Faculty Bibliography

Objectives: To differentiate pulmonary tumor type by volumetric iodine quantification and texture analysis on dual-energy CT images.
Material(s) and Method(s): Radiology information system search for all contrast-enhanced DECT chest examinations from 1/1/2015-4/30/ 2018 was performed, filtering for those with pathology within 120 days, yielding 80 cases of pathologically-proven pulmonary lesions. 73 lesions meeting inclusion criteria were manually volumetrically segmented via open-source software using the low-kV DECT dataset. 3D-iodine quantification was achieved by mapping between high/low energy HU on a representative 2D-image, and applying to surrounding slices, with absolute iodine normalized to mid-descending aorta. Full Width Tenth Maximum was applied to each normalized iodine histogram, providing a single comprehensive measure of relative iodine concentration. Volumetric iodine values and first order texture features were assessed using Hoteling's T-squared multivariate analysis.
Result(s): 72 individuals (37 women, 35 men) with mean age 64 years were included. 44 primary, 25 metastatic, and 3 benign lesions were assessed; 22 with history of chemotherapy. Mean time between histopathologic sampling and imaging was 26 days. Mean, median and minimum volumetric iodine concentration were significant (P< 0.05) in distinguishing primary versus metastatic lesions, with P<0.01 for these measures between de novo primary and metastatic lesions. Metastatic lesions demonstrated higher mean iodine (1.2 mg/mL) in comparison to primary lesions (0.83 mg/mL). Mean and median 3D-iodine values significantly (P<0.05) differed between primary lung adenocarcinoma and squamous lesions (mean 0.95 mg/mL and 0.49 mg/mL, respectively). Skewness significantly differed between de novo versus treated primary (P=0.01), and metastatic versus primary lesions (P=0.03), and entropy between de novo primary and metastatic lesions (P<0.001), and treated versus non-treated metastases (P= 0.03).
Conclusion(s): Volumetric iodine quantification significantly differs between de novo primary versus metastatic, and primary lung adenocarcinoma versus squamous lesions. Texture features may also have a role in distinguishing tumor type and treatment response. Clinical Relevance Application: Potential role of DECT in distinguishing tumor type and treatment response

Background: Subsolid nodules account for 20% of lesions detected on CT lung cancer screening, and many are incidentally detected on routine CT exams. Persistent subsolid nodules may correlate with adenocarcinoma spectrum, though commonly are due to other etiologies, emphasizing the importance of accurate nodule characterization and management recommendations. This review will used a case-based approach to showcase how lesion description and management may differ from that of solid nodules, including application of Fleischner guidelines and discussion of management options. Educational Goals/Teaching Points: * Highlight technical pitfalls in evaluation of subsolid nodules * Highlight interpretive pitfalls in evaluation of subsolid nodules * Review differential considerations including adenocarcinoma spectrum: AAH, AIS, MIA, Invasive adenocarcinoma * Describe differential considerations beyond the adenocarcinoma spectrum, such as: * Neoplastic: lymphoma, metastatic disease, treatment response * Infectious/Inflammatory: organizing pneumonia, eosinophilic pneumonia, alveolar sarcoid, various infection, drug reaction * Adapt management guidelines to diverse clinical scenarios: age, multiplicity, baseline versus follow-up, incidental versus screening * Explain treatment options for subsolid adenocarcinoma lesions including emerging technology such as cryoablation
Conclusion(s): Subsolid nodules are commonly encountered clinically, with accurate interpretation based on avoiding technical pitfalls and providing relevant descriptors to differentiate actionable findings. Management guidelines and further steps must take into account nodule features, clinical risk factors, and patient specific considerations

Background: Anterior mediastinal lesions may be radiographically challenging to diagnose. Helpful imaging findings for the radiologist and pathologist, and relevant reporting information for the clinician will be reviewed. * Educational Goals/Teaching Points: Review multimodality imaging of thymic lesions with histopathologic correlation * Thymic hyperplasia * Thymic cyst * Thymolipoma * Staging of thymic carcinoma * Highlight distinguishing features between common anterior mediastinal lesions * Lymphoma * Germ Cell tumor * Thyroid * Present atypical anterior mediastinal lesions * Ectopic Parathyroid * Lymphangioma * Lipoma and Lipomatosis * Sarcoma * Nodal mesothelioma
Conclusion(s): Pathologists and radiologists often work in tandem to arrive at a unifying diagnosis, and understanding the radiopathologic correlation of anterior mediastinal lesions will serve to improve diagnosis and reporting

Diseases that are predominantly peribronchovascular in distribution on computed tomography by definition involve the bronchi, adjacent vasculature, and associated lymphatics involving the central or axial lung interstitium. An understanding of diseases that can present with focal peribronchovascular findings is useful for establishing diagnoses and guiding patient management. This review will cover clinical and imaging features that may assist in differentiating amongst the various causes of primarily peribronchovascular disease.

Pyrite FeS₂ has long been considered a potential earth-abundant low-cost photovoltaic material for thin-film solar cells but has been plagued by low power conversion efficiencies and open-circuit voltages. Recent efforts have identified a lack of understanding and control of doping, as well as uncontrolled surface conduction, as key roadblocks to the development of pyrite photovoltaics. In particular, while n-type bulk behavior in unintentionally doped single crystals and thin films is speculated to arise from sulfur vacancies (V_S), proof remains elusive. Here, we provide strong evidence, from extensive electronic transport measurements on high-quality crystals, that V_S are deep donors in bulk pyrite. Otherwise identical crystals grown via chemical vapor transport under varied S vapor pressures are thoroughly characterized structurally and chemically, and shown to exhibit systematically different electronic transport. Decreased S vapor pressure during growth leads to reduced bulk resistivity, increased bulk Hall electron density, reduced transport activation energy, onset of positive temperature coefficient of resistivity, and approach to an insulator-metal transition, all as would be expected from increased V_S donor density. Impurity analyses show that these trends are uncorrelated with metal impurity concentration and that extracted donor densities significantly exceed total impurity concentrations, directly evidencing a native defect. Well-controlled, wide-range n-doping of pyrite is thus achieved via the control of V_S concentration, with substantial implications for photovoltaic and other applications. The location of the V_S state within the gap, the influence of specific impurities, unusual aspects to the insulator-metal transition, and the influence of doping on surface conduction are also discussed.

BACKGROUND:Computed tomography (CT) and spirometry are the current standard methods for assessing lung anatomy and pulmonary ventilation, respectively. However, CT provides limited ventilation information and spirometry only provides global measures of lung ventilation. Thus, a method that can enable simultaneous examination of lung anatomy and ventilation is of clinical interest. PURPOSE/OBJECTIVE:To develop and test a 4D respiratory-resolved sparse lung MRI (XD-UTE: eXtra-Dimensional Ultrashort TE imaging) approach for simultaneous evaluation of lung anatomy and pulmonary ventilation. STUDY TYPE/METHODS:Prospective. POPULATION/METHODS:In all, 23 subjects (11 volunteers and 12 patients, mean age = 63.6 ± 8.4). FIELD STRENGTH/SEQUENCE/UNASSIGNED:3T MR; a prototype 3D golden-angle radial UTE sequence, a Cartesian breath-hold volumetric-interpolated examination (BH-VIBE) sequence. ASSESSMENT/RESULTS:All subjects were scanned using the 3D golden-angle radial UTE sequence during normal breathing. Ten subjects underwent an additional scan during alternating normal and deep breathing. Respiratory-motion-resolved sparse reconstruction was performed for all the acquired data to generate dynamic normal-breathing or deep-breathing image series. For comparison, BH-VIBE was performed in 12 subjects. Lung images were visually scored by three experienced chest radiologists and were analyzed by two observers who segmented the left and right lung to derive ventilation parameters in comparison with spirometry. STATISTICAL TESTS/UNASSIGNED:Nonparametric paired two-tailed Wilcoxon signed-rank test; intraclass correlation coefficient, Pearson correlation coefficient. RESULTS:XD-UTE achieved significantly improved image quality compared both with Cartesian BH-VIBE and radial reconstruction without motion compensation (P < 0.05). The global ventilation parameters (a sum of the left and right lung measures) were in good correlation with spirometry in the same subjects (correlation coefficient = 0.724). There were excellent correlations between the results obtained by two observers (intraclass correlation coefficient ranged from 0.8855-0.9995). DATA CONCLUSION/UNASSIGNED:Simultaneous evaluation of lung anatomy and ventilation using XD-UTE is demonstrated, which have shown good potential for improved diagnosis and management of patients with heterogeneous lung diseases. LEVEL OF EVIDENCE/METHODS:2 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2018.

Radiologists are facing increasing workplace pressures that can lead to decreased job satisfaction and burnout. The increasing complexity and volumes of cases and increasing numbers of noninterpretive tasks, compounded by decreasing reimbursements and visibility in this digital age, have created a critical need to develop innovations that optimize workflow, increase radiologist engagement, and enhance patient care. During their workday, radiologists often must navigate through multiple software programs, including picture archiving and communication systems, electronic health records, and dictation software. Furthermore, additional noninterpretive duties can interrupt image review. Fragmented data and frequent task switching can create frustration and potentially affect patient care. Despite the current successful technological advancements across industries, radiology software systems often remain nonintegrated and not leveraged to their full potential. Each step of the imaging process can be enhanced with use of information technology (IT). Successful implementation of IT innovations requires a collaborative team of radiologists, IT professionals, and software programmers to develop customized solutions. This article includes a discussion of how IT tools are used to improve many steps of the imaging process, including examination protocoling, image interpretation, reporting, communication, and radiologist feedback. ^©RSNA, 2018.

OBJECTIVES AND RATIONALE/UNASSIGNED:Radiology-pathology correlation is time-consuming and is not feasible in most clinical settings, with the notable exception of breast imaging. The purpose of this study was to determine if an automated radiology-pathology report pairing system could accurately match radiology and pathology reports, thus creating a feedback loop allowing for more frequent and timely radiology-pathology correlation. METHODS:An experienced radiologist created a matching matrix of radiology and pathology reports. These matching rules were then exported to a novel comprehensive radiology-pathology module. All distinct radiology-pathology pairings at our institution from January 1, 2016 to July 1, 2016 were included (n = 8999). The appropriateness of each radiology-pathology report pairing was scored as either "correlative" or "non-correlative." Pathology reports relating to anatomy imaged in the specific imaging study were deemed correlative, whereas pathology reports describing anatomy not imaged with the particular study were denoted non-correlative. RESULTS:Overall, there was 88.3% correlation (accuracy) of the radiology and pathology reports (n = 8999). Subset analysis demonstrated that computed tomography (CT) abdomen/pelvis, CT head/neck/face, CT chest, musculoskeletal CT (excluding spine), mammography, magnetic resonance imaging (MRI) abdomen/pelvis, MRI brain, musculoskeletal MRI (excluding spine), breast MRI, positron emission tomography (PET), breast ultrasound, and head/neck ultrasound all demonstrated greater than 91% correlation. When further stratified by imaging modality, CT, MRI, mammography, and PET demonstrated excellent correlation (greater than 96.3%). Ultrasound and non-PET nuclear medicine studies demonstrated poorer correlation (80%). CONCLUSION/CONCLUSIONS:There is excellent correlation of radiology imaging reports and appropriate pathology reports when matched by organ system. Rapid, appropriate radiology-pathology report pairings provide an excellent opportunity to close feedback loop to the interpreting radiologist.

RATIONALE AND OBJECTIVES: Correlation of imaging studies and reference standard outcomes is a significant challenge in radiology. This study evaluates the effectiveness of a new communication tool by assessing the ability of this system to correctly match the imaging studies to arthroscopy reports and qualitatively assessing radiologist behavior before and after the implementation of this system. MATERIALS AND METHODS: Using a commercially available communication or educational tool and applying a novel matching rule algorithm, radiology and arthroscopy reports were matched from January 17, 2017 to March 1, 2017 based on anatomy. The interpreting radiologist was presented with email notifications containing the impression of the imaging report and the entire arthroscopy report. Total correlation rate of appropriate report pairings, modality-specific correlation rate, and the anatomy-specific correlation rate were calculated. Radiologists using the system were given a survey. RESULTS: Overall correlation rate for all musculoskeletal imaging was 83.1% (433 or 508). Low correlation was found in fluoroscopic procedures at 74.4%, and the highest correlation was found with ultrasound at 88.4%. Anatomic location varied from 51.6% for spine to 98.8% for hips and pelvis studies. Survey results revealed 87.5% of the respondents reporting being either satisfied or very satisfied with the new communication tool. The survey also revealed that some radiologists reviewed more cases than before. CONCLUSIONS: Matching of radiology and arthroscopy reports by anatomy allows for excellent report correlation (83.1%). Automated correlation improves the quality and efficiency of feedback to radiologists, providing important opportunities for learning and improved accuracy.