Radiology最新文献

{"title":"Hepatocellular Carcinoma: The Meaning of Intratumoral Fat Patterns in Different Patient Populations.","authors":"Carla Harmath","doi":"10.1148/radiol.242740","DOIUrl":"https://doi.org/10.1148/radiol.242740","url":null,"abstract":"","PeriodicalId":20896,"journal":{"name":"Radiology","volume":"313 2","pages":"e242740"},"PeriodicalIF":12.1,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142584109","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Case 331: Cardiac Sarcoidosis.","authors":"Muhammad Umer, Usman Sagheer, Wilfred Furtado, Matthew Shotwell, Jonathan Joshi, Mrinali Shetty, Dinesh K Kalra","doi":"10.1148/radiol.232441","DOIUrl":"https://doi.org/10.1148/radiol.232441","url":null,"abstract":"<p><strong>History: </strong>A 43-year-old male patient with no known past medical history presented to the emergency department with new-onset bitemporal headache, dizziness, and bilateral lower extremity weakness for 1 day. The patient denied chest pain, shortness of breath, cough, or recent exposure to sick individuals. He was not on any medications and denied alcohol or illicit drug use. Vital signs were unremarkable. Physical examination was notable for a left-sided pronator drift and bilateral dysmetria that was more pronounced on the left. Results of routine laboratory workup, including complete blood count, metabolic panel, and high-sensitivity troponin level, were normal. An electrocardiogram revealed sinus tachycardia with a heart rate of 102 beats per minute, T-wave inversions in the inferior leads, left axis deviation, incomplete right bundle branch block, and frequent premature ventricular contractions. A radiograph of the chest was unremarkable. CT of the head without contrast enhancement demonstrated no acute intracranial abnormalities. MRI of the brain without contrast enhancement revealed multiple acute infarcts involving left posterior inferior cerebellar artery distribution, right cerebellar hemisphere, right mesial temporal lobe, and right posterior limb of the internal capsule. CT angiography of the head and neck showed an occlusion of the right posterior cerebral artery near its origin, with a trace of distal flow. Given that these findings were concerning for a cardioembolic etiology of acute ischemic stroke, transesophageal echocardiography was performed. This showed mild left ventricular systolic dysfunction with an ejection fraction of 40%, mild global hypokinesis, and an additional finding also seen at subsequent cardiac CT and MRI, disclosed herein. The patient was started on systemic anticoagulation and guideline-directed medical therapy for heart failure with reduced ejection fraction. CT of the chest showed no evidence of lymphadenopathy or abnormalities in the lung parenchyma or interstitium. Coronary CT angiography (CCTA) was performed, followed by cardiac MRI.</p>","PeriodicalId":20896,"journal":{"name":"Radiology","volume":"313 2","pages":"e232441"},"PeriodicalIF":12.1,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142716986","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Changes in Reader Performance During Sequential Reading of Breast Cancer Screening Digital Breast Tomosynthesis Examinations.","authors":"Craig K Abbey, Andriy I Bandos, Mohana K Parthasarathy, Michael A Webster, Margarita L Zuley","doi":"10.1148/radiol.232885","DOIUrl":"10.1148/radiol.232885","url":null,"abstract":"<p><p>Background Studies suggest that readers experience perceptual adaptation when interpreting batched screening mammograms, which may serve as a mechanism for improved performance. Purpose To analyze clinical digital breast tomosynthesis (DBT) screening data to evaluate changes in reader performance during sequential batch reading. Materials and Methods This observational retrospective study used data from the radiology information system collected for screening DBT examinations performed from January 2018 to December 2019. The reference standard was established based on pathology results, if applicable, or imaging findings at 1-year follow-up. Examinations were aggregated into batches, defined as a sequence of cases for a given reader with differences in interexamination time of 10 minutes or less. Mixed-effect models were used to evaluate performance and timing across batch positions. Statistical adjustments accounted for potential confounders, including patient characteristics (age, breast density), reading factors (day of week, time of day), and between-reader heterogeneity. Results The dataset included 121 652 examinations (median patient age, 61 years [IQR, 53-69 years]), including 1081 cancers interpreted by 15 radiologists. Unadjusted false-positive rates decreased from an averaged 15.5% at the first within-batch examination to 10.5% after three sequentially read examinations (<i>P</i> < .001), without a significant change in sensitivity (82.6% vs 84.2%; <i>P</i> = .15). The interpretation time consistently decreased, achieving a substantial reduction in longer batches (average 2.8 to 2.2 minutes for noncancer examinations; <i>P</i> < .001). Adjustment for sampling bias and confounders (patient age, breast density, day of week, time of day; all <i>P</i> < .005) reduced the effect on false-positive rates (11.5% to 9.4% after three examinations; <i>P</i> < .001) and interpretation time (3.2 to 2.7 minutes for noncancer examinations; <i>P</i> < .001). Conclusion Radiologists showed improved recall rates and interpretation times without change in sensitivity over the course of batch reading of DBT screening examinations. © RSNA, 2024 See also the editorial by Iima and Satake in this issue.</p>","PeriodicalId":20896,"journal":{"name":"Radiology","volume":"313 2","pages":"e232885"},"PeriodicalIF":12.1,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11605108/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142626325","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Increased Emergency Department Medical Imaging: Association with Short-Term Exposures to Ambient Heat and Particulate Air Pollution.","authors":"Kate Hanneman, Omar Taboun, Anish Kirpalani, Birgit Ertl-Wagner, Julien Aguet, Scott Delaney, Rachel C Nethery, Joseph Choi, Hayley Panet, Maura J Brown, Heidi Schmidt, Ania Kielar, Michael Patlas","doi":"10.1148/radiol.241624","DOIUrl":"10.1148/radiol.241624","url":null,"abstract":"<p><p>Background Climate change adversely affects human health, resulting in higher demand for health care services. However, the impact of climate-related environmental exposures on medical imaging utilization is currently unknown. Purpose To determine associations of short-term exposures to ambient heat and particulate air pollution with utilization of emergency department medical imaging. Materials and Methods In this retrospective time-stratified case-crossover study, daily imaging utilization counts from four emergency departments were linked to local daily environmental data-including fine particulate matter with 2.5-µm or smaller aerodynamic diameter (PM_2.5) and ambient temperature-over 10 years (January 2013 to December 2022). Conditional Poisson regression models were used to evaluate the associations between daily imaging utilization and environmental exposures on the same day and each of the 7 days preceding imaging, lag days 0-7, controlling for day of the week, month, and year. Moving averages of mean daily PM_2.5 and temperature were calculated to account for lagged exposure effects. Imaging counts were also stratified by modality (CT, radiography, US, and MRI). Results In an analysis of 1 666 420 emergency department imaging studies, a rise of 10 °C in the 2-day moving average of mean daily temperature and a rise of 10 μg/m³ in the 3-day moving average of mean daily PM_2.5 were associated with overall imaging utilization increases of 5.1% (incidence rate ratio [IRR], 1.051; 95% CI: 1.045, 1.056) and 4.0% (IRR, 1.040; 95% CI: 1.035, 1.046), respectively. Heat exposure days (mean temperature >20 °C) and air pollution exposure days (mean PM_2.5 >12 μg/m³) were associated with same-day excess absolute risk of 5.5 and 6.4 imaging studies per 1 million people at risk per day, respectively. Heat exposure days and air pollution exposure days were associated with increased utilization of radiography (excess relative risk, 2.7% [<i>P</i> < .001] and 2.1% [<i>P</i> < .001], respectively) and CT (excess relative risk, 2.0% [<i>P</i> = .001] and 2.7% [<i>P</i> < .001]) but not US (<i>P</i> = .14 and <i>P</i> = .14) or MRI (<i>P</i> = .70 and <i>P</i> = .65). Conclusion Short-term exposures to ambient heat and particulate air pollution were associated with increased utilization of radiography and CT but not US or MRI. © RSNA, 2024 <i>Supplemental material is available for this article.</i> See also the editorial by Vosshenrich in this issue.</p>","PeriodicalId":20896,"journal":{"name":"Radiology","volume":"313 2","pages":"e241624"},"PeriodicalIF":12.1,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11605103/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142669067","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Environmental Life Cycle Assessment of a U.S. Hospital-based Radiology Practice.","authors":"Cassandra L Thiel, Marta Vigil-Garcia, Sachin Nande, Cecilia Meijer, Josephine Gehrels, Olesya Struk, Sophie Thornander, Denise Pullella, Reed A Omary, Diana E Carver, John R Scheel","doi":"10.1148/radiol.240398","DOIUrl":"10.1148/radiol.240398","url":null,"abstract":"<p><p>Background Climate change, driven primarily by human-induced greenhouse gas (GHG) emissions, poses major risks to human health. Health care contributes 8.5% of GHG emissions in the United States. Purpose To estimate the life cycle environmental impact of diagnostic radiology services within a single academic medical center. Materials and Methods This process-based life cycle assessment (LCA) of a diagnostic radiology department serving adult inpatient, outpatient, and emergency department patients in a U.S. hospital followed International Organization for Standardization (ISO 14040:2006) guidelines. System components included production and distribution of imaging equipment; energy use of imaging equipment, including MRI, CT, radiography and fluoroscopy, and US; production and use of other capital equipment; production of single-use, semidurable, and durable supplies and linens; and production and energy use from onsite data storage. Meters monitored the power usage of selected imaging equipment during April 2023. Modeling assumed an equipment lifespan of 10 years. Results are reported in kilotons of CO₂ equivalent (kt CO₂e) emissions per scan and over a 10-year period. A sensitivity analysis assessed variability of data. Results Over a decade, these radiology services generated 4.6 kt CO₂e GHG emissions, with MRI responsible for 48% (2.2 of 4.6 kt CO₂e) and CT responsible for 24% (1.1 of 4.6 kt CO₂e) of cumulative emissions. Clinical use of imaging equipment (all modalities) accounted for 54% of departmental GHGs (2.5 of 4.6 kt CO₂e). Other notable contributions include the production of imaging equipment (11%, 0.49 of 4.6 kt CO₂e), the production and use of picture archiving and communication system workstations (11%, 0.48 of 4.6 kt CO₂e), and linens production and laundering (10%, 0.47 of 4.6 kt CO₂e). Conclusion Energy consumption from clinical use of imaging equipment accounted for more than 50% of departmental GHG emissions, with MRI and CT equipment as the major emitters. Other notable GHG contributors include the production of imaging equipment, the production and use of picture archiving and communication system workstations, and linens production and laundering. © RSNA, 2024 <i>Supplemental material is available for this article.</i> See also the editorial by Thrall in this issue.</p>","PeriodicalId":20896,"journal":{"name":"Radiology","volume":"313 2","pages":"e240398"},"PeriodicalIF":12.1,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11605107/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142716989","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Enhancing Radiologist Reading Performance by Ordering Screening Mammograms Based on Characteristics That Promote Visual Adaptation.","authors":"Jessie J J Gommers,Sarah D Verboom,Katya M Duvivier,Jan-Kees van Rooden,A Fleur van Raamt,Janneke B Houwers,Dick B Naafs,Lucien E M Duijm,Craig K Abbey,Michael A Webster,Mireille J M Broeders,Ioannis Sechopoulos","doi":"10.1148/radiol.240237","DOIUrl":"https://doi.org/10.1148/radiol.240237","url":null,"abstract":"Background Mammographic background characteristics may stimulate human visual adaptation, allowing radiologists to detect abnormalities more effectively. However, it is unclear whether density, or another image characteristic, drives visual adaptation. Purpose To investigate whether screening performance improves when screening mammography examinations are ordered for batch reading according to mammographic characteristics that may promote visual adaptation. Materials and Methods This retrospective multireader multicase study was performed with mammograms obtained between September 2016 and May 2019. The screening examinations, each consisting of four mammograms, were interpreted by 13 radiologists in three distinct orders: randomly, by increasing volumetric breast density (VBD), and based on a self-supervised learning (SSL) encoding (examinations automatically grouped as \"looking similar\"). An eye tracker recorded radiologists' eye movements during interpretation. The area under the receiver operating characteristic curve (AUC), sensitivity, and specificity of random-ordered readings were compared with those of VBD- and SSL-ordered readings using mixed-model analysis of variance. Reading time, fixation metrics, and perceived density were compared using Wilcoxon signed-rank tests. Results Mammography examinations (75 with breast cancer, 75 without breast cancer) from 150 women (median age, 55 years [IQR, 50-63]) were read. The examinations ordered by increasing VBD versus randomly had an increased AUC (0.93 [95% CI: 0.91, 0.96] vs 0.92 [95% CI: 0.89, 0.95]; P = .009), without evidence of a difference in specificity (89% [871 of 975] vs 86% [837 of 975], P = .04) and sensitivity (both 81% [794 of 975 vs 788 of 975], P = .78), and a reduced reading time (24.3 vs 27.9 seconds, P < .001), fixation count (47 vs 52, P < .001), and fixation time in malignant regions (3.7 vs 4.6 seconds, P < .001). For SSL-ordered readings, there was no evidence of differences in AUC (0.92 [95% CI: 0.89, 0.95]; P = .70), specificity (84% [820 of 975], P = .37), sensitivity (80% [784 of 975], P = .79), fixation count (54, P = .05), or fixation time in malignant regions (4.6 seconds, P > .99) compared with random-ordered readings. Reading times were significantly higher for SSL-ordered readings compared with random-ordered readings (28.4 seconds, P = .02). Conclusion Screening mammography examinations ordered from low to high VBD improved screening performance while reducing reading and fixation times. © RSNA, 2024 Supplemental material is available for this article. See also the editorial by Grimm in this issue.","PeriodicalId":20896,"journal":{"name":"Radiology","volume":"8 1","pages":"e240237"},"PeriodicalIF":19.7,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142385573","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Navigating Hemodynamic Insights: A Promising Future with Four-dimensional Flow MRI and Computational Fluid Dynamics in Transjugular Intrahepatic Portosystemic Shunt Management.","authors":"Utaroh Motosugi, Hiroaki Watanabe","doi":"10.1148/radiol.241857","DOIUrl":"https://doi.org/10.1148/radiol.241857","url":null,"abstract":"","PeriodicalId":20896,"journal":{"name":"Radiology","volume":"313 1","pages":"e241857"},"PeriodicalIF":12.1,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142352745","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Weighing the Benefits and Risks of Mammography Screening Strategies.","authors":"Amy Trentham-Dietz","doi":"10.1148/radiol.240819","DOIUrl":"10.1148/radiol.240819","url":null,"abstract":"","PeriodicalId":20896,"journal":{"name":"Radiology","volume":"313 1","pages":"e240819"},"PeriodicalIF":12.1,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11551279/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142352746","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Calcification as a Natural Arterial Repair Mechanism.","authors":"Pim A de Jong, Daniel Bos, Willem P T M Mali","doi":"10.1148/radiol.241040","DOIUrl":"https://doi.org/10.1148/radiol.241040","url":null,"abstract":"","PeriodicalId":20896,"journal":{"name":"Radiology","volume":"313 1","pages":"e241040"},"PeriodicalIF":12.1,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142473335","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prediction of Ischemic Stroke Functional Outcomes from Acute-Phase Noncontrast CT and Clinical Information.","authors":"Yongkai Liu, Yannan Yu, Jiahong Ouyang, Bin Jiang, Sophie Ostmeier, Jia Wang, Sarah Lu-Liang, Yirong Yang, Guang Yang, Patrik Michel, David S Liebeskind, Maarten Lansberg, Michael E Moseley, Jeremy J Heit, Max Wintermark, Gregory Albers, Greg Zaharchuk","doi":"10.1148/radiol.240137","DOIUrl":"10.1148/radiol.240137","url":null,"abstract":"<p><p>Background Clinical outcome prediction based on acute-phase ischemic stroke data is valuable for planning health care resources, designing clinical trials, and setting patient expectations. Existing methods require individualized features and often involve manually engineered, time-consuming postprocessing activities. Purpose To predict the 90-day modified Rankin Scale (mRS) score with a deep learning (DL) model fusing noncontrast-enhanced CT (NCCT) and clinical information from the acute phase of stroke. Materials and Methods This retrospective study included data from six patient datasets from four multicenter trials and two registries. The DL-based imaging and clinical model was trained by using NCCT data obtained 1-7 days after baseline imaging and clinical data (age; sex; baseline and 24-hour National Institutes of Health Stroke Scale scores; and history of hypertension, diabetes, and atrial fibrillation). This model was compared with models based on either NCCT or clinical information alone. Model-specific mRS score prediction accuracy, mRS score accuracy within 1 point of the actual mRS score, mean absolute error (MAE), and performance in identifying unfavorable outcomes (mRS score, >2) were evaluated. Results A total of 1335 patients (median age, 71 years; IQR, 60-80 years; 674 female patients) were included for model development and testing through sixfold cross validation, with distributions of 979, 133, and 223 patients across training, validation, and test sets in each of the six cross-validation folds, respectively. The fused model achieved an MAE of 0.94 (95% CI: 0.89, 0.98) for predicting the specific mRS score, outperforming the imaging-only (MAE, 1.10; 95% CI: 1.05, 1.16; <i>P</i> < .001) and the clinical information-only (MAE, 1.00; 95% CI: 0.94, 1.05; <i>P</i> = .04) models. The fused model achieved an area under the receiver operating characteristic curve (AUC) of 0.91 (95% CI: 0.89, 0.92) for predicting unfavorable outcomes, outperforming the clinical information-only model (AUC, 0.88; 95% CI: 0.87, 0.90; <i>P</i> < .001) and the imaging-only model (AUC, 0.85; 95% CI: 0.84, 0.87; <i>P</i> < .001). Conclusion A fused DL-based NCCT and clinical model outperformed an imaging-only model and a clinical-information-only model in predicting 90-day mRS scores. © RSNA, 2024 <i>Supplemental material is available for this article.</i> See also the editorial by Lee in this issue.</p>","PeriodicalId":20896,"journal":{"name":"Radiology","volume":"313 1","pages":"e240137"},"PeriodicalIF":12.1,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11535867/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142473370","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}