European journal of radiology

Publisher: Elsevier

Journal description

Current impact factor: 2.16

Impact Factor Rankings

2015 Impact Factor Available summer 2015
2013 / 2014 Impact Factor 2.16
2012 Impact Factor 2.512
2011 Impact Factor 2.606
2010 Impact Factor 2.941
2009 Impact Factor 2.645
2008 Impact Factor 2.339
2007 Impact Factor 1.915
2006 Impact Factor 1.332
2005 Impact Factor 1.888
2004 Impact Factor 1.745
2003 Impact Factor 1.06
2002 Impact Factor 1.118
2001 Impact Factor 1.084
2000 Impact Factor 0.822
1999 Impact Factor 0.574
1998 Impact Factor 0.537
1997 Impact Factor 0.537
1996 Impact Factor 0.358
1995 Impact Factor 0.449
1994 Impact Factor 0.418
1993 Impact Factor 0.41
1992 Impact Factor 0.308

Impact factor over time

Impact factor

Additional details

5-year impact 2.62
Cited half-life 4.30
Immediacy index 0.37
Eigenfactor 0.02
Article influence 0.78
ISSN 1872-7727

Publisher details


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    • NIH Authors articles will be submitted to PubMed Central after 12 months
    • Publisher last contacted on 18/10/2013
  • Classification
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Publications in this journal

  • [Show abstract] [Hide abstract]
    ABSTRACT: To determine if the menstrual cycle affects MR interpretation in patients with pelvic endometriosis. Thirty-one patients with either laparoscopically proven endometriosis, or a high clinical suspicion of deep infiltrative endometriosis, were prospectively recruited from May 2008 to October 2009 and January to June 2012. Two pelvic MR scans were performed for pre-operative planning; during menses and the other mid-cycle. Two experienced radiologists independently assessed image quality and disease extent. Both were blinded to patient identity, previous imaging and menstrual status. Interobserver agreement was assessed using the Kappa (k) test. Descriptive statistics were prepared using chi-squared (or Fishers' exact) tests and Mann-Whitney (rank sum) tests to assess for significant differences between menstrual and non-menstrual imaging. Interobserver agreement for image quality was moderate for T2 weighted imaging (k=0.475, p-value <0.001) and substantial for T1 fat saturated imaging (k=0.733, p-value<0.001), with no significant difference in image quality between menstrual and non-menstrual scans (all p-values>0.255). Readers demonstrated at least moderate interobserver agreement for certainty level of endometriosis at site-specific locations, with median k 0.599 (IQR 0.488-0.807). No significant difference in disease extent was observed between menstruating and non-menstruating scans (all p-values>0.05). Findings suggest no significant differences in image quality, disease extent or disease severity between menstruating and non-menstruating MR; thus, timing of pelvic MR for assessment of endometriosis need not be influenced by the menstrual cycle. Crown Copyright © 2015. Published by Elsevier Ireland Ltd. All rights reserved.
    European journal of radiology 08/2015; DOI:10.1016/j.ejrad.2015.08.003
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    ABSTRACT: In patients with multiple myeloma (MM), computed tomography is widely used for staging and to detect fractures. Detecting patients at severe fracture risk is of utmost importance. However the criteria for impaired stability of vertebral bodies are not yet clearly defined. We investigated the performance of parameters that can be detected by the radiologist for discrimination of patients with and without fractures. We analyzed 128 whole body low-dose CT of MM patients. In all scans a QCT calibration phantom was integrated into the positioning mat (Image Analysis Phantom(®)). A QCT-software (Structural Insight) performed the volumetric bone mineral density (vBMD) measurements. Description of fracture risk was provided from the clinical radiological report. Suspected progressive disease (PD) was reported by the referring clinicians. Two radiologists that were blinded to study outcome reported on the following parameters based on predefined criteria: reduced radiodensity in the massa lateralis of the os sacrum (RDS), trabecular thickening and sclerosis of three or more vertebrae (TTS), extraosseous MM manifestations (EOM), visible small osteolytic lesions up to a length of 8mm (SO) and osteolytic lesions larger than 8mm (LO). Prevalent vertebral fractures (PVF) were defined by Genant criteria. Age-adjusted standardized odds ratios (sOR) per standard deviation change were derived from logistic regression analysis and area under the curve (AUC) from receiver operating characteristics (ROC) analyses were calculated. ROC curves were compared using the DeLong method. 45% of the 128 patients showed PVF (29 of 75 men, 24 of 53 women). Patients with PVF were not significantly older than patients without fractures (64.6±9.2 vs. 63.3±12.3 years: mean±SD, p=0.5). The prevalence of each parameter did not differ significantly by sex. Significant fracture discrimination for age adjusted single models was provided by the parameters vBMD (OR 3.5 [1.4-8.8], AUC=0.64±0.14), SO (sOR 1.6[1.1-2.2], AUC=0.63±0.05), LO (sOR 2.1[1.1-4.2] AUC=0.69±0.05) and RDS (sOR 2.6[1.6-4.7], AUC=0.69±0.05). Multivariate models of these four parameters showed a significantly stronger association with the development of PVF (AUC=0.80±0.04) than single variables. TTS showed a significant association with PVF in men(sOR 1.5 [0.8-3.0], AUC=0.63±0.08), but not in women (sOR 2.3[1.4-3.7], AUC=0.70±0.07). PD was significantly associated with PVF in women (sOR 1.9[1.1-3.6], AUC=0.67±0.08) but not in men (sOR 1.4[0.9-2.3], AUC=0.57±.07). EOM were not associated with PVF (sOR 1.0[0.4-2.6], AUC=0.51±.05). In multiple myeloma, focal skeletal changes in low dose CT scans show a significant association with prevalent vertebral fractures. The combination of large osteolytic lesions and loss in radiodensity as can be detected with simple CT Hounsfield measurements of the os sacrum or BMD measurements showed the strongest association to fractures and may be of value for prospective studies. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
    European journal of radiology 08/2015; DOI:10.1016/j.ejrad.2015.07.024
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    ABSTRACT: To compare the differences of visceral anomalies shown by computed tomography (CT) in patients with polysplenia syndrome (PS) or asplenia syndrome (AS). This retrospective study was approved by the institutional review board, and informed consent was waived. Thirty-one patients with PS and 29 patients with AS underwent chest-abdominal CT. The evaluated CT findings were as follows: the orientation of stomach, liver and gallbladder; short pancreas; azygous/hemiazygous continuation; ipsilateral position of the inferior vena cava and aorta; preduodenal portal vein; abnormal confluence of renal vein (defined as renal vein drains to the inferior vena cava or azygous/hemiazygous vein at the upper level of celiac trunk origin); gastrointestinal malrotation; and tracheobronchial tree. Azygous/hemiazygous continuation was seen in 74% (20 of 27)/0% (0 of 28) of PS/AS (P<0.0001), bilateral hyparterial bronchi in 75% (24 of 32)/5% (1 of 22), bilateral eparterial bronchi in 9% (3 of 32)/95% (21 of 22), ipsilateral position of the inferior vena cava and aorta in 59% (16 of 27)/89% (25 of 28), and abnormal confluence of renal vein in 7% (2 of 27)/57% (16 of 28), respectively. No significant differences were found in the other anomalies. Significant differences in anomalous systemic venous connections and tracheobronchial anomaly were observed between PS and AS. Abnormal confluence of renal vein is relatively rare anomalous venous connections, but frequently observed in AS. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
    European journal of radiology 08/2015; DOI:10.1016/j.ejrad.2015.08.004
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    ABSTRACT: To compare the diagnostic values of retraction phenomenon in the coronal planes and descriptors in the Breast Imaging Reporting and Data System-Ultrasound (BI-RADS-US) lexicon in differentiating benign and malignant breast masses using an automated breast volume scanner (ABVS). Two hundred and eight female patients with 237 pathologically proven breast masses (120 benign and 117 malignant) were included in this study. ABVS was performed for each mass after preoperative localization by conventional ultrasonography (US). Multivariate logistic regression analysis was performed to assess independent variables for malignancy prediction. Diagnostic performance was evaluated through the receiver operating characteristic (ROC) curve analysis. Retraction phenomenon (odds ratio [OR]: 76.70; 95% confidence interval [CI]: 12.55, 468.70; P<0.001) was the strongest independent predictor for malignant masses, followed by microlobulated margins (OR: 55.87; 95% CI: 12.56, 248.44; P<0.001), angular margins (OR: 36.44; 95% CI: 4.55, 292.06; P=0.001), calcifications (OR: 5.53; 95% CI: 1.34, 22.88; P=0.018,) and patient age (OR: 1.10; 95% CI: 1.03, 1.17; P=0.004). Mass shape, orientation, echo pattern, indistinct margins, spiculated margins, and mass size were not significantly associated with breast malignancy. Area under the ROC curve (Az) for microlobulated margins and retraction phenomenon was higher than that for other significant independent predictors. Az, sensitivity, and specificity were 0.877 (95% CI: 0.829, 0.926) and 0.838 (95% CI: 0.783, 0.892), 82.9% and 70.1%, and 92.5% and 98.3%, respectively, for microlobulated margins and retraction phenomenon. Retraction phenomenon and microlobulated margins have high diagnostic values in the differentiation of benign and malignant breast masses using an ABVS. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
    European journal of radiology 07/2015; DOI:10.1016/j.ejrad.2015.07.028
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    ABSTRACT: To investigate the diagnostic value of tumor blood flow (TBF) obtained with pseudo-continuous arterial spin labeling (pCASL) for the differentiation of squamous cell carcinoma (SCC) and malignant lymphoma (ML) in the nasal or sinonasal cavity. Thirty-three patients with SCC and 6 patients with ML in the nasal or sinonasal cavity were retrospectively analyzed. Quantitative TBF values were obtained using whole-tumor region of interest (ROI) from pCASL data. The histogram analysis of TBF values within the tumor ROI was also performed by calculating the coefficient of variation (CV), kurtosis, and skewness. The mean TBF value, histogram CV, kurtosis and skewness of the patients with SCC were compared with those of the ML patients. The diagnostic accuracy to differentiate SCC from ML was also calculated by receiver operating characteristic (ROC) curve analysis. In addition, multiple logistic regression models were also performed to determine their independent predictive value, and diagnostic accuracy with the combined use of these parameters. Between the SCC and ML groups, significant differences were observed in mean TBF, CV, and kurtosis, but not in skewness. In ROC curve analysis, the diagnostic accuracy values for the differentiation of SCC from ML in mean TBF, CV, and kurtosis were all 0.87, respectively. Multiple logistic regression models revealed TBF and CV were respectively independent predictive value. With the combination of these parameters, the diagnostic accuracy was elevated to 0.97. The TBF value and its histogram analysis obtained with pCASL can help differentiate SCC and ML. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
    European journal of radiology 07/2015; DOI:10.1016/j.ejrad.2015.07.026
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    ABSTRACT: To evaluate whether CT findings suggesting active pulmonary tuberculosis correlate with sputum microbiological studies, and to determine whether CT could predict infectivity. Total 108 patients with active pulmonary tuberculosis were enrolled. We reviewed CT findings and sputum microbiological studies. Then, we analyzed the statistical difference in CT findings between the positive and negative groups of each sputum microbiological study (AFB smear, PCR, and culture). Also, we divided the patients into five groups according to sputum AFB smear grade and analyzed linear trends of CT findings between the five groups. Both frequencies and extents of centrilobular micronodules (63% vs 38%, p=0.011 for frequency; 1.6±1.6 vs 0.6±1.1, p=0.001 for extent), tree-in-bud opacities (63% vs 33%, p=0.002; 1.6±1.6 vs 0.5±0.9, p<0.001, respectively), consolidation (98% vs 81%, p=0.003; 2.7±1.5 vs 1.3±1.1, p<0.001, respectively), and cavitation (86% vs 33%, p<0.001; 1.5±1.2 vs 0.4±0.7, p<0.001, respectively), were significantly increased in the sputum AFB-positive group than in the negative group. These four CT findings were increase in frequency and extent in the sputum PCR-positive group with or without statistical significance. They did not show significant differences between the sputum culture-positive and negative groups. As the AFB smear grade increased, frequencies and extents of centrilobular micronodules, tree-in-bud, consolidation, and cavitation also increased. CT features representing active tuberculosis-centrilobular nodules, tree-in-bud, consolidation, and, cavitation-strongly correlate with the positivity and grading of AFB smear. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
    European journal of radiology 07/2015; DOI:10.1016/j.ejrad.2015.07.032
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    ABSTRACT: To evaluate the CT and (18)fluorine FDG PET findings of large cell neuroendocrine carcinomas (LCNECs) of the lung and to evaluate whether CT and FDG PET findings can help predict the clinical outcome. Thirty-one patients (Male:Female=29:2; mean age, 69 years) who underwent surgical resection of an LCNEC of the lung were included in this retrospective study. The tumours were assessed with respect to morphologic characteristics and the maximum standardised uptake value (SUVmax) on pre-operative CT and FDG PET. For patients undergoing curative resection (n=26), disease-free survival was evaluated using the Kaplan-Meier test. The prognostic significance was assessed using a multivariate Cox proportional hazards regression analysis. The mean tumour diameter was 3.8±2.1cm. Eight tumours (25.8%) were located centrally in the lung, and 23 (74.2%) were located peripherally. The margins were lobulated in 29 patients (93.5%) and well defined in 20 (64.5%). The mean SUVmax was 9.0±3.8. The five-year disease-free survival rate was 46.3%. The shorter disease-free survival was related to the TNM stage greater than stage I, no lobulated margin of a tumour, a SUVmax >12.9 of a tumour, a long diameter >5.6cm of a tumour, or female gender (P=0.115, P=0.134, P=0.056, P=0.168, P=0.113, respectively). The multivariate analysis indicated that a long diameter >5.6cm (hazard ratio, 9.265; 90% confidence interval (CI), 1.996-42.992; P=0.017), female gender (hazard ratio, 5.579; 90% CI, 1.398-22.264; P=0.041), no lobulated margin (hazard ratio, 9.955; 90% CI, 1.433-69.136; P=0.051), and SUVmax >12.9 (hazard ratio, 4.062; 90% CI, 1.235-13.368; P=0.053) were independent predictors of shorter disease-free survival. LCNECs of the lung more commonly occurred peripherally and exhibited well-defined and lobulated margins on CT. The mean SUVmax was consistent with malignant tumours. Female gender, a larger tumour diameter, no lobulated margin, and higher SUVmax were poor prognostic factors. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
    European journal of radiology 07/2015; DOI:10.1016/j.ejrad.2015.07.033
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    ABSTRACT: This paper aims (1) to propose a novel bone adaptation model for age-related trabecular changes by adopting two implicit parameters in optimization, (2) to compare the simulated bone volume fraction (BV/TV) with the reported bone mineral density (BMD), and (3) to review the simulated trabecular architectures with the age-matched radiographs. The proposed model simulated the trabecular changes for an age span of 32-80 years. Quantitative comparison was conducted in terms of BMD and other morphometric indices. Then, two radiologists scored the simulated trabecular architectures using the age-matched radiographs. This protocol was approved by the hospital institutional review board. The simulated BV/TV was well correlated with BMD reported in the literature (R(2)=0.855; p<0.05). In comparison with age-matched radiographs, the consensus scores of agreement of the trabeculae were higher in age groups over the 50s, and the means of the Ward's triangle areas were strongly correlated with those in the age-matched radiographs (R(2)=0.982; p<0.05). The proposed model could reflect the targeted trabecular changes in proximal femur with age. With further follow-up measurements, this research would contribute to the development of patient-specific models that assist radiologists in predicting skeletal integrity with aging. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
    European journal of radiology 07/2015; DOI:10.1016/j.ejrad.2015.07.027
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    ABSTRACT: To evaluate MR imaging features of solid pseudopapillary neoplasms (SPN) in male patients and to compare them with the MR imaging features in female patients. Fifty patients who were histologically confirmed as SPN (M:F=8:42, mean age=36.4 years) with preoperative MRI were included. The following imaging features were reviewed: size, location, shape, margin, encapsulation, solid-cystic ratio, pancreatic duct dilatation, parenchymal atrophy, T1 signal intensity, T2 signal intensity, and morphological and dynamic pattern of enhancement. The statistical differences between male and female patients were analyzed. The average age of male patients (50.8±4.1 years) was significantly higher (p<0.01) than female patients (33.7±2.0 years). The shape of SPN in male patients was predominantly lobulated (n=6/8, 75.0%) compared to female patients, in whom oval shaped SPN was most prevalent (n=26/42, 61.91%) (P=0.02). SPN in male patients contained less cystic component (solid, n=4/8, 50.0%; mainly solid, n=4/8, 50.0%) while cystic (n=5/42, 11.90%) or mainly cystic (n=13/42, 30.95%) lesions were significantly more prevalent in female patients (P=0.03). The majority of SPNs in both groups showed progressive heterogeneous enhancement pattern. Other MR imaging features showed no significant differences between the male and female patients. On MRI, SPN in male patients appeared as mainly solid mass with a lobulating contour and heterogeneous progressive enhancement occurring at an older age than female patients. Recognition of imaging features of SPN in male patients compared to typical SPN in female patients should assist in correct differentiation of SPN from other pancreatic tumors. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
    European journal of radiology 07/2015; DOI:10.1016/j.ejrad.2015.07.025
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    ABSTRACT: Echocardiography is the principal non-invasive tool for initial evaluation and longitudinal monitoring of patients with significant valvular heart disease. However echocardiography can be limited by poor acoustic windows, and is dependent on the skill and experience of the sonographer. Cardiovascular magnetic resonance (CMR) can provide a comprehensive non-invasive assessment of valvular morphology, quantification of the severity of valvular dysfunction, determination of its aetiology, assessment of the consequences for the heart from the valve lesion including measurement of ventricular volumes and function, and evaluation of haemodynamic abnormalities. Additional information such as great vessel anatomy and the presence of coronary disease and myocardial scar can also be obtained from CMR. Aortic valve disease can manifest as aortic regurgitation, aortic stenosis or a mixture of both. Structural abnormalities of the valve (congenital or acquired) or disease of the aorta (structurally normal valve) can cause aortic valve disease. This review describes the role of CMR in evaluation of patients with aortic valve diseases, and illustrates the typical and distinguishing morphological features seen on CMR in a range of congenital and some common acquired aortic valve lesions. Although CMR can provide important information about the morphology of aortic valve, its full potential has yet to be realised, and further studies of clinical outcomes are needed before CMR data can be integrated into the management of patients with significant aortic valvular lesions. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
    European journal of radiology 07/2015; DOI:10.1016/j.ejrad.2015.07.022
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    ABSTRACT: Aim of this study was to test the hypothesis that peak injection pressures and image quality using low concentrated contrast media (CM) (240mg/mL) injected with high flow rates will be comparable to a standard injection protocol (CM: 300mg/mL) in coronary computed tomographic angiography (CCTA). One hundred consecutive patients were scanned on a 2nd generation dual-source CT scanner. Group 1 (n=50) received prewarmed Iopromide 240mg/mL at an injection rate of 9mL/s, followed by a saline chaser. Group 2 (n=50) received the standard injection protocol: prewarmed Iopromide 300mg/mL; flow rate: 7.2mL/s. For both protocols, the iodine delivery rate (IDR, 2.16gI/s) and the total iodine load (22.5gI) were kept identical. Injection pressure (psi) was continuously monitored by a data acquisition program. Contrast enhancement was measured in the thoracic aorta and all proximal and distal coronary segments. Subjective and objective image quality was evaluated between both groups. No significant differences in peak injection pressures were found between both CM groups (121±5.6psi vs. 120±5.3psi, p=0.54). Flow rates of 9mL/s were safely injected without any complications. No significant differences in contrast-to-noise ratio, signal-to-noise ratio and subjective image quality were found (all p>0.05). No significant differences in attenuation levels were found in the thoracic aorta and all segments of the coronary arteries (all p>0.05). Usage of low iodine concentration CM and injection with high flow rates is feasible. High flow rates (9mL/s) of Iopromide 240 were safely injected without complications and should not be considered a drawback in clinical practice. No significant differences in peak pressure and image quality were found. This creates a doorway towards applicability of a broad variety in flow rates and IDRs and subsequently more individually tailored injection protocols. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
    European journal of radiology 07/2015; DOI:10.1016/j.ejrad.2015.06.031
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    ABSTRACT: To prospectively compare the diagnostic capability of diffusion-weighted MR imaging obtained with fast advantage spin-echo sequence (FASE-DWI) and echo planar imaging sequence (EPI-DWI), short inversion time inversion recovery fast advanced spin-echo (STIR FASE) imaging and FDG PET/CT for N-stage assessment of non-small cell carcinoma (NSCLC) patients. 95 consecutive operable NSCLC patients underwent STIR FASE imaging, FASE-DWI and EPI-DWI with a 3T system, integrated PET/CT, surgical treatment and pathological and follow-up examinations. Probability of lymph node metastasis was visually assessed using a 5-point visual scoring system. ROC analyses were used to compare diagnostic capability of all methods, while their diagnostic performance was also compared by means of McNemar's test on a per node basis. Finally, McNemar's test was also used for statistical comparison of accuracy of N-stage assessment. Areas under the curve (Azs) for STIR FASE imaging (Az=0.95) and FASE-DWI (Az=0.92) were significantly larger than those for EPI-DWI (Az=0.78; p<0.0001 for STIR FSE imaging and FASE-DWI) and PET/CT (Az=0.85; p=0.0001 for STIR FSE imaging, p=0.03 for FASE-DWI) on a per node basis analysis. Accuracy of N-stage assessment using STIR FASE imaging (84.2% [80/95]) and FASE-DWI (83.2% [79/95]) was significantly higher than that using EPI-DWI (76.8% [73/95]; p=0.02 for STIR FASE imaging, p=0.03 for FASE-DWI) and PET/CT (73.7% [70/95]; p=0.002 for STIR FSE imaging, p=0.004 for FASE-DWI). Qualitative N-stage assessments of NSCLC patients obtained with FASE-DWI as well as STIR FASE imaging are more sensitive and/or accurate than those obtained with EPI-DWI and FDG PET/CT. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
    European journal of radiology 07/2015; DOI:10.1016/j.ejrad.2015.07.019
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    ABSTRACT: To evaluate the utility of dynamic, contrast-enhanced magnetic resonance imaging (MRI) in combination with single-shot T2-weighted (ssT2) sequences in the differentiation of lipid-poor adrenal adenomas from non-adenomas. This retrospective study was approved by the institutional review board and is HIPAA compliant. Between January 2007 and December 2010, 46 patients with MRI demonstrating a lipid-poor adrenal lesion who underwent either surgical resection or a minimum of 24 months of imaging follow-up were identified retrospectively. All images were retrospectively reviewed in blinded fashion by two radiologists. Each adrenal lesion was categorized by dynamic enhancement features and qualitative signal on ssT2 images and was categorized as an adenoma if it demonstrated homogenous enhancement in the arterial phase, washout with capsule enhancement in the delayed phase, and T2 signal isointense to normal adrenal tissue. Any lesion that did not fulfill all the criteria was classified as a non-adenoma. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy for characterization of adenoma were calculated for each reader with 95% confidence intervals. A κ test assessed level of agreement between readers. Application of our criteria lead to an MRI diagnosis of lipid-poor adrenal adenoma with a sensitivity of 84.2-89.5% (16/19-17/19), specificity of 96.3% (26/27), positive predictive value of 94.1-94.4% (16/17-17/18), negative predictive value of 89.7-92.9% (26/29-26/28), and accuracy of 91.3-93.5% (42/46-43/46). Agreement between the two readers showed substantial κ agreement for the differentiation of adenoma from non-adenoma. Dynamic, contrast-enhanced T1-weighted three-dimensional gradient echo sequences in combination with ssT2 images can accurately differentiate lipid-poor adrenal adenomas from non-adenomas. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
    European journal of radiology 07/2015; DOI:10.1016/j.ejrad.2015.06.032
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    ABSTRACT: To prospectively evaluate the diagnostic performance of magnetic-resonance-arthrography (MRA) by experienced musculoskeletal radiologists in patients with traumatic-anterior-shoulder-instability (TASI), after feedback protocol execution. Forty-five surgically confirmed MRA's were used to enhance personal feedback, to discuss differences in outcome between MRA assessment and surgical findings and to fine-tune definition interpretation agreement of 7 different TASI-related lesions, between experienced musculoskeletal radiologists and experienced orthopaedic shoulder surgeons. After execution of the feedback protocol 20 new, surgically confirmed, MRA's were assessed by 2 experienced musculoskeletal radiologists using a seven-lesion standardized scoring form. Kappa coefficients, sensitivity, specificity, and differences in percentage agreement or correct diagnosis (p-value, McNemar's test) were calculated per lesion and overall per 7 lesion types to assess whether diagnostic reproducibility and accuracy was improved. Per 7 lesion types, the overall kappa and percentage of agreement, between the 2 radiologists, were dramatically increased in comparison with our former study (k=0.81 versus k=0.48 and 90.7% versus 78.2%, respectively). The overall sensitivity of radiologist 1 increased from 45.9% to 87.8%, the overall sensitivity of radiologist 2 increased from 63.5% to 79.6% and the overall specificity of radiologist 2 increased from 80.1% to 85.7%. Furthermore, the overall percentage of correct diagnosis of both radiologist was also exceedingly higher (85.7% and 83.6%) compared to our former study (74.4% and 74.8%). The implementation of our feedback protocol dramatically improved the reproducibility and accuracy of high field MRA by experienced musculoskeletal radiologist in patients with traumatic anterior shoulder instability. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
    European journal of radiology 07/2015; DOI:10.1016/j.ejrad.2015.07.016
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    ABSTRACT: To estimate and compare the radiation dose using a standard protocol and that of a dose reduction protocol in patients undergoing CT-guided percutaneous cryoablation of renal tumors. An IRB-approved, HIPAA-compliant retrospective study of 97 CT-guided cryoablation procedures to treat a solitary renal tumor in each of 97 patients (64M, 33F; range 31-84 yrs) was performed. Fifty patients were treated using a standard dose protocol (kVp=120, mean mAs=180, monitoring scans every 3min during freezes), and an additional 47 patients were treated using a dose reduction protocol (kVp=100, mean mAs=100, monitoring scans less frequently than every 3min during freezes). Multiple Wilcoxon Mann-Whitney (rank-sum) tests were used to compare dose-length product (DLP) between the two groups. Fisher's exact test was used to compare technique effectiveness at 12 months post ablation between the two groups. Median DLP for the standard protocol group was 4833.5 mGy*cm (range, 1667-8267 mGy*cm); median DLP for the dose reduction group was 2648 mGy*cm (range, 850-7169 mGy*cm), significantly less than that of the standard protocol group (p<0.01). The technique effectiveness for the dose reduction group was not significantly different from that of the standard protocol group at 12 month follow up (p=0.434). The radiation dose during percutaneous CT-guided cryoablation of renal tumors was substantial in both the standard and the dose reduction groups; however, it was significantly lower with the protocol change that reduced dose parameters and decreased the number of CT scans. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
    European journal of radiology 07/2015; DOI:10.1016/j.ejrad.2015.07.021
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    ABSTRACT: To evaluate a novel monoenergetic reconstruction algorithm (nMERA) with improved noise reduction for dual-energy CT (DECT) of pancreatic adenocarcinoma. Sixty patients with suspected pancreatic carcinoma underwent dual-source dual-energy CT with arterial phase. Images were reconstructed as linearly-blended 120-kV series (M_0.6) and with the standard monoenergetic (sMERA) and the novel monoenergetic algorithm (nMERA) with photon energies of 40, 55, 70 and 80keV. Objective image quality was compared regarding image noise, pancreas attenuation, signal-to-noise ratio (SNR) and pancreas-to-lesion contrast. Subjective image quality was assessed by two observers. Thirty pancreatic adenocarcinomas were detected. nMERA showed significantly reduced image noise at low keV levels compared with sMERA images (55 keV: 7.19±2.75 vs. 20.68±7.01HU; 40 keV: 7.33±3.20 vs. 37.22±14.66HU) and M_0.6 (10.69±3.57HU). nMERA pancreatic SNR was significantly superior to standard monoenergetic at 40 (47.02±23.41 vs. 9.37±5.83) and 55 keV (28.29±16.86 vs. 9.88±7.01), and M_0.6 series (11.42±6.00). Pancreas-to-lesion contrast peaked in the nMERA 40 keV series (26.39±16.83) and was significantly higher than in all other series (p<0.001). nMERA 55 keV images series were consistently preferred by both observers over all other series (p<0.01). nMERA DECT can significantly improve image quality and pancreas-to-lesion contrast in the diagnosis of pancreatic adenocarcinoma. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
    European journal of radiology 07/2015; DOI:10.1016/j.ejrad.2015.07.020
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    ABSTRACT: Rationale of this study was to evaluate whether unfolded rib images enhance time efficiency in detection of rib fractures and time efficiency in patients with acute thoracic trauma. 51 subsequent patients with thoracic trauma underwent 64-slice computed tomography. 1mm thick axial slices were reformatted using a commercially available post-processing software application generating rotatable unfolded rib images. Diagnostic accuracy was evaluated by 3 readers and compared to multiplanar reformations of the original CT images. Reformation and evaluation times were recorded. 116 rib fractures were detected. The multiplanar reformation analysis yielded a sensitivity of 87.9%/93.9%/79.7% with a specificity of 97%/97%/82.2%, whilst the unfolded rib image analysis yielded a sensitivity of 94.8%/94.8%/92.2% and a specificity of 85.2/87.8%/82.4 (p=0.06/0.8/0.04) with high inter-observer agreement (k=0.79-0.85). The mean reading time for the multiplanar reformations was significantly longer (reader 1: 103.7±27.1s/reader 2: 81.8±40.6s/reader 3: 154.3±39.2s) than the evaluation of the unfolded rib images (19.4±4.9s/26.9±15.0s/49.9±18.7s; p<0.01). Concluding, the unfolded rib display reduces reading time for detection of rib fractures in acute thoracic trauma patients significantly and does not compromise the diagnostic accuracy significantly in experienced radiologists. However, unexperienced readers may profit from use of this display. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
    European journal of radiology 07/2015; DOI:10.1016/j.ejrad.2015.07.023