Gelareh Sadigh

Acoustic radiation force impulse imaging with virtual touch tissue quantification: measurements of normal breast tissue and dependence on the degree of pre-compression.

Acoustic radiation force impulse imaging (ARFI) with Virtual Touch tissue quantification (VTTQ) enables the determination of shear wave velocity in meters per second (m/s). We investigated shear wave velocity in normal breast tissue and analyzed the influence of the degree of pre-compression on the measurements. In repeated measurements and with normal pre-compression, the mean shear wave velocity in breast parenchyma was significantly higher than that in breast adipose tissue (3.33 ± 1.18 m/s vs. 2.90 ± 1.10 m/s; p < 0.001; 712 measurements in 89 patients). Furthermore, we found a significant positive correlation between degree of pre-compression and velocity measurements. Shear wave velocities with low, moderate and high pre-compression were 1.89, 3.18 and 4.39 m/s in parenchyma, compared with 1.46, 2.55 and 3.64 m/s in adipose tissue, respectively (p < 0.001; 360 measurements in 60 patients). VTTQ of breast tissue is a feasible method with high accuracy; however, the degree of pre-compression applied may significantly influence the measurements.

Meta-analysis of Air Versus Liquid Enema for Intussusception Reduction in Children.

OBJECTIVE The purpose of this study was to assess the effectiveness and safety of air versus liquid enema reduction in the treatment of intussusception in children. MATERIALS AND METHODS Literature searches of the PubMed, Embase, and Cochrane Library databases were conducted from January 1, 1966, through May 31, 2013. Articles on the use of air or liquid enema in children with a confirmed diagnosis of intussusception and reporting either a success rate for enema reduction of intussusception or a perforation rate were selected. Enema reduction success rate, perforation rate, and recurrence rate were the main outcomes and were calculated by random effects modeling. RESULTS One hundred two articles (101 reporting success rate, 71 reporting perforation rate) were included that presented results for 32,451 children (age range, 1 day-22 years; boys, 66%; girls, 34%). In 44 studies (16,187 children), the combined estimate for success rate of air enema was 82.7% (95% CI, 79.9-85.6%; inconsistency index [I(2)] = 97%), and in 52 studies (13,081 children) of liquid enema, it was 69.6% (95% CI, 65.0-74.1%; I(2) = 98%). In 38 studies (15,752 children), the combined estimate of perforation rate for air enema was 0.39% (95% CI, 0.23- 0.55%; I(2) = 40%), and in 30 studies (9429 children) of liquid enema, it was 0.43% (95% CI, 0.24- 0.62%; I(2) = 9%). Among 10,494 children (26 studies) undergoing air enema reduction, the rate of first intussusception recurrence was 6% (95% CI, 4.5-7.5%; I(2) = 89%), similar to the 7.3% (95% CI, 5.8-8.8%; I(2) = 71%) found for 4004 children (24 studies) undergoing liquid enema reduction. CONCLUSION Air enema was superior to liquid enema for intussusception reduction. The success rate was higher without a difference in perforation rate. Limitations included heterogeneity and publication bias.

Value of Imaging Part I: Perspectives for the Academic Radiologist.

With payers and policymakers increasingly scrutinizing the value of medical imaging, opportunities abound for radiologists and radiology health services researchers to meaningfully and rigorously demonstrate value. Part one of this two-part series on the value of imaging explores the concept of value in health care from the perspective of multiple stakeholders and discusses the opportunities and challenges for radiologists and health service researchers to demonstrate value. The current absence of meaningful national value metrics also presents an opportunity for radiologists to take the lead on the discussions of these metrics that may serve as the basis for future value-based payments. As both practitioners and investigators, radiologists should consider the perspectives of multiple stakeholders in all they do-interdisciplinary support and cooperation are essential to the success of value-focused imaging research and initiatives that improve patient outcomes. Radiology departments that align their cultures, infrastructures, and incentives to support these initiatives will greatly increase their chances of being successful in these endeavors.

Diagnostic Performance of MRI Sequences for Evaluation of Dural Venous Sinus Thrombosis

OBJECTIVE The purpose of this study is to assess the performance of routinely used MRI sequences with and without contrast enhancement in the diagnostic evaluation of dural venous sinus thrombosis (DVST). MATERIALS AND METHODS We identified consecutive patients older than 18 years who underwent concurrent standardized brain MRI and contrast-enhanced (CE) MR venography (MRV) examinations for suspected DVST. The seven MRI sequences that were used (axial unenhanced T1-weighted, T1-weighted CE, T2-weighted, DWI, T2-weighted FLAIR, T2-weighted gradient-recalled echo [GRE], and sagittal 3D T1-weighted GRE CE sequences) were randomized, anonymized, and reviewed independently by two neuroradiologists who were blinded to the final diagnosis. Ten separate venous sinus segments were evaluated. CE MRV was the reference standard for determining the presence or absence of DVST, and it was performed using the following imaging parameters: TR/TE, 4.1-77/1.4-9.5; flip angle, 12-35°; and slice thickness, 0.8-1.4 mm. The diagnostic performance of and interobserver variability for each sequence was assessed per patient and per segment. RESULTS Thirty-six patients with DVST (72% of whom had acute thrombosis and 28% of whom had chronic thrombosis) and 29 patients without DVST were included in the study. For each sequence, the AUC values for the detection of DVST per patient, as determined by reviewer 1 and reviewer 2, respectively, were as follows: for T1-weighted unenhanced sequences, 55% and 61%; for T1-weighted CE sequences, 79% and 80%; for T2-weighted sequences, 77% and 76%; for DWI sequences, 59% and 64%; for T2-weighted FLAIR sequences, 70% and 72%; for T2-weighted GRE sequences, 64% and 66%; and for the 3D T1-weighted GRE CE sequence, 77% and 81%. The diagnostic performance of the 3D T1-weighted GRE CE sequences was statistically significantly greater than that of the other sequences. Interobserver variability ranged from 0.26 (for T1-weighted unenhanced sequences) to 0.73 (for the DWI sequence). Overall, for each reviewer and with the use of all evaluated sequences, MRI had a high sensitivity (> 99% for both reviewers) but low specificity (14% for reviewer 1 and 48% for reviewer 2) for the detection of DVST. CONCLUSION Sequences used in routine brain MRI performed with and without contrast enhancement have varying strengths that are important to recognize when the likelihood of DVST is assessed, but they do not replace the utility of dedicated CE MRV.

Can Patients Comprehend the Educational Materials that Hospitals Provide about Common IR Procedures

PURPOSE To assess the readability of online education materials offered by hospitals describing commonly performed interventional radiology (IR) procedures. MATERIALS AND METHODS Online patient education materials from 402 hospitals selected from the Medicare Hospital Compare database were assessed. The presence of an IR service was determined by representation in the Society of Interventional Radiology physician finder directory. Patient online education materials about (i) uterine artery embolization for fibroid tumors, (ii) liver cancer embolization, (iii) varicose vein treatment, (iv) central venous access, (v) inferior vena cava (IVC) filter placement, (vi) nephrostomy tube insertion, (vii) gastrostomy tube placement, and (viii) vertebral augmentation were targeted and assessed by using six validated readability scoring systems. RESULTS Of 402 hospitals sampled, 156 (39%) were presumed to offer IR services. Of these, 119 (76%) offered online patient education material for one or more of the eight service lines. The average readability scores corresponding to grade varied between the ninth- and 12th-grade levels. All were higher than the recommended seventh-grade level (P < .05) except for nephrostomy and gastrostomy tube placement. Average Flesch-Kincaid Reading Ease scores ranged from 42 to 69, corresponding with fairly difficult to difficult readability for all service lines except IVC filter and gastrostomy tube placement, which corresponded with standard readability. CONCLUSIONS A majority of hospitals offering IR services provide at least some online patient education material. Most, however, are written significantly above the reading comprehension level of most Americans. More attention to health literacy by hospitals and IR physicians is warranted.

Diagnostic Quality of 3D T2-SPACE Compared with T2-FSE in the Evaluation of Cervical Spine MRI Anatomy

BACKGROUND AND PURPOSE: Spinal anatomy has been variably investigated using 3D MRI. We aimed to compare the diagnostic quality of T2 sampling perfection with application-optimized contrasts by using flip angle evolution (SPACE) with T2-FSE sequences for visualization of cervical spine anatomy. We predicted that T2-SPACE will be equivalent or superior to T2-FSE for visibility of anatomic structures. MATERIALS AND METHODS: Adult patients undergoing cervical spine MR imaging with both T2-SPACE and T2-FSE sequences for radiculopathy or myelopathy between September 2014 and February 2015 were included. Two blinded subspecialty-trained radiologists independently assessed the visibility of 12 anatomic structures by using a 5-point scale and assessed CSF pulsation artifact by using a 4-point scale. Sagittal images and 6 axial levels from C2–T1 on T2-FSE were reviewed; 2 weeks later and after randomization, T2-SPACE was evaluated. Diagnostic quality for each structure and CSF pulsation artifact visibility on both sequences were compared by using a paired t test. Interobserver agreement was calculated (κ). RESULTS: Forty-five patients were included (mean age, 57 years; 40% male). The average visibility scores for intervertebral disc signal, neural foramina, ligamentum flavum, ventral rootlets, and dorsal rootlets were higher for T2-SPACE compared with T2-FSE for both reviewers (P < .001). Average scores for remaining structures were either not statistically different or the superiority of one sequence was discordant between reviewers. T2-SPACE showed less degree of CSF flow artifact (P < .001). Interobserver variability ranged between −0.02–0.20 for T2-SPACE and −0.02–0.30 for T2-FSE (slight to fair agreement). CONCLUSIONS: T2-SPACE may be equivalent or superior to T2-FSE for the evaluation of cervical spine anatomic structures, and T2-SPACE shows a lower degree of CSF pulsation artifact.

Impact of Coronary CT Angiography on Surgical Decision-Making for Coronary Artery Bypass Graft Surgery

RATIONALE AND OBJECTIVES To determine the impact of coronary computed tomography angiography (CCTA) on treatment decisions made by cardiac surgeons and to explore barriers to implementation of CCTA as first-line imaging workup before coronary artery bypass. MATERIALS AND METHODS Tertiary academic medical center retrospective cohort study. Questionnaires administered to three cardiac surgeons regarding diagnosis and treatment decisions with level of confidence in decision making for 30 chest pain patients, after reviewing deidentified catheter coronary angiogram (CCA) and CCTA images on the same patients, several weeks apart. RESULTS All surgeons tended to report more severe disease with CCTA than CCA (P < .05). Treatment decisions differed in 12 (40%), 14 (47%), and 18 (60%) patients within each individual surgeon based on CCTA images compared to CCA images (P = .11, .01, and .02, respectively). Confidence levels were significantly higher with CCA for the diagnosis and treatment of coronary artery disease for all three surgeons (P < .05). There was a tendency toward more invasive treatment choices (angioplasty, stent insertion, or coronary artery bypass graft) when making treatment decisions based upon CCTA images. CONCLUSIONS Severity of disease may be overestimated by cardiac surgeons when using CCTA as a decision-making test, tending toward more invasive treatment choices compared to CCA. Additionally, cardiac surgeons may be more confident with their diagnosis and treatment based on CCA. These may be important limitations in the application of CCTA in clinical practice and may reflect the maturation of CCTA use in practice, diffusion of the technology and/or a reflection of the technology itself.

Prevalence of Unanticipated Events Associated With MRI Examinations: A Benchmark for MRI Quality, Safety, and Patient Experience

PURPOSE To determine the prevalence of unanticipated events (UE) associated with MRI examinations in a multicenter academic radiology department. METHODS UE reported by MRI technologists for examinations performed between June 2013 and November 2014 on 17 scanners in a university- and community-affiliated single health system were retrospectively reviewed. Events were categorized into the following categories: (1) problems with orders and scheduling; (2) scan delays; (3) unanticipated foreign bodies; (4) non-contrast-related patient events (eg, patient motion, discomfort, claustrophobia, need for sedation); (5) contrast-related patient events; and (6) technical acquisition issues. Logistic regression analysis of UE was performed after adjusting based on scanner site (university- vs community-affiliated hospital), hospital setting (outpatient [OP] vs mixed outpatient and inpatient [OP/IP]), and timing of the scan (business days vs weekends/holidays). RESULTS A total of 34,587 MRI examinations were assessed (87% university-affiliated; 58% OP) with 5775 (16.7%) UE (1.9% of patients had more than one category event). Rates of UE for each category were as follows: 1.9% orders and scheduling, 3.3% delays in scan, 0.5% foreign bodies, 10.4% non-contrast-related patient events, 1.3% contrast-related patient events, and 1.5% technical issues. After adjustment for location of scanner, clinical setting, and timing of the scan, the rate of overall UE was significantly higher in university-affiliated sites (coefficient, 0.09 [95% confidence interval (CI), 0.07-0.10]; P < .001), in scans performed in the mixed OP/IP setting (coefficient, 0.09 [95% CI, 0.08-0.09]; P < .001), and in scans performed during weekends/holidays (coefficient, 0.02 [95% CI, 0.01-0.04]; P < .001). CONCLUSIONS UE associated with MRI examinations are common (16.7%), with the majority being patient-related issues unrelated to contrast administration.

Breast Cancer Screening in Patients With Newly Diagnosed Lung and Colorectal Cancer: A Population-Based Study of Utilization

PURPOSE To assess breast cancer screening utilization in Medicare beneficiaries with colorectal and lung cancer versus cancer-free controls. METHODS Female fee-for-service Medicare beneficiaries who were ≥67 years old and diagnosed with lung or colorectal cancer between 2000 and 2011 and who reported to a Surveillance, Epidemiology, and End Results (SEER) registry (case group) were followed for 2 years after their diagnoses, unless death, a diagnosis of breast cancer, or the end of 2013 came first. A similar number of cancer-free controls were individually matched to cases by age, race, registry region, and follow-up time. Screening utilization was defined as the percentage of women with ≥1 screening mammogram during follow-up. RESULTS Overall, 104,164 cases (48% colorectal, 52% lung; 30% advanced cancer) and 104,164 controls were included. Among women with lung or colorectal cancer, 22% underwent ≥1 screening mammogram versus 26% of controls (odds ratio [OR] 0.80; 95% confidence interval [CI] 0.78-0.82). Stratified by cancer type, 28% of colorectal cancer cases versus 29% of controls (OR 0.98; 95% CI 0.95-1.01) and 17% of lung cancer cases versus 23% of controls (OR 0.63; 95% CI 0.60-0.65) received ≥1 mammogram. When stratified by stage, 8% with advanced cancer versus 18% of controls (OR 0.33; 95% CI 0.31-0.35) and 30% with early-stage cancer versus 30% of controls (OR 1; 95% CI 0.97-1.02) underwent ≥1 mammogram. CONCLUSION Screening mammography utilization rates are similar between Medicare beneficiaries with early-stage cancer versus controls. Although the majority of patients with advanced-stage cancer appropriately do not pursue screening mammography, a small number (8%) continue with screening.

Health Care Price Transparency and Communication: Implications for Radiologists and Patients in an Era of Expanding Shared Decision Making

OBJECTIVE The purpose of this article is to review the literature on communicating transparency in health care pricing, both overall and specifically for medical imaging. Focus is also placed on the imperatives and initiatives that will increasingly impact radiologists and their patients. CONCLUSION Most Americans seek transparency in health care pricing, yet such discussions occur in fewer than half of patient encounters. Although price transparency tools can help decrease health care spending, most are used infrequently and most lack information about quality. Given the high costs associated with many imaging services, radiologists should be aware of such initiatives to optimize patient engagement and informed shared decision making.