Disproportionate Use in Minor Trauma Is Driving Emergency Department Cervical Spine Imaging: An Injury Severity Score–Based Analysis

PurposeClinical practice guidelines intended to reduce unnecessary cervical spine imaging have yielded mixed results. We aimed to assess evolving emergency department (ED) cervical spine imaging utilization in patients with trauma by injury severity.MethodsUsing 2009 to 2018 IBM MarketScan Commercial Databases, we identified ED trauma encounters, associated cervical spine imaging, and related diagnosis codes. We classified encounters by injury severity (minor, intermediate, major) using an International Classification of Disease code-derived Injury Severity Score algorithm and studied evolving imaging utilization using multivariable Poisson regression models.ResultsOf all 11,346,684 ED visits for trauma, 7,753,914 (68.3%), 3,524,250 (31.1%), and 68,520 (0.6%) involved minor, intermediate, and major injuries, respectively. Overall cervical spine imaging increased 5.7% annually (incidence rate ratio [IRR] 1.057, P < .001) with radiography decreasing 2.7% annually (IRR 0.973, P < .001) and CT increasing 10.5% annually (IRR 1.105, P < .001). Radiography utilization remained unchanged for minor injuries (IRR 0.994, P = .14) but decreased for intermediate (IRR 0.928 versus minor, P < .001) and major (IRR 0.931 versus minor, P < .001) injuries. Increases in CT utilization were greatest for minor injuries (IRR 1.109, P < .001) with smaller increases in intermediate (IRR 0.960 versus minor, P < .001) and major (IRR 0.987 versus minor, P = .022) injuries.ConclusionsRecent increases in cervical spine imaging in commercially insured patients with trauma seen in the ED have been largely related to increases in CT for patients with only minor injuries, in whom imaging utilization has been historically low. Further study is necessary to assess appropriateness, implications on costs and population radiation dose, and factors influencing ordering decision making.     

The Adoption and Impact on Performance of an Automated Outcomes Feedback Application for Tomosynthesis Screening Mammography

ObjectiveTo evaluate a tomosynthesis screening mammography automated outcomes feedback application’s adoption and impact on performance.MethodsThis prospective intervention study evaluated a feedback application that provided mammographers subsequent imaging and pathology results for patients that radiologists had personally recalled from screening. Deployed to 13 academic and 5 private practice attending radiologists, adoption was studied from March 29, 2018, to March 20, 2019. Radiologists indicated if reviewed feedback would influence future clinical decisions. For a subset of eight academic radiologists consistently interpreting screening mammograms during the study, performance metrics were compared pre-intervention (January 1, 2016, to September 30, 2017) and post-intervention (October 1, 2017 to June 30, 2018). Abnormal interpretation rate, positive predictive value of biopsies performed, sensitivity, specificity, and cancer detection rate were compared using Pearson’s χ² test. Logistic regression models were fit, adjusting for age, race, breast density, prior comparison, breast cancer history, and radiologist.ResultsThe 18 radiologists reviewed 68.5% (1,398 of 2,042) of available feedback cases and indicated that 17.4% of cases (243 of 1,398) could influence future decisions. For the eight academic radiologist subset, after multivariable adjustment with comparison to pre-intervention, average abnormal interpretation rate decreased (from 7.5% to 6.7%, adjusted odds ratio [aOR] 0.86, P < .01), positive predictive value of biopsies performed increased (from 40.6% to 51.3%, aOR 1.48, P = .011), and specificity increased (from 93.0% to 93.9%, aOR 1.17, P < .01) post-intervention. There was no difference in cancer detection rate per 1,000 examinations (from 5.8 to 6.1, aOR 1.01, P = .91) or sensitivity (from 81.2% to 78.7%, aOR 0.84, P = .47).ConclusionsRadiologists used a screening mammography automated outcomes feedback application. Its use decreased false-positive examinations, without evidence of reduced cancer detection.     

Trends in Hospital Performance on the Medicare National Outpatient Imaging Metrics: A 5-Year Longitudinal Cohort Analysis

PurposeMedicare established its Hospital Outpatient Quality Reporting Program (HOQRP) to promote and incentivize quality care and appropriate utilization in the hospital outpatient setting. The program includes “imaging efficiency” metrics evaluating appropriate utilization of imaging examinations. Our purpose was to evaluate the longitudinal performance of the nation’s hospitals on the HOQPR’s imaging efficiency metrics.MethodsData were obtained from CMS Hospital Compare for hospitals participating in the Medicare HOQRP during both initial (January 1, 2011, to December 31, 2011) and follow-up (July 1, 2015, to June 30, 2016) periods. The six reported imaging efficiency metrics were: MRI lumbar spine for low back pain, mammography follow-up rates, abdomen and chest CT double scans (imaging with and without intravenous contrast), cardiac imaging for preoperative risk assessment for low-risk surgery, and simultaneous use of brain and sinus CT. Differences in imaging efficiency metrics were calculated using fixed effects linear regression models.ResultsBaseline and follow-up data were available for 3,960 hospitals. Median changes were MRI lumbar spine for low back pain: +3.6% (range: ?27.9% to +31.4%; P < .001); mammography follow-up: ?0.3% (range: ?69.5% to +62.6%; P = .03); double scan abdomen CT: ?1.9% (range: ?73.5% to +32.3%; P < .001); double scan chest CT: ?0.4% (range: ?73.2% to +28.0%; P < .001); preoperative cardiac imaging: ?0.7% (range: ?10.0% to +9.9%; P < .001); simultaneous brain and sinus CT: ?0.9% (range: ?11.8% to +7.8%; P < .001).ConclusionMedicare’s nationwide hospital outpatient imaging efficiency reporting initiative was associating with worse performance in lumbar spine MRI utilization and small improvements in double CT scans. Because quality metrics are increasingly imposed on health care providers, health service researchers will need to rigorously evaluate their effectiveness before and during early implementation.     

Insufficient Leiomyoma Infarction in Uterine Artery Embolization: Relationship with Tumor Location

PurposeTo evaluate which leiomyoma location in the uterus predicts insufficient tumor infarction after uterine artery embolization (UAE).Materials and MethodsIn this single-institution retrospective study, 45 patients (mean age, 43.4 y ± 4.1) underwent UAE for leiomyomas using trisacryl gelatin microspheres alone with “pruned-tree” endpoint performed by qualified interventional radiologists between October 2015 and July 2017. Technical outcomes and complications were assessed. All patients underwent unenhanced and enhanced MR imaging before and after UAE. A total of 476 tumors of ≥ 1 cm observed in all patients were evaluated. Multivariate generalized linear mixed model analysis was performed to investigate relationships between insufficient tumor infarction (< 90%) on contrast-enhanced MR imaging after UAE and baseline factors, including tumor location in the long-axis, front-back, and inner-outer directions and tumor size.ResultsAll patients successfully underwent UAE with no major complications. Multivariate analysis revealed that there was a higher likelihood of insufficient infarction of tumors at the cervix (odds ratio [OR] 80.45; 95% confidence interval [CI] 9.97, 649.09; P < .001) and lower body (OR 4.31; 95% CI 2.52, 7.38; P < .001) than at the upper body and of tumors at the front than at the back wall (OR 2.20; 95% CI 1.32, 3.67; P = .002). Tumor size (OR 0.71; 95% CI 0.61, 0.82; P < .001) was a significant factor, whereas tumor location in the inner-outer direction was not.ConclusionsInsufficient leiomyoma infarction after UAE was more likely to involve tumors at the cervix, lower body, or front wall of the uterus or smaller tumors.     

Understanding Why Patients No-Show: Observations of 2.9 Million Outpatient Imaging Visits Over 16 Years

PurposeTo understand why patients “no-show” for imaging appointments, and to provide new insights for improving resource utilization.Materials and MethodsWe conducted a retrospective analysis of nearly 2.9 million outpatient examinations in our radiology information system from 2000 to 2015 at our multihospital academic institution. No-show visits were identified by the “reason code” entry “NOSHOW” in our radiology information system. We restricted data to radiography, CT, mammography, MRI, ultrasound, and nuclear medicine examinations that included all studied variables. These variables included modality, patient age, appointment time, day of week, and scheduling lead time. Multivariate logistic regression was used to identify factors associated with no-show visits.ResultsOut of 2,893,626 patient visits that met our inclusion criteria, there were 94,096 no-shows during the 16-year period. Rates of no-show visits varied from 3.36% in 2000 to 2.26% in 2015. The effect size for no-shows was strongest for modality and scheduling lead time. Mammography had the highest modality no-show visit rate of 6.99% (odds ratio [OR] 5.38, P < .001) compared with the lowest modality rate of 1.25% in radiography. Scheduling lead time greater than 6 months was associated with more no-show visits than scheduling within 1 week (OR 3.18, P < .001). Patients 60 years and older were less likely to miss imaging appointments than patients under 40 (OR 0.70, P < .001). Mondays and Saturdays had significantly higher rates of no-show than Sundays (OR 1.52 and 1.51, P < .001).ConclusionModality type and scheduling lead time were the most predictive factors of no-show. This may be used to guide new interventions such as targeted reminders and flexible scheduling.     

Shorter Perceived Outpatient MRI Wait Times Associated With Higher Patient Satisfaction

PurposeThe aim of this study was to assess differences in perceived versus actual wait times among patients undergoing outpatient MRI examinations and to correlate those times with patient satisfaction.MethodsOver 15 weeks, 190 patients presenting for outpatient MR in a radiology department in which “patient experience” is one of the stated strategic priorities were asked to (1) estimate their wait times for various stages in the imaging process and (2) state their satisfaction with their imaging experience. Perceived times were compared with actual electronic time stamps. Perceived and actual times were compared and correlated with standardized satisfaction scores using Kendall τ correlation.ResultsThe mean actual wait time between patient arrival and examination start was 53.4 ± 33.8 min, whereas patients perceived a mean wait time of 27.8 ± 23.1 min, a statistically significant underestimation of 25.6 min (P < .001). Both shorter actual and perceived wait times at all points during patient encounters were correlated with higher satisfaction scores (P < .001).ConclusionsPatients undergoing outpatient MR examinations in an environment designed to optimize patient experience underestimated wait times at all points during their encounters. Shorter perceived and actual wait times were both correlated with higher satisfaction scores. As satisfaction surveys play a larger role in an environment of metric transparency and value-based payments, better understanding of such factors will be increasingly important.     

The Value of Preprocedural MR Imaging in Genicular Artery Embolization for Patients with Osteoarthritic Knee Pain

PurposeTo determine the value of preprocedural MR imaging in genicular artery embolization (GAE) for patients with osteoarthritic knee pain.Materials and MethodsThis single-center study retrospectively analyzed 28 knees in 18 patients who underwent GAE for intractable knee pain < 1 month after MR imaging. The pain experienced in each knee was evaluated on a 100-mm visual analog scale (VAS) at baseline and 1- and 3-month after GAE. “GAE responders” were defined as knees that exhibited greater than 30% reduction of VAS pain scores from baseline at both follow-up visits. Musculoskeletal radiologists evaluated MR images of the affected knee compartment regarding cartilage defects, osteophytes, subchondral cysts, bone marrow lesions (BMLs), meniscal injury, and joint effusion. The performances of Kellgren–Lawrence (KL) grading and MR findings in predicting GAE responders was estimated based on receiver operating characteristic curves.ResultsThe mean VAS pain score was 84.3 mm. BML (area under the curve [AUC], 0.860; P < .001), meniscal injury (AUC, 0.811; P = .003), and KL grading (AUC, 0.898; P < .001) were significantly associated with GAE outcome. To predict GAE responders, KL grade ≤ 2 yielded a sensitivity of 87.5% and a specificity of 60.9%, BML grade ≤ 1 yielded a sensitivity of 75.0% and a specificity of 69.6%, and meniscal injury grade ≤ 2 yielded a sensitivity of 83.3% and a specificity of 72.7%.ConclusionsLarge BMLs and severe meniscal injuries on MR imaging, as well as high KL grades, indicated poor responses to GAE.     

A multicenter evaluation of the appropriate use of single-photon emission tomography myocardial perfusion imaging in Greece

Background

This study evaluates the appropriate use of myocardial perfusion imaging (MPI) and determines patterns and variables associated with inappropriate testing.

Methods

Over a 10-month period data were collected prospectively from consecutive patients referred for MPI in four academic departments and an appropriate use grade was assigned (appropriate, uncertain, inappropriate, and unclassifiable scans) according to established criteria.

Results

Among 3,032 referrals appropriate MPI had 72.8% of patients and 19.2% of studies were inappropriate, the remaining being uncertain (7.2%) or unclassifiable (0.8%). In multivariate analysis the asymptomatic status (odds ratio 10.7, P < .001), good functional capacity (odds ratio 1.9, P < .001), an interpretable resting electrocardiogram (odds ratio 1.8, P = .004), an age <65 years (odds ratio 1.5, P = .001) and the absence of diabetes (odds ratio 1.7, P < .001) or dyslipidemia (odds ratio 1.3, P = .014) were independent predictors of inappropriate scintigraphy. The most common indication for inappropriate testing was the assessment of asymptomatic patients <2 years after percutaneous coronary intervention (PCI) (38.9%).

Conclusions

The appropriate use of MPI is relatively high, but a considerable proportion of inappropriate scans is noted which is associated with markers of lower risk. The most common source of inappropriate testing is the assessment of asymptomatic patients <2 years after PCI.     

Diagnostic Emergency Imaging Utilization at an Academic Trauma Center From 1996 to 2012

PurposeThe aim of this study was to retrospectively review the growth rate in emergency radiology volume at an urban academic trauma center from 1996 to 2012.MethodsThe authors reviewed aggregated billing data, for which the requirement for institutional review board approval was waived, from 1,458,230 diagnostic radiologic examinations ordered for emergency department (ED) visits from 1996 to 2012. The growth rate was calculated as the average annual percentage change in imaging examinations per ED visits. The growth rates between 1996 to 2003 and 2004 to 2012 were statistically compared using a t test.ResultsED patient visits showed continual growth at an average of 3% per year. Total imaging per ED visit grew from 1996 to 2003 at 4 ± 4% per year but significantly decreased from 2004 to 2012 at −2 ± 3% per year (P = .01). By modality, statistically significant decreased growth was observed in CT and MRI from 2004 to 2012. Ultrasound and x-ray showed unchanged growth from 1996 through 2012. ED physician ultrasound data available for 2002 to 2011 also showed increased growth.ConclusionsWhen adjusting ED imaging volume by ED visits, significantly decreased growth of overall ED imaging, specifically CT and MRI, was observed during the past 9 years. This may be due to slowing of new imaging indications, improved awareness of practice guidelines, and increased use of ultrasound. Although the national health care discussion focuses on continual imaging growth, these results demonstrate that long-term stability in ED imaging utilization is achievable.     

National Trends in Oncologic Diagnostic Imaging

ObjectiveTo characterize national trends in oncologic imaging (OI) utilization.MethodsThis retrospective cross-sectional study used 2004 and 2016 CMS 5% Carrier Claims Research Identifiable Files. Radiologist-performed, primary noninvasive diagnostic imaging examinations were identified from billed Current Procedural Terminology codes; CT, MRI, and PET/CT examinations were categorized as “advanced” imaging. OI examinations were identified from imaging claims’ primary International Classification of Diseases-9 and International Classification of Diseases-10 codes. Imaging services were stratified by academic practice status and place of service. State-level correlations of oncologic advanced imaging utilization (examinations per 1,000 beneficiaries) with cancer prevalence and radiologist supply were assessed by Spearman correlation coefficient.ResultsThe national Medicare sample included 5,051,095 diagnostic imaging examinations (1,220,224 of them advanced) in 2004 and 5,023,115 diagnostic imaging examinations (1,504,608 of them advanced) in 2016. In 2004 and 2016, OI represented 4.3% and 3.9%, respectively, of all imaging versus 10.8% and 9.5%, respectively, of advanced imaging. The percentage of advanced OI done in academic practices rose from 18.8% in 2004 to 34.1% in 2016, leaving 65.9% outside academia. In 2016, 58.0% of advanced OI was performed in the hospital outpatient setting and 23.9% in the physician office setting. In 2016, state-level oncologic advanced imaging utilization correlated with state-level radiologist supply (r = +0.489, P < .001) but not with state-level cancer prevalence (r = −0.139, P = .329).DiscussionOI usage varied between practice settings. Although the percentage of advanced OI done in academic settings nearly doubled from 2004 to 2016, the majority remained in nonacademic practices. State-level oncologic advanced imaging utilization correlated with radiologist supply but not cancer prevalence.     

Percutaneous Vertebroplasty and Kyphoplasty for Pathologic Vertebral Fractures in the Medicare Population: Safer and Less Expensive than Open Surgery

PurposeTo compare cost and outcomes of surgical and percutaneous treatments of pathologic vertebral fractures.Materials and MethodsStandard Medicare 5% anonymized inpatient files (1999–2009) were retrospectively reviewed. Patients with a diagnosis of vertebral fracture without spinal cord injury and primary or metastatic bony malignancy were divided into percutaneous or surgical groups based on whether they received vertebroplasty/kyphoplasty or surgical treatment. Patients who had no intervention or both interventions were excluded. Cost, length of stay, and type of discharge were examined while controlling for demographic and comorbidity variables.ResultsA total of 451 patients were included; 52% received percutaneous treatment and 48% received surgery. Patients treated percutaneously were older (P<.001) and more likely to be female (P=.04). Percutaneous therapy predicted $14,862 less Medicare cost and $13,565 less overall cost (P<.001 for both), and 4.1 fewer inpatient days (P<.001). Patients who underwent surgery had higher odds of death (odds ratio=3.38, P=.016), discharge to a rehabilitation facility (odds ratio=3.3, P=.003), and transfer to another inpatient facility (odds ratio=8.53, P<.001), and lower odds of discharge to home (odds ratio=0.42, P<.001) and hospice (odds ratio=0.08, P=.002).ConclusionsIn a Medicare population with bony malignancy and vertebral fractures, percutaneous therapy predicted significantly reduced cost and length of stay versus surgery. Patients who underwent percutaneous therapy were significantly less likely to die, be transferred, or be discharged to rehabilitation facilities, and were more likely to be discharged to home or hospice.     

Does Distance Matter? Effect of Having a Dedicated CT Scanner in the Emergency Department on Completion of CT Imaging and Final Patient Disposition Times

PurposeTo evaluate whether presence of a CT scanner in the emergency department (ED) improves ED workflow by decreasing time between imaging requisition and completion, and time to final patient disposition.MethodsInstitutional review board approval was obtained for this retrospective study conducted on 2,142 consecutive, acute thoracic, abdomino- pelvic imaging requests from 2 ED hospital campuses affiliated with the same academic institution, August 1 to October 31, 2012. Of these patients, only 1,696 had complete records and were used for analysis. One hospital had a CT scanner in the ED; the other was in the radiology department, 300 meters from the ED. Patients were stratified based on acuity of CT indication, interpreting radiologist training level, and time of day. Time points were compared between hospitals: (1) time of CT requisition receipt to time of scan initiation (2) time from scan initiation to time of preliminary report by resident or fellow, or verbally by staff to the ED; and (3) time of CT requisition receipt to time of final patient disposition.ResultsDecreases in time, favoring the institution with the ED CT scanner, are 16 min (P < .0001); 15 minutes (P < .0001); and 19 minutes (P < .04) for the 3 times, respectively. Significant differences were seen in morning and overnight shifts and for CT reporting times with higher radiology levels of training (20 min, P = .04; and 18 min, P < .0001 for staff and postgraduate year-5 residents, respectively).ConclusionsPresence of an ED CT scanner is associated with decreases in time to CT scan completion, radiologic interpretation, and patient disposition.     

Chest CT Has Higher Yield for Infection than CT Sinus in Febrile Neutropenic Patients

ObjectiveChest and sinus CT imaging among cancer patients undergoing chemotherapy and bone marrow transplant in the setting of neutropenic fever is not uncommon, yet the utility of routine imaging surveillance remains unclear. We aim to compare the rates of acute infection detected on CT chest and CT sinus exams performed in this clinical setting.MethodsReports of 1059 consecutive CT chest and sinus examinations for the clinical indication of neutropenic fever on 262 patients performed between January through June 2017 were retrospectively reviewed. Infection as reported was characterized as acute or worsening, improving, stable, indeterminate or negative. Results were tabulated and Pearson's chi-square test was used for comparison analysis.ResultsAbsence of infection on CT sinus was significantly higher than CT chest (86.1% vs. 58.5%; P<0.001). Conversely, CT chest had significantly higher incidence of acute or worsening infection than CT sinus (28.7% vs. 11.6%; P<0.001). CT chest also showed significantly higher incidence of improving infection compared to CT sinus (6.2% vs. 1.1%; P<0.001). There was no significant difference between incidence of stable infection on CT chest and CT sinus (1.1% vs. 0.2%; P=0.059). Infection was indeterminate in 5.5% of CT chest vs. 1% on CT sinus (P<0.001).ConclusionsCT chest showed significantly higher diagnostic yield for acute infection than CT sinus, suggesting that sinusitis is less likely to be the source of fever than chest infections in febrile neutropenic patients. The majority of CT studies showed absence of infection, raising the question of the overall utility of routine surveillance CT imaging among this subset of patients.     

MRI of small intrahepatic mass-forming cholangiocarcinoma and atypical small hepatocellular carcinoma (≤ 3 cm) with cirrhosis and chronic viral hepatitis: a comparative study

ObjectiveThe objective was to identify the decision-making magnetic resonance (MR) features in differentiating small intrahepatic mass-forming cholangiocarcinoma (sIMCC) from atypical small hepatocellular carcinoma (sHCC) (≤ 3 cm) in patients with cirrhosis and chronic viral hepatitis.MethodsSignal features and relative contrast of sHCCs and sIMCCs in T2-weighted and dynamic enhanced imaging were analyzed. A subgroup comparison between the cirrhosis and noncirrhosis chronic viral hepatitis group was also made.ResultsUnivariate analysis revealed that tumor contours (P< .001), signals in T2-weighted (P< .001) and each phase of contrast-enhanced scanning (P< .001), enhancement patterns (P< .001), as well as accompanying findings of tumor capsule (P< .001), hepatic capsule retraction (P< .001), bile duct dilation (P= .031), and transient hepatic intensity difference (P= .002) were different between sIMCC and atypical sHCC. Multivariate analysis indicated that dynamic enhancement patterns (P< .001) and signals in T2-weighted images (P= .024) were independent predictors for differentiation. Confusing MR features were more often observed in the cirrhosis group compared with those in the noncirrhosis chronic viral hepatitis group.ConclusionDynamic enhancement patterns and signals in T2-weighted images were the most important MR features to differentiate sIMCC from atypical sHCC with cirrhosis and chronic viral hepatitis.     

“Concordance” Revisited: A Multispecialty Appraisal of “Concordant” Preliminary Abdominopelvic CT Reports

PurposeTo determine whether resident abdominopelvic CT reports considered prospectively concordant with the final interpretation are also considered concordant by other blinded specialists and abdominal radiologists.MethodsIn this institutional review board–approved retrospective cohort study, 119 randomly selected urgent abdominopelvic CT examinations with a resident preliminary report deemed prospectively “concordant” by the signing faculty were identified. Nine blinded specialists from Emergency Medicine, Internal Medicine, and Abdominal Radiology reviewed the preliminary and final reports and scored the preliminary report with respect to urgent findings as follows: 1.) concordant; 2.) discordant with minor differences; 3.) discordant with major differences that do not alter patient management; or 4.) discordant with major differences that do alter patient management. Predicted management resulting from scores of 4 was recorded. Consensus was defined as majority agreement within a specialty. Consensus major discrepancy rates (ie, scores 3 or 4) were compared to the original major discrepancy rate of 0% (0/119) using the McNemar test.ResultsConsensus scores of 4 were assigned in 18% (21/119, P < .001, Emergency Medicine), 5% (6/119, P = .03, Internal Medicine), and 13% (16/119, P < .001, Abdominal Radiology) of examinations. Consensus scores of 3 or 4 were assigned in 31% (37/119, P < .001, Emergency Medicine), 14% (17/119, P < .001, Internal Medicine), and 18% (22/119, P < .001, Abdominal Radiology). Predicted management alterations included hospital status (0-4%), medical therapy (1%-4%), imaging (1%-10%), subspecialty consultation (3%-13%), nonsurgical procedure (3%), operation (1%-3%), and other (0-3%).ConclusionsThe historical low major discrepancy rate for urgent findings between resident and faculty radiologists is likely underreported.     

Radiologists’ Contribution to Variation in Detecting Clinically Significant Prostate Cancer in Men With Prostate MRI

ObjectiveAssess radiologists’ contribution to variation in clinically significant prostate cancer (csPCa) detection in patients with elevated prostate-specific antigen (PSA) and multiparametric MRI (mpMRI).MethodsThis institutional review board–approved, retrospective cohort study was performed at a tertiary, academic, National Cancer Institute–designated Comprehensive Cancer Center with a multidisciplinary prostate cancer program. Men undergoing mpMRI examinations from January 1, 2015, to December 31, 2019, with elevated PSA (≥4 ng/mL) and biopsy within 6 months pre- or post-MRI or prostatectomy within 6 months post-mpMRI were included. Univariate and multivariable hierarchical logistic regression assessed impact of patient, provider, mpMRI examination, mpMRI report, and pathology factors on the diagnosis of Grade Group ≥ 2 csPCa.ResultsStudy cohort included 960 MRIs in 928 men, mean age 64.0 years (SD ± 7.4), and 59.8% (555 of 928) had csPCa. Interpreting radiologist was not significant individually (P > .999) or combined with mpMRI ordering physician and physician performing biopsy or prostatectomy (P = .41). Prostate Imaging Reporting and Data System (PI-RADS) category 2 (odds ratio [OR] 0.18, P = .04), PI-RADS category 4 (OR 2.52, P < .001), and PI-RADS category 5 (OR 4.99, P < .001) assessment compared with no focal lesion; PSA density of 0.1 to 0.15 ng/mL/cc (OR 2.46, P < .001), 0.15 to 0.2 ng/mL/cc (OR 2.77, P < .001), or ≥0.2 ng/mL/cc (OR 4.52, P < .001); private insurance (reference = Medicare, OR 0.52, P = .001), and unambiguous extraprostatic extension on mpMRI (OR 2.94, P = .01) were independently associated with csPCa. PI-RADS 3 assessment (OR 1.18, P = .56), age (OR 0.99, P = .39), and African American race (OR 0.90, P = .75) were not.DiscussionAlthough there is known in-practice variation in radiologists’ interpretation of mpMRI, in our multidisciplinary prostate cancer program we found no significant radiologist-attributable variation in csPCa detection.     

Incidentally detected atherosclerosis in the abdominal aorta or its major branches on computed tomography is highly associated with coronary heart disease in asymptomatic adults

BackgroundAtherosclerotic lesions in the abdominal aorta or its major branches are often incidentally detected on abdominal CT. However, clinical implications and optimal subsequent management are mostly left undetermined.MethodsConsecutive, asymptomatic adults (age≥30) who underwent both abdominal CT and coronary computed tomography angiography as part of a self-referred health check-up were investigated (n = 1494).ResultsAdjusted for cardiovascular risk factors, abdominal atherosclerotic lesions with stenosis<25% were associated with significant coronary stenosis, especially in the abdominal aorta (adjusted odds ratio [aOR] 3.37, 95% confidence interval [CI] 0.99–11.45) and any common iliac artery (aOR 2.99, 95% CI 1.43–6.26). The association was higher in atherosclerotic lesions with stenosis≥25%, respectively (aOR 16.39, 95% CI 4.00–67.11; aOR 7.32, 95% CI 2.84–18.86). Furthermore, any major abdominal artery stenosis added predictive value to significant coronary stenosis (area under the receiver operating curve: 0.7598 vs. 0.8019, P < 0.001). The extent of arterial territory involvement was associated with the presence of significant coronary stenoses (P for trend <0.001).ConclusionStenotic atherosclerotic lesions in the abdominal aorta or its major branches incidentally detected on abdominal CT are relatively prevalent and carry high risk for asymptomatic coronary arterial disease.     

Dynamic Contrast-Enhanced MR Imaging Evaluation of Perfusional Changes and Ablation Zone Size after Combination Embolization and Ablation Therapy

PurposeThe objectives of this study were to assess the utility of dynamic contrast-enhanced magnetic resonance (MR) imaging in quantifying parenchymal perfusional changes after embolization and to characterize the association between pharmacokinetic (PK) parameters and final microwave ablation volume.Materials and MethodsPK parameters from dynamic contrast-enhanced MR imaging were used to quantify perfusional changes in the liver after transarterial embolization of the right or left lobe in a swine liver model (n = 5). Each animal subject subsequently underwent microwave ablation (60 W for 5 minutes) of the embolized and nonembolized liver lobes. Changes in PK parameters from dynamic contrast-enhanced MR imaging were correlated with their respective final microwave ablation volumes in each liver lobe.ResultsMicrowave ablation volumes of embolized liver lobes were significantly larger than those of nonembolized liver lobes (28.0 mL ± 6.2 vs 15.1 mL ± 5.2, P < .001). PK perfusion parameters were significantly lower in embolized liver lobes than in nonembolized liver lobes (K^trans = 0.69 min^?1 ± 0.15 vs 1.52 min^?1 ± 0.37, P < .001; k_ep = 0.69 min^?1 ± 0.19 vs 1.54 min^?1 ± 0.42, P < .001). There was a moderate but significant correlation between normalized k_ep and ablation volume, with each unit increase in normalized k_ep corresponding to a 9.8-mL decrease in ablation volume (P = .035).ConclusionsPK-derived parameters from dynamic contrast-enhanced MR imaging can be used to quantify perfusional changes after transarterial embolization and are directly inversely correlated with final ablation volume.     

The quantitative diagnostic capability of routine MR imaging and diffusion-weighted imaging in osteoporosis patients

ObjectivesTo determine the quantitative diagnostic capability of magnetic resonance imaging (MRI), compared to dual-energy X-ray absorptiometry (DEXA), for osteoporosis.Materials and MethodsEight male volunteers and eight patients underwent both DEXA and MRI. Results were obtained from each subject's L2 to L4, for a total of 48 lumbar vertebrae. Based on their bone mineral density (BMD) acquired from DEXA, the vertebrae were classified as follows: normal (n= 28), osteopenic (n= 0), and osteoporotic (n= 20). All MR examinations were performed on a 1.5-T scanner to obtain T₁-weighted imaging (T1WI), fat-suppression T₂-weighted imaging (FS-T2WI), and diffusion-weighted imaging (DWI). These quantitative MR parameters were determined: T1WI and FS-T2WI signal-to-noise ratios and DWI apparent diffusion coefficient values. To determine the diagnostic capability of MRI as an osteoporosis indicator, MR parameters were assessed statistically.ResultsAll MR parameters significantly correlated with BMD (T1WI: r=?0.64, FS-T2WI: r=?0.36, DWI: r=?0.29), with significant differences among normal and osteoporotic vertebrae (P< .05). By receiver operating characteristic analysis, the area under the curve of T1WI was significantly higher than others (P< .05). When adapted as feasible threshold values, sensitivity, specificity, and accuracy of T1WI were 95.0% (19/20), 92.9% (26/28), and 93.8% (45/48), respectively.ConclusionRoutine MRI, in particular T1WI, had a potential for the assessment of osteoporosis.