Imaging Pearls ❯ March 2023
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Chest
- “The goal of oncology is to provide the longest possible survival outcomes with the therapeutics that are currently available without sacrificing patients’ quality of life. In lung cancer, several data points over a patient’s diagnostic and treatment course are relevant to optimizing outcomes in the form of precision medicine, and artificial intelligence (AI) provides the opportunity to use available data from molecular information to radiomics, in combination with patient and tumor characteristics, to help clinicians provide individualized care. In doing so, AI can help create models to identify cancer early in diagnosis and deliver tailored therapy on the basis of available information, both at the time of diagnosis and in real time as they are undergoing treatment. The purpose of this review is to summarize the current literature in AI specific to lung cancer and how it applies to the multidisciplinary team taking care of these complex patients.”
Integration of artificial intelligencein lung cancer: Rise of the machine
Colton Ladbury et al.
Cell Reports Medicine (2023), https://doi.org/10.1016/j.xcrm.2023.100933 - “The use of AI to augment imaging technology has found success in several disciplines, including computer-aided detection and diagnosis (CAD), convolutional neural networks (CNNs), and radiomics.CAD systems are typically standalone with a unified goal of detection or diagnosis of disease. At its core, it is simply trying to aid practitioners with identification of disease, with primary focus on that binary outcome. The field of radiomics seeks to use medical imaging to generate high-dimensional quantitative data, which can in turn be used for analysis that seeks to better understand the underlying characteristics of disease.Radiomics is inherently meant to support the overall diagnosis and management of patients at any point in the imaging workflow and can be combined with other patient characteristics to produce powerful support tools, and therefore can be considered a natural extension of CAD.”
Integration of artificial intelligencein lung cancer: Rise of the machine
Colton Ladbury et al.
Cell Reports Medicine (2023), https://doi.org/10.1016/j.xcrm.2023.100933 - In addition to assisting with identifying lung cancers, AI can also help predict oncologic outcomes overall and who will respond to therapy. Predicting outcomes including locoregional and distant recurrence, progression-free survival, and overall survival (OS) can be challenging, given that factors that influence these outcomesare multivariate. Imaging features are no doubt highly relevant, but these must be combined with patient and tumor.
Integration of artificial intelligence in lung cancer: Rise of the machine
Colton Ladbury et al.
Cell Reports Medicine (2023), https://doi.org/10.1016/j.xcrm.2023.100933 - “AI has also been applied to treatment decision making. A clinical decision support system (CDSS) is a tool to assist physicians in making clinical decisions on the basis of analyses of multiple data points on a particular patient. Watson for Oncology (WFO) is one example of a CDSS that has been applied to the treatment management of lung cancer. A study comparing decisions made by WFO to a multidisciplinary team found relatively high concordance in recommendations for early stage and metastatic disease (92.4%–100%) but lower rates of concordance in stage II or III (80.8%–84.6%).51 Therefore, although there is room for improvement for decision support, these tools will be critical for standardizing lung cancer treatment across available treatment options and disciplines, thereby enhancing outcomes.”
Integration of artificial intelligence in lung cancer: Rise of the machine
Colton Ladbury et al.
Cell Reports Medicine (2023), https://doi.org/10.1016/j.xcrm.2023.100933 - “Surgical resection is standard of care for management of localized lung cancer. Extent of surgery depends on several factors, including disease progression and patient eligibility. When possible, lobectomy has been established as standard, with improved disease control and/or survival compared with smaller wedge resections63 and larger pneumonectomies.64 Furthermore, the mortality rate of lobectomies is 2.3% compared with 6.8% with pneumonectomies. However, not every patient will be a candidate for lobectomy, because of factors such as medical history, smoking history, and lung function. AI offers an opportunity to better risk-stratify patients to come up with an optimal treatment plan, which might also include no surgery at all if risk is too high.”
Integration of artificial intelligence in lung cancer: Rise of the machine
Colton Ladbury et al.
Cell Reports Medicine (2023), https://doi.org/10.1016/j.xcrm.2023.100933 - “Although AI is clearly an invaluable tool to the multidisciplinary lung cancer care team, several barriers remain to its widespread implementation and availability. First, AI relies heavily on data, and data acquisition and organization continue to be a challenge that AI will need to overcome. Efforts will optimally focus on ways of efficiently extracting EMR data to create large databases for AI research. Sample size is important in AI research, as it must be sufficiently large to train, test and validate models. Presently, most outcomes-based research studies include relatively small numbers of patients (between tens and hundreds of patients) that are somewhat heterogeneous as far as patient demographics, genomics, and imaging features are concerned. Though it is sometimes possible to perform AI analyses on datasets of that size, sample sizes in the thousands might be required for many applications. Otherwise, models may be inaccurate, poorly generalizable, and not applicable or reproducible to clinical outcomes. Additionally, although the EMR system has provided the opportunity to extract data into models for AI-based research, a number of variables are recorded as free text, which cannot directly be extracted for data analysis.”
Integration of artificial intelligence in lung cancer: Rise of the machine
Colton Ladbury et al.
Cell Reports Medicine (2023), https://doi.org/10.1016/j.xcrm.2023.100933 - “The present is an exciting time for lung cancer treatment, as the available treatment options, and the precision with which we can select them, have improved dramatically in recent years. However, these increasingly tailored treatment options are accompanied by a need for data to inform clinical decisions, and therefore a need to be able to make sense of large volumes of data throughout a hypothetical patients’ treatment course. The overarching field of AI, inclusive of ML, NNs, DL, NLP, XAI, and other domains and methodologies, offers a promising avenue for improving all aspects of lung cancer management with datadriven approaches. Advances in radiomics allow us to derive additional value from existing diagnostic imaging, while ML algorithms help with optimizing treatment selection. Although there are limitations to AI and challenges as discussed, with large databases and suitable platforms AI research will continue to grow and become more reproducible, accurate, and applicable. With the rise in AI-based research over the past decade and increasing interest toward AI in the oncology community, including young trainees, AI-based interventions in lung cancer management will play a key role in the future.”
Integration of artificial intelligence in lung cancer: Rise of the machine
Colton Ladbury et al.
Cell Reports Medicine (2023), https://doi.org/10.1016/j.xcrm.2023.100933
- Histoplasmosis: CT Findings
- Pulmonary nodules
- Broncholithiasis
- Adenopathy
- Fibrosing mediastinitis - Histoplasmosis: CT Findings
CT scanning is helpful in detecting calcification in a lung nodule (histoplasmoma) and in evaluating patients with fibrosing mediastinitis and broncholithiasis. CT may define the extent of the fibrous mass in the mediastinum/hilum and demonstrate its obstructing effect . - Histoplasmosis: Clinical Findings
- fever
- malaise
- cough
- headache
- chest pain
- chills
- myalgias - Histoplasmosis: Complications
- Mediastinal granuloma
- Fibrosing mediastinitis
- Broncholithiasis
- Cavitary pulmonary histoplasmosis - “In the article that accompanies this editorial, Mikhael et al report that an artificial intelligence and deep learning model, called Sybil, may predict an individual’s future lung cancer risk after one baseline computed tomography chest scan. This model is an important first step toward a precision approach to lung cancer screening, but understanding who would truly benefit from this technology will require significantly more investment in prospective studies targeting groups with differing risk profiles.”
The Intersection of Lung Cancer creening, Radiomics, and Artificial Intelligence: Can One Scan Really Predict the Future Development of Lung Cancer?
Gerard A. Silvestri and James R. Jett
American Society of Clinical Oncology 2023 (in press)
Colon
- “In this cohort study, AI systems showed higher assistance ability in late sessions per half day, which suggests the potential to maintain high quality and homogeneity of colonoscopies and further improve endoscopist performance in large screening programs and centers with high workloads.”
Assessment of the Role of Artificial Intelligence in the Association Between Time of Day and Colonoscopy Quality
Zihua Lu, MD
JAMA Network Open. 2023;6(1):e2253840. doi:10.1001/jamanetworkopen.2022.53840 - IMPORTANCE Time of day was associated with a decline in adenoma detection during colonoscopy. Artificial intelligence (AI) systems are effective in improving the adenoma detection rate (ADR), but the performance of AI during different times of the day remains unknown.
Assessment of the Role of Artificial Intelligence in the Association Between Time of Day and Colonoscopy Quality
Zihua Lu, MD
JAMA Network Open. 2023;6(1):e2253840. doi:10.1001/jamanetworkopen.2022.53840 - Conclusions
“In conclusion, our results suggest that later sessions per half day were associated with a decline adenoma detection. Furthermore, AI systems could eliminate the time-related degradation of colonoscopy quality. In the future, the application of AI systems has the potential to maintain high quality and homogeneity of colonoscopies and further improve endoscopist performance in large screening programs and centers with high workloads.”
Assessment of the Role of Artificial Intelligence in the Association Between Time of Day and Colonoscopy Quality
Zihua Lu, MD
JAMA Network Open. 2023;6(1):e2253840. doi:10.1001/jamanetworkopen.2022.53840
- “One of the CT hallmarks of acute appendicitis is appendiceal dilation, classically defined as an outer-wall-to-outer-wall transverse diameter greater than 6 mm. A more nuanced approach describing appendiceal diameters between 6 and 9 mm as “equivocal” when secondary signs are absent can improve accuracy. Peri-appendiceal fat stranding is the main secondary sign; others include single wall thickness > 3 mm, wall hyperenhancement, cecal changes, and increased caliber from baseline. Communicating air or contrast has strong negative predictive value. If the air is not communicating with the cecum nor the appendix is not predominantly air filled, an intraluminal abscess is possible, increasing the risk for perforated appendicitis. Any diameter > 10 mm is considered abnormal.”
Review of appendicitis: routine, complicated, and mimics
Joshua C. Hunsaker et al.
Emergency Radiology (2023) 30:107–117 - “Appendicitis with appendicoliths is associated with more severe or perforated appendicitis (odds ratio 2.2). It is important to note, however, that the presence of incidental appendicoliths on imaging does not significantly increase the risk of appendicitis. Khan et al. showed that 0 out of 111 patients with incidental findings of appendicoliths on CT had appendicitis after a 4-year follow-up.”
Review of appendicitis: routine, complicated, and mimics
Joshua C. Hunsaker et al.
Emergency Radiology (2023) 30:107–117 - “The origin of RLQ pain can be difficult to determine when significant inflammation is present as other etiologies including cecal diverticulitis, inflammatory bowel disease (IBD), pelvic inflammatory disease (PID), tubo-ovarian abscess, infectious enteritis/colitis, and bowel perforation obscure the appendix nor can cause reactive appendicitis. Table 3 provides a list of considerations for RLQ pain. We suggest using the following tips and uncommon sources of RLQ inflammation to increase the likelihood of making the correct diagnosis.”
Review of appendicitis: routine, complicated, and mimics
Joshua C. Hunsaker et al.
Emergency Radiology (2023) 30:107–117 - “Epiploic appendagitis is a benign self-limiting inflammatory process of the epiploic appendages, which are small fatty outpouchings located along the serosal surface of the colon. The primary mechanism is acute torsion with subsequent ischemia and necrosis of an epiploic appendage or spontaneous venous thrombosis of the involved epiploic appendage. CT findings include an ovoid fat-density lesion with a thin enhancing wall and associated fat stranding. Very rarely, the involved epiploic appendage is located along the appendix, resulting in appendiceal epiploic appendagitis. Accurate diagnosis is critical as conservative management with anti-inflammatorym medication is the standard of care.”
Review of appendicitis: routine, complicated, and mimics
Joshua C. Hunsaker et al.
Emergency Radiology (2023) 30:107–117 - Appendiceal mucocele describes a subset of appendiceal neoplasms including adenoma, low-grade appendiceal mucinous neoplasm (LAMN), high-grade appendiceal mucinous neoplasm (HAMN), and mucinous adenocarcinoma. They are more common in the elderly and up to 50% show rim calcification. An infected mucocele can appear similarly to ruptured appendicitis , but a tubular connection to the cecum is more likely in mucocele than in ruptured appendicitis.
Review of appendicitis: routine, complicated, and mimics
Joshua C. Hunsaker et al.
Emergency Radiology (2023) 30:107–117 - Dilation of the appendiceal tip with or without calcifications is suspicious for mucocele. Focal dilation of the appendix > 15 mm is 87% specific for mucocele compared to 57% with diffuse dilation. Tip appendicitiscould have a similar presentation and findings but should not have any calcifications. Rupture of an appendiceal mucocele of the abdomen and may cause pseudomyxoma peritonei. If a patient presents with an appendix > 15 mm with or without calcifications, the report should state concern for appendiceal mucocele with risk for pseudomyxoma if it ruptures .
Review of appendicitis: routine, complicated, and mimics
Joshua C. Hunsaker et al.
Emergency Radiology (2023) 30:107–117 - “The diagnosis of appendicitis is not always straightforward. Presentation may be atypical, and there are a number of pathologies that mimic or complicate the diagnosis. It is important to systematically approach each imaging study with a broad differential and a basic understanding of the overall medical history. Despite the complexity and broad differential, appendicitis accounts for about half of all RLQ inflammation. A systematic approach and search for secondary signs will help the radiologist to differentiate an equivocal appendix from true appendicitis."
Review of appendicitis: routine, complicated, and mimics
Joshua C. Hunsaker et al.
Emergency Radiology (2023) 30:107–117
Deep Learning
- “Artificial intelligence (AI) technologies to help authors improve the preparation and quality of their manuscripts and published articles are rapidly increasing in number and sophistication. These include tools to assist with writing, grammar, language, references, statistical analysis, and reporting standards. Editors and publishers also use AI-assisted tools for myriad purposes, including to screen submissions for problems (eg, plagiarism, image manipulation, ethical issues), triage submissions, validate references, edit, and code content for publication in different media and to facilitate postpublication search and discoverability.”
Nonhuman “Authors” and Implications for the Integrity of Scientific Publication and Medical Knowledge.
Flanagin A, Bibbins-Domingo K, Berkwits M, Christiansen SL.
JAMA. Published online January 31, 2023. doi:10.1001/jama.2023.1344 - “In November 2022, OpenAI released a new open source, natural language processing tool called ChatGPT. ChatGPT is an evolution of a chatbot that is designed to simulate human conversation in response to prompts or questions (GPT stands for “generative pretrained transformer”). The release has prompted immediate excitement about its many potential uses4 but also trepidation about potential misuse, such as concerns about using the language model to cheat on homework assignments, write student essays, and take examinations, including medical licensing examinations.In January 2023, Nature reported on 2 preprints and 2 articles published in the science and health fields that included ChatGPT as a bylined author.Each of these includes an affiliation for ChatGPT, and 1 of the articles includes an email address for the nonhuman “author.” According to Nature, that article’s inclusion of ChatGPT in the author byline was an “error that will soon be corrected.”However, these articles and their nonhuman “authors” have already been indexed in PubMed and Google Scholar.”
Nonhuman “Authors” and Implications for the Integrity of Scientific Publication and Medical Knowledge.
Flanagin A, Bibbins-Domingo K, Berkwits M, Christiansen SL.
JAMA. Published online January 31, 2023. doi:10.1001/jama.2023.1344 - Nonhuman artificial intelligence, language models, machine learning, or similar technologies do not qualify for authorship. If these models or tools are used to create content or assist with writing or manuscript preparation, authors must take responsibility for the integrity of the content generated by these tools. Authors should report the use of artificial intelligence, language models, machine learning, or similar technologies to create content or assist with writing or editing of manuscripts in the Acknowledgment section or the Methods section if this is part of formal research design or methods. This should include a description of the content that was created or edited and the name of the language model or tool, version and extension numbers, and manufacturer. (Note: this does not include basic tools for checking grammar, spelling, references, etc.)
Nonhuman “Authors” and Implications for the Integrity of Scientific Publication and Medical Knowledge.
Flanagin A, Bibbins-Domingo K, Berkwits M, Christiansen SL.
JAMA. Published online January 31, 2023. doi:10.1001/jama.2023.1344 - “Transformative, disruptive technologies, like AI language models, create promise and opportunities as well as risks and threats for all involved in the scientific enterprise. Calls for journals to implement screening for AI-generated content will likely escalate,especially for journals that have been targets of paper mills and other unscrupulous or fraudulent practices. But with large investments in further development, AI tools may be capable of evading any such screens. Regardless, AI technologies have existed for some time, will be further and faster developed, and will continue to be used in all stages of research and the dissemination of information, hopefully with innovative advances that offset any perils. In this era of pervasive misinformation and mistrust, responsible use of AI language models and transparent reporting of how these tools are used in the creation of information and publication are vital to promote and protect the credibility and integrity of medical research and trust in medical knowledge.”
Nonhuman “Authors” and Implications for the Integrity of Scientific Publication and Medical Knowledge.
Flanagin A, Bibbins-Domingo K, Berkwits M, Christiansen SL.
JAMA. Published online January 31, 2023. doi:10.1001/jama.2023.1344 - “This exploratory study found that a popular online AI model provided largely appropriate responses to simple CVD prevention questions as evaluated by preventive cardiology clinicians. Findings suggest the potential of interactive AI to assist clinical workflows by augmenting patient education and patient-clinician communication around common CVD prevention queries. For example, such an application may provide conversational responses to simple queries on informational platforms or create automated draft responses to patient electronic messages for clinicians. Whether these approaches can improve readability should be explored, because prior work has indicated low readability of certain online patient educational materials for CVD prevention.”
Appropriateness of Cardiovascular Disease Prevention Recommendations Obtained From a Popular Online Chat-Based Artificial Intelligence Model.
Sarraju A, Bruemmer D, Van Iterson E, Cho L, Rodriguez F, Laffin L.
JAMA. Published online February 03, 2023. doi:10.1001/jama.2023.1044 - “AI model responses to 21 of 25 questions (84%) were graded as appropriate in both contexts (Table). Four responses (16%) were graded as inappropriate in both contexts. For 3 of the 4 sets of responses, all 3 responses had inappropriate information; for 1 set, 1 of 3 responses was inappropriate. For example, the AI model responded to questions about exercise by firmly recommending both cardiovascular activity and lifting weights, which may be incorrect and potentially harmful for certain patients. Responses about interpreting a low-density lipoprotein cholesterol level of 200 mg/dL lacked relevant details, including familial hypercholesterolemia and genetic considerations. Responses about inclisiran suggested that it is commercially unavailable. No responses were graded as unreliable.”
Appropriateness of Cardiovascular Disease Prevention Recommendations Obtained From a Popular Online Chat-Based Artificial Intelligence Model.
Sarraju A, Bruemmer D, Van Iterson E, Cho L, Rodriguez F, Laffin L.
JAMA. Published online February 03, 2023. doi:10.1001/jama.2023.1044
- “In the article that accompanies this editorial, Mikhael et al report that an artificial intelligence and deep learning model, called Sybil, may predict an individual’s future lung cancer risk after one baseline computed tomography chest scan. This model is an important first step toward a precision approach to lung cancer screening, but understanding who would truly benefit from this technology will require significantly more investment in prospective studies targeting groups with differing risk profiles.”
The Intersection of Lung Cancer creening, Radiomics, and Artificial Intelligence: Can One Scan Really Predict the Future Development of Lung Cancer?
Gerard A. Silvestri and James R. Jett
American Society of Clinical Oncology 2023 (in press) - “The goal of oncology is to provide the longest possible survival outcomes with the therapeutics that are currently available without sacrificing patients’ quality of life. In lung cancer, several data points over a patient’s diagnostic and treatment course are relevant to optimizing outcomes in the form of precision medicine, and artificial intelligence (AI) provides the opportunity to use available data from molecular information to radiomics, in combination with patient and tumor characteristics, to help clinicians provide individualized care. In doing so, AI can help create models to identify cancer early in diagnosis and deliver tailored therapy on the basis of available information, both at the time of diagnosis and in real time as they are undergoing treatment. The purpose of this review is to summarize the current literature in AI specific to lung cancer and how it applies to the multidisciplinary team taking care of these complex patients.”
Integration of artificial intelligencein lung cancer: Rise of the machine
Colton Ladbury et al.
Cell Reports Medicine (2023), https://doi.org/10.1016/j.xcrm.2023.100933 - “The use of AI to augment imaging technology has found success in several disciplines, including computer-aided detection and diagnosis (CAD), convolutional neural networks (CNNs), and radiomics.CAD systems are typically standalone with a unified goal of detection or diagnosis of disease. At its core, it is simply trying to aid practitioners with identification of disease, with primary focus on that binary outcome. The field of radiomics seeks to use medical imaging to generate high-dimensional quantitative data, which can in turn be used for analysis that seeks to better understand the underlying characteristics of disease.Radiomics is inherently meant to support the overall diagnosis and management of patients at any point in the imaging workflow and can be combined with other patient characteristics to produce powerful support tools, and therefore can be considered a natural extension of CAD.”
Integration of artificial intelligencein lung cancer: Rise of the machine
Colton Ladbury et al.
Cell Reports Medicine (2023), https://doi.org/10.1016/j.xcrm.2023.100933 - In addition to assisting with identifying lung cancers, AI can also help predict oncologic outcomes overall and who will respond to therapy. Predicting outcomes including locoregional and distant recurrence, progression-free survival, and overall survival (OS) can be challenging, given that factors that influence these outcomesare multivariate. Imaging features are no doubt highly relevant, but these must be combined with patient and tumor.
Integration of artificial intelligence in lung cancer: Rise of the machine
Colton Ladbury et al.
Cell Reports Medicine (2023), https://doi.org/10.1016/j.xcrm.2023.100933 - “AI has also been applied to treatment decision making. A clinical decision support system (CDSS) is a tool to assist physicians in making clinical decisions on the basis of analyses of multiple data points on a particular patient. Watson for Oncology (WFO) is one example of a CDSS that has been applied to the treatment management of lung cancer. A study comparing decisions made by WFO to a multidisciplinary team found relatively high concordance in recommendations for early stage and metastatic disease (92.4%–100%) but lower rates of concordance in stage II or III (80.8%–84.6%).51 Therefore, although there is room for improvement for decision support, these tools will be critical for standardizing lung cancer treatment across available treatment options and disciplines, thereby enhancing outcomes.”
Integration of artificial intelligence in lung cancer: Rise of the machine
Colton Ladbury et al.
Cell Reports Medicine (2023), https://doi.org/10.1016/j.xcrm.2023.100933 - “Surgical resection is standard of care for management of localized lung cancer. Extent of surgery depends on several factors, including disease progression and patient eligibility. When possible, lobectomy has been established as standard, with improved disease control and/or survival compared with smaller wedge resections63 and larger pneumonectomies.64 Furthermore, the mortality rate of lobectomies is 2.3% compared with 6.8% with pneumonectomies. However, not every patient will be a candidate for lobectomy, because of factors such as medical history, smoking history, and lung function. AI offers an opportunity to better risk-stratify patients to come up with an optimal treatment plan, which might also include no surgery at all if risk is too high.”
Integration of artificial intelligence in lung cancer: Rise of the machine
Colton Ladbury et al.
Cell Reports Medicine (2023), https://doi.org/10.1016/j.xcrm.2023.100933 - “Although AI is clearly an invaluable tool to the multidisciplinary lung cancer care team, several barriers remain to its widespread implementation and availability. First, AI relies heavily on data, and data acquisition and organization continue to be a challenge that AI will need to overcome. Efforts will optimally focus on ways of efficiently extracting EMR data to create large databases for AI research. Sample size is important in AI research, as it must be sufficiently large to train, test and validate models. Presently, most outcomes-based research studies include relatively small numbers of patients (between tens and hundreds of patients) that are somewhat heterogeneous as far as patient demographics, genomics, and imaging features are concerned. Though it is sometimes possible to perform AI analyses on datasets of that size, sample sizes in the thousands might be required for many applications. Otherwise, models may be inaccurate, poorly generalizable, and not applicable or reproducible to clinical outcomes. Additionally, although the EMR system has provided the opportunity to extract data into models for AI-based research, a number of variables are recorded as free text, which cannot directly be extracted for data analysis.”
Integration of artificial intelligence in lung cancer: Rise of the machine
Colton Ladbury et al.
Cell Reports Medicine (2023), https://doi.org/10.1016/j.xcrm.2023.100933 - “The present is an exciting time for lung cancer treatment, as the available treatment options, and the precision with which we can select them, have improved dramatically in recent years. However, these increasingly tailored treatment options are accompanied by a need for data to inform clinical decisions, and therefore a need to be able to make sense of large volumes of data throughout a hypothetical patients’ treatment course. The overarching field of AI, inclusive of ML, NNs, DL, NLP, XAI, and other domains and methodologies, offers a promising avenue for improving all aspects of lung cancer management with datadriven approaches. Advances in radiomics allow us to derive additional value from existing diagnostic imaging, while ML algorithms help with optimizing treatment selection. Although there are limitations to AI and challenges as discussed, with large databases and suitable platforms AI research will continue to grow and become more reproducible, accurate, and applicable. With the rise in AI-based research over the past decade and increasing interest toward AI in the oncology community, including young trainees, AI-based interventions in lung cancer management will play a key role in the future.”
Integration of artificial intelligence in lung cancer: Rise of the machine
Colton Ladbury et al.
Cell Reports Medicine (2023), https://doi.org/10.1016/j.xcrm.2023.100933
- “In this cohort study, AI systems showed higher assistance ability in late sessions per half day, which suggests the potential to maintain high quality and homogeneity of colonoscopies and further improve endoscopist performance in large screening programs and centers with high workloads.”
Assessment of the Role of Artificial Intelligence in the Association Between Time of Day and Colonoscopy Quality
Zihua Lu, MD
JAMA Network Open. 2023;6(1):e2253840. doi:10.1001/jamanetworkopen.2022.53840 - IMPORTANCE Time of day was associated with a decline in adenoma detection during colonoscopy. Artificial intelligence (AI) systems are effective in improving the adenoma detection rate (ADR), but the performance of AI during different times of the day remains unknown.
Assessment of the Role of Artificial Intelligence in the Association Between Time of Day and Colonoscopy Quality
Zihua Lu, MD
JAMA Network Open. 2023;6(1):e2253840. doi:10.1001/jamanetworkopen.2022.53840 - Conclusions
“In conclusion, our results suggest that later sessions per half day were associated with a decline adenoma detection. Furthermore, AI systems could eliminate the time-related degradation of colonoscopy quality. In the future, the application of AI systems has the potential to maintain high quality and homogeneity of colonoscopies and further improve endoscopist performance in large screening programs and centers with high workloads.”
Assessment of the Role of Artificial Intelligence in the Association Between Time of Day and Colonoscopy Quality
Zihua Lu, MD
JAMA Network Open. 2023;6(1):e2253840. doi:10.1001/jamanetworkopen.2022.53840
Liver
- “Posttransplant malignancies can arise by means of three different mechanisms: de novo, donor-related, and recurrent cancers. De novo malignancies are new cancers arising in transplant recipients that originate separately from the transplanted organs, such as NMSC and Kaposi sarcoma. Donor-related cancers can either be from direct transmission of tumors that preexisted in the donor or de novo development of cancer in the transplanted organ without a preexisting history.”
Malignancy after Solid Organ Transplantation: Comprehensive Imaging Review
Katabathina VS et al.
RadioGraphics 2016; 36:1390–1407 - “Direct oncogenic effects of immunosuppressive drugs, impaired immunosurveillance of neoplastic cells, and increased incidence of virally induced malignancies are also mechanisms in the pathogenesis of malignancies that develop in transplant recipients.”
Malignancy after Solid Organ Transplantation: Comprehensive Imaging Review
Katabathina VS et al.
RadioGraphics 2016; 36:1390–1407 
Malignancy after Solid Organ Transplantation: Comprehensive Imaging Review
Katabathina VS et al.
RadioGraphics 2016; 36:1390–1407- "Kaposi sarcoma is a multifocal angioproliferative endothelial malignancy driven by HHV-8 infection. HHV-8 is a complex DNA virus that can induce malignancy by inhibition of apoptosis, damaging antigen-processing pathways, evasion of mutated host cells from immunosurveillance, activating the mTOR pathway, and upregulating vascular endothelial growth factor receptors. Although most Kaposi sarcomas are due to reactivation of HHV-8 in recipients because of prolonged immunosuppression, infection can also be transmitted from the donor. There is a 400- to 500-fold greater incidence of Kaposi sarcoma in solid organ transplant recipients than in the general population."
Malignancy after Solid Organ Transplantation: Comprehensive Imaging Review
Katabathina VS et al.
RadioGraphics 2016; 36:1390–1407 - “Visceral Kaposi sarcoma can involve the gastrointestinal tract, lymph nodes, and lungs. Although rare, direct involvement of the allografts has also been described. At imaging, skin lesions can be seen as vascular nodules or masses with associated hypervascular lymph nodes. Abdominal findings of Kaposi sarcoma include nodular bowel wall thickening, enhanced masses in the liver and spleen, lymphadenopathy, and vascular mesenteric masses.”
Malignancy after Solid Organ Transplantation: Comprehensive Imaging Review
Katabathina VS et al.
RadioGraphics 2016; 36:1390–1407 - “PTLD is a spectrum of lymphoproliferative diseases that occur after organ transplantation and range from benign lymphoid hyperplasia to lymphoma. The incidence of PTLD ranges from 1% to 20%, depending on the level of immunosuppression and the presence of Epstein-Barr virus infection. Lung, heart, and pancreas transplants, which require higher doses of immunosuppressive agents, are associated with a higher risk of PTLD than are kidney or liver transplants. About 85% of PTLDs are from activation of B lymphocytes by Epstein-Barr virus, although proliferation of T-cells, natural killer cells, or plasma cells may also cause PTLD. PTLD manifests in two well-recognized forms: early-onset PTLD, which develops within the first year after transplantation (80% of cases) and late-onset PTLD, which manifests 4–5 years after transplant.”
Malignancy after Solid Organ Transplantation: Comprehensive Imaging Review
Katabathina VS et al.
RadioGraphics 2016; 36:1390–1407 - “About 85% of PTLDs are from activation of B lymphocytes by Epstein-Barr virus, although proliferation of T-cells, natural killer cells, or plasma cells may also cause PTLD. PTLD manifests in two well-recognized forms: early-onset PTLD, which develops within the first year after transplantation (80% of cases) and late-onset PTLD, which manifests 4–5 years after transplant.”
Malignancy after Solid Organ Transplantation: Comprehensive Imaging Review
Katabathina VS et al.
RadioGraphics 2016; 36:1390–1407 - “Approximately 50%–75% of PTLD cases manifest in the abdomen and primarily involve the gastrointestinal tract (more often in the distal small bowel than in the proximal small bowel). Imaging findings in gastrointestinal PTLD include irregular bowel wall thickening with eccentric mural masses, aneurysmal dilatation, luminal ulceration, and, rarely, intussusception. The liver is the most common solid organ involved in PTLD of the abdomen.”
Malignancy after Solid Organ Transplantation: Comprehensive Imaging Review
Katabathina VS et al.
RadioGraphics 2016; 36:1390–1407 - “PTLD is potentially fatal, with a mortality rate between 22% and 70%, and early diagnosis is a key factor for overall survival rates. Limited levels of immunosuppression can help to prevent PTLD, and reduction in immunosuppression is the initial step in the treatment of PTLD and may result in complete regression of early lesions or polymorphic PTLD. Antibody or antiviral therapy and chemotherapy are other treatment strategies.”
Malignancy after Solid Organ Transplantation: Comprehensive Imaging Review
Katabathina VS et al.
RadioGraphics 2016; 36:1390–1407
Musculoskeletal
- “Extramedullary hematopoiesis (EMH) refers to an abnormal condition in which the bone marrow is not able to maintain adequate hematopoietic function, and hence, other locations in the body start compensatory hematopoiesis. Decreased or ineffective marrow hematopoiesis results from various pathologic conditions such as anemia and hemoglobinopathies [eg, severe hypochromic anemia, pernicious anemia, megaloblastic anemia, thalassemia, sickle cell disease ,myelophthisic disorders [eg, hematological malignancies, myelofibrosis, myelosclerosis, storage disorders, granulomatous diseases, osteoporosis, diffuse metastases, or peripheral hemolysis (eg, hemoglobinopathies, hereditary spherocytosis, autoimmune hemolytic anemias).”
Extramedullary Hematopoiesis: A Forgotten Diagnosis and aGreat Mimicker of Malignancy
Daniel Fadaei Fouladi, Elliot K. Fishman, and Satomi Kawamoto
J Comput Assist Tomogr. 2023 in press - “In over 85% of patients with EMH, liver, spleen, and lymph nodes serve as the secondary sites of the hematopoiesis, followed by the paraspinal space in 5% of patients and the retroperitoneum in less than 2% of patients. Other rare sites of EMH include the pelvis (eg, presacral region, prostate), intraabdominal locations (eg, the gastrointestinal tract, adrenal glands, omentum, mesentery, peritoneum), head and neck, and central nervous system (eg, nasopharynx, paranasal sinuses, middle ear, lacrimal glands, thyroid, peripheral and cranial nerves, spinal canal), urinary system (eg, urinary tract, kidneys, prostate), skin, and breast.”
Extramedullary Hematopoiesis: A Forgotten Diagnosis and aGreat Mimicker of Malignancy
Daniel Fadaei Fouladi, Elliot K. Fishman, and Satomi Kawamoto
J Comput Assist Tomogr. 2023 in press - The presacral area is the third most common site of EMH after the liver-spleen and thoracic paravertebral location. Patients are usually asymptomatic or report nonspecific symptoms. Similar to paraspinal EMH,most patients have an underlying hematologic disorder. Therefore, related osseous features such as periosteal elevation, cortical interruption, and medullary expansion usually are present at the time of the imaging study. On CT, presacral EMH typically presents as a well-marginated, round, or lobulated solid mass with interspersed fat, located adjacent and anterior to the sacrum. The normal contour of the sacrum is generally preserved owing to the pliable and soft nature of the EMH tissue. However, the mass effect of an adequately large lesion may displace the rectum. Other imaging findings follow the general rules for the EMH masses occurring in other parts of the body.
Extramedullary Hematopoiesis: A Forgotten Diagnosis and aGreat Mimicker of Malignancy
Daniel Fadaei Fouladi, Elliot K. Fishman, and Satomi Kawamoto
J Comput Assist Tomogr. 2023 in press - “Extramedullary hematopoiesis is one of those uncommon disease processes that can produce many imaging findings potentially resembling malignancy and may cause diagnostic challenges with other more serious resembling conditions such as metastases or lymphoma or other malignant conditions. The patient's underlying conditions predisposed to EMH and recognizing the imaging features of EMH, in particular typical location and imaging appearance, are helpful in making the correct diagnosis.”
Extramedullary Hematopoiesis: A Forgotten Diagnosis and aGreat Mimicker of Malignancy
Daniel Fadaei Fouladi, Elliot K. Fishman, and Satomi Kawamoto
J Comput Assist Tomogr. 2023 in press
Practice Management
- While the adoption of social media platforms has become commonplace for personal life use, its practice has tremendously grown for professional usage in medicine, and particularly in the field of radiology. The use of alternative metrics, or altmetrics, scores have developed in an effort to quantify the impact of research beyond traditional metrics, such as citation rate and journal impact factor, particularly to recognize the impact of social media on dissemination and promotion of research. Social media usage in the realm of radiology has expectedly been adopted for the purposes of medical education, research, networking, and advocacy. However, some platforms have been used as a medium to discuss and share the day-to-day nature in the field of radiology, burnout in radiology, as well as radiology-themed humor. The purpose of this review article was discuss the role of altmetrics, as well as the specific uses of social media platforms including Twitter, Instagram, Facebook, Youtube, and more. The role of ethics in social media practice related to radiology are discussed.
The growing role of social media for research and education in radiology
Alex Pozdnyakova, Mostafa Alabousib, Michael N. Patlasa
Diagnostic and Interventional Imaging 000 (2023) 1−4 (in press) - “The rise of medical education on Twitter can be traced to the emergence of the concept of free open-access medical education (FOAMed), championed by many physicians on Twitter as a vehicle to globalize medical knowledge. Due to Twitter’s signature utilization of hashtags to filter content, the #radFOAMed and #radres hashtags have been widely accepted to categorize radiological education tweets . Moreover, major radiology conferences have added Twitter coverage of their educational events. Hawkins et al. reported a 30% increase in Twitter activity at the 2012 Radiological Society of North America (RSNA) conference by comparison with 2011.”
The growing role of social media for research and education in radiology
Alex Pozdnyakova, Mostafa Alabousib, Michael N. Patlasa
Diagnostic and Interventional Imaging 000 (2023) 1−4 (in press) - “The current landscape of radiology content on Instagram is represented by radiology departments, radiological societies and individual physicians, who post interesting cases and other educational content. The latter represents the majority of existing radiology related Instagram accounts. As an example, a journal article by Wadhwa et al. describes a detailed experience of an academic radiology department posting their teaching files as case studies. Similarly, an article by Yu and Sharma highlights the perspective of a radiologist educator and outlines recommendations for curating a personalized radiology medical education account.”
The growing role of social media for research and education in radiology
Alex Pozdnyakova, Mostafa Alabousib, Michael N. Patlasa
Diagnostic and Interventional Imaging 000 (2023) 1−4 (in press) - “The experiences with the above-mentioned educational CTisus project, curated by the Radiology Department at Johns Hopkins Hospital, Baltimore, have been also described in literature. In addition to Instagram, this educational initiative also has a presence on Youtube and Facebook, which Kauffman et al. report in their study viewership on Youtube was significantly increased with 10−15 min Facebook Livevideos in comparison to other video formats, indicating the utility of Youtube as a complementary social media tool.”
The growing role of social media for research and education in radiology
Alex Pozdnyakova, Mostafa Alabousib, Michael N. Patlasa
Diagnostic and Interventional Imaging 000 (2023) 1−4 (in press) - “One of the most pertinent issues in using social media as a tool of radiology education is the issue of patient information confidentiality . Other than exceedingly rare explicit violations of patient privacy, such as exposure of patient’s identity on images without their informed consent, there is a wide spectrum of other potential identifications that accompanies a large portion of educational cases posted online. Effort should be made to minimize all ancillary clinical information that might potentially result in identification of patients, particularly if it does not provide educational value.”
The growing role of social media for research and education in radiology
Alex Pozdnyakova, Mostafa Alabousib, Michael N. Patlasa
Diagnostic and Interventional Imaging 000 (2023) 1−4 (in press) - “The ascent of social media culture poses a new opportunity for theworld of radiology to new networking, education, promotional and advocacy opportunities. Global accessibility of social media creates a favourable environment for professional cohesion and collegiality among radiologists from different parts of the world. While this review summarizes the body of published literature on social media usage in radiology, there are still a lot of new creative ways to utilize social media in the interests of radiology that need to be researched. There is persistent paucity of scholarly work that describes the phenomenology of social media in radiology, yet given the rapid technological progress, it is expected that radiologists’ interest in social media will only grow.”
The growing role of social media for research and education in radiology
Alex Pozdnyakova, Mostafa Alabousib, Michael N. Patlasa
Diagnostic and Interventional Imaging 000 (2023) 1−4 (in press) - “Interleaved practice is specifically helpful in conceptual learning and building higher order learning for complex topics. Social media is perfectly set up for embracing distributed practice. A learner can leverage social media to watch a YouTube (San Bruno, CA) video on a certain topic, and then view and learn a different topic by reviewing a case presentation on Twitter, all within a short period of time. This learning style also taps into the different methods of learning; namely auditory, visual, and kinesthetic. This learning strategy of distributed and interleaved practice provides real-world context to learning based on the needs and choices of the learner, as the student is picking what content to view or learn from.”
Leveraging Social Media to Learn: A New Era for Medical Education
Maryam Zeba, MBBS, Omer A. Awan, MD, MPH, CIIP
Acad Radiol 2023; 30:565–566 - “The most widespread social media platforms also allow learners and instructors to connect outside the formal learning environment, share ideas, and create peer groups to share their opinions regarding the learning experience. The most common social media platforms being used for digital learning in medical education include Facebook (Menlo Park, CA), YouTube, Instagram, and Twitter. These platforms not only help create and share informative and engaging videos, quizzes, posters, infographics, and illustrations; but also provide an opportunity to connect with the educators and peers in an informal and highly convenient way. Telegram (Tortola, British Virgin Islands) is another such platform where professionals from all over the world create their own unique learning groups to network, learn, and share highly valuable information. Learning and staying updated with rapidly evolving scientific knowledge has never been as convenient and accessible as it is today.”
Leveraging Social Media to Learn: A New Era for Medical Education
Maryam Zeba, MBBS, Omer A. Awan, MD, MPH, CIIP
Acad Radiol 2023; 30:565–566 - “In recent years, medical educators and learners are showing a positive trend toward the use of social media for educational purposes. For example, educators are supporting their own YouTube channels to share lectures and cases. Medical education social media influencers often share their day-to-day cases and educational pearls on Twitter, some of whom conduct quizzes and interact with the learners in the comment sections. International medical journals are also starting to share cases, quizzes, and podcasts on their social media platforms. This constantly updating, highly effective platform with an over expanding worldwide audience has immense potential for eLearning including the ability to influence the educational pedagogy of future physicians.”
Leveraging Social Media to Learn: A New Era for Medical Education
Maryam Zeba, MBBS, Omer A. Awan, MD, MPH, CIIP
Acad Radiol 2023; 30:565–566 - “The power of social media really lies in cultivating a sense of excitement in learning, which can inspire learners to engage in lifelong learning in a fun, interactive manner. Social media platforms provide students the opportunity to think critically about educational topics and enjoy learning, with the added value of collaborative engagement. Next time you find yourself on Twitter; take that quiz, click the possible correct poll option below it, watch a short 5 minute video, and have faith that you are engaging in and applying an educational strategy that will undoubtedly enhance your learning.”
Leveraging Social Media to Learn: A New Era for Medical Education
Maryam Zeba, MBBS, Omer A. Awan, MD, MPH, CIIP
Acad Radiol 2023; 30:565–566
- “One of the things I learned was that there is nothing more important than love and friendship. There are two particularly important people in my life. The first is a girl I met in 6th grade, who more than a dozen years later became my wife. She is still by my side through good times and bad. We have been married for 58 years. The other person who stands out among the many people I have known is Art Garfunkel. He was my roommate at Columbia. Friendship is not, “what can you do for me?”, but is about what we can do for each other, and how the two of us can do ever-greater things. I have learned that friendship can be lifesaving. My friend Art stood by my side through the darkest of moments and helped me reach the other side. It is without a doubt that I would not be where I am today without the love and friendship of Sue and Art.”
Life Lessons on the Importance of Love and Friendship
Sanford D. Greenberg, Elliot K. Fishman, Linda C. Chu, Steven P. Rowe
Current Problems in Diagnostic Radiology, 2023, in press - “It is the kindness of others and the friendship of others that helps us succeed and overcome our own limitations. So, take time out of your busy schedule to find, make and be a good friend to others. Friendship is never, and will never be, a one-way interaction. A relationship will only prosper and last over time if both parties benefit from the relationship. Imagine the kindness of friends reading all of my textbooks to me when I was blind and only their readings allowed me to graduate with my class and succeed. It is a lesson for all of us on kindness, empathy, and the human spirit.”
Life Lessons on the Importance of Love and Friendship
Sanford D. Greenberg, Elliot K. Fishman, Linda C. Chu, Steven P. Rowe
Current Problems in Diagnostic Radiology, 2023, in press - “Over my life, I have spent time in government, industry and education. I have been on the board of Johns Hopkins and have been particularly involved with the Wilmer Eye Institute, where I began the three million-dollar challenge to end blindness. It is only with audacious goals that we can expect to see audacious results. The program End Blindness 2020 was a reach. Nevertheless, there is much work being done and the goal to end blindness is within our grasp. Despite my many life challenges, I am here to tell you that life, even at the darkest moments, is worth living. You achieve a full life when you are able to make discoveries or change outcomes for your fellow human beings. Thus, you will have your moment of brilliance.”
Life Lessons on the Importance of Love and Friendship
Sanford D. Greenberg, Elliot K. Fishman, Linda C. Chu, Steven P. Rowe
Current Problems in Diagnostic Radiology, 2023, in press - Questions for Reflection
1.. What impact have friends had on your life to date? Particularly, how might your career be different without friends at work?
2. How might you deepen your relationship with friends at work? What has been lost during the COVID pandemic and how might we recover our lost/diminished relationships in the post-COVID era?
3. How can you contribute to a culture of inclusivity and friendliness at work? What can you do to avoid creating a hostile work environment?
Life Lessons on the Importance of Love and Friendship
Sanford D. Greenberg, Elliot K. Fishman, Linda C. Chu, Steven P. Rowe
Current Problems in Diagnostic Radiology, 2023, in press
Small Bowel
- Hypervascular metastatic and lymphoproliferative disorders can cause high attenuation lymphadenopathy due to intranodal hemorrhage (on unenhanced CT) or hyperenhancement (on contrast-enhanced CT):
- Kaposi sarcoma
- papillary thyroid carcinoma
- Castleman disease
- Kikuchi-Fujimoto disease
- Kimura disease
- angioimmunoblastic T cell lymphoma
- neuroendocrine tumors
- renal cell carcinoma
- "Kaposi sarcoma is a multifocal angioproliferative endothelial malignancy driven by HHV-8 infection. HHV-8 is a complex DNA virus that can induce malignancy by inhibition of apoptosis, damaging antigen-processing pathways, evasion of mutated host cells from immunosurveillance, activating the mTOR pathway, and upregulating vascular endothelial growth factor receptors. Although most Kaposi sarcomas are due to reactivation of HHV-8 in recipients because of prolonged immunosuppression, infection can also be transmitted from the donor. There is a 400- to 500-fold greater incidence of Kaposi sarcoma in solid organ transplant recipients than in the general population."
Malignancy after Solid Organ Transplantation: Comprehensive Imaging Review
Katabathina VS et al.
RadioGraphics 2016; 36:1390–1407 - “Visceral Kaposi sarcoma can involve the gastrointestinal tract, lymph nodes, and lungs. Although rare, direct involvement of the allografts has also been described. At imaging, skin lesions can be seen as vascular nodules or masses with associated hypervascular lymph nodes. Abdominal findings of Kaposi sarcoma include nodular bowel wall thickening, enhanced masses in the liver and spleen, lymphadenopathy, and vascular mesenteric masses.”
Malignancy after Solid Organ Transplantation: Comprehensive Imaging Review
Katabathina VS et al.
RadioGraphics 2016; 36:1390–1407 - “PTLD is a spectrum of lymphoproliferative diseases that occur after organ transplantation and range from benign lymphoid hyperplasia to lymphoma. The incidence of PTLD ranges from 1% to 20%, depending on the level of immunosuppression and the presence of Epstein-Barr virus infection. Lung, heart, and pancreas transplants, which require higher doses of immunosuppressive agents, are associated with a higher risk of PTLD than are kidney or liver transplants. About 85% of PTLDs are from activation of B lymphocytes by Epstein-Barr virus, although proliferation of T-cells, natural killer cells, or plasma cells may also cause PTLD. PTLD manifests in two well-recognized forms: early-onset PTLD, which develops within the first year after transplantation (80% of cases) and late-onset PTLD, which manifests 4–5 years after transplant.”
Malignancy after Solid Organ Transplantation: Comprehensive Imaging Review
Katabathina VS et al.
RadioGraphics 2016; 36:1390–1407 - “About 85% of PTLDs are from activation of B lymphocytes by Epstein-Barr virus, although proliferation of T-cells, natural killer cells, or plasma cells may also cause PTLD. PTLD manifests in two well-recognized forms: early-onset PTLD, which develops within the first year after transplantation (80% of cases) and late-onset PTLD, which manifests 4–5 years after transplant.”
Malignancy after Solid Organ Transplantation: Comprehensive Imaging Review
Katabathina VS et al.
RadioGraphics 2016; 36:1390–1407 - “Approximately 50%–75% of PTLD cases manifest in the abdomen and primarily involve the gastrointestinal tract (more often in the distal small bowel than in the proximal small bowel). Imaging findings in gastrointestinal PTLD include irregular bowel wall thickening with eccentric mural masses, aneurysmal dilatation, luminal ulceration, and, rarely, intussusception. The liver is the most common solid organ involved in PTLD of the abdomen.”
Malignancy after Solid Organ Transplantation: Comprehensive Imaging Review
Katabathina VS et al.
RadioGraphics 2016; 36:1390–1407 - “PTLD is potentially fatal, with a mortality rate between 22% and 70%, and early diagnosis is a key factor for overall survival rates. Limited levels of immunosuppression can help to prevent PTLD, and reduction in immunosuppression is the initial step in the treatment of PTLD and may result in complete regression of early lesions or polymorphic PTLD. Antibody or antiviral therapy and chemotherapy are other treatment strategies.”
Malignancy after Solid Organ Transplantation: Comprehensive Imaging Review
Katabathina VS et al.
RadioGraphics 2016; 36:1390–1407
- “Posttransplant malignancies can arise by means of three different mechanisms: de novo, donor-related, and recurrent cancers. De novo malignancies are new cancers arising in transplant recipients that originate separately from the transplanted organs, such as NMSC and Kaposi sarcoma. Donor-related cancers can either be from direct transmission of tumors that preexisted in the donor or de novo development of cancer in the transplanted organ without a preexisting history.”
Malignancy after Solid Organ Transplantation: Comprehensive Imaging Review
Katabathina VS et al.
RadioGraphics 2016; 36:1390–1407 - “Approximately 50%–75% of PTLD cases manifest in the abdomen and primarily involve the gastrointestinal tract (more often in the distal small bowel than in the proximal small bowel). Imaging findings in gastrointestinal PTLD include irregular bowel wall thickening with eccentric mural masses, aneurysmal dilatation, luminal ulceration, and, rarely, intussusception.”
Malignancy after Solid Organ Transplantation: Comprehensive Imaging Review
Katabathina VS et al.
RadioGraphics 2016; 36:1390–1407 - “Direct oncogenic effects of immunosuppressive drugs, impaired immunosurveillance of neoplastic cells, and increased incidence of virally induced malignancies are also mechanisms in the pathogenesis of malignancies that develop in transplant recipients.”
Malignancy after Solid Organ Transplantation: Comprehensive Imaging Review
Katabathina VS et al.
RadioGraphics 2016; 36:1390–1407
Malignancy after Solid Organ Transplantation: Comprehensive Imaging Review
Katabathina VS et al.
RadioGraphics 2016; 36:1390–1407
- “Segmental arterial mediolysis (SAM) is a non-inflammatory, non-atherosclerotic vasculopathy mostly involving the abdominal arteries. SAM was recently recognized as a more prevalent aetiology of abdominal pain than initially thought by healthcare providers. It is still a commonly missed diagnosis in patients with recurrent emergency room (ER) visits for abdominal pain. Most published case reports in the past have highlighted catastrophic sequelae such as intra-abdominal haemorrhage requiring surgical intervention. We report a case of SAM where the diagnosis was initially missed. After diagnosis, conservative medical management was offered which led to clinical improvement.”
Segmental Arterial Mediolysis: An Under-Recognized Cause of Chronic Abdominal Pain.
Chatterjee T, Stephens J, Roy M
Eur J Case Rep Intern Med. 2020 Jul - SAM is a non-inflammatory, non-atherosclerotic vasculopathy of unclear aetiology, with a propensity to involve splanchnic vessels but it can also affect carotid, renal and intracranial vessels. Arterial vasospasm is thought to lead to dissection of arterial walls, although the exact pathogenesis of the disease remains unclear. nother pathophysiological mechanism suggested is vacuolar degeneration leading to disruption of the outer arterial media eventually causing aneurysms and dissections. SAM mainly affects middle-aged and elderly patients. Abdominal pain is the most common clinical presentation, while it can also present as shock due to haemorrhage, haematochezia, chest pain or stroke.”
Segmental Arterial Mediolysis: An Under-Recognized Cause of Chronic Abdominal Pain.
Chatterjee T, Stephens J, Roy M
Eur J Case Rep Intern Med. 2020 Jul - “Positive angiographic evidence of disease in the visceral arteries is found in 40-90% of patients with PAN at the time of presentation.Arteries of the extremities and small branches of the aorta are less commonly involved. The typical angiographic feature is the presence of micro-aneurysms. Arterial steno-occlusive lesions are less common.”
Role of multidetector abdominal CT in the evaluation of abnormalities in polyarteritis nodosa
M. Singhal et al.
Clinical Radiology 71 (2016) 222-227 - “PAN is a focal pan-mural necrotising vasculitis involving small- and medium-sized arteries with multiple organ system involvement to varying degrees, The kidneys are the most common site of involvement (70-80%) with the renal artery most frequently involved, followed by the gastrointestinal tract (GIT), peripheral nerves and skin (50% each) and skeletal muscles (30%). The central nervous system is involved in 10% of cases. Rare sites of involvement are the lung, heart, testicles, and spleen.”
Role of multidetector abdominal CT in the evaluation of abnormalities in polyarteritis nodosa
M. Singhal et al.
Clinical Radiology 71 (2016) 222-227 - “In conclusion, CT, including CTA, is a comprehensive imaging method that can assist in the diagnosis of PAN in occult cases based on the combination of arterial and parenchymal abnormalities. Knowledge of various CT/CTA abnormalities may obviate the need for angiography and biopsy, which is beneficial considering the invasive nature and potential complications associated with these interventions.”
Role of multidetector abdominal CT in the evaluation of abnormalities in polyarteritis nodosa
M. Singhal et al.
Clinical Radiology 71 (2016) 222-227 - “None of the CT studies reported arterial changes in PAN besides aneurysms; however, in the present study arterial changes were classified similar to those reported on angi- ography. In their review of the angiographic findings in 56 patients with PAN, Stanson et al.reported occlusive lesions in 39% cases. The spectrum of findings included luminal irregularity, stenosis, and occlusion. Similar changes were found in 11 arteries in the present study; however, in the study of Stanson et al., the SMA was the most common site of involvement followed by the hepatic and splenic arteries. Similarly, ectasia was not reported in CT studies of PAN. Ectasia is less common compared to aneurysms and stenosis and was reported in 12.5% of patients, SMA being the most commonly involved artery.”
Role of multidetector abdominal CT in the evaluation of abnormalities in polyarteritis nodosa
M. Singhal et al.
Clinical Radiology 71 (2016) 222-227 - “Segmental arterial mediolysis is a rare nonatheroscle-rotic, noninflammatory disease affecting middle-aged and older patients (median age, 55 years) with a mild male predominance (male-to-female ratio, 1.5:1) Vacuolization and lysis of the outer media originate arte-rial gaps and patchy transmural loss of the external elastic lamina, resulting in formation of dissecting hematomas and aneurysms due to weakening of the wall. The main differential diagnoses include fibromuscular dysplasia, which is usually asymptomatic and affects younger patients with predominant involvement of the renal arteries, and polyarteritis nodosa.”
Segmental Arterial Mediolysis.
Borde P, Vilgrain V.
Radiology. 2022 Mar;302(3):515. - “Segmental arterial mediolysis (SAM) is a rare but serious nonatherosclerotic, noninflammatory vasculopathy of unknown etiology that often results in dissection, aneurysm, occlusion, or stenosis of, primarily, the abdominal arteries. Current literature lacks consensus on diagnostic criteria and management options for SAM.”
Segmental arterial mediolysis (SAM): Systematic review and analysis of 143 cases.
Skeik N, Olson SL, Hari G, Pavia ML.
Vasc Med. 2019 Dec;24(6):549-563. - Patients with SAM were most commonly men (68%) in their 60s. Hypertension (43%), tobacco use (12%), and hyperlipidemia (12%) were common comorbidities. Abdominal pain (80%) and intraabdominal bleeding (50%) were the most common presenting symptoms. Computed tomography was the most frequently used imaging method (78%), and histology was available in 44% of cases. The most commonly affected vessels were the superior mesenteric (53%), hepatic (45%), celiac (36%), renal (26%), and splenic (25%) arteries with aneurysm (76%), dissection (61%), and arterial rupture (46%). Treatments included coil embolization (28%), abdominal organ surgery (24%), open arterial repair (21%), and medical management (20%). Case-specific treatment modalities yielded symptom relief in the vast majority (91%) of patients, with a mortality rate of 7%.
Segmental arterial mediolysis (SAM): Systematic review and analysis of 143 cases.
Skeik N, Olson SL, Hari G, Pavia ML.
Vasc Med. 2019 Dec;24(6):549-563. - “Abdominal pain (80%) and intraabdominal bleeding (50%) were the most common presenting symptoms. Computed tomography was the most frequently used imaging method (78%), and histology was available in 44% of cases. The most commonly affected vessels were the superior mesenteric (53%), hepatic (45%), celiac (36%), renal (26%), and splenic (25%) arteries with aneurysm (76%), dissection (61%), and arterial rupture (46%). Treatments included coil embolization (28%), abdominal organ surgery (24%), open arterial repair (21%), and medical management (20%). Case-specific treatment modalities yielded symptom relief in the vast majority (91%) of patients, with a mortality rate of 7%.”
Segmental arterial mediolysis (SAM): Systematic review and analysis of 143 cases.
Skeik N, Olson SL, Hari G, Pavia ML.
Vasc Med. 2019 Dec;24(6):549-563. - “SAM most commonly affects the abdominal aortic branches, such as the celiac, mesenteric, and/or renal arteries with occasional carotid, cerebral, and coronary artery involvement. Depending on the involved artery and underlying pathology (dissection with stenosis versus rupture), patients with SAM may present with chronic abdominal pain, acute mesenteric ischemia, or even hemorrhagic shock. Previous case studies have reported high rates of emergent presentation related to arterial rupture and hemorrhage in approximately two-thirds of patients, with a mortality rate reaching up to 50%.”
Segmental arterial mediolysis (SAM): Systematic review and analysis of 143 cases.
Skeik N, Olson SL, Hari G, Pavia ML.
Vasc Med. 2019 Dec;24(6):549-563.
Vascular
- Vasculitis: Differential Dx
- PAN
- SAM (Segmental Arterial Mediolysis)
- FMD - “Segmental arterial mediolysis (SAM) is a non-inflammatory, non-atherosclerotic vasculopathy mostly involving the abdominal arteries. SAM was recently recognized as a more prevalent aetiology of abdominal pain than initially thought by healthcare providers. It is still a commonly missed diagnosis in patients with recurrent emergency room (ER) visits for abdominal pain. Most published case reports in the past have highlighted catastrophic sequelae such as intra-abdominal haemorrhage requiring surgical intervention. We report a case of SAM where the diagnosis was initially missed. After diagnosis, conservative medical management was offered which led to clinical improvement.”
Segmental Arterial Mediolysis: An Under-Recognized Cause of Chronic Abdominal Pain.
Chatterjee T, Stephens J, Roy M
Eur J Case Rep Intern Med. 2020 Jul - “Positive angiographic evidence of disease in the visceral arteries is found in 40-90% of patients with PAN at the time of presentation.Arteries of the extremities and small branches of the aorta are less commonly involved. The typical angiographic feature is the presence of micro-aneurysms. Arterial steno-occlusive lesions are less common.”
Role of multidetector abdominal CT in the evaluation of abnormalities in polyarteritis nodosa
M. Singhal et al.
Clinical Radiology 71 (2016) 222-227 - “PAN is a focal pan-mural necrotising vasculitis involving small- and medium-sized arteries with multiple organ system involvement to varying degrees, The kidneys are the most common site of involvement (70-80%) with the renal artery most frequently involved, followed by the gastrointestinal tract (GIT), peripheral nerves and skin (50% each) and skeletal muscles (30%). The central nervous system is involved in 10% of cases. Rare sites of involvement are the lung, heart, testicles, and spleen.”
Role of multidetector abdominal CT in the evaluation of abnormalities in polyarteritis nodosa
M. Singhal et al.
Clinical Radiology 71 (2016) 222-227 - “In conclusion, CT, including CTA, is a comprehensive imaging method that can assist in the diagnosis of PAN in occult cases based on the combination of arterial and parenchymal abnormalities. Knowledge of various CT/CTA abnormalities may obviate the need for angiography and biopsy, which is beneficial considering the invasive nature and potential complications associated with these interventions.”
Role of multidetector abdominal CT in the evaluation of abnormalities in polyarteritis nodosa
M. Singhal et al.
Clinical Radiology 71 (2016) 222-227 - “None of the CT studies reported arterial changes in PAN besides aneurysms; however, in the present study arterial changes were classified similar to those reported on angi- ography. In their review of the angiographic findings in 56 patients with PAN, Stanson et al.reported occlusive lesions in 39% cases. The spectrum of findings included luminal irregularity, stenosis, and occlusion. Similar changes were found in 11 arteries in the present study; however, in the study of Stanson et al., the SMA was the most common site of involvement followed by the hepatic and splenic arteries. Similarly, ectasia was not reported in CT studies of PAN. Ectasia is less common compared to aneurysms and stenosis and was reported in 12.5% of patients, SMA being the most commonly involved artery.”
Role of multidetector abdominal CT in the evaluation of abnormalities in polyarteritis nodosa
M. Singhal et al.
Clinical Radiology 71 (2016) 222-227 - “Segmental arterial mediolysis is a rare nonatheroscle-rotic, noninflammatory disease affecting middle-aged and older patients (median age, 55 years) with a mild male predominance (male-to-female ratio, 1.5:1) Vacuolization and lysis of the outer media originate arte-rial gaps and patchy transmural loss of the external elastic lamina, resulting in formation of dissecting hematomas and aneurysms due to weakening of the wall. The main differential diagnoses include fibromuscular dysplasia, which is usually asymptomatic and affects younger patients with predominant involvement of the renal arteries, and polyarteritis nodosa.”
Segmental Arterial Mediolysis.
Borde P, Vilgrain V.
Radiology. 2022 Mar;302(3):515. - “Segmental arterial mediolysis (SAM) is a rare but serious nonatherosclerotic, noninflammatory vasculopathy of unknown etiology that often results in dissection, aneurysm, occlusion, or stenosis of, primarily, the abdominal arteries. Current literature lacks consensus on diagnostic criteria and management options for SAM.”
Segmental arterial mediolysis (SAM): Systematic review and analysis of 143 cases.
Skeik N, Olson SL, Hari G, Pavia ML.
Vasc Med. 2019 Dec;24(6):549-563. - Patients with SAM were most commonly men (68%) in their 60s. Hypertension (43%), tobacco use (12%), and hyperlipidemia (12%) were common comorbidities. Abdominal pain (80%) and intraabdominal bleeding (50%) were the most common presenting symptoms. Computed tomography was the most frequently used imaging method (78%), and histology was available in 44% of cases. The most commonly affected vessels were the superior mesenteric (53%), hepatic (45%), celiac (36%), renal (26%), and splenic (25%) arteries with aneurysm (76%), dissection (61%), and arterial rupture (46%). Treatments included coil embolization (28%), abdominal organ surgery (24%), open arterial repair (21%), and medical management (20%). Case-specific treatment modalities yielded symptom relief in the vast majority (91%) of patients, with a mortality rate of 7%.
Segmental arterial mediolysis (SAM): Systematic review and analysis of 143 cases.
Skeik N, Olson SL, Hari G, Pavia ML.
Vasc Med. 2019 Dec;24(6):549-563. - “Abdominal pain (80%) and intraabdominal bleeding (50%) were the most common presenting symptoms. Computed tomography was the most frequently used imaging method (78%), and histology was available in 44% of cases. The most commonly affected vessels were the superior mesenteric (53%), hepatic (45%), celiac (36%), renal (26%), and splenic (25%) arteries with aneurysm (76%), dissection (61%), and arterial rupture (46%). Treatments included coil embolization (28%), abdominal organ surgery (24%), open arterial repair (21%), and medical management (20%). Case-specific treatment modalities yielded symptom relief in the vast majority (91%) of patients, with a mortality rate of 7%.”
Segmental arterial mediolysis (SAM): Systematic review and analysis of 143 cases.
Skeik N, Olson SL, Hari G, Pavia ML.
Vasc Med. 2019 Dec;24(6):549-563. - “SAM most commonly affects the abdominal aortic branches, such as the celiac, mesenteric, and/or renal arteries with occasional carotid, cerebral, and coronary artery involvement. Depending on the involved artery and underlying pathology (dissection with stenosis versus rupture), patients with SAM may present with chronic abdominal pain, acute mesenteric ischemia, or even hemorrhagic shock. Previous case studies have reported high rates of emergent presentation related to arterial rupture and hemorrhage in approximately two-thirds of patients, with a mortality rate reaching up to 50%.”
Segmental arterial mediolysis (SAM): Systematic review and analysis of 143 cases.
Skeik N, Olson SL, Hari G, Pavia ML.
Vasc Med. 2019 Dec;24(6):549-563.
- “In addition to being used to identify the underlying cause of the septic state, CT is required for the early recognition of shock-associated CT imaging signs, collectively referred to as CT hypoperfusion complex, which can improve patient prognosis and management. The CT hypoperfusion complex is frequently associated with hypotension, which can also present in many no sepsis related clinical conditions, such as trauma-induced hypotensive shock (e.g. severe head or spine injury), cardiac arrest, and diabetic ketoacidosis.”
Computed tomography imaging of septic shock. Beyond the cause: the “CT hypoperfusion complex”. A pictorial essay
Marco Di Serafino et al.
Insights Imaging (2021) 12:70 - “These signs include the decreased enhancement of the viscera, the increased mucosal enhancement and luminal dilation of the small bowel, the mural thickening and identification of fluid-filled loops in the small bowel, the halo sign and flattening of the inferior vena cava (IVC), reduced aortic diameter, peripancreatic oedema and other controversialparenchymal and visceral findings and ascites that can occur in varying combinations and are often and reversible during early stages. The presence of 2 or more vascular, visceral, or parenchymal signs is necessary to establish the presence of CT hypoperfusion complex.”
Computed tomography imaging of septic shock. Beyond the cause: the “CT hypoperfusion complex”. A pictorial essay
Marco Di Serafino et al.
Insights Imaging (2021) 12:70 - “The flattening of the IVC calibre has been defined as the identification of reduced anterior–posterior diameter (< 9 mm) in three consecutive segments, 20 mm above and below the renal veins, and at the level of the perihepatic portion. Flattening is the result of decreased circulating blood volume and indicates reduced venous return in patients with systemic hypotension, which may not be appreciable due to the massive infusion of liquids. In addition, variations in intra-abdominal pressure and the respiratory cycle can also affect the IVC diameter. IVC flattening has a specificity of 90% and a sensitivity of 84% for the identification of hypoperfusion shock due to sepsis in spontaneously breathing patients, whereas the sensitivity and specificity are both 90% in ventilated patients .”
Computed tomography imaging of septic shock. Beyond the cause: the “CT hypoperfusion complex”. A pictorial essay
Marco Di Serafino et al.
Insights Imaging (2021) 12:70 - “A small-calibre abdominal aorta is defined as a reduced anteroposterior diameter (< 13 mm) detected 20 mm above and below the renal arteries. Small-calibre aorta occurs in approximately 30% of patients with systemic hypotension and is not specific to hypoperfusive shock due to sepsis, as it may be observed in the normal population. This sign is associated with vasoconstriction induced by the adrenergic system to compensate for the shock condition.”
Computed tomography imaging of septic shock. Beyond the cause: the “CT hypoperfusion complex”. A pictorial essay
Marco Di Serafino et al.
Insights Imaging (2021) 12:70 - “The most frequent findings associated with shock bowel include fluid-filled, dilated loops with thickened walls (> 3 mm) due to oedema of the submucosa and increased mucosal enhancement relative to the psoas muscle . Changes to the small intestine are the most commonly observed characteristics among the CT signs indicative of shock. The small intestine is often diffusely involved in the occurrence of hypotensive shock, whereas the colon is rarely involved.”
Computed tomography imaging of septic shock. Beyond the cause: the “CT hypoperfusion complex”. A pictorial essay
Marco Di Serafino et al.
Insights Imaging (2021) 12:70 - “Abnormal renal perfusion typically manifests as an increased and prolonged parenchymal enhancement; however, focal and heterogeneous enhancement can also be observed. A fall in systolic pressure causes intense efferent glomerular arteriolar vasoconstriction, which drives glomerular filtration, leading to tubular stasis and the increased resorption of salt and water. Renal parenchymal enhancement is dependent on several factors, including cardiac output and scans timing relative to the injection of contrast agent and, thus, is a non-specific sign. However, kidney enhancement can vary depending on the severity of systemic hypotension. In some cases, unlike hyperenhancement, the decreased enhancement of the renal medulla can be observed in the venous phase, likely due to the impairment of contrast medium outflow from the renal cortex to the medulla, induced by acute renal tubular dysfunction and associated with poor prognosis.”
Computed tomography imaging of septic shock. Beyond the cause: the “CT hypoperfusion complex”. A pictorial essay
Marco Di Serafino et al.
Insights Imaging (2021) 12:70 - “The bilateral hyperenhancement of the adrenal gland is more common in paediatric cases than in adults and can also present in combination with acute adrenal haemorrhage, which most commonly affects the right side unilaterally, with a homogeneous increase in the size of the gland and the associated suffusion of fat around the adrenal gland. Bilateral adrenal hyperenhancement is the manifestation of adrenergic mechanisms that enhance the blood flow to the vital organs. In the arterial phase, the central zone of the adrenal gland shows less intense enhancement than the peripheral zone or presents a mosaic appearance due to the heterogeneous enhancement of the central zone. In both cases, in the venous phase, the whole adrenal gland is homogenously enhanced . This sign highlights the central role played by the adrenal glands in mediating the sympathetic response to hypotensive shock and is associated with poor prognosis.”
Computed tomography imaging of septic shock. Beyond the cause: the “CT hypoperfusion complex”. A pictorial essay
Marco Di Serafino et al.
Insights Imaging (2021) 12:70