Community-based Participatory Research: A Practical Guide for Radiologists

CBPR is a collaborative process that involves all partners in research to improve community health. It begins with a research topic of importance to the community and combines knowledge and action with social change. Radiology has several potential applications for CBPR, such as improving imaging quality and increasing diversity in clinical trials. This article provides an overview of CBPR, explains how to conduct it, and discusses the challenges and resources.

Systematic Approach to Pediatric Macrocephaly

Do you have a child with a big head? Don't worry, it's relatively common! Macrocephaly, defined as a head circumference greater than 2 standard deviations above the mean, is a common indication for neuroimaging. Imaging modalities such as US, CT, and MRI can help determine the cause. The differential diagnosis is broad, and age, additional imaging findings, and clinical symptoms can help narrow it down. Most cases in the pediatric population are due to increased cerebrospinal fluid spaces, such as benign enlargement of the subarachnoid space. Other common causes include hydrocephalus, hemorrhage, or a neoplasm. Rarer diseases may require genetic testing.

Translating AI to Clinical Practice: Overcoming Data Shift with Explainability

AI algorithms have the potential to revolutionize clinical practice, but data shift can be a major obstacle. Explainable AI techniques can detect and mitigate data shift, allowing for reliable AI applications. AI models are often trained with limited datasets, leading to potential performance decreases in deployment environments. Explainability can detect model susceptibility to data shift, which is otherwise hidden. Performance-based assessments can't distinguish model overfitting without external data. Explainability can help translate AI to clinical practice, allowing for reliable applications.

Cardiac Outpouchings: Practical Approach to Normal Variants and Pathologic Conditions at CT and MRI

Cardiac pouches and outpouchings can be confusing to diagnose, but this article provides a practical guide to help. Structural and pathologic entities can manifest as contrast material- or blood-filled outpouchings. Diagnosis can be made based on chamber location or involvement with septa, as well as ancillary features like motion, morphology, and thrombus. Mimics such as Bachmann bundle, atrial veins, and thebesian vessels are also discussed. Get ready to ace your quiz with this helpful guide!

Placenta Accreta Spectrum Disorders: Update and Pictorial Review of the SAR-ESUR Joint Consensus Statement for MRI

Placenta accreta spectrum (PAS) disorders are a major cause of maternal morbidity and mortality, and their incidence is increasing due to rising cesarean delivery rates. US is the primary imaging tool for diagnosis, while MRI provides additional value in equivocal cases and for surgical planning. Accurate antenatal diagnosis and multidisciplinary management are essential for optimal outcomes. SAR and ESUR have released a joint consensus statement to standardize MRI assessment. Radiologists must be familiar with the spectrum of MRI findings to accurately diagnose and make a greater impact on patient care.

Skeletal Dysplasia Families: A Stepwise Approach to Diagnosis

Radiologists can use a stepwise approach to diagnose skeletal dysplasias, a group of over 400 genetic disorders characterized by bone and cartilage abnormalities. Professor Juergen Spranger proposed the concept of bone dysplasia families in the 1980s, which has since been validated and expanded. Radiologists can recognize patterns of major skeletal dysplasias and identify different severities of the same pattern or subtle but distinctive findings. With this approach, radiologists can accurately diagnose these rare but common disorders.

Women 75 Years Old or Older: To Screen or Not to Screen?

Breast cancer is the most common cancer in women, especially as they age. Screening mammography can detect smaller, lower-stage cancers, leading to less invasive treatment and lower morbidity and mortality. Mammography performs better in older women, with higher sensitivity, specificity, and cancer detection rate. Benefits outweigh risks until age 90, and for women in good health, continuing annual screening mammography will save the most lives. National and international guidelines conflict on whether to continue screening mammography in women beyond age 74, but shared decision making can help women make informed decisions.

Imaging Patients with Kidney Failure

Imaging plays an important role in the diagnosis and treatment of kidney failure. Guidelines for the use of iodinated and gadolinium-based contrast materials affect screening and choice of contrast material. Imaging is used to assess the feasibility of a transplant, evaluate for underlying malignancy and peripheral vascular disease, and detect renal cell carcinoma. US is used for dialysis planning and postoperative evaluation. Systemic manifestations of kidney failure may be related to the underlying cause or treatment effects, and can include disturbances in mineral and bone metabolism, soft-tissue and vascular calcifications, neurologic and cardiothoracic complications. This article provides an overview of imaging considerations for kidney failure, including the appropriate use of CT, MRI, and US.

MRI of Benign Prostatic Hyperplasia: Important Pre- and Posttherapeutic Considerations

Modern treatments for lower urinary tract symptoms due to benign prostatic hypertrophy (BPH) are becoming increasingly popular alternatives to traditional techniques such as TURP and simple prostatectomy. MRI is not routinely used for these treatments, but it is important to understand the expected changes in the prostate after treatment in order to accurately interpret MRI results. This article discusses the imaging evaluation of LUTS due to BPH and emerging predictors of treatment success, as well as the posttreatment appearance and underlying anatomic changes in the prostate after medical, surgical, and minimally invasive treatments. It also covers the detection of clinically significant prostate cancer in the postprocedural prostate and imaging of BPH procedure complications.

Seeing More with Less: Clinical Benefits of Photon-counting Detector CT

PCD CT is a revolutionary technology that has been approved for clinical use in the US. It directly records x-ray photons as electric signals, providing improved spatial resolution, higher iodine image contrast, increased geometric dose efficiency, reduced radiation dose, multienergy imaging capabilities, and reduced artifacts. Early studies have shown improved visualization of key anatomic structures and radiologist confidence for some diagnostic tasks, and as PCD CT evolves, its clinical use and applications will continue to grow.

Continued Infarction Growth and Penumbral Consumption After Reperfusion in Vaccine-Naïve Patients With COVID-19: A Case-Control Study

COVID-19 may cause more aggressive cerebrovascular events than in those without the virus. This study compared 100 COVID-positive and 282 COVID-negative patients with acute ischemic stroke who underwent endovascular therapy. Results showed that COVID-positive patients had larger infarction volumes and greater infarction growth than COVID-negative patients. This suggests that even after angiographic reperfusion, COVID-19 may promote continued tissue damage. These findings may have implications for prognostication, treatment selection, and surveillance for revascularized patients.

Development and Validation of a Risk Model for Predicting Contrast-Associated Acute Kidney Injury in Patients With Cancer: Evaluation in Over 46,000 CT Scans

This study developed and validated a risk model to predict the likelihood of contrast-associated acute kidney injury (CA-AKI) after contrast-enhanced CT in patients with cancer. The model includes factors such as hematologic malignancy, diuretic use, CKD stage, serum albumin, platelet count, proteinuria, diabetes, heart failure, and contrast media volume. A risk score was created, with CA-AKI frequency increasing with higher risk categories. The risk score was found to be a good fit, and may help facilitate appropriate preventive measures for those at high risk for CA-AKI.

A Practical Guide for Paid Family and Medical Leave in Radiology, From the AJR Special Series on DEI

Paid family and medical leave (FML) has numerous benefits for organizations and individuals alike. It can improve recruitment and retention, workplace culture, and employee morale and productivity, and can even lead to cost savings. For individuals, paid FML related to childbirth can lead to improved maternal and infant health outcomes, as well as improved breastfeeding initiation and duration. Non-childbearing parental leave can lead to more equitable long-term division of household labor and childcare. National societies and governing bodies, such as the American Board of Medical Specialties, American Board of Radiology, and American Medical Association, are recognizing the importance of paid FML. To ensure an optimal policy, organizations must adhere to federal, state, and local laws, as well as consider flexibility, work coverage, culture, and finances.

Dual-Energy CT for Pediatric Thoracic Imaging: A Review

Dual-energy CT is revolutionizing thoracic imaging for both children and adults. It allows for material- and energy-specific reconstructions, which improve tissue characterization and material differentiation compared to single-energy CT. These reconstructions can help assess vascular, mediastinal, and parenchymal abnormalities. The energy-specific algorithm also allows for virtual mono-energetic reconstructions, which can increase iodine conspicuity and reduce beam-hardening and metal artifacts. This article explores the potential of dual-energy CT and photon counting in pediatric thoracic imaging.

Bleeding Events After Image-Guided Breast Biopsies: Comparison of Patients Temporarily Discontinuing Versus Maintaining Antithrombotic Therapy During Biopsy

This study compared the frequency of post-biopsy bleeding events between patients without antithrombic therapy (AT), those who temporarily discontinued AT, and those who maintained AT during breast core-needle biopsy. Results showed that discontinuing AT did not significantly increase the risk of imaging-apparent or palpable hematoma, but did reduce the risk of bruise. No patient developed clinically significant post-biopsy hematoma. The findings suggest that continuing AT during CNB is safe and patients should be counseled about the risk of bruise.

External Validation of a Five-Tiered CT Algorithm for the Diagnosis of Clear-Cell Renal Cell Carcinoma: A Retrospective Five-Reader Study

This study tested a 5-tiered CT algorithm for predicting clear-cell renal cell carcinoma (ccRCC) among small solid renal masses. Results showed a high negative predictive value (NPV) for ccRCC, with a pooled NPV of 90%. The algorithm also had fair interreader agreement and may be used to help risk stratify and select patients for active surveillance.

MR Elastography: Practical Questions, From the AJR Special Series on Imaging of Fibrosis

MR elastography (MRE) is a non-invasive tool for detecting and staging liver fibrosis in patients with chronic liver disease. Studies have shown that MRE has the highest diagnostic performance among tests for staging liver fibrosis. It is increasingly being used as a quantitative surrogate of disease severity and predictor of important clinical outcomes. MRE is also being incorporated into clinical guidelines. Advances in MRE technology are offering higher precision and new biomarkers, allowing independent assessment of inflammation and other histologic processes.

High-Speed Onsite Deep-Learning Based FFR-CT Algorithm: Evaluation Using Invasive Angiography as Reference Standard

This study evaluated the diagnostic performance of an onsite deep-learning based algorithm for fractional flow reserve (FFR) computed from coronary CTA (FFR-CT). Results showed strong correlation between FFR-CT and invasive FFR, with excellent diagnostic performance for hemodynamically significant stenosis. Analysis time per patient was 7 minutes 54 seconds, and interobserver and intraobserver agreement were good-to-excellent. This algorithm should facilitate the FFR-CT technology's implementation into routine clinical practice.

Complications After Renal Mass Biopsy: Frequency, Nature, Timing, and Associated Characteristics

RMBs are a common procedure, but complications can occur. This study found that acute and subacute complications occurred in 3.6% and 0.7% of cases, respectively. Most acute complications were bleeding-related, and deviations from normal clinical management occurred in 1.6% of cases. Patients with bleeding-related complications had lower platelet counts and more endophytic renal masses. Monitoring for 3 hours after RMB may provide safe patient management and resource utilization.

Coronary CTA for Acute Chest Pain in the Emergency Department: Comparison of 64-Detector-Row Single-Source and Third-Generation Dual-Source Scanners

This study compared the use of a single-source CT scanner with HR control to a dual-source CT scanner without HR control for coronary CTA in the emergency department. Results showed that the dual-source CT scanner had shorter CT completion time and higher image quality, while the single-source CT scanner had longer CT completion time and lower image quality. Both scanners had similar clinical outcomes, with no 30-day mortality or major adverse cardiovascular events. The dual-source CT scanner can expedite clinical processes in the ED without compromising patient safety.

Staging Chest CT in Patients With Early-Stage Colon Cancer: Analysis of Impact on Survival Using Inverse Probability Weighting and Causal Diagram

This study found that performing a staging chest CT did not have an impact on survival in patients with early-stage colon cancer. After analyzing 991 patients, the difference in restricted mean survival time at 5 years was not significant for overall survival, relapse-free survival, or thoracic metastasis-free survival. Sensitivity analyses also showed similar results. Therefore, staging chest CT may be omitted from the staging workup for these patients.