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AMERICAN JOURNAL OF ROENTGENOLOGY
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NEW ARTICLES
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* Accepted Manuscripts
* Official Articles
ACCEPTED MANUSCRIPTS
* Original ResearchGenitourinary Imaging
ADRENAL MASS BIOPSY IN PATIENTS WITHOUT EXTRA-ADRENAL PRIMARY MALIGNANCY: A
MULTICENTER STUDY
* Satheesh Krishna,
* Brian M. Moloney,
* Bo Bao,
* Karim Samji,
* Adam James Williams,
* Christopher S. Lim,
* Abdullah Alabousi,
* Oleg Mironov,
* James Russell,
* Silvia D. Chang,
* Sumaya Alrasheed,
* Robert Frank, and
* Nicola Schieda
First published:October 25, 2023
https://doi.org/10.2214/AJR.23.29826
Preview Abstract
Background: Adrenal washout CT is not useful for evaluating incidental
adrenal masses in patients without known or suspected primary extra-adrenal
malignancy.
Objectives: To evaluate the diagnostic utility of adrenal mass biopsy (AMB)
in patients without known or suspected extra-adrenal primary malignancy.
Methods: This retrospective six-center study included 69 patients (mean age
56 years; 32 men, 37 women) without known or suspected extra-adrenal primary
malignancy who underwent image-guided core-needle biopsy between January 2004
and June 2021 of a mass suspected to be arising from the adrenal gland.
Biopsy results were classified as diagnostic or non-diagnostic. For masses
resected after biopsy, histopathologic concordance was assessed between
diagnoses from biopsy and resection. Masses were classified as benign or
malignant by resection or imaging follow-up, classifying all nondiagnostic
biopsies as false results.
Results: Median mass size was 7.4 cm (range, 1.9-19.2 cm). AMB had diagnostic
yield of 64% (44/69; 95% CI: 51%, 75%). After biopsy, 25 masses were
resected, and 44 had imaging follow-up. Of masses that were resected after
diagnostic biopsy, diagnosis was concordant between biopsy and resection in
100% (12/12). Of 13 masses that were resected after non-diagnostic biopsy,
the diagnosis from resection was benign in 8 masses and malignant in 5
masses. The 44 masses with imaging follow-up included one mass with
diagnostic biopsy yielding benign adenoma and two masses with non-diagnostic
biopsy result that were all classified as malignant by imaging follow-up.
Biopsy had overall sensitivity and specificity for malignancy of 73% (22/30)
and 54% (21/39), respectively; diagnostic biopsies had sensitivity and
specificity for malignancy of 96% (22/23) and 100% (21/21), respectively.
Among nine nondiagnostic biopsies reported as adrenocortical neoplasm, six
were classified as malignant by the reference standard (resection showing
adrenal cortical carcinoma in 4, resection showing adrenocortical neoplasm of
uncertain malignant potential in 1, malignant imaging follow-up in 1).
Conclusion: AMB had low diagnostic yield, with low sensitivity and low
specificity for malignancy. A biopsy result of adrenocortical neoplasm did
not reliably differentiate benign and malignant adrenal masses.
Clinical Impact: Biopsy appears to have limited utility for evaluation of
incidental adrenal masses in patients without primary extra-adrenal
malignancy.
* ABSTRACT
* PDF
* Free Access
Original ResearchMultispecialty
SKELETAL MUSCLE AREA ON CT: DETERMINATION OF AN OPTIMAL HEIGHT SCALING POWER
AND TESTING FOR MORTALITY RISK PREDICTION
* Louis Blankemeier,
* Lawrence Yao,
* Jin Long,
* Eduardo Pontes Reis,
* Leon Lenchik,
* Akshay S. Chaudhari, and
* Robert D. Boutin
First published:October 25, 2023
https://doi.org/10.2214/AJR.23.29889
Preview Abstract
BACKGROUND: Sarcopenia is commonly assessed on CT using the skeletal muscle
index (SMI), calculated as skeletal muscle area (SMA) at L3 divided by
patient height squared (i.e., height scaling power of 2).
OBJECTIVE: To determine the optimal height scaling power for SMA measurements
on CT, and to test the influence of the derived optimal scaling power on the
utility of SMI in predicting all-cause mortality.
METHODS: This retrospective study included 16,575 patients (mean age, 56.4
years; 6985 men, 9590 women) who underwent abdominal CT from December 2012
through October 2018. SMA at L3 was determined using automated software. The
sample was stratified into 5459 patients without major medical conditions
(using ICD-9 and ICD-10 codes) for determining an optimal height scaling
power, and 11,116 patients with major medical conditions for testing this
power. The optimal scaling power was determined by allometric analysis
(whereby regression coefficients were fitted to log-linear sex-specific
models relating height to SMA) and by analysis of statistical independence of
SMI from height across scaling powers. Cox proportional hazards models were
used to test the derived optimal scaling power's influence on utility of SMI
in predicting all-cause mortality.
RESULTS: In allometric analysis, the regression coefficient of log(height) in
patients ≤40 years was 1.02 in men and 1.08 in women, and in patients >40
years was 1.07 in men and 1.10 in women (all p<.05 vs regression coefficient
of 2). In analyses for statistical independence of SMI from height, the
optimal height scaling power (i.e., those yielding correlations closest to 0)
was, in patients ≤40 years, 0.97 in men and 1.08 in women, and in patients
>40 years, 1.03 in men and 1.09 in women. In the Cox model used for testing,
SMI predicted all-cause mortality with greater concordance index using a
height scaling power of 1 than 2 in men (0.675 vs 0.663, p<.001) and women
(0.664 vs 0.653, p<.001).
CONCLUSION: The findings support a height scaling power of 1, rather than
conventional power of 2, for SMI computation.
CLINICAL IMPACT: A revised height scaling power for SMI could impact the
utility of CT-based sarcopenia diagnoses in risk assessment.
* ABSTRACT
* PDF
* AJR Expert Panel Narrative ReviewGenitourinary Imaging
MANAGEMENT OF PATIENTS WITH A NEGATIVE MULTIPARAMETRIC PROSTATE MRI
EXAMINATION: AJR EXPERT PANEL NARRATIVE REVIEW
* Nelly Tan,
* Jordan R. Pollock,
* Daniel J. A. Margolis,
* Anwar R. Padhani,
* Clare Tempany,
* Sungmin Woo, and
* Michael A. Gorin
First published:October 25, 2023
https://doi.org/10.2214/AJR.23.29969
Preview Abstract
Multiparametric prostate MRI (mpMRI) aids risk stratification of patients
with elevated PSA levels. While most clinically significant prostate cancers
are detected by mpMRI, insignificant cancers are less evident. Thus, multiple
international prostate cancer guidelines now endorse routine use of prostate
MRI as a secondary screening test before prostate biopsy. Nonetheless,
management of patients with negative mpMRI results (defined as PI-RADS
category 1 or 2) remains unclear. This AJR Expert Panel Narrative Review
summarizes the available literature on patients with an elevated screening
PSA level and a negative prostate mpMRI, and provides guidance for these
patients' management. Systematic biopsy should not be routinely performed
after a negative mpMRI in patients at average risk but should be considered
in patients at high risk. In patients who undergo PSA screening rather than
systematic biopsy after negative mpMRI, clear triggers should be established
for when to perform a repeat MRI. Patients with negative MRI followed by
negative biopsy should follow their healthcare practitioners' preferred
guidelines concerning subsequent PSA screening for the patient's risk level.
Insufficient high-level data exist to support routine use of adjunctive serum
or urine biomarkers, artificial intelligence, or PSMA PET to determine the
need for prostate biopsy after negative mpMRI.
* ABSTRACT
* PDF
* Special Series ReviewGastrointestinal Imaging
ORAL CT CONTRAST AGENTS: WHAT'S NEW AND WHY, FROM THE AJR SPECIAL SERIES ON
CONTRAST MEDIA
* Maurice M. Heimer,
* Yuxin Sun,
* Peter J. Bonitatibus, and
* Benjamin M. Yeh
First published:October 25, 2023
https://doi.org/10.2214/AJR.23.29970
Preview Abstract
Current CT oral contrast agents improve the conspicuity and confidence for
bowel and peritoneal findings in many clinical scenarios, particularly for
outpatient and oncologic abdominopelvic imaging. Yet, existing positive and
neutral oral contrast agents may diminish the detectability of certain
radiologic findings, frequently in the same scans in which the oral contrast
agent improves the detectability of other findings. With ongoing improvements
in CT technology, particularly multi-energy CT, opportunities are opening for
new types of oral contrast agents to further improve anatomic delineation and
disease detection using CT. The CT signal of new dark oral contrast agents
and of new high-Z oral contrast agents promise to combine the strengths of
both positive and neutral oral CT contrast agents by providing distinct CT
appearances in comparison with bodily tissues, iodinated IV contrast agents,
and other classes of new CT contrast agents. High-Z oral contrast agents will
unlock previously inaccessible capabilities of multi-energy CT, particularly
photon-counting detector CT, for differentiating simultaneously administered
IV and oral contrast agents; this technique will allow generation of rich 3D,
intuitive, perfectly co-registered, high-resolution image sets with
individual contrast-agent “colors” that provide compelling clarity for
intertwined intraabdominal anatomy and disease processes.
* ABSTRACT
* PDF
* Point/CounterpointMusculoskeletal Imaging
POINT-OF-CARE MUSCULOSKELETAL ULTRASOUND: COUNTERPOINT—THE GENIE IS OUT OF
THE BOTTLE, WHAT DO WE DO NOW?
* Theodore T. Miller
First published:October 25, 2023
https://doi.org/10.2214/AJR.23.30341
* FIRST PAGE
* PDF
* Point/CounterpointMusculoskeletal Imaging
POINT-OF-CARE MUSCULOSKELETAL ULTRASOUND: POINT—THE EVOLUTION OF ULTRASOUND
IMPROVING PATIENT CARE
* Nathalie J. Bureau
First published:October 25, 2023
https://doi.org/10.2214/AJR.23.30398
* FIRST PAGE
* PDF
* Editorial CommentPolicy, Quality, and Practice Management
EDITORIAL COMMENT: RECOGNITION AND MANAGEMENT OF ALLERGIC-LIKE REACTIONS TO
ADMINISTERED CONTRAST MEDIA
* Stacy Goergen
First published:October 25, 2023
https://doi.org/10.2214/AJR.23.30401
* FIRST PAGE
* PDF
* Beyond the AJRGenitourinary Imaging
BEYOND THE AJR: INCREASED USE OF PROSTATE MRI BEFORE BIOPSY REDUCES BIOPSY
FREQUENCY WITHOUT COMPROMISING DETECTION OF AGGRESSIVE CANCER
* Rajesh Thampy and
* Benjamin Spilseth
First published:October 25, 2023
https://doi.org/10.2214/AJR.23.30407
* FIRST PAGE
* PDF
* Beyond the AJRPolicy, Quality, and Practice Management
BEYOND THE AJR: INCOMPLETELY ENGINEERED REGULATORY PRICE TRANSPARENCY EFFORTS
LIKELY FAIL TO HELP OUR MOST VULNERABLE PATIENTS
* Richard Sharpe and
* Jonathan Flug
First published:October 25, 2023
https://doi.org/10.2214/AJR.23.30421
* FIRST PAGE
* PDF
* Editorial CommentMultispecialty
EDITORIAL COMMENT: PER ASPERA AD ASTRA—PERFECTING ORAL CONTRAST MEDIA USE
* Mark Guelfguat
First published:October 25, 2023
https://doi.org/10.2214/AJR.23.30439
* FIRST PAGE
* PDF
* Free Access
ReviewBreast Imaging
UPDATE ON DWI FOR BREAST CANCER DIAGNOSIS AND TREATMENT MONITORING
* Roberto Lo Gullo,
* Savannah C. Partridge,
* Hee Jung Shin,
* Sunitha B. Thakur, and
* Katja Pinker
First published:October 18, 2023
https://doi.org/10.2214/AJR.23.29933
Preview Abstract
DWI is a noncontrast MRI technique that measures the diffusion of water
molecules within biologic tissue. DWI is increasingly incorporated into
routine breast MRI examinations. Currently, the main applications of DWI are
breast cancer detection and characterization, prognostication, and the
prediction of treatment response to neoadjuvant chemotherapy. In addition,
DWI is promising as a noncontrast MRI alternative for breast cancer
screening. Problems with suboptimal resolution and image quality have
restricted the mainstream use of DWI for breast imaging, but these
shortcomings are being addressed through several technologic advancements. In
this article, we present an up-to-date review on the use of DWI for breast
cancer imaging, including a summary of the clinical literature and
recommendations for future use.
* ABSTRACT
* PDF
* Special Series ReviewMultispecialty
UPDATE ON GADOLINIUM BASED CONTRAST AGENT SAFETY, FROM THE AJR SPECIAL SERIES
ON CONTRAST MEDIA
* Jitka Starekova,
* Ali Pirasteh, and
* Scott B. Reeder
First published:October 18, 2023
https://doi.org/10.2214/AJR.23.30036
Preview Abstract
Since its introduction 35 years ago, gadolinium-enhanced MRI has
fundamentally changed medical practice. While extraordinarily safe,
gadolinium-based contrast agents (GBCAs) may have side effects. Four distinct
safety considerations include: acute allergic-like reactions, nephrogenic
systemic fibrosis (NSF), gadolinium deposition, and symptoms associated with
gadolinium exposure. Acute reactions after GBCA administration are
uncommon—far less than with iodinated contrast agents—and, while rare,
serious reactions can occur. NSF is a rare, but serious, scleroderma-like
condition occurring in patients with kidney failure after exposure to
American College of Radiology (ACR) Group 1 GBCAs. Group 2 and 3 GBCAs are
considered lower risk, and, through their use, NSF has largely been
eliminated. Unrelated to NSF, retention of trace amounts of gadolinium in the
brain and other organs has been recognized for over a decade. Deposition
occurs with all agents, although linear agents appear to deposit more than
macrocyclic agents. Importantly, to date, no data demonstrate any adverse
biologic or clinical effects from gadolinium deposition, even with normal
kidney function. This article summarizes the latest safety evidence of
commercially available GBCAs with a focus on new agents, discusses updates to
the ACR NSF GBCA safety classification, and describes approaches for
strengthening the evidence needed for regulatory decisions.
* ABSTRACT
* PDF
* Letter to the Editor and ReplyPediatric Imaging
AUTOMATIC ADIPOSE TISSUE SEGMENTATION IN ADOLESCENTS: A PROMISING FRONTIER
* Xin Bai,
* Zhengyu Jin, and
* Hao Sun
First published:October 18, 2023
https://doi.org/10.2214/AJR.23.30276
* FIRST PAGE
* PDF
* Beyond the AJRBreast Imaging
BEYOND THE AJR: A BREAKTHROUGH IN THE USE OF ARTIFICIAL INTELLIGENCE FOR
MAMMOGRAPHY IN SCREENING FOR BREAST CANCER
* Ritse M. Mann and
* Jonas Teuwen
First published:October 18, 2023
https://doi.org/10.2214/AJR.23.30359
* FIRST PAGE
* PDF
* Reply to LTEPediatric Imaging
REPLY TO “AUTOMATIC ADIPOSE TISSUE SEGMENTATION IN ADOLESCENTS: A PROMISING
FRONTIER”
* Tong Wu,
* Santiago Estrada,
* Renza van Gils,
* Ruisheng Su,
* Vincent W. V. Jaddoe,
* Edwin H. G. Oei, and
* Stefan Klein
First published:October 18, 2023
https://doi.org/10.2214/AJR.23.30371
* FIRST PAGE
* PDF
* Special Series ReviewPolicy, Quality, and Practice Management
MANAGEMENT OF SEVERE ALLERGIC-LIKE CONTRAST MEDIA REACTIONS: PITFALLS AND
STRATEGIES, FROM THE AJR SPECIAL SERIES ON CONTRAST MEDIA
* Daniella Asch,
* Michael J. Callahan,
* Kerry L. Thomas,
* Sagar Desai, and
* Jay K. Pahade
First published:October 11, 2023
https://doi.org/10.2214/AJR.23.30044
Preview Abstract
Adverse reactions to contrast media are often high-acuity events that are
uncommon potentially life-threatening. Nonetheless, these events are
treatable, and radiologists may be called upon to manage a contrast media
reaction. However, because these events are infrequent, they are prone to
management errors. This article highlights common pitfalls and practical tips
for the management of acute contrast media reactions in children and adults.
Recognition of frequent management errors and implementation of the
mitigation strategies presented can ameliorate risk and improve patient
outcomes. These measures include proper training on reaction management and
medication administration, the prompt use of IM epinephrine autoinjectors
whenever a severe allergic-like reaction is suspected, the use of visual aids
for quick reference in the setting of a reaction, and the recognition of
adverse events that are not allergic-like reactions, which commonly require
only supportive care.
* ABSTRACT
* PDF
* Editorial CommentGastrointestinal Imaging
EDITORIAL COMMENT: RADIOLOGISTS' ROLES AND OPPORTUNITIES IN
ALCOHOL-ASSOCIATED LIVER DISEASE
* Ania Kielar
First published:October 11, 2023
https://doi.org/10.2214/AJR.23.30296
* FIRST PAGE
* PDF
* Editorial CommentGenitourinary Imaging
EDITORIAL COMMENT: SIMILAR UPGRADE AND DOWNGRADE RATES BETWEEN PI-RADS
VERSION 2.0 AND VERSION 2.1
* Edward M. Lawrence
First published:October 11, 2023
https://doi.org/10.2214/AJR.23.30325
* FIRST PAGE
* PDF
* Beyond the AJRPolicy, Quality, and Practice Management
BEYOND THE AJR: DON'T BELIEVE EVERYTHING YOU READ—NEARLY ONE-FIFTH OF CLEARED
ARTIFICIAL INTELLIGENCE DEVICES MAY HAVE DISCORDANT DOCUMENTATION
* George Shih and
* Adam E. Flanders
First published:October 11, 2023
https://doi.org/10.2214/AJR.23.30331
* FIRST PAGE
* PDF
* Beyond the AJRNeuroradiology / Head and Neck Imaging
BEYOND THE AJR: SHOULD PATIENTS WITH FIRST-EPISODE PSYCHOSIS UNDERGO BRAIN
MRI?
* Jody Tanabe and
* Jason R. Tregellas
First published:October 11, 2023
https://doi.org/10.2214/AJR.23.30338
* FIRST PAGE
* PDF
* Editorial CommentNeuroradiology / Head and Neck Imaging
EDITORIAL COMMENT: EVIDENCE-BASED RETROPHARYNGEAL NODAL STAGING USING MRI IN
NASOPHARYNGEAL SQUAMOUS CELL CARCINOMA
* Paul M. Bunch
First published:October 11, 2023
https://doi.org/10.2214/AJR.23.30358
* FIRST PAGE
* PDF
* AJR Expert Panel Narrative ReviewNeuroradiology/Head and Neck Imaging
TRAUMATIC CERVICAL CEREBROVASCULAR INJURY AND THE ROLE OF CTA: AJR EXPERT
PANEL NARRATIVE REVIEW
* Arindam Rano Chatterjee,
* Ajay Malhotra,
* Patti Curl,
* Jalal B. Andre,
* Gloria J. Guzman Perez-Carrillo, and
* Elana B. Smith
First published:October 4, 2023
https://doi.org/10.2214/AJR.23.29783
Preview Abstract
Traumatic cerebrovascular injury (CVI) involving the cervical carotid and
vertebral arteries is rare but can lead to stroke, hemodynamic compromise,
and mortality in the absence of early diagnosis and treatment. The diagnosis
of both blunt CVI (BCVI) and penetrating CVI is based on cerebrovascular
imaging. The most commonly used screening criteria for BCVI include the
expanded Denver criteria and the Memphis criteria, each providing varying
thresholds for subsequent imaging. Neck CTA has supplanted catheter-based
digital subtraction angiography as the preferred screening modality for CVI
in patients with trauma. This AJR Expert Panel Narrative Review describes the
current state of CTA-based cervical imaging in trauma. We review the most
common screening criteria for BCVI, discuss BCVI grading scales that are
based on neck CTA, describe the diagnostic performance of CTA in the context
of other imaging modalities and evolving treatment strategies, and provide a
practical guide for neck CTA implementation.
* ABSTRACT
* PDF
* Special Series ReviewEvidence Synthesis and Decision Analysis
RISK OF ACUTE KIDNEY INJURY FOLLOWING IV IODINATED CONTRAST MEDIA EXPOSURE:
2023 UPDATE, FROM THE AJR SPECIAL SERIES ON CONTRAST MEDIA
* Jennifer S. McDonald and
* Robert J. McDonald
First published:October 4, 2023
https://doi.org/10.2214/AJR.23.30037
Preview Abstract
Iodinated contrast material (ICM) has revolutionized the field of diagnostic
radiology through improvements in diagnostic performance and expansion in
clinical indications for radiographic and CT examinations. Historically,
nephrotoxicity was a feared complication of ICM use, thought to be associated
with a significant risk of morbidity and mortality. Such fears often
precluded use of ICM in imaging evaluations, commonly at the expense of
diagnostic performance and timely diagnosis. Over the past 20 years, the
nephrotoxic risk of ICM has become a topic of debate, as more recent evidence
from higher-quality studies now suggest that many cases of what was
considered contrast-induced acute kidney injury (CI-AKI) were likely cases of
mistaken causal attribution; most of these cases represented either acute
kidney injury (AKI) caused by any of myriad other known factors that can
adversely affect renal function and were coincidentally present at the time
of contrast media exposure (contrast-associated AKI (CA-AKI)) or a
manifestation of the normal variation in renal function that increases with
worsening renal function. This review discusses the current state of
knowledge on CI-AKI and CA-AKI including the incidence, risk factors,
outcomes, and prophylactic strategies in the identification and management of
these clinical conditions.
* ABSTRACT
* PDF
* Point/CounterpointGastrointestinal Imaging
ABBREVIATED MRI FOR HEPATOCELLULAR CARCINOMA SURVEILLANCE:
COUNTERPOINT—HEPATOBILIARY CONTRAST AGENTS IMPROVE DETECTION AND
CHARACTERIZATION
* Li Xin Zhang and
* An Tang
First published:October 4, 2023
https://doi.org/10.2214/AJR.23.30140
* FIRST PAGE
* PDF
* Point/CounterpointGastrointestinal Imaging
ABBREVIATED MRI FOR HEPATOCELLULAR CARCINOMA SURVEILLANCE: POINT—WHY
EXTRACELLULAR CONTRAST AGENTS ARE SUPERIOR FOR THIS TASK
* Dietmar Tamandl and
* Wolfgang Schima
First published:October 4, 2023
https://doi.org/10.2214/AJR.23.30254
* FIRST PAGE
* PDF
* Editorial CommentCardiothoracic Imaging
EDITORIAL COMMENT: ARTIFICIAL INTELLIGENCE FOR DETECTION OF ENDOTRACHEAL TUBE
MALPOSITION—AUGMENTED RATHER THAN AUTONOMOUS RADIOLOGY INTERPRETATION
* Brent P. Little
First published:October 4, 2023
https://doi.org/10.2214/AJR.23.30297
* FIRST PAGE
* PDF
* Global Reading RoomGenitourinary Imaging
THE GLOBAL READING ROOM: A PATIENT WITH A BENIGN MRI-TARGETED BIOPSY OF A
PI-RADS CATEGORY 4 LESION
* Thaís C. Mussi,
* Arnaldo Stanzione,
* Sree Harsha Tirumani, and
* Chen-Jiang Wu
First published:October 4, 2023
https://doi.org/10.2214/AJR.23.30299
* FIRST PAGE
* PDF
* Video
Special Series ReviewCardiothoracic Imaging
IMAGING OF CARDIAC FIBROSIS: AN UPDATE, FROM THE AJR SPECIAL SERIES ON
IMAGING OF FIBROSIS
* Gauri Rani Karur,
* Ashish Aneja,
* Jadranka Stojanovska,
* Kate Hanneman,
* Rakesh Latchamsetty,
* David Kersting, and
* Prabhakar Shantha Rajiah
First published:September 27, 2023
https://doi.org/10.2214/AJR.23.29870
Preview Abstract
Myocardial fibrosis (MF) is defined as excessive production and deposition of
extracellular matrix (ECM) proteins, resulting in pathologic myocardial
remodeling. Three types of MF have been identified: replacement fibrosis from
tissue necrosis, reactive fibrosis from myocardial stress, and infiltrative
interstitial fibrosis from progressive deposition of non-degradable material
such as amyloid. While echocardiography, nuclear medicine, and CT play
important roles in the assessment of MF, MRI is pivotal in the evaluation of
MF, using the late gadolinium enhancement (LGE) technique as a primary
endpoint. The LGE technique focuses on the pattern and distribution of
gadolinium accumulation in the myocardium and assists the diagnosis and
establishment of the etiology of both ischemic and non-ischemic
cardiomyopathy. LGE MRI aids prognostication and risk stratification. In
addition, LGE MRI is used to guide management of patients being considered
for ablation for arrhythmias. Parametric mapping techniques, including T1
mapping and extracellular volume measurement, allow detection and
quantification of diffuse fibrosis, which may not be detected by LGE MRI.
These techniques also allow monitoring of disease progression and therapy
response. This review provides an update on imaging of MF, including
prognostication and risk stratification tools, electrophysiologic
considerations, and disease monitoring.
* ABSTRACT
* PDF
* Free Access
Original ResearchNeuroradiology / Head and Neck Imaging
OPTIMAL SIZE THRESHOLD FOR MRI-DETECTED RETROPHARYNGEAL LYMPH NODES TO
PREDICT OUTCOMES IN NASOPHARYNGEAL CARCINOMA: A TWO-CENTER STUDY
* Yuliang Zhu,
* Chao Luo,
* Shumin Zhou,
* Haojiang Li,
* Lizhi Liu,
* Kit Ian Kou,
* Feng Lei,
* Guoyi Zhang,
* Di Cao, and
* Zhiying Liang
First published:September 27, 2023
https://doi.org/10.2214/AJR.23.29984
Preview Abstract
Background: Retropharyngeal lymph node (RLN) metastases have profound
prognostic implications in patients with nasopharyngeal carcinoma (NPC).
However, the AJCC staging system does not specify a size threshold for
determining RLN involvement, resulting in inconsistent thresholds in
practice.
Objective: To determine the optimal size threshold for determining the
presence of metastatic RLNs on MRI in patients with NPC, in terms of outcome
predictions.
Methods: This retrospective study included 1752 patients (median age, 46
years; 1297 men, 455 women) with NPC treated by intensity-modulated
radiotherapy from January 2010 to March 2014 from two hospitals; 438 patients
underwent MRI 3-4 months after treatment. Two radiologists measured the
minimal axial diameter (MAD) of the largest RLN for each patient using a
consensus process. A third radiologist measured MAD in 260 randomly selected
patients to assess interobserver agreement. Initial ROC and restricted cubic
spline (RCS) analyses were used to derive an optimal MAD threshold for
predicting progression-free survival (PFS). The threshold's predictive
utility was assessed in multivariable Cox regression analyses, controlling
for standard clinical predictors. The threshold's utility for predicting PFS
and overall survival (OS) was compared with a 5-mm threshold using
Kaplan-Meier curves and log-rank tests.
Results: Intraclass correlation coefficient for MAD was 0.943. ROC and RCS
analyses yielded an optimal threshold of 6 mm. In multivariable analyses, MAD
≥6 mm independently predicted PFS in all patients (HR=1.35, p=.02), patients
with N0-N1 disease (HR=1.80, p=.008), and patients who underwent
post-treatment MRI (HR=1.68, p=.04). In patients with N1 disease without
cervical lymph node involvement, 5-year PFS was worse for MAD ≥6 mm than for
MAD from ≥5 to <6 mm (77.2% vs 89.7%, p=.03). OS was significantly different
in patients with stage-I and stage-II disease defined using a 6-mm threshold
(p=.04), but not using a 5-mm threshold (p=.09). The 5-year PFS rate was
associated with post-RT MAD ≥6 mm (HR=1.68, p=.04) but not post-RT MAD ≥5 mm
(HR=1.09, p=.71).
Conclusion: The findings support a threshold MAD of ≥6 mm for determining RLN
involvement in patients with NPC.
Clinical Impact: Future AJCC staging updates should consider incorporation of
the 6-mm threshold for N-category and tumor-stage determinations.
* ABSTRACT
* PDF
* Practice PearlCardiothoracic Imaging
TROUBLESHOOTING VA-ECMO ON CTA
* Justin R. Tse and
* Jody Shen
First published:September 27, 2023
https://doi.org/10.2214/AJR.23.30137
* FIRST PAGE
* PDF
* Editorial CommentMusculoskeletal Imaging
EDITORIAL COMMENT: BETTER IMAGES OF THE PELVIS WITH LESS DOSE USING
PHOTON-COUNTING DETECTOR CT
* Trenton D. Roth
First published:September 27, 2023
https://doi.org/10.2214/AJR.23.30212
* FIRST PAGE
* PDF
* Free Access
ReviewGastrointestinal Imaging
IMAGING OF ALCOHOL-ASSOCIATED LIVER DISEASE
* Sharad Maheshwari,
* Chris N. Gu,
* Melanie P. Caserta,
* Camille A. Kezer,
* Vijay H. Shah,
* Michael S. Torbenson,
* Jeff L. Fidler,
* Christine O. Menias, and
* Sudhakar K. Venkatesh
First published:September 20, 2023
https://doi.org/10.2214/AJR.23.29917
Preview Abstract
Alcohol-associated liver disease (ALD) continues to be a global health
concern, responsible for a significant number of deaths worldwide. While most
individuals who consume alcohol do not develop ALD, heavy drinkers and binge
drinkers are at increased risk. Unfortunately, ALD is often undetected until
it reaches advanced stages, frequently associated with portal hypertension
and hepatocellular carcinoma (HCC). ALD is now the leading indication for
liver transplantation. The incidence of alcohol-associated hepatitis (AH)
surged during the COVID-19 pandemic. Early diagnosis of ALD is therefore
important in patient management and determination of prognosis, as abstinence
can halt disease progression. The spectrum of ALD includes steatosis,
steatohepatitis, and cirrhosis, with steatosis being the most common
manifestation. Diagnostic techniques including ultrasound, CT, and MRI
provide useful information for identifying ALD and excluding other causes of
liver dysfunction. Heterogeneous steatosis and transient perfusion changes on
CT and MRI in the clinical setting of alcohol-use disorder is diagnostic of
severe AH. Elastography techniques are useful for assessing fibrosis and for
monitoring treatment response. These various imaging modalities are also
useful in the HCC surveillance and diagnosis. This article reviews the
imaging modalities currently used in the evaluation of ALD, highlighting
their strengths, limitations, and clinical applications.
* ABSTRACT
* PDF
* Free Access
AJR Global
Original ResearchGenitourinary Imaging
PI-RADS VERSION 2.0 VERSUS VERSION 2.1: COMPARISON OF PROSTATE CANCER GLEASON
GRADE UPGRADE AND DOWNGRADE RATES FROM MRI-TARGETED BIOPSY TO RADICAL
PROSTATECTOMY
* Enis C. Yilmaz,
* Yue Lin,
* Mason J. Belue,
* Stephanie A. Harmon,
* Tim E. Phelps,
* Katie M. Merriman,
* Lindsey A. Hazen,
* Charisse Garcia,
* Latrice Johnson,
* Nathan S. Lay,
* Antoun Toubaji,
* Maria J. Merino,
* Krishnan R. Patel,
* … View all authors
First published:September 20, 2023
https://doi.org/10.2214/AJR.23.29964
Preview Abstract
Background: Precise risk stratification through MRI/US fusion-guided targeted
biopsy (TBx) can guide optimal prostate cancer (PCa) management.
Objective: The purpose of this study was to compare PI-RADS version 2.0
(v2.0) and PI-RADS version 2.1 (v2.1) in terms of the rates of International
Society of Urological Pathology (ISUP) grade group (GG) upgrade and down
grade from TBx to radical prostatectomy (RP).
Methods: This study entailed a retrospective post-hoc analysis of patients
who underwent 3-T prostate MRI at a single institution from May 2015 to March
2023 as part of prospective clinical trials. From the trial participants,
those who underwent MRI followed by MRI/ultrasound-fusion guided TBx and RP
within a 1-year interval were identified. A single genitourinary radiologist
performed clinical interpretations of the MRI examinations using PI-RADS v2.0
from May 2015 to March 2019, and using PI-RADS v2.1 from April 2019 to March
2023. Upgrade and downgrade rates from TBx to RP were compared using
chi-square tests. Clinically significant cancer was defined as GG ≥2.
Results: The final analysis included 308 patients (median age, 65 years;
median PSA density, 0.16 ng/mL2). The v2.0 group (n=177) and v2.1 group
(n=131) showed no significant difference in terms of upgrade rate (29% vs
22%, p=.15), downgrade rate (19% vs 21%, p=.76), clinically significant
upgrade rate (14% vs 10%, p=.27) or clinically significant downgrade rate (1%
vs 1%, p>.99). The upgrade rate and downgrade rate were also not
significantly different between the v2.0 and v2.1 groups when stratifying by
index lesion PI-RADS category or index lesion zone, as well as when assessed
only in patients without a prior PCa diagnosis (all p>.01). Among patients
with GG2 or GG3 at RP (n=121 for v2.0; n=103 for v2.1), the concordance rate
between TBx and RP was not significantly different between the v2.0 and v2.1
groups (53% vs 57%, p=.51).
Conclusion: Upgrade and downgrade rates from TBx to RP were not significantly
different between patients whose MRI examinations were clinically interpreted
using v2.0 or v2.1.
Clinical Impact: Implementation of the most recent PI-RADS update did not
improve the incongruence in PCa grade assessment between Tbx and surgery.
* ABSTRACT
* PDF
* Point/CounterpointCardiothoracic Imaging
CARDIAC MRI FIELD STRENGTH: COUNTERPOINT—IMAGE QUALITY GAINS FROM HIGHER SNR
ARE ACHIEVABLE AT 3 T
* Sophie You and
* Albert Hsiao
First published:September 20, 2023
https://doi.org/10.2214/AJR.23.30071
* FIRST PAGE
* PDF
* Point/CounterpointCardiothoracic Imaging
CARDIAC MRI FIELD STRENGTH: POINT—IF I COULD ONLY HAVE A SINGLE MAGNET, WHY I
WOULD OPT FOR A 1.5-T SCANNER OVER A 3-T SCANNER
* Seth Kligerman
First published:September 20, 2023
https://doi.org/10.2214/AJR.23.30097
* FIRST PAGE
* PDF
* Editorial CommentBreast Imaging
EDITORIAL COMMENT: GREATER VIGILANCE FOR BREAST BIOPSY MARKERS
* Richard A. Benedikt
First published:September 20, 2023
https://doi.org/10.2214/AJR.23.30203
* FIRST PAGE
* PDF
* Beyond the AJRNuclear Medicine
BEYOND THE AJR: FOLLOW-UP IMAGING WITH FDG PET/CT IN HEAD AND NECK CANCER
IMPROVES PATIENT OUTCOME
* Heiko Schöder
First published:September 20, 2023
https://doi.org/10.2214/AJR.23.30240
* FIRST PAGE
* PDF
* Free Access
AJR Global
Video
Visual Abstract
Original ResearchCardiothoracic Imaging
ARTIFICIAL INTELLIGENCE FOR ASSESSMENT OF ENDOTRACHEAL TUBE POSITION ON CHEST
RADIOGRAPHS: VALIDATION IN PATIENTS FROM TWO INSTITUTIONS
* Ji Yeong An,
* Eui Jin Hwang,
* Gunhee Nam,
* Sang Hyup Lee,
* Chang Min Park,
* Jin Mo Goo, and
* Ye Ra Choi
First published:September 13, 2023
https://doi.org/10.2214/AJR.23.29769
Preview Abstract
Background: Timely and accurate interpretation of chest radiographs obtained
to evaluate endotracheal tube (ETT) position is important for facilitating
prompt adjustment if needed.
Objective: To evaluate the performance of a deep learning (DL)-based
artificial intelligence (AI) system for detecting ETT presence and position
on chest radiographs in three patient samples from two different
institutions.
Methods: This retrospective study included 539 chest radiographs obtained
immediately after ETT insertion from January 1, 2020 to March 31, 2020 in 505
patients (293 men, 212 women; mean age, 63 years) from institution A (sample
A); 637 chest radiographs obtained from January 1, 2020 to January 3, 2020 in
304 patients (158 men, 147 women; mean age, 63 years) in the ICU (with or
without an ETT) from institution A (sample B); and 546 chest radiographs
obtained from January 1, 2020 to January 20, 2020 in 83 patients (54 men, 29
women; mean age, 70 years) in the ICU (with or without an ETT) from
institution B (sample C). A commercial DL-based AI system was used to
identify ETT presence and measure ETT tip-to-carina distance (TCD). Reference
standard for proper ETT position was TCD between 3 cm and 7 cm, determined by
human readers. Critical ETT position was separately defined as ETT tip below
the carina or TCD ≤1 cm. ROC analysis was performed.
Results: AI had sensitivity and specificity for identification of ETT
presence of 100.0% and 98.7% (sample B) and 99.2% and 94.5% (sample C). AI
had sensitivity and specificity for identification of improper ETT position
of 72.5% and 92.0% (sample A), 78.9% and 100.0% (sample B), and 83.7% and
99.1% (sample C). At threshold y-axis TCD ≤2 cm, AI had sensitivity and
specificity for critical ETT position of 100.0% and 96.7% (sample A), 100.0%
and 100.0% (sample B), and 100.0% and 99.2% (sample C).
Conclusion: AI identified improperly positioned ETTs on chest radiographs
obtained after ETT insertion, as well as on chest radiographs obtained from
patients in the ICU at two institutions.
Clinical Impact: Automated AI identification of improper ETT position on
chest radiograph may allow earlier repositioning and thereby reduce
complications.
* ABSTRACT
* PDF
* AJR ViewboxInterventional Radiology
PROPER HEPATIC ARTERY PSEUDOANEURYSM TREATED BY ENDOVASCULAR STENT
* Tian Lan and
* Bo Wei
First published:September 13, 2023
https://doi.org/10.2214/AJR.23.30088
* FIRST PAGE
* PDF
* Point/CounterpointPolicy, Quality, and Practice Management
INDIVIDUAL RADIOLOGIST PRODUCTIVITY METRICS: POINT—TRANSPARENCY AMONG GROUP
MEMBERS IS NECESSARY TO OPTIMIZE LONG-TERM PRACTICE SUCCESS
* Jonathan R. Medverd
First published:September 13, 2023
https://doi.org/10.2214/AJR.23.30118
* FIRST PAGE
* PDF
* Editorial CommentGastrointestinal Imaging
EDITORIAL COMMENT: THE MARIA SCORE REMAINS A LEADING TOOL FOR MRI EVALUATION
OF PATIENTS WITH CROHN DISEASE
* Sarah Johnson
First published:September 13, 2023
https://doi.org/10.2214/AJR.23.30135
* FIRST PAGE
* PDF
* Point/CounterpointPolicy, Quality, and Practice Management
INDIVIDUAL RADIOLOGIST PRODUCTIVITY METRICS: COUNTERPOINT—NO INDIVIDUAL
METRICS SHOULD BE SHARED
* Ronnie Sebro
First published:September 13, 2023
https://doi.org/10.2214/AJR.23.30145
* FIRST PAGE
* PDF
* Practice PearlCardiothoracic Imaging
VIRTUAL NONCONTRAST RECONSTRUCTIONS ON CONTRAST-ENHANCED DUAL-ENERGY CT FOR
THE DIFFERENTIATION OF VERTEBRAL VENOUS CONGESTION AND SCLEROTIC METASTASIS
* Aaron M. McGuire,
* Jordan Chamberlin,
* Dhiraj Baruah,
* Reginald F. Munden, and
* Ismail M. Kabakus
First published:September 13, 2023
https://doi.org/10.2214/AJR.23.30152
* FIRST PAGE
* PDF
* Editorial CommentMusculoskeletal Imaging
EDITORIAL COMMENT: ADVANCING MUSCLE IMAGING WITH QUANTITATIVE APPROACHES AND
EMERGING MEDICAL CONCEPTS
* Nathalie J. Bureau
First published:September 13, 2023
https://doi.org/10.2214/AJR.23.30186
* FIRST PAGE
* PDF
* Editorial CommentPediatric Imaging
EDITORIAL COMMENT: STANDARDIZING MRI IN CHILDREN WITH ACUTE RECURRENT OR
CHRONIC PANCREATITIS
* Elizabeth Snyder
First published:September 13, 2023
https://doi.org/10.2214/AJR.23.30214
* FIRST PAGE
* PDF
* Editorial CommentMusculoskeletal Imaging
EDITORIAL COMMENT: SPECTRAL SHAPING AND PHOTON-COUNTING CT FOR DOSE
REDUCTION—OPPORTUNITIES AND TRADEOFFS
* Francis I. Baffour
First published:September 13, 2023
https://doi.org/10.2214/AJR.23.30217
* FIRST PAGE
* PDF
* AJR Expert Panel Narrative ReviewPolicy, Quality, and Practice Management
THE REMOTE ACADEMIC RADIOLOGIST: AJR EXPERT PANEL NARRATIVE REVIEW
* Mohammed Ismail,
* Tarek N. Hanna,
* Melissa A. Davis,
* Eric Rubin,
* Ivan M. DeQuesada,
* Randy C. Miles, and
* Pari Pandharipande
First published:September 6, 2023
https://doi.org/10.2214/AJR.23.29601
Preview Abstract
The importance of developing a robust remote workforce in academic radiology
has come to the forefront due to several converging factors. COVID-19, and
the abrupt transformation it precipitated in terms of how radiologists
worked, has been the biggest impetus for change; concurrent factors such as
increasing examination volumes and radiologist burnout have also contributed.
How to best advance the most desirable and favorable aspects of remote work
while preserving an academic environment that fulfills the tripartite mission
is a critical challenge that nearly all academic institutions face today. In
this article, we discuss current challenges in academic radiology, including
effects of the COVID-19 pandemic, from three perspectives–the radiologist,
the learner, and the health system–addressing the following topics:
productivity, recruitment, wellness, clinical supervision, mentorship and
research, educational engagement, radiologist access, investments in
technology, and radiologist value. Throughout, we focus on the opportunities
and drawbacks of remote work, to help guide its effective and reliable
integration into academic radiology practices.
* ABSTRACT
* PDF
* AJR Expert Panel Narrative ReviewPediatric Imaging
IMAGING OF VESICOURETERAL REFLUX: AJR EXPERT PANEL NARRATIVE REVIEW
* Stephanie C. Cajigas-Loyola,
* Jeanne S. Chow,
* Shireen Hayatghaibi,
* Ramesh S. Iyer,
* Jeannie Kwon,
* Erika Rubesova,
* Ramón Sánchez-Jacob,
* Mary Wyers, and
* Hansel J. Otero
First published:September 6, 2023
https://doi.org/10.2214/AJR.23.29741
Preview Abstract
Vesicoureteral reflux (VUR) is a common congenital anomaly of the urinary
tract that can present with collecting system dilation or as a febrile
infection. VUR can lead to permanent renal sequela requiring surgery but can
also spontaneously resolve without complication. Therefore, it is important
to recognize those patient populations who warrant imaging for screening,
confirmation, or ongoing surveillance for VUR, while avoiding overdiagnosis.
In the appropriate patient populations, an accurate diagnosis of VUR allows
early treatment and prevention of pyelonephritis and scarring. Various
imaging modalities are available to diagnose and grade VUR, including voiding
cystourethrogram (VCUG), radionucleotide cystography (RNC), and
contrast-enhanced voiding urosonography (ceVUS). The objective of this
article is to summarize the current understanding of VUR diagnosis and
management and to discuss these imaging modalities' strengths and pitfalls.
Considerations include indications for VUR imaging, patient preparation,
conduct of the examination, issues related to radiologic reporting, and
cost-effectiveness. An emphasis is placed on ceVUS, which is the most
recently introduced of the three imaging modalities and is receiving growing
support among pediatric radiologists.
* ABSTRACT
* PDF
* Free Access
Podcast
Original ResearchBreast Imaging
RETAINED BIOPSY SITE MARKERS AFTER BREAST LESION SURGICAL RESECTION:
ASSOCIATIONS WITH RESIDUAL MALIGNANCY
* Eun L. Langman,
* Karen S. Johnson, and
* Maggie L. Dinome
First published:August 30, 2023
https://doi.org/10.2214/AJR.23.29670
Preview Abstract
BACKGROUND. Biopsy site markers (BSM) placed during image-guided core-needle
breast biopsies are typically targeted for surgical excision, along with the
breast imaging abnormality. Retained BSMs raise concern of incomplete
resection of the breast abnormality.
OBJECTIVE. To assess the frequency of residual malignancy in patients with
retained BSMs identified on initial mammogram after breast lesion surgical
excision.
METHODS. This retrospective study included 30 patients (median age, 59 years)
who underwent surgical resection between August 2015 and April 2022 of a
borderline, high-risk, or malignant breast lesion after core-needle biopsy
and technically adequate preoperative image-guided localization, in whom
initial postoperative mammogram described a retained nonmigrated BSM. EMR
data were extracted. Index pathology from core-needle biopsy and initial
surgical resection was classified as malignant or non-malignant. Presence of
residual malignancy after initial surgical resection required pathologic
confirmation from subsequent tissue sampling; absence of residual malignancy
required 2 years of benign imaging follow-up.
RESULTS. Thirteen specimen radiographs were interpreted intraoperatively by
the surgeon with later radiologist interpretation; seventeen underwent
real-time radiologist interpretation. Eighteen patients had malignant index
pathology from the initially resected lesion. Frequency of residual
malignancy on subsequent follow-up after initial surgical resection was
higher in patients with malignant than nonmalignant index pathology [39%
(7/18) vs 0% (0/12); p=.02]. Among patients having malignant index pathology,
frequency of residual malignancy was higher in those without, than with,
malignancy in the initial surgical specimen than [80% (4/5) vs 23% (3/13);
p=.047]. Also in these patients, frequency of a positive interpretation of
the initial postoperative mammogram (BIRADS category 4 or 6) was not
significantly different between those with and without residual malignancy
[57% (4/7) vs 54% (6/11); p>.99].
CONCLUSION. Patients with retained BSMs associated with malignant index
lesions are at substantial risk of having residual malignancy. Initial
postoperative mammography is not sufficient for excluding residual
malignancy.
CLINICAL IMPACT. Retained BSMs associated with index malignancy should be
considered suspicious for residual malignancy. In this scenario, timely
additional tissue sampling targeting the retained BSM is warranted, given >2%
chance of malignancy. Active surveillance is a reasonable management strategy
in patients with retained BSMs from nonmalignant index lesions.
* ABSTRACT
* PDF
* Original ResearchMusculoskeletal Imaging
PHOTON-COUNTING DETECTOR CT WITH DENOISING FOR IMAGING OF THE OSSEOUS PELVIS
AT LOW RADIATION DOSES: A PHANTOM STUDY
* Roy P. Marcus,
* Daniel Nagy,
* Georg C. Feuerriegel,
* Julian Anhaus,
* Daniel Nanz, and
* Reto Sutter
First published:August 30, 2023
https://doi.org/10.2214/AJR.23.29765
Preview Abstract
Background: Photon-counting detector (PCD) CT may allow lower radiation doses
than used for conventional energy-integrating detector (EID) CT, with
preserved image quality.
Objective: To compare PCD CT and EID CT, reconstructed with and without a
denoising tool, in terms of image quality of the osseous pelvis in a phantom,
with attention to low radiation doses.
Methods: A pelvic phantom comprising human bones in acrylic material
mimicking soft tissue underwent PCD CT and EID CT at various tube potentials
and radiation doses ranging from 0.05 to 5 mGy. Additional denoised
reconstructions were generated using a commercial tool. Noise was measured in
the acrylic material. Two readers performed independent qualitative
assessments that entailed determining the denoised EID CT reconstruction with
the lowest acceptable dose and then comparing this reference reconstruction
with PCD CT reconstructions without and with denoising, using subjective
Likert scales.
Results: Noise was lower for PCD CT than for EID CT. For instance, at 0.05
mGy and 100 kV with tin filter, noise was 38.4 HU for PCD CT versus 48.8 HU
for EID CT. Denoising further reduced noise; for example, for PCD CT at 100
kV with tin filter at 0.25 mGy, noise was 19.9 HU without denoising versus
9.7 HU with denoising. For both readers, lowest acceptable dose for EID CT
was 0.1 mGy (total score, 11 of 15 for both readers). Both readers somewhat
agreed that PCD CT without denoising at 0.1 mGy (reflecting reference
reconstruction dose) was relatively better than the reference reconstruction
in terms of osseous structures, artifacts, and image quality. Both readers
also somewhat agreed that denoised PCD CT reconstructions at 0.1 mGy and 0.05
mGy (reflecting matched and lower doses, respectively, with respect to
reference reconstruction dose) were relatively better than the reference
reconstruction for the image quality measures.
Conclusion: PCD CT demonstrated better quality images than EID CT when
performed at the lowest acceptable radiation dose for EID CT. PCD CT with
denoising yielded better quality images at a dose lower than lowest
acceptable dose for EID CT.
Clinical Impact: PCD CT with denoising could facilitate lower radiation doses
for pelvic imaging.
* ABSTRACT
* PDF
* Clinical PerspectivePediatric Imaging
CONSENSUS MINIMUM MRI PROTOCOL FOR THE CHILD WITH ACUTE RECURRENT OR CHRONIC
PANCREATITIS
* Andrew T. Trout,
* Judy H. Squires,
* Mitchell A. Rees,
* Matthew R. Plunk,
* Michael A. Murati,
* Meghan B. Marine,
* Lorna P. Browne,
* Sudha A. Anupindi, and
* Maisam Abu-El-Haija
First published:August 30, 2023
https://doi.org/10.2214/AJR.23.29940
Preview Abstract
Imaging plays an important role in the diagnosis and follow-up of children
with acute recurrent pancreatitis (ARP) and chronic pancreatitis (CP).
Consensus is lacking for a minimum MRI protocol for the child with known or
suspected ARP or CP. Lack of standardization contributes to variable
diagnostic performance and hampers application of uniform interpretive
criteria for clinical diagnosis and multicenter research studies. We convened
a working group to achieve consensus for a minimum MRI protocol for children
with suspected ARP or CP. The group included eight pediatric radiologists
experienced in interpreting MRI for pediatric pancreatitis and one medical
pancreatologist, and functioned from November 2022 to March 2023. Existing
clinical protocols were summarized across sites represented by group members,
and commonly used sequences guided the group's discussion. The final
consensus minimum MRI protocol includes five non-contrast sequences and two
post-contrast sequences (which are required only in select clinical
scenarios). The working group also provides recommended acquisition
parameters, sequence-specific technical suggestions, and general
recommendations for optimal imaging technique. We recommend that all sites
imaging children with ARP and CP for clinical care, and particularly those
engaged in cooperative group trials for pancreatitis, ensure that their local
protocol includes these minimum sequences.
* ABSTRACT
* PDF
* Free Access
AJR Global
Original ResearchMusculoskeletal Imaging
PHOTON-COUNTING DETECTOR CT VERSUS ENERGY-INTEGRATING DETECTOR CT OF THE
LUMBAR SPINE: COMPARISON OF RADIATION DOSE AND IMAGE QUALITY
* Adrian A. Marth,
* Roy P. Marcus,
* Georg C. Feuerriegel,
* Daniel Nanz, and
* Reto Sutter
First published:August 30, 2023
https://doi.org/10.2214/AJR.23.29950
Preview Abstract
Background: Photon-counting detector (PCD) CT could be useful to help address
the typically high radiation doses of conventional energy-integrating
detector (EID) CT of the lumbar spine.
Objective: To compare PCD CT and EID CT of the lumbar spine, both performed
using tin filtration, in terms of radiation dose and image quality.
Methods: This study included a prospective sample of 39 patients (22 male, 17
female; mean age, 27.2 years) who underwent investigational PCD CT of the
lumbar spine as part of a separate study, and a retrospective sample of 39
patients (22 male, 17 female; mean age, 34.9 years) who underwent clinically
indicated EID CT of the lumbar spine. In both groups, all examinations were
performed using unenhanced technique with tin prefiltration from June 2022 to
January 2023. Patients were matched between groups using age, sex, and BMI. A
custom Gaussian curve-fitting algorithm was used to automatically calculate
image noise, SNR, and CNR for each examination, based on all voxels within
the image set. Three radiologists independently reviewed examinations to
perform a subjective visual assessment of visualization of trabecular
architecture, cortical bone, neurofominal content, paraspinal muscles, and
intervertebral disk, as well as overall image quality, using a 4-point Likert
scale (1=poor, 4=excellent). PCD CT and EID CT examinations were compared.
Results: Mean CTDIvol was 4.4±1.0 mGy for PCD CT versus 11.1±1.9 mGy for EID
CT (p<.001). Mean SSDE was 6.2±1.0 mGy for PCD CT versus 14.2±1.8 mGy for EID
CT (p<.001). PCD CT and EID CT examinations were not significantly different
in terms of image noise or SNR (both p>.05). PCD CT, in comparison with EID
CT, showed significantly higher CNR (33.6±3.3 vs 29.3±4.1, p<.001). For all
three readers, the median score for overall image quality was 4 (range, 3-4)
for both PCD CT and EID CT. PCD CT and EID CT examinations showed no
significant difference in terms of any qualitative measure for any reader
(all p>.05).
Conclusion: PCD CT, in comparison with EID CT, yielded significantly lower
radiation dose with preserved image quality.
Clinical Impact: The findings support expanded use of PCD CT for lumbar spine
evaluation.
* ABSTRACT
* PDF
* Beyond the AJRCardiothoracic Imaging
BEYOND THE AJR: CORONARY CALCIUM REMAINS THE BEST RISK PREDICTOR FOR CORONARY
HEART DISEASE FOR NOW, BUT THE POLYGENIC RISK SCORE IS FAST BECOMING A
CONTENDER AMONG YOUNG ADULTS
* Julianna M. Czum
First published:August 30, 2023
https://doi.org/10.2214/AJR.23.30030
* FIRST PAGE
* PDF
* Beyond the AJRGenitourinary Imaging
BEYOND THE AJR: AUGMENTING ADNEXAL MASS EVALUATION THROUGH STANDARDIZED RISK
MODELS
* Mayur Virarkar and
* Priya Bhosale
First published:August 30, 2023
https://doi.org/10.2214/AJR.23.30052
* FIRST PAGE
* PDF
* Beyond the AJRCardiothoracic Imaging
BEYOND THE AJR: RIGHT HEART ASSESSMENT REMAINS IMPORTANT IN PATIENTS
PRESENTING WITH PULMONARY EMBOLISM
* Mark M. Hammer and
* Constantine A. Raptis
First published:August 30, 2023
https://doi.org/10.2214/AJR.23.30091
* FIRST PAGE
* PDF
* Special Series ReviewMusculoskeletal Imaging
MUSCLE STEATOSIS AND FIBROSIS IN OLDER ADULTS, FROM THE AJR SPECIAL SERIES ON
IMAGING OF FIBROSIS
* Leon Lenchik,
* Valentina Mazzoli,
* Peggy M. Cawthon,
* Russell T. Hepple, and
* Robert D. Boutin
First published:August 23, 2023
https://doi.org/10.2214/AJR.23.29742
Preview Abstract
The purpose of this article is to review steatosis and fibrosis of skeletal
muscle, focusing on older adults. Although CT, MRI, and ultrasound are
commonly used to image skeletal muscle and provide diagnoses for a variety of
medical conditions, quantitative assessment of muscle steatosis and fibrosis
is uncommon. This review provides radiologists with a broad perspective on
muscle steatosis and fibrosis in older adults by considering their public
health impact, biologic mechanisms, and evaluation using CT, MRI, and
ultrasound. Promising directions in clinical research that employ artificial
intelligence algorithms and the imaging assessment of biologic age are also
reviewed. The presented imaging methods hold promise for improving the
evaluation of common conditions affecting older adults including sarcopenia,
frailty, and cachexia.
* ABSTRACT
* PDF
* Point/CounterpointNeuroradiology/Head and Neck Imaging
MRI SURVEILLANCE OF NONRESECTED PITUITARY MACROADENOMA: COUNTERPOINT—THE
ESSENTIAL ROLE OF GADOLINIUM-BASED CONTRAST AGENTS
* Gangemi Emma and
* Feraco Paola
First published:August 23, 2023
https://doi.org/10.2214/AJR.23.29972
* FIRST PAGE
* PDF
* Point/CounterpointNeuroradiology/Head and Neck Imaging
MRI SURVEILLANCE OF NONRESECTED PITUITARY MACROADENOMA: POINT—IV CONTRAST
MEDIA MAY NOT BE NEEDED
* Vivek Pai and
* Pejman Jabehdar Maralani
First published:August 23, 2023
https://doi.org/10.2214/AJR.23.30003
* FIRST PAGE
* PDF
* Editorial CommentGastrointestinal Imaging
EDITORIAL COMMENT: THE SEARCH FOR A RELIABLE BIOMARKER FOR FIBROSIS IN
INTESTINAL STRICTURES
* Chenchan Huang
First published:August 23, 2023
https://doi.org/10.2214/AJR.23.30078
* FIRST PAGE
* PDF
* Beyond the AJRNeuroradiology/Head and Neck Imaging
BEYOND THE AJR: DEEP LEARNING SHOWS PROMISE IN THE DETECTION OF RETINAL
HEMORRHAGE ON PEDIATRIC HEAD CT
* Elizabeth George and
* Andreas M. Rauschecker
First published:August 23, 2023
https://doi.org/10.2214/AJR.23.30096
* FIRST PAGE
* PDF
* Global Reading RoomInterventional Radiology
THE GLOBAL READING ROOM: A PATIENT WITH NEUROENDOCRINE LIVER METASTASES AFTER
PANCREATICODUODENECTOMY
* A. J. A. T. Braat,
* Hyo-Cheol Kim,
* Thomas J. Vogl, and
* Sarah B. White
First published:August 23, 2023
https://doi.org/10.2214/AJR.23.30113
* FIRST PAGE
* PDF
* Free Access
AJR Global
Podcast
Video
Original ResearchPediatric Imaging
AUTOMATED DEEP LEARNING–BASED SEGMENTATION OF ABDOMINAL ADIPOSE TISSUE ON
DIXON MRI IN ADOLESCENTS: A PROSPECTIVE POPULATION-BASED STUDY
* Tong Wu,
* Santiago Estrada,
* Renza van Gils,
* Ruisheng Su,
* Vincent W. V. Jaddoe,
* Edwin H. G. Oei, and
* Stefan Klein
First published:August 16, 2023
https://doi.org/10.2214/AJR.23.29570
Preview Abstract
Background: Prevalence of childhood obesity has increased significantly
worldwide, highlighting a need for accurate noninvasive quantification of
body fat distribution in children.
Objective: To develop and test an automated deep learning method for
subcutaneous adipose tissue (SAT) and visceral adipose tissue (VAT)
segmentation using Dixon MRI acquisitions in adolescents.
Methods: This study was embedded within the Generation R Study, a prospective
population-based cohort study in Rotterdam, the Netherlands. The present
study included 2989 children (mean age, 13.5 years; 1432 boys, 1557 girls)
who underwent investigational whole-body Dixon MRI after reaching age 13
years, during the Generation R Study's follow-up phase. A competitive dense
fully convolutional network (2D-CDFNet) was trained from scratch to segment
abdominal SAT and VAT using Dixon-based images. The model underwent training,
validation, and testing in 62, 8, and 15 children, respectively, selected by
stratified random sampling, using manual segmentations as reference.
Segmentation performance was assessed using Dice similarity coefficient and
volumetric similarity. Two observers independently performed subjective
visual assessments of automated segmentations in 504 children, selected by
stratified random sampling, scoring undersegmentation and oversegmentation on
0-3 scales (3=nearly perfect segmentation). In 2820 children with complete
data, Spearman correlation coefficients were computed between MRI
measurements with BMI and dual-energy X-ray absorption (DEXA)-based
measurements. The model is publicly available:
https://gitlab.com/radiology/msk/genr/abdomen/cdfnet
Results: In the test dataset, Dice similarity coefficient and volumetric
similarity were, for SAT, 0.94±0.03 and 0.98±0.01, and for VAT, 0.85±0.05 and
0.92±0.04. The two observers assigned score of 3 for SAT in 94% and 93% for
undersegmentation proportion and 99% and 99% for oversegmentation proportion,
and score of 3 for VAT in 99% and 99% for undersegmentation proportion and
95% and 97% for oversegmentation proportion. Correlations with SAT and VAT
were 0.808 and 0.698 for BMI, and 0.941 and 0.801 for DEXA-derived fat mass.
Conclusion: We trained and evaluated the 2D-CDFNet model on Dixon MRI in
adolescents. Quantitative and qualitative measures of automated SAT and VAT
segmentations indicated strong model performance.
Clinical Impact: The automated model may facilitate largescale studies in
adolescents investigating abdominal fat distribution on MRI, as well as
associations of fat distribution with clinical outcomes.
* ABSTRACT
* PDF
* Free Access
AJR Global
Original ResearchGastrointestinal Imaging
ADC VALUES FOR DETECTING BOWEL INFLAMMATION AND BIOLOGIC THERAPY RESPONSE IN
PATIENTS WITH CROHN DISEASE: A POST-HOC PROSPECTIVE TRIAL ANALYSIS
* Jordi Rimola,
* Agnès Fernandez-Clotet,
* Nunzia Capozzi,
* Berta Caballol,
* Sonia Rodríguez,
* Marta Gallego,
* Maria Carme Masamunt,
* Julian Panés,
* Elena Ricart, and
* Ingrid Ordás
First published:August 16, 2023
https://doi.org/10.2214/AJR.23.29639
Preview Abstract
Background: New biologic agents for Crohn disease (CD) create a need for
noninvasive disease markers. DWI may assess bowel inflammation without
contrast agents.
Objective: To evaluate ADC values for identifying bowel inflammation and
therapeutic response in patients with CD treated with biologic therapy.
Methods: This study entailed post-hoc analysis of prospective trial data.
Analysis included 89 patients (median age, 37 years; 49 women, 40 men) with
CD treated by biologic therapy who underwent MR enterography (MRE) at
baseline and 46 weeks after therapy, from March 2013 to April 2021; 43
patients underwent ileocolonoscopy at both time points. Analysis was
conducted at the level of small-bowel and colorectal segments (586 segments
analyzed). Magnetic Resonance Index of Activity (MaRIA) score and presence of
endoscopic ulcers were determined at both time points. One observer measured
bowel-wall ADC. Diagnostic performance was evaluated. Dichotomous ADC
assessments used threshold of 1301×10-6 mm2/s based on initial ROC analysis;
dichotomous MaRIA score assessments used threshold of 11 (moderate-to-severe
inflammation). Second observer repeated ADC measurements in 15 patients.
Results: At baseline, ADC had AUC of 0.92, sensitivity of 78.6%, specificity
of 91.4%, and accuracy of 88.2% for detecting segments with MaRIA score ≥11.
At baseline, AUC for detecting endoscopic ulcers was 0.96 for MaRIA score
versus 0.87 for ADC (p<.001); sensitivity, specificity, and accuracy were
70.8%, 90.2%, and 85.1% for ADC, and 86.2%, 96.2%, and 93.6% for MaRIA score.
At follow-up, ADC had AUC of 0.87, sensitivity of 75.4%, specificity of
83.6%, and accuracy of 80.0% for detecting improvement in MaRIA score to <11.
At follow-up, AUC for detecting endoscopic ulcer healing was 0.94 for MaRIA
score versus 0.84 for ADC (p<.001); sensitivity, specificity, and accuracy
were 70.7%, 95.8%, and 84.4% for ADC, and 90.2%, 100.0%, and 95.6% for MaRIA
score. Interobserver agreement for ADC, based on intraclass correlation
coefficient, was 0.70 at baseline and 0.65 at follow-up.
Conclusions: The findings do not support use of ADC rather than MaRIA scores
for detecting biologic therapy response.
Clinical Impact: ADC may have an adjunctive role in assessing bowel
inflammation in CD, but showed limited performance for detecting biologic
therapy response.
* ABSTRACT
* PDF
* Editorial CommentPediatric Imaging
EDITORIAL COMMENT: A ROLE FOR ASSESSING LIVER STIFFNESS BY SHEAR-WAVE
ELASTOGRAPHY IN PATIENTS WITH FONTAN CIRCULATION
* Judy H. Squires
First published:August 16, 2023
https://doi.org/10.2214/AJR.23.30073
* FIRST PAGE
* PDF
* Research LetterGenitourinary Imaging
MULTICENTER VALIDATION OF A T2-WEIGHTED MRI CALCULATOR TO DIFFERENTIATE
ADRENAL ADENOMA FROM ADRENAL METASTASES
* Wendy Tu,
* Mohamed Badawy,
* Benjamin W. Carney,
* Elaine M. Caoili,
* Michael T. Corwin,
* Khaled M. Elsayes,
* William Mayo-Smith,
* Daniel I. Glazer,
* Barun Bagga,
* Robert Petrocelli,
* Myles T. Taffel, and
* Nicola Schieda
First published:August 9, 2023
https://doi.org/10.2214/AJR.23.29727
* FIRST PAGE
* PDF
* Original ResearchPediatric Imaging
ASSOCIATIONS OF LIVER STIFFNESS MEASURED BY ULTRASOUND SHEAR-WAVE
ELASTOGRAPHY WITH PORTAL HYPERTENSION AND CIRCULATORY FAILURE IN INDIVIDUALS
WITH FONTAN CIRCULATION
* Betul E. Derinkuyu,
* Jonathan R. Dillman,
* Adam M. Lubert,
* Joseph J. Palermo,
* Alexander R. Opotowsky, and
* Andrew T. Trout
First published:August 2, 2023
https://doi.org/10.2214/AJR.23.29640
Preview Abstract
Background: The Fontan operation palliates single-ventricle congenital heart
disease but causes hepatic congestion with associated progressive hepatic
fibrosis.
Objective: To evaluate associations between liver stiffness measured using
ultrasound shear-wave elastography (SWE) in patients with Fontan palliation
and occurrence of portal hypertension and Fontan circulatory failure during
follow-up.
Methods: This retrospective study included 119 individuals ≥10 years old
(median age, 19.1 years; 61 female, 58 male) with Fontan circulation who
underwent liver ultrasound with 2D SWE from January 1, 2015, to January 1,
2022 and had ≥1 year of clinical follow-up (unless experiencing earlier
outcome-related events). Median liver stiffness from initial ultrasound was
documented. VAST (varices, ascites, splenomegaly, and thrombocytopenia)
scores (range, 0-4) were determined as a marker of portal hypertension on
initial ultrasound and ≥1-year follow-up imaging (ultrasound, CT, or MRI).
Composite clinical outcome for Fontan circulatory failure (death, mechanical
circulatory support, cardiac transplantation, or unexpected Fontan-related
hospitalization) was assessed. Analysis included Wilcoxon rank-sum test,
logistic regression analysis with stepwise variable selection, and ROC
analysis.
Results: Median initial liver stiffness was 2.22 m/s. Median initial VAST
score was 0 (IQR: 0-1); median follow-up VAST score was 1 (IQR: 0-2)
(p=.004). Fontan circulatory failure occurred in 37/119 (31%) patients
(median follow-up, 3.4 years). Initial liver stiffness was higher in patients
with follow-up VAST score ≥1 (2.37 m/s) than follow-up VAST score 0 (2.08
m/s) (p=.005), and in patients with (2.43 m/s) than without (2.10 m/s) Fontan
circulatory failure at follow-up (p<.001). Initial liver stiffness was the
only significant independent predictor of Fontan circulatory failure
(OR=3.76; p<.001); age, sex, Fontan operation type, dominant ventricular
morphology, and initial VAST score were not independent predictors. Initial
liver stiffness had AUC of 0.70 (sensitivity 79%, specificity 57%; threshold,
>2.11 m/s) for predicting follow-up VAST score ≥1, and 0.74 (sensitivity 84%,
specificity 52%; threshold, >2.12 m/s) for predicting Fontan circulatory
failure.
Conclusion: In patients with Fontan circulation, increased initial liver
stiffness was associated with portal hypertension and circulatory failure
during follow-up, although had moderate performance in predicting these
outcomes.
Clinical Impact: Ultrasound SWE may play a role in post-Fontan surveillance,
supporting tailored medical and surgical care.
* ABSTRACT
* PDF
* Special Series ReviewGastrointestinal Imaging
CONTEMPORARY IMAGING ASSESSMENT OF STRICTURES AND FIBROSIS IN CROHN DISEASE,
WITH FOCUS ON QUANTITATIVE BIOMARKERS: FROM THE AJR SPECIAL SERIES ON IMAGING
OF FIBROSIS
* Jordi Rimola,
* Kim Beek,
* Ingrid Ordás,
* Krisztina Gecse,
* Míriam Cuatrecasas, and
* Jaap Stoker
First published:August 2, 2023
https://doi.org/10.2214/AJR.23.29693
Preview Abstract
Patients with Crohn disease commonly develop bowel strictures, which exhibit
varying degrees of inflammation and fibrosis. Differentiation of strictures'
distinct inflammatory and fibrotic components is key for the optimization of
therapeutic management and for the development of antifibrotic drugs.
Cross-sectional imaging techniques, including ultrasound, CT, and MRI, allow
evaluation of the full thickness of the bowel wall, as well as of extramural
complications and associated mesenteric abnormalities. Although promising
data have been reported for a range of novel imaging biomarkers for fibrosis
detection and quantification of fibrosis degree, these biomarkers lack
sufficient validation and standardization for clinical use. Additional
methods, including PET with emerging radiotracers, artificial intelligence,
and radiomics are also under investigation for stricture characterization. In
this article, we highlight the clinical relevance of identifying fibrosis in
Crohn disease, review histopathologic aspects of strictures in Crohn disease,
summarize morphologic imaging findings of strictures, and explore
contemporary developments in the use of cross-sectional imaging techniques
for detecting and characterizing intestinal strictures, with attention to
emerging quantitative biomarkers.
* ABSTRACT
* PDF
* Free Access
AJR Global
Original ResearchPediatric Imaging
MACHINE LEARNING DIAGNOSIS OF SMALL BOWEL CROHN DISEASE USING T2-WEIGHTED MRI
RADIOMIC AND CLINICAL DATA
* Richard X. Liu,
* Hailong Li,
* Alexander J. Towbin,
* Nadeen Abu Ata,
* Ethan A. Smith,
* Jean A. Tkach,
* Lee A. Denson,
* Lili He, and
* Jonathan R. Dillman
First published:August 2, 2023
https://doi.org/10.2214/AJR.23.29812
Preview Abstract
Background: Radiologists show variable diagnostic performance and
considerable inter-reader variability when interpreting MR enterography (MRE)
examinations for suspected Crohn disease (CD).
Objective: To develop a machine learning-based method for predicting ileal CD
using radiomic features of ileal wall and mesenteric fat from noncontrast
T2-weighted MR images, and to compare performance with that of expert
radiologists.
Methods: This single-institution study included retrospectively identified
patients who underwent MRE for suspected ileal CD from January 1, 2020 to
January 31, 2021, and prospectively enrolled participants (with newly
diagnosed ileal CD or serving as healthy controls) from December 2018 to
October 2021. Using axial T2-weighted SSFSE images, a radiologist selected
two slices show-ing greatest terminal ileal wall thickening; four ROIs were
segmented, and radiomic features were extracted from each ROI. Following
feature selection, support-vector machine models were trained to classify
presence of ileal CD. Three fellowship-trained pediatric abdominal
radiologists inde-pendently classified presence of ileal CD on SSFSE images.
Reference standard was clinical diag-nosis of ileal CD following positive
endoscopy and biopsy. Radiomic-only, clinical-only, and radi-omic-clinical
ensemble models were trained and evaluated using nested cross-validation.
Results: The study included 135 patients (mean age, 15.2±3.2 years; 67
female, 68 male); 70 were diagnosed with ileal CD. The three radiologists had
accuracies of 83.7% (113/135), 86.7% (117/135), and 88.1% (119/135) for
diagnosing CD; consensus accuracy was 88.1%. Inter-radiologist agreement was
substantial (kappa=0.78). Best-performing ROI was bowel-core (AUC=0.95,
accuracy=89.6%); other ROIs had worse performance (whole-bowel AUC=0.86;
fat-core AUC=0.70; whole-fat AUC=0.73). For clinical-only model, AUC was 0.85
and accuracy was 80.0%. Ensemble model combining bowel-core radiomic and
clinical models achieved AUC of 0.98 and accuracy of 93.5%. Bowel-core
radiomic-only model demonstrated better accuracy than radiologist 1 (P=.009)
and radiologist 2 (P=.02), but not radiologist 3 (P>.99) or radiologists'
consensus (P=.05). Ensemble model demonstrated better accuracy than
radiologists' consensus (P=.02).
Conclusions: A radiomic machine learning model predicted CD diagnosis with
better performance than two of three expert radiologists. Model performance
improved when ensembled with clinical data.
Clinical Impact: Deployment of a radiomic-based model using T2-weighted MR
data could de-crease inter-radiologist variability and increase diagnostic
accuracy for pediatric CD.
* ABSTRACT
* PDF
* Global Reading RoomMusculoskeletal Imaging
THE GLOBAL READING ROOM: A SUPERIOR LABRAL TEAR ON MRI
* Miraude EAPM Adriaensen,
* Ian Amber,
* Philip Robinson, and
* Jisook Yi
First published:August 2, 2023
https://doi.org/10.2214/AJR.23.29993
* FIRST PAGE
* PDF
* Beyond the AJRNeuroradiology/Head and Neck Imaging
BEYOND THE AJR: BENEFITS OF ARTIFICIAL INTELLIGENCE–BASED THYROID NODULE
INTERPRETATION DEPEND ON RADIOLOGIST SKILL LEVEL
* Andrew L. Wentland
First published:August 2, 2023
https://doi.org/10.2214/AJR.23.30001
* FIRST PAGE
* PDF
* Global Reading RoomNuclear Imaging
THE GLOBAL READING ROOM: AN ANXIOUS CHILD AWAITING RENAL SCINTIGRAPHY
* Zvi Bar-Sever,
* Lorenzo Biassoni,
* Suyun Chen, and
* Helen R. Nadel
First published:August 2, 2023
https://doi.org/10.2214/AJR.23.30014
* FIRST PAGE
* PDF
* AJR Expert Panel Narrative ReviewGastrointestinal Imaging
BILIARY DUCT DILATATION: AJR EXPERT PANEL NARRATIVE REVIEW
* Daniel R. Ludwig,
* Malak Itani,
* David D. Childs,
* Margarita V. Revzin,
* Koushik K. Das,
* Mark A. Anderson,
* Hina Arif-Tiwari,
* Mark E. Lockhart, and
* Ann S. Fulcher
First published:July 26, 2023
https://doi.org/10.2214/AJR.23.29671
Preview Abstract
Biliary duct dilation is a common incidental finding in practice, but one
unlikely to indicate biliary obstruction in the absence of clinical symptoms
or elevated liver chemistries. However, the clinical presentation may be
nonspecific, and the liver chemistries either unavailable or difficult to
interpret. The goal of this article is to review a series of topics
fundamental to the management of biliary duct dilation, providing consensus
recommendations in a question-and-answer format. We start by covering a basic
approach to interpreting liver chemistries, strengths and weaknesses of the
biliary imaging modalities, and how and where to measure the extrahepatic
bile duct. Next, we define criteria for biliary duct dilation, including
patients with prior cholecystectomy and advanced age, and cover when and if
biliary duct dilation can be attributed to papillary stenosis or sphincter of
Oddi dysfunction. Subsequently, we discuss two conditions in which the duct
is pathologically dilated but not obstructed: congenital cystic dilation
(i.e., choledochal cyst) and intraductal papillary neoplasm of the bile duct.
Finally, we provide guidance on when to recommend obtaining additional
imaging or testing such as endoscopic ultrasound or ERCP, and include a
discussion of future directions in biliary imaging.
* ABSTRACT
* PDF
* Beyond the AJRMultispecialty
BEYOND THE AJR: ULTRASOUND FOR PEDIATRIC FOREARM FRACTURES CAN REPLACE
RADIOGRAPHY IN SPECIFIC SCENARIOS
* Jade Iwasaka-Neder and
* Sarah D. Bixby
First published:July 26, 2023
https://doi.org/10.2214/AJR.23.29939
* FIRST PAGE
* PDF
* Beyond the AJRGenitourinary Imaging
BEYOND THE AJR: PREOPERATIVE MRI SCORING IN PATIENTS WITH ENDOMETRIOSIS
OPTIMIZES PATIENT COUNSELING AND SURGICAL PLANNING
* Anuradha S. Shenoy-Bhangle and
* Aoife Kilcoyne
First published:July 19, 2023
https://doi.org/10.2214/AJR.23.29911
* FIRST PAGE
* PDF
* Beyond the AJRPolicy, Quality, and Practice Management
BEYOND THE AJR: ACCURACY OF UNENHANCED ABDOMINOPELVIC CT IN THE EMERGENCY
DEPARTMENT—QUANTIFYING WHAT THE RADIOLOGIST ALREADY KNOWS
* Lakshmi Ananthakrishnan
First published:July 19, 2023
https://doi.org/10.2214/AJR.23.29920
* FIRST PAGE
* PDF
* AJR Expert Panel Narrative ReviewMusculoskeletal Imaging
CLINICAL APPLICATIONS, CHALLENGES, AND RECOMMENDATIONS FOR ARTIFICIAL
INTELLIGENCE IN MUSCULOSKELETAL AND SOFT TISSUE ULTRASOUND: AJR EXPERT PANEL
NARRATIVE REVIEW
* Paul H. Yi,
* Hillary W. Garner,
* Anna Hirschmann,
* Jon A. Jacobson,
* Patrick Omoumi,
* Kangrok Oh,
* John R. Zech, and
* Young Han Lee
First published:July 12, 2023
https://doi.org/10.2214/AJR.23.29530
Preview Abstract
Artificial intelligence (AI) is increasingly used in clinical practice for
musculoskeletal imaging tasks, such as disease diagnosis and image
reconstruction. AI applications in musculoskeletal imaging have focused
primarily on radiography, CT, and MRI. Although musculoskeletal ultrasound
stands to benefit from AI in similar ways, such applications have been
relatively underdeveloped. In comparison with other modalities, ultrasound
has unique advantages and disadvantages that must be considered in AI
algorithm development and clinical translation. Challenges in developing AI
for musculoskeletal ultrasound involve both clinical aspects of image
acquisition and practical limitations in image processing and annotation.
Solutions from other radiology subspecialties (e.g., crowdsourced annotations
coordinated by professional societies), along with use cases (most commonly
rotator cuff tendon tears and palpable soft tissue masses), can be applied to
musculoskeletal ultrasound to help develop AI. To facilitate creation of
high-quality imaging datasets for AI model development, focus should be given
to increasing uniformity in musculoskeletal ultrasound performance by
technologists and radiologists, and to annotation of images for specific
anatomic regions. This AJR Expert Panel Narrative Review summarizes available
evidence regarding AI's potential utility in musculoskeletal ultrasound, and
challenges facing its development. Recommendations for future AI advancement
and clinical translation in musculoskeletal ultrasound are discussed.
* ABSTRACT
* PDF
* Editorial CommentGenitourinary Imaging
EDITORIAL COMMENT: RENAL TRANSPLANT IMAGING CONTINUES TO EVOLVE AND IMPROVE
* Mark Lockhart
First published:July 5, 2023
https://doi.org/10.2214/AJR.23.29839
* FIRST PAGE
* PDF
* Global Reading RoomPolicy, Quality, and Practice Management
THE GLOBAL READING ROOM: RESPONDING TO A SOCIAL MEDIA POST
* Sally L. Ayesa,
* Eduardo Moreno Júdice de Mattos Farina,
* Naveen Sharma, and
* Rebecca L. Seidel
First published:July 5, 2023
https://doi.org/10.2214/AJR.23.29846
* FIRST PAGE
* PDF
* AJR Expert Panel Narrative ReviewInterventional Radiology
LOCOREGIONAL THERAPIES FOR PRIMARY AND METASTATIC BREAST CANCER: AJR EXPERT
PANEL NARRATIVE REVIEW
* Amy R. Deipolyi,
* Robert C. Ward,
* Ahsun Riaz,
* Thomas J. Vogl,
* Rache M. Simmons,
* Claus C. Pieper, and
* Yolanda Bryce
First published:June 28, 2023
https://doi.org/10.2214/AJR.23.29454
Preview Abstract
This article explores the growing role of minimally invasive locoregional
therapies in the multidisciplinary treatment of primary and metastatic breast
cancer. Factors contributing to the expanding role of ablation for primary
breast cancer include earlier diagnosis when tumors are small and increased
longevity of patients who are poor surgical candidates. Cryoablation has
emerged as the leading ablative modality for primary breast cancer due to its
wide availability, lack of need for sedation, and ability to monitor the
ablation zone. In patients with oligometastatic breast cancer, emerging
evidence suggests that use of locoregional therapies to eradicate all disease
sites may confer a survival advantage. Evidence also suggests that
transarterial therapies (including chemoembolization, chemoperfusion, and
radioembolization) may be helpful in some patients with advanced liver
metastases from breast cancer in the setting of hepatic oligoprogression or
inability to tolerate systemic therapy. However, the optimal modalities for
treatment of oligometastatic and advanced metastatic disease remain unknown.
Finally, locoregional therapies may produce tumor antigens that, in
combination with immunotherapy, drive anti-tumor immunity. Although key
trials are ongoing, additional prospective studies are needed to establish
the inclusion of interventional oncology in societal breast cancer
guidelines, to support further clinical adoption and improved patient
outcomes.
* ABSTRACT
* PDF
* Beyond the AJRNeuroradiology/Head and Neck Imaging
BEYOND THE AJR: ROUTINE MRI MAY PROVIDE UTILITY IN IDENTIFYING SECONDARY
CAUSES IN ADULT PATIENTS WITH SUSPECTED BELL PALSY AT INITIAL PRESENTATION
* Brent Ross and
* Courtney M. Tomblinson
First published:June 28, 2023
https://doi.org/10.2214/AJR.23.29811
* FIRST PAGE
* PDF
* AJR Expert Panel Narrative ReviewNuclear Medicine
EMERGING ROLE OF SCINTIGRAPHY USING BONE-SEEKING TRACERS FOR DIAGNOSIS OF
CARDIAC AMYLOIDOSIS: AJR EXPERT PANEL NARRATIVE REVIEW
* Riemer H. J. A. Slart,
* Wengen Chen,
* Alwin Tubben,
* Hendrea S. A. Tingen,
* Daniel R. Davies,
* Martha Grogan,
* Ashutosh D. Wechalekar,
* Michelle M. Kittleson,
* Louise E. J. Thomson,
* Piotr J. Slomka,
* Kshama Wechalekar, and
* … View all authors
First published:June 14, 2023
https://doi.org/10.2214/AJR.23.29347
Preview Abstract
Amyloidoses are a complex group of clinical diseases that result from
progressive organ dysfunction due to extracellular protein misfolding and
deposition. The two most common types of cardiac amyloidosis are
transthyretin amyloidosis (ATTR) and light chain (AL) amyloidosis. The
diagnosis of ATTR cardiomyopathy (ATTR-CM) is challenging due to its
phenotypic similarity to other more common cardiac conditions, perceived
rarity of the disease, and unfamiliarity with its diagnostic algorithms;
endomyocardial biopsy was historically required for diagnosis. However,
myocardial scintigraphy using bone-seeking tracers has shown high accuracy
for detection of ATTR-CM and has become a key noninvasive diagnostic test for
the condition, being supported by professional society guidelines and
transforming prior diagnostic paradigms. This AJR Expert Panel Narrative
Review describes the role of myocardial scintigraphy using bone-seeking
tracers in the diagnosis of ATTR-CM. The article summarizes available
tracers, acquisition techniques, interpretation and reporting considerations,
diagnostic pitfalls, and gaps in the current literature. The critical need
for monoclonal testing in patients with positive scintigraphy results to
differentiate ATTR-CM and AL cardiac amyloidosis is highlighted. Recent
updates in guideline recommendations that emphasize the importance of a
qualitative visual assessment are also discussed.
* ABSTRACT
* PDF
* Special Series ReviewGenitourinary Imaging
CONTEMPORARY AND EMERGING MRI STRATEGIES FOR ASSESSING KIDNEY ALLOGRAFT
COMPLICATIONS: ARTERIAL STENOSIS AND PARENCHYMAL INJURY, FROM THE AJR SPECIAL
SERIES ON IMAGING OF FIBROSIS
* Octavia Bane,
* Sara C. Lewis,
* Ruth Lim,
* Benjamin W. Carney,
* Amar Shah, and
* Ghaneh Fananapazir
First published:June 14, 2023
https://doi.org/10.2214/AJR.23.29418
Preview Abstract
MRI plays an important role in the evaluation of kidney allografts for
vascular complications as well as parenchymal insults. Transplant renal
artery stenosis (TRAS), the most common vascular complication of kidney
transplantation, can be evaluated by MRA using gadolinium and non-gadolinium
contrast agents, as well as by unenhanced MRA techniques. Parenchymal injury
occurs through a variety of pathways, including graft rejection, acute
tubular injury, BK viral infection, drug-induced interstitial nephritis, and
pyelonephritis. Investigational MRI techniques have sought to differentiate
among these causes of dysfunction as well as to assess the degree of
interstitial fibrosis or tubular atrophy (IFTA)—the common end pathway for
all of these processes—which is currently evaluated by invasively obtained
core biopsies. Some of these MRI sequences have shown promise in not only
assessing the cause of parenchymal injury but also assessing IFTA
noninvasively. This review describes current clinically used MRI techniques,
and previews promising investigational MRI techniques, for assessing
complications of kidney grafts.
* ABSTRACT
* PDF
* Beyond the AJRCardiothoracic Imaging
BEYOND THE AJR: APPLYING SCREENING ALGORITHMS (ARTIFICIALLY) INTELLIGENTLY
* Ryan Godwin and
* Srini Tridandapani
First published:June 14, 2023
https://doi.org/10.2214/AJR.23.29663
* FIRST PAGE
* PDF
* Global Reading RoomGastrointestinal Imaging
THE GLOBAL READING ROOM: IMAGING SURVEILLANCE FOR PRIMARY SCLEROSING
CHOLANGITIS
* Aristeidis Grigoriadis,
* Davide Ippolito,
* Malak Itani,
* Cher Heng Tan, and
* Sudhakar K. Venkatesh
First published:May 31, 2023
https://doi.org/10.2214/AJR.23.29661
* FIRST PAGE
* PDF
* Beyond the AJRBreast Imaging
BEYOND THE AJR: PATIENT COST-SHARING ADVERSELY AFFECTS ADHERENCE TO
DOWNSTREAM IMAGING AFTER MAMMOGRAPHY SCREENING
* Liane E. Philpotts
First published:May 31, 2023
https://doi.org/10.2214/AJR.23.29685
* FIRST PAGE
* PDF
* Editorial CommentGastrointestinal Imaging
EDITORIAL COMMENT: MR ELASTOGRAPHY OF THE LIVER: PRACTICAL GUIDELINES FOR
OPTIMAL CLINICAL USE
* Krishna Shanbhogue
First published:May 24, 2023
https://doi.org/10.2214/AJR.23.29642
Preview Abstract
This Editorial Comment discusses the following AJR article: MR Elastography:
Practical Questions, From the AJR Special Series on Imaging of Fibrosis.
Please see the Editorial Comment by Krishna Shanbhogue discussing this
article.
MR elastography (MRE), first described in 1995 and FDA-cleared in 2009, has
emerged as an important tool for non-invasively detecting and staging liver
fibrosis in patients with known or suspected chronic liver disease. This
review focuses on a series of practical questions about the clinical use of
MRE. Most head-to-head comparison studies with other laboratory and
imaging-based tests have concluded that MRE has the highest diagnostic
performance among tests for staging liver fibrosis. Limitations in the
accuracy of biopsy as a standard of truth in staging liver fibrosis are
increasingly being recognized. MRE-based measurements show promise as
quantitative surrogates of disease severity and predictors of important
clinical outcomes. The appropriate role of MRE in management of patients with
chronic liver disease is being actively incorporated into recognized clinical
guidelines. Growing evidence shows that MRI measurement of elevated liver fat
is the most important single biomarker for detecting non-alcoholic
steatohepatitis (NASH), while MRE-based liver stiffness is the most important
single biomarker for detecting at-risk NASH (i.e., NASH with stage ≥F2
fibrosis). Advances in MRE technology are offering higher precision and new
biomarkers, which have potential to allow independent assessment of
inflammation and other histologic processes in addition to fibrosis.
* ABSTRACT
* PDF
* Beyond the AJRBreast Imaging
BEYOND THE AJR: AN INTERNATIONAL COMPETITION ADVANCES ARTIFICIAL INTELLIGENCE
RESEARCH
* Manisha Bahl and
* Synho Do
First published:May 24, 2023
https://doi.org/10.2214/AJR.23.29644
* FIRST PAGE
* PDF
* Special Series ReviewGastrointestinal Imaging
MR ELASTOGRAPHY: PRACTICAL QUESTIONS, FROM THE AJR SPECIAL SERIES ON IMAGING
OF FIBROSIS
* Meng Yin and
* Richard L. Ehman
First published:May 10, 2023
https://doi.org/10.2214/AJR.23.29437
Preview Abstract
Please see the Editorial Comment by Krishna Shanbhogue discussing this
article.
MR elastography (MRE), first described in 1995 and FDA-cleared in 2009, has
emerged as an important tool for non-invasively detecting and staging liver
fibrosis in patients with known or suspected chronic liver disease. This
review focuses on a series of practical questions about the clinical use of
MRE. Most head-to-head comparison studies with other laboratory and
imaging-based tests have concluded that MRE has the highest diagnostic
performance among tests for staging liver fibrosis. Limitations in the
accuracy of biopsy as a standard of truth in staging liver fibrosis are
increasingly being recognized. MRE-based measurements show promise as
quantitative surrogates of disease severity and predictors of important
clinical outcomes. The appropriate role of MRE in management of patients with
chronic liver disease is being actively incorporated into recognized clinical
guidelines. Growing evidence shows that MRI measurement of elevated liver fat
is the most important single biomarker for detecting non-alcoholic
steatohepatitis (NASH), while MRE-based liver stiffness is the most important
single biomarker for detecting at-risk NASH (i.e., NASH with stage ≥F2
fibrosis). Advances in MRE technology are offering higher precision and new
biomarkers, which have potential to allow independent assessment of
inflammation and other histologic processes in addition to fibrosis.
This Editorial Comment discusses the following AJR article: MR Elastography:
Practical Questions, From the AJR Special Series on Imaging of Fibrosis.
* ABSTRACT
* PDF
* Beyond the AJRPolicy, Quality, and Practice Management
BEYOND THE AJR: EVALUATION AND MANAGEMENT PAYMENT POLICY CHANGES
REDISTRIBUTED MONEY FROM RADIOLOGISTS TO PRIMARY CARE PRACTITIONERS
* Melissa M. Chen and
* Lauren Nicola
First published:May 10, 2023
https://doi.org/10.2214/AJR.23.29560
* FIRST PAGE
* PDF
* Editorial CommentCardiothoracic Imaging
EDITORIAL COMMENT: RADIOLOGISTS AS CORE CONTRIBUTORS TO THE MULTIDISCIPLINARY
MANAGEMENT OF PULMONARY FIBROSIS
* Francis Girvin
First published:April 26, 2023
https://doi.org/10.2214/AJR.23.29461
Preview Abstract
This Editorial Comment discusses the following AJR article: Imaging of
Pulmonary Fibrosis: An Update, From the AJR Special Series on Imaging of
Fibrosis.
Please see the Editorial Comment by Francis Girvin discussing this article.
Pulmonary fibrosis is recognized to occur in association with a wide and
increasing array of conditions, and presents with a spectrum of chest CT
appearances. Idiopathic pulmonary fibrosis (IPF), corresponding
histologically with usual interstitial pneumonia and representing the most
common idiopathic interstitial pneumonia, is a chronic progressive fibrotic
interstitial lung disease (ILD) of unknown cause. Progressive pulmonary
fibrosis (PPF) describes the radiologic development of pulmonary fibrosis in
patients with ILD of a known or unknown cause other than IPF. The recognition
of PPF impacts management of patients with ILD, for example guiding
initiation of antifibrotic therapy. Interstitial lung abnormalities (ILAs)
represent an incidental CT finding in patients without suspected ILD and may
represent an early intervenable form of pulmonary fibrosis. Traction
bronchiectasis and/or bronchiolectasis, when detected in the setting of
chronic fibrosis, is generally considered evidence of irreversible disease,
and progression predicts worse mortality. Awareness is increasing of the
relation between pulmonary fibrosis and connective tissue diseases,
particularly rheumatoid arthritis. This review provides an update on imaging
of pulmonary fibrosis, with attention to recent advances in disease
understanding with relevance to radiologic practice. The essential role of a
multidisciplinary approach to clinical and radiologic data is highlighted.
* ABSTRACT
* PDF
* Special Series ReviewCardiothoracic Imaging
IMAGING OF PULMONARY FIBROSIS: AN UPDATE, FROM THE AJR SPECIAL SERIES ON
IMAGING OF FIBROSIS
* Kyung Soo Lee,
* Joungho Han,
* Noriaki Wada,
* Akinori Hata,
* Ho Yun Lee,
* ChinA Yi,
* Takuya Hino,
* Tracy J. Doyle,
* Tomas Franquet, and
* Hiroto Hatabu
First published:April 12, 2023
https://doi.org/10.2214/AJR.23.29119
Preview Abstract
Pulmonary fibrosis is recognized to occur in association with a wide and
increasing array of conditions, and presents with a spectrum of chest CT
appearances. Idiopathic pulmonary fibrosis (IPF), corresponding
histologically with usual interstitial pneumonia and representing the most
common idiopathic interstitial pneumonia, is a chronic progressive fibrotic
interstitial lung disease (ILD) of unknown cause. Progressive pulmonary
fibrosis (PPF) describes the radiologic development of pulmonary fibrosis in
patients with ILD of a known or unknown cause other than IPF. The recognition
of PPF impacts management of patients with ILD, for example guiding
initiation of antifibrotic therapy. Interstitial lung abnormalities (ILAs)
represent an incidental CT finding in patients without suspected ILD and may
represent an early intervenable form of pulmonary fibrosis. Traction
bronchiectasis and/or bronchiolectasis, when detected in the setting of
chronic fibrosis, is generally considered evidence of irreversible disease,
and progression predicts worse mortality. Awareness is increasing of the
relation between pulmonary fibrosis and connective tissue diseases,
particularly rheumatoid arthritis. This review provides an update on imaging
of pulmonary fibrosis, with attention to recent advances in disease
understanding with relevance to radiologic practice. The essential role of a
multidisciplinary approach to clinical and radiologic data is highlighted.
This Editorial Comment discusses the following AJR article: Imaging of
Pulmonary Fibrosis: An Update, From the AJR Special Series on Imaging of
Fibrosis.
* ABSTRACT
* PDF
* Global Reading RoomPediatric Imaging
THE GLOBAL READING ROOM: AN INCIDENTAL LIVER LESION IN A TEENAGER
* Govind B. Chavhan,
* Ji Hye Kim,
* Judy H. Squires, and
* Seema Toso
First published:March 29, 2023
https://doi.org/10.2214/AJR.23.29350
* FIRST PAGE
* PDF
OFFICIAL ARTICLES
* CME Credit
Special Series ReviewGenitourinary Imaging
EXPANDING ROLE OF DUAL-ENERGY CT FOR GENITOURINARY TRACT ASSESSMENT IN THE
EMERGENCY DEPARTMENT, FROM THE AJR SPECIAL SERIES ON EMERGENCY RADIOLOGY
* Sachiv Chakravarti and
* Jennifer W. Uyeda
First published:October 4, 2023
https://doi.org/10.2214/AJR.22.27864
Preview Abstract
Among explored applications of dual-energy CT (DECT) in the abdomen and
pelvis, the genitourinary (GU) tract represents an area where accumulated
evidence has established the role of DECT to provide useful information that
may change management. This review discusses established applications of DECT
for GU tract assessment in the emergency department (ED) setting, including
characterization of renal stones, evaluation of traumatic injuries and
hemorrhage, and characterization of incidental renal and adrenal findings.
Use of DECT for such applications can reduce the need for additional
multiphase CT or MRI examinations and reduce follow-up imaging
recommendations. Emerging applications are also highlighted, including use of
low-energy virtual monoenergetic images (VMIs) to improve image quality and
potentially reduce contrast media doses and use of high-energy VMIs to
mitigate renal mass pseudoenhancement. Finally, implementation of DECT into
busy ED radiology practices is presented, weighing the trade-off of
additional image acquisition, processing time, and interpretation time
against potential additional useful clinical information. Automatic
generation of DECT-derived images with direct PACS transfer can facilitate
radiologists' adoption of DECT in busy ED environments and minimize impact on
interpretation times. Using the described approaches, radiologists can apply
DECT technology to improve the quality and efficiency of care in the ED.
* ABSTRACT
* FULL TEXT
* PDF
* Free Access
Editorial CommentGenitourinary Imaging
EDITORIAL COMMENT: TOWARD ROUTINE APPLICATION OF DUAL-ENERGY CT FOR
GENITOURINARY ASSESSMENT—A PERSPECTIVE IN THE EMERGENCY SETTING
* Sung Yoon Park
First published:October 4, 2023
https://doi.org/10.2214/AJR.23.29510
* FULL TEXT
* PDF
* LetterBreast Imaging
SPATIAL RESOLUTION VERSUS CONTRAST RESOLUTION IN BREAST ULTRASOUND
* Richard G. Barr
First published:September 27, 2023
https://doi.org/10.2214/AJR.23.29516
* FULL TEXT
* PDF
* LetterBreast Imaging
REPLY TO “SPATIAL RESOLUTION VERSUS CONTRAST RESOLUTION IN BREAST ULTRASOUND”
* Ellen B. Mendelson
First published:September 27, 2023
https://doi.org/10.2214/AJR.23.29628
* FULL TEXT
* PDF
* Free Access
Editorial CommentPolicy, Quality, and Practice Management
EDITORIAL COMMENT: LACK OF MEDICARE COVERAGE FOR SCREENING CT COLONOGRAPHY
CONTRIBUTES TO INEQUITABLE UTILIZATION AND A CONFUSING CURRENT STATE OF
COLORECTAL CANCER SCREENING
* Douglas Kitchin
First published:August 9, 2023
https://doi.org/10.2214/AJR.23.30007
* FULL TEXT
* PDF
* Free Access
Editorial CommentBreast Imaging
EDITORIAL COMMENT: ARTIFICIAL INTELLIGENCE MAY HELP DEFINE SCREENING
STRATEGIES IN PATIENTS WITH DENSE BREASTS
* Reni S. Butler
First published:August 9, 2023
https://doi.org/10.2214/AJR.23.30042
* FULL TEXT
* PDF
* Free Access
Editorial CommentGenitourinary Imaging
EDITORIAL COMMENT: PROS AND CONS OF IMPLEMENTATION OF SYNOPTIC REPORTING IN
ONCOLOGIC IMAGING
* Gaiane M. Rauch
First published:August 2, 2023
https://doi.org/10.2214/AJR.23.29942
* FULL TEXT
* PDF
* Free Access
Editorial CommentCardiothoracic Imaging
EDITORIAL COMMENT: IMPLEMENTING AN END-TO-END DEEP LEARNING MODEL IN THE TASK
OF DIFFERENTIATING PURE GROUND-GLASS NODULES ON CHEST CT
* Takuma Usuzaki
First published:August 2, 2023
https://doi.org/10.2214/AJR.23.30002
* FULL TEXT
* PDF
* ViewpointEvidence Synthesis and Decision Analysis
HOW SYSTEMATIC REVIEW CAN SHAPE CLINICAL PRACTICE IN RADIOLOGY
* Tae-Hyung Kim and
* Sungmin Woo
First published:July 26, 2023
https://doi.org/10.2214/AJR.23.29603
Preview Abstract
Systematic reviews offer radiologists a comprehensive synthesis of all
relevant evidence pertaining to a specific question, aiding them in shaping
their clinical practices. It is crucial for radiologists to familiarize
themselves with the methods used in systematic reviews and meta-analyses and
to understand the limitations. By doing so, they can effectively appraise and
interpret results, enabling them to make informed decisions based on the
evidence provided in systematic reviews and meta-analyses.
* ABSTRACT
* FULL TEXT
* PDF
* Free Access
AJR Global
CME Credit
Podcast
Visual Abstract
Original ResearchBreast Imaging
SCREENING IN PATIENTS WITH DENSE BREASTS: COMPARISON OF MAMMOGRAPHY,
ARTIFICIAL INTELLIGENCE, AND SUPPLEMENTARY ULTRASOUND
* Si Eun Lee,
* Jung Hyun Yoon,
* Nak-Hoon Son,
* Kyunghwa Han, and
* Hee Jung Moon
First published:July 26, 2023
https://doi.org/10.2214/AJR.23.29655
Preview Abstract
BACKGROUND. Screening mammography has decreased performance in patients with
dense breasts. Supplementary screening ultrasound is a recommended option in
such patients, although it has yielded mixed results in prior investigations.
OBJECTIVE. The purpose of this article is to compare the performance
characteristics of screening mammography alone, standalone artificial
intelligence (AI), ultrasound alone, and mammography in combination with AI
and/or ultrasound in patients with dense breasts.
METHODS. This retrospective study included 1325 women (mean age, 53 years)
with dense breasts who underwent both screening mammography and supplementary
breast ultrasound within a 1-month interval from January 2017 to December
2017; prior mammography and prior ultrasound examinations were available for
comparison in 91.2% and 91.8%, respectively. Mammography and ultrasound
examinations were interpreted by one of 15 radiologists (five staff; 10
fellows); clinical reports were used for the present analysis. A commercial
AI tool was used to retrospectively evaluate mammographic examinations for
presence of cancer. Screening performances were compared among mammography,
AI, ultrasound, and test combinations, using generalized estimating
equations. Benign diagnoses required 24 months or longer of imaging
stability.
RESULTS. Twelve cancers (six invasive ductal carcinoma; six ductal carcinoma
in situ) were diagnosed. Mammography, standalone AI, and ultrasound showed
cancer detection rates (per 1000 patients) of 6.0, 6.8, and 6.0 (all p >
.05); recall rates of 4.4%, 11.9%, and 9.2% (all p < .05); sensitivity of
66.7%, 75.0%, and 66.7% (all p > .05); specificity of 96.2%, 88.7%, and 91.3%
(all p < .05); and accuracy of 95.9%, 88.5%, and 91.1% (all p < .05).
Mammography with AI, mammography with ultrasound, and mammography with both
ultrasound and AI showed cancer detection rates of 7.5, 9.1, and 9.1 (all p >
.05); recall rates of 14.9, 11.7, and 21.4 (all p < .05); sensitivity of
83.3%, 100.0%, and 100.0% (all p > .05); specificity of 85.8%, 89.1%, and
79.4% (all p < .05); and accuracy of 85.7%, 89.2%, and 79.5% (all p < .05).
CONCLUSION. Mammography with supplementary ultrasound showed higher accuracy,
higher specificity, and lower recall rate in comparison with mammography with
AI and in comparison with mammography with both ultrasound and AI.
CLINICAL IMPACT. The findings fail to show benefit of AI with respect to
screening mammography performed with supplementary breast ultrasound in
patients with dense breasts.
* ABSTRACT
* FULL TEXT
* PDF
* Free Access
AJR Global
CME Credit
Podcast
Original ResearchCardiothoracic Imaging
LUNG-PNET: AN AUTOMATED DEEP LEARNING MODEL FOR THE DIAGNOSIS OF INVASIVE
ADENOCARCINOMA IN PURE GROUND-GLASS NODULES ON CHEST CT
* Kang Qi,
* Kexin Wang,
* Xiaoying Wang,
* Yu-Dong Zhang,
* Gang Lin,
* Xining Zhang,
* Haibo Liu,
* Weiming Huang,
* Jingyun Wu,
* Kai Zhao,
* Jing Liu,
* Jian Li, and
* Xiaodong Zhang
First published:July 26, 2023
https://doi.org/10.2214/AJR.23.29674
Preview Abstract
BACKGROUND. Pure ground-glass nodules (pGGNs) on chest CT representing
invasive adenocarcinoma (IAC) warrant lobectomy with lymph node resection.
For pGGNs representing other entities, close follow-up or sublobar resection
without node dissection may be appropriate.
OBJECTIVE. The purpose of this study was to develop and validate an automated
deep learning model for differentiation of pGGNs on chest CT representing IAC
from those representing atypical adenomatous hyperplasia (AAH),
adenocarcinoma in situ (AIS), and minimally invasive adenocarcinoma (MIA).
METHODS. This retrospective study included 402 patients (283 women, 119 men;
mean age, 53.2 years) with a total of 448 pGGNs on noncontrast chest CT that
were resected from January 2019 to June 2022 and were histologically
diagnosed as AAH (n = 29), AIS (n = 83), MIA (n = 235), or IAC (n = 101).
Lung-PNet, a 3D deep learning model, was developed for automatic segmentation
and classification (probability of IAC vs other entities) of pGGNs on CT.
Nodules resected from January 2019 to December 2021 were randomly allocated
to training (n = 327) and internal test (n = 82) sets. Nodules resected from
January 2022 to June 2022 formed a holdout test set (n = 39). Segmentation
performance was assessed with Dice coefficients with radiologists' manual
segmentations as reference. Classification performance was assessed by ROC
AUC and precision-recall AUC (PR AUC) and compared with that of four readers
(three radiologists, one surgeon). The code used is publicly available
(https://github.com/XiaodongZhang-PKUFH/Lung-PNet.git).
RESULTS. In the holdout test set, Dice coefficients for segmentation of IACs
and of other lesions were 0.860 and 0.838, and ROC AUC and PR AUC for
classification as IAC were 0.911 and 0.842. At threshold probability of 50.0%
or greater for prediction of IAC, Lung-PNet had sensitivity, specificity,
accuracy, and F1 score of 50.0%, 92.0%, 76.9%, and 60.9% in the holdout test
set. In the holdout test set, accuracy and F1 score (p values vs Lung-PNet)
for individual readers were as follows: reader 1, 51.3% (p = .02) and 48.6%
(p = .008); reader 2, 79.5% (p = .75) and 75.0% (p = .10); reader 3, 66.7% (p
= .35) and 68.3% (p < .001); reader 4, 71.8% (p = .48) and 42.1% (p = .18).
CONCLUSION. Lung-PNet had robust performance for segmenting and classifying
(IAC vs other entities) pGGNs on chest CT.
CLINICAL IMPACT. This automated deep learning tool may help guide selection
of surgical strategies for pGGN management.
* ABSTRACT
* FULL TEXT
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* Free Access
Editorial CommentGastrointestinal Imaging
EDITORIAL COMMENT: HEPATIC STEATOSIS—CONTRAST-ENHANCED CT IS A LEADING MARK
* Takamichi Murakami
First published:July 26, 2023
https://doi.org/10.2214/AJR.23.29953
* FULL TEXT
* PDF
* Free Access
Editorial CommentNeuroradiology/Head and Neck Imaging
EDITORIAL COMMENT: PREDICTION OF CEREBRAL ISCHEMIA AFTER ANEURYSMAL
SUBARACHNOID HEMORRHAGE BY CT PERFUSION IMAGING ON ADMISSION
* Kazuhiro Tsuchiya
First published:July 26, 2023
https://doi.org/10.2214/AJR.23.29956
* FULL TEXT
* PDF
* Free Access
AJR Global
CME Credit
Original ResearchNeuroradiology/Head and Neck Imaging
MACHINE LEARNING USING PRESENTATION CT PERFUSION IMAGING FOR PREDICTING
CLINICAL OUTCOMES IN PATIENTS WITH ANEURYSMAL SUBARACHNOID HEMORRHAGE
* Pengzhan Yin,
* Jiaqi Wang,
* Chao Zhang,
* Jinlong Yuan,
* Mingquan Ye, and
* Yunfeng Zhou
First published:July 19, 2023
https://doi.org/10.2214/AJR.23.29579
Preview Abstract
BACKGROUND. Prediction of outcomes in patients with aneurysmal subarachnoid
hemorrhage (aSAH) is challenging using current clinical predictors.
OBJECTIVE. The purpose of our study was to evaluate the utility of machine
learning (ML) models incorporating presentation clinical and CT perfusion
imaging (CTP) data in predicting delayed cerebral ischemia (DCI) and poor
functional outcome in patients with aSAH.
METHODS. This study entailed retrospective analysis of data from 242 patients
(mean age, 60.9 ± 11.8 [SD] years; 165 women, 77 men) with aSAH who, as part
of a prospective trial, underwent CTP followed by standardized evaluation for
DCI during initial hospitalization and poor 3-month functional outcome (i.e.,
modified Rankin scale score ≥ 4). Patients were randomly divided into
training (n = 194) and test (n = 48) sets. Five ML models (k-nearest neighbor
[KNN], logistic regression [LR], support vector machine [SVM], random forest
[RF], and category boosting [CatBoost]) were developed for predicting
outcomes using presentation clinical and CTP data. The least absolute
shrinkage and selection operator method was used for feature selection.
Ten-fold cross-validation was performed in the training set. Traditional
clinical models were developed using stepwise LR analysis of clinical, but
not CTP, data.
RESULTS. Qualitative CTP analysis was identified as the most impactful
feature for both outcomes. In the test set, the traditional clinical model,
KNN, LR, SVM, RF, and CatBoost showed AUC for predicting DCI of 0.771, 0.812,
0.824, 0.908, 0.930, and 0.949, respectively, and AUC for predicting poor
3-month functional outcome of 0.863, 0.858, 0.879, 0.908, 0.926, and 0.958.
CatBoost was selected as the optimal model. In the test set, AUC was higher
for CatBoost than for the traditional clinical model for predicting DCI (p =
.004) and poor 3-month functional outcome (p = .04). In the test set,
sensitivity and specificity for predicting DCI were 92.3% and 60.0% for the
traditional clinical model versus 92.3% and 85.7% for CatBoost, and
sensitivity and specificity for predicting poor 3-month functional outcome
were 100.0% and 65.8% for the traditional clinical model versus 90.0% and
94.7% for CatBoost. A web-based prediction tool based on CatBoost was
created.
CONCLUSION. ML models incorporating presentation clinical and CTP data
outperformed traditional clinical models in predicting DCI and poor 3-month
functional outcome.
CLINICAL IMPACT. ML models may help guide early management of patients with
aSAH.
* ABSTRACT
* FULL TEXT
* PDF
* CME Credit
Visual Abstract
Original ResearchGastrointestinal Imaging
DETECTION OF MODERATE HEPATIC STEATOSIS ON PORTAL VENOUS PHASE
CONTRAST-ENHANCED CT: EVALUATION USING AN AUTOMATED ARTIFICIAL INTELLIGENCE
TOOL
* Perry J. Pickhardt,
* Glen M. Blake,
* Yotam Kimmel,
* Esther Weinstock,
* Keren Shaanan,
* Shiri Hassid,
* Ahmad Abbas, and
* Matthew A. Fox
First published:July 19, 2023
https://doi.org/10.2214/AJR.23.29651
Preview Abstract
BACKGROUND. Precontrast CT is an established means of evaluating for hepatic
steatosis; postcontrast CT has historically been limited for this purpose.
OBJECTIVE. The purpose of this study was to evaluate the diagnostic
performance of portal venous phase postcontrast CT in detecting at least
moderate hepatic steatosis using liver and spleen attenuation measurements
determined by an automated artificial intelligence (AI) tool.
METHODS. This retrospective study included 2917 patients (1381 men, 1536
women; mean age, 56.8 years) who underwent a CT examination that included at
least two series through the liver. Examinations were obtained from an AI
vendor's data lake of data from 24 centers in one U.S. health care network
and 29 centers in one Israeli health care network. An automated deep learning
tool extracted liver and spleen attenuation measurements. The reference for
at least moderate steatosis was precontrast liver attenuation of less than 40
HU (i.e., estimated liver fat > 15%). A radiologist manually reviewed
examinations with outlier AI results to confirm portal venous timing and
identify issues impacting attenuation measurements.
RESULTS. After outlier review, analysis included 2777 patients with portal
venous phase images. Prevalence of at least moderate steatosis was 13.9%
(387/2777). Patients without and with at least moderate steatosis,
respectively, had mean postcontrast liver attenuation of 104.5 ± 18.1 (SD) HU
and 67.1 ± 18.6 HU (p < .001); a mean difference in postcontrast attenuation
between the liver and the spleen (hereafter, postcontrast liver-spleen
attenuation difference) of −7.6 ± 16.4 (SD) HU and −31.8 ± 20.3 HU (p <
.001); and mean liver enhancement of 49.3 ± 15.9 (SD) HU versus 38.6 ± 13.6
HU (p < .001). Diagnostic performance for the detection of at least moderate
steatosis was higher for postcontrast liver attenuation (AUC = 0.938) than
for the postcontrast liver-spleen attenuation difference (AUC = 0.832) (p <
.001). For detection of at least moderate steatosis, postcontrast liver
attenuation had sensitivity and specificity of 77.8% and 93.2%, respectively,
at less than 80 HU and 90.5% and 78.4%, respectively, at less than 90 HU; the
postcontrast liver-spleen attenuation difference had sensitivity and
specificity of 71.4% and 79.3%, respectively, at less than −20 HU and 87.0%
and 62.1%, respectively, at less than −10 HU.
CONCLUSION. Postcontrast liver attenuation outperformed the postcontrast
liver-spleen attenuation difference for detecting at least moderate steatosis
in a heterogeneous patient sample, as evaluated using an automated AI tool.
Splenic attenuation likely is not needed to assess for at least moderate
steatosis on postcontrast images.
CLINICAL IMPACT. The technique could promote early detection of clinically
significant nonalcoholic fatty liver disease through individualized or
large-scale opportunistic evaluation.
* ABSTRACT
* FULL TEXT
* PDF
* CME Credit
Original ResearchPolicy, Quality, and Practice Management
SOCIODEMOGRAPHIC FACTORS AND SCREENING CT COLONOGRAPHY USE AMONG MEDICARE
BENEFICIARIES
* Eric W. Christensen,
* Pina C. Sanelli,
* Elizabeth Y. Rula,
* Kevin J. Chang,
* Courtney C. Moreno,
* David H. Bruining, and
* Judy Yee
First published:July 19, 2023
https://doi.org/10.2214/AJR.23.29703
Preview Abstract
BACKGROUND. Approximately one-third of the eligible U.S. population have not
undergone guideline-compliant colorectal cancer (CRC) screening. Guidelines
recognize various screening strategies to increase adherence. CMS provides
coverage for all recommended screening tests except CT colonography (CTC).
OBJECTIVE. The purpose of this study was to compare CTC and other CRC
screening tests in terms of associations of utilization with income, race and
ethnicity, and urbanicity in Medicare fee-for-service beneficiaries.
METHODS. This retrospective study used CMS Research Identifiable Files from
January 1, 2011, through December 31, 2020. These files contain claims
information for 5% of Medicare fee-for-service beneficiaries. Data were
extracted for individuals 45–85 years old, and individuals with high CRC risk
were excluded. Multivariable logistic regression models were constructed to
determine the likelihood of undergoing CRC screening tests (as well as of
undergoing diagnostic CTC, a CMS-covered test with similar physical access as
screening CTC) as a function of income, race and ethnicity, and urbanicity
while controlling for sex, age, Charlson comorbidity index, U.S. census
region, screening year, and related conditions and procedures.
RESULTS. For 12,273,363 beneficiary years (mean age, 70.5 ± 8.2 [SD] years;
2,436,849 unique beneficiaries: 6,774,837 female beneficiaries, 5,498,526
male beneficiaries), there were 785,103 CRC screenings events, including 645
for screening CTC. Compared with individuals living in communities with per
capita income of less than USD25,000, individuals in communities with income
of USD100,000 or more had OR for undergoing screening CTC of 5.73, optical
colonoscopy (OC) of 1.36, sigmoidoscopy of 1.03, guaiac fecal occult blood
test or fecal immunochemical test of 1.50, stool DNA of 1.43, and diagnostic
CTC of 2.00. The OR for undergoing screening CTC was 1.00 for Hispanic
individuals and 1.08 for non-Hispanic Black individuals compared with
non-Hispanic White individuals. Compared with the OR for undergoing screening
CTC for residents of metropolitan areas, the OR was 0.51 for residents of
micropolitan areas and 0.65 for residents of small or rural areas.
CONCLUSION. The association with income was substantially larger for
screening CTC than for other CRC screening tests or for diagnostic CTC.
CLINICAL IMPACT. Medicare's noncoverage for screening CTC may contribute to
lower adherence with CRC screening guidelines for lower-income beneficiaries.
Medicare coverage of CTC could reduce income-based disparities for
individuals avoiding OC owing to invasiveness, need for anesthesia, or
complication risk.
* ABSTRACT
* FULL TEXT
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* Free Access
Editorial CommentGenitourinary Imaging
EDITORIAL COMMENT: MRI IMPROVES PREOPERATIVE PROGNOSIS PREDICTION IN PATIENTS
WITH PROSTATE CANCER
* Chen Jiang
First published:July 19, 2023
https://doi.org/10.2214/AJR.23.29909
* FULL TEXT
* PDF
* CME Credit
Original ResearchGenitourinary Imaging
SYNOPTIC REPORTING FOR PRETREATMENT CT EXAMINATION IN PATIENTS WITH ADVANCED
OVARIAN CANCER: IMPACT ON DOCUMENTATION OF DISEASE SITES AND PHYSICIAN
SATISFACTION
* Pamela Causa Andrieu,
* Ines Nikolovski,
* Krishna Juluru,
* Elizabeth Sadowski,
* Natalie Gangai,
* Junting Zheng,
* Marinela Capanu,
* Aaron M. Praiss,
* Stephanie Nougaret,
* Atul B. Shinagare,
* Weining Ma,
* Jean M. Torrisi,
* … View all authors
First published:July 12, 2023
https://doi.org/10.2214/AJR.23.29096
Preview Abstract
BACKGROUND. Imaging reports that consistently document all disease sites with
a potential to increase surgical complexity or morbidity can facilitate
ovarian cancer treatment planning.
OBJECTIVE. The aims of this study were to compare simple structured reports
and synoptic reports from pretreatment CT examinations in patients with
advanced ovarian cancer in terms of completeness of documenting involvement
of clinically relevant anatomic sites as well as to evaluate physician
satisfaction with synoptic reports.
METHODS. This retrospective study included 205 patients (median age, 65
years) who underwent contrast-enhanced abdominopelvic CT before primary
treatment of advanced ovarian cancer from June 1, 2018, to January 31, 2022.
A total of 128 reports generated on or before March 31, 2020, used a simple
structured report (free text organized into sections); 77 reports generated
on or after April 1, 2020, used a synoptic report (a list of 45 anatomic
sites relevant to ovarian cancer management, each of which was classified in
terms of disease absence versus presence). Reports were reviewed for
completeness of documentation of involvement of the 45 sites. For patients
who underwent neoadjuvant chemotherapy based on diagnostic laparoscopy
findings or underwent primary debulking surgery with suboptimal resection,
the EMR was reviewed to identify surgically established sites of disease that
were unresectable or challenging to resect. Gynecologic oncology surgeons
were electronically surveyed.
RESULTS. The mean report turnaround time was 29.8 minutes for simple
structured reports versus 54.5 minutes for synoptic reports (p < .001). A
mean of 17.6 of 45 sites (range, four to 43 sites) were mentioned by simple
structured reports versus 44.5 of 45 sites (range, 39–45) for synoptic
reports (p < .001). Forty-three patients had surgically established
unresectable or challenging-to-resect disease; involvement of anatomic
site(s) with such disease was mentioned in 37% (11/30) of simple structured
reports versus 100% (13/13) of synoptic reports (p < .001). All eight
surveyed gynecologic oncology surgeons completed the survey.
CONCLUSION. A synoptic report improved completeness of pretreatment CT
reports in patients with advanced ovarian cancer, including for established
sites of unresectable or challenging-to-resect disease.
CLINICAL IMPACT. The findings indicate the role of disease-specific synoptic
reports in facilitating referrer communication and potentially guiding
clinical decision-making.
* ABSTRACT
* FULL TEXT
* PDF
* Point/CounterpointInterventional Radiology
THE FUTURE OF INTERVENTIONAL RADIOLOGY: COUNTERPOINT—INTERVENTIONAL AND
DIAGNOSTIC RADIOLOGY WILL BE BETTER TOGETHER
* Adam D. Talenfeld and
* Robert J. Min
First published:July 12, 2023
https://doi.org/10.2214/AJR.23.29683
* FULL TEXT
* PDF
* Point/CounterpointInterventional Radiology
THE FUTURE OF INTERVENTIONAL RADIOLOGY: POINT—WHY INTERVENTIONAL RADIOLOGY
MUST BECOME A STAND-ALONE SPECIALTY
* Kavi K. Devulapalli and
* William H. Julien
First published:July 12, 2023
https://doi.org/10.2214/AJR.23.29815
* FULL TEXT
* PDF
* Free Access
CME Credit
Journal Club
Podcast
Original ResearchGenitourinary Imaging
COMPARISON OF MRI-BASED STAGING AND PATHOLOGIC STAGING FOR PREDICTING
BIOCHEMICAL RECURRENCE OF PROSTATE CANCER AFTER RADICAL PROSTATECTOMY
* Katie M. Merriman,
* Stephanie A. Harmon,
* Mason J. Belue,
* Enis C. Yilmaz,
* Zoë Blake,
* Nathan S. Lay,
* Tim E. Phelps,
* Maria J. Merino,
* Howard L. Parnes,
* Yan Mee Law,
* Sandeep Gurram,
* Bradford J. Wood,
* Peter L. Choyke,
* … View all authors
First published:July 5, 2023
https://doi.org/10.2214/AJR.23.29609
Preview Abstract
BACKGROUND. Currently most clinical models for predicting biochemical
recurrence (BCR) of prostate cancer (PCa) after radical prostatectomy (RP)
incorporate staging information from RP specimens, creating a gap in
preoperative risk assessment.
OBJECTIVE. The purpose of our study was to compare the utility of presurgical
staging information from MRI and postsurgical staging information from RP
pathology in predicting BCR in patients with PCa.
METHODS. This retrospective study included 604 patients (median age, 60
years) with PCa who underwent prostate MRI before RP from June 2007 to
December 2018. A single genitourinary radiologist assessed MRI examinations
for extraprostatic extension (EPE) and seminal vesicle invasion (SVI) during
clinical interpretations. The utility of EPE and SVI on MRI and RP pathology
for BCR prediction was assessed through Kaplan-Meier and Cox proportional
hazards analyses. Established clinical BCR prediction models, including the
University of California San Francisco Cancer of the Prostate Risk Assessment
(UCSF-CAPRA) model and the Cancer of the Prostate Risk Assessment
Postsurgical (CAPRA-S) model, were evaluated in a subset of 374 patients with
available Gleason grade groups from biopsy and RP pathology; two CAPRA-MRI
models (CAPRA-S model with modifications to replace RP pathologic staging
features with MRI staging features) were also assessed.
RESULTS. Univariable predictors of BCR included EPE on MRI (HR = 3.6), SVI on
MRI (HR = 4.4), EPE on RP pathology (HR = 5.0), and SVI on RP pathology (HR =
4.6) (all p < .001). Three-year BCR-free survival (RFS) rates for patients
without versus with EPE were 84% versus 59% for MRI and 89% versus 58% for RP
pathology, and 3-year RFS rates for patients without versus with SVI were 82%
versus 50% for MRI and 83% versus 54% for RP histology (all p < .001). For
patients with T3 disease on RP pathology, 3-year RFS rates were 67% and 41%
for patients without and with T3 disease on MRI. AUCs of CAPRA models,
including CAPRA-MRI models, ranged from 0.743 to 0.778. AUCs were not
significantly different between CAPRA-S and CAPRA-MRI models (p > .05). RFS
rates were significantly different between low- and intermediate-risk groups
for only CAPRA-MRI models (80% vs 51% and 74% vs 44%; both p < .001).
CONCLUSION. Presurgical MRI-based staging features perform comparably to
postsurgical pathologic staging features for predicting BCR.
CLINICAL IMPACT. MRI staging can preoperatively identify patients at high BCR
risk, helping to inform early clinical decision-making.
TRIAL REGISTRATION. ClinicalTrials.gov NCT00026884 and NCT02594202.
* ABSTRACT
* FULL TEXT
* PDF
* Free Access
AJR Global
CME Credit
Video
Original ResearchNeuroradiology / Head and Neck Imaging
CT WITH CTA VERSUS MRI IN PATIENTS PRESENTING TO THE EMERGENCY DEPARTMENT
WITH DIZZINESS: ANALYSIS USING PROPENSITY SCORE MATCHING
* Long H. Tu,
* Dhasakumar Navaratnam,
* Edward R. Melnick,
* Howard P. Forman,
* Arjun K. Venkatesh,
* Ajay Malhotra,
* Reza Yaesoubi,
* Soundari Sureshanand,
* Kevin N. Sheth, and
* Amit Mahajan
First published:July 5, 2023
https://doi.org/10.2214/AJR.23.29617
Preview Abstract
BACKGROUND. CT with CTA is widely used to exclude stroke in patients with
dizziness, although MRI has higher sensitivity.
OBJECTIVE. The purpose of this article was to compare patients presenting to
the emergency department (ED) with dizziness who undergo CT with CTA alone
versus those who undergo MRI in terms of stroke-related management and
outcomes.
METHODS. This retrospective study included 1917 patients (mean age, 59.5
years; 776 men, 1141 women) presenting to the ED with dizziness from January
1, 2018, to December 31, 2021. A first propensity score matching analysis
incorporated demographic characteristics, medical history, findings from the
review of systems, physical examination findings, and symptoms to construct
matched groups of patients discharged from the ED after undergoing head CT
with head and neck CTA alone and patients who underwent brain MRI (with or
without CT and CTA). Outcomes were compared. A second analysis compared
matched patients discharged after CT with CTA alone and patients who
underwent specialized abbreviated MRI using multiplanar high-resolution DWI
for increased sensitivity for posterior circulation stroke. Sensitivity
analyses were performed involving MRI examinations performed as the first or
only neuroimaging examination and involving alternative matching and
imputation techniques.
RESULTS. In the first analysis (406 patients per group), patients who
underwent MRI, compared with patients who underwent CT with CTA alone, showed
greater frequency of critical neuroimaging results (10.1% vs 4.7%, p = .005),
change in secondary stroke prevention medication (9.6% vs 3.2%, p = .001),
and subsequent echocardiography evaluation (6.4% vs 1.0%, p < .001). In the
second analysis (100 patients per group), patients who underwent specialized
abbreviated MRI, compared with patients who underwent CT with CTA alone,
showed greater frequency of critical neuroimaging results (10.0% vs 2.0%, p =
.04), change in secondary stroke prevention medication (14.0% vs 1.0%, p =
.001), and subsequent echocardiography evaluation (12.0% vs 2.0%, p = .01)
and lower frequency of 90-day ED readmissions (12.0% vs 28.0%, p = .008).
Sensitivity analyses showed qualitatively similar findings.
CONCLUSION. A proportion of patients discharged after CT with CTA alone may
have benefitted from alternative or additional evaluation by MRI (including
MRI using a specialized abbreviated protocol).
CLINICAL IMPACT. Use of MRI may motivate clinically impactful management
changes in patients presenting with dizziness.
* ABSTRACT
* FULL TEXT
* PDF
* Free Access
Editorial CommentNeuroradiology / Head and Neck Imaging
EDITORIAL COMMENT: PRACTICAL GUIDANCE FOR CLINICAL 7-T BRAIN MRI
* Jeffrey P. Guenette
First published:July 5, 2023
https://doi.org/10.2214/AJR.23.29843
* FULL TEXT
* PDF
* Free Access
CME Credit
Clinical PerspectiveNeuroradiology / Head and Neck Imaging
USE OF A COMMERCIAL 7-T MRI SCANNER FOR CLINICAL BRAIN IMAGING: INDICATIONS,
PROTOCOLS, CHALLENGES, AND SOLUTIONS—A SINGLE-CENTER EXPERIENCE
* Can Özütemiz,
* Matthew White,
* Wendy Elvendahl,
* Yigitcan Eryaman,
* Małgorzata Marjańska,
* Gregory J. Metzger,
* Rémi Patriat,
* Jeramy Kulesa,
* Noam Harel,
* Yoichi Watanabe,
* Andrea Grant,
* Guglielmo Genovese, and
* Zuzan Cayci
First published:June 28, 2023
https://doi.org/10.2214/AJR.23.29342
Preview Abstract
The first commercially available 7-T MRI scanner (Magnetom Terra) was
approved by the FDA in 2017 for clinical imaging of the brain and knee. After
initial protocol development and sequence optimization efforts in volunteers,
the 7-T system, in combination with an FDA-approved 1-channel
transmit/32-channel receive array head coil, can now be routinely used for
clinical brain MRI examinations. The ultrahigh field strength of 7-T MRI has
the advantages of improved spatial resolution, increased SNR, and increased
CNR but also introduces an array of new technical challenges. The purpose of
this article is to describe an institutional experience with the use of the
commercially available 7-T MRI scanner for routine clinical brain imaging.
Specific clinical indications for which 7-T MRI may be useful for brain
imaging include brain tumor evaluation with possible perfusion imaging and/or
spectroscopy, radiotherapy planning; evaluation of multiple sclerosis and
other demyelinating diseases, evaluation of Parkinson disease and guidance of
deep brain stimulator placement, high-detail intracranial MRA and vessel wall
imaging, evaluation of pituitary pathology, and evaluation of epilepsy.
Detailed protocols, including sequence parameters, for these various
indications are presented, and implementation challenges (including
artifacts, safety, and side effects) and potential solutions are explored.
* ABSTRACT
* FULL TEXT
* PDF
* CME Credit
Original ResearchNeuroradiology/Head and Neck Imaging
ASSOCIATION OF LACK OF SPEECH ARREST DURING CORTICAL STIMULATION WITH
INTERHEMISPHERIC REORGANIZATION OF THE FUNCTIONAL LANGUAGE NETWORK IN
PATIENTS WITH BRAIN TUMORS
* Luca Pasquini,
* Alice Tao,
* Gino Del Ferraro,
* Mehrnaz Jenabi,
* Kyung K. Peck,
* Antonio Napolitano,
* Tara A. Fahy,
* Cameron Brennan,
* Nelson S. Moss,
* Vivian Tabar,
* Hernan Makse, and
* Andrei I. Holodny
First published:June 28, 2023
https://doi.org/10.2214/AJR.23.29434
Preview Abstract
BACKGROUND. Brain tumors induce language reorganization, which may influence
the extent of resection in surgical planning. Direct cortical stimulation
(DCS) allows definitive language mapping during awake surgery by locating
areas of speech arrest (SA) surrounding the tumor. Although functional MRI
(fMRI) combined with graph theory analysis can illustrate whole-brain network
reorganization, few studies have corroborated these findings with DCS
intraoperative mapping and clinical language performance.
OBJECTIVE. We evaluated whether patients with low-grade gliomas (LGGs)
without SA during DCS show increased right-hemispheric connections and better
speech performance compared with patients with SA.
METHODS. We retrospectively recruited 44 consecutive patients with left
perisylvian LGG, preoperative language task–based fMRI, speech performance
evaluation, and awake surgery with DCS. We generated language networks from
ROIs corresponding to known language areas (i.e., language core) on fMRI
using optimal percolation. Language core connectivity in the left and right
hemispheres was quantified as fMRI laterality index (LI) and connectivity LI
on the basis of fMRI activation maps and connectivity matrices. We compared
fMRI LI and connectivity LI between patients with SA and without SA and used
multivariable logistic regression (p < .05) to assess associations between
DCS and connectivity LI, fMRI LI, tumor location, Broca area and Wernicke
area involvement, prior treatments, age, handedness, sex, tumor size, and
speech deficit before surgery, within 1 week after surgery, and 3–6 months
after surgery.
RESULTS. Patients with SA showed left-dominant connectivity; patients without
SA lateralized more to the right hemisphere (p < .001). Between patients with
SA and those without, fMRI LI was not significantly different. Patients
without SA showed right-greater-than-left connectivity of Broca area and
premotor area compared with patients with SA. Regression analysis showed
significant association between no SA and right-lateralized connectivity LI
(p < .001) and fewer speech deficits before (p < .001) and 1 week after (p =
.02) surgery.
CONCLUSION. Patients without SA had increased right-hemispheric connections
and right translocation of the language core, suggesting language
reorganization. Lack of interoperative SA was associated with fewer speech
deficits both before and immediately after surgery.
CLINICAL IMPACT. These findings support tumor-induced language plasticity as
a compensatory mechanism, which may lead to fewer postsurgical deficits and
allow extended resection.
* ABSTRACT
* FULL TEXT
* PDF
* Free Access
Editorial CommentCardiothoracic Imaging
EDITORIAL COMMENT: MRA MAY FINALLY BE READY TO BECOME A FIRST-LINE IMAGING
MODALITY FOR ASSESSMENT OF PULMONARY EMBOLISM
* Leonid Roshkovan
First published:June 28, 2023
https://doi.org/10.2214/AJR.23.29823
* FULL TEXT
* PDF
* AJR Global
CME Credit
Podcast
Original ResearchCardiothoracic Imaging
MRA AS THE PREFERRED TEST FOR PULMONARY EMBOLISM DURING THE IODINATED
CONTRAST MEDIA SHORTAGE OF 2022: A SINGLE-CENTER EXPERIENCE
* Jitka Starekova,
* Sheena Y. Chu,
* David A. Bluemke,
* Thomas M. Grist,
* Joanna E. Kusmirek,
* Scott K. Nagle,
* Mark L. Schiebler,
* Meghan G. Lubner,
* Prashant Nagpal, and
* Scott B. Reeder
First published:June 21, 2023
https://doi.org/10.2214/AJR.23.29340
Preview Abstract
BACKGROUND. Closure of a GE Healthcare facility in Shanghai, China, in 2022
disrupted the iodinated contrast media supply. Technologic advances have
addressed limitations associated with the use of pulmonary MRA for diagnosis
of pulmonary embolism (PE).
OBJECTIVE. The purpose of this study was to describe a single institution's
experience in the use of pulmonary MRA as an alternative to CTA for the
diagnosis of PE in the general population during the iodinated contrast media
shortage in 2022.
METHODS. This retrospective single-center study included all CTA and MRA
examinations performed to exclude PE from April 1 through July 31 (18 weekly
periods) in 2019 (before the COVID-19 pandemic and contrast media shortage),
2021 (during the pandemic but before the shortage), and 2022 (during both the
pandemic and the shortage). From early May through mid-July of 2022, MRA
served as the preferred test for PE diagnosis, to preserve iodinated contrast
media. CTA and MRA reports were reviewed. The total savings in iodinated
contrast media volume resulting from preferred use of MRA was estimated.
RESULTS. The study included 4491 examinations of 4006 patients (mean age, 57
± 18 [SD] years; 1715 men, 2291 women): 1245 examinations (1111 CTA, 134 MRA)
in 2019, 1547 examinations (1403 CTA, 144 MRA) in 2021, and 1699 examinations
(1282 CTA, 417 MRA) in 2022. In 2022, the number of MRA examinations was four
(nine when normalized to a 7-day period) in week 1, and this number increased
to a maximum of 63 in week 10 and then decreased to 10 in week 18. During
weeks 8–11, more MRA examinations (range, 45–63 examinations) than CTA
examinations (range, 27–46 examinations) were performed. In 2022, seven
patients with negative MRA underwent subsequent CTA within 2 weeks; CTA was
negative in all cases. In 2022, 13.9% of CTA examinations (vs 10.3% of MRA
examinations) were reported as having limited image quality. The estimated
4-month savings resulting from preferred use of MRA in 2022, under the
assumption of uniform simple linear growth in CTA utilization annually and a
CTA dose of 1 mL/kg, was 27 L of iohexol (350 mg I/mL).
CONCLUSION. Preferred use of pulmonary MRA for PE diagnosis in the general
population helped to conserve iodinated contrast media during the 2022
shortage.
CLINICAL IMPACT. This single-center experience shows pulmonary MRA to be a
practical substitute for pulmonary CTA in emergency settings.
* ABSTRACT
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CME Credit
AJR Expert Panel Narrative ReviewPolicy, Quality, and Practice Management
FOSTERING PATIENT-CENTERED EQUITABLE CARE IN RADIOLOGY: AJR EXPERT PANEL
NARRATIVE REVIEW
* Anand K. Narayan,
* Randy C. Miles,
* Arissa Milton,
* Gloria Salazar,
* Lucy B. Spalluto,
* Kemi Babagbemi,
* Justin T. Stowell,
* Efren J. Flores,
* Farouk Dako, and
* Ian A. Weissman
First published:May 31, 2023
https://doi.org/10.2214/AJR.23.29261
Preview Abstract
Patient-centered care (PCC) and equity are two of the six core domains of
quality health care, according to the Institute of Medicine. Exceptional
imaging care requires radiology practices to provide patient-centered (i.e.,
respectful and responsive to individual patient preferences, needs, and
values) and equitable (i.e., does not vary in quality on the basis of gender,
ethnicity, geographic location, or socioeconomic status) care. Specific
barriers that prevent the delivery of patient-centered equitable care include
information gaps, breaches of trust, organizational medical culture, and
financial incentives. Information gaps limit practitioners in understanding
the lived experience of patients. Breaches of trust prevent patients from
seeking needed medical care. Organizational medical cultures may not be
centered around patient experiences. Financial incentives can impede
practitioners' ability to spend the time and resources required to meet
patient goals and needs. Intentional approaches that integrate core
principles in both PCC and health equity are required to deliver high-quality
patient-centered imaging care for diverse patient populations. The purpose of
this AJR Expert Panel Narrative Review is to review the origins of the PCC
movement in radiology, characterize connections between the PCC and health
equity movements, and describe concrete examples of ways to foster
patient-centered equitable care in radiology.
* ABSTRACT
* FULL TEXT
* PDF
* Beyond the AJRBreast Imaging
BEYOND THE AJR: PATIENT KNOWLEDGE ABOUT THE RISK OF DENSE BREASTS IS LACKING
* Lars J. Grimm
First published:May 3, 2023
https://doi.org/10.2214/AJR.23.29537
* FULL TEXT
* PDF
* Beyond the AJRGastrointestinal Imaging
BEYOND THE AJR: ARTIFICIAL INTELLIGENCE HELPS RADIOLOGISTS TO IMPROVE THEIR
PERFORMANCE IN DIFFERENTIATING COLON CARCINOMA FROM ACUTE DIVERTICULITIS ON
CT
* Teodoro Martín-Noguerol and
* Antonio Luna
First published:April 19, 2023
https://doi.org/10.2214/AJR.23.29466
* FULL TEXT
* PDF
* Beyond the AJRBreast Imaging
BEYOND THE AJR: SUPPLEMENTAL ULTRASOUND SCREENING COMPLEMENTS DIGITAL BREAST
TOMOSYNTHESIS IN CANCER DETECTION
* Ellen B. Mendelson
First published:April 5, 2023
https://doi.org/10.2214/AJR.23.29364
* FULL TEXT
* PDF
* Global Reading RoomCardiothoracic Imaging
THE GLOBAL READING ROOM: INCIDENTAL LUNG NODULES ON ABDOMINOPELVIC CT
* Eva Castañer,
* Joanna G. Escalon,
* Christian J. Herold, and
* Yung-Liang Wan
First published:March 8, 2023
https://doi.org/10.2214/AJR.23.29220
* FULL TEXT
* PDF
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