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Profound improvements in perfusion and diffusion tensor imaging over the past few decades are changing the ways in which radiologists understand disease processes, especially those involving small blood vessels in the brain.

Not all those who suffer heart attacks have typical symptoms. Many people, including the elderly, those with renal disease, and women, are at risk of having a silent myocardial infarction. People with diabetes, in particular, are among those at highest risk of experiencing a silent MI. Now there is a clinical MRI technique that can identify abnormal myocardium, which signifies a high-risk profile, in diabetic patients.

righam and Women's Hospital researchers have shown that MR-guided focused ultrasound surgery reduces the painful symptoms of uterine leiomyomas for at least a year after treatment. Better technique and growing experience with the minimally invasive procedure have improved its effectiveness and safety while helping physicians with patient selection.

Breast MRI suffered from a serious image problem during the second half of the 1990s. Because of its limited specificity and high cost, the technique was written off by many specialists, but clinical acceptance of it has increased over the past few years. It is now widely recognized as a valuable adjunct to mammography and ultrasound.

The most highly anticipated stroke imaging trial of the year has left radiologists scratching their heads about the disappointing results. No more than 47% of acute stroke patients administered the clot-dissolving protein desmoteplase three to nine hours after the onset of symptoms showed improvement. The positive outcome rate was about the same among patients given a placebo.

Radiologists could be shortchanged if Medicare goes through with plans announced Monday to end its long-standing policy of paying separately for imaging contrast media, radiopharmaceuticals, interventional radiology supervision, and interpretation.

Myriad Genetics is the only place to go for BRCA1/BRCA2 mutation testing. The Salt Lake City biopharmaceutical company has a monopoly on the test. Its scientists discovered the BRCA1 and BRCA2 genes in 1996 and patented their use for assessing the risk of genetically related cancer.

Like other medical journalists, I can usually be found in the front rows of the radiology meeting lecture halls, dutifully taking copious notes. The American Roentgen Ray Society meeting in May was no exception. But this time I was also under a vow of silence for three weeks, after a vocal cord nodule diagnosis.

Case Of The Month

Back pain and weakness of both legs had bothered this 60-year-old woman for one week. Left breast cancer, stage 2, had been diagnosed two years before, and she subsequently underwent a lumpectomy followed by chemotherapy and radiation therapy.

In a flash, after the American Cancer Society guidelines came out in favor of breast MRI for high-risk screening in late March, prominent radiology preauthorization company CareCore proclaimed it had been ahead of the times. The ACS release was a major coup for the technique.

An influential trial has left neuroradiologists in a quandary about the best imaging approach for the initial evaluation of acute stroke. The single-center prospective trial concluded that MRI accurately diagnoses acute stroke while noncontrast CT, the old gold standard, is about as accurate as a coin flip.

Monty Python, the British comedy troupe, got it at least partially wrong. Contrary to the claim of their legendary skit involving Catholic cardinals, a matronly lady, and torture in a comfy chair, one can expect the Spanish Inquisition. An Albequerque oncologist has found evidence of Spain's infamous campaign to rid itself and its territories of heretics by testing Hispanic women in northern New Mexico for BRCA1/BRCA2 mutations.

A new web-based automated mail and phone system that helps medical secretaries remind women to schedule a mammogram could boost breast cancer screening rates, according to Mayo Clinic researchers.

Some women who carry a strong genetic susceptibility to cancer have consented to the surgical removal of their breasts to avoid likely cancer. The combination of reliable genetic testing, however, and close surveillance using breast MRI, mammography, and ultrasound now offers an alternative to such excision or the acceptance of a strong possibility of cancer.