Value of Reporting Coronary Calcium on Non-Gated Chest CT [critique of article by Fresno et al.]

Gregory Lee, MD and Jean Jeudy, MD discuss the accuracy of visual scoring of coronary artery calcium on chest CT, regardless of contrast. By more accurately reporting these scores, large groups of patients may greater benefit from preventative treatment of coronary disease.

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Advanced CKD Using Patient Reported Risk Factors [critique of article by Abbasi et al.]

Xiaochen Denise Liu, PGY 5, discusses an article in which the preliminary findings suggest the need for modification of the current consensus for CKD risk factor prior to outpatient administration of iodinated contrast.

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Coronary CTA With AI-QCT Interpretation [critique of article by Lipkin et al.]

Rosalind Gerson, PGY3, discusses a study that compared the diagnostic performance of stress myocardial perfusion imaging (MPI) and CT angiography with AI-Quantitative CT (CTA + AI-QCT) in detecting obstructive coronary artery stenosis, with invasive angiography serving as the reference standard. CTA + AI-QCT demonstrated better diagnostic performance than MPI. Modelling of diagnostic algorithms showed that incorporating CTA + AI-QCT reduced both costs and rates of invasive testing.

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Hepatic Artery Guidewire for TIPS Creation [critique of article by Wang et al.]

The key step in the creation of a transjugular intrahepatic portosystemic shunt (TIPS) is the needle puncture from a hepatic vein to a portal vein. This can be challenging in patients with portal vein thrombosis, where the portal vein is poorly visualized. Liwei Jiang, MD discusses a feasibility study that employs a previously described technique of placing a guidewire into the right hepatic artery to serve as a landmark for the target portal vein.

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Deep Learning-Based Algorithm to Reduce Radiation Dose in Pediatric CTs [critique of article by Nagayama et al.]

Radiation safety is important, particularly in pediatric imaging. Viet Le, MD discusses an article that demonstrates how a deep learning-based algorithm reduces radiation dose in pediatric CTs compared to current techniques without loss of image quality.

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I’ve Fallen and I Can’t Get Up: To Scan or Not to Scan? [critique of article by Vardar et al.]

Ground-level fall is a common injury in older patients and a frequent cause of ED visits. These low-impact falls may lead to intracranial hemorrhage, which is a particular concern in patients on antithrombotic therapy. In this episode, Sara Tedla, MD, discusses a recently published study in AJR, which evaluates traumatic intracranial hemorrhage on CT after minor head trauma in adult patients on antithrombotic therapy.

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Subpleural Nodules: Reducing Unnecessary Follow-up Studies and the Future of Lung-RADS [critique of article by Hammer et al.]

Lung cancer screening and the use of Lung-RADS is becoming more prevalent. Gregory Michael Lee, MD discusses an article on applying strategies that better identify benign intrapulmonary lymph nodes and using volumetric-based measurements result in improved specificity without loss in sensitivity, as compared to Lung-RADS version 1.1.

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Patient Experience Scores for Radiologists [critique of article by Kapoor et al.]

We are moving towards patient-centered care. Thus, it is important to listen to patients’ feedback. Hyunjoong William Kim, MD discusses an article that evaluated the role of an individual hospital’s effort to make the provider reviews from patients transparent and public on its website; specifically, it looked at if there were any score differences between the radiologists and the non-radiology physicians. Radiologists, particularly those who are involved in direct patient care, may be subjected to similar patient review and ratings mechanisms as other clinical providers, and this article is a good starting point to think about the ever-changing health care field.

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Management of Nonmalignant Architectural Distortion on Digital Breast Tomosynthesis [critique of article by Villa-Camacho et al.]

Management of nonmalignant architectural distortion on DBT remains controversial. Alexandra Millet, MD discusses study results suggesting that imaging surveillance, rather than surgery, can be considered for architectural distortion on DBT yielding radial scar without atypia or other concordant benign pathologies without atypia.

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Interobserver Agreement for CT and MRI Findings of Chronic Pancreatitis in Children [critique of article by Trout et al.]

Rosalind Gerson, PGY3, discusses a recent AJR article that assessed interobserver agreement for multiple qualitative and quantitative findings in chronic pediatric pancreatitis, finding fair or moderate agreement for most qualitative features, and good inter-rater agreement for pancreatic duct diameter on both MR and CT.

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Post-TIPS Survival: Time to Settle the (Prognostic) Score? [critique of article by Yang et al.]

Several prognostic scores have been applied for predicting survival after transjugular intrahepatic portosystemic shunt (TIPS) placement to guide patient selection. In this episode, John Do, MD speaks with TIPS expert Jonas Redmond, MD, interventional radiologist and associate professor at the University of California San Diego, to discuss the results of a recently published study in AJR that supports the utility of FIPS score in differentiating patients who are optimal candidates.

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Detecting Pulmonary Hypertension with CT Pulmonary Angiography and Automated Cardiac Chamber Volumetry [critique of article by Melzig et al.]

Early diagnosis and treatment of pulmonary hypertension are crucial to prevent chronic progression and a poor prognosis. The nonspecific presenting symptoms and need for right heart catheterization may contribute to a delay in diagnosis. In this episode, Sara Tedla, MD discusses a recently published study in AJR, which evaluates the utility of cardiac chamber volumetric measurements based on non-gated CT pulmonary angiography and the updated 2018 pulmonary hypertension criteria.

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Automated CNN-Based Analysis for MR Elastography to Assess Hepatic Fibrosis [critique of article by Cunha et al.]

Wenhui Zhou, MD, PhD reviews a recent AJR article examining the diagnostic performance of six different imaging modalities in the detection of sporadic pheochromocytoma, and the science behind several radiotracers used in the detection of pheochromocytoma. This study incentivizes the use of automated MR elastography to screen for hepatic fibrosis in nonalcoholic hepatosteatotitis.

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Utility of Preoperative SWE of the Supraspinatus Muscle for Predicting Successful Rotator Cuff Repair [critique of article by Jeong et al.]

Xiaochen D. Liu, MD discusses an article that assesses the utility of preoperative shear wave elastography measurements of the supraspinatus muscle to predict successful rotator cuff repair, including comparison with MRI-based measures.

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4D CT in Primary Hyperparathyroidism: Helping Our Surgical Colleagues [critique of article by Bunch et al.]

Ragheed Al-Dulaimi, MD discusses an AJR article that assesses utility of second-largest lesion size on parathyroid CT for differentiating single-gland disease from multigland disease.

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Post-Embolization Syndrome After Bland Hepatic Artery Embolization [critique of article by Rmilah et al.]

Post-embolization syndrome (abdominal pain, nausea, emesis, and fever) is the most common adverse effect of liver embolotherapy and is the primary reason for post-procedure hospitalization. Liwei Jiang, MD, discusses a new study that links cirrhosis with the severity of post-embolization syndrome after bland hepatic artery embolization. The findings may help select patients for early discharge after the procedure.

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Use of Whole-Spine MRI in Kids with Suspected Abusive Head Trauma [critique of article by Karmazyn et al.]

Viet Le, MD discusses the utility of additional whole-spine MRI in children with suspected abusive head trauma. Clinical providers, including radiologists, may find diagnostic value to consider incorporating whole-spine MRI in cases of possible abusive head trauma as many spinal injuries are localized to the thoracolumbar spine, in addition to the cervical spine.

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Coronary Vascular Inflammatory Marker on Photon Counting Study [critique of article by Mergen et al.]

In this episode, Shambo Guha Roy, MD discusses an article in which the authors tried to standardize epicardial adipose attenuation and fat attenuation index, on the newest generation photon counting CT.

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Associations of Ultrasound LI-RADS Visualization Score with Examination-, Sonographer-, and Radiologist-Factors [critique of article by Fetzer et al.]

Lara Gabrielle L Lim, MD discusses multiple factors that affect the ultrasound LI-RADS visualization score, such as examination, sonographer and radiologist characteristics. Awareness of these factors are opportunities for improved practices and quality assurance measures.

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Comparing Field Strength in the Detection of Paramagnetic Rim Lesions in Multiple Sclerosis [critique of article by Hemond et al.]

Wenhui Zhou, MD, PhD reviews a recent AJR article examining the feasibility of 1.5-T and 3-T MRI to detect a novel marker for smoldering multiple sclerosis and histopathological correlate of this MR marker. This study supports the widespread utilization of 1.5-T MRI to further explore the clinical utility of a novel MR marker in multiple sclerosis patients.

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Comparison of False-Positive versus True-Positive Findings on Contrast-Enhanced Digital Mammography [critique of article by Amir et al.]

Alexandra Millet, MD discusses a study that compares imaging characteristics of false-positive and true-positive findings on CEDM. The conclusions include that a low-energy mammographic finding with associated enhancement, or a finding with sonographic or MRI correlate, predicts a true-positive result. Calcifications with associated enhancement had a high malignancy rate. Nonetheless, half of true-positive lesions enhanced on iodine images without a mammographic finding on low-energy images. These observations inform radiologists’ management of abnormalities detected on screening CEDM.

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Comparison of Negative Pre-Biopsy Biparametric vs Multiparametric MRI in the Detection of Clinically Significant Prostate Cancer [critique of article by Gan et al.]

In this episode, Rosalind Gerson, PGY3 discusses a new study showing similar rates of clinically significant prostate cancer found on systematic biopsy performed after negative biparametric vs multiparametric MRI. In patients from either MRI cohort, specified PSA density thresholds had similarly high negative predictive values for clinically significant prostate cancer.

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Head and Neck CTA in the ED: Analysis of Ordering Frequency and Nonroutine Results Communication [critique of article by Tu et al.]

Imaging in the emergency department has continued to increase over the years with the growth of head and neck CTA disproportionately higher than other neuroimaging. In this episode, Sara Tedla MD, discusses a recently published study in AJR, which characterizes utilization of head and neck CTA in the ED, and frequency of non-routine results communication among patients’ chief concerns.

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Deep Learning for the Evaluation of Interstitial Lung Disease on Chest Radiograph [critique of article by Yi et al.]

Early and mild stages of intersitial lung disease can be challenging to evaluate by radiography. A commercially available deep learning algorithm to detect reticular opacities in surgically confirmed interstitial lung disease was more accurate than radiologists. Gregory Lee, MD discusses a new AJR article that examines the use of a deep learning algorithm tool increased interobserver agreement for readers, as well as increased the sensitivity, specificity and accuracy of the radiologist.

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Monitoring Chronic Budd-Chiari Syndrome Using 2D Shear-Wave Elastography After Image-Guided Intervention [critique of article by Dohare et al.]

Viet Le, MD discusses the utility of monitoring liver disease in kids after endovascular intervention with 2D shear-wave elastography.

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Surveillance of LR-2 and LR-3 Observations: Playing It Safe or Playing with Fire? [critique of article by Ranathunga et al.]

In patients at high risk for hepatocellular carcinoma, progression to higher categories from LR-2 and LR-3 observations remains a concern with surveillance of these lesions. Tune into this podcast to hear the results of a recently published study in AJR that found low progression rates of LR-2 and LR-3 observations with insights and comments from our special guest, the developer and leader of LI-RADS, Claude Sirlin, MD, who is an abdominal radiologist and professor at the University of California San Diego.

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Microwave Ablation Versus Cryoablation for Sarcoma Lung Metastases [critique of article by Bourgouin et al.]

Percutaneous ablation is an effective treatment for sarcoma lung metastases that improves survival with minimal damage to healthy lung. Two increasingly used ablation modalities, microwave ablation and cryoablation, have not been directly compared. Liwei Jiang, MD, discusses a new study that compares the outcomes following microwave ablation and cryoablation of sarcoma lung metastases.

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Longitudinal Follow-Up of Incidental Gallbladder Polyps on HCC Screening Ultrasound in a Cohort of Patients with Liver Disease [critique of article by Walsh et al.]

Ragheed Al-Dulaimi, MD discusses a new article in which the authors explore the natural history of incidentally discovered gallbladder polyps on ultrasound performed for hepatocellular carcinoma surveillance.

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Prediction of Early Treatment Response in Multiple Myeloma Using MY-RADS Total Burden Score [critique of article by Dong et al.]

Xiaochen Denise Liu, MD discusses a new article that discusses the utility of the MY-RADS total burden score.

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Thoracic CT predictor of Post Op Mechanical Ventilation After Major Abdominopelvic Surgery [critique of article by Canan et al.]

Shambo Guha Roy, MBBS, MD discusses a new article in which the authors explored associations between preoperative thoracic CT findings and need for postoperative mechanical ventilation after major abdominal or pelvic surgeries.

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Impact Of Deep Learning Reconstruction On Image Quality And Diagnostic Performance Of Accelerated Shoulder MRI [critique of article by Hahn et al.]

Rosalind Gerson, PGY3 discusses a new study which shows that applying deep learning reconstruction to accelerated shoulder MRI improves image quality and decreases artifact severity to a level similar to that of standard sequences, without compromising sensitivity, specificity, and diagnostic accuracy.

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Comparing Imaging Modalities in the Detection of Sporadic Primary Pheochromocytoma [critique of article by Jha et al.]

Wenhui Zhou, MD, PhD reviews a recent AJR article examining the diagnostic performance of six different imaging modalities in the detection of sporadic pheochromocytoma, and the science behind several radiotracers used in the detection of pheochromocytoma. This study supports the use of ¹⁸F-FDOPA as the first-line imaging modality in the workup of suspected adrenal pheochromocytoma.

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Impact of DBT and AI-CAD on Mammographic Surveillance After BCT [critique of article by Yoon et al.]

Alexandra Millet, MD discusses a new study showing that accuracy improves and recall rates decrease when digital breast tomosynthesis or artificial intelligence-based computer-aided detection are used as adjuncts to digital mammography alone for surveillance of the ipsilateral and contralateral breasts in women with a personal history of breast cancer after breast concerving therapy—indicating that these additional methods can reduce unnecessary callbacks.

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Dual-Energy CT Derived Electron Density in the Evaluation of Lung Cancer Nodal Disease [critique of article by Nagano et al.]

In this episode, Gregory Lee, MD focuses on a new AJR article that focuses on how dual-energy CT derived electron density values can add accuracy in the diagnosis of lymph node metastasis in the setting of non-small cell lung cancer.

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Use of Contrast-Enhanced Ultrasound to Evaluate Neonatal Brain Injury [critique of article by Squires et al.]

Viet Le, MD discusses the diagnostic performance of contrast-enhanced ultrasound in evaluating neonatal brain injury while highlighting the safety and feasibility of the modality, which are important considerations for potentially critically ill patients.

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Giving the Cold Shoulder to Warming CT Contrast Media? [critique of article by Basharat et al.]

Should CT contrast media be warmed? Currently, the ACR has not provided conclusive recommendations, and data to guide decision-making have been sparse. In this episode, John Do, MD discusses a recently published study showing that prewarming iohexol 350 may not be necessary to reduce the risk of extravasation and reaction rates.

Association of Clear Cell Likelihood Score and Growth of Small Solid Renal Masses [critique of article by Rasmussen et al.]

Clear cell Likelihood Score (ccLS) is a non-invasive method to grade the likelihood of a small renal lesion being a clear cell renal cell carcinoma based on the MRI appearance. Hyunjoong William Kim, MD discusses a new AJR article in which the authors demonstrate a relationship between the ccLS and the rate of growth, as higher clear cell Likelihood Score is associated with faster growth rate of the renal lesion.

Learning Curve of CT-Guided Lung Biopsies [critique of article by Park et al.]

How many CT-guided lung biopsies should one perform before being considered competent? Knowing metrics for performance and how to measure performance may help set guidelines for training and clinical practice. Liwei Jiang, MD details a new study in which the authors seek to define the learning curve of CT-guided lung biopsies, looking at diagnostic accuracy and complication rates.

CT Findings of the Pancreas Before the Diagnosis of Pancreatic Ductal Adenocarcinoma [critique of article by Toshima et al.]

Lara Gabrielle L Lim discusses a new AJR study that focuses on CT changes of the pancreas before the diagnosis of pancreatic ductal adenocarcinoma. This involves six focal pancreatic abnormalities that when detected will aid in early disease detection, early disease management, and improved patient outcomes.

Analysis of 612 Benign Papillomas Diagnosed at Core Biopsy [critique of article by Lee et al.]

Xiaochen D. Liu, MD discusses a proposed selective surgery of benign papillomas that was discussed in a recent AJR article.

Water Soluble Contrast Challenge for Predicting Non-Operative Management of Small Bowel Obstuction [critique of article by Pickhardt et al.]

Jeffrey Guccione, MD discusses an article that examines the use of iohexol in a water-soluble contrast challenge for predicting non-operative management of small bowel obstruction. Technical success rates are also examined, and the real-world practicality discussed. Strengths and limitations are addressed as well, including the use of iohexol over gastrografin.

Added Value of MRI for Evaluation and Management of Placental Adhesion Disorder [critique of article by Stewart et al.]

In this podcast, Pei-Kang (Ken) Wei, MD and Cinthia Cruz-Romero, MD summarized the study by Stewart et al. and then provided a discussion regarding the limitation of this article as well as whether including MRI to the diagnostic algorithm for placental adhesion disorder may provide added benefit to clinical management.

Imaging Surveillance and Risk Factors for Development of Brain Metastases in Non-Small Cell Lung Cancer Patients [critique of article by Kim et al.]

In this podcast, Tyler Richards, MD discusses an observational retrospective study that looks at risk factors for patients with non-small cell lung cancer, which they found to be advanced clinical stage at diagnosis (stage III or IV) and EGFR mutation in patients with adenocarcinoma histology. They recommend that patients in these risk groups receive a surveillance brain MRI at 12 months.

Rectal Tube Insertion for Improving Prostate MR Image Quality [critique of article by Huang et al.]

David Ballard, MD discusses an AJR article in which the authors provide a practical practice consideration for optimizing prostate MR image quality. To reduce susceptibility from rectal gas, the authors had MR technologist place 18-French rectal tubes in patients undergoing prostate MR and compared them to patients without rectal tube placement.

The FEVER View for Elbow MRI in MLB Pitchers [critique of article by Lund et al.]

Drew Gunio, MD discusses a new AJR study assessing the impact of a flexed elbow valgus external rotation (FEVER) view on ulnotrochlear (UT) joint space measurement and reader evaluation of the UCL when incorporated into standard elbow MRI in throwing athletes.

Retrospective ECG-gated CT Angiography for Detecting Coronary Artery Involvement in Type A Aortic Dissection [critique of article by Ma et al.]

Kerem Ozturk, MD discusses a new AJR articles that includes retrospective ECG-Gated CTA findings which may help guide presurgical planning in Type A Aortic Dissection with sinus Valsalva involvement that impacts patient prognosis and surgical planning.

Can Differences in T1 Relaxivity Between Gadolinium-Based Contrast Agents be Taken Advantage of to Lower the Administered Dose of Gadolinium? [critique of article by Liu et al.]

Intracranial deposition of gadolinium after contrast-enhanced MRI is an emerging area of concern with much still to be learned. Kalen Riley, MD, MBA discusses a new article that proposes a dose-reduction strategy that takes advantage of relatively higher T1 relaxivity of one macrocyclic agent compared to another while still striving to maintain an adequate imaging examination.

Substantial Overlap of CT Findings of COVID-19, Influenza, and Organizing Pneumonia Limit Radiologists’ Diagnostic Accuracy [critique of article by Garrana et al.]

Characteristic CT findings of COVID-19 pneumonia have been extensively described, including the substantial overlap with findings of other infectious etiologies such as influenza. However, CT findings also have substantial overlap with those of non-infectious organizing pneumonia. Matthew Peterson, MD discusses a new AJR study sample with equal proportions of these infectious and non-infectious diagnoses, in which radiologists’ diagnostic accuracy was low.

Does Bosniak Version 2019 Optimize Diagnostic Performance for the Prediction of Malignant Cystic Renal Masses? [critique of article by Park et al.]

Giuseppe V. Toia, MD reviews a retrospective study which compares CT and MRI cystic renal mass characterization using the Bosniak 2019 and 2005 versions. This study concludes that version 2019 demonstrated decreased sensitivity, but increased specificity for detecting malignancy.

Peering into the Box; Can MRI identify tibial polyethylene post fractures pre-operatively? [critique of article by Sahr et al.]

David Robinson, MD discusses a short report study exploring the role of MRI in the diagnosis of tibial polyethylene post fractures in posterior stabilized total knee arthroplasties, including a comparison of conventional sequences versus metal artifact reduction sequences.

Ultrasound-Guided Omental Biopsy – Why Have We Been Missing Out? [critique of article by Perez et al.]

Michael Nellamattathil, DO discusses a new article that finds ultrasound-guided biopsy of omental disease suspected on CT is safe and effective for tissue diagnosis. Though omental disease commonly appears on ultrasound as diffuse infiltrative thickening without a discrete target, sampling based on pre-biopsy CT landmarks is diagnostic in the large majority of cases.

Meta-Analysis of the Noninvasive Colorectal Screening Tests [critique of article by Pickhardt et al.]

There has been a dearth of head to head comparison of the performance of the different noninvasive colorectal cancer screening tests. Alicia Chen, MD discusses a new study that has completed a valuable meta-analysis comparing the positive predictive value and detection rate of stool DNA, FIT, and CT colonography.

Adding Delayed Phase Images to Dual-Phase Contrast-Enhanced CT Increases Sensitivity for Small Pancreatic Ductal Adenocarcinoma [critique of article by Fukukura et al.]

Dual phase pancreatic CT has been the traditional work horse for evaluation of pancreatic masses. Ben Kipper, MD discusses a paper examining an additional “delayed” phase to enhance the sensitivity and detection of small pancreatic adenocarcinomas.

Acute Exacerbation of Interstitial Pneumonia after Lung Cancer Surgery: Challenges in Developing Imaging Criteria and Opportunities for Future Research [critique of article by Ozawa et al.]

Jordan Perchik, MD discusses a new study in which a team of radiologists attempt to detail imaging findings that can identify patients with interstitial lung disease who are at high risk of developing acute exacerbation after thoracic surgery. Several promising metrics are described however the close overlap between the statistically significant values leads to a broader discussion of statistical significance versus practical application.

Performance of MRI for Detection of Lateral Meniscus Posterior Root Injury in Children with Anterior Cruciate Ligament Tear [critique of article by Nguyen et al.]

Yoon-Jin Kim, MD discusses a study identifying imaging findings of lateral meniscus posterior root tear on pre-operative MRI in children. Imaging findings generally having a high specificity put low sensitivity with tears of the root proper having the best accuracy for identifying root tears when arthroscopy reports are used at the reference standard.

Axillary Adenopathy Following COVID-19 Vaccination in Breast Imaging [critique of article by Mortazavi]

Jeff Guccione, MD discusses an article has potential implications for future guidelines in how to manage axillary adenopathy following vaccination.

Post-Lumpectomy Surveillance Mammography: Diagnostic versus Screening? [critique of article by Nguyen et al.]

For patients who have undergone prior lumpectomy for localized breast cancer, no clear guidelines exist regarding use of diagnostic or screening mammography for post-lumpectomy imaging surveillance. Amber Liles, MD, MPH dives into a recently published article which seeks to answer this research question.

Evaluating the MRI characteristics and frequency of Displaced Flap Tears of the Triangular Fibrocartilage Complex [critique of article by Boutin et al.]

The triangular fibrocartilage complex is a structure which is often associated with ulnar sided wrist pain. Injuries to this structure can result in displaced tears which have a characteristic appearance. Shrey Patel, MD discusses a new AJR article that describes characteristic MRI findings and the frequency of this injury.

Y-90 Radioembolization for the Treatment of Metastatic Colorectal Cancer – Does Primary Tumor Location Prognosticate Survival? [critique of article by Wu et al.]

Giuseppe V. Toia, MD reviews a retrospective study exploring prognostic factors for patients with chemorefractory metastatic colorectal cancer treated with Y-90 radioembolization. The study emphasizes primary tumor location as a predictor of overall survival. 

In-Bore Versus Fusion MRI-Targeted Prostate Biopsy of PI-RADS Category 4 or 5 Lesions: A Retrospective Comparative Analysis Using Propensity Score Weighting [critique of article by Prince et al.]

Shrav Sridhar MD, discusses a retrospective study in which target-specific prostate cancer detection rate in a cohort of patients who underwent in-bore MRI biopsy was compared to the rate in a cohort of patients who underwent ultrasound-MRI fusion-guided biopsy. 

In-Gantry MRI-Guided Prostate Biopsy: Finding a Sweet Spot in Lesion Sampling [critique of article by Seyfried et al.]

Frederic J. Bertino, MD discusses a recent AJR article that investigates how to optimize the cores samples for in-gantry prostate MRI biopsy. It is suggested by this retrospective study that three cores from the dominant lesion achieves the “sweet spot” in balancing significant cancer detection and reducing anesthesia and procedure time. Study limitations and future directions are discussed.

Can We Reliably Utilize Ultrasound to Evaluate Fatty Liver? [critique of article by D'Hondt et al.]

Pei-Kang Wei, MD and Cinthia Cruz-Romero, MD discuss the importance of ultrasound as a reliable and affordable method to evaluate fatty liver in various patient populations—children and adult.

Should Thyroid Nodule Location Factor into TI-RADS Scoring? [critique of article by Jasim et al.]

Kalen Riley, MD discusses an article in which the authors believe TI-RADS should be accounting for nodule location and that a revision to the scoring system should be considered.

Incidental Infectious and Inflammatory Findings on Lung Cancer Screening CT: Significance and Outcome‪s‬ [critique of article by Mendoza et al.]

Kerem Ozturk, MD discusses how adoption of a conservative management algorithm can standardize recommendations and reduce unnecessary imaging without increasing the risk of missing a malignancy.

Conventional vs. Drug Eluting Bead TACE - The Debate Continues [critique of article by Zhang et al.]

David Ballard, MD discusses an important contribution to the literature in assessing the ongoing debate of conventional vs. drug eluting bead transarterial chemoembolization.

The Potential of a Patient Symptom Questionnaire and its Potential Role in Improving Diagnostic Specificity of Pain Generators for Lumbar Spine MRI [critique of article by Balza et al.]

Identifying primary pain generators with lumbar spine MRI can be a challenging task. Adequate patient symptom information is often lacking and its absence may lead radiologists astray in their own interpretations. Drew Guino, MD discusses the development of a patient symptom questionnaire that appears to address this very issue.

¹⁸F-Fluciclovine PET/MRI: Too Little, Too Late? [critique of article by Galgano et al.]

David Robinson, MD discusses an AJR pilot study exploring ¹⁸F-Fluciclovine PET/MRI for initial staging of prostate cancer and the effects of androgen deprivation therapy on ¹⁸F-Fluciclovine uptake.

Normal Range MRI-derived Left Ventricular Global Strain – Is It Ready for Primetime? [critique of article by Smith et al.]

Giuseppe V. Toia, MD reviews a timely meta-analysis which defines the normal reference ranges for MRI-derived left ventricular strain in healthy adults.

Chest CT Findings of Immune Checkpoint Inhibitor Therapy-Related Adverse Events [critique of article by Smith et al.]

Kerem Ozturk, MD discusses why awareness of early chest CT findings is required for early detection and accurate diagnosis of immune checkpoint inhibitor therapy-related adverse events such as pneumonitis, new consolidation, worsening thoracic tumor burden, pleural/pericardial effusion, and pulmonary emboli in the emergency department.

Chest CT Findings of Immune Checkpoint Inhibitor Therapy-Related Adverse Events [critique of article by Ozturk et al.]

Tyler Richards, MD discusses an AJR article that found no significant increase in the intrinsic T1 signal in the globus pallidus and dentate nucleus after more than 10 administrations of gadobutrol in pediatric patients compared to matched-age gadolinium naïve control and discussion of similar imaging based and autopsy studies.

Chest Radiograph as Predictor and Clinical Guide for Management of Patients with COVID-19: Current Studies and Future Direction [critique of article by Reeves et al.]

In this podcast, Pei-Kang (Ken) Wei, MD and Diana Litmanovich, MD first summarized the study by Reeves et al. and then provided an in-depth discussion about the current status and future direction of utilizing chest radiograph as a guiding tool for clinical management. Key aspects of the discussion are the practicality and applicability of the scoring system developed by Reeves et al., chest radiograph as a more desirable modality for evaluating patients with COVID-19 compared to CT, and chest radiograph as an outcome predictor.

Findings of COVID-related Disseminated Leukoencephalopathy [critique of article by Freeman et al.]

While the primary manifestations of COVID-19 are respiratory in nature—it has become clear as we take care of patients and learn more that COVID can have an effect on the nervous system. On this podcast, Edgar Perez, MD discusses MRI findings of COVID related-Disseminated Leukoencephalaopathy, which should remain an important differential consideration in COVID patients with neurologic manifestations.

Radiofrequency Tag Localization Is a Feasible Alternative to Wire Localization of Breast Lesions [critique of article by Lamb et al.]

Wire localization has long been the standard of care for localization of non-palpable breast lesions. Additional wireless localization options exist, including use of radioactive seeds, magnetic markers, radar/infrared reflectors, or most recently a radiofrequency identification tags, which address some of the disadvantages involved in wire localization. Matthew Petterson, MD discusses results an AJR study of one year of use at a single institution that suggests that RF tag localization is a feasible alternative to wire localization.

Borderline Resectable and Locally Advanced Pancreas Cancer: FDG PET/MRI and CT Tumor Metrics for Assessment of Neoadjuvant Therapy Pathologic Response and Prediction of Survival [critique of article by Smith et al.]

Patients with borderline resectable and locally advanced pancreatic cancer receiving neoadjuvant therapy can have results comparable to patients with resectable tumor at presentation, however some patients have early recurrence after neoadjuvant therapy and resection. Jordan Perchik, MD discusses a new AJR study in which a team of radiologists evaluate multiple imaging parameters and tumor metrics to assess for characteristics to predict pathologic response prior to resection.

Use of Enteric Contrast for Abdominopelvic CT in Penetrating Traumatic Injury in Adults [critique of article by Alabousi et al.]

Michael Nellamattathil, DO discusses whether or not enteric contrast is necessary in the setting of penetrating traumatic injury in light of a recent AJR article on the subject.

Thermal Ablation versus stereotactic body radiation therapy following trans-arterial chemoembolization – A comparison of outcomes [critique of article by Nabavizadeh et al.]

Percutaneous interventions are the mainstay for patients with non-operative HCC. This podcast by Ben Kipper, MD examines a paper comparing outcomes between thermal ablation and stereotactic body radiation therapy following transarterial chemoembolization and how those outcomes might affect clinical treatment plans going forward.

Malignant Outcomes of Architectural Distortion [critique of article by Choudhery et al.]

Architectural distortion is a subtle but suspicious finding increasingly detected using digital breast tomosynthesis. Alicia Chen, MD discusses a timely meta-analysis by Dr. Choudhery and colleagues that found the pooled positive predictive value for AD without a known cause on DBT is 35%, the great majority of which represents invasive disease. This finding warrants tissue sampling.

Ultrasound guided percutaneous biopsy of small pleural lesions [critique of article by Park et al.]

In this episode, Yoon-Jin Kim, MD discusses a study evaluating the diagnostic yield of ultrasound guided percutaneous biopsy of small pleural lesions. Important findings include that the technique is safe and fairly high yield for lesions 20 mm or less and that features such as nodular.

Evaluating PI-RADS 3 atypical BPH nodules using v2.1. [critique of article by Costa et al.]

Jeff Guccione, MD discusses a new article comparing atypical BPH prostatic nodules in the problematic prostate transition zone to traditional PI-RADS 3 lesions using PI-RADS version 2.1. All nodules contain pathologic confirmation from biopsy.

Prediction of Stroke Recurrence: A Comparison of Transthoracic Echocardiography, Cardiac CTA, and Cardiac MRI in Patients with Suspected Cardioembolic Stroke [critique of article by Apfaltrer et al.]

Transthoracic echocardiography (TTE) is the standard of care in cardiac imaging for patients with suspected cardioembolic stroke. In this podcast, Amber Liles, MD discusses how cardiac MRI and cardiac CT angiography perform in comparison to TTE in terms of prediction of stroke recurrence.

Can an unconventional diffusion weighted technique aid in the MRI management of sacroiliitis? [critique of article by Zhang et al.]

Shrey Patel, MD discusses a new AJR article on whether using an unconventional DWI technique, readout-segmented echo-planar imaging, can improve image quality and differentiate disease activity in patients with axial spondyloarthritis.

CT and MR perform similarly using Bosniak v2019 for cystic renal masses [critique of article by Tse et al.]

In this episode, David Ballard, MD summarizes Bosniak v2019 and Tse et al.’s imaging cohort with this study of radiologists applying Bosniak v2019.

Liver steatosis categorization on contrast-enhanced CT using a fully-automated deep learning volumetric segmentation tool: Evaluation in 1,204 healthy adults using unenhanced CT as the reference standard [critique of article by Pickhardt et al.]

Shrav Sridhar, MD discusses a retrospective study in which automated volumetric segmentation-assisted hepatic parenchymal attenuation measurement was performed on contrast-enhanced and unenhanced abdominal CT scans of a cohort of healthy adults to investigate the possibility of stratifying liver fat content on contrast-enhanced CT.

Increasing Specificity of Recommendations for Renal Incidentalomas [critique of article by Corwin et al.]

Incidentally detected renal masses are common, and can require follow-up. Recommendations from the 2017 ACR white paper on incidental renal masses suggest that small homogeneous masses measuring less than 20 Hounsfield units are probably benign, and do not require further characterization. However, new evidence from a multi-institutional study in AJR suggests that this cutoff should be raised to at least 30 Hounsfield units. In this episode, Matthew Petterson, MD discusses the new evidence.

Treating Sinistral Portal Hypertension: Stenting or Embolization? A first-of-its-kind study. [critique of article by Wei et al.]

Frederic J. Bertino, MD reviews a new AJR study in which the authors attempt to compare the clinical efficacy and technical feasibility of Splenic vein stenting and splenic artery embolization (the current standard) for the treatment of SPH.

A New Medial Meniscal Extrusion Threshold Relating Clinical Symptoms and MRI Findings [critique of article by Liu et al.]

The addition of clinical information and verified cartilage damage progression on MRI may represent a new standard in determining progression of knee osteoarthritis. Drew Gunio, MD, MS discusses a new AJR article on why 2.5 mm may now be the new number to consider when reporting medial meniscal extrusion.

Altar of the Hounsfield Unit [critique of article by Azar et al.]

Can HU reliably differentiate any benign sclerotic bone lesion (not just bone islands) from sclerotic metastases? David Robinson, MD explores the topic through the lens of a new AJR article on the subject.

Improving radiologist performance in detection of microinvasive disease on mammography [critique of article by Grimm et al.]

Jordan Perchik, MD discusses a new AJR study in which a team of breast imaging radiologists determine if case review and a targeted educational session can improve detection of microinvasive disease on mammography. The authors describe patterns key to upstaging DCIS and address the difficulty and limitations of detecting microinvasive disease.

Predictors of Anesthetic Exposure in Pediatric MRI [critique of article by Zhou et al.]

In this podcast, Edgar Perez, MD reviews new AJR data on how ablation fares in the morbidly obese demographic. Additionally, this podcast may help facilitate discussions about expectations, safety, efficacy, and complications during consultations with morbidly obese patients.

A Look at Thermal Ablation of RCC in the Morbidly Obese [critique of article by Machado-Rivas et al.]

Michael Nellamattathil, MD analyzes and reviews a recent AJR article on the various factors contributing to anesthesia time and exposure in pediatric patients undergoing MRI examinations and what can be done to improve these measures.

Comparing Chest CT findings in Coronavirus and Influenza Pneumonias [critique of article by Lin et al.]

Jeffrey Guccione, MD highlights the keys points of a new AJR article, which retrospectively compares the imaging features on CT of coronavirus pneumonia and influenza. The importance of this research is put into the broader context of the evolving COVID-19 pandemic, including the possibility for concurrent outbreaks of SARS-CoV-2 and influenza. The strengths and weaknesses are outlined along with some future avenues for investigation.

Stroke and COVID-19: A New Association [critique of article by Kihira et al.]

COVID-19 has been shown to affect a variety of organ systems. In this podcast, Ben Kipper, MD examines the association between stroke subtypes and COVID-19 as well as the effect that association may have on clinicians and radiologists.

Lung US Findings in Coronavirus Disease-19 (COVID-19) Patients [critique of article by Zhang et al.]

On this episode, Alicia Chen, MD takes a closer look at a very timely new AJR article titled, “Lung US Findings in Coronavirus Disease-19 (COVID-19) Patients” by Yao Zhang and colleagues from Beijing Ditan Hospital and Peking University Third Hospital. Compared to CT, ultrasound is portable, less costly, and does not use radiation. These characteristics suggest ultrasound could be particularly useful tool for triage, particularly in the pre-hospital/outpatient setting, and severity stratification and monitoring, particularly of critically ill patients who may be challenging to transport and require careful ventilation management. This study demonstrates that lung ultrasound has a high sensitivity for COVID-19 pneumonia in moderate and severe disease and that sonographic findings can suggest infection length and severity. Ultrasound is a promising adjunct modality for COVID-19 management.

Factors Associated with Background Parenchymal Enhancement on Contrast Enhanced Mammography [critique of article by Karimi et al.]

In this episode, Yoon-Jin Kim, MD, discusses a study evaluating factors associated with background parenchymal enhancement (BPE) on contrast-enhanced mammography. The findings are important as BPE impacts study interpretation and high BPE may be an independent breast cancer risk factor. The study findings are valuable for physicians currently interpreting this emerging breast imaging modality and those considering integrating it into their own clinical practice.

Opportunistic Screening for Metabolic Syndrome in Asymptomatic Adults Utilizing Fully Automated Abdominal CT-based Biomarkers

Metabolic syndrome is typically thought of as a clinical disease. In this podcast, Shrey Patel explores reevaluating the role of imaging in identifying and potentially diagnosing patients at risk for metabolic syndrome by using CT biomarkers.

Whole-Body Bone Scintigraphy Helps to Detect Kidney Diseases

Shravan Sridhar, MD, MS discusses his study in AJR that provides a retrospective review of patients with abnormal renal uptake Technicium 99m MDP bone scans in which the causes of abnormal renal uptake, imaging follow up, and interventions are assessed. The study identifies several different conditions responsible for abnormal uptake, ranging in levels of clinical significance and degree of actionability. This study underscores the importance of careful assessment of the kidneys on whole body bone scan.

ACR TI-RADS: What Are We Missing?

Compared to other guidelines, ACR TI-RADS results in a decreased number of thyroid nodules which are either followed or given a recommendation of fine needle aspiration (FNA). Find out on this podcast hosted by Amber Liles, MD, MPH, what thyroid malignancies are missed and why and how changes in size thresholds might affect ACR TI-RADS performance and outcomes.