Negative Ultrasound Study Can Rule Out Upper Extremity DVT

MedicalResearch.com Interview with:
Dott. Michelangelo Sartori

U.O. di Angiologia e Malattie della Coagulazione
Azienda Ospedaliera di Bologna
Policlinico Sant’Orsola Malpighi
Bologna

Medical Research: What is the background for this study? What are the main findings?

Response: The safety of withholding anticoagulation only on the basis of ultrasound imaging has not been evaluated in patients with suspected (Upper Extremity Deep Vein Thromobsis) UEDVT. The purpose of this management study was to evaluate the failure rate of ultrasound testing for UEDVT diagnosis in outpatients. Our data show that, similarly to the lower extremity, a negative complete ultrasound assessment of the upper extremity can safely exclude DVT. We found a 3-month VTE rate of 0.6% after a negative ultrasound and such figure is not different from the 3-month VTE incidence in management studies for lower limb DVT.  Thus anticoagulant therapy can be withheld for clinically suspected UEDVT after negative ultrasound examination without further testing in the ambulatory office setting.
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Novel 68Ga-PSMA-ligand Improves PET/CT Detection of Recurrent Prostate Cancer

Matthias Eiber, MD Department of Nuclear Medicine Munich, GermanMedicalResearch.com Interview with:
Matthias Eiber, MD
Department of Nuclear Medicine
Munich, Germany

Medical Research: What is the background for this study? What are the main findings?

Dr. Eiber: The background of the study is the investigation of a novel 68Ga-PSMA ligand using PET/CT in the workup of patients with recurrent prostate cancer after radical prostatectomy. Hereby, we found substantial higher detection rate compared to other methods. In total 222 (89.5%) patients showed pathological findings in 68Ga-PSMA-ligand PET/CT. Stratified by PSA-level the detection rates were 96.8%,93.0%,72.7% and 57.9% of ≥2,1-<2, 0.5-<1 and 0.2-<0.5ng/mL, respectively.

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German Study Suggests CT Screening For Lung Cancer Has Unresolved Questions

MedicalResearch.com Interview with:
Prof. Dr. Nikolaus Becker

Epidemiologisches Krebsregister Baden-Württemberg
Deutsches Krebsforschungszentrum
Heidelberg Germany

Medical Research: What is the background for this study? What are the main findings?

Prof. Becker: Lung cancer is the leading cause of cancer death in our Western countries as well as worldwide. One reason is that it is clinically diagnosed mostly in an advanced stage with a poor five-year survival of less than 10%. Diagnosed at an early stage, more than 70% would survive 5 years. For low dose-multislice CT (MSCT) indications exist that it is able to detect lung cancers early. As every newly upcoming screening tool, it has to be carefully analyzed whether it is really able to decrease the mortality from lung cancers and at which costs in terms of undesired side effects such as false-positive findings and overdiagnosis. Our results indicate that spontaneous MSCT screening with changing doctors might be ineffective due to many false-positive alarms; if screening then within an organizational framework.

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New Classification System For Low-dose CT Screening For Lung Cancer

MedicalResearch.com Interview with:
Paul F. Pinsky, PhD
MPH
Acting Chief Early Detection Research Group
National Cancer Institute
Bethesda, MD, 20892

Medical Research: What is the background for this study? What are the main findings?

Response: The National Lung Screening Trial (NLST) reported, in 2011, a 20% reduction in lung cancer mortality with low-dose CT screening. However, there was a high false positive rate, around 25% in the first two screening rounds, and somewhat lower in the final round. In order to reduce the high false positive rate, and also to standardize the reported system for low-dose CT screening, analogous to the use of BIRADS for mammography screening, the American College of Radiology (ACR) developed the Lung-RADS classification system. It was released in May, 2014. Although it was developed based on published summary data from several studies, including the NLST, it was never applied to a large group of screened subjects on an individual basis. Therefore, we retrospectively applied Lung-RADS to previously collected, detailed screening data from the National Lung Screening Trial .

The major findings were that the false positive rate decreased very substantially using Lung-RADS instead of the original National Lung Screening Trial criteria. At the baseline screen, it decreased by 50% and at subsequent screens it decreased by 75%. There was also, however, a modest decrease in the sensitivity rate, from 93% to 85% at baseline and from 93% to 79% at subsequent screens.

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Targeted MR/Ultrasound Biopsy May Improve Prostate Cancer Diagnosis

MedicalResearch.com Interview with:
Mohummad Minhaj Siddiqui, MD
AssiMohummad Minhaj Siddiqui, MD Assistant Professor of Surgery - Urology Director of Urologic Robotic Surgery University of Maryland School of Medicine andstant Professor of Surgery – Urology
Director of Urologic Robotic Surgery
University of Maryland School of Medicine and

Peter A. Pinto, M.D Head, Prostate Cancer Section  Director, Fellowship Program  Urologic Oncology Branch National Cancer Institute  National Institutes of Health  Bethesda, Maryland 20892-1210 Peter A. Pinto, M.D
Head, Prostate Cancer Section  Director, Fellowship Program
Urologic Oncology Branch National Cancer Institute  National Institutes of Health  Bethesda, Maryland

Medical Research: What is the background for this study? What are the main findings?

Response: For men suspected of having prostate cancer due to an elevated PSA or abnormal digital rectal exam, the next step in their diagnostic workup has traditionally been a standard 12-core biopsy to evenly sample the entire gland.  Unlike most other cancers, prostate cancer is one of the few solid tumors left which is diagnosed by randomly sampling the gland with the hope of biopsying the tumor, if it is present.  This paradigm has been largely due to the fact that imaging to date has been limited in its ability to identify prostate cancer.  Recent advancements in multiparametric MRI of the prostate however has significantly improved clinician’s ability to identify regions in the prostate suspicious for cancer.  This has led to the emergence of MR/Ultrasound fusion technology which allows for targeted biopsy of the prostate into regions suspicious for cancer.

Although conceptually, it makes sense that a targeted biopsy has the potential to perform better than the standard random sampling of the prostate in the diagnosis of prostate cancer, studies were needed to understand if this is true, and if so, if the improvement was substantial enough to justify the extra expense and effort needed to obtain a MRI guided biopsy.  This study performed at the National Cancer Institute’s Clinical Center sought to address this clinical question of interest.  From 2007-2014, a total of 1003 men suspected to have prostate cancer underwent an MRI of the prostate.  If an area of suspicion was seen in the prostate, these men underwent both the targeted biopsy of the suspicious region in the prostate as well as the standard 12-core needle biopsy during the same session.  The results from the targeted biopsy were compared to the results of the standard biopsy.

The key findings in this study was that targeted biopsy improved the rate at which high-risk clinically significant cancer was diagnosed by 30%.  Of interest, the study also found that low-risk, clinically insignificant disease (the type of prostate cancer that is unlikely to cause any harm to the patient over the course of his natural life) was decreased in diagnosis by 17%.  Decrease of diagnosis of such disease has the potential benefit that it could lead to less over-treatment of cancer that never needed to be treated.  In a subset of 170 men that ultimately underwent surgery to remove the prostate to treat their cancer, we were further able to examine how well the prostate biopsy reflected the actual cancer burden in the whole gland.   It is well known that standard biopsy can actually underestimate the total cancer grade in the whole prostate in upwards of 30-40% of cases.  We found that the targeted biopsy was significantly better at predicting whether the patient had intermediate to high-risk cancer compared to standard biopsy.  Through further analysis using a statistical method called decision curve analysis, we further found that for men who wish to undergo surgery for intermediate to high-risk cancer, but wish to go on active surveillance for low-risk cancer, targeted biopsy led to better decision making compared to standard biopsy, or even the two techniques combined.

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Brain Study Reveals Emotional Instability Foci in Autism

Gabriel S. Dichter, PhD Associate Professor UNC Departments of Psychiatry and Psychology Carolina Institute for Developmental Disabilities MedicalResearch.com Interview with:
Gabriel S. Dichter, PhD

Associate Professor
UNC Departments of Psychiatry and Psychology
Carolina Institute for Developmental Disabilities

Medical Research: What is the background for this study? What are the main findings?

Dr. Dichter: The background for this study is that although most brain imaging research in autism spectrum disorders has focused on understanding the brain basis of social communication impairments, we know that autism symptoms are pervasive and may include difficulties with irritability, anxiety, mood, and even in some instances aggression or self injurious behaviors.  Additionally, these types of associated features are among the first that prompt parents to bring their child to a pediatrician for an evaluation for a neurodevelopmental disorder, and so we know these symptoms can be deeply troubling to parents.  All of these associated symptoms of autism suggest difficulty with regulating emotional responses, and so our team set out to investigate the brain basis of these difficulties.  We taught participants with and without autism simple strategies to change their emotion responses and then scanned them using functional MRI to measure brain activity when they actively tried to change their emotional responses to pictures of faces.  Our central finding was that although they reported they were able to change their emotional responses, brain imaging findings told us something quite different.  The dorsolateral prefrontal cortex, a part of the brain that controls emotional responses, was underactive in the participants with autism.  Consequently, they were less able to modulate parts of the brain’s limbic system that produces strong emotional responses.  In other words, they had difficulty “turning on the brakes” to control emotional responses.  Finally, the differences we observed in their brain activity predicted the severity of their overall autism symptoms, suggestion a direct linkage between emotion regulation impairments and autism severity. Continue reading

Primary Care Physicians Believe Advanced Radiology Imaging Important For Patient Care

Christine Hughes Hadley Hart Group, Chicago, IllinoisMedicalResearch.com Interview with:
Christine Hughes
Hadley Hart Group, Chicago, Illinois

Medical Research: What is the background for this study?

Response: Value in healthcare is a popular topic today. Yet no clear value measures have been developed which could be used in policy decisions on reimbursement for diagnostic imaging procedures.  Within the imaging sector it is a given that imaging has value.  However efforts to articulate that value to payers and policy makers and others outside the sector have come up short.   We did conduct qualitative research with radiologists but during this process of mapping a value chain it became clear that those M.D.s who use the data that radiology provides to make decisions on patient care could better speak to imaging’s value.  And primary care because of the gatekeeper status for all types of care seemed appropriate.

Medical Research: What are the main findings?

Response: Primary care physicians highly value access to advanced imaging: 88% of the PCPs indicated that advanced imaging increases their diagnostic confidence; 90% believe imaging provides data not otherwise available; 88% reported access to imaging  permits better clinical decision making;  88% reported increases confidence in treatment choices , and 86% say it shortens time to definitive diagnosis. Most  Primary care physicians ( 85%) believe that patient care would be negatively impacted without access to advanced imaging.

One very interesting finding is in differences in attitudes and valuations in younger vs. older physicians towards advanced imaging modalities.  For the purposes of this part of the analysis we divided the survey respondents into those in practice 1-20 years and those practicing radiology more than 21 years.  Presumably those practicing less 21 years trained with ready access to advanced imaging versus those who presumably having practiced without ready access to the advanced imaging modalities of MRI, CT and PET. Respondents who have practiced without ready access attach higher value to the ability to shorten the time to definitive diagnosis, ability to replace invasive procedures, make better clinical decisions, and believe the quality of patient care would be negatively impacted without access to advanced imaging.  The younger physicians attach more value to the practice efficiency issues such as enabling the Primary care physician to see more patients, or patient centric issues like the ability to communicate on a visual level with the patient.

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Study Examines Follow-up Of Abnormal Radiology Results

MedicalResearch.com Interview with:
Aymer Al-Mutairi, MD
Primary Care Research fellow
Dept. Family and Community Medicine
Baylor College of Medicine

Medical Research: What is the background for this study? What are the main findings?

Dr. Al-Mutairi: Previous studies indicate that 8% of abnormal imaging results did not receive follow-up actions by referring providers within 4 weeks. In addition, abnormal imaging results often state recommendations for further testing and radiology reports occasionally contain language that conveys doubt regarding the results.

We hypothesized that recommendations for further imaging, and expressions of doubt or uncertainty in the radiology report, are more likely to be associated with lack of timely follow-up. We found that patients with abnormal imaging results where radiologists recommended further imaging were less likely to be followed-up by a treating clinician within 4 weeks compared with patients without such recommendations. Expression of “doubt” in the radiology reports did not affect follow-up actions.

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Endoscopic Imaging System Sees and Treats Tumors

Ulas Sunar, Ph.D. Research Assistant Prof. Dept of Biomedical Engineering SUNY-University at BuffaloMedicalResearch.com Interview with:
Ulas Sunar, Ph.D.

Research Assistant Prof.
Dept of Biomedical Engineering
SUNY-University at Buffalo

Medical Research: What is the background for this device? What are the main implications?

Dr. Sunar: Most of ovarian cancer cases are not diagnosed until after the disease has spread in the abdominal cavity. A major challenge is to detect and remove dozens or hundreds of metastatic tumor nodules within the abdominal cavity. Fluorescence endoscopy can utilize the high sensitivity and specificity of fluorescence contrast and high resolution of endoscopic imaging.

We are developing a clinically-relevant, fiber-based endoscopy system that allows both accurate fluorescence imaging and for projecting adaptive-shaped light for light-induced chemodrug delivery. The system can provide high contrast for improved demarcation and trigger drug release to destroy micrometastases. The system utilizes a highly sensitive camera and structured light illumination scheme with a projector for accurate fluorescence imaging of drug distribution, as well as allows light-triggered drug release and adaptive light delivery for optimized treatment of micrometastases. We expect that our novel illumination and drug release strategy will permit lower doxorubicin doses to be administered while simultaneously achieving more specific drug delivery in order to destroy the micrometastases and improve survival rates.

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CT Scanner in Emergency Room Improves ER Efficiency

Ania Z. Kielar, MD, FRCPC Department of Radiology at the University of Ottawa The Ottawa Hospital, Ottawa, Ontario,CanadaMedicalResearch.com Interview with:
Ania Z. Kielar, MD, FRCPC
Department of Radiology at the University of Ottawa
The Ottawa Hospital, Ottawa, Ontario,Canada

Medical Research: What is the background for this study? What are the main findings?

Dr. Kielar: One of the goals of imaging is to provide homogeneous and consistent, high-quality care for patients using available equipment.  In our hospital system, we had two separate hospitals that merged to form one teaching centre over 15 years ago.  Most processes and protocols are same between the two hospital sites as a result of having the same administration and the same University affiliation. Also,  the same residents and staff  rotate through the emergency departments and radiology departments at both hospitals.  One variable that persists is the location of the CT scanner.  At one center a space was created to place a CT scanner in the Emergency Department. At the other site, the CT scanner is in the radiology department.  For non-trauma cases, we wanted to see if the difference in distance of the scanner with respect to  the emergency department location, has a role in the time required to obtain CT scan from the time it is requested ,as well as the time to final patient disposition. We defined final patient disposition to include admission, subspecialty consultation or discharge home.

Medical Research: What are the main findings?

Dr. Kielar:  We found that there was a statistically significant difference in the time between requested CT and time to completion of the CT between the two hospital sites. It was faster when the CT scanner was located in the emergency department.  This was in the range of 16 minutes ,which is longer than simply the time required to walk over (and back) to the the CT scanner from the emergency department.

We also found a statistically significant difference in the time of the final patient disposition.  Of note, there was no statistically significant difference noted in the time to obtain a CT scan as well as the preliminary radiology interpretation for patients with hyperacute conditions such as suspected abdominal aortic aneurysm rupture, regardless of the location of the CT scanner with respect to the ED.

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Ultrasonography For All Dense Breasts Not Cost Effective

 Brian L. Sprague, PhD Office of Health Promotion Research, University of Vermont, Burlington, VT MedicalResearch.com Interview with: 
Brian L. Sprague, PhD
Office of Health Promotion Research,
University of Vermont, Burlington, VT


MedicalResearch: What is the background for this study?

Dr. Sprague: Mammographic breast density refers to the appearance of breast tissue on a mammogram.  High breast density means that there is a greater amount of glandular tissue and connective tissue, which appears white on a mammogram.  It is more difficult to detect breast cancer on a mammogram when there is greater breast density.  It has also been shown that women with dense breasts are at a higher risk of developing breast cancer.  Because of these two factors, women with dense breasts have a greater chance of developing breast cancer after a normal screening mammogram than women whose breasts are not dense.  Many states have now passed laws that require mammography facilities to inform women with dense breasts so that they are aware of this.  Similar legislation is now under consideration at the national level.  More than 40% of women undergoing mammography screening have dense breasts.

Researchers are trying to determine whether supplemental breast cancer screening with other tools would improve outcomes for women with dense breasts.  One possible approach is to use ultrasound imaging to screen for breast cancer in women with dense breasts after they have had a normal mammogram.  We wanted to estimate the benefits, harms, and cost-effectiveness of this approach compared to mammography screening only.  No randomized trials or observational studies have assessed long term outcomes after ultrasound screening for women with dense breasts, but we have short term data on how often cancer is diagnosed by ultrasound screening and how often false positive exams occur.  We used computer simulation modeling to estimate long term outcomes by combining the currently available data on mammography and ultrasound screening with the best available data on breast cancer risk and survival.

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Meniscal Knee Surgery May Accelerate Arthritis and Cartilage Loss

Frank W. Roemer, MD Associate Professor of Radiology Co-Director, Quantitative Imaging Center (QIC), Department of Radiology Boston University School of Medicine Boston MA 02118MedicalResearch.com Interview with:
Frank W. Roemer, MD

Associate Professor of Radiology
Co-Director, Quantitative Imaging Center (QIC), Department of Radiology Boston University School of Medicine
and Associate Professor of Radiology, University of Erlangen-Nuremberg, Germany

Medical Research: What is the background for this study? What are the main findings?

Dr. Roemer: Meniscal surgery is one of the most common orthopedic procedures performed in order to alleviate pain and improve joint function. However, increasing evidence is emerging that suggests that meniscal resection is detrimental for knee joint preservation including accelerated rates of OA and joint deterioration defined as cartilage loss. Our study focuses on disease onset and shows that structural damage due to surgery might also be observed in these early stages of disease. In light of this the indications for performing meniscal surgery might need to be defined more stringently as is the case today in order to preserve joint structure in the long term.
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3D Printing Will Guide and Improve Face Transplantation

Frank J. Rybicki, MD PhD Director, Applied Imaging Science Laboratory Director, Cardiac CT and Vascular CT / MRI Brigham and Women's Hospital Associate Professor, Harvard Medical School Boston, MAMedicalResearch.com Interview with
Frank J. Rybicki, MD PhD
Director, Applied Imaging Science Laboratory
Director, Cardiac CT and Vascular CT / MRI
Brigham and Women’s Hospital
Associate Professor, Harvard Medical School
Boston, MA

Medical Research: What is the background for this study? What are the main findings?

Dr. Rybicki: Face transplantation restores form and function to patients with catastrophic facial injuries. To date, surgical planning a vascular anastamoses have been well described. While all 7 patients at BWH have had 3d printed models from their CT scans, to date the findings and impact of 3D printing has not been described. Also, the role of printing the soft tissues of the face has not been described.

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More CT Scans Done For Minor Head Trauma Than Guidelines Recommend

Dr. Jennifer Marin MD MSc Director of Emergency Ultrasound, Division of Pediatric Emergency Medicine Assistant Professor of Pediatrics and Emergency Medicine University of Pittsburgh School of MedicineMedicalResearch.com Interview with:
Dr. Jennifer Marin MD MSc

Director of Emergency Ultrasound
Division of Pediatric Emergency Medicine
Assistant Professor of Pediatrics and Emergency Medicine
University of Pittsburgh School of Medicine

Medical Research: What is the background for this study? What are the main findings?

Dr. Marin: Overuse of diagnostic imaging in the emergency department has become a focus of concern from policy makers, patients, and physicians. There are evidence-based clinical decision rules and policy recommendations published in order to optimize the use of such imaging. However, physicians don’t necessarily use these tools in their decision-making. Head computed tomography (CT) imaging for patients with minor head trauma is a common CT performed in the emergency setting. Our study sought to evaluate how often physicians adhered to the American College of Emergency Physicians (ACEP) Clinical Policy on Neuroimaging. The policy outlines which patients warrant a CT in the setting of minor head trauma based on certain factors, such as age, mechanism of injury, and signs and symptoms of head trauma. What we found is that when the policy recommends that a head CT be performed, it is obtained more than 90% of the time. However, when a head CT is not recommended, it is actually obtained in nearly half of those patients. We hope this will draw attention to decision rules and clinical policies, such as that from ACEP, and remind physicians that using these tools can assist in appropriate imaging practices.
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Age-Related Macular Degeneration: Computerized Imaging Predicts Risk Progression

Daniel L. Rubin, MD, MS  Assistant Professor of Radiology and Medicine (Biomedical Informatics) Department of Radiology | Stanford University Stanford, CA 94305-5488MedicalResearch.com Interview with:
Daniel L. Rubin, MD, MS 
Assistant Professor of Radiology and Medicine (Biomedical Informatics)
Department of Radiology | Stanford University
Stanford, CA 94305-5488

Medical Research: What is the background for this study? What are the main findings?

Dr. Rubin: Age-Related Macular Degeneration is the leading cause of blindness and central vision loss among adults older than 65. An estimated 10-15 million people in the United States suffer from the disease, in which the macula — the area of the retina responsible for vision — shows signs of degeneration. While about one of every five people with AMD develop the so-called “wet” form of the disease that can cause devastating blindness. In wet AMD, abnormal blood vessels accumulate underneath the macula and leak blood and fluid. When that happens, irreversible damage to the macula can quickly ensue if not treated quickly. Until now, there has been no effective way to tell which individuals with AMD are likely to convert to the wet stage. Current treatments are costly and invasive — they typically involve injections of medicines directly into the eyeball — making the notion of treating people with early or intermediate stages of Age-Related Macular Degeneration a non-starter. In our study, we report on a computerized method that analyzes images of the retina obtained with a test called spectral domain optical coherence tomography (SD-OCT), and our method can predict, with high accuracy, whether a patient with mild or intermediate Age-Related Macular Degeneration will progress to the wet stage. Our method generates a risk score, a value that predicts a patient’s likelihood of progressing to the wet stage within one year, three years or five years. The likelihood of progression within one year is most relevant, because it can be used to guide a recommendation as to how soon to schedule the patient’s next office visit. In our study, we analyzed data from 2,146 scans of 330 eyes in 244 patients seen at Stanford Health Care over a five-year period. Patients were followed for as long as four years, and predictions of the model were compared with actual instances of conversion to wet AMD. The model accurately predicted every occurrence of conversion to the wet stage of AMD within a year. In approximately 40% of the cases when the model predicted conversion to wet AMD within a year, the prediction was not borne out, however. We are currently refining the model to reduce the frequency of these false positives.
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Practical Approach to Management of Incidental Thyroid Nodules

Dr. Jenny Hoang MBBS (Hons) Associate Professor of Radiology and Radiation Oncology Duke University Medical CenterMedicalResearch.com Interview with:
Dr. Jenny Hoang MBBS (Hons)

Associate Professor of Radiology and Radiation Oncology
Duke University Medical Center

 

Medical Research: What is the background for this study? What are the main findings?

Dr. Hoang: The incidental thyroid nodule (ITN) is a very common finding on imaging studies of the neck, chest and cervical spine. The workup of incidental thyroid nodules has led to increased costs from additional procedures and in some cases to increased risk to the patient. Physicians are concerned about the risk of malignancy and a delayed cancer diagnosis, but the majority of incidental thyroid nodules are benign and small incidental thyroid malignancies typically have indolent behavior.

The American College of Radiology (ACR) formed the Incidental Thyroid Findings Committee to derive a practical approach to managing ITNs on CT, MRI, nuclear medicine, and ultrasound studies. This white paper describes consensus recommendations representing the Committee’s review of the literature and their practice experience. Continue reading

Specialized MRI May Predict Early Cognitive Decline

Sven Haller, M.D. University of Geneva in Geneva, Switzerland.
MedicalResearch.com Interview with:

Sven Haller, M.D.
University of Geneva in Geneva, Switzerland.

Medical Research: What are the main findings of the study?

Dr. Haller: The main finding is that some elderly individuals with intact cognitive function at baseline already have visible alterations of the brain perfusion measured in Arterial Spin Labeling (ASL)  MRI, which is similar to patients with mild cognitive impairment (MCI). This elderly individual may initially maintain intact cognitive functions due to the activation of their cognitive reserve, yet eventually the cognitive reserve is exhausted and those individuals develop subtle cognitive decline at follow-up 18 months later.

Consequently, Arterial Spin Labeling MRI may predict the very earliest form of cognitive decline.

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Ultrasound Equal To CT As First Test For Kidney Stone Diagnosis

Rebecca Smith-Bindman, MD Professor in the Departments of Radiology; Epidemiology and Biostatistics; and Obstetrics, Gynecology and Reproductive Medicine UCSF San Francisco Calif.MedicalResearch.com Interview with:
Rebecca Smith-Bindman, MD
Professor in the Departments of Radiology;
Epidemiology and Biostatistics; and Obstetrics, Gynecology and Reproductive Medicine UCSF San Francisco Calif.


Medical Research: What are the main findings of the study?

Dr. Smith-Bindman: New technology is rapidly developed in medicine, and its important to understand how that technology should be used to improve patient health outcomes. Sometimes the technology is far better than existing technology and it should replace the earlier technology, and sometimes it is not and therefore should not be used. In this clinical scenario – I e. patients who present to an emergency department with abdomen or back pain thought to possibly reflect kidney stones, ultrasound is a simpler, less expensive , and more readily available test in the emergency department setting and therefore if it is equal to CT with respect to patient outcomes, it should be used as the first test in these patients. Currently, CT is the test widely used for patients with suspected kidney stones.

We assessed a large number of patients with suspected kidney stones seen at one of 15 large academic emergency medicine departments across the country. Patients were assigned to point of care ultrasound performed by an ED physician, radiology ultrasound or radiology CT. We assessed a broad range of patient centered outcomes and found each of the three tests we studied were equivalent in terms of these outcomes including complications related to missed diagnoses, related serious adverse events, time spent in the emergency department and repeated ED visits and hospitalizations. However, the exposure to ionizing radiation was around half as high in patients who underwent ultrasound as their first test, and thus ultrasound should be used as the first imaging test in patients with suspected nephrolithiasis.
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Carotid Stenosis: Using Cerebrovascular Reserve To Assess Stroke Risk

Ankur Pandya, PhD Assistant Professor of Healthcare Policy and Research Departments of Healthcare Policy and Research Weill Cornell Medical College New York, NY 10065.MedicalResearch.com Interview with:
Ankur Pandya, PhD
Assistant Professor of Healthcare Policy and Research
Departments of Healthcare Policy and Research
Weill Cornell Medical College
New York, NY 10065.

Medical Research: What are the main findings of the study?

Dr. Pandya: Asymptomatic carotid stenosis is a highly prevalent condition that can lead to ischemic stroke, which is a leading cause of death and healthcare costs in the U.S. Revascularization procedures are often performed on asymptomatic carotid stenosis patients, but experts have questioned whether the stroke prevention benefits outweigh the risks and costs of revascularization in these patients. Imaging-based stroke risk assessment has traditionally focused on the degree of artery narrowing, but there has been growing interest in using cerebrovascular reserve (CVR) assessment to stratify these patients into those that are more likely to have a stroke, and thus better candidates for revascularization, and those that would be better off with less invasive management strategies (such as medical therapy). We therefore developed a simulation model to evaluate whether the CVR-based decision rule could be used efficiently select the right patients for revascularization. We found that the CVR-based strategy represented the best value for money compared to immediate revascularizations or medical therapy-based treatment for all patients.
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Prostate Cancer Detection: Accuracy of Multiparametric MRI For Detection

Dr. Maarten de Rooij MD, PhD Candidate Department of Radiology, Radboud University Nijmegen Medical Centre, Nijmegen, Gelderland 6525 GA, The NetherlaMedicalResearch.com Interview with:
Dr. Maarten de Rooij MD, PhD Candidate
Department of Radiology
Radboud University Nijmegen Medical Centre
Nijmegen, Gelderland 6525 GA, The Netherlands

 

MedicalResearch.com: What are the main findings of the study?

Dr. de Rooij : Prostate cancer is the most common cancer in men and the second leading cause of cancer related death. The current diagnosis is based on ‘random or blind’ systematic transrectal ultrasound guided prostate biopsies in men with an elevated PSA. This can lead to over-diagnosis and over-treatment of prostate cancer, but can also miss important tumors. The role of multiparametric MRI (mpMRI) to improve the diagnosis of prostate cancer is evolving. In this meta-analysis we determined the diagnostic accuracy of mpMRI for the detection of prostate cancer. Our analysis included 7 studies using mpMRI which showed high overall specificity (0.88; 95% CI 0.82-0.92), with variable but high negative predictive values (0.65 – 0.95) and sensitivities (0.74; 95% CI 0.66-0.81).
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Headache Imaging Costs $1 Billion Dollars Per Year

Dr. Brian C. Callaghan MD Department of Neurology University of Michigan Health System, Ann ArborMedicalResearch.com Interview Invitation with:
Dr. Brian C. Callaghan MD
Department of Neurology
University of Michigan Health System, Ann Arbor


MedicalResearch.com: What are the main findings of the study?

Dr. Callaghan:  The main findings are that we order headache neuroimaging (MRIs and CTs) frequently, this accounts for approximately $1 billion dollars annually, and the number of tests ordered is only increasing with time.
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ALS Amyotrophic Lateral Sclerosis: FDG-PET as Marker of Cerebral Involvement

Prof. Dr. Philip Van Damme, MD, PhD Neuromuscular Reference Center, Neurology Department, University Hospitals Leuven Vesalius Research Center, VIB, Leuven Leuven Institute of Neurodegenerative Disorders (LIND) KU Leuven, BelgiumMedicalResearch.com Interview with:
Prof. Dr. Philip Van Damme, MD, PhD
Neuromuscular Reference Center, Neurology Department, University Hospitals Leuven
Vesalius Research Center, VIB, Leuven
Leuven Institute of Neurodegenerative Disorders (LIND)
KU Leuven, Belgium

MedicalResearch.com: What are the main findings of the study?

Prof: Van Damme: Earlier FDG-PET studies carried out in the 80’ties already pointed out that patients with ALS had decrease glucose uptake in the brain that is more extended than the motor cortex, at least at the group level. Of course, this imaging technique has been improved since then.

We prospectively assessed the diagnostic and prognostic value of FDG-PET in patients that were referred to us because a diagnosis of ALS was suspected.

The most important finding of our study probably is that FDG-PET shows perirolandic and variable frontotemporal hypometabolism in most patients with ALS at the first presentation in our clinic. It suggests that FDG-PET is a very sensitive marker of cerebral involvement in ALS, which has a high sensitivity at the single patient level.

In addition our study revealed that the co-occurrence of extensive prefrontal or anterior temporal hypometabolism was present in about 10% of patients and had a negative effect on survival after disease onset.
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Breast Imaging with Combined MRI and Near Infrared Spectroscopy

Michael Mastanduno Thayer School of Engineering, Dartmouth College 14 Engineering Dr. Hanover, NH 03755MedicalResearch.com Interview with:
Michael Mastanduno
Thayer School of Engineering, Dartmouth College
14 Engineering Dr.
Hanover, NH 03755


MedicalResearch.com: What are the main findings of the study?

Answer: The study was able to illustrate the design and clinical testing of an MRI breast coil for combined MRI and Near Infrared Spectroscopy. The coil was tested on 8 healthy volunteers spanning all bra cup sizes and mammographic density categories. In the past, MRI/NIRS imaging was only possible in C and D cup sized breasts. The system also will give researchers the ability to target lesions in hard-to-reach areas close to the chest wall. With the successful completion of this study, simultaneous MRI/NIRS is possible in all breast sizes, tissue compositions, and lesion locations.
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ADHD: Using MRI to Measure Brain Iron

Dr. Vitria Adisetiyo, Ph.D. Postdoctoral Research Fellow Medical University of South Carolina Center for Biomedical Imaging Charleston, SC 29425MedicalResearch.com Interview with:
Dr. Vitria Adisetiyo, Ph.D.
Postdoctoral Research Fellow
Medical University of South Carolina
Center for Biomedical Imaging Charleston, SC 29425


MedicalResearch.com: What are the main findings of the study?

Dr. Adisetiyo:  Using a non-invasive MRI method called magnetic field correlation imaging, we detected significantly reduced striatal and thalamic brain iron in medication-naive children and adolescents with ADHD compared to age-, gender- and IQ-matched typically developing controls. ADHD patients who had a history of psychostimulant medication treatment (e.g. Ritalin, Aderrall) had brain iron levels comparable to controls, suggesting brain iron may normalize with psychostimulants. Blood iron measures did not differ between patients and controls.

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Breast Density Associated with Increased Breast Cancer Risk

Nicholas M Perry MD London Breast InstituteMedicalResearch.com Interview with:
Nicholas M Perry MD
London Breast Institute

MedicalResearch.com: What are the main findings of your study?

Dr. Perry: The main findings from the study were that automated density readings outperformed radiologists, and that women under the age of 50 had a more significant risk of breast cancer from higher breast density.

Also, and quite surprising was the appearance of a completely different age- density pattern in women with breast cancer. Whereas the women in the study without cancer showed a normal and steady decline in breast density with age, those with cancer showed a completely different curvi-linear pattern, which was evident in women as young as 30.

The message is that breast density remains an important factor for both the current breast screening methodologies, and for future research into investigation and management.
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Cancer Risk from Imaging Radiation in Ischemic Heart Disease

Prof. Dr. Gunnar Brix Division of Medical and Occupational Radiation Protection Federal Office for Radiation Protection Institut für Med. Strahlenhygiene 85764 NeuherbergMedicalResearch.com:
Prof. Dr. Gunnar Brix

Division of Medical and Occupational Radiation Protection
Federal Office for Radiation Protection
Institut für Med. Strahlenhygiene
85764 Neuherberg
MedicalResearch.com:  What are the main findings of the study?

Answer: We investigated the cumulative radiation exposure and cancer risk of more than 1200 patients with ischemic heart diseases (IHD) from diagnostic and therapeutic imaging procedures performed 3 month before and 12 month after the date of diagnosis. The major findings were:

  • ­    87% of patient exposure resulted from heart catheter procedures.
  • ­    The average cumulative effective dose was 13.3 mSv in males and 10.3 mSv in females. The highest dose was nearly 100 mSv.
  • ­    The estimated average attributable life-time risk of male and female patients to develop a radiation-induced cancer in their remaining life was 0.09 % and  0.07 %, respectively. This correspond to 1 excess cancer in about 1100 male and 1400 female IHD patients. The highest risk was 0.9 %.
  • ­ The effective dose is inadequate to characterize individual radiation risks, since neither the age nor the sex of the patient is taken into account. According to our results, cancer risks can vary by a factor of more than 10 for comparable values of the effective dose. Continue reading

Mammography: Screening Recall Rate and Practice Site

 Ana P Lourenco MD  Assistant Professor of Diagnostic Imaging Alpert Medical School of Brown UniversityMedicalResearch.com Interview with: Ana P Lourenco MD

Assistant Professor of Diagnostic Imaging
Alpert Medical School of Brown University


MedicalResearch.com What are the main findings of the study?

Dr. Lourenco: Our study found a significantly higher recall rate for screening mammography at a tertiary referral hospital compared with a community private practice.  We compared recall rates for 5 fellowship trained radiologists reading at both sites, and all five radiologists had higher recall rates at the hospital site.  When we analyzed patient factors in an effort to explain why this might be, we found that the average age of patients in the hospital was younger (which is known to be associated with higher recall rate) and that more patients at the hospital had a personal history of prior breast biopsy or surgery (also known to be associated with higher recall rate).

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PET/MRI : A Feasible Modality for Cardiac Imaging

Hybrid PET/MR Imaging of the Heart: Feasibility and Initial Results
Felix Nensa, MD
Department of Diagnostic and Interventional Radiology and Neuroradiology
University Hospital Essen, University of Duisburg-Essen,
Hufelandstrasse 55, 45147 Essen, Germany;

MedicalResearch.com: What are the main findings of the study?

Dr. Nensa: Cardiac positron emission tomography (PET)/magnetic resonance imaging (MRI) with fluorine 18 fluorodeoxyglucose (FDG) turned out to be feasible with an integrated whole-body 3-Tesla PET/MRI system. Despite the presence of a PET detector in the magnetic field of the MR imaging unit, high-quality cardiac MR images were acquired. PET images originating from a PET/CT and the PET/MR scanner showed very good visual agreement and no statistical significant difference of the mean was found in standardized uptake values, however, variance was considerable. In patients with myocardial infarction, PET and MR images were in good concordance regarding both, cine imaging and late gadolinium-enhanced imaging.

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Lung Cancer: Screening with Low-Dose CT

MedicalResearch.com Interview with:
Linda L. Humphrey, M.D., M.P.H.
Professor of Medicine
Informatics and Clinical Epidemiology and Public Health for Oregon Health & Science University;Associate Chief of Medicine at the Portland VA Medical Center

Dr. Humphrey comments on this important study on
Screening for Lung Cancer With Low-Dose Computed Tomography:

Lung cancer is the 3rd leading cause of cancer in the United States and the leading cause of cancer related death.  It is estimated that in 2012 there were 226,160 cases of lung cancer and 160, 340 lung cancer related death in the US.   In addition, lung cancer is the leading cause of years of life lost to cancer.   Cigarette smoking is by far the leading cause of lung cancer in the US and while many people have quit smoking, data in the US indicate that 37% of adults are either current or former smokers and at risk of lung cancer.    Continue reading

Tomosynthesis Reduces Mammogram Call-Backs for Additional Testing

MedicalResearch.com Interview with Dr. Brian Haas MD Department of Diagnostic Radiology,Yale University School of Medicine, New Haven, CT
Dr. Brian Haas MD
Department of Diagnostic Radiology,Yale University School of Medicine, New Haven, CT

MedicalResearch.com: What are the main findings of the study?

Dr. Haas: We found that tomosynthesis helped to reduce the number of women who undergo a screening mammogram and are called back for additional imaging and testing. Specifically, the greatest reductions in patients being called back were seen in younger patients and those with dense breasts. Tomosynthesis is analogous to a 3D mammogram, and improves contrast of cancers against the background breast parenchyma.
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