Listen in as our team of resident and fellow Podcast Editors critique articles and provide synthesized overviews of timely research from the “Yellow Journal” for in-training and practicing radiologists.
Association of Clear Cell Likelihood Score and Growth of Small Solid Renal Masses [critique of article by Rasmussen et al.]
Clear cell Likelihood Score (ccLS) is a non-invasive method to grade the likelihood of a small renal lesion being a clear cell renal cell carcinoma based on the MRI appearance. Hyunjoong William Kim, MD discusses a new AJR article in which the authors demonstrate a relationship between the ccLS and the rate of growth, as higher clear cell Likelihood Score is associated with faster growth rate of the renal lesion.
Learning Curve of CT-Guided Lung Biopsies [critique of article by Park et al.]
How many CT-guided lung biopsies should one perform before being considered competent? Knowing metrics for performance and how to measure performance may help set guidelines for training and clinical practice. Liwei Jiang, MD details a new study in which the authors seek to define the learning curve of CT-guided lung biopsies, looking at diagnostic accuracy and complication rates.
CT Findings of the Pancreas Before the Diagnosis of Pancreatic Ductal Adenocarcinoma [critique of article by Toshima et al.]
Lara Gabrielle L Lim discusses a new AJR study that focuses on CT changes of the pancreas before the diagnosis of pancreatic ductal adenocarcinoma. This involves six focal pancreatic abnormalities that when detected will aid in early disease detection, early disease management, and improved patient outcomes.
Analysis of 612 Benign Papillomas Diagnosed at Core Biopsy [critique of article by Lee et al.]
Xiaochen D. Liu, MD discusses a proposed selective surgery of benign papillomas that was discussed in a recent AJR article.
Water Soluble Contrast Challenge for Predicting Non-Operative Management of Small Bowel Obstuction [critique of article by Pickhardt et al.]
Jeffrey Guccione, MD discusses an article that examines the use of iohexol in a water-soluble contrast challenge for predicting non-operative management of small bowel obstruction. Technical success rates are also examined, and the real-world practicality discussed. Strengths and limitations are addressed as well, including the use of iohexol over gastrografin.
Added Value of MRI for Evaluation and Management of Placental Adhesion Disorder [critique of article by Stewart et al.]
In this podcast, Pei-Kang (Ken) Wei, MD and Cinthia Cruz-Romero, MD summarized the study by Stewart et al. and then provided a discussion regarding the limitation of this article as well as whether including MRI to the diagnostic algorithm for placental adhesion disorder may provide added benefit to clinical management.
Imaging Surveillance and Risk Factors for Development of Brain Metastases in Non-Small Cell Lung Cancer Patients [critique of article by Kim et al.]
In this podcast, Tyler Richards, MD discusses an observational retrospective study that looks at risk factors for patients with non-small cell lung cancer, which they found to be advanced clinical stage at diagnosis (stage III or IV) and EGFR mutation in patients with adenocarcinoma histology. They recommend that patients in these risk groups receive a surveillance brain MRI at 12 months.
Rectal Tube Insertion for Improving Prostate MR Image Quality [critique of article by Huang et al.]
David Ballard, MD discusses an AJR article in which the authors provide a practical practice consideration for optimizing prostate MR image quality. To reduce susceptibility from rectal gas, the authors had MR technologist place 18-French rectal tubes in patients undergoing prostate MR and compared them to patients without rectal tube placement.
The FEVER View for Elbow MRI in MLB Pitchers [critique of article by Lund et al.]
Drew Gunio, MD discusses a new AJR study assessing the impact of a flexed elbow valgus external rotation (FEVER) view on ulnotrochlear (UT) joint space measurement and reader evaluation of the UCL when incorporated into standard elbow MRI in throwing athletes.
Retrospective ECG-gated CT Angiography for Detecting Coronary Artery Involvement in Type A Aortic Dissection [critique of article by Ma et al.]
Kerem Ozturk, MD discusses a new AJR articles that includes retrospective ECG-Gated CTA findings which may help guide presurgical planning in Type A Aortic Dissection with sinus Valsalva involvement that impacts patient prognosis and surgical planning.
Can Differences in T1 Relaxivity Between Gadolinium-Based Contrast Agents be Taken Advantage of to Lower the Administered Dose of Gadolinium? [critique of article by Liu et al.]
Intracranial deposition of gadolinium after contrast-enhanced MRI is an emerging area of concern with much still to be learned. Kalen Riley, MD, MBA discusses a new article that proposes a dose-reduction strategy that takes advantage of relatively higher T1 relaxivity of one macrocyclic agent compared to another while still striving to maintain an adequate imaging examination.
Substantial Overlap of CT Findings of COVID-19, Influenza, and Organizing Pneumonia Limit Radiologists’ Diagnostic Accuracy [critique of article by Garrana et al.]
Characteristic CT findings of COVID-19 pneumonia have been extensively described, including the substantial overlap with findings of other infectious etiologies such as influenza. However, CT findings also have substantial overlap with those of non-infectious organizing pneumonia. Matthew Peterson, MD discusses a new AJR study sample with equal proportions of these infectious and non-infectious diagnoses, in which radiologists’ diagnostic accuracy was low.
Does Bosniak Version 2019 Optimize Diagnostic Performance for the Prediction of Malignant Cystic Renal Masses? [critique of article by Park et al.]
Giuseppe V. Toia, MD reviews a retrospective study which compares CT and MRI cystic renal mass characterization using the Bosniak 2019 and 2005 versions. This study concludes that version 2019 demonstrated decreased sensitivity, but increased specificity for detecting malignancy.
Peering into the Box; Can MRI identify tibial polyethylene post fractures pre-operatively? [critique of article by Sahr et al.]
David Robinson, MD discusses a short report study exploring the role of MRI in the diagnosis of tibial polyethylene post fractures in posterior stabilized total knee arthroplasties, including a comparison of conventional sequences versus metal artifact reduction sequences.
Ultrasound-Guided Omental Biopsy – Why Have We Been Missing Out? [critique of article by Perez et al.]
Michael Nellamattathil, DO discusses a new article that finds ultrasound-guided biopsy of omental disease suspected on CT is safe and effective for tissue diagnosis. Though omental disease commonly appears on ultrasound as diffuse infiltrative thickening without a discrete target, sampling based on pre-biopsy CT landmarks is diagnostic in the large majority of cases.
Meta-Analysis of the Noninvasive Colorectal Screening Tests [critique of article by Pickhardt et al.]
There has been a dearth of head to head comparison of the performance of the different noninvasive colorectal cancer screening tests. Alicia Chen, MD discusses a new study that has completed a valuable meta-analysis comparing the positive predictive value and detection rate of stool DNA, FIT, and CT colonography.
Adding Delayed Phase Images to Dual-Phase Contrast-Enhanced CT Increases Sensitivity for Small Pancreatic Ductal Adenocarcinoma [critique of article by Fukukura et al.]
Dual phase pancreatic CT has been the traditional work horse for evaluation of pancreatic masses. Ben Kipper, MD discusses a paper examining an additional “delayed” phase to enhance the sensitivity and detection of small pancreatic adenocarcinomas.
Acute Exacerbation of Interstitial Pneumonia after Lung Cancer Surgery: Challenges in Developing Imaging Criteria and Opportunities for Future Research [critique of article by Ozawa et al.]
Jordan Perchik, MD discusses a new study in which a team of radiologists attempt to detail imaging findings that can identify patients with interstitial lung disease who are at high risk of developing acute exacerbation after thoracic surgery. Several promising metrics are described however the close overlap between the statistically significant values leads to a broader discussion of statistical significance versus practical application.
Performance of MRI for Detection of Lateral Meniscus Posterior Root Injury in Children with Anterior Cruciate Ligament Tear [critique of article by Nguyen et al.]
Yoon-Jin Kim, MD discusses a study identifying imaging findings of lateral meniscus posterior root tear on pre-operative MRI in children. Imaging findings generally having a high specificity put low sensitivity with tears of the root proper having the best accuracy for identifying root tears when arthroscopy reports are used at the reference standard.
Axillary Adenopathy Following COVID-19 Vaccination in Breast Imaging [critique of article by Mortazavi]
Jeff Guccione, MD discusses an article has potential implications for future guidelines in how to manage axillary adenopathy following vaccination.
Post-Lumpectomy Surveillance Mammography: Diagnostic versus Screening? [critique of article by Nguyen et al.]
For patients who have undergone prior lumpectomy for localized breast cancer, no clear guidelines exist regarding use of diagnostic or screening mammography for post-lumpectomy imaging surveillance. Amber Liles, MD, MPH dives into a recently published article which seeks to answer this research question.
Evaluating the MRI characteristics and frequency of Displaced Flap Tears of the Triangular Fibrocartilage Complex [critique of article by Boutin et al.]
The triangular fibrocartilage complex is a structure which is often associated with ulnar sided wrist pain. Injuries to this structure can result in displaced tears which have a characteristic appearance. Shrey Patel, MD discusses a new AJR article that describes characteristic MRI findings and the frequency of this injury.
Y-90 Radioembolization for the Treatment of Metastatic Colorectal Cancer – Does Primary Tumor Location Prognosticate Survival? [critique of article by Wu et al.]
Giuseppe V. Toia, MD reviews a retrospective study exploring prognostic factors for patients with chemorefractory metastatic colorectal cancer treated with Y-90 radioembolization. The study emphasizes primary tumor location as a predictor of overall survival.
In-Bore Versus Fusion MRI-Targeted Prostate Biopsy of PI-RADS Category 4 or 5 Lesions: A Retrospective Comparative Analysis Using Propensity Score Weighting [critique of article by Prince et al.]
Shrav Sridhar MD, discusses a retrospective study in which target-specific prostate cancer detection rate in a cohort of patients who underwent in-bore MRI biopsy was compared to the rate in a cohort of patients who underwent ultrasound-MRI fusion-guided biopsy.
In-Gantry MRI-Guided Prostate Biopsy: Finding a Sweet Spot in Lesion Sampling [critique of article by Seyfried et al.]
Frederic J. Bertino, MD discusses a recent AJR article that investigates how to optimize the cores samples for in-gantry prostate MRI biopsy. It is suggested by this retrospective study that three cores from the dominant lesion achieves the “sweet spot” in balancing significant cancer detection and reducing anesthesia and procedure time. Study limitations and future directions are discussed.
Can We Reliably Utilize Ultrasound to Evaluate Fatty Liver? [critique of article by D'Hondt et al.]
Pei-Kang Wei, MD and Cinthia Cruz-Romero, MD discuss the importance of ultrasound as a reliable and affordable method to evaluate fatty liver in various patient populations—children and adult.
Should Thyroid Nodule Location Factor into TI-RADS Scoring? [critique of article by Jasim et al.]
Kalen Riley, MD discusses an article in which the authors believe TI-RADS should be accounting for nodule location and that a revision to the scoring system should be considered.
Incidental Infectious and Inflammatory Findings on Lung Cancer Screening CT: Significance and Outcomes [critique of article by Mendoza et al.]
Kerem Ozturk, MD discusses how adoption of a conservative management algorithm can standardize recommendations and reduce unnecessary imaging without increasing the risk of missing a malignancy.
Conventional vs. Drug Eluting Bead TACE - The Debate Continues [critique of article by Zhang et al.]
David Ballard, MD discusses an important contribution to the literature in assessing the ongoing debate of conventional vs. drug eluting bead transarterial chemoembolization.
The Potential of a Patient Symptom Questionnaire and its Potential Role in Improving Diagnostic Specificity of Pain Generators for Lumbar Spine MRI [critique of article by Balza et al.]
Identifying primary pain generators with lumbar spine MRI can be a challenging task. Adequate patient symptom information is often lacking and its absence may lead radiologists astray in their own interpretations. Drew Guino, MD discusses the development of a patient symptom questionnaire that appears to address this very issue.
18F-Fluciclovine PET/MRI: Too Little, Too Late? [critique of article by Galgano et al.]
David Robinson, MD discusses an AJR pilot study exploring 18F-Fluciclovine PET/MRI for initial staging of prostate cancer and the effects of androgen deprivation therapy on 18F-Fluciclovine uptake.
Normal Range MRI-derived Left Ventricular Global Strain – Is It Ready for Primetime? [critique of article by Smith et al.]
Giuseppe V. Toia, MD reviews a timely meta-analysis which defines the normal reference ranges for MRI-derived left ventricular strain in healthy adults.
Chest CT Findings of Immune Checkpoint Inhibitor Therapy-Related Adverse Events [critique of article by Smith et al.]
Kerem Ozturk, MD discusses why awareness of early chest CT findings is required for early detection and accurate diagnosis of immune checkpoint inhibitor therapy-related adverse events such as pneumonitis, new consolidation, worsening thoracic tumor burden, pleural/pericardial effusion, and pulmonary emboli in the emergency department.
Chest CT Findings of Immune Checkpoint Inhibitor Therapy-Related Adverse Events [critique of article by Ozturk et al.]
Tyler Richards, MD discusses an AJR article that found no significant increase in the intrinsic T1 signal in the globus pallidus and dentate nucleus after more than 10 administrations of gadobutrol in pediatric patients compared to matched-age gadolinium naïve control and discussion of similar imaging based and autopsy studies.
Chest Radiograph as Predictor and Clinical Guide for Management of Patients with COVID-19: Current Studies and Future Direction [critique of article by Reeves et al.]
In this podcast, Pei-Kang (Ken) Wei, MD and Diana Litmanovich, MD first summarized the study by Reeves et al. and then provided an in-depth discussion about the current status and future direction of utilizing chest radiograph as a guiding tool for clinical management. Key aspects of the discussion are the practicality and applicability of the scoring system developed by Reeves et al., chest radiograph as a more desirable modality for evaluating patients with COVID-19 compared to CT, and chest radiograph as an outcome predictor.
Findings of COVID-related Disseminated Leukoencephalopathy [critique of article by Freeman et al.]
While the primary manifestations of COVID-19 are respiratory in nature—it has become clear as we take care of patients and learn more that COVID can have an effect on the nervous system. On this podcast, Edgar Perez, MD discusses MRI findings of COVID related-Disseminated Leukoencephalaopathy, which should remain an important differential consideration in COVID patients with neurologic manifestations.
Radiofrequency Tag Localization Is a Feasible Alternative to Wire Localization of Breast Lesions [critique of article by Lamb et al.]
Wire localization has long been the standard of care for localization of non-palpable breast lesions. Additional wireless localization options exist, including use of radioactive seeds, magnetic markers, radar/infrared reflectors, or most recently a radiofrequency identification tags, which address some of the disadvantages involved in wire localization. Matthew Petterson, MD discusses results an AJR study of one year of use at a single institution that suggests that RF tag localization is a feasible alternative to wire localization.
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 [critique of article by Smith et al.]
Patients with borderline resectable and locally advanced pancreatic cancer receiving neoadjuvant therapy can have results comparable to patients with resectable tumor at presentation, however some patients have early recurrence after neoadjuvant therapy and resection. Jordan Perchik, MD discusses a new AJR study in which a team of radiologists evaluate multiple imaging parameters and tumor metrics to assess for characteristics to predict pathologic response prior to resection.
Use of Enteric Contrast for Abdominopelvic CT in Penetrating Traumatic Injury in Adults [critique of article by Alabousi et al.]
Michael Nellamattathil, DO discusses whether or not enteric contrast is necessary in the setting of penetrating traumatic injury in light of a recent AJR article on the subject.
Thermal Ablation versus stereotactic body radiation therapy following trans-arterial chemoembolization – A comparison of outcomes [critique of article by Nabavizadeh et al.]
Percutaneous interventions are the mainstay for patients with non-operative HCC. This podcast by Ben Kipper, MD examines a paper comparing outcomes between thermal ablation and stereotactic body radiation therapy following transarterial chemoembolization and how those outcomes might affect clinical treatment plans going forward.
Malignant Outcomes of Architectural Distortion [critique of article by Choudhery et al.]
Architectural distortion is a subtle but suspicious finding increasingly detected using digital breast tomosynthesis. Alicia Chen, MD discusses a timely meta-analysis by Dr. Choudhery and colleagues that found the pooled positive predictive value for AD without a known cause on DBT is 35%, the great majority of which represents invasive disease. This finding warrants tissue sampling.
Ultrasound guided percutaneous biopsy of small pleural lesions [critique of article by Park et al.]
In this episode, Yoon-Jin Kim, MD discusses a study evaluating the diagnostic yield of ultrasound guided percutaneous biopsy of small pleural lesions. Important findings include that the technique is safe and fairly high yield for lesions 20 mm or less and that features such as nodular.
Evaluating PI-RADS 3 atypical BPH nodules using v2.1. [critique of article by Costa et al.]
Jeff Guccione, MD discusses a new article comparing atypical BPH prostatic nodules in the problematic prostate transition zone to traditional PI-RADS 3 lesions using PI-RADS version 2.1. All nodules contain pathologic confirmation from biopsy.
Prediction of Stroke Recurrence: A Comparison of Transthoracic Echocardiography, Cardiac CTA, and Cardiac MRI in Patients with Suspected Cardioembolic Stroke [critique of article by Apfaltrer et al.]
Transthoracic echocardiography (TTE) is the standard of care in cardiac imaging for patients with suspected cardioembolic stroke. In this podcast, Amber Liles, MD discusses how cardiac MRI and cardiac CT angiography perform in comparison to TTE in terms of prediction of stroke recurrence.
Can an unconventional diffusion weighted technique aid in the MRI management of sacroiliitis? [critique of article by Zhang et al.]
Shrey Patel, MD discusses a new AJR article on whether using an unconventional DWI technique, readout-segmented echo-planar imaging, can improve image quality and differentiate disease activity in patients with axial spondyloarthritis.
CT and MR perform similarly using Bosniak v2019 for cystic renal masses [critique of article by Tse et al.]
In this episode, David Ballard, MD summarizes Bosniak v2019 and Tse et al.’s imaging cohort with this study of radiologists applying Bosniak v2019.
Liver steatosis categorization on contrast-enhanced CT using a fully-automated deep learning volumetric segmentation tool: Evaluation in 1,204 healthy adults using unenhanced CT as the reference standard [critique of article by Pickhardt et al.]
Shrav Sridhar, MD discusses a retrospective study in which automated volumetric segmentation-assisted hepatic parenchymal attenuation measurement was performed on contrast-enhanced and unenhanced abdominal CT scans of a cohort of healthy adults to investigate the possibility of stratifying liver fat content on contrast-enhanced CT.
Increasing Specificity of Recommendations for Renal Incidentalomas [critique of article by Corwin et al.]
Incidentally detected renal masses are common, and can require follow-up. Recommendations from the 2017 ACR white paper on incidental renal masses suggest that small homogeneous masses measuring less than 20 Hounsfield units are probably benign, and do not require further characterization. However, new evidence from a multi-institutional study in AJR suggests that this cutoff should be raised to at least 30 Hounsfield units. In this episode, Matthew Petterson, MD discusses the new evidence.
Treating Sinistral Portal Hypertension: Stenting or Embolization? A first-of-its-kind study. [critique of article by Wei et al.]
Frederic J. Bertino, MD reviews a new AJR study in which the authors attempt to compare the clinical efficacy and technical feasibility of Splenic vein stenting and splenic artery embolization (the current standard) for the treatment of SPH.
A New Medial Meniscal Extrusion Threshold Relating Clinical Symptoms and MRI Findings [critique of article by Liu et al.]
The addition of clinical information and verified cartilage damage progression on MRI may represent a new standard in determining progression of knee osteoarthritis. Drew Gunio, MD, MS discusses a new AJR article on why 2.5 mm may now be the new number to consider when reporting medial meniscal extrusion.
Altar of the Hounsfield Unit [critique of article by Azar et al.]
Can HU reliably differentiate any benign sclerotic bone lesion (not just bone islands) from sclerotic metastases? David Robinson, MD explores the topic through the lens of a new AJR article on the subject.
Improving radiologist performance in detection of microinvasive disease on mammography [critique of article by Grimm et al.]
Jordan Perchik, MD discusses a new AJR study in which a team of breast imaging radiologists determine if case review and a targeted educational session can improve detection of microinvasive disease on mammography. The authors describe patterns key to upstaging DCIS and address the difficulty and limitations of detecting microinvasive disease.
Predictors of Anesthetic Exposure in Pediatric MRI [critique of article by Zhou et al.]
In this podcast, Edgar Perez, MD reviews new AJR data on how ablation fares in the morbidly obese demographic. Additionally, this podcast may help facilitate discussions about expectations, safety, efficacy, and complications during consultations with morbidly obese patients.
A Look at Thermal Ablation of RCC in the Morbidly Obese [critique of article by Machado-Rivas et al.]
Michael Nellamattathil, MD analyzes and reviews a recent AJR article on the various factors contributing to anesthesia time and exposure in pediatric patients undergoing MRI examinations and what can be done to improve these measures.
Comparing Chest CT findings in Coronavirus and Influenza Pneumonias [critique of article by Lin et al.]
Jeffrey Guccione, MD highlights the keys points of a new AJR article, which retrospectively compares the imaging features on CT of coronavirus pneumonia and influenza. The importance of this research is put into the broader context of the evolving COVID-19 pandemic, including the possibility for concurrent outbreaks of SARS-CoV-2 and influenza. The strengths and weaknesses are outlined along with some future avenues for investigation.
Stroke and COVID-19: A New Association [critique of article by Kihira et al.]
COVID-19 has been shown to affect a variety of organ systems. In this podcast, Ben Kipper, MD examines the association between stroke subtypes and COVID-19 as well as the effect that association may have on clinicians and radiologists.
Lung US Findings in Coronavirus Disease-19 (COVID-19) Patients [critique of article by Zhang et al.]
On this episode, Alicia Chen, MD takes a closer look at a very timely new AJR article titled, “Lung US Findings in Coronavirus Disease-19 (COVID-19) Patients” by Yao Zhang and colleagues from Beijing Ditan Hospital and Peking University Third Hospital. Compared to CT, ultrasound is portable, less costly, and does not use radiation. These characteristics suggest ultrasound could be particularly useful tool for triage, particularly in the pre-hospital/outpatient setting, and severity stratification and monitoring, particularly of critically ill patients who may be challenging to transport and require careful ventilation management. This study demonstrates that lung ultrasound has a high sensitivity for COVID-19 pneumonia in moderate and severe disease and that sonographic findings can suggest infection length and severity. Ultrasound is a promising adjunct modality for COVID-19 management.
Factors Associated with Background Parenchymal Enhancement on Contrast Enhanced Mammography [critique of article by Karimi et al.]
In this episode, Yoon-Jin Kim, MD, discusses a study evaluating factors associated with background parenchymal enhancement (BPE) on contrast-enhanced mammography. The findings are important as BPE impacts study interpretation and high BPE may be an independent breast cancer risk factor. The study findings are valuable for physicians currently interpreting this emerging breast imaging modality and those considering integrating it into their own clinical practice.
Opportunistic Screening for Metabolic Syndrome in Asymptomatic Adults Utilizing Fully Automated Abdominal CT-based Biomarkers
Metabolic syndrome is typically thought of as a clinical disease. In this podcast, Shrey Patel explores reevaluating the role of imaging in identifying and potentially diagnosing patients at risk for metabolic syndrome by using CT biomarkers.
Whole-Body Bone Scintigraphy Helps to Detect Kidney Diseases
Shravan Sridhar, MD, MS discusses his study in AJR that provides a retrospective review of patients with abnormal renal uptake Technicium 99m MDP bone scans in which the causes of abnormal renal uptake, imaging follow up, and interventions are assessed. The study identifies several different conditions responsible for abnormal uptake, ranging in levels of clinical significance and degree of actionability. This study underscores the importance of careful assessment of the kidneys on whole body bone scan.
ACR TI-RADS: What Are We Missing?
Compared to other guidelines, ACR TI-RADS results in a decreased number of thyroid nodules which are either followed or given a recommendation of fine needle aspiration (FNA). Find out on this podcast hosted by Amber Liles, MD, MPH, what thyroid malignancies are missed and why and how changes in size thresholds might affect ACR TI-RADS performance and outcomes.