FDG-PET in HIV-Positive Patient with Extranodal Diffuse Large B-Cell Lymphoma.

Extranodal diffuse large B-cell lymphoma (DLBCL) is a heterogeneous disease process and an aggressive form of non-Hodgkin's lymphoma. We present a case of multiorgan involvement of DLBCL in a patient with documented risk factors, including [ 18 F] fluorodeoxyglucose positron emission tomography/magnetic resonance imaging findings highlighting striking perineural spread involving intracranial and extracranial segments of the bilateral trigeminal nerves.

Optimization of [18F]-FDOPA Brain PET Acquisition Times for Assessment of Parkinsonism in the Clinical Setting.

BACKGROUND AND PURPOSE: Fluorine 18-fluoro-L-dopa ([18F]-FDOPA) was approved by the FDA in 2019 and reimbursed by the Centers for Medicare & Medicaid Services in 2022 for use with PET to visualize dopaminergic nerve terminals in the striatum for evaluation of parkinsonism. We sought to determine the optimal image acquisition time for [18F]-FDOPA PET by evaluating rater-estimated FDOPA positivity and image quality across 4 time points. MATERIALS AND METHODS: Brain PET/CT was acquired 90 minutes following injection of 185 megabecquerel (5 mCi) of [18F]-FDOPA. PET was acquired in list mode for 20 minutes, and data were replayed to represent 15-, 10-, and 5-minute acquisitions. By means of MIMneuro, PET/MR imaging or PET/CT was independently graded for FDOPA positivity and image quality by 2 readers, blinded to the clinical report and diagnosis. Expert neuroradiologist clinical reads were used as the criterion standard. RESULTS: Twenty patients were included, average age 65.6 years, 55% women. Image-quality ratings decreased with shorter acquisition times for both readers (reader 1, ρ = 0.23, P = .044; reader 2, ρ = 0.24, P = .036), but there was no association between abnormality confidence scores and acquisition time (reader 1, ρ = -0.13, P = .250; reader 2, ρ = -0.19, P = .100). There was a high degree of consistency in intra- and interrater agreement and agreement with the expert reads when using acquisition times of ≥10 minutes (maximal confidence score consistency [ρ = 0.92] and interrater agreement [κ = 0.90] were observed at 15 minutes), while image quality was consistently rated as low and FDOPA positivity ratings were inconsistent when using a 5-minute acquisition time. CONCLUSIONS: Our study suggests that image-quality ratings were stable after 15 minutes and that between-subject abnormality detection rates were highly consistent between the 2 readers when acquired for at least 10 and up to 20 minutes but were inconsistent at 5 minutes. Shorter [18F]-FDOPA PET acquisition times may help maximize patient comfort while increasing throughput in the clinical setting.

Radiology advocacy: Promoting collaboration between trainees and professional societies.

From mammographic screening guidelines to resident work hour regulations, public policy affects every aspect of the practice of radiology and ultimately determines how radiological care is delivered to patients. Shaping public policy through advocacy is therefore critical to ensure patient access to equitable, high-quality radiological care. In advocacy, individual practicing radiologists and radiology trainees can increase the scope of their influence by collaborating with professional radiology societies. When radiology trainees participate in organized radiology advocacy, they learn about regulatory and legislative issues that will affect their careers, and they learn how to effect policy change. Radiology societies in turn benefit from trainee involvement, as engaging trainees early in their careers leads to more robust future participation and leadership. To encourage trainee involvement, radiology societies can engage individual residency programs and medical student radiology interest groups, invest in trainee-focused events, and maximize the number of positions of responsibility open to trainees. To circumvent the barriers to participation that many trainees face, radiology societies can make meeting proceedings free and available through virtual mediums. Through active collaboration, trainees and professional societies can help assure a bright future for radiologists and patients in need of radiological care.

The early effect of COVID-19 on dental infections by neuroimaging in the emergency department setting.

OBJECTIVES: In early 2020, at COVID-19's onset in the United States, the American Dental Association recommended postponing elective dental procedures to minimize viral spread. Subsequently, concerns arose that this could result in increased dental infections and resultant emergency department visits. This study quantifies the number and severity of dental infections at the onset of the early COVID-19 outbreak in early 2020 in the Northeast United States resulting in emergency room visits and radiographic imaging compared to 2017-2019 with an analysis of geographic population characteristics. METHODS: Cross-sectional head and neck imaging performed at an East Coast hospital system was retrospectively reviewed for dental infections from March 2020 through December 2020, and compared to prior years 2017-2019. Inclusion criteria included radiology reporting of a dental infection, ranging in severity. Electronic medical records (EMR) and imaging reports were queried for patient characteristics and dental findings. RESULTS: There were 735 confirmed imaging reports of odontogenic infections. There was a significant increase in imaging reporting of odontogenic infections in the post-shutdown period. These were more frequently early-type infections, involved a higher proportion of male and non-white patients, and the patients were more often from disadvantaged zip codes when compared with prior years. CONCLUSIONS: These findings highlight the varying impact of outpatient dental office closures on different socioeconomic groups in the setting of a pandemic. Potential implications include increased morbidity and mortality for patients, as well as increased cost and resource allocations for the healthcare system.

Using artificial intelligence in medical school admissions screening to decrease inter- and intra-observer variability.

Objectives: Inter- and intra-observer variability is a concern for medical school admissions. Artificial intelligence (AI) may present an opportunity to apply a fair standard to all applicants systematically and yet maintain sensitivity to nuances that have been a part of traditional screening methods. Material and Methods: Data from 5 years of medical school applications were retrospectively accrued and analyzed. The applicants (m = 22 258 applicants) were split 60%-20%-20% into a training set (m = 13 354), validation set (m = 4452), and test set (m = 4452). An AI model was trained and evaluated with the ground truth being whether a given applicant was invited for an interview. In addition, a "real-world" evaluation was conducted simultaneously within an admissions cycle to observe how it would perform if utilized. Results: The algorithm had an accuracy of 95% on the training set, 88% on the validation set, and 88% on the test set. The area under the curve of the test set was 0.93. The SHapely Additive exPlanations (SHAP) values demonstrated that the model utilizes features in a concordant manner with current admissions rubrics. By using a combined human and AI evaluation process, the accuracy of the process was demonstrated to be 96% on the "real-world" evaluation with a negative predictive value of 0.97. Discussion and Conclusion: These results demonstrate the feasibility of an AI approach applied to medical school admissions screening decision-making. Model explainability and supplemental analyses help ensure that the model makes decisions as intended.

Hypertrophic cardiomyopathy - phenotypic variations beyond wall thickness.

Hypertrophic cardiomyopathy (HCM) is characterized by left ventricular hypertrophy (LVH) in the absence of another causal disease. Several morphologic and histologic changes have been described. Given the morbidity and mortality associated with HCM, understanding these anatomic variations is key to interpreting imaging. This is especially important since many patients exhibit these associated findings in the absence of LVH and prompt early detection of these variations may lead to early diagnosis and treatment. This article describes the appearance of morphologic variations seen in HCM beyond myocardial thickening including: papillary muscle and mitral valve variants, myocardial crypts, left ventricular myocardial bands, and dystrophic calcification related to increased wall tension.

Unique Imaging Findings of Neurologic Phantosmia Following Pfizer-BioNtech COVID-19 Vaccination: A Case Report.

ABSTRACT: Olfactory dysfunction related to SARS-CoV-2 infection and COVID-19 disease is now well established in the literature. In December 2020, the FDA approved the Pfizer-BioNTech and Moderna vaccines for use in preventing COVID-19 in the United States. To the best of our knowledge, this is the first report of a phantosmia post-Pfizer COVID-19 vaccination, with positive magnetic resonance imaging radiographic findings in a patient with documented absence of infection by SARS-CoV-2 virus or concomitant sinonasal disease.

Computed Tomography Features of Coronavirus Disease 2019 (COVID-19): A Review for Radiologists.

Coronavirus Disease 2019 (COVID-19) pneumonia has become a global pandemic. Although the rate of new infections in China has decreased, currently, 169 countries report confirmed cases, with many nations showing increasing numbers daily. Testing for COVID-19 infection is performed via reverse transcriptase polymerase chain reaction, but availability is limited in many parts of the world. The role of chest computed tomography is yet to be determined and may vary depending on the local prevalence of disease and availability of laboratory testing. A common but nonspecific pattern of disease with a somewhat predictable progression is seen in patients with COVID-19. Specifically, patchy ground-glass opacities in the periphery of the lower lungs may be present initially, eventually undergoing coalescence, consolidation, and organization, and ultimately showing features of fibrosis. In this article, we review the computed tomography features of COVID-19 infection. Familiarity with these findings and their evolution will help radiologists recognize potential COVID-19 and recognize the significant overlap with other causes of acute lung injury.

Liposomal bupivacaine versus bupivacaine/epinephrine after video-assisted thoracoscopic wedge resection†.

OBJECTIVES: The purpose of this research is to compare liposomal bupivacaine and bupivacaine/epinephrine for intercostal blocks related to analgesic use and length of stay following video-assisted thoracoscopic wedge resection. METHODS: A retrospective study of patients undergoing video-assisted thoracoscopic wedge resection from 2010 to 2015 was performed. We selected patients who stayed longer than 24 h in hospital. Primary outcomes were length of stay and postoperative analgesic use at 12-h intervals from 24 to 72 h. RESULTS: Intercostal blocks were performed with liposomal bupivacaine in 62 patients and bupivacaine/epinephrine in 51 patients. A Wilcoxon signed-rank test evaluated differences in median postoperative analgesic use and length of stay. Those who received liposomal bupivacaine consumed fewer analgesics than those who received bupivacaine/epinephrine, with a statistically significant difference from 24 to 36 h (20.25 vs 45.0 mg; P = 0.0059) and from 60 to 72 h postoperatively (15.0 vs 33.75 mg; P = 0.0350). In patients who stayed longer than 72 h, the median cumulative analgesic consumption in those who received liposomal bupivacaine was statistically significantly lower than those who received bupivacaine/epinephrine (120.0 vs 296.5 mg; P = 0.0414). Median length of stay for the liposomal bupivacaine and bupivacaine/epinephrine groups were 45:05 h and 44:29 h, respectively. There were no adverse events related to blocks performed with liposomal bupivacaine. CONCLUSIONS: Thoracic surgery patients who have blocks performed with liposomal bupivacaine require fewer analgesics postoperatively. This may decrease complications related to poor pain control and decrease side effects related to narcotic use in our patient population.

Management Strategy for Patients With Chronic Subclavian Vein Thrombosis.

We performed a systematic review to determine best practice for the management of patients with chronic or subacute subclavian vein thrombosis. This condition is best managed with surgical excision of the first rib followed by long-term anticoagulation. Interventional techniques aimed at restoring patency are ineffective beyond 2 weeks postthrombosis. Additional therapeutic options should be made based on the severity of symptoms as well as vein status. Patients with milder symptoms are given decompression surgery followed by anticoagulation whereas patients with more severe symptoms are considered for either a jugular vein transposition or saphenous patch based on the vein characteristics.