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March 25, 2014
Submit Abstracts
for RSNA 2014
Now is the time to submit your abstract to be
considered for presentation at RSNA 2014. The submission deadline is 12
p.m. Central Time on April 9, 2014. Abstracts are required for scientific
presentations, applied science exhibits, educational exhibits, quality storyboards
and quantitative imaging reading room showcase applications. To submit an abstract
online, go to RSNA.org/abstracts.
More information about RSNA 2014,
including registration and course enrollment dates, is available at RSNA.org/Annual_Meeting.aspx.
NEW THIS WEEK IN RSNA SA-CME
Don't miss new Refresher Courses, including "RSNA Resident and Fellow Symposium
2013: Planning for Success After Residency" and "Musculoskeletal Pitfalls and
Pearls."
RSNA continuously updates its SA-CME offerings. Go to RSNA.org/library and click "Browse New."
LEADING THE NEWS
$1
Billion Worth of Brain Scans Ordered for Headache Sufferers in U.S. Each Year
A new study shows that 12 percent of patient visits resulting from a persistent
or severe headache or migraine end in a brain scan being ordered for the patient.
Those brain scans add up to a total cost of roughly $1 billion a year. Researchers
analyzed 51.1 million headache-related visits between 2007 and 2010, and 12.4
percent of those visits resulted in a MRI or CT scan of the brain. The research
was published in JAMA Internal Medicine
 From "$1 Billion Worth of Brain Scans Ordered for
Headache Sufferers in U.S. Each Year" UPI (03/17/14) Brooks Hays
| Back to Top
RESEARCH
CT
Perfusion Useful for Evaluating Esophageal Tumors
In a study presented
at the recent ECR 2014 conference, researchers compared CT perfusion's ability
to evaluate esophageal cancers to that of the preferred PET/CT method. Specifically,
the researchers examined CT perfusion's usefulness in assessing tumor angiogensis,
for which it may be better suited due to its shorter exam time and ability to
offer quantitative assessments. To this end, they compared CT perfusion parameters
— such as blood volume, blood flow, and permeability surface — with glucose
metabolism and maximum standardized uptake values (SUV) established via PET/CT.
Researchers examined 31 patients who underwent FDG-PET/CT for esophageal cancer
staging, as well as CT perfusion and thoracoabdominal CT, between May 2012 and
November 2013. They found that CT perfusion results aligned with PET SUV values
across histological types and tumor diameters. CT perfusion parameters were all
very similar for stage I, II, and III cancers, but differences in blood flow were
observed in cancers stage IV and up. Study co-author Dr. Mecit Kantarci said that
while the study had significant limitations, it indicated that CT perfusion may
have useful applications for quantitatively evaluating the vascularity of esophogeal
tumors during staging and while monitoring therapy response.
From "CT Perfusion Useful for Evaluating Esophageal
Tumors" AuntMinnie.com (03/19/14) Rabia Mughal | Back to Top
Emergency
Bedside Ultrasound Exhibits Improved Sensitivity in Urinary Stone Detection
In a new study published in the Western Journal of Emergency Medicine, researchers
examined the merits of using the detection of hydronephrosis by bedside ultrasound
as a suitable emergency department detection method for urinary stones. The researchers
carried out a structured, retrospective chart review of 125 patients with both
CT-proven renal calculi and bedside ultrasound results. They found that bedside
ultrasound's overall sensitivity to hydronephrosis was 78.4 percent, with positive
overall sensitivity of 82.4 percent to either hydronephrosis or visualized stones.
Sensitivity was greater in patients with larger stones, with researchers able
to identify 100 percent of patients with stones 6 millimeters or larger that would
benefit from medical expulsive therapy. Sensitivity was also 100 percent for patients
with three or more stones.
From "Emergency Bedside Ultrasound Exhibits Improved
Sensitivity in Urinary Stone Detection" Health Imaging (03/17/14) Anna
Streere | Back to Top
Increased
Risk of Relapse Omitting RT in Early PET Scan Negative Hodgkin Lymphoma
Interim analysis of the intergroup EORTC-LYSA-FIL 20051 H10 trial published in
the Journal of Clinical Oncology suggests that omitting radiotherapy in early
PET scan negative patients during treatment of stage I/II Hodgkin's lymphoma patients
increases the risk of early relapse. Standard treatment for patients with clinical
stage I/II Hodgkin's Lymphoma is adriamycin, bleomycin, vinblastin, and dacarbazin
(ABVD) chemotherapy followed by involved-node radiotherapy. The primary objective
of the H10 trial was to determine if radiotherapy could be omitted in patients
who returned negative early PET scans following two cycles of ABVD chemotherapy.
The interim analysis included 1,137 patients with untreated I/II Hodgkin's Lymphoma,
444 with favorable and 693 with unfavorable prognoses. Patients in both prognostic
groups were randomly assigned to either an experimental arm, in which patients
who attained negative early PET scans following two cycles of ABVD would be spared
radiotherapy, or a control arm receiving the standard treatment. The experimental
arms of both prognostic groups developed more progressions than the control arms,
nine compared to one in the favorable prognosis group and 16 compared to seven
in the unfavorable prognosis group. Based on these results, the Independent Data
Monitoring Committee advised halting randomization for early PET negative patients.
From "Increased Risk of Relapse Omitting RT in Early
PET Scan Negative Hodgkin Lymphoma" Science Codex (03/19/14) | Back to Top
Lung
Ultrasounds Detect Pulmonary Edema in Preeclampsia
A study published in
the journal Anesthesiology found that lung ultrasounds (US) can spot both pulmonary
edema and increased left ventricular end-diastolic pressure (LVEDP) in patients
suffering from severe preeclampsia. Participating in the study were 20 otherwise
healthy adult patients with severe preeclampsia, and they all received lung and
cardiac US before and after delivery. The researchers determined pulmonary edema
using the B-pattern and the Echo Comet Score, while left ventricular LVEDPs were
evaluated by transthoracic echocardiography. Lung US revealed that five women
had pulmonary edema before delivery, while cardiac US found only four with the
condition. The lung US also identified a patient with non-cardiac pulmonary edema,
which the cardiac US had overlooked. The researchers observed that lung US detected
B-pattern in a quarter of patients with severe preeclampsia, and this incidence
was higher than that of clinical edema disclosed in the literature.
From "Lung Ultrasounds Detect Pulmonary Edema in
Preeclampsia" Diagnostic Imaging (03/19/14) | Back to Top
MRI
Effective Alternative for Diagnosing Pediatric Appendicitis
According
to a study
published online March 17 in the journal Radiology, magnetic resonance imaging
without contrast is a viable alternative test for suspected pediatric appendicitis.
Researchers from the Texas Children's Hospital in Houston compared MR imaging
without contrast and ultrasound for diagnosis of pediatric appendicitis. Traditionally,
if ultrasound is inconclusive, it is followed by a CT scan for diagnosis. However,
ultrasounds are not always available, and CT scans increase the patients' overall
exposure to radiation. All patients underwent an ultrasound on the right lower
quadrant and a nonenhanced, nonsedated abdominopelvic MR imaging exam. When equivocal
interpretations were designated positive, MR imaging had 93.3 percent sensitivity,
and ultrasound had 90.0 percent sensitivity. The specificity was 98 percent for
MR imaging and 86.3 percent for ultrasound. Positive predictive value was 96.5
percent for MR imaging and 79.4 percent for ultrasound, while negative predictive
value was 96.2 percent for MR imaging and 93.6 percent for ultrasound. When equivocal
interpretations were designated negative, MR imaging sensitivity, specificity,
positive predictive value, and negative predictive value were unchanged. For ultrasound,
sensitivity was 86.7 percent, specificity was 100 percent, positive predictive
value was 100 percent, and negative predictive value was 92.7 percent. The authors
conclude that nonenhanced MR imaging demonstrated high diagnostic performance
similar to ultrasound in the pediatric population examined.
From "MRI Effective Alternative for Diagnosing Pediatric
Appendicitis" Diagnostic Imaging (03/20/14) | Back to Top
Single-Screening
MRI Beneficial for Women With Breast Conservation Therapy History
A study
published online March 17 in the journal Radiology suggests that certain women
with a history of breast conservation therapy (BCT), following treatment of early-stage
breast cancer, may benefit from MRI screening to detect secondary cancers. Researchers
conducted a retrospective study of 607 women who underwent 932 MRI screening exams,
following previous negative mammography and ultrasonographic results. The researchers
focused on cancer detection rate and the characteristics of detected cancers,
as well positive predictive value, sensitivity, and specificity. MRI screening
yielded an overall cancer detection rate of 18.1 per 1,000, identifying 11 cancers
in total, eight of which were invasive ductal carcinomas and three of which were
ductal carcinomas in situ. Sensitivity of the screenings was 91.7 percent and
specificity was 82.2 percent, with positive predictive values for recall and biopsy
of 9.4 percent and 43.5 percent, respectively. The study found that those who
developed MRI-detected cancers were more likely to be younger than 50 and had
undergone initial surgery more than 24 months before screening.
From "Single-Screening MRI Beneficial for Women
With Breast Conservation Therapy History" Health Imaging (03/18/14) Anna
Steere | Back to Top
Study
Finds Heart Scans Only Useful in Prescribing Statins Under Certain Conditions
Research published online in the journal Circulation: Cardiovascular Quality Outcomes
finds that using coronary artery calcium (CAC) testing to screen patients before
prescribing statin medication is not cost effective. Researchers from the University
of California San Francisco used data from the Multi-Ethnic Study of Atherosclerosis
and other sources to model treatment for 10,000 55-year-old women with high cholesterol
and 7.5 percent 10-year risk of coronary heart disease. They found that, while
giving statins to all of these patients would cause 70 cases of statin-induced
muscle disease, it would prevent 32 heart attacks and add 1,108 years to the patients'
cumulative life span. On the other hand, screening patients using CAC would lower
the rate of statin-induced illness and reduce overall medication costs. However,
the tests alone cost between $200 and $400 each and carry a small risk of radiation-induced
cancer. The researchers concluded that, because statins currently cost only 13
cents per pill and have a limited impact on quality of life, it is more cost effective
to prescribe the drugs to all at-risk patients. Statin prices would have to rise
above $1 per pill or show a more dramatic negative effect on quality of life to
make CAC screening more cost effective.
From "Study Finds Heart Scans Only Useful in Prescribing
Statins Under Certain Conditions" Medical News Today (03/16/14)
| Back to Top
MEDICAL-LEGAL ISSUES
Doctors
Urge CMS to Issue Rule on Premium Grace Period
The American Medical Association
(AMA) and dozens of other physician groups sent a letter to Centers for Medicare
& Medicaid Services (CMS) Administrator Marilyn Tavenner earlier this month
asking her to develop new requirements that govern the notifications healthcare
providers are given about whether or not patients who have enrolled in subsidized
health insurance exchange plans have paid their premiums. Under the current rules,
insurance companies are required to notify healthcare providers that their claims
could be denied when patients are in the second or third month of a 90-day grace
period that allows them to obtain care before paying their premiums. But the AMA
and other physician groups said in their letter that insurance companies have
too much freedom in how and when they issue such notices, adding that this could
result in "administrative confusion" for doctors. The AMA and the physician groups
also note that CMS' decision to allow insurers to classify claims as pending during
the second and third months of the 90-day grace period would force physicians
to swallow the cost of treating patients who have not paid their premiums. In
addition to asking for new requirements for notifications about patients' payment
statuses, the groups also want CMS to make insurers pay for claims if they provide
incorrect information about whether or not a patient has paid his premiums during
the second and third months of the grace period.
From "Doctors Urge CMS to Issue Rule on Premium
Grace Period" Modern Healthcare (03/17/14) Andis Robeznieks - May
Require Free Registration | Back to Top
CLINICAL
PRACTICE
Mammography
Texture Analysis May Predict False Positives
Researchers presented findings
at the recent SPIE Medical Imaging 2014 conference indicating that an algorithm
that analyzes breast tissue texture on mammograms may be able to predict which
patients are more likely to have negative biopsy results, clearing a path for
more individualized screening. The researchers conducted a retrospective analysis
to determine that their texture analysis algorithm produced 51 percent sensitivity
for predicting false positives while operating at a 100 percent cancer detection
setting. The algorithm measures parenchymal tissue complexity to return objective
and reproducible thresholds for predicting the risk of false-positive biopsies,
and it allows for adaptive region-of-interest (ROI) selection based on the spatial
distribution and parenchymal tissue patterns of a specific digital mammogram.
The algorithm was assessed retrospectively on a series of digital mammography
images from the American College of Radiology Imaging Network PA 4006 trial. The
cohort featured 69 women who were recalled based on digital mammography results,
11 of whom were true positives and 59 were false positives. The algorithm computed
an individual mean feature for each corresponding texture feature over all selected
ROIs. For every patient, 13 mean texture features were calculated, including energy,
correlation, entropy, contrast, inverse difference moment, sum average, sum variance,
sum entropy, difference average, difference variance, difference entropy, information
measure of correlation 1, and information measure of correlation 2.
From "Mammography Texture Analysis May Predict False
Positives" AuntMinnie.com (03/21/14) Erik L. Ridley - May Require
Free Registration | Back to Top
RSNA Weekly is a briefing of the latest radiology-related news selected
from hundreds of sources by the editors of Information, Inc. While care is taken
to use good sources, inaccuracies in source material are not the responsibility
of RSNA or Information, Inc. |
