American Journal Of Roentgenology Research Articles

Gender Disparities in Academic Radiology Authorship: A 13-Year Review

Underrepresentation of women in many scientific fields has been linked to biases against female-authored publications in peer-reviewed journals, thereby reducing their opportunities for career development and promotions. The objective of this study is to determine the representation of female academic radiologists in four flagship general radiology journals to elucidate gender-specific trends and disparities in academic radiology. We analyzed 23,741 peer-reviewed articles published in Radiology, American Journal of Roentgenology, Journal of the American College of Radiology and Academic Radiology from 2007 to 2020. Data abstraction and statistical analysis were performed for author gender, first and last authorship, research funding, and number of citations and grants. Baseline demographics data of academic radiologists was obtained from the Association of American Medical Colleges (AAMC). A total of 72.4% of authors were male with 54% of articles were written by a male first author and male last author. When compared with assumed random pairing, there were significantly fewer Male/Female author combinations and more Female/Female author combinations than expected (p<0.01). Over the 13-year time period, the rate of increase in the number of female authors exceeded the rate of increase in women in academic radiology as reported by the AAMC. Female last authors received on average 3.2 less citations than their male counterparts (p=.03). Of manuscripts with last female authors, 31.7% of female last authors were funded compared to 25.9% of last male authors. This study showed the increasing numbers and higher productivity of female authors in academic radiology, suggesting progress is being made in overcoming gender disparities.

LARGE BILATERAL PNEUMATOCELES COMPLICATING COVID-19 RECOVERY

LARGE BILATERAL PNEUMATOCELES COMPLICATING COVID-19 RECOVERY

Preferential reporting of significant p-values in radiology journal abstracts

To assess the prevalence of publication bias in the radiology literature, data-mining techniques were used to extract p-values in abstracts published in key radiology journals over the past 20 years. A total of 34,699 abstracts published in Radiology, Investigative Radiology, European Radiology, American Journal of Roentgenology, and American Journal of Neuroradiology published between January 2000 and December 2019 were included in the analysis. Automated text mining using regular expressions was used to mine abstracts for p-values. The text mining algorithm detected 43,489 p-values, the majority (82.4%) of which were reported as "significant", i.e., p<0.05. There has also been an increased propensity to report more p-values over time. The distribution of p-values showed a step change at the conventional significance threshold of 0.05. The odds ratio of a "significant" p-value being reported in the abstract compared to the full text was calculated to be 2.52 (95% confidence interval 1.78-3.58; p<0.001). Taken together, these results provide strong evidence for selective reporting of significant p-values in abstracts. Statistically significant p-values are preferentially reported in radiology journal abstracts.

Dedicated COVID-19 Resource Center in Radiology Journals: Its Citation Metrics and Altmetrics Impact.

Since the emergence of coronavirus disease 2019 (COVID-19), several journals have established a dedicated resource center for all the articles published on COVID-19. Our study compared the altmetric impact captured by articles published in journals having a COVID-19 resource center. We used the Web of Science database to assess radiology journals publishing the most common articles on COVID-19. We used the dimensions database to assess citations received and altmetric attention score for each article. For each article, we extracted several citations received and altmetric attention scores. To account for the variation in strength and exposure between included journals, we adopted a normalization strategy and regression analysis in our statistical analysis. A total of 494 articles were included in the current assessment, including 334 (67.6%) articles published in journals with the dedicated COVID-19 resource center, including European radiology, American Journal of Roentgenology, Radiology, and Journal of the American college of radiology, while European Journal of Nuclear Medicine and Molecular Imaging, Academic Radiology did not have COVID-19 resource center. Journals with COVID-19 resource center had a mean normalized altmetric attention score of 0.38 higher (95% CI 0.25 to 0.50; p< 0.001) and a mean normalized citation count of 6.73 higher (95% CI 3.99 to 9.48; p< 0.001) than those without COVID-19 resource center. Radiology journals that provided COVID-19 articles in a dedicated resource center within its homepage had greater attention and higher citation for their COVID-19 articles than journals that did not have such a dedicated resource center.

MO909: Dialysis After Contrast Agent Administration in Patients on Chronic Haemodialysis: It is a Common Clinical Practice?

Abstract BACKGROUND AND AIMS Though the current dialysis population is characterized by a better survival, there is a greater burden of cardiovascular comorbidities. These two factors together expose patients to a greater number of diagnostic and therapeutic contrast tests. The European Society of Urogenital Radiology (ESUR) Guidelines on Contrast Agents 10.0 report that there is no need for urgent dialysis after intravascular iodinated contrast agent administration based on the results of the only study that addressed this problem, conducted in 10 patients by Younathan CM and published in the American Journal of Roentgenology in 1994. As far as the use of gadolinium contrast agent in dialysis patients, the recommendation is to try to perform the contrast agent injection prior to and close to the haemodialysis session, and an extra haemodialysis session to remove the contrast agent as soon as possible after it has been administered is recommended. It is now a well-known phenomenon that when there are low-level recommendations, the behaviour of nephrologists is not homogeneous. METHOD We have created a very simple survey (only 10 questions) to explore the behaviour of Italian nephrologists with respect to the administration of contrast agents in dialysis patients. The main information we wanted to obtain concerned the attitude towards the need for a dialysis session after the administration of a contrast agent (iodate or gadolinium), the timing respect to the contrast examination and the duration of the dialysis session. A total of 50 Italian nephrologists of 50 dialysis centres, respectively, responded to the questionnaire. The average number of chronic dialysis patients treated per single centre was 94 (median 80, interquartile range 46–135), meaning that these are representative of a population of at least 5000 haemodialysis patients. RESULTS After intravascular iodinated contrast agent, according to the ESUR guidelines 9 nephrologists (18%) do not perform an additional dialysis, while 34 nephrologists ( 68%) carry out an additional dialysis session (or organize the contrast examination to coincide with the scheduled dialysis session) (Fig. 1). A total of 32 nephrologists (64%) perform a specific dialysis session after magnetic resonance with gadolinium, as indicated in the ESUR guidelines (Fig. 2). In both cases (iodinated contrast agent or gadolinium), 28 nephrologists (56%) schedule the dialysis session within 4 h of the contrast examination (at least 2 h of treatment or complete dialysis session if possible). Remarkably, 10 nephrologists (20%) do not organize a specific dialysis section after MR with gadolinium (Fig. 2). CONCLUSION Our data confirm that in Italy, the majority of nephrologists still carry out an additional dialysis session after the administration of an iodinated contrast agent to avoid the potential risk of delay and adverse effects (intravascular volume expansion, pulmonary edema, depression of myocardial contractility and arrhythmias). Haemodialysis is an expensive procedure, in particular when performed as a nonscheduled emergent treatment at odd hours of the day or night. Further studies are needed to clarify this controversial point.

Neuropathy Score Reporting and Data System (NS-RADS): MRI Reporting Guideline of Peripheral Neuropathy Explained and Reviewed

A standardized guideline and scoring system should be used for the MR imaging diagnosis of peripheral neuropathy. The MR imaging-based Neuropathy Score Reporting and Data System (NS-RADS) is a newly devised classification system (in press in AJR) that can be used to communicate both type and severity of peripheral neuropathy in the light of clinical history and examination findings. The spectrum of neuropathic conditions and peripheral nerve disorders covered in this system includes nerve injury, entrapment, neoplasm, diffuse neuropathy, and post-interventional states. This classification system also describes the temporal MR imaging appearances of regional muscle denervation changes. This review article is based on the multicenter validation study pre-published in American journal of Roentgenology and discusses technical considerations of optimal MR imaging for peripheral nerve evaluation and discusses the NS-RADS classification and its severity scales with illustration of conditions that fall under each classification. The readers can gain knowledge of the NS-RADS classification system and learn to apply it in their practices for improved inter-disciplinary communications and timely patient management.

Comprehensive Study for Breast Cancer Using Deep Learning and Traditional Machine Learning

Comprehensive Study for Breast Cancer Using Deep Learning and Traditional Machine Learning

MYCOTIC PULMONARY ARTERY PSEUDOANEURYSM TREATED WITH ENDOVASCULAR COILING

TOPIC: Procedures TYPE: Medical Student/Resident Case Reports INTRODUCTION: Mycotic pulmonary artery pseudoaneurysm (PAP) presents with a focal dilatation of the affected vessel as a result of infection that leads to significant wall weakening. PSA can be life-threatening if rupture occurs, thus aggressive intervention is usually thought to prevent catastrophic hemorrhage. Coil embolization or stent placement are the most frequently used treatments. We present a case of right middle lobe (RML) pulmonary artery segmental branch pseudoaneurysm successfully treated with endovascular coiling in a patient with history of tricuspid valve (TV) endocarditis, bacteremia, and septic pulmonary emboli. CASE PRESENTATION: Patient is a 27-year-old female with past medical history of IV drug use and Hepatitis C. She had recently been hospitalized for 45 days due to methicillin-susceptible S. aureus (MSSA) bacteremia and native TV endocarditis with septic emboli to the lungs. 5 days prior to discharge, CT pulmonary angiogram showed a 1.8 cm enhancing lesion concerning for a pseudoaneurysm within medial segment of the RML. Subsequent outpatient evaluation by interventional radiology two weeks later revealed normal hemodynamic parameters (HR 87 bpm, BP 143/88 mmHg, RR 20 breaths/min, O2 sat 97% on room air), and unremarkable coagulation profile (including Hb of 11.3 g/dL and Hct of 35%). Endovascular embolization of the PAP was planned. Briefly, pulmonary artery was accessed using a 0.035-inch guidewire & pigtail catheter. Initial non-selective pulmonary angiogram demonstrated faint visualization of the RML PAP. Subsequent selective right pulmonary artery medial branch angiogram confirmed the location of the PAP. The pigtail catheter was exchanged for a vertebral artery catheter through which a PROGREAT® microcatheter was advanced into the pseudoaneurysm sac. Position of the catheter within the sac was confirmed. Coil embolization was performed using Concerto™ coils. Post-coiling RML pulmonary artery angiogram showed obliteration of the aneurysmal sac with preservation of distal vessels. The patient tolerated the procedure well and was discharged the following day. DISCUSSION: The etiology of PAPs can be iatrogenic, infectious, traumatic, or related to malignancy. When linked to infection, PAPs most commonly occur in the settings of TV endocarditis and septic embolism, with Staphylococcus and Streptococcus as the usual culprits. In our patient, IV drug use led to the development of MSSA bacteremia and TV endocarditis. The subsequent hematogenous spread of septic emboli to the pulmonary artery resulted in pseudoaneurysm formation. CONCLUSIONS: Mycotic PAPs can occur in patients with S. aureus TV endocarditis and can be treated with endovascular coil embolization. REFERENCE #1: Chen, Y., Gilman, M. D., Humphrey, K. L., Salazar, G. M., Sharma, A., Muniappan, A., Shepard, J.-A. O., & Wu, C. C. (2017). Pulmonary Artery Pseudoaneurysms: Clinical Features and CT Findings. American Journal of Roentgenology, 208(1), 84–91. https://doi.org/10.2214/AJR.16.16312 REFERENCE #2: Guillaume, B., Vendrell, A., Stefanovic, X., Thony, F., & Ferretti, G. R. (2017). Acquired pulmonary artery pseudoaneurysms: A pictorial review. In British Journal of Radiology (Vol. 90, Issue 1074). British Institute of Radiology. https://doi.org/10.1259/bjr.20160783 DISCLOSURES: No relevant relationships by Emad Chishti, source=Web Response No relevant relationships by Gaby Gabriel, source=Web Response No relevant relationships by Marianna Zagurovskaya, source=Web Response

THE FAULT IN OUR MOSAIC PATTERNS: PULMONARY HYPERTENSION MISSED AND TREATED AS HYPERSENSITIVITY PNEUMONITIS

TOPIC: Pulmonary Vascular Disease TYPE: Medical Student/Resident Case Reports INTRODUCTION: Mosaic Pattern refers to areas of variable lung attenuation seen on Computed Tomography (CT) of the chest. The pattern is a nonspecific finding and can be associated with airway, infiltrative lung, or pulmonary vascular diseases[1]. We present a case of exertional dyspnea with mosaic pattern on high resolution CT (HRCT) that was initially misdiagnosed and treated as hypersensitivity pneumonitis (HP) and found later to be caused by pulmonary arterial hypertension. CASE PRESENTATION: A 70-year-old Caucasian female presented with worsening exertional dyspnea after percutaneous coronary intervention. HRCT of the chest done at an outside office showed mosaic pattern and few tiny bilateral nodules with no fibrotic changes that was interpreted as possible chronic hypersensitivity pneumonitis. She was started on prednisone 40mg daily with minimal improvement in symptoms and referred to our Interstitial Lung Disease (ILD) Clinic for further work up and treatment. Upon interviewing the patient, she reported previous intake of anorexigenics (dextroamphetamine) in her 20's for 2 months. Review of the HRCT study showed parenchymal changes were not consistent with any specific ILD pattern and no exaggeration of mosaic pattern with expiratory cuts suggesting the presence of pulmonary hypertension and absence of significant air trapping. Prednisone was tapered off, and serologic work up showed no evidence of connective tissue disease. 6-minute walk test revealed severe reduction in exercise capacity with patient covering 38m which was 12% of predicted distance, and spirometry showed moderate-severe restrictive defect. Her echocardiography showed normal LV systolic function with ejection fraction (55-65%), and her ventilation-perfusion (VQ) scan was negative for any embolic disease. The patient was admitted to the hospital for hypervolemia and after adequate diuresis, a detailed hemodynamic study by right heart catheterization for the assessment of pulmonary hypertension was done. Results showed increased mean pulmonary artery pressure (mPAP) (31 mmHg) at rest; however, during limited exercise challenge which she could not complete, pulmonary artery occlusion pressure (PAOP) increased to 23 mmHg suggesting decreased left atrial/ventricular compliance. She was started on sildenafil and discharged with close follow up. DISCUSSION: Air-trapping in airway diseases causing relative hyperemia of healthy lungs, pulmonary vascular diseases causing relative oligemia in hypo-perfused lungs, and parenchymal disease presenting as patchy ground-glass opacities, all can give a mosaic pattern on CT[1]. Infiltrative diseases and airway diseases are reliably differentiated as the cause of mosaic attenuation on CT scan, but vascular diseases are often misinterpreted.[2] CONCLUSIONS: Careful review of HRCT with a chest radiologist in an advanced lung disease center is necessary to avoid misdiagnoses and unnecessary treatments. REFERENCE #1: Stern, Eric J., et al. "CT mosaic pattern of lung attenuation: distinguishing different causes.” AJR. American journal of roentgenology 165.4 (1995) REFERENCE #2: Worthy, Sylvia A., et al. "Mosaic attenuation pattern on thin-section CT scans of the lung: differentiation among infiltrative lung, airway, and vascular diseases as a cause.” Radiology205.2 (1997) DISCLOSURES: No relevant relationships by Roberto Bernardo, source=Web Response No relevant relationships by Salim Daouk, source=Web Response No relevant relationships by Ahmad Hassan, source=Web Response No relevant relationships by Abed Madanieh, source=Web Response No relevant relationships by Chirin Orabi, source=Web Response

SPONTANEOUS SUBCUTANEOUS EMPHYSEMA AND PNEUMOMEDIASTINUM WITH PROGRESSION TO PNEUMORETROPERITONEUM AS A RARE COMPLICATION OF COVID-19 PNEUMONIA

TOPIC: Chest Infections TYPE: Medical Student/Resident Case Reports INTRODUCTION: Spontaneous pneumothorax, pneumomediastinum, and subcutaneous emphysema have been described as rare life-threatening complications of COVID-19. Reports of pneumoperitoneum or pneumoretroperitoneum are extremely rare. We present a patient with COVID-19 pneumonia who developed spontaneous pneumomediastinum and subcutaneous emphysema with subsequent progression to pneumoretroperitoneum, without evidence of pneumothorax. CASE PRESENTATION: A 61 year old man with HIV and Addison's disease presented to the emergency department with worsening dyspnea, cough, and diarrhea. On admission, his oxygen saturation was 80% on room air, and he had diffuse bilateral lung rhonchi. Nasopharyngeal swab was positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Chest x-ray showed bilateral interstitial opacities. He was treated with dexamethasone, remdesivir, enoxaparin and supplemental oxygen. On hospital day three, he developed worsening hypoxia with pO2 of 41mmHg on 15L non-rebreather oxygen. He was transferred to the intensive care unit (ICU) and placed on non-invasive positive pressure ventilation but was quickly weaned to high-flow oxygen. On hospital day 17, he developed worsening hypoxia and reported neck swelling and tenderness. Computed tomography (CT) of the neck and chest confirmed extensive subcutaneous emphysema and pneumomediastinum and diffuse granular lung opacities without any normally aerated lung parenchyma, without evidence of pneumothorax. He was placed on mechanical ventilation after failing non-invasive positive pressure ventilation. Despite supportive care and lung protective ventilation, he remained hypoxic with worsening subcutaneous emphysema. CT of the chest, abdomen and pelvis showed development of pneumoperitoneum and pneumoretroperitoneum. Due to the patient's refractory hypoxia with progression to multi-system organ failure, his family opted for compassionate extubation and he expired on hospital day 34. DISCUSSION: Common causes of pneumoretroperitoneum include perforated viscous or iatrogenic introduction of air. As this patient had neither surgical procedures or evidence of perforation, his pneumoretroperitoneum was likely due to prolonged positive end expiratory pressure (PEEP) in setting of acute respiratory distress syndrome due to COVID-19. Mechanical ventilation likely acted as a shearing force intensifying air leak into the mediastinum which tracked inferiorly into the retroperitoneum. CONCLUSIONS: In conclusion, pneumomediastinum is a possible complication of COVID-19 pneumonia that can progress to pneumoretroperitoneum despite lung protective ventilation causing acute decompensation that can worsen patient prognosis. REFERENCE #1: Salehi, S., Abedi, A., Balakrishnan, S., & Gholamrezanezhad, A. (2020). Coronavirus Disease 2019 (COVID-19): A Systematic Review of Imaging Findings in 919 Patients. AJR. American journal of roentgenology, 215(1), 87–93. https://doi.org/10.2214/AJR.20.23034Zhou, C., Gao, C., Xie, Y., & Xu, M. (2020). COVID-19 with spontaneous pneumomediastinum. The Lancet. Infectious diseases, 20(4), 510. https://doi.org/10.1016/S1473-3099(20)30156-0 REFERENCE #2: Ahmed, A., Mohamed, M., & Ahmed, K. (2021). Severe COVID-19 Pneumonia Complicated by Pneumothorax, Pneumomediastinum, and Pneumoperitoneum. The American journal of tropical medicine and hygiene, tpmd210092. Advance online publication. https://doi.org/10.4269/ajtmh.21-0092Hillman K. M. (1983). Pneumoretroperitoneum. Anaesthesia, 38(2), 136–139. https://doi.org/10.1111/j.1365-2044.1983.tb13932. REFERENCE #3: Okamoto, A., Nakao, A., Matsuda, K., Yamada, T., Osako, T., Sakata, H., Yamaguchi, Y., Terashima, M., Iwano, J., & Kotani, J. (2014). Non-surgical pneumoperitoneum associated with mechanical ventilation. Acute medicine & surgery, 1(4), 254–255. https://doi.org/10.1002/ams2.52 DISCLOSURES: No relevant relationships by Christopher Ignatz, source=Web Response No relevant relationships by Bao Nhi Nguyen, source=Web Res onse No relevant relationships by Navitha Ramesh, source=Web Response

INTRAPULMONARY TERATOMA: A RARE PRESENTATION OF BRONCHIECTASIS

TOPIC: Lung Pathology TYPE: Medical Student/Resident Case Reports INTRODUCTION: Intrapulmonary teratomas (IPT) are a rare extra-gonadal manifestation of teratomas and are a challenging diagnosis to make. We present a patient with IPT presenting with hemoptysis. CASE PRESENTATION: A 49-year-old man presented with intermittent non-massive hemoptysis throughout the previous year. Labs were normal with the exception of normocytic anemia with hemoglobin of 12.1 g/dL. CT chest with contrast revealed a necrotic mass in the central left upper lobe invading the left upper lobe bronchus and obliterating the left pulmonary artery with severe bronchiectatic changes. Multiple mediastinal lymph nodes were enlarged. Flexible bronchoscopy was performed and demonstrated occlusion of the left upper lobe with a dense, white mass, and hair-like material within the bronchus. Attempts at biopsy with the cryoprobe demonstrated friable mucosa that easily bled. No intervention was necessary as spontaneous hemostasis occurred. Attempts at forceps biopsy were unsuccessful because of dense, calcified material. As a result, the cryoprobe was used. Cryoprobe biopsies revealed inflammatory cells without evidence of malignancy. Cultures including bacterial, fungal, and AFB were negative. Lack of diagnosis, severe bronchiectasis, and recurrent hemoptysis prompted the recommendation for resection, and he underwent left thoracotomy with interpleural pneumolysis. Due to involvement of the left pulmonary artery, lung sparing surgery could not be safely achieved and ultimately required a left pneumonectomy. Final pathology was consistent with a lung teratoma. DISCUSSION: Teratomas are germ cell tumors commonly located in the sacrococcygeal region, anterior mediastinum, retroperitoneum, cranium, ovary, or gonads. Rarely they are intrapulmonary in location (1). Less than 100 IPT cases have been reported to date, and usually reported in the left upper lobe. (2,7). Patients present with chest pain, cough, fever, dyspnea, bronchiectasis, or recurrent pneumonia (5). Patients may expectorate hair (trichoptysis), which is considered pathognomonic (3). Untreated, patients are at risk of malignant transformation, tumor rupture, hemoptysis, and airway obstruction from compression. (5). CT chest shows well-defined round or lobulated masses that are smooth in contour with areas of peripheral translucency and may contain fat, calcium, or fluid (5,6). Irregular or ill-defined margins can suggest malignant transformation (4).The only definitive treatment is complete surgical resection and diagnosis is often made concomitantly from the gross pathology. Early resection is crucial in order to prevent complications (6). CONCLUSIONS: IPT is a rare cause of endobronchial obstruction and highlights the need for early bronchoscopic evaluation of hemoptysis. Early diagnosis and resection of IPT is critical to prevent complications and provide definitive treatment. REFERENCE #1: Khan J, Aslam F, Fatimi S, Ahmed R. Cough, fever and a cavitary lung lesion-an intrapulmonary teratoma. J Postgrad Med. 2005;51(4):330-1. REFERENCE #2: Faria RA, Bizon JA, Junior RS, Neto VD, Botter M, Saieg MA. Intrapulmonary teratoma. J Bras Pneumol 2007; 33: 612– 615. REFERENCE #3: Siddiqui, F.A., Jain, A., Maheshwari, V. and Beg, M.H. (2010), FNA diagnosis of teratoma lung: A case report. Diagn. Cytopathol., 38: 758-760. https://doi.org/10.1002/dc.21318Webb, W., Brant, W. E., & Helms, C. A. (1991). Fundamentals of Body CT (1st ed.). Philadelphia, PA: W. B. Saunders Company.Sasaka, K., Kurihara, Y., Nakajima, Y., Seto, Y., Endo, I., Ishikawa, T., & Takagi, M. (1998). Spontaneous rupture: A complication of benign mature teratomas of the mediastinum. American Journal of Roentgenology, 170(2), 323-328. doi:10.2214/ajr.170.2.9456938 Mardani P, Naseri R, Amirian A, et al. Intrapulmonary mature cystic teratoma of the lung: Case report of a rare entity. BMC Surgery. 2020;20:1-6. Ditah C, Templin T, Mandal R, Pinchot JW, Macke RA. Isolated intrapulmonary teratoma. J Thorac Cardiovasc Surg. 2016 Dec;152(6):e129-e131. doi: 10.1016/j.jtcvs.2016.07.056. Epub 2016 Aug 5. PMID: 27576374. DISCLOSURES: No relevant relationships by Beren Chandler, source=Web Response No relevant relationships by Garret Duron, source=Web Response No relevant relationships by Lindsey Goldberg, source=Web Response No relevant relationships by Joanna Kosko, source=Web Response No relevant relationships by Jason McClune, source=Web Response No relevant relationships by Lourens Willekes, source=Web Response

Relationship between Twitter and Radiology Journal Citations.

Relationship between Twitter and Radiology Journal Citations.

Mapping the scientific research on radiology departments: Global trends in publication, collaboration and trending topics

PurposeTo characterize the global research trend in radiology departments based on bibliometric indicators. Material and methodAs a source of information, Science Citation Index Expanded and Journal Citation Reports from Web of Science Core Collection (WoSCC) were used. Annual trends, journals of publication, subject categories of journals, collaboration indexes between authors and institutions, network of cowords and most cited papers were identified and analysed. The period of study was 2009–2018. Results283,587 downloaded papers were analysed. The number of articles was increasing, as well as the percentage of funded works. Papers were published in 7314 different journals, being the most productive Plos One (5077), followed by American Journal of Roentgenology (4602) and European Radiology (3644). Most productive subject categories of journals were Radiology, Nuclear Medicine & Medical Imaging (86,568 papers), Clinical Neurology (29,722) and Surgery (23,564). International collaboration has increased more than 5 points, from 15.2% in 2009 to 20.7% in 2018. ConclusionsMost cited articles were published in high impact journals outside the scope of diagnostic imaging. Most influential topics included technical innovations within imaging modalities. MRI replaced conventional radiography and CT as the imaging technique of choice in imaging research.

Profile of Articles Published in AJR From 2014 to 2018 and Potential Association With Bibliometric Parameters.

OBJECTIVE. The purpose of this study was to assess the profile of articles published in the American Journal of Roentgenology (AJR) and potential associations with bibliometric indexes over a 5-year period. MATERIALS AND METHODS. Citable documents published from 2014 to 2018 were retrieved from the Journal Citation Reports database. Six bibliometric indexes were assessed. The following article parameters were retrieved: type, subspecialty (17 topics covered by AJR), origin, and title. Differences between groups were assessed by t test, ANOVA, Kruskal-Wallis test, or chi-square test. Citability was assessed by regression analysis. RESULTS. After exclusions, 2210 articles were considered citable and included in the analyses. Most of the metrics improved slightly, except for the Eigenfactor score and article influence score, which decreased. Original articles were preponderant; AJR published significantly more review articles than did three other general radiology journals. The mean number of citations per year of original articles (2.03 ± 2.18) was significantly larger than that of review articles (2.06 ± 2.47) (p = .02). The mean number of citations per year was significantly higher for articles with mixed-origin authorship (3.12 ± 3.19) than for articles with American (2.02 ± 2.17) or non-American (1.93 ± 2.26) authors only (p < .001). The distributions of mean number of citations per year among subspecialties differed significantly (p = .001). Articles on abdominal, musculoskeletal, pediatric, and women's imaging were more frequently cited. Multivariate regression analysis showed that subspecialty and presence of acronyms or initialisms in the title were the only independent predictors of citability (both, p = .001). CONCLUSION. The main AJR bibliometric indexes increased slightly from 2014 to 2018, except for those from the Eigenfactor Project. The presence of acronyms or initialisms in the title and subspecialty were the only independent predictors of citability.

Changes in Social Media Impact of the Radiological Literature During the Covid-19 Pandemic

The objective of this study was to determine how the social media impact of the radiological literature has changed during the Covid-19 pandemic. Altmetric Attention scores were collected for all articles in five leading radiology journals over a 5-year period ending in June 2020, and temporal smoothing yielded the filtered Altmetric Attention (fAA) score. Natural language processing methods were used to label articles with major topic areas. A forecasting model was used to identify periods of outlier behavior in the fAA score aggregated across all journals, for each journal individually, and stratified by article topic area. The distributions of fAA scores prior to the onset of the pandemic were statistically compared to those during the pandemic. For journals exhibiting increased fAA scores, the frequency distributions of articles not related to Covid-19 was compared to that prior to the pandemic. During the pandemic, we found sustained outliers and statistically significant increases in the aggregate fAA score across all five journals, as well as for Radiology, American Journal of Roentgenology, and Academic Radiology individually. Articles related to Covid-19, thoracic imaging, and radiology education also experienced significantly increased fAA scores during the pandemic period. We did not find significantly decreased rates of publication of non-Covid articles in the journals experiencing elevated fAA scores. Social media engagement with the radiological literature significantly increased during the Covid-19 pandemic. This preferentially affected certain journals and articles addressing specific topics, reflecting the intense public interest in the diagnosis and treatment of Covid-19.

LIPOID PNEUMONIA SEEN IN PATIENT WITH HISTORY OF PURGING

SESSION TITLE: Medical Student/Resident Imaging Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: Lipoid pneumonia is seen when mineral oil (commonly used for constipation) is aspirated [1]. Two responses are noted: (1) an inflammatory response with regional edema and intra alveolar hemorrhage; these patients acutely present with cough, fever, and dyspnea, or (2) a “paraffinoma” with aspirated oils encapsulated by fibrous tissues; these patients present asymptomatically with mass seen on imaging [2]. Most patients who develop lipoid pneumonia have risk factors for aspiration. CASE PRESENTATION: Patient is a 61-year-old female with known history of Hepatitis C, anxiety, self-described “obsessive-compulsive disorder”, homebound for eight years, and no recent physician visits, brought in by Emergency Medical Services after patient was standing from chair and heard a loud “snap”. On interview, patient remarked that she consistently “eats healthy” and took “natural” supplements for her “constipation”. On arrival, the patient's vital signs were within normal limits, afebrile, saturating 99 percent on room air. Patient was cachectic appearing with bitemporal wasting and four out of five strength globally. She exhibited pressured speech and tangential thought. Lungs were clear to auscultation bilaterally. Patient was found to have pathologic fracture of left femur on Computed Tomography (CT) imaging and underwent open reduction and internal fixation. Chest X-Ray revealed a right middle lobe or lingular opacity concerning for aspiration or a questionable pneumonia. Further imaging of chest with a noncontrast CT showed fat attenuation and patchy areas of consolidation in the mid to lower lungs bilaterally, compatible with lipoid pneumonia. In-patient psychiatry diagnosed the patient as hypomanic and noted that she exhibited multiple signs of anorexia nervosa including limited oral intake and excessive purging. Patient was otherwise asymptomatic throughout hospital course. DISCUSSION: This presentation is unique in that the patient had been taking mineral oil supplements for purging in addition to emesis; emesis of these oil particles and subsequent aspiration were the cause of her development of lipoid pneumonia. While aspiration of food particles is common, aspiration of organic oils is quite rare. It is important remember that patients with body dysmorphic disorder can use laxatives as a form of purging. All patients that exhibit signs of purging are at great risk for aspiration pneumonitis and pneumonia. CONCLUSIONS: The patient’s presentation and CT findings suggests a “paraffinoma” rather than inflammation with hemorrhage. While typical paraffinomas are skin conditions characterized by granulomatous and fibrotic reactions in subcutaneous fats, interestingly, the same reactions can take place in the lung resulting in above CT findings. Reference #1: Spickard, A., & Hirschmann, J. V. (1994). Exogenous lipoid pneumonia. Archives of internal medicine, 154(6), 686-692. Reference #2: Betancourt, S. L., Martinez-Jimenez, S., Rossi, S. E., Truong, M. T., Carrillo, J., & Erasmus, J. J. (2010). Lipoid pneumonia: spectrum of clinical and radiologic manifestations. American Journal of Roentgenology, 194(1), 103-109. DISCLOSURES: No relevant relationships by George Apergis, source=Web Response No relevant relationships by Karthik Bharadwaj, source=Web Response No relevant relationships by Doris Zavaro, source=Web Response

OVERLAP SYNDROME AND MYELOPEROXIDASE-POSITIVE VASCULITIS: NEW PULMONARY FINDINGS

SESSION TITLE: Medical Student/Resident Pulmonary Manifestations of Systemic Disease Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: We report a case of connective tissue disease-associated interstitial lung disease (CTD-ILD) in a patient with Overlap Syndrome and myeloperoxidase (MPO) positive vasculitis. We will review the disease presentation and hallmark radiologic features seen on computed tomography (CT) imaging. These specific radiologic features can be used in conjunction with laboratory markers to correctly identify the underlying etiology. CASE PRESENTATION: Our patient is a 52-year-old African American female with a past medical history of hypertension and asthma who had been complaining of dyspnea for 2 years prior to obtaining imaging studies. In March 2019, a CT chest was done and revealed bilateral anterior upper lobe fibrosis. In April 2019, she was diagnosed with Overlap Syndrome based on her symptoms of anterior uveitis and chronic polyarthritis, radiographic findings of fibrotic interstitial lung disease (ILD), and positive serology. Laboratory studies were remarkably positive for anti-nuclear antibody (ANA) speckled pattern with a titer of 1:1280, anti- ribonucleoprotein (RNP) antibody 127, and MPO 48.1 (ANCA’s unable to test). Negative studies included ds-DNA, anti-centromere, anti- scl-70, anti-cyclic citrullinated peptide, rheumatoid factor, RNA polymerase III, anti- smith antibody, anti-Ro/ SSA, anti-La/ SSB, and an extended myositis panel. She also developed pulmonary hypertension group I disease in late 2019 and was started on Selexipag. She was offered immunosuppression therapy with Mycophenolate Mofetil but unfortunately is still hesitant to start the medication due to the side effect panel. DISCUSSION: There are 3 hallmark radiologic signs that were recently observed in patients with CTD-ILD in a retrospective analysis from University of Chicago. These signs are: 1- the anterior upper lobe sign, 2- the “exuberant honeycombing sign”, 3- the straight edge sign. Our patient had all these signs present in her imaging studies; findings of which were not described in patients with MPO positive vasculitis presenting with ILD. CONCLUSIONS: We report this case to add patients with overlap syndrome and MPO positive vasculitis related ILD to the panel of previously described patients with scleroderma, rheumatoid arthritis, myositis and Sjogren’s disease. Reference #1: Chung J, Cox C, Montner S, Adegunsoya A, Oldham J, Husain A, Vij R, Noth I, Lynch D, Strek M. CT Features of the Usual Interstitial Pneumonia Pattern: Differentiating Connective Tissue Disease- Associated Interstitial Lung Disease from Idiopathic Pulmonary Fibrosis. American Journal of Roentgenology. 2018 February; 210: 307-313 Reference #2: Maillet T, Goletto T, Beltramo G, Dupay G, Jouneau S, Borie R, Crestani B and others. Usual Interstitial Pnuemonia in ANCA- associated vasculitis: A poor prognostic factor. Journal of Autoimmunity. 2019 July. DISCLOSURES: No relevant relationships by ALAA ABU SAYF, source=Web Response No relevant relationships by Guneet Ahluwalia, source=Web Response Speaker/Speaker's Bureau relationship with Genentech Please note: $1001 - $5000 Added 05/04/2020 by Krishna Thavarajah, source=Web Response, value=speaker fees for IPF rally stockholder relationship with Medtronic Please note: $5001 - $20000 Added 05/04/2020 by Krishna Thavarajah, source=Web Response, value=stockholder

MILIARY MICRONODULES: TB OR NOT TB?

SESSION TITLE: Medical Student/Resident Lung Pathology SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: Miliary nodules are randomly dispersed pulmonary micronodules found on chest radiograph and CT imaging that can be the manifestation of many diseases, carrying a broad differential based on imaging alone. While an infectious process is most likely, it is important to avoid anchoring on a single diagnosis with this finding, especially in the face of inconclusive data. CASE PRESENTATION: A 49-year-old male nonsmoker with past medical history of hypertension, hyperlipidemia, diabetes mellitus, and stable ulcerative colitis presented to the Emergency Room from his primary care physician’s office with a 3-week history of cough, dyspnea on exertion and a chest x-ray concerning for diffuse airspace disease. He denied fevers, chills, or night sweats, but endorsed unintentional weight loss. He has had extensive international travel, and most recently traveled to England and Vietnam, where he was in predominantly urban areas. On arrival, he was afebrile, hemodynamically stable, but hypoxemic on room air. Chest CT demonstrated diffuse pulmonary nodular opacities in a miliary pattern bilaterally with a 1.7 cm cavitary lesion in the LUL. He was admitted and placed in airborne isolation amid concern of miliary tuberculosis. BAL on day 2 of multiple lung zones was performed. Mtb PCR and AFB smears were negative for tuberculosis, but positive for PCP PCR in only one LUL sample. His respiratory symptoms persisted despite antibiotic therapy; he was not started on anti-tuberculoid therapy. VATS was then performed, and tissue biopsies revealed non-small cell lung carcinoma with bilateral pulmonary metastases. Pathology and genotyping demonstrated poorly differentiated HER2+/EGFR- lung adenocarcinoma. DISCUSSION: We describe a middle-aged nonsmoking male with a subacute cough and progressive dyspnea in the setting of extensive international travel and randomly dispersed pulmonary micronodules on CT. Miliary pattern is thought to be due to hematogenous spread of disease. In areas where tuberculosis is endemic, image findings can often be diagnostic, however these must be differentiated from centrilobular or perilymphatic patterns of distribution. While this presentation had several features suspicious for miliary tuberculosis, BAL Mtb PCR specimens were negative, forcing reconsideration of non-infectious etiologies. Rapid evaluation by VATS tissue biopsy diagnosed primary lung adenocarcinoma with pulmonary metastasis. The data on genotyping intrapulmonary carcinomatosis as a means of further characterization is still growing, and the HER2+ mutation is found in only 1% of non-small cell lung cancers. CONCLUSIONS: This case represents the importance of rapid testing, without premature diagnostic closure for distinguishing two potentially fatal, but treatable diseases such as miliary tuberculosis and poorly differentiated HER2+ lung adenocarcinoma. Reference #1: Walker C, Abbott G, Greene R, Shepard JA, Vummidi D, Digumarthy S. Imaging Pulmonary Infection: Classic Signs and Patterns. American Journal of Roentgenology (2014);202: 479-492. DISCLOSURES: No relevant relationships by Irmgard Behlau, source=Web Response no disclosure on file for Augustin Delago; No relevant relationships by Joseph Khoory, source=Web Response No relevant relationships by David Miller, source=Web Response No relevant relationships by MARIANA STOLERU, source=Web Response

Three-dimensional reconstruction of the luminal structure of human seminal vesicle.

The seminal vesicles are the glands of male reproductive organs that produce the fluid and nutrient constituents of semen. It has been believed for a long time that the lumen of a seminal vesicle was a single-coiled tubular structure with irregular diverticula. There are several previous reports on the symmetry, differences in morphological sizes and classification of the seminal vesicles. However, a three-dimensional-coiled tubular structure is difficult to understand using a classical anatomical methodology, and hence, three-dimensional reconstruction is needed to understand the structure of the lumen. Thirty-one seminal vesicles harvested from 21 formalin-embalmed cadavers were investigated. The seminal vesicle along with the ampulla of the ductus deferens was separated, and the length and width of each seminal vesicle were measured. The vesicles were then embedded in coloured paraffin, and the resulting paraffin block was sectioned transversely and photographed at an interval of 500μm, with the sectioned surfaces then utilized in three-dimensional reconstruction performed by 'Reconstruct' software. The mean length and width of the seminal vesicles were 39.4mm and 13.4mm, respectively, and the right seminal vesicle was a little larger than the one on the left. The size differed from previous reports, while the luminal structure was similar to the classification of Aboul-azm (Archives of Andrology, 3, 1979, 287-292) but differed from that of Pereira (AJR. American Journal of Roentgenology, 69, 1953, 361-379). The seminal vesicles typically comprised about 9 curls and had about 12 diverticula. The seminal vesicles resembled a skein of coral rather than comprising a single strand. These findings will help in improving the understanding of pathophysiologies of the seminal vesicles, such as recurrent inflammation of the gland.

Decline to Review a Manuscript: Insight and Implications for AJR Reviewers, Authors, and Editorial Staff.

OBJECTIVE. The objective of the study was to evaluate and categorize the decline-to-review response to a manuscript review invitation that would allow American Journal of Roentgenology (AJR) editorial staff to improve the peer review process and to reduce manuscript turnaround time. MATERIALS AND METHODS. This retrospective analysis included 9366 decline-to-review responses received by AJR editorial staff between January 1, 2015, and December 31, 2017 (a 3-year period). The responses were sorted into six broad categories: no reason given, reviewer was overcommitted (with academic or personal commitments), manuscript was not in an area of the reviewer's expertise, the reviewer had already committed to a simultaneous AJR manuscript review, the reviewer claimed a conflict of interest, and miscellaneous and otherwise not listed reasons. RESULTS. The 9366 declined reviews were declined according to six general categories: no reason (3251, 34.7%), overcommitted (4629, 49.4%), not an area of expertise (1181, 12.6%), simultaneous AJR manuscript review (235, 2.5%), conflict of interest (55, 0.6%), and miscellaneous (15, 0.2%). CONCLUSION. The analyzed data provide a valuable insight for AJR editorial staff and reviewers to further improve the peer review process. The results and subsequent actions could help to reduce decline-to-review responses, which will help shorten the manuscript turnaround time and contribute to a timely decision on manuscripts for authors.