Judith K. Amorosa

Multicenter clinical trial of ultrasmall superparamagnetic iron oxide in the evaluation of mediastinal lymph nodes in patients with primary lung carcinoma

The purpose of this study was to evaluate the clinical efficacy of ultrasmall superparamagnetic iron oxide particles as a magnetic resonance (MR) contrast agent in differentiating metastatic from benign lymph nodes. Eighteen patients with primary lung malignancy and suspected regional lymph node metastases underwent MR imaging before and after Combidex® infusion in a multi‐institutional study. All MR sequences were interpreted by one or more board‐certified radiologists experienced in imaging thoracic malignancy. Each patient was evaluated for the number and location of lymph nodes, homogeneity of nodal signal, and possible change of MR signal post contrast. All patients underwent resection or sampling of the MR‐identified lymph node(s) 1–35 day(s) post contrast MR imaging. In all, 27 lymph nodes or nodal groups were available for histopathologic correlation. Combidex had a sensitivity of 92% and a specificity of 80% in identifying pathologically confirmed metastatic mediastinal lymph nodes. Based on our preliminary data, Combidex MR imaging may provide additional functional information useful in the staging of mediastinal lymph nodes. J. Magn. Reson. Imaging 1999;10:468–473.

Acute Focal Bacterial Nephritis

Clinical and radiographic characteristics of 12 patients with acute focal bacterial nephritis (AFBN) are presented along with review of the literature. Most patients presented with symptoms of an inflammatory or infectious process. Fever and pyuria were the most frequently encountered clinical characteristics. Imaging modalities that were used to establish a definitive diagnosis of focal bacterial nephritis included ultrasound, computed tomography, and intravenous urography with nephrotomography. Ultrasound was found to be the most effective and least costly method of diagnosis. Misdiagnosis of AFBN as abscess or tumor, which it may stimulate, could lead to inappropriate surgical therapy.

Fine Needle Aspiration of the Kidney and Adrenal Gland

AbstractExperience with percutaneous fine needle aspiration of 21 lesions of the kidney and adrenal gland is discussed. The correct diagnosis of tumor, infection or hematoma was made in 20 of 21 patients, for an accuracy of 95 per cent. No complications were encountered in this series.

Tuberculous Mediastinal Lymphadenitis in the Adult

The authors present the roentogenological findings and response to treatment of 10 patients with tuberculous mediastinal lymphadenitis (TML). The clinical presentation is usually nonspecific except for the positive tuberculin skin test. The roentgenographic appearance varies but very often includes right tracheobronchial involvement. Tissue diagnosis is often necessary to establish the diagnosis. Since the epidemiology of tuberculosis is shifting, TML will be encountered more frequently in the adult.

ACR CT Accreditation Program and the Lung Cancer Screening Program Designation

The ACR recognizes that low-dose CT for lung cancer screening has the potential to significantly reduce mortality from lung cancer in the appropriate high-risk population. The ACR supports the recommendations of the US Preventive Services Task Force and the National Comprehensive Cancer Network for screening patients. To be effective, lung cancer screening should be performed at sites providing high-quality low-dose CT examinations overseen and interpreted by qualified physicians using a structured reporting and management system. The ACR has developed a set of tools necessary for radiologists to take the lead on the front lines of lung cancer screening. The ACR Lung Cancer Screening Center designation is built upon the ACR CT accreditation program and requires use of Lung-RADS or a similar structured reporting and management system. This designation provides patients and referring providers with the assurance that they will receive high-quality screening with appropriate follow-up care.

ACR appropriateness criteria® hemoptysis.

Hemoptysis is defined as the expectoration of blood originating from the tracheobronchial tree or pulmonary parenchyma, ranging from 100 mL to 1 L in volume over a 24-hour period. This article reviews the literature on the indications and usefulness of radiologic studies for the evaluation of hemoptysis. The following recommendations are the result of evidence-based consensus by the American College of Radiology Appropriateness Criteria Expert Panel on Thoracic Radiology: (1) Initial evaluation of patients with hemoptysis should include a chest radiograph; (2) Patients at high risk for malignancy (>40 y old, >40 pack-year smoking history) with negative chest radiograph, computed tomography (CT) scan, and bronchoscopy can be followed with observation for the following 3 years. Radiography and CT are recommended imaging modalities for follow-up. Bronchoscopy may complement imaging during the period of observation; (3) In patients who are at high risk for malignancy and have suspicious chest radiograph findings, CT is suggested for initial evaluation; CT should also be considered in patients who are active or exsmokers, despite a negative chest radiograph; and (4) Massive hemoptysis can be effectively treated with either surgery or percutaneous embolization. Contrast-enhanced multidetector CT before embolization or surgery can define the source of hemoptysis as bronchial systemic, nonbronchial systemic, and/or pulmonary arterial. Percutaneous embolization may be used initially to halt the hemorrhage before definitive surgery.

ACR Appropriateness Criteria® screening for pulmonary metastases.

Screening for pulmonary metastatic disease is an important step for staging a patient with a known or recently discovered malignancy. Here we present our recommendations for screening for metastatic disease based on recommendations from the literature and experiences of pulmonary radiologists. In short, chest computed tomographic (CT) screening is the most appropriate tool for evaluation of pulmonary metastasis in the majority of cases. Chest computed tomographic screening is also recommended for follow-up and to determine response to therapy. Other modalities such as chest radiography, magnetic resonance imaging, and scintigraphy will also be discussed. Please note that this study is a summary of the complete version of this topic, which is available on the ACR website at www.acr.org. Practitioners are encouraged to refer to the complete version.

Medical Students’ Preferences in Radiology Education: A Comparison Between the Socratic and Didactic Methods Utilizing PowerPoint Features in Radiology Education

RATIONALE AND OBJECTIVES The Socratic method has long been a traditional teaching method in medicine and law. It is currently accepted as the standard of teaching in clinical wards, while the didactic teaching method is widely used during the first 2 years of medical school. There are arguments in support of both styles of teaching. MATERIALS AND METHODS After attending a radiology conference demonstrating different teaching methods, third-year and fourth-year medical students were invited to participate in an online anonymous survey. RESULTS Of the 74 students who responded, 72% preferred to learn radiology in an active context. They preferred being given adequate time to find abnormalities on images, with feedback afterward from instructors, and they thought the best approach was a volunteer-based system of answering questions using the Socratic method in the small group. They desired to be asked questions in a way that was constructive and not belittling, to realize their knowledge deficits and to have daily pressure to come prepared. The respondents thought that pimping was an effective teaching tool, supporting previous studies. CONCLUSIONS When teaching radiology, instructors should use the Socratic method to a greater extent. Combining Socratic teaching with gentle questioning by an instructor through the use of PowerPoint is a preferred method among medical students. This information is useful to improve medical education in the future, especially in radiology education.

The air-fluid level in cavitary pulmonary tuberculosis.

Pulmonary tuberculosis has long been associated with the formation of cavities in the lung. Many reports in the literature indicate that the occurrence of air-fluid levels in tuberculosis is unusual. The authors present 18 cases of proved active cavitary tuberculosis where air-fluid levels occurred during the active phase of the disease. The consideration of tuberculosis in the differential diagnosis of an air-fluid containing pulmonary cavity is emphasized and the pathogenesis of cavity formation is discussed.

ACR appropriateness criteria routine chest radiographs in intensive care unit patients.

Daily routine chest radiographs in the intensive care unit (ICU) have been a tradition for many years. Anecdotal reports of misplacement of life support items, acute lung processes, and extra pulmonary air collections in a small number of patients served as a justification for routine chest radiographs in the ICU. Having analyzed this practice, the ACR Appropriateness Criteria Expert Panel on Thoracic Imaging has made the following recommendations: • When monitoring a stable patient or a patient on mechanical ventilation in the ICU, a portable chest radiograph is appropriate for clinical indications only. • It is appropriate to obtain a chest radiograph after placement of an endotracheal tube, central venous line, Swan-Ganz catheter, nasogastric tube, feeding tube, or chest tube. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every 2 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances where evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment. The strongest data contributing to these recommendations were derived from a meta-analysis of 8 trials comprising 7,078 ICU patients by Oba and Zaza [1].