Radiologic Clinics of North America

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The following is an overview of the numerous efforts to reduce access for women to breast cancer screening. Misinformation has been promoted over the many years to suggest that screening only works for women aged 50 years and over. In fact, there are no, scientifically derived data, to support the use of the age of 50 years as a threshold for screening. The randomized, controlled trials have proved that screening saves lives for women aged 40 to 74 years (the age of the women who participated)...

Osteoporotic vertebral compression fractures can be quite challenging to treat, especially since they often occur in older adults and can be associated with significant morbidity and mortality. The standard treatment for these fractures has been medical management, as many of these patients are not candidates for open surgery. Vertebral augmentation procedures have emerged as another treatment option. Though initially accepted by clinicians, the benefit of these procedures has been questioned by several clinical trials...

There are many misconceptions related to the usage of intravenous contrast agents for medical imaging. These misconceptions can affect patient care, as they can lead to nonoptimal examination usage. Knowledge of the current contrast-related misconceptions can help radiologists provide higher quality care to their patients.

Iodinated contrast material (ICM) is a critical component for many radiologic examinations and procedures. However, ICM has often been withheld in the past out of concern for its potential nephrotoxicity and increased risk of morbidity and mortality, often at the expense of diagnostic accuracy and timely diagnosis. Evidence from controlled studies now suggest that most cases of acute kidney injury (AKI) caused by ICM were instead due to contrast-independent causes of AKI or normal variation in renal function...

Immediate hypersensitivity reactions to iodinated contrast media and gadolinium-based contrast media can be life-threatening. While corticosteroid premedication or agent-switching may mitigate risk, evidence is largely indirect and based on historical studies; recent literature refutes the efficacy. Guidance on premedication varies between organizations worldwide. No strategy eliminates reactions, and indirect consequences of premedication are substantial. Accelerated regimens are often used for emergencies, but are of questionable efficacy...

The integration of artificial intelligence (AI) in radiology has brought about substantial advancements and transformative potential in diagnostic imaging practices. This study presents an overview of the current research on the application of AI in radiology, highlighting key insights from recent studies and surveys. These recent studies have explored the expected impact of AI, encompassing machine learning and deep learning, on the work volume of diagnostic radiologists. The present and future role of AI in radiology holds great promise for enhancing diagnostic capabilities, improving workflow efficiency, and ultimately, advancing patient care...

At its best, the practice of medicine involves careful integration of experience and evidence. Generating evidence to address controversies in radiology - and translating such evidence to practice - requires appropriate selection of methods, and an understanding of the strengths, shortcomings, and biases inherent to different research designs and analyses. Equipped with such knowledge, the radiologic community can ensure that both research and clinical practice in our discipline excels, and that those questions that will be the most critical to answer will be formulated for successful investigation in the years to come...

Imaging plays a crucial role in the immediate evaluation of the trauma patient, particularly using multi-detector computed tomography (CT), and especially in moderately to severely injured trauma patients. There are specific areas of relative consensus, while other aspects of whole-body computed tomography (WB-CT) use remain controversial and are subject to opinion/debate based on the current literature. Even a few hours of a delayed diagnosis may result in a detrimental outcome for the patient. One must utilize all the tools available to enhance the interpretation of images...

Intravenous contrast-enhanced ultrasound (CEUS) is a rapidly evolving imaging technique that uses a microbubble contrast agent to enhance ultrasonographic images by augmenting characterization of blood vessels and organ perfusion. CEUS is considered as a useful problem-solving tool and as an indicated first-line imaging modality in select settings. CEUS technique has an inherent advantage over its predecessor B-mode and Doppler imaging. This article reviews different approved and off-label use of CEUS in the pediatric and adult population and also discusses Food and Drug Administration-approved contrast agents in the United States, their reported side effects, and ongoing efforts in the field...

CT and MR enterography are cross-sectional imaging examinations used in the assessment of inflammatory bowel disease. Consistent reporting and standardized nomenclature are important for clear communication with referring clinicians. Enterography has not only been used to depict inflammation in the small bowel, but it has also been used to quantify disease activity, assess distribution of disease, and detect complications including penetrating disease. This article reviews cross-sectional imaging findings in inflammatory bowel disease, including the current literature focusing on small bowel Crohn's disease and ulcerative colitis, with evidence-based guidelines on appropriate protocols and imaging procedures...

Hepatocellular carcinoma (HCC) is a leading cause of cancer-related deaths worldwide. Early detection of HCC is a key factor in enabling curative therapies and improving overall survival. Worldwide, several guidelines are available for surveillance of at-risk populations and diagnosis of HCC. This article provides a current comprehensive update on screening and diagnosis of HCC.

Lower extremity deep venous thrombosis (DVT) is estimated to occur in 1 in 1000 persons annually in adult populations, with prevalence predicted to double by the year 2050. While acute DVT and pulmonary embolism are a major cause of cardiovascular morbidity and mortality, the long-term prognosis for patients with venous thromboembolism is in part determined by the development of post-thrombotic syndrome (PTS), which occurs in up to 50% of patients. PTS refers to a chronic syndrome complex, invariably characterized by intractable edema, pain, stasis dermatitis, and venous stasis ulceration when severe...

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Imaging plays a key role in the management of rheumatological pathologies, also as guidance for diagnostic and therapeutic interventional procedures, as it can provide better accuracy and safety compared to palpation-guided interventions. Inflammatory and degenerative conditions nonresponsive to systemic treatment may benefit from intra-articular and periarticular administration of drugs, with therapeutic and symptomatic actions or providing a bridge for surgery. Desired effects include reduction of inflammation and pain and improvement of physical function of patients...

High-resolution peripheral quantitative computed tomography (HR-pQCT) provides a new opportunity for the noninvasive measurement of bone microarchitecture in patient research of rheumatic disease in joints of the extremities. Rheumatoid arthritis of the hand and osteoarthritis of the knee are highly prevalent and there are no cures, so an improved understanding of the etiology of these diseases, particularly when combining HR-pQCT with other imaging modalities, is important to develop new disease management strategies...

MRI, ultrasound, and conventional radiography each play distinct roles in the evaluation of juvenile idiopathic arthritis (JIA), with MRI being the preferred imaging modality of choice for assessing both inflammatory and destructive changes. These various imaging modalities provide valuable insights into JIA in pediatric patients. However, challenges persist in terms of achieving precision, ensuring validity, and distinguishing between pathologic findings and normal anatomic variations. Establishing normal reference values and implementing scoring systems can aid in the precise evaluation of disease activity and provide information to assist treatment decisions for children with JIA...

This article highlights the crucial role of various imaging techniques in the diagnosis and monitoring of rheumatologic diseases. It provides an overview of the different modalities available for imaging rheumatic diseases, the disease processes they are able to demonstrate, and their utility in the monitoring response to therapy. It emphasizes the need for a multifaceted approach that combines radiography, ultrasound, MR imaging, and PET imaging to gain a comprehensive understanding of disease progression and treatment response...

This review focuses on the most frequent whole-body MRI applications in patients with rheumatological pathologies, for which this tool can be helpful to both radiologists and clinicians. It reports technical aspects of the acquisition of both 1.5 and 3.0 T scanners. The article lists the main findings that help radiologists during the evaluation of a specific pathology, both in the diagnostic phase and during follow-up.

Dual-energy computed tomography (DECT) has emerged as a transformative tool in the past decade. Initially employed in gout within the field of rheumatology to distinguish and quantify monosodium urate crystals through its dual-material discrimination capability, DECT has since broadened its clinical applications. It now encompasses various rheumatic diseases, employing advanced techniques such as bone marrow edema assessment, iodine mapping, and collagen-specific imaging. This review article aims to examine the unique characteristics of DECT, discuss its strengths and limitations, illustrate its applications for accurately evaluating various rheumatic diseases in clinical practice, and propose future directions for DECT in rheumatology...