CT Angiography
    • Authors: Fuminari Tatsugami; Toru Higaki; Hiroaki Sakane; Wataru Fukumoto; Yoko Kaichi; Makoto Iida; Yasutaka Baba; Masao Kiguchi; Yasuki Kihara; So Tsushima; Kazuo Awai
      Pages: 975 - 981
      Abstract: Publication date: August 2017
      Source:Academic Radiology, Volume 24, Issue 8
      Author(s): Fuminari Tatsugami, Toru Higaki, Hiroaki Sakane, Wataru Fukumoto, Yoko Kaichi, Makoto Iida, Yasutaka Baba, Masao Kiguchi, Yasuki Kihara, So Tsushima, Kazuo Awai
      Rationale and Objectives This study aims to compare the image quality of coronary artery stent scans on computed tomography images reconstructed with forward projected model-based iterative reconstruction solution (FIRST) and adaptive iterative dose reduction 3D (AIDR 3D). Materials and Methods Coronary computed tomography angiography scans of 23 patients with 32 coronary stents were used. The images were reconstructed with AIDR 3D and FIRST. We generated computed tomography attenuation profiles across the stents and measured the width of the edge rise distance and the edge rise slope (ERS). We also calculated the stent lumen attenuation increase ratio (SAIR) and measured visible stent lumen diameters. Two radiologists visually evaluated the image quality of the stents using a 4-point scale (1 = poor, 4 = excellent). Results There was no significant difference in the edge rise distance between the two reconstruction methods (P = 0.36). The ERS on FIRST images was greater than the ERS on AIDR 3D images (325.2 HU/mm vs 224.4 HU/mm; P < 0.01). The rate of the visible stent lumen diameter compared to the true diameter on FIRST images was higher than that on AIDR 3D images (51.4% vs 47.3%, P < 0.01). The SAIR on FIRST images was lower than the SAIR on AIDR 3D images (0.19 vs 0.30, P < 0.01). The mean image quality scores for AIDR 3D and FIRST images were 3.18 and 3.63, respectively; the difference was also significant (P < 0.01). Conclusion The image quality of coronary artery stent scans is better on FIRST than on AIDR 3D images.

      PubDate: 2017-07-24T12:51:02Z
      DOI: 10.1016/j.acra.2016.12.020
       
  • 1H MRS Assessment of Hepatic Fat Content
    • Authors: Elizaveta Chabanova; Cilius Esmann Fonvig; Christine Bøjsøe; Jens-Christian Holm; Henrik S. Thomsen
      Pages: 982 - 987
      Abstract: Publication date: August 2017
      Source:Academic Radiology, Volume 24, Issue 8
      Author(s): Elizaveta Chabanova, Cilius Esmann Fonvig, Christine Bøjsøe, Jens-Christian Holm, Henrik S. Thomsen
      Rationale and Objectives The purpose of the present study was to obtain a cutoff value of liver fat content for the diagnosis of hepatic steatosis by comparing magnetic resonance (MR) spectroscopy results in children and adolescents with normal and excess weight. Materials and Methods The study included 420 children and adolescents (91 normal-weight, 99 overweight, and 230 obese) 8–18 years of age. Proton magnetic resonance spectroscopy was performed with a 3T MR system using point resolved spectroscopy sequence with series echo times. Results The mean absolute mass concentration of liver fat was obtained: 0.5 ± 0.04% in normal-weight boys; 0.5 ± 0.03% in normal-weight girls; 0.9 ± 0.16% in boys with overweight; 1.1 ± 0.24% in girls with overweight; 1.7 ± 0.24% in boys with obesity; and 1.4 ± 0.21% in girls with obesity. The cutoff value of absolute mass concentration of liver fat for hepatic steatosis was found to be 1.5%. Based on this cutoff value, hepatic steatosis was diagnosed in 16% of boys with overweight, 11% of girls with overweight, 32% of boys with obesity, and 27% of girls with obesity. Conclusions Proton magnetic resonance spectroscopy was successfully applied to obtain the cutoff value of absolute mass concentration of liver fat for the diagnosis of hepatic steatosis in children and adolescents. Children and adolescents with obesity have higher risk of hepatic steatosis than their peers with overweight.

      PubDate: 2017-07-24T12:51:02Z
      DOI: 10.1016/j.acra.2017.02.010
       
  • Variation in Patients' Travel Times among Imaging Examination Types at a
           Large Academic Health System
    • Authors: Andrew B. Rosenkrantz; Yu Liang; Richard Duszak; Michael P. Recht
      Pages: 1008 - 1012
      Abstract: Publication date: August 2017
      Source:Academic Radiology, Volume 24, Issue 8
      Author(s): Andrew B. Rosenkrantz, Yu Liang, Richard Duszak, Michael P. Recht
      Rationale and Objectives Patients' willingness to travel farther distances for certain imaging services may reflect their perceptions of the degree of differentiation of such services. We compare patients' travel times for a range of imaging examinations performed across a large academic health system. Materials and Methods We searched the NYU Langone Medical Center Enterprise Data Warehouse to identify 442,990 adult outpatient imaging examinations performed over a recent 3.5-year period. Geocoding software was used to estimate typical driving times from patients' residences to imaging facilities. Variation in travel times was assessed among examination types. Results The mean expected travel time was 29.2 ± 20.6 minutes, but this varied significantly (p < 0.001) among examination types. By modality, travel times were shortest for ultrasound (26.8 ± 18.9) and longest for positron emission tomography-computed tomography (31.9 ± 21.5). For magnetic resonance imaging, travel times were shortest for musculoskeletal extremity (26.4 ± 19.2) and spine (28.6 ± 21.0) examinations and longest for prostate (35.9 ± 25.6) and breast (32.4 ± 22.3) examinations. For computed tomography, travel times were shortest for a range of screening examinations [colonography (25.5 ± 20.8), coronary artery calcium scoring (26.1 ± 19.2), and lung cancer screening (26.4 ± 14.9)] and longest for angiography (32.0 ± 22.6). For ultrasound, travel times were shortest for aortic aneurysm screening (22.3 ± 18.4) and longest for breast (30.1 ± 19.2) examinations. Overall, men (29.9 ± 21.6) had longer (p < 0.001) travel times than women (27.8 ± 20.3); this difference persisted for each modality individually (p ≤ 0.006). Conclusions Patients' willingness to travel longer times for certain imaging examination types (particularly breast and prostate imaging) supports the role of specialized services in combating potential commoditization of imaging services. Disparities in travel times by gender warrant further investigation.

      PubDate: 2017-07-24T12:51:02Z
      DOI: 10.1016/j.acra.2017.02.017
       
  • Characteristics, Trends, and Quality of Systematic Review and
           Meta-Analysis in General Radiology between 2007 and 2015
    • Authors: Ju Yong Park; Kyung Hee Lee; You Jin Ku; Soon Gu Cho; Yeo Ju Kim; Ha Young Lee; Jun Ho Kim
      Pages: 1013 - 1022
      Abstract: Publication date: August 2017
      Source:Academic Radiology, Volume 24, Issue 8
      Author(s): Ju Yong Park, Kyung Hee Lee, You Jin Ku, Soon Gu Cho, Yeo Ju Kim, Ha Young Lee, Jun Ho Kim
      Rationale and Objectives To evaluate the trends, characteristics, and quality of systematic review and meta-analysis in general radiology journals. Materials and Methods We performed a PubMed search to identify systematic reviews and meta-analyses that had been carried out in the field of radiology between 2007 and 2015. The following data were extracted: journal, impact factor, type of research, year of publication, radiological subspecialty, imaging modalities used, number of authors, affiliated department of the first and corresponding authors, presence of a radiologist and a statistician among the authors, discordance between the first and corresponding authors, funding, country of first author, methodological quality, methods used for quality assessment, and statistics. Results Ultimately, we included 210 articles from nine general radiology journals. The European Journal of Radiology was the most common journal represented (47 of 210; 22.4%). Meta-analyses (n = 177; 84.3%) were published about five times more than systematic reviews without meta-analysis (n = 33; 15.7%). Radiology of the gastrointestinal tract was the most commonly represented subspecialty (n = 49, 23.3%). The first authors were most frequently located in China (n = 64; 30.3%). In terms of modality, magnetic resonance imaging was used most often (n = 59; 28.1%). The number of authors tended to progressively increase over time, and the ratio of discordance between the first and corresponding authors also increased significantly, as did the proportion of research that has received funding from an external source. The mean AMSTAR assessment score improved over time (5.87/11 in 2007–2009, 7.11/11 in 2010–2012, and 7.49/11 in 2013–2015). In this regard, the journal Radiology had the highest score (7.59/11). Conclusions The quantity and quality of radiological meta-analyses have significantly increased over the past 9 years; however, specific weak areas remain, providing the opportunity for quality improvement.

      PubDate: 2017-08-01T13:03:12Z
      DOI: 10.1016/j.acra.2017.02.009
       
  • Chart-stimulated Recall as a Learning Tool for Improving Radiology
           Residents' Reports
    • Authors: Naila Nadeem; Abdul Mueed Zafar; Sonia Haider; Rukhsana W. Zuberi; Muhammad Nadeem Ahmad; Vijayanadh Ojili
      Pages: 1023 - 1026
      Abstract: Publication date: August 2017
      Source:Academic Radiology, Volume 24, Issue 8
      Author(s): Naila Nadeem, Abdul Mueed Zafar, Sonia Haider, Rukhsana W. Zuberi, Muhammad Nadeem Ahmad, Vijayanadh Ojili
      Rationale and Objectives Workplace-based assessments gauge the highest tier of clinical competence. Chart-stimulated recall (CSR) is a workplace-based assessment method that complements chart audit with an interview based on the residents' notes. It allows evaluation of the residents' knowledge and heuristics while providing opportunities for feedback and self-reflection. We evaluated the utility of CSR for improving the radiology residents' reporting skills. Materials and Methods Residents in each year of training were randomly assigned to an intervention group (n = 12) or a control group (n = 13). Five pre-intervention and five post-intervention reports of each resident were independently evaluated by three blinded reviewers using a modified Bristol Radiology Report Assessment Tool. The study intervention comprised a CSR interview tailored to each individual resident's learning needs based on the pre-intervention assessment. The CSR process focused on the clinical relevance of the radiology reports. Student's t test (P < .05) was used to compare pre- and post-intervention scores of each group. Results A total of 125 pre-intervention and 125 post-intervention reports were evaluated (total 750 assessments). The Cronbach's alpha for the study tool was 0.865. A significant improvement was seen in the cumulative 19-item score (66% versus 73%, P < .001) and the global rating score (59% versus 72%, P < .001) of the intervention group after the CSR. The reports of the control group did not demonstrate any significant improvement. Conclusion CSR is a feasible workplace-based assessment method for improving reporting skills of the radiology residents.

      PubDate: 2017-07-24T12:51:02Z
      DOI: 10.1016/j.acra.2017.02.013
       
  • Beyond Correlations, Sensitivities, and Specificities
    • Authors: Frank I. Lin; Erich P. Huang; Lalitha K. Shankar
      Pages: 1027 - 1035
      Abstract: Publication date: August 2017
      Source:Academic Radiology, Volume 24, Issue 8
      Author(s): Frank I. Lin, Erich P. Huang, Lalitha K. Shankar
      Although advanced imaging is an important component of oncology clinical trials, there has not been a lot of success in advancing its use from a research perspective. One likely reason is the lack of consensus on the methodology used to study advanced imaging in trials, which results in a disconcerted research effort and produces data that are difficult to collate for use in validating the imaging components being studied. Imaging is used in cancer clinical trials for various indications, and the study design needed to evaluate the imaging in a particular indication will vary. Through case examples, this paper will discuss how advanced imaging is currently being investigated in oncology clinical trials, categorized by the potential clinical indication for the imaging tool and offer suggestions on how development should proceed to further evaluate imaging in the given indication. Available National Cancer Institute resources that can assist in this process will also be discussed.

      PubDate: 2017-07-24T12:51:02Z
      DOI: 10.1016/j.acra.2016.11.024
       
  • Beyond Correlations, Sensitivities, and Specificities
    • Authors: Frank I. Lin; Erich P. Huang; Lalitha K. Shankar
      Pages: 1027 - 1035
      Abstract: Publication date: August 2017
      Source:Academic Radiology, Volume 24, Issue 8
      Author(s): Erich P. Huang, Frank I. Lin, Lalitha K. Shankar
      Despite the widespread belief that advanced imaging should be very helpful in guiding oncology treatment decision and improving efficiency and success rates in treatment clinical trials, its acceptance has been slow. Part of this is likely attributable to gaps in study design and statistical methodology for these imaging studies. Also, results supporting the performance of the imaging in these roles have largely been insufficient to justify their use within the design of a clinical trial or in treatment decision making. Statistically significant correlations between the imaging results and clinical outcomes are often incorrectly taken as evidence of adequate performance. Assessments of whether the imaging can outperform standard techniques or meaningfully supplement them are also frequently neglected. This paper provides guidance on study designs and statistical analyses for evaluating the performance of advanced imaging in the various roles in treatment decision guidance and clinical trial conduct. Relevant methodology from the imaging literature is reviewed; gaps in the literature are addressed using related concepts from the more extensive genomic and in vitro biomarker literature.

      PubDate: 2017-07-24T12:51:02Z
      DOI: 10.1016/j.acra.2016.11.024
       
  • A Response to Skerl et al. (2016)
    • Authors: Man Zhang; Jonathan M. Rubin
      First page: 1050
      Abstract: Publication date: August 2017
      Source:Academic Radiology, Volume 24, Issue 8
      Author(s): Man Zhang, Jonathan M. Rubin


      PubDate: 2017-07-24T12:51:02Z
      DOI: 10.1016/j.acra.2017.02.007
       
  • A Response to Dr. Zhang and Dr. Rubin
    • Authors: Katrin Skerl; Sarah Vinnicombe; Andrew Evans
      First page: 1051
      Abstract: Publication date: August 2017
      Source:Academic Radiology, Volume 24, Issue 8
      Author(s): Katrin Skerl, Sarah Vinnicombe, Andrew Evans


      PubDate: 2017-07-24T12:51:02Z
      DOI: 10.1016/j.acra.2017.03.004
       
  • Learning the Limits of Robert's Rules
    • Authors: Richard B. Gunderman
      Pages: 1052 - 1053
      Abstract: Publication date: August 2017
      Source:Academic Radiology, Volume 24, Issue 8
      Author(s): Richard B. Gunderman


      PubDate: 2017-07-24T12:51:02Z
      DOI: 10.1016/j.acra.2017.04.009
       
  • Should We Teach Radiology to Undergraduates'
    • Authors: David Alvarez; Richard B. Gunderman
      Abstract: Publication date: Available online 18 August 2017
      Source:Academic Radiology
      Author(s): David Alvarez, Richard B. Gunderman


      PubDate: 2017-08-20T19:30:13Z
      DOI: 10.1016/j.acra.2017.07.005
       
  • Diagnostic Performance of Ultrasonography for Pediatric Appendicitis
    • Authors: Kate Louise M. Mangona; R. Paul Guillerman; Victor S. Mangona; Jennifer Carpenter; Wei Zhang; Monica Lopez; Robert C. Orth
      Abstract: Publication date: Available online 18 August 2017
      Source:Academic Radiology
      Author(s): Kate Louise M. Mangona, R. Paul Guillerman, Victor S. Mangona, Jennifer Carpenter, Wei Zhang, Monica Lopez, Robert C. Orth
      Rationale and Objectives For imaging pediatric appendicitis, ultrasonography (US) is preferred because of its lack of ionizing radiation, but is limited by operator dependence. This study investigates the US diagnostic performance during night shifts covered by radiology trainees compared to day shifts covered by attending radiologists. Materials and Methods Appy-Scores (1 = completely visualized normal appendix; 2 = partially visualized normal appendix; 3 = nonvisualized appendix with no inflammatory changes in the expected region of the appendix; 4 = equivocal; 5a = nonperforated appendicitis; 5b = perforated appendicitis) from 2935 US examinations (2161:774, day-to-night) from July 2013 to 2014 were correlated with the intraoperative diagnoses and the clinical follow-up. The diagnostic performance of trainees and attendings was compared with Fisher exact test. Interobserver agreement was measured by Cohen kappa coefficient. Results Appendicitis prevalence was 25.3% (day) and 22.5% (night). Sensitivity, specificity, accuracy, negative predictive value, and positive predictive vale were 94.0%, 93.7%, 93.8%, 97.9%, and 83.4% during the day and 92.0%, 91.2%, 91.3%, 97.5%, and 75.2% at night. Specificity (P = .048) and positive predictive value (P = .011) differed, with more false positives at night (7%) than during the day (4.7%). Trainee and attending agreement was high (k = 0.995), with Appy-Scores of 1, 4, and 5a most frequently discordant. Conclusions US has a high diagnostic performance and interobserver agreement for pediatric appendicitis when interpreted by radiology trainees during night shifts or attending radiologists during day shifts. However, lower specificity and positive predictive value at night warrants a thorough trainee education to avoid false-positive examinations.

      PubDate: 2017-08-20T19:30:13Z
      DOI: 10.1016/j.acra.2017.06.007
       
  • MR Imaging Biomarkers in Amyotrophic Lateral Sclerosis
    • Authors: Elias R. Melhem
      Abstract: Publication date: Available online 16 August 2017
      Source:Academic Radiology
      Author(s): Elias R. Melhem


      PubDate: 2017-08-20T19:30:13Z
      DOI: 10.1016/j.acra.2017.07.004
       
  • Differences in Texture Analysis Parameters Between Active Alveolitis and
           Lung Fibrosis in Chest CT of Patients with Systemic Sclerosis
    • Authors: Christopher Kloth; Anya C. Blum; Wolfgang M. Thaiss; Heike Preibsch; Hendrik Ditt; Rainer Grimmer; Jan Fritz; Konstantin Nikolaou; Hans Bösmüller; Marius Horger
      Abstract: Publication date: Available online 12 August 2017
      Source:Academic Radiology
      Author(s): Christopher Kloth, Anya C. Blum, Wolfgang M. Thaiss, Heike Preibsch, Hendrik Ditt, Rainer Grimmer, Jan Fritz, Konstantin Nikolaou, Hans Bösmüller, Marius Horger
      Rationale and Objectives This study aimed to determine the diagnostic aid of computed tomography (CT) features for the differentiation of active alveolitis and fibrosis using a CT texture analysis (CTTA) prototype and CT densitometry in patients with systemic sclerosis (SSc) using ancillary high-resolution computed tomography (HRCT) features and their longitudinal course as standard of reference. Materials and Methods We retrospectively analyzed thin-slice noncontrast chest CT image data of 43 patients with SSc (18 men, mean age 51.55 ± 15.52 years; range 23–71 years). All of them had repeated noncontrast enhanced HRCT of the lung. Classification into active alveolitis or fibrosis was done on HRCT based on classical HRCT findings (active alveolitis [19; 44.2%] and fibrosis [24; 55.8%]) and their course at midterm. Results were compared to pulmonary functional tests and were followed up by CT. Ground glass opacity was considered suggestive of alveolitis, whereas coarse reticulation with parenchymal distortion, traction bronchiectasis, and honeycombing were assigned to fibrosis. Results Statistically significant differences in CTTA were found for first-order textural features (mean intensity, average, deviation, skewness) and second-order statistics (entropy of co-occurrence matrix, mean number of nonuniformity (NGLDM), entropy of NGLDM, entropy of heterogeneity, intensity, and average). Cut-off value for the prediction of fibrosis at baseline was significant for entropy of intensity (P value < .001) and for mean deviation (P value < .001), and for prediction of alveolitis was significant for uniformity of intensity (P value < .001) and for NGLDM (P value < .001). At pulmonary functional tests, forced expiratory volume in 1 second and single-breath diffusion capacity for carbon monoxide were significantly lower in fibrosis than in alveolitis 2.03 ± 0.78 vs. 2.61 ± 0.83, P < .016 and 4.51 ± 1.61 vs. 6.04 ± 1.75, P < .009, respectively. Differences in CT densitometry between alveolitis and fibrosis were not significant. Conclusions CTTA parameters are significantly different in active alveolitis vs. fibrosis in patients with SSc and may be helpful for differentiation of these two entities.

      PubDate: 2017-08-20T19:30:13Z
      DOI: 10.1016/j.acra.2017.07.002
       
  • Added Value of Bone Subtraction in Dual-energy Digital Radiography in the
           Detection of Pneumothorax
    • Authors: Ayla Urbaneja; Gauthier Dodin; Gabriela Hossu; Omar Bakour; Rachid Kechidi; Pedro Gondim Teixeira; Alain Blum
      Abstract: Publication date: Available online 8 August 2017
      Source:Academic Radiology
      Author(s): Ayla Urbaneja, Gauthier Dodin, Gabriela Hossu, Omar Bakour, Rachid Kechidi, Pedro Gondim Teixeira, Alain Blum
      Rationale and Objectives This study aimed to determine the value of dual-energy thoracic radiography in the diagnosis of pneumothorax considering the reader's experience. Materials and Methods Forty patients with a suspected pneumothorax, imaged with dual-energy chest radiographs, were divided into two groups: those with pneumothorax as the final diagnosis (n = 19) and those without (n = 21). The images were analyzed by 36 readers (5 interns, 16 residents, 15 senior physicians) for the presence or absence of pneumothorax during three readout sessions at 2-week intervals: standard images alone (session 1), dual-energy images with bone subtraction alone (session 2), and a combination of the two (session 3). Results The number of correct responses increased 13.3% between sessions 1 and 2 (P < .001) and 9.4% between sessions 1 and 3 (P < .001). The mean sensitivity for pneumothorax detection was higher in sessions 2 (82%) and 3 (79%) compared to session 1 (70%). There was no statistically significant difference in specificity between the sessions. The number of correct responses for small volume pneumothoraces was higher in sessions 2 (10.6 ± 1.8) and 3 (10.1 ± 2.0) than in session 1 (8.9 ± 2.3), with a statistically significant difference between sessions 1 and 2 (P = .002) and between sessions 1 and 3 (P = .048). Conclusion Bone subtracted dual-energy thoracic radiographs improve the detection sensitivity of pneumothorax, including in cases of small pneumothoraces, regardless of the reader's level or expertise.

      PubDate: 2017-08-10T19:00:07Z
      DOI: 10.1016/j.acra.2017.06.015
       
  • The Best Single Measurement for Assessing Splenomegaly in Patients with
           Cirrhotic Liver Morphology
    • Authors: Zachary Nuffer; Thomas Marini; Andrey Rupasov; Stephen Kwak; Shweta Bhatt
      Abstract: Publication date: Available online 8 August 2017
      Source:Academic Radiology
      Author(s): Zachary Nuffer, Thomas Marini, Andrey Rupasov, Stephen Kwak, Shweta Bhatt
      Rationale and Objectives There is little agreement within the radiology literature as to the best single measurement for assessing splenomegaly. In this study, we evaluate the correlation of multiple unidirectional measurements of the spleen with splenic volume in patients with cirrhotic liver morphology on computed tomography (CT). Materials and Methods Splenic volume was retrospectively calculated from CT examinations of 179 adult patients, 47 of whom were approved as renal donors, and 132 of whom were referred for various other indications, and were found to have cirrhotic liver morphology on CT. Seven unidimensional measurements (long-axis, cranial-caudal, width, and four measures of thickness) of each spleen were evaluated to identify which most closely correlated with the calculated volume. Results The splenic width had the best correlation with splenic volume for mild-to-moderate splenomegaly, and the splenic cranial-caudal measurement had the best correlation with splenic volume for massive splenomegaly. Receiver operating characteristic analysis demonstrates that a splenic width measurement of approximately 10.5 cm has a sensitivity of 89% and a specificity of 78% for mild-to-moderate splenomegaly, and a cranial-caudal measurement of 14.6 cm has a sensitivity of 92% and a specificity of 91% for massive splenomegaly. Conclusions A splenic width threshold of 10.5 cm is the most sensitive (89%) and specific (78%) single measurement for mild-to-moderate splenomegaly in patients with cirrhotic liver morphology, whereas a cranial-caudal height threshold of 14.6 cm is the most sensitive (92%) and specific (91%) single measurement for massive splenomegaly.

      PubDate: 2017-08-10T19:00:07Z
      DOI: 10.1016/j.acra.2017.06.006
       
  • Evaluation of a High Concentrated Contrast Media Injection Protocol in
           Combination with Low Tube Current for Dose Reduction in Coronary Computed
           Tomography Angiography
    • Authors: Yibo Sun; Yanqing Hua; Mingpeng Wang; Dingbiao Mao; Xiu Jin; Cheng Li; Kailei Shi; Jianrong Xu
      Abstract: Publication date: Available online 8 August 2017
      Source:Academic Radiology
      Author(s): Yibo Sun, Yanqing Hua, Mingpeng Wang, Dingbiao Mao, Xiu Jin, Cheng Li, Kailei Shi, Jianrong Xu
      Rationale and Objectives The study aimed to prospectively evaluate the radiation dose reduction potential and image quality (IQ) of a high-concentration contrast media (HCCM) injection protocol in combination with a low tube current (mAs) in coronary computed tomography angiography. Materials and Methods Eighty-one consecutive patients (mean age: 62 years; 34 females; body mass index: 18–31) were included and randomized-assigned into two groups. All computed tomography (CT) examinations were performed in two groups with the same tube voltage (100 kV), flow rate of contrast medium (5.0 mL/s), and iodine dose (22.8 g). An automatic mAs and low concentration contrast medium (300 mgI/mL) were used in group A, whereas effective mAs was reduced by a factor 0.6 along with HCCM (400 mgI/mL) in group B. Radiation dose was assessed (CT dose index [CTDIvol] and dose length product), and vessel-based objective IQ for various regions of interest (enhancement, noise, signal-to-noise ratio, and contrast-to-noise ratio), subjective IQ, noise, and motion artifacts were analyzed overall and vessel-based with a 5-point Likert scale. Results The CT attenuation of coronary arteries and image noise in group B were significantly higher than those in group A (ranges: 507.5–548.1 Hounsfield units vs 407.5–444.5 Hounsfield units; and 20.3 ± 8.6 vs 17.7 ± 8.0) (P ≤ 0.0166). There was no significant difference between the two groups in signal-to-noise ratio, contrast-to-noise ratio, and subjective IQ of coronary arteries (29.4–31.7, 30.0–37.0, and medium score of 5 in group A vs 29.4–32.4, 27.7–36.3, and medium score of 5 in group B, respectively, P ≥ 0.1859). Both mean CTDIvol and dose length product in group B were 58% of those of group A. Conclusions HCCM combined with low tube current allows dose reduction in coronary computed tomography angiography and does not compromise IQ.

      PubDate: 2017-08-10T19:00:07Z
      DOI: 10.1016/j.acra.2017.07.001
       
  • The Incidence of Totally Implantable Venous Access Devices Insertion and
           the Associated Abnormalities in Patients With Cancer Revealed in 18F-FDG
           PET-CT Imaging
    • Authors: Pan-Fu Kao; Jui-Hung Weng; Yeu-Sheng Tyan; Shun-Fa Yang; Thomas Chang-Yao Tsao
      Abstract: Publication date: Available online 4 August 2017
      Source:Academic Radiology
      Author(s): Pan-Fu Kao, Jui-Hung Weng, Yeu-Sheng Tyan, Shun-Fa Yang, Thomas Chang-Yao Tsao
      Rationale and Objectives The purpose of this retrospective study was to evaluate the incidence of totally implantable venous access devices, also called ports, implantation and the associated abnormalities in 2-[18F]-fluoro-2-deoxy-D-glucose (FDG) positron emission tomography-computed tomography (PET-CT) images for patients with cancer, and to determine the percentage of abnormalities identified in the original reports. Materials and Methods The study aimed to perform a retrospective review of all FDG PET-CT imaging in a 3-year period. Cases of port-associated abnormalities found on the FDG PET-CT images were identified and then correlated with X-ray reports and clinical treatment or follow-up. Results In total, 2442 FDG PET-CT scans were retrospectively reviewed. Among them, 897 (897 of 2442, 36.7%) demonstrated port implantation. Abnormalities, including 22 port fractures (22 of 897, 2.45%), 14 malposition (1.56%), one infection (0.11%), and one embraced by a fibrin sheath or tumor (0.11%) were found. Only the infectious one had clinical symptoms. Among the 22 fractured ports, eight fractured catheters migrated and became dislodged. All of the malpositioned ports, except two in the contralateral subclavian vein, were found in the ipsilateral jugular vein. Both the port infection and the port embraced by a fibrin sheath or tumor occurred at the tips of the devices, which demonstrated FDG uptake in the mediastinal region. Only seven of the 38 (18.42%) images of port abnormalities had been identified in the original reports. Conclusions Based on this study, we recommend that the interpretation of FDG PET-CT scans should include a checklist to record all metallic device implantations and to interpret the whole-body X-ray topography as a standard part of PET-CT image report.

      PubDate: 2017-08-10T19:00:07Z
      DOI: 10.1016/j.acra.2017.06.017
       
  • Validation of Feasibility of Magnetic Resonance Imaging for the
           Measurement of Depth of Tumor Invasion in Distal Bile Duct Cancer
           According to the New American Joint Committee on Cancer Staging System
    • Authors: Na Yeon Han; Joo Young Kim; Min Ju Kim; Beom Jin Park; Deuk Jae Sung; Ki Choon Sim; Sung Bum Cho; Dong Sik Kim
      Abstract: Publication date: Available online 2 August 2017
      Source:Academic Radiology
      Author(s): Na Yeon Han, Joo Young Kim, Min Ju Kim, Beom Jin Park, Deuk Jae Sung, Ki Choon Sim, Sung Bum Cho, Dong Sik Kim
      Rationale and Objectives This study aimed to develop and validate a method for measuring the depth of tumor invasion (DoI) using magnetic resonance imaging (MRI) and to investigate the diagnostic performance of the measured DoI for stratifying tumor (T) classification in patients with distal bile duct cancer according to the new American Joint Committee on Cancer staging system. Materials and Methods Fifty-four patients (30 men and 24 women; age range, 43–81 years) with distal bile duct cancer were enrolled. A study coordinator first developed a “provisional method” for measuring DoI on T2-weighted MRI. Subsequently, after compensating for defects, the “improved method” was developed. Two reviewers independently measured DoI and assessed its correlations with the histopathologic reference standard using intraclass correlation coefficient (ICC). The study population was grouped according to the DoI for T classification based on the new staging system for evaluation of diagnostic predictive values. Results The ICC values between the radiologic and the histopathologic DoI were calculated. Using the “improved method,” the ICC for the coordinator's DoI was very good (ICC, 0.885), which was a significantly higher value than that obtained using the “provisional method” (ICC, 0.501, P = .00000); and for two reviewers' DoIs, the ICC values were good (ICC, 0.752 and 0.784, respectively). The overall accuracy of MRI for stratifying bile duct tumors using DoI was 87.0% and 85.2%, respectively. Conclusions This newly developed method reliably measured DoI on T2-weighted MRI and can be used for preoperative T classification of patients with distal bile duct cancer according to the new staging system.

      PubDate: 2017-08-10T19:00:07Z
      DOI: 10.1016/j.acra.2017.06.011
       
  • Differentiation Between Luminal-A and Luminal-B Breast Cancer Using
           Intravoxel Incoherent Motion and Dynamic Contrast-Enhanced Magnetic
           Resonance Imaging
    • Authors: Hiroko Kawashima; Tosiaki Miyati; Naoki Ohno; Masako Ohno; Masafumi Inokuchi; Hiroko Ikeda; Toshifumi Gabata
      Abstract: Publication date: Available online 1 August 2017
      Source:Academic Radiology
      Author(s): Hiroko Kawashima, Tosiaki Miyati, Naoki Ohno, Masako Ohno, Masafumi Inokuchi, Hiroko Ikeda, Toshifumi Gabata
      Rationale and Objectives The study aimed to investigate whether intravoxel incoherent motion (IVIM) and dynamic contrast-enhanced (DCE) magnetic resonance imaging (MRI) can differentiate luminal-B from luminal-A breast cancer Materials and Methods Biexponential analyses of IVIM and DCE MRI were performed using a 3.0-T MRI scanner, involving 134 patients with 137 pathologically confirmed luminal-type invasive breast cancers. Luminal-type breast cancer was categorized as luminal-B breast cancer (LBBC, Ki-67 ≧ 14%) or luminal-A breast cancer (LABC, Ki-67 < 14%). Quantitative parameters from IVIM (pure diffusion coefficient [D], perfusion-related diffusion coefficient [D*], and fraction [f]) and DCE MRI (initial percentage of enhancement and signal enhancement ratio [SER]) were calculated. The apparent diffusion coefficient (ADC) was also calculated using monoexponential fitting. We correlated these data with the Ki-67 status. Results The D and ADC values of LBBC were significantly lower than those of LABC (P = 0.028, P = 0.037). The SER of LBBC was significantly higher than that of LABC (P = 0.004). A univariate analysis showed that a significantly lower D (<0.847 x 10−3 mm2/s), lower ADC (<0.960 × 10−3 mm2/s), and higher SER (>1.071) values were associated with LBBC (all P values <0.01), compared to LABC. In a multivariate analysis, a higher SER (>1.071; odds ratio: 3.0099, 95% confidence interval: 1.4246–6.3593; P = 0.003) value and a lower D (<0.847 × 10−3 mm2/s; odds ratio: 2.6878, 95% confidence interval: 1.0445–6.9162; P = 0.040) value were significantly associated with LBBC, compared to LABC. Conclusion The SER derived from DCE MRI and the D derived from IVIM are associated independently with the Ki-67 status in patients with luminal-type breast cancer.

      PubDate: 2017-08-10T19:00:07Z
      DOI: 10.1016/j.acra.2017.06.016
       
  • Now You See It, But Would You Later' Examining the Mechanisms of
           Satisfaction of Search in the Fatigued Radiologist
    • Authors: Tessa S. Cook
      Abstract: Publication date: Available online 25 July 2017
      Source:Academic Radiology
      Author(s): Tessa S. Cook


      PubDate: 2017-08-01T13:03:12Z
      DOI: 10.1016/j.acra.2017.06.004
       
  • Less Is More
    • Authors: Nicholas Koontz; Richard Wiggins Megan Mills Michael McLaughlin Elaine Pigman
      Abstract: Publication date: August 2017
      Source:Academic Radiology, Volume 24, Issue 8
      Author(s): Nicholas A. Koontz, Richard H. Wiggins, Megan K. Mills, Michael S. McLaughlin, Elaine C. Pigman, Yoshimi Anzai, Lubdha M. Shah
      Rationale and Objectives Emergency department (ED) patients with acute low back pain (LBP) may present with ambiguous clinical findings that pose diagnostic challenges to exclude cauda equina syndrome (CES). As a proof of concept, we aimed to determine the efficacy of a rapid lumbar spine (LS) magnetic resonance imaging (MRI) screening protocol consisting of a single 3D-T2 SPACE FS (3D-T2 Sampling Perfection with Application optimized Contrasts using different flip angle Evolution fat saturated) sequence relative to conventional LS MRI to exclude emergently treatable pathologies in this complex patient population. Materials and Methods LS MRI protocol including a sagittal 3D-T2 SPACE FS pulse sequence was added to the routine for ED patients presenting with acute atypical LBP over a 12-month period. Imaging findings were categorically scored on the 3D-T2 SPACE FS sequence and separately on the reference standard conventional LS MRI sequences. Patients' symptoms were obtained from review of the electronic medical record. Descriptive test statistics were performed. Results Of the 206 ED patients who obtained MRI for acute atypical LBP, 118 (43.3 ± 13.5 years of age; 61 female) were included. Specific pathologies detected on reference standard conventional MRI included disc herniation (n = 30), acute fracture (n = 3), synovial cyst (n = 3), epidural hematoma (n = 2), cerebrospinal fluid leak (n = 1), and leptomeningeal metastases (n = 1), and on multiple occasions these pathologies resulted in nerve root impingement (n = 36), severe spinal canal stenosis (n = 13), cord/conus compression (n = 2), and cord signal abnormality (n = 2). The 3D-T2 SPACE FS sequence was an effective screen for fracture (sensitivity [sens] = 100%, specificity [spec] = 100%), cord signal abnormality (sens = 100%, spec = 99%), and severe spinal canal stenosis (sens = 100%, spec = 96%), and identified cord compression not seen on reference standard. Motion artifact was not seen on the 3D-T2 SPACE FS but noted on 8.5% of conventional LS MRI. Conclusions The 3D-T2 SPACE FS sequence MRI is a rapid, effective screen for emergently actionable pathologies that might be a cause of CES in ED patients presenting with acute atypical LBP. As this abbreviated, highly sensitive sequence requires a fraction of the acquisition time of conventional LS MRI, it has the potential of contributing to increased efficiencies in the radiology department and improved ED throughput.

      PubDate: 2017-07-24T12:51:02Z
       
  • Re: Association between Imaging Characteristics and Different Molecular
           Subtypes of Breast Cancer
    • Authors: Xinyun Li; Yan Huang; Zhou Shuqin; Zhiguang Chen; Siwei Zhang
      Abstract: Publication date: Available online 5 July 2017
      Source:Academic Radiology
      Author(s): Xinyun Li, Yan Huang, Zhou Shuqin, Zhiguang Chen, Siwei Zhang


      PubDate: 2017-07-24T12:51:02Z
      DOI: 10.1016/j.acra.2017.02.019
       
  • Sub-solid Nodule Detection Performance on Reduced-dose Computed Tomography
           with Iterative Reduction
    • Authors: Yukihiro Nagatani; Masashi Takahashi Mitsuru Ikeda Tsuneo Yamashiro Hisanobu Koyama
      Abstract: Publication date: Available online 9 June 2017
      Source:Academic Radiology
      Author(s): Yukihiro Nagatani, Masashi Takahashi, Mitsuru Ikeda, Tsuneo Yamashiro, Hisanobu Koyama, Mitsuhiro Koyama, Hiroshi Moriya, Satoshi Noma, Noriyuki Tomiyama, Yoshiharu Ohno, Kiyoshi Murata, Sadayuki Murayama
      Rationale and Objectives This study aimed to compare sub-solid nodule detection performances (SSNDP) on chest computed tomography (CT) with Adaptive Iterative Dose Reduction using Three Dimensional Processing (AIDR 3D) between 7 mAs (0.21 mSv) and 42 mAs (1.28 mSv) in total and in subgroups classified by nodular size, characteristics, and location, and analyze the association of SSNDP with size-specific dose estimate (SSDE). Materials and Methods As part of the Area-detector Computed Tomography for the Investigation of Thoracic Diseases Study, a Japanese multicenter research project, 68 subjects underwent chest CT with 120 kV, 0.35 seconds per rotation, and three tube currents: 240 mA (84 mAs), 120 mA (42 mAs), and 20 mA (7 mAs). The research committee of the study project outlined and approved our study protocols. The institutional review board of each institution approved this study. Axial 2-mm-thick CT images were reconstructed using AIDR 3D. Standard reference was determined by CT images at 84 mAs. Four radiologists recorded SSN presence by continuously distributed rating on CT at 7 mAs and 42 mAs. Receiver operating characteristic analysis was used to evaluate SSNDP at both doses in total and in subgroups classified by nodular longest diameter (LD) (≥5 mm), characteristics(pure and part-solid), and locations (ventral, intermediate, or dorsal; central or peripheral; and upper, middle, or lower). Detection sensitivity was compared among five groups of SSNs classified based on particular SSDE to nodule on CT with AIDR 3D at 7 mAs. Results Twenty-two part-solid and 86 pure SSNs were identified. For larger SSNs (LD ≥ 5 mm) as well as subgroups classified by nodular locations and part-solid nodules, SSNDP was similar in both methods (area under the receiver operating characteristics curve: 0.96 ± 0.02 in CT at 7 mAs and 0.97 ± 0.01 in CT at 42 mAs), with acceptable interobserver agreements in five locations. For larger SSNs (LD ≥ 5 mm), on CT at 42 mAs, no significant differences in detection sensitivity were found among the five groups classified by SSDE, whereas on CT with 7 mAs, four groups with SSDE of 0.65 or higher were superior in detection sensitivity to the other group, with SSDE less than 0.65 mGy. Conclusions For SSNs with 5 mm or more in cases with normal range of body habitus, CT at 7 mAs was demonstrated to have comparable SSNDP to CT at 42 mAs regardless of nodular location and characteristics, and SSDE higher than 0.65 mGy is desirable to obtain sufficient SSNDP.

      PubDate: 2017-06-10T04:15:03Z
       
 
 
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