Journal highlights
The following are highlights from the current issues of RSNA’s peer-reviewed journals.
Thrombectomy Is Effective Regardless of Collateral Status after Stroke
Endovascular thrombectomy (EVT) can improve functional outcomes in patients with large ischemic stroke.
The 2018-2023 TENSION (Efficacy and Safety of Thrombectomy in Stroke with Extended Lesion and Extended Time Window) trial showed that EVT reduced disability at 90 days when combined with best medical treatment.
Traditionally, intracranial arterial collateral status has been used to select candidates for EVT. Good collaterals were thought to result in better outcomes. But does collateral status modify the treatment effect of EVT in patients with large-vessel occlusion and extended ischemic lesion?
Researchers led by Laurens Winkelmeier, MD, from Universitätsklinikum Hamburg-Eppendorf, Germany, recently published a secondary analysis of the TENSION trial in Radiology. The study of 201 patients found that EVT significantly improved outcomes for patients with good and poor collaterals, regardless of collateral status at pretreatment CT angiography (CTA).
“These findings suggest that endovascular treatment should not be withheld based on single-phase CTA collateral status in patients with acute ischemic stroke and large infarct presenting within 12 hours after stroke onset,” the authors conclude.
Read the full article, “Arterial Collaterals and Endovascular Treatment Effect in Acute Ischemic Stroke with Large Infarct: A Secondary Analysis of the TENSION Trial.”
Follow the Radiology editor on X @RadiologyEditor.
Axial CT angiography images show two exemplary patients, each with left-sided intracranial large-vessel occlusion and large ischemic stroke. Patient A (left side) showed a poor collateral status, defined as a collateral supply filling 50% or less of the affected middle cerebral artery territory. A good collateral status was assigned to Patient B (right side), indicating a collateral supply filling more than 50% of the affected middle cerebral artery.
Complete legend details can be found at https://pubs.rsna.org/doi/10.1148/radiol.242401 ©RSNA 2025.
A Radiologist's Guide for Navigating Malpractice
Radiologists will likely face litigation during their careers, but this important topic is often overlooked in training programs and educational conferences. The financial, psychological and time burdens associated with malpractice can be considerable, regardless of the outcome. To prepare, radiologists should familiarize themselves with the concepts, language and actions involved in legal proceedings, as well as their evolving roles and responsibilities.
A new RadioGraphics article by Luke M. Wojdyla, DO, and James Y. Chen, MD, from UC San Diego Health System in California, aims to help radiologists reduce their vulnerability to litigation and ultimately improve patient care. The authors explore the four components required to establish medical negligence: patient duty, breach of standard of care, injury and proximate causality. They also describe the mechanics of a lawsuit, common causes of lawsuits, and common practices that may affect a radiologist’s legal risk.
“Although litigation may not always be preventable, radiologists who understand the U.S. malpractice and medicolegal environment will be better positioned to mitigate unfavorable patient and legal outcomes,” the authors explain.
Read the full article, “Navigating Malpractice: Guide for U.S. Radiologists.”
This article is also available for CME on EdCentral. Follow the RadioGraphics editor on X @RadG_Editor.
Discitis-osteomyelitis in a 65-year-old man who presented with back pain. Saggital CT images in the same patient on different dates. The contemporaneous image (A) shows progressive cortical erosions and lucencies of thoracic endplates. These were present on the prior examination images obtained 1 week earlier (B) but were not reported, whereas the images from the examination from 2 weeks prior were normal. (C) Example reports from the contemporary examination. Reporting the missed finding is at the radiologists’ discretion, although some phrases may call more attention to it than others.
https://doi.org/10.1148/org.240092 ©RSNA 2025.
CT Volumetry vs. RECIST: Measuring Tumor Response
Advances in precision medicine, targeted, immune and combination cancer therapies are accelerating, but clinical trials still take years and large patient groups to reach gold-standard outcomes.
For over 20 years, Response Evaluation Criteria in Solid Tumors (RECIST) has been the foundation of clinical trials, assessing tumor response through changes in unidimensional measurements on CT. To enhance this, the Quantitative Imaging Biomarkers Alliance (QIBA) developed the “CT Tumor Volume Change for Advanced Disease (CTV-AD)” profile.
A Radiology Advances study led by Binsheng Zhao, DSc, Memorial Sloan Kettering Cancer Center in New York City, and colleagues evaluated QIBA CT volumetry change classifications (CTvol) alignment with RECIST. They analyzed 478 lesions from lung, liver and lymph nodes in 10 clinical trials with three radiologists independently segmenting each lesion.
QIBA CTvol and RECIST classifications agreed in 66.6% of cases, with major disagreements in only 1.5%. Larger lesions (≥ 50mm) showed more discrepancies. Factors like scanner vendor and segmentation tool had no significant impact. “QIBA CTvol classifications agree with RECIST categories,” the authors conclude.
Read the full article, “Comparing quantitative imaging biomarker alliance volumetric CT classifications with RECIST response categories.”
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