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Publisher: Elsevier   (Total: 3184 journals)

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Showing 1 - 200 of 3184 Journals sorted alphabetically
Academic Pediatrics     Hybrid Journal   (Followers: 37, SJR: 1.655, CiteScore: 2)
Academic Radiology     Hybrid Journal   (Followers: 25, SJR: 1.015, CiteScore: 2)
Accident Analysis & Prevention     Partially Free   (Followers: 100, SJR: 1.462, CiteScore: 3)
Accounting Forum     Hybrid Journal   (Followers: 27, SJR: 0.932, CiteScore: 2)
Accounting, Organizations and Society     Hybrid Journal   (Followers: 37, SJR: 1.771, CiteScore: 3)
Achievements in the Life Sciences     Open Access   (Followers: 5)
Acta Anaesthesiologica Taiwanica     Open Access   (Followers: 7)
Acta Astronautica     Hybrid Journal   (Followers: 430, SJR: 0.758, CiteScore: 2)
Acta Automatica Sinica     Full-text available via subscription   (Followers: 2)
Acta Biomaterialia     Hybrid Journal   (Followers: 28, SJR: 1.967, CiteScore: 7)
Acta Colombiana de Cuidado Intensivo     Full-text available via subscription   (Followers: 3)
Acta de Investigación Psicológica     Open Access   (Followers: 3)
Acta Ecologica Sinica     Open Access   (Followers: 10, SJR: 0.18, CiteScore: 1)
Acta Histochemica     Hybrid Journal   (Followers: 3, SJR: 0.661, CiteScore: 2)
Acta Materialia     Hybrid Journal   (Followers: 293, SJR: 3.263, CiteScore: 6)
Acta Mathematica Scientia     Full-text available via subscription   (Followers: 6, SJR: 0.504, CiteScore: 1)
Acta Mechanica Solida Sinica     Full-text available via subscription   (Followers: 9, SJR: 0.542, CiteScore: 1)
Acta Oecologica     Hybrid Journal   (Followers: 12, SJR: 0.834, CiteScore: 2)
Acta Otorrinolaringologica (English Edition)     Full-text available via subscription  
Acta Otorrinolaringológica Española     Full-text available via subscription   (Followers: 2, SJR: 0.307, CiteScore: 0)
Acta Pharmaceutica Sinica B     Open Access   (Followers: 1, SJR: 1.793, CiteScore: 6)
Acta Poética     Open Access   (Followers: 4, SJR: 0.101, CiteScore: 0)
Acta Psychologica     Hybrid Journal   (Followers: 26, SJR: 1.331, CiteScore: 2)
Acta Sociológica     Open Access   (Followers: 1)
Acta Tropica     Hybrid Journal   (Followers: 6, SJR: 1.052, CiteScore: 2)
Acta Urológica Portuguesa     Open Access  
Actas Dermo-Sifiliograficas     Full-text available via subscription   (Followers: 3, SJR: 0.374, CiteScore: 1)
Actas Dermo-Sifiliográficas (English Edition)     Full-text available via subscription   (Followers: 2)
Actas Urológicas Españolas     Full-text available via subscription   (Followers: 3, SJR: 0.344, CiteScore: 1)
Actas Urológicas Españolas (English Edition)     Full-text available via subscription   (Followers: 1)
Actualites Pharmaceutiques     Full-text available via subscription   (Followers: 7, SJR: 0.19, CiteScore: 0)
Actualites Pharmaceutiques Hospitalieres     Full-text available via subscription   (Followers: 3)
Acupuncture and Related Therapies     Hybrid Journal   (Followers: 8)
Acute Pain     Full-text available via subscription   (Followers: 15, SJR: 2.671, CiteScore: 5)
Ad Hoc Networks     Hybrid Journal   (Followers: 11, SJR: 0.53, CiteScore: 4)
Addictive Behaviors     Hybrid Journal   (Followers: 17, SJR: 1.29, CiteScore: 3)
Addictive Behaviors Reports     Open Access   (Followers: 9, SJR: 0.755, CiteScore: 2)
Additive Manufacturing     Hybrid Journal   (Followers: 11, SJR: 2.611, CiteScore: 8)
Additives for Polymers     Full-text available via subscription   (Followers: 23)
Advanced Drug Delivery Reviews     Hybrid Journal   (Followers: 180, SJR: 4.09, CiteScore: 13)
Advanced Engineering Informatics     Hybrid Journal   (Followers: 12, SJR: 1.167, CiteScore: 4)
Advanced Powder Technology     Hybrid Journal   (Followers: 17, SJR: 0.694, CiteScore: 3)
Advances in Accounting     Hybrid Journal   (Followers: 9, SJR: 0.277, CiteScore: 1)
Advances in Agronomy     Full-text available via subscription   (Followers: 16, SJR: 2.384, CiteScore: 5)
Advances in Anesthesia     Full-text available via subscription   (Followers: 28, SJR: 0.126, CiteScore: 0)
Advances in Antiviral Drug Design     Full-text available via subscription   (Followers: 2)
Advances in Applied Mathematics     Full-text available via subscription   (Followers: 11, SJR: 0.992, CiteScore: 1)
Advances in Applied Mechanics     Full-text available via subscription   (Followers: 11, SJR: 1.551, CiteScore: 4)
Advances in Applied Microbiology     Full-text available via subscription   (Followers: 24, SJR: 2.089, CiteScore: 5)
Advances In Atomic, Molecular, and Optical Physics     Full-text available via subscription   (Followers: 15, SJR: 0.572, CiteScore: 2)
Advances in Biological Regulation     Hybrid Journal   (Followers: 4, SJR: 2.61, CiteScore: 7)
Advances in Botanical Research     Full-text available via subscription   (Followers: 2, SJR: 0.686, CiteScore: 2)
Advances in Cancer Research     Full-text available via subscription   (Followers: 32, SJR: 3.043, CiteScore: 6)
Advances in Carbohydrate Chemistry and Biochemistry     Full-text available via subscription   (Followers: 9, SJR: 1.453, CiteScore: 2)
Advances in Catalysis     Full-text available via subscription   (Followers: 5, SJR: 1.992, CiteScore: 5)
Advances in Cell Aging and Gerontology     Full-text available via subscription   (Followers: 5)
Advances in Cellular and Molecular Biology of Membranes and Organelles     Full-text available via subscription   (Followers: 14)
Advances in Chemical Engineering     Full-text available via subscription   (Followers: 28, SJR: 0.156, CiteScore: 1)
Advances in Child Development and Behavior     Full-text available via subscription   (Followers: 10, SJR: 0.713, CiteScore: 1)
Advances in Chronic Kidney Disease     Full-text available via subscription   (Followers: 10, SJR: 1.316, CiteScore: 2)
Advances in Clinical Chemistry     Full-text available via subscription   (Followers: 26, SJR: 1.562, CiteScore: 3)
Advances in Colloid and Interface Science     Full-text available via subscription   (Followers: 20, SJR: 1.977, CiteScore: 8)
Advances in Computers     Full-text available via subscription   (Followers: 14, SJR: 0.205, CiteScore: 1)
Advances in Dermatology     Full-text available via subscription   (Followers: 15)
Advances in Developmental Biology     Full-text available via subscription   (Followers: 13)
Advances in Digestive Medicine     Open Access   (Followers: 11)
Advances in DNA Sequence-Specific Agents     Full-text available via subscription   (Followers: 7)
Advances in Drug Research     Full-text available via subscription   (Followers: 26)
Advances in Ecological Research     Full-text available via subscription   (Followers: 43, SJR: 2.524, CiteScore: 4)
Advances in Engineering Software     Hybrid Journal   (Followers: 29, SJR: 1.159, CiteScore: 4)
Advances in Experimental Biology     Full-text available via subscription   (Followers: 8)
Advances in Experimental Social Psychology     Full-text available via subscription   (Followers: 49, SJR: 5.39, CiteScore: 8)
Advances in Exploration Geophysics     Full-text available via subscription   (Followers: 1)
Advances in Fluorine Science     Full-text available via subscription   (Followers: 9)
Advances in Food and Nutrition Research     Full-text available via subscription   (Followers: 62, SJR: 0.591, CiteScore: 2)
Advances in Fuel Cells     Full-text available via subscription   (Followers: 17)
Advances in Genetics     Full-text available via subscription   (Followers: 20, SJR: 1.354, CiteScore: 4)
Advances in Genome Biology     Full-text available via subscription   (Followers: 10, SJR: 12.74, CiteScore: 13)
Advances in Geophysics     Full-text available via subscription   (Followers: 6, SJR: 1.193, CiteScore: 3)
Advances in Heat Transfer     Full-text available via subscription   (Followers: 24, SJR: 0.368, CiteScore: 1)
Advances in Heterocyclic Chemistry     Full-text available via subscription   (Followers: 12, SJR: 0.749, CiteScore: 3)
Advances in Human Factors/Ergonomics     Full-text available via subscription   (Followers: 23)
Advances in Imaging and Electron Physics     Full-text available via subscription   (Followers: 3, SJR: 0.193, CiteScore: 0)
Advances in Immunology     Full-text available via subscription   (Followers: 36, SJR: 4.433, CiteScore: 6)
Advances in Inorganic Chemistry     Full-text available via subscription   (Followers: 10, SJR: 1.163, CiteScore: 2)
Advances in Insect Physiology     Full-text available via subscription   (Followers: 2, SJR: 1.938, CiteScore: 3)
Advances in Integrative Medicine     Hybrid Journal   (Followers: 6, SJR: 0.176, CiteScore: 0)
Advances in Intl. Accounting     Full-text available via subscription   (Followers: 3)
Advances in Life Course Research     Hybrid Journal   (Followers: 8, SJR: 0.682, CiteScore: 2)
Advances in Lipobiology     Full-text available via subscription   (Followers: 1)
Advances in Magnetic and Optical Resonance     Full-text available via subscription   (Followers: 8)
Advances in Marine Biology     Full-text available via subscription   (Followers: 20, SJR: 0.88, CiteScore: 2)
Advances in Mathematics     Full-text available via subscription   (Followers: 12, SJR: 3.027, CiteScore: 2)
Advances in Medical Sciences     Hybrid Journal   (Followers: 7, SJR: 0.694, CiteScore: 2)
Advances in Medicinal Chemistry     Full-text available via subscription   (Followers: 5)
Advances in Microbial Physiology     Full-text available via subscription   (Followers: 4, SJR: 1.158, CiteScore: 3)
Advances in Molecular and Cell Biology     Full-text available via subscription   (Followers: 23)
Advances in Molecular and Cellular Endocrinology     Full-text available via subscription   (Followers: 8)
Advances in Molecular Toxicology     Full-text available via subscription   (Followers: 7, SJR: 0.182, CiteScore: 0)
Advances in Nanoporous Materials     Full-text available via subscription   (Followers: 4)
Advances in Oncobiology     Full-text available via subscription   (Followers: 2)
Advances in Organ Biology     Full-text available via subscription   (Followers: 2)
Advances in Organometallic Chemistry     Full-text available via subscription   (Followers: 17, SJR: 1.875, CiteScore: 4)
Advances in Parallel Computing     Full-text available via subscription   (Followers: 7, SJR: 0.174, CiteScore: 0)
Advances in Parasitology     Full-text available via subscription   (Followers: 5, SJR: 1.579, CiteScore: 4)
Advances in Pediatrics     Full-text available via subscription   (Followers: 25, SJR: 0.461, CiteScore: 1)
Advances in Pharmaceutical Sciences     Full-text available via subscription   (Followers: 17)
Advances in Pharmacology     Full-text available via subscription   (Followers: 16, SJR: 1.536, CiteScore: 3)
Advances in Physical Organic Chemistry     Full-text available via subscription   (Followers: 8, SJR: 0.574, CiteScore: 1)
Advances in Phytomedicine     Full-text available via subscription  
Advances in Planar Lipid Bilayers and Liposomes     Full-text available via subscription   (Followers: 3, SJR: 0.109, CiteScore: 1)
Advances in Plant Biochemistry and Molecular Biology     Full-text available via subscription   (Followers: 10)
Advances in Plant Pathology     Full-text available via subscription   (Followers: 5)
Advances in Porous Media     Full-text available via subscription   (Followers: 5)
Advances in Protein Chemistry     Full-text available via subscription   (Followers: 19)
Advances in Protein Chemistry and Structural Biology     Full-text available via subscription   (Followers: 20, SJR: 0.791, CiteScore: 2)
Advances in Psychology     Full-text available via subscription   (Followers: 65)
Advances in Quantum Chemistry     Full-text available via subscription   (Followers: 6, SJR: 0.371, CiteScore: 1)
Advances in Radiation Oncology     Open Access   (Followers: 1, SJR: 0.263, CiteScore: 1)
Advances in Small Animal Medicine and Surgery     Hybrid Journal   (Followers: 3, SJR: 0.101, CiteScore: 0)
Advances in Space Biology and Medicine     Full-text available via subscription   (Followers: 6)
Advances in Space Research     Full-text available via subscription   (Followers: 414, SJR: 0.569, CiteScore: 2)
Advances in Structural Biology     Full-text available via subscription   (Followers: 5)
Advances in Surgery     Full-text available via subscription   (Followers: 13, SJR: 0.555, CiteScore: 2)
Advances in the Study of Behavior     Full-text available via subscription   (Followers: 36, SJR: 2.208, CiteScore: 4)
Advances in Veterinary Medicine     Full-text available via subscription   (Followers: 20)
Advances in Veterinary Science and Comparative Medicine     Full-text available via subscription   (Followers: 15)
Advances in Virus Research     Full-text available via subscription   (Followers: 5, SJR: 2.262, CiteScore: 5)
Advances in Water Resources     Hybrid Journal   (Followers: 51, SJR: 1.551, CiteScore: 3)
Aeolian Research     Hybrid Journal   (Followers: 6, SJR: 1.117, CiteScore: 3)
Aerospace Science and Technology     Hybrid Journal   (Followers: 365, SJR: 0.796, CiteScore: 3)
AEU - Intl. J. of Electronics and Communications     Hybrid Journal   (Followers: 8, SJR: 0.42, CiteScore: 2)
African J. of Emergency Medicine     Open Access   (Followers: 6, SJR: 0.296, CiteScore: 0)
Ageing Research Reviews     Hybrid Journal   (Followers: 11, SJR: 3.671, CiteScore: 9)
Aggression and Violent Behavior     Hybrid Journal   (Followers: 468, SJR: 1.238, CiteScore: 3)
Agri Gene     Hybrid Journal   (Followers: 1, SJR: 0.13, CiteScore: 0)
Agricultural and Forest Meteorology     Hybrid Journal   (Followers: 17, SJR: 1.818, CiteScore: 5)
Agricultural Systems     Hybrid Journal   (Followers: 31, SJR: 1.156, CiteScore: 4)
Agricultural Water Management     Hybrid Journal   (Followers: 44, SJR: 1.272, CiteScore: 3)
Agriculture and Agricultural Science Procedia     Open Access   (Followers: 4)
Agriculture and Natural Resources     Open Access   (Followers: 3)
Agriculture, Ecosystems & Environment     Hybrid Journal   (Followers: 58, SJR: 1.747, CiteScore: 4)
Ain Shams Engineering J.     Open Access   (Followers: 5, SJR: 0.589, CiteScore: 3)
Air Medical J.     Hybrid Journal   (Followers: 6, SJR: 0.26, CiteScore: 0)
AKCE Intl. J. of Graphs and Combinatorics     Open Access   (SJR: 0.19, CiteScore: 0)
Alcohol     Hybrid Journal   (Followers: 12, SJR: 1.153, CiteScore: 3)
Alcoholism and Drug Addiction     Open Access   (Followers: 11)
Alergologia Polska : Polish J. of Allergology     Full-text available via subscription   (Followers: 1)
Alexandria Engineering J.     Open Access   (Followers: 2, SJR: 0.604, CiteScore: 3)
Alexandria J. of Medicine     Open Access   (Followers: 1, SJR: 0.191, CiteScore: 1)
Algal Research     Partially Free   (Followers: 11, SJR: 1.142, CiteScore: 4)
Alkaloids: Chemical and Biological Perspectives     Full-text available via subscription   (Followers: 2)
Allergologia et Immunopathologia     Full-text available via subscription   (Followers: 1, SJR: 0.504, CiteScore: 1)
Allergology Intl.     Open Access   (Followers: 5, SJR: 1.148, CiteScore: 2)
Alpha Omegan     Full-text available via subscription   (SJR: 3.521, CiteScore: 6)
ALTER - European J. of Disability Research / Revue Européenne de Recherche sur le Handicap     Full-text available via subscription   (Followers: 10, SJR: 0.201, CiteScore: 1)
Alzheimer's & Dementia     Hybrid Journal   (Followers: 53, SJR: 4.66, CiteScore: 10)
Alzheimer's & Dementia: Diagnosis, Assessment & Disease Monitoring     Open Access   (Followers: 5, SJR: 1.796, CiteScore: 4)
Alzheimer's & Dementia: Translational Research & Clinical Interventions     Open Access   (Followers: 5, SJR: 1.108, CiteScore: 3)
Ambulatory Pediatrics     Hybrid Journal   (Followers: 6)
American Heart J.     Hybrid Journal   (Followers: 57, SJR: 3.267, CiteScore: 4)
American J. of Cardiology     Hybrid Journal   (Followers: 62, SJR: 1.93, CiteScore: 3)
American J. of Emergency Medicine     Hybrid Journal   (Followers: 45, SJR: 0.604, CiteScore: 1)
American J. of Geriatric Pharmacotherapy     Full-text available via subscription   (Followers: 11)
American J. of Geriatric Psychiatry     Hybrid Journal   (Followers: 13, SJR: 1.524, CiteScore: 3)
American J. of Human Genetics     Hybrid Journal   (Followers: 34, SJR: 7.45, CiteScore: 8)
American J. of Infection Control     Hybrid Journal   (Followers: 29, SJR: 1.062, CiteScore: 2)
American J. of Kidney Diseases     Hybrid Journal   (Followers: 35, SJR: 2.973, CiteScore: 4)
American J. of Medicine     Hybrid Journal   (Followers: 49)
American J. of Medicine Supplements     Full-text available via subscription   (Followers: 3, SJR: 1.967, CiteScore: 2)
American J. of Obstetrics and Gynecology     Hybrid Journal   (Followers: 234, SJR: 2.7, CiteScore: 4)
American J. of Ophthalmology     Hybrid Journal   (Followers: 66, SJR: 3.184, CiteScore: 4)
American J. of Ophthalmology Case Reports     Open Access   (Followers: 5, SJR: 0.265, CiteScore: 0)
American J. of Orthodontics and Dentofacial Orthopedics     Full-text available via subscription   (Followers: 6, SJR: 1.289, CiteScore: 1)
American J. of Otolaryngology     Hybrid Journal   (Followers: 25, SJR: 0.59, CiteScore: 1)
American J. of Pathology     Hybrid Journal   (Followers: 30, SJR: 2.139, CiteScore: 4)
American J. of Preventive Medicine     Hybrid Journal   (Followers: 28, SJR: 2.164, CiteScore: 4)
American J. of Surgery     Hybrid Journal   (Followers: 39, SJR: 1.141, CiteScore: 2)
American J. of the Medical Sciences     Hybrid Journal   (Followers: 12, SJR: 0.767, CiteScore: 1)
Ampersand : An Intl. J. of General and Applied Linguistics     Open Access   (Followers: 7)
Anaerobe     Hybrid Journal   (Followers: 4, SJR: 1.144, CiteScore: 3)
Anaesthesia & Intensive Care Medicine     Full-text available via subscription   (Followers: 63, SJR: 0.138, CiteScore: 0)
Anaesthesia Critical Care & Pain Medicine     Full-text available via subscription   (Followers: 20, SJR: 0.411, CiteScore: 1)
Anales de Cirugia Vascular     Full-text available via subscription   (Followers: 1)
Anales de Pediatría     Full-text available via subscription   (Followers: 3, SJR: 0.277, CiteScore: 0)
Anales de Pediatría (English Edition)     Full-text available via subscription  
Anales de Pediatría Continuada     Full-text available via subscription  
Analytic Methods in Accident Research     Hybrid Journal   (Followers: 5, SJR: 4.849, CiteScore: 10)
Analytica Chimica Acta     Hybrid Journal   (Followers: 44, SJR: 1.512, CiteScore: 5)
Analytica Chimica Acta : X     Open Access  
Analytical Biochemistry     Hybrid Journal   (Followers: 202, SJR: 0.633, CiteScore: 2)
Analytical Chemistry Research     Open Access   (Followers: 12, SJR: 0.411, CiteScore: 2)
Analytical Spectroscopy Library     Full-text available via subscription   (Followers: 14)
Anesthésie & Réanimation     Full-text available via subscription   (Followers: 2)
Anesthesiology Clinics     Full-text available via subscription   (Followers: 24, SJR: 0.683, CiteScore: 2)
Angiología     Full-text available via subscription   (SJR: 0.121, CiteScore: 0)
Angiologia e Cirurgia Vascular     Open Access   (Followers: 1, SJR: 0.111, CiteScore: 0)
Animal Behaviour     Hybrid Journal   (Followers: 208, SJR: 1.58, CiteScore: 3)
Animal Feed Science and Technology     Hybrid Journal   (Followers: 6, SJR: 0.937, CiteScore: 2)
Animal Reproduction Science     Hybrid Journal   (Followers: 7, SJR: 0.704, CiteScore: 2)

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Similar Journals
Journal Cover
Academic Radiology
Journal Prestige (SJR): 1.015
Citation Impact (citeScore): 2
Number of Followers: 25  
  Hybrid Journal Hybrid journal (It can contain Open Access articles)
ISSN (Print) 1076-6332
Published by Elsevier Homepage  [3184 journals]
  • How Certain Are Your Radiology Reports And Are We Alone in Our
    • Abstract: Publication date: Available online 20 June 2019Source: Academic RadiologyAuthor(s): Elizabeth A. Krupinski
  • Machine Learning Algorithms Utilizing Functional Respiratory Imaging May
           Predict COPD Exacerbations
    • Abstract: Publication date: Available online 19 June 2019Source: Academic RadiologyAuthor(s): Brett W. Carter
  • Value of TSCT Features for Differentiating Preinvasive and Minimally
           Invasive Adenocarcinoma From Invasive Adenocarcinoma Presenting as
           Subsolid Nodules Smaller Than 3 cm
    • Abstract: Publication date: Available online 11 June 2019Source: Academic RadiologyAuthor(s): Hailin Wang, Qiaoyou Weng, Junguo Hui, Shiji Fang, Xulu Wu, Weibo Mao, Minjiang Chen, Liyun Zheng, Zufei Wang, Zhongwei Zhao, Limin Zhou, Jianfei Tu, Min Xu, Yuan Huang, Jiansong JiBackgroundTo distinguish preinvasive (adenocarcinoma in situ/atypical adenomatous hyperplasia) and minimally invasive adenocarcinoma (MIA) from invasive adenocarcinoma (IA) appearing as solitary subsolid nodules (SSNs) less than 3 cm based on thin-section computed tomography (TSCT) features to guide therapeutic approaches.MethodsA total of 154 lesions that were histopathologically confirmed to have pre/minimally invasive adenocarcinoma (hereafter pre/MIA) and IA presenting as part-solid nodules (PSNs) or pure ground-glass nodules (pGGNs) were retrospectively reviewed. The TSCT features, including diameter, area, CT value, shape, air bronchogram, margins, and location, were compared and assessed. Receiver operating characteristic analyses were conducted to determine the cut-off values for the qualitative variables and their diagnostic performances.ResultsOf 154 nodules, 89 IA, 53 MIA, eight adenocarcinoma in situ, and four atypical adenomatous hyperplasia lesions were found. Univariate and multivariate logistic regression of the pre/MIA and IA lesions were compared and analyzed among PSNs and pGGNs. Among pGGNs, a significant difference was found in the area (p = 0.004, odds ratio [OR] = 0.124, 95% confidence interval [CI] = 0.300–0.515) between the pre/MIA and IA groups. In PSNs, significant differences were found in the diameter (p = 0.001, OR = 0.171, 95% CI = 0.063–0.467) and CT value (p = 0.001, OR = 0.996, 95% CI = 0.993–0.998) between the pre/MIA and IA groups. According to the corresponding receiver operating characteristic curves, the optimal cut-off tumor area in pGGNs to differentiate pre/MIA from IA was 0.595 cm2. A higher CT value of the lesion (≥ −298.500 HU) and a larger diameter (≥1.450 cm) in PSNs were significantly associated with IA.ConclusionImaging features from TSCT contribute to distinguishing pre/MIA from IA in solitary subsolid nodules and may contribute to guide the clinical management of these lesions.
  • Express Team-Based Learning (eTBL): A Time-Efficient TBL Approach in
    • Abstract: Publication date: Available online 8 June 2019Source: Academic RadiologyAuthor(s): Susanne Skjervold Smeby, Børge Lillebo, Tobias S Slørdahl, Erik Magnus BerntsenRationale and ObjectivesTeam-based learning (TBL) is a student-centred, teacher-directed instructional method that promotes active learning. The application phase of TBL stimulates group discussion and critical thinking, which could be useful for learning radiology. We designed and evaluated two modified TBL-sessions on computed tomography and magnetic resonance imaging diagnostics in neuroradiology. Our aim was to examine what effects engaging students in in-class team application tasks had on student learning.Materials and MethodsA cross-over study was conducted, including 105 third-year medical students using two modified TBL sessions as the active learning intervention compared with two traditional lectures as a control. Student learning was assessed by results on the neuroradiology part of the end-of-year written examination. Student engagement and perceptions were assessed using the Student Self-Report of Engagement Measure and an additional four Likert-type items.ResultsThere were no statistically significant differences in student scores on the examination. Students reported high levels of engagement, and reported being more satisfied overall with the TBL sessions than traditional lectures. Students rated the TBL sessions higher than lectures on ability to make difficult material comprehensible, ability to engage students and to give them feedback.ConclusionThe modified TBL sessions halved in-class teaching time and by omitting the readiness assurance tests, there was more in-class time to focus on problem-solving of real clinical cases. Moreover, shorter sessions may ease implementation of TBL in the curriculum and allow for more frequent sessions. Students were more satisfied with eTBL than lectures, and reported high levels of engagement.
  • Discrepancy in Practices Related to the Use of Oral Contrast in Abdominal
           CT Scan
    • Abstract: Publication date: July 2019Source: Academic Radiology, Volume 26, Issue 7Author(s): Shahmeer Khan, Muhammad Awais, Anwar Ahmed
  • How Intrapersonal Diversity Enhances Creativity: Leonardo da Vinci
    • Abstract: Publication date: July 2019Source: Academic Radiology, Volume 26, Issue 7Author(s): Alex Lion, Richard B. Gunderman
  • Social Media and Radiology Education: Are We #Ready'
    • Abstract: Publication date: July 2019Source: Academic Radiology, Volume 26, Issue 7Author(s): Joshua P NickersonSocial media has become integrated into the lives of millions of people, but it has only recently been explored as a potential teaching tool. There is a body of literature to suggest that today's learners desire use of these interactive platforms for learning and that they result in higher degrees of student satisfaction, although it is not yet clear that a greater degree of knowledge transfer or retention is achieved. There are barriers to implementation in a curriculum, but as we learn to overcome these barriers and find new and creative ways to leverage social media we as educators will meet our students needs in the era of “web 2.0” and the digital native generation.
  • Counterpoint: Why Some Imposed Structure is a Necessity in Radiology
    • Abstract: Publication date: July 2019Source: Academic Radiology, Volume 26, Issue 7Author(s): Adam E. Flanders
  • In Opposition to Standardized Templated Reporting
    • Abstract: Publication date: July 2019Source: Academic Radiology, Volume 26, Issue 7Author(s): David Mark Yousem
  • Institutional Implementation of a Structured Reporting System: Our
           Experience with the Brain Tumor Reporting and Data System
    • Abstract: Publication date: July 2019Source: Academic Radiology, Volume 26, Issue 7Author(s): Ashwani Gore, Michael J. Hoch, Hui-Kuo G. Shu, Jeffrey J. Olson, Alfredo D. Voloschin, Brent D. WeinbergRationale and ObjectivesAnalyze the impact of implementing a structured reporting system for primary brain tumors, the Brain Tumor Reporting and Data System, on attitudes toward radiology reports at a single institution.Materials and MethodsFollowing Institutional Review Board approval, an initial 22 question, 5 point (1—worst to 5—best), survey was sent to faculty members, house staff members, and nonphysician providers at our institution who participate in the direct care of brain tumor patients. Results were used to develop a structured reporting strategy for brain tumors which was implemented across an entire neuroradiology section in a staged approach. Nine months following structured reporting implementation, a follow-up 27 question survey was sent to the same group of providers. Keyword search of radiology reports was used to assess usage of Brain Tumor Reporting and Data System over time.ResultsFifty-three brain tumor care providers responded to the initial survey and 38 to the follow-up survey. After implementing BT-RADS, respondents reported improved attitudes across multiple areas including: report consistency (4.3 vs. 3.4; p < 0.001), report ambiguity (4.2 vs. 3.2, p < 0.001), radiologist/physician communication (4.5 vs. 3.8; p < 0.001), facilitation of patient management (4.2 vs. 3.6; p = 0.003), and confidence in reports (4.3 vs. 3.5; p < 0.001). Providers were more satisfied with the BT-RADS structured reporting system (4.3 vs. 3.7; p = 0.04). Use of the reporting template progressively increased with 81% of brain tumor reports dictated using the new template by 9 months.ConclusionImplementing a structured template for brain tumor imaging improves perception of radiology reports among radiologists and referring providers involved in the care of brain tumor patients.
  • Reliability of MRI-Derived Depth of Invasion of Oral Tongue Cancer
    • Abstract: Publication date: July 2019Source: Academic Radiology, Volume 26, Issue 7Author(s): Ryuji Murakami, Shinya Shiraishi, Ryoji Yoshida, Junki Sakata, Keisuke Yamana, Akiyuki Hirosue, Yoshikazu Uchiyama, Hideki Nakayama, Yasuyuki YamashitaRationale and ObjectiveTo evaluate the inter-rater reliability of the magnetic resonance imaging (MRI)-derived depth of invasion (
      DOI ) and the agreement between MRI and pathological measurements of oral tongue cancer.Materials and MethodsThe institutional review board approved this retrospective study. The study population consisted of 29 patients with clinical T2N0 oral tongue cancer treated by surgery. Routine pretreatment MRI was performed on a 3T superconducting imager. Two raters with 23 and 18 years of head-and-neck MRI experience, respectively, independently chosen MRI sequences for each patient, then delineate the tumor, and then used three protocols to measure the MRI-derived
      DOI : the axial reconstructed thickness (method 1), the axial invasive portion (method 2), and the coronal invasive portion (method 3). Then they consensually selected the optimal among the three methods for each patient; it was designated method 4. The Bland-Altman plots, intraclass correlation coefficients (ICCs), and the paired samples test were used. According to the median follow-up of 41 months, the relationship between the MRI-derived
      DOI and nodal recurrence was also investigated.ResultsThe inter-rater reliability of methods 2 and 4 was excellent (ICC of 0.829 and 0.807, respectively). The correlation between MRI and pathological measurements was good for method 4 (ICC of 0.611), however, all measurements recorded on MRI were 2–3 mm larger than on pathology. No patients whose MRI-derived
      DOI was less than 5 mm suffered nodal recurrence.ConclusionThe MRI-derived
      DOI was valuable for the preoperative staging. The optimal measurement method should be selected on a case-by-case basis.
  • Influence of Monoenergetic Images at Different Energy Levels in
           Dual-Energy Spectral CT on the Accuracy of Computer-Aided Detection for
           Pulmonary Embolism
    • Abstract: Publication date: July 2019Source: Academic Radiology, Volume 26, Issue 7Author(s): Guangming Ma, Yuequn Dou, Shan Dang, Nan Yu, Yanbing Guo, Chuangbo Yang, Shuanhong Lu, Dong Han, Chenwang JinPurposeTo investigate the influence of monoenergetic images of different energy levels in spectral computed tomography (CT) on the accuracy of computer aided detection (CAD) for pulmonary embolism (PE).Materials and MethodsCT images of 20 PE patients who underwent spectral CT pulmonary angiography were retrospectively analyzed. Nine sets of monochromatic images from 40 to 80 keV at 5 keV interval were reconstructed and then independently analyzed for detecting PE using a commercially available CAD software. Two experienced radiologists reviewed all images and recorded the number of emboli manually, which was used as the reference standard. The CAD findings for the number of PE at different energies were compared with the reference standard to determine the number of true positives and false positives with CAD and to calculate the sensitivity and false positive rate at different energies.ResultThere were 120 true emboli. The total numbers of CAD-detected PE at 40–80 keV were 48, 67, 63, 87, 106, 115, 138, 157, and 226. Images at low energies had low sensitivities and low false positive rates; images at high energies had high sensitivities and high false positive rates. At 60 keV and 65 keV, CAD achieved sensitivity at 81.67% and 84.17%, respectively and false positive rate at 7.55% and 12.17%, respectively to provide the optimum combination of high sensitivity and low false positive rate.ConclusionMonochromatic images of different energies in dual-energy spectral CT affect the accuracy of CAD for PE. The combination of CAD with images at 60–65 keV provides the optimum combination of high sensitivity and low false positive rate in detecting PE.
  • The Association Between Bronchial Wall CT Attenuation and Spirometry in
           Patients with Bronchial Asthma
    • Abstract: Publication date: July 2019Source: Academic Radiology, Volume 26, Issue 7Author(s): Shoichiro Matsushita, Tsuneo Yamashiro, Shin Matsuoka, Kunihiro Yagihashi, Yasuo NakajimaRationale and ObjectiveThe purpose of this study was to evaluate the correlation between generation-based bronchial wall attenuation on thin-section computed tomography (CT) scans and airflow limitation in patients with bronchial asthma.Materials and MethodsThis study included 28 bronchial asthma patients (13 men, 15 women; age range, 23–89 years) who underwent both chest CT and spirometry. On CT, the mean values of peak wall attenuation, wall area percentage, and luminal area were measured in the segmental, subsegmental, and sub-subsegmental bronchi of the right B1 and B10 bronchi. Correlations of the CT measurements with forced expiratory volume in 1 second/forced vital capacity (FEV1/FVC), percent predicted forced expiratory flow at 25%–75% of the FVC (%pred forced expiratory flow25–75), and percent predicted peak flow rate were evaluated with Spearman's rank correlation test.ResultsThe peak wall attenuation of each generation of segmental bronchi significantly correlated with the forced expiratory volume in 1 second/FVC (B1 segmental, ρ = −0.683, p < 0.0001; B1 subsegmental, ρ = −0.875, p < 0.0001; B1 sub-subsegmental, ρ = −0.926, p < 0.0001; B10 segmental, ρ = −0.811, p < 0.0001; B10 subsegmental, ρ = −0.903, p < 0.0001; B10 sub-subsegmental ρ = −0.950, p < 0.0001). Similar correlations were found between the peak wall attenuation and %pred forced expiratory flow 25–75 or percent predicted peak flow rate. Overall, the correlation coefficients were relatively high in the more peripheral bronchial generations. In all measurements, the coefficients of the peak wall attenuations were higher than those of the wall area percentage and luminal area.ConclusionPeak attenuation of the bronchial wall, particularly in the peripheral bronchi, measured on CT is a good biomarker for the severity of bronchial asthma.
  • A Comparison of Two Hyperpolarized 129Xe MRI Ventilation Quantification
           Pipelines: The Effect of Signal to Noise Ratio
    • Abstract: Publication date: July 2019Source: Academic Radiology, Volume 26, Issue 7Author(s): Mu He, Wei Zha, Fei Tan, Leith Rankine, Sean Fain, Bastiaan DriehuysRationaleHyperpolarized 129Xe MRI enables quantitative evaluation of regional ventilation. To this end, multiple classifiers have been proposed to determine ventilation defect percentage (VDP) as well as other cluster populations. However, consensus has not yet been reached regarding which of these methods to deploy for multicenter clinical trials. Here, we compare two published classification techniques–linear-binning and adaptive K-means–to establish their limits of agreement and their robustness against reduced signal-to-noise ratio (SNR).MethodsA total of 29 subjects (age: 38.4 ± 19.0 years) were retrospectively identified for inter-method comparison. For each 129Xe ventilation image, 7 images with reduced SNR were generated with equal decrements relative to the native SNR. All 8 sets of images were then analyzed using both methods independently to classify all lung voxels into four clusters: VDP, low-, medium-, and high-ventilation-percentage (LVP, MVP and HVP). For each cluster, the percentage of the lung it comprised was compared between the two methods, as well as how these values persisted as SNR was degraded.ResultsThe limits of agreement for calculating VDP were [+0.2%, +4.0%] with a +1.5% bias for binning relative to K-means. However, the inter-method agreement for the other clusters was moderate, with biases of −5.7%, 8.1%, and −4.0% for LVP, MVP, and HVP, respectively. As SNR decreased below ∼4, both methods began reporting values that deviated substantially from the native image. By requiring VDP to remain within ≤1.8% of that calculated from the native image, the minimum tolerable SNR values were 2.4 ± 1.0 for the linear-binning, and 3.5 ± 1.5 for the K-means.ConclusionsBoth methods agree well in quantifying VDP, but agreement for LVP and MVP remains variable. We suggest a required SNR threshold be two standard deviations above the minimum value of 3.5 ± 1.5 for robust determination of VDP, suggesting a minimum SNR of 6.6. However, robust quantification of the ventilated clusters required an SNR of 13.4.
  • Discrimination of Pulmonary Nodule Volume Change for Low- and
           High-contrast Tasks in a Phantom CT Study with Low-dose Protocols
    • Abstract: Publication date: July 2019Source: Academic Radiology, Volume 26, Issue 7Author(s): Marios A. Gavrielides, Qin Li, Rongping Zeng, Benjamin Paul Berman, Berkman Sahiner, Qi Gong, Kyle J. Myers, Gino DeFilippo, Nicholas PetrickRationale and ObjectivesThe quantitative assessment of volumetric CT for discriminating small changes in nodule size has been under-examined. This phantom study examined the effect of imaging protocol, nodule size, and measurement method on volume-based change discrimination across low and high object to background contrast tasks.Materials and MethodsEight spherical objects ranging in diameter from 5.0 mm to 5.75 mm and 8.0 mm to 8.75 mm with 0.25 mm increments were scanned within an anthropomorphic phantom with either foam-background (high-contrast task, ∼1000 HU object to background difference)) or gelatin-background (low-contrast task, ∼50 to 100 HU difference). Ten repeat acquisitions were collected for each protocol with varying exposures, reconstructed slice thicknesses and reconstruction kernels. Volume measurements were obtained using a matched-filter approach (MF) and a publicly available 3D segmentation-based tool (SB). Discrimination of nodule sizes was assessed using the area under the ROC curve (AUC).ResultsUsing a low-dose (1.3 mGy), thin-slice (≤1.5 mm) protocol, changes of 0.25 mm in diameter were detected with AU = 1.0 for all baseline sizes for the high-contrast task regardless of measurement method. For the more challenging low-contrast task and same protocol, MF detected changes of 0.25 mm from baseline sizes ≥5.25 mm and volume changes ≥9.4% with AUC≥0.81 whereas corresponding results for SB were poor (AUC within 0.49-0.60). Performance for SB was improved, but still inconsistent, when exposure was increased to 4.4 mGy.ConclusionThe reliable discrimination of small changes in pulmonary nodule size with low-dose, thin-slice CT protocols suitable for lung cancer screening was dependent on the inter-related effects of nodule to background contrast and measurement method.
  • Relationship Between Tube Voltage and Physical Image Quality of Pulmonary
           Nodules on Chest Radiographs Obtained Using the Bone-Suppression Technique
    • Abstract: Publication date: July 2019Source: Academic Radiology, Volume 26, Issue 7Author(s): Satoshi Takagi, Tatsuya Yaegashi, Masayori IshikawaRationale and ObjectivesImage quality of chest radiographs is affected by tube voltage. This study aimed to clarify the relationship between tube voltage and physical image quality of pulmonary nodules on bone-suppressed chest radiographs.Materials and MethodsAn anthropomorphic chest phantom and a spherical simulated nodule, with a 12-mm diameter and approximately +100 Hounsfield units were used. The lung field of the phantom was divided into three areas, based on the overlap with the ribs in the chest radiograph. Ten positions of the simulated nodule were defined in each area. One hundred and twenty chest radiographs were acquired using four tube voltages (70 kVp, 90 kVp, 110 kVp, and 130 kVp) for a total of 30 nodule positions and were processed to create bone-suppressed images. Differences in contrast and contrast-to-noise ratio (CNR) were analyzed for all pairs of the four tube voltages using a two-sided Wilcoxon signed-rank test.ResultsIn the area not overlapping with ribs, a statistically significant difference was observed only in contrast between tube voltage of 70 kVp and 90 kVp (p = 0.01). In the area overlapping with one or two ribs, the contrast and CNR tended to be higher at a lower tube voltage. In particular, the p values between the contrast at 70 kVp and that at the other three tube voltage settings were less than 0.01.ConclusionFor a relatively dense nodule, the contrast and CNR in the bone-suppressed chest radiograph were significantly improved with lower tube voltage in the lung field overlapping with the ribs.
  • Evaluation of Simulated Lesions as Surrogates to Clinical Lesions for
           Thoracic CT Volumetry: The Results of an International Challenge
    • Abstract: Publication date: July 2019Source: Academic Radiology, Volume 26, Issue 7Author(s): Marthony Robins, Jayashree Kalpathy-Cramer, Nancy A. Obuchowski, Andrew Buckler, Maria Athelogou, Rudresh Jarecha, Nicholas Petrick, Aria Pezeshk, Berkman Sahiner, Ehsan SameiRationale and ObjectivesTo evaluate a new approach to establish compliance of segmentation tools with the computed tomography volumetry profile of the Quantitative Imaging Biomarker Alliance (QIBA); and determine the statistical exchangeability between real and simulated lesions through an international challenge.Materials and MethodsThe study used an anthropomorphic phantom with 16 embedded physical lesions and 30 patient cases from the Reference Image Database to Evaluate Therapy Response with pathologically confirmed malignancies. Hybrid datasets were generated by virtually inserting simulated lesions corresponding to physical lesions into the phantom datasets using one projection-domain-based method (Method 1), two image-domain insertion methods (Methods 2 and 3), and simulated lesions corresponding to real lesions into the Reference Image Database to Evaluate Therapy Response dataset (using Method 2). The volumes of the real and simulated lesions were compared based on bias (measured mean volume differences between physical and virtually inserted lesions in phantoms as quantified by segmentation algorithms), repeatability, reproducibility, equivalence (phantom phase), and overall QIBA compliance (phantom and clinical phase).ResultsFor phantom phase, three of eight groups were fully QIBA compliant, and one was marginally compliant. For compliant groups, the estimated biases were −1.8 ± 1.4%, −2.5 ± 1.1%, −3 ± 1%, −1.8 ± 1.5% (±95% confidence interval). No virtual insertion method showed statistical equivalence to physical insertion in bias equivalence testing using Schuirmann's two one-sided test (±5% equivalence margin). Differences in repeatability and reproducibility across physical and simulated lesions were largely comparable (0.1%–16% and 7%–18% differences, respectively). For clinical phase, 7 of 16 groups were QIBA compliant.ConclusionHybrid datasets yielded conclusions similar to real computed tomography datasets where phantom QIBA compliant was also compliant for hybrid datasets. Some groups deemed compliant for simulated methods, not for physical lesion measurements. The magnitude of this difference was small (
  • Low Iodine Contrast Injection for CT Acquisition Prior to Transcatheter
           Aortic Valve Replacement: Aorta Assessment and Screening for Coronary
           Artery Disease
    • Abstract: Publication date: July 2019Source: Academic Radiology, Volume 26, Issue 7Author(s): Anne-Lise Hachulla, Stéphane Noble, Maxime Ronot, Gabriel Guglielmi, Thomas de Perrot, Xavier Montet, Jean-Paul ValléeRationale and ObjectivesTo assess both the complete aorta and coronary artery disease (CAD) using low iodine contrast computed-tomography angiography before transcatheter aortic valve replacement.Materials and Methods84 patients underwent computed-tomography angiography before transcatheter aortic valve replacement: 42 with standard iodine injection protocol (P1:120 mL); 42 with a low dose iodine injection protocol (P2:60 mL). Mean attenuation and subjective image quality were rated at different levels of the aorta, iliac and coronary arteries. Sensitivity, specificity, negative and positive predictive values for depiction of CAD were calculated according to the coronary angiography.ResultsMean attenuation was significantly higher in P1 for the ascending aorta (p < 0.001). No significant difference was observed regarding image quality of the aortic valve (p = 0.876), the ascending aorta (p = 0.306), or the abdominal aorta (p = 1.0). Diagnostic image quality of coronary arteries was excellent for P1 and P2 (94.6% vs 96.5%, p = 0.08). Sensitivity, specificity, negative and positive predictive values, and accuracy for depiction of CAD were excellent for P1 and P2 (100% vs 100%; 79% vs 86%, 70% vs 87%, 100% vs 100% and 86% vs 93%) without significant differences (p = 0.93; p = 0.58; p = 0.90; p = 1.0; p = 0.74), respectively.ConclusionDespite a difference in aortic mean attenuation, a reduced iodine injection protocol showed similar image quality and detection of CAD in comparison with a standard injection protocol.
  • Prevalence and Types of Aortic Arch Variants and Anomalies in Congenital
           Heart Diseases
    • Abstract: Publication date: July 2019Source: Academic Radiology, Volume 26, Issue 7Author(s): Ahmed M. Tawfik, Donia M. Sobh, Germeen A. Ashamallah, Nihal M. BatoutyRationale and ObjectivesAortic arch (AA) variants and anomalies are important to recognize in patients with congenital heart disease (CHD) before surgery or intervention. The aim was to study the prevalence of AA anomalies and variants in patients with CHD compared to a control group. The secondary outcome was to report the associations between common variations of AA and specific types of CHD.Materials and MethodsAfter institutional review board approval, computed tomography studies of 352 CHD patients and control group of 400 consecutive computed tomography scans of the thorax were evaluated. The AA was assigned to one of seven common types, and their distribution was compared between CHD and control. The distribution of the AA anomalies and variants was evaluated as regard specific types of CHD and the visceroatrial situs.ResultsNormal three-vessel branching pattern was the commonest in both groups, but was present in only 50.5% in the CHD compared to 68.5% in the control group, p < 0.00001. Right AA and aberrant right subclavian artery were significantly more common in CHD than control group (18.1% versus 0.25%, p < 0.00001) and (4.5% versus 0.25%, p = 0.0001), respectively. Direct aortic origin of left vertebral artery was insignificantly more common in CHD group (4.2% versus 2.7%, p = 0.258). Brachiobicephalic trunk was significantly more common in control than CHD group (27.7% versus 19.3%, p = 0.007).ConclusionNormal three-vessel AA was significantly less common in CHD. AA anomalies (right arch and aberrant right subclavian) were more common in CHD than control, while AA variants (brachiobicephalic trunk and direct aortic origin of left vertebral artery) were not.
  • Ultrafast Dynamic Contrast-Enhanced Breast MRI: Kinetic Curve Assessment
           Using Empirical Mathematical Model Validated with Histological Microvessel
    • Abstract: Publication date: July 2019Source: Academic Radiology, Volume 26, Issue 7Author(s): Naoko Mori, Hiroyuki Abe, Shunji Mugikura, Chiaki Takasawa, Satoko Sato, Minoru Miyashita, Yu Mori, Federico D. Pineda, Gregory S. Karczmar, Hajime Tamura, Shoki Takahashi, Kei TakaseRationale and ObjectivesTo evaluate whether parameters from empirical mathematical model (EMM) for ultrafast dynamic contrast-enhanced (DCE) magnetic resonance imaging (MRI) correlate with histological microvessel density (MVD) in invasive breast cancer.Materials and MethodsNinety-eight consecutive patients with invasive breast cancer underwent an institutional review board-approved ultrafast DCE-MRI including a pre- and 18 postcontrast whole breast ultrafast scans (3 seconds) followed by four standard scans (60 seconds) using a 3T system. Region of interest was placed within each lesion where the highest signal increase was observed on ultrafast DCE-MRI, and the increase rate of enhancement was calculated as follows: ΔS = (SIpost − SIpre)/SIpre. The kinetic curve obtained from ultrafast DCE-MRI was analyzed using a truncated EMM: ΔS(t) = A(1 − e−αt), where A is the upper limit of the signal intensity, α (min−1) is the rate of signal increase. The initial slope of the kinetic curve is given by Aα. Initial area under curve (AUC30) and time of initial enhancement was calculated. From the standard DCE-MRI, the initial enhancement rate (IER) and the signal enhancement ratio (SER) were calculated as follows: IER = (SIearly − SIpre)/SIpre, SER = (SIearly − SIpre)/(SIdelayed − SIpre). The parameters were compared to MVD obtained from surgical specimens.ResultsA, α, Aα, AUC30, and time of initial enhancement significantly correlated with MVD (r = 0.29, 0.40, 0.51, 0.43, and −0.32 with p = 0.0027, p < 0.0001, p < 0.0001, p < 0.0001, and p = 0.0012, respectively), whereas IER and SER from standard DCE-MRI did not.ConclusionThe parameters of the EMM, especially the initial slope or Aα, for ultrafast DCE-MRI correlated with MVD in invasive breast cancer.
  • Complicated Cysts: Should Management Depend Upon Age'
    • Abstract: Publication date: July 2019Source: Academic Radiology, Volume 26, Issue 7Author(s): Dana Ataya, Bethany L. Niell
  • Correlation Between Intravoxel Incoherent Motion and Dynamic
           Contrast-Enhanced Magnetic Resonance Imaging Parameters in Rectal Cancer
    • Abstract: Publication date: July 2019Source: Academic Radiology, Volume 26, Issue 7Author(s): Hongliang Sun, Yanyan Xu, Qiaoyu Xu, Jianghui Duan, Haibo Zhang, Tongxi Liu, Lu Li, Queenie Chan, Sheng Xie, Wu WangRationale and ObjectivesThis study aimed to determine the correlation between intravoxel incoherent motion (IVIM) and multiphase dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) quantitative parameters in patients with rectal cancer.Materials and MethodsNinety-seven patients with rectal cancer were included in this study. All pelvic MRI examinations were performed in a 3.0 T MR unit, including diffusion-weighted imaging with 16 b values, DCE-MRI with two different flip angles (5° and 10°, respectively), and T1-fast field echo sequences as the reference. The IVIM perfusion-related parameters (f, perfusion fraction; D*, pseudo-diffusion coefficient; f·D*, the multiplication of the two parameters) were calculated by biexponential analysis. Quantitative DCE-MRI parameters were transfer constant (Ktrans) between blood plasma and extravascular extracellular space), Kep (rate between extravascular extracellular space and blood plasma), Ve (extravascular volume fraction), Vp (plasma volume fraction), and area under the gadolinium concentration curve. Interobserver agreements were evaluated using the intraclass correlation coefficient and Bland–Altman analysis. A p value
  • Radiologic and Pathologic Features Associated With Upgrade of Atypical
           Ductal Hyperplasia at Surgical Excision
    • Abstract: Publication date: July 2019Source: Academic Radiology, Volume 26, Issue 7Author(s): Kristin E. Williams, Amanda Amin, Jacqueline Hill, Carissa Walter, Marc Inciardi, Jason Gatewood, Mark Redick, Jo Wick, Suzanne Hunt, Onalisa WinbladRationale and ObjectivesTo evaluate radiologic and pathologic features associated with upgrade of atypical ductal hyperplasia (ADH) to ductal carcinoma in situ or invasive breast cancer at surgical excision, in order to identify patients who may consider alternatives to excision.Materials and MethodsThis retrospective analysis examined patients who underwent surgical excision of biopsy-proven ADH at our institution. Imaging and pathology from biopsy were reviewed to determine radiologic (lesion size, radiologic abnormality, biopsy type, needle gauge, number of cores, percent of lesion removed) and pathologic features (histologic calcifications, presence of necrosis, micropapillary features, extent of ADH) associated with ADH upgrade.ResultsOne hundred twenty four cases of percutaneous biopsy-proven ADH with subsequent excision were included. The overall upgrade rate was 17.7% (n = 22), with 17 cases to ductal carcinoma in situ and five to invasive cancer. Radiologic features associated with a lower upgrade rate were smaller lesion size (p = 0.032) and larger percent of lesion removed at biopsy (p = 0.047). Larger needle gauge at biopsy (p = 0.070), absence of necrosis (p = 0.051) and focal ADH (
  • Robustness of Textural Features to Predict Stone Fragility Across Computed
           Tomography Acquisition and Reconstruction Parameters
    • Abstract: Publication date: July 2019Source: Academic Radiology, Volume 26, Issue 7Author(s): Taylor Moen, Andrea Ferrero, Cynthia McColloughRationale and ObjectivesPrevious studies have demonstrated that quantitative relationships exist between stone fragility at lithotripsy and morphological features extracted from computed tomography (CT) scans. The goal of this study was to determine if variations in scanner model, patient size, radiation dose, or reconstruction parameters impact the accuracy of the prediction of renal stone fragility in an in vitro model.Materials and MethodsSixty-seven kidney stones were scanned using routine single and dual energy stone protocols, mimicking average, and large patient habitus. Low dose scans were also performed. Each scan was reconstructed with routine protocol parameters, and with thinner (0.6 mm) or thicker (3 mm) images, two different reconstruction kernels, and iterative reconstruction at two strengths. Fragility of each stone was measured in a controlled ex vivo experiment. A single predictive model was developed from a reference CT protocol configuration and applied to data from each CT acquisition and reconstruction parameter tested to obtain estimated stone comminution times.ResultsNone of the investigated protocols showed a significant variation in the accuracy of stone fragility classification, except for the ones with the most aggressive iterative reconstruction and/or with thicker images. In these protocols, a number of stone fragility assessments changed from fragile to hard (or vice versa), compared to their ground truth measurement.ConclusionPrediction accuracy of stone fragility models developed from CT data is robust to expected variations in CT stone protocols used for quantification tasks. This finding facilitates their future adoption to different clinical practices.
  • Invited Commentary on “Spectral CT Imaging in the Differential Diagnosis
           of Small Bowel Adenocarcinoma From Primary Small Intestinal Lymphoma”
    • Abstract: Publication date: July 2019Source: Academic Radiology, Volume 26, Issue 7Author(s): Vincent M. Mellnick
  • Spectral CT Imaging in the Differential Diagnosis of Small Bowel
           Adenocarcinoma From Primary Small Intestinal Lymphoma
    • Abstract: Publication date: July 2019Source: Academic Radiology, Volume 26, Issue 7Author(s): Chuang-bo Yang, Nan Yu, Yong-jun Jian, Yong Yu, Hai-feng Duan, Xi-rong Zhang, Guang-ming Ma, Youmin Guo, Xiaoyi DuanPurposeTo investigate the value of dual-energy spectral computed tomography (CT) imaging in the differential diagnosis of small bowel adenocarcinoma (SBA) from primary small intestinal lymphoma (PSIL).Materials and MethodsWe retrospectively analyzed the images of 27 SBA cases and 15 PSIL cases. These patients underwent spectral CT imaging in the arterial phase (AP) and venous phase (VP). CT attenuation values of tumors at different energy levels were measured to generate spectral attenuation curve and to calculate curve slope (λHU). Iodine concentration (IC) in tumors at AP and VP were measured and normalized to that of aorta as normalized iodine concentration (NIC). Independent samples t test was used to analyze the spectral CT parameters; Receiver operating characteristic curves were generated to evaluate the diagnostic efficacy of each parameter.ResultsThere were significant differences between SBA and PSIL in IC (2.09 ± 0.71 vs 1.33 ± 0.15 mg/ml), NIC (0.20 ± 0.06 vs 0.13 ± 0.02) and slope (λHU) (2.78 ± 1.06 vs 1.86 ± 0.30) in AP and (1.86 ± 0.68 vs 1.37 ± 0.18 mg/ml for IC; 0.47 ± 0.13 vs 0.33 ± 0.02 for NIC and 2.00 ± 0.56 vs 1.50 ± 0.26 for λHU) in VP (all p < 0.05). For the CT value measurement, there were significant differences between SBA and PSIL in the 40–60keV energy range (p < 0.05), but not in the 70–140keV range (p> 0.05). Using 1.38 mg/ml as a threshold value for iodine concentration at AP, one could obtain the area-under-curve of 0.93 for receiver operating characteristic study and sensitivity of 94% and specificity of 85% for differentiating SBA from PSIL. The sensitivity and specificity values were significantly higher than the respective values of 62% and 60% with the conventional CT numbers at 70keV.ConclusionQuantitative parameters obtained in spectral CT, especially iodine concentration in AP, provide high accuracy for differentiating SBA from PSIL.
  • Iodine density Changes in Hepatic and Splenic Parenchyma in Liver
           Cirrhosis with Dual Energy CT (DECT): A Preliminary Study
    • Abstract: Publication date: July 2019Source: Academic Radiology, Volume 26, Issue 7Author(s): Jian Dong, Fuliang He, Lei Wang, Zhendong Yue, Tingguo Wen, Rengui Wang, Fuquan LiuPurposeTo investigate the hemodynamic changes in liver cirrhosis by comparing iodine density in hepatic and splenic parenchyma with 8 cm detector dual energy CT (DECT).Materials and MethodsForty-six consecutive patients with liver cirrhosis and 22 healthy volunteers were recruited in this study, and they were all performed contrast enhanced examination with 8 cm detector DECT. All raw data were reconstructed with 1.25 mm slice thickness, Iodine density (in milligrams per milliliter) were measured on iodine-based material decomposition images. Quantitative indices of iodine density (ID), including normalized ID of liver parenchyma for arterial phase (NIDLAP), ID of liver parenchyma for venous phase (IDLVP), ID of splenic parenchyma for arterial phase (IDSAP), ID of splenic parenchyma for venous phase (IDSVP), ID of portal vein in venous phase (IDPVP) and Liver arterial iodine density fraction (AIF) were measured and compared between two groups. The correlation between Child-Pugh grade and other quantitative indices were calculated, with statistical significance as P0.05), (2) higher iodine density of NIDLAP, IDSVP, IDPVP and AIF, and lower NIDSAP (all P
  • Ultrasound-Diagnosed Nonalcoholic Fatty Liver Disease Independently
           Predicts a Higher Risk of Developing Diabetes Mellitus in Nonoverweight
    • Abstract: Publication date: July 2019Source: Academic Radiology, Volume 26, Issue 7Author(s): Liang WangRationale and ObjectivesThis study was aimed to evaluate the independent value of ultrasound-diagnosed nonalcoholic fatty liver disease (us-NAFLD), as a surrogate imaging marker of the pathologic entity of NAFLD, in predicting incident diabetes mellitus (DM) in nonoverweight individuals.Materials and MethodsA total of 10,064 participants who had a body mass index
  • Interview Techniques Utilized in Radiology Resident Selection—A
           Survey of the APDR
    • Abstract: Publication date: July 2019Source: Academic Radiology, Volume 26, Issue 7Author(s): Claudia Kasales, Christine Peterson, Eric GagnonRationale and ObjectivesTo evaluate interview techniques currently used in the selection of diagnostic radiology resident candidates and to identify factors influencing the use of alternative interview techniques.Materials and MethodsAn anonymous 25 question e-mail survey was provided to 319 active members of the Association of Program Directors in Radiology. The survey included questions on residency demographics, organization of resident applicant interviews, types of interview techniques utilized, scoring and ranking of applicants, and facets of the interview/application felt most important to the selection process. Statistical analysis was performed to identify factors associated with the use of alternative interview techniques.Results93.7% of responding programs use traditional interview techniques, with 92% using unblinded, unstructured interviews, 8% blinded, unstructured interviews. Structured interview questions were incorporated in 22%. Few programs used alternative techniques like the multiple mini-interview. None of the programs used written prompts during the interview, 3% used casual visual cognitive testing, 10% used panel interview techniques, and none used formal personality testing. For ranking candidates in the match, the most important facets considered were USMLE Step scores, performance on the interview, clinical course grades, and letters of reference. Factors associated with use of alternative techniques were domains associated with program size and number of faculty.ConclusionThe majority of radiology training programs still rely upon the traditional unblinded interview technique. There is an opportunity for training programs to examine alternative techniques that reduce bias and may provide better insight into other aspects of the candidate that may not be as readily highlighted with the traditional, unblinded interview.
  • Characterization of Iodide-induced Sialadenitis: Meta-analysis of the
           Published Case Reports in the Medical Literature
    • Abstract: Publication date: Available online 7 June 2019Source: Academic RadiologyAuthor(s): Albert Jiao, Khashayar Farsad, David W. McVinnie, Younes Jahangiri, James J. MorrisonPurposeTo evaluate the patient presentation of postcontrast sialadenitis and factors associated with its duration of symptoms through meta-analysis of case reports.BackgroundAcute iodide sialadenitis, or “iodide mumps,” is a rare adverse reaction to iodinated contrast causing salivary gland swelling. The condition may be underdiagnosed, with researchers postulating that its true incidence may be close to 1-2%.Methods and MaterialsThis study was a meta-analysis performed using PRISMA Reporting Standards. A literature search with no language restriction was performed of the Medline database, primarily through PubMed, using keywords: “iodide mumps,” “iodide sialadenitis,” “sialadenitis,” “salivary enlargement,” “contrast reaction,” “parotid swelling,” and “submandibular swelling.” Matching case reports and case series were reviewed, and data regarding the subjects’ demographics, renal function, contrast administration, and symptoms were extracted. Uni- and multivariate linear regression analyses were applied to assess the predicting factors of a prolonged symptoms duration.ResultsSixty-five case reports and case series were identified, with 77 cases of iodide-induced sialadenitis. Two cases were unpublished and from the author's institution. Reported subjects’ median age was 63 years, and 61% (47/77) were males. Median time to onset was 16 hours, and symptoms resolved in a median of 3 days after the initial onset. Twenty-seven subjects (35%, 27/77) were reported to have an impaired renal function at baseline. Administration of nonionic, low osmolarity contrast medium was reported most frequently (53%, 41/77). There was no difference in resolution of symptoms among subjects with impaired versus normal renal function. Symptoms were resolved in all cases over a median of 3 days with no statistically significant difference between those who received therapeutic intervention and those who did not (p = 0.430). Older age and longer time to onset were significantly associated with longer duration of symptoms in both uni- and multivariate linear regression models, and presence of tenderness demonstrated statistical significance associated with longer duration of symptoms in the univariate model.ConclusionPostcontrast sialadenitis is a rare reaction to iodinated contrast media. Older age and a longer time to onset of symptoms are associated with longer duration of symptoms.
  • Gray Matter Structural Network Disruptions in Survivors of Acute
           Lymphoblastic Leukemia with Chemotherapy Treatment
    • Abstract: Publication date: Available online 4 June 2019Source: Academic RadiologyAuthor(s): Longsheng Wang, Liwei Zou, Qi Chen, Lianzi Su, Jiajia Xu, Ru Zhao, Yanqi Shan, Qing Zhang, Zhimin Zhai, Xijun Gong, Hong Zhao, Fangbiao Tao, Suisheng ZhengObjectivesNeuroimaging studies of acute lymphoblastic leukemia (ALL) during chemotherapy treatment have shown alterations in structure, function, and connectivity in several brain regions, suggesting neurobiological impairment that might influence the large-scale brain network. This study aimed to detect the alterations in the topological organization of structural covariance networks of ALL patients.MethodsThis study included 28 ALL patients undergoing chemotherapy and 20 matched healthy controls. We calculated the gray matter volume of 90 brain regions based on an automated anatomical labeling template and applied graph theoretical analysis to compare the topological parameters of the gray matter structural networks between the two groups.ResultsThe results demonstrated that both the ALL and healthy control groups exhibited a small-world topology across the range of densities. Compared to healthy controls, ALL patients had less highly interactive nodes and a reduced degree/betweenness in temporal regions, which may contribute to impaired memory and executive functions in these patients.ConclusionThese results reveal that ALL patients undergoing chemotherapy treatment may have decreased regional connectivity and reduced efficiency of their structural covariance network. This is the first report of anomalous large-scale gray matter structural networks in ALL patients undergoing chemotherapy treatment and provides new insights regarding the neurobiological mechanisms underlying the chemo-brain network.
  • Developing an Education Budget for Radiology Vice Chairs and Leaders: An
           ADVICER Template
    • Abstract: Publication date: Available online 3 June 2019Source: Academic RadiologyAuthor(s): Nancy R. Fefferman, Sheryl G. Jordan, Priscilla J. Slanetz, Desiree E. Morgan, Leonie L. Gordon, Robert D. Suh, Mark E. MullinsRationale and ObjectivesThe Alliance of Directors and Vice Chairs in Education group identified the need to develop an education budget template as resource for our community. Having a framework and working knowledge of budgetary considerations is crucial to those with general oversight and executive managerial responsibility for departmental educational programs.MethodsAn online survey was sent to all the Alliance of Directors and Vice Chairs in Education members. Survey questions included education funding sources, presence of vice chair of finance, expectation of revenue generation, existing education budget, funding decision-makers, education budget formulation and approval, vice chair of education's role in budget, education budget line items, and income statement review.ResultsThe survey response rate was 41/81 (51%). A majority 26/41 (63%) of respondents had an education budget that typically included funding for all medical students, residents, and fellows but only a minority of respondents report they developed 10/22 (45%), approved 6/22 (27%), or regularly reviewed 6/21 (29%) this budget. In sharp contrast was the role of department chairs and administrators, who presumably all participated in this process. To assist in education budget development and review, as well as meet the need to improve participants' financial accounting knowledge as a key tenet of faculty professional development, the authors developed sample budget templates and an income statement primer.ConclusionOur survey results suggested the need for an educational budget framework and financial accounting resources for those in radiology education posts, and resources have been provided.
  • Lipid Fraction Derived From MRI In- and Opposed-Phase Sequence as a Novel
           Biomarker for Predicting Survival Outcome of Glioma
    • Abstract: Publication date: Available online 31 May 2019Source: Academic RadiologyAuthor(s): Pohchoo Seow, Vairavan Narayanan, Ronie J. Romelean, Jeannie Hsiu Ding Wong, Myint Tun Win, Hari Chandran, Karuthan Chinna, Kartini Rahmat, Norlisah RamliRationale and PurposeOur study evaluated the capability of magnetic resonance imaging in- and opposed-phase (IOP) derived lipid fraction as a novel prognostic biomarker of survival outcome in glioma.Materials and MethodsWe analyzed 46 histologically proven glioma (WHO grades II–IV) patients using standard 3T magnetic resonance imaging brain tumor protocol and IOP sequence. Lipid fraction was derived from the IOP sequence signal-loss ratio. The lipid fraction of solid nonenhancing region of glioma was analyzed, using a three-group analysis approach based on volume under surface of receiver-operating characteristics to stratify the prognostic factors into three groups of low, medium, and high lipid fraction. The survival outcome was evaluated, using Kaplan-Meier survival analysis and Cox regression model.ResultsSignificant differences were seen between the three groups (low, medium, and high lipid fraction groups) stratified by the optimal cut-off point for overall survival (OS) (p ≤ 0.01) and time to progression (p ≤ 0.01) for solid nonenhancing region. The group with high lipid fraction had five times higher risk of poor survival and earlier time to progression compared to the low lipid fraction group. The OS plot stratified by lipid fraction also had a strong correlation with OS plot stratified by WHO grade (R = 0.61, p < 0.01), implying association to underlying histopathological changes.ConclusionThe lipid fraction of solid nonenhancing region showed potential for prognostication of glioma. This method will be a useful adjunct in imaging protocol for treatment stratification and as a prognostic tool in glioma patients.
  • An Optimized Test Bolus Contrast Injection Protocol for Consistent
           Coronary Artery Luminal Enhancement for Coronary CT Angiography
    • Abstract: Publication date: Available online 30 May 2019Source: Academic RadiologyAuthor(s): Veit Sandfort, Younhee Choi, Rolf Symons, Marcus Y. Chen, David A. BluemkeObjectivesConsistent levels of coronary artery enhancement are essential for quantitative analysis of coronary artery plaque. We studied three contrast injection protocols for coronary CT angiography (CCTA) and compared mean attenuation level and consistency of vascular contrast enhancement. We hypothesized that test bolus adjusted protocols will have a superior consistency of coronary attenuation compared to a weight-based protocol.Materials and MethodsWe prospectively evaluated a standard test bolus injection protocol (protocol 1, 32 subjects) and an optimized test bolus injection protocol (protocol 2, 59 subjects) in comparison to a body weight-based injection protocol (60 subjects). The test bolus was diluted contrast (20%-30% iopamidol 370 mixed with normal saline); peak aortic attenuation was measured and used to calculate a specific water/contrast mixture for the CCTA. The mean attenuation of the coronary lumen was measured on CCTA. Metrics of optimum arterial enhancement included the percentage of patients within a predetermined range for coronary attenuation (325–500 HU) and optimal timing with maximal ascending aortic attenuation. In addition, interpatient variation in coronary enhancement was quantified as percentage standard deviation of the attenuation.ResultsThe mean attenuation of the coronary arteries was similar in all protocols (362, 364, and 375 HU for the weight-based, test bolus 1 and 2 protocols, respectively). The percentage standard deviations of the weight-based, test bolus 1 and 2 protocols for coronary attenuation were 25.3%, 27.1%, and 10.5%, respectively (p < 0.0001). Test optimized bolus protocol 2 yielded the highest percentage of scans within the preferred coronary attenuation range (88%, p = 0.002). In test bolus protocol 2, the contrast timing was optimal in 73% of cases compared to only 22% of cases in the body mass guided injection protocol (protocol 1, p < 0.0001).ConclusionAn optimized test bolus guided injection protocol resulted in a marked reduction in variation in coronary enhancement for CCTA compared to a body weight-based injection protocol.
  • Shear Wave Elastography (SWE) for the Evaluation of Patients with Plantar
    • Abstract: Publication date: Available online 30 May 2019Source: Academic RadiologyAuthor(s): Matthias Gatz, Ljudmila Bejder, Valentin Quack, Simone Schrading, Timm Dirrichs, Markus Tingart, Christiane Kuhl, Marcel BetschRationale and ObjectivesThe current imaging standard for diagnosing plantar fasciitis is B-Mode ultrasound (B-US). The aim of this study was to determine the diagnostic potential of Shear Wave Elastography (SWE) and the correlation of clinical scores to elastographic parameters.Materials and MethodsDiagnostic case-control study with n = 82 plantar fascia (PF). PF were divided into three subgroups: (1) symptomatic PF (n = 39); (2) control group of unilateral asymptomatic PF (n = 23); (3) bilateral asymptomatic PF (n = 20). Reference standard for positive findings in B-US was a PF thickness greater than 4 mm. For SWE tissue elasticity (Young's modulus kPa; shear wave speed m/s) was measured at Location 1: directly at the calcaneus; Location 2: +1 cm distal of the calcaneus and Location 3: central part of the calcaneus. Sensitivity, specificity, and diagnostic accuracy as well as correlation to American Orthopaedic Foot and Ankle Score (AOFAS) and Food Functional Index (FFI) were determined.ResultsSymptomatic PF are thicker (4.2 mm, n = 39) than asymptomatic (3.0 mm, n = 43) (p < 0.001). Thickness of the PF (n = 82) correlated poorly to clinical scores (p = 0.001): FFI-pain (r = 0.349); FFI-function (r = 0.381); AOFAS (r = −0.387). Cut-off point for positive SWE finding was 51.5 kPa (4.14 m/s). Symptomatic PF (31.9 kPa, 3.26 m/s, n = 39) differ significantly from asymptomatic PF (93.3 kPa, 5.58 m/s, n = 43) with significant differences at L1 between all groups (p < 0.001). Correlation between Young's modulus (n = 82) and clinical scores was strong (p < 0.001): FFI-pain (r = −0.595); FFI-function (r = −0.567); AOFAS (r = 0.623,). B-US: sensitivity (61%), specificity (95%); SWE sensitivity (85%), specificity (83%). The combination of SWE and B-US increases the sensitivity (100%) with a diagnostic accuracy of 90%.ConclusionBased on our results, we could show that SWE can improve the diagnostic accuracy in patients with plantar fasciitis compared to B-US.Level of evidenceII
  • The Effect of Transjugular Intrahepatic Portosystemic Shunt Plus Partial
           Splenic Embolization for the Treatment of Patients with Recurrent Variceal
    • Abstract: Publication date: Available online 28 May 2019Source: Academic RadiologyAuthor(s): Yu-Hua Li, Jie-Fang Wu, Hua-Mei Wu, Xi-Nan Wu, Ying Xu, Yue-Meng WanRationale and ObjectivesTransjugular intrahepatic portosystemic shunt (TIPS) and partial splenic embolization (PSE) were two interventional therapies effective for the management of variceal bleeding with cirrhosis. This study aimed to investigate the effect of TIPS plus PSE for the treatment of patients with cirrhosis and recurrent variceal bleeding.Material and MethodsThis is a single-center, nonrandomized and retrospective study that included 32 patients undergoing TIPS alone (the TIPS group) and 16 patients undergoing TIPS plus PSE (the TIPS+PSE group).ResultsThe 5-year cumulative rates of variceal rebleeding (20.0% vs. 37.9%, p = 0.027) and shunt stenosis (35.1% vs. 55.9%, p = 0.036) in the TIPS+PSE group were significantly lower than in the TIPS group, whereas the 5-year cumulative rates of shunt blockage (12.5% vs. 25.8%, p = 0.388), and all-cause mortality (37.5% vs. 69.3%, p = 0.414) were not statistically different between the two groups. The 2-year cumulative rate of remaining free of hepatic encephalopathy was also similar between the two groups (75.0% vs. 81.3%, p = 0.704). Cox-regression analyses showed that group and reduction of portal venous pressure before and after TIPS creation were associated with both variceal rebleeding and shunt stenosis, whereas only reduction of portal venous pressure (hazard ratio 0.648, 95% confidence interval: 0.444-0.946, p = 0.025) was associated with shunt blockage. No severe adverse event was observed in the two groups.ConclusionTIPS+PSE is superior to TIPS alone in control of variceal rebleeding and shunt stenosis. Further prospective studies are warranted to confirm our findings.
  • Bayesian Statistical Model of Item Response Theory in Observer Studies of
    • Abstract: Publication date: Available online 28 May 2019Source: Academic RadiologyAuthor(s): Mizuho Nishio, Thai Akasaka, Ryo Sakamoto, Kaori TogashiRationale and ObjectivesThe purpose of this study was to validate a Bayesian statistical model of item response theory (IRT). IRT was used to evaluate a new modality (temporal subtraction, TS) in observer studies of radiologists, compared with a conventional modality (computed tomography).Materials and MethodsFrom previously published papers, we obtained two datasets of clinical observer studies of radiologists. Those studies used a multi-reader and multi-case paradigm to evaluate radiologists’ detection abilities, primarily to determine if TS could enhance the detectability of bone metastasis or brain infarctions. We applied IRT to these studies’ datasets using Stan software. Before applying IRT, the radiologists’ responses were recorded as binaries for each case (1 = correct, 0 = incorrect). Effect of TS on detectability was evaluated by using our IRT model and calculating the 95% credible interval of the effect.ResultsThe mean, median, and 95% credible interval of the effect of TS were 0.913, 0.885, and 0.243–1.745 for the bone metastasis detection, and 2.524, 2.50, and 1.827–3.310, for the brain infarction detection. For both detection studies, the 95% credible intervals of the effect of TS did not include zero, indicating that TS significantly improved diagnostic ability.ConclusionJudgments based on the present study results were compatible with the two previous studies. Our study results demonstrated that the Bayesian statistical model of IRT could judge a new modality's usefulness.
  • Histological Grade of Meningioma: Prediction by Intravoxel Incoherent
           Motion Histogram Parameters
    • Abstract: Publication date: Available online 28 May 2019Source: Academic RadiologyAuthor(s): Manisha Bohara, Masanori Nakajo, Kiyohisa Kamimura, Tomohide Yoneyama, Yoshihiko Fukukura, Yutaro Kiyao, Hajime Yonezawa, Nayuta Higa, Mari Kirishima, Takashi YoshiuraRationale and ObjectivesTo evaluate the usefulness of intravoxel incoherent motion (IVIM) histogram analysis for differentiating low-grade meningiomas (LGMs) and high-grade meningiomas (HGMs).Materials and MethodsFifty-nine patients with pathologically confirmed meningiomas (45 LGMs and 14 HGMs) underwent IVIM MR imaging. Maps of IVIM parameters (perfusion fraction, f; true diffusion coefficient, D; and pseudo diffusion coefficient, D*), as well as of the apparent diffusion coefficient (ADC), were generated. Histogram analysis was performed using parametric values from all voxels in regions-of-interest manually drawn to encompass the whole tumor. The histogram results of ADC and IVIM parameters were compared using the Mann-Whitney U test. Area under the receiver operating characteristic curve (AUC) values were generated to evaluate how well each parameter could differentiate LGMs from HGMs. Spearman's rank correlation coefficients were used to evaluate correlations between histogram parameters and Ki-67 expression.ResultsCompared to LGM, HGM showed significantly higher standard deviation (SD), variance, and coefficient of variation (CV) of ADC (p< 0.006–0.028; AUC, 0.693–0.748), D (p< 0.004–0.032; AUC, 0.670–0.752), and significantly higher CV of f (p< 0.005–0.024; AUC = 0.737). Means and percentiles of ADC and IVIM parameters did not differ significantly between LGM and HGM. Significant positive correlations were identified between Ki-67 and histogram parameters of ADC (SD, variance, kurtosis, skewness, and CV) and D (SD, variance, kurtosis, and CV), whereas no significant correlation with Ki-67 was shown for mean or percentiles of ADC and IVIM parameters.ConclusionHeterogeneity histogram parameters of ADC, D, and f may be useful for differentiating LGMs from HGMs.
  • Automated Identification of Optimal Portal Venous Phase Timing with
           Convolutional Neural Networks
    • Abstract: Publication date: Available online 28 May 2019Source: Academic RadiologyAuthor(s): Jingchen Ma, Laurent Dercle, Philip Lichtenstein, Deling Wang, Aiping Chen, Jianguo Zhu, Hubert Piessevaux, Jun Zhao, Lawrence H. Schwartz, Lin Lu, Binsheng ZhaoObjectivesTo develop a deep learning-based algorithm to automatically identify optimal portal venous phase timing (PVP-timing) so that image analysis techniques can be accurately performed on post contrast studies.Methods681 CT-scans (training: 479 CT-scans; validation: 202 CT-scans) from a multicenter clinical trial in patients with liver metastases from colorectal cancer were retrospectively analyzed for algorithm development and validation. An additional external validation was performed on a cohort of 228 CT-scans from gastroenteropancreatic neuroendocrine cancer patients. Image acquisition was performed according to each centers’ standard CT protocol for single portal venous phase, portal venous acquisition. The reference gold standard for the classification of PVP-timing as either optimal or nonoptimal was based on experienced radiologists' consensus opinion. The algorithm performed automated localization (on axial slices) of the portal vein and aorta upon which a novel dual input Convolutional Neural Network calculated a probability of the optimal PVP-timing.ResultsThe algorithm automatically computed a PVP-timing score in 3 seconds and reached area under the curve of 0.837 (95% CI: 0.765, 0.890) in validation set and 0.844 (95% CI: 0.786, 0.889) in external validation set.ConclusionA fully automated, deep-learning derived PVP-timing algorithm was developed to classify scans’ contrast-enhancement timing and identify scans with optimal PVP-timing. The rapid identification of such scans will aid in the analysis of quantitative (radiomics) features used to characterize tumors and changes in enhancement with treatment in a multitude of settings including quantitative response criteria such as Choi and MASS which rely on reproducible measurement of enhancement.
  • Practical Wisdom and the Program Coordinator
    • Abstract: Publication date: Available online 27 May 2019Source: Academic RadiologyAuthor(s): Richard B. Gunderman
  • Grading of Clear Cell Renal Cell Carcinomas by Using Machine Learning
           Based on Artificial Neural Networks and Radiomic Signatures Extracted From
           Multidetector Computed Tomography Images
    • Abstract: Publication date: Available online 27 May 2019Source: Academic RadiologyAuthor(s): Xiaopeng He, Yi Wei, Hanmei Zhang, Tong Zhang, Fang Yuan, Zixing Huang, Fugang Han, Bin SongRationale and ObjectivesTo evaluate the ability of artificial neural networks (ANN) fed with radiomic signatures (RSs) extracted from multidetector computed tomography images in differentiating the histopathological grades of clear cell renal cell carcinomas (ccRCCs).Materials and MethodsThe multidetector computed tomography images of 227 ccRCCs were retrospectively analyzed. For each ccRCC, 14 conventional image features (CIFs) were extracted manually by two radiologists, and 556 texture features (TFs) were extracted by a free software application, MaZda (version 4.6). The high-dimensional dataset of these RSs was reduced using the least absolute shrinkage and selection operator. Five minimum mean squared error models (minMSEMs) for predicting the ccRCC histopathological grades were constructed from the CIFs, the TFs of the corticomedullary phase images (CMP), and the TFs of the parenchyma phase (PP) images and their combinations, respectively abbreviated as CIF-minMSEM, CMP-minMSEM, PP-minMSEM, CIF+CMP-minMSEM, and CIF+PP-minMSEM. The RSs of each model were fed 30 times consecutively into an ANN for machine learning, and the predictive accuracy of each time ML was recorded for the statistical analysis.ResultsThe five predictive models were constructed from 12, 19, and 10 features selected from the CIFs, the TFs of the CMP images, and that of PP images, respectively. On the basis of their accuracy across the whole cohort, the five models were ranked as follows: CIF+CMP-minMSEM (accuracy: 94.06% ± 1.14%), CIF + PP-minMSEM (accuracy: 93.32% ± 1.23%), CIF-minMSEM (accuracy: 92.26% ± 1.65%), CMP-minMSEM (accuracy: 91.76% ± 1.74%), and PP-minMSEM (accuracy: 90.89% ± 1.47%).ConclusionMachine learning based on ANN helped establish an optimal predictive model, and TFs contributed to the development of high accuracy predictive models. The CIF+CMP-minMSEM showed the greatest accuracy for differentiating low- and high-grade ccRCCs.
  • Teleradiology and Artificial Intelligence – Birds of the Same
    • Abstract: Publication date: Available online 27 May 2019Source: Academic RadiologyAuthor(s): Arjun Kalyanpur
  • Assessing PD-L1 Expression Level by Radiomic Features From PET/CT in
           Nonsmall Cell Lung Cancer Patients: An Initial Result
    • Abstract: Publication date: Available online 27 May 2019Source: Academic RadiologyAuthor(s): Mengmeng Jiang, Dazhen Sun, Yinglong Guo, Yixian Guo, Jie Xiao, Lisheng Wang, Xiuzhong YaoRationale and ObjectivesTo explore the potential value of radiomic features-derived approach in assessing PD-L1 expression status in nonsmall cell lung cancer (NSCLC) patients.Materials and MethodsA cohort of 399 stage I–IV NSCLC patients were enrolled. Tumor segmentation was performed to select essential primary lesions of NSCLC cases after PET/CT images acquisition. Features were extracted, then filtered with automatic relevance determination and minimized with LASSO model based on its relevance of PD-L1 expression status. Finally, we built predictive models with features from the CT, the PET, and the PET/CT images, respectively, for differentiating different status of specific PD-L1 types. Five-fold cross validation was practiced to evaluate the signatures’ accuracy, and the receiver operating characteristic as well as the corresponding area under the curve (AUC) was reckoned for each model.ResultsWith the total of 24 selected features which were significantly associated with PD-L1 expression levels, models based on CT-, PET-, PET/CT-derived features were built and compared. For PD-L1 (SP142) expression level over 1% prediction, models that comprised radiomic features from the CT, the PET, and the PET/CT images resulted in an AUC of 0.97, 0.61, and 0.97, respectively; models for over 50% prediction resulted with AUC of 0.80, 0.65, and 0.77. For PD-L1 (28-8) expression level prediction, predictive models of over 1% expression scored at 0.86, 0.62, and 0.85; and signatures of over 50% expression reached the score of AUCs at 0.91, 0.75, and 0.88, respectively.ConclusionThe radiomic-based predictive approach, especially CT-derived predictive model, may anticipate PD-L1 expression status in NSCLC patients relatively accurate. It may be helpful in guiding immunotherapy in clinical practice and deserves further analysis.
  • Advancing Competency-Based Medical Education Through Assessment and
           Feedback in Breast Imaging
    • Abstract: Publication date: Available online 27 May 2019Source: Academic RadiologyAuthor(s): Anna I. Holbrook, Claudia Kasales
  • Contrast Extravasation using Power Injectors for Contrast-Enhanced
           Computed Tomography in Children: Frequency and Injury Severity
    • Abstract: Publication date: Available online 25 May 2019Source: Academic RadiologyAuthor(s): Christian A. Barrera, Ammie M. White, Ashley M. Shepherd, Patricia Mecca, David M. Biko, David Saul, Hansel J. OteroPurposeTo evaluate the safety of power injectors for contrast-enhanced computed tomography (CT) in children, namely: the prevalence and injury severity of contrast extravasations related to power injectors and the factors associated with these events.MethodsThe need to obtain informed consent was waived for this HIPAA-compliant and IRB approved retrospective study. Around 2429 contrast-enhanced CT performed with a power injector were identified during a 3-year period. Data collected included patient demographic, power injector, and contrast agent information. The patients' symptoms, severity of injury and treatment with contrast extravasation were recorded. Around 1496 cases (823 boys, 673 girls) were included in the analysis. Independent-sample t test and Chi-square were used. For a sub-analysis using the extravasation cases, nonparametric tests were used.ResultsThe mean age was 9.5 ± 6.1 years. The most common access site, catheter site, and contrast agent used were the antecubital fossa, 22 gauge and Iohexol. The mean peak pressure was 68.9 ± 62.3 psi and the flow rate was 1.7 ± 0.9 mL/s. Eighteen cases of contrast extravasation were identified with a mean age of 11.2 ± 6.2 years. There were seven mild, six moderate, and five severe. Cases with extravasation had significantly higher peak pressure (p < 0.001) and flow rate (p < 0.001) compared to those without extravasation. Patients who received Iohexol-350 had significantly more contrast extravasation compared to those who used Iohexol-300 (p = 0.03). However, after post-hoc correction, only peak pressure (p < 0.01) and flow rate (p = 0.01) remained significant.ConclusionThe use of power injectors in children undergoing contrast-enhanced CT is associated with a low rate of extravasation and of long-term injury.
  • Evidence-based Clinical Decision Support Systems for Suspected Pulmonary
           Embolism: Are We Ready to Go'
    • Abstract: Publication date: Available online 22 May 2019Source: Academic RadiologyAuthor(s): Lorenzo Faggioni, Michela Gabelloni, Emanuele Neri, Davide Caramella
  • We Must Invest in Our Future
    • Abstract: Publication date: Available online 22 May 2019Source: Academic RadiologyAuthor(s): Theresa C. McLoud
  • Response to: Accuracy of Breast MRI Compared to MG in the Preoperative
           Detection and Measurement of Pure Ductal Carcinoma In Situ: A
           Methodological Issue
    • Abstract: Publication date: June 2019Source: Academic Radiology, Volume 26, Issue 6Author(s): Heike Preibsch, Gunnar Blumenstock
  • Accuracy of Breast MRI Compared to MG in the Preoperative Detection and
           Measurement of Pure Ductal Carcinoma In Situ: A Methodological Issue
    • Abstract: Publication date: June 2019Source: Academic Radiology, Volume 26, Issue 6Author(s): Soodeh Shahsavari
  • The Resident Travel Dilemma
    • Abstract: Publication date: June 2019Source: Academic Radiology, Volume 26, Issue 6Author(s): Cory M. Pfeifer
  • The Importance of Learning to Listen
    • Abstract: Publication date: June 2019Source: Academic Radiology, Volume 26, Issue 6Author(s): Richard B. Gunderman
  • Automated Test-Item Generation System for Retrieval Practice in Radiology
    • Abstract: Publication date: June 2019Source: Academic Radiology, Volume 26, Issue 6Author(s): Gowthaman Gunabushanam, Caroline R. Taylor, Mahan Mathur, Jamal Bokhari, Leslie M. ScouttObjectiveTo develop and disseminate an automated item generation (AIG) system for retrieval practice (self-testing) in radiology and to obtain trainee feedback on its educational utility.Materials and MethodsAn AIG software program (Radmatic) that is capable of generating large numbers of distinct multiple-choice self-testing items from a given “item-model” was created. Instead of writing multiple individual self-testing items, an educator creates an “item-model” for one of two distinct item styles: true/false knowledge based items and image-based items. The software program then uses the item model to generate self-testing items upon trainee request. This internet-based system was made available to all radiology residents at our institution in conjunction with our didactic conferences. After obtaining institutional review board approval and informed consent, a written survey was conducted to obtain trainee feedback.ResultsTwo faculty members with no computer programming experience were able to create item-models using a standard template. Twenty five of 54 (46%) radiology residents at our institution participated in the study. Twelve of these 25 (48%) study participants reported using the self-testing items regularly, which correlated well with the anonymous website usage statistics. The residents’ overall impression and satisfaction with the self-testing items was quite positive, with a score of 7.89 ± 1.91 (mean ± SD) out of 10. Lack of time and email overload were the main reasons provided by residents for not using self-testing items.ConclusionAIG enabled self-testing is technically feasible, and is perceived positively by radiology residents as useful to their education.
  • Patient-Centered and Specialty-Specific Case Work-Up: An Effective Method
           for Teaching Appropriateness of Imaging to Medical Students
    • Abstract: Publication date: June 2019Source: Academic Radiology, Volume 26, Issue 6Author(s): Mike Sheng, Preya Shah, John M. Choi, Eleanor Gillis, Sharyn I. Katz, Scott A. Simpson, Sean H. Novak, Arun C. NachiappanRationale and ObjectivesOur institution has developed a mini-course program within the diagnostic radiology elective curriculum that promotes active learning, using patient cases specifically tailored to students’ future specialties. The purpose of this study is to evaluate the effectiveness of this mini-course on medical student knowledge of imaging appropriateness and attitude toward radiologist consultation.Materials and MethodsDuring each month-long radiology elective course, students were divided into teams of up to four students based on their specialty interest and assigned recent patient cases with imaging findings relevant to their specialties. The students researched their customized patient cases, integrated pertinent clinical and imaging findings, and presented their findings in a final preceptor-led session. A five-point Likert-type item preprogram and postprogram survey assessing knowledge of imaging appropriateness and attitude toward radiologist consultation was sent to the enrolled medical students.ResultsOut of 36 medical students, 33 (92%) completed the preprogram survey and 31 (86%) completed the postprogram survey. Students reported improved confidence in knowledge of imaging appropriateness, such as indications for intravenous contrast (p < 0.0005) and oral contrast (p < 0.0005). Furthermore, students reported an improved understanding of how to utilize radiologists (p < 0.005) and how to provide pertinent clinical historical information when requesting a radiology exam (p < 0.0005). Students reported that researching the patient's historical and clinical information in conjunction with the radiology images made them more invested in the case.ConclusionAssigning customized patient cases to medical students on diagnostic radiology elective, tailored to their future specialties, is an effective and active way to teach imaging appropriateness and to improve attitudes toward radiologist consultation.
  • Perceptual and Interpretive Error in Diagnostic Radiology—Causes and
           Potential Solutions
    • Abstract: Publication date: June 2019Source: Academic Radiology, Volume 26, Issue 6Author(s): Andrew J. Degnan, Emily H. Ghobadi, Peter Hardy, Elizabeth Krupinski, Elena P. Scali, Lindsay Stratchko, Adam Ulano, Eric Walker, Ashish P. Wasnik, William F. AuffermannInterpretation of increasingly complex imaging studies involves multiple intricate tasks requiring visual evaluation, cognitive processing, and decision-making. At each stage of this process, there are opportunities for error due to human factors including perceptual and ergonomic conditions. Investigation into the root causes of interpretive error in radiology first began over a century ago. In more recent work, there has been increasing recognition of the limits of human image perception and other human factors and greater acknowledgement of the role of the radiologist's environment in increasing the risk of error. This article reviews the state of research on perceptual and interpretive error in radiology. This article focuses on avenues for further error examination, and strategies for mitigating these errors are discussed. The relationship between artificial intelligence and interpretive error is also considered.
  • A Review of Options for Localization of Axillary Lymph Nodes in the
           Treatment of Invasive Breast Cancer
    • Abstract: Publication date: June 2019Source: Academic Radiology, Volume 26, Issue 6Author(s): Ryan W. Woods, Melissa S. Camp, Nicholas J. Durr, Susan C. HarveyInvasive breast cancer is a common disease, and the most common initial site of metastatic disease are the axillary lymph nodes. As the standard of care shifts towards less invasive surgery in the axilla for patients with invasive breast cancer, techniques have been developed for axillary node localization that allow targeted dissection of specific lymph nodes without requiring full axillary lymph node dissection. Many of these techniques have been adapted from technologies developed for localization of lesions within the breast and include marker clip placement with intraoperative ultrasound, carbon-suspension liquids, localization wires, radioactive seeds, magnetic seeds, radar reflectors, and radiofrequency identification devices.The purpose of this article is to summarize these methods and describe benefits and drawbacks of each method for performing localization of lymph nodes in the axilla.
  • Contrast-to-Noise Ratio Optimization in Coronary Computed Tomography
           Angiography: Validation in a Swine Model
    • Abstract: Publication date: June 2019Source: Academic Radiology, Volume 26, Issue 6Author(s): Logan Hubbard, Shant Malkasian, Yixiao Zhao, Pablo Abbona, Sabee MolloiRationale and ObjectivesThe accuracy of coronary computed tomography (CT) angiography depends upon the degree of coronary enhancement as compared to the background noise. Unfortunately, coronary contrast-to-noise ratio (CNR) optimization is difficult on a patient-specific basis. Hence, the objective of this study was to validate a new combined diluted test bolus and CT angiography protocol for improved coronary enhancement and CNR.Materials and MethodsThe combined diluted test bolus and CT angiography protocol was validated in six swine (28.9 ± 2.7 kg). Specifically, the aortic and coronary enhancement and CNR of a standard CT angiography protocol, and a new combined diluted test bolus and CT angiography protocol were compared to a reference retrospective CT angiography protocol. Comparisons for all data were made using box plots, t tests, regression, Bland–Altman, root-mean-square error and deviation, as well as Lin's concordance correlation.ResultsThe combined diluted test bolus and CT angiography protocol was found to improve aortic and coronary enhancement by 26% and 13%, respectively, as compared to the standard CT angiography protocol. More importantly, the combined protocol was found to improve aortic and coronary CNR by 29% and 20%, respectively, as compared to the standard protocol.ConclusionA new combined diluted test bolus and CT angiography protocol was shown to improve coronary enhancement and CNR as compared to an existing standard CT angiography protocol.
  • CT and 18F- FDG-PET-CT Findings in Secondary Adrenal Lymphoma
           with Pathologic Correlation
    • Abstract: Publication date: June 2019Source: Academic Radiology, Volume 26, Issue 6Author(s): Emre Altinmakas, Fehime Eymen Üçışık-Keser, L. Jeffrey Medeiros, Chaan S. NgRationale and ObjectiveTo evaluate computed tomography (CT) and positron emission tomography-computed tomography (PET-CT) imaging manifestations of lymphomas secondarily involving the adrenal gland.Materials and MethodsSeven patients (Five men, two women; median age [range], 66 years [34–75 years]) with pathologically proven adrenal lymphoma were assessed retrospectively. Clinical findings, prior history of lymphoproliferative malignancy, CT (n = 7) and fludeoxyglucose positron emission tomography-computed tomography (18F-FDG-PET-CT) (n = 6) features were analyzed.ResultsSix cases were diffuse large B-cell lymphoma, and one case was peripheral T-cell lymphoma. The longest diameter of the lesions ranged from 3.2 to 6.6 cm (median 4.3 cm). Six lesions were well-defined and one lesion was ill-defined. In five cases, an adreniform shape was preserved. No lesions contained fat, calcification or hemorrhage. Two lesions had necrosis on CT. Median (range) unenhanced CT density of six lesions was 31.8 (29.2–35.2) Hounsfield units. Following administration of IV contrast media (n = 6), three lesions enhanced homogenously whereas three enhanced heterogeneously. The median increase in attenuation was 35.1 Hounsfield units. Two patients had 15-minute delayed CT and they both demonstrated limited wash-out consistent with nonadenoma. Six patients had fludeoxyglucose positron emission tomography-computed tomography(18-F-FDG-PET-CT) and all lesions were fludeoxyglucose (FDG) avid with a median SUVmax of 18.6 (range: 10.3–49.2).ConclusionSecondary adrenal lymphomas usually manifest as, large (>3 cm), well-defined, homogenously or slightly heterogeneously enhancing masses on CT with preserved adreniform shape. These lesions tend to show limited wash-out and high fludeoxyglucose (FDG) uptake.
  • Low-Dose Coronary CT Angiography in Patients with Atrial Fibrillation:
           Comparison of Image Quality and Radiation Exposure with Two Different
    • Abstract: Publication date: June 2019Source: Academic Radiology, Volume 26, Issue 6Author(s): Saima Mushtaq, Gianluca Pontone, Edoardo Conte, Marco Guglielmo, Elisa Consiglio, Marco Magatelli, Margarida Oliveira, Giuseppe Muscogiuri, Andrea Annoni, Andrea Baggiano, Alberto Formenti, Maria Elisabetta Mancini, Luca Di Odoardo, Eleonora Melotti, Cesare Fiorentini, Antonio L. Bartorelli, Mauro Pepi, Daniele AndreiniRationale and ObjectivesTo evaluate image quality, coronary interpretability and radiation exposure of coronary CT angiography (CCTA) performed in patients with atrial fibrillation (AF) with the latest scanner generation, comparing two different technical approaches. A new scanner that combines a 0.23 mm spatial resolution, a new generation of iterative reconstruction, fast gantry rotation time and the intracycle motion-correction algorithm to improve the temporal resolution was recently introduced in the clinical field.Materials and MethodsWe enrolled 105 consecutive patients with chronic AF who performed CCTA with a whole-heart coverage high-definition CT scanner (16-cm z-axis coverage with 256 detector rows, 0.28 s gantry rotation time). Five of them were excluded for impaired renal function. Patients were randomized between a double acquisition protocol (50 patients, group 1) or a single acquisition protocol (50 patients, group 2). The image quality, coronary segment interpretability and effective dose (ED) of CCTA were assessed.ResultsThe mean HR during the scan was 85.6±21 bpm in group 1 vs. 83.7±23 bpm in Group 2, respectively (p 
  • Quantification of Myocardial Enhancement on Cine-MRI: Diagnostic Value in
           Cardiac Amyloidosis
    • Abstract: Publication date: June 2019Source: Academic Radiology, Volume 26, Issue 6Author(s): Clément Cholet, Thibaud Damy, François Legou, Hicham Kobeiter, Alain Rahmouni, Jean-François DeuxRationale and ObjectivesDiagnosis of cardiac amyloidosis (CA) on cardiac magnetic resonance (CMR) can be challenging and quantitative indexes are relevant to further characterize the myocardium. We hypothesize that the relative myocardial enhancement measured from pre and post contrast cine imaging provides diagnostic information for CA in the setting of left ventricular hypertrophy (LVH).Materials and MethodsPatients with LVH referred to our center and control subjects with normal CMR were retrospectively included. Percentage of myocardial enhancement (percentage ME) was obtained from pre and post contrast (5 minutes) cine sequences. Post contrast myocardial T1 and LGE extent were also recorded.ResultsTwenty-one patients with CA, 25 patients with non-amyloid left ventricular myocardial hypertrophy (CH) and 20 controls with normal CMR were analyzed. Percentage ME was significantly higher in CA patients (200% (174–238)) than in CH patients (122% (88–151); p = 0.0001) and control patients (104% (90–149); p = 0.0001). Percentage ME was significantly correlated with the LGE extent (Rho Spearman coefficient = 0.66; p = 0.0001) and with the post contrast myocardial T1 (Rho Spearman coefficient = −0.61; p = 0.0001). With a cutoff value of 152%, the sensitivity and specificity of percentage ME for detection of CA were 90% and 80%, respectively.ConclusionPercentage ME obtained from pre and post contrast cine imaging is correlated to LGE extent and myocardial T1 and may represent an additional diagnostic parameter to consider CA in patients with LVH.
  • Effects of Radiation Dose Reduction on Diagnostic Accuracy of Abdominal CT
           in Young Adults with Suspected Acute Diverticulitis: A Retrospective
           Intraindividual Analysis
    • Abstract: Publication date: June 2019Source: Academic Radiology, Volume 26, Issue 6Author(s): Sven S. Walter, Michael Maurer, Corinna Storz, Jakob Weiss, Rami Archid, Fabian Bamberg, Jong Hyo Kim, Konstantin Nikolaou, Ahmed E. OthmanRationale and ObjectivesTo assess the effects of radiation dose reduction on image quality and diagnostic accuracy of abdominal computed tomography (CT) in young adults with suspected acute diverticulitis.Materials and MethodsFifty-four patients ≤40 years who received contrast-enhanced abdominal CT for suspected acute diverticulitis were included. Low-dose CT (LDCT) datasets (25%, 50%, and 75% of the original dose) were generated using sinogram synthesis and quantum noise modeling. A five-point scale was used to assess images qualitatively (overall image quality, noise, artefacts, and sharpness) and for diagnostic confidence (5 being the best possible outcome). Furthermore, the diagnostic accuracy was determined for the presence of acute diverticulitis.ResultsAmong 54 patients (mean age: 35.2 ± 5.3 years, 77.8% male), the prevalence of acute diverticulitis was high (57.4%). Subjective image quality was highest for original datasets and lowest for LDCT datasets with 25% of the original dose (median [interquartile range]: 5 [5] vs. 3 [2–3], p < 0.001). Diagnostic confidence was high for all datasets down to 50% of the original dose, while 25% LDCT datasets were associated with a significantly decreased diagnostic confidence (p < 0.001). Diagnostic accuracy was high for all LDCT and original datasets (sensitivity: 100%, negative predictive value [NPV]: 100% for 75% and 100% dose levels; sensitivity: 96.8%, NPV: 95.8% for 50% dose level; sensitivity: 93.6%, NPV: 91.7% for 25% dose level, respectively). Inter-rater agreement regarding the detection of diverticulitis was almost perfect at doses ≥50% (kappa:>0.81), while lower for datasets of 25% of the original radiation dose agreement (kappa: 0.67–0.78).ConclusionRadiation dose reduction down to 50% of the original radiation exposure permits high image quality, diagnostic confidence, and accuracy for the assessment of acute diverticulitis in abdominal CT in young adults without the use of iterative reconstruction algorithms.
  • The Time to and Type of Pancreatic Cancer Recurrence after Surgical
           Resection: Is Prediction Possible'
    • Abstract: Publication date: June 2019Source: Academic Radiology, Volume 26, Issue 6Author(s): Jelena Djokić Kovač, Philipp Mayer, Thilo Hackert, Miriam KlaussRationale and ObjectivesTo evaluate factors predicting pancreatic cancer recurrence, and to determine the most common appearance of tumor relapse.Materials and MethodsNinety patients with recurrent pancreatic cancer were retrospectively included in the study. 74.4% had pancreatic head tumors (group 1) and 25.6% pancreatic body and/or tail tumor (group 2). The tumor localization, operative technique, TNM stage, the R-status, tumor grade, lymphovascular, and perineural invasion were recorded. Location of local tumor recurrence, lymph node recurrence, or organ metastases were analyzed on the basis of follow-up CT imaging.ResultsMean recurrence time was 17.4 ± 13.2 months. The most common recurrence type was local recurrence (84.4%), followed by lymph node (15.5%), liver (14.4%), and lung metastasis (6.7%). The predominant site of local recurrence in pancreatic head tumors was close to superior mesenteric artery, common hepatic artery, and/or celiac artery (57.4%), followed by area defined by portal vein, inferior vena cava, CA or superior mesenteric artery (31.2%). Patients with pancreatic body and/or tail carcinoma had higher incidence (p = 0.003) of metastatic disease comparing to pancreatic head tumors, while resection margin was the most common type of local tumor recurrence, seen in 46.7% cases versus 8.2% of patients with pancreatic head tumors (p < 0.001).ConclusionThe most common recurrence type in patients with resected pancreatic carcinoma was local recurrence along cardinal arteries. The localization of primary tumor influences the type of tumor relapse and site of local recurrence.
  • Magnetic Resonance Diffusion Kurtosis Imaging for Evaluating Stage of
           Liver Fibrosis in a Rabbit Model
    • Abstract: Publication date: June 2019Source: Academic Radiology, Volume 26, Issue 6Author(s): Jie Li, Dan Wang, Tian-wu Chen, Fei Xie, Rui Li, Xiao-ming Zhang, Zong-lin Jing, Jian-qiong Yang, Jing Ou, Jin-ming CaoRationale and ObjectivesAs an extension of the conventional diffusion weighted imaging, diffusion kurtosis imaging (DKI) is based on the non-Gaussian diffusion model that can inherently account for restricted water diffusion within the complex microstructure of most tissues. This study aimed to investigate association of liver DKI derived parameter with stage of liver fibrosis.Materials and MethodsFifty-six healthy New Zealand white rabbits were enrolled into this study, among which 48 rabbits were randomly given carbon tetrachloride to model liver fibrosis, and 8 rabbits treated with normal saline served as control subjects. All rabbits underwent liver DKI followed by biopsy to stage fibrosis (stages F0–F4) on 6th, 8th, 10th, and 12th weekends after initiation of modeling fibrosis. Mean kurtosis (MK), fractional anisotropy (FA), and mean diffusion (MD) were derived from DKI data. Statistical analysis was to evaluate association of DKI derived parameter with stage of fibrosis.ResultsFA (r = 0.512) and MK (r = 0.567) increased, and MD (r = −0.574) decreased with increasing stage of fibrosis from F0 to F4 (all p values < 0.05). Significant differences were found in all parameters between F0 and F3 or F4, F1 and F4, F0 and F1–4, and F0–1 and F2–4 (all p values < 0.05). FA and MD could distinguish between F0 from F2, MD, and MK could distinguish F1 from F3, F0–2 from F3–4, and F1–2 from F3–4, and MK and FA could distinguish F2 from F4, and F0–3 from F4 (all p values < 0.05). According to receiver operating characteristic analysis, MK could best predict stage ≥F1, ≥F2, ≥F3, and F4, and discriminate F1–2 from F3–4 with areas under receiver operating characteristic curve of 0.766–0.930.ConclusionDKI derived parameters can help stage fibrosis.
  • Noninvasive Differential Diagnosis of Liver Iron Contents in Nonalcoholic
           Steatohepatitis and Simple Steatosis Using Multiecho Dixon Magnetic
           Resonance Imaging
    • Abstract: Publication date: June 2019Source: Academic Radiology, Volume 26, Issue 6Author(s): Tae-Hoon Kim, Chang-Won Jeong, Hong Young Jun, Youe Ree Kim, Ju Young Kim, Young Hwan Lee, Kwon-Ha YoonRationale and ObjectivesThe roles of iron stores in nonalcoholic fatty liver disease have not yet been clearly identified, and it is lack of uniform criteria and a standardized study design for assessing the liver iron content (LIC) in nonalcoholic steatohepatitis (NASH). This study was to compare LICs in biopsy-proven simple steatosis (SS) and NASH based on T2⁎-relaxometry.Material and MethodsA total of 32 subjects divided to three groups, consisting of 10 healthy controls, 12 SS and 10 NASH. All MRI examinations were performed on a 3 T MRI with a 32-channel body coil. To measure T2⁎-value, we used a gradient echo sequence with six multiechoes within a single breath-hold. Hepatic iron contents among three groups were compared using Kruskal–Wallis H test and Mann–Whitney's posthoc tests. Diagnostic accuracy was determined by calculating the area under the receiver operating characteristics curve. To identify the reliability of iron measurements in the different region of interests, coefficient of variance (CV) was calculated overall CV values for the variability of measurements. Interobserver agreement and reliability were estimated by calculating the intraclass correlation coefficient.ResultsThe variations of all LIC measurements are not exceeded 20%, as a mean CV value 18.3%. intraclass correlation coefficients were higher than 0.9. Mean T2⁎-values at localized region of interests were healthy controls 45.42 ± 7.19 ms, SS 20.96 ± 4.28 ms, and NASH 15.49 ± 2.87 ms. The mean T2⁎-value in NASH is significantly shorter than that in SS (p = 0.008). The area under the receiver operating characteristics curve to distinguish NASH from SS was 0.908 (95% confidence interval 0.775–1.000, p = 0.001) at a cut-off of iron contents greater than 17.95 ms, and its diagnostic accuracy had 0.833 sensitivity and 0.800 specificity.ConclusionThis study demonstrates that the T2⁎ calculation can help to differentially diagnose NASH.
  • Accuracy of Breast Magnetic Resonance Imaging Compared to Mammography in
           the Preoperative Detection and Measurement of Pure Ductal Carcinoma In
           Situ: A Retrospective Analysis
    • Abstract: Publication date: June 2019Source: Academic Radiology, Volume 26, Issue 6Author(s): Heike Preibsch, Johannes Beckmann, Johannes Pawlowski, Christopher Kloth, Markus Hahn, Annette Staebler, Beate M. Wietek, Konstantin Nikolaou, Benjamin WiesingerRationale and ObjectivesDuctal carcinoma in situ (DCIS) hinders imaging detection due to multifocal appearance and discontinuous growth. Preoperative determination of its extent is therefore challenging.Aim of this study was to investigate the additional benefit of breast magnetic resonance imaging (MRI) to mammography (MG) in the diagnosis of DCIS according to size and grading.Materials and MethodsRetrospective analysis of 295 patients with biopsy-proven, pure DCIS. Mean patient age was 57.0 years (27–87 years). All patients obtained MG. Additional MRI was performed in 41.7% (123/295). Mammographic breast density, background parenchymal enhancement (BPE), tumor size and grading were analysed. Tumor size on MG and MRI were compared to histopathological size of the surgical specimen.ResultsMean tumor size was 39.6 mm. DCIS was occult on MG in 24.4% (30/123) and on MRI in 1.6% (2/123). Size was underestimated by 4.6 mm (mean) mammographically. DCIS was high grade in 54.5% (67/123), intermediate grade in 40.7% (50/123) and low grade in 4.9% (6/123). MG was exact regarding tumor size in low grade DCIS, underestimated intermediate grade DCIS by 1 mm (median) and high grade DCIS by 10.5 mm. MRI overestimated low grade DCIS by 1 mm (median), was exact regarding intermediate grade DCIS and underestimated high grade DCIS by 1 mm. BPE did not influence tumor detection and measurement.ConclusionMRI outperforms MG in the detection and size estimation of DCIS and can reduce positive margin rates.
  • A Reliability Comparison of Cone-Beam Breast Computed Tomography and
           Mammography: Breast Density Assessment Referring to the Fifth Edition of
           the BI-RADS Atlas
    • Abstract: Publication date: June 2019Source: Academic Radiology, Volume 26, Issue 6Author(s): Yue Ma, Yang Cao, Aidi Liu, Lu Yin, Peng Han, Haijie Li, Xiaohua Zhang, Zhaoxiang YeRationale and ObjectivesTo evaluate the reliability of cone-beam breast computed tomography (CBBCT) in visual assessment of breast density referring to the fifth edition of the Breast Imaging Reporting and Data System compared to digital mammography.Materials and MethodsBreast density assessments of 130 female patients were performed by five radiologists referring to the fifth edition of Breast Imaging Reporting and Data System atlas both on two-view mammograms and CBBCT images. Assessments were repeated by three radiologists with different experience more than 1 month after the initial evaluation. The inter- and intrareader agreements were compared by using the Cohen's weighted Kappa statistic and intraclass correlation coefficient. Weighted Kappa statistic was also used to analyze the agreement between CBBCT images and mammograms. The influence of radiologist experience for breast density assessment was analyzed using a chi-square test.ResultsFor CBBCT images, the inter-reader agreement was 0.781, whereas the agreement on mammograms was 0.744, both demonstrating moderate agreement. The level of intrareader reliability was higher on the CBBCT images than mammograms for breast density evaluation, 0.856 versus 0.786. Based on the majority report, the agreement between these two modalities was on substantial agreement degree. There was a statistically significant difference among radiologists with different levels of experience, and higher density categories were reported more often by experienced reader.ConclusionCBBCT showed equal aptitude and better agreement for the breast density evaluation compared to mammography. CBBCT could be an effective modality for breast density assessment and breast cancer risk evaluation in routine diagnosis and breast cancer screening.
  • MRI Findings After Cryoablation of Primary Breast Cancer Without Surgical
    • Abstract: Publication date: June 2019Source: Academic Radiology, Volume 26, Issue 6Author(s): Youichi Machida, Akiko Shimauchi, Takao Igarashi, Eisuke FukumaRationale and ObjectivesTo retrospectively evaluate findings on serial magnetic resonance imaging (MRI) after cryoablation for breast cancer lesions without subsequent surgical resection.Materials and MethodsThis study was approved by the Institutional Review Board and the requirement to obtain informed consent waived. Ductal carcinoma in situ or invasive carcinoma ≤15 mm, nuclear grade 1 or 2, estrogen receptor positive/human epidermal growth factor 2 negative without lymph node metastasis were treated with cryoablation without subsequent excision. Two observers independently reviewed the first two postcryoablation MRIs for shape (none, focus-to-mass, or nonmass enhancement) and suspicion of residual disease (positive or negative). Fisher's exact or the Mann–Whitney U test was used to assess significance. Interobserver agreement on findings was evaluated by calculating κ values.ResultsFifty-four patients were enrolled. The first and second postcryoablation MRIs were performed 22–171 days and 82–487 days after cryoablation, respectively. Interobserver agreement ranged from fair to moderate (κ = 0.356–0.434). Observer 1 or 2 identified suspicious areas on the first postcryoablation MRI in seven cases (13.0%). These were significantly associated with focus-to-mass shape (vs non–focus-to-mass: nonmass enhancement or none) and residual disease or recurrence suspected by both observers (p < 0.001). There were no cases of both observers identifying suspicious findings on the second postcryoablation MRI.ConclusionSuspicious findings can be detected within the treated area at the first postcryoablation MRI. These can resolve during subsequent adjuvant therapies and follow-up.
  • Toward Improving Breast Cancer Imaging: Radiological Assessment of
           Propagation-Based Phase-Contrast CT Technology
    • Abstract: Publication date: June 2019Source: Academic Radiology, Volume 26, Issue 6Author(s): Seyedamir Tavakoli Taba, Patrycja Baran, Sarah Lewis, Robert Heard, Serena Pacile, Yakov I. Nesterets, Sherry C. Mayo, Christian Dullin, Diego Dreossi, Fulvia Arfelli, Darren Thompson, Mikkaela McCormack, Maram Alakhras, Francesco Brun, Maurizio Pinamonti, Carolyn Nickson, Chris Hall, Fabrizio Zanconati, Darren Lockie, Harry M QuineyRationale and ObjectivesThis study employs clinical/radiological evaluation in establishing the optimum imaging conditions for breast cancer imaging using the X-ray propagation-based phase-contrast tomography.Materials and MethodsTwo series of experiments were conducted and in total 161 synchrotron-based computed tomography (CT) reconstructions of one breast mastectomy specimen were produced at different imaging conditions. Imaging factors include sample-to-detector distance, X-ray energy, CT reconstruction method, phase retrieval algorithm applied to the CT projection images and maximum intensity projection. Observers including breast radiologists and medical imaging experts compared the quality of the reconstructed images with reference images approximating the conventional (absorption) CT. Various radiological image quality attributes in a visual grading analysis design were used for the radiological assessments.ResultsThe results show that the application of the longest achievable sample-to-detector distance (9.31 m), the lowest employed X-ray energy (32 keV), the full phase retrieval, and the maximum intensity projection can significantly improve the radiological quality of the image. Several combinations of imaging variables resulted in images with very high-quality scores.ConclusionThe results of the present study will support future experimental and clinical attempts to further optimize this innovative approach to breast cancer imaging.
  • Transfer Learning From Convolutional Neural Networks for Computer-Aided
           Diagnosis: A Comparison of Digital Breast Tomosynthesis and Full-Field
           Digital Mammography
    • Abstract: Publication date: June 2019Source: Academic Radiology, Volume 26, Issue 6Author(s): Kayla Mendel, Hui Li, Deepa Sheth, Maryellen GigerRationale and ObjectivesWith the growing adoption of digital breast tomosynthesis (DBT) in breast cancer screening, we compare the performance of deep learning computer-aided diagnosis on DBT images to that of conventional full-field digital mammography (FFDM).Materials and MethodsIn this study, we retrospectively collected FFDM and DBT images of 78 biopsy-proven lesions from 76 patients. A region of interest was selected for each lesion on FFDM, synthesized 2D, and DBT key slice images. Features were extracted from each lesion using a pretrained convolutional neural network (CNN) and served as input to a support vector machine classifier trained in the task of predicting likelihood of malignancy.ResultsFrom receiver operating characteristic (ROC) analysis of all 78 lesions, the synthesized 2D image performed best in both the cradiocaudal view (area under the ROC curve [AUC] = 0.81, SE = 0.05) and mediolateral oblique view (AUC = 0.88, SE = 0.04) in the task of lesion characterization. When cradiocaudal and mediolateral oblique data of each lesion were merged through soft voting, DBT key slice image performed best (AUC = 0.89, SE = 0.04). When only masses and architectural distortions (ARDs) were considered, DBT performed significantly better than FFDM (p = 0.024).ConclusionDBT performed significantly better than FFDM in the merged view classification of mass and ARD lesions. The increased performance suggests that the information extracted by the CNN from DBT images may be more relevant to lesion malignancy status than the information extracted from FFDM images. Therefore, this study provides supporting evidence for the efficacy of computer-aided diagnosis on DBT in the evaluation of mass and ARD lesions.
  • Patient-Reported Breast Density Awareness and Knowledge after Breast
           Density Legislation Passage
    • Abstract: Publication date: June 2019Source: Academic Radiology, Volume 26, Issue 6Author(s): Randy C. Miles, Constance Lehman, Erica Warner, Ashley Tuttle, Mansi SaksenaRationale and ObjectivesTo determine awareness and knowledge of breast density and breast density legislation among women receiving routine mammography following passage of Massachusetts breast density legislation.Materials and MethodsA survey assessing breast density awareness and knowledge was administered to all women receiving screening mammography over two separate 1-week periods at an academic medical center following implementation of mandatory breast density notification. Survey questions queried sociodemographic factors, breast density knowledge, legislation awareness, and medical decision-making intent.ResultsOf 1000 survey recipients, 338 (33.8%) returned their survey. Most women were surprised (207/338; 61.2%) to receive their breast density notification letter and unaware (302/338; 89.9%) of newly implemented breast density legislation. The majority (185/338; 54.7%) of survey respondents self-reported having dense breasts. Only 61.1% (113/185) of women with dense breasts reported that their personal breast density increased breast cancer risk, while only 60.0% (78/130) of women with non dense breasts reported that their personal breast density did not increase breast cancer risk. Significant differences between women with dense and nondense breasts were observed related to intention to follow-up with a health practitioner (118/185; 63.8% vs. 66/130; 50.8%, p = 0.03) and views on necessity of supplemental screening based on personal breast density (83/185; 45.1% vs. 20/130; 15.4%, p < 0.01).ConclusionsDespite implementation of state breast density laws since 2009, confusion and misinformation about breast density persists among women receiving mammography screening. Innovative tools that more effectively inform patients, may be required to improve communication and patient understanding about breast density and subsequent breast care management.
  • Benefits of Independent Double Reading in Digital Mammography: A
           Theoretical Evaluation of All Possible Pairing Methodologies
    • Abstract: Publication date: June 2019Source: Academic Radiology, Volume 26, Issue 6Author(s): Patrick C. Brennan, Aarthi Ganesan, Miguel P. Eckstein, Ernest Usang Ekpo, Kriscia Tapia, Claudia Mello-Thoms, Sarah Lewis, Mordechai Z. JuniRationale and ObjectivesTo establish the efficacy of pairing readers randomly and evaluate the merits of developing optimal pairing methodologies.Materials and MethodsSensitivity, specificity, and proportion correct were computed for three different case sets that were independently read by 16 radiologists. Performance of radiologists as single readers was compared to expected double reading performance. We theoretically evaluated all possible pairing methodologies. Bootstrap resampling methods were used for statistical analyses.ResultsSignificant improvements in expected performance for double versus single reading (ie, delta performance) were shown for all performance measures and case-sets (p ≤ .003), with overall delta performance across all theoretically possible pairing schemes (n = 10,395) ranging between .05 and .08. Delta performance for the 20 best pairing schemes was significant (p < .001) and ranged between .07 and .10. Delta performance for 20 random pairing schemes was also significant (p ≤ .003) and ranged between .05 and .08. Delta performance for the 20 worst pairing schemes ranged between .03 and .06, reaching significance in delta proportion correct (p ≤ .021) for all three case-sets and in delta specificity for two case-sets (p ≤ .033) but not for a third case-set (p = .131), and not reaching significance in delta sensitivity for any of the three case-sets (.098 ≥ p ≥ .067).ConclusionSignificant benefits accrue from double reading, and while random reader pairing achieves most double reading benefits, a strategic pairing approach may maximize the benefits of double reading.
  • The Baader-Meinhof Phenomenon in Radiology
    • Abstract: Publication date: June 2019Source: Academic Radiology, Volume 26, Issue 6Author(s): Kush Purohit
  • The accuracy of multi-detector computed tomography and laparoscopy in the
           prediction of peritoneal carcinomatosis index score in primary ovarian
    • Abstract: Publication date: Available online 14 May 2019Source: Academic RadiologyAuthor(s): Shimaa Abdalla Ahmed, Hisham Abou-Taleb, Ahmed Yehia, Noha Ali Abd El Malek, Gehan S. Siefeldein, Dalia M. Badary, Murad Aly JabirRationale and ObjectivesThe purpose of this study was to compare the accuracy of MDCT and laparoscopy in the prediction of peritoneal carcinomatosis index score. Reproducibility of MDCT interpretation was also assessed.MethodsThis prospective study included 85 ovarian cancer patients underwent MDCT and diagnostic laparoscopy before cytoreductive surgery. We calculated the accuracy of diagnostic modalities in the calculation of the peritoneal cancer index score (PCI). Radiologist interobserver agreement was calculated using kappa statistics.ResultsNine hundred-thirty (84.2%) of the 1105 regions had peritoneal deposits at exploratory laparotomy. Computed tomography (CT) and laparoscopy sensitivity were 94.9%, 98.3%, specificity 86.7%, 80.4%, PPV 97.9 %, 96.8%, NPV 72.2%, 88.8 %, and accuracy 93.8 %, 95.7%, respectively. However, computed tomography (CT) diagnostic performance is less accurate than laparoscopy in pelvic and small intestinal regions; no statistically significant differences were evident regarding total PCI score compared to surgery (p> 0.05). CT and laparoscopy correctly depicted peritoneal carcinomatosis in 88.2%, 90.6% of patients, respectively. Optimal cytoreduction was achieved in 68 (80%) patients.ConclusionBoth CT and laparoscopy seems to be effective tools for assessment of peritoneal carcinomatosis using the PCI score. Dedicated MDCT protocol with routine use of a standardized PCI form may provide better comprehensive multi-regional analysis that may help surgeons referring patients to the best treatment option. Laparoscopy is a valuable tool in cases with a high risk of suboptimal cytoreduction related to disease extent.
  • Critical Challenges to the Management of Clinical Trial Imaging:
           Recommendations for the Conduct of Imaging at Investigational Sites
    • Abstract: Publication date: Available online 13 May 2019Source: Academic RadiologyAuthor(s): Nicholas P. Gruszauskas, Samuel G. ArmatoRationale and ObjectivesParticipation in clinical research can be both highly rewarding and logistically demanding. As highlighted by recent Food and Drug Administration guidance, imaging has become an integral part of this research. The unique technical and administrative aspects of clinical trial imaging may differ substantially from those of standard-of-care imaging and thus burden the established clinical infrastructure at investigational sites. Failure to comply with requirements can lead to unusable data, repeat imaging, or the removal of patients from the trial. It is therefore imperative that all stakeholders address these challenges to engage in clinical research successfully.Materials and MethodsThe authors’ experiences in managing clinical trial imaging requirements at their institution were used to identify common challenges. The impact of these challenges was assessed from an operational perspective.ResultsAlthough contract research organizations attempt to minimize these challenges, their efforts are necessarily limited and insufficient, and there is a lack of infrastructure available at investigational sites to address these issues. As such, recommendations are proposed for addressing these challenges at institutional and industry levels.ConclusionThe challenges associated with clinical trial imaging require an investment of resources from all stakeholders. Investigational sites must confront these challenges to satisfy trial requirements effectively, maintain a superior level of patient care, and guarantee trial integrity. Similarly, sponsors must acknowledge the burden of clinical trial imaging and support the development of the necessary local infrastructure. The implementation of the recommendations described here will improve the conduct of clinical trial imaging.
  • Hybrid Interactive and Didactic Teaching Format Improves Resident
           Retention and Attention Compared to Traditional Lectures
    • Abstract: Publication date: Available online 11 May 2019Source: Academic RadiologyAuthor(s): Vishwan Pamarthi, Lars Grimm, Karen Johnson, Charles MaxfieldPurposeTo compare the traditional lecture to a hybrid interactive and didactic teaching format with regards to radiology resident short- and long-term retention, as well as attention.Materials and MethodsThe tested hybrid format consists of a 30-minute didactic lecture followed by 30 minutes of interactive cases based on material from the lecture portion. Faculty members were randomly selected to give a 60-minute lecture or a hybrid presentation. To assess short- and long-term retention, a test developed from the presenter's slides was sent to all residents approximately 15 minutes after each presentation, and again approximately 3 months later. The presenters were blinded to the survey questions. Attention was assessed by comparing the proportion of questions answered correctly from each quarter of the presentation. Equality in difficulty of questions was validated across teaching methods.ResultsFor 6 hybrid presentations, 106 and 60 retention tests were submitted, answering 848 and 480 short- and long-term survey questions, respectively. For 6 lectures, 91 and 55 retention tests were submitted, answering 728 and 440 short- and long-term survey questions, respectively. Short-term retention was 75.7% (640/848) for hybrid presentations, versus 63.2% (460/728) for lectures (p < 0.0001). Long-term retention was 59.4% (285/480) for hybrid presentations, versus 49.3% (217/440) for lectures (p = 0.002). Regarding attention, 61.6% (554/600) of questions from the first 3 quarters of traditional lectures were answered correctly versus 49.3% (148/300) of final quarter questions (p = 0.0003). No significant drop-off was noted for hybrid presentations.ConclusionA hybrid interactive and didactic teaching format for radiology residents demonstrates better short-term retention, long-term retention, and attention when compared to traditional lectures.
  • How can Artistic Paintings Broaden Medical Students’ Understanding of
           the Radiology Profession'
    • Abstract: Publication date: Available online 9 May 2019Source: Academic RadiologyAuthor(s): Kari L. Visscher, Lynn F. Bloom, Kori A. LaDonna, Lisa Faden, Kawan S. RakhraRationale and ObjectivesThe purpose of this study is to explore how representational paintings of radiology encounters with patients may impact medical students' understanding and impression of both radiologists and the radiology profession.MethodsParticipants included third year medical students at a single institution rotating through a one-week radiology elective. Three works of art were analyzed using the validated Visual Thinking Strategies technique. Data collected included a postsession questionnaire and transcriptions of audio-recorded sessions. Data analysis involved both qualitative and quantitative methodology.ResultsFifty students participated; all participants completed the postsession questionnaire and 10 participated in the audio recorded sessions. Total 82% found the experience “very enjoyable” and 86% agreed that the paintings positively affected their understanding of how radiologists provide care to patients; 96% would recommend this session to others. Exploring representational paintings of radiology encounters seemed to influence perception and understanding of radiology with students reporting “light bulb moments;” create a dissonance between the student experience and the experience depicted in the paintings; and address gaps in content specific knowledge.ConclusionThe findings of this study suggest that analyzing paintings depicting radiology encounters with patients can challenge negative stereotypes that medical students have of the radiology profession and radiologists. This arts-based learning module employing a learning strategy such as Visual Thinking Strategies, should be considered by the radiology profession as a strategy to positively inform and educate trainees about the specialty.
  • Evaluation of Pseudoreader Study Designs to Estimate Observer Performance
           Results as an Alternative to Fully Crossed, Multireader, Multicase Studies
    • Abstract: Publication date: Available online 7 May 2019Source: Academic RadiologyAuthor(s): Rickey E. Carter, David R. Holmes, Joel G. Fletcher, Cynthia H. McColloughRationale and ObjectivesTo examine the ability of a pseudoreader study design to estimate the observer performance obtained using a traditional fully crossed, multireader, multicase (MRMC) study.Materials and MethodsA 10-reader MRMC study with 20 computed tomography datasets was designed to measure observer performance on four novel noise reduction methods. This study served as the foundation for the empirical evaluation of three different pseudoreader designs, each of which used a similar bootstrap approach for generating 2000 realizations from the fully crossed study. Our three approaches to generating a pseudoreader varied in the degree to which reader performance was matched and integrated into the pseudoreader design. One randomly selected simulation was selected as a “mock study” to represent a hypothetical, prospective implementation of the design.ResultsUsing the traditional fully crossed design, figures of merit) (95% CIs) for the four noise reductions methods were 68.2 (55.5–81.0), 69.6 (58.4–80.8), 70.8 (60.2–81.4), and 70.9 (60.4–81.3), respectively. When radiologists’ performances on the fourth noise reduction method were used to pair readers during the mock study, there was strong agreement in the estimated figures of merits with estimates using the pseudoreader design being within ±3% of the fully crossed design.ConclusionFully crossed MRMC studies require significant investment in resources and time, often resulting in delayed implementation or minimal human testing before dissemination. The pseudoreader approach accelerates study conduct by combining readers judiciously and was found to provide comparable results to the traditional fully crossed design by making strong assumptions about exchangeability of the readers.
  • Diagnosis of Lymphangiomatosis: A Study Based on CT Lymphangiography
    • Abstract: Publication date: Available online 7 May 2019Source: Academic RadiologyAuthor(s): Dan Jin, Xiaoli Sun, Wenbin Shen, Qingqing Zhao, Rengui WangRationale and ObjectivesLymphangiomatosis is a rare disease characterized by the widespread presence of lymphangiomas in any part of the body. In previous studies, lymphatic vessel abnormalities in lymphangiomatosis have only rarely been mentioned. The objective of this paper is to discuss the imaging features of lymphangiomatosis, including cystic lesions and lymphatic abnormalities, on computed tomography lymphangiography (CTL).Materials and MethodsAll 34 patients who were diagnosed with lymphangiomatosis underwent direct lymphangiography followed by CTL. The CTL images were independently analyzed by two experienced radiologists. The CTL image analyses included assessment of the features of cystic lesions and lymphatic vessel abnormalities.Results(i) CTL revealed several cystic lesions ranging in size from 3 mm to 14 cm; the lesions were located in the neck and shoulders (61.8%), mediastinum (52.9%), retroperitoneum (70.6%), and pelvis and perineum (64.7%). (ii) Approximately 29.4% of patients showed abnormal contrast medium accumulation in cystic masses. (iii) Approximately 67.6% of patients showed lymphatic reflux. (iv) Dilated lymphatic vessels were distributed in the mediastinum (38.2%), retroperitoneum (50.0%), pelvis and lower limbs (47.1%). (v) Finally, 8.8% of patients had perineal lymphatic fistulae, and 2.9% of patients had chyluria.ConclusionLymphangiomatosis is a type of systemic lymphatic abnormality that is accompanied by multiple cystic lesions. The therapeutic measures for lymphangiomatosis are determined by the size of the cystic lesions. Furthermore, the prognosis of lymphangiomatosis is affected by lymphatic abnormalities.
  • Coronary Atherosclerotic Plaque Volume Quantified by Computed Tomographic
           Angiography in Smokers Compared to Nonsmokers
    • Abstract: Publication date: Available online 7 May 2019Source: Academic RadiologyAuthor(s): Zhi-hui Hou, Bin Lu, Zhen-nan Li, Yun-qiang An, Yang Gao, Wei-hua YinRationale and ObjectivesWe sought to compare the prevalence and volume of lipid plaque, fibrous plaque, and calcified plaque in patients with smokers versus nonsmokers.Materials and MethodsWe studied consecutive patients suspected of coronary artery disease and who underwent coronary computed tomography angiography. A structured interview and review of existing clinical data was conducted before computed tomography angiography to collect information on demographic characteristics, the presence of cardiovascular risk factors. The volume of lipid, fibrous, and calcified plaque were automatically calculated and marked in different colors according to predefined Hounsfield unit thresholds. The prevalence and volume of plaques were compared between smokers and nonsmokers.ResultsOverall 6380 patients (3351 men and 3029 women, mean age 55.35 years) were finally analyzed, of whom 2075 (32.5%) were smokers, and 4305 (67.5%) were never smokers. The prevalence of any plaque in smokers was significantly higher compared to never smokers (47.7% vs. 32.3%, p < 0.001). Smoking was an independent risk factor of the presence of any plaque after correcting for age, gender, body mass index, hypertension, dyslipidemia, diabetes, and family history in a multivariate model (odds ratio = 1.250 (1.088–1.437), p = 0.002). The volume of lipid plaque, fibrous plaque, calcified plaque, and total plaque in smokers was significantly greater than nonsmokers (p < 0.001).ConclusionThe prevalence and volume of lipid plaque, fibrous plaque, and calcified plaque were significantly higher in smokers versus never smokers.
  • Radiologist as Lifelong Learner: Strategies for Ongoing Education
    • Abstract: Publication date: Available online 6 May 2019Source: Academic RadiologyAuthor(s): Xuan V. Nguyen, Scott J. Adams, Susan K. Hobbs, Dhakshinamoorthy Ganeshan, Ashish P. WasnikGiven the rapid pace at which modern radiology is evolving and the associated paradigm shifts in health care delivery, it is critical that radiologists adapt and constantly update the skills and knowledge required to practice safe, patient-centered care. The Association of University Radiologists-Radiology Research Alliance Lifelong Learning Task Force convened to explore the current status and future directions of lifelong learning in radiology and summarized its finding in this article. We review the various learning platforms and resources available to radiologists in their self-motivated and self-directed pursuit of lifelong learning. We also discuss the challenges and perceived barriers to lifelong learning and strategies to mitigate those barriers and optimize learning outcomes.
  • Association of Parity and Infant Feeding Method with Breast Density on
    • Abstract: Publication date: Available online 6 May 2019Source: Academic RadiologyAuthor(s): Eiji Nakajima, Takuji Iwase, Yumi Miyagi, Takashi Fujita, Norihiko Ikeda, Takashi Ishikawa, Hiroji IwataBackgroundMammography (MMG) is widely used for the screening and diagnosis of breast cancer. High breast density on MMG prevents breast cancer detection. In the present study, we analyzed the effects of parity and infant feeding method on mammographic breast density.Materials and MethodsNinety women diagnosed as having breast cancer were analyzed. Using the results of medical questionnaires, subjects were grouped according to their parity and infant feeding method, into either nulliparity or parity, and formula-feeding or breastfeeding. Each group consisted of 30 consecutive women from 45 to 49 years. Nulliparous group was unaffected by either parity or breastfeeding, formula-feeding group was affected by parity but not breastfeeding, and breastfeeding group was affected by both parity and breastfeeding. Mammographic breast density was evaluated on the contralateral and cancer-free breast, and was classified into ≥ 50% dense as high breast density and
  • Cost Comparison of Ultrasound Versus MRI to Diagnose Adolescent Female
           Patients Presenting with Acute Abdominal/Pelvic Pain Using Time-Driven
           Activity-Based Costing
    • Abstract: Publication date: Available online 4 May 2019Source: Academic RadiologyAuthor(s): Kelly N. Hagedorn, Shireen E. Hayatghaibi, Matt H. Levine, Robert C. OrthRationale and ObjectivesTo compare the cost of ultrasound (US) versus magnetic resonance imaging (MRI) using time-driven activity-based costing in adolescent female patients with suspected appendicitis.Materials and MethodsProcess maps were created using data from electronic medical record review and patient shadowing for adolescent female patients undergoing US or noncontrast MRI exams of the abdomen and pelvis for suspected appendicitis. Capacity cost rates for all personnel, equipment, facilities, and supplies in each exam pathway were established from institutional accounting data. The cost of each process step was determined by multiplying step-specific capacity cost rates by the mean time required to complete the step. Total pathway costs for US and MRI were computed by summing the costs of all steps through each pathway, and a direct cost comparison was made between the two modalities.ResultsProcess maps for US and MRI pathways were generated from 231 and 52 patient encounters, respectively. Patients undergoing US exams followed one of six pathways depending on exam order (abdomen versus pelvis performed first) and whether additional time was needed for bladder filling. Mean total US pathway time was 91 minutes longer than for MRI (US = 166 minutes; MRI = 75 minutes). Total MRI pathway cost was $209.97 compared to a mean US cost of $258.33 (range = $163.21–$293.24).ConclusionMRI can be a faster and less costly alternative to US for evaluating suspected appendicitis in adolescent female patients. While precise costs will vary by institution, MRI may be a viable and at times preferable alternative to US in this patient population.
  • Web-based Radiology Subspecialty Training Program: Pilot Feasibility and
           Effectiveness Analysis on Ethiopian Radiologists
    • Abstract: Publication date: Available online 4 May 2019Source: Academic RadiologyAuthor(s): Arya Haj-Mirzaian, Nikita Sethi, Brian de Francesca, Sumedha Sahni, Atif ZaheerRationale and ObjectivesTo investigate the feasibility and effectiveness of a novel web-based radiology subspecialty training program.Materials and MethodsTen Ethiopian general radiologists were enrolled; each participant selected two out of four available subspecialty training programs including abdominal imaging, neuroradiology, chest imaging, and musculoskeletal imaging. Participants were trained simultaneously in 4-stages over 20-months remotely. The program contains online lectures (previously recorded), online interactive case reviews, learning modules, and one-month observership at Johns Hopkins University. Each subspecialty training program consisted of nearly 50 recorded lectures, 26 case reviews, and 40 modules, all provided by subspecialty-trained radiology faculty. Trainees were evaluated using pre- and postcourse multiple choice questions, and the effectiveness of the program was assessed by comparing pre- and postcourse performances using paired t test or Wilcoxon signed-rank test. Regression analysis was conducted to determine the association between the magnitude of score change and trainees’ age and years after graduation.ResultsAll programs including abdominal imaging (p
  • Imaging Biomarkers for Nonalcoholic Fatty Liver Disease
    • Abstract: Publication date: Available online 3 May 2019Source: Academic RadiologyAuthor(s): Man Zhang
  • Forensic Radiology: An Exciting and Developing Field That Needs More
           Trained Radiologists
    • Abstract: Publication date: Available online 27 April 2019Source: Academic RadiologyAuthor(s): Barry Daly
  • Forensic Radiology: A Primer
    • Abstract: Publication date: Available online 17 April 2019Source: Academic RadiologyAuthor(s): Summer J. Decker, Maria Braileanu, Courtney Dey, Leon Lenchik, Michael Pickup, Jason Powell, Maria Tucker, Linda ProbynRationale and objective: Forensic radiology is a relatively unknown subspecialty which is becoming increasingly more important. The field incorporates antemortem and postmortem imaging for the detection and documentation of various pathologies for medicolegal purposes. Postmortem imaging is increasingly used in conjunction with the traditional autopsy in a process called a “virtual” autopsy. Radiography has been a staple of forensic investigations for over a century, first used in 1896. Advanced imaging techniques such as postmortem computed tomography and postmortem magnetic resonance imaging have only recently gained acceptance in the forensic science community. Postmortem computed tomography and postmortem magnetic resonance imaging methods are now widely used in some parts of the world, while other countries including the United States have been slower to adopt these methods into their daily practice. Advanced forensic imaging is increasingly used in the courts where juries have responded positively to such presentation of forensic data. For these reasons, advanced postmortem imaging is becoming a regular part of forensic investigations. The increase in the use of forensic imaging presents a unique opportunity for radiologists to collaborate with pathologists and law enforcement officials. This paper provides an overview of forensic radiology and identifies potential challenges and opportunities.
  • Dense Confusion Surrounding Obligatory Mammography Notification
    • Abstract: Publication date: Available online 5 April 2019Source: Academic RadiologyAuthor(s): Renee W. Pinsky
  • Image Perception and Diagnostic Accuracy of Digital Mammography: An
    • Abstract: Publication date: Available online 20 March 2019Source: Academic RadiologyAuthor(s): Kelly H. Zou, Kathryn Evers
  • Pulmonary Nodules As a Gateway to Value-Based Care
    • Abstract: Publication date: Available online 20 March 2019Source: Academic RadiologyAuthor(s): Joshua A. Hirsch
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