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Women who undergo annual screening mammography beginning at age 40 have lower-stage breast cancer at diagnosis and have fewer interval cancers that women who have biennial or non-annual screenings.

Amidst the ongoing debate around at what age and at what interval women should have mammograms, these findings support earlier and more frequent screenings.

“Despite the large number of lives saved because of cancer detection with screening mammography, controversy persists regarding screening frequency for women at average risk for breast cancer,” said a team led by Mark A. Helvie, M.D., FACR, radiology professor and director of breast imaging at the University of Michigan Rogel Cancer Center. “In this study, among all women and among post-menopausal women analyzed separately, annual screening was associated with lower [American Joint Committee on Cancer (AJCC)] stage, fewer interval cancers, and smaller mean tumor size compared with biennial or non-annual screening.”

The multi-institutional team published their findings in the May 6 

Currently, there is little consensus about when women should begin mammography screening. Recommendations range from annual screening beginning at age 40 – supported by both the American College of Radiology (ACR) and the National Comprehensive Cancer Network (NCCN) – to biennial screening for women ages 50 to 74 proposed by the U.S. Preventive Services Task Force.

To offer some clarity on which screening interval offers the best performance, Helvie’s team examined screening mammography records of 245 women ages 40-to-84 scanned between Jan. 1, 2016, and Dec. 31, 2017, who had mammographically detectable or clinically palpable interval primary breast cancer. Of the group, 200 (81.2 percent) had annual screening (every nine-to-15 months), 32 (13.1 percent) had biennial scans (every 21-to-27 months), and 13 (5.3 percent) had triennial (every 33-to-39 months) screening. Together, biennial and triennial screenings were considered non-annual.

Based on the analysis of 14 fellowship-trained breast radiologists, the team determined that annual screening offered women the most benefit. For women of all ages, annual screening was associated with fewer late-stage cancer presentations, a lower likelihood of interval cancers, and smaller average tumor diameter.

These findings held true for post-menopausal women, as well. Of the 191 post-menopausal women included in the study, those who were screened annually had less late-stage cancer, fewer interval cancers, and small average tumor diameters. These outcomes are important, the team noted, because previous research has not identified these benefits in this patient group.

Screening Outcomes for Post-Menopausal Women

The team noted that interval cancers have a two-fold higher hazard ratio for death than screening-detected cancers. In addition, they said, larger tumor size is an independent predictor of increased mortality.

The team found no statistically significant differences in the frequency of axillary lymph node positivity among interval groups, as well as no statistical differences in pathologic diagnosis. Also, while not statistically significant, annually screened women were less likely to undergo any axillary nodal surgery, showed less frequency use of chemotherapy, and used hormone therapy less frequently. Biennially- and non-annually screened women demonstrated greater use of axillary lymph node dissection.

“Our data show that breast cancers diagnosed in the setting of annual screening require less extensive treatment, which is not surprising given the lower AJCC stage, fewer interval cancers, and smaller mean tumor size,” the team said. “The results of this study support the recommendation for annual screening mammography for pre- and post-menopausal patients, consistent with annual screening recommendations by the ACR and the NCCN, which recommend screening initiation at age 40-years-old.”

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Both pre- and post-menopausal women who undergo annual screening mammography have fewer late-stage breast cancer diagnoses, fewer interval cancers, and smaller average tumor size.

Annual Mammography Screening Offers Women of All Ages Same Benefits

Adding amino acid PET to contrast-enhanced MRI imaging can help radiologists better determine whether a patient has suffered a recurrence of a brain metastasis and how well he or she is responding to treatment.

Although new treatments for brain metastases, such as immune checkpoint inhibitors (ICI) and targeted therapies (TT), are effective, assessing just how well they are working in an individual patient can be difficult. The results produced by contrast-enhanced MRI can be variable, said a team of German investigators.

Consequently, there is a need for new assessment strategy, they said.

“Essentially, these new treatments have requirements of brain imaging which cannot be met by conventional MRI,” said Norbert Galldiks, M.D., a neurology professor, as well as a neurologist and neuro-oncologist at the University Hospital Cologne and Research Center in Juelich, Germany. “In our study, we tried to determine if adding 

F-FET PET could help to overcome some of these imaging challenges.”

Galldiks’ team published their findings recently in the 

PET/MRI Outperforms PET/CT in Cancer Imaging

For their retrospective study, the team enrolled 40 patients who had 107 brain metastases that were secondary to melanoma and small cell lung cancer. These individuals were treated with either ICI or TT alone or in combination with radiotherapy.

After radiosurgery concurrent with nivolumab in 59-year-old patient with melanoma BM (patient 1; Supplemental Tables 3 and 5), F-18 FET PET at follow-up 12 weeks after treatment initiation (bottom row) shows significant decrease of metabolic activity (TBRmean, ?28%) compared with baseline (top row), although MRI changes were consistent with progression according to iRANO criteria. Reduction of metabolic activity was associated with stable clinical course over 10 mo. CE = contrast-enhanced.

CREDIT: N. Galldiks et al., Research Center Juelich, Juelich, Germany.

F-FET PET scans to monitor their treatment efficacy between 2015 and 2019. In 27 patients, it was used to differentiate treatment-related changes from metastasis relapse after ICI or TT, and in 13 patients, it was performed for response assessment to both treatments, using baseline and follow-up scans.

Based on their analysis, the team determined that 

F-FET PET can correctly diagnose brain metastasis relapse and pinpoint which patients are responding to treatment and which are not. Specifically, they found a tumor-to-brain ratio threshold of 1.95 differentiated brain metastasis relapse from treatment-related changes with 85-percent accuracy. In addition, they saw that metabolic responders to ICI or TT on 

F-FET PET had significantly longer stable follow-up, and their time to peak also increased substantially, as well.

F-FET PET is beneficial in monitoring ICI- or TT-treated patients.

“In cases of ambiguous MRI findings, supplemental FET PET is helpful for treatment monitoring. It provides physicians with a longer time window for subsequent patient management and allows them to optimize the treatment strategy for each individual patient,” he said. “Since this approach is so accurate, it has the potential to influence clinical decision making. This may help to reduce the number of invasive procedures and limit over-treatment for a considerable number of seriously ill patients with brain metastases."

Adding 18F-FET PET to contrast-enhanced MRI can better determine which patients are responding well to immune checkpoint inhibitors or targeted therapies.

PET Imaging Identifies Efficacy of New Brain Metastasis Treatments

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A new MRI technique can measure the levels of water exchange across the blood-brain barrier (BBB), identifying dysfunction that is associated with the development of small vessel disease (SVD).

Cerebral SVD is the most common form of vascular cognitive impairment, and many individuals who have it go on to develop dementia. The BBB is responsible for clearing the brain of toxic substances, and a malfunction is widely considered to be an early marker of SVD.

PET scans and dynamic contrast-enhanced (DCE) MRI can effectively detect damage to the BBB, but these measures also subject patients to radiation and contrast dye. They are also limited because they generally only pick up later-stage BBB dysfunction. Consequently, there is a need for a non-invasive technique that can catch problems earlier, said a team of investigators from the University of Kentucky and the University of Southern California.

Leaky Blood-Brain Barrier Causes Brain Damage Before MRI Catches Lesions

Alzheimer’s & Dementia: The Journal of the Alzheimer’s Association

the team detailed their solution: diffusion-prepared arterial spin labeling (DP-ASL), a non-invasive technique developed by Xingfeng Shao, Ph.D., a research scientist, and Danny Wang, Ph.D., a neurology and radiology professor, both with the USC Mark and Mary Stevens Neuroimaging and Informatics Institute. This MRI method measures the subtle BBB dysfunctions that are associated with a modified water exchange rate across the BBB.

“Our results provide evidence for an in vivo association between water exchange rate across the BBB and cerebral spinal fluid (CSF) amyloid-beta42 concentration,” said the team. “These findings suggest that [water exchange rate across the BBB] computed from a novel DP-ASL sequence may be a potential indicator of BBB-related clearance functions.”

To make this determination, the team conducted DP-ASL sequence MRI scans on 39 healthy older adults without any cognitive impairment between the ages 67 and 86. Participants were scanned with 3T scanners, using a 64-channel head coil, and the team used high-resolution, multi-echo, T1-weighted anatomical image and 3D gradient-and-spin echo diffusion-prepared pCASL sequences. In addition, the patients underwent a lumbar CSF draw.

For their assessment, the team concentrated on levels of amyloid-beta in the CSF – levels are low when the protein is not sufficiently cleared from the brain into the CSF. Based on their evaluation, the team determined that low CSF amyloid-beta levels were associated with a low BBB water exchange rate captured by the DP-ASL method.

In addition, they identified significant associations between CSF amyloid-beta42 concentration and water exchange values in the whole brain (beta=0.51, t=3.4, P=0.002, VIF=1.04), frontal lobe (beta=0.50, t-3.4, P=0.02, VIF=1.04), parietal lobe (beta=0.56, t=3.9, P<0.001, VIF=1.03), and precuneus (beta=0.46, t=3.1, P=0.004, VIF=1.02) after controlling for sex and age. Each measurement, they said was associated with low CSF amyloid-beta42 concentration.

“Our results suggest that DP-ASL may provide a non-invasive index of BBB clearance dysfunction prior to any detectable cognitive impairment,” said Brian Gold, Ph.D., a neuroscience professor at the University of Kentucky Sanders-Brown Center on Aging.

Ultimately, the team said, these results add to the growing body of evidence that BBB dysfunction could represent a link between SVD and a clinical diagnosis for Alzheimer’s, and DP-ASL could be used to non-invasively assess BBB water exchange in SVD clinical trials.

Diffusion-prepared arterial spin labeling can measure the water exchange rate across the blood-brain barrier, catching malfunctions at an earlier state.

New MRI Technique Identifies Early-Stage BBB Dysfunction with Small Vessel Disease

 Wall thickening of the ileum is seen on follow-through of GI series on fluoroscopy. Findings are consistent with inflammation of the terminal ileum in Crohn’s disease.

 In the small bowel, in Crohn’s disease, there can be skip lesions and discrete ulcers. The terminal ileum is usually affected first, but remaining segments of the small bowel are also commonly affected. On fluoroscopy, on small bowel follow-through, mucosal ulcers can be seen and widely separated bowel loops of bowel can also be seen due to fatty proliferation (“creeping fat”). There can also be the “string sign” seen, which is narrowing or spasm of small bowel segments. Look for partial bowel obstructions and also pseudodiverticulum formation.

What is causing this appearance on small bowel GI series follow-through?

Image IQ Quiz: What Do You See on This Small Bowel GI Series?

Women who have lower levels of a fibroblast protein that is integral to the development of the cardiovascular system – PDGFRb – have a better response to radiotherapy treatment for early-stage breast cancer.

For ductal carcinoma in situ (DCIS), the current treatment is surgery and subsequent radiotherapy. Long-term outcomes are generally good, but up to 10 percent of women do suffer a recurrent within 10 years. Consequently, unearthing a more personalized way to treat these women is vital, said investigators from Karolinska Institutet and Gothenburg University in Sweden.

“It is well known that the benefits of radiotherapy are individual, so we need to find predictive markers that can be used to avoid unnecessary or ineffective radiotherapy,” said Fredrik Wärnberg, professor in the clinical sciences department at Gothenburg University’s Sahlgrenska Academy.

The team, co-led by Wärnberg, published their findings recently in 

Instead of focusing on markers within the tumor cells, the team pivoted to examine the role cells surrounding the tumor might play in the efficacy of radiotherapy. To do so, researchers analyzed a large tissue collection from a randomized radiotherapy study (SweDCIS), and they found that women who have low PDGFRb levels have better outcomes with radiotherapy for ipsilateral breast events (IBE).

Specifically, women with low PDGFRb experience an absolute risk reduction of recurrence of 21 percent at 10 years. This predictive effect was equally strong for women with in situ and invasive IBE. Unfortunately, women with high PDGFRb levels did not see a significant risk reduction.

These results, the team said, support the possibility of changing approaches to therapy.

“The treatment guidelines of DCIS might need to be changed if these studies confirm our original findings,” said first author Carina Strell, a researcher oncology-pathology department at Karolinska Institutet.

Additional work is underway to investigate whether radiotherapy efficacy can be further improved by blocking PDGFRb.

Women with low levels of PDGFRb, a protein involved in cardiovascular development, have reduced recurrence risk. 



Protein Marker Can Predict 10-Year Radiotherapy Efficacy for DCIS

Despite a mandate to give patients timely and easy access to their radiology reports, many healthcare institutions have a built-in delay or embargo for releasing and making radiology reports available to patients. But, even that isn't a standardized practice.

Under the 21st Century Cures Act, providers are required to make electronic medical test reports, including those from radiologist, available to patients once they’re finalized. But, few facilities are following this requirement to the letter, according to a team of investigators from the Yale School of Medicine.

“Many [facilities] have made use of built-in delays or embargo periods, during which radiology reports were not released to patients, either because of technologic feasibility hurdles, or, in many cases, to give ordering clinicians the opportunity to first receive, review, and discuss the radiology report with their patients,” said the team led by Jonathan L. Mezrich, M.D., JD, MBA, assistant professor of emergency radiology.

To determine how prevalent the embargo period is, Mezrich’s team conducted a telephone survey of 70 “top hospitals” recognized in the 2019-2020 

 They published their results on May 4 in 

Based on the outcome of the survey, during which investigators posed as patients and family members interested in patient portal protocols, the team determined that 64 facilities (91 percent) offer online portals, and of those, 22 hospitals (34 percent) reported using a 1-to-3-day embargo period. Eight hospitals (13 percent) had 4-to-6-day delay, six facilities (9 percent) waited between 7-to-14 days, and 13 hospitals (20 percent) used an indefinite period. The remaining 15 institutions (23 percent) didn’t know.

5 Strategies to Streamline Patient Access to Radiology Reports

In addition, only 52 percent of hospitals confirmed they would send radiology reports to the referring clinician prior to making them available to the patient.

“However, there appears to be no standard with respect to embargo periods, with many institutions incorporating at least some period of delay into the process,” the team said. “Early patient access to their health information is valuable because it allows patients to better participate in their healthcare and to become their own advocates.”

It is possible that giving patients earlier access would reduce the likelihood that details found in the reports will be lost in the shuffle, they said. It could also improve compliance with follow-up recommendations – existing research shows that up to 15 percent of referring clinicians do not radiology reports, so they may never convey the radiologist’s guidance to the patient.

Still, the team said, there are several reasons why facilities could still resist giving patient’s earlier access to their radiology reports, and it is likely that these obstacles could fall into a patient safety, security, privacy, or feasibility exception under the Cures Act.

For example, hospitals could highlight these issues:

Early access isn’t feasible because they lack a streamlined system to make reports seamlessly available to patients.

Emotional harm to the patient who learns of a devastating diagnosis via an impersonal radiology report rather than an empathetic referring provider.

High-level medical language contained in radiology reports may be confusing to patients.

Early access limits a radiologists’ ability to make additions or corrections to reports before they are made available.

Security of electronically accessible reports cannot be guaranteed.

Still Mezrich’s team said, the march toward greater use of patient portals is continuing, so radiology must prepare for the high likelihood that patients will soon have open access to reports on their imaging findings.

“It is inevitable that radiologists will need to begin drafting reports for a lay audience, either through the use of structured reporting or decreased use of medical jargon, or both,” the team said. “Greater interface with patients through early receipt of radiology reports may even prove beneficial to the field of radiology, as patient will have a greater awareness of those providing their care; it may also decrease liability risks of lack of communication and may pave the way for other avenues of patient interaction.”

In addition, radiologists should build a habit of consulting with referring providers as promptly as possible to ensure that any findings are communicated in the safest most compassionate way.

Ultimately, the team said, radiology should view this continued push toward information transparency as a helpful move in healthcare.

“Given the benefits to patients, radiologists, and possibly institutions in providing early access, radiologists should embrace the final rule as a positive step in patient autonomy,” the team concluded.

Institutions still do not have a standardized way to make radiology reports available to patients, but providing earlier access could be beneficial for all parties involved.

To Embargo or Not to Embargo? No Consensus on Releasing Patient Radiology Reports

Ultra-high field 7T MRI is shedding light on a new potential early indicator of the decline toward Alzheimer’s disease – the level of energy metabolism in the living brain.

Although research efforts have been significant, any effective treatments for Alzheimer’s remain hidden. Identifying markers – such as the accumulation of beta-amyloid and tau protein in the brain – is proving helpful, but researchers from the Center for BrainHealth® at The University of Texas at Dallas wanted to go further.

a team led by Namrata Das, Ph.D., a program specialist and research neuroscientist, outlined how they are using phosphorus magnetic resonance spectroscopy with 7T MRI to illustrate the brain’s energy consumption and reserves. This is the first study, the team said, that shows it is possible to measure brain energy metabolism in living subjects.

“Much of what we know about cognitive decline at the molecular level comes from post-mortem brain examinations or animal models,” Das said. “What we set out to do was monitor in real time the biological mechanisms that cause this decline in humans to better understand the multiple factors involved.”

Ultra-High Field MRI Reveals Subtle Brain Differences in Individuals with Down Syndrome

For their study, the team enrolled 41 participants – 15 who were cognitively normal, 15 with mild cognitive impairment, and 11 with early Alzheimer’s. The patients completed assessments for executive function, memory, attention, visuospatial skills, and language, and the team also completed 7T scans that measured the ratios between adenosine triphosphate (ATP) and phosphocreatine (PCr) – also called the energy reserve index – as well as inorganic intracellular phosphate.

The hypothesis, Das said, is that dysfunction in the mitochondria – the energy powerhouse of the cell – occurs early in Alzheimer’s and that ATP and PCr are not synthesized properly. Existing 3T MRI technology is not powerful enough to visualize these molecular levels accurately, but 7T MRI can.

According to their analysis, the team said, the 7T MRI scans of a participant’s temporal lobes point to a correlation between the energy reserve index and the patient’s cognition level.

“The energy reserve was lower in patients with mild cognitive impairment and lower still in those with Alzheimer’s,” Das said. “We believe this is the first paper to confirm that energy reserve decreases with [mild cognitive impairment], years before Alzheimer’s sets in.”

Specifically, the team saw lower energy reserve (p=0.009) and lower energy consumption (p=0.05) in the mild cognitive impairment group compared to those participants who were cognitively normal. In addition, in cognitively normal patients, the team identified a significant positive correlation between magnesium levels and cognitive performance of memory (p=0.013), executive function (p=0.023), and attention (p=0.0003). However, the same correlation did not exist with patients who had mild cognitive impairment or Alzheimer’s.

The study’s results point to new opportunities for discovery in understanding and treating Alzheimer’s, said senior author Sandra Bond Chapman, Ph.D., chief director of the Center for BrainHealth®.

“This research provides a promising new way to elucidate the brain’s health – or early disturbance of its health – due to changes in metabolism. The new approach is the utilization of [7T MRI], a non-invasive safe technology,” she said. “It has exciting implications for early detection of Alzheimer’s disease and the potential to measure disease response to treatments.”

As a next step, Das said, the team plans to combine the energy-level biomarker with PET scans to measure beta-amyloid and tau protein.

“We hope to determine if the abnormal brain energy metabolism has a relationship with the accumulation of beta-amyloid and tau,” she said. “Researchers have hypothesized for years that such metabolism short falls might precede such accumulations, but only now, with 7T, do we have the modality to find out.”

Study shows lower energy reserve index in patients with mild cognitive impairment and early Alzheimer’s.

Alzheimer’s Energy Metabolism Biomarker Revealed with 7T MRI

In an agreement announced this week, Konica Minolta and nVoq will embed nVoq’s cloud-based speech recognition and automation solution into Konica’s Exa® Platform.

With the integration, Exa users will still have no workstation installation and a diagnostic-quality zero footprint fewer, Konica officials said, and they will also have access to voice-enabled reporting using nVoq’s speech recognition application programming interface (nVoq.SPS).

“Integrating Exa with nVoq’s clinically relevant solution empowers and complements our entire product portfolio of zero footprint technologies,” said Kevin Borden, Konica Minolta’s vice president of product, healthcare IT. “While our customers will benefit from streamlined implementation and operation, the real advantage is the ability to access the speech recognition software from anywhere at any time – in the office, clinic, or on a mobile device.”

In addition, Borden said, the integration will augment clinical productivity and reduce the need for software maintenance.

With this partnership, Exa users will have access to fast, accurate speech recognition that can be operational within seconds because it requires no downloads to workstations or devices, company officials said. Consequently, IT resources can be applied elsewhere.

“Improving clinical workflow through automation is a shared vision of our companies,” said Deborah Gillotti, nVoq Incorporated, chief operating officer. “We look forward to bringing these powerful solutions together to meet customer’s needs and helping make better decisions sooner.”

Move embeds cloud-based speech recognition and automation solutions into Konica-Minolta’s Exa® Platform.  

Konica Minolta-nVoq Partnership Accelerates Speech Recognition Integration

Recent research with MRI has kicked neuroimaging up a notch. With recent developments, investigators can now see real-time brain movement in exceptional detail.

Typically, MRI is used to capture static brain images, but with 3D amplified MRI (3D aMRI), researchers can see pulsations of the brain. Being able to see these movements could help providers pick up on hard-to-detect conditions, such as obstructive brain disorders and aneurysms, before they become fatal.

In two studies published this week – in 

researchers from Stanford University, the University of Auckland, and other institutions not only compared 3D aMRI to the existing 2D technology, but they also demonstrated how the software effectively captures brain movement.

Overall, the team said, this method, which can visualize brain movements the width of a human hair, could allow providers to non-invasively see brain disorders – a benefit that could lead to better treatment strategies for tiny deformations or disorders that obstruct or block the flow of brain fluids. You can see a video of 3D aMRI 

“The new method magnifies microscopic rhythmic pulsations of the brain as the heart beats to allow the visualization of minute piston-like movements, that are less than the width of a human hair,” said Itamar Terem, a Stanford graduate student who is lead author on the 

 paper. “The new 3D version provides a larger magnification factor, which gives us better visibility of brain motions, and better accuracy.”

For their study, the team enrolled seven healthy male and female volunteers between ages 24 and 65 and conducted 3T MRI scans. They, then, compared 3D a MRI to 2D aMRI on multi-slice and 3D balanced steady-state free precession cine data and phase contrast (PC-MRI).

Their results showed 3D aMRI produces better image quality and fewer motion artifacts compared to 2D aMRI, the team said, and tissue motion matched PC-MRI. In addition, optical flow maps captured brain tissue motion and displayed physical changes to ventricle shapes, and 4D animations reveal complete brain tissue and cerebrospinal fluid motion.

Investigators have already employed this technique in assessing how mild traumatic brain injury impacts the brain. In addition, they are looking at whether combining 3D aMRI and brain modeling can open the door to effectively measuring brain pressure. Doing so could help patients avoid surgery.

Real-time visualization of brain movement can help radiologists identify hard-to-detect brain conditions.



Alzheimer’s Energy Metabolism Biomarker Revealed with 7T MRI

Konica Minolta-nVoq Partnership Accelerates Speech Recognition Integration

“Stunning” Brain Movement Detail Possible with 3D Amplified MRI