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  • Journal Highlights

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

    August 31, 2018


    Importance of Long-term Low-Dose CT Follow-up after Negative Findings at Previous Lung Cancer Screening

    While lung cancer screening has been extensively studied over the last two decades, the long-term duration and time interval of low-dose CT in lung cancer screening remains unclear.

    In an article published online inRadiology (RSNA.org/Radiology), John Kavanagh, FFR, RCSI, University Health Network, Toronto Canada, and colleagues studied the incidence of lung cancer in a cohort of patients with negative findings at previous lung cancer screening.

    Of those who were part of the International Early Lung Cancer Action Program screening study between 2003 and 2009, 4,782 were identified with negative screening results, which was defined as no solid nodules greater than 5 mm and no nonsolid nodules greater than 8 mm at the close of the study.

    Starting with those at highest risk, identified by factors including age, smoking history, body mass index, family history of lung cancer, years since smoking cessation and diagnosis of chronic obstructive pulmonary disease, 327 participants were contacted and 200 underwent low-dose CT.

    The median time since previous CT was seven years. The incidence rate of developing lung cancer during the next six years was estimated at 5.6 percent. The period prevalence of lung cancer was 20.8 percent (new and preexisting lung cancer, 68 of 327). The detection rate of low-dose CT was 7 percent (14 of 200 subjects). Of the 14 screening-detected cancers, 12 were stage I or II.

    “Our study shows that high-risk individuals have a high incidence of lung cancer after previous negative low-dose CT examinations and, therefore, that screening should continue beyond three years. The definition of the optimum screening interval may be different for various groups of individuals and will be the subject of future studies,” the authors conclude.

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

    Opening in October – Radiology: Cardiothoracic Imaging Submissions

    Radiology: Cardiothoracic Imaging, one of the three new online-only journals from RSNA, is accepting original research and editorial submissions beginning Oct. 1. The journal will debut in spring 2019.

    Suhny Abbara, MD, is editor of the bi-monthly journal that will emphasize research advances and technical developments in medical imaging that drive cardiothoracic medicine.

    Submissions are currently open for Radiology: Artificial Intelligence, which will publish in early 2019.

    For more information on the new journals, go to RSNA.org/Journals.


    Successful Integration of Contrast-enhanced US into Routine Abdominal Imaging

    Contrast–enhanced ultrasound (US) is recognized increasingly as a useful tool in a wide variety of hepatic and nonhepatic applications and was recently approved for limited use for liver indications in adult and pediatric patients in the U.S.

    In an article in the September-October issue ofRadioGraphics (RSNA.org/RadioGraphics), Xiaoyang Liu, MD, PhD, University Health Network, Toronto, Ontario, Canada, and colleagues discuss common abdominal applications of contrast-enhanced US and how to implement it into a clinical practice.

    Contrast-enhanced US is useful to characterize indeterminate lesions detected at baseline US and those found with other imaging modalities such as CT or MRI. Contrast-enhanced US can also be used when intravenous contrast material is necessary but iodine and/or gadolinium-based contrast agents are contraindicated, mostly in patients with renal failure.

    The most common renal indication for contrast-enhanced US is for differentiation of neoplastic from non-neoplastic complex cysts. Owing to its high sensitivity for detection of vascularity, contrast-enhanced US is a simple and useful tool to confirm the vascularity of a neoplastic cyst or exclude malignancy in the absence of vascularity in a complex-appearing cyst with high confidence.

    The real-time nature of contrast-enhanced US and its high contrast resolution allow the modality to show arterial enhancement more consistently than does CT or MRI. The purely intravascular nature of contrast-enhanced US also allows for better determination of washout.

    “Contrast-enhanced US offers advantages that provide added value to imaging practice in various organ systems and has an essential role in multimodality imaging. These advantages include extremely high sensitivity to the microbubble contrast agent, real-time imaging, the purely intravascular property of contrast agents, lack of nephrotoxicity, easy repeatability, portability and relatively low cost,” 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.

     Highlights include: 

    “US Time-Harmonic Elastography: Detection of Liver Fibrosis in Adolescents with Extreme Obesity with Nonalcoholic Fatty Liver Disease,” Hudert CA, et al.

    “General Practitioners Referring Adults to MR Imaging for Knee Pain: A Randomized Controlled Trial to Assess Cost-effectiveness,” Oudenaarde K, et al.

    “Radiation Dose Reduction by Using CT with Iterative Model Reconstruction in Patients with Pulmonary Invasive Fungal Infection,” Yan C, et al.


    Radiology Podcasts 


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

    “CT for Evaluation of Acute Gastrointestinal Bleeding,” Wells, M.L., et al.

    “Incomplete Cord Syndromes: Clinical and Imaging Review,” Kunam, V.K., et al.

    Audio summary podcasts (also available on iTunes and Google Play) include these studies: “CT and MR Imaging of Cardiothoracic Vasculitis,” Broncano, J. et al; “Imaging of Acute Conditions of the Perineum,” Choe J., et al; and “Sarcoidosis from Head to Toe,” Ganeshan, D., et al.

    Axial low-dose noncontrast CT images in 77-year-old man (risk score, 18.9%). A CT scan obtained in 2007 (left) demonstrates punctate nodule in the right upper lobe. A follow-up CT scan obtained in 2016 (right) shows that the nodule has developed into a spiculated nodule. Kavanagh, et al., Radiology 2018;InPress © RSNA 2018.

    three shot
    Small solid malignant nodule in a 31-year-old man after a kidney transplant. (a) Surveillance US image of the transplanted kidney shows a hyperechoic nodule (arrows). (b) Contrast-enhanced US image obtained immediately after the baseline US image shows arterial phase hypovascularity of the nodule (arrows) compared with the adjacent renal cortex at 9 seconds. (c) At 60 seconds, relatively early washout (arrows) is seen. The contrast-enhanced US findings were highly suggestive of malignancy. Biopsy results showed papillary renal cell carcinoma, and the patient was treated successfully with radiofrequency ablation. Liu, et al., RadioGraphics 2018:38;5 © RSNA 2018.