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  • Journal Highlights

    August 01, 2014

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

    Perfusion software used in this example automatically generates color-coded perfusion maps of entire liver
    (Click to enlarge) Perfusion software used in this example automatically generates color-coded perfusion maps of entire liver representing blood flow (BF), blood volume (BV), permeability, hepatic arterial perfusion (HAP), portal venous perfusion (PVP) and hepatic perfusion index (HPI). Note increased blood flow, blood volume, HAP and HPI (solid arrows) and decreased permeability and PVP (open arrows) in the hepatic nodule.
    (Radiology 2014;272;2:322–344) ©RSNA 2014 All rights reserved. Printed with permission. (Image courtesy of J. M. Lee.)

    CT Perfusion of the Liver: Principles and Applications in Oncology

    CT perfusion imaging of the liver provides functional information about the microcirculation of normal parenchyma and focal liver lesions and is a promising technique for assessing the efficacy of anticancer treatments. Many limitations of early CT perfusion studies performed in the liver, such as limited coverage, motion artifacts, and high radiation dose, are being addressed by technical advances. While other issues must still be solved, CT perfusion has now reached technical maturity, allowing for its use in larger-scale prospective clinical trials.

    In a review in the August issue of Radiology (RSNA.org/Radiology), Se Hyung Kim, M.D., of the Molecular Imaging Program at Stanford University, and colleagues discuss the basic principles, current acquisition protocols and pharmacokinetic models used for CT perfusion imaging of the liver. In addition, various oncologic applications are discussed in detail:

    • Early detection of liver tumors
    • Assessment of prognosis based on tumor perfusion
    • Monitoring therapeutic effects
    • Diagnosing tumor recurrence

    The authors also discuss possible solutions to challenges that remain in CT perfusion of the liver, including radiation dose, reproducibility, motion correction and protocol standardization.

    “The lack of standardization in image acquisition and the methodologies applied for data analysis is an acknowledged issue by researchers in the field of perfusion imaging, and there is fortunately increasing efforts toward the standardization and harmonization of both data acquisition and analysis,” the authors note. “Such developments are of paramount importance for the wider clinical acceptance of the technique and industry-academia collaborations are being developed to address such challenges.”

    This article meets the criteria for AMA PRA Category 1 Credit™. SA-CME is available online only.
    IDC in a 42-year-old woman. Bilateral MLO (a) and craniocaudal (b) screening DM images
    (Click to enlarge) IDC in a 42-year-old woman. Bilateral MLO (a) and craniocaudal (b) screening DM images show subtle architectural distortion in the lateral and subareolar right breast, a finding that is more conspicuous on DBT images. The extensive nature of the finding is also appreciated on the DBT images. (c) Sagittal contrast-enhanced fat-saturated T1-weighted MR subtraction image of the right breast shows patchy extensive enhancement in the region of architectural distortion. Pathologic analysis confirmed extensive IDC.
    (RadioGraphics 2014;34;E89–E105) ©RSNA 2014 All rights reserved. Printed with permission.

    Digital Breast Tomosynthesis: Lessons Learned from Early Clinical Implementation

    In light of the limitations of mammography, including low sensitivity in detecting some cancers and high false-positive recall rates, controversy exists over when and how often screening mammography should occur. Digital breast tomosynthesis (DBT) is rapidly being implemented in breast imaging clinics around the world as early clinical data demonstrate that it may address some of the limitations of conventional mammography.

    In an article in the July-August issue of RadioGraphics (RSNA.org/RadioGraphics), Robyn Gartner Roth, M.D., of the Department of Radiology at the Hospital of the University of Pennsylvania, and colleagues detail the clinical applications of digital breast tomosynthesis in both screening and diagnostic settings. Specifically the authors:

    • Describe the principles of DBT and how information obtained at 3D DBT may replace the need for some 2D diagnostic imaging in the evaluation of suspicious breast lesions
    • Discuss how a combination of digital mammography and DBT can be used to decrease callback rates, increase cancer detection and assist with problem solving
    • Identify the limitations of DBT and issues to consider in clinical implementation

    “This article focuses on our early clinical experiences with DBT in both screening and diagnostic settings,” the authors note. “One year after implementing DBT for all screening patients, we demonstrated a substantial reduction in our overall callback rate and a trend toward increased cancer detection … As with any new technology, several issues must be considered when implementing DBT into daily practice. Ongoing large-scale prospective trials will help guide the evidence-based utilization of this new technology.”

    In an accompanying invited commentary, Stephen A. Feig, M.D., of the Department of Radiology at the University of California Irvine Medical Center, notes that while many supplementary screening modalities, including breast US and MR imaging, have been developed to supplement digital mammography, DBT could perhaps provide the most clinically significant benefit for most women.

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

    Radiology Podcasts
    Radiology Podcasts

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

    • “Two-View Digital Breast Tomosynthesis Screening with Synthetically Reconstructed Projection Images: Comparison with Digital Breast Tomosynthesis with Full-Field Digital Mammographic Images,” Per Skaane, M.D., Ph.D., and colleagues.
    • “Comparison of Two-dimensional Synthesized Mammograms versus Original Digital Mammograms Alone and in Combination with Tomosynthesis Images,” Margarita Zuley, M.D., and colleagues.
    • “Thyroid Cancers Incidentally Detected at Imaging in a 10-year Period: How Many Cancers Would Be Missed with Use of the Recommendations from the Society of Radiologists in Ultrasound?” Manisha Bahl, M.D., M.P.H., and colleagues.
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