Diagnostic Imaging Weekly Scan: July 31, 2020

July 31, 2020

COVID-19, Stroke, and Heart Damage; Limitations of Digital Breast Tomosynthesis; Guidance for Pediatric CTA; and Micro-Ultrasound and Prostate Cancer

Welcome to Diagnostic Imaging’s Weekly Scan. I’m Whitney Palmer, senior editor.

Before we get to our interview with renowned urologist Dr. Laurence Klotz about the growing role of micro-ultrasound in prostate cancer detection and how it compares to multi-parametric MRI, here are the top stories of the week.

As research continues, we are learning more and more about the relationship between COVID-19 and stroke. In a new study published in the American Journal of Roentgenology, investigators from Mount Sinai Ichan School of Medicine determined that patients who come to the emergency department with neurological symptoms face a 2.4-times greater likelihood that they will experience a large vessel occlusion stroke than people who are not infected with the virus. By reviewing neuroimaging scans from 329 patients between March 16 and April 30 of this year, the team found that 38.3 percent of patients for whom providers initiated a stroke code were also positive for the virus. And, 62 percent of those patients experienced large vessel occlusion strokes involving the M1-M2 segments of the middle cerebral artery. Based on this information, the team urged providers to pay closer attention to COVID-19-positive patients who have neurological symptoms and to lower the threshold for initiating a stroke code.

In addition, research published this week in JAMA Cardiology highlights that 78 percent of patients who have COVID-19 and recover have lingering heart damage even after they enter recovery regardless of any pre-existing conditions or the severity of their disease. These results, seen on MRI scans, identify the presence of ongoing inflammation in the heart muscle and heart lining that point to myocarditis and pericarditis. By examining 3T MRI scans from an unselected cohort of 100 patients, the team of German investigators found that 78 percent of patients had abnormal cardiac findings, including raised myocardial native T1 in 73 percent of patients and increased myocardial native T2 in 60 percent of patients. In addition, they found detectable high-sensitivity troponin in 76 percent of patients, as well as myocardial late gadolinium enhancement in 32 percent and pericardial enhancement in 22 percent. Overall, the team said, these findings point to a long-term, lingering impact of COVID-19 that could affect the future of patient care.

In non-COVID-19 news, investigators from the University of Washington School of Medicine published a study in JAMA Network Open this week that revealed not all women benefit from digital breast tomosynthesis. Although the screening technique is known for improved cancer detection and the reduction in recall rates, the researchers discovered that the 10 percent of women who have extremely dense breast tissue do not experience those outcomes, raising a concern for undetected – and therefore – untreated breast cancers. The team examined more than 1.5 million breast exams, including 1.27 million digital mammograms and 310,000 3D mammograms, and they found improved cancer detection rates, as well as a drop in recall rates, across all age groups examined. They also found that a higher biopsy recommendation rate was associated with 3D mammography. Ultimately, investigators said providers should apply these findings to determining which patients would benefit the most from digital breast tomosynthesis and which patients should stick with digital mammography.

For pediatric imaging, researchers from Nemours Children’s Health System in Florida published guidance to help you maximize the use and safety of pediatric CT angiography. As always, these tips are guided by the Image Gently and Image Wisely campaign. Overall, the team offered pearls of wisdom in 10 areas: knowing your patient, scanner, and clinical context; scan timing; IV access and contrast material risks; the importance of a saline chaser; gantry rotation time and pitch; kilovoltage setting; tube current; scan direction; post-processing; and dual- or single-bolus techniques. The details of their guidance are published in the American Journal of Roentgenology.

And, finally this week, Diagnostic Imaging spoke with Dr. Laurence Klotz, former chief of the division of urology at Sunnybrook Health Sciences Center and former president of the Canadian Urological Association and his colleague Dr. Brian Wodlinger, director of research at clinical projects at Exact Imaging, about the use of micro-ultrasound in detecting prostate cancer and the role it could play in supplementing multi-parametric MRI in searching for and more easily identifying the disease. Here’s what they shared.