Supriya Gupta

Role of Imaging in the Era of Precision Medicine

Precision medicine is an emerging approach for treating medical disorders, which takes into account individual variability in genetic and environmental factors. Preventive or therapeutic interventions can then be directed to those who will benefit most from targeted interventions, thereby maximizing benefits and minimizing costs and complications. Precision medicine is gaining increasing recognition by clinicians, healthcare systems, pharmaceutical companies, patients, and the government. Imaging plays a critical role in precision medicine including screening, early diagnosis, guiding treatment, evaluating response to therapy, and assessing likelihood of disease recurrence. The Association of University Radiologists Radiology Research Alliance Precision Imaging Task Force convened to explore the current and future role of imaging in the era of precision medicine and summarized its finding in this article. We review the increasingly important role of imaging in various oncological and non-oncological disorders. We also highlight the challenges for radiology in the era of precision medicine.

Translating New Imaging Technologies to Clinical Practice

Radiology continues to benefit from constant innovation and technological advances. However, for promising new imaging technologies to reach widespread clinical practice, several milestones must be met. These include regulatory approval, early clinical evaluation, payer reimbursement, and broader marketplace adoption. Successful implementation of new imaging tests into clinical practice requires active stakeholder engagement and a focus on demonstrating clinical value during each phase of translation.

A case of coarctation of the abdominal aorta and renal artery stenosis due to neurofibromatosis type 1

We report a case of an adolescent female with history of neurofibromatosis type 1 (NF1) found to have incidental hypertension. She was hypertensive in all four extremities with medical treatment. CT angiogram confirmed narrowing of the abdominal aorta above the bifurcation and atrophic left kidney (figures 1⇓–3). Treatment with a graft to bypass the stenotic segment was performed (figure 4).nnnnFigurexa01 nAxial CT with contrast showing superior …

Analysis of Low Appropriateness Score Exam Trends in Decision Support–based Radiology Order Entry System

PURPOSEnAwareness of imaging utilization increased after implementation of Radiology Order Entry with decision support systems (ROE-DS). Our hypothesis is few exams with low Clinical Appropriateness Score (CAS) on ROE-DS are performed. Clinical indications of exams with CAS less than 3 (9-point scale) were re-reviewed and reports analyzed.nnnMATERIALS AND METHODSnStructured Query Language-based query retrieved exams with CAS less than 3 in ROE-DS from January 2007 to December 2011. Reasons provided by physicians for ordering these exams and reports of exams performed were analyzed. For each indication, number of exams ordered and performed was calculated. Statistical significance was assessed using Students t test and χ2 analysis (P < .05).nnnRESULTSnFrom 445,984 exams, 12,615 exams (2.8%) had CAS less than 3, and 7,956 exams (63%) were performed. Reasons for ordering of 12,615 low CAS exams were as follows: Requests by physician specialists without further explanation (4,516xa0= 35.8%), notation of special clinical circumstances (2,877xa0= 22.8%), requests by nonphysician staff without further explanation (1,383xa0= 10.9%), absence of suspected finding on previous modality (1,099xa0= 8.7%), patient preference (737xa0= 5.8%), and requests based on radiologists recommendations (706xa0= 5.6%). Difference between male and female (male < female) preferences for low CAS exams was statistically significant (P < .01). Imaging outcome was highest for extremity MRI cases (66.7%; P < .01).nnnCONCLUSIONnLess than 3% of exams ordered had low CAS and about two-thirds of these were performed. Most common indication for ordering these exams was physician specialist request based on opinion of medical necessity without specification. Extremity MRI constituted the highest positive findings for low CAS exams performed.

Ectopic thyroid: The great mimicker

Ectopic thyroid tissue is very rare, but its prevalence increases in those with thyroid pathology. It typically occurs due to aberrant development of the thyroid gland during its migration to the pretracheal region. In this report, there are two cases of mediastinal ectopic thyroid tissue discussed, which were initially considered to be malignancies. The hospital course, diagnostic workup, including the use of computed tomography and positron emission tomography scans, and the characteristic features of the tissue are examined here. Due to the imaging characteristics, it is important to consider ectopic thyroid tissue as a differential diagnosis for mediastinal masses as encountered in these cases. Asymptomatic ectopic thyroid tissue is usually treated medically; however, patients in both of our cases opted for surgical resection of the masses even after confirmation of the origin of the tissues.

A diagnostic challenge: An incidental lung nodule in a 48-year-old nonsmoker

A 43-year-old female with a medical history of renal stones, hypertension, diabetes mellitus Type 2, and depression presented to her urologist with bilateral flank pain. She complained of worsening exertional dyspnea over the last several months with recent weight gain. She also endorsed night sweats and intermittent, scant hemoptysis over the past year. She denied fever, chills, nausea, vomiting, diarrhea, constipation, hematuria, or excessive joint or muscle pain. Physical examination was unremarkable. Computed tomography scan of abdomen and pelvis demonstrated bilateral nonobstructing renal stones and a 1.8 cm × 1.7 cm nodular opacity in the right lower lobe of the lung, not present on previous scan 1 year prior. Surgical wedge resection was performed and subsequent pathologic examination demonstrated a 1.2 cm × 0.6 cm × 0.5 cm soft, gelatinous well-demarcated mass in the right lower lobe wedge specimen without gross evidence of necrosis or hemorrhage confirming colloid adenocarcinoma of the lung.

Case-based approach to demonstrate utility of cardiac magnetic resonance imaging (MRI) for planning biventricular repair with inconclusive echo: Illustration of two cases

Congenital heart defects that present earlier in life and involving a hypoplastic ventricle are sometimes channeled towards single-ventricle repair because of anatomical or logistic challenges (1). With the single-ventricular repair, the final result is the shunting of venous return directly into the pulmonary artery and the utilization of the functioning ventricle for systemic circulation (2). Though singleventricular repair has remarkable short-term results, long-term survivors experience declines in exercise tolerance, heart failure, arrhythmias, and thromboembolic complications (3). Given long-term functional and survival advantages of a two-ventricle circulation, exploring feasibility of biventricular repair is essential for improving prognosis. However, a successful biventricular repair requires sufficiently functioning ventricles to sustain a balanced flow through the pulmonary and systemic circuit. To evaluate the functional adequacy of the ventricle with hypoplasia, echocardiogram is conventionally used.