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Training Program Improves Sensitivity of Novice CT Colonographic Data Reader
Radiology 2008
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Radiology 2008
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This Month In Radiology October


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I write "This Month in Radiology", the montly synopses of featured articles in the peer-reviewed journal Radiology

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This Month In Radiology October

  1. 1. Note: This copy is for your personal, non-commercial use only. To order presentation-ready copies for distribution to your colleagues or clients, use the Radiology Reprints form at the end of this article. DEPARTMENTS ■ This Month in Radiology Judgment Recommended for Extracolonic CT Findings Extracolonic findings at screening CT colonography present radiologists with a quandary in weighing care and cost effectiveness. In a study of 2195 asymptomatic adults who underwent CT colonography, Pickhardt and colleagues found that further diagnostic work-up was performed for extracolonic findings in 133 patients, including 18 for whom the radiologist recommended no additional work-up. Benign findings were confirmed in the majority of cases, but relevant new diagnoses, including nine malignancies, were found in 55 patients. CT screening detection of relevant unsuspected extracolonic ab- normalities is not rare, the researchers concluded, and radiologists should take great care to balance the cost of additional work-up against the potential for early disease detection, because many findings will prove to be of no clinical consequence. ❚ Page 151 T1-weighted MR in the Identification of Intraplaque Hemorrhage Location T1-weighted 3D MR imaging can depict the precise location of hemorrhage in com- plicated plaques in the carotid arteries. Bitar and colleagues studied 97 images from 11 patients undergoing carotid endarterectomy, using a 3D T1-weighted fat-suppressed spoiled gradient-echo sequence for high-spatial-resolution MR examination. Compared with histologic findings, the sequence yielded high sensitivity, specificity, and nega- tive predictive values for in-section detection of intraplaque hemorrhage location. The method is easy to implement, the researchers assert, because it uses one contrast weighting and the innate T1 hyperintensity thought to be provided by methemoglobin, and it may be useful in understanding why plaques become symptomatic. ❚ Page 259 Multidetector CT Generates Lower Cost Care for Coronary Artery Disease Multidetector CT may be a cost-efficient alternative to myocardial perfusion SPECT as an initial diagnostic test for patients with unconfirmed coronary artery disease (CAD). In a data warehouse study weighing medical costs against clinical outcomes for 39 174 patients, Min and colleagues found that over a 1-year period following the initial diag- nostic test, CAD-related costs were 25.9% lower for individuals who underwent CT than in matched individuals who underwent myocardial perfusion SPECT. The use of multi- detector CT in individuals suspected of having CAD, the researchers advise, may reduce downstream health care costs without compromising clinical risk assessment. ❚ Page 62 CT Helps Detect Intracardiac Thrombi after Stroke Cardiac CT angiography is highly sensitive for detecting left atrial appendage thrombi in patients after stroke. In a study of 101 patients within 1 month of a stroke, Hur and colleagues found that cardiac CT angiography demonstrated 100% sensitivity, 95% specificity, and 96% accuracy when compared with the semi-invasive reference stan- dard modality, transesophageal echocardiography (TEE). Four of the thrombi detected at CT angiography were not diagnosed as thrombi at TEE. The researchers conclud- ed that CT angiography can be useful for detecting intracardiac thrombi. ❚ Page 81 MR Signal Intensity Loss: Better Indicator of Liver Steatosis than Body Mass Index Opposed-phase liver signal intensity loss and visceral fat area may be better MR imag- ing biomarkers than body mass index (BMI) for the presence of liver steatosis. In 52 patients with nonalcoholic fatty liver disease or with hepatitis C-- or HIV-related liver disease, Bahl and colleagues found that histopathologic liver steatosis correlated well with liver signal intensity loss on opposed-phase MR images, fat-suppressed MR images, and average visceral fat area but correlated poorly with BMI. Relative signal intensity loss on opposed-phase and fat-saturated MR images can reliably and noninvasively dem- onstrate and grade the severity of liver steatosis, the researchers concluded. ❚ Page 160 3A Radiology: Volume 249: Number 1—October 2008
  2. 2. ■ CONTINUED THIS MONTH IN RADIOLOGY Training Program Improves Sensitivity of Novice CT Colonographic Data Reader Novice readers, including nonradiologists, can achieve high sensitivity in reading CT colonography after a comprehensive training program. Dachman and colleagues observed six medical students and one radiology fellow who participated in a 1-day course, read- ing assignments, a self-study computer module, observation of expert interpretation, and full interpretation of 10 cases with unblinding after each case. When presented with a set of 10 normal cases and 50 abnormal cases containing 93 polyps, the trainees demon- strated high sensitivity for identifying polyps measuring 6 mm or larger. The research- ers recommend a similar training program for use in reader certification. ❚ Page 167 BOLD MR Helps Predict Infarction Risk after Carotid Revascularization CO2-induced blood oxygen level--dependent (BOLD) MR imaging can be used to monitor the hemodynamic effects of carotid revascularization in patients with high-grade internal carotid artery stenosis. In a study of 24 patients, Haller and colleagues found that severely reduced cerebrovascular reserve prior to treatment was associated with increased risk of infarction during revascularization procedures. If the results are validated in a larger cohort, BOLD MR could be a safe, fast, and convenient addition to routine MR proto- cols for evaluating patients at risk for stroke, the researchers concluded. ❚ Page 251 “Laboratory Effect” May Impact Validity and Clinical Relevance of Retrospective Observer Studies Radiologists perform significantly more consistently among themselves and better when interpreting screening mammograms in the clinic than they do in the laboratory. With- out revealing the origin of the studies, Gur and colleagues presented nine experienced radiologists with a set of studies that they had previously read in a clinical setting mixed in with a set of studies that they had not previously seen. The researchers found that, on average, the radiologists demonstrated significantly better consistency, namely, less “spread” or variability among their performance levels in the clinic, as well as higher sensitivity and specificity during actual clinical interpretations when recommending ad- ditional diagnostic work-up or not. On the basis of these results, Gur and colleagues proposed that retrospective observer performance type laboratory experiments may not realistically represent radiologists’ performance in a clinical setting. ❚ Page 47 MR-guided Focused Ultrasound Reduces Metastatic Bone Pain Palliative treatment of bone metastases with MR-guided focused ultrasound signifi- cantly reduces pain. Gianfelice and colleagues examined 11 patients treated with MR- guided focused ultrasound for pain related to non--weight-bearing bone metasta- ses. In the 3 months after treatment, all patients reported a progressive decrease in pain and reduction in pain medication usage, with pain scores reduced by an av- erage of 92%. Five patients had increased bone density at the treatment site on fol- low-up unenhanced CT scans. MR-guided focused ultrasound allows noninvasive pal- liative treatment of bone metastases with little or no morbidity, the researchers con- cluded, and may provide the secondary benefit of new bone formation. ❚ Page 355 Multidetector CT Evaluation for Patent Foramen Ovale, Atrial Septal Aneurysm Multidetector CT is highly specific for detection of patent foramen ovale (PFO) and atrial septal aneurysm. In 105 patients with a recent stroke, Revel and colleagues found that overall sensitivity and specificity for PFO were 55% and 98%, respective- ly, with sensitivity increasing with patency grade. Sensitivity was 22% and specificity was 97% for atrial septal aneurysm. The researchers propose that multidetector CT could be used to help detect high-grade shunts through a PFO in patients with unex- plained hypoxemia but should not be used to evaluate the risk for stroke recurrence because of its low sensitivity for detection of atrial septal aneurysms. ❚ Page 338 Radiology: Volume 249: Number 1—October 2008 4A
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