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This Month In Radiology February 2009

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  • 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 ©RSNA, 2009 US Followed by CT Cost-Effective for Diagnosing Pediatric Appendicitis For diagnosis of pediatric appendicitis, a cost-effective method is to start with US (especially when prevalence is extremely low) and follow negative US findings with CT. In a Markov- based model comprising lifetime radiation risk, societal willingness to pay, and other fac- tors, Wan and colleagues found that US followed by CT was a cost-effective imaging strategy in children as young as 5 years old. Acknowledging that clinicians should avoid radiation exposure to children whenever possible, the researchers said they hoped the study would encourage clinicians to recognize that the use of CT is justified when the diagnosis of appendicitis is in question, especially in those cases when US is inconclusive. ❚  Page 378 CT Texture Analysis Predicts Colorectal Cancer Survival Texture analysis shows promise as a potential biomarker for survival in patients with col- orectal cancer. In an evaluation of 48 patients, Miles and colleagues found that a texture pa- rameter comparing the uniformity of distribution of CT image features between 10 and 12 pixels, when applied to portal phase CT of the liver, can help identify patients who had poor survival outcomes. The researchers concluded that the method is potentially a better pre- dictor of survival in patients with colorectal cancer than CT perfusion imaging. ❚  Page 444 CT Excludes Appendicitis, Even When the Appendix Is Not Visualized The accuracy of excluding the diagnosis of appendicitis on a normal pediatric abdomi- nopelvic CT image with a nonvisualized appendix is similar to that obtained in cas- es with a partially or even fully visualized appendix. In a study of 156 children sus- pected of having appendicitis, Garcia and colleagues found that while the amount of pericecal fat correlated positively with the detectability of the appendix, CT im- ages with nonvisualized appendix yielded a high negative predictive value similar to that of CT images with a partially or fully visualized appendix. The false-negative rate was similar to those in two adult series, the researchers observed. ❚  Page 531 Consensus Panel Improves Breast Screening Diagnosis, Reduces Recall Rates A consensus review of cases with discordant findings increases the number of malignant cancers diagnosed, reduces unwarranted patient recall, and is associated with a low false-negative rate. Shaw and colleagues found that the Irish National Breast Screen- ing Program consensus panel—which reviewed 1% of the 128 569 screening cases— identified 7.33% of the 968 cancers diagnosed in the screening population, with an overall recall rate of 4.41%. The researchers concluded this method facilitates the early diagnosis of cancers with subtle findings on mammograms while significant- ly reducing the number of normal cases recalled for further assessment. ❚  Page 354 Combined CT Protocol Cuts Time to Differentiate Adrenal Adenomas from Nonadenomas A combined diagnostic CT protocol for distinguishing adrenal adenomas from non- adenomas with a short examination time yields results comparable to those with longer protocols. In a retrospective study of CT diagnostic parameters in 61 pa- tients, Kamiyama and colleagues found that combined use of unenhanced CT at- tenuation, 5-minute enhanced CT attenuation, percentage enhancement washout ratio, and relative percentage enhancement washout ratio yielded high specific- ity in diagnosing total adrenal adenomas and lipid-poor adenomas. The researchers concluded that the combined methods demonstrate high diagnostic accuracy with a shorter examination time than does a standard 10-minute protocol. ❚  Page 474 Radiology: Volume 250: Number 2—February 2009 3A
  • 2. THIS MONTH IN Radiology ■ ContinueD Functional MR Demonstrates Early Transarterial Chemoembolization Response in Hepatocellular Carcinoma Functional MR imaging of hepatocellular carcinoma demonstrates vascular and cellu- lar response to transarterial chemoembolization (TACE) well before changes in tumor size occur. In 24 patients who underwent TACE, Kamel and colleagues found a signif- icant persistent reduction in tumor enhancement within 24 hours after treatment, as well as changes in apparent diffusion coefficient values during the following weeks. Tu- mor size remained unchanged up to 4 weeks after therapy. The researchers conclud- ed functional images depicting vascularization and cellularity may be an early indica- tor of TACE response and should be incorporated into early assessment. ❚  Page 466 An editorial by Padhani accompanies this article (p 324). Right Pulmonary Artery Distensibility Assists Pulmonary Hypertension Diagnosis Measuring right pulmonary artery (RPA) distensibility on electrocardiographi- cally gated multidetector CT can improve diagnosis of pulmonary hypertension. In 45 patients, Revel and colleagues evaluated RPA distensibility, as well as right ven- tricular outflow tract myocardial thickness, diameter, and cross-sectional area, dur- ing the systole and diastole. They found the largest area under the receiver oper- ating characteristic curve for RPA distensibility, which also showed the closest corre- lation with mean pulmonary arterial pressure. RPA distensibility could be useful for pulmonary hypertension risk stratification, the researchers concluded. ❚  Page 558 Airflow Obstruction from Asthma Persists Despite Treatment, Disease Severity MR imaging with hyperpolarized helium 3 (3He) reveals that focal airflow impediment within the lungs of asthma patients can persist over time. de Lange and colleagues ob- served in 26 patients imaged twice on the same day that 75% of focal airway narrow- ing defects remained in the same location, with 71% remaining unchanged in size. The researchers observed in another 17 patients imaged on multiple days that up to 67% of defects persisted between the first and second examinations, with 46%–58% remaining unchanged in size. More than a third of defects remained in the same location after ap- proximately 3 months, the researchers noted, and more than 50% of those defects did not change in size. The persistence of regional airflow impediment was independent of disease severity or whether patients used asthma medications, the researchers found. They con- cluded that 3He MR imaging improves understanding of the changes in regional airflow obstruction occurring over time within the lungs of patients with asthma. ❚  Page 567 PET/CT Algorithm Refines Characterization of Adrenal Nodules in Lung Cancer A proposed combined PET/CT algorithm for evaluating adrenal nodules provides more definitive characterization in patients known to have or suspected of having lung can- cer. In 147 patients with 187 adrenal nodules, Brady and colleagues found that com- bined PET/CT criteria utilizing a standardized uptake value (SUV) of the most intense pixel within the adrenal nodule (maximum SUV) of greater than 3.1 and hyperattenua- tion (>10 HU) was highly sensitive for depicting metastatic nodules, and applying a fur- ther cutoff—ratio of nodule maximum SUV to liver average SUV greater than 2.5—identi- fied 22 of 37 metastatic lesions and excluded all fluorodeoxyglucose-avid benign nodules. The proposed algorithm refines adrenal nodule characterization, the researchers con- cluded, and can spare some patients from undergoing further interventions. ❚  Page 523 In Patients with Intermittent Claudication Supervised Exercise Offers Same Benefits as Endovascular Revascularization Patients with intermittent claudication who undergo a supervised exercise program may ex- perience the same benefits within a year of intervention as those who undergo endovascular revascularization. Spronk and colleagues observed 151 patients who either underwent en- dovascular revascularization with an angioplasty-first approach or participated in hospital- based supervised exercise. The researchers found that, while patients who underwent en- dovascular revascularization saw more immediate improvement in functional capacity and quality of life, there was no significant difference in these parameters between the two treat- ment groups after 6 months and 12 months. The researchers noted that the findings may lead to further investigation of supervised exercise in addition to revascularization. ❚  Page 586 4A Radiology: Volume 250: Number 2—February 2009
  • 3. Radiology 2009 This is your reprint order form or pro forma invoice (Please keep a copy of this document for your records.) Reprint order forms and purchase orders or prepayments must be received 72 hours after receipt of form either by mail or by fax at 410-820-9765. It is the policy of Cadmus Reprints to issue one invoice per order. Please print clearly. Author Name _______________________________________________________________________________________________ Title of Article _______________________________________________________________________________________________ Issue of Journal_______________________________ Reprint # _____________ Publication Date ________________ Number of Pages_______________________________ KB # _____________ Symbol Radiology Color in Article? Yes / No (Please Circle) Please include the journal name and reprint number or manuscript number on your purchase order or other correspondence. Order and Shipping Information Reprint Costs (Please see page 2 of 2 for reprint costs/fees.) Shipping Address (cannot ship to a P.O. Box) Please Print Clearly Name ___________________________________________ ________ Number of reprints ordered $_________ Institution _________________________________________ ________ Number of color reprints ordered $_________ Street ___________________________________________ ________ Number of covers ordered $_________ City ____________________ State _____ Zip ___________ Country ___________________________________________ Subtotal $_________ Quantity___________________ Fax ___________________ Taxes $_________ Phone: Day _________________ Evening _______________ (Add appropriate sales tax for Virginia, Maryland, Pennsylvania, and the E-mail Address _____________________________________ District of Columbia or Canadian GST to the reprints if your order is to be shipped to these locations.) Additional Shipping Address* (cannot ship to a P.O. Box) Name ___________________________________________ First address included, add $32 for Institution _________________________________________ each additional shipping address $_________ Street ___________________________________________ City ________________ State ______ Zip ___________ Country _________________________________________ Quantity __________________ Fax __________________ TOTAL $_________ Phone: Day ________________ Evening ______________ E-mail Address ____________________________________ * Add $32 for each additional shipping address Payment and Credit Card Details Invoice or Credit Card Information Enclosed: Personal Check ___________ Invoice Address Please Print Clearly Please complete Invoice address as it appears on credit card statement Credit Card Payment Details _________ Name ____________________________________________ Checks must be paid in U.S. dollars and drawn on a U.S. Bank. Institution ________________________________________ Credit Card: __ VISA __ Am. Exp. __ MasterCard Department _______________________________________ Card Number __________________________________ Street ____________________________________________ Expiration Date_________________________________ City ________________________ State _____ Zip _______ Signature: _____________________________________ Country ___________________________________________ Phone _____________________ Fax _________________ Please send your order form and prepayment made payable to: E-mail Address _____________________________________ Cadmus Reprints P.O. Box 751903 Cadmus will process credit cards and Cadmus Journal Charlotte, NC 28275-1903 Services will appear on the credit card statement. Note: Do not send express packages to this location, PO Box. If you don’t mail your order form, you may fax it to 410-820-9765 with FEIN #:541274108 your credit card information. Signature __________________________________________ Date _______________________________________ Signature is required. By signing this form, the author agrees to accept the responsibility for the payment of reprints and/or all charges described in this document. RB-1/01/09 Page 1 of 2
  • 4. Radiology 2009 Black and White Reprint Prices Color Reprint Prices Domestic (USA only) Domestic (USA only) # of # of 50 100 200 300 400 500 50 100 200 300 400 500 Pages Pages 1-4 $239 $260 $285 $303 $323 $340 1-4 $247 $267 $385 $515 $650 $780 5-8 $379 $420 $455 $491 $534 $572 5-8 $297 $435 $655 $923 $1194 $1467 9-12 $507 $560 $651 $684 $748 $814 9-12 $445 $563 $926 $1,339 $1,748 $2,162 13-16 $627 $698 $784 $868 $954 $1,038 13-16 $587 $710 $1,201 $1,748 $2,297 $2,843 17-20 $755 $845 $947 $1,064 $1,166 $1,272 17-20 $738 $858 $1,474 $2,167 $2,846 $3,532 21-24 $878 $985 $1,115 $1,250 $1,377 $1,518 21-24 $888 $1,005 $1,750 $2,575 $3,400 $4,230 25-28 $1,003 $1,136 $1,294 $1,446 $1,607 $1,757 25-28 $1,035 $1,164 $2,034 $2,986 $3,957 $4,912 29-32 $1,128 $1,281 $1,459 $1,632 $1,819 $2,002 29-32 $1,186 $1,311 $2,302 $3,402 $4,509 $5,612 Covers $149 $164 $219 $275 $335 $393 Covers $149 $164 $219 $275 $335 $393 International (includes Canada and Mexico) International (includes Canada and Mexico)) # of # of 50 100 200 300 400 500 50 100 200 300 400 500 Pages Pages 1-4 $299 $314 $367 $429 $484 $546 1-4 $306 $321 $467 $642 $811 $986 5-8 $470 $502 $616 $722 $838 $949 5-8 $387 $517 $816 $1,154 $1,498 $1,844 9-12 $637 $687 $852 $1,031 $1,190 $1,369 9-12 $574 $689 $1,157 $1,686 $2,190 $2,717 13-16 $794 $861 $1,088 $1,313 $1,540 $1,765 13-16 $754 $874 $1,506 $2,193 $2,883 $3,570 17-20 $963 $1,051 $1,324 $1,619 $1,892 $2,168 17-20 $710 $1,063 $1,852 $2,722 $3,572 $4,428 21-24 $1,114 $1,222 $1,560 $1,906 $2,244 $2,588 21-24 $1,124 $1,242 $2,195 $3,231 $4,267 $5,300 25-28 $1,287 $1,412 $1,801 $2,198 $2,607 $2,998 25-28 $1,320 $1,440 $2,541 $3,738 $4,957 $6,153 29-32 $1,441 $1,586 $2,045 $2,499 $2,959 $3,418 29-32 $1,498 $1,616 $2,888 $4,269 $5,649 $7028 Covers $211 $224 $324 $444 $558 $672 Covers $211 $224 $324 $444 $558 $672 Minimum order is 50 copies. For orders larger than 500 copies, Tax Due please consult Cadmus Reprints at 800-407-9190. Residents of Virginia, Maryland, Pennsylvania, and the District of Columbia are required to add the appropriate sales tax to each Reprint Cover reprint order. For orders shipped to Canada, please add 7% Cover prices are listed above. The cover will include the Canadian GST unless exemption is claimed. publication title, article title, and author name in black. Ordering Reprint order forms and purchase order or prepayment is Shipping required to process your order. Please reference journal name Shipping costs are included in the reprint prices. Do mestic and reprint number or manuscript number on any orders are shipped via FedEx Ground service. Foreign orders correspondence. You may use the reverse side of this form as a are shipped via a proof of delivery air service. proforma invoice. Please return your order form and prepayment to: Multiple Shipments Cadmus Reprints Orders can be shipped to more than one location. Please be P.O. Box 751903 aware that it will cost $32 for each additional location. Charlotte, NC 28275-1903 Delivery Note: Do not send express packages to this location, PO Box. Your order will be shipped within 2 weeks of the journal print FEIN #:541274108 date. Allow extra time for delivery. Please direct all inquiries to: Reprint Order Forms and purchase order Rose A. Baynard or prepayments must 800-407-9190 (toll free number) be received 72 hours 410-819-3966 (direct number) after receipt of form. 410-820-9765 (FAX number) baynardr@cadmus.com (e-mail) Page 2 of 2