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RADIOLOGY AND NUCLEAR MEDICINE (191 journals)                     

Showing 1 - 191 of 191 Journals sorted alphabetically
Abdominal Radiology     Hybrid Journal   (Followers: 21)
Academic Radiology     Hybrid Journal   (Followers: 27)
Acta Cytologica     Hybrid Journal   (Followers: 3)
Acta Radiologica     Hybrid Journal   (Followers: 2)
Acta Radiologica Open     Open Access   (Followers: 3)
Acta Radiológica Portuguesa     Open Access  
Advanced Structural and Chemical Imaging     Open Access   (Followers: 2)
Advances in Computed Tomography     Open Access   (Followers: 3)
Advances in Radiation Oncology     Open Access   (Followers: 3)
AINS - Anasthesiologie - Intensivmedizin - Notfallmedizin - Schmerztherapie     Hybrid Journal   (Followers: 5)
Alasbimn Journal     Open Access   (Followers: 2)
American Journal of Neuroradiology     Full-text available via subscription   (Followers: 20)
American Journal of Roentgenology     Full-text available via subscription   (Followers: 34)
Annals of Nuclear Medicine     Hybrid Journal   (Followers: 4)
Annals of the ICRP     Hybrid Journal   (Followers: 4)
Applied In Vitro Toxicology     Hybrid Journal   (Followers: 2)
Applied Radiology     Full-text available via subscription   (Followers: 10)
Arab Journal of Interventional Radiology     Open Access   (Followers: 1)
Asia Oceania Journal of Nuclear Medicine & Biology     Open Access   (Followers: 3)
Bangladesh Journal of Nuclear Medicine     Open Access  
Belgian Journal of Radiology     Open Access   (Followers: 3)
Biomedical Imaging and Intervention Journal     Open Access   (Followers: 4)
BJR     Hybrid Journal   (Followers: 21)
BJR | case reports     Open Access   (Followers: 6)
BMC Medical Imaging     Open Access   (Followers: 10)
Canadian Association of Radiologists Journal     Full-text available via subscription   (Followers: 2)
Cancer Biotherapy & Radiopharmaceuticals     Hybrid Journal   (Followers: 1)
Cancer Radiothérapie     Full-text available via subscription   (Followers: 1)
Case Reports in Radiology     Open Access   (Followers: 12)
Chinese Journal of Academic Radiology     Hybrid Journal  
Clinical and Translational Imaging     Hybrid Journal   (Followers: 1)
Clinical and Translational Radiation Oncology     Open Access   (Followers: 1)
Clinical Imaging     Hybrid Journal   (Followers: 5)
Clinical Mass Spectrometry     Open Access  
Clinical Neuroradiology     Hybrid Journal   (Followers: 3)
Clinical Nuclear Medicine     Hybrid Journal   (Followers: 2)
Clinical Radiology     Hybrid Journal   (Followers: 18)
Computerized Medical Imaging and Graphics     Hybrid Journal   (Followers: 14)
Concepts in Magnetic Resonance Part A     Open Access   (Followers: 1)
Concepts in Magnetic Resonance Part B, Magnetic Resonance Engineering     Open Access   (Followers: 1)
Concussion     Open Access  
Contemporary Diagnostic Radiology     Full-text available via subscription   (Followers: 3)
Contrast Media & Molecular Imaging     Open Access   (Followers: 2)
Critical Ultrasound Journal     Open Access   (Followers: 3)
Current Medical Imaging Reviews     Hybrid Journal   (Followers: 3)
Current Problems in Diagnostic Radiology     Hybrid Journal   (Followers: 10)
Current Radiology Reports     Hybrid Journal   (Followers: 4)
Dentomaxillofacial Radiology     Hybrid Journal   (Followers: 4)
Der Nuklearmediziner     Hybrid Journal  
Der Radiologe     Hybrid Journal   (Followers: 1)
Diagnostic and Interventional Radiology     Open Access   (Followers: 6)
Digestive Disease Interventions     Hybrid Journal  
DNA and RNA Nanotechnology     Open Access   (Followers: 6)
Egyptian Journal of Radiology and Nuclear Medicine     Open Access   (Followers: 1)
EJNMMI Radiopharmacy and Chemistry     Open Access  
Emergency Radiology     Hybrid Journal   (Followers: 8)
Endoscopic Ultrasound     Open Access  
European Journal of Nanomedicine     Hybrid Journal   (Followers: 1)
European Journal of Nuclear Medicine and Molecular Imaging     Hybrid Journal   (Followers: 12)
European Journal of Radiology     Hybrid Journal   (Followers: 21)
European Journal of Radiology Open     Open Access   (Followers: 9)
European Radiology     Hybrid Journal   (Followers: 17)
European Radiology Experimental     Open Access  
European Radiology Supplements     Hybrid Journal   (Followers: 3)
Feuillets de Radiologie     Full-text available via subscription  
Frontiers in Neurogenesis     Open Access   (Followers: 2)
IEEE Transactions on Medical Imaging     Hybrid Journal   (Followers: 28)
IEEE Transactions on Radiation and Plasma Medical Sciences     Hybrid Journal   (Followers: 1)
Imagen Diagnóstica     Full-text available via subscription  
Imaging Decisions MRI     Hybrid Journal   (Followers: 2)
Indian Journal of Nuclear Medicine     Open Access   (Followers: 2)
Indian Journal of Radiology and Imaging     Open Access   (Followers: 4)
Insights into Imaging     Open Access   (Followers: 4)
International Journal of Biomedical Nanoscience and Nanotechnology     Hybrid Journal   (Followers: 8)
International Journal of Computer Assisted Radiology and Surgery     Hybrid Journal   (Followers: 6)
International Journal of Medical Physics, Clinical Engineering and Radiation Oncology     Open Access   (Followers: 10)
International Journal of Nanomedicine     Open Access   (Followers: 2)
International Journal of Radiation Biology     Hybrid Journal   (Followers: 6)
International Journal of Tomography & Simulation     Full-text available via subscription   (Followers: 1)
Interventional Neuroradiology     Hybrid Journal   (Followers: 1)
Interventionelle Radiologie Scan     Hybrid Journal   (Followers: 1)
Investigative Radiology     Hybrid Journal   (Followers: 10)
Iranian Journal of Medical Physics     Open Access  
Iranian Journal of Nuclear Medicine     Open Access   (Followers: 1)
Iranian Journal of Radiology     Open Access   (Followers: 5)
Japanese Journal of Radiology     Hybrid Journal   (Followers: 4)
Journal de Radiologie     Full-text available via subscription  
Journal de Radiologie Diagnostique et Interventionnelle     Full-text available via subscription   (Followers: 2)
Journal of Nanomedicine & Nanotechnology     Open Access   (Followers: 1)
Journal of Clinical Imaging Science     Open Access   (Followers: 3)
Journal of Clinical Interventional Radiology ISVIR     Open Access   (Followers: 2)
Journal of Clinical Ultrasound     Hybrid Journal   (Followers: 6)
Journal of Computer Assisted Tomography     Hybrid Journal   (Followers: 1)
Journal of Diagnostic Medical Sonography     Hybrid Journal  
Journal of Diagnostic Radiography and Imaging     Hybrid Journal   (Followers: 4)
Journal of Fetal Medicine     Hybrid Journal  
Journal of Global Radiology     Open Access   (Followers: 2)
Journal of Indian Academy of Oral Medicine and Radiology     Open Access   (Followers: 3)
Journal of Innovative Optical Health Sciences     Open Access  
Journal of Liver : Disease & Transplantation     Hybrid Journal   (Followers: 7)
Journal of Magnetic Resonance     Hybrid Journal   (Followers: 14)
Journal of Magnetic Resonance Imaging     Hybrid Journal   (Followers: 17)
Journal of Medical Imaging     Free   (Followers: 5)
Journal of Medical Imaging and Radiation Oncology     Hybrid Journal   (Followers: 3)
Journal of Medical Imaging and Radiation Sciences     Hybrid Journal   (Followers: 5)
Journal of Medical Radiation Sciences     Open Access   (Followers: 3)
Journal of Neuroradiology     Full-text available via subscription   (Followers: 4)
Journal of Nuclear Medicine     Full-text available via subscription   (Followers: 20)
Journal of Nuclear Medicine & Radiation Therapy     Open Access   (Followers: 3)
Journal of Nucleic Acids Investigation     Open Access   (Followers: 2)
Journal of Oral and Maxillofacial Radiology     Open Access   (Followers: 1)
Journal of Pediatric Neuroradiology     Hybrid Journal   (Followers: 3)
Journal of Radiation and Cancer Research     Open Access  
Journal of Radiation Research     Open Access   (Followers: 3)
Journal of Radiation Research and Applied Sciences     Open Access   (Followers: 2)
Journal of Radiobiology     Open Access   (Followers: 1)
Journal of Radiological Protection     Full-text available via subscription   (Followers: 4)
Journal of Radiology and Oncology     Open Access  
Journal of Radiology Nursing     Hybrid Journal   (Followers: 2)
Journal of Radiosurgery     Hybrid Journal   (Followers: 2)
Journal of Radiotherapy in Practice     Hybrid Journal   (Followers: 7)
Journal of the American College of Radiology     Hybrid Journal   (Followers: 10)
Journal of Thoracic Imaging     Hybrid Journal   (Followers: 3)
Journal of Vascular and Interventional Radiology     Hybrid Journal   (Followers: 13)
La radiologia medica     Hybrid Journal  
Magnetic Resonance Imaging     Hybrid Journal   (Followers: 7)
Magnetic Resonance Imaging Clinics of North America     Full-text available via subscription   (Followers: 8)
Magnetic Resonance in Medicine     Hybrid Journal   (Followers: 16)
Medical Image Analysis     Hybrid Journal   (Followers: 15)
Medical Imaging and Radiology     Open Access   (Followers: 7)
Nepalese Journal of Radiology     Open Access   (Followers: 1)
Neurographics     Free   (Followers: 3)
NeuroImage : Clinical     Open Access   (Followers: 15)
Neuroradiology     Hybrid Journal   (Followers: 9)
Neuroradiology Journal The     Hybrid Journal   (Followers: 1)
Nuclear Medicine and Biology     Hybrid Journal   (Followers: 4)
Nuclear Medicine and Molecular Imaging     Hybrid Journal   (Followers: 4)
Nuclear Medicine Communications     Hybrid Journal   (Followers: 2)
Nuclear Medicine Review     Open Access   (Followers: 2)
Nuklearmedizin / NuclearMedicine     Hybrid Journal  
Open Journal of Clinical Diagnostics     Open Access   (Followers: 1)
Open Journal of Medical Imaging     Open Access   (Followers: 1)
Open Journal of Radiology     Open Access   (Followers: 4)
Open Medical Imaging Journal     Open Access  
Oral Radiology     Hybrid Journal   (Followers: 1)
Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology     Full-text available via subscription   (Followers: 9)
Pediatric Radiology     Hybrid Journal   (Followers: 6)
Physica Medica     Full-text available via subscription   (Followers: 3)
Progress in Nuclear Magnetic Resonance Spectroscopy     Full-text available via subscription   (Followers: 8)
Radiation Protection and Environment     Open Access   (Followers: 1)
Radiatsionnaya Gygiena = Radiation Hygiene     Open Access  
Radiographics     Full-text available via subscription   (Followers: 27)
Radiography     Full-text available via subscription   (Followers: 7)
Radiography Open     Open Access   (Followers: 1)
Radiología     Full-text available via subscription   (Followers: 1)
Radiología (English Edition)     Full-text available via subscription  
Radiologia Brasileira     Open Access  
Radiologic Clinics of North America     Full-text available via subscription   (Followers: 19)
Radiologie up2date     Hybrid Journal   (Followers: 1)
Radiology     Full-text available via subscription   (Followers: 41)
Radiology Case Reports     Open Access   (Followers: 2)
Radiology of Infectious Diseases     Open Access   (Followers: 3)
Radiology Research and Practice     Open Access   (Followers: 3)
Radiopraxis     Hybrid Journal  
Reports in Medical Imaging     Open Access  
Research and Reports in Nuclear Medicine     Open Access   (Followers: 1)
Research Journal of Radiology     Open Access   (Followers: 5)
Revista Argentina de Radiología / Argentinian Journal of Radiology     Open Access  
Revista Chilena de Radiologia     Open Access  
Revista Española de Medicina Nuclear e Imagen Molecular     Full-text available via subscription   (Followers: 2)
Revista Española de Medicina Nuclear e Imagen Molecular (English Edition)     Full-text available via subscription  
Revista Internacional de Ciencias Podológicas     Open Access  
Seminars in Interventional Radiology     Hybrid Journal   (Followers: 6)
Seminars in Musculoskeletal Radiology     Hybrid Journal   (Followers: 6)
Seminars in Nuclear Medicine     Hybrid Journal   (Followers: 5)
Seminars in Roentgenology     Hybrid Journal   (Followers: 3)
Seminars in Ultrasound, CT and MRI     Hybrid Journal   (Followers: 9)
Shadows : The New Zealand Journal of Medical Radiation Technology     Full-text available via subscription   (Followers: 2)
Skeletal Radiology     Hybrid Journal   (Followers: 10)
Solid State Nuclear Magnetic Resonance     Hybrid Journal   (Followers: 3)
South African Journal of Radiology     Open Access   (Followers: 1)
South African Radiographer     Full-text available via subscription  
Sri Lanka Journal of Radiology     Open Access  
Surgical and Radiologic Anatomy     Hybrid Journal   (Followers: 6)
Techniques in Vascular and Interventional Radiology     Full-text available via subscription   (Followers: 8)
Topics in Magnetic Resonance Imaging     Hybrid Journal   (Followers: 3)
Ultraschall in der Medizin - European Journal of Ultrasound     Hybrid Journal   (Followers: 2)
Ultrasonic Imaging     Hybrid Journal   (Followers: 2)
Ultrasound Quarterly     Hybrid Journal   (Followers: 2)
West African Journal of Radiology     Open Access   (Followers: 1)
World Journal of Nuclear Medicine     Open Access   (Followers: 2)


Similar Journals
Journal Cover
Academic Radiology
Journal Prestige (SJR): 1.015
Citation Impact (citeScore): 2
Number of Followers: 27  
  Hybrid Journal Hybrid journal (It can contain Open Access articles)
ISSN (Print) 1076-6332
Published by Elsevier Homepage  [3206 journals]
  • Hindsight Bias—A Tricky Concept to Study in Radiology
    • Abstract: Publication date: Available online 21 February 2020Source: Academic RadiologyAuthor(s): Elizabeth A. Krupinski
  • Effects of Patient Size and Radiation Dose on Iodine Quantification in
           Dual-Source Dual-Energy CT
    • Abstract: Publication date: Available online 21 February 2020Source: Academic RadiologyAuthor(s): Xia Jiang, Xiangyu Yang, David E. Hintenlang, Richard D. WhiteRationale and ObjectivesThe purpose of this study was to investigate the potential effects of patient size and radiation dose on the accuracy of iodine quantification using dual-source dual-energy computed tomography (CT).Materials and MethodsThree phantoms representing different patient sizes were constructed, containing iodine inserts with concentrations from 0 to 20 mg/ml. Dual-energy CT scans were performed at six dose levels from 2 to 30 mGy. Iodine concentrations were measured using a three-material-decomposition algorithm and their accuracy was assessed.ResultsIn a small phantom, iodine quantification was accurate and consistent at all dose levels. In a medium phantom, minor underestimations were observed, and the results were consistent except at low dose. In the large phantom, more significant underestimation of iodine concentration was observed at higher doses (≥15 mGy), which was attributed to the beam-hardening effect. At lower doses, increasing upward bias was observed in the CT number, leading to significant overestimations of both iodine concentration and fat fraction, which was attributed to the photon-starvation effect. The severity of the latter effect was determined by mA instead of mAs, suggesting that the electronic noise, rather than the quantum noise, was responsible for the bias. Using higher kVp for the low-energy tube was found to alleviate these effects.ConclusionReliable iodine quantification can be achieved using dual-source CT, but the result can be affected by patient size and dose rate. In large patients, biases may occur due to the beam-hardening and the photon-starvation effects, in which case higher dose rate and higher kVp are recommended to minimize these effects.
  • Optimizing Contrast-Enhanced Thoracoabdominal CT in Patients During
           Extracorporeal Membrane Oxygenation
    • Abstract: Publication date: Available online 21 February 2020Source: Academic RadiologyAuthor(s): Marika Gullberg Lidegran, Lena Gordon Murkes, Jonas Andersson Lindholm, Björn FrencknerRationale and ObjectivesTo evaluate the quality and value of contrast-enhanced (CE) chest- and abdominal computed tomography (CT) and CT angiography in neonates, children, and adults undergoing extracorporeal membrane oxygenation (ECMO) using a customized protocol for contrast delivery.Materials and MethodsAll patients admitted for CE thoracic- and/or abdominal CT while on ECMO were prospectively included in the study. A protocol for contrast delivery adapted for the type of ECMO circulation, cannulation sites, anatomy of interest, and desired contrast phase was applied. Clinical information, ECMO and CT technique, including contrast administration strategy, was noted for each patient. Two radiologists separately evaluated the quality of the scan. The value of the examination was decided in consensus with the referring ECMO physician.ResultsOne hundred thirty CE thoracoabdominal scans were performed at 103 different occasions during the study time. Eighty-nine scans were performed during veno-arterial ECMO and 41 during veno-venous ECMO. In the majority, contrast was delivered to the oxygenator with preserved ECMO flow. A peripheral or central venous line with reduced flow was utilized in the remaining cases. Mean scan quality was graded 4.2 on a five-grade scale. In 56% of the examinations, the findings affected the immediate treatment of the patient.ConclusionHigh-quality CT and CT angiography can be achieved in ECMO patients of different ages and clinical issues considering the type of ECMO circulation, ECMO cannulation sites, preferred contrast phase and anatomy of interest. CT diagnoses affect the treatment of the patient.
  • Differentiation between Luminal A and B Molecular Subtypes of Breast
           Cancer Using Pharmacokinetic Quantitative Parameters with Histogram and
           Texture Features on Preoperative Dynamic Contrast-Enhanced Magnetic
           Resonance Imaging
    • Abstract: Publication date: March 2020Source: Academic Radiology, Volume 27, Issue 3Author(s): Hong-Bing Luo, Ming-Ying Du, Yuan-Yuan Liu, Min Wang, Hao-Miao Qing, Zhi-peng Wen, Guo-Hui Xu, Peng Zhou, Jing RenObjectiveThe aim of the present study was to use pharmacokinetic quantitative parameters with histogram and texture features on dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) to differentiate between the luminal A and luminal B molecular subtypes of breast cancer.MethodsWe retrospectively reviewed the data of 94 patients with histopathologically proven breast cancer. The pharmacokinetic quantitative parameters (Ktrans, Kep, and Ve) with their corresponding histogram and texture features based on preoperative DCE-MRI were obtained. The parameters were compared using the Mann–Whitney U-test between the luminal A and luminal B groups, the human epidermal growth factor receptor-2 (HER2)-positive luminal B and HER2-negative luminal B groups, and the lymph node metastasis (LNM)-positive and LNM-negative groups. Receiver operating characteristic curves were generated for parameters that presented significant between-group differences.ResultsThe maximum values of Ktrans, Kep, and Ve, and the mean and 90th percentile values of Ve were significantly higher in the luminal B group than in the luminal A group. Among the texture features, only skewness of Ktrans significantly differed between the luminal A and B groups. All histogram features of Ktrans were higher in the HER2-positive luminal B group than in the HER2-negative luminal B group. However, no parameter differed between the LNM-positive and LNM-negative groups.ConclusionPharmacokinetic quantitative parameters with histogram and texture features obtained from DCE-MRI are associated with the molecular subtypes of breast cancer, and may serve as potential imaging biomarkers to differentiate between the luminal A and luminal B molecular subtypes.
  • Corrigendum to “What Program Directors Think IV: Results of the 2017
           Annual Survey of the Association of Program Directors in Radiology”
           [Acad Radiol 2019; 26:1102-1109]
    • Abstract: Publication date: March 2020Source: Academic Radiology, Volume 27, Issue 3Author(s): Anna Rozenshtein, Brent Griffith, T.L. Mohammed, Darel E. Heitkamp, Linda A. Deloney, Angelisa M. Paladin, Stacy E. Smith, Ernest F. Wiggins, Jonathan O. Swanson
  • The Added Value of the Program Coordinator in the IR/DR Era
    • Abstract: Publication date: March 2020Source: Academic Radiology, Volume 27, Issue 3Author(s): Cory M. Pfeifer
  • Sharing with Medical Students: The Difference Diagnostic Radiologists Make
    • Abstract: Publication date: March 2020Source: Academic Radiology, Volume 27, Issue 3Author(s): Jason P. Davis, Richard B. Gunderman
  • Web-based Conferencing: What Radiology Educators Need to Know
    • Abstract: Publication date: March 2020Source: Academic Radiology, Volume 27, Issue 3Author(s): P.J. Lewis, T.M. Catanzano, L.P. Davis, S.G. JordanAdvances in technology have resulted in the significant growth of web-based conferencing and teaching. While these remote sessions have many advantages, they may result in challenges and frustration for both host and attendees when there are technological issues, poor or distracting audio, or ineffective presentation styles. Knowing a few basic concepts behind web conferencing and preparing in advance can markedly improve the experience and facilitate effective distance learning and collaboration.
  • Advancing Competency-Based Medical Education Through Assessment and
           Feedback in Breast Imaging
    • Abstract: Publication date: March 2020Source: Academic Radiology, Volume 27, Issue 3Author(s): Anna I. Holbrook, Claudia KasalesCompetency-based medical education (CBME) is a method of educating and assessing trainees that focuses on outcomes, rather than process. In this review, we inform radiologists involved in breast imaging training on the tenets of CBME and its relationship to the milestones, feedback and assessment. We also describe multiple methods for assessment specific to the breast imaging curriculum, and techniques for improving feedback to trainees in breast imaging.
  • Radiology Reports Must Adapt as Patient Needs Evolve and Access Improves
    • Abstract: Publication date: March 2020Source: Academic Radiology, Volume 27, Issue 3Author(s): Vivek Kalia
  • Optimizing Radiology Reports for Patients and Referring Physicians:
           Mitigating the Curse of Knowledge
    • Abstract: Publication date: March 2020Source: Academic Radiology, Volume 27, Issue 3Author(s): Ana P. Lourenco, Grayson L. BairdAs the movement for increased transparency in healthcare continues, more and more patients are accessing their imaging reports via patient portals. The shift to structured radiology reports has increased report clarity for referring providers and is supported by most radiologists. When radiologists address the clinical question that was posed, avoid the use of abbreviations, and create a report impression that is as simple as possible, we provide real added value via effective communication through our reports. In creating our reports with the patient in mind, and specifically knowing that many patients now directly review their imaging reports, we must be cognizant of the “curse of knowledge.” The curse of knowledge is a cognitive bias that exists when we assume others have the background to understand our often complex radiology reports. Striving to mitigate the curse of knowledge is important for both patients and referring providers reading our reports, and a report impression that is presented as simply as possible in “lay language” is one tangible step toward this goal. Educating our residents and fellows about these important considerations as they create their reports is imperative to their success as radiologists.
  • Characterization of Iodide-induced Sialadenitis: Meta-analysis of the
           Published Case Reports in the Medical Literature
    • Abstract: Publication date: March 2020Source: Academic Radiology, Volume 27, Issue 3Author(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.
  • Factors Affecting Response Rates in Medical Imaging Survey Studies
    • Abstract: Publication date: March 2020Source: Academic Radiology, Volume 27, Issue 3Author(s): Nanxi Zha, Mostafa Alabousi, Douglas S. Katz, Johnny Su, Michael PatlasRationale and ObjectiveTo review response rates published in medical imaging journals, and to analyze potential factors which contributed to a low response rate.Materials and MethodsA literature search was performed in MEDLINE and Embase to identify and assess published medical imaging survey studies. Variables assessed were response rate, incentives such as reminders and remuneration, and rationales provided for a potential low response rate. Statistical significance was calculated using unpaired t tests, ANOVA, Mann-Whitney, and Kruskal-Wallis tests.ResultsThree hundred and fifty-six unique surveys were included for analysis. The mean survey response rate in the current age of predominately electronic surveys was 45%. Factors which statistically significantly demonstrated a difference in response rate were survey location (European countries: 52%, Canada: 47%, United States: 42%; p < 0.05), survey topic (musculoskeletal: 69%, nuclear medicine: 64%, and education: 47%; p < 0.05), survey delivery method (telephone: 76%, email: 41%; p < 0.0001), and survey question type (short answer: 62%, multiple choice: 43%; p < 0.01). Statistically significant linear correlations were observed between the response rate compared to the number of reminders sent (r = 0.27; p < 0.01) and the number of participants (r = −0.26; p < 0.0001).ConclusionThe survey response rate serves as a surrogate marker for nonresponse bias. Survey response controlled for intrinsic nonadjustable characteristics offer achievable research goals. Adjustable factors to low response, including survey delivery method, question type, and number of reminders demonstrated statistical difference in response rate, and can be utilized by researchers to prospectively minimize nonresponse bias.
  • Bayesian Statistical Model of Item Response Theory in Observer Studies of
    • Abstract: Publication date: March 2020Source: Academic Radiology, Volume 27, Issue 3Author(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.
  • Impact of Patient Size and Radiation Dose on Accuracy and Precision of
           Iodine Quantification and Virtual Noncontrast Values in Dual-layer
           Detector CT—A Phantom Study
    • Abstract: Publication date: March 2020Source: Academic Radiology, Volume 27, Issue 3Author(s): Steven Van Hedent, Curtis Tatsuoka, Sarah Carr, Kai Roman Laukamp, Brendan Eck, Nils Große Hokamp, Rivka Kessner, Pablo Ros, David JordanRationale and ObjectivesIodine quantification (IQ) and virtual noncontrast (VNC) images produced by dual-energy CT (DECT) can be used for various clinical applications. We investigate the performance of dual-layer DECT (DLDECT) in different phantom sizes and varying radiation doses and tube voltages, including a low-dose pediatric setting.Materials and MethodsThree phantom sizes (simulating a 10-year-old child, an average, and a large-sized adult) were scanned with iodine solution inserts with concentrations ranging 0-32 mg/ml, using the DLDECT. Each phantom size was scanned with CTDIvol 2-15 mGy at 120 and 140 kVp. The smallest phantom underwent additional scans with CTDIvol 0.9-1.8 mGy. All scans were repeated 3 times. Each iodine insert was analyzed using VNC and IQ images for accuracy and precision, by comparison to known values.ResultsFor scans from 2 to 15 mGy mean VNC attenuation and IQ error in the iodine inserts in the small, medium, and large phantoms was 1.2 HU ± 3.2, −1.2 HU ± 14.9, 2.6 HU ± 23.6; and +0.1 mg/cc ± 0.4, −0.9 mg/cc ± 0.9, and −1.8 mg/cc ± 1.8, respectively. In this dose range, there were no significant differences (p ≥ 0.05) in mean VNC attenuation or IQ accuracy in each phantom size, while IQ was significantly less precise in the small phantom at 2 mGy and 10 mGy (p < 0.05). Scans with CTDIvol 0.9-1.8 mGy in the small phantom showed a limited, but statistically significantly lower VNC attenuation precision and IQ accuracy (−0.5 HU ± 5.3 and −0.3 mg/cc ± 0.5, respectively) compared to higher dose scans in the same phantom size.ConclusionPerformance of iodine quantification and subtraction by VNC images in DLDECT is largely dose independent, with the primary factor being patient size. Low-dose pediatric scan protocols have a significant, but limited impact on IQ and VNC attenuation values.
  • 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: March 2020Source: Academic Radiology, Volume 27, Issue 3Author(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.
  • Response to Dr. Cory Pfeifer
    • Abstract: Publication date: March 2020Source: Academic Radiology, Volume 27, Issue 3Author(s): Richard B. Gunderman
  • An Optimized Test Bolus Contrast Injection Protocol for Consistent
           Coronary Artery Luminal Enhancement for Coronary CT Angiography
    • Abstract: Publication date: March 2020Source: Academic Radiology, Volume 27, Issue 3Author(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: March 2020Source: Academic Radiology, Volume 27, Issue 3Author(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
  • Distinguishing Benign From Malignant Soft Tissue Tumors By Dynamic
           Susceptibility Contrast Magnetic Resonance Imaging
    • Abstract: Publication date: March 2020Source: Academic Radiology, Volume 27, Issue 3Author(s): Masaaki Hori
  • Clinical Applications of DSC-MRI Parameters Assess Angiogenesis and
           Differentiate Malignant From Benign Soft Tissue Tumors in Limbs
    • Abstract: Publication date: March 2020Source: Academic Radiology, Volume 27, Issue 3Author(s): Yitong Bian, Ping Jin, Yanliang Wang, Xiaocheng Wei, Yongqian Qiang, Gang Niu, Guohong Jin, Jian YangObjectiveTo investigate the correlation between dynamic susceptibility contrast magnetic resonance imaging (DSC-MRI) parameters and angiogenesis and to explore prospectively the feasibility of using DSC-MRI to differentiate malignant from benign soft tissue tumors (STTs) in limbs.MethodsThis prospective study included 33 patients with STTs in limbs who underwent DSC-MRI after bolus Gd-DTPA infusion. All STTs were confirmed by pathological examination after surgery and microvessel density (MVD), vascular endothelial growth factor (VEGF) expression, were evaluated by immune-histochemical analysis. Semiquantitative DSC-MRI parameters, including negative enhancement integral (NEI), maximum slopes of decrease (MSD) and increase (MSI), and mean time to enhancement were calculated by postprocessing in workstation. The correlation was analyzed between DSC-MRI parameters and angiogenesis factors. Then, the DSC-MRI parameters were compared between benign and malignant STTs and evaluated for diagnostic efficiency by receiver operating characteristic.ResultsThe 33 evaluated tumors were consisted of 13 benign and 20 malignant STTs in limbs. Significant positive correlations were observed between NEI, MSD, MSI and MVD, VEGF (p < 0.05). However, mean time to enhancement had no correlation with MVD and VEGF. The benign and malignant STTs differed significantly in terms of NEI, MSD, and MSI (p < 0.05). The areas under the curve (AUC) of NEI, MSD, and MSI were 0.915, 0.862, and 0.815 for discriminating between benign and malignant STTs, respectively.ConclusionDSC-MRI parameters are positively correlated with MVD and VEGF, which can evaluate angiogenesis indirectly. Furthermore, DSC-MRI can be considered as one of assistant noninvasive MR imaging technique in differentiation between benign and malignant STTs in limbs.
  • Gray Matter Structural Network Disruptions in Survivors of Acute
           Lymphoblastic Leukemia with Chemotherapy Treatment
    • Abstract: Publication date: March 2020Source: Academic Radiology, Volume 27, Issue 3Author(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.
  • Histological Grade of Meningioma: Prediction by Intravoxel Incoherent
           Motion Histogram Parameters
    • Abstract: Publication date: March 2020Source: Academic Radiology, Volume 27, Issue 3Author(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.
  • Differential Diagnosis of Nonhypervascular Pancreatic Neuroendocrine
           Neoplasms From Pancreatic Ductal Adenocarcinomas, Based on Computed
           Tomography Radiological Features and Texture Analysis
    • Abstract: Publication date: March 2020Source: Academic Radiology, Volume 27, Issue 3Author(s): Haopeng Yu, Zixing Huang, Mou Li, Yi Wei, Lin Zhang, Chengmin Yang, Yongchang Zhang, Bin SongRationale and ObjectivesTo determine computed tomography (CT) radiological features and texture features that are rewarding in differentiating nonhypervascular pancreatic neuroendocrine neoplasms (PNENs) from pancreatic ductal adenocarcinomas (PDACs).Materials and MethodsWe compared patients to pathologically proven nonhypervascular PNENs and age-matched controls with pathologically proven PDACs in a 1:2 ratio. Preoperative CT images in the arterial phase (AP) and portal vein phase (PVP) were obtained. Two radiologists independently reviewed the morphological characteristics of each tumor. Three-dimensional regions of interest (ROIs), drawn using ITK-SNAP software, were input into AK software (Artificial Intelligent Kit, GE) to extract texture features from AP and PVP images. Differences between PNENs and PDACs were analyzed with the chi-squared test, least absolute shrinkage and selection operator, kappa statistics, and uni- and multivariate logistic regression analyses.ResultsIn total, 40 nonhypervascular PNENs and 80 PDACs were evaluated. Maximum diameter on axial section, margin, calcification, vascularity in the tumor, and tumor heterogeneity were significantly different between PDACs and nonhypervascular PNENs. Multivariate analysis showed well-defined tumor margin (odds ratio: 21.0) and presence of calcification (odds ratio: 4.4) were significant predictors of nonhypervascular PNENs. The area under the receiver operating characteristic curve of the radiological feature model, AP texture model, and PVP texture model were 0.780, 0.855, and 0.929, respectively, based on logistic regression.ConclusionA well-defined margin and calcification in the tumor were helpful in discriminating nonhypervascular PNENs from PDACs. Texture analysis of contrast-enhanced CT images could be beneficial in differentially diagnosing nonhypervascular PNENs and PDACs.
  • The Effect of Transjugular Intrahepatic Portosystemic Shunt Plus Partial
           Splenic Embolization for the Treatment of Patients with Recurrent Variceal
    • Abstract: Publication date: March 2020Source: Academic Radiology, Volume 27, Issue 3Author(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.
  • Corrigendum to “Evaluation of Texture Analysis Parameter for Response
           Prediction in Patients with Hepatocellular Carcinoma Undergoing
           Drug-Eluting Bead Transarterial Chemoembolization (DEB-TACE) Using
           Biphasic Contrast-Enhanced CT Image Data Correlation with Liver Perfusion
           CT” [Acad Radiol 24 (2017): 1352–1363]
    • Abstract: Publication date: March 2020Source: Academic Radiology, Volume 27, Issue 3Author(s):
  • Comments on “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: March 2020Source: Academic Radiology, Volume 27, Issue 3Author(s): Ge Wen, Yongmei Deng, Fuchao Liu, Xiaojia Wu
  • Detection of Mice Colorectal Tumors by Endoluminal Ultrasound
           Biomicroscopic Images and Quantification of Image Augmented Gray Values
           Following Injection of VEGFR-2 Targeted Contrast Agent
    • Abstract: Publication date: Available online 15 February 2020Source: Academic RadiologyAuthor(s): Rossana Colla Soletti, Marcelo Alexandre Pinto de Britto, Helena Lobo Borges, João Carlos MachadoRationale and ObjectivesUltrasound biomicroscopy (UBM) is a noninvasive imaging technique that can be applied in detecting colonic tumors and, once associated with an ultrasound contrast agent (UCA), can identify the molecular expression of cancer-related biomarkers, such as the vascular endothelial growth factor receptor 2 (VEGFR-2). The present work aimed to detect colonic tumors and quantify augmented gray values of endoluminal UBM (eUBM) images from colonic tumors following the injection of VEGFR-2 targeted UCA (VEGFR2-UCA) into a mouse model of colorectal cancer.Material and MethodsA 40 MHz miniprobe catheter inserted through the biopsy channel of a pediatric flexible bronchofiberscope was used to obtain colonoscopic and B-mode eUBM images simultaneously. Seventeen tumor-bearing mice had their colons inspected and six of them were subjected to a VEGFR2-UCA injection to predict VEGFR-2 expression.ResultsAll animals developed distal colon tumors and eUBM was able to detect all of them and also to characterize the tumors, with 71.4% being in situ lesions and 28.6% being tumors invading the mucosa + muscularis mucosae + submucosa layers, as confirmed by histopathology. After VEGFR2-UCA injection, gray values from the eUBM tumoral images increased significantly (p < 0.01). Tumor sites with increased eUBM image gray values corresponded to areas with increased VEGFR-2 expression, as confirmed by immunohistochemistry.ConclusionThe results confirm eUBM as a powerful noninvasive and real-time tool for detecting colon tumor and its invasiveness and once associated with VEGFR2-UCA may become a tool for the detection of VEGFR-2 expression in colonic tumors.
  • Clinical Value of 18F-FDG PET/CT in Prediction of Visceral Pleural
           Invasion of Subsolid Nodule Stage I Lung Adenocarcinoma
    • Abstract: Publication date: Available online 14 February 2020Source: Academic RadiologyAuthor(s): Zhifeng Chen, Suxiang Jiang, Zhoulei Li, Liangjun Rao, Xiangsong ZhangRationale and ObjectivesThis study investigated the utility of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) for predicting visceral pleural invasion (VPI) of subsolid nodule (SSN) stage I lung adenocarcinoma.Materials and MethodsA retrospective analysis of 18F-FDG PET/CT data from 65 postsurgical cases with surgical pathology-confirmed SSN lung adenocarcinoma identified significant VPI predictors using multivariate logistic regression.ResultsNodule and solid component sizes, solid component-to-tumor ratios, pleural indentations, distances between nodules and pleura, and maximum standardized uptake values (SUVmax) differed significantly between VPI-positive (n = 30) and VPI-negative (n = 35) cases on univariate analysis. The distance between the nodule and pleura and SUVmax were significant independent VPI predictors on multivariate analysis. Areas under the curve of the distance between the nodule and pleura and SUVmax on receiver operating characteristic curves were 0.76 and 0.79, respectively; both factors were 0.90. The area under the curve of combined predictors was significantly superior to the distance between the nodule and pleura only but not SUVmax alone. The threshold of the distance between the nodule and pleura, to predict VPI was 4.50 mm, with 96.67% sensitivity, and 57.14% specificity. The threshold of SUVmax to predict VPI was 1.05, with 100% sensitivity and 60% specificity. The sensitivity and specificity of model 2 using the independent predictive factors were 96.67%, and 71.43%, respectively.ConclusionDistance between the nodule and pleura and SUVmax are independent predictors of VPI in SSN stage I lung adenocarcinoma. Further, combining these factors improves their predictive ability.
  • Prediction of Platinum-based Chemotherapy Response in Advanced High-grade
           Serous Ovarian Cancer: ADC Histogram Analysis of Primary Tumors
    • Abstract: Publication date: Available online 13 February 2020Source: Academic RadiologyAuthor(s): Jing Lu, Hai Ming Li, Song Qi Cai, Shu Hui Zhao, Feng Hua Ma, Yong Ai Li, Xiao Liang Ma, Jin Wei QiangRationale and ObjectivesTo investigate the feasibility of apparent diffusion coefficient (ADC) histogram analysis of primary advanced high-grade serous ovarian cancer (HGSOC) to predict patient response to platinum-based chemotherapy.Materials and MethodsA total of 70 patients with 102 advanced stage HGSOCs (International Federation of Gynecology and Obstetrics (FIGO) stages III-IV) who received standard treatment of primary debulking surgery followed by the first line of platinum-based chemotherapy were retrospectively enrolled. Patients were grouped as platinum-resistant and platinum-sensitive according to whether relapse occurred within 6 months. Clinical characteristics, including age, pretherapy CA125 level, International Federation of Gynecology and Obstetrics stage, residual tumor, and histogram parameters derived from whole tumor and solid component such as ADCmean; 10th, 20th, 25th, 30th, 40th, 50th, 60th, 70th, 75th, 80th, 90th percentiles; skewness and kurtosis, were compared between platinum-resistant and platinum-sensitive groups.ResultsNo significantly different clinical characteristics were observed between platinum-sensitive and platinum-resistant patients. There were no significant differences in any whole-tumor histogram-derived parameters between the two groups. Significantly higher ADCmean and percentiles and significantly lower skewness and kurtosis from the solid-component histogram parameters were observed in the platinum-sensitive group when compared with the platinum-resistant group. ADCmean, skewness and kurtosis showed moderate prediction performances, with areas under the curve of 0.667, 0.733 and 0.616, respectively. Skewness was an independent risk factor for platinum resistance.ConclusionPretreatment ADC histogram analysis of primary tumors has the potential to allow prediction of response to platinum-based chemotherapy in patients with advanced HGSOC.
  • The Utility of Modified Dixon Turbo Spin Echo Shoulder Magnetic Resonance
           Arthrography in Assessing Rotator Cuff Disorder and Evaluating the Rotator
           Cuff Muscles
    • Abstract: Publication date: Available online 13 February 2020Source: Academic RadiologyAuthor(s): Seok Hahn, Young Han Lee, Hong Seon Lee, Ho-Taek Song, Jin-Suck SuhRationale and ObjectivesTo compare the diagnostic ability of modified Dixon (mDixon) turbo spin echo (TSE) T1-weighted (T1W) shoulder magnetic resonance arthrography (MRA) with that of conventional shoulder MRA, and evaluate the feasibility of mDixon TSE in-phase (IP) images in measuring the fat fraction and size of rotator cuff muscles.Materials and MethodsThis retrospective study included 57 patients who underwent 3T shoulder MRA examinations with conventional and mDixon TSE T1W images (mean age: 56.7 years; range: 20–78 years). Two musculoskeletal radiologists independently evaluated the rotator cuff tendons with fat saturated T1W images and mDixon TSE T1W water images. Occupation ratios measured on T1W and mDixon TSE T1W IP images were compared. The fat fraction of the supraspinatus from the mDixon TSE T1W images was calculated and correlated with fatty infiltration of the supraspinatus on T1W images.ResultsFor tendon pathology, the kappa value for inter-sequence and inter-reader agreement was 0.957 (95% confidence interval [CI]: 0.923–0.990) and 0.839 (95% CI: 0.778–0.899), respectively. For retear, the kappa value for inter-sequence and inter-reader agreement was 0.913 (95% CI: 0.796–1.000) and 0.779 (95% CI: 0.594–0.963), respectively. The intraclass correlation coefficient for both occupation ratios was 0.986 (95% CI: 0.973–0.993). Comparison of mDixon TSE T1W fat fraction with Goutallier grade showed a strong positive linear correlation (r = 0.929).ConclusionsThe mDixon TSE T1W sequence is a good alternative to conventional sequences in shoulder MRA for evaluating rotator cuff pathology. Furthermore, this sequence provides information on the size and fat infiltration of rotator cuff muscles.
  • Peer Learning Through Multi-Institutional Case Conferences: Abdominal and
           Cardiothoracic Radiology Experience
    • Abstract: Publication date: Available online 13 February 2020Source: Academic RadiologyAuthor(s): Ryan A. Chow, Nelly Tan, Travis S Henry, Jeffrey P. Kanne, Aarti SekharRationale and ObjectivesWe describe a model of multi-institutional, multisociety, online case conferences that is a case-based group discussion of selected (nonrandom) cases which are subsequently hosted on social media and online platforms (e.g., YouTube, websites) to be available for a wider audience.Materials and MethodsUsing online conferencing software (Zoom, GoToMeeting), participants from both abdominal and cardiothoracic radiologists engage in separate, subspecialty one-hour meetings discussing a variety of meaningful cases. Participants take turns presenting their cases to the group and discuss significant findings, interpretations, differential diagnoses, and any other teaching points. All of the case conferences for both societies are recorded and edited to be uploaded on YouTube and their respective websites.ResultsParticipants from these conferences log in from 14 institutions in 7 states across the United States. The YouTube videos reach thousands of people around the world. The abdominal case conference on YouTube has received almost 1,300 views with 90 videos uploaded. The thoracic (the Society of Thoracic Radiology) case conference has been running for over 7 years, with 226 videos uploaded to YouTube and 38,200 views, 1426 subscribers, and a total watch time of over 525,800 minutes. Twitter has been utilized by both groups to promote online viewership.ConclusionOur model is feasible and effective compared to traditional peer review. The cases selected are deliberate and focused on quality improvement and/or education. We harness online engagement, specifically social media presence, which has opened new opportunities to educate our peers and reach a global audience, including the nonradiologic community, to learn about radiology and unique practices.
  • Aligning the Implicit Curriculum with the Explicit Curriculum in Radiology
    • Abstract: Publication date: Available online 12 February 2020Source: Academic RadiologyAuthor(s): Keith D. Herr, Elizabeth George, Vikas Agarwal, Colin D. McKnight, Liwei Jiang, Anugayathri Jawahar, Mini Pakkal, Adam Ulano, Dhakshinamoorthy GaneshanPhysician education occurs through two mechanisms that operate in tandem: the explicit and the implicit curriculum. The explicit, or formal, curriculum is the official version that is usually taken as the one-and-only curriculum and which is detailed in official documentation; however, an implicit curriculum exists, comprised of subtle messaging about professional norms, values, and beliefs that are tacitly communicated through both positive and negative role modeling. Both contribute to the overall education of the medical student and physician-in-training. Despite its well-documented influence in medical education, much of the teachings of the implicit curriculum occurs in the shadows, unspoken and unarticulated, and outside the awareness of both teacher and student. As panel members of the The Implicit Curriculum in Radiology Task Force of the Association of University Radiologists-Radiology Research Alliance (AUR-RRA), we present a review of the implicit curriculum, exploring its origin and impact on medical education, and on the overall professional development of medical students, post-graduate medical trainees and practicing physicians. Strategies for recognizing and contending with the implicit curriculum in radiology training are discussed, with a special emphasis on opportunities to leverage its potential through positive role modeling.
  • Noninterpretive Uses of Artificial Intelligence in Radiology
    • Abstract: Publication date: Available online 12 February 2020Source: Academic RadiologyAuthor(s): Michael L. Richardson, Elisabeth R. Garwood, Yueh Lee, Matthew D. Li, Hao S. Lo, Arun Nagaraju, Xuan V. Nguyen, Linda Probyn, Prabhakar Rajiah, Jessica Sin, Ashish P. Wasnik, Kali XuWe deem a computer to exhibit artificial intelligence (AI) when it performs a task that would normally require intelligent action by a human. Much of the recent excitement about AI in the medical literature has revolved around the ability of AI models to recognize anatomy and detect pathology on medical images, sometimes at the level of expert physicians. However, AI can also be used to solve a wide range of noninterpretive problems that are relevant to radiologists and their patients. This review summarizes some of the newer noninterpretive uses of AI in radiology.
  • Evaluation of Significant Coronary Artery Disease Based on CT Fractional
           Flow Reserve and Plaque Characteristics Using Random Forest Analysis in
           Machine Learning
    • Abstract: Publication date: Available online 10 February 2020Source: Academic RadiologyAuthor(s): Tomohiro Kawasaki, Masafumi Kidoh, Teruhito Kido, Daisuke Sueta, Shinichiro Fujimoto, Kanako Kunishima Kumamaru, Teruyoshi Uetani, Yuki Tanabe, Toshio Ueda, Daisuke Sakabe, Seitaro Oda, Tsuneo Yamashiro, Kenichi Tsujita, Shingo Kato, Hideaki Yuki, Daisuke UtsunomiyaRationale and ObjectivesFractional flow reserve (FFR) is an established technique for detecting lesion-specific ischemia but is invasive. Our objective was to investigate the effects of combined assessment of coronary CT angiography (CCTA) imaging features and CT-FFR on detecting lesion-specific ischemia by comparing with invasive FFR.Materials and MethodsForty-seven patients who had 60 coronary vessels with 30%–90% stenosis were included. Six anatomic CCTA descriptors (Agatston score, stenosis severity, mean plaque CT attenuation value, noncalcified and calcified plaque volumes, remodeling index) and a functional descriptor (CT-FFR) were measured. Random forest was used to identify which descriptors were useful to identify ischemia-related lesion. Receiver-operating characteristic (ROC) curves were calculated for 2 models: i.e. Model-1 for anatomical CT descriptors and Model-2 for anatomical CT descriptors plus CT-FFR.ResultsStenosis severity (40.8 ± 15.7% vs 57.6 ± 14.1%), noncalcified plaque volume (190 ± 100 vs 254.8 ± 133.3), and remodeling index (1.04 ± 0.12 vs 1.11 ± 0.13) were significantly higher in ischemia-related lesions than nonischemia-related lesions. CT-FFR was 0.84 ± 0.14 and 0.71 ± 0.14, respectively, for ischemia-related and nonischemia-related lesions, and the difference was significant. The area under the ROC curve was 0.738 and 0.835 in Model-1 and Model-2, respectively. Reclassification of ischemic lesion risk was significantly improved after adding CT-FFR: net reclassification improvement was 0.297 and integrated discrimination improvement was 0.254.ConclusionCombined assessment of anatomical CCTA features and functional CT-FFR was helpful for detecting lesion-specific ischemia.
  • Magnetic Resonance Texture Analysis in Alzheimer's disease
    • Abstract: Publication date: Available online 10 February 2020Source: Academic RadiologyAuthor(s): Jia-Hui Cai, Yuan He, Xiao-Lin Zhong, Hao Lei, Fang Wang, Guang-Hua Luo, Heng Zhao, Jin-Cai LiuTexture analysis is an emerging field that allows mathematical detection of changes in MRI signals that are not visible among image pixels. Alzheimer's disease, a progressive neurodegenerative disease, is the most common cause of dementia. Recently, multiple texture analysis studies in patients with Alzheimer's disease have been performed. This review summarizes the main contributors to Alzheimer's disease-associated cognitive decline, presents a brief overview of texture analysis, followed by review of various MR imaging texture analysis applications in Alzheimer's disease. We also discuss the current challenges for widespread clinical utilization. MR texture analysis could potentially be applied to develop neuroimaging biomarkers for use in Alzheimer's disease clinical trials and diagnosis.
  • Improved Depictions of the Anterior Choroidal Artery and
           Thalamoperforating Arteries on 3D-CTA Images Using Model-based Iterative
    • Abstract: Publication date: Available online 7 February 2020Source: Academic RadiologyAuthor(s): Naoko Hamaguchi, Noriyuki Fujima, Akiyoshi Hamaguchi, Shuuichi KoderaRationale and ObjectivesTo evaluate the depictability of intracranial small arteries using high-resolution CTA with model-based iterative reconstruction (MBIR).Materials and MethodsWe retrospectively analyzed 21 patients who underwent brain 3D-CTA. Axial and volume-rendered (VR) images were reconstructed from the 3D-CTA raw data using adaptive statistical image reconstruction (ASIR) and MBIR.As a quantitative assessment, intra-arterial CT values of the ICA and contrast-to-noise ratio were measured to evaluate vessel enhancement. Additionally, CT values and standard deviations (SDs) of CT values and signal to noise ratio in white matter parenchyma were measured to evaluate background noise.As a qualitative assessment, the degree of vessel depictability in the anterior choroidal artery (AchoA) and the perforating branches of thalamoperforating arteries (TPA) on VR images using two different reconstruction algorithms was visually evaluated using a 3-point grading system.ResultsThe CT value of the ICA [605.27± 89.76 Hounsfield units (HU)] was significantly increased and the SD value (i.e., image noise) of the white matter parenchyma [6.79 ± 0.81(HU)] was decreased on MBIR compared with ASIR [546.76 ± 85.27 (HU)] and [8.04 ± 1.08 HU)] (p
  • Impact of Brain Functional Network Properties on Intelligence in Children
           and Adolescents with Focal Epilepsy: A Resting-state MRI Study
    • Abstract: Publication date: Available online 6 February 2020Source: Academic RadiologyAuthor(s): Liu Songjiang, Zhang Tijiang, Liu Heng, Zhang Wenjing, Tao Bo, Song Ganjun, Tian Maoqiang, Lui SuRationale and ObjectiveEpilepsy is a common pediatric disease that often leads to cognitive and intellectual impairments. Here, we explore the reorganized functional networks in children and adolescents with focal epilepsy (CAFE) and analyze the relationship between network reorganization and intellectual deficits to reveal the underlying link between them.Materials and MethodsFifty-four CAFE (6–16 years old; right-handed) and 42 well-matched healthy controls were recruited. Subjects underwent resting-state functional magnetic resonance imaging, and functional networks were analyzed by graph analysis. Intelligence testing (Wechsler Intelligence Scale for Children-Chinese revision) included measures for verbal IQ (VIQ), performance IQ, and full-scale IQ.Results(1) In the CAFE compared with the healthy controls, (a) the local efficiency, clustering coefficient and standardized clustering coefficient were significantly decreased (p < 0.05); (b) the degree centrality and nodal efficiency of the left precentral gyrus (LPG) were significantly increased (p < 0.05, Bonferroni correction), and the nodal shortest path length was significantly decreased (p < 0.05, Bonferroni correction); and (c) functional connectivity of the LPG with the bilateral inferior frontal ventral gyrus, right lateral superior occipital gyrus, left middle occipital gyrus, bilateral superior parietal lobule, right anterior prefrontal cortex, and bilateral cerebellum was enhanced (p < 0.05,GRF correction), while functional connectivity with the bilateral superior temporal gyrus was decreased (p < 0.05, GRF correction). (2) The nodal shortest path length of the LPG in CAFE was associated with full-scale IQ, performance IQ, and VIQ, and local efficiency was associated with VIQ.ConclusionOur results showed that the middle LPG in CAFE undergoes network reorganization that positively influences intelligence. Differences in local efficiency of functional networks in children and early adolescents have a significant effect on intelligence.
  • Impact of Vessel Suppressed-CT on Diagnostic Accuracy in Detection of
           Pulmonary Metastasis and Reading Time
    • Abstract: Publication date: Available online 6 February 2020Source: Academic RadiologyAuthor(s): K. Martini, C. Blüthgen, M. Eberhard, A.L.N. Schönenberger, I. De Martini, F.A. Huber, B.K. Barth, A. Euler, T. FrauenfelderRationale and ObjectivesTo assess if vessel suppression (VS) improves nodule detection rate, interreader agreement, and reduces reading time in oncologic chest computed tomography (CT).Material and MethodsOne-hundred consecutive oncologic patients (65 male; median age 60y) who underwent contrast-enhanced chest CT were retrospectively included. For all exams, additional VS series (ClearRead CT, Riverrain Technologies, Miamisburg) were reconstructed. Two groups of three radiologists each with matched experience were defined. Each group evaluated the SD-CT as well as VS-CT. Each reader marked the presence, size, and position of pulmonary nodules and documented reading time. In addition, for the VS-CT the presence of false positive nodules had to be stated. Cohen's Kappa (k) was used to calculate the interreader-agreement between groups. Reading time was compared using paired t test.ResultsNodule detection rate was significantly higher in VS-CT compared to the SD-CT (+21%; p
  • Analysis of Different Levels of Structured Reporting in Knee Magnetic
           Resonance Imaging
    • Abstract: Publication date: Available online 6 February 2020Source: Academic RadiologyAuthor(s): Kishore Chundru, Alexandra Roudenko, Hien Pham, Carlos L. BenitezRationale and ObjectivesThe aim of this study is to investigate the most appropriate knee MRI report template that not only provides structure and consistency, but also allows enough narrative freedom for the logical organization of findings and improved communication with the orthopedic referral base.Materials and MethodsThree fictitious knee MRI reports were created using templates with different levels of structuring: unstructured free text (FT), structured with headers (SH), and highly structured and itemized (SI). These were then distributed to clinicians in the orthopedics department at all levels of training along with a survey with numerical scoring questions on report readability, usefulness, and quality. Statistical analysis was used to evaluate the data.ResultsFifty-three surveys were completed with responses from residents, attendings, and physician assistants. The structured format with headers had statistically significant (p value
  • Transcatheter Intraarterial Perfusion MRI Approaches to Differentiate
           Reversibly Electroporated Penumbra From Irreversibly Electroporated Zones
           in Rabbit Liver
    • Abstract: Publication date: Available online 6 February 2020Source: Academic RadiologyAuthor(s): Liang Pan, Chong Sun, Kang Zhou, Matteo Figini, Bin Wang, Junjie Shangguan, Su Hu, Jia Yang, Wei Xing, Jian Wang, Yury Velichko, Vahid Yaghmai, Zhuoli ZhangRationale and ObjectivesTo investigate whether transcatheter intraarterial perfusion (TRIP) magnetic resonance imaging (MRI) can differentiate reversible electroporation (RE) zones from irreversible electroporation (IRE) zones immediately after IRE procedure in the rabbit liver.Materials and MethodsAll studies were approved by the institutional animal care and use committee and performed in accordance with institutional guidelines. A total of 13 healthy New Zealand White rabbits were used. After selective catheterization of the hepatic artery under X-ray fluoroscopy, we acquired TRIP-MRI at 20 minutes post-IRE using 3 mL of 5% intraarterial gadopentetate dimeglumine. Semi-quantitative (peak enhancement, PE; time to peak, TTP; wash-in slope, WIS; areas under the time-intensity curve, AUT, over 30, 60, 90, 120, 150, and 180 seconds after the initiation of enhancement) and quantitative (Ktrans, ve, and vp) TRIP-MRI parameters were calculated. The relationships between TRIP-MRI parameters and histological measurements and the differential ability of TRIP-MRI parameters was assessed.ResultsPE, AUT60, AUT90, AUT120, AUT150, AUT180, Ktrans, and ve were significantly higher in RE zones than in IRE zones (all P < 0.05), and AUC for these parameters ranged from 0.91(95% CI, 0.80, 1.00) to 0.99 (95% CI, 0.98, 1.00). There was no significant difference in AUC between any two parameters (Z, 0–1.47; P, 0.14–1.00). Hepatocyte apoptosis strongly correlated with PE, AUT60, AUT90, AUT120, AUT150, AUT180, Ktrans, and vp (the absolute value r, 0.6–0.7, all P < 0.0001).ConclusionAUT150 or AUT180 could be a potential imaging biomarker to differentiate RE from IRE zones, and TRIP-MRI permits to differentiate RE from IRE zones immediately after IRE procedure in the rabbit liver.
  • Erratum to “Impact of Effective Detector Pixel and CT Voxel Size on
           Accurate Estimation of Blood Volume in Opacified Microvasculature” [Acad
           Radiol 2019; 26:1410-1416]
    • Abstract: Publication date: Available online 5 February 2020Source: Academic RadiologyAuthor(s): Mahya Sheikhzadeh, Andrew J. Vercnocke, Shengzhen Tao, Kishore Rajendran, Shuai Leng, Erik L. Ritman, Cynthia H. McCollough
  • Propagation-Based Phase-Contrast CT of the Breast Demonstrates Higher
           Quality Than Conventional Absorption-Based CT Even at Lower Radiation Dose
    • Abstract: Publication date: Available online 5 February 2020Source: Academic RadiologyAuthor(s): Seyedamir Tavakoli Taba, Benedicta D. Arhatari, Yakov I. Nesterets, Ziba Gadomkar, Sheridan C. Mayo, Darren Thompson, Jane Fox, Beena Kumar, Zdenka Prodanovic, Daniel Hausermann, Anton Maksimenko, Christopher Hall, Matthew Dimmock, Konstantin M. Pavlov, Darren Lockie, Masoumeh Gity, Andrew Peele, Harry M. Quiney, Sarah Lewis, Timur E. GureyevRationale and ObjectivesPropagation-based phase-contrast CT (PB-CT) is an advanced X-ray imaging technology that exploits both refraction and absorption of the transmitted X-ray beam. This study was aimed at optimizing the experimental conditions of PB-CT for breast cancer imaging and examined its performance relative to conventional absorption-based CT (AB-CT) in terms of image quality and radiation dose.Materials and MethodsSurgically excised breast mastectomy specimens (n = 12) were scanned using both PB-CT and AB-CT techniques under varying imaging conditions. To evaluate the radiological image quality, visual grading characteristics (VGC) analysis was used in which 11 breast specialist radiologists compared the overall image quality of PB-CT images with respect to the corresponding AB-CT images. The area under the VGC curve was calculated to measure the differences between PB-CT and AB-CT images.ResultsThe highest radiological quality was obtained for PB-CT images using a 32 keV energy X-ray beam and by applying the Homogeneous Transport of Intensity Equation phase retrieval with the value of its parameter γ set to one-half of the theoretically optimal value for the given materials. Using these optimized conditions, the image quality of PB-CT images obtained at 4 mGy and 2 mGy mean glandular dose was significantly higher than AB-CT images at 4 mGy (AUCVGC = 0.901, p = 0.001 and AUCVGC = 0.819, p = 0.011, respectively).ConclusionPB-CT achieves a higher radiological image quality compared to AB-CT even at a considerably lower mean glandular dose. Successful translation of the PB-CT technique for breast cancer imaging can potentially result in improved breast cancer diagnosis.
  • Receiver Operating Characteristic (ROC) Analysis of Image
           Search-and-Localize Tasks
    • Abstract: Publication date: Available online 5 February 2020Source: Academic RadiologyAuthor(s): Yulei JiangRationale and ObjectivesReceiver operating characteristic (ROC) analysis for the common image search-and-localize task, in which readers search an image for lesion or lesions not knowing a priori any exists, has been studied for over four decades. However, a satisfactory solution seems elusive.Materials and MethodsWe show that the ROC curve predictive of clinical outcomes where readers are penalized appropriately for not correctly localizing known lesions cannot be obtained because it is a missing data problem. Further, this ROC curve is between the case-based ROC curve where readers are not penalized and the lesion-based ROC curve where penalty applies. Moreover, the lesion-based ROC curve is the LROC curve proposed by Starr et al. We show maximum-likelihood (ML) estimation of the LROC curve, validation of this procedure with Monte Carlo simulations, and its application to reader ROC datasets.ResultsMonte Carlo simulations validated ML estimation of area under the LROC curve (AUC) and its variance. Example applications showed that ML estimate of LROC curve fits experimental datasets.ConclusionThe ROC curve predictive of clinical performance cannot be estimated from reader ROC data alone because it is a missing data problem, and is between the case-based ROC curve where readers are not penalized for not correctly identifying known lesions and the lesion-based ROC curve where penalty applies. The lesion-based ROC curve is the LROC curve proposed by Starr et al. and can be estimated via ML estimation.
  • Fully-automated Segmentation of Muscle Measurement on CT in Detecting
           Central Sarcopenia: A Trend of Standardization
    • Abstract: Publication date: Available online 27 January 2020Source: Academic RadiologyAuthor(s): Qian Dong
  • Critical Challenges to the Management of Clinical Trial Imaging:
           Recommendations for the Conduct of Imaging at Investigational Sites
    • Abstract: Publication date: February 2020Source: Academic Radiology, Volume 27, Issue 2Author(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.
  • Association of Parity and Infant Feeding Method with Breast Density on
    • Abstract: Publication date: February 2020Source: Academic Radiology, Volume 27, Issue 2Author(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
  • Deep Learning in the Prediction of Ischaemic Stroke Thrombolysis
           Functional Outcomes: A Pilot Study
    • Abstract: Publication date: February 2020Source: Academic Radiology, Volume 27, Issue 2Author(s): Stephen Bacchi, Toby Zerner, Luke Oakden-Rayner, Timothy Kleinig, Sandy Patel, Jim JannesRationale and ObjectivesIntravenous thrombolysis decision-making and obtaining of consent would be assisted by an individualized risk-benefit ratio. Deep learning (DL) models may be able to assist with this patient selection.Materials and MethodsClinical data regarding consecutive patients who received intravenous thrombolysis across two tertiary hospitals over a 7-year period were extracted from existing databases. The noncontrast computed tomography brain scans for these patients were then retrieved with hospital picture archiving and communication systems. Using a combination of convolutional neural networks (CNN) and artificial neural networks (ANN) several models were developed to predict either improvement in the National Institutes of Health Stroke Scale of ≥4 points at 24 hours (“NIHSS24”), or modified Rankin Scale 0–1 at 90 days (“mRS90”). The developed CNN and ANN were then applied to a test set. The THRIVE, HIAT, and SPAN-100 scores were also calculated for the patients in the test set and used to predict NIHSS24 and mRS90.ResultsData from 204 individuals were included in the project. The best performing DL model for prediction of mRS90 was a combination CNN + ANN based on clinical data and computed tomography brain (accuracy = 0.74, F1 score = 0.69). The best performing model for NIHSS24 prediction was also the combination CNN + ANN (accuracy = 0.71, F1 score = 0.74).ConclusionDL models may aid in the prediction of functional thrombolysis outcomes. Further investigation with larger datasets and additional imaging sequences is indicated.
  • Web-based Radiology Subspecialty Training Program: Pilot Feasibility and
           Effectiveness Analysis on Ethiopian Radiologists
    • Abstract: Publication date: February 2020Source: Academic Radiology, Volume 27, Issue 2Author(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
  • Enthusiasm's Vital Role in Education
    • Abstract: Publication date: February 2020Source: Academic Radiology, Volume 27, Issue 2Author(s): Giovanni D. Rodriguez, Richard B. Gunderman
  • Express Team-Based Learning (eTBL): A Time-Efficient TBL Approach in
    • Abstract: Publication date: February 2020Source: Academic Radiology, Volume 27, Issue 2Author(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.
  • ACGME Case Log Values Correlate with Performance on ABR Core Exam
    • Abstract: Publication date: February 2020Source: Academic Radiology, Volume 27, Issue 2Author(s): Charles M. Maxfield
  • Correlation Between Radiology ACGME Case Logs Values and ABR Core Exam
           Pass Rate
    • Abstract: Publication date: February 2020Source: Academic Radiology, Volume 27, Issue 2Author(s): Joshua P. Nickerson, Chris Koski, James C. Anderson, Brooke Beckett, Valerie P. JacksonRationale and ObjectivesThere is discordance between the American Board of Radiology (ABR) and many radiology trainees with respect to the most appropriate means to prepare for the ABR Core Examination. Whereas the ABR suggests that participation in routine clinical examination interpretation best prepares a trainee for the practical material of the test, residents, and many program directors feel that time away from clinical service for study and review courses are necessary. This study examines the relationship between studies interpreted in the first three years of residency as reported in the Accreditation Council for Graduate Medical Education case logs and performance of first-time test takers on the ABR Core Examination.Materials and MethodsAccreditation Council for Graduate Medical Education case log data was anonymized for a single year cohort of residents in all accredited radiology residencies. This was then provided to the ABR and matched with performance on the Core Examination. A random effects logistic regression model was used to evaluate for a relationship between the number of examinations read and the pass/fail status of the Core Exam.ResultsModeling using a linear and a quadratic term yields a significant relationship between case log values and Core Exam performance. There is a positive correlation until an inflection point of approximately 11,000 examinations, at which point a negative correlation develops.ConclusionThe data supports that active engagement in clinical duties is associated with better performance on the ABR Core Examination, with the caveat that there appears to be a point at which service outweighs educational value. Beyond this, performance on the examination declines.
  • Making Technology Work for Radiologists
    • Abstract: Publication date: February 2020Source: Academic Radiology, Volume 27, Issue 2Author(s): David Avrin
  • Moving Radiology Workflow to the Electronic Health Record: Quantitative
           and Qualitative Experience From a Large Academic Medical Center
    • Abstract: Publication date: February 2020Source: Academic Radiology, Volume 27, Issue 2Author(s): Benjamin Wildman-Tobriner, Matthew P. Thorpe, Nicholas Said, Wendy L. Ehieli, Christopher J. Roth, Tracy A. JaffeRationale and ObjectivesTo objectively and subjectively evaluate a large, academic radiology department's transition to electronic health record (EHR) centered workflow.Materials and MethodsMultiple metrics were compared from before and after the move to EHR-driven workflow. Examination ordering and reading priority data were obtained for 30 days both before and after the transition. Sixteen radiologists were observed opening a computed tomography (CT) examination, and time to open, mouse clicks, and keystrokes were recorded. Information available to the radiologist during interpretation was also compared. Additionally, a 12 question survey was sent out to the residents and faculty both before and after the transition.ResultsImplementation of an eight-level reading priority system increased worklist granularity and improved identification of more urgent studies to read. Radiologists opened CT studies in picture archiving and communications system-driven workflow in 52.4 ± 16.9 seconds using 9.5 ± 3.9 clicks and 6.3 ± 2.9 keystrokes, compared to 17.3 ± 9.5 seconds, 4.8 ± 1.5 clicks, and 0.1 ± 0.3 keystrokes in EHR-driven workflow (p < 0.001 for each measure). More information was available to the radiologist during examination interpretation, and 54.7% of radiologists rated the ease of use of the new system as good or very good (compared to 4.2% for the old system, p < 0.001).ConclusionTransitioning to an EHR-driven workflow at a large academic medical center improved efficiency, was favorable to radiologists, and enhanced examination prioritization.
  • Evaluation of Pseudoreader Study Designs to Estimate Observer Performance
           Results as an Alternative to Fully Crossed, Multireader, Multicase Studies
    • Abstract: Publication date: February 2020Source: Academic Radiology, Volume 27, Issue 2Author(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.
  • Automated Identification of Optimal Portal Venous Phase Timing with
           Convolutional Neural Networks
    • Abstract: Publication date: February 2020Source: Academic Radiology, Volume 27, Issue 2Author(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.
  • Reducing Radiation Dose and Improving Image Quality in CT Portal
           Venography Using 80 kV and Adaptive Statistical Iterative Reconstruction-V
           in Slender Patients
    • Abstract: Publication date: February 2020Source: Academic Radiology, Volume 27, Issue 2Author(s): Zhanli Ren, Xirong Zhang, Zhijun Hu, Dou Li, Zhentang Liu, Donghong Wei, Yongjun Jia, Nan Yu, Yong Yu, Yuxin Lei, Xiaoxia Chen, Changyi Guo, Zhanliang Ren, Taiping HeObjectiveTo explore the feasibility of reducing radiation dose and improving image quality in CT portal venography (CTPV) using 80 kV and adaptive statistical iterative reconstruction-V(ASIR-V) in slender patients in comparison with conventional protocol using 120 kV and ASIR.MethodsSixty slender patients for enhanced abdominal CT scanning were randomly divided into group A and group B. Group A used the conventional 120 kV tube voltage, 600 mgI/kg contrast dose and reconstructed with the recommended 40% ASIR. Group B used 80 kV tube voltage, 350 mgI/kg contrast dose and reconstructed with ASIR-V from 40% to 100% with 10% interval. The CT values and standard deviation (SD) values of the main portal vein, left branch, and right branch of portal vein, liver, and erector spinae at the same level were measured to calculate the signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR). The image quality was subjectively scored by two experienced radiologists blindly using a 5-point criterion. The contrast dose, volumetric CT dose index, and dose length product were recorded in both groups and the effective dose was calculated.ResultsThere was no significant difference in general data between the two groups (p> 0.05), the effective dose and contrast dose in group B were reduced by 63.3% (p < 0.001) and 39.7% (p < 0.001), respectively compared with group A. With the percentage of ASIR-V increased in group B, the CT values showed no significant difference, while the SD values gradually decreased and SNR values and CNR values increased accordingly. Compared with group A, group B demonstrated similar CT values (p> 0.05), while the SD values with 80% ASIR-V to 100% ASIR-V were significantly lower than those of 40% ASIR (p < 0.001), and the SNR values and CNR values with 70% ASIR-V to 100% ASIR-V were significantly higher than those of 40% ASIR (p < 0.001). The subjective image quality scores by the two radiologists had excellent consistency (kappa value>0.75, p < 0.001), and the final subjective image quality scores and the subjective scores in each of the 5 scoring categories with 60% ASIR-V to 100% ASIR-V were all significantly higher than those of 40% ASIR, and 80% ASIR-V obtained the highest subjective score among different reconstructions.ConclusionIn CTPV, the application of 80 kV and ASIR-V reconstruction in slender patients can significantly reduce radiation dose (by 63.3%) and contrast agent dose (by 39.7%). Compared with the recommended 40% ASIR using 120 kV, ASIR-V with 80% to 100% percentages can further improve image quality and with 80% ASIR-V being the best reconstruction algorithm.Advances in knowledgeCTPV with 80 kV and ASIR-V algorithm in slender patients can significantly reduce radiation dose and contrast agent dose as well as improve image quality, compared with the conventional 120 kV protocol using 40% ASIR.
  • Dual-Energy CT of Material Decomposition Analysis for Detection with Bone
           Marrow Edema in Patients with Vertebral Compression Fractures
    • Abstract: Publication date: February 2020Source: Academic Radiology, Volume 27, Issue 2Author(s): Kyouhei Akisato, Reisuke Nishihara, Hajime Okazaki, Takanori Masuda, Ayako Hironobe, Hiromi Ishizaki, Kondo Shota, Hiroshi Yamaguchi, Yoshinori FunamaRationale and ObjectivesThis study investigated detecting bone marrow edema (BME) in patients with vertebral compression fractures. We compared dual-energy material density analysis images to magnetic resonance imaging (MRI), which is considered the gold standard.Materials and MethodsIn this retrospective study, 260 vertebral bodies from 30 patients (11 males, 19 females, mean age of 81) were assessed by MRI and dual-energy material density analysis. Diagnostic accuracy was assessed using the receiver operating characteristic (ROC) curve. Fifty-two of the 260 vertebral bodies were considered to have BME based on the dual-energy material density analysis images; 50 were deemed to have BME by MRI.ResultsROC analysis of the dual-energy material density analysis values revealed an area under the ROC curve of 0.95 for radiologist 1, 0.97 for radiologist 2, and 0.96 for radiologist 3. A mean cutoff value of 1032.6 mg/cm3 provided an overall sensitivity of 93.0% (95% confidence intervals [CI]: 86.0%–99.9%), specificity of 98.0% (95% CI: 95.5%–99.0%), accuracy of 97.0% (95% CI: 95.2%–99.0%), positive predictive value of 95.0% (95% CI: 81.0%–97.5%), and negative predictive value of 98.0% (95% CI: 93.0%–99.9%).ConclusionBME in patients with vertebral compression fractures can be detected using dual-energy material density analysis images.
  • Diagnosis of Lymphangiomatosis: A Study Based on CT Lymphangiography
    • Abstract: Publication date: February 2020Source: Academic Radiology, Volume 27, Issue 2Author(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.
  • Response: The USMLE Step 1 Pass/Fail Reporting Proposal: Another Opinion
    • Abstract: Publication date: February 2020Source: Academic Radiology, Volume 27, Issue 2Author(s): Absia Jabbar, Shahzaib Nabi, Adeel Arshad, Muhammad Ali
  • The Diagnostic Value of 3D Power Doppler Ultrasound Combined With VOCAL in
           the Vascular Distribution of Breast Masses
    • Abstract: Publication date: February 2020Source: Academic Radiology, Volume 27, Issue 2Author(s): Huizhu Wang, Bing Yan, Lifang Yue, Mingyu He, Yuehua Liu, Hezhou LiRationale and ObjectivesThis study uses a three-dimensional energy Doppler technique combined with the Virtual Organ Computer-aided Analysis (VOCAL) method in order to determine the diagnostic threshold of blood flow index in breast tumors to provide a reference for evaluation and treatment options.Materials and methodsWe collected 322 solid lesions which had been operated. Each lesion met the definite pathological diagnosis; collected lesions included 262 cases of benign lesions and 60 cases of malignant lesions. All examinations were performed by using GE LOGIQ E9 with VOCAL software. Volume and four distinct vascular indices of gray mean (MG), power mean, ratio (R), and vascular flow index (VFI) were calculated by using the VOCAL software. Sampling and calculation were repeated three times and the mean value was calculated.ResultsThe average age and power of the malignant group were greater than those of the benign group, ie p < .01 which had significant differences. The gray mean of the malignant group was lower than that of the benign group, ie p> .05 which had no significant differences between benign and malignant groups. The ratio, vascular flow index and volume had significant differences, i.e. p < .01. The area under the receiver operating characteristic curve (AUC) were 0.864, 0.830, 0.800, 0.758, and 0.764 for age, power, ratio, vascular flow index, and volume, respectively. The research indicators were higher than 50% of the curve showing their diagnostic value. The cut-off points of age, power, ratio, vascular flow index, and volume were 37.5, 26.56, 0.031, 0.846, and 1.75, respectively. Their corresponding sensitivity were 93.3%, 75%, 81.7%, 68.3%, 63.3%, and the specificity were 68.7%, 81%, 70.2%, 75.6%, and 81.7%, respectively. Comparison of vascular indices combined with the Breast imaging reporting and data System (BI-RADS) score and simple BI-RADS method, the AUC of power + BI-RADS, ratio + BI-RADS, VFI + BI-RADS, and BI-RADS alone are 0.928, 0.903, 0.895, and 0.796, respectively, which were higher than 50% of the curve. Sensitivity was 81.7%, 80%, 88.3%, 86.7%, and specificity was 88.5%, 85.5%, 77.1%, 69.5%, respectively. The power + BI-RADS method has the highest AUC among these three methods.ConclusionsQuantitative measurement of blood flow and blood vessel distribution in breast tumors by three-dimensional power Doppler ultrasound combined with the VOCAL method is more accurate and sensitive than the traditional two-dimensional ultrasound. And this method has potential promising applications in many current active research areas, such as the studies of random distribution of intratumoral blood vessels or the normalization of tumor blood vessels. Three-dimensional power Doppler ultrasound combined with the VOCAL method provides a new approach to achieving accurate judgments and the method evaluates the curative effect in breast cancer patients.
  • Assessment of Myocardial Viability in Ischemic Heart Disease by PET/MRI:
           Comparison of Left Ventricular Perfusion, Hibernation, and Scar Burden
    • Abstract: Publication date: February 2020Source: Academic Radiology, Volume 27, Issue 2Author(s): Dietrich Beitzke, Sazan Rasul, Martin Lyngby Lassen, Verena Pichler, Daniela Senn, Marie Elisabeth Stelzmüller, Richard Nolz, Christian Loewe, Marcus HackerRationale and objectivesHybrid positron emission tomography-magnetic resonance (PET-MR) is a novel imaging technology that enables a comprehensive assessment of myocardial viability. The aim of this study was to intra-individually compare simultaneously acquired viability parameters from MRI and PET to determine complementary and redundant information.Materials and MethodsThirty-nine patients with ischemic heart disease (IHD) underwent cardiac PET-MR for myocardial viability assessment. Cardiac magnetic resonance (CMR), including late gadolinium enhancement (LGE), and PET, including a dynamic dual-tracer acquisition of [13N]ammonia ([13N]NH3)/[18F]fluorodeoxyglucose ([18F]FDG), were performed simultaneously. Allocation, extent, and transmural degree of left ventricular (LV) scars were measured from LGE. Perfusion, viability, and hibernation were assessed by PET.ResultsA comparison of scar location revealed six more areas of infarction on MR than on PET. Mean LV scarring by CMR was 14% (range, 2% to 42%) and 14% (range, 1% to 46%) by PET (CMR vs. PET: p = 0.9). An intra-individual comparison of scarring showed a good inter-method correlation (r = 0.7), which was also evident in the subgroup with low ejection fraction (EF) (r = 0.6). Hibernation and transmural degree of scars showed a moderate to weak correlation (r = 0.4), which was even worse in the low EF group (r = 0.1).ConclusionsIn patients with IHD, there was a good correlation between PET and CMR for the LV scar extent using hybrid cardiac PET-MR. The degree of transmural scarring by CMR showed no correlation to PET hibernation. Therefore, cardiac PET-MR might be a suitable tool for a comprehensive assessment of myocardial viability if used to predict response to cardiac reperfusion strategies.
  • Paired Drainage Catheter Insertion: Feasibility of Placing Two Catheters
           within the Same Complex Abscess Cavity as a Primary and Salvage
           Percutaneous Drainage Technique
    • Abstract: Publication date: February 2020Source: Academic Radiology, Volume 27, Issue 2Author(s): David H. Ballard, Sarah T. Flanagan, Ryan W. Brown, Romulo Vea, Chaitanya Ahuja, Horacio B. D'AgostinoRationale and ObjectivesTo assess the feasibility of paired catheter drainage for management of complex abdominal abscesses.Materials and MethodsThis was a single-center retrospective study of 54 patients (35 males; mean age 48.9 years) that underwent paired catheter insertion for complex abdominal fluid collections in an 18-month period. Complex collections were defined as abscesses ≥6 cm in diameter with septations, high viscosity fluid or necrotic debris, or abscesses with an associated fistula. Abscess etiologies included postoperative (n = 28), pancreatitis (n = 12), perforated bowel (n = 7), liver abscess (n = 4), and perihepatic from gallbladder perforation (n = 3). Paired catheter insertion was defined two catheters co-located within one collection through the same skin incision or two closely spaced insertion sites. Paired catheter insertion was used primarily as initial drainage for complex intraabdominal abscesses and for salvage drainage in collections that could not be evacuated by a single catheter. Primary paired catheter insertion was used in 45 patients and as salvage in nine patients.ResultsAbscess resolution occurred in 51 (94.4%) patients. Patients had a median of three drainage procedures. Median duration of paired catheterization was 22 days. Seven abscesses recurred and all resolved with repeated drainage. Complications included one hemorrhage that was taken for surgical exploration. Overall, 48 patients had good clinical outcome, 3 patients died (multiorgan failure, n = 2; sepsis, n = 1), and 3 patients were lost to follow-up.ConclusionPercutaneous paired catheter drainage is a feasible technique for the treatment of both complex intraabdominal abscesses and abscesses unresponsive to single catheter drainage.
  • Lipid Fraction Derived From MRI In- and Opposed-Phase Sequence as a Novel
           Biomarker for Predicting Survival Outcome of Glioma
    • Abstract: Publication date: February 2020Source: Academic Radiology, Volume 27, Issue 2Author(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.
  • Assessing PD-L1 Expression Level by Radiomic Features From PET/CT in
           Nonsmall Cell Lung Cancer Patients: An Initial Result
    • Abstract: Publication date: February 2020Source: Academic Radiology, Volume 27, Issue 2Author(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.
  • On High Grade Kidney Cancer and Machine Learning
    • Abstract: Publication date: February 2020Source: Academic Radiology, Volume 27, Issue 2Author(s): Nicole E. Curci
  • 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: February 2020Source: Academic Radiology, Volume 27, Issue 2Author(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.
  • Re: Radiogenomics of Clear Cell Renal Cell Carcinoma: Associations Between
           mRNA-based Subtyping and CT Imaging Features
    • Abstract: Publication date: Available online 26 December 2019Source: Academic RadiologyAuthor(s): Dongzhi Cen, An Xian, Bao Lv, Wenhao Zeng
  • The Accuracy of Multidetector Computed Tomography and Laparoscopy in the
           Prediction of Peritoneal Carcinomatosis Index Score in Primary Ovarian
           Cancer: Terminology Issues
    • Abstract: Publication date: Available online 13 December 2019Source: Academic RadiologyAuthor(s): Farideh Mohtasham, Jamal Rahmani, Yousef Khani, Siamak Sabour
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