Description

Publisher details

Elsevier

Publications in this journal

• Communicating results directly to patients: don't ignore the price tag of this added "value".

  Authors: Saurabh Jha

  Academic radiology. 19(6):643-5.

• Assessing Renal Parenchymal Volume on Unenhanced CT as a Marker for Predicting Renal Function in Patients with Chronic Kidney Disease.

  Authors: Supriya Gupta, Anand H Singh, Amna Shabbir, Peter F Hahn, Gordon Harris, Dushyant Sahani

  Academic radiology. 19(6):654-60.

  To estimate renal volume in chronic kidney disease (CKD) patients using a semiautomated software and compare them with split renal function estimates from radionuclide renogram (RR). We proposed thatTo estimate renal volume in chronic kidney disease (CKD) patients using a semiautomated software and compare them with split renal function estimates from radionuclide renogram (RR). We proposed that renal volume from unenhanced computed tomography (CT) scans may serve as surrogate marker for assessing renal function in CKD patients. Unenhanced multidetector CT scans of 26 patients with CKD (estimated glomerular filtration rate [eGFR] <60 mL/kg/body surface area [BSA]) and 10 controls (eGFR >60 mL/kg/BSA) were analyzed to calculate renal volumes using a semiautomated software (AMIRAV5.2.0). Volumes obtained were then correlated with corresponding eGFR and split renal function estimates from RR. Volumes were also compared with those obtained on enhanced scans in 10 cases (five disease group, five controls). Bland-Altman analysis was used to assess agreement between methods. A moderately positive correlation was found between renal volume obtained on unenhanced CT and eGFR (r = 0.65, P < .0001), whereas a significantly high correlation with split function estimates from RR (r = 0.95, P < .001) was found. Bland-Altman analysis revealed a good agreement between renal volume from CT and renal function from RR (34/36 observations were within 95% CI and there were two outliers). Correlation between volumes obtained from unenhanced and enhanced CT scans was also significant (r = 0.96). In patients with CKD, renal volume derived from unenhanced CT can possibly serve as a surrogate marker for assessing and monitoring renal function reserves to plan further management.

• Automated vs. Manual Pattern Recognition of 3D (1)H MRSI Data of Patients with Prostate Cancer.

  Authors: Christian M Zechmann, Bjoern H Menze, B Michael Kelm, Patrik Zamecnik, Uwe Ikinger, Frederik L Giesel, Christian Thieke, Stefan Delorme, Fred A Hamprecht, Peter Bachert

  Academic radiology. 19(6):675-84.

  The aim of this study was to assess (1) automated analysis methods versus manual evaluation by human experts of three-dimensional proton magnetic resonance spectroscopic imaging (MRSI) data fromThe aim of this study was to assess (1) automated analysis methods versus manual evaluation by human experts of three-dimensional proton magnetic resonance spectroscopic imaging (MRSI) data from patients with prostate cancer and (2) the contribution of spatial information to decision making. Three-dimensional proton MRSI was applied at 1.5 T. MRSI data from 10 patients with histologically proven prostate adenocarcinoma, scheduled either for prostatectomy or intensity-modulated radiation therapy, were evaluated. First, two readers manually labeled spectra using spatial information to identify the localization of spectra and neighborhood information, establishing the reference set of this study. Then, spectra were labeled again manually in a blinded and randomized manner and evaluated automatically using software that applied spectral line fitting as well as pattern recognition routines. Statistical analysis of the results of the different approaches was performed. Altogether, 1018 spectra were evaluable by all methods. Numbers of evaluable spectra differed significantly depending on patient and evaluation method. Compared to automated analysis, the readers made rather binary decisions, using information from neighboring spectra in ambiguous cases, when evaluating MRSI data as a whole. Differences between anatomically blinded and unblinded evaluation were larger than differences between evaluations using blinded data and automated techniques. An automated approach, which evaluates each spectrum individually, can be as good as an anatomy-blinded human reader. Spatial information is routinely used by human experts to support their final decisions. Automated procedures that consider anatomic information for spectral evaluation will enhance the diagnostic impact of MRSI of the human prostate.

• Running an Online Radiology Teaching Conference: Why It's a Great Idea and How to Do It Successfully.

  Authors: Michael L Richardson, Jonelle M Petscavage, John C Hunter, Catherine C Roberts, Thomas P Martin

  Academic radiology. 19(6):746-51.

  At the authors' institutions, faculty members and trainees work at multiple sites scattered miles apart, making it difficult to physically attend weekly teaching conferences. As a possible solution,At the authors' institutions, faculty members and trainees work at multiple sites scattered miles apart, making it difficult to physically attend weekly teaching conferences. As a possible solution, a weekly online musculoskeletal teaching conference was undertaken. This quickly grew to include multiple other sites around North America. The authors share their experiences to assist other radiologists in organizing similar educational conferences. The conferences are run using the Citrix GoToMeeting online meeting system. It runs on multiple platforms, including Mac, PC, iPhone, iPad, and Android. Attendees use a wide variety of microphones, sound cards, powered speakers, and webcams. Most users have fast institutional Internet connections, though several attend via slower connections, such as 3G. The conference has run successfully for 2 years, with participants logging in from 24 different sites in 18 states, two Canadian provinces, and three countries. About 48 sessions are held each year, with 10 to 15 sites joining the conferences each week and about 10 to 15 cases seen each week. Most attendees are from university medical centers, though several private practice radiologists attend regularly. Screen-sharing quality is superb, with no discernible difference between local and remote slide quality. Audio quality is usually quite good, particularly for those using computer audio. Audio feedback is an occasional problem, but this issue is now more easily addressed. No single time is equally convenient for participants scattered among four to six time zones. However, some sites find the conferences sufficiently valuable to rearrange their afternoon procedure schedules to reduce conflicts with the conferences. The social aspect of visiting weekly with friends and colleagues from afar is highly valued, as are seeing the wide range of pathology from other institutions and the ability to confer with colleagues on difficult cases. The conferences have also spawned several collaborative educational projects, such as an online journal club, a published book of conference cases, and an online musculoskeletal hardware atlas. The weekly online musculoskeletal conference described in this report has matured over 2 years from a peculiar experiment to a very popular conference. Cases not seen locally provide enrichment, and attendees gain educational opportunities not otherwise available. Other radiology groups should be able to create and maintain similar conferences.

• Direct reporting of results to patients: the future of radiology?

  Authors: Melanie Kuhlman, Monique Meyer, Elizabeth A Krupinski

  Academic radiology. 19(6):646-50.

  Radiologists have traditionally left relaying exam results to patients in the hands of clinicians. Recent editorials have reexamined radiologists' traditional position and questioned whetherRadiologists have traditionally left relaying exam results to patients in the hands of clinicians. Recent editorials have reexamined radiologists' traditional position and questioned whether radiologists should continue to remain within the confines of the reading room or increase their contact with patients. The present study addressed this issue by surveying patients directly regarding their preferences. A survey was given to all patients aged ≥ 21 years undergoing outpatient magnetic resonance imaging or computed tomographic examinations at an academic medical center and at an associated outpatient center. Responses were anonymous. Surveys were provided over a 4-week period in February and March 2011; 237 were returned. The majority of patients (73%-77%) continue to prefer the practice model already established, regardless of whether the results are normal or abnormal. However, the same percentage of patients preferred to hear the results of their exams from the experts interpreting the exams. The discrepancy in these results is likely reflected in the fact that there is persistent confusion as to the role of radiologists. Although most patients correctly defined a radiologist as a physician, 40% believed that a radiologist is a technician or a nurse. A large percentage of patients (64%) responded positively to wanting to meet the radiologists interpreting their exams. As radiologists, we need to reevaluate the established model of communication for reporting radiology results and consider the positive impact on patient care, and on the vitality of the radiology profession, of directly communicating with patients.

• Breast-specific Gamma Imaging in the Detection of Atypical Ductal Hyperplasia and Lobular Neoplasia.

  Authors: Caroline M Ling, Caitrín M Coffey, Jocelyn A Rapelyea, Jessica Torrente, Christine B Teal, Anita P McSwain, Rachel F Brem

  Academic radiology. 19(6):661-6.

  Atypical lesions such as atypical ductal hyperplasia (ADH) and lobular neoplasia are nonmalignant lesions that are associated with significant increased risk of developing breast cancer. AtypicalAtypical lesions such as atypical ductal hyperplasia (ADH) and lobular neoplasia are nonmalignant lesions that are associated with significant increased risk of developing breast cancer. Atypical lesions have been reported to present with focal increased radiotracer uptake on breast-specific gamma imaging (BSGI) examination, a novel physiologic tool for the detection of breast cancer. To date the sensitivity of BSGI in the detection of atypical lesions has not been reported. The purpose of this study is to determine the sensitivity of BSGI in detecting ADH and lobular neoplasia. A total of 1316 patients who received a BSGI exam between January 2006 and July 2009 were retrospectively reviewed. All patients who underwent minimally invasive biopsy and subsequent surgical excision where the highest pathology was solely ADH or lobular neoplasia (reported as ALH, lobular carcinoma in situ or lobular neoplasia), according to the pathology database were included (n = 15). The sensitivity was determined as the percentage of positive BSGI exams out of all patients diagnosed with ADH or lobular neoplasia who received a BSGI. Patient ages ranged from 39 to 67 (mean, 52). Eight of 15 patients had ADH, 6/15 lobular neoplasia, and 1/15 ADH and lobular neoplasia in one lesion. Fifteen of the 15 (100%) patients with surgically confirmed ADH or lobular neoplasia had a positive BSGI, with focally increased radiotracer uptake at the site of the verified high-risk lesion. BSGI has a high sensitivity for the detection of atypical, high-risk breast lesions. A diagnosis of an atypical lesion is concordant with focal increased radiotracer uptake with BSGI and can identify women at increased risk for breast cancer.

• Benefits of 3D Rotational DSA Compared with 2D DSA in the Evaluation of Intracranial Aneurysm.

  Authors: Siong Chuong Wong, Ouzreiah Nawawi, Norlisah Ramli, Khairul Azmi Abd Kadir

  Academic radiology. 19(6):701-7.

  The aim of this study was to compare conventional two-dimensional (2D) digital subtraction angiography (DSA) with three-dimensional (3D) rotational DSA in the investigation of intracranial aneurysmThe aim of this study was to compare conventional two-dimensional (2D) digital subtraction angiography (DSA) with three-dimensional (3D) rotational DSA in the investigation of intracranial aneurysm in terms of detection, size measurement, neck diameter, neck delineation, and relationship with surrounding vessels. A further aim was to compare radiation dose, contrast volume, and procedural time between the two protocols. Thirty-five patients who presented with subarachnoid bleeds on computed tomography and were suspected of having intracranial aneurysms underwent conventional 2D DSA followed by 3D DSA. The 3D digital subtraction angiographic images were displayed as surface shaded display images. Aneurysm detection, sac size, neck diameter, neck delineation, and relationship of aneurysm to the surrounding vessels analyzed from the two protocols were compared. Radiation dose, contrast volume, and procedural time for both examinations were also compared. Three-dimensional DSA detected 44 aneurysms in 31 patients, with negative findings seen in four patients. A false-negative detection rate of 6.8% (three of 44) for 2D DSA was noted. There was no significant difference in aneurysm size between 3D and 2D DSA. The sizes of aneurysm necks were found to be significantly larger in 3D DSA than on 2D DSA. The aneurysm neck and relationship to surrounding vessels were significantly better demonstrated on 3D DSA than on 2D DSA. Radiation dose (entrance surface dose), contrast use, and procedural time with 3D DSA were significantly less than with 2D DSA. Three-dimensional DSA improves the detection and delineation of intracranial aneurysms, with lower radiation dose, less contrast use, and shorter procedural time compared to 2D DSA. The size of the aneurysm neck on 3D DSA tended to be larger than on 2D DSA.

• Lifetime acquaintances.

  Authors: Otha Linton

  Academic radiology. 19(6):773.

• Semi-Automatic Segmentation Software for Quantitative Clinical Brain Glioblastoma Evaluation.

  Authors: Ying Zhu, Geoffrey S Young, Zhong Xue, Raymond Y Huang, Hui You, Kian Setayesh, Hiroto Hatabu, Fei Cao, Stephen T Wong

  Academic radiology.

  RATIONALE AND OBJECTIVES: Quantitative measurement provides essential information about disease progression and treatment response in patients with glioblastoma multiforme (GBM). The goal of thisRATIONALE AND OBJECTIVES: Quantitative measurement provides essential information about disease progression and treatment response in patients with glioblastoma multiforme (GBM). The goal of this article is to present and validate a software pipeline for semi-automatic GBM segmentation, called AFINITI (Assisted Follow-up in NeuroImaging of Therapeutic Intervention), using clinical data from GBM patients. MATERIALS AND METHODS: Our software adopts the current state-of-the-art tumor segmentation algorithms and combines them into one clinically usable pipeline. Both the advantages of the traditional voxel-based and the deformable shape-based segmentation are embedded into the software pipeline. The former provides an automatic tumor segmentation scheme based on T1- and T2-weighted magnetic resonance (MR) brain data, and the latter refines the segmentation results with minimal manual input. RESULTS: Twenty-six clinical MR brain images of GBM patients were processed and compared with manual results. The results can be visualized using the embedded graphic user interface. CONCLUSION: Validation results using clinical GBM data showed high correlation between the AFINITI results and manual annotation. Compared to the voxel-wise segmentation, AFINITI yielded more accurate results in segmenting the enhanced GBM from multimodality MR imaging data. The proposed pipeline could be used as additional information to interpret MR brain images in neuroradiology.

• Radiofrequency Ablation of the Liver: Effect of Variation of Portal Venous Blood Flow on Lesion Size in an In-vitro Perfused Bovine Liver.

  Authors: Liping Huang, Gerald D Dodd Iii, Anthony C Lanctot

  Academic radiology.

  RATIONALE AND OBJECTIVES: An in vitro perfused bovine liver model was used to evaluate the relationship between the sizes of radiofrequency ablation lesions and variation in portal venous blood flow.RATIONALE AND OBJECTIVES: An in vitro perfused bovine liver model was used to evaluate the relationship between the sizes of radiofrequency ablation lesions and variation in portal venous blood flow. MATERIALS AND METHODS: Fourteen bovine livers were perfused with autologous heparinized blood at 37°C and 40% to 50% oxygenation via the portal vein. Flow rates were adjusted from 10 to 50 mL/min/100 g tissue. A 480-kHz generator and a 3.0-cm monopolar internally cooled electrode were used to create 57 ablations. The long-axis diameter, short-axis diameter (SAD), and volume of each ablation zone were measured and calculated from the dissected livers. Correlations between SAD, long-axis diameter, and volume versus blood flow were assessed using linear regression analysis. RESULTS: SAD and lesion volume demonstrated inverse linear correlations with blood flow (for SAD, y = -0.044x + 3.925, r = 0.836, P < .001; for volume, y = -0.556x + 31.574, r = 0.842, P < .001). A 10 mL/min/100 g change in flow rate produced an average 4.4 ± 0.4 mm change in SAD and an average 5.6 ± 0.5 cm(3) change in volume. Long-axis diameter was not correlated with blood flow (y = -0.7694x + 4.1899, r = 0.2173, P = .111). CONCLUSIONS: The SAD and volume of radiofrequency ablation lesions have statistically significant inverse linear correlations with portal venous blood flow, with an average 4.4-mm change in SAD and an average 5.6-cm(3) change in volume for each 10 mL/min/100 g change in flow rate.

• Hyperpolarized (129)Xe Magnetic Resonance Imaging: Tolerability in Healthy Volunteers and Subjects with Pulmonary Disease.

  Authors: Yajur Shukla, Andrew Wheatley, Miranda Kirby, Sarah Svenningsen, Adam Farag, Giles E Santyr, Nigel A M Paterson, David G McCormack, Grace Parraga

  Academic radiology.

  RATIONALE AND OBJECTIVES: The objective of this study was to evaluate the tolerability of hyperpolarized (129)Xe gas inhaled from functional residual capacity and magnetic resonance imaging inRATIONALE AND OBJECTIVES: The objective of this study was to evaluate the tolerability of hyperpolarized (129)Xe gas inhaled from functional residual capacity and magnetic resonance imaging in healthy subjects and those with pulmonary disease. MATERIALS AND METHODS: Twelve healthy volunteers (mean age, 59 ± 17 years), seven subjects with asthma (mean age, 47 ± 7 years), 10 subjects with chronic obstructive pulmonary disease (mean age, 74 ± 4 years), three subjects with cystic fibrosis (mean age, 27 ± 10 years), and a single subject with radiation-induced lung injury (age, 66 years) were enrolled and evaluated over 43 visits with 136 anoxic inhalations of 500 mL (129)Xe gas mixed with 500 mL (4)He gas. Oxygen saturation and heart rate were monitored during the breath-hold and imaging; subjects were queried for adverse events (AEs) before and immediately following gas inhalation and for 24 hours after the last dose. RESULTS: No subjects withdrew from the study or reported serious, hypoxic, or severe AEs. Over the course of 136 dose administrations, two mild AEs (1%) were reported in two different subjects (two of 33 [6%]). One of these AEs (light-headedness) was temporally related and judged as possibly related to (129)Xe administration and resolved without treatment within 2 minutes. Statistically significant but clinically insignificant changes in oxygen saturation and heart rate were observed after inhalation (P < .001), and both resolved 1 minute later, with no difference between subject groups. CONCLUSIONS: Inhalation of hyperpolarized (129)Xe gas and subsequent magnetic resonance imaging were well tolerated in healthy subjects and ambulatory subjects with obstructive and restrictive pulmonary disease.

• Correlation between Dynamic Contrast-enhanced Perfusion MRI Relative Cerebral Blood Volume and Vascular Endothelial Growth Factor Expression in Meningiomas.

  Authors: Daniel T Ginat, Rajiv Mangla, Gabrielle Yeaney, Pamela W Schaefer, Henry Wang

  Academic radiology.

  PURPOSE: To determine whether there is a correlation between vascular endothelial growth factor (VEGF) expression and cerebral blood flow (CBV) measurements in dynamic contrast-enhancedPURPOSE: To determine whether there is a correlation between vascular endothelial growth factor (VEGF) expression and cerebral blood flow (CBV) measurements in dynamic contrast-enhanced susceptibility perfusion magnetic resonance imaging (MRI) and to correlate the perfusion characteristics in high- versus low-grade meningiomas. METHODS AND MATERIALS: A total of 48 (24 high-grade and 24 low-grade) meningiomas with available dynamic susceptibility-weighted MRI were retrospectively reviewed for maximum CBV and semiquantitative VEGF immunoreactivity. Correlation between normalized CBV and VEGF was made using the Spearman rank test and comparison between CBV in high- versus low-grade meningiomas was made using the Wilcoxon test. RESULTS: There was a significant (P = .01) correlation between normalized maximum CBV and VEGF scores with a Spearman correlation coefficient of 0.37. In addition, there was a significant (P < .01) difference in normalized maximum CBV ratios between high-grade meningiomas (mean 12.6; standard deviation 5.2) and low-grade meningiomas (mean 8.2; standard deviation 5.2). CONCLUSION: The data suggest that CBV accurately reflects VEGF expression and tumor grade in meningiomas. Perfusion-weighted MRI can potentially serve as a useful biomarker for meningiomas, pending prospective studies.

• Engineering and Radiology: Implications for Education.

  Authors: Richard B Gunderman, Todd A Rickett

  Academic radiology.

• Radiofrequency Ablation of Retroperitoneal Metastatic Lymph Nodes from Hepatocellular Carcinoma.

  Authors: Fei Gao, Yangkui Gu, Jinhua Huang, Ming Zhao, Peihong Wu

  Academic radiology.

  RATIONALE AND OBJECTIVES: To retrospectively evaluate effectiveness and safety of radiofrequency (RF) ablation with retroperitoneal metastatic lymph nodes from hepatocellular carcinoma (HCC).RATIONALE AND OBJECTIVES: To retrospectively evaluate effectiveness and safety of radiofrequency (RF) ablation with retroperitoneal metastatic lymph nodes from hepatocellular carcinoma (HCC). MATERIALS AND METHODS: Thirty-two patients with retroperitoneal metastatic lymph node recurrence from HCC were enrolled in our study and the patients stratified into two groups based on the treatment. Nineteen patients in Group A were percutaneously treated and each metastatic lymph node was ablated with computed tomographic (CT) guidance. Thirteen patients in Group B only underwent RF ablation for hematogenous metastases, but did not undergo RF ablation or any other treatment for metastatic lymph nodes. Follow-up contrast material-enhanced CT or positron emission tomographic scans were reviewed and Kaplan-Meier survival estimates were analyzed. RESULTS: There were no significant differences between characteristics of the two groups. Kaplan-Meier analysis indicated the patients of Group A had an overall survival of 26.3% at 1 year compared with 7.7% for those of Group B. Mantel-Cox log rank test showed the 1-year survival rate of Group A was significantly higher than that of Group B (P = .029). In Group A, the local control rate of 3, 6, 10, and 15 months was 78.9%, 73.3%, 41.7%, and 25.0%, respectively. Sixteen, 12, 6, and 2 patients showed no evidence of local progression for 3, 6, 10, and 15 months, respectively. There was no thermal injury of gastrointestinal tract or bile duct during RF ablation in all the 19 patients of Group A. CONCLUSION: RF ablation is effective and may be safely applied to retroperitoneal metastatic lymph nodes from HCC.

• Improved Detection of Parenchymal Cysticercal Lesions in Neurocysticercosis with T2*-weighted Angiography Magnetic Resonance Imaging.

  Authors: Avantika Verma, Rishi Awasthi, Kashi N Prasad, Neetu Soni, Kamini Singh, Vimal K Paliwal, Hira Lal, Chandra M Pandey, Rakesh K Gupta

  Academic radiology.

  RATIONALE AND OBJECTIVES: Magnetic resonance imaging (MRI) is an important tool for the diagnosis and management of various central nervous system infections. In the present study, we investigatedRATIONALE AND OBJECTIVES: Magnetic resonance imaging (MRI) is an important tool for the diagnosis and management of various central nervous system infections. In the present study, we investigated the role of T2*-weighted angiography (SWAN) imaging in the diagnosis of neurocysticercosis (NCC) viz-a-viz conventional MRI. METHODS: Symptomatic (n = 46) and asymptomatic (n = 88) cases from a pig-farming community were imaged using both conventional and SWAN MRI between July 2009 and May 2011. Two experienced neuroradiologists independently reviewed all the images to characterize the lesions as well as detection of the scolex. RESULTS: A total of 250 lesions were detected in 70 individuals. On conventional MRI, the lesion and scolex visibility was 82.4% (206/250) and 60% (150/250), respectively, which increased to 96.8% and 81%, respectively, using SWAN imaging. On combining SWAN with conventional MRI, the scolex visibility increased to 85% (213/250) of the total 250 lesions detected. Overall, adding SWAN to conventional MRI increased the lesion detection and scolex visibility up to 18% (206 vs. 250) and 30% (150 vs. 213), respectively. CONCLUSION: SWAN imaging when added to the conventional MRI protocol for population screening for NCC in endemic regions improves both lesion detection and definitive diagnosis of neurocysticercosis.

• CT Scans of the Chest in Carriers of Human T-cell Lymphotropic Virus Type 1: Presence of Interstitial Pneumonia.

  Authors: Tsuneo Yamashiro, Hisashi Kamiya, Tetsuhiro Miyara, Shinji Gibo, Kazuhiko Ogawa, Tamaki Akamine, Hidekazu Moromizato, Satomi Yara, Sadayuki Murayama

  Academic radiology.

  RATIONALE AND OBJECTIVES: To evaluate pulmonary findings on computed tomography (CT) scans in carriers of human T-lymphotropic virus type 1 (HTLV-1). MATERIALS AND METHODS: This retrospective studyRATIONALE AND OBJECTIVES: To evaluate pulmonary findings on computed tomography (CT) scans in carriers of human T-lymphotropic virus type 1 (HTLV-1). MATERIALS AND METHODS: This retrospective study was approved by the Institutional Review Board at each institution, and informed consent was waived. Patients who were diagnosed with adult T-cell lymphoma/leukemia or collagen vascular disease were excluded from the study. Chest CT of 106 HTLV-1 carriers (54 females and 52 males; age range 44-94 years) were initially evaluated by two chest radiologists. Assessed CT findings included centrilobular nodules, thickening of bronchovascular bundles, ground-glass opacity, bronchiectasis, interlobular septal thickening, consolidation, honeycombing, crazy-paving appearance, enlarged lymph nodes, pleural effusion, and pericardial effusion. Three chest radiologists secondarily evaluated the CT scans with the abnormal findings to judge the presence of interstitial pneumonia patterns or a bronchiolitis/bronchitis pattern. RESULTS: Abnormal CT findings were found in 65 (61.3%) patients, including ground-glass opacity (n = 33), bronchiectasis (n = 28), centrilobular nodules (n = 25), and interlobular septal thickening (n = 19). Honeycombing (n = 5) and crazy-paving appearance (n = 3) were also observed. Based on the CT findings, 10 subjects were diagnosed with interstitial pneumonia (usual interstitial pneumonia pattern, n = 3; nonspecific interstitial pneumonia pattern, n = 5; organizing pneumonia pattern, n = 2; respectively). Twenty subjects were diagnosed with the bronchitis/bronchiolitis pattern. CONCLUSION: Although the bronchiolitis/bronchitis pattern is predominant on chest CT in HTLV-1 carriers, the HTLV-1 infection is associated with various interstitial pneumonias.

• Cross-specialty Integrated Resident Conferences: An Educational Approach to Bridging the Gap.

  Authors: David M Naeger, Andrew Phelps, Maureen Kohi, Anand Patel, Brett Elicker, Karen Ordovas, Thomas Urbania, David Avrin, Aliya Qayyum

  Academic radiology.

  RATIONALE AND OBJECTIVES: Radiologists play a pivotal role in patient management, primarily through interacting with referring clinicians. Despite this extensive cross-specialty interaction,RATIONALE AND OBJECTIVES: Radiologists play a pivotal role in patient management, primarily through interacting with referring clinicians. Despite this extensive cross-specialty interaction, radiology resident education rarely involves direct education from clinicians outside the department. We surveyed resident attitudes toward integrated conferences with subspecialty referring physicians both before and after a pilot lecture series at our institution. MATERIALS AND METHODS: Three thoracic-themed multidisciplinary conferences were organized, which involved a variety of clinicians lecturing during normal resident conference times. Resident surveys were administered before and after the complete lectures series as well as immediately after each individual lecture. RESULTS: The prelecture series survey indicated residents felt neutral about their confidence in knowing what clinicians want from radiology reports and the current level of "clinician-focus" in the curriculum. Residents indicated a desire for more clinician involvement in lectures. After completion of the series, residents expressed that the integrated conferences were useful and that they had greater confidence in understanding the clinicians' expectation of reports. Resident interest in clinician participation in lectures was higher after series completion. Most residents indicated that prespecified, self-identified learning objectives were met by the lectures. After the completion of the series, most residents indicated that they wanted the series to continue, with the most commonly indicated desired frequency being once or twice a month. CONCLUSION: Subspecialty clinician participation in a cross-specialty integrated resident lecture series was highly favored and well received. An "Integrated Clinical Lecture Series" may be a beneficial addition to radiology residency curriculums.

• Battle against Alzheimer's Disease: The Scope and Potential Value of Magnetic Resonance Imaging Biomarkers.

  Authors: Sophie Paquerault

  Academic radiology. 19(5):509-11.

• Pre-residency Publication Rate Strongly Predicts Future Academic Radiology Potential.

  Authors: Issa Rezek, Robert J McDonald, David F Kallmes

  Academic radiology. 19(5):632-4.

  Radiology resident selection committees often favor candidates with strong academic potential. The aim of this study was to determine if preresidency academic productivity of current radiologists wasRadiology resident selection committees often favor candidates with strong academic potential. The aim of this study was to determine if preresidency academic productivity of current radiologists was predictive of subsequent of future academic performance. The academic productivity of all radiology residents trained between 1975 and 2005 at the authors' institution was assessed through identification of their publication histories, National Institutes of Health funding statuses, and Hirsch indexes (h-indexes). These metrics were correlated with numbers of publications generated prior to beginning radiology residency and grouped accordingly (group 0, none prior to residency; group 1, one publication; and group 2, more than one publication). Academic productivity metrics of the different groups were compared using one-way analysis of variance and χ(2) analysis. Spearman's ρ coefficient was used to evaluate correlations between the number of preresidency publications and subsequent productivity. A cohort of 269 residents was included in this study. Group 0 comprised 182 of the 269 residents (68%), while groups 1 and 2 comprised 27 (10%) and 60 (22%) residents, respectively. Rates of subsequent publication, mean h-index, and National Institutes of Health funding statuses were significantly higher in group 2 compared to both groups 0 and 1 (P < .0001 for each metric). Preresidency publication volume was significantly correlated with future publication performance (ρ = 0.3977, P < .0001), mean h-index (ρ = 0.3086, P < .0001), and National Institutes of Health funding status (ρ = 0.4916, P < .0001). Radiology residency candidates with multiple publications are more likely to achieve future academic success compared to candidates with one or zero publications.

• Systems for Lung Volume Standardization during Static and Dynamic MDCT-based Quantitative Assessment of Pulmonary Structure and Function.

  Authors: Matthew K Fuld, Randall W Grout, Junfeng Guo, John H Morgan, Eric A Hoffman

  Academic radiology.

  RATIONALE AND OBJECTIVES: Multidetector-row computed tomography (MDCT) has emerged as a tool for quantitative assessment of parenchymal destruction, air trapping (density metrics), and airwayRATIONALE AND OBJECTIVES: Multidetector-row computed tomography (MDCT) has emerged as a tool for quantitative assessment of parenchymal destruction, air trapping (density metrics), and airway remodeling (metrics relating airway wall and lumen geometry) in chronic obstructive pulmonary disease (COPD) and asthma. Critical to the accuracy and interpretability of these MDCT-derived metrics is the assurance that the lungs are scanned during a breathhold at a standardized volume. MATERIALS AND METHODS: A computer monitored turbine-based flow meter system was developed to control patient breathholds and facilitate static imaging at fixed percentages of the vital capacity. Because of calibration challenges with gas density changes during multibreath xenon CT, an alternative system was required. The design incorporated dual rolling seal pistons. Both systems were tested in a laboratory environment and human subject trials. RESULTS: The turbine-based system successfully controlled lung volumes in 32/37 subjects, having a linear relationship for CT measured air volume between repeated scans: for all scans, the mean and confidence interval of the differences (scan1-scan2) was -9 mL (-169, 151); for total lung capacity alone 6 mL (-164, 177); for functional residual capacity alone, -23 mL (-172, 126). The dual-piston system successfully controlled lung volume in 31/41 subjects. Study failures related largely to subject noncompliance with verbal instruction and gas leaks around the mouthpiece. CONCLUSION: We demonstrate the successful use of a turbine-based system for static lung volume control and demonstrate its inadequacies for dynamic xenon CT studies. Implementation of a dual-rolling seal spirometer has been shown to adequately control lung volume for multibreath wash-in xenon CT studies. These systems coupled with proper patient coaching provide the tools for the use of CT to quantitate regional lung structure and function. The wash-in xenon CT method for assessing regional lung function, although not necessarily practical for routine clinical studies, provides for a dynamic protocol against which newly emerging single breath, dual-energy xenon CT measures can be validated.

• Altered Excitation-inhibition Balance in the Brain of Patients with Diabetic Neuropathy.

  Authors: Myria Petrou, Rodica Pop-Busui, Bradley R Foerster, Richard A Edden, Brian C Callaghan, Steve E Harte, Richard E Harris, Daniel J Clauw, Eva L Feldman

  Academic radiology. 19(5):607-12.

  To assess differences in excitatory (glutamate/glutamine or Glx) and inhibitory (γ-Aminobutyric acid or GABA) neurotransmitter levels using MR spectroscopy in pain processing regions of the brain inTo assess differences in excitatory (glutamate/glutamine or Glx) and inhibitory (γ-Aminobutyric acid or GABA) neurotransmitter levels using MR spectroscopy in pain processing regions of the brain in patients diabetic neuropathy (DN) and positive sensory symptoms and age-matched healthy control (HC) subjects. Seven diabetic patients (5 males, 2 females, mean age = 57.0 ± 8.5 years) with confirmed DN and positive sensory symptoms and 7 age and sex matched HC subjects (mean age = 57.7 ± 3.2 years) underwent 3 Tesla MR spectroscopy. Glx and GABA levels were quantified in the right anterior and posterior insula, anterior cingulate cortex and right thalamus. Mean Glx levels were significantly higher and mean GABA levels were significantly lower within the posterior insula in the DN patients compared to HC (P = 0.005 and 0.012 respectively). This pilot data demonstrates an excitatory/inhibitory neurotransmitter imbalance in the brain of in patients with DN and positive sensory symptoms compared to pain free HC subjects.

• Like brothers.

  Authors: Otha W Linton

  Academic radiology. 19(5):640.

• Identification of Noncalcified Plaque in Young Persons with Diabetes: An Opportunity for Early Primary Prevention of Coronary Artery Disease Identified with Low-dose Coronary Computed Tomographic Angiography.

  Authors: Paul M Madaj, Matthew J Budoff, Dong Li, John A Tayek, Ronald P Karlsberg, Harold L Karpman

  Academic radiology.

  PURPOSE: Coronary computed tomographic angiography (CTA) is a valuable tool for assessing coronary artery disease (CAD). Although statin use is widely recommended for persons with diabetes older thanPURPOSE: Coronary computed tomographic angiography (CTA) is a valuable tool for assessing coronary artery disease (CAD). Although statin use is widely recommended for persons with diabetes older than age 40, little is known about the presence and severity of CAD in younger patients with diabetes mellitus (DM). We evaluated coronary artery calcium (CAC) and coronary CTA in young persons with both DM1 and DM2 in an attempt to detect the earliest objective evidence of arteriosclerosis eligible for primary prevention. METHODS AND MATERIALS: We prospectively enrolled 40 persons with DM (25 type 1 and 15 type 2) between the ages of 19 and 35 presenting with diabetes for 5 years or longer. All patients underwent coronary CTA and CAC scans to evaluate for early atherosclerotic disease. Each plaque in the coronary artery was classified as noncalcified or calcified-mixed. We also evaluated all segments with stenosis, dividing them into mild (<50%), moderate (50-70%), and severe (>70%). RESULTS: The average age of the DM1 subjects were 26 ± 4 (SD) years and 30 ± 4 years for DM2 patients (P < .01), with duration of diabetes of 8 ± 5 years and average HbA1c% of 8.7 ± 1.6 (norm = 4.6-6.2). Abnormal scans were present in 57.5%, noncalcified in 35% and calcified-mixed plaque in 22.5%. Persons with DM2 had a higher prevalence of positive coronary CTA scans than DM1: 80% versus 44% (P < .03) and more positive CAC scores 53% versus 4%, (P < .01). The total segment score of 2.1 ± 3.4 (P < .01) and total plaque score 1.9 ± 2.8 (P < .01) were highly correlated to each other. Plaque was almost uniformly absent below age 25, and became increasingly common in individuals over the age of 25 years for both groups. The average radiation exposure was 2.5 ± 1.3 mSv. CONCLUSION: Our study verifies that early CAD can be diagnosed with coronary CTA and minimal radiation exposure in young adults with DM. A negative CAC score was not sufficient to exclude early CAD as we observed a preponderance of noncalcified plaque in this cohort. Coronary CTA in young DM patients older than age 25 may provide earlier identification of disease than does a CAC because only noncalcified plaque is frequently present. Coronary CTA provides an opportunity to consider initiation of earlier primary CAD prevention rather than waiting for the age of 40 as currently recommended by the American Diabetes Association guidelines.

• CAD-associated Reader Error in CT Colonography.

  Authors: Vadim S Koshkin, J Louis Hinshaw, Kristen Wroblewski, Abraham H Dachman

  Academic radiology.

  RATIONALE AND OBJECTIVES: Computed tomographic colonographic interpretation with computer-aided detection (CAD) may be superior to unaided viewing, although polyp characteristics may influenceRATIONALE AND OBJECTIVES: Computed tomographic colonographic interpretation with computer-aided detection (CAD) may be superior to unaided viewing, although polyp characteristics may influence accuracy. Reader error due to polyp characteristics was evaluated in a multiple-case, multiple-reader trial of computed tomographic colonography with CAD. MATERIALS AND METHODS: Two experts retrospectively reviewed 52 positive cases (74 polyps) and categorized them as hard, moderate, or easy to detect. Each case was evaluated without and with CAD. Features that may influence a reader's ability to detect a polyp or to accept or reject a CAD mark were tabulated. The association between polyp characteristics and detection rates in the trial was assessed. The difference in detection rates (CAD vs unassisted) was calculated, and regression analysis was performed. RESULTS: Of 64 polyps found by CAD, experts categorized 20 as hard, 28 as moderate, and 16 as easy to detect. Reader characterization errors predominated (47.3%) over other errors. Factors associated with lower detection rates included small size, flat morphology, and resemblance to a thickened fold. CAD was superior for polyps resembling lipomas compared to those that did not resemble lipomas (average increase in detection rate with CAD, 12.8% vs 5.5%; P < .05). CONCLUSIONS: Polyp characteristic may impair computed tomographic colonographic interpretation augmented by CAD. Readers can avoid errors of measurement by evaluating diminutive polyp candidates with sample measurements. Caution should be taken when evaluating focally thick folds and when using visual impression to dismiss a polyp candidate as a lipoma when it is submerged in densely tagged fluid.

• Improved Understanding of Human Anatomy through Self-guided Radiological Anatomy Modules.

  Authors: Andrew W Phillips, Sandy G Smith, Callum F Ross, Christopher M Straus

  Academic radiology.

  RATIONALE AND OBJECTIVE: To quantifiably measure the impact of self-instructed radiological anatomy modules on anatomy comprehension, demonstrated by radiology, gross, and written exams. MATERIALSRATIONALE AND OBJECTIVE: To quantifiably measure the impact of self-instructed radiological anatomy modules on anatomy comprehension, demonstrated by radiology, gross, and written exams. MATERIALS AND METHODS: Study guides for independent use that emphasized structural relationships were created for use with two online radiology atlases. A guide was created for each module of the first year medical anatomy course and incorporated as an optional course component. A total of 93 of 96 eligible students participated. All exams were normalized to control for variances in exam difficulty and body region tested. An independent t-test was used to compare overall exam scores with respect to guide completion or incompletion. To account for aptitude differences between students, a paired t-test of each student's exam scores with and without completion of the associated guide was performed, thus allowing students to serve as their own controls. RESULTS: Twenty-one students completed no study guides; 22 completed all six guides; and 50 students completed between one and five guides. Aggregate comparisons of all students' exam scores showed significantly improved mean performance when guides were used (radiology, 57.8% [percentile] vs. 45.1%, P < .001; gross, 56.9% vs. 46.5%, P = .001; written, 57.8% vs. 50.2%, P = .011). Paired comparisons among students who completed between one and five guides demonstrated significantly higher mean practical exam scores when guides were used (radiology, 49.3% [percentile] vs. 36.0%, P = .001; gross, 51.5% vs. 40.4%, P = .005), but not higher written scores. CONCLUSIONS: Radiological anatomy study guides significantly improved anatomy comprehension on radiology, gross, and written exams.

Data provided are for informational purposes only. Although carefully collected, accuracy cannot be guaranteed. The impact factor represents a rough estimation of the journal's impact factor and does not reflect the actual current impact factor. Publisher conditions are provided by RoMEO. Differing provisions from the publisher's actual policy or licence agreement may be applicable.