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This Month In Radiology December


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

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This Month In Radiology December

  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 ©RSNA, 2008 Sparse Prostate Tumors Indistinguishable by Using T2, ADC Apparent diffusion coefficient (ADC) and T2 values at MR examinations may not iden- tify sparse areas of prostate cancer. Langer and colleagues studied 18 patients with 28 peripheral zone prostate tumors. The researchers found that while dense tumors had significantly lower ADC and T2 values than normal peripheral regions, there was no significant difference between sparse tumors—which contain a high percent- age of normal tissue—and surrounding normal regions. The researchers warn that the presence of regions within prostate tumors that are intrinsically invisible by us- ing T2- and ADC-based tissue contrast may hinder accurate focal therapy. ❚ Page 900 Tomosynthesis Outperforms Radiography in Pulmonary Nodule Detection Chest tomosynthesis is significantly better than chest radiography at depict- ing pulmonary nodules. Vikgren and colleagues found in a study of 89 patients that the number of lesion localizations relative to the total number of lesions was three times higher for tomosynthesis and the number of nonlesion localizations rela- tive to the total number of cases was approximately 50% higher for tomosynthesis than radiography. The sensitivity of tomosynthesis was especially increased for nod- ules smaller than 9 mm. The researchers proposed that while the depth resolution in tomosynthesis is lower than that of CT, it is far superior to radiography, and its low radiation dose makes it an interesting alternative in chest radiology. ❚ Page 1034 MR Depicts Small Myocardial Lesions MR imaging can depict small multifocal areas of myocardial damage. In an animal study of 18 minipigs in which coronary microembolization was performed, Nassenstein and col- leagues found that myocardial lesions appeared as blurred areas of moderately increased signal intensity in vivo. Damage exceeding 5% of myocardium within the region of interest was necessary to detect late gadolinium enhancement in vivo, and high-spatial-resolution imaging with high signal-to-noise and contrast-to-noise ratios allowed more detailed char- acterization of lesions, the researchers found. They advised that the color gray, repre- senting intermediate signal intensity, is important in patients with nonischemic disease, because it may result from a mixture of damaged and normal myocardium. ❚ Page 829 On-Call Residents Provide Relatively Accurate MR Interpretation Discrepancy rates in neuroradiologic MR interpretation by residents on call are low and do not result in significant adverse clinical outcomes. Comparing residents’ pre- liminary interpretations of 361 emergent brain and spine MR and MR angiographic examinations to the final reports of attending radiologists, Filippi and colleagues found an overall agreement rate of 92.8%. While misinterpretations among 1st-year residents were significantly greater than among more senior-level residents, major discrepancies— those that could affect patient care or clinical outcome—were low and comparable with reported error rates for head CT interpretation. Discrepancies between 1st-year and senior residents will likely be mitigated by recent changes recommending resident call deferral until the 2nd year of training, as determined by the researchers. ❚ Page 972 3A Radiology: Volume 249: Number 3—December 2008
  2. 2. ■ CONTINUED THIS MONTH IN RADIOLOGY Upper Extremity CT Accurate for Assessing Penetrating Trauma CT angiography can help direct treatment in patients with penetrating trauma to the up- per extremities. In a study of 59 patients, Anderson and colleagues found that, in con- junction with clinical assessment, upper extremity multidetector CT angiography helped detect acute vascular injuries and allowed 88% of patients to undergo conservative treat- ment with no complications at follow-up. The researchers concluded that with appropriate patient selection, optimized CT protocols, and experienced clinicians, upper extremity CT angiograms are technically accurate for assessing penetrating trauma. ❚ Page 1064 Intravoxel Incoherent Motion DW Imaging Demonstrates Restricted Diffusion and Perfusion-related Parameters in Liver Cirrhosis An MR imaging sequence based on the intravoxel incoherent motion (IVIM) theory may have applications in liver cirrhosis. Using IVIM diffusion-weighted (DW) imag- ing that combined parallel and respiratory-triggered acquisition in a study of 37 pa- tients, Luciani and colleagues observed restricted global diffusion with decreased apparent diffusion coefficient in liver cirrhosis. The researchers proposed that re- stricted diffusion could be explained in part by perfusion-related diffusion param- eters within the liver parenchyma. IVIM DW imaging enables the extraction of diffu- sion parameters reflecting microcirculation, or perfusion, which could potentially be used as surrogate markers for liver cirrhosis, the researchers concluded. ❚ Page 891 An editorial by LeBihan accompanies this article (p 748). Flat-Panel Volume CT Demonstrates Effects of Anorexia Nervosa on Bone Structure Flat-panel volume CT reveals that bone structure in adolescent girls with anorexia nervosa (AN) is abnormal despite normal bone mineral density. In a study of 10 ad- olescent girls with mild AN and 10 normal-weight control subjects, Bredella and col- leagues found that flat-panel volume CT effectively depicted trabecular microarchi- tecture and demonstrated bone structure deficiencies in girls with AN, even when bone mineral density at dual-energy x-ray absorptiometry was normal. Flat-panel vol- ume CT depicts abnormalities even in mild or early disease, the researchers ob- served, and may have major implications in treatment and follow-up. ❚ Page 938 MR Techniques Identify Viable Myocardium after Chronic Myocardial Infarction In patients with chronic myocardial infarction, reduced perfusion in the infarct zone as detected at MR is related to the extent of viable myocardium. In a study of 29 patients who underwent first-pass contrast-enhanced MR and delayed-enhancement MR at least 6 months after onset of infarction, Su and colleagues found that remaining viable myocardium demonstrated increased perfusion during stress tests and presented similarly to remote myocardium. The researchers concluded that the combination of MR techniques can estimate the extent of scar tissue, regional perfusion, and myocardial perfusion reserve in chronically infarcted myocardium. ❚ Page 820 3D Isotropic MRCP Highly Sensitive for Biliary Disease MR cholangiopancreatography (MRCP) using a respiratory-triggered isotropic 3D fast-recov- ery fast spin-echo sequence with parallel imaging is excellent for diagnosing biliary disease. In a study of 95 patients suspected of having biliary disease, Nandalur and colleagues found that MRCP was highly sensitive and specific for strictures, dilatation, and intraductal filling defects, but yielded sensitivity of 33%--42% for stones 3 mm or smaller. The researchers proposed that the high spatial resolution and relatively short acquisition times of the MRCP technique make it feasible for diagnosing strictures, dilatation, and stones larger than 3 mm. ❚ Page 883 Ethnic Differences Influence Screening Mammography Behavior Differences in ethnic background influence women’s preferences for screening mammog- raphy recall, desire for early detection, and adherence to annual screening mammog- raphy once given a false-positive result. In a study of 911 women in an underserved, predominantly minority population, Jafri and colleagues found that black and Hispan- ic women were significantly less likely than were white women to continue with future screening after a false-positive result and were also more reluctant to return for both noninvasive and invasive studies with a higher possibility of cancer detection. Targeted education is needed to address cultural barriers to screening mammography and improve breast cancer prognoses among minority women, the researchers concluded. ❚ Page 785 Radiology: Volume 249: Number 3—December 2008 4A
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