Radiology
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Purpose To determine whether regions of low apparent diffusion coefficient (ADC) with high relative cerebral blood volume (rCBV) represented elevated choline (Cho)-to-N-acetylaspartate (NAA) ratio (hereafter, Cho/NAA ratio) and whether their volumes correlated with progression-free survival (PFS) and overall survival (OS) in patients with glioblastoma (GBM). Materials and Methods This retrospective analysis was approved by the local research ethics committee. Volumetric analysis of imaging data from 43 patients with histologically confirmed GBM was performed. ⋯ Results ADC-rCBV ROIs within contrast-enhancing and nonenhancing regions showed elevated Cho/NAA ratios, which were significantly higher than those in other abnormal tumor regions (P < .001 and P = .008 for contrast-enhancing and nonenhancing regions, respectively) and in normal-appearing white matter (P < .001 for both contrast-enhancing and nonenhancing regions). After Cox regression analysis controlling for age, tumor size, resection extent, O-6-methylguanine-DNA methyltransferase-methylation, and isocitrate dehydrogenase mutation status, the proportional volume of ADC-rCBV ROIs in nonenhancing regions significantly contributed to multivariate models of OS (hazard ratio, 1.132; P = .026) and PFS (hazard ratio, 1.454; P = .017). Conclusion Volumetric analysis of ADC-rCBV ROIs in nonenhancing regions of GBM can be used to identify patients with poor survival trends after accounting for known confounders of GBM patient outcome.
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While pulmonary embolism (PE) causes approximately 100 000-180 000 deaths per year in the United States, mortality is restricted to patients who have massive or submassive PEs. This state of the art review familiarizes the reader with these categories of PE. The review discusses the following topics: pathophysiology, clinical presentation, rationale for stratification, imaging, massive PE management and outcomes, submassive PE management and outcomes, and future directions. It summarizes the most up-to-date literature on imaging, systemic thrombolysis, surgical embolectomy, and catheter-directed therapy for submassive and massive PE and gives representative examples that reflect modern practice. © RSNA, 2017.
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Purpose To evaluate the diagnostic accuracy of aneurysm detection and the fidelity of morphologic characterization of three-dimensional (3D) time-of-flight (TOF) magnetic resonance (MR) angiography at 3.0 T in patients with a Glasgow coma score of 15 and noncontrast material-enhanced computed tomography (CT) findings that showed acute nontraumatic subarachnoid hemorrhage. Materials and Methods The institutional review board approved this prospective study, and patients provided informed consent. A total of 277 patients who had not experienced trauma but in whom nonenhanced CT showed subarachnoid hemorrhage, who had a Glasgow coma score of 15, and who underwent both 3D TOF MR angiography and digital subtraction angiography (DSA) (the reference standard) were included. ⋯ Accuracy of display of morphologic features was 92.5% (236 of 255) for size, 86.3% (220 of 255) for neck width, 94.5% for shape (241 of 255), and 96.9% (247 of 255) for relationship to adjacent vessel. Width of aneurysm neck was the only variable that significantly affected the morphologic assessment of 3D TOF MR angiography (odds ratio, 0.378; 95% confidence interval: 0.337, 8.347; P = .004). Conclusion Three-dimensional TOF MR angiography can accurately depict cerebral aneurysms and accurately display their morphologic features in stable patients with subarachnoid hemorrhage and a Glasgow coma score of 15. © RSNA, 2017.
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Diffuse Pulmonary Ossification in Fibrosing Interstitial Lung Diseases: Prevalence and Associations.
Purpose To investigate the prevalence of diffuse pulmonary ossification (DPO) in patients with fibrosing interstitial lung disease (ILD) and determine whether there are differences among the types of ILDs. Materials and Methods Institutional review board approval was given and patient consent was not required for this study. The study population comprised 892 consecutive patients with fibrosing ILD, including 456 patients with idiopathic pulmonary fibrosis (IPF) (men, 366; women, 90; median age, 72 years [range, 38-93 years]), 244 with nonspecific interstitial pneumonia (men, 79; women, 165; median age, 60.5 years [range, 23-86 years]), and 192 with chronic hypersensitivity pneumonitis (men, 76; women, 116; median age, 66 years [range, 35-88 years]). ⋯ At multivariate analysis, DPO according to definition 1 was an independent predictor of IPF diagnosis (P < .001) and male sex (P = .003). Coarseness of fibrosing ILD (P = .011) and IPF diagnosis (P = .016) were independently associated with pulmonary ossification profusion. Conclusion DPO is common in patients with fibrosing ILD and is significantly more prevalent in patients with IPF than in those with other fibrosing ILDs, and thus, computed tomographic signs of DPO may be helpful for diagnosis of IPF. © RSNA, 2017 Online supplemental material is available for this article.
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Purpose To assess the diagnostic performance of a third-generation dual-energy computed tomographic (CT) virtual noncalcium (VNCa) technique for detection of traumatic bone marrow edema in patients with vertebral compression fractures. Materials and Methods This prospective study was approved by the institutional review board. Informed consent was obtained from all participants. ⋯ Receiver operating characteristic analysis revealed an area under the curve of 0.922. A cutoff value of -47 provided sensitivity of 92.0%, specificity of 82.6%, accuracy of 84.0%, positive predictive value of 48.9%, and negative predictive value of 98.3% for the differentiation of edematous vertebral bodies. Conclusion Visual and quantitative analyses of dual-energy VNCa images showed excellent diagnostic performance for assessing traumatic bone marrow edema in vertebral compression fractures. © RSNA, 2017 Online supplemental material is available for this article.