Faculty Bibliography

BACKGROUND AND PURPOSE/OBJECTIVE:Although visibility of Deep Medullary Veins (DMVs) has been suggested as an imaging biomarker for cerebral small vessel disease (CSVD) and brain atrophy, qualitative visual assessment of DMVs may lack reliability. In this study, we used a rigorous, automated approach to segment DMVs on SWI and to estimate a vein voxel fraction (VVF). We hypothesized that VVF would be associated with vascular risk factors, imaging markers of CSVD, and brain volumes. MATERIAL AND METHODS/METHODS:A retrospective analysis of data from participants enrolled in studies of brain aging and prediction of Alzheimer's disease. All underwent 3T MRI (T1WI, FLAIR, SWI, and arterial spin labeling), clinical evaluations, and laboratory tests to assess vascular risks. A SWI image processing pipeline included denoising, bias field correction, adaptive histogram equalization, and multi-scale Jerman filtering that yielded vesselness maps. The vein voxel fraction (VVF) was calculated as a ratio of DMVs voxels in a periventricular region to the volume of the periventricular region. White matter hyperintensities, microbleeds, brain volumes, and CBF were also assessed. RESULTS:This study included 131 cognitively healthy participants, 71 (65, 76) years (median, Q1, Q3), (51%) female, and a subgroup of subjects with cognitive impairment (n=30, 69 (59, 76) years, 43% female). In the unimpaired group, the VVF positively correlated with systolic blood pressure and body mass index. It showed an inverse association with lateral ventricle volume (all at p < 0.05). It was related to white matter hyperintensities volume only in unadjusted analysis. CONCLUSION/CONCLUSIONS:Vein voxel fraction was associated with increased weight and high blood pressure. Possibly, these observations reflect venous stasis. These factors should be accounted for while evaluating brain venous system with SWI. In addition, subcortical atrophy was related to less visible DMVs.

Radiology is undergoing a global transformation across its workforce, workplace, and workflows. Imaging demand and examination complexity continue to increase, while workforce growth has lagged. Although these challenges are global, they manifest differently across regions and practice settings. Workforce shortages, burnout, and a weakening academic mission with less emphasis on research and teaching are systemic problems. In response to growing workloads, digital technologies, including artificial intelligence, have been introduced to increase capacity. Although these tools have the potential to improve efficiency, quality, and education, their effect on radiologist productivity has been mixed. Practice models such as teleradiology and hybrid work offer more flexibility for radiologists and have improved access to imaging services, especially in rural and underserved regions. However, remote work can lead to isolation, as well as lack of collaboration and exchange of ideas, which may contribute to burnout. In addition, declining reimbursement, rising costs, and growing unreimbursed noninterpretive tasks put a strain on the radiology workforce. This review from the International Society for Strategic Studies in Radiology (IS3R) examines international experiences on the challenges affecting the global workforce capacity, imaging demand, workplace, work design, and the work environment for radiology, and offers potential solutions.

BACKGROUND AND OBJECTIVES/OBJECTIVE:Intradural extramedullary spinal tumors (IDEMs) are ideally managed with gross total resection (GTR) for optimal local disease control in the absence of established adjuvant regimens. In this retrospective cohort study, we investigated the utility of morphology-based analysis of optimal IDEM resection quality compared with current linear measurement benchmarks. METHODS:Tumors were manually segmented from preoperative contrast-enhanced MRI. Morphological features of sphericity, elongation, and volume were extracted from masks, along with manual anteroposterior, craniocaudal, and transverse linear measurements. Optimal resection was defined as Simpson Grade 1 or 2 for meningiomas or en bloc GTR for myxopapillary ependymomas (MPEs) and was predicted for dorsal and ventral spinal meningiomas plus conus and nonconus MPEs. RESULTS:We identified 103 tumors, including 71 meningiomas and 32 MPEs. Linear measurement did not reliably predict optimal resection across anatomic subtypes of meningiomas or MPEs (all P > .05). Instead, optimal resection was determined by higher sphericity across meningiomas and, specifically, dorsal meningiomas (optimal resection median 0.80 (IQR: 0.77-0.82) vs suboptimal 0.76 (0.72-0.77), P = .027). Shape features were not predictive in ventral meningiomas. En bloc GTR was limited to nonconus MPEs, in which sphericity again emerged as a predictor (0.74 (0.69-0.77) for en bloc vs 0.68 (0.64-0.72) for piecemeal, P = .047), likely reflecting resectability for encapsulated tumors. After excluding patients with <1 year of surveillance to determine nonrecurrence, 62 patients without genetic syndromes remained for recurrence analysis with a median follow-up of 36.1 months. Optimal resection was associated with significantly lower recurrence (optimal 8.6% vs suboptimal 29.6%, P = .045). This protective effect remained, although statistically insignificant after adjusting for adjuvant radiation and tumor grade (recurrence odds ratio = 0.22, 95% CI: 0.04-1.07, P = .077). CONCLUSION/CONCLUSIONS:IDEM tumor morphology is predictive of optimal resection for dorsal meningiomas and nonconus MPEs, whereas linear measurements offer less consistent predictive value. Morphological assessment is feasible with standard MRI and may be further automated.

OBJECTIVE:To evaluate whether there is an association between a maternal classification of Long COVID and adverse pregnancy outcomes. METHODS:RECOVER (Researching COVID to Enhance Recovery)-Adult is a multicenter prospective longitudinal cohort study of adults with and without prior severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection enrolled from October 2021 to January 2024. This analysis included participants with a SARS-CoV-2 infection and at least one symptom survey for classification of Long COVID status recorded before or during pregnancy. Participants were classified as either likely having Long COVID (LCRI [Long COVID Research Index] score of 11 or higher) or as having Long COVID-indeterminate (LCRI score 0-10), with comparisons made between groups. The primary outcome was preterm birth before 37 weeks of gestation. Secondary outcomes included hypertensive disorders of pregnancy, cesarean delivery, neonatal intensive care admission, and small-for-gestational-age birth weight (below the 10th percentile). Propensity score methods with full matching were used to balance differences in baseline characteristics in estimating an average treatment effect, with a sensitivity analysis estimating the average treatment effect among the treated. RESULTS:Among 603 participants, 118 (19.6%) were classified as likely having Long COVID before or during pregnancy. Participants classified as likely having Long COVID were more likely to have specific adverse social determinants of health (difficulty covering expenses and paying bills, food insecurity, missed care because of cost, medical discrimination) and had higher prepregnancy body mass index (BMI) than those who were classified as having Long COVID-indeterminate. In the primary average treatment effect analysis, there was no association between likely Long COVID and preterm delivery (adjusted outcome rate 8.1% exposed vs 9.6% unexposed, absolute risk reduction [ARR] 0.82, 95% CI, 0.36-1.90) or secondary outcomes. In average treatment effect among the treated sensitivity analyses, likely Long COVID was similarly not associated with preterm delivery (ARR 1.11, 95% CI, 0.60-2.06) but was associated with an increased risk of hypertensive disorders of pregnancy (adjusted outcome rate 39.0% exposed vs 25.9% unexposed, ARR 1.51, 95% CI, 1.12-2.03) but not with other secondary outcomes. CONCLUSION/CONCLUSIONS:A classification of likely Long COVID was not significantly associated with preterm birth or several other adverse pregnancy outcomes. However, the association with hypertensive disorders of pregnancy in the average treatment effect among the treated analysis highlights the need for further research.

BACKGROUND AND AIMS/OBJECTIVE:Absolute risk estimates of serious infections in inflammatory bowel disease (IBD) across therapies and concomitant corticosteroid treatment are limited. We aimed to assess serious infection risk in IBD patients receiving different therapies, with or without corticosteroids. METHODS:Using nationwide Swedish registers (2007-2024), we compared rates of serious infections in patients with IBD treated with different therapies versus matched population comparators (≤10 per patient), stratified by corticosteroid use. We also performed 1:1 propensity score (PS)-matching for direct comparison of infection risk in IBD with or without concomitant corticosteroids exposure across advanced therapies. Incidence rates and adjusted hazard ratios (aHRs) with 95% confidence intervals (CIs) were calculated. RESULTS:We identified 145,125 exposure periods in patients with IBD naïve to immunomodulators and advanced therapies, 82,675 to immunomodulators, and 90,181 to advanced therapies (TNF inhibitors with and without immunomodulator, anti-integrins, anti-interleukins, and JAK inhibitors). Across therapies, exposure periods with corticosteroids carried a higher risk of serious infections than periods without, both compared to the general population (incidence rate difference range=3.6-10.2/100 person-years; aHR range=4.52-15.86) and in PS-matched within therapy group comparisons (incidence rate difference range=3.9-8.5/100 person-years; aHR=1.82-3.60). Relative risk was highest in children and increased with cumulative corticosteroid dose. CONCLUSION/CONCLUSIONS:Patients with IBD receiving corticosteroids had significantly higher rates of serious infections compared with those not receiving corticosteroids across therapies, with rate differences across age groups and combinations of treatments. These data will inform infection risk assessment and consideration of individualized infection-prevention strategies.

Targeted and biologic therapies are increasingly being used for treatment of dermatological conditions. Certain agents are associated with cardiometabolic toxicities, including major adverse cardiovascular events and altered lipid profiles, necessitating baseline and on-treatment monitoring. Close cardiometabolic monitoring is needed throughout treatment with co-management by cardiology, endocrinology, rheumatology, oncology, and primary care for symptomatic or high-risk patients. Conversely, some therapies may reduce systemic inflammation and atherogenic factors, possibly conferring reduced risk of cardiometabolic events. Randomized, controlled trials in dermatological populations are needed to corroborate these observations. In part II of this two-part continuing medical education series, we describe cardiometabolic effects of targeted and biologic therapies, including immune checkpoint inhibitors, antitumor monoclonal antibodies, intravenous immunoglobulins, Janus kinase inhibitors, tumor necrosis factor inhibitors, interleukin inhibitors, and apremilast. In addition, we outline recent advances in pathophysiology and supplement with practical recommendations for baseline assessment and monitoring in dermatological patients.

BACKGROUND/UNASSIGNED:Lower extremity peripheral artery disease (PAD) is a major contributor to cardiovascular morbidity and mortality; however, the metabolic pathways underlying disease development and progression are poorly understood. METHODS/UNASSIGNED:We conducted a prospective cohort study of 3759 participants from the ARIC study (Atherosclerosis Risk in Communities; mean age, 53.5 years; 60% women; 62% Black participants) with untargeted metabolomic profiling at baseline (1987-1989). Incident PAD (458 cases) and its severe form with rest pain or tissue loss, critical limb ischemia (CLI; 135 cases), were identified through hospitalization codes over a median follow-up of 27 years. We used Cox regression with adjustment for traditional risk factors and accounted for multiple testing using a false discovery rate correction at a threshold of 0.05. Risk prediction improvement was evaluated using Harrell C statistics and the net reclassification improvement. RESULTS/UNASSIGNED:Thirteen metabolites were significantly associated with incident PAD and primarily reflected dysregulated glycemic control, impaired redox balance, and altered lipid remodeling (eg, higher levels of mannose and lower levels of 1,5-anhydroglucitol, gamma-glutamyl dipeptides, and lysophospholipids). For CLI, 18 metabolites were identified, 11 of which were unique to CLI and reflected intensified oxidative and bioenergetic stress (eg, homocitrulline, arabonate, and 1-linoleoylglycerol). Metabolites significantly improved risk prediction for PAD beyond traditional risk factors (∆C statistic, 0.017 [95% CI, 0.008-0.025] from a base C statistic of 0.770; net reclassification improvement, 0.053 [95% CI, 0.018-0.083]) and particularly CLI (∆C statistic, 0.041 [95% CI, 0.018-0.064] from a base C statistic of 0.823; net reclassification improvement, 0.176 [95% CI, 0.085-0.268]). CONCLUSIONS/UNASSIGNED:Distinct metabolomic profiles were associated with incident PAD and CLI years before clinical onset, highlighting dysregulated glycemic control, impaired redox balance, and altered lipid remodeling as key underlying pathways. These findings suggest that circulating metabolites may serve as early indicators of metabolic health relevant to PAD risk identification and progression to advanced disease.

Inflammation is a pivotal driver of the progression from metabolic dysfunction-associated steatotic liver disease (MASLD) to metabolic dysfunction-associated steatohepatitis (MASH), an aggressive form associated with substantial liver-related mortality. However, the molecular mechanisms underlying the initiation and persistence of liver inflammation remain poorly defined. Here, we demonstrated a previously unrecognized role for hepatic acetyl-CoA synthetase short-chain family member 2 (ACSS2) in MASH, showing that ACSS2 upregulation in patients exacerbates MASH progression by functioning as an epigenetic regulator, independent of its canonical lipogenic role. Mechanistically, ACSS2, in complex with lysine acetyltransferase 5 (KAT5), upregulates allograft inflammatory factor-1 (AIF1) transcription via histone crotonylation, thereby inducing liver inflammation and subsequently resulting in the aberrant accumulation of senescent hepatocytes, which further enhances proinflammatory cytokine production. This ultimately initiates a vicious cycle of chronic inflammation, which directly promotes the progression from simple steatosis to MASH. Thus, our work reveals a mechanistically defined and pivotal role for ACSS2 in promoting the MASLD-to-MASH transition, highlighting its potential as a compelling therapeutic target.