Prior Imaging Research Articles

Management Impact of 68Ga-DOTATATE PET/CT in Neuroendocrine Tumors.

The goal of our retrospective single tertiary academic medical center investigation was to examine the added diagnostic value and clinical impact of 68Ga-DOTATATE PET/CT in the therapeutic management of patients with neuroendocrine tumors (NETs). Imaging database was queried for all "PET-DOTATATE" examinations performed at our tertiary care academic institution using MONTAGE™. The patient's clinical history and recent prior imaging were reviewed. The additional diagnostic value and clinical management impact of 68Ga-DOTATATE were assessed through retrospective chart review. A total of 81 68Ga-DOTATATE PET/CT scans in 74 patients were found, and 11 patients were excluded from analysis as they had no prior imaging available for comparison, with resultant analysis cohort of 63 patients. Six patients had 2 or more 68Ga-DOTATATE PET/CT examinations. The most common primary diagnosis was undifferentiated NET (63.5%), followed by carcinoid (27.0%), paraganglioma (4.8%), insulinoma (3.2%), and pheochromocytoma (1.6%). The primary sites of disease from the most to the least common were the pancreas (36.5%), small bowel (22.2%), unknown primary (15.9%), lung (6.3%), large bowel (6.3%), and mesentery (4.8%), and other locations accounted for 7.9%. In patients who had prior imaging available for comparison, there were new lesions identified on 68Ga-DOTATATE PET/CT in 21 patients (33.3%) that were not identified on other prior imaging modalities. Of these patients, 5 underwent subsequent MRI and 1 had a repeat 68Ga-DOTATATE PET/CT to further characterize new lesions seen. Moreover, 15 patients (23.8%) had a change in treatment plan, including altering medical therapy in 9 patients, change in planned extent of surgical management in 5 patients, and cancelation of a planned primary tumor resection in 1 patient with metastatic disease. Our retrospective cohort demonstrated that 68Ga-DOTATATE PET/CT improves lesion detection over conventional imaging in 33.3% and impacts the therapeutic management in 23.8% of patients with NET.

SOP: emergency workup in patients with suspected acute bacterial meningitis

IntroductionDespite antibiotic therapy, adjunctive treatment with dexamethasone, and care on modern intensive care units, bacterial meningitis remains a life-threatening disease with a high mortality and morbidity. One of most critical factors that influences outcome is a targeted quick but profound workup and early initiation of therapy in the Emergency Department. This standardized operating procedure was designed to guide physicians through the workup of patients with suspected acute bacterial meningitis.First stepsIn patients with suspected community-acquired bacterial meningitis, the first steps aim at establishing a diagnosis and at starting empiric therapy without delay. Therefore, physicians need to seek for an early lumbar puncture that can be done safely without prior imaging if clinical signs that point at contraindications of a lumbar puncture are absent. Immediately after lumbar puncture, empiric therapy with ceftriaxone, ampicillin and dexamethasone should be started. In regions with a critical resistance rate of pneumococci against third generation cephalosporines, vancomycin or rifampicin need to be added.CommentsClinical signs that are associated with intracranial conditions that are a contraindication for a lumbar puncture are severely decreased consciousness, new onset focal neurological signs, and epileptic seizures. If any of these clinical signs are present, cerebral imaging is recommended before lumbar puncture. Whenever lumbar puncture is delayed, empiric therapy needs to be begun before cerebrospinal fluid is obtained.ConclusionSuspected acute bacterial meningitis is an emergency and requires attention with high priority in the emergency department to ensure a quick workup and early start of therapy.

Adult with infected spontaneous perinephric urinoma secondary to uro-obstruction by VUJ calculus: ‘pop-off’ mechanism

An 18-year-old man presented with insidious, progressive right flank pain of 2-month duration, with fever of 2-week onset. Examination revealed right flank tenderness, with suspicion of ballotable right lumbar mass....

The Life of a Myxoma—Transoesophageal Images of the Progressive Growth of a Myxoma Over a 19-month Period

A paucity in data exists regarding the expected growth rate of myxomas given the prompt transition to surgical intervention on initial discovery. Most case reports describe an initial normal echocardiogram compared with a subsequent echocardiogram revealing a myxoma at the time of diagnosis [ 1 Karlof E. Salzberg S.P. Anyanwu A.C. Steinbock B. Filsoufi F. How fast does an atrial myxoma grow?. Ann Thorac Surg. 2006; 82: 1510-1512 Abstract Full Text Full Text PDF PubMed Scopus (14) Google Scholar , 2 Strecker T. Nooh E. Marwan M. Agaimy A. Rapidly growing cardiac myxoma diagnosed within 1 year after unremarkable prior cardiac imaging. J Card Surg. 2019; 34: 1645-1646 Crossref PubMed Scopus (0) Google Scholar , 3 Vazir A. Douthwaite H. Rapidly growing left atrial myxoma: a case report. J Med Case Rep. 2011; 5: 417 Crossref PubMed Scopus (12) Google Scholar ]. Uniquely, our case follows the sequential monitored growth of an atrial myxoma with transoesophageal images over a 19-month period.

Detection of incidental findings on chest CT scans in patients with suspected COVID-19 pneumonia

This study aimed to evaluate the chest Computed Tomography (CT) scans of COVID-19 suspected patients in the first period of the pandemic, to reveal the frequency of parenchymal-extraparenchymal incidental findings (IFs). Our single-center retrospective observational study was initiated with the approval of the ethics committee. Chest CT records taken during March-August 2020 due to the suspicion of COVID-19 pneumonia were scanned using the imaging archive of our center. The study was conducted with 1540 patients with non-contrast chest CT without prior CT imaging to detect IFs. Histopathological results and clinical-radiological follow-up data of the patients were scanned from medical records. Of the 1540 patients in our study, 902 (58.57%) were male and 638 (41.43%) were female, with a mean age of 41.96±17.08 (5-92) years. While 248 (16.1%) patients had a typical appearance for COVID-19 pneumonia on thorax CT, no findings were found in 1180 (76.6%) patients. Except for COVID-19 pneumonia, parenchymal IFs(primary malignant lung lesions, metastatic lesions, benign pathologies) were detected in 73 patients (4.74%) and extraparenchymal IFs(lymphadenopathy, breast lesions, thyroid nodule, bone, liver and kidney lesions…) in 280 patients (18.8%). Our study showed that the number of patients without any findings in terms of COVID-19 pneumonia on CT scans is high. It is understood that CT scans for pneumonia are unnecessary due to radiation exposure and should be used when clinically necessary. However, due to the ability of CT to detect incidental findings, it is also important to define IFs oth er than pneumonia in patients who underwent chest CT examination during the pandemic.

Underwater image enhancement algorithm based on dark channel prior and underwater imaging model

The main reason for the degradation of the underwater image is the light absorption and scattering. The images are captured in the underwater environment often have some problems such as loss of image information, low contrast, and color distortion. In order to solve the above problems, this paper proposes an image enhancement method for the underwater environment. With the help of the underwater imaging model and dark channel prior theory, a new idea of adding transmission correction and color compensation to G and B color channels is proposed. Experimental results show that, compared with the traditional methods, this method has a better effect on the underwater image with less color deviation.

Prior PSMA PET-CT Imaging and Hounsfield Unit Impact on Tumor Yield and Success of Molecular Analyses from Bone Biopsies in Metastatic Prostate Cancer.

Simple SummaryProstate cancer is currently the fifth leading cause of death in men worldwide. To personalize and guide treatment in prostate cancer, identification of druggable genomic alterations is of major importance. Prostate cancer often metastasizes solely or predominantly to the bones, with molecular analyses on bone biopsies challenging due to technical difficulties to identify and obtain biopsies from high tumor cell containing locations. In our retrospective analysis, we showed a significantly higher success rate in patients where biopsy location was selected by a prior PSMA PET-CT compared to solely CT or MRI. CT-guided biopsies in locations with low Hounsfield units (HUs) and deviation of HUs were associated with a higher proportion of successful histological and molecular biopsies. Based on these results, we designed a simple prediction model for daily clinical practice to increase the success rate of bone biopsies for molecular analyses in prostate cancer to guide precision medicine.Developing and optimizing targeted therapies in metastatic castration-resistant prostate cancer (mCRPC) necessitates molecular characterization. Obtaining sufficient tumor material for molecular characterization has been challenging. We aimed to identify clinical and imaging variables of imaging-guided bone biopsies in metastatic prostate cancer patients that associate with tumor yield and success in obtaining molecular results, and to design a predictive model: Clinical and imaging data were collected retrospectively from patients with prostate cancer who underwent a bone biopsy for histological and molecular characterization. Clinical characteristics, imaging modalities and imaging variables, were associated with successful biopsy results. In our study, we included a total of 110 bone biopsies. Histological conformation was possible in 84 of all biopsies, of which, in 73 of the 84, successful molecular characterization was performed. Prior use of PSMA PET-CT resulted in higher success rates in histological and molecular successful biopsies compared to CT or MRI. Evaluation of spine biopsies showed more often successful results compared to other locations for both histological and molecular biopsies (p = 0.027 and p = 0.012, respectively). Low Hounsfield units (HUs) and deviation (Dev), taken at CT-guidance, were associated with histological successful biopsies (p = 0.025 and p = 0.023, respectively) and with molecular successful biopsies (p = 0.010 and p = 0.006, respectively). A prediction tool combining low HUs and low Dev resulted in significantly more successful biopsies, histological and molecular (p = 0.023 and p = 0.007, respectively). Based on these results, we concluded that site selection for metastatic tissue biopsies with prior PSMA PET-CT imaging improves the chance of a successful biopsy. Further optimization can be achieved at CT-guidance, by selection of low HU and low Dev lesions. A prediction tool is provided to increase the success rate of bone biopsies in mCRPC patients, which can easily be implemented in daily practice.

NURS-10. IMPROVEMENTS IN A BEHAVIORAL TRAINING AND PHARMACOLOGICAL ANXIOLYSIS ALGORITHM FOR INCREASED COMPLIANCE IN PEDIATRIC PATIENTS IN PREPARATION FOR RADIATION THERAPY: A RETROSPECTIVE ANALYSIS

BACKGROUNDIn the pediatric population, the probability of compliance with radiation involves multifactorial elements. Younger pediatric patients often require anesthesia to ensure accurate delivery of radiotherapy. The purpose of this analysis was to refine our algorithm in pediatric patients to better identify children who would benefit from behavioral training and/or anxiolyxis intervention with the goal of minimizing anesthesia use.METHODRetrospective data was collected from electronic medical records from 150 pediatric oncology patients <18 years old, treated with photon and proton radiation at our center from August 2016 to December 2019. We identified potential socio-developmental treatment factors thought to impact behavioral compliance and categorized risk factors based on an algorithm to determine risk for noncompliance with radiotherapy.RESULTSSix categories demonstrated statistical significance (p<0.05) in their influence on behavioral compliance during radiotherapy: age category (specifically age <7: Odds ratio [OR] 3.0, 95% Confidence Interval [CI] 1.0, 9.1), need for sedation with prior imaging studies (p<0.001), parental premonition of requiring anesthesia for successful treatment (p<0.001), duration of treatment, primary language (p<0.001), and use of total body irradiation (OR 3.1, 95% CI 1.1, 9.3).CONCLUSIONIdentification of pre-radiation risk factors allowed for better recognition of patients at risk for treatment non-compliance and for requiring daily sedation. Future studies should focus on implementing the algorithm prospectively in an effort to identify and direct early intervention with behavioral training and/or anxiolytics to minimize the need for sedation.

Concordance of patient beliefs and expectations regarding the management of low back pain with guideline recommendations \u2013 a cross-sectional study in Germany

BackgroundLow back pain is a common reason for patients to seek medical care. Physician non-adherence to clinical guidelines has been observed. We investigated the extent to which patient expectations correspond to recommendations of the German national guideline for management of low back pain (G-LBP) and whether patient characteristics, history of LBP and previous treatment experience are associated with expectations.MethodsA cross-sectional study including patients from 13 general practices was conducted. Data were collected using a questionnaire. Inverse probability weights were used to address non-response bias. Descriptive analysis and multivariate logistic regression models were performed.ResultsA total of 977 patients were included in analyses (median age 57 years, 39% male). 75% of patients reported experiencing LBP currently or within the last year. More than 65% indicated they would agree to forgo further examinations if their LBP was judged by their physician to be of no serious concern. This was associated with the highest level of education and no prior imaging, and negatively associated with good-to-poor health status and moderate-to-severe pain intensity. 40% of participants expected imaging. The highest educational level, female gender and no prior imaging were associated with a decreased expectation of imaging. 70% expected prescriptions for massages. Females, participants with good-to-poor health status, current LBP or LBP in the last 12 months had an increased expectation for massages. Expectations for injection therapy (45%) were mainly associated with previous injections. Expectations for physiotherapy (64%) were associated with female gender, lower educational level, good-to-poor health status, current LBP or in the last 12 months. The perspective that daily activities should be continued (66%) was associated with female gender and higher educational level. Participants who agreed to the statement ‘There is no effective treatment for LBP’ (11%) had a poor health status, current LBP and a severe pain intensity.ConclusionPatient views regarding LBP management are partially concordant with guideline recommendations and are strongly influenced by previous treatment experiences and education level. Exploration of patient expectations and experiences in LBP treatment may help minimize dissatisfaction of patients expecting treatments not endorsed by guidelines and simultaneously increase physician guideline adherence.

Clinical impact of Ga68-DOTATOC PET/CT on neuroendocrine tumors. A preliminary experience

Ga-68-DOTATOC PET/CT is a recently introduced imaging technique for the diagnosis and follow-up of neuroendocrine tumors.A prospective observational study was conducted in seven patients who underwent a Ga-68-DOTATOC PET/CT study. They were suspected of active neuroendocrine tumor lesions, either on initial diagnosis or as a possible recurrence and/or progression of already known tumors. The results of prior imaging studies (MRI, thoracoabdominal CT scan, octreotide…), had been negative or inconclusive.All positive Ga-68-DOTATOC PETs were true positives, confirmed by pathological examination. There were no false positive results. Only one false negative result was found.Ga-68-DOTATOC PET/CC is more sensitive and specific for the detection of primary neuroendocrine tumor lesions, allows for a more complete extension study, and detects recurrences in earlier stages, conditioning changes in staging and surgical treatment. It provides additional information on somatostatin receptor overexpression, which is essential for the indication of PRRT (peptide receptor radionuclide therapy) with Lu177 dotatate.

Early palliative radiation versus observation for high-risk asymptomatic or minimally symptomatic bone metastases: study protocol for a randomized controlled trial

BackgroundIn patients with metastatic cancer, the bone is the third-most common site of involvement. Radiation to painful bone metastases results in high rates of pain control and is an integral part of bone metastases management. Up to one-third of inpatient consults are requested for painful bone metastases, and up to 60% of these patients had evidence of these lesions visible on prior imaging. Meanwhile recent advances have reduced potential side effects of radiation. Therefore, there is an opportunity to further improve outcomes for patients using prophylactic palliative radiation to manage asymptomatic bone metastases.Methods/study designIn this trial, 74 patients with metastatic solid tumors and high-risk asymptomatic or minimally symptomatic bone metastases will be enrolled and randomized to early palliative radiation or standard of care. This will be the first trial to assess the efficacy of prophylactic palliative radiation in preventing skeletal related events (SREs), the primary endpoint. This endpoint was selected to encompass patient-centered outcomes that impact quality of life including pathologic fracture, spinal cord compression, and intervention with surgery or radiation. Secondary endpoints include hospitalizations, Bone Pain Index, pain-free survival, pain-related quality of life, and side effects of radiation therapy.DiscussionIn this study, we propose a novel definition of high-risk bone metastases most likely to benefit from preventive radiation and use validated questionnaires to assess pain and impact on quality of life and health resource utilization. Observations from early patient enrollment have demonstrated robustness of the primary endpoint and need for minor modifications to Bone Pain Index and data collection for opioid use and hospitalizations. With increasing indications for radiation in the oligometastatic setting, this trial aims to improve patient-centered outcomes in the polymetastatic setting.Trial registrationISRCTN Number/Clinical trials.gov, ID:NCT03523351. Registered on 14 May 2018.

Abstract 14770: Reduction With Evolocumab in Complex Coronary Disease Requiring Revascularization: Insights From the FOURIER Trial

Introduction: Although PCSK9 inhibitors induce plaque regression and reduce the risk of coronary revascularization overall, their ability to specifically reduce the risk of complex coronary atherosclerosis requiring revascularization has not been explored. Methods: FOURIER was a randomized trial of the PCSK9 inhibitor evolocumab vs. placebo in 27,564 patients with ASCVD on statin therapy (median achieved LDL-C 32 mg/dL vs. 89 mg/dL) followed for a median of 2.2 years. The study database was blindly reviewed to assess characteristics of coronary revascularization procedures. Complex revascularization was the composite of complex PCI (per GLOBAL LEADERS criteria, at least one of: multivessel PCI, 3 or more stents implanted, 3 or more lesions treated, bifurcation PCI with 2 or more stents, or total stent length &gt;60 mm) or CABG. PCI complications included no-reflow, side branch loss, thrombus formation, major dissection, or perforation. The effects of evolocumab on types of revascularization and PCI complications were evaluated using Cox proportional hazards models. Results: 1724 patients underwent revascularization procedures during follow-up. Evolocumab reduced the risk of non-complex PCI by 22% (HR 0.78; 95%CI 0.70-0.88; P&lt;0.001) and the risk of complex revascularization by 29% (HR 0.71; 95%CI 0.61-0.84; P&lt;0.001), including complex PCI by 33% (HR 0.67; 95%CI 0.54-0.84; P&lt;0.001) and CABG by 24% (HR 0.76; 95%CI 0.60-0.96; P=0.019; Figure). The incidence of reported PCI complications tended to be lower with evolocumab (HR 0.74; 95% CI 0.49-1.11). Conclusions: Adding evolocumab to statin therapy reduced the risk of developing complex coronary disease requiring revascularization, including complex PCI and CABG individually. Together with prior coronary imaging findings, these data suggest very aggressive LDL-C lowering to &lt;1 mmol/L has beneficial effects on coronary atherosclerosis burden, anatomical complexity, and the need for intervention.

Abstract 17030: Stress-Related Neurobiological Activity Contributes to the Link Between Cardiovascular Polygenic Risk Score and Myocardial Infarction

Introduction: A polygenic risk score for coronary artery disease (PRS CAD ) integrates information from many sites of DNA variation into a single metric of inherited susceptibility. Heightened metabolic activity of the amygdala (AmygA), a stress-associated brain center, associates with increases in leukopoietic activity, atherosclerosis and CVD risk. We hypothesized that genes included in the PRS CAD link to MI in part by encoding for heightened stress-associated neurobiological activity. Accordingly, we tested whether CVPRS associates with heightened AmygA as a contributing factor linking high CVPRS and CVD events. Methods: Individuals (N=16821, median age (IQR): 63 (52, 74) years, 46% male) were identified from the Partners Biobank where genome-wide PRS CAD and principle components of ancestry (PCI) were calculated. Using validated 18 FDG-PET/CT imaging methods, AmygA was measured in individuals with prior clinical imaging (N=854). MI incidence was derived using International Classification of Diseases (ICD) diagnoses. Traditional CVD risk factors and psychiatric history were obtained using ICD codes and questionnaires and were used for covariable adjustments. Linear and logistic regression were employed. Results: A total of 2046 (12.1%) participants experienced an MI. PRS CAD associated with increased AmygA after adjusting for age and sex (β [95% confidence interval (CI)]: 0.099 [0.015, 0.183], p=0.021) as well as increased MI incidence (odds ratio (OR) [95% CI]: 1.208 [1.120, 1.302], p&lt;0.001) ( Table 1, Figure 1 ). Concurrently, AmygA associated with increased MI incidence in adjusted analyses (OR [95% CI]: 1.451 [1.061, 1.983], p=0.003). Conclusion: High PRS CAD associates with higher AmygA and AmygA in-turn associates with MI. These findings suggest increased stress-related neurobiological activity may contribute to the link between PRS CAD and MI.

Diagnostic performance of 18F-DCFPyL positron emission tomography/computed tomography for biochemically recurrent prostate cancer and change-of-management analysis.

Conventional imaging (CI) performs poorly to identify sites of disease in biochemically recurrent prostate cancer. 68Ga-PSMA-11 positron emission tomography/computed tomography (PET/CT) is most studied but has a very short half-life. This study reports the diagnostic performance of the novel prostate-specific membrane antigen (PSMA) radiotracer 18F-DCFPyL using real-life data and tumor board simulation to estimate the impact of 18F-DCFPyL PET on patient management. Ninety-three 18F-DCFPyL PET/CT scans performed for patients previously treated for prostate cancer with a rising prostate-specific antigen (PSA) were retrospectively compared to contemporary CI and clinical imaging and PSA followups. A chart review was performed to document prior imaging, pathology results, serial serum PSA measurements, and other pertinent clinical data. Clinical utility of 18F-DCFPyL PET was measured using a simulated tumor board formed by three physicians with extensive prostate cancer experience deciding on management with and without knowledge of PET/CT results. At median PSA 2.27 (interquartile rage [IQR] 5.27], 82% of 18F-DCFPyL PET/CT demonstrated at least one site of disease: non-regional lymph nodes (37% of scans), regional lymph node metastases (28%), local recurrence (27%), and bone metastases (20%), with higher PET positivity at higher PSA. Compared to 18F-DCFPyL PET/CT, CI showed overall poor performance, with accuracy below 20% for all extent of disease. PET/CT changed management in 44% of cases. The most frequent scenario was a radical change from initiating androgen deprivation therapy (ADT) to stereotactic body radiotherapy (SBRT) of oligo-lesional disease. In univariate and multivariate analysis, no patient characteristic could predict change of management by PET/CT results. 18F-DCFPyL significantly outperforms CI in recurring prostate cancer and is likely to impact management.

The impact of COVID-19 upon student radiographers and clinical training

IntroductionTo investigate student clinical placement concerns and opinions, during the initial COVID-19 pandemic outbreak and to inform educational institution support planning. MethodsBetween mid-June to mid-July 2020, educational institutions from 12 countries were invited to participate in an online survey designed to gain student radiographer opinion from a wide geographical spread and countries with varying levels of COVID-19 cases. Results1277 respondents participated, of these 592 had completed clinical placements during January to June 2020. Accommodation and cohabiting risks were identified as challenging, as was isolation from family, travel to clinical placements, and to a lesser extent childcare. Students stated they had been affected by the feeling of isolation and concerns about the virus whilst on placement. Overall 35.4% of all respondents were ‘Not at all worried’ about being a radiographer, however, 64.6% expressed varying levels of concern and individual domestic or health situations significantly impacted responses (p ≤ 0.05). Year 4 students and recent graduates were significantly more likely to be ‘Not worried at all’ compared to Year 2 and 3 students (p ≤ 0.05). The need for improved communication regarding clinical placements scheduling was identified as almost 50% of students on clinical placements between January to June 2020 identified the completion of assessments as challenging. Furthermore, only 66% of respondents with COVID-19 imaging experience stated being confident with personal protective equipment (PPE) use. ConclusionStudent radiographers identified key challenges which require consideration to ensure appropriate measures are in place to support their ongoing needs. Importantly PPE training is required before placement regardless of prior COVID-19 imaging experience. Implications for practiceAs the next academic year commences, the study findings identify important matters to be considered by education institutions with responsibility for Radiography training and as students commence clinical placements during the on-going global COVID-19 pandemic.

Rare Lymphoma Cases: Online Education Significantly Improves Hematologist/Oncologist Ability to Personalize Treatment

Background: Mantle cell lymphoma (MCL) and marginal zone lymphoma (MZL) are rare types of non-Hodgkin lymphoma (NHL). While MZL is generally indolent, MCL often has a more aggressive clinical course and many patients progress after initial treatment. This study was conducted to determine if an online, case-based continuing medical education (CME) intervention could improve skills of hematologists/oncologists (hem/oncs) to personalize treatment for patients with relapsed/refractory (R/R) MCL or R/R MZL. Methods: The format was an online CME-certified text-based activity composed of 2 patient cases with interactive questions on the diagnosis and treatment of rare types of NHL. Evidence-based educational feedback was provided following each response. Three case-based questions were repeated immediately after activity participation and learners had to select treatment for patients based on prior treatment history, imaging results, and lab values. Question 1, 2, and 3 tested hem/oncs ability to select treatment for a patient with R/R MZL, R/R MCL, and R/R MCL, respectively. Additionally, 1 self-efficacy question was also repeated immediately after activity participation. These questions assessed the impact of the education in the form of a repeated pairs pre-assessment/post-assessment study design in which each participant served as his/her own control. Using data from the assessment completers, percentages of correct responses to pre- and post-assessment questions were compared. A chi-square test was used to assess statistical significance of the educational impact, where P &amp;lt; .05 was considered statistically significant. Cramer's V was used to estimate the magnitude of change in the total number of correct responses between the compared test scores, where V &amp;gt;0.26 indicates an extensive educational impact. The activity launched online on January 9, 2020 and data reported were collected through July 9, 2020. Results: At the time of data collection 203 hem/oncs had completed the activity. Of these 104 (57%) were community-based practitioners. Education had an extensive impact (V =.424) and significantly improved hem/oncs competence to select personalized treatment for patients with these rare types of NHL (Figure 1). Table 1 shows the case summary, questions, and answer choices. Conclusions: This online, interactive, case-based CME-certified educational activity led to statistically significant improvements in the clinical competence of hematologists/oncologists regarding personalizing treatment selection for patients with R/R mantle cell or marginal zone lymphoma. The results indicate that unique educational methodologies and platforms, which are available on-demand, can be effective tools for advancing clinical decision making. Additional studies are needed to assess whether improved aptitude translates to improved performance during clinical practice. Acknowledgements: This CME activity was supported by an independent educational grant from Celgene Corporation and Pharmacyclics, Inc. Reference: https://www.medscape.org/viewarticle/923424 Figure 1 Disclosures No relevant conflicts of interest to declare.

Comparative Performance of Artificial Intelligence Algorithms for Screening Mammography.

HomeRadiology: Imaging CancerVol. 2, No. 6 PreviousNext Research HighlightsFree AccessComparative Performance of Artificial Intelligence Algorithms for Screening MammographyMichio TayaMichio TayaMichio TayaPublished Online:Nov 27 2020https://doi.org/10.1148/rycan.2020209034MoreSectionsPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In Take-Away Points■ Major Focus: To evaluate the performance of three commercially available artificial intelligence algorithms in screening mammography assessment in an external population both independently and in combination with radiologists.■ Key Result: One of the three artificial intelligence algorithms had significantly higher accuracy for breast cancer detection (area under receiver operating characteristic curve of 0.96 vs 0.92 vs 0.92; P < .001). Combining this best algorithm with first-reader radiologists achieved the highest accuracy at 88.6% sensitivity and 93.0% specificity.■ Impact: A commercially available artificial intelligence algorithm can assess screening mammograms with comparable diagnostic accuracy as radiologists. Whether such an algorithm can act as independent readers prospectively in a screening population remains unanswered.Screening mammography is currently the clinical standard for early detection of breast cancer. However, performance of individual radiologists in screening mammography programs varies widely. Efforts to develop artificial intelligence (AI) algorithms for screening mammography have yielded mixed outcomes owing to variability in quality of training data and study methodology. External validation studies comparing the performance of different AI algorithms in a screening population are lacking.This external validation study compared the diagnostic performance of three commercially available AI algorithms both independently and in combination with radiologists in a retrospective population-based screening cohort. Women with implants or prior breast cancer were excluded. The study population included 739 women with pathology-verified breast cancer diagnosed at screening or within 12 months and 8066 randomly sampled healthy controls with negative findings by 2-year cancer-free follow-up. The AI algorithm determined suspicion of cancer on a continuous scale from 0 to 1.0 with a decision threshold for normal and abnormal set at the mean specificity of the first-reader radiologist (96.6%).Algorithm 1 performed significantly better than the other two algorithms with area under receiver operating characteristic curve of 0.96 versus 0.92 versus 0.92 (P < .001). No significant difference in sensitivity existed compared with radiologist consensus at the same specificity (81.9% vs 85.0%, P = .11), despite the algorithm having no inputs from prior imaging or clinical history. When choosing an operating point corresponding to the U.S. Breast Cancer Surveillance Consortium benchmark of 88.9% specificity, algorithm 1’s sensitivity of 88.6% was comparable to the benchmark sensitivity of 86.9%.In combination with a radiologist where abnormal was defined by either the algorithm or radiologist, the cancer detection rate increased 8% from 5.32 per 1000 for algorithm 1 alone to 5.76 per 1000 in combination with the first reader with a corresponding 77% increase in recall rate from 39.1 to 69.1 per 1000.The most accurate algorithm was trained on the largest training set and utilized pixel-level annotations and higher capacity network architecture, despite training on a patient population and vendor system different from the external validation data set. In conclusion, only one of the three algorithms performed at an independent level comparable to radiologists, setting the groundwork for prospective trial evaluation of AI systems in screening mammography.Highlighted ArticleSalim M, Wåhlin E, Dembrower K, et al. External evaluation of 3 commercial artificial intelligence algorithms for independent assessment of screening mammograms. JAMA Oncol 2020;6(10):1581–1588. doi: 10.1001/jamaoncol.2020.3321Highlighted ArticleSalim M, Wåhlin E, Dembrower K, et al. External evaluation of 3 commercial artificial intelligence algorithms for independent assessment of screening mammograms. JAMA Oncol 2020;6(10):1581–1588. doi: 10.1001/jamaoncol.2020.3321 Crossref, Medline, Google ScholarArticle HistoryPublished online: Nov 27 2020 FiguresReferencesRelatedDetailsRecommended Articles MRI for Evaluation of Complications of Breast AugmentationRadioGraphics2022Volume: 42Issue: 4pp. 929-946Does Reader Performance with Digital Breast Tomosynthesis Vary according to Experience with Two-dimensional Mammography?Radiology2017Volume: 283Issue: 2pp. 371-380Invited Commentary: High-Quality MRI after Breast AugmentationRadioGraphics2022Volume: 42Issue: 4pp. E113-E114Artificial Intelligence for Reducing Workload in Breast Cancer Screening with Digital Breast TomosynthesisRadiology2022Volume: 303Issue: 1pp. 69-77Breast Imaging in Transgender Patients: What the Radiologist Should KnowRadioGraphics2019Volume: 40Issue: 1pp. 13-27See More RSNA Education Exhibits What the Breast Radiologist Needs to Know About Imaging Transgender PatientsDigital Posters2018Evaluation of Breast Implants by Traditional Methods, Mammography, and Ultrasonography: When Suspicious of RuptureDigital Posters2019Imaging the Post Mastectomy and Post Implant Breast: Challenges and PitfallsDigital Posters2019 RSNA Case Collection Intracapsular Implant RuptureRSNA Case Collection2021Silicone lymph node on 18F-FDG PET/CTRSNA Case Collection2020Breast implant-associated anaplastic large cell lymphoma RSNA Case Collection2021 Vol. 2, No. 6 Metrics Altmetric Score PDF download

EP011 - Factors predicting positive saturation biopsy in prostate cancer patients with prior negative multiparametric magnetic resonance imaging

EP011 - Factors predicting positive saturation biopsy in prostate cancer patients with prior negative multiparametric magnetic resonance imaging

MRI-guided breast biopsy based on diffusion-weighted imaging: a feasibility study

ObjectivesThis study evaluated the feasibility of DWI for lesion targeting in MRI-guided breast biopsies. Furthermore, it assessed device positioning on DWI during biopsy procedures.MethodsA total of 87 biopsy procedures (5/87 bilateral) consecutively performed between March 2019 and June 2020 were retrospectively reviewed: in these procedures, a preliminary DWI sequence (b = 1300 s/mm2) was acquired to assess lesion detectability. We included 64/87 procedures on lesions detectable at DWI; DWI sequences were added to the standard protocol to localize lesion and biopsy device and to assess the site marker correct positioning.ResultsMass lesions ranged from 5 to 48 mm, with a mean size of 10.7 mm and a median size of 8 mm. Non-mass lesions ranged from 7 to 90 mm, with a mean size of 33.9 mm and a median size of 31 mm. Positioning of the coaxial system was confirmed on both T1-weighted and DWI sequences. At DWI, the biopsy needle was detectable in 62/64 (96.9%) cases; it was not visible in 2/64 (3.1%) cases. The site marker was always identified using T1-weighted imaging; a final DWI sequence was acquired in 44/64 cases (68.8%). In 42/44 cases (95.5%), the marker was recognizable at DWI.ConclusionsDWI can be used as a cost-effective, highly reliable technique for targeting both mass and non-mass lesions, with a minimum size of 5 mm, detectable at pre-procedural DWI. DWI is also a feasible technique to localize the biopsy device and to confirm the deployment of the site marker.Key Points• MRI-guided breast biopsy is performed in referral centers by an expert dedicated staff, based on prior MR imaging; contrast agent administration is usually needed for lesion targeting.• DWI represents a feasible, highly reliable technique for lesion targeting, avoiding contrast agent administration.• DWI allows a precise localization of both biopsy needle device and site marker.

Impact of 68Ga-PSMA-11 PET/CT on Initial Staging of High-Risk Prostate Cancer Patients: Post-Hoc Analysis of a Prospective Single Center Experience

Conventional imaging for initial staging of prostate cancer (PCa) lacks sensitivity and underestimates disease burden. Prostate-specific membrane antigen PET/CT (PSMA PET) is an emerging imaging modality shown to have improved sensitivity over conventional imaging in the setting of biochemical recurrence. We sought to evaluate the impact of 68Ga-PSMA PET on initial staging of patients with high risk PCa, as well as clinicopathologic features that might predict for upstaging, by analyzing patients who prospectively underwent PSMA PET on a clinical trial. This was a post hoc analysis of 249 eligible patients with NCCN high/very high risk PCa who underwent a staging PSMA PET (12/2016 to 1/2020) on a prospective trial. Patients with known non-regional lymph node or distant metastasis on prior imaging, or initiation of androgen deprivation therapy more than 3 months before PSMA PET were excluded. Chi square analysis was used to evaluate the association of clinicopathologic features (Gleason grade group [GG], initial PSA [iPSA], T stage, percent positive cores [PPC]≥50%) with upstaging. Overall, 22.9% patients were upstaged by PSMA PET; 18.9% of patients with iN0 disease by CT or MRI were found to have N1 disease by PSMA PET, and 10.6% of patients who had M0 disease by CT or bone scan had M1 disease by PSMA PET. New M1a disease was found in 7.4% and M1b/M1c disease was found in 5.3% of patients. PSMA PET detected ECE, SVI or invasion of surrounding structures in 8.1% patients deemed T2 on prior MRI imaging. PPC≥50% was significantly associated with regional and any nodal upstage (23.9% vs. 12.1%, p = 0.0227 and 22.6% vs. 3.7%, p = 0.0261, respectively), and any upstage in general (29.3% vs. 14.6%, p = 0.0102). Patients with GG 5 or ≥50% PPC were more likely to have regional nodal upstage (23.4% vs. 6.3%, p = 0.0031) and any upstage in general (28.2% vs. 9.4%, p = 0.0024), while GG 5 together with ≥50% PPC was predictive of M stage upstage (23.3% vs. 4.7%, p = 0.0063). cT and iPSA were not associated with upstaging. PSMA PET/CT has a significant impact on initial staging of high risk PCa patients. This impact appears to be most marked in patients with GG 5 or PPC≥50%.