Journal of the American College of Radiology最新文献

{"title":"A 3-Minute Ultrafast MRI and MRA Protocol for Screening of Acute Ischemic Stroke","authors":"Maria Camila Cortes-Albornoz MD ,&nbsp;Bryan Clifford PhD ,&nbsp;Wei-Ching Lo PhD ,&nbsp;Seonghwan Yee PhD ,&nbsp;Brooks P. Applewhite MD ,&nbsp;Azadeh Tabari MD ,&nbsp;Claire White-Dzuro BA ,&nbsp;Stephen F. Cauley PhD ,&nbsp;Pamela W. Schaefer MD ,&nbsp;Otto Rapalino MD ,&nbsp;Michael H. Lev MD ,&nbsp;Berkin Bilgic ,&nbsp;Thorsten Feiweier ,&nbsp;Susie Y. Huang MD, PhD ,&nbsp;John M. Conklin MD ,&nbsp;Min Lang MD, MSc","doi":"10.1016/j.jacr.2025.01.002","DOIUrl":"10.1016/j.jacr.2025.01.002","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate the diagnostic performance of a 3-min ultrafast brain MRI and MRA protocol for screening of acute ischemic stroke.</div></div><div><h3>Methods</h3><div>This study involved 67 adult patients who underwent ultrafast and reference MRI and MRA scans from September 2023 to June 2024 for stroke evaluation. Two readers independently assessed the ultrafast and reference MRI and MRA images in a masked and randomized manner for acute and chronic infarct and hemorrhage as well as large-vessel occlusion and severe stenosis. A 3-point Likert scale was used to evaluate diagnostic quality of the ultrafast sequences and Cohen’s κ was used to assess interrater agreement.</div></div><div><h3>Results</h3><div>The ultrafast MRI and MRA protocol showed high diagnostic quality, with 98% of sequences rated as diagnostic. Raters showed perfect agreement in identifying acute infarcts, aneurysms, and vascular occlusions using both ultrafast and reference protocols and near-perfect agreement (&gt;95%) for detecting acute hemorrhage and severe stenosis. For chronic conditions such as chronic infarction and chronic hemorrhage, there was substantial agreement with κ values ranging from 0.73 to 0.76.</div></div><div><h3>Discussion</h3><div>The screening ultrafast MRI and MRA protocol can effectively identify acute ischemic stroke and intracranial large-vessel occlusion with high diagnostic accuracy while significantly reducing acquisition time, making it suitable for initial stroke triage. Evaluation for chronic pathologies on the ultrafast protocol is inferior compared with standard MRI and MRA imaging.</div></div>","PeriodicalId":49044,"journal":{"name":"Journal of the American College of Radiology","volume":"22 3","pages":"Pages 366-375"},"PeriodicalIF":4.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143529371","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Using Radiology as a Screening Tool to Identify Intimate Partner Violence","authors":"Patrick J. Lenehan MD, PhD ,&nbsp;Anji Tang MD ,&nbsp;Gaurav V. Watane MD ,&nbsp;Rahul Gujrathi MD ,&nbsp;Hyesun Park MD ,&nbsp;Babina Gosangi MD ,&nbsp;Richard Thomas MD ,&nbsp;Felipe Boschini Franco MD ,&nbsp;Krishna Patel MPH ,&nbsp;Ilana Warsofsky MD ,&nbsp;Bernard Rosner PhD ,&nbsp;Bharti Khurana MD, MBA","doi":"10.1016/j.jacr.2025.01.003","DOIUrl":"10.1016/j.jacr.2025.01.003","url":null,"abstract":"<div><h3>Objective</h3><div>To identify imaging utilization patterns and radiologically evident injuries suggestive of intimate partner violence (IPV).</div></div><div><h3>Methods</h3><div>This retrospective case-control study analyzed historical imaging reports from women reporting physical IPV between 2013 and 2018 (“cases”; n = 265; 6,401 imaging studies) and age- and race-matched controls not reporting IPV (n = 875; 13,462 imaging studies). Adjusted incidence rate ratios (aIRRs) were calculated using Poisson regression to compare imaging utilization by organ system or modality. Logistic regression calculated adjusted odds ratios (aORs) for canceled studies and studies conducted in the emergency department (ED), overnight, or on weekends. Injury patterns were assessed by calculating aIRRs of injury by anatomic site and comparing synchronous and asynchronous injury detection. A time-to-event analysis using Cox proportional hazards regression compared the cumulative incidence of asynchronous injury in patients with at least one injury.</div></div><div><h3>Results</h3><div>Patients experiencing IPV underwent imaging at a higher rate than controls (aIRR: 1.5, 95 confidence interval [CI]: 1.5-1.6). They were more likely to cancel screening mammograms (aOR: 3.2, 95% CI: 1.8-5.7) and undergo imaging in the ED (aOR: 3.8, 95% CI: 2.9-5.0), overnight (aOR: 1.6, 95% CI: 1.3-1.9) and on weekends (aOR: 1.3, 95% CI: 1.1-1.5). The injury rate was higher in cases (aIRR: 15.1, 95% CI: 12.5-18.1), particularly for cranial (aIRR: 104.5, 95% CI: 14.2-770.1), facial (aIRR: 47.0, 95% CI: 18.9-117.0), and thoracic (aIRR: 32.6, 95% CI: 11.5-92.2) injuries. Cases were more likely to have multiple injuries in a single encounter (aOR: 4.7, 95% CI: 1.5-14.1) or multiple encounters with unique injuries (hazard ratio: 4.9, 95% CI: 2.6-9.3).</div></div><div><h3>Conclusion</h3><div>Patients experiencing IPV had higher rates of imaging studies, imaging utilization in the ED, weekend, and overnight settings, screening examination cancellation, and radiologically evident injuries than controls.</div></div>","PeriodicalId":49044,"journal":{"name":"Journal of the American College of Radiology","volume":"22 3","pages":"Pages 395-404"},"PeriodicalIF":4.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143529387","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Table of Content","authors":"","doi":"10.1016/S1546-1440(25)00053-5","DOIUrl":"10.1016/S1546-1440(25)00053-5","url":null,"abstract":"","PeriodicalId":49044,"journal":{"name":"Journal of the American College of Radiology","volume":"22 3","pages":"Pages A1-A4"},"PeriodicalIF":4.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143529424","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Quantifying the Opportunity and Economic Value of Bone Density Screening Using Opportunistic CT: A Medicare Database Analysis","authors":"Soterios Gyftopoulos MD, MBA ,&nbsp;Casey E. Pelzl MPH ,&nbsp;Connie Y. Chang MD","doi":"10.1016/j.jacr.2024.10.003","DOIUrl":"10.1016/j.jacr.2024.10.003","url":null,"abstract":"<div><h3>Purpose</h3><div>The aim of this study was to determine the potential impact of opportunistic CT bone density screening in terms of increasing screening rates and cost avoidance.</div></div><div><h3>Methods</h3><div>The analytic dataset was extracted from the Medicare 5% Research Identifiable Files (2015-2022). All dual-energy x-ray absorptiometry (DEXA) procedures and contrast and/or noncontrast CT procedures of pertinent body regions were identified using Current Procedural Terminology codes. Outcomes of interest included osteoporosis screening imaging and fragility fractures of the hip or spine. Potential annual cost avoidance was calculated.</div></div><div><h3>Results</h3><div>In total, 2,897,040 beneficiaries were identified for analysis, of whom 584,391 beneficiaries (20.2%) underwent DEXA and 658,703 beneficiaries (22.7%) did not undergo DEXA but did undergo at least one CT examination that included the L1 vertebral body, 446,706 (67.8%) without and 211,997 (32.2%) with contrast. In the noncontrast and contrast CT groups, there were 2,766 (0.6%) and 613 (0.3%) hip and 23,889 (5.3%) and 5,222 (2.5%) spine fragility fractures within 1 year of CT. The osteoporosis screening rate would increase by 76% using only noncontrast CT studies and by 113% using all CT studies. If only noncontrast CT was used to identify osteoporosis and treatment was successfully implemented in 100% of eligible beneficiaries, this study population would see a medical cost avoidance in excess of $17 million. If any CT was used, potential annual cost avoidance for this study’s population would be nearly $100 million and $2.5 billion for all 2023 Medicare fee-for-service beneficiaries.</div></div><div><h3>Conclusions</h3><div>Implementing opportunistic CT bone density screening could potentially have a substantial patient care and economic impact.</div></div>","PeriodicalId":49044,"journal":{"name":"Journal of the American College of Radiology","volume":"22 3","pages":"Pages 349-357"},"PeriodicalIF":4.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143529369","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Applying Artificial Intelligence to Quantify Body Composition on Abdominal CTs and Better Predict Kidney Transplantation Wait-List Mortality","authors":"Karim Yatim MD ,&nbsp;Guilherme T. Ribas PhD ,&nbsp;Daniel C. Elton PhD ,&nbsp;Marcio A.B.C. Rockenbach MD ,&nbsp;Ayman Al Jurdi MD ,&nbsp;Perry J. Pickhardt MD ,&nbsp;John W. Garrett PhD ,&nbsp;Keith J. Dreyer DO, PhD ,&nbsp;Bernardo C. Bizzo MD, PhD ,&nbsp;Leonardo V. Riella MD, PhD","doi":"10.1016/j.jacr.2025.01.004","DOIUrl":"10.1016/j.jacr.2025.01.004","url":null,"abstract":"<div><h3>Background</h3><div>Prekidney transplant evaluation routinely includes abdominal CT for presurgical vascular assessment. A wealth of body composition data are available from these CT examinations, but they remain an underused source of data, often missing from prognostication models, as these measurements require organ segmentation not routinely performed clinically by radiologists. We hypothesize that artificial intelligence facilitates accurate extraction of abdominal CT body composition data, allowing better prediction of outcomes.</div></div><div><h3>Methods</h3><div>We conducted a retrospective, single-center observational study of kidney transplant candidates wait-listed between January 1, 2007, and December 31, 2017, with available CT data. Validated deep learning models quantified body composition including fat, aortic calcification, bone density, and muscle mass. Logistic regression was used to compare body composition data to Expected Post-Transplant Survival Score (EPTS) as a predictor of 5-year wait-list mortality.</div></div><div><h3>Results</h3><div>In all, 899 patients were followed for a median 943 days (interquartile range 320-1,697). Of 899, 589 (65.5%) were men and 680 of 899 (75.6%) were White, non-Hispanic. Of 899, 167 patients (18.6%) died while on the waiting list. Myosteatosis (defined as the lowest tertile of muscle attenuation) and increased total aortic and abdominal calcification were associated with increased 5-year wait-list mortality. Logistic regression showed that imaging parameters performed similarly to EPTS at predicting 5-year wait-list mortality (area under receiver operating characteristic curve 0.70 [0.64-0.75] versus 0.67 [0.62-0.72], respectively), and combining body composition parameters with EPTS led to a slight improved survival prediction (area under receiver operating characteristic curve = 0.72, 95% confidence interval 0.66-0.76).</div></div><div><h3>Conclusions</h3><div>Fully automated quantification of body composition in kidney transplant candidates is feasible. Myosteatosis and atherosclerosis are associated with 5-year wait-list mortality.</div></div>","PeriodicalId":49044,"journal":{"name":"Journal of the American College of Radiology","volume":"22 3","pages":"Pages 332-341"},"PeriodicalIF":4.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143529367","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Screening via Imaging: Updates and Innovations","authors":"Resmi A. Charalel MD, MPH ,&nbsp;Jeffrey P. Guenette MD, MPH ,&nbsp;Christoph I. Lee MD, MS, MBA","doi":"10.1016/j.jacr.2025.01.007","DOIUrl":"10.1016/j.jacr.2025.01.007","url":null,"abstract":"","PeriodicalId":49044,"journal":{"name":"Journal of the American College of Radiology","volume":"22 3","pages":"Pages 247-248"},"PeriodicalIF":4.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143529425","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Using Self-Scheduling to Improve Screening Mammography Completion Rates","authors":"Gillean Cortes DO ,&nbsp;Wen-Pin Chen MS ,&nbsp;Ziogas Aryagus PhD ,&nbsp;Ali Rashidi MD ,&nbsp;Irene Tsai MD ,&nbsp;Gelareh Sadigh MD","doi":"10.1016/j.jacr.2024.10.007","DOIUrl":"10.1016/j.jacr.2024.10.007","url":null,"abstract":"<div><h3>Purpose</h3><div>Self-scheduling has the potential to enhance convenience and patient engagement. We compared outpatient screening mammography completion rates before and after implementing an online self-scheduling system between patients who use self-scheduling versus traditional scheduling.</div></div><div><h3>Methods</h3><div>In February 2021, a self-scheduling process was implemented at an institutional level through the Epic MyChart online portal, allowing patients to self-schedule screening mammography. This retrospective cohort study included women aged 18 and over who scheduled outpatient screening mammography in a tertiary health care facility from October 1, 2017, to June 30, 2023, had at least one encounter during the pre-implementation phase and one encounter during the postimplementation period, and only used one scheduling method (self-scheduling or traditional scheduling) in the postimplementation period. Difference-in-difference analyses were conducted to compare screening mammography completion rates between patients who used traditional versus self-scheduling in the postimplementation period.</div></div><div><h3>Results</h3><div>In all, 29,893 screening mammography were scheduled by 7,203 patients (mean age: 58.1 years; 70.0% White, 18.2% Asian, 1.8% Black, and 19.5% Hispanic). The overall mammography completion rate in pre-implementation period was 78.9% and increased to 79.8% in the postimplementation period. Using difference-in-difference estimator, the completion rates in the self-scheduling cohort was 8.4 percentage point (95% confidence interval, 5.2-11.6) higher than traditional scheduling. The change in screening mammography completion rate from the postimplementation to pre-implementation period was +8.5 percentage point (88.1% postimplementation versus 79.6% pre-implementation) for the self-scheduling cohort and +0.1 percentage point (80.8% postimplementation versus 80.7% pre-implementation) for the traditional scheduling cohort.</div></div><div><h3>Conclusion</h3><div>Self-scheduling was linked to increased screening mammography completion rates postimplementation when compared to traditional scheduling.</div></div>","PeriodicalId":49044,"journal":{"name":"Journal of the American College of Radiology","volume":"22 3","pages":"Pages 307-314"},"PeriodicalIF":4.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143529490","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk-Stratified Screening: A Simulation Study of Scheduling Templates on Daily Mammography Recalls","authors":"Yannan Lin MD, MPH, PhD ,&nbsp;Anne C. Hoyt MD ,&nbsp;Vladimir G. Manuel MD ,&nbsp;Moira Inkelas MPH, PhD ,&nbsp;Mehmet Ulvi Saygi Ayvaci PhD ,&nbsp;Mehmet Eren Ahsen PhD ,&nbsp;William Hsu PhD","doi":"10.1016/j.jacr.2024.12.010","DOIUrl":"10.1016/j.jacr.2024.12.010","url":null,"abstract":"<div><h3>Introduction</h3><div>Risk-stratified screening (RSS) scheduling may facilitate more effective use of same-day diagnostic testing for potentially abnormal mammograms, thereby reducing the need for follow-up appointments (“recall”). Our simulation study assessed the potential impact of RSS scheduling on patients recommended for same-day diagnostics.</div></div><div><h3>Methods</h3><div>We used a discrete event simulation to model workflow at a high-volume breast imaging center, incorporating artificial intelligence (AI)-triaged same-day diagnostic workups after screening mammograms. The RSS design sequences patients in the daily screening schedule using cancer risk categories developed from Tyrer-Cuzick and deep learning model scores. We compared recall variance, required hours of operation to accommodate all patients, and patient wait times using traditional (random) and RSS schedules.</div></div><div><h3>Results</h3><div>The baseline simulation included 60 daily patients, with an average of 42% receiving screening mammograms and 11% (about three patients) being recommended for diagnostic workups. Compared with traditional scheduling, RSS scheduling reduces recall variance by up to 30% (1.98 versus 2.82, <em>P</em> &lt; .05). With same-day diagnostics, RSS scheduling had a modest impact, increasing the number of patients served within normal operating hours by up to 1.3% (55.4 versus 54.7, <em>P</em> &lt; .05), decreasing necessary operational hours by 12 min (10.3 versus 10.5 hours, <em>P</em> &lt; .05), and increasing patient waiting times by an average of 2.4 min (0.24 versus 0.20 hours, <em>P</em> &lt; .05).</div></div><div><h3>Conclusion</h3><div>Our simulation study suggests that RSS scheduling could reduce recall variance. This approach might enable same-day diagnostics using AI triage by accommodating patients within normal operating hours.</div></div>","PeriodicalId":49044,"journal":{"name":"Journal of the American College of Radiology","volume":"22 3","pages":"Pages 297-306"},"PeriodicalIF":4.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143529857","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Comparison of Radiography, X-Ray Tomosynthesis, and CT for Intraorbital Metallic Foreign Body Screening","authors":"Christina L. Brunnquell PhD ,&nbsp;Ana Gabriela Vasconcelos MS ,&nbsp;Michael N. Hoff PhD ,&nbsp;Jalal B. Andre MD ,&nbsp;Bryan A. Comstock MS ,&nbsp;Diana L. Lam MD ,&nbsp;Pattana Wangaryattawanich MD ,&nbsp;Jason Hartman MD ,&nbsp;Nathan M. Cross MD","doi":"10.1016/j.jacr.2024.12.002","DOIUrl":"10.1016/j.jacr.2024.12.002","url":null,"abstract":"<div><h3>Objective</h3><div>Before MRI examination, patients are often screened for intraorbital metallic foreign bodies (IMFBs) via questioning, clinical record review, and imaging when appropriate. This work compares the screening performance of digital radiography (DR), digital tomosynthesis (DT), and CT in detecting IMFBs composed of various metals and identifies their limits of detection.</div></div><div><h3>Methods</h3><div>Fragments of aluminum, steel, and cobalt-cemented tungsten carbide were produced. A human skull model, with metal fragments embedded in grapes placed in each orbit, was submerged in a water bath to create a semi-anthropomorphic phantom. Phantom orbit images were acquired with DR, DT, and CT. Six experienced radiologists reviewed images and scored their confidence in detecting IMFBs. Receiver operating characteristic analysis was performed and a multireader, multicase analysis of variance was used to compare the modalities.</div></div><div><h3>Results</h3><div>Performance comparison across modalities yielded area under the receiver operating characteristic curve values of 0.90, 0.79, and 0.78 for CT, DT, and DR, respectively. Pairwise comparison revealed that CT was superior to both DT and DR (<em>P</em> &lt; .05). When stratified by metal type, a significant performance difference among modalities was only observed for steel. Steel fragments of mass 0.8 mg and smaller were not detected using DT or DR, but even the smallest steel fragments of 0.4 mg were detectable with CT.</div></div><div><h3>Conclusion</h3><div>CT outperformed DT and DR in detecting IMFBs using a semi-anthropomorphic phantom. This performance difference is largely attributed to differences in detection of steel fragments. Since steel is often ferromagnetic, this distinction is relevant for imaging modality selection for orbit screening before MRI.</div></div>","PeriodicalId":49044,"journal":{"name":"Journal of the American College of Radiology","volume":"22 3","pages":"Pages 386-394"},"PeriodicalIF":4.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143529385","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Potential Impact of Opportunistic CT for Closing Diagnosis Gaps in Primary Hyperparathyroidism","authors":"Paul M. Bunch MD ,&nbsp;Joseph Rigdon PhD ,&nbsp;Leon Lenchik MD ,&nbsp;Matthew A. Gorris MD ,&nbsp;Reese W. Randle MD","doi":"10.1016/j.jacr.2024.09.009","DOIUrl":"10.1016/j.jacr.2024.09.009","url":null,"abstract":"<div><h3>Objective</h3><div>Primary hyperparathyroidism (PHPT) is underdiagnosed. Opportunistic assessment for enlarged parathyroid glands on routine CT examinations is a proposed approach to improve diagnosis. However, the proportion of at-risk patients with a relevant CT is unknown. We aimed to determine the proportion of individuals with hypercalcemia untested for PHPT who had CT examinations on which opportunistic screening could have been performed and to assess characteristics associated with imaging availability.</div></div><div><h3>Methods</h3><div>This retrospective study included adults with hypercalcemia untested for PHPT within our health system between January 2018 and December 2022. Each patient was classified as imaging available versus unavailable based on the presence of contrast-enhanced CTs including the parathyroid region performed between January 2013 and December 2022. Characteristics of these groups were compared.</div></div><div><h3>Results</h3><div>The sample comprised 10,702 patients (mean age, 57 years; 6,422 female and 4,280 male patients) with CTs available in 1,318 (12.3%). Characteristics associated with the greatest odds of available CT were Charlson Comorbidity Index ≥ 5 (odds ratio [OR] 5.29, <em>P</em> &lt; .0001), death during the study period (OR 2.31, <em>P</em> &lt; .0001), fatigue (OR 1.90, <em>P</em> &lt; .0001), weakness (OR 1.60, <em>P</em> &lt; .0001), and calcium &gt; 12.0 mg/dL (OR 1.44, <em>P</em> &lt; .0001). Characteristics associated with the lowest odds of available CT were age ≥ 85 years (OR 0.27, <em>P</em> &lt; .0001), age &lt; 35 years (OR 0.58, <em>P</em> &lt; .0001), and chronic kidney disease (OR 0.64, <em>P</em> &lt; .0001).</div></div><div><h3>Conclusion</h3><div>More than 12% of patients with hypercalcemia who were untested for PHPT had at least one CT that could have been used to opportunistically assess the parathyroid glands. Patients with imaging tended to have more comorbidities than those without.</div></div>","PeriodicalId":49044,"journal":{"name":"Journal of the American College of Radiology","volume":"22 3","pages":"Pages 376-385"},"PeriodicalIF":4.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143529372","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}