Radiology in public focus

Press releases were sent to the medical news media for the following articles appearing in a recent issue of Radiology.

Brain Iron Accumulation Linked to Cognitive Decline in Alzheimer’s Patients

Radiology researchers using MRI have found that iron accumulation in the outer layer of the brain is associated with cognitive deterioration in people with Alzheimer’s disease (AD).

Reinhold Schmidt, MD, professor of neurology and chairman of the Department of Neurology at the Medical University of Graz in Graz, Austria, and colleagues developed an approach using a 3T MRI scanner that allowed the best tradeoff between resolution and scan time, along with postprocessing to correct the influence of the distortions.

The technique enabled the researchers to create a map of brain iron, determining iron levels in parts of the brain like the temporal lobes and the occipital lobes in the back of the head. T

he results point to a potential role in AD treatment for drugs that reduce the iron burden in the brain. These drugs, known as chelators, can remove excess iron from the body.

“Our study provides support for the hypothesis of impaired iron homeostasis in Alzheimer’s disease and indicates that the use of iron chelators in clinical trials might be a promising treatment target,” Dr. Schmidt said. “MRI-based iron mapping could be used as a biomarker for Alzheimer’s disease prediction and as a tool to monitor treatment response in therapeutic studies.”

Schmidt

Schematic representation of MRI processing. Left: FreeSurfer-derived cortical and subcortical segmentations overlaid on a T1-weighted scan were affinely registered into R2* space. Right: R2* map corrected for macroscopic field inhomogeneities, where median R2* values were calculated for each region and then used for further statistical analyses.

Schmidt et al, Radiology 2020 ©️RSNA 2020

Cardiac CT Can Double as Osteoporosis Test

Cardiac CT exams performed to assess heart health also provide an effective way to screen for osteoporosis, potentially speeding treatment to the previously undiagnosed.

Bone mineral density (BMD) tests can diagnose osteoporosis, but the number of people who get these tests is suboptimal. Josephine Therkildsen, MD, from Herning Hospital, Hospital Unit West, in Herning, Denmark, and colleagues studied cardiac CT as a method for screening for osteoporosis. Because the cardiac CT scan also visualizes the thoracic vertebrae, it is relatively easy to add a BMD test to the procedure.

Of the 1,487 people in the study, 179, or 12%, had very low BMD. During follow-up of just over three years on average, 80 of the participants, or 5.3%, were diagnosed with a fracture. The fracture was osteoporosis- related in 31 of the 80 people.

The association between a very low BMD and a higher rate of fracture strongly suggests that thoracic spine BMD may be used to guide osteoporosis preventive measures and treatment decisions, the study authors said.

“We believe that opportunistic BMD testing using routine CT scans can be done with little change to normal clinical practice and with the benefit of identifying individuals with a greater fracture rate,” Dr. Therkildsen said.

Therkildsen

The Mindways Solid phantom with volume of interest in the quality assurance phantom (red circles, left side). A participant’s noncontrast-enhanced axial CT (right side) with volume of interest (yellow circles) in the trabecular bone compartment of three vertebrae for bone mineral density measurements.

Therkildsen et al, Radiology 2020 ©️RSNA 2020

Chest X-Rays Show More Severe COVID-19 in Non-White Patients

Racial/ethnic minority patients admitted to the hospital with COVID-19 infection are more likely to have more severe disease on chest X-rays than white/non-Hispanic patients, increasing the likelihood of adverse outcomes, such as intubation or death.

Emerging data show that racial/ethnic minorities have been disproportionately affected by COVID-19. Socioeconomic factors and pre-existing medical conditions like hypertension are likely contributing factors to this disparity. Furthermore, limited English proficiency may introduce additional linguistic and health literacy barriers to care, potentially resulting in delays seeking medical attention and greater severity of disease at the time of admission to the hospital with COVID-19 infection.

Efren J. Flores, MD, a radiologist at Massachusetts General Hospital, Boston, and colleagues studied these disparities with an eye toward developing a better understanding of some of the factors. They looked at data from 326 patients hospitalized with confirmed COVID-19 infection between March 27 and April 10, 2020. Analysis of chest X-ray results revealed that non-white patients had significantly more severe lung disease on admission than white/non-Hispanic patients. Increased disease severity on chest X-rays increased the likelihood of adverse clinical outcomes, including admission to the intensive care unit, intubation and death.

As expected, the increased severity of lung disease on chest X-rays among non-white patients correlated with a combination of factors, including delay in seeking care at the hospital, higher prevalence of pre-existing comorbidities and limited English proficiency.

“Limited English proficiency is an additional socioeconomic factor that really influences many aspects of access to care,” Dr. Flores said.

Flores

Number of admitted patients with confirmed COVID-19 infection by zip code, B, Hispanic or Latino Fraction by Population by Zip Code (2018 American Community Survey 5yr Survey) C, Personsper- room by zip code expressed in percent of individuals living in overcrowded conditions (PPR > 1.01; 2018 American Community Survey 5yr Survey), D, Median income by zip code expressed in U.S. dollars. Majority of patients admitted for COVID-19 infection included in the study cohort were living in home addresses with zip codes with a relatively higher proportion of Hispanic or Latino individuals, higher persons per room and lower median household income.

Flores et al, Radiology 2020 ©️RSNA 2020

For Your Information

Access the Radiology study, "Racial/Ethnic Disparities in Disease Severity on Admission Chest Radiographs among Patients Admitted with Confirmed COVID-19: A Retrospective Cohort Study."

Access, "Chest X-Rays Show More Severe COVID-19 in Non-White Patients,” at RSNA.org/Learning-Center.

Dangerous Blood Clots Form in Leg Arteries of COVID-19 Patients

COVID-19 is associated with life-threatening blood clots in the arteries of the legs. COVID-19’s association with blood clots in the pulmonary arteries is well-established. Less is known about the virus’ connection to lower extremity arterial thrombosis.

In a recent Radiology article, Inessa A. Goldman, MD, a radiologist at Montefiore and assistant professor at Albert Einstein College of Medicine in New York City, and colleagues identified 16 COVID-19-positive patients, average age 70, who underwent CT angiography of the lower extremities for symptoms of leg ischemia. These patients were compared with 32 COVID-19-negative patients, average age 71, who underwent CT angiography with similar symptoms in previous years and who were well matched with COVID-19 cohort for demographic and clinical characteristics.

All patients with COVID-19 infection undergoing lower extremity CT angiography had at least one clot in the leg, compared with only 69% of controls. The clots in the COVID-19 patients were significantly larger and affected arteries higher up in the leg with greater frequency than those in controls. Death or limb amputation was more common in the COVID-19 patients.

“We found that arterial thrombosis associated with COVID-19 infection was characterized by dire outcomes, namely strikingly increased rates of amputation and death, which in our series were 25% and 38%, respectively,” Dr. Goldman said. 

 

For Your Information

Access the Radiology study, "Lower Extremity Arterial Thrombosis Associated with COVID-19 is Characterized by Greater Thrombus Burden and Increased Rate of Amputation and Death."

Media Coverage of RSNA

In June, 487 RSNA-related news stories were tracked in the media. These stories had over 249 million audience impressions.

 

Coverage included U.S. News & World Report, San Francisco Chronicle, The Arizona Republic, Houston Chronicle, HealthDay, Drugs.com, Pittsburgh Post-Gazette, ScienceDaily, Auntminnie.com, Healthcare Business News, Diagnostic Imaging, Radiology Business, Applied Radiology and Health Imaging News.

Breast Cancer Awareness Month: Share RadiologyInfo.org With Your Patients

Visit RadiologyInfo.org, the public information website produced by RSNA and ACR, for easy-to-read patient information about the risk factors, available screening methods and treatment options for breast cancer.

RadiologyInfo.org