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    September 01, 2013

    Press releases were sent to the medical news media for the following articles appearing in recent issues of Radiology.

    Exercise and Type 2 Diabetes Mellitus: Changes in Tissue-Specific Fat Distribution and Cardiac Function

    Six months of exercise training decreased visceral abdominal fat and hepatic triglyceride (TG) content in 12 patients with type 2 diabetes mellitus as measured by MR imaging and proton MR spectroscopy, new research shows.

    Jacqueline T. Jonker, M.D., of Leiden University Medical Center, the Netherlands, and colleagues followed 12 patients with type 2 diabetes mellitus (seven men; mean age, 46 years ± 2 [standard error]) before and after 6 months of moderate-intensity exercise, followed by a high-altitude trekking expedition with exercise of long duration. Abdominal, epicardial and paracardial fat volume were measured with MR imaging. Cardiac function was quantified with cardiac MR and images were analyzed by a researcher who was supervised by a senior researcher.

    Exercise reduced visceral abdominal fat volume from 348 mL ± 57 to 219 mL ± 33 (P < .01), and subcutaneous abdominal fat volume remained unchanged (P = .9). Exercise decreased hepatic TG content from 6.8 percent ± 2.3 to 4.6 percent ± 1.6 (P < .01) and paracardial fat volume from 4.6 mL ± 0.9 to 3.7 mL ± 0.8 (P = .02). Exercise did not change epicardial fat volume (P = .9), myocardial TG content (P = .9), intramyocellular lipid content (P = .3) or cardiac function (P = .5).

    “Dietary interventions or substantial weight loss did not seem to be a requisite for beneficial reductions in visceral abdominal, paracardial, and hepatic fat volume in patients with type 2 diabetes mellitus,” the authors write.

    Use of Imaging in the Emergency Department: Physicians Have Limited Effect on Variation

    After careful and comprehensive case-mix adjustment by using hierarchical logistic regression, only about 1 percent of the variability in emergency department (ED) imaging utilization was attributable to physicians in a recent study.

    In this retrospective study of 88,851 consecutive ED visits during 2011 at Massachusetts General Hospital (MGH), Boston, Hannah J. Wong, Ph.D., York University, Ontario, Canada, and colleagues from MGH used a hierarchical logistic regression model to identify multiple predictors for the probability that low- or high-cost imaging would be ordered during a given visit. Physician-specific random effects were estimated to articulate (by odds ratio) and quantify (by intraclass correlation coefficient [ICC]) interphysician variation.

    Patient- and visit-level factors found to be statistically significant predictors of imaging use included measures of ED busyness, prior ED visit, referral source to the ED and ED arrival mode. Physician-level factors (for example, gender, years since graduation, annual workload and residency training) did not correlate with imaging use. The remaining amount of interphysician variation was very low (ICC, 0.97 percent for low-cost imaging; ICC, 1.07 percent for high-cost imaging).

    “The minimal variation in use of per-visit imaging between physicians (ICC, ~1 percent) after careful case-mix adjustment and hierarchical modeling suggested that measuring and reporting physician-specific rates of ED imaging has substantial risk of misclassification and very little potential for reduction in overall utilization,” the authors write.

    Ectopic and Serum Lipid Levels are Positively Associated
    (Click to enlarge) Nonadjusted regression analysis between bone marrow fat and ectopic and serum lipid levels. There are positive correlations between bone marrow fat and total muscle lipid levels.
    (Radiology 2013;InPress) ©RSNA, 2013. All rights reserved. Printed with permission. 

    Ectopic and Serum Lipid Levels are Positively Associated with Bone Marrow Fat in Obesity

    Mean intrahepatic lipids (IHL) and intramyocellular lipids (IMCL), as well as mean serum triglyceride levels, are on average significantly positively associated with bone marrow fat in obese men and women, new research shows.

    Miriam A. Bredella, M.D., of Massachusetts General Hospital and Harvard Medical School, Boston, and colleagues studied 106 healthy young men and women (mean age, 33.7 years ± 6.8 [standard deviation]; range, 19–45 years; mean body mass index (BMI), 33.1 kg/m2 ± 7.1; range, 18.1–48.8 kg/m2) who underwent hydrogen 1(1H) MR spectroscopy.

    Results showed a positive correlation between bone marrow fat and IHL (r = 0.21, P = .048), IMCL (r = 0.27, P = .02), and serum triglyceride level (r = 0.33, P = .001), independent of BMI, age, IR and exercise status (P < .05).

    Significant positive correlation between mean IHL and IMCL with bone marrow fat is independent of insulin resistance and exercise status. “Increased ectopic and serum lipid levels may be detrimental to bone, and 1H MR spectroscopy can be used to identify patients at risk for bone loss,” the authors write.

    Emerging H7N9 Influenza A Pneumonia
    (Click to enlarge) Anteroposterior chest radiographs obtained with portable bedside unit in 56-year-old man with H7N9 influenza on day 7.
    (Radiology 2013;268;3:882–889) ©RSNA, 2013. All rights reserved. Printed with permission. 

    Emerging H7N9 Influenza A (Novel Reassortant Avian-Origin) Pneumonia: Radiologic Findings

    Rapidly progressive ground-glass opacities (GGOs) and consolidations with air bronchograms and interlobular septal thickening with right lower lobe predominance are the main imaging findings in H7N9 pneumonia, new research shows. The severity of these findings is associated with the severity of the clinical presentation.

    Twelve patients (nine men and three women) with novel avian-origin influenza A H7N9 virus infection were enrolled in the study conducted by Qingle Wang, M.D, of Shanghai Medical College of Fudan University, China, and colleagues. All patients underwent chest radiography and thin-section CT. Lesion patterns, distributions and changes at follow-up CT were investigated.

    At presentation, all patients had progressing infection of the lower respiratory tract, with fever, cough and shortness of breath, which rapidly progressed to acute respiratory distress syndrome.

    The most common patterns at thin-section CT were diffuse GGO (in all patients), consolidations (in 11 patients), air bronchograms (in 11 patients), and interlobular septal thickening (in 11 patients) involving three or more lobes, with right lower lobe pre-dominance.

    “The distribution and very rapid progression of H7N9 pneumonia were other characteristics seen in our patients,” the authors write. “The severity of imaging findings was associated with the severity of the underlying clinical condition.”

    Asymptomatic Unruptured Cerebral Aneurysms Evaluated at CT Angiography
    (Click to enlarge) Frontal projection 3D volume-rendered images with anteroposterior projection in a 48-year-old woman with small saccular basilar tip aneurysm that arose from small contour deformity located at basilar tip. Image shows minor contour deformity at basilar tip.
    (Radiology 2013;269;2:InPress) ©RSNA, 2013. All rights reserved. Printed with permission. 

    Natural History of Asymptomatic Unruptured Cerebral Aneurysms Evaluated at CT Angiography: Growth and Rupture Incidence and Correlation with Epidemiologic Risk Factors

    Imaging follow-up of all patients with aneurysms—including those whose aneurysms are smaller than the current 7 mm treatment threshold—is necessary, new research shows. Aneurysm growth and size and smoking were associated with increased rupture risk.

    In the study of 165 patients with known asymptomatic unruptured intracerebral aneurysms (258 total aneurysms), J. Pablo Villablanca, M.D., of the University of California Medical Center, Los Angeles, and colleagues followed subjects longitudinally with CT angiographic (CTA) examinations.

    Over the study period (mean of 2.24 years), researchers observed growth in 46 or nearly 18 percent of all the intracranial aneurysms in a total of 38 patients. There was a 12-fold higher risk of rupture for growing aneurysms (P < .002), with high intra- and interobserver correlation coefficients for size, volume and growth. Tobacco smoking (3.806, one degree of freedom; P < .015) and initial size (5.895, two degrees of freedom; P < .051) were independent covariates, predicting 78.4 percent of growing aneurysms.

    “The positive association of cigarette smoking and the size and growth of aneurysms suggests that the combination of these factors is associated with an increased risk of rupture, which may influence consideration for therapeutic intervention,” the researchers write.

    RadiologyInfo.org Posts New “Your Radiologist Explains” Videos

    Visit RadiologyInfo.org, RSNA and ACR’s jointly-sponsored public information website, to view recently posted “Your Radiologist Explains” video presentations, including:

    September Public Information Activities Focus on Ovarian and Prostate Cancers

    In recognition of Ovarian Cancer Awareness Month and Prostate Cancer Awareness Month in September, RSNA is distributing public service announcements (PSAs) focusing on the symptoms of ovarian and prostate cancers, as well as risk factors, screening methods and possible treatment options.

    The RSNA “60-Second Checkup” audio program will also be distributed to nearly 100 radio stations across the U. S. September segments will focus on risk factors of prostate cancer.

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