Editor’s Choice

CLINICAL IMPLEMENTATION OF DUAL-ENERGY CT FOR GASTROINTESTINAL IMAGING
Achille Mileto, MD, Lakshmi Ananthakrishnan, MD, Desiree E. Morgan, MD, Benjamin M. Yeh, MD, Daniele Marin, MD, Avinash R. Kambadakone, MD
This article provides an overview of practical aspects of the DECT technology and acquisition protocols, reviews existing clinical applications, discusses current challenges, and describes future directions, with a focus on gastrointestinal imaging.

MANAGEMENT AND OUTCOMES OF SUSPECTED INFECTIOUS AND INFLAMMATORY LUNG ABNORMALITIES IDENTIFIED ON LUNG CANCER SCREENING CT
Dexter P. Mendoza, MD, Wariya Chintanapakdee, MD, Eric W. Zhang, MD, Matthew D. Gilman, MD, Inga T. Lennes, MD, MPH, MBA, Angela J. Frank, MD, MPH, Jo-Anne O. Shepard, MD, Subba R. Digumarthy, MD
Adopting a conservative management algorithm for suspected infectious or inflammatory lung abnormalities identified on LCS can reduce unnecessary imaging without increasing risk for missing malignancy.

FACIAL FEMINIZATION SURGERY: KEY CT FINDINGS FOR PREOPERATIVE PLANNING AND POSTOPERATIVE EVALUATION
Andrew L. Callen, MD, Ryan K. Badiee, Andrew Phelps, MD, Valeria Potigailo, MD, Eric Wang, MD, Solomon Lee, MD, Jason Talbott, MD, PhD, Christine Glastonbury, MBBS, Jason H. Pomerantz, MD, Jared Narvid, MD
We describe readily identifiable CT features with a key role in FFS planning. Familiarity with these findings will facilitate improved communication between radiologists and surgeons, thereby contributing to the care of transgender women.

DIAGNOSTIC YIELD OF INCREMENTAL BIOPSY CORES AND SECOND LESION SAMPLING FOR INGANTRY MRI-GUIDED PROSTATE BIOPSY
Nicole Seyfried, BS, Amr Mahran, MD, Ananya Panda, MD, Verena C. Obmann, MD, Christina A Buzzy, PhD, Yun Jiang, PhD, Katherine L. Wright, PhD, Dean A. Nakomoto, MD, Indravadan J. Patel, MD, Britt Conroy, MD, PhD, JD, Lee Ponsky, MD, Vikas Gulani, MD, PhD
Obtaining only three cores from the primary lesion during in-gantry MRGB may be sufficient for high diagnostic yield while reducing patient discomfort and procedure times.

BEST PRACTICES: CT-GUIDED PERCUTANEOUS SAMPLING OF VERTEBRAL DISCITIS-OSTEOMYELITIS AND TECHNICAL FACTORS MAXIMIZING BIOPSY YIELD
Jad S. Husseini, MD, Sina Habibollahi, MD, Sandra B. Nelson, MD, Daniel I. Rosenthal, MD, Connie Y. Chang, MD
CT-guided percutaneous sampling of vertebral discitis-osteomyelitis, despite a relatively low microbiologic yield, may be safely performed for detection of causative microorganisms.

FINDINGS ON CHEST CT PERFORMED IN THE EMERGENCY DEPARTMENT IN PATIENTS ON IMMUNE CHECKPOINT INHIBITOR THERAPY: SINGLE-INSTITUTION 8-YEAR EXPERIENCE IN 136 PATIENTS
Daniel A. Smith, MD, Ethan Radzinsky, Sree Harasha Tirumani, MD, Ezgi Guler, MD, Andrew Petraszko, MD, Elias Kikano, MD, Christopher J. Hoimes, DO, Nikhil H. Ramaiya, MD
Most chest CT examinations in the ED in patients on ICI therapy exhibited worsening lung tumor burden, which was associated with worse survival. New consolidation and ICI-associated pneumonitis (most commonly radiation recall pneumonitis) were also commonly detected in the ED setting.

BORDERLINE RESECTABLE AND LOCALLY ADVANCED PANCREAS CANCER: FDG PET/MRI AND CT TUMOR METRICS FOR ASSESSMENT OF NEOADJUVANT THERAPY PATHOLOGIC RESPONSE AND PREDICTION OF SURVIVAL
Ananya Panda, MD, Ishan Garg, MBBS, Mark J. Truty, MD, Timothy M. Kline, PhD, Matthew P. Johnson, MS, Eric C. Ehman, MD, Garima Suman, MD, Deema A. Anaam, MBBS, Bradley J. Kemp, PhD, Geoffrey B. Johnson, MD, PhD, Thorvardur R. Halfdanarson, MD, Sudhakar K. Venkatesh, MD, Jeff L. Fidler, MD, Ajit, H. Goenka, MD
PET/MRI and CT metrics can help guide post-NAT pancreatic cancer treatment decisions. In comparison, serum CA 19-9 was not associated with pathologic response or survival.

IMAGING CHANGES AND CLINICAL COMPLICATIONS AFTER DRUG-ELUTING BEADS VERSUS CONVENTIONAL TRANSARTERIAL CHEMOEMBOLIZATION FOR UNRESECTABLE HEPATOCELLULAR CARCINOMA: MULTICENTER STUDY
Lei Zhang, MD, Jun-Hui Sun, MD PhD, Jian-Song Ji, MD, PhD, Bin-Yan Zhong, MD, PhD, Guan-Hui Zhou, MD, Jing-Jing Song, MD, Zhong-Heng Hou, MD, Peng Huang, MD, Shen Zhang, MD, Zhi Li, Xiao-Li Zhu, MD, PhD, Cai-Fang Ni, MD, PhD
Compared to cTACE, DEB-TACE for treatment-naïve HCC is associated with a higher frequency of hepatobiliary injury, although similar short-term local control.

PATIENT CHARACTERISTICS ASSOCIATED WITH PATIENT-REPORTED DETERRENTS TO ADJUNCT BREAST CANCER SCREENING AMONG PATIENTS WITH DENSE BREASTS
Matthew M. Miller, Kathy Repich, James T. Patrie, Roger T. Anderson, Jennifer A. Harvey
Among 508 women with dense breasts, lower confidence in sensitivity of mammography in dense breasts was associated with lower concern about examination time and additional imaging resulting from adjunct screening, and with higher preference for more sensitive hypothetical screening examinations. Examination cost was the most common adjunct screening deterrent (66.9%).

TOMOSYNTHESIS-GUIDED VACUUM-ASSISTED BREAST BIOPSY OF ARCHITECTURAL DISTORTION WITHOUT A SONOGRAPHIC CORRELATE: A RETROSPECTIVE REVIEW
Emily B. Ambinder, MD, Amy Plotkin, MD, David Euhus, MD, Lisa A. Mullen, MD, Eniola Oluyemi, MD, Philip Di Carlo, MD, Mary Philip, MD, Babita Panigrahi, MD, Ashley Cimino-Matthews, MD, Keely S. Myers, MD
Up to half of architectural distortions without a sonographic correlate represent malignancy or a high-risk lesion, justifying a recommendation for biopsy, using TVAB when available.

EFFECT OF AT LEAST TEN SERIAL GADOBUTROL ADMINISTRATIONS ON BRAIN SIGNAL INTENSITY RATIOS ON T1-WEIGHTED MRI IN CHILDREN: A MATCHED CASE-CONTROL STUDY
Kerem Ozturk, MD, David Nascene, MD
In a matched case-control analysis, 10 or more serial gadobutrol administrations was not associated with increased signal intensity on T1-weighted imaging in the dentate nucleus or globus pallidus using visual and quantitative analyses.

ULTRASOUND-GUIDED PERCUTANEOUS NEEDLE BIOPSY FOR SMALL PLEURAL LESIONS: DIAGNOSTIC YIELD AND IMPACT OF CT AND ULTRASOUND CHARACTERISTICS
Jongmin Park, MD, Byunggeon Park, MD, Jae-Kwang Lim, MD, Kyung Min Shin, MD, Jaehee Lee, MD, PhD, Chang Ho Kim, MD, PhD, Hyewon Seo, MD, Yong Hoon Lee, MD, Jun Heo, MD, PHD, Young Woo Do, MD
US-guided percutaneous pleural needle biopsy may be warranted as an initial or repeat diagnostic test if the pleura is nodular or thicker than 4.5 mm on CT.

UTILITY OF 18F-FLUCICLOVINE PET/MRI FOR STAGING NEWLY DIAGNOSED HIGH-RISK PROSTATE CANCER AND EVALUATING RESPONSE TO INITIAL ANDROGEN DEPRIVATION THERAPY: A PROSPECTIVE SINGLE-ARM PILOT STUDY
Samuel J. Galgano, MD, Andrew McDonald, MD, Soroush Rais-Bahrami, MD, Kristin K. Porter, MD, PhD, Gagandeep Choudhary, MD, Constantine Burgan, MD, Pradeep Bhambhvani, MD, Jeffrey Nix, MD, Desiree E. Morgan, MD, Yufeng Li, PhD, John V. Thomas, MD, Jonathan McConathy, MD, PhD
Fluorine-18-labeled fluciclovine PET/MRI demonstrates potential utility in initial staging of high-risk prostate cancer and in evaluating response to ADT. 

USE OF ENTERIC CONTRAST FOR ABDOMINOPELVIC CT IN PENETRATING TRAUMATIC INJURY IN ADULTS: COMPARISON OF DIAGNOSTIC ACCURACY SYSTEMATIC REVIEW AND META-ANALYSIS
Mostafa Alabousi, MD, Nanxi Zha, Michael N. Patlas, MD
This systematic review and meta-analysis assessed the utility of enteric contrast for CT in the detection of penetrating traumatic abdominopelvic injuries in 1,287 adults and found no additional diagnostic benefit of enteric contrast compared with use of IV contrast alone.

THERMAL ABLATION VERSUS STEREOTACTIC BODY RADIOTHERAPY FOLLOWING TRANSARTERIAL CHEMOEMBOLIZATION FOR INOPERABLE HEPATOCELLULAR CARCINOMA: A PROPENSITY SCORE WEIGHTED
Nima Nabavizadeh, MD, Younes Jahangiri, MD, Ramtin Rahmani, BA, Yuki Tomozawa, MD, PhD, Yindee Geeratikun, MD, Yiyi Chen, PhD, Arthur Hung, MD, Catherine Degnin, PhD, Khashayar Farsad, MD, PhD
TACE with percutaneous thermal ablation may be superior to TACE with stereotactic body radiotherapy for inoperable hepatocellular carcinoma.

MALIGNANT OUTCOMES OF ARCHITECTURAL DISTORTION ON TOMOSYNTHESIS: A SYSTEMATIC REVIEW AND META-ANALYSIS
Sadia Choudhery, MD, Matthew Johnson, MS, Nicholas B. Larson, PhD, Tara Anderson, MD
Pooled PPV for malignancy of architectural distortion without a known cause on DBT is high at 34.6%. Since most malignant distortions have an US finding, US should be performed to look for a correlate, but the absence of a correlate does not obviate the need for a biopsy.

THE PAIN CRISIS: INTERVENTIONAL RADIOLOGY’S ROLE IN PAIN MANAGEMENT
Austin Fletcher, MD, Kelli J. Moore, MD, James D. Stensby, MD, Anna Hulbert, MD, Arash M. Saemi, MD, Ryan M. Davis, MD, Ambarish Bhat, MD
This article reviews a wide range of minimally invasive procedures, including vertebral augmentation, sacroplasty, thermal ablation of osseous metastasis, nerve blocks, and gonadal vein embolization, that interventional radiologists are now using successfully to treat chronic pain.

PREDICTIVE VALUE OF CARDIAC CT ANGIOGRAPHY, CARDIAC MRI, AND TRANSTHORACIC ECHOCARDIOGRAPHY FOR CARDIOEMBOLIC STROKE RECURRENCE
Georg Apfaltrer, MD, Francesco Lavra, Carlo N. De Cecco, Akos Varga-Szemes MD, PhD, Marly van Assen BS, Domenico Mastrodicasa, MD, Marco Scarabello, MD, Marwen H. Eid, MD, L. Parkwood Griffith, MD, John W. Nance, MD, Sheldon E. Litwin, MD, Luca Saba, MD, U. Joseph Schoepf, MD
Given their high negative predictive value, cardiac MRI and cardiac CT angiography are potential alternatives when echocardiography provides equivocal findings for cardioembolic stroke recurrence.

DIFFUSION-WEIGHTED MRI IN THE ASSESSMENT OF SACROILIITIS: IMPROVED IMAGE QUALITY AND DIAGNOSTIC PERFORMANCE WITH READOUT-SEGMENTED ECHO-PLANAR IMAGING COMPARED WITH CONVENTIONAL SINGLE-SHOT ECHO-PLANAR IMAGING
Hua Zhang, MD, Hongjie Huang, MD, Yuyang Zhang, MD, Zhandai Tu, MD, Zebin Xiao, MD, Jummin Chen, MD, PhD, Dairong Cao, MD
Readout-segmented EPI (rs-EPI) significantly improves the image quality and diagnostic confidence for DWI of the sacroiliac joints compared with single-shot-EPI (ss-EPI). ADC values from rs-EPI better differentiated among disease activity states in patients with axial spondyloarthritis than did ADC values from ss-EPI.

BEST PRACTICES FOR POST-TREATMENT SURVEILLANCE IMAGING IN HEAD AND NECK CANCER: APPLICATION OF THE NECK IMAGING REPORTING AND DATA SYSTEM (NI-RADS)
Sara B. Strauss, MD, Ashley H. Aiken, MD, Josua E. Lantos, MD, C. Douglas Phillips, MD
NI-RADS is a practical solution to the inconsistency in surveillance practices, both in terms of modality choice and surveillance schedule, as well as imaging description in post-treatment HNSCC.

TEMPORAL PATTERN OF RADIOGRAPHIC FINDINGS OF COSTOCHONDRAL JUNCTION RIB FRACTURES ON SERIAL SKELETAL SURVEYS IN SUSPECTED INFANT ABUSE
Andy Tsai, MD PhD, Jeannette Perez-Rossello, MD, Susan A. Connolly, MD, Kosuke Kawai, ScD, Paul K. Kleinman, MD
Costochondral junction fractures in suspected infant abuse show primary injury patterns on initial skeletal survey in 59% (most commonly bucket-handle pattern) and on 2-week follow-up in 6%; secondary healing patterns on initial survey in 89% (most commonly growth disturbance) and on 2-week follow-up in 80%.

DIAGNOSTIC ACCURACY OF QUANTITATIVE MULTI-CONTRAST 5-MINUTE KNEE MRI USING PROSPECTIVE ARTIFICIAL INTELLIGENCE IMAGE QUALITY ENHANCEMENT
Akshay S. Chaudhari, PhD, Murray J. Grissom, MD, Zhongman Fang, PhD, Bragi Sveinsson, PhD, Jin Hyung Lee, PhD, Garry E. Gold, MD, Brian A. Hargreaves, PhD, Kathryn J. Stevens, MD
A 5-minute quantitative double-echo steady-state (qDESS) sequence prospectively enhanced with deep learning had high agreement with conventional knee MRI findings and comparable accuracy as conventional knee MRI with respect to surgical findings. Automatic qDESS T2 relaxation time maps improve sensitivity for subtle cartilage lesions compared to conventional knee MRI.

MIXED-METHODS STUDY TO PREDICT UPSTAGING OF DCIS TO INVASIVE DISEASE ON MAMMOGRAPHY
Lars J. Grimm, MD, Benjamin Neely, MS, Rui Hou, MS, Vignesh Selvakumaran, BSE, Jay A. Baker, MD, Sora C. Yoon, MD, Sujata V. Ghate, MD, Ruth Walsh, MD, Tyler P. Litton, MD, Amrita Devalapalli, MD, Connie Kim, MD, Mary Scott Soo, MD, Terry Hyslop, PhD, E. Shelley Hwang, MD, MPH, Joseph Y. Lo, PhD
A mixed-methods two stage observer study demonstrated that radiologists can improve their ability to predict upstaging of DCIS to invasive disease. The performance of radiologists is currently superior to that achieved by deep learning and computer vision algorithms.

VESICLE IMAGING AND DATA REPORTING SYSTEM (VI-RADS): MULTI-INSTITUTIONAL MULTI-READER DIAGNOSTIC ACCURACY AND INTER-OBSERVER AGREEMENT STUDY
Yoshiko Ueno, MD, PhD, Tsutomo Tamada, MD, PhD, Mitsuru Takeuchi, MD, PhD, Keitaro Sofue, MD, PhD, Satoru Takahashi, MD, PhD, Yuki Kamishimi, MD, PhD, Yasuyo Urase, MD, Ayumu Kido, MD, PhD, Nobuyuki Hinata, MD, PhD, Kenichi Harada, MD, PhD, Masato Fujisawa, MD, PhD, Yoshiyuki Miyaji, MD, PhD, Takamichi Murakami, MD, PhD
Among seven radiologists with different levels of experience in bladder MRI interpretation, the Vesical Imaging-Reporting and Data System (VI-RADS) demonstrated moderate to substantial interobserver agreement (κ-value: 0.55-0.80) and a pooled AUC of 0.87 (range: 0.82-0.91) for diagnosing muscle-invasive bladder.

REAL WORLD LUNG CANCER CT SCREENING PERFORMANCE, SMOKING BEHAVIOR, AND ADHERENCE TO RECOMMENDATIONS: LUNG-RADS CATEGORY AND SMOKING STATUS PREDICT ADHERENCE
Eduardo Jose Mortani Barbosa, MD, Rochelle Yang, BA, Michelle Hershman, MD
Patient adherence to lung cancer screening recommendations is low (43.0%). However, adherence is higher in patients with an increased suspicion for lung cancer (i.e., a higher Lung-RADS category) and in former smokers.

DIAGNOSTIC ACCURACY OF 68Ga-PSMA PET/CT FOR INITIAL DETECTION IN PATIENTS WITH SUSPECTED PROSTATE CANCER: A SYSTEMATIC REVIEW AND META-ANALYSIS
Swayamjeet Satapathy, MBBS, Harmandeep Sing, MD, Rajender Kumar, MD, Bhagwant Rai Mittal, MD
68Ga-PSMA-PET/CT had high diagnostic accuracy for initial detection in patients with suspected prostate cancer and has potential application as a ‘rule-out’ test in this setting.

ADVANCED MUSCULOSKELETAL ULTRASOUND TECHNIQUES: WHAT ARE THE APPLICATIONS?
Marnix van Holsbeeck, MD, Steven Soliman, DO, Filip Van Kerkhove, MD, Joseph Craig, MD
This review covers technical advances in musculoskeletal ultrasound from the viewpoint of the user. The authors take a critical look at the recent literature to highlight progress and unsolved questions.

PREDICTORS OF ANESTHETIC EXPOSURE IN PEDIATRIC MRI
Fedel Machado-Rivas, MD, Ellen Leitman, MD, PhD, Camilo Jaimes, MD, John Conklin, MD, Paul A. Caruso, MD, Chang A. Liu, MD, Michael S. Gee, MD, PhD
A direct relationship between pediatric MRI scan time and dose of anesthetic exposure can be modeled using imaging and clinical variables.

PERCUTANEOUS MICROWAVE ABLATION OF STAGE T1A RENAL CELL CARCINOMA: INTERMEDIATE RESULTS ON SAFETY, TECHNICAL FEASIBILITY, AND CLINICAL OUTCOMES OF 119 TUMORS
Jianhai Guo, MD, Ronald S. Arellano, MD
CT-guided percutaneous microwave ablation is associated with high rates of technical success, excellent local progression-free survival and overall survival, and low complication rate for stage T1a renal cell carcinoma.

DIAGNOSTIC PERFORMANCE OF AMERICAN COLLEGE OF RADIOLOGY THYROID IMAGING REPORT AND DATA SYSTEM: A SYSTEMIC REVIEW AND META-ANALYSIS
Wei Li, MS, Yueming Wang, MS, Jing Wen, MS, Lanlan Zhang, MS, Yuan Sun, MS
When compared with ATA guidelines and Korean TI-RADS, ACR TIRADS could avoid a large number of unnecessary biopsies, with acceptable decline in sensitivity..