Spectrum of Cognitive Biases in Diagnostic Radiology.

Cognitive biases are systematic thought processes involving the use of a filter of personal experiences and preferences arising from the tendency of the human brain to simplify information processing, especially when taking in vast amounts of data such as from imaging studies. These biases encompass a wide spectrum of thought processes and frequently overlap in their concepts, with multiple biases usually in operation when interpretive and perceptual errors occur in radiology. The authors review the gamut of cognitive biases that occur in radiology. These biases are organized according to their expected stage of occurrence while the radiologist reads and interprets an imaging study. In addition, the authors propose several additional cognitive biases that have not yet, to their knowledge, been defined in the radiologic literature but are applicable to diagnostic radiology. Case examples are used to illustrate potential biases and their impact, with emergency radiology serving as the clinical paradigm, given the associated high imaging volumes, wide diversity of imaging examinations, and rapid pace, which can further increase a radiologist's reliance on biases and heuristics. Potential strategies to recognize and overcome one's personal biases at each stage of image interpretation are also discussed. Awareness of such biases and their unintended effects on imaging interpretations and patient outcomes may help make radiologists cognizant of their own biases that can result in diagnostic errors. Identification of cognitive bias in departmental and systematic quality improvement practices may represent another tool to prevent diagnostic errors in radiology. ©RSNA, 2024 See the invited commentary by Larson in this issue.

Does the presence of macroscopic intralesional fat exclude malignancy? An analysis of 613 histologically proven malignant bone lesions.

OBJECTIVE: To determine if macroscopic intralesional fat detected in bone lesions on CT by Hounsfield unit (HU) measurement and on MRI by macroscopic assessment excludes malignancy. MATERIALS AND METHODS: All consecutive CT-guided core needle biopsies (CNB) of non-spinal bone lesions performed at a tertiary center between December 2005 and September 2021 were reviewed. Demographic and histopathology data were recorded. All cases with malignant histopathology were selected, and imaging studies were reviewed. Two independent readers performed CT HU measurements on all bone lesions using a circular region of interest (ROI) to quantitate intralesional fat density (mean HU < -30). MRI images were reviewed to qualitatively assess for macroscopic intralesional fat signal in a subset of patients. Inter-reader agreement was assessed with Cronbach's alpha and intraclass correlation coefficient. RESULTS: In 613 patients (mean age 62.9 years (range 19-95 years), 47.6% female), CT scans from the CNB of 613 malignant bone lesions were reviewed, and 212 cases had additional MRI images. Only 3 cases (0.5%) demonstrated macroscopic intralesional fat on either CT or MRI. One case demonstrated macroscopic intralesional fat density on CT in a case of metastatic prostate cancer. Two cases demonstrated macroscopic intralesional fat signal on MRI in cases of chondrosarcoma and osteosarcoma. Inter-reader agreement was excellent (Cronbach's alpha, 0.95-0.98; intraclass correlation coefficient, 0.90-0.97). CONCLUSION: Malignant lesions rarely contain macroscopic intralesional fat on CT or MRI. While CT is effective in detecting macroscopic intralesional fat in primarily lytic lesions, MRI may be better for the assessment of heterogenous and infiltrative lesions with mixed lytic and sclerotic components. CLINICAL RELEVANCE STATEMENT: Macroscopic intralesional fat is rarely seen in malignant bone tumors and its presence can help to guide the diagnostic workup of bone lesions. KEY POINTS: • Presence of macroscopic intralesional fat in bone lesions has been widely theorized as a sign of benignity, but there is limited supporting evidence in the literature. • CT and MRI are effective in evaluating for macroscopic intralesional fat in malignant bone lesions with excellent inter-reader agreement. • Macroscopic intralesional fat is rarely seen in malignant bone lesions.

Neonatal and Infant Lung Disorders: Glossary, Practical Approach, and Diagnoses.

A multitude of lung disorders ranging from congenital and genetic anomalies to iatrogenic complications can affect the neonate or the infant within the first year of life. Neonatal and infant chest imaging, predominantly by plain radiography and computed tomography, is frequently employed to aid in diagnosis and management; however, these disorders can be challenging to differentiate due to their broad-ranging, and frequently overlapping radiographic features. A systematic and practical approach to imaging interpretation which includes recognition of radiologic patterns, utilization of commonly accepted nomenclature and classification, as well as interpretation of imaging findings in conjunction with clinical history can not only assist radiologists to suggest the diagnosis, but also aid clinicians in management planning. The contents of this article were endorsed by the leadership of both the World Federation of Pediatric Imaging (WFPI), and the International Society of Pediatric Thoracic Imaging (ISPTI).

1-hour versus 3-hour 99mTc-PYP imaging to evaluate suspected cardiac transthyretin amyloidosis.

The diagnosis of cardiac transthyretin amyloidosis can involve early or delayed 99mTc-pyrophosphate planar, single photon emission computed tomography (SPECT), and/or SPECT/CT imaging. We investigated whether image interpretations differed among modalities and time points. In this observational study, data were reviewed for 173 patients with suspected transthyretin amyloidosis who underwent planar and SPECT/CT 1 and 3 hours after radiopharmaceutical injection. Planar heart-to-contralateral lung ratios were calculated. Myocardial-to-rib uptake was independently scored on SPECT and SPECT/CT as follows: 0 (negative), 1 < rib (equivocal), 2 = rib (positive), or 3 > rib (positive), and the image quality was as follows:1 (poor), 2 (adequate), and 3 (good). Three-hour SPECT/CT readings were used as the reference standard against which the other readings were compared. Twenty-five percent of patients were positive (3-hour SPECT/CT score ≥ 2). Compared to 3-hour SPECT/CT readings, there was "fair agreement" (κ = .27 - .33) with SPECT, and "fair agreement" (κ = .23 - .31) with planar imaging at 1 and 3 hours. More patients had abnormal SPECT and SPECT/CT than planar imaging (24-25% vs 16-17%, P < .007). There were more equivocal cases for 1 and 3 hours planar imaging than for 1 and 3 hours SPECT (71-73% vs 23-26%, P < .001) and 1 and 3 hours SPECT/CT (3-5%, P < .001). SPECT/CT image quality was higher at 3 hours than at 1 hour and higher than that on SPECT (P = .001). Three-hour SPECT/CT readings provided the highest number of definitive readings, had the highest image quality, and constituted the preferred protocol for evaluating unselected populations of patients that have a clinical suspicion of possible cardiac amyloidosis.

99mTc-PYP SPECT and SPECT/CT quantitation for diagnosing cardiac transthyretin amyloidosis.

BACKGROUND: We investigated quantitative 99mTc-pyrophosphate (PYP) SPECT/CT reproducibility and accuracy for diagnosing cardiac transthyretin amyloidosis (ATTR), and whether SPECT/CT improved visual and quantitative results compared to SPECT-only. METHODS: Data were reviewed for 318 patients with suspected ATTR who underwent PYP SPECT/CT. Myocardial-to-blood pool count (MBP) ratios were computed and repeated independently > 1 month later. A physician independently scored LV myocardial-to-rib uptake on SPECT/CT as: 0 (negative), 1 < rib (equivocal), 2 = rib (positive) or 3 > rib (positive), and the image quality as: 1 (poor), 2 (adequate), and 3 (good). SPECT-only MBP ratios and visual scores were assessed separately for a subgroup of the first sequential 191 patients. RESULTS: 25% of patients had positive myocardial uptake (myocardial-to-rib uptake score of ≥ 2). SPECT/CT MBP ratios were reproducible (1.35 ± .68 vs 1.33 ± .74, p = .09) and corresponded with visual scores ≥ 2 (ROC AUC = 99 ± 1%) more accurately than SPECT-only MBPs (93 ± 3%, p = .02). SPECT/CT image quality was better than that of SPECT-only (2.7 ± .5 vs 2.1 ± .5, p < .0001) with fewer equivocal results (2.6% vs 22.5%, p < .0001). CONCLUSION: SPECT/CT produces MBP ratios that are reproducible and accurately identify a positive scan, with better image quality and fewer equivocal cases than SPECT-only.

Effects of Zinc Oxide and Arginine on the Intestinal Microbiota and Immune Status of Weaned Pigs Subjected to High Ambient Temperature.

This study aimed to investigate the effect of the l-arginine (Arg) inclusion and different doses of ZnO on the growth performance, intestinal microbiota and integrity, and immune status of weaned pigs. A total of 180 pigs (28-day-old) were randomly allotted to six treatments with six replicate pens in each treatment and five pigs per pen. The dietary treatments were Con (1.1% Arg); P-Zn (1.1% Arg + 2500 mg Zn as ZnO/kg diet); ARG (1.6% Arg); ZnArg1 (500 mg of Zn as ZnO/kg diet + 1.6% Arg); ZnArg2 (1000 mg of Zn as ZnO/kg diet + 1.6% Arg); ZnArg3 (2500 mg of Zn as ZnO/kg diet + 1.6% Arg). The overall result showed that the inclusion of ZnArg3 significantly improved the average daily gain of pigs compared with the Con treatment. There was a reduction in feed intake in pigs fed the Con diet compared with pigs fed the ZnArg3 diet at phase 1 and overall. At phase 1, pigs fed the ZnArg3 diet and P-Zn diet showed a decreased population of Clostridium spp. in the ileum compared with those of the Con treatment. In addition, a lower ileal Clostridium spp. population was detected in pigs fed the ZnArg2 diet compared with pigs fed the Con diet. The pigs fed ZnArg1 and ZnArg3 diets showed a greater villus height of duodenum compared with the Con and P-Zn treatments. The pigs in the Con treatment showed increased mRNA expression of heat shock protein-27 in the liver compared with the P-Zn, ZnArg1, ZnArg2, and ZnArg3 treatments. When fed the basal diet, mRNA expressions of interleukin-6 were increased in the muscle compared with the ZnArg3 treatment. Dietary supplementation with ZnArg2 decreased the mRNA expressions of interferon-γ in the muscle compared with the Con treatment. Supplementation with P-Zn, ZnArg1, ZnArg2, and ZnArg3 decreased mRNA expressions of tumor necrosis factor-α (TNF-α) compared with the Con treatment. The mRNA gene expressions of interleukin-4 were decreased in the jejunum of pigs fed P-Zn, ARG, ZnArg1, ZnArg2, and ZnArg3 diets compared with pigs fed the Con diet. The jejunum gene expression of toll-like receptor-4 was upregulated in the Con and ARG treatments compared with the ZnArg1 and ZnArg3. The ZnArg1, ZnArg2, and ZnArg3 treatments showed lower mRNA expression of TNF-α compared with the Con treatment. In conclusion, there was no difference in growth performance, intestinal microbiota, gene expression of interleukins between ZnArg1 and ZnArg3 treatments. Therefore, the low level of ZnO (500 mg/kg) plus 1.6% dietary Arg may be recommended for pigs during the weaning stress.

Robust stabilization at uncertain equilibrium by output derivative feedback control.

The problem of stabilizing dynamic systems with unknown or uncertain equilibrium states is studied. Derivative control schemes are proposed for both state and output feedback for the local stabilization at the true equilibrium states. The case where norm-bounded uncertainties are present in the system model is considered to derive robust stability conditions in linear matrix inequality form. The proposed control solutions drive the closed-loop system exponentially to its equilibrium states as shown via simulation on the chaotic Rössler and Lorenz attractors, when the equilibrium states are unknown and model uncertainties are present. A practical example involving a magnetic levitation system, in which two disks are to be levitated at an unknown magnetic equilibrium, demonstrates the effectiveness of the output derivative feedback controller.

Robust effect of metabolic syndrome on major metabolic pathways in the myocardium.

Although the high-fat-diet-induced metabolic syndrome (MetS) is a precursor of human cardiac pathology, the myocardial metabolic state in MetS is far from clear. The discrepancies in metabolite handling between human and small animal models and the difficulties inherent in obtaining human tissue complicate the identification of the myocardium-specific metabolic response in patients. Here we use the large animal model of swine that develops the hallmark criteria of human MetS. Our comparative metabolomics together with transcriptomics and computational nonnegative matrix factorization (NMF) interpretation of the data exposes significant decline in metabolites related to the fatty acid oxidation, glycolysis, and pentose phosphate pathway. Behind the reversal lies decreased expression of enzymes that operate in the pathways. We showed that diminished glycogen deposition is a metabolic signature of MetS in the pig myocardium. The depletion of glycogen arises from disbalance in expression of genes that break down and synthesize glycogen. We show robust acetoacetate accumulation and activated expression of key enzymes in ketone body formation, catabolism and transporters, suggesting a shift in fuel utilization in MetS. A contrasting enrichment in O-GlcNAcylated proteins uncovers hexosamine pathway and O-GlcNAcase (OGA) expression involvement in the myocardial response to MetS. Although the hexosamine biosynthetic pathway (HBP) activity and the availability of the UDP-GlcNAc substrate in the MetS myocardium is low, the level of O-GlcNacylated proteins is high as the O-GlcNacase is significantly diminished. Our data support the perception of transcriptionally driven myocardial alterations in expression of standard fatty acids, glucose metabolism, glycogen, and ketone body related enzymes and subsequent paucity of their metabolite products in MetS. This aberrant energy metabolism in the MetS myocardium provide insight into the pathogenesis of CVD in MetS.

Stabilization of compressor surge in systems with uncertain equilibrium flow.

The adaptive correction of uncertain equilibrium states in feedback controlled systems is studied in this paper, with application to the active control of compressor surge with uncertainty in the characteristic curves. Adaptive compensation methods are introduced to correct for the uncertainty in the equilibrium state in both the state and the output feedback control cases, using information from the feedback control signal to determine the true equilibrium of the nonlinear plant. In particular, our proposed solutions overcome the odd-number condition, or parity condition, which appears as a recurring limitation in comparable solutions reported in the literature. Conditions for the existence of the adaptive solutions are presented, and the stability of the closed-loop system is demonstrated. The effectiveness of the proposed adaptation mechanism is verified using a high fidelity mathematical model of a compression system, commissioned to test active surge control methods by active magnetic bearings.

Enhanced biodiesel production in Neochloris oleoabundans by a semi-continuous process in two stage photobioreactors.

Under autotrophic conditions, highly productive biodiesel production was achieved using a semi-continuous culture system in Neochloris oleoabundans. In particular, the flue gas generated by combustion of liquefied natural gas and natural solar radiation were used for cost-effective microalgal culture system. In semi-continuous culture, the greater part (~80%) of the culture volume containing vegetative cells grown under nitrogen-replete conditions in a first photobioreactor (PBR) was directly transferred to a second PBR and cultured sequentially under nitrogen-deplete conditions for accelerating oil accumulation. As a result, in semi-continuous culture, the productivities of biomass and biodiesel in the cells were increased by 58% (growth phase) and 51% (induction phase) compared to the cells in batch culture, respectively. The semi-continuous culture system using two stage photobioreactors is a very efficient strategy to further improve biodiesel production from microalgae under photoautotrophic conditions.

Inhibition of acrolein-stimulated MUC5AC production by fucoidan in human bronchial epithelial cells.

Fucoidan, a marine sulfated polysaccharide has both antithrombotic and anti-inflammatory effects. We determined the effect of fucoidan on MUC5AC expression in a human bronchial epithelial cell line, NCI-H292. Reverse transcription-polymerase chain reaction (RT-PCR) analysis showed that fucoidan inhibited MUC5AC expression and protein secretion in cells stimulated with acrolein, a toxic aldehyde present in tobacco smoke. The activation of both nuclear factor-kappa B (NF-kappa B) and activator protein 1 (AP-1) are key steps in the transcriptional activation of MUC5AC. We found that the acrolein-mediated transactivation of MUC5AC was selectively dependent on AP-1 activation and was suppressed by fucoidan. Fucoidan-induced AP-1 inhibition and MUC5AC repression might be associated with fucoidan's protective effects against respiratory diseases.

Bifunctional effects of fucoidan on the expression of inducible nitric oxide synthase.

Algal fucoidan is a marine sulfated polysaccharide with a wide variety of biological activities including anti-thrombotic and anti-inflammatory effects. This study evaluated the effect of fucoidan on the expression of inducible nitric oxide synthase (iNOS) in a macrophage cell line, RAW264.7. Low concentration range of fucoidan (10 microg/ml) increased the basal expression level of iNOS in quiescent macrophages. However, we found for the first time that fucoidan inhibited the release of nitric oxide (NO) in RAW264.7 cells stimulated with lipopolysaccharide (LPS). Western blot analysis revealed that fucoidan suppressed the LPS-induced expression of the inducible nitric oxide synthase (iNOS) gene. Moreover, the activation of both nuclear factor-kappaB (NF-kappaB) and activator protein 1 (AP-1) are key steps in the transcriptional activation of the iNOS gene. Here, it was revealed that fucoidan selectively suppressed AP-1 activation, and that the activation of AP-1 appears to be essential for the induction of iNOS in activated macrophages. This inhibitory effect on AP-1 activation by fucoidan might be associated with its NO blocking and anti-inflammatory effects.

Flocculation and reflocculation of clay suspension by different polymer systems under turbulent conditions.

The focused beam reflectance measurement (FBRM), also known as scanning laser microscopy (SLM), was used as a real-time monitor to study the flocculation and reflocculation of clay suspensions under different shear conditions in the presence of single polymer, dual polymer, microparticle and poly(ethylene oxide)/phenolformaldehyde (PEO/PFR) flocculation systems. For initial flocculation, the high molecular weight PEO and cationic polyacrylamide (CPAM) produced larger flocs than others. However, reflocculation of clay suspensions formed by these non- or low-charged polymers was insignificant after the initial flocs were broken under high shear force. In contrast, high charge density polymers, such as poly(diallyldimethylammonium chloride) (PDADMAC), do not form large initial flocs, but they showed significant reflocculation ability under a continuous shear condition. It is concluded that high flocculation can be obtained by effective polymer bridging, but high reflocculation can only be induced by high electrostatic attractive forces between suspended particles.