Diagnostic Imaging Weekly Scan, Sept. 11, 2020

September 11, 2020

Portable, Low-field MRI; COVID-19 and Cardiac MRI; High-Intensity Focused Ultrasound; Coronary CTA Guidance; and Pediatric Advanced Imaging Utilization

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

Before we get to our featured interview of the week with Dr. Jennifer Marin from the University of Pittsburg Medical Center about advanced imaging utilization rates with pediatric patients, here are the top stories of the week.

After all the anticipatory talk about whether a portable, low-field MRI would be able to produce images that were accurate and of diagnostic quality, a study was published this week in JAMA Neurology shows it can effectively assess patients in the intensive care unit for brain injury just as well as conventional imaging methods. According to a team from Yale New Haven Hospital, the 64mT MRI that can plug into a standard electrical outlet in any room matched the performance of standard imaging with both patients who were infected with COVID-19 and those who were virus free. They tested the technology between Oct. 30, 2019, and May 20, 2020, with 50 patients, 20 of whom were COVID-19-positive. The remaining patients had suffered ischemic, hemorrhagic, or subarachnoid stroke or they had traumatic brain injury or a brain tumor. All patients also underwent conventional CT or MRI as a comparison scan. Based on their analysis, the portable MRI identified neurological findings in 29 of the 30 infection-free patients – a performance that corresponded to the results of conventional imaging except for one diffuse subarachnoid hemorrhage. In addition, the portable system pinpointed findings in eight of the 20 COVID-19 patients, including intracranial hemorrhage, cerebral infarction, diffuse cerebral edema, and leukoencephalopathy. This performance was identical to that of conventional imaging. These results, the team said, show the potential for portable assessment of neurological injury in other scenarios, including the emergency department, mobile stroke units, and resource-limited environments.

And, when it comes to COVID-19, cardiac MRI can have an important role to play with competitive athletes who have recovered from the virus. In a study published in JAMA Cardiology, a team of investigators from The Ohio State University shared their results. The team conducted cardiac MRI on 26 competitive athletes with an average age of 19.5 years who ran track or played football, soccer, lacrosse, or basketball. Twelve athletes reported mild infection with sore throat, shortness of breath, fatigue, or fever, while the remaining 14 individuals were asymptomatic. Based on the scans, the team determined four athletes had evidence of myocarditis based on the presence of myocardial edema and myocardial injury. Other athletes also experienced myocardial inflammation. Based on these results, the team said, cardiac MRI can potentially identify a high-risk cohort for adverse outcomes. It may also be able to effectively risk stratify which athletes can safely resume competitive play as the scan has a high negative predictive value for ruling out myocarditis.

There was also news in treatment for prostate cancer this week. In a study published in the Journal of Urology, researchers from the University of Southern California in Los Angeles laid out the results of their work with high-intensity focused ultrasound – or HIFU – and its potential to help men avoid more invasive treatment options, such as surgery or radiation therapy. By testing HIFU between December 2015 and December 2019 with 100 men who have localized prostate cancer, they found the strategy was effective with most men. The team defined failure as a prostate cancer recurrence, radical treatment, systemic therapy, metastasis, or death specifically related to prostate cancer. Based on their evaluations, at initial follow-up they discovered 73 percent of men avoided treatment failure, and 76 percent had no evidence of clinically significant prostate cancer. In addition, 100 percent retained continence. After two years, 91 percent of men had avoided radical treatment, and only 13 percent had experienced minor complications. Overall, the team said, they believe their data represents actual clinical practice in the United States.

In addition, this week, the American College of Cardiology published updated guidelines, calling for greater use of coronary CT angiography in the Journal of the American College of Cardiology. This guidance reflects evidence that shows that, for patients with no known coronary artery disease, providers should look to pinpoint coronary atherosclerosis instead of myocardial perfusion abnormality when looking to identify the disease. To move the industry toward a coronary CTA-first strategy, the ACC made six recommendations, including using coronary CTA as a first-line test for patients with stable chest pain, exploring bundled payment options for cardiac testing, identifying ways to increase the number of coronary CTA providers, establishing a coronary CTA registry for evaluating chest pain, engaging commercial payers to potential eliminate pre-approvals for the test, and improving provider education about when to consider coronary CTA.

And, finally this week, Diagnostic Imaging spoke with Dr. Jennifer Marin, assistant professor of pediatrics and emergency medicine at the University of Pittsburgh Medical Center, about her recent study published in JAMA Pediatricsthat examined the changes in the utilization rate of advanced imaging with the pediatric population. She talked with us about some of the surprising results of her findings with CT, ultrasound, and MRI, as well as how these results can potentially inform clinical decision making with children in the emergency department. Here’s what she had to say.