Canadian Association of Radiologists journal = Journal l'Association canadienne des radiologistes最新文献

{"title":"Digital Breast Tomosynthesis: Potential Benefits in Routine Clinical Practice.","authors":"Supriya Kulkarni,&nbsp;Vivianne Freitas,&nbsp;Derek Muradali","doi":"10.1177/08465371211025229","DOIUrl":"https://doi.org/10.1177/08465371211025229","url":null,"abstract":"<p><p>Digital breast tomosynthesis (DBT) is gradually being implemented in routine clinical breast imaging practice. The technique of image acquisition reduces the confounding effect of overlapping breast tissue, which substantially affects cancer detection, abnormal recall, and interval cancer rates in a screening/ surveillance setting. In a diagnostic setting, tomosynthesis also allows for improved lesion localization and characterization over conventional imaging, which potentially improves the accuracy and improved workflow efficiency. To optimize the utility of tomosynthesis, imagers should be aware of the pertinent aspects of image acquisition as it relates to interpretation, the appearance of benign and malignant pathologies, and sources of possible misinterpretation. This article aims to provide a practical knowledge base of DBT and demonstrate its potential benefits when incorporated into routine clinical practice.</p>","PeriodicalId":444006,"journal":{"name":"Canadian Association of Radiologists journal = Journal l'Association canadienne des radiologistes","volume":" ","pages":"107-120"},"PeriodicalIF":3.1,"publicationDate":"2022-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/08465371211025229","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39155148","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Breast Density and Risk of Interval Cancers: The Effect of Annual Versus Biennial Screening Mammography Policies in Canada.","authors":"Jean Morag Seely,&nbsp;Susan Elizabeth Peddle,&nbsp;Huiming Yang,&nbsp;Anna M Chiarelli,&nbsp;Megan McCallum,&nbsp;Gopinath Narasimhan,&nbsp;Dianne Zakaria,&nbsp;Craig C Earle,&nbsp;Sharon Fung,&nbsp;Heather Bryant,&nbsp;Erika Nicholson,&nbsp;Chris Politis,&nbsp;Wendie A Berg","doi":"10.1177/08465371211027958","DOIUrl":"https://doi.org/10.1177/08465371211027958","url":null,"abstract":"<p><p>Regular screening mammography reduces breast cancer mortality. However, in women with dense breasts, the performance of screening mammography is reduced, which is reflected in higher interval cancer rates (ICR). In Canada, population-based screening mammography programs generally screen women biennially; however, some provinces and territories offer annual mammography for women with dense breast tissue routinely and/or on recommendation of the radiologist. This study compared the ICRs in those breast screening programs with a policy of annual vs. those with biennial screening for women with dense breasts. Among 148,575 women with dense breasts screened between 2008 to 2010, there were 288 invasive interval breast cancers; screening programs with policies offering annual screening for women with dense breasts had fewer interval cancers 63/70,814 (ICR 0.89/1000, 95% CI: 0.67-1.11) compared with those with policies of usual biennial screening 225/77,761 (ICR 1.45 /1000 (annualized), 95% CI: 1.19-1.72) i.e. 63% higher (p = 0.0016). In screening programs where radiologists' screening recommendations were able to be analyzed, a total of 76,103 women were screened, with 87 interval cancers; the ICR was lower for recommended annual (65/69,650, ICR 0.93/1000, 95% CI: 0.71, 1.16) versus recommended biennial screening (22/6,453, ICR 1.70/1000 (annualized), 95%CI: 0.70, 2.71)(p = 0.0605). Screening program policies of annual as compared with biennial screening in women with dense breasts had the greatest impact on reducing interval cancer rates. We review our results in the context of current dense breast notification in Canada.</p>","PeriodicalId":444006,"journal":{"name":"Canadian Association of Radiologists journal = Journal l'Association canadienne des radiologistes","volume":" ","pages":"90-100"},"PeriodicalIF":3.1,"publicationDate":"2022-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/08465371211027958","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39197844","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"<b>P</b>rospective Clinical Trial Comparing IV Esmolol to IV Metoprolol in CT Coronary Angiography: Effect on Hemodynamic, Technical Parameters and Cost.","authors":"Leena Robinson Vimala,&nbsp;Diego Andre Eifer,&nbsp;Yasser Karimzad,&nbsp;Narinder S Paul","doi":"10.1177/08465371211023947","DOIUrl":"https://doi.org/10.1177/08465371211023947","url":null,"abstract":"<p><strong>Background: </strong>Intravenous [IV] esmolol, an alternative to IV metoprolol for coronary computed tomography angiography [CCTA], has shorter half-life that decreases the risk of prolonged hypotension. The primary aim was to prospectively compare IV esmolol alone to IV metoprolol alone for effectiveness in achieving heart rate [HR] of 60 beats per minute[bpm] during CCTA. The secondary aim was to compare hemodynamic response, image quality, radiation dose and cost.</p><p><strong>Materials and methods: </strong>Institutional Review Board approved prospective randomized study of 28 CCTA patients medicated in a 1:1 blinded match with IV esmolol or IV metoprolol to achieve HR of 60 bpm. Serial hemodynamic response was measured at 6 specified times. Two cardiac radiologists independently scored the image quality.</p><p><strong>Results: </strong>Both IV esmolol and IV metoprolol achieved the target HR. IV esmolol resulted in significantly less profound and shorter duration of reduction in systolic blood pressure [BP] than IV metoprolol with a difference of -10, -14 and -9 mm Hg compared to -20, -26 and -25 mmHg at 2, 15 & 30 min respectively. No significant difference in HR at image acquisition, exposure window, radiation dose and image quality. Although IV esmolol was expensive, the overall cost of care was comparable to IV metoprolol due to shortened post CCTA observation period consequent to faster restoration of hemodynamic status.</p><p><strong>Conclusion: </strong>Comparison of IV esmolol and IV metoprolol demonstrate that both are effective in achieving the target HR but significantly faster recovery of HR and BP in patients who receive IV esmolol was found.</p>","PeriodicalId":444006,"journal":{"name":"Canadian Association of Radiologists journal = Journal l'Association canadienne des radiologistes","volume":" ","pages":"240-248"},"PeriodicalIF":3.1,"publicationDate":"2022-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/08465371211023947","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39209177","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Burnout Exacerbation due to COVID-19 Pandemic.","authors":"Amer Alaref,&nbsp;Amr Elnayal,&nbsp;Ameya Kulkarni,&nbsp;Abdullah Alabousi,&nbsp;Christian Van Der Pol","doi":"10.1177/08465371211022291","DOIUrl":"https://doi.org/10.1177/08465371211022291","url":null,"abstract":"","PeriodicalId":444006,"journal":{"name":"Canadian Association of Radiologists journal = Journal l'Association canadienne des radiologistes","volume":" ","pages":"272"},"PeriodicalIF":3.1,"publicationDate":"2022-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/08465371211022291","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39241149","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Canadian Society of Thoracic Radiology/Canadian Association of Radiologists Best Practice Guidance for Investigation of Acute Pulmonary Embolism, Part 1: Acquisition and Safety Considerations.","authors":"Elsie T Nguyen,&nbsp;Cameron Hague,&nbsp;Daria Manos,&nbsp;Brett Memauri,&nbsp;Carolina Souza,&nbsp;Jana Taylor,&nbsp;Carole Dennie","doi":"10.1177/08465371211000737","DOIUrl":"https://doi.org/10.1177/08465371211000737","url":null,"abstract":"<p><p>Acute pulmonary embolism (APE) is a well-recognized cause of circulatory system compromise and even demise which can frequently present a diagnostic challenge for the physician. The diagnostic challenge is primarily due to the frequency of indeterminate presentations as well as several other conditions which can have a similar clinical presentation. This often obliges the physician to establish a firm diagnosis due to the potentially serious outcomes related to this disease. Computed tomography pulmonary angiography (CTPA) has increasingly cemented its role as the primary investigation tool in this clinical context and is widely accepted as the standard of care due to several desired attributes which include great accuracy, accessibility, rapid turn-around time and the ability to suggest an alternate diagnosis when APE is not the culprit. In Part 1 of this guidance document, a series of up-to-date recommendations are provided to the reader pertaining to CTPA protocol optimization (including scan range, radiation and intravenous contrast dose), safety measures including the departure from breast and gonadal shielding, population-specific scenarios (pregnancy and early post-partum) and consideration of alternate diagnostic techniques when clinically deemed appropriate.</p>","PeriodicalId":444006,"journal":{"name":"Canadian Association of Radiologists journal = Journal l'Association canadienne des radiologistes","volume":" ","pages":"203-213"},"PeriodicalIF":3.1,"publicationDate":"2022-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/08465371211000737","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25528897","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Imaging for Predicting Hemorrhagic Transformation of Acute Ischemic Stroke-A Narrative Review.","authors":"Sudharsana Rao Ande,&nbsp;Jonathan Grynspan,&nbsp;Richard I Aviv,&nbsp;Jai Jai Shiva Shankar","doi":"10.1177/08465371211018369","DOIUrl":"https://doi.org/10.1177/08465371211018369","url":null,"abstract":"Hemorrhagic transformation is caused by extravasation of blood products from vessels after acute ischemic stroke. It is an undesirable and potentially devastating complication, which occurs in 10%-40% of clinical cases. Hemorrhagic transformation is classified into four subtypes based on European cooperative acute stroke study II. Predicting hemorrhagic complications at presentation can be useful life saving/altering decisions for the patient. Also, understanding the mechanisms of hemorrhagic transformation can lead to new treatments and intervention measures. We highlighted various imaging techniques that have been used to predict hemorrhagic transformation. Specifically, we looked at the usefulness of perfusion and permeability imaging for hemorrhagic transformation. Use of imaging to predict hemorrhagic transformation could change patient management that may lead to the prevention of hemorrhagic transformation before it occurs. We concluded that the current evidence is not strong enough to rely on these imaging parameters for predicting hemorrhagic transformation and more studies are required.","PeriodicalId":444006,"journal":{"name":"Canadian Association of Radiologists journal = Journal l'Association canadienne des radiologistes","volume":" ","pages":"194-202"},"PeriodicalIF":3.1,"publicationDate":"2022-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/08465371211018369","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39112849","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Updates to Reporting Computed Tomography Angiograms of Acute Aortic Syndromes.","authors":"Andreu F Costa,&nbsp;Bruce Precious","doi":"10.1177/08465371211010400","DOIUrl":"https://doi.org/10.1177/08465371211010400","url":null,"abstract":"In their review article, Modares et al. have provided a comprehensive and beautifully illustrated overview of acute aortic syndromes. Although the 3 main acute aortic pathologies are well known to radiologists, Modares et al. provide us with upto-date entities perhaps less familiar to radiologists, such as intramural blood pool, ulcer-like projections and limited intimal tear. The authors also highlight imaging pitfalls and considerations for reporting CT examinations of these entities, in light of management and follow-up. In 2020, the Society for Vascular Surgery and Society of Thoracic Surgeons (SVS-STS) published a consensus on standards for reporting type B dissections. Research over the last several years has led to an improved understanding of the pathophysiology, natural history and management of aortic dissections, particularly with the use of thoracic endovascular aortic repair. With ongoing scientific advances, the treatment of type B dissections is evolving rapidly, and may include medical, surgical and endovascular options provided by a variety of specialists, including vascular surgeons, cardiothoracic surgeons, cardiologists and interventional radiologists. Hence, the need for an up-to-date, comprehensive standard to classify acute aortic syndromes. The SVS-STS reporting standards provide a ‘‘unified consensus on reporting, nomenclature and classification of type B aortic dissection.’’ These standards overcome several deficiencies of the Debakey and more simplified Stanford classifications systems, which date back to 1965 and 1970, respectively. The limitations of these older systems include: 1) inconsistent classification of dissections arising from the aortic arch (both systems); 2) lack of distant extent description (Stanford); 3) exclusion of aortic syndromes other than dissection (DeBakey); and 4) unclear nomenclature for dissections with proximal extent. The SVS-STS reporting standards classify aortic syndromes according to the site of the entry tear: type A dissections have entry tears arising from zone 0, which corresponds to the ascending aorta including the ostium of the brachiocephalic artery; and type B dissections have entry tears arising distal to the brachiocephalic artery, including those with retrograde extension to the ascending aorta. An indeterminate type I is used to classify dissections that involve the ascending aorta and extend distal to the brachiocephalic artery, but cannot be classified as A or B because the entry tear is not evident. A type A dissection extending to zone 4 would be labeled A4, and a type B dissection arising from zone 2 and extending to zone 9 (corresponding to the infrarenal aorta) would be labeled B2,9. The subscripts denote the extent of involved aorta and include both patent and thrombosed false lumen, as well as intramural hematoma. Should radiologists adopt the SVS-STS standard when reporting CTA examinations of acute aortic syndromes? According to the Writing Committee of the SVS-","PeriodicalId":444006,"journal":{"name":"Canadian Association of Radiologists journal = Journal l'Association canadienne des radiologistes","volume":" ","pages":"23-24"},"PeriodicalIF":3.1,"publicationDate":"2022-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/08465371211010400","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38887899","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Computed Tomography Angiography Assessment of Acute Aortic Syndromes: Classification, Differentiating Imaging Features, and Imaging Interpretation Pitfalls.","authors":"Mana Modares,&nbsp;Kate Hanneman,&nbsp;Maral Ouzounian,&nbsp;Jennifer Chung,&nbsp;Elsie T Nguyen","doi":"10.1177/08465371211001525","DOIUrl":"https://doi.org/10.1177/08465371211001525","url":null,"abstract":"<p><p>An acute aortic syndrome (AAS) is an important life-threatening condition that requires early detection and management. Acute intramural hematoma (IMH), aortic dissection (AD) and penetrating atherosclerotic ulcer (PAU) are included in AAS. ADs can be classified using the well-known Stanford or DeBakey classification systems. However, these classification systems omit description of arch dissections, anatomic variants, and morphologic features that impact outcome. The Society for Vascular Surgery and Society of Thoracic Surgeons (SVS-STS) have recently introduced a classification system that classifies ADs according to the location of the entry tear (primary intimomedial tear, PIT) and the proximal and distal extent of involvement, but does not include description of all morphologic features that may have diagnostic and prognostic significance. This review describes these classification systems for ADs and other AAS entities as well as their limitations. Typical computed tomography angiography (CTA) imaging appearance and differentiating features of ADs, limited intimal tears (LITs), IMHs, intramural blood pools (IBPs), ulcer-like projections (ULPs), and PAUs will be discussed. Furthermore, this review highlights common imaging interpretation pitfalls, what should be included in a comprehensive CTA report, and provides a brief overview of current management options.</p>","PeriodicalId":444006,"journal":{"name":"Canadian Association of Radiologists journal = Journal l'Association canadienne des radiologistes","volume":" ","pages":"228-239"},"PeriodicalIF":3.1,"publicationDate":"2022-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/08465371211001525","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38889305","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reply to \"Arteries of the Lower Limb-Embryology, Variations, and Clinical Significance\".","authors":"Riccardo Cau,&nbsp;Luca Saba","doi":"10.1177/08465371211020011","DOIUrl":"https://doi.org/10.1177/08465371211020011","url":null,"abstract":"In their review, Qazi et al. provided a useful and comprehensive overview of arteries of lower limbs. If normal anatomy is well known to all radiologists, embryology and anatomic variants of arteries of lower limbs represent a more challengingtopic due to its rarity. In this scenario, Qazi et al. have supplied us with a deep and illustrated explanation of these arduous field potentially lessknown to radiologist. The authors also reported clinical presentation and key clinical considerations to improve radiological reports and management. In 2019, the European Society of Cardiovascular Radiology and the Society of Cardiovascular Computed Tomography published two different consensuses on imaging in the context of transcatheter Aortic Valve Implantation and Replacement (TAVI and TAVR, respectively). Since its introduction in 2002, there has been enormous development in the field due to technological advancements with an established role of computed tomography in clinical practice. In this type of minimally invasive surgery, arterial transfemoral access remains the approach of preference. CT provides a comprehensive and accurate assessment of access site, including vessel size, calcification, and tortuosity, providing great predictive value for vascular complication. The aforementioned expert consensuses highlighted the importance of a careful evaluation of iliac-femoral vessels with a review of the vessel anatomy and introduced a recommended standardized CT report in pre-TAVI/TAVR assessment. The same pre-operative CT evaluation should be performed in all the fields of minimally invasive cardiac surgery, including mitral and tricuspid valve surgery. In our opinion, a standardized CT report should customarily include an assessment of vascular access incorporating lower limb arteries variants to plan the access and improve patient outcome. In summary, as the minimally invasive cardiac surgery continues to grow, a CT report should highlight not only vessel size, calcification, and tortuosity but also the numerous anatomical variants of the lower limb arteries, which can impact the success of the endovascular intervention. Consequently, a potential improvement for pre-operative transcatheter valve implantation planning to consider is to create a standardized reporting template, that includes accurate evaluation of the lower limb arteries anatomy.","PeriodicalId":444006,"journal":{"name":"Canadian Association of Radiologists journal = Journal l'Association canadienne des radiologistes","volume":" ","pages":"271"},"PeriodicalIF":3.1,"publicationDate":"2022-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/08465371211020011","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39009844","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Canadian Association of Radiologists Recommendations for the Safe Use of MRI During Pregnancy.","authors":"Pejman Jabehdar Maralani,&nbsp;Anish Kapadia,&nbsp;Grace Liu,&nbsp;Felipe Moretti,&nbsp;Hournaz Ghandehari,&nbsp;Sharon E Clarke,&nbsp;Sheldon Wiebe,&nbsp;Juliette Garel,&nbsp;Birgit Ertl-Wagner,&nbsp;Casey Hurrell,&nbsp;Nicola Schieda","doi":"10.1177/08465371211015657","DOIUrl":"https://doi.org/10.1177/08465371211015657","url":null,"abstract":"<p><p>The use of magnetic resonance imaging (MRI) during pregnancy is associated with concerns among patients and health professionals with regards to fetal safety. In this work, the Canadian Association of Radiologists (CAR) Working Group on MRI in Pregnancy presents recommendations for the use of MRI in pregnancy, derived from literature review as well as expert panel opinions and discussions. The working group, which consists of academic subspecialty radiologists and obstetrician-gynaecologists, aimed to provide updated, evidence-based recommendations addressing safety domains related to energy deposition, acoustic noise, and gadolinium-based contrast agent use based on magnetic field strength (1.5T and 3T) and trimester scanned, in addition to the effects of sedative use and occupational exposure.</p>","PeriodicalId":444006,"journal":{"name":"Canadian Association of Radiologists journal = Journal l'Association canadienne des radiologistes","volume":" ","pages":"56-67"},"PeriodicalIF":3.1,"publicationDate":"2022-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/08465371211015657","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38910120","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}