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Everything you need to know about Computed Tomography (CT) & CT Scanning

October 2019 Imaging Pearls - Educational Tools | CT Scanning | CT Imaging | CT Scan Protocols - CTisus
Imaging Pearls ❯ October 2019

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3D and Workflow

  • Purpose: Software solutions such as mRay allow review of radiological images on handheld devices. We investigated if the quality is adequate for evaluating CT scans of patients with suspected stroke.
    Results: All LVOs (large-vessel occlusion) , intracranial tumors and ICHs were detected on both mobile devices. There was no significant difference in the rating of CCT and CBF ASPECTS between all three devices, while the sensitivity for detecting a CBF/CBV-mismatch was above 80% on both devices. Both raters assessed the diagnostic quality to be sufficient on both mobile devices to base treatment decisions on.
    Image review on mobile devices for suspected stroke patients: Evaluation of the mRay software solution
    Alex Brehm et al.
    PLOS ONE | https://doi.org/10.1371/journal.pone.0219051 June 28, 2019
  • Methods:50 patients (Median age 80 years, 28 females) were retrospectively selected. All patients had undergone multidetector CT angiography ± perfusion and presented with clinical signs of acute stroke. Out of the 50 patients, 19 had large-vessel occlusion (LVO), 5 had intracra- nial hemorrhage (ICH), 10 had severe intracranial stenosis of at least one major vessel, 2 had intracranial tumor and 15 had no or an unrelated pathology. One experienced neurora- diologist and one resident scored the anonymized pictures separately on two handheld devices (iPhone 7 Plus, MED-TAB) equipped with mRay Software and on a PACS worksta- tion. Each case was reviewed on all three devices with a break in-between of at least 12 weeks. The scoring on the traditional workstation was compared with the two handheld devices, regarding detection of early ischemic signs, LVOs, CBV/CBF-mismatch, ICHs and severe stenosis. Both raters were asked to rate the diagnostic quality of both handheld devices regarding detection of LVOs, ICHs, early ischemic signs and overall.
    Image review on mobile devices for suspected stroke patients: Evaluation of the mRay software solution
    Alex Brehm et al.
    PLOS ONE | https://doi.org/10.1371/journal.pone.0219051 June 28, 2019
  • Conclusion: Our study shows that mobile devices can be safely used for image review of CT scans of suspected stroke patients and in case of an experienced rater treatment decisions can be based on such reviews. However for assuring, that additional findings are not missed reviewing the scans later on a traditional workstation should still be mandatory.
    Image review on mobile devices for suspected stroke patients: Evaluation of the mRay software solution
    Alex Brehm et al.
    PLOS ONE | https://doi.org/10.1371/journal.pone.0219051 June 28, 2019
  • “Email and SoMe (Social Media) can serve as effective tools for the dissemination of radiology educational content. SoMe offers the additional advantage of substantial visibility outside the home institution, enabling other important career benefits such as networking and personal and institutional branding. Archival of educational material is another advantage of electronic SoMe-based education, allowing many future learners to benefit from the effort of today’s online educators.”
    Electronic and Social Media-based Radiology Learning Initiative: Development, Implementation, Viewership Trends, and Assessment at 1 Year
    Koontz NA et al.
    Acad Radiol 2018; 25:687-698
  • “Both in terms of widely disseminating educational content and providing visibility for educational efforts, SoMe was a clear winner over email and traditional website means. This is supported by our data, which showed an overall viewer- ship growth trend on Twitter with regard to both case and answer Tweets, as well as a mild decrease in email viewership over the same time interval. With regard to SoMe, Twitter outperformed YouTube, which also showed an overall downward trend in viewership over the course of the first year of COTD implementation.”
    Electronic and Social Media-based Radiology Learning Initiative: Development, Implementation, Viewership Trends, and Assessment at 1 Year
    Koontz NA et al.
    Acad Radiol 2018; 25:687-698
  • Cinematic Rendering: The Reality in Clinical Practice
    - Robust rendering technique across multiple body regions ranging from head to feet
    - Excellent for demonstration of skin, muscle, soft tissues, bone, vasculature
    - Complex trapizoids can allow for multiple tissue types to be displayed in a single visualization
  • Cinematic Rendering: The Reality in Clinical Practice
    - Preset values of specific anatomic values can be used in most cases to speed up the generation of the 3D image dataset
    - Preset values may change depending on the specific visualization (anterior vs lateral view) and the scan protocol used (IV contrast and injection rate and acquisition timing such as arterial/venous/delayed phase imaging)
  • Cinematic Rendering: The Reality in Clinical Practice
    - AI may prove to be of value in choosing the best (or a series of potential best) image displays based on the dataset used.
    - For example could the system provide a series of select “preset views” to image a suspected pancreatic mass based on learning from previously generated datasets?
  • Cinematic Rendering: The Reality in Clinical Practice
    - Visualization of cinematic rendered images can be done with select images or with the creation of a video file. Video files have the advantage over static images especially for the referring physician who may not have access to the workstation
    - Newer display technologies like Microsoft HoloLens 2 may enhance the value of cinematic rendering
  • HoloLens 2
  • HoloLens 2
  • HoloLens 2
  • HoloLens 2
  • HoloLens 2
Cardiac

  • ”Cinematic rendering is a novel technique which is similar to VR but incorporates a more complex lighting model to create more photorealistic images. It has not been widely studied and is not widely available but it has shown promise in several applications, including cardiac imaging. Rowe et al. published a case of a spindle cell sarcoma of the right ventricle illustrating how cinematic rendering can be used to demarcate the margins and extent of the mass.”
    The Assessment of Cardiac Masses by Cardiac CT and CMR Including Pre-op 3D Reconstruction and Planning
    Stephen Liddy et al.
    Current Cardiology Reports (2019) 21:103
  • ”Cinematic rendering is a novel technique which is similar to VR but incorporates a more complex lighting model to create more photorealistic images. It has not been widely studied and is not widely available but it has shown promise in several applications, including cardiac imaging. Rowe et al. published a case of a spindle cell sarcoma of the right ventricle illustrating how cinematic rendering can be used to demarcate the margins and extent of the mass.”
    The Assessment of Cardiac Masses by Cardiac CT and CMR Including Pre-op 3D Reconstruction and Planning
    Stephen Liddy et al.
    Current Cardiology Reports (2019) 21:103
  • “Secondary cardiac tumors (metastases) are 30–40 times more common than primary tumors and can spread to the heart by hematogenous dissemination, lymphatic spread, venous extension, or direct invasion. Melanoma and thoracic neoplasms such as lung, breast, and esophageal carcinomas are the most frequently implicated primaries.”
    The Assessment of Cardiac Masses by Cardiac CT and CMR Including Pre-op 3D Reconstruction and Planning
    Stephen Liddy et al.
    Current Cardiology Reports (2019) 21:103
  • Benign and malignant masses by location, with characteristic imaging features
  • “The typical appearance is of a polypoid intracavitary mass within the left atrium, attached to the fossa ovalis by a stalk. On non-contrast-enhanced CT, myxomas appear as smooth, lobulated, hypodense masses. Calcification may be present but is more commonly seen when located in the right atrium. On contrast- enhanced CT, myxomas appear as intracavitary filling defects. Necrosis or hemorrhage may give rise to a het- erogenous enhancement pattern following the administration of contrast. Myxomas may be detected incidentally at CT and can often diagnosed with confidence without the need for CMR due to their typical appearance. The high spatial resolution of CT enables precise location of the size and insertion of the stalk.”
    The Assessment of Cardiac Masses by Cardiac CT and CMR Including Pre-op 3D Reconstruction and Planning
    Stephen Liddy et al.
    Current Cardiology Reports (2019) 21:103
  • Fibromas are the second most common primary cardiac neoplasm of childhood presenting at a mean age of 11 years . Like rhabdomyomas, they also arise in an intramural location, typically within the left ventricle or interventricular septum. However, in contrast to rhabdomyomas, fibromas are usually solitary. Histologically, they are composed of neoplas- tic fibroblasts interspersed with large amounts of collagen. Associations include familial adenomatous polyposis, Gardner syndrome, and several developmental anomalies including cleft lip and cleft palate.
    The Assessment of Cardiac Masses by Cardiac CT and CMR Including Pre-op 3D Reconstruction and Planning
    Stephen Liddy et al.
    Current Cardiology Reports (2019) 21:103
  • “Cardiac hemangiomas, also known as cardiac venous malformations, are rare lesions accounting for 5–10% of primary cardiac tumors. They consist of endothelial-lined channels and may be divided into capillary, cavernous, or arteriovenous subtypes. They are usually solitary lesions and are typically found in the ventricles, although they may arise in any cardiac chamber.”
    The Assessment of Cardiac Masses by Cardiac CT and CMR Including Pre-op 3D Reconstruction and Planning
    Stephen Liddy et al.
    Current Cardiology Reports (2019) 21:103
  • ”Rhabdomyosarcomas represent 4–7% of cardiac sarcomas and are the most common cardiac malignancy in infants and children. Unlike undifferentiated sarcomas and angiosarcomas, rhabdomyosarcomas demonstrate no predi- lection for any specific chamber. Similar to rhabdomyomas, multiple sites of origin are not uncommon . On CT, rhabdomyosarcomas appear as large infiltrative masses that may surround central areas of necrosis. On CMR, they appear isointense to myocardium on T1-weighted images and hyper intense on T2-weighted images. Enhancement is typically homogenous, although central areas of necrosis may give rise to central areas hypoenhancement.”
    The Assessment of Cardiac Masses by Cardiac CT and CMR Including Pre-op 3D Reconstruction and Planning
    Stephen Liddy et al.
    Current Cardiology Reports (2019) 21:103
  • “Primary cardiac lymphoma usually arises in the right side of the heart, most commonly in the right atrium, and often infiltrates the pericardium resulting in a pericardial effusion. Extensive nodular infiltration of the myocardium is also often present at the time of diagnosis. Epicardial extension along the surface of the heart and encasement of the aortic root and coronary arteries have been described.”
    The Assessment of Cardiac Masses by Cardiac CT and CMR Including Pre-op 3D Reconstruction and Planning
    Stephen Liddy et al.
    Current Cardiology Reports (2019) 21:103
  • “Pericardial metastases may present as pericardial thickening, nodularity, or a pericardial effusion. Malignant pericardial effusions are typically exudative and often hemorrhagic, and thus appear denser on CT and more hyperintense on T1- weighted CMR images compared with simple transudative effusions.”
    The Assessment of Cardiac Masses by Cardiac CT and CMR Including Pre-op 3D Reconstruction and Planning
    Stephen Liddy et al.
    Current Cardiology Reports (2019) 21:103
  • “Four routes of spread are described: hematogenous dissemination, lymphatic spread, venous extension and direct invasion. Hematogenous dissemination usually results in myocardial deposits and is typically seen with melanoma, lymphoma, or leukemia. Lymphatic spread is usually the result of retrograde propagation through the mediastinal lymphatics and results in cancerous cells implanting on the epicardium or pericardium. Thoracic malignancies, in particular lung and breast carcinomas, account for the majority of such cases.”
    The Assessment of Cardiac Masses by Cardiac CT and CMR Including Pre-op 3D Reconstruction and Planning
    Stephen Liddy et al.
    Current Cardiology Reports (2019) 21:103
  • Four routes of spread are described: hematogenous dissem- ination, lymphatic spread, venous extension and direct invasion. Hematogenous dissemination usually results in myocardial deposits and is typically seen with melanoma, lymphoma, or leukemia. Lymphatic spread is usually the result of retro- grade propagation through the mediastinal lymphatics and results in cancerous cells implanting on the epicardium or pericardium. Thoracic malignancies, in particular lung and breast carcinomas, account for the majority of such cases. Venous extension describes tumors propagating along the veins leading to the heart. Infradiaphragmatic tumors may ascend along the IVC and involve the right atrium. Renal cell carcinoma is the typical example, but hepatocellular and adrenocortical carcinoma may also spread via this route. Lastly, direct extension is usually seen in thoracic malignan- cies due to their proximity to the heart and is most commonly the result of lung, breast or esophageal carcinoma or, less commonly, pleural mesothelioma.
    The Assessment of Cardiac Masses by Cardiac CT and CMR Including Pre-op 3D Reconstruction and Planning
    Stephen Liddy et al.
    Current Cardiology Reports (2019) 21:103
  • “Venous extension describes tumors propagating along the veins leading to the heart. Infradiaphragmatic tumors may ascend along the IVC and involve the right atrium. Renal cell carcinoma is the typical example, but hepatocellular and adrenocortical carcinoma may also spread via this route. Lastly, direct extension is usually seen in thoracic malignancies due to their proximity to the heart and is most commonly the result of lung, breast or esophageal carcinoma or, less commonly, pleural mesothelioma.”
    The Assessment of Cardiac Masses by Cardiac CT and CMR Including Pre-op 3D Reconstruction and Planning
    Stephen Liddy et al.
    Current Cardiology Reports (2019) 21:103
  • “Pericardial cysts are benign, congenital, fluid-filled lesions, most commonly located in the right cardiophrenic angle. Their typical location helps distinguish them from other cystic mediastinal abnormalities such as bronchogenic, thy- mic, and foregut duplication cysts. They are almost always asymptomatic but rare cases have been reported of large cysts causing hemodynamic compromise, or hemorrhage into a cyst leading it to exert mass effect. On CT, pericardial cysts appear as thin-walled, fluid- density structures which do not communicate with the peri- cardial space (unlike pericardial diverticulae) and do not enhance post-contrast.”
    The Assessment of Cardiac Masses by Cardiac CT and CMR Including Pre-op 3D Reconstruction and Planning
    Stephen Liddy et al.
    Current Cardiology Reports (2019) 21:103
  • “Advances in multidetector CT hardware and more sophisticated post-processing algorithms have made 3D reconstructions a useful adjunct in the assessment of a cardiac mass [82]. Both maximum intensity projection (MIP) and volume rendering (VR) can be used for reconstructing CT datasets and can assist in displaying information that can be difficult to appreciate on two-dimensional (2D) images.”
    The Assessment of Cardiac Masses by Cardiac CT and CMR Including Pre-op 3D Reconstruction and Planning
    Stephen Liddy et al.
    Current Cardiology Reports (2019) 21:103
  • “MIP images are reconstructed by selecting the highest at- tenuation voxels in a given volume and displaying them as a single 2D image. MIP images are optimized for evaluating vascular anatomy and can be of value in assessing the course and locations of the coronary arteries and their relationship to the mass. Volume rendering employs a more complex algorithm and allows for better visualization of soft tissues, bony structures, and vasculature in a single image. In VR, each voxel is assigned a color and transparency based on its attenuation and the information is displayed as a single image which can be manipulated to better understand the anatomic and spatial relationships between the margins of the mass and the surrounding structures.”
    The Assessment of Cardiac Masses by Cardiac CT and CMR Including Pre-op 3D Reconstruction and Planning
    Stephen Liddy et al.
    Current Cardiology Reports (2019) 21:103
Colon

  • Purpose To compare CT angiography (CTA) and tagged red blood cell (RBC) scan as a function of time from these initial imaging studies to subsequent conventional angiography and catheter-directed embolization in patients with gastrointestinal (GI) bleeding.
    Conclusions In patients requiring conventional angiography for GI bleeding, CT angiography results in a faster time to angi- ography than tagged RBC scan, which appears to be due to the longer duration required to complete the tagged RBC scan. Decreasing time to angiography is vital, as GI bleeding can be fatal and earlier diagnosis and intervention has the potential to reduce morbidity and mortality, while also increasing sensitivity of angiography. These findings may assist ordering clinicians in deciding on the appropriate diagnostic study.
    Time to conventional angiography in gastrointestinal bleeding: CT angiography compared to tagged RBC scan
    Hsu MJ et al.
    Abdominal Radiol (in press ) 2019
  • “The mean time from diagnostic study order to study completion was 3 h and 4 min for the CTA group and 5 h and 1 min for the tagged RBC scan group (p value = 0.0001). There was no statistically significant difference between the time to angiography after completion of the preceding diagnostic study. The total mean time from diagnostic study order to inter- vention was 6 h and 8 min for the CTA group and 9 h and 29 min for the tagged RBC scan group, a statistically significant difference (p value = 0.028).”
    Time to conventional angiography in gastrointestinal bleeding: CT angiography compared to tagged RBC scan
    Hsu MJ et al.
    Abdominal Radiol (in press ) 2019
  • ”The results show that in the clinical setting of a patient presenting with GI bleeding requiring catheter-directed embolization, CTA reduces the time to angiography as compared to tagged RBC scanning. Furthermore, the overall time from the decision to order a radiologic study to catheter angiography is faster with CTA. Given the time from diagnostic study completion to angiography was not statistically significant between the two groups, it can be inferred that the limiting step was with diagnosis.”
    Time to conventional angiography in gastrointestinal bleeding: CT angiography compared to tagged RBC scan
    Hsu MJ et al.
    Abdominal Radiol (in press ) 2019
  • Purpose To compare CT angiography (CTA) and tagged red blood cell (RBC) scan as a function of time from these initial imaging studies to subsequent conventional angiography and catheter-directed embolization in patients with gastrointestinal (GI) bleeding.
    Conclusions In patients requiring conventional angiography for GI bleeding, CT angiography results in a faster time to angi- ography than tagged RBC scan, which appears to be due to the longer duration required to complete the tagged RBC scan. Decreasing time to angiography is vital, as GI bleeding can be fatal and earlier diagnosis and intervention has the potential to reduce morbidity and mortality, while also increasing sensitivity of angiography. These findings may assist ordering clinicians in deciding on the appropriate diagnostic study.
    Time to conventional angiography in gastrointestinal bleeding: CT angiography compared to tagged RBC scan
    Hsu MJ et al.
    Abdominal Radiol (in press ) 2019
  • “The mean time from diagnostic study order to study completion was 3 h and 4 min for the CTA group and 5 h and 1 min for the tagged RBC scan group (p value = 0.0001). There was no statistically significant difference between the time to angiography after completion of the preceding diagnostic study. The total mean time from diagnostic study order to inter- vention was 6 h and 8 min for the CTA group and 9 h and 29 min for the tagged RBC scan group, a statistically significant difference (p value = 0.028).”
    Time to conventional angiography in gastrointestinal bleeding: CT angiography compared to tagged RBC scan
    Hsu MJ et al.
    Abdominal Radiol (in press ) 2019
  • ”The results show that in the clinical setting of a patient presenting with GI bleeding requiring catheter-directed embolization, CTA reduces the time to angiography as compared to tagged RBC scanning. Furthermore, the overall time from the decision to order a radiologic study to catheter angiography is faster with CTA. Given the time from diagnostic study completion to angiography was not statistically significant between the two groups, it can be inferred that the limiting step was with diagnosis.”
    Time to conventional angiography in gastrointestinal bleeding: CT angiography compared to tagged RBC scan
    Hsu MJ et al.
    Abdominal Radiol (in press ) 2019
Deep Learning

  • Innovative Partnerships
  • Google and Mayo Clinic
  • As the global expert in solving rare and complex disease, Mayo Clinic has a long history of excellence in healthcare and medical innovation. This rich legacy has long been supported by Mayo Clinic’s focus on innovation, research, and cutting-edge science. As healthcare increasingly embraces digital technology, the collection, management and analysis of complex healthcare data has become a critical factor in providing advanced care to patients worldwide. 
    With these factors in mind, Mayo Clinic has chosen to partner with Google to positively transform patient and clinician experiences, improve diagnostics and patient outcomes, as well as enable it to conduct unparalleled clinical research.
    This strategic partnership will combine Google’s cloud and AI capabilities and Mayo’s world-leading clinical expertise to improve the health of people—and entire communities—through the transformative impact of understanding insights at scale. Ultimately, we will work together to solve humanity’s most serious and complex medical challenges. 
    How Google and Mayo Clinic will transform the future of healthcare
  • “This article focuses on the role of radiologists in imaging AI and suggests specific ways they can be engaged by (1) considering the clinical need for AI tools in specific clinical use cases, (2) undertaking formal evaluation of AI tools they are considering adopting in their practices, and (3) maintaining their expertise and guarding against the pitfalls of overreliance on technology.”
    Artificial Intelligence in Imaging: The Radiologist’s Role
    Daniel L. Rubin
    J Am Coll Radiol 2019;16:1309-1317.
  • “Failure of AI algorithms to generalize well to new data arises because everything that AI algorithms that are trained solely on data (deep learning) “know” is based on the data that were used to train them. If the training data do not include certain types of cases that a radiology practice may encounter (eg, different diseases, different image types, artifacts), then the algorithm may provide unexpected results. Bias in training data is a common cause of AI algorithms to fail to generalize, for example, because of differences in patient populations, types of equipment, and imaging parameters used and lack of representation of rare diseases.”
    Artificial Intelligence in Imaging: The Radiologist’s Role
    Daniel L. Rubin
    J Am Coll Radiol 2019;16:1309-1317.
  • Artificial Intelligence in Imaging: The Radiologist’s Role
    Daniel L. Rubin
    J Am Coll Radiol 2019;16:1309-1317.

  • “There are some dangers, however, of unexpected negative consequences of AI on radiology practice, even if these algorithms perform well according to metrics on local practice data as described earlier. The first negative consequence is blind acceptance of the AI output. The AI algorithms are generally expected to be used to supplement, not replace, radiologists, who are presumed to have formulated an independent judgement before considering the output from the AI algorithm.”
    Artificial Intelligence in Imaging: The Radiologist’s Role
    Daniel L. Rubin
    J Am Coll Radiol 2019;16:1309-1317.
  • ”In some cases, especially high-volume and time-pressured practices, there may be a temptation to simply accept the AI reading and not formulate an independent judgement. In that case, radiologist performance will be no better than that of the AI algorithm (of course, the same applies to showing a case to a colleague). The danger in the case of the AI algorithm, however, is that if it does not generalize well to unusual cases, it may lead radiologists astray.”
    Artificial Intelligence in Imaging: The Radiologist’s Role
    Daniel L. Rubin
    J Am Coll Radiol 2019;16:1309-1317.
  • ”Patients have concerns that AI tools could produce restricted views with wrong diagnoses, and they believe that such automated systems should remain secondary to the opinions of radiologists. It will thus be beneficial for radiologists to keep these patient perspectives in mind as well as the pitfalls of assistive technologies as AI algorithms enter the market. Finally, overreliance on technology and temptation to blindly accept AI outputs could adversely affect the training of future radiologists, who may not learn the critical observation and interpretative skills that make radiology a unique discipline.”
    Artificial Intelligence in Imaging: The Radiologist’s Role
    Daniel L. Rubin
    J Am Coll Radiol 2019;16:1309-1317.
  • TAKE-HOME POINTS
    - The pace of AI development is exploding, and the number of AI tools being marketed to radiologists is accelerating, posing challenges for radiologists to decide which tools to adopt.
    - The role of radiologists in imaging AI is to identify important clinical use cases for which these tools are needed and to evaluate their effectiveness in their clinical practice.
    - AI tools are expected to improve radiologist prac- tice, but radiologists must guard against overreliance on these technologies and the potential accompa- nying loss of clinical expertise.
    Artificial Intelligence in Imaging: The Radiologist’s Role
    Daniel L. Rubin
    J Am Coll Radiol 2019;16:1309-1317.
  • Pneumothorax Detection
  • GE Critical Care Suite
    - Helps radiologists prioritize critical cases with a suspected pneumothorax – a type of collapsed lung – by immediately flagging critical cases to radiologists for triage, which could drastically cut the average review time from up to eight hours
    - Critical Care Suite’s overall Area Under the Curve (AUC) for detecting a pneumothorax is 0.96. Large PTXs are detected with extremely high accuracy (AUC = 0.99). Small PTXs are detected with high accuracy (AUC = 0.94). GE Healthcare 510k K183182.
  • GE Critical Care Suite
    A prioritized “STAT” X-ray can sit waiting for up to eight hours for a radiologist’s review1. However, when a patient is scanned on a device with Critical Care Suite, the system automatically analyzes the images by simultaneously searching for a pneumothorax. If a pneumothorax is suspected, an alert – along with the original chest X-ray – is sent directly to the radiologist for review via picture archiving and communication systems (PACS). The technologist also receives a subsequent on-device notification[1] to give awareness of the prioritized cases. Quality-focused AI algorithms simultaneously analyze and flag protocol and field of view errors as well as auto rotate the images on-device. 
  • “Rapid technological advancements in artificial intelligence (AI) methods have fueled explosive growth in decision tools being marketed by a rapidly growing number of companies. AI developments are being driven largely by computer scientists, informaticians, engineers, and businesspeople, with much less direct participation by radiologists. Participation by radiologists in AI is largely restricted to educational efforts to familiarize them with the tools and promising results, but techniques to help them decide which AI tools should be used in their practices and to how to quantify their value are not being addressed. This article focuses on the role of radiologists in imaging AI and suggests specific ways they can be engaged by (1) considering the clinical need for AI tools in specific clinical use cases, (2) undertaking formal evaluation of AI tools they are considering adopting in their practices, and (3) maintaining their expertise and guarding against the pitfalls of overreliance on technology.”
    Artificial Intelligence in Imaging: The Radiologist’s Role
    Daniel L. Rubin
    J Am Coll Radiol 2019;16:1309-1317.

  • Application of Deep Learning to Pancreatic Cancer Detection: Lessons Learned From Our Initial Experience.
    Chu LC, Park S, Kawamoto S, Wang Y, Zhou Y, Shen W, Zhu Z, Xia Y, Xie L, Liu F, Yu Q, Fouladi DF, Shayesteh S, Zinreich E, Graves JS, Horton KM, Yuille AL, Hruban RH, Kinzler KW, Vogelstein B, Fishman EK.
    J Am Coll Radiol. 2019 Sep;16(9 Pt B):1338-1342
  • “There is a common perception that one can simply provide any number of unprocessed cases to the computer, and AI can then easily perform the discovery or classification task. This approach is referred to as unsupervised learning, in which the deep-learning algorithm is presented with unlabeled data and learns to group the data by similarities or differences. Although this approach is plausible, complex image analysis, such as the detection of pancreatic cancer, may require supervised learning to achieve acceptable results.”
    Application of Deep Learning to Pancreatic Cancer Detection: Lessons Learned From Our Initial Experience.
    Chu LC, Park S, Kawamoto S, et al
    J Am Coll Radiol. 2019 Sep;16(9 Pt B):1338-1342
  • In supervised learning, the algorithm is provided with labeled data, referred to as ground truth, which is used as feedback to improve the algorithm during each iteration. The degree of data labeling can range from a per case level of normal versus abnormal to more detailed labeling in which the boundaries of each region of interest are drawn on the image on every image slice; this boundary drawing is referred to as “segmentation.” Because we have chosen to tackle a difficult AI application, we decided that supervised learning with high- quality input data would yield the best chance of success.
    Application of Deep Learning to Pancreatic Cancer Detection: Lessons Learned From Our Initial Experience.
    Chu LC, Park S, Kawamoto S, et al
    J Am Coll Radiol. 2019 Sep;16(9 Pt B):1338-1342

  • Application of Deep Learning to Pancreatic Cancer Detection: Lessons Learned From Our Initial Experience.
    Chu LC, Park S, Kawamoto S, et al
    J Am Coll Radiol. 2019 Sep;16(9 Pt B):1338-1342

  • Application of Deep Learning to Pancreatic Cancer Detection: Lessons Learned From Our Initial Experience.
    Chu LC, Park S, Kawamoto S, et al
    J Am Coll Radiol. 2019 Sep;16(9 Pt B):1338-1342
  • “Our initial decision to train the deep network to recognize all major abdominal organs instead of focusing on the pancreas proved to be a wise investment of time and resources. As we reviewed the false positives, the deep network occasionally predicted the duodenum or jejunum as an exophytic tumor. This was especially problematic in thin patients with poor fat planes. As we trained the deep network to recognize and segment the major abdominal organs, we were able to use this algorithm to prune out false- positive predictions that overlapped with other organs.”
    Application of Deep Learning to Pancreatic Cancer Detection: Lessons Learned From Our Initial Experience.
    Chu LC, Park S, Kawamoto S, et al
    J Am Coll Radiol. 2019 Sep;16(9 Pt B):1338-1342
  • “In the future, we envision that that AI system for automatic PDAC detection will be seamlessly integrated into the radiology workflow as a “second reader,” similar to how computer-aided diagnosis operates in mammographic screening. The AI system will directly receive the CT data sets from the PACS, automatically segment the abdominal organs, and annotate any suspicious pancreatic pathology. These annotated cases will be sent back to the PACS for the radiologist to review. The “second reader” can improve diagnostic confidence and has the potential to identify subtle cases that can be missed by a busy radiologist. By increasing the sensitivity and accuracy of PDAC detection, AI- integrated workflow has the potential to significantly improve patient outcomes. As radiologists, we should not sit on the sidelines. Instead, we should actively engage the AI revolution, hoping to enhance our efficiency and reduce our errors, eventually improving patient outcomes.”
    Application of Deep Learning to Pancreatic Cancer Detection: Lessons Learned From Our Initial Experience.
    Chu LC, Park S, Kawamoto S, et al
    J Am Coll Radiol. 2019 Sep;16(9 Pt B):1338-1342
  • “In the future, we envision that that AI system for automatic PDAC detection will be seamlessly integrated into the radiology workflow as a “second reader,” similar to how computer-aided diagnosis operates in mammographic screening. The AI system will directly receive the CT data sets from the PACS, automatically segment the abdominal organs, and annotate any suspicious pancreatic pathology. These annotated cases will be sent back to the PACS for the radiologist to review. The “second reader” can improve diagnostic confidence and has the potential to identify subtle cases that can be missed by a busy radiologist.”
    Application of Deep Learning to Pancreatic Cancer Detection: Lessons Learned From Our Initial Experience.
    Chu LC, Park S, Kawamoto S, et al
    J Am Coll Radiol. 2019 Sep;16(9 Pt B):1338-1342
  • “We aim at segmenting a wide variety of organs, including tiny targets (e.g., adrenal gland) and neoplasms (e.g., pancreatic cyst), from abdominal CT scans. This is a challenging task in two aspects. First, some organs (e.g., the pancreas), are highly variable in both anatomy and geometry, and thus very difficult to depict. Second, the neoplasms often vary a lot in its size, shape, as well as its location within the organ. Third, the targets (organs and neoplasms) can be considerably small compared to the human body, and so standard deep networks for segmentation are often less sensitive to these targets and thus predict less accurately especially around their boundaries.”
    Recurrent Saliency Transformation Network for Tiny Target Segmentation in Abdominal CT Scans
    Lingxi Xie, Qihang Yu, Yan Wang, Yuyin Zhou, Elliot K. Fishman, and Alan L. Yuille
    IEEE Trans Med Imaging. 2019 Jul 23. doi: 10.1109/TMI.2019.2930679
  • In this paper, we present an end-to-end framework named Recurrent Saliency Transformation Network (RSTN) for seg- menting tiny and/or variable targets. RSTN is a coarse-to-fine approach, which uses prediction from the first (coarse) stage to shrink the input region for the second (fine) stage. A saliency transformation module is inserted between these two stages, so that (i) the coarse-scaled segmentation mask can be transferred as spatial weights and applied to the fine stage; and (ii) the gradients can be back-propagated from the loss layer to the entire network, so that the two stages are optimized in a joint manner. In the testing stage, we perform segmentation iteratively to improve accuracy.
    Recurrent Saliency Transformation Network for Tiny Target Segmentation in Abdominal CT Scans
    Lingxi Xie, Qihang Yu, Yan Wang, Yuyin Zhou, Elliot K. Fishman, and Alan L. Yuille
    IEEE Trans Med Imaging. 2019 Jul 23. doi: 10.1109/TMI.2019.2930679
  • “In this extended journal paper, we allow a gradual optimization to improve the stability of RSTN, and introduce a hierarchical version named H-RSTN to segment tiny and variable neoplasms such as pancreatic cysts. Experiments are performed on several CT datasets, including a public pancreas segmentation dataset, our own multi-organ dataset, and a cystic pancreas dataset. In all these cases, RSTN outperforms the baseline (a stage-wise coarse-to-fine approach) significantly. Confirmed by the radiologists in our team, these promising segmentation results can help early diagnosis of pancreatic cancer.”
    Recurrent Saliency Transformation Network for Tiny Target Segmentation in Abdominal CT Scans
    Lingxi Xie, Qihang Yu, Yan Wang, Yuyin Zhou, Elliot K. Fishman, and Alan L. Yuille
    IEEE Trans Med Imaging. 2019 Jul 23. doi: 10.1109/TMI.2019.2930679
  • “Motivated by the above, we propose a Recurrent Saliency Transformation Network (RSTN) for segmenting very small targets. The chief innovation lies in the mechanism to relate the coarse and fine stages with a saliency transformation module, which repeatedly transforms the segmentation probability map as spatial weights, from the previous iterations to the current iteration. In the training process, the differentiability of this module makes it possible to optimize the coarse-scaled and fine-scaled networks in a joint manner, so that the overall mod- el gets improved after being aware of a global optimization goal.”
    Recurrent Saliency Transformation Network for Tiny Target Segmentation in Abdominal CT Scans
    Lingxi Xie, Qihang Yu, Yan Wang, Yuyin Zhou, Elliot K. Fishman, and Alan L. Yuille
    IEEE Trans Med Imaging. 2019 Jul 23. doi: 10.1109/TMI.2019.2930679

  • Recurrent Saliency Transformation Network for Tiny Target Segmentation in Abdominal CT Scans
    Lingxi Xie, Qihang Yu, Yan Wang, Yuyin Zhou, Elliot K. Fishman, and Alan L. Yuille
    IEEE Trans Med Imaging. 2019 Jul 23. doi: 10.1109/TMI.2019.2930679

  • Recurrent Saliency Transformation Network for Tiny Target Segmentation in Abdominal CT Scans
    Lingxi Xie, Qihang Yu, Yan Wang, Yuyin Zhou, Elliot K. Fishman, and Alan L. Yuille
    IEEE Trans Med Imaging. 2019 Jul 23. doi: 10.1109/TMI.2019.2930679

  • Recurrent Saliency Transformation Network for Tiny Target Segmentation in Abdominal CT Scans
    Lingxi Xie, Qihang Yu, Yan Wang, Yuyin Zhou, Elliot K. Fishman, and Alan L. Yuille
    IEEE Trans Med Imaging. 2019 Jul 23. doi: 10.1109/TMI.2019.2930679
  • “We present the Recurrent Saliency Transformation Network, which enjoys three advantages. (i) Benefited by a (recurrent) global energy function, it is easier to generalize our models from training data to testing data. (ii) With joint optimization over two networks, both of them get improved individually. (iii) By incorporating multi-stage visual cues, more accurate segmentation results are obtained.”
    Recurrent Saliency Transformation Network for Tiny Target Segmentation in Abdominal CT Scans
    Lingxi Xie, Qihang Yu, Yan Wang, Yuyin Zhou, Elliot K. Fishman, and Alan L. Yuille
    IEEE Trans Med Imaging. 2019 Jul 23. doi: 10.1109/TMI.2019.2930679
  • “The United States is the global leader in AI radiology publication productivity, accounting for almost half of total radiology AI output. Other countries have increased their productivity. Notably, China has increased its productivity exponentially to close to 20% of all AI publications. The top three most productive radiology subspecialties were neuroradiology, body and chest, and nuclear medicine.”
    Global Trend in Artificial Intelligence–Based Publications in Radiology From 2000 to 2018
    West E et al.
    AJR 2019; 213:1–3

  • Global Trend in Artificial Intelligence–Based Publications in Radiology From 2000 to 2018
    West E et al.
    AJR 2019; 213:1–3

  • Global Trend in Artificial Intelligence–Based Publications in Radiology From 2000 to 2018
    West E et al.
    AJR 2019; 213:1–3
  • ”Of note, China has increased its productivity exponentially, from less than 5% to close to 20% of all AI publications. China’s ability to exponentially increase productivity is likely due to the country’s unique research infrastructure. The availability of large centralized data and rapid implementation across commercial industries have already helped the nation become very productive in AI research in a short period. In addition, Chinese government di- rectives and funding for the advancement of AI have generated an incredible mobilization.”
    Global Trend in Artificial Intelligence–Based Publications in Radiology From 2000 to 2018
    West E et al.
    AJR 2019; 213:1–3
  • “Exponential growth in AI radiology research has occurred worldwide, with the United States leading overall AI research productivity. China has made the second biggest contribution, largely driven by unique research infrastructure ideal for AI research and significant government funding support. The future success of the United States will depend on continued government funding and prioritization of AI radiology research within the research community.”
    Global Trend in Artificial Intelligence–Based Publications in Radiology From 2000 to 2018
    West E et al.
    AJR 2019; 213:1–3
  • ”Exponential growth in AI radiology research has occurred worldwide, with the United States leading overall AI research productivity. China has made the second big- gest contribution, largely driven by unique research infrastructure ideal for AI research and significant government funding support. The future success of the United States will depend on continued government funding and prioritization of AI radiology research within the research community.”
    Global Trend in Artificial Intelligence–Based Publications in Radiology From 2000 to 2018
    West E et al.
    AJR 2019; 213:1–3
  • Objective: In this study we evaluate the accuracy of the newest version of a smartphone application (SA) for risk assessment of skin lesions.
    Methods: This SA uses a machine learning algorithm to compute a risk rating. The algorithm is trained on 131,873 images taken by 31,449 users in multiple countries between January 2016 and August 2018 and rated for risk by dermatologists. To evaluate the sensitivity of the algorithm we use 285 histopathologically validated skin cancer cases (including 138 malignant melanomas), from two previously published clinical studies (195 cases) and from the SA user database (90 cases). We calculate the specificity on a separate set from the SA user database containing 6000 clinically validated benign cases.
    Results: The algorithm scored a 95.1% (95% CI, 91.9% - 97.3%) sensitivity in detecting (pre)malignant conditions (93% for malignant melanoma and 97% for keratinocyte carcinomas and precursors). This level of sensitivity was achieved with a 78.3% (95% CI, 77.2%-79.3%) specificity.
    Conclusions: This SA provides a high sensitivity to detect skin cancer, however there is still room for improvement in terms of specificity. Future studies are needed to assess the impact of this SA on the health systems and its users.
    Accuracy of a smartphone application for triage of skin lesions based on machine learning algorithms
    Udrea A et al.
    J European Academy of Dermatology (in press 2019)
  • Objective: In this study we evaluate the accuracy of the newest version of a smartphone application (SA) for risk assessment of skin lesions.
    Methods: This SA uses a machine learning algorithm to compute a risk rating. The algorithm is trained on 131,873 images taken by 31,449 users in multiple countries between January 2016 and August 2018 and rated for risk by dermatologists. To evaluate the sensitivity of the algorithm we use 285 histopathologically validated skin cancer cases (including 138 malignant melanomas), from two previously published clinical studies (195 cases) and from the SA user database (90 cases). We calculate the specificity on a separate set from the SA user database containing 6000 clinically validated benign cases.
    Accuracy of a smartphone application for triage of skin lesions based on machine learning algorithms
    Udrea A et al.
    J European Academy of Dermatology (in press 2019)
  • Results: The algorithm scored a 95.1% (95% CI, 91.9% - 97.3%) sensitivity in detecting (pre)malignant conditions (93% for malignant melanoma and 97% for keratinocyte carcinomas and precursors). This level of sensitivity was achieved with a 78.3% (95% CI, 77.2%-79.3%) specificity.
    Conclusions: This SA provides a high sensitivity to detect skin cancer, however there is still room for improvement in terms of specificity. Future studies are needed to assess the impact of this SA on the health systems and its users.
    Accuracy of a smartphone application for triage of skin lesions based on machine learning algorithms
    Udrea A et al.
    J European Academy of Dermatology (in press 2019)
  • Objective: In this study we evaluate the accuracy of the newest version of a smartphone application (SA) for risk assessment of skin lesions.
    Methods: This SA uses a machine learning algorithm to compute a risk rating. The algorithm is trained on 131,873 images taken by 31,449 users in multiple countries between January 2016 and August 2018 and rated for risk by dermatologists. To evaluate the sensitivity of the algorithm we use 285 histopathologically validated skin cancer cases (including 138 malignant melanomas), from two previously published clinical studies (195 cases) and from the SA user database (90 cases). We calculate the specificity on a separate set from the SA user database containing 6000 clinically validated benign cases.
    Results: The algorithm scored a 95.1% (95% CI, 91.9% - 97.3%) sensitivity in detecting (pre)malignant conditions (93% for malignant melanoma and 97% for keratinocyte carcinomas and precursors). This level of sensitivity was achieved with a 78.3% (95% CI, 77.2%-79.3%) specificity.
    Conclusions: This SA provides a high sensitivity to detect skin cancer, however there is still room for improvement in terms of specificity. Future studies are needed to assess the impact of this SA on the health systems and its users.
    Accuracy of a smartphone application for triage of skin lesions based on machine learning algorithms
    Udrea A et al.
    J European Academy of Dermatology (in press 2019)
  • Objective: In this study we evaluate the accuracy of the newest version of a smartphone application (SA) for risk assessment of skin lesions.
    Methods: This SA uses a machine learning algorithm to compute a risk rating. The algorithm is trained on 131,873 images taken by 31,449 users in multiple countries between January 2016 and August 2018 and rated for risk by dermatologists. To evaluate the sensitivity of the algorithm we use 285 histopathologically validated skin cancer cases (including 138 malignant melanomas), from two previously published clinical studies (195 cases) and from the SA user database (90 cases). We calculate the specificity on a separate set from the SA user database containing 6000 clinically validated benign cases.
    Accuracy of a smartphone application for triage of skin lesions based on machine learning algorithms
    Udrea A et al.
    J European Academy of Dermatology (in press 2019)
  • Results: The algorithm scored a 95.1% (95% CI, 91.9% - 97.3%) sensitivity in detecting (pre)malignant conditions (93% for malignant melanoma and 97% for keratinocyte carcinomas and precursors). This level of sensitivity was achieved with a 78.3% (95% CI, 77.2%-79.3%) specificity.
    Conclusions: This SA provides a high sensitivity to detect skin cancer, however there is still room for improvement in terms of specificity. Future studies are needed to assess the impact of this SA on the health systems and its users.
    Accuracy of a smartphone application for triage of skin lesions based on machine learning algorithms
    Udrea A et al.
    J European Academy of Dermatology (in press 2019)
Kidney

  • “Urothelial carcinoma of the upper urinary tract (renal collecting system and ureter) is a relatively uncommon malignancy, accounting for 5–7% of urothelial tumors and up to 10–15% of all renal tumors. The exact incidence of upper urinary tract urothelial carcinoma is difficult to assess, given its rarity; about 2290 Americans were diagnosed with ureteral urothelial carcinoma, and nearly 700 patients died from it in 2008 . The renal pelvis is the most commonly involved site in the UUT , and is second to the urinary bladder in overall incidence of urothelial carcinoma.”
    Upper urinary tract urothelial carcinoma on multidetector CT: spectrum of disease
    Osama Ali1 · Elliot Fishman1 · Sheila Sheth1
    Abdominal Radiology https://doi.org/10.1007/s00261-019-02173-2
  • Multifocality is a key feature in urothelial carcinoma warranting long-term surveillance. Up to 40% of patients with UUT urothelial carcinoma will develop a metachronous tumor in the urinary bladder, usually within the first 2 years following surgical resection, and this is typically seen more with ureteric tumors than with renal pelvic tumors. Approximately, 2–9% of patients with urothelial carcinoma of the urinary bladder have a metachronous upper tract urothelial carcinoma.
    Upper urinary tract urothelial carcinoma on multidetector CT: spectrum of disease
    Osama Ali1 · Elliot Fishman1 · Sheila Sheth1
    Abdominal Radiology https://doi.org/10.1007/s00261-019-02173-2
  • “When the ureter is affected, the most commonly involved segment is the distal third (73%), followed by the mid ureter (24%), and proximal ureter (3%). Bilateral ureteral involvement occurs in 2–5% of cases . Approximately, 11–13% of patients with upper tract urothelial carcinoma develop metachronous upper tract tumors. Patients usually pre- sent with microscopic or gross hematuria, flank pain, or renal colic. However, up to 20% of lesions are detected incidentally or during surveillance imaging for a known urothelial tumor in the urinary bladder.”
    Upper urinary tract urothelial carcinoma on multidetector CT: spectrum of disease
    Osama Ali · Elliot K. Fishman · Sheila Sheth
    Abdominal Radiology https://doi.org/10.1007/s00261-019-02173-2
  • “Papillary forms of urothelial carcinoma in the upper urinary tract, which accounts for up to 85% of urothelial carcinomas, are cytologically and histologically similar to their urinary bladder counterpart. These tumors are usually low-stage and superficial, with frondlike morphology, and tend to have a slow growth rate with a relatively indolent course. Solid, flat tumors, accounting for approximately 15% of cases, tend to be more aggressive with a higher stage at presentation.
    Upper urinary tract urothelial carcinoma on multidetector CT: spectrum of disease
    Osama Ali · Elliot K. Fishman · Sheila Sheth
    Abdominal Radiology https://doi.org/10.1007/s00261-019-02173-2
  • “Accurate diagnosis of UTT urothelial carcinoma requires careful evaluation of the source axial images in combination with multiplanar and 3D reconstructions. In fact, 3D reconstructions have become an integral part of CTU in recent years, as multidetector technology allows acquisition of isotropic source images. At our institution, the source axial images (0.5 mm) are sent to a separate workstation for creation of three sets of 3D reconstructions: maximum intensity projection (MIP), traditional volume-rendered reconstructions (VR), and virtual ureteroscopy images (specialized volume-rendered images).”
    Upper urinary tract urothelial carcinoma on multidetector CT: spectrum of disease
    Osama Ali · Elliot K. Fishman · Sheila Sheth
    Abdominal Radiology https://doi.org/10.1007/s00261-019-02173-2
  • “3D reconstructions, although a useful complementary tool in detection of subtle urothelial carcinomas, are sus- ceptible to suboptimal distension of the collecting system and ureteral peristalsis, and both these limitations can be mistakenly interpreted as strictures. In addition, tumors pro- ducing soft tissue thickening without narrowing of the lumen are best demonstrated on the axial images [2]. Therefore, it is imperative to cross-reference the 3D images with axial source images to avoid these potential pitfalls.”
    Upper urinary tract urothelial carcinoma on multidetector CT: spectrum of disease
    Osama Ali · Elliot K. Fishman · Sheila Sheth
    Abdominal Radiology https://doi.org/10.1007/s00261-019-02173-2
  • “Urothelial carcinoma of the upper urinary tract is a relatively uncommon malignancy. Multifocality and high rates of recur- rence are key features of these tumors. The CTU protocol focuses on maximizing ureteral distension to optimize detec- tion of small lesions in the collecting system. 3D imaging helps maximize sensitivity of CTU in detection of subtle tumors. CTU tends to perform well in differentiating early stage from advanced-stage tumors; however, it is not that accurate in dif- ferentiation among early-stage tumors (Ta, T1, and T2).”
    Upper urinary tract urothelial carcinoma on multidetector CT: spectrum of disease
    Osama Ali · Elliot K. Fishman · Sheila Sheth
    Abdominal Radiology https://doi.org/10.1007/s00261-019-02173-2 
  • Angiographic Findings in Patients with PAN

    Polyarteritis Nodosa: Spectrum of Angiographic Findings
    Anthony W. Stanson et al.
    RadioGraphics 2001; 21:151-159
  • PAN Vascular Findings
    - occlusive lesions (luminal irregularities resulting in reduction of caliber, stenosis, or occlusion)
    - microaneurysms
    Polyarteritis Nodosa: Spectrum of Angiographic Findings
    Anthony W. Stanson et al.
    RadioGraphics 2001; 21:151-159
  • Differential Dx for Multiple Renal Artery Aneurysms on CT
    - polyarteritis nodosa
    - rheumatoid vasculitis,
    - systemic lupus erythematosus,
    - Churg- Strauss syndrome
    - IVDA
  • “As seen in this review of the spectrum of angiographic findings in PAN, a variety of arterial beds may be affected and a variety of lesions may be seen. Skeletal muscle arterial disease was seen in nearly one-third of our patients. The lesions seen most frequently were occlusive. The presence of aneurysms increases the specificity of the diagnosis of PAN, but in their absence other arterial lesions such as luminal irregularities, stenoses, and occlusions can suggest the diagnosis. In a patient without fulminant disease but in whom clinical suspicion is firm, comprehensive angiography may lead to the diagnosis of PAN on the basis of the constellation of angiographic findings.”
    Polyarteritis Nodosa: Spectrum of Angiographic Findings
    Anthony W. Stanson et al.
    RadioGraphics 2001; 21:151-159
  • “Many of the clinical symptoms are related to organ ischemia secondary to arterial branch occlusions. Aneurysm rupture is a less common cause of pain. Arthralgias are noted in 50% of patients as are peripheral neuropathies (mononeuritis multiplex), which are often symptomatic early. Renal involvement including proteinuria and hypertension are found in 75%. Branch vessel occlusions can lead to multiple renal infarcts. Abdominal pain from ischemia or infarction secondary to occlusive lesions is the most common gastrointestinal complaint. Abdominal pain may also be caused by rupture of an aneurysm in one of the viscera: liver, kidney, or mesentery. Cutaneous lesions include palpable purpura, infections, and ischemic ulcers. Muscle pain and limb claudication may occur.”
    Polyarteritis Nodosa: Spectrum of Angiographic Findings
    Anthony W. Stanson et al.
    RadioGraphics 2001; 21:151-159
  • “Polyarteritis nodosa (PN) is a systemic necrotizing vasculitis of medium and small arteries, and is typically found in middle-aged men. The most common clinical symptoms are persistent fever, weight loss, and polyarthragia. As these symptoms are nonspecific, diagnosing PN is sometimes difficult and delayed. The kidney is the most commonly involved, and multiple small wedge-shaped less-enhanced areas are typically seen on enhanced CT. These are considered to be multiple bilateral renal cortical infarctions due to vasculitis of the interlobar arteries and arcuate arteries.”
    Renal involvement of polyarteritis nodosa: CT and MR findings
    Ozaki, K., Miyayama, S., Ushiogi, Y. et al.
    Abdom Imaging (2009) 34: 265. https://doi.org/10.1007/s00261-008-9377-7
  • Some studies reported that multiple small wedge-shaped less-enhanced areas were observed on enhanced CT, which were multiple bilateral renal cortical infarctions from vasculitis of the interlobar arteries and the arcuate arteries. In addition, perirenal hematoma by aneurysmal rupture, and small microaneurysms are sometimes observed.
    Renal involvement of polyarteritis nodosa: CT and MR findings
    Ozaki, K., Miyayama, S., Ushiogi, Y. et al.
    Abdom Imaging (2009) 34: 265. https://doi.org/10.1007/s00261-008-9377-7
  • “Most aneurysms are 2–10 mm in diameter. In the present study, multiple microaneurysms, 2–3 mm in diameter, were observed in all patients. However, it is important to note that renal microaneurysms are not specific to PN. They may be demonstrated in other systemic necrotizing vasculitis, drug abuse, and bacterial endocarditis. The specificity of angiographic findings of microaneurysm becomes much higher when the clinical symptoms are supportive.”
    Renal involvement of polyarteritis nodosa: CT and MR findings
    Ozaki, K., Miyayama, S., Ushiogi, Y. et al.
    Abdom Imaging (2009) 34: 265. https://doi.org/10.1007/s00261-008-9377-7

  • Hur JH, Chun EJ, Kwag HJ, Yoo JY, Kim HY, Kim JJ, Lee KW. CT Features of Vasculitides Based on the 2012 International Chapel Hill Consensus Conference Revised Classification. Korean J Radiol. 2017 Sep-Oct;18(5):786-798.

  • Hur JH, Chun EJ, Kwag HJ, Yoo JY, Kim HY, Kim JJ, Lee KW. CT Features of Vasculitides Based on the 2012 International Chapel Hill Consensus Conference Revised Classification. Korean J Radiol. 2017 Sep-Oct;18(5):786-798.

  • Hur JH, Chun EJ, Kwag HJ, Yoo JY, Kim HY, Kim JJ, Lee KW. CT Features of Vasculitides Based on the 2012 International Chapel Hill Consensus Conference Revised Classification. Korean J Radiol. 2017 Sep-Oct;18(5):786-798.
  • Polyarteritis Nodosa: Facts
    - Polyarteritis nodosa (PAN) is a necrotizing vasculitis of medium and small arteries without glomerulonephritis, and is unassociated with the anti-neutrophil cytoplasmic antibody (ANCA). Absence of ANCA is a distinguishing point from microscopic polyangiitis (MPA), which is an ANCA-associated small vessel vasculitis that shares similar pathologic and radiologic findings with PAN.
    - Polyarteritis nodosa affects men twice as often as women in the 5–7th decades. Etiology is unclear, but the hepatitis B virus may play an important role in the development of the disease. Renal involvement is common with an incidence of 70–80%, resulting in proteinuria, hematuria, and hypertension, but not glomerulonephritis. Other involvements are the gastrointestinal tract and skin at an incidence rate of 50%; skeletal muscles and mesentery at an incidence rate of 30%; and the central nervous system at an incidence rate of 10%.
    - Characteristic imaging findings of PAN are microaneurysms of medium or small arteries, often involving the renal arteries.
  • Polyarteritis Nodosa: Facts
    - Small vessel vasculitides mainly affect small intraparenchymal arteries, arterioles, capillaries, and venules. They are divided into two categories; ANCA-associated small vessel vasculitis and immune complex-associated small vessel vasculitis.
    - Anti-neutrophil cytoplasmic antibody is an antibody against intracellular antigens in neutrophils and monocytes. According to immunofluorescent staining pattern, there are cytoplasmic ANCA (c-ANCA) and perinuclear ANCA (p-ANCA). Granulomatosis with polyangiitis (GPA) is a c-ANCA (+) vasculitis, whereas eosinophilic GPA (EGPA) or MPA are characteristic of p-ANCA (+) vasculitis. Although ANCA is an important characteristic of ANCA-associated vasculitis, its positive predictive value is only around 45%. This means that ANCA negativity does not exclude the possibility of ANCA-associated vasculitis.
  • Behçet’s Disease: Facts
    - Behçet's disease is a chronic, relapsing autoinflammatory condition involving multiple organs. Clinically, Behçet's disease manifests as recurrent oral or genital aphthous ulcers, and inflammatory lesions of the cutaneous, ocular, articular, gastrointestinal, and central nervous system. It is most prevalent in the 3rd and 4th decades of life, and is more common in males.
    - Vascular involvement occurs in 5–30% of Behçet's disease cases, and it can be divided into three types: venous thrombosis, arterial aneurysm and aortic occlusion. Venous thrombosis is associated with a prevalence range of 10–30%. Deep vein thrombosis of the lower extremities is the most common finding, followed by superficial thrombophlebitis after venipuncture. Aneurysms, which are frequently seen in the aorta, pulmonary, subclavian, and popliteal arteries, can be the most serious complication of Behçet's disease. Saccular types are more frequent than fusiform aneurysms. In case of pulmonary involvement, pulmonary artery aneurysm is the most common finding with a prevalence of 1–10%, and tends to be multiple and bilateral.
  • Differential Diagnosis of Vasculitis: Facts
    The presence of known etiology or associated systemic disease can be helpful for the differential diagnosis of vasculitis. Systemic lupus erythematosus or rheumatoid arthritis are systemic inflammatory disorders, which may lead to inflammation of the cardiovascular system. IgG4-related sclerosing disease is characterized by idiopathic inflammatory lesions infiltrated with numerous IgG4-positive plasma cells. IgG4-related periarteritis predominantly involves the abdominal aorta, iliac vessels and thoracic aorta. CT findings include arterial wall thickening, homogeneous enhancement at the delayed phase of contrast enhanced CT, luminal change (mostly dilation and rarely stenosis), and exaggerated atherosclerotic change. An elevated serum IgG4 level and associated organ damage are essential in discerning this disease from other vasculitides. A few cases of IgG4-related periarteritis affecting the coronary arteries have been reported, which appeared as soft tissue encasing the coronary artery with or without luminal narrowing, wall calcification, and aneurysm.
  • Differential Diagnosis of Vasculitis: Facts
    Multidetector CT is a useful noninvasive imaging modality for the evaluation of vasculitis and vasculitis mimics because CT can provide the information of the vessel wall change and other accompanied findings. Although CT features of various vasculitis are often overlapping, CT features via consideration of the involved vessel type, location, morphology, and associated systemic disease, can be useful in narrowing down the differential diagnosis .Getting familiar with CT features will help radiologists to establish appropriate diagnosis for vasculitis.
OB GYN

  • Ovarian Cancer: Key Numbers
  • Ovarian Cancer: Key Numbers
  • Ovarian Cancer: Key Numbers
  • Ovarian Cancer: Key Numbers
  • Ovarian Cancer: Key Numbers
  • Ovarian Cancer: Key Numbers

  • Update on Imaging of Ovarian Cancer
    Forstner R, Meissnitzer M, Cunha TM.
    Curr Radiol Rep. 2016;4:31.
  • Ovarian Cancer: Facts
    - The concept of ovarian cancer as a single disease has been revised. Epithelial ovarian cancer is now understood as a subsumption of diverse cancer entities that vary significantly clinically as well as pathologically and on a molecular level. It comprises the following main cancer subtypes:
    - high-grade serous,
    - low-grade serous,
    - endometrioid,
    - clear cell and
    - mucinous ovarian cancer
  • Ovarian Cancer: Staging
  • “In MDC, imaging plays a central role for treatment stratification in ovarian cancer. It serves as a roadmap for surgery and is one of the major predictors for successful primary cytoreductive surgery. Currently, CT is the standard of care for staging patients with ovarian cancer. However, MRI using functional techniques is emerging as technique that may be able to overcome limitations of staging CT.”
    Update on Imaging of Ovarian Cancer
    Forstner R, Meissnitzer M, Cunha TM.
    Curr Radiol Rep. 2016;4:31.
Pancreas

  • “The guideline conditionally recommends conventionally fractionated or stereotactic body radiation for neoadjuvant and definitive therapy in certain patients and conventionally fractionated regimens for adjuvant therapy. The task force suggests a range of appropriate dose-fractionation schemes and provides recommendations on target volumes and sequencing of radiation and chemotherapy. Motion management, daily image guidance, use of contrast, and treatment with modulated techniques are all recommended. The task force supported prophylactic antiemetic medication, and patients may also benefit from medications to reduce acid secretion.”
    Radiation Therapy for Pancreatic Cancer: Executive Summary of an ASTRO Clinical Practice Guideline
    Manisha Palta et al.
    Practical Radiation Oncology (2019) 9, 322-332
  • “ The role of radiation in the management of pancreatic cancer is evolving, with many ongoing areas of active investigation. Radiation therapy is likely to become even more important as new systemic therapies are developed and there is increased focus on controlling local disease. It is important that the nuances of available data are discussed with patients and families and that care be coordinated in a multidisciplinary fashion.”
    Radiation Therapy for Pancreatic Cancer: Executive Summary of an ASTRO Clinical Practice Guideline
    Manisha Palta et al.
    Practical Radiation Oncology (2019) 9, 322-332
  • ”The role of radiation in the management of pancreatic cancer is evolving in the adjuvant, neoadjuvant, and definitive settings, as is the use of dose escalation and ablative RT, with advances in motion management, target delineation, treatment planning, and image guidance. The role of RT is likely to become even more important as new systemic therapies are developed and there is increased focus on controlling local disease. It is critical that the nuances of available data are discussed with pa- tients and families and that care for patients with pancreatic cancer be coordinated in a multidisciplinary fashion.”
    Radiation Therapy for Pancreatic Cancer: Executive Summary of an ASTRO Clinical Practice Guideline
    Manisha Palta et al.
    Practical Radiation Oncology (2019) 9, 322-332
Practice Management

  • “Instagram is an incredibly intuitive and easy-to-use plat-form; however, it is important to post quality images ratherthan quantity. Instagram automatically converts all images square format so images should be sized appropriately to avoid unwanted cropping. When publishing patient cases,images need to be anonymized before posting to Instagram to ensure that no protected health information gets published. Instagram does not have in-app tools to anonymize the image. Lastly, the default setting for Instagram videos is autoplay with the sound off. The user must actively turn the volume up on their device to hear the video’s sound.”
    Instagram as a Vehicle for Education: What Radiology Educators Need to Know.
    Shafer S, Johnson MB, Thomas RB, Johnson PT, Fishman EK.
    Acad Radiol. 2018 Jun;25(6):819-822
  • The CTisus Instagram account has gained over 6000 follow-ers in under 2 years. The growth can be attributed to consistencyin post type, hashtags, and post schedule. CTisus posts oneimage each day around 12 PM (EST). All images are originalcontent and range from computed tomography, magnetic res-onance imaging, plain films, medical illustrations, and radiologyrelated diagrams (Fig 1). The images are accompanied by abrief description or diagnosis and 20–25 related hashtags. Themajority of CTisus’ followers (51%) are 25–34 years old andfrom around the world including United States (14%), Brazil(10%), Russia (9%), Iran (5%), and India (5%).
    Instagram as a Vehicle for Education: What Radiology Educators Need to Know.
    Shafer S, Johnson MB, Thomas RB, Johnson PT, Fishman EK.
    Acad Radiol. 2018 Jun;25(6):819-822
  • “Instagram offers an exciting new means to develop a free, far-reaching radiology education resource for students, housestaff, technologists, and practicing radiologists. With ease, educators can upload medical images and videos displaying captivating radiology and pathology on an international scale.The popularity of Instagram, an image sharing application presents radiology with a unique opportunity to educate the inquisitive younger generation that populates the application and to potentially inspire more medical professionals to pursue the field. Future investigations should measure the relative utility of various social media platforms (Facebook, Twitter, andInstagram) for knowledge gain.”
    Instagram as a Vehicle for Education: What Radiology Educators Need to Know.
    Shafer S, Johnson MB, Thomas RB, Johnson PT, Fishman EK.
    Acad Radiol. 2018 Jun;25(6):819-822
  • “Instagram is an incredibly intuitive and easy-to-use plat-form; however, it is important to post quality images ratherthan quantity. Instagram automatically converts all images square format so images should be sized appropriately to avoid unwanted cropping. When publishing patient cases,images need to be anonymized before posting to Instagram to ensure that no protected health information gets published. Instagram does not have in-app tools to anonymize the image. Lastly, the default setting for Instagram videos is autoplay with the sound off. The user must actively turn the volume up on their device to hear the video’s sound.”
    Instagram as a Vehicle for Education: What Radiology Educators Need to Know.
    Shafer S, Johnson MB, Thomas RB, Johnson PT, Fishman EK.
    Acad Radiol. 2018 Jun;25(6):819-822
  • The CTisus Instagram account has gained over 6000 follow-ers in under 2 years. The growth can be attributed to consistencyin post type, hashtags, and post schedule. CTisus posts oneimage each day around 12 PM (EST). All images are originalcontent and range from computed tomography, magnetic res-onance imaging, plain films, medical illustrations, and radiologyrelated diagrams (Fig 1). The images are accompanied by abrief description or diagnosis and 20–25 related hashtags. Themajority of CTisus’ followers (51%) are 25–34 years old andfrom around the world including United States (14%), Brazil(10%), Russia (9%), Iran (5%), and India (5%).
    Instagram as a Vehicle for Education: What Radiology Educators Need to Know.
    Shafer S, Johnson MB, Thomas RB, Johnson PT, Fishman EK.
    Acad Radiol. 2018 Jun;25(6):819-822
  • “Instagram offers an exciting new means to develop a free, far-reaching radiology education resource for students, housestaff, technologists, and practicing radiologists. With ease, educators can upload medical images and videos displaying captivating radiology and pathology on an international scale.The popularity of Instagram, an image sharing application presents radiology with a unique opportunity to educate the inquisitive younger generation that populates the application and to potentially inspire more medical professionals to pursue the field. Future investigations should measure the relative utility of various social media platforms (Facebook, Twitter, andInstagram) for knowledge gain.”
    Instagram as a Vehicle for Education: What Radiology Educators Need to Know.
    Shafer S, Johnson MB, Thomas RB, Johnson PT, Fishman EK.
    Acad Radiol. 2018 Jun;25(6):819-822
  • “A study of YouTube as a source of information on the risks and benefits of CT radiation found that the majority of videos related to this topic were uploaded by non-radiologists. Although there was no difference in the number of views, those uploaded by radiologists were more likely to be accurate and have a favorable or neutral position toward CT radiation. With so much misinformation available, we believe that health care institutions have a responsibility to provide reliable health information online.”
    The Strategic Imperative for the Use of Social Media in Health Care
    Journal of the American College of Radiology, Volume 15, Issue 1, Part B, 2018, pp. 155-161
    Amy L. Kotsenas et al.
  • TAKE-HOME POINTS
    - In addition to typical media relations and marketing goals, social media can be successfully used as part of an organization’s overall strategy to improve patient care, expand medical education, and advance medical research.
    - Social media efforts have been valuable to Mayo Clinic through expanding brand reach, generating demand, accelerating the translation from scientific discovery to practice adoption, and increasing event attendance and revenue.
    - The social media benefits for patients and the institution can be applied to and evidenced in radiology.
  • “Social media represent a rapidly maturing channel of communication that can be used to disseminate health policy decisions and evidence that supports those decisions. Effective dissemination strategies, particularly for health coverage, should include a social media strategy informed by the patient perspective. Evidence-based guidance on how to effectively do this needs to be derived.”
    Social Media, Health Policy, and Knowledge Translation
    Journal of the American College of Radiology, Volume 15, Issue 1, Part B, 2018, pp. 149-152
    Damian Roland
  • TAKE-HOME POINTS
    - Social media is associated with the generation of communities of practice that promote the transfer of information at scale
    - How social media definitively affects health policy is not clear, and evidence is scant
    - It will be necessary to generate scholarship and academic interest, specifically in relation to the role of social media in health policy
    Social Media, Health Policy, and Knowledge Translation
    Journal of the American College of Radiology, Volume 15, Issue 1, Part B, 2018, pp. 149-152
    Damian Roland
  • “The preferred social platform for CTisus is Facebook. It provides the greatest flexibility in type of content that can be shared and ease of use, and it also provides an in-depth analytics tool to measure performance. Facebook enables sharing of photos, mp4files, live videos, links, and posted text. Text posts have a generous 60,000-character limit as opposed to the Twitter limit of 280 characters. Facebook also enables scheduling of posts, which is extremely helpful tomanage Ctisus high post volume strategy. CTisus posts about 15 to 20 times a day to Facebook with awide range of content: CT case studies, medical illustrations, pearls relevant to radiology, management tips, and current articles relating to health and medicine.”
    Social Media for Global Education: Pearls and Pitfalls of Using Facebook, Twitter, and Instagram.
    Thomas RB, Johnson PT, Fishman EK.
    J Am Coll Radiol. 2018 Oct;15(10):1513-1516
  • ”Two-thirds of US adults get their news from social media. CTisus strives to provide a variety of content to satisfy user’s craving for information. In efforts to appeal to a larger audience and maintain a positive message,CTisus shares factual articles and tends to leave out opinion pieces. Users are driven from Facebook to the website, CTisus.com, for a broad range of strictly educational resources that pertain to radiology.”
    Social Media for Global Education: Pearls and Pitfalls of Using Facebook, Twitter, and Instagram.
    Thomas RB, Johnson PT, Fishman EK.
    J Am Coll Radiol. 2018 Oct;15(10):1513-1516
  • “ In April 2016, Facebook launched a live broadcast tool, which Ctisus started using in March 2017 as a new way to engage users. Once a week at the same time, CTisus hosts a brief live discussion on a topic related toradiology. Users have the ability topost questions in the live interface,and CTisus can answer in real time viatext or voice. Based on positive engagement and user feedback from Facebook users, CTisus began broadcasting the same live discussion on Instagram in October 2017. Twitter also has live broadcasting ca-pabilities, which CTisus is considering testing.”
    Social Media for Global Education: Pearls and Pitfalls of Using Facebook, Twitter, and Instagram.
    Thomas RB, Johnson PT, Fishman EK.
    J Am Coll Radiol. 2018 Oct;15(10):1513-1516
  • “In April 2016,Facebook launcheda live broadcast tool, which Ctisus started using in March 2017 as a new way to engage users. Once a week atthe same time, CTisus hosts a brief live discussion on a topic related to radiology. Users have the ability to post questions in the live interface,and CTisus can answer in real time via text or voice. Based on positive engagement and user feedback from Facebook users, CTisus began broadcasting the same live discussion on Instagram in October 2017.Twitter also has live broadcasting capabilities, which CTisus is considering testing.
    Social Media for Global Education: Pearls and Pitfalls of Using Facebook, Twitter, and Instagram.
    Thomas RB, Johnson PT, Fishman EK.
    J Am Coll Radiol. 2018 Oct;15(10):1513-1516
  • “In 2016, CTisus joined Insta-gram because of its popularity in thesocial media space, particularly among medical students. In just under a year, the CTisus Instagram account outperformed Twitter withover 2,100 followers. The Instagram app is an infinite scroll of images with a small text caption beneath; this model works well with the image-heavy field of radiology. Instagram posts are limited to square images, 2,200 characters, video lengths of less than 1 min, and no links, and you can only post from a mobile device.”
    Social Media for Global Education: Pearls and Pitfalls of Using Facebook, Twitter, and Instagram.
    Thomas RB, Johnson PT, Fishman EK.
    J Am Coll Radiol. 2018 Oct;15(10):1513-1516

  • Social Media for Global Education: Pearls and Pitfalls of Using Facebook, Twitter, and Instagram.
    Thomas RB, Johnson PT, Fishman EK.
    J Am Coll Radiol. 2018 Oct;15(10):1513-1516
  • “For CTisus, social media has proven invaluable in expanding outreach to achieve our mission of worldwide content distribution. Regular review of use patterns through analytics is important to understand what users want and to drive quality improvement. Students and trainees, who represent the future of the medical profession, are heavily dependent on these platforms. Medical educators interested in global outreach shouldmaster these tools to easily provide free medical education dissemination on an international scale.”
    Social Media for Global Education: Pearls and Pitfalls of Using Facebook, Twitter, and Instagram.
    Thomas RB, Johnson PT, Fishman EK.
    J Am Coll Radiol. 2018 Oct;15(10):1513-1516
  • “Facebook Live is a free, easy-to-use, and easy-to-access online resource for live, interactive educational delivery, which has quickly become one of our most popular social media channels. This venue provides students, trainees,and medical providers around the world with unprecedented access to leaders in the field. Educators interested in delivering free medical education resources on a global scale should engage in this activity”
    Facebook Live: A Free Real-Time Interactive Information Platform.
    Johnson PT, Thomas RB, Fishman EK.
    J Am Coll Radiol. 2018 Jan;15(1 Pt B):201-204.
  • “In 2016, Facebook (Menlo Park,California, USA) launched an on-line live broadcast platform. “Face-book Live” was created as a way for users to communicate to their friends and followers in real-time. Clicking the“go live” button within Facebook automatically en-gages your computer’s camera and microphone and begins streaming a live video. Along with the video,this platform also has a comments section, which allows the host and viewers to post and respond to comments during the live feed. Once the live feed has ended, Facebook automatically posts the recording to the user’s Facebook page for further viewing and commenting.”
    Facebook Live: A Free Real-Time Interactive Information Platform.
    Johnson PT, Thomas RB, Fishman EK.
    J Am Coll Radiol. 2018 Jan;15(1 Pt B):201-204.
  • “Each week, the faculty lead discusses one topic relevant to the body CT; occasionally, a guest who is an expert in the topic being discussed joins the discussion. Throughout the live feed, the presenter can monitor and answer questions posted in the comments via verbal response; additionally, one can respond to questions posted after the live feed has ended. Overall, the live feature within Facebook is incredibly intuitive and produces a high-quality output with very little render time. Facebook offers a built-in analytics tool, Facebook Insights,which provides performance data oneach post.”
    Facebook Live: A Free Real-Time Interactive Information Platform.
    Johnson PT, Thomas RB, Fishman EK.
    J Am Coll Radiol. 2018 Jan;15(1 Pt B):201-204.
  • “Although health care lags behind many other industries in adopting social media as part of a business strategy, the Mayo Clinic recognized the importance of these applications more than a decade ago. In addition to typical media relations and marketing tactics, the Mayo Clinic has successfully used social media as part of an overall program to support the strategic imperatives of the institution.”
    The Strategic Imperative for the Use of Social Media in Health Care
    Journal of the American College of Radiology, Volume 15, Issue 1, Part B, 2018, pp. 155-161
    Amy L. Kotsenas et al.
  • “Social media tools enable health information dissemination via channels that patients already frequent. This gives health care providers the powerful ability to communicate in a one-to-many fashion, as opposed to the standard health care approach of one to one, exponentially increasing the reach of high-quality educational content. Also, rather than waiting until people perform online searches for health concerns, institutions can proactively send information regarding conditions, treatments, and preventive care to consumers’ social media newsfeeds.This content is often packaged in “bite-size” pieces that allow easy understanding by health consumers and canalso direct them to additional educational content, on a website for example, if they seek more thorough information.”
    The Strategic Imperative for the Use of Social Media in Health Care
    Journal of the American College of Radiology, Volume 15, Issue 1, Part B, 2018, pp. 155-161
    Amy L. Kotsenas et al.
  • ”RadiologyInfo.org is a public information portal designed to support patient care and broaden public awareness of the essential role radiology plays in overall patient health care. Over the past 14 years, RadiologyInfo.org has evolved considerably to provide access to more than 220 mixed-media descriptions of tests, treatments, and diseases through a spectrum of mobile and desktop platforms, social media, and downloadable documents in both English and Spanish. In 2014, the RSNA-ACR Public Information Website Committee, which stewards RadiologyInfo.org, developed 3- to 5-year strategic and implementation plans for the website. The process was informed by RadiologyInfo.org user surveys, formal stakeholder interviews, focus groups, and usability testing.”
    Enhancing Public Access to Relevant and Valued Medical Information: Fresh Directions for RadiologyInfo.org
    Geoffrey D. Rubin, Arun Krishnaraj, Mahadevappa Mahesh, Ramji R. Rajendran, Elliot K. Fishman
    J Am Coll Radiol. 2017 May;14(5):697-702
  • “Over the past year, visits to RadiologyInfo.org have increased by 60.27% to 1,424,523 in August 2016 from 235 countries and territories. Twenty-two organizations have affiliated with RadiologyInfo.org with new organizations being added on a monthly basis. RadiologyInfo provides a tangible demonstration of how radiologists can engage directly with the global public to educate them on the value of radiology in their health care and to allay concerns and dispel misconceptions. Regular self-assessment and responsive planning will ensure its continued growth and relevance.”
    Enhancing Public Access to Relevant and Valued Medical Information: Fresh Directions for RadiologyInfo.org
    Geoffrey D. Rubin, Arun Krishnaraj, Mahadevappa Mahesh, Ramji R. Rajendran, Elliot K. Fishman
    J Am Coll Radiol. 2017 May;14(5):697-702
  • “However, participants expressed concerns that the language and images were too “doctor-centric” and expected a more “patient-centric” focus and reassuring tone. They expressed concerns about navigating and remaining oriented within the site and had difficulty interpreting some of the information categories. Participants requested that the site have a warmer look and feel, prioritization of topics of greatest interest to patients, more efficient access to content relevant to their queries, and integration of patient-friendly images and videos. Finally, they noted that RadiologyInfo.org did not always appear at the top of search results when participants generated their own search terms.”
    Enhancing Public Access to Relevant and Valued Medical Information: Fresh Directions for RadiologyInfo.org
    Geoffrey D. Rubin, Arun Krishnaraj, Mahadevappa Mahesh, Ramji R. Rajendran, Elliot K. Fishman
    J Am Coll Radiol. 2017 May;14(5):697-702
  • “To evolve the site further and improve its outreach, the committee has pursued an active social media campaign. Our efforts on social media are primarily through the two leading platforms, Facebook and Twitter. To date the site has garnered more than 240,000 likes on its Facebook page and more than 3,000 followers on Twitter. Social media platforms allow direct and real-time connections with patients, something a website cannot accomplish. As this aspect of RadiologyInfo evolves, care must be taken to ensure that responses are quick and vetted for appropriateness.”
    Enhancing Public Access to Relevant and Valued Medical Information: Fresh Directions for RadiologyInfo.org
    Geoffrey D. Rubin, Arun Krishnaraj, Mahadevappa Mahesh, Ramji R. Rajendran, Elliot K. Fishman
    J Am Coll Radiol. 2017 May;14(5):697-702
  • TAKE-HOME POINTS
    * RadiologyInfo.org is an authoritative and trusted portal designed to support public care and public awareness of the essential role radiology in health care.
    * Recent enhancements to the site have aimed to improve its usefulness for patients and their families.
    * With more than 1.4 million visitors in August 2016 from 235 countries and territories worldwide, monthly engagement has grown by more than 60% from the prior year.
    *Diversification of access through social media channels as well as mobile platforms has expanded the reach of RadiologyInfo.org.”
    Enhancing Public Access to Relevant and Valued Medical Information: Fresh Directions for RadiologyInfo.org
    Geoffrey D. Rubin, Arun Krishnaraj, Mahadevappa Mahesh, Ramji R. Rajendran, Elliot K. Fishman
    J Am Coll Radiol. 2017 May;14(5):697-702
  • TAKE-HOME POINTS
    - RadiologyInfo.org is an authoritative and trusted portal designed to support public care and public awareness of the essential role radiology in health care.
    - Recent enhancements to the site have aimed to improve its usefulness for patients and their families.
  • TAKE-HOME POINTS
    - With more than 1.4 million visitors in August 2016 from 235 countries and territories worldwide, monthly engagement has grown by more than 60% from the prior year.
    - Diversification of access through social media channels as well as mobile platforms has expanded the reach of RadiologyInfo.org.
  • Social Media Platforms
    - Facebook
    - Instagram
    - YouTube
    - Twitter
    - Google
  • “Pinterest allows users to categorize website links using primarily photos, as well as GIFs and videos, and catalog them for future consideration. Initially billed as a “pinboard-style image sharing network for people with good taste,” it began as an invitation-only beta site before its 2012 public unveiling. Pinterest, a portmanteau of the words “pin” and “interest,” quickly rose to become the third most popular social media site in a meteoric rise within a year of its official inception.”
    What Can Pinterest Do for Radiology?
    Kauffman L1, Weisberg EM1, Fishman EK2.
    J Digit Imaging. 2019 Jul 31. doi: 10.1007/s10278-019-00248-6. [Epub ahead of print]
  • ”Pinterest is a great vehicle for categorizing website links using images. Radiology represents only a small portion of the Education category on Pinterest, and Pinterest is barely a blip on the radar of the radiology community. However, as Pinterest grows and, perhaps, evolves, its reach may present the opportunity to expand radiology awareness and other on-line medical resources.”
    What Can Pinterest Do for Radiology?
    Kauffman L1, Weisberg EM1, Fishman EK2.
    J Digit Imaging. 2019 Jul 31. doi: 10.1007/s10278-019-00248-6. [Epub ahead of print]
  • Pinterest Users
  • Take Home Points
    - Some of the visually oriented medical specialties are considering the potential application of the image- based social media and curation website Pinterest in their fields.
    - With a wide reach of users as the fourth most popular social media site, Pinterest is a largely untapped resource for radiology.
  • Take Home Points
    We created Pinterest boards that correlate with sec- tions of our website, CTisus, such as Case Studies, Medical Illustrations, Quiz Questions, etc., with the hypothesis that Pinterest could help capture users in- terested in a specific case or image that may not be prominently displayed among our thousands of case studies.
  • Take Home Points
    The fact that Pinterest users skew younger leads us to speculate that this social media platform may appeal to our medical students, residents, and fellows.
    As Pinterest grows and, perhaps, evolves, its reach may present the opportunity to expand radiology awareness and other online medical resources.
  • Social Media Platforms
    - Facebook
    - Instagram
    - YouTube
    - Twitter
    - Google
  • “Pinterest allows users to categorize website links using primarily photos, as well as GIFs and videos, and catalog them for future consideration. Initially billed as a “pinboard-style image sharing network for people with good taste,” it began as an invitation-only beta site before its 2012 public unveiling. Pinterest, a portmanteau of the words “pin” and “interest,” quickly rose to become the third most popular social media site in a meteoric rise within a year of its official inception.”
    What Can Pinterest Do for Radiology?
    Kauffman L1, Weisberg EM1, Fishman EK2.
    J Digit Imaging. 2019 Jul 31. doi: 10.1007/s10278-019-00248-6. [Epub ahead of print]
  • ”Pinterest is a great vehicle for categorizing website links using images. Radiology represents only a small portion of the Education category on Pinterest, and Pinterest is barely a blip on the radar of the radiology community. However, as Pinterest grows and, perhaps, evolves, its reach may present the opportunity to expand radiology awareness and other on-line medical resources.”
    What Can Pinterest Do for Radiology?
    Kauffman L1, Weisberg EM1, Fishman EK2.
    J Digit Imaging. 2019 Jul 31. doi: 10.1007/s10278-019-00248-6. [Epub ahead of print]
  • Pinterest Users
  • Take Home Points
    - Some of the visually oriented medical specialties are considering the potential application of the image- based social media and curation website Pinterest in their fields.
    - With a wide reach of users as the fourth most popular social media site, Pinterest is a largely untapped resource for radiology.
  • Take Home Points
    We created Pinterest boards that correlate with sec- tions of our website, CTisus, such as Case Studies, Medical Illustrations, Quiz Questions, etc., with the hypothesis that Pinterest could help capture users in- terested in a specific case or image that may not be prominently displayed among our thousands of case studies.
  • Take Home Points
    The fact that Pinterest users skew younger leads us to speculate that this social media platform may appeal to our medical students, residents, and fellows.
    As Pinterest grows and, perhaps, evolves, its reach may present the opportunity to expand radiology awareness and other online medical resources.
  • App Development for our Patients
    - How to prepare for a Radiology exam (i.e. virtual colonoscopy or angiography)
    - What to do after a Radiology exam is finished? (i.e. can I go back to work)
    - Disease specific information
    - Treatment specific information (i.e. surgery vs chemotherapy vs radiation therapy)
  • “Most women felt that the app was both helpful and user-friendly. The app increased their participation in decision making, helped them obtain more accurate risk perceptions, and clarified their values. It also helped the women make decisions regarding breast reconstruction more confidently.”
    Development and Usability Testing of a Decision Support App for Women Considering Breast Reconstruction Surgery
    Pin-Jun Li et al.
    Journal of Cancer Education (in press)
  • “Women with breast cancer have difficulty deciding whether to undergo breast reconstruction when mastectomy is necessary. A computer-based decision aid that can be individualized to provide both surgery information and value clarification may be helpful for women considering breast reconstruction surgery. The objectives of this study are to program a prototype of an application (app) with a value clarification exercise and to evaluate the pilot usability, feasibility, and efficacy of the app.”
    Development and Usability Testing of a Decision Support App for Women Considering Breast Reconstruction Surgery
    Pin-Jun Li et al.
    Journal of Cancer Education (in press)
  • ”The women appreciated the app. As a decision aid, the app is an acceptable and feasible tool that increased the women’s participation in decision making, helped them attain more accurate risk perceptions and facilitated value clarification.”
    Development and Usability Testing of a Decision Support App for Women Considering Breast Reconstruction Surgery
    Pin-Jun Li et al.
    Journal of Cancer Education (in press)
  • Apple as a Healthcare Company
    - iPhone
    - iPad
    - iWATCH
  • Cycle Log
  • Step Counting
  • Blood Pressure
  • Health Categories
  • Your Medical Info
  • Your Health Records
  • Apps are in Development
  • App Development for our Patients
    - How to prepare for a Radiology exam (i.e. virtual colonoscopy or angiography)
    - What to do after a Radiology exam is finished? (i.e. can I go back to work)
    - Disease specific information
    - Treatment specific information (i.e. surgery vs chemotherapy vs radiation therapy)
  • “Most women felt that the app was both helpful and user-friendly. The app increased their participation in decision making, helped them obtain more accurate risk perceptions, and clarified their values. It also helped the women make decisions regarding breast reconstruction more confidently.”
    Development and Usability Testing of a Decision Support App for Women Considering Breast Reconstruction Surgery
    Pin-Jun Li et al.
    Journal of Cancer Education (in press)
  • “Women with breast cancer have difficulty deciding whether to undergo breast reconstruction when mastectomy is necessary. A computer-based decision aid that can be individualized to provide both surgery information and value clarification may be helpful for women considering breast reconstruction surgery. The objectives of this study are to program a prototype of an application (app) with a value clarification exercise and to evaluate the pilot usability, feasibility, and efficacy of the app.”
    Development and Usability Testing of a Decision Support App for Women Considering Breast Reconstruction Surgery
    Pin-Jun Li et al.
    Journal of Cancer Education (in press)
  • ”The women appreciated the app. As a decision aid, the app is an acceptable and feasible tool that increased the women’s participation in decision making, helped them attain more accurate risk perceptions and facilitated value clarification.”
    Development and Usability Testing of a Decision Support App for Women Considering Breast Reconstruction Surgery
    Pin-Jun Li et al.
    Journal of Cancer Education (in press)
  • Apple as a Healthcare Company
    - iPhone
    - iPad
    - iWATCH
  • Cycle Log
  • Step Counting
  • Blood Pressure
  • Health Categories
  • Your Medical Info
  • Your Health Records
  • Apps are in Development
Quotes

  • “You have power over your mind - not outside events. Realize this, and you will find strength.” ― Marcus Aurelius, Meditations
  • “You have power over your mind - not outside events. Realize this, and you will find strength.” ― MarcusAurelius, Meditations
  • “The happiness of your life depends upon the quality of your thoughts.” Marcus Aurelius, Meditations
  • “Everything we hear is an opinion, not a fact. Everything we see is a perspective, not the truth.” ― Marcus Aurelius , Meditations
  • “It is not death that a man should fear, but he should fear never beginning to live.” Marcus Aurelius, Meditations
  • “The object of life is not to be on the side of the majority, but to escape finding oneself in the ranks of the insane.” ― Marcus Aurelius, Meditations
  • “When you wake up in the morning, tell yourself: the people I deal with today will be meddling, ungrateful, arrogant, dishonest, jealous and surly. They are like this because they can't tell good from evil. But I have seen the beauty of good, and the ugliness of evil, and have recognized that the wrongdoer has a nature related to my own - not of the same blood and birth, but the same mind, and possessing a share of the divine. And so none of them can hurt me. No one can implicate me in ugliness. Nor can I feel angry at my relative, or hate him. We were born to work together like feet, hands and eyes, like the two rows of teeth, upper and lower.” - Marcus Aurelius, Meditations
  • “Live a good life. If there are gods and they are just, then they will not care how devout you have been, but will welcome you based on the virtues you have lived by. If there are gods, but unjust, then you should not want to worship them. If there are no gods, then you will be gone, but will have lived a noble life that will live on in the memories of your loved ones.” ― Marcus Aurelius
  • “Think of yourself as dead. You have lived your life. Now, take what's left and live it properly. What doesn't transmit light creates its own darkness.” ― Marcus Aurelius, Meditations
  • “If someone can prove me wrong and show me my mistake in any thought or action, I shall gladly change. I seek the truth, which never harmed anyone: the harm is to persist in one's own self-deception and ignorance.” ― Marcus Aurelius, Meditations
  • “Do not act as if you had ten thousand years to throw away. Death stands at your elbow. Be good for something while you live and it is in your power.” ― Marcus Aurelius, Meditations
  • “Your days are numbered. Use them to throw open the windows of your soul to the sun. If you do not, the sun will soon set, and you with it.” ― Marcus Aurelius, The Emperor's Handbook
  • “Which is recorded of Socrates, that he was able both to abstain from, and to enjoy, those things which many are too weak to abstain from, and cannot enjoy without excess. But to be strong enough both to bear the one and to be sober in the other is the mark of a man who has a perfect and invincible soul.” ― Marcus Aurelius, Meditations
  • “The time is at hand when you will have forgotten everything; and the time is at hand when all will have forgotten you. Always reflect that soon you will be no one, and nowhere.” ― Marcus Aurelius, Meditations
  • “In the human life time is but an instant, and the substance of it a flux, and the perception dull, and the composition of the whole body subject to putrefaction, and the soul a whirl, and fortune hard to divine, and fame a thing devoid of certainty. And, to say all in a word, everything that belongs to the body is a stream, and what belongs to the soul is a dream and vapor, and life is a warfare and a stranger's sojourn, and after- fame is oblivion. What then can guide a man? One thing and only one, philosophy.” ― Marcus Aurelius, Meditations
Stomach

  • Gastric Cancer: Statistics 2019
  • Gastric Cancer: Statistics 2019
  • Gastric Cancer: Statistics 2019
  • Gastric Cancer: Statistics 2019
  • Gastric Cancer: Statistics 2019
  • Gastric Cancer: Statistics 2019
  • Gastric Cancer: Statistics 2019
  • Gastric Cancer: Statistics 2019
  • Gastric Cancer: Statistics 2019
Vascular

  • Purpose To compare CT angiography (CTA) and tagged red blood cell (RBC) scan as a function of time from these initial imaging studies to subsequent conventional angiography and catheter-directed embolization in patients with gastrointestinal (GI) bleeding.
    Conclusions In patients requiring conventional angiography for GI bleeding, CT angiography results in a faster time to angi- ography than tagged RBC scan, which appears to be due to the longer duration required to complete the tagged RBC scan. Decreasing time to angiography is vital, as GI bleeding can be fatal and earlier diagnosis and intervention has the potential to reduce morbidity and mortality, while also increasing sensitivity of angiography. These findings may assist ordering clinicians in deciding on the appropriate diagnostic study.
    Time to conventional angiography in gastrointestinal bleeding: CT angiography compared to tagged RBC scan
    Hsu MJ et al.
    Abdominal Radiol (in press ) 2019
  • “The mean time from diagnostic study order to study completion was 3 h and 4 min for the CTA group and 5 h and 1 min for the tagged RBC scan group (p value = 0.0001). There was no statistically significant difference between the time to angiography after completion of the preceding diagnostic study. The total mean time from diagnostic study order to inter- vention was 6 h and 8 min for the CTA group and 9 h and 29 min for the tagged RBC scan group, a statistically significant difference (p value = 0.028).”
    Time to conventional angiography in gastrointestinal bleeding: CT angiography compared to tagged RBC scan
    Hsu MJ et al.
    Abdominal Radiol (in press ) 2019
  • ”The results show that in the clinical setting of a patient presenting with GI bleeding requiring catheter-directed embolization, CTA reduces the time to angiography as compared to tagged RBC scanning. Furthermore, the overall time from the decision to order a radiologic study to catheter angiography is faster with CTA. Given the time from diagnostic study completion to angiography was not statistically significant between the two groups, it can be inferred that the limiting step was with diagnosis.”
    Time to conventional angiography in gastrointestinal bleeding: CT angiography compared to tagged RBC scan
    Hsu MJ et al.
    Abdominal Radiol (in press ) 2019
  • Angiographic Findings in Patients with PAN



    Polyarteritis Nodosa: Spectrum of Angiographic Findings
    Anthony W. Stanson et al.
    RadioGraphics 2001; 21:151-159
  • PAN Vascular Findings
    - occlusive lesions (luminal irregularities resulting in reduction of caliber, stenosis, or occlusion)
    - microaneurysms
    - Polyarteritis Nodosa: Spectrum of Angiographic Findings
    - Anthony W. Stanson et al.
    - RadioGraphics 2001; 21:151-159
  • Differential Dx for Multiple Renal Artery Aneurysms on CT
    - polyarteritis nodosa
    - rheumatoid vasculitis,
    - systemic lupus erythematosus,
    - Churg- Strauss syndrome
    - IVDA
  • “As seen in this review of the spectrum of angiographic findings in PAN, a variety of arterial beds may be affected and a variety of lesions may be seen. Skeletal muscle arterial disease was seen in nearly one-third of our patients. The lesions seen most frequently were occlusive. The presence of aneurysms increases the specificity of the diagnosis of PAN, but in their absence other arterial lesions such as luminal irregularities, stenoses, and occlusions can suggest the diagnosis. In a patient without fulminant disease but in whom clinical suspicion is firm, comprehensive angiography may lead to the diagnosis of PAN on the basis of the constellation of angiographic findings.”
    Polyarteritis Nodosa: Spectrum of Angiographic Findings
    Anthony W. Stanson et al.
    RadioGraphics 2001; 21:151-159
  • “Many of the clinical symptoms are related to organ ischemia secondary to arterial branch occlusions. Aneurysm rupture is a less common cause of pain. Arthralgias are noted in 50% of patients as are peripheral neuropathies (mononeuritis multiplex), which are often symptomatic early. Renal involvement including proteinuria and hypertension are found in 75%. Branch vessel occlusions can lead to multiple renal infarcts. Abdominal pain from ischemia or infarction secondary to occlusive lesions is the most common gastrointestinal complaint. Abdominal pain may also be caused by rupture of an aneurysm in one of the viscera: liver, kidney, or mesentery. Cutaneous lesions include palpable purpura, infections, and ischemic ulcers. Muscle pain and limb claudication may occur.”
    Polyarteritis Nodosa: Spectrum of Angiographic Findings
    Anthony W. Stanson et al.
    RadioGraphics 2001; 21:151-159
  • “Polyarteritis nodosa (PN) is a systemic necrotizing vasculitis of medium and small arteries, and is typically found in middle-aged men. The most common clinical symptoms are persistent fever, weight loss, and polyarthragia. As these symptoms are nonspecific, diagnosing PN is sometimes difficult and delayed. The kidney is the most commonly involved, and multiple small wedge-shaped less-enhanced areas are typically seen on enhanced CT. These are considered to be multiple bilateral renal cortical infarctions due to vasculitis of the interlobar arteries and arcuate arteries.”
    Renal involvement of polyarteritis nodosa: CT and MR findings
    Ozaki, K., Miyayama, S., Ushiogi, Y. et al.
    Abdom Imaging (2009) 34: 265. https://doi.org/10.1007/s00261-008-9377-7
  • Some studies reported that multiple small wedge-shaped less-enhanced areas were observed on enhanced CT, which were multiple bilateral renal cortical infarctions from vasculitis of the interlobar arteries and the arcuate arteries. In addition, perirenal hematoma by aneurysmal rupture, and small microaneurysms are sometimes observed.
    Renal involvement of polyarteritis nodosa: CT and MR findings
    Ozaki, K., Miyayama, S., Ushiogi, Y. et al.
    Abdom Imaging (2009) 34: 265. https://doi.org/10.1007/s00261-008-9377-7
  • “Most aneurysms are 2–10 mm in diameter. In the present study, multiple microaneurysms, 2–3 mm in diameter, were observed in all patients. However, it is important to note that renal microaneurysms are not specific to PN. They may be demonstrated in other systemic necrotizing vasculitis, drug abuse, and bacterial endocarditis. The specificity of angiographic findings of microaneurysm becomes much higher when the clinical symptoms are supportive.”
    Renal involvement of polyarteritis nodosa: CT and MR findings
    Ozaki, K., Miyayama, S., Ushiogi, Y. et al.
    Abdom Imaging (2009) 34: 265. https://doi.org/10.1007/s00261-008-9377-7

  • Hur JH, Chun EJ, Kwag HJ, Yoo JY, Kim HY, Kim JJ, Lee KW. CT Features of Vasculitides Based on the 2012 International Chapel Hill Consensus Conference Revised Classification. Korean J Radiol. 2017 Sep-Oct;18(5):786-798.

  • Hur JH, Chun EJ, Kwag HJ, Yoo JY, Kim HY, Kim JJ, Lee KW. CT Features of Vasculitides Based on the 2012 International Chapel Hill Consensus Conference Revised Classification. Korean J Radiol. 2017 Sep-Oct;18(5):786-798.

  • Hur JH, Chun EJ, Kwag HJ, Yoo JY, Kim HY, Kim JJ, Lee KW. CT Features of Vasculitides Based on the 2012 International Chapel Hill Consensus Conference Revised Classification. Korean J Radiol. 2017 Sep-Oct;18(5):786-798.
  • Takayasu Arteritis: Facts
    - Takayasu arteritis, which is also known as “aortic arch syndrome” and “pulseless disease”, is an idiopathic inflammatory disease that primarily affects large vessels such as the aorta, major branches of the aorta, and coronary and pulmonary arteries. Pathologically, TA is characterized by panarteritis affecting all three arterial layers, and subsequent scarring of media leading to luminal occlusion.
    - Takayasu arteritis occurs worldwide, but is much more common in Asia . Women are predominantly affected compared to men, with a 7:1 ratio. The American College of Rheumatology states that TA can be suspected when patients have at least three of the following criteria; age < 40 years at disease onset, claudication of the extremities, decreased brachial artery pressure, blood pressure difference of more than 10 mm Hg in between the arms, bruit over the subclavian arteries or aorta, and abnormal arteriographic results.
  • Takayasu Arteritis: Facts
    CT findings of TA differ depending on the stage. In the early phase (active stage), concentric mural thickening of the involved arteries is characteristic. On pre-contrast CT scanning, the mural thickening is of high attenuation compared with the lumen, while on the post-enhanced CT angiographic images, it exhibits a “double ring sign”. Double ring sign is typically shown in the venous phase, as an inner low attenuating wall surrounded by an outer high attenuating wall. In the late phase (occlusive stage), arterial stenosis, occlusion, or aneurysmal dilatation may occur, associated with the mural thickening . Extensive vascular calcification and collateral vessels may be observed with luminal narrowing.
  • Giant Cell Arteritis: Facts
    Giant cell arteritis (GCA) is another form of large vessel vasculitis affecting the aorta and its large arterial branches. Characteristically, it commonly affects the branches of carotid arteries, vertebral arteries, and temporal arteries, leading to characteristic temporal headaches. A microscopic exam reveals vasculitis with mononuclear infiltrates or granulomas in the active stage and vessel wall fibrosis in the chronic stage.
  • Giant Cell Arteritis: Facts
    Clinical differentiation between GCA and TA is sometimes difficult, but GCA predominantly affects female patients who are older than 50 years old, and is prevalent in the western countries, in contrast to TA. Pathologically, TA is commonly associated with extensive intimal and adventitial fibrosis with resultant luminal narrowing, whereas GCA is more commonly associated with extensive medial inflammation, necrosis, and formation of aortic aneurysm. “Skip lesion”, or aortic inflammation, is also more common in GCA.
  • Polyarteritis Nodosa: Facts
    - Polyarteritis nodosa (PAN) is a necrotizing vasculitis of medium and small arteries without glomerulonephritis, and is unassociated with the anti-neutrophil cytoplasmic antibody (ANCA). Absence of ANCA is a distinguishing point from microscopic polyangiitis (MPA), which is an ANCA-associated small vessel vasculitis that shares similar pathologic and radiologic findings with PAN.
    - Polyarteritis nodosa affects men twice as often as women in the 5–7th decades. Etiology is unclear, but the hepatitis B virus may play an important role in the development of the disease. Renal involvement is common with an incidence of 70–80%, resulting in proteinuria, hematuria, and hypertension, but not glomerulonephritis. Other involvements are the gastrointestinal tract and skin at an incidence rate of 50%; skeletal muscles and mesentery at an incidence rate of 30%; and the central nervous system at an incidence rate of 10%.
    - Characteristic imaging findings of PAN are microaneurysms of medium or small arteries, often involving the renal arteries.
  • Polyarteritis Nodosa: Facts
    - Small vessel vasculitides mainly affect small intraparenchymal arteries, arterioles, capillaries, and venules. They are divided into two categories; ANCA-associated small vessel vasculitis and immune complex-associated small vessel vasculitis.
    - Anti-neutrophil cytoplasmic antibody is an antibody against intracellular antigens in neutrophils and monocytes. According to immunofluorescent staining pattern, there are cytoplasmic ANCA (c-ANCA) and perinuclear ANCA (p-ANCA). Granulomatosis with polyangiitis (GPA) is a c-ANCA (+) vasculitis, whereas eosinophilic GPA (EGPA) or MPA are characteristic of p-ANCA (+) vasculitis. Although ANCA is an important characteristic of ANCA-associated vasculitis, its positive predictive value is only around 45%. This means that ANCA negativity does not exclude the possibility of ANCA-associated vasculitis.
  • Behçet’s Disease: Facts
    - Behçet's disease is a chronic, relapsing autoinflammatory condition involving multiple organs. Clinically, Behçet's disease manifests as recurrent oral or genital aphthous ulcers, and inflammatory lesions of the cutaneous, ocular, articular, gastrointestinal, and central nervous system. It is most prevalent in the 3rd and 4th decades of life, and is more common in males.
    - Vascular involvement occurs in 5–30% of Behçet's disease cases, and it can be divided into three types: venous thrombosis, arterial aneurysm and aortic occlusion. Venous thrombosis is associated with a prevalence range of 10–30%. Deep vein thrombosis of the lower extremities is the most common finding, followed by superficial thrombophlebitis after venipuncture. Aneurysms, which are frequently seen in the aorta, pulmonary, subclavian, and popliteal arteries, can be the most serious complication of Behçet's disease. Saccular types are more frequent than fusiform aneurysms. In case of pulmonary involvement, pulmonary artery aneurysm is the most common finding with a prevalence of 1–10%, and tends to be multiple and bilateral.
  • Differential Diagnosis of Vasculitis: Facts
    The presence of known etiology or associated systemic disease can be helpful for the differential diagnosis of vasculitis. Systemic lupus erythematosus or rheumatoid arthritis are systemic inflammatory disorders, which may lead to inflammation of the cardiovascular system. IgG4-related sclerosing disease is characterized by idiopathic inflammatory lesions infiltrated with numerous IgG4-positive plasma cells. IgG4-related periarteritis predominantly involves the abdominal aorta, iliac vessels and thoracic aorta. CT findings include arterial wall thickening, homogeneous enhancement at the delayed phase of contrast enhanced CT, luminal change (mostly dilation and rarely stenosis), and exaggerated atherosclerotic change. An elevated serum IgG4 level and associated organ damage are essential in discerning this disease from other vasculitides. A few cases of IgG4-related periarteritis affecting the coronary arteries have been reported, which appeared as soft tissue encasing the coronary artery with or without luminal narrowing, wall calcification, and aneurysm.
  • Differential Diagnosis of Vasculitis: Facts
    Multidetector CT is a useful noninvasive imaging modality for the evaluation of vasculitis and vasculitis mimics because CT can provide the information of the vessel wall change and other accompanied findings. Although CT features of various vasculitis are often overlapping, CT features via consideration of the involved vessel type, location, morphology, and associated systemic disease, can be useful in narrowing down the differential diagnosis .Getting familiar with CT features will help radiologists to establish appropriate diagnosis for vasculitis.
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