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Showing 1 - 200 of 3159 Journals sorted alphabetically
A Practical Logic of Cognitive Systems     Full-text available via subscription   (Followers: 9)
AASRI Procedia     Open Access   (Followers: 15)
Academic Pediatrics     Hybrid Journal   (Followers: 32, SJR: 1.655, CiteScore: 2)
Academic Radiology     Hybrid Journal   (Followers: 22, SJR: 1.015, CiteScore: 2)
Accident Analysis & Prevention     Partially Free   (Followers: 90, SJR: 1.462, CiteScore: 3)
Accounting Forum     Hybrid Journal   (Followers: 25, SJR: 0.932, CiteScore: 2)
Accounting, Organizations and Society     Hybrid Journal   (Followers: 34, SJR: 1.771, CiteScore: 3)
Achievements in the Life Sciences     Open Access   (Followers: 5)
Acta Anaesthesiologica Taiwanica     Open Access   (Followers: 7)
Acta Astronautica     Hybrid Journal   (Followers: 407, SJR: 0.758, CiteScore: 2)
Acta Automatica Sinica     Full-text available via subscription   (Followers: 2)
Acta Biomaterialia     Hybrid Journal   (Followers: 27, SJR: 1.967, CiteScore: 7)
Acta Colombiana de Cuidado Intensivo     Full-text available via subscription   (Followers: 2)
Acta de Investigación Psicológica     Open Access   (Followers: 3)
Acta Ecologica Sinica     Open Access   (Followers: 8, SJR: 0.18, CiteScore: 1)
Acta Haematologica Polonica     Free   (Followers: 1, SJR: 0.128, CiteScore: 0)
Acta Histochemica     Hybrid Journal   (Followers: 3, SJR: 0.661, CiteScore: 2)
Acta Materialia     Hybrid Journal   (Followers: 246, SJR: 3.263, CiteScore: 6)
Acta Mathematica Scientia     Full-text available via subscription   (Followers: 5, SJR: 0.504, CiteScore: 1)
Acta Mechanica Solida Sinica     Full-text available via subscription   (Followers: 9, SJR: 0.542, CiteScore: 1)
Acta Oecologica     Hybrid Journal   (Followers: 10, SJR: 0.834, CiteScore: 2)
Acta Otorrinolaringologica (English Edition)     Full-text available via subscription  
Acta Otorrinolaringológica Española     Full-text available via subscription   (Followers: 2, SJR: 0.307, CiteScore: 0)
Acta Pharmaceutica Sinica B     Open Access   (Followers: 1, SJR: 1.793, CiteScore: 6)
Acta Poética     Open Access   (Followers: 4, SJR: 0.101, CiteScore: 0)
Acta Psychologica     Hybrid Journal   (Followers: 27, SJR: 1.331, CiteScore: 2)
Acta Sociológica     Open Access   (Followers: 1)
Acta Tropica     Hybrid Journal   (Followers: 6, SJR: 1.052, CiteScore: 2)
Acta Urológica Portuguesa     Open Access  
Actas Dermo-Sifiliograficas     Full-text available via subscription   (Followers: 3, SJR: 0.374, CiteScore: 1)
Actas Dermo-Sifiliográficas (English Edition)     Full-text available via subscription   (Followers: 2)
Actas Urológicas Españolas     Full-text available via subscription   (Followers: 3, SJR: 0.344, CiteScore: 1)
Actas Urológicas Españolas (English Edition)     Full-text available via subscription   (Followers: 1)
Actualites Pharmaceutiques     Full-text available via subscription   (Followers: 6, SJR: 0.19, CiteScore: 0)
Actualites Pharmaceutiques Hospitalieres     Full-text available via subscription   (Followers: 3)
Acupuncture and Related Therapies     Hybrid Journal   (Followers: 6)
Acute Pain     Full-text available via subscription   (Followers: 15, SJR: 2.671, CiteScore: 5)
Ad Hoc Networks     Hybrid Journal   (Followers: 11, SJR: 0.53, CiteScore: 4)
Addictive Behaviors     Hybrid Journal   (Followers: 16, SJR: 1.29, CiteScore: 3)
Addictive Behaviors Reports     Open Access   (Followers: 8, SJR: 0.755, CiteScore: 2)
Additive Manufacturing     Hybrid Journal   (Followers: 9, SJR: 2.611, CiteScore: 8)
Additives for Polymers     Full-text available via subscription   (Followers: 22)
Advanced Drug Delivery Reviews     Hybrid Journal   (Followers: 142, SJR: 4.09, CiteScore: 13)
Advanced Engineering Informatics     Hybrid Journal   (Followers: 11, SJR: 1.167, CiteScore: 4)
Advanced Powder Technology     Hybrid Journal   (Followers: 16, SJR: 0.694, CiteScore: 3)
Advances in Accounting     Hybrid Journal   (Followers: 8, SJR: 0.277, CiteScore: 1)
Advances in Agronomy     Full-text available via subscription   (Followers: 12, SJR: 2.384, CiteScore: 5)
Advances in Anesthesia     Full-text available via subscription   (Followers: 28, SJR: 0.126, CiteScore: 0)
Advances in Antiviral Drug Design     Full-text available via subscription   (Followers: 2)
Advances in Applied Mathematics     Full-text available via subscription   (Followers: 10, SJR: 0.992, CiteScore: 1)
Advances in Applied Mechanics     Full-text available via subscription   (Followers: 11, SJR: 1.551, CiteScore: 4)
Advances in Applied Microbiology     Full-text available via subscription   (Followers: 22, SJR: 2.089, CiteScore: 5)
Advances In Atomic, Molecular, and Optical Physics     Full-text available via subscription   (Followers: 14, SJR: 0.572, CiteScore: 2)
Advances in Biological Regulation     Hybrid Journal   (Followers: 4, SJR: 2.61, CiteScore: 7)
Advances in Botanical Research     Full-text available via subscription   (Followers: 2, SJR: 0.686, CiteScore: 2)
Advances in Cancer Research     Full-text available via subscription   (Followers: 30, SJR: 3.043, CiteScore: 6)
Advances in Carbohydrate Chemistry and Biochemistry     Full-text available via subscription   (Followers: 7, SJR: 1.453, CiteScore: 2)
Advances in Catalysis     Full-text available via subscription   (Followers: 5, SJR: 1.992, CiteScore: 5)
Advances in Cell Aging and Gerontology     Full-text available via subscription   (Followers: 3)
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: 27, SJR: 0.156, CiteScore: 1)
Advances in Child Development and Behavior     Full-text available via subscription   (Followers: 10, SJR: 0.713, CiteScore: 1)
Advances in Chronic Kidney Disease     Full-text available via subscription   (Followers: 10, SJR: 1.316, CiteScore: 2)
Advances in Clinical Chemistry     Full-text available via subscription   (Followers: 28, SJR: 1.562, CiteScore: 3)
Advances in Colloid and Interface Science     Full-text available via subscription   (Followers: 19, SJR: 1.977, CiteScore: 8)
Advances in Computers     Full-text available via subscription   (Followers: 14, SJR: 0.205, CiteScore: 1)
Advances in Dermatology     Full-text available via subscription   (Followers: 15)
Advances in Developmental Biology     Full-text available via subscription   (Followers: 11)
Advances in Digestive Medicine     Open Access   (Followers: 9)
Advances in DNA Sequence-Specific Agents     Full-text available via subscription   (Followers: 5)
Advances in Drug Research     Full-text available via subscription   (Followers: 24)
Advances in Ecological Research     Full-text available via subscription   (Followers: 43, SJR: 2.524, CiteScore: 4)
Advances in Engineering Software     Hybrid Journal   (Followers: 27, SJR: 1.159, CiteScore: 4)
Advances in Experimental Biology     Full-text available via subscription   (Followers: 7)
Advances in Experimental Social Psychology     Full-text available via subscription   (Followers: 44, SJR: 5.39, CiteScore: 8)
Advances in Exploration Geophysics     Full-text available via subscription   (Followers: 1)
Advances in Fluorine Science     Full-text available via subscription   (Followers: 9)
Advances in Food and Nutrition Research     Full-text available via subscription   (Followers: 54, SJR: 0.591, CiteScore: 2)
Advances in Fuel Cells     Full-text available via subscription   (Followers: 16)
Advances in Genetics     Full-text available via subscription   (Followers: 16, SJR: 1.354, CiteScore: 4)
Advances in Genome Biology     Full-text available via subscription   (Followers: 8, SJR: 12.74, CiteScore: 13)
Advances in Geophysics     Full-text available via subscription   (Followers: 6, SJR: 1.193, CiteScore: 3)
Advances in Heat Transfer     Full-text available via subscription   (Followers: 21, SJR: 0.368, CiteScore: 1)
Advances in Heterocyclic Chemistry     Full-text available via subscription   (Followers: 11, SJR: 0.749, CiteScore: 3)
Advances in Human Factors/Ergonomics     Full-text available via subscription   (Followers: 22)
Advances in Imaging and Electron Physics     Full-text available via subscription   (Followers: 2, SJR: 0.193, CiteScore: 0)
Advances in Immunology     Full-text available via subscription   (Followers: 36, SJR: 4.433, CiteScore: 6)
Advances in Inorganic Chemistry     Full-text available via subscription   (Followers: 8, SJR: 1.163, CiteScore: 2)
Advances in Insect Physiology     Full-text available via subscription   (Followers: 2, SJR: 1.938, CiteScore: 3)
Advances in Integrative Medicine     Hybrid Journal   (Followers: 6, SJR: 0.176, CiteScore: 0)
Advances in Intl. Accounting     Full-text available via subscription   (Followers: 3)
Advances in Life Course Research     Hybrid Journal   (Followers: 8, SJR: 0.682, CiteScore: 2)
Advances in Lipobiology     Full-text available via subscription   (Followers: 1)
Advances in Magnetic and Optical Resonance     Full-text available via subscription   (Followers: 9)
Advances in Marine Biology     Full-text available via subscription   (Followers: 14, SJR: 0.88, CiteScore: 2)
Advances in Mathematics     Full-text available via subscription   (Followers: 11, SJR: 3.027, CiteScore: 2)
Advances in Medical Sciences     Hybrid Journal   (Followers: 6, SJR: 0.694, CiteScore: 2)
Advances in Medicinal Chemistry     Full-text available via subscription   (Followers: 5)
Advances in Microbial Physiology     Full-text available via subscription   (Followers: 4, SJR: 1.158, CiteScore: 3)
Advances in Molecular and Cell Biology     Full-text available via subscription   (Followers: 21)
Advances in Molecular and Cellular Endocrinology     Full-text available via subscription   (Followers: 8)
Advances in Molecular Toxicology     Full-text available via subscription   (Followers: 7, SJR: 0.182, CiteScore: 0)
Advances in Nanoporous Materials     Full-text available via subscription   (Followers: 3)
Advances in Oncobiology     Full-text available via subscription   (Followers: 1)
Advances in Organ Biology     Full-text available via subscription   (Followers: 1)
Advances in Organometallic Chemistry     Full-text available via subscription   (Followers: 16, SJR: 1.875, CiteScore: 4)
Advances in Parallel Computing     Full-text available via subscription   (Followers: 7, SJR: 0.174, CiteScore: 0)
Advances in Parasitology     Full-text available via subscription   (Followers: 5, SJR: 1.579, CiteScore: 4)
Advances in Pediatrics     Full-text available via subscription   (Followers: 24, SJR: 0.461, CiteScore: 1)
Advances in Pharmaceutical Sciences     Full-text available via subscription   (Followers: 10)
Advances in Pharmacology     Full-text available via subscription   (Followers: 16, SJR: 1.536, CiteScore: 3)
Advances in Physical Organic Chemistry     Full-text available via subscription   (Followers: 8, SJR: 0.574, CiteScore: 1)
Advances in Phytomedicine     Full-text available via subscription  
Advances in Planar Lipid Bilayers and Liposomes     Full-text available via subscription   (Followers: 3, SJR: 0.109, CiteScore: 1)
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: 5)
Advances in Protein Chemistry     Full-text available via subscription   (Followers: 18)
Advances in Protein Chemistry and Structural Biology     Full-text available via subscription   (Followers: 20, SJR: 0.791, CiteScore: 2)
Advances in Psychology     Full-text available via subscription   (Followers: 62)
Advances in Quantum Chemistry     Full-text available via subscription   (Followers: 6, SJR: 0.371, CiteScore: 1)
Advances in Radiation Oncology     Open Access   (SJR: 0.263, CiteScore: 1)
Advances in Small Animal Medicine and Surgery     Hybrid Journal   (Followers: 3, SJR: 0.101, CiteScore: 0)
Advances in Space Biology and Medicine     Full-text available via subscription   (Followers: 5)
Advances in Space Research     Full-text available via subscription   (Followers: 396, SJR: 0.569, CiteScore: 2)
Advances in Structural Biology     Full-text available via subscription   (Followers: 5)
Advances in Surgery     Full-text available via subscription   (Followers: 10, SJR: 0.555, CiteScore: 2)
Advances in the Study of Behavior     Full-text available via subscription   (Followers: 31, SJR: 2.208, CiteScore: 4)
Advances in Veterinary Medicine     Full-text available via subscription   (Followers: 18)
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: 2.262, CiteScore: 5)
Advances in Water Resources     Hybrid Journal   (Followers: 46, SJR: 1.551, CiteScore: 3)
Aeolian Research     Hybrid Journal   (Followers: 6, SJR: 1.117, CiteScore: 3)
Aerospace Science and Technology     Hybrid Journal   (Followers: 336, SJR: 0.796, CiteScore: 3)
AEU - Intl. J. of Electronics and Communications     Hybrid Journal   (Followers: 8, SJR: 0.42, CiteScore: 2)
African J. of Emergency Medicine     Open Access   (Followers: 6, SJR: 0.296, CiteScore: 0)
Ageing Research Reviews     Hybrid Journal   (Followers: 11, SJR: 3.671, CiteScore: 9)
Aggression and Violent Behavior     Hybrid Journal   (Followers: 444, SJR: 1.238, CiteScore: 3)
Agri Gene     Hybrid Journal   (SJR: 0.13, CiteScore: 0)
Agricultural and Forest Meteorology     Hybrid Journal   (Followers: 16, SJR: 1.818, CiteScore: 5)
Agricultural Systems     Hybrid Journal   (Followers: 32, SJR: 1.156, CiteScore: 4)
Agricultural Water Management     Hybrid Journal   (Followers: 43, SJR: 1.272, CiteScore: 3)
Agriculture and Agricultural Science Procedia     Open Access   (Followers: 1)
Agriculture and Natural Resources     Open Access   (Followers: 2)
Agriculture, Ecosystems & Environment     Hybrid Journal   (Followers: 57, SJR: 1.747, CiteScore: 4)
Ain Shams Engineering J.     Open Access   (Followers: 5, SJR: 0.589, CiteScore: 3)
Air Medical J.     Hybrid Journal   (Followers: 6, SJR: 0.26, CiteScore: 0)
AKCE Intl. J. of Graphs and Combinatorics     Open Access   (SJR: 0.19, CiteScore: 0)
Alcohol     Hybrid Journal   (Followers: 11, SJR: 1.153, CiteScore: 3)
Alcoholism and Drug Addiction     Open Access   (Followers: 9)
Alergologia Polska : Polish J. of Allergology     Full-text available via subscription   (Followers: 1)
Alexandria Engineering J.     Open Access   (Followers: 1, SJR: 0.604, CiteScore: 3)
Alexandria J. of Medicine     Open Access   (Followers: 1, SJR: 0.191, CiteScore: 1)
Algal Research     Partially Free   (Followers: 10, SJR: 1.142, CiteScore: 4)
Alkaloids: Chemical and Biological Perspectives     Full-text available via subscription   (Followers: 2)
Allergologia et Immunopathologia     Full-text available via subscription   (Followers: 1, SJR: 0.504, CiteScore: 1)
Allergology Intl.     Open Access   (Followers: 5, SJR: 1.148, CiteScore: 2)
Alpha Omegan     Full-text available via subscription   (SJR: 3.521, CiteScore: 6)
ALTER - European J. of Disability Research / Revue Européenne de Recherche sur le Handicap     Full-text available via subscription   (Followers: 9, SJR: 0.201, CiteScore: 1)
Alzheimer's & Dementia     Hybrid Journal   (Followers: 50, SJR: 4.66, CiteScore: 10)
Alzheimer's & Dementia: Diagnosis, Assessment & Disease Monitoring     Open Access   (Followers: 4, SJR: 1.796, CiteScore: 4)
Alzheimer's & Dementia: Translational Research & Clinical Interventions     Open Access   (Followers: 4, SJR: 1.108, CiteScore: 3)
Ambulatory Pediatrics     Hybrid Journal   (Followers: 6)
American Heart J.     Hybrid Journal   (Followers: 50, SJR: 3.267, CiteScore: 4)
American J. of Cardiology     Hybrid Journal   (Followers: 54, SJR: 1.93, CiteScore: 3)
American J. of Emergency Medicine     Hybrid Journal   (Followers: 44, SJR: 0.604, CiteScore: 1)
American J. of Geriatric Pharmacotherapy     Full-text available via subscription   (Followers: 10)
American J. of Geriatric Psychiatry     Hybrid Journal   (Followers: 14, SJR: 1.524, CiteScore: 3)
American J. of Human Genetics     Hybrid Journal   (Followers: 34, SJR: 7.45, CiteScore: 8)
American J. of Infection Control     Hybrid Journal   (Followers: 28, SJR: 1.062, CiteScore: 2)
American J. of Kidney Diseases     Hybrid Journal   (Followers: 34, SJR: 2.973, CiteScore: 4)
American J. of Medicine     Hybrid Journal   (Followers: 45)
American J. of Medicine Supplements     Full-text available via subscription   (Followers: 3, SJR: 1.967, CiteScore: 2)
American J. of Obstetrics and Gynecology     Hybrid Journal   (Followers: 204, SJR: 2.7, CiteScore: 4)
American J. of Ophthalmology     Hybrid Journal   (Followers: 63, SJR: 3.184, CiteScore: 4)
American J. of Ophthalmology Case Reports     Open Access   (Followers: 5, SJR: 0.265, CiteScore: 0)
American J. of Orthodontics and Dentofacial Orthopedics     Full-text available via subscription   (Followers: 6, SJR: 1.289, CiteScore: 1)
American J. of Otolaryngology     Hybrid Journal   (Followers: 25, SJR: 0.59, CiteScore: 1)
American J. of Pathology     Hybrid Journal   (Followers: 27, SJR: 2.139, CiteScore: 4)
American J. of Preventive Medicine     Hybrid Journal   (Followers: 28, SJR: 2.164, CiteScore: 4)
American J. of Surgery     Hybrid Journal   (Followers: 37, SJR: 1.141, CiteScore: 2)
American J. of the Medical Sciences     Hybrid Journal   (Followers: 12, SJR: 0.767, CiteScore: 1)
Ampersand : An Intl. J. of General and Applied Linguistics     Open Access   (Followers: 6)
Anaerobe     Hybrid Journal   (Followers: 4, SJR: 1.144, CiteScore: 3)
Anaesthesia & Intensive Care Medicine     Full-text available via subscription   (Followers: 62, SJR: 0.138, CiteScore: 0)
Anaesthesia Critical Care & Pain Medicine     Full-text available via subscription   (Followers: 16, SJR: 0.411, CiteScore: 1)
Anales de Cirugia Vascular     Full-text available via subscription  
Anales de Pediatría     Full-text available via subscription   (Followers: 3, SJR: 0.277, CiteScore: 0)
Anales de Pediatría (English Edition)     Full-text available via subscription  
Anales de Pediatría Continuada     Full-text available via subscription  
Analytic Methods in Accident Research     Hybrid Journal   (Followers: 5, SJR: 4.849, CiteScore: 10)
Analytica Chimica Acta     Hybrid Journal   (Followers: 40, SJR: 1.512, CiteScore: 5)
Analytical Biochemistry     Hybrid Journal   (Followers: 171, SJR: 0.633, CiteScore: 2)
Analytical Chemistry Research     Open Access   (Followers: 10, SJR: 0.411, CiteScore: 2)
Analytical Spectroscopy Library     Full-text available via subscription   (Followers: 11)
Anesthésie & Réanimation     Full-text available via subscription   (Followers: 2)
Anesthesiology Clinics     Full-text available via subscription   (Followers: 23, SJR: 0.683, CiteScore: 2)
Angiología     Full-text available via subscription   (SJR: 0.121, CiteScore: 0)
Angiologia e Cirurgia Vascular     Open Access   (Followers: 1, SJR: 0.111, CiteScore: 0)
Animal Behaviour     Hybrid Journal   (Followers: 189, SJR: 1.58, CiteScore: 3)

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Journal Cover
Academic Radiology
Journal Prestige (SJR): 1.015
Citation Impact (citeScore): 2
Number of Followers: 22  
  Hybrid Journal Hybrid journal (It can contain Open Access articles)
ISSN (Print) 1076-6332
Published by Elsevier Homepage  [3159 journals]
  • Supporting Radiology Residents’ Professional Development Through a
           Competitive Intramural Grant
    • Abstract: Publication date: Available online 12 August 2018Source: Academic RadiologyAuthor(s): Dexter Mendoza, Anna Holbrook, Frederic Bertino, Patricia Balthazar, Mary Newell, Carolyn C. MeltzerResearch and other scholarly activities are an important and required component of diagnostic radiology training. Several strategies, both at the departmental and the larger organizational levels, have been implemented to encourage radiology trainees to participate in these activities. In this article, we review and discuss our institution's 10-year experience in supporting the development and realization of scholarly projects through a competitive intramural grant for residents.
  • Evaluating Renal Fibrosis with R2* Histogram Analysis of the Whole Cortex
           in a Unilateral Ureteral Obstruction Model
    • Abstract: Publication date: Available online 12 August 2018Source: Academic RadiologyAuthor(s): Tingting Zha, Xiaojun Ren, Zhaoyu Xing, Jinggang Zhang, Xiaojuan Tian, Yanan Du, Wei Xing, Jie ChenRationale and ObjectivesThe aim of this study was to use histogram analysis to assess the correlation between blood oxygen-level dependent magnetic resonance imaging (BOLD-MRI) and renal fibrosis induced by unilateral ureteral obstruction (UUO) in an animal model for a long experimental period.Materials and MethodsThe rabbits were randomly divided into a control group (n = 6) and a UUO group (n = 30). The rabbits in the UUO group underwent left ureteral obstruction surgery. BOLD-MRI examinations were performed at 2, 4, 6, and 8 weeks after ligation. After the examinations, nephrectomy was performed for histologic evaluation. Histogram analysis of the left renal cortex (C) R2* values was performed to measure the mean, median, 10th percentile, 90th percentile, skewness, and kurtosis for all kidneys. Masson trichrome staining was used to assess the percentage of fibrotic area.ResultsThe histogram R2* values of the mean, median, 10th percentile, and 90th percentile at week 2 were all lower than those at baseline. Over the course of UUO progression, there were statistical differences between the histogram R2* values at any other two time points, except between weeks 4 and 6, and weeks 6 and 8. A close correlation was found between the percentage of fibrotic area and R2* values (mean: F = 21.49, p = 0.0001, R2 = 0.49, median: F = 30.07, p < 0.0001, R2 = 0.58, 10th percentile: F = 31.02, p < 0.0001, R2 = 0.59, 90th percentile: F = 24.13, p < 0.0001, R2 = 0.52).ConclusionBOLD-MRI could reflect the formation and progression of renal fibrosis in a rabbit UUO model; however, the value of BOLD-MRI in the long-term evaluation of fibrosis is limited.
  • Prediction of Cancer Masking in Screening Mammography Using Density and
           Textural Features
    • Abstract: Publication date: Available online 10 August 2018Source: Academic RadiologyAuthor(s): James G. Mainprize, Olivier Alonzo-Proulx, Taghreed I. Alshafeiy, James T. Patrie, Jennifer A. Harvey, Martin J. YaffeRationale and ObjectivesHigh mammographic density reduces the diagnostic accuracy of screening mammography due to masking of tumors, resulting in possible delayed diagnosis and missed cancers. Women with high masking risk could be preselected for alternative screening regimens less susceptible to masking. In this study, various models to predict masking status are presented based on biometric and image-based parameters.Materials and MethodsFor a cohort of 67 nonscreen-detected (cancers detected via other means after a negative mammogram) and 147 screen-detected invasive cancers, quantitative volumetric breast density, BI-RADS density, and the distribution and appearance of dense tissue through statistical and texture metrics were measured. Age and Body Mass Index were recorded. Stepwise multivariate logistic regressions were computed to select those parameters that predicted nonscreen-detected cancers. Accuracy of the models was evaluated using the area under receiver operator characteristic curve (AUC).ResultsUsing BI-RADS density alone to predict masking risk yielded an AUC of 0.64 (95% confidence interval [0.57–0.70]). Age-adjusted BI-RADS density or volumetric breast density had AUCs of 0.72 [0.64–0.79] and 0.71 [0.62–0.78], respectively. A model extracted from the full pool of variables had an AUC of 0.75 [0.67–0.82].ConclusionThe optimal model predicts masking more accurately than density alone, suggesting that texture metrics may be useful in models to guide a stratified screening strategy.
  • Practical Presentation Pearls: Evidence-based Recommendations From the
           Psychology and Physiology Literature
    • Abstract: Publication date: Available online 9 August 2018Source: Academic RadiologyAuthor(s): Michael L. Richardson, Nicole E. Curci, Elizabeth M. Johnson, Diana L. Lam, James T. Lee, Rebecca T. SivarajahOral presentations remain a common teaching method in academic radiology. The goal of these presentations is to transfer knowledge from the presenter’s brain to brains in the audience in a way that sticks. A number of studies from the recent psychological and physiological literature offer some rather practical and evidence-based advice on ways to optimize our oral presentations. The purpose of this paper is to summarize this work, and to give examples of how it can be harnessed to increase the efficacy of radiology presentations, whether they are for resident education, a continuing medical education course, or for a scientific presentation at a national radiology meeting.
  • Letter to the Editor: Women Representation on Radiology Journal Editorial
    • Abstract: Publication date: Available online 9 August 2018Source: Academic RadiologyAuthor(s): Prachi P. Agarwal, Sowmya Balasubramanian, Deborah Levine, Ella A Kazerooni, M Elizabeth Oates
  • Musculoskeletal Radiology Fellowship Application and Selection Process:
           Perceptions of Residents, Fellows, and Fellowship Directors
    • Abstract: Publication date: September 2018Source: Academic Radiology, Volume 25, Issue 9Author(s): Jennifer L. Demertzis, Jonathan C. Baker, Michael V. Friedman, Charles S. Resnik, Theodore T. Miller, David A. RubinRational and ObjectivesThis study aimed to assess resident, fellow, and fellowship director perceptions of the musculoskeletal (MSK) radiology fellowship application process.Materials and MethodsA task group constructed three surveys with questions about current and “ideal” fellowship application and selection processes. Surveys were distributed to MSK fellowship directors, who were also asked to give separate surveys to current fellows. US and Canadian radiology residency directors were asked to distribute surveys to current R3 and R4 residents. Responses were tabulated and analyzed.ResultsResponses were received from 47 MSK fellowship directors, 73 MSK fellows, and 147 residents. Fellowship directors and fellows reported that most fellowship offers occur between July and September of the R3 year, although 19% of directors made offers as early as the R2 year. Of the 43 director respondents, 31 (72%) noted “pressure from other programs” as the main driving force behind their policies, but 28 (65%) felt that their timelines were “too early.” A formal match was supported by 55% of responding fellowship directors, 57% of fellows, and 61.9% of residents, citing “fairness” as a major justification.ConclusionsMSK radiology fellowship selection occurs as early as the R2 year, before many residents have had substantial exposure to different subspecialties. An “arms race” has developed with programs moving their timelines earlier in response to the actions of other programs, presumably to avoid missing the best candidates. Although a majority of respondents would support a formalized match to increase fairness, there is not universal agreement that it would be the best approach.
  • Rethinking the PGY-1 Basic Clinical Year: A Canadian National Survey of
           Its Educational Value for Diagnostic Radiology Residents
    • Abstract: Publication date: September 2018Source: Academic Radiology, Volume 25, Issue 9Author(s): Kathryn E. Darras, Abigail A. Arnold, Colin Mar, Bruce B. Forster, Linda Probyn, Silvia D. ChangRationale and ObjectivesRecently, the relevance of the postgraduate year 1 (PGY-1) Basic Clinical Year for radiology residents has been questioned. The purpose of this study was to determine the attitude of radiologists and trainees toward this year and which clinical rotations they perceived as most valuable to clinical practice.Materials and MethodsFollowing institutional review board approval, an anonymous online survey was administered to Canadian radiologists and radiology trainees. In addition to reporting demographic information, respondents were asked to rank the usefulness of individual rotations on a five-point Likert scale. To assess whether there are differences in the ratings and therefore rankings of the rotations by gender, position, and level of training, the Kruskal-Wallis one-way analysis of variance test was used with significance defined as P 
  • Machine Learning Algorithms Utilizing Quantitative CT Features May Predict
           Eventual Onset of Bronchiolitis Obliterans Syndrome After Lung
    • Abstract: Publication date: September 2018Source: Academic Radiology, Volume 25, Issue 9Author(s): Eduardo J. Mortani Barbosa, Maarten Lanclus, Wim Vos, Cedric Van Holsbeke, William De Backer, Jan De Backer, James LeeRationale and ObjectivesLong-term survival after lung transplantation (LTx) is limited by bronchiolitis obliterans syndrome (BOS), defined as a sustained decline in forced expiratory volume in the first second (FEV1) not explained by other causes. We assessed whether machine learning (ML) utilizing quantitative computed tomography (qCT) metrics can predict eventual development of BOS.Materials and MethodsPaired inspiratory-expiratory CT scans of 71 patients who underwent LTx were analyzed retrospectively (BOS [n = 41] versus non-BOS [n = 30]), using at least two different time points. The BOS cohort experienced a reduction in FEV1 of>10% compared to baseline FEV1 post LTx. Multifactor analysis correlated declining FEV1 with qCT features linked to acute inflammation or BOS onset. Student t test and ML were applied on baseline qCT features to identify lung transplant patients at baseline that eventually developed BOS.ResultsThe FEV1 decline in the BOS cohort correlated with an increase in the lung volume (P = .027) and in the central airway volume at functional residual capacity (P = .018), not observed in non-BOS patients, whereas the non-BOS cohort experienced a decrease in the central airway volume at total lung capacity with declining FEV1 (P = .039). Twenty-three baseline qCT parameters could significantly distinguish between non-BOS patients and eventual BOS developers (P 
  • Computed Tomography Window Blending: Feasibility in Thoracic Trauma
    • Abstract: Publication date: September 2018Source: Academic Radiology, Volume 25, Issue 9Author(s): Jacob C. Mandell, Jeremy R. Wortman, Tatiana C. Rocha, Les R. Folio, Katherine P. Andriole, Bharti KhuranaRationale and ObjectivesThis study aims to demonstrate the feasibility of processing computed tomography (CT) images with a custom window blending algorithm that combines soft-tissue, bone, and lung window settings into a single image; to compare the time for interpretation of chest CT for thoracic trauma with window blending and conventional window settings; and to assess diagnostic performance of both techniques.Materials and MethodsAdobe Photoshop was scripted to process axial DICOM images from retrospective contrast-enhanced chest CTs performed for trauma with a window-blending algorithm. Two emergency radiologists independently interpreted the axial images from 103 chest CTs with both blended and conventional windows. Interpretation time and diagnostic performance were compared with Wilcoxon signed-rank test and McNemar test, respectively. Agreement with Nexus CT Chest injury severity was assessed with the weighted kappa statistic.ResultsA total of 13,295 images were processed without error. Interpretation was faster with window blending, resulting in a 20.3% time saving (P 
  • The Yellow Scale Is Superior to the Gray Scale for Detecting Acute
           Ischemic Stroke on a Monitor Display in Computed Tomography
    • Abstract: Publication date: September 2018Source: Academic Radiology, Volume 25, Issue 9Author(s): Akio Ogura, Katsumi Hayakawa, Yoshito Tsushima, Fumie Maeda, Aoi Kamakura, Kunihiko KatagiriRationale and ObjectivesThe purpose of this study was to compare the efficacy of the color scale with regard to focal detection with computed tomography in acute ischemic stroke.Materials and MethodsComputed tomography images of the brain of 19 patients diagnosed with acute stroke, based on magnetic resonance diffusion-weighted images obtained within an onset of 24 hours, and the images of five normal patients were displayed in each color look-up table on a monitor. The detection of acute stroke was compared among 15 radiologists. The images were compared in the gray, green, yellow, red, and blue scales of the look-up tables. The observers recorded acute ischemic stroke as “present” or “absent.” They also located the position of the stroke lesion and described the degree of their conviction as to whether a lesion existed. Detection was evaluated by receiver operating characteristic analysis. The area under the receiver operating characteristic curves was compared. In addition, reduced fatigue and the ease in image observation were compared.ResultsCompared to the other scales, the yellow scale had a significantly higher area under the receiver operating characteristic curve, which indicated that this scale allowed better detection of acute ischemic stroke. The gray scale produced the least fatigue in image observation.ConclusionsThe detection of acute ischemic stroke is improved by changing the display monitor from the gray scale to the yellow scale. From the perspective of color psychology, yellow is associated with higher arousal, cheerfulness, confidence, creativity, and excitement. Therefore, the yellow scale may be suitable for a medical imaging display.
  • Neurometabolites Alteration in the Acute Phase of Mild Traumatic Brain
           Injury (mTBI): An In Vivo Proton Magnetic Resonance Spectroscopy (1H-MRS)
    • Abstract: Publication date: September 2018Source: Academic Radiology, Volume 25, Issue 9Author(s): Vigneswaran Veeramuthu, Pohchoo Seow, Vairavan Narayanan, Jeannie Hsiu Ding Wong, Li Kuo Tan, Aditya Tri Hernowo, Norlisah RamliRationale and ObjectivesMagnetic resonance spectroscopy is a noninvasive imaging technique that allows for reliable assessment of microscopic changes in brain cytoarchitecture, neuronal injuries, and neurochemical changes resultant from traumatic insults. We aimed to evaluate the acute alteration of neurometabolites in complicated and uncomplicated mild traumatic brain injury (mTBI) patients in comparison to control subjects using proton magnetic resonance spectroscopy (1H magnetic resonance spectroscopy).Material and MethodsForty-eight subjects (23 complicated mTBI [cmTBI] patients, 12 uncomplicated mTBI [umTBI] patients, and 13 controls) underwent magnetic resonance imaging scan with additional single voxel spectroscopy sequence. Magnetic resonance imaging scans for patients were done at an average of 10 hours (standard deviation 4.26) post injury. The single voxel spectroscopy adjacent to side of injury and noninjury regions were analysed to obtain absolute concentrations and ratio relative to creatine of the neurometabolites. One-way analysis of variance was performed to compare neurometabolite concentrations of the three groups, and a correlation study was done between the neurometabolite concentration and Glasgow Coma Scale.ResultsSignificant difference was found in ratio of N-acetylaspartate to creatine (NAA/Cr + PCr) (χ2(2) = 0.22, P 
  • Association of Focal Radiation Dose Adjusted on Cross Sections with
           Subsolid Nodule Visibility and Quantification on Computed Tomography
           Images Using AIDR 3D: Comparison Among Scanning at 84, 42, and 7 mAs
    • Abstract: Publication date: September 2018Source: Academic Radiology, Volume 25, Issue 9Author(s): Yukihiro Nagatani, Hiroshi Moriya, Satoshi Noma, Shigetaka Sato, Shinsuke Tsukagoshi, Tsuneo Yamashiro, Mitsuhiro Koyama, Noriyuki Tomiyama, Yoshiharu Ono, Sadayuki Murayama, Kiyoshi Murata, Mitsuhiro Koyama, Yoshifumi Narumi, Masahiro Yanagawa, Osamu Honda, Noriyuki Tomiyama, Yoshiharu Ohno, Kazuro Sugimura, Kotaro Sakuma, Hiroshi MoriyaRationale and ObjectivesThe objectives of this study were to compare the visibility and quantification of subsolid nodules (SSNs) on computed tomography (CT) using adaptive iterative dose reduction using three-dimensional processing between 7 and 42 mAs and to assess the association of size-specific dose estimate (SSDE) with relative measured value change between 7 and 84 mAs (RMVC7–84) and relative measured value change between 42 and 84 mAs (RMVC42–84).Materials and MethodsAs a Japanese multicenter research project (Area-detector Computed Tomography for the Investigation of Thoracic Diseases [ACTIve] study), 50 subjects underwent chest CT with 120 kV, 0.35 second per location and three tube currents: 240 mA (84 mAs), 120 mA (42 mAs), and 20 mA (7 mAs). Axial CT images were reconstructed using adaptive iterative dose reduction using three-dimensional processing. SSN visibility was assessed with three grades (1, obscure, to 3, definitely visible) using CT at 84 mAs as reference standard and compared between 7 and 42 mAs using t test. Dimension, mean CT density, and particular SSDE to the nodular center of 71 SSNs and volume of 58 SSNs (diameter>5 mm) were measured. Measured values (MVs) were compared using Wilcoxon signed-rank tests among CTs at three doses. Pearson correlation analyses were performed to assess the association of SSDE with RMVC7–84: 100 × (MV at 7 mAs − MV at 84 mAs)/MV at 84 mAs and RMVC42–84.ResultsSSN visibilities were similar between 7 and 42 mAs (2.76 ± 0.45 vs 2.78 ± 0.40) (P = .67). For larger SSNs (>8 mm), MVs were similar among CTs at three doses (P > .05). For smaller SSNs (
  • Incidental Thyroid Nodules in the National Lung Screening Trial:
           Estimation of Prevalence, Malignancy Rate, and Strategy for Workup
    • Abstract: Publication date: September 2018Source: Academic Radiology, Volume 25, Issue 9Author(s): Manisha BahlRationale and ObjectivesThere is limited research on the prevalence of incidental thyroid nodules (ITNs) in the United States screening population and on the appropriate evaluation of computed tomography (CT)-detected ITNs. The purpose of this study is to determine the prevalence of ITNs in the National Lung Screening Trial (NLST) and develop a workup strategy for ITNs.Materials and MethodsCT images were obtained for subjects with documented thyroid abnormalities in the CT screening arm of the NLST, subjects diagnosed with thyroid malignancies, and control subjects. Several size thresholds were compared to determine how many nodules would be further evaluated and how many thyroid malignancies would be missed had each threshold been applied at the time of workup.ResultsThyroid nodules were reported in 0.7% (117 of 17,309 subjects). In 663 control subjects without reported thyroid nodules, thyroid nodules were identified in 78 (11.8%). Reported nodules were larger than unreported nodules (21.3 vs 16.9 mm, P = .03). Thyroid malignancies were diagnosed in 0.1% (22 of 17,309). If a 20-mm rather than a 10-mm cutoff were used to determine which nodules should be further evaluated, all malignancies would be detected, but 24 rather than 62 patients would require workup, for a workup reduction rate of 48.7% (38 of 78).ConclusionsLess than 1% of subjects in the NLST had reported ITNs. The true prevalence of ITNs was estimated to be 11.8%, which provides a better approximation of the number of patients who could potentially receive workup. A 20-mm rather than a 10-mm cutoff would reduce the workup rate by almost 50% while still capturing all malignancies.
  • Reinforcing the Importance and Feasibility of Implementing a Low-dose
           Protocol for CT-guided Biopsies
    • Abstract: Publication date: September 2018Source: Academic Radiology, Volume 25, Issue 9Author(s): Eric J. Keller, Robert J. Lewandowski, Lee Goodwin, Vahid Yaghmai, Albert Nemcek, James C. Carr, Jeremy D. CollinsRationale and ObjectivesThis study sought to more definitely illustrate the impact and feasibility of implementing a low-dose protocol for computed tomography (CT)-guided biopsies using size-specific dose estimates and multivariate analyses.Materials and MethodsFifty consecutive CT-guided lung and extrapulmonary biopsies were reviewed before and after implementation of a low-dose protocol (200 patients total, mean age 61 ± 15 years, 128 women). Analyses of variance with Bonferroni correction were used to compare standard and low-dose protocols in terms of patient demographics, physician experience, target lesion size, total dose-length product, total acquisitions, size-specific dose estimate, signal-to-noise ratio, contrast-to-noise ratio, and lesion conspicuity ratings. All procedures were performed on the same 16-slice CT scanner.ResultsVoluntary protocol adherence was 100% (lung) and 89% (extrapulmonary). The low-dose protocol achieved significantly lower total average dose-length product [(lung) 735.6 ± 599.4 mGy × cm to 252.1 ± 101.9 mGy × cm, P 
  • A Dynamic Graph Cuts Method with Integrated Multiple Feature Maps for
           Segmenting Kidneys in 2D Ultrasound Images
    • Abstract: Publication date: September 2018Source: Academic Radiology, Volume 25, Issue 9Author(s): Qiang Zheng, Steven Warner, Gregory Tasian, Yong FanRationale and ObjectivesAutomatic segmentation of kidneys in ultrasound (US) images remains a challenging task because of high speckle noise, low contrast, and large appearance variations of kidneys in US images. Because texture features may improve the US image segmentation performance, we propose a novel graph cuts method to segment kidney in US images by integrating image intensity information and texture feature maps.Materials and MethodsWe develop a new graph cuts-based method to segment kidney US images by integrating original image intensity information and texture feature maps extracted using Gabor filters. To handle large appearance variation within kidney images and improve computational efficiency, we build a graph of image pixels close to kidney boundary instead of building a graph of the whole image. To make the kidney segmentation robust to weak boundaries, we adopt localized regional information to measure similarity between image pixels for computing edge weights to build the graph of image pixels. The localized graph is dynamically updated and the graph cuts-based segmentation iteratively progresses until convergence. Our method has been evaluated based on kidney US images of 85 subjects. The imaging data of 20 randomly selected subjects were used as training data to tune parameters of the image segmentation method, and the remaining data were used as testing data for validation.ResultsExperiment results demonstrated that the proposed method obtained promising segmentation results for bilateral kidneys (average Dice index = 0.9446, average mean distance = 2.2551, average specificity = 0.9971, average accuracy = 0.9919), better than other methods under comparison (P 
  • Intravoxel Incoherent Motion Diffusion-weighted MR Imaging for Early
           Evaluation of the Effect of Radiofrequency Ablation in Rabbit Liver VX2
    • Abstract: Publication date: September 2018Source: Academic Radiology, Volume 25, Issue 9Author(s): Lian Shanshan, Shi Feng, Wei Kaikai, Zhang Yijun, Liu Huiming, Xie ChuanmiaoRationale and ObjectivesThis study aims to investigate the value of intravoxel incoherent motion (IVIM)-derived parameters for early evaluation of the efficiency of radiofrequency ablation (RFA) treatment for rabbit liver VX2 tumor.Materials and MethodsEighteen rabbit liver VX2 tumor models were constructed, and computed tomography–guided RFA was performed. One day before and 7 days after RFA, 18 models underwent magnetic resonance imaging, including contrast-enhanced imaging and IVIM diffusion-weighted imaging with 16 b-factors (0–1000 s/mm2). Post-RFA liver tumors were segmented into viable tumor, inflammatory reaction, and ablation necrotic regions according to gross and histopathologic examinations. Parameters derived from IVIM were calculated. One-way analysis of variance and least significant difference test were used for comparisons among the three regions. The diagnostic performance of parameters was evaluated using receiver operating characteristic (ROC) analysis.ResultsADCtotal, D, and f values were significantly lower in viable tumor than in inflammatory reaction regions (all P 
  • An MRI-based Radiomics Classifier for Preoperative Prediction of Ki-67
           Status in Breast Cancer
    • Abstract: Publication date: September 2018Source: Academic Radiology, Volume 25, Issue 9Author(s): Cuishan Liang, Zixuan Cheng, Yanqi Huang, Lan He, Xin Chen, Zelan Ma, Xiaomei Huang, Changhong Liang, Zaiyi LiuRationale and ObjectivesThis study aims to investigate the value of a magnetic resonance imaging–based radiomics classifier for preoperatively predicting the Ki-67 status in patients with breast cancer.Materials and MethodsWe chronologically divided 318 patients with clinicopathologically confirmed breast cancer into a training dataset (n = 200) and a validation dataset (n = 118). Radiomics features were extracted from T2-weighted (T2W) and contrast-enhanced T1-weighted (T1+C) images of breast cancer. Radiomics feature selection and radiomics classifiers were generated using the least absolute shrinkage and selection operator regression analysis method. The correlation between the radiomics classifiers and the Ki-67 status in patients with breast cancer was explored. The predictive performances of the radiomics classifiers for the Ki-67 status were evaluated with receiver operating characteristic curves in the training dataset and validated in the validation dataset.ResultsThrough the radiomics feature selection, 16 and 14 features based on T2W and T1+C images, respectively, were selected to constitute the radiomics classifiers. The radiomics classifier based on T2W images was significantly correlated with the Ki-67 status in both the training and the validation datasets (both P 
  • Cultivating Future Radiology Educators: Development and Implementation of
           a Clinician-Educator Track for Residents
    • Abstract: Publication date: September 2018Source: Academic Radiology, Volume 25, Issue 9Author(s): Dexter Mendoza, Ryan Peterson, Christopher Ho, Peter Harri, Deborah Baumgarten, Mark E. MullinsEffective and dedicated educators are critical to the preservation and advancement of the practice of radiology. The need for innovative and adaptable educators is increasingly being recognized, with several institutions granting academic promotions through clinician-educator tracks. The implementation of resident “clinician-educator tracks” or “teaching tracks” should better prepare residents aspiring to become academic radiologists focused on teaching. In this work, we describe our experience in the development and implementation of a clinician-educator track for diagnostic radiology residents at our institution.
  • Integration of Chest CT CAD into the Clinical Workflow and Impact on
           Radiologist Efficiency
    • Abstract: Publication date: Available online 8 August 2018Source: Academic RadiologyAuthor(s): Matthew Brown, Patrick Browning, M. Wasil Wahi-Anwar, Mitchell Murphy, Jayson Delgado, Hayit Greenspan, Fereidoun Abtin, Shahnaz Ghahremani, Nazanin Yaghmai, Irene da Costa, Moshe Becker, Jonathan GoldinRationale and ObjectivesThe purpose of this paper is to describe the integration of a commercial chest CT computer-aided detection (CAD) system into the clinical radiology reporting workflow and perform an initial investigation of its impact on radiologist efficiency. It seeks to complement research into CAD sensitivity and specificity of stand-alone systems, by focusing on report generation time when the CAD is integrated into the clinical workflow.Materials and MethodsA commercial chest CT CAD software that provides automated detection and measurement of lung nodules, ascending and descending aorta, and pleural effusion was integrated with a commercial radiology report dictation application. The CAD system automatically prepopulated a radiology report template, thus offering the potential for increased efficiency. The integrated system was evaluated using 40 scans from a publicly available lung nodule database. Each scan was read using two methods: (1) without CAD analytics, i.e., manually populated report with measurements using electronic calipers, and (2) with CAD analytics to prepopulate the report for reader review and editing. Three radiologists participated as readers in this study.ResultsCAD assistance reduced reading times by 7%–44%, relative to the conventional manual method, for the three radiologists from opening of the case to signing of the final report.ConclusionThis study provides an investigation of the impact of CAD and measurement on chest CTs within a clinical reporting workflow. Prepopulation of a report with automated nodule and aorta measurements yielded substantial time savings relative to manual measurement and entry.
  • Current Advances in COPD Imaging
    • Abstract: Publication date: Available online 6 August 2018Source: Academic RadiologyAuthor(s): Jeffrey Thiboutot, Wu Yuan, Hyeon-Cheol Park, Andrew D Lerner, Wayne Mitzner, Lonny B Yarmus, Xingde Li, Robert H. BrownObjectiveTo review the recent advances in available technologies for imaging COPD and present the novel optical coherence tomography (OCT) airway imaging technology.Materials and MethodsThis is an unstructured review of published evidence of available pulmonary imaging technologies along with a demonstration of state-of-the-art OCT imaging technology of in vivo human and animal airways.ResultsAdvanced imaging techniques such as Magnetic Resonance (MR) imaging using hyperoloarized noble gases, micro-Computed Tomography (micro-CT), and OCT aim to further our understanding of COPD. Lung densitometry can aid in identifying an exacerbation prone phenotype which may have implications for targeting specific therapies to these individuals. MR ventilation scans have the ability to provide a functional and regional distribution of airflow obstruction offering insight into the airway and parenchymal changes induced by COPD. Micro-CT gives a near microscopic view of the terminal bronchioles and alveoli permitting study of the microarchitecture of the lung ex vivo. Optical coherence tomography can visualize the microstructure of the airway walls (epithelium, smooth muscle, blood vessels, cartilage) permitting real time in vivo as well as longitudinal evaluation of airway changes in patients with COPD.ConclusionAdvanced imaging techniques play a vital role in expanding our current understanding of COPD.
  • Low-Dose Coronary CT Angiography in Patients with Atrial Fibrillation:
           Comparison of Image Quality and Radiation Exposure with Two Different
    • Abstract: Publication date: Available online 6 August 2018Source: Academic RadiologyAuthor(s): Saima Mushtaq, Gianluca Pontone, Edoardo Conte, Marco Guglielmo, Elisa Consiglio, Marco Magatelli, Margarida Oliveira, Giuseppe Muscogiuri, Andrea Annoni, Andrea Baggiano, Alberto Formenti, Maria Elisabetta Mancini, Luca Di Odoardo, Eleonora Melotti, Cesare Fiorentini, Antonio L. Bartorelli, Mauro Pepi, Daniele AndreiniRationale and ObjectivesTo evaluate image quality, coronary interpretability and radiation exposure of coronary CT angiography (CCTA) performed in patients with atrial fibrillation (AF) with the latest scanner generation, comparing two different technical approaches. A new scanner that combines a 0.23 mm spatial resolution, a new generation of iterative reconstruction, fast gantry rotation time and the intracycle motion-correction algorithm to improve the temporal resolution was recently introduced in the clinical field.Materials and MethodsWe enrolled 105 consecutive patients with chronic AF who performed CCTA with a whole-heart coverage high-definition CT scanner (16-cm z-axis coverage with 256 detector rows, 0.28 s gantry rotation time). Five of them were excluded for impaired renal function. Patients were randomized between a double acquisition protocol (50 patients, group 1) or a single acquisition protocol (50 patients, group 2). The image quality, coronary segment interpretability and effective dose (ED) of CCTA were assessed.ResultsThe mean HR during the scan was 85.6±21 bpm in group 1 vs. 83.7±23 bpm in Group 2, respectively (p 
  • Probing Changes in Lung Physiology in COPD Using CT, Perfusion MRI, and
           Hyperpolarized Xenon-129 MRI
    • Abstract: Publication date: Available online 5 August 2018Source: Academic RadiologyAuthor(s): Kun Qing, Nicholas J. Tustison, John P. Mugler, Jaime F. Mata, Zixuan Lin, Li Zhao, Da Wang, Xue Feng, Ji Young Shin, Sean J. Callahan, Michael P. Bergman, Kai Ruppert, Talissa A. Altes, Joanne M. Cassani, Y. Michael ShimRationale and ObjectivesChronic obstructive pulmonary disease (COPD) is highly heterogeneous and not well understood. Hyperpolarized xenon-129 (Xe129) magnetic resonance imaging (MRI) provides a unique way to assess important lung functions such as gas uptake. In this pilot study, we exploited multiple imaging modalities, including computed tomography (CT), gadolinium-enhanced perfusion MRI, and Xe129 MRI, to perform a detailed investigation of changes in lung morphology and functions in COPD. Utility and strengths of Xe129 MRI in assessing COPD were also evaluated against the other imaging modalities.Materials and MethodsFour COPD patients and four age-matched normal subjects participated in this study. Lung tissue density measured by CT, perfusion measures from gadolinium-enhanced MRI, and ventilation and gas uptake measures from Xe129 MRI were calculated for individual lung lobes to assess regional changes in lung morphology and function, and to investigate correlations among the different imaging modalities.ResultsNo significant differences were found for all measures among the five lobes in either the COPD or age-matched normal group. Strong correlations (R> 0.5 or < −0.5, p < 0.001) were found between ventilation and perfusion measures. Also gas uptake by blood as measured by Xe129 MRI showed strong correlations with CT tissue density and ventilation measures (R> 0.5 or < −0.5, p < 0.001) and moderate to strong correlations with perfusion measures (R> 0.4 or < −0.5, p < 0.01). Four distinctive patterns of functional abnormalities were found in patients with COPD.ConclusionXe129 MRI has high potential to uniquely identify multiple changes in lung physiology in COPD using a single breath-hold acquisition.
  • Whole-Tumor Quantitative Apparent Diffusion Coefficient Histogram and
           Texture Analysis to Differentiation of Minimal Fat Angiomyolipoma from
           Clear Cell Renal Cell Carcinoma
    • Abstract: Publication date: Available online 5 August 2018Source: Academic RadiologyAuthor(s): Haojie Li, Anqin Li, Hui Zhu, Yao Hu, Jiali Li, Liming Xia, Daoyu Hu, Ihab R. Kamel, Zhen LiAimTo evaluate the diagnostic value of whole-tumor quantitative apparent diffusion coefficient (ADC) histogram and texture analysis for differentiation of minimal fat angiomyolipoma (MFAML) from clear cell renal cell carcinoma (ccRCC).Materials and MethodsWe retrospectively reviewed 27 patients with MFAML and 113 patients with ccRCC pathologically proven. All patients performed magnetic resonance imaging (MRI) including diffusion-weighted imaging (b = 0, 800s/mm2). Whole-tumor regions of interest were drawn on all slices of diffusion-weighted imaging to obtain histogram and texture parameters, including the mean ADC, median ADC, 10th, 25th, 75th, 90th percentiles ADC, standard deviation, skewness, kurtosis, and entropy. The Student's t test was used to compare the parameters between MFAML and ccRCC. Receiver operating characteristic curves analysis was used to compare the diagnostic value of each significant parameter.ResultsMFAML had significantly lower mean ADC, median ADC, 10th, 25th, 75th, 90th percentiles ADC than ccRCC (p < 0.001, p < 0.001, p < 0.001, p < 0.001, p < 0.001, p < 0.001, respectively). Skewness of MFAML was significantly higher than that of ccRCC (p = 0.016). However, standard deviation, kurtosis, and entropy were not significantly different (p = 0.409, p = 0.085, p = 0.206, respectively). The 90th percentile ADC generated the highest AUC (AUC, 0.854; Sensitivity, 78.8%; Specificity, 81.5%) for differentiating MFAML from ccRCC.ConclusionWhole-tumor ADC histogram and texture analysis could be considered a useful and noninvasive method to help differentiate MFAML of ccRCC with higher accuracy.
  • Hyperpolarized Gas Magnetic Resonance Imaging of Pediatric Cystic Fibrosis
           Lung Disease
    • Abstract: Publication date: Available online 5 August 2018Source: Academic RadiologyAuthor(s): Giles Santyr, Nikhil Kanhere, Felipe Morgado, Jonathan H. Rayment, Felix Ratjen, Marcus J. CouchConventional pulmonary function tests appear normal in early cystic fibrosis (CF) lung disease. Therefore, new diagnostic approaches are required that can detect CF lung disease in children and monitor treatment response. Hyperpolarized (HP) gas (129Xe and 3He) magnetic resonance imaging (MRI) is a powerful, emergent tool for mapping regional lung function and may be well suited for studying pediatric CF. HP gas MRI is well tolerated, reproducible, and it can be performed longitudinally without the need for ionizing radiation. In particular, quantification of the distribution of ventilation, or ventilation defect percent (VDP), has been shown to be a sensitive indicator of CF lung disease and correlates well with pulmonary function tests.This article presents the current state of CF diagnosis and treatment and describes the potential role of HP gas MRI for detection of early CF lung disease and following the effects of interventions. The typical HP gas imaging workflow is described, along with a discussion of image analysis to calculate VDP, dosing considerations, and the reproducibility of VDP.The potential use of VDP as an outcome measure in CF is discussed, by considering the correlation with pulmonary function measures, preliminary interventional studies, and case studies involving longitudinal imaging and pulmonary exacerbations.Finally, emerging HP gas imaging techniques such as multiple breath washout imaging are introduced, followed by a discussion of future directions. Overall, HP gas MRI biomarkers are expected to provide sensitive outcome measures that can be used in disease surveillance as well as interventional studies involving novel CF therapies.
  • A Model for Predicting Future FEV1 Decline in Smokers Using Hyperpolarized
           3He Magnetic Resonance Imaging
    • Abstract: Publication date: Available online 4 August 2018Source: Academic RadiologyAuthor(s): Ryan J. Baron, Hooman Hamedani, Stephen J. Kadlecek, Ian F. Duncan, Yi Xin, Sarmad Siddiqui, Mehrdad Pourfathi, Maurizio Cereda, Rahim R. RiziRationale and ObjectivesThe purpose of this study was to assess the effectiveness of hyperpolarized helium-3 magnetic resonance (MR)-based imaging markers in predicting future forced expiratory volume in one second decline/chronic obstructive pulmonary disorder progression in smokers compared to current diagnostic techniques.Materials and MethodsTotal 60 subjects (15 nonsmokers and 45 smokers) participated in both baseline and follow-up visits (∼1.4 years apart). At both visits, subjects completed pulmonary function testing, a six-minute walk test , and the St. George Respiratory Questionnaire. Using helium-3 MR imaging, means (M) and standard deviations (H) of oxygen tension (PAO2), fractional ventilation, and apparent diffusion coefficient were calculated across 12 regions of interest in the lungs. Subjects who experienced FEV1 decline>100 mL/year were deemed “decliners,” while those who did not were deemed “sustainers.” Nonimaging and imaging prediction models were generated through a logistic regression model, which utilized measurements from sustainers and decliners.ResultsThe nonimaging prediction model included the St. George Respiratory Questionnaire total score, diffusing capacity of carbon monoxide by the alveolar volume (DLCO/VA), and distance walked in a six-minute walk test. A receiving operating character curve for this model yielded a sensitivity of 75% and specificity of 68% with an overall area under the curve of 65%. The imaging prediction model generated following the same methodology included ADCH, FVH, and PAO2H. The resulting receiving operating character curve yielded a sensitivity of 87.5%, specificity of 82.8%, and an area under the curve of 89.7%.ConclusionThe imaging predication model generated from measurements obtained during 3He MR imaging is better able to predict future FEV1 decline compared to one based on current clinical tests and demographics. The imaging model's superiority appears to arise from its ability to distinguish well-circumscribed, severe disease from a more uniform distribution of moderately altered lung function, which is more closely associated with subsequent FEV1 decline.
  • Motor Cortex Mapping in Patients With Hepatic Myelopathy After
           Transjugular Intrahepatic Portosystemic Shunt
    • Abstract: Publication date: Available online 1 August 2018Source: Academic RadiologyAuthor(s): Long-Biao Cui, Shuyao Ren, Yi-Bin Xi, Ling-Li Zeng, Gang Chen, Kang Liu, Tianlei Yu, Chuangye He, Wengang Guo, Zhanxin Yin, Zhengyu Wang, Jing Niu, Bohan Luo, Dewen Hu, Guohong Han, Hong YinRationale and ObjectivesAs a special movement disorder, hepatic myelopathy (HM) is characterized by spastic paraperesis and may be secondary to transjugular intrahepatic portosystemic shunt (TIPS). The prediction and diagnosis of HM is difficult due to largely unknown neuropathological underpinnings and a lack of specific biomarkers. We aimed to delve into the alterations in motor system of HM patients’ brain and their potential clinical implication.Material and MethodsTwenty-three patients with HM and 23 without HM after TIPS and 24 demographically matched healthy controls were enrolled. High-spatial-resolution structural imaging and functional data at rest were acquired. Motor areas were included as seed regions for functional connectivity analysis. Then, we performed brain volume analysis.ResultsWe found decreased right supplementary motor area (SMA)-seeded functional connectivity with bilateral insula, thalamus and midbrain, left cerebellum and middle temporal gyrus, and right middle cingulate gyrus in HM compared to non-HM patients (p < 0.001). The right insula revealed decreased volume (p < 0.001), and white matter volume reduced in the right corona radiata beneath the right SMA (p < 0.001) in HM relative to non-HM patients. Furthermore, the strength of right SMA-seeded connectivity with insula was positively correlated with folic acid level in HM patients (r = 0.60, p = 0.03), showing an accuracy of 0.87 to distinguish HM from non-HM.ConclusionOur study demonstrates the HM-specific dysconnectivity with an anatomical basis, and its correlation with laboratory findings and diagnostic value. Detecting these abnormalities might help to predict and diagnose post-TIPS HM.
  • Low Iodine Contrast Injection for CT Acquisition Prior to Transcatheter
           Aortic Valve Replacement: Aorta Assessment and Screening for Coronary
           Artery Disease
    • Abstract: Publication date: Available online 1 August 2018Source: Academic RadiologyAuthor(s): Anne-Lise Hachulla, Stéphane Noble, Maxime Ronot, Gabriel Guglielmi, Thomas de Perrot, Xavier Montet, Jean-Paul ValléeRationale and ObjectivesTo assess both the complete aorta and coronary artery disease (CAD) using low iodine contrast computed-tomography angiography before transcatheter aortic valve replacement.Materials and Methods84 patients underwent computed-tomography angiography before transcatheter aortic valve replacement: 42 with standard iodine injection protocol (P1:120 mL); 42 with a low dose iodine injection protocol (P2:60 mL). Mean attenuation and subjective image quality were rated at different levels of the aorta, iliac and coronary arteries. Sensitivity, specificity, negative and positive predictive values for depiction of CAD were calculated according to the coronary angiography.ResultsMean attenuation was significantly higher in P1 for the ascending aorta (p < 0.001). No significant difference was observed regarding image quality of the aortic valve (p = 0.876), the ascending aorta (p = 0.306), or the abdominal aorta (p = 1.0). Diagnostic image quality of coronary arteries was excellent for P1 and P2 (94.6% vs 96.5%, p = 0.08). Sensitivity, specificity, negative and positive predictive values, and accuracy for depiction of CAD were excellent for P1 and P2 (100% vs 100%; 79% vs 86%, 70% vs 87%, 100% vs 100% and 86% vs 93%) without significant differences (p = 0.93; p = 0.58; p = 0.90; p = 1.0; p = 0.74), respectively.ConclusionDespite a difference in aortic mean attenuation, a reduced iodine injection protocol showed similar image quality and detection of CAD in comparison with a standard injection protocol.
  • Transfer Learning From Convolutional Neural Networks for Computer-Aided
           Diagnosis: A Comparison of Digital Breast Tomosynthesis and Full-Field
           Digital Mammography
    • Abstract: Publication date: Available online 1 August 2018Source: Academic RadiologyAuthor(s): Kayla Mendel, Hui Li, Deepa Sheth, Maryellen GigerRationale and ObjectivesWith the growing adoption of digital breast tomosynthesis (DBT) in breast cancer screening, we compare the performance of deep learning computer-aided diagnosis on DBT images to that of conventional full-field digital mammography (FFDM).Materials and MethodsIn this study, we retrospectively collected FFDM and DBT images of 78 biopsy-proven lesions from 76 patients. A region of interest was selected for each lesion on FFDM, synthesized 2D, and DBT key slice images. Features were extracted from each lesion using a pretrained convolutional neural network (CNN) and served as input to a support vector machine classifier trained in the task of predicting likelihood of malignancy.ResultsFrom receiver operating characteristic (ROC) analysis of all 78 lesions, the synthesized 2D image performed best in both the cradiocaudal view (area under the ROC curve [AUC] = 0.81, SE = 0.05) and mediolateral oblique view (AUC = 0.88, SE = 0.04) in the task of lesion characterization. When cradiocaudal and mediolateral oblique data of each lesion were merged through soft voting, DBT key slice image performed best (AUC = 0.89, SE = 0.04). When only masses and architectural distortions (ARDs) were considered, DBT performed significantly better than FFDM (p = 0.024).ConclusionDBT performed significantly better than FFDM in the merged view classification of mass and ARD lesions. The increased performance suggests that the information extracted by the CNN from DBT images may be more relevant to lesion malignancy status than the information extracted from FFDM images. Therefore, this study provides supporting evidence for the efficacy of computer-aided diagnosis on DBT in the evaluation of mass and ARD lesions.
  • Addressing Burnout in Radiologists
    • Abstract: Publication date: Available online 31 July 2018Source: Academic RadiologyAuthor(s): Alison L. Chetlen, Tiffany L. Chan, David H. Ballard, L. Alexandre Frigini, Andrea Hildebrand, Shannon Kim, James M. Brian, Elizabeth A. Krupinski, Dhakshinamoorthy GaneshanBurnout is a global health problem affecting physicians across all medical specialties. Radiologists, in particular, experience high rates of burn out, and this trend has only continued to worsen. The “Promoting Health and Wellness for Radiologists Task Force of the Association of University Radiologists—Radiology Research Alliance” presents a review of the prevalence, causes, and impact of burnout among radiology faculty and trainees, and a discussion on strategies for overcoming burnout and promoting overall health and well-being among radiologists.
  • Systematic Review of the Literature: Best Practices
    • Abstract: Publication date: Available online 31 July 2018Source: Academic RadiologyAuthor(s): Supriya Gupta, Prabhakar Rajiah, Erik H. Middlebrooks, Dhiraj Baruah, Brett W. Carter, Kirsteen R. Burton, Arindam Rano Chatterjee, Matthew M. MillerReviews of published scientific literature are a valuable resource that can underline best practices in medicine and clarify clinical controversies. Among the various types of reviews, the systematic review of the literature is ranked as the most rigorous since it is a high-level summary of existing evidence focused on answering a precise question. Systematic reviews employ a pre-defined protocol to identify relevant and trustworthy literature. Such reviews can accomplish several critical goals that are not easily achievable with typical empirical studies by allowing identification and discussion of best evidence, contradictory findings, and gaps in the literature. The Association of University Radiologists Radiology Research Alliance Systematic Review Task Force convened to explore the methodology and practical considerations involved in performing a systematic review. This article provides a detailed and practical guide for performing a systematic review and discusses its applications in radiology.
  • Quantification of Myocardial Enhancement on Cine-MRI: Diagnostic Value in
           Cardiac Amyloidosis
    • Abstract: Publication date: Available online 31 July 2018Source: Academic RadiologyAuthor(s): Clément Cholet, Thibaud Damy, François Legou, Hicham Kobeiter, Alain Rahmouni, Jean-François DeuxRationale and ObjectivesDiagnosis of cardiac amyloidosis (CA) on cardiac magnetic resonance (CMR) can be challenging and quantitative indexes are relevant to further characterize the myocardium. We hypothesize that the relative myocardial enhancement measured from pre and post contrast cine imaging provides diagnostic information for CA in the setting of left ventricular hypertrophy (LVH).Materials and MethodsPatients with LVH referred to our center and control subjects with normal CMR were retrospectively included. Percentage of myocardial enhancement (percentage ME) was obtained from pre and post contrast (5 minutes) cine sequences. Post contrast myocardial T1 and LGE extent were also recorded.ResultsTwenty-one patients with CA, 25 patients with non-amyloid left ventricular myocardial hypertrophy (CH) and 20 controls with normal CMR were analyzed. Percentage ME was significantly higher in CA patients (200% (174–238)) than in CH patients (122% (88–151); p = 0.0001) and control patients (104% (90–149); p = 0.0001). Percentage ME was significantly correlated with the LGE extent (Rho Spearman coefficient = 0.66; p = 0.0001) and with the post contrast myocardial T1 (Rho Spearman coefficient = −0.61; p = 0.0001). With a cutoff value of 152%, the sensitivity and specificity of percentage ME for detection of CA were 90% and 80%, respectively.ConclusionPercentage ME obtained from pre and post contrast cine imaging is correlated to LGE extent and myocardial T1 and may represent an additional diagnostic parameter to consider CA in patients with LVH.
  • CT and 18F- FDG-PET-CT Findings in Secondary Adrenal Lymphoma
           with Pathologic Correlation
    • Abstract: Publication date: Available online 31 July 2018Source: Academic RadiologyAuthor(s): Emre Altinmakas, Fehime Eymen Üçışık-Keser, L. Jeffrey Medeiros, Chaan S. NgRationale and ObjectiveTo evaluate computed tomography (CT) and positron emission tomography-computed tomography (PET-CT) imaging manifestations of lymphomas secondarily involving the adrenal gland.Materials and MethodsSeven patients (Five men, two women; median age [range], 66 years [34–75 years]) with pathologically proven adrenal lymphoma were assessed retrospectively. Clinical findings, prior history of lymphoproliferative malignancy, CT (n = 7) and fludeoxyglucose positron emission tomography-computed tomography (18F-FDG-PET-CT) (n = 6) features were analyzed.ResultsSix cases were diffuse large B-cell lymphoma, and one case was peripheral T-cell lymphoma. The longest diameter of the lesions ranged from 3.2 to 6.6 cm (median 4.3 cm). Six lesions were well-defined and one lesion was ill-defined. In five cases, an adreniform shape was preserved. No lesions contained fat, calcification or hemorrhage. Two lesions had necrosis on CT. Median (range) unenhanced CT density of six lesions was 31.8 (29.2–35.2) Hounsfield units. Following administration of IV contrast media (n = 6), three lesions enhanced homogenously whereas three enhanced heterogeneously. The median increase in attenuation was 35.1 Hounsfield units. Two patients had 15-minute delayed CT and they both demonstrated limited wash-out consistent with nonadenoma. Six patients had fludeoxyglucose positron emission tomography-computed tomography(18-F-FDG-PET-CT) and all lesions were fludeoxyglucose (FDG) avid with a median SUVmax of 18.6 (range: 10.3–49.2).ConclusionSecondary adrenal lymphomas usually manifest as, large (>3 cm), well-defined, homogenously or slightly heterogeneously enhancing masses on CT with preserved adreniform shape. These lesions tend to show limited wash-out and high fludeoxyglucose (FDG) uptake.
  • Convolutional Neural Network Based Breast Cancer Risk Stratification Using
           a Mammographic Dataset
    • Abstract: Publication date: Available online 31 July 2018Source: Academic RadiologyAuthor(s): Richard Ha, Peter Chang, Jenika Karcich, Simukayi Mutasa, Eduardo Pascual Van Sant, Michael Z. Liu, Sachin JambawalikarRationale and ObjectivesWe propose a novel convolutional neural network derived pixel-wise breast cancer risk model using mammographic dataset.Materials and MethodsAn institutional review board approved retrospective case-control study of 1474 mammographic images was performed in average risk women. First, 210 patients with new incidence of breast cancer were identified. Mammograms from these patients prior to developing breast cancer were identified and made up the case group [420 bilateral craniocaudal mammograms]. The control group consisted of 527 patients without breast cancer from the same time period. Prior mammograms from these patients made up the control group [1054 bilateral craniocaudal mammograms]. A convolutional neural network (CNN) architecture was designed for pixel-wise breast cancer risk prediction. Briefly, each mammogram was normalized as a map of z-scores and resized to an input image size of 256 × 256. Then a contracting and expanding fully convolutional CNN architecture was composed entirely of 3 × 3 convolutions, a total of four strided convolutions instead of pooling layers, and symmetric residual connections. L2 regularization and augmentation methods were implemented to prevent overfitting. Cases were separated into training (80%) and test sets (20%). A 5-fold cross validation was performed. Software code was written in Python using the TensorFlow module on a Linux workstation with NVIDIA GTX 1070 Pascal GPU.ResultsThe average age of patients between the case and the control groups was not statistically different [case: 57.4 years (SD, 10.4) and control: 58.2 years (SD, 10.9), p = 0.33]. Breast Density (BD) was significantly higher in the case group [2.39 (SD, 0.7)] than the control group [1.98 (SD, 0.75), p < 0.0001]. On multivariate logistic regression analysis, both CNN pixel-wise mammographic risk model and BD were significant independent predictors of breast cancer risk (p < 0.0001). The CNN risk model showed greater predictive potential [OR = 4.42 (95% CI, 3.4–5.7] compared to BD [OR = 1.67 (95% CI, 1.4–1.9). The CNN risk model achieved an overall accuracy of 72% (95%CI, 69.8–74.4) in predicting patients in the case group.ConclusionNovel pixel-wise mammographic breast evaluation using a CNN architecture can stratify breast cancer risk, independent of the BD. Larger dataset will likely improve our model.
  • Potential Complementary Value of Noncontrast and Contrast Enhanced CT
           Radiomics in Colorectal Cancers
    • Abstract: Publication date: Available online 31 July 2018Source: Academic RadiologyAuthor(s): Bogdan Badic, Marie Charlotte Desseroit, Mathieu Hatt, Dimitris VisvikisRationale and ObjectivesThe aim of our study was to assess the relationships between textural features extracted from contrast enhanced (CE) and noncontrast enhanced (NCE) computed tomography (CT) images of primary colorectal cancer, in order to identify radiomics features more likely to provide potential complementary information regarding outcome.Materials and MethodsSixty-one patients with primary colorectal cancer underwent both CE-CT and NCE-CT scans within the same acquisition. First-order and textural features (with three different methods for grey-level discretization) were extracted from the tumor volume in both modalities and their correlation was assessed with Spearman's rank correlation (rs). Significance was assessed at p < 0.05 with correction for multiple comparisons. Kaplan–Meier estimation and log-rank tests were used to identify features associated with long term patient survival.ResultsModerate positive correlations were observed between CE-CT and NCE-CT histogram-derived entropy (EntropyHist) and area under the curve (CHAUC) (rs = 0.49, p < 0.001 and rs= 0.45, p < 0.001, respectively). Some second and third order textural features were found highly correlated between CE-CT and NCE-CT, such as small zone-size emphasis SZSE (rs = 0.729, p < 0.001) and zone-size percentage (rs = 0.770, p < 0.001). Grey-levels discretization methods influenced these correlations. A few of the third order NCE-CT and CE-CT features were significantly associated with survival.ConclusionSome radiomics features with moderate correlations between nonenhanced and enhanced CT images were found to be associated with survival, thus suggesting that complementary prognostic value may be extracted from both modalities when available.
  • Magnetic Resonance Diffusion Kurtosis Imaging for Evaluating Stage of
           Liver Fibrosis in a Rabbit Model
    • Abstract: Publication date: Available online 31 July 2018Source: Academic RadiologyAuthor(s): Jie Li, Dan Wang, Tian-wu Chen, Fei Xie, Rui Li, Xiao-ming Zhang, Zong-lin Jing, Jian-qiong Yang, Jing Ou, Jin-ming CaoRationale and ObjectivesAs an extension of the conventional diffusion weighted imaging, diffusion kurtosis imaging (DKI) is based on the non-Gaussian diffusion model that can inherently account for restricted water diffusion within the complex microstructure of most tissues. This study aimed to investigate association of liver DKI derived parameter with stage of liver fibrosis.Materials and MethodsFifty-six healthy New Zealand white rabbits were enrolled into this study, among which 48 rabbits were randomly given carbon tetrachloride to model liver fibrosis, and 8 rabbits treated with normal saline served as control subjects. All rabbits underwent liver DKI followed by biopsy to stage fibrosis (stages F0–F4) on 6th, 8th, 10th, and 12th weekends after initiation of modeling fibrosis. Mean kurtosis (MK), fractional anisotropy (FA), and mean diffusion (MD) were derived from DKI data. Statistical analysis was to evaluate association of DKI derived parameter with stage of fibrosis.ResultsFA (r = 0.512) and MK (r = 0.567) increased, and MD (r = −0.574) decreased with increasing stage of fibrosis from F0 to F4 (all p values < 0.05). Significant differences were found in all parameters between F0 and F3 or F4, F1 and F4, F0 and F1–4, and F0–1 and F2–4 (all p values < 0.05). FA and MD could distinguish between F0 from F2, MD, and MK could distinguish F1 from F3, F0–2 from F3–4, and F1–2 from F3–4, and MK and FA could distinguish F2 from F4, and F0–3 from F4 (all p values < 0.05). According to receiver operating characteristic analysis, MK could best predict stage ≥F1, ≥F2, ≥F3, and F4, and discriminate F1–2 from F3–4 with areas under receiver operating characteristic curve of 0.766–0.930.ConclusionDKI derived parameters can help stage fibrosis.
  • Optimization of Monoenergetic Extrapolations in Dual-Energy CT for Metal
           Artifact Reduction in Different Body Regions and Orthopedic Implants
    • Abstract: Publication date: Available online 30 July 2018Source: Academic RadiologyAuthor(s): Lukas Horat, Mustafa Q. Hamie, Florian A. Huber, Roman GuggenbergerRationale and ObjectivesTo define an optimal monoenergetic extrapolation (ME) in dual-energy computed tomography (DECT) for metal artifact reduction (MAR) including different body regions and orthopedic implants.Material and MethodsDECT scans were acquired with dual-source CT (SOMATOM Force, Siemens, Germany) at tube voltage A 80–100 kV/B Sn150 kV from 39 patients (mean 54.1 ± 20.7 years, 23 male vs. 16 female) with orthopedic implants ranging from wires to joint implants. Scans were assembled in four groups based on scan regions and volume. Single- and weighted-energy images at a ratio of 0.3 and MEs at 100, 130, 160, and 190 keV were produced using vendor-specific postprocessing software (Syngo.Via, Siemens, Germany). Artifact degree was assessed quantitatively by metal-induced Hounsfield unit changes in relation to reference tissues. Visibility of screw–bone interface, hardware integrity, adjacent bone, and soft tissues were visually rated on a four-point Likert scale (0, none; 3, strong artifacts with nondiagnostic quality). Optimal energy was visually determined by side-by-side comparisons. Artifact degree was statistically compared between regions and energies.ResultsMetal-induced attenuation changes were most severe in large scan volume groups for all energies. Reference tissue attenuation outside metal artifacts was not affected by ME (p = 0.57). Independent of region, ME at 130–190 keV quantitatively performed significantly better for MAR than the remainder. ME 130 keV showed the highest frequency (54%) in optimal energy ratings based on qualitative image criteria.ConclusionDECT significantly reduces image artifacts in patients with orthopedic hardware and prospective choice of ME at 130 keV may suit best for optimal MAR, independent of region or implant.
  • Efficacy of 3D Printed Models on Resident Learning and Understanding of
           Common Acetabular Fracturers
    • Abstract: Publication date: Available online 30 July 2018Source: Academic RadiologyAuthor(s): Omer A. Awan, Maunil Sheth, Ian Sullivan, Jafar Hussain, Padmaja Jonnalagadda, Stephen Ling, Sayed AliRationale and ObjectivesThe conceptualization of acetabular fractures can present a daunting challenge to radiology residents. 3D models have been shown to aid in the spatial perception of complicated anatomy and may help residents grasp the elaborate classification systems for these anatomically complex fractures. Prior studies have explored the utility of 3D printed models for surgical planning in various settings. To our knowledge, no study has evaluated their efficacy in radiology resident training.Materials and MethodsFollowing IRB approval, 22 radiology residents were randomized and stratified by Post Graduate Year into two groups of 11 residents. Both groups received separate identical presentations on the 5 most common acetabular fractures given by a musculoskeletal trained radiologist. Residents in the experimental group received 3D printed models of the five most common fracture types with which to interact during the presentation, while the control group did not. Both groups received a pretest and a follow up posttest three weeks later.ResultsA Wilcoxon rank sum test was performed to determine if statistically significant differences between the pretest and posttest scores of the experimental and control groups existed. There was no statistically significant difference in scores on the pre-test, which confirmed successful randomization. There was a statistically significant difference (P = 0.02) on the posttest scores between the experimental and control groups.Conclusion3D printed models promise as an effective educational tool for resident learning with respect to acetabular fractures, improving short-term understanding of complex anatomy and classification systems.
  • Radiology Field Trips—A List of “Must Sees” in the Radiology
           Department for Medical Students: How We Do It
    • Abstract: Publication date: Available online 30 July 2018Source: Academic RadiologyAuthor(s): Matthew Hartman, Sarah Thomas, Andres AyoobRationale and ObjectiveTraditionally, the radiology elective has been designed to teach medical students the fundamentals of radiologic interpretation, typically through passive means, such as didactic conferences and observational shadowing of radiologists as they interpret images. In doing so, the importance of noninterpretive skills and active learning has been minimized. Additionally, in the traditional model, students typically only gain a superficial appreciation of radiologists’ role in patient care and their interactions with clinical services, multidisciplinary teams, and patients. With the emphasis on value-focused, team-based, patient-centered care, it is important to expand the focus of radiology education beyond interpretive skills alone such that these future physicians can most effectively utilize imaging to care for patients.Materials and MethodsA list of integrated radiology field trips was created for medical students from two institutions, Allegheny Health Network and the University of Kentucky, representing a consolidation of the instructional strategies utilized at these institutions. This paradigm uses active observation to extend learning beyond the reading room.ResultsIt targets noninterpretive skills that will be of vital importance in the majority of students’ future clinical practice, such as patient safety and appropriate ordering practices.ConclusionThis article describes the integration of nine field trip experiences into a 4-week radiology clerkship and its effect on learning outcomes and student satisfaction.
  • Postoperative CT of the Mandible Following Trauma: Review of Normal
           Appearances and Common Complications
    • Abstract: Publication date: Available online 30 July 2018Source: Academic RadiologyAuthor(s): Michael J. Reiter, Ryan B. Schwope, Jared M. ThelerRationale and ObjectivesSurgeons aim to restore occlusion and jaw function to baseline status for patients with mandibular fractures using either closed treatment or reduction and fixation.Materials and MethodsOcclusion is defined as the relationship between the maxillary and mandibular teeth as they approach each other.ResultsRadiologists should be familiar with the goals of repair to help identify which treatment is adequate as well as to diagnose potential complications. Some of the more common complications encountered are infection, nonunion or malunion, and malocclusion.ConclusionWe provide a comprehensive review of both the desired and untoward CT findings after surgical repair of traumatic mandibular injuries.
  • Enhancement of Musculoskeletal Radiology Resident Education with the Use
           of an Individual Smart Portable Ultrasound Device (iSPUD)
    • Abstract: Publication date: Available online 29 July 2018Source: Academic RadiologyAuthor(s): Troy H. Maetani, Cody Schwartz, Robert J. Ward, Daniel B. NissmanRationale and ObjectivesMany medical specialties have incorporated portable ultrasound into their educational curriculum. Our objective was to determine the utility of an individual smart portable ultrasound device (iSPUD) as an educational tool in resident and fellowship Musculoskeletal Radiology training.Materials and MethodsAfter Institutional Review Board approval, volunteer radiology trainees were instructed to use the iSPUD (Philips Lumify ultrasound probe and Samsung Galaxy Tab S2 8 inch tablet), asked to identify 10 wrist structures with the iSPUD and completed a Likert scale-based, pretest survey. Trainees were then given the iSPUD for 3 days of independent scanning practice. Afterward, trainees were asked to identify the same 10 wrist structures with the iSPUD and to complete a Likert scale-based, post-test survey.ResultsTwenty trainees volunteered to participate. Trainee performance on the 10-wrist structure identification test with the iSPUD resulted in a pretest mean number correct of 2.5 ± 2.16 and a post-test mean number correct of 9.85 ± 0.37 (p < 0.001). On the pretest survey, 68.42% (13/20) had never performed and 42.11% (8/20) had never interpreted a musculoskeletal ultrasound. On the post-test survey, 18/20 (94.74%) strongly agreed that access to an iSPUD would improve their ability to perform musculoskeletal ultrasound, improve ultrasound-guided interventional skills, and help them become better Radiologists.ConclusionThe use of an iSPUD as a tool in Musculoskeletal Radiology resident and fellow education can improve clinical ultrasound skills, build trainee technical confidence during diagnostic ultrasound procedures, and help trainees achieve their goal of becoming a competent Radiologist.
  • Lesion Nonvisualization at MRI-Guided Breast Biopsy: Now What'
    • Abstract: Publication date: Available online 29 July 2018Source: Academic RadiologyAuthor(s): Colleen H. Neal
  • Benefits of Independent Double Reading in Digital Mammography: A
           Theoretical Evaluation of All Possible Pairing Methodologies
    • Abstract: Publication date: Available online 29 July 2018Source: Academic RadiologyAuthor(s): Patrick C. Brennan, Aarthi Ganesan, Miguel P. Eckstein, Ernest Usang Ekpo, Kriscia Tapia, Claudia Mello-Thoms, Sarah Lewis, Mordechai Z. JuniRationale and ObjectivesTo establish the efficacy of pairing readers randomly and evaluate the merits of developing optimal pairing methodologies.Materials and MethodsSensitivity, specificity, and proportion correct were computed for three different case sets that were independently read by 16 radiologists. Performance of radiologists as single readers was compared to expected double reading performance. We theoretically evaluated all possible pairing methodologies. Bootstrap resampling methods were used for statistical analyses.ResultsSignificant improvements in expected performance for double versus single reading (ie, delta performance) were shown for all performance measures and case-sets (p ≤ .003), with overall delta performance across all theoretically possible pairing schemes (n = 10,395) ranging between .05 and .08. Delta performance for the 20 best pairing schemes was significant (p < .001) and ranged between .07 and .10. Delta performance for 20 random pairing schemes was also significant (p ≤ .003) and ranged between .05 and .08. Delta performance for the 20 worst pairing schemes ranged between .03 and .06, reaching significance in delta proportion correct (p ≤ .021) for all three case-sets and in delta specificity for two case-sets (p ≤ .033) but not for a third case-set (p = .131), and not reaching significance in delta sensitivity for any of the three case-sets (.098 ≥ p ≥ .067).ConclusionSignificant benefits accrue from double reading, and while random reader pairing achieves most double reading benefits, a strategic pairing approach may maximize the benefits of double reading.
  • Can Quantitative Volumetric Analysis Predict Tumor Recurrence in the
           Patients with Mucinous Adenocarcinoma of the Lung After Surgical
    • Abstract: Publication date: Available online 29 July 2018Source: Academic RadiologyAuthor(s): Jae-Kwang Lim, Kyung Min Shin, Hui Joong Lee, Hoseok Lee, Myong Hun Hahm, Jaehee Lee, Chang Ho Kim, Seung Ick Cha, Ji Yun Jeong, Tae-In ParkRationale and ObjectivesMucinous adenocarcinoma (MAC) is a distinct histologic variant subtype of lung adenocarcinomas. However, detailed radiologic findings and prognostic factors are still poorly understood. Thus, this study aimed to investigate the prognostic value of quantitative volumetric analysis of the computed tomography images of patients with MAC after. surgical resection.Materials and MethodsSemiautomatic segmentation from computed tomography images of 60 patients with pathologically confirmed MAC was performed and retrospectively reviewed. The main cutoff value in Hounsfield Units (HU) to predict tumor recurrence was defined by receiver-operating curve analysis. Solid volume of mass (SVM) was defined as the volume of HU greater than this cutoff, and solid ratio (Sratio) was defined as SVM divided by total volume. Each parameter was compared to clinicopathologic characteristics and maximum standardized uptake value. Disease-free survival (DFS) was assessed and was compared among patients. Univariate and multivariate Cox regression was performed to predict DFS of MAC.ResultsThe cutoff value of HU as determined by ROC analysis was 20 HU. SVM and Sratio were positively correlated with the maximum standardized uptake and pathologic invasion size, respectively (p < 0.001). SVM and Sratio were significantly higher in the recurrence group than in the no-recurrence group (p < 0.001). Multivariate Cox proportional hazards regression analysis revealed that the SVM (Hazard Ratio 1.016; 95% Confidence Interval 1.000–1.032; p = 0.048) and Sratio (Hazard Ratio 29.136; 95% Confidence Interval 1.419–598.191; p = 0.029) were independent significant predictors of DFS.ConclusionQuantitative volumetric parameters can predict the prognosis of patients with MAC after surgical resection.
  • Radiogenomics of Clear Cell Renal Cell Carcinoma: Associations Between
           mRNA-Based Subtyping and CT Imaging Features
    • Abstract: Publication date: Available online 29 July 2018Source: Academic RadiologyAuthor(s): Lan Bowen, Li XiaojingPurposeTo investigate associations between clear-cell renal cell carcinoma mRNA-based subtyping and CT features.Materials and MethodsThe CT data from 177 patients generated with The Cancer Imaging Archive were reviewed. The correlation was analyzed using chi-square test and univariate regression analysis.ResultsIdentified were 124 (53.2%) m1, 67 (28.8%) m2, 17 (7.3%) m3, and 14 (8.7%) m4 subtypes. m1-subtype rates were significantly higher in well-defined margin lesions (p = 0.041). m3-subtype rates were significantly higher in ill-defined margin lesions (p = 0.012), in collecting system invasion lesions (p = 0.028) and collecting system invasion lesions (p = 0.026).On univariate logistic regression analysis, tumor margin (well-defined margin vs ill-defined margin, OR: 2.104; p = 0.041; 95% CI: 1.024–4.322) was associated with m1-subtype. Tumor margin (well-defined margin vs ill-defined margin, OR: 2.104; p = 0.012; 95% CI: 0.212–0.834) and collecting system invasion (yes vs no, OR: 0.421; p = 0.028; 95% CI: 0.212–0.834) and renal vein invasion (yes vs no, OR: 2.164; p = 0.026; 95% CI: 1.090–4.294) were associated with m3-subtype. There was no significant difference between mRNA-based subtyping (m2 vs other; m4 vs other) and the CT features.ConclusionsThis preliminary radiogenomics analysis of clear-cell renal cell carcinoma revealed associations between CT features and mRNA-based subtyping which warrant further investigation and validation.
  • Spatial Heterogeneity of Lung Strain and Aeration and Regional
           Inflammation During Early Lung Injury Assessed with PET/CT
    • Abstract: Publication date: Available online 26 July 2018Source: Academic RadiologyAuthor(s): Gabriel Motta-Ribeiro, Tilo Winkler, Soshi Hashimoto, Vidal MeloIntroductionSpatial heterogeneity of lung aeration and strain (change volume/resting volume) occurs at microscopic levels and contributes to lung injury. Yet, it is mostly assessed with histograms or large regions-of-interest. Spatial heterogeneity could also influence regional gene expression. We used positron emission tomography (PET)/computed tomography (CT) to assess the contribution of different length-scales to mechanical heterogeneity and to direct lung injury biological pathway identification.Materials and MethodsSheep exposed to mild (n = 5, supine and n = 3, prone) and moderate (n = 6, supine) systemic endotoxemia were protectively ventilated. At baseline, 6 hours and 20 hours length-scale analysis was applied to aeration in CT (mild groups) and PET transmission (moderate group) scans; and voxel-level strain derived from image registration of end-inspiratory and end-expiratory CTs (mild). 2-deoxy-2-[(18)F]fluoro-d-glucose (18F-FDG)-PET kinetics parameters in ventral and dorsal regions were correlated with tissue microarray gene expression (moderate).ResultsWhile aeration and strain heterogeneity were highest at 5–10 mm length-scales, larger length-scales contained a higher fraction of strain than aeration heterogeneity. Contributions of length-scales>5–10 mm to aeration and strain heterogeneity increased as lung injury progressed (p < 0.001) and were higher in supine than prone animals. Genes expressed with regional correlation to 18F-FDG-PET kinetics ( r  = 0.81 [0.78–0.85]) yielded pathways associated with immune system activation and fluid clearance.ConclusionNormal spatial heterogeneity of aeration and strain suggest larger anatomical and functional determinants of lung strain than aeration heterogeneity. Lung injury and supine position increase the contribution of larger length-scales. 18F−FDG-PET-based categorization of gene expression results in known and novel biological pathways relevant to lung injury.
  • Voxel-Wise Longitudinal Parametric Response Mapping Analysis of Chest
           Computed Tomography in Smokers
    • Abstract: Publication date: Available online 26 July 2018Source: Academic RadiologyAuthor(s): Wassim W. Labaki, Tian Gu, Susan Murray, Charles R. Hatt, Craig J. Galbán, Brian D. Ross, Carlos H. Martinez, Jeffrey L. Curtis, Eric A. Hoffman, Esther Pompe, David A. Lynch, Ella A. Kazerooni, Fernando J. Martinez, MeiLan K. HanRationale and ObjectivesChronic obstructive pulmonary disease is a heterogeneous disease characterized by small airway abnormality and emphysema. We hypothesized that a voxel-wise computed tomography analytic approach would identify patterns of disease progression in smokers.Materials and MethodsWe analyzed 725 smokers in spirometric GOLD stages 0-4 with two chest CTs 5 years apart. Baseline inspiration, follow-up inspiration and follow-up expiration images were spatially registered to baseline expiration so that each voxel had correspondences across all time points and respiratory phases. Voxel-wise Parametric Response Mapping (PRM) was then generated for the baseline and follow-up scans. PRM classifies lung as normal, functional small airway disease (PRMfSAD), and emphysema (PRMEMPH).ResultsSubjects with low baseline PRMfSAD and PRMEMPH predominantly had an increase in PRMfSAD on follow-up; those with higher baseline PRMfSAD and PRMEMPH mostly had increases in PRMEMPH. For GOLD 0 participants (n = 419), mean 5-year increases in PRMfSAD and PRMEMPH were 0.3% for both; for GOLD 1–4 participants (n = 306), they were 0.6% and 1.6%, respectively. Eighty GOLD 0 subjects (19.1%) had overall radiologic progression (30.0% to PRMfSAD, 52.5% to PRMEMPH, and 17.5% to both); 153 GOLD 1–4 subjects (50.0%) experienced progression (17.6% to PRMfSAD, 48.4% to PRMEMPH, and 34.0% to both). In a multivariable model, both baseline PRMfSAD and PRMEMPH were associated with development of PRMEMPH on follow-up, although this relationship was diminished at higher levels of baseline PRMEMPH.ConclusionA voxel-wise longitudinal PRM analytic approach can identify patterns of disease progression in smokers with and without chronic obstructive pulmonary disease.
  • Lightly Embalmed Cadavers as a Training Tool for Ultrasound-Guided
           Procedures Commonly Used in Interventional Radiology
    • Abstract: Publication date: Available online 17 July 2018Source: Academic RadiologyAuthor(s): Mary E. (Mollie) Meek, James C. Meek, Blake Hollowoa, Ruizong Li, Linda A. Deloney, Kevin D. PhelanRationale and ObjectivesCompetency in ultrasound (US) imaging and US-guided procedures is often difficult for medical students and residents to master. The use of simulation training has been strongly encouraged but the quality of phantom models available for US-guided procedures is limited. As a feasible alternative, we describe the innovative use of a lightly embalmed cadaver for realistic practice of common interventional radiology (IR) procedures prior to direct patient care.Materials and MethodsLightly embalmed cadavers were positioned as patients would be in the IR suite: supine, prone, and erect seated position. Lidocaine was injected and visualized under standard percutaneous techniques and sonographic guidance was used to simulate common US-guided procedures performed in IR including liver biopsy, kidney biopsy, thoracentesis, and vascular access.ResultsThe ability to position cadavers was a key factor that allowed entire procedures to be simulated. Medical students with very limited exposure to US imaging and diagnostic radiology residents with minimal exposure to US imaging successfully completed common US-guided procedures. Arterial and venous vascular access was obtained. Wires were passed and catheters easily placed via both access sites. The texture of the tissue layers provided realistic feedback for the trainees as they advanced the needle or dilated the tissues. Images from each simulated procedure resembled images expected in a living patient.ConclusionLightly embalmed cadavers are an innovative and feasible tool to simulate common IR US-guided procedures in a realistic fashion for deliberate practice in advance of first-attempt encounters with patients.
  • Quantitative Analysis of Airway Tree in Low-dose Chest CT with a New
           Model-based Iterative Reconstruction Algorithm: Comparison to Adaptive
           Statistical Iterative Reconstruction in Routine-dose CT
    • Abstract: Publication date: Available online 13 July 2018Source: Academic RadiologyAuthor(s): Yongjun Jia, Xing Ji, Taiping He, Yong Yu, Nan Yu, Haifeng Duan, Youmin GuoObjectiveWe aimed to evaluate a new model-based iterative reconstruction (MBIRn) algorithm either with spatial resolution and noise reduction balance (MBIRSTND) or spatial resolution preference (MBIRRP20) for quantitative analysis of airway in low-dose chest computed tomography (CT) with a computer-aided detection (CAD) software, in comparison to adaptive statistical iterative reconstruction (ASIR) in routine-dose CT.MethodsThirty patients who underwent both the routine-dose (noise index [NI] = 14 HU) and low-dose (at 30% level with NI = 28 HU) CT examination for pulmonary disease were included. Image acquisition was performed with 120 kVp tube voltage and automatic tube current modulation. Routine-dose scans were reconstructed with ASIR, whereas low-dose scans were reconstructed with ASIR, MBIRSTND, and MBIRRP20. Airway dimensions of the right middle lobe bronchus from the four reconstructions were measured using CAD software. Two radiologists used a semiquantitative 5 scoring criteria (−2, inferior to; +2, superior to; −1 slightly inferior to; +1, slightly superior to; and 0, equal to ASIR in routine-dose CT) to rate the subjective image quality of MBIRSTND and MBIRRP20 of airway trees. The paired t test and Wilcoxon signed-rank test were used for statistical comparison.ResultsThe low-dose CT provided 70.76% dose reduction compared to the routine-dose CT (0.88 ± 0.83 mSv vs 3.01 ± 1.89 mSv). MBIRSTND and MBIRRP20 with low-dose CT provided longer bronchial length measurements and were better in measurement variability and continuity and completeness of bronchial walls than ASIR in routine-dose CT (P 
  • Burnout Education: The Relationship of Personal Life to Work Life
    • Abstract: Publication date: August 2018Source: Academic Radiology, Volume 25, Issue 8Author(s): Morgan N. McLuckey, Richard B. Gunderman
  • Exploring the Potential of Undergraduate Radiology Education in the
           Virtual World Second Life with First-cycle and Second-cycle Medical
    • Abstract: Publication date: August 2018Source: Academic Radiology, Volume 25, Issue 8Author(s): Rocio Lorenzo-Alvarez, Jose Pavia-Molina, Francisco Sendra-PorteroRationale and ObjectivesVirtual worlds have a remarkable potential for effective teaching and learning, providing immersive, realistic, and engaging online events. Previous studies have explored online education of health professionals in Second Life (SL), the most widely used virtual world, but none of the previous learning experiences were related to radiology. The purpose of this study was to explore the potential use of SL for undergraduate radiology education and the involvement of students in SL learning activities.Materials and MethodsWe delivered a 4-week voluntary undergraduate radiology education program in SL, based on synchronous sessions and asynchronous tasks, with two modalities: introduction to basic radiology for first-cycle (first- to third-year) students and case-based clinical radiology for second-cycle (fourth- to sixth-year) students. Participants completed an evaluation questionnaire about the experiences after the learning program.ResultsForty-six students (20 first-cycle and 26 second-cycle) participated in this study. They found the contents of the course appropriate (mean ≥ 4.53/5), the initiative interesting, and the environment attractive (mean ≥ 4.32/5), and they were willing to participate in future SL experiences (mean ≥ 4.63/5). All students highly rated the organization, the content, the benefit to their medical education, and the professor (mean ≥ 9.05/10).ConclusionOnline radiology education using SL is feasible and well received by medical students of all year groups. The students participated and engaged in this activity very positively and rated the experience highly. The potential of using SL for radiology education includes promising expectations regarding collaborative learning and gamification.
  • Bridging the Gap: Identifying Global Trends in Gender Disparity Among the
           Radiology Physician Workforce
    • Abstract: Publication date: August 2018Source: Academic Radiology, Volume 25, Issue 8Author(s): Sarah Wallace Cater, Sora C. Yoon, Dorothy A. Lowell, James C. Campbell, Gary Sulioti, Rosie Qin, Brian Jiang, Lars J. GrimmRationale and ObjectivesWomen make up half of American medical school graduates, but remain underrepresented among radiologists. This study sought to determine whether workforce gender disparities exist in other countries, and to identify any country-specific indices associated with increased female representation.Materials and MethodsIn this cross-sectional study, 95 professional radiology organizations in 75 countries were contacted via email to provide membership statistics, including proportion of female members, female members aged 35 or under, and women in society leadership positions. Country-specific metrics collected included gross domestic product, Gini index, percent female medical school enrollment, and Gender Development Index for the purposes of univariate multiple regression analysis.ResultsTwenty-nine organizations provided data on 184,888 radiologists, representing 26 countries from Europe (n = 12), North America (n = 2), Central/South America (n = 6), Oceania (n = 2), Asia (n = 3), and Africa (n = 1) for a response rate of 34.7% (26/75). Globally, 33.5% of radiologists are female. Women constitute a higher proportion of younger radiologists, with 48.5% of radiologists aged 35 or under being female. Female representation in radiology is lowest in the United States (27.2%), highest in Thailand (85.0%), and most variable in Europe (mean 40.1%, range 28.8%–68.9%). The proportion of female radiologists was positively associated with a country's Gender Development Index (P = .006), percent female medical student enrollment (P = .001), and Gini index (P = .002), and negatively associated with gross domestic product (P = .03).ConclusionsWomen are underrepresented in radiology globally, most notably in the United States. Countries with greater representation of women had higher gender equality and percent female medical school enrollment, suggesting these factors may play a role in the gender gap.
  • Virtual Computed Tomography Colonography: Evaluation of 2D and Virtual 3D
           Image Quality of Sub-mSv Examinations Enabled by Third-generation Dual
           Source Scanner Featuring Tin Filtering
    • Abstract: Publication date: August 2018Source: Academic Radiology, Volume 25, Issue 8Author(s): Hannes Seuss, Rolf Janka, Matthias Hammon, Alexander Cavallaro, Michael Uder, Peter DankerlRationale and ObjectivesTo evaluate two- and three-dimensional (2D and 3D) image quality of sub-milliSievert (mSv) computed tomography (CT) colonography utilizing a third-generation dual source CT scanner featuring a tin filter.MethodsWe retrospectively evaluated 26 consecutive patients who underwent third-generation dual source CT colonography, nine with the standard-dose clinical-scan protocol (SDP) and 17 with a low-dose protocol (LDP) featuring a tin filter. Radiation dose was evaluated by volume computed tomography dose index (CTDIvol), dose length product (DLP), effective dose (E), and size-specific dose estimate. Objective image quality was evaluated utilizing signal-to-noise ratio (SNR) derived from standardized placed regions of interest on the transverse 2D images and the ratio of SNR/CTDIvol (normalized SNR). Two radiologists in consensus assessed subjective image quality of the virtual 3D images.ResultsThere were no significant differences in subjective image quality (P = .661). All examinations were rated “excellent” or “good” for diagnostic confidence. The mean total for DLP/E was 143.4 ± 29.8 mGy/3.00 ± 0.40 mSv in the SDP and therefore significantly higher than in the LDP with 36.9 ± 8.7 mGy/0.75 ± 0.16 mSv (P 
  • Semiautomatic Assessment of the Terminal Ileum and Colon in Patients with
           Crohn Disease Using MRI (the VIGOR++ Project)
    • Abstract: Publication date: August 2018Source: Academic Radiology, Volume 25, Issue 8Author(s): Carl A.J. Puylaert, Peter J. Schüffler, Robiel E. Naziroglu, Jeroen A.W. Tielbeek, Zhang Li, Jesica C. Makanyanga, Charlotte J. Tutein Nolthenius, C. Yung Nio, Douglas A. Pendsé, Alex Menys, Cyriel Y. Ponsioen, David Atkinson, Alastair Forbes, Joachim M. Buhmann, Thomas J. Fuchs, Haralambos Hatzakis, Lucas J. van Vliet, Jaap Stoker, Stuart A. Taylor, Frans M. VosRationale and ObjectivesThe objective of this study was to develop and validate a predictive magnetic resonance imaging (MRI) activity score for ileocolonic Crohn disease activity based on both subjective and semiautomatic MRI features.Materials and MethodsAn MRI activity score (the “virtual gastrointestinal tract [VIGOR]” score) was developed from 27 validated magnetic resonance enterography datasets, including subjective radiologist observation of mural T2 signal and semiautomatic measurements of bowel wall thickness, excess volume, and dynamic contrast enhancement (initial slope of increase). A second subjective score was developed based on only radiologist observations. For validation, two observers applied both scores and three existing scores to a prospective dataset of 106 patients (59 women, median age 33) with known Crohn disease, using the endoscopic Crohn's Disease Endoscopic Index of Severity (CDEIS) as a reference standard.ResultsThe VIGOR score (17.1 × initial slope of increase + 0.2 × excess volume + 2.3 × mural T2) and other activity scores all had comparable correlation to the CDEIS scores (observer 1: r = 0.58 and 0.59, and observer 2: r = 0.34–0.40 and 0.43–0.51, respectively). The VIGOR score, however, improved interobserver agreement compared to the other activity scores (intraclass correlation coefficient = 0.81 vs 0.44–0.59). A diagnostic accuracy of 80%–81% was seen for the VIGOR score, similar to the other scores.ConclusionsThe VIGOR score achieves comparable accuracy to conventional MRI activity scores, but with significantly improved reproducibility, favoring its use for disease monitoring and therapy evaluation.
  • Dual-phase Cone-beam CT-based Navigation Imaging Significantly Enhances
           Tumor Detectability and Aids Superselective Transarterial
           Chemoembolization of Liver Cancer
    • Abstract: Publication date: August 2018Source: Academic Radiology, Volume 25, Issue 8Author(s): Xuesong Yao, Dong Yan, Xianxian Jiang, Xiao Li, Huiying Zeng, Dezhong Liu, Huai LiRationale and ObjectivesThe objective of this study was to investigate the impact of a dual-phase cone-beam computed tomography (DP-CBCT)-based navigation imaging during transarterial chemoembolization (TACE) of hepatocellular carcinoma (HCC) in a perspective randomized study.Materials and MethodsForty-two patients with HCC (39 men, 57 ± 9 years, 13 first-time TACE) underwent TACE using three-dimensional image guidance with automatic detection of tumor-feeding vessels computed from DP-CBCT (early and delayed arterial phases). Forty-nine other patients with HCC (44 men, 55 ± 12 years, 14 first-time TACE) were treated conventionally using digital subtraction angiography (DSA). Tumor detectability in DP-CBCT was compared to DSA and preoperative CT or magnetic resonance (MR) imaging. Tumor-feeding vessel visibility was rated (good, fair, and poor) intraoperatively by the operators. The superselective embolization success rate, the number of DSA acquisitions, fluoroscopy time, and patient radiation dose were collected and compared using paired t test and the Mann-Whitney U test.ResultsTumor detection of DP-CBCT was superior to DSA (100% vs 83%, P = .001) and comparable to CT-MR (96%, P = .456). Tumor and feeder visibilities were significantly enhanced by DP-CBCT (P 
  • Adaptive Iterative Dose Reduction 3D Integrated with Automatic Tube
           Current Modulation for CT Coronary Artery Calcium Quantification:
           Comparison to Traditional Filtered Back Projection in an Anthropomorphic
           Phantom and Patients
    • Abstract: Publication date: August 2018Source: Academic Radiology, Volume 25, Issue 8Author(s): Ya-Chun Tang, Yuan-Chang Liu, Ming-Yi Hsu, Hui-Yu Tsai, Chien-Ming ChenRationale and ObjectivesWe aimed to evaluate integrated adaptive iterative dose reduction 3D (AIDR 3D) algorithm in automatic tube current modulation (ATCM) for the quantification of coronary artery calcium score (CACS) and cardiac risk stratification.Materials and MethodsA thoracic phantom with calcium inserts of known densities was scanned with filtered back projection (FBP) and AIDR 3D algorithms in small- and medium-sized phantoms. Twenty-four patients underwent two consecutive scans of CACS with FBP and AIDR 3D algorithms. The absolute Agatston score, Agatston score risk, volume score, and Agatston score percentile-based risk were compared, and concordance coefficients and agreement plots were made.ResultsAgatston and volume scores were significantly different between the phantom sizes (P 
  • Shear Wave Speed of the Lesion in Preoperative Breast Ultrasonography:
           Association with Disease-free Survival of Patients with Primary Operable
           Invasive Breast Cancer
    • Abstract: Publication date: August 2018Source: Academic Radiology, Volume 25, Issue 8Author(s): Youichi Machida, Akiko Shimauchi, Hidemi Okuma, Mitsuhiro Tozaki, Sachiko Isobe, Eisuke FukumaRationale and ObjectivesWe aimed to investigate the relationship between shear wave speed (SWS) of the lesion on preoperative breast ultrasonography (US) and disease-free survival of patients with primary operable invasive breast cancer.Materials and MethodsThis retrospective study was approved by our Institutional Review Board. The requirement for informed consent was waived. A total of 195 consecutive newly diagnosed invasive breast cancer patients (age 33–83 years; mean 54.0 years) with preoperative breast US with SWS measurement of the lesion were identified. They underwent surgery between May 2012 and May 2013. SWS was measured at the center and three marginal zones in the main tumors, and the maximum value was used for analyses. For 35 patients who underwent primary systemic therapy (PST), the maximum SWS before PST was used. Cox proportional hazards modeling was used to identify the relationship between clinical-pathologic factors and disease-free survival.ResultsFourteen recurrences occurred at 6–47 months (mean 22.3 months) after surgery. On multivariate analysis, a positive history of PST (hazard ratio [HR] = 4.93; 95% confidence interval [CI]: 1.66, 14.70; P = .004), adjuvant chemotherapy (HR = 3.67; 95% CI: 1.11, 12.1; P = .033), and higher maximum SWS (HR = 1.55; 95% CI: 1.07, 2.23; P = .020) were associated with poorer disease-free survival.ConclusionHigher maximum SWS on preoperative US, in addition to a positive history of PST and adjuvant chemotherapy, was significantly associated with poorer disease-free survival of patients with invasive breast cancer.
  • Utility of Clinical Parameters and Multiparametric MRI as Predictive
           Factors for Differentiating Uterine Sarcoma From Atypical Leiomyoma
    • Abstract: Publication date: August 2018Source: Academic Radiology, Volume 25, Issue 8Author(s): Qiu Bi, Zhibo Xiao, Fajin Lv, Yao Liu, Chunxia Zou, Yiqing ShenObjectivesThe objective of this study was to find clinical parameters and qualitative and quantitative magnetic resonance imaging (MRI) features for differentiating uterine sarcoma from atypical leiomyoma (ALM) preoperatively and to calculate predictive values for uterine sarcoma.Materials and MethodsData from 60 patients with uterine sarcoma and 88 patients with ALM confirmed by surgery and pathology were collected. Clinical parameters, qualitative MRI features, diffusion-weighted imaging with apparent diffusion coefficient values, and quantitative parameters of dynamic contrast-enhanced MRI of these two tumor types were compared. Predictive values for uterine sarcoma were calculated using multivariable logistic regression.ResultsPatient clinical manifestations, tumor locations, margins, T2-weighted imaging signals, mean apparent diffusion coefficient values, minimum apparent diffusion coefficient values, and time-signal intensity curves of solid tumor components were obvious significant parameters for distinguishing between uterine sarcoma and ALM (all P 
  • Fat Necrosis of the Breast: Magnetic Resonance Imaging Characteristics and
           Pathologic Correlation
    • Abstract: Publication date: August 2018Source: Academic Radiology, Volume 25, Issue 8Author(s): Hebatallah Hassan Mamdouh Hassan, Amr Magdi El Abd, Amany Abdel Bary, Nagy N.N. NaguibRationale and ObjectivesThis study aims to describe the magnetic resonance imaging (MRI) features of fat necrosis on magnetic resonance mammography, which may downstage a suspicious lesion to a merely benign finding.Materials and MethodsThis prospective study included 82 female patients (mean age 50 years) who were diagnosed to have suspicious lesions by mammography, ultrasonography or both. All patients underwent MRI including diffusion-weighted imaging and spectroscopy. Image postprocessing and analysis included signal intensity, enhancement characteristics, diffusion restriction, and spectroscopic analysis. All patients underwent histopathological analysis for confirmation. Sensitivity, specificity, positive predictive value (PPV), and negative (NPV) predictive value were calculated.ResultsTo label a lesion as fat necrosis on MRI analysis, presence of fat signal in a lesion revealed sensitivity of 98.04%, specificity of 100%, PPV of 100%, and NPP of 96.88%, whereas nonenhancement of the lesion itself revealed sensitivity of 96.08%, specificity of 100%, PPV of 100%, and NPP of 93.94%. However, adding both the nonrestriction on diffusion analysis and the lack of tCholine at 3.22 ppm increased the sensitivity and specificity to 100%, as well as PPV of 100% for fat necrosis and hence a NPV for malignancy of 100%.ConclusionsMRI proved to be of value in differentiating fat necrosis from malignancy based on the molecular composition of fat necrosis, clearly depicted by MRI without the need for invasive confirmation by biopsy.
  • Using Convolutional Neural Networks for Enhanced Capture of Breast
           Parenchymal Complexity Patterns Associated with Breast Cancer Risk
    • Abstract: Publication date: August 2018Source: Academic Radiology, Volume 25, Issue 8Author(s): Aimilia Gastounioti, Andrew Oustimov, Meng-Kang Hsieh, Lauren Pantalone, Emily F. Conant, Despina KontosRationale and ObjectivesWe evaluate utilizing convolutional neural networks (CNNs) to optimally fuse parenchymal complexity measurements generated by texture analysis into discriminative meta-features relevant for breast cancer risk prediction.Materials and MethodsWith Institutional Review Board approval and Health Insurance Portability and Accountability Act compliance, we retrospectively analyzed “For Processing” contralateral digital mammograms (GE Healthcare 2000D/DS) from 106 women with unilateral invasive breast cancer and 318 age-matched controls. We coupled established texture features (histogram, co-occurrence, run-length, structural), extracted using a previously validated lattice-based strategy, with a multichannel CNN into a hybrid framework in which a multitude of texture feature maps are reduced to meta-features predicting the case or control status. We evaluated the framework in a randomized split-sample setting, using the area under the curve (AUC) of the receiver operating characteristic (ROC) to assess case-control discriminatory capacity. We also compared the framework to CNNs directly fed with mammographic images, as well as to conventional texture analysis, where texture feature maps are summarized via simple statistical measures that are then used as inputs to a logistic regression model.ResultsStrong case-control discriminatory capacity was demonstrated on the basis of the meta-features generated by the hybrid framework (AUC = 0.90), outperforming both CNNs applied directly to raw image data (AUC = 0.63, P 
  • Artificial Intelligence and Radiology: Have Rumors of the Radiologist's
           Demise Been Greatly Exaggerated'
    • Abstract: Publication date: August 2018Source: Academic Radiology, Volume 25, Issue 8Author(s): Tomer Nawrocki, Pierre D. Maldjian, Shira E. Slasky, Sohail G. ContractorArtificial intelligence is a rapidly evolving computerized technology affecting multiple aspects of our lives. It is predicted that artificial intelligence will lead to a fundamental change in practice of many professional fields, including medicine. One of the most significant advances in artificial intelligence involves digital imaging and image recognition. Consequently, radiologists, who work in the most digitalized field of medicine, need to be familiar with this rapidly progressing technology. “Artificial intelligence,” “machine learning,” and “deep learning” are terms that tend to be used interchangeably in terms of advanced computer algorithms, but each has a different meaning. Objectives for this article are to demystify these terms for radiologists and to establish a basic understanding of this topic for the reader. We also discuss the impact that artificial intelligence might have on the field of radiology in the foreseeable future. Although artificial intelligence is unlikely to replace radiologists any time soon (if ever), we explore how this technology could be beneficial to radiologists.
  • Radiology “Hits Refresh” with Artificial Intelligence
    • Abstract: Publication date: August 2018Source: Academic Radiology, Volume 25, Issue 8Author(s): Srini Tridandapani
  • Image Quality on Dual-energy CTPA Virtual Monoenergetic Images:
           Quantitative and Qualitative Assessment
    • Abstract: Publication date: August 2018Source: Academic Radiology, Volume 25, Issue 8Author(s): Bari Dane, Hersh Patel, Thomas O'Donnell, Francis Girvin, Geraldine Brusca-Augello, Jeffrey B. Alpert, Bowen Niu, Mariam Attia, James Babb, Jane P. KoRationale and ObjectivesThis study aims to determine the optimal photon energy for image quality of the pulmonary arteries (PAs) on dual-energy computed tomography (CT) pulmonary angiography (CTPA) utilizing low volumes of iodinated contrast.Materials and MethodsThe study received institutional review board exemption and was Health Insurance Portability and Accountability Act compliant. Adults (n = 56) who underwent dual-energy CTPA with 50–60 cc of iodinated contrast on a third-generation dual-source multidetector CT were retrospectively and consecutively identified. Twelve virtual monoenergetic kiloelectron volt (keV) image data sets (40–150 keV, 10-keV increments) were generated with a second-generation noise-reducing algorithm. Standard regions of interest were placed on main, right, left, and right interlobar pulmonary arteries; pectoralis muscle; and extrathoracic air. Attenuation [mean CT number (Hounsfield unit, HU)], noise [standard deviation (HU)], signal to noise (SNR), and contrast to noise ratio were evaluated. Three blinded chest radiologists rated (from 1 to 5, with 5 being the best) randomized monoenergetic and weighted-average images for attenuation and noise. P 
  • Low Dose Lung CT Screening in an Asian Population
    • Abstract: Publication date: Available online 13 July 2018Source: Academic RadiologyAuthor(s): David P. Naidich
  • Evaluation on Heterogeneity of Fatty Liver in Rats: A Multiparameter
           Quantitative Analysis by Dual Energy CT
    • Abstract: Publication date: Available online 2 July 2018Source: Academic RadiologyAuthor(s): Qiuting Cao, Shufan Shang, Xinjun Han, Di Cao, Liqin ZhaoRationale and ObjectivesTo investigate the value of using rapid kVp switching dual energy computed tomography (rsDECT) for the multi-parameter analysis of the heterogeneity of fatty liver in rat.Materials and MethodsTwenty-four male rats were randomly divided into experimental (n = 16) and control (n = 8) groups. Four rats in the experimental group and two in the control group were examined by rsDECT every 3 weeks starting from week 8. The liver fat contents (LFC) of the left and right liver lobes were measured on the fat(water)-based material decomposition images to calculate fat content and CT value of liver and spleen were measured on the 70keV monochromatic images to calculate the liver-to-spleen CT value ratio [(L/S)70 keV] and difference at 70keV[(L−S)70 keV], and the spectral curve slopes of the left and right liver lobes (Slope-L, Slope-R). Measurements were evaluated statistically.ResultsThe statistical analysis showed that the (L/S)70 keV, (L−S)70 keV, Slope and LFC in the different fatty liver groups were all significantly different (p < 0.05). Pearson correlation analysis results showed that the rsDECT results of the left and right liver lobes correlated with the fat percentage from pathological analysis (p < 0.05), with the left liver lobe having better correlation. Paired t-tests showed that the fat percentage of the left liver lobe was significantly higher than that of the right one, while (L/S)70 keV, and (L−S)70 keV were significantly lower. Diagnostic analysis using ROC curve showed that the areas under the curves with parameters of the left liver lobe were also greater than those of the right liver lobe.ConclusionrsDECT multi-parameter imaging could quantitatively evaluate the heterogeneity of fat deposition in the liver, providing valuable information for the accurate and effective assessment of the heterogeneity of fatty liver.
  • Metabolic Changes of Brain Developmental Venous Anomalies on
    • Abstract: Publication date: Available online 28 June 2018Source: Academic RadiologyAuthor(s): Jillian W. Lazor, J. Eric Schmitt, Laurie A. Loevner, S. Ali NabavizadehRationale and ObjectivesTo determine the metabolic effects of developmental venous anomalies (DVAs) and to correlate those effects with conventional magnetic resonance imaging (MRI) findings.Materials and MethodsWe conducted a retrospective review of MRI and brain 18F-fluorodeoxyglucose positron emission tomography (18F-FDG-PET) examinations in subjects with DVAs. Conventional MRI was used to determine DVA number, location, size, and associated parenchymal findings such as atrophy, hemorrhage, cavernoma, capillary telangiectasia, cortical dysplasia/polymicrogyria, and white matter signal abnormality. Qualitative and quantitative measures of relative metabolism in the drainage territory of the DVA were measured on 18F-FDG-PET.ResultsFifty-four subjects with 57 DVAs were included in the analysis. 38% were associated with qualitative and quantitative metabolic abnormalities on 18F-FDG-PET, with decreased metabolism in the parenchyma surrounding all but one of these DVAs. DVAs draining gray matter were significantly more likely to be hypometabolic than those draining only white matter, suggesting that the metabolic effects of DVAs may be underestimated on 18F-FDG-PET.ConclusionAltered metabolism is seen in the drainage territory of a significant proportion of DVAs, suggesting that these anomalies are vascular lesions with abnormal physiologic features.
  • Association Between BRAFV600E Mutation and the American College of
           Radiology Thyroid Imaging, Reporting and Data System in Solitary Papillary
           Thyroid Carcinoma
    • Abstract: Publication date: Available online 23 June 2018Source: Academic RadiologyAuthor(s): Ronger Shangguan, Yuan-Ping Hu, Jun Huang, Shao-Jun Yang, Ling Ye, Ri-Xu Lin, Jian Zhu, Tong-Long Zhang, Li Ying, Peng LiRationale and Objectives: The purpose of this study was to evaluate the associations between BRAFV600E mutation, the American College of Radiology (ACR) thyroid imaging, reporting and data system (TI-RADS) on ultrasound and clinicopathological characteristics in patients with a solitary papillary thyroid carcinoma (PTC).Materials and Methods: This retrospective study included 397 patients with a solitary PTC, proved pathologically. BRAFV600E mutation status was detected in postoperative samples by real-time fluorescent polymerase chain reaction. Associations of BRAFV600E mutation with the ACR TI-RADS and clinicopathological characteristics were analyzed.Results: In this study, the incidence of BRAFV600E mutation was 81.4% (323/397) in patients with a solitary PTC. Univariate analyses showed that BRAFV600E mutation was significantly associated with margin, higher ACR TI-RADS point scores, and Hashimoto's thyroiditis. In multivariate analyses, lobulated or irregular margin was independently associated with BRAFV600E mutation in total solitary PTC. Furthermore, both in total solitary PTC and papillary thyroid microcarcinoma, BRAFV600E mutation was associated with ACR TI-RADS point scores, which was positively correlated with the risk of BRAFV600E mutation. There was no significant relationship between BRAFV600E mutation and ACR TI-RADS point scores in PTC>10mm. In addition, Hashimoto's thyroiditis had a significant negative association with BRAFV600E mutation.Conclusion: A lobulated or irregular margin of the thyroid nodule is independently associated with BRAFV600E mutation in patients with PTC. In addition, higher ACR TI-RADS point scores is an independent risk factor for BRAFV600E mutation, and ACR TI-RADS point scores is positively associated with the risk of BRAFV600E mutation in solitary PTC, especially in papillary thyroid microcarcinoma. Our findings may be helpful for preoperative identification and medical management of PTC patients with BRAFV600E mutation.
  • The Long-To-Short-Axis Ratio and Multifocality are Associated With TP53
           Mutation Status in Surgically Resected Hepatocellular Carcinomas
    • Abstract: Publication date: Available online 23 June 2018Source: Academic RadiologyAuthor(s): Xiaodong Wang, Dongying Chen, Bin ChenRationale and ObjectivesIn hepatocellular carcinoma (HCC), the tumor protein 53 (TP53) gene is frequently mutated and the mutations have been associated with poor prognosis. We aim to retrospectively identify the relationship between TP53 mutation status, tumor size (long-axis diameter, short-axis diameter, and long-to-short-axis ratio [L/S ratio]), margin and multifocality in surgically resected HCC.Materials and MethodsThe image features and TP53 mutation data from 78 patients generated with National Cancer Institute's multi-institutional The Cancer Genome Atlas (TCGA)/The Cancer Imaging Archive databases were assessed. Binary logistic regression analyses were performed to identify independent factors of harboring TP53 mutation status. The final model was selected by using the backward elimination method.ResultsTP53 mutations were found in 19 (31.5%) of 78 patients. TP53 mutation rates were significantly higher (a) in L/S ratio ≤ 1.2 14 of 41 [34.1%]) lesions than in L/S ratio>1.2 lesions (five of 37 [13.5%]) (p = 0.034) and (b) in nonmultifocality (17 of 54[31.5%]) than in multifocality lesions (two of 24 [8.3%]) (p = 0.028). On univariate logistic regression analysis, L/S ratio (≤1.20vs>1.20. odds ratio [OR]: 3.319; p = 0.040; 95% confidence interval [CI]: 1.059–10.401 Area Under Curve (AUC) = 0.634) and multifocality (no vs yes OR: 5.054; p = 0.041; 95% CI: 1.065–23.986 AUC = 0.640) were associated with TP53 mutations. On multivariate logistic regression analysis, L/S ratio (≤1.20vs>1.20 OR: 3.430; p = 0.040; 95% CI: 1.058–11.118) and multifocality (no vs yes OR: 5.232; p = 0.041; 95% CI: 1.072–25.526) were associated with TP53 mutations. The area under the receiver operating characteristic curve for predicting TP53 mutation status was 0.714 (95% CI: 0.590–0.837).ConclusionOur study focusing on identifying imaging aspects related to TP53 positive HCC. L/S ratio of HCC in combination with multifocality might be used to prognosticate TP53 mutation status. And the discriminatory power for this prediction model was good.
  • 68Ga-PSMA PET/CT in Patients with Rising Prostatic-Specific Antigen After
           Definitive Treatment of Prostate Cancer: Detection Efficacy and Diagnostic
    • Abstract: Publication date: Available online 21 June 2018Source: Academic RadiologyAuthor(s): Maged Abdel Galil Hamed, Mohammad Abd Alkhalik Basha, Hussien Ahmed, Ahmed Ali Obaya, Amira Hamed Mohamed Afifi, Eman H. AbdelbaryRationale and Objectives68Ga-prostate-specific membrane antigen-11 (68Ga-PSMA-11) is a recently developed positron emission tomography (PET) tracer that can detect prostate cancer (PC) relapses and metastases with high contrast resolution. The aim of this study was to assess the detection efficacy and diagnostic accuracy of 68Ga-PSMA PET/CT image in patients with rising prostatic-specific antigen (PSA) after treatment of PC.Materials and MethodsThe present prospective study included 188 patients who exhibited rising of PSA level on a routine follow-up examination after definitive treatment of PC. All patients underwent a 68Ga-PSMA PET/CT examination. For each patient, we determined the disease stage, the Gleason score, and the maximum standardized uptake value of the local recurrence and extraprostatic metastases. The detection efficacy and diagnostic accuracy of 68Ga-PSMA PET/CT were established by histopathology and clinical and imaging follow-up as the reference standards.Results68Ga-PSMA PET/CT detected tumour relapse in 165 patients (35 patients had local recurrence, 106 patients had extraprostatic metastases, and 24 patients had combined lesions). The sensitivity, specificity, and accuracy values of 68Ga-PSMA PET/CT examination in the detection of PC recurrence were 98.8%, 100%, and 98.8%, respectively. 68Ga-PSMA PET/CT revealed an overall detection rate of 87.8% (165/188) in patients with rising PSA (median of 2.2 ng/mL, and range of 0.01–70 ng/mL).Conclusion68Ga-PSMA PET/CT is a valuable tool for the detection of PC local recurrence or extraprostatic metastases following rising PSA levels after primary definitive therapy and should be incorporated during routine work-up.
  • Implementation of an Innovative Tablet-based Curriculum for Radiology
           Resident Education
    • Abstract: Publication date: Available online 20 June 2018Source: Academic RadiologyAuthor(s): Mina S. Makary, Summit H. Shah, Rose J. Miller, Steven P. Doukides, Mark A. KingRationale and ObjectivesThe aim of this study was to prospectively examine the impact of a tablet-based curriculum on the radiology resident educational experience.Materials and MethodsA comprehensive tablet-based curriculum was developed by creating subspecialty modules with appropriate content level for each required rotation at our diagnostic radiology residency program. Daily assignments included key learning points, readings, and reference presentation slides, covering all objectives published by the ABR Core Exam Study Guide. Residents were provided with iPad devices preconfigured with the curriculum and online access to most major radiology textbooks available in our institutional digital library. Assessment surveys were administered at baseline and 12 months following curriculum implementation.ResultsTwenty-two residents completed both surveys. In comparing the pre versus postsurvey results, 32% versus 73% residents agreed or strongly agreed that study resources were well-organized, 41% versus 91% agreed or strongly agreed that study resources were easily accessible, 27% versus 77% agreed or strongly agreed that the modules encouraged active learning, 18% versus 82% agreed or strongly agreed that resources motivate them to study daily, 36% versus 82% agreed or strongly agreed that the resources adequately prepared the resident for the radiology board exam, and 36% versus 82% agreed or strongly agreed that they were satisfied with the resources provided by the residency program (p < 0.05).ConclusionOur study demonstrated the positive impact of implementing a complete tablet-based curriculum on radiology resident motivation, satisfaction, and engagement. Use of mobile tablet devices has the potential to dramatically transform content delivery in residency education.
  • Transjugular Intrahepatic Portosystemic Shunt:The Impact of Portal Venous
           Pressure Declines on Shunt Patency and Clinical Efficacy
    • Abstract: Publication date: Available online 20 June 2018Source: Academic RadiologyAuthor(s): Yue-Meng Wan, Yu-Hua Li, Zhi-Yuan Xu, Hua-Mei Wu, Xi-Nan Wu, Ying Xu, Tao GuoRationale and ObjectivesTransjugular intrahepatic portosystemic shunt (TIPS) placement using the same-diameter covered stents can lead to differed declines of portal venous pressure declines (PVDs). This study aimed to compare the long-term shunt patency and clinical efficacy of TIPS placement that caused low PVDs (≤9 mmHg) and high PVDs (>9 mmHg).Materials and MethodsA total of 129 patients treated by TIPS placement with 8 mm-diameter polytetrafluoroethylene covered stents were included and analyzed retrospectively. They were stratified into group A with low PVDs (n = 69) and group B with high PVDs (n = 60).ResultsThe 6-year actuarial probabilities of remaining free of shunt dysfunction (47.2% vs 64.6%; p = 0.007) and variceal rebleeding (48.3% vs 63.9%; p = 0.038) were significantly lower in group A than in group B. The 6-year actuarial probability of remaining free of hepatic encephalopathy was significantly higher in group A than in group B (44.5% vs 32.5%; p = 0.010), though the 6-year cumulative survival rate was similar in both groups (A vs B: 65.5% vs 56.0%; p = 0.240). The baseline portal vein thrombosis (hazard ratio [HR]: 6.045, 95% confidence interval [CI]: 2.762–13.233; p = 0.000) and stent type (HR: 4.447, 95%CI: 1.711–11.559, p = 0.002) were associated with shunt dysfunction, whereas only ascites was associated with mortality (HR: 1.373, 95%CI: 1.114–3.215; p = 0.024).ConclusionHigh PVDs (>9 mmHg) were associated with higher shunt patency, lower incidence of variceal rebleeding, but higher frequency of hepatic encephalopathy and similar survival rate than low PVDs (≤9 mmHg) after TIPS placement.
  • Evaluation of the Talar Cartilage in Chronic Lateral Ankle Instability
           with Lateral Ligament Injury Using Biochemical T2* Mapping: Correlation
           with Clinical Symptoms
    • Abstract: Publication date: Available online 20 June 2018Source: Academic RadiologyAuthor(s): Yiwen Hu, Hongyue Tao, Yang Qiao, Kui Ma, Yinghui Hua, Xu Yan, Shuang ChenRationale and ObjectivesThis study aims to quantitatively compare T2* measurements of the talar cartilage between chronic lateral ankle instability (LAI) patients with lateral ligament injury and healthy volunteers, and to assess the association of T2* value with American Orthopedic Foot and Ankle Society (AOFAS) score.Materials and MethodsNineteen consecutive patients with chronic LAI (LAI group) and 19 healthy individuals (control group) were enrolled. Biochemical magnetic resonance examination of the ankle was performed in all participants using three-dimensional gradient-echo T2* mapping. Total talar cartilage was divided into six subcompartments, including medial anterior (MA), central medial, medial posterior, lateral anterior, central lateral (LC), and lateral posterior regions. T2* values of respective cartilage areas were measured and compared between the two groups using Student t test. AOFAS scoring was performed for clinical evaluation. Then, the association of T2* value with AOFAS score was evaluated by Pearson correlation.ResultsThe T2* values of total talar cartilage, as well as MA and LC cartilage compartments, in the chronic LAI group were significantly higher than control values (P 
  • Interobserver Variation in Response Evaluation Criteria in Solid Tumors
    • Abstract: Publication date: Available online 20 June 2018Source: Academic RadiologyAuthor(s): Arunabha Karmakar, Apeksha Kumtakar, Himanshu Sehgal, Savith Kumar, Arjun KalyanpurPurposeResponse Evaluation Criteria in Solid Tumors (RECIST 1.1) is the gold standard for imaging response evaluation in cancer trials. We sought to evaluate consistency of applying RECIST 1.1 between 2 conventionally trained radiologists, designated as A and B; identify reasons for variation; and reconcile these differences for future studies.MethodsThe study was approved as an institutional quality check exercise. Since no identifiable patient data was collected or used, a waiver of informed consent was granted. Imaging case report forms of a concluded multicentric breast cancer trial were retrospectively reviewed. Cohen's kappa was used to rate interobserver agreement in Response Evaluation Data (target response, nontarget response, new lesions, overall response). Significant variations were reassessed by a senior radiologist to extrapolate reasons for disagreement. Methods to improve agreement were similarly ascertained.ResultsSixty one cases with total of 82 data-pairs were evaluated (35 data-pairs in visit 5, 47 in visit 9). Both radiologists showed moderate agreement in target response (n = 82; ĸ = 0.477; 95% confidence interval [CI]: 0.314–0.640-), nontarget response (n = 82; ĸ = 0.578; 95% CI: 0.213–0.944) and overall response evaluation in both visits (n = 82; ĸ = 0.510; 95% CI: 0.344–0.676). Further assessment demonstrated "Prevalence effect" of Kappa in some cases which led to underestimation of agreement. Percent agreement of overall response was 74.39% while percent variation was 25.6%. Differences in interpreting RECIST 1.1 and in radiological image interpretation were the primary sources of variation. The commonest overall response was "Partial Response" (Rad A:45/82; Rad B:63/82).ConclusionInspite of moderate interobserver agreement, qualitative interpretation differences in some cases increased interobserver variability. Protocols such as Adjudication, to reduce easily avoidable inconsistencies are or should be a part of the Standard Operating Procedure in imaging institutions. Based on our findings, a standard checklist has been developed to help reduce the interpretation error-margin for future studies. Such check-lists may improve interobserver agreement in the preadjudication phase thereby improving quality of results and reducing adjudication per case ratio.Clinical RelevanceImproving data reliability when using RECIST 1.1 will reflect in better cancer clinical trial outcomes. A checklist can be of use to imaging centers to assess and improve their own processes.
  • Functional Pulmonary Magnetic Resonance Imaging for Detection of Ischemic
           Injury in a Porcine Ex-Vivo Lung Perfusion System Prior to Transplantation
    • Abstract: Publication date: Available online 19 June 2018Source: Academic RadiologyAuthor(s): Julius Renne, Marcel Gutberlet, Andreas Voskrebenzev, Agilo Kern, Till Kaireit, Jan B Hinrichs, Peter Braubach, Christine S Falk, Klaus Höffler, Gregor Warnecke, Patrick Zardo, Axel Haverich, Frank Wacker, Jens Vogel-Claussen, Norman ZinneRationale and ObjectivesTo evaluate the feasibility of multiparametric magnetic resonance imaging (MRI) of the lungs to detect impaired organ function in a porcine model of ischemic injury within an ex-vivo lung perfusion system (EVLP) prior to transplantation.Materials and MethodsTwelve pigs were anesthetized, and left lungs were clamped to induce warm ischemia for 3hours. Right lungs remained perfused as controls. Lungs were removed and installed in an EVLP for 12hours. Lungs in the EVLP were imaged repeatedly using computed tomography, proton MRI (1H-MRI) and fluorine MRI (19F-MRI). Dynamic contrast-enhanced derived parenchymal blood volume, oxygen washout times, and 19F washout times were calculated. PaO2 was measured for ischemic and normal lungs, wet/dry ratio was determined, histologic samples were assessed, and cytokines in the lung tissue were analyzed. Statistical analysis was performed using nonparametric testing.ResultsEleven pigs were included in the final analysis. Ischemic lungs showed significantly higher wet/dry ratios (p = 0.024), as well as IL-8 tissue levels (p = 0.0098). Histologic assessment as well as morphologic scoring of computed tomography and 1H-MRI did not revealsignificant differences between ischemic and control lungs. 19F washout (p = 0.966) and parenchymal blood flow (p = 0.32) were not significantly different. Oxygen washout was significantly prolonged in ischemic lungs compared to normal control lungs at the beginning (p = 0.018) and further prolonged at the end of the EVLP run (p = 0.005).ConclusionMultiparametric pulmonary MRI is feasible in lung allografts within an EVLP system. Oxygen-enhanced imaging seems to be a promising marker for ischemic injury, enabling detection of affected lung segments prior to transplantation.
  • Feasibility of Intravoxel Incoherent Motion for Differentiating Benign and
           Malignant Thyroid Nodules
    • Abstract: Publication date: Available online 19 June 2018Source: Academic RadiologyAuthor(s): Hui Tan, Jun Chen, Yi ling Zhao, Jin huan Liu, Liang Zhang, Chang sheng Liu, Dongjie HuangRationale and ObjectivesThis study aimed to preliminarily investigate the feasibility of intravoxel incoherent motion (IVIM) theory in the differential diagnosis of benign and malignant thyroid nodules.Materials and MethodsForty-five patients with 56 confirmed thyroid nodules underwent preoperative routine magnetic resonance imaging and IVIM diffusion-weighted imaging. The histopathologic diagnosis was confirmed by surgery. Apparent diffusion coefficient (ADC), perfusion fraction f, diffusivity D, and pseudo-diffusivity D* were quantified. Independent samples t test of IVIM-derived metrics were conducted between benign and malignant nodules. Receiver-operating characteristic analyses were performed to determine the optimal thresholds as well as the sensitivity and specificity for differentiating.ResultsSignificant intergroup difference was observed in ADC, D, D*, and f (p < 0.001). Malignant tumors featured significantly lower ADC, D and D* values and a higher f value than that of benign nodules. The ADC, D, and D* could distinguish the benign from malignant thyroid nodules, and parameter f differentiate the malignant tumors from benign nodules. The values of the area under the curve for parameter ADC, D, and D* were 0.784 (p = 0.001), 0.795 (p = 0.001), and 0.850 (p < 0.001), separately, of which the area under the curve of f value was the maximum for identifying the malignant from benign nodules, which was 0.841 (p < 0.001).ConclusionThis study suggested that ADC and IVIM-derived metrics, including D, D*, and f, could potentially serve as noninvasive predictors for the preoperative differentiating of thyroid nodules, and f value performed best in identifying the malignant from benign nodules among these parameters.
  • Detection of Pulmonary Nodule Growth with Chest Tomosynthesis: A Human
           Observer Study Using Simulated Nodules
    • Abstract: Publication date: Available online 19 June 2018Source: Academic RadiologyAuthor(s): Christina Söderman, Åse Allansdotter Johnsson, Jenny Vikgren, Rauni Rossi Norrlund, David Molnar, Maral Mirzai, Angelica Svalkvist, Lars Gunnar Månsson, Magnus BåthRationale and ObjectivesChest tomosynthesis has been suggested as a suitable alternative to CT for follow-up of pulmonary nodules. The aim of the present study was to investigate the possibility of detecting pulmonary nodule growth using chest tomosynthesis.Materials and MethodsSimulated nodules with volumes of approximately 100 mm3 and 300 mm3 as well as additional versions with increasing volumes were created. The nodules were inserted into images from pairs of chest tomosynthesis examinations, simulating cases where the nodule had either remained stable in size or increased in size between the two imaging occasions. Nodule volume growths ranging from 11% to 252% were included. A simulated dose reduction was applied to a subset of the cases. Cases differing in terms of nodule size, dose level, and nodule position relative to the plane of image reconstruction were included. Observers rated their confidence that the nodules were stable in size or not. The rating data for the nodules that were stable in size was compared to the rating data for the nodules simulated to have increased in size using ROC analysis.ResultsArea under the curve values ranging from 0.65 to 1 were found. The lowest area under the curve values were found when there was a mismatch in nodule position relative to the reconstructed image plane between the two examinations. Nodule size and dose level affected the results.ConclusionThe study indicates that chest tomosynthesis can be used to detect pulmonary nodule growth. Nodule size, dose level, and mismatch in position relative to the image reconstruction plane in the baseline and follow-up examination may affect the precision.
  • Monitoring and Follow-Up of High Radiation Dose Cases in Interventional
    • Abstract: Publication date: Available online 19 June 2018Source: Academic RadiologyAuthor(s): Brandon C. Perry, Christopher R. Ingraham, Brent K. Stewart, Karim Valji, Kalpana M. KanalRationale and ObjectivesTo assess the implementation of radiation dose monitoring software, create a process for clinical follow-up and documentation of high-dose cases, and quantify the number of patient reported radiation-induced tissue reactions in fluoroscopically guided interventional radiology (IR) and neuro-interventional radiology (NIR) procedures.Materials and MethodsWeb-based radiation dose monitoring software was installed at our institution and a process to flag all procedures with reference point air kerma (Ka,r)> 5000 mGy was implemented. The entrance skin dose was estimated and formal reports generated, allowing for physician-initiated clinical follow-up. To evaluate our process, we reviewed all IR and NIR procedures performed at our hospital over a 1-year period. For all procedures with Ka,r> 5000 mGy, retrospective medical chart review was performed to evaluate for patient reported tissue reactions.ResultsThree thousand five hundred eighty-two procedures were performed over the 1-year period. The software successfully transferred dose data on 3363 (93.9%) procedures. One thousand three hundred ninety-three (368 IR and 1025 NIR) procedures were further analyzed after excluding 2189 IR procedures with Ka,r < 2000 mGy. Ten of 368 (2.7%) IR and 52 of 1025 (5.1%) NIR procedures exceeded estimated skin doses of 5000 mGy. All 10 IR cases were abdominal/pelvic trauma angiograms with/without embolization; there were no reported tissue reactions. Of 52 NIR cases, 49 were interventions and 3 were diagnostic angiograms. Five of 49 (10.2%) NIR patients reported skin/hair injuries, all of which were temporary.ConclusionSoftware monitoring and documentation of radiation dose in interventional procedures can be successfully implemented. Radiation-induced tissue reactions are relatively uncommon.
  • Learning How Professionalism Evolves: Lessons From the Law
    • Abstract: Publication date: Available online 15 June 2018Source: Academic RadiologyAuthor(s): Richard B. Gunderman, Mark J. Mutz
  • Intracranial Aneurysm Wall Enhancement Associated with Aneurysm Rupture: A
           Systematic Review and Meta-analysis
    • Abstract: Publication date: Available online 13 June 2018Source: Academic RadiologyAuthor(s): Xinrui Wang, Chengcheng Zhu, Yue Leng, Andrew J. Degnan, Jianping LuRationale and ObjectivesAneurysm wall enhancement (AWE) on magnetic resonance vessel wall imaging has been proposed as an imaging marker of aneurysm wall inflammation and instability. We performed a systematic review and meta-analysis to summarize the association between AWE and aneurysm rupture.Materials and MethodsWe performed a comprehensive literature search of studies evaluating the association between AWE and aneurysm rupture. We abstracted the following study data: study design, patient demographics, aneurysm characteristics, MRI protocols, and AWE assessment. We performed meta-analysis using a random-effects model. Study heterogeneity was assessed by using the Cochrane Q and I2 statistic, and publication bias was examined by using the Begg–Mazumdar test.ResultsFive studies with 492 subjects met eligibility for systematic review. We found a significant positive overall association between AWE and aneurysm rupture, with an odds ratio (OR) of 34.26 (95% confidence interval [CI] 10.20–115.07, p < 0.001). No significant heterogeneity (Q = 5.38, p = 0.25; I2 = 26%) or publication bias (p = 1.000) was present. In the separate analysis of circumferential AWE and aneurysm rupture, we identified marked heterogeneity across studies (Q = 21.23, p < 0.001; I2 = 86%). Further subgroup analysis considering the effect of aneurysm size showed that the strength of association between circumferential AWE and aneurysm rupture was significant in small aneurysms (
  • Single Injection Dual-Phase Cone Beam CT (DP-CBCT): Vascular Anatomy
           Assessment and Occult Nodule Detection; Have We Reached the Focus'
    • Abstract: Publication date: Available online 12 June 2018Source: Academic RadiologyAuthor(s): Pierleone Lucatelli, Gianluca De Rubeis, Renato Argirò, Mario Corona, Mario Bezzi
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