Radiology Bulletin: May 2008

Thursday 29 May 2008

BMJ 10 May 2008; Vol. 336, No. 7652

Imaging technology could be useful in poor countries
Judy Siegel-Itzkovich

Everyone’s a radiologist now [Feature article]
Jacqui Wise

Wednesday 28 May 2008

AJR 2008 ; VOL 190 ; PART 5

Cone Beam Computed Tomography: An Innovative Tool for Airway Assessment

Link to journal
Osorio, Federico; Perilla, Mauricio; Doyle, D John; Palomo, J Martin
Cone Beam Computed Tomography: An Innovative Tool for Airway Assessment
Anesthesia & Analgesia. 106(6):1803-1807, June 2008.
Abstract
Improvements in airway imaging technology provide the potential for an improved understanding of airway pathology and upper airway mechanics. We present here a preliminary report on the applicability of cone beam computed tomography technology in conjunction with multidimensional digital analysis for the purposes of clinical airway management. The use of this technology for airway imaging in anesthesiology has not been reported. Traditional skeletal and soft tissue images as well as distance and volume measurements were obtained without difficulty. Three-dimensional image reconstructions as well as "virtual laryngoscopy" were achieved with resulting excellent image quality, suggesting a broad range of possibilities for upper airway examination and analysis. A modified Muller test with volumetric rendering of the airway passages under baseline and negative pressure conditions was also performed, made possible as a result of the system's short (9 s) scanning times. We believe that cone beam computed tomography technology offers an additional dimension to airway evaluation that has considerable potential.

Recent articles from Spine journal

Link to journal
Videman, Tapio MD; Battie, Michele C.; Parent, Eric; Gibbons, Laura E.; Vainio, Pauli; Kaprio, Jaakko
Progression and Determinants of Quantitative Magnetic Resonance Imaging Measures of Lumbar Disc Degeneration: A Five-Year Follow-up of Adult Male Monozygotic Twins
Publish Ahead of Print, POST AUTHOR CORRECTIONS, 9 May 2008
Abstract
Study Design. A longitudinal study.Objective. Our goal was to explore the role of digital magnetic resonance imaging (MRI) data, by extending our earlier 5-year follow-up study of progression of lumbar spine degeneration with quantitative measures of disc degeneration.Summary of Background Data. A longitudinal study is optimal for investigating disc degeneration but only a few studies (with small sample sizes) or short follow-up studies include repeated MRI data.Methods. Subjects consisted of 134 male monozygotic twins (age 35-69 years). Quantitative MRI measures included changes in disc bulging and height. Inter-rater reliability coefficients were between 0.77 and 0.96. At baseline and follow-up, an extensive interview about exposures to suspected determinants was conducted.Results. Reduction in disc height and increases in bulges (worsening) were seen in 2/3 of subjects. The mean reduction in disc height was 2.2% to 3.6%. A mean increase in bulging of 7% to 10% was found in the L1-L4 discs and 4% in L4-S1 discs. Although the mean changes were small, few reverse changes were observed. Familial aggregation, a proxy for genetic influences, explained 17% of changes in disc height, and 11% and 0% of changes in the sizes of anterior and posterior bulges in the regression models. Higher maximal occupational lifting (AR2 = 4.9%) and smoking (AR2 = 3.5%) during follow-up predicted more disc height reduction. Greater increases in bulging (AR2 = 7.4%-10.2%) were predicted by smaller bulges at baseline.Conclusion. The mean annual changes in disc heights (<1%)>

Kanayama, Masahiro; Togawa, Daisuke; Terai, Tomoya; Hashimoto, Tomoyuki et al
RISK FACTORS FOR LUMBAR DISC DEGENERATION: AN MRI ANALYSIS OF 130 HEALTHY VOLUNTEERS. [Abstract]
Spine. (Supplement 2008 Meeting Abstracts):101, August 2008.

Davis, Rick
ROUTINE DYNAMIC IMAGING FOR EVALUATING DEGENERATIVE LUMBAR STENOSIS: INCIDENCE OF DEGENERATIVE SPONDYLOLISTHESIS MISSED ON SUPINE MRI.[Abstract]
Spine. (Supplement 2008 Meeting Abstracts):6, August 2008.

Recent articles from Stroke journal

Link to journal
Nitkunan, Arani; Barrick, Tom R.; Charlton, Rebecca A.; Clark, Chris A.; Markus, Hugh S.
Multimodal MRI in Cerebral Small Vessel Disease: Its Relationship With Cognition and Sensitivity to Change Over Time
Publish Ahead of Print, published online before print, 24 April 2008
Abstract
Background and Purpose-: Cerebral small vessel disease is the most common cause of vascular dementia. Interest in using MRI parameters as surrogate markers of disease to assess therapies is increasing. In patients with symptomatic sporadic small vessel disease, we determined which MRI parameters best correlated with cognitive function on cross-sectional analysis and which changed over a period of 1 year.Methods-: Thirty-five patients with lacunar stroke and leukoaraiosis were recruited. They underwent multimodal MRI (brain volume, fluid-attenuated inversion recovery lesion load, lacunar infarct number, fractional anisotropy, and mean diffusivity from diffusion tensor imaging) and neuropsychological testing. Twenty-seven agreed to reattend for repeat MRI and neuropsychology at 1 year.Results-: An executive function score correlated most strongly with diffusion tensor imaging (fractional anisotropy histogram, r=-0.640, P=0.004) and brain volume (r=0.501, P=0.034). Associations with diffusion tensor imaging were stronger than with all other MRI parameters. On multiple regression of all imaging parameters, a model that contained brain volume and fractional anisotropy, together with age, gender, and premorbid IQ, explained 74% of the variance of the executive function score (P=0.0001). Changes in mean diffusivity and fractional anisotropy were detectable over the 1-year follow-up; in contrast, no change in other MRI parameters was detectable over this time period.Conclusion-: A multimodal MRI model explains a large proportion of the variation in executive function in cerebral small vessel disease. In particular, diffusion tensor imaging correlates best with executive function and is the most sensitive to change. This supports the use of MRI, in particular diffusion tensor imaging, as a surrogate marker in treatment trials.

Burgess, Richard E. ; Warach, Steven; Schaewe, Timothy J. et al
Development and Validation of a Simple Conversion Model for Comparison of Intracerebral Hemorrhage Volumes Measured on CT and Gradient Recalled Echo MRI
Status Publish Ahead of Print, published online before print, 15 May 2008
Abstract
Background and Purpose-: Gradient recalled echo MRI (GRE) has been shown to be as accurate as CT for the detection of acute intracerebral hemorrhage (ICH). However, because of the differences in the signal parameter being detected, apparent hemorrhage size is expected to vary by imaging modality, with GRE providing larger volumes attributable to susceptibility effects.Methods-: Image data from patients participating in 3 ICH studies were retrospectively reviewed. Patients with acute ICH were included if (1) concurrent MRI and CT were performed within 72 hours of symptom onset, and (2) each modality was performed within 240 minutes of each other. ICH volumes were calculated using a semiautomated image analysis program. The least squares method was used to develop a conversion equation based on a linear regression of GRE volume on CT volume.Results-: Thirty-six patients met inclusion criteria. MRI was performed first in 18, CT first in 18. Mean hemorrhage volume was 25.2cc (range 0.1 to 83.9cc) on CT and 32.7cc (range 0.1 to 98.7cc) measured on GRE. A linear relationship defined by CT Volume=GRE Volume*0.8 (Spearman's correlation coefficient=0.992, P<0.001) volume="0.8*GRE">

Starting early: MRI evidence of gray matter atrophy in children with MS

Link to journal
Banwell, Brenda L. MD; Sled, John G. PhD;
Starting early: MRI evidence of gray matter atrophy in children with multiple sclerosis
[Editorial]
Neurology. 70(13, Part 2 of 2):1065-1066, March 25, 2008.

Friday 16 May 2008

Altered fMRI activation during mental rotation in those at genetic risk for Alzheimer disease

Link to journal
Yassa, Michael A. ; Verduzco, Guillermo ; Cristinzio, Catherine ; Bassett, Susan Spear
Altered fMRI activation during mental rotation in those at genetic risk for Alzheimer disease
Neurology. 70(20):1898-1904, May 13, 2008.
Abstract
Objective: This study was undertaken to examine differential functional MRI patterns in those at genetic risk for Alzheimer disease (AD), specifically investigating parietal lobe activation, a brain region with changes noted in the early stages of AD.Methods: This study uses functional MRI to investigate blood oxygenation level dependent changes in the parietal lobe in a high-risk sample of 18 asymptomatic offspring of autopsy-confirmed AD cases, compared to 15 matched controls. The cognitive activation paradigm was a mental rotation task, which requires individuals to rotate three-dimensional cube stimuli to judge their similarity.Results: We found no differences in either reaction time or performance accuracy between groups. However, the at-risk individuals showed increases in activation in the right superior parietal lobule (BA 7), the right insula (BA 13), the right middle frontal gyrus (BA 10), and the right inferior frontal gyrus (BA 47).Conclusions: We present evidence for a compensatory mechanism for those at increased risk for Alzheimer disease (AD). This study examines and confirms parietal changes with increased risk for late-onset AD, despite normal cognitive performance. Added to the previous findings from this group, these results demonstrate the sensitivity of functional imaging measures to brain changes that are not yet reflected in cognitive performance, which may ultimately serve as an important indicator of disease.(C)2008AAN Enterprises, Inc.

Journal of Medical Imaging and Radiation Oncology vol. 52 no.3 June 2008

N.B. This journal is not available to us in full text

EDITORIAL
Multidisciplinary meetings: Patient expectations and legal liability
I Freckelton
pages 199–200
RADIOLOGY
Pictorial Essays
Novel intra-arterial strategies in the treatment of acute ischaemic stroke
PP Ng, EA Stevens EJ Skalabrin
pages 201–207
Unusual causes of small bowel obstruction and contemporary diagnostic algorithm
OG Gümüta, A Gümüta, R Yalçn, G Savc RA Soylu
pages 208–215
RADIOLOGY
Review Article
Imaging of horseshoe kidneys and their complications
J O’Brien, O Buckley, O Doody, E Ward, T Persaud W Torreggiani
pages 216–226
RADIOLOGY
Original Articles
Clinical significance of intrasubstance meniscal lesions on MRI
AK Low, MR Chia, DJ Carmody, P Lucas D Hale
pages 227–230
Fine-needle trucut biopsy versus fine-needle aspiration cytology with ultrasound guidance in the abdomen
AM O’Connell, F Keeling, M Given, M Logan MJ Lee
pages 231–236
Radiological management of patients with urinary obstruction following urinary diversion procedures: Technical factors, complications, long-term management and outcome. Experience with 378 procedures
MM Maher, S Rizzo, M Kalra, SE Mc Sweeney, R Arellano, P Hahn, D Gervais P Mueller
pages 237–243
Prototype system for enhancement of frontal chest radiographs using eigenimage processing
A Butler, P Bones M Hurrell
pages 244–253
Clinical influence of 18F-fluorodeoxyglucose positron emission tomography on the management of primary tumours of the thymus
JW-Y Lee, M Mac Manus, A Hogg, R Hicks D Ball
pages 254–261
Development of an instrument to measure the clinical learning environment in diagnostic radiology
L Bloomfield R Subramaniam
pages 262–268
RADIATION ONCOLOGY
Review Articles
Use of ‘sham’ radiotherapy in randomized clinical trials
F Schwarz D Christie
pages 269–277
The important role of radiotherapy in patients with non-melanoma skin cancer and other cutaneous entities
MJ Veness
pages 278–286
RADIATION ONCOLOGY
Original Articles
Group decisions in oncology: Doctors’ perceptions of the legal responsibilities arising from multidisciplinary meetings
MA Sidhom MG Poulsen
pages 287–292
Interplanner variability in carrying out three-dimensional conformal radiation therapy for non-small-cell lung cancer
S Everitt, T Kron, N Fimmell, J Reynolds, C Laferlita, D Ball, M Schneider-Kolsky, R Budd M Mac Manus
pages 293–296
Low-dose palliative splenic irradiation in haematolymphoid malignancy
RK Shrimali, PD Correa N O’Rourke
pages 297–302
LETTER TO THE EDITOR
RE: Multicentre quality assurance of intensity-modulated radiation therapy planning: Beware the benchmarker
MJ Williams, MJ Bailey, D Forstner PE Metcalfe
pages 303–303

Thursday 15 May 2008

British Journal of Radiology 2008 ; Vol 81 ; Part 964

N.B. This journal is not available to us in full text

Current issues in nuclear cardiology
Tonge , C . M . ; Fernandez , R . C . ; Harbinson , M . T .
Page: 270-274
Search the Web:
[article] [author(s)]

Imaging the heart valves using ECG - gated 64 - detector row cardiac CT
Manghat , N . E . ; Rachapalli , V . ; Van Lingen , R . ; Veitch , A . M . ; Roobottom , C . A . ; Morgan - Hughes , G . J .
Page:275-290
Search the Web:
[article] [author(s)]

The impact of ^ 1 ^ 8F - FDG PET / CT on assessment of nasopharyngeal carcinoma at diagnosis
King , A . D . ; Ma , B . B . ; Yau , Y . Y . ; Zee , B . ; Leung , S . F . et al
Page:291-298
Search the Web:
[article] [author(s)]

Treatment of ruptured intracranial aneurysms : a decision analysis
Takao , H . ; Nojo , T . ; Ohtomo , K.
Page:299-303
Search the Web:
[article] [author(s)]

A comparison between cobalt and linear accelerator - based treatment plans for conformal and intensity - modulated radiotherapy
Adams , E . J . ; Warrington , A . P .
Page:304-310
Search the Web:
[article] [author(s)]

An investigation into methods of IMRT planning applied to breast radiotherapy
Donovan , E . M . ; Yarnold , J . R . ; Adams , E . J . ; Morgan , A . ; Warrington , A . P J . ; Evans , P . M .
Page:311-322
Search the Web:
[article] [author(s)]

Radiobiological compensation of treatment errors in radiotherapy
Jones , B . ; Dale , R . G .
Page:323-326
Search the Web:
[article] [author(s)]

Re - defining rectal volume and DVH for analysis of rectal morbidity risk after radiotherapy for early prostate cancer
O Donnell , H . E . ; Finnegan , K . ; Eliades , H . ; Oliveros , S . ; Plowman , P . N
Page: 327-332
Search the Web:
[article] [author(s)]

A dosimetric comparison between two intensity - modulated radiotherapy techniques : tomotherapy vs dynamic linear accelerator

Whitelaw , G . L . ; Blasiak - Wal , I . ; Cooke , K . ; Usher , C . et al
Page:333-340
Search the Web:
[article] [author(s)]

Validation of correction methods for the non - linear response of digital radiography systems
Mackenzie , A
Page: 341-345
Search the Web:
[article] [author(s)]

Radiological features of synovial cell sarcoma
O Sullivan , P . J . ; Harris , A . C . ; Munk , P . L .
Page:346-356
Search the Web:
[article] [author(s)]

Rapidly enlarging mediastinal mass in a middle - aged patient with fever
Kandpal , H . ; Seith , A .
Page: 357-359
Search the Web:
[article] [author(s)]

BMJ Learning module - Transoesophageal echocardiography

Transoesophageal echocardiography
Multiple choice questionnaire
What's in this case:
This is a series of multiple choice questions to accompany the article "Transoesophageal echocardiography" from Education in Heart.View user opinions
Author: Partho P Sengupta and Bijoy K Khandheria

Multimodal MRI in Cerebral Small Vessel Disease

Stroke - articles published ahead of print

Link to journal
Nitkunan, Arani; Barrick, Tom R. ; Charlton, Rebecca A. ; Clark, Chris A. ; Markus, Hugh S. et al
Multimodal MRI in Cerebral Small Vessel Disease: Its Relationship With Cognition and Sensitivity to Change Over Time
Status : Publish Ahead of Print, published online before print, 24 April 2008
Abstract
Background and Purpose-: Cerebral small vessel disease is the most common cause of vascular dementia. Interest in using MRI parameters as surrogate markers of disease to assess therapies is increasing. In patients with symptomatic sporadic small vessel disease, we determined which MRI parameters best correlated with cognitive function on cross-sectional analysis and which changed over a period of 1 year.Methods-: Thirty-five patients with lacunar stroke and leukoaraiosis were recruited. They underwent multimodal MRI (brain volume, fluid-attenuated inversion recovery lesion load, lacunar infarct number, fractional anisotropy, and mean diffusivity from diffusion tensor imaging) and neuropsychological testing. Twenty-seven agreed to reattend for repeat MRI and neuropsychology at 1 year.Results-: An executive function score correlated most strongly with diffusion tensor imaging (fractional anisotropy histogram, r=-0.640, P=0.004) and brain volume (r=0.501, P=0.034). Associations with diffusion tensor imaging were stronger than with all other MRI parameters. On multiple regression of all imaging parameters, a model that contained brain volume and fractional anisotropy, together with age, gender, and premorbid IQ, explained 74% of the variance of the executive function score (P=0.0001). Changes in mean diffusivity and fractional anisotropy were detectable over the 1-year follow-up; in contrast, no change in other MRI parameters was detectable over this time period.Conclusion-: A multimodal MRI model explains a large proportion of the variation in executive function in cerebral small vessel disease. In particular, diffusion tensor imaging correlates best with executive function and is the most sensitive to change. This supports the use of MRI, in particular diffusion tensor imaging, as a surrogate marker in treatment trials.

Mandell, Daniel M. ; Han, Jay S. ; Poublanc, Julien ; Crawley, Adrian P. ; Stainsby, Jeff A. et al
Mapping Cerebrovascular Reactivity Using Blood Oxygen Level-Dependent MRI in Patients With Arterial Steno-occlusive Disease: Comparison With Arterial Spin Labeling MRI.
Status: published online before print, 1 May 2008
Abstract
Background and Purpose-: Blood oxygen level-dependent MRI (BOLD MRI) of hypercapnia-induced changes in cerebral blood flow is an emerging technique for mapping cerebrovascular reactivity (CVR). BOLD MRI signal reflects cerebral blood flow, but also depends on cerebral blood volume, cerebral metabolic rate, arterial oxygenation, and hematocrit. The purpose of this study was to determine whether, in patients with stenoocclusive disease, the BOLD MRI signal response to hypercapnia is directly related to changes in cerebral blood flow.Methods-: Thirty-eight patients with steno-occlusive disease underwent mapping of CVR by both BOLD MRI and arterial spin labeling MRI. The latter technique was used as a reference standard for measurement of cerebral blood flow changes.Results-: Hemispheric CVR measured by BOLD MRI was significantly correlated with that measured by arterial spin labeling MRI for both gray matter (R=0.83, P<0.0001) and white matter (R=0.80, P<0.0001). Diagnostic accuracy (area under receiver operating characteristic curve) for BOLD MRI discrimination between normal and abnormal hemispheric CVR was 0.90 (95% CI=0.81 to 0.98; P<0.001) for gray matter and 0.82 (95% CI=0.70 to 0.94; P<0.001) for white matter. Regions of paradoxical CVR on BOLD MRI had a moderate predictive value (14 of 19 hemispheres) for spatially corresponding paradoxical CVR on arterial spin labeling MRI. Complete absence of paradoxical CVR on BOLD MRI had a high predictive value (31 of 31 hemispheres) for corresponding nonparadoxical CVR on arterial spin labeling MRI.Conclusions-: Arterial spin labeling MRI confirms that, even in patients with stenoocclusive disease, the BOLD MRI signal response to hypercapnia predominantly reflects changes in cerebral blood flow.

Electrical impedance tomography

Link to journal
Schultz, Marcus J. MD, PhD, FCCP
Electrical impedance tomography - A new toy for boys or the future for mechanically ventilated patients? [Editorial]
Critical Care Medicine. 36(4):1380-1381, April 2008.

Costa, Eduardo L. V.; Chaves, Caroline N.; Gomes, Susimeire; Beraldo, Marcelo A.; Volpe, Marcia S. et al
Real-time detection of pneumothorax using electrical impedance tomography
Critical Care Medicine. 36(4):1230-1238, April 2008.
Abstract
Objectives: Pneumothorax is a frequent complication during mechanical ventilation. Electrical impedance tomography (EIT) is a noninvasive tool that allows real-time imaging of regional ventilation. The purpose of this study was to 1) identify characteristic changes in the EIT signals associated with pneumothoraces; 2) develop and fine-tune an algorithm for their automatic detection; and 3) prospectively evaluate this algorithm for its sensitivity and specificity in detecting pneumothoraces in real time.Design: Prospective controlled laboratory animal investigation.Setting: Experimental Pulmonology Laboratory of the University of Sao Paulo.Subjects: Thirty-nine anesthetized mechanically ventilated supine pigs (31.0 +/- 3.2 kg, mean +/- sd).Interventions: In a first group of 18 animals monitored by EIT, we either injected progressive amounts of air (from 20 to 500 mL) through chest tubes or applied large positive end-expiratory pressure (PEEP) increments to simulate extreme lung overdistension. This first data set was used to calibrate an EIT-based pneumothorax detection algorithm. Subsequently, we evaluated the real-time performance of the detection algorithm in 21 additional animals (with normal or preinjured lungs), submitted to multiple ventilatory interventions or traumatic punctures of the lung.Measurements and Main Results: Primary EIT relative images were acquired online (50 images/sec) and processed according to a few imaging-analysis routines running automatically and in parallel. Pneumothoraces as small as 20 mL could be detected with a sensitivity of 100% and specificity 95% and could be easily distinguished from parenchymal overdistension induced by PEEP or recruiting maneuvers. Their location was correctly identified in all cases, with a total delay of only three respiratory cycles.Conclusions: We created an EIT-based algorithm capable of detecting early signs of pneumothoraces in high-risk situations, which also identifies its location. It requires that the pneumothorax occurs or enlarges at least minimally during the monitoring period. Such detection was operator-free and in quasi real-time, opening opportunities for improving patient safety during mechanical ventilation.

Radiology Management 2008 ; Vol 30 ; Part 2

Where Art Thou Content ?
Murphy , D . L
Page: 6-7
Search the Web:
[article] [author(s)]

Hindling a Friendship with Inspector Clouseau
Lipcamon , J . D
Page: 8-10
Search the Web:
[article] [author(s)]

Hiring the Right Person
Edge , R
Page: 11-12
Search the Web:
[article] [author(s)]

Is It a Screening or Diagnostic Mammogram ?
Mulaik , M . W
Page: 13-17
Search the Web:
[article] [author(s)]

The Impact Leadership Has on Training and Change
Lia , S . ; Grady , S . ; Peters , L .
Page: 18-26
Search the Web:
[article] [author(s)]

Results That Last : Hardwiring Behaviors That Will Take Your Company to the Top
Grieshaber , W
Page: 27-29
Search the Web:
[article] [author(s)]

Personality Assessments as a Workforce Diversity Tool
Collins , S . K . ; Sord , B . ; Griffin , C . ; Borges , L .
Page: 30-38
Search the Web:
[article] [author(s)]

The Radiology Report : A New Look at an Old Standard
Kroken , P
Page: 39-41
Search the Web:
[article] [author(s)]

Critical Perspectives on Cultural Competence as a Strategic Opportunity for Achieving High Performance in Healthcare Organizations
Strelitz , P . ; Watson , K .
Page: 42-47
Search the Web:
[article] [author(s)]

Searching for Savings
Boyd , G . D
Page: 48-49
Search the Web:
[article] [author(s)]

The Economic and Clinical Benefits of Portable Head / Neck CT Imaging in the Intensive Care Unit
Masaryk , T . ; Kolonick , R . ; Painter , T . ; Weinreb , D . B .
Page: 50-55
Search the Web:
[article] [author(s)]

Are Your Vendors Competent ?
Yoder , E
Page: 56-59
Search the Web:
[article] [author(s)]

Treasure Hunt
Tye , G . A
Page:
60-60
Search the Web:
[article] [author(s)]

Evaluation of Obstetric and Gynecologic Patients

CT, MRI, PET, PET/CT, and Ultrasound in the Evaluation of Obstetric and Gynecologic Patients
Andrew C. Gjelsteen, Brian H. Ching, Mark W. Meyermann, Douglas A. Prager, Thomas F. Murphy, Bryan D. Berkey, Lex A. Mitchell
pages 361-390
http://www.surgical.theclinics.com/article/S0039-6109%2808%2900006-6/abstract

AJR Library subscription - update

Delivery of paper copies has resumed - still awaiting news on electronic options.

Radiology Bulletin