'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: January 22-January 28

Slideshows

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

In a new study comparing photon-counting detector computed tomography (PCD CT) to energy-integrating detector CT (EID CT) for thoracoabdominal CT angiography, researchers found a 25 percent higher contrast-to-noise ratio (CNR) with PCD CT and subsequently determined that a revised protocol with PCD CT could reduce iodinated contrast media (ICM) by 25 percent in comparison to EID CT.

Noting the potential risk for contrast-induced acute kidney injury (CI-AKI) in patients with multiple computed tomography angiography (CTA) exams, the researchers sought to develop and assess the use of PCD CT with a reduced ICM protocol in this patient population.

For the prospective study, which was recently published in 

, researchers assessed 100 patients (mean age of 75) who had CTA with PCD CT and prior EID CT for imaging of the thoracoabdominal aorta.

In the first group of 40 patients, the study authors noted the use of PCD CT with virtual monoenergetic images (VMI) at 50 keV had a 25 percent higher contrast-to-noise ratio (CNR) than EID CT. In the second group of 60 patients, the researchers found that a 25 percent reduction of ICM with PCD CT at VMI of 50 keV was non-inferior to EID CT for imaging of the thoracoabdominal aorta.

“Compared with EID CT, VMI at 50 keV from PCD CT had noninferior objective and subjective image quality, with mean differences in CNR and subjective image quality between EID CT and PCD CT at 50 keV being above the pre-defined boundaries of noninferiority …, illustrating the potential of PCD CT to reduce contrast media exposure to potentially susceptible patients,” wrote Hatem Alkadhi, M.D., MPH, EBCR, FESER, a professor of radiology at the Institute of Diagnostic and Interventional Radiology of the University Hospital Zurich in Switzerland, and colleagues.

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

Five Takeaways from New Consensus Recommendations for CT Imaging and Reporting in Patients with CAD

HeartFlow Garners FDA Clearances for Two AI-Powered Assessment Tools with CCTA

, James Dundas, MBBS, MRCP and Jonathon A. Leipsic, M.D., FRCPC, MSCCT., noted a number of potential benefits with PCD CT, ranging from virtual non-contrast imaging for coronary calcium scoring and reducing metallic artifacts in close proximity to implanted cardiac devices to utility in assessing myocardial fibrosis and complex congenital heart disease. While acknowledging the “framework” of the study’s findings with photon-counting CT, Drs. Dundas and Leipsic said measurable clinical impact demonstrated in future studies will be more of a driver for wider adoption than ICM reduction in aortic imaging.

“Delivering benefit in clinically relevant outcomes would make a stronger case for embracing photon counting in routine clinical practice,” noted Dr. Dundas, an advanced cardiac imaging fellow at the University of British Columbia, and Dr. Leipsic, a professor and head of the Department of Radiology at the University of British Columbia.

In regard to study limitations, the study authors acknowledged a small proportion of women in the study and the overall small cohort size. The researchers also noted the study was not designed to compare the diagnostic accuracy of photon-counting detector CT (PCD CT) versus energy-integrating detector CT (EID CT). Pointing out that their image quality comparison of PCD CT and EID CT was based on single-energy mode imaging, Alkadhi and colleagues maintained that future studies should assess dual-energy CT use as well as the impact of quantum iterative reconstruction (QIR) upon image quality.

Articles

Preliminary research suggests the use of photon-counting detector computed tomography (CT) may facilitate a 25 percent reduction of iodinated contrast media (ICM) in comparison to energy-integrating detector CT for angiographic imaging of the thoracoabdominal aorta.

Could Photon Counting Reduce Iodinated Contrast Media for CT Angiography?

Keya Medical has launched the DeepVessel FFR, a software device that utilizes deep learning to facilitate fractional flow reserve (FFR) assessment based on coronary computed tomography angiography (CCTA).

Cleared by the Food and Drug Administration (FDA), the 

 provides a three-dimensional coronary artery tree model and estimates of FFR CT value after semi-automated review of CCTA images, according to Keya Medical.

The company said the DeepVessel FFR has demonstrated higher accuracy than other non-invasive tests and suggested the software could help reduce invasive procedures for coronary angiography and stent implantation in the diagnostic workup and subsequent treatment of coronary artery disease.

Joseph Schoepf, M.D., FACR, FAHA, FNASCI, the principal investigator of a recent multicenter trial to evaluate DeepVessel FFR, says the introduction of the modality in the United States dovetails nicely with recent guidelines for the diagnosis of chest pain.

“I am excited to see the implementation of DeepVessel FFR. It comes together with the 2021 ACC/AHA Chest Pain Guidelines’ recognition of the elevated diagnostic role of CCTA and FFR CT for the non-invasive evaluation of patients with stable or acute chest pain,” noted Dr. Schoepf, a professor of Radiology, Medicine, and Pediatrics at the Medical University South Carolina.

Can Deep Learning Assessment of X-Rays Improve Triage of Patients with Acute Chest Pain?

New CT Protocol May Improve Diagnosis of Acute Chest Pain by 40 Percent

Employing deep learning capabilities, the DeepVessel FFR reportedly provides enhanced non-invasive evaluation of coronary arteries through semi-automated analysis of coronary computed tomography angiography (CCTA) imaging.

Could an Emerging Deep Learning Modality Enhance CCTA Assessment of Coronary Artery Disease?

The degree of background parenchymal enhancement (BPE) on contrast-enhanced mammography (CEM) is reportedly lowest during days eight through 14 of the menstrual cycle of premenopausal women with regular cycles.

This is one of the findings from a new retrospective study looking at the impact of clinical factors upon early BPE on CEM. For the study, recently published in the 

, researchers reviewed clinical data from the electronic medical records (EMRs) and imaging of 207 women (median age of 46) who had contrast-enhanced mammography exams between April 2020 and September 2021.

According to the study, the researchers used two different criteria to assess the degree of BPE with “criteria 1” involving dual-energy subtraction (DES) imaging of a standard craniocaudal image of the suspicious or affected breast, and “criteria 2” involving the greater degree of BPE on DES imaging of craniocaudal views of both breasts.

For both criteria, the study authors found a lower degree of BPE for older patients, those with a personal history of breast cancer and patients with a history of chemotherapy or radiation therapy. Patients with dense breasts had a higher degree of BPE, according to the researchers. The researchers also pointed out that postmenopausal and perimenopausal status had negative associations with BPE degree whereas premenopausal women with regular or irregular menstrual cycles had positive associations with BPE degree.

In the multivariable analysis, the study authors noted that menstrual status and timing of menstrual cycle were the only independent predictors of BPE degree. For premenopausal women with regular menstrual cycles, the researchers found the lowest degree of BPE occurred during days eight through 14 of the menstrual cycle.

“This finding may reflect fluctuation in circulating estrogen levels throughout the menstrual cycle and the effects of estrogen on vascularization. This association could inform decisions regarding scheduling of CEM examinations based on the time of the menstrual cycle,” wrote study co-author Yajia Gu, M.D., who is affiliated with the Department of Radiology at the Fudan University Shanghai Cancer Center in China, and colleagues.

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

Study Highlights Use of Contrast-Enhanced Mammography in Women with Breast Implants

Key Considerations with Implementing Contrast-Enhanced Mammography in Your Practice

Current Insights on Breast Density, Contrast-Enhanced Mammography and Supplemental Breast Cancer Screening

In regard to univariable analysis associations of younger age, dense breasts and premenopausal status that were linked to a higher degree of BPE in the study, Gu and colleagues said “ … these associations may represent decreases in estrogen hormone levels and in fibroglandular tissue as patients age.” However, noting the work of other authors who found no difference with BPE degree with respect to age in premenopausal and postmenopausal women, Gu and colleagues suggested that “ … menstrual status, which reflects hormonal status, may have a more direct influence on BPE than does age.”

Acknowledging the limitations of a retrospective study with a small sample size, the study authors also conceded patient selection bias with high proportions of women with newly diagnosed breast cancer as well as women with dense breasts in the study cohort. However, Gu and colleagues noted the focus of the study was on CEM, which was not employed for screening purposes during the study. The researchers noted they did not assess the relationship between BPE degree and additional risk factors for breast cancer, nor did they evaluate whether higher BPE affected cancer detection rates.

1. Wang S, Sun Y, You C, et al. Association of clinical factors and degree of early background parenchymal enhancement on contrast-enhanced mammography. 

. 2023 Jan 25. Doi: 10.2214/AJR.22.28769. Online ahead of print.

2. King V, Goldfarb SB, Brooks JD, et al. Effect of aromatase inhibitors on background parenchymal enhancement and amount of fibroglandular tissue at breast MR imaging. 

3. Zhao S, Zhang X, Zhong H, et al. Background parenchymal enhancement on contrast-enhanced spectral mammography: influence of age, breast density, menstruation status, and menstrual cycle timing. 

For premenopausal women with regular menstrual cycles, researchers have found a significant association between the timing of menstrual cycles and the degree of background parenchymal enhancement (BPE) on contrast-enhanced mammography (CEM).

Contrast-Enhanced Mammography Study Examines Impact of Clinical Factors on Background Parenchymal Enhancement

's Advances in AI monthly roundup is your chance to catch up on the latest AI news, AI-powered imaging modalities and emerging AI research affecting the field of radiology. Review the slideshow below to see highlights from the past month.

Diagnostic Imaging's Advances in AI: January 2023

Catch up on the top AI-related news and research of the past month.

Is dynamic abbreviated magnetic resonance imaging (MRI) a viable alternative for diagnosing early-stage hepatocellular carcinoma (HCC)?

In a retrospective multicenter study, recently published in 

, researchers assessed the use of dynamic abbreviated MRI for the detection of early-stage HCC among patients with cirrhosis who had liver transplant or resection.

 The study cohort was comprised of 161 patients with early-stage HCC (median age of 62) and 138 patients (median age of 55) who did not have HCC. For the simulated dynamic abbreviated MRI, researchers selected and reviewed coronal T2-weighted and axial 3D, fat-suppressed T1 dynamic, contrast-enhanced sequences at pre-contrast, late arterial, portal venous and delayed phases from preoperative MRI examinations, according to the study.

Employing liver pathologic findings as a reference standard, the study authors noted a sensitivity rate of 88.2 percent and a specificity rate of 89.1 percent for dynamic abbreviated MRI in the diagnosis of early-stage HCC.

Citing a variety of benefits, the researchers suggested the technology could be easily incorporated into workflows at MRI facilities with minimal training.

“The imaging protocol can be easily replicated at most MRI facilities by using 1.5-T or 3.0-T scanners equipped with standard three-dimensional T1-weighted gradient-echo sequences,” wrote lead study author Takeshi Yokoo, M.D., Ph.D., the medical director of MRI at the Harold C. Simmons Comprehensive Cancer Center in Dallas, and an associate professor of radiology at the University of Texas Southwestern Medical Center, and colleagues. “The workflow is non-disruptive, and the need for technologist education is minimal. LI-RADS (Liver Imaging Reporting and Data System) interpretation of dynamic abbreviated MRI is analogous to multiphase CT interpretation and offers all LI-RADS major features needed for category LR-5 classification.”

The researchers also maintained that abbreviated MRI could be an alternative to ultrasound for HCC screening and surveillance in obese patients and those with non-viral etiologies of cirrhosis.

“We did not find the sensitivity of abbreviated MRI to be modulated by obesity or by cause of cirrhosis, an important finding considering that (ultrasound) has worse visualization and performance in patients with obesity and those with non-viral causes of cirrhosis,” noted Yokoo and colleagues.

“Our findings therefore suggest that abbreviated MRI may serve as a viable surveillance strategy in these patients in whom (ultrasound) may be problematic.”

However, the researchers did acknowledge variation in the sensitivity rates for abbreviated MRI in regard to the Child-Pugh scoring system for cirrhosis. For patients with Child-Pugh class A cirrhosis, Yokoo and colleagues found high sensitivity rates for a variety of lesion sizes (83.3 percent for 1 to 1.9 cm tumors; 96.8 percent for 2 to 2.9 cm tumors; and 98.1 percent for tumors 

 3 cm). The authors also found moderate sensitivity for Child-Pugh class B and C cirrhosis (61.1 percent for 1 to 1.9 cm tumors; 64.3 percent for 2 to 2.9 cm tumors; and 71.4 percent for tumors 

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

Could Contrast-Enhanced Ultrasound with Perfluorobutane Provide a Viable Option for Diagnosing Hepatocellular Carcinoma?

Study Says Machine Learning MRI Model May Help Predict Recurrence Risk of Hepatocellular Carcinoma

While noting the potential of dynamic abbreviated MRI for diagnosing HCC in patients with compensated cirrhosis, Yokoo and colleagues said prospective studies are necessary to validate their findings and provide clarity into the lower sensitivity they noted in patients with decompensated cirrhosis.

, Harrison Kim, Ph.D., M.B.A., said it remains to be seen whether abbreviated MRI would be a more cost-effective option for HCC surveillance in comparison to computed tomography (CT) or contrast-enhanced ultrasound.

“Although MRI cost varies across different countries and facilities, it is unlikely that the cost will be less than that of a CT or contrast-enhanced (ultrasound) examination, even after being reduced by 30%,” noted Dr. Kim, a professor in the Division of Advanced Medical Imaging Research in the Department of Radiology at the Heersink School of Medicine at the University of Alabama at Birmingham. “Although MRI generally yields higher contrast than CT, four-phase dynamic CT has demonstrated comparable accuracy with MRI in detecting HCC. CT is faster than abbreviated MRI for active HCC surveillance (10 minutes vs. 20 minutes) with minimal motion artifact and without inducing claustrophobia.”

1. Yokoo T, Masaki N, Parikh ND, et al. Multicenter validation of abbreviated MRI for detecting early-stage hepatocellular carcinoma. 

. 2023 Jan 24;220917. doi: 10.1148/radiol.220917. Online ahead of print.

2. Chong N, Schoenberger H, Yekkaluri S, et al. Association between ultrasound quality and test performance for HCC surveillance in patients with cirrhosis: a retrospective cohort study. 

3. Schoenberger H, Chong N, Fetzer DT, et al. Dynamic changes in ultrasound quality for hepatocellular carcinoma screening in patients with cirrhosis. 

4. Kim H. The feasibility of abbreviated MRI for active surveillance of hepatocellular carcinoma. 

 2023 Jan 24;223113. doi: 10.1148/radiol.223113. Online ahead of print.

In a multicenter study involving nearly 300 patients, researchers found that abbreviated magnetic resonance imaging (MRI) had a sensitivity rate of 88.2 percent and a specificity rate of 89.1 percent for detecting early-stage hepatocellular carcinoma (HCC).

Abbreviated MRI and Early-Stage Hepatocellular Carcinoma: What a New Multicenter Study Reveals

Emerging research suggests that magnetic resonance imaging (MRI) guidance may be more advantageous than computed tomography (CT) guidance for reducing the side effects of stereotactic body radiation therapy (SBRT) in the treatment of prostate cancer.

Results from the phase 3 randomized trial, recently published in 

, showed that MRI guidance for SBRT led to a significantly reduced acute grade 2 or greater genitourinary (GU) toxicity rate (24.4 percent) versus that of CT guidance (43.4 percent). Researchers also noted no acute grade 2 or greater gastrointestinal (GI) toxic effects with MRI guidance in comparison to a 10.5 percent toxicity rate for CT guidance.

In a recent video interview, lead study author Amar Kishan, M.D. called the MRIdian LINAC (ViewRay) a “major technological breakthrough” that allows physicians to combine continuous MRI imaging with a more targeted radiation delivery system for 

“(With) these advanced precision and accuracy capabilities, particularly that high degree of tracking during the treatment, we felt we could reduce the margins around the prostate that we need to treat from four millimeters to two millimeters,” explained Dr. Kishan, an associate professor, vice-chair of Clinical and Translational Research and chief of the Genitourinary Oncology Service within the Department of Radiation Oncology at UCLA.

For more insights from Dr. Kishan, watch the video below.

Videos

In a recent video interview, Amar Kishan, M.D., discussed a new study that demonstrated significant side effect reduction when utilizing magnetic resonance imaging (MRI) guidance instead of computed tomography (CT) guidance for stereotactic body radiation therapy (SBRT) to treat localized prostate cancer.

Emerging Insights on MRI-Guided Stereotactic Body Radiation Therapy (SBRT) for Prostate Cancer

Images 1-2

Review the case study and test your knowledge to make the correct diagnosis.

Image IQ Quiz: Young Adult Female with Pelvic Pain and Syncope

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

As a med student, I was introduced to the concept of a "doctor's doctor." At the time, the phrase referred to a pathologist, someone to whom other physicians turned to when they themselves needed medical answers. The notion resonated enough to have me considering path as a specialty for myself.

I guess it is not all that surprising that I wound up as a radiologist, another specialist referenced as a doc's doc in subsequent years. It often lets me be the answer man, if not with specific diagnoses, then at least with actionable guidance for referrers.

Sometimes, of course, I'm also a doc seeking another doc. This may stem from consultations in the course of my work, administrative stuff pertaining to my job and, yes, when I'm a patient myself.

Fortunately, that last one hasn't had to happen too much. I'm a healthy cuss. While I can take credit for some of that due to my lifestyle choices, much of it is luck. Still, one doesn't want to wait for injury or illness before looking around for trustworthy primary (and preventive) care.

That is particularly an issue for docs like me. I wish I could just shrug, pick a name out of a directory, and tell myself that I could switch if whomever I chose turned out to be a dud. Chalk it up to my insider experience of the health-care system for the past few decades. Call me a worrywart or nitpicker but I'm extremely averse to getting involved with Dr. Piginapoke. Plus, there's the matter of wanting to spend as little time as possible rather than enduring a series of "intake" appointments until I happen to hit paydirt.

My search has been repeated a few times. For instance, when changing jobs, I have to find someone local who's in whatever network my new employer uses and is currently accepting new patients. When I've been an independent contractor, I had to figure out what insurers wanted to be bothered with a lone wolf like me (and not gouge for a small fortune in the process). It got even more complicated during years when the federal government kept changing the rules regarding what health care I should be allowed to get.

All these considerations aside, it's very much been on my mind that my doc and I need to be on the same health care/philosophical page. I'm far from unique in this regard, but I've been surprised how little I hear other people talk about it.

Readers who've attended med school or similar may remember learning what I'm talking about here. Doctor-patient relationship models have been described in various ways (paternalistic, informative, interpretive, and deliberative to name a few). The upshot is that not everybody's style and expectations will harmoniously mesh.

An old-fashioned patient, for instance, might expect to have the physician size up his or her situation, and wisely proclaim what is to be done. If the doc instead spews a bunch of data so the patient can make up his or her own mind or takes a touchy-feely approach of "let's figure this out together," the patient might doubt the doc's confidence and capability, or even get annoyed at what seems like game playing.

Meanwhile, a more modern and assertive patient who has already consulted Dr. Google and knows exactly what he or she wants might hate the wise/decisive doc mentioned above. This could especially be the case if said doc blithely waves aside the patient's notions about the proper course of action. The "let's figure this out together" doc could achieve far greater patient satisfaction here.

Being an experienced physician myself, I'm liable to seem more like patient #2. Hopefully I wouldn’t be quite that demanding. I am of course seeing another doctor to get a perspective beyond my own, so the last thing I'd want is to ignore his or her advice.

However, I do have definite ideas about how I want my health care managed. I'm much more about quality of life than quantity. I'm not the sort of person who wants a lot of diagnostic testing done "just in case." I took it very much to heart when I learned as a medical student that 80 percent of diagnoses came from clinical history. If I don't have any issues to report, I have little motivation to go looking for trouble.

So, going back to the notion of randomly picking a doc's name out of a directory, it's entirely possible that whomever I chose would be fine with my approach. On the other hand, physicians are somewhat notorious for being bad patients, and I can easily imagine one seeing a fellow doc coming in the door and thinking uh-oh.

Maybe the doc doesn't give a darn if I turn out to be selectively noncompliant. But maybe it annoys him a little that I seem to think I know better than him or the guidelines set forth by the primary care industry. Maybe he or she doesn't like the medicolegal liability of having to document every single time I choose to do my own thing. Perhaps the doc imagines a lawyer for my estate turning up someday, claiming that he or she didn't do enough to convince me.

I would just as soon ensure that none of this will be an issue before we waste a single moment of each other's time. Unfortunately, there's no medical version of eHarmony out there that matches up docs and patients for sympatico health care. The only way I can think of to do that is show up to a primary care appointment and lay my cards on the table, hoping that the doc will seriously think about it and give an answer that's honest and fair to both of us.

I did try another approach, sending a few emails or phoning offices in the hope of not having to actually make an appointment. To date, I've gotten zero responses. I chalk that up more to disorganized offices than unprofessional snubbing.

Maybe it's inconceivable to the clinicians. Most of them don't reach out to us and ask if we'd mind reading the studies they refer in a certain way, and offer to find other rads if we say we'd rather not. They just assume we will do it. Of course, if we don't do it that way, we will hear from them (requests for addenda and the like).

When looking for a doc for your own health care needs, do you opt for a colleague, the closest in-network option or someone on the same page with your perspective on health care?

What Do You Look For in a Doctor's Doctor?

Mixed perceptions and awareness about breast cancer risk factors such as family history, breast density and whether one could reduce breast cancer risk were some of the findings from a new study looking at perceptions of breast cancer among women who had a recent mammogram.

, was largely based on a telephone survey of 1,858 women between 40 to 76 years of age, who had a mammogram in the two years prior to the survey, had no history of breast cancer and had heard of breast density. In a subset of the study, researchers also did qualitative interviews with 61 of the survey respondents.

Here are some of the findings from the study.

1. Ninety-three percent of the survey respondents (1,706) indicated that a family history of breast cancer was a stronger risk factor than breast density for future breast cancer despite reported estimates that have noted a 1.2 to 4 times higher risk depending on the degree of breast density in comparison to a doubling of risk for those with a first-degree family history of breast cancer. The researchers also noted that women without a family history of breast cancer “believed they were safe or had limited risk based on this factor alone,” according to the study. The study authors suggested that an emphasis on family history and genetic risk factors in popular media and perhaps a lack of asking patients in primary care offices about breast cancer risk factors beyond family history may contribute to some of the patient perceptions voiced in the study.

“Frequent health messaging around family history and breast cancer risk may play a role in how this sample of women perceived their own breast cancer risk,” wrote study co-author Christine M. Gunn, Ph.D., an assistant professor with the Dartmouth Institute for Health Policy and Clinical Practice, and colleagues.

What a New Study Reveals About Breast Density Awareness

DeepHealth Gets FDA Nod for AI Mammography Software that Assesses Breast Density

2. Sixty-five percent of the survey respondents (1,188) said being obese or overweight was a greater risk factor for breast cancer than breast density.

3. Slightly more than half of the survey respondents (52 percent or 957 women) indicated that breast density was a greater risk factor than not having children. Researchers also noted that a higher percentage of Black women and Hispanic women (58 percent in each group) rated breast density as a higher risk factor than not having children in contrast to 45 percent of Asian women and 48 percent of White women.

4. When asked about actions to reduce breast cancer risk, the researchers noted that many of those interviewed referred to mammograms and self-examinations of breasts as prevention strategies. Interviewees also noted exercise, dietary changes, smoking cessation and limiting alcohol but Gunn and colleagues said there was “less certainty about the direct effect on their breast cancer risk.”

The researchers also noted that 28 percent of the 61 interviewees (17) indicated a lack of awareness on actions they could take to mitigate breast cancer risk.

“Women may benefit from general guidance and information about cancer prevention strategies, such as tools that can help patients understand overall cancer risk and prevention options,” noted Gunn and colleagues.

The researchers added that partnerships between primary care and radiology could be beneficial to bolster knowledge of preventive measures as well as supplemental imaging options in this patient population.

In a new survey that examined perceptions of breast cancer risk among more than 1,800 women who had a recent mammogram, 65 percent noted that being overweight or obese was a greater risk factor than breast density, and over a quarter of those interviewed noted they were not aware that they could reduce their breast cancer risk.