Diagnostic Imaging Weekly Scan: Sept. 18, 2020

September 18, 2020

Rethinking CMR during COVID-19; Abdominal Imaging and COVID-19; Mental Health Impacts of COVID-19; African American and Lung Cancer Screening; Plus, African American Women and Disadvantages in Breast Cancer Screening

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

Before we get to our featured interview this week with Dr. Murray Rebner about the disadvantages African American women experience with breast cancer screening, here are the top stories of the week.

Last week, JAMA Cardiology published a study, revealing that 15 percent of competitive athletes had evidence of myocarditis on cardiac MRI scans after recovering from COVID-19. The news is certainly concerning and has pushed many in healthcare to investigate these findings further. But, the results of that study – which included asymptomatic patients – also caught the attention of a cadre of experts from cardiology, diagnostic imaging, and general medicine. And, they are worried the investigation’s outcome could lead clinicians down a questionable path. In an open letter to the American College of Radiology, the Radiological Society of North America, the European Society of Radiology and more than a dozen other professional organizations, this group requested those organizations craft and publish guidance that does not recommend the use of cardiac MRI in patients who are asymptomatic for COVID-19. Ohio State cardiologist, Dr. Matthew Tong who was involved with the JAMA Cardiology study spoke with Diagnostic Imaging, and he agreed these concerns are not unfounded and that there is a need for more data that enable direct comparisons. The important thing, he stressed, is to continue to investigate this problem.

In addition to cardiac imaging, abdominal radiologists should keep their eyes open for signs of COVID-19, too. That’s according to a study published this week in Abdominal Radiology. According to investigators from the University of Alberta, 18 percent of patients who end up testing positive for the virus first present with complaints of appetite loss, nausea, vomiting, diarrhea, and abdominal gas – in fact, 16 percent of patients only show those symptoms. For their study, the researchers analyzed 36 articles published between March 31 and July 15 of this year. In that review, they identified the most common findings as small and large bowel wall thickening, fluid-filled colon, pneumatosis intestinalis, pneumoperitoneum, intussusception, and ascites. And, in most cases, radiologists only caught these as incidental findings in the base of the lungs that show up on abdominal CT scans. So, if you’re examining any abdominal scans, be on the look out for evidence that might help you diagnose a COVID-19-positive patient.

And, once again, this week, investigators turned their eyes to how the pandemic is continuing to affect you and your colleagues. In a study published in the European Journal of Radiology, a team from France showed that many of you are still experiencing insomnia, anxiety, and depression brought on by the continued outbreak. Based on an anonymous survey conducted from April 10 to April 19 of this year with responses from 1,515 radiologists, the team found that more than one-third of providers are struggling with these issues. In particular, 40.9 percent reported having trouble sleeping, 35 percent said they had symptoms of anxiety, and 30.6 percent wrestled with depression. Between 12 percent and 15 percent self-report that these issues were clinically significant. Radiologists in all care environments said they experienced these problems to some degree, but those in private practice were most affected. It’s possible the team said that substantial drops in workload led to a reduced sense of usefulness, as well as worries about financial stability. It’s also important to note, the team said, that these added feelings of stress and anxiety have compounded the already heavy sense of burnout that many providers in radiology were already dealing with prior to the pandemic.

In non-COVID-19 news, lung cancer screening guidelines could be overlooking African American smokers who are at risk for developing the disease. This sounds an alarm bell because African Americans have a higher incidence of and worse outcomes with lung cancer. In a study published in the Journal of the American College of Radiology, researchers from Cook County Health and Northwestern University in Chicago shared evidence that the 30-pack-year threshold used to determine which patients should undergo low-dose CT screening could be too high. They found that while African Americans might smoke for the same number of years as their white counterparts, they aren’t actually smoking as many packs a day. So, they are closer to a 20-pack-year threshold. Based on their review of CT scans from 784 current and former smokers, the team determined African Americans had an incidence of lung cancer of 2.5 percent while their white counterparts experienced 1.9 percent. When looking at lung cancer diagnosis in the context of smoking, African American participants were the only race who received the cancer diagnoses when they had a pack-year history below 30. Specifically, 30-pack-year smokers had an incidence of 2.2 percent, but for those less than 30, it was 2.7 percent. Based on these results, the team recommended changing the lung cancer screening threshold from 30-pack-years to 20-pack-years.

And, finally, this week, Diagnostic Imaging spoke with Dr. Murray Rebner, professor of diagnostic radiology and molecular imaging at Oakland University William Beaumont School of Medicine. He is also the director of the division of breast imaging at Beaumont Health System. He spoke with us about his latest research published in the Journal of Breast Imaging that examines the many obstacles and disadvantages that African American women face when it comes to being properly screened for breast cancer in a timely manner. Here’s what he had to say.