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Background Lumbar spine MRI studies are widely used for back pain assessment. Interpretation involves grading lumbar spinal stenosis, which is repetitive and time consuming. Deep learning (DL) could provide faster and more consistent interpretation. Purpose To assess the speed and interobserver agreement of radiologists for reporting lumbar spinal stenosis with and without DL assistance. Materials and Methods In this retrospective study, a DL model designed to assist radiologists in the interpretation of spinal canal, lateral recess, and neural foraminal stenoses on lumbar spine MRI scans was used. Randomly selected lumbar spine MRI studies obtained in patients with back pain who were 18 years and older over a 3-year period, from September 2015 to September 2018, were included in an internal test data set. Studies with instrumentation and scoliosis were excluded. Eight radiologists, each with 2-13 years of experience in spine MRI interpretation, reviewed studies with and without DL model assistance with a 1-month washout period. Time to diagnosis (in seconds) and interobserver agreement (using Gwet κ) were assessed for stenosis grading for each radiologist with and without the DL model and compared with test data set labels provided by an external musculoskeletal radiologist (with 32 years of experience) as the reference standard. Results Overall, 444 images in 25 patients (mean age, 51 years ± 20 [SD]; 14 women) were evaluated in a test data set. DL-assisted radiologists had a reduced interpretation time per spine MRI study, from a mean of 124-274 seconds (SD, 25-88 seconds) to 47-71 seconds (SD, 24-29 seconds) (

Objective To evaluate the impact of pre-operative contrast-enhanced mammography (CEM) in breast cancer patients with dense breasts. Methods We conducted a retrospective review of 232 histologically proven breast cancers in 200 women (mean age: 53.4 years ± 10.2) who underwent pre-surgical CEM imaging across two Asian institutions (Singapore and Taiwan). Majority (95.5%) of patients had dense breast tissue (BI-RADS category C or D). Surgical decision was recorded in a simulated blinded multi-disciplinary team setting on two separate scenarios: (i) pre-CEM setting with standard imaging, and clinical and histopathological results; and (ii) post-CEM setting with new imaging and corresponding histological findings from CEM. Alterations in surgical plan (if any) because of CEM imaging were recorded. Predictors CEM of patients who benefitted from surgical plan alterations were evaluated using logistic regression. Results CEM resulted in altered surgical plans in 36 (18%) of 200 patients in this study. CEM discovered clinically significant larger tumor size or extent in 24 (12%) patients and additional tumors in 12 (6%) patients. CEM also detected additional benign/false-positive lesions in 13 (6.5%) of the 200 patients. Significant predictors of patients who benefitted from surgical alterations found on multivariate analysis were pre-CEM surgical decision for upfront breast conservation (OR, 7.7; 95% CI, 1.9-32.1; p = 0.005), architectural distortion on mammograms (OR, 7.6; 95% CI, 1.3–42.9; p = .022), and tumor size of ≥ 1.5 cm (OR, 1.5; 95% CI, 1.0-2.2; p = .034). Conclusion CEM is an effective imaging technique for pre-surgical planning for Asian breast cancer patients with dense breasts. Key Points • CEM significantly altered surgical plans in 18% (nearly 1 in 5) of this Asian study cohort with dense breasts. • Significant patient and imaging predictors for surgical plan alteration include (i) patients considered for upfront breast-conserving surgery; (ii) architectural distortion lesions; and (iii) tumor size of ≥ 1.5 cm. • Additional false-positive/benign lesions detected through CEM were uncommon, affecting only 6.5% of the study cohort.

Introduction: Computed tomography angiography of the aorta (CTAA) is the modality of choice for investigating aortic disease. Our aim was to evaluate image quality, contrast enhancement and radiation dose of electrocardiograph (ECG)-triggered and non-ECG-triggered CTAA on a 256-slice single source CT scanner. Knowledge of these will allow requesting clinician and radiologist to balance radiation risk and image quality. Methods: We retrospectively assessed data from 126 patients who had undergone CTAA on a single-source CT scanner using ECG-triggered (group 1, n = 77) or non-ECG-triggered (group 2, n =49) protocols. Radiation doses were compared. Qualitative (4-point scale) and quantitative image quality assessments were performed. Results: The mean volume CT dose index, dose length product and effective dose in group 1 were 12.4 ± 1.9 mGy, 765.8 ± 112.4 mGy x cm and 13.0 ± 1.9 mSv, respectively. These were significantly higher compared with group 2 (9.1 ± 2.6 mGy, 624.1 ± 174.8 mGy x cm and 10.6 ± 3.0 mSv, respectively) ( p < 0.001). Qualitative assessment showed image quality at the aortic root-proximal ascending aorta was significantly higher in group 1 (median = 3) than in group 2 (median = 2, p < 0.001). Quantitative assessment showed significantly better mean arterial attenuation, signal-to-noise ratio and contrast-to-noise ratio in ECG-triggered CTAA compared with non-ECG-triggered CTAA. Conclusion: ECG-triggered CTAA in a single-source scanner has superior image quality and vessel attenuation of aortic root/ascending aorta but a higher radiation dose of approximately 23%. Its use should be considered specifically when assessing aortic root/ascending aorta pathology.

A prospective radiographic comparative study.The aim of this study was to compare full-body EOS with conventional chest X-ray (CXR) for use in the preoperative evaluation of the chest in patients undergoing spine operations.The full-body EOS reproduces an image of the chest similar to a routine CXR. The potential for the former replacing the latter is plausible. This is especially applicable in spine patients who would routinely have a preoperative full-body EOS performed.A radiographic comparative study of 266 patients was conducted at a single tertiary center from January 2013 to July 2016. Each patient had EOS and CXR done in random order2 weeks apart. Two radiologists reported the image findings using a checklist. A third radiologist was consulted in cases of discrepancy. Interobserver agreement was calculated using Gwet AC1 and a comparison between EOS and CXR findings was analyzed using paired Chi-squared test. Multivariate analysis was performed to identify predictors for abnormal radiological findings. The institutional ethics committee approved this prospective study and waiver of informed consent was obtained.There were 84 males (31.6%) and 182 females (68.4%). The mean age was 38.9 years (SD = 25.0 years). High interobserver agreement was found for EOS and CXR (Gwet AC1 0.993 and 0.988, respectively). There were no significant differences between both imaging modalities. Rare diagnoses precluded comparison of certain conditions. Age18 years [odds ratio (OR) 7.69; P = 0.009] and American Society of Anesthesiologists physical status 3 (OR 6.64; P = 0.018) were independent predictors of abnormal radiological findings.EOS is not inferior to, and may be used to replace CXR in preoperative radiological screening of thoracic conditions especially in low-risk patients ≤18 years old and patients with ASA3. Preoperative assessment should never rely on a single modality. High-risk patients should be sent for a thorough work-up before spine surgery.4.

Intramural esophageal dissection is an uncommon condition, involving the separation of the esophageal mucosa from the muscular layers. To our knowledge, the temporal evolution of intramural esophageal dissection on computed tomography has not been previously demonstrated. We present a case of a 51-year-old male who first presented to the emergency department with fever, odynophagia, and dysphagia. He was treated for acute tonsillitis and discharged, but presented again after 10 days with worsening symptoms. A series of radiographs and computed tomography studies, with 3D reconstruction and cinematic virtual fly-through, in these 2 admissions depicts the temporal evolution of intramural hematoma to subsequent intramural esophageal dissection. Recognizing its appearance on imaging is invaluable in distinguishing it from other important differential diagnoses. A complete description of the case, relevant radiologic imaging, and review of the relevant literature are provided.