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Showing 1 - 200 of 3175 Journals sorted alphabetically
A Practical Logic of Cognitive Systems     Full-text available via subscription   (Followers: 8)
AASRI Procedia     Open Access   (Followers: 14)
Academic Pediatrics     Hybrid Journal   (Followers: 28, SJR: 1.402, h-index: 51)
Academic Radiology     Hybrid Journal   (Followers: 22, SJR: 1.008, h-index: 75)
Accident Analysis & Prevention     Partially Free   (Followers: 90, 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: 33, SJR: 2.515, h-index: 90)
Achievements in the Life Sciences     Open Access   (Followers: 5)
Acta Anaesthesiologica Taiwanica     Open Access   (Followers: 6, SJR: 0.338, h-index: 19)
Acta Astronautica     Hybrid Journal   (Followers: 377, SJR: 0.726, h-index: 43)
Acta Automatica Sinica     Full-text available via subscription   (Followers: 2)
Acta Biomaterialia     Hybrid Journal   (Followers: 27, SJR: 2.02, h-index: 104)
Acta Colombiana de Cuidado Intensivo     Full-text available via subscription   (Followers: 2)
Acta de Investigación Psicológica     Open Access   (Followers: 3)
Acta Ecologica Sinica     Open Access   (Followers: 8, SJR: 0.172, h-index: 29)
Acta Haematologica Polonica     Free   (Followers: 1, SJR: 0.123, h-index: 8)
Acta Histochemica     Hybrid Journal   (Followers: 3, SJR: 0.604, h-index: 38)
Acta Materialia     Hybrid Journal   (Followers: 236, 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  
Acta Otorrinolaringológica Española     Full-text available via subscription   (Followers: 2, 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: 25, SJR: 1.365, h-index: 73)
Acta Sociológica     Open Access  
Acta Tropica     Hybrid Journal   (Followers: 6, SJR: 1.059, h-index: 77)
Acta Urológica Portuguesa     Open Access  
Actas Dermo-Sifiliograficas     Full-text available via subscription   (Followers: 3)
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Actualites Pharmaceutiques     Full-text available via subscription   (Followers: 5, SJR: 0.141, h-index: 3)
Actualites Pharmaceutiques Hospitalieres     Full-text available via subscription   (Followers: 3, SJR: 0.112, h-index: 2)
Acupuncture and Related Therapies     Hybrid Journal   (Followers: 6)
Acute Pain     Full-text available via subscription   (Followers: 14)
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: 7)
Additive Manufacturing     Hybrid Journal   (Followers: 9, SJR: 1.039, h-index: 5)
Additives for Polymers     Full-text available via subscription   (Followers: 22)
Advanced Cement Based Materials     Full-text available via subscription   (Followers: 3)
Advanced Drug Delivery Reviews     Hybrid Journal   (Followers: 129, 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: 16, SJR: 0.739, h-index: 33)
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Advances in Anesthesia     Full-text available via subscription   (Followers: 27, SJR: 0.169, h-index: 4)
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Advances In Atomic, Molecular, and Optical Physics     Full-text available via subscription   (Followers: 14, 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: 2, SJR: 0.619, h-index: 48)
Advances in Cancer Research     Full-text available via subscription   (Followers: 28, SJR: 2.215, h-index: 78)
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Advances in Cell Aging and Gerontology     Full-text available via subscription   (Followers: 3)
Advances in Cellular and Molecular Biology of Membranes and Organelles     Full-text available via subscription   (Followers: 12)
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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: 10, SJR: 1.268, h-index: 45)
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Advances in Colloid and Interface Science     Full-text available via subscription   (Followers: 19, SJR: 2.314, h-index: 130)
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Advances in Digestive Medicine     Open Access   (Followers: 8)
Advances in DNA Sequence-Specific Agents     Full-text available via subscription   (Followers: 5)
Advances in Drug Research     Full-text available via subscription   (Followers: 21)
Advances in Ecological Research     Full-text available via subscription   (Followers: 42, SJR: 3.25, h-index: 43)
Advances in Engineering Software     Hybrid Journal   (Followers: 27, SJR: 0.486, h-index: 10)
Advances in Experimental Biology     Full-text available via subscription   (Followers: 6)
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: 1)
Advances in Fluorine Science     Full-text available via subscription   (Followers: 7)
Advances in Food and Nutrition Research     Full-text available via subscription   (Followers: 54, SJR: 0.674, h-index: 38)
Advances in Fuel Cells     Full-text available via subscription   (Followers: 15)
Advances in Genetics     Full-text available via subscription   (Followers: 14, SJR: 2.558, h-index: 54)
Advances in Genome Biology     Full-text available via subscription   (Followers: 7)
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: 21, 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: 23)
Advances in Imaging and Electron Physics     Full-text available via subscription   (Followers: 1, 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: 8, SJR: 1.132, h-index: 42)
Advances in Insect Physiology     Full-text available via subscription   (Followers: 2, SJR: 1.274, h-index: 27)
Advances in Integrative Medicine     Hybrid Journal   (Followers: 6)
Advances in Intl. Accounting     Full-text available via subscription   (Followers: 3)
Advances in Life Course Research     Hybrid Journal   (Followers: 8, SJR: 0.764, h-index: 15)
Advances in Lipobiology     Full-text available via subscription   (Followers: 1)
Advances in Magnetic and Optical Resonance     Full-text available via subscription   (Followers: 9)
Advances in Marine Biology     Full-text available via subscription   (Followers: 14, 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: 21)
Advances in Molecular and Cellular Endocrinology     Full-text available via subscription   (Followers: 8)
Advances in Molecular Toxicology     Full-text available via subscription   (Followers: 7, SJR: 0.324, h-index: 8)
Advances in Nanoporous Materials     Full-text available via subscription   (Followers: 3)
Advances in Oncobiology     Full-text available via subscription   (Followers: 1)
Advances in Organ Biology     Full-text available via subscription   (Followers: 1)
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: 6, SJR: 0.148, h-index: 11)
Advances in Parasitology     Full-text available via subscription   (Followers: 5, 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: 10)
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: 7)
Advances in Plant Pathology     Full-text available via subscription   (Followers: 5)
Advances in Porous Media     Full-text available via subscription   (Followers: 5)
Advances in Protein Chemistry     Full-text available via subscription   (Followers: 17)
Advances in Protein Chemistry and Structural Biology     Full-text available via subscription   (Followers: 18, SJR: 1.5, h-index: 62)
Advances in Psychology     Full-text available via subscription   (Followers: 59)
Advances in Quantum Chemistry     Full-text available via subscription   (Followers: 6, SJR: 0.478, h-index: 32)
Advances in Radiation Oncology     Open Access  
Advances in Small Animal Medicine and Surgery     Hybrid Journal   (Followers: 3, SJR: 0.1, h-index: 2)
Advances in Space Biology and Medicine     Full-text available via subscription   (Followers: 5)
Advances in Space Research     Full-text available via subscription   (Followers: 378, SJR: 0.606, h-index: 65)
Advances in Structural Biology     Full-text available via subscription   (Followers: 5)
Advances in Surgery     Full-text available via subscription   (Followers: 9, SJR: 0.823, h-index: 27)
Advances in the Study of Behavior     Full-text available via subscription   (Followers: 29, SJR: 1.321, h-index: 56)
Advances in Veterinary Medicine     Full-text available via subscription   (Followers: 17)
Advances in Veterinary Science and Comparative Medicine     Full-text available via subscription   (Followers: 13)
Advances in Virus Research     Full-text available via subscription   (Followers: 5, SJR: 1.878, h-index: 68)
Advances in Water Resources     Hybrid Journal   (Followers: 46, SJR: 2.408, h-index: 94)
Aeolian Research     Hybrid Journal   (Followers: 6, SJR: 0.973, h-index: 22)
Aerospace Science and Technology     Hybrid Journal   (Followers: 334, SJR: 0.816, h-index: 49)
AEU - Intl. J. of Electronics and Communications     Hybrid Journal   (Followers: 8, SJR: 0.318, h-index: 36)
African J. of Emergency Medicine     Open Access   (Followers: 6, SJR: 0.344, h-index: 6)
Ageing Research Reviews     Hybrid Journal   (Followers: 9, SJR: 3.289, h-index: 78)
Aggression and Violent Behavior     Hybrid Journal   (Followers: 432, SJR: 1.385, h-index: 72)
Agri Gene     Hybrid Journal  
Agricultural and Forest Meteorology     Hybrid Journal   (Followers: 15, SJR: 2.18, h-index: 116)
Agricultural Systems     Hybrid Journal   (Followers: 31, SJR: 1.275, h-index: 74)
Agricultural Water Management     Hybrid Journal   (Followers: 43, SJR: 1.546, h-index: 79)
Agriculture and Agricultural Science Procedia     Open Access   (Followers: 1)
Agriculture and Natural Resources     Open Access   (Followers: 2)
Agriculture, Ecosystems & Environment     Hybrid Journal   (Followers: 56, SJR: 1.879, h-index: 120)
Ain Shams Engineering J.     Open Access   (Followers: 5, SJR: 0.434, h-index: 14)
Air Medical J.     Hybrid Journal   (Followers: 5, SJR: 0.234, h-index: 18)
AKCE Intl. J. of Graphs and Combinatorics     Open Access   (SJR: 0.285, h-index: 3)
Alcohol     Hybrid Journal   (Followers: 11, SJR: 0.922, h-index: 66)
Alcoholism and Drug Addiction     Open Access   (Followers: 9)
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: 9, SJR: 2.05, h-index: 20)
Alkaloids: Chemical and Biological Perspectives     Full-text available via subscription   (Followers: 2)
Allergologia et Immunopathologia     Full-text available via subscription   (Followers: 1, SJR: 0.46, h-index: 29)
Allergology Intl.     Open Access   (Followers: 5, SJR: 0.776, h-index: 35)
Alpha Omegan     Full-text available via subscription   (SJR: 0.121, h-index: 9)
ALTER - European J. of Disability Research / Revue Européenne de Recherche sur le Handicap     Full-text available via subscription   (Followers: 9, SJR: 0.158, h-index: 9)
Alzheimer's & Dementia     Hybrid Journal   (Followers: 48, SJR: 4.289, h-index: 64)
Alzheimer's & Dementia: Diagnosis, Assessment & Disease Monitoring     Open Access   (Followers: 4)
Alzheimer's & Dementia: Translational Research & Clinical Interventions     Open Access   (Followers: 4)
Ambulatory Pediatrics     Hybrid Journal   (Followers: 6)
American Heart J.     Hybrid Journal   (Followers: 50, SJR: 3.157, h-index: 153)
American J. of Cardiology     Hybrid Journal   (Followers: 50, SJR: 2.063, h-index: 186)
American J. of Emergency Medicine     Hybrid Journal   (Followers: 42, SJR: 0.574, h-index: 65)
American J. of Geriatric Pharmacotherapy     Full-text available via subscription   (Followers: 10, 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: 31, 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: 42, 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: 190, SJR: 2.255, h-index: 171)
American J. of Ophthalmology     Hybrid Journal   (Followers: 62, 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: 27, SJR: 2.653, h-index: 228)
American J. of Preventive Medicine     Hybrid Journal   (Followers: 27, SJR: 2.764, h-index: 154)
American J. of Surgery     Hybrid Journal   (Followers: 36, SJR: 1.286, h-index: 125)
American J. of the Medical Sciences     Hybrid Journal   (Followers: 12, SJR: 0.653, h-index: 70)
Ampersand : An Intl. J. of General and Applied Linguistics     Open Access   (Followers: 6)
Anaerobe     Hybrid Journal   (Followers: 4, SJR: 1.066, h-index: 51)
Anaesthesia & Intensive Care Medicine     Full-text available via subscription   (Followers: 61, SJR: 0.124, h-index: 9)
Anaesthesia Critical Care & Pain Medicine     Full-text available via subscription   (Followers: 14)
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: 39, SJR: 1.548, h-index: 152)
Analytical Biochemistry     Hybrid Journal   (Followers: 165, SJR: 0.725, h-index: 154)
Analytical Chemistry Research     Open Access   (Followers: 10, SJR: 0.18, h-index: 2)
Analytical Spectroscopy Library     Full-text available via subscription   (Followers: 11)
Anesthésie & Réanimation     Full-text available via subscription   (Followers: 1)
Anesthesiology Clinics     Full-text available via subscription   (Followers: 22, SJR: 0.421, h-index: 40)
Angiología     Full-text available via subscription   (SJR: 0.124, h-index: 9)
Angiologia e Cirurgia Vascular     Open Access   (Followers: 1)

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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  [3175 journals]
  • Invited Commentary
    • Authors: Charles E. Ray
      Pages: 405 - 406
      Abstract: Publication date: April 2018
      Source:Academic Radiology, Volume 25, Issue 4
      Author(s): Charles E. Ray

      PubDate: 2018-04-10T20:41:10Z
      DOI: 10.1016/j.acra.2018.01.001
  • Model-based Iterative Reconstruction in Low-radiation-dose Computed
           Tomography Colonography
    • Authors: Narumi Taguchi; Seitaro Oda; Masanori Imuta; Sadahiro Yamamura; Takeshi Nakaura; Daisuke Utsunomiya; Masafumi Kidoh; Yasunori Nagayama; Hideaki Yuki; Kenichiro Hirata; Yuji Iyama; Yoshinori Funama; Hideo Baba; Yasuyuki Yamashita
      Pages: 415 - 422
      Abstract: Publication date: April 2018
      Source:Academic Radiology, Volume 25, Issue 4
      Author(s): Narumi Taguchi, Seitaro Oda, Masanori Imuta, Sadahiro Yamamura, Takeshi Nakaura, Daisuke Utsunomiya, Masafumi Kidoh, Yasunori Nagayama, Hideaki Yuki, Kenichiro Hirata, Yuji Iyama, Yoshinori Funama, Hideo Baba, Yasuyuki Yamashita
      Rationale and Objectives To assess the effect of model-based iterative reconstruction (MBIR) on image quality and diagnostic performance of low-radiation-dose computed tomography colonography (CTC) in the preoperative assessment of colorectal cancer. Materials and Methods This study included 30 patients with colorectal cancer referred for surgical treatment. All patients underwent CTC with a standard dose (SD) protocol in the supine position and a low-dose (LD; radiation dose reduction of approximately 85%) protocol in the prone position. The SD protocol images were post-processed using filtered back projection (FBP), whereas the LD protocol images were post-processed using FBP and MBIR. Objective and subjective image quality parameters were compared among the three different methods. Preoperative evaluations, including site, length, and tumor and node staging were performed, and the findings were compared to the postsurgical findings. Results The mean image noise of SD-FBP, LD-FBP, and LD-MBIR images was 17.3 ± 3.2, 40.5 ± 10.9, and 11.2 ± 2.0 Hounsfield units, respectively. There were significant differences for all comparison combinations among the three methods (P < .01). For image noise, the mean visual scores were significantly higher for SD-FBP and LD-MBIR than for LD-FBP, and the scores for SD-FBP and LD-MBIR were equivalent (3.9 ± 0.3 [SD-FBP], 2.0 ± 0.5 [LD-FBP], and 3.7 ± 0.3 [LD-MBIR]). Preoperative information was more accurate under SD-FBP and LD-MBIR than under LD-FBP, and the information was comparable between SD-FBP and LD-MBIR. Conclusion MBIR can yield significantly improved image quality on low-radiation-dose CTC and provide preoperative information equivalent to that of standard-radiation-dose protocol.

      PubDate: 2018-04-10T20:41:10Z
      DOI: 10.1016/j.acra.2017.10.008
  • Prognostic Factors for Survival After Transarterial Chemoembolization
           Combined with Sorafenib in the Treatment of BCLC Stage B and C
           Hepatocellular Carcinomas
    • Authors: Jia-yan Ni; Jian Kong; Hong-liang Sun; Yao-ting Chen; Jiang-hong Luo; Wei-dong Wang; Dong Chen; Xiong-ying Jiang; Lin-feng Xu
      Pages: 423 - 429
      Abstract: Publication date: April 2018
      Source:Academic Radiology, Volume 25, Issue 4
      Author(s): Jia-yan Ni, Jian Kong, Hong-liang Sun, Yao-ting Chen, Jiang-hong Luo, Wei-dong Wang, Dong Chen, Xiong-ying Jiang, Lin-feng Xu
      Rationale and Objective The objective of this study was to analyze prognostic factors for survival after transarterial chemoembolization (TACE) combined with sorafenib for hepatocellular carcinoma (HCC) of Barcelona Clinic Liver Cancer (BCLC) stages B and C. Materials and Methods Clinical data of 198 patients with BCLC stage B and C HCCs who underwent TACE combined with sorafenib between June 2012 and January 2017 were retrospectively collected and analyzed. Survival curves were detected using log-rank test. Univariate analysis was performed using log-rank test with respect to 11 prognostic factors potentially affecting survival. All statistically significant prognostic factors identified by univariate analysis were entered into a Cox proportion hazards regression model to identify independent predictors of survival. P values were two-sided and P < 0.05 was considered statistically significant. Results By the end of this study, the median follow-up duration was 43.6 months. The median overall survival (OS) of the patients was 21.0 months (95% confidence interval [CI]: 16.94–25.05), and the 1-, 2-, 3- and 5-year OS rates were 72%, 43%, 28%, and 4%, respectively. Tumor size (χ2 = 33.607, P < 0.0001), tumor number (χ2 = 4.084, P = 0.043), Child-Pugh class (χ2 = 33.187, P < 0.0001), BCLC stage (χ2 = 50.224, P < 0.0001), portal vein tumor thrombus (χ2 = 88.905, P < 0.0001), Eastern Cooperative Oncology Group (ECOG) performance status (χ2 = 98.007, P < 0.0001), extrahepatic spread (χ2 = 34.980, P < 0.0001), TACE times (χ2 = 8.350, P = 0.015), and sorafenib treatment strategy (χ2 = 81.593, P < 0.0001) were found to be significantly associated with OS by univariate analysis. Multivariate analysis showed that BCLC stage (95% CI: 1.133–3.982, P = 0.019), extrahepatic spread (95% CI: 1.136–2.774, P = 0.012), and sorafenib treatment duration (95% CI: 0.352–0.574, P = 0.000) were independent prognostic factors associated with OS. There were no serious treatment-related adverse events. Conclusions This study showed that extrahepatic spread was a risk factor, and sorafenib treatment and superior BCLC stage were protective factors. Therefore, the study indicated that TACE combined with sorafenib was an effective and safe treatment for patients with BCLC stage B HCC without extrahepatic spread.

      PubDate: 2018-04-10T20:41:10Z
      DOI: 10.1016/j.acra.2017.10.018
  • The Study of Clear Cell Renal Cell Carcinoma with MR Diffusion Kurtosis
           Tensor Imaging and Its Histopathologic Correlation
    • Authors: Guangyu Wu; Zizhou Zhao; Qiuying Yao; Wen Kong; Jianrong Xu; Jin Zhang; Guiqin Liu; Yongming Dai
      Pages: 430 - 438
      Abstract: Publication date: April 2018
      Source:Academic Radiology, Volume 25, Issue 4
      Author(s): Guangyu Wu, Zizhou Zhao, Qiuying Yao, Wen Kong, Jianrong Xu, Jin Zhang, Guiqin Liu, Yongming Dai
      Rationale and Objectives The objective of this study was to compare the performance of diffusion kurtosis tensor imaging and diffusion-weighted imaging in the characterization of clear cell renal cell carcinoma (ccRCC) and their correlations with tumor histopathology. Materials and Methods Ninety-one patients diagnosed with ccRCC who underwent diffusion kurtosis tensor imaging were included in this study. Fractional anisotropy, mean diffusivity, radial diffusivity, axial diffusivity, mean kurtosis (MK), radial kurtosis (Krad), and axial kurtosis (Kax) data were produced. A nuclear grade of 1–4 (G1–4) was assigned for each case based on the Fuhrman grading system, whereas tumor histopathology was characterized by the nuclear-to-cytoplasm ratio, the cell nuclei count, and the cell volume fraction. Results All of the metric values except for Kax and fractional anisotropy could be used to discriminate G1 vs G3, G1 vs G4, G2 vs G3, and G2 vs G4, whereas MK and Kax could be used to discriminate G3 vs G4 (P < 0.05). Moreover, the MK and Krad values exhibited better performance in differentiating G2 from G3 (P < 0.04 compared to the other metrics). The nuclear-to-cytoplasm ratio was positively correlated with the MK, Krad, and Kax values (P < 0.001) and negatively correlated with the mean diffusivity, radial diffusivity, and axial diffusivity values (P < 0.001), whereas the cell volume fraction and the cell nuclei count did not correlate with any metric examined. Conclusion The kurtosis metrics were superior to the diffusion metrics in grading ccRCC.

      PubDate: 2018-04-10T20:41:10Z
      DOI: 10.1016/j.acra.2017.10.016
  • Understanding Patient Preference in Female Pelvic Imaging
    • Authors: Michelle D. Sakala; Ruth C. Carlos; Mishal Mendiratta-Lala; Elisabeth H. Quint; Katherine E. Maturen
      Pages: 439 - 444
      Abstract: Publication date: April 2018
      Source:Academic Radiology, Volume 25, Issue 4
      Author(s): Michelle D. Sakala, Ruth C. Carlos, Mishal Mendiratta-Lala, Elisabeth H. Quint, Katherine E. Maturen
      Rationale and Objectives Women with pelvic pain or abnormal uterine bleeding may undergo diagnostic imaging. This study evaluates patient experience in transvaginal ultrasound (TVUS) and magnetic resonance imaging (MRI) and explores correlations between preference and symptom severity. Materials and Methods Institutional review board approval was obtained for this Health Insurance Portability and Accountability Act-compliant prospective study. Fifty premenopausal women with pelvic symptoms evaluated by recent TVUS and MRI and without history of gynecologic cancer or hysterectomy were included. A phone questionnaire used validated survey instruments including Uterine Fibroid Symptoms Quality of Life index, Testing Morbidities Index, and Wait Trade Off for TVUS and MRI examinations. Results Using Wait Trade Off, patients preferred TVUS over MRI (3.58 vs 2.80 weeks, 95% confidence interval [CI] −1.63, 0.12; P = .08). Summary test utility of Testing Morbidities Index for MRI was worse than for TVUS (81.64 vs 87.42, 95%CI 0.41, 11.15; P = .03). Patients reported greater embarrassment during TVUS than during MRI (P < .0001), but greater fear and anxiety both before (P < .0001) and during (P < .001) MRI, and greater mental (P = .02) and physical (P = .02) problems after MRI versus TVUS. Subscale correlations showed physically inactive women rated TVUS more negatively (R = −0.32, P = .03), whereas women with more severe symptoms of loss of control of health (R = −0.28, P = .04) and sexual dysfunction (R = −0.30, P = .03) rated MRI more negatively. Conclusion Women with pelvic symptoms had a slight but significant preference for TVUS over MRI. Identifying specific distressing aspects of each test and patient factors contributing to negative perceptions can direct improvement in both test environment and patient preparation. Improved patient experience may increase imaging value.

      PubDate: 2018-04-10T20:41:10Z
      DOI: 10.1016/j.acra.2017.10.011
  • Multi-model Analysis of Diffusion-weighted Imaging of Normal Testes at 3.0
    • Authors: Xiangde Min; Zhaoyan Feng; Liang Wang; Jie Cai; Basen Li; Zan Ke; Peipei Zhang; Huijuan You; Xu Yan
      Pages: 445 - 452
      Abstract: Publication date: April 2018
      Source:Academic Radiology, Volume 25, Issue 4
      Author(s): Xiangde Min, Zhaoyan Feng, Liang Wang, Jie Cai, Basen Li, Zan Ke, Peipei Zhang, Huijuan You, Xu Yan
      Rationale and Objectives This study aimed to establish diffusion quantitative parameters (apparent diffusion coefficient [ADC], DDC, α, Dapp, and Kapp) in normal testes at 3.0 T. Materials and methods Sixty-four healthy volunteers in two age groups (A: 10–39 years; B: ≥ 40 years) underwent diffusion-weighted imaging scanning at 3.0 T. ADC1000, ADC2000, ADC3000, DDC, α, Dapp, and Kapp were calculated using the mono-exponential, stretched-exponential, and kurtosis models. The correlations between parameters and the age were analyzed. The parameters were compared between the age groups and between the right and the left testes. Results The average ADC1000, ADC2000, ADC3000, DDC, α, Dapp, and Kapp values did not significantly differ between the right and the left testes (P > .05 for all). The following significant correlations were found: positive correlations between age and testicular ADC1000, ADC2000, ADC3000, DDC, and Dapp (r = 0.516, 0.518, 0.518, 0.521, and 0.516, respectively; P < .01 for all) and negative correlations between age and testicular α and Kapp (r = −0.363, −0.427, respectively; P < .01 for both). Compared to group B, in group A, ADC1000, ADC2000, ADC3000, DDC, and Dapp were significantly lower (P < .05 for all), but α and Kapp were significantly higher (P < .05 for both). Conclusions Our study demonstrated the applicability of the testicular mono-exponential, stretched-exponential, and kurtosis models. Our results can help establish a baseline for the normal testicular parameters in these diffusion models. The contralateral normal testis can serve as a suitable reference for evaluating the abnormalities of the other side. The effect of age on these parameters requires further attention.

      PubDate: 2018-04-10T20:41:10Z
      DOI: 10.1016/j.acra.2017.11.004
  • Bone Marrow Involvement in Malignant Lymphoma
    • Authors: Ulrika Asenbaum; Richard Nolz; Georgios Karanikas; Julia Furtner; Ramona Woitek; Ingrid Simonitsch-Klupp; Markus Raderer; Marius E. Mayerhoefer
      Pages: 453 - 460
      Abstract: Publication date: April 2018
      Source:Academic Radiology, Volume 25, Issue 4
      Author(s): Ulrika Asenbaum, Richard Nolz, Georgios Karanikas, Julia Furtner, Ramona Woitek, Ingrid Simonitsch-Klupp, Markus Raderer, Marius E. Mayerhoefer
      Rationale and Objectives This study aimed to determine the diagnostic utility of standardized uptake values (SUV) and apparent diffusion coefficients (ADC) for assessment of focal and diffuse bone marrow involvement in patients with malignant lymphoma. Materials and Methods Sixty treatment-naive patients (28 males; mean age 51.2 ± 16.7 years) with histologically proven lymphoma, who underwent fludeoxyglucose (18F) positron emission tomography-computed tomography ([F18]-FDG-PET/CT) and whole-body diffusion-weighted imaging (WB-DWI) within 7 days, and also routine bone marrow biopsy, were included in this institutional review board-approved, retrospective study. The maximum SUV (SUVmax) on [F18]-FDG-PET/CT, and the mean ADC (ADCmean, ×10−3 mm2/s) on whole-body-DWI, were extracted from focal lesions, or, in their absence, from the thoracic (Th8) and lumbar vertebral bodies (L4), the sacral bone (S1), and the iliac crest. Lesion-to-liver-ratios (SUVmax-ratio) were calculated. Pearson correlation coefficients were used to assess the correlation between SUVmax-ratios and ADCmean values. Results Bone marrow involvement was observed in 16 of 60 patients (8 of 16 with diffuse infiltration). The SUVmax-ratio cutoff value was 95.25% for focal and 70.2% for diffuse bone marrow involvement (sensitivity/specificity of 87.5%/86.4% and 100%/43.2%, respectively). The ADCmean cutoff value was 0.498 for focal and 0.401 for diffuse bone marrow involvement (sensitivity/specificity of 100%/90.9% and 87.5%/56.8%, respectively). No significant correlations were found between SUVmax-ratios and ADCmean values in the different groups. Conclusion With the liver as reference tissue, quantitative [F18]-FDG-PET/CT may be useful to differentiate bone marrow involvement from normal bone marrow in patients with lymphoma, even though the specificity for diffuse marrow involvement is rather low. Quantitative DWI can be used only to distinguish focal bone marrow lesions from normal bone marrow.

      PubDate: 2018-04-10T20:41:10Z
      DOI: 10.1016/j.acra.2017.10.024
  • Soft Tissue Sarcoma Response to Two Cycles of Neoadjuvant Chemotherapy
    • Authors: Jennifer L. Favinger; Daniel S. Hippe; Darin J. Davidson; Saeed Elojeimy; Eira S. Roth; Antoinette W. Lindberg; Alice S. Ha
      Pages: 470 - 475
      Abstract: Publication date: April 2018
      Source:Academic Radiology, Volume 25, Issue 4
      Author(s): Jennifer L. Favinger, Daniel S. Hippe, Darin J. Davidson, Saeed Elojeimy, Eira S. Roth, Antoinette W. Lindberg, Alice S. Ha
      Rationale and Objectives When soft tissue sarcomas are treated with neoadjuvant chemotherapy, the number of cycles of chemotherapy is usually dependent on the tumor's initial response. Popular methods to assess tumor response include Response Evaluation Criteria in Solid Tumors (RECIST) criteria, which rely solely on tumor size, and maximum standardized uptake value (SUVmax) reduction in positron emission tomography (PET), which requires an expensive and high radiation test. We hypothesized that contrast-enhanced magnetic resonance imaging (MRI) may offer a good alternative by providing additional information beyond tumor size. Materials and Methods Following IRB approval, a retrospective review identified patients with soft tissue sarcomas who underwent both PET and MRI before and after two cycles of neoadjuvant chemotherapy. Five readers independently examined the MRI exams for: changes in size, T2 or T1 signal, necrosis and degree of enhancement. Readers then made a subjective binary assessment of tumor response to therapy. Each reader repeated the anonymized randomized reading at least 2 weeks apart. 18 F-FDG PET exams were interpreted by a nuclear medicine specialist. The maximum standardized uptake values (SUVmax) for pre and post-chemotherapy exams were compared. Intra- and inter-reader agreement was assessed using Cohen's kappa and Light's kappa, respectively. . Results Twenty cases were selected for this multireader study, of which 9 (45%) were responders and 11 were nonresponders by SUVmax. Using all MRI criteria, 43% were classified as responders based on MRI and 1.5% were classified as responders by RECIST criteria. Using PET as the reference, the sensitivity and the specificity of the MRI diagnosis for response using all findings were 50% and 63%, respectively. There was fair to moderate intrareader (kappa = 0.37) and inter-reader (kappa = 0.48) agreement for the MRI diagnosis of response. None of the individual MRI signal characteristics were significantly different between the PET responders and nonresponders. Additionally, no MRI findings were significantly different between those with and without good clinical responses. Conclusion By our assessment, there is a poor correlation between tumor response by RECIST criteria and PET SUVmax. In addition, varying MR features did not help in diagnosing tumor response. Imaging of tumor response remains a challenging area that requires further research.

      PubDate: 2018-04-10T20:41:10Z
      DOI: 10.1016/j.acra.2017.10.013
  • One-Year Follow-up Study Detects Myocardial Changes with Cardiovascular
           Magnetic Resonance Tagging in Active Rheumatoid Arthritis
    • Authors: Lauri Lehmonen; Aino-Maija Vuorinen; Riitta Koivuniemi; Marjatta Leirisalo-Repo; Miia Holmström; Sari Kivistö; Touko Kaasalainen
      Pages: 476 - 485
      Abstract: Publication date: April 2018
      Source:Academic Radiology, Volume 25, Issue 4
      Author(s): Lauri Lehmonen, Aino-Maija Vuorinen, Riitta Koivuniemi, Marjatta Leirisalo-Repo, Miia Holmström, Sari Kivistö, Touko Kaasalainen
      Rationale and Objectives To evaluate the effects of 1 year of medical treatment on myocardial function in active rheumatoid arthritis (RA). Materials and Methods Thirty-nine female patients with RA without any known cardiovascular disease underwent a cardiovascular magnetic resonance (CMR) examination before and after 1 year of antirheumatic treatment. The population comprised untreated active early RA (ERA) and chronic RA patients, who were grouped accordingly. The CMR protocol included volumetric determinations, late gadolinium enhancement imaging, myocardial tagging, and native T1 mapping. DAS28-CRP disease activity scores were calculated before and after the treatment. Results Results are reported as median (quartile 1–quartile 3). Time to peak diastolic filling rate improved in ERA (495 [443–561] ms vs 441 [340–518] ms, P = .018). Peak diastolic mean mid short-axis circumferential strain rate of all six segments was improved (82 [74–91] %/s vs 91 [77–100] %/s, P = .05), particularly in the anterior segment (82 [63–98] %/s vs 86 [77–109] %/s, P = .013). DAS28-CRP decreased in ERA (3.8 [3.2–4.1] vs 1.6 [1.4–2.2], P < .001). In chronic RA, no statistically significant improvement was detected. Conclusions Early treatment of active RA is important, as myocardial function detected with CMR tagging improved in ERA in parallel with decreasing inflammatory activity.

      PubDate: 2018-04-10T20:41:10Z
      DOI: 10.1016/j.acra.2017.10.017
  • Low Tube Voltage and Iterative Model Reconstruction in Follow-up CT
           Angiography After Thoracic Endovascular Aortic Repair
    • Authors: Ping Hou; Xiangnan Feng; Jie Liu; Xiaopeng Wang; Yaojun Jiang; Leigang Dong; Jianbo Gao
      Pages: 494 - 501
      Abstract: Publication date: April 2018
      Source:Academic Radiology, Volume 25, Issue 4
      Author(s): Ping Hou, Xiangnan Feng, Jie Liu, Xiaopeng Wang, Yaojun Jiang, Leigang Dong, Jianbo Gao
      Rationale and Objectives This study aimed to investigate the feasibility of reducing radiation exposure and contrast medium (CM) dose in follow-up computed tomography angiography (CTA) after thoracic endovascular aortic repair (TEVAR) using low tube voltage and knowledge-based iterative model reconstruction (IMR). Materials and Methods Thirty-six patients that required follow-up CTA after TEVAR were included in this intra-individual study. The conventional protocol with standard tube voltage of 120 kVp and CM volume of 70 mL was applied in the first follow-up CTA of all the patients (control group A). The ultra-low CM dose protocol with low tube voltage of 80 kVp and weight-adapted CM volume of 0.4 mL/kg was utilized in the second follow-up CTA (study group B). Set A.FBP (group A filtered back-projection) contained images for group A that were reconstructed through FBP method. Three sets (B.FBP, B.HIR, and B.IMR) for group B were reconstructed using three methods, FBP, hybrid iterative reconstruction (HIR), and IMR, respectively. Objective measurements including aortic attenuations, image noise, contrast-to-noise ratios (CNRs), and figure of merit of CNR (FOMCNR), and subjective rating scores of the four image sets were compared. Results Compared to the images in set A.FBP, the images in set B.IMR had better quality in terms of equivalent attenuation values, equivalent subjective scores, lower noise, higher or equivalent CNRs, and higher FOMCNR. The quality of images in sets B.FBP and B.HIR was unacceptable. The radiation exposure and CM dose in group B were 1.94 mGy and 28 ± 5 mL, respectively, representing reductions of 77.6% (P < .001) and 60% (P < .001) as compared to those in group A. Conclusions In follow-up examinations after TEVAR, CTA with ultra-low radiation exposure and CM dose is feasible using low tube voltage and IMR for nonobese patients.

      PubDate: 2018-04-10T20:41:10Z
      DOI: 10.1016/j.acra.2017.11.001
  • Quantitative Measurements Versus Receiver Operating Characteristics and
           Visual Grading Regression in CT Images Reconstructed with Iterative
    • Authors: Kristin Jensen; Hilde Kjernlie Andersen; Örjan Smedby; Bjørn Helge Østerås; Anette Aarsnes; Anders Tingberg; Erik Fosse; Anne Catrine Martinsen
      Pages: 509 - 518
      Abstract: Publication date: April 2018
      Source:Academic Radiology, Volume 25, Issue 4
      Author(s): Kristin Jensen, Hilde Kjernlie Andersen, Örjan Smedby, Bjørn Helge Østerås, Anette Aarsnes, Anders Tingberg, Erik Fosse, Anne Catrine Martinsen
      Rationale and Objectives This study aimed to evaluate the correlation of quantitative measurements with visual grading regression (VGR) and receiver operating characteristics (ROC) analysis in computed tomography (CT) images reconstructed with iterative reconstruction. Materials and Methods CT scans on a liver phantom were performed on CT scanners from GE, Philips, and Toshiba at three dose levels. Images were reconstructed with filtered back projection (FBP) and hybrid iterative techniques (ASiR, iDose, and AIDR 3D of different strengths). Images were visually assessed by five readers using a four- and five-grade ordinal scale for liver low contrast lesions and for 10 image quality criteria. The results were analyzed with ROC and VGR. Standard deviation, signal-to-noise ratios, and contrast-to-noise ratios were measured in the images. Results All data were compared to FBP. The results of the quantitative measurements were improved for all algorithms. ROC analysis showed improved lesion detection with ASiR and AIDR and decreased lesion detection with iDose. VGR found improved noise properties for all algorithms, increased sharpness with iDose and AIDR, and decreased artifacts from the spine with AIDR, whereas iDose increased the artifacts from the spine. The contrast in the spine decreased with ASiR and iDose. Conclusions Improved quantitative measurements in images reconstructed with iterative reconstruction compared to FBP are not equivalent to improved diagnostic image accuracy.

      PubDate: 2018-04-10T20:41:10Z
      DOI: 10.1016/j.acra.2017.10.020
  • How Well Does Dual-energy CT with Fast Kilovoltage Switching Quantify CT
           Number and Iodine and Calcium Concentrations'
    • Authors: Shingo Ohira; Tsukasa Karino; Yoshihiro Ueda; Yuya Nitta; Naoyuki Kanayama; Masayoshi Miyazaki; Masahiko Koizumi; Teruki Teshima
      Pages: 519 - 528
      Abstract: Publication date: April 2018
      Source:Academic Radiology, Volume 25, Issue 4
      Author(s): Shingo Ohira, Tsukasa Karino, Yoshihiro Ueda, Yuya Nitta, Naoyuki Kanayama, Masayoshi Miyazaki, Masahiko Koizumi, Teruki Teshima
      Rationale and Objectives Because it is imperative for understanding the performance of dual-energy computed tomography scanner to determine clinical diagnosis, we aimed to assess the accuracy of quantitative measurements using dual-energy computed tomography with fast kilovoltage switching. Materials and Methods Quantitative measurements were performed for 16 reference materials (physical density, 0.965–1.550 g/cm3; diameter of rod, 2.0–28.5 mm; iodine concentration, 2–15 mg/mL; and calcium concentration, 50–300 mg/mL) with varying scanning settings, and the measured values were compared to their theoretical values. Results For high-density material, the maximum differences in Hounsfield unit values in the virtual monochromatic images at 50, 70, and 100 keV were −176.2, 61.0, and −35.2 HU, respectively, and the standard deviations over short- and long-term periods were 11.1, 6.1, and 3.5 HU at maximum. The accuracy of the Hounsfield unit measurement at 50 and 70 keV was significantly higher (P < 0.05) with higher radiation output and smaller phantom size. The difference in the iodine and calcium measurements in the large phantom were up to −2.6 and −60.4 mg/mL for iodine (5 mg/mL with 2-mm diameter) and calcium (300 mg/mL) materials, and the difference was improved with a small phantom. Metal artifact reduction software improved subjective image quality; however, the quantitative values were significantly underestimated (P < 0.05) (−49.5, −26.9, and −15.3 HU for 50, 70, and 100 keV, respectively; −1.0 and −17 mg/mL for iodine and calcium concentration, respectively) compared to that acquired without a metal material. Conclusions The accuracy of quantitative measurements can be affected by material density and the size of the object, radiation output, phantom size, and the presence of metal materials.

      PubDate: 2018-04-10T20:41:10Z
      DOI: 10.1016/j.acra.2017.11.002
  • Review of Simulation Training in Interventional Radiology
    • Authors: Souzan Mirza; Sriharsha Athreya
      Pages: 529 - 539
      Abstract: Publication date: April 2018
      Source:Academic Radiology, Volume 25, Issue 4
      Author(s): Souzan Mirza, Sriharsha Athreya
      Simulation training has evolved and is now able to offer numerous training opportunities to supplement the practice of and overcome some of the shortcomings of the traditional Master-Apprentice model currently used in medical training. Simulation training provides new opportunities to practice skills used in clinical procedures, crisis management scenarios, and everyday clinical practice in a risk-free environment. Procedural and nonprocedural skills used in interventional radiology can be taught with the use of simulation devices and technologies. This review will inform the reader of which clinical skills can be trained with simulation, the types of commercially available simulators and their educational validity, and the assessment tools used to evaluate simulation training.

      PubDate: 2018-04-10T20:41:10Z
      DOI: 10.1016/j.acra.2017.10.009
  • Educating Radiologists for Self-governance
    • Authors: Richard B. Gunderman; Paul J. Martin
      Pages: 540 - 542
      Abstract: Publication date: April 2018
      Source:Academic Radiology, Volume 25, Issue 4
      Author(s): Richard B. Gunderman, Paul J. Martin

      PubDate: 2018-04-10T20:41:10Z
      DOI: 10.1016/j.acra.2017.12.017
  • Breast Imaging Match Highlights the Need to Unify the Approach to
    • Authors: Cory M. Pfeifer
      First page: 543
      Abstract: Publication date: April 2018
      Source:Academic Radiology, Volume 25, Issue 4
      Author(s): Cory M. Pfeifer

      PubDate: 2018-04-10T20:41:10Z
      DOI: 10.1016/j.acra.2017.11.005
  • Corrigendum to “Evaluation of Texture Analysis Parameter for Response
           Prediction in Patients with Hepatocellular Carcinoma Undergoing
           Drug-Eluting Bead Transarterial Chemoembolization (DEB-TACE) Using
           Biphasic Contrast-Enhanced CT Image Data
    • Authors: Christopher Kloth; Wolfgang Maximilian Thaiss; Rainer Kärgel; Rainer Grimmer; Jan Fritz; Sorin Dumitru Ioanoviciu; Dominik Ketelsen; Konstantin Nikolaou; Marius Horger
      Abstract: Publication date: Available online 13 April 2018
      Source:Academic Radiology
      Author(s): Christopher Kloth, Wolfgang Maximilian Thaiss, Rainer Kärgel, Rainer Grimmer, Jan Fritz, Sorin Dumitru Ioanoviciu, Dominik Ketelsen, Konstantin Nikolaou, Marius Horger

      PubDate: 2018-04-15T21:02:03Z
      DOI: 10.1016/j.acra.2018.03.019
  • What is Health Services Research'
    • Authors: James V. Rawson; Paul Cronin
      Abstract: Publication date: Available online 7 April 2018
      Source:Academic Radiology
      Author(s): James V. Rawson, Paul Cronin

      PubDate: 2018-04-10T20:41:10Z
      DOI: 10.1016/j.acra.2018.03.009
  • Musculoskeletal Radiology Fellowship Application and Selection Process
    • Authors: Jennifer L. Demertzis; Jonathan C. Baker; Michael V. Friedman; Charles S. Resnik; Theodore T. Miller; David A. Rubin
      Abstract: Publication date: Available online 6 April 2018
      Source:Academic Radiology
      Author(s): Jennifer L. Demertzis, Jonathan C. Baker, Michael V. Friedman, Charles S. Resnik, Theodore T. Miller, David A. Rubin
      Rational and Objectives This study aimed to assess resident, fellow, and fellowship director perceptions of the musculoskeletal (MSK) radiology fellowship application process. Materials and Methods A task group constructed three surveys with questions about current and “ideal” fellowship application and selection processes. Surveys were distributed to MSK fellowship directors, who were also asked to give separate surveys to current fellows. US and Canadian radiology residency directors were asked to distribute surveys to current R3 and R4 residents. Responses were tabulated and analyzed. Results Responses were received from 47 MSK fellowship directors, 73 MSK fellows, and 147 residents. Fellowship directors and fellows reported that most fellowship offers occur between July and September of the R3 year, although 19% of directors made offers as early as the R2 year. Of the 43 director respondents, 31 (72%) noted “pressure from other programs” as the main driving force behind their policies, but 28 (65%) felt that their timelines were “too early.” A formal match was supported by 55% of responding fellowship directors, 57% of fellows, and 61.9% of residents, citing “fairness” as a major justification. Conclusions MSK radiology fellowship selection occurs as early as the R2 year, before many residents have had substantial exposure to different subspecialties. An “arms race” has developed with programs moving their timelines earlier in response to the actions of other programs, presumably to avoid missing the best candidates. Although a majority of respondents would support a formalized match to increase fairness, there is not universal agreement that it would be the best approach.

      PubDate: 2018-04-10T20:41:10Z
      DOI: 10.1016/j.acra.2018.03.011
  • Radiology “Hits Refresh” with Artificial Intelligence
    • Authors: Srini Tridandapani
      Abstract: Publication date: Available online 6 April 2018
      Source:Academic Radiology
      Author(s): Srini Tridandapani

      PubDate: 2018-04-10T20:41:10Z
      DOI: 10.1016/j.acra.2018.02.006
  • Multiparametric Whole-body MRI with Diffusion-weighted Imaging and ADC
           Mapping for the Identification of Visceral and Osseous Metastases From
           Solid Tumors
    • Authors: Michael A. Jacobs; Katarzyna J. Macura; Atif Zaheer; Emmanuel S. Antonarakis; Vered Stearns; Antonio C. Wolff; Thorsten Feiweier; Ihab R. Kamel; Richard L. Wahl; Li Pan
      Abstract: Publication date: Available online 4 April 2018
      Source:Academic Radiology
      Author(s): Michael A. Jacobs, Katarzyna J. Macura, Atif Zaheer, Emmanuel S. Antonarakis, Vered Stearns, Antonio C. Wolff, Thorsten Feiweier, Ihab R. Kamel, Richard L. Wahl, Li Pan
      Rationale and Objectives The purpose of this study was to investigate the use of multiparametric, whole-body, diffusion-weighted imaging (WB-DWI) and apparent diffusion coefficient (ADC) maps with T2-weighted magnetic resonance imaging (MRI) at 3T for the detection and monitoring of metastatic disease in patients. Materials and Methods Fifty-four participants (32 healthy subjects and 22 patients) were scanned with WB-DWI methods using a 3T MRI scanner. Axial, sagittal, or coronal fat-suppressed T2-weighted (T2WI), T1-weighted (T1WI), and DWI images were acquired. Total MRI acquisition and set-up time was approximately 45 minutes. Metastatic disease on MRI was confirmed based on T2WI characteristics. The number of lesions was established on computed tomography (CT) or positron emission tomography (PET-CT). Whole-body ADC maps and T2WI were constructed, and region-of-interests were drawn in normal and abnormal-appearing tissue for quantitative analysis. Statistical analysis was performed using a paired t tests and P < .05 was considered statistically significant. Results There were 91 metastatic lesions detected from the CT or PET-CT with a missed recurrent lesion in the prostate. Multiparametric WB-MRI had excellent sensitivity (96%) for detection of metastatic lesions compared to CT. ADC map values and the ADC ratio in metastatic bone lesions were significantly increased (P < .05) compared to normal bone. In soft tissue, ADC map values and ratios in metastatic lesions were decreased compared to normal soft tissue. Conclusion We have demonstrated that multiparametric WB-MRI is feasible for oncologic staging to identify bony and visceral metastasis in breast, prostate, pancreatic, and colorectal cancers. WB-MRI can be tailored to fit the patient, such that an “individualized patient sequence” can be developed for a comprehensive evaluation for staging and response during treatment.

      PubDate: 2018-04-10T20:41:10Z
      DOI: 10.1016/j.acra.2018.02.010
  • Deep Learning in Radiology
    • Authors: Morgan P. McBee; Omer A. Awan; Andrew T. Colucci; Comeron W. Ghobadi; Nadja Kadom; Akash P. Kansagra; Srini Tridandapani; William F. Auffermann
      Abstract: Publication date: Available online 30 March 2018
      Source:Academic Radiology
      Author(s): Morgan P. McBee, Omer A. Awan, Andrew T. Colucci, Comeron W. Ghobadi, Nadja Kadom, Akash P. Kansagra, Srini Tridandapani, William F. Auffermann
      As radiology is inherently a data-driven specialty, it is especially conducive to utilizing data processing techniques. One such technique, deep learning (DL), has become a remarkably powerful tool for image processing in recent years. In this work, the Association of University Radiologists Radiology Research Alliance Task Force on Deep Learning provides an overview of DL for the radiologist. This article aims to present an overview of DL in a manner that is understandable to radiologists; to examine past, present, and future applications; as well as to evaluate how radiologists may benefit from this remarkable new tool. We describe several areas within radiology in which DL techniques are having the most significant impact: lesion or disease detection, classification, quantification, and segmentation. The legal and ethical hurdles to implementation are also discussed. By taking advantage of this powerful tool, radiologists can become increasingly more accurate in their interpretations with fewer errors and spend more time to focus on patient care.

      PubDate: 2018-04-10T20:41:10Z
      DOI: 10.1016/j.acra.2018.02.018
  • Rethinking the PGY-1 Basic Clinical Year
    • Authors: Kathryn E. Darras; Abigail A. Arnold; Colin Mar; Bruce B. Forster; Linda Probyn; Silvia D. Chang
      Abstract: Publication date: Available online 30 March 2018
      Source:Academic Radiology
      Author(s): Kathryn E. Darras, Abigail A. Arnold, Colin Mar, Bruce B. Forster, Linda Probyn, Silvia D. Chang
      Rationale and Objectives Recently, the relevance of the postgraduate year 1 (PGY-1) Basic Clinical Year for radiology residents has been questioned. The purpose of this study was to determine the attitude of radiologists and trainees toward this year and which clinical rotations they perceived as most valuable to clinical practice. Materials and Methods Following institutional review board approval, an anonymous online survey was administered to Canadian radiologists and radiology trainees. In addition to reporting demographic information, respondents were asked to rank the usefulness of individual rotations on a five-point Likert scale. To assess whether there are differences in the ratings and therefore rankings of the rotations by gender, position, and level of training, the Kruskal-Wallis one-way analysis of variance test was used with significance defined as P < .05. The Schulze method was used to rank the perceived usefulness of clinical rotations considered. Results Of the 275 respondents, 73.1% were male and 47.3% were trainees. A total of 71.3% of respondents were in favor of the basic clinical year, whereas 16.4% opposed. There was a statistically significant difference between the responses of staff radiologists and trainees, with the staff more strongly favoring the Basic Clinical Year (84.1%) than the trainees (56.9%) (P < .0001). As a whole, the respondents favored general surgery rotations as most relevant to their clinical practice (agreement rate of 48.3%). Interventional radiologists found general and subspecialty surgical rotations to be equally relevant. The rotations deemed to be “essential” were emergency medicine (48.7%) and general surgery (46.6%), and the rotations deemed to be “very useful” were orthopedics (45.8%), trauma (44.4%), neurosurgery (43.3%), neurology (42.2%), and hepatobiliary surgery (38.9%). There was no statistical difference between the respondents' choices based on their level of experience and scope of practice. Conclusions Most radiologists and radiology trainees were in favor of completing the PGY-1 Basic Clinical Year. However, programs should maximize the education value of this year by including more of the top-ranked rotations. As the practice of radiology evolves, it is important to ensure that training paradigms continue to prepare residents for independent practice.

      PubDate: 2018-04-10T20:41:10Z
      DOI: 10.1016/j.acra.2018.03.012
  • A Feasibility Study of Single-inhalation, Single-energy Xenon-enhanced CT
           for High-resolution Imaging of Regional Lung Ventilation in Humans
    • Authors: Daniel W. Pinkham; Mohammadreza Negahdar; Tokihiro Yamamoto; Erik Mittra; Maximilian Diehn; Viswam S. Nair; Paul J. Keall; Peter G. Maxim; Billy W. Loo
      Abstract: Publication date: Available online 29 March 2018
      Source:Academic Radiology
      Author(s): Daniel W. Pinkham, Mohammadreza Negahdar, Tokihiro Yamamoto, Erik Mittra, Maximilian Diehn, Viswam S. Nair, Paul J. Keall, Peter G. Maxim, Billy W. Loo
      Rationale and Objectives The objective of this study was to assess the feasibility of single-inhalation xenon-enhanced computed tomography (XeCT) to provide clinically practical, high-resolution pulmonary ventilation imaging to clinics with access to only a single-energy computed tomography scanner, and to reduce the subject's overall exposure to xenon by utilizing a higher (70%) concentration for a much shorter time than has been employed in prior studies. Materials and Methods We conducted an institutional review board-approved prospective feasibility study of XeCT for 15 patients undergoing thoracic radiotherapy. For XeCT, we acquired two breath-hold single-energy computed tomography images of the entire lung with a single inhalation each of 100% oxygen and a mixture of 70% xenon and 30% oxygen, respectively. A video biofeedback system for coached patient breathing was used to achieve reproducible breath holds. We assessed the technical success of XeCT acquisition and side effects. We then used deformable image registration to align the breath-hold images with each other to accurately subtract them, producing a map of lung xenon distribution. Additionally, we acquired ventilation single-photon emission computed tomography-computed tomography (V-SPECT-CT) images for 11 of the 15 patients. For a comparative analysis, we partitioned each lung into 12 sectors, calculated the xenon concentration from the Hounsfield unit enhancement in each sector, and then correlated this with the corresponding V-SPECT-CT counts. Results XeCT scans were tolerated well overall, with a mild (grade 1) dizziness as the only side effect in 5 of the 15 patients. Technical failures in five patients occurred because of inaccurate breathing synchronization with xenon gas delivery, leaving seven patients analyzable for XeCT and single-photon emission computed tomography correlation. Sector-wise correlations were strong (Spearman coefficient >0.75, Pearson coefficient >0.65, P value <.002) for two patients for whom ventilation deficits were visibly pronounced in both scans. Correlations were nonsignificant for the remaining five who had more homogeneous XeCT ventilation maps, as well as strong V-SPECT-CT imaging artifacts attributable to airway deposition of the aerosolized imaging agent. Qualitatively, XeCT demonstrated higher resolution and no central airway deposition artifacts compared to V-SPECT-CT. Conclusions In this pilot study, single-breath XeCT ventilation imaging was generally feasible for patients undergoing thoracic radiotherapy, using an imaging protocol that is clinically practical and potentially widely available. In the future, the xenon delivery failures can be addressed by straightforward technical improvements to the patient biofeedback coaching system.

      PubDate: 2018-04-10T20:41:10Z
      DOI: 10.1016/j.acra.2018.03.006
  • Vital Signs in Radiologic Education
    • Authors: Priscilla J. Slanetz
      Abstract: Publication date: Available online 29 March 2018
      Source:Academic Radiology
      Author(s): Priscilla J. Slanetz

      PubDate: 2018-04-10T20:41:10Z
      DOI: 10.1016/j.acra.2018.02.012
  • Comparison of Natural Language Processing Rules-based and Machine-learning
           Systems to Identify Lumbar Spine Imaging Findings Related to Low Back Pain
    • Authors: W. Katherine Tan; Saeed Hassanpour; Patrick J. Heagerty; Sean D. Rundell; Pradeep Suri; Hannu T. Huhdanpaa; Kathryn James; David S. Carrell; Curtis P. Langlotz; Nancy L. Organ; Eric N. Meier; Karen J. Sherman; David F. Kallmes; Patrick H. Luetmer; Brent Griffith; David R. Nerenz; Jeffrey G. Jarvik
      Abstract: Publication date: Available online 28 March 2018
      Source:Academic Radiology
      Author(s): W. Katherine Tan, Saeed Hassanpour, Patrick J. Heagerty, Sean D. Rundell, Pradeep Suri, Hannu T. Huhdanpaa, Kathryn James, David S. Carrell, Curtis P. Langlotz, Nancy L. Organ, Eric N. Meier, Karen J. Sherman, David F. Kallmes, Patrick H. Luetmer, Brent Griffith, David R. Nerenz, Jeffrey G. Jarvik
      Rationale and Objectives To evaluate a natural language processing (NLP) system built with open-source tools for identification of lumbar spine imaging findings related to low back pain on magnetic resonance and x-ray radiology reports from four health systems. Materials and Methods We used a limited data set (de-identified except for dates) sampled from lumbar spine imaging reports of a prospectively assembled cohort of adults. From N = 178,333 reports, we randomly selected N = 871 to form a reference-standard dataset, consisting of N = 413 x-ray reports and N = 458 MR reports. Using standardized criteria, four spine experts annotated the presence of 26 findings, where 71 reports were annotated by all four experts and 800 were each annotated by two experts. We calculated inter-rater agreement and finding prevalence from annotated data. We randomly split the annotated data into development (80%) and testing (20%) sets. We developed an NLP system from both rule-based and machine-learned models. We validated the system using accuracy metrics such as sensitivity, specificity, and area under the receiver operating characteristic curve (AUC). Results The multirater annotated dataset achieved inter-rater agreement of Cohen's kappa > 0.60 (substantial agreement) for 25 of 26 findings, with finding prevalence ranging from 3% to 89%. In the testing sample, rule-based and machine-learned predictions both had comparable average specificity (0.97 and 0.95, respectively). The machine-learned approach had a higher average sensitivity (0.94, compared to 0.83 for rules-based), and a higher overall AUC (0.98, compared to 0.90 for rules-based). Conclusions Our NLP system performed well in identifying the 26 lumbar spine findings, as benchmarked by reference-standard annotation by medical experts. Machine-learned models provided substantial gains in model sensitivity with slight loss of specificity, and overall higher AUC.

      PubDate: 2018-04-10T20:41:10Z
      DOI: 10.1016/j.acra.2018.03.008
  • Subspecialist Reader Reinterpretation of Referred Imaging Studies
    • Authors: Mahmoud Al-Hawary
      Abstract: Publication date: Available online 27 March 2018
      Source:Academic Radiology
      Author(s): Mahmoud Al-Hawary

      PubDate: 2018-04-10T20:41:10Z
      DOI: 10.1016/j.acra.2018.03.018
  • Gallbladder Scalloping, Mammillated Caudate Lobe, and Inferior Vena Cava
    • Authors: Mohammad Amarneh; Ahmed Akhter; M. Zak Rajput; Douglas R. LaBrecque; Monzer Abu-Yousef
      Abstract: Publication date: Available online 27 March 2018
      Source:Academic Radiology
      Author(s): Mohammad Amarneh, Ahmed Akhter, M. Zak Rajput, Douglas R. LaBrecque, Monzer Abu-Yousef
      Purpose We aimed to present three new ultrasound signs—gallbladder scalloping, mammillated caudate lobe, and inferior vena cava scalloping—and determine their accuracy in diagnosing liver cirrhosis. Materials and Methods A total of 201 consecutive patients with a history of chronic liver disease who had undergone ultrasound imaging and liver biopsy were identified. A senior ultrasound radiologist blindly reviewed the ultrasound examinations. Specificity, sensitivity, positive predictive value, and negative predictive value of diagnosing cirrhosis were calculated for all evaluated ultrasound signs and selected combinations of signs, using the liver biopsy results as the reference standard. Results Of the 201 patients, 152 (76%) had either pathology-proven cirrhosis or significant fibrosis. Caudate lobe hypertrophy was the most specific (88%) and most positive predictor (90%) for cirrhosis, whereas mammillated caudate lobe was the most sensitive (78%). Inferior vena cava scalloping was the most specific (78%) of the three proposed ultrasound signs. When signs were combined, the presence of either gallbladder scalloping or liver surface nodularity was highly sensitive for cirrhosis (87%), whereas the presence of either gallbladder scalloping or inferior vena cava scalloping with caudate lobe hypertrophy was highly specific (93%). Conclusions Gallbladder scalloping, mammillated caudate lobe, and inferior vena cava scalloping are three novel signs that improve the accuracy of ultrasound in diagnosing cirrhosis.

      PubDate: 2018-04-10T20:41:10Z
      DOI: 10.1016/j.acra.2018.02.011
  • Impact of a New Adaptive Statistical Iterative Reconstruction (ASIR)-V
           Algorithm on Image Quality in Coronary Computed Tomography Angiography
    • Authors: Gianluca Pontone; Giuseppe Muscogiuri; Daniele Andreini; Andrea I. Guaricci; Marco Guglielmo; Andrea Baggiano; Fabio Fazzari; Saima Mushtaq; Edoardo Conte; Andrea Annoni; Alberto Formenti; Elisabetta Mancini; Massimo Verdecchia; Alessandro Campari; Chiara Martini; Marco Gatti; Laura Fusini; Lorenzo Bonfanti; Elisa Consiglio; Mark G. Rabbat; Antonio L. Bartorelli; Mauro Pepi
      Abstract: Publication date: Available online 27 March 2018
      Source:Academic Radiology
      Author(s): Gianluca Pontone, Giuseppe Muscogiuri, Daniele Andreini, Andrea I. Guaricci, Marco Guglielmo, Andrea Baggiano, Fabio Fazzari, Saima Mushtaq, Edoardo Conte, Andrea Annoni, Alberto Formenti, Elisabetta Mancini, Massimo Verdecchia, Alessandro Campari, Chiara Martini, Marco Gatti, Laura Fusini, Lorenzo Bonfanti, Elisa Consiglio, Mark G. Rabbat, Antonio L. Bartorelli, Mauro Pepi
      Rationale and objectives A new postprocessing algorithm named adaptive statistical iterative reconstruction (ASIR)-V has been recently introduced. The aim of this article was to analyze the impact of ASIR-V algorithm on signal, noise, and image quality of coronary computed tomography angiography. Materials and Methods Fifty consecutive patients underwent clinically indicated coronary computed tomography angiography (Revolution CT; GE Healthcare, Milwaukee, WI). Images were reconstructed using filtered back projection and ASIR-V 0%, and a combination of filtered back projection and ASIR-V 20%–80% and ASIR-V 100%. Image noise, signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR) were calculated for left main coronary artery (LM), left anterior descending artery (LAD), left circumflex artery (LCX), and right coronary artery (RCA) and were compared between the different postprocessing algorithms used. Similarly a four-point Likert image quality score of coronary segments was graded for each dataset and compared. A cutoff value of P < .05 was considered statistically significant. Results Compared to ASIR-V 0%, ASIR-V 100% demonstrated a significant reduction of image noise in all coronaries (P < .01). Compared to ASIR-V 0%, SNR was significantly higher with ASIR-V 60% in LM (P < .01), LAD (P < .05), LCX (P < .05), and RCA (P < .01). Compared to ASIR-V 0%, CNR for ASIR-V ≥60% was significantly improved in LM (P < .01), LAD (P < .05), and RCA (P < .01), whereas LCX demonstrated a significant improvement with ASIR-V ≥80%. ASIR-V 60% had significantly better Likert image quality scores compared to ASIR-V 0% in segment-, vessel-, and patient-based analyses (P < .01). Conclusions Reconstruction with ASIR-V 60% provides the optimal balance between image noise, SNR, CNR, and image quality.

      PubDate: 2018-04-10T20:41:10Z
      DOI: 10.1016/j.acra.2018.02.009
  • Incidental Thyroid Nodules in the National Lung Screening Trial
    • Authors: Manisha Bahl
      Abstract: Publication date: Available online 27 March 2018
      Source:Academic Radiology
      Author(s): Manisha Bahl
      Rationale and Objectives There is limited research on the prevalence of incidental thyroid nodules (ITNs) in the United States screening population and on the appropriate evaluation of computed tomography (CT)-detected ITNs. The purpose of this study is to determine the prevalence of ITNs in the National Lung Screening Trial (NLST) and develop a workup strategy for ITNs. Materials and Methods CT images were obtained for subjects with documented thyroid abnormalities in the CT screening arm of the NLST, subjects diagnosed with thyroid malignancies, and control subjects. Several size thresholds were compared to determine how many nodules would be further evaluated and how many thyroid malignancies would be missed had each threshold been applied at the time of workup. Results Thyroid nodules were reported in 0.7% (117 of 17,309 subjects). In 663 control subjects without reported thyroid nodules, thyroid nodules were identified in 78 (11.8%). Reported nodules were larger than unreported nodules (21.3 vs 16.9 mm, P = .03). Thyroid malignancies were diagnosed in 0.1% (22 of 17,309). If a 20-mm rather than a 10-mm cutoff were used to determine which nodules should be further evaluated, all malignancies would be detected, but 24 rather than 62 patients would require workup, for a workup reduction rate of 48.7% (38 of 78). Conclusions Less than 1% of subjects in the NLST had reported ITNs. The true prevalence of ITNs was estimated to be 11.8%, which provides a better approximation of the number of patients who could potentially receive workup. A 20-mm rather than a 10-mm cutoff would reduce the workup rate by almost 50% while still capturing all malignancies.

      PubDate: 2018-04-10T20:41:10Z
      DOI: 10.1016/j.acra.2018.02.016
  • Exploring the Potential of Undergraduate Radiology Education in the
           Virtual World Second Life with First-cycle and Second-cycle Medical
    • Authors: Rocio Lorenzo-Alvarez; Jose Pavia-Molina; Francisco Sendra-Portero
      Abstract: Publication date: Available online 26 March 2018
      Source:Academic Radiology
      Author(s): Rocio Lorenzo-Alvarez, Jose Pavia-Molina, Francisco Sendra-Portero
      Rationale and Objectives Virtual worlds have a remarkable potential for effective teaching and learning, providing immersive, realistic, and engaging online events. Previous studies have explored online education of health professionals in Second Life (SL), the most widely used virtual world, but none of the previous learning experiences were related to radiology. The purpose of this study was to explore the potential use of SL for undergraduate radiology education and the involvement of students in SL learning activities. Materials and Methods We delivered a 4-week voluntary undergraduate radiology education program in SL, based on synchronous sessions and asynchronous tasks, with two modalities: introduction to basic radiology for first-cycle (first- to third-year) students and case-based clinical radiology for second-cycle (fourth- to sixth-year) students. Participants completed an evaluation questionnaire about the experiences after the learning program. Results Forty-six students (20 first-cycle and 26 second-cycle) participated in this study. They found the contents of the course appropriate (mean ≥ 4.53/5), the initiative interesting, and the environment attractive (mean ≥ 4.32/5), and they were willing to participate in future SL experiences (mean ≥ 4.63/5). All students highly rated the organization, the content, the benefit to their medical education, and the professor (mean ≥ 9.05/10). Conclusion Online radiology education using SL is feasible and well received by medical students of all year groups. The students participated and engaged in this activity very positively and rated the experience highly. The potential of using SL for radiology education includes promising expectations regarding collaborative learning and gamification.

      PubDate: 2018-04-10T20:41:10Z
      DOI: 10.1016/j.acra.2018.02.026
  • Toward Augmented Radiologists
    • Authors: Shahein H. Tajmir; Tarik K. Alkasab
      Abstract: Publication date: Available online 26 March 2018
      Source:Academic Radiology
      Author(s): Shahein H. Tajmir, Tarik K. Alkasab
      Radiology practice will be altered by the coming of artificial intelligence, and the process of learning in radiology will be similarly affected. In the short term, radiologists will need to understand the first wave of artificially intelligent tools, how they can help them improve their practice, and be able to effectively supervise their use. Radiology training programs will need to develop curricula to help trainees acquire the knowledge to carry out this new supervisory duty of radiologists. In the longer term, artificially intelligent software assistants could have a transformative effect on the training of residents and fellows, and offer new opportunities to bring learning into the ongoing practice of attending radiologists.

      PubDate: 2018-04-10T20:41:10Z
      DOI: 10.1016/j.acra.2018.03.007
  • Radiation Dose Reduction at Low Tube Voltage CCTA Based on the CNR Index
    • Authors: Takanori Masuda; Yoshinori Funama; Takeshi Nakaura; Tomoyasu Satou; Tomokazu Okimoto; Yukari Yamashita; Naoyuki Imada; Kazuo Awai
      Abstract: Publication date: Available online 26 March 2018
      Source:Academic Radiology
      Author(s): Takanori Masuda, Yoshinori Funama, Takeshi Nakaura, Tomoyasu Satou, Tomokazu Okimoto, Yukari Yamashita, Naoyuki Imada, Kazuo Awai
      Rationale and Objectives We compared the radiation dose and diagnostic accuracy on 120- and 100-kVp coronary computed tomography angiography (CCTA) scans whose contrast-to-noise ratio (CNR) was the same. Materials and Methods We studied 1311 coronary artery segments from 100 patients. For 120-kVp scans, the targeted image level was set at 25 Hounsfield units (HU). For 100-kVp scans, the targeted noise level was set at 30 HU to obtain the same CNR as at 120 kVp. We compared the CNR and the radiation dose on scans acquired at 120 and 100 kVp. Invasive coronary angiography (ICA) images were evaluated by an interventional coronary angiography specialist, and CCTA images were evaluated by a radiologist. Coronary artery disease was defined as a luminal narrowing ≧50% for ICA and CCTA. With ICA considered the gold standard, the diagnostic accuracy (sensitivity, specificity, positive predictive value, and negative predictive value) was analyzed on both 120- and 100-kVp CCTA images. We also compared the diagnostic accuracy for area under the receiver operating characteristic curve of the ICA and CCTA performed at 120 and 100 kVp. Two blinded observers visually evaluated the septal branch. Results The mean dose-length product was 48% lower at 100 kVp than at 120 kVp (P < .01). Under the 120-kVp CCTA protocol, the area under the curve, 95% confidence interval, sensitivity, specificity, positive predictive value, and negative predictive value were 0.94%, 0.91%–0.96%, 94.0%, 93.0%, 82.3%, and 98.1%, respectively; at 100 kVp these values were 0.94%, 0.92%–0.97%, 96.1%, 92.0%, 85.2%, and 98.0%, respectively. Area under the receiver operating characteristic curve analysis revealed no significant difference in diagnostic accuracy between the two protocols (P = .87). Conclusions At the same CNR, the 100-kVp CCTA protocol may help to reduce the radiation dose by approximately 50% compared to the 120-kVp protocol without degradation of diagnostic accuracy.

      PubDate: 2018-04-10T20:41:10Z
      DOI: 10.1016/j.acra.2018.01.019
  • Observer Variability in Breast Cancer Diagnosis between Countries with and
           without Breast Screening
    • Authors: Delgermaa Demchig; Claudia Mello-Thoms; Warwick Lee; Khulan Khurelsukh; Asai Ramish; Patrick Brennan
      Abstract: Publication date: Available online 23 March 2018
      Source:Academic Radiology
      Author(s): Delgermaa Demchig, Claudia Mello-Thoms, Warwick Lee, Khulan Khurelsukh, Asai Ramish, Patrick Brennan
      Rational and Objectives Image reporting is a vital component of patient management depending on individual radiologists' performance. Our objective was to explore mammographic diagnostic efficacy in a country where breast cancer screening does not exist. Materials and Methods Two mammographic test sets were used: a typical screening (TS) and high-difficulty (HD) test set. Nonscreening (NS) radiologists (n = 11) read both test sets, while 52 and 49 screening radiologists read the TS and HD test sets, respectively. The screening radiologists were classified into two groups: a less experienced (LE) group with ≤5 years' experience and a more experienced (ME) group with ≥5 years' experience. A Kruskal–Wallis and Tukey–Kramer post hoc test were used to compare reading performance among reader groups, and the Wilcoxon matched pairs tests was used to compare TS and ND test sets for the NS radiologists. Results Across the three reader groups, there were significant differences in case sensitivity (χ2 [2] = 9.4, P = .008), specificity (χ2 [2] = 10.3, P = .006), location sensitivity (χ2 [2] = 19.8, P < .001), receiver operating characteristics, area under the curve (χ2 [2] = 19.7, P < .001) and jack-knife free-response receiver operating characteristics (JAFROCs) (χ2 [2] = 18.1, P < .001). NS performance for all measured scores was significantly lower than those for the ME readers (P < .006), while only location sensitivity was lower (χ2 [2] = 17.5, P = .026) for the NS compared to the LE group. No other significant differences were observed. Conclusion Large variations in mammographic performance exist between radiologists from screening and nonscreening countries.

      PubDate: 2018-04-10T20:41:10Z
      DOI: 10.1016/j.acra.2018.03.003
  • Breast Lesions Detected via Molecular Breast Imaging
    • Authors: Jason G. Ching; Rachel F. Brem
      Abstract: Publication date: Available online 23 March 2018
      Source:Academic Radiology
      Author(s): Jason G. Ching, Rachel F. Brem
      Rationale and Objectives To evaluate correlations between molecular breast imaging (MBI) descriptor characteristics and positive predictive value (PPV) in detecting breast cancer. Materials and Methods A retrospective review was performed on 193 suspicious findings from 153 women (31–81 years) with positive MBI examinations. We assessed associations between (i) lesion pattern (mass vs. nonmass) and PPV; (ii) lesion pattern and suspected likelihood of cancer (low vs. moderate vs. high); (iii) background parenchymal uptake (BPU) (homogeneous vs. heterogeneous) and PPV; (iv) breast density (dense vs. non-dense) and PPV; and (v) BPU and density. Results One hundred ten of 153 patients were diagnosed with malignancy or high-risk pathology (PPV1 = 71.9%), and 130/193 biopsies resulted in malignant or high-risk lesions (PPV3 = 67.4%). Biopsies of mass vs. nonmass findings had comparable PPV3 (71.7% vs. 61.3%; P = .0717). Mass findings were correlated with higher suspicion for cancer than nonmass findings (P < .001). There was no significant difference in PPV3 when comparing biopsies from homogeneous vs. heterogeneous BPU (72.5% vs. 60.7%; P = .103). No association was found between patients' BPU and diagnosed cancer or high-risk lesions (P = .513). Biopsies from nondense breasts demonstrated higher PPV3 than biopsies from dense breasts (85.4% vs. 60.6%; P = .0025); patients with nondense breasts were more likely to be diagnosed with cancer or high-risk pathology (PPV1 = 87.8% vs. 66.0%; P = .00844). Dense breasts had a greater association with heterogeneous BPU (P = .0844). Conclusion Neither variability in mass or nonmass positive MBI findings, nor variability in BPU on MBI were significant determinants for the probability of malignancy. Dense breasts were associated with lower predictability and heterogeneous BPU on MBI.

      PubDate: 2018-04-10T20:41:10Z
      DOI: 10.1016/j.acra.2018.03.004
  • Designing a Curriculum for Professionalism and Ethics Within Radiology
    • Authors: Aine Marie Kelly; Patricia B. Mullan
      Abstract: Publication date: Available online 23 March 2018
      Source:Academic Radiology
      Author(s): Aine Marie Kelly, Patricia B. Mullan
      Although professionalism and ethics represent required competencies, they are more challenging than other competencies to design a curriculum for and teach. Reasons include variability in agreed definitions of professionalism within medicine and radiology. This competency is also framed differently whether as roles, duties, actions, skills, behavior, beliefs, and attitudes. Standardizing a curriculum in professionalism is difficult because each learner's (medical student/resident) professional experiences and interactions will be unique. Professionalism is intertwined throughout all (sub) specialties and areas and its teaching cannot occur in isolation as a standalone curriculum. In the past, professionalism was not emphasized enough or at all, with global (or no) assessments, with the potential effect of trainees not valuing it. Although we can teach it formally in the classroom and informally in small groups, much of professionalism is witnessed and learned as “hidden curricula”. The formal, informal, and hidden curricula often contradict each other creating confusion, disillusion, and cynicism in trainees. The corporatization of medicine pressurizes us to increase efficiency (throughput) with less focus on aspects of professionalism that add value, creating a disjoint between what we do in practice and preach to trainees. Progressively, expectations for our curriculum include providing evidence for the impacts of our efforts on patient outcomes. Generational differences in the perception of professionalism and the increasingly diverse and multicultural society in which we live affects our interpretation of professionalism, which can add to confusion and misunderstanding. The objectives of this article are to outline challenges facing curriculum design in professionalism and to make suggestions to help educators avoid or overcome them.

      PubDate: 2018-04-10T20:41:10Z
      DOI: 10.1016/j.acra.2018.02.007
  • Recognition of Neonatal Lymphatic Flow Disorder
    • Authors: David M. Biko; Jordan A. Johnstone; Yoav Dori; Teresa Victoria; Edward R. Oliver; Maxim Itkin
      Abstract: Publication date: Available online 23 March 2018
      Source:Academic Radiology
      Author(s): David M. Biko, Jordan A. Johnstone, Yoav Dori, Teresa Victoria, Edward R. Oliver, Maxim Itkin
      Rationale and Objectives This study aimed to describe prenatal and postnatal imaging features and outcomes of neonates with neonatal lymphatic disorders (NLDs). Materials and Methods An institutional review board-approved search of the radiology database for patients with NLD identified five patients. Inclusion criteria include prenatal imaging (fetal magnetic resonance [MR] imaging and ultrasound) and postnatal three-dimensional T2 Sampling Perfection with Application optimized Contrasts using different flip angle Evolution (SPACE) and dynamic contrast-enhanced MR lymphangiography within 6 months of life. Chart review was undertaken to evaluate morbidity and mortality. Results Prenatal finding of “nutmeg lung” or fetal pulmonary lymphatic disorder was identified in all five patients on fetal MR imaging, and in four of five patients on fetal ultrasound. Postnatal dynamic contrast-enhanced MR lymphangiography demonstrated abnormal lymphatic flow to the lungs in four of five patients, but absent in the single patient with coexisting hypoplastic left heart syndrome (HLHS). Dermal backflow was seen in one patient, also the only patient with prenatal body wall edema. Three patients with lymphatic flow to the lungs only were classified as neonatal chylothorax. The patient with dermal backflow and perfusion to the lungs was diagnosed with central lymphatic flow disorder (CLFD). The HLHS patient with normal lymphatic perfusion maintained the HLHS diagnosis. Of the five patients, the patient with CLFD and the one with HLHS expired because of respiratory distress. Conclusions NLDs can be recognized on prenatal and postnatal imaging and may be primary, as in neonatal chylothorax or CLFD, or secondary. In this small series, “nutmeg lung” was present in all patients. Prenatal imaging demonstrates that body wall edema may correlate with postnatal dermal backflow, which, in our small cohort, carried a poor prognosis.

      PubDate: 2018-04-10T20:41:10Z
      DOI: 10.1016/j.acra.2018.02.020
  • Comparison of Local Injection of Fresh Frozen Plasma to Traditional
           Methods of Hemostasis in Minimally Invasive Procedures
    • Authors: John Haaga; Shiraz Rahim; Victor Kondray; Jon Davidson; Indravadan Patel; Dean Nakamoto
      Abstract: Publication date: Available online 22 March 2018
      Source:Academic Radiology
      Author(s): John Haaga, Shiraz Rahim, Victor Kondray, Jon Davidson, Indravadan Patel, Dean Nakamoto
      Rationale and Objectives To evaluate different techniques for reducing hemorrhagic complications in coagulopathic patients with elevated international normalized ratio having an image-guided percutaneous invasive procedure; techniques included systemic transfusion of fresh frozen plasma (FFP), local injection of FFP, percutaneous injection of gelatin sponge, and percutaneous placements of angiographic coils. Materials and Methods Retrospective review of 232 consecutive patients with known coagulopathy undergoing image-guided minimally invasive procedures were selected. Ninety-one patients had local FFP injected, 40 patients underwent local synthetic gelatin injection, 16 patients had percutaneous coil embolization, and 85 patients received systemic FFP. The number of bleeds, complications related to bleeds, and systemic complications were recorded. A 30 cc threshold was used to delineate significant bleeding. Results No patients experienced clinically significant or insignificant bleeding with local FFP injection (P value <.05). Other local hemostatic methods (Gelfoam, systemic FFP, and coil embolization) were associated with higher levels of bleeding (12.5%, 17.1%, 37.5%, respectively) and complications (7.5%, 31.4%, 37.5%, respectively). Systemic FFP infusion was associated with respiratory, infectious, and mortal complications. Conclusions Local injection of blood products provides a safe and efficacious hemostatic agent to reduce the incidence of postprocedural bleeding. The technique is associated with lower rates of bleeding and systemic complications when compared to other local and systemic techniques. Further randomized prospective studies with a larger patient cohort need to be performed to corroborate these initial findings.

      PubDate: 2018-04-10T20:41:10Z
      DOI: 10.1016/j.acra.2018.03.001
  • Teaching Radiology Trainees From the Perspective of a Millennial
    • Authors: Po-Hao Chen; Mary H. Scanlon
      Abstract: Publication date: Available online 21 March 2018
      Source:Academic Radiology
      Author(s): Po-Hao Chen, Mary H. Scanlon
      The millennial generation consists of today's medical students, radiology residents, fellows, and junior staff. Millennials' comfort with immersive technology, high expectations for success, and desire for constant feedback differentiate them from previous generations. Drawing from an author's experiences through radiology residency and fellowship as a millennial, from published literature, and from the mentorship of a long-time radiology educator, this article explores educational strategies that embrace these characteristics to engage today's youngest generation both in and out of the reading room.

      PubDate: 2018-04-10T20:41:10Z
      DOI: 10.1016/j.acra.2018.02.008
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