Faculty Bibliography

BACKGROUND:e-Cigarette or vaping-induced lung injury (EVALI) causes a spectrum of CT lung injury patterns. Relative frequencies and associations with vaping behavior are unknown. RESEARCH QUESTION:What are the frequencies of imaging findings and CT patterns in EVALI and what is the relationship to vaping behavior? STUDY DESIGN AND METHODS:test, and multivariable analyses were used for statistical analysis. RESULTS:A total of 160 patients (79.4% men) with a mean age of 28.2 years (range, 15-68 years) with EVALI underwent CT scan. Seventy-seven (48.1%), 15 (9.4%), and 68 (42.5%) patients admitted to vaping THC, nicotine, or both, respectively. Common findings included diffuse or lower lobe GGO with subpleural (78.1%), lobular (59.4%), or peribronchovascular (PBV) sparing (40%). Septal thickening (50.6%), lymphadenopathy (63.1%), and CNs (36.3%) were common. PBV sparing was associated with younger age (P = .02). Of 160 subjects, 156 (97.5%) had one of six defined patterns. Parenchymal, airway-centered, and mixed OP patterns were seen in 89 (55.6%), 14 (8.8%), and 32 (20%) patients, respectively. Acute eosinophilic-like pneumonia (six of 160, 3.8%), DAD (nine of 160, 5.6%), pulmonary hemorrhage (six of 160, 3.8%), and atypical (four of 160, 2.5%) patterns were less common. Increased vaping frequency was associated with more severe injury (P = .008). Multivariable analysis showed a negative association between vaping for > 6 months and DAD pattern (P = .03). Two subjects (1.25%) with DAD pattern died. There was no relation between pattern and injury severity, geographic location, and state legality of recreational use of THC. INTERPRETATION:EVALI typically causes an OP pattern but exists on a spectrum of acute lung injury. Vaping habits do not correlate with CT patterns except for negative correlation between vaping > 6 months and DAD pattern. PBV sparing, not previously described in acute lung injury, is a common finding.

RATIONALE AND OBJECTIVES/OBJECTIVE:The Association of Program Directors in Radiology (APDR) surveys its membership annually on hot topics and new developments in radiology residency training. Here we report the results of that annual survey. MATERIALS AND METHODS/METHODS:A web-based survey was posed to the APDR membership in the Fall of 2018. Members were asked 43 questions on program staffing, resident education resources/funding, impact of the integrated-Interventional Radiology residency program on Diagnostic Radiology program resources, resident interest in imaging informatics, Accreditation Council for Graduate Medical Education requirements on resident practice habits data reporting, institutional reliance on residents for clinical coverage, teaching format in the post-oral board era, resident conference attendance, confidentiality of the Match rank list, Early Specialization in Interventional Radiology pathway recruitment and selection, Diagnostic Radiology and Interventional Radiology program relationships, independent resident call, pediatric radiology training, diversity and unconscious bias training, and social media in radiology education. RESULTS:Responses were collected electronically, results were tallied using Qualtrics software, and qualitative responses were tabulated or summarized as comments. There were 86 respondents with a response rate of 31.3%. CONCLUSION/CONCLUSIONS:Survey result highlights include perceived resident interest in imaging informatics with the vast majority of residency programs offering an informatics curriculum; the provision of resident practice habits data by nearly all residency programs despite lack of clarity surrounding this Accreditation Council for Graduate Medical Education requirement; continued use of case-taking in the post-oral boards era; frequent disclosure of the Match rank list to departmental and hospital administration; low penetration of unconscious bias training in academic radiology; and finally, the successful integration of interventional and diagnostic radiology training programs.

OBJECTIVE:To evaluate quantitative chest computed tomography (CT) methods for the detection of air trapping (AT) and to assess its diagnostic performance for the diagnosis of bronchiolitis obliterans syndrome (BOS) in single lung transplant (SLT) patients. METHODS:Adult patients who had a SLT at a single transplant center and underwent CT scan after transplantation were retrospectively included. CT findings of air trapping were measured by three different methods: expiratory air-trapping index (ATIexp), mean lung density on expiratory acquisition (MLDexp) and expiratory to inspiratory ratio of mean lung density (E/I-ratio(MLD). Sensitivity, specificity and diagnostic accuracy of the three methods for the detection of BOS status evaluated by serial routine measures of pulmonary function tests (gold standard) were assessed. RESULTS:Forty-six SLT patients (52.2% females, mean age 58 ± 6 years) were included in the analysis, 12 (26%) patients with a diagnosis of BOS. Quantitative CT diagnosis of AT ranged from 26 to 35%. Sensitivity, specificity and accuracy of each method for the detection of BOS were 85.7%, 84.7% and 85.0% for ATIexp, 78.5%, 93.4% and 90.0% for MLD and 64.2%, 89.1% and 83.3% E/I-ratio(MLD), respectively. CONCLUSION:Quantitative measures of AT obtained from standard CT are feasible and show high specificity and accuracy for the detection of BOS in SLT patients.

Lymphangitic carcinomatosis, the presence of tumor within the pulmonary lymphatics, occurs in the setting of malignant tumors and is associated with a poor prognosis. Here we describe a case of lymphangitic carcinomatosis in the setting of renal cell carcinoma and review the radiological manifestations of this disease.