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Showing 1 - 200 of 3048 Journals sorted alphabetically
A Practical Logic of Cognitive Systems     Full-text available via subscription   (Followers: 7)
AASRI Procedia     Open Access   (Followers: 15)
Academic Pediatrics     Hybrid Journal   (Followers: 25, SJR: 1.402, h-index: 51)
Academic Radiology     Hybrid Journal   (Followers: 22, SJR: 1.008, h-index: 75)
Accident Analysis & Prevention     Partially Free   (Followers: 86, SJR: 1.109, h-index: 94)
Accounting Forum     Hybrid Journal   (Followers: 25, SJR: 0.612, h-index: 27)
Accounting, Organizations and Society     Hybrid Journal   (Followers: 30, SJR: 2.515, h-index: 90)
Achievements in the Life Sciences     Open Access   (Followers: 4)
Acta Anaesthesiologica Taiwanica     Open Access   (Followers: 5, SJR: 0.338, h-index: 19)
Acta Astronautica     Hybrid Journal   (Followers: 361, SJR: 0.726, h-index: 43)
Acta Automatica Sinica     Full-text available via subscription   (Followers: 3)
Acta Biomaterialia     Hybrid Journal   (Followers: 25, SJR: 2.02, h-index: 104)
Acta Colombiana de Cuidado Intensivo     Full-text available via subscription   (Followers: 1)
Acta de Investigación Psicológica     Open Access   (Followers: 2)
Acta Ecologica Sinica     Open Access   (Followers: 8, SJR: 0.172, h-index: 29)
Acta Haematologica Polonica     Free   (SJR: 0.123, h-index: 8)
Acta Histochemica     Hybrid Journal   (Followers: 3, SJR: 0.604, h-index: 38)
Acta Materialia     Hybrid Journal   (Followers: 226, SJR: 3.683, h-index: 202)
Acta Mathematica Scientia     Full-text available via subscription   (Followers: 5, SJR: 0.615, h-index: 21)
Acta Mechanica Solida Sinica     Full-text available via subscription   (Followers: 9, SJR: 0.442, h-index: 21)
Acta Oecologica     Hybrid Journal   (Followers: 10, SJR: 0.915, h-index: 53)
Acta Otorrinolaringologica (English Edition)     Full-text available via subscription   (Followers: 1)
Acta Otorrinolaringológica Española     Full-text available via subscription   (Followers: 3, SJR: 0.311, h-index: 16)
Acta Pharmaceutica Sinica B     Open Access   (Followers: 1)
Acta Poética     Open Access   (Followers: 4)
Acta Psychologica     Hybrid Journal   (Followers: 24, SJR: 1.365, h-index: 73)
Acta Sociológica     Open Access  
Acta Tropica     Hybrid Journal   (Followers: 6, SJR: 1.059, h-index: 77)
Acta Urológica Portuguesa     Open Access  
Actas Dermo-Sifiliograficas     Full-text available via subscription   (Followers: 4)
Actas Dermo-Sifiliográficas (English Edition)     Full-text available via subscription   (Followers: 3)
Actas Urológicas Españolas     Full-text available via subscription   (Followers: 4, SJR: 0.383, h-index: 19)
Actas Urológicas Españolas (English Edition)     Full-text available via subscription   (Followers: 2)
Actualites Pharmaceutiques     Full-text available via subscription   (Followers: 5, SJR: 0.141, h-index: 3)
Actualites Pharmaceutiques Hospitalieres     Full-text available via subscription   (Followers: 4, SJR: 0.112, h-index: 2)
Acupuncture and Related Therapies     Hybrid Journal   (Followers: 4)
Acute Pain     Full-text available via subscription   (Followers: 13)
Ad Hoc Networks     Hybrid Journal   (Followers: 11, SJR: 0.967, h-index: 57)
Addictive Behaviors     Hybrid Journal   (Followers: 15, SJR: 1.514, h-index: 92)
Addictive Behaviors Reports     Open Access   (Followers: 6)
Additive Manufacturing     Hybrid Journal   (Followers: 7, SJR: 1.039, h-index: 5)
Additives for Polymers     Full-text available via subscription   (Followers: 21)
Advanced Drug Delivery Reviews     Hybrid Journal   (Followers: 135, SJR: 5.2, h-index: 222)
Advanced Engineering Informatics     Hybrid Journal   (Followers: 11, SJR: 1.265, h-index: 53)
Advanced Powder Technology     Hybrid Journal   (Followers: 17, SJR: 0.739, h-index: 33)
Advances in Accounting     Hybrid Journal   (Followers: 9, SJR: 0.299, h-index: 15)
Advances in Agronomy     Full-text available via subscription   (Followers: 15, SJR: 2.071, h-index: 82)
Advances in Anesthesia     Full-text available via subscription   (Followers: 26, SJR: 0.169, h-index: 4)
Advances in Antiviral Drug Design     Full-text available via subscription   (Followers: 3)
Advances in Applied Mathematics     Full-text available via subscription   (Followers: 6, SJR: 1.054, h-index: 35)
Advances in Applied Mechanics     Full-text available via subscription   (Followers: 11, SJR: 0.801, h-index: 26)
Advances in Applied Microbiology     Full-text available via subscription   (Followers: 22, SJR: 1.286, h-index: 49)
Advances In Atomic, Molecular, and Optical Physics     Full-text available via subscription   (Followers: 16, SJR: 3.31, h-index: 42)
Advances in Biological Regulation     Hybrid Journal   (Followers: 4, SJR: 2.277, h-index: 43)
Advances in Botanical Research     Full-text available via subscription   (Followers: 3, SJR: 0.619, h-index: 48)
Advances in Cancer Research     Full-text available via subscription   (Followers: 25, SJR: 2.215, h-index: 78)
Advances in Carbohydrate Chemistry and Biochemistry     Full-text available via subscription   (Followers: 9, SJR: 0.9, h-index: 30)
Advances in Catalysis     Full-text available via subscription   (Followers: 5, SJR: 2.139, h-index: 42)
Advances in Cell Aging and Gerontology     Full-text available via subscription   (Followers: 4)
Advances in Cellular and Molecular Biology of Membranes and Organelles     Full-text available via subscription   (Followers: 12)
Advances in Chemical Engineering     Full-text available via subscription   (Followers: 27, SJR: 0.183, h-index: 23)
Advances in Child Development and Behavior     Full-text available via subscription   (Followers: 10, SJR: 0.665, h-index: 29)
Advances in Chronic Kidney Disease     Full-text available via subscription   (Followers: 9, SJR: 1.268, h-index: 45)
Advances in Clinical Chemistry     Full-text available via subscription   (Followers: 29, SJR: 0.938, h-index: 33)
Advances in Colloid and Interface Science     Full-text available via subscription   (Followers: 18, SJR: 2.314, h-index: 130)
Advances in Computers     Full-text available via subscription   (Followers: 16, SJR: 0.223, h-index: 22)
Advances in Dermatology     Full-text available via subscription   (Followers: 12)
Advances in Developmental Biology     Full-text available via subscription   (Followers: 11)
Advances in Digestive Medicine     Open Access   (Followers: 6)
Advances in DNA Sequence-Specific Agents     Full-text available via subscription   (Followers: 5)
Advances in Drug Research     Full-text available via subscription   (Followers: 22)
Advances in Ecological Research     Full-text available via subscription   (Followers: 44, SJR: 3.25, h-index: 43)
Advances in Engineering Software     Hybrid Journal   (Followers: 26, SJR: 0.486, h-index: 10)
Advances in Experimental Biology     Full-text available via subscription   (Followers: 7)
Advances in Experimental Social Psychology     Full-text available via subscription   (Followers: 42, SJR: 5.465, h-index: 64)
Advances in Exploration Geophysics     Full-text available via subscription   (Followers: 3)
Advances in Fluorine Science     Full-text available via subscription   (Followers: 8)
Advances in Food and Nutrition Research     Full-text available via subscription   (Followers: 50, SJR: 0.674, h-index: 38)
Advances in Fuel Cells     Full-text available via subscription   (Followers: 16)
Advances in Genetics     Full-text available via subscription   (Followers: 15, SJR: 2.558, h-index: 54)
Advances in Genome Biology     Full-text available via subscription   (Followers: 12)
Advances in Geophysics     Full-text available via subscription   (Followers: 6, SJR: 2.325, h-index: 20)
Advances in Heat Transfer     Full-text available via subscription   (Followers: 22, SJR: 0.906, h-index: 24)
Advances in Heterocyclic Chemistry     Full-text available via subscription   (Followers: 9, SJR: 0.497, h-index: 31)
Advances in Human Factors/Ergonomics     Full-text available via subscription   (Followers: 26)
Advances in Imaging and Electron Physics     Full-text available via subscription   (Followers: 2, SJR: 0.396, h-index: 27)
Advances in Immunology     Full-text available via subscription   (Followers: 36, SJR: 4.152, h-index: 85)
Advances in Inorganic Chemistry     Full-text available via subscription   (Followers: 9, SJR: 1.132, h-index: 42)
Advances in Insect Physiology     Full-text available via subscription   (Followers: 3, SJR: 1.274, h-index: 27)
Advances in Integrative Medicine     Hybrid Journal   (Followers: 6)
Advances in Intl. Accounting     Full-text available via subscription   (Followers: 4)
Advances in Life Course Research     Hybrid Journal   (Followers: 8, SJR: 0.764, h-index: 15)
Advances in Lipobiology     Full-text available via subscription   (Followers: 2)
Advances in Magnetic and Optical Resonance     Full-text available via subscription   (Followers: 9)
Advances in Marine Biology     Full-text available via subscription   (Followers: 16, SJR: 1.645, h-index: 45)
Advances in Mathematics     Full-text available via subscription   (Followers: 10, SJR: 3.261, h-index: 65)
Advances in Medical Sciences     Hybrid Journal   (Followers: 6, SJR: 0.489, h-index: 25)
Advances in Medicinal Chemistry     Full-text available via subscription   (Followers: 5)
Advances in Microbial Physiology     Full-text available via subscription   (Followers: 4, SJR: 1.44, h-index: 51)
Advances in Molecular and Cell Biology     Full-text available via subscription   (Followers: 22)
Advances in Molecular and Cellular Endocrinology     Full-text available via subscription   (Followers: 10)
Advances in Molecular Toxicology     Full-text available via subscription   (Followers: 8, SJR: 0.324, h-index: 8)
Advances in Nanoporous Materials     Full-text available via subscription   (Followers: 4)
Advances in Oncobiology     Full-text available via subscription   (Followers: 3)
Advances in Organ Biology     Full-text available via subscription   (Followers: 2)
Advances in Organometallic Chemistry     Full-text available via subscription   (Followers: 15, SJR: 2.885, h-index: 45)
Advances in Parallel Computing     Full-text available via subscription   (Followers: 7, SJR: 0.148, h-index: 11)
Advances in Parasitology     Full-text available via subscription   (Followers: 7, SJR: 2.37, h-index: 73)
Advances in Pediatrics     Full-text available via subscription   (Followers: 24, SJR: 0.4, h-index: 28)
Advances in Pharmaceutical Sciences     Full-text available via subscription   (Followers: 13)
Advances in Pharmacology     Full-text available via subscription   (Followers: 15, SJR: 1.718, h-index: 58)
Advances in Physical Organic Chemistry     Full-text available via subscription   (Followers: 8, SJR: 0.384, h-index: 26)
Advances in Phytomedicine     Full-text available via subscription  
Advances in Planar Lipid Bilayers and Liposomes     Full-text available via subscription   (Followers: 3, SJR: 0.248, h-index: 11)
Advances in Plant Biochemistry and Molecular Biology     Full-text available via subscription   (Followers: 8)
Advances in Plant Pathology     Full-text available via subscription   (Followers: 5)
Advances in Porous Media     Full-text available via subscription   (Followers: 4)
Advances in Protein Chemistry     Full-text available via subscription   (Followers: 17)
Advances in Protein Chemistry and Structural Biology     Full-text available via subscription   (Followers: 20, SJR: 1.5, h-index: 62)
Advances in Psychology     Full-text available via subscription   (Followers: 62)
Advances in Quantum Chemistry     Full-text available via subscription   (Followers: 5, SJR: 0.478, h-index: 32)
Advances in Radiation Oncology     Open Access  
Advances in Small Animal Medicine and Surgery     Hybrid Journal   (Followers: 2, SJR: 0.1, h-index: 2)
Advances in Space Biology and Medicine     Full-text available via subscription   (Followers: 5)
Advances in Space Research     Full-text available via subscription   (Followers: 361, SJR: 0.606, h-index: 65)
Advances in Structural Biology     Full-text available via subscription   (Followers: 8)
Advances in Surgery     Full-text available via subscription   (Followers: 7, SJR: 0.823, h-index: 27)
Advances in the Study of Behavior     Full-text available via subscription   (Followers: 30, SJR: 1.321, h-index: 56)
Advances in Veterinary Medicine     Full-text available via subscription   (Followers: 16)
Advances in Veterinary Science and Comparative Medicine     Full-text available via subscription   (Followers: 13)
Advances in Virus Research     Full-text available via subscription   (Followers: 5, SJR: 1.878, h-index: 68)
Advances in Water Resources     Hybrid Journal   (Followers: 44, SJR: 2.408, h-index: 94)
Aeolian Research     Hybrid Journal   (Followers: 5, SJR: 0.973, h-index: 22)
Aerospace Science and Technology     Hybrid Journal   (Followers: 327, SJR: 0.816, h-index: 49)
AEU - Intl. J. of Electronics and Communications     Hybrid Journal   (Followers: 8, SJR: 0.318, h-index: 36)
African J. of Emergency Medicine     Open Access   (Followers: 5, SJR: 0.344, h-index: 6)
Ageing Research Reviews     Hybrid Journal   (Followers: 8, SJR: 3.289, h-index: 78)
Aggression and Violent Behavior     Hybrid Journal   (Followers: 413, SJR: 1.385, h-index: 72)
Agri Gene     Hybrid Journal  
Agricultural and Forest Meteorology     Hybrid Journal   (Followers: 16, SJR: 2.18, h-index: 116)
Agricultural Systems     Hybrid Journal   (Followers: 30, SJR: 1.275, h-index: 74)
Agricultural Water Management     Hybrid Journal   (Followers: 40, SJR: 1.546, h-index: 79)
Agriculture and Agricultural Science Procedia     Open Access  
Agriculture and Natural Resources     Open Access   (Followers: 1)
Agriculture, Ecosystems & Environment     Hybrid Journal   (Followers: 55, SJR: 1.879, h-index: 120)
Ain Shams Engineering J.     Open Access   (Followers: 5, SJR: 0.434, h-index: 14)
Air Medical J.     Hybrid Journal   (Followers: 5, SJR: 0.234, h-index: 18)
AKCE Intl. J. of Graphs and Combinatorics     Open Access   (SJR: 0.285, h-index: 3)
Alcohol     Hybrid Journal   (Followers: 11, SJR: 0.922, h-index: 66)
Alcoholism and Drug Addiction     Open Access   (Followers: 8)
Alergologia Polska : Polish J. of Allergology     Full-text available via subscription   (Followers: 1)
Alexandria Engineering J.     Open Access   (Followers: 1, SJR: 0.436, h-index: 12)
Alexandria J. of Medicine     Open Access   (Followers: 1)
Algal Research     Partially Free   (Followers: 8, SJR: 2.05, h-index: 20)
Alkaloids: Chemical and Biological Perspectives     Full-text available via subscription   (Followers: 3)
Allergologia et Immunopathologia     Full-text available via subscription   (Followers: 1, SJR: 0.46, h-index: 29)
Allergology Intl.     Open Access   (Followers: 4, SJR: 0.776, h-index: 35)
Alpha Omegan     Full-text available via subscription   (SJR: 0.121, h-index: 9)
ALTER - European J. of Disability Research / Revue Européenne de Recherche sur le Handicap     Full-text available via subscription   (Followers: 9, SJR: 0.158, h-index: 9)
Alzheimer's & Dementia     Hybrid Journal   (Followers: 46, SJR: 4.289, h-index: 64)
Alzheimer's & Dementia: Diagnosis, Assessment & Disease Monitoring     Open Access   (Followers: 4)
Alzheimer's & Dementia: Translational Research & Clinical Interventions     Open Access   (Followers: 4)
Ambulatory Pediatrics     Hybrid Journal   (Followers: 5)
American Heart J.     Hybrid Journal   (Followers: 48, SJR: 3.157, h-index: 153)
American J. of Cardiology     Hybrid Journal   (Followers: 47, SJR: 2.063, h-index: 186)
American J. of Emergency Medicine     Hybrid Journal   (Followers: 40, SJR: 0.574, h-index: 65)
American J. of Geriatric Pharmacotherapy     Full-text available via subscription   (Followers: 9, SJR: 1.091, h-index: 45)
American J. of Geriatric Psychiatry     Hybrid Journal   (Followers: 14, SJR: 1.653, h-index: 93)
American J. of Human Genetics     Hybrid Journal   (Followers: 32, SJR: 8.769, h-index: 256)
American J. of Infection Control     Hybrid Journal   (Followers: 26, SJR: 1.259, h-index: 81)
American J. of Kidney Diseases     Hybrid Journal   (Followers: 32, SJR: 2.313, h-index: 172)
American J. of Medicine     Hybrid Journal   (Followers: 46, SJR: 2.023, h-index: 189)
American J. of Medicine Supplements     Full-text available via subscription   (Followers: 3)
American J. of Obstetrics and Gynecology     Hybrid Journal   (Followers: 201, SJR: 2.255, h-index: 171)
American J. of Ophthalmology     Hybrid Journal   (Followers: 59, SJR: 2.803, h-index: 148)
American J. of Ophthalmology Case Reports     Open Access   (Followers: 6)
American J. of Orthodontics and Dentofacial Orthopedics     Full-text available via subscription   (Followers: 6, SJR: 1.249, h-index: 88)
American J. of Otolaryngology     Hybrid Journal   (Followers: 25, SJR: 0.59, h-index: 45)
American J. of Pathology     Hybrid Journal   (Followers: 26, SJR: 2.653, h-index: 228)
American J. of Preventive Medicine     Hybrid Journal   (Followers: 24, SJR: 2.764, h-index: 154)
American J. of Surgery     Hybrid Journal   (Followers: 35, SJR: 1.286, h-index: 125)
American J. of the Medical Sciences     Hybrid Journal   (Followers: 12, SJR: 0.653, h-index: 70)
Ampersand : An Intl. J. of General and Applied Linguistics     Open Access   (Followers: 5)
Anaerobe     Hybrid Journal   (Followers: 4, SJR: 1.066, h-index: 51)
Anaesthesia & Intensive Care Medicine     Full-text available via subscription   (Followers: 58, SJR: 0.124, h-index: 9)
Anaesthesia Critical Care & Pain Medicine     Full-text available via subscription   (Followers: 12)
Anales de Cirugia Vascular     Full-text available via subscription  
Anales de Pediatría     Full-text available via subscription   (Followers: 2, SJR: 0.209, h-index: 27)
Anales de Pediatría (English Edition)     Full-text available via subscription  
Anales de Pediatría Continuada     Full-text available via subscription   (SJR: 0.104, h-index: 3)
Analytic Methods in Accident Research     Hybrid Journal   (Followers: 4, SJR: 2.577, h-index: 7)
Analytica Chimica Acta     Hybrid Journal   (Followers: 37, SJR: 1.548, h-index: 152)
Analytical Biochemistry     Hybrid Journal   (Followers: 167, SJR: 0.725, h-index: 154)
Analytical Chemistry Research     Open Access   (Followers: 8, SJR: 0.18, h-index: 2)
Analytical Spectroscopy Library     Full-text available via subscription   (Followers: 12)
Anesthésie & Réanimation     Full-text available via subscription   (Followers: 1)
Anesthesiology Clinics     Full-text available via subscription   (Followers: 23, SJR: 0.421, h-index: 40)
Angiología     Full-text available via subscription   (SJR: 0.124, h-index: 9)
Angiologia e Cirurgia Vascular     Open Access  
Animal Behaviour     Hybrid Journal   (Followers: 172, SJR: 1.907, h-index: 126)

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Journal Cover Academic Radiology
  [SJR: 1.008]   [H-I: 75]   [22 followers]  Follow
   Hybrid Journal Hybrid journal (It can contain Open Access articles)
   ISSN (Print) 1076-6332
   Published by Elsevier Homepage  [3048 journals]
  • The Efficacy of Low-intensity Vibration to Improve Bone Health in Patients
           with End-stage Renal Disease Is Highly Dependent on Compliance and Muscle
    • Authors: Chamith S. Rajapakse; Mary B. Leonard; Elizabeth A. Kobe; Michelle A. Slinger; Kelly A. Borges; Erica Billig; Clinton T. Rubin; Felix W. Wehrli
      Pages: 1332 - 1342
      Abstract: Publication date: November 2017
      Source:Academic Radiology, Volume 24, Issue 11
      Author(s): Chamith S. Rajapakse, Mary B. Leonard, Elizabeth A. Kobe, Michelle A. Slinger, Kelly A. Borges, Erica Billig, Clinton T. Rubin, Felix W. Wehrli
      Rational and Objectives Low intensity vibration (LIV) may represent a nondrug strategy to mitigate bone deficits in patients with end-stage renal disease. Materials and Methods Thirty end-stage renal patients on maintenance hemodialysis were randomized to stand for 20 minutes each day on either an active or placebo LIV device. Analysis at baseline and completion of 6-month intervention included magnetic resonance imaging (tibia and fibula stiffness; trabecular thickness, number, separation, bone volume fraction, plate-to-rod ratio; and cortical bone porosity), dual-energy X-ray absorptiometry (hip and spine bone mineral density [BMD]), and peripheral quantitative computed tomography (tibia trabecular and cortical BMD; calf muscle cross-sectional area). Results Intention-to-treat analysis did not show any significant changes in outcomes associated with LIV. Subjects using the active device and with greater than the median adherence (70%) demonstrated an increase in distal tibia stiffness (5.3%), trabecular number (1.7%), BMD (2.3%), and plate-to-rod ratio (6.5%), and a decrease in trabecular separation (−1.8%). Changes in calf muscle cross-sectional area were associated with changes in distal tibia stiffness (R = 0.85), trabecular bone volume/total volume (R = 0.91), number (R = 0.92), and separation (R = −0.94) in the active group but not in the placebo group. Baseline parathyroid hormone levels were positively associated with increased cortical bone porosity over the 6-month study period in the placebo group (R = 0.55) but not in the active group (R = 0.01). No changes were observed in the nondistal tibia locations for either group except a decrease in hip BMD in the placebo group (−1.7%). Conclusion Outcomes and adherence thresholds identified from this pilot study could guide future longitudinal studies involving vibration therapy.

      PubDate: 2017-10-25T12:45:07Z
      DOI: 10.1016/j.acra.2017.05.014
  • Reliability of MR Quantification of Rotator Cuff Muscle Fatty Degeneration
           Using a 2-point Dixon Technique in Comparison with the Goutallier
    • Authors: Saya Horiuchi; Taiki Nozaki; Atsushi Tasaki; Akira Yamakawa; Yasuhito Kaneko; Takeshi Hara; Hiroshi Yoshioka
      Pages: 1343 - 1351
      Abstract: Publication date: November 2017
      Source:Academic Radiology, Volume 24, Issue 11
      Author(s): Saya Horiuchi, Taiki Nozaki, Atsushi Tasaki, Akira Yamakawa, Yasuhito Kaneko, Takeshi Hara, Hiroshi Yoshioka
      Rationale and Objectives Presurgical assessment of fatty degeneration is important in the management of patients with rotator cuff tears. The Goutallier classification is widely accepted as a qualitative scoring system, although it is highly observer-dependent and has poor reproducibility. The objective of this study was to quantify fatty degeneration of the supraspinatus muscle using a 2-point Dixon technique in patients with rotator cuff tears by multiple readers, and to evaluate the reproducibility compared to Goutallier classification. Materials and Methods Two hundred patients with rotator cuff tears who underwent magnetic resonance imaging (MRI), including 2-point Dixon sequence at 3.0-T, were selected retrospectively. Qualitative and quantitative analyses of fatty degeneration were performed by two radiologists and three orthopedic surgeons independently. The fat quantification was performed by measuring signal intensity values of in phase (S(In)) and fat image (S(Fat)), and calculating fat fraction as S(Fat)/S(In). The reproducibility of MR quantification was analyzed by the intra- and interclass correlation coefficients and Bland-Altman plots. Results The interobserver agreement of the Goutallier classification among five readers was moderate (k = 0.51), whereas the interclass correlation coefficient regarding fat fraction value quantified in 2-point Dixon sequence was excellent (0.893). The mean differences in fat fraction values from the individual segmentation results were from −0.072 to 0.081. Proposed fat fraction grading and Goutallier grading showed similar frequency and distribution in severity of rotator cuff tears. Conclusions Fat quantification in the rotator cuff muscles using a 2-point Dixon technique at 3.0-T MRI is highly reproducible and clinically feasible in comparison to the qualitative evaluation using Goutallier classification.

      PubDate: 2017-10-25T12:45:07Z
      DOI: 10.1016/j.acra.2017.03.026
  • 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
    • Authors: Christopher Kloth; Wolfgang M. Thaiss; Rainer Kärgel; Rainer Grimmer; Jan Fritz; Sorin Dumitru Ioanoviciu; Dominik Ketelsen; Konstantin Nikolaou; Marius Horger
      Pages: 1352 - 1363
      Abstract: Publication date: November 2017
      Source:Academic Radiology, Volume 24, Issue 11
      Author(s): Christopher Kloth, Wolfgang M. Thaiss, Rainer Kärgel, Rainer Grimmer, Jan Fritz, Sorin Dumitru Ioanoviciu, Dominik Ketelsen, Konstantin Nikolaou, Marius Horger
      Rationale and Objectives This study aimed to evaluate the potential role of computed tomography texture analysis (CTTA) of arterial and portal-venous enhancement phase image data for prediction and accurate assessment of response of hepatocellular carcinoma undergoing drug-eluting bead transarterial chemoembolization (TACE) by comparison to liver perfusion CT (PCT). Materials and Methods Twenty-eight patients (27 male; mean age 67.2 ± 10.4) with 56 hepatocellular carcinoma-typical liver lesions were included. Arterial and portal-venous phase CT data obtained before and after TACE with a mean time of 39.93 ± 62.21 days between examinations were analyzed. TACE was performed within 48 hours after first contrast-enhanced CT. CTTA software was a prototype. CTTA analysis was performed blinded (for results) by two observers separately. Combined results of modified Response Evaluation Criteria In Solid Tumors (mRECIST) and PCT of the liver were used as the standard of reference. Time to progression was additionally assessed for all patients. CTTA parameters included heterogeneity, intensity, average, deviation, skewness, and entropy of co-occurrence. Each parameter was compared to those of PCT (blood flow [BF], blood volume, arterial liver perfusion [ALP], portal-venous perfusion, and hepatic perfusion index) measured before and after TACE. Results mRECIST + PCT yielded 28.6% complete response (CR), 42.8% partial response, and 28.6% stable disease. Significant correlations were registered in the arterial phase in CR between changes in mean heterogeneity and BF (P = .004, r = −0.815), blood volume (P = .002, r = −0.851), and ALP (P = .002, r = −0.851), respectively. In the partial response group, changes in mean heterogeneity correlated with changes in ALP (P = .003) and to a lesser degree with hepatic perfusion index (P = .027) in the arterial phase. In the stable disease group, BF correlated with entropy of nonuniformity (P = .010). In the portal-venous phase, no statistically significant correlations were registered in all groups. Receiver operating characteristic analysis of CTTA parameters yielded predictive cutoff values for CR in the arterial contrast-enhanced CT phase for uniformity of skewness (sensitivity: 90.0%; specificity: 45.8%), and in the portal-venous phase for uniformity of heterogeneity (sensitivity: 92.3%; specificity: 81.8%). Conclusions Significant correlations exist between CTTA parameters and those derived from PCT both in the pre- and the post-TACE settings, and some of them have predictive value for TACE midterm outcome.

      PubDate: 2017-10-25T12:45:07Z
      DOI: 10.1016/j.acra.2017.05.006
  • Imaging Features of Patients Undergoing Active Surveillance for Ductal
           Carcinoma in Situ
    • Authors: Lars J. Grimm; Sujata V. Ghate; E. Shelley Hwang; Mary Scott Soo
      Pages: 1364 - 1371
      Abstract: Publication date: November 2017
      Source:Academic Radiology, Volume 24, Issue 11
      Author(s): Lars J. Grimm, Sujata V. Ghate, E. Shelley Hwang, Mary Scott Soo
      Rationale and Objectives The aim of this study was to describe the imaging appearance of patients undergoing active surveillance for ductal carcinoma in situ (DCIS). Materials and Methods We retrospectively identified 29 patients undergoing active surveillance for DCIS from 2009 to 2014. Twenty-two patients (group 1) refused surgery or were not surgical candidates. Seven patients (group 2) enrolled in a trial of letrozole and deferred surgical excision for 6–12 months. Pathology and imaging results at the initial biopsy and follow-up were recorded. Results In group 1, the median follow-up was 2.7 years (range: 0.6–13.9 years). Fifteen patients (68%) remained stable. Seven patients (32%) underwent additional biopsies with invasive ductal carcinoma diagnosed in two patients after 3.9 and 3.6 years who developed increasing calcifications and new masses. In group 2, one patient (14%) was upstaged to microinvasive ductal carcinoma at surgery. Among the patients in both groups with calcifications (n = 26), there was no progression to invasive disease among those with stable (50%, 13/26) or decreased (19%, 5/26) calcifications. Conclusions Among a DCIS active surveillance cohort, invasive disease progression presented as increasing calcifications and a new mass following more than 3.5 years of stable imaging. In contrast, there was no progression to invasive disease among cases of DCIS with stable or decreasing calcifications. Close imaging is a key follow-up component in active surveillance.

      PubDate: 2017-11-16T09:47:51Z
      DOI: 10.1016/j.acra.2017.05.017
  • Characterization of Breast Masses in Digital Breast Tomosynthesis and
           Digital Mammograms
    • Authors: Heang-Ping Chan; Mark A. Helvie; Lubomir Hadjiiski; Deborah O. Jeffries; Katherine A. Klein; Colleen H. Neal; Mitra Noroozian; Chintana Paramagul; Marilyn A. Roubidoux
      Pages: 1372 - 1379
      Abstract: Publication date: November 2017
      Source:Academic Radiology, Volume 24, Issue 11
      Author(s): Heang-Ping Chan, Mark A. Helvie, Lubomir Hadjiiski, Deborah O. Jeffries, Katherine A. Klein, Colleen H. Neal, Mitra Noroozian, Chintana Paramagul, Marilyn A. Roubidoux
      Rationale and Objectives This study aimed to compare Breast Imaging Reporting and Data System (BI-RADS) assessment of lesions in two-view digital mammogram (DM) to two-view wide-angle digital breast tomosynthesis (DBT) without DM. Materials and Methods With Institutional Review Board approval and written informed consent, two-view DBTs were acquired from 134 subjects and the corresponding DMs were collected retrospectively. The study included 125 subjects with 61 malignant (size: 3.9–36.9 mm, median: 13.4 mm) and 81 benign lesions (size: 4.8–43.8 mm, median: 12.0 mm), and 9 normal subjects. The cases in the two modalities were read independently by six experienced Mammography Quality Standards Act radiologists in a fully crossed counterbalanced manner. The readers were blinded to the prevalence of malignant, benign, or normal cases and were asked to assess the lesions based on the BI-RADS lexicon. The ratings were analyzed by the receiver operating characteristic methodology. Results Lesion conspicuity was significantly higher (P << .0001) and fewer lesion margins were considered obscured in DBT. The mean area under the receiver operating characteristic curve for the six readers increased significantly (P = .0001) from 0.783 (range: 0.723–0.886) for DM to 0.911 (range: 0.884–0.936) for DBT. Of the 366 ratings for malignant lesions, 343 on DBT and 278 on DM were rated as BI-RADS 4a and above. Of the 486 ratings for benign lesions, 220 on DBT and 206 on DM were rated as BI-RADS 4a and above. On average, 17.8% (65 of 366) more malignant lesions and 2.9% (14 of 486) more benign lesions would be recommended for biopsy using DBT. The inter-radiologist variability was reduced significantly. Conclusion With DBT alone, the BI-RADS assessment of breast lesions and inter-radiologist reliability were significantly improved compared to DM.

      PubDate: 2017-10-25T12:45:07Z
      DOI: 10.1016/j.acra.2017.04.016
  • Contrast Enhancement in Breast Cancer and Background Mammary-Gland Tissue
    • Authors: Tetsuya Tomida; Atsushi Urikura; Takayoshi Uematsu; Kensei Shirata; Yoshihiro Nakaya
      Pages: 1380 - 1386
      Abstract: Publication date: November 2017
      Source:Academic Radiology, Volume 24, Issue 11
      Author(s): Tetsuya Tomida, Atsushi Urikura, Takayoshi Uematsu, Kensei Shirata, Yoshihiro Nakaya
      Rationale and Objectives We aimed to compare the contrast enhancement between tumor and mammary-gland tissue to distinguish lesions in the super-early phase, during which minimal contrast media uptake is observed in mammary-gland tissue. Materials and Methods Dynamic magnetic resonance imaging, including the super-early phase with bolus tracking (BT) method (to determine the optimal imaging start time), was performed by using identical parameters to obtain transverse fat-suppressed T1-weighted images of both breasts. The percent enhancement (PE) and the contrast ratio (CR) indicators for tumor and mammary-gland tissue were assessed in each dynamic phase. Results The PE values of the tumor were 62.4% and 151.6%, and those of the mammary gland were 0.3% and 20.7% in the super-early and early phases, respectively. Therefore, virtually no background parenchymal enhancement was observed in the super-early phase. The variation in the PE values during the super-early phase was significantly smaller when the values were determined with the BT method (P < .05). The CR was highest in the early phase, and the CR in the super-early phase was lower than in the other phases. Early-phase PE and CR were significantly higher in invasive cancer cases than in noninvasive cancer cases (P < .01). A significant difference in the imaging start time was observed for the anatomic side factor by the BT method. Conclusion Background parenchymal enhancement almost never appeared in the super-early phase, but the CR was lower in the super-early phase than in the early phase. The BT method allowed for an optimal imaging start time for the super-early phase and yielded images with less deviation of contrast enhancement.

      PubDate: 2017-10-25T12:45:07Z
      DOI: 10.1016/j.acra.2017.05.018
  • Preliminary Results of a Simplified Breast MRI Protocol to Characterize
           Breast Lesions
    • Authors: Valeria Romeo; Renato Cuocolo; Raffaele Liuzzi; Albina Riccardi; Antonello Accurso; Alessandra Acquaviva; Roberta Buonocore; Massimo Imbriaco
      Pages: 1387 - 1394
      Abstract: Publication date: November 2017
      Source:Academic Radiology, Volume 24, Issue 11
      Author(s): Valeria Romeo, Renato Cuocolo, Raffaele Liuzzi, Albina Riccardi, Antonello Accurso, Alessandra Acquaviva, Roberta Buonocore, Massimo Imbriaco
      Rationale and Objectives This study aimed to investigate whether a simplified breast magnetic resonance imaging (MRI) protocol consisting of a localizer, one precontrast sequence, and three time-point postcontrast sequences (at 28 seconds, 84 seconds and 252 seconds after the contrast agent administration) is suitable for the characterization of breast lesions as compared to a full diagnostic protocol (FDP). This study also aimed to review the current literature concerning abbreviated breast MRI protocols and offer an alternative protocol. Materials and Methods Breast magnetic resonance (MR) examinations with detected breast lesions of 98 patients were retrospectively evaluated. Two expert radiologists in consensus reviewed the simplified breast protocol (SBP) first and only thereafter the regular FDP, recording a diagnosis for each detected lesion for both protocols. Receiver operating characteristic curve analysis was performed to determine the diagnostic performance of the SBP compared to the standard FDP. A revision of the previously reported abbreviated breast magnetic resonance protocols was also carried out. Results A total of 180 lesions were identified; of these, 110 (61%) were malignant and 70 (39%) were benign. Of the 110 malignant lesions, 86 (78%) were invasive ductal carcinoma, 18 (16%) were invasive lobular carcinoma, and 6 (6%) were ductal carcinoma in situ. Areas under the curve for the receiver operating characteristic curves for the SBP vs the FDP were equivalent (0.98 vs 0.99, respectively; P = 0.76). The SBP could be performed in approximately 6 minutes and 58 seconds, compared to 14 minutes and 48 seconds for the FDP. Conclusions An SBP protocol including a late postcontrast time point is accurate for the characterization of breast lesions and was comparable to the standard FDP protocol, allowing a potential reduction of the total acquisition and interpretation times.

      PubDate: 2017-10-25T12:45:07Z
      DOI: 10.1016/j.acra.2017.04.011
  • Potential Use of American College of Radiology BI-RADS Mammography Atlas
           for Reporting and Assessing Lesions Detected on Dedicated Breast CT
    • Authors: Hae Kyoung Jung; Cherie M. Kuzmiak; Keum Won Kim; Na Mi Choi; Hye Jeong Kim; Eun Lee Langman; Sora Yoon; Doreen Steen; Donglin Zeng; Fei Gao
      Pages: 1395 - 1401
      Abstract: Publication date: November 2017
      Source:Academic Radiology, Volume 24, Issue 11
      Author(s): Hae Kyoung Jung, Cherie M. Kuzmiak, Keum Won Kim, Na Mi Choi, Hye Jeong Kim, Eun Lee Langman, Sora Yoon, Doreen Steen, Donglin Zeng, Fei Gao
      Rationale and Objectives Dedicated breast computed tomography (DBCT) is an emerging and promising modality for breast lesions. The objective of this study was to evaluate the potential use of applying the BI-RADS Mammography Atlas 5th Edition for reporting and assessing breast lesions on DBCT. Currently, no atlas exists for DBCT. Materials and Methods Four radiologists trained in breast imaging were recruited in this institutional review board-approved, Health Insurance Portability and Accountability Act-compliant study. The enrolled radiologists, who were blinded to mammographic and histopathologic findings, individually reviewed 30 randomized DBCT cases that contained marked lesions. Thirty-four lesions were included in this study: 24 (70.6%) masses, 7 (20.6%) calcifications, and 3 (8.8%) architectural distortions. Eight (23.5%) lesions were malignant and 26 (76.5%) were benign. The reader was asked to specify according to the BI-RADS Mammography Atlas for each marked DBCT lesion: primary findings, features, breast density, and final assessment. We calculated readers' diagnostic performances for differentiating between benign and malignant lesions and interobserver variability for reporting and assessing lesions using a generalized estimating equation and the Fleiss kappa (κ) statistic. Results The estimated overall sensitivity of the readers was 0.969, and the specificity was 0.529. There were no significant differences in the sensitivity and the specificity between lesion types. For reporting the presence of a primary finding, the overall substantial agreement (κ = 0.70) was seen. In assigning the breast density and the final assessment, the overall agreement was moderate (κ = 0.53) and fair (κ = 0.30). Conclusion The use of the BI-RADS Mammography Atlas 5th Edition for DBCT showed high performance and good agreement among readers.

      PubDate: 2017-10-25T12:45:07Z
      DOI: 10.1016/j.acra.2017.06.003
  • Pulmonary 3He Magnetic Resonance Imaging Biomarkers of Regional Airspace
           Enlargement in Alpha-1 Antitrypsin Deficiency
    • Authors: Eric Lessard; Heather M. Young; Anurag Bhalla; Damien Pike; Khadija Sheikh; David G. McCormack; Alexei Ouriadov; Grace Parraga
      Pages: 1402 - 1411
      Abstract: Publication date: November 2017
      Source:Academic Radiology, Volume 24, Issue 11
      Author(s): Eric Lessard, Heather M. Young, Anurag Bhalla, Damien Pike, Khadija Sheikh, David G. McCormack, Alexei Ouriadov, Grace Parraga
      Rationale and Objectives Thoracic x-ray computed tomography (CT) and hyperpolarized 3He magnetic resonance imaging (MRI) provide quantitative measurements of airspace enlargement in patients with emphysema. For patients with panlobular emphysema due to alpha-1 antitrypsin deficiency (AATD), sensitive biomarkers of disease progression and response to therapy have been difficult to develop and exploit, especially those biomarkers that correlate with outcomes like quality of life. Here, our objective was to generate and compare CT and diffusion-weighted inhaled-gas MRI measurements of emphysema including apparent diffusion coefficient (ADC) and MRI-derived mean linear intercept (Lm) in patients with AATD, chronic obstructive pulmonary disease (COPD) ex-smokers, and elderly never-smokers. Materials and Methods We enrolled patients with AATD (n = 8; 57 ± 7 years), ex-smokers with COPD (n = 8; 77 ± 6 years), and a control group of never-smokers (n = 5; 64 ± 2 years) who underwent thoracic CT, MRI, spirometry, plethysmography, the St. George's Respiratory Questionnaire, and the 6-minute walk test during a single 2-hour visit. MRI-derived ADC, Lm, surface-to-volume ratio, and ventilation defect percent were generated for the apical, basal, and whole lung as was CT lung area ≤−950 Hounsfield units (RA950), low attenuating clusters, and airway count. Results In patients with AATD, there was a significantly different MRI-derived ADC (P = .03), Lm (P < .0001), and surface-to-volume ratio (P < .0001), but not diffusing capacity of carbon monoxide, residual volume or total lung capacity, or CT RA950 (P > .05) compared to COPD ex-smokers with a significantly different St. George's Respiratory Questionnaire. Conclusions In this proof-of-concept demonstration, we evaluated CT and MRI lung emphysema measurements and observed significantly worse MRI biomarkers of emphysema in patients with AATD compared to patients with COPD, although CT RA950 and diffusing capacity of carbon monoxide were not significantly different, underscoring the sensitivity of MRI measurements of AATD emphysema.

      PubDate: 2017-10-25T12:45:07Z
      DOI: 10.1016/j.acra.2017.05.008
  • Regional Distribution of Pulmonary Blood Volume with Dual-Energy Computed
    • Authors: Paul Felloni; Alain Duhamel; Jean-Baptiste Faivre; Jessica Giordano; Suonita Khung; Valérie Deken; Jacques Remy; Martine Remy-Jardin
      Pages: 1412 - 1421
      Abstract: Publication date: November 2017
      Source:Academic Radiology, Volume 24, Issue 11
      Author(s): Paul Felloni, Alain Duhamel, Jean-Baptiste Faivre, Jessica Giordano, Suonita Khung, Valérie Deken, Jacques Remy, Martine Remy-Jardin
      Rationale and Objectives The noninvasive approach of lung perfusion generated from dual-energy computed tomography acquisitions has entered clinical practice. The purpose of this study was to analyze the regional distribution of iodine within distal portions of the pulmonary arterial bed on dual-source, dual-energy computed tomography examinations in a cohort of subjects without cardiopulmonary pathologies. Materials and Methods The study population included 42 patients without cardiorespiratory disease, enabling quantitative and qualitative analysis of pulmonary blood volume after administration of a 40% contrast agent. Qualitative analysis was based on visual assessment. Quantitative analysis was obtained after semiautomatic division of each lung into 18 areas. Results The iodine concentration did not significantly differ between the right (R) and left (L) lungs (P = .49), with a mean attenuation of 41.35 Hounsfield units (HU) and 41.14 HU, respectively. Three regional gradients of attenuation were observed between: (a) lung bases and apices (P < .001), linked to the conditions of examination (mean Δ: 6.23 in the R lung; 5.96 in the L lung); (b) posterior and anterior parts of the lung (P < .001) due to gravity (mean Δ: 11.92 in the R lung ; 15.93 in the L lung); and (c) medullary and cortical lung zones (P < .001) (mean Δ: 9.35 in the R lung ; 8.37 in the L lung). The intensity of dependent-nondependent (r = 0.42; P < .001) and corticomedullary (r = 0.58; P < .0001) gradients was correlated to the overall iodine concentration. Conclusion Distribution of pulmonary blood volume is influenced by physiological gradients and scanning conditions.

      PubDate: 2017-10-25T12:45:07Z
      DOI: 10.1016/j.acra.2017.05.003
  • “Rounding” the Size of Pulmonary Nodules
    • Authors: Benedikt H. Heidinger; Ursula Nemec; Kevin R. Anderson; Daniel B. Costa; Sidhu P. Gangadharan; Paul A. VanderLaan; Alexander A. Bankier
      Pages: 1422 - 1427
      Abstract: Publication date: November 2017
      Source:Academic Radiology, Volume 24, Issue 11
      Author(s): Benedikt H. Heidinger, Ursula Nemec, Kevin R. Anderson, Daniel B. Costa, Sidhu P. Gangadharan, Paul A. VanderLaan, Alexander A. Bankier
      Rationale and Objectives The objective of this study was to quantify the impact of different rounding methods on size measurements of pulmonary nodules and to determine the number of nodules that change management categories as a result of rounding. Materials and Methods For this retrospective institutional review board-approved study, we included 503 incidental pulmonary nodules (308 solid and 195 subsolid) from a data repository. Long and short axes were measured. Average diameters were calculated using four different rounding methods (method 1: no rounding; method 2: rounding only the average diameter to the closest millimeter; method 3: rounding only short and long axes; and method 4: rounding short and long axes and the average diameter to the closest millimeter). Nodules were classified for each rounding method according to the 2017 Fleischner Society guideline management categories. Measurements were compared among the four rounding methods using analysis of variance. Results Without rounding, the average nodule diameter was 15.67 ± 5.97 mm. This increased between 0.03  and 0.29 mm using rounding methods 2–4 (range: P < 0.001–0.017). The nodule size was more frequently rounded up (range: 52.1%–77.5%) than rounded down (range: 17.7%–42.5%) using rounding methods 2–4, as compared to no rounding. In the 308 solid nodules, up to 2.9% of the nodules changed management category, whereas none of the 195 subsolid nodules changed category. Conclusions Rounding methods have a small absolute but statically significant effect on nodule size, impacting management category in less than 3% of the nodules. This suggests that, in clinical practice, any rounding method can be used for determining nodule size without substantially biasing individual nodules toward given management categories.

      PubDate: 2017-10-25T12:45:07Z
      DOI: 10.1016/j.acra.2017.05.013
  • Improving Abnormality Detection on Chest Radiography Using Game-Like
           Reinforcement Mechanics
    • Authors: Po-Hao Chen; Howard Roth; Maya Galperin-Aizenberg; Alexander T. Ruutiainen; Warren Gefter; Tessa S. Cook
      Pages: 1428 - 1435
      Abstract: Publication date: November 2017
      Source:Academic Radiology, Volume 24, Issue 11
      Author(s): Po-Hao Chen, Howard Roth, Maya Galperin-Aizenberg, Alexander T. Ruutiainen, Warren Gefter, Tessa S. Cook
      Rationale and Objectives Despite their increasing prevalence, online textbooks, question banks, and digital references focus primarily on explicit knowledge. Implicit skills such as abnormality detection require repeated practice on clinical service and have few digital substitutes. Using mechanics traditionally deployed in video games such as clearly defined goals, rapid-fire levels, and narrow time constraints may be an effective way to teach implicit skills. Materials and Methods We created a freely available, online module to evaluate the ability of individuals to differentiate between normal and abnormal chest radiographs by implementing mechanics, including instantaneous feedback, rapid-fire cases, and 15-second timers. Volunteer subjects completed the modules and were separated based on formal experience with chest radiography. Performance between training and testing sets were measured for each group, and a survey was administered after each session. Results The module contained 74 cases and took approximately 20 minutes to complete. Thirty-two cases were normal radiographs and 56 cases were abnormal. Of the 60 volunteers recruited, 25 were “never trained” and 35 were “previously trained.” “Never trained” users scored 21.9 out of 37 during training and 24.0 out of 37 during testing (59.1% vs 64.9%, P value <.001). “Previously trained” users scored 28.0 out of 37 during training and 28.3 out of 37 during testing phases (75.6% vs 76.4%, P value = .56). Survey results showed that 87% of all subjects agreed the module is an efficient way of learning, and 83% agreed the rapid-fire module is valuable for medical students. Conclusions A gamified online module may improve the abnormality detection rates of novice interpreters of chest radiography, although experienced interpreters are less likely to derive similar benefits. Users reviewed the educational module favorably.

      PubDate: 2017-10-25T12:45:07Z
      DOI: 10.1016/j.acra.2017.05.005
  • The Reproducibility of Changes in Diagnostic Figures of Merit Across
           Laboratory and Clinical Imaging Reader Studies
    • Authors: Frank W. Samuelson; Craig K. Abbey
      Pages: 1436 - 1446
      Abstract: Publication date: November 2017
      Source:Academic Radiology, Volume 24, Issue 11
      Author(s): Frank W. Samuelson, Craig K. Abbey
      Rationale and Objectives In this paper we examine which comparisons of reading performance between diagnostic imaging systems made in controlled retrospective laboratory studies may be representative of what we observe in later clinical studies. The change in a meaningful diagnostic figure of merit between two diagnostic modalities should be qualitatively or quantitatively comparable across all kinds of studies. Materials and Methods In this meta-study we examine the reproducibility of relative measures of sensitivity, false positive fraction (FPF), area under the receiver operating characteristic (ROC) curve, and expected utility across laboratory and observational clinical studies for several different breast imaging modalities, including screen film mammography, digital mammography, breast tomosynthesis, and ultrasound. Results Across studies of all types, the changes in the FPFs yielded very small probabilities of having a common mean value. The probabilities of relative sensitivity being the same across ultrasound and tomosynthesis studies were low. No evidence was found for different mean values of relative area under the ROC curve or relative expected utility within any of the study sets. Conclusion The comparison demonstrates that the ratios of areas under the ROC curve and expected utilities are reproducible across laboratory and clinical studies, whereas sensitivity and FPF are not.

      PubDate: 2017-10-25T12:45:07Z
      DOI: 10.1016/j.acra.2017.05.007
  • Practical Considerations for the Use of Breast MRI for Breast Cancer
           Evaluation in the Preoperative Setting
    • Authors: Debra L. Monticciolo
      Pages: 1447 - 1450
      Abstract: Publication date: November 2017
      Source:Academic Radiology, Volume 24, Issue 11
      Author(s): Debra L. Monticciolo
      Preoperative contrast-enhanced (CE) breast magnetic resonance imaging (MRI) remains controversial in the newly diagnosed breast cancer patient. Additional lesions are frequently discovered in these patients with CE breast MRI. As staging and treatment planning evolve to include more information on tumor biology and aggression, so should our consideration of extent of disease. Directing CE breast MRI to those patients most likely to have additional disease may be beneficial. We sought to develop practical guidance for the use of preoperative CE breast MRI in the newly diagnosed breast cancer patient based on recent scientific data. Our review suggests several populations for whom preoperative breast MRI is most likely to find additional disease beyond that seen on conventional imaging. These can be viewed in three categories: (1) tumor biology—patients with invasive lobular carcinoma or aggressive tumors such as triple negative breast cancer (estrogen receptor negative, progesterone receptor negative, and human epidermal growth factor receptor 2 (HER2) negative) and HER2 positive tumors; (2) patient characteristics—dense breast tissue or younger age, especially those age <60; and (3) clinical scenarios—patients with more sonographic disease than expected or those who are node positive at initial diagnosis. Focusing breast MRI on patients with any of the aforementioned characteristics may help utilize preoperative breast MRI where it is likely to have the most impact.

      PubDate: 2017-10-25T12:45:07Z
      DOI: 10.1016/j.acra.2017.05.012
  • Implementation of Upright Digital Breast Tomosynthesis-guided Stereotactic
    • Authors: Toma S. Omofoye; Sarah Martaindale; Davis C. Teichgraeber; Jay R. Parikh
      Pages: 1451 - 1455
      Abstract: Publication date: November 2017
      Source:Academic Radiology, Volume 24, Issue 11
      Author(s): Toma S. Omofoye, Sarah Martaindale, Davis C. Teichgraeber, Jay R. Parikh
      With growing adoption of digital breast tomosynthesis, an increasing number of imaging abnormalities are being identified only by tomosynthesis. Upright digital breast tomosynthesis-guided stereotactic biopsy is a proven method for sampling these abnormalities as well as abnormalities traditionally evaluated using conventional stereotactic biopsy. In this article, we describe the technique of upright digital breast tomosynthesis-guided stereotactic biopsy and outline a systematic operational approach to implementation of this technique in clinical radiology practices.

      PubDate: 2017-10-25T12:45:07Z
      DOI: 10.1016/j.acra.2017.05.010
  • Diagnostic Medical Imaging in Pediatric Patients and Subsequent Cancer
    • Authors: David J. Mulvihill; Sachin Jhawar; John B. Kostis; Sharad Goyal
      Pages: 1456 - 1462
      Abstract: Publication date: November 2017
      Source:Academic Radiology, Volume 24, Issue 11
      Author(s): David J. Mulvihill, Sachin Jhawar, John B. Kostis, Sharad Goyal
      The use of diagnostic medical imaging is becoming increasingly more commonplace in the pediatric setting. However, many medical imaging modalities expose pediatric patients to ionizing radiation, which has been shown to increase the risk of cancer development in later life. This review article provides a comprehensive overview of the available data regarding the risk of cancer development following exposure to ionizing radiation from diagnostic medical imaging. Attention is paid to modalities such as computed tomography scans and fluoroscopic procedures that can expose children to radiation doses orders of magnitude higher than standard diagnostic x-rays. Ongoing studies that seek to more precisely determine the relationship of diagnostic medical radiation in children and subsequent cancer development are discussed, as well as modern strategies to better quantify this risk. Finally, as cardiovascular imaging and intervention contribute substantially to medical radiation exposure, we discuss strategies to enhance radiation safety in these areas.

      PubDate: 2017-10-25T12:45:07Z
      DOI: 10.1016/j.acra.2017.05.009
  • Does the Oral “Mock Board” Examination Still Have a Role as a
           Training Tool'
    • Authors: Colin Strickland; Alexandria Jensen; Tatum McArthur
      Pages: 1463 - 1467
      Abstract: Publication date: November 2017
      Source:Academic Radiology, Volume 24, Issue 11
      Author(s): Colin Strickland, Alexandria Jensen, Tatum McArthur
      Rationale and Objectives The American Board of Radiology has adopted a new standardized board examination and the traditional oral examination has been abandoned. Although many programs have changed their educational efforts to reflect the new test format, some faculty members and residents have expressed a desire to keep an oral examination as a component of education and evaluation in radiology residency programs. Materials and Methods An oral comprehensive examination including all the appropriate subspecialties was administered to each second year and third year resident in our training program by faculty members. Both the resident examinees and faculty examiners were surveyed after the examination to gauge the perceived value of the experience. Results Residents were divided in their perceptions of the fairness and utility of an oral examination as a tool to aid in board preparation and as an assessment of their knowledge and communication skill. Faculty members were universal in their endorsement of the oral examination and suggested continued use of the technique. Conclusions Residents and faculty members have differing perceptions of an oral examination delivered during training to assess knowledge and communication skill. The value of an oral examination in providing actionable feedback to trainees and the possibility of detecting struggling residents made it useful in our training program, and it thus it has been implemented for future years. Whether resident performance measured by this technique is predictive of success on American Board of Radiology examinations remains unclear.

      PubDate: 2017-10-25T12:45:07Z
      DOI: 10.1016/j.acra.2017.06.012
  • Should We Teach Radiology to Undergraduates'
    • Authors: David Alvarez; Richard B. Gunderman
      Pages: 1468 - 1469
      Abstract: Publication date: November 2017
      Source:Academic Radiology, Volume 24, Issue 11
      Author(s): David Alvarez, Richard B. Gunderman

      PubDate: 2017-10-25T12:45:07Z
      DOI: 10.1016/j.acra.2017.07.005
  • Quantitative FLAIR MRI in Amyotrophic Lateral Sclerosis
    • Authors: Jeremy Fabes; Lucy Matthews; Nicola Filippini; Kevin Talbot; Mark Jenkinson; Martin R. Turner
      Pages: 1187 - 1194
      Abstract: Publication date: October 2017
      Source:Academic Radiology, Volume 24, Issue 10
      Author(s): Jeremy Fabes, Lucy Matthews, Nicola Filippini, Kevin Talbot, Mark Jenkinson, Martin R. Turner
      Rationale and Objectives T2-weighted magnetic resonance imaging (MRI) hyperintensity assessed visually in the corticospinal tract (CST) lacks sensitivity for a diagnosis of amyotrophic lateral sclerosis (ALS). We sought to explore a quantitative approach to fluid-attenuated inversion recovery (FLAIR) MRI intensity across a range of ALS phenotypes. Materials and Methods Thirty-three classical ALS patients, 10 with a flail arm presentation, and six with primary lateral sclerosis underwent MRI at 3 Tesla. Comparisons of quantitative FLAIR intensity in the CST and corpus callosum were made between 21 healthy controls and within patient phenotypic subgroups, some of whom were studied longitudinally. Results Mean FLAIR intensity was greater in patient groups. The cerebral peduncle intensity provided the strongest subgroup classification. FLAIR intensity increased longitudinally. The rate of change of FLAIR within CST correlated with rate of decline in executive function and ALS functional rating score. Conclusions FLAIR MRI encodes quantifiable information of potential diagnostic, stratification, and monitoring value.

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

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

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

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

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

      PubDate: 2017-09-06T13:37:01Z
      DOI: 10.1016/j.acra.2017.04.014
  • Educational Effects of Radiation Reduction During Fluoroscopic Examination
           of the Adult Gastrointestinal Tract
    • Authors: Moon Hyung Choi; Seung Eun Jung; Soon Nam Oh; Jae Young Byun
      Abstract: Publication date: Available online 9 November 2017
      Source:Academic Radiology
      Author(s): Moon Hyung Choi, Seung Eun Jung, Soon Nam Oh, Jae Young Byun
      Rationale and Objectives This study aimed to evaluate the effects of educating radiology residents and radiographers about radiation exposure on reduction of dose area product (DAP) and fluoroscopy time in diagnostic fluoroscopy of the gastrointestinal (GI) tract in adult patients. Materials and Methods In April 2015, we offered 1 hour of education to radiology residents and radiographers on how to reduce radiation doses during fluoroscopic examinations. Fluoroscopic examinations of the GI tracts of adult patients performed from June 2014 to February 2016 were evaluated. A total of 2326 fluoroscopic examinations (779 and 1547 examinations before and after education, respectively) were performed, including 10 kinds of examinations. Fluoroscopy time and DAP were collected. A radiologist evaluated the number of spot images, captured images, cine video, captured video, and the use of collimation or magnification. We used the Mann-Whitney U test to assess the difference in fluoroscopy-related factors before and after education. Results Median DAP decreased significantly after education, from 21.1 to 18.2 Gy∙cm2 (P < .001) in all examinations. After education DAP decreased significantly in defecography (P < .001) and fluoroscopy time decreased significantly in upper gastrointestinal series with water-soluble contrast (P < .001). Spot and cine images that increased the radiation dose were used less frequently after education than before in some kinds of examinations, especially in defecography (P < .001). More images were collimated after education in barium swallow than before (P < .001). Conclusions Educating radiologist residents and radiographers could reduce DAP in fluoroscopy examinations of the GI tract in adult patients.

      PubDate: 2017-11-16T09:47:51Z
      DOI: 10.1016/j.acra.2017.09.009
  • Imaging Facilities' Adherence to PI-RADS v2 Minimum Technical Standards
           for the Performance of Prostate MRI
    • Authors: Steven J. Esses; Samir S. Taneja; Andrew B. Rosenkrantz
      Abstract: Publication date: Available online 6 November 2017
      Source:Academic Radiology
      Author(s): Steven J. Esses, Samir S. Taneja, Andrew B. Rosenkrantz
      Purpose This study aimed to assess variability in imaging facilities' adherence to the minimum technical standards for prostate magnetic resonance imaging acquisition established by Prostate Imaging-Reporting and Data System (PI-RADS) version 2 (v2). Methods A total of 107 prostate magnetic resonance imaging examinations performed at 107 unique imaging facilities after the release of PI-RADS v2 and that were referred to a tertiary care center for secondary interpretation were included. Image sets, DICOM headers, and outside reports were reviewed to assess adherence to 21 selected PI-RADS v2 minimum technical standards. Results Hardware arrangements were 23.1%, 1.5T without endorectal coil; 7.7%, 1.5T with endorectal coil; 63.5%, 3T without endorectal coil; and 5.8%, 3T with endorectal coil. Adherence to minimum standards was lowest on T2 weighted imaging (T2WI) for frequency resolution ≤0.4 mm (16.8%) and phase resolution ≤0.7 mm (48.6%), lowest on diffusion-weighted imaging (DWI) for field of view (FOV) 120–220 mm (30.0%), and lowest on dynamic contrast-enhanced (DCE) imaging for slice thickness 3 mm (33.3%) and temporal resolution <10 s (31.5%). High b-value (≥1400 s/mm2) images were included in 58.0% (calculated in 25.9%). Adherence to T2WI phase resolution and DWI inter-slice gap were greater (P < .05) at 3T than at 1.5T. Adherence did not differ (P > .05) for any parameter between examinations performed with and without an endorectal coil. Adherence was greater for examinations performed at teaching facilities for T2WI slice thickness and DCE temporal resolution (P < .05). Adherence was not better for examinations performed in 2016 than in 2015 for any parameter (P > .05). Conclusion Facilities' adherence to PI-RADS v2 minimum technical standards was variable, being particularly poor for T2WI frequency resolution and DCE temporal resolution. The standards warrant greater community education. Certain technical standards may be too stringent, and revisions should be considered.

      PubDate: 2017-11-16T09:47:51Z
      DOI: 10.1016/j.acra.2017.08.013
  • Physician Specialty and Radiologist Characteristics Associated with Higher
           Medicare Patient Complexity
    • Authors: Andrew B. Rosenkrantz; Wenyi Wang; Arvind Vijayasarathi; Richard Duszak
      Abstract: Publication date: Available online 3 November 2017
      Source:Academic Radiology
      Author(s): Andrew B. Rosenkrantz, Wenyi Wang, Arvind Vijayasarathi, Richard Duszak
      Rationale and Objectives Meaningfully measuring physician outcomes and resource utilization requires appropriate patient risk adjustment. We aimed to assess Medicare patient complexity by physician specialty and to further identify radiologist characteristics associated with higher patient complexity. Materials and Methods The average beneficiary Hierarchical Condition Category (HCC) risk scores (Medicare's preferred measure of clinical complexity) were identified for all physicians using 2014 Medicare claims data. HCC scores were compared among physician specialties and further stratified for radiologists based on a range of characteristics. Univariable and multivariable analyses were performed. Results Of 549,194 physicians across 54 specialties, the mean HCC risk score was 1.62 ± 0.75. Of the 54 specialties, interventional radiology ranked 4th (2.60 ± 1.29), nuclear medicine ranked 16th (1.87 ± 0.45), and diagnostic radiology ranked 21st (1.75 ± 0.61). Among 31,175 radiologists, risk scores were higher (P < 0.001) for those with teaching (2.03 ± 0.74) vs nonteaching affiliations (1.72 ± 0.61), practice size ≥100 (1.94 ± 0.70) vs ≤9 (1.59 ± 0.79) members, urban (1.79 ± 0.69) vs rural (1.67 ± 0.59) practices, and subspecialized (1.85 ± 0.81) vs generalized (1.68 ± 0.42) practice patterns. Among noninterventional radiology subspecialties, patient complexity was highest for cardiothoracic (2.09 ± 0.57) and lowest for breast (1.08 ± 0.32) imagers. At multivariable analysis, a teaching affiliation was the strongest independent predictor of patient complexity for both interventional (β = +0.23, P = 0.005) and noninterventional radiologists (β = +0.21, P < 0.001). Conclusions Radiologists on average serve more clinically complex Medicare patients than most physicians nationally. However, patient complexity varies considerably among radiologists and is particularly high for those with teaching affiliations and interventional radiologists. With patient complexity increasingly recognized as a central predictor of clinical outcomes and resource utilization, ongoing insights into complexity measures may assist radiologists navigating emerging risk-based payment models.

      PubDate: 2017-11-16T09:47:51Z
      DOI: 10.1016/j.acra.2017.09.008
  • Is Diagnostic Performance of Quantitative 2D-Shear Wave Elastography
           Optimal for Clinical Classification of Benign and Malignant Thyroid
    • Authors: Haliimah A. Nattabi; Norhafidzah M. Sharif; Noorazrul Yahya; Rozilawati Ahmad; Mazlyfarina Mohamad; Faizah M. Zaki; Ahmad N. Yusoff
      Abstract: Publication date: Available online 18 October 2017
      Source:Academic Radiology
      Author(s): Haliimah A. Nattabi, Norhafidzah M. Sharif, Noorazrul Yahya, Rozilawati Ahmad, Mazlyfarina Mohamad, Faizah M. Zaki, Ahmad N. Yusoff
      Rationale and Objective This study is a dedicated 2D-shear wave elastography (2D-SWE) review aimed at systematically eliciting up-to-date evidence of its clinical value in differential diagnosis of benign and malignant thyroid nodules. Methods PubMed, Web of Science, and Scopus databases were searched for studies assessing the diagnostic value of 2D-SWE for thyroid malignancy risk stratification published until December 2016. The retrieved titles and abstracts were screened and evaluated according to the predefined inclusion and exclusion criteria. Methodological quality of the studies was assessed using the Quality Assessment of Studies of Diagnostic Accuracy included in Systematic Review 2 (QUADAS-2) tool. Extracted 2D-SWE diagnostic performance data were meta-analyzed to assess the summary sensitivity, specificity, and area under the receiver operating characteristic curve. Results After stepwise review, 14 studies in which 2D-SWE was used to evaluate 2851 thyroid nodules (1092 malignant, 1759 benign) from 2139 patients were selected for the current study. Study quality on QUADAS-2 assessment was moderate to high. The summary sensitivity, specificity and area under the receiver operating characteristic curve of 2D-SWE for differential diagnosis of benign and malignant thyroid nodules were 0.66 (95% confidence interval [CI]: 0.64–0.69), 0.78 (CI: 0.76–0.80), and 0.851 (Q* = 0.85), respectively. The pooled diagnostic odds ratio, negative likelihood ratio, and positive likelihood ratio were 12.73 (CI: 8.80–18.43), 0.31 (CI: 0.22–0.44), and 3.87 (CI: 2.83–5.29), respectively. Conclusion Diagnostic performance of quantitative 2D-SWE for malignancy risk stratification of thyroid nodules is suboptimal with mediocre sensitivity and specificity, contrary to earlier reports of excellence.

      PubDate: 2017-11-16T09:47:51Z
      DOI: 10.1016/j.acra.2017.09.002
  • Recipe for a Successful Hybrid Academic-Community Radiology Practice
    • Authors: Kaela L. Gusenbauer; Michael N. Patlas; Ania Z. Kielar; Douglas S. Katz
      Abstract: Publication date: Available online 7 November 2017
      Source:Academic Radiology
      Author(s): Kaela L. Gusenbauer, Michael N. Patlas, Ania Z. Kielar, Douglas S. Katz

      PubDate: 2017-11-09T04:30:09Z
      DOI: 10.1016/j.acra.2017.08.017
  • Can Radiologists Learn From Airport Baggage Screening'
    • Authors: Andrew Phelps; Andrew L. Callen; Peter Marcovici; David M. Naeger; John Mongan; Emily M. Webb
      Abstract: Publication date: Available online 6 November 2017
      Source:Academic Radiology
      Author(s): Andrew Phelps, Andrew L. Callen, Peter Marcovici, David M. Naeger, John Mongan, Emily M. Webb
      Rationale and Objectives For both airport baggage screeners and radiologists, low target prevalence is associated with low detection rate, a phenomenon known as “prevalence effect.” In airport baggage screening, the target prevalence is artificially increased with fictional weapons that are digitally superimposed on real baggage. This strategy improves the detection rate of real weapons and also allows airport supervisors to monitor screener performance. A similar strategy using fictional patients could be applied in radiology. The purpose of this study was twofold: (1) to review the psychophysics literature regarding low target prevalence and (2) to survey radiologists' attitudes toward using fictional patients as a quality assurance tool. Materials and Methods We reviewed the psychophysics literature on low target prevalence and airport x-ray baggage screeners. An online survey was e-mailed to all members of the Association of University Radiologists to determine their attitudes toward using fictional patients in radiology. Results Of the 1503 Association of University Radiologists member recipients, there were 153 respondents (10% response rate). When asked whether the use of fictional patients was a good idea, the responses were as follows: disagree (44%), neutral (25%), and agree (31%). The most frequent concern was the time taken away from doing clinical work (89% of the respondents). Conclusions The psychophysics literature supports the use of fictional targets to mitigate the prevalence effect. However, the use of fictional patients is not a popular idea among academic radiologists.

      PubDate: 2017-11-09T04:30:09Z
      DOI: 10.1016/j.acra.2017.08.014
  • Accuracy of Computed Tomographic Enterography for Obscure Gastrointestinal
    • Authors: Bosheng He; Jushun Yang; Jing Xiao; Jinhua Gu; Feixiang Chen; Lin Wang; Junbo Qian; Shenchu Gong
      Abstract: Publication date: Available online 6 November 2017
      Source:Academic Radiology
      Author(s): Bosheng He, Jushun Yang, Jing Xiao, Jinhua Gu, Feixiang Chen, Lin Wang, Junbo Qian, Shenchu Gong
      Rationale and Objectives Obscure gastrointestinal bleeding (OGIB) is the bleeding from the gastrointestinal tract without definite source that persists and recurs after a negative endoscopic evaluation. The study aimed to systematically evaluate the diagnostic accuracy of computed tomography enterography on OGIB detection by meta-analysis. Materials and Methods Studies were searched in relevant databases. With predefined inclusion criteria, eligible studies were included, followed by quality assessment using the Quality Assessment of Diagnostic Accuracy Studies scoring system. The Meta-DiSc software was used to implement the meta-analysis, and sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio with their 95% confidence intervals (CIs) were used as the effect size. Publication bias was determined by Egger test. Results A set of nine studies was included in this meta-analysis, having a relatively high quality. Under the random effects model, the pooled sensitivity and specificity were 0.724 (95% CI: 0.651–0.789) and 0.752 (95% CI: 0.691–0.807), respectively. Under the fixed effects model, the pooled positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio were 2.949 (95% CI: 2.259–3.850), 0.393 (95% CI: 0.310–0.497), and 9.452 (95% CI: 5.693–15.692), respectively. The area under curve of the summary receiver operating characteristic curve was 0.7916 (95% CI: 0.723–0.860). No obvious publication bias was detected (t = 1.62, P = .181). Conclusions Computed tomography enterography might be used as a complementary to video capsule endoscopy instead of an alternative for the detection of OGIB.

      PubDate: 2017-11-09T04:30:09Z
      DOI: 10.1016/j.acra.2017.09.001
  • 3D Registration of mpMRI for Assessment of Prostate Cancer Focal Therapy
    • Authors: Clément Orczyk; Andrew B. Rosenkrantz; Artem Mikheev; Arnauld Villers; Myriam Bernaudin; Samir S. Taneja; Samuel Valable; Henry Rusinek
      Abstract: Publication date: Available online 6 November 2017
      Source:Academic Radiology
      Author(s): Clément Orczyk, Andrew B. Rosenkrantz, Artem Mikheev, Arnauld Villers, Myriam Bernaudin, Samir S. Taneja, Samuel Valable, Henry Rusinek
      Rationale and Objectives This study aimed to assess a novel method of three-dimensional (3D) co-registration of prostate magnetic resonance imaging (MRI) examinations performed before and after prostate cancer focal therapy. Materials and Methods We developed a software platform for automatic 3D deformable co-registration of prostate MRI at different time points and applied this method to 10 patients who underwent focal ablative therapy. MRI examinations were performed preoperatively, as well as 1 week and 6 months post treatment. Rigid registration served as reference for assessing co-registration accuracy and precision. Results Segmentation of preoperative and postoperative prostate revealed a significant postoperative volume decrease of the gland that averaged 6.49 cc (P = .017). Applying deformable transformation based on mutual information from 120 pairs of MRI slices, we refined by 2.9 mm (max. 6.25 mm) the alignment of the ablation zone, segmented from contrast-enhanced images on the 1-week postoperative examination, to the 6-month postoperative T2-weighted images. This represented a 500% improvement over the rigid approach (P = .001), corrected by volume. The dissimilarity by Dice index of the mapped ablation zone using deformable transformation vs rigid control was significantly (P = .04) higher at the ablation site than in the whole gland. Conclusions Our findings illustrate our method's ability to correct for deformation at the ablation site. The preliminary analysis suggests that deformable transformation computed from mutual information of preoperative and follow-up MRI is accurate in co-registration of MRI examinations performed before and after focal therapy. The ability to localize the previously ablated tissue in 3D space may improve targeting for image-guided follow-up biopsy within focal therapy protocols.

      PubDate: 2017-11-09T04:30:09Z
      DOI: 10.1016/j.acra.2017.06.010
  • Automated Radiology-Operative Note Communication Tool; Closing the Loop in
           Musculoskeletal Imaging
    • Authors: William Moore; Ankur Doshi; Priya Bhattacharji; Soterios Gyftopoulos; Gina Ciavarra; Danny Kim; Michael Recht
      Abstract: Publication date: Available online 6 November 2017
      Source:Academic Radiology
      Author(s): William Moore, Ankur Doshi, Priya Bhattacharji, Soterios Gyftopoulos, Gina Ciavarra, Danny Kim, Michael Recht
      Rationale and Objectives Correlation of imaging studies and reference standard outcomes is a significant challenge in radiology. This study evaluates the effectiveness of a new communication tool by assessing the ability of this system to correctly match the imaging studies to arthroscopy reports and qualitatively assessing radiologist behavior before and after the implementation of this system. Materials and Methods Using a commercially available communication or educational tool and applying a novel matching rule algorithm, radiology and arthroscopy reports were matched from January 17, 2017 to March 1, 2017 based on anatomy. The interpreting radiologist was presented with email notifications containing the impression of the imaging report and the entire arthroscopy report. Total correlation rate of appropriate report pairings, modality-specific correlation rate, and the anatomy-specific correlation rate were calculated. Radiologists using the system were given a survey. Results Overall correlation rate for all musculoskeletal imaging was 83.1% (433 or 508). Low correlation was found in fluoroscopic procedures at 74.4%, and the highest correlation was found with ultrasound at 88.4%. Anatomic location varied from 51.6% for spine to 98.8% for hips and pelvis studies. Survey results revealed 87.5% of the respondents reporting being either satisfied or very satisfied with the new communication tool. The survey also revealed that some radiologists reviewed more cases than before. Conclusions Matching of radiology and arthroscopy reports by anatomy allows for excellent report correlation (83.1%). Automated correlation improves the quality and efficiency of feedback to radiologists, providing important opportunities for learning and improved accuracy.

      PubDate: 2017-11-09T04:30:09Z
      DOI: 10.1016/j.acra.2017.08.016
  • Correlation of Brown Adipose Tissue with Other Body Fat Compartments and
           Patient Characteristics
    • Authors: Cornelia Brendle; Matthias K. Werner; Maria Schmadl; Christian la Fougère; Konstantin Nikolaou; Norbert Stefan; Christina Pfannenberg
      Abstract: Publication date: Available online 3 November 2017
      Source:Academic Radiology
      Author(s): Cornelia Brendle, Matthias K. Werner, Maria Schmadl, Christian la Fougère, Konstantin Nikolaou, Norbert Stefan, Christina Pfannenberg
      Rationale and Objectives The objective of this study was to assess the relationship of brown adipose tissue (BAT) activity with different fat compartments of the body, body mass index (BMI), outdoor temperature, thyroid-stimulating hormone (TSH) levels, blood glucose, age, and sex in a large patient population using F-18-fluordesoxyglucose positron emission tomography-computer tomography (FDG-PET/CT) scans obtained under thermoneutral conditions. Materials and Methods FDG-PET/CT scans of 4852 patients were retrospectively analyzed for BAT activity. The volumes of the different fat compartments visceral adipose tissue (VAT), subcutaneous adipose tissue (SCAT), and liver fat, were assessed by computed tomography. Age, sex, TSH levels, blood glucose levels, BMI, primary disease, and the outdoor temperature were determined. Multiple linear regression analyses were performed to identify independent relationships between the parameters. Results The VAT, SCAT, and liver fat content were lower in BAT-positive patients than in BAT-negative patients (each P < 0.0001). BAT-positive patients had a lower BMI (P < 0.0001) and were more often female (P < 0.0001), younger (P < 0.0001), and had higher TSH levels (P = 0.0002), whereas the outdoor temperature and the blood glucose level were not different compared to BAT-negative patients. Age, sex, VAT, and SCAT were independent factors related to BAT. Conclusions Age, sex, and VAT are the most important determinants of BAT activity under thermoneutral conditions. VAT reflects the association between BAT activity and body fat mass more clearly than BMI. The strength of the association between VAT and BAT decreases during aging in men, but increases in women. This may indicate a different importance of BAT activity for obesity in men and in women.

      PubDate: 2017-11-09T04:30:09Z
      DOI: 10.1016/j.acra.2017.09.007
  • Volumetric MRI Analysis of Plexiform Neurofibromas in Neurofibromatosis
           Type 1
    • Authors: Wenli Cai; Seth M. Steinberg; Miriam A. Bredella; Gina Basinsky; Bhanusupriya Somarouthu; Scott R. Plotkin; Jeffrey Solomon; Brigitte C. Widemann; Gordon J. Harris; Eva Dombi
      Abstract: Publication date: Available online 31 October 2017
      Source:Academic Radiology
      Author(s): Wenli Cai, Seth M. Steinberg, Miriam A. Bredella, Gina Basinsky, Bhanusupriya Somarouthu, Scott R. Plotkin, Jeffrey Solomon, Brigitte C. Widemann, Gordon J. Harris, Eva Dombi
      Objectives Plexiform neurofibromas (PNs) are complex, histologically benign peripheral nerve sheath tumors that are challenging to measure by simple line measurements. Computer-aided volumetric segmentation of PN has become the recommended method to assess response in clinical trials directed at PN. Different methods for volumetric analysis of PN have been developed. The goal of this study is to test the level of agreement in volume measurements and in interval changes using two separate methods of volumetric magnetic resonance imaging analysis. Methods Three independent volume measurements were performed on 15 PN imaged at three time-points using 3DQI software at Massachusetts General Hospital (MGH) and National Cancer Institute (NCI) and MEDx software at NCI. Results Median volume differences at each time-point comparing MGH-3DQI and NCI-3DQI were −0.5, −4.2, and −19.9 mL; comparing NCI-3DQI and NCI-MEDx were −21.0, −47.0, and −21.0 mL; comparing MGH-3DQI and NCI-MEDx were −10.0, −70.3, and −29.9 mL. Median differences in percentage change over time comparing MGH-3DQI and NCI-3DQI were −1.7, 1.1, and −1.0%; comparing NCI-3DQI and NCI-MEDx were −2.3, 3.3, and −1.1%; comparing MGH-3DQI and NCI-MEDx were −0.4, 2.0, and −1.5%. Volume differences were <20% of the mean of the two measurements in 117 of 135 comparisons (86.7%). Difference in interval change was <20% in 120 of the 135 comparisons (88.9%), while disease status classification was concordant in 115 of 135 comparisons (85.2%). Conclusions The volumes, interval changes, and progression status classifications were in good agreement. The comparison of two volumetric analysis methods suggests no systematic differences in tumor assessment. A prospective comparison of the two methods is planned.

      PubDate: 2017-11-02T03:58:16Z
      DOI: 10.1016/j.acra.2017.09.004
  • Educational Implications of Health Insurance Changes
    • Authors: Lindsey Shea; Darel E. Heitkamp; Jeffrey W. Dunkle; Richard B. Gunderman
      Abstract: Publication date: Available online 26 October 2017
      Source:Academic Radiology
      Author(s): Lindsey Shea, Darel E. Heitkamp, Jeffrey W. Dunkle, Richard B. Gunderman

      PubDate: 2017-11-02T03:58:16Z
      DOI: 10.1016/j.acra.2017.09.003
  • Increased Epicardial Fat Volume in Systemic Sclerosis
    • Authors: Matthew J. Budoff
      Abstract: Publication date: Available online 26 October 2017
      Source:Academic Radiology
      Author(s): Matthew J. Budoff

      PubDate: 2017-11-02T03:58:16Z
      DOI: 10.1016/j.acra.2017.09.005
  • Robotically Assisted Long Bone Biopsy Under MRI Imaging
    • Authors: Kevin Cleary; Sunghwan Lim; Changhan Jun; Reza Monfaredi; Karun Sharma; Stanley Thomas Fricke; Luis Vargas; Doru Petrisor; Dan Stoianovici
      Abstract: Publication date: Available online 23 October 2017
      Source:Academic Radiology
      Author(s): Kevin Cleary, Sunghwan Lim, Changhan Jun, Reza Monfaredi, Karun Sharma, Stanley Thomas Fricke, Luis Vargas, Doru Petrisor, Dan Stoianovici
      Rationale and Objectives Our research team has developed a magnetic resonance imaging (MRI)-compatible robot for long bone biopsy. The robot is intended to enable a new workflow for bone biopsy in pediatrics under MRI imaging. Our long-term objectives are to minimize trauma and eliminate radiation exposure when diagnosing children with bone cancers and bone infections. This article presents our robotic systems, phantom accuracy studies, and workflow analysis. Materials and Methods This section describes several aspects of our work including the envisioned clinical workflow, the MRI-compatible robot, and the experimental setup. The workflow consists of five steps and is intended to enable the entire procedure to be completed in the MRI suite. The MRI-compatible robot is MR Safe, has 3 degrees of freedom, and a remote center of motion mechanism for orienting a needle guide. The accuracy study was done in a Siemens Aera 1.5T scanner with a long bone phantom. Four targeting holes were drilled in the phantom. Results Each target was approached twice at slightly oblique angles using the robot needle guide for a total of eight attempts. A workflow analysis showed the average time for each targeting attempt was 32 minutes, including robot setup time. The average 3D targeting error was 1.39 mm with a standard deviation of 0.40 mm. All of the targets were successfully reached. Conclusion The results showed the ability of the robotic system in assisting the radiologist to precisely target a bone phantom in the MRI environment. The robot system has several potential advantages for clinical application, including the ability to work at the MRI isocenter and serve as a steady and precise guide.

      PubDate: 2017-10-25T12:45:07Z
      DOI: 10.1016/j.acra.2017.08.008
  • Apparent Diffusion Coefficient Value to Evaluate Tumor Response After
           Neoadjuvant Chemotherapy in Patients with Breast Cancer
    • Authors: Yazmín Aseret Ramírez-Galván; Servando Cardona-Huerta; Guillermo Elizondo-Riojas; Neri Alejandro Álvarez-Villalobos
      Abstract: Publication date: Available online 21 October 2017
      Source:Academic Radiology
      Author(s): Yazmín Aseret Ramírez-Galván, Servando Cardona-Huerta, Guillermo Elizondo-Riojas, Neri Alejandro Álvarez-Villalobos
      Rationale and Objectives This study explored tumor behavior in patients with breast cancer during neoadjuvant chemotherapy (NAC) by sequential measurements of tumor apparent diffusion coefficient (ADC) after each chemotherapy cycle. The aim was to determine if the tumor ADC is useful to differentiate complete pathological response (cPR) from partial pathological response (pPR) during NAC. Materials and Methods A total of 16 cases (in 14 patients) with diagnosis of breast cancer eligible to receive NAC were included. There were 70 magnetic resonance imaging examinations performed, 5 for each patient, during NAC cycles. Diffusion-weighted imaging was performed on a 1.5T system (b values of 0 and 700s/mm2). Four ADC ratios between the five MRI examinations were obtained to assess ADC changes during NAC. Absence of invasive breast cancer at surgical specimens (Miller-Payne 5) was considered as cPR and was used as reference for ADC cutoff ratios. Results In this study, we were able to differentiate between cPR and pPR, after two cycles of NAC until the end of NAC before surgery (ADC ratios 2–4). The thresholds to differentiate between cPR and pPR of ADC ratios 2, 3, and 4, were 1.14 × 10−3mm2/s, 1.08 × 10−3mm2/s, and 1.25 × 10−3mm2/s, respectively, and have a cross-validated sensitivity and specificity of 79.2%, 79.7% (ADC ratio 2); 100%, 66.7% (ADC ratio 3); and 100%, 83.8% (ADC ratio 4), respectively. Conclusions The ADC ratios were useful to differentiate cPR from pPR in breast cancer tumors after NAC. Thus, it may be useful in tailoring treatment in these patients.

      PubDate: 2017-10-25T12:45:07Z
      DOI: 10.1016/j.acra.2017.08.009
  • Social Media Utilization at an Academic Radiology Practice
    • Authors: Nicholas A. Koontz; Aaron P. Kamer; Sean C. Dodson; Alisha E. Capps; Courtney M. Tomblinson; Brandon P. Brown; Mark S. Frank; Darel E. Heitkamp
      Abstract: Publication date: Available online 19 October 2017
      Source:Academic Radiology
      Author(s): Nicholas A. Koontz, Aaron P. Kamer, Sean C. Dodson, Alisha E. Capps, Courtney M. Tomblinson, Brandon P. Brown, Mark S. Frank, Darel E. Heitkamp
      Rationale and Objectives We report social media (SoMe) utilization trends at an academic radiology department, highlighting differences between trainees and faculty and between Baby Boomers versus Generation X and Millennials. Materials and Methods An anonymous online survey regarding SoMe utilization and SoMe-based educational curriculum was distributed to all radiologists (trainees and faculty) in our department. Regular chi-square, ordered (Mantel-Haenszel) chi-square, and Fischer exact tests were performed. Results The survey instrument was sent to 172 radiologists with a 65% completion rate (N = 112). Eighty-three percent (n = 92) of the respondents use SoMe, with Facebook (67%, n = 75), YouTube (57%, n = 64), Instagram (26%, n = 29), and Twitter (21%, n = 23) as the most commonly used platforms. Eighty-one percent (n = 91) use SoMe for 30 minutes or less per day. Thirty-five percent (n = 39) reported previously using SoMe for educational purposes, although 66% (n = 73) would be willing to join SoMe for educational activities. The faculty are more likely than trainees to avoid using SoMe (30% vs 9%, P < 0.03). Trainees are more likely than faculty to find an electronic case-based curriculum valuable (95% vs 83%, P < 0.05) and are willing to spend more time on cases (P < 0.01). Baby Boomers are less interested in joining SoMe for educational activities than Generation X and Millennials (24% vs 73%, P = 0.0001). Conclusions Generation gaps between trainees and faculty, as well as between Generation X and Millennials versus Baby Boomers, exist with regard to the use of SoMe, which may be underutilized in radiology education.

      PubDate: 2017-10-25T12:45:07Z
      DOI: 10.1016/j.acra.2017.08.012
  • Spectral Beam Shaping in Unenhanced Chest CT Examinations
    • Authors: Saravanabavaan Suntharalingam; Thomas Allmendinger; Sebastian Blex; Mohammad Al-Bayati; Kai Nassenstein; Bernd Schweiger; Michael Forsting; Axel Wetter
      Abstract: Publication date: Available online 18 October 2017
      Source:Academic Radiology
      Author(s): Saravanabavaan Suntharalingam, Thomas Allmendinger, Sebastian Blex, Mohammad Al-Bayati, Kai Nassenstein, Bernd Schweiger, Michael Forsting, Axel Wetter
      Rationale and Objectives This study aimed to determine the optimal tube potential for unenhanced chest computed tomographies (CTs) with age-related phantoms. Materials and Methods Three physical anthropomorphic phantoms (newborn, 5-year-old child, and adult) were scanned on a third-generation dual-source CT using CAREkV in semi-mode and CAREDose4D (ref. KV: 120; ref. mAs 50). Scans were performed with all available tube potentials (70–150 kV and Sn150 kV). The lowest volume computed tomography dose index (CTDIvol) was selected to perform additional Sn100-kV scans with matched and half (Sn100-half) CTDIvol value. Image quality was evaluated on the basis of contrast-to-noise ratio (CNR). Results For the newborn phantom, 70–110 kV was selected as the optimal range (0.36–0.37 mGy). Using Sn150 kV led to an increase in radiation dose (0.75 mGy) without improving CNR (96.9 vs 101.5). Sn100-half showed a decrease in CNR (73.1 vs 101.5). The lowest CTDIvol for the child phantom was achieved between 100 and 120 kV (0.78–0.80 mGy). Using Sn150 kV increased radiation dose (1.02 mGy) without improvement of CNR (92.4 vs 95.8). At Sn100-half CNR was decreased (61.4 vs 95.8). For adults, 140 and 150 kV revealed the lowest CTDIvol (2.68 and 2.67 mGy). The Sn150 kV scan delivered comparable CNR (54.4 vs 56.6), but a lower CTDIvol (2.08 mGy). At Sn100-half CNR was comparable to the 150 kV scan (58.1 vs 56.6). Conclusion Unenhanced chest CT performed at 100 kV or 150 kV with tin filtration enables radiation dose reduction for the adult phantom, but not for the pediatric phantoms.

      PubDate: 2017-10-25T12:45:07Z
      DOI: 10.1016/j.acra.2017.08.011
  • On the Potential Role of MRI Biomarkers of COPD to Guide Bronchoscopic
           Lung Volume Reduction
    • Authors: Colin J. Adams; Dante P.I. Capaldi; Robert Di Cesare; David G. McCormack; Grace Parraga
      Abstract: Publication date: Available online 16 October 2017
      Source:Academic Radiology
      Author(s): Colin J. Adams, Dante P.I. Capaldi, Robert Di Cesare, David G. McCormack, Grace Parraga
      Rationale and Objectives In patients with severe emphysema and poor quality of life, bronchoscopic lung volume reduction (BLVR) may be considered and guided based on lobar emphysema severity. In particular, x-ray computed tomography (CT) emphysema measurements are used to identify the most diseased and the second–most diseased lobes as BLVR targets. Inhaled gas magnetic resonance imaging (MRI) also provides chronic obstructive pulmonary disease (COPD) biomarkers of lobar emphysema and ventilation abnormalities. Our objective was to retrospectively evaluate CT and MRI biomarkers of lobar emphysema and ventilation in patients with COPD eligible for BLVR. We hypothesized that MRI would provide complementary biomarkers of emphysema and ventilation that help determine the most appropriate lung lobar targets for BLVR in patients with COPD. Materials and Methods We retrospectively evaluated 22 BLVR-eligible patients from the Thoracic Imaging Network of Canada cohort (diffusing capacity of the lung for carbon monoxide = 37 ± 12%predicted, forced expiratory volume in 1 second = 34 ± 7%predicted, total lung capacity = 131 ± 17%predicted, and residual volume = 216 ± 36%predicted). Lobar CT emphysema, measured using a relative area of <−950 Hounsfield units (RA950) and MRI ventilation defect percent, was independently used to rank lung lobe disease severity. Results In 7 of 22 patients, there were different CT and MRI predictions of the most diseased lobe. In some patients, there were large ventilation defects in lobes not targeted by CT, indicative of a poorly ventilated lung. CT and MRI classification of the most diseased and the second–most diseased lobes showed a fair-to-moderate intermethod reliability (Cohen κ = 0.40–0.59). Conclusions In this proof-of-concept retrospective analysis, quantitative MRI ventilation and CT emphysema measurements provided different BLVR targets in over 30% of the patients. The presence of large MRI ventilation defects in lobes next to CT-targeted lobes might also change the decision to proceed or to guide BLVR to a different lobar target.

      PubDate: 2017-10-25T12:45:07Z
      DOI: 10.1016/j.acra.2017.08.010
  • Logistics of Three-dimensional Printing
    • Authors: Taryn Hodgdon; Raman Danrad; Midhir J. Patel; Stacy E. Smith; Michael L. Richardson; David H. Ballard; Sayed Ali; Anthony Paul Trace; Carolynn M. DeBenedectis; Matthew E. Zygmont; Leon Lenchik; Summer J. Decker
      Abstract: Publication date: Available online 10 October 2017
      Source:Academic Radiology
      Author(s): Taryn Hodgdon, Raman Danrad, Midhir J. Patel, Stacy E. Smith, Michael L. Richardson, David H. Ballard, Sayed Ali, Anthony Paul Trace, Carolynn M. DeBenedectis, Matthew E. Zygmont, Leon Lenchik, Summer J. Decker
      The Association of University Radiologists Radiology Research Alliance Task Force on three-dimensional (3D) printing presents a review of the logistic considerations for establishing a clinical service using this new technology, specifically focused on implications for radiology. Specific topics include printer selection for 3D printing, software selection, creating a 3D model for printing, providing a 3D printing service, research directions, and opportunities for radiologists to be involved in 3D printing. A thorough understanding of the technology and its capabilities is necessary as the field of 3D printing continues to grow. Radiologists are in the unique position to guide this emerging technology and its use in the clinical arena.

      PubDate: 2017-10-12T14:04:08Z
      DOI: 10.1016/j.acra.2017.08.003
  • Clinical Applications of 3D Printing
    • Authors: Taryn Hodgdon; Raman Danrad; Midhir J. Patel; Stacy E. Smith; Michael L. Richardson; David H. Ballard; Sayed Ali; Anthony Paul Trace; Carolynn M. DeBenedectis; Matthew E. Zygmont; Leon Lenchik; Summer J. Decker
      Abstract: Publication date: Available online 10 October 2017
      Source:Academic Radiology
      Author(s): David H. Ballard, Anthony Paul Trace, Sayed Ali, Taryn Hodgdon, Matthew E. Zygmont, Carolynn M. DeBenedectis, Stacy E. Smith, Michael L. Richardson, Midhir J. Patel, Summer J. Decker, Leon Lenchik
      Three-dimensional (3D) printing refers to a number of manufacturing technologies that create physical models from digital information. Radiology is poised to advance the application of 3D printing in health care because our specialty has an established history of acquiring and managing the digital information needed to create such models. The 3D Printing Task Force of the Radiology Research Alliance presents a review of the clinical applications of this burgeoning technology, with a focus on the opportunities for radiology. Topics include uses for treatment planning, medical education, and procedural simulation, as well as patient education. Challenges for creating custom implantable devices including financial and regulatory processes for clinical application are reviewed. Precedent procedures that may translate to this new technology are discussed. The task force identifies research opportunities needed to document the value of 3D printing as it relates to patient care.

      PubDate: 2017-10-12T14:04:08Z
      DOI: 10.1016/j.acra.2017.08.003
  • Structured Reporting in Radiology
    • Authors: Dhakshinamoorthy Ganeshan; Phuong-Anh Thi Duong Linda Probyn Leon Lenchik Tatum
      Abstract: Publication date: Available online 10 October 2017
      Source:Academic Radiology
      Author(s): Dhakshinamoorthy Ganeshan, Phuong-Anh Thi Duong, Linda Probyn, Leon Lenchik, Tatum A. McArthur, Michele Retrouvey, Emily H. Ghobadi, Stephane L. Desouches, David Pastel, Isaac R. Francis
      Radiology reports are vital for patient care as referring physicians depend upon them for deciding appropriate patient management. Traditional narrative reports are associated with excessive variability in the language, length, and style, which can minimize report clarity and make it difficult for referring clinicians to identify key information needed for patient care. Structured reporting has been advocated as a potential solution for improving the quality of radiology reports. The Association of University Radiologists—Radiology Research Alliance Structured Reporting Task Force convened to explore the current and future role of structured reporting in radiology and summarized its finding in this article. We review the advantages and disadvantages of structured radiology reports and discuss the current prevailing sentiments among radiologists regarding structured reports. We also discuss the obstacles to the use of structured reports and highlight ways to overcome some of those challenges. We also discuss the future directions in radiology reporting in the era of personalized medicine.

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

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

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

      PubDate: 2017-10-05T13:36:23Z
      DOI: 10.1016/j.acra.2017.08.007
  • Low-intensity Vibration Therapy for Bone Health in Renal Osteodystrophy
    • Authors: Sachin Sharma; Garry E. Gold
      Abstract: Publication date: Available online 15 September 2017
      Source:Academic Radiology
      Author(s): Sachin Sharma, Garry E. Gold

      PubDate: 2017-09-16T14:10:07Z
      DOI: 10.1016/j.acra.2017.08.001
  • MR Imaging Biomarkers in Amyotrophic Lateral Sclerosis
    • Authors: Elias R. Melhem
      Abstract: Publication date: Available online 16 August 2017
      Source:Academic Radiology
      Author(s): Elias R. Melhem

      PubDate: 2017-08-20T19:30:13Z
      DOI: 10.1016/j.acra.2017.07.004
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