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Showing 1 - 200 of 3118 Journals sorted alphabetically
A Practical Logic of Cognitive Systems     Full-text available via subscription   (Followers: 7)
AASRI Procedia     Open Access   (Followers: 15)
Academic Pediatrics     Hybrid Journal   (Followers: 25, SJR: 1.402, h-index: 51)
Academic Radiology     Hybrid Journal   (Followers: 22, SJR: 1.008, h-index: 75)
Accident Analysis & Prevention     Partially Free   (Followers: 89, SJR: 1.109, h-index: 94)
Accounting Forum     Hybrid Journal   (Followers: 25, SJR: 0.612, h-index: 27)
Accounting, Organizations and Society     Hybrid Journal   (Followers: 30, SJR: 2.515, h-index: 90)
Achievements in the Life Sciences     Open Access   (Followers: 4)
Acta Anaesthesiologica Taiwanica     Open Access   (Followers: 5, SJR: 0.338, h-index: 19)
Acta Astronautica     Hybrid Journal   (Followers: 371, SJR: 0.726, h-index: 43)
Acta Automatica Sinica     Full-text available via subscription   (Followers: 3)
Acta Biomaterialia     Hybrid Journal   (Followers: 27, SJR: 2.02, h-index: 104)
Acta Colombiana de Cuidado Intensivo     Full-text available via subscription   (Followers: 1)
Acta de Investigación Psicológica     Open Access   (Followers: 2)
Acta Ecologica Sinica     Open Access   (Followers: 8, SJR: 0.172, h-index: 29)
Acta Haematologica Polonica     Free   (Followers: 1, SJR: 0.123, h-index: 8)
Acta Histochemica     Hybrid Journal   (Followers: 3, SJR: 0.604, h-index: 38)
Acta Materialia     Hybrid Journal   (Followers: 235, SJR: 3.683, h-index: 202)
Acta Mathematica Scientia     Full-text available via subscription   (Followers: 5, SJR: 0.615, h-index: 21)
Acta Mechanica Solida Sinica     Full-text available via subscription   (Followers: 9, SJR: 0.442, h-index: 21)
Acta Oecologica     Hybrid Journal   (Followers: 10, SJR: 0.915, h-index: 53)
Acta Otorrinolaringologica (English Edition)     Full-text available via subscription   (Followers: 1)
Acta Otorrinolaringológica Española     Full-text available via subscription   (Followers: 3, SJR: 0.311, h-index: 16)
Acta Pharmaceutica Sinica B     Open Access   (Followers: 2)
Acta Poética     Open Access   (Followers: 4)
Acta Psychologica     Hybrid Journal   (Followers: 25, SJR: 1.365, h-index: 73)
Acta Sociológica     Open Access  
Acta Tropica     Hybrid Journal   (Followers: 6, SJR: 1.059, h-index: 77)
Acta Urológica Portuguesa     Open Access  
Actas Dermo-Sifiliograficas     Full-text available via subscription   (Followers: 4)
Actas Dermo-Sifiliográficas (English Edition)     Full-text available via subscription   (Followers: 3)
Actas Urológicas Españolas     Full-text available via subscription   (Followers: 4, SJR: 0.383, h-index: 19)
Actas Urológicas Españolas (English Edition)     Full-text available via subscription   (Followers: 2)
Actualites Pharmaceutiques     Full-text available via subscription   (Followers: 5, SJR: 0.141, h-index: 3)
Actualites Pharmaceutiques Hospitalieres     Full-text available via subscription   (Followers: 4, SJR: 0.112, h-index: 2)
Acupuncture and Related Therapies     Hybrid Journal   (Followers: 5)
Acute Pain     Full-text available via subscription   (Followers: 13)
Ad Hoc Networks     Hybrid Journal   (Followers: 11, SJR: 0.967, h-index: 57)
Addictive Behaviors     Hybrid Journal   (Followers: 15, SJR: 1.514, h-index: 92)
Addictive Behaviors Reports     Open Access   (Followers: 6)
Additive Manufacturing     Hybrid Journal   (Followers: 7, SJR: 1.039, h-index: 5)
Additives for Polymers     Full-text available via subscription   (Followers: 22)
Advanced Cement Based Materials     Full-text available via subscription   (Followers: 3)
Advanced Drug Delivery Reviews     Hybrid Journal   (Followers: 136, SJR: 5.2, h-index: 222)
Advanced Engineering Informatics     Hybrid Journal   (Followers: 11, SJR: 1.265, h-index: 53)
Advanced Powder Technology     Hybrid Journal   (Followers: 17, SJR: 0.739, h-index: 33)
Advances in Accounting     Hybrid Journal   (Followers: 9, SJR: 0.299, h-index: 15)
Advances in Agronomy     Full-text available via subscription   (Followers: 15, SJR: 2.071, h-index: 82)
Advances in Anesthesia     Full-text available via subscription   (Followers: 27, SJR: 0.169, h-index: 4)
Advances in Antiviral Drug Design     Full-text available via subscription   (Followers: 3)
Advances in Applied Mathematics     Full-text available via subscription   (Followers: 6, SJR: 1.054, h-index: 35)
Advances in Applied Mechanics     Full-text available via subscription   (Followers: 11, SJR: 0.801, h-index: 26)
Advances in Applied Microbiology     Full-text available via subscription   (Followers: 22, SJR: 1.286, h-index: 49)
Advances In Atomic, Molecular, and Optical Physics     Full-text available via subscription   (Followers: 16, SJR: 3.31, h-index: 42)
Advances in Biological Regulation     Hybrid Journal   (Followers: 4, SJR: 2.277, h-index: 43)
Advances in Botanical Research     Full-text available via subscription   (Followers: 3, SJR: 0.619, h-index: 48)
Advances in Cancer Research     Full-text available via subscription   (Followers: 26, SJR: 2.215, h-index: 78)
Advances in Carbohydrate Chemistry and Biochemistry     Full-text available via subscription   (Followers: 9, SJR: 0.9, h-index: 30)
Advances in Catalysis     Full-text available via subscription   (Followers: 5, SJR: 2.139, h-index: 42)
Advances in Cell Aging and Gerontology     Full-text available via subscription   (Followers: 4)
Advances in Cellular and Molecular Biology of Membranes and Organelles     Full-text available via subscription   (Followers: 13)
Advances in Chemical Engineering     Full-text available via subscription   (Followers: 26, SJR: 0.183, h-index: 23)
Advances in Child Development and Behavior     Full-text available via subscription   (Followers: 10, SJR: 0.665, h-index: 29)
Advances in Chronic Kidney Disease     Full-text available via subscription   (Followers: 9, SJR: 1.268, h-index: 45)
Advances in Clinical Chemistry     Full-text available via subscription   (Followers: 29, SJR: 0.938, h-index: 33)
Advances in Colloid and Interface Science     Full-text available via subscription   (Followers: 18, SJR: 2.314, h-index: 130)
Advances in Computers     Full-text available via subscription   (Followers: 16, SJR: 0.223, h-index: 22)
Advances in Dermatology     Full-text available via subscription   (Followers: 12)
Advances in Developmental Biology     Full-text available via subscription   (Followers: 12)
Advances in Digestive Medicine     Open Access   (Followers: 7)
Advances in DNA Sequence-Specific Agents     Full-text available via subscription   (Followers: 6)
Advances in Drug Research     Full-text available via subscription   (Followers: 22)
Advances in Ecological Research     Full-text available via subscription   (Followers: 46, SJR: 3.25, h-index: 43)
Advances in Engineering Software     Hybrid Journal   (Followers: 26, SJR: 0.486, h-index: 10)
Advances in Experimental Biology     Full-text available via subscription   (Followers: 8)
Advances in Experimental Social Psychology     Full-text available via subscription   (Followers: 44, SJR: 5.465, h-index: 64)
Advances in Exploration Geophysics     Full-text available via subscription   (Followers: 3)
Advances in Fluorine Science     Full-text available via subscription   (Followers: 8)
Advances in Food and Nutrition Research     Full-text available via subscription   (Followers: 52, SJR: 0.674, h-index: 38)
Advances in Fuel Cells     Full-text available via subscription   (Followers: 16)
Advances in Genetics     Full-text available via subscription   (Followers: 15, SJR: 2.558, h-index: 54)
Advances in Genome Biology     Full-text available via subscription   (Followers: 11)
Advances in Geophysics     Full-text available via subscription   (Followers: 6, SJR: 2.325, h-index: 20)
Advances in Heat Transfer     Full-text available via subscription   (Followers: 22, SJR: 0.906, h-index: 24)
Advances in Heterocyclic Chemistry     Full-text available via subscription   (Followers: 9, SJR: 0.497, h-index: 31)
Advances in Human Factors/Ergonomics     Full-text available via subscription   (Followers: 26)
Advances in Imaging and Electron Physics     Full-text available via subscription   (Followers: 2, SJR: 0.396, h-index: 27)
Advances in Immunology     Full-text available via subscription   (Followers: 36, SJR: 4.152, h-index: 85)
Advances in Inorganic Chemistry     Full-text available via subscription   (Followers: 9, SJR: 1.132, h-index: 42)
Advances in Insect Physiology     Full-text available via subscription   (Followers: 3, SJR: 1.274, h-index: 27)
Advances in Integrative Medicine     Hybrid Journal   (Followers: 6)
Advances in Intl. Accounting     Full-text available via subscription   (Followers: 4)
Advances in Life Course Research     Hybrid Journal   (Followers: 8, SJR: 0.764, h-index: 15)
Advances in Lipobiology     Full-text available via subscription   (Followers: 2)
Advances in Magnetic and Optical Resonance     Full-text available via subscription   (Followers: 9)
Advances in Marine Biology     Full-text available via subscription   (Followers: 16, SJR: 1.645, h-index: 45)
Advances in Mathematics     Full-text available via subscription   (Followers: 10, SJR: 3.261, h-index: 65)
Advances in Medical Sciences     Hybrid Journal   (Followers: 6, SJR: 0.489, h-index: 25)
Advances in Medicinal Chemistry     Full-text available via subscription   (Followers: 5)
Advances in Microbial Physiology     Full-text available via subscription   (Followers: 5, SJR: 1.44, h-index: 51)
Advances in Molecular and Cell Biology     Full-text available via subscription   (Followers: 23)
Advances in Molecular and Cellular Endocrinology     Full-text available via subscription   (Followers: 10)
Advances in Molecular Toxicology     Full-text available via subscription   (Followers: 9, SJR: 0.324, h-index: 8)
Advances in Nanoporous Materials     Full-text available via subscription   (Followers: 4)
Advances in Oncobiology     Full-text available via subscription   (Followers: 3)
Advances in Organ Biology     Full-text available via subscription   (Followers: 2)
Advances in Organometallic Chemistry     Full-text available via subscription   (Followers: 15, SJR: 2.885, h-index: 45)
Advances in Parallel Computing     Full-text available via subscription   (Followers: 7, SJR: 0.148, h-index: 11)
Advances in Parasitology     Full-text available via subscription   (Followers: 7, SJR: 2.37, h-index: 73)
Advances in Pediatrics     Full-text available via subscription   (Followers: 24, SJR: 0.4, h-index: 28)
Advances in Pharmaceutical Sciences     Full-text available via subscription   (Followers: 13)
Advances in Pharmacology     Full-text available via subscription   (Followers: 15, SJR: 1.718, h-index: 58)
Advances in Physical Organic Chemistry     Full-text available via subscription   (Followers: 8, SJR: 0.384, h-index: 26)
Advances in Phytomedicine     Full-text available via subscription  
Advances in Planar Lipid Bilayers and Liposomes     Full-text available via subscription   (Followers: 3, SJR: 0.248, h-index: 11)
Advances in Plant Biochemistry and Molecular Biology     Full-text available via subscription   (Followers: 8)
Advances in Plant Pathology     Full-text available via subscription   (Followers: 5)
Advances in Porous Media     Full-text available via subscription   (Followers: 4)
Advances in Protein Chemistry     Full-text available via subscription   (Followers: 18)
Advances in Protein Chemistry and Structural Biology     Full-text available via subscription   (Followers: 20, SJR: 1.5, h-index: 62)
Advances in Psychology     Full-text available via subscription   (Followers: 62)
Advances in Quantum Chemistry     Full-text available via subscription   (Followers: 5, SJR: 0.478, h-index: 32)
Advances in Radiation Oncology     Open Access  
Advances in Small Animal Medicine and Surgery     Hybrid Journal   (Followers: 3, SJR: 0.1, h-index: 2)
Advances in Space Biology and Medicine     Full-text available via subscription   (Followers: 5)
Advances in Space Research     Full-text available via subscription   (Followers: 366, SJR: 0.606, h-index: 65)
Advances in Structural Biology     Full-text available via subscription   (Followers: 8)
Advances in Surgery     Full-text available via subscription   (Followers: 8, SJR: 0.823, h-index: 27)
Advances in the Study of Behavior     Full-text available via subscription   (Followers: 31, SJR: 1.321, h-index: 56)
Advances in Veterinary Medicine     Full-text available via subscription   (Followers: 16)
Advances in Veterinary Science and Comparative Medicine     Full-text available via subscription   (Followers: 13)
Advances in Virus Research     Full-text available via subscription   (Followers: 6, SJR: 1.878, h-index: 68)
Advances in Water Resources     Hybrid Journal   (Followers: 45, SJR: 2.408, h-index: 94)
Aeolian Research     Hybrid Journal   (Followers: 5, SJR: 0.973, h-index: 22)
Aerospace Science and Technology     Hybrid Journal   (Followers: 334, SJR: 0.816, h-index: 49)
AEU - Intl. J. of Electronics and Communications     Hybrid Journal   (Followers: 8, SJR: 0.318, h-index: 36)
African J. of Emergency Medicine     Open Access   (Followers: 5, SJR: 0.344, h-index: 6)
Ageing Research Reviews     Hybrid Journal   (Followers: 9, SJR: 3.289, h-index: 78)
Aggression and Violent Behavior     Hybrid Journal   (Followers: 446, SJR: 1.385, h-index: 72)
Agri Gene     Hybrid Journal  
Agricultural and Forest Meteorology     Hybrid Journal   (Followers: 15, SJR: 2.18, h-index: 116)
Agricultural Systems     Hybrid Journal   (Followers: 31, SJR: 1.275, h-index: 74)
Agricultural Water Management     Hybrid Journal   (Followers: 41, SJR: 1.546, h-index: 79)
Agriculture and Agricultural Science Procedia     Open Access  
Agriculture and Natural Resources     Open Access   (Followers: 3)
Agriculture, Ecosystems & Environment     Hybrid Journal   (Followers: 56, SJR: 1.879, h-index: 120)
Ain Shams Engineering J.     Open Access   (Followers: 5, SJR: 0.434, h-index: 14)
Air Medical J.     Hybrid Journal   (Followers: 5, SJR: 0.234, h-index: 18)
AKCE Intl. J. of Graphs and Combinatorics     Open Access   (SJR: 0.285, h-index: 3)
Alcohol     Hybrid Journal   (Followers: 11, SJR: 0.922, h-index: 66)
Alcoholism and Drug Addiction     Open Access   (Followers: 8)
Alergologia Polska : Polish J. of Allergology     Full-text available via subscription   (Followers: 1)
Alexandria Engineering J.     Open Access   (Followers: 1, SJR: 0.436, h-index: 12)
Alexandria J. of Medicine     Open Access   (Followers: 1)
Algal Research     Partially Free   (Followers: 8, SJR: 2.05, h-index: 20)
Alkaloids: Chemical and Biological Perspectives     Full-text available via subscription   (Followers: 3)
Allergologia et Immunopathologia     Full-text available via subscription   (Followers: 1, SJR: 0.46, h-index: 29)
Allergology Intl.     Open Access   (Followers: 4, SJR: 0.776, h-index: 35)
Alpha Omegan     Full-text available via subscription   (SJR: 0.121, h-index: 9)
ALTER - European J. of Disability Research / Revue Européenne de Recherche sur le Handicap     Full-text available via subscription   (Followers: 9, SJR: 0.158, h-index: 9)
Alzheimer's & Dementia     Hybrid Journal   (Followers: 48, SJR: 4.289, h-index: 64)
Alzheimer's & Dementia: Diagnosis, Assessment & Disease Monitoring     Open Access   (Followers: 4)
Alzheimer's & Dementia: Translational Research & Clinical Interventions     Open Access   (Followers: 4)
Ambulatory Pediatrics     Hybrid Journal   (Followers: 5)
American Heart J.     Hybrid Journal   (Followers: 49, SJR: 3.157, h-index: 153)
American J. of Cardiology     Hybrid Journal   (Followers: 48, SJR: 2.063, h-index: 186)
American J. of Emergency Medicine     Hybrid Journal   (Followers: 41, SJR: 0.574, h-index: 65)
American J. of Geriatric Pharmacotherapy     Full-text available via subscription   (Followers: 9, SJR: 1.091, h-index: 45)
American J. of Geriatric Psychiatry     Hybrid Journal   (Followers: 14, SJR: 1.653, h-index: 93)
American J. of Human Genetics     Hybrid Journal   (Followers: 32, SJR: 8.769, h-index: 256)
American J. of Infection Control     Hybrid Journal   (Followers: 26, SJR: 1.259, h-index: 81)
American J. of Kidney Diseases     Hybrid Journal   (Followers: 31, SJR: 2.313, h-index: 172)
American J. of Medicine     Hybrid Journal   (Followers: 46, SJR: 2.023, h-index: 189)
American J. of Medicine Supplements     Full-text available via subscription   (Followers: 3)
American J. of Obstetrics and Gynecology     Hybrid Journal   (Followers: 201, SJR: 2.255, h-index: 171)
American J. of Ophthalmology     Hybrid Journal   (Followers: 60, SJR: 2.803, h-index: 148)
American J. of Ophthalmology Case Reports     Open Access   (Followers: 6)
American J. of Orthodontics and Dentofacial Orthopedics     Full-text available via subscription   (Followers: 6, SJR: 1.249, h-index: 88)
American J. of Otolaryngology     Hybrid Journal   (Followers: 24, SJR: 0.59, h-index: 45)
American J. of Pathology     Hybrid Journal   (Followers: 27, SJR: 2.653, h-index: 228)
American J. of Preventive Medicine     Hybrid Journal   (Followers: 26, SJR: 2.764, h-index: 154)
American J. of Surgery     Hybrid Journal   (Followers: 35, SJR: 1.286, h-index: 125)
American J. of the Medical Sciences     Hybrid Journal   (Followers: 12, SJR: 0.653, h-index: 70)
Ampersand : An Intl. J. of General and Applied Linguistics     Open Access   (Followers: 6)
Anaerobe     Hybrid Journal   (Followers: 4, SJR: 1.066, h-index: 51)
Anaesthesia & Intensive Care Medicine     Full-text available via subscription   (Followers: 59, SJR: 0.124, h-index: 9)
Anaesthesia Critical Care & Pain Medicine     Full-text available via subscription   (Followers: 13)
Anales de Cirugia Vascular     Full-text available via subscription  
Anales de Pediatría     Full-text available via subscription   (Followers: 2, SJR: 0.209, h-index: 27)
Anales de Pediatría (English Edition)     Full-text available via subscription  
Anales de Pediatría Continuada     Full-text available via subscription   (SJR: 0.104, h-index: 3)
Analytic Methods in Accident Research     Hybrid Journal   (Followers: 4, SJR: 2.577, h-index: 7)
Analytica Chimica Acta     Hybrid Journal   (Followers: 36, SJR: 1.548, h-index: 152)
Analytical Biochemistry     Hybrid Journal   (Followers: 164, SJR: 0.725, h-index: 154)
Analytical Chemistry Research     Open Access   (Followers: 8, SJR: 0.18, h-index: 2)
Analytical Spectroscopy Library     Full-text available via subscription   (Followers: 12)
Anesthésie & Réanimation     Full-text available via subscription   (Followers: 1)
Anesthesiology Clinics     Full-text available via subscription   (Followers: 22, SJR: 0.421, h-index: 40)
Angiología     Full-text available via subscription   (SJR: 0.124, h-index: 9)
Angiologia e Cirurgia Vascular     Open Access  

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Journal Cover Academic Radiology
  [SJR: 1.008]   [H-I: 75]   [22 followers]  Follow
   Hybrid Journal Hybrid journal (It can contain Open Access articles)
   ISSN (Print) 1076-6332
   Published by Elsevier Homepage  [3118 journals]
  • The Clinical Impact of Resident-attending Discrepancies in On-call
           Radiology Reporting
    • Authors: Sebastian R. McWilliams; Christopher Smith; Yaseen Oweis; Kareem Mawad; Constantine Raptis; Vincent Mellnick
      Abstract: Publication date: Available online 12 January 2018
      Source:Academic Radiology
      Author(s): Sebastian R. McWilliams, Christopher Smith, Yaseen Oweis, Kareem Mawad, Constantine Raptis, Vincent Mellnick
      Rationale and Objectives The purpose of this study is to quantify the clinical impact of resident-attending discrepancies at a tertiary referral academic radiology residency program by assessing rates of intervention, discrepancy confirmation, recall rate, and management change rate; furthermore, a discrepancy categorization system will be assessed. Materials and Methods Retrospective review of the records was performed for n = 1482 discrepancies that occurred in the 17-month study period to assess the clinical impact of discrepancies. Discrepancies were grouped according to a previously published classification system. Management changes were recorded and grouped by severity. The recall rate was estimated for discharged patients. Any confirmatory testing was reviewed to evaluate the accuracy of the discrepant report. Categorical variables were compared to the chi-square test. Results The 1482 discrepancies led to management change in 661 cases (44.6%). The most common management change was follow-up imaging. Procedural interventions including surgery occurred in 50 cases (3.3%). The recall rate was 2.6%. Management changes were more severe with computed tomography examinations, inpatients, and when the discrepancy was in the chest and abdomen subspecialty. Also, management changes correlated with the discrepancy category assigned by the attending at the time of review. Conclusions Resident-attending discrepancies do cause management changes in 44.6% of discrepancies (0.62% overall); the most frequent change is follow-up imaging. The discrepancy categorization assigned by the attending correlated with the severity of management change.

      PubDate: 2018-01-14T07:15:13Z
      DOI: 10.1016/j.acra.2017.11.016
  • Diagnostic Usefulness of Combination of Diffusion-weighted Imaging and
           T2WI, Including Apparent Diffusion Coefficient in Breast Lesions
    • Authors: Keum Won Kim; Cherie M. Kuzmiak; Young Joong Kim; Jae Young Seo; Hae Kyoung Jung; Mu-Sik Lee
      Abstract: Publication date: Available online 12 January 2018
      Source:Academic Radiology
      Author(s): Keum Won Kim, Cherie M. Kuzmiak, Young Joong Kim, Jae Young Seo, Hae Kyoung Jung, Mu-Sik Lee
      Purpose This study aimed to compare the diagnostic values of a combination of diffusion-weighted imaging and T2-weighted imaging (DWI-T2WI) with dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI), and to evaluate the correlation of DWI with the histologic grade in breast cancer. Materials and Methods This study evaluated a total of 169 breast lesions from 136 patients who underwent both DCE-MRI and DWI (b value, 1000s/mm2). Morphologic and kinetic analyses for DCE-MRI were classified according to the Breast Imaging-Reporting and Data System. For the DWI-T2WI set, a DWI-T2WI score for lesion characterization that compared signal intensity of DWI and T2WI (benign: DWI-T2WI score of 1, 2; malignant: DWI-T2WI score of 3, 4, 5) was used. The diagnostic values of DCE-MRI, DWI-T2WI set, and combined assessment of DCE and DWI-T2WI were calculated. Results Of 169 breast lesions, 48 were benign and 121 were malignant (89 invasive ductal carcinoma, 24 ductal carcinoma in situ, 4 invasive lobular carcinoma, 4 mucinous carcinoma). The mean apparent diffusion coefficient (ADC) of invasive ductal carcinoma (0.92 ± 0.19 × 10−3 mm2/s) and ductal carcinoma in situ (1.11 ± 0.13 × 10−3 mm2/s) was significantly lower than the value seen in benign lesions (1.36 ± 0.22 × 10−3 mm2/s). The specificity, positive predictive value (PPV), and accuracy of DWI-T2WI set and combined assessment of DCE and DWI-T2WI (specificity, 87.5% and 91.7%; PPV, 94.3% and 96.2%; accuracy, Az = 0.876 and 0.922) were significantly higher than those of the DCE-MRI (specificity, 45.8%; PPV, 81.7%; accuracy, Az = 0.854; P < .05). A low ADC value and the presence of rim enhancement were associated with a higher histologic grade cancer (P < .05). Conclusion Combining DWI, T2WI, and ADC values provides increased accuracy for differentiation between benign and malignant lesions, compared with DCE-MRI. A lower ADC value was associated with a higher histologic grade cancer.

      PubDate: 2018-01-14T07:15:13Z
      DOI: 10.1016/j.acra.2017.11.011
  • A Clinically Meaningful Interpretation of the Prospective Investigation of
           Pulmonary Embolism Diagnosis (PIOPED) II and III Data
    • Authors: Paul Cronin; Ben A. Dwamena
      Abstract: Publication date: Available online 11 January 2018
      Source:Academic Radiology
      Author(s): Paul Cronin, Ben A. Dwamena
      Rationale and Objectives This study aimed to calculate the multiple-level likelihood ratios (LRs) and posttest probabilities for a positive, indeterminate, or negative test result for multidetector computed tomography pulmonary angiography (MDCTPA) ± computed tomography venography (CTV) and magnetic resonance pulmonary angiography (MRPA) ± magnetic resonance venography (MRV) for each clinical probability level (two-, three-, and four-level) for the nine most commonly used clinical prediction rules (CPRs) (Wells, Geneva, Miniati, and Charlotte). The study design is a review of observational studies with critical review of multiple cohort studies. The settings are acute care, emergency room care, and ambulatory care (inpatients and outpatients). Materials and Methods Data were used to estimate pulmonary embolism (PE) pretest probability for each of the most commonly used CPRs at each probability level. Multiple-level LRs (positive, indeterminate, negative test) were generated and used to calculate posttest probabilities for MDCTPA, MDCTPA + CTV, MRPA, and MRPA + MRV from sensitivity and specificity results from Prospective Investigation of Pulmonary Embolism Diagnosis (PIOPED) II and PIOPED III for each clinical probability level for each CPR. Nomograms were also created. Results The LRs for a positive test result were higher for MRPA compared to MDCTPA without venography (76 vs 20) and with venography (42 vs 18). LRs for a negative test result were lower for MDCTPA compared to MRPA without venography (0.18 vs 0.22) and with venography (0.12 vs 0.15). In the three-level Wells score, the pretest clinical probability of PE for a low, moderate, and high clinical probability score is 5.7, 23, and 49. The posttest probability for an initially low clinical probability PE for a positive, indeterminate, and negative test result, respectively, for MDCTPA is 54, 5 and 1; for MDCTPA + CTV is 52, 2, and 0.7; for MRPA is 82, 6, and 1; and for MRPA + MRV is 72, 3, and 1; for an initially moderate clinical probability PE for MDCTPA is 86, 22, and 5; for MDCTPA + CTV is 85, 10, and 4; for MRPA is 96, 25, and 6; and for MRPA + MRV is 93, 14, and 4; and for an initially high clinical probability of PE for MDCTPA is 95, 47, and 15; for MDCTPA + CTV is 95, 27, and 10; for MRPA is 99, 52, and 17; and for MRPA + MRV is 98, 34, and 13. Conclusions For a positive test result, LRs were considerably higher for MRPA compared to MDCTPA. However, both a positive MRPA and MDCTPA have LRs >10 and therefore can confirm the presence of PE. Performing venography reduced the LR for a positive and negative test for both MDCTPA and MRPA. The nomograms give posttest probabilities for a positive, indeterminate, or negative test result for MDCTPA and MRPA (with and without venography) for each clinical probability level for each of the CPR.

      PubDate: 2018-01-14T07:15:13Z
      DOI: 10.1016/j.acra.2017.11.014
  • Thermal Field Distributions of Ablative Experiments Using Cyst-mimicking
    • Authors: Xiao-wen Huang; Fang Nie; Zeng-cheng Wa; Hang-tong Hu; Qing-xiu Huang; Huan-ling Guo; Qiao Zheng; Xiao-yan Xie; Wei Wang; Ming-De Lu
      Abstract: Publication date: Available online 11 January 2018
      Source:Academic Radiology
      Author(s): Xiao-wen Huang, Fang Nie, Zeng-cheng Wa, Hang-tong Hu, Qing-xiu Huang, Huan-ling Guo, Qiao Zheng, Xiao-yan Xie, Wei Wang, Ming-De Lu
      Rationale and Objectives The objective of this study was to explore the thermal field distribution of cystic lesions undergoing microwave ablation (MWA) and radiofrequency ablation (RFA) using in vitro phantoms. Materials and Methods Cyst-mimicking lesions filled with sodium chloride (NaCl) solution in acrylamide phantoms were treated with MWA and RFA in vitro. The radiofrequency electrodes or MWA antennas were implanted in the centers of the artificial cystic lesions. We used temperature fields located 5, 15, and 25 mm from the electrode or the antenna to plot the temperature-rise curves. Solid phantoms without cysts were also fabricated as controls. Results The temperature within cysts increased faster and reached a higher maximum temperature during MWA than during RFA, and this result was independent of the NaCl solution concentration. RFA treatment caused the temperatures within the lesion to increase significantly faster in the cysts containing 0.9% NaCl than in those containing 5.0% NaCl. However, the MWA temperature-rise curves were only weakly affected by the ionic concentration. The median temperature difference values between the 5- and 15-mm points were markedly lower in the 0.9% NaCl cyst-mimicking phantom (P < 0.001) than in the solid phantom after either MWA or RFA. Conclusions Our data indicate that MWA is a more effective technique for focal cystic lesions than RFA and has higher overall energy utilization. MWA was also less affected by the ionic concentration of the cystic fluid.

      PubDate: 2018-01-14T07:15:13Z
      DOI: 10.1016/j.acra.2017.11.010
  • Uterine Artery Embolization
    • Authors: Timothy E. Murray; Tayyaub Mansoor; Dermot J. Bowden; Damien C. O'Neill; Michael J. Lee
      Abstract: Publication date: Available online 10 January 2018
      Source:Academic Radiology
      Author(s): Timothy E. Murray, Tayyaub Mansoor, Dermot J. Bowden, Damien C. O'Neill, Michael J. Lee
      Rationale and Objectives Investigators aimed to assess online information describing uterine artery embolization (UAE) to examine the quality and readability of websites patients are accessing. Materials and Methods A list of applicable, commonly used searchable terms was generated, including “Uterine Artery Embolization,” “Fibroid Embolization,” “Uterine Fibroid Embolization,” and “Uterine Artery Embolisation.” Each possible term was assessed across the five most-used English language search engines to determine the most commonly used term. The most common term was then investigated across each search engine, with the first 25 pages returned by each engine included for analysis. Duplicate pages, nontext content such as video or audio, and pages behind paywalls were excluded. Pages were analyzed for quality and readability using validated tools including DISCERN score, JAMA Benchmark Criteria, HONcode Certification, Flesch Reading Ease Score, Flesch-Kincaid Grade Level, and Gunning-Fog Index. Secondary features such as age, rank, author, and publisher were recorded. Results The most common applicable term was “Uterine Artery Embolization” (492,900 results). Mean DISCERN quality of information provided by UAE websites is “fair”; however, it has declined since comparative 2012 studies. Adherence to JAMA Benchmark Criteria has reduced to 6.7%. UAE website readability remains more difficult than the World Health Organization–recommended 7–8th grade reading levels. HONcode-certified websites (35.6%) demonstrated significantly higher quality than noncertified websites. Conclusions Quality of online UAE information remains “fair.” Adherence to JAMA benchmark criteria is poor. Readability is above recommended 7–8th grade levels. HONcode certification was predictive of higher website quality, a useful guide to patients requesting additional information.

      PubDate: 2018-01-14T07:15:13Z
      DOI: 10.1016/j.acra.2017.11.007
  • Multi-model Analysis of Diffusion-weighted Imaging of Normal Testes at 3.0
    • Authors: Xiangde Min; Zhaoyan Feng; Liang Wang; Jie Cai; Basen Li; Zan Ke; Peipei Zhang; Huijuan You; Xu Yan
      Abstract: Publication date: Available online 10 January 2018
      Source:Academic Radiology
      Author(s): Xiangde Min, Zhaoyan Feng, Liang Wang, Jie Cai, Basen Li, Zan Ke, Peipei Zhang, Huijuan You, Xu Yan
      Rationale and Objectives This study aimed to establish diffusion quantitative parameters (apparent diffusion coefficient [ADC], DDC, α, Dapp, and Kapp) in normal testes at 3.0 T. Materials and methods Sixty-four healthy volunteers in two age groups (A: 10–39 years; B: ≥ 40 years) underwent diffusion-weighted imaging scanning at 3.0 T. ADC1000, ADC2000, ADC3000, DDC, α, Dapp, and Kapp were calculated using the mono-exponential, stretched-exponential, and kurtosis models. The correlations between parameters and the age were analyzed. The parameters were compared between the age groups and between the right and the left testes. Results The average ADC1000, ADC2000, ADC3000, DDC, α, Dapp, and Kapp values did not significantly differ between the right and the left testes (P > .05 for all). The following significant correlations were found: positive correlations between age and testicular ADC1000, ADC2000, ADC3000, DDC, and Dapp (r = 0.516, 0.518, 0.518, 0.521, and 0.516, respectively; P < .01 for all) and negative correlations between age and testicular α and Kapp (r = −0.363, −0.427, respectively; P < .01 for both). Compared to group B, in group A, ADC1000, ADC2000, ADC3000, DDC, and Dapp were significantly lower (P < .05 for all), but α and Kapp were significantly higher (P < .05 for both). Conclusions Our study demonstrated the applicability of the testicular mono-exponential, stretched-exponential, and kurtosis models. Our results can help establish a baseline for the normal testicular parameters in these diffusion models. The contralateral normal testis can serve as a suitable reference for evaluating the abnormalities of the other side. The effect of age on these parameters requires further attention.

      PubDate: 2018-01-14T07:15:13Z
      DOI: 10.1016/j.acra.2017.11.004
  • Breast Imaging Match Highlights the Need to Unify the Approach to
    • Authors: Cory M. Pfeifer
      Abstract: Publication date: Available online 10 January 2018
      Source:Academic Radiology
      Author(s): Cory M. Pfeifer

      PubDate: 2018-01-14T07:15:13Z
      DOI: 10.1016/j.acra.2017.11.005
  • Quantitative CT Evaluation of Small Pulmonary Vessels in Patients with
           Acute Pulmonary Embolism
    • Authors: Shin Matsuoka; Akiyuki Kotoku; Tsuneo Yamashiro; Shoichiro Matsushita; Atsuko Fujikawa; Kunihiro Yagihashi; Yasuo Nakajima
      Abstract: Publication date: Available online 10 January 2018
      Source:Academic Radiology
      Author(s): Shin Matsuoka, Akiyuki Kotoku, Tsuneo Yamashiro, Shoichiro Matsushita, Atsuko Fujikawa, Kunihiro Yagihashi, Yasuo Nakajima
      Rationale and Objectives The objective of this study was to investigate the correlation between the computed tomography (CT) cross-sectional area (CSA) of small pulmonary vessels and the CT obstruction index in patients with acute pulmonary embolism (PE) and the correlation between the changes in these measurements after anticoagulant therapy. Materials and Methods Fifty-two patients with acute PE were selected for this study. We measured the CSA less than 5 mm2 on coronal reconstructed images to obtain the percentage of the CSA (%CSA < 5). CT angiographic index was obtained based on the Qanadli method for the evaluation of the degree of pulmonary arterial obstruction. Spearman rank correlation analysis was used to evaluate the relationship between the initial and the follow-up values and changes in the %CSA < 5 and the CT obstruction index. Results There was no significant correlation between the %CSA < 5 and CT obstruction index on both initial (ρ = −0.03, P = 0.84) and follow-up (ρ = −0.03, P = 0.82) assessments. In contrast, there was a significant negative correlation between the changes in %CSA < 5 and the CT obstruction index (ρ = −0.59, P < 0.0001). Conclusions Although the absolute %CSA < 5 and CT obstruction index were not significantly correlated, the changes in the values of the two parameters had a significant correlation. Changes in %CSA < 5, which can be obtained easily, can be used as biomarker of therapeutic response in patients with acute PE.

      PubDate: 2018-01-14T07:15:13Z
      DOI: 10.1016/j.acra.2017.11.013
  • Fully Automated Segmentation of Polycystic Kidneys From Noncontrast
           Computed Tomography
    • Authors: Dario Turco; Maddalena Valinoti; Eva Maria Martin; Carlo Tagliaferri; Francesco Scolari; Cristiana Corsi
      Abstract: Publication date: Available online 10 January 2018
      Source:Academic Radiology
      Author(s): Dario Turco, Maddalena Valinoti, Eva Maria Martin, Carlo Tagliaferri, Francesco Scolari, Cristiana Corsi
      Rationale and Objectives Total kidney volume is an important biomarker for the evaluation of autosomal dominant polycystic kidney disease progression. In this study, we present a novel approach for automated segmentation of polycystic kidneys from non–contrast-enhanced computed tomography (CT) images. Materials and Methods Non–contrast-enhanced CT images were acquired from 21 patients with a diagnosis of autosomal dominant polycystic kidney disease. Kidney volumes obtained from the fully automated method were compared to volumes obtained by manual segmentation and evaluated using linear regression and Bland-Altman analyses. Dice coefficient was used for performance evaluation. Results Kidney volumes from the automated method well correlated with the ones obtained by manual segmentation. Bland-Altman analysis showed a low percentage bias (−0.3%) and narrow limits of agreements (11.0%). The overlap between the three-dimensional kidney surfaces obtained with our approach and by manual tracing, expressed in terms of Dice coefficient, showed good agreement (0.91 ± 0.02). Conclusions This preliminary study showed the proposed fully automated method for renal volume assessment is feasible, exhibiting how a correct use of biomedical image processing may allow polycystic kidney segmentation also in non–contrast-enhanced CT. Further investigation on a larger dataset is needed to confirm the robustness of the presented approach.

      PubDate: 2018-01-14T07:15:13Z
      DOI: 10.1016/j.acra.2017.11.015
  • Quantitative CT Assessment of Gynecomastia in the General Population and
           in Dialysis, Cirrhotic, and Obese Patients
    • Authors: Eyal Klang; Nayroz Kanana; Alon Grossman; Steve Raskin; Jana Pikovsky; Miri Sklair; Lior Heller; Shelly Soffer; Edith M. Marom; Eli Konen; Marianne Michal Amitai
      Abstract: Publication date: Available online 8 January 2018
      Source:Academic Radiology
      Author(s): Eyal Klang, Nayroz Kanana, Alon Grossman, Steve Raskin, Jana Pikovsky, Miri Sklair, Lior Heller, Shelly Soffer, Edith M. Marom, Eli Konen, Marianne Michal Amitai
      Rationale and Objectives Gynecomastia is the benign enlargement of the male breast because of proliferation of the glandular component. To date, there is no radiological definition of gynecomastia and no quantitative evaluation of breast glandular tissues in the general male population. The aims of this study were to supply radiological-based measurements of breast glandular tissue in the general male population, to quantitatively assess the prevalence of gynecomastia according to age by decades, and to evaluate associations between gynecomastia and obesity, cirrhosis, and dialysis. Materials and Methods This retrospective study included 506 men who presented to the emergency department following trauma and underwent chest-abdominal computed tomography. Also included were 45 patients undergoing hemodialysis and 50 patients with cirrhosis who underwent chest computed tomography. The incidence and size of gynecomastia for all the study population were calculated. Results Breast tissue diameters of 22 mm, 28 mm, and 36 mm corresponded to 90th, 95th, and 97.5th cumulative percentiles of diameters in the general male population. Peaks of gynecomastia were shown in the ninth decade and in boys aged 13–14 years. Breast tissue diameter did not correlate with body mass index (r = −0.031). Patients undergoing hemodialysis and patients with cirrhosis had higher percentages (P < .0001) of breast tissue diameters above 22 mm, 28 mm, and 36 mm. Conclusions Breast tissue diameter is a simple and reliable quantitative tool for the assessment of gynecomastia. This method provides the ability to determine the incidence of gynecomastia by age in the general population. Radiological gynecomastia should be defined as 22 mm, 28 mm, or 36 mm (90th, 95th, and 97.5th percentiles, respectively). Radiological gynecomastia is not associated with obesity, but is associated with cirrhosis and dialysis.

      PubDate: 2018-01-14T07:15:13Z
      DOI: 10.1016/j.acra.2017.11.008
  • Self-authorship in Radiology Education
    • Authors: Richard B. Gunderman; Jakob A. Weaver
      Abstract: Publication date: Available online 29 December 2017
      Source:Academic Radiology
      Author(s): Richard B. Gunderman, Jakob A. Weaver

      PubDate: 2018-01-02T21:53:09Z
      DOI: 10.1016/j.acra.2017.12.001
  • Translating New Imaging Technologies to Clinical Practice
    • Authors: Christoph I. Lee; Supriya Gupta; Steven J. Sherry; Allan Chiunda; Emilia Olson; Falgun H. Chokshi; Lori Mankowski-Gettle; Mishal Mendiratta-Lala; Yueh Z. Lee; Franklin G. Moser; Richard Duszak
      Pages: 3 - 8
      Abstract: Publication date: January 2018
      Source:Academic Radiology, Volume 25, Issue 1
      Author(s): Christoph I. Lee, Supriya Gupta, Steven J. Sherry, Allan Chiunda, Emilia Olson, Falgun H. Chokshi, Lori Mankowski-Gettle, Mishal Mendiratta-Lala, Yueh Z. Lee, Franklin G. Moser, Richard Duszak
      Radiology continues to benefit from constant innovation and technological advances. However, for promising new imaging technologies to reach widespread clinical practice, several milestones must be met. These include regulatory approval, early clinical evaluation, payer reimbursement, and broader marketplace adoption. Successful implementation of new imaging tests into clinical practice requires active stakeholder engagement and a focus on demonstrating clinical value during each phase of translation.

      PubDate: 2017-12-07T01:28:49Z
      DOI: 10.1016/j.acra.2017.03.027
  • Promoting Collaborations Between Radiologists and Scientists
    • Authors: John-Paul J. Yu; Bradley M. Spieler; Tiffany L. Chan; Elizabeth M. Johnson; Vikas Gulani; Kim L. Sandler; Ponnada A. Narayana; Winnie A. Mar; James M. Brian; Chin K. Ng
      Pages: 9 - 17
      Abstract: Publication date: January 2018
      Source:Academic Radiology, Volume 25, Issue 1
      Author(s): John-Paul J. Yu, Bradley M. Spieler, Tiffany L. Chan, Elizabeth M. Johnson, Vikas Gulani, Kim L. Sandler, Ponnada A. Narayana, Winnie A. Mar, James M. Brian, Chin K. Ng
      Radiology as a discipline thrives on the dynamic interplay between technological and clinical advances. Progress in almost all facets of the imaging sciences is highly dependent on complex tools sourced from physics, engineering, biology, and the clinical sciences to obtain, process, and view imaging studies. The application of these tools, however, requires broad and deep medical knowledge about disease pathophysiology and its relationship with medical imaging. This relationship between clinical medicine and imaging technology, nurtured and fostered over the past 75 years, has cultivated extraordinarily rich collaborative opportunities between basic scientists, engineers, and physicians. In this review, we attempt to provide a framework to identify both currently successful collaborative ventures and future opportunities for scientific partnership. This invited review is a product of a special working group within the Association of University Radiologists-Radiology Research Alliance.

      PubDate: 2017-12-07T01:28:49Z
      DOI: 10.1016/j.acra.2017.05.020
  • Multicenter Research Studies in Radiology
    • Authors: Brittany Z. Dashevsky; Zachary L. Bercu; Priya R. Bhosale; Kirsteen R. Burton; Arindam R. Chatterjee; L. Alexandre R. Frigini; Laura Heacock; Edward H. Herskovits; James T. Lee; Naveen Subhas; Ashish P. Wasnik; Soterios Gyftopoulos
      Pages: 18 - 25
      Abstract: Publication date: January 2018
      Source:Academic Radiology, Volume 25, Issue 1
      Author(s): Brittany Z. Dashevsky, Zachary L. Bercu, Priya R. Bhosale, Kirsteen R. Burton, Arindam R. Chatterjee, L. Alexandre R. Frigini, Laura Heacock, Edward H. Herskovits, James T. Lee, Naveen Subhas, Ashish P. Wasnik, Soterios Gyftopoulos
      Rationale and Objectives Here we review the current state of multicenter radiology research (MRR), and utilize a survey of experienced researchers to identify common advantages, barriers, and resources to guide future investigators. Materials and Methods The Association of University Radiologists established a Radiology Research Alliance task force, Multi-center Research Studies in Radiology, composed of 12 society members to review MRR. A REDCap survey was designed to gain more insight from experienced researchers. Recipients were authors identified from a PubMed database search, utilizing search terms “multicenter” or “multisite” and “radiology.” The survey included investigator background information, reasons why, barriers to, and resources that investigators found helpful in conducting or participating in MRR. Results The survey was completed by 23 of 80 recipients (29%), the majority (76%) of whom served as a primary investigator on at least one MRR project. Respondents reported meeting collaborators at national or international (74%) and society (39%) meetings. The most common perceived advantages of MRR were increased sample size (100%) and improved generalizability (91%). External funding was considered the most significant barrier to MRR, reported by 26% of respondents. Institutional funding, setting up a central picture archiving and communication system, and setting up a central database were considered a significant barrier by 30%, 22%, and 22% of respondents, respectively. Resources for overcoming barriers included motivated staff (74%), strong leadership (70%), regular conference calls (57%), and at least one face-to-face meeting (57%). Conclusions Barriers to MRR include funding and establishing a central database and a picture archiving and communication system. Upon embarking on an MRR project, forming a motivated team who meets and speaks regularly is essential.

      PubDate: 2017-12-07T01:28:49Z
      DOI: 10.1016/j.acra.2017.05.019
  • Radiology Research Funding
    • Authors: Alison L. Chetlen; Andrew J. Degnan; Mark Guelfguat; Brent Griffith; Jason Itri; Hazem Matta; Angela Tong; Jonathan Flug; Dennis Toy; Nikita Consul; Eric Walker; Lucy Spalluto; Andrew D. Smith; Elizabeth A. Krupinski
      Pages: 26 - 39
      Abstract: Publication date: January 2018
      Source:Academic Radiology, Volume 25, Issue 1
      Author(s): Alison L. Chetlen, Andrew J. Degnan, Mark Guelfguat, Brent Griffith, Jason Itri, Hazem Matta, Angela Tong, Jonathan Flug, Dennis Toy, Nikita Consul, Eric Walker, Lucy Spalluto, Andrew D. Smith, Elizabeth A. Krupinski
      Funding for research has become increasingly difficult to obtain in an environment of decreasing clinical revenue, increasing research costs, and growing competition for federal and nonfederal funding sources. This paper identifies critical requirements to build and sustain a successful radiology research program (eg, key personnel and leadership, research training and mentorship, infrastructure, institutional and departmental funding or support), reviews the current state of available funding for radiology (including federal, nonfederal, philanthropy, crowdfunding, and industry), and describes promising opportunities for future funding (eg, health services, comparative effectiveness, and patient-centered outcomes research). The funding climate, especially at the federal level, changes periodically, so it is important to have radiology-specific organizations such as the American College of Radiology and the Academy of Radiology Research serving as our key advocates. Key to obtaining any funding, no matter what the source, is a well-formulated grant proposal, so a review of opportunities specifically available to radiologists to develop and hone their grant-writing skills is provided. Effective and sustained funding for radiology research has the potential to cultivate young researchers, bolster quality research, and enhance health care. Those interested in pursuing research need to be aware of the ever-changing funding landscape, research priority areas, and the resources available to them to succeed. To succeed, radiology researchers need to think about diversification and flexibility in their interests, developing multidisciplinary and multi-institutional projects, and engaging a broader base of stakeholders that includes patients.

      PubDate: 2017-12-07T01:28:49Z
      DOI: 10.1016/j.acra.2017.07.013
  • Logistics of Three-dimensional Printing
    • Authors: Taryn Hodgdon; Raman Danrad; Midhir J. Patel; Stacy E. Smith; Michael L. Richardson; David H. Ballard; Sayed Ali; Anthony Paul Trace; Carolynn M. DeBenedectis; Matthew E. Zygmont; Leon Lenchik; Summer J. Decker
      Pages: 40 - 51
      Abstract: Publication date: January 2018
      Source:Academic Radiology, Volume 25, Issue 1
      Author(s): Taryn Hodgdon, Raman Danrad, Midhir J. Patel, Stacy E. Smith, Michael L. Richardson, David H. Ballard, Sayed Ali, Anthony Paul Trace, Carolynn M. DeBenedectis, Matthew E. Zygmont, Leon Lenchik, Summer J. Decker
      The Association of University Radiologists Radiology Research Alliance Task Force on three-dimensional (3D) printing presents a review of the logistic considerations for establishing a clinical service using this new technology, specifically focused on implications for radiology. Specific topics include printer selection for 3D printing, software selection, creating a 3D model for printing, providing a 3D printing service, research directions, and opportunities for radiologists to be involved in 3D printing. A thorough understanding of the technology and its capabilities is necessary as the field of 3D printing continues to grow. Radiologists are in the unique position to guide this emerging technology and its use in the clinical arena.

      PubDate: 2017-12-07T01:28:49Z
      DOI: 10.1016/j.acra.2017.08.003
  • Clinical Applications of 3D Printing
    • Authors: David H. Ballard; Anthony Paul Trace; Sayed Ali; Taryn Hodgdon; Matthew E. Zygmont; Carolynn M. DeBenedectis; Stacy E. Smith; Michael L. Richardson; Midhir J. Patel; Summer J. Decker; Leon Lenchik
      Pages: 52 - 65
      Abstract: Publication date: January 2018
      Source:Academic Radiology, Volume 25, Issue 1
      Author(s): David H. Ballard, Anthony Paul Trace, Sayed Ali, Taryn Hodgdon, Matthew E. Zygmont, Carolynn M. DeBenedectis, Stacy E. Smith, Michael L. Richardson, Midhir J. Patel, Summer J. Decker, Leon Lenchik
      Three-dimensional (3D) printing refers to a number of manufacturing technologies that create physical models from digital information. Radiology is poised to advance the application of 3D printing in health care because our specialty has an established history of acquiring and managing the digital information needed to create such models. The 3D Printing Task Force of the Radiology Research Alliance presents a review of the clinical applications of this burgeoning technology, with a focus on the opportunities for radiology. Topics include uses for treatment planning, medical education, and procedural simulation, as well as patient education. Challenges for creating custom implantable devices including financial and regulatory processes for clinical application are reviewed. Precedent procedures that may translate to this new technology are discussed. The task force identifies research opportunities needed to document the value of 3D printing as it relates to patient care.

      PubDate: 2017-12-07T01:28:49Z
      DOI: 10.1016/j.acra.2017.08.004
  • Structured Reporting in Radiology
    • Authors: Dhakshinamoorthy Ganeshan; Phuong-Anh Thi Duong; Linda Probyn; Leon Lenchik; Tatum A. McArthur; Michele Retrouvey; Emily H. Ghobadi; Stephane L. Desouches; David Pastel; Isaac R. Francis
      Pages: 66 - 73
      Abstract: Publication date: January 2018
      Source:Academic Radiology, Volume 25, Issue 1
      Author(s): Dhakshinamoorthy Ganeshan, Phuong-Anh Thi Duong, Linda Probyn, Leon Lenchik, Tatum A. McArthur, Michele Retrouvey, Emily H. Ghobadi, Stephane L. Desouches, David Pastel, Isaac R. Francis
      Radiology reports are vital for patient care as referring physicians depend upon them for deciding appropriate patient management. Traditional narrative reports are associated with excessive variability in the language, length, and style, which can minimize report clarity and make it difficult for referring clinicians to identify key information needed for patient care. Structured reporting has been advocated as a potential solution for improving the quality of radiology reports. The Association of University Radiologists—Radiology Research Alliance Structured Reporting Task Force convened to explore the current and future role of structured reporting in radiology and summarized its finding in this article. We review the advantages and disadvantages of structured radiology reports and discuss the current prevailing sentiments among radiologists regarding structured reports. We also discuss the obstacles to the use of structured reports and highlight ways to overcome some of those challenges. We also discuss the future directions in radiology reporting in the era of personalized medicine.

      PubDate: 2017-12-07T01:28:49Z
      DOI: 10.1016/j.acra.2017.08.005
  • Added Value of Bone Subtraction in Dual-energy Digital Radiography in the
           Detection of Pneumothorax
    • Authors: Ayla Urbaneja; Gauthier Dodin; Gabriela Hossu; Omar Bakour; Rachid Kechidi; Pedro Gondim Teixeira; Alain Blum
      Pages: 82 - 87
      Abstract: Publication date: January 2018
      Source:Academic Radiology, Volume 25, Issue 1
      Author(s): Ayla Urbaneja, Gauthier Dodin, Gabriela Hossu, Omar Bakour, Rachid Kechidi, Pedro Gondim Teixeira, Alain Blum
      Rationale and Objectives This study aimed to determine the value of dual-energy thoracic radiography in the diagnosis of pneumothorax considering the reader's experience. Materials and Methods Forty patients with a suspected pneumothorax, imaged with dual-energy chest radiographs, were divided into two groups: those with pneumothorax as the final diagnosis (n = 19) and those without (n = 21). The images were analyzed by 36 readers (5 interns, 16 residents, 15 senior physicians) for the presence or absence of pneumothorax during three readout sessions at 2-week intervals: standard images alone (session 1), dual-energy images with bone subtraction alone (session 2), and a combination of the two (session 3). Results The number of correct responses increased 13.3% between sessions 1 and 2 (P < .001) and 9.4% between sessions 1 and 3 (P < .001). The mean sensitivity for pneumothorax detection was higher in sessions 2 (82%) and 3 (79%) compared to session 1 (70%). There was no statistically significant difference in specificity between the sessions. The number of correct responses for small volume pneumothoraces was higher in sessions 2 (10.6 ± 1.8) and 3 (10.1 ± 2.0) than in session 1 (8.9 ± 2.3), with a statistically significant difference between sessions 1 and 2 (P = .002) and between sessions 1 and 3 (P = .048). Conclusion Bone subtracted dual-energy thoracic radiographs improve the detection sensitivity of pneumothorax, including in cases of small pneumothoraces, regardless of the reader's level or expertise.

      PubDate: 2017-12-07T01:28:49Z
      DOI: 10.1016/j.acra.2017.06.015
  • Further Investigation on High-intensity Focused Ultrasound (HIFU)
           Treatment for Thyroid Nodules
    • Authors: Michael Sennert; Christian Happel; Yücel Korkusuz; Frank Grünwald; Björn Polenz; Daniel Gröner
      Pages: 88 - 94
      Abstract: Publication date: January 2018
      Source:Academic Radiology, Volume 25, Issue 1
      Author(s): Michael Sennert, Christian Happel, Yücel Korkusuz, Frank Grünwald, Björn Polenz, Daniel Gröner
      Rationale and Objectives Several minimally invasive thermal techniques have been developed for the treatment of benign thyroid nodules. A new technique for this indication is high-intensity focused ultrasound (HIFU). The aim of this study was to assess effectiveness in varying preablative nodule volumes and whether outcome patterns that were reported during studies with other thermal ablative procedures for thyroid nodule ablation would also apply to HIFU. Materials and Methods Over the last 2 years, 19 nodules in 15 patients (12 women) whose average age was 58.7 years (36–80) were treated with HIFU in an ambulatory setting. Patients with more than one nodule were treated in multiple sessions on the same day. The mean nodule volume was 2.56 mL (range 0.13–7.67 mL). The therapeutic ultrasound probe (Echopulse THC900888-H) used in this series functions with a frequency of 3 MHz, reaching temperatures of approximately 80°C–90°C and delivering an energy ranging from 87.6 to 320.3 J per sonication. To assess the effectiveness of thermal ablation, nodular volume was measured at baseline and at 3-month follow-up. The end point of the study was the volume reduction assessment after 3 months' follow-up. Therapeutic success was defined as volume reduction of more than 50% compared to baseline. This study was retrospectively analyzed using the Wilcoxon signed rank test and Kendall tau. Results The median percentage volume reduction of all 19 nodules after 3 months was 58%. An inverse correlation between preablative nodular volume and percentage volume shrinking was found (tau = −0.46, P < .05). Therapeutic success was achieved in 10 out of 19 patients (53%). Conclusions HIFU of benign thyroid nodules can be carried out as an alternative therapy for nodules ≤3 mL if patients are refusing surgery or radioiodine therapy.

      PubDate: 2017-12-07T01:28:49Z
      DOI: 10.1016/j.acra.2017.07.011
  • T2 Star-weighted Angiography (SWAN) Allows to Concomitantly Assess the
           Prostate Contour While Detecting Fiducials Before MR-based
           Intensity-modulated Radiation Therapy in Prostate Carcinoma
    • Authors: Pierre-Antoine Dirajlal; Eva Jambon; Agnes Albat-Esquirou; Chloe Galmiche; Jean-Christophe Bernhard; Nicolas Grenier; Thibaud Haaser; François H. Cornelis
      Pages: 95 - 101
      Abstract: Publication date: January 2018
      Source:Academic Radiology, Volume 25, Issue 1
      Author(s): Pierre-Antoine Dirajlal, Eva Jambon, Agnes Albat-Esquirou, Chloe Galmiche, Jean-Christophe Bernhard, Nicolas Grenier, Thibaud Haaser, François H. Cornelis
      Purpose To evaluate the performance of T2 star-weighted angiography (SWAN) to concomitantly assess the prostate contour while detecting fiducials before magnetic resonance (MR)-based intensity-modulated radiation therapy (IMRT) in prostate carcinoma. Materials and Methods Forty patients (mean age: 73.1 ± 7.5 years; average Gleason score: 7 ± 1; average prostate-specific antigen: 14.7 ± 11.6 ng/mL) underwent MR and computed tomography imaging before fiducial-based IMRT. MR protocol included SWAN, T2-weighted (T2w) and diffusion-weighted imaging in a first group (n = 20) and SWAN, T2w and T2-star weighted imaging in a second group (n = 20). In group 1, the depiction of fiducials, image sharpness and visibility of prostate boundaries were independently evaluated by 2 readers on SWAN, T2w or diffusion-weighted images. In group 2, a similar evaluation was performed by 2 other readers on SWAN and T2-star images only. Depiction of fiducials was compared to computed tomography findings. Results The median scores of visibility of prostate boundaries, image sharpness and depiction of fiducials by SWAN were above average to excellent for all readers. In group 1, readers correctly located 56 of 57 (98.2%) and 47 of 57 (82.5%) fiducials, respectively; and 50 of 51 (98%), and 48 of 51 (88.2%) fiducials in group 2, respectively. Conclusion By allowing adequate visualization of the prostate boundaries and high depiction of fiducial markers concomitantly, SWAN might be used for treatment planning of IMRT. The use of this sequence might simplify the registration process and limit any errors associated with image fusion.

      PubDate: 2017-12-07T01:28:49Z
      DOI: 10.1016/j.acra.2017.07.012
  • Coronary Artery Calcium Imaging in the ROBINSCA Trial
    • Authors: Marleen Vonder; Carlijn M. van der Aalst; Rozemarijn Vliegenthart; Peter M.A. van Ooijen; Dirkjan Kuijpers; Jan Willem Gratama; Harry J. de Koning; Matthijs Oudkerk
      Pages: 118 - 128
      Abstract: Publication date: January 2018
      Source:Academic Radiology, Volume 25, Issue 1
      Author(s): Marleen Vonder, Carlijn M. van der Aalst, Rozemarijn Vliegenthart, Peter M.A. van Ooijen, Dirkjan Kuijpers, Jan Willem Gratama, Harry J. de Koning, Matthijs Oudkerk
      Rationale and Objectives To describe the rationale, design, and technical background of coronary artery calcium (CAC) imaging in the large-scale population-based cardiovascular disease screening trial (Risk Or Benefit IN Screening for CArdiovascular Diseases [ROBINSCA]). Materials and Methods First, literature search was performed to review the logistics, setup, and settings of previously performed CAC imaging studies, and current clinical CAC imaging protocols of participating centers in the ROBINSCA trial were evaluated. A second literature search was performed to evaluate the impact of computed tomography parameter settings on CAC score. Results Based on literature reviews and experts opinion an imaging protocol accompanied by data management protocol was created for ROBINSCA. The imaging protocol should consist of a fixed tube voltage, individually tailored tube current setting, mid-diastolic electrocardiography-triggering, fixed field-of-view, fixed reconstruction kernel, fixed slice thickness, overlapping reconstruction and without iterative reconstruction. The analysis of scans is performed with one type and version of CAC scoring software, by two dedicated and experienced researchers. The data management protocol describes the organization of data handling between the coordinating center, participating centers, and core analysis center. Conclusion In this paper we describe the rationale and technical considerations to be taken in developing CAC imaging protocol, and we present a detailed protocol that can be implemented for CAC screening purposes.

      PubDate: 2017-12-07T01:28:49Z
      DOI: 10.1016/j.acra.2017.07.010
  • Cardiac Magnetic Resonance Evaluation of Left Ventricular Myocardial
           Strain in Pulmonary Hypertension
    • Authors: Kimberly Kallianos; Gabriel C. Brooks; Kanae Mukai; Florent Seguro de Carvalho; Jing Liu; David M. Naeger; Teresa De Marco; Karen G. Ordovas
      Pages: 129 - 135
      Abstract: Publication date: January 2018
      Source:Academic Radiology, Volume 25, Issue 1
      Author(s): Kimberly Kallianos, Gabriel C. Brooks, Kanae Mukai, Florent Seguro de Carvalho, Jing Liu, David M. Naeger, Teresa De Marco, Karen G. Ordovas
      Rationale and Objectives We investigated the feasibility of detecting left ventricular (LV) cardiac magnetic resonance (CMR) strain abnormalities using feature-tracking in patients with pulmonary hypertension (PH). Materials and Methods CMR was performed in 16 patients with all groups of PH and in 13 controls. Global and regional peak circumferential strains (%) (which have been shown to be robust by CMR), peak diastolic strain rate (%/s), and dyssynchrony index (ms) were quantified with feature-tracking software. Ventricular function and volumes were calculated from CMR, and right heart pressures were measured with catheterization. Results Left ventricular ejection fraction (LVEF) was similar in patients (60.2% ± 11.0%) and controls (61.9% ± 4.5%), P = .150. Global LV peak circumferential strain was significantly different in patients compared to controls, −16.7 ± 2.8% vs −19.9 ± 1.8%, respectively (P = .001). The greatest difference in strain was seen in the LV septum, −11.6 ± 4.3% in patients vs −16.7 ± 4.0% in controls (P < .001). There was a significant association between septal strain and right ventricular end-diastolic volume index (P = .047) in patients with PH; however, there were no associations with pulmonary artery pressures or right ventricular ejection fraction. Conclusions Feature-tracking CMR can detect LV strain abnormalities in patients with PH and preserved or mildly depressed LVEF, with greatest abnormality in the septum. The association between septal strain and right ventricular end-diastolic volume index suggests that ventricular interdependence may be a mechanism of LV dysfunction in PH. Feature-tracking CMR may be useful for identification of LV dysfunction before LVEF significantly declines in patients with PH. The feasibility of detecting LV strain abnormalities in patients with PH shown by this study paves the way for a variety of future investigations into the applications of LV strain in this patient population.

      PubDate: 2017-12-07T01:28:49Z
      DOI: 10.1016/j.acra.2017.07.009
  • How Art Can Educate the Radiologist's Eye
    • Authors: Richard B. Gunderman; Aimebenomon O. Idahosa
      Pages: 136 - 138
      Abstract: Publication date: January 2018
      Source:Academic Radiology, Volume 25, Issue 1
      Author(s): Richard B. Gunderman, Aimebenomon O. Idahosa

      PubDate: 2017-12-07T01:28:49Z
      DOI: 10.1016/j.acra.2017.08.006
  • Does the Tumor Size Affect the Signal Enhancement Ratio in Luminal Breast
    • Authors: Kadri Altundag
      First page: 139
      Abstract: Publication date: January 2018
      Source:Academic Radiology, Volume 25, Issue 1
      Author(s): Kadri Altundag

      PubDate: 2017-12-07T01:28:49Z
      DOI: 10.1016/j.acra.2017.08.015
  • Increased Epicardial Fat Volume in Systemic Sclerosis
    • Authors: Matthew J. Budoff
      Pages: 1471 - 1472
      Abstract: Publication date: December 2017
      Source:Academic Radiology, Volume 24, Issue 12
      Author(s): Matthew J. Budoff

      PubDate: 2017-12-09T01:30:11Z
      DOI: 10.1016/j.acra.2017.09.005
  • Increased Epicardial Fat Volume Is Independently Associated with the
           Presence and Severity of Systemic Sclerosis
    • Authors: Benjamin D. Long; Jadranka Stojanovska; Richard K.J. Brown; Anil K. Attili; Eizabeth A. Jackson; Vladimir Ognenovski
      Pages: 1473 - 1481
      Abstract: Publication date: December 2017
      Source:Academic Radiology, Volume 24, Issue 12
      Author(s): Benjamin D. Long, Jadranka Stojanovska, Richard K.J. Brown, Anil K. Attili, Eizabeth A. Jackson, Vladimir Ognenovski
      Rationale and Objectives The study aimed to determine if intrathoracic fat volumes are associated with the presence and severity of systemic sclerosis (SSc), defined by the presence of pulmonary arterial hypertension (PAH). Materials and Methods A total of 265 patients were included in the study, 202 of whom had SSc (134 had SSc with no PAH and 68 had SSc-associated PAH) and who underwent high-resolution computed tomography, and 63 controls who underwent coronary computed tomography angiography with calcium scoring. Intrathoracic and epicardial (EFV) fat volumes were quantified by manual tracing of the mediastinum and the pericardium, the difference of which represents the extrapericardial fat volume. Associations between these three fat volumes and the presence and severity of SSc, adjusted for cardiovascular risk factors and interstitial lung disease, were evaluated by logistic regression analysis. Results Of the 202 patients with SSc, the mean age was 55 years (ranged from 20 to 86), and 79% (159 of 202) were women. Adjusted EFV (odds ratio [OR]: 1.065; 95% confidence interval [CI]: 1.046–1.084, P = < 0.0001), extrapericardial fat volume (OR: 1.028, 95% CI: 1.017–1.038, P = < 0.0001), and intrathoracic fat volume (OR: 1.033, 95% CI: 1.023–1.043, P = 0.001) were associated with the presence of SSc. Only EFV was associated with SSc severity (adjusted OR: 1.010, 95% CI: 1.003–1.018, P = 0.007). Conclusion Increased epicardial fat volume is associated with the presence and severity of SSc, independent of cardiovascular risk factors and interstitial lung disease.

      PubDate: 2017-12-09T01:30:11Z
      DOI: 10.1016/j.acra.2017.07.003
  • Evaluation of a High Concentrated Contrast Media Injection Protocol in
           Combination with Low Tube Current for Dose Reduction in Coronary Computed
           Tomography Angiography
    • Authors: Yibo Sun; Yanqing Hua; Mingpeng Wang; Dingbiao Mao; Xiu Jin; Cheng Li; Kailei Shi; Jianrong Xu
      Pages: 1482 - 1490
      Abstract: Publication date: December 2017
      Source:Academic Radiology, Volume 24, Issue 12
      Author(s): Yibo Sun, Yanqing Hua, Mingpeng Wang, Dingbiao Mao, Xiu Jin, Cheng Li, Kailei Shi, Jianrong Xu
      Rationale and Objectives The study aimed to prospectively evaluate the radiation dose reduction potential and image quality (IQ) of a high-concentration contrast media (HCCM) injection protocol in combination with a low tube current (mAs) in coronary computed tomography angiography. Materials and Methods Eighty-one consecutive patients (mean age: 62 years; 34 females; body mass index: 18–31) were included and randomized-assigned into two groups. All computed tomography (CT) examinations were performed in two groups with the same tube voltage (100 kV), flow rate of contrast medium (5.0 mL/s), and iodine dose (22.8 g). An automatic mAs and low concentration contrast medium (300 mgI/mL) were used in group A, whereas effective mAs was reduced by a factor 0.6 along with HCCM (400 mgI/mL) in group B. Radiation dose was assessed (CT dose index [CTDIvol] and dose length product), and vessel-based objective IQ for various regions of interest (enhancement, noise, signal-to-noise ratio, and contrast-to-noise ratio), subjective IQ, noise, and motion artifacts were analyzed overall and vessel-based with a 5-point Likert scale. Results The CT attenuation of coronary arteries and image noise in group B were significantly higher than those in group A (ranges: 507.5–548.1 Hounsfield units vs 407.5–444.5 Hounsfield units; and 20.3 ± 8.6 vs 17.7 ± 8.0) (P ≤ 0.0166). There was no significant difference between the two groups in signal-to-noise ratio, contrast-to-noise ratio, and subjective IQ of coronary arteries (29.4–31.7, 30.0–37.0, and medium score of 5 in group A vs 29.4–32.4, 27.7–36.3, and medium score of 5 in group B, respectively, P ≥ 0.1859). Both mean CTDIvol and dose length product in group B were 58% of those of group A. Conclusions HCCM combined with low tube current allows dose reduction in coronary computed tomography angiography and does not compromise IQ.

      PubDate: 2017-12-09T01:30:11Z
      DOI: 10.1016/j.acra.2017.07.001
  • Differentiation of Intrahepatic Cholangiocellular Carcinoma from
           Hepatocellular Carcinoma in the Cirrhotic Liver Using Contrast-enhanced MR
    • Authors: Georg J. Wengert; Pascal A.T. Baltzer; Hubert Bickel; Patrick Thurner; Julia Breitenseher; Mathias Lazar; Matthias Pones; Markus Peck-Radosavljevic; Florian Hucke; Ahmed Ba-Ssalamah
      Pages: 1491 - 1500
      Abstract: Publication date: December 2017
      Source:Academic Radiology, Volume 24, Issue 12
      Author(s): Georg J. Wengert, Pascal A.T. Baltzer, Hubert Bickel, Patrick Thurner, Julia Breitenseher, Mathias Lazar, Matthias Pones, Markus Peck-Radosavljevic, Florian Hucke, Ahmed Ba-Ssalamah
      Rationale and Objectives This study aimed to investigate the potential of contrast-enhanced magnetic resonance imaging features to differentiate between mass-forming intrahepatic cholangiocellular carcinoma (ICC) and hepatocellular carcinoma (HCC) in cirrhotic livers. Materials and Methods This study, performed between 2001 and 2013, included 64 baseline magnetic resonance imaging examinations with pathohistologically proven liver cirrhosis, presenting with either ICC (n = 32) or HCC (n = 32) tumors. To distinguish ICC form HCC tumors, 20 qualitative single-lesion descriptors were evaluated by two readers, in consensus, and statistically classified using the chi-square automatic interaction detection (CHAID) methodology. Diagnostic performance was assessed by a receiver operating characteristic analysis. Results The CHAID algorithm identified three independent categorical lesion descriptors, including (1) liver capsular retraction; (2) progressive or persistent enhancement pattern or wash-out on the T1-weighted delayed phase; and (3) signal intensity appearance on T2-weighted images that could help to reliably differentiate ICC from HCC, which resulted in an AUC of 0.807, and a sensitivity and specificity of 68.8 and 90.6 (95% confidence interval 75.0–98.0), respectively. Conclusions The proposed CHAID algorithm provides a simple and robust step-by-step classification tool for a reliable and solid differentiation between ICC and HCC tumors in cirrhotic livers.

      PubDate: 2017-12-23T15:01:00Z
      DOI: 10.1016/j.acra.2017.06.005
  • CT Image-based Decision Support System for Categorization of Liver
           Metastases Into Primary Cancer Sites
    • Authors: Avi Ben-Cohen; Eyal Klang; Idit Diamant; Noa Rozendorn; Stephen P. Raskin; Eli Konen; Michal Marianne Amitai; Hayit Greenspan
      Pages: 1501 - 1509
      Abstract: Publication date: December 2017
      Source:Academic Radiology, Volume 24, Issue 12
      Author(s): Avi Ben-Cohen, Eyal Klang, Idit Diamant, Noa Rozendorn, Stephen P. Raskin, Eli Konen, Michal Marianne Amitai, Hayit Greenspan
      Rationale and Objectives This study aimed to provide decision support for the human expert, to categorize liver metastases into their primary cancer sites. Currently, once a liver metastasis is detected, the process of finding the primary site is challenging, time-consuming, and requires multiple examinations. The proposed system can support the human expert in localizing the search for the cancer source by prioritizing the examinations to probable cancer sites. Materials and Methods The suggested method is a learning-based approach, using computed tomography (CT) data as the input source. Each metastasis is circumscribed by a radiologist in portal phase and in non-contrast CT images. Visual features are computed from these images, combined into feature vectors, and classified using support vector machine classification. A variety of different features were explored and tested. A leave-one-out cross-validation technique was conducted for classification evaluation. The methods were developed on a set of 50 lesion cases taken from 29 patients. Results Experiments were conducted on a separate set of 142 lesion cases taken from 71 patients with four different primary sites. Multiclass categorization results (four classes) achieved low accuracy results. However, the proposed system was found to provide promising results of 83% and 99% for top-2 and top-3 classification tasks, respectively. Moreover, when compared to the experts' ability to distinguish the different metastases, the system shows improved results. Conclusions Automated systems, such as the one proposed, show promising new results and demonstrate new capabilities that, in the future, will be able to provide decision and treatment support for radiologists and oncologists, toward more efficient detection and treatment of cancer.

      PubDate: 2017-12-09T01:30:11Z
      DOI: 10.1016/j.acra.2017.06.008
  • The Best Single Measurement for Assessing Splenomegaly in Patients with
           Cirrhotic Liver Morphology
    • Authors: Zachary Nuffer; Thomas Marini; Andrey Rupasov; Stephen Kwak; Shweta Bhatt
      Pages: 1510 - 1516
      Abstract: Publication date: December 2017
      Source:Academic Radiology, Volume 24, Issue 12
      Author(s): Zachary Nuffer, Thomas Marini, Andrey Rupasov, Stephen Kwak, Shweta Bhatt
      Rationale and Objectives There is little agreement within the radiology literature as to the best single measurement for assessing splenomegaly. In this study, we evaluate the correlation of multiple unidirectional measurements of the spleen with splenic volume in patients with cirrhotic liver morphology on computed tomography (CT). Materials and Methods Splenic volume was retrospectively calculated from CT examinations of 179 adult patients, 47 of whom were approved as renal donors, and 132 of whom were referred for various other indications, and were found to have cirrhotic liver morphology on CT. Seven unidimensional measurements (long-axis, cranial-caudal, width, and four measures of thickness) of each spleen were evaluated to identify which most closely correlated with the calculated volume. Results The splenic width had the best correlation with splenic volume for mild-to-moderate splenomegaly, and the splenic cranial-caudal measurement had the best correlation with splenic volume for massive splenomegaly. Receiver operating characteristic analysis demonstrates that a splenic width measurement of approximately 10.5 cm has a sensitivity of 89% and a specificity of 78% for mild-to-moderate splenomegaly, and a cranial-caudal measurement of 14.6 cm has a sensitivity of 92% and a specificity of 91% for massive splenomegaly. Conclusions A splenic width threshold of 10.5 cm is the most sensitive (89%) and specific (78%) single measurement for mild-to-moderate splenomegaly in patients with cirrhotic liver morphology, whereas a cranial-caudal height threshold of 14.6 cm is the most sensitive (92%) and specific (91%) single measurement for massive splenomegaly.

      PubDate: 2017-12-09T01:30:11Z
      DOI: 10.1016/j.acra.2017.06.006
  • Long-term Observation of CT-guided Radiofrequency Ablation of Lung
           Neoplasm in 476 Consecutive Patients by a Thoracic Surgical Service
    • Authors: Bing-Yang Huang; Jun-Jun Zhou; Zhi-Qi Yu; Xiao-Yong Song; Yi Lin; Xin-Min Li; Lu Li
      Pages: 1517 - 1525
      Abstract: Publication date: December 2017
      Source:Academic Radiology, Volume 24, Issue 12
      Author(s): Bing-Yang Huang, Jun-Jun Zhou, Zhi-Qi Yu, Xiao-Yong Song, Yi Lin, Xin-Min Li, Lu Li
      Rationale and Objectives The aim of the study was to evaluate the overall survival (OS) rate, progression survival rate, and local control rate over 10 years of medically inoperable patients with lung cancer undergoing computed tomography (CT)-guided radiofrequency ablation (RFA). Materials and Methods Between September 2004 to March 2016, 668 neoplasms were treated in 476 medically inoperable patients (294 men, 60 women; median age 74 years; range 29–84) who underwent CT-guided RFA. All patients had clinical or pathologic evidence of the neoplastic lesion: 22.1% patients with primary non–small cell lung cancer (NSCLC), 22.3% patients with recurrent NSCLC, 45.2% with metastases, and 10.3% with small cell lung cancer. The mean size of the lesions was 3.8 cm (range of 1–16 cm). Twenty-one lesions were re-treated from one to as many as four times. Results The procedure was technically successful in all cases. No procedure-related deaths occurred in the RFA procedures. Major complications consisted in 104 (21.8%) cases of low-grade fever, 46 (9.6%) of the pneumothorax. The mean follow-up was 32 months. The probabilities of 1-, 2-, 3-, 5-, and 10-year OS rate were 98.1%, 86.6%, 68.9% 34.5%, and 9.5% for primary NSCLC; 59.7%, 18.5%, 8%, 3.4%, and 1.5% for metastases; 93.3%, 59.1%, 49.6%, 19.7%, and 0% for recurrence; and 89.4%, 67.5%, 39.1%, 16.5%, and 0% for small cell lung cancer. In primary NSCLC, progression-free survival (PFS) and OS were significantly related to tumor size, but there was no significant difference in recurrent NSCLC, metastasis, and peripheral SCLC. The median OS of metastases of NSCLC was significantly related to nodal or distant metastases. The most common pattern of recurrence was local; any type of recurrence at 1-year follow-up imaging was seen in 7.1% of primary NSCLC diameter less than 3 cm. Conclusions Our experience indicates that CT-guided RFA done by the thoracic surgeons is feasible and safe in high-risk patients. Maximum tumor diameter less than 3 cm and lack of extrapulmonary metastasis are all positive prognostic factors of survival after RFA. RFA offers good local control of recurrent NSCLC, lung metastases, and SCLC, also in the long-term period. RFA should continue to offer an alternative option in medically inoperable patients.

      PubDate: 2017-12-23T15:01:00Z
      DOI: 10.1016/j.acra.2017.06.018
  • Validation of Feasibility of Magnetic Resonance Imaging for the
           Measurement of Depth of Tumor Invasion in Distal Bile Duct Cancer
           According to the New American Joint Committee on Cancer Staging System
    • Authors: Na Yeon Han; Joo Young Kim; Min Ju Kim; Beom Jin Park; Deuk Jae Sung; Ki Choon Sim; Sung Bum Cho; Dong Sik Kim
      Pages: 1526 - 1534
      Abstract: Publication date: December 2017
      Source:Academic Radiology, Volume 24, Issue 12
      Author(s): Na Yeon Han, Joo Young Kim, Min Ju Kim, Beom Jin Park, Deuk Jae Sung, Ki Choon Sim, Sung Bum Cho, Dong Sik Kim
      Rationale and Objectives This study aimed to develop and validate a method for measuring the depth of tumor invasion (DoI) using magnetic resonance imaging (MRI) and to investigate the diagnostic performance of the measured DoI for stratifying tumor (T) classification in patients with distal bile duct cancer according to the new American Joint Committee on Cancer staging system. Materials and Methods Fifty-four patients (30 men and 24 women; age range, 43–81 years) with distal bile duct cancer were enrolled. A study coordinator first developed a “provisional method” for measuring DoI on T2-weighted MRI. Subsequently, after compensating for defects, the “improved method” was developed. Two reviewers independently measured DoI and assessed its correlations with the histopathologic reference standard using intraclass correlation coefficient (ICC). The study population was grouped according to the DoI for T classification based on the new staging system for evaluation of diagnostic predictive values. Results The ICC values between the radiologic and the histopathologic DoI were calculated. Using the “improved method,” the ICC for the coordinator's DoI was very good (ICC, 0.885), which was a significantly higher value than that obtained using the “provisional method” (ICC, 0.501, P = .00000); and for two reviewers' DoIs, the ICC values were good (ICC, 0.752 and 0.784, respectively). The overall accuracy of MRI for stratifying bile duct tumors using DoI was 87.0% and 85.2%, respectively. Conclusions This newly developed method reliably measured DoI on T2-weighted MRI and can be used for preoperative T classification of patients with distal bile duct cancer according to the new staging system.

      PubDate: 2017-12-09T01:30:11Z
      DOI: 10.1016/j.acra.2017.06.011
  • How Well Does Dual-energy CT with Fast Kilovoltage Switching Quantify CT
           Number and Iodine and Calcium Concentrations'
    • Authors: Shingo Ohira; Tsukasa Karino; Yoshihiro Ueda; Yuya Nitta; Naoyuki Kanayama; Masayoshi Miyazaki; Masahiko Koizumi; Teruki Teshima
      Abstract: Publication date: Available online 21 December 2017
      Source:Academic Radiology
      Author(s): Shingo Ohira, Tsukasa Karino, Yoshihiro Ueda, Yuya Nitta, Naoyuki Kanayama, Masayoshi Miyazaki, Masahiko Koizumi, Teruki Teshima
      Rationale and Objectives Because it is imperative for understanding the performance of dual-energy computed tomography scanner to determine clinical diagnosis, we aimed to assess the accuracy of quantitative measurements using dual-energy computed tomography with fast kilovoltage switching. Materials and Methods Quantitative measurements were performed for 16 reference materials (physical density, 0.965–1.550 g/cm3; diameter of rod, 2.0–28.5 mm; iodine concentration, 2–15 mg/mL; and calcium concentration, 50–300 mg/mL) with varying scanning settings, and the measured values were compared to their theoretical values. Results For high-density material, the maximum differences in Hounsfield unit values in the virtual monochromatic images at 50, 70, and 100 keV were −176.2, 61.0, and −35.2 HU, respectively, and the standard deviations over short- and long-term periods were 11.1, 6.1, and 3.5 HU at maximum. The accuracy of the Hounsfield unit measurement at 50 and 70 keV was significantly higher (P < 0.05) with higher radiation output and smaller phantom size. The difference in the iodine and calcium measurements in the large phantom were up to −2.6 and −60.4 mg/mL for iodine (5 mg/mL with 2-mm diameter) and calcium (300 mg/mL) materials, and the difference was improved with a small phantom. Metal artifact reduction software improved subjective image quality; however, the quantitative values were significantly underestimated (P < 0.05) (−49.5, −26.9, and −15.3 HU for 50, 70, and 100 keV, respectively; −1.0 and −17 mg/mL for iodine and calcium concentration, respectively) compared to that acquired without a metal material. Conclusions The accuracy of quantitative measurements can be affected by material density and the size of the object, radiation output, phantom size, and the presence of metal materials.

      PubDate: 2017-12-23T15:01:00Z
      DOI: 10.1016/j.acra.2017.11.002
  • Breast Imaging Outcomes following Abnormal Thermography
    • Authors: Colleen H. Neal; Kelsey A. Flynt; Deborah O. Jeffries; Mark A. Helvie
      Abstract: Publication date: Available online 21 December 2017
      Source:Academic Radiology
      Author(s): Colleen H. Neal, Kelsey A. Flynt, Deborah O. Jeffries, Mark A. Helvie
      Rationale and Objectives The study aimed to determine the outcome of patients presenting for evaluation of abnormal breast thermography. Materials and Methods Following Institutional Review Board approval, retrospective search identified 38 patients who presented for conventional breast imaging following a thermography-detected abnormality. Study criteria included women who had mammogram and/or breast ultrasound performed for evaluation of a thermography-detected abnormality between January 1, 2000, and December 31, 2015. Patients whose mammograms and ultrasounds were initiated at an outside institution or who did not have imaging at our institution were excluded. Records were reviewed for clinical history, thermography results, mammogram and/or ultrasound findings, and pathology. Mammograms and ultrasounds were prospectively interpreted by one of 14 Mammography Quality Standards Act–certified breast imaging radiologists with 3–30 years of experience. Patient outcomes were determined by biopsy or at least 1 year of follow-up. Patient ages ranged from 23 to 70 years (mean = 50 years). Results Ninety-five percent (36 of 38) of patients did not have breast cancer. The two patients diagnosed with breast cancer had suspicious clinical symptoms including palpable mass and erythema. No asymptomatic woman had breast cancer. Negative predictive value was 100%. Of 38 patients, 79% (30 of 38) had Breast Imaging Reporting and Data System (BI-RADS) 1 or 2 assessments; 5% (2 of 38) had BI-RADS 3; and 16% (6 of 38) had BI-RADS 4 (n = 5) or BI-RADS 5 (n = 1) assessments. Two of six patients with biopsy recommendations were diagnosed with breast cancer (Positive predictive value 2 = 33.3%). All findings recommended for biopsy were ipsilateral to the reported thermography abnormality. Conclusions No cancer was diagnosed among asymptomatic women. The 5% of patients diagnosed with cancer had co-existing suspicious clinical findings. Mammogram and/or ultrasound were useful in accurately characterizing patients with abnormal thermography.

      PubDate: 2017-12-23T15:01:00Z
      DOI: 10.1016/j.acra.2017.10.015
  • Soft Tissue Sarcoma Response to Two Cycles of Neoadjuvant Chemotherapy
    • Authors: Jennifer L. Favinger; Daniel S. Hippe; Darin J. Davidson; Saeed Elojeimy; Eira S. Roth; Antoinette W. Lindberg; Alice S. Ha
      Abstract: Publication date: Available online 19 December 2017
      Source:Academic Radiology
      Author(s): Jennifer L. Favinger, Daniel S. Hippe, Darin J. Davidson, Saeed Elojeimy, Eira S. Roth, Antoinette W. Lindberg, Alice S. Ha
      Rationale and Objectives When soft tissue sarcomas are treated with neoadjuvant chemotherapy, the number of cycles of chemotherapy is usually dependent on the tumor's initial response. Popular methods to assess tumor response include Response Evaluation Criteria in Solid Tumors (RECIST) criteria, which rely solely on tumor size, and maximum standardized uptake value (SUVmax) reduction in positron emission tomography (PET), which requires an expensive and high radiation test. We hypothesized that contrast-enhanced magnetic resonance imaging (MRI) may offer a good alternative by providing additional information beyond tumor size. Materials and Methods Following IRB approval, a retrospective review identified patients with soft tissue sarcomas who underwent both PET and MRI before and after two cycles of neoadjuvant chemotherapy. Five readers independently examined the MRI exams for: changes in size, T2 or T1 signal, necrosis and degree of enhancement. Readers then made a subjective binary assessment of tumor response to therapy. Each reader repeated the anonymized randomized reading at least 2 weeks apart. 18 F-FDG PET exams were interpreted by a nuclear medicine specialist. The maximum standardized uptake values (SUVmax) for pre and post-chemotherapy exams were compared. Intra- and inter-reader agreement was assessed using Cohen's kappa and Light's kappa, respectively. . Results Twenty cases were selected for this multireader study, of which 9 (45%) were responders and 11 were nonresponders by SUVmax. Using all MRI criteria, 43% were classified as responders based on MRI and 1.5% were classified as responders by RECIST criteria. Using PET as the reference, the sensitivity and the specificity of the MRI diagnosis for response using all findings were 50% and 63%, respectively. There was fair to moderate intrareader (kappa = 0.37) and inter-reader (kappa = 0.48) agreement for the MRI diagnosis of response. None of the individual MRI signal characteristics were significantly different between the PET responders and nonresponders. Additionally, no MRI findings were significantly different between those with and without good clinical responses. Conclusion By our assessment, there is a poor correlation between tumor response by RECIST criteria and PET SUVmax. In addition, varying MR features did not help in diagnosing tumor response. Imaging of tumor response remains a challenging area that requires further research.

      PubDate: 2017-12-23T15:01:00Z
      DOI: 10.1016/j.acra.2017.10.013
  • Detection of Intra-Articular Screw Penetration of Proximal Humerus
    • Authors: Xiaoyang Jia; Yanxi Chen; Minfei Qiang; Kun Zhang; Haobo Li; Yuchen Jiang; Yijie Zhang
      Abstract: Publication date: Available online 18 December 2017
      Source:Academic Radiology
      Author(s): Xiaoyang Jia, Yanxi Chen, Minfei Qiang, Kun Zhang, Haobo Li, Yuchen Jiang, Yijie Zhang
      Rationale and Objective Screw penetration is the common complication of proximal humerus fractures treated with locking plates. This study compared postoperative plain radiography to computed tomography (CT) for their abilities in determining screw penetration, and was to evaluate whether advanced imaging modalities (two-dimensional [2D] CT; three-dimensional [3D] CT) could increase surgeons' level of confidence regarding their diagnoses. Materials and Methods Two observers reviewed radiological images of 134 patients who sustained proximal humerus fractures treated with locking plates. The observers were asked to answer two questions: (1) Is there screw penetrating into glenohumeral joint for this patient (Yes/No)' and (2) On a scale from 0 to 10, how confident are you about this diagnosis: (0–10) (0 = not at all confident; 10 = very confident)' Three evaluations were performed: (1) plain radiography alone, (2) radiography and 2D CT 4 weeks later, and (3) radiography in combination with 2D and 3D CT after that. This process was then repeated for intraobserver analysis. Results CT obtained almost perfect interobserver and intraobserver agreement (0.818–0.961), which was higher than radiography (0.377–0.655). For incidence of screw penetration, the significant difference was found between radiographs and CT images (P < .0125), but not between 2D and 3D CT images (P > .05). For confidence of diagnosis, the differences between imaging modalities were significant (all P < .001). Conclusions We suggest that postoperative CT scans (especially 3D CT images) should be used to evaluate the intra-articular screw penetration of proximal humerus fractures, especially when surgeons have not enough confidence in determining screw penetration using radiography alone.

      PubDate: 2017-12-23T15:01:00Z
      DOI: 10.1016/j.acra.2017.10.021
  • Low Tube Voltage and Iterative Model Reconstruction in Follow-up CT
           Angiography After Thoracic Endovascular Aortic Repair
    • Authors: Ping Hou; Xiangnan Feng; Jie Liu; Xiaopeng Wang; Yaojun Jiang; Leigang Dong; Jianbo Gao
      Abstract: Publication date: Available online 14 December 2017
      Source:Academic Radiology
      Author(s): Ping Hou, Xiangnan Feng, Jie Liu, Xiaopeng Wang, Yaojun Jiang, Leigang Dong, Jianbo Gao
      Rationale and Objectives This study aimed to investigate the feasibility of reducing radiation exposure and contrast medium (CM) dose in follow-up computed tomography angiography (CTA) after thoracic endovascular aortic repair (TEVAR) using low tube voltage and knowledge-based iterative model reconstruction (IMR). Materials and Methods Thirty-six patients that required follow-up CTA after TEVAR were included in this intra-individual study. The conventional protocol with standard tube voltage of 120 kVp and CM volume of 70 mL was applied in the first follow-up CTA of all the patients (control group A). The ultra-low CM dose protocol with low tube voltage of 80 kVp and weight-adapted CM volume of 0.4 mL/kg was utilized in the second follow-up CTA (study group B). Set A.FBP (group A filtered back-projection) contained images for group A that were reconstructed through FBP method. Three sets (B.FBP, B.HIR, and B.IMR) for group B were reconstructed using three methods, FBP, hybrid iterative reconstruction (HIR), and IMR, respectively. Objective measurements including aortic attenuations, image noise, contrast-to-noise ratios (CNRs), and figure of merit of CNR (FOMCNR), and subjective rating scores of the four image sets were compared. Results Compared to the images in set A.FBP, the images in set B.IMR had better quality in terms of equivalent attenuation values, equivalent subjective scores, lower noise, higher or equivalent CNRs, and higher FOMCNR. The quality of images in sets B.FBP and B.HIR was unacceptable. The radiation exposure and CM dose in group B were 1.94 mGy and 28 ± 5 mL, respectively, representing reductions of 77.6% (P < .001) and 60% (P < .001) as compared to those in group A. Conclusions In follow-up examinations after TEVAR, CTA with ultra-low radiation exposure and CM dose is feasible using low tube voltage and IMR for nonobese patients.

      PubDate: 2017-12-23T15:01:00Z
      DOI: 10.1016/j.acra.2017.11.001
  • Volumetric MRI in Neurofibromatosis Type 1 (NF1) Comes of Age to Help
           Determine Initiation and Monitoring of Targeted Therapies for Plexiform
    • Authors: David Viskochil; Luke L. Linscott
      Abstract: Publication date: Available online 13 December 2017
      Source:Academic Radiology
      Author(s): David Viskochil, Luke L. Linscott

      PubDate: 2017-12-23T15:01:00Z
      DOI: 10.1016/j.acra.2017.11.003
  • Essentials of Statistical Methods for Assessing Reliability and Agreement
           in Quantitative Imaging
    • Authors: Arash Anvari; Elkan F. Halpern; Anthony E. Samir
      Abstract: Publication date: Available online 11 December 2017
      Source:Academic Radiology
      Author(s): Arash Anvari, Elkan F. Halpern, Anthony E. Samir
      Quantitative imaging is increasing in almost all fields of radiological science. Modern quantitative imaging biomarkers measure complex parameters including metabolism, tissue microenvironment, tissue chemical properties or physical properties. In this paper, we focus on measurement reliability assessment in quantitative imaging. We review essential concepts related to measurement such as measurement variability and measurement error. We also discuss reliability study methods for intraobserver and interobserver variability, and the applicable statistical tests including: intraclass correlation coefficient, Pearson correlation coefficient, and Bland-Altman graphs and limits of agreement, standard error of measurement, and coefficient of variation.

      PubDate: 2017-12-23T15:01:00Z
      DOI: 10.1016/j.acra.2017.09.010
  • Understanding Patient Preference in Female Pelvic Imaging
    • Authors: Michelle D. Sakala; Ruth C. Carlos; Mishal Mendiratta-Lala; Elisabeth H. Quint; Katherine E. Maturen
      Abstract: Publication date: Available online 11 December 2017
      Source:Academic Radiology
      Author(s): Michelle D. Sakala, Ruth C. Carlos, Mishal Mendiratta-Lala, Elisabeth H. Quint, Katherine E. Maturen
      Rationale and Objectives Women with pelvic pain or abnormal uterine bleeding may undergo diagnostic imaging. This study evaluates patient experience in transvaginal ultrasound (TVUS) and magnetic resonance imaging (MRI) and explores correlations between preference and symptom severity. Materials and Methods Institutional review board approval was obtained for this Health Insurance Portability and Accountability Act-compliant prospective study. Fifty premenopausal women with pelvic symptoms evaluated by recent TVUS and MRI and without history of gynecologic cancer or hysterectomy were included. A phone questionnaire used validated survey instruments including Uterine Fibroid Symptoms Quality of Life index, Testing Morbidities Index, and Wait Trade Off for TVUS and MRI examinations. Results Using Wait Trade Off, patients preferred TVUS over MRI (3.58 vs 2.80 weeks, 95% confidence interval [CI] −1.63, 0.12; P = .08). Summary test utility of Testing Morbidities Index for MRI was worse than for TVUS (81.64 vs 87.42, 95%CI 0.41, 11.15; P = .03). Patients reported greater embarrassment during TVUS than during MRI (P < .0001), but greater fear and anxiety both before (P < .0001) and during (P < .001) MRI, and greater mental (P = .02) and physical (P = .02) problems after MRI versus TVUS. Subscale correlations showed physically inactive women rated TVUS more negatively (R = −0.32, P = .03), whereas women with more severe symptoms of loss of control of health (R = −0.28, P = .04) and sexual dysfunction (R = −0.30, P = .03) rated MRI more negatively. Conclusion Women with pelvic symptoms had a slight but significant preference for TVUS over MRI. Identifying specific distressing aspects of each test and patient factors contributing to negative perceptions can direct improvement in both test environment and patient preparation. Improved patient experience may increase imaging value.

      PubDate: 2017-12-23T15:01:00Z
      DOI: 10.1016/j.acra.2017.10.011
  • Determinants of Difficulty and Discriminating Power of Image-based Test
           Items in Postgraduate Radiological Examinations
    • Authors: Dirk R. Rutgers; Fleur van Raamt; Anouk van der Gijp; Christian Mol; Olle ten Cate
      Abstract: Publication date: Available online 6 December 2017
      Source:Academic Radiology
      Author(s): Dirk R. Rutgers, Fleur van Raamt, Anouk van der Gijp, Christian Mol, Olle ten Cate
      Rationale and Objectives The psychometric characteristics of image-based test items in radiological written examinations are not well known. In this study, we explored difficulty and discriminating power of these test items in postgraduate radiological digital examinations. Materials and Methods We reviewed test items of seven Dutch Radiology Progress Tests (DRPTs) that were taken from October 2013 to April 2017. The DRPT is a semiannual formative examination, required for all Dutch radiology residents. We assessed several stimulus and response characteristics of test items. The response format of test items included true or false, single right multiple choice with 2, 3, 4, or ≥5 answer options, pick-N multiple-choice, drag-and-drop, and long-list-menu formats. We calculated item P values and item-rest-correlation (Rir) values to assess difficulty and discriminating power. We performed linear regression analysis in image-based test items to investigate whether P and Rir values were significantly related to stimulus and response characteristics. Also, we compared psychometric indices between image-based test items and text-alone items. Results P and Rir values of image-based items (n = 369) were significantly related to the type of response format (P < .001), and not to which of the seven DRPTs the item was obtained from, radiological subspecialty domain, nonvolumetric or volumetric character of images, or context-rich or context-free character of the stimulus. When accounted for type of response format, difficulty and discriminating power of image-based items did not differ significantly from text-alone items (n = 881). Test items with a relatively large number of answer options were generally more difficult, and discriminated better among high- and low-performing candidates. Conclusion In postgraduate radiological written examinations, difficulty and discriminating power of image-based test items are related to the type of response format and are comparable to those of text-alone items. We recommend a response format with a relatively large number of answer options to optimize psychometric indices of radiological image-based test items.

      PubDate: 2017-12-23T15:01:00Z
      DOI: 10.1016/j.acra.2017.10.014
  • Diagnostic Values of DCE-MRI and DSC-MRI for Differentiation Between
           High-grade and Low-grade Gliomas
    • Authors: Jianye Liang; Dexiang Liu; Peng Gao; Dong Zhang; Hanwei Chen; Changzheng Shi; Liangping Luo
      Abstract: Publication date: Available online 6 December 2017
      Source:Academic Radiology
      Author(s): Jianye Liang, Dexiang Liu, Peng Gao, Dong Zhang, Hanwei Chen, Changzheng Shi, Liangping Luo
      Rationale and Objectives This study aimed to collect the studies on the role of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) and dynamic susceptibility contrast MRI (DSC-MRI) in differentiating the grades of gliomas, and evaluate the diagnostic performances of relevant quantitative parameters in glioma grading. Materials and Methods We systematically searched studies on the diagnosis of gliomas with DCE-MRI or DSC-MRI in Medline, PubMed, China National Knowledge Infrastructure database, Cochrane Library, and Embase published between January 2005 and December 2016. Standardized mean differences and 95% confidence intervals were calculated for volume transfer coefficient (Ktrans), volume fraction of extravascular extracellular space (Ve), rate constant of backflux (Kep), relative cerebral blood volume (rCBV), and relative cerebral blood flow (rCBF) using Review Manager 5.2 software. Sensitivity, specificity, area under the curve (AUC), and Begg test were calculated by Stata 12.0. Results Twenty-two studies with available outcome data were included in the analysis. The standardized mean difference of Ktrans values between high-grade glioma and low-grade glioma were 1.18 (0.91, 1.45); Ve values were 1.43 (1.06, 1.80); Kep values were 0.65 (−0.05, 1.36); rCBV values were 1.44 (1.08, 1.81); and rCBF values were 1.17 (0.68, 1.67), respectively. The results were all significant statistically (P < .05) except Kep values (P = .07), and high-grade glioma had higher Ktrans, Ve, rCBV, and rCBF values than low-grade glioma. AUC values of Ktrans, Ve, rCBV, and rCBF were 0.90, 0.88, 0.93, and 0.73, respectively; rCBV had the largest AUC among the four parameters (P < .05). Conclusion Both DCE-MRI and DSC-MRI are reliable techniques in differentiating the grades of gliomas, and rCBV was found to be the most sensitive one.

      PubDate: 2017-12-23T15:01:00Z
      DOI: 10.1016/j.acra.2017.10.001
  • Review of Simulation Training in Interventional Radiology
    • Authors: Souzan Mirza; Sriharsha Athreya
      Abstract: Publication date: Available online 6 December 2017
      Source:Academic Radiology
      Author(s): Souzan Mirza, Sriharsha Athreya
      Simulation training has evolved and is now able to offer numerous training opportunities to supplement the practice of and overcome some of the shortcomings of the traditional Master-Apprentice model currently used in medical training. Simulation training provides new opportunities to practice skills used in clinical procedures, crisis management scenarios, and everyday clinical practice in a risk-free environment. Procedural and nonprocedural skills used in interventional radiology can be taught with the use of simulation devices and technologies. This review will inform the reader of which clinical skills can be trained with simulation, the types of commercially available simulators and their educational validity, and the assessment tools used to evaluate simulation training.

      PubDate: 2017-12-07T01:28:49Z
      DOI: 10.1016/j.acra.2017.10.009
  • Preventing Overdiagnosis of Acetabular Labral “Tears” in
           40-Plus-year-old Patients
    • Authors: Ian Amber; Suyash Mohan
      Abstract: Publication date: Available online 6 December 2017
      Source:Academic Radiology
      Author(s): Ian Amber, Suyash Mohan
      Acetabular labral tears represent a common finding on magnetic resonance imaging of the hip. Labral tears can arise from a multitude of underlying pathological processes or they may be an asymptomatic incidental finding. The prevalence of labral tears and their lack of specificity make this an area vulnerable to potential overdiagnosis. The overdiagnosis of labral tears leads to overtreatment by exposing patients to unnecessary surgeries as well as complications ranging from unsatisfying outcomes to deep venous thrombosis. This risk is compounded by the tabloid popularization of labral surgeries by celebrities such as Lady Gaga, which could potentiate patient perception of a two-tiered level of health care. Following a similar situation with spine nomenclature, one solution to this issue is to reclassify “labral tears” as “labral fissures” in some or all cases to mitigate the acute traumatic connotation of the term “tear.”

      PubDate: 2017-12-07T01:28:49Z
      DOI: 10.1016/j.acra.2017.10.019
  • Epidemiology of Hepatic Steatosis at a Tertiary Care Center
    • Authors: Tyler J. Fraum; Daniel R. Ludwig; Scott Kilian; William A. Curtis; Thomas K. Pilgram; Claude B. Sirlin; Kathryn J. Fowler
      Abstract: Publication date: Available online 2 December 2017
      Source:Academic Radiology
      Author(s): Tyler J. Fraum, Daniel R. Ludwig, Scott Kilian, William A. Curtis, Thomas K. Pilgram, Claude B. Sirlin, Kathryn J. Fowler
      Rationale and Objectives Little is known about the frequency and risk factors of hepatic steatosis in the tertiary care setting. Such knowledge is essential to clinicians making decisions about testing for this condition. Thus, our aim was to describe the epidemiology of hepatic steatosis, as captured by magnetic resonance imaging (MRI), at a tertiary care center. Materials and Methods A near-consecutive cohort of 1006 adult patients underwent standard-of-care liver MRIs. Images were retrospectively processed to derive proton density fat fraction (PDFF) maps. Data from three spatially distinct regions of interest (ROIs) were aggregated to derive overall hepatic PDFF values. Demographic, anthropometric, clinical, and laboratory variables were included in a multivariate analysis to determine predictors of hepatic steatosis grades (based on established PDFF cutoffs). Hepatic steatosis grades derived from single vs aggregated ROIs were compared. Results Hepatic steatosis was observed in 25% of patients (19% grade 1; 3% grade 2; 3% grade 3). Controlling for all other variables, the odds of hepatic steatosis increased by 7%–9% (P < .001) for each whole point increase in body mass index (BMI), whereas elevated serum bilirubin was associated with lower odds of hepatic steatosis (P = .002). Race, diabetes mellitus, dyslipidemia, and metabolic syndrome were not independently predictive of hepatic steatosis when controlling for other variables (eg, BMI). Employing single ROIs (rather than three aggregated ROIs) resulted in incorrect steatosis grading in up to 8.0% of patients. Conclusion Many adult patients undergoing liver MRI at a tertiary care center have hepatic steatosis, with larger BMIs as the only independent predictor of higher grades. This information can be used by clinicians at such centers to make evidence-based decisions about when to test for hepatic steatosis in their patients.

      PubDate: 2017-12-07T01:28:49Z
      DOI: 10.1016/j.acra.2017.10.002
  • Leveraging Mega-trends in Medicine Today to Enhance Patient Care in
           Radiology Tomorrow
    • Authors: Andrew B. Rosenkrantz
      Abstract: Publication date: Available online 22 November 2017
      Source:Academic Radiology
      Author(s): Andrew B. Rosenkrantz

      PubDate: 2017-11-26T00:57:31Z
      DOI: 10.1016/j.acra.2017.10.005
  • Correlation of Brown Adipose Tissue with Other Body Fat Compartments and
           Patient Characteristics
    • Authors: Cornelia Brendle; Matthias K. Werner; Maria Schmadl; Christian la Fougère; Konstantin Nikolaou; Norbert Stefan; Christina Pfannenberg
      Abstract: Publication date: Available online 3 November 2017
      Source:Academic Radiology
      Author(s): Cornelia Brendle, Matthias K. Werner, Maria Schmadl, Christian la Fougère, Konstantin Nikolaou, Norbert Stefan, Christina Pfannenberg
      Rationale and Objectives The objective of this study was to assess the relationship of brown adipose tissue (BAT) activity with different fat compartments of the body, body mass index (BMI), outdoor temperature, thyroid-stimulating hormone (TSH) levels, blood glucose, age, and sex in a large patient population using F-18-fluordesoxyglucose positron emission tomography-computer tomography (FDG-PET/CT) scans obtained under thermoneutral conditions. Materials and Methods FDG-PET/CT scans of 4852 patients were retrospectively analyzed for BAT activity. The volumes of the different fat compartments visceral adipose tissue (VAT), subcutaneous adipose tissue (SCAT), and liver fat, were assessed by computed tomography. Age, sex, TSH levels, blood glucose levels, BMI, primary disease, and the outdoor temperature were determined. Multiple linear regression analyses were performed to identify independent relationships between the parameters. Results The VAT, SCAT, and liver fat content were lower in BAT-positive patients than in BAT-negative patients (each P < 0.0001). BAT-positive patients had a lower BMI (P < 0.0001) and were more often female (P < 0.0001), younger (P < 0.0001), and had higher TSH levels (P = 0.0002), whereas the outdoor temperature and the blood glucose level were not different compared to BAT-negative patients. Age, sex, VAT, and SCAT were independent factors related to BAT. Conclusions Age, sex, and VAT are the most important determinants of BAT activity under thermoneutral conditions. VAT reflects the association between BAT activity and body fat mass more clearly than BMI. The strength of the association between VAT and BAT decreases during aging in men, but increases in women. This may indicate a different importance of BAT activity for obesity in men and in women.

      PubDate: 2017-11-09T04:30:09Z
      DOI: 10.1016/j.acra.2017.09.007
  • Robotically Assisted Long Bone Biopsy Under MRI Imaging
    • Authors: Kevin Cleary; Sunghwan Lim; Changhan Jun; Reza Monfaredi; Karun Sharma; Stanley Thomas Fricke; Luis Vargas; Doru Petrisor; Dan Stoianovici
      Abstract: Publication date: Available online 23 October 2017
      Source:Academic Radiology
      Author(s): Kevin Cleary, Sunghwan Lim, Changhan Jun, Reza Monfaredi, Karun Sharma, Stanley Thomas Fricke, Luis Vargas, Doru Petrisor, Dan Stoianovici
      Rationale and Objectives Our research team has developed a magnetic resonance imaging (MRI)-compatible robot for long bone biopsy. The robot is intended to enable a new workflow for bone biopsy in pediatrics under MRI imaging. Our long-term objectives are to minimize trauma and eliminate radiation exposure when diagnosing children with bone cancers and bone infections. This article presents our robotic systems, phantom accuracy studies, and workflow analysis. Materials and Methods This section describes several aspects of our work including the envisioned clinical workflow, the MRI-compatible robot, and the experimental setup. The workflow consists of five steps and is intended to enable the entire procedure to be completed in the MRI suite. The MRI-compatible robot is MR Safe, has 3 degrees of freedom, and a remote center of motion mechanism for orienting a needle guide. The accuracy study was done in a Siemens Aera 1.5T scanner with a long bone phantom. Four targeting holes were drilled in the phantom. Results Each target was approached twice at slightly oblique angles using the robot needle guide for a total of eight attempts. A workflow analysis showed the average time for each targeting attempt was 32 minutes, including robot setup time. The average 3D targeting error was 1.39 mm with a standard deviation of 0.40 mm. All of the targets were successfully reached. Conclusion The results showed the ability of the robotic system in assisting the radiologist to precisely target a bone phantom in the MRI environment. The robot system has several potential advantages for clinical application, including the ability to work at the MRI isocenter and serve as a steady and precise guide.

      PubDate: 2017-10-25T12:45:07Z
      DOI: 10.1016/j.acra.2017.08.008
  • Social Media Utilization at an Academic Radiology Practice
    • Authors: Nicholas A. Koontz; Aaron P. Kamer; Sean C. Dodson; Alisha E. Capps; Courtney M. Tomblinson; Brandon P. Brown; Mark S. Frank; Darel E. Heitkamp
      Abstract: Publication date: Available online 19 October 2017
      Source:Academic Radiology
      Author(s): Nicholas A. Koontz, Aaron P. Kamer, Sean C. Dodson, Alisha E. Capps, Courtney M. Tomblinson, Brandon P. Brown, Mark S. Frank, Darel E. Heitkamp
      Rationale and Objectives We report social media (SoMe) utilization trends at an academic radiology department, highlighting differences between trainees and faculty and between Baby Boomers versus Generation X and Millennials. Materials and Methods An anonymous online survey regarding SoMe utilization and SoMe-based educational curriculum was distributed to all radiologists (trainees and faculty) in our department. Regular chi-square, ordered (Mantel-Haenszel) chi-square, and Fischer exact tests were performed. Results The survey instrument was sent to 172 radiologists with a 65% completion rate (N = 112). Eighty-three percent (n = 92) of the respondents use SoMe, with Facebook (67%, n = 75), YouTube (57%, n = 64), Instagram (26%, n = 29), and Twitter (21%, n = 23) as the most commonly used platforms. Eighty-one percent (n = 91) use SoMe for 30 minutes or less per day. Thirty-five percent (n = 39) reported previously using SoMe for educational purposes, although 66% (n = 73) would be willing to join SoMe for educational activities. The faculty are more likely than trainees to avoid using SoMe (30% vs 9%, P < 0.03). Trainees are more likely than faculty to find an electronic case-based curriculum valuable (95% vs 83%, P < 0.05) and are willing to spend more time on cases (P < 0.01). Baby Boomers are less interested in joining SoMe for educational activities than Generation X and Millennials (24% vs 73%, P = 0.0001). Conclusions Generation gaps between trainees and faculty, as well as between Generation X and Millennials versus Baby Boomers, exist with regard to the use of SoMe, which may be underutilized in radiology education.

      PubDate: 2017-10-25T12:45:07Z
      DOI: 10.1016/j.acra.2017.08.012
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