Radiology最新文献

Health equity is a foundational principle for providing high-quality care. The COVID-19 pandemic has increased the urgency of health systems and regulatory agencies to address longstanding health disparities. Imaging disparities have been documented in the imaging literature for decades, but there is paucity of published interventions to successfully reduce disparities in imaging. Quality and safety approaches can be successfully employed to catalyze and rigorously evaluate interventions to reduce imaging disparities. Emerging from the Toyota Production System, the lean management framework focuses on continuous quality improvement to improve efficiency and reduce waste. Lean approaches have been successfully adopted by quality and safety experts in health care for problem-solving and process improvement. This article provides readers with step-by-step guidance on how to address health equity issues by adapting selected lean tools for quality improvement and patient safety. Core steps include (a) problem identification, (b) team building, (c) creation of a data infrastructure, (d) problem analysis, (e) development and testing of solutions, and (f) change management strategies to help organizations sustain successful health equity initiatives. Readers can use these six core steps to catalyze data-driven quality improvement initiatives to reduce imaging disparities within their health systems.

Background Patients with acute SARS-CoV-2 infection are reportedly at increased risk for future cardiovascular events; the mechanism underlying this risk remains unclear. Purpose To evaluate the impact of SARS-CoV-2 infection on coronary inflammation and plaques by using coronary CT angiography (CCTA) and the impact on clinical outcomes. Materials and Methods This retrospective analysis of a prospective study included consecutive patients who underwent serial CCTA between September 2018 and October 2023. The quantitative total and compositional percent atheroma volume (PAV) and annualized PAV change, presence of high-risk plaque, and attenuation of lesion-specific pericoronary adipose tissue (PCAT) at baseline and follow-up were compared between lesions in patients with and without SARS-CoV-2 infection. Relationships between SARS-CoV-2 infection and target lesion failure, which is a composite of cardiac death, target lesion myocardial infarction, and clinically driven target lesion revascularizations, were assessed with Cox models and log-rank tests. Results In 803 patients (mean age, 63.9 years ± 10.1 [SD]; 543 [67.6%] male patients), 2108 coronary artery lesions were evaluated in patients with SARS-CoV-2 infection (n = 690) and 480 coronary artery lesions were evaluated in patients without SARS-CoV-2 infection (n = 113). Compared with lesions in patients without SARS-CoV-2 infection, lesions in patients with SARS-CoV-2 infection demonstrated more rapid progression of overall PAV (0.90% per year ± 0.91 vs 0.62% per year ± 0.68, respectively; P < .001) and noncalcified PAV (0.78% per year ± 0.79 vs 0.42% per year ± 0.45, respectively; P < .001). The incidence of becoming high-risk plaque (21.0% [442 of 2108] vs 15.8% [76 of 480]; P = .03) and PCAT attenuation of -70.1 HU or higher (27.1% [571 of 2108] vs 19.8% [95 of 480]; P < .001) at follow-up was also greater in lesions in patients with SARS-CoV-2 infection (P < .001), despite similar prevalence at baseline. Lesions in patients with COVID-19 had a higher risk of target lesion failure (10.4% vs 3.1%, respectively; adjusted hazard ratio, 2.90; 95% CI: 1.68, 5.02; P < .001). Conclusion SARS-CoV-2 infection was associated with a more rapid progression of lesion-based plaque volume and an increase in incidence of becoming high-risk plaque. Coronary plaques among patients who experienced COVID-19 were more prone to having an elevated risk of target lesion failure. Clinical trial registration no. NCT05380622 © RSNA, 2025 Supplemental material is available for this article. See also the editorial by Weir-McCall and Bell in this issue.

Background Background parenchymal enhancement (BPE) is an important diagnostic and prognostic imaging biomarker. Although hormonal regulation of BPE at breast MRI has been investigated, information regarding hormonal regulation of BPE at contrast-enhanced mammography (CEM) remains scarce. Purpose To investigate how BPE at CEM changes across various short- and long-term physiologic and pharmacologic hormonal effects, including menopausal status, lactation, hormone replacement therapy (HRT), and tamoxifen therapy and its cessation. Materials and Methods This retrospective study included CEM examinations performed between December 2012 and January 2024. A computational search was performed to identify CEMs performed in patients with various hormonal statuses and several subgroups of patients were identified, including premenopausal, postmenopausal, lactating, HRT, and tamoxifen subgroups. For patients who received tamoxifen therapy, the first follow-up image at treatment cessation was included, when available. The four ordinal BPE grades, ranging from minimal to marked, as reported in the official radiologic reports were used for analysis. Subgroup comparisons were performed using the Kruskal-Wallis rank sum test and χ² test or Fisher exact test. Results A total of 507 female patients (mean age, 49.8 years ± 10.8 [SD]; range, 25-75 years) were included. Premenopausal patients (n = 200) exhibited higher BPE compared with postmenopausal patients (n = 200) (median grade, 1.0 [IQR, 0-2.0] vs 0 [IQR, 0-1.0]; P < .001). Lactating patients (n = 16) exhibited higher BPE (median grade, 3.0; IQR, 2.0-3.0) compared with nonlactating controls (median grade, 1.0; IQR, 0-2.0; P < .001). Patients receiving HRT (n = 14) exhibited higher BPE (median grade, 1.5; IQR, 0-3.0) compared with postmenopausal controls (median grade, 0; IQR, 0-1.0; P < .001). Patients receiving tamoxifen therapy (n = 77) exhibited lower BPE (median grade, 1.0; IQR, 0-2.0) compared with nontreated control patients (9% of patients with high BPE vs 31% for controls, P < .001) and increased BPE (median grade, 2.0; IQR, 1.5-2.5; P = .003) at the cessation of tamoxifen therapy. Conclusion Hormonal effects, including menopausal status, lactation, HRT, and tamoxifen therapy, influenced the degree of BPE at CEM. © RSNA, 2025 Supplemental material is available for this article. See also the editorial by Slanetz in this issue.

Cervical spine MRI is essential for evaluating potential complications and symptomatic degenerative changes following cervical decompression and fusion surgery. High-yield diagnostic interpretation considers the underlying surgical approach (anterior vs posterior), the time elapsed since surgery, and the clinical status of the patient to reliably differentiate expected postoperative changes from surgical complications. As cervical anatomy, such as the foramina and nerve roots, is smaller than that of the lumbar spine, MRI acquisition challenges include the demand for higher spatial resolution. Another unique challenge for cervical spine MRI is susceptibility to motion artifacts from swallowing, breathing, and cerebrospinal fluid pulsation. Modified MRI protocols, including the use of metal artifact suppression techniques, can help mitigate susceptibility artifacts from metallic implants. This focused review of postoperative cervical spine MRI discusses common cervical surgery decompression and fusion approaches and recommended MRI acquisition and interpretation algorithms, briefly considers radiofrequency coil selection, and illustrates complications in both early and delayed phases.

Cross-sectional imaging, especially MR enterography (MRE) and intestinal US, plays an increasingly important role in the diagnosis and monitoring of Crohn disease. In this article, the authors share their approach to imaging Crohn disease, drawing on their clinical and research experience. They consider how to select the most appropriate modality for different clinical indications and discuss technical aspects to maximize diagnostic accuracy. The focus then shifts to how to use imaging to assess disease activity and treatment response in day-to-day clinical practice and the clinical potential of disease activity scores from MRE and intestinal US. The authors finish by discussing the benefits of intestinal US in ulcerative colitis.

Background External beam radiation therapy for primary and secondary pulmonary malignancies has limited utility for treating ultracentral tumors (ie, adjacent to the proximal bronchial tree or heart) or multiple metastases due to either radiation to central organs at risk (OARs) or extensive lung tissue exposure. Bronchial artery yttrium 90 (⁹⁰Y) radioembolization may be a therapeutic option for these patients. Purpose To evaluate the feasibility of bronchial artery ⁹⁰Y radioembolization using technetium 99m (^99mTc) macroaggregated albumin (MAA) injection as a surrogate for ⁹⁰Y microspheres and to use SPECT/CT dosimetry to assess ^99mTc-MAA distribution and calculated anticipated ⁹⁰Y doses to tumors and OARs. Materials and Methods In this prospective clinical trial, study participants with either primary lung cancer or pulmonary metastases were enrolled between August 2020 and October 2023 from a single academic medical center. All participants underwent bronchial artery embolization for malignancy-induced hemoptysis prophylaxis. ^99mTc-MAA was injected via bronchial arteries, followed by bland embolization. SPECT/CT imaging and Monte Carlo simulations were used to evaluate ^99mTc-MAA distribution and predict ⁹⁰Y doses. Predicted ⁹⁰Y doses to tumors and OARs are reported as means ± SDs. Results Eight participants (mean age, 63.0 years ± 13.58; six [75%] male participants) were included. All had ultracentral tumors, and four had four or more tumors. SPECT/CT revealed a concentrated ^99mTc-MAA accumulation in tumors, with a mean tumor-to-normal tissue ratio of 22.71 ± 20.17. Simulations indicated that a ⁹⁰Y biologically effective dose (α/β ratio of 10 Gy) of 175.7-3173.6 Gy (mean, 778.8 Gy ± 981.9) could be delivered to all tumors while remaining under OAR toxicity thresholds. Conclusion SPECT/CT dosimetric analysis of ^99mTc-MAA injected via the bronchial artery for pulmonary malignancy suggests that bronchial artery ⁹⁰Y radioembolization is feasible and could be an alternative treatment for patients unable to receive external beam radiation therapy. ClinicalTrials.gov Identifier: NCT04105283 © RSNA, 2025 Supplemental material is available for this article.