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Publisher: Elsevier   (Total: 3043 journals)

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Showing 1 - 200 of 3043 Journals sorted alphabetically
AASRI Procedia     Open Access   (Followers: 15)
Academic Pediatrics     Hybrid Journal   (Followers: 22, SJR: 1.402, h-index: 51)
Academic Radiology     Hybrid Journal   (Followers: 21, SJR: 1.008, h-index: 75)
Accident Analysis & Prevention     Partially Free   (Followers: 84, 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: 354, SJR: 0.726, h-index: 43)
Acta Automatica Sinica     Full-text available via subscription   (Followers: 3)
Acta Biomaterialia     Hybrid Journal   (Followers: 25, SJR: 2.02, h-index: 104)
Acta Colombiana de Cuidado Intensivo     Full-text available via subscription   (Followers: 1)
Acta de Investigación Psicológica     Open Access   (Followers: 2)
Acta Ecologica Sinica     Open Access   (Followers: 8, SJR: 0.172, h-index: 29)
Acta Haematologica Polonica     Free   (SJR: 0.123, h-index: 8)
Acta Histochemica     Hybrid Journal   (Followers: 3, SJR: 0.604, h-index: 38)
Acta Materialia     Hybrid Journal   (Followers: 233, 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: 23, SJR: 1.365, h-index: 73)
Acta Sociológica     Open Access  
Acta Tropica     Hybrid Journal   (Followers: 6, SJR: 1.059, h-index: 77)
Acta Urológica Portuguesa     Open Access  
Actas Dermo-Sifiliograficas     Full-text available via subscription   (Followers: 4)
Actas Dermo-Sifiliográficas (English Edition)     Full-text available via subscription   (Followers: 3)
Actas Urológicas Españolas     Full-text available via subscription   (Followers: 4, SJR: 0.383, h-index: 19)
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Actualites Pharmaceutiques     Full-text available via subscription   (Followers: 5, SJR: 0.141, h-index: 3)
Actualites Pharmaceutiques Hospitalieres     Full-text available via subscription   (Followers: 4, SJR: 0.112, h-index: 2)
Acupuncture and Related Therapies     Hybrid Journal   (Followers: 4)
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: 5)
Additive Manufacturing     Hybrid Journal   (Followers: 7, SJR: 1.039, h-index: 5)
Additives for Polymers     Full-text available via subscription   (Followers: 21)
Advanced Drug Delivery Reviews     Hybrid Journal   (Followers: 135, 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: 25, SJR: 0.169, h-index: 4)
Advances in Antiviral Drug Design     Full-text available via subscription   (Followers: 3)
Advances in Applied Mathematics     Full-text available via subscription   (Followers: 6, SJR: 1.054, h-index: 35)
Advances in Applied Mechanics     Full-text available via subscription   (Followers: 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: 25, SJR: 2.215, h-index: 78)
Advances in Carbohydrate Chemistry and Biochemistry     Full-text available via subscription   (Followers: 9, SJR: 0.9, h-index: 30)
Advances in Catalysis     Full-text available via subscription   (Followers: 5, SJR: 2.139, h-index: 42)
Advances in Cellular and Molecular Biology of Membranes and Organelles     Full-text available via subscription   (Followers: 12)
Advances in Chemical Engineering     Full-text available via subscription   (Followers: 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: 11)
Advances in Digestive Medicine     Open Access   (Followers: 6)
Advances in DNA Sequence-Specific Agents     Full-text available via subscription   (Followers: 5)
Advances in Drug Research     Full-text available via subscription   (Followers: 22)
Advances in Ecological Research     Full-text available via subscription   (Followers: 41, SJR: 3.25, h-index: 43)
Advances in Engineering Software     Hybrid Journal   (Followers: 25, SJR: 0.486, h-index: 10)
Advances in Experimental Biology     Full-text available via subscription   (Followers: 7)
Advances in Experimental Social Psychology     Full-text available via subscription   (Followers: 41, SJR: 5.465, h-index: 64)
Advances in Exploration Geophysics     Full-text available via subscription   (Followers: 3)
Advances in Food and Nutrition Research     Full-text available via subscription   (Followers: 50, 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 Imaging and Electron Physics     Full-text available via subscription   (Followers: 2, SJR: 0.396, h-index: 27)
Advances in Immunology     Full-text available via subscription   (Followers: 35, SJR: 4.152, h-index: 85)
Advances in Inorganic Chemistry     Full-text available via subscription   (Followers: 9, SJR: 1.132, h-index: 42)
Advances in Insect Physiology     Full-text available via subscription   (Followers: 3, SJR: 1.274, h-index: 27)
Advances in Integrative Medicine     Hybrid Journal   (Followers: 6)
Advances in Life Course Research     Hybrid Journal   (Followers: 8, SJR: 0.764, h-index: 15)
Advances in Lipobiology     Full-text available via subscription   (Followers: 2)
Advances in Magnetic and Optical Resonance     Full-text available via subscription   (Followers: 9)
Advances in Marine Biology     Full-text available via subscription   (Followers: 16, SJR: 1.645, h-index: 45)
Advances in Mathematics     Full-text available via subscription   (Followers: 10, SJR: 3.261, h-index: 65)
Advances in Medical Sciences     Hybrid Journal   (Followers: 6, SJR: 0.489, h-index: 25)
Advances in Medicinal Chemistry     Full-text available via subscription   (Followers: 5)
Advances in Microbial Physiology     Full-text available via subscription   (Followers: 4, SJR: 1.44, h-index: 51)
Advances in Molecular and Cell Biology     Full-text available via subscription   (Followers: 22)
Advances in Molecular and Cellular Endocrinology     Full-text available via subscription   (Followers: 10)
Advances in Molecular Toxicology     Full-text available via subscription   (Followers: 7, SJR: 0.324, h-index: 8)
Advances in Nanoporous Materials     Full-text available via subscription   (Followers: 4)
Advances in Oncobiology     Full-text available via subscription   (Followers: 3)
Advances in Organometallic Chemistry     Full-text available via subscription   (Followers: 15, SJR: 2.885, h-index: 45)
Advances in Parallel Computing     Full-text available via subscription   (Followers: 7, SJR: 0.148, h-index: 11)
Advances in Parasitology     Full-text available via subscription   (Followers: 7, SJR: 2.37, h-index: 73)
Advances in Pediatrics     Full-text available via subscription   (Followers: 24, SJR: 0.4, h-index: 28)
Advances in Pharmaceutical Sciences     Full-text available via subscription   (Followers: 13)
Advances in Pharmacology     Full-text available via subscription   (Followers: 15, SJR: 1.718, h-index: 58)
Advances in Physical Organic Chemistry     Full-text available via subscription   (Followers: 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: 17)
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: 61)
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 Research     Full-text available via subscription   (Followers: 355, SJR: 0.606, h-index: 65)
Advances in Structural Biology     Full-text available via subscription   (Followers: 8)
Advances in Surgery     Full-text available via subscription   (Followers: 7, SJR: 0.823, h-index: 27)
Advances in the Study of Behavior     Full-text available via subscription   (Followers: 30, SJR: 1.321, h-index: 56)
Advances in Veterinary Medicine     Full-text available via subscription   (Followers: 17)
Advances in Veterinary Science and Comparative Medicine     Full-text available via subscription   (Followers: 13)
Advances in Virus Research     Full-text available via subscription   (Followers: 5, SJR: 1.878, h-index: 68)
Advances in Water Resources     Hybrid Journal   (Followers: 44, 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: 326, SJR: 0.816, h-index: 49)
AEU - Intl. J. of Electronics and Communications     Hybrid Journal   (Followers: 8, SJR: 0.318, h-index: 36)
African J. of Emergency Medicine     Open Access   (Followers: 5, SJR: 0.344, h-index: 6)
Ageing Research Reviews     Hybrid Journal   (Followers: 8, SJR: 3.289, h-index: 78)
Aggression and Violent Behavior     Hybrid Journal   (Followers: 405, SJR: 1.385, h-index: 72)
Agri Gene     Hybrid Journal  
Agricultural and Forest Meteorology     Hybrid Journal   (Followers: 16, SJR: 2.18, h-index: 116)
Agricultural Systems     Hybrid Journal   (Followers: 30, SJR: 1.275, h-index: 74)
Agricultural Water Management     Hybrid Journal   (Followers: 39, SJR: 1.546, h-index: 79)
Agriculture and Agricultural Science Procedia     Open Access  
Agriculture and Natural Resources     Open Access   (Followers: 1)
Agriculture, Ecosystems & Environment     Hybrid Journal   (Followers: 54, 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  
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: 8, 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: 6)
Alzheimer's & Dementia: Translational Research & Clinical Interventions     Open Access   (Followers: 5)
American Heart J.     Hybrid Journal   (Followers: 49, SJR: 3.157, h-index: 153)
American J. of Cardiology     Hybrid Journal   (Followers: 47, SJR: 2.063, h-index: 186)
American J. of Emergency Medicine     Hybrid Journal   (Followers: 39, SJR: 0.574, h-index: 65)
American J. of Geriatric Pharmacotherapy     Full-text available via subscription   (Followers: 8, SJR: 1.091, h-index: 45)
American J. of Geriatric Psychiatry     Hybrid Journal   (Followers: 15, SJR: 1.653, h-index: 93)
American J. of Human Genetics     Hybrid Journal   (Followers: 31, SJR: 8.769, h-index: 256)
American J. of Infection Control     Hybrid Journal   (Followers: 25, SJR: 1.259, h-index: 81)
American J. of Kidney Diseases     Hybrid Journal   (Followers: 32, SJR: 2.313, h-index: 172)
American J. of Medicine     Hybrid Journal   (Followers: 45, 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: 229, SJR: 2.255, h-index: 171)
American J. of Ophthalmology     Hybrid Journal   (Followers: 58, SJR: 2.803, h-index: 148)
American J. of Ophthalmology Case Reports     Open Access   (Followers: 5)
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: 25, SJR: 0.59, h-index: 45)
American J. of Pathology     Hybrid Journal   (Followers: 26, SJR: 2.653, h-index: 228)
American J. of Preventive Medicine     Hybrid Journal   (Followers: 22, SJR: 2.764, h-index: 154)
American J. of Surgery     Hybrid Journal   (Followers: 34, SJR: 1.286, h-index: 125)
American J. of the Medical Sciences     Hybrid Journal   (Followers: 12, SJR: 0.653, h-index: 70)
Ampersand : An Intl. J. of General and Applied Linguistics     Open Access   (Followers: 5)
Anaerobe     Hybrid Journal   (Followers: 4, SJR: 1.066, h-index: 51)
Anaesthesia & Intensive Care Medicine     Full-text available via subscription   (Followers: 57, SJR: 0.124, h-index: 9)
Anaesthesia Critical Care & Pain Medicine     Full-text available via subscription   (Followers: 11)
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: 37, SJR: 1.548, h-index: 152)
Analytical Biochemistry     Hybrid Journal   (Followers: 167, SJR: 0.725, h-index: 154)
Analytical Chemistry Research     Open Access   (Followers: 8, SJR: 0.18, h-index: 2)
Analytical Spectroscopy Library     Full-text available via subscription   (Followers: 11)
Anesthésie & Réanimation     Full-text available via subscription   (Followers: 1)
Anesthesiology Clinics     Full-text available via subscription   (Followers: 22, SJR: 0.421, h-index: 40)
Angiología     Full-text available via subscription   (SJR: 0.124, h-index: 9)
Angiologia e Cirurgia Vascular     Open Access  
Animal Behaviour     Hybrid Journal   (Followers: 161, SJR: 1.907, h-index: 126)
Animal Feed Science and Technology     Hybrid Journal   (Followers: 5, SJR: 1.151, h-index: 83)
Animal Reproduction Science     Hybrid Journal   (Followers: 5, SJR: 0.711, h-index: 78)
Annales d'Endocrinologie     Full-text available via subscription   (Followers: 1, SJR: 0.394, h-index: 30)
Annales d'Urologie     Full-text available via subscription  
Annales de Cardiologie et d'Angéiologie     Full-text available via subscription   (SJR: 0.177, h-index: 13)
Annales de Chirurgie de la Main et du Membre Supérieur     Full-text available via subscription  
Annales de Chirurgie Plastique Esthétique     Full-text available via subscription   (Followers: 2, SJR: 0.354, h-index: 22)
Annales de Chirurgie Vasculaire     Full-text available via subscription   (Followers: 1)

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Journal Cover Academic Radiology
  [SJR: 1.008]   [H-I: 75]   [21 followers]  Follow
    
   Hybrid Journal Hybrid journal (It can contain Open Access articles)
   ISSN (Print) 1076-6332
   Published by Elsevier Homepage  [3043 journals]
  • The Impact of Fatigue on Satisfaction of Search in Chest Radiography
    • Authors: Elizabeth A. Krupinski; Kevin S. Berbaum; Kevin M. Schartz; Robert T. Caldwell; Mark T. Madsen
      Pages: 1058 - 1063
      Abstract: Publication date: September 2017
      Source:Academic Radiology, Volume 24, Issue 9
      Author(s): Elizabeth A. Krupinski, Kevin S. Berbaum, Kevin M. Schartz, Robert T. Caldwell, Mark T. Madsen
      Rationale and Objectives To assess the nature of the satisfaction of search (SOS) effect in chest radiography when observers are fatigued; determine if we could replicate recent findings that have documented the nature of the SOS effect to be due to a threshold shift rather than a change in diagnostic accuracy as in earlier film-based studies. Materials and Methods Nearing or at the end of a clinical workday, 20 radiologists read 64 chest images twice, once with and once without the addition of a simulated pulmonary nodule. Half of the images had different types of “test” abnormalities. Decision thresholds were analyzed using the center of the range of false-positive (FP) and true-positive (TP) fractions associated with each receiver operating characteristic (ROC) point for reporting test abnormalities. Detection accuracy was assessed with ROC technique and inspection time was recorded. Results The SOS effect was confirmed to be a reduction in willingness to respond (threshold shift). The center of the FP range was significantly reduced (FP = 0.10 without added nodules, FP = 0.05 with added nodules, F(1,18) = 19.85, P = 0.0003). The center of the TP range was significantly reduced (TP = 0.39 without added nodules, TP = 0.33 with added nodules, F(1,18) = 10.81, P = 0.004). Conclusions This study suggests that fatigue does not change the nature of the SOS effect, but rather may be additive with the SOS effect. SOS reduces both TP and FP responses, whereas fatigue reduces TPs more than FPs.

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

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

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

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

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

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

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

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

      PubDate: 2017-08-20T19:30:13Z
      DOI: 10.1016/j.acra.2017.02.012
       
  • An Abbreviated Protocol for High-risk Screening Breast Magnetic Resonance
           Imaging
    • Authors: Babita Panigrahi; Lisa Mullen; Eniola Falomo; Benita Panigrahi; Susan Harvey
      Pages: 1132 - 1138
      Abstract: Publication date: September 2017
      Source:Academic Radiology, Volume 24, Issue 9
      Author(s): Babita Panigrahi, Lisa Mullen, Eniola Falomo, Benita Panigrahi, Susan Harvey
      Rationale and Objectives Annual breast magnetic resonance imaging (MRI) is recommended to screen high-risk populations for breast cancer, although costs are significant. This study assesses the performance of an abbreviated MRI protocol as a resource-efficient approach for screening patients at high-risk of breast cancer, and assesses whether the abbreviated protocol alters the assigned Breast Imaging Reporting and Data System (BI-RADS) category. Materials and Methods This is a prospective paired cohort study performed in an academic ambulatory setting. MRI images of women at high risk of breast cancer were reviewed using an abbreviated MRI protocol, followed by an immediate review of additional sequences included in a full diagnostic protocol. BI-RADS assessments, including all changes and interpretation times, were recorded for both the abbreviated and full protocol reviews. Cancer detection rate, positive predictive value 3 (PPV3), sensitivity, and specificity were calculated. Results A total of 1052 MRI cases were reviewed. The cancer detection rate was 13.3 per 1000 with a PPV3 of 30.4% based on the full protocol. Review of sequences included in the full protocol resulted in a change in the final BI-RADS assessments in 3.4% of the cases, the majority of which did not change clinical management with respect to biopsy. The sensitivity and specificity of the abbreviated and full protocols were not significantly different. Conclusions This pilot study of an abbreviated MRI protocol demonstrates effective performance in cancer detection. BI-RADS assessments were rarely altered with the additional information afforded by the full protocol. The abbreviated protocol holds promise for resource-efficient breast cancer screening in high-risk women.

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

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

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

      PubDate: 2017-08-20T19:30:13Z
      DOI: 10.1016/j.acra.2017.02.008
       
  • Patients' Use and Evaluation of an Online System to Annotate Radiology
           Reports with Lay Language Definitions
    • Authors: Tessa S. Cook; Seong Cheol Oh; Charles E. Kahn
      Pages: 1169 - 1174
      Abstract: Publication date: September 2017
      Source:Academic Radiology, Volume 24, Issue 9
      Author(s): Tessa S. Cook, Seong Cheol Oh, Charles E. Kahn
      Rationale and Objectives The increasing availability of personal health portals has made it easier for patients to obtain their imaging results online. However, the radiology report typically is designed to communicate findings and recommendations to the referring clinician, and may contain many terms unfamiliar to lay readers. We sought to evaluate a web-based interface that presented reports of knee MRI (magnetic resonance imaging) examinations with annotations that included patient-oriented definitions, anatomic illustrations, and hyperlinks to additional information. Materials and Methods During a 7-month observational trial, a statement added to all knee MRI reports invited patients to view their annotated report online. We tracked the number of patients who opened their reports, the terms they hovered over to view definitions, and the time hovering over each term. Patients who accessed their annotated reports were invited to complete a survey. Results Of 1138 knee MRI examinations during the trial period, 185 patients (16.3%) opened their report in the viewing portal. Of those, 141 (76%) hovered over at least one term to view its definition, and 121 patients (65%) viewed a mean of 27.5 terms per examination and spent an average of 3.5 minutes viewing those terms. Of the 22 patients who completed the survey, 77% agreed that the definitions helped them understand the report and 91% stated that the illustrations were helpful. Conclusions A system that provided definitions and illustrations of the medical and technical terms in radiology reports has potential to improve patients' understanding of their reports and their diagnoses.

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

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


      PubDate: 2017-08-20T19:30:13Z
      DOI: 10.1016/j.acra.2017.05.016
       
  • Quantitative FLAIR MRI in Amyotrophic Lateral Sclerosis
    • Authors: Jeremy Fabes; Lucy Matthews; Nicola Filippini; Kevin Talbot; Mark Jenkinson; Martin R. Turner
      Pages: 1187 - 1194
      Abstract: Publication date: October 2017
      Source:Academic Radiology, Volume 24, Issue 10
      Author(s): Jeremy Fabes, Lucy Matthews, Nicola Filippini, Kevin Talbot, Mark Jenkinson, Martin R. Turner
      Rationale and Objectives T2-weighted magnetic resonance imaging (MRI) hyperintensity assessed visually in the corticospinal tract (CST) lacks sensitivity for a diagnosis of amyotrophic lateral sclerosis (ALS). We sought to explore a quantitative approach to fluid-attenuated inversion recovery (FLAIR) MRI intensity across a range of ALS phenotypes. Materials and Methods Thirty-three classical ALS patients, 10 with a flail arm presentation, and six with primary lateral sclerosis underwent MRI at 3 Tesla. Comparisons of quantitative FLAIR intensity in the CST and corpus callosum were made between 21 healthy controls and within patient phenotypic subgroups, some of whom were studied longitudinally. Results Mean FLAIR intensity was greater in patient groups. The cerebral peduncle intensity provided the strongest subgroup classification. FLAIR intensity increased longitudinally. The rate of change of FLAIR within CST correlated with rate of decline in executive function and ALS functional rating score. Conclusions FLAIR MRI encodes quantifiable information of potential diagnostic, stratification, and monitoring value.

      PubDate: 2017-09-06T13:37:01Z
      DOI: 10.1016/j.acra.2017.04.008
       
  • Imaging Workup of Suspected Classical Paraneoplastic Neurological
           Syndromes
    • Authors: Benedikt Sundermann; Jens-Burchard Schröder; Tobias Warnecke; Walter Heindel; Michael Schäfers; Matthias Weckesser; Boris Buerke
      Pages: 1195 - 1202
      Abstract: Publication date: October 2017
      Source:Academic Radiology, Volume 24, Issue 10
      Author(s): Benedikt Sundermann, Jens-Burchard Schröder, Tobias Warnecke, Walter Heindel, Michael Schäfers, Matthias Weckesser, Boris Buerke
      Rationale and Objectives This study aimed to assess the clinical efficacy of positron emission tomography (PET) or combined PET-computed tomography (CT) with 18F-fluorodeoxyglucose (FDG) for whole-body cancer screening in patients with suspected paraneoplastic neurological syndromes (PNS). The following main research questions were addressed: What is the percentage of positive findings to be expected in whole-body FDG-PET-CT in adult patients with PNS' How many false positives can be expected as assessed by clinical and histopathological workup' Are there patients who present with a tumor despite initially negative findings' Materials and Methods This is a systematic review of the literature and retrospective analysis of FDG-PET-CT and clinical follow-up data from 45 consecutive patients (age: 56.6 ± standard deviation 15.8 years, 14 female, 31 male). Suspicious lesions were identified and correlated with immediate workup and clinical follow-up. Results Fourteen studies were included in the review. Eleven malignancies (24.4% of patients) were identified by FDG-PET-CT in this sample. This is a higher percentage of positive findings compared to most previous reports. There was one initially negative finding. Conclusions Whole-body FDG-PET-CT is suitable to identify additional malignancies in patients with suspected classical PNS referred to a tertiary medical center. The utility by means of true-positive findings is higher in classical PNS than suggested by studies in less select patient populations.

      PubDate: 2017-09-06T13:37:01Z
      DOI: 10.1016/j.acra.2017.03.022
       
  • Measurement Accuracy of Atherosclerotic Plaque Structure on CT Using
           Phantoms to Establish Ground Truth
    • Authors: Samantha St. Pierre; Jenifer Siegelman; Nancy A. Obuchowski; Xiaonan Ma; David Paik; Andrew J. Buckler
      Pages: 1203 - 1215
      Abstract: Publication date: October 2017
      Source:Academic Radiology, Volume 24, Issue 10
      Author(s): Samantha St. Pierre, Jenifer Siegelman, Nancy A. Obuchowski, Xiaonan Ma, David Paik, Andrew J. Buckler
      Rationale and Objectives The purpose of this study was to characterize analytic performance of software-aided arterial vessel structure measurements across a range of scanner settings for computed tomography angiography where ground truth is known. We characterized performance for measurands that may be efficiently measured for clinical cases without use of software, as well as those that may be done manually but which is generally not done due to the effort level required unless software is employed. Materials and Methods Four measurands (lumen area, stenosis, wall area, wall thickness) were evaluated using tissue-mimicking phantoms to estimate bias, heteroscedasticity, and limits of quantitation both pooled across scanner settings and individually for eight different settings. Reproducibility across scanner settings was also estimated. Results Measurements of lumen area have a near constant bias of +1.3 mm for measurements ranging from 3 mm2 to 40 mm2; stenosis bias is +7% across a 30%–70% range; wall area bias is +14% across a 50–450 mm2 range; and wall thickness bias is +1.2 mm across a 3–9 mm range. All measurements possess properties that make them suitable for measuring longitudinal change. Lumen area demonstrates the most sensitivity to scanner settings (bias from as low as +.1 mm to as high as +2.7 mm); wall thickness demonstrates negligible sensitivity. Conclusions Variability across scanner settings for lumen measurands was generally higher than bias for a given setting. The converse was true for the wall measurands, where variability due to scanner settings was very low. Both bias and variability due to scanner settings of vessel structure were within clinically useful levels.

      PubDate: 2017-09-06T13:37:01Z
      DOI: 10.1016/j.acra.2017.04.007
       
  • A Diagnostic Accuracy Meta-analysis of CT and MRI for the Evaluation of
           Small Bowel Crohn Disease
    • Authors: Wenhong Liu; Jincai Liu; Wenlian Xiao; Guanghua Luo
      Pages: 1216 - 1225
      Abstract: Publication date: October 2017
      Source:Academic Radiology, Volume 24, Issue 10
      Author(s): Wenhong Liu, Jincai Liu, Wenlian Xiao, Guanghua Luo
      Rationale and Objectives This study aimed to evaluate the diagnostic accuracy of magnetic resonance imaging (MRI) and computed tomography (CT) in assessing small bowel (SB) Crohn disease (CD). Materials and Methods We systematically searched PubMed, Elsevier, ScienceDirect, Karger, Web of Science, Wiley Online Library, and Springer for studies in which CT or MRI were evaluated to assess SB CD. Bivariate random effect meta-analytic methods were used to estimate pooled sensitivity, specificity, and receiver operating characteristic curves. Diagnostic odds ratios (DORs) in a per-patient–based analysis were estimated. The area under the receiver operating characteristic curve was also calculated to measure the diagnostic accuracy. Results Twenty-one studies involving 913 patients were included in this meta-analysis. There was no significant difference observed between modalities. The diagnostic performances (lnDOR) for CT and MRI also showed no significant difference. Subgroup analysis was performed for MR imaging (MR enteroclysis, MR enterography, and CT enterography). The diagnostic performances (lnDOR) for MR enteroclysis, MR enterography, and CT enterography did not show a significant difference among them. No significant difference was found between these techniques. Deeks funnel plot asymmetry test for publication bias showed that no significant publication bias was observed in this analysis. Conclusions This meta-analysis suggests that both MRI and CT have high diagnostic accuracy in detecting SB CD. MRI has the potential to be the first-line radiation-free modality for SB CD imaging.

      PubDate: 2017-09-06T13:37:01Z
      DOI: 10.1016/j.acra.2017.04.013
       
  • Sarcomatoid Renal Cell Carcinoma and Collecting Duct Carcinoma
    • Authors: Jonathan R. Young; Jocelyn A. Young; Daniel J.A. Margolis; Steven Sauk; James Sayre; Allan J. Pantuck; Steven S. Raman
      Pages: 1226 - 1232
      Abstract: Publication date: October 2017
      Source:Academic Radiology, Volume 24, Issue 10
      Author(s): Jonathan R. Young, Jocelyn A. Young, Daniel J.A. Margolis, Steven Sauk, James Sayre, Allan J. Pantuck, Steven S. Raman
      Rationale and Objectives To investigate whether imaging features on multiphasic multidetector computed tomography (MDCT) can help discriminate sarcomatoid renal cell carcinoma (RCC) and collecting duct carcinoma (CDC) from other solid renal masses. Materials and Methods With institutional review board approval for this HIPAA-compliant study, we derived a cohort of 7 sarcomatoid RCCs, 4 CDCs, 165 clear cell RCCs, 56 papillary RCCs, 22 chromophobe RCCs, 49 oncocytomas, and 16 lipid-poor angiomyolipomas with preoperative multiphasic MDCT with up to four phases (unenhanced, corticomedullary, nephrographic, and excretory). Each lesion was reviewed for contour, spread pattern, pattern of enhancement, neovascularity, and calcification. Results Sarcomatoid RCCs and CDCs were more likely than other solid renal masses to have an irregular contour (64% vs 2%, P < 0.001) and an infiltrative spread pattern, defined as infiltration into adjacent renal parenchyma, collecting system, or neighboring structures (82% vs 7%, P < 0.001). When used to discriminate sarcomatoid RCC and CDC from other solid renal masses, an infiltrative spread pattern had a specificity of 93% (287/308) and sensitivity of 82% (9/11), and an irregular contour had a specificity of 98% (303/308) and sensitivity of 64% (7/11). Conclusions Solid renal lesions with an irregular contour or an infiltrative spread pattern are suspicious for sarcomatoid RCC or CDC.

      PubDate: 2017-09-06T13:37:01Z
      DOI: 10.1016/j.acra.2017.03.017
       
  • Applying Quantitative CT Image Feature Analysis to Predict Response of
           Ovarian Cancer Patients to Chemotherapy
    • Authors: Gopichandh Danala; Theresa Thai; Camille C. Gunderson; Katherine M. Moxley; Kathleen Moore; Robert S. Mannel; Hong Liu; Bin Zheng; Yuchen Qiu
      Pages: 1233 - 1239
      Abstract: Publication date: October 2017
      Source:Academic Radiology, Volume 24, Issue 10
      Author(s): Gopichandh Danala, Theresa Thai, Camille C. Gunderson, Katherine M. Moxley, Kathleen Moore, Robert S. Mannel, Hong Liu, Bin Zheng, Yuchen Qiu
      Rationale and Objectives The study aimed to investigate the role of applying quantitative image features computed from computed tomography (CT) images for early prediction of tumor response to chemotherapy in the clinical trials for treating ovarian cancer patients. Materials and Methods A dataset involving 91 patients was retrospectively assembled. Each patient had two sets of pre- and post-therapy CT images. A computer-aided detection scheme was applied to segment metastatic tumors previously tracked by radiologists on CT images and computed image features. Two initial feature pools were built using image features computed from pre-therapy CT images only and image feature difference computed from both pre- and post-therapy images. A feature selection method was applied to select optimal features, and an equal-weighted fusion method was used to generate a new quantitative imaging marker from each pool to predict 6-month progression-free survival. The prediction accuracy between quantitative imaging markers and the Response Evaluation Criteria in Solid Tumors (RECIST) criteria was also compared. Results The highest areas under the receiver operating characteristic curve are 0.684 ± 0.056 and 0.771 ± 0.050 when using a single image feature computed from pre-therapy CT images and feature difference computed from pre- and post-therapy CT images, respectively. Using two corresponding fusion-based image markers, the areas under the receiver operating characteristic curve significantly increased to 0.810 ± 0.045 and 0.829 ± 0.043 (P < 0.05), respectively. Overall prediction accuracy levels are 71.4%, 80.2%, and 74.7% when using two imaging markers and RECIST, respectively. Conclusions This study demonstrated the feasibility of predicting patients' response to chemotherapy using quantitative imaging markers computed from pre-therapy CT images. However, using image feature difference computed between pre- and post-therapy CT images yielded higher prediction accuracy.

      PubDate: 2017-09-06T13:37:01Z
      DOI: 10.1016/j.acra.2017.04.014
       
  • Optical Mammography in Patients with Breast Cancer Undergoing Neoadjuvant
           Chemotherapy
    • Authors: Pamela G. Anderson; Sirishma Kalli; Angelo Sassaroli; Nishanth Krishnamurthy; Shital S. Makim; Roger A. Graham; Sergio Fantini
      Pages: 1240 - 1255
      Abstract: Publication date: October 2017
      Source:Academic Radiology, Volume 24, Issue 10
      Author(s): Pamela G. Anderson, Sirishma Kalli, Angelo Sassaroli, Nishanth Krishnamurthy, Shital S. Makim, Roger A. Graham, Sergio Fantini
      Rationale and Objectives We present an optical mammography study that aims to develop quantitative measures of pathologic response to neoadjuvant chemotherapy (NAC) in patients with breast cancer. Such quantitative measures are based on the concentrations of oxyhemoglobin ([HbO2]), deoxyhemoglobin ([Hb]), total hemoglobin ([HbT]), and hemoglobin saturation (SO2) in breast tissue at the tumor location and at sequential time points during chemotherapy. Materials and Methods Continuous-wave, spectrally resolved optical mammography was performed in transmission and parallel-plate geometry on 10 patients before treatment initiation and at each NAC administration (mean number of optical mammography sessions: 12, range: 7–18). Data on two patients were discarded for technical reasons. The patients were categorized as responders (R, >50% decrease in tumor size), or nonresponders (NR, <50% decrease in tumor size) based on imaging and histopathology results. Results At 50% completion of the NAC regimen (therapy midpoint), R (6/8) demonstrated significant decreases in SO2 (−27% ± 4%) and [HbT] (−35 ± 4 µM) at the tumor location with respect to baseline values. By contrast, NR (2/8) showed nonsignificant changes in SO2 and [HbT] at therapy midpoint. We introduce a cumulative response index as a quantitative measure of the individual patient's response to therapy. At therapy midpoint, the SO2-based cumulative response index had a sensitivity of 100% and a specificity of 100% for the identification of R. Conclusions These results show that optical mammography is a promising tool to assess individual response to NAC at therapy midpoint to guide further decision making for neoadjuvant therapy.

      PubDate: 2017-09-06T13:37:01Z
      DOI: 10.1016/j.acra.2017.03.020
       
  • Correlation Between Screening Mammography Interpretive Performance on a
           Test Set and Performance in Clinical Practice
    • Authors: Diana L. Miglioretti; Laura Ichikawa; Robert A. Smith; Diana S.M. Buist; Patricia A. Carney; Berta Geller; Barbara Monsees; Tracy Onega; Robert Rosenberg; Edward A. Sickles; Bonnie C. Yankaskas; Karla Kerlikowske
      Pages: 1256 - 1264
      Abstract: Publication date: October 2017
      Source:Academic Radiology, Volume 24, Issue 10
      Author(s): Diana L. Miglioretti, Laura Ichikawa, Robert A. Smith, Diana S.M. Buist, Patricia A. Carney, Berta Geller, Barbara Monsees, Tracy Onega, Robert Rosenberg, Edward A. Sickles, Bonnie C. Yankaskas, Karla Kerlikowske
      Rationale and Objectives Evidence is inconsistent about whether radiologists' interpretive performance on a screening mammography test set reflects their performance in clinical practice. This study aimed to estimate the correlation between test set and clinical performance and determine if the correlation is influenced by cancer prevalence or lesion difficulty in the test set. Materials and Methods This institutional review board-approved study randomized 83 radiologists from six Breast Cancer Surveillance Consortium registries to assess one of four test sets of 109 screening mammograms each; 48 radiologists completed a fifth test set of 110 mammograms 2 years later. Test sets differed in number of cancer cases and difficulty of lesion detection. Test set sensitivity and specificity were estimated using woman-level and breast-level recall with cancer status and expert opinion as gold standards. Clinical performance was estimated using women-level recall with cancer status as the gold standard. Spearman rank correlations between test set and clinical performance with 95% confidence intervals (CI) were estimated. Results For test sets with fewer cancers (N = 15) that were more difficult to detect, correlations were weak to moderate for sensitivity (woman level = 0.46, 95% CI = 0.16, 0.69; breast level = 0.35, 95% CI = 0.03, 0.61) and weak for specificity (0.24, 95% CI = 0.01, 0.45) relative to expert recall. Correlations for test sets with more cancers (N = 30) were close to 0 and not statistically significant. Conclusions Correlations between screening performance on a test set and performance in clinical practice are not strong. Test set performance more accurately reflects performance in clinical practice if cancer prevalence is low and lesions are challenging to detect.

      PubDate: 2017-09-06T13:37:01Z
      DOI: 10.1016/j.acra.2017.03.016
       
  • Breast Density Legislation in New England
    • Authors: Ana P. Lourenco; Roberta M. DiFlorio-Alexander; Priscilla J. Slanetz
      Pages: 1265 - 1267
      Abstract: Publication date: October 2017
      Source:Academic Radiology, Volume 24, Issue 10
      Author(s): Ana P. Lourenco, Roberta M. DiFlorio-Alexander, Priscilla J. Slanetz
      Rationale and Objectives This study aimed to assess radiologists' knowledge about breast density legislation as well as perceived practice changes resulting from the enactment of breast density legislation. Materials and Methods This is an institutional review board-exempt anonymous email survey of 523 members of the New England Roentgen Ray Society. In addition to radiologist demographics, survey questions addressed radiologist knowledge of breast density legislation, knowledge of breast density as a risk factor for breast cancer, recommendations for supplemental screening, and perceived practice changes resulting from density notification legislation. Results Of the 523 members, 96 responded, yielding an 18% response rate. Seventy-three percent of respondents practiced in a state with breast density legislation. Sixty-nine percent felt that breast density notification increased patient anxiety about breast cancer, but also increased patient (74%) and provider (66%) understanding of the effect of breast density on mammographic sensitivity. Radiologist knowledge of the relative risk of breast cancer when comparing breasts of different density was variable. Conclusions Considerable confusion and controversy regarding breast density persists, even among practicing radiologists.

      PubDate: 2017-09-06T13:37:01Z
      DOI: 10.1016/j.acra.2017.03.009
       
  • Free-breathing Functional Pulmonary MRI
    • Authors: Dante P.I. Capaldi; Khadija Sheikh; Rachel L. Eddy; Fumin Guo; Sarah Svenningsen; Parameswaran Nair; David G. McCormack; Grace Parraga
      Pages: 1268 - 1276
      Abstract: Publication date: October 2017
      Source:Academic Radiology, Volume 24, Issue 10
      Author(s): Dante P.I. Capaldi, Khadija Sheikh, Rachel L. Eddy, Fumin Guo, Sarah Svenningsen, Parameswaran Nair, David G. McCormack, Grace Parraga
      Rationale and Objectives Ventilation heterogeneity is a hallmark feature of asthma. Our objective was to evaluate ventilation heterogeneity in patients with severe asthma, both pre- and post-salbutamol, as well as post-methacholine (MCh) challenge using the lung clearance index, free-breathing pulmonary 1 H magnetic resonance imaging (FDMRI), and inhaled-gas MRI ventilation defect percent (VDP). Materials and Methods Sixteen severe asthmatics (49 ± 10 years) provided written informed consent to an ethics board-approved protocol. Spirometry, plethysmography, and multiple breath nitrogen washout to measure the lung clearance index were performed during a single visit within 15 minutes of MRI. Inhaled-gas MRI and FDMRI were performed pre- and post-bronchodilator to generate VDP. For asthmatics with forced expiratory volume in 1 second (FEV1) >70%predicted, MRI was also performed before and after MCh challenge. Wilcoxon signed-rank tests, Spearman correlations, and a repeated-measures analysis of variance were performed. Results Hyperpolarized 3 He (P = .02) and FDMRI (P = .02) VDP significantly improved post-salbutamol and for four asthmatics who could perform MCh (n = 4). 3 He and FDMRI VDP significantly increased at the provocative concentration of MCh, resulting in a 20% decrease in FEV1 (PC20) and decreased post-bronchodilator (P = .02), with a significant difference between methods (P = .01). FDMRI VDP was moderately correlated with 3 He VDP (ρ = .61, P = .01), but underestimated VDP relative to 3 He VDP (−6 ± 9%). Whereas 3 He MRI VDP was significantly correlated with the lung clearance index, FDMRI was not (ρ = .49, P = .06). Conclusions FDMRI VDP generated in free-breathing asthmatic patients was correlated with static inspiratory breath-hold 3 He MRI VDP but underestimated VDP relative to 3 He MRI VDP. Although less sensitive to salbutamol and MCh, FDMRI VDP may be considered for asthma patient evaluations at centers without inhaled-gas MRI.

      PubDate: 2017-09-06T13:37:01Z
      DOI: 10.1016/j.acra.2017.04.012
       
  • Can CT and MR Shape and Textural Features Differentiate Benign Versus
           Malignant Pleural Lesions'
    • Authors: Elena Pena; MacArinze Ojiaku; Joao R. Inacio; Ashish Gupta; D. Blair Macdonald; Wael Shabana; Jean M. Seely; Frank J. Rybicki; Carole Dennie; Rebecca E. Thornhill
      Pages: 1277 - 1287
      Abstract: Publication date: October 2017
      Source:Academic Radiology, Volume 24, Issue 10
      Author(s): Elena Pena, MacArinze Ojiaku, Joao R. Inacio, Ashish Gupta, D. Blair Macdonald, Wael Shabana, Jean M. Seely, Frank J. Rybicki, Carole Dennie, Rebecca E. Thornhill
      Rationale and Objectives The study aimed to identify a radiomic approach based on CT and or magnetic resonance (MR) features (shape and texture) that may help differentiate benign versus malignant pleural lesions, and to assess if the radiomic model may improve confidence and accuracy of radiologists with different subspecialty backgrounds. Materials and Methods Twenty-nine patients with pleural lesions studied on both contrast-enhanced CT and MR imaging were reviewed retrospectively. Three texture and three shape features were extracted. Combinations of features were used to generate logistic regression models using histopathology as outcome. Two thoracic and two abdominal radiologists evaluated their degree of confidence in malignancy. Diagnostic accuracy of radiologists was determined using contingency tables. Cohen's kappa coefficient was used to assess inter-reader agreement. Using optimal threshold criteria, sensitivity, specificity, and accuracy of each feature and combination of features were obtained and compared to the accuracy and confidence of radiologists. Results The CT model that best discriminated malignant from benign lesions revealed an AUCCT = 0.92 ± 0.05 (P < 0.0001). The most discriminative MR model showed an AUCMR = 0.87 ± 0.09 (P < 0.0001). The CT model was compared to the diagnostic confidence of all radiologists and the model outperformed both abdominal radiologists (P < 0.002), whereas the top discriminative MR model outperformed one of the abdominal radiologists (P = 0.02). The most discriminative MR model was more accurate than one abdominal (P = 0.04) and one thoracic radiologist (P = 0.02). Conclusion Quantitative textural and shape analysis may help distinguish malignant from benign lesions. A radiomics-based approach may increase diagnostic confidence of abdominal radiologists on CT and MR and may potentially improve radiologists' accuracy in the assessment of pleural lesions characterized by MR.

      PubDate: 2017-09-06T13:37:01Z
      DOI: 10.1016/j.acra.2017.03.006
       
  • Regional Variation in Skeletal Muscle and Adipose Tissue FDG Uptake Using
           PET/CT and Their Relation to BMI
    • Authors: Marcus D. Goncalves; Judith Green-McKenzie; Abass Alavi; Drew A. Torigian
      Pages: 1288 - 1294
      Abstract: Publication date: October 2017
      Source:Academic Radiology, Volume 24, Issue 10
      Author(s): Marcus D. Goncalves, Judith Green-McKenzie, Abass Alavi, Drew A. Torigian
      Rationale and Objectives Skeletal muscle metabolism is a primary contributor to whole-body energy expenditure. Currently, methods to measure changes in skeletal muscle metabolism in vivo are limited. Our objectives were to characterize the regional variation in skeletal muscle and adipose tissue (AT) FDG uptake as a surrogate for glycolytic metabolism using 18F-2-fluorodeoxyglucose (FDG)-positron emission tomography (PET)/computed tomography (CT) in healthy men and to correlate these findings to body mass index (BMI). Materials and Methods Eighteen healthy men were enrolled and underwent FDG-PET/CT. The mean standardized uptake value of 14 skeletal muscles and two AT regions was measured and linear regression analysis was performed to identify metabolic predictors of BMI. Results FDG-PET/CT reliably detected changes in skeletal muscle and AT depot metabolic activity based on location. The most metabolically active muscles were those used for posture and breathing, which have the highest percentage of reported type I muscle myofiber content. Visceral AT tended to have a higher FDG uptake than subcutaneous AT. The mean standardized uptake value of VAT, pectoralis major, and gluteus maximus muscles accounted for 64% of the variance in BMI. Conclusions FDG-PET/CT can be used to quantify the regional variation in glucose metabolism of multiple skeletal muscle groups and AT depots.

      PubDate: 2017-09-06T13:37:01Z
      DOI: 10.1016/j.acra.2017.04.010
       
  • Automated T2-mapping of the Menisci From Magnetic Resonance Images in
           Patients with Acute Knee Injury
    • Authors: Anthony Paproki; Craig Engstrom; Mark Strudwick; Katharine J. Wilson; Rachel K. Surowiec; Charles Ho; Stuart Crozier; Jurgen Fripp
      Pages: 1295 - 1304
      Abstract: Publication date: October 2017
      Source:Academic Radiology, Volume 24, Issue 10
      Author(s): Anthony Paproki, Craig Engstrom, Mark Strudwick, Katharine J. Wilson, Rachel K. Surowiec, Charles Ho, Stuart Crozier, Jurgen Fripp
      Rationale and Objectives This study aimed to evaluate the accuracy of an automated method for segmentation and T2 mapping of the medial meniscus (MM) and lateral meniscus (LM) in clinical magnetic resonance images from patients with acute knee injury. Materials and Methods Eighty patients scheduled for surgery of an anterior cruciate ligament or meniscal injury underwent magnetic resonance imaging of the knee (multiplanar two-dimensional [2D] turbo spin echo [TSE] or three-dimensional [3D]-TSE examinations, T2 mapping). Each meniscus was automatically segmented from the 2D-TSE (composite volume) or 3D-TSE images, auto-partitioned into anterior, mid, and posterior regions, and co-registered onto the T2 maps. The Dice similarity index (spatial overlap) was calculated between automated and manual segmentations of 2D-TSE (15 patients), 3D-TSE (16 patients), and corresponding T2 maps (31 patients). Pearson and intraclass correlation coefficients (ICC) were calculated between automated and manual T2 values. T2 values were compared (Wilcoxon rank sum tests) between torn and non-torn menisci for the subset of patients with both manual and automated segmentations to compare statistical outcomes of both methods. Results The Dice similarity index values for the 2D-TSE, 3D-TSE, and T2 map volumes, respectively, were 76.4%, 84.3%, and 75.2% for the MM and 76.4%, 85.1%, and 76.1% for the LM. There were strong correlations between automated and manual T2 values (rMM = 0.95, ICCMM = 0.94; rLM = 0.97, ICCLM = 0.97). For both the manual and the automated methods, T2 values were significantly higher in torn than in non-torn MM for the full meniscus and its subregions (P < .05). Non-torn LM had higher T2 values than non-torn MM (P < .05). Conclusions The present automated method offers a promising alternative to manual T2 mapping analyses of the menisci and a considerable advance for integration into clinical workflows.

      PubDate: 2017-09-06T13:37:01Z
      DOI: 10.1016/j.acra.2017.03.025
       
  • The Radiologist in the Crypt
    • Authors: Katherine van Schaik; Ronald Eisenberg; Jelena Bekvalac; Frank Rühli
      Pages: 1305 - 1311
      Abstract: Publication date: October 2017
      Source:Academic Radiology, Volume 24, Issue 10
      Author(s): Katherine van Schaik, Ronald Eisenberg, Jelena Bekvalac, Frank Rühli
      Rationale and Objectives Our study provides a critical assessment of osteological and radiological techniques in the analysis of bioarchaeological samples for evidence of pathology. Teams of physicians, anthropologists, historians, and archaeologists have used these methods to provide a clearer picture of health and disease burden in the past. Of relevance for clinicians, these efforts have led to a reconsideration of the physiology and epidemiology of contemporary disease. Materials and Methods We examined 213 18th- to 19th-century adult skeletons from the crypt of St. Bride's Church in London using two methods of skeletal analysis (osteological and radiological). All available bones were examined by an osteologist. Radiographs of the crania, humeri, pelvises, femora, and tibiae were examined by a radiologist. Identified lesions were grouped into nine standard categories used in an osteological examination, and statistical analysis was completed. Results Among lesion categories, and between lesion categories and age, correlations were weaker among the radiologically analyzed data than among data evaluated osteologically. Correlations between age at death and total number of lesions identified were nearly identical, regardless of the method of lesion identification. Conclusions Although osteological analysis seemed more sensitive in identifying infectious and neoplastic lesions, radiological analysis often provided a clearer illustration of the extent of these conditions, especially when the lesion involved a large area (eg, osteoporosis or Paget disease). Radiological analysis suggested that, as they age, men accumulate skeletal lesions more rapidly than women. Using bioarchaeological data, our study suggests the potential that radiological analysis might have in the establishment of general baseline levels of ill health in both past and present populations.

      PubDate: 2017-09-06T13:37:01Z
      DOI: 10.1016/j.acra.2017.03.008
       
  • Use of Hyperlinks in PowerPoint Presentations as an Educational Tool
    • Authors: Gregory Scott Stacy; Steven G. Thiel
      Pages: 1318 - 1324
      Abstract: Publication date: October 2017
      Source:Academic Radiology, Volume 24, Issue 10
      Author(s): Gregory Scott Stacy, Steven G. Thiel
      PowerPoint software (Microsoft, Redmond, WA) has become a popular tool for creating and displaying electronic presentations. The “hyperlink” function in PowerPoint allows users to advance from one slide to another slide in the presentation when they click on a predetermined word, shape, or image, thereby allowing for a more dynamic and interactive experience than can be obtained with serial presentation of slides alone. The objective of this article is to provide a tutorial describing the necessary steps to create hyperlinks and incorporate them in a variety of ways into a PowerPoint presentation. Hyperlinks can turn a passive learning experience into an active one by allowing the participant to become more engaged with the presentation.

      PubDate: 2017-09-06T13:37:01Z
      DOI: 10.1016/j.acra.2017.03.018
       
  • Andragogic Approaches to Continuing Medical Education
    • Authors: Christian W. Cox; Richard B. Gunderman
      Pages: 1325 - 1326
      Abstract: Publication date: October 2017
      Source:Academic Radiology, Volume 24, Issue 10
      Author(s): Christian W. Cox, Richard B. Gunderman


      PubDate: 2017-09-06T13:37:01Z
      DOI: 10.1016/j.acra.2017.05.004
       
  • Radiology Resident Education
    • Authors: Ciaran E. Redmond; Gerard M. Healy; Simon Clifford; Eric J. Heffernan
      First page: 1327
      Abstract: Publication date: October 2017
      Source:Academic Radiology, Volume 24, Issue 10
      Author(s): Ciaran E. Redmond, Gerard M. Healy, Simon Clifford, Eric J. Heffernan


      PubDate: 2017-09-06T13:37:01Z
      DOI: 10.1016/j.acra.2017.04.015
       
  • The Importance of Combined Teaching Methods in Radiology Resident
           Education
    • Authors: Teresa Chapman; Janet R. Reid; Erin E. O'Connor
      First page: 1328
      Abstract: Publication date: October 2017
      Source:Academic Radiology, Volume 24, Issue 10
      Author(s): Teresa Chapman, Janet R. Reid, Erin E. O'Connor


      PubDate: 2017-09-06T13:37:01Z
      DOI: 10.1016/j.acra.2017.05.015
       
  • 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
      Abstract: Publication date: Available online 10 October 2017
      Source:Academic Radiology
      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: 2017-10-12T14:04:08Z
      DOI: 10.1016/j.acra.2017.08.003
       
  • Clinical Applications of 3D 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
      Abstract: Publication date: Available online 10 October 2017
      Source:Academic Radiology
      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: 2017-10-12T14:04:08Z
      DOI: 10.1016/j.acra.2017.08.003
       
  • Structured Reporting in Radiology
    • Authors: Dhakshinamoorthy Ganeshan; Phuong-Anh Thi Duong Linda Probyn Leon Lenchik Tatum
      Abstract: Publication date: Available online 10 October 2017
      Source:Academic Radiology
      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: 2017-10-12T14:04:08Z
       
  • Virtual Simulation in Enhancing Procedural Training for Fluoroscopy-guided
           Lumbar Puncture
    • Authors: Saad Ali; Monther Qandeel; Rishi Ramakrishna; Carina W. Yang
      Abstract: Publication date: Available online 9 October 2017
      Source:Academic Radiology
      Author(s): Saad Ali, Monther Qandeel, Rishi Ramakrishna, Carina W. Yang
      Rationale and Objectives Fluoroscopy-guided lumbar puncture (FGLP) is a basic procedural component of radiology residency and neuroradiology fellowship training. Performance of the procedure with limited experience is associated with increased patient discomfort as well as increased radiation dose, puncture attempts, and complication rate. Simulation in health care is a developing field that has potential for enhancing procedural training. We demonstrate the design and utility of a virtual reality simulator for performing FGLP. Materials and Methods An FGLP module was developed on an ImmersiveTouch platform, which digitally reproduces the procedural environment with a hologram-like projection. From computed tomography datasets of healthy adult spines, we constructed a 3-D model of the lumbar spine and overlying soft tissues. We assigned different physical characteristics to each tissue type, which the user can experience through haptic feedback while advancing a virtual spinal needle. Virtual fluoroscopy as well as 3-D images can be obtained for procedural planning and guidance. The number of puncture attempts, the distance to the target, the number of fluoroscopic shots, and the approximate radiation dose can be calculated. Preliminary data from users who participated in the simulation were obtained in a postsimulation survey. Results All users found the simulation to be a realistic replication of the anatomy and procedure and would recommend to a colleague. On a scale of 1–5 (lowest to highest) rating the virtual simulator training overall, the mean score was 4.3 (range 3–5). Conclusions We describe the design of a virtual reality simulator for performing FGLP and present the initial experience with this new technique.

      PubDate: 2017-10-12T14:04:08Z
      DOI: 10.1016/j.acra.2017.08.002
       
  • How Art Can Educate the Radiologist's Eye
    • Authors: Richard B. Gunderman; Aimebenomon O. Idahosa
      Abstract: Publication date: Available online 3 October 2017
      Source:Academic Radiology
      Author(s): Richard B. Gunderman, Aimebenomon O. Idahosa


      PubDate: 2017-10-05T13:36:23Z
      DOI: 10.1016/j.acra.2017.08.006
       
  • Improving Performance of Breast Cancer Risk Prediction by Incorporating
           Optical Density Image Feature Analysis
    • Authors: Shiju Yan; Yunzhi Wang; Faranak Aghaei; Yuchen Qiu; Bin Zheng
      Abstract: Publication date: Available online 3 October 2017
      Source:Academic Radiology
      Author(s): Shiju Yan, Yunzhi Wang, Faranak Aghaei, Yuchen Qiu, Bin Zheng
      Rationale and Objectives The purpose of this study is to improve accuracy of near-term breast cancer risk prediction by applying a new mammographic image conversion method combined with a two-stage artificial neural network (ANN)-based classification scheme. Materials and Methods The dataset included 168 negative mammography screening cases. In developing and testing our new risk model, we first converted the original grayscale value (GV)-based mammographic images into optical density (OD)-based images. For each case, our computer-aided scheme then computed two types of image features representing bilateral asymmetry and the maximum of the image features computed from GV and OD images, respectively. A two-stage classification scheme consisting of three ANNs was developed. The first stage included two ANNs trained using features computed separately from GV and OD images of 138 cases. The second stage included another ANN to fuse the prediction scores produced by two ANNs in the first stage. The risk prediction performance was tested using the rest 30 cases. Results With the two-stage classification scheme, the computed area under the receiver operating characteristic curve (AUC) was  0.816 ± 0.071, which was significantly higher than the AUC values of 0.669 ± 0.099 and 0.646 ± 0.099 achieved using two ANNs trained using GV features and OD features, respectively (P < .05). Conclusion This study demonstrated that applying an OD image conversion method can acquire new complimentary information to those acquired from the original images. As a result, fusion image features computed from these two types of images yielded significantly higher performance in near-term breast cancer risk prediction.

      PubDate: 2017-10-05T13:36:23Z
      DOI: 10.1016/j.acra.2017.08.007
       
  • Does the Tumor Size Affect the Signal Enhancement Ratio in Luminal Breast
           Cancers'
    • Authors: Kadri Altundag
      Abstract: Publication date: Available online 21 September 2017
      Source:Academic Radiology
      Author(s): Kadri Altundag


      PubDate: 2017-09-22T10:14:47Z
      DOI: 10.1016/j.acra.2017.08.015
       
  • 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
      Abstract: Publication date: Available online 15 September 2017
      Source:Academic Radiology
      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: 2017-09-16T14:10:07Z
      DOI: 10.1016/j.acra.2017.05.019
       
  • Low-intensity Vibration Therapy for Bone Health in Renal Osteodystrophy
    • Authors: Sachin Sharma; Garry E. Gold
      Abstract: Publication date: Available online 15 September 2017
      Source:Academic Radiology
      Author(s): Sachin Sharma, Garry E. Gold


      PubDate: 2017-09-16T14:10:07Z
      DOI: 10.1016/j.acra.2017.08.001
       
  • Differential Aging Signals in Abdominal CT Scans
    • Authors: Nikita V. Orlov; Sokratis Makrogiannis; Luigi Ferrucci; Ilya G. Goldberg
      Abstract: Publication date: Available online 15 September 2017
      Source:Academic Radiology
      Author(s): Nikita V. Orlov, Sokratis Makrogiannis, Luigi Ferrucci, Ilya G. Goldberg
      Rationale and Objectives Changes in the composition of body tissues are major aging phenotypes, but they have been difficult to study in depth. Here we describe age-related change in abdominal tissues observable in computed tomography (CT) scans. We used pattern recognition and machine learning to detect and quantify these changes in a model-agnostic fashion. Materials and Methods CT scans of abdominal L4 sections were obtained from Baltimore Longitudinal Study of Aging (BLSA) participants. Age-related change in the constituent tissues were determined by training machine classifiers to differentiate age groups within male and female strata (“Younger” at 50–70 years old vs “Older” at 80–99 years old). The accuracy achieved by the classifiers in differentiating the age cohorts was used as a surrogate measure of the aging signal in the different tissues. Results The highest accuracy for discriminating age differences was 0.76 and 0.72 for males and females, respectively. The classification accuracy was 0.79 and 0.71 for adipose tissue, 0.70 and 0.68 for soft tissue, and 0.65 and 0.64 for bone. Conclusions Using image data from a large sample of well-characterized pool of participants dispersed over a wide age range, we explored age-related differences in gross morphology and texture of abdominal tissues. This technology is advantageous for tracking effects of biological aging and predicting adverse outcomes when compared to the traditional use of specific molecular biomarkers. Application of pattern recognition and machine learning as a tool for analyzing medical images may provide much needed insight into tissue changes occurring with aging and, further, connect these changes with their metabolic and functional consequences.

      PubDate: 2017-09-16T14:10:07Z
      DOI: 10.1016/j.acra.2017.07.007
       
  • MR Imaging Biomarkers in Amyotrophic Lateral Sclerosis
    • Authors: Elias R. Melhem
      Abstract: Publication date: Available online 16 August 2017
      Source:Academic Radiology
      Author(s): Elias R. Melhem


      PubDate: 2017-08-20T19:30:13Z
      DOI: 10.1016/j.acra.2017.07.004
       
  • Now You See It, But Would You Later' Examining the Mechanisms of
           Satisfaction of Search in the Fatigued Radiologist
    • Authors: Tessa S. Cook
      Abstract: Publication date: Available online 25 July 2017
      Source:Academic Radiology
      Author(s): Tessa S. Cook


      PubDate: 2017-08-01T13:03:12Z
      DOI: 10.1016/j.acra.2017.06.004
       
 
 
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