American Journal of Roentgenology (Am J Roentgenol)

Publications in this journal

• Article: Retrospective review of diagnosis and treatment in children presenting to the pediatric department with acute scrotum.

  Teresa Liang, Peter Metcalfe, William Sevcik, Michelle Noga
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  ABSTRACT: OBJECTIVE. Testicular torsion is a common acute condition in boys requiring prompt accurate management. The objective of this article was to evaluate ultrasound accuracy, findings, and clinical predictors in testicular torsion in boys presenting to the Stollery pediatric emergency department with acute scrotal pain. METHODS. Retrospective review of surgical and emergency department ultrasound records for boys from 1 month to 17 years old presenting with acute scrotal pain from 2008 to 2011 was performed. Clinical symptoms, ultrasound and surgical findings, and diagnoses were recorded. Surgical results and follow-up were used as the reference standard. RESULTS. Of 342 patients who presented to the emergency department with acute scrotum, 35 had testicular torsion. Of 266 ultrasound examinations performed, 29 boys had torsion confirmed by surgery. The false-positive rate for ultrasound was 2.6%, and there were no false-negative findings. Mean times from presentation at the emergency department to ultrasound and surgery were 209.4 and 309.4 minutes, respectively. Of the torsed testicles, 69% were salvageable. Sensitivity, specificity, and diagnostic accuracy of ultrasound for testicular torsion were 100%, 97.9%, and 98.1%, respectively. Sonographic heterogeneity was seen in 80% of nonviable testes at surgery and 58% of patients with viable testes (p = 0.41). Sudden-onset scrotal pain (88%), abnormal position (86%), and absent cremasteric reflex (91%) were most prevalent in torsion patients. CONCLUSION. Color Doppler ultrasound is accurate and sensitive for diagnosis of torsion in the setting of acute scrotum. Despite heterogeneity on preoperative ultrasound, many testes were considered to be salvageable at surgery. The salvage rate of torsed testes was high.
  American Journal of Roentgenology 05/2013; 200(5):W444-9.
• Article: Lobular neoplasia: what does it mean and how should it be treated?

  Ferris M Hall
  American Journal of Roentgenology 05/2013; 200(5):W538.
• Article: Responsibilities and risks when radiologists evaluate patients for child abuse.

  Jeffrey L Brown
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  ABSTRACT: OBJECTIVE. The objective of this article is to discuss the a radiologist's responsibilities as a mandated reporter of child abuse and the risks in failing to do so. CONCLUSION. All states have established rules that require licensed physicians to report any reasonable suspicion of child abuse. Failure to do so may result in serious consequences for both the physician and the patient.
  American Journal of Roentgenology 05/2013; 200(5):948-9.
• Article: Reply.

  Bethany Niell, Michelle Specht, Elizabeth Rafferty
  American Journal of Roentgenology 05/2013; 200(5):W539.
• Article: Imaging key wrist ligaments: what the surgeon needs the radiologist to know.

  Cyrus P Bateni, Roger J Bartolotta, Michael L Richardson, Hyojeong Mulcahy, Christopher H Allan
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  ABSTRACT: OBJECTIVE. Although much attention is paid to the scapholunate ligament, lunotriquetral ligament, and the triangular fibrocartilage complex, additional intrinsic and extrinsic ligaments in the wrist play an important part in carpal stability. With improved MRI techniques, the radiologist can increasingly visualize these ligaments. CONCLUSION. The anatomy, MRI appearance, and clinical significance of the scapholunate ligament, lunotriquetral ligament, triangular fibrocartilage complex, carpal metacarpal ligaments, and volar and dorsal extrinsic ligaments are reviewed.
  American Journal of Roentgenology 05/2013; 200(5):1089-95.
• Article: Reporting of critical findings in neuroradiology.

  Valentina G Viertel, Stacey A Trotter, Lukasz S Babiarz, Fatma Alluwaimi, Paul G Nagy, Jonathan S Lewin, David M Yousem
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  ABSTRACT: OBJECTIVE. The objective of our study was to assess compliance among academic neuroradiologists in reporting institutionally derived critical findings. MATERIALS AND METHODS. We analyzed 3054 neuroradiology CT and MRI reports generated in 1 month. Reports were categorized by whether or not they contained a critical finding based on a previously established list. The reports were subcategorized by whether the reporting neuroradiologist flagged the report as containing a critical finding and whether the radiologist verbally communicated the critical finding to the referring clinician. Reports were divided into day or night categories and the frequency of critical findings for each time period was calculated. RESULTS. Of the 3054 reports included in this study, 301 (9.9%) had critical findings. Of those 301 reports, 233 (77.4%) were flagged and the referring clinician was called. Of the remaining 68 reports with critical findings, the reporting radiologist did not call the clinician about 35.3% of them (24/68). Of the 2753 reports without critical findings, 2658 (96.5%) were appropriately not flagged and the clinician was not called. However, radiologists called clinicians about 3.5% (95/2753) of the reports without critical findings and erroneously flagged 68.4% (65/95) of those reports as critical. A majority of the cases with critical findings were reported at night (55.1%) despite the fact that 67.2% of the studies occurred during the day. CONCLUSION. Compliance with reporting and communicating critical findings must be monitored. Calling clinicians to report noncritical findings may result in unnecessary interruptions in work flow for radiologists and referring health care providers.
  American Journal of Roentgenology 05/2013; 200(5):1132-7.
• Article: Effect of Tube Voltage on CT Noise Levels in Different Phantom Sizes.

  Boaz Karmazyn, Yun Liang, Paul Klahr, S Gregory Jennings
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  ABSTRACT: OBJECTIVE. The purpose of this study was to determine the effect of lowering tube voltage on dose and noise in cylindric water phantoms to optimize quality and decrease the radiation dose for body CT. MATERIALS AND METHODS. We performed CT on cylindric water phantoms with diameters of 10, 20, 25, and 30 cm, simulating the abdomen of an infant, child, adolescent, and adult. We used tube voltages of 120, 100, and 80 kVp. The CT dose index (32-cm reference) ranged from 1 to 10 mGy in 10- and 20-cm phantoms and from 2 to 20 mGy in the 25- and 30-cm phantoms. The noise was measured at the center and periphery of the scans. Central and peripheral doses were measured in 16- and 32-cm CT dose index phantoms, and the ratio of central to peripheral doses was calculated. RESULTS. At the same noise levels, there was no significant increase in dose in 10-cm cylindric water phantoms when tube voltage was decreased to either 80 or 100 kVp. In 20-, 25-, and 30-cm phantoms, there was a 1-6% increase in dose when tube voltage was decreased to 100 kVp. Central-to-peripheral noise ratios increased 7-37% with increased phantom size. The measured peripheral dose increased as much as 5%. CONCLUSION. Our findings support the practice of lowering tube voltage to 80 kVp for imaging of infants and to 100 kVp for imaging of older children. The increase in peripheral dose with decreased tube voltage is minimal and is unlikely to cause substantial change in the effective dose.
  American Journal of Roentgenology 05/2013; 200(5):1001-5.
• Article: Reply.

  Nabeel Sarwani, Rafel Tappouni, Donald Flemming
  American Journal of Roentgenology 05/2013; 200(5):W537.
• Article: Does antiplatelet therapy increase the risk of hemoptysis during percutaneous transthoracic needle biopsy of a pulmonary lesion?

  Yong Sub Song, Chang Min Park, Kyung Woo Park, Kwang Gi Kim, Hyun-Ju Lee, Mi-Suk Shim, Jin Mo Goo
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  ABSTRACT: OBJECTIVE. The purpose of this article is to evaluate whether antiplatelet therapy increases the occurrence and severity of percutaneous transthoracic needle biopsy (PTNB)-related hemoptysis. MATERIALS AND METHODS. Our institutional review board approved this retrospective study, with waiver of informed consent. From May 2007 to December 2009, 1251 patients undergoing 1346 PTNBs constituted our study population. Of these PTNBs, 163 were performed in patients who had suspended antiplatelet therapy for less than 10 days (mean discontinuation time, 2.56 ± 2.35 days), and these patients were classified as antiplatelet agent users: 143 patients with single aspirin (mean discontinuation time, 2.55 ± 2.35 days), 12 patients with single clopidogrel (mean discontinuation time, 2.33 ± 2.10 days), and eight patients with dual-antiplatelet therapy (i.e., aspirin plus clopidogrel; mean discontinuation time, 3.12 ± 2.90 days). The influence of antiplatelet therapy on the occurrence and severity of PTNB-related hemoptysis was retrospectively evaluated. RESULTS. Among 1346 PTNBs, there were 128 cases (9.5%) of hemoptysis, including 21 cases of severe hemoptysis (1.6%). Multivariate analysis revealed that dual-antiplatelet therapy (odds ratio [OR], 10.09), female sex (OR, 1.88), smaller lesions (OR, 0.88), deeply located lesions (OR, 1.17), and the use of cutting needles (OR, 3.22) were independent risk factors for overall hemoptysis. For severe hemoptysis, dual-antiplatelet therapy (OR, 13.02), ground-glass nodules (OR, 8.86), and deeply located lesions (OR, 1.24) were proven to be independent risk factors. Single-antiplatelet therapy suspended for less than 10 days was not a significant risk factor for either overall or severe hemoptysis. CONCLUSION. Single-antiplatelet therapy suspended for less than 10 days is not an independent risk factor for the occurrence of PTNB-related hemoptysis, whereas dual-antiplatelet therapy increases its risk.
  American Journal of Roentgenology 05/2013; 200(5):1014-9.
• Article: Influence of analysis technique on measurement of diffusion tensor imaging parameters.

  Efsun Urger, Michael D Debellis, Steven R Hooper, Donald P Woolley, Steven Chen, James M Provenzale
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  ABSTRACT: OBJECTIVE. We compared results from various methods of analysis of diffusion tensor imaging (DTI) data from a single dataset consisting of 10 healthy adolescents. SUBJECTS AND METHODS. All subjects were imaged on a single 3-T MRI system (single-shot echo-planar imaging pulse sequence; b value, 1000 s/mm(2)). We measured fractional anisotropy (FA), apparent diffusion coefficient (ADC), and axial and radial diffusivity values using 64-pixel rectangular regions of interest (ROIs) in the right side, midline, and left side of the central portion of the splenium of the corpus callosum for fixed (i.e., at same sites in all subjects) and targeted (i.e., at sites of highest FA values) locations. We compared results with those obtained using 64-pixel oval ROIs and 100-pixel rectangular ROIs in the same locations. Finally, we compared results from ROI-based methods and from tractography. All comparisons used the Wilcoxon signed rank test and the intraclass correlation of individual values. RESULTS. Compared to tractography, the average of mean ROI-based values was significantly higher for fixed (approximately 14%) and targeted (approximately 39%) FA values and was significantly lower for ADC (approximately 16%) and radial diffusivity (approximately 38%) values. For solely ROI-based comparisons, statistically significant differences were found in the following comparisons: 64- versus 100-pixel ROI, oval versus rectangular ROI, targeted FA left of midline versus mean targeted FA value, and targeted ROI right of midline versus mean targeted FA value. CONCLUSION. Markedly different values were obtained when using either ROI- or tractography-based techniques or ROI analysis techniques that differ only relatively slightly.
  American Journal of Roentgenology 05/2013; 200(5):W510-7.
• Article: Rotator cable: MRI study of its appearance in the intact rotator cuff with anatomic and histologic correlation.

  Soterios Gyftopoulos, Jenny Bencardino, Gregory Nevsky, Gregory Hall, Yousef Soofi, Panna Desai, Laith Jazrawi, Michael P Recht
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  ABSTRACT: OBJECTIVE. The purpose of this study was to define and correlate the appearance of the rotator cable on MRI with arthroscopy, band-saw cadaveric sections, and histology. MATERIALS AND METHODS. Two cadaveric shoulders underwent 3-T MRI, band-sawing, and histologic evaluation. Three readers evaluated the MRI for the presence of the cable, and the same readers and a pathologist reviewed the macroscopic and microscopic specimens for a structure that corresponded to the cable. Cadaver 1 underwent arthroscopic evaluation to evaluate for the presence of a cable. Seventy consecutive shoulders that underwent 1.5- or 3-T MRI were also reviewed for the presence of the cable and evaluation of its characteristics (location, thickness, and width). RESULTS. A linear band of hypointense signal intensity was found along the undersur-face of the supraspinatus and infraspinatus tendons on both cadaveric MR images, which correlated to a linear band of tissue in the same location on macroscopic and microscopic evaluation and linear thickening along the cuff articular surface on arthroscopy consistent with the cable. The cable was seen in 74.3% of the MRI studies in both sagittal and coronal planes with a mean (± SD) distance of the cable from the medial margin of the enthesis of 1.33 ± 0.27 cm, a mean width of the cable of 1.24 ± 0.31 cm, and a mean thickness of 0.19 ± 0.05 cm. CONCLUSION. The rotator cable is a structure that can be consistently seen on gross anatomic and histologic analysis, arthroscopy, and MRI in the intact rotator cuff. Familiarity with the typical location and morphology of the cable may allow easier characterization of disease that can involve the cable, such as rotator cuff tears.
  American Journal of Roentgenology 05/2013; 200(5):1101-5.
• Article: Diagnostic Performance of Resting CT Myocardial Perfusion in Patients With Possible Acute Coronary Syndrome.

  Kelley R Branch, Janet Busey, Lee M Mitsumori, Jared Strote, James H Caldwell, Joshua H Busch, William P Shuman
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  ABSTRACT: OBJECTIVE. Coronary CT angiography has high sensitivity, but modest specificity, to detect acute coronary syndrome. We studied whether adding resting CT myocardial perfusion imaging improved the detection of acute coronary syndrome. SUBJECTS AND METHODS. Patients with low-to-intermediate cardiac risk presenting with possible acute coronary syndrome received both the standard of care evaluation and a research thoracic 64-MDCT examination. Patients with an obstructive (> 50%) stenosis or a nonevaluable coronary segment on CT were diagnosed with possible acute coronary syndrome. CT perfusion was determined by applying gray and color Hounsfield unit maps to resting CT angiography images. Adjudicated patient diagnoses were based on the standard of care and 3-month follow-up. Patient-level diagnostic performance for acute coronary syndrome was calculated for coronary CT, CT perfusion, and combined techniques. RESULTS. A total of 105 patients were enrolled. Of the nine (9%) patients with acute coronary syndrome, all had obstructive CT stenoses but only three had abnormal CT perfusion. CT perfusion was normal in all other patients. To detect acute coronary syndrome, CT angiography had 100% sensitivity, 89% specificity, and a positive predictive value of 45%. For CT perfusion, specificity and positive predictive value were each 100%, and sensitivity was 33%. Combined cardiac CT and CT perfusion had similar specificity but a higher positive predictive value (100%) than did CT angiography. CONCLUSION. Resting CT perfusion using CT angiographic images may have high specificity and may improve CT positive predictive value for acute coronary syndrome without added radiation and contrast. However, normal resting CT perfusion cannot exclude acute coronary syndrome.
  American Journal of Roentgenology 05/2013; 200(5):W450-7.
• Article: Effect of Patient Size on Mean Sterile Water Attenuation During Multiphase CT Examinations.

  Michael D Beland, Albert A Scappaticci, Jason T Machan, Walter Huda, Scott A Collins, William W Mayo-Smith
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  ABSTRACT: OBJECTIVE. The purpose of this study was to determine the variability of attenuation measurements in a water phantom included in the FOV during multiphase 64-MDCT. SUBJECTS AND METHODS. Ninety-seven consecutively registered patients undergoing multiphase kidney and liver protocol CT of the abdomen on the same 64-MDCT scanner had a sealed water bottle placed on their anterior abdomen during the examination. Region of interest (ROI) measurements of the mean attenuation (in HU) of the water bottle were made during the unenhanced, dynamic, and delayed phases of contrast enhancement. Generalized estimating equations were used to model mean attenuation in the ROI as a function of cross-sectional patient area, contrast phase, and protocol. Day of month and time of day were covariates. A phantom was created to model the patient study. RESULTS. The mean attenuation values in the water bottle ROIs were -13.1 HU for the kidney protocol and -9.1 HU for the liver protocol in the unenhanced phase, -11.7 HU for the kidney and -9.5 HU for the liver protocol in the dynamic phase, and -11.9 HU for the kidney and 11.0 HU for the liver protocol in the delayed phase. Kidney protocol water bottle ROI attenuation values were lower than the liver values (p = 0.04). In all phases with both protocols, the values differed from 0 HU (all p < 0.0001). Water bottle ROI attenuation decreased as patient cross-sectional area increased (-0.01 HU/cm(2), p < 0.0001). Three patients had absolute water bottle attenuation changes greater than 20 HU between phases. Day of the month (p = 0.08) and time of day (p = 0.93) were not significant factors. Phantom data supported the study findings. CONCLUSION. The mean attenuation of water decreased as patient diameter increased. Both artifactual enhancement and decrease in enhancement greater than 20 HU were found in three larger patients.
  American Journal of Roentgenology 05/2013; 200(5):1048-53.
• Article: Spatial Relationship Between the Hepatic Artery and Portal Vein Based on the Fusion Image of CT Angiography and CT Arterial Portography: The Left Hemiliver.

  Kenji Ibukuro, Takaya Takeguchi, Hozumi Fukuda, Shoko Abe, Kimiko Tobe, Kazumi Tagawa
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  ABSTRACT: OBJECTIVE. The objective of our study was to clarify the hepatic artery anatomy of the left hemiliver using the fusion image of CT angiography (CTA) and CT arterial portography. MATERIALS AND METHODS. CTA and CT arterial portography were performed on a 64-MDCT scanner in 144 patients. All images were transferred to a workstation for 3D analysis using the multiimage fusion mode. We classified the left hepatic artery (LHA) and middle hepatic artery (MHA) as type L when only the LHA was present, type MB when a medial branch from the LHA was present, type LM when both the LHA and MHA were present, and type M when only the MHA was present. The hepatic artery was classified into infraportal and supraportal groups on the basis of its relationship with the laterosuperior branch of the left portal vein. We also classified the branching pattern of the arteries to each segment. Pattern 1 was defined as when the LHA divided into the laterosuperior segment artery (A2), which then divided into the lateroinferior segment artery (A3) and medial segment artery (A4). Pattern 2 was defined as when the LHA divided into A3, which then divided into A2 and A4. Pattern 3 was defined as when the LHA divided into A4, which then divided into A2 and A3. Pattern 4 was defined as when the LHA divided into A2, A3, and A4 simultaneously. RESULTS. The prevalence of each type was as follows: type L (n = 37, 25.7%), type MB (n = 44, 30.6%), type LM (n = 53, 36.8%), and type M (n = 6, 4.2%). The number of cases classified as infraportal was 54 (37.5%) and supraportal, 73 (50.7%). The cases classified by branching pattern were as follows: pattern 1, 26 cases (18.0%); pattern 2, eight (5.6%); pattern 3, 93 (64.5%); and pattern 4, 13 (9.0 %). CONCLUSION. Three-dimensional fusion images based on CTA and CT arterial portography can show the various anatomic patterns of the left hemiliver hepatic artery in relation to the left portal vein.
  American Journal of Roentgenology 05/2013; 200(5):1160-6.
• Article: Subcutaneous T-fastener gastropexy: a new technique.

  Michelle T Black, Caitlin A Hung, Christopher Loh
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  ABSTRACT: OBJECTIVE. T-fastener gastropexy is a step in percutaneous radiologic gastrostomy in which the stomach is fastened to the abdominal wall. Minor complications of gastropexy are often related to the prolonged presence of T-fastener sutures. We describe a new technique for gastropexy using absorbable sutures placed subcutaneously, as opposed to the standard percutaneous approach. CONCLUSION. Subcutaneous gastropexy is safe, obviates follow-up suture removal, and eliminates complications associated with cutaneous sutures.
  American Journal of Roentgenology 05/2013; 200(5):1157-9.
• Article: The future of the radiology information system.

  John W Nance, Christopher Meenan, Paul G Nagy
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  ABSTRACT: OBJECTIVE. Today in the hospital setting, several functions of the radiology information system (RIS), including order entry, patient registration, report repository, and the physician directory, have moved to enterprise electronic medical records. Some observers might conclude that the RIS is going away. In this article, we contend that because of the maturity of the RIS market compared with other areas of the health care enterprise, radiology has a unique opportunity to innovate. CONCLUSION. While most of the hospital enterprise spends the next several years going through the digital transformation converting from paper to a digital format, radiology can leap ahead in its use of analytics and information technology. This article presents a summary of new RIS functions still maturing and open to innovation in the RIS market.
  American Journal of Roentgenology 05/2013; 200(5):1064-70.
• Article: Hyperechoic lesions of the breast: radiologic-histopathologic correlation.

  Beatriz Adrada, Yun Wu, Wei Yang
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  ABSTRACT: OBJECTIVE. Breast ultrasound is helpful in the characterization of masses to differentiate benign from malignant disease. The internal echotexture of a mass is an important ultra-sound feature in breast diagnostic workup. This article reviews the imaging and histopathology findings of benign and malignant hyperechoic masses to better recognize these conditions. CONCLUSION. Hyperechoic masses are frequently benign, including hematoma, fat necrosis, abscess, and benign neoplasm. Malignant hyperechoic lesions include invasive ductal and invasive lobular carcinoma, lymphoma, and sarcoma. Understanding lesion echotexture in the context of clinical and mammographic findings will help establish appropriate diagnoses for hyperechoic masses.
  American Journal of Roentgenology 05/2013; 200(5):W518-30.
• Article: Voiding cystourethrography revisited: descriptive statistics for the detection of vesicoureteral reflux.

  Anh-Vu Ngo, Seth D Friedman, Stephen Darling, Marla B K Sammer, Teresa Chapman
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  ABSTRACT: OBJECTIVE. To determine which factors might influence the detection of vesicoureteral reflux (VUR), we retrospectively reviewed factors including fluoroscopy time, number of true radiographic acquisitions, and patient characteristics from a large number of voiding cystourethrography (VCUG) examinations. MATERIALS AND METHODS. Nine hundred eighty-seven VCUG examinations performed between March 2006 and March 2009 were randomly selected for review. Data recorded were presence of VUR, patient age and sex, examination indication, follow-up status, presence of a diagnostic radiology trainee, fluoroscopy time, and number of true radiographic acquisitions. For initial examinations, descriptive comparison and logistic analyses were performed. To evaluate which variables related to reflux identification, we analyzed variables by logistic regression after stratifying by patient age (≤ 1 or > 1 year) for both the full sample and cases grouped by VUR severity (grades I and II [mild] or grades III-V [moderate to severe]). RESULTS. Nine hundred eighty-seven VCUG examinations were evaluated for the study (65.5% female; mean age, 3 years 2 months; age range, 2 weeks-16 years), and 761 cases met the inclusion criteria. VUR was detected in 101 of 349 infants (40 mild, 61 moderate to severe) and in 107 of 412 children older than 1 year (52 mild, 55 moderate to severe). A wide range of fluoroscopy times was similar between both positive and negative cases (0.033-4.233 minutes). The number of true radiographic acquisitions differed significantly between the negative and positive cases. CONCLUSION. Descriptive statistics and logistic regression analyses for a large number of VCUG examinations in a pediatric population are summarized. Our results showed that high fluoroscopy times were not associated with a higher likelihood of VUR. There may be a small benefit to the use of true radiographic acquisitions for detecting VUR.
  American Journal of Roentgenology 05/2013; 200(5):963-8.
• Article: Informed consent for imaging studies.

  Reginald F Munden
  American Journal of Roentgenology 05/2013; 200(5):W534.
• Article: Evaluation of Perfusion CT in Grading and Prognostication of High-Grade Gliomas at Diagnosis: A Pilot Study.

  Jai Jai Shiva Shankar, John Woulfe, Vasco Da Silva, Thanh B Nguyen
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  ABSTRACT: OBJECTIVE. Differentiation of grade 3 astrocytoma from glioblastoma multiforme can be difficult with conventional structural imaging but is important for prognosis. The purpose of this study was to assess perfusion CT in differentiating high-grade gliomas (HGGs) and their role in prognosis in the care of patients with HGG. SUBJECTS AND METHODS. Twenty patients with previously untreated HGG underwent prospective evaluation with perfusion CT. Permeability surface area product (PS) and cerebral blood volume (CBV) were calculated by the deconvolution method and were compared between HGGs with Student two-sample t tests. Receiver operating characteristic curves were generated for PS, CBV, and the conjoint factor PS + CBV. Cox regression analysis was used to correlate these parameters with patient survival over a follow-up period. Hazard ratios were calculated, and Kaplan-Meier survival curves were drawn. RESULTS. There was a significant difference between grade 3 and grade 4 gliomas for PS (p = 0.022) and PS + CBV (p = 0.019) but not for CBV alone (p = 0.411). Receiver operating characteristic analyses showed that PS (area under the curve [AUC], 0.72) and CBV + PS (AUC, 0.73) can be used to differentiate grade 3 from grade 4 gliomas but that CBV alone cannot be so used (AUC, 0.54). There was a significant relation between patient outcome and age (p = 0.034) and CBV + PS (p = 0.048). Patients with HGG and a CBV + PS greater than 9 had a poor outcome (hazard ratio, 6.00). CONCLUSION. PS and CBV + PS can be used to differentiate grade 3 from grade 4 gliomas. The outcome of patients with HGG depends on age and CBV + PS.
  American Journal of Roentgenology 05/2013; 200(5):W504-9.