The Potential Impact of Risk-Based Screening Mammography in Women 40-49 Years Old.

OBJECTIVE: The purpose of this study was to determine the prevalence of very strong family history and extremely dense tissue in women 40-49 years old with breast cancer detected on screening mammography. MATERIALS AND METHODS: All cancers detected by screening mammography at our institution between January 1997 and November 2012 in 40- to 49-year-old women were retrospectively identified. Those with a personal history of breast cancer were excluded. Family history, breast density, type of malignancy, hormone receptor status, and lymph node status were recorded. RESULTS: One hundred thirty-six cases of breast cancer were identified on screening mammography in 40- to 49-year-old women; 50% were invasive cancers, and 50%, ductal carcinoma in situ. Very strong family history was absent in 88%, and extremely dense breast tissue was absent in 86%. Seventy-six percent of patients had neither very strong family history nor extremely dense breasts, including 79% of the cases of invasive cancers, of which 25% had axillary nodal involvement and 89% were estrogen receptor positive. CONCLUSION: Very strong family history and extremely dense breast tissue were absent in most 40- to 49-year-old women with breast cancer detected at screening mammography. These cancers were frequently invasive (often with nodal metastases) and treatable (hormone receptor positive). Reducing the number of women to be screened in this age group by using this risk-based approach would reduce the number of screen-detected cancers by more than 75%, thereby precluding the benefit of mortality reduction. Even using a risk-based strategy with an expanded definition of high risk that included any first-degree family history, extremely dense tissue, or both, 66% of malignancies would still be missed.

Determinants of second-order bile duct visualization at CT cholangiography in potential living liver donors.

OBJECTIVE: The purpose of this article is to investigate the determinants of second-order bile duct visualization at CT cholangiography in living potential liver donors. MATERIALS AND METHODS: We retrospectively identified 143 potential living liver donors (83 men and 60 women; mean age, 37 years) evaluated with CT cholangiography, which included a slow infusion of iodipamide meglumine with CT acquisition 15 minutes after biliary contrast agent administration. Two readers independently scored the visualization of the second-order bile duct branches on a previously established 4-point scale (0 = not seen, 1 = faintly seen, 2 = well seen, and 3 = excellent visualization). Multivariate analysis was used to investigate the correlation between visualization scores and potential determinants of second-order bile duct opacification, specifically age, body mass index, creatinine level, total and direct bilirubin levels, alkaline phosphatase level, aspartate aminotransferase level, alanine aminotransferase level, patient maximum linear width, CT noise, and hepatosplenic attenuation difference at unenhanced CT. RESULTS: The mean (± SD) second-order bile duct visualization scores were 2.35 ± 0.66 and 2.55 ± 0.60 for readers 1 and 2, respectively. In the multivariate analysis, the only independent predictors of reduced second-order bile duct visualization were higher alkaline phosphatase level (p = 0.01) and higher CT noise (p = 0.02). CONCLUSION: Higher serum alkaline phosphatase level and higher CT noise in potential living liver donors indicate a higher risk of poor second-order bile duct visualization at CT cholangiography.

Contrast delay on perfusion CT as a predictor of new, incident infarct: a retrospective cohort study.

BACKGROUND AND PURPOSE: The purpose of this study was to determine if the assessment of intracranial collateral circulation by CT angiography and/or perfusion CT (PCT) can predict the risk of future ischemic stroke in a large, retrospective cohort study. METHODS: We identified 135 consecutive patients who underwent CT angiography of the head and neck and PCT of the brain at baseline and with subsequent follow-up brain imaging. Clinical and demographic information and carotid wall features were collected. Collateral circulation was assessed anatomically at CT angiography and functionally by measuring the mean transit time delay at PCT. The clinical, carotid, CT angiography, and PCT variables were compared between those with and without new incident infarct at follow-up imaging using mixed effect logistic statistical models. RESULTS: During the follow-up period, 15 patients developed a new infarct and 120 patients did not. Clinical features associated with the stroke risk were age, hypertension, hyperlipidemia, and atrial fibrillation. The carotid features associated with stroke risk were wall thickness. Anatomic assessment of collaterals on CT angiography was not associated with stroke risk, whereas the functional assessment of collaterals (mean transit time delay on PCT) was associated with stroke risk. In a multivariate model, age, atrial fibrillation, and mean transit time delay (OR, 22.8; P<0.001) were the only covariates that were independent predictors of future ischemic stroke. CONCLUSIONS: The mean transit time delay on PCT contains important physiological information and should not be discarded. Along with age and atrial fibrillation, this functional assessment of intracranial collateral circulation predicts the risk of future hemispheric infarct.

Reduced cathartic bowel preparation for CT colonography: prospective comparison of 2-L polyethylene glycol and magnesium citrate.

PURPOSE: To prospectively compare adequacy of colonic cleansing, adequacy of solid stool and fluid tagging, and patient acceptance by using reduced-volume, 2-L polyethylene glycol (PEG) versus magnesium citrate bowel preparations for CT colonography. MATERIALS AND METHODS: This study was approved by the institutional Committee on Human Research and was compliant with HIPAA; all patients provided written consent. In this randomized, investigator-blinded study, 50 patients underwent oral preparation with either a 2-L PEG or a magnesium citrate solution, tagging with oral contrast agents, and subsequent CT colonography and segmentally unblinded colonoscopy. The residual stool (score 0 [best] to 3 [worst]) and fluid (score 0 [best] to 4 [worst]) burden and tagging adequacy were qualitatively assessed. Residual fluid attenuation was recorded as a quantitative measure of tagging adequacy. Patients completed a tolerance questionnaire within 2 weeks of scanning. Preparations were compared for residual stool and fluid by using generalized estimating equations; the Mann-Whitney test was used to compare the qualitative tagging score, mean residual fluid attenuation, and adverse effects assessed on the patient experience questionnaire. RESULTS: The mean residual stool (0.90 of three) and fluid burden (1.05 of four) scores for PEG were similar to those for magnesium citrate (0.96 [P = .58] and 0.98 [P = .48], respectively). However, the mean fecal and fluid tagging scores were significantly better for PEG (0.48 and 0.28, respectively) than for magnesium citrate (1.52 [P < .01] and 1.28 [P < .01], respectively). Mean residual fluid attenuation was higher for PEG (765 HU) than for magnesium citrate (443 HU, P = .01), and mean interpretation time was shorter for PEG (14.8 minutes) than for magnesium citrate (18.0 minutes, P = .04). Tolerance ratings were not significantly different between preparations. CONCLUSION: Reduced-volume PEG and magnesium citrate bowel preparations demonstrated adequate cleansing effectiveness for CT colonography, with better tagging and shorter interpretation time observed in the PEG group. Adequate polyp detection was maintained but requires further validation because of the small number of clinically important polyps.

Evaluation of potential outcome predictors in type II Endoleak: a retrospective study with CT angiography feature analysis.

OBJECTIVE: The purpose of this study is to investigate which CT features of type II endoleaks following abdominal aortic aneurysm (AAA) endoluminal stent-graft repair can be used to predict clinical outcome. MATERIALS AND METHODS: We retrospectively identified 59 patients with type II endoleak after endovascular repair of an AAA with CT of the abdomen and pelvis. Patients were stratified into two groups: those who did (n = 23) and those who did not (n = 35) require reintervention. CT characteristics of type II endoleaks were recorded and correlated with the clinical outcome. RESULTS: The CT features showing the strongest association with the clinical outcome were the transverse diameter of the endoleak cavity (mean, 1.13 cm in the nonreintervention group vs 1.85 cm in the reintervention group; p = 0.007) and the maximum diameter of the vessel communicating with the endoleak (0.34 vs 0.40 cm; p = 0.046). The transverse diameter of the endoleak cavity on arterial phase imaging had the greatest predictive capability, with an area under the receiver operating characteristic curve of 0.74. A transverse diameter greater than 1.42 cm had a positive predictive value of 0.71 and a negative predictive value of 0.82. The anteroposterior diameter, location, and heterogeneity of the endoleak cavity and the number of patent communicating vessels did not correlate well with clinical outcome. The correlation between endoleak cavity measurements and clinical outcome was independent of the aneurysm size. CONCLUSION: There are identifiable CT features associated with the clinical outcome of patients with type II endoleak that have moderate predictive capabilities.

Comparison of traditional methods with 3D computer models in the instruction of hepatobiliary anatomy.

This study was designed to determine whether an interactive three-dimensional presentation depicting liver and biliary anatomy is more effective for teaching medical students than a traditional textbook format presentation of the same material. Forty-six medical students volunteered for participation in this study. Baseline demographic information, spatial ability, and knowledge of relevant anatomy were measured. Participants were randomized into two groups and presented with a computer-based interactive learning module comprised of animations and still images to highlight various anatomical structures (3D group), or a computer-based text document containing the same images and text without animation or interactive features (2D group). Following each teaching module, students completed a satisfaction survey and nine-item anatomic knowledge post-test. The 3D group scored higher on the post-test than the 2D group, with a mean score of 74% and 64%, respectively; however, when baseline differences in pretest scores were accounted for, this difference was not statistically significant (P = 0.33). Spatial ability did not statistically significantly correlate with post-test scores for the 3D group or the 2D group. In the post-test satisfaction survey the 3D group expressed a statistically significantly higher overall satisfaction rating compared to students in the 2D control group (4.5 versus 3.7 out of 5, P = 0.02). While the interactive 3D multimedia module received higher satisfaction ratings from students, it neither enhanced nor inhibited learning of complex hepatobiliary anatomy compared to an informationally equivalent traditional textbook style approach. .