Magnetic resonance imaging for prospective assessment of local recurrence of non-small cell lung cancer after stereotactic body radiation therapy.

OBJECTIVES: To evaluate multi-parametric MRI for distinguishing stereotactic body radiation therapy (SBRT) induced pulmonary fibrosis from local recurrence (LR). MATERIALS AND METHODS: SBRT treated non-small cell lung cancer (NSCLC) patients suspected of LR by conventional imaging underwent MRI: T2 weighted, diffusion weighted imaging, dynamic contrast enhancement (DCE) with a 5-minute delayed sequence. MRI was reported as high or low suspicion of LR. Follow-up imaging ≥12 months or biopsy defined LR status as proven LR, no-LR or not-verified. RESULTS: MRI was performed between 10/2017 and 12/2021, at a median interval of 22.5 (interquartile range 10.5-32.75) months after SBRT. Of the 20 lesions in 18 patients: 4 had proven LR, 10 did not have LR and 6 were not verified for LR due to subsequent additional local and/or systemic therapy. MRI correctly identified as high suspicion LR in all proven LR lesions and low suspicion LR in all confirmed no-LR lesions. All proven LR lesions (4/4) showed heterogeneous enhancement and heterogeneous T2 signal, as compared to the proven no-LR lesions in which 7/10 had homogeneous enhancement and homogeneous T2 signal. DCE kinetic curves could not predict LR status. Although lower apparent diffusion coefficient (ADC) values were seen in proven LR lesions, no absolute cut-off ADC value could determine LR status. CONCLUSION: In this pilot study of NSCLC patients after SBRT, multi-parametric chest MRI was able to correctly determine LR status, with no single parameter being diagnostic by itself. Further studies are warranted.

No correlation between diffuse idiopathic skeletal hyperostosis and coronary artery disease on computed tomography using two different scoring systems.

BACKGROUND: An association between diffuse idiopathic skeletal hyperostosis (DISH) and a history of coronary artery disease (CAD) was previously reported. PURPOSE: To investigate the association between DISH and CAD as assessed using the coronary artery calcification score (CACS) and the CAD-Reporting and Data System (CAD-RADS) score in patients with symptomatic chest pain. MATERIAL AND METHODS: Consecutive cardiac CT scans performed before and after IV contrast administration were evaluated for CACS (Agatston method), CAD-RADS, and the presence of DISH. The association of DISH with the presence and extent of CACS/CAD-RADS scores was analyzed with and without adjustment for known atherosclerotic risk factors. RESULTS: The study cohort included 268 individuals (157 men, 111 women; median age = 54 years). DISH was present in 65 (24.3%) individuals. CACS was significantly higher in the DISH group compared to the non-DISH group in the univariate analysis (median CACS DISH = 2, range = 0-80.5 vs. median CACS non-DISH = 0, range = 0-11; P < 0.005) but this association did not persist on multivariate analysis. There was a positive trend toward higher CAD-RADS scores in the DISH group (P = 0.03) but after adjustment for age, male sex, and family history, this tendency was not significant. CONCLUSION: No independent association was found between the presence of DISH and CACS and CAD-RADS scores. Our findings suggest a more complex and possibly non-causal relationship between coronary artery disease and DISH.

Trend in radiologist workload compared to number of admissions in the emergency department.

INTRODUCTION: Recent years have shown an increase in radiologists' workload, both during regular working hours and during on-call. We aimed to quantify the 8-year trend in on-call workload in a large tertiary academic medical center, and to compare the workload growth rate to emergency department (ED) visits growth rate during the same period. METHODS: The number of computed tomography (CT) studies during on-call hours (weekdays between 3.00 p.m. and 8.00 a.m., and weekends) between 2012 and 2019 was extracted from our hospital's Radiologic Information System. To estimate the on-call workload, all studies were converted to relative value units (RVUs) using the US Medicare physician reimbursement tables. The Kendall's tau b test was used to assess the temporal trend. RESULTS: Overall, on-call CT RVUs increased by 52% (Kendall's tau b = 0.776, p = 0.001) while ED visit rate grew by 23% with a weaker correlation coefficient (Kendall's tau b = 0.323, p = 0.009). RVUs of brain CT, the most prevalent examination type, increased by 33%, while abdominal CT, the second most prevalent examination, increased by 70%. Thoracic-lumbar spine CT examinations increased by 1375% and head and neck CT angiography examinations (stroke protocol and CT-Venography) grew by 287%. CONCLUSIONS: Radiologists' on-call workload more than doubled the growth rate of ED visits over an 8-year period. Radiologists, radiographers and on-call ED workforce should be adjusted to accommodate these evolving changes to enhance quality and safety of patient care and to avoid caregivers' burnout.

Limitations of Plain Film Radiography in Identification of Hyperextension Fractures in Patients With Ankylosing Spinal Disorders.

STUDY DESIGN: Efficacy study. OBJECTIVES: To elucidate the limitations of radiography in patients with spinal ankylosing disorders (SAD) with an emphasis on thoracolumbar injuries, which have been less focused upon. METHODS: We searched our hospital's emergency room database for patients who underwent a total spine computed tomography (CT) following a diagnosis of SAD on radiographs following a minor fall. A high-quality presentation containing 50 randomly situated anteroposterior + lateral radiographs was created. Of these, 24 contained a hyperextension type fracture diagnosed by CT. Twelve physicians-4 spine surgeons, 4 senior orthopedic residents and 4 junior orthopedic residents were requested to identify the pathologic radiographs and note the fracture level. RESULTS: Fracture diagnosis stood at 65% for the best reader. When examining the different subgroups, the mean rate of diagnosis for spine surgeons was 55% and for orthopedic residents 32%. Mean diagnosis of thoracic fractures was 26%, of lumbar fractures was 55%, and for the entire thoracolumbar spine was 40%. The interobserver agreement (kappa coefficient) was found to be 0.37 for the entire group and 0.39 for spine surgeons. This finding was statistically significant. CONCLUSIONS: The simple radiograph is an inefficient modality for diagnosis of hyperextension type thoracolumbar fractures in patients with SAD. The poor interobserver agreement rate further amplifies this finding. Advanced imaging is recommended in these patients.

Whole Spine CT Scan for the Detection of Acute Spinal Fractures in Diffuse Idiopathic Skeletal Hyperostosis Patients Who Sustained Low-energy Trauma.

STUDY DESIGN: Retrospective cohort study. OBJECTIVE: The aim of this study was to evaluate the role and value of whole-spine computerized tomography (WSCT) versus radiographs and targeted CT to tender spinal regions in patients with diffuse idiopathic skeletal hyperostosis (DISH) after low-energy trauma. SUMMARY OF BACKGROUND DATA: Subjects with DISH are prone to spinal fractures even after low-impact trauma due to a rigid spinal structure. METHODS: One-hundred forty-seven subjects (average age: 83 years, M:F 64/83) with verified DISH (Resnick and Niwayama radiographic criteria) on WSCT who were admitted to the emergency room (ER) after low-energy trauma and for whom there were radiographs of at least the thoracic and lumbar spine were evaluated for the presence of acute spinal fractures on both radiographs and WSCT. Agreement between fracture location and spinal tenderness location (cervical, thoracic, or lumbar) as reported in the medical record was evaluated. RESULTS: Significantly more acute fractures were detected on WSCT compared to radiographs (55 and 32, P < 0.00001, respectively). The site of tenderness was not indicative of the fractured spinal segment in 57% of all acute fractures (seven cervical, 15 thoracic, and 16 lumbar). No fracture was detected on WSCT in 10 subjects with an unspecified pain location. Multilevel distant fractures were detected in two patients with a specified pain location to only one of the fractures. CONCLUSION: WSCT in DISH subjects after low-impact trauma is mandatory due to the high prevalence of acute fractures and the low specificity for fracture detection on radiographs. A targeted CT approach to the tender spinal segment proved to be inadequate and would have missed 57% of the acute single fractures with incompatible spinal tenderness location. These results support the significant role of WSCT in the ER setting for detecting and pinpointing the spinal fracture site of DISH subjects who present with low-impact trauma. LEVEL OF EVIDENCE: 3.