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Vertebral artery duplication and aneurysms: 64-slice multidetector CT findings

A rare case of combined soft-tissue and intraosseous arteriovenous malformation of the hand with diffuse periosteal elevation: imaging appearances

Intractable bronchopleural fistula caused by radiofrequency ablation: endoscopic bronchial occlusion with silicone embolic material

Absence of uterine arteries discovered at fibroid embolisation

Chordoma masquerading as a nerve root tumour a clinical lesson

CT appearance of persistent left superior vena cava, anomalous right superior pulmonary venous return into the right-sided superior vena cava and a sinus venosus-type atrial septal defect

Characteristics of in vivo radiotherapy dosimetry

Joint symposium 2009 on carbon ion radiotherapy

A description of CT features of Clostridium difficile infection of the small bowel in four patients and a review of literature

Conventional MRI and magnetisation transfer imaging of the brain and optic pathway in primary open-angle glaucoma

Gastric bezoars: reassessment of clinical and radiographic findings in 19 patients

Percutaneous radiofrequency ablation of small hepatocellular carcinoma invisible on both ultrasonography and unenhanced CT: a preliminary study of combined treatment with transarterial chemoembolisation

Warthins tumour: a retrospective case series

Reduction of dose to the female breast as a result of spectral optimisation for high-contrast thoracic CT imaging: a phantom study

Therapeutic effect of balloon-occluded retrograde transvenous obliteration for gastric varices in relation to haemodynamics in the short gastric vein

Optimisation techniques in vaginal cuff brachytherapy

Implantation of fiducial markers for image guidance in prostate radiotherapy: patient-reported toxicity

Personnel radiation dose considerations in the use of an integrated PETCT scanner for radiotherapy treatment planning

Thorax set-up verification with multiple oblique treatment portal images

Brain: non-infective and non-neoplastic manifestations of HIV

Persistent scrotal lesion

Acute Knee Dislocation: Review of an Elusive Entity

Publication year: 2009Source: Current Problems in Diagnostic Radiology, Volume 38, Issue 6, November-December 2009, Pages 237-250Sangita, Kapur , Robert D., Wissman , Michael, Robertson , Sadhna, Verma , Michael C., Kreeger , ...The knee consists of three articulations: the patellofemoral, the tibiofemoral, and the proximal tibiofibular joint. Any of these joints can dislocate. Dislocations are uncommon, tend to spontaneously reduce, and can be difficult to detect on clinical examination. There are, however, telltale imaging features and the radiologist may be the first to suggest the correct diagnosis. A timely diagnosis is important as some forms are associated with limb-threatening complications. Lateral patellofemoral dislocation, in the acute setting, is typically an injury of young athletes and usually spontaneously reduces at the time of trauma. In transient lateral dislocation, contusions may be seen in...

Multidetector Computed Tomography Findings of Dense Pulmonary Emboli in Oncologic Patients

Publication year: 2009Source: Current Problems in Diagnostic Radiology, Volume 38, Issue 6, November-December 2009, Pages 251-263Alberto, Villanueva , Maria Lourdes, Díaz , Armando, Sánchez , Eva, Castañer , Gorka, Bastarrika , ...Pulmonary embolism is a frequent condition for which multidetector computed tomography (MDCT) plays an important role in its detection. Occasionally, on MDCT studies, dense linear branching opacities may be found within the pulmonary vessels. They represent dense emboli within the pulmonary arteries (DEPA). These may occur in oncologic patients that undergo specific treatments or interventional procedures, such as cement embolus from vertebroplasty, catheter or coil migration after embolization procedures, radioactive seed embolus in patients treated with local brachytherapy for prostate, lung, or liver cancer, and also in chronic pulmonary embolism. Usually DEPA does not have any clinical significance but may...

Computed Tomographic Appearances of Hepatic Vascular Lesions

Publication year: 2009Source: Current Problems in Diagnostic Radiology, Volume 38, Issue 6, November-December 2009, Pages 264-273Lye Quen, Hon , Arul, Ganeshan , Sarfraz, Nazir , Sara, Upponi , Helen, Bungay , ...Improvements in Imaging technology have revolutionized liver imaging and allowed the recognition of abnormalities arising from various architectural components such as vessels and biliary ducts of the liver. A spectrum of various hepatic vascular disorders as demonstrated by multidetector CT (MDCT) is presented in this review article.

Upcoming Articles

Publication year: 2009Source: Current Problems in Diagnostic Radiology, Volume 38, Issue 6, November-December 2009, Page IBC[No author name available]

In Recent Issues

Publication year: 2009Source: Current Problems in Diagnostic Radiology, Volume 38, Issue 6, November-December 2009, Page OBC[No author name available]

Hysterosalpingography: Technique and Applications

Publication year: 2009Source: Current Problems in Diagnostic Radiology, Volume 38, Issue 5, September-October 2009, Pages 199-205Athanasios, Chalazonitis , Ioanna, Tzovara , Fotios, Laspas , Petros, Porfyridis , Nikos, Ptohis , ...Hysterosalpingography (HSG) remains an important radiologic procedure in the investigation of infertility and has become a commonly performed examination due to recent advances of reproductive medicine. HSG demonstrates the morphology of the uterine cavity, the lumina, and the patency of the fallopian tubes. In this review article, we present the technical parameters of the examination, indications, contraindications, and possible complications of HSG. We also illustrate a variety of abnormalities of the uterus and fallopian tubes that can be detected accurately with HSG. We believe that, with the increased demand for HSG, radiologists should be familiar with HSG technique and the...

Non-Electrocardiogram-Gated Multidetector-Row Computed Tomography Findings of Cardiac Pathology in Oncologic Patients

Publication year: 2009Source: Current Problems in Diagnostic Radiology, Volume 38, Issue 5, September-October 2009, Pages 206-217Maria Lourdes, Díaz , Alberto, Villanueva , Gorka, Bastarrika , Beatriz, Zudaire , Loreto García, del Barrio , ...Multidetector-row computed tomography (MDCT) plays an essential role in oncologic imaging as the modality of mapping out the treatment strategy at staging, assessing response to the treatment, and following up patient outcome after the treatment. Even without electrocardiogram gating, MDCT provides accurate information about the heart. In the group of oncologic patients, different tumoral and non-tumoral-related heart disorders can be found, for example, metastatic cardiac involvement (approximately 10% of patients with lung or breast cancer will develop metastases to the heart), paraneoplastic cardiac disorders, non-tumor-related heart disorders, and chemotherapy- and radiotherapy-related cardiac side effects. MDCT plays a role in the...

Pediatric Cranial Doppler Sonography in Children: Non-Sickle Cell Applications

Publication year: 2009Source: Current Problems in Diagnostic Radiology, Volume 38, Issue 5, September-October 2009, Pages 218-227Amy M., Soetaert , Lisa H., Lowe , Christopher, FormenThis article presents an overview of transcranial Doppler, well known for its use as a screening tool in children with sickle cell disease. However, there are many other pediatric applications in which cranial Doppler ultrasound can supply otherwise unavailable information regarding neurovascular flow dynamics. Images illustrate examples of normal anatomy and pathologic conditions that can be evaluated with cranial Doppler ultrasound. Characteristic imaging features of various pediatric applications of cranial Doppler ultrasound are discussed and illustrated. This image presentation discusses cranial Doppler ultrasound technique and normal findings and illustrates various pediatric disorders including benign enlargement of the subarachnoid space versus...

Radiological Manifestations of Skeletal Lymphoma

Publication year: 2009Source: Current Problems in Diagnostic Radiology, Volume 38, Issue 5, September-October 2009, Pages 228-236John, O'Neill , Karen, Finlay , Eric, Jurriaans , Lawrence, FriedmanLymphoreticular neoplasms primarily arise in extraskeletal locations with skeletal involvement usually secondary to hematogenous spread or by direct invasion from surrounding involved lymph nodes or soft tissues. Primary lymphoma of bone is relatively rare in comparison. Lymphoma encompasses Hodgkin's and non-Hodgkin's disease, Burkitt's lymphoma, and mycosis fungoides. Skeletal disease may present with symptoms localized to the site of bone involvement, as an incidental finding on imaging for other reasons, or as part of the staging of the disease. It is important that the radiologist is cognizant of the many presentations of skeletal lymphoma. We present a review of the radiological...

Upcoming Articles

Publication year: 2009Source: Current Problems in Diagnostic Radiology, Volume 38, Issue 5, September-October 2009, Page IBC[No author name available]

In Recent Issues

Publication year: 2009Source: Current Problems in Diagnostic Radiology, Volume 38, Issue 5, September-October 2009, Page OBC[No author name available]

Multidetector Computed Tomography of the Acute Abdomen in the Immunocompromised Host: A Pictorial Review

Publication year: 2009Source: Current Problems in Diagnostic Radiology, Volume 38, Issue 4, July-August 2009, Pages 145-155Simon P., Spencer , Niall, Power , Rodney H., ReznekImmunocompromised patients include those receiving chemotherapy for malignant disease, post-transplant patients, patients with acquired immunodeficiency syndrome (AIDS), and those receiving steroids for autoimmune diseases. Advances in transplantation, oncology, and the treatment of AIDS have extended these patients' life expectancies and thereby increased the immunocompromised population. Classical clinical signs of abdominal sepsis may be absent in the immunocompromised host. Consequently, the radiologist is increasingly called on to diagnose specific acute intra-abdominal complications associated with immunodeficiency. This review describes the etiology of the acute abdomen in this heterogeneous group of immunocompromised patients, causes including opportunistic infections, neutropenic enterocolitis, complications of therapy, and...

Positron Emission Tomography/Computed Tomography Potential Pitfalls and Artifacts

Publication year: 2009Source: Current Problems in Diagnostic Radiology, Volume 38, Issue 4, July-August 2009, Pages 156-169Xia, Wang , Spencer, KochWith the recent use of 18-fluoro-2-deoxyglucose (FDG) positron emission tomography (PET) for tumor staging and treatment response, it is important to recognize many pitfalls, artifacts, and benign uptakes that are commonly encountered. Normal physiology can explain many regions of increased FDG activity, as well as incidental benign tumors and benign metabolic conditions. Recognition of characterization of benign causes and physiologic variants for FDG uptake are discussed to avoid improper characterization as a malignancy. A basic understanding of PET/computed tomographic physics is also discussed, in relation to attenuation correction artifacts caused by metallic implants and contrast agents in the gastrointestinal tract,...

Diagnosis and Management of Pseudoaneurysms: An Update

Publication year: 2009Source: Current Problems in Diagnostic Radiology, Volume 38, Issue 4, July-August 2009, Pages 170-188Baljendra S., Kapoor , Heather L., Haddad , Souheil, Saddekni , Mark E., Lockhart“Pseudoaneurysm” is a term that describes disruption of an artery with patent flow in a defined space beyond the confines of the vessels. A pseudoaneurysm can involve any vascular bed and is usually associated with direct arterial injury or erosion of an artery by an adjacent tumor or inflammation. In this article, we discuss different clinical settings and various imaging modalities such as ultrasound, computerized tomography, magnetic resonance imaging, as well as conventional angiography used for the diagnosis of pseudoaneurysms. We also describe the role of newer endovascular, percutaneous, and traditional surgical approaches for the treatment of visceral and peripheral...

The Great Mimicker: Fat Necrosis of the Breast—Magnetic Resonance Mammography Approach

Publication year: 2009Source: Current Problems in Diagnostic Radiology, Volume 38, Issue 4, July-August 2009, Pages 189-197Sergi, Ganau , Lidia, Tortajada , Fernanda, Escribano , Xavier, Andreu , Melcior, SentísFat necrosis of the breast is a common benign inflammatory process resulting from injury to breast fat. The pathogenesis of fat necrosis helps to explain its imaging features, which range from benign to malignant-appearing findings. This article reviews the role of magnetic resonance mammography and other conventional imaging techniques in the differential diagnosis of fat necrosis.

Upcoming Articles

Publication year: 2009Source: Current Problems in Diagnostic Radiology, Volume 38, Issue 4, July-August 2009, Page IBC[No author name available]

In Recent Issues

Publication year: 2009Source: Current Problems in Diagnostic Radiology, Volume 38, Issue 4, July-August 2009, Page OBC[No author name available]

Computed Tomographic Appearance of Chest Ports and Catheters: A Pictorial Review for Noninterventional Radiologists

Publication year: 2009Source: Current Problems in Diagnostic Radiology, Volume 38, Issue 3, May-June 2009, Pages 99-110Maria Lourdes, Díaz , Alberto, Villanueva , Maria Jose, Herraiz , Jose Juan, Noguera , Alberto, Alonso-Burgos , ...Medical practice has expanded the need for long-term central venous catheterization. Chest ports play an important role in the management of oncology patients who need frequent blood products, chemotherapy, and other intravenous drugs. Imaging-guided placement of chest ports and catheters (CR) is a safe and efficacious procedure. Moreover, many cases of catheter-induced central thrombosis go unrecognized, but the incidence of pulmonary embolism in this group may be as high as 12%. Multi-detector computed tomography represents the main imaging method in the follow-up of oncologic patients. We review the radiologic features, mainly on multi-detector computed tomography, of CR commonly used for...

Ultrasound of Wrist Pain

Publication year: 2009Source: Current Problems in Diagnostic Radiology, Volume 38, Issue 3, May-June 2009, Pages 111-125Srinivasan, Harish , John, O'Neill , Karen, Finlay , Erik, Jurriaans , Lawrence, FriedmanUltrasound is a valuable imaging modality for evaluation of patients presenting with wrist pain. An important advantage is the ability to correlate the site of pain or discomfort with the underlying sonographic appearance. The capacity to dynamically assess the wrist and use the contralateral asymptomatic wrist for comparison purposes are strengths of ultrasound as a diagnostic tool. This pictorial review deals with the sonographic assessment of the commonly encountered wrist pathologies.

Magnetic Resonance Imaging of the Liver and Biliary Tree in Children

Publication year: 2009Source: Current Problems in Diagnostic Radiology, Volume 38, Issue 3, May-June 2009, Pages 126-134Pedro A.B., Albuquerque , D. Alicia, Morales Ramos , Ricardo, FaingoldMagnetic resonance imaging (MRI) is a great modality for the assessment of the liver and biliary tree in the pediatric population. In this review, we illustrate and discuss MRI technique and a variety of congenital abnormalities and acquired conditions including infectious, inflammatory, metabolic, benign, and malignant processes. The role of magnetic resonance angiography and magnetic resonance venography is discussed in hepatic tumors and portal hypertension. Magnetic resonance cholangiopancreatography protocol is also addressed. Although ultrasound remains a screening tool and computer tomography is readily available, MRI accurately depicts the pathology, leading to a better understanding of the disease process with optimal...

Radiofrequency and Microwave Ablation of the Liver, Lung, Kidney, and Bone: What Are the Differences?

Publication year: 2009Source: Current Problems in Diagnostic Radiology, Volume 38, Issue 3, May-June 2009, Pages 135-143Christopher L., BraceRadiofrequency (RF) ablation is becoming an accepted treatment modality for many tumors of the liver and is being explored for tumors in the lung, kidney, and bone. While RF energy is the most familiar heat source for tissue ablation, it has certain limitations that may hamper its efficacy in these new organ systems. Microwave energy may be a better source for tissue ablation but has technical hurdles that must be overcome as well. This article outlines the physics behind RF and microwave heating, discusses relevant properties of the liver, lung, kidney, and bone for thermal ablation and examines the roles...

Upcoming Articles

Publication year: 2009Source: Current Problems in Diagnostic Radiology, Volume 38, Issue 3, May-June 2009, Page IBC[No author name available]

In Recent Issues

Publication year: 2009Source: Current Problems in Diagnostic Radiology, Volume 38, Issue 3, May-June 2009, Page OBC[No author name available]

Technical Essentials of Hepatic Doppler Sonography

Publication year: 2009Source: Current Problems in Diagnostic Radiology, Volume 38, Issue 2, March-April 2009, Pages 53-60Min Ju, Kim , Kyoung Won, Kim , So Yeon, Kim , Jeong Kon, Kim , Hyung Jin, Won , ...Doppler ultrasound is an important diagnostic tool for detecting hepatic vascular abnormalities, especially following liver transplantation. Doppler ultrasound has an advantage over computed tomography or other imaging modalities in that it is noninvasive, can be used intraoperatively or immediately postoperatively at the patient's bedside, and is free from radiation hazard. Doppler ultrasound is also sensitive to very slow flow and is not limited by an optimal temporal window because it is a real-time examination. However, this examination is highly operator-dependent. For a proper evaluation of patient hemodynamic status, optimization of Doppler parameters and liberal use of spectral analysis will help...

Microwave Ablation Technology: What Every User Should Know

Publication year: 2009Source: Current Problems in Diagnostic Radiology, Volume 38, Issue 2, March-April 2009, Pages 61-67Christopher L., BraceMicrowave ablation is a relatively new technology under development and testing to treat the same types of cancer that can be treated with radiofrequency ablation. Microwave energy has several possible benefits over radiofrequency energy for tumor ablation but, because clinical microwave ablation systems are not widespread, the underlying principles and technologies may not be as familiar. The basic microwave ablation system contains many of the same components as a radiofrequency ablation system: a generator, a power distribution system, and an interstitial applicator. This article attempts to provide an overview of each of these components, outline their functions and roles, and...

Practical Applications of Nuclear Medicine in Imaging Breast Cancer

Publication year: 2009Source: Current Problems in Diagnostic Radiology, Volume 38, Issue 2, March-April 2009, Pages 68-83Ba.D., Nguyen , Michael C., Roarke , Patricia J., Karstaedt , Christian J., Ingui , Panol C., RamThe rise in incidence, morbidity, and mortality of breast cancer has triggered multiple imaging efforts to detect this malignancy early, stage it accurately, and monitor it with precision in the posttherapeutic course. Among different imaging modalities, nuclear medicine provides an important contribution to the clinical management of breast cancer. This article discusses four practical applications based on the use of radionuclides in the evaluation of breast malignancy, focusing on scintimammography, preoperative tumor localization procedure using radioactive seeds, sentinel nodal scintigraphy, and F-18 fluorodeoxyglucose positron emission tomography/computed tomography.

Multidetector Computed Tomography of the Mesocolon: Review of Anatomy and Pathology

Publication year: 2009Source: Current Problems in Diagnostic Radiology, Volume 38, Issue 2, March-April 2009, Pages 84-90Iswaran, Ramachandran , Peter, Rodgers , Moshier, Elabassy , Rakesh, SinhaThe anatomy of the mesocolon can be seen on multidetector computed tomography (MDCT) scans, and its most important anatomic landmarks are the mesocolic vessels. The high spatial resolution of the current generation scanner coupled with the ability to generate high quality multiplanar images is very helpful in the delineation of the mesocolon. These vessels include the ileocolic and right colic vessels for the ascending mesocolon, the middle colic vessels for the transverse mesocolon, and the inferior mesenteric vein for the sigmoid and descending mesocolon. Knowledge of the anatomic landmarks of the mesocolon can help the radiologist identify the pathways for...

Magnetic Resonance Arthrography of Superior Labrum Anterior-Posterior Lesions: A Practical Approach to Interpretation

Publication year: 2009Source: Current Problems in Diagnostic Radiology, Volume 38, Issue 2, March-April 2009, Pages 91-97Eugene, LinSuperior labrum anterior and posterior (SLAP) lesions are well-evaluated with magnetic resonance (MR) arthography. This article discusses a practical approach to interpretation of MR arthrography exams for the evaluation of suspected SLAP lesions.

Issues in Imaging Malignant Neoplasms of the Female Reproductive System

Publication year: 2009Source: Current Problems in Diagnostic Radiology, Volume 38, Issue 1, January-February 2009, Pages 1-16Nagaraj-Setty, Holalkere , Avinash M., Katur , Susanna I., LeeRadiological evaluation of malignant neoplasms of the female reproductive system is invaluable in the initial diagnosis, staging, treatment planning, and follow-up management. Radiologists serving as consultants for the general primary care internist, gynecologists, and specialists in gynecologic oncology should be familiar with the strengths and limitations of various modalities used to evaluate gynecologic cancer patients. This article discusses the most common female reproductive tract neoplasms (ie, cervical, endometrial, and ovarian cancers) and the role of ultrasound, computed tomography, magnetic resonance imaging, and positron emission tomography in their diagnosis and management. Imaging features that impact on clinical diagnostic or treatment algorithms...

Pharyngeal Dysphagia: What the Radiologist Needs to Know

Publication year: 2009Source: Current Problems in Diagnostic Radiology, Volume 38, Issue 1, January-February 2009, Pages 17-32Patrick D., Grant , Desiree E., Morgan , Francis J., Scholz , Cheri L., CanonDysphagia is defined as difficulty in swallowing. Oropharyngeal dysphagia is defined as difficulty in moving the bolus from the mouth to the esophagus. The best initial evaluation of suspected oropharyngeal dysphagia is a barium study which can evaluate motility of the oropharynx and hypopharynx and provide double-contrast views that may identify structural or mucosal abnormalities. Pharyngeal diverticula, Zenker's and Killian–Jamieson diverticula, and pharyngeal pouches are readily identified on these studies. Zenker's diverticula are the commonest diverticulum implicated in pharyngeal dysphagia and typically occur in the setting of cricopharyngeal dysfunction. The radiologist must not only diagnose these diverticula but also understand...

Vascular Closure Devices: A Comparative Overview

Publication year: 2009Source: Current Problems in Diagnostic Radiology, Volume 38, Issue 1, January-February 2009, Pages 33-43Lye-Quen, Hon , Arul, Ganeshan , Steven Mark, Thomas , Dinuke, Warakaulle , Jagalpathy, Jagdish , ...The use of closure devices is widespread and becoming more common. Radiologists performing arterial access procedures should be aware of when and how to use them, as well as the advantages and disadvantages of various devices, and any complications that may occur. This review intends to provide an overview of these devices, focusing on how they work, their efficacy in achieving hemostasis, any risks associated with their use, and our view as to which should be used for particular indications. There are three main categories of vascular closure devices: collagen based, suture based, and staples and clips. Newer generation devices...

Radiofrequency Ablation of Lung Lesions: Practical Applications and Tips

Publication year: 2009Source: Current Problems in Diagnostic Radiology, Volume 38, Issue 1, January-February 2009, Pages 44-52A. Molly, Roy , Clare, Bent , Tim, FotheringhamRadiofrequency ablation (RFA) therapy is a minimally invasive technique that can be used in the management of inoperable non-small-cell lung cancer and for palliation in selected patients with pulmonary metastases. Surgical resection remains the gold standard of treatment; however, many patients are ineligible due to comorbidities or poor cardiopulmonary reserve. Others may simply decline radical surgical intervention. Alternative treatment options are limited mainly to chemotherapy and external beam radiation. With the development of RFA, a new promising technique has evolved that can be offered to many, as an alternative choice or as part of combination therapy. The published results of...

Upcoming Articles

Publication year: 2009Source: Current Problems in Diagnostic Radiology, Volume 38, Issue 1, January-February 2009, Page IBC[No author name available]

In Recent Issues

Publication year: 2009Source: Current Problems in Diagnostic Radiology, Volume 38, Issue 1, January-February 2009, Page OBC[No author name available]

Magnetic Resonance Imaging Features of the Discrete Epiphyseal Radiolucency: A Problem-Solving Approach to Differential Diagnosis

Publication year: 2008Source: Current Problems in Diagnostic Radiology, Volume 37, Issue 6, November-December 2008, Pages 243-261José M., Mellado , Jenny T., Bencardino , Laura, Pérez del PalomarDiscrete radiolucencies in the epiphysis of the long bones may be a major radiographic finding in many arthropathies and synovial-based processes, and also in various osteolytic tumors and tumor-like lesions. In addition, a number of miscellaneous bone disorders, particularly infection and avascular necrosis, may present as discrete epiphyseal radiolucencies. Magnetic resonance imaging is frequently used in the diagnostic workup of these lesions. Our purpose was to review and illustrate, in a problem-solving approach, the potential contributions of magnetic resonance imaging in the characterization of discrete epiphyseal radiolucent lesions.

Computed Tomography and Magnetic Resonance Imaging Features of Lesions of the Renal Medulla and Sinus

Publication year: 2008Source: Current Problems in Diagnostic Radiology, Volume 37, Issue 6, November-December 2008, Pages 262-278Paul, Nikolaidis , Helena, Gabriel , Kathleen, Khong , Michael, Brusco , Nancy, Hammond , ...The kidneys can harbor a wide variety of lesions, many of which can be visualized by computed tomography and magnetic resonance imaging. In this article, the pertinent renal anatomic relationships as well as the histologic composition and function of the renal medulla and sinus are reviewed. Additionally, computed tomography and magnetic resonance imaging features of renal sinus and medullary lesions in adult patients are presented. This article reviews the salient imaging features of various malignant, benign neoplastic, and nonneoplastic lesions of the sinus and medulla.

Computed Tomographic Enterography and Enteroclysis: Pearls and Pitfalls

Publication year: 2008Source: Current Problems in Diagnostic Radiology, Volume 37, Issue 6, November-December 2008, Pages 279-287Hetal, Dave-Verma , Scott, Moore , Ajay, Singh , Noel, Martins , John, ZawackiComputed tomographic (CT) enterography and enteroclysis improve visualization of the small bowel mucosa and wall in comparison with traditional CT and fluoroscopic studies by distending the small bowel through enteric hyperhydration with a negative contrast agent. Although CT enterography is performed with oral hyperhydration, CT enteroclysis requires the placement of an enteroclysis tube, often in patients who are unable to orally consume the amount of liquid. When tolerated, CT enterography is often preferred due to its lack of invasiveness. Magnetic resonance enterography and enteroclysis are other modalities that are still being studied and show promise in the imaging of small...

Editorial Board

Publication year: 2008Source: Current Problems in Diagnostic Radiology, Volume 37, Issue 5, September-October 2008, Page IFC[No author name available]

Information for Readers

Publication year: 2008Source: Current Problems in Diagnostic Radiology, Volume 37, Issue 5, September-October 2008, Page i[No author name available]

Publication year: 2008Source: Current Problems in Diagnostic Radiology, Volume 37, Issue 5, September-October 2008, Page ii[No author name available]

More Than Just Stones: A Pictorial Review of Common and Less Common Gallbladder Pathologies

Publication year: 2008Source: Current Problems in Diagnostic Radiology, Volume 37, Issue 5, September-October 2008, Pages 189-202Janice, Ash-Miles , Huw, Roach , Jim, Virjee , Mark, CallawayAlthough stone disease is by far the most commonly encountered pathology of the gallbladder, there are several other important disease processes affecting it. These include adenomyomatosis, cholesterolosis, polyps, porcelain gallbladder, acalculous cholecystitis, xanthogranulomatous cholecystitis, emphysematous cholecystitis, gallbladder cancer, and gallbladder hemorrhage. The purpose of this article was to review the different gallbladder pathologies encountered in everyday radiological practice and to describe their features in the standard imaging modalities.

Ultrasound-Guided Therapeutic Procedures in the Musculoskeletal System

Publication year: 2008Source: Current Problems in Diagnostic Radiology, Volume 37, Issue 5, September-October 2008, Pages 203-218Jose Luis, del CuraUltrasound allows the exploration of most of the musculoskeletal system, including lytic bone lesions. Its flexibility, availability, and low cost make it the best tool to guide interventional therapeutic procedures in any musculoskeletal system lesion visible on ultrasound. These techniques include drainages of abscesses, bursitis, hematomas or muscular strains, treatment of cystic lesions (ganglions, Baker's cysts), arthrocentesis, injection of substances in joints and soft tissues, and aspiration of calcific tendinitis. Although the puncture of joints for arthrocentesis and injection of substances are performed by clinicians using palpation, the use of ultrasound guidance improves the effectiveness of the technique especially for...

Ultrasound of Muscle

Publication year: 2008Source: Current Problems in Diagnostic Radiology, Volume 37, Issue 5, September-October 2008, Pages 219-230Marianna, Vlychou , James, TehThis pictorial review illustrates the ultrasound appearances of pathological conditions affecting muscle with particular emphasis on extended field-of-view imaging.

Magnetic Resonance Imaging Findings of Golf-Related Injuries

Publication year: 2008Source: Current Problems in Diagnostic Radiology, Volume 37, Issue 5, September-October 2008, Pages 231-241Joseph, Sutcliffe , Justin Q., Ly , Amy, Kirby , Douglas P., BeallInjuries related to participation in golf are becoming more common given the increasing popularity of the sport itself. Golf is considered to be an activity associated with a moderate risk for sports injuries. Golf injuries are usually attributable to overuse or traumatic mechanisms and primarily occur at the elbow, wrist, shoulder, and lumbar spine. None of these injuries are unique to golf, but each of these injuries represent the most common injuries associated with golfing. This article reviews a wide range of injuries that are encountered in golfers and describes the magnetic resonance imaging findings of each of these injuries.

Upcoming Articles

Publication year: 2008Source: Current Problems in Diagnostic Radiology, Volume 37, Issue 5, September-October 2008, Page IBC[No author name available]

In Recent Issues

Publication year: 2008Source: Current Problems in Diagnostic Radiology, Volume 37, Issue 5, September-October 2008, Page OBC[No author name available]

Editorial Board

Publication year: 2008Source: Current Problems in Diagnostic Radiology, Volume 37, Issue 4, July-August 2008, Page IFC[No author name available]

Information for Readers

Publication year: 2008Source: Current Problems in Diagnostic Radiology, Volume 37, Issue 4, July-August 2008, Page i[No author name available]

Publication year: 2008Source: Current Problems in Diagnostic Radiology, Volume 37, Issue 4, July-August 2008, Page ii[No author name available]

Magnetic Resonance Imaging of Cystic Adnexal Lesions During Pregnancy

Publication year: 2008Source: Current Problems in Diagnostic Radiology, Volume 37, Issue 4, July-August 2008, Pages 139-144Aytekin, Oto , Randy, Ernst , Mary K., Jesse , George, SaadeManagement of cystic adnexal lesions diagnosed during pregnancy is a challenging issue for obstetricians. The range of treatment options changes from immediate surgery to close follow-up. This pictorial essay illustrates the magnetic resonance imaging findings of various cystic adnexal lesions in pregnant patients. Magnetic resonance imaging may help in better characterization of some of the cystic adnexal lesions diagnosed during pregnancy without exposing the fetus to ionizing radiation.

Re: diagnosis of hepatic angiomyolipomata using CT: report of three cases and review of the literature.

Related Articles Re: diagnosis of hepatic angiomyolipomata using CT: report of three cases and review of the literature. Clin Radiol. 2009 Sep;64(9):948 Authors: McNeill G, Halpenny D, Snow A, Torreggiani WC PMID: 19664488 [PubMed - indexed for MEDLINE]

Re: imaging features of primary extranodal lymphomas.

Related Articles Re: imaging features of primary extranodal lymphomas. Clin Radiol. 2009 Sep;64(9):948-50 Authors: Archer L, Wilson D, McCoubrie P PMID: 19664487 [PubMed - indexed for MEDLINE]

High-grade chondrosarcoma mimicking Brodie's abscess.

Related Articles High-grade chondrosarcoma mimicking Brodie's abscess. Clin Radiol. 2009 Sep;64(9):944-7 Authors: Datir A, Lidder S, Pollock R, Tirabosco R, Saifuddin A PMID: 19664486 [PubMed - indexed for MEDLINE]

Calcific tendonitis of the adductor brevis insertion.

Related Articles Calcific tendonitis of the adductor brevis insertion. Clin Radiol. 2009 Sep;64(9):940-3 Authors: Tamangani J, Davies AM, James SL, Christie-Large M PMID: 19664485 [PubMed - indexed for MEDLINE]

Getting to the heel of the problem: plantar fascia lesions.

Related Articles Getting to the heel of the problem: plantar fascia lesions. Clin Radiol. 2009 Sep;64(9):931-9 Authors: Jeswani T, Morlese J, McNally EG Heel pain is a frequent disabling symptom. Clinical diagnosis is often difficult with a large range of possible diagnoses. Lesions of the plantar fascia form an important group. We present a review describing the common lesions of the plantar fascia, including plantar fasciitis, plantar fascia rupture, plantar fibromatosis, and plantar xanthoma, and illustrate them with appropriate magnetic resonance imaging (MRI) and ultrasound imaging. We also address foreign-body reactions, enthesopathy, and diabetic fascial disease. PMID: 19664484 [PubMed - indexed for MEDLINE]

CT appearances of pleural tumours.

Related Articles CT appearances of pleural tumours. Clin Radiol. 2009 Sep;64(9):918-30 Authors: Salahudeen HM, Hoey ET, Robertson RJ, Darby MJ Computed tomography (CT) is the imaging technique of choice for characterizing pleural masses with respect to their location, composition, and extent. CT also provides important information regarding invasion of the chest wall and surrounding structures. A spectrum of tumours can affect the pleura of which metastatic adenocarcinoma is the commonest cause of malignant pleural disease, while malignant mesothelioma is the most common primary pleural tumour. Certain CT features help differentiate benign from malignant processes. This pictorial review highlights the salient CT appearances of a range of tumours that may affect the pleura. PMID: 19664483 [PubMed - indexed for MEDLINE]

Contribution of the amount of contrast media used in pulmonary CT angiography to assess the diagnostic value of CT venography; comparison of 100 and 150ml of contrast media.

Related Articles Contribution of the amount of contrast media used in pulmonary CT angiography to assess the diagnostic value of CT venography; comparison of 100 and 150ml of contrast media. Clin Radiol. 2009 Sep;64(9):912-7 Authors: Calisir C, Yavas US, Kebapci M, Korkmaz A, Ozkan R AIM: To prospectively compare the vascular attenuation achieved with 100ml iohexol (350mgI/ml) 75% with that achieved with 150ml iohexol (350mgI/ml) 75% for computed tomography (CT) venography, which was performed after CT pulmonary angiography. MATERIALS AND METHODS: A total of 122 patients were included in the study. Group A, comprising 52 patients (mean age 64.8 years, mean body weight 70.8kg) received 150ml iohexol (350mgI/ml) contrast media. Group B, comprising 70 patients (mean age 61.2 years, mean body weight 71.4kg) received 100ml iohexol (350mgI/ml) contrast medium. RESULTS: Venous opacification values measured at all levels were significantly higher in group A than those in group B (p<0.001). In group B the mean HU values were between 87 and 115 and only three of the patients had HU values less than 60 at the level of femoral vein. Assuming a venous enhancement of 80HU as the cut-off value for accurate diagnosis of deep venous thrombosis, 22.8% (16/70) in group B and 7.6% (4/52; p=0.028) in group A had non-diagnostic CT venography of left femoral vein. CONCLUSION: One hundred millilitres of contrast medium with a concentration of 350mgI/ml may produce sufficient enhancement, but 150ml of contrast medium provides better accuracy for the diagnosis of deep venous thrombosis diagnosis. For better enhancement of lower extremity deep veins, the concentration of the contrast medium and the patient's body weight may also have significance. PMID: 19664482 [PubMed - indexed for MEDLINE]

Are pancreatic calcifications specific for the diagnosis of chronic pancreatitis? A multidetector-row CT analysis.

Related Articles Are pancreatic calcifications specific for the diagnosis of chronic pancreatitis? A multidetector-row CT analysis. Clin Radiol. 2009 Sep;64(9):903-11 Authors: Campisi A, Brancatelli G, Vullierme MP, Levy P, Ruzniewski P, Vilgrain V AIM: To retrospectively establish the most frequently encountered diagnoses in patients with pancreatic calcifications and to investigate whether the association of certain findings could be helpful for diagnosis. MATERIALS AND METHODS: One hundred and three patients were included in the study. The location and distribution of calcifications; presence, nature, and enhancement pattern of pancreatic lesions; pancreatic atrophy and ductal dilatation were recorded. Differences between patients with chronic pancreatitis and patients with other entities were compared by using Fisher's exact test. RESULTS: Patients had chronic pancreatitis (n=70), neuroendocrine tumours (n=14), intraductal papillary mucinous neoplasm (n=11), pancreatic adenocarcinoma (n=4), serous cystadenoma (n=4). Four CT findings had a specificity of over 60% for the diagnosis of chronic pancreatitis: parenchymal calcifications, intraductal calcifications, parenchymal atrophy, and cystic lesions. When at least two of these four criteria were used in combination, 54 of 70 (77%) patients with chronic pancreatitis could be identified, but only 17 of 33 (51%) patients with other diseases. When at least three of these four criteria were present, a specificity of 79% for the diagnosis of chronic pancreatitis was achieved. CONCLUSION: Certain findings are noted more often in chronic pancreatitis than in other pancreatic diseases. The presence of a combination of CT findings can suggest chronic pancreatitis and be helpful in diagnosis. PMID: 19664481 [PubMed - indexed for MEDLINE]

Radiological impact of the use of calcium hydroxylapatite dermal fillers.

Related Articles Radiological impact of the use of calcium hydroxylapatite dermal fillers. Clin Radiol. 2009 Sep;64(9):897-902 Authors: Feeney JN, Fox JJ, Akhurst T AIM: To report a case series in which the radiological features of the subcutaneous use of calcium hydroxylapatite (CaHa) dermal fillers are described for the first time. MATERIALS AND METHODS: Five patients with facial hyperattenuating hypermetabolic subcutaneous lesions were identified on 2- [(18)F]-fluoro-2-deoxy-D-glucose (FDG) positron-emission tomography/computed tomography (PET/CT), who gave a history of facial injections to augment physical appearance. Correlation with additional imaging studies was performed. RESULTS: All cases had subcutaneous high attenuation material on CT (range 280-700HU), which was FDG avid on PET, with a standardized uptake value (SUV) range of 2.9-13.4. Magnetic resonance imaging (MRI) demonstrated a heterogeneous intermediate signal intensity subcutaneous lesion with enhancement post-gadolinium in one case. CONCLUSIONS: CaHa dermal filler is hyperattenuating on CT, hypermetabolic on FDG-PET imaging, of intermediate signal intensity on MRI, and is a potential cause of a false-positive imaging study. PMID: 19664480 [PubMed - indexed for MEDLINE]

Discrepancy in reporting among specialist registrars and the role of a paediatric neuroradiologist in reporting paediatric CT head examinations.

Related Articles Discrepancy in reporting among specialist registrars and the role of a paediatric neuroradiologist in reporting paediatric CT head examinations. Clin Radiol. 2009 Sep;64(9):891-6 Authors: Nagaraja S, Ullah Q, Lee KJ, Bickle I, Hon LQ, Griffiths PD, Raghavan A, Flynn P, Connolly DJ AIM: To evaluate the discrepancy rate among specialist registrars (SPR) to assess whether seniority had a bearing on the discrepancy rate. To investigate which were the commonly missed abnormalities and the consequences for teaching purposes. To investigate the role of a specialist consultant neuroradiologist in reporting paediatric head computed tomography examinations. MATERIALS AND METHODS: The study was carried out over a 9-month period at the regional paediatric hospital during which time 270 CT head examinations were reported. Reporting in the department is carried out by one of the five general paediatric radiologists (GR) and also a specialist paediatric neuroradiologist (NR). The NR was considered the reference standard, who corroborated in areas of discrepancy with a second senior NR for this study. Of the 270 examinations, 260 were reported by the paediatric NR, 160 were reported by the SPR, GR, and NR, and 51 were reported by an SPR and the NR. In addition, four were reported by the GR and the NR, 45 by the NR only, seven by the GR only, and three cases were reported by the GR and an SPR. The discrepancy rates were calculated for GR versus NR, and SPR versus NR. All the discrepancies were re-evaluated by a second senior NR and confirmed in all cases. The reports of the SPR were further scrutinized. The trainees of training years 1-3 were considered junior and 4-5 were considered senior. RESULTS: There was a discrepancy in 26/164 cases (15.9%) reported by the GR and NR. There was a discrepancy in 59/211 cases (28%) reported by an SPR and NR. The chi-squared test (two-sided) showed a significant difference (p=0.005) between the two groups. There was a discrepancy in 36/118 cases (30.5%) reported by the junior SPR and NR. There was a discrepancy in 23/93 cases (24.7%) reported by a senior SPR and NR. The chi-squared test (two-sided) showed a non-significant difference (p=0.353) between the two groups. CONCLUSION: The performance of the SPR was considered to be significantly different than the GR in this study. The year of training did not have a statistically significant bearing on the discrepancy rates. This study has been useful in guiding SPR with regards to paediatric CT head examination reporting. The NR played an important role, particularly in picking up subtle fractures and congenital abnormalities, which were missed by both the SPR and GR. PMID: 19664479 [PubMed - indexed for MEDLINE]

CT staging of loco-regional breast cancer recurrence. A worthwhile practice?

Related Articles CT staging of loco-regional breast cancer recurrence. A worthwhile practice? Clin Radiol. 2009 Sep;64(9):885-90 Authors: Tennant S, Evans A, Macmillan D, Lee A, Cornford E, James J, Ellis I AIMS: To assess the usefulness of computed tomography of the chest, abdomen, and pelvis (CTCAP) in the detection of metastatic disease in patients presenting with loco-regional recurrence of breast cancer, and to identify subgroups particularly likely to have metastases. MATERIALS AND METHODS: Over a 32-month period, 63 patients with 65 recurrences underwent CTCAP, and were identified from the hospital's computerized radiology system. RESULTS: Twenty-one patients (32%) had metastases, including bony (n=5, 8%), liver (n=7, 11%), and thoracic disease (n=11, 17%). Patients with recurrence in a conserved breast had lower rates of metastasis on CT than those with other sites of recurrence [three of 21 (14%) versus 18 of 44 (41%), p=0.03]. Patients younger than 50 years at primary diagnosis or younger than 60 years at recurrence had statistically significantly higher rates of metastasis than older patients [10 of 16 (63%) versus 11 of 48 (23%), p=0.003, and 13 of 23 (57%) versus eight of 42 (19%), p=0.002, respectively]. CONCLUSION: CT staging of patients presenting with loco-regional recurrence of breast cancer is a worthwhile practice. Younger patients and those with recurrence other than in the conserved breast are particularly likely to have metastatic disease. PMID: 19664478 [PubMed - indexed for MEDLINE]

Incidentally detected small pulmonary nodules on CT.

Related Articles Incidentally detected small pulmonary nodules on CT. Clin Radiol. 2009 Sep;64(9):872-84 Authors: Edey AJ, Hansell DM The widespread use of multidetector computed tomography for imaging of the chest has lead to a significant increase in the number of incidentally detected pulmonary nodules. The significance of these nodules is often uncertain and further investigations may be required. This article will review the spectrum of imaging appearances of small pulmonary nodules, and highlight the few features that allow confident characterization of a nodule as benign or malignant; current guidelines for the management of incidentally detected nodules will also be discussed. PMID: 19664477 [PubMed - indexed for MEDLINE]

Cancer presenting during pregnancy: radiological perspectives.

Related Articles Cancer presenting during pregnancy: radiological perspectives. Clin Radiol. 2009 Sep;64(9):857-71 Authors: Doyle S, Messiou C, Rutherford JM, Dineen RA Malignancy presenting during pregnancy is rare. When it does, there are important considerations and challenges for the radiologist. The physiological changes of pregnancy may mask signs and symptoms of malignancy leading to delayed presentation. Endocrine and physiological changes during pregnancy can interact with tumour biology to alter the behaviour and patterns of growth of certain tumours. The timing and choice of imaging technique pose potential risks to the foetus, but this must be weighed against the risks to both mother and foetus of inadequate investigation or misdiagnosis. This review outlines the general principles and approach to imaging the pregnant patient with suspected malignancy, following which there is a more detailed discussion of the effects of pregnancy on tumour biology and presentation of specific tumours. Imaging strategies are discussed for the different entities, and where possible, evidence-based imaging recommendations are made. PMID: 19664476 [PubMed - indexed for MEDLINE]

Radiology accreditation-towards a safer quality service.

Related Articles Radiology accreditation-towards a safer quality service. Clin Radiol. 2009 Sep;64(9):853-6 Authors: Garvey CJ, Cook JV, Wiltsher C, Whitley S PMID: 19664475 [PubMed - indexed for MEDLINE]

Result categories for ventilation-perfusion scintigraphy.

Related Articles Result categories for ventilation-perfusion scintigraphy. Radiology. 2009 Nov;253(2):575; author reply 575 Authors: Kohn MA, Fahimi J, Newman TB, Sostman HD, Stein PD, Hull RD PMID: 19864536 [PubMed - in process]

Falsely claiming use of NASCET percentage stenosis method.

Related Articles Falsely claiming use of NASCET percentage stenosis method. Radiology. 2009 Nov;253(2):574-5; author reply 575 Authors: Fox AJ, Symons SP, Aviv RI, Howard P, Yeung R, Bartlett ES, Anzidei M, Napoli A, Catalano C, Passariello R PMID: 19864535 [PubMed - in process]

Epinephrine dose for treating contrast material-induced reactions.

Related Articles Epinephrine dose for treating contrast material-induced reactions. Radiology. 2009 Nov;253(2):573; author reply 573 Authors: Winter TC, Abraham RJ, Lightfoot CB, Kapur S PMID: 19864534 [PubMed - in process]

The need for spatially standardized methods in clinical applications of diffusion tensor imaging of white matter.

Related Articles The need for spatially standardized methods in clinical applications of diffusion tensor imaging of white matter. Radiology. 2009 Nov;253(2):571; author reply 572 Authors: Hasan KM, Kamali A, Rollins NK PMID: 19864533 [PubMed - in process]

Barking up the wrong straw man.

Related Articles Barking up the wrong straw man. Radiology. 2009 Nov;253(2):570; author reply 570-1 Authors: Brant-Zawadzki MN, Chappell FM, Wardlaw JM PMID: 19864532 [PubMed - in process]

Case 151: hereditary angioedema in the duodenum.

Related Articles Case 151: hereditary angioedema in the duodenum. Radiology. 2009 Nov;253(2):564-9 Authors: Courtier J, Ali K PMID: 19864531 [PubMed - in process]

Case 155.

Related Articles Case 155. Radiology. 2009 Nov;253(2):562-3 Authors: Nishino M, Patrick JL, Connors JM PMID: 19864530 [PubMed - in process]

Clinical stage T1c prostate cancer: evaluation with endorectal MR imaging and MR spectroscopic imaging.

Related Articles Clinical stage T1c prostate cancer: evaluation with endorectal MR imaging and MR spectroscopic imaging. Radiology. 2009 Nov;253(2):425-34 Authors: Zhang J, Hricak H, Shukla-Dave A, Akin O, Ishill NM, Carlino LJ, Reuter VE, Eastham JA PURPOSE: To assess the diagnostic accuracy of endorectal magnetic resonance (MR) imaging and MR spectroscopic imaging for prediction of the pathologic stage of prostate cancer and the presence of clinically nonimportant disease in patients with clinical stage T1c prostate cancer. MATERIALS AND METHODS: The institutional review board approved-and waived the informed patient consent requirement for-this HIPAA-compliant study involving 158 patients (median age, 58 years; age range, 40-76 years) who had clinical stage T1c prostate cancer, had not been treated preoperatively, and underwent combined 1.5-T endorectal MR imaging-MR spectroscopic imaging between January 2003 and March 2004 before undergoing radical prostatectomy. On the MR images and combined endorectal MR-MR spectroscopic images, two radiologists retrospectively and independently rated the likelihood of cancer in 12 prostate regions and the likelihoods of extracapsular extension (ECE), seminal vesicle invasion (SVI), and adjacent organ invasion by using a five-point scale, and they determined the probability of clinically nonimportant prostate cancer by using a four-point scale. Whole-mount step-section pathology maps were used for imaging-pathologic analysis correlation. Receiver operating characteristic curves were constructed and areas under the curves (AUCs) were estimated nonparametrically for assessment of reader accuracy. RESULTS: At surgical-pathologic analysis, one (0.6%) patient had no cancer; 124 (78%) patients, organ-confined (stage pT2) disease; 29 (18%) patients, ECE (stage pT3a); two (1%) patients, SVI (stage pT3b); and two (1%) patients, bladder neck invasion (stage pT4). Forty-six (29%) patients had a total tumor volume of less than 0.5 cm(3). With combined MR imaging-MR spectroscopic imaging, the two readers achieved 80% accuracy in disease staging and AUCs of 0.62 and 0.71 for the prediction of clinically nonimportant cancer. CONCLUSION: Clinical stage T1c prostate cancers are heterogeneous in pathologic stage and volume. MR imaging may help to stratify patients with clinical stage T1c disease for appropriate clinical management. PMID: 19864529 [PubMed - in process]

CT enteroclysis features of uncomplicated celiac disease: retrospective analysis of 44 patients.

Related Articles CT enteroclysis features of uncomplicated celiac disease: retrospective analysis of 44 patients. Radiology. 2009 Nov;253(2):416-24 Authors: Soyer P, Boudiaf M, Dray X, Fargeaudou Y, Vahedi K, Aout M, Vicaut E, Hamzi L, Rymer R PURPOSE: To describe the computed tomographic (CT) enteroclysis features of uncomplicated celiac disease (CD) and to determine the most indicative appearance of this condition by using a retrospective case-control study. MATERIALS AND METHODS: This study had institutional review board approval. The CT enteroclysis examinations of 44 consecutive patients with proved uncomplicated CD (21 men, 23 women; mean age, 44.45 years) were reviewed by two blinded readers and compared with those obtained in 44 control subjects (21 men, 23 women; mean age, 44.48 years), who were matched for sex and age. Comparisons were calculated by using univariate analysis. RESULTS: Reversed jejunoileal fold pattern had the highest specificity (100%; 44 of 44; 95% confidence interval [CI]: 91.96%, 100%) and was the most discriminating independent variable for the diagnosis of uncomplicated CD (odds ratio, 39.9; P < .0001) but had a sensitivity of 63.64% (28 of 44; 95% CI: 47.77%, 77.59%). Ileal fold thickening, vascular engorgement, and splenic atrophy were other variables that strongly correlated with the presence of uncomplicated CD. CONCLUSION: CT enteroclysis may help establish a diagnosis of uncomplicated CD and may clarify the cause of nonspecific gastrointestinal symptoms in patients with unknown CD. However, future prospective trials are needed to determine the actual value of CT enteroclysis in patients with CD and validate the clinical usefulness of CT enteroclysis in the detection of unknown uncomplicated CD. PMID: 19864528 [PubMed - in process]

Ductal carcinoma in situ: X-ray fluorescence microscopy and dynamic contrast-enhanced MR imaging reveals gadolinium uptake within neoplastic mammary ducts in a murine model.

Related Articles Ductal carcinoma in situ: X-ray fluorescence microscopy and dynamic contrast-enhanced MR imaging reveals gadolinium uptake within neoplastic mammary ducts in a murine model. Radiology. 2009 Nov;253(2):399-406 Authors: Jansen SA, Paunesku T, Fan X, Woloschak GE, Vogt S, Conzen SD, Krausz T, Newstead GM, Karczmar GS PURPOSE: To combine dynamic contrast material-enhanced (DCE) magnetic resonance (MR) imaging with x-ray fluorescence microscopy (XFM) of mammary gland tissue samples from mice to identify the spatial distribution of gadolinium after intravenous injection. MATERIALS AND METHODS: C3(1) Sv-40 large T antigen transgenic mice (n = 23) were studied with institutional animal care and use committee approval. Twelve mice underwent DCE MR imaging after injection of gadodiamide, and gadolinium concentration-time curves were fit to a two-compartment pharmacokinetic model with the following parameters: transfer constant (K(trans)) and volume of extravascular extracellular space per unit volume of tissue (v(e)). Eleven mice received gadodiamide before XFM. These mice were sacrificed 2 minutes after injection, and frozen slices containing ducts distended with murine ductal carcinoma in situ (DCIS) were prepared for XFM. One mouse received saline and served as the control animal. Elemental gadolinium concentrations were measured in and around the ducts with DCIS. Hematoxylin-eosin-stained slices of mammary tissues were obtained after DCE MR imaging and XFM. RESULTS: Ducts containing DCIS were unambiguously identified on MR images. DCE MR imaging revealed gadolinium uptake along the length of ducts with DCIS, with an average K(trans) of 0.21 min(-1) +/- 0.14 (standard deviation) and an average v(e) of 0.40 +/- 0.16. XFM revealed gadolinium uptake inside ducts with DCIS, with an average concentration of 0.475 mmol/L +/- 0.380; the corresponding value for DCE MR imaging was 0.30 mmol/L +/- 0.13. CONCLUSION: These results provide insight into the physiologic basis of contrast enhancement of DCIS lesions on DCE MR images: Gadolinium penetrates and collects inside neoplastic ducts. PMID: 19864527 [PubMed - in process]

CT of coronary artery disease.

Related Articles CT of coronary artery disease. Radiology. 2009 Nov;253(2):317-38 Authors: Bastarrika G, Lee YS, Huda W, Ruzsics B, Costello P, Schoepf UJ Technical innovation is rapidly improving the clinical utility of cardiac computed tomography (CT) and will increasingly address current technical limitations, especially the association of this test with relatively high levels of radiation. Guidelines for appropriate indications are in place and are evolving, with an increasing evidence base to ensure the appropriate use of this modality. New technologies and new applications, such as myocardial perfusion imaging and dual-energy CT, are being explored and are widening the scope of coronary CT angiography from mere coronary artery assessment to the integrative analysis of cardiac morphology, function, perfusion, and viability. The scientific evaluation of coronary CT angiography has left the stage of feasibility testing and increasingly, evidence-based data are accumulating on outcomes, prognosis, and cost-effectiveness. In this review, these developments will be discussed in the context of current pivotal transitions in cardiovascular disease management and their potential influence on the current role and future fate of coronary CT angiography will be examined. PMID: 19864526 [PubMed - in process]

Soft-tissue tumors and tumorlike lesions: a systematic imaging approach.

Related Articles Soft-tissue tumors and tumorlike lesions: a systematic imaging approach. Radiology. 2009 Nov;253(2):297-316 Authors: Wu JS, Hochman MG Soft-tissue lesions are frequently encountered by radiologists in everyday clinical practice. Characterization of these soft-tissue lesions remains problematic, despite advances in imaging. By systematically using clinical history, lesion location, mineralization on radiographs, and signal intensity characteristics on magnetic resonance images, one can (a) determine the diagnosis for the subset of determinate lesions that have characteristic clinical and imaging features and (b) narrow the differential diagnosis for lesions that demonstrate indeterminate characteristics. If a lesion cannot be characterized as a benign entity, the lesion should be reported as indeterminate, and the patient should undergo biopsy to exclude malignancy. PMID: 19864525 [PubMed - in process]

National Council on Radiation Protection and Measurements report shows substantial medical exposure increase.

Related Articles National Council on Radiation Protection and Measurements report shows substantial medical exposure increase. Radiology. 2009 Nov;253(2):293-6 Authors: Schauer DA, Linton OW PMID: 19864524 [PubMed - in process]

Recommendations for additional imaging in radiology reports: radiologists' self-referral or good clinical practice?

Related Articles Recommendations for additional imaging in radiology reports: radiologists' self-referral or good clinical practice? Radiology. 2009 Nov;253(2):291-2 Authors: Arenson RL PMID: 19864523 [PubMed - in process]

The mea culpa conundrum.

Related Articles The mea culpa conundrum. Radiology. 2009 Nov;253(2):284-7 Authors: Berlin L PMID: 19864521 [PubMed - in process]

Why do purely intraductal cancers enhance on breast MR images?

Why do purely intraductal cancers enhance on breast MR images? Radiology. 2009 Nov;253(2):281-3 Authors: Kuhl CK PMID: 19864520 [PubMed - in process]

Impact of Heart Rate Frequency and Variability on Radiation Exposure, Image Quality, and Diagnostic Performance in Dual-Source Spiral CT Coronary Angiography.

Related Articles Impact of Heart Rate Frequency and Variability on Radiation Exposure, Image Quality, and Diagnostic Performance in Dual-Source Spiral CT Coronary Angiography. Radiology. 2009 Oct 28; Authors: Weustink AC, Neefjes LA, Kyrzopoulos S, van Straten M, Neoh Eu R, Meijboom WB, van Mieghem CA, Capuano E, Dijkshoorn ML, Cademartiri F, Boersma E, de Feyter PJ, Krestin GP, Mollet NR Purpose: To investigate the effect of heart rate frequency (HRF) and heart rate variability (HRV) on radiation exposure, image quality, and diagnostic performance to help detect significant stenosis (>/=50% lumen diameter reduction) by using adaptive electrocardiographic (ECG) pulsing at dual-source (DS) spiral computed tomographic (CT) coronary angiography. Materials and Methods: Institutional review committee approval and informed consent were obtained. No prescan beta-blockers were applied. Unenhanced CT and CT coronary angiography with adaptive ECG pulsing were performed in 927 consecutive patients (600 men, 327 women; mean age, 60.3 years +/- 11.0 [standard deviation]) divided in three HRF groups: low, intermediate, and high (/=80 beats/min, respectively), and four HRV groups given mean interbeat difference (IBD) during CT coronary angiography: normal, minor, moderate, and severe (IBDs of 0-1, 2-3, 4-10, and >10, respectively). Radiation exposure and image quality were also evaluated. In 444 of these, diagnostic performance was presented as sensitivity, specificity, positive predictive values (PPVs), and negative predictive values and likelihood ratios with corresponding 95% confidence intervals by using quantitative coronary angiography as the reference standard. Results: CT coronary angiography yielded good image quality in 98% of patients and no significant differences in image quality were found among HRF and HRV groups. Radiation exposure was significantly higher in patients with low versus high HRF and in patients with severe versus normal HRV. No significant differences among HRF and HRV groups in image quality and diagnostic performance were found. A nonsignificant trend was found toward a lower specificity and PPV in patients with a high HRF or severe HRV when compared with low HRF or normal HRV in patients with a low calcium score (Agatston score <100). Conclusion: DS spiral CT coronary angiography performed with adaptive ECG pulsing results in preserved diagnostic image quality and performance independent of HRF or HRV at the cost of limited dose reduction in arrhythmic patients. (c) RSNA, 2009. PMID: 19864512 [PubMed - as supplied by publisher]

Breast US Computer-aided Diagnosis System: Robustness across Urban Populations in South Korea and the United States.

Related Articles Breast US Computer-aided Diagnosis System: Robustness across Urban Populations in South Korea and the United States. Radiology. 2009 Oct 28; Authors: Gruszauskas NP, Drukker K, Giger ML, Chang RF, Sennett CA, Moon WK, Pesce LL Purpose: To evaluate the robustness of a breast ultrasonographic (US) computer-aided diagnosis (CAD) system in terms of its performance across different patient populations. Materials and Methods: Three US databases were analyzed for this study: one South Korean and two United States databases. All three databases were utilized in an institutional review board-approved and HIPAA-compliant manner. Round-robin analysis and independent testing were performed to evaluate the performance of a computerized breast cancer classification scheme across the databases. Receiver operating characteristic (ROC) analysis was used to evaluate performance differences. Results: The round-robin analyses of each database demonstrated similar results, with areas under the ROC curve ranging from 0.88 (95% confidence interval [CI]: 0.820, 0.918) to 0.91 (95% CI: 0.86, 0.95). The independent testing of each database, however, indicated that although the performances were similar, the range in areas under the ROC curve (from 0.79 [95% CI: 0.730, 0.842] to 0.87 [95% CI: 0.794, 0.923]) was wider than that with the round-robin tests. However, the only instances in which statistically significant differences in performance were demonstrated occurred when the Korean database was used in a testing capacity in independent testing. Conclusion: The few observed statistically significant differences in performance indicated that while the US features used by the system were useful across the databases, their relative importance differed. In practice, this means that a CAD system may need to be adjusted when applied to a different population. (c) RSNA, 2009. PMID: 19864511 [PubMed - as supplied by publisher]

Experimental Design and Data Analysis in Receiver Operating Characteristic Studies: Lessons Learned from Reports in Radiology from 1997 to 2006.

Related Articles Experimental Design and Data Analysis in Receiver Operating Characteristic Studies: Lessons Learned from Reports in Radiology from 1997 to 2006. Radiology. 2009 Oct 28; Authors: Shiraishi J, Pesce LL, Metz CE, Doi K Purpose: To provide a broad perspective concerning the recent use of receiver operating characteristic (ROC) analysis in medical imaging by reviewing ROC studies published in Radiology between 1997 and 2006 for experimental design, imaging modality, medical condition, and ROC paradigm. Materials and Methods: Two hundred ninety-five studies were obtained by conducting a literature search with PubMed with two criteria: publication in Radiology between 1997 and 2006 and occurrence of the phrase "receiver operating characteristic." Studies returned by the query that were not diagnostic imaging procedure performance evaluations were excluded. Characteristics of the remaining studies were tabulated. Results: Two hundred thirty-three (79.0%) of the 295 studies reported findings based on observers' diagnostic judgments or objective measurements. Forty-three (14.6%) did not include human observers, with most of these reporting an evaluation of a computer-aided diagnosis system or functional data obtained with computed tomography (CT) or magnetic resonance (MR) imaging. The remaining 19 (6.4%) studies were classified as reviews or meta-analyses and were excluded from our subsequent analysis. Among the various imaging modalities, MR imaging (46.0%) and CT (25.7%) were investigated most frequently. Approximately 60% (144 of 233) of ROC studies with human observers published in Radiology included three or fewer observers. Conclusion: ROC analysis is widely used in radiologic research, confirming its fundamental role in assessing diagnostic performance. However, the ROC studies reported in Radiology were not always adequate to support clear and clinically relevant conclusions. Supplemental material: http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.2533081632/-/DC1 (c) RSNA, 2009. PMID: 19864510 [PubMed - as supplied by publisher]

CT Coronary Angiography in Patients Suspected of Having Coronary Artery Disease: Decision Making from Various Perspectives in the Face of Uncertainty.

Related Articles CT Coronary Angiography in Patients Suspected of Having Coronary Artery Disease: Decision Making from Various Perspectives in the Face of Uncertainty. Radiology. 2009 Oct 28; Authors: Genders TS, Meijboom WB, Meijs MF, Schuijf JD, Mollet NR, Weustink AC, Pugliese F, Bax JJ, Cramer MJ, Krestin GP, de Feyter PJ, Hunink MG Purpose: To determine the cost-effectiveness of computed tomographic (CT) coronary angiography as a triage test, performed prior to conventional coronary angiography, by using a Markov model. Materials and Methods: A Markov model was used to analyze the cost-effectiveness of CT coronary angiography performed as a triage test prior to conventional coronary angiography from the perspective of the patient, physician, hospital, health care system, and society by using recommendations from the United Kingdom, the United States, and the Netherlands for cost-effectiveness analyses. For CT coronary angiography, a range of sensitivities (79%-100%) and specificities (63%-94%) were used to help diagnose significant coronary artery disease (CAD). Optimization criteria (ie, outcomes considered) were: revised posttest probability of CAD, life-years, quality-adjusted life-years (QALYs), costs, and incremental cost-effectiveness ratios (ICERs). Extensive sensitivity analysis was performed. Results: For a prior probability of CAD of less than 40%, the probability of CAD after CT coronary angiography with negative results was less than 1%. The Markov model calculations from the patient/physician perspective suggest that CT coronary angiography maximizes life-years respectively in 60-year-old men and women at a prior probability of less than 38% and 24% and maximizes QALYs at a prior probability of less than 17% and 11%. From the hospital/health care perspective, CT coronary angiography helps reduce health care and direct nonhealth care-related costs (according to UK/U.S. recommendations), regardless of prior probability, and lowers all costs, including production losses (Netherlands recommendations) at a prior probability of less than 87%-92%. Analysis performed from a societal perspective by using a willingness-to-pay threshold level of euro80 000/QALY suggests that CT coronary angiography is cost-effective when the prior probability is lower than 44% and 37% in men and women, respectively. Sensitivity analyses showed that results changed across the reported range of sensitivity of CT coronary angiography. Conclusion: The optimal diagnostic work-up depends on the optimization criterion, prior probability of CAD, and the diagnostic performance of CT coronary angiography. Supplemental material: http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.2533090507/-/DC1 (c) RSNA, 2009. PMID: 19864509 [PubMed - as supplied by publisher]

MR Angiography of Infrapopliteal Arteries in Patients with Peripheral Arterial Occlusive Disease by Using Gadofosveset at 3.0 T: Diagnostic Accuracy Compared with Selective DSA.

Related Articles MR Angiography of Infrapopliteal Arteries in Patients with Peripheral Arterial Occlusive Disease by Using Gadofosveset at 3.0 T: Diagnostic Accuracy Compared with Selective DSA. Radiology. 2009 Oct 28; Authors: Bonel HM, Saar B, Hoppe H, Keo HH, Husmann M, Nikolaou K, Ludwig K, Szucs-Farkas Z, Srivastav S, Kickuth R Purpose: To prospectively compare the diagnostic accuracy of steady-state, high-spatial-resolution magnetic resonance (MR) angiography of the lower leg, performed with a blood pool contrast agent, with selective digital subtraction angiography (DSA) as the reference standard in patients with symptomatic peripheral arterial disease. Materials and Methods: Local ethics committee approval and written informed consent were obtained. In a nonrandomized trial, selective DSA and MR angiography were performed at 3.0 T with a blood pool contrast agent on 22 calves in 20 patients (mean age, 69.4 years +/- 11.3 [standard deviation]), 16 men (mean age, 67.8 years +/- 12.4) and four women (mean age, 75.6 years +/- 3.6 years), to evaluate 352 arterial segments. DSA and MR angiography were performed within 24 hours of each other and directly compared by three experienced, blinded radiologists by using high-spatial-resolution steady-state MR angiograms. Consensus reading for both DSA and MR angiography served as the reference standard. Results: MR angiography was successful and occurred without serious adverse events in all patients. Seven significantly stenosed and 40 occluded segments were rated equally in both modalities. In three cases, the tibial arteries were shown to be occluded or significantly stenosed at DSA but appeared normal or significantly stenosed at MR angiography. The respective average segment sensitivity, specificity, and accuracy were 98.3% (59 of 60), 98% (113.7 of 116), and 98.1% (172.7 of 176) for DSA and 100% (60 of 60), 100% (116 of 116), and 100% (176 of 176) for MR angiography. Steady-state MR angiography was especially useful for the distal peroneal artery and the proximal anterior tibial artery. Conclusion: MR angiography performed with blood pool agents has an accuracy comparable with that of selective DSA in the lower leg but with less risk involved. Steady-state imaging performed with blood pool agents facilitates evaluation of MR angiography of infrapopliteal arteries. (c) RSNA, 2009. PMID: 19864508 [PubMed - as supplied by publisher]

Variability in Interpretive Performance at Screening Mammography and Radiologists' Characteristics Associated with Accuracy.

Related Articles Variability in Interpretive Performance at Screening Mammography and Radiologists' Characteristics Associated with Accuracy. Radiology. 2009 Oct 28; Authors: Elmore JG, Jackson SL, Abraham L, Miglioretti DL, Carney PA, Geller BM, Yankaskas BC, Kerlikowske K, Onega T, Rosenberg RD, Sickles EA, Buist DS Purpose: To identify radiologists' characteristics associated with interpretive performance in screening mammography. Materials and Methods: The study was approved by institutional review boards of University of Washington (Seattle, Wash) and institutions at seven Breast Cancer Surveillance Consortium sites, informed consent was obtained, and procedures were HIPAA compliant. Radiologists who interpreted mammograms in seven U.S. regions completed a self-administered mailed survey; information on demographics, practice type, and experience in and perceptions of general radiology and breast imaging was collected. Survey data were linked to data on screening mammograms the radiologists interpreted between January 1, 1998, and December 31, 2005, and included patient risk factors, Breast Imaging Reporting and Data System assessment, and follow-up breast cancer data. The survey was returned by 71% (257 of 364) of radiologists; in 56% (205 of 364) of the eligible radiologists, complete data on screening mammograms during the study period were provided; these data were used in the final analysis. An evaluation of whether the radiologists' characteristics were associated with recall rate, false-positive rate, sensitivity, or positive predictive value of recall (PPV(1)) of the screening examinations was performed with logistic regression models that were adjusted for patients' characteristics and radiologist-specific random effects. Results: Study radiologists interpreted 1 036 155 screening mammograms; 4961 breast cancers were detected. Median percentages and interquartile ranges, respectively, were as follows: recall rate, 9.3% and 6.3%-13.2%; false-positive rate, 8.9% and 5.9%-12.8%; sensitivity, 83.8% and 74.5%-92.3%; and PPV(1), 4.0% and 2.6%-5.9%. Wide variability in sensitivity was noted, even among radiologists with similar false-positive rates. In adjusted regression models, female radiologists or fellowship-trained radiologists had significantly higher recall and false-positive rates (P < .05, all). Fellowship training in breast imaging was the only characteristic significantly associated with improved sensitivity (odds ratio, 2.32; 95% confidence interval: 1.42, 3.80; P < .001) and the overall accuracy parameter (odds ratio, 1.61; 95% confidence interval: 1.05, 2.45; P = .028). Conclusion: Fellowship training in breast imaging may lead to improved cancer detection, but it is associated with higher false-positive rates. (c) RSNA, 2009. PMID: 19864507 [PubMed - as supplied by publisher]

Association of Aortic Arch Pulse Wave Velocity with Left Ventricular Mass and Lacunar Brain Infarcts in Hypertensive Patients: Assessment with MR Imaging.

Related Articles Association of Aortic Arch Pulse Wave Velocity with Left Ventricular Mass and Lacunar Brain Infarcts in Hypertensive Patients: Assessment with MR Imaging. Radiology. 2009 Oct 28; Authors: Brandts A, van Elderen SG, Westenberg JJ, van der Grond J, van Buchem MA, Huisman MV, Kroft LJ, Tamsma JT, de Roos A Purpose: To assess the possible association between aortic arch stiffness, which may cause hypertensive cardiovascular disease, and cardiac and cerebral end-organ damage in patients with hypertension by using magnetic resonance (MR) imaging. Materials and Methods: Approval from the local institutional review board was obtained, and patients gave informed consent. Fifty patients with hypertension (31 women and 19 men; mean age +/- standard deviation, 49.2 years +/- 12.7; mean systolic blood pressure, 152.1 mm Hg +/- 22.3; mean diastolic blood pressure, 88.0 mm Hg +/- 13.1), compliant for treatment with antihypertensive medication, were prospectively enrolled for MR examinations of the aorta, heart, and brain with standard pulse sequences. Aortic arch pulse wave velocity (PWV), left ventricular (LV) mass, LV systolic and diastolic function, lacunar brain infarcts, and periventricular and deep white matter hyperintensities (WMHs) were assessed. Univariable and multiple linear and logistic regression analyses were used for statistical analyses. Results: Mean aortic arch PWV was 7.3 m/sec +/- 2.5. Aortic arch PWV was statistically significantly associated with LV mass (r = 0.30, P = .03, beta = 1.73); indexes of systolic function, including ejection fraction (r = -0.38, P = .01, beta = -1.12); indexes of diastolic function, including the ratio of early diastolic to atrial contraction peak filling rates (r = -0.44, P < .01, beta = -0.11); lacunar brain infarcts (odds ratio [OR] = 1.8, P < .01); and periventricular (OR = 1.5, P = .01) and deep (OR = 1.6, P = .01) WMHs. Aortic arch PWV was statistically significantly associated with LV mass (r = 0.37, P = .03, beta = 2.11) and lacunar brain infarcts (OR = 1.8, P = .04), independent of age, sex, and hypertension duration, but not with indexes of diastolic and systolic function and WMHs. Conclusion: Aortic arch stiffness is associated with LV mass and lacunar brain infarcts in hypertensive patients, independent of age, sex, and hypertension duration; these manifestations of end-organ damage may help to risk stratify hypertensive patients. (c) RSNA, 2009. PMID: 19864506 [PubMed - as supplied by publisher]

Age-related changes on thin-section CT images.

Related Articles Age-related changes on thin-section CT images. Radiology. 2009 Oct;253(1):279; author reply 279-80 Authors: Vehmas T, Copley SJ, Wells AU, Hansell DM PMID: 19789262 [PubMed - indexed for MEDLINE]

Lung cancer screening outcomes.

Related Articles Lung cancer screening outcomes. Radiology. 2009 Oct;253(1):277 Authors: Reich JM PMID: 19789261 [PubMed - indexed for MEDLINE]

CT attenuation in acute pulmonary embolism: an enigma.

Related Articles CT attenuation in acute pulmonary embolism: an enigma. Radiology. 2009 Oct;253(1):277-8; author reply 278 Authors: Arakawa H, Thoma P, Gevenois PA PMID: 19789260 [PubMed - indexed for MEDLINE]

Case 150: Van Buchem disease (hyperostosis corticalis generalisata).

Related Articles Case 150: Van Buchem disease (hyperostosis corticalis generalisata). Radiology. 2009 Oct;253(1):272-6 Authors: Wengenroth M, Vasvari G, Federspil PA, Mair J, Schneider P, Stippich C PMID: 19789259 [PubMed - indexed for MEDLINE]

Locally advanced rectal cancer: added value of diffusion-weighted MR imaging in the evaluation of tumor response to neoadjuvant chemo- and radiation therapy.

Related Articles Locally advanced rectal cancer: added value of diffusion-weighted MR imaging in the evaluation of tumor response to neoadjuvant chemo- and radiation therapy. Radiology. 2009 Oct;253(1):116-25 Authors: Kim SH, Lee JM, Hong SH, Kim GH, Lee JY, Han JK, Choi BI PURPOSE: To investigate the added value of diffusion-weighted (DW) magnetic resonance (MR) imaging in the evaluation of complete response (CR) to neoadjuvant combined chemotherapy and radiation therapy (CRT) in patients with locally advanced rectal cancer. MATERIALS AND METHODS: Institutional review board approval was obtained for this retrospective study, and the patient informed consent requirement was waived. Forty consecutive patients with locally advanced rectal cancer (>or=T3 or lymph node positive) who underwent CRT and subsequent surgery were enrolled in this study. All patients underwent pre- and post-CRT 1.5-T rectal MR imaging and post-CRT DW MR imaging. For qualitative analysis, two radiologists who were blinded to pathologic staging and prior imaging data retrospectively and independently reviewed conventional MR images and the combined set of MR images and DW MR images over a 2-week interval and recorded their confidence level with respect to the CR to neoadjuvant CRT. Diagnostic accuracy was calculated for each reviewer with receiver operating characteristic (ROC) curve analysis. For quantitative analysis, a third radiologist measured the apparent diffusion coefficient (ADC) of the region of interest three times. Mean ADCs in the CR group were compared with those in the non-CR group. Pathology reports served as the reference standard. RESULTS: Diagnostic accuracy (area under the ROC curve [A(z)]) in the evaluation of CR was significantly improved after additional review of DW MR images for both reviewers: For reviewer 1, A(z) improved from 0.676 to 0.876 (P = .005), whereas for reviewer 2, A(z) improved from 0.658 to 0.815 (P = .036). Mean ADC ([1.62 +/- 0.36] x 10(-3) mm(2)/sec) (standard deviation) of the CR group (n = 11) was significantly higher than that ([1.04 +/- 0.24] x 10(-3) mm(2)/sec) of the non-CR group (n = 29) (P < .0001). CONCLUSION: Adding DW MR imaging to conventional MR imaging yields better diagnostic accuracy than use of conventional MR imaging alone in the evaluation of CR to neoadjuvant CRT in patients with locally advanced rectal cancer. PMID: 19789256 [PubMed - indexed for MEDLINE]

MR labeling information for implants and devices: explanation of terminology.

Related Articles MR labeling information for implants and devices: explanation of terminology. Radiology. 2009 Oct;253(1):26-30 Authors: Shellock FG, Woods TO, Crues JV PMID: 19789253 [PubMed - indexed for MEDLINE]

Can computer-aided detection be detrimental to mammographic interpretation?

Related Articles Can computer-aided detection be detrimental to mammographic interpretation? Radiology. 2009 Oct;253(1):17-22 Authors: Philpotts LE PMID: 19789251 [PubMed - indexed for MEDLINE]

The preponderance of evidence supports computer-aided detection for screening mammography.

Related Articles The preponderance of evidence supports computer-aided detection for screening mammography. Radiology. 2009 Oct;253(1):9-16 Authors: Birdwell RL PMID: 19789250 [PubMed - indexed for MEDLINE]

Science to practice: can MR elastography be used to detect early steatohepatitis in fatty liver disease?

Related Articles Science to practice: can MR elastography be used to detect early steatohepatitis in fatty liver disease? Radiology. 2009 Oct;253(1):1-3 Authors: Ehman RL SUMMARY: Fatty liver disease is common in Western countries. Some patients with this condition develop steatohepatitis, with ongoing liver injury that can lead to cirrhosis. Liver biopsy is currently required to differentiate between uncomplicated fatty liver disease and the more serious condition of steatohepatitis. Salameh and colleagues (1) studied the potential role of MR elastography for this diagnostic task in rat models of simple fatty liver and steatohepatitis. Their results suggest that MR elastography may have a potentially important role for noninvasive early detection of steatohepatitis in patients with fatty liver disease. PMID: 19789246 [PubMed - indexed for MEDLINE]

Wide-necked intracranial aneurysms: treatment with stent-assisted coil embolization during acute (<72 hours) subarachnoid hemorrhage--experience in 61 consecutive patients.

Related Articles Wide-necked intracranial aneurysms: treatment with stent-assisted coil embolization during acute (<72 hours) subarachnoid hemorrhage--experience in 61 consecutive patients. Radiology. 2009 Oct;253(1):199-208 Authors: Tähtinen OI, Vanninen RL, Manninen HI, Rautio R, Haapanen A, Niskakangas T, Rinne J, Keski-Nisula L PURPOSE: To evaluate the safety and efficacy of stent-assisted embolization of ruptured wide-necked intracranial aneurysms during acute subarachnoid hemorrhage (SAH). MATERIALS AND METHODS: Institutional review board approval for this retrospective study was obtained; the need to obtain informed consent was waived. Results in 61 consecutive patients (20 men, 41 women; mean age, 55.1 years; range, 26-83 years) with acutely ruptured wide-necked intracranial aneurysms who were treated with stent-assisted coil embolization were evaluated. The mean length of angiographic follow-up was 12.1 months (range, 0-52 months). Statistical analysis was performed to determine whether the features of the patient and the ruptured aneurysm affected the primary angiographic result or the patient's clinical outcome. Categoric and dichotomous variables were examined with the chi(2) test or the Fisher exact test; the Mann-Whitney U test and Kruskal-Wallis one-way analysis were used to compare continuous-scale data for non-normally distributed variables. RESULTS: The technical success rate was 72% (44 of 61). The technique-related complication rate was 21% (13 of 61), and the 30-day mortality rate was 20% (12 of 61). There was only one case of rebleeding, and clinical outcome was good for the majority of the patients (69% [42 of 61] had Glasgow Outcome Scale scores of 4 or 5 at the end of the study period). CONCLUSION: Stent-assisted coil embolization is a feasible method for the endovascular treatment of wide-necked intracranial aneurysms that are difficult to treat surgically or with balloon-assisted embolization during acute SAH. The risk of subsequent rerupture of the aneurysm seems to be reduced for aneurysms treated early compared with that for nonsecured aneurysms. PMID: 19710006 [PubMed - indexed for MEDLINE]

Cystic fibrosis: are volumetric ultra-low-dose expiratory CT scans sufficient for monitoring related lung disease?

Related Articles Cystic fibrosis: are volumetric ultra-low-dose expiratory CT scans sufficient for monitoring related lung disease? Radiology. 2009 Oct;253(1):223-9 Authors: Loeve M, Lequin MH, de Bruijne M, Hartmann IJ, Gerbrands K, van Straten M, Hop WC, Tiddens HA PURPOSE: To assess whether chest computed tomography (CT) scores from ultra-low-dose end-expiratory scans alone could suffice for assessment of all cystic fibrosis (CF)-related structural lung abnormalities. MATERIALS AND METHODS: In this institutional review board-approved study, 20 patients with CF aged 6-20 years (eight males, 12 females) underwent low-dose end-inspiratory CT and ultra-low-dose end-expiratory CT. Informed consent was obtained. Scans were randomized and scored by using the Brody-II CT scoring system to assess bronchiectasis, airway wall thickening, mucus plugging, and opacities. Scoring was performed by two observers who were blinded to patient identity and clinical information. Mean scores were used for all analyses. Statistical analysis included assessment of intra- and interobserver variability, calculation of intraclass correlation coefficients (ICCs), and Bland-Altman plots. RESULTS: Median age was 12.6 years (range, 6.3-20.3 years), median forced expiratory volume in 1 second was 100% (range, 46%-127%) of the predicted value, and median forced vital capacity was 99% (range, 61%-123%) of the predicted value. Very good agreement was observed between end-inspiratory and end-expiratory CT scores for Brody-II total score (ICC = 0.96), bronchiectasis (ICC = 0.98), airway wall thickening (ICC = 0.94), mucus plugging (ICC = 0.96), and opacities (ICC = 0.90). Intra- and interobserver agreement were good to very good (ICC range, 0.70-0.98). Bland-Altman plots showed that differences in scores were independent of score magnitude. CONCLUSION: In this pilot study, CT scores from end-expiratory and end-inspiratory CT match closely, suggesting that ultra-low-dose end-expiratory CT alone may be sufficient for monitoring CF-related lung disease. This would help reduce radiation dose for a single investigation by up to 75%. PMID: 19710003 [PubMed - indexed for MEDLINE]

Value of 18F-fluoro-L-dopa PET in the preoperative localization of focal lesions in congenital hyperinsulinism.

Related Articles Value of 18F-fluoro-L-dopa PET in the preoperative localization of focal lesions in congenital hyperinsulinism. Radiology. 2009 Oct;253(1):216-22 Authors: Capito C, Khen-Dunlop N, Ribeiro MJ, Brunelle F, Aigrain Y, Crétolle C, Jaubert F, De Lonlay P, Nihoul-Fékété C PURPOSE: To retrospectively compare fluorine 18 ((18)F) fluoro-L-dopa positron emission tomography (PET) and pancreatic venous sampling (PVS) in the preoperative differentiation of diffuse from focal congenital hyperinsulinism (CHI) and localization of focal lesions. MATERIALS AND METHODS: This study was approved by the institutional ethical committee, and informed consent for the research study was obtained from the parents of all subjects. Fifty-one patients evaluated for focal CHI between January 1, 1995, and January 31, 2008, were included. Thirty five underwent PVS evaluation alone, and 16 underwent a PET evaluation alone. The sensitivity values of each technique for the diagnosis and localization of focal lesions were compared in regard to results of surgery and pathologic analyses. In each patient, perioperative treatment was reviewed, and the presence of postoperative hypoglycemia was assessed as evidence of incomplete resection. Comparisons of the sensitivity values and recurrence rates were performed by using the Fisher exact test in regard to the number of patients. Comparisons of median age, weight, or number of biopsies were performed with a two-tailed unpaired Mann-Whitney U test. A difference with P < .05 was considered significant. RESULTS: For PVS and PET groups, there was no error in differentiating focal from diffuse forms. PVS was not completed in four of 35 patients. In 27 (87%) of 31 patients in whom PVS was completed and 13 (81%) of 16 patients in whom PET was completed, preoperative localization of the focal lesion was in accordance with the surgical findings (P = .7). Although not significant, the number of biopsies performed before discovering the focal lesion was higher in the PET group compared with the PVS group (P = .06). Inadequate localization occurred in two (6%) patients in the PVS group and five (31%) patients in the PET group at initial preoperative imaging study; these patients underwent repeat surgery for residual CHI (P = .03). CONCLUSION: (18)F-fluoro-L-dopa PET is equivalent to PVS in the characterization of CHI but does not provide localization of the lesion as precisely as does PVS. PMID: 19709999 [PubMed - indexed for MEDLINE]

The Medical Image Perception Society update on key issues for image perception research.

Related Articles The Medical Image Perception Society update on key issues for image perception research. Radiology. 2009 Oct;253(1):230-3 Authors: Krupinski EA, Berbaum KS PMID: 19709995 [PubMed - indexed for MEDLINE]

Endovascular abdominal aortic aneurysm repair: nonenhanced volumetric CT for follow-up.

Related Articles Endovascular abdominal aortic aneurysm repair: nonenhanced volumetric CT for follow-up. Radiology. 2009 Oct;253(1):253-62 Authors: Bley TA, Chase PJ, Reeder SB, François CJ, Shinki K, Tefera G, Ranallo FN, Grist TM, Pozniak M PURPOSE: To evaluate the clinical usefulness of volumetric analysis at nonenhanced computed tomography (CT) as the sole method with which to follow up endovascular abdominal aortic aneurysm repair (EVAR) and to identify endoleaks causing more than 2% volumetric increase from the previous volume determination. MATERIALS AND METHODS: The study had institutional review board approval. Images were reviewed retrospectively in a HIPAA-compliant manner for 230 CT studies in 70 patients (11 women, 59 men; mean age, 74 years) who underwent EVAR. The scannning protocol consisted of three steps: (a) contrast material-enhanced CT angiography before endovascular stent placement, (b) contrast-enhanced CT angiography 0-3 months after repair to depict immediate complications, and (c) nonenhanced CT at 3, 6, and 12 months after repair. At each follow-up visit, immediate aortic volume analysis was performed. If the interval volumetric change was 2% or less, no further imaging was performed. If the volume increased by more than 2% on the nonenhanced CT image, contrast-enhanced CT angiography was performed immediately to identify the suspected endoleak. Confidence intervals (CIs) were obtained by using bootstrapping to account for repeated measurements in the same patients. RESULTS: Mean volume decrease was -3.2% (95% CI: -4.7%, -1.9%) in intervals without occurrence of a clinically relevant endoleak (n = 183). Types I and III high-pressure endoleaks (n = 10) showed a 10.0% (95% CI: 5.0%, 18.2%) interval volumetric increase. Type II low-pressure endoleaks (n = 37) showed a 5.4% (95% CI: 4.6%, 6.2%) interval volumetric increase. Endoleaks associated with minimal aortic volume increase of less than 2% did not require any intervention. This protocol reduced radiation exposure by approximately 57%-82% in an average-sized patient. CONCLUSION: Serial volumetric analysis of aortic aneurysm with nonenhanced CT serves as an adequate screening test for endoleak, causing volumetric increase of more than 2% from the volume seen at the previous examination. PMID: 19703867 [PubMed - indexed for MEDLINE]

Rheumatoid synovial inflammation: pixel-by-pixel dynamic contrast-enhanced MR imaging time-intensity curve shape analysis--a feasibility study.

Related Articles Rheumatoid synovial inflammation: pixel-by-pixel dynamic contrast-enhanced MR imaging time-intensity curve shape analysis--a feasibility study. Radiology. 2009 Oct;253(1):234-40 Authors: van der Leij C, van de Sande MG, Lavini C, Tak PP, Maas M PURPOSE: To analyze the distribution of different shapes of time-intensity curves (TICs) in synovial tissue of patients with rheumatoid arthritis (RA) and to compare relative numbers of TIC shapes between patients with RA and healthy control subjects. MATERIALS AND METHODS: This prospective study was approved by the institutional review board; patients and control subjects gave written informed consent. Dynamic contrast material-enhanced magnetic resonance (MR) imaging of the knee joint in five patients with early RA and in five control subjects was performed. Parametric maps showing seven TIC shape types were created. Spatial information of the synovial TIC shape distribution pattern and relative number of TIC shapes were calculated on a three-dimensional region of interest. Relative TIC shape numbers were compared by using a nonparametric Mann-Whitney U test. RESULTS: Synovial enhancement in patients with RA consisted of type 2 TIC shapes (slow enhancement) with heterogeneous zones of types 3 (fast enhancement followed by plateau phase), 4 (fast enhancement followed by early washout phase), and 5 (fast enhancement followed by slow enhancement increase) TIC shapes, compared with almost only type 2 TIC shapes in control subjects. The heterogeneous zones were seen in the lateral and medial knee compartments and around the cruciate ligaments. A significantly higher relative number of type 4 TIC shapes was observed in the patient group compared with the control group (16.5% vs 6.9%, P = .008). CONCLUSION: The pixel-by-pixel dynamic contrast-enhanced MR imaging TIC shape analysis may help distinguish patients with RA from control subjects on the basis of the relative number of type 4 TIC shapes. This study provides the rationale for future research to evaluate the utility of this approach in clinical practice. PMID: 19703863 [PubMed - indexed for MEDLINE]

Myocardial fat deposition after left ventricular myocardial infarction: assessment by using MR water-fat separation imaging.

Related Articles Myocardial fat deposition after left ventricular myocardial infarction: assessment by using MR water-fat separation imaging. Radiology. 2009 Oct;253(1):65-73 Authors: Goldfarb JW, Roth M, Han J PURPOSE: To prospectively investigate the prevalence of fat deposition in chronic myocardial infarction (MI) by using magnetic resonance (MR) fat-water separation imaging with sampling of the entire left ventricular (LV) myocardium. A subsidiary aim was to determine the relationship between LV fat deposition and scar characteristics, as well as regional and global cardiac functional parameters. MATERIALS AND METHODS: Twenty-five patients with LV MI were evaluated in this prospective institutional review board-approved, Health Insurance Portability and Accountability Act-compliant study after they provided written informed consent. A 1.5-T MR system was used to perform volumetric cine, fat-sensitive, and late gadolinium-enhanced (LGE) infarct imaging. Water-fat separation was performed by using a three-point Dixon reconstruction from in- and opposed-phase black-blood gradient-echo images. Fat deposition location was compared with LGE infarct imaging by using a 17-segment model. Global and regional functional variables, LGE volumes, and fat deposition were compared by using the Pearson correlation, Student t test, and multiple regression. RESULTS: A fat deposition prevalence of 68% was found in areas of chronic MI. The patients with fat deposition had larger infarctions (30.0 mL +/- 15.1 [standard deviation] vs 14.8 mL +/- 6.1; P = .002), decreased wall thickening (2.3% +/- 20.0 vs 37.8% +/- 34.4; P = .003), and impaired endocardial wall motion (2.9 mm +/- 2.0 vs 5.8 mm +/- 2.6; P = .007). The volume of fat deposition was correlated with infarct volume, LV ejection fraction, LV end-diastolic volume index, and LV end-systolic volume index. CONCLUSION: There is a high prevalence of fat deposition in healed MI. It is associated with post-infarction characteristics including infarct volume, LV mass, wall thickness, wall thickening, and wall motion. PMID: 19703860 [PubMed - indexed for MEDLINE]

Influence of E-cadherin expression on the mammographic appearance of invasive nonlobular breast carcinoma detected at screening.

Related Articles Influence of E-cadherin expression on the mammographic appearance of invasive nonlobular breast carcinoma detected at screening. Radiology. 2009 Oct;253(1):51-5 Authors: Doyle S, Evans AJ, Rakha EA, Green AR, Ellis IO PURPOSE: To determine whether E-cadherin loss causes nonlobular cancers (NLCs) detected at mammographic screening to have different mammographic appearances than do NLCs with normal E-cadherin expression. MATERIALS AND METHODS: This study design had hospital ethics committee approval; informed consent was waived. Membranous expression of E-cadherin was assessed immunohistochemically in patients younger than 70 years from a consecutive series of 1944 operable invasive breast cancers. Of those, 276 NLC cases (age range, 45-70 years) were common to a prospectively collected database of breast cancer detected at screening. The mammographic features of 131 NLCs with reduced E-cadherin expression were compared with those of 145 NLCs with normal E-cadherin expression. RESULTS: NLCs with E-cadherin loss were more likely to manifest as an ill-defined mass and less likely to manifest noncomedo microcalcifications at mammography than were NLCs with normal E-cadherin expression (47 [35.9%] of 131 vs 35 [24.1%] of 145, P = .03; and one [0.8%] of 131 versus 13 [9%] of 145, P = .001; respectively). NLCs with E-cadherin loss were significantly larger (>or=15 mm) than NLCs with normal E-cadherin expression (71 [54.2%] of 131 NLCs vs 57 [39.3%] of 145; P = .01). Both groups had a similar distribution of grade, tumor type, nodal metastases, and vascular invasion. CONCLUSION: Invasive NLCs with reduced E-cadherin expression detected at screening are more likely to appear as ill-defined masses and less likely to manifest noncomedo microcalcifications than are NLCs with normal E-cadherin expression. NLCs with reduced E-cadherin expression appear to have mammographic features that make them difficult to detect at small sizes. PMID: 19703859 [PubMed - indexed for MEDLINE]

Endovascular treatment of 174 middle cerebral artery aneurysms: clinical outcome and radiologic results at long-term follow-up.

Related Articles Endovascular treatment of 174 middle cerebral artery aneurysms: clinical outcome and radiologic results at long-term follow-up. Radiology. 2009 Oct;253(1):191-8 Authors: Vendrell JF, Menjot N, Costalat V, Hoa D, Moritz J, Brunel H, Bonafe A PURPOSE: To retrospectively evaluate the immediate safety and efficacy as well as the clinical outcome and long-term angiographic results of endovascular treatment (EVT) of middle cerebral artery (MCA) aneurysms. MATERIALS AND METHODS: This is a retrospective review of patients in whom coiling of MCA aneurysms was attempted over a 7-year period. Institutional review board approval and informed written consent were obtained. This study included 153 patients (90 women, 63 men; mean age, 49.5 years +/- 11.7 [standard deviation]) with 174 MCA aneurysms (71 unruptured, 103 ruptured). Complications of EVT, clinical outcome, and the results of either cerebral digital subtraction angiography (DSA) or magnetic resonance (MR) angiography were analyzed at initial, intermediate (6-18 months), and late (2-7 years) follow-up. RESULTS: Coiling was performed in 160 (92%) aneurysms in 141 patients. Periprocedural complications were observed in 31 (19.4%) procedures, including aneurysm perforations (n = 7, 4.4%) and thromboembolic events (n = 24, 15.0%). EVT induced permanent morbidity in eight (5.7%) patients, with severe neurologic impairment in three (2.1%) and two deaths (1.4%). Of 114 MCA aneurysms controlled by using DSA (n = 50) or MR angiography (n = 64) at 50 months +/- 14, 73 (64%) remained completely occluded, 31 (27.2%) recurred, and 12 (10.5%) major recurrences were retreated. A balloon remodeling technique allowed treatment of complex aneurysms (n = 63) but was associated with more recurrences in the long term (42.6%) than aneurysms treated without balloon assistance (16.4%; P = .016). CONCLUSION: EVT of MCA aneurysms was safe and long-term monitoring of patients showed a low rate of recurrence requiring retreatment. However, complex anatomy and long-term recurrences have to be addressed when considering EVT for MCA aneurysms. PMID: 19703857 [PubMed - indexed for MEDLINE]

Peripheral zone prostate cancer in patients with elevated PSA levels and low free-to-total PSA ratio: detection with MR imaging and MR spectroscopy.

Related Articles Peripheral zone prostate cancer in patients with elevated PSA levels and low free-to-total PSA ratio: detection with MR imaging and MR spectroscopy. Radiology. 2009 Oct;253(1):135-43 Authors: Vilanova JC, Comet J, Barceló-Vidal C, Barceló J, López-Bonet E, Maroto A, Arzoz M, Moreno A, Areal J PURPOSE: To retrospectively assess the value of endorectal magnetic resonance (MR) imaging and MR spectroscopy combined with the free-to-total prostate-specific antigen (PSA) ratio for detecting prostate cancer in men with elevated PSA levels. MATERIALS AND METHODS: The institutional review board approved the study, and all patients provided informed written consent. Endorectal MR imaging and MR spectroscopy were performed in 54 patients with PSA levels greater than 3 ng/mL but less than 15 ng/mL and free-to-total PSA ratio of less than 20%, followed by sextant biopsy in the peripheral zone. For each patient, MR imaging and MR spectroscopic findings, PSA level, and free-to-total PSA ratio were analyzed and compared with biopsy results and/or histopathologic tumor maps with regard to a sextant-modified distribution. The likelihood of cancer in each sextant according to MR and MR spectroscopic findings was graded independently on a scale of 1 (benign) to 5 (malignant). Detection accuracy and a multivariate logistic regression analysis were used to determine the most accurate combination of imaging, and clinical tests were used to detect prostate cancer according to the area under the receiver operating characteristic curve (AUC). RESULTS: The model incorporating MR imaging, MR spectroscopy, and free-to-total PSA ratio (AUC = 97.5%) was significantly more accurate in predicting prostate cancer than models using MR imaging alone (AUC = 85.1%; P = .007), MR spectroscopy alone (AUC = 87.2%; P = .041), or MR imaging and free-to-total PSA ratio combined (AUC = 90.8%; P = .038). CONCLUSION: MR and MR spectroscopy combined with free-to-total PSA ratio improves the predictive value for prostate cancer detection. PMID: 19703854 [PubMed - indexed for MEDLINE]

Kidney neoplasms: renal halo sign after percutaneous radiofrequency ablation--incidence and clinical importance in 101 consecutive patients.

Related Articles Kidney neoplasms: renal halo sign after percutaneous radiofrequency ablation--incidence and clinical importance in 101 consecutive patients. Radiology. 2009 Oct;253(1):263-9 Authors: Schirmang TC, Mayo-Smith WW, Dupuy DE, Beland MD, Grand DJ PURPOSE: To describe the incidence and clinical importance of the renal halo sign after percutaneous radiofrequency ablation (RFA) of renal neoplasms. MATERIALS AND METHODS: Institutional review board approval was obtained for this HIPAA-compliant retrospective study. The study population consisted of 101 consecutive patients with 106 solid renal neoplasms that were treated with percutaneous RFA. Postablation computed tomographic (CT) and magnetic resonance (MR) images were retrospectively reviewed by three board-certified radiologists to determine the presence of the renal halo sign. Statistical analyses were performed to determine reader agreement and assess the effect that tumor size and location, radiofrequency (RF) applicator type, RFA treatment time and success, maximum RFA treatment temperature, and number of RF applications performed had on development of the renal halo sign. RESULTS: The renal halo sign developed in 79 (75%) of the 106 ablated tumors. Average imaging follow-up lasted 25 months (range, 1-98 months). The renal halo sign appeared, on average, 6 months (range, 1 month to 3 years) after RFA. The renal halo sign resolved in five (6%) of 79 tumors treated. Interobserver agreement for the presence of the renal halo sign was high. Tumor size and location, RF applicator type, RFA treatment time and success, maximum RFA treatment temperature, and number of RF applications performed were not independent predictors of renal halo sign development. CONCLUSION: The renal halo sign is seen in 75% of patients after percutaneous RFA of renal neoplasms. It may decrease in size over time; however, it rarely disappears. It is important to recognize this sign, as it can be mistaken for recurrent tumor or angiomyolipoma by radiologists who are not familiar with RFA. PMID: 19703853 [PubMed - indexed for MEDLINE]

Primary progressive multiple sclerosis: tactile-associated functional MR activity in the cervical spinal cord.

Related Articles Primary progressive multiple sclerosis: tactile-associated functional MR activity in the cervical spinal cord. Radiology. 2009 Oct;253(1):209-15 Authors: Agosta F, Valsasina P, Absinta M, Sala S, Caputo D, Filippi M PURPOSE: To assess the extent of tactile-associated cervical spinal cord activation in patients with primary progressive (PP) multiple sclerosis (MS) and to investigate the relationship between spinal cord functional activation and the severity of cervical spinal cord and brain structural damage by using magnetic resonance (MR) images. MATERIALS AND METHODS: The study was conducted with institutional review board approval. Written informed consent was obtained from each participant. Cervical spinal cord functional MR images were obtained in 23 patients with PP MS and 18 healthy control subjects during tactile stimulation of the right hand. Conventional and diffusion-tensor MR images of the brain and spinal cord were also acquired. Mean stimulus-related signal intensity change for all activated voxels and the distribution of functional MR activity at each spinal cord level were obtained. Univariate analysis was used to compare MR findings between groups. Between-group differences in topographic distribution of functional MR activity were evaluated by using random-effects logistic regression models. RESULTS: Patients with PP MS had higher mean spinal cord activity on functional MR images than did controls. A higher occurrence of functional MR activation in the right versus left side of the spinal cord and in the posterior versus anterior section of the spinal cord was found in both control subjects and patients with PP MS. Patients who were mildly disabled had a pattern of functional MR activity distribution similar to that of controls, but patients who were more severely disabled did not show differential activation between the right and left sides of the spinal cord. A higher occurrence of functional MR activity in the anterior section of the right side of the spinal cord at the level of the C6-7 intervertebral disk (P = .05) and the left side of the spinal cord at the level of the C7-T1 intervertebral disk (P = .03) was found in patients with PP MS than in control subjects. Mean spinal cord functional MR imaging signal intensity change correlated with spinal cord fractional anisotropy. CONCLUSION: Patients with PP MS showed tactile-associated cervical spinal cord overactivation. Spinal cord functional changes, possibly owing to injured interneurons, likely contribute to the complex process that leads to the accumulation of irreversible disability in patients with PP MS. PMID: 19703852 [PubMed - indexed for MEDLINE]

Fatty muscle atrophy: prevalence in the hindfoot muscles on MR images of asymptomatic volunteers and patients with foot pain.

Related Articles Fatty muscle atrophy: prevalence in the hindfoot muscles on MR images of asymptomatic volunteers and patients with foot pain. Radiology. 2009 Oct;253(1):160-6 Authors: Schmid DT, Hodler J, Mengiardi B, Pfirrmann CW, Espinosa N, Zanetti M PURPOSE: To determine prevalence and degree of fatty muscle atrophy in plantar foot muscles in asymptomatic volunteers and in patients with foot pain. MATERIALS AND METHODS: Institutional review board approval and informed consent were obtained. The prevalence and degree of fatty muscle atrophy were evaluated with magnetic resonance imaging in the abductor digiti minimi (ADM), flexor digitorum brevis (FDB), abductor hallucis (AH), and quadratus plantae (QP) muscles in 80 asymptomatic volunteers (mean age, 48 years; range, 23-84 years) and 80 patients with foot pain (mean age, 48 years; range, 20-86 years). Muscles were characterized as normal (grade 0) or as having mild (grade 1) or substantial (grade 2) fatty atrophy by two readers separately. Results of visual grading for both readers were compared by using the Mann-Whitney test. Associations between age and degree of fatty muscle atrophy were assessed by using the Kruskal-Wallis test. RESULTS: Readers 1 and 2 found substantial fatty atrophy of the ADM muscle in four (5%) and five (6%) volunteers, respectively, and in three (4%) and nine (11%) patients, respectively. One reader diagnosed substantial fatty atrophy of the AH muscle in three (4%) volunteers and of the FDB muscle in two (2%) volunteers. Prevalence for the QP muscle varied between 0% and 1%. An association between age and degree of fatty atrophy of the ADM muscle was found for volunteers by both readers and for patients by reader 1 (P < .01). CONCLUSION: Prevalence of fatty muscle atrophy of the ADM muscle-classically considered to represent entrapment neuropathy-is between 4% and 11% in both asymptomatic volunteers and patients with foot pain, and it increases with age. PMID: 19703848 [PubMed - indexed for MEDLINE]

Diagnostic imaging of patients in a memory clinic: comparison of MR imaging and 64-detector row CT.

Related Articles Diagnostic imaging of patients in a memory clinic: comparison of MR imaging and 64-detector row CT. Radiology. 2009 Oct;253(1):174-83 Authors: Wattjes MP, Henneman WJ, van der Flier WM, de Vries O, Träber F, Geurts JJ, Scheltens P, Vrenken H, Barkhof F PURPOSE: To investigate the assessment of global cortical atrophy (GCA), medial temporal lobe atrophy (MTA), and white matter changes (WMCs) in patients screened at a memory clinic with a 64-detector row computed tomography (CT) brain protocol, in comparison with the reference standard, magnetic resonance (MR) imaging. MATERIALS AND METHODS: The study protocol was approved by the local institutional review board. Written informed consent was obtained from all participants. Thirty patients (21 men, nine women; median age, 62 years) who presented to a memory clinic underwent 64-detector row CT and multisequence MR imaging of the brain on the same day. Three readers blinded to the clinical diagnosis assessed the resultant images. Images were presented in random order and scored for GCA, MTA, and WMC with published visual rating scales. Intermodality agreement between CT and MR imaging (intrareader agreement across both modalities), expressed by weighted kappa analysis, and interobserver agreement within each modality between readers (Kendall W test) were assessed. RESULTS: Overall, excellent intraobserver agreement between CT and MR imaging was observed for GCA (mean kappa, 0.83) and MTA (mean kappa, 0.88 and 0.86 on the left and right sides of the brain, respectively). There was substantial overall agreement concerning WMC (mean kappa, 0.79). For all three tested scales, interobserver variability was low and comparable for CT and MR imaging. CONCLUSION: Use of 64-detector row brain CT yields reliable information that is comparable with that obtained with MR imaging. Thus, multidetector row CT is a suitable diagnostic imaging tool in a memory clinic setting. PMID: 19635835 [PubMed - indexed for MEDLINE]

Dual-source versus 64-section CT coronary angiography at lower heart rates: comparison of accuracy and radiation dose.

Related Articles Dual-source versus 64-section CT coronary angiography at lower heart rates: comparison of accuracy and radiation dose. Radiology. 2009 Oct;253(1):56-64 Authors: Baumüller S, Leschka S, Desbiolles L, Stolzmann P, Scheffel H, Seifert B, Marincek B, Alkadhi H PURPOSE: To compare the diagnostic performance and radiation doses of dual-source and 64-section computed tomographic (CT) coronary angiography for the diagnosis of significant coronary stenoses in patients with heart rates of 65 beats/min or less. MATERIALS AND METHODS: This retrospective study had local ethics committee approval; all patients gave written informed consent. Two hundred patients with heart rates of 65 beats/min or less were enrolled; 100 underwent dual-source and 100 underwent 64-section CT coronary angiography. Two blinded observers independently assessed image quality of all coronary segments by using a four-point scale and searched for significant (>50%) stenoses in each segment. Catheter angiography was used as the reference standard. Image noise was measured in the ascending aorta. Radiation doses were calculated. RESULTS: No significant differences were found regarding sex, age, body weight, cardiovascular risk profile, prevalence of stenosis, mean and variability of heart rate, Agatston score, and image noise (all P > .1) between patients in both CT coronary angiography groups. No significant difference was found in the rate of nonassessable coronary segments between dual-source (1.0%, 14 of 1405) and 64-section CT coronary angiography (1.8%, 25 of 1387; P = .08). Motion artifacts occurred significantly more often in 64-section (21 of 25) versus dual-source (five of 14, P = .004) CT coronary angiography. Segment-based accuracy and specificity were significantly higher for dual-source versus 64-section CT coronary angiography. There was no significant difference in accuracy parameters at the per-vessel and per-patient analyses. No significant difference (P = .13) was found between the effective doses of dual-source (mean +/- standard deviation, 10.9 mSv +/- 1.1) and 64-section CT (10.4 mSv +/- 1.7) coronary angiography. CONCLUSION: In patients with heart rates of 65 beats/min or less, the higher temporal resolution of dual-source CT coronary angiography results in improved accuracy and specificity for the diagnosis of significant stenoses on a per-segment level at a similar radiation dose, but provides a comparable diagnostic accuracy on a patient-based level as does 64-section coronary angiography. PMID: 19587311 [PubMed - indexed for MEDLINE]

Neuro-lyme disease: MR imaging findings.

Related Articles Neuro-lyme disease: MR imaging findings. Radiology. 2009 Oct;253(1):167-73 Authors: Agarwal R, Sze G PURPOSE: To describe the neuroimaging manifestations of Lyme disease at magnetic resonance (MR) imaging of the brain. MATERIALS AND METHODS: Institutional review board approval was obtained and HIPAA compliance was followed. This study retrospectively reviewed the MR imaging findings of all patients seen from 1993 to 2007 in whom neuro-Lyme disease was suspected and who were referred for MR imaging of the brain for the evaluation of neurologic symptoms. RESULTS: Of 392 patients suspected of having neuro-Lyme disease, 66 patients proved to have the disease on the basis of clinical criteria, serologic results, and response to treatment. Seven of these 66 patients showed foci of T2 prolongation in the cerebral white matter, one had an enhancing lesion with edema, and three demonstrated nerve-root or meningeal enhancement. Of the seven patients with foci of T2 prolongation in the white matter, three were an age at which white matter findings due to small-vessel disease are common. CONCLUSION: In cases of nerve-root or meningeal enhancement, Lyme disease should be considered in the differential diagnosis in the proper clinical setting. PMID: 19587309 [PubMed - indexed for MEDLINE]

Endometriosis: contribution of 3.0-T pelvic MR imaging in preoperative assessment--initial results.

Related Articles Endometriosis: contribution of 3.0-T pelvic MR imaging in preoperative assessment--initial results. Radiology. 2009 Oct;253(1):126-34 Authors: Hottat N, Larrousse C, Anaf V, Noël JC, Matos C, Absil J, Metens T PURPOSE: To determine the accuracy of 3.0-T pelvic magnetic resonance (MR) imaging in the preoperative assessment of endometriosis and to evaluate colon wall involvement after intrarectal gel administration. MATERIALS AND METHODS: Institutional review board approval for this study was obtained, and each patient gave written informed consent. Forty-one consecutive patients with clinical suspicion of endometriosis underwent pelvic MR imaging at 3.0 T before surgery. Single-shot and high-spatial-resolution axial T2-weighted, sagittal fat-suppressed T2-weighted, and axial fat-suppressed T1-weighted sequences were performed. T2-weighted sequences were repeated after the rectum was filled with ultrasonographic (US) gel. Two blinded readers interpreted images independently. Image quality was scored by using a four-point scale. Detailed mapping of deep endometriosis was performed. Colon wall infiltration was graded (none, serosa, muscularis, submucosa, mucosa). MR imaging results were compared with surgical and pathologic findings. Interobserver agreement was assessed by using kappa statistics. Nonparametric tests were performed to compare colon wall infiltration scores without and those with US gel and between observers. RESULTS: Twenty-seven of 41 patients had deep endometriosis at surgery and histopathologic examination. Sensitivity, specificity, positive and negative predictive values, and accuracy for the diagnosis of deep endometriosis at MR imaging were 96.3% (26 of 27), 100% (14 of 14), 100% (26 of 26), 93.3% (14 of 15), and 97.6% (40 of 41), respectively. kappa Values ranged from 0.65 to 1.0, depending on the location of deep endometriosis. Colon wall infiltration assessment by both readers correlated well with pathologic findings (Spearman coefficient, >0.93), although median wall involvement scores were lower at pathologic examination than for both readers both before (P = .042 and P = .011) and after (P = .079 and P = .011) intrarectal gel filling. CONCLUSION: MR imaging of the pelvis at 3.0 T is accurate in the diagnosis and staging of deep endometriosis for the preoperative assessment of patients clinically suspected of having endometriosis. PMID: 19584256 [PubMed - indexed for MEDLINE]

Idiopathic syringomyelia: phase-contrast MR of cerebrospinal fluid flow dynamics at level of foramen magnum.

Related Articles Idiopathic syringomyelia: phase-contrast MR of cerebrospinal fluid flow dynamics at level of foramen magnum. Radiology. 2009 Oct;253(1):184-90 Authors: Struck AF, Haughton VM PURPOSE: To measure cerebrospinal fluid (CSF) flow velocities in the foramen magnum in patients with idiopathic syringomyelia (IS). MATERIALS AND METHODS: Patient consent for this retrospective study was waived by the institutional review board within the guidelines of HIPAA. The authors reviewed the medical records of a neurosurgery specialty clinic to identify patients with IS-that is, syringomyelia without evidence of Chiari malformation, tumor, or substantial spine trauma. Patients without syringomyelia or Chiari malformation identified from the review served as control subjects. The data of patients and control subjects who had undergone phase-contrast magnetic resonance (MR) imaging were included in the study. MR flow images were inspected for evidence of synchronous bidirectional CSF flow and heterogeneous spatial and temporal flow patterns. Peak CSF flow velocities in the IS and control groups were calculated, and differences were tested for statistical significance by using the Wilcoxon rank sum test. RESULTS: Eight patients who met the criteria for IS and six who met the criteria to serve as control subjects were identified. The phase-contrast MR images obtained in five of the eight patients with IS and in none of the control subjects depicted synchronous bidirectional flow and/or large flow jets. Mean peak systolic (caudal) CSF flow velocities were 6.7 cm/sec in the IS group and 3.6 cm/sec in the control group; the difference was significant (P < .01). Mean peak diastolic (cephalic) velocities were 3.9 and 3.4 cm/sec in the IS and control groups, respectively; the difference was not significant (P = .36). CONCLUSION: Some patients with IS have increased peak systolic CSF flow velocities. PMID: 19567652 [PubMed - indexed for MEDLINE]

Coagulation disorders in patients with cancer: nontunneled central venous catheter placement with US guidance--a single-institution retrospective analysis.

Related Articles Coagulation disorders in patients with cancer: nontunneled central venous catheter placement with US guidance--a single-institution retrospective analysis. Radiology. 2009 Oct;253(1):249-52 Authors: Della Vigna P, Monfardini L, Bonomo G, Curigliano G, Agazzi A, Bellomi M, Orsi F PURPOSE: To assess the feasibility and safety of ultrasonographic (US) guidance in the placement of nontunneled central venous catheters (CVCs) in patients with cancer who had altered coagulation profiles. MATERIALS AND METHODS: The study was approved by the institutional review board; informed consent was obtained. Medical charts of all patients with cancer who underwent nontunneled CVC placement at the European Institute of Oncology, Milan, from September 2001 to August 2008 were retrospectively reviewed. Patients were considered to have coagulation disorders or risk of bleeding when they had the following: prothrombin time more than 1.2 times normal or activated partial thromboplastin time more than 1.2 times normal and/or platelet count less than 150 x 10(9)/L. Patients with a prothrombin time and partial thromboplastin time more than 2.2 times normal and/or a platelet count less than 50,000/mm(3) were considered to be at high risk for bleeding. Two hundred thirty-nine nontunneled CVCs were placed with US guidance in 157 patients. RESULTS: One hundred twenty-two (51%) of 239 nontunneled CVCs were inserted in patients with cancer who had hemostasic disorders. Forty-five (37%) of 122 nontunneled CVCs were implanted in patients considered to be at high risk for bleeding. All catheters were successfully placed at the first needle pass with no major complications such as bleeding or pneumothorax. Two hundred thirty-three (97%) nontunneled CVCs were placed in the subclavian vein, and six (3%) were placed in the internal jugular vein. No patient underwent any correction for an abnormal coagulation profile. CONCLUSION: In patients with cancer who had coagulation disorders, nontunneled CVC placement with US guidance was feasible and safe and did not require correction of coagulation parameters. PMID: 19567651 [PubMed - indexed for MEDLINE]

Re: "Do you purge your PACS archive? Should you?".

Related Articles Re: "Do you purge your PACS archive? Should you?". J Am Coll Radiol. 2009 Nov;6(11):815-6 Authors: Benedetto AR PMID: 19878895 [PubMed - in process]

Re: "MR-guided focused ultrasound for malignant tumors: the importance of margins".

Related Articles Re: "MR-guided focused ultrasound for malignant tumors: the importance of margins". J Am Coll Radiol. 2009 Nov;6(11):814; author reply 814-5 Authors: Schmitz AC, van den Bosch MA, Gilhuijs KG PMID: 19878894 [PubMed - in process]

Lee Theros.

Related Articles Lee Theros. J Am Coll Radiol. 2009 Nov;6(11):812-3 Authors: Linton O PMID: 19878892 [PubMed - in process]

From the ACR grassroots: why residents should fight for medicare coverage of CT colonography.

Related Articles From the ACR grassroots: why residents should fight for medicare coverage of CT colonography. J Am Coll Radiol. 2009 Nov;6(11):809-11 Authors: MacLean AV PMID: 19878891 [PubMed - in process]

Anesthetic and steroid injections for musculoskeletal pain.

Related Articles Anesthetic and steroid injections for musculoskeletal pain. J Am Coll Radiol. 2009 Nov;6(11):806-8 Authors: Miller JC, Palmer WE, Goroll AH, Thrall JH, Uppot RN PMID: 19878890 [PubMed - in process]

Diagnostic medical physics procedures carrying reimbursement.

Related Articles Diagnostic medical physics procedures carrying reimbursement. J Am Coll Radiol. 2009 Nov;6(11):804-5 Authors: Hevezi JM, Seibert JA, Brateman L PMID: 19878889 [PubMed - in process]

Treatment delays using an automated afterloading low-dose-rate brachytherapy system.

Related Articles Treatment delays using an automated afterloading low-dose-rate brachytherapy system. J Am Coll Radiol. 2009 Nov;6(11):800-3 Authors: DesRosiers CM, Slessinger E, Schilder J, Stehman F, Das IJ, DesRosiers P, Cardenes H, Johnstone PA PURPOSE: Low-dose-rate (LDR) brachytherapy is an integral treatment modality in radiation oncology. Clinical efficacy is based on experience with manual source loading and continuous dose delivery. With remote afterloading technology, sources may be loaded and unloaded during the treatment course to prevent radiation exposure to nursing staff members and visitors. The aim of this study was to investigate treatment interruptions in terms of frequency and duration as well as extension of the overall treatment time period. The potential clinical impact of treatment interruptions was also considered. MATERIALS AND METHODS: The treatment records of 20 patients who underwent brachytherapy in the Indiana University Department of Radiation Oncology administered with a Selectron LDR remote afterloader were reviewed. Results were tabulated and analysis performed with respect to 1) the number of interruptions, 2) delay time, 3) delay time (T(d)) as a function of total implant time (T), 4) the time of day that each interruption occurred, and 5) the time in minutes of each individual interruption. RESULTS: The mean number of interruptions was 44.9 per patient, (range, 24-76), with a mean prescription implantation duration of 45.7 hours and a mean actual treatment time of 51.2 hours resulting in a mean interruption time of 6.4 minutes per treatment hour. The number of interruptions was standardized and divided by the number of prescribed dose in grays, translating to 1.2 to 3.7 interruptions per gray delivered, with a mean of 1.6, resulting in an average T(d) of 11.21% (range, 7.35%-17.12%). CONCLUSION: Significant interruptions are frequent using remote afterloading LDR techniques, reducing the effective dose rate. Careful monitoring of such interruptions is warranted. PMID: 19878888 [PubMed - in process]

Comparison of two methods to transmit clinical history information from referring providers to radiologists.

Related Articles Comparison of two methods to transmit clinical history information from referring providers to radiologists. J Am Coll Radiol. 2009 Nov;6(11):795-9 Authors: Agarwal R, Bleshman MH, Langlotz CP PURPOSE: At many institutions, clerical personnel manually enter clinical histories into radiology information systems during the process of scheduling examinations. For outpatients, radiologists use this information as their primary source of clinical histories. The purpose of this study was to determine the discrepancy rate between these manually recorded clinical histories and paper request slips, thereby assessing the accuracy of the clinical information used by radiologists at the time of interpretation. MATERIALS AND METHODS: A total of 129 imaging request slips for CT scans were randomly selected from 7 days in February and March 2007. The clinical history on each request slip was compared with the clinical history manually entered into the radiology information system. Discrepancies between paper request slips and the electronic information available to radiologists were placed into 4 categories: 1) no discrepancy, 2) electronic or paper history incomplete, 3) disagreement between electronic and paper information, and 4) other. Incomplete or discrepant histories were further subcategorized on the basis of whether they were clinically significant. RESULTS: Thirty-eight percent of studies (49 of 129) had no discrepancies between the paper request slips and the manually entered electronic information. The remaining 62% of studies (80 of 129) had incomplete or discrepant clinical histories. Forty-nine percent of studies (63 of 129) had incomplete electronic or paper information. Greater than half of those incomplete histories (36 of 63) were clinically significant. Ten percent of cases (13 of 129) showed frank disagreements between paper and electronic information. Sixty-nine percent of these (9 of 13) were clinically significant. Three percent of studies (4 of 129) showed other discrepancies whose clinical significance could not be categorized. CONCLUSION: The manual entry of clinical information introduces a high rate of discrepancies, most of which are clinically significant. These discrepancies highlight the need for better communication between referring providers and radiologists. PMID: 19878887 [PubMed - in process]

Insight from patients for radiologists: improving our reporting systems.

Related Articles Insight from patients for radiologists: improving our reporting systems. J Am Coll Radiol. 2009 Nov;6(11):786-94 Authors: Johnson AJ, Easterling D, Williams LS, Glover S, Frankel RM PURPOSE: The aim of this study was to seek patients' perspectives on radiology reporting systems, so that reporting systems can begin to be reorganized and made more patient-centered by giving patients greater access to their personal health information. METHODS: Focus group methodology was used to explore which aspects of radiology information are important to patients and to identify their preferred means of access to and format of this information. Subjects for the two groups were outpatients who had recently undergone MR imaging at a single academic medical center. Transcripts were analyzed using thematic content analysis. RESULTS: Most subjects were dissatisfied with current reporting systems, citing delays and a lack of detail as the most important problems. Subjects varied with regard to preferences for who should relay results to them, with some expressing a desire for increased direct input from radiologists because they have greater expertise in imaging interpretation. Most subjects wanted results in writing and in detail, with attached lay language explanations, though a few subjects preferred less detail. Subjects were decidedly in favor of having the option to access results immediately via an online system, proposing some potential problems and potentially multiple benefits of such a system. CONCLUSIONS: Whatever system revisions are attempted to increase the patient-centeredness of care as regards to radiology reporting, patients will need to be able to choose their preferred levels of access and will need to have the option of accessing full details. PMID: 19878886 [PubMed - in process]

The association between hospital outcomes and diagnostic imaging: early findings.

Related Articles The association between hospital outcomes and diagnostic imaging: early findings. J Am Coll Radiol. 2009 Nov;6(11):780-5 Authors: Lee DW, Foster DA PURPOSE: Resource use variation across the United States prompts the important question of whether "more is better" when it comes to health care services. The aim of this study was to examine correlations between the use of 4 common imaging modalities (CT, MR, ultrasound, and radiography) and in-hospital mortality and costs. METHODS: Using clinical and utilization data for 1.1 million inpatient admissions at 102 US hospitals during 2007, two hospital-specific, risk-adjusted imaging utilization measures for each modality were constructed that controlled for patients' demographic and clinical characteristics and for hospital characteristics were constructed for each modality. First, logistic regression was used to estimate the odds that each type of imaging service would be provided during an admission. Second, the mean number of services per admission was estimated using output from a two-part ordinary least squares model. Hospital-specific, risk-adjusted inpatient mortality and total hospital costs were also computed, and correlations between the imaging utilization measures and the mortality and cost outcome measures were then assessed using Pearson's correlation coefficients (P < .05). The correlation analyses were weighted by hospital admission volume. RESULTS: Hospitals in which patients were more likely to receive imaging services during admissions had lower mortality, even after controlling for potential confounders. Correlation coefficients were -0.2 for all modalities (P = .02-.05). Weaker correlations existed between mean services per admission and mortality, while costs trended insignificantly higher with greater utilization. CONCLUSIONS: This study lays the foundation for further exploration of the relationship between resource use and the clinical and economic outcomes associated with imaging utilization. PMID: 19878885 [PubMed - in process]

Self-referral of imaging and increased utilization: some practical perspectives on tackling the dilemma.

Related Articles Self-referral of imaging and increased utilization: some practical perspectives on tackling the dilemma. J Am Coll Radiol. 2009 Nov;6(11):773-9 Authors: Romano DH Health care costs are higher in the United States than in any other country in the world, and imaging services have been growing much more rapidly than other services. Studies have shown a tendency for increased utilization of services, including imaging services, when referring physicians have ownership interest in the services. In recent years, the CMS has taken some action with respect to how it pays for imaging, including reducing physician payments when multiple images are taken on contiguous body parts during the same visit, establishing a cap on payments for certain imaging services, and imposing an antimarkup rule on diagnostic tests. In addition, CMS has made some changes to the Stark rules, which included adding nuclear medicine to the list of designated health services, prohibiting certain per-service or per-click leasing arrangements, and prohibiting physicians from owning entities that sell services to providers that then bill for them under arrangements. Because it is unclear whether these policy changes will have much effect on imaging utilization, CMS will continue to seek new ways to rein in utilization. In the near future, CMS and the US Department of Health and Human Services are likely to attempt to curb utilization not only through postpayment review and education but also through its various initiatives on improving the quality of services furnished to Medicare benificiaries. PMID: 19878884 [PubMed - in process]

ACR Colon Cancer Committee white paper: status of CT colonography 2009.

Related Articles ACR Colon Cancer Committee white paper: status of CT colonography 2009. J Am Coll Radiol. 2009 Nov;6(11):756-772.e4 Authors: McFarland EG, Fletcher JG, Pickhardt P, Dachman A, Yee J, McCollough CH, Macari M, Knechtges P, Zalis M, Barish M, Kim DH, Keysor KJ, Johnson CD PURPOSE: To review the current status and rationale of the updated ACR practice guidelines for CT colonography (CTC). METHODS: Clinical validation trials in both the United States and Europe are reviewed. Key technical aspects of the CTC examination are emphasized, including low-dose protocols, proper insufflation, and bowel preparation. Important issues of implementation are discussed, including training and certification, definition of the target lesion, reporting of colonic and extracolonic findings, quality metrics, reimbursement, and cost-effectiveness. RESULTS: Successful validation trials in screening cohorts both in the United States with ACRIN and in Germany demonstrated sensitivity > or = 90% for patients with polyps >10 mm. Proper technique is critical, including low-dose techniques in screening cohorts, with an upper limit of the CT dose index by volume of 12.5 mGy per examination. Training new readers includes the requirement of interactive workstation training with 2-D and 3-D image display techniques. The target lesion is defined as a polyp > or = 6 mm, consistent with the American Cancer Society joint guidelines. Five quality metrics have been defined for CTC, with pilot data entered. Although the CMS national noncoverage decision in May 2009 was a disappointment, multiple third-party payers are reimbursing for screening CTC. Cost-effective modeling has shown CTC to be a dominant strategy, including in a Medicare cohort. CONCLUSION: Supported by third-party payer reimbursement for screening, CTC will continue to further transition into community practice and can provide an important adjunctive examination for colorectal screening. PMID: 19878883 [PubMed - in process]

ACR presidential address: with change inevitable, can we survive?

Related Articles ACR presidential address: with change inevitable, can we survive? J Am Coll Radiol. 2009 Nov;6(11):749-55 Authors: Van Moore A The universe of medical practice is changing at an ever increasing rate, an exponentially increasing rate. In examining Earth's history from the beginning of time, it is not necessarily change per se that has threatened countless species but the rate of change that has challenged species survival. Darwin's thesis indicates that those who are most able to adapt to change will be more likely to survive. Medical technology, especially imaging technology, has been on a exponential growth curve for the past 2 decades, dramatically changing not only the field of medical imaging but the environment of all of medicine. Change in our practice environment represents both threats and opportunities to medical specialties to adapt and survive in the context of radiology and remain relevant to the future practice of medicine. Can we as radiologists survive and remain relevant in the future practice of medicine? What is the path to survival? The approach to survival will be multifactorial. We must continue to put our patients first, maintaining high-quality patient care in our adaptation strategy. We must do a better job of developing and investing in leaders, not only within radiology, but within all of medicine. We will need to hypersubspecialize within our profession and with that hypersubspecialization develop an integrated team concept, working together like a well-oiled Swiss watch. Last, we must as a profession invest in ourselves vigorously, supporting imaging research in a number of arenas, searching for the next imaging breakthrough, and exploring and adapting nanotechnology applications in both imaging and therapy. PMID: 19878882 [PubMed - in process]

Hospitality.

Related Articles Hospitality. J Am Coll Radiol. 2009 Nov;6(11):746-8 Authors: Gunderman RB PMID: 19878881 [PubMed - in process]

Colonic and cardiac imaging: two steps forward...

Related Articles Colonic and cardiac imaging: two steps forward... J Am Coll Radiol. 2009 Nov;6(11):744-5 Authors: Duszak R PMID: 19878880 [PubMed - in process]

State advocacy: establish relationships, find lobbyists.

Related Articles State advocacy: establish relationships, find lobbyists. J Am Coll Radiol. 2009 Nov;6(11):741-3 Authors: Chin KW, Bluth EI, Coleman B, Kaye AD PMID: 19878879 [PubMed - in process]

Medicine's geek squad.

Related Articles Medicine's geek squad. J Am Coll Radiol. 2009 Nov;6(11):739-40 Authors: Fleishon HB PMID: 19878878 [PubMed - in process]

What happened to payment reform?

Related Articles What happened to payment reform? J Am Coll Radiol. 2009 Nov;6(11):737-8 Authors: Hillman BJ PMID: 19878877 [PubMed - in process]

One patient at a time.

Related Articles One patient at a time. J Am Coll Radiol. 2009 Nov;6(11):735-6 Authors: Thrall JH PMID: 19878876 [PubMed - in process]

Introduction

Publication year: 2009Source: Techniques in Vascular and Interventional Radiology, Volume 12, Issue 2, June 2009, Page 79T. Gregory, Walker

Acute Gastrointestinal Hemorrhage

Publication year: 2009Source: Techniques in Vascular and Interventional Radiology, Volume 12, Issue 2, June 2009, Pages 80-91T. Gregory, WalkerAlthough most cases of acute gastrointestinal (GI) hemorrhage either spontaneously resolve or respond to medical management and/or endoscopic treatment, there remain a significant number of patients who require emergency evaluation and treatment by the interventional radiologist. Any angiographic evaluation should begin with selective catheterization of the artery supplying the most likely site of bleeding, as determined by the available clinical, endoscopic, and imaging data. If a source of hemorrhage is identified, superselective catheterization followed by transcatheter embolization with microcoils is the most effective means of successfully controlling hemorrhage while minimizing potential complications. This is now well-recognized as a viable and...

Transjugular Intrahepatic Portosystemic Shunt for Acute Variceal Hemorrhage

Publication year: 2009Source: Techniques in Vascular and Interventional Radiology, Volume 12, Issue 2, June 2009, Pages 92-101Sanjeeva P., Kalva , Gloria M., Salazar , T. Gregory, WalkerAcute variceal hemorrhage is life-threatening and requires a multidisciplinary approach for effective therapy. Transfusion of blood products, systemic therapy with vasopressin, octreotide, and selective β-blockers and early endoscopic therapy are often effective; however, uncontrollable variceal hemorrhage is best treated with transjugular intrahepatic porto-systemic shunt (TIPS) creation. This procedure involves establishment of a direct pathway between the hepatic veins and the portal veins to decompress the portal venous hypertension that is the source of the patient's hemorrhage. The procedure is technically challenging, especially in critically ill patients, and has a mortality of 30%-50% in the emergency setting, but has greater than...

Evaluation and Management of Acute Vascular Trauma

Publication year: 2009Source: Techniques in Vascular and Interventional Radiology, Volume 12, Issue 2, June 2009, Pages 102-116Gloria M.M., Salazar , T. Gregory, WalkerWith the technical advances and the increasing availability of sophisticated imaging equipment, techniques, and protocols, and with continually evolving transcatheter endovascular therapies, minimally invasive imaging and treatment options are being routinely used for the clinical management of trauma patients. Thus, the primary treatment algorithm for managing acute vascular trauma now increasingly involves the interventional radiologist or other endovascular specialist. Endovascular techniques represent an attractive option for both stabilizing and definitively treating patients who have sustained significant trauma, with resultant vascular injury. Endovascular treatment frequently offers the benefit of a focused definitive therapy, even in the presence of massive hemorrhage that...

Acute Limb Ischemia

Publication year: 2009Source: Techniques in Vascular and Interventional Radiology, Volume 12, Issue 2, June 2009, Pages 117-129T. Gregory, WalkerAcute limb ischemia occurs when there is an abrupt interruption of blood flow to an extremity usually because of either embolic or thrombotic vascular occlusion. When profound ischemia ensues, this represents an emergency in which restoration of perfusion through early intervention can lead to limb salvage, whereas delay may result in significant morbidity, including limb loss and, potentially, death. Patients in whom urgent or semi-urgent surgical or endovascular revascularization is indicated may undergo catheter angiography unless there is a contraindication, such as profound critical limb ischemia, renal dysfunction, or contrast allergy. Alternative imaging modalities include ultrasound, contrast-enhanced computed tomographic angiography,...

Bronchial Artery Embolization

Publication year: 2009Source: Techniques in Vascular and Interventional Radiology, Volume 12, Issue 2, June 2009, Pages 130-138Sanjeeva P., KalvaMassive hemoptysis is a life-threatening emergency. Chest radiograph, computed tomography, and bronchoscopy play a complementary role in diagnosing the underlying cause of hemorrhage and localizing the bleeding site. Bronchial artery embolization remains the primary and most effective method in controlling massive hemoptysis. Bronchial and nonbronchial systemic arteries are the main source of bleeding and are embolized with polyvinyl alcohol particles or gelatin sponge. Immediate cessation of bleeding occurs in more than 75% of patients; however, long-term recurrences are common in patients with progressive lung disease. Complications are infrequent except for a rare occurrence of spinal cord ischemia.

Transcatheter Endovascular Techniques for Management of Obstetrical and Gynecologic Emergencies

Publication year: 2009Source: Techniques in Vascular and Interventional Radiology, Volume 12, Issue 2, June 2009, Pages 139-147Gloria M.M., Salazar , John C., Petrozza , T. Gregory, WalkerSince the initial description of selective uterine artery embolization for the treatment of postpartum hemorrhage in 1979, transcatheter embolization and other endovascular techniques have become the second-line therapeutic option for the management of intractable obstetrical and gynecologic bleeding. Advances in catheter-based techniques, as well as recognition of the effectiveness of minimally invasive treatment options, have expanded the role of interventional radiology in the management of hemorrhage for a variety of indications, such as postpartum hemorrhage, menorrhagia, and postmenopausal bleeding. Transcatheter interventions include the following: (1) prophylactic selective catheterization of the internal iliac arteries, with either temporary balloon occlusion or embolotherapy;...

Acute Deep Vein Thrombosis and Thrombolysis

Publication year: 2009Source: Techniques in Vascular and Interventional Radiology, Volume 12, Issue 2, June 2009, Pages 148-153Stephan T., WickyPulmonary embolism is a well-known and feared complication of deep venous thrombosis (DVT). Patients who present with acute DVT are treated with anticoagulation therapy whenever possible. Nonetheless, anticoagulation therapy does not actually treat DVT by dissolution of thrombus but instead prevents the propagation of the existing acute DVT. Unfortunately, a significant number of patients, particularly those with femoral or iliofemoral DVT, will develop the postthrombotic syndrome (PTS), despite receiving anticoagulation therapy. PTS is clinically manifested by leg pain, swelling, skin discoloration, and venous claudication; venous ulceration is the most severe form of PTS. The natural course of DVT is that...

Emergent Nephrostomy Tube Placement for Acute Urinary Obstruction

Publication year: 2009Source: Techniques in Vascular and Interventional Radiology, Volume 12, Issue 2, June 2009, Pages 154-161Raul N., UppotObstructive uropathy and urosepsis constitute a medical emergency and require emergent decompression of the urinary collecting system. Image-guided percutaneous nephrostomy tube placement using ultrasound and fluoroscopy allows for decompression of the obstructed renal collecting system with minimal complications.

Biliary Tract Interventions

Publication year: 2009Source: Techniques in Vascular and Interventional Radiology, Volume 12, Issue 2, June 2009, Pages 162-170Benjamin J., PomerantzBiliary tract interventions remain a tremendous technical challenge to the interventionalist and require appropriate clinical postprocedural management. The increased use of endoscopy for biliary tract evaluation and intervention has served to largely replace percutaneous techniques, resulting in a decreased number of patients requiring primary percutaneous transhepatic biliary interventions. However, those patients who do present for percutaneous biliary procedures often represent a more technically difficult subset. Thorough familiarity with normal and variant biliary tract anatomy, and experience with a variety of techniques, will allow for successful biliary tract interventions in complex situations. This article reviews the current role of percutaneous transhepatic...

Editorial Board

Publication year: 2009Source: Techniques in Vascular and Interventional Radiology, Volume 12, Issue 2, June 2009, Page i[No author name available]

Publication year: 2009Source: Techniques in Vascular and Interventional Radiology, Volume 12, Issue 2, June 2009, Page iii[No author name available]

Forthcoming Topics

Publication year: 2009Source: Techniques in Vascular and Interventional Radiology, Volume 12, Issue 2, June 2009, Page iv[No author name available]

Editorial Board

Publication year: 2009Source: Techniques in Vascular and Interventional Radiology, Volume 12, Issue 1, March 2009, Page ii[No author name available]

Publication year: 2009Source: Techniques in Vascular and Interventional Radiology, Volume 12, Issue 1, March 2009, Page iii[No author name available]

Introduction

Publication year: 2009Source: Techniques in Vascular and Interventional Radiology, Volume 12, Issue 1, March 2009, Page 1Walter S., Bartynski

Clinical, Anatomic, and Imaging Correlation in Spine-Related Pain: The Essential Elements

Publication year: 2009Source: Techniques in Vascular and Interventional Radiology, Volume 12, Issue 1, March 2009, Pages 2-10Walter S., BartynskiSuccessful treatment of a patient's spine-related pain depends on accurate targeting of its location and cause. At a basic level, a focused history and physical examination is essential. Understanding of spine anatomy, in particular, spine innervation, is fundamental. Correlation with preprocedure imaging is important to confirm the suspected location(s) of the pain generator and is helpful in planning the approach for image-guided treatment. Understanding the variations in spine anatomy, subtle imaging features, or correlates of root irritation and factors that can affect the patient's presentation at the time of treatment are also critical to accurate targeting and effective treatment. This...

Epidural Steroid Injections and Selective Nerve Root Blocks

Publication year: 2009Source: Techniques in Vascular and Interventional Radiology, Volume 12, Issue 1, March 2009, Pages 11-21Timothy S., Eckel , Walter S., BartynskiEpidural steroid injections and lumbar nerve root block/steroid injection are commonly performed interventional treatments for spine-related pain. These procedures are the foundation of any image-guided spine pain management practice. While more generic and not target-specific, epidural steroid injections are highly effective in a large proportion of patients, including patients with axial pain (neck or low back pain), radiculopathy, or spinal stenosis with neurogenic claudication. When isolated lumbar nerve root irritation is more clearly suspected, transforaminal nerve root blocks can provide useful diagnostic information as well as deliver more specifically targeted steroid treatment. Sustained pain relief can be achieved in a...

Treatment of Facet and Sacroiliac Joint Arthropathy: Steroid Injections and Radiofrequency Ablation

Publication year: 2009Source: Techniques in Vascular and Interventional Radiology, Volume 12, Issue 1, March 2009, Pages 22-32Jeffrey A., Stone , Walter S., BartynskiFacet and sacroiliac joint arthropathy are common, specific causes of low back pain. With a combination of a focused physical examination and image guidance, pain originating from these joints can be accurately targeted and these joints respond well to the direct application of long-acting deposition preparation steroids. When routine steroid treatment of the facet joint is not effective and more advanced treatment is required, denervation of the facet joint through the use of radiofrequency ablation (RFA) is a preferred method. Image guidance is a critical tool in targeting facet joint innervation, performing a central role in the techniques used in...

Interventional Assessment of the Lumbar Disk: Provocation Lumbar Diskography and Functional Anesthetic Diskography

Publication year: 2009Source: Techniques in Vascular and Interventional Radiology, Volume 12, Issue 1, March 2009, Pages 33-43Walter S., Bartynski , A. Orlando, OrtizThe diagnosis of diskogenic low back pain (LBP) can be elusive. Physical examination of the lumbar disk is limited and imaging offers few objective clues. While invasive, lumbar diskography is a method available to examine or “provoke” the disk directly and determine if LBP is coming from a disk and which disk(s) is responsible for the pain. Once identified, features of the abnormal disk can be evaluated, including the disk's response to intradiskal local anesthetic and disk architecture as observed on diskography imaging and postdiskogram computed tomography. Response to anesthetic can be correlated with imaging features potentially impacting treatment but...

Vertebroplasty and Vertebral Augmentation Techniques

Publication year: 2009Source: Techniques in Vascular and Interventional Radiology, Volume 12, Issue 1, March 2009, Pages 44-50Timothy S., Eckel , Wayne, OlanVertebroplasty, the percutaneous administration of acrylic bone cement into a vertebral body, was developed in France in 1984, initially as a treatment for a painful vertebral hemangioma. Subsequent adaptations of the technique, development of materials and devices, and expansion of indications have led to many vertebral augmentation variants that have proven highly successful in treating pain related to osteoporotic compression fractures and vertebral body pathology, such as metastasis and myeloma. Vertebroplasty involves the image-guided percutaneous placement of a bone access needle into the affected vertebral body, followed by injection of the bone cement under intermittent imaging to assure appropriate placement...

Sacroplasty

Publication year: 2009Source: Techniques in Vascular and Interventional Radiology, Volume 12, Issue 1, March 2009, Pages 51-63A. Orlando, Ortiz , Allan L., BrookSacral vertebroplasty, or sacroplasty, entails the percutaneous insertion of 1 or more bone needles into the sacral ala and, less commonly, the sacral vertebra with fluoroscopic and/or computed tomographic guidance. Acrylic bone cement is then injected under imaging guidance to treat the lesion and stabilize the sacrum. Sacroplasty is indicated for the treatment of painful sacral insufficiency fractures and painful sacral masses, both of which destabilize the sacrum. In properly selected patients, sacroplasty is an extremely efficacious procedure with a low-risk profile when performed with meticulous imaging guidance and a thorough appreciation of the complex sacral anatomy. Complete pain relief...

Spinal Cord Stimulation: A Basic Approach

Publication year: 2009Source: Techniques in Vascular and Interventional Radiology, Volume 12, Issue 1, March 2009, Pages 64-70Allan L., Brook , Bassem A., Georgy , Wayne J., OlanChronic back pain and other refractory pain syndromes are a documented burden on our society. They also are a huge cost in quality of life and dollars spent on health care. Neuromodulation and specifically dorsal column stimulation of the spinal cord has been shown to decrease pain with minimal risk to the patient. We describe in this article the basic techniques and methods of both the stimulation trial and the permanent implantation of the leads and generator. With advanced imaging and the minimally invasive approach we further explain how to minimize any risk associated with this percutaneous procedure.

Percutaneous Image-Guided Augmentation for Spinal Metastatic Tumors

Publication year: 2009Source: Techniques in Vascular and Interventional Radiology, Volume 12, Issue 1, March 2009, Pages 71-77Bassem A., GeorgyThe purpose of this article is to review the current state of the art for treating symptomatic spinal fractures associated with malignant lesions by image-guided interventional techniques. Epidemiology, clinical presentation, and biomechanical ramifications of these lesions are summarized. A suggested treatment algorithm is also presented. The second part of the article deals with how to approach these lesions, explaining the issues that pertain to patient evaluation, preoperative, operative, and postoperative treatment regimes. Tips for certain difficult situations and potential complications are also discussed.

Editorial Board

Publication year: 2008Source: Techniques in Vascular and Interventional Radiology, Volume 11, Issue 4, December 2008, Page i[No author name available]

Publication year: 2008Source: Techniques in Vascular and Interventional Radiology, Volume 11, Issue 4, December 2008, Page iii[No author name available]

Introduction

Publication year: 2008Source: Techniques in Vascular and Interventional Radiology, Volume 11, Issue 4, December 2008, Pages 201-202Timothy, Clark

Portal Anatomic Variants Relevant to Transjugular Intrahepatic Portosystemic Shunt

Publication year: 2008Source: Techniques in Vascular and Interventional Radiology, Volume 11, Issue 4, December 2008, Pages 203-207Nael, Saad , Michael, Darcy , Wael, SaadTransjugular intrahepatic portosystemic shunt (TIPS) creation is an accepted treatment for portal hypertension. TIPS creation remains a challenging procedure because it involves the successful passage of a needle from a point of origin (hepatic vein) to a target point (portal vein) through the liver substance. An understanding of the anatomy of these two vascular beds facilitates overcoming the challenge of the spatial relationship between these two points. In this article the authors review the vascular and parenchymal anatomic variations, both congenital and acquired that impact the success of TIPS creation.

Stepwise Placement of a Transjugular Intrahepatic Portosystemic Shunt Endograft

Publication year: 2008Source: Techniques in Vascular and Interventional Radiology, Volume 11, Issue 4, December 2008, Pages 208-211Timothy W.I., ClarkEndografts continue to evolve the role of transjugular intrahepatic portosystemic shunts for patients with complications of portal hypertension. Transjugular intrahepatic portosystemic shunt (TIPS) created with bare stents, although associated with high rates of short-term portal decompression, are plagued by shunt stenosis and thrombosis over the long term. In contrast, TIPS created with endografts achieve durable, sustained patency in most patients with portal hypertension. The technique of successful endograft placement does have technical nuances that differ from TIPS creation with bare stents. This article provides a step-by-step approach for the interventional radiologist for placement of the via Torr device, which is...

Management of Shunt Dysfunction in the Era of TIPS Endografts

Publication year: 2008Source: Techniques in Vascular and Interventional Radiology, Volume 11, Issue 4, December 2008, Pages 212-216Timothy W.I., ClarkSignificantly improved long-term patency can be achieved with transjugular intrahepatic portosystemic shunt (TIPS) endografts compared to conventional bare stents. In the USA, approximately 80% of TIPS procedures are performed using these devices. The phenomenon of early shunt thrombosis with TIPS created with bare stent TIPS, attributed to biliary fistulae, is seldom observed in patients with TIPS endografts. Intrashunt stenoses within the polytetrafluoroethylene-lined conduit are also rare. However, as with shunts created with bare stents, distinct patterns of dysfunction can occur with TIPS endografts. Some of these are inherent to the learning curve of placing these devices and others are secondary...

Portal Vein Imaging and Access for Transjugular Intrahepatic Portosystemic Shunts

Publication year: 2008Source: Techniques in Vascular and Interventional Radiology, Volume 11, Issue 4, December 2008, Pages 217-224Timothy, Scanlon , Robert K., Ryu

Balloon-occluded Retrograde Transvenous Occlusion

Publication year: 2008Source: Techniques in Vascular and Interventional Radiology, Volume 11, Issue 4, December 2008, Pages 225-229Hector, FerralThe current article describes a patient with acute, massive upper gastrointestinal bleeding from isolated gastric varices. The patient had a large gastrosystemic shunt and was managed with a combination of splenic artery embolization followed by balloon-occluded retrograde transvenous occlusion (BORTO) of the gastric varices. BORTO is a procedure that was recently described in Japan by Dr Kanagawa. This technique is extensively used in Japan as first-line therapy in the management of bleeding gastric varices but has not been popularized in the USA. The purpose of this review is to present the technique used to perform BORTO at our institution and...

Direct Intrahepatic Portocaval Shunt

Publication year: 2008Source: Techniques in Vascular and Interventional Radiology, Volume 11, Issue 4, December 2008, Pages 230-234Bryan D., Petersen , Timothy W.I., ClarkThe direct intrahepatic portacaval shunt (DIPS) is a modification of the TIPS procedure, using intravascular ultrasound-guidance, combined with fluoroscopy. The DIPS procedure was initially conceived to increase the durability of shunt patency and extend the spectrum of patients with portal hypertension for whom endovascular portocaval shunting can be performed. The DIPS procedure involves intravascular ultrasound-guided puncture from the inferior vena cava to the portal vein through the caudate lobe of the liver. The shunt is completed with a polytetrafluoroethylene-covered stent graft. This article describes the indications, technique, and outcomes of the DIPS procedure to enable the interventional radiologist currently experienced...

Placement of Transjugular Intrahepatic Portosystemic Shunts in Children

Publication year: 2008Source: Techniques in Vascular and Interventional Radiology, Volume 11, Issue 4, December 2008, Pages 235-240Jonathan M., LorenzPerformance of transjugular intrahepatic portosystemic shunting (TIPS) in children requires an awareness of the technical challenges posed by pediatric anatomy and physiology. Any interventional radiologist skilled in adult TIPS and contemplating performing their first pediatric TIPS should consider adding a second set of more experienced hands. This article reviews some of the more salient technical considerations for performing TIPS in this unique patient population.

Editorial Board

Publication year: 2008Source: Techniques in Vascular and Interventional Radiology, Volume 11, Issue 3, September 2008, Page i[No author name available]

Publication year: 2008Source: Techniques in Vascular and Interventional Radiology, Volume 11, Issue 3, September 2008, Page iii[No author name available]

Forthcoming Topics

Publication year: 2008Source: Techniques in Vascular and Interventional Radiology, Volume 11, Issue 3, September 2008, Page iv[No author name available]

Introduction

Publication year: 2008Source: Techniques in Vascular and Interventional Radiology, Volume 11, Issue 3, September 2008, Page 155Dmitry J., Rabkin

Clinical Surveillance and Monitoring of Arteriovenous Access for Hemodialysis

Publication year: 2008Source: Techniques in Vascular and Interventional Radiology, Volume 11, Issue 3, September 2008, Pages 156-166Gary A., GelbfishClinical surveillance and monitoring of arteriovenous access for hemodialysis can best ensure long term access function. The failing access can be identified and referred for intervention prior to complete access failure. This article reviews the basic science of access function and the various techniques for detecting the failing access. These techniques are utilized by the dialysis unit staff and by the physician, often the interventionalist, who takes primary care of the access. A combination of various techniques to detect dysfunction and trend analysis of various parameters is most likely to identify in a timely manner, those patients who need intervention.

Hemodialysis Fistula Interventions: Diagnostic and Treatment Challenges and Technical Considerations

Publication year: 2008Source: Techniques in Vascular and Interventional Radiology, Volume 11, Issue 3, September 2008, Pages 167-174Boris, NikolicEnd-stage renal disease is one of the main epidemiologic health problems and dialysis access continues to be the Achilles' heel of its treatment. Consequently, hemodialysis fistula maintenance is of great importance which can best be accomplished by close collaboration between primary care, nephrology, surgery and interventional radiology services, routine access monitoring as well as early intervention in cases of impending access failure. Also, knowledge and application of specific interventional techniques that are additionally described in this article may increase intervention efficiency, decrease the incidence of complications and overcome technical challenges thus improving procedural outcome and maximizing access patency rates.

Endovascular Management of the “Failing to Mature” Arteriovenous Fistula

Publication year: 2008Source: Techniques in Vascular and Interventional Radiology, Volume 11, Issue 3, September 2008, Pages 175-180George M., NassarThe “failing to mature” arteriovenous fistula (AVF) is frequently encountered among patients in need of hemodialysis (HD). It is essential that its prompt recognition and management are conducted in a timely manner to allow its use in HD. The physical examination is essential in early identification of the “failing to mature” AVF and helps guide initial endovascular management. In most instances, endovascular evaluation successfully identifies all the lesions that have contributed to AVF derangement and retarded its proper maturation. It is common to find juxta-arterial stenosis as well as venous stenosis in the body of the AVF, or its venous...

Tunneled Dialysis Catheters: Pearls and Pitfalls

Publication year: 2008Source: Techniques in Vascular and Interventional Radiology, Volume 11, Issue 3, September 2008, Pages 181-185Jeffrey B., SiegelA review of the issues involved in placement of Tunneled Dialysis Catheter with a suggested scheme for maximizing good catheter placement and function.

Selecting Optimal Hemodialysis Catheters: Material, Design, Advanced Features, and Preferences

Publication year: 2008Source: Techniques in Vascular and Interventional Radiology, Volume 11, Issue 3, September 2008, Pages 186-191Michael G., Tal , Nina, NiHemodialysis catheters are a necessary evil. They provide an immediate and effective lifeline for hemodialysis patients, and their use is steadily increasing. This increasingly important role has lead to the development of many generations of dialysis catheters. Some aspects of novel designs have shown potential to reduce complications, while others provide options for physician insertion preference. The two major biomaterials for catheter construction are currently polyurethane and silicone, while copolymers such as carbothane are becoming more widespread. Catheter coatings such as heparin, antibiotics, and silver ion are designed to minimize thrombosis and infection. Finally, many lumen and tip designs are...

Minimally Invasive Outpatient Centers

Publication year: 2008Source: Techniques in Vascular and Interventional Radiology, Volume 11, Issue 3, September 2008, Pages 192-194James, McGuckin , Kim, ParkinsonMinimally-invasive medicine has continually progressed from its beginning in the 1960's. Evolution of technology and techniques have led to treatment of new disease states in minimally-invasive therapies. Now the venue of those therapies is shifting outpatient procedures from the hospital and into outpatient centers.

Malfunction of Dialysis Catheters: Management of Fibrin Sheath and Related Problems

Publication year: 2008Source: Techniques in Vascular and Interventional Radiology, Volume 11, Issue 3, September 2008, Pages 195-200Salao, Faintuch , G.M.M., SalazarSuitable central venous access for hemodialysis is frequently required in patients with end-stage renal disease, whenever an arteriovenous fistula or peritoneal dialysis fails or is not a possibility. Ultimately, long-term dialysis via central access may result in dysfunctional catheter with problems such as malpositioning of catheter tip, fibrin sheath formation, thrombosis, infection, and bleeding. The role of interventional radiology is to deliver appropriate treatment to maintain patent and functional access, while minimizing the risk of venous occlusive disease. This article aims at describing different techniques and approaches for management of fibrin sheath associated with malfunctioning tunneled dialysis catheters, as well...

Editorial Board

Publication year: 2008Source: Techniques in Vascular and Interventional Radiology, Volume 11, Issue 2, June 2008, Page i[No author name available]

Forthcoming Topics

Publication year: 2008Source: Techniques in Vascular and Interventional Radiology, Volume 11, Issue 2, June 2008, Page iv[No author name available]

Introduction

Publication year: 2008Source: Techniques in Vascular and Interventional Radiology, Volume 11, Issue 2, June 2008, Page 73Wael E.A., Saad , Michael D., Darcy

Computed Tomography and Magnetic Resonance Cholangiography

Publication year: 2008Source: Techniques in Vascular and Interventional Radiology, Volume 11, Issue 2, June 2008, Pages 74-89Wael E.A., Saad , Daniel, GinatIn patients with biliary obstruction, determining the level and the cause of the obstruction is essential because it can be a key factor for the next step in diagnostic or therapeutic intervention. Noninvasive cholangiography, such as computed tomography (CT) cholangiography or magnetic resonance (MR) cholangiography, allows the diagnosis of cause and level of biliary disease with minimal risk. Traditional magnetic resonance cholangiopancreatography (MRCP) is an established and effective noninvasive diagnostic modality particularly for extrahepatic biliary tract evaluation. Intrahepatic biliary duct evaluation and functional MR, including evaluating for leaks and gallbladder dyskinesia and outlet obstruction, are evolving diagnostic techniques that show...

Unconventional Cholangiography

Publication year: 2008Source: Techniques in Vascular and Interventional Radiology, Volume 11, Issue 2, June 2008, Pages 90-101Wael E.A., SaadConventional imaging of the biliary tract includes fluoroscopic cholangiography, oral contrast computed tomography (CT) cholangiography, and magnetic resonance cholangiopancreatography. The latter two are discussed in the prior article of noninvasive cholangiography. Fluoroscopic cholangiography can be divided into endoscopic retrograde cholangiopancreatography and percutaneous transhepatic cholangiography (see pages 74-89, this issue). This article discussed a varying group of imaging techniques that can be added as modifiers to some of the above imaging modalities to obtain different, if not clearer, images of the biliary tract in particular clinical scenarios. These techniques, which are collectively called by the author, “unconventional cholangiography,” include (1) distal...

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Vertebral artery duplication and aneurysms: 64-slice multidetector CT findings

A rare case of combined soft-tissue and intraosseous arteriovenous malformation of the hand with diffuse periosteal elevation: imaging appearances

Intractable bronchopleural fistula caused by radiofrequency ablation: endoscopic bronchial occlusion with silicone embolic material

Absence of uterine arteries discovered at fibroid embolisation

Chordoma masquerading as a nerve root tumour a clinical lesson

CT appearance of persistent left superior vena cava, anomalous right superior pulmonary venous return into the right-sided superior vena cava and a sinus venosus-type atrial septal defect

Characteristics of in vivo radiotherapy dosimetry

Joint symposium 2009 on carbon ion radiotherapy

A description of CT features of Clostridium difficile infection of the small bowel in four patients and a review of literature

Conventional MRI and magnetisation transfer imaging of the brain and optic pathway in primary open-angle glaucoma

Gastric bezoars: reassessment of clinical and radiographic findings in 19 patients

Percutaneous radiofrequency ablation of small hepatocellular carcinoma invisible on both ultrasonography and unenhanced CT: a preliminary study of combined treatment with transarterial chemoembolisation

Warthins tumour: a retrospective case series

Reduction of dose to the female breast as a result of spectral optimisation for high-contrast thoracic CT imaging: a phantom study

Therapeutic effect of balloon-occluded retrograde transvenous obliteration for gastric varices in relation to haemodynamics in the short gastric vein

Optimisation techniques in vaginal cuff brachytherapy

Implantation of fiducial markers for image guidance in prostate radiotherapy: patient-reported toxicity

Personnel radiation dose considerations in the use of an integrated PETCT scanner for radiotherapy treatment planning

Thorax set-up verification with multiple oblique treatment portal images

Brain: non-infective and non-neoplastic manifestations of HIV

Persistent scrotal lesion

Acute Knee Dislocation: Review of an Elusive Entity

Multidetector Computed Tomography Findings of Dense Pulmonary Emboli in Oncologic Patients

Computed Tomographic Appearances of Hepatic Vascular Lesions

Upcoming Articles

In Recent Issues

Hysterosalpingography: Technique and Applications

Non-Electrocardiogram-Gated Multidetector-Row Computed Tomography Findings of Cardiac Pathology in Oncologic Patients

Pediatric Cranial Doppler Sonography in Children: Non-Sickle Cell Applications

Radiological Manifestations of Skeletal Lymphoma

Upcoming Articles

In Recent Issues

Multidetector Computed Tomography of the Acute Abdomen in the Immunocompromised Host: A Pictorial Review

Positron Emission Tomography/Computed Tomography Potential Pitfalls and Artifacts

Diagnosis and Management of Pseudoaneurysms: An Update

The Great Mimicker: Fat Necrosis of the Breast—Magnetic Resonance Mammography Approach

Upcoming Articles

In Recent Issues

Computed Tomographic Appearance of Chest Ports and Catheters: A Pictorial Review for Noninterventional Radiologists

Ultrasound of Wrist Pain

Magnetic Resonance Imaging of the Liver and Biliary Tree in Children

Radiofrequency and Microwave Ablation of the Liver, Lung, Kidney, and Bone: What Are the Differences?

Upcoming Articles

In Recent Issues

Technical Essentials of Hepatic Doppler Sonography

Microwave Ablation Technology: What Every User Should Know

Practical Applications of Nuclear Medicine in Imaging Breast Cancer

Multidetector Computed Tomography of the Mesocolon: Review of Anatomy and Pathology

Magnetic Resonance Arthrography of Superior Labrum Anterior-Posterior Lesions: A Practical Approach to Interpretation

Issues in Imaging Malignant Neoplasms of the Female Reproductive System

Pharyngeal Dysphagia: What the Radiologist Needs to Know

Vascular Closure Devices: A Comparative Overview

Radiofrequency Ablation of Lung Lesions: Practical Applications and Tips

Upcoming Articles

In Recent Issues

Magnetic Resonance Imaging Features of the Discrete Epiphyseal Radiolucency: A Problem-Solving Approach to Differential Diagnosis

Computed Tomography and Magnetic Resonance Imaging Features of Lesions of the Renal Medulla and Sinus

Computed Tomographic Enterography and Enteroclysis: Pearls and Pitfalls

Editorial Board

Information for Readers

Table of Contents

More Than Just Stones: A Pictorial Review of Common and Less Common Gallbladder Pathologies

Ultrasound-Guided Therapeutic Procedures in the Musculoskeletal System

Ultrasound of Muscle

Magnetic Resonance Imaging Findings of Golf-Related Injuries

Upcoming Articles

In Recent Issues

Editorial Board

Information for Readers

Table of Contents

Magnetic Resonance Imaging of Cystic Adnexal Lesions During Pregnancy

Re: diagnosis of hepatic angiomyolipomata using CT: report of three cases and review of the literature.

Re: imaging features of primary extranodal lymphomas.

High-grade chondrosarcoma mimicking Brodie's abscess.

Calcific tendonitis of the adductor brevis insertion.

Getting to the heel of the problem: plantar fascia lesions.

CT appearances of pleural tumours.

Contribution of the amount of contrast media used in pulmonary CT angiography to assess the diagnostic value of CT venography; comparison of 100 and 150ml of contrast media.

Are pancreatic calcifications specific for the diagnosis of chronic pancreatitis? A multidetector-row CT analysis.