Improving Quality and Communication in Cardiac Imaging: The Coronary Artery Disease Reporting and Data System (CAD-RADS™)

Purpose of Review

To critically examine the Coronary Artery Disease Reporting and Data System (CAD-RADS?) lexicon and its nuances, with representative case examples provided for each of the major CAD-RADS classification categories and modifiers.

Recent Findings

CAD-RADS is a recently developed multi-disciplinary, multi-society standardized reporting system for coronary CTA based on scientific data and expert consensus from leaders in cardiac imaging.

Summary

CAD-RADS was developed to improve quality and communication in cardiac imaging, and to provide management recommendations based on actionable information from the coronary CTA imaging report. Widespread adoption of CAD-RADS in clinical practice will help maximize the clinical impact of coronary CTA for the care of patients with acute and stable chest pain.

     

Procarbazine--a traditional drug in the treatment of malignant gliomas

The methylhydrazine derivative Procarbazine (PCZ) as monotherapy or in combination with CCNU and vincristine (PCV) was evaluated in a vast number of clinical trials and is still used in patients with high-grade and low-grade gliomas. The compound is an antineoplastic agent with multiple sites of action. It inhibits incorporation of small DNA precursors, as well as RNA and protein synthesis. PCZ can also directly damage DNA through an alkylation reaction. The drug is not cross-resistant with other mustard-type alkylating agents. As PCZ was in almost all trials used in a combination with CCNU and Vincristin, the efficacy can only be evaluated in the view of the PCV regimen. The published data suggest a role of PCV as a salvage regimen, especially in oligodendroglial tumors; however, well designed studies with high evidence are rare in all entities. This article summarizes the existing data with the goal to define the role of PCZ/PCV in modern neurooncology.     

Dual-layer spectral detector CT: non-inferiority assessment compared to dual-source dual-energy CT in discriminating uric acid from non-uric acid renal stones ex vivo

Purpose

To assess the non-inferiority of dual-layer spectral detector CT (SDCT) compared to dual-source dual-energy CT (dsDECT) in discriminating uric acid (UA) from non-UA stones.

Methods

Fifty-seven extracted urinary calculi were placed in a cylindrical phantom in a water bath and scanned on a SDCT scanner (IQon, Philips Healthcare) and second- and third-generation dsDECT scanners (Somatom Flash and Force, Siemens Healthcare) under matched scan parameters. For SDCT data, conventional images and virtual monoenergetic reconstructions were created. A customized 3D growing region segmentation tool was used to segment each stone on a pixel-by-pixel basis for statistical analysis. Median virtual monoenergetic ratios (VMRs) of 40/200, 62/92, and 62/100 for each stone were recorded. For dsDECT data, dual-energy ratio (DER) for each stone was recorded from vendor-specific postprocessing software (Syngo Via) using the Kidney Stones Application. The clinical reference standard of X-ray diffraction analysis was used to assess non-inferiority. Area under the receiver-operating characteristic curve (AUC) was used to assess diagnostic performance of detecting UA stones.

Results

Six pure UA, 47 pure calcium-based, 1 pure cystine, and 3 mixed struvite stones were scanned. All pure UA stones were correctly separated from non-UA stones using SDCT and dsDECT (AUC = 1). For UA stones, median VMR was 0.95–0.99 and DER 1.00–1.02. For non-UA stones, median VMR was 1.4–4.1 and DER 1.39–1.69.

Conclusion

SDCT spectral reconstructions demonstrate similar performance to those of dsDECT in discriminating UA from non-UA stones in a phantom model.