New Information on H1N1 Infection in Middle-aged Adults
RadioGraphics Provides Insight into H1N1 findings
New information on H1N1 infection in middle-aged adults is available online ahead of print in RSNA’s peer-reviewed journal RadioGraphics.
“Fatal 2009 Influenza A (H1N1) Infection, Complicated by Acute Respiratory Distress Syndrome and Pulmonary Interstitial Emphysema” is a “Best Cases from the AFIP” article that provides insight into a case of a 56-year-old man who died after H1N1 infection complicated by acute respiratory distress syndrome and pulmonary interstitial emphysema. Read it now.
Earlier this month, an article was published online in Radiology examining H1N1 chest X-ray findings in children.
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Leading the News
New Guidelines Back Mammograms Starting at Age 40
Two joint recommendations by the American College of Radiology and the Society of Breast Imaging advise women with an average risk of breast cancer to begin undergoing regular mammograms at 40. According to Dr. Carol Lee of Memorial Sloan-Kettering Cancer Center in New York, these guidelines take into account the success of annual mammography screening at age 40. "The significant decrease in breast cancer mortality, which amounts to nearly 30 percent since 1990, is a major medical success and is due largely to earlier detection of breast cancer through mammography screening," Lee said. The recommendations also advise high-risk women to start screening at 30; however, they should not start before 25, when the risk of radiation from mammograms begin to outweigh the benefits of screening. Additionally, the recommendations say high-risk women should be screened using MRI as well as mammography because it provides improved sensitivity for tumor detection. For high-risk women who cannot undergo MRI because of claustrophobia or for other reasons, a breast ultrasound should be used. These recommendations contradict recent guidelines published by the U.S. Preventive Services Task Force, which recommend against routine breast mammograms for women in their 40s.
From "New Guidelines Back Mammograms Starting at Age 40"
Reuters (01/04/10) Steenhuysen, Julie
Brain Imaging Could Help Diagnose Autism
Researchers have found that children with autism spectrum disorders (ASDs) process sound and language a fraction of a second slower than children without ASDs, suggesting that measuring magnetic signals that mark this delay could become a standardized way to diagnose autism. Whole-cortex magnetoencephalography (MEG) was obtained from 17 typically developing children and 25 children with ASD. Using a helmet that surrounds the child's head, they presented a series of recorded beeps, vowels, and sentences. As the child's brain responded to each sound, noninvasive detectors in the MEG machine analyzed the brain's changing magnetic fields. The children with ASDs had an average delay of 11 milliseconds (about 1/100 of a second) in their brain responses to sounds compared to the control children. Among the group with ASDs, the delays were similar, whether or not the children had language impairments.
From "MEG Detection of Delayed Auditory Evoked Responses in Autism Spectrum Disorders: Towards an Imaging Biomarker for Autism"
Autism Research (01/08/10) Roberts, Timothy P. L.; Khan, Sarah Y.; Rey, Mike; et al.
Research
Ultrasound Detects Shoulder Dislocation After Birth Injury
Ultrasound can be used to detect a posterior shoulder dislocation in infants between three and six months with a permanent brachial plexus birth injury (BPBI), according to a study in the January 2010 issue of Radiology. Researchers used ultrasonography to screen for posterior shoulder subluxation (PSS) in 132 infants with BPBI at various times up to 12 months of age. They found that PSS of the humeral head developed in one-third of the 27 patients with permanent BPBI that failed to heal in the first year. Posterior subluxation was detected by ultrasound in 55 percent of patients at three months of age and 89 percent at six months of age.
From "Brachial Plexus Birth Injury: US Screening for Glenohumeral Joint Instability"
Radiology (01/01/10) Vol. 254, No. 1, P. 253; Poyhia, Tiina H.; Lamminen, Antti E.; Peltonen, Jari I.; et al.
Radiofrequency Ablation Found Therapeutic for Lung Cancer
Radiofrequency (RF) ablation appears to be a viable treatment option for patients with primary non-small cell lung cancer (NSCLC) who are not eligible for surgical intervention, according to a study published in the January 2010 issue of Radiology. Researchers analyzed data from 79 patients with primary NSCLC who underwent RF ablation during a one-year period. They found that 43 percent of patients had recurrence at an average of 14 months. Recurrence was local in 38 percent of those patients, intrapulmonary in 18 percent, nodal in 18 percent, and included distant metastases in 21 percent. Risk of recurrence increased with larger tumor size and cancer stage; however, patient sex, tumor location, and concomitant external beam radiation or brachytherapy were not.
From "Primary Non-Small Cell Lung Cancer: Review of Frequency, Location, and Time of Recurrence After Radiofrequency Ablation"
Radiology (01/01/10) Vol. 254, No. 1, P. 301; Beland, Michael D.; Wasser, Elliot J.; Mayo-Smith, William W.; et al.
Technology
F-FDOPA PET Predicts Long-term Clinical Outcomes for Dopamine Cell Implantation in Parkinson's Disease
PET scans are able to detect the biomarker 18-F-fluorodopa (18F-FDOPA) for Parkinson's disease, which may indicate patients that could benefit most from treatment with transplanted fetal neural tissue, according to a recent study. The study found that the success of engrafting dopamine-producing brain tissue from fetuses into the deteriorating brains of patients with Parkinson's peaked approximately two years following engraftment, with modest gains tending to vanish after four years. Researchers are hopeful that the use of PET may help optimize the results of these treatments. Patients whose FDOPA scans indicated they had relatively stronger dopamine activity in the putamen were vastly more likely to experience improvement after the operation.
From "Dopamine Cell Implantation in Parkinson's Disease: Long-Term Clinical and 18F-FDOPA PET Outcomes"
Journal of Nuclear Medicine (01/10) Vol. 51, No. 1, P. 7; Ma, Yilong; Tang, Chengke; Chaly, Thomas; et al.
DTI Better Detects Earliest Signs of Alzheimer in Healthy Individuals
Diffusion tensor imaging (DTI) appears to be more effective at detecting whether a person with memory loss might have brain changes indicative of Alzheimer disease, according to a new study. For the study, 76 healthy people between the ages of 20 and 80 underwent DTI-MRI brain scanning, which is able to map fiber tracts that connect brain regions. The researchers examined DTI changes in the hippocampus. Participants were given verbal and visual perception tests. Radiologists then compared the brain scans, finding that DTI imaging better explained declines in memory than did measuring hippocampus volume through a traditional MRI. They found that mean diffusivity in the hippocampus also better predicted verbal and spatial memory performance in participants, especially those who were 50 years of age or older.
From "Hippocampal Mean Diffusivity and Memory in Healthy Elderly Individuals"
Neurology (01/06/2010) Carlesimo, Giovanni A.; Cherubini, Andrea; Caltagirone, Carlo; et al.
Researchers Compare Techniques for Improving Imaging of Upper Abdomen
The T2-weighted free-breathing navigator-triggered turbo spin echo (TSE) sequence with the BLADE technique provides a promising approach for reducing motion artifacts and improving image quality in upper abdominal MRI scans, researchers have found. Their study used MRI to image 32 consecutive patients referred for upper abdominal scans for the evaluation of various suspected pathologies. Several different T2-weighted sequences were evaluated, including free-breathing navigator-triggered TSE as well as free-breathing navigator-triggered TSE with restore pulse (RP), breath-hold TSE with RP, and free-breathing navigator-triggered TSE with RP using the periodically rotated overlapping parallel lines with enhanced reconstruction technique. All images were independently assessed by two radiologists for motion artifacts; the edge sharpness of the liver, pancreas, and intrahepatic vessels; depictions of intrahepatic vessels; and overall image quality.
From "T2-Weighted MRI of the Upper Abdomen: Comparison of Four Fat-Suppressed T2-Weighted Sequences"
Academic Radiology (12/09) Bayramoglu, Sibel; Kilickesmez, Ozgur; Cimilli, Tan; et al.
Clinical Practice
Radiologists and Emergency Physicians Prefer CT for Suspected PE
Nearly all emergency physicians and radiologists prefer CT to diagnose pulmonary embolism (PE), according to a recent survey of 62 radiologists and 52 emergency physicians. This survey found that CT was the first-line diagnostic choice for 90 percent of radiologists and 96 percent of emergency physicians. They also observed that there was an increased use of ventilation-perfusion scintigraphy in patients with renal failure and allergy to iodinated contrast material. Additionally, the survey showed that few respondents preferred MRI. However, the researchers indicated that as "patient safety is a primary concern with regard to imaging, a role for MRI is likely to emerge."
From "Imaging Evaluation for Suspected Pulmonary Embolism: What Do Emergency Physicians and Radiologists Say?"
American Journal of Roentgenology (01/01/2010) Vol. 194, No. 1, P. W38; Jha, Saurabh; Ho, Alex; Bhargavan, Mythreyi; et al.
CTDIvol Can Be Used to Estimate Lens Dose During Whole-Brain CT
Recent studies on radiation lens injuries have shown that using significantly lower dose thresholds than specified by current radiation protection guidelines may be advisable. A study in Tokyo aimed to measure the lens dose during brain CT scans with multidetector row CT, and to assess methods for estimating the lens dose. With 8 kinds of multidetector row CT scanners, both axial and helical scans were obtained for the head part of a human-shaped phantom by using normal clinical settings with the orbitomeatal line as the baseline. The researchers measured the doses on both eyelids by using an RPLGD during whole-brain scans, including the orbit with the starting point doses by using two other starting points for scanning, specifically the orbitomeatal line and the superior orbital rim. The study found that the CTDIvols and the lens doses during whole-brain CT including the orbit were 50.9–113.3 mGy and 42.6–103.5 mGy, respectively. The study also found that the ratios of lens dose to CTDIvol were 80.6 percent to 103.4 percent, and that lens doses decreased as the starting points were set more superiorly. The findings mean that CTDIvol can be used to estimate the lens dose during whole-brain CT when the orbit is included in the scanning range.
From "Lens Exposure During Brain Scans Using Multidetector Row CT Scanners: Methods for Estimation of Lens Dose"
American Journal of Neuroradiology (12/09) Suzuki, S.; Furui, S.; Ishitake, T.; et al.
High-Resolution CT Aids Diagnosis of Neuroendocrine Cell Hyperplasia of Infancy
Neuroendocrine cell hyperplasia of infancy can have a characteristic appearance on high-resolution CT scans, the imaging findings being useful in differentiating neuroendocrine cell hyperplasia of infancy from other types of childhood interstitial lung disease. The most common of these findings is ground-glass opacification, often involving the right middle lobe and lingula. The second most common finding was air trapping with a mosaic pattern. The appearance of these findings aids radiologists in suggesting a specific diagnosis; however, it should be noted that they do not exclude this diagnosis.
From "Neuroendocrine Cell Hyperplasia of Infancy: Diagnosis With High-Resolution CT"
American Journal of Roentgenology (01/01/2010) Vol. 194, No. 1, P. 238; Brody, Alan S.; Guillerman, R. Paul; Hay, Thomas C.; et al.
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