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  • Journal Highlights

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


    February 1, 2016

    Radiology
    Portal Venous Interventions

    Although portal venous interventions have had major impact on the outcomes of patients with liver cancer, portal hypertension and insulin-dependent diabetes mellitus, further improvements are needed in order to expand the availability of this treatment to patients.

    In a State-of-the-Art review in the January issue of Radiology, (RSNA.org/Radiology) David C. Madoff, M.D., of Presbyterian Hospital/Weill Cornell Medical Center, New York, and colleagues provide an overview of the most recent data and strategies for utilization of portal venous interventions:

    Preoperative portal vein embolization: This technique allows patients previously considered unresectable due to an inadequate anticipated future liver remnant to have safe major hepatic resection.

    Transjugular intrahepatic portosystemic shunt (TIPS): Multiple clinical trials for various indications show TIPS to be an effective, durable therapy for treating sequelae of portal hypertension.

    Balloon retrograde transvenous obliteration: Commonly practiced in Asia, the procedure is gaining acceptance in the U.S. as a potential alternative to TIPS in the management of variceal hemorrhage and hepatic encephalopathy.

    Islet cell transplantation: A promising cellular-based therapy aimed at long-term stabilization of glycemic control in Type 1 diabetics and reduction of complications related to diabetes.

    The techniques—although performed for very different intent—require a thorough understanding of portal venous anatomy, physiology and pathophysiology, according to the authors.

    “Although considerable progress has been made in all of the areas discussed herein, these approaches remain early in their utilization. Hopefully, further research will advance these fields and define how they fit into modern treatment paradigms,” the authors write.

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

    Radiographics
    Internal Hernias in the Era of Multidetector CT: Correlation of Imaging and Surgical Findings

    The advent of multidetector CT (MDCT), with its thin-section axial images, high-quality multiplanar reformations and 3-D images, currently plays an essential role in preoperative diagnosis of internal hernias, with a correlated expansion of the roles expected of radiologists.

    In an article in the January-February issue of RadioGraphics (RSNA.org/RadioGraphics), Satoshi Doishita, M.D., Osaka City University Graduate School of Medicine, Japan, and colleagues provide an overview of the diagnostic approach to internal hernias with MDCT, placing an emphasis on tracing key vessels; present various pathognomonic findings for the various types of internal hernias at MDCT; and discuss the usefulness of MDCT with correlation of imaging and intraoperative findings.

    For definitive diagnosis of an internal hernia, analysis of displacement of anatomic landmarks around the hernia orifice is particularly important, and thin-section images provide the required information, according to the authors.

    “A detailed knowledge of the anatomy, etiology and imaging landmarks of the various hernia types is also necessary,” the authors write. “Familiarity with the appearances of internal hernias at MDCT allows accurate and specific preoperative diagnoses.”

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

    Access RadioGraphics and Radiology CME Tests

    Earn CME credit through RSNA’s RadioGraphics and Radiology CME tests offered in an interactive online format.

    Access convenient features such as a “view article” button linking to the related CME journal article and “preview test” enabling users to see question content before beginning the graded exercise. During tests, users can enlarge images and receive instant feedback. Users can also revisit the question and remediation for deeper understanding.

    RadioGraphics and Radiology online CME tests offer 1.00 AMA PRA Category 1 Credit™ as well as SA-CME credit toward the American Board of Radiology (ABR) Maintenance of Certification (MOC) requirements.

    Access the CME tests at RSNA.org/eLearn.

    Radiology Podcasts

    Listen to Radiology Editor Herbert Y. Kressel, M.D., deputy editors and authors discuss the following articles in the December issue of Radiology at RSNA.org/Radiology-Podcasts.

    • “Sex Differences in Gray Matter Changes and Brain-Behavior Relationships in Patients with Stimulant Dependence,” Michael F. Regner, M.D., and colleagues.
    • “COPD: Do Imaging Measurements of Emphysema and Airway Disease Explain Symptoms and Exercise Capacity?” Miranda Kirby, Ph.D., and colleagues.
    • A combined podcast on Radiology’s paired “Controversies” pieces:
      • “Controversies in Contrast Material–induced Acute Kidney Injury: Closing in on the Truth?” Robert J. McDonald, M.D., Ph.D., and colleagues.
      • “Controversies in Contrast Material−induced Acute Kidney Injury: Propensity Score Matching of Patients with Different Dose/Absolute Glomerular Filtration Rate Ratios,” Ulf R. Nyman, M.D., Ph.D., and colleagues.
       



    FLR hypertrophy after portal vein embolization (PVE) as determined by 3-D reconstruction of CT images
    FLR hypertrophy after portal vein embolization (PVE) as determined by 3-D reconstruction of CT images. Before embolization (left), the volume of segments 2 and 3 was 282 cm3 (14 percent of total liver volume [2036 cm3]). After embolization (right), the volume of segments 2 and 3 was 440 cm3 (21 percent of total liver volume [2036 cm3]). (Radiology 2016;278;2:333–353) © RSNA 2016 All rights reserved. Reprinted with permission.

    Transmesenteric hernia in a 59-year-old woman with right lower abdominal pain
    Transmesenteric hernia in a 59-year-old woman with right lower abdominal pain. Volume-rendered CT image shows a defect (→) in the mesentery of the terminal ileum (→) through which the converging mesenteric vessels pass. Approximately 190 cm of gangrenous small intestine was resected, and the defect was closed with sutures. (Images courtesy of Sakae Nagaoka, M.D., Japanese Red Cross Medical Center, Tokyo, and Chikara Shirata, M.D., Graduate School of Medicine, University of Tokyo). (Radiographics 2016;36;88-106) © RSNA 2016 All rights reserved. Reprinted with permission.




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