Faculty Bibliography

OBJECTIVE:The purpose of our study was to prospectively determine the incidence and nature of unblinding by authors as to their identities or institutions in their submission of original major manuscripts to two radiology journals with double-blinded peer review policies. MATERIALS AND METHODS/METHODS:The editors of two radiology journals reviewed 880 major original manuscripts submitted to their journals during a 6-month period without knowledge of the identities and institutions of the authors. Each manuscript was inventoried for possible author or institutional unblinding and for the specific types of unblinding violations. RESULTS:Of 880 manuscripts, 300 (34%) contained information that potentially unblinded the identities of the authors, their institutions, or both. The editors correctly identified the authors or institutions in 221 (74%) of the 300 manuscripts, which represented 25% of the total manuscripts. The most frequent unblinding violations were statement of the authors' initials within the manuscript, referencing work "in press," identifying references as the authors' previous work, and revealing the identity of the institution in the figures. CONCLUSION/CONCLUSIONS:Despite explicit instructions to authors, 34% of 880 prospectively evaluated manuscripts submitted to two radiology journals contained information that potentially or definitely unblinded the identities of the authors or their institutions.

The CT findings of a congenital portacaval shunt are presented, and the literature on this unusual anomaly is reviewed.

RATIONALE AND OBJECTIVES: The purpose of this study was to determine whether a simple rapid blood test can obviate computed tomography (CT) in a sizable percentage of patients suspected of having pulmonary embolism, based on the hypothesis that negative D-dimer results could eliminate any further search for pulmonary embolism. MATERIALS AND METHODS: At the authors' institution, 2,121 sequential patients underwent a whole-blood antibody agglutination test for cross-linked fibrin degradation products (D-dimer). Of these patients, 844 had positive test results and were not further considered. A retrospective review included reports of all multisection combined CT venographic and pulmonary angiographic studies obtained within 48 hours of the D-dimer assay for the 1,277 patients with negative D-dimer results; 229 (18%) of these 1,277 patients underwent combined CT venography and pulmonary angiography, usually within 24 hours. RESULTS: Retrospective review of the imaging examinations that were discrepant with the D-dimer results revealed only three false-negative D-dimer results. Of the 229 patients in whom combined CT venography and pulmonary angiography was performed for suspected pulmonary embolism, 226 (98.7%) had no evidence of acute pulmonary embolism or deep venous thrombosis. The negative predictive value of a negative D-dimer result was therefore 98.7% (confidence interval, 96.2%-99.7%). CONCLUSION: The D-dimer assay is a simple rapid blood test that is sensitive to the presence of acute thrombosis. Very few patients with negative results have acute deep venous thrombosis or pulmonary embolism, with combined CT venography and pulmonary angiography used as the reference standard.

OBJECTIVES: To determine the utility of hematuria testing in a large series of patients with suspected renal colic using unenhanced helical computed tomography (CT) as the reference standard. METHODS: A retrospective review of the CT reports of all patients who underwent unenhanced helical CT for suspected renal colic at one institution during a 3.5-year period and who also underwent a formal microscopic urinalysis within 24 hours of the CT study was conducted. The sensitivity, specificity, positive predictive value, and negative predictive value of the presence of any blood on the urinalysis for renal colic were calculated. RESULTS: Urolithiasis was present in 587 (62%) of the 950 patients, and 363 patients had negative examinations for renal colic, including 69 with significant alternative diagnoses in the latter group. Of the urinalyses, 492 were true-positive, 174 were true-negative, 189 were false-positive, and 95 were false-negative, yielding a sensitivity, specificity, positive predictive value, and negative predictive value of 84%, 48%, 72%, and 65%, respectively. Forty-six percent of the urinalysis results were negative for blood in the subset of patients with significant alternative diagnoses. CONCLUSIONS: The sensitivity of hematuria on microscopic urinalysis for renal colic using unenhanced CT as the reference standard was 84%, and the specificity and negative predictive value was low. The presence or absence of blood on urinalysis cannot be used to reliably determine which patients actually have ureteral stones

Calcification is very rarely reported in untreated thoracic lymphoma. However, calcification can occur (although uncommonly) in lymphoma following chemotherapy or radiation, and in areas of scaring or fibrous healing. The authors describe the case of a pregnant woman with a large mediastinal mass that contained calcifications visible on both chest radiography and thoracic computed tomography, which proved to be Hodgkin's lymphoma.