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  • Journal Highlights

    The following are highlights from the current issues of RSNA’s two peer-reviewed journals.

    October 1, 2017

    Coronary CT Angiography–Derived Fractional Flow Reserve

    Invasive coronary angiography (ICA) with measurement of fractional flow reserve (FFR) by pressure wire technique is the established reference standard for the functional assessment of coronary artery disease (CAD). Coronary CT angiography (cCTA) has emerged as a noninvasive method for direct assessment of CAD and plaque characterization with high diagnostic accuracy compared with ICA. FFR derived from standard cCTA data sets (CT-FFR) using any of several advanced computational analytic approaches enables combined anatomic and hemodynamic assessment of a coronary lesion by a single noninvasive test.

    In an article published in Radiology(RSNA.org/Radiology), Christian Tesche, MD, of the Heart Center Munich-Bogenhausen, Germany, and colleagues review the growing body of evidence that has validated the diagnostic accuracy of CT-FFR techniques compared with invasive FFR.

    Present CT-FFR algorithms focus solely on the noninvasive derivation of flow conditions through a diseased coronary artery. While FFR quantitation is a key determinant in clinical decision making, conceptually this narrow focus makes insufficient use of the richness of cCTA data in terms of plaque characteristics and vessel remodeling. These features in themselves are predictors of flow obstruction and, more importantly, portend strong predictive value for patient outcome.

    “Current evidence shows that FFRCT may be an important adjunct to coronary CT angiography for clinical decision making and appropriate, guideline driven patient management while reducing the rate of unnecessary invasive testing," the authors write.

    This article meets the criteria for AMA PRA Category 1 Credit™. SA-CME is available online only.

    Molecular and Clinical Approach to Intra-abdominal Adverse Effects of Targeted Cancer Therapies

    Targeted cancer therapies encompass an exponentially growing number of agents that involve myriad molecular pathways. To excel within this rapidly changing field of clinical oncology, radiologists must eschew traditional organ system-based approaches of cataloging adverse effects in favor of a conceptual framework that incorporates molecular mechanisms and associated clinical outcomes.

    In the September-October issue of RadioGraphics, (RSNA.org/RadioGraphics), Stephanie T. Chang, MD, of Stanford University, CA, and colleagues review the adverse effects primarily within the abdomen and pelvis. The authors advocate that adverse effects from targeted therapies are approached most effectively when they are grouped into four categories based on the molecular mechanism and association with treatment response: Category 1, on-target adverse effects associated with treatment response; Category 2, on-target adverse effects without associated treatment response; Category 3, off-target adverse effects; and Category 4, tumor necrosis–related adverse effects.

    Understanding molecular mechanisms that underlie imaging manifestations of adverse effects and known associations with treatment response allows radiologists to more effectively recognize adverse effects and differentiate them from tumor progression. Radiologists can therefore more effectively guide oncologists in the management of adverse effects and treatment decisions regarding continuation or cessation of drug therapy.

    “Radiologists must adopt a conceptual framework that incorporates molecular mechanisms and clinical prognosis to accurately recognize and interpret drug toxic effects, differentiate adverse effects from disease progression, and predict emerging drug toxic effects,” the authors write. “As clinical oncology enters a golden age of targeted therapies, radiologists must also move toward a molecular-based perspective of drug-related adverse effects to offer optimal patient care.”

    This article meets the criteria for AMA PRA Category 1 Credit™. SA-CME is available online only.

    Radiology Podcasts

    Radiology Podcasts
    Radiology Podcasts

    Listen to Radiology Editor Herbert Y. Kressel, MD, deputy editors and authors discuss the following articles in the
    August issue of Radiology at RSNA.org/Radiology-Podcasts.

    • “Is Weight Loss Associated with Less Progression of Changes in Knee Articular Cartilage among Obese and Overweight Patients as Assessed with MR Imaging over 48 Months? Data from the Osteoarthritis Initiative,” Alexandra S. Gersing, MD, and colleagues.
    • “Deep Learning at Chest Radiography: Automated Classification of Pulmonary Tuberculosis by Using Convolutional Neural Networks,” Paras Lakhani, MD, and Baskaran Sundaram, MD.

    RadioGraphics Podcasts

    Radiology Podcasts

    Listen to RadioGraphics Editor Jeffrey S. Klein, MD, and authors discuss the following articles in recent issues of RadioGraphics at pubs.RSNA.org/RG-Podcasts.

    • “Decreasing Stroke Code to CT Time in Patients Presenting with Stroke Symptoms,” Aleksandrs Kalnins, MD, MBA, and colleagues
    • “Beyond the Bowel: Extraintestinal Manifestations of Inflammatory Bowel Disease,” Jeffrey D. Olpin, MD, and colleagues.
    • “Imaging of Pregnancy-related Vascular Complications,” R. Scooter Plowman, MD, MBA, MHSA, and colleagues.

    Three-dimensional color-coded cinematic rendering (not yet available for clinical use) of cardiac anatomy with FFRCT map superimposed on the coronary artery course illustrates functional data in the context of the heart’s morphology. Stent placement was subsequently performed. (Radiology 2017;285;1:17–33) © RSNA 2017. All rights reserved. Printed with permission.

    Metastatic ovarian cystadenocarcinoma in a 44-year-old woman who had undergone debulking surgery, intraperitoneal chemotherapy, and adjuvant chemotherapy with bevacizumab and who presented with abdominal distention. Frontal abdominal radiograph (a) and follow-up coronal CT image of the abdomen (b) show diffuse pneumatosis of the ascending colon (arrow).