New Information on H1N1 Infection in Children
Radiology Reveals New H1N1 Findings in Children
New information on H1N1 infection is now available from a radiologic perspective—and publicly accessible—in RSNA’s peer-reviewed journal Radiology.
“Swine-Origin Influenza A (H1N1) Viral Infection in Children: Initial Chest Radiographic Findings” examines H1N1 chest X-ray findings in children. Read it now.
By the end of January, an article will be published online in RadioGraphics detailing H1N1 in middle-aged adults.
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Leading the News
Claustrophobia Is Common Cause of Refusing Breast Screening
A study published in the January 2010 issue of Radiology shows that 42 percent of women eligible for MRI screening for breast cancer decline to undergo the procedure. The analysis was performed as part of the American College of Radiology Imaging Network (ACRIN) 6666 clinical trial to gauge patient acceptance of MRI as a breast screening tool. The study included 1,215 eligible women at intermediate or high risk for breast cancer enrolled in the ACRIN trial who were offered MRI screening. Of those women, only 57.9 percent agreed to the exam and 51.6 percent completed the exam protocol. The primary reason given for nonparticipation was claustrophobia. Other common concerns included time constraints, financial concerns involving insurance, a physician not providing a referral and/or not believing MR imaging was indicated, lack of interest, medical inability to tolerate MRI, reluctance to receive intravenous injection, fear of further testing or biopsy, MRI scheduling, distance, and contrast agent allergies.
From "Reasons Women at Elevated Risk of Breast Cancer Refuse Breast MR Imaging Screening: ACRIN 6666"
Radiology (01/01/10) Vol. 254, No. 1, P. 79; Berg, Wendie A.; Blume, Jeffrey D.; Adams, Amanda M.; et al.
Research
Timing Critical to Measurement of Myocardial Infarct With CE Cardiac MRI
The timing of contrast agent-enhanced (CE) cardiac MRI is crucial to provide accurate measurement of myocardial infarct after acute myocardial infarction (AMI). Researchers found that the size of delayed gadolinium enhancement at CE cardiac MRI significantly diminished during the first week after infarction in patients with AMI and successful coronary reperfusion. This finding was based on a 17-patient study, published in the January 2010 issue of Radiology. All patients included in the study had reperfused AMI. Study participants underwent cine and CE cardiac MRI an average of one, seven, 35, and 180 days following reperfusion. Infarct size was determined based on delayed enhancement MRI at different times compared using nonparametric tests and Bland-Altman analysis.
From "Acute Myocardial Infarction: Serial Cardiac MR Imaging Shows a Decrease in Delayed Enhancement of the Myocardium During the 1st Week After Reperfusion"
Radiology (01/01/10) Vol. 254, No. 1, P. 88; Ibrahim, Tareq; Hackl, Thomas; Nekolla, Stephan G.; et al.
Adverse Events Common With Chemoradiation for Head and Neck Cancer
The vast majority of patients who undergo chemoradiation for head and neck cancer have adverse events, most of which affect oropharyngeal and laryngeal function. However, intensity-modulated radiation therapy (IMRT) can reduce the toxicity of chemoradiation treatments. Researchers conducted a study with 104 patients treated for head and neck cancer between Feb. 1, 2000 and March 1, 2007. The most common adverse event observed was mucositis, seen in 92.3 percent of patients, followed by hematologic toxicity, observed in 59.6 percent of patients. Less common side effects included moist desquamation, neurotoxicity and/or ototoxicity, severe nausea or vomiting, severe dehydration or malnutrition, pneumonia, mild or moderate fever, elevated creatinine, severe fever, trismus, osteoradionecrosis, and treatment-related death.
From "Adverse Events Associated With Concurrent Chemoradiation Therapy in Patients With Head and Neck Cancer"
Archives of Otolaryngology Head and Neck Surgery (12/09) Vol. 135, No. 12, P. 1209; Givens, Daniel J.; Karnell, Lucy Hynds; Gupta, Anjali K.; et al.
Observer Experience Effects Diagnostic Performance of CEUS in Liver Tumor Characterization
The diagnostic performance of contrast-enhanced ultrasound imaging (CEUS) in liver tumor characterization is dependant on the observer's level of expertise, a new study finds. This conclusion is based on a search of 286 biopsy-proven tumors in 235 patients who underwent CEUS after sulfur hexafluoride-filled microbubble injection. Digital cine clips were recorded during the arterial, portal, and late phases. These clips where then analyzed by six independent observers - one group without experience and one group with two to 10 years of experience. The analysis of observer diagnostic confidence found higher intragroup than intergroup agreement. Experienced observers showed higher diagnostic performance in malignancy diagnosis than inexperienced observers.
From "Effect of Observer Experience in the Differentiation Between Benign and Malignant Liver Tumors After Ultrasound Contrast Agent Injection"
Journal of Ultrasound in Medicine (01/01/10) Vol. 29, No. 1, P. 25; Quaia, Emilio; Alaimo, Valerio; Baratella, Elisa; et al.
Ultrasound-guided Cortisone Injections May Help Treat Severe Hip Pain
Ultrasound-guided cortisone injections may provide an effective treatment for gluteus medius tendinopathy. A study, conducted at the University of Montreal's Hospital Center, included 54 patients with the condition. Ultrasound-guided cortisone injections were performed on all patients. One month following treatment, 72 percent of the patients demonstrated a clinically significant improvement in pain level, while 70 percent of patients were satisfied with the results of the intervention.
From "Effectiveness of Ultrasound-Guided Corticosteroid Injection for the Treatment of Gluteus Medius Tendinopathy"
American Journal of Roentgenology (01/01/2010) Vol. 194, No. 1, P. 202; Labrosse, Julie M.; Cardinal, Etienne; Leduc, Bernard E.; et al.
Technology
4D Flow Used to Evaluate Intracranial Arterial Stenoses and Aneurysms
Researchers have evaluated intracranial arterial stenoses and aneurysms with accelerated time-resolved three-dimensional (3D) phase-contrast MRI, or 4D flow. The 4D flow technique was used to image four normal volunteers, two patients with intracranial stenoses, and two patients with intracranial aneurysms. To reduce scan time, parallel imaging was combined with an acquisition strategy that eliminates the corners of k-space. In the patients with intracranial stenoses, 4D flow velocity measurements showed that one patient had normal velocity profiles in agreement with a previous magnetic resonance angiogram (MRA); while the second showed increased velocities that indicated a less significant narrowing than suspected on a previous MRA, as confirmed by catheter angiography, which may have prevented an invasive angiogram. In the two patients with 4-mm intracranial aneurysms, one had a stable helical flow pattern with a large jet and the other had a temporally unstable flow pattern with a more focal jet, potentially indicating that the second aneurysm had a higher chance of rupture. Accelerated 4D flow provides time-resolved 3D velocity data in an 8-to-10 minute scan. In the stenosis patients, adding 4D flow to a traditional MRA adds the velocity data provided from transcranial Doppler ultrasound, potentially allowing for more accurate grading of stenoses. The visualization of flow patterns in aneurysm patients could help provide prognostic information about the risk of rupture.
From "Evaluation of Intracranial Stenoses and Aneurysms With Accelerated 4D Flow"
Journal of Magnetic Resonance Imaging (01/01/10) Hope, T. A.; Hope, M. D.; Purcell, D. D.; et al.
Medical-Legal Issues
Senate Health Reform Bill Preserves Essential Diagnostic Services for Osteoporosis
The passage of healthcare reform in Congress will help older Americans more easily access quality osteoporosis diagnosis, prevention, and treatment services. The Senate health reform bill features a provision on restoring Medicare reimbursement for dial energy X-ray absorptiometry (DXA), the leading diagnostic tool for the early detection and management of osteoporosis. Medicare cuts for DXA tests have jeopardized patient access to this important preventive healthcare service, and without congressional action many doctors would have to discontinue providing DXA services in their offices as reimbursement is currently far lower than the cost of the test. The inclusion of DXA in the healthcare reform bill is an example of a renewed focus on prevention. Numerous studies have shown that increased DXA testing and treatment result in a significant drop in fractures and related healthcare costs.
From "Senate Health Reform Bill Preserves Essential Diagnostic Services for Osteoporosis"
Newswise (12/24/09)
FDA Panel Recommends Approval for Hexaminolevulinate
An FDA advisory committee has recommended approval for hexaminolevulinate (Hexvix), which is indicated for imaging cancerous lesions during cystoscopy. This approval was based on a clinical trial of 814 patients which found that 16 percent of patients had tumors detected only using hexaminolevulinate. However, the drug did not demonstrate superior efficacy over the traditional method during follow-up testing performed up to nine months later. Additionally, some panelists voiced concern that the risk of repeated use of hexaminolevulinate remains unknown. FDA staff report that no significant safety risks were detected in clinical trials of the drug, but there were three reports of allergic reactions that may be associated with hexaminolevulinate in countries where it is already approved.
From "U.S. Panel Narrowly Backs Photocure Cancer Test Drug"
Reuters (12/17/09) Richwine, Lisa
Clinical Practice
Gelfoam Appears on Sonography After Thyroidectomy Surgery
Gelfoam may mimic residual or recurrent thyroid carcinoma on early surveillance sonography performed after thyroidectomy. In order to avoid an errant diagnosis of a tumor, radiologists should strive to recognize the foam's characteristic appearance, which should prompt a search for an appropriate surgical history. Researchers reviewed the early postoperative sonographic examinations of six patients after thyroidectomy in which Gelfoam was used for hemostasis. Screening cervical sonography was performed to identify possible lateral compartment adenopathy before completion of thyroidectomy or ablation. In all cases, uniform elongated echogenicity was shown within the lobectomy bed. In one patient, sonographically guided fine-needle aspiration of this area yielded scant red blood cells, multinuclearted giant cells, and macrophages. Follow-up sonography performed in one patient 14 months after thyroidectomy confirmed complete Gelfoam absorption.
From "Appearance of Absorbable Gelatin Compressed Sponge on Early Post-Thyroidectomy Neck Sonography"
Journal of Ultrasound in Medicine (01/01/10) Vol. 29, No. 1, P. 117; Tublin, Mitchell E.; Alexander, Jacob M.; Ogilvie, Jennifer B.
Patient Factors Mar Accuracy of Multi-Detector CT Scans
Multi-detector CT (MDCT) outcomes can be affected by factors including patient ethnicity, height/weight ratio, and heart rate when use to detect coronary artery stenosis, according to a recent study. Researchers examined MDCT for 291 patients, finding that images from black patients tended to have poorer image quality than those of white patients. Other physiologic factors negatively affecting scan quality included high heart rate, arrhythmia, obesity, and high coronary calcium burden with motion.
From "Patient Characteristics As Predictors of Image Quality and Diagnostic Accuracy of MDCT Compared With Conventional Coronary Angiography for …"
American Journal of Roentgenology (01/01/2010) Vol. 194, No. 1, P. 93; Dewey, Marc; Vavere, Andrea L.; Arbab-Zadeh, Armin; et al.
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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