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  • Journal Highlights

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

    March 1, 2018

    Quantitative Elastography Methods in Liver Disease: Current Evidence and Future Directions

    Because treatment strategies and prognosis differ greatly depending on the severity of liver fibrosis, determining fibrosis staging is important. Liver biopsy is the method of choice for fibrosis evaluation, but alternative, noninvasive methods of evaluating liver health are being developed, such as ultrasonographically (US) and MR-based elastography.

    In an article published online in Radiology(RSNA.org/Radiology), Paul Kennedy, PhD, Icahn School of Medicine at Mount Sinai, New York City, and colleagues review the techniques, results and limitations of US- and MRI-based elastography techniques.

    Quantitative US elastography methods include transient elastography (TE) – the most validated elastographic technique – and acoustic radiation force impulse (ARFI) techniques. MR elastography offers equivalent to slightly better diagnostic accuracy than TE and ARFI, although it is less well validated and less available than US elastography methods.

    Increasing fibrosis stage is associated with increased liver stiffness, providing a discriminatory feature that can be exploited by elastographic methods. However, for all elastographic methods, liver stiffness measurement can be affected by a variety of factors such as hepatic inflammation, congestion and cholestasis while TE can be affected by steatosis.

    Ultrasound and MR elastography techniques have developed into accurate methods for quantitative, noninvasive diagnosis of liver fibrosis in a wide range of etiologies, the authors concluded.

    “Interpretation of results should take into account potential confounding factors of liver stiffness measurements, pitfalls and technical limitations.

    "The emergence of advanced techniques such as three-dimensional MR elastography and US-based controlled attenuation parameter measurement may increase the accuracy of fibrosis and steatosis staging in liver disease, although more data are needed," the authors write.

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

    High-Intensity Focused Ultrasound for Pain Management in Patients with Cancer

    Cancer-related pain affects up to 80 percent of patients with malignancies. High-intensity focused ultrasound (HIFU) is a noninvasive technique that can be used to achieve pain palliation by producing several effects, including tissue denervation, tumor mass reduction and neuromodulation, each of which can influence different pathways at the origin of the pain.

    In the March-April issue of RadioGraphics (RSNA.org/RadioGraphics), Susan Dababou, MD, Sapienza University of Rome, Italy, and colleagues discuss the emerging technique involving the use of high-energy ultrasound waves to precisely ablate a well-circumscribed target volume with MRI or ultrasonographic (US) guidance, without damaging the surrounding healthy structures.

    The main benefit of HIFU for cancer patients is the capability to address different features of a malignancy by decreasing painful stimuli, locally controlling the tumor, potentially enhancing local drug delivery and stimulating the host antineoplastic immune response.

    Currently, MRI-guided HIFU is recommended as a second-line treatment after unsuccessful radiation therapy for palliation of pain related to nonspinal and nonskull bone metastases. Current evidence suggests that the use of HIFU can facilitate reduced pain in patients with pancreatic adenocarcinoma, with up to 81 percent of affected patients reportedly experiencing pain relief.

    “The improvement in pain control can be immediate, and the procedure can be safely combined with chemotherapy and radiation therapy to synergistically enhance their effects. Moreover, this procedure is noninvasive, and the absence of ionizing radiation ensures that there is no radiation-related risk if retreatment is deemed necessary after the recurrence of symptoms or worsening of the primary condition,” the authors write.

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

    Radiology Podcasts


    Listen to Radiology Editor David A. Bluemke, MD, PhD, discuss this month’s research you need to know. Podcasts summarize the importance and context of selected recent articles. Subscribe today at RSNA.org/Radiology-Podcasts and never miss a single episode.

    • “MR Spectroscopy–derived Proton Density Fat Fraction Is Superior to Controlled Attenuation Parameter for Detecting and Grading Hepatic Steatosis” Jurgen Henk Runge, MD, PhD, and colleagues.
    • “Evaluation of Kidney Stones with Reduced–Radiation Dose CT: Progress from 2011−2012 to 2015−2016—Not There Yet” Karrin Weisenthal, BA, and colleagues.
    • “Temporary Hearing Threshold Shift in Healthy Volunteers with Hearing Protection Caused by Acoustic Noise Exposure during 3-T Multisequence MR Neuroimaging” Chao Jin, PhD, and colleagues.

    RadioGraphics Podcasts

    Radiology Podcasts

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

    • “MR Imaging of Muscle Trauma: Anatomy, Biomechanics, Pathophysiology, and Imaging Appearance,” Dyan V. Flores, MD, and colleagues.
    • “Prostate-specific Membrane Antigen PET: Clinical Utility in Prostate Cancer, Normal Patterns, Pearls, and Pitfalls,” Michael S. Hofman, MBBS, and colleagues.
    • “Acute Radiologic Manifestations of America’s Opioid Epidemic,” David D.B. Bates, MD, and colleagues.

    Image 1
    Images in a 59-year-old man with chronic hepatitis C virus infection and infiltrative HCC in right hepatic lobe (arrows). MR elastography demonstrates increased stiffness (7.7 kPa) compared with background liver parenchyma (3.2 kPa). Another HCC nodule is present in left lateral hepatic lobe (arrowheads), also demonstrating increased stiffness. HCC = hepatocellular carcinoma. Radiology 2018;286(3):737-763) © RSNA 2018. All rights reserved. Printed with permission.

    Image 2
    Treatment of bone metastasis in the right scapula, secondary to melanoma, in a 74-year-old man. (a, b) Axial dynamic contrast-enhanced color-coded T1-weighted MR images acquired before (a) and after (b) HIFU treatment show intense vascularization of the malignant area (arrows in a) before treatment and markedly decreased vascularization (* in b) after the procedure. Color gradients indicate blood perfusion, from less perfused (blue) to highly perfused (red). (RadioGraphics 2018:38;2;InPress) © RSNA 2018. All rights reserved. Printed with permission.