Diagnostic Imaging brings you coverage of ARRS 2022 annual meeting.

Coverage of ARRS 2022 Annual Meeting

In a new study involving over 3,400 participants, researchers found that postmenopausal women had a higher load of white matter hyperintensities on brain magnetic resonance imaging (MRI) in comparison to men and premenopausal women of a similar age.

For the study, which was recently published in 

, researchers reviewed T1-weighted, T2-weighted, and fluid-attenuated inversion recovery (FLAIR) MRI images for 3,410 participants. The study population included 1,167 postmenopausal women, 806 premenopausal women and 1,437 men with a mean age of 54.3 years, according to the study.

After adjustments for age and risk factors such as diabetes and high blood pressure, the study authors found that for people 45 years of age and older, postmenopausal women had an average 0.94 ml volume of white matter hyperintensities in comparison to an average of 0.72 ml in men. In a subgroup analysis of women between 45 and 59 years of age, researchers found that postmenopausal women had an average 0.51 ml volume of white matter hyperintensities in comparison to 0.33 ml in premenopausal women.

Acknowledging previous research that has noted potential neurological and cardiovascular issues associated with white matter hyperintensities, study co-author Monique M.B. Bretelet, M.D., Ph.D. suggests that postmenopausal women may have elevated risks.

“White matter hyperintensities increase as the brain ages, and while having them does not mean that a person will develop dementia or have a stroke, larger amounts may increase a person’s risk,” noted Dr. Breteler, who is affiliated with the German Center of Neurodegenerative Diseases (DZNE) in Bonn, Germany. “ … Our results imply that white matter hyperintensities evolve differently for men and women, where menopause or factors that determine where menopause starts, such as variations in the aging process, are defining factors.”

The study authors also found that controlled and uncontrolled hypertension led to higher white matter hyperintensities in men and postmenopausal women 45 years of age and older. However, researchers noted a stronger association in postmenopausal women, particularly when it came to uncontrolled hypertension (b = 0.31 [95% CI: 0.20-0.43]), in comparison to men (b = 0.12 [95% CI: 0.01-0.24]). There were no differences between premenopausal and postmenopausal women in regard to the association between uncontrolled hypertension and white matter hyperintensities.

“The results of our study not only show more research is needed to investigate how menopause may be related to the vascular health of the brain. They also demonstrate the necessity to account for different health trajectories for men, women, and menopausal status,” maintained Dr. Breteler.

The authors noted that study limitations included a lack of information on the onset of menopause, the duration, type, or dosing of hormone therapy, and whether study participants were perimenopausal. They also acknowledged that the study findings cannot be extrapolated to a gender diverse population as the baseline questionnaire for the study did not allow for sufficient detail in regard to sex and gender identity.

Articles

Emerging research with brain magnetic resonance imaging (MRI) scans 
shows that postmenopausal women have higher amounts of white matter hyperintensities that may lead to elevated risks for cognitive dysfunction and stroke.


MRI Study Reveals Increased Brain Changes in Postmenopausal Women

In the ongoing quest to expedite timely intervention for patients with lung cancer and rein in the amount of biopsies on benign nodules, Philips has added Nodify Lung (Biodesix), a blood-based risk assessment tool for lung nodules, to the company’s Lung Cancer Orchestrator system.

Philips said the Nodify Lung testing detects the presence of blood-based biomarkers and provides proteomic data that may provide adjunctive value to clinical and radiomic assessment in the classification of malignancy risk.

“By incorporating Biodesix’s Nodify Lung testing, we take another step in leveraging integrated diagnostics from imaging, genomics, and now proteomic results from a simple blood draw to address key moments in the lung cancer patient journey, support care team decision-making, and help health systems learn from their practice patterns in a dashboard view,” said Louis Culot, the general manager of oncology informatics and genomics at Philips.

“We are delighted that our tests are being incorporated into Philips’ vision for end-to-end cancer care management using a multi-diagnostic approach,” said Scott Hutton, the president and chief executive officer at Biodesix. “By integrating our Nodify® tests in Philips Lung Cancer Orchestrator, we hope to make these tests more accessible to physicians and patients and more easily utilized by care teams with the ultimate goal of improving patient care and outcomes.”

Philips said the Lung Cancer Orchestrator, an integrated patient management system that can be utilized for computed tomography (CT) lung cancer screening programs as well as incidental findings of lung nodules, enables physicians to keep track of imaging findings, appointments, and clinical decisions.

The addition of Biodesix’s Nodify Lung nodule risk assessment tool to Philips’ lung cancer patient management system may enhance diagnostic efficiency and facilitate improved management of high-risk patients.

Philips Adds Proteomic Nodule Risk Assessment to Lung Cancer Orchestrator System

Due to rising incidence rates of colorectal cancer in people below the age of 50, the United States Preventive Services Task Force (USPSTF) issued new guidelines in May 2021 that lowered the age threshold for colorectal cancer screening from 50 to 45 years of age.

However, emerging research suggests that the lowered age threshold may have a limited impact in improving the prevalence of screening procedures (including computed tomography colonography) among younger adult populations.

In a new study of over 80,000 patients with no history of colorectal cancer, researchers found the lowest prevalence of colorectal cancer screening and the highest screening gaps with racial and socioeconomic disparities among people who range between 50 to 54 years of age.

Incorporating data from eight National Health Interview Surveys conducted between 2000 and 2018, researchers assessed the prevalence of colorectal cancer screening among five-year age groups, according to the study, which was recently published in 

Cancer Epidemiology, Biomarkers and Prevention

 The study authors also examined factors such as race/ethnicity and socioeconomic factors including family income, education level and access to health insurance.

While the overall prevalence of colorectal cancer screening increased by nearly 30 percent between 2000 (36.7 percent) and 2018 (66.1 percent), the study authors noted a 19.4 percent increase in screening in the 50 to 54 age group (from 28.2 percent in 2020 to 47.6 percent in 2018) in comparison to a 31.6 percent increase in the 70 to 74 age group (from 46.4 percent in 2000 to 78 percent in 2018).

Comparing 2000 and 2018 statistics for the age groups in the study, the authors found that the 50 to 54 age group consistently had the smallest increases in colorectal cancer screening prevalence when it came to factors such as race and ethnicity, education, family income and health insurance access. For those who had less than a high school degree, there was a 16.1 percent increase in colorectal screening in the 50 to 54 age group in comparison to a 34.2 percent increase in the 70 to 75 age group. Hispanic people in the 70-75 age group had a more than threefold greater increase in screening (54 percent) in comparison to Hispanic people in the 50 to 54 age group (16.7 percent).

“Our findings are especially relevant to the new USPSTF guidelines that recommend average-risk screening to begin at (the age of 45 years). The persistent and worsening disparities we observed in adults 50 to 54 years (of age) may extend to those ages 45 to 49 years as they become eligible for screening,” wrote Caitlin C. Murphy, PhD, an associate professor of health promotion and behavioral sciences with the School of Public Health at the University of Texas Health Sciences Center at Houston., and colleagues.

(Editor’s note: For related content, see “

Emerging Perspectives on Computed Tomography Colonography

Study Finds CT Colonography is Extremely Underutilized.

 regard to factors that may contribute to the lower increases in colorectal cancer screening in the 50 to 54 age group, Murphy and colleagues acknowledged that cancer screening is usually not a significant concern for younger adults. They noted that access to medical care may be more limited for younger adults, who also may be juggling more family and work responsibilities than older age groups.

“Public awareness campaigns may encourage screening among younger adults, and ongoing efforts are needed to identify and address barriers to screening that are unique to this age group,” noted Murphy and colleagues.

Acknowledging inherent limitations of working with cross-sectional survey data, the study authors said other study limitations included a low 53 percent survey response in 2018 and a lack of information on repeat or longitudinal screening.

1. Lin JS, Perdue LA, Henrikson NB, Bean SI, Blasi PR. Screening for colorectal cancer: updated evidence report and systematic review for the US Preventive Services Task Force. 

2. Liu PH, Sanford NN, Liang PS, Singal AG, Murphy CC. Persistent disparities in colorectal cancer screening: a tell-tale sign for implementing new guidelines in younger adults. 

 2022 Jun 23; OF1-OF9. doi: 10.1158/1055-9965. EPI-21-1330. Online ahead of print.

In a large study looking at the use of colorectal cancer screening techniques (including computed tomography (CT) colonography) between 2000 and 2018, researchers found that the 50 to 54 age group had the lowest increases in screening and a significantly higher chasm of racial and socioeconomic disparities in comparison to other age groups.

Colorectal Cancer Screening: Could a Lower Age Threshold Reveal Greater Screening Disparities?

Could a new cloud-based suite of imaging apps help radiologists navigate increasing imaging volume in their practices?

apps that target three key aspects of radiology workflow

, according to Bayer, the manufacturer of the new platform. The company said the system includes apps to assist with lesion detection, triage of suspicious findings for expedited review, and automation of routine tasks and measurements.

The artificial intelligence (AI)-powered aspects of the imaging app platform and access to digital tools may be beneficial in improving diagnostic accuracy and efficiency with imaging assessment, according to Ryan K. Lee, MD, MBA, MRMD, chair of the department of radiology with Einstein Healthcare Network in Philadelphia

“AI has the potential to transform health care, and, particularly in medical imaging, it can turn the growing amounts of data into value-adding insights to support radiologists and their teams in their decision-making,” noted Dr. Lee, an associate professor at the Sydney Kimmel College at Thomas Jefferson University.

Offering a variety of applications, ranging from assistance with pulmonary nodule detection to triage of suspected intracerebral hemorrhage, the initial platform for Calantric Digital Solutions is primarily focused on the assessment of thoracic and neurological diseases, according to Bayer. However, the company said it plans to add more disease-specific apps to the platform in the future.

Calantric™ Digital Solutions reportedly offers artificial intelligence (AI)-powered apps, bolsters lesion detection, facilitates triage priorities and enhances workflow efficiency.

Bayer Launches Medical Imaging App Platform for Radiologists

In a new study presented recently at the 8th European Academy of Neurology (EAN) Congress in Vienna, Austria, researchers from Denmark found that patients who tested positive for COVID-19 were 3.5 times more likely to be diagnosed with Alzheimer’s disease and 2.6 times more likely to have Parkinson’s disease in comparison to patients without COVID-19. 

(Editor's note: For a related article, see "New Study Shows Link Between COVID-19 and Elevated Risks for Neurological Disorders.")

In a recent video interview, neurologist Pardis Zarifkar, MD discussed the findings of the exploratory observational study.

The study authors also found that patients with COVID-19 had a 2.7 times higher risk of ischemic stroke and a 4.8 times higher risk for intracerebral hemorrhage. While the higher prevalence of cerebrovascular disorders was expected given the previously reported association between these disorders and COVID-19, the “extent of the increase (with neurodegenerative disorders) was quite surprising,” noted Dr. Zarifkar, who is affiliated with the Department of Neurology at Rigshospitalet in Copenhagen, Denmark.

That said, Dr. Zarifkar emphasized that “neurodegenerative disorders are a long time in the making” and it is “highly unlikely” that a COVID-19 infection could cause the development of a neurodegenerative disorder at one year.

While maintaining that more research is needed to evaluate potential long-term neurological complications with COVID-19, Dr. Zarifkar is also hopeful that future studies will examine the phenomenon of cognitive and mental health issues after critical illness.

For more insights from Dr. Zarifkar, watch the video below:

Videos

In a recent video interview, neurologist Pardis Zarifkar, MD discussed a new study that found significantly elevated risks for Alzheimer’s disease and Parkinson’s disease among patients who tested positive for COVID-19. 

Video Interview: Is There an Increased Incidence of Neurodegenerative Diseases in Patients with COVID-19?

Eric Postal, MD, is a diagnostic radiologist with the University of Pittsburgh Medical Center. 

How do you like it when people put words in your mouth? In other words, some may claim you have said things you did not, or that you hold opinions you do not hold at all. It’s kind of infuriating, isn’t it?

In a worse scenario, others tell you what to say and could punish you if you don’t. This could range from financial penalties to blots on your professional record. Further, when you obediently parrot whatever you have been given, it is to audiences who have no way to distinguish your assigned utterances from what you actually wanted to say. As far as they know, you came up with and meant every word of it.

Anybody who has been working in radiology for even a little while knows the feeling all too well. Indeed, most of health care is probably like that by now, but I am just focusing on the corner of the profession I have lived in for the past couple of decades. During that time, I’ve seen a slowly rising, evil tide of “Put this in your report or else.” I have even written about it in this blog a couple of times.

Someone recently posted a thread about it on a radiology social media group I frequently visit. It was a semi-plea for advice about how others were dealing with the ever-increasing volume of required verbiage that was cluttering their reports. This includes stuff like contrast dosage, number of recent scans, radiation dose reduction jargon, the different types of Doppler or maximum intensity projection (MIP)/3D recons utilized, etc.

Other than an insurance company or some other regulator looking for “gotcha!” bait (as in “we found a flimsy excuse not to pay you for the work you’ve done”), who has any interest in how much contrast was used for a scan? If someone really does, the tech’s documentation can be referenced later. Does it clinically impact anybody’s negative DVT study if I don’t specifically say that color Doppler and spectral analysis were utilized?

I thought it was endearing that some respondents to the social media thread expressed a hope/belief that we could do something about this. One poster commented: “What we need to do is join up, all radiologists … and fight this absolute nonsense.”

Folks, the horse is not only out of the barn, he has crossed the country and has established a new life more inaccessible to us than if he has been in the witness relocation program. The time to assert some semblance of control over what went in our reports was back before an army of middlemen and regulators established a stranglehold on our profession. They have got the power now, and if you think you can take it back without severely disruptive change in the health-care field, you have got another thing coming.

Not all of the non-physicians who are putting words in our mouths are doing it for nefarious purposes like clawing back payments. Some are just political types looking to score points in the public eye by saying they “improved safety” in health care, etc. And there are always actual professionals in the field willing, if not eager, to get in good graces with such folks by furthering their agenda. “The (insert leading radiology organization) endorses Senator Blather’s initiative to put an extra paragraph in all CT reports stating that radiation can be bad.” Next week: “The (insert leading radiology organization) hopes that Sen. Blather will stand against these outrageous CMS cuts.”

Heck, some outsiders, who may never have tried to read through radiology reports, might not even understand that they are doing more harm than good. Why 

, they might honestly think, require a statement that going above the speed limit can result in loss of life and limb? Somebody might read it and drive more carefully. What does it matter that they read the advice in a mammo report? Let’s put in an anti-smoking blurb too!

So we add an extra sentence here, and an extra paragraph there. Before you know it, we’ve got a ton of boilerplate info we have to put in our reports. It buries whatever useful information we were trying to convey and makes the whole thing less readable for referring physicians, let alone the occasional patient trying to understand his or her own imaging findings.

A couple of folks responding to that social media thread, myself included, thought it might minimize the damage if we just took all of the required verbiage and put it in a dense little paragraph at the end of our reports, maybe after a page break. In other words, let as much as possible of the required nonsense get automatically populated, or input by techs and clerks, before we even get the study to read. Have the rads waste zero time on it. I suggested that the paragraph have a header like “Required verbiage from non-physician regulators.”

For good measure, I’d say let’s make it the smallest type of font possible and do away with niceties like spaces after periods and commas. Maybe use a super-flowery font that is annoying to read. Why make it easy for the regulator enforcers? Heck, put it in an almost invisibly faint color, like light cyan on a white page.

Does excess boilerplate verbiage hamper the review of radiology reports by referring physicians?

Reining in the Boilerplate Info on Radiology Reports

's Weekly Scan is your chance to catch up on the latest radiology content, from new research and device news to the latest case quizzes and conference reports. Review the slideshow below to see this week's top content:

Diagnostic Imaging's Weekly Scan: June 19-June 25

Slideshows

Catch up on the top radiology news of the past week.

Patients who tested positive for COVID-19 had significantly elevated risks for developing Alzheimer’s disease, Parkinson’s disease, ischemic stroke, and intracerebral hemorrhage in comparison to people who tested negative for COVID-19, according to the findings of a new study presented recently at the 8th European Academy of Neurology (EAN) Congress in Vienna, Austria.

In the study, which involved over 919,000 people in Denmark who were tested for COVID-19 between February 2020 and November 2021, 43,375 patients tested positive for COVID-19. Researchers found that patients with COVID-19 had 3.5 times the risk of developing Alzheimer’s disease, 2.6 times the risk of having Parkinson’s disease, 2.7 times the risk for suffering ischemic stroke and 4.8 times the risk of having intracerebral hemorrhage in comparison to patients who did not have COVID-19.

While previous research has noted an association between neurological disorders and COVID-19, lead study author Pardis Zarifkar, MD said the new study findings offer more clarity on the impact of COVID-19 on the incidence of neurological disease.

“These findings will help to inform our understanding of the long-term effect of COVID-19 on the body and the role that infections play in neurodegenerative diseases and stroke,” noted Dr. Zarifkar, who is affiliated with the Department of Neurology at Rigshospitalet in Copenhagen, Denmark.

(Editor's note: For a recent video interview with Pardis Zarifkar, MD, 

The study authors also compared patients who tested positive for COVID-19 to patients with influenza or pneumonia and found similar elevated risks for the development of neurological diseases. However, when comparing COVID-19 to influenza and inpatients with pneumonia over the age of 80, the researchers noted a 1.7 times elevated risk of ischemic stroke for patients with COVID-19.

Emerging research showed that patients with COVID-19 had 3.5 times the risk for developing Alzheimer’s disease and 2.6 times the risk for Parkinson’s disease in comparison to those who did not have COVID-19.

New Study Shows Link Between COVID-19 and Elevated Risks for Neurological Disorders

In a recently published systematic review of guidelines for breast cancer screening, researchers assessed 23 guidelines from 11 countries or regions that were published between 2010 to 2021. 

In what may be the largest review to date to examine international breast screening guidelines

, the authors noted common similarities as well as differences regarding recommendations for screening age, intervals and methods for women who have average or high risk for breast cancer.

Here are some takeaways from the research.

1. When should breast cancer screening stop? Three guidelines, including those from the American College of Radiology (ACR) and the Society of Breast Imaging (SBI), emphasized that this decision is subject to health status, noting that breast cancer screening could cease for those with lower than five to 10 years of remaining life expectancy. Other guidelines, including guidelines from the American College of Physicians, said screening can stop after the age of 75 unless projected life expectancy was greater than seven to 10 years. Guidelines from Germany and Singapore suggested an age limit of 70. There was no age limit noted for breast cancer screening in nine of the reviewed guidelines.

2. When it comes to women with dense breasts, the ACR recommended annual magnetic resonance imaging (MRI) screening. Adjunctive use of ultrasound in addition to mammogram is recommended for screening of asymptomatic women with dense breasts, according to Brazilian guidelines as well as those from SBI/ACR. Annual mammography and ultrasound screening are recommended by the National Cancer Center of China for those with dense breasts.

(Editor's note: For related articles, see "

Large Study Finds Elevated 10-Year Breast Cancer Risks in Women with Dense Breasts and Benign Breast Disease

3. For women with genetic susceptibility to breast cancer, guidelines from the SBI/ACR and the Ministry of Health in Singapore recommended annual screening with mammograms or MRI beginning at ages 25-30. For women who have breast cancer susceptibility gene 2 (BRCA2), the European Society of Breast Cancer Specialists (EUSOMA) recommended the start of annual MRI screening between the ages of 25 to 29. For women who have the TP53 gene, EUSOMA encouraged initial screening to begin at the age of 20. When it comes to patients with genetic predisposition who cannot tolerate MRI, the ACR recommended ultrasound as an adjunct to mammograms or digital breast tomosynthesis (DBT).

4. The authors of the systematic review noted that a number of randomized controlled trials from Canada, Sweden, the United Kingdom and other countries revealed higher false positive biopsy results and overdiagnosis with screening in patients aged 40 to 44. However, the majority of guidelines recommended that women at average risk of breast cancer begin mammographic screening at the age of 40.

5. Multiple guidelines recommended annual mammograms or MRI screening for patients diagnosed with invasive breast cancer, ovarian cancer, lobular carcinoma in situ (LCIS), ductal carcinoma in situ (DCIS) or atypical ductal hyperplasia (ADH).

The review of breast cancer screening guidelines from the United States and abroad summarized current recommendations on modalities, intervals, and screening age considerations.

Breast Cancer Screening: Five Takeaways from New Systematic Review of Global Guidelines

A large prospective study of over 45,000 women with abnormal findings on screening mammograms found significant racial and ethnic disparities associated with breast biopsy delays at 30, 60 and 90 days after screening.

, examined data from 45,186 women who had abnormal findings on mammograms between 2009 and 2019.

Culling the data from 109 imaging centers in six states, the researchers noted the study population ranged between 40 and 79 years of age. The study population included 30,053 White women, 6,227 Black women, 5,644 Asian women, 3,055 Hispanic women and 1,206 women of other or mixed races, including native Hawaiian, Alaska natives, American Indians, and Pacific Islander women, according to the study.

The researchers found that 48 percent of Asian women, 43.3 percent of Black women, 42.8 percent of Hispanic women and 38.8 percent of women of other or mixed races did not have a biopsy 30 days after having abnormal findings on mammogram in comparison to 29.2 percent of White women.

While the differences declined with time, the researchers noted that 21.7 percent of Asian women, 19.5 percent of other or mixed races, 19.1 percent of Black women and 18.8 percent of Hispanic women had no biopsy 60 days after mammography screening in comparison to 14.2 percent of White women. At 90 days after mammography, 14.1 percent of Black women and 13.7 percent of women did not have a biopsy, according to the study.

“Although almost 90 percent of women in our cohort received a biopsy within 90 days of screening, the increased adjusted risk of no biopsy at 90 days for Black and Asian women is of particular importance in light of the Cancer Intervention and Surveillance Modeling Network study showing a decline in life-years gained with screening mammography after a 3-month delay in diagnostic testing,” wrote lead author Marissa B. Lawson, MD, an acting instructor of radiology at the University of Washington School of Medicine.

 “Together, these findings suggest that racial and ethnic disparities in time to diagnosis may exacerbate disparities in breast cancer outcomes.”

The study authors speculated that factors specific to different health-care systems may have contributed to the racial and ethnic disparities observed with biopsy delays, noting that adjustment for imaging facilities comprised close to 30 percent of the additional risk of no biopsy 90 days after screening mammography.

“Our findings highlight an opportunity for radiology departments to consider where they can commit resources to improve wait times for biopsy,” noted senior author Christoph Lee, MD, a professor of radiology at the University of Washington School of Medicine. “This could include implementing changes in that diagnostic pathway such as using navigators to help guide patients through the process of scheduling exams and procedures.”

, Randy C. Miles, MD, MPH, said feedback from minority groups about their mammography screening experience, increased hours for breast imaging services and consolidation of those services into fewer visits can have a considerable impact.

“Access to same-day care, in particular, has been shown to eliminate previously seen disparities in time to biopsy between White and non-White patients following implementation,” noted Dr. Miles, division chief of breast imaging and associate director of radiology for research at Denver Health.

In regard to study limitations, the authors noted the exclusion of breast imaging facilities with less than 75 percent biopsy capture may have contributed to underestimation of breast biopsy delays in racial and ethnic groups. According to Lawson and colleagues, other possible limitations include no assessment of the type of first biopsy performed and a lack of adjustment for the availability of on-site diagnostic services, factors that can affect the timing with biopsies.

1. Lawson MB, Bissell MCS, Miglioretti DL, et al. Multilevel factors associated with time to biopsy after abnormal screening mammography results by race and ethnicity. 

 Published online June 23, 2022. doi: 10.1001/jamaoncol.2022.1990. Available at: 

https://jamanetwork.com/journals/jamaoncology/article-abstract/2793713

2. Rutter CM, Kim JJ, Meester RGS, et al. Effect of time to diagnostic testing for breast, cervical, and colorectal cancer screening efficacy: a modeling study. 

3. Miles RC. Addressing racial and ethnic differences in diagnostic resolution of abnormal mammographic findings. 

 Published online June 23, 2022. doi: 10.1001/jamaoncol.2022.1864 . Available at: 

https://jamanetwork.com/journals/jamaoncology/article-abstract/2793717

4. Dontchos BN, Narayan AK, Seidler M, Miles RC, Ebert E, Lehman CD. Impact of a same-day breast biopsy program on disparities in time to biopsy. 

Forty-eight percent of Asian women, 43.3 percent of Black women and 42.8 percent of Hispanic women did not have a biopsy 30 days after abnormal findings on mammography, according to newly published research.