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Leading the News
Smartphones Allow Quick Diagnosis of Acute Appendicitis
Radiologists can accurately diagnose acute appendicitis from a remote location with the use of a smartphone equipped with special software, according to a study presented at RSNA's annual meeting. "The goal is to improve the speed and accuracy of medical diagnoses, as well as to improve communications among different consulting physicians," said the study's lead author, Asim F. Choudhri of the Division of Neuroradiology at Johns Hopkins University in Baltimore. "When we can make these determinations earlier, the appropriate surgical teams and equipment can be assembled before the surgeon even has the chance to examine the patient." For the study, CT examinations of the abdomen and pelvis of 25 patients with pain in the right lower abdomen were reviewed over an encrypted wireless network by five radiologists using an iPhone G3 equipped with OsiriX Mobile medical image viewing software.
From "Smartphones Allow Quick Diagnosis of Acute Appendicitis"
Cellular-News (11/30/09)
Research
PET-CT Provides Early Predictions of Response to Chemotherapy for Head and Neck Cancer
Researchers have found that combination PET-CT conducted six to eight weeks after patients complete chemoradiotherapy for head and neck cancer may help differentiate between patients who will respond to the treatment and those who will need surgical follow-up. Researchers analyzed 31 patients with advanced stage-head and neck cancer treated with chemoradiotherapy between 2004 and 2006. All patients underwent combined PET-CT to detect evidence of persistent tumors six to eight weeks after the completion of treatment. In assessing the response to the treatment, PET-CT had a sensitivity of 83 percent, a specificity of 54 percent, a positive predictive value of 31 percent, and a negative predictive value of 92 percent.
From "Early Prediction of Response to Chemoradiotherapy for Head and Neck Cancer"
Archives of Otolaryngology Head and Neck Surgery (11/09) Vol. 135, No. 11, P. 1119; Malone, James P.; Gerberi, Michael A. T.; Vasireddy, Syam; et al.
Dynamic MRI Reveals Pelvic Prolapse
Researchers performed an MRI of the urethra on 84 women with lower urinary tract symptoms using multiplanar T2-weighted turbo spin-echo and unenhanced and contrast-enhanced gradient-echo sequences to determine the findings at both static and dynamic MRI in women with a clinically suspected urethral abnormality. A dynamic true fast imaging with steady-state free precession sequence was performed during straining in the sagittal plane. The images were examined by radiologists for urethral pathology and pelvic organ prolapse, and the MRI findings were correlated with clinical symptoms using the Fisher's exact and Mann-Whitney tests. Urethral abnormalities were found in only 10 of the patients, or 11.9 percent, including two urethral diverticula, five Skene's gland cysts or abscesses, and three periurethral cysts. Just over a third of patients, 39.3 percent, were diagnosed with pelvic organ prolapse. Most of the patients with prolapse, 87.9 percent, had normally structured urethras. The MRI screenings revealed 13 cystoceles and 17 cases of urethral hypermobility that were not detected through physical examinations. Patients who had more vaginal deliveries, stress urinary incontinence, frequency of voiding, and voiding difficulties were more likely to have anterior compartment prolapse. The researchers conclude that including a dynamic sequence allows both the structural and functional evaluation of the urethra, which may be beneficial to women with lower urinary tract symptoms, and dynamic MRI screening allows for the detection of organ prolapse that may not be apparent through conventional static sequences.
From "MRI of the Urethra in Women With Lower Urinary Tract Symptoms: Spectrum of Findings at Static and Dynamic Imaging"
American Journal of Roentgenology (12/01/2009) Vol. 193, No. 6, P. 1708; Bennett, Genevieve L.; Hecht, Elizabeth M.; Tanpitukpongse, Teerath Peter; et al.
Researchers Search for Optimal Threshold Selection for CT Angiography SSD of the Renal Arteries
Researchers have conducted a study to define objective criteria to calculate a tissue segmentation threshold for shaded surface display (SSD) rendering of the renal arteries with CT angiography. To do so, they obtained contrast-enhanced spiral CT scans through the renal arteries of nine patients. Six sets of SSD images were rendered for each patient, with lower threshold values ranging from 80 to 130 Hounsfield units (HU). The degree of stenosis was overestimated in one of the 18 renal arteries imaged because of an inappropriate threshold selected by evaluation of SSD images alone. Based on these findings, investigators concluded that a segmentation threshold is best selected by qualitative evaluation of resulting SSD images. Due to the subjective nature of such threshold selection, further research may be needed to determine whether threshold selection could result in inaccurate grading of stenosis.
From "Threshold Selection for CT Angiography Shaded Surface Display of the Renal Arteries"
Journal of Digital Imaging (11/09) Halpern, Ethan J.; Wechsler, Richard J.; DiCampli, Dennis
Transvenous Variceal Embolization During or After LDLT Improves PV Flow
Transvenous embolization of varices may be an effective method to improve portal vein (PV) inflow in patients receiving living-donor liver transplantation (LDLT), according to a recent study. For the purposes of the study, researchers followed 1,435 patients who had undergone LDLT, 105 of whom also underwent percutaneous intraoperative venography to evaluate the status of PV inflow and portosystemic collateral vessels. Of these 105 patients, 19 underwent percutaneous or intraoperative transvenous embolization of the portosystemic collateral vessels to improve PV inflow. Successful embolization with subsequently improved PV inflow was achieved in 100 percent of patients treated with the intraoperative approach and 67 percent of those treated with the percutaneous approach. Doppler ultrasonography showed adequate PV inflow in 17 of 19 patients and follow-up CT showed collateral flow to the varices disappeared in 13 patients and decreased in four patients.
From "Transvenous Variceal Embolization During or After Living-Donor Liver Transplantation to Improve Portal Venous Flow"
Journal of the Society for Interventional Radiology (11/09) Vol. 20, No. 11, P. 1454; Kim, Jin Hyoung; Ko, Gi-Young; Sung, Kyu-Bo; et al.
Technology
Bubbles Used to Find Cancer Cells
A group of British clinicians performed a study with the goal of identifying and localizing sentinel lymph nodes prior to surgery by first injecting microbubbles in breast cancer patients and then imaging the area with contrast-enhanced ultrasonography. The nodes can then be examined for signs of cancer metastasis via a fine needle biopsy. Should cancer be detected, patients only need a single operation to excise all the lymph glands at the same time as their primary operation. The clinicians tested the microbubble procedure on 54 patients and determined that the test was more sensitive than the traditional method of injecting a colored dye into the nodes in 89 percent of the cases used in the study. "The use of ultrasound with microbubbles to detect the sentinel lymph node is unique and something that will benefit breast cancer care around the world," said study leader and consultant radiologist Ali Sever with the U.K.'s Maidstone Hospital.
From "Preoperative Localization of Sentinel Lymph Nodes Using Intradermal Microbubbles and Contrast-Enhanced Ultrasonography in Patients With Breast Cancer"
British Journal of Surgery (11/01/09) Vol. 96, No. 11, P. 1295; Sever, A.; Jones, S.; Cox, K.; et al.
New Cancer Treatment Uses Radioactive Gold Nanoparticles
Researchers at the University of Missouri Department of Radiology have discovered a new technique that could be used to treat prostate cancer. After four years of research, university radiologists found that injecting radioactive gold nanoparticles directly into a tumor can reduce its size. The first stage of their study tested the safety and efficacy of the nanoparticles in dogs, mice, and pigs. In mice, researchers found an average 82 percent decrease in tumor size. The study's authors predicted that human testing for the particles will begin in 2011.
From "Radioactive Gold Nanoparticles in Cancer Therapy"
Nanomedicine (11/09) Chanda, Nripen; Kan, Para; Watkinson, Lisa D.; et al.
Clinical Practice
CAD Improves Radiologists' Performance for Detecting Small Pulmonary Nodules
CAD improves thoracic radiologists' performance for detecting pulmonary nodules smaller than 5 mm on CT examinations, a recent study shows. Researchers reviewed 52 CT examinations, all of which were read by multiple expert thoracic radiologists to identify and reference standard for detection. Six other thoracic radiologists read the CT examinations first without and then with CAD. A total of 241 nodules were identified. At diameter thresholds of 3, 4, 5, and 6 mm, the CAD system had a sensitivity of 54 percent, 64 percent, 68 percent, and 76 percent, respectively. Without CAD, the average figures of merit for the six radiologists were 0.661, 0.729, 0.793, and 0.838 for the same nodule diameter thresholds, respectively. With CAD, the corresponding average FOMs improved to 0.705, 0.763, 0.810, and 0.862, respectively.
From "Effect of CAD on Radiologists' Detection of Lung Nodules on Thoracic CT Scans"
Academic Radiology (12/09) Vol. 16, No. 12, P. 1518; Sahiner, Berkman; Chan, Heang-Ping; Hadjiiski, Lubomir M.; et al.
New Passive Navigation Method Can Be Applied to MRI-guided Musculoskeletal Interventions
For orthopedic interventions, magnetic resonance (MR) fluoroscopy is still in an early stage of development. A new innovative passive navigation method potentially could be applied to numerous MRI-guided musculoskeletal interventions. The new method eliminates the need to switch between different planes because the cross-sectional modality of the MRI is used as a new navigation approach. The method was evaluated primarily through retrograde drilling of artificial osteochondral lesions of the talus as an example of difficult navigation in drill placement due to poor visualization with X-ray and complex anatomy. A passive navigation device was constructed and evaluated in nine cadaveric ankle joint specimens. The interactive high-field MR fluoroscopy and the passive aiming device allow for precise drilling of osteochondral lesions of the talus, even with the ankle's complex anatomy. The system allows drilling to be performed with an accuracy of 1.6 mm, and the drilling guide was safe and easy to handle. The MR-assisted retrograde drilling of osteochondral lesions may allow for precise and safe treatment without radiation exposure. The passive navigation technique for MR fluoroscopy potentially could be applied to numerous orthopedic interventions and could provide an alternative to other navigation methods. Pediatric and adolescent patients may particularly benefit from the treatment.
From "Passive Navigation Principle for Orthopedic Interventions With MR Fluoroscopy"
Archives of Orthopaedic and Trauma Surgery (11/09) Bail, Hermann J.; Teichgraber, Ulf K. M.; Wichlas, Florian; et al.
Industry News
fMRI Evidence Used in Murder Sentencing
For possibly the first time, fMRI scans of brain activity were used as evidence in the sentencing phase of a murder trial. Defense lawyers for an Illinois man convicted of raping and killing a 10-year-old girl argued that the scans give evidence that the defendant should be spared the death penalty because he has a brain disorder. The defense argued that the defendant was born with a mental illness, psychopathy, that should be considered a mitigating factor because it impairs his ability to control his behavior. The defendant, Brian Dugan, exhibits antisocial behavior, impulsivity, lack of remorse, and other characteristics of psychopathy, according to University of New Mexico neuroscientist Kent Kiehl, an expert witness for the defense. Kiehl researches psychopathy in New Mexico state prisons by collecting life histories, anatomical brain scans, and fMRI scans of brain activities as inmates perform various tasks, including moral reasoning tests. Kiehl testified that Dugan exhibited abnormalities similar to those found in others that have been reported as psychopaths. Kiehl was careful not to claim that the brain scans prove that Dugan, who pleaded guilty, committed his crimes as a result of the brain abnormality. The prosecution argued that a fMRI scan taken in September of 2009 has no relation to a crime that took place in 1983, and the jury returned a sentence of death. Evidence of anatomical abnormalities in the brain has been introduced previously in sentencing, with PET scans having been used to show abnormalities in brain metabolism consistent with mental illness, but the Dugan case may be the first to involve an fMRI.
From "fMRI Evidence Used in Murder Sentencing"
Science (11/23/09) Miller, Greg
RSNA Weekly is a briefing of the latest radiology-related news selected from hundreds of sources by the editors of Information, Inc. While care is taken to use good sources, inaccuracies in source material are not the responsibility of RSNA or Information, Inc.
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