Sex Differences In Body Fat Composition Predictive of Cardiometabolic Risk Profile

MedicalResearch.com Interview with:

Miriam Bredella, MD Associate Professor of Radiology, Harvard Medical School Department of Radiology Massachusetts General Hospital Boston, MA 02114

Dr. Bredella

Miriam Bredella, MD
Associate Professor of Radiology
Harvard Medical School
Department of Radiology
Massachusetts General Hospital
Boston, MA 02114

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: It is well known that body composition differs between men and women, with women having proportionally more fat and men more muscle mass.

But not the amount of fat but its distribution is an important determinant of cardiometabolic risk, with certain ectopic fat depots, such as visceral adipose tissue, fat within muscle cells – intramyocellular (IMCL), and liver fat, being more detrimental than others, such as femorogluteal subcutaneous adipose tissue.

We therefore wanted to study sex differences in body composition and cardiometabolic risk in men and women with obesity.

We found that at the same BMI, men had relatively higher visceral adipose tissue, IMCL, liver fat, muscle and lean mass, while women higher percent fat mass and higher subcutaneous adipose tissue. This female anthropometric phenotype was associated with a better cardiometabolic risk profile at similar BMI compared to men. However, ectopic fat depots were more strongly associated with adverse cardiometabolic risk factors in women compared to men

Continue reading

Thunderclap Headache: Ottawa Rule To Exclude Subarachnoid Bleeding

MedicalResearch.com Interview with:

Jeff Perry, MD, MSc, CCFP-EM Professor, Department of Emergency Medicine Senior Scientist, Ottawa Hospital Research Institute Research Chair in Emergency Neurological Research, University of Ottawa Emergency Physician and Epidemiology Program The Ottawa Hospital Ottawa, Ontario

Dr. Perry

Jeff Perry, MD, MSc, CCFP-EM
Professor, Department of Emergency Medicine
Senior Scientist, Ottawa Hospital Research Institute
Research Chair in Emergency Neurological Research, University of Ottawa
Emergency Physician and Epidemiology Program
The Ottawa Hospital
Ottawa, Ontario

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Headache accounts for about 1-2% of all emergency department visits.  One of the most feared diagnosis within these patients is subarachnoid hemorrhage. While investigations are clearly warranted for patients with a diminished level of consciousness or new focal neurological deficits, approximately 50% of patients with subarachnoid hemorrhage (SAH) have no focal or global neurological findings. Deciding whether to image headache patients with no deficits is difficult, especially since timely diagnosis and treatment results in substantially better outcomes.

The desire to never miss a subarachnoid hemorrhage, however, contributes to escalating neuroimaging rates and a dogmatic adherence to lumbar puncture, even if the scan is negative, despite the very high sensitivity of computed tomography. However, a recent population-based study suggested that over 5% of confirmed subarachnoid hemorrhages were missed at initial presentation, especially in smaller hospitals. Therefore, identifying which headache patients require investigations to rule-out SAH is of great importance.

We have previously derived (N=1,999) and refined (N=2,131) the Ottawa SAH Rule. In this study, we conducted an multicenter prospective cohort study at six tertiary care hospitals, and found that the Ottawa SAH Rule performed well, with an 100% sensitivity, and specificity of 13.6%.

Continue reading

FDG-PET Scans of Lung Nodules Should Be Interpreted With Caution

MedicalResearch.com Interview with:

PET Scan Vanderbilt Health

PET Scan Vanderbilt Health

Amelia W. Maiga, MD MPH
Vanderbilt General Surgery Resident
VA Quality Scholar, TVHS

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Positron emission tomography (PET) combined with fludeoxyglucose F18 (FDG) is currently recommended for the noninvasive diagnosis of lung nodules suspicious for lung cancer. Our investigation adds to growing evidence that FDG-PET scans should be interpreted with caution in the diagnosis of lung cancer. Misdiagnosis of lung lesions driven by FDG-PET avidity can lead to unnecessary tests and surgeries for patients, along with potentially additional complications and mortality.

To estimate FDG-PET diagnostic accuracy, we conducted a multi-center retrospective cohort study. The seven cohorts originating from Tennessee, Arizona, Massachusetts and Virginia together comprised 1188 nodules, 81 percent of which were malignant. Smaller nodules were missed by FDG-PET imaging. Surprisingly, negative PET scans were also not reliable indicators of the absence of disease, especially in patients with smaller nodules or who are known to have a high probability of lung cancer prior to the FDG-PET test.

Our study supports a previous meta-analyses that found FDG-PET to be less reliable in regions of the country where fungal lung diseases are endemic. The most common fungal lung diseases in the United States are histoplasmosis, coccidioidomycosis and blastomycosis. All three fungi reside in soils. Histoplasmosis and blastomycosis are common across much of the Mississippi, Ohio and Missouri river valleys and coccidioidomycosis is prevalent in the southwestern U.S. These infections generate inflamed nodules in the lungs (granulomas), which can be mistaken for cancerous lesions by imaging.

Continue reading

Machine Learning Applied To Predicting High-Risk Breast Lesions May Reduce Unnecessary Surgeries

MedicalResearch.com Interview with:

Manisha Bahl, MD, MPH Director, Breast Imaging Fellowship Program, Massachusetts General Hospital Assistant Professor of Radiology, Harvard Medical School

Dr. Bahl

Manisha Bahl, MD, MPH
Director, Breast Imaging Fellowship Program,
Massachusetts General Hospital
Assistant Professor of Radiology,
Harvard Medical School

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Image-guided biopsies that we perform based on suspicious findings on mammography can yield one of three pathology results: cancer, high-risk, or benign. Most high-risk breast lesions are noncancerous, but surgical excision is typically recommended because some high-risk lesions can be upgraded to cancer at surgery. Currently, there are no imaging or other features that reliably allow us to distinguish between high-risk lesions that warrant surgery from those that can be safely followed, which has led to unnecessary surgery of high-risk lesions that are not associated with cancer.

We decided to apply machine learning algorithms to help us with this challenging clinical scenario: to distinguish between high-risk lesions that warrant surgery from those that can be safely followed. Machine learning allows us to incorporate the full spectrum of diverse and complex data that we have available, such as patient risk factors and imaging features, in order to predict which high-risk lesions are likely to be upgraded to cancer and, ultimately, to help our patients make more informed decisions about surgery versus surveillance.

We developed the machine learning model with almost 700 high-risk lesions, then tested it with more than 300 high-risk lesions. Instead of surgical excision of all high-risk lesions, if those categorized with the model to be at low risk for upgrade were surveilled and the remainder were excised, then 97.4% malignancies would have been diagnosed at surgery, and 30.6% of surgeries of benign lesions could have been avoided.

Continue reading

Novel Brain Imaging May Detect Preclinical Alzheimer’s Disease

MedicalResearch.com Interview with:
Dr. Sanja Josef Golubic, dr. sc

Department of Physics, Faculty of Science
University of Zagreb, Croatia

MedicalResearch.com: What is the background for this study?

Response: Our study was aimed to search the topological biomarker of Alzheimer’s disease. A recent evidences suggest that the decades long progression of brain degeneration that is irreversible by the stage of symptomatic Alzheimer’s disease, may account for failures to develop successful disease-modifying therapies. Currently, there is a pressing worldwide search for a marker of very early, possibly reversible, pathological changes related to Alzheimer’s disease in still cognitively intact individuals, that could provide a critical opportunity for evolving of efficient therapeutic interventions.

Three years ago we reported the discovery of the novel, fast brain pathway specialized for rapid processing of the simple tones. We named it gating loop. Gating loop directly links auditory brain areas to prefrontal brain area. We have also noticed the high sensitivity of the gating loop processing on AD pathology. It was inspiration to focus our Alzheimer’s disease biomarker search in the direction of prefrontal brain activation during listening of simple tones.

Continue reading

Brain Imaging Patterns Moving Closer To Identifying Schizophrenia on Functional MRI

MedicalResearch.com Interview with:

Irina Rish PhD IBM T.J. Watson Research Center Yorktown Heights, NY 10598

Dr. Rish

Irina Rish PhD
IBM T.J. Watson Research Center
Yorktown Heights, NY 10598 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Schizophrenia is a chronic and severe psychiatric disorder that affects roughly about 1% of population. Although it is not as common as other mental disorders, such as depression, anxiety, and attention deficit disorder (ADD), and so on, schizophrenia  is perhaps one of  the most debilitating psychiatric disorders,  preventing people from normal  functioning in daily life. It is characterized primarily by a range of psychotic symptoms, including hallucinations (false auditory, visual or tactile perceptions detached from reality), as well as delusions, disorganized thoughts, speech and behavior, and multiple other symptoms including difficulty showing (and recognizing) emotions, poor executive functioning, inattentiveness, problems with working memory,  and so one. Overall, schizophrenia has a devastating impact not only on patients and their families, but on the economy, as it was estimated to cost the US about 2% off  gross national product in treatment costs, missed work, etc.
Thus, taking steps towards better understanding of the disease can potentially lead to more accurate early diagnosis and better treatments.

In this work, the objective was to identify “statistical biomarkers’ of schizophrenia from brain imaging data (specifically, functional MRI), i.e. brain activity patterns that would be capable of accurately discriminating between schizophrenic patients and controls, and reproducible (stable) across multiple datasets. The focus on both predictive accuracy (generalization to previously unseen subjects) as well as on stability (reproducibility) across multiple datsets differentiates our work from majority of similar studies in neuroimaging field that tend to focus only on statistically significant differences between such patterns on a fixed dataset, and may not reliably generalize to new data.

Our prior work on neuroimaging-based analysis of schizoprenia http://journals.plos.org/plosone/article/related?id=10.1371/journal.pone.0050625, as well as other research in the field, suggest that disrupted functional connectivity can be a much more informative source of discriminative patterns than local changes in brain activations, since schizophrenia is well known to be a “network disease”, rather than a localized one.

Continue reading

MRI Biomarkers Track Cognitive Impairment Due to Head Trauma

MedicalResearch.com Interview with:

Virendra Mishra, Ph.D. Department of Imaging Research Cleveland Clinic Lou Ruvo Center for Brain Health in Las Vegas

Dr. Virendra Mishra

Virendra Mishra, Ph.D.
Department of Imaging Research
Cleveland Clinic Lou Ruvo Center for Brain Health in Las Vegas

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Repetitive head trauma has been shown to be a risk factor for various neurodegenerative disorders, mood swings, depression and chronic traumatic encephalopathy. There has been a significant amount of research into identifying an imaging biomarker of mild traumatic brain injury (mTBI) due to repetitive head trauma. Unfortunately, most of the biomarkers have not been able to find a successful translation to clinics. Additionally, the quest for the mTBI imaging biomarker especially using Magnetic Resonance Imaging (MRI) techniques has been done by looking at either the gray matter (T1-weighted) or the white matter (Diffusion Tensor Imaging) independently; and both have shown changes that are associated with repetitive head trauma.

Hence in this study, we wanted to investigate if combining gray matter and white matter information enables us to better predict the fighters who are more vulnerable to cognitive decline due to repetitive head trauma. Our method found seven imaging biomarkers that when combined together in a multivariate sense were able to predict with greater than 73% accuracy those fighters who are vulnerable to cognitive decline both at baseline and follow-up. The imaging biomarkers were indeed a combination of gray and white matter measures of regions reported previously in the literature. A key point in our study was we found the regions predicting cognitive decline without enforcing any assumptions on the regions previously reported.

Continue reading

Photodynamic Therapy Being Developed To Target Prostate Cancer

MedicalResearch.com Interview with:
Dr. Susanne Lütje
Ärztlicher Dienst
Universitätsklinikum Essen (AöR)
Klinik für Nuklearmedizin
Essen Germany

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Prostate cancer (PCa) is the most common cancer in men and accounts for a significant amount of morbidity and mortality. At present, the curative treatment option of choice for localized stages of PCa is radical prostatectomy, which may include extended lymph node dissection. Unfortunately, surgical procedures can be accompanied by complications such as urinary incontinence. Most importantly, small tumor deposits may not be seen by the surgeon during surgery and could ultimately lead to disease recurrence. To overcome these issues, new and innovative treatments are needed. The prostate-specific membrane antigen (PSMA) is a surface protein that is overexpressed in prostate cancer and can be used as a target to guide new therapies.

Photodynamic therapy (PDT) is an ablative procedure in which tumor cells can be destroyed effectively by irradiation of light of a specific wavelength, which activates previously administered photosensitizers. The photosensitizers can respond by emitting fluorescence or emitting oxygen radicals which can cause cellular damage. Coupling the photosensitizer to an agent that targets PSMA on the tumor surface offers the possibility to selectively and effectively destroy prostate tumor remnants and micrometastases, while surrounding healthy tissues remain unaffected.

In our study, the PSMA targeting antibody D2B was coupled to the photosensitizer IRDye700DX and radiolabeled with 111In. In a mouse model, this multi-modality agent was used to preoperatively visualize tumor lesions with SPECT/CT to allow rough localization of the tumors. During surgery, the fluorescent signal originating from the photosensitizer facilitates visualization of tumors and residual tumor tissue, so the surgeon can be guided towards accurate resection of the entire tumors and metastases. In addition, the PSMA-targeted PDT can be applied to destroy small tumor deposits in cases where close proximity of the tumors.

Continue reading

MRI At Six Months Can Predict Which High Risk Babies Will Develop Autism

MedicalResearch.com Interview with:

Joseph Piven, MD The Thomas E. Castelloe Distinguished Professor of Psychiatry UNC School of Medicine Director of the Carolina Institute for Developmental Disabilities Co-senior author of the study

Dr. Piven

Joseph Piven, MD
The Thomas E. Castelloe Distinguished Professor of Psychiatry
UNC School of Medicine
Director of the Carolina Institute for Developmental Disabilities
Co-senior author of the study

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Babies with older siblings with autism are at an increased risk (20%) of getting autism over the general population (1%).  Infants who later are diagnosed with autism don’t have any of the stigmata of autism in the first year of life. The symptoms of autism unfold in the first and particularly in the second year of life and beyond.

We have evidence to support the idea that behavioral symptoms of autism arise from changes in the brain that occur very early in life. So we have employed MRI and computer analyses to study those early brain changes and abnormalities in infancy to see if early brain changes at 6 months of age can predict whether babies at high-risk of developing autism will indeed develop the condition at age two.

For this particular study, we used data from MRIs of six-month olds to show the pattern of synchronization or connection across brain regions throughout the brain and then predict which babies at high familial risk of developing autism would be most likely to be diagnosed with the condition at age two.

Continue reading

Diagnostic Accuracy of FFR-CT Varies Across Spectrum of Coronary Artery Disease

MedicalResearch.com Interview with:
Dr Christopher Michael Cook MBBS Bsc(Hons) MRCP

MRC Clinical Research Fellow
NHLI, Cardiovascular Medicine, Imperial College London 

MedicalResearch.com: What is the background for this study?

Response: FFR-CT is a novel non-invasive technique for estimating the functional significance of a coronary stenosis from CT coronary angiography images. A number of meta-analyses already exist for determining the diagnostic accuracy of FFR-CT (compared to invasive FFR as the reference standard). However, although knowing the overall diagnostic accuracy of FFR-CT is reassuring, in clinical practice a clinician knows not only whether the FFR-CT is positive or negative, but also its actual value. The purpose of this study was to provide clinicians a means of interpreting the diagnostic accuracy of any individual FFR-CT result that may be received in clinical practice.

MedicalResearch.com: What are the main findings?

Response: The main finding of this study is that the diagnostic accuracy of FFR-CT varies markedly across the spectrum of disease. For vessels with FFR-CT above 0.90, 98% met the invasive FFR guideline criterion for deferral. At the other end of the spectrum, for vessels with FFR-CT below 0.60, 86% met the invasive FFR guideline criterion for stenting. However, in between, FFR-CT gives less certainty as to whether the invasive FFR will meet the stenting criterion or not.

MedicalResearch.com: What should readers take away from your report?

Response: Readers can combine the findings of our study with patient specific factors in order to judge when the cost and risk of an invasive angiogram may safely be avoided. Because we now have a more complete picture of what different levels of FFR-CT mean in terms of invasive FFR, it is apparent that a single cut-off value for FFR-CT in deciding on invasive coronary angiography need not always apply. For example, in the asymptomatic patient, further investigations may not be desirable even if an FFR-CT still left a substantial possibility of a positive invasive FFR. Conversely, in the symptomatic patient, the patient and clinician would likely pursue invasive angiography unless the possibility of a positive FFR is very remote.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Response: This study adopted novel methodology to ascertain the probability that both FFR-CT and invasive FFR agreed on the functional classification of a stenosis, for any given individual FFR-CT value. This type of analysis could be used to determine if further iterative versions of the FFR-CT software translate into improved diagnostic performance, particularly in more intermediate disease severities. 

MedicalResearch.com: Is there anything else you would like to add?

Response:

MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.

Citation:

Cook CM, Petraco R, Shun-Shin MJ, Ahmad Y, Nijjer S, Al-Lamee R, Kikuta Y, Shiono Y, Mayet J, Francis DP, Sen S, Davies JE. Diagnostic Accuracy of Computed Tomography–Derived Fractional Flow Reserve A Systematic Review . JAMA Cardiol. Published online May 24, 2017. doi:10.1001/jamacardio.2017.1314

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

More Medical Research Interviews on MedicalResearch.com

 

 

MRI Guided Prostate Biopsies Can Improve Care and Reduce Costs

MedicalResearch.com Interview with:

Vikas Gulani, MD, PhD Director, MRI, UH Cleveland Medical Center Associate Professor, Radiology, CWRU School of Medicine

Dr. Gulani

Vikas Gulani, MD, PhD
Director, MRI, UH Cleveland Medical Center
Associate Professor, Radiology, CWRU School of Medicine

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: We wanted to learn if performing MR before prostate biopsy, followed by MR guided strategies for biopsy, are cost effective for the diagnosis of prostate cancer in men who have not previously undergone a biopsy and who have a suspicion of prostate cancer.

The most significant findings are as follows:

We found that all three MR guided strategies for lesion targeting (cognitive targeting, MR-ultrasound fusion targeting, and in-gantry targeting) are cost effective, as the increase in net health benefits as measured by addition of quality adjusted life years (QALY), outweigh the additional costs according to commonly accepted willingness to pay thresholds in the United States.

Cognitive targeting was the most cost effective. In-gantry biopsy added the most health benefit, and this additional benefit was cost-effective as well.

Continue reading

No Magic Age To Stop Performing Screening Mammograms

MedicalResearch.com Interview with:
Cindy S. Lee, MD

Department of Radiology and Biomedical Imaging
University of California, San Francisco, San Francisco
Now with Department of Radiology
NYU Langone Medical Center, Garden City, New York

MedicalResearch.com: What led you and colleagues to conduct this study?

Response: I am a breast imager. I see patients who come in for their screening mammograms and I get asked, a lot, if patients aged 75 years and older should continue screening, because of their age. There is not enough evidence out there to determine how breast cancer screening benefits women older than 75. In fact, all previously randomized trials of screening mammography excluded people older than 75 years.

Unfortunately, age is the biggest risk factor for breast cancer, so as patients get older, they have higher risks of developing breast cancer. It is therefore important to know how well screening mammography works in these patients.

Continue reading

Cardiac Magnetic Resonance Can Exclude Clinically Relevant Coronary Artery Disease

MedicalResearch.com Interview with:

Pr. Juerg Schwitter MD Médecin Chef Cardiologie Directeur du Centre de la RM Cardiaque du CHUV Centre Hospitalier Universitaire Vaudois - CHUV Suisse

Pr. Schwitter

Pr. Juerg Schwitter MD
Médecin Chef Cardiologie
Directeur du Centre de la RM Cardiaque du CHUV
Centre Hospitalier Universitaire Vaudois – CHUV
Suisse 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Coronary artery disease (CAD) is still one of the leading causes of death in the industrialized world and as such, it is also an important cost driver in the health care systems of most countries. For the European Union, the estimated costs for CAD management were 60 billion Euros in 2009, of which approximately 20 billion Euros were attributed to direct health care costs (1). In 2015, the total costs of CAD management in the United States were estimated to be 47 billion dollars (2).

Substantial progress has been achieved regarding the treatment of CAD including drug treatment but also revascularizations procedures. There exists a large body of evidence demonstrating myocardial ischemia as one of the most important factors determining the patient’s prognosis and reduction of ischemia has been shown to improve outcome.

On the other hand, techniques to detect CAD, i.e. relevant myocardial ischemia, were insufficient in the past. Evaluation of myocardial perfusion by first-pass perfusion cardiac magnetic resonance (CMR) is now closing this gap (3) and CMR is recommended by most international guidelines for the work-up of known or suspected CAD (4,5).

Still, a major issue was not clarified until now, i.e. “how much ischemia is required to trigger revascularization procedures”. Thus, this large study was undertaken to assess at which level of ischemia burden, patients can be safely deferred from revascularization and can be managed by risk factor treatment only. Of note, this crucial question was addressed in both, patients with suspected CAD but also in patients with known (and sometimes already advanced) CAD, thereby answering this question in the setting of daily clinical practice.

Continue reading

Doctors Continue To Order Mammograms Outside of Current Age Guidelines

MedicalResearch.com Interview with:
Archana Radhakrishnan MD MHS
Division of General Internal Medicine
Johns Hopkins University
Baltimore, Maryland

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: We were interested in understanding the current practice trends in breast cancer screening recommendations by doctors in light of the guideline changes.  We performed a national survey of primary care providers and gynecologists asking about their breast cancer screening practices.

We found that a large number of doctors recommend breast cancer screening to younger and older women—upwards of 80% of doctors recommend it for younger women (ages 40-44) and almost 70% for women 75 and older.  But this varies by the type of doctor that a woman see.  Gynecologists were, in general, more likely to recommend routine mammograms.

Continue reading

Ischemic Stroke: Collateral Blood Vessels Detected by Arterial Spin Labeling MRI Correlates With Good Neurological Outcome

MedicalResearch.com Interview with:
Jalal B. Andre M.D., D.A.B.R.®

Drector of neurological MRI and
MRI safety officer at Harborview Medical Center
University of Washington 

MedicalResearch.com: What is the background for this study?

Response: Acute ischemic stroke (AIS) patients with good collaterals have better clinical outcomes. AIS is characterized by an ischemic penumbra, a region of salvageable brain tissue, that surrounds a core of irreversible ischemic infarct. The penumbra is tenuously perfused by collateral blood vessels which, if extensive enough, can maintain penumbral perfusion, improving the odds that a larger volume of brain tissue will survive. Standard, first-line methods for evaluating collaterals in the acute setting include CT angiography, MR angiography, and (less commonly) digital subtraction angiography. Arterial spin labeling (ASL) is an emerging MRI technique that assesses cerebral perfusion. Its advantages include relatively short scan time (4-6 minutes), lack of ionizing radiation, and independence from an exogenous contrast agent (contraindicated in patients with impaired renal function or documented sensitivity). Collaterals can be identified within ASL images as foci of curvilinear hyperintensity bordering regions of hypoperfusion. We sought to explore a novel relationship between the presence of ASL collaterals (ASLc) and neurological outcome in acute ischemic stroke patients.

Continue reading

Instantaneous Wave-Free Ratio To Evaluate Coronary Artery Disease

MedicalResearch.com Interview with:

Matthias Götberg, MD, PhD Director Cardiac Cath Lab Department of Coronary Heart Disease Skane University Hospital- Lund Lund, Sweden

Dr. Matthias Götberg

Matthias Götberg, MD, PhD
Director Cardiac Cath Lab
Department of Coronary Heart Disease
Skane University Hospital- Lund
Lund, Sweden

MedicalResearch.com: What is the background for this study?

Response: Cardiologists encounter patients with narrowing of the coronary arteries on a daily basis. They typically use visual estimation of the severity of narrowing when performing coronary angiography, but it is difficult to accurately assess, based on a visual estimation alone, whether a stent is needed to widen the artery and allow the blood to more freely.

FFR (Fractional Flow Reserve) is more precise tool and results in better outcomes than using angiography alone to assess narrowing of the coronary arteries. With FFR, the doctor threads a thin wire through the coronary artery and measures the loss of blood pressure across the narrowed area. To acquire an accurate measurement, the patient must be given adenosine, which is a drug that dilates the blood vessels during the procedure. This drug causes discomfort; patients describe having difficulty breathing or feeling as if someone is sitting on their chest. The drug also adds to the cost of the procedure and can have other rare but serious side effects.

iFR (Instantaneous Wave-Free Ratio) is also based on coronary blood pressure measurements using a thin wire, but unlike FFR, it uses a mathematical algorithm to measure the pressure in the coronary artery only when the heart is relaxed and the coronary blood flow is high. As a result, a vasodilator drug is not needed.
iFR has been validated in smaller trials and have been found to be equally good as FFR to detect ischemia, but larger randomized outcome trials are lacking.

iFR-Swedeheart is a Scandinavian Registry-based Randomized Clinical Trial (RRCT) in which 2000 patients were randomized between iFR and FFR as strategies for performing assessment of narrowed coronary vessels. The primary composite endpoint at 12 months was all-cause death, non-fatal myocardial infarction, and unplanned revascularization.
RRCT is a new trial design originating from Scandinavia using existing web-based national quality registries for online data entry, randomization and tracking of events. This allows for a very high inclusion rate and low costs to run clinical trials while ensuring robust data quality.

Continue reading

iFR Can Assess Need For Coronary Revascularization Without Adenosine

MedicalResearch.com Interview with:

Dr. Justin Davies PhD Senior Reserch Fellow and Hononary Consultant Cardiologist National Heart and Lung Institute, Imperial College Londo

Dr. Davies

Dr. Justin Davies PhD
Senior Reserch Fellow and Hononary Consultant Cardiologist
National Heart and Lung Institute,
Imperial College London

MedicalResearch.com: What is the background for this study?

Response: We know from the FAME study that compared to angiography alone, FFR guided revascularization improves long-term clinical outcomes for our patients. Despite this, adoption of FFR into everyday clinical practice remains stubbornly low. One major factor for this is the need for adenosine (or other potent vasodilator medications) in order to perform an FFR measurement. Adenosine is expensive, unpleasant for the patient, time consuming and even potentially harmful.

iFR is a newer coronary physiology index that does not require adenosine for its measurement. In the prospective, multi center, blinded DEFINE FLAIR study, 2492 patients were randomly assigned to either FFR guided revascularisation or iFR guided revascularization and followed up for a period of 1 year.
Continue reading

Radiation Exposure and Vascular Access in Acute Coronary Syndromes: The RADMatrix Trial

MedicalResearch.com Interview with: Dr. Marco Valgimigli,

Dr. Marco Valgimigli

MedicalResearch.com Interview with:
Dr. Marco Valgimigli, MD, PhD

Interventional Cardiology
Sandro Pertini Hospital, ASL RM2, Rome, Italy

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Every year millions of people with coronary artery disease are treated worldwide with percutaneous coronary intervention (PCI). Radial access as compared to femoral access reduces bleeding and mortality in patients with acute coronary syndrome (ACS) undergoing invasive management. However, prior studies have raised concerns over the increased risk of radiation exposure for both patients and operators with radial instead of femoral access and it remains still unclear whether radial access increases the risk of operator or patient radiation exposure in contemporary practice when performed by expert operators.

The MATRIX (Minimizing Adverse Haemorrhagic Events by TRansradial Access Site and Systemic Implementation of angioX) trial is the largest randomized trial comparing radial versus femoral access in ACS patients undergoing invasive management. In this radiation sub-study (RAD-MATRIX), we collected fluoroscopy time and dose area product (DAP) and equipped radial operators consenting to participate with dedicated dosimeters, each wearing a thorax (primary endpoint), wrist and head (secondary endpoints) lithium fluoride thermo luminescent dosimeter, during study conduct to establish non-inferiority of radial versus femoral access.

Among eighteen operators, performing 777 procedures in 767 patients, the non-inferiority primary endpoint was not achieved. Operator equivalent dose at the thorax was significantly higher with radial than femoral access. After normalization of operator radiation dose by fluoroscopy time or DAP, the difference remained significant. Radiation dose at wrist or head did not differ between radial and femoral access. Thorax operator dose did not differ in the right radial compared to the left radial access. In the overall MATRIX population, fluoroscopy time and DAP were higher with radial as compared to femoral access.

Continue reading

Instantaneous Wave-free Ratio vs Fractional Flow Reserve to Guide PCI

MedicalResearch.com Interview with:

Dr. Matthias Götberg MD PhD Department of Cardiology, Clinical Sciences Lund University, Skåne University Hospital Lund, Sweden

Dr. Matthias Götberg

Dr. Matthias Götberg MD PhD
Department of Cardiology, Clinical Sciences
Lund University, Skåne University Hospital
Lund, Sweden

MedicalResearch.com: What is the background for this study?

Response: Cardiologists encounter patients with narrowing of the coronary arteries on a daily basis. They typically use visual estimation of the severity of narrowing when performing coronary angiography, but it is difficult to accurately assess, based on a visual estimation alone, whether a stent is needed to widen the artery and allow the blood to more freely.

FFR (Fractional Flow Reserve) is more precise tool and results in better outcomes than using angiography alone to assess narrowing of the coronary arteries. With FFR, the doctor threads a thin wire through the coronary artery and measures the loss of blood pressure across the narrowed area. To acquire an accurate measurement, the patient must be given adenosine, which is a drug that dilates the blood vessels during the procedure. This drug causes discomfort; patients describe having difficulty breathing or feeling as if someone is sitting on their chest. The drug also adds to the cost of the procedure and can have other rare but serious side effects.

iFR (Instantaneous Wave-Free Ratio) is also based on coronary blood pressure measurements using a thin wire, but unlike FFR, it uses a mathematical algorithm to measure the pressure in the coronary artery only when the heart is relaxed and the coronary blood flow is high. As a result, a vasodilator drug is not needed.

iFR has been validated in smaller trials and have been found to be equally good as FFR to detect ischemia, but larger randomized outcome trials are lacking.

iFR-Swedeheart is a Scandinavian Registry-based Randomized Clinical Trial (RRCT) in which 2000 patients were randomized between iFR and FFR as strategies for performing assessment of narrowed coronary vessels. The primary composite endpoint at 12 months was all-cause death, non-fatal myocardial infarction, and unplanned revascularization.

RRCT is a new trial design originating from Scandinavia using existing web-based national quality registries for online data entry, randomization and tracking of events. This allows for a very high inclusion rate and low costs to run clinical trials while ensuring robust data quality.  Continue reading

Clinical Outcomes Following a Low-Suspicion MRI for Prostate Cancer

MedicalResearch.com Interview with:

Lars Boesen MD PhD Department of Urology Herlev Gentofte University Hospital Herlev

Dr. Boessen

Lars Boesen MD PhD
Department of Urology
Herlev Gentofte University Hospital
Herlev

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Transrectal ultrasound-guided biopsies (TRUS-bx) traditionally used for detecting prostate cancer (PCa) are prone to sampling errors due to difficulties in target identification. Therefore, concerns about the possibility of missing significant prostate cancer result in men with negative biopsy results frequently undergo repeated biopsies, leading to increased medical costs, patient anxiety and morbidity.

Multiparametric MRI (mp-MRI) has become increasingly important in prostate cancer diagnosis. A suspicious lesion can be targeted by MRI-guided biopsies and improve diagnosis. Conversely, a normal mp-MRI may non-invasively exclude the possibility of an aggressive disease, avoiding the need for further biopsies. However, there are no current guidelines for clinicians whether standard repeated biopsies (TRUS-bx) should be performed in men with either a low-suspicion mp-MRI or benign MRI-targeted biopsies of a suspicious lesion and the clinical outcome and future risk of detecting significant prostate cancer following these findings is unknown.

Therefore, we assessed the risk of being diagnosed with prostate cancer after either a low-suspicion mp-MRI or benign targeted biopsies of a suspicious lesion in men with prior negative TRUS-bx, but a persistent clinical suspicion of missed significant cancer over a follow-up period of at least three years. Our results suggest that a low-suspicion MRI in men with prior negative TRUS-bx can be used non-invasively in ruling out longer term significant cancer and immediate repeated biopsies are of limited clinical value and might be avoided even if prostate-specific-antigen levels are persistently elevated.

MedicalResearch.com: What should readers take away from your report?

Response: A low-suspicion mp-MRI in a man with prior negative TRUS-bx has a high accuracy in ruling out a significant aggressive prostate cancer during follow-up of at least three years. Thus, immediate repeated biopsies rarely find significant disease and could be avoided even if the prostate-specific-antigen level is persistently elevated.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Response: Our results should be verified in larger prospective studies with a longer follow-up period to assess other clinical endpoints that include disease progression, cancer specific mortality and associated costs with an mp-MRI approach.

There are no disclosures or conflicts of interest

MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.

Citation:
J Urol. 2017 Feb 21. pii: S0022-5347(17)30297-5. doi: 10.1016/j.juro.2017.02.073. [Epub ahead of print]
Clinical outcome following a low-suspicion multiparametric prostate MRI or benign MRI-guided biopsy to detect prostate cancer: A follow-up study in men with prior negative transrectal ultrasound-guided biopsies.
Boesen L1, Nørgaard N2, Løgager V3, Thomsen HS4.
Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

More Medical Research Interviews on MedicalResearch.com

Using Post-Resuscitation ECG To Predict Need For Brain CT

MedicalResearch.com Interview with:

Won Young Kim, MD Department of Emergency Medicine Ulsan University College of Medicine Asan Medical Center Seoul, Korea

Dr. Won Young Kim

Won Young Kim, MD
Department of Emergency Medicine
Ulsan University College of Medicine
Asan Medical Center
Seoul, Korea

MedicalResearch.com: What is the background for this study?

Response: The current advanced cardiac life support guidelines recommended emergent percutaneous intervention for out-of-hospital cardiac arrest (OHCA) survivors with ST-segment elevation and suspected cardiac origin without ST-segment elevation. However, spontaneous subarachnoid hemorrhage (SAH) is a well-known cause of cardiac arrest, and its electrocardiogram may mimic myocardial infarction or ischemia. The need and timing for brain computed tomography in non-traumatic OHCA remain controversial.

The present study aimed at determining the role of the post-resuscitation ECG in patients with significant ST-segment changes on initial ECG to investigate the difference in post-resuscitation ECG characteristics between OHCA patients with SAH and those with suspected cardiac origin of OHCA.

Continue reading

Subtle Differences in Brain Volume Detected On MRI In ADHD

MedicalResearch.com Interview with:
M. (Martine) Hoogman PhD.

Postdoc and PI of ENIGMA-ADHD
Radboud universitair medisch centrum
Department of Human Genetics
Nijmegen, The Netherlands

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: There are many neuro-imaging studies aimed at investigating structural brain changes related to ADHD, but the results are often inconclusive.

There are two main reasons for this:

1) the small sample size of the studies and
2) the heterogeneous methods used.

We tried to address these issues by forming an international collaboration to provide a sample size sufficient to detect even small effects in volume differences. And in addition, we analyzed all the raw scans again using homogenized methods. There are data of more than 1700 patients (aged 4-63 years of age) and more than 1500 healthy controls in our dataset, coming from 23 sites around the world. We studied the possible volume differences between cases and controls of 7 subcortical regions and intracranial volume by performing mega- and meta-analysis.

Continue reading

Can Patients With A Pacemaker or Defibrillator Get An MRI?

MedicalResearch.com Interview with:

Robert Russo, MD, PhD, FACC The Scripps Research Institute The La Jolla Cardiovascular Research Institute

Dr. Robert Russo

Robert Russo, MD, PhD, FACC
The Scripps Research Institute
The La Jolla Cardiovascular Research Institute 

MedicalResearch.com: What is the background for this study?

Response: For an estimated 2 million people in the United States and an additional 6 million people worldwide, the presence of a non-MRI-conditional pacemaker or implantable cardioverter defibrillator (ICD) is considered a contraindication to magnetic resonance imaging. This creates a dilemma for at least half of these patients, who are predicted to require an MRI scan during their lifetime after a cardiac device has been implanted. Safety concerns for patients with an implanted cardiac device undergoing MRI are related to the potential for magnetic field-induced cardiac lead heating resulting in myocardial thermal injury, and a detrimental change in pacing properties. As a result, patients with an implanted device have long been denied access to MRI, although it may have been the most appropriate diagnostic imaging modality for their clinical care. Despite the development of MRI-conditional cardiac devices, a strategy for mitigating risks for patients with non MRI-conditional devices and leads will remain an enduring problem for the foreseeable future due to an ever increasing demand for MRI and the large number of previously and currently implanted non-MRI-conditional devices.

Continue reading

False Positive Mammograms Can Lead Women To Delay or Skip Next Exam

MedicalResearch.com Interview with:

Mammogram showing small lesion - Wikipedia

Mammogram showing small lesion
– Wikipedia

Firas Dabbous, PhD
Manager, Patient Centered Outcomes Research
Russell Institute for Research & Innovation
Advocate Lutheran General Hospital
Park Ridge, IL 

MedicalResearch.com: What is the background for this study?

Response: When women are told that there is something abnormal on their screening mammogram that can cause stress and worry while undergoing additional testing, even when they are later told that there is nothing wrong. We wanted to know if receiving a false positive screening mammogram would cause women to think twice before getting their next screening mammogram, and maybe delay coming back for their next screen. This is important because patients who have a false positive experience may have higher chance to develop breast cancer at a later point in time. Therefore, it is important to understand their screening patterns to better educate and inform them about the importance of adhering to mammography guidelines and emphasize the importance of returning on schedule for their next screens.

Continue reading

Annual CT Lung Cancer Screening Among Former Smokers Remains Underutilized

MedicalResearch.com Interview with:

Ahmedin Jemal, DVM, PHD Vice President, Surveillance and Health Services Research American Cancer Society, Inc. 250 Williams St. Atlanta, GA 30303

Dr. Ahmedin Jemal

Ahmedin Jemal, DVM, PHD
Vice President, Surveillance and Health Services Research
American Cancer Society, Inc.
250 Williams St.
Atlanta, GA 30303

MedicalResearch.com: What is the background for this study?

Response: In December 2013, the United States Preventive Services Task Force (USPSTF) recommended annual screening for lung cancer with low dose computed tomography (LDCT) for current or former heavy smokers who quit within the past 15 years.

A previous study estimated that only 2-4% of heavy smokers received LDCT for lung cancer screening in 2010 in the United States. We sought to determine whether lung cancer screening among high risk smokers increased in 2015, following the USPSTF recommendation in 2013.

Continue reading

Comprehensive Lung Cancer Screening Is Complex Task With Many False Positives

MedicalResearch.com Interview with:

Dr-Linda-Kinsinger.jpg

Dr. Linda Kinsinger

Linda Kinsinger, MD, MPH
National Center for Health Promotion and Disease Prevention
U.S. Department of Veterans Affairs
NW Washington DC 20420

MedicalResearch.com: What is the background for this study? 

Response: The U.S. Preventive Services Task Force recommends annual lung cancer screening with low-dose computed tomography (LDCT) for current and former heavy smokers ages 55 to 80.

However, clinicians have questioned the practical aspects of implementing lung cancer screening. VA provides care for 6.7 million Veterans each year, mostly older men – many of whom are current or former smokers – thus the implementation of a lung cancer screening program for VA patients would require substantial resources. In order to understand the feasibility and implications of this for patients and clinical staff, VA implemented a three-year Lung Cancer Screening Demonstration Project (LCSDP) in eight geographically-diverse VA hospitals. Investigators identified 93,033 primary care patients at eight sites who were assessed on screening criteria, of whom 2,106 patients were screened between July 2013 and June 2015.

Continue reading

Many CT Scans Can Be Avoided During ER Evaluation of Head Trauma

MedicalResearch.com Interview with:

Adam L. Sharp MD MS Research Scientist/Emergency Physician Kaiser Permanente Southern California Kaiser Permanente Research Department of Research & Evaluation Pasadena, CA 91101

Dr. Adam Sharp

Adam L. Sharp MD MS
Research Scientist/Emergency Physician
Kaiser Permanente Southern California
Kaiser Permanente Research
Department of Research & Evaluation
Pasadena, CA 91101

MedicalResearch.com: What is the background for this study?

Response: Millions of head computed tomography (CT) scans are ordered annually in U.S. emergency Departments (EDs), but the extent of avoidable imaging is poorly defined. Ensuring appropriate use is important to ensure patient outcomes and limited resources are optimized. A large number of stake holders have highlighted the need to reduce “unnecessary” CT scanning as part of their recommendations for the Choosing Wisely campaign. However, despite calls for improved stewardship, the extent of avoidable CT use among adults with minor trauma in community EDs is not known.

The Canadian CT Head Rule (CCHR) is perhaps the most studied of many validated decision instruments designed to assist providers in evaluating patients with minor head trauma. This study aims to describe the scope of overuse of CT imaging by ED providers in cases where application of the CCHR could have avoided imaging.

Secondarily, we sought to describe the extent to which avoidable CTs, if averted, would have resulted in “missed” intracranial hemorrhages requiring a neurosurgical intervention.

Continue reading

PET Scanning Highlights Link Between Stress and Heart Disease

MedicalResearch.com Interview with:

Dr Ahmed Tawakol MD Massachusetts General Hospital and Harvard Medical Schoo

Dr Ahmed Tawakol

Dr Ahmed Tawakol MD
Co-Director, Cardiac MR PET CT Program
Massachusetts General Hospital and
Harvard Medical School 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: While the link between stress and heart disease has long been established, the mechanism mediating that risk hasn’t been clearly understood. Animal studies showed that stress activates bone marrow to produce white blood cells, leading to arterial inflammation.  This study suggests an analogous path exists in humans. Moreover, this study identifies, for the first time in animal models or humans, the region of the brain (the amygdala) that links stress to the risk of heart attack and stroke.

The paper reports on two complementary studies.

The first analyzed imaging and medical records data from almost 300 individuals who had PET/CT brain imaging, primarily for cancer screening, using a radiopharmaceutical called FDG that both measures the activity of areas within the brain and reflects inflammation within arteries.  All participants in that study had no active cancer or cardiovascular disease at the time of imaging and each had information in their medical records on at least three additional clinical visits after imaging.

The second study enrolled 13 individuals with a history of post-traumatic stress disorder, who were evaluated for their current levels of perceived stress and received FDG-PET scanning to measure both amygdala activity and arterial inflammation.

Continue reading

ACA: Screening Disparities Fall For Mammograms But Not Colonoscopies

MedicalResearch.com Interview with:

Dr. Gregory Cooper, MD Program Director, Gastroenterology, UH Cleveland Medical Center Co-Program Leader for Cancer Prevention and Control, UH Cleveland Medical Center Professor, Medicine, CWRU School of Medicine Co-Program Leader for Cancer Prevention and Control UH Seidman Cancer Center

Dr. Gregory Cooper

Dr. Gregory Cooper, MD
Program Director, Gastroenterology
UH Cleveland Medical Center
Co-Program Leader for Cancer Prevention and Control, UH Cleveland Medical Center
Professor, Medicine, CWRU School of Medicine
Co-Program Leader for Cancer Prevention and Control
UH Seidman Cancer Center

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The Affordable Care Act, among other features, removed out of pocket expenses for approved preventive services, and this may have served as a barrier to cancer screening in socioeconomically disadvantaged individuals. If so, then the gap in screening between socioeconomic groups should narrow following the ACA.

The main findings of the study were that although in the pre-ACA era, there were disparities in screening, they narrowed only for mammography and not colonoscopy.

Continue reading

MRI Can Better Diagnose Fetal Brain Abnormalities in-Utero

MedicalResearch.com Interview with:
Prof Paul D Griffiths, FRCR and

Cara Mooney, Study Manager: MERIDIAN
Clinical Trials Research Unit
The University of Sheffield 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Around three in every 1000 pregnancies is complicated by a fetal abnormality. In the UK Ultrasonography (USS) has, for many years, been the mainstay of antenatal screening and detailed anomaly scanning to detect such abnormalities.  However previous studies have suggested that in utero Magnetic Resonance (iuMR) imaging may be a useful adjunct to USS for detecting these brain abnormalities in the developing fetus.

This study was designed to test the diagnostic accuracy and clinical impact of introducing fetal MR in to the diagnostic pathway.

Our results show that iuMR has an overall diagnostic accuracy of 93% compared to ultrasound at 68%, this is an increase in diagnostic accuracy of 25%. When divided into gestational age group the improvement in diagnostic accuracy ranged from 23% in the 18-23 week group, and 29% in the 24 week and over group.

IuMR provided additional diagnostic information in 49% of cases, changed prognostic information in at least 20% and the contribution to clinical management was felt to be at least ‘significant’ in 35% of cases. IuMR also had high patient acceptability with at least 95% of women stating that they would have an iuMR if a future pregnancy were complicated by a fetal brain abnormality.

Continue reading

Image-Guided Biopsies May Reduce Need For Surgery in Breast Cancer Patients Who Respond to Chemotherapy

MedicalResearch.com Interview with:

Henry M. Kuerer, MD, PhD, FACS</strong> Executive Director, Breast Network Programs MD Anderson Cancer Network PH and Fay Etta Robinson Distinguished Professor in Research Department of Breast Surgical Oncology Director, Breast Surgical Oncology Training Program

Dr. Henry M. Kuerer

Henry M. Kuerer, MD, PhD, FACS
Executive Director, Breast Network Programs
MD Anderson Cancer Network
PH and Fay Etta Robinson Distinguished Professor in Research
Department of Breast Surgical Oncology
Director, Breast Surgical Oncology Training Program

MedicalResearch.com: What is the background for this study?

Response: Worldwide, triple negative and HER2 positive breast cancers, combined, account for about 370,000 women diagnosed annually. With recent advances in neoadjuvant systemic therapy (NST, chemotherapy and targeted therapy given before surgery) for both subsets, the pCR (pathologic complete response- when no residual cancer is found) rates found at the time of surgery in these populations can be as high as 60 percent. This high rate of pCR naturally raises the question of whether surgery is required for all patients, particularly those who will receive adjuvant radiation.

We believe surgery may potentially be redundant – at least for these two subtypes of breast cancer – because of such a high chance for no evidence of disease at the time of pathological review. If there’s no cancer left after the patient has received chemotherapy and the patient is going to receive local radiation therapy, is surgery actually needed?

The challenge has been that standard breast imaging methods cannot accurately predict residual disease after NST. However, by doing the same image-guided percutaneous needle biopsies after neoadjuvant systemic therapy that we do at time of diagnosis, our preliminary research reveals that we may be able to accurately predict which women will have cancer or not.

Continue reading

Cerebral Perfusion Is Perturbed by Preterm Birth and Brain Injury

MedicalResearch.com Interview with:
Eman S. Mahdi, MD, MBChB
Pediatric Radiology Fellow

Catherine Limperopoulos, PhD Director, Developing Brain Research Laboratory Co-Director of Research, Division of Neonatology Diagnostic Imaging and Radiology Children’s National Health System Washington, DC

Dr. Catherine Limperopoulos

Catherine Limperopoulos, PhD
Director, Developing Brain Research Laboratory
Co-Director of Research, Division of Neonatology
Diagnostic Imaging and Radiology
Children’s National Health System
Washington, DC

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Premature birth is a major public health concern in the United States affecting 1 in 10 infants each year. Prematurity-related brain injury is very common and associated with a high prevalence of brain injury and accompanying lifelong neurodevelopmental morbidities.

Early disturbances in systemic and cerebral hemodynamics are thought to mediate prematurity-related brain injury. The extent to which cerebral blood flow (CBF) is disturbed in preterm birth is poorly understood, in large part because of the lack of monitoring techniques that can directly and non-invasively measure cerebral blood flow.

We report for the first time early disturbances in global and regional cerebral blood flow in preterm infants following brain injury on conventional magnetic resonance imaging (MRI) over the third trimester of ex-uterine life using arterial spin labelling images. In terms of regional differences, we saw a marked decrease in blood flow to the thalamus and the pons, regions known to be metabolically active during this time.

Continue reading

CT Angiography Study Finds No Association Between Alcohol and Coronary Artery Disease

MedicalResearch.com Interview with:
Pál Maurovich-Horvat MD, PhD, MPH, FSCCT

Assistant Professor of Cardiology
Director of the MTA-SE Cardiovascular Imaging Research Group
Heart and Vascular Center, Semmelweis University
Budapest, Hungary

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Several studies have been published on alcohol consumption and its association with the presence of coronary artery disease, however the data remains controversial. Some studies suggested that moderate alcohol consumption reduces the risk of heart disease and others found no protective effect.

Our study is the first investigation that aims to assess the effect of alcohol on the coronary arteries using coronary CT angiography. We found no association between regular alcohol consumption and the presence of coronary disease.

Continue reading

God Activates Reward Centers In Brain

MedicalResearch.com Interview with:

Jeffrey S. Anderson, MD, PhD Director the fMRI Neurosurgical Mapping Service Principal Investigator for the Utah Functional Neuroimaging Laboratory University of Utah

Dr. Jeffrey S. Anderson

Jeffrey S. Anderson, MD, PhD
Director the fMRI Neurosurgical Mapping Service
Principal Investigator for the Utah Functional Neuroimaging Laboratory
University of Utah

MedicalResearch.com: What is your study about?

Response: Billions of people find meaning in life and make choices based on religious and spiritual experiences. These experiences range from epiphanies that change the lives of celebrated mystics to subtle feelings of peace and joy in the lives of neighbors, friends, or family members that are interpreted as spiritual, divine, or transcendent.

Astonishingly, with all we understand about the brain, we still know very little about how the brain participates in these experiences. We set out to answer what brain networks are involved in representing spiritual feelings in one group of people, devout Mormons.
Continue reading

No Clear Cut-Off Age To Stop Screening Mammograms

MedicalResearch.com Interview with:
Cindy Lee, MD

Assistant Professor
Department of Radiology and Biomedical Imaging
University of California San Francisco
San Francisco, CA

MedicalResearch.com: What’s new about the research? How is it different than what’s come before?

• The largest study on the topic, including national data from 31 states in the United States. Including 5.7 million screening mammograms with follow up.
• All exams using digital techniques, up to date data, more representative of community practices in the U.S.

Continue reading

Virtual Reality Systems Can Generate Immersive 3D Images of Fetuses

Close-up of fetus at 26 weeks RSNA16

Close-up of fetus at 26 weeks

MedicalResearch.com Interview with:
Dr. Heron Werner Junior
Clínica de Diagnóstico por Imagem – CDPI
Rio de Janeiro – Brazil

MedicalResearch.com: What is the background for this study?

Response: A growing number of technological advancements in obtaining and viewing images through noninvasive techniques have brought major breakthroughs in fetal medicine.

In general, two main technologies are used to obtain images within the uterus during pregnancy i.e. ultrasound (US) and magnetic resonance imaging (MRI).

Continue reading

Coronary Artery Calcium Found in 1/3 Women Designated “Low-Risk’

MedicalResearch.com Interview with:

Dr-Maryam-Kavousi

Dr. Maryam Kavousi

Maryam Kavousi MD, PhD, FESC
Assistant Professor
Department of Epidemiology
Erasmus University Medical Center
Rotterdam The Netherlands 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The most recent American College of Cardiology/American Heart Association (ACC/AHA) cardiovascular disease (CVD) prevention guidelines recommend statins for a larger proportion of populations.

Notably, a large group of women are categorized as low CVD risk by the guidelines and would therefore not typically qualify for intensive management of their standard risk factors. Coronary artery calcium (CAC) scanning allows for the detection of subclinical coronary atherosclerosis and is viewed as the vessel’s memory of lifetime exposure to risk factors. We therefore aimed to address the utility of CAC as a potential tool for refining CVD risk assessment in asymptomatic women at low CVD risk based on the new guidelines.

This study involved data on 6,739 low-risk women from 5 population-based cohort studies across the United States and Europe. We found that CAC was present in 36% of low-risk women and was associated with increased risk of CVD. Continue reading

Brain Gray Matter Volume Predictive of Weight Loss Success

MedicalResearch.com Interview with:
Fatemeh Mokhtari

Medical Imaging PhD Student
VT-WFU SBES

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The objective of this study was to use baseline anatomical brain MRI scans to prospectively predict weight loss success following an intensive lifestyle intervention. In the study, 52 participants, age 60 to 79, were recruited from the Cooperative Lifestyle Interventions Programs II (CLIP-II) project. The participants were overweight or obese (BMI greater than 28 and less than 42) and had a history of either cardiovascular disease or metabolic syndrome. All participants had a baseline MRI scan, and then were randomized to one of three groups – diet only, diet plus aerobic exercise training or diet plus resistance exercise training. The goal of the 18-month diet and exercise program was a weight loss of 7 to 10 percent of body mass.
Basic brain structure information garnered from the MRIs was classified using a support vector machine, a type of computerized predictive algorithm. Specifically, we trained a computational predictive model which mapped each subject’s brain scan to weight loss performance. Predictions were based on baseline brain gray and white matter volume from the participants’ MRIs and compared to the study participants’ actual weight loss after the 18 months. The accuracy of the model was then tested, and our prediction algorithms were 78% accurate in predicting successful weight loss. Brain gray matter volume provided higher prediction accuracy compared with white matter and the combination of the two outperformed either one alone.

Continue reading

Six Sigma Lean Models Applicable To Emergency Room Care

MedicalResearch.com Interview with:

Devon A. Klein, MD, MPH Asst. Professor of Radiology and Orthopaedics Hofstra Northwell School of Medicine Associate Chairman, Radiology Lenox Hill Hospital New York, NY 10075

Dr. Devon A. Klein

Devon A. Klein, MD, MPH
Asst. Professor of Radiology and Orthopaedics
Hofstra Northwell School of Medicine
Associate Chairman, Radiology
Lenox Hill Hospital
New York, NY 10075

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: As our Emergency Department continued to grow our Radiology Department was challenged to accommodate the resultant increased volume with fixed resources (i.e. CT Scanners) and maintain CT scan throughput. Uncoordinated insular efforts within the Department of Radiology failed to resolve the problem. A collaborative approach utilizing Six Sigma lean and involving stakeholders from the Departments of Radiology, Emergency, Medicine, and Patient Transportation was able to better illustrate the “bottlenecks” and devise solutions.

Continue reading

ECG and Echocardiography for Identification of Arrhythmic Events in Early ARVC

MedicalResearch.com Interview with:
Kristina H. Haugaa, MD, PhD, FESC
Ida Skrinde Leren MD, PhD
Department of Cardiology and
Center for Cardiological Innovation,
Oslo University Hospital, Rikshospitalet
Oslo, Norway

MedicalResearch.com: What is the background for this study?

Response: Arrhythmogenic right ventricular cardiomyopathy (ARVC) is an inheritable cardiomyopathy, predisposing to life-threatening arrhythmias. Ventricular arrhythmias are frequent in ARVC patients and importantly, arrhythmias may occur also before evident structural changes are seen, making risk stratification challenging. Additional tools are needed to detect early disease and to optimize medication and timing of implantation of a cardioverter defibrillator (ICD). We aimed to explore early markers of ARVC disease and their association with previous ventricular arrhythmias.

Continue reading

Cardiac CT Reduces Need for Catheterization in Atypical Chest Pain

MedicalResearch.com Interview with:

Professor Marc Dewey Heisenberg professor of radiology Vice Chairman of the Department of Radiology at Charité (Campus Mitte) Berlin Germany

Prof. Marc Dewey

Professor Marc Dewey
Heisenberg professor of radiology
Vice Chairman of the Department of Radiology at Charité (Campus Mitte)
Berlin Germany 

MedicalResearch.com: What is the background for this study?

Response: Over 3.5 million cardiac catheterisations are performed in Europe each year. This study, jointly conducted by radiologists and cardiologists at Charité – Universitätsmedizin Berlin and published in today’s issue of The BMJ, compares computed tomography (CT) with cardiac catheterisation in patients with atypical chest pain and suspected coronary artery disease (CAD).

MedicalResearch.com: What are the main findings?

Response: CT reduced the need for cardiac catheterisation from 100% to 14% in the group of patients who received CT first instead of catheterisation. If catheterisation was needed in the CT group, the proportion of catheterisations showing obstructive CAD was 5 times higher than in the catheterisation group. Over a period of 3.3 years, the patients in the CT group neither had more cardiac catheterisations nor an increase in cardiovascular events. Moreover, CT shortened the length of stay by 23 hours and 79% of patients said they would prefer CT for future examinations of the heart. Overall, the results of the BMJ study show that CT is a gentle test for reliably ruling out CAD in patients with atypical chest pain who are currently being referred for cardiac catheterisation in routine clinical practice.

Continue reading

Medicare Shared Savings Program May Reduce Hospitals’ Propensity To Purchase New CT Machines

MedicalResearch.com Interview with:
Hui Zhang, Ph.D., MBA

Virginia Polytechnic Institute and State University
Blacksburg

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: To promote healthcare coordination and contain the rising costs in the US healthcare system, a variety of payment innovations has been developed and field-tested in both public and private sector. Among them, the Medicare Shared Savings Program (MSSP) for Accountable Care Organizations (ACOs), administered by the Centers for Medicare and Medicaid Services (CMS) has received considerable attention.

Our study took a mathematical modeling approach and comprehensively captured and analyzed the effect of this new payment systems on healthcare stakeholder decisions and system-wide outcomes. Our results provided decision-making insights for payers on how to improve MSSP, for ACOs on how to distribute MSSP incentives among their members, and for hospitals on whether to invest in new CT imaging systems.

Continue reading

Computer Bests Neuroradiologists in Distinguishing Tumor Recurrence From Radiation Necrosis

MedicalResearch.com Interview with:

Dr. Pallavi Tiwari PhD Assistant Professor biomedical engineering Case Western Reserve University

Dr. Pallavi Tiwari

Dr. Pallavi Tiwari PhD
Assistant Professor biomedical engineering
Case Western Reserve University

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: One of the biggest challenges in neuro-oncology currently is distinguishing radionecrosis, a side-effect of aggressive radiation, from tumor recurrence on imaging. Surgical intervention is the only means of definitive diagnosis, but suffers from considerable morbidity and mortality. The treatments for radionecrosis and cancer recurrence are very different. Early identification of the two conditions can help speed prognosis, therapy, and improve patient outcomes.

The purpose of this feasibility study was to evaluate the role of machine learning algorithms along with computer extracted texture features, also known as radiomic features, in distinguishing radionecrosis and tumor recurrence on routine MRI scans (T1w, T2w, FLAIR). The radiomic algorithms were trained on 43 studies from our local collaborating institution – University Hospitals Case Medical Center, and tested on 15 studies at a collaborating institution, University of Texas Southwest Medical Center. We further compared the performance of the radiomic techniques with two expert readers.

Our results demonstrated that radiomic features can identify subtle differences in quantitative measurements of tumor heterogeneity on routine MRIs, that are not visually appreciable to human readers. Of the 15 test studies, the radiomics algorithm could identify 12 of 15 correctly, while expert 1 could identify 7 of 15, and expert 2, 8 of 15.

Continue reading

Brain Scans Can Predict Specific Spontaneous Emotions

MedicalResearch.com Interview with:

Kevin S. LaBar, Ph.D. Professor and Head, Cognition & Cognitive Neuroscience Program Co-Director of Undergraduate Studies in Neuroscience Center for Cognitive Neuroscience Duke University Durham, NC

Dr. Kevin LaBar

Kevin S. LaBar, Ph.D.
Professor and Head, Cognition & Cognitive Neuroscience Program
Co-Director of Undergraduate Studies in Neuroscience
Center for Cognitive Neuroscience
Duke University
Durham, NC

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Emotion research is limited by a lack of objective markers of emotional states. Most human research relies on self-report, but individuals may not have good insight into their own emotions. We have developed a new way to identify emotional states using brain imaging and machine learning tools. First, we induced emotional states using film and music clips while individuals were in an MRI scanner. We trained a computer algorithm to identify the brain areas that distinguished 7 emotions from each other (fear, anger, surprise, sadness, amusement, contentment, and a neutral state). This procedure created a brain map for each of the 7 emotions. Then, a new group of participants self-reported their emotional state every 30 seconds in an MRI scanner while no stimuli were presented. We could predict which emotion was spontaneously reported by the subjects by comparing their brain scans to each of the 7 emotion maps. Finally, in a large group of 499 subjects, we found that the presence of the fear map during rest predicted state and trait anxiety while the presence of the sadness map predicted state and trait depression.

Continue reading

MRI Not Always Better Than Regular X Rays For Knee Pain Evaluation

MedicalResearch.com Interview with:

Dr-Muyibat-Adelani.jpg

Dr. Muyibat Adelani

Muyibat Adelani, MD
Assistant Professor of Orthopaedic Surgery
Washington University
St. Louis

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: In our practice, we noticed that more patients are coming in already having had MRIs. We wanted to know how many people actually had weight-bearing knee x-rays before the MRI. We found that only a quarter of patients had weight-bearing x-rays before the MRI. We found that half of the MRIs obtained prior to referral to an orthopaedic surgeon did not contribute to the patient’s treatment.

Continue reading

MRI Generally Safe For Fetus in First Trimester, But Gadolinium Should Be Avoided Unless Strongly Indicated

MedicalResearch.com Interview with:
Dr. Joel G. Ray MD, MS, FRCPC

Professor, Department of Medicine, University of Toronto
Professor Department of Obstetrics and Gynecology
St. Michael’s Hospital

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: We have little information about the fetal safety to of MRI in the first trimester of pregnancy, or that of MRI with gadolinium contrast performed at any point in pregnancy.

Continue reading

How Can Radiologists Detect Cancer In a Fraction of a Second?

MedicalResearch.com Interview with:

Karla K. Evans, Ph.D. Lecturer, Department of Psychology The University of York Heslington, York UK

Dr. Karla Evans

Karla K. Evans, Ph.D.
Lecturer, Department of Psychology
The University of York
Heslington, York UK

MedicalResearch.com: What is the background for this study?

Response: This research started after initially talking to radiologists and pathologists about how they search a radiograph or micrograph for abnormalities. They talked about being able to tell at the first glance if the image had something bad about it. Jokingly, they talked about “having the force” to see the bad. We wanted to know whether this hunch after the brief initial viewing was real and to systematically test it. We collected radiographic and micrographic images, half of them that had signs of cancer in them and half of them that didn’t, and we briefly presented them (250 millisecond to 2000 milliseconds) to radiologists or pathologistsrespectively. They simply had to report whether they would recall the patient or not and try localize on the outline the location of the abnormality. We first reported these finding in the following paper.

Evans et al. (2013) The Gist of the Abnormal: Above chance medical decision making in the blink of an eye. Psychonomic Bulletin & Review (DOI) 10.3758/s13423-013-0459-3
In addition to finding that radiologists and pathologists can indeed detect subtle cancers in a quarter of a second we also found that they did not know where it was in the image leading us to conclude that the signal that they were picking up must be a global signal (i.e. the global image statistic or the texture of the breast as a whole) rather than the result of a local saliency. This led me to start further exploring this signal in order to characterize it when I moved to University or York, UK to establish my own lab.
Continue reading

Technetium Cardiac Imaging Predicts Prognosis of Cardiac Amyloidosis

MedicalResearch.com Interview with:

Adam Castano, M.D., M.S. Division of Cardiology Columbia University Medical Center New York Presbyterian Hospital

Dr. Adam Castano

Adam Castano, M.D., M.S.
Division of Cardiology
Columbia University Medical Center
New York Presbyterian Hospital

MedicalResearch.com: What is the background for this study?

Response: Transthyretin cardiac amyloidosis (ATTR-CA) is an increasingly recognized cause of heart failure with preserved ejection fraction (HFpEF). Traditionally, the gold standard for diagnosis has required an endomyocardial biopsy coupled with either immunohistochemistry or mass spectroscopy. These specialized tests are only performed at centers with experienced satff, do not yield prognostically useful information, may be inadvisable for frail older adults, and often present logistical challenges that lead to delayed care.

Fortunately, single center studies have demonstrated excellent diagnostic accuracy using technetium 99m pyrophosphate (Tc99mPYP) cardiac imaging for noninvasively detecting ATTR-CA and differentiating it from another major type of cardiac amyloidosis called light chain (AL). But the diagnostic accuracy of this technique in a multicenter study and the association of Tc99mPYP myocardial uptake with survival were not known prior to this study.

Therefore, we assessed in a multicenter study Tc99mPYP cardiac imaging as a diagnostic tool and its association with survival. We conducted a retrospective cohort study of 229 patients evaluated at 3 academic specialty centers for cardiac amyloidosis and also underwent Tc99mPYP cardiac imaging. We measured retention of Tc99mPYP in the heart using a semiquantitative visual score (range 0-3) and a more quantitative heart-to-contralateral (H/CL) ratio calculated as total counts in a region of interest over the heart divided by background counts in an identical size region of interest over the contralateral chest. The outcome measured was time to death after Tc99mPYP imaging.

Continue reading

Patients With Psoriasis Have Coronary Calcium Scores Comparable to Diabetes

MedicalResearch.com Interview with:
Nehal N. Mehta, .MD., M.S.C.E. F.A.H.A.
Lasker Clinical Research Scholar
Section of Inflammation and Cardiometabolic Diseases
NIH

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Psoriasis is associated with accelerated cardiovascular (CV) disease; however, screening for CV risk factors in psoriasis remains low. Coronary artery calcium (CAC) score estimates the total burden of atherosclerosis. Psoriasis has been associated with increase CAC score, but how this compares to patients with diabetes, who are aggressively screened for CV risk factors, is unknown.

Continue reading

Lung Cancers Detected On Screening CT Scans Have Better Survival

MedicalResearch.com Interview with:

Matthew B. Schabath PhD Department of Cancer Epidemiology H. Lee Moffitt Cancer Center and Research Institute Tampa, Florida

Dr. Matthew Schabath

Matthew B. Schabath PhD
Department of Cancer Epidemiology
H. Lee Moffitt Cancer Center and Research Institute
Tampa, Florida

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Our study is a post-hoc analysis of data from a large randomized clinical trial (RCT) called the National Lung Screening Trial (NLST). The NLST found that lung cancer screening with low-dose helical computed tomography (LDCT) significantly reduced lung cancer deaths by 20 percent compared to screening with standard chest radiography (i.e., X-Ray).

In our publication, we performed a very detailed analysis comparing outcomes of lung cancer patients screened by LDCT according to their initial (i.e., baseline), 12 month, and 24 month screening results. We found that patients who had a negative baseline screening but tested positive for lung cancer at the 12- or 24-month screen had lower survival and higher mortality rates than patients who had a positive initial screen that was a non-cancerous abnormality but developed lung cancer in subsequent screens.

Continue reading